Stark II and its effect on orthopaedic practice

The Omnibus Budget Reconciliation Act (OBRA) of 1989, "Stark I," and OBRA 1993, "Stark II," contain provisions introduced by Rep. Fortney "Pete" Stark of California that limit certain referral and compensation arrangements for physicians. Since some of these restrictions affect the practice of orthopaedic surgeons and the nurses employed in these practice settings, this article provides general information related to the Stark self-referral legislation.

Gene delivery systems for use in gene therapy: an overview of quality assurance and safety issues

The development of safe and effective agents for gene therapy is founded on three main principles; careful choice and design of vectors, assessment of vector safety under GLP and production of the vector stocks under GMP. The first ensures the safe and appropriate contained delivery and expression of the required gene to the recipient of the therapy. GLP provides fully documented studies of potency, efficacy and safety of the product while the production of clinical grade agents under GMP is essential.

Plaque-associated expression of human herpesvirus 6 in multiple sclerosis

Representational difference analysis was used to search for pathogens in multiple sclerosis brains. We detected a 341-nucleotide fragment that was 99.4% identical to the major DNA binding protein gene of human herpesvirus 6 (HHV-6). Examination of 86 brain specimens by PCR demonstrated that HHV-6 was present in > 70% of MS cases and controls and is thus a commensal virus of the human brain. By DNA sequencing, 36/37 viruses from MS cases and controls were typed as HHV-6 variant B group 2. Other herpesviruses, retroviruses, and measles virus were detected infrequently or not at all. HHV-6 expression was examined by immunocytochemistry with monoclonal antibodies against HHV-6 virion protein 101K and DNA binding protein p41. Nuclear staining of oligodendrocytes was observed in MS cases but not in controls, and in MS cases it was observed around plaques more frequently than in uninvolved white matter. MS cases showed prominent cytoplasmic staining of neurons in gray matter adjacent to plaques, although neurons expressing HHV-6 were also found in certain controls. Since destruction of oligodendrocytes is a hallmark of MS, these studies suggest an association of HHV-6 with the etiology or pathogenesis of MS.

Detection, cloning and characterisation of papillomaviral DNA present in sarcoid tumours of Equus asinus

Molecular investigations on 18 naturally occurring sarcoid tumors removed from donkeys identified papillomaviral DNA homologous to bovine papillomavirus (BPV)-2 DNA under stringent conditions, in all the samples. Restriction endonuclease analysis of 15 of the tumours demonstrated papillomaviral DNA similar to BPV-1 and BPV-2. The type of DNA was not specific to either the site or the type of lesion. The analysis of the nucleotide base sequence of a cloned papillomaviral element from a sarcoid showed that the isolate was 96 and 98 per cent homologous to BPV-1 in the L1 and E5 open reading frames, respectively. It was concluded that the disease in the donkey is similar to that in the horse and that the E5 open reading frame may be involved in oncogenesis in the sarcoid.

Evaluation of apheresis platelet concentrates collected with a reduced (30-ml) collection chamber with resuspension and storage in a synthetic medium

Recently, the CS-3000 Plus Blood Cell Separator with the TNX-6 platelet separation chamber insert has been furnished with a small-volume (30-ml) collection chamber. In this study, a platelet synthetic medium containing glucose and bicarbonate (PSM) was used for resuspension and storage of this highly concentrated platelet product. Eighteen donors participated in a paired study design where each participant donated platelets on two occasions, once following collection in a standard chamber with resuspension and storage in plasma and once following collection in the new chamber with resuspension and storage in PSM. Substantially higher total platelet counts were obtained using platelets collected in the small chamber and stored in PSM as compared to control (4.4 +/- 0.9 x 10(11) vs. 3.5 +/- 0.9 x 10(11) platelets, p < 0.01 by paired t test). After 5 days of storage, PSM-stored platelets demonstrated higher ATP levels, less lactate dehydrogenase in the supernatant and increased lactate production with resulting lower pH at day 5 of storage (6.94 +/- 0.15 vs. 7.08 +/- 0.09, p < 0.05). There were no statistically significant differences of the survival by multiple-hit estimation of PSM-stored as compared to plasma-stored platelets as determined by 111In labeling and infusion. A slight decrease in the initial percent recovery with the additive-suspended as compared to suspended plasma cells was noted: 50 +/- 8 versus 54 +/- 9%, respectively (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Spinal bone loss in postmenopausal women supplemented with calcium and trace minerals

The effects of calcium supplementation (as calcium citrate malate, 1000 mg elemental Ca/d) with and without the addition of zinc (15.0 mg/d), manganese (5.0 mg/d) and copper (2.5 mg/d) on spinal bone loss (L2-L4 vertebrae) was evaluated in healthy older postmenopausal women (n = 59, mean age 66 y) in a 2-y, double-blind, placebo-controlled trial. Changes (mean +/- SEM) in bone density were -3.53 +/- 1.24% (placebo), -1.89 +/- 1.40% (trace minerals only), -1.25 +/- 1.46% (calcium only) and 1.48 +/- 1.40% (calcium plus trace minerals). Bone loss relative to base-line value was significant (P = 0.0061) in the placebo group but not in the groups receiving trace minerals alone, calcium alone, or calcium plus trace minerals. The only significant group difference occurred between the placebo group and the group receiving calcium plus trace minerals (P = 0.0099). These data suggest that bone loss in calcium-supplemented, older postmenopausal women can be further arrested by concomitant increases in trace mineral intake.