Total Synthesis of (±)-Aspidospermidine, (±)-Aspidofractinine, (±)-Limaspermidine, and (±)-Vincadifformine via a Cascade and Common Intermediate Strategy

A concise strategy for the total synthesis of several Aspidosperma alkaloids is reported. A Suzuki-Miyaura cross-coupling provides access to a 2-vinyl indole that undergoes a Diels-Alder cascade reaction with butyn-2-one to deliver a pyrroloindoline intermediate. This undergoes cascade amidation, reduction, skeletal rearrangement, and intramolecular Michael addition to provide a common intermediate containing the full framework of the Aspidosperma alkaloids. The utility of this intermediate is shown in the synthesis of four different natural products.

Discovery of GSK251: A Highly Potent, Highly Selective, Orally Bioavailable Inhibitor of PI3Kδ with a Novel Binding Mode

Optimization of a previously reported lead series of PI3Kδ inhibitors with a novel binding mode led to the identification of a clinical candidate compound 31 (GSK251). Removal of an embedded Ames-positive heteroaromatic amine by reversing a sulfonamide followed by locating an interaction with Trp760 led to a highly selective compound 9. Further optimization to avoid glutathione trapping, to enhance potency and selectivity, and to optimize an oral pharmacokinetic profile led to the discovery of compound 31 (GSK215) that had a low predicted daily dose (45 mg, b.i.d) and a rat toxicity profile suitable for further development.

Selective CDK6 degradation mediated by cereblon, VHL, and novel IAP-recruiting PROTACs

Inhibitors of CDK4 and CDK6 have emerged as important FDA-approved treatment options for breast cancer patients. The properties and pharmacology of CDK4/6 inhibitor medicines have been extensively profiled, and investigations into the degradation of these targets via a PROTAC strategy have also been reported. PROTACs are a novel class of small-molecules that offer the potential for differentiated pharmacology compared to traditional inhibitors by redirecting the cellular ubiquitin-proteasome system to degrade target proteins of interest. We report here the preparation of palbociclib-based PROTACs that incorporate binders for three different E3 ligases, including a novel IAP-binder, which effectively degrade CDK4 and CDK6 in cells. In addition, we show that the palbociclib-based PROTACs in this study that recruit different E3 ligases all exhibit preferential CDK6 vs. CDK4 degradation selectivity despite employing a selection of linkers between the target binder and the E3 ligase binder.

Discovery of an Orally Bioavailable Pan αv Integrin Inhibitor for Idiopathic Pulmonary Fibrosis

The heterodimeric transmembrane αv integrin receptors have recently emerged as potential targets for the treatment of idiopathic pulmonary fibrosis. Herein, we describe how subtle modifications of the central aromatic ring of a series of phenylbutyrate-based antagonists of the vitronectin receptors αvβ3 and αvβ5 significantly change the biological activities against αvβ6 and αvβ8. This resulted in the discovery of a pan αv antagonist (compound 39, 4-40 nM for the integrin receptors named above) possessing excellent oral pharmacokinetic properties in rats (with a clearance of 7.6 mL/(min kg) and a bioavailability of 97%).

Targeting IRAK4 for Degradation with PROTACs

Interleukin-1 Receptor-Associated Kinase 4 (IRAK4) is a key mediator of innate immunity. IRAK4 overactivation is linked with several autoimmune diseases. To date, many IRAK4 inhibitors have been developed to block the protein's kinase activity with the most advanced reaching Phase II clinical trials. Nevertheless, several reports suggest kinase activity is not disease-relevant in certain cell types, so removing scaffolding signaling in addition to IRAK4 kinase activity may offer a better therapeutic outcome. Herein, we describe the design and synthesis of an IRAK4 Proteolysis Targeted Chimera (PROTAC). We show that IRAK4 degradation induced by compound 9 leads to the inhibition of multiple cytokines in PBMCs. However, in IL-1β stimulated human dermal fibroblasts, inhibition of IL-6 and TNF-α release was not observed despite IRAK4 degradation. Nonetheless, the possibility of targeting both IRAK4 kinase and scaffolding function could potentially lead to new therapeutic opportunities to treat autoimmune, inflammatory, and oncological diseases.

