Genetic basis of cancer of the kidney: disease-specific approaches to therapy

Studies during the past two decades have shown that kidney cancer is not a single disease; it is made up of a number of different types of cancer that occur in this organ. Clear cell renal carcinoma is characterized by mutation of the VHL gene. The VHL gene product forms a heterotrimeric complex with elongin C, elongin B, and Cul-2 to target hypoxia-inducible factors 1 and 2alpha for ubiquitin-mediated degradation. VHL-/- clear cell renal carcinoma overexpresses epidermal growth factor receptor and transforming growth factor alpha. Both hypoxia-inducible factor 1alpha and the epidermal growth factor receptor are potential therapeutic targets in clear cell renal carcinoma. Studies of the hereditary form of renal cell carcinoma (RCC) associated with hereditary papillary renal carcinoma (HPRC) determined that the c-Met proto-oncogene on chromosome 7 is the gene for HPRC and for a number of sporadic papillary RCCs. The HPRC c-Met mutations are activating mutations in the tyrosine kinase domain of the gene. The gene for a new form of hereditary RCC (Birt Hogg Dubé syndrome) associated with cutaneous tumors, lung cysts, and colon polyps or cancer has recently been identified. Studies are currently under way to determine what type of gene BHD is and how damage to this gene leads to kidney cancer. Individuals affected with hereditary leiomyomatosis renal cell carcinoma are at risk for the development of cutaneous leiomyomas, uterine leiomyomas (fibroids), and type 2 papillary RCC. The HLRC gene has been found to be the Krebs cycle enzyme, fumarate hydratase. Studies are under way to understand the downstream pathway of this cancer gene.

High ratings of satisfaction with fertility treatment are common: findings from the Copenhagen Multi-centre Psychosocial Infertility (COMPI) Research Programme

BACKGROUND

The aims were: (i). to identify gender differences in evaluation of medical and patient-centred (psychosocial) care in fertility clinics and (ii). to identify predictors of satisfaction.

METHODS

An epidemiological prospective study based on questionnaire responses among all new couples attending five fertility clinics. The response rate at the 12 month follow-up was 87.7% and included a total of 1934 patients.

RESULTS

During the follow-up period about two-thirds had achieved a pregnancy and about a third became parents. The participants were satisfied with both the medical and patient-centred (psychosocial) services. There were no sex differences in the evaluation of treatment except that women were more satisfied than men with how the staff had performed their medical examinations. Satisfaction with medical and patient-centred services was positively associated with a treatment-related pregnancy/delivery and the report of marital benefits resulting from the infertility experience. Lower social class was a significant predictor for satisfaction.

CONCLUSIONS

Both men and women in fertility treatment had high ratings on medical and patient-centred care. It seemed that satisfaction with the psychosocial services was higher than in earlier studies from other countries.

Surface field activated fragmentation of arginine oligomers

Protonated arginine oligomers produced by matrix-assisted laser desorption/ionization (MALDI) graze at a kinetic energy of 350 eV along a surface of fluorinated hydrocarbon or mineral oil. The cation fragments activated by excitation processes during the slide on the surface are analyzed by time-of-flight mass spectrometry. The resulting fragment ion mass spectra are interpreted by applying a theoretical concept of excimol accumulation and trap bond dissociation, suggested earlier. According to this theory, energy is accumulated and fragments are formed independently by each arginine residue of a sliding oligomer ion. It is concluded that the observed variation in the fragment ion spectra of the oligomers is a consequence of different oligomer velocities and not a fingerprint of different ion structures.

The role of community services and informal support on five-year drinking trajectories of alcohol dependent and problem drinkers

OBJECTIVE

The purpose of this study was to examine how informal support and community services impact the course of alcohol disorders by examining the trajectories of alcohol consumption over 5 years in dependent and problem drinkers.

METHOD

Alcohol dependent adults (n = 600) and problem drinkers (n = 992) were identified through probability surveys in the general population and in public and private treatment programs throughout a California county. Participants were interviewed at baseline and again 1, 3 and 5 years later. Models controlling for demographic characteristics, problem severity, community services and recovery-oriented social networks were estimated, using a multi-level, mixed model to predict alcohol consumption over time.

