SAR studies on a novel series of human cytomegalovirus primase inhibitors

A novel series of imidazolylpyrimidines were found to possess inhibitory activity against the human CMV UL70 primase. Extensive SAR studies on an HTS lead led to potent, orally bioavailable compounds with anti-CMV IC(50) values of 150 nM in both viral yield and viral DNA replication assays and with a much reduced cytotoxicity compared to marketed treatments ganciclovir and cidofovir.

Discovery of a novel series of inhibitors of human cytomegalovirus primase

Infection by human cytomegalovirus (hCMV) remains a potent threat to susceptible people throughout the world. We have discovered a series of imidazolyl-pyrimidine compounds, which were found to be irreversible inhibitors of the hCMV UL70 primase based on results from radiolabeling and SAR studies. Two promising analogs are described that rival ganciclovir and cidofovir in antiviral potency and possess improved cytotoxicity profiles.

Prolonged operative time correlates with increased infection rate after total knee arthroplasty

Risk stratification has proven to be a useful tool in surgical site infection prevention. The duration of the surgical procedure has been recommended for use in surgical site infection (SSI) risk stratification (Infect Control Hosp Epidemiol 20:247-248, 1999). A retrospective analysis of 6489 patients who underwent total knee replacement (TKR) between 1993 and 1999 assessed the association between the duration of the surgical procedure and the risk of postoperative infection. One hundred thirteen infected patients were matched with 236 controls, and nominal variables were statistically processed. Patients without infections (n = 236) had surgery durations of 94 +/- 28 min, and patients with infection (n = 104) had durations of 127 +/- 45 min (p < 0.001). Operation time has positive correlations with weight (r = 0.3, p < 0.001), body mass index (r = 0.3, p < 0.001), and the total number of comorbidities (r = 0.2, p < 0.001; n = 340). The results confirm that the duration of the surgical procedure can be used as a risk predictor for SSI in TKR.

Reporting consistency in systemic lupus erythematosus patients: how reliable are patient histories?

Systemic lupus erythematosus (SLE) patients are frequently seen by multiple physicians and at multiple times. In each instance, most of the information important in clinical decision-making is gathered from the patient. There are no studies looking at reporting consistency of certain aspects of SLE patients' history. We studied this by administering the same nine-item questionnaire 4 months apart to the same cohort of SLE patients. In addition, a retrospective chart review was done to correlate the information obtained by prospective questioning and with that on the charts. Our results showed overall good consistency in the areas of general medical history, SLE-specific history and social history. The information gathered by the chart review, in general, went in parallel with that obtained by prospective questioning. This was also true for the poor correlation observed in the family history questions. Many studies and databases depend rather heavily on patient reporting and the quality of this information is usually not substantiated. Our study suggests that, even though SLE patients are generally consistent reporters of certain aspects of their histories, family history information provided is frequently not consistent with previous reporting.

A cross-sectional study of clinical thrombotic risk factors and preventive treatments in antiphospholipid syndrome

OBJECTIVE

Antiphospholipid antibodies (aPL) are major risk factors for thrombosis. Other clinical factors exist in antiphospholipid syndrome (APS) patients which may have an additive or preventive effect on thrombosis. We therefore performed a cross-sectional study to analyse additive clinical thrombotic risk factors and possible preventive treatments in APS patients, and to compare the results with those obtained in asymptomatic aPL-positive (no history of vascular thrombosis or pregnancy morbidity) patients.

METHODS

We identified 77 APS patients with non-gravid thrombotic events (group A) and 56 asymptomatic aPL-positive patients (group B). The study periods were defined as 6 months prior to the time of first vascular event in group A and 6 months prior to the patient's last visit in group B. Medical records were reviewed to evaluate the incidence of hypertension, diabetes mellitus, hypercholesterolaemia, regular cigarette smoking, oral contraceptive use or hormone replacement therapy, surgical procedures, pregnancy with or without an APS-related event, malignancy and infections. In addition, any history of thrombocytopenia or the use of aspirin, hydroxychloroquine, corticosteroids or immunosuppressives during the study periods was recorded. Bivariate statistical analysis and logistic regression tests were performed to compare groups.

RESULTS

In group A, 75% (n=58) of patients and in group B 48% (n=27) of patients had at least one of the additional risk factors during the study periods. In the bivariate analysis, pregnancy (P=0.005) and surgical procedures (P=0.04) were significantly more frequent in group A, while aspirin (P<0.001), hydroxychloroquine (P<0.001) and corticosteroids (P=0.002) were used significantly more frequently in group B. In logistic regression, the probability of an event was decreased by taking aspirin and/or hydroxychloroquine. In women only, the probability of an event was increased with thrombocytopenia and pregnancy or surgical procedures. The incidences of hypertension and smoking and the presence of more than one risk factor were significantly associated with arterial thrombosis but not venous thrombosis.

CONCLUSION

While traditional risk factors were similar between groups, pregnancy and surgical procedures increased the risk of thrombosis. Hypertension and smoking were associated with arterial events. Possessing a combination of risk factors may increase the occurrence of arterial thrombosis but not venous thrombosis. Use of aspirin and/or hydroxychloroquine may be protective against thrombosis in asymptomatic aPL-positive individuals.

Inflatable pillows as axillary support devices during surgery performed in the lateral decubitus position under epidural anesthesia

The lateral decubitus position can cause dependent shoulder discomfort or result in traction on the brachial plexus. We measured pressure beneath the dependent shoulder and lateral angulation of the cervical spine in patients positioned in the lateral decubitus position for total hip replacement under epidural anesthesia. Inflatable pillows (Shoulder-Float) beneath the chest wall and head reduced pressure beneath the dependent shoulder from 66 to 12 mm Hg (P < 0.001) and lateral angulation of the cervical spine from 14 degrees to 4 degrees (P < 0.001). In a randomized crossover study of a further 15 patients, the use of inflatable pillows resulted in significantly less pressure beneath the dependent shoulder and chest wall than either a gel-pad or a 1000-mL lactated Ringer's bag. Inflatable pillows placed beneath the chest wall and head in the lateral decubitus position provided lower pressure beneath the dependent shoulder than other support devices and facilitated alignment of the cervical spine.

IMPLICATIONS

When patients lie on their side, this results in pressure beneath the shoulder and tilting of the head and neck to one side. These problems were effectively corrected with an inflatable pillow (Shoulder-Float).

A prospective, double-blind, randomized, placebo controlled trial of methotrexate in the treatment of giant cell arteritis (GCA)

OBJECTIVE

To determine if methotrexate has disease-controlling and corticosteroid (cs)-sparing effects in the treatment of giant cell arteritis (GCA).

METHODS

This was a randomized, controlled, double-blind trial comparing methotrexate versus placebo in addition to corticosteroid therapy in patients with newly diagnosed giant cell arteritis. Patients with giant cell arteritis were enrolled and treated with high dose corticosteroids as well as methotrexate starting at 7.5 mg/week or placebo. Corticosteroids were tapered by the treating physician as guided by the clinical picture, with methotrexate or placebo dose increased by 2.5 mg/week for disease flare with a maximum allowable dose of 20 mg/week. After a clinically-defined remission and steroid discontinuation, methotrexate or placebo was tapered monthly to zero by 2.5 mg/week.

