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H. Ernesto, MD
Medical Instructor, San Juan Bautista School of Medicine
Such a composite image can be analyzed in a similar way to a histologically stained tissue section. This means that the endmember spectrum representing the central vein and red blood cells is plotted green, liver parenchyma red, and cell nuclei blue. The green spectrum is characterized by intense contributions of the heme group at 665, 743, 1122, 1248, 1341, 1580, and 1619 cmА1 that are enhanced by a resonance effect. The red and blue spectra are dominated by spectral contributions of proteins near 828, 852, 1003, 1449, and 1658 cmА1. The difference spectrum (black) between the blue and the red was calculated to improve visualization of the variations. Further positive difference bands at 621, 643, 829, 853, and 1003 cmА1 are assigned to proteins. Negative difference bands at 971, 1226, 1364, 1436, and 1605 cmА1 are consistent with bilirubin in bile acid. This result demonstrates the wealth of molecular information that can be obtained simultaneously from the analysis of Raman images of tissue sections. A prohibitive factor in Raman microscopic References j241 imaging remains the acquisition time. Therefore, technical improvements aim to (i) increase the sensitivity to reduce the exposure time per spectrum and (ii) apply parallel data acquisition strategies to register multiple spectra simultaneously. Innovations include optical filters with higher transmission, spectrographs with reduced light losses, and detectors with optimized quantum efficiency. Modern Raman microscopic instruments are able to collect several hundred spectra per second. Another challenge is the automatic processing of extended Raman microscopic images because the spectral features are often small and distributed over a wide range. In addition to unsupervised segmentation and spectral unmixing algorithms such as cluster analysis, principal component analysis, and vertex component analysis, supervised algorithms such as artificial neural networks, linear discriminant analysis, and support vector machines have to be trained to classify cells and tissues objectively based on their Raman signatures. A full description of all technical and theoretical details is beyond the scope of this chapter. The intention of the chapter was to highlight the potential of Raman microscopy in biophotonics. Further progress requires interdisciplinary efforts of natural scientists, engineers, and physicians. The interaction between optics and biology has for centuries been enormously fruitful for both areas. In recent decades, especially fluorescence microscopic techniques have found very widespread applications. This is due to their high sensitivity, which can reach the single-molecule detection limit [1], their high specificity achieved by powerful labeling strategies, and the noninvasive character common to most optical microscopy techniques. Despite the great success of fluorescence microscopy, much effort has recently been invested in research on complementary label-free microscopy techniques. The motivation for these efforts is twofold: first, not all samples can be fluorescently labeled, and second, all fluorescent labels suffer from photobleaching, which severely limits the observation times. Ideally, new techniques should despite working without labels offer the abovementioned advantages of fluorescence-based approaches. In general, if the requirement of offering (molecular) specificity without the use of labels is to be fulfilled, contrast generation should not be based on electronic spectra. This is due to the large linewidths of electronic transitions with respect to the width of the relevant spectral detection window. Concerning this point, vibrational spectra offer much more information, since medium-sized molecules can clearly be identified based on their characteristic vibrational spectra, which typically feature rather narrow linewidths. These two problems are avoided when using spontaneous Raman scattering microscopy. Here, however, low scattering cross-sections and an overwhelmingly strong fluorescence background, which is present in many samples, are new difficulties. Despite these problems, Raman-type scattering can be exploited for generating images of unlabeled samples with high spatial resolution if nonlinear optical techniques are used. However, both techniques generate structural and not chemically specific contrast.
