Aberrant splicing contributes to severe α-spectrin-linked congenital hemolytic anemia

The etiology of severe hemolytic anemia in most patients with recessive hereditary spherocytosis (rHS) and the related disorder hereditary pyropoikilocytosis (HPP) is unknown. Whole exome sequencing of DNA from probands of 24 rHS or HPP kindreds identified numerous mutations in erythrocyte membrane α-spectrin (SPTA1). Twenty-eight mutations were novel, with null alleles frequently found in trans to missense mutations. No mutations were identified in a third of SPTA1 alleles (17/48). Whole genome sequencing revealed linkage disequilibrium between the common rHS-linked α-spectrinBug Hill polymorphism and a rare intron 30 variant in all 17 mutation-negative alleles. In vitro minigene studies and in vivo splicing analyses revealed the intron 30 variant changes a weak alternate branch point (BP) to a strong BP. This change leads to increased utilization of an alternate 3' splice acceptor site, perturbing normal α-spectrin mRNA splicing and creating an elongated mRNA transcript. In vivo mRNA stability studies revealed the newly created termination codon in the elongated transcript activates nonsense mediated decay leading to spectrin deficiency. These results demonstrate a unique mechanism of human genetic disease contributes to the etiology of a third of cases of rHS, facilitating diagnosis and treatment of severe anemia, and identifying a new target for therapeutic manipulation.

Effects of hydroxyurea treatment for patients with hemoglobin SC disease

Although hemoglobin SC (HbSC) disease is usually considered less severe than sickle cell anemia (SCA), which includes HbSS and HbS/β(0) -thalassemia genotypes, many patients with HbSC experience severe disease complications, including vaso-occlusive pain, acute chest syndrome, avascular necrosis, retinopathy, and poor quality of life. Fully 20 years after the clinical and laboratory efficacy of hydroxyurea was proven in adult SCA patients, the safety and utility of hydroxyurea treatment for HbSC patients remain unclear. Recent NHLBI evidence-based guidelines highlight this as a critical knowledge gap, noting HbSC accounts for ∼30% of sickle cell patients within the United States. To date, only 5 publications have reported short-term, incomplete, or conflicting laboratory and clinical outcomes of hydroxyurea treatment in a total of 71 adults and children with HbSC. We now report on a cohort of 133 adult and pediatric HbSC patients who received hydroxyurea, typically for recurrent vaso-occlusive pain. Hydroxyurea treatment was associated with a stable hemoglobin concentration; increased fetal hemoglobin (HbF) and mean corpuscular volume (MCV); and reduced white blood cell count (WBC), absolute neutrophil count (ANC), and absolute reticulocyte count (ARC). Reversible cytopenias occurred in 22% of patients, primarily neutropenia and thrombocytopenia. Painful events were reduced with hydroxyurea, more in patients >15 years old. These multicenter data support the safety and potentially salutary effects of hydroxyurea treatment for HbSC disease; however, a multicenter, placebo-controlled, Phase 3 clinical trial is needed to determine if hydroxyurea therapy has efficacy for patients with HbSC disease.

Hematologic outcomes after total splenectomy and partial splenectomy for congenital hemolytic anemia

PURPOSE

The purpose of this study was to define the hematologic response to total splenectomy (TS) or partial splenectomy (PS) in children with hereditary spherocytosis (HS) or sickle cell disease (SCD).

METHODS

The Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium registry collected hematologic outcomes of children with CHA undergoing TS or PS to 1 year after surgery. Using random effects mixed modeling, we evaluated the association of operative type with change in hemoglobin, reticulocyte counts, and bilirubin. We also compared laparoscopic to open splenectomy.

RESULTS

The analysis included 130 children, with 62.3% (n=81) undergoing TS. For children with HS, all hematologic measures improved after TS, including a 4.1g/dl increase in hemoglobin. Hematologic parameters also improved after PS, although the response was less robust (hemoglobin increase 2.4 g/dl, p<0.001). For children with SCD, there was no change in hemoglobin. Laparoscopy was not associated with differences in hematologic outcomes compared to open. TS and laparoscopy were associated with shorter length of stay.

CONCLUSION

Children with HS have an excellent hematologic response after TS or PS, although the hematologic response is more robust following TS. Children with SCD have smaller changes in their hematologic parameters. These data offer guidance to families and clinicians considering TS or PS.

