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Safety net urban hospitals are being overwhelmed by an increasing number of patients with diabetes, who frequently only access the health system through visits to emergency departments and urgent care clinics. It is uncertain whether the chronic care model advocated for diabetes care would be feasible and effective for managing diabetes in an acute care setting.Determine if redesigning the system of care for treating diabetic patients who do not have primary care doctors is feasible, acceptable to patients and effectively lowers patients' haemoglobin A1c, blood pressure and cholesterol levels.Prospective single cohort study.A total of 1098 consecutive diabetic patients presenting to an urgent care clinic at an urban safety net public hospital in Chicago between October 2004 and April 2006 who had a haemoglobin A1c measured at baseline.Adapt the chronic care model for managing diabetes to the acute care setting of an urgent care clinic to manage uninsured patients with diabetes who do not have primary care.Among the 1098 patients, 833 (76%) had a repeat A1c during the 2- to 12-month follow-up period. On average, A1c values decreased by 1.5 percentage points; systolic blood pressure decreased by 9 mmHg; low-density lipoprotein cholesterol decreased 11 points; and weight decreased 2.3 pounds (all: P0.001). The percentage using angiotensin-converting enzyme inhibitor drugs increased from 45% to 83%; aspirin use increased from 38% to 83%; and statin use increased from 34% to 76%.This novel chronic care model for diabetes care of uninsured patients without primary care doctors was feasible, acceptable and effective in increasing the quality of diabetes care and decreasing haemoglobin A1c, blood pressure, cholesterol and weight.

Anomalous left coronary artery arising from the pulmonary artery (ALCAPA) is a rare congenital anomaly commonly presenting in infancy with severe congestive cardiac failure due to myocardial ischemia. We present a two and half year old child who presented with severe mitral regurgitation and near normal left ventricular function and turned out to be having ALCAPA. High pulmonary artery pressures prevented coronary steal into the pulmonary arteries and preserved LV function (near noprmal) at presentation.

Objective Anatomic repair is being actively evaluated as the preferred option for congenitally corrected transposition of the great arteries. We present our 13-year experience with this approach. Methods Between May 1994 and September 2007, 68 patients with congenitally corrected transposition of the great arteries underwent anatomic repair. Thirty-one patients (group 1, mean age of 94.8 ± 42.3 months) underwent a combined Rastelli and atrial switch operation. Thirty-seven patients (group 2, mean age of 36.1 ± 46.9 months) underwent an arterial switch operation and atrial rerouting. Eight patients in group 2 had an intact ventricular septum. Results Group 1 had 5 early deaths (17%) but no late deaths. Three patients underwent conduit revision at a mean follow-up of 62 months. Group 2 had 5 early deaths (13.5%). There were 4 late reoperations (2 pulmonary baffle revisions, 1 mitral valve replacement, and 1 permanent pacemaker implantation) and 4 late deaths (1 secondary to progressive left ventricular dysfunction, 2 secondary to uncontrolled atrial tachyarrhythmia, and 1 secondary to pulmonary hypertension and right ventricular failure). In group 2, 4 patients have a left ventricular ejection fraction less than 40%, 5 patients have moderate aortic incompetence, 5 patients have symptomatic tricuspid incompetence, 1 patient has tricuspid stenosis, 1 patient has superior cava obstruction, and 3 patients are receiving antiarrhythmic therapy. Conclusion The occurrence of left ventricular dysfunction indicate that anatomic repair in the arterial switch group is still fraught with imperfections. The Rastelli group required conduit revisions but has otherwise performed well.

Aim: The present study was undertaken to assess the accuracy of pediatric echocardiograms done at non-tertiary centers and to evaluate the relationship of inaccurate interpretations with age, echocardiogram performer and complexity of congenital heart disease (CHD). Materials and Methods: The echocardiogram reports of 182 consecutive children with CHD (5 days-16 years) who were evaluated at a non-tertiary center and subsequently referred to our center were reviewed. Age of the child at echocardiogram, echocardiogram performer and complexity of CHD were noted. These reports were compared with echocardiogram done at our center. Discrepancies were noted and categorized. To assess our own error rate, we compared our echocardiogram reports with the findings obtained during surgery (n = 172), CT scan (n = 9) or cardiac catheterization reports (n = 1). Results: Most of the children at the non-tertiary center (92%) underwent echocardiogram by personnel other than a pediatric cardiologist. Overall, diagnostic errors were found in 69/182 (38%) children. Moderate and major discrepancies affecting the final management were found in 42/182 (23%) children. Discrepancies were higher when the echocardiogram was done by personnel other than pediatric cardiologist (P < 0.01) and with moderate and high complexity lesions (P = 0.0001). There was no significant difference in proportion of these discrepancies in children ≤ 1 year vs. >1 year of age. Conclusions: A significant number of pediatric echocardiograms done at non-tertiary centers had discrepancies that affected the management of these children. More discrepancies were seen when the echocardiogram performer was not a pediatric cardiologist and with complex CHD.

