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Biomedical subjects

D Kushner

Publications and source records attributed to D Kushner.

At least 19 recordsLinked to original sources

E1A-based determinants of oncogenicity in human adenovirus groups A and C.

A broad spectrum of genetic and molecular investigations carried out with group C, Ad2 and Ad5, and with group A, Ad12, have shown that early region1 (E1) gene products are sufficient for complete transformation of rodent cells in vitro by these viruses. During the past quarter century, the processes by which E1A proteins, in cooperation with E1B proteins, perturb the cell cycle and induce the transformed phenotype, have become well defined. Somewhat less understood is the basis for the differential oncogenicity of these two groups of viruses, and the processes by which the E1A proteins of Ad12 induce a tumorigenic phenotype in transformants resulting from infection of cells in vivo and in vitro. In this chapter we review previous findings and present new evidence which demonstrates that Ad12 E1A possesses two or more independent functions enabling it to induce tumors. One of these functions lies in its capacity to repress transcription of MHC class I genes, allowing the tumor cells to avoid lysis by cytotoxic T lymphocytes. We have shown that class I repression is mediated through increased binding of repressor COUP-TF and decreased binding of NF-kB to the class I enhancer. In addition to mediating immune escape, E1A also determines the susceptibility of transformants to Natural Killer (NK) cell lysis, and in this case, also, Ad12 transformants are not susceptible. By using Ad12 mutants containing chimeric E1A Ad12-Ad5 genes, point mutations, or a specific deletion, we have shown that the unique spacer region of Ad12 E1A is an oncogenic determinant, but is not required for transformation in vitro. Given that the E1A regions responsible for class I repression are first exon encoded, we have examined a set of cell lines transformed by these altered viruses, and have found that while they display greatly reduced tumorigenicity, they maintain a wildtype capacity to repress class I transcription. Whether the spacer contributes to NK evasion remains unresolved. Lastly, we discuss the properties of the Ad2/Ad5 E1A C-terminal negative modulator of tumorigenicity, and examine the effects on transformation, tumor induction and transformant tumorigenicity, when the Ad5 negative modulator is placed by chimeric construction in Ad12 E1A.

Adenovirus E1A Proteins↗

Chronic administration of single-agent paclitaxel in gynecologic malignancies.

OBJECTIVE: There are currently limited published data available on the safety and feasibility of the prolonged administration of paclitaxel. The goal of this study was to review the cumulative toxicity associated with the continuous long-term administration of this agent to women with gynecologic cancers. METHODS: Eleven patients with gynecologic malignancies of varying histologic subtypes who received >15 consecutive courses of paclitaxel were identified in a retrospective review of individuals treated between 1994 and 1999 in the Gynecologic Oncology Program of the Cleveland Clinic Taussig Cancer Center. The analysis excluded paclitaxel delivered as a component of an initial chemotherapy regimen for the cancer. Paclitaxel was administered at doses ranging from 80 to 175 mg/m(2) every 3-4 weeks as a 3-h infusion. RESULTS: In general, the patients included in this report were heavily pretreated and were continued on therapy either as a result of documentation of an objective response or with evidence of stabilization of disease (e.g., physical examination, radiographic evaluation, CA-125 antigen level) and the maintenance of a satisfactory quality of life. In the 11 patients, the median duration of therapy was 20 cycles (range: 16-36 cycles). Alopecia was observed in all patients. A single patient experienced grade 3 anemia and grade 4 neutropenia. Of note, there was 1 case of grade 2 and no cases of grade 3 peripheral neuropathy in this population. CONCLUSION: Prolonged delivery of paclitaxel for >15 consecutive cycles can be safely administered to carefully selected patients with persistent or recurrent advanced gynecologic cancers.

Adult↗

Levels of evidence of articles in podiatric medical journals.

The authors reviewed 322 articles in podiatric medical journals to determine their level of evidence. Only 1% of the articles reviewed were randomized controlled trials. The authors concluded that if the podiatric medical profession wishes to become a participant in evidence-based medicine, greater emphasis must be placed on studies that assess hypotheses.