Clinical outcomes of splenectomy in children: report of the splenectomy in congenital hemolytic anemia registry

The outcomes of children with congenital hemolytic anemia (CHA) undergoing total splenectomy (TS) or partial splenectomy (PS) remain unclear. In this study, we collected data from 100 children with CHA who underwent TS or PS from 2005 to 2013 at 16 sites in the Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium using a patient registry. We analyzed demographics and baseline clinical status, operative details, and outcomes at 4, 24, and 52 weeks after surgery. Results were summarized as hematologic outcomes, short-term adverse events (AEs) (≤30 days after surgery), and long-term AEs (31-365 days after surgery). For children with hereditary spherocytosis, after surgery there was an increase in hemoglobin (baseline 10.1 ± 1.8 g/dl, 52 week 12.8 ± 1.6 g/dl; mean ± SD), decrease in reticulocyte and bilirubin as well as control of symptoms. Children with sickle cell disease had control of clinical symptoms after surgery, but had no change in hematologic parameters. There was an 11% rate of short-term AEs and 11% rate of long-term AEs. As we accumulate more subjects and longer follow-up, use of a patient registry should enhance our capacity for clinical trials and engage all stakeholders in the decision-making process.

Complications of implantable venous access devices in patients with sickle cell disease

Implantable venous access devices (VADs) are used in sickle cell disease (SCD) for patients with poor venous access to facilitate chronic blood transfusions and manage acute complications. We attempted to define the frequency of bloodstream infections (BSI) and thrombosis in adults and children with SCD and VADs. We performed a single-institution, retrospective review of VAD-associated infection and thrombosis in patients with SCD. Thirty-two patients (median age 20 years, range, 1-59) had 86 VADs placed (median, 2.7 VADs per patient, range, 1-7) with a total of 41,292 catheter days (median, 1,376 days; range, 323-3,999). Mean catheter lifespan in adults (691 days ± 123) was not significantly higher than children (614 days ± 154). A total of 66 VAD-associated BSI (1.59 infections per 1,000 catheter days) occurred in 17 of 32 (53%) patients. Children with VADs had fewer BSI (3 of 10; 30%) than adults (14 of 22; 64%, P = 0.08). 24 catheter-associated thromboses (0.49 thromboses per 1,000 catheter days) occurred in 10 of 32 (41%) of patients. Children also had fewer VAD-associated-thrombosis (1 of 10; 10%) than adults (9 of 22; 40%, P = 0.08). In conclusion, the use of VADs in SCD was linked to a significant rate of infection and thrombosis.

Therapeutic cancer vaccines in cervical cancer: phase I study of Lovaxin-C

Producing effective therapeutic vaccines has proved much more difficult and challenging than developing cancer preventive vaccines. Despite huge research in the area of cancer immunology, FDA/EMEA have not approved any type of cancer treatment vaccine so far. More than 99% of cervical cancers have detectable amounts of human papillomavirus (HPV) DNA. Integration of high-risk HPV into the host cell genome is followed by continual expression of HPV E6 and E7 oncoproteins, making them excellent targets for developing vaccines which could be used in high grade precancerous (CIN) lesions or invasive cancer or in the prevention of cancer recurrence. Therapeutic cervical cancer vaccines have been extensively studied. Strategies used were vaccination with HPV peptides or proteins, alone or in pulsed dendritic cells, DNA vaccines, virus-like particles or viral and bacterial vectors. Lovaxin-C is a recombinant live-attenuated Listeria monocytogenes (Lm) that secretes the antigen HPV-16 E7 fused to a non-hemolytic listeriolysin O protein. In a phase I study Lovaxin-C was administered to advanced cervical cancer patients refractory to existing therapies. The dose-limiting toxicity was hypotension and flue-like syndrome. There were no serious adverse events. Specific T-cell response was detected as well as clinical response to Lovaxin-C. Several other therapeutic HPV vaccines are in clinical development and in most of the studies specific immunological and clinical responses were seen. Efficacious therapeutic vaccine for the treatment of cervical cancer should be expected in the near future.

Sexual activity and functioning in female scleroderma patients

OBJECTIVE

Few studies exist on sexual activity and functioning in female patients with systemic sclerosis (SSc, scleroderma). We studied the patient-reported impact of SSc on sexual functioning among female patients.

METHODS

101 SSc patients completed the Short Form-36 (SF-36), the Female Sexual Functioning Index (FSFI) and the Female Sexual Function in Scleroderma (FSFS) questionnaires.

