Cytotoxic phenotype of intra-epithelial lymphocytes in normal and cryptorchid human testicular excurrent ducts

BACKGROUND

Most testicular and epididymal lymphocytes express T-cell markers, but their cytotoxic potential and activation status have not been reported. In this study, distribution of the cytotoxic cells was compared between normal and cryptorchid testes stratified into two groups: the first with complete absence of germ cells [Sertoli cell-only (SCO)] and the second with arrested spermatogenesis (SCA).

METHODS

Immunohistochemistry for the T-lymphocyte marker CD3 and cytotoxic markers CD8, TIA-1 and granzyme B was performed on paraffin-embedded sections.

RESULTS

The number of CD8+ and CD3+ intra-epithelial lymphocytes (IELs) increased distally throughout the normal epididymis. TIA-1 immunostaining revealed that a significant proportion of IELs exhibited cytotoxic potential, whereas granzyme B staining disclosed a subpopulation of activated cytotoxic lymphocytes (CTLs). TIA-1/CD8 and granzyme B/CD8 double immunostaining revealed that the vast majority of TIA-1+ and granzyme B+ cells were CD8+. The proportion of activated granzyme B+ lymphocytes increased distally throughout the normal epididymis. The number of TIA-1+ and granzyme B+ intra-epithelial and stromal lymphocytes was significantly increased in the normal as opposed to the SCO cryptorchid epididymis and proximal vas deferens.

CONCLUSIONS

These results suggest that exposure of the testicular excurrent ducts to spermatozoa or immature germ cells triggers the activation and recruitment of CTLs. Cytotoxic granule effector mechanisms may contribute to the immunological barrier preventing the immune response to spermatozoa in testicular ducts.

Regioselective functionalization of starch: synthesis and 1H NMR characterization of 6-O-silyl ethers

A high regioselective 6-O silylation of starch by using thexyldimethylchlorosilane (TDSCl, chlorodimethyl-(2,3-dimethylbut-2-yl)silane) as bulky silylating agent in the reaction system N-methylpyrrolidone (NMP)/ammonia was carried out and investigated. The control of the degree of substitution (DSSi), the control of the regioselectivity, and the control of the reaction pathway are described in detail. After peracetylation of the silyl ethers of starch, the distribution of the silyl and acetyl substituents was characterized not only in the anhydroglucose repeating units (AGU) but also in the nonreducing end groups (NEG) by means of multidimensional 1H NMR techniques. In both cases, the silyl substituents were detected exclusively in the 6-O position, and the acetyl groups in the 2-O and 3-O positions of the AGU and in the 2-O, 3-O, and 4-O positions of the NEG, respectively. The described 6-O-thexyldimethylsilyl (TDS) units are potentially protecting groups of the primary OH position of starches.

Quantification of antigen-reactive T cells by a modified ELISPOT assay based on freshly isolated blood dendritic cells

The enzyme-linked immunospot (ELISPOT) assay has become a widely employed method for quantification of antigen-reactive T lymphocytes. In recent years, various types of antigen-presenting cells (APCs) have been tested as stimulator cells in ELISPOT protocols to achieve a highly sensitive and rapid assay which is not impaired by a marked nonspecific cytokine release. However, the currently available APCs still have disadvantages, such as significant background reactivities, limited sensitivity, and time-consuming preparation procedures. Recently, we succeeded in defining a novel subpopulation of circulating dendritic cells (DCs) that can easily be prepared from human blood. These M-DC8+ DCs proved to be very effective in the induction of antigen-specific T cell responses. In the present study we provide evidence that M-DC8+ DCs are particularly well suited as APCs for the detection of antigen-specific CD8+ T cells after challenge with viral or tumor peptides in ELISPOT assays. In addition, protein-loaded M-DC8+ DCs proved to be quite efficient in the presentation of MHC class II-bound peptides, thus allowing the determination of frequencies of antigen-reactive CD4+ T cells. The use of M-DC8+ DCs as stimulator cells can improve the ELISPOT assay by combining high sensitivity, rapidity, and low background reactivity.