RESULTS

A significant trend of reduced drinking over time was observed for both dependent and problem drinkers. Recovery-oriented social networks and AA participation predicted decreased consumption for both groups. Contacts with medical, mental health, welfare and legal systems were predictive of reduced consumption for problem drinkers. In the dependent group, only contacts with mental health agencies marginally predicted decreased consumption.

CONCLUSIONS

Findings point to the importance of developing mechanisms for better identifying problem drinkers in the course of contacts with health and social service systems and for facilitating use of self-help groups and positive changes in social networks. Development of recovery-oriented social networks should be emphasized to extend the benefits of treatment for dependent individuals.

Photoelectron-photoion momentum spectroscopy as a clock for chemical rearrangements: isomerization of the di-cation of acetylene to the vinylidene configuration

We have used complete correlated momentum mapping of the photoelectron and heavy ion products from the dissociation of the di-cation of acetylene, induced by photoionizing the carbon K shell of one of the atoms, to map out the angular correlation between the electron and the axis of the target molecule. The (quasi-) symmetric decay is found to proceed through both acetylene and vinylidene configurations. By using the strongly peaked photoelectron emission to "start a clock," an upper limit of 60 fs is placed on the isomerization time from the acetylene to the vinylidene configuration.

Auger electron emission from fixed-in-space CO

We have measured the angular distribution of carbon K-Auger electrons from fixed in space, core-ionized, CO molecules in coincidence with the kinetic energy release of the C+ and O+ fragments. We find a very narrow ejection of Auger electrons in the direction of the oxygen and an oscillatory diffraction pattern. Even for similar electron energies, the angular distribution strongly depends on the symmetry of the final state.

Patients' attitudes to medical and psychosocial aspects of care in fertility clinics: findings from the Copenhagen Multi-centre Psychosocial Infertility (COMPI) Research Programme

BACKGROUND

The aims were (i) to identify gender differences in motivations to seek assisted reproduction and gender differences in expectations about medical and psychosocial services and (ii) to examine factors that predict the perceived importance of, and intention to use, psychosocial services among infertile people.

METHODS

We conducted an epidemiological study based on questionnaires among all new couples attending five fertility clinics with a response rate of 80.0% and a total of 2250 patients.

RESULTS

The vast majority of both men and women considered a high level of medical information and patient-centred care as important. Fewer respondents (women 10.0-20.8%, men 4.1-8.9%) felt that professional psychosocial services were important and/or had the intention to use these services. The main predictor of perceived importance of patient-centred care and professional psychosocial services for both men and women was high infertility-related stress in the marital, personal and social domain.

CONCLUSIONS

A supportive attitude from medical staff and the provision of both medical and psychosocial information and support should be integral aspects of medical care in fertility clinics. Although only a minority of the participants perceived professional psychosocial services as important, they should be available for patients whose infertility causes them much strain, especially for patients whose marital relationship suffered much because of infertility.

Who goes to alcohol and drug treatment? Understanding utilization within the context of insurance

OBJECTIVE

This study assesses the differential roles of demographic characteristics, problem severity, motivational factors and insurance in entrance into alcohol and drug treatment.

METHOD

A probability sample of adult problem and dependent drinkers from a Northem California county (N = 672) and consecutive adult intakes from the county's public (n = 298) and private (n = 628) alcohol and drug treatment programs. Interviewers conducted telephone screening for individuals meeting problem-drinking criteria in the general population; in-person interviews were conducted for those who screened positive, and also for individuals entering treatment.

RESULTS

Insurance did not play an independent role in treatment entry. In logistic regression analysis, using a model from the medical utilization literature, black ethnicity (odds ratio [OR] = 2.98, p < .001); older age (OR = 4.67, p < .001); less education (OR = 1.81, p < .01); legal (OR = 7.46, p < .001) and work (OR = 3.57,p <.001) pressures; higher psychiatric (OR = 4.03,p <.001) and drug (OR = 3.04,p <.001) severity; and social consequences (OR = 1.35, p < .01) predicted treatment entry. Interventions from legal sources (OR = 6.22, p < .01) were related to entering treatment for the uninsured; legal (OR = 7.02, p < .001), workplace (OR = 6.01, p < .001) and family (OR = 1.62, p < .05) pressures were related for the insured.