RESULTS

Sixty patients reported being sexually active (59.4%). Reasons for sexual inactivity included lack of a partner (36.6%), personal choice (31.7%), and health status of the respondent's partner (19.5%). Only 7 subjects (17%) listed scleroderma as the primary reason for sexual inactivity. The mean FSFI score in the sexually active population was 24.9 (SD=6.7, range = 4.5-34.8) which is significantly lower than the mean score of 30.5 reported for the general population. Sexual functioning was significantly correlated with the Mental Component Score of the SF-36 (r=0.54, p<0.001) but surprisingly not with the Physical Component Score of the SF-36, age, and disease classification or duration. Several scleroderma-related problems including fatigue, body pain, vaginal dryness, and vaginal discomfort were cited as contributing to sexual difficulties.

CONCLUSION

Women with scleroderma do remain sexually active overall in spite of several disease-related physical and psychological difficulties. Many of their problems are amenable to health interventions and should be addressed during health care visits.

Differential requirement for the SAP-Fyn interaction during NK T cell development and function

The adaptor molecule SAP (signaling lymphocytic activation molecule-associated protein) plays a critical role during NK T (NKT) cell development in humans and mice. In CD4(+) T cells, SAP interacts with the tyrosine kinase Fyn to deliver signals required for TCR-induced Th2-type cytokine production. To determine whether the SAP-dependent signals controlling NKT cell ontogeny rely on its binding to Fyn, we used the OP9-DL1 system to initiate structure function studies of SAP in murine NKT cell development. In cultures containing wild-type (WT) hematopoietic progenitors, we noted the transient emergence of cells that reacted with the NKT cell-specific agonist alpha-galactosyl ceramide and its analog PBS57. Sap(-/-) cells failed to give rise to NKT cells in vitro; however, their development could be rescued by re-expression of WT SAP. Emergence of NKT cells was also restored by a mutant version of SAP (SAP R78A) that cannot bind to Fyn, but with less efficiency than WT SAP. This finding was accentuated in vivo in Sap(R78A) knock-in mice as well as Sap(R78A) competitive bone marrow chimeras, which retained NKT cells but at significantly reduced numbers compared with controls. Unlike Sap(R78A) CD4(+) T cells, which produce reduced levels of IL-4 following TCR ligation, alpha-galactosyl ceramide-stimulated NKT cells from the livers and spleens of Sap(R78A) mice produced Th2 cytokines and activated NK cells in a manner mimicking WT cells. Thus, SAP appears to use differential signaling mechanisms in NKT cells, with optimal ontogeny requiring Fyn binding, while functional responses occur independently of this interaction.

The effects of multifocal refractive lenses on occipital extension and forward head posture during a visual task

The purpose of this study was to determine if a change in forward head posture and occipital extension occurred in participants who wore multifocal lenses vs. those persons with non-multifocal lenses while performing an 8-min visual reading task on a visual display unit (VDU). Forty-two healthy human participants were recruited for this study. Thirty-three participants completed the study. Fourteen participants wore multifocal lenses and 19 wore frames with non-multifocal lenses. To evaluate the degree of change of forward head posture and occipital extension digital photographs of cervical posture were taken at four different time intervals: prior to performing the reading task and at 3, 5 and 8 min during the reading task. The digital photographs were analysed utilizing a computer program. Two one-way ANOVA were utilized to determine the degree of change of forward head posture and occipital extension between groups. A significant difference was identified between groups for changes in degrees of forward head posture while performing a visual reading task on a VDU. However, no significant difference between groups was found for occipital extension while performing the same task. Multifocal wearers exhibit greater degrees of change in forward head posture and occipital extension than non-multifocal wearers. These postural changes may place them at a greater risk for musculoskeletal disorders and headaches.

Emergency department visits for concern regarding anthrax--New Jersey, 2001

INTRODUCTION

In October of 2001, after letters processed in Trenton, New Jersey, resulted in multiple cases of anthrax, emergency departments (EDs) in New Jersey experienced an increase in visits from patients concerned about possible exposure to agents of biologic terrorism. Information about the effect of an actual biologic terrorism attack on the emergency department population might be useful in the design of biosurveillance systems, particularly with regard to their performance during the mitigation phase that occurs after an attack. In addition, such information might help identify issues that arise regarding the public health response in the ED setting.

