User talk:A. Rad

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Welcome!

Hello A. Rad, and welcome to Wikipedia! Thank you for your contributions. I hope you like the place and decide to stay. Here are a few good links for newcomers:

I hope you enjoy editing here and being a Wikipedian! Please sign your name on talk pages using four tildes (~~~~); this will automatically produce your name and the date. If you have any questions, check out Wikipedia:Where to ask a question or ask me on my talk page. Again, welcome!  JFW | T@lk 19:03, 4 January 2006 (UTC)

PS We hebben altijd dokters nodig, en je bent in goed gezelschap - andere Hollandse medici hier zijn Nescio (talk · contribs), Wouterstomp (talk · contribs) en ikke. Laat me weten als je hulp nodig hebt. Ik heb je vraag t.a.v. de afbeelding beantwoord op mijn overlegpagina.

Hello there, and thanks for the big welcome! ;) Nice to know some other people who are in the same business as I am. BTW, I'm merely a medical student at the present, but hopefully a real doc in a few years :) Greets, A. Rad 09:49, 5 January 2006 (UTC)

Contents

[edit] Edsger Dijkstra

Hi there. Since you're a native Dutch speaker, I was wondering if you could take a look at Edsger Dijkstra. There's a bit of a debate on how to pronounce his name, especially the first name. If you could supply a phonetic pronunciation, it would be of great help. Thanks Gershwinrb 08:30, 1 February 2006 (UTC)


[edit] Coombs test

Overall your diagram of the Coombs test is good. I may be mistaken, as it has been some time since I worked in blood transfusion, but one situation may not covered in your diagram. This is when the patient's RBCs are used in the indirect Coombs test with serums of known type. We always did blood groups with the indirect Coombs test by using both the patients cells (against known serums) and the patients serum (against known cells) to double check the methods and to find very weak antibodies or antigens that were not fully expressed. Your diagram only covers screening for serum antibodies in the indirect test and not screening for RBC antigens. It may be better not to specify "donor" and "recipient" in your diagram for the indirect Coombs test portion. Snowman 19:20, 16 February 2006 (UTC)

Hi, I know basic Coombs test, so that's why the diagram is basic too. But I'm willing to expand the diagram. I just need to make sure I understand you correctly on the indirect part: the part I've drawn is the part where the known RBCs are added to patient's serum to see if agglutination occurs, right? And therefore, I should replace recipient by patient's serum and donor by known RBCs? Or is it the other way round?
And there's also a part of the test where the patient's RBCs receive known serum, which is not covered in the diagram? So this part would be practically the same, only the test tube should contain RBCs and the eye-dropper (or whatever it's called) contains known serum? Please check me on that to see if it's all correct. If this is all, I can start working on it. But I got an exam on Wednesday, so it could be that the new diagram won't be up till then, depending on how busy I get. ;) Greets, --A. Rad 23:10, 17 February 2006 (UTC)

Good luck with exam. Lets do the direct Coombs test first, as it is easier. There is some work to do on the indirect Coombs test as well. I have wrote it on your user page to save space on the article talk page. Of course delete this, if you want to.

There are three pictures (all very good) in the top half of your diagram for a positive DCT.

Can you show antigens (possibly a triangle shape) on the RBC surface (underneith the antibodies)?


Caption 1 Blood sample from a patient with immune mediated haemolytic anaemia: antibodies are shown attached to antigens on the RBC surface.

Caption 2 The patients washed RBCs are then incubated with Antihuman antibodies (Coombs reagent).

Caption 3 RBCs agglutinate: antihuman antibodies form links between RBCs by binding to the human antibodies, which are bound to the RBC surface antigens.


This may be a bit verbose. Perhaps you can shorten parts of it. Snowman 09:12, 23 February 2006 (UTC)


I've edited it:
I've changed the captions (and slightly condensed them). Antibodies have 2 antigen binding sites, so shouldn't there be 1 antigen per Ig-binding site? A. Rad 15:15, 23 February 2006

More Coombs test 1

I think that it would be prudent to wait for more comments from readers of the article. I think that your diagrams of the Coombs test are very good and show visually what the Coombs test is about. I think that the Coombs test antibody-antigen reactions are basic and there is no such think as an advanced diagram. The captions will probably need several edits over the months, but do not be disheartened by this as your diagrams are excellent.