Evidence-Based Medicine↗

Hand-foot-and-mouth disease.

Hand-foot-and-mouth disease is a highly contagious disease most often seen in children during the summer. It is caused most commonly by the virus coxsackie A16, but other enteroviruses have been implicated. It presents with low grade fever, and a vesicular eruption on the hands, feet, and mouth. More serious manifestations are seen less commonly. Diagnosis is most often clinical and treatment is symptomatic in nature. The infection in a male adult is presented.

Child, Preschool↗

Kaposi's sarcoma versus bacillary angiomatosis.

Persons with acquired immune deficiency syndrome (AIDS) are subject to a host of pathologic entities secondary to a depressed immune system. Kaposi's sarcoma frequently presents in this immunocompromised population and, therefore, diagnosis seems clinically straightforward. However, because of the prevalence of a strikingly similar infectious disease known as bacillary angiomatosis, skin biopsy of one or more lesions is crucial.

AIDS-Related Opportunistic Infections↗

Total hip replacement and other orthopedic hip procedures.

The history of total hip replacement including that of the Girdlestone procedure and resurfacing procedures is discussed. An overview of total hip replacement and its indications and complications forms the bulk of this section. Also, the use of porous-coated prostheses and endoprostheses as well as pins and plates is discussed and illustrated.

Bone Cements↗

A successful technique for the treatment of diabetic neurotrophic ulcers.

Over 90% of the diabetic neurotrophic ulcers treated with the felted foam technique at the Cleveland Foot Clinic have completely healed. The average healing time for plantar ulcers has been approximately 8 weeks. After the ulcerations have healed, molded shoes or orthopedic shoes with Plastazote inserts are prescribed. The felted foam technique is simple to perform in an office setting and can be used by both the novice and the experienced practitioner.

Adhesives↗

Voices From the Future: what students, interns, and residents want from osteopathic graduate medical training.

The need to attract students to--and keep them in--osteopathic internship and residency programs is great. Recognizing this fact, the osteopathic hospitals, through the American Osteopathic Hospital Association, have placed a renewed focus on liaisons with osteopathic medical education. Voices From the Future represents one such effort. This report reveals how osteopathic medical students, interns, and residents perceive the current state of osteopathic graduate medical education programs as well as the changes that they would like to see incorporated.

Education, Medical, Graduate↗

Primary podiatric care of the vascularly compromised patient.

Primary podiatric care encompasses patient education, disease prevention, diagnosis, treatment, and patient referral. When performed on a regular basis, primary podiatric care can delay or prevent some of the complications associated with the vascularly compromised patient.

Foot Diseases↗

Polyamines in the anemia of end-stage renal disease.

The improvement in the anemia in patients with end-stage renal disease (ESRD) on continuous ambulatory peritoneal dialysis (CAPD) suggests that dialyzable substances present in the sera of uremic patients either inhibit erythropoiesis directly or inactivate erythropoietin (EPO). In the present study predialysis sera from patients with ESRD inhibited erythroid colony (CFU-E) (N = 10) formation to a significantly (P less than 0.01) greater degree than granulocyte-macrophage (CFU-GM) (N = 7) colony formation in mouse bone marrow (MBM) cultures. The polyamines spermine (SP) (18 to 560 nm/ml) and spermidine (SD) (4 to 648 nm/ml) exerted a more significant (P less than 0.05) inhibition of CFU-E (N greater than or equal to 5) than that of CFU-GM (N greater than or equal to 5) growth. Concentrations of 0.80, 1.0, and 1.5 nm/ml of putrescine (PU) were 92%, 85%, and 77% of erythroid colony (CFU-E) controls (N = 4) and 104%, 130%, and 127% of CFU-GM controls (N = 4). Putrescine (PU) at 1.5 nm/ml also produced a significant (P less than 0.05) inhibition of CFU-E, whereas CFU-GM were stimulated by PU. These data suggest that predialysis sera from uremic patients, as well as SP, SD, and PU, are selectively more inhibitory to CFU-E than CFU-GM growth. The immunoreactivity of EPO was not significantly changed when it was coincubated with SP, SD and PU and measured by radioimmunoassay. PU was found to inhibit noncompetitively the bioactivity of EPO in a CFU-E assay. These data support the hypothesis that polyamines may be important uremic toxins in the anemia of ESRD.