The carboxyl-terminal domain of connexin43 (Cx43CT) is involved in various intra- and intermolecular interactions that regulate gap junctions. Here, we used phage display to identify novel peptidic sequences that bind Cx43CT and modify Cx43 regulation. We found that Cx43CT binds preferentially to peptides containing a sequence RXP, where X represents any amino acid and R and P correspond to the amino acids arginine and proline, respectively. A biased “RXP library” led to the identification of a peptide (dubbed “RXP-E”) that bound Cx43CT with high affinity. Nuclear magnetic resonance data showed RXP-E–induced shifts in the resonance peaks of residues 343 to 346 and 376 to 379 of Cx43CT. Patch-clamp studies revealed that RXP-E partially prevented octanol-induced and acidification-induced uncoupling in Cx43-expressing cells. Moreover, RXP-E increased mean open time of Cx43 channels. The full effect of RXP-E was dependent on the integrity of the CT domain. These data suggest that RXP-based peptides could serve as tools to help determine the role of Cx43 as a regulator of function in conditions such as ischemia-induced arrhythmias.

Elevated levels of the cyclin-dependent kinase (CDK) inhibitor p27 block the cell in G(0)/G(1) until mitogenic signals activate G(1) cyclins and initiate proliferation. Post-translational regulation of p27 by different phosphorylation events is critical in allowing cells to proceed through the cell cycle. We now demonstrate that the arginine-directed kinase, Mirk/dyrk1B, is maximally active in G(0) in NIH3T3 cells, when it stabilizes p27 by phosphorylating it at Ser-10. The phospho-mimetic mutant p27-S10D was more stable, and the non-phosphorylatable mutant p27-S10A was less stable than wild-type when expressed in G(0)-arrested cells. Following phosphorylation by Mirk, p27 remains a functional CDK inhibitor, capable of binding to CDK2. Mirk did not induce the translocation of p27 from the nucleus in G(0), but instead co-localized with nuclear p27. Depletion of Mirk by RNA interference decreased the phosphorylation of p27 at Ser-10 and the stability of endogenous p27. RNA(i) to Mirk increased cell entry from G(0) into G(1) as shown by increased expression of proliferating cell nuclear antigen and decreased expression of p27. These data suggest a model in which Mirk increases the amount of nuclear p27 by stabilizing it during G(0) when Mirk is most abundant. Mitogen stimulation then causes cells to enter G(1), reduces Mirk levels (Deng, X., Ewton, D., Pawlikowski, B., Maimone, M., and Friedman, E. (2003) J. Biol. Chem. 278, 41347-41354), and initiates the translocation of p27 to the cytoplasm. In addition, depletion of Mirk by RNA(i) in postmitotic C2C12 myoblasts decreased protein but not mRNA levels of p27, suggesting that stabilization of p27 by Mirk also occurs during differentiation.

PIMT (PRIP-interacting protein with methyltransferase domain), an RNA-binding protein with a methyltransferase domain capable of binding S-adenosylmethionine, has been shown previously to interact with nuclear receptor coactivator PRIP (peroxisome proliferator-activated receptor (PPAR)-interacting protein) and enhance its coactivator function. We now report that PIMT strongly interacts with transcriptional coactivators, CBP, p300, and PBP but not with SRC-1 and PGC-1alpha under in vitro and in vivo conditions. The PIMT binding sites on CBP and p300 are located in the cysteine-histidine-rich C/H1 and C/H3 domains, and the PIMT binding site on PBP is in the region encompassing amino acids 1101-1560. The N-terminal of PIMT (residues 1-369) containing the RNA binding domain interacts with both C/H1 and C/H3 domains of CBP and p300 and with the C-terminal portion of PBP that encompasses amino acids 1371-1560. The C-terminal of PIMT (residues 611-852), which binds S-adenosyl-l-methionine, interacts respectively with the C/H3 domain of CBP/p300 and with a region encompassing amino acids 1101-1370 of PBP. Immunoprecipitation data showed that PIMT forms a complex in vivo with CBP, p300, PBP, and PRIP. PIMT appeared to be co-localized in the nucleus with CBP, p300, and PBP. PIMT enhanced PBP-mediated transcriptional activity of the PPARgamma, as it did for PRIP, indicating synergism between PIMT and PBP. In contrast, PIMT functioned as a repressor of CBP/p300-mediated transactivation of PPARgamma. Based on these observations, we suggest that PIMT bridges the CBP/p300-anchored coactivator complex with the PBP-anchored coactivator complex but differentially modulates coactivator function such that inhibition of the CBP/p300 effect may be designed to enhance the activity of PBP and PRIP.