Jap; eng] · Summary: the authors isolated four different isoflavones from the ethanol extract of soybeans. Lecithin was salted out from the solution and a crude saponin was precipitated from the alcoholic filtrate by the addition of acid. The saponinpigment complex was dissolved in alcohol and the saponin precipitated by the addition of lead acetate. The lead-saponin complex was removed from the filtrate after which the pigments were fractionally separated. The mixture of ethanol and ethyl ether was added to the solution which resulted in the separation of yellow insoluble needles melting at 265єC. On hydrolysis, glucose and an aglycone, isogenistein, melting at 302єC were obtained. The aglycone corresponded to C15H10O5 and gave a triacetyl derivative melting at 189єC and a di-methyl ether melting at 120-125єC. One of these, which was designated as tatoin, consisted of colorless needles melting at 318єC and having the formula C16H12O4. It gave a diacetyl derivative melting at 185єC, a monomethyl-ether melting at 160-163єC and a dimethyl-ether melting at 165єC. The second product, which was designated as methylgenistein, consisted of faintly yellow needles melting at 298єC. The third product consisted of faintly yellow lustrous needles melting at 255єC and corresponding to the formula C22H22O10 was designated as methylisogenistein. On hydrolysis it yielded glucose and an aglucone melting at 301302єC, corresponding to the formula C16H12O5. It is likely that of the 1938 soybean crop, some 4-5 million bushels have been exported to Europe, mostly to the Scandinavian countries and to Belgium and the Netherlands which have had difficulty in being assured a supply from Manchukuo [Manchuria]. And though they were shown as imports to other countries, they were actually being processed in transit to Germany. Germany and Italy are not allowed to buy American soybeans because both countries have contracts with Japan involving the exchange of Manchukuo soybeans for airplanes and other semi-war supplies. Today over 95% of the production of soybean oilmeal goes into the feeding of livestock and poultry; the rest goes into industrial utilization. Soybean oil usually sells for slightly less than cottonseed oil due to a partly higher refining loss, and a somewhat more expensive hydrogenating process (necessary to remove the "beany" taste). About 15-20% of our total soybean oil is used in the "industrial field or technical field," as in the production of duco finishing for automobiles, blends with other oils in the production of paint and varnishes, absorption in the waterproof line of goods such as oilcloth and linoleum, and such other minor uses as printers ink and core binders. The meal from some 2 to 3 million bushels of soybeans is now used to make "highest type" soybean glues. Laboratory research shows that soy protein can be used in the production of paper sizing. The material that is intended to be used will carry a sizeable percentage of soybean protein. Soybean flour, lecithin, and the "green vegetable practical man, and second by the chemist. In this country [England] the use of lecithin in chocolate is covered by Patent No. Soybean flour has large future possibilities, but the green vegetable soybean "has to my mind probably the greatest possibilities. I hesitate to make much comment on this new table delicacy, since without doubt the state of Wisconsin leads all others in the development and utilization of this soybean. Sufficient research has been carried on so that the recommended varieties of edible soybeans are fairly well established. If you wish to grow them in your garden, you have opportunity to select varieties that will be ready to eat in 70 days or 150 days, as you wish. The development of the canning and quick freezing methods are such that we may expect a tremendous increase in the acreage devoted to the vegetable soybean. McIlroy of Ohio] is now said to be experimenting on the use of soybean oil for restoring hair to bald pates. This milk compound is a hormone building food and therefore can be used by children and adults with most beneficial results. Drink Soy-Milk Compound and strengthen the brain by Lecithin contained in this Defensive Food.
