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Integrative medicine includes a holistic approach, consisting of a combination of conventional treatment and complementary and alternative medicine (CAM). Our objective is to identify if patients with allergic and immunologic (AI) conditions in our academic allergy clinic are currently using or interested in future CAM to supplement their conventional allergy treatment.

Here, we present a unique case of a patient who developed EGPA with painless vision loss after a trial of dupilumab.

Rhinorrhea is common and frequently occurs secondary to chronic rhinitis. However, other causes should be considered. We describe rhinorrhea secondary to vasomotor rhinitis and cerebrospinal fluid (CSF) leak.

Thin-walled storage tanks are prone to vacuum collapse due to the development of a net external pressure. Condensation of steam inside the vessel can cause a rapid development of this mode of failure. External atmospheric conditions also affect the process; specifically, the enhanced heat transfer associated with rainfall on the vessel external surface accelerates the collapse process. Short but intense rain storms are becoming more common. An expression to predict the time taken for a storage vessel to collapse while subject to external rainfall is developed. Good agreement was found between the predictions of the modelling techniques and the experimentally obtained results. It is shown that the thermal energy stored in the vessel wall is very significant in determining the collapse time especially for outdoor vessels exposed to rain.

ABSTRACTThe ResPlex I assay (Qiagen) was designed to amplify and detect DNA of six bacterial respiratory pathogens. This assay was compared with real-time PCR assays based upon the same target sequences for the ability detect the target bacteria by use of both stock strains and specimens from respiratory disease patients. The ResPlex I assay is somewhat less sensitive than real-time PCR assays but offers the advantage of multiple assays in a single reaction.

Background & Aims: Gastrointestinal (GI) and liver diseases inflict a heavy economic burden. Although the burden is considerable, current and accessible information on the prevalence, morbidity, and cost is sparse. This study was undertaken to estimate the economic burden of GI and liver disease in the United States for use by policy makers, health care providers, and the public. Methods: Data were extracted from a number of publicly available and proprietary national databases to determine the prevalence, direct costs, and indirect costs for 17 selected GI and liver diseases. Indirect cost calculations were purposefully very conservative. These costs were compared with National Institutes of Health (NIH) research expenditures for selected GI and liver diseases. Results: The most prevalent diseases were non-food-borne gastroenteritis (135 million cases/year), food-borne illness (76 million), gastroesophageal reflux disease (GERD; 19 million), and irritable bowel syndrome (IBS; 15 million). The disease with the highest annual direct costs in the United States was GERD ($9.3 billion), followed by gallbladder disease ($5.8 billion), colorectal cancer ($4.8 billion), and peptic ulcer disease ($3.1 billion). The estimated direct costs for these 17 diseases in 1998 dollars were $36.0 billion, with estimated indirect costs of $22.8 billion. The estimated direct costs for ail digestive diseases were $85.5 billion. Total NIH research expenditures were $676 million in 2000. Conclusions: GI and liver diseases exact heavy economic and social costs in the United States. Understanding the prevalence and costs of these diseases is important to help set priorities to reduce the burden of illness.

Therapeutic models using gene transfer into tumor cells have pursued three objectives: (1) to induce rejection of the tumor transduced with therapeutic genes, (2) to induce immune-mediated regression of metastatic disease, and (3) to induce long-lasting immunity to protect against challenge with tumor cells or clinical regrowth of micrometastatic disease. Because in vivo therapy for patients with cancer using gene transfer would, as a first step, attempt to eliminate the existing tumor, we have investigated whether antitumor immunity induced by tumor cells secreting a single cytokine could be increased by cotransfer of a second cytokine gene. To test this approach, CMS-5, a murine fibrosarcoma, was transduced with retroviral vectors carrying interleukin-2 (IL-2), interferon-gamma (IFN-gamma), or granulocyte- macrophage-colony-stimulating factor (GM-CSF) cDNA alone or IL-2 cDNA in combination with IFN-gamma or GM-CSF cDNA. Single cytokine-secreting clones were selected to match levels of cytokine production by double cytokine-secreting clones so that similar amounts of cytokine were secreted. IFN-gamma- and IL-2/IFN-gamma-secreting CMS-5 cells showed increased levels of major histocompatability complex class I expression compared with IL-2- and GM-CSF-secreting or parental CMS-5 cells, IL- 2/IFN-gamma-secreting CMS-5 cells were always rejected by syngeneic mice, whereas the same number of CMS-5 cells secreting only one of these cytokines or mixtures of single cytokine-secreting CMS-5 cells were not rejected. In vivo depletion of CD4+, CD8+, or natural-killer effector cell subpopulations showed that CD8+ cytotoxic T cells were primarily responsible for rejection of IL-2/IFN-gamma-transduced tumor cells. Our data show the successful use of a single retroviral vector to stably transduce two cytokine genes into the same tumor cell, leading to an increased effect on the in vivo induction of antitumor immunity.

