Preclinical development of 1B7/CD3, a novel anti-TSLPR bispecific antibody that targets CRLF2-rearranged Ph-like B-ALL

Patients harboring CRLF2-rearranged B-lineage acute lymphocytic leukemia (B-ALL) face a 5-year survival rate as low as 20%. While significant gains have been made to position targeted therapies for B-ALL treatment, continued efforts are needed to develop therapeutic options with improved duration of response. Here, first we have demonstrated that patients with CRLF2-rearranged Ph-like ALL harbor elevated thymic stromal lymphopoietin receptor (TSLPR) expression, which is comparable with CD19. Then we present and evaluate the anti-tumor characteristics of 1B7/CD3, a novel CD3-redirecting bispecific antibody (BsAb) that co-targets TSLPR. In vitro, 1B7/CD3 exhibits optimal binding to both human and cynomolgus CD3 and TSLPR. Further, 1B7/CD3 was shown to induce potent T cell activation and tumor lytic activity in both cell lines and primary B-ALL patient samples. Using humanized cell- or patient-derived xenograft models, 1B7/CD3 treatment was shown to trigger dose-dependent tumor remission or growth inhibition across donors as well as induce T cell activation and expansion. Pharmacokinetic studies in murine models revealed 1B7/CD3 to exhibit a prolonged half-life. Finally, toxicology studies using cynomolgus monkeys found that the maximum tolerated dose of 1B7/CD3 was ≤1 mg/kg. Overall, our preclinical data provide the framework for the clinical evaluation of 1B7/CD3 in patients with CRLF2-rearranged B-ALL.

In vivo peptide-based delivery of a gene-modifying enzyme into cells of the central nervous system

We report on the successful delivery of the Cre recombinase enzyme in the neural cells of mice in vivo by simple coinjection with peptides derived from HIV-TAT. Cre delivery activates the expression of a reporter gene in both neurons and astrocytes of the cortex without tissue damage and with a transduction efficiency that parallels or exceeds that of a commonly used adeno-associated virus. Our data indicate that the delivery peptides mediate efficient endosomal leakage and cytosolic escape in cells that have endocytosed Cre. The peptides, therefore, act in trans and do not require conjugation to the payload, greatly simplifying sample preparation. Moreover, the delivery peptides are exclusively composed of natural amino acids and are consequently readily degradable and processed by cells. We envision that this approach will be beneficial to applications that require the transient introduction of proteins into cells in vivo.

Secondary prevention of coronary artery disease in patients undergoing elective surgery for peripheral arterial disease

The purpose of the study was to assess the implementation of secondary prevention guidelines of coronary artery disease (CAD) in patients undergoing peripheral revascularization surgery. The design was a descriptive study of the prevalence of cardiac risk factors and preventive pharmacological therapy in vascular surgical patients set in an academic medical center between July 1996 and February 1999. A total of 237 patients were recruited, 82 (35%) having carotid surgery and 155 (65%) having lower extremity bypass. Data were collected from an existing database of a study examining perioperative cardiac events in vascular surgery patients. The majority of patients were hypertensive and 58% of patients had a blood pressure.140/90 mmHg. Most patients (81%) reported a history of tobacco use and 23% were active smokers. Of the 41% of patients who were diabetic, 46% had a random glucose .140 mg/dl. Half of the patients took aspirin, 35% a lipid-lowering medication, 30% a beta-blocker. Patients with lower extremity disease were less likely than patients with carotid disease to be on aspirin (45% vs. 62%), a lipid-lowering agent (30% vs. 45%), or a beta-blocker (26% vs. 39%) (all p,0.05). Of patients with heart disease, more men than women were on aspirin (62% vs. 45%) (p,0.05). In conclusion, our findings suggest that patients presenting for vascular surgery have a high prevalence of modifiable CAD risk factors that are not being adequately managed. Preoperative examination of vascular patients is an important opportunity to assess and implement neglected secondary prevention measures.

Socioeconomic status is associated with frailty: the Women's Health and Aging Studies

BACKGROUND

Frailty is a common risk factor for morbidity and mortality in older adults. Although both low socioeconomic status (SES) and frailty are important sources of vulnerability, there is limited research examining their relationship. A study was undertaken to determine (1) the extent to which low SES was associated with increased odds of frailty and (2) whether race was associated with frailty, independent of SES.

METHODS

A cross-sectional analysis of the Women's Health and Aging Studies using multivariable ordinal logistic regression modelling was conducted to estimate the relationship between SES measures and frailty status in 727 older women. Control variables included race, age, smoking status, insurance status and co-morbidities.

RESULTS

Of the sample, 10% were frail, 46% were intermediately frail and 44% were robust. In adjusted models, older women with less than a high school degree had a threefold greater odds of frailty compared with more educated individuals. Those with an annual income of less than $10 000 had two times greater odds of frailty than wealthier individuals. These findings were independent of age, race, health insurance status, co-morbidity and smoking status. African-Americans were more likely to be frail than Caucasians (p<0.01). However, after adjusting for education, race was not associated with frailty. The effect of race was confounded by socioeconomic position.

CONCLUSIONS

In this population-based sample, the odds of frailty were increased for those of low education or income regardless of race. The growing population of older adults with low levels of education and income renders these findings important.

Allostatic load and frailty in the women's health and aging studies

BACKGROUND

Frailty involves decrements in many physiologic systems, is prevalent in older ages, and is characterized by increased vulnerability to disability and mortality. It is yet unclear how this geriatric syndrome relates to a preclinical cumulative marker of multisystem dysregulation. The purpose of this study was to evaluate whether allostatic load (AL) was associated with the geriatric syndrome of frailty in older community-dwelling women.