[Multiple miliary osteomas of the face]

Osteoma cutis is a single or multiple ectope calcification with development of bony structures in the skin. We distinguish between primary and secondary ossification. Multiple miliary osteoma in the face has mostly been described secondary to preexisting acne vulgaris. We present a 62-year-old woman who developed multiple miliary osteoma in the face together with repeated doses of estrogen and discuss pathogenesis and therapeutic possibilities.

Improved sampling of wildlife populations using airborne surveys

Parameter estimates, obtained from airborne surveys of wildlife populations, often have large bias and large standard errors. Sampling error is one of the major causes of this imprecision and the occurrence of many animals in herds violates the common assumptions in traditional sampling designs like systematic or simple random sampling even when stratification is used. In this paper, we present an adaptive sampling design that uses criteria of observed animal counts to maximise sample information and that is independent of the usual assumption of a uniform distribution for wildlife populations. For illustration, the design is applied to data derived from a survey carried out in the Masai Mara ecosystem (Mara) of Kenya, with a focus on three species: elephant (Loxodonta africana), kongoni (Alcelaphus buselaphus) and wildebeest (Connochaetes taurinus). The sampling design's more efficient estimates show an improvement on those from conventional systematic design, with a greater than 10 times reduction in estimated bias and a 37% lowering of the standard error. The adaptive design, however, underestimates population totals for species in large herds, while a multivariate extension gives only marginal improvements.

Optimization of a monitoring network for sulfur dioxide

In this study, we develop and apply a methodology to reduce an existing monitoring network to find an optimal configuration of a smaller network. We use a criterion based on locally weighted regression with two different weight functions. The methodology is applied to the Dutch national SO2 network and offers the possibility to include different politically relevant options in the model by weight criteria. Because full enumeration of all monitoring networks is impossible, a combinatorial search algorithm is applied to find a (sub)optimal solution. If different (optimal) monitoring networks result from different criteria, then the best can be selected.

Synthesis and characterization of 2D and 3D structures from organic derivatives of polyoxometalate clusters: role of organic moiety, counterion, and solvent

New organic derivatives of "inverse-Keggin" polyoxometalate (POM) clusters, [Mo(12)O(46)(AsR)(4)](4-) (R = C(6)H(4)-4-COOH, C(6)H(3)-4-OH-3-NO(2), C(6)H(4)-4-OH), have been synthesized. Structures of the corresponding sodium or iron salts were elucidated by single-crystal X-ray diffraction and shown to be 3D structures connected through hydrogen bonds and/or O-Na-O linkages. Parameters which influence the final solid-state architecture, such as the crystallizing solvent, organic moiety, and counterions, have been examined. The hydrogen-bonding ability of the solvent affects the connectivity of the POM clusters through interactions with the organic group and the inorganic core. The organic groups influence the structure through hydrogen bonds to other organic groups, to neighboring clusters, and/or to solvent molecules. Hydrogen bonding between the organic groups and the solvent appears to inhibit some possible connectivity patterns, such as the hydrogen-bonded dimerization of carboxylic acid groups. Na(+) ions were found directly bonded to the cluster oxo ligands and provided linkages between clusters. Larger cations, such as transition metals, did not show this interaction, and other bonding methods dominated.

Trimethoprim-sulfamethoxazole (TMP-SMZ) dose escalation versus direct rechallenge for Pneumocystis Carinii pneumonia prophylaxis in human immunodeficiency virus-infected patients with previous adverse reaction to TMP-SMZ

Trimethoprim-sulfamethoxazole (TMP-SMZ) is the most effective Pneumocystis carinii pneumonia (PCP) prophylactic agent, but adverse reactions are common among human immunodeficiency virus (HIV)-infected patients and limit its use. This randomized, double-blind controlled trial compared 2 methods of TMP-SMZ reintroduction, 6-day dose escalation and direct rechallenge, for PCP prophylaxis in HIV-infected patients who had experienced previous treatment-limiting reactions. The primary end point was the ability to take single-strength TMP-SMZ daily for 6 months. Seventy-five percent of the dose-escalation group and 57% of the direct-rechallenge group continued to receive daily single-strength TMP-SMZ for 6 months (P= .014). Among premature discontinuations, 58% of the dose-escalation group and 70% of the direct-rechallenge group were due to adverse reactions. None of these reactions was serious. This study provides evidence that it is possible to successfully reintroduce TMP-SMZ to a significant proportion of HIV-infected patients who have experienced mild-to-moderate treatment-limiting adverse reactions.