Anemia↗

Epiphyseal replacement using developing tissue donors in a murine model: a combined histologic and radiographic study.

Epiphyseal transplantation has long been a goal of orthopaedic surgeons. While microvascular surgery has raised hopes that this goal could be achieved, factors other than blood supply also appear capable of affecting the function of the epiphysis. Basic research into the biology of the epiphysis appears to be required. This would be facilitated with a model of epiphyseal transplantation using a small mammal. The purpose of this experiment was to develop such a model in the mouse. Developing CD1 mouse or Lewis rat limb tissue was used to replace knee tissue that had been resected from CD1 postnatal mouse hosts. Donor tissue ranged from 14-day embryonic mouse to 9-day postnatal mouse or 18- and 19-day fetal rat, which has a gestation similar to the mouse. The murine tissue is known to be avascular prior to the sixth postnatal day. The limbs were analyzed radiographically and histologically. The results show that epiphyseal replacement could be studied using developing tissue donors in a murine model. The results suggest that donor tissue prior to vascularization and tissue combinations with the least developmental time mismatch (the least heterochronicity) produced relatively the best, although still abnormal epiphyses.

Animals↗

Transaxial tomography: an alternative to computerized tomography in pediatric orthopedic problems.

Because of the information it provides, computerized tomography has gained wide acceptance. However, the radiation delivered is considerable, and the gonads cannot be shielded effectively. Transaxial tomography also produces a cross-sectional image. While the image has less resolution, it is obtained at a fraction of the exposure. The use of transaxial tomography in several clinical situations is outlined here.

Bone Diseases↗

Hospital expansion of ambulatory-care services: implications for pharmacy.

Implications for hospital and community pharmacists of the hospital industry's increased involvement in ambulatory care are discussed. There will certainly be competition between hospital and community pharmacists for the right to provide pharmaceutical services to ambulatory patients. Various developments are encouraging hospitals to expand their ambulatory services, and these will increase the competition and add urgency to minimizing confrontation between the two groups. The need for a forum within pharmacy to discuss difficult issues such as this is emphasized.

Ambulatory Care↗

A comparison of speech intelligibility between esophageal and normal speakers via three modes of presentation.

This study compared intelligibility scores obtained for sentences read by good-to-superior esophageal speakers with scores obtained for sentences read by normal speakers via three modes of presentation: visual, auditory and auditory-visual combined. Statistical analysis showed significant differences between intelligibility scores for esophageal speakers and for normal speakers in the auditory and in the combined conditions. No significant difference was found between the scores for the two groups in the visual condition. Further analysis showed that the esophageal speakers' intelligibility scores improved significantly from the auditory to the combined auditory-visual condition where they most closely approximated, but never equaled, the highest intelligibility scores for normal speakers. Implications of the findings for rehabilitation of esophageal speakers are discussed.

Audiovisual Aids↗

Letter recognition ability of aphasic subjects.

This study examined the letter-recognition abilities of 44 aphasic and 10 normal subjects. On a 26-item letter recognition task normal subjects made no errors. Moderately aphasic subjects illustrated minimal difficulty but did not differ significantly in performance from normals. Severely aphasic subjects exhibited marked impairment and made significantly lower letter-recognition scores than moderate aphasic or normal subjects. Type of aphasia as determined by conversational speech fluency (fluent or nonfluent) seemed to affect the letter-recognition performance of the severely aphasic subjects. Fluent severely aphasic subjects made significantly lower scores than all groups; nonfluent severely aphasic subjects made significantly lower scores than all groups except the severe nonfluent group. The types of letter-recognition errors produced by the two severely aphasic groups offer some explanation as to their performance differences. Errors of the latter group were more likely to be related to the stimulus letter; errors from the former group tended to be random. Findings indicate the intactness of the aphasic subjects's semantic associational network is important to the letter-recognition process.

Adult↗