Suggestions Put an asterisk at the end of the heading for the indirect Coombs test * and a footnote to say that if the antigens on the RBC surface are known then the test can be used to screen for antibodies in the serum.6 (UTC)

Antibodies are Y shaped. There is a receptor site on each of the top ends of the Y, so there are two identical antibody receptor sites per antibody. The tops of the Y are variable. The bottom of the Y is constant and is not a receptor site. You should be able to look this up in any immunology book.

Your diagrams of antibodies look exactly correct to me. It would be nice to see an RBC surface antigen "possibly a triangular solid or a D shaped solid" under the antibodies. I am fairly sure that both the top ends of the Y would each be fixed to separate antigens on the RBC surface. One antibody fixes to two antigens. RBC surface antigens are very small being short strings of sugar molecules and one would be completely covered by just one end of the "Y". Snowman 14:35, 27 February 2006 (UTC)

More Coombs test 2

There are five pictures (all very good) in the lower half of your diagram for the ICT. No more pictures are needed.

Could you indicate graphically with coloured bars (or lines or brackets) stage 1 and stage 2 of the ICT or would it be too cluttered?

Could you put a “key” to say what each part of the drawing is on the top row where there is room or would it look too cluttered? eg
blue “Y” = antihuman antibody
grey “Y” = human antibody
and so on.

INDIRECT COOMBS TEST $

Caption 1 Serum from blood sample A containing antibodies

Caption 2 Washed RBCs from blood sample B are incubated with serum from blood sample A

Caption 3 Antibodies from blood sample A bind onto RBC surface antigens from blood sample B IF the serum antibodies are specific for RBC surface antigens.

Caption 4 Incubation with antihuman antibodies (Coombs reagent)

Caption 5 Agglutination occurs IF an antibody from serum A was bound to RBC surface antigens from Serum B in the first stage of the indirect Coombs test

FOOTERS
$1 The indirect Coombs test is commonly used for antibody screening: an unknown serum is incubated against a known range of RBCs with known surface antigens.

$2 The indirect Coombs test can also be used to detect RBC surface antigens: unknown RBCs are incubated against serums containing known antibodies.

Suggest actually add these last two sentences to the bottom of the diagram to be built into the graphic.

Again, I have wrote this on your user page to save space on the article talk page. Of course delete it, if you want to. Snowman 13:46, 28 February 2006 (UTC)


Renin Angitensin system
You appear to have Renin being made from the adrenal gland in the diagram. It is actually made in the kidney. This is a serious mistake. The juxtaglomerular apparatus is near to the glomerulus as the name suggests Snowman 13:54, 28 February 2006 (UTC)


Hi, that's what I thought (about the antibodies and antigens). But other Coombs diagrams show each Ig bound to only 1 antigen (triangular, D-shaped or otherwise)... Since each antibody is bound to 2 antigens, I think it would be more correct to put several small antigens on/behind the RBC's surface (small squares e.g.) and have each binding site of the antibody bind to 1 small antigen :)
The page is indeed not very much viewed by other people, but I think I once came along a place where wikipedians could bring their medical articles to attention so other wikipedians could help them. I'll see if I can find that page...
Also it's not that I lose my motivation for having to re-edit the diagram, but if you think the caption will change a lot over the months, it would seem better to me to wait till the article is completed and then make a final caption for it :) Otherwise the Wiki will get cluttered by dozens of different versions of this diagram (older pictures are archived on the wiki) and this will all take much room. The same happens with the text of each wiki article, but text is different than graphics: e.g. the Coombs test graphic is 268 Kb, so every time a new version is uploaded - be it only slightly different from the previous - 268 Kb will replace the original, but the original will also stay in the archive :)


