The Nancy Grace Roman Space Telescope is NASA's flagship astrophysics mission planned for launch in 2026. The Coronagraph Instrument (CGI) on Roman will demonstrate the technology for direct imaging and spectroscopy of exoplanets around nearby stars. It will work with the 2.4-meter diameter telescope to achieve starlight suppression and point source detection limits that are 2–3 orders of magnitude deeper than previous space-based and groundbased coronagraphs by using active wavefront control with deformable mirrors. CGI has passed its Critical Design Review (CDR) in April of 2021, and System Integration Review (SIR) in June of 2022. We describe the status of CGI's development and plans for the upcoming integration and testing phase.
Screening for benzodiazepines is an important component of many drug testing programs. Current immunochemical methods are limited by a lack of sensitivity to many of the 35 forms of benzodiazepines available and because the antibodies used are insensitive to the glucuronic acid conjugates that constitute the major metabolites in urine. The Triage™ Panel for Drugs of Abuse (Biosite Diagnostics), a new screening device, is a competitive immunoassay containing monoclonal antibodies directed against glucuronide metabolites of benzodiazepines. We tested this device on 326 urine specimens, which were also tested by two other immunoassay methods (FPIA and EMIT®) and by GC/MS. We found a sensitivity of 97.5% and a specificity of 94.3% for the Triage assay when it was applied to a population in which approximately 50% of the specimens were positive; a distribution of eight different benzodiazepines was found in the positive samples. Other immunoassays performed with lower sensitivity or specificity or both. We found no significant difference between two analysts using the Triage test. We conclude that the Triage method represents a superior method for benzodiazepine screening when compared with other immunoassay methods.
The December 14, 1998 NIH/NIAID workshop: ‘Crohn's Disease - Is there a microbial etiology? Recommendations for a research agenda’ was organized to review evidence for and against the hypothesis that the bacterium Mycobacterium avium subspecies paratuberculosis (MAP) is the cause of Crohn's disease (CD). The workshop conclusions stated that there is insufficient evidence to prove or disprove that MAP is a human pathogen or that it is the cause of CD. It recommended further research into the etiology and pathogenesis of MAP in CD through an extensive list of research requirements designed to contribute sufficient knowledge and data so that a firm conclusion could then be achieved. The workshop stressed the need to define a potential infectious etiology, to characterize the host immune and inflammatory responses, and to conduct crucial epidemiological and familial genetic research. Despite the absence of an assigned champion to follow up and ensure that this work was completed, additional basic and clinical research has been reported by multiple centers around the world, contributing to our body of knowledge regarding MAP in CD. The aim of this study was to evaluate new knowledge and data involving MAP in CD. A detailed examination was made of all publications identified in a literature search. Over 145 clinical and laboratory studies demonstrate evidence supporting an association between MAP and CD. Eleven detection studies indicate that up to 95% of all CD patientsare infected with MAP. Due to improved methods involving PCR and DNA hybridization techniques, the majority of recent studies have shown a significantly higher frequency of MAP in CD compared to older studies. Higher rates of seroreactivity against MAP antigens were detected in CD patients compared to controls. Six clinical trials using MAP specific drugs have shown a mean remission rate of 52% (range: 44%-89%). More knowledge has accumulated regarding drug selection and enhanced clinical efficacy. In all, over 145 studies have been published that respond to the needs identified by the 1998 workshop. Significant basic and clinical research has been conducted in the evaluation of an association between MAP and CD. The results supports our belief that for the future of causative research in CD, it is imperative to convene experts for a formal conference to update the 1998 workshop and to establish new clinical and research directions for this important aspect of Crohn's disease.
An entry from the Cambridge Structural Database, the world’s repository for small molecule crystal structures. The entry contains experimental data from a crystal diffraction study. The deposited dataset for this entry is freely available from the CCDC and typically includes 3D coordinates, cell parameters, space group, experimental conditions and quality measures.
Purpose: Patients with HIV are pictured by some clinicians as being wasted and underweight. However, obesity is more prevalent than wasting in HIV patients. HAART therapy appears to be less effective in HIV patients who are obese, while specific HAART medications can induce lipodystrophy with an increase in abdominal visceral fat. Last year, an estimated 220,000 patients in the U.S. and Canada underwent bariatric surgery. Clinical gastroenterologists are increasingly being asked to see patients, including those with HIV, who have GI symptoms after bariatric surgery. The aim of this study was to evaluate the presentation of and weight loss for HIV patients after bariatric surgery. Methods: This is a retrospective study of patients with HIV. Patients were seen in our bariatric GI clinic from February 2008 to May 2011. Data that was collected includes patient demographics, weights, medical history, type of and results from bariatric surgery, types of anti-retroviral medications, and GI symptoms. Results: This study includes 8 patients (2 males and 6 females; ages 40 to 64 years old; mean age 49) who had been diagnosed with HIV. Body mass index at surgery ranged from 40 to 133 kg/m2. Subjects had undergone vertical sleeve gastrectomy (n=2), Roux-en-Y gastric bypass (n=3), vertical banded gastroplasty (n=1), and laparoscopic adjustable gastric band (n=2). HIV was diagnosed in 2 patients who had previously undergone bariatric surgery, but who presented with significant weight loss after a stable plateau. Subjects were seen for nausea/emesis (6/8 patients, 75%), or for heartburn, dysphagia, or constipation (for each symptom: 3/8 or 38%). Seven patients were receiving HAART therapy. Percent excess body weight lost at 1 year ranged from 7 to 83% in 6 patients, while 1 patient gained weight after bariatric surgery. One patient with a vertical banded gastroplasty had a normal sized stomach at upper GI radiography, 8 months postoperatively. At 3 and 6 years postoperatively, 2 patients had regained their original weights, and both had an underlying psychiatric disease that was not well controlled. Conclusion: Our study shows that bariatric surgery could be a valuable treatment option for morbidly obese HIV patients who have important metabolic disorders that alter HIV treatment. Patients with HIV are seen postoperatively for nausea/emesis, heartburn, dysphagia, and constipation, and so we expect that clinical gastroenterologists are increasingly likely to see HIV patients after bariatric surgery. Sudden, unintentional weight loss after bariatric surgery should raise the question of development of HIV. Patients with HIV and an underlying psychiatric disorder may have difficulty obtaining weight loss after bariatric surgery.