Discovery of ( S)-3-(3-(3,5-Dimethyl-1 H-pyrazol-1-yl)phenyl)-4-(( R)-3-(2-(5,6,7,8-tetrahydro-1,8-naphthyridin-2-yl)ethyl)pyrrolidin-1-yl)butanoic Acid, a Nonpeptidic αvβ6 Integrin Inhibitor for the Inhaled Treatment of Idiopathic Pulmonary Fibrosis

A series of 3-aryl(pyrrolidin-1-yl)butanoic acids were synthesized using a diastereoselective route, via a rhodium catalyzed asymmetric 1,4-addition of arylboronic acids in the presence of ( R)-BINAP to a crotonate ester to provide the ( S) absolute configuration for the major product. A variety of aryl substituents including morpholine, pyrazole, triazole, imidazole, and cyclic ether were screened in cell adhesion assays for affinity against α_vβ₁, α_vβ₃, α_vβ₅, α_vβ₆, and α_vβ₈ integrins. Numerous analogs with high affinity and selectivity for the α_vβ₆ integrin were identified. The analog ( S)-3-(3-(3,5-dimethyl-1 H-pyrazol-1-yl)phenyl)-4-(( R)-3-(2-(5,6,7,8-tetrahydro-1,8-naphthyridin-2-yl)ethyl)pyrrolidin-1-yl)butanoic acid hydrochloride salt was found to have very high affinity for α_vβ₆ integrin in a radioligand binding assay (p K_i = 11), a long dissociation half-life (7 h), very high solubility in saline at pH 7 (>71 mg/mL), and pharmacokinetic properties commensurate with inhaled dosing by nebulization. It was selected for further clinical investigation as a potential therapeutic agent for the treatment of idiopathic pulmonary fibrosis.

Chemoselective One-Pot Synthesis of Functionalized Amino-azaheterocycles Enabled by COware

Functionalized bicyclic amino-azaheterocycles are rapidly accessed in a one-pot cross-coupling/reduction sequence enabled by the use of COware. Incompatible reagents are physically separated in a single reaction vessel to effect two chemoselective transformations-Suzuki-Miyaura cross-coupling and heteroarene reduction. The developed method allows access to novel heterocyclic templates, including semisaturated Hedgehog and dual PI3K/mTOR inhibitors, which show enhanced physicochemical properties compared to their unsaturated counterparts.

Chemoselective oxidation of aryl organoboron systems enabled by boronic acid-selective phase transfer

We report the direct chemoselective Brown-type oxidation of aryl organoboron systems containing two oxidizable boron groups. Basic biphasic reaction conditions enable selective formation and phase transfer of a boronic acid trihydroxyboronate in the presence of boronic acid pinacol (BPin) esters, while avoiding speciation equilibria. Spectroscopic investigations validate a base-promoted phase-selective discrimination of organoboron species. This phenomenon is general across a broad range of organoboron compounds and can also be used to invert conventional protecting group strategies, enabling chemoselective oxidation of BMIDA species over normally more reactive BPin substrates. We also demonstrate the selective oxidation of diboronic acid systems with chemoselectivity predictable a priori. The utility of this method is exemplified through the development of a chemoselective oxidative nucleophile coupling.

Synthesis and determination of absolute configuration of a non-peptidic αvβ6 integrin antagonist for the treatment of idiopathic pulmonary fibrosis

Integrin inhibitor (cell adhesion assays) pIC₅₀ α_vβ₆ = 8.4, α_vβ₃ = 6.0, α_vβ₅ = 5.9 and α_vβ₈ = 7.7.

A Second Spore Stage Confirmed for Apioplagiostoma populi, the Causal Agent of Bronze Leaf Disease of Populus in Minnesota