About the indirect test: sure, I think there's place to put a key :)
Do you think it's a good idea to use blood groups A and B as an example? I'd prefer a more "general" approach that can be applied to each blood group (A, B, O, Rh and possibly other groups?).
Since this diagram shows the Coombs test when positive, I wouldn't put additional info like "IF the serum antibodies are specific for RBC surface antigens" - this would make the text longer and is a bit redundant. The diagram is to give a brief key description. For more info, one should always refer to the article itself.
Also, wasn't there a major and minor antibody screen? That would require 2 sets of diagrams, which wouldn't be a problem cause they'd both be almost similar. Not sure if that's what you're refering to with the foot notes. Personally, I think a separate section in the diagram would explain things better.
Yeah, thanks for pointing that error on the RAAS diagram out to me. Somewhere along the line I was very confused, apparently ;) That was a quick fix. I'll see if I can work a bit on the Coombs, but for reasons I gave above, I'm going to keep re-uploads to a minimum. Greets, A. Rad 15:02, 28 February 2006 (UTC)
I think that the juxtaglomular apparatus can be confusing. As well as having the kidney in the diagram, can you include a JGA diagram as a magnified view from the kidney? Snowman 10:06, 2 March 2006 (UTC)

More Coombs 3
A think that a specific example using one blood type would be fine, with appropriate captions and foot notes. I suggest, use the example a mother who has been sensitised to Rh D, as it is a well known example of a positive indirect Coombs test. Your direct Coombs test could be the example of the infant with Rh D haemolytic disease of the newborn. The caption could then also link from the Rh haemolytic disease of the newborn wiki page Rh disease and would probably be viewed more. As your Coombs drawing are very good I think that they (with appropriate captions) should help to explain Rh D haemolytic disease of the newborn visually and clearly better.

I have not heard of the expression major and minor antibody screen. Do you have any more information on what you call major and minor antibody screens? How can they be different?

I have heard of cold and warm antibodies (but the Coombs test mechanism is the same for each) and no more diagrams are needed. These are usually against anti I or anti i agtigens on the RBC surface. Snowman 10:06, 2 March 2006 (UTC)


Hi, I tried to draw a JGA before, but the results were disappointing. For now, people can always read the RAAS or Juxtaglomerular apparatus if they don't know what is meant by that term.
Well, I think the Coombs test shouldn't give the impression that it's testing something specific as a Rh disease or so, otherwise the reader might think it's not suitable for anything else. Way at the beginning, you suggested the use of terms like "patient's serum" and "known RBCs" which sounds more broad and suitable IMO :) The article already links to Rh disease, so that's not a big problem.
I don't have the terms correct there. I meant the screen for weak antibodies/antigens (read the beginning of the discussion). :)
Meanwhile, I've placed a message on this topic at the Wikipedia talk:WikiProject Clinical medicine#Coombs test needs some help. I hope some people come in to help :) A. Rad 16:23, 4 March 2006 (UTC)
Changes on Coombs and RAS seen. Snowman 09:51, 18 March 2006 (UTC)

More Coombs 4

I think the Coombs schematic and the wording as it stands today is actually a the specific explanation of a cross-match. This is where neither the antigens on the RBCs or the antibodies are specifically identified, but the test shows that an antigen (of some unknown specificity)is binding to an antibody (of same unknown specificity). I am considering saying that the schematic for the indirect Coombs test is a cross-match in the text of the article page. Do you have any further plans for the schematic. Snowman 11:25, 31 March 2006 (UTC)

