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PubMed1993

No longer destined to eat their young: satisfaction among Army family practice faculty.

In January 1987, all 63 faculty members at Army Family Practice Residencies received satisfaction questionnaires. Fifty-nine faculty (93.8%) responded with 40 (67.8%) being satisfied and 19 (32.2%) dissatisfied. Compared to faculty 7 years prior, these faculty are slightly older, have more practice experience, more opportunities for fellowship training, and are less likely both to have remaining mandatory military obligation and to leave the Army after 3 years. The key areas of faculty development, control over professional life, administration, and departmental goals and objectives truly discriminated satisfaction from dissatisfaction. A strategy to systematically develop potential faculty and reduce dissatisfaction is proposed.

Faculty, Medical↗
PubMed1996

[Endovascular treatment of arteries with cerebral destination: failures and limits].

OBJECTIVE: Evaluate endovascular treatment of vessels irrigating the brain. Assess risks and indications of balloon angioplasty and stents. METHODS: Retrospective study in 38 patients (6 females, 32 males) who underwent revascularization from December 1990 to July 1995: 47 balloon angioplasties and 17 stents (36%). Three patients were asymtomatic, 17 had a past history of transient ischaemia, 5 had amauraosis, 9 signs of vertebrobasilar insufficiency and 2 had an ischaemia of the upper limbs. Endoluminal treatment was performed in 4 brachiocephalic trunks with implantation of 1 stent, in 7 common carotid arteries with 4 stents, in 24 internal carotid arteries with 9 stents, 2 osteal stenosis of the vertebral artery and one external carotid. RESULTS: There were no complications in patients treated for lesions of the brachiocephalic trunk, the subclavian artery and the vertebral arteries. Among the 7 patients with a stenosis of the common carotid artery, there was one death after reperfusion due to cerebral oedema. For the carotid internal, two groups of patients could be distinguished. In one group of 13 patients with restenosis of the internal carotid artery who were treated by balloon angioplasty, there were 3 transient episodes of ischaemia, one reversible hemiplegia and one silent infarction. A second group of 8 patients had atheromatous stenosis. One was treated by balloon angioplasty with one transient episode of ischaemia and the 7 others were treated with a stent without complications. The rate of neurological complications was 15.7% (6 deficits in 38 patients). The permeability after revascularization was verified at mid-term with repeated echo-Doppler examinations and by angiography one year after operation. Restenosis occurred early after one subclavian stent covered with a patch. Among the 16 Palmaz stents, one implanted in a post-irradiation common carotid occluded after 2 months. The other 15 stents were patent at a mean follow-up of 18 months (2-56), i.e. 93%. There were 2 restenoses after balloon angioplasty in the group of carotid restenosis, i.e. 15%. CONCLUSIONS: Risk in balloon angioplasty of arteries irrigating the brain is a serious problem. Stenosis of the subclavian artery and the vertebral arteries appears to be a good indication. Lesions of the carotid bifurcation should not be treated with balloon angioplasty due to the risk of neurological complications. Among the restenosis after endarterectomy, only those lesions situated in the distal internal carotid are good indications. Stents have greatly improved treatment possibilities. They should be implanted whenever there is a risk of supra-aortic lesions and in certain lesions of the carotid bifurcation in high-risk, patients. Their application in all situations cannot be proposed yet before long-term outcome is established.

Angioplasty, Balloon↗
PubMed1996

Apolipoprotein B-100 destined for lipoprotein assembly and intracellular degradation undergoes efficient translocation across the endoplasmic reticulum membrane.

It has been proposed that inefficient translocation across the endoplasmic reticulum (ER) membrane gives rise to transmembrane forms of apolipoprotein B-100 (apoB). However, we previously demonstrated that the amino-terminal 50% of apoB (apoB-50) was efficiently translocated across the ER membrane in the nonhepatic cell line COS-1. To determine whether liver-specific factors modulate apoB membrane translocation or topology, hybrid proteins containing 300 amino acid overlapping segments of apoB-48 were transiently expressed in HepG2 cells and their protease sensitivities were examined in membrane vesicles. The hybrid proteins demonstrated the same range of protection from exogenously added protease (75-100%) as a transfected secretory control protein. When endogenous apoB was examined, its protection from trypsin in intact membranes was -80%, a value similar to that of two endogenous secretory control proteins, transferrin and alpha 2-macroglobulin. No discretely sized fragments of apoB were generated by trypsin digestion of membranes unless they were first permeabilized with detergent. In contrast to the behavior of apoB and other control proteins, albumin predominantly resisted degradation by trypsin in both intact and detergent permeabilized membranes. HepG2 cells were treated with ALLN, a protease inhibitor that has been proposed to inhibit the turnover of partially translocated forms of apoB. Although an -6-fold increase in intracellular apoB was observed in ALLN-treated cells, no corresponding increase in protease sensitivity was observed. These results indicate that the efficient translocation of apoB across the ER membrane occurs independently of its ability to undergo assembly into a secretion competent lipoprotein.

Apolipoprotein B-100↗
PubMedDate not supplied

Is dentistry destined to follow medicine in managed care?

Our professional calling is to assist our patients in reaching and maintaining a state of good oral health. If managed care assists in that effort, that's good. However, if we can identify and eliminate poor dental HMOs and identify the quality plans, dentistry will begin to realize that keeping people well can be as financially and professionally rewarding as treating disease. Is dentistry headed down the same path as medicine? Unfortunately, the answer is not clear. What is clear is that managed care is here and will impact significantly on dentistry, both positively and negatively. An opportunity exists to mold managed care into a form that is acceptable to dentists and improve the oral health of Americans on a cost-effective basis. However, we as dentists must act, and react, in a rational and logical manner if we are to have a voice in shaping the future of dental benefits and how they will be provided.

Economic Competition↗