French healthcare. Les miserables: what drove French doctors onto the streets?
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France↗
Biomedical subjects
S Bach
Publications and source records attributed to S Bach.
Heat-shock protein expression on the membrane of T cells undergoing apoptosis.
Heat-shock proteins (hsp) represent a highly conserved family of proteins, normally localized in the cytoplasm and nucleus, whose expression is induced in situations involving cell stress. This paper reports the unusual translocation of hsp to the cell membrane of T cells undergoing apoptosis. We observed that glucocorticosteroid-induced thymocyte death is associated to the surface expression of hsp 60 and hsp 70 in a discrete fraction of apoptotic cells. hsp surface expression is closely related to a thymic subset of immature CD3low/- T cells. The expression of surface hsp 60 appears early after treatment with dexamethasone (3 hr) whereas the membrane expression of hsp 70 follows different kinetics and peaks later. Morphological analysis of the hsp+ apoptotic cells suggest that this subset represents late-stage apoptotic cells at their minimal volume before fragmentation into apoptotic bodies. Membrane expression of hsp is also associated with apoptosis in peripheral blood mononuclear cells from AIDS patients cultured in vitro. Altogether, we show that a discrete fraction of cells undergoing apoptosis expresses membrane hsp 60 and hsp 70, supporting the hypothesis that apoptosis causes a radical alteration in the expression of cell surface molecules. Surface hsp expressed during apoptosis may constitute a novel immune-context able to generate packages of self- and exogenous antigens, originating from degradation of altered cells.
Acquired Immunodeficiency Syndrome↗
Moving toward managed care: the United Kingdom National Health Service reforms.
The divergence between health care in the United States and the United Kingdom appears to be lessening. Although the starting points of the two countries are quite different, the demand for cost containment in the U.S. and the interest in increased competition in the U.K. have led to a similar emphasis on managed care. The author examines the benefits and problems of reform in the U.K.
Economic Competition↗
CD4-8- T-cells increase in MRI/lpr mice treated with thymic factors.
The in vivo effect of thymic factors on immature lymphocytes was analysed in MRL/lpr mice. This strain carries a genetic defect that causes during their life cycle a block of T-cell differentiation and abnormal proliferation of CD4-8- (double-negative, DN) T-lymphocytes. In vivo administration of four preparations of thymic factors, thymopentin (TP-1), thymopoietin (TP-5), thymolymphotropin (TLT), and thymomodulin (TMD) into young (2-month-old) MRL/lpr mice induced a significant increase of DN T-cells both in the thymus and in the peripheral lymph nodes, with a concomitant decrease of double-positive (DP) T-cells in the thymus and of single-positive (SP) T-cells in the lymph nodes. The level of DNA fragmentation measured as propidium iodide fluorescence was increased in the thymus population of young mice and in the lymph node population of old mice treated with TLT. SCID mice transplanted with lymph node cells from MRL/lpr donors (MRL-->SCID) developed graft versus host (GvH) reaction due to the activation of MRL CD8+ alloreactive T-cells. This model was used to analyse the effect of TMD/TLT in vivo on MRL cell proliferation and expansion; in fact, spleen cells from MRL-->SCID mice after treatment with TMD/TLT showed an increased cell proliferation, and an expansion of DN T-cells with a concomitant decrease of SP cells (both CD4+ and CD8+ cells). Decreased SP cell numbers in this context could explain why TMD/TLT treatment of SCID mice engrafted with MRL cells increased their survival compared to untreated MRL-->SCID mice.
Animals↗
Managing a pluralist health system: the case of health care reform in France.
During the last decade increasing health care expenditure led to persistent difficulties in the financing and management of the French health care system. A series of cost-containment measures in the 1980s and early 1990s concentrated on raising patient contributions and establishing global budgets for public hospitals. These initiatives met with limited success and did not address the issue of hospital management. In 1991 new reforms were instigated to strengthen the public sector and achieve a better balance with the private sector. Although these reforms altered management practice within public hospitals, they failed to tackle the underlying problems of the long-term financing and management of the French health system, ensuring continuing attempts at reform. The French experience provides evidence of the difficulties of reforming a pluralist health system that contains few incentives to stem rising expenditure.
Cost Control↗
[Favorable outcome of severe right cardiac insufficiency after bipulmonary transplantation].
The authors report a long term success of bipulmonary transplantation in a 15 year old girl with cystic fibrosis and respiratory failure complicated by severe right heart failure. The operation did not cause any particular problems. After transplantation, the clinical signs of right ventricular failure and echocardiographic right ventricular dilatation regressed in less than one week. The right ventricular hypertrophy also regressed. Echocardiography shows no abnormality after 5 years' follow-up.