Introduction: Worldwide, 468,609 individuals underwent bariatric surgery in 2013. Postoperative surveys have shown that a high percentage of individuals note gastrointestinal symptoms after bariatric surgery. Bariatric surgeries are performed on the stomach and the small intestine and could therefore alter bowel function. However, as a second possible explanation, the potential role of irritable bowel syndrome (IBS) on gastrointestinal symptoms after bariatric surgery is unknown. The Manning criteria have been validated in four studies for the diagnosis of IBS and are more focused on bowel symptoms, rather than chronic abdominal pain and weight loss. The prevalence of IBS in the general US population is 12% but is reported to be 18-19% in obese individuals. The hypothesis of this study is that there is a high prevalence of IBS in individuals who undergo bariatric surgery. Methods: This is a retrospective study of 278 individuals (81% women; 74% black Americans & 25% white Americans) who underwent sleeve gastrectomy (n=128), gastric bypass (n=96), and adjustable gastric band (n=54) from 2010 to 2013 in a large, urban community hospital. The mean[SD] age was 45.8[10.0] years-old with a range of 21 to 73 years-old. The presence of IBS was assessed by asking all patients to complete a preoperative survey of the 6 Manning criteria (a diagnosis of IBS was defined by ≥ 3 criteria). Results: There were 83 individuals (30%) with ≥ 3 Manning criteria, supporting the diagnosis of IBS. Among 278 individuals, 98 (35%) had been diagnosed with diabetes mellitus (DM). There was no relationship (Chi-Squared 2X2: p=.31) between DM and IBS (as defined by ≥ 3 Manning criteria). The body mass index (mean[SD]) of individuals with < 3 Manning criteria (48.7[9.0] kg/m2) was not different from that of individuals with ≥ 3 Manning criteria (49.5[10.4]; p=.53). Conclusion: This study revealed a higher prevalence of IBS in morbidly obese individuals who underwent bariatric surgery. The high prevalence of IBS in this present study is not related to the presence of DM. This finding may be important in understanding the high percentage of individuals who note gastrointestinal symptoms after bariatric surgery. It is not clear whether morbidly obese individuals with abdominal symptoms were more likely to seek bariatric surgery. Gastroenterologists who see patients for assessment and evaluation of symptoms after bariatric surgery will need to consider the potential for an ongoing diagnosis of IBS.
Introduction: In the past 20 years, the prevalence of obesity has risen to 35% of adults in the US. Preoperative biochemical studies have reported a 6%-29% prevalence of low whole blood thiamine levels in the morbidly obese. In our prior study of individuals seen for GI consultation after gastric bypass surgery, 18% had thiamine deficiency, and 41% of deficient individuals had gastrointestinal manifestations. The hypothesis of this study is that symptoms of subclinical thiamine deficiency are common in morbidly obese individuals seeking bariatric surgery. Methods: This is a retrospective evaluation of morbidly obese individuals with no history of prior bariatric surgery who underwent preoperative GI consultation in a large, urban community teaching hospital from 2013 to 2014. Men with 15 or more drinks (1 drink = 14 g of alcohol) weekly or women with 8 or more drinks weekly were excluded. Patient charts were reviewed to record the symptoms of thiamine deficiencies including gastrointestinal (abdominal pain, nausea/emesis, or constipation), cardiologic (dyspnea on exertion, palpitations, or lower extremity edema), neurologic (blurred vision, nystagmus, ataxia, or paresthesias), or psychiatric (aggressive behavior or psychosis). Patient demographics were also recorded. Thiamine deficiency is defined by consistent clinical symptoms and either: A. a low whole blood thiamine level or B. resolution of an individual's clinical symptoms after receiving oral or intramuscular thiamine. Results: Among the 138 individuals, the mean age was 46 years (range: 18 to 75 years). The mean body mass index was 47.9 kg/m2 (range: 35 to 102); 84% were women and 16% were men. At evaluation, 11% of these individuals were taking a multivitamin supplement. Twenty-three out of 138 individuals (16.7%) fulfilled the dual criteria for thiamine deficiency: 6 patients (26%) had consistent GI symptoms, 17 patients (73%) had cardiac manifestations, 14 patients (61%) had neurological manifestations, and 1 patient (4%) had a psychiatric manifestation. Conclusion: Symptoms of subclinical thiamine deficiency are common in morbidly obese individuals seen for bariatric surgery. The results of this study support prior preoperative biochemical studies of thiamine deficiency in the morbidly obese. Dietary intake may be both an origin for obesity as well as an origin for thiamine deficiency. GI physicians should consider thiamine deficiency when evaluating morbidly obese patients who have consistent gastrointestinal symptoms.
