Preconditioning stimuli do not benefit the myocardium of hypoxia-tolerant rainbow trout ( Oncorhynchus mykiss)

In many vertebrates, a short episode of oxygen lack protects against myocardial necrosis during a subsequent, longer period of oxygen deprivation. This protective effect, termed preconditioning, also improves the functional recovery. Improved functional recovery has been reported for hypoxia-sensitive, in situ perfused rainbow trout hearts, but appears absent in another strain of rainbow trout that has a more hypoxia-tolerant heart. The results for the hypoxia-tolerant rainbow trout heart, however, might have occurred because the preconditioning stimuli were insufficient in either intensity or type to elicit cardioprotective effects. In the present study, we attempted to induce preconditioning in in situ perfused hearts from hypoxia-tolerant rainbow trout ( Oncorhynchus mykiss), acclimated and tested at 10 degrees C, by either doubling the anoxic preconditioning stimulus (PO(2) of the perfusate <0.5 kPa) relative to earlier studies or by using short exposures to high concentrations of adrenaline. In addition, anoxic-preconditioning experiments were conducted at an acutely elevated temperature (15 degrees C) to increase myocardial sensitivity to oxygen lack. The effect of preconditioning stimuli was assessed by measuring cardiac performance before and after exposure to a 20-min anoxic challenge. In addition, myocardial condition was evaluated at the termination of the experiment by measuring myocardial concentrations of glycogen, high energy phosphates and lactate, as well as activities of pyruvate kinase and lactate dehydrogenase. Maximal cardiac performance in oxygenated control hearts was unchanged by the 2-h experimental protocol, whereas inclusion of a 20-min period of anoxia led to 25 and 35% reductions in maximal cardiac performance at 10 and 15 degrees C, respectively. Reduced contractility, however, could not be ascribed to myocardial necrosis, as the biochemical and energy state of the hearts was unaffected. Hence, anoxic exposure merely stunned the myocardium. At 10 degrees C, neither the anoxic nor adrenergic preconditioning protocols improved post-anoxic cardiac performance. Further, the preconditioning protocols did not reduce post-anoxic myocardial dysfunction at 15 degrees C, despite the increased cardiac sensitivity to anoxia at this temperature. Thus, despite using strong and different preconditioning stimuli compared with earlier studies, the cardio-protective effect of preconditioning seems to be absent in rainbow trout hearts that are inherently more hypoxia-tolerant.

Effects of temperature and anoxia upon the performance ofin situperfused trout hearts

Rainbow trout (Oncorhynchus mykiss) are likely to experience acute changes in both temperature and oxygen availability and, like many other organisms, exhibit behavioural selection of low temperatures during hypoxia that acts to reduce metabolism and alleviate the demands on the heart. To investigate whether low temperature protects cardiac performance during anoxia, we studied the effects of an acute temperature change, from 10°C to either 5°C, 15°C or 18°C, upon the performance of in situ perfused trout hearts before, during and after exposure to 20 min of anoxia. Routine cardiac workload mimicked in vivo conditions at the given temperatures, and the effects of anoxia were evaluated as maximal cardiac performance before and after 20 min of anoxic perfusion. Functional data were related to maximal activities of glycolytic enzymes and energetic status of the heart at the termination of the experiment.

At high oxygenation, maximum cardiac output and power output increased with temperature (Q10 values of 1.8 and 2.1, respectively) as a result of increased heart rate. Hypoxia tolerance was inversely related to temperature. At 5°C, the hearts maintained routine cardiac output throughout the 20 min period of anoxia, and maximal cardiac performance was fully restored following reoxygenation. By contrast, cardiac function failed sooner during anoxia as temperature was increased and maximal performance after reoxygenation was reduced by 25%, 35% and 55% at 10°C, 15°C and 18°C, respectively. Increased functional impairment following anoxic exposure at elevated temperature occurred even though both cardiac glycolytic enzyme activity and the rate of lactate production were increased proportionally with cardiac work. Nonetheless, there was no indication of myocardial necrosis, as biochemical and energetic parameters were generally unaffected by anoxia.