OBJECTIVES

The objectives of this report were to identify and characterize ED visits, by patients concerned with exposure to biologic terrorism agents, in selected New Jersey hospitals after the anthrax attack in fall 2001.

METHODS

A retrospective cohort design was used in this study. The setting was 15 New Jersey EDs within a 55-mile radius of Trenton. Participants were consecutive patients evaluated by ED physicians for the following four periods in 2001: 1 month before September 11; 1 month after September 11; 1 month after October 11; and for the second month after October 11. Percentages of visits were calculated with a concern for exposure (CE) visits by using International Classification of Diseases, Ninth Revision (ICD-9) descriptors: Feared Complaint-No Diagnosis (ICD-9 code v65.6) and Screening for Infectious Disease (ICD-9 code v75.9) for all hospitals and for Trenton versus non-Trenton hospitals as a percentage of ED visits. Charts were reviewed by using a structured data form.

RESULTS

A total of 225,403 ED visits occurred during the 4 months, of which 698 were CE visits. The percentages of CE visits for the four periods were 0.06%, 0.06%, 0.92%, and 0.10%, respectively. For the peak third period, the percentage was increased for the two Trenton hospitals, 1.81%, versus 0.82% for the 13 non-Trenton hospitals. This report is a summary of the 508 visits associated with concern for anthrax exposure during the peak third period: 47% reported exposure to powder, 13% were postal workers, 4% received chest radiographs, 65% had a nasal swab for anthrax, 13% had ED decontamination, and 32% received antibiotics.

CONCLUSION

An increase in CE visits occurred during the 1-month period after October 11, 2001. During the peak month, a higher increase occurred in Trenton EDs. Considering the substantial variation in diagnostic evaluation and treatment, readily available guidelines are needed.

Neuronal conduction studies of the median nerve in non-impaired humans: a comparison of accepted techniques

BACKGROUND AND PURPOSE

There are two commonly accepted techniques used for distal electro-stimulation placement when performing median motor nerve conduction studies. The purpose of this study was to compare latency using two commonly accepted sites of distal stimulation of the median nerve when performing motor nerve conduction studies on non-impaired adult humans.

PARTICIPANTS

The sample consisted of 36 non-impaired participants (15 female, 21 male) aged 20 to 40 years.

METHODS

Participants were randomly assigned to two groups and tested bilaterally for the median motor nerve. For distal stimulation of the median motor nerve, in the first group, 8 cm was measured from the center of the muscle diagonally to arrive at a point between the flexor carpi radialis and plamaris longus tendons. In the second group, 3.5 cm was measured from the distal wrist crease proximally along the median nerve for the distal stimulation of the median motor nerve. Distal latency of both techniques was obtained. Surface skin temperature of the palm was recorded throughout the procedures.

RESULTS

No significant differences were found between the 8 cm and 3.5 cm techniques at p < or = 0. 05 level.

COMMENT

Even though no differences were found between the two techniques, the 3.5-cm technique is recommended because of its consistency as an anatomical landmark reducing the potential for measurement error.

The relationship between temperature and neuronal characteristics

The purpose of this study was to determine a relationship between surface temperature of the limb and neuronal characteristics of the median and ulnar nerves in non-impaired individuals. Previous literature demonstrates that there is a negative correlation between distal latency and amplitude and temperature while a positive correlation exists between nerve conduction velocity and temperature. It is a common clinical practice to externally manipulate the temperature of a cold limb. Thirty-six participants (21 male, 15 female,) with an age range between 20-38 years old (mean age = 26.6) completed the study. Temperature of the limb was not manipulated by the researchers prior to testing and was measured at the distal wrist crease using a surface probe. Relationship was determined using a Pearson product-moment coefficient of correlation. A significant negative correlation existed for median distal sensory latency (DSL), ulnar DSL, ulnar motor amplitude (CMAP), and ulnar sensory amplitude (SNAP). The investigators conclude that temperature is a factor to consider when performing nerve conduction studies. The researchers suggest using mathematical correction factors to compensate for a cool limb rather than external heating.

Role of oral anti-diabetic agents in modifying cardiovascular risk factors

Patients with type 2 diabetes have an increased risk for cardiovascular disease (CVD) and it accounts for up to 80% of excess deaths in these patients. It has been recognized that type 2 diabetes is associated with an increased prevalence of CVD risk factors, including hypertension, dyslipidemia, microalbuminuria, and altered hemostasis. The benefit of cardiovascular protection can only be partially explained by controlling hyperglycemia. Some of the oral agents used to treat hyperglycemia significantly modify other cardiovascular risk factors. This article will review oral agents used to treat type 2 diabetes and their effects on modifying CVD risk factors.