The parameters used to rate acoustic wave-based chemical sensors are sensitivity and selectivity. While sensitivity can be improved by selecting the appropriate sensor device, selectivity still remains a major concern. This is primarily because the analytes under consideration often belong to the same group/class of chemicals. In such cases, the sensor output does not provide enough information to reliably identify, estimate and/or classify the analytes being investigated. As a result, data analysis techniques are used to extract selectivity from the sensor. An approach to analyze sensor signal data using statistical pattern recognition techniques such as principal component analysis and nearest neighbor algorithm is presented.

Background: Fetal echocardiography is a well established sensitive tool to diagnose congenital heart disease (CHD) in utero. One of the determinants of effective utilization of fetal echocardiography is its awareness in the general population. The present hospital based study was undertaken to assess the awareness of the need for fetal echocardiography amongst Indian parents. Methods: One thousand one hundred and thirty eight consecutive parents who visited the pediatric cardiology outpatient department of a tertiary care centre over a period of two months were asked to fill up a questionnaire that included their demographic data, educational status, history of CHD in children, awareness of fetal echocardiography and source of information and timing of fetal echocardiogram if performed. The data was categorized and awareness was noted in different groups. Results: The awareness in the study population was 2.2%. Awareness was found to be similar across the study population irrespective of the demographics and high risk status of the parents. Conclusions: The awareness of fetal echocardiography, an important tool in reducing the incidence of complex CHD, thereby impacting public health, is alarmingly low in the population studied. Appropriate action to increase awareness of fetal echocardiography needs to be looked into.

The effect of low energy (300 eV) argon plasma treatment on the morphology of polycarbonate was studied by means of contact angle measurement, X-ray photoelectron spectroscopy (XPS), Vickers' micro hardness indentation and atomic force microscopy (AFM). The surface free energy (SFE) changes from 38.5 mJ/m2 to 74.9 mJ/m2 on increasing the treatment time and the corresponding contact angle was changed from 63° to 17°, which shows the enhancement in surface adhesion. The XPS analysis shows the increase of the C-O and C=O functional groups upon treatment. The Vickers' micro hardness was studied in the load range 10-500 gf. The micro hardness of the film increases with the treatment time. Atomic force microscopy (AFM) reveals that average surface roughness increases from 7.0 nm to 27.2 nm as treatment time increases.

The surfaces of polycarbonate films were treated by nitrogen plasma, in order to understand the effect of low energy ions on the surface modification of polycarbonate. The modified samples were characterized by micro-hardness tester, optical micrograph/atomic force microscopy (AFM), X-ray photoelectron spectroscopy (XPS), and FTIR spectroscopy. It was observed that the hardness of the film increases as fluence increases. This may be attributed to the cross-linking effect as corroborated with FTIR spectra. XPS analysis indicates that chemical bonding on the surface of the film, especially C=O, C-O and C-C/C-H functional groups, was found to change due to plasma treatment. AFM analysis reveals that average surface roughness increases from 5.9 nm to 42.7 nm as fluence increases.

Surface production of negative ion is a dominating process in a high current negative ion source. In presence of surface produced negative ions, the plasma sheath near a metallic plane is modified and has been analysed in this report. The multivalued nature of electric potential at the sheath edge in electronegative plasma, determined by Bohm criterion is pursued in presence of surface produced negative ions.

Cutaneous leishmaniasis and human immunodeficiency virus (HIV) co-infection is emerging as increasingly frequent and serious new disease. Leishmaniasis may be acquired before or after HIV infection. We describe two cases of post-kala-azar dermal leishmaniasis in HIV-positive patients. Both the patients had papulonodular lesions on upper extremities and back with low CD4 count. Slit skin smear with giemsa stain revealed Leishman Donovan (LD) bodies and skin biopsy of both the patients revealed lymphohistiocytic infiltrate with numerous intracytoplasmic LD bodies.

We describe the findings in a neonate with aortic atresia, interruption of the aortic arch between the carotid arteries, and aortopulmonary window. This unusual association changes the anticipated physiology, and helps in the survival. We emphasize the fact that this combination simulates common arterial trunk, both clinically and on echocardiography.

The role of surface produced negative ions in a negative ion source on the sheath structure, which takes place in the surroundings of a metallic plane immersed in a plasma, is analysed using a simple model. It is well known that the Bohm criterion which determines the electric potential at the sheath edge can be multi-valued in electronegative plasmas. It is observed in this study that a multi-valued sheath potential equally holds well in the case of a negative ion source where surface production mechanism of negative ions also exists. Due to the presence of surface produced negative ions, the positive ion current flux towards the metallic plane increases and the sheath potential with respect to the metallic plane increases.

