PubMed Health⌕ Search

Biomedical subjects

L A Burns

Publications and source records attributed to L A Burns.

At least 19 recordsLinked to original sources

Physicians and group practice: balancing autonomy with market reality.

Developing or joining multispecialty group practices is emerging as a premier competitive strategy for physicians. "Physicians and Group Practice: Balancing Autonomy with Market Reality" explores the driving forces causing the restructure of physician services into multispecialty group practices. The growth and characteristics of group practices are outlined as well as the advantages and trade-offs inherent in a group practice.

Capitation Fee↗

Strategic business planning for the multispecialty group practice.

A clear plan for guiding the activities of the multispecialty group practice (GP) is critical for ensuring success as the health care industry undergoes profound change. This article describes the process of developing a strategic business plan, and includes examples of pertinent analyses as well as practical considerations for ensuring successful development of a strategic business plan for a GP.

Ambulatory Care Information Systems↗

Managing space for managed care: the challenge for a multispecialty group practice.

A project that began as an architectural study to determine space requirements and remedy space deficiencies for an academic medical center's faculty multispecialty group practice led to development of an analytical methodology for assessing real space needs and viable options for solutions in the context of the group's operational policies, physician practice patterns, and business goals. Major facility investments for new or renovated construction demand significant capital expenditure, which can severely affect a group's ability to complete as a financially viable player in a marketplace environment of increasingly competitive managed care delivery systems. The methodology created during this project helped the group practice to understand how they could optimize the use of existing space, minimize capital costs, and provide flexibility for future developments.

Academic Medical Centers↗

Interleukin-2 triggers a novel phosphatidylinositol 3-kinase-dependent MEK activation pathway.

Phosphatidylinositol 3-kinase (PI3-K) has been implicated as a signal-transducing component in interleukin-2 (IL-2)-induced mitogenesis. However, the function of this lipid kinase in regulating IL-2-triggered downstream events has remained obscure. Using the potent and specific PI3-K inhibitor, wortmannin, we assessed the role of PI3-K in IL-2-mediated signaling and proliferation in the murine T-cell line CTLL-2. Addition of the drug to exponentially growing cells resulted in an accumulation of cells in the G0/G1 phase of the cell cycle. Furthermore, wortmannin also partially suppressed IL-2-induced S-phase entry in G1-synchronized cells. Analysis of IL-2-triggered signaling pathways revealed that wortmannin pretreatment resulted in complete inhibition of IL-2-provoked p70 S6 kinase activation and also attenuated IL-2-induced MAP kinase activation at drug concentrations identical to those required for inhibition of PI3-K catalytic activity. Wortmannin also diminished the IL-2-triggered activation of the MAP kinase activator, MEK, but did not inhibit activation of Raf, the canonical upstream activator of MEK. These results suggest that a novel wortmannin-sensitive activation pathway regulates MEK and MAP kinase in IL-2-stimulated T lymphocytes.

Androstadienes↗

Immunotoxicity of nitrobenzene in female B6C3F1 mice.

Nitrobenzene (NBZ) is primarily employed as an oxidizing agent in the synthesis of analine and benzene compounds. It produces myelotoxic effects and effects on erythrocytes in both animal models and man. Reported hepatosplenomegaly and effects on the bone marrow are indicators that NBZ may be immunotoxic. In these studies, female B6C3F1 mice were exposed to 30, 100 and 300 mg/kg of NBZ in corn oil by gavage for 14 consecutive days. To assess the immunotoxic potential of NBZ, body and organ weights were determined and selected immunologic and host resistance responses were studied. In these studies, the liver and spleen appeared to be the primary target organs. Both liver and spleen weights were dose dependently increased. Gross histopathologic examinations revealed significant changes in the spleen, consisting of severe congestion of the red pulp areas with erythrocytes and reticulocytes. Serum chemistry profiles showed increases in alanine aminotransferase and aspartate aminotransferase activities, indicating liver toxicity. Hematologic studies showed a decrease in erythrocyte number and a concomitant increase in mean corpuscular hemoglobin and mean corpuscular volume. A dose-dependent increase in peripheral reticulocytes was also seen. DNA synthesis was enhanced, as was the number of formed elements and the number of monocyte/granulocyte stem cells in the bone marrow of treated mice. IgM responses were decreased and the phagocytic activity of macrophages in the liver was dose dependently increased with a concomitant decrease in the activities in the spleen and lung. Other immunological parameters examined were unchanged. Host resistance to microbial or viral infection was not markedly altered by NBZ; however, there were trends towards increased susceptibility where T-cell function contributes to host defense. These data indicate that NBZ-induced hemolysis and liver injury are linked to the observed alterations in bone marrow activity.