The treatment alliance in the interaction with the patient starts with the first contact. If the patient feels good about the analyst from the start, the treatment alliance is mostly good. Further "good" interactions of the analytical couple will support the process of treatment. If a patient has defences such as splitting or projective identification, we mostly have negative reactions and a difficult treatment alliance. To explain to the patient how the treatment works, we should offer him some help, such as telling him that he will learn a new way of dealing with his feelings and relationships. We might also say that we will put together the personal story of his growing up in order to better understand how he deals with daily life. Hence, we will find some "patterns" in the inner life which are responsible for his suffering. In the beginning and during further work we should try to explain and show the patient his transference to us. This means that the patient transfers his feelings for the object relations of his childhood to the analyst. A further step towards increasing the working alliance is when the patient is able to understand that certain feelings towards people can trigger or re-awaken feelings which he has had for a long time- since his childhood, for example. If the patient understands these movements, he will experience that the old unconscious processes still hurt. At the same time, he can feel that mourning these hurts is a relieving act and is an important step towards changing childhood behaviour. To strengthen the treatment alliance, the analyst should become somewhat less active verbally; he should omit his own personality and try not to mix his own personal story (countertransference) with the story of the patient. As mentioned in the chapter about resistance, in the free flow of speaking we may find blocks (resistance), for example, when a patient stops talking at a particular point because the topic he is talking about triggers negative feelings. Further factors, such as the treatment room, environment, and regulation of payment are also part of the treatment alliance. How the patient uses the different parts of the treatment depends on his inner structure, his level of fixation, and his particular defence mechanisms. Ethical aspects Ethical rules for the therapeutic relationship are necessary as the relationship between the therapist and the patient is an artificial one and has to be protected against sexual and narcissistic abuse. This is important because this relationship is unequal, as the patient comes with an inner suffering. Common ethical rules the patient should become able to develop himself during treatment. In this process, we should help the patient to become conscious of his neurotic inner world. The analyst has no economic or private relationship with his patients, and neither should the therapist abuse the patient for his own narcissistic needs, such as being admired or idealised. Regarding sexual needs, the therapist should never have a sexual relationship with the patient during or after treatment. Even when the treatment is over and some time has elapsed, the identification with the therapist is still internalised, so a sexual relationship could, in fact, destroy the therapeutic work afterwards. Regarding confidentiality, the psychoanalyst should take care of all documents he collects from the patient. He should not speak about his patients with others by revealing names or other personal details. Scientific publications about the patient can only be written if the patient has given his consent. Financial arrangements should be clarified with the patient before treatment starts. Finally, a psychotherapist should be informed about relevant professional and scientific developments and their application to the practice of psychotherapy. He should also be informed about legal conditions of his profession and he should not damage the reputation of any person or organisation recklessly or maliciously.
Therefore, whether hyperfiltration is a risk factor for development of diabetic nephropathy in type 2 diabetes or a short-term transient phase is unknown. The present data do not indicate a higher risk of progression of diabetic renal disease in hyperfiltering patients, because diabetic nephropathy developed in only one patient in this group. Antihypertensive medications have been withdrawn in several previous and recent trials in hypertensive diabetic patients, typically in a 1-month wash-out period or placebo run-in phase before the study to assess baseline values (43 46). Withdrawal of antihypertensive treatment for 1 month is justified and essential to compare effects of different drugs before and/or after treatment, provided appropriate safety procedures are applied, as in our study. However, dose-titration studies of maximal antialbuminuric dose have not been performed; therefore, doses 300 mg may even be more effective. Persistent reduction of microalbuminuria