RESULTS

Twenty-one patients were enrolled, 12 randomized to methotrexate, 9 to placebo. Baseline characteristics (age, height, weight, sedimentation rate, bone mineral density, total corticosteroid dose prior to randomization, and quality of life as measured by SF-36 and function as measured by AIMS) were comparable between groups. At completion, there was no significant difference between methotrexate- and placebo-treated patients with regard to the cumulative corticosteroid dose (6469 mg and 5908 mg respectively, p = 0.6), number of weeks to completion of steroids (68 and 60 respectively, p = 0.5), time (weeks) to taper prednisone to less than 10 mg prednisone/day (23 and 25 respectively, p = 0.5), bone mineral density in lumbar spine (p = 0.2) or hip (p = 0.4) at one year, or functional status as measured by AIMS and quality of life as measured by SF36. There was no late vision loss in either group, and only one major treatment-responsive relapse in a methotrexate-treated patient. There were few major corticosteroid-related side effects and these did not significantly differ between groups.

CONCLUSION

With this study design, no corticosteroid-sparing benefit could be attributed to the combination of methotrexate with corticosteroid therapy for the treatment of patients with giant cell arteritis. Both groups did well, with few major corticosteroid-related side effects, and most patients were safely tapered off corticosteroids sooner than reported in many series. The shorter overall duration of steroid treatment in this study probably contributed to the remarkably low frequency of side effects, without increased ischemic risk for the patient.

Bone strength and related traits in HcB/Dem recombinant congenic mice

Fracture susceptibility depends jointly on bone mineral content (BMC), gross bone anatomy, and bone microarchitecture and quality. Overall, it has been estimated that 50-70% of bone strength is determined genetically. Because of the difficulty of performing studies of the genetics of bone strength in humans, we have used the HcB/Dem series of recombinant congenic (RC) mice to investigate this phenotype. We performed a comprehensive phenotypic analysis of the HcB/Dem strains including morphological analysis of long bones, measurement of ash percentage, and biomechanical testing. Body mass, ash percentage, and moment of inertia each correlated moderately but imperfectly with biomechanical performance. Several chromosome regions, on chromosomes 1, 2, 8, 10, 11, and 12, show sufficient evidence of linkage to warrant closer examination in further crosses. These studies support the view that mineral content, diaphyseal diameter, and additional nonmineral material properties contributing to overall bone strength are controlled by distinct sets of genes. Moreover, the mapping data are consistent with the existence of pleiotropic loci for bone strength-related phenotypes. These findings show the importance of factors other than mineral content in determining skeletal performance and that these factors can be dissected genetically.

Comparing discriminative validity between a disease-specific and a general health scale in patients with moderate asthma

Health-related quality of life scales such as the Asthma Quality of Life Questionnaire and the Medical Outcomes Study Short-form General Health Survey SF-36 have become important measures of health status in clinical asthma trials. The discriminative properties of these scales, however, have not been extensively evaluated and compared. The purposes of this study were to assess and compare scale and discriminative properties of the Asthma Quality of Life Questionnaire (AQLQ) and the SF-36 in a group of patients with moderate asthma using a patient-rated global measure of disease activity as the criterion variable. Patients were interviewed in-person with a series of questionnaires including the AQLQ and the SF-36, and were also asked the global question "How active is your asthma now?" with possible responses of "extremely," "very," "moderately," "mildly" or "not active." Discriminative properties were determined using receiver operating characteristic (ROC) curves with responses to the global question as the criterion variable and mean domain scale scores as the independent variables. Relative validities for the AQLQ and SF-36 domains were also compared. A total of 230 patients, mean age of 41 years, were enrolled. Scores were lower and ranges were narrower for the AQLQ compared to the SF-36. In general, the AQLQ and the SF-36 were highly correlated, with r = 0.69 for the AQLQ overall score and the SF-36 Physical Component Summary (PCS) score. According to ROC analyses, both scales had excellent discriminative properties; however the area under the ROC curve was higher for the AQLQ overall score (0.81) than for the PCS (0.75). When ranked according to ROC area, the symptoms domain (0.83) had the greatest area under the ROC curve, followed by the emotional (0.76) and activities (0.76) domains of the AQLQ. However, in some cases, the area under the curve was less for an AQLQ domain (for example, 0.71 for the environmental domain) than for SF-36 domains (for example, 0.75 for the role physical, and 0.75 for the social domain). Similarly, the AQLQ overall had a higher relative validity (5.2) compared to the PCS (2.2), and the symptoms domain of the AQLQ had the highest relative validity (6.0). Thus, both the Asthma Quality of Life Questionnaire and the SF-36 were able to characterize patients with moderate asthma in our cross-sectional study. In addition, both scales had strong discriminative properties when assessed with a global patient rating of current disease activity.

The need for comprehensive educational osteoporosis prevention programs for young women: results from a second osteoporosis prevention survey

OBJECTIVE

To assess osteoporosis knowledge, beliefs, and preventive behaviors among young adult women and to identify sources that they would mostly likely utilize to learn more about the disease.

METHODS

Information was gathered through a cross-sectional survey of 321 women (mean age 21.6 years; 63.5% were white, 29.2% were black) enrolled in a required undergraduate health course at a southeastern state university.

RESULTS

Two hundred seventy-seven (86%) of the survey participants had heard about osteoporosis, but only 3.8% of respondents reported getting both adequate exercise and the recommended 1,200 mg of calcium per day. Respondents believed that they were unlikely to develop osteoporosis and that osteoporosis is less serious than other common causes of morbidity and mortality in women, such as heart disease and breast cancer (P < 0.0001). Brochures, magazines, and short counseling sessions were preferred information sources for learning about osteoporosis. CONCLUSIONS. The majority of young women studied are at risk for developing premature osteoporosis. They prefer brochures, magazines, and short counseling sessions during medical office visits to learn about osteoporosis.

Low-binding alleles of Fcgamma receptor types IIA and IIIA are inherited independently and are associated with systemic lupus erythematosus in Hispanic patients

OBJECTIVE

To examine the relationship between allelic polymorphisms of IgG receptors (FcgammaR) and the development of lupus nephritis in a prospective study, and to determine the distribution of FcgammaR haplotypes (FcgammaRIIA and FcgammaRIIIA genotypes) in lupus patients and disease-free control subjects.

METHODS

We studied 67 Hispanic systemic lupus erythematosus (SLE) patients from a prospective study of outcome and 53 disease-free control subjects. Patients were followed up longitudinally for 3 years. FcgammaRIIA and FcgammaRIIIA genotypes were determined using allele-specific polymerase chain reaction.

RESULTS

Nephritis was present in 28% of patients at entry into the study and in 69% at the end of 3 years. In the nephritis group (n = 46), as well as the entire SLE cohort, there was a predominance of genotypes with low-binding alleles (FcgammaRIIa-R131 and FcgammaRIIIa-F176) at both loci (SLE nephritis patients 89% versus controls 62%; P < 0.002; odds ratio 0.20 [95% confidence interval 0.05-0.6] for risk of nephritis in individuals homozygous for either FcgammaRIIa-H131 or FcgammaRIIIaV176). The frequency of individuals homozygous for high-binding alleles at either locus decreased as the burden of disease increased (P < 0.002, by Mann-Whitney test). There was no linkage disequilibrium between FcgammaRIIA and FcgammaRIIIA in Hispanics, yet in the SLE patients, there was a clear overrepresentation of the FcgammaRIIa-R131;FcgammaRIIIa-F176 haplotype (SLE patients 48% versus controls 30%) and a decrease in the frequency of the high-binding haplotype (4% versus 23%) (P < 0.002).

