Comparison of methods to enumerate white blood cells in semen

Seminal WBC counts obtained by an mAb-based immunohistologic method correlated well with seminal granulocyte counts obtained with a simple peroxidase method (rho = +0.70; P < 0.0001). However, total WBC counts were significantly higher than granulocyte counts for most samples. With the immunohistologic method, 17 of 112 samples (15.2%) contained > 10(6) WBC/mL semen, whereas the peroxidase method resulted in only 10 samples (8.9%) with > 10(6) WBC/mL. When the threshold defining leukocytospermia was set at 1 x 10(6) positive cells/mL for both methods, the specificity of the peroxidase test compared with the immunohistology technique was 100% (10/10), but the sensitivity was only 58.8% (10/17). When the threshold for leukocytospermia in the peroxidase test was lowered to 5 x 10(5) positive cells/mL semen, the sensitivity relative to the immunohistology technique increased to 94.1% (16/17), and specificity remained 100% (16/16). Likewise, good interassay sensitivity and specificity values were obtained with thresholds of 10(6) WBC/mL for the peroxidase assay and 2 x 10(6) WBC/mL for the immunohistology assay. We conclude that either peroxidase or immunohistology assays can be used to screen for leukocytospermia, but that more research is needed to establish thresholds for pathological levels of WBC in semen using these two approaches. Total round cell counts are of no value for enumerating WBC in semen.

Effects of growth factors and growth factor-extracellular matrix interactions on mouse trophoblast outgrowth in vitro

A variety of cell types at the blastocyst implantation site produce growth factors that could play important role(s) in the implantation process. Recent evidence indicates that decidual cells and/or embryos produce transforming growth factor-alpha (TGF-alpha), epidermal growth factor (EGF), platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), and colony-stimulating factor (CSF-1). Furthermore, receptors for EGF, PDGF, and CSF-1 have been detected on embryonic and trophoblastic cells. The purpose of this study was to investigate the effects of these growth factors and possibly growth factor-extracellular matrix interactions on mouse blastocyst attachment and trophoblast outgrowth in vitro. Various dilutions of the growth factors TGF-alpha, EGF, PDGF, FGF, and CSF-1 were added to cultures of 5-day-old hatched blastocysts in fibronectin-coated plastic wells. Blastocysts were scored for attachment, trophoblast outgrowth, and surface area at 24, 48, and 72 h. Each of these growth factors significantly enhanced trophoblast outgrowth, and a cocktail containing all of the growth factors had a significantly stronger effect. PDGF and FGF, but no other growth factors, also enhanced trophoblast outgrowth following pulsatile incubation with the fibronectin matrix coating of the culture wells, indicating that interactions between these growth factors and extracellular matrix elements could influence implantation. This study suggests that various growth factors may play an important role in the implantation process, that synergistic effects may be obtained by combinations of growth factors, and that interactions between certain growth factors and extracellular matrix elements may be significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytokines and growth factors in implantation

A variety of cell types at the blastocyst implantation site produce cytokines and growth factors that could play an important role in the implantation process. Furthermore, receptors for cytokines and growth factors have been detected on embryonic and trophoblastic cells. The purpose of the article is to review the published literature on the effect of cytokines and growth factors on implantation events, and to present recent data from our laboratory on effects of growth factors and cytokines on mouse blastocyst implantation events in vitro.

Pediatric lung transplantation: radiographic-histopathologic correlation

Chest radiographic and histopathologic findings were retrospectively reviewed to determine the spectrum of findings in 16 children who underwent a total of 19 lung transplantations. Radiographs were evaluated for air-space disease, interstitial disease, Kerley B lines, pleural fluid, and cardiac size, and the interval from transplantation to the onset of complications was determined. Radiographic findings were correlated with 62 histopathologic diagnoses obtained from 51 transbronchial and open lung biopsy specimens. The final histopathologic diagnoses were acute rejection (n = 19), chronic rejection (n = 8), infection (n = 11), lymphoproliferative disorder (n = 4), and nonspecific (n = 20). The radiographic patterns of the complications were not significantly different. Seventy-nine percent (15 of 19) of episodes of acute rejection and 64% (seven of 11) of episodes of infection occurred within 5 weeks of transplantation, while 63% (five of eight) of the episodes of chronic rejection occurred after this period. Since chest radiographs are nonspecific, caution should be exercised in basing clinical decisions only on the radiographic pattern in the absence of corroborative clinical and histopathologic findings.