Cytokines are important modulators of host antitumor responses. Two of these cytokines, interleukin-2 (IL-2) and interferon gamma (IFN-gamma), are produced after antigen-induced activation of helper lymphocytes. The cytokines are released into the immediate vicinity where they either interact with the appropriate receptors on effector cell populations or are rapidly degraded. To mimic this physiologic release of cytokines at the effector-target site, we used retroviral vectors to transduce melanoma cells with the IL-2 or IFN-gamma cDNA. Five melanoma cell lines were transduced with IL-2- or IFN-gamma-containing vectors and secreted IL-2 at 1 to 40 U/mL/10(6) cells/24 h or IFN-gamma 1 to 8 U/mL/10(6) cells/24 h, respectively. After gamma irradiation, these cells continued to secrete cytokines for about 3 to 4 weeks. Secretion of IFN-gamma induced upregulation of major histocompatibility complex class I molecules in a subset of melanoma cell lines. IL-2 production by human melanoma xenografts induced tumor rejection in BALB/c nu/nu mice, showing the in vivo effect of this cytokine. This study shows that (1) human melanoma cells can be stably transduced with cytokine- containing retroviral vectors; (2) cytokines are secreted constitutively by the transduced tumor cells and have the expected biologic effects in vitro and in vivo; and (3) after gamma irradiation, cytokines continue to be secreted for several weeks. These data suggest that irradiated cytokine-secreting allogenic or autologous tumor cells can be used in vaccination protocols for cancer patients.

Objective assessment of the results of surgical sympathectomy and sympathetic block (both temporary and permanent) are not widely practised. This article comments briefly on the available methods, and describes the use of the abolition of the skin potential response (formerly known as the psychogalvanic reflex) to assess the abolition of sympathetic function. This method of assessment has proved useful in clinical practice.

Blood pressure changes following carotid endarterectomy were studied in 39 patients undergoing 42 carotid endarterectomies, in order to establish the incidence of hypertension and to study the use of hydrallazine for its treatment.Hypertension occurred in 28 cases (66%) and was treated with intravenous hydrallazine in a dose of 20 ±8 mg; this resulted in a systolic blood pressure fall of 46 ±22 mmHg, diastolic blood pressure fall of 24 ± 12 mmHg, mean blood pressure fall of 31 ± 15 mmHg, and a pulse rate increase of 7 ±9 beats per minute. Hydrallazine is a safe, effective drug for the treatment of intraoperative hypertension.

Arterial lignocaine concentrations were measured in twenty-six patients who had carotid endarterectomy performed under deep and superficial cervical plexus blockade. A dose of 6 mg/kg of 1.5% lignocaine with 1:200,000 adrenaline was used, as well as additional supplementation by the surgeons when required. Concentrations obtained produced a mean peak of 5 fig/ml and were similar to those previously reported from multiple bilateral intercostal blockade, which is the regional technique widely considered to produce the highest systemic levels of local anaesthetic. Apart from one peak concentration of 16.9 μg/ml, levels were well below the convulsion threshold. We find the technique acceptable and safe for carotid surgery and lignocaine toxicity is not identified as a problem.

Various attempts have made been made to quantify the cardiovascular risk factors associated with anaesthesia and surgery. Two such schemes are the “Multifactorial Index of Cardiac Risk” developed by Goldmanet al., and the one devised by Coopermanet al. The validity of these two schemes in relation to anaesthesia for vascular surgery was investigated by carrying out a prospective study of 100 patients. Cooperman's scheme was found to be much more accurate than Goldman's scheme in assessing patient risk. The study confirms the impression that the vascular patient falls into a higher risk group than most other surgical patients with regard to cardiovascular complications.

A processed electroencephalogram (EEG) produced by the Lifescan monitor (Neurometrics), was compared to awake neurological assessment for detecting cerebral ischaemia in seventy patients undergoing carotid endarterectomy under cervical plexus block. Of the six patients demonstrating neurological signs on cross-clamping the carotid, five displayed simultaneous EEG changes, four being detected during surgery, and one being detected after reviewing the EEG postoperatively. Another four patients displayed EEG changes indicative of ischaemia but unassociated with neurological signs. A further patient displayed contralateral intraoperative EEG changes. Hypotension resulted in one EEG change and two cases were associated with technical difficulties with the monitor. The presence of false negatives, possible false positives, technical errors and subjective interpretation associated with the processed EEG make it less reliable than awake neurological assessment for the detection of cerebral ischaemia.