METHODS

We examined the cross-sectional relationship between AL and a validated measure of frailty in the baseline examination of two complementary population-based cohort studies, the Women's Health and Aging studies (WHAS) I and II. This sample of 728 women had an age range of 70-79. We used ordinal logistic regression to estimate the relationship between AL and frailty controlling for covariates.

RESULTS

About 10% of women were frail and 46% were prefrail. AL ranged from 0 to 8 with 91% of participants scoring between 0 and 4. Regression models showed that a unit increase in the AL score was associated with increasing levels of frailty (OR = 1.16, 95% CI = 1.04-1.28) controlling for race, age, education, smoking status, and comorbidities.

CONCLUSION

This study suggests that frailty is associated with AL. The observed relationship provides some support for the hypothesis that accumulation of physiological dysregulation may be related to the loss of reserve characterized by frailty.

First Report of Iris yellow spot virus on Onion in Canada

Iris yellow spot virus (IYSV; family Bunyaviridae, genus Tospovirus) is an economically important viral pathogen of onion vectored by onion thrips (Thrips tabaci Lindeman). Rapid spread of IYSV has occurred in the western United States and Georgia, with recent reports of IYSV from New York in the northeastern United States (1). In June and mid-July of 2007, symptomatic plants were found in Ontario, Canada in onions grown from sets in a home garden in Grey County (44°27'N, 80°53'W) and on a small commercial farm in Ottawa-Carleton County (45°14'N, 75°28'W), respectively. In the home garden, bleached, elongated lesions with tapered ends occurred on middle-aged leaves of 30% of 100 plants. By August 2007, 91% of these plants were symptomatic. In Ottawa-Carleton, two lesions with green centers and yellow borders occurred on a single leaf of a single plant in a field of 1,120 plants. Symptomatic leaf tissue tested positive for IYSV by IYSV-specific antiserum from Agdia Inc. (Elkhart, IN) in a double-antibody sandwich (DAS)-ELISA. These two isolated and remote finds of IYSV in Ontario prompted a survey in early August of 2007 of the Holland Marsh (44°5'N, 79°35'W), the largest onion-producing region in Ontario. Nine onion fields separated geographically across the Holland Marsh Region were scouted and one to three samples of symptomatic tissue per field were analyzed by DAS-ELISA. IYSV was confirmed in seven of nine (78%) fields surveyed and in 13 of 16 (81%) of the individual samples. A reverse transcription (RT)-PCR assay was used to verify the presence of IYSV in one new symptomatic tissue sample per field collected from three of the fields where IYSV was confirmed by ELISA. Primers specific to the small (S) RNA of IYSV (5'-TAA AAC AAA CAT TCA AAC AA-3' and 5'-CTC TTA AAC ACA TTT AAC AAG CAC-3') were used (2). The resulting 1.2-kb amplicon, which included the 772-bp nucleocapsid (N) gene was cloned and sequenced. Sequence analysis showed that the N gene of the Ontario isolate (GenBank Accession No. EU287943) shared 92 to 98% nucleotide sequence identity with known IYSV N gene sequences. The highest nucleotide sequence identity (98%) was with Genbank Accession Nos. DQ233475 and DQ233472. To our knowledge, this is the first report of IYSV infection of onion in Ontario and Canada. This finding confirms further spread of the virus within North America and the need for research to develop more effective management options to reduce the impact of IYSV on onion production. The finding of IYSV in remote and isolated locations where onions were grown from sets implies that the spread of IYSV via infected bulbs warrants further investigation as a potentially important route of distribution of the virus. References: (1) D. H. Gent et al. Plant Dis. 88:446, 2004. (2) H. R. Pappu et al. Arch. Virol. 151:1015, 2006.

Improving compliance in your dyslipidemic patient: an evidence-based approach

PURPOSE

To synthesize the evidence from landmark clinical studies of lipid-lowering pharmacotherapy and nurse management of hyperlipidemia, discuss issues related to nonadherence, and proposes strategies for achieving long-term cholesterol control.

DATA SOURCES

All publications of lipid-lowering clinical trials related to pharmacotherapy for dyslipidemias were accessed from a thorough Medline Search and reviewed by two nurse experts.

CONCLUSIONS

Randomized controlled studies provide compelling evidence that reduction of blood cholesterol with pharmacotherapy reduces both first and subsequent coronary events. Nonetheless, inadequate provider and patient adherence to guidelines for lipid lowering remains prevalent. Studies show that nurses provide safe and effective care for patients with abnormal lipids.

IMPLICATIONS

This article assists nurse practitioners in playing an active role in the implementation of the National Cholesterol Education Program Adult Treatment Panel III Report to be released in Spring 2001, where a strong emphasis will be placed on multidisciplinary approaches and adherence.

Global risk assessment for lipid therapy to prevent coronary heart disease

Randomized clinical trials have established that lipid- lowering pharmacologic therapy can substantially reduce morbidity and mortality in patients with known coronary artery disease (CAD). Researchers are now working to define the role of lipid-lowering agents in the primary prevention of CAD to extend their benefit to patients at increased risk for future coronary events. The risk assessment models presently used for secondary prevention are not sufficient to identify high-risk, asymptomatic patients. Building on the accumulated data about the physiologic mechanisms and metabolic factors that contribute to CAD, novel serum markers and diagnostic tests are being critically studied to gauge their utility for the assessment of high-risk patients and occult vascular disease. New risk prediction models that combine traditional risk factors for CAD with the prudent use of new screening methods will allow clinicians to target proven risk reduction therapies at high-risk patients before they experience a cardiac event.

