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Biomedical subjects

J B Mitchell

Publications and source records attributed to J B Mitchell.

At least 343 records · Page 19Linked to original sources
PubMed1984

Heterogeneity in the radiation survival curves and biochemical properties of human lung cancer cell lines.

Human lung cancers of distinct histology exhibit different responses to radiation therapy in vivo. For examination of the basis of this phenomenon, the radiation survival curves and levels of relevant enzymes were determined in 16 lung cancer cell lines derived from tumors of different histology. These included lines from 5 adenocarcinomas, 7 small cell tumors, 3 variant small cell tumors, and 1 large cell tumor. These findings were compared to those obtained with the use of a normal skin fibroblast cell line. Whether cloned in liquid culture or soft agarose, cell lines had similar radiation survival curves. These curves were consistent with the apparent in vivo radiation responsiveness of the tumors. Although considerable heterogeneity in radiation survival curves was observed among the cell lines, cells from large cell lines and small variant lines had pronounced shoulders and extrapolation numbers (n) from 5.6 to 14. In contrast, cells from small cell lines and adenocarcinoma cell lines were more "sensitive" (-n values of 1-3.3). In these cell lines, levels of DNA polymerase beta, glutathione (GSH), GSH transferase, GSH reductase (NAD(P)H), gamma-glutamyltransferase did not correlate with radiation parameters of sensitivity. DNA polymerase beta and GSH levels were, however, higher than those in a line of normal skin fibroblasts. These cell lines may be useful in identifying the basis of the variable responsiveness of human lung cancer cells to ionizing radiation.

Cell Line↗
PubMed1984

Why do women physicians work fewer hours than men physicians?

Because of the large public investment in medical education, it is important to understand why women physicians work significantly less than men physicians. National survey data on office-based private practice physicians were used to estimate (using two-stage least squares technique) hours and weeks worked for men and women physicians separately. Contrary to conventional wisdom, shorter work weeks for women physicians are not the result of child care responsibilities. Nor would higher earnings encourage women physicians to work longer hours. Instead, we found significant work reductions among married women physicians (but not men), implying subordination of careers by women where combined family incomes are high.

Adult↗
PubMed1984

An economic model of large Medicaid practices.

Public attention given to Medicaid "mills" prompted this more general investigation of the origins of large Medicaid practices. A dual market demand model is proposed showing how Medicaid competes with private insurers for scarce physician time. Various program parameters--fee schedules, coverage, collection costs--are analyzed along with physician preferences, specialties, and other supply-side characteristics. Maximum likelihood techniques are used to test the model. The principal finding is that in raising Medicaid fees, as many physicians opt into the program as expand their Medicaid caseloads to exceptional levels, leaving the maldistribution of patients unaffected while notably improving access. Still, the fact that Medicaid fees are lower than those of private insurers does lead to reduced access to more qualified practitioners. Where anti-Medicaid sentiment is stronger, access is also reduced and large Medicaid practices more likely to flourish.

Fee Schedules↗
PubMed1984

Pharmacological evaluation of intravenous delivery of 5-bromodeoxyuridine to patients with brain tumors.

Previously, 5-bromodeoxyuridine (BrdUrd) has been shown to be an effective radiosensitizing agent in rapidly dividing cells. As part of a Phase I/II study to evaluate BrdUrd as a radiosensitizer in gliomas, the pharmacology was studied in eight patients. BrdUrd was infused using an i.v. route as a 12-hr constant infusion each day for as long as 14 days. BrdUrd steady-state arterial levels are described for three different infusional rates: 1.6 mumol/sq m/min (350 mg/sq m/12 hr) produced a steady-state arterial level of 0.7 microM; 3.2 mumol/sq m/min (700 mg/sq m/12 hr) resulted in 2.1 microM; 5.9 mumol/sq m/min (650 mg/sq m/6 hr) showed a level of 3.9 microM. Because of myelosuppression, the highest tolerable dose for this intermittent long-term infusional therapy with BrdUrd appears to be 700 mg/sq m/12 hr. Contrary to the nonlinear pharmacokinetics of thymidine, 5-fluorouracil, and 5-fluorodeoxyuridine described previously, BrdUrd shows linear behavior in the range studied. BrdUrd still has promise as a radiosensitizer for gliomas in humans, but an alternative means of safe delivery into the carotid artery is needed. Because of an estimated 11- to 16-fold-higher local concentration, use of the intraarterial route could deliver optimum levels of BrdUrd to the tumor with minimal systemic toxicity.

Brain Neoplasms↗
PubMed1983

Radiosensitization of hematopoietic precursor cells (CFUc) in glioblastoma patients receiving intermittent intravenous infusions of bromodeoxyuridine (BUdR).

