A modified hTERT promoter-directed oncolytic adenovirus replication with concurrent inhibition of TGFbeta signaling for breast cancer therapy

Our laboratory is interested to develop oncolytic adenoviral vectors that can be administered systemically for the treatment of breast cancer. To restrict viral replication in breast tumor cells, we have constructed mhTERTAd.sTβRFc, a 01/07 based adenoviral vector expressing the soluble form of TGFβ receptor II fused with human Fc IgG1 (sTGFβRIIFc) gene, in which viral replication is under the control of modified human telomerase reverse transcriptase (mhTERT) promoter. In addition, mhTERTAd.sTβRFc-mediated sTGFβRIIFc production would target growth factor-β (TGFβ) pathway known to contribute to the tumor progression breast cancer metastasis. We chose to use mhTERT promoter because it was found to be relatively more active (approximately 20-times) in breast cancer cells compared to normal human cells. We showed that infection of MDA-MB-231 and MCF-7 breast cancer cells for 48 hrs with mhTERTAd.sTβRFc produced high levels of sTGFβRIIFc (greater than 1 μg/ml) in the medium. Breast cancer cells produced nearly 6,000-fold increase in the viral titers during 48 hrs infection period. However, mhTERTAd.sTβRFc replication was attenuated in normal cells. Infection of breast cancer cells with a replication deficient virus Ad(E1^-).sTβRFc also produced high levels of sTGFβRIIFc, but under these conditions no detectable viral replication was observed. Adenoviral-mediated production of sTGFβRIIFc was shown to bind with TGFβ-1, and abolished the effects of TGFβ-1 on downstream SMAD-3 phosphorylation. The administration of mhTERTAd.sTβRFc intravenously into MDA-MB-231 human xenograft bearing mice resulted in significant inhibition of tumor growth, and production of sTGFβRIIFc in the blood. On the other hand, intravenous injection of Ad(E1^-).sTβRFc did not exhibit significant inhibition of the tumor growth, but resulted in the sTGFβRIIFc in the blood, suggesting that viral replication along with sTGFβRIIFc protein production play a critical role in inducing inhibition of tumor growth. These results warrant future investigation of mhTERTAd.sTβRFc as an anti-tumor agent in vivo.

Screening for substance use in pregnancy: a practical approach for the primary care physician

Our goal was to identify risk factors for substance use during pregnancy for primary care physicians so that we could assess a woman's risk of alcohol or illicit drug use. Participants were 2002 Medicaid-eligible pregnant women with < or =2 visits to prenatal care clinics in South Carolina and Washington State. Structured interviews were used to collect data. Logistic regressions and classification and regression trees identified predictors for pregnant women at high risk for substance use. Approximately 9% of the sample reported current use of either drugs or alcohol or both. Past use of alcohol or cigarettes, including during the month before pregnancy, most differentiated current drug or alcohol users from current nonusers. Our analysis suggests that primary care physicians can ask 3 questions in the context of a prenatal health evaluation to target women for referral to a full clinical assessment for drug and alcohol use.

Reengineering outcomes management: an integrated approach to managing data, systems, and processes

The integration of outcomes management into organizational reengineering projects is often overlooked or marginalized in proportion to the entire project. Incorporation of an integrated outcomes management program strengthens the overall quality of reengineering projects and enhances their sustainability. This article presents a case study in which data, systems, and processes were reengineered to form an effective Outcomes Management program as a component of the organization's overall project. The authors describe eight steps to develop and monitor an integrated outcomes management program. An example of an integrated report format is included.

Understanding organizational reengineering in health care: strategies for social work's survival

Confronted with decreasing reimbursement and managed care, hospitals across the country have been "reengineering" in an effort to streamline processes and enhance revenue. Because of the financial implications of discharge planning, hospital social workers and their departments are typically examined and realigned in some way during a reengineering process. To survive in this environment, social workers must understand the principles of reengineering; its hoped for and actual impact; be able to identify opportunities to contribute; and have the capacity to cope with an evolving professional role. This paper presents a general overview of reengineering and its adaptation to the health care environment. Specific challenges for medical social workers are described along with strategies for surviving in a reengineered health care system.

Do advanced practice nurses and physician assistants benefit small rural hospitals?

Advanced practice nurses and physician assistants have offered small, rural hospitals an alternative to scarce primary care physicians for 30 years. This paper uses survey data from 285 small rural hospitals and case studies of 36 of these hospitals to answer questions about the extent to which advanced practice nurses and physician assistants provide primary care in small, rural hospitals, the benefits that might bring to the hospitals as well as the reactions of the public. The study used survey data collected as part of an evaluation of 285 hospitals, which received a Rural Health Care Transition grant from the Health Care Financing Administration in 1993 and 1994. Most of the hospitals used the practitioners; 70 percent used nurse practitioners; 30 percent used physician assistants; and 20 percent used both. There were some negative reactions to the use of the practitioners, but, overall, there was acceptance and benefits to the hospitals in the form of reduced recruitment costs, increased revenues and increased service offerings. These practitioners are beneficial to rural hospitals, and mechanisms to encourage their acceptance should be developed and implemented.