α-Adrenergic regulation of systemic peripheral resistance and blood flow distribution in the turtleTrachemys scriptaduring anoxic submergence at 5°C and 21°C

Anoxic exposure in the anoxia-tolerant freshwater turtle is attended by substantial decreases in heart rate and blood flows, but systemic blood pressure (Psys) only decreases marginally due to an increase in systemic peripheral resistance (Rsys). Here,we investigate the role of the α-adrenergic system in modulating Rsys during anoxia at 5°C and 21°C in the turtle Trachemys scripta, and also describe how anoxia affects relative systemic blood flow distribution(%Q̇sys) and absolute tissue blood flows. Turtles were instrumented with an arterial cannula for measurement of Psys and ultrasonic flow probes on major systemic blood vessels for determination of systemic cardiac output(Q̇sys). α-Adrenergic tone was assessed from vascular injections of α-adrenergic agonists and antagonists (phenylephrine and phentolamine, respectively) during normoxia and following either 6 h (21°C) or 12 days (5°C) of anoxic submergence. Coloured microspheres, injected through a left atrial cannula during normoxia and anoxia, as well as after α-adrenergic stimulation and blockade during anoxia at both temperatures, were used to determine relative and absolute tissue blood flows.

Anoxia was associated with an increased Rsys and functional α-adrenergic vasoactivity at both acclimation temperatures. However, while anoxia at 21°C was associated with a high systemicα-adrenergic tone, the progressive increase of Rsysat 5°C was not mediated by α-adrenergic control. A redistribution of blood flow away from ancillary vascular beds towards more vital circulations occurred with anoxia at both acclimation temperatures.%Q̇sys and absolute blood flow were reduced to the digestive and urogenital tissues (approximately 2- to 15-fold), while %Q̇sys and absolute blood flows to the heart and brain were maintained at normoxic levels. The importance of liver and muscle glycogen stores in fueling anaerobic metabolism were indicated by increases in%Q̇sys to the muscle at 21°C (1.3-fold) and liver at 5°C (1.7-fold). As well, the crucial importance of the turtle shell as a buffer reserve during anoxic submergence was indicated by 40-50% of Q̇sys being directed towards the shell during anoxia at both 5°C and 21°C. α-Adrenergic stimulation and blockade during anoxia caused few changes in%Q̇sys and absolute tissue blood flow. However, there was evidence of α-adrenergic vasoactivity contributing to blood flow regulation to the liver and shell during anoxic submergence at 5°C.

The prognostic relevance of estimates of proliferative activity in early breast cancer

AIMS

Immunohistochemical estimates of cell proliferation evaluated with MIB-1 antibody have been suggested as prognostic indicators in different types of carcinoma. This study investigates whether MIB-1 scores add additional prognostic impact when evaluated together with classical clinicopathological parameters at diagnosis in early breast cancer patients.

MATERIALS AND METHODS

Tumour specimens from 365 consecutively treated breast cancer patients were immunostained for MIB-1 and evaluated under the microscope using systematic random sampling accomplished by the CAST-grid system.

RESULTS

The systematic random sampling technique resulted in MIB-1 estimates with very high interobserver and intraobserver reproducibilities (P < 0.0001). Median MIB-1 was 16% (range 0-83%). Patients were stratified by MIB-1 in tertiles, and increasing MIB-1 was significantly associated with poor overall and disease-specific survival in node-positive patients, but not in node-negative patients. High MIB-1 was significantly related to large tumour size, and strongly associated with high grade, high mitotic score, negative oestrogen receptor status and young age. In multivariate analysis, both with and without malignancy grade and number of mitoses included in the analysis, MIB-1 estimates showed no independent prognostic impact.

CONCLUSIONS

High MIB-1 estimates did not add independent prognostic information at diagnosis when evaluated together with classical prognostic markers of early breast cancer.