CONCLUSION

We observed an increase in the frequency of low-binding FcgammaR alleles in an SLE population with a high prevalence of renal disease. The apparent selection for the FcgammaRIIa-R131;FcgammaRIIIa-F176 haplotype in Hispanic patients suggests that low-binding alleles of both FcgammaRIIa and FcgammaRIIIa confer risk for SLE and may act additively in the pathogenesis of disease, whereas the high-binding haplotype FcgammaRIIa-H131;FcgammaRIIIa-V176 is protective, particularly in the homozygous state.

Social monogamy in a territorial salamander

Social monogamy, which does not necessarily imply mating or genetic monogamy, is important in the formation of male-female pair associations. We operationally define social monogamy as occurring when two heterosexual adults, exclusive of kin-directed behaviour, direct significantly less aggression and significantly more submission towards each other, and/or spend significantly more time associating with each other relative to other adult heterosexual conspecifics. Long-term pair associations (i.e. those lasting through a lengthy breeding season) that are characteristic of social monogamy are common in some taxa but are virtually unknown in amphibians. Recent studies, however, have suggested that red-backed salamanders, Plethodon cinereus, have complex (for amphibians) social systems. Our laboratory experiments tested the hypothesis that red-backed salamanders found in pairs in the forest display behaviours consistent with social monogamy. During the summer noncourtship season, newly collected male-females pairs showed no preference to associate with their partners more than with a novel conspecific of the opposite sex. However, during the autumn courtship season, paired males and females significantly directed preferential behaviours towards their partners rather than towards a surrogate or a novel paired salamander. Focal animals showed no significant preferences when presented with their partner and a novel single salamander, but they never directed preferential behaviours towards a novel salamander (whether paired or single) or a surrogate. These results are the first to suggest that a salamander species engages in social monogamy. Furthermore, our results suggest that social monogamy may not inhibit paired males and females from displaying alternative strategies: preferring partners when extrapair associations may be disadvantageous (i.e. the extrapair animal is already paired) but not preferring partners when extrapair associations may be advantageous (i.e. the extrapair animal is single). Copyright 2000 The Association for the Study of Animal Behaviour.

Major life events as antecedents to hip fracture

BACKGROUND

This study sought to determine whether the number of antecedent life events reported in the year before hip fracture among elderly patients was normal for the population from which these patients derive. Major life events are events such as births, deaths, major financial dealings, and major health changes.

METHODS

Life events reported in the year before a fall and hip fracture for 111 hip fracture patients were compared with those of a control sample of 90 nonfracture, community-dwelling ambulatory elderly.

RESULTS

The total number of life events was higher in the hip fracture group (p = 0.0001) than in the community control group. Fracture was also associated with the number of events experienced (adjusted OR, 2.1; 95% CI, 1.6-2.7; p < 0.0007), notwithstanding age, marital status, and education.

CONCLUSION

Older persons who had sustained a fall-related traumatic hip fracture experienced an increased number of major life events compared with a nonfracture population sample of community-dwelling elderly controls.

Effects of depressive symptoms on health-related quality of life in asthma patients

OBJECTIVE

To assess the effects of depressive symptoms on asthma patients' reports of functional status and health-related quality of life.

DESIGN

Cross-sectional study.

SETTING

Primary care internal medicine practice at a tertiary care center in New York City.

PATIENTS

We studied 230 outpatients between the ages of 18 and 62 years with moderate asthma.

MEASUREMENTS AND MAIN RESULTS

Patients were interviewed in person in English or Spanish with two health-related quality-of-life measures, the disease-specific Asthma Quality of Life Questionnaire (AQLQ) (possible score range, 1 to 7; higher scores reflect better function) and the generic Medical Outcomes Study SF-36 (general population mean is 50 for both the Physical Component Summary [PCS] score and Mental Component Summary [MCS] score). Patients also completed a screen for depressive symptoms, the Geriatric Depression Scale (GDS), and a global question regarding current disease activity. Stepwise multivariate analyses were conducted with the AQLQ and SF-36 scores as the dependent variables and depressive symptoms, comorbidity, asthma, and demographic characteristics as independent variables. The mean age of patients was 41 +/- SD 11 years and 83% were women. The mean GDS score was 11 +/- SD 8 (possible range, 0 to 30; higher scores reflect more depressive symptoms), and a large percentage of patients, 45%, scored above the threshold considered positive for depression screening. Compared with patients with a negative screen for depressive symptoms, patients with a positive screen had worse composite AQLQ scores (3.9 +/- SD 1.3 vs 2.8 +/- SD 0.8, P <.0001) and worse PCS scores (40 +/- SD 11 vs 34 +/- SD 8, P <.0001) and worse MCS scores (48 +/- SD 11 vs 32 +/- SD 10, P <.0001) scores. In stepwise analyses, current asthma activity and GDS scores had the greatest effects on patient-reported health-related quality of life, accounting for 36% and 11% of the variance, respectively, for the composite AQLQ, and 11% and 38% of the variance, respectively, for the MCS in multivariate analyses.

CONCLUSIONS

Nearly half of asthma patients in this study had a positive screen for depressive symptoms. Asthma patients with more depressive symptoms reported worse health-related quality of life than asthma patients with similar disease activity but fewer depressive symptoms. Given the new emphasis on functional status and health-related quality of life measured by disease-specific and general health scales, we conclude that psychological status indicators should also be considered when patient-derived measures are used to assess outcomes in asthma.

Maintenance of bone density: outcomes over five years of attendance at an osteoporosis center

BACKGROUND

This is a longitudinal analysis of the data from women who visited the Osteoporosis Prevention Center for at least five years. The study is part of an ongoing evaluation of the results of the Center visits.

METHODS

A random sample of 100 women who had attended the clinic for more than five years and were not referred for a definite medical diagnosis was pulled from the records. Descriptive statistics were compiled on this sample. Seventy-five women were postmenopausal and over 49 years of age. This subgroup was studied for change in bone mineral density (BMD) over the five years.

RESULTS

The BMD change was 0.03 gm/cm2 in the spine, -0.01 gm/cm2 in the femoral-neck. and -0.008 gm/cm2 at the radius over the five years.

CONCLUSION

Attendance at the Osteoporosis Prevention Center was associated with maintenance of bone density in the spine over a five-year period.

Randomized trial of hypotensive epidural anesthesia in older adults

BACKGROUND

Data are sparse on the incidence of postoperative cognitive, cardiac, and renal complications after deliberate hypotensive anesthesia in elderly patients.

METHODS

This randomized, controlled clinical trial included 235 older adults with comorbid medical illnesses undergoing elective primary total hip replacement with epidural anesthesia. The patients were randomly assigned to one of two levels of intraoperative mean arterial blood pressure management: either to a markedly hypotensive mean arterial blood pressure range of 45-55 mmHg or to a less hypotensive range of 55-70 mmHg. Cognitive outcome was assessed by within-patient change on 10 neuropsychologic tests assessing memory, psychomotor, and language skills from before surgery to 1 week and 4 months after surgery. Prospective standardized surveillance was performed for cardiovascular and renal outcomes, delirium, thromboembolism, and blood loss and replacement.