The potential use of bromodeoxyuridine (BUdR) as a radiosensitizer given by an intermittent intravenous route is being studied in a Phase I/II trial at the National Cancer Institute. In order to assess the extent of radiosensitization, we have studied the radiation response of human bone marrow cells CFUc taken from 6 patients prior to and after a 14-day infusion of BUdR. Varying concentrations (1000-1500 mg) of BUdR were infused for 12 hours every 24 hours for up to 14 consecutive days. Cell survival was determined by colony formation of CFUc in soft agar suspension. X ray survival curves were generated over a dose range of 0-300 rad and the slopes of the survival curves (DO) before and after BUdR infusion were compared. Radiation enhancement ratios (ER) (DO pre-BUdR/DO post-BUdR) ranged from 1.0-2.2 and appeared to be BUdR dose dependent. Above 650 mg/m2, the radiation ER was greater than or equal to 1.5. Dose dependent systemic toxicity to bone marrow and skin was also observed with intermittent intravenous infusions of BUdR. From our study, it appears that an intravenous dose of less than 700 mg/m2/12 hours is well tolerated and may result in radiosensitization of CFUc in man.

Adult↗
PubMed1983

Nonprotein thiols and the radiation response of A549 human lung carcinoma cells.

Glutathione (GSH)-depletion by buthionine sulphoximine (BSO) altered both the aerobic and anaerobic radiation response of A549 human lung cancer cells grown in vitro. The oxygen enhancement ratio (o.e.r) was increased slightly from 3.0-3.3. The lack of an effect of GSH-depletion on o.e.r. reduction, provides a system whereby the mechanism of action of the thiol reactive reagent diethylmaleate (DEM) can be investigated. Pretreatment of cells with DEM, under non-toxic concentrations, removed 13 per cent of the intracellular NPSH and resulted in an o.e.r. of 2. When BSO followed by DEM was used, so that both GSH and NPSH were reduced to zero, an o.e.r. of 1.5 was obtained. Cells treated with 1 mM BSO for 24 hours contained 10 per cent NPSH and no GSH. When these cells were exposed to 0.5 or 1 mM DEM briefly, during irradiation, the o.e.r. was 2.4 and 1.7 respectively. In some cases altered o.e.r.s occurred in combination with increased aerobic responses. This was especially true for aerobic irradiations of BSO-treated cells in the presence or absence of DEM. However, the increased aerobic response was offset by a more dramatic increase in the hypoxic response. These results indicate (a) that GSH plays a significant role in aerobic radiation response but is not a principal factor in o.e.r.-reduction, and (b) that reduction of the o.e.r. by DEM is not due primarily to GSH-removal. The preferential radiosensitization of hypoxic cells by DEM may involve reactions of this compound with NPSH or protein SH, or may be related to the ability of DEM to mimic oxygen as a hypoxic cell radiosensitizer.

Aerobiosis↗
PubMed1983

Medicaid participation by medical and surgical specialists.

Most studies of physician participation in Medicaid have focused on primary care physicians, but access by the poor to specialists' services is also a policy concern. This study examined Medicaid participation rates for a national sample of 2291 private practice physicians in nine medical and surgical specialties. Four fifths of the specialists treated at least some Medicaid patients, with an average case load of 11.2% Medicaid patients, rates very similar to those obtained elsewhere for primary care physicians. Surgical specialists, especially ophthalmologists, otolaryngologists, and urologists, were the most willing to participate, and cardiologists were the least willing. Multivariate analysis confirmed the importance of Medicaid programmatic characteristics on both physician entry and level of participation. A 10% increase in the Medicaid fee would raise specialist participation by 3%. Other factors encouraging participation included faster claims processing, fewer limits on the quantity of services covered, and more generous eligibility criteria.

Economics, Medical↗
PubMed1983

Bromodeoxyuridine in tumors and chromosomes detected with a monoclonal antibody.

Using a monoclonal antibody to bromodeoxyuridine (BUdR) and immunohistochemistry, we measured the incorporation of this thymidine analogue into the DNA of human normal and malignant cells exposed in vivo. BUdR given as a constant intravenous infusion for 12 or 24 h daily for up to 13 d resulted in a steady-state plasma level of 10(-6) M during the infusion. We demonstrated extensive incorporation of BUdR into both normal skin, normal bone marrow, and malignant melanoma cells. In addition, this infusion of BUdR was adequate to identify sister chromatid exchanges from human marrow chromosomes exposed in vivo. Using this constant infusion, significant but reversible (acute) toxicity was observed with myelosuppression and skin photosensitivity. These techniques, which are considerably less cumbersome and time-consuming than the use of radioactive isotopes of thymidine, can be used for further human studies of cell kinetics and chromosomal replication in both normal and malignant cells.