Administration, Oral↗

Immunotoxicity of mono-nitrotoluenes in female B6C3F1 mice: I. Para-nitrotoluene.

para-Nitrotoluene (p-nitrotoluene) is used primarily as an intermediate in the production of various dyes, explosives, pharmaceuticals, and in the production of rubber and agricultural products. Previous investigations indicated that p-nitrotoluene was mutagenic in the Ames Test and that other mono-substituted nitrotoluenes bound covalently to hepatic macromolecules. The objective of these studies was to evaluate the potential immunotoxicity of p-nitrotoluene in mice exposed by the oral route. Mice exposed to p-nitrotoluene (200-600 mg/kg) daily for 14 days showed modest dose-dependent increases in liver and spleen weights. The livers of mice exposed subchronically to 400 and 600 mg/kg showed a mild to moderate swelling of the hepatocytes adjacent to the central veins; this swelling appeared to be reversible and there was no evidence of necrosis. The proportion of monocytes in blood was decreased in mice treated with p-nitrotoluene or toluene. Serum chemistries, bone marrow cellularity and the number of CFU-M and CFU-GM were unaffected. Immunologic investigations showed p-nitrotoluene suppressed the IgM response to sRBC and the DHR response to KLH. There was a 24% decrease in the percentage of CD4+ T lymphocytes in the spleen. There was no dose-dependent alteration of peritoneal macrophage numbers or differential count, unstimulated natural killer cell activity, response to B cell mitogen LPS, C3 activity or interferon levels. Exposure of mice to p-nitrotoluene decreased resistance to Listeria monocytogenes but not to Streptococcus pneumoniae, Plasmodium yoelii or the B16F10 melanoma, and increased resistance to the PYB6 tumor. These studies indicated that the immune system is an important target for toxicity of p-nitrotoluene. The decreased host resistance to L. monocytogenes can be attributed to the decrease in T lymphocytes and to a decreased delayed hypersensitivity response to KLH.

Administration, Oral↗

Immunotoxicity of mono-nitrotoluenes in female B6C3F1 mice: II. Meta-nitrotoluene.

The nitrotoluenes are chemicals used in dyes, agricultural products, pharmaceuticals and explosives. In the present studies, the toxicology and immunotoxicity of meta-nitrotoluene (m-nitrotoluene) were evaluated. Mice, exposed to m-nitrotoluene at dose levels of 200, 400 and 600 mg/kg/body weight for 2 weeks by gastric gavage, gained body weight over the treatment period to a slightly greater extent than the control groups. Of the selected organs weighed, the liver and kidney of mice exposed to m-nitrotoluene were increased in weight while the thymus weight was decreased. The liver of mice exposed to m-nitrotoluene, but not ortho-nitrotoluene, showed slight to moderate swelling of the hepatocytes adjacent to the central veins. The hepatocyte swelling appeared to be reversible and there was no evidence of necrosis. The hematology and serum chemistries examined were unaffected by m-nitrotoluene exposure although there were modest decreases in the percentage of polymorphonuclear leukocytes and eosinophils in differential blood counts. Bone marrow cellularity and the number of CFU/M and CFU/GM were unaffected by m-nitrotoluene exposure. m-Nitrotoluene suppressed the IgM response to sRBC and the DHR response to KLH. There was a slight (8%) decrease in the percentage of B lymphocytes in the spleen. The response to the T cell mitogens was suppressed by as much as 39%. Fc-mediated adherence and phagocytosis of chicken erythrocytes and NK cell activity were increased dose dependently in mice exposed to m-nitrotoluene. Several immune parameters were unaffected by exposure to m-nitrotoluene, including the IgG response to sRBC, responses to the B cell mitogen LPS and to allogeneic cells, and serum interferon levels. Resistance to Streptococcus pneumoniae and Plasmodium yoelii were unaffected also. Resistance to the tumor model PYB6 was increased. Exposure of mice to m-nitrotoluene decreased resistance to Listeria monocytogenes. The decreased resistance to L. monocytogenes may be related to an effect on T cells, evidenced by a decrease in T cell numbers and in the DHR.

Administration, Oral↗

Immunotoxicity of 2,4-diaminotoluene in female B6C3F1 mice.