RESULTS

The two groups were similar at baseline in terms of age (mean, 72 yr), sex (50% women), comorbid conditions, and cognitive function. After operation, no significant differences in the incidence of early or long-term cognitive dysfunction were observed between the two blood pressure management groups. There were no significant differences in the rates of other adverse consequences, including cardiac, renal, and thromboembolic complications. In addition, no differences occurred in the duration of surgery, intraoperative estimated blood loss, or transfusion rates.

CONCLUSIONS

Elderly patients can safely receive controlled hypotensive epidural anesthesia with this protocol. There was no evidence of greater risks, or early benefits, with the use of the more markedly hypotensive range.

Bootstrap prediction and confidence bands: a superior statistical method for analysis of gait data

Gait analysis studies typically utilize continuous curves of data measured over the gait cycle, or a portion of the gait cycle. Statistical methods which are appropriate for use in studies involving a single point of data are not adequate for analysis of continuous curves of data. This paper determines the operating characteristics for two methods of constructing statistical prediction and confidence bands. The methods are compared, and their performance is evaluated using cross-validation methodology with a data set of the sort commonly evaluated in gait analysis. The methods evaluated are the often-used point-by-point Gaussian theory intervals, and the simultaneous bootstrap intervals of Sutherland et al. The Development of Mature Walking, MacKeith Press, London, 1988 and Olshen et al. Ann. Statist. 17 (1989) 1419-40. The bootstrap bands are shown to provide appropriate coverage for continuous curve gait data (86% coverage for a targeted coverage of 90%). The Gaussian bands are shown to provide inadequate coverage (54% for a targeted coverage of 90%). The deficiency in the Gaussian method can lead to inaccurate conclusions in gait studies. Bootstrap prediction and confidence bands are advocated for use as a standard method for evaluating gait data curves because the method is non-parametric and maintains nominal coverage levels for entire curves of gait data.

High-throughput screening assay for helicase enzymes

We have developed a novel 96-well microtiter plate high-throughput screening filtration assay for the detection of helicase activity. In this paper we present data for detection of helicase activity of the UL5/8/52 helicase-primase complex from herpes simplex virus 1 (HSV1). The assay involves the detection of radioactively labeled oligonucleotide annealed to a single-stranded circular DNA following capture of the annealed complex on silica beads. We have screened over 200,000 samples containing small organic molecules and natural products and identified T157602, a two-amino thiazole, as a specific inhibitor of HSV replication.

Inhibition of herpes simplex virus replication by a 2-amino thiazole via interactions with the helicase component of the UL5-UL8-UL52 complex

With the use of a high-throughput biochemical DNA helicase assay as a screen, T157602, a 2-amino thiazole compound, was identified as a specific inhibitor of herpes simplex virus (HSV) DNA replication. T157602 inhibited reversibly the helicase activity of the HSV UL5-UL8-UL52 (UL5/8/52) helicase-primase complex with an IC50 (concentration of compound that yields 50% inhibition) of 5 microM. T157602 inhibited specifically the UL5/8/52 helicase and not several other helicases. The primase activity of the UL5/8/52 complex was also inhibited by T157602 (IC50 = 20 microM). T157602 inhibited HSV growth in a one-step viral growth assay (IC90 = 3 microM), and plaque formation was completely prevented at concentrations of 25 to 50 microM T157602. Vero, human foreskin fibroblast (HFF), and Jurkat cells could be propagated in the presence of T157602 at concentrations exceeding 100 microM with no obvious cytotoxic effects, indicating that the window between antiviral activity and cellular toxicity is at least 33-fold. Seven independently derived T157602-resistant mutant viruses (four HSV type 2 and three HSV type 1) carried single base pair mutations in the UL5 that resulted in single amino acid changes in the UL5 protein. Marker rescue experiments demonstrated that the UL5 gene from T157602-resistant viruses conferred resistance to T157602-sensitive wild-type viruses. Recombinant UL5/8/52 helicase-primase complex purified from baculoviruses expressing mutant UL5 protein showed complete resistance to T157602 in the in vitro helicase assay. T157602 and its analogs represent a novel class of specific and reversible anti-HSV agents eliciting their inhibitory effects on HSV replication by interacting with the UL5 helicase.

One-year followup of patients with osteoarthritis of the knee who participated in a program of supervised fitness walking and supportive patient education

OBJECTIVE

To determine whether gains in functioning observed immediately following participation in an 8-week program of supervised fitness walking for patients with knee osteoarthritis were sustained at 1-year followup.

METHODS

Twenty-nine (61.1%) of 47 original intervention program patients and 23 (51.1%) of 45 original control patients were interviewed by telephone at 1-year followup. Patients completed the Arthritis Impact Measurement Scales physical activity, arthritis impact, pain, medication use, and general health perceptions subscales, as well as a separate visual analog pain scale and measures of perceived self-efficacy to cope with arthritis pain and other symptoms.

RESULTS

Adherence to walking was low, and there were no statistically significant differences between intervention and control patients at one year.

CONCLUSIONS

The failure of intervention patients to maintain regular walking resulted in loss of functional benefits that were observed at 8 weeks in the original study. Long-term adherence to walking is critical to maintenance of initial gains in functional outcomes.

The utility of high-resolution magnetic resonance imaging in the evaluation of the triangular fibrocartilage complex of the wrist

We performed a prospective study in order to assess the utility of high-resolution magnetic resonance imaging in the detection and specific localization of tears of the triangular fibrocartilage complex. Seventy-seven patients who had pain in the wrist were studied with use of a dedicated surface coil and three-dimensional gradient-recalled techniques with a field of view of eight centimeters and a slice thickness of one millimeter. The patients had pain on the ulnar side of the wrist, ligamentous instability, occult ganglia, or a combination of these. Magnetic resonance images were assessed for radial or ulnar avulsion, or both; central defects; degenerative intrasubstance changes; and complex tears of the triangular fibrocartilage complex. Partial tears were differentiated from complete tears. The findings on the magnetic resonance images were then compared with the arthroscopic findings. Fifty-seven of the fifty-nine tears that were suspected on magnetic resonance images were confirmed with arthroscopy; the two suspected tears that were not confirmed had been interpreted as small partial tears on the magnetic resonance images. With use of arthroscopy as the standard, magnetic resonance imaging had a sensitivity of 100 per cent (fifty-seven of fifty-seven), a specificity of 90 per cent (eighteen of twenty), and an accuracy of 97 per cent (seventy-five of seventy-seven) for the detection of a tear (kappa = 0.93, p < 0.00001). Fifty-three of the fifty-seven tears were localized correctly with use of magnetic resonance imaging. With regard to the location of the tear, magnetic resonance imaging had a sensitivity of 100 per cent (fifty-three of fifty-three), a specificity of 75 per cent (eighteen of twenty-four), and an accuracy of 92 per cent (seventy-one of seventy-seven) (kappa = 0.9, p < 0.0001). We concluded that high-resolution magnetic resonance imaging permits accurate depiction and localization of tears of the triangular fibrocartilage complex. When the appropriate pulse sequence is used, magnetic resonance imaging is an accurate and effective method for the non-invasive evaluation of pain in the wrist.