Genetics and cardiovascular disease

The traditional risk factors associated with the development of cardiovascular disease (CVD) account for approximately 50% of the variability in the risk for developing heart disease. Research in the genetic basis of CVD has helped scientists begin to quantify the nature of the additional unexplained variance. CVD may result from a variety of genetic causes, including single-gene mutations, the combined effect of more than one mutation, and the interaction of multiple genes and environmental factors. This article describes genetic influences on risk factors for CVD, discusses three genetic CVD disorders, and highlights recent developments in genetic therapy for the treatment of CVD.

Knowledge of menopause and hormone replacement therapy use in low-income urban women

Hormone replacement therapy (HRT) can have significant long-term health benefits in postmenopausal women, yet rates of HRT use are low, especially in low-income urban women. Previous research has revealed that knowledge of menopause is a key predictor of HRT use in this population. A descriptive cross-sectional survey of 215 perimenopausal and postmenopausal low-income urban women was carried out to characterize knowledge of menopause and HRT and factors associated with knowledge level. Sociodemographic characteristics, patterns of HRT use, and knowledge about menopause and HRT were collected through a structured interview. Results revealed a general lack of knowledge about menopause and HRT, particularly relative to heart disease and the role of HRT in prevention. Major independent predictors of increased knowledge (R2 = 0.31) were having talked with a healthcare provider about HRT, having at least a high school education, and being less than 60 years of age. These findings emphasize the key role of providers in educating this vulnerable population about menopause and HRT and the potential subsequent impact on HRT use.

Cholesterol management: an opportunity for nurse case managers

There is compelling scientific evidence that the modification of cardiovascular risk factors, including hypercholesterolemia, can reduce the incidence of myocardial infarction, effectively extend survival, decrease the need for interventional procedures, and improve quality of life in persons with and without known cardiovascular disease. Unfortunately, neither the publication of results from clinical trials of cholesterol lowering alone nor the 1993 National Cholesterol Education Program Adult Treatment Panel (NCEP-ATPII) updated guidelines for the treatment of hypercholesterolemia have resulted in widespread changes in cholesterol management and control. Systematic nurse case management of dyslipidemias in patients with or at high risk for the development of coronary heart disease has the potential to improve compliance with NCEP-ATPII guidelines. In cooperation with physicians, nurses have the opportunity to address a major public health problem with the potential to eventually affect the more than 11 million people with coronary heart disease.

Changes in cholesterol levels in women after coronary artery bypass surgery

OBJECTIVE

To examine the predictors of change in cholesterol levels in a cohort of women between the time of surgery and 1 year after coronary artery bypass graft surgery (CABG).

DESIGN AND SETTING

This study was a prospective, descriptive study held at a Mid-Atlantic tertiary care medical center.

METHODS

Lipid profiles, lifestyle behaviors, and other major coronary risk factors were measured at the time of surgery and again 12 months later from a consecutive convenience sample of 130 women who underwent first-time, isolated CABG.

RESULTS

The sample population was 24% black and 76% white and had a mean age of 65 years and an average of 11 years of education. Although no statistically significant changes in cholesterol levels were observed, a majority (55%) of women had increases in total cholesterol level, whereas 45% had decreased total cholesterol level between baseline and 1 year of follow-up. After controlling for preoperative cholesterol values, a change in cholesterol level was independently predicted by ejection fraction, smoking status, and body mass index. At 1 year, plasma lipoprotein levels were not optimally managed, with high proportions of values exceeding national guidelines for secondary prevention.

CONCLUSIONS

Women continue to have high cholesterol levels after CABG, putting them at high risk for future coronary heart disease events. Effective secondary prevention programs targeting multiple lifestyle behaviors and adequate pharmacotherapy are needed.

Coronary risk factors in women one year after coronary artery bypass grafting

Given the importance of risk factor management to long-term outcome following coronary artery bypass grafting (CABG) and the paucity of information on risk factor changes in women, a study was undertaken to examine the coronary risk factor status of women before and 1 year after CABG. This study was a prospective investigation of 130 women who underwent first-time, isolated CABG between February 1992 and October 1993. Lipid profiles, blood pressure, weight, smoking status, and other lifestyle behaviors were measured at the time of surgery and again 12 months later. The sample was 24% African American and had a mean age of 65 years and an average of 11 years of education. Substantial favorable changes in risk factor status occurred in the prevalence of smoking and the number of cigarettes smoked per day among smokers. Although the women experienced weight loss, 58% continued to be obese, and the self-reported dietary intake of fat, saturated fat, and cholesterol remained above the recommended levels of the National Cholesterol Education Program's Step II diet. Mean systolic and diastolic blood pressures significantly increased, and a substantial number of patients (54%) continued to exhibit hypertension at 1 year. No significant changes in plasma lipid concentrations were observed. At 1 year, one third of the women exceeded recommended levels for triglycerides, 78% for total cholesterol, and 92% for low-density lipoproteins. These findings indicate that women continue to have multiple coronary risk factors after CABG, putting them at high risk for future coronary heart disease events. Healthcare professionals need to target these women for effective secondary prevention.

The Montefiore community children's project: a controlled study of cognitive and emotional problems of homeless mothers and children

OBJECTIVES

This study compares the prevalence of emotional, academic, and cognitive impairment in children and mothers living in the community with those living in shelters for the homeless.

