Issues in the recovery of physicians from addictive illnesses.

The issues discussed in this article introduce and examine topics related to physicians' health which are salient in their clinical usefulness or their heuristic value in planning future research. Physicians in general possess physical, emotional and intellectual strengths that are needed to face high stress and low social support. Physicians are also less likely to seek routine medical care. With many illnesses physicians are inherently resistant but have higher risk factors. It is postulated that the opposing tendencies cancel each other. Physicians have better intrinsic physical and mental health but live under higher stress and get less routine preventive care. Physicians also may have a tendency to live healthy lives without addiction but have high risk factors for addiction. Adults who have grown up in families with addiction have a tendency to choose health care professions. Genetic composition may predispose to alcoholism and other chemical addictions. Taking into consideration inherent health and risk it is thought that physicians have a similar prevalence of alcoholism and drug dependence as compared to the general population. Physicians have higher access to pharmaceutical drugs but are less inclined to use street drugs. In the New York State Physicians' Health Program, 88% of the participants used alcohol or prescription drugs and only 12 percent used marihuana or Cocaine. Additional risk factors for Substance Use Disorders in Physicians have been postulated to be pharmaco-logical optimism, intellectual strength, strong will, love of challenges, instrumental use of medications and a daily need for denial. These factors require rigorous investigation to establish their role. Clinical approaches and techniques discussed include the incubation period for a Substance Use Disorder, initial high tolerance, state dependent learning, and the signal properties of drugs. As recovery progresses it is postulated that it becomes increasingly important to deal with substitute addictions and family of origin issues.

The pentanucleotide ATTGG, the "inverted CCAAT," is an essential element for HLA class I gene transcription.

The HLA class I genes, HLA-A, -B, and -C, contain an inverted CCAAT sequence (ATTGG) located 20 bp upstream of the canonical CCAAT and approximately 70 bp upstream of the transcription initiation site. We have investigated the transcriptional function of the class I inverted CCAAT sequence using the HLA-normal cell line, HeLa. Deletion, mutation, or inversion of the inverted CCAAT sequence abrogated or reduced the activity of the class I promoter, as assessed by luciferase reporter gene assays in transient gene expression experiments. This activity coincided with occupancy of the inverted CCAAT motif, as tested by electrophoretic mobility shift assays using the wild-type sequence and mutated variants of the sequence. The ATTGG-binding protein was not CP2, NF-1, or other known CCAAT-binding proteins, but the complex may contain a CP1/NF-Y-like protein. Our results indicate that this inverted CCAAT sequence is an essential element for the expression of HLA class I genes and that its transcriptional activity depends upon the sequence, position, and orientation of the pentanucleotide.

Lateral and radial growth uncoupled in reaggregated retinospheroids of embryonic avian retina.

According to an earlier resented model (Layer and Willbold, Int. Rev. Cytol. 146: 1-47, 1993), growth of the retina can be conceived of as an areal increase of an epithelial tissue sheet ("lateralization") plus a concomitant establishment of the layered retina ("radialization"). To provide further support for this model, here we have reaggregated dissociated retinal plus pigmented cells from chick or quail embryos and observed their development into histotypic three-dimensional spheres in rotation culture. These so-called stratospheroids consist of a continuous fully laminated retinal part with a coiled-up pigmented epithelial core. Using BrdU-labeling, we show that radial growth, i.e. the sequential production of cell types in spheroids, is comparable to normal vitreal-scleral retinogenesis. The region next to the pigmented epithelial core represents a "lateral growth zone" (equivalent to an ora serrata in vivo), where mitotic cell numbers are highest, even when in the laminated part proliferation has already ceased. Gradients of lateral differentiation emanate from this growth zone into the retinal tissue, as revealed by immunostaining of the photoreceptor protein opsin and the cell recognition molecule F11. Moreover, we found that stratospheroids derived from older embryos consist only of a hollow monolayered neuroepithelium which develops in the absence of any radial growth. This indicates that cell production is sustained longer in lateral than in radial direction. These differently staged stratospheroids will be excellent models to characterize genes involved in the regulation of lateral and radial growth processes.

Local Control of Microdomain Orientation in Diblock Copolymer Thin Films with Electric Fields

Local control of the domain orientation in diblock copolymer thin films can be obtained by the application of electric fields on micrometer-length scales. Thin films of an asymmetric polystyrene-polymethylmethacrylate diblock copolymer, with cylindrical polymethylmethacrylate microdomains, were spin-coated onto substrates previously patterned with planar electrodes. The substrates, 100-nanometer-thick silicon nitride membranes, allow direct observation of the electrodes and the copolymer domain structure by transmission electron microscopy. The cylinders aligned parallel to the electric field lines for fields exceeding 30 kilovolts per centimeter, after annealing at 250°C in an inert atmosphere for 24 hours. This technique could find application in nanostructure fabrication.

