Faculty Bibliography

15-Deoxy-Delta12,14-PGJ2 (dPGJ2) is a bioactive metabolite of the J2 series that has been identified as a ligand for peroxisome proliferator-activated receptor gamma (PPARgamma) and has received attention for its potential antiinflammatory effects. Because neutrophils express cell-surface receptors for PGs, the effect of dPGJ2 was tested on an inflammatory response that should not require PPARgamma, the oxidative burst made by adherent human neutrophils. dPGJ2 inhibited adhesion-dependent H2O2 production with an IC50 of 1. 5 microM when neutrophils were stimulated with TNF, N-formylnorleucylleucylphenylalanine, or LPS. Inhibition by dPGJ2 occurred during the lag phase, before generation of peroxide, suggesting blockade of an early signaling step. Indeed, dPGJ2 blocked adhesion of neutrophils to fibrinogen in response to TNF or LPS with an IC50 of 3-5 micro+dPGJ2 was more potent at inhibiting the adhesion-dependent oxidative burst than several other PGs tested. Further, dPGJ2 did not appear to act through either the DP receptor or receptors for PGE2. PG receptors modulate cAMP levels, and the inhibition of adhesion and oxidative burst by dPGJ2 was enhanced in the presence of 3-isobutyl-1-methylxanthine, a cAMP phosphodiesterase inhibitor. A potent PPARgamma agonist (AD-5075) did not inhibit peroxide production or adhesion, nor did it change the IC50 for dPGJ2 inhibition. These studies suggest that dPGJ2 may interact with an unknown receptor on neutrophils, distinct from PPARgamma, to modulate the production of reactive oxygen intermediates.

In 1938, as a New York University/Bellevue Hospital intern, I recorded notes on the 384 cases I saw during my 1-month ambulance duty. Although I intended to use them to follow up the clinical course of patients I admitted to Bellevue, the long hours and pressure of work made this ambitious goal unachievable. Sixty years later, after retirement from academic medicine and medical practice at New York University School of Medicine, I found the long-lost notes among my papers. They are of historic interest since they provide insight into aspects of primary and emergency medicine of the era when the therapeutic efficacy of the sulfanilamide class of agents was under investigation, a unique view of the life of an intern just before interns were replaced on ambulances by technicians, and a glimpse of the surprising character of several neighborhoods of pre-World War II Manhattan. The notes also provide the basis for a current analysis of case incidence and treatment by disease category. A description of the confluence of social, economic, and political forces that led to the establishment of the Bellevue Hospital Ambulance Service, the first such urban service in the world, is included

CONTEXT: Typing of Mycobacterium tuberculosis could provide a more sensitive means of identifying outbreaks than use of conventional surveillance techniques alone. Variants of the New York City W strain of M tuberculosis were identified in New Jersey. OBJECTIVE: To describe the spread of the W family of M tuberculosis strains in New Jersey identified by molecular typing and surveillance data. DESIGN: Population-based cross-sectional study. SETTING AND SUBJECTS: All incident culture-positive tuberculosis cases reported in New Jersey from January 1996 to September 1998, for which the W family was defined by insertion sequence (IS) IS6110 DNA fingerprinting, polymorphic GC-rich repetitive sequence (PGRS) typing, spacer oligotyping (spoligotyping), and variable number tandem repeat (VNTR) analysis. MAIN OUTCOME MEASURE: Identification and characterization of W family clones supplemented by surveillance data. RESULTS: Isolates from 1207 cases were analyzed, of which 68 isolates (6%) belonged to the W family based on IS6110 and spoligotype hybridization patterns. The IS6110 hybridization patterns or fingerprints revealed that43 patients (designated group A) shared a unique banding motif not present in other W family isolates. Strains collected from the remaining 25 patients (designated group B), while related to W, displayed a variety of IS6110 patterns and did not share this motif. The PGRS and VNTR typing confirmed the division of the W family into groups A and B and again showed group A strains to be closely related and group B strains to be more diverse. The demographic characteristics of individuals from groups A and B were specific and defined. Group A patients were more likely than group B patients to be US born (91 % vs 24%, P<.001), black (76% vs 16%, P<.001), human immunodeficiency virus positive (40% vs 0%, P = .007), and residents of urban northeast New Jersey counties (P<.001). Patients with group B strains were primarily non-US born, of Asian descent, and more dispersed throughout New Jersey. No outbreak had been detected using conventional surveillance alone. CONCLUSIONS: The implementation of multiple molecular techniques in conjunction with surveillance data enabled us to identify a previously undetected outbreak in a defined geographical setting. The outbreak isolates comprise members of a distinct branch of the W family phylogenetic lineage. The use of molecular strain typing provides a proactive approach that may be used to initiate, and not just augment, traditional surveillance outbreak investigations