We report a case of intracardiac calcification associated with oculomotor apraxia and corneal deposits in a 12-year-old girl, who presented with dyspnea on exertion, sinusitis, and epistaxis since the age of 6 years. Unusual presentation with multiorgan involvement prompted us to evaluate her in terms of metabolic/storage disorder. The bone marrow aspirate confirmed the diagnosis of Gaucher's disease.

We present a 5 month old baby who was referred for an incidental detection of a murmur and was found to have tortuous pulmonary arteries with multiple peripheral pulmonary stenoses and bilateral inguinal hernia pointing towards the diagnosis of arterial tortuosity syndrome.

Background: A phase III trial of antithrombin (AT) in sepsis showed benefit only in patients who did not receive concurrent heparin. We have shown that some of the beneficial effects of AT on leukocyte-endothelial (LE) interactions in sepsis models requires the activity of heparan sulfate 3-O-sulfotransferase-1 (3-OST-1), the enzyme that is responsible for the rate-limiting step in the biosynthesis of anticoagulant heparan sulfate. Fondiparinux (FOND) is a pharmacological agent that mimics the anticoagulant heparan sulfate pentasaccharide sequence synthesized by 3-OST-1. Objectives: We hypothesized that FOND treatment would alter LE interactions in sepsis models in mice, and AT effects in these models. Methods: Using intravital microscopy, we evaluated the effects of proinflammatory stimuli on leukocyte rolling and firm adhesion in post-capillary venules, and extravasation, into the cremaster muscle in live C57BL/6 mice. Human AT (0.25 U/g Thrombate III), and/or heparanoid or vehicle was infused intravenously prior to proinflammatory stimuli. Venules were chosen such that in all comparisons, the average diameter (range 20 to 50 μm) and shear rate (range 200 to 800 s−1) was not different between treatment groups. The number of leukocytes rolling past a defined vessel point was expressed as leukocyte rolling flux, which normalizes for leukocyte count and flow rate. The number of firmly adherent leukocytes (stationary for 30 s) was normalized for the area of vessel wall analyzed. The number of extravasated leukocytes was normalized for the area of tissue analyzed. Results: AT treatment decreased leukocyte rolling flux (23 vs. 15%, P=0.01) induced by an injection of lipopolysaccharide (LPS at 1 μg i.p.) 2 h before observation. However, in this model, AT did not inhibit the number of firmly adherent leukocytes. When mice were pretreated with FOND (0.1 μg/g), the leukocyte rolling flux was increased compared to without heparanoid (22 vs. 25%, P Conclusions: These studies further our knowledge of how the anticoagulant pentasaccharide sequence, mimicked by fondiparinux and lacking in 3-OST-1 deficient mice, is important in leukocyte recruitment that occurs in response to inflammation. This will allow for more rational use of mediators of this pathway such as AT in sepsis.

Incyte has developed a new gene expression microarray (GEM) for analysis of the plant functional genomic system Arabidopsis thaliana. This GEM features over 7,000 array elements from a non-redundant cDNA collection; nearly 30% of the estimated 25,000 genes in this organism. Over 2,000 of these clones represent genes that have functional annotation in public databases. We are offering hybridization and analysis services for the Arabidopsis GEM via Incyte and Genome Systems. Arabidopsis is the primary model system for the study of dicot plant genomics. Academic and commercial groups are using the combination of genomic and genetic tools available for Arabidopsis to study complex problems in plant biology. We have performed a few biological studies using the Arabidopsis GEM to validate the platform and provide examples of possible applications. We will present sample data on these studies.

This paper reports the results of a self-reporting survey (N = 821) that was conducted to examine the travel behaviour of primary school children in the study area of Vadodara city. In many Indian cities including metropolis, auto-rickshaw and van are the main modes opted by the parents for the school trips of children. The issues related to driver's behaviour, safety, comfort and over occupancy of children in vehicles were analysed regarding these current travel modes. An alternative in the form of proposed co-ordinated bus mode providing service to two or more schools and working simultaneously was offered to the school children and the response to this service was modelled by using logit models. The survey result indicates the complaints of more than 60% respondents for the current travel modes. Most effective reasons for choosing the current travel modes of auto-rickshaw and van are door to door service (>50%) and regularity of service (>40%). As about 83% respondents agreed for decision to travel in co-ordinated bus, so this indicates higher probability regarding acceptance of bus service for school trips. Family income and fare relationship seems to be significant for above response. The probability of shifting to co-ordinated bus mode increases if reductions in travel distance and cost can be achieved. Also the significant parameters are age of child, number of persons in family, expected walk time, number of employed persons in family and car ownership in family at 90% confidence level. Bus routes and the number of buses have been estimated based on the study. The proposed co-ordinated bus service is found to be economically viable.