New modality for treatment of resistant anastomotic strictures after radical prostatectomy: UroLume urethral stent

A new approach for the treatment of vesicourethral anastomotic stricture after radical retropubic prostatectomy is presented. The patient had failed treatment with bougies, balloon dilation, and cold-knife incision of the anastomotic area. Transurethral resection of the bladder neck resulted in a rapid recurrence of the stricture. He was successfully treated with insertion of a UroLume urethral stent. After 18 months of follow-up, the patient is symptom free.

Geochemistry of Bulgarian soils in villages affected and not affected by Balkan endemic nephropathy: a pilot study

Balkan endemic nephropathy (BEN) is a chronic tubulointerstitial disease whose mosaic-like distribution throughout the Balkans has not changed significantly since its initial description. In this study, we explored the hypothesis that the occurrence of BEN is linked with the environmental geochemistry of villages. Soil samples were collected from BEN and non-BEN villages in the Vratza region of Bulgaria. Samples were digested in nitric acid and analyzed for 22 elements by hexapole, inductively coupled plasma, and mass spectrometry. Selected results are that: 1) absolute concentrations from both types of villages were not enriched above "background" concentrations; and 2) copper, molybdenum, lead, and cadmium concentrations were higher in BEN than in non-BEN soils, while selenium concentrations were lower. Although geochemical differences between BEN and non-BEN villages were found, not all differences were statistically significant, in part due to a limited number of samples.

Telomerase activity and cytokeratin 20 as markers for the detection and followup of transitional cell carcinoma: an unfulfilled promise

PURPOSE

Telomerase activity compensates for the erosion of chromosomes and it has been detected in a wide variety of human tumors. Cytokeratin 20, an intermediate filament of epithelial cells, is expressed particularly in the urinary tract. These 2 molecules are candidates to become markers for the detection and followup of bladder carcinoma. We evaluate whether each molecule may serve as a potential marker and whether the 2 combined would improve the detection or followup of bladder carcinoma in a noninvasive manner.

MATERIALS AND METHODS

We obtained 44 morning urine samples from patients with transitional cell carcinoma patients and 26 from age matched patients with a wide variety of clinical disorders but no malignancy of any kind. A telomerase polymerase chain reaction-enzyme-linked immunosorbent assay kit was used to determine telomerase activity and cytokeratin 20 expression was determined by nested reverse transcriptase-polymerase chain reaction.

RESULTS

All samples tested positive for cytokeratin 8 expression, which verified epithelial cells in the urine samples. Of the 44 transitional cell carcinoma cases of all stages and grades 37 (84.1%) were positive for telomerase activity, 36 (81.8%) were positive for cytokeratin 20 expression and 65.9% were double positive. Of the 29 controls with various clinical conditions other that malignancy 22 (75.9%) were positive for telomerase activity, 13 (44.83%) were positive for cytokeratin 20 expression and 34.6% were double positive.

CONCLUSIONS

Telomerase activity and cytokeratin 20 expression are not specific for malignancy and may be detected in many nonmalignant pathological conditions. Therefore, their use as potential markers of bladder carcinoma should be carefully reevaluated.

Clinical and psychological course of diabetes from adolescence to young adulthood: a longitudinal cohort study

OBJECTIVE

To determine the clinical and psychological course of diabetes through adolescence and the relationship with glycemic control in young adulthood.

RESEARCH DESIGN AND METHODS

A longitudinal cohort study of adolescents recruited from the register of the outpatient pediatric diabetes clinic. A total of 76 individuals (43 male patients, 33 female patients) aged 11-18 years completed baseline assessments, and 65 individuals (86%) were reinterviewed as young adults (20-28 years of age). Longitudinal assessments were made of glycemic control (HbA(1c)), weight gain (BMI), and development of complications. Adolescents completed self-report questionnaires to assess emotional and behavioral problems as well as self-esteem. As young adults, psychological state was assessed by the Revised Clinical Interview Schedule and the self-report Brief Symptom Inventory.