Time trends and regional differences in registration, stage distribution, surgical management and survival of breast cancer in Denmark

The aim of this study was to analyse time trends, stage at diagnosis, survival and registration of population-based cohorts of breast cancer patients in selected Danish counties (in total 2504) in 1986 and 1996-1997. In 1986, no differences in the extent of disease were observed between the counties. Patients from one county (Funen) had centralised surgery, significantly more lymph nodes removed and a better survival in the multivariate analysis. In 1996-1997, mammographical screening had been implemented in Funen, leading to a significantly better stage distribution, whereas stage remained unchanged in the other counties. In Funen, survival was significantly better than in the other counties in univariate, but not in multivariate analysis. Survival increased significantly with time only in Funen. Inclusion in clinical trials increased over time and the coverage of the database in the Danish Breast Cancer Cooperative Group (DBCG) was high. However, patients not notified in DBCG had, beside older age, also worse stage of disease distribution and less extensive surgery. A difference in survival was observed between the counties. In 1986, this may be explained by a centralised surgical system in one county, whereas in 1996-1997 improvements could be due to an early diagnosis and other as yet unknown factors. The DBCG database cannot be considered as representative of the Danish population of breast cancer patients.

Quantification of angiogenesis as a prognostic marker in human carcinomas: a critical evaluation of histopathological methods for estimation of vascular density

Chalkley counts have been suggested as the primary method for immunohistochemical evaluation of angiogenesis, however, most studies have used microvessel density (MVD). We present paired Chalkley and MVD estimates in carcinomas of the prostate, breast, bladder and lung. The clinical data has previously been reported. In prostate carcinomas, high MVD indicated poor prognosis, whereas high Chalkley counts in breast carcinoma were associated with a poor prognosis. In bladder carcinoma, high estimates using both methods showed good prognosis and were associated with a high degree of inflammation. Neither of the counts revealed prognostic value in lung carcinomas, where the vascular pattern indicated that this cancer was non-angiogenic. We highlight methodological problems with both counting methods. Since angiogenic processes in lung and bladder cancers may be different from those occuring in prostate cancer, we suggest that future analyses also focus on measuring angiogenic factors to obtain more information on the biology of angiogenesis.

The role of pelvic lymph node dissection as a predictive and prognostic factor in bladder cancer

The aim of this study was to evaluate the value of pelvic lymph node dissection (PLND) performed as a separate procedure in a consecutive Danish bladder cancer cohort and also to analyse if the number of lymph nodes excised had an impact on outcome. From 1992 to 1998, 339 cystectomy candidates were retrospectively reviewed. Based on a preoperative PLND, 248 patients (10% N+) underwent radical cystectomy and 91 (87% N+) underwent radio- or chemotherapy. The median follow-up was 6.3 years. PLND was able to separate N+ from N0 patients with a false-negative rate of 3% compared with the following cystectomy. Lymph node-positive patients treated with cystectomy (n=24) all died from their bladder cancer. Therefore, accurate pathological N classification before the treatment decision seems worthwhile. The median number of lymph nodes excised was six and the number of lymph nodes had an independent prognostic impact on survival. This underlines the need for guidelines for surgical lymphadenectomy and the pathological assessment of lymph nodes in bladder cancer.

Independent prognostic value of angiogenesis and the level of plasminogen activator inhibitor type 1 in breast cancer patients