Determination of fibrinogen in plasma by high-performance immunoaffinity chromatography

A high-performance immunoaffinity chromatographic (HPIAC) method for fibrinogen was developed which had several advantages over existing methodologies including increased linear range and no interference from heparin. Several modifications of usual HPIAC procedures were necessary including the employment of a methacrylate polymeric support to reduce non-specific adsorption and the addition of urea to a pH 2.1 elution buffer to affect elution. A significant split-peak effect (i.e., unretained fibrinogen) was noted at higher flow-rates and at higher fibrinogen concentrations, which was shown to be temperature-dependent, with the amount of fibrinogen retained on the column increasing with increased temperature.

High-resolution computer display of portable, digital, chest radiographs of adults: suitability for primary interpretation

OBJECTIVE

The suitability of using a high-resolution computer-display system for primary interpretation of adult chest radiographs obtained with portable apparatus and storage phosphor technology was evaluated with receiver operating characteristic analysis and subjective methods.

MATERIALS AND METHODS

Sixty portable digital chest radiographs showing abnormalities that approached the resolution limits of our computed radiography system were selected. The original digital data making up the 2140 x 1760 x 10 bit images were transferred to a cathode ray tube (CRT) display system composed of two Megascan monitors. Postprocessing rendered two images, one for each monitor, to emulate the two-on-one hard-copy format produced by the computed radiography system. Each image set was interpreted independently by three radiologists experienced with hard-copy format. Limited level and window adjustments were allowed during CRT interpretation. For both CRT and hard-copy display, images were graded on the basis of the interpreter's confidence in the presence of pneumothorax and parenchymal abnormalities. Three types of foreign devices were subjectively analyzed: endotracheal tubes, nasogastric tubes, and temporary epicardial pacer wires.

RESULTS

No significant differences were found in detecting pneumothorax or focal infiltrates. One radiologist found the hard copy better for detecting diffuse infiltrates (p = .02); two radiologists favored CRT for visualizing nasogastric tubes (p < .005, p < .02); and one radiologist favored CRT for visualizing temporary epicardial pacer wires (p = .05).

CONCLUSION

We conclude that an optimized high-resolution CRT system is quite promising for primary interpretation of digital portable chest radiographs, but further investigation and greater statistical power are necessary to confirm our results.

Molecular control of cell fate in the neural crest: the sympathoadrenal lineage

Over the past five years, new insights have been gained into the biology of the SA lineage. These advances have been powered by the development of immunologic methods to isolate embryonic SA progenitors from fetal adrenal glands and sympathetic ganglia. Analysis of these embryonic progenitors has confirmed many of the ideas derived from earlier studies of postnatal cells, but has necessitated several revisions in our thinking, as well. First, embryonic SA progenitors appear to be distinct from mature SIF cells, a cell type initially postulated to be the central intermediate in the SA lineage. Second, FGF, not NGF, appears to be an important early influence on neuronal fate; NGF responsiveness appears relatively late in differentiation. Third, the development of both sympathetic neurons and adrenal chromaffin cells is not a one-step process, but rather involves a series of events, in which the cells change their responsiveness to growth factors and glucocorticoids. Fourth, emerging circumstantial evidence suggests that SA progenitors may have additional developmental potentials. Finally, new insights have been gained into the molecular mechanisms that underlie both the differentiation of SA progenitors and their determination from earlier multipotent neural crest cells. These advances have made the SA progenitor a well-defined system for studying the molecular control of cell fate in a vertebrate neurogenic precursor cell. The analysis of the SA lineage at the cell biological level has raised several interesting molecular questions for future investigation. In the neuronal branch of the SA lineage, how is the acquisition of NGF-responsiveness and NGF-dependence controlled, and what is the relationship of these events to the expression of p140trk and p75? In the chromaffin branch of the pathway, which molecules control the timing of PNMT expression? In the uncommitted SA progenitor, what is the molecular basis of the antagonism between the competing neuronal and chromaffin pathways of differentiation, and how does commitment to neuronal differentiation occur? Can SA progenitors differentiate to enteric neurons in vitro, and which differentiation and survival factors control this phenotype, as well as the other classical neurotransmitter and neuropeptide phenotypes expressed by SA derivatives? What are the roles of MASH1 and other regulatory genes in controlling early stages in neural crest cell determination, and how is the expression of these molecules in turn controlled? How much of the genetic regulatory network controlling neuronal differentiation in Drosophila has been conserved in vertebrates?(ABSTRACT TRUNCATED AT 400 WORDS)