Twenty-five patients having aortic surgery had blood scavenged using the Sorenson Receptal Device (Group A) and were compared with twenty-five patients having homologous blood transfusion (Group H). Mean intraoperative blood loss was similar in both groups, Group A 3224 (SD 2392) ml, Group H 2999 (SD 1579) ml, but the mean homologous blood replacement was significantly different intraoperatively, Group A 1.2 (SD 1.7) units, Group H 2.7 (SD 1.8) units. Total intra-hospital homologous blood replacement was not significantly different, Group A 4.0 (SD 3.4) units, Group H 5.5 (SD 5.8) units. Mean haemoglobin concentration in the scavenged blood was 8.5 (SD 2.1) g/dl compared to 10.8 (SD 2.4) g/dl in the median aged homologous blood units crossmatched for Group H. Mean red cell half life in the scavenged blood was the same as that for the homologous blood, 24 (SD 5) days, but plasma-free haemoglobin and bacterial contamination was greater in the scavenged blood. There was no difference in the incidence of postoperative renal dysfunction, coagulopathy or mortality between the two groups of patients.

A prospective randomised study of two hundred patients undergoing open-heart surgery was carried out to determine if the method of radial artery cannulation (direct threading or transfixion) had any influence on the incidence of abnormal flow after decannulation. A standard 20-gauge non-tapered teflon-coated cannula was used and the groups were well matched for age, sex, wrist circumference, duration of cannulation and haematoma formation, all of which have been postulated to influence thrombosis rate. We were unable to demonstrate a statistically significant difference between the two methods of cannulation. The overall abnormal flow rate at five days assessed by Doppler ultrasound was low at 5%.

One hundred and one patients were randomly allocated to have their peripheral vascular surgery performed under general anaesthesia (51 patients) or spinal anaesthesia (50 patients). Intraoperative haemodynamic changes were markedly different between the two groups with a higher incidence of hypotension in the spinal group (72% vs 31%) and a higher incidence of hypertension in the general anaesthesia group (22% vs 0%). Blood loss was significantly less in the spinal group (560, SD 340, ml vs 792, SD 440, ml). Postoperatively three patients from the general anaesthesia group died from causes unrelated to the anaesthesia, and one had a myocardial infarct. Two patients in the spinal group had myocardial infarcts, both had been treated for bradycardia and hypotension intraoperatively, and one died. There was a significantly higher incidence of postoperative chest infection in the general anaesthesia group (33% vs 16%). There was no significant difference between the groups in the incidence of postoperative confusion, or lower limb amputation rate or need for further surgery prior to hospital discharge.

One hundred patients undergoing elective coronary artery surgery were studied to determine the incidence of pre-bypass myocardial ischaemia. Leads II, aVF and V5 of the electrocardiogram (ECG) were recorded at five-minute intervals from arrival in the anaesthetic room until onset of cardiopulmonary bypass. Thirteen patients developed sixteen episodes of significant ST depression on the ECG during the study period. Three patients were diagnosed as having postoperative myocardial infarction by ECG criteria and creatine phosphokinase-MB rise above 80 units. None of these patients had pre-bypass ST depression. Comparisons of these results with similar studies are presented.

One hundred and twenty-eight patients having carotid endarterectomy under superficial and deep cervical plexus blocks were prospectively audited. The aim of the audit was to determine the incidence of intra-operative and postoperative neurological and cardiovascular complications and to establish patient acceptance of the technique. Twenty-seven patients who had intraoperative neurological changes following carotid artery clamping responded to shunt insertion. Six patients had transient neurological changes after the operation but there were no permanent neurological complications. Tachycardia (55%) and hypertension (67%) were the most common intra-operative cardiovascular changes and there was one clinical postoperative myocardial infarction. Ninety-two per cent of patients who could be adequately assessed preferred to have the same method of anaesthesia for future carotid endarterectomy. The authors concluded that carotid endarterectomy under superficial and deep cervical plexus blocks was associated with a high patient acceptance, low neurological complication rate and an acceptable rate of cardiovascular complications.

A new processed EEG machine, the Lifescan, ®which uses aperiodic analysis, was used to monitor cerebral activity prospectively in twenty-one patients undergoing carotid artery surgery under general anaesthesia. The machine was easy to apply, use and read. Volatile agents caused a bilateral decrease in high frequency activity. Unilateral changes consistent with cerebral ischaemia at the time of carotid cross-clamping were also seen. One such prolonged change was not associated with neurological deficit. A further patient awoke with neurological deficit without displaying Lifescan®evidence of ischaemia. The machine requires further assessment.