Action of the peroneus longus tendon on the first metatarsal against metatarsus primus varus force

A medially directed force was applied to the first metatarsal in 10 cadaver feet. The peroneus longus tendon was subjected to a pull of 5 pounds. The soft tissues between the first and second metatarsals were cut sequentially, starting with the skin on the dorsal and plantar aspect, followed by the intermetatarsal ligament and adductor hallucis tendon, and, finally, the peroneus longus tendon at its distal insertion. Dorsoplantar radiographs while weightbearing were taken after each sectioning. A statistically significant varus displacement of the first metatarsal was observed only after transection of the peroneus longus tendon. It was concluded that the peroneus longus tendon is a strong retaining mechanism of the first metatarsal.

Users evaluate LupusLine, a telephone peer counseling service

OBJECTIVE

To assess the impact of LupusLine during its pilot phase of operation by determining patterns of utilization and user satisfaction. LupusLine is a peer counseling service designed to provide ongoing emotional support from home to home by telephone appointment.

METHODS

One hundred fifty-three respondents were surveyed, using a 72-item structured questionnaire administered over the telephone by interviewers separately trained and hired specifically for this purpose. The questionnaire was pilot tested on 10 volunteers with systemic lupus erythematosus (SLE), and a panel of related health professionals reviewed the questionnaire for face validity.

RESULTS

Most users were women (94.5%) who had SLE themselves (87.5%) and who called the service because of recent changes in their physical functioning and reported feelings of depression and anxiety about their illness. Forty-one percent of respondents made 6 or more calls to their assigned peer counselor. Respondents reported high levels of satisfaction across 5 highly correlated measures, with 92% of callers reporting at least moderate satisfaction with the service. Over 60% of respondents who reported a change in 6 "feeling" categories attributed this change to using LupusLine. Fewer users reported a change in 4 specific behaviors since using the service, but more respondents attributed changes, when they occurred, to LupusLine.

CONCLUSIONS

Based on these initial findings, we believe that telephone networks similar to the LupusLine model may be able to offer substantial benefit to people coping with the complex, ongoing psychosocial challenges of SLE. Further, the at-home accessibility and low cost of such volunteer-based interventions may play an ever more needed role in the present health care environment.

A point mutation abolishes the helicase but not the nucleoside triphosphatase activity of hepatitis C virus NS3 protein

The NS3 protein of hepatitis C virus contains a bipartite structure consisting of an N-terminal serine protease and a C-terminal DEAD box helicase. We show that the C-terminal domain has ATPase and panhelicase activities. The integrity of the helicase function is dependent on the conserved DEAD motif and can be abolished by a His-Ala point mutation, leaving a fully functional nucleoside triphosphatase.

Patients' expectations and satisfaction with total hip arthroplasty

Although there have been many studies focusing on the increasingly important assessment of patients' satisfaction, few studies have specifically addressed this tissue for total hip arthroplasty (THA). The goals of this study were to measure patients' satisfaction with THA and to evaluate the relationships of expectations and outcome to patients' satisfaction. A total of 180 patients were surveyed 2 to 3 years after THA about their experiences with THA. Patients cited 45 different expectations, which were grouped into five categories reflecting improvement in pain, walking, psychological state, essential activities, and nonessential activities. Overall, 89% of patients were satisfied with the results of surgery. Lower rates of satisfaction were found in patients who had a better preoperative condition (as measured by the surgeons with The Hospital for Special Surgery Hip Scale), in patients who expected improvement in nonessential activities, and in patients who reported worse postoperative condition (as measured by self-assessment with the Hip Rating Questionnaire and the Medical Outcomes Study Short-form General Health Survey). Patients were also asked how they came to THA. Nearly 50% of patients were first referred to an orthopaedist by family or friends or based on their own knowledge. Seventy-four percent either had subsequently referred others for THA or would have done so if they knew someone with hip pain. This study demonstrates that satisfaction with THA is a complex phenomenon, affected by expectations, outcome, and what patients know about the procedure from their community network. A better understanding of THA satisfaction will enable better future selection of patients and an additional dimension of outcome, both of which are important to patients and payers.

A self-administered questionnaire for assessment of symptoms and function of the shoulder

A self-administered questionnaire was designed to assess the severity of symptoms related to and the functional status of the shoulder. It includes domains of global assessment, pain, daily activities, recreational and athletic activities, work, satisfaction, and areas for improvement. Each domain is graded separately and is weighted to arrive at the total score. The over-all scale and each domain were prospectively tested for validity, reliability, and responsiveness to clinical change. One hundred patients who were seen for evaluation of the shoulder were enrolled in the study. The validity of the scale was demonstrated by moderate-to-high correlation of the domains and individual questions of the Shoulder Rating Questionnaire with those of the Arthritis Impact Measurement Scales 2. Validity was supported further by significant correlation of the scores in each domain with the level of satisfaction in that domain and by significantly lower scores in domains that patients selected as areas important for improvement. The over-all scale and each domain were internally consistent (Cronbach alpha, 0.71 to 0.90). Reproducibility was evaluated by repeated administration of the questionnaire after a mean of three days to forty patients whose condition was clinically stable. Reproducibility of the over-all questionnaire and individual domains was excellent (Spearman-Brown index, 0.94 to 0.98). Individual questions were reproducible, with a weighted kappa value of more than 0.7 for each. Responsiveness was evaluated by comparison of the preoperative and postoperative scores of thirty patients who had a satisfactory result one year after an operation on the shoulder. The over-all Shoulder Rating Questionnaire and each domain were responsive to clinical change as demonstrated by favorable standardized response means (range, 1.1 to 1.9) and indices of responsiveness (range, 1.1 to 2.0). Similar analysis performed for individual diagnostic groups supported the validity, reliability, and responsiveness of the questionnaire in each group. The self-administered shoulder questionnaire was found to be valid, reliable, and responsive to clinical change. These qualities should make it a useful instrument for the prospective assessment of the outcome of treatment of disorders related to the shoulder.

Fc gamma RIIA alleles are heritable risk factors for lupus nephritis in African Americans

Allelic variants of Fc gamma R confer distinct phagocytic capacities providing a mechanism for heritable susceptibility to immune complex disease. Human Fc gamma RIIa has two codominantly expressed alleles, R131 and H131, which differ substantially in their ability to ligate human IgG2. The Fc gamma RIIa-H131 is the only human Fc gamma R which recognizes IgG2 efficiently and optimal IgG2 handling occurs only in the homozygous state. Therefore, since immune complex clearance is essential in SLE, we hypothesized that Fc gamma RIIA genes are important disease susceptibility factors for SLE, particularly lupus nephritis. In a two-stage cross-sectional study, we compared the distribution of Fc gamma RIIA alleles in African Americans with SLE to that in African American non-SLE controls. A pilot study of 43 SLE patients and 39 controls demonstrated a skewed distribution of Fc gamma RIIA alleles, with only 9% of SLE patients homozygous for Fc gamma RIIa-H131 compared with 36% of controls (odds ratio, 0.18; 95% CI, 0.05-0.69, P = 0.009). This was confirmed with a multicenter study of 214 SLE patients and 100 non-SLE controls. The altered distribution of Fc gamma RIIA alleles was most striking in lupus nephritis. Trend analysis of the genotype distribution showed a highly significant decrease in Fc gamma RIIA-H131 as the likelihood for lupus nephritis increased (P = 0.0004) consistent with a protective effect of the Fc gamma RIIA-H131 gene. The skewing in the distribution of Fc gamma RIIA alleles identifies this gene as a risk factor with pathophysiologic importance for the SLE diathesis in African Americans.