RESULTS

Mean HbA(1c) levels peaked in late adolescence and were worse in female participants (average 11.1% at 18-19 years of age). The proportion of individuals who were overweight (BMI >25.0 kg/m(2)) increased during the 8-year period from 21 to 54% in female patients and from 2 to 28% in male patients. Serious diabetes-related events included death in one patient and cognitive impairment in two patients. Individuals in whom diabetic complications developed (25% of male patients and 38% of female patients) had significantly higher mean HbA(1c) levels than those without complications (difference 1.9%, 95% CI 1.1-2.7, P < 0.0001). Behavioral problems at baseline were related to higher mean HbA(1c) during the subsequent 8 years (beta = 0.15, SEM (beta) 0.04, P < 0.001, 95% CI 0.07-0.24).

CONCLUSIONS

The outcome for this cohort was generally poor. Behavioral problems in adolescence seem to be important in influencing later glycemic control.

Influence of psychiatric disorder on the controlling behaviour of mothers with 1-year-old infants. A study of women with maternal eating disorder, postnatal depression and a healthy comparison group

BACKGROUND

Certain styles of parental controlling behaviour influence child development. Work with mothers with eating disorders suggests that they may be particularly controlling of their infants.

AIMS

To examine the nature and specificity of maternal controlling behaviour in mothers with eating disorders compared with mothers who had experienced postnatal depression and a healthy comparison group.

METHOD

Mothers with eating disorders (n=34), postnatal depression (n=39) and a healthy comparison group (n=61) and their 12-month-old infants were observed during play and mealtimes, and blind ratings made of verbal and non-verbal control exerted by the mother.

RESULTS

Mothers in the eating disorder group used more verbal control, especially strong control. There were no differences between the groups on gentle verbal control and physical contact. Maternal dietary restraint was the one feature of eating disorder psychopathology associated with the use of verbal control. Marital criticism was also associated with the extent of verbal controlling behaviour.

CONCLUSIONS

Aspects of maternal control of infants were found to be specific to maternal eating disorder psychopathology.

Accuracy of the intra-operative radioguided localization of the sentinel lymph node (SLN) 24 hours after lymphoscintigraphy in patients with malignant melanoma

AIM

For optimized logistics for the sentinel lymphadenectomy (SL) it might be helpful for the clinics involved if a longer time period between the lymphoscintigraphy (LS) and surgery is possible. Therefore, we investigated if a precise localization of the sentinel lymph node is possible 24 hours after LS.

METHODS

78 patients with primary malignant melanoma (MM; n = 44) or with MM pre-operated by excisional biopsy (n = 34) were investigated. In 40 cases the tumor was localized on the trunk and in 38 cases on the extremities. Mean MM thickness was 2.68 mm (range: 0.29 to 12 mm). In all patients a lymphoscintigraphy (LS) with an average of 85 MBq of Tc-99m nanocolloid was performed one day prior to surgery. Immediately after tracer application dynamic data acquisition was started at a LFOV gamma camera followed by a whole body scan. With a hand-held gamma detector (C-Trak) 2, 4, 6, 8, and 24 hours after tracer administration the SLN was identified and the counts registered.

RESULTS

94 SLNs were identified in 87 lymphatic basins from which 86 could be resected. Nine MM showed two draining channels. After 24 hours 15.5% (as an average) of the initial counts could be measured in the SLN. The uptake in the SLN in pre-operated versus patients with primary tumor was statistically not significant (p = 0.4). In 16 cases (20.5%) the SLN was tumor positive. Four of those patients developed distant metastases and two died within the first year. None of the patients with negative SLN developed distant metastases or died.

CONCLUSION

The remaining activity in the SLN up to 24 hours after administration is sufficient for their intra operative localization. The method of lymphoscintigraphy and localization of the SLN by a hand-held gamma detector optimizes the intra operative identification of the SLN in patients with malignant melanoma.

Computed tomography for pancreatic diseases

CT has evolved over 24 years as an effective cross-sectional imaging modality for benign and malignant pancreatic diseases. Multiphase helical scanners with rapid infusion of intravenous contrast medium allow for the delineation of pancreatic parenchymal, arterial, and venous studies with identification of malignant and benign lesions. Therapeutic applications abound, and CT drainage of postoperative fluid collections, pseudocysts, and abscesses will have an increasing role in the new millennium.