Domain wall pinning in narrow ferromagnetic ring structures probed by magnetoresistance measurements

We present a magnetoresistance study of magnetization reversal and domain wall pinning effects in a mesoscopic narrow ferromagnetic Permalloy ring structure containing notches. The size and strength of the attractive pinning potential created by a notch is measured and the resistance minimum at remanence is found to occur when a single transverse domain wall is pinned at the notch, in agreement with the results of numerical simulations of the anisotropic magnetoresistance. When a field is applied in the direction corresponding to a potential well edge, a novel magnetic state with a very wide domain wall is stabilized, giving rise to a characteristic signature in the magnetoresistance at such angles.

Models of care in New York State Medicaid substance abuse clinics. Range of services and linkages to medical care

PURPOSE

To explore the range of health care services in substance abuse clinics.

METHODS

Survey of directors of a stratified random sample of 125 substance abuse treatment clinics offering methadone, drug-free therapy, or both, representing 344 clinics participating in the New York State (NYS) Medicaid program. Survey asked about clinic services and referral patterns. We defined five categories of linkage of substance abuse to medical care ranging from unlinked (e.g. referral to distant sites) to highly linked (e.g. on site). To estimate the number of patients served, State data on licensed patient capacity for each clinic were used.

RESULTS

This sample represented 344 clinics statewide serving an estimated 60,914 patients. For patients with acute, chronic, or HIV-related medical conditions, weighted analyses showed highly linked care in 54 of the 344 (16%) clinics statewide, serving an estimated 13,741 patients. Unlinked care for all these medical conditions was found for 28% of statewide clinics, serving an estimated 8866 patients. Clinics offering both methadone and drug-free therapy were generally more likely to have medically related services on site.

IMPLICATIONS

The extent of medical care services available at substance abuse clinics varies widely. Over one-quarter of clinics offered only loosely connected medical and substance abuse care.

Regular outpatient medical and drug abuse care and subsequent hospitalization of persons who use illicit drugs

CONTEXT

Patients and the public could benefit from identification of factors that prevent drug users' heavy reliance on inpatient care; however, optimal health care delivery models for illicit drug users remain ill-defined.

OBJECTIVE

To evaluate associations of outpatient medical and drug abuse care with drug users' subsequent hospitalization rates.

DESIGN AND SETTING

Retrospective cohort study of data from longitudinally linked claims for all ambulatory physician/clinic services and drug abuse services covered by the New York State Medicaid program.

SUBJECTS

A total of 11 556 human immunodeficiency virus (HIV)-positive and 46 687 HIV-negative drug users.

MAIN OUTCOME MEASURES

Hospitalization in federal fiscal year (FFY) 1997 compared by 4 patterns of care in FFY 1996: regular drug abuse care (>/=6 months in 1 program), regular medical care (>35% of care from 1 clinic, group practice, or individual physician), both, or neither.

RESULTS

Hospitalization occurred in 55.6% of HIV-positive and 37.5% of HIV-negative drug users, with a mean of 27.5 and 24.5 inpatient days, respectively. In HIV-positive drug users, the adjusted odds ratio (AOR) for hospitalization was lowest among those with both regular medical and drug abuse care (AOR, 0.76; 95% confidence interval [CI], 0.67-0.85) followed by those with regular medical care alone (AOR, 0.82; 95% CI, 0.74-0.91) and regular drug abuse care alone (AOR, 0.85; 95% CI, 0.76-0.96) vs those with neither. In HIV-negative drug users, the AOR of hospitalization was lower for those with regular medical and drug abuse care (AOR, 0.73; 95% CI, 0.68-0.79), regular drug abuse care alone (AOR, 0.71; 95% CI, 0.66-0.76), and regular medical care (AOR, 0.91; 95% CI, 0.86-0.95) vs those with neither. Both types of care showed favorable effects for all but drug abuse-related hospitalizations.

CONCLUSION

Our data indicate that regular drug abuse care with regular medical care for drug users is associated with less subsequent hospitalization.