CONCLUSIONS

Social consequences, rather than severity of dependence, in both insured and uninsured problem drinkers are important predictors of treatment entry when traditional utilization measures are controlled. Public programs play a crucial part in the alcohol and drug treatment system, and their viability is important as health policy changes.

Double-to-single target ionization ratio for electron capture in fast p-He collisions

We have used the ion storage ring CRYRING and its internal gas-jet target and recoil-ion-momentum spectrometer to measure absolute cross sections for transfer ionization (TI: p+He-->H0+He2++e(-)) in 2.5-4.5 MeV p-He collisions with separate Thomas (TTI) and kinematic (KTI) TI contributions. The probability for electron emission in kinematical capture decreases with increasing velocity and appears to approach the photoionization shakeoff value (1.63%) [T. Aberg, Phys. Rev. A 2, 1726 (1970)]]. The velocity dependence of the TTI cross section is consistent with the theoretically predicted v(-11) scaling [J. S. Briggs and K. Taulbjerg, J. Phys. B 12, 2565 (1979)]].

Effects of different fixatives on beta-galactosidase activity

beta-Galactosidase (beta-Gal) staining is widely used to demonstrate specific gene expression during evaluation of gene targets in vivo. This technique is extremely sensitive to fixation. Optimal fixation conditions are necessary to obtain the maximal beta-Gal activity. In this experiment, Carnoy's and three different aldehyde fixatives were used at different temperatures and over different time points. Kidneys from LacZ-stop-human alkaline phosphatase (ZA/P) double reporter mice were used to generate positive material for the experiment. The results show that glutaraldehyde combinative solution (LacZ) produced the most consistent and reliable results. Paraformaldehyde and formaldehyde were effective as fixatives only at 4C for a period of less than 4 hr, and Carnoy's solution destroyed beta-Gal activity.

Preoperative evaluation of chronic alcoholics assessed for surgery of the upper digestive tract

BACKGROUND

Alcoholics are at risk of developing major complications in the postoperative period. Adequate prophylactic treatment, as well as preoperative abstinence, can significantly decrease the rate of complications. However, the preoperative diagnosis of alcoholism is difficult to establish. The purpose of this study was to assess whether three preoperative visits, an alcohol-related questionnaire (CAGE), and the laboratory markers carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT) would increase the rate of detection of chronic alcoholics.

METHODS

The study included the Departments of ENT, Facial and Maxillofacial Surgery, and General Surgery of a university hospital; 705 male patients were assessed for tumor surgery of the upper digestive tract and were allocated to 5 different groups. All patients were seen three times, and five different strategies were used to detect chronic alcoholics. The gold standard was the diagnosis of alcohol misuse made by an experienced (blinded) investigator according to the DSM-III-R. The main outcome measurements were the detection rates of the different test strategies.

RESULTS

By clinical routine alone, only 16% were detected during the first visit and 34% after three visits. If the CAGE questionnaire was added, sensitivity increased to 64%. The further addition of GGT or CDT led to 80 and 85% detections, respectively. A combination of all tests had a sensitivity of 91%.

CONCLUSIONS

To detect more alcoholic patients at risk for major complications, patients should be seen more often, and additional diagnostic tools such as the CAGE, CDT, and GGT should be used before surgery.

Risk of renal and colonic neoplasms and spontaneous pneumothorax in the Birt-Hogg-Dubé syndrome