Bronze leaf disease (BLD) affects several Populus species in North America but is particularly damaging to hybrids in section Populus (4). BLD, caused by the fungus Apioplagiostoma populi (syn. Plagiostoma populi) described by Cash and Waterman (1), takes its name from the characteristic dark purple to brown pigmentation of infected leaves. A. populi has not been cultured on artificial media either from diseased tissues or cast ascospores. An anamorph has not been conclusively identified but spores from blister-like acervuli on symptomatic leaves have been suggested to function as spermatia (3). In an attempt to describe the imperfect stage of A. populi, collections of diseased leaves of P. alba × sieboldii and P. alba × grandidentata'Crandon' growing in a plantation near Rosemount, MN, were made on September 14, 2011 (leaves attached to shoots, rolled inward), October 12, 2011 (leaves attached or on the ground, tightly rolled inward), and November 1, 2011 (most leaves on the ground), and examined in the laboratory for fungal development. Leaf laminae from the September 14 collection were uniformly covered with erumpent, subcuticular blister-like acervuli on the adaxial surface only, containing unicellular, colorless spores ranging in size from 2.2 to 10.0 × 2.0 to 5.0 μm (mean 3.6 × 6.2 μm) (n = 100). Attempts to germinate and obtain cultures from these spores on common artificial media were unsuccessful. On leaves collected October 12, the blister-like acervuli were predominantly empty or releasing spores and immature perithecia of A. populi were present. Leaves collected on November 1 contained immature perithecia but were heavily colonized by surface saprophytic fungi and no intact blister-like acervuli were present. DNA was extracted from bulked samples of spores removed from the blister-like acervuli in leaves from multiple trees collected on September 14 using the DNeasy Plant Mini Kit (Qiagen Sciences, Germantown, MD). The internal transcribed spacer (ITS2) region of rDNA was PCR amplified and sequenced with primers ITS3 and ITS4. BLASTn searches revealed that sequences from three independent bulked samples were homologous (99% identity, 353 of 355 nucleotides) to A. populi from isolated perithecia (GenBank Accession No. GU205341) (2). The inability of the spores to germinate, the timing of their development and release, and the tight, inward roll of infected leaves facilitating their spread across the upper leaf surface suggest that these spores function as spermatia in the life cycle of A. populi and the blister-like acervuli in which they develop are spermogonia. References: (1) E. K. Cash and A. M. Waterman. Mycologia 49:756, 1957. (2) L. M. Kawchuk et al. Plant Disease 94:377, 2010. (3) W. A. Sinclair and H. H. Lyon, Comstock Publishing Associates, Cornell University Press, Ithaca, NY, 2005. (4) J. A. Smith et al. Plant Disease 86:462, 2002.

Etiology of Bronze Leaf Disease of Populus

Bronze leaf disease is a potentially destructive disorder of the Populus section of the genus Populus. The causal agent has been reported to be Apioplagiostoma populi (anamorph: Discula sp.). Based on etiological and symptomological studies, field observations of symptom development suggest that the pathogen moves systemically in the host. This was verified by graft experiments where symptoms progressed from the scion into the elongating stem. A bronze-pigmented vascular discoloration was observed in symptomatic leaves and branches. Dieback of affected stems also was common. Spore-trap studies elucidated the timing and necessary weather conditions of A. populi ascospore dispersal in relation to infection and symptom development. Exposure-tree experiments revealed that ascospores of A. populi are the primary inoculum and resulting infection causes distinctive disease symptoms on affected trees. Perithecia of A. populi were observed on overwintered symptomatic leaves, but were not observed on asymptomatic leaves. Acervular conidiomata were observed on symptomatic leaves during August and September. Although A. populi ascospores germinated in vitro, A. populi was not recovered from symptomatic tissue. Isolations from diseased leaves consistently yielded Epicoccum nigrum, but the role of this species is unclear. Inoculations of susceptible plants with E. nigrum conidia failed to reproduce symptoms, but inoculations with ascospores of A. populi produced symptoms typical of bronze leaf disease and Koch's postulates were performed.

Melampsora Leaf Rust of Willow Causing a Stem Canker in Minnesota

In June 2000, during a routine examination of native willow (Salix sp.) growing in northwestern Minnesota, several plants were observed with multiple stem cankers. The cankers, some reaching 6 cm in length, were found on 1- to 3-year-old wood. Within the canker, the bark was blistered in several areas, exposing urediniospores averaging 15 × 24 μm. Although all North American willow leaf rusts are now included in the collective species Melampsora epitea, the spores fit the description of M. paradoxa (syn. M. bigelowii) (1). While evidence of previous sporulating cankers was present on older wood, no symptoms of leaf rust were present on the foliage in the area. Similarly, evidence of overwintering of M. bigelowii on young willow stems has been reported in Michigan (2). Willow species and cultivars used in biomass plantings need to be screened for rust resistance to local rust populations as the presence of a leaf rust infecting stems could become damaging to cultivated willow. For this reason, revision of the willow rust species and determination of their distribution and host range should be undertaken. References: (1) J. C. Arthur. 1962. Manual of the Rusts in United States and Canada, Hafner Publishing, New York. (2) J. R. Weir and E. E. Hubert. Phytopathology 8:55, 1918.