Hi, afaik, the cross-match and the antibody screen are the most familiar examples of the Coombs test in practice. One for determining the compatibility between donor and recipient, the other for determining the blood group the way I understand it; No, I'm currently not working on the schematic. Greets, A. Rad 15:38, 2 April 2006 (UTC)
Your schematic has reached a plateau of development and looks like a finished product.
I have changed the Coombs article page and blood grouping is now not on the Coombs page any more. The usual way blood grouping is done is with LISS (low ionic strength saline) because the blood group antibodies are IgM. IgM are bigger molecules and can link between RBCs if the electrical forces between RBCs are reduced in LISS or enzyme treated RBCs. ie RBCs can move closer and permit IgM linking between RBCs. Coombs test used for IgG antibodies or weak antibodies. The Coombs article page has almost reached a plateau of development. There are higher plateaus of development, but I can not edit much more as I do not work in blood bank these days.
References to your schematic recently added to the article in the laboratory method for both the direct and the indirect Coombs test.
Are these edits ok with you? Snowman 18:05, 3 April 2006 (UTC)
Hi, yeah they're fine with me :) The article looks very good too. Well done! ;) Greets, A. Rad 14:43, 5 April 2006 (UTC)
 :) Snowman 13:17, 8 April 2006 (UTC)

There is a schematic about blood groups on the Blood type page. I thought you might like to see someone else's work. In his schematic the antibodies look like IgG and I think that they should be IgM. Snowman 13:17, 8 April 2006 (UTC)

Hi, I don't know for sure whether the antibodies should be IgM or IgG. I read that initially the antibodies are developed by contact with common bacteria. These bacteria have antigens on them that closely resemble the antigens on RBCs. Thus, when these bacterial antigens are recognised and they don't resemble the person's own RBC antigens, antibodies are created against these, which eventually will shift from IgM to something else (although I'm not sure about this last one). E.g. a baby with blood type A will not have anti-A Ig's, nor anti-B Ig's until it comes into contact with these bacteria that have "B-antigen-like" antigens. When it does, the baby will develop its own anti-B Ig's from that point onward. A. Rad 16:07, 13 April 2006 (UTC)
The blood group page has been a medical collaboration of the week and all this IgM stuff is on blood group page (or linked pages). Snowman 12:29, 11 July 2006 (UTC)

[edit] RAAS

I think that the kidney, lungs and the blood vessel all need an label, like you have for the liver and adrenal gland. This is for consistency. Snowman 11:23, 1 April 2006 (UTC)

OK, I updated the diagram. The changes may not show up in the article's page, if that pic is still stored in the local internet cache though (it does, when you click on the pic). CTRL+F5 (or Shift+F5) should clean the cache and show the updated pic. Greets, A. Rad 15:39, 2 April 2006 (UTC)

[edit] VWN en WCN

Beste allemaal Al enige tijd is er een Nederlandstalig chapter in oprichting, te vinden op http://nl.wikimedia.org . Dit wordt de Vereniging Wikimedia Nederland (VWN). Je kunt je interesse om lid te worden van deze vereniging hier aangeven.

Deze vereniging gaat eind augustus/begin september een Wikimedia Conferentie in Nederland (WCN) houden, volgend op Wikimania in Boston, gedeeltelijk erop inspelend middels een aantal discussiegroepen. Om iets dergelijks te organiseren is imput erg gewenst. Dus als je wilt meehelpen, of als je interesse hebt om bij een dergelijk evenement aanwezig te zijn, geef dat dan aan op nl.wikimedia. Ik hoop daar snel je imput tegemoet te zien! Met vriendelijke groet, Effeietsanders 25 feb 2006 12:27 (CET)

[edit] Dutch edit

The OA disambiguation page has an irritating red link: Onder Andere, in Dutch. Is there anythink that you can do about it? I hope you are doing well with your studies. Snowman 19:16, 9 July 2006 (UTC)

Hi, I directed the red link to the Dutch wikipedia. I was very much in doubt whether I should just delete that entry or direct it to an external sister wiki. There's a small note on linking to external pages at Manual of Style - Individual entries. The downside is that the link is now a "piped link"...
Since "onder andere" means "amongst others", creating a page for it here wasn't appropriate. If links to other wikis don't belong on disambiguation pages, then go ahead and delete that entry :) Greets, A. Rad 08:32, 10 July 2006 (UTC)
If anyone knows what to do about that link it is a person that can speak Dutch. Does it have any special use or is it used in any particular circumstances in Holland? Snowman 12:03, 10 July 2006 (UTC)
Well, I don't know what you mean exactly by special use. It's just a normal everyday abbreviation and could be used in a sentence like: amongst others, Paul, July and Bob were at the party. (Grammar or placement of the words may be a bit weird, but you get the idea ;)). Instead of saying "onder andere" in Dutch, we abbreviate it in text by typing o.a. :) Greets, A. Rad 14:11, 10 July 2006 (UTC)
I have made minor changes to the OA page in line to what you have said. :) Snowman 12:23, 11 July 2006 (UTC)