The Birt-Hogg-Dubé syndrome, a genodermatosis characterized by benign tumors of the hair follicle, has been associated with renal and colonic neoplasms and spontaneous pneumothorax, but the risk of developing these disorders is unknown. We identified risk factors for renal tumors and spontaneous pneumothorax in 98 patients affected with the Birt-Hogg-Dubé syndrome, in 13 Birt-Hogg-Dubé haplotype carriers, and in 112 unaffected family members. Development of renal tumors was strongly associated with the Birt-Hogg-Dubé syndrome and age. The odds ratio for renal tumor in BHD-affected family members adjusted for age was 6.9 (95% confidence interval, 1.5-31.6) and approximately 9.0 for the other risk factors considered. Chromophobe renal carcinoma, an uncommon type of renal cancer, was the predominant type of renal cancer found. Spontaneous pneumothorax was also strongly associated with the Birt-Hogg-Dubé syndrome and age. The odds ratio for pneumothorax in BHD-affected individuals, adjusted for age, was 50.3 (95% confidence interval, 6.4-392), and about 32 times higher adjusting for the other risk variables. Colon cancer and colon polyps were not related to the Birt-Hogg-Dubé syndrome. The Birt-Hogg-Dubé syndrome confers an increased risk for the development of renal tumors and spontaneous pneumothorax. We found no increase in risk for the development of colon polyps or colon carcinomas.

Circular dichroism in K-shell ionization from fixed-in-space CO and N2 molecules

We have measured the angular distributions of 1s photoelectrons excited by circularly and linearly polarized light from fixed-in-space CO and N2 molecules, in the vicinity of their shape resonances. A strong circular dichroism, i.e., a strong dependence on the sense of rotation of the polarization vector of the photons, is found for both molecules. State-of-the-art one-electron multiple scattering and partially correlated random phase approximation calculations are in good agreement with many, but not all, aspects of the experimental data.

Patient-assessed health outcome measures for diabetes: a structured review

AIMS

To identify available disease-specific measures of health-related quality of life (HRQL) for diabetes and to review evidence for the reliability, validity and responsiveness of instruments.

METHODS

Systematic searches were used to identify instruments. Instruments were assessed against predefined inclusion and exclusion criteria. Letters were sent to authors requesting details of further instrument evaluation. Information relating to instrument content, patients, reliability, validity and responsiveness to change was extracted from published papers.

RESULTS

The search produced 252 references. Nine instruments met the inclusion criteria: Appraisal of Diabetes Scale (ADS), Audit of Diabetes-Dependent Quality of Life (ADDQoL), Diabetes Health Profile (DHP-1, DHP-18), Diabetes Impact Measurement Scales (DIMS), Diabetes Quality of Life Measure (DQOL), Diabetes-Specific Quality of Life Scale (DSQOLS), Questionnaire on Stress in Diabetic Patients-Revised (QSD-R), Diabetes-39 (D-39) and Well-being Enquiry for Diabetics (WED). The shortest instrument (ADS) has seven items and the longest (WED) has 50 items. The ADS and ADDQoL are single-index measures. The seven multidimensional instruments have dimensions covering psychological well-being and social functioning but vary in the remainder of their content. The DHP-1 and DSQOLS are specific to Type 1 diabetes patients. The DHP-18 is specific to Type 2 diabetes patients. The DIMS and DQOL have weaker evidence for reliability and internal construct validity. Patients contributed to the content of the ADDQoL, DHP-1/18, DQOL, DSQOLS, D-39, QSD-R and WED. The authors of the ADDQoL, DHP-1/18, DQOL, DSQOLS gave explicit consideration to content validity. The construct validity of instruments was assessed through comparisons with instruments measuring related constructs and clinical and sociodemographic variables. None of the instruments has been formally assessed for responsiveness to changes in health.

CONCLUSIONS

Five of the diabetes-specific instruments have good evidence for reliability and internal and external construct validity: the ADDQoL, DHP-1/18, DSQOLS, D-39 and QSD-R. Instrument content should be assessed for relevance before application. The instruments should be evaluated concurrently for validity and responsiveness to important changes in health.

The emergence of problem-drinking women as a special population in need of treatment

This chapter chronicles the development of advocacy for improvements in alcohol treatment services for women during the 1970s and 1980s, tracing its influence in terms of real change in treatment systems in the United States. We follow the development of a "women's alcoholism movement" from its inception in the late 1970s through its transition during the late 1980s into a broader movement focused on drug abuse and perinatal addiction. We describe the new governing images of problem-drinking women that advocates presented, their claims about the nature of substance abuse problems in women, and their recommendations for a more "gender-sensitive" treatment system. We also review increased federal involvement in this issue over the course of the 1980s, as pressure mounted on policymakers to respond to the crisis over drug-exposed infants by making treatment services more accessible to women. The chapter concludes by considering these developments from the perspective of national treatment system statistics, finding modest growth in specialized and women-only treatment units, as well as moderate increases in the representation of women in substance abuse treatment caseloads.