To study the effects of localized secretion of cytokines on tumor progression, the gene for human interleukin 2 (IL-2) was introduced via retroviral vectors into CMS-5 cells, a weakly immunogenic mouse fibrosarcoma cell line of BALB/c origin. Secretion of low levels of IL-2 from the tumor cells abrogated their tumorigenicity and induced a long-lasting protective immune response against a challenge with a tumorigenic dose of parental CMS-5 cells. Co-injection of IL-2-producing CMS-5 cells with unmodified tumor cells inhibited tumor formation even when highly tumorigenic doses of CMS-5 cells were used. Cytolytic activity in mice injected with parental CMS-5 cells was transient and was greatly diminished 3 wk after injection, as commonly observed in tumor-bearing animals. However, in mice injected with IL-2-producing cells, tumor-specific cytolytic activity persisted at high levels for the duration of the observation period (at least 75 d). High levels of tumor-specific cytolytic activity could also be detected in parental CMS-5 tumor-bearing animals 18 d after inoculation with tumor cells, if IL-2-producing CMS-5 cells but not unmodified parental tumor cells were used as targets. These studies highlight the potential advantages of localized secretion of cytokines mediated via gene transfer to induce potent anti-tumor immune responses.

Although merging clinically within the spectrum of the AIDS dementia complex, vacuolar myelopathy is a pathologically distinct entity detected in up to 30 of autopsied patients succumbing to the late complications of human immunodeficiency virus type 1 (HIV-1) infection. Using immunohistochemistry and in situ hybridization to detect an HIV-1 core protein and viral mRNA, respectively, in tissue sections, and culture isolation to assess infectious virus in tissue homogenates, we found that vacuolar myelopathy was independent of productive HIV-1 infection of the spinal cord and brain. These results indicate that AIDS-associated vacuolar myelopathy is either not related directly to spinal cord HIV-1 infection or involves nonproductive infection and pathobiological processes distinct from those responsible for the multinucleated-cell inflammatory infiltrates that serve as histopathologic markers of productive CNS HIV-1 infection.

SYNOPSISTimber, while being a low energy intensive material, requires a relatively high energy input in its processing operations, particularly drying. The schedules used for drying timber have largely been developed empirically by various government laboratories, trade organizations and sawmill operators. The schedules are generally low temperature and conservative which can mean unnecessary energy consumption and needlessly long residence times in the kiln. Thus processing costs are high due to recurrent energy costs and a relatively low return on capital investment in physical plant. This paper considers the energy related aspects of timber in general and the results of an empirical study in particular which indicate that the inherent energy advantages of using timber can be improved by the use of High Temperature Drying (HTD) techniques.

The value of dried lumber to the kiln operator is to a large extent dependent on the final moisture content distribution of the batch. This variation in moisture content arises from the intrinsic heterogeneity of wood and the stochastic nature of the timber drying process. Theoretical analyses of wood drying have hitherto relied upon deterministic models and have limited practical applicability. A methodology is proposed herein whereby the inherent probabilistic dynamics of batch drying can be modelled efliciently using Markov chains. The discretization of the variables of moisture and time that is necessary for this approach is discussed. By simulating the drying process with the model, the progressive transformation of the batch moisture distribution throughout the drying cycle can be studied. Output from the model is compared with experimental drying results to test its validity. There are

Cytokines are important modulators of host antitumor responses. Two of these cytokines, interleukin-2 (IL-2) and interferon γ (IFN-γ), are produced after antigen-induced activation of helper lymphocytes. The cytokines are released into the immediate vicinity where they either interact with the appropriate receptors on effector cell populations or are rapidly degraded. To mimic this physiologic release of cytokines at the effector-target site, we used retroviral vectors to transduce melanoma cells with the IL-2 or IFN-γ cDNA. Five melanoma cell lines were transduced with IL-2– or IFN-γ-containing vectors and secreted IL-2 at 1 to 40 U/mL/106cells/24 h or IFN-γ 1 to 8 U/mL/106cells/24 h, respectively. After γ irradiation, these cells continued to secrete cytokines for about 3 to 4 weeks. Secretion of IFN-γ induced upregulation of major histocompatibility complex class I molecules in a subset of melanoma cell lines. IL-2 production by human melanoma xenografts induced tumor rejection in BALB/c nu/numice, showing the in vivo effect of this cytokine. This study shows that (1) human melanoma cells can be stably transduced with cytokine-containing retroviral vectors; (2) cytokines are secreted constitutively by the transduced tumor cells and have the expected biologic effects in vitro and in vivo; and (3) after γ irradiation, cytokines continue to be secreted for several weeks. These data suggest that irradiated cytokine-secreting allogenic or autologous tumor cells can be used in vaccination protocols for cancer patients.

Intercostal nerve blocks with 0·5 per cent bupivicaine were used for post operative pain relief in 100 patients having upper abdominal operations. The blocks were very effective in 86 patients and had an average duration of 11 hours. Two asymptomatic pneumothoraces occurred.