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NOD (nonobese diabetic) mice develop chronic lymphocytic infiltrates of the salivary glands (sialoadenitis) that correlate with a temporal decline in saliva production. To differentiate autoimmune and nonautoimmune components in this decline, we evaluated glandular function in NOD-scid mice. Although saliva volumes and protein concentrations appeared normal, amylase and EGF activities declined 50 and 20%, respectively, in NOD-scid mice between 10 and 25 weeks of age. Salivary protein profiles on SDS-polyacrylamide gels showed a profound decline in two prominent proteins of 32 and 20 kDa, and the emergence of a new 27-kDa protein. All three proteins exhibited amino acid sequence homology to parotid secretory protein (PSP) and reacted with PSP-specific antibody, suggesting an age-dependent alteration in PSP. In addition, there was an induced expression of proline-rich protein in the salivary glands and saliva of NOD and NOD-scid mice that was not detectable in mouse strains lacking autoimmune disease. Submandibular gland histology revealed selective loss of acinar tissue despite an absence of sialoadenitis. These changes in salivary protein composition and histology in the absence of detectable lymphocytic infiltration suggest that glandular defects in the NOD genetic background may contribute to the triggering of the autoimmune response in the salivary glands.
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Seriously emotionally handicapped adolescents face significant transition issues as they move through our system of care and attempt to assume adult role responsibilities in the community. Service delivery efforts must be sensitive to these issues and begin to realistically address the transition needs of this population. Nine integrative principles are discussed which appear essential when developing transition services.
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The object-oriented computing model of Smalltalk/V proved to be very well suited for the creation of a medical expert system on the diagnosis of calcium-phosphorus metabolism abnormalities. A major reason for this was that a disease could be viewed as a self-contained, active, entity. The expert system is implemented in ALEX, an expert system shell that is written in Smalltalk/V. The shell consists of classes and methods that can be modified, as needed, by the developer. The expert system is, at present, 140,000 bytes in size, and includes 43 diseases, arranged in 7 contexts. Sixty case reports were used to test the expert system. In 30 cases, there was complete agreement between clinician and expert system; in 12 cases, the expert system responded appropriately when presented with diseases that were not known to the system; and in 18 cases, the system gave plausible results.
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