Truncated mammalian Notch1 activates CBF1/RBPJk-repressed genes by a mechanism resembling that of Epstein-Barr virus EBNA2

The Notch/Lin-12/Glp-1 receptor family participates in cell-cell signaling events that influence cell fate decisions. Although several Notch homologs and receptor ligands have been identified, the nuclear events involved in this pathway remain incompletely understood. A truncated form of Notch, consisting only of the intracellular domain (NotchIC), localizes to the nucleus and functions as an activated receptor. Using both an in vitro binding assay and a cotransfection assay based on the two-hybrid principle, we show that mammalian NotchIC interacts with the transcriptional repressor CBF1, which is the human homolog of Drosophila Suppressor of Hairless. Cotransfection assays using segments of mouse NotchIC and CBF1 demonstrated that the N-terminal 114-amino-acid region of mouse NotchIC contains the CBF1 interactive domain and that the cdc10/ankyrin repeats are not essential for this interaction. This result was confirmed in immunoprecipation assays in which the N-terminal 114-amino-acid segment of NotchIC, but not the ankyrin repeat region, coprecipitated with CBF1. Mouse NotchIC itself is targeted to the transcriptional repression domain (aa179 to 361) of CBF1. Furthermore, transfection assays in which mouse NotchIC was targeted through Gal4-CBF1 or through endogenous cellular CBF1 indicated that NotchIC transactivates gene expression via CBF1 tethering to DNA. Transactivation by NotchIC occurs partially through abolition of CBF1-mediated repession. This same mechanism is used by Epstein-Barr virus EBNA2. Thus, mimicry of Notch signal transduction is involved in Epstein-Barr virus-driven immortalization.

Balloon photodynamic therapy of esophageal cancer: effect of increasing balloon size

BACKGROUND AND OBJECTIVE

Photodynamic therapy is currently being used to treat various malignancies including esophageal cancer. The effect of photodynamic therapy depends upon the concentration of photosensitizing drug, light energy delivered to tissue, and the presence of oxygen in the targeted tissue. We have found that an esophageal centering balloon improves light delivery to esophageal mucosa. However, balloon pressure on esophageal mucosa could possibly reduce mucosal blood flow and oxygenation, therefore reducing the effect of photodynamic therapy. This study was conducted to investigate the effect of balloon pressure on the esophageal wall during photodynamic therapy in the canine esophageal model.

STUDY DESIGN/MATERIALS AND METHODS

Studies were performed in the canine esophagus of ten animals to investigate whether increasing the size of the centering balloon, and hence the pressure on esophageal mucosa, would alter the tissue effect of PDT. Porfimer sodium 4 mg/Kg was administered and 630 nm light was delivered via a 1 cm diffuser located in the center of a 360 degrees 2 cm windowed balloon. Mucosal light measurements were made to ascertain equivalent mucosal light dosing of approximately 25 J/cm2. Endoscopic and necropsy findings obtained following photodynamic therapy with 25 mm, 33 mm, and 35 mm balloons were compared.

RESULTS

In larger dogs (groups A and B), increasing the size of the esophageal centering balloon from a 25-33 mm size did not result in an overly tight fit nor was the increase associated with significant change in the PDT effect. In contrast, increasing the balloon size to 35 mm in smaller dogs (group C) resulted in a tight fit of the balloon in the esophagus and in significant reduction in the PDT effect on mucosal damage when mucosal equivalent light dose was administered during photodynamic therapy in the canine esophageal model.

CONCLUSION

Increasing centering balloon size resulted in reduced tissue damage when mucosal equivalent light dose was administered during photodynamic therapy in the canine esophageal model. Proper sizing of centering balloons will be necessary for balloon PDT of esophageal mucosal dysplasia or cancer in humans.

The HCF repeat is an unusual proteolytic cleavage signal

The herpes simplex virus VP16-associated protein HCF is a nuclear host-cell factor that exists as a family of polypeptides encoded by a single gene. The mature HCF polypeptides are amino- and carboxy-terminal fragments of a large approximately 300-kD precursor protein that arise through cleavage at one or more centrally located sites. The sites of cleavage are the HCF repeats, highly conserved 26-amino-acid sequences repeated six times in the HCF precursor protein. The HCF repeat alone is sufficient to induce cleavage of a heterologous protein, and cleavage occurs at a defined site--PPCE/THET--within the HCF repeat. Alanine-scan mutagenesis was used to identify a large 18-amino-acid segment of the HCF repeat that is important to induce cleavage of a heterologous protein. Even though HCF is cleaved, the majority of amino- and carboxy-terminal cleavage products remain tightly, albeit noncovalently, associated. Modulation of this noncovalent association may provide a mechanism for regulating HCF activity. For example, the cleaved products of an alternative mRNA splicing variant of HCF do not remain associated.

A brief educational intervention for patients with rheumatic disease chosen to be presented in a clinic conference

Being presented in a case conference can be anxiety-provoking and intimidating for the patient. We observed that patients, at times, would show signs of apparent discomfort. A structured interview of the patient was designed to assess, address, and clarify concerns the patient might have beforehand. The patients' concerns were communicated to the staff. The structured interview was given to 31 patients before they were presented. An additional 14 patients were interviewed after the conference about their experience without the prior interview. One year later, we followed up by interviewing another 15 patients who had been selected for clinic conference cases. The structured interview revealed confusion on the patient's part about the purpose of the conference, and a desire for information about the physical setting and who would be there. Patients wanted to be introduced formally when entering the room and to be thanked when leaving, and preferred to be questioned directly about their symptoms. Of the 31 patients interviewed before the conference, 23 (74%) reported that the conference was a positive experience when questioned afterward, compared with only 9 of 14 (64%) of those who were not interviewed before the conference. The results of this study were presented to the clinic staff, and education of the patients was stressed as a primary responsibility. At the follow up, 12 of the 15 patients reported real understanding of the clinic conference purpose. The only patient who reported being uncomfortable with the clinic conference and unwilling to attend another was the only patient who reported not being informed about what the conference entailed. It can be too easy for medical staff to forget that what is routine to them is very unusual and can be very stressful to the patient.