I was wondering, have you heard about citizendium.org? check it out for I think you would be a good candidate as an author / editor. the pilot page is pilot.citizendium.org

one of the cofounders of wikipedia broke away and made this wiki to address some of the problems that wikipedia is having.

[edit] hematopoiesis chart

gorgeous chart. a great contribution!

at risk of messing up the simplicity of it, it would be nice to show that the predominant location for the develpment of T-cells is the thymus. you have B-cells and T-cells parallel on the chart, but B-cells mature in the marrow, and so should be a higher so they are in the "marrow" row, while T-cells mature in the thymus, and so should be lower, to fall into the "tissue" row. Openlander 03:51, 19 December 2006 (UTC)

Hi. Thanks for your comments :)
Indeed you're right that both cells mature in different organs. However, I've drawn the B- and T-cells in the location they are in their mature forms (see the far right vertical text next the the lymphoid DC) :) When mature, the B- and T-cells are mostly in the secondary lymphoid tissue (as I understand from Parham's Immunology). I too was in doubt whether I should - somehow - create a seperate compartment for the B/T cells, but thought it would be too complex and decided to draw them as they are in their mature stadium.
Of course, I can draw a Thymus and a Bone(marrow) on top of the diagonal arrows that seperate both cells. The problem would be that this suggests the small lymphocyte differentiates into a T/B cell later on, which is not true as far as I know... I could also create that split before the "Small lymphocyte", like so. This however means the "small lymphocyte" would be omitted from the diagram... In this case, I could group the T/C cells and tag them as "small lymphocyte" the way I did with the thrombo-/erythro-/granulo-/monocyto-/lymphopoiesis and the Stem cell/committed progenitor/mature cell; it could interfere with the "lymphopoiesis" group below it, but I'm not sure about this. I dunno exactly what would work best really. I'm open to all suggestions :) Greets, A. Rad 16:39, 19 December 2006 (UTC)

Great picture! Your diagram has evolved from an easy to follow diagram of haematopoiesis to something I'd expect in a textbook like Robbins. However, there is one small error (or at least I think it might be an error), your diagram shows basophils turning into mast cells, which (I think) isn't true. Not that it's really important in my opinion, but in a journal article by Prussin C., Metcalfe D.D. not be able to tell the difference between the two (unless you included the surrounding tissue as well); they certainly look s, (2006) 5. IgE, mast cells, basophils, and eosinophils Journal of Allergy and Clinical Immunology. Aug;117(2 suppliment mini-primer) S450-456 they claim that "Basophils are granulocytes that comprise a separate lineage from mast cells, although both cells share common features..." Someone from my PBL brought up this subject last year and was the subject of much controversy (even though it wasn't important in my opinion) and this article was considered to be the final deciding factor in the argument. If you can't get access to the full article and would like it, give me your email address and I'll email it to you. Again congratulations on a wonderful diagram. Serrin 09:00, 17 April 2007 (UTC)