Wound response characteristics as related to phenylpropanoid enzyme activity and lignin deposition in resistant and susceptible Populus tremuloides inoculated with Entoleuca mammata (Hypoxylon mammatum)

Green internodal stem tissues of glasshouse grown Populus tremuloides were either wounded or wound-inoculated with Entoleuca mammata (Hypoxylon mammatum) and assayed for phenylalanine ammonia-lyase (PAL), caffeic acid - o-methyltransferase (CA-OMT), and cinnamyl - alcohol dehydrogenase (CAD) activity over a 96-h period. Lignin deposited in response to the treatments was analyzed by the Klason and the pyrolysis - gas chromatographic (GC) - mass spectroscopy (MS) methodologies. The wound-inoculated treatment resulted in a wound morphology congruent with a typical resistant and susceptible response to E. mammata. Wounding alone resulted in no morphological differences between the two genotypes. In wound-inoculated stem tissue PAL and CAD activities were substantially higher in the resistant relative to the susceptible genotype. Total Klason lignin was similar for both genotypes; however, pyrolysis-GC-MS analysis revealed a difference in the lignin monomeric composition between the two genotypes, with the susceptible genotype accumulating higher levels of hydroxyphenyl units relative to the resistant genotype. It is concluded that differences in PAL and CAD activity and the synthesis of distinct phenylpropanoid monomers distinguish the resistant from the susceptible aspen genotype. Alterations in boundary zone formation due to the differential synthesis of phenylpropanoid monomers and its effect on compartmentalization of the pathogen are discussed.Key words: aspen, Hypoxylon canker, phenylalanine ammonia-lyase, cinnamyl - alcohol dehydrogenase, caffeic acid - o-methyltransferase, disease resistance.

A prospective randomized study of three types of platelet concentrates in patients with haematological malignancy: corrected platelet count increments and frequency of nonhaemolytic febrile transfusion reactions

We prospectively randomized 51 patients with haematological malignancy requiring platelet concentrates (PCs) to receive either single donor platelet-pheresis products (SD-PC), PCs made from pooled buffy coats (BC-PC) or pooled units of platelets made by the platelet-rich plasma method (PRP-PC). The leucocyte content of each type of PC was 0.33 (0.03-13.5), 5.68 (0.19-99.0) and 365 (65-910) x 10(6); median (range), respectively; P < 0.0001. All red cell transfusions were leucodepleted by filtration. Statistical comparison of the probability of the occurrence of a nonhaemolytic febrile transfusion reaction (NHFTR) following transfusion of PCs in patients in each group showed a significant decrease for the SD-PC and BC-PC groups (0.031 and 0.038, respectively) when compared with PRP-PC (0.171); P = 0.0001. The actual corrected platelet count increments (CCI) at 1-6 and 18-24 h post-transfusion for all three types of PC did not differ significantly. We conclude that transfusion of PRP-PC is associated with a significant increase in NHFTR.

Haemolytic disease of the newborn due to anti-G

Mrs P. presented at 13 weeks of gestation with apparent anti-C+D. At week 34, with antibody levels of 168 IU/ml, a D-negative (r'r) baby was delivered with a strongly positive DAT and an Hb of 3.0 g/dl. Anti-G in maternal serum was isolated by adsorption and elution from R2R2 cells and shown, using flow-cytometric and chemiluminescence assays, to sensitize r'r cells at levels of cell-bound IgG consistent with fetal haemolysis. In an analysis of 28 sera from alloimmunized women with over 5 IU/ml anti-C+D, 2 sera were shown to contain levels of anti-G consistent with moderate or severe haemolytic disease of the newborn (HDN). Thus HDN due to anti-G may not be rare. An analysis of 187,037 blood donors in the south-west of England showed the r' gene frequency to be 0.005897 suggesting that approximately 2.9% of matings of rr women with D-negative fathers can produce an r'r baby. These findings highlight the need for the continuous non-invasive monitoring of D-negative fetuses of women with apparent anti-C+D.

Reproducibility of Bayesian belief network assessment of breast fine needle aspirates

OBJECTIVE

To assess the consistency of diagnosis of fine needle aspiration biopsies of breast lesions by three experienced and five less experienced pathologists using conventional means and applying a Bayesian belief network (BBN) to 10 diagnostic features to support diagnostic decision making.

STUDY DESIGN

Forty fine needle aspiration biopsies, previously assessed by one of the experienced pathologists both conventionally and using a BBN, were assessed by two further experienced pathologists and five less experienced pathologists.