Animals↗
PubMed1983

Impact of an all-or-nothing assignment requirement under Medicare.

In an effort to raise assignment rates, some policymakers have considered dropping Medicare's case-by-case assignment option. Physicians would have to decide whether to accept all of their patients on assignment, or none of them. In a 1976 national survey, over two-thirds of the physicians stated they would take none of their patients on assignment if forced to choose. Simulation analysis showed that in that event, assignment rates nationwide would fall almost 10 percent. The mean supply of assigned visits would actually increase 11 percent for general practitioners, while decreasing 12-25 percent for general surgeons, internists, and obstetricians/gynecologists.

Decision Making↗
PubMed1983

In vitro radiation and chemotherapy sensitivity of established cell lines of human small cell lung cancer and its large cell morphological variants.

The in vitro response to radiation and chemotherapeutic drugs of cell lines established from 7 patients with small cell (SC) lung cancer were tested using a soft agarose clonogenic assay. Five cell lines retained the typical morphological and biochemical amine precursor uptake decarboxylation characteristics of SC, while two cell lines had undergone "transformation" to large cell (LC) morphological variants with loss of amine precursor uptake decarboxylation cell characteristics of SC. The radiation survival curves for the SC lines were characterized by D0 values ranging from 51 to 140 rads and extrapolation values (n) ranging from 1.0 to 3.3. While the D0 values of the radiation survival curves of the LC variants were similar (91 and 80 rads), the extrapolation values were 5.6 and 11.1 In vitro chemosensitivity testing of the cell lines revealed an excellent correlation between prior treatment status of the patient and in vitro sensitivity or resistance. No correlation was observed between in vitro chemosensitivity and radiation response. These data suggest that transformation of SC to LC with loss of amine precursor uptake and decarboxylation characteristics is associated with a marked increase in radiation resistance (n) in vitro. The observation of a 2- to 5-fold increase in survival of the LC compared to the SC lines following 200 rads suggests that the use of larger daily radiation fractions and/or radiation-sensitizing drugs might lead to a significantly greater clinical response in patients with LC morphology. This clinical approach may have a major impact on patient response and survival.

Antineoplastic Agents↗
PubMed1983

Thiols, thiol depletion, and thermosensitivity.

Hyperthermia sensitization or tolerance is subject to cellular events that may occur at membrane, nuclear, and cytoplasmic sites. We have studied the effects of elevated temperatures on the oxidative-reductive state of the cell by measuring and altering glutathione (GSH) concentrations. GSH plays a pivotal role in maintaining the overall cellular redox state and detoxification of peroxides. Continuous heating at 42.5 degrees C or acute exposure at 43 degrees C or 45.5 degrees C resulted in rapid elevations of cellular GSH to 120-200% of control values. Qualitatively, the more severe the heat exposure, the quicker the maximal GSH levels are attained. Ethanol, a compound that also induces thermal tolerance, likewise increases intracellular GSH concentrations. GSH depletion by two different modalities, diethylmaleate (DEM) and buthionine sulfoximine (BSO), results in thermal sensitization. It was demonstrated that once thermotolerance has been induced, depletion of GSH has minimal effects on subsequent heating and thermotolerance. Heat shock protein (HSP) synthesis is lessened by treatment with buthionine sulfoximine; the extent of the decrease in HSP production correlates with the decrease in thermotolerance. The exogenous thiol cysteine combined with heat treatment results in thermosensitization. Exogenous cysteine is found to oxidize to cysteine and to enhance oxygen consumption. The use of N-acetylcysteine resulted in less oxygen consumption and less thermosensitization. A proposed mechanism of peroxide-induced cell damage is suggested by exogenous thiols, as well as an involvement of GSH in the initial aspects of thermotolerance induction.

Acetylcysteine↗
PubMed1983

Cellular glutathione depletion by diethyl maleate or buthionine sulfoximine: no effect of glutathione depletion on the oxygen enhancement ratio.

