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Proteinuria is pathogenic to proximal tubular cells (PTC) and linked with progression to renal failure. The aim of this study was to determine the effects of human serum albumin (HSA) overload on the changes in gene and protein expression stimulated by oxidative stress in PTC and any interaction with ANG II that is pivotal in disease pathogenesis. Markers of oxidative stress, antioxidant defences, transcription factor activation, and the expression of stress-related genes were measured in human PTC (HK-2 cells) overloaded with either globulin-free fatty acid free (GF/FAF) HSA or globulin-free (GF) HSA. The effects of ANG II were also determined. HSA overload in HK-2 cells caused PTC hyperfunction, increased oxidative stress, and an upregulation of adaptive responses and stress-related genes. Some responses were common to both HSAs but others were unique to either HSA and unaffected by addition of ANG II or candesartan (a specific ANG II type 1 receptor blocker). ANG II also independently induced oxidative stress and upregulated other stress-related genes. HSA overload in HK-2 cells stimulated increased oxidative stress and upregulated changes in stress-related gene expression indicating new pathways of PTC injury that are not mediated via ANG II type 1 receptors.

Chronic allograft nephropathy (CAN) is commonly associated with proteinuria. In native nephropathies, proteinuria is linked with proximal renal tubular damage. This study uses regression analysis to link proteinuria with urinary N-acetyl-β-d-glucosaminidase (NAG) as a marker of tubular injury or hyperfunction in renal transplant patients.

Prologue:Responding to the Clinton administration's call for a government mandate on employers that would require them to provide health insurance to their workers, Congress is locked in a debate over whether such a step is appropriate public policy. As controversial as the proposal itself is, its implementation would be even more difficult, Frank McArdle asserts in this paper. As a consequence of history and economics, wide diversity exists in the workplace in the share of total compensation that is devoted to paying for health insurance. McArdle is persuaded that if Congress crafts an employer obligation to provide insurance to workers that is sensitive to the current diversity of arrangements in the business community, the likelihood of gaining greater acceptance among private entrepreneurs would be far greater. “Perhaps the most important consideration,” he writes, “is for reform to emerge from a process that inspires confidence, trust, and a sense of fair play…. Token representation [of business] on a regional alliance board will not do it.” McArdle is a principal of Hewitt Associates LLC, a worldwide human resources consulting firm. As manager of Hewitt Associates' Washington research office, McArdle consults on long-term trends in federal health policy as they apply to the design and costs of benefit programs offered by private and public employers. Prior to joining Hewitt Associates in 1988, McArdle was director of education and communication at the Employee Benefit Research Institute. Earlier, McArdle worked on the staff of the Senate Special Committee on Aging as a senior legislative analyst. McArdle is an elected member of the National Academy of Social Insurance and holds a doctorate in economic history from the University of Virginia.Abstract:As difficult and controversial as it is to pass an employer mandate, implementation will be even harder. Business reactions will not be monolithic, but diverse and complicated, often diametrically opposed. Reactions also will vary dramatically with the actual design of the provision in question, for which there are many alternatives. “What exists out there now” has overt and subtle variations from employer to employer, from region to region, and from sector to sector. If an employer obligation were designed to be more respectful and reflective of that diversity, the odds of gaining greater acceptance and successful implementation by businesses would improve.

Prologue:A popular rallying cry among persons who actively sought health system reform in 1994 was, “Americans should have the same coverage to which their members of Congress are entitled.” Put into operational terms, this would mean opening up the Federal Employees Health Benefits Program (FEHBP) to persons other than federal workers. The FEHBP, which offers a network of more than 400 health plan options, provides health care coverage for millions of federal workers, retirees, and their dependents nationwide. Satisfaction with FEHBP coverage is high, as evidenced by a 1994 survey by the Office of Personnel Management. As Frank McArdle explains in this paper, opening up the FEHBP to other Americans (including employees of small businesses and uninsured persons who are not eligible for other federal or state assistance) has considerable political and administrative appeal. As evidence of this, President Clinton proposed that small businesses be allowed to buy into the FEHBP, as a part of the Clinton administration's scaled-down health care reform package that was unveiled in June 1995. Among other advantages, opening up the FEHBP would mean minimal disruption of the health care arrangements of the majority of working Americans, while offering affordable coverage to those lacking it. McArdle stresses that this approach should be considered in the context of a package of incremental reforms, because it is not without its faults. McArdle is a principal of Hewitt Associates LLC and directs its Washington, D.C., research office. Before joining Hewitt Associates, he was director of education and communications with the Employee Benefit Research Institute (EBRI). He consults frequently on long-term trends in federal health policy that affect the design and the costs of benefit programs offered by public and private employers. McArdle holds a doctoral degree from the University of Virginia.Abstract:The Federal Employees Health Benefits Program (FEHBP) can serve as a vehicle to extend access to private health insurance to nonfederal workers. Opening up the FEHBP may also be a politically feasible incremental change because it potentially appeals to those at both ends of the political spectrum. Each of the various ways of enabling nonfederal workers to participate in the FEHBP has its pros and cons. This paper looks at using the FEHBP as a voluntary buy-in opportunity to help those who lack health insurance—without displacing or disrupting existing sources of health coverage or creating an expensive federal program.

1. Applied potential tomography is a new, noninvasive technology for observing changes in blood volume. We have used it to study 12 women with lower abdominal pain caused by pelvic congestion, and 15 control subjects. 2. A significant increase in blood volume of 1.8% was observed in the pelvis of women with congestion when changing from the supine to the erect position, and of 2.7% in the control subjects (P< 0.0002). The difference between the groups was not significant. 3. The distribution of the area over which blood volume changes took place was significantly different between the two groups (P< 0.002). More of the posterolateral part of the pelvis was involved in women with pelvic congestion than in the control subjects. 4. Applied potential tomography distinguishes between normal women and those having pelvic congestion with a specificity of 87% and a sensitivity of 75%.

Editorial. Comments on the subway expansion programs of New York. Information on the #7 line extension project; Problem with the extension program; Opinion on the Second Avenue subway expansion project.