2,4-Diaminotoluene (DAT) has been demonstrated to be a potent carcinogen. The present studies were carried out to determine the toxic and immunotoxic potential of DAT. Mice exposed to DAT at 25-100 mg/kg per day for 14 days by gavage showed a 42% increase in liver weight and a slight decrease in spleen weight. Histopathologic evaluation of selected organs showed the liver to be the major target with morphological changes which were dose dependent. The high dose (100 mg/kg) was associated with moderate centrilobular necrosis. No abnormal structure was noted in the spleen, lungs, thymus, kidney or mesenteric lymph nodes. The liver toxicity was associated with an elevation in alanine aminotransferase activity. The only change noted in selected hematologic parameters was a 64% increase in peripheral blood leukocytes. Mice exposed to DAT showed a decreased IgM and IgG response to sheep erythrocytes. The decrease was not a function of a decreased number of B cells because the number of B cells increased dose dependently. Proliferative capacity of immunocompetent cells was not impaired by exposure to DAT as measured by the response to several mitogens. The delayed hypersensitivity response to keyhole limpet hemocyanin in mice exposed to DAT was increased. Natural killer cell activity was decreased dose dependently and may represent a spleen cell pool shift because the number of B cells increased in the presence of a decreasing spleen size. Serum C3 was suppressed at the high dose of DAT. Phagocytosis by splenic macrophages, but not peritoneal macrophages, was inhibited by DAT exposure. DAT exposure for 14 days decreased host resistance to the bacteria, Streptococcus pneumoniae and Listeria monocytogenes, while host resistance to the pulmonary tumor model, B16F10, and the PYB6 fibrosarcoma was unaffected by DAT exposure. These data indicate that DAT is hepatotoxic and perturbs the differentiation and maturation of leukocytes.

Administration, Oral↗

Gallium arsenide-induced increase in serum corticosterone is not responsible for suppression of the IgM antibody response.

Previous investigations demonstrated gallium arsenide (GaAs) to be an immunosuppressive agent that alters the function of all cell types involved in the generation of a primary antibody response. In those studies, GaAs was administered as a particulate compound that remained in the lung at least 14 days after exposure. The extended presence of the particulate in the lung may induce a stress response that leads to the release of endogenous corticosteroids. In addition, some of the observed immunomodulatory effects of GaAs were similar to immunological alterations reported to be induced by corticosteroids. The present studies were designed to determine whether suppression of the immunoglobulin (Ig) M antibody-forming calls (AFC) response by GaAs was a result of a GaAs-induced increase in serum corticosterone. GaAs (50-200 mg/kg) significantly decreased the weights of both the thymus and spleen and the cellularity of the spleen. In addition, there was a GaAs-induced decrease in the CD4+/CD8+ thymocyte subpopulations and a concomitant increase in CD4+ and CD8+ cells. Within the spleen, there were no alterations in the percentages of CD4, CD8 or Ig-positive cells. However, when expressed as an absolute cell number, there was a 50% decrease in the numbers of CD4+ and CD8+ cells in the spleen. GaAs also dose-dependently suppressed (50-75%) the IgM AFC response. The GaAs-induced changes in cell populations and immune organ weights were correlated with an increase (6- to 10-fold) in serum corticosterone levels. The treatment of mice with the glucocorticoid antagonist mifepristone (also called RU 486) blocked the observed alterations in splenic and thymic cell populations induced by GaAs.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Interleukin-2-induced tyrosine phosphorylation of p52shc in T lymphocytes.

Stimulation of activated T cells with interleukin-2 (IL-2) results in the tyrosine phosphorylation of several intracellular proteins. The present studies demonstrate that IL-2 stimulation induces phosphorylation of the src homology 2 domain-containing protein, p52shc, on both tyrosine and serine residues. The level of p52shc phosphorylation was maximal within 5 min after growth factor addition and declined gradually thereafter. In addition, anti-Shc immunoprecipitates from IL-2-stimulated T cells contained a co-precipitating protein tyrosine kinase (PTK) activity that phosphorylated p52shc on tyrosine residues in immune complex kinase assays. These results demonstrate that p52shc is an early substrate for IL-2 receptor-coupled PTK activity(s) and suggest that this protein may be involved in the transduction of PTK-dependent regulatory signals in IL-2-stimulated T cells.

Adaptor Proteins, Signal Transducing↗

Inhibition of protein tyrosine phosphatase by the antitumor agent gallium nitrate.