METHOD

In New York City, 82 homeless mothers and their 102 children, aged 6 to 11, recruited from family shelters were compared to 115 nonhomeless mothers with 176 children recruited from classmates of the homeless children. Assessments included standardized tests and interviews.

RESULTS

Mothers in shelters for the homeless showed higher rates of depression and anxiety than did nonhomeless mothers. Boys in homeless shelters showed higher rates of serious emotional and behavioral problems. Both boys and girls in homeless shelters showed more academic problems than did nonhomeless children.

CONCLUSION

Study findings suggest a need among homeless children for special attention to academic problems that are not attributable to intellectual deficits in either children or their mothers. Although high rates of emotional and behavioral problems characterized poor children living in both settings, boys in shelters for the homeless may be particularly in need of professional attention.

Predictors of long-term change in functional status after coronary artery bypass graft surgery in women

A cohort of 164 women who had undergone coronary artery bypass graft surgery (CABG) was followed for one year to examine changes in functional status and determine the relative influence of clinical, psychosocial and sociodemographic factors on change in functional status outcomes between 6 and 12 months after surgery. Clinical, psychosocial, sociodemographic and preoperative functional status data were collected by written questionnaire and personal interview at the time of surgery and again at 6 and 12 months after CABG. Functional status scores improved significantly from before to 6 months after CABG. Between 6 and 12 months post-CABG 65% sustained or continued to experience improvement in physical functioning, 83% in social and leisure activities, and 54% in psychological functioning. Predictors of sustained improvement in physical functioning were being married, younger age, low 6-month functioning, having an ejection fraction of 50% or greater, and being white. The significant predictors of sustained improvement in social and leisure activities and psychological functioning were being married and low 6-month psychological functioning, respectively. These data suggest that interventions to improve long-term outcomes in women undergoing CABG should take into account not only their age, functional capacity and level of functioning at 6 months post-CABG, but also their race and marital status as potential risk factors for long-term functional status disability.

Assessment of functional status in patients with cardiac disease

The evaluation of functional status as an outcome for patients with cardiac disease has become common practice in both clinical settings and research studies. However, the measurement of functional status lacks conceptual clarity, frequently focuses on only one dimension of functioning, and overlooks the individuality of the patient. Some measures of functional status have questionable sensitivity to capture change over time, or the ability to discriminate between groups, and lack reports of reliability and validity testing. The purpose of this article is to discuss critical issues related to the evaluation of functional status, with a focus on objective and subjective measures of functional status frequently used in cardiac populations.

Risk factors in the offspring of women with premature coronary heart disease

Some studies suggest that first-degree relatives of female patients with premature coronary heart disease (CHD) are at greater risk for early disease than if the proband is a male patient. To examine coronary risk factors, related knowledge, attitudes, and beliefs concerning CHD risk, we screened a sample of 87 apparently healthy offspring (56 female subjects and 31 male subjects) of women with documented premature CHD. More than half of the offspring had total and low-density lipoprotein cholesterol levels above the recommended levels for primary prevention, 31% were current smokers, and 56% exercised fewer than three times a week. A high proportion were overweight with a high prevalence of central obesity. A total of 13% had only one major risk factor, a family history of premature CHD, 10% had two risk factors, 23% had three, and 54% had four or more CHD risk factors. When compared with the Framingham cohort, 29% of sons and 30% of daughters exceeded their age- and sex-specific average risk for having CHD in 10 years. Only 28% identified heredity as a major cause of CHD, and 47% perceived their risk for future myocardial infarction as less than or equal to that of others their age. These findings suggest that adult children of women with premature CHD have a high prevalence of modifiable risk factors and do not perceive themselves to be at risk for CHD.

Coronary revascularization in women

Women who undergo revascularization with CABG or PTCA may experience more negative acute outcomes compared with men. These gender differences in acute outcome are partly explained by the size of coronary arteries, baseline differences in clinical risk factors, and the unfavorable cardiovascular profiles seen in women. However, once women have survived the revascularization procedure, long-term outcomes are generally similar to those of men. Risk factor identification and modification is an important approach to enhance our ability to reduce long-term restenosis and progression of atherosclerosis following revascularization in women as well as men. After these interventions, only one in three patients benefits from comprehensive risk factor intervention. Nurses are in key positions to approach patients and their families at the time of these major interventions when they are likely to be more receptive to the idea of risk factor modification.

Coronary risk factor modification in women after coronary artery bypass surgery

In a trial to evaluate the effectiveness of a nurse-directed intervention designed to help patients decrease dietary intake of fat, quit or decrease smoking, and increase exercise, 138 women who underwent coronary artery bypass surgery were randomized to receive special intervention (SI) or usual care (UC). The SI group received a behavioral program based on self-efficacy theory in the home 2 weeks after discharge with regular follow-up. The UC group received routine medical care. Risk factors and lifestyle behaviors were measured at baseline and 1 year after surgery in 116 (84%) women (SI = 59, UC = 57). The SI group decreased their total fat intake from a mean of 38% of calories at baseline to 35% at 1 year, while the UC group increased it from 36% to 38%. The prevalence of smoking decreased from 24% at baseline to 8% at 1 year in the SI group and from 19% to 14% in the UC group. At follow-up, the quit rate in those smoking at baseline was 64% in the SI group, with no new smokers, and 55% in the UC group, with three new smokers. Both groups reported improvement in exercise, with the proportion of women reporting participation in some form of regular exercise slightly higher in the SI group than in the UC group, 54% and 51%, respectively.