Hi. Thanks for your comments :)
I found the fulltext of the article at PMID: 16455345. It should be the one you mean (only difference I found with your description is that it's in the February edition; typo?). You're absolutely right. The mast cell does not arise from the baso, but has its own lineage. I'll correct this soon. Should the mast cell arise from the myeloblast or the common myeloid progenitor? From what I've read in other sources, it should directly arise from the common myeloid progenitor, but this is a bit vague cause the sources I found this info in use the "CFU" notation (CFU-GEMM) :\ But I assume it's the common myeloid progenitor. Greets, A. Rad 15:40, 17 April 2007 (UTC)
OK, fixed it :)
I placed the mast cell between the erythroid series and the granulocytes. I was thinking of either doing it like this, or placing the mast cell at the right of to monocyte/DC branch. It may look a bit weird this way, but it's easier to compare the baso with the mast like this. I'll leave it for others to decide and advise on the current placement :) Greets, A. Rad 08:52, 20 April 2007 (UTC)
Indeed, my bad, it is a typo; February not March. As to whether the mast cell derives from the same common granulocyte progenitor that neutrophils, eosinophils and basophils share I don't know; my knowledge of haematology is pretty crap. However, if you were to put a mast cell and a basophil on a slide next to each other, I probably wouldn't be able to tell them apart (unless you included the surrounding tissue as well). They look very similar, although like many things in life, appearances can be deceiving. Sorry I can't be of more help.
Serrin 07:15, 21 April 2007 (UTC)
Oh well, doesn't matter. Unfortunately I'm not an expert either, but I'm sure that sooner or later someone will shed more light on this matter :) Thanks again for the help. Greets, A. Rad 16:32, 21 April 2007 (UTC)

[edit] Renin-Angiotensin Diagram

Hi, I find this diagram especially helpful and clear to understand. Great job on this!

Piotrr 02:33, 25 March 2007 (UTC)

Hi, glad it was of help to you :) Greets, A. Rad 15:02, 25 March 2007 (UTC)

[edit] Left bundle branch block

I found an error in one of your images and I was wondering if you could correct it. The QRS complex for LBBB in lead V6 is labeled RsR'. I know what you're trying to say (because of the M shape at the top) but technically this is a monophasic R wave. The notch is not considered an S wave unless it travels below the isoelectric line. Otherwise great work on the image! Best, MoodyGroove 00:38, 24 April 2007 (UTC)MoodyGroove

Hi and thanks for pointing that error out. So I assume that this complex is simply called an R instead of RsR'? I've also asked this on the image's talk page a while back, but didn't get a reply. I'll correct it as soon as I know the correct designation of that complex. Greets, A. Rad 08:22, 24 April 2007 (UTC)
That's an interesting question, because I've never attempted to label that particular complex. I'd be forced to call it an R, RR', rR', or Rr' complex depending on its appearance, but perhaps simply R wave is the least confusing for everyone. A qR complex would be suggestive of myocardial infarction and an Rs complex would suggest a nonspecific intraventricular conduction defect (because it would look like LBBB in lead V1 and RBBB in leads I and V6). Tom Evans' Cribsheets are quite useful as a quick reference guide. Best, MoodyGroove 11:39, 24 April 2007 (UTC)MoodyGroove
Thanks for the info and ECG reference. I've corrected and updated the image. I agree that a simple R will do here. What you said about that the exact designation of the complex depends on its appearance: I think the article's text is a suitable place for that info. Or maybe not...depends on whether the rules on nomenclature are clear in that ;) Greets, A. Rad 13:22, 24 April 2007 (UTC)


[edit] Typo in hematopoiesis picture

Hey man. I love your big hematopoiesis pic. But the neutrophil is misspelled to neuthrophil. —Preceding unsigned comment added by Zhuuu (talk • contribs) 01:11, 22 May 2007

Hi and thanks for pointing that out. I can't believe how I've missed it - I must have gone over that drawing a 1000 times. Anyway, I've fixed it now :) Greets, A. Rad 16:59, 22 May 2007 (UTC)

[edit] Your image is a featured picture candidate

You might be interested in the discussion here, specifically Sean's offer regarding SVG conversion. —Vanderdecken∴ ∫ξφ 14:54, 31 October 2007 (UTC)

I had one suggestion for this image, if you redraw, it might be a good idea to fix the shadows. As it is now, the shadows are a little too far out from under the objects, especially the antibody shadows. Otherwise, the image looks good and hopefully we can have an SVG version. Jeff Dahl (Talk • contribs) 22:04, 5 November 2007 (UTC)
Sure, I'll try to remember when I redo the image :) A. Rad 17:06, 8 November 2007 (UTC)