Specialist ventures: new business partnerships with hospitals

Hospital-physician partnering, a proposition perpetually loaded with opportunities and dangers, remains one of the key strategies for hospital-based organizations pursuing network- and integrated system-oriented strategies. Developing and pursuing well-thought-out models for partnerships with specialists is key to a successful outcome.

Hospital-physician relationships: what's working, what's not working

A new survey by McManis Associates shows that hospitals and health systems are moving toward shard hospital-doctor partnerships and away from physician employment arrangements and MSOs. McManis'Kate Berry writes about what's working and what's not.

Group practices say growth good but tough

McManis Associates, a health care consulting firm, in conjunction with MGMA, sponsored the fourth annual roundtable for executives from leading medical groups across the country. This event is structured to capture key insights related to the success of medical group, with a special focus on medical group growth strategies. This article briefly profiles the roundtable participants and their organizations, summarizes the highlights of the discussion that took place and synthesizes the information into lessons learned that are applicable to other medical groups.

Medical group practices today and tomorrow. Key challenges and opportunities. Roundtable discussion

McManis Associates, a nationally known health care consulting firm, and MGMA sponsored a round table for executives from leading medical groups across the country in May 1997. The purpose of the session was to share thoughts and insights related to creating successful medical groups, with a special focus on how medical groups approach partnerships and what makes those partnerships successes or failures. This article briefly profiles the round table participants and their organizations, summarizes the highlights of the discussion that took place and synthesizes the information into lessons learned that may be applicable to others.

Expression of basic fibroblast growth factor is necessary but insufficient for production of metastasis

We determined whether overexpression of basic fibroblast growth factor (bFGF) is necessary for enhanced growth and production of metastasis by murine K-1735 melanoma cells. The bFGF gene was transfected into three nonmetastatic clones (C-IO, C-19, and C-23) that do not express bFGF mRNA and protein and one metastatic clone that expresses high levels of bFGF mRNA and protein. Control cells were transfected with a dominant selectable marker neomycin resistance gene (neo). All bFGF-transduced cells expressed bFGF-specific mRNA transcripts and cellular bFGF protein and proliferated in culture with medium containing low concentrations of serum. Anchorage-independent growth in hard agarose was enhanced only in bFGF-transfected nonmetastatic C-10 cells which, subsequent to the transfection, also expressed high levels of collagenase IV/gelatinase A activity. The treatment of C-10, C-19, and C-23 cells with exogenous bFGF induced collagenase IV/gelatinase expression, as did the addition of lysates from C-10/bFGF and C-23/bFGF cells. C-10/bFGF cells (but not C-19/bFGF or C-23/bFGF) produced highly vascular and rapidly growing subcutaneous tumors as well as a high incidence of lung metastasis. These data suggest that overexpression of bFGF is necessary but in itself not sufficient to convert nonmetastatic K-1735 cells to the metastatic phenotype and that enhanced tumorigenicity and metastasis require at least concurrent expression of bFGF and collagenase type TV genes.

Pancreatic adenocarcinoma cell line, MDAPanc-28, with features of both acinar and ductal cells

CONCLUSION

We established a new human pancreatic adenocarcinoma cell line, MDAPanc-28. Studies on this new line indicate that it expressed both acinar and ductal gene products suggesting that the patterns of gene expression in the pancreatic adenocarcinoma from which this cell line arose have features similar to those of the protodifferentiated cells hypothesized by Rutter and his colleagues for the developing pancreas (1,2).

BACKGROUND

The cell line arose from a tumor that, like most pancreatic adenocarcinomas, was ductal on the basis of its histological appearance.

METHODS

Once the cell line was established in culture, they were subjected to cytogenetic analysis and tested for their ability to grow in nude mice. RNA from the cells was analyzed by Northern blot analysis and PCR of reverse transcribed cDNA for the expression of both acinar and duct cell gene products. DNA was analyzed for the presence of mutated K-ras at codon 12.

RESULTS

The cell line expressed trypsin and ribonuclease RNA, which are considered to be acinar cell markers, and carbonic anhydrase II (CAII), which is considered to be a duct-cell markers. The histological appearance of xenografts in nude mice was similar to that of the tumor from which the cell line was established. The chromosome number varied between 46 and 60.