after withdrawal of all antihypertensive treatment suggests that high-dose irbesartan therapy confers long-term renoprotective effects that may reflect reversal of renal structural and/or biochemical abnormalities. Acknowledgments - this study was supported by a grant from Sanofi-Synthelabo and Bristol-Myers Squibb. N Engl J Med 345:851 860, 2001 Hofmann W, Guder W: Preanalytical and analytical factors involved in the determination of urinary immunoglobulin G, albumin, alpha1-microglobulin and retinol binding protein using the Behring nephelometer. Lab Med 13:470 478, 1989 Brochner-Mortensen J, Rodbro P: SelecЁ Ё tion of routine method for determination of glomerular filtration rate in adult patients. Scand J Clin Lab Invest 36:35 45, 1976 Brochner-Mortensen J: A simple method Ё for the determination of glomerular filtration rate. Scand J Clin Lab Invest 42:261264, 1982 Stшckel M: Kompensatorisk renal hyperfunktion. Kidney Int 47: 1726 1731, 1995 Rossing P: Promotion, prediction and prevention of progression of nephropathy in type 1 diabetes mellitus. Kidney Int 57:1882 1894, 2000 Hill C, Logan A, Smith C, Gronbaek H, Flyvbjerg A: Angiotensin converting enzyme inhibitor suppresses glomerular transforming growth factor beta receptor expression in experimental diabetes in rats. Diabetologia 42:589 595, 1999 Lervang H-H, Jensen S, BrochnerЁ Mortensen J, Ditzel J: Early glomerular hyperfiltration and the development of late nephropathy in type 1 (insulin-dependent) diabetes mellitus. Scand J Clin Lab Invest 46:201206, 1986 Rudberg S, Persson B, Dahlquist G: Increased glomerular filtration rate as a predictor of diabetic nephropathy: an 8-year prospective study. Diabetes 45:1729 1733, 1996 Lervang H-H, Jensen S, BrochnerЁ Mortensen J, Ditzel J: Does increased glomerular filtration rate or disturbed tubular function early in the course of childhood type 1 diabetes predict the development of nephropathy? Secondary Tumors of Bone Mechanism of transport Paravertebral venous plexuses retrograde access of tumor cells to bone bypass of porto-caval venous drainage this mechanism explains the predilection of metastases for the axial skeleton (spine, pelvis) and adjacent proximal humerus and femur Primary neoplasms of bone Definition: tumors of mesenchymal origin arising in bone Routes of spread: hematogenous (lung, liver, bone) One of the characteristics of primary bone tumors are their predilection for certain bones and, within these bone, certain anatomic sites (diaphysis, metaphysis, epiphysis), central or excentric location. Primary neoplasms of bone Means of identification Matrix morphology Immunophenotypical markers Clin/ radiologic correlation: a must! Primary tumors of bone produce their particular matrices (mesenchymal cells) in an attempt to imitate the original tissue. For example, bone tumors produce neoplastic osteoid, cartilage tumors neoplastic chondroid, fibrous tumors neoplastic fibrous matrix, etc. The morphologic or immunohistochemical identification of this matrix, and the knowledge of the clinical/ radiographic presentation (location, location, location! Primary Tumors of Bone Classification Bone-forming Cartilage-forming Fibrous tumors Tumors of unknown origin Bone-forming tumors Benign Malignant Osteoid osteoma Osteoblastoma Osteosarcoma this tumor predilects the lower extremities, particularly the femur, less frequently the tibia, with the single most common site being the neck of the femur. Pain, exacerbated at night, is the hallmark of this tumor and is dramatically relieved by aspirin. Grossly and histologically, a small round defect of the bone "nidus" measuring no more than 1. Malignant Tumors of Bone Osteosarcomas Central Low Grade High Grade Surface Low Grade High Grade Osteosarcomas Definition Malignant neoplasm of bone malignant mesenchymal cell malignant bone matrix Recognition of osteosarcoma is based on the close relationship between the malignant mesenchymal cell and the malignant bone matrix "osteoid", strongly suggesting the production of this matrix by the tumor cells. Most frequent sites are overwhelmingly the knee (distal femur, proximal tibia), followed by the proximal femur and proximal humerus. Also characteristic of osteosarcoma is the frequency with which the tumor breaks out of the medullary canal to invade the soft tissues and form a soft tissue mass. The tumor typically does not breach the growth plate to enter the epiphysis until late in the disease. Read about the hereditary germline or acquired mutation of Rb and retinoblastoma and the high risk of development of osteosarcoma. A germline mutation of p53 allele leads to the Li-Fraumeni syndrome which carries a high risk of osteosarcoma. Osteosarcoma is generally a high-grade tumor and is lethal if not treated or poorly treated. In the past 30 years, the 5 years survival has climbed from 18% to 70% due to advances in the therapy (limb-salvage surgery+ multidrug chemotherapy), with marked improvement in the quality of life.