Advance directives: the experience of health care professionals across the continuum of care

This study explored the perceptions of health care providers across the continuum of care as to how effective advance directive arrangements were in assuring compliance with the patients' wishes, as well as their overall satisfaction levels with the process. The health care providers who responded to the survey indicated high levels of overall satisfaction with advance directives, despite low patient completion rates and, most significantly, low confidence levels that surrogate decision making accurately reflected the patient's wishes. A secondary analysis compared the perceptions of health care providers with consumers' reasons for failing to complete advance directives. The need for further education was perceived as a primary need by the health care professionals but not by the consumers. Recommendations for policy initiatives and further research are then presented.

Transmission of vancomycin-resistant enterococcus among family members: a case study

Enterococci are persistent organisms naturally occurring in the digestive tract, able to persist on environmental surfaces for days or weeks, surviving heat and desiccation. They are the second most common bacterial cause of nosocomial infection. Recent strains of enterococci resistant to vancomycin pose a serious health hazard to hospitalized, institutionalized, and immunocompromised patients. This article presents a case study of community-acquired vancomycin-resistant enterococcus in an otherwise healthy child and suggests strategies for management and containment in the community.

Cell type specific regulation of COUP-TF II promoter activity

COUP-TF family orphan receptors regulate activity of ligand-activated nuclear hormone receptors or function independently in the regulation of gene expression. COUP-TF II has a complex expression pattern suggesting that different mechanisms are involved in the regulation of its expression. We isolated the 5' regulatory region of the mouse COUP-TF II gene and demonstrated that the basal promoter is localized in a -200 bp region 5' from the transcription start site. All-trans retinoic acid and dibutyryl cyclic AMP have cell type specific effects on COUP-TF II promoter activity. The effect of cyclic AMP is mediated by the cyclic AMP response element that is localized 74 nucleotides upstream from the major transcriptional start. In vitro promoter analyses also demonstrated that the effect of all-trans RA is not directly mediated by the binding of RARs or RXRs to the promoter sequence.

Do smog advisories work? Results of an evaluation of the Canadian Smog Advisory Program

OBJECTIVE

To determine the effectiveness of the Canadian Smog Advisory Program.

METHODS

Telephone interviews covering perceptions, knowledge, recall of and response to advisories, and general views on their usefulness and effectiveness were conducted with 1,474 randomly selected individuals in four geographic areas. Multiple logistic regression was used to model advisory recall as a function of explanatory variables.

RESULTS

Recall of advisories was higher (72%; 95% CI 68-77%) when measured immediately following an advisory in southern New Brunswick. Recall was lower when measured at the end of the smog "season", and varied significantly between Toronto (46%; 42-51%), Haldimand-Norfolk (18%; 14-24%) and Vancouver (61%; 56-65%). Education and geographic area (urban versus rural) were the strongest explanatory variables in two final multiple logistic regression models. A minority of those who recalled an advisory reported taking action.

CONCLUSIONS

Smog advisories were partially successful in generating awareness, but only marginally effective in promoting action.

Helix-loop-helix transcription factors mediate activation and repression of the p75LNGFR gene

Sequence analysis of rat and human low-affinity nerve growth factor receptor p75LNGFR gene promoter regions revealed a single E-box cis-acting element, located upstream of the major transcription start sites. Deletion analysis of the E-box sequence demonstrated that it significantly contributes to p75LNGFR promoter activity. This E box has a dual function; it mediates either activation or repression of the p75LNGFR promoter activity, depending on the interacting transcription factors. We showed that the two isoforms of the class A basic helix-loop-helix (bHLH) transcription factor ME1 (ME1a and ME1b), the murine homolog of the human HEB transcription factor, specifically repress p75LNGFR promoter activity. This repression can be released by coexpression of the HLH Id2 transcriptional regulator. In vitro analyses demonstrated that ME1a forms a stable complex with the p75LNGFR E box and likely competes with activating E-box-binding proteins. By using ME1a-overexpressing PC12 cells, we showed that the endogenous p75LNGFR gene is a target of ME1a repression. Together, these data demonstrate that the p75LNGFR E box and the interacting bHLH transcription factors are involved in the regulation of p75LNGFR gene expression. These results also show that class A bHLH transcription factors can repress and Id-like negative regulators can stimulate gene expression.

