Orbital presentations of giant cell arteritis.

BACKGROUND: giant cell arteritis (GCA) is a systemic vasculitis that may affect the optic nerve and cause blindness (e.g. ischemic optic neuropathy). Orbital inflammatory disease, however, is an uncommon presentation of GCA. PURPOSE: to alert clinicians to the orbital presentations of GCA. PATIENTS AND METHODS: a retrospective case series from tertiary care academic ophthalmic referral centers of four patients with orbital manifestations of giant cell arteritis. RESULTS: presentation of cases and review of the literature. In three cases, a temporal artery biopsy was diagnostic of GCA, but in one case, an orbital biopsy was needed to confirm the diagnosis. CONCLUSION: GCA can have orbital manifestations and clinicians should be aware of this unusual presentation of GCA in cases of presumed orbital inflammatory pseudotumor in the elderly.

A sequence element of p53 that determines its susceptibility to viral oncoprotein-targeted degradation.

The molecular basis that the viral oncoproteins, including HPV16 E6 and E1B55k/E4 34k complex, differentially target p53 but not its homolog p73 for degradation remains elusive. Using a series of p53/p73 chimeras, we demonstrated that despite binding to the different regions of p53, both HPV16 E6 and E1B55k/E4 34k required a very same p53 sequence, amino acid residues 92 to 112 [p53(aa.92-112)], previously identified as a necessity for Mdm2-mediated degradation, to target p53 for degradation. Removal of the p53(aa.92-112) by either substitution or deletion resulted in a p53 protein that was no longer degradable by the viral proteins. More significantly, swapping the oncoprotein-binding motif and the p53(aa.92-112) rendered p73 susceptible to oncoprotein-mediated degradation. Collectively, our data supports a model in which the p53(aa.92-112) functions as a determinant for p53 stability while the binding of the oncoproteins directs p53 into the specific pathway for proteolysis.

Measuring the costs of primary care education in the ambulatory setting.

In 1995, the authors obtained cost, operations, and educational activity data from 98 ambulatory care sites across the United States in which primary care teaching was occurring and compared those data with the corresponding data from 84 ambulatory care sites where no teaching was going on. The teaching sites in the sample were found to have 24-36% higher operating costs than the non-teaching sites. This overall difference in costs is approximately the same difference in costs earlier estimated for university teaching hospitals compared with non-teaching hospitals. These costs are shared by all involved in the ambulatory education process: sponsors, sites, and faculty. In a related finding, the authors discovered that 30-50% of all ambulatory care sites thought not to be involved in education are in fact teaching at a high level of involvement. Further research into not only the costs but the value of education in the clinical setting is encouraged. The authors also hope that the publication of this report will encourage accrediting bodies and professional organizations to improve the information available about ambulatory care training in general.

Identification of a sequence element from p53 that signals for Mdm2-targeted degradation.

The binding of Mdm2 to p53 is required for targeting p53 for degradation. p73, however, binds to Mdm2 but is refractory to Mdm2-mediated degradation, indicating that binding to Mdm2 is not sufficient for degradation. By utilizing the structural homology between p53 and p73, we generated p53-p73 chimeras to determine the sequence element unique to p53 essential for regulation of its stability. We found that replacing an element consisting of amino acids 92 to 112 of p53 with the corresponding region of p73 results in a protein that is not degradable by Mdm2. Removal of amino acids 92 to 112 of p53 by deletion also results in a non-Mdm2-degradable protein. Significantly, the finding that swapping this fragment converts p73 from refractory to sensitive to Mdm2-mediated degradation supports the conclusion that the amino acids 92 to 112 of p53 function as a degradation signal. We propose that the presence of an additional protein recognizes the degradation signal and coordinates with Mdm2 to target p53 for degradation. Our finding opens the possibility of searching for the additional protein, which most likely plays a critical role in the regulation of p53 stability and therefore function.

Uninsured under TennCare: a case study of public health clinic users.

BACKGROUND: We characterized public health clinic users 4 years after implementation of a major public health insurance reform and identified barriers to health care access. METHODS: We used face-to-face interviews and profile analysis of survey findings. RESULTS: The typical public health client household is larger, poorer, and more likely to be black than the wider population. The health status of participants is generally good; the level of insurance coverage is preponderantly TennCare; and 90% of respondents are willing to pay some premium. CONCLUSIONS: Lack of health insurance does not present a serious health care access barrier, nor do transportation or location; but taking time off from work with loss of wages is a problem for those employed. A cost-effective way to enroll uninsured children is to use the County Health Department clinics as a contact point.

Change in expenditure patterns of retirees: 1972-1973 and 1986-1987.

This study presents a comparative analysis of changes over time in expenditure patterns of retirees. Tobit regressions reveal significant differences in expenditure patterns in health care, leisure, necessities, and philanthropy. Over the past two decades, health care became more of a necessity, and its budget share increased. The marginal propensity to consume (MPC) leisure activities more than doubled. Retirees allocated lesser budget shares to the necessity areas of food and apparel, but single females had increased housing shares. The budget share and MPC for charitable contributions declined. Over time, the average propensity to consume (APC) increased greatly from 94 to 103 percent, a potential problem if elderly persons dissave at unsustainable rates. The spending of older retirees now differs substantially from younger retirees, with the APC declining with age, an apparent contradiction of the life cycle hypothesis. Apparently, the retired are more cautious about spending in the latter stages of the life cycle.

Out-of-pocket health expenditures by elderly households: change over the 1980s.

This study compares out-of-pocket health expenditures of elderly and nonelderly households over the past decade, using descriptive statistics and two-stage least squares analysis of Consumer Expenditure Survey data for 1980-1981 and 1989-90. This empirical analysis provides a basis for discussion of both efficiency and equity issues in health policy. We find that increases in out-of-pocket medical care expenditures over the last decade were mainly for insurance premiums rather than medical goods and services, which indicates potential inefficiencies in health care markets. We also find that Medicare promoted equity of out-of-pocket expenditures on health care among elderly persons over the 1980s, which implies that universal national health insurance would enhance distribution equity.