Cell fate determination in the peripheral nervous system: the sympathoadrenal progenitor

Studies of postnatal chromaffin cells, sympathetic neurons and Small Intensely Fluorescent (SIF) cells have suggested that these cells develop from a common progenitor, the sympathoadrenal (SA) progenitor, whose fate is determined by the relative levels of nerve growth factor (NGF) and glucocorticoid (GC) in its environment (Unsicker et al., 1978, Proc. Natl. Acad. Sci. USA 75:3498-3502; Doupe et al., 1985a, J. Neurosci. 5:2119-2142). Recent studies have identified such a bipotential SA progenitor in the rat embryo. Surprisingly, this progenitor is initially unresponsive to NGF; neuronal differentiation is instead promoted by fibroblast growth factor (FGF). However, FGF appears to promote NGF responsiveness, suggesting that neuronal differentiation involves a relay or cascade of growth factor action. Furthermore, chromaffin cell differentiation appears to involve two sequential, GC-dependent events: the inhibition of neuronal differentiation and the induction of epinephrine synthesis. The former event is a prerequisite to the latter. Thus both the chromaffin and neuronal pathways of differentiation follow a series of dependent events, involving changes in the responsiveness of SA progenitors to environmental factors. Such changes correlate with changes in antigenic marker expression that can be observed in vivo. In addition to choosing between neuronal and endocrine fates, SA progenitors must also express an appropriate neurotransmitter phenotype. For example, sympathetic neurons can become either noradrenergic or cholinergic. This cholinergic potential is already present in uncommitted SA progenitors, as evidenced by their ability to synthesize acetylcholine. Recent studies suggest that these cells may have yet other developmental capacities, including the ability to synthesize serotonin. This capacity is consistent with the hypothesis that SA progenitors are closely related to progenitors of enteric neurons, an idea supported by recent observations using novel antigenic markers. The SA progenitor may be, therefore, a "master" neuroendocrine progenitor for the peripheral nervous system.

Cell and molecular biology of neural crest cell lineage diversification

Neural crest cells are multipotent progenitor cells, but it is not understood how these cells generate their diverse differentiated progeny. This review considers the issues of whether neural crest cells self-renew, whether they generate partially committed intermediate progenitors, and how the local embryonic environment may act to control this diversification process. Novel molecular markers for neural crest cells are also discussed.

Isolation of a stem cell for neurons and glia from the mammalian neural crest

We have isolated mammalian neural crest cells using a monoclonal antibody to the low affinity NGF receptor, and established conditions for the serial propagation of these cells in clonal culture to assess their developmental potential. This analysis indicates that, first, single mammalian neural crest cells are multipotent, able to generate at least neurons and Schwann cells like their avian counterparts. Second, multipotent neural crest cells generate multipotent progeny, indicating that they are capable of self-renewal and therefore are stem cells. Third, multipotent neural crest cells also generate some clonal progeny that form only neurons or glia, suggesting the production of committed neuroblasts and glioblasts. Manipulation of the substrate alters the fate of the multipotent cells. These findings have implications for models of neural crest development in vivo, and establish a system for studying the generation of cellular diversity by a multipotent stem cell in vitro.