Helix-loop-helix transcription factors regulate Id2 gene promoter activity

Id-like helix-loop-helix (HLH) transcription factors are involved in the regulation of proliferation and differentiation of several cell types. We isolated 5' regulatory region of mouse Id2 gene and demonstrated that it contains several E-box clusters. These E-boxes mediate stimulatory effects of basic-HLH (bHLH) transcription factors ME1, ME2, and NSCL1 on Id2 promoter activity. Co-expression of Id2 blocks the stimulatory effect of bHLH transcription factors which suggests the presence of feedback loops in Id2 transcriptional regulation. Overexpression of NSCL1 in F9 cells blocks the downregulation of Id2 gene expression during retinoic acid induced differentiation. Our data demonstrate that bHLH transcription factors regulate Id2 gene expression.

Orphan receptor COUP-TF I antagonizes retinoic acid-induced neuronal differentiation

Chicken ovalbumin upstream promoter-transcription factors (COUP-TF) are expressed in the developing nervous system and interact with nuclear hormone receptors to regulate expression of different genes. The role of COUP-TF orphan receptors in neurogenesis is virtually unknown. To study the possible function of COUP-TF I during neuronal differentiation, we generated COUP-TF I overexpressing teratocarcinoma PCC7 cell lines and analyzed retinoic acid (RA)-induced neuronal differentiation of these cells. COUP-TF I overexpression results in the blockade of morphological differentiation after induction to differentiate. COUP-TF I represses expression of microtubule-associated protein 2 (MAP2) gene and delays induction of growth-associated protein 43 (GAP43) gene expression. In contrast, expression of the neurofilament light subunit (NF-L) gene is not affected by COUP-TF I overexpression during neuronal differentiation. Also, cells overexpressing COUP-TF I do not stop proliferating after RA and dBcAMP treatment and possess suppressed transcriptional activation from different RA response elements. These results suggest that COUP-TF I plays an important role in regulating RA-induced neuronal differentiation.

Acneiform eruption on the legs

A case of acne on the legs of a 55-year-old white woman is reported. The drugs and chemicals that are known to cause acneiform eruptions are reviewed. No clues to the localization of the disease in this patient were detected.

Blue polka dots: an unusual presentation of mycosis fungoides

A 69-year-old black woman with a patchy chronic eczematous dermatitis developed striking blue macules within her lesions. These discolored macules contained an abnormal dermal mononuclear cell infiltrate typical of mycosis fungoides.

[An attempt to induce mastitis in cows using Klebsiella pneumoniae isolated in the cow barn]

The importance was studied of cowshed strains of K. pneumoniae as causative agents of bovine mastitis. An experiment was conducted with a healthy lactating dairy cow at the age of five years. The microbial inoculum was introduced by a teat tubule, at a dose of 2 ml broth culture 24 hours old. At first, Bac. subtilis was instilled in one udder quarter, to find out the local reaction to nutrient medium, and/or to an uninjurious saprophyte . After five days, a trial was performed on the other udder quarters using three strains of K. pneumoniae, isolated from the rectal contents and the skin of healthy cattle. Finally reinfection followed to study potential allergization of mammary gland. The conclusions as follows may be drawn from the results: 1) Bac. subtilis did not cause any alteration of the main clinic signs, but the inoculated quarter became swollen and its watery secretion contained pus corpuscles. No elimination of bacilli was observed and the morbid condition recovered in five to seven days. 2) After instillation of K. pneumoniae cultures bodily temperature rose by 1.9 degrees C in the course of six hours, all three udder quarters became swollen, showed symptoms of hyperthermia and pain , their secretion also exhibited pathological changes. The NK test revealed highly increased gelling of secretion and pH shift to alkalinity, the number of somatic cells increased 12 to 17 times. The main clinic signs, as well as appearance and consistence of the udder became normal in three days, but the other parameters like NK test and the number of somatic cells in milk normalized in about ten days. 3) Klebsiellae were eliminated from the quarters for one to eleven days, the elimination lasted longer and the counts were significantly higher in capsular strains.(ABSTRACT TRUNCATED AT 250 WORDS)

[Infective situation in a cow barn contaminated with Klebsiella mastitis]

The infection situation in a four-row cow-house for 153 animals with a frequent occurrence of Klebsiella mastitis was subject to a detailed analysis. The following results were obtained after two collections of blood and udder-quarter milk samples examined by the test-tube agglutination, gel precipitation, and bacteriological diagnosis methods: 1. Streptococcus agalactiae was isolated from milk samples 28 and 31 times, Pseudomonas aeruginosa 15 and 19 times, Staphylococcus arueus 16 and 19 times, Klebsiella pneumoniae 6 and 6 times, Acinetobacter calcoaceticus once and 4 times, Enterobacter aerogenes twice and three times, and Escherichia coli twice. The authors failed to determine the causative agent in 26--38 cows (20--30%) with a pathologically changed secretion. 2. Double test-tube agglutination performed in a 30-day interval revealed suspected Klebsiella antibodies having a titre of 80 + + and higher in 13 dairy cows (12%); However, the suspicion was disproved by the negative results of gel precipitation. 3. The final deduction concerning the exogenic character of Klebsiella mastitis should encourage efforts for good housing, due nutrition, efficacious disinfection, and hygienic milk production.