Adolescent↗
Cytotoxic activity of human lymphocytes against differentiated intestinal tumour cell lines.
The natural killer (NK) and lymphokine-activated killer (LAK) cytotoxic activity of human peripheral blood lymphocytes (PBL) against various human tumour cell lines from intestinal origin (WIDR, HT29, Caco-2) has been investigated. The differentiated Caco-2 cells were then used as a model to investigate the cytotoxic activity against enterocyte-like target cells. Caco-2 were seeded on polycarbonate filters and maintained in culture for at least 15 days to allow the differentiation and formation of tight junctions. The integrity of tight junctions was assayed by measuring [3H]mannitol flux from apical to basolateral compartment. Cytotoxic analysis showed that both differentiated and undifferentiated Caco-2 cells were similarly susceptible to NK and LAK activity. The capacity of cytotoxic lymphocytes to kill enterocyte-like cells with intact junctional complex may suggest a direct role of cytotoxic lymphocytes in causing intestinal lesions under inflammatory conditions.
Cell Line↗
Recognition and killing of tumour cells expressing heat shock protein 65 kD with immunotoxins containing saporin.
The expression of heat shock proteins (HSP) of the 65 kD family (groEL) has been observed by flow cytometry using murine monoclonal antibody (MoAb) anti-HSP 65 kD (ML30) on the surface of B (Daudi) or T (H9) lymphoma cells, on a monocyte cell line (U937) and also on a primary culture of a human pancreatic carcinoma (HPC). Moreover, the MoAb ML30 was coupled to Saporin 6, a ribosome-inactivating protein recovered from the seeds of Saponaria officinalis, to kill HSP-expressing cells with a specific immunotoxin. An indirect method using first MoAb ML30 and then anti-mouse IgG1 immunotoxin was also performed. With this method a human serum positive for HSP65-antibodies was tested using anti-human IgG1 or IgM immunotoxins. All cell lines were inhibited when preincubated with the specific immunotoxin directed to HSP65 (ML30 SO6), although H9 cells were susceptible to immunotoxin only after thermal stress. Daudi and HPC cells were inhibited both after long-term culture and when freshly explanted from SCID mice. Proliferation of the U937 monocytic cell line, that constitutively expresses high levels of HSP65 on the surface (as determined by flow cytometry), was completely inhibited (100% inhibition) by the ML30 SO6. However, not all tumour cells constitutively express high levels of surface HSP65, as determined by cytometric analysis. For this reason it was not always possible to obtain complete inhibition of cellular proliferation.
Animals↗
Cytotoxic activity of intestinal lamina propria lymphocytes on human immunodeficiency virus (HIV)-infected cells.
The phenotype and cytotoxic activity of lamina propria lymphocytes (LPL) from the colorectal mucosa have been investigated primarily to analyse the role of LPL in human immunodeficiency virus (HIV) infection. The results reported here show that LPL strictly required a proliferative stimulus [either interleukin-2 (IL-2) or phytohaemaglutinin (PHA) to develop strong in vitro cytotoxicity, since freshly isolated LPL do not exhert cytotoxicity against either natural killer (NK)-sensitive or NK-resistant target cells. The cytotoxicity of activated LPL against a large panel of myeloid tumours or colorectal carcinoma target cells shows the irrelevance of the tissue origin of target cells. Moreover, activated LPL lysed HIV-infected H9 cells more efficiently than peripheral blood lymphocytes (PBL), and were susceptible to HIV infection. In contrast, unstimulated LPL failed to be cytotoxic and susceptible to HIV. Thus, we strongly suggest that for the lymphocytes of the colorectal mucosa expression of cytotoxic activity and susceptibility to HIV-infection show two faces of the same coin, and therefore may be relevant in understanding the mechanisms and paths of transmission of HIV infection.
Cells, Cultured↗
Ethical issues in health care institutions. Lesson three: Hospital ethics committees.
The hospital ethics committee serves as the topic for this third lesson of a five-part WMU/AHRA magazine course on ethics. Proliferating during the last ten years and fostered by the Karen Ann Quinlan case, hospital ethics committees today function in three areas: education, development of guidelines and policies, and individual case consultation. Using specific examples in the discussion of each function, the authors give a detailed picture of the valuable contribution these committees make to the institutions they serve.
Aged↗
Ethical issues in health care institutions. Lesson five: Research ethics.