Molar villous fluid suppresses mononuclear cell cytotoxicity

Complete molar pregnancy tissue is an allograft to the mother because all molar chromosomes are of paternal origin. Interactions between molar tissue and the maternal immune system may be important in the natural history of complete molar pregnancy. Molar villous fluid (MVF) has previously been demonstrated to suppress both mitogen and interleukin-2-induced T lymphocyte proliferation. The current study was undertaken to evaluate the potential effect of MVF on the cytotoxic activity of mononuclear cells (MNC) and lymphokine-activated mononuclear cells (LA-MNC). Sera and molar villous fluid were obtained from four women at the time of molar evacuation. K-562 erythroblastoid cells were used as target cells for MNC-mediated lysis, and JEG-3 choriocarcinoma cells were used as targets for LA-MNC-mediated lysis in a 51Cr release assay. Relative to patient sera, all MVF tested significantly inhibited both MNC and LA-MNC lysis of target cells (48.3 and 91% mean inhibition, respectively; P < 0.05). This study provides additional evidence that molar gestational tissue produces factor(s) that suppress maternal immunologic responses. Potential therapies may become available to reduce or eliminate the immunosuppressive effects of molar gestations resulting in a more favorable clinical outcome in patients with complete molar pregnancy and postmolar gestational trophoblastic tumors.

Omental flap in lung transplantation

Some surgeons performing lung transplantation will wrap the bronchial anastomosis with omentum in an attempt to improve healing. The authors retrospectively reviewed the chest radiographs and computed tomographic (CT) scans of 31 patients who underwent lung transplantation with bronchial omentopexy to determine the CT appearance of the intrathoracic omentum and the frequency and type of chest radiographic manifestations created by the omental flap. The omental flap was seen at CT in all patients, was predominantly of fatlike attenuation, and contained linear areas of increased attenuation representing omental vessels. In 16 patients (52%), a total of 29 chest radiographic findings that corresponded to the omental flap were seen. There was no statistically significant correlation between the type of operative procedure and the presence of a chest radiographic correlate for the omentum. The results showed that the omental flap is a potential diagnostic pitfall on post-lung transplantation chest radiographs; when there is confusion, however, the omentum can be identified with CT because of its attenuation value and characteristic course.

Antifertility effects of antisperm cell-mediated immunity in mice

C57BL/6 female mice were immunized with allogeneic (DBA/2) sperm in Freund's adjuvant either subcutaneously (s.c.), transcervically into the uterine lumen (i.u.), or with a combination of s.c. and i.u. immunization approaches. Control mice received DBA/2 lymphocytes, human erythrocytes or saline in adjuvant using the same immunization protocols. Immunization with sperm or control cells in adjuvant exclusively by s.c. or i.u. approaches did not affect subsequent fertility, although sperm-injected mice from both protocols had high titers of circulating antisperm antibodies. In contrast, mice that were immunized with sperm in adjuvant by a combination of s.c. and i.u. injections demonstrated significant reductions in fertilization rate and number of viable fetuses and an increased rate of fetal resorption when compared with non-immunized and control-immunized mice. Mice receiving sperm by the s.c./i.u. protocol had high titers of antisperm antibodies and a marked infiltration of T lymphocytes and macrophages into the uterine endometrium. To determine whether cellular immune mechanisms contributed to the infertility effect, T lymphocytes from spleens and pelvic lymph nodes of s.c./i.u. sperm-immunized mice and non-immunized mice were passively transferred to naive syngeneic female recipients which were subsequently mated. The total number of fetuses on day 15 of pregnancy was significantly reduced in mice receiving T-lymphocytes from sperm-immunized mice and a significant increase in fetal resorption sites was also observed. These mice did not have detectable titers of circulating antisperm antibodies, but had a significant infiltration of CD4+ T lymphocytes and macrophages in the uterine epithelium and endometrium. These data indicate that intrauterine antisperm cell-mediated immunity can be induced in mice by a combination of systemic and intrauterine immunizations and provide evidence for the existence of reproductive tract mucosal antisperm cellular immune responses that adversely affect fertility and pregnancy.

Cone biopsy: has endocervical sampling a role?

OBJECTIVE

To investigate the sensitivity, specificity and predictive value of endocervical sampling in women with abnormal cervical smears.

DESIGN

A randomized study of two methods of endocervical sampling.

SETTING

Colposcopy clinic at Aberdeen Royal Infirmary.