The hypoxic and euoxic radiation response for Chinese hamster lung and A549 human lung carcinoma cells was obtained under conditions where their nonprotein thiols, consisting primarily of glutathione (GSH), were depleted by different mechanisms. The GSH conjugating reagent diethylmaleate (DEM) was compared to DL-buthionine-S,R-sulfoximine (BSO), an inhibitor of glutathionine biosynthesis. Each reagent depleted cellular GSH to less than 5% of control values. A 2-hr exposure to 0.5 mM DEM or a 4- or 24-hr exposure to BSO at 10 or 1 mM, respectively, depleted cellular GSH to less than 5% of control values. Both agents sensitized cells irradiated under air or hypoxic conditions. When GSH levels are lowered to less than 5% by both agents, hypoxic DEM-treated cells exhibited slightly greater X-ray sensitization than hypoxic BSO-treated cells. The D0's for hypoxic survival curves were as follows: control, 4.87 Gy; DEM, 3.22 Gy; and BSO, 4.30 Gy for the V79 cells and 5.00 Gy versus 4.02 Gy for BSO-treated A549 cells. The D0's for aerobic V79 cells were 1.70 Gy versus 1.13 Gy, DEM, and 1.43 Gy for BSO-treated cells. The D0's for the aerobic A549 were 1.70 and 1.20 for BSO-treated cells. The aerobic and anoxic sensitization of the cells results in the OER's of 2.8 and 3.0 for the DEM- and BSO-treated cells compared to 2.9 for the V79 control A549. BSO-treated cells showed an OER of 3.3 versus 3 for the control. Our results suggest that GSH depletion by either BSO or DEM sensitizes aerobic cells to radiation but does not appreciably alter the OER.

Animals↗
PubMed1983

Glutathione elevation during thermotolerance induction and thermosensitization by glutathione depletion.

Chinese hamster V79 cells were made thermotolerant by either continuous heating at 42.5 degrees or by fractionated 43 degrees exposures with interfraction incubation at 37 degrees. For both methods of thermotolerance induction, elevations in cellular glutathione (GSH) were observed. Additionally, GSH was also shown to be elevated following a 1-hr exposure to 6% ethanol, which also induces thermotolerance. These elevations in cellular GSH preceded thermotolerance induction in regard to cell survival. To determine if a reduction in cellular GSH prior to or during heating at 42.5 degrees would influence thermotolerance, GSH levels were reduced by either pretreatment with diethylmaleate, an agent that binds GSH, or treatment during heating with buthionine sulfoximine, an agent that inhibits GSH synthesis. Both depleting protocols resulted in thermosensitization. These data suggest that GSH may be important in the early cellular response to thermal stress.

Animals↗
PubMed1982

Physician behavior under the Medicare assignment option.

Using a national sample of general practitioners, internists, and general surgeons, we analyzed the willingness of physicians to accept Medicare patients on assignment. Assignment rates were found to be very sensitive to reimbursement and administrative practices under Medicare. A ten percent increase in the prevailing charge, for example, raised assignment by 14.7 percent. The assigned and non-assigned components of the Medicare program were found to compete with each other; assignment rates were lower where the demand for non-assigned services was stronger. As for the kinds of physicians who take assignment, they were disproportionately general surgeons and foreign medical graduates.

Aged↗
PubMed1982

Medicaid participation by psychiatrists in private practice.

Using national survey data, the authors examined the characteristics of psychiatrists in private practice who treat Medicaid patients. They found that the average Medicaid participation rate was 8%; 39.9% of psychiatrists did not see any Medicaid patients. Participating psychiatrists were more likely to be foreign medical graduates and to have a hospital-oriented practice. Psychiatrists with large Medicaid practices saw significantly more patients per week but spent less time with them. These psychiatrists were also disproportionately located in the West. The authors conclude that these variations are a result of state program differences in Medicaid reimbursement and eligibility policies.

Appointments and Schedules↗
PubMed1982

Response of human hematopoietic precursor cells (CFUc) to hyperthermia and radiation.

Currently, whole-body and local hyperthermia is being evaluated in clinical studies as a potential method of cancer treatment. Since the hyperthermic sensitivity of normal human bone marrow cells is not known, we have studied the in vitro response of these cells to two anticancer modalities when administered alone or in combination. Cell survival following various treatment schedules was determined by colony formation of bone marrow cells (CFUc) in soft agar suspensions. Within the survival range studied, a thermal tolerant plateau on the cell survival was not observed for temperatures of 42 degrees or less. However, thermotolerance induction could not be ruled out. In addition, when hyperthermia (42.5 degrees for 1 hr) and radiation (100 rads) were sequenced, the human CFUc survival remained the same regardless of whether the radiation was administered before, during, or after the hyperthermic exposure. Under our experimental conditions, we found the human CFUc to be more radiosensitive (D0 = 84 rads) than what has been reported previously. The radiation survival response of human CFUc was similar for cells irradiated either in vitro or in vivo. The possible clinical implications for these data are discussed.

Cell Survival↗