The next several years will be truly exciting times in medicine. The field of gene therapy, for example, will use newly discovered techniques to treat genetic disorders and chronic diseases

E-mail has the potential to improve both the quality and efficiency of healthcare service delivery. Despite the substantial growth of this form of communication over the past decade, its promise to patients, providers, and their health plans remains largely untapped. In this article we (1) review the literature on e-mail use between patients and providers; (2) identify challenges and opportunities facing managed care organizations that wish to maximize the potential of this form of communication; (3) describe the components of 2 systems aimed at enhancing e-mail use in clinical settings; and (4) discuss the implications of increased e-mail use for managed care.

Is AIDS a disaster inadvertently brought on by humans that arose from early testing of a polio vaccine in Africa in the 1950s? In The River (Little, Brown, $35), Edward Hooper suggests that an experimental oral polio vaccine might have been made with chimpanzee tissue contaminated with an ancestor of the virus that was to cause AIDS. Although he has no medical expertise, Mr. Hooper, 48, has done a prodigious amount of research since 1990. In 1,070 pages, including extensive footnotes, he builds a case based entirely on circumstantial evidence that he accumulated in hundreds of interviews and exhaustive library research. He finds close coincidence in both time and place between the earliest cases of AIDS and the testing of an oral vaccine developed at the Wistar Institute in Philadelphia and, later, in two laboratories in Belgium. From 1957 to 1960, the vaccine was given to a million people in what are now Rwanda, Burundi and Congo

In ''The River'' (Little, Brown, $35), Edward Hooper suggests that an experimental oral polio vaccine might have been made with chimpanzee tissue contaminated with an ancestor of the virus that was to cause AIDS. Although he has no medical expertise, Mr. Hooper, 48, has done a prodigious amount of research since 1990. In 1,070 pages, with extensive footnotes, he builds a case based entirely on circumstantial evidence that he accumulated in hundreds of interviews and exhaustive library research. The similarities could be coincidence. ''The River'' does not prove his extraordinary theory, nor does it claim to. But it builds a sufficiently detailed case to require serious examination of his theory. Attempts to find answers require extensive research, and in the book and in subsequent interviews Mr. Hooper has offered a long list of suggestions, including laboratory testing of the small amounts of vaccine that still exist after having been stored for more than 40 years. Because the vaccine may have degraded over the decades, performing all the proposed research might still not determine whether it accidentally touched off the AIDS epidemic. And even if a simian virus turned up in the stored samples, it would not prove that it started the epidemic. The Wistar Institute, the first independent medical research center in the United States, appointed the 1992 panel to examine the theory that its vaccine might have touched off the AIDS epidemic. Now it says it is trying to find independent experts to do what they were unwilling to do seven years ago, when the panel recommended testing the remaining stocks of the experimental polio vaccine. One aim is to detect evidence of simian cousins of H.I.V.-1, the virus responsible for the overwhelming majority of AIDS cases in the world. A second is to determine the primate species from which the vaccine was prepared

AIDS has long been considered primarily a men's disease, but Tuesday the United Nations reported that more women than men were infected with the AIDS virus in Africa, the site of the vast majority of such infections. In a report released in advance of World AIDS Day on Dec. 1, the United Nations said that of the 22.3 million adults in sub-Sahara Africa infected with HIV, 12.2 million, or 55 percent, are women. U.N. officials said the reasons for the shift were unclear, though they noted that HIV was spread in Africa primarily through heterosexual intercourse. The virus passes more easily from men to women than from women to men

AIDS has long been considered primarily a men's disease, but Tuesday the United Nations reported for the first time that more women than men were infected with the AIDS virus in Africa, the site of the vast majority of such infections in the world

AIDS has long been considered primarily a men's disease, but Tuesday the United Nations reported for the first time that more women than men were infected with the AIDS virus in Africa, the site of the vast majority of such infections in the world. In a report released in advance of World AIDS Day on Dec. 1, the United Nations said that of the 22.3 million adults in sub-Sahara Africa infected with HIV, the AIDS virus, 12.2 million, or 55 percent, are women. The new evidence that Africa has six infected women for every five infected men comes from a number of studies in several African countries, U.N. AIDS said. Many AIDS experts have assumed that more women were infected than men in Africa. But documentation was not possible because much of the data was not broken down by sex, Dr. Bernhard Schwartlander, an epidemiologist for the agency and a principal author of the report, said in an interview