The influence of philosophical versus theological education on the moral development of clinical medical ethicists

PURPOSE: Because of the increasing involvement of clinical medical ethicists in patient care and the resultant controversy over the appropriate background, training, and certification of clinical ethicists, this study was designed to investigate whether different educational backgrounds (philosophical versus theological) affected the moral reasoning of clinical ethicists and their orientations toward justice or care. METHOD: From 1987 through 1990, extensive oral interviews were conducted with 50 clinical medical ethicists (26 philosophers and 24 theologians) who were at 32 medical centers in 14 states from all sections of the United States. The interviews were used to gather selected demographic characteristics about the ethicists (age, gender, and educational background) as well as to determine the ethicists' scores for stages of moral reasoning and for moral orientation. Polyserial correlations and multivariant analyses were then performed between the demographic characteristics and the data on moral reasoning and moral orientation. RESULTS: The philosophers and theologians were found not to be significantly different (p > .05) in their moral reasoning skills in terms of either moral stage score or weighted average score. Similarly, the philosophers and theologians were found not to be significantly different in their moral orientations toward justice or care in terms of recognition, predominance, or alignment. No significant relationship was found between age or gender and moral reasoning or moral orientation. CONCLUSION: Based on the results of this study, it appears that clinical medical ethicists, whether philosophers or theologians, are a fairly homogeneous group with regard to their moral development, in terms of both their stages of moral reasoning and their moral orientations toward justice and care.     

Bcl-xL regulates the membrane potential and volume homeostasis of mitochondria

Mitochondrial physiology is disrupted in either apoptosis or necrosis. Here, we report that a wide variety of apoptotic and necrotic stimuli induce progressive mitochondrial swelling and outer mitochondrial membrane rupture. Discontinuity of the outer mitochondrial membrane results in cytochrome c redistribution from the intermembrane space to the cytosol followed by subsequent inner mitochondrial membrane depolarization. The mitochondrial membrane protein Bcl-xL can inhibit these changes in cells treated with apoptotic stimuli. In addition, Bcl-xL-expressing cells adapt to growth factor withdrawal or staurosporine treatment by maintaining a decreased mitochondrial membrane potential. Bcl-xL expression also prevents mitochondrial swelling in response to agents that inhibit oxidative phosphorylation. These data suggest that Bcl-xL promotes cell survival by regulating the electrical and osmotic homeostasis of mitochondria.     

Ig V region hypermutation in B cell hybrids mimics in vivo mutation and allows for isolation of clonal variants

In order to investigate the regulation of Ig hypermutation, we have established a cell culture system in which reversion of a V region stop codon in a stably transfected Ig gene permits the quantitation of mutation rates by fluctuation analysis. Transfected heavy chain V regions associated with the mu constant region undergo low rates of mutation in the NSO plasmacytoma cell line and a moderate rate of mutation in the 18.81 pre-B cell line. Most of the hybrids created by fusing these two cell lines resembled the non-permissive NSO cell line, though a few hybrids had constitutive V region mutation rates that were even higher than 18.81 and similar to the high rates of mutation that occur in vivo (Green, N. S., Rabinowitz, J. L., Zhu, M., Kobrin, B. J. and Scharff, M. D. (1995) Proc. Nat. Acad. Sci. (USA) 92, 6304 6308). Characterization of these hybrids now demonstrates that the transfected genes were integrated outside of the Ig locus. Mutation was due to multiple single base pair replacements in the V region and not the C region, was ongoing and often arose in hot spot motifs described by V region hypermutation in vivo. Subcloning of unstable hybrids allowed for the isolation of highly related clones with 44-70-fold different mutation rates. These results suggest that V region hypermutation in this mode in vitro systems is under both positive and negative regulation.     

Interleukin-9 promotes allergen-induced eosinophilic inflammation and airway hyperresponsiveness in transgenic mice

Human atopic asthma is a complex heritable inflammatory disorder of the airways associated with clinical signs of allergic inflammation and airway hyperresponsiveness. Recent studies demonstrate that the degree of airway responsiveness is strongly associated with interleukin (IL)-9 expression in murine lung. To investigate the contribution of IL-9 to airway hyperresponsiveness, and to explore directly its relationship to airway inflammation, we studied transgenic mice overexpressing IL-9. In this report we show that IL-9 transgenic mice (FVB/N-TG5), in comparison with FVB/NJ mice, display significantly enhanced eosinophilic airway inflammation, elevated serum total immunoglobulin E, and airway hyperresponsiveness following lung challenge with a natural antigen (Aspergillus fumigatus). These data support a central role for IL-9 in the complex pathogenesis of allergic inflammation.     

A 3-Mb contig from D11S987 to MLK3, a gene-rich region in 11q13

We have combined genetic, radiation-reduced somatic cell hybrid (RRH), fluorescent in situ hybridization (FISH), and physical mapping methods to generate a contig of overlapping YAC, PAC, and cosmid clones corresponding to > 3 continuous Mb in 11q13. A total of 15 STSs [7 genes (GSTP1, ACTN, PC, MLK3, FRA1, SEA, HNP36), 4 polymorphic loci (D11S807, D11S987, GSTP1, D11S913), 3 ESTs (D11S1956E, D11S951E, and W1-12191), and 1 anonymous STS (D11S703)], mapping to three independent RRH segregation groups, identified 26 YAC, 7 PAC, and 16 cosmid clones from the CGM, Roswell Park, CEPH Mark I, and CEPH MegaYAC YAC libraries, a 5 genome equivalent PAC library, and a chromosome II-specific cosmid library. Thirty-six Alu-PCR products derived from 10 anonymous bacteriophage lambda clones, a cosmid containing the polymorphic marker D11S460, or STS-positive YAC or cosmid clones were identified and used to screen selected libraries by hybridization, resulting in the identification of 19 additional clones. The integrity and relative position of a subset of clones was confirmed by FISH and were found to be consistent with the physical and RRH mapping results. The combination of STS and Alu-PCR-based approaches has proven to be successful in attaining contiguous cloned coverage in this very GC-rich region, thereby establishing for the first time the absolute order and distance between the markers: CEN-MLK3-(D11S1956E/D11S951E/W1-12191)-FRA1-D 11S460-SEA-HNP36/ D11S913-ACTN-PC-D11S703-GSTP1-D11S987-TEL.     

Balloon assisted endoscopic harvest of the latissimus dorsi muscle

In this study, we present our experience with balloon assisted endoscopic harvest of the latissimus dorsi muscle for extremity reconstruction. The balloon performs most of the dissection under the muscle and creates the optical work space used in the endoscopic dissection. Over the course of this series the operative time has been reduced and averaged 2 hours and 44 minutes. The reconstructive goals were met in all cases. The average axillary incision length was 5.6 cm, and there were an average of 1.3 one-centimeter or smaller counter incisions.     

Biovars and antibiotic resistance of enterobacter cloacae strains isolated from colonized newborns

A total of 120 strains of E. cloacae were isolated from colonized newborns in a maternity hospital (96 strains) and from inpatients of other hospitals (23 strains). Biovars of these strains and of 1 reference strain were determined by two methods of biochemical typing and their sensitivity to 14 antibiotics assessed. The overwhelming majority of isolates from newborns were referred to type 2 according to typing after Old (original) or to biovar 62 if typed using the modification of this method. The phenotypical profile of determinants of resistance to 10 antibacterial drugs were the same, including those to aminoglycosides (except amikacin) and third-generation cephalosporins. The strains isolated from non-obstetrical inpatients belonged to biovars with phenotypical profiles of resistance to only 3 antibiotics and sensitive to aminoglycosides and third-generation cephalosporins.