SUBJECTS

100 women with abnormal cervical smears selected for cone biopsy according to current colposcopy criteria.

INTERVENTIONS

53 women were randomized to have endocervical sampling with the Kevorkian curette and 47 to have sampling with the Medscand endocervical brush.

MAIN OUTCOME MEASURES

Cytology and histology results from endocervical sampling compared with cone biopsy histology.

RESULTS

The overall sensitivity of endocervical sampling was 56%, with a false negative rate of 44% and a negative predictive value of 26%.

CONCLUSIONS

Endocervical sampling should not influence management when colposcopy is unsatisfactory.

Interferon-gamma receptors on human gestational choriocarcinoma cell lines: quantitative and functional studies

OBJECTIVES

This study was performed to further define the effects of interferon-gamma on choriocarcinoma cell lines and to determine whether variations in response among cell lines are attributable to quantitative differences in interferon-gamma receptors.

STUDY DESIGN

Interferon-gamma receptors were quantified on BeWo, JEG-3 and Jar choriocarcinoma cell lines by a radiolabeled interferon-gamma ligand binding assay. The response of these cell lines to interferon-gamma was measured in two functional assays: a cell proliferation assay and a cell lysis assay after exposure to interferon-gamma with and without actinomycin-D.

RESULTS

The number of interferon-gamma receptors on BeWo, Jar, and JEG-3 cells did not differ significantly (650, 560, and 420 interferon-gamma receptors per cell, respectively). Proliferation of all three choriocarcinoma cell lines was significantly inhibited to a similar extent by interferon-gamma. After treatment with interferon-gamma actinomycin-D, each choriocarcinoma cell line exhibited dose-dependent cell lysis; lysis of Jar was significantly less than that of either BeWo or JEG-3.

CONCLUSION

These data further document variations in the response of choriocarcinoma cell lines to interferon-gamma and indicate that these differences are not the result of interferon-gamma receptor number but of postreceptor mechanisms.

Pulmonary nodular opacities after transbronchial biopsy in patients with lung transplants

Focal nodular opacities were seen on 26 of 74 (35%) postbiopsy radiographs obtained in 39 patients who underwent lung transplantation. The subsequent clinical course and diagnostic evaluation suggested that the opacities were due to focal hemorrhage at the biopsy sites. This finding was evident on only three of 40 (8%) postbiopsy radiographs obtained in 40 control patients who underwent transbronchial biopsy for diffuse interstitial lung disease. The differential diagnosis of new pulmonary nodular opacities in lung transplantation patients should include focal postbiopsy hematomas, because of their relatively frequent occurrence in this clinical situation.

Membrane depolarization induces p140trk and NGF responsiveness, but not p75LNGFR, in MAH cells

Nerve growth factor (NGF) is required for the maturation and survival of sympathetic neurons, but the mechanisms controlling expression of the NGF receptor in developing neuroblasts have not been defined. MAH cells, an immortalized sympathoadrenal progenitor cell line, did not respond to NGF and expressed neither low-affinity NGF receptor (p75) nor p140trk messenger RNAs. Depolarizing concentrations of potassium chloride, but none of a variety of growth factors, induced expression of p140trk but not p75 messenger RNA. A functional response to NGF was acquired by MAH cells under these conditions, suggesting that expression of p75 is not essential for this response. Depolarization also permitted a relatively high proportion of MAH cells to develop and survive as neurons in fibroblast growth factor and NGF. These data establish a relation between electrical activity and neurotrophic factor responsiveness in developing neurons, which may operate in the functioning of the mature nervous system as well.

Mild and moderate dyskaryosis: can women be selected for colposcopy on the basis of social criteria?

OBJECTIVE

To describe the distribution of cervical intraepithelial neoplasia grades among women with mild and moderate dyskaryosis after a single cervical smear and to determine whether social criteria could help identify women who are at increased risk of grade II or III disease.

DESIGN

Cross sectional analysis within a randomised prospective study. Subjects had a repeat smear, a colposcopic examination, and an excision biopsy of the transformation zone. In addition, women were asked to complete a social questionnaire.

SETTING

Colposcopy clinic, Aberdeen.

