The Resource-Based Relative Value Scale. Toward the development of an alternative physician payment system.

This article describes the design and methods of a study currently under way to develop a Resource-Based Relative Value Scale (RBRVS); an alternative basis for establishing the payment rate for the services and procedures (S/Ps) of physicians in medical and surgical specialties. Physician resource inputs to be measured include (1) S/P time, (2) pre-S/P and post-S/P times, (3) intensity, (4) practice costs, including malpractice premiums, and (5) the cost of specialty training. These five factors will be combined to produce an RBRVS denominated in nonmonetary units.

Chloroform markedly stimulates the phosphorylation of myelin basic proteins.

We have investigated the effect of chloroform on the phosphorylation of myelin basic proteins because tumor-promoting agents such as phorbol esters and chloroform are known to enhance the activity of protein kinase C. We report that the presence of chloroform, at a concentration known to enhance protein kinase C activity, stimulated the phosphorylation of myelin basic proteins 15-17 fold over control conditions. The phosphorylation of a 50 kiloDalton myelin protein was also stimulated but to a lesser extent.

Identification of regions of alpha-thrombin involved in its interaction with hirudin.

The contributions of various regions of human alpha-thrombin to the formation of the tight complex with hirudin have been assessed by using derivatives of thrombin. alpha-Thrombin in which the active-site serine was modified with diisopropyl fluorophosphate was able to bind hirudin, but its affinity for hirudin was decreased by 10(3)-fold compared to unmodified alpha-thrombin. Modification of the active-site histidine with D-Phe-Pro-Arg-CH2Cl resulted in a form of thrombin with a 10(6)-fold reduced affinity for hirudin.

Effect of cerulenin and sodium butyrate on chitin synthesis in Candida albicans.

Experiments were conducted to gain insight concerning the mechanism(s) whereby cerulenin and sodium butyrate affect chitin synthesis in Candida albicans. In vitro studies with isolated membrane-bound chitin synthase from C. albicans, strain 4918, showed that neither agent affected the level of either unactivated or trypsin-activated enzyme activity.

Cyclic AMP decreases the phosphorylation state of myelin basic proteins in rat brain cell cultures.

Previous work has suggested that myelin basic proteins are phosphorylated prior to their appearance in the myelin sheath (Ulmer, J. B. and Braun, P.

Extracorporeal membrane oxygenation for postoperative cardiac support in children.

Prolonged circulatory support for cardiac failure has been increasingly successful in adults but has had very limited use in children. From January 1982 to December 1985, 13 children with postoperative cardiac failure refractory to conventional therapy were treated with extracorporeal membrane oxygenation. Ages ranged from 9 days to 17.

[Preventive activity: II].

In this paper a construct called "Präventives Handeln" is outlined. This term is developed within the framework of a general term of "action". First the actualisation of preventive actions in concrete situations is analysed.

Molecular cloning and primary structure of myelin-associated glycoprotein.

Myelin-associated glycoprotein (MAG) may play a role in the cellular interactions leading to myelination. Using monoclonal antibodies and conventional antisera against MAG, we have isolated a cDNA clone from an expression library prepared from rat brain mRNA. The identity of the clone was confirmed by the exact match between its nucleotide sequence and two peptide sequences of 13 and 9 amino acids that we obtained by Edman degradation of two CNBr fragments of MAG.

Myelin instability and oligodendrocyte metabolism in myelin-deficient mutant mice.

During the active phase of myelination in myelin-deficient mutant mice (mld), myelin basic protein (MBP) synthesis is defective and the myelin lamellae are uncompacted. In these mutants, we found a fast metabolism of the myelin-associated glycoprotein (MAG) and of sulfatides, and the presence of cholesterol esters and a degradation product of MAG, dMAG, indicating that mld myelin was unstable. The increased synthesis of MAG and Wolfgram protein, two proteins present in uncompacted myelin sheath and paranodal loops, was demonstrated by high levels of messengers.

Extracorporeal membrane oxygenation for newborn respiratory failure.

Jugular vein-carotid artery extracorporeal membrane oxygenation (ECMO) was utilized in 22 newborns (16 male and 6 female) 1 to 12 days old with respiratory failure due to meconium aspiration (12 patients), diaphragmatic hernia (4), persistent fetal circulation (3), hyaline membrane disease (2), and Rh incompatibility (1). Prior to ECMO, all patients had alveolar-arterial O2 pressure gradients greater than 580 mm Hg (predicted mortality greater than 90%), weighed more than 1,800 gm, had a gestation period of longer than 35 weeks, and had no cerebral hemorrhage. The duration of ECMO was 41 to 310 hours (mean, 134.

A 96-well epifluorescence assay for rapid assessment of compounds inhibitory to Candida spp.

A rapid method for the screening of potential antifungal compounds was developed. A variety of compounds were tested against regenerating protoplasts of Candida spp. in a microtiter format.

In vivo phosphorylation of myelin basic proteins: single and double isotope incorporation in developmentally related myelin fractions.

The phosphorylation of myelin basic proteins (MBPs) was studied in developing mouse brain. Based on our previous work we postulated that phosphorylation of MBPs takes place prior to their appearance in the myelin compartment as well as within the myelin sheath. To further test this hypothesis we utilized a subfractionation protocol that yields brain fractions enriched in myelin membranes of differing developmental stages.

In vivo phosphorylation of myelin basic proteins: age-related differences in 32P incorporation.