Diminished material properties and altered bone structure in rat femora during pregnancy

Pregnancy and lactation are known to cause structural and mechanical changes in bone, but the effects of pregnancy alone have not been evaluated thoroughly. This study used radiographic measurements, torsion testing, mineral analyses, and histological evaluation to determine whether there are changes in bone material and geometric properties during pregnancy in the growing rat, as implied by earlier biochemical and histological studies. The bones of pregnant 9 to 12-week-old rats and controls that were not pregnant and were matched by age (but not weight) were evaluated at times corresponding to 5, 10, 15, and 20 days of the 23-day gestation period to address the following questions: (a) How is the growth of whole bone affected by pregnancy in the growing rat (as determined by radiographic analyses)? (b) How are the mechanical properties (structural and material) of whole bone affected by pregnancy (as assessed by torsion testing)? (c) Are there changes in the characteristics of bone mineral during pregnancy (as determined by measurement of mineral content and x-ray diffraction analyses)? and (d) Are there detectable morphological or ultrastructural differences between the bones of pregnant and control rats (as assessed by analyses based on histology and back-scattered electron imaging)? The presence of statistically significant differences in this study was determined initially on the basis of a two-factor analysis of variance. In general, significant differences were noted only at late gestation (day 20), when the bones were longer and had a greater outer radius and cortical thickness; this indicates that more growth occurred during pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Knowledge, beliefs, and behaviors among college women concerning the prevention of osteoporosis

OBJECTIVE

To assess the knowledge of osteoporosis risk factors among young women, their beliefs about the disease, and to what extent they practice preventive behaviors, such as adequate calcium intake and physical activity.

DESIGN

Cross-sectional survey.

SETTING/PARTICIPANTS

One hundred twenty-seven women (mean age, 19.6 years; 92% were white) enrolled in a required undergraduate health course at a midwestern state university.

RESULTS

One hundred fourteen (90%) of the survey respondents had heard about osteoporosis, but only 49 (43%) of the 114 had received information from either a health care provider or a school. There was a significant relationship between receiving osteoporosis information and the ability to correctly identify risk factors (P < or = .006). Only 6.7% of the women reported getting both adequate "osteoprotective" exercise per week and the recommended 1200 mg of calcium per day. Respondents believed that it was unlikely that osteoporosis would develop in them. They also expressed less responsibility and concern about osteoporosis and believed that it is less serious than other common causes of morbidity and mortality in women, such as heart disease and breast cancer (P < or = .02). There was no significant relationship between risk-factor identification and exercise habits, calcium intake, or beliefs about osteoporosis.

CONCLUSIONS

The majority of young women are not consuming the recommended daily amount of calcium and are lacking sufficient osteoprotective exercise for building healthy bone. Health care providers and educational institutions either have missed opportunities to educate young women about osteoporosis or such information has not been received and retained. Increasing levels of osteoporosis awareness may not be associated with influencing beliefs or behaviors. However, because of the importance of building an adequate bone mass in early life, our data suggest that the development and evaluation of comprehensive osteoporosis educational interventions targeted at younger women are warranted.

Mediation of Epstein-Barr virus EBNA2 transactivation by recombination signal-binding protein J kappa

The Epstein-Barr virus (EBV) transactivator protein, termed Epstein-Barr virus nuclear antigen 2 (EBNA2), plays a critical role in the regulation of latent viral transcription and in the immortalization of EBV-infected B cells. Unlike most transcription factors, EBNA2 does not bind directly to its cis-responsive DNA element but requires a cellular factor, termed C-promoter binding factor 1 (CBF1). Here, CBF1 was purified and was found to directly interact with EBNA2. CBF1 is identical to a protein thought to be involved in immunoglobulin gene rearrangement, RBPJ kappa. Contrary to previous reports, CBF1-RBPJ kappa did not bind to the recombination signal sequences but instead bound to sites in the EBV C-promoter and in the CD23 promoter.

Changes in the moment arms of the rotator cuff and deltoid muscles with abduction and rotation

The behavior of the moment arms of the rotator cuff and deltoid muscles was studied during simple and combine movements of abduction and rotation about the glenohumeral joint. This was done by experimental measurement of excursions of the muscles in an in vitro cadaver model and by use of a multiple-regression analysis to delineate the changes in the moment arms as a function of abduction and rotation. The results demonstrated the potential of some rotator cuff muscles to contribute to both abduction and rotation, the sensitivity of the abductor moment-arm lengths to internal and external rotation and of the rotator moment-arm lengths to the degree of abduction, and the capacity of the abductor moment-arm lengths of the deltoid to increase with increasing abduction. Characterization of this behavior resulted in an increased understanding of the complex role of the rotator cuff and deltoid muscles about the gleno-humeral joint and provided quantitative descriptions of functional relationships. This study demonstrates the capacity of the infraspinatus and subscapularis muscles to contribute not only to external and internal rotation, respectively, but also to elevation of the arm in the plane of the scapula, a role for which these muscles have been given little or no consideration. Furthermore, it demonstrates that the contribution of the infraspinatus to abduction is enhanced with internal rotation while that of the subscapularis is enhanced with external rotation. Thus, dysfunction of the supraspinatus muscle need not preclude good elevation of the arm, and rehabilitation to reprogram and strengthen the remaining muscles becomes an important consideration.

Strength in polymyositis and dermatomyositis: best outcome in patients treated early

OBJECTIVE

To study the influence of clinical variables on improvement in muscle strength in patients with polymyositis and dermatomyositis.

METHODS

We biomechanically examined muscle strength over the course of 2.54 years of 65 patients.

RESULTS

Disease duration before therapy was predictive of outcome. Those treated within 6 months or one year of disease onset had better outcomes than those with later treatment. In addition, among those who gained strength, degree of elevation of creatine kinase was correlated with greater gains.

CONCLUSION

Early treatment after disease onset increases the chance of a favorable response.

Lyme disease: an infectious and postinfectious syndrome

OBJECTIVE

To determine chronic morbidity and the variables that influence recovery in patients who had been treated for Lyme disease.

METHODS

Retrospective evaluation of 215 patients from Westchester County, NY, who fulfilled Centers for Disease Control case definition for Lyme disease, were anti-Borrelia antibody positive and were diagnosed and treated at least one year before our examination.

RESULTS

Erythema migrans had occurred in 70% of patients, neurological involvement in 29%, objective cardiac problems in 6%, arthralgia in 78% and arthritis in 41%. Patients were seen at a mean of 3.2 years after initial treatment. A history of relapse with major organ involvement had occurred in 28% and a history of reinfection in 18%. Anti-Borrelia antibodies, initially present in all patients, were still positive in 32%. At followup, 82 (38%) patients were asymptomatic and clinically active Lyme disease was found in 19 (9%). Persistent symptoms of arthralgia, arthritis, cardiac or neurologic involvement with or without fatigue were present in 114 (53%) patients. Persistent symptoms correlated with a history of major organ involvement or relapse but not the continued presence of anti-Borrelial antibodies. Thirty-five of the 114 (31%) patients with persistent symptoms had predominantly arthralgia and fatigue. Antibiotic treatment within 4 weeks of disease onset was more likely to result in complete recovery. Children did not significantly differ from adults in disease manifestations or in the frequency of relapse, reinfection or complete recovery.

CONCLUSION

Despite recognition and treatment, Lyme disease is associated with significant infectious and postinfectious sequelae.