Prevalence of hypercholesterolemia among siblings of persons with premature coronary heart disease. Application of the Second Adult Treatment Panel guidelines

BACKGROUND

Increased blood cholesterol, specifically high low-density lipoprotein cholesterol, increases risk for coronary heart disease (CHD). Persons with a positive family history of premature CHD also are at markedly increased risk.

OBJECTIVE

To examine the prevalence of hypercholesterolemia based on the second report of the National Cholesterol Educational Program Adult Treatment Panel (ATP II) guidelines in the asymptomatic healthy siblings of people with premature CHD.

METHODS

A total of 668 asymptomatic healthy siblings (354 men and 314 women) underwent screening for risk factors for CHD. Siblings were categorized into treatment categories for primary prevention defined by ATP II. The percentage who were candidates for intervention were compared with the published national estimates for those without CHD from the third National Health and Nutrition Examination Survey (NHANES III).

RESULTS

Based on ATP II guidelines, 65% of the asymptomatic adult siblings required fasting lipoprotein analysis compared with 33% of adults without CHD in the national reference population. Of the siblings who met the criteria for fasting lipoprotein analysis, most (56%) were candidates for dietary therapy, more than twice the proportion of adults from NHANES III. The percentage of the siblings who qualified for drug intervention and dietary therapy was 3 times greater than the national sample, 33% vs 11%, respectively. Assuming a 10% hypothetical reduction in low-density lipoprotein cholesterol levels as the result of dietary modification, the proportion of the sibling sample who were possible candidates for drug therapy was 20%, still 4 times that predicted for the national sample.

CONCLUSIONS

These results underscore the need for aggressive detection and treatment of hypercholesterolemia in this easily identifiable high-risk population of siblings of people with premature CHD.

Cardiac rehabilitation in the elderly: improving effectiveness

Heart disease is a major cause of mortality and morbidity among adults who are older than 65 years of age. One-third of cardiac operations on adults in the United States are performed on patients who are more than 65 years old, and almost half of the hospitalized candidates for an outpatient cardiac rehabilitation programs are in the older patient population. Structured educational program that include exercise and modification of risk factors have been shown to reduce the risk of subsequent coronary events; however, studies show that older adults enroll in these programs at a significantly lower rate than do patients in other age groups. Nurses and other healthcare professionals must eliminate barriers to participation and adapt their programs to meet the needs of older adults with cardiac disease to reduce morbidity, enhance functioning, and improve quality of life. In this article, the authors describe current knowledge about the efficacy and use of cardiac education and rehabilitation in elderly patients and suggest implications for future practice and research.

Cognitive and academic functioning of homeless children compared with housed children

BACKGROUND

During the past 10 years, the number of homeless families has increased in every region of the United States. Despite several studies of this population, there are few data regarding the cognitive functioning of these homeless children. The aim of this controlled study was to determine the effect of homelessness on cognitive and academic functioning of children aged 6 to 11 years.

METHODS

Homeless children (N = 102) and their mothers living in shelters were compared with a housed group of children (N = 178) and their mothers selected from the homeless child's classroom in New York City between August 1990 and August 1992. Groups were compared using standardized cognitive and academic performance instruments.

RESULTS

Controlling for child's age, sex, race, social class, and family status, verbal intelligence (estimated by the Peabody Picture Vocabulary Test) and nonverbal intelligence (estimated by the Raven's Progressive Matrices) were not significantly different between the groups. However, academic achievement (measured by the Wide Range Achievement Test-Revised [WRAT-R]) was significantly poorer in reading, (75% of homeless children compared with 48% of housed children were below grade level), spelling (72.4% of the homeless children compared with 50% of housed children were below grade level) and arthmetic (53.6% of homeless children compared with 21.7% of housed children were below grade level). These dramatic differences in academic performance did not appear to be related to the mother's report of the number of days missed from school or the length of homelessness, but were associated with: (1) the number of school changes for the WRAT-R reading subtest and (2) grade repetition for the WRAT-R spelling subtest.

CONCLUSIONS

These data demonstrae no difference in cognitive functioning between homeless and housed children. However, homeless children performed significantly more poorly than housed children in tests of academic performance.

Coronary risk factors in women six months after coronary artery bypass grafting

The coronary risk factor status of women before and after coronary artery bypass grafting has not been fully described. This study was a prospective investigation of 136 women who underwent first-time, isolated coronary artery bypass grafting between February 1992 and October 1993. Major coronary risk factors were measured at the time of surgery and again 6 months later. The sample was 22% black, had a mean age of 64 years, and an average of 11 years of education. Substantial favorable changes in risk factor status occurred in the prevalence of smoking and the number of cigarettes smoked per day among smokers. Although the self-reported dietary intake of fat decreased significantly, the dietary consumption of fat, saturated fat, and cholesterol remained above the recommended levels of the Step II diet and weights remained essentially the same. Mean systolic and diastolic blood pressures significantly increased and a substantial number of patients (59%) continued to exhibit hypertension at 6 months. No significant changes in plasma lipid concentrations were achieved. At 6 months, one third of the women exceeded recommended levels for triglycerides, 85% for total cholesterol, and 92% for low-density lipoproteins. In addition, 34% had high-density lipoprotein levels < 40 mg/dl. Health care professionals need to target these women for effective secondary prevention.