Protein tyrosine phosphatases (PTPases) play an important role in regulating cell growth and transformation. We report that the antitumor agent gallium nitrate is a potent inhibitor (concentration producing 50% inhibition, 2-6 microM) of detergent-solubilized cellular membrane PTPase from Jurkat human T-cell leukemia cells and HT-29 human colon cancer cells. This is the first report of a selective, small molecule drug inhibitor of PTPase. Gallium nitrate did not inhibit CD45, a PTPase found in the membranes of hemopoietic lineage cells such as Jurkat cells. Studies with gallium nitrate and a series of gallium-containing analogues revealed no correlation between growth-inhibitory activity in Jurkat and HT-29 cells and the ability to inhibit detergent-solubilized PTPase. Gallium nitrate and most of the gallium analogues penetrate poorly into cells. In contrast, a gallium-hydrogen peroxide complex inhibits DNA synthesis in Jurkat cells and induces the accumulation of phosphotyrosines on multiple intracellular proteins in this cell line. Gallium-hydrogen peroxide complex and gallium nitrate have similar inhibitory activity toward detergent-soluble PTPase. This is a new mechanism of action for gallium nitrate but it is not known if the inhibition of PTPase is related to the antitumor activity of gallium nitrate.

3T3 Cells↗

Stimulatory effects of the protein tyrosine phosphatase inhibitor, pervanadate, on T-cell activation events.

Ligation of the multimeric T-cell antigen receptor complex (TCR) triggers a pleiotropic cellular activation response that includes lymphokine secretion, cell-cycle progression, and ultimately, T-cell proliferation. The earliest detectable biochemical event triggered by TCR cross-linkage is the tyrosine phosphorylation of specific intracellular proteins, which, in turn, propagate receptor-mediated signals into the cytoplasm and nucleus. In this study, we have examined the effects of pervanadate, a powerful inhibitor of protein tyrosine phosphatases (PTP), on the activation state of the human leukemic T-cell line, Jurkat. Treatment of Jurkat cells with pervanadate rapidly induced a series of proximal T-cell activation events that closely resembled those induced by TCR-dependent stimuli. Moreover, pervanadate treatment, like TCR cross-linkage, stimulated interleukin-2 production in wild-type Jurkat cells, indicating that the biochemical events initiated by this TCR-independent stimulus were sufficient to induce lymphokine gene expression. Exposure of intact cells to pervanadate also stimulated the in vitro catalytic activities of both p59fyn and p56lck, src family kinases strongly implicated in TCR-mediated signaling. The stimulatory effects of pervanadate on protein tyrosine kinase-mediated signaling events were accompanied by a marked inhibition of CD45-associated PTP activity. However, the ability of pervanadate to stimulate tyrosine phosphorylation in CD45-negative Jurkat cells suggests that PTPs other than CD45 are important intracellular targets for pervanadate. These studies demonstrate that inhibition of PTP activities in Jurkat cells leads to a T-cell activation response that is remarkably similar to that induced by TCR crosslinkage.

Catalysis↗

A halo jacket for stabilisation of the paediatric cervical spine.

Stabilisation of the paediatric cervical spine may be necessary in the management of trauma, infection and deformity. Surgery is technically difficult due to the immaturity of the bony elements and therefore external support is generally preferred. Our experience of halter traction and Minerva casts is that they either fail to achieve stability or are poorly tolerated. Halo pins are associated with significant pin tract complications in children. The technique for application of a plaster halo jacket is presented, together with the results of its use in eight children. Attention is drawn to the ease of application, tolerance by the patients and absence of significant complications.

Cervical Vertebrae↗

Gallium arsenide selectively inhibits T cell proliferation and alters expression of CD25 (IL-2R/p55).