The second kappa B element, kappa B2, of the HLA-A class I regulatory complex is an essential part of the promoter.

The MHC class I regulatory complex (CRC) contains the well characterized palindromic kappa B element, kappa B1, to which a number of nuclear factors are known to bind. This cis element plays an important role in controlling the transcription of MHC class I genes. In addition, the CRC contains a second kappa B element, kappa B2, which is located in tandem with the kappa B1 site, 5 bp upstream. In this study, from reporter gene transfection experiments, we present evidence that this kappa B2 site is as important as kappa B1 in regulating HLA-A locus transcription. Mutations introduced into either kappa B site reduced promoter activity to approximately the level obtained when the entire CRC was deleted. Electrophoretic mobility shift and supershift assays showed that the kappa B2-binding complex (BIII) contained a p65-like subunit, but apparently not the p50 subunit of NF-kappa B. Complex BIII also bound to the kappa B1 site, but the kappa B2 sequence was poorly recognized by the kappa B1-binding complex, BI, probably KBF1, the p50 homodimer. These results demonstrate that both kappa B sites are essential components of the promoter and suggest that they may function together to control MHC class I gene transcription.

Reminiscence of an addictionologist: thoughts of a researcher and clinician.

The changes in the field of addiction are discussed from the prospective of twenty-two years of work as a researcher and clinician. The growing importance and relevance of twelve step programs to clinical practice is explored as is the changing experiences of working with early stage alcoholics. This is followed by a discussion of the interaction the research and clinical aspects of chemical dependency. Behavioral and learning theory in relationship to chemical dependency, the disease concept and the importance of the incubation period, withdrawal syndromes, and hereditary aspects of chemical dependency are all discussed.

Regeneration of a chimeric retina from single cells in vitro: cell-lineage-dependent formation of radial cell columns by segregated chick and quail cells.

We report here that similar to E6-chicken retinal cells, dissociated cells from 5.5-day-old (E5.5) quail retinae reaggregate in rotary culture, multiply about tenfold and reestablish histotypical areas. These cellular aggregates include all nuclear layers either with inversed or correct laminar polarity, depending on the local origin of the cells (called "rosetted" and "laminar" in-vitro-retinae (IVR), respectively; Layer and Willbold 1989). In combined cultures, chick and quail cells are evenly mixed only during the first two days of culture. Along with the assembly of single cells into rosettes and then into discrete laminae, sectors of chick and quail cells begin to segregate. They are delineated by borders running radially through all three nuclear layers. Thus, interspecies migration of cells at this advanced stage of differentiation is strongly inhibited. Concomitant with this segregation, coherent radial columns spanning all three layers but containing cells from either species only, can be traced histologically. We conclude that a weak segregation of chick and quail retinal cells takes place already at the single cell level, but that the permanent segregation of entire tissue parts must be due to clonal cellular proliferation within the IVR in conjunction with some developmental-structure mechanism retaining clonal progenies within a columnar order.

Drug therapy in the prevention of recurrences in unipolar and bipolar affective disorders. Report of the NIMH Collaborative Study Group comparing lithium carbonate, imipramine, and a lithium carbonate-imipramine combination.

In a double-blind, long-term follow-up study, 117 bipolar patients received lithium carbonate, imipramine hydrochloride, or both and 150 unipolar patients received lithium carbonate, imipramine, both lithium carbonate and imipramine, or placebo. With bipolar patients, lithium carbonate and the combination treatment were superior to imipramine in preventing manic recurrences and were as effective as imipramine in preventing manic recurrences and were as effective as imipramine in preventing depressive episodes. The combination treatment provided no advantage over lithium carbonate alone. With unipolar patients, imipramine and the combination treatment were more effective than lithium carbonate and placebo in preventing depressive recurrences. The combination treatment provided no advantage over imipramine alone. The lithium carbonate-treated group had fewer manic episodes than the other groups. Treatment outcome, which was evaluated primarily in terms of the occurrence of major depression or manic episodes, was significantly related to characteristics of the index episode, ie, the episode that brought the patient into the study.

MMPI correlates of affective disorders.

Compared 24 unipolar depressives with 24 chronic intermittent depressives on the MMPI. The mean profiles did not differ significantly. However, an MMPI clinician was able to sort the profiles, at an above-chance level, into two groups. The rules for such classification are stated. The results are contrasted with the findings of significant differences between unipolar and bipolar depressives. The hypothesis is offered that unipolar and chronic depressives may not differ on severity of symptomatology.