Observation of a bi-domain state and nucleation free switching in mesoscopic ring magnets

We present the results of a study of the magnetic properties of an array of 34-nm thick Co(100) epitaxial ring magnets, with inner and outer diameters of d(in) = 1.3 microm and d(out) = 1.6 microm, respectively. Magnetic measurements and micromagnetic simulations show that a two step switching process occurs at high fields, indicating the existence of two different stable states. In addition to the vortex state, which occurs at intermediate fields, we have identified a new bi-domain state, which we term the onion state, corresponding to opposite circulation of the magnetization in each half of the ring. The onion state is stable at remanence and undergoes a simple and well characterized nucleation free switching.

Establishing the etiology of thrombocytopenia

Hemostasis is dependent on an adequate number of well-functioning platelets in the circulating blood. As the number of circulating platelets decreases, the chance of bleeding increases. Thrombocytopenia, a platelet count of less than 150,000 per microliter, is a laboratory finding and not a diagnosis. Therefore, once thrombocytopenia is identified, a detailed history, physical examination, and further laboratory tests are used to establish an etiology. This article reviews the assessment, diagnosis, and treatment of thrombocytopenia.

Client self-determination and professional intervention: striking a balance

Social workers find themselves caught in the cross fire between two imperatives: (1) outcome-oriented and competency-based practice requisites and (2) the principle of client self-determination. In this context, the authors hypothesize that social workers use a wide range of gradations along a continuum of practice directiveness. Furthermore, there is ethical justification for this diverse role repertoire. Directiveness modalities are influenced by specific conditional factors that guide practitioner behavior. A study is described that empirically explores and amplifies these hypotheses.

Flavimonas oryzihabitans (CDC group Ve-2) bacteraemia associated with Hickman catheters

Flavimonas oryzihabitans is a potential pathogen that may infect patients who have major medical illnesses, especially those who are undergoing surgery or have indwelling venous catheters in situ. Flavimonas oryzihabitans has been isolated from a wide range of body sites, and the portals of entry are major wounds or implanted foreign materials. We report two cases of F. oryzihabitans bacteraemia associated with the use of Hickman catheters for administration of the patients' chemotherapeutic agents. However, a common source for these infections could not be demonstrated.

A profile of faculty development in physical therapy education programs

The purpose of this study was to report on the status of faculty development in physical therapy education programs. A survey questionnaire was sent to the directors of 110 physical therapy programs nationwide. Analysis of responses from respondents (n = 79; 72%) demonstrated 1) criteria used to evaluate faculty members were similar among different institutions, 2) fewer than half of the institutions have a faculty development plan (FDP), 3) the majority of those institutions that have an FDP supported similar areas and activities to facilitate faculty development, and 4) respondents used creative ways to support faculty development. The results appear to indicate that most physical therapy programs do not have a formalized program to assist faculty members in their development of skills in research, teaching, and service. [Rothman J. Rinehart ME: A profile of faculty development in therapy education programs.

The partialization strategy: an empirical reformulation of demonstration project planning

The demonstration project approach to planning is described and analyzed. Reasons for its frequent failure as a chosen strategy are delineated. The article introduces the concept of partialization as a broader framework for understanding and using demonstration projects. Four key elements for implementing the partialization strategy through selecting an appropriate initial demonstration site are delineated: success potential, access, linkage, and acceptance by the larger population. Partialization in this context examined two research case studies. The case studies provide specific illustrations of how partialization, when conducted as postulated, facilitated desired diffusion of innovations.

Biological effects of White-type polysaccharides of gram-negative bacteria

The White-type polysaccharide (WPS), often called Freeman polysaccharide, was obtained by hydrolyzing gram-negative bacteria in 0.2 N acetic acid at 100 degrees C for 2 h. The crude product contained partially degraded O-antigens as well as other components that were active as immune adjuvants, enhancers of macrophage cytotoxicity of tumor target cells, and inducers of osteoclastic bone resorption. The same WPS preparation augmented the tumor cytotoxicity of normal mouse spleen cells and slightly retarded the take of L1210 leukemia in mice. The WPS preparations generated colony-stimulating factor in mice but were not active in lymphoproliferative (mitogenicity) tests. Chemical analyses of the WPS preparations did not detect the presence of components characteristic of the lipid moiety of endotoxins. The WPS samples were also negative in biological assays of endotoxicity such as local Shwartzman and toxicity tests. These findings indicate that gram-negative bacteria contain nonendotoxin components that are potent modifiers of some biological responses.