Induction of transplantable mouse renal cell cancers by streptozotocin: in vivo growth, metastases, and angiogenic phenotype

Interleukin-2-based regimens of biological therapy have shown some clinical promise for the treatment of kidney cancer in humans, although the mechanisms responsible for tumor regression occurring in these patients remain unclear. Preclinical insight into these mechanisms is limited by a paucity of orthotopic animal models of kidney cancer. We have used streptozotocin, an antibiotic and diabetogenic nitrosamine compound derived from Streptomyces achromogenes to induce new kidney tumors in BALB/c mice. Single or multiple doses of streptozotocin induced kidney tumors in up to 25% of mice by 50-90 weeks of age, with up to 18% characterized as renal cell carcinomas (RCCs). Several transplantable lines were obtained from the RCCs, and one of these lines was subsequently cloned. The initial tumor isolates and sublines were histologically reconfirmed to be RCCs, and all grew progressively but slowly (mean survival times, 57 to >100 days) in vivo after intrarenal implant. None of the primary isolates or sublines revealed mutations in either the VHL or Ras genes, although karyotype analysis and chromosome painting revealed the consistent presence of a submetacentric chromosome resulting from the fusion of chromosomes 16 and 19. Biological characterization of these tumors revealed several features analogous to the growth of human kidney cancers, including a propensity for the formation of lung metastases and high vascularity. This hypervascularity is evident by both gross and microscopic analysis and correlates with the expression of several proangiogenic genes. Overall, the features of orthotopic transplantability, slower in vivo growth (relative to the rapid growth rates of other transplantable mouse kidney tumors), propensity for lung metastases, and hypervascularity may make these tumors valuable models for the study of new therapeutic strategies based on antineovascular agents and antitumor cytokines.

The utility of the Substance Abuse Subtle Screening Inventory-3 for use with individuals with brain injury

The utility of the Substance Abuse Subtle Screening Inventory (SASSI-3) for the use with individuals with traumatic brain injuries (TBI) was investigated. The SASSI-3 was administered to 78 subjects prior to discharge from inpatient rehabilitation. The SASSI-3 diagnosis of chemical dependency was compared with the diagnosis of staff psychologists. Lower accuracy, sensitivity, and specificity were found in SASSI-3 diagnosis for the subjects with brain injury, as compared to a normative sample of persons with disabilities participating in a vocational rehabilitation programme. When a diagnosis of 'dependence or abuse' was used, accuracy of the SASSI-3 increased. Comparison of diagnosis based on SASSI-3 versus Blood Alcohol Level (BAL) at the time of injury showed comparable accuracy; however, BAL was found to have higher specificity. For dependence or abuse, BAL continued to be more specific than the SASSI-3; however, the SASSI-3 was more sensitive. Based on these findings, a clinical approach to screening using both BAL and the SASSI-3 is discussed.

[The secrecy aspect of donor insemination]

A literature review among couples treated with donor insemination (DI) showed that almost all participants had planned not to inform the child that this treatment had taken place. Many of the couples had told other people about the treatment, and thus opened up the possibility of a traumatic disclosure. Though secrecy about DI treatment could be taxing for the couple, this strain did not negatively influence the assessment of the relationship, parenthood, or the parent-child relation. Psychosocial development of DI-children was not different from other children's development. It was not possible to show a deleterious effect of keeping the treatment a secret. There is a lack of qualitative studies about the consequences of secrecy for the relationship between DI-parents, for parenthood and for the child. Only one study included adult DI-children.

Abrupt rise of the longitudinal recoil ion momentum distribution for ionizing collisions

We report on the experimental observation of an abrupt rise in the longitudinal momentum distribution of recoil ions created in proton helium collision. The details of this structure can be related to electrons traveling with the velocity of the projectile [electron capture to the continuum (ECC)]. The longitudinal as well as the transverse distribution of the recoil ions can be explained as a continuation of the momentum distribution from ions resulting from electron capture illustrating the smooth transition from the capture to bound states of the projectile to the ECC.