Microscopic analysis and significance of vascular architectural complexity in renal cell carcinoma

The objective of this study was to evaluate the utility of measuring microvessel fractal dimension (MFD) as a parameter of architectural microvascular complexity in localized renal cell carcinoma (RCC). Forty-nine patients with low-stage clear cell RCC were assessed in a 9-year follow-up retrospective study. Tumor vessels were visualized with the endothelial marker CD34. Tumor microvessel density (MVD) was measured by computerized morphometry. Fractal analysis of the RCC microvascular network was performed and the MFD was computed in each case. Correlation between tumor vascular parameters, histological grade, extent of tumor necrosis and patient survival were tested by uni- and multivariate analyses. A significant correlation was found between tumor grade and decreased survival (P = 0.04). The extent of macroscopic tumor necrosis also significantly correlated with poor prognosis (P = 0.0001). Survival analysis revealed a significantly higher MVD in patients who survived longer than 5 years as compared with those who died before the end of the 5-year follow-up period (MVD = 10.8 +/- 4.7% versus 6.4 +/- 3.7%; P = 0.03). MVD was also inversely associated with the extent of tumor necrosis (P = 0.03). Microvessel fractal dimension was significantly higher in low- as compared with high-grade tumors (1.55 +/- 0.11 versus 1.45 +/- 0.15; P = 0.03). Survival analysis revealed a significantly higher MFD in those who lived >5 years as compared with those who died earlier (1.56 +/- 0.11 versus 1.46 +/- 0.15; P = 0.02). The MFD was inversely associated with the extent of tumor necrosis (P = 0.01). Multivariate analysis revealed that the MFD was the only significant factor to correlate with tumor necrosis, and that tumor necrosis was the only independent predictor of patient survival. These results indicate that the analysis of MFD as a marker of tumor microvascular complexity may provide important prognostic information as well as novel insight into the biology of tumor angiogenesis.

A quantitative evaluation of monitoring networks for region-specific nitrate reduction policies

Modern environmental policy implementation in many developed countries is increasingly regionally oriented. Regional governments have undertaken measures designed for the specific needs of the region but, so far, the resulting change in environmental quality has hardly been monitored. This study develops a method for the quantitative evaluation of region-specific environmental policy. Two forms of monitoring are distinguished: monitoring of performance of policy measures and monitoring of environmental quality. This study investigates two regions in the Netherlands where region-specific policy has been implemented. Performance monitoring focused on reduction of nitrate leaching to groundwater. Leaching reductions were calculated with simple models or rules of thumb. Quality monitoring focused on nitrate concentrations under grassland and other land use. An analysis of variance showed significant differences between different soil units. Stratified kriging was applied for spatial interpolation, showing within-unit variability. The current monitoring network could be improved by using a more regular type of grid.

Effects of allogeneic bone marrow transplantation on recipient bone mineral density: A prospective study

Allogeneic bone marrow transplant (BMT) recipients have many known risk factors for developing decreased bone mineral density (BMD) after transplantation. We performed a prospective sequential evaluation of BMD in the lumbar spine and nondominant hip using dual-energy x-ray absorptiometry (DEXA) in a cohort of 47 adult patients (median age, 43 years) who were undergoing radiation-based BMT for hematologic malignancies. Baseline DEXA studies were performed before BMT and repeated at 3 to 4 months, 6 to 8 months, and 12 to 14 months after BMT. The majority of patients (60%) had been minimally treated with combination cytotoxic chemotherapy, having received no more than 1 treatment regimen before BMT. Graft-versus-host disease prophylaxis consisted of cyclosporine in combination with either methotrexate or prednisone, or both. Mean lumbar spine and hip BMD were normal before BMT (spine: 1.01 g/cm2, z score = 96%; hip: 0.86 g/cm2, z score = 100%) and gradually decreased (spine: 0.98 g/cm2, z score = 94%; hip: 0.76 g/cm2, z score = 91%) at 12 to 14 months. These declines were statistically significant (P < .006 and < .002 for lumbar spine; P < .001 and < .001 for hip). In addition, the sharpest decline occurred during the first 6 months after BMT and was more marked in the hip than the lumbar spine. These data suggest that BMT adversely affects BMD in this patient population.