The heart as a target organ of immune injury

Over the last 10 years, our knowledge of immunologically mediated processes involving the myocardium appears to have made quantum leaps. New and important disease entities such as AIDS have appeared and the cardiologist now becomes an important member of the "AIDS team." Our understanding of "older diseases" such as sarcoidosis, Lyme disease, systemic lupus and other connective tissue syndromes has significantly increased. The concept of high-dose steroid therapy for these processes may, in fact, turn out to be futile and more selective, as less dangerous immunosuppression is being introduced. This concept has significantly advanced in the field of cardiac transplantation where immunosuppression has now been usurped by specific immunotherapy aimed at selective aspects of the immune sequence. New and exciting concepts will emerge from the molecular biology laboratory that will have direct bearing on the management of patients with cardiovascular disorders. This information explosion will force the cardiovascular physician to become more in tune with the world of immunology and molecular biology. Many obvious, significant problems remain, such as accelerated atherosclerosis in the transplant patient and the role of myocarditis in the patient with heart failure. However, it will truly be an exciting decade in which to work and watch the unraveling of these mysteries and hopefully, the study of today's problems will give way to solutions and a clearer understanding of the heart as a target of immune injury.     

Hypoglycemia prediction and detection using optimal estimation

Patients with diabetes play with a double-edged sword when it comes to deciding glucose and A1c target levels. On the one side, tight control has been shown to be crucial in avoiding long-term complications; on the other, tighter control leads to an increased risk of iatrogenic hypoglycemia, which is compounded when hypoglycemia unawareness sets in. Development of continuous glucose monitoring systems has led to the possibility of being able not only to detect hypoglycemic episodes, but to make predictions based on trends that would allow the patient to take preemptive action to entirely avoid the condition. Using an optimal estimation theory approach to hypoglycemia prediction, we demonstrate the effect of measurement sampling frequency, threshold level, and prediction horizon on the sensitivity and specificity of the predictions. We discuss how optimal estimators can be tuned to trade-off the false alarm rate with the rate of missed predicted hypoglycemic episodes. We also suggest the use of different alarm levels as a function of current and future estimates of glucose and the hypoglycemic threshold and prediction horizon.     

Biologically templated organic polymers with nanoscale order

Methods for the construction of ordered nanoscale arrays have been implicated in fields ranging from separation technologies to microelectronics. Yet, despite the plethora of nanoscale structures assembled in nature that use a templating strategy, chemists have been unable to replicate this success. A technology is reported for templated organic polymers composed of filamentous bacteriophage-polyacrylamide biomacromolecules that self-assemble into highly ordered helical bundles displaying hexagonal close packing. The results align with a previously reported mathematical prediction for the close packing of flexible tubes. This biopolymeric assembly can be viewed as a magnification of the inherent microscopic chirality and helicity present in individual phage particles at the macroscale level.     

A Brief Report on WAIS-R Normative Data Collection in Mayo's Older African Americans Normative Studies

ABSTRACT

Historically, neuropsychological measures such as the Wechsler Adult Intelligence Scale-Revised (WAIS-R) have yielded unacceptably high rates of misdiagnosis of impairment among cognitively normal African Americans, primarily due to poor test specificity and inadequate representation of ethnic minorities in the normative sample. In this report, we briefly review these issues and describe efforts by investigators in Mayo's Older African Americans Normative Studies (MOAANS) to develop more appropriate norms for African American elders on the WAIS-R. During MOAANS data collection, the third edition of the WAIS (WAIS-III) was introduced with updated representation of ethnic minorities in the normative database. More recently, specific demographic corrections for African Americans have been derived for WAIS-III subtest scores and indices. As such, WAIS-R normative estimates are not presented here. Interested readers who wish to obtain a full set of MOAANS WAIS-R norms, however, are invited to contact the authors for these data.