Dipstick analysis of urinary protein. A comparison of Chemstrip-9 and Multistix-10SG

The Boehringer-Mannheim Chemstrip-9 and Ames Multistix-10SG urine dipstick assays for the detection of proteinuria were evaluated. Chemstrip-9 was more precise than Multistix-10SG (13 inconsistencies vs 32 among duplicate pairs). Precision was poorest with the group of inexperienced technologists using Multistix-10SG (Chemstrip-9 yielded two inconsistencies vs 15 for Multistix-10SG) with the use of urine supplemented with protein standard. In the evaluation of both protein-supplemented and consecutively acquired patient specimens, Multistix-10SG and Chemstrip-9 performed in a statistically similar fashion regarding sensitivity and predictive value of a negative test result: supplemented sample sensitivity, patient sample sensitivity, and a predictive value of a negative test result of 90.3%, 46.8%, and 68.6%, respectively, for Multistix-10SG compared with 80.6%, 31.5%, and 63.5%, respectively, for Chemstrip-9. We conclude that neither test is sufficiently sensitive for the detection of low levels of proteinuria (1+ range) to function as a screening test for renal disease.

Functional status after coronary artery bypass grafting and percutaneous transluminal coronary angioplasty

Two cohorts of consecutive patients of comparable age with similar preprocedure cardiac function who underwent either coronary artery bypass grafting (CABG; n = 106) or percutaneous transluminal coronary angioplasty (PTCA; n = 64) were entered into a prospective comparison study examining functional status and return to work during the first year of recovery. Patients were evaluated using standardized functional status instruments for activities of daily living, work performance, social activity, mental health and quality of social interaction at 1, 6 and 12 months after the procedure. Within the CABG group, statistically significant improvements of functional status on every subscale were noted over the 1-year follow-up. Patients undergoing PTCA demonstrated significant improvement in all dimensions except for the quality of interaction at 1 year as compared with baseline. When the 2 groups were compared, the PTCA group demonstrated greater participation than the CABG group in routine daily physical and social activities at 1 and 6 months, but this apparent advantage disappeared by 1 year. Measures of psychological functioning were better after CABG than after PTCA. A reduction in the number of those with employment occurred in both the CABG and PTCA groups, independent of physical functional status measures, which improved in both groups after the procedures. For those with employment, the CABG group reported the greatest improvement in work performance.

Factors related to functional status after coronary artery bypass surgery

We studied physical functioning and social and leisure functioning of 125 men before, 1 month after, and 6 months after coronary artery bypass surgery. Relationships between functional status outcomes and selected psychosocial and physical variables were examined. Although functional status outcomes improved significantly 6 months after surgery, 13% of patients continued to report important functional status disabilities, and 45% reported difficulty in or no participation in moderately vigorous activities. The variable most predictive of functional status was the patient's estimation a priori of his ability to carry out specific activities (self-efficacy). Other psychosocial and physical factors, other than postoperative treadmill performance, did not add significantly to the prediction of the outcomes. Findings suggest that rehabilitative programs attempting to facilitate physical and social reintegration of the patient after coronary artery bypass surgery should test the effects of interventions to increase self-efficacy.

Physical and psychosocial outcomes after coronary artery bypass graft surgery: review of the literature

Coronary artery bypass graft (CABG) surgery is a common technique for improving myocardial blood flow in patients with ischemic heart disease. It is assumed that revascularization translates into improved outcomes in patients who undergo this surgery. In this article the literature on physical and psychosocial outcomes after CABG surgery is reviewed with a focus on prolongation of life, relief of angina pectoris, improvement in functional status, and return to work. Predictive factors are summarized, and implications of findings are discussed.

Learning after graduation: are nurses taking advantage of the resources?

The vast majority of clients in long-term care facilities are elderly, but only half the RNs working with these clients had any specific training related to the elderly either before or after graduation. The majority of respondents preferred to attend educational offerings rather than read journal articles and felt it was beneficial to leave their facility to interact with peers from other agencies. A majority of the nurses read general interest nursing journals rather than ones specifically geared to gerontological nursing or geriatrics. Within an agency, time should be set aside for discussions and nurses should be encouraged to network outside the facility; guest staff nurses should also be encouraged to present new ideas.

Massive congenital intracranial teratoma: a report of two cases

Although intracranial teratoma is a well-recognized entity in the differential diagnosis of pediatric brain tumors, massive congenital intracranial teratoma replacing the cerebral hemispheres of a neonate has seldom been reported. We describe two such instances that histologically exhibit predominantly neuroepithelial differentiation. In 1 case serial prenatal ultrasonography revealed ventricular dilatation prior to identification of the lesion. Theories of pathogenesis are briefly discussed.

Evaluation of an automated method for leukocyte differential counts based on electronic volume analysis

An electronic blood cell counter (Coulter S-plus IV) classifies leukocytes as lymphocytes, large mononuclear cells, or granulocytes based on volume after treatment with a reagent. Correlation coefficients as compared with stained film microscopy are .94 for lymphocytes, .91 for granulocytes, and .49 for mononuclear cells. As a screening tool, it could reduce the number of traditional manual differential cell counts. We devised criteria for identifying those specimens requiring additional visual examination, giving particular attention to "low-density" abnormalities. Over 2,200 specimens were studied. Among 791 specimens obtained primarily from inpatients, the screening procedure yielded 267 true-positive, 298 false-positive, 213 true-negative, and 13 false-negative specimens. The 1,216 specimens obtained primarily from outpatients included 54 true-positive, 234 false-positive, 912 true-negative, and 16 false-negative specimens. All false-negative specimens represented low-density abnormalities. The usefulness of this approach is partially dependent on patient population.