SUBJECTS

228 women with a single smear test showing mild or moderate dyskaryosis.

MAIN OUTCOME MEASURES

Histology, age, sexual and contraceptive history, cigarette smoking.

RESULTS

159 (70%) women had cervical intraepithelial neoplasia grades II or III. Among current smokers the prevalence of grade II and III disease was higher in women who smoked greater than or equal to 20 cigarettes a day (84%) than among those who smoked less (66%; p less than 0.04). Women with more than one sexual partner also had a higher prevalence (75%) than women with only one partner (50%; p = 0.0028). Use of oral contraceptives and younger age were not significantly associated. The prevalence of grade II or III disease was up to 66% in the lower risk groups.

CONCLUSIONS

Because of the high prevalence of cervical intraepithelial neoplasia grades II and III in both the high and the low risk groups social factors are not useful for selecting women with mild or moderate dyskaryosis for either early referral to colposcopy or cytological surveillance.

A common silencer element in the SCG10 and type II Na+ channel genes binds a factor present in nonneuronal cells but not in neuronal cells

We have localized a cell type-specific silencer element in the SCG10 gene by deletion analysis. This neural-restrictive silencer element (NRSE) selectively represses SCG10 expression in nonneuronal cells and tissues. The NRSE contains a 21 bp region with striking homology to a sequence present in a silencer domain of the rat type II sodium channel (NaII), another neuron-specific gene. We have identified a sequence-specific protein(s) that binds the SCG10 NRSE, as well as the homologous element in the NaII gene. A point mutation in the NRSE that abolishes binding of this neural-restrictive silencer-binding factor (NRSBF) in vitro also eliminates silencing activity in vivo. NRSBF is present in nuclear extracts from nonneuronal cells but not in extracts from neuronal cells, suggesting that the neuron-specific expression of SCG10 reflects, at least in part, the absence or inactivity of this protein. These data identify the NRSE as a potentially general DNA element for the control of neuron-specific gene expression in vertebrates.

CNTF and LIF act on neuronal cells via shared signaling pathways that involve the IL-6 signal transducing receptor component gp130

Ciliary neurotrophic factor (CNTF) has a variety of actions within the nervous system. While some of the actions of leukemia inhibitory factor (LIF) on neurons resemble those of CNTF, LIF also has broad actions outside of the nervous system that in many cases mimic those of interleukin-6 (IL-6). Comparison of the tyrosine phosphorylations and gene activations induced by CNTF and LIF in neuron cell lines reveals that they are indistinguishable and also very similar to signaling events that characterize LIF and IL-6 responses in hematopoietic cells. We provide a basis for the overlapping actions of these three factors by demonstrating that the shared CNTF and LIF signaling pathways involve the IL-6 signal transducing receptor component gp130. Thus, the receptor system for CNTF is surprisingly unlike those used by the nerve growth factor family of neurotrophic factors, but is instead related to those used by a subclass of hematopoietic cytokines.

Generalized anxiety disorder vs. panic disorder. Distinguishing characteristics and patterns of comorbidity

In order to examine the validity of the distinction between generalized anxiety disorder (GAD) and panic disorder (PD) we compared 41 subjects with GAD and 71 subjects with PD. The GAD subjects had never had panic attacks. In contrast to the symptom profile in PD subjects suggestive of autonomic hyperactivity, GAD subjects had a symptom pattern indicative of central nervous system hyperarousal. Also, subjects with GAD had an earlier, more gradual onset of illness. In terms of coexisting syndromes, GAD subjects more often had simple phobias, whereas PD subjects more commonly reported depersonalization and agoraphobia. GAD subjects more frequently had first-degree relatives with GAD, whereas PD subjects more frequently had relatives with PD. A variety of measures indicated that our GAD subjects had a milder illness than those with PD. Also, fewer GAD subjects gave histories of major depression than did PD subjects. Among GAD subjects, coexisting major depression was associated with simple phobia and thyroid disorders and among PD subjects, comorbid depression was associated with social phobia and hypertension. Our findings indicate that the separation of GAD from PD is a valid one. They also indicate that, within disorders, unique patterns of comorbidity may exist that are important both clinically and theoretically.