Well-constructed research protocols provide the mechanism to examine new clinical practices and new approaches to the provision of health care services which can be evaluated in a systematic manner. In order to be consistent with the underlying ethical duties of health care providers, the principle of respect for persons requires fully informed consent of those subjects who can act autonomously. If the subjects have diminished autonomy, special precautions must be taken to protect their interests and welfare if they are to take part in research projects which may be of benefit to them. Research, if it is to be consistent with duties of beneficence, must be directed toward the best interests of the subject. Careful attention must be paid to the assessment of potential benefits and risks, so that the balance of benefit to risk is a favorable one. Considerations of fairness prevent us from inequitably distributing the benefits and risks, thus subjecting the most disadvantaged groups in society to further disadvantage. The requirement for prospective review of research protocols by an IRB is important in protecting the rights, health and welfare of people who take part in research.
Ethics, Institutional↗
The effect of electrical current on healing skin incision. An experimental study.
The effect of electrostimulation on healing of a 6 cm long incision on the dorsum of rats was investigated. Postoperative stimulation was given with direct current (DC) to ten rats, and with alternating current (AC) to ten. Non-stimulated controls were used for each group. The words were biomechanically and biochemically tested three days after the final stimulation. Both DC and AC stimulation caused significant increase of the collagen content around the incision line compared with controls, but the collagen increase did not affect the tensile strength or the energy absorption. Electrostimulation of short duration is concluded to have a minor but significant enhancing effect on the formation of collagen in clean surgical wounds, but no effect on mechanical wound strength in the early postoperative period.
Animals↗
[Early ultrasonic diagnosis of twins after insemination and contralateral embryo transfer in cattle and the results of calving].
In order to test the efficacy of ultrasonic diagnosis of early twin pregnancy, 20 dairy cows were inseminated, and 4-8 days later a seven-day old embryo was additionally transferred into the uterine horn contralateral to the site of ovulation. Sixteen of 20 cows became pregnant (80%). In 7 of 16 animals a twin pregnancy resulted (44%). Out of eight single pregnancies five (62.5%) followed insemination, and three (37.5%) followed egg transfer. Sixteen pregnant animals were examined ultrasonically. In 7 cases it was possible to estimate a twin pregnancy on the 41st day. This diagnosis was verified on parturition. The ultrasonically diagnosed side of pregnant horn in the singles was correct in 7 of 8 cases, identified by the genetical different origin of the offspring from artificial insemination or egg transfer.
Animals↗
[Assault on a field hospital in El Salvador].
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El Salvador↗
Site, size, and tumour involvement of resected extrapulmonary lymph nodes in lung cancer.
A prospective study was performed analyzing resected extrapulmonary lymph nodes of 544 operated lung carcinoma patients. Volume of lymph nodes was determined by weight. Lymph nodes were cut in serial sections 300 microns thick, and the volume of tumour metastasis in each resected lymph node was computed measuring the tumourous area in the lymph node sections. The following results were obtained: Percentage of resected lymph nodes varied with lymph node site and site of the primary lung cancer. Hilar lymph nodes were resected in 50% of the patients, lymph nodes of the main and stem bronchi in 57% and 63%, respectively. Tumour metastases were found in 10%-15% of the resected lymph nodes. The size of the lymph nodes varied to a large amount and was found to be independent of the lymph node site if no metastases could be detected. Lymph nodes measuring less than 0.1 ccm were tumour infiltrated in 9% (77/706 lymph nodes), large lymph nodes (greater than 10 ccm) in 62% of the cases (20/32). Tumourous involved lymph nodes of the main bronchus were found more frequently in cases of central localized lung cancer compared to carcinoma arising from the peripheral lung, where the opposite was seen in subaortal located lymph nodes. The percentage of lymph node involvement and size of tumour infiltrated lymph nodes was found to be independent of tumour cell type. Size of resected lymph nodes is not a reliable parameter for estimating existence of tumour infiltrations.
Adenocarcinoma↗
[Physiologic studies of maturity diagnosis in the calf and its relationship to the postnatal condition].
The parameters of kidney, lung, and skin maturity, known from human medicine, were for the first time determined from amniotic fluid of cattle. Given the difference in placentation, it is not known whether the conditions of the human fetus can be fully applied to the bovine fetus, the detectability of such maturity criteria may be indicative of comparable morphokinetic conditions in the bovine fetus. All physiological parameters investigated exhibited difference to the benefit of surviving calves. Positive correlations were found to exist between the lecithin/sphingomyelin quotient and body weight gain in the first week of age as well as drinking behaviour of the calves. Hence, insufficient concentration of surface-active phospholipids in calf breeding has measurable effects on quantitatively definable characteristics.
Animals↗