Gruentzig balloon catheter dilation for acquired bronchial stenosis in an infant

A long stricture of the left main bronchus, which was resistant to the traditional methods of treatment, developed in a 992-gm twin who was ventilated for 114 days. The patient had two bronchial dilations with the Gruentzig balloon catheter placed under fluoroscopic control and inflated to 6 atm of pressure. The treatment was well tolerated by the patient, and one year after the Gruentzig balloon dilation she had a normal chest roentgenogram. Gruentzig balloon catheter dilation is a new technique for repairing bronchial stenosis in infancy without major intrathoracic surgical intervention.

The association between plasma cholesterol, high-density-lipoprotein cholesterol, triglycerides and uric acid in ethanol consumers

The relationship between the concentrations of plasma cholesterol, high-density-lipoprotein (HDL) cholesterol, triglycerides and uric acid has been studied in relation to alcohol consumption in men attending a health-screening centre. Although it has been suggested that these metabolites are associated with each other by environmental factors, including ethanol consumption, the only correlation we have found between the variables which is statistically significantly related to alcohol consumption is that between total cholesterol and uric acid. A comparison of these correlations with epidemiological data suggests that assessment of cardiovascular risk is best done by using plasma cholesterol and uric acid levels, corrected for alcohol consumption. The correlation between HDL-cholesterol and the remaining fractions of plasma cholesterol is constant over all levels of alcohol consumption, and therefore the division of cholesterol between these fractions is apparently independent of both alcohol consumption and cholesterol synthesis.

Thermotropic properties and molecular dynamics of cholesteryl ester rich very low density lipoproteins: effect of hydrophobic core on polar surface

Cholesteryl ester rich very low density lipoproteins (CER-VLDL), isolated from the plasma of rabbits fed a hypercholesterolemic diet, have been studied by differential scanning calorimetry (DSC), 13C nuclear magnetic resonance (NMR), and spin-label electron paramagnetic resonance (EPR) to determine the temperature-dependent dynamics of cholesteryl esters in the hydrophobic core and of phospholipids on the polar surface. Intact CER-VLDL exhibit two DSC heating endotherms; these occur at 40-42 and 45-48 degrees C. Cholesteryl esters isolated from CER-VLDL also exhibit two DSC endotherms; these occur at 50.0 and 55.1 degrees C and correspond to the smectic----cholesteric and cholesteric----isotropic liquid-crystalline phase transitions. A model mixture containing cholesteryl linoleate, oleate, and palmitate in a ratio (0.21, 0.51, and 0.28 mol fraction) similar to that in CER-VLDL exhibited comparable DSC endotherms at 45.2 and 51.5 degrees C. CER-VLDL at 37 degrees C gave 13C NMR spectra that contained no resonances assignable to cholesteryl ring carbons but detectable broad resonances for some fatty acyl chain carbons, suggesting the cholesteryl esters were in a liquid-crystalline state. When the mixture was heated to 42 degrees C, broad ring carbon resonances became detectable; at 48 degrees C, they became narrow, indicating the cholesteryl esters were in an isotropic, liquid-like state. With increasing temperature over the range 38-60 degrees C, the resonances for cholesteryl ring carbons C3 and C6 in CER-VLDL narrowed differentially. Similar spectral changes were observed for the synthetic cholesteryl ester mixture, except they occurred at temperatures about 10 degrees C higher. These results indicate that the two DSC transitions in CER-VLDL do not directly correlate with the smectic----cholesteric and cholesteric----isotropic transitions exhibited by pure cholesteryl esters. (5-Doxylpalmitoyl)-phosphatidylcholine (5-DP-PC) and (12-doxylstearoyl)phosphatidylcholine (12-DS-PC) were used to probe the polar surface monolayer of CER-VLDL; the corresponding cholesteryl esters (5-DP-CE and 12-DS-CE) were used to probe the hydrophobic core. None of these probes in CER-VLDL detected an abrupt change in EPR order parameters, S, or maximum splitting, 2T max, over the temperature range 20-58 degrees C even though 12-DS-PC and 5-DP-PC can detect phase transitions in phospholipid bilayers and 12-DS-CE and 5-DP-CE can detect phase transitions in neat cholesteryl esters. However, 12-DS-CE and 5-DP-CE did detect a much greater acyl chain order for the neutral lipids of CER-VLDL than for those of normal triglyceride-rich VLDL.(ABSTRACT TRUNCATED AT 400 WORDS)

Direct observation of the distribution of fluorescent probes in phosphatidylcholine/cholesterol vesicles using flow microfluorometry

The technique of flow microfluorometry has been extended to the study of small lipid complexes to assess either the lipid (hydrophobic) or aqueous (hydrophilic) compartments of selected natural or model membrane systems. sn-1-Palmitoyl-sn-2-oleoyl-phosphatidylcholine/cholesterol unilamellar vesicles, averaging 268 nm in diameter and containing varying concentrations of the synthetic lipophile probe, sn-1-palmitoyl-sn-2-12-[N-4-nitrobenzo-2-oxa-1,3- diazole]-aminocaproyl-phosphatidylcholine (NBD-PC), were analyzed using an Ortho Series 50-H Cytofluorograf and an Ortho 2150 computer system. NBD-labeled vesicles were analyzed for green fluorescence and the intensity of scattered light, the later being analyzed both at low angle (2-5 degrees) and at 90 degrees to the incident beam. At the high amplification required for vesicle detection, background signals from the sheath buffer, nonspecific laser light, and electronic noise were observed. However, this background noise signal was removed by appropriately setting a discriminator window. Profiles of signals falling within this region were then constructed. For the settings selected, more than 98% of data recorded could be attributed to observations on vesicles. Size information from the intensity of scattered light was obtained by comparison of the sample with fluorescent microspheres after correcting for the particle-scattering function difference between hollow and solid spheres and for refractive index differences. Additionally, cytograms and profiles were constructed for vesicles containing 5 mM 6-carboxyfluorescein, 3',6'-dihydroxy-3-oxospiro(isobenzofuran-1(3H),9'-(9H)xan then)-6-carboxylic acid, trapped in the aqueous core. Thus, the utility of flow microfluorometry has been extended to much smaller particle populations than studied previously by this technique.(ABSTRACT TRUNCATED AT 250 WORDS)