RESULTS

Using the BBN, the experienced pathologists arrived at diagnoses in agreement with an established consensus at a slightly lower rate than by conventional means. The less experienced pathologists arrived at the correct diagnoses no more frequently with the help of the BBN than conventionally.

CONCLUSION

As used in this study, the BBN did not help less experienced pathologists to interpret their observations but did not enable less experienced pathologists to identify how their observations differed and affected their diagnoses. The prototype system used in this study has since been upgraded by providing computer graphic displays of the features to be observed so that a more uniform mental image can be held by the participating pathologists. This will be tested with the same study design.

Immediate and long-term results following repair of aortic left ventricular discontinuity: a 25-year experience

From 1967 to 1993, 21 patients underwent surgical repair of aortic left ventricular discontinuity as a result of acute bacterial endocarditis. Repair of the defect between the aorta and left ventricle was usually with interposition of a patch (prosthetic patch or autologous pericardium), using a continuous monofilament suture. Interrupted pledgetted stitches were used when the ventricular tissue appeared friable. A valve prosthesis was then sewn to the patch and remaining annulus. Three patients died in the immediate perioperative period. Long follow-up ranging from 5 to 142 months (mean 36 months) is available on 17 of 18 survivors. There were six deaths in this group from 11 to 142 months (mean 67 months) from initial surgery. Of 11 long-term survivors (5 to 61 months (mean 21 months) after operation), nine have had event-free courses. Two cases of recurrent subacute bacterial endocarditis occurred 3 and 52 months after surgery in patients who were intravenous drug abusers, both of whom were managed medically. It is concluded that while aortic left ventricular discontinuity remains a potentially lethal complication of acute bacterial endocarditis, débridement of infected necrotic tissue, patch repair of the defect, and prosthetic valve replacement offer satisfactory immediate and late results.

Faculty practice: creating a new culture

This article provides specifics on the development of a clinical track for faculty appointments at the University of Pittsburgh. The criteria to be used for appointment and promotion on the clinical track are discussed along with the practice requirements of 60 hours per term of participation in and responsibility for direct care of patients. The purposes of faculty practice are set forth along with the formation and functioning of a Faculty Practice Council which handles decisions related to faculty practice. Results of the first year after implementation of a clinical track showed that 64 per cent (18) of the faculty had met all of their faculty practice obligations; of the remaining 36 percent (10) who had not, a variety of circumstances were cited. The Income to the School of Nursing for faculty practice, although modest, has helped to highlight that practice is valued and an integral part of the faculty role.

Hepatitis C (HCV)-positive blood donors in south-west England: a case control study

The aim of this study was to compare the socio-demographic characteristics and risk factors in anti-HCV positive blood donors with those of matched controls. The participants were 50 hepatitis C antibody (HCV) positive blood donors and 50 matched blood donors with no evidence of HCV infection, who gave blood to the South Western Transfusion Centre between November 1991 and July 1992. A confidential structured interview was conducted to collect socio-demographic data and to elicit information on risk factors for HCV. Measurements were made of the prevalence of risk factors and socio-demographic characteristics in cases and controls. The main results were that 45 of the 50 cases could have been exposed to HCV by previous intravenous drug abuse (IVDA), blood transfusion or medical employment. Cases were significantly more likely to have a history of IVDA, tattooing or of medical employment than matched controls. Cases with no history of IVDA were significantly more likely to have had a blood transfusion. The key conclusions to emerge are that current policies are ineffective at excluding those with a history of IVDA from the donor pool. Consideration should be given to the introduction of a policy of direct confidential questioning about risk factors for all donors, or, at a minimum, the use of a questionnaire.

U.K. multicentre study on blood donors for surrogate markers of non-A non-B hepatitis. Part I: Alanine transferase and anti-HBc testing

Blood samples from 9,215 blood donors in three U.K. centres (North London, Bristol and Manchester) were tested for their alanine aminotransferase (ALT) level and the presence of anti-HBc and anti-HCV. This paper presents the results of the ALT and anti-HBc tests. The prevalence of ALT > 45 IU/l was 3.1% overall (North London 3.06%, Bristol 4.56% and Manchester 1.97%). Manchester results were skewed by the methodology used for ALT measurement, highlighting the need for standard test methods. Anti-HBc was detected using the Wellcome enzyme-immunosorbent assay (EIA) and confirmatory testing was performed using a radioimmunoassay (RIA) and the Corecell haemagglutination assay. Repeat reactive rates were 0.9, 0.79 and 0.94% for North London, Bristol and Manchester, respectively, with an overall rate of 0.9%. The confirmed positive rate was 0.73, 0.53 and 0.65% for the three centres with an overall rate of 0.63%. Donors with an ALT > 45 IU/l, or with confirmed anti-HBc, were interviewed with a medical questionnaire for risk factors. The major contributing factors in donors with a raised ALT were alcohol consumption and obesity.