Myelin basic proteins (MBPs) are phosphoproteins of central and peripheral nervous system myelin. We studied the phosphorylation of mouse MBPs in vivo at three different stages of development (12, 30, and 50 days) and found age-related differences in the incorporation of 32P into MBPs. At all ages studied, significant amounts of 32P were found in the MBPs as early as 1 min after intracranial injection of isotope.

Synergistic action of nikkomycins X and Z with papulacandin B on whole cells and regenerating protoplasts of Candida albicans.

Combinations of nikkomycin X (NX) or nikkomycin Z (NZ), known inhibitors of chitin synthesis in fungi, together with papulacandin B (PB), an inhibitor of beta-glucan synthesis, were tested for synergistic activity against four isolates of Candida albicans by using the broth microdilution checkerboard technique and a method to assess the regeneration of cell wall material in protoplasts. The construction of isobolograms from the data generated by the checkerboard determinations revealed a synergistic effect for the two classes of compounds against all strains. The combination of NX and PB was more effective than the combination of NZ and PB, perhaps reflecting the lower Ki value of NX.

[Surgery of microcellular bronchial cancer: retrospective multicenter study apropos of 110 cases].

The results of a multicentric retrospective study of 110 cases of small cell bronchial cancer are reported. In 57 of these patients the histological diagnosis was unknown before surgery. Among the remaining 53 patients, 22 were operated upon immediately and 31 after chemo-and/or radiotherapy (12 full responders, 10 partial responders, 5 no change and 4 in relapse).

The characterization and cellular distribution of a family of antigens related to myelin associated glycoprotein in the developing nervous system.

The antigenic epitope detected on myelin associated glycoprotein (MAG) by the monoclonal antibody HNK-1 (Leu 7) was sensitive to degradation by trifluoromethane-sulfonic acid (TFMS) and is therefore probably carbohydrate in nature. This antigen was found to be widely distributed within the rat and chicken embryonic nervous system and was present on cultured central and peripheral neurons (100%), oligodendrocytes (100%) and astrocytes (70-80%) as detected by double marker immunofluorescence. The antigen could be removed from cultured neurons by trypsinization and its resynthesis was blocked by cycloheximide, suggesting that the carbohydrate epitope detected by HNK-1 was attached to a de novo synthesized protein.

Porcine-pancreatic alpha amylase hydrolysis of substrates containing 6-deoxy-D-glucose and 6-deoxy-6-fluoro-D-glucose and the specificity of subsite binding.

Hydrolysis of 6-deoxyamylose and mono-6-deoxy-6-fluorocyclomaltoheptaose by porcine-pancreatic alpha amylase produces low-molecular-weight modified products, which have been analyzed by chemical and chromatographic techniques. Results for both substrates show that modified D-glucose and two isomers of modified maltoses are produced in the enzyme reaction. In addition, the formation of maltoses modified in the nonreducing residue is more favored than the formation of maltoses modified in the reducing residue.

The effect of substrate modification on porcine pancreatic alpha-amylase subsite binding: hydrolysis of substrates containing 2-deoxy-D-glucose and 2-amino-2-deoxy-D-glucose.

Modified alpha-D-(1----4)-glucans containing a small proportion of 14C-labeled 2-deoxy-D-glucose or 2-amino-2-deoxy-D-glucose were examined as substrates for porcine pancreatic alpha-amylase (PPA). Cyclomaltoheptaose containing single 2-deoxy-D-glucose residues, synthesized by incubation of 2-deoxyglucosylglycogen with cyclomaltodextrin glucanotransferase in the presence of Triton X-100, was hydrolyzed by PPA to produce 2-deoxy-D-glucose; two isomers of 2-deoxymaltose, and a mixture of modified maltotrioses. These results indicate that 2-deoxymaltose, and a mixture of modified maltotrioses.

Developmental expression of the myelin-associated glycoprotein in the peripheral nervous system is different from that in the central nervous system.

We recently characterized two developmentally regulated myelin-associated glycoprotein (MAG) polypeptides synthesized by mouse brain mRNA in vitro. We now extended these studies to include the peripheral nervous system (PNS). Total cytoplasmic RNA was isolated from the sciatic nerves of 7-, 12-, and 17-day-old and adult rats and translated in vitro in a rabbit reticulocyte lysate system.

Abnormal expression of the myelin-associated glycoprotein in the central nervous system of dysmyelinating mutant mice.

Total cytoplasmic brain RNA was isolated at two different ages from three neurological mutant mice (qk/qk, jp/Y, and shi/shi) and their apparently normal littermates. This RNA was translated in vitro in a rabbit reticulocyte lysate system. Myelin-associated glycoprotein (MAG)-related polypeptides were immunoprecipitated from equal amounts of total translation products derived from mRNA of mutant animals, normal littermates, or control animals.

Elective hysterectomy. Benefits, risks, and costs.

This study evaluated the effect of hysterectomy or hysterectomy and bilateral salpingo-oophorectomy (hysterectomy and oophorectomy) versus alternative medical management on life expectancy, quality of life, and direct medical costs. Using techniques of decision analysis and available data on sequelae, it was found that gains in life expectancy and quality of life can be expected when women ages 30-60 undergo hysterectomy for benign neoplasm, disorders of menstruation, acquired abnormal anatomy, cervical disease, or endometriosis, owing primarily to prevention of reproductive tract cancers, which outweighs the impact of operative mortality. However, women who have relatively high operative risk or low expected cancer risks, beyond thresholds estimated in sensitivity analyses, suffer losses in life expectancy.