Exposure (24 hr) to a single intratracheal administration of gallium arsenide (GaAs; 200 mg/kg) has been shown to suppress antibody production as well as other T cell-mediated immunological functions. GaAs has also been shown to exert toxic effects on events occurring early in the antibody-forming cell response which may include lymphocyte activation and proliferation. Studies were undertaken to determine whether GaAs exposure resulted in the inability of T and B lymphocytes to proliferate in response to an antigenic stimulus. During the first 24 hr after in vitro immunization with sheep red blood cells, GaAs-exposed splenocytes were suppressed 51% in their ability to proliferate compared to the vehicle (0.05% Tween 80 in saline; VH) control. There was no significant difference in absolute numbers of cluster designation (CD)8+ cells between VH- and GaAs-exposed cultures. There was, however, a 50% decrease in CD4+ cells evaluated 24 hr after immunization with sheep red blood cells which persisted for the 5-day culture period. T and B cells were isolated and analyzed for proliferative capacity in response to various mitogenic stimuli. Isolated B cells exhibited no difference between VH- and GaAs-exposed cells in proliferative capacity to either lipopolysaccharide or anti-immunoglobulin plus interleukin-4. However, isolated T cells exposed to GaAs were significantly suppressed in their ability to proliferate to concanavalin A, phytohemagglutinin and anti-CD3 epsilon plus interleukin-2 when compared to VH. In addition, expression of CD25, leukocyte function antigen-1 and intercellular adhesion molecule-1 in GaAs-exposed mice were significantly below VH (36, 18 and 18%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Reversal of gallium arsenide-induced suppression of the antibody response by a mixed disulfide metabolite of meso-2,3-dimercaptosuccinic acid.

Meso-2,3-dimercaptosuccinic acid (DMSA) has been demonstrated to be an effective chelator of lead, mercury and arsenic in humans and in rodent experiments. Studies involving cadmium exposure have typically shown DMSA to be less effective than 2,3-dimercapto-1-propanesulfonic acid, and this is possibly due to an inability of DMSA to cross cell membranes and bind intracellularly-bound metal ions. The present studies were designed to determine whether in vitro addition of DMSA could effectively reverse arsenic-induced immunosuppression in splenocytes exposed in vivo to gallium arsenide (GaAs; 200 mg/kg, intratracheally). In those investigations, DMSA (25-100 microM) was incapable of reversing suppression of the in vitro-generated antibody response induced by in vivo exposure to GaAs. Addition of the recently synthesized 2:1 mixed disulfide (L-cysteine-DMSA) metabolite of DMSA (0.1-100 microM) to cultures of splenocytes exposed in vitro to GaAs (50 microM) dose-dependently reversed GaAs-induced suppression of the antibody-forming cell response with no effect on the vehicle (complete media) response or on cell viability, indicating that the metabolite retained binding capacity. Unlike DMSA, however, addition of the 2:1 mixed disulfide metabolite to splenocyte cultures exposed in vivo to vehicle (0.05% Tween 80 in saline) or GaAs dose-dependently partially reversed GaAs-induced suppression. The reversal of suppression could not be attributed to cleavage of L-cysteine from the 2:1 mixed disulfide metabolite, as addition of equimolar concentrations of L-cysteine or L-cystine (0.2-200 microM) to in vitro generated antibody cultures of splenocytes exposed in vivo to vehicle or GaAs had no effect on the GaAs-induced suppression.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Reversal of gallium arsenide-induced suppression of the antibody-forming cell response by vehicle supernatants. I. Pharmacokinetics after in vitro and in vivo exposure.

Exposure of splenocytes in vivo or in vitro to gallium arsenide (GaAs) dose-dependently suppresses the ability of these cells to produce antibody after in vitro immunization with sheep red blood cells. In addition, it has been demonstrated that GaAs exerts immunosuppressive effects early (36 hr) in the generation of a primary antibody-forming cell (AFC) response. The objective of this study was to determine if the GaAs-induced suppression was produced as a result of a GaAs-induced alteration in the secretion of soluble mediators. Supernatants from in vivo and in vitro vehicle (VH)-exposed splenocyte cultures time-dependently reversed GaAs-induced suppression of the in vitro-generated primary AFC response produced by both in vitro (50 microM) and in vivo (200 mg/kg) exposure to GaAs. Supernatants from in vitro GaAs-exposed cells suppressed the VH response 40, 89 and 93% at 24, 36 and 48 hr, respectively. Using the arsenic-binding compound meso-2,3-dimercaptosuccinic acid (100 microM), it was determined that the suppression of the VH response by supernatants from in vitro GaAs-exposed cultures was confounded by the presence of free arsenic in the in vitro GaAs-exposed culture supernatant. In contrast, suppression of in vivo VH-exposed AFC responses by supernatants from in vivo GaAs-exposed cells was not seen. The time-dependent reversal of immunosuppression produced by in vivo or in vitro exposure to GaAs, by supernatants from in vivo and in vitro VH-exposed cells mimics the reported kinetics of suppression by addition of GaAs to antibody cultures.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