Cyproterone acetate and the treatment of hirsutism

Forty-two women with hirsutism completed 12 months of treatment with cyproterone acetate and ethinyl oestradiol given in a reverse sequential regimen. A highly significant improvement was recorded in the whole group using the Ferriman and Gallwey scoring system. Ten patients recorded a poor response whereas 19 recorded a good or very good result. Patients from groups with polycystic ovarian disease and idiopathic hirsutism recorded equally beneficial responses. Fasting plasma triglycerides rose significantly after 12 months. Other lipids were largely unaffected although a small fall in high density lipoprotein-cholesterol was detected at mid-cycle. No other biochemical abnormalities were found. Circulating levels of testosterone and 17 hydroxyprogesterone were suppressed during treatment. Side-effects were not prominent. This appears to be a very useful medication for a clinical problem which hitherto has been difficult to treat.

A multivariate assessment of alcohol consumption

Subjects attending a large, multiphasic health screening centre in Sydney, Australia estimated their alcohol consumption and specimens of their blood were analysed. The most useful univariate estimates of alcohol consumption were erythrocyte mean corpuscular volume and plasma aspartate-aminotransferase, gamma-glutamyl-transpeptidase, triglycerides and uric acid. The most statistically significant of these tests have been combined to form a multivariate predictor of alcohol intake which is more successful in identifying heavy-drinkers than single tests. To describe this population further, and to aid comparisons between populations, information about non-drinkers has also been provided.

Cholesterol, high density lipoprotein and danazol

The synthetic steroid, danazol [17 alpha-pregna-2,4-dien-20-yno-(2,3,d)isoxazol-17-ol], is used widely for the treatment of endometriosis. In nine subjects studied over a 6-month course of treatment and for 5 months subsequently, plasma high density lipoprotein cholesterol (HDL-C) levels fell during treatment (P less than 0.001) and were restored to pretreatment levels within 3-5 months after treatment ceased. In these patients, total cholesterol did not increase significantly, yet the depressed levels of HDL-C apparently masked an increase in the total cholesterol in the remaining lipoprotein classes (P less than 0.01). Triglyceride levels were not affected significantly over the course of the treatment. Lipoprotein electrophoresis indicated an elevated beta-lipoprotein band in the subjects using danazol. All effects of danazol on plasma levels of cholesterol and HDL-C were reversed within 3-5 months after the cessation of treatment.

Effect of drinking on correlations between biochemical variables

Several clinical laboratory tests correlate with alcohol consumption, for example, the plasma activities of gamma-glutamyl transpeptidase (GGT) and aspartate aminotransferase (AST), the concentrations of triglycerides (TG) and uric acid (UA) and the erythrocyte mean corpuscular volume (MCV). The correlations of these test results with each other have been studied in a population of men attending a multiphasic health-screening centre. The patterns of correlation were of two types: those between the pairs of variables GGT/TG/UA, TG/AST, and TG/UA were all unchanged as the level of alcohol consumption increased; the pairs of variables GGT/MCV, UA/AST, AST/MCV, UA/MCV, and GGT/AST all became more highly correlated as the level of alcohol consumption increased.

Biofeedback-based stress management training with a population of business managers

A biofeedback-based stress management training program was experimentally evaluated using populations of middle-level managers from a large corporation. The training program, once-weekly 1-hour sessions for 6 weeks, combined frontal and other site EMG biofeedback, progressive relaxation and breathing exercises, cognitive stress management, and generalization techniques. Control groups participated in either the assessment procedures only or the assessment procedures and six once-weekly discussions of stress and the job on both an individual (two sessions) and group (four sessions) basis. Significant effects were found in self-report measures, state and trait anxiety, experience of stress; in physiological measures, basal frontal EMG and frontal EMG during recovery from stress, and finger temperature; and in ratings of overall job performance. However, no consistent advantage for the training group or either control group was found. Several possible explanations for the failure of the biofeedback-based stress management training condition to achieve a consistent advantage over the control conditions are presented.

The effects of diphenylhydantoin on the relationship between high-density lipoprotein cholesterol and several biochemical assays

Correlations have been calculated between high-density lipoprotein cholesterol and total plasma cholesterol, albumin, gamma-glutamyl transpeptidase, aspartate aminotransferase, alkaline phosphatase, triglyceride, urea, creatinine and uric acid for diphenylhydantoin (DPH) users and for subjects attending a multiphasic health screening centre. For women DPH users, high-density lipoprotein levels correlated significantly with gamma glutamyl transpeptidase, cholesterol and alkaline phosphatase. These correlations were significantly different from those found for male DPH users and from subjects attending the health screening centre. In male DPH users, high-density lipoprotein cholesterol correlates negatively with urea and uric acid levels, a relationship which is found neither in women DPH users nor in the health screening centre population.