A Phase II trial of high-dose intravenous interferon alpha-2 in advanced colorectal cancer

Twenty-one patients with metastatic colorectal cancer were treated with high-dose intravenous interferon alpha-2 (30-50 X 10(6) units/m2) administered daily for 5 consecutive days. Courses of therapy were repeated every 2 to 3 weeks. No tumor responses were seen among 15 evaluable patients. In two subjects, disease remained stable for 3 and 7 months, respectively. Toxicity was substantial and a de-escalation of dose was frequently required. Fevers, gastrointestinal symptoms, fatigue, leukopenia, and elevated serum transaminases were common. High-dose interferon was found to be ineffective in the treatment of metastatic colorectal cancer. A daily dose of 50 X 10(6) units/m2 was greater than the maximum tolerated dose in this group of patients.

Purification and characterization of myosin from calf brain

Actomyosin complex was extracted from the brain cortex in a medium consisting of low salt, ATP, and EDTA, in the presence of protease inhibitors, followed by ammonium sulfate fractionation. Myosin was then purified from the actomyosin. Myosin obtained according to the procedure used was significantly contaminated with actin high (greater than 200,000 dalton) and low molecular weight proteins. Therefore, an alternative method based on affinity chromatography (Blue Dextran/Sepharose) and gel filtration (Sepharose 4B) was developed to purify myosin. This procedure yielded myosin that was greater than 95% pure as judged by electron microscopy and sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The subunit composition of purified brain myosin was monitored by sodium dodecyl sulfate-polyacrylamide gel also containing a urea gradient. A closely migrating triplet in the heavy chain and three light chains, LC1, LC2, and LC3, of Mr 21,000, 19,000, and 17,000, respectively, were observed. These findings raise the possibility of the existence of myosin isoenzymes in the brain. Brain myosin formed bipolar thick filaments in 0.075 M KCl and MgCl2. At low ionic strength, the Mg2+-ATPase activity of myosin was stimulated 3- to 3.5-fold in the presence of skeletal muscle f-actin. Brain myosin also hydrolyzed other nucleotides; the rate of hydrolysis was ITP greater than ATP approximately equal to CTP greater than GTP approximately equal to UTP. The substrate (ATP) saturation curve in the presence of 10 mM CaCl2 and 0.6 M KCl was complex and consisted of plateau regions. The Arrhenius plot of the Ca-ATPase data was linear, whereas with ITPase, it was biphasic with a break occurring around 20 degrees C.

Pyogenic liver abscesses: successful non-surgical therapy

Eleven consecutive patients with pyogenic liver abscesses were seen in a 20-month study period. Ten patients were treated with antibiotics alone. All ten had abscesses demonstrated by hepatic scintigraphy or sonography. In six patients purulent material was obtained by percutaneous aspiration of the liver. Blood-cultures were positive in each of the nine patients in whom they were obtained. Nine of the ten patients treated with antibiotics alone were cured; one died from complications of a liver biopsy. These results indicate that pyogenic liver abscesses can be effectively managed by medical therapy and that surgery is rarely required.

Community mental health centers and family service agencies

This study presents documentation that compares community mental health centers and family service agencies. Although these are complementary in function, their degree of interaction is less than optimal. This paper compares the characteristics of the two systems, using data regarding staff, finances and expenditures, clients, and programs.

Nephrosonography in the evaluation of renal failure and masses in infants

The diagnostic accuracy of nephrosonography is compared with conventional radiologic techniques and surgical findings in 13 infants aged 1 day to 14 months, who were in renal failure or had abdominal masses. Ten of the 13 infants presented with marked renal failure and in half of them neither kidneys nor collecting systems were visualized on the first intravenous pyelogram. Normal renal architecture was demonstrated by nephrosonography in three, hypoplastic kidneys in three, hydronephrosis in three, and a combination of hydronephrosis and contralateral multicystic kidney in one. In the three infants without renal failure, only one kidney was demonstrated by IVP; The cystic contralateral kidney in each of them was demonstrated by nephrosonography. In all cases the diagnosis was confirmed by conventional radiologic techniques when renal function had improved or by surgical exploration. This technique appears to be a useful adjunct to conventional radiography in the differential diagnosis of the infant with abnormalities of the urinary tract. Nephrosonography is of especial value when a kidney is not visualized by IVP, and it may appropriately aid in therapeutic decisions regarding the use of invasive procedures in small critically ill infants.