Reducing the risk of eye contamination

The recent case of an Italian nurse waiting for compensation after contracting HIV from a splash to her eye (1) has highlighted the serious risk of contracting infection through the eye conjunctiva. In this article, the author suggests nurses need to take more notice of recommendations and guidelines that they should wear eye protection when performing procedures likely to cause splashes to the eye.

Allergy to colophony

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Traumatic tear of tela choroidea resulting in fatal intraventricular hemorrhage

A 39-year-old man was rendered comatose after being struck repeatedly on the head in an altercation. After admission to the hospital, he had computed tomographic scan evidence of diffuse intraventricular and subarachnoid hemorrhage as well as cerebral edema. He shortly thereafter became "brain dead" and life-support systems were discontinued the following day. At autopsy, he had a swollen brain as well as evidence of intraventricular and subarachnoid hemorrhage. No aneurysm or other grossly obvious cause for the hemorrhage was detected. There was, however, a small laceration of the lateral wall of the right lateral ventricle in the region of the caudate nucleus and thalamus, the choroid plexus was detached bilaterally, and the fornices were separated from the corpus callosum. Microscopically, there was further evidence of disruption of the lateral wall of the lateral ventricles, with fragments of ependymal lining mixed in with choroid plexus as well as blood between the fronds of the choroid plexus, and blood dissecting along the wall of the lateral ventricle deep to the ependyma. These findings were felt to be consistent with the recently proposed thesis that tears of the tela choroidea, as part of a so-called inner cerebral trauma, might produce intraventricular and subarachnoid hemorrhage, which, in this case, proved to be fatal.

Anti-Fas on nonhematopoietic tumors: levels of Fas/APO-1 and bcl-2 are not predictive of biological responsiveness

Fas/APO-1 is a cell surface protein known to trigger apoptosis in a variety of cell types upon specific antibody binding. Although extensively studied on normal and malignant hematopoietic cells, little is known about Fas/APO-1 on nonhematopoietic cells. In the study presented here, we have examined Fas/APO-1 expression and function on 11 human tumors of nonhematopoietic origin. By flow cytometric analysis, Fas/APO-1 was expressed on 10 of the 11 tumors at levels comparable to those previously reported for lymphoid cells sensitive to the cytolytic effects of anti-Fas. Despite abundant cell surface expression, only 4 of the 10 Fas-positive tumors were sensitive to the cell-killing effects of anti-Fas. Moreover, anti-Fas enhanced the growth of 2 of 10 Fas-positive tumors. Additional studies using cycloheximide demonstrated that de novo protein synthesis was required for anti-Fas-triggered growth stimulation and, at least in one case, was responsible for the resistance to antibody-induced apoptosis. The biological effects initiated by anti-Fas engagement, however, were not correlated with endogenous bcl-2 expression. This report documents that: (a) Fas/APO-1 is widely expressed on cultured nonhematopoietic tumors; (b) the inherent susceptibility to anti-Fas-induced apoptosis is not correlated with expression of the Fas/APO-1 protein; (c) Fas/APO-1 engagement can result in growth enhancement; and (d) protective/growth-promoting proteins other than bcl-2 may contribute to the diverse spectrum of biological effects induced by anti-Fas engagement of the Fas/APO-1 protein.

Hippocampal synaptic pathology in patients with temporal lobe epilepsy

Immunostaining of synaptic terminals was studied in the hippocampus of 26 patients who had surgical resections for intractable temporal lobe epilepsy. Two monoclonal antibodies (EP10 and SP12) reactive with distinct synaptic antigens were used on paraffin-embedded tissues. The results indicated qualitative reductions on synaptic terminals in CA4 and other regions where cell loss is reported. The inner molecular layer of the dentate gyrus was observed to have increased synaptic immunostaining. Synaptic terminal loss in CA4 and redistribution in the molecular layer were most frequent in cases with hippocampal sclerosis. However, both forms of synaptic pathology were also noted in most cases where the pathological findings were classified as indefinite, and in some cases associated with mass lesions of the temporal lobe. These results support the importance of neuronal loss and synaptic reorganization as possible mechanisms of illness in epilepsy. They also indicate that synaptic immunostaining may be a useful adjunct to routine neuropathological diagnostic techniques.