Supraventricular tachyarrhythmias during total joint arthroplasty. Incidence and risk

Perioperative supraventricular tachyarrhythmias (AF/SVT) have been long recognized as a complication after major surgery, but little is known about the incidence after major nonthoracic surgery. One thousand two hundred ten consecutive patients undergoing total hip or knee arthroplasty were studied to determine the incidence of new onset AF/SVT. Information on preoperative medical history and laboratory tests were collected in a subset of 583 patients, and analyzed using logistic regression and linear analysis to determine risk. Ninety-four-and-one-half percent of patients received an epidural anesthetic, 4.1% had general anesthesia and 1.3% had spinal anesthesia. New onset AF/SVT was found in 38 of 1210 patients, representing an incidence of 3.1%. In the subset of 583 patients, the incidence was 4.8%. The only variables found to be independently associated with the perioperative development of AF/SVT were a history of atrial fibrillation, increasing age, left anterior hemi-block, and atrial premature depolarizations on the preoperative electrocardiogram. In those patients 60 years of age or older with one or more positive risk factors (13% of the study population), the incidence was 18.2%. In those patients less than 60 years of age with none of the identified risks, the incidence was 1.9%.

A musculoskeletal outreach screening, treatment, and education program for urban minority children

PURPOSE

A hospital-based outreach program was initiated to screen minority children in medically underserved areas of New York City for musculoskeletal diseases. We examine the number of such diseases in this population, and evaluate the program's success to facilitate referral and follow-up of children with referral conditions.

METHODS

Screenings were conducted at schools and day-care centers. Children requiring further evaluation were referred to the sponsoring hospital, a major referral center for musculoskeletal diseases. Bilingual educational strategies, transportation reimbursement, and coverage for uninsured children were used to foster participation and increase follow-up.

RESULTS

A total of 2,523 children were screened, 168 (6.7%) of whom were referred for one of 45 different musculoskeletal disorders, including scoliosis and back problems, foot problems, in- and out-toeing, knee or hip pain, and problems of joint range of motion. Sixty-seven percent of those referred had a follow-up medical consultation.

CONCLUSIONS

A substantial proportion of urban minority children have previously undiagnosed musculoskeletal disorders that, if left untreated, have the potential to lead to significant disability in later life. Targeted screening programs can be effective in identifying such disorders, and providing and opportunity for early diagnosis, treatment, and education.

The VP16 accessory protein HCF is a family of polypeptides processed from a large precursor protein

Upon lytic infection of permissive cells, the herpes simplex virus (HSV) transactivator protein VP16 associates with an accessory protein termed host cell factor (HCF). Binding to HCF activates VP16 for association with the octamer motif-binding protein Oct-1, to form a multiprotein-DNA complex responsible for activating transcription of the HSV immediate early genes. We show that HCF comprises a series of related polypeptides that range from 110 to 300 kd, all of which are encoded by a single gene. Although there is no obvious sequence similarity between HCF and other known proteins, HCF contains eight repeats of a new 26 amino acid motif. cDNAs encoding HCF predict a large open reading frame of 2035 codons. When expressed in human cells, this large open reading frame encodes both the 300 kd and smaller HCF polypeptides, indicating that the smaller polypeptides arise by processing of the 300 kd protein.

An organizational model for developing multidisciplinary clinical research in the academic medical center

OBJECTIVE

To assess the impact of a new organizational model designed to stimulate multidisciplinary clinical research.

METHODS

We conducted a prospective, 3 1/2-year followup of a research training program for residents, fellows, faculty, nurses, and allied health professionals in rheumatology and orthopedic surgery. Program components included a multidisciplinary clinical research conference, a clinical research methods curriculum, consultations, a patient registry, and regular meetings of a Research Methodology Core group. Measures included participation in each program component and the number of new investigators who developed funded clinical research projects.

RESULTS

The multidisciplinary clinical research conference was attended by 369 new health professionals; 218 professionals participated in at least one of the courses; and 280 consultations were provided to 108 professionals. Thirteen new investigators developed 17 new grant proposals, of which 14 were externally funded. Investigators who successfully procured funding for new projects demonstrated significantly more participation in program components compared with those who did not (P < 0.001 overall).

CONCLUSION

Participation in the program was significantly correlated with the development of new prospective patient-based studies. We conclude that our model has the potential to foster such research in other settings.

A walking education program for patients with osteoarthritis of the knee: theory and intervention strategies

Walking is an ideal physical activity for patients with osteoarthritis because it can help to improve functional status without exacerbating pain or necessitating an increase in the use of medication. Although patient education programs designed to encourage walking have become increasingly important in the management of this condition, there is no single synthesis or other published source of theory and intervention strategies to guide the practitioner in the development of such programs. This paper describes a hospital-based patient education program designed to enhance the functional capacity of who have osteoarthritis of the knee by encouraging the adoption and maintenance of walking. The paper describes the goals, objectives, process, and impact of the program; the principal theoretical model utilized in the design of the program; and how concepts and intervention strategies from the literatures on patient compliance and patient education, exercise compliance, behavioral psychology, and relapse prevention have been operationalized and integrated in a walking program that we have evaluated for safety and efficacy.

Factors affecting deep vein thrombosis rate following total knee arthroplasty under epidural anesthesia

A retrospective review was performed of 448 consecutive patients undergoing primary, unilateral, bicondylar, and cemented total knee arthroplasty under epidural anesthesia by three surgeons to determine factors contributing to deep vein thrombosis rate. All had venography on the fourth or fifth postoperative day and received aspirin and elastic stockings as their only thromboprophylaxis. The overall deep vein thrombosis rate was 41% (2% had proximal clots). The rate of deep vein thrombosis was not related to obesity, history of heart disease, hypertension, prior malignancy, smoking, diagnosis of osteoarthritis, duration of surgery, type of local anesthetic used, or the use of postoperative epidural analgesia. The rate of deep vein thrombosis varied significantly between surgeons: one surgeon had an overall deep vein thrombosis rate of 58% (proximal thrombi, 4%) whereas the other two surgeons had a deep vein thrombosis rate of 35% (proximal clot thrombi, 1%). A number of possible mechanisms to explain the variation in deep vein thrombosis rates between surgeons are provided.

Effect of a walking program on gait characteristics in patients with osteoarthritis

This paper reports the results of a study of the gait of 102 patients with osteoarthritis of the knee. Functional status was measured by a 6-min test of walking distance; the stride characteristics associated with the walk test were assessed. Stride characteristics were measured by a Stride Analyzer. Patients were randomized to an 8-week educational and walking program (the intervention group) or to a weekly telephone survey (the control group). The intervention group patients had a 15% increase in walking distance (P < 0.0001) and increases of 9.1% in stride length at free walking speeds (P < 0.007) and 17% in stride length at fast walking speeds (P < 0.01) compared to the control group. The results of this study have shown that the walking and educational program was effective in improving gait function in patients with osteoarthritis of the knee.

Effect of counselor training on skills development and psychosocial status of volunteers with systemic lupus erythematosus

Volunteers with systemic lupus erythematosus were recruited for a telephone service to provide psychosocial support to peers. The volunteers attended an 8-week counselor training program. The aim was to evaluate the impact of the training on counselors' skill development and to record possible changes in the counselors' psychosocial status. A second group of trainees (n = 15) was used as a delayed control for the first group (n = 14). The data were analyzed using multivariate repeated measures analysis of variance. Tests chosen to monitor psychosocial status included: Arthritis Impact Measurement Scales Anxiety and Depression subscales, Arthritis Helplessness Index, Wallston General Self-Efficacy Scale, University of California at Los Angeles Loneliness Scale, Rosenberg Self-Esteem, and Campbell Personal Competence scales. Tests selected to measure skills and knowledge.