Comparison of platelet-rich plasma collection using the Haemonetics PCS and Baxter Autopheresis C

We have compared 118 platelet-rich plasma donations collected using the Autopheresis-C Platelet cell (Auto C) with 166 donations using the Haemonetics PCS. The median platelet yield from the Auto C was superior (2.51 vs. 1.54 x 10(11] although collection times differed (60 vs./40 min). There was greater variability in the platelet yield from the Auto C (0.45-5.6 vs./0.26-2.8 x 10(11], but leucocyte contamination was not significantly different. After secondary processing, there was significantly less residual platelet-poor plasma (272 vs. 369 ml). Platelet function assessed during 5 days of storage was satisfactory for both, although platelet aggregation responses to collagen and adenosine diphosphate were superior in the Auto C platelets.

Plasma exchange in the treatment of Guillain-Barré syndrome: experience in a sub-regional referral centre

Plasma exchange became popular in the treatment of Guillain-Barré syndrome with the publication in 1985 of results by the Guillain-Barré Study Group. Since then we have treated 24 patients referred for plasma exchange. We have audited their outcome and compared this with the results of patients in the treatment arm of the USA Study. Our patients were of comparable age and clinical severity and had similar duration of illness before starting plasma exchange. Nine of our patients required ventilation for a median of 24 days. The median time to improve one clinical grade was 19 days which compared well with the Study Group results. We have shown that plasma exchange may be safely performed in a district general hospital in a setting appropriate to the patient's clinical condition. We concur with the central conclusion of the Study, that if treatment is started early in the disease, the patient's outcome is improved.

Bone marrow processing on the Haemonetics V50 cell separator

We have processed 27 bone marrow (BM) harvests using the Haemonetics V50 cell separator with a paediatric plasmapheresis set and programmed for lymphocyte collection. The mean starting volume of 843 mL was processed in 6-8 cycles to a buffy coat (BC) with a mean volume of 230 mL. The mean starting mononuclear cell (MNC) count was 1.22 x 10 8/kg recipient weight, and recovery was 92%. Clonogenic potential of the BC was assessed using CFU-GM assays and recovery was measured after cryopreservation or purging. On 4 occasions where major ABO incompatibility existed between donor and recipient, both BM and BC were consecutively diluted in compatible blood and processed twice. This achieved a calculated reduction in donor erythrocytes of 98%. The procedure was efficient and yielded a BC fraction suitable for cryopreservation and purging. Adequate stem-cells were retained as verified by CFU-GM assays and documentation of stable engraftment.

Social network advice during pregnancy: myths, misinformation, and sound counsel

One hundred eighty-five low-income, inner-city women were interviewed after they gave birth. They were allowed to report on up to 30 members of their social networks, including household members, relatives, and friends. Questions were asked regarding the types and nature of health advice given to them by these individuals, the relationship of each advisor, and his or her age and sex. Respondents received between 0 and 211 (median 20) pieces of advice related to pregnancy health from 0 to 19 (median 5) members of their social networks. Both folk beliefs and information aligned with accepted medical views of health promotion were communicated to individual women. Most advice rendered was sound, but often the rationale for the recommended health action was poorly understood. Some respondents received advice that, if followed, could be harmful to health. This suggests that for some low-income, inner-city women, social networks serve as important resources for health information. However, the advice they convey may cause unnecessary worry or come into conflict with recommendations of health care providers. Therefore, new educational strategies are required to address the informational needs not just of individual women, but of their social networks as well.

Spontaneous remission and relapse in adult T cell lymphoma/leukaemia associated with HTLV-I

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Nursing concerns and hospital product sterilization

Nurses and other health care professionals must be aware of the rationale and methodology for in-hospital health care product standardization, including consideration of the hospital standardization committee composition, pilot-study prerequisites, and general evaluation criteria. They must be familiar with the techniques of product sterilization, their effectiveness, and the materials required to maintain sterile product shelf-life until a product is used. Hospital standardization committees can assist in the product-use decisionmaking process. Product evaluation criteria should include considerations pertaining to cost, quality, service, and comparison to similar products.