Tumour angiogenesis and the levels of plasminogen activator inhibitor type 1 (PAI-1) are both informative prognostic markers in breast cancer. In cell cultures and in animal model systems, PAI-1 has a proangiogenic effect. To evaluate the interrelationship of angiogenesis and the PAI-1 level in breast cancer, we have evaluated the prognostic value of those factors in a total of 228 patients with primary, unilateral, invasive breast cancer, evaluated at a median follow-up time of 12 years. Microvessels were immunohistochemically stained by antibodies against CD34 and quantitated by the Chalkley counting technique. The levels of PAI-1 and its target proteinase uPA in tumour extracts were analysed by ELISA. The Chalkley count was not correlated with the levels of uPA or PAI-1. High values of uPA, PAI-1, and Chalkley count were all significantly correlated with a shorter recurrence-free survival and overall survival. In the multivariate analysis, the uPA level did not show independent prognostic impact for any of the analysed end points. In contrast, the risk of recurrence was independently and significantly predicted by both the PAI-1 level and the Chalkley count, with a hazard ratio (95% CI) of 1.6 (1.01-2.69) and 1.4 (1.02-1.81), respectively. For overall survival, the Chalkley count, but not PAI-1, was of significant independent prognostic value. The risk of death was 1.7 (1.30-2.15) for Chalkley counts in the upper tertile compared to the lower one. We conclude that the PAI-1 level and the Chalkley count are independent prognostic markers for recurrence-free survival in patients with primary breast cancer, suggesting that the prognostic impact of PAI-1 is not only based on its involvement in angiogenesis.

Intense inflammation in bladder carcinoma is associated with angiogenesis and indicates good prognosis

The aim of this study was to investigate the prognostic influence of microvessel density using the hot spot method in 107 patients diagnosed with transitional cell carcinoma of the bladder. In each case, inflammation was found in the invasive carcinoma, therefore we classified the degree of inflammation as minimal, moderate or intense. Microvessel density was then reevaluated in each tumour in areas corresponding to these three categories. Median microvessel density irrespective of degree of inflammation was 71. Areas of minimal, moderate and intense inflammation were found in 48, 92 and 32 tumours. Microvessel density increased significantly with increasing degree of inflammation. Disease-specific survival was improved if areas of intense inflammation were present in the carcinoma (P=0.004). High microvessel density, irrespective of the degree of inflammation, was associated with a significantly better disease-specific survival (P=0.01). Multivariate analysis using death of disease as endpoint demonstrated an independent prognostic value of N-classification (N0, hazard ratio (HR)=1 vs N1, HR=2.89 (range, 1.52-5.52) vs N2, HR=3.61 (range, 1.84-7.08)), and intense inflammation, HR=0.48 (range, 0.24-0.96). Malignancy grade, T classification and microvessel density were not independent significant markers of poor outcome. In conclusion, inflammation was significantly correlated to microvessel density, and areas of intense inflammation were an independent marker of good prognosis.

Prognostic indicators for malignant tumours of the parotid gland

The best treatment of malignant parotid tumours still remains to be defined, and a better knowledge about the tumour features that predict the treatment result is needed. The histological classification of parotid tumours may present difficulties on account of their great morphological diversity. In a series of 152 patients with a malignant tumour of the parotid gland, the prognostic factors and treatment results were investigated over a 25-year period. Treatment consisted of surgery, radiation therapy or a combination (49%, 13% and 38% respectively). Crude 5-year survival was 50% with significant differences related to stage (stage I, 65%; stage II, 50%; stage III, 21%; and stage IV, 9%). With respect to histopathology, the adenoid cystic carcinomas and the acinic cell carcinomas had the best prognosis (76% and 67% 5-year crude survival and 53% and 67% 10-year crude survival respectively). There was a significant difference in crude survival between well/intermediate and poorly differentiated tumours (P = 0.007). In a Cox hazard regression analysis including 136 patients and using death from cancer as the end-point, the following parameters were independent prognostic predictors: T-classification (P = 0.002), M-classification (P < 0.0001), N-classification (N+versus N0) (P = 0.005), local invasion (P = 0.003) and histological differentiation of the tumour (P = 0.03). The TNM system is a good predictor of treatment outcome for malignant parotid tumours. The use of a combination of clinical and histological factors will assist the design of treatment strategies for parotid gland tumours.

Increased blood oxygen affinity during digestion in the snakePython molurus

Many snakes exhibit large increases in metabolic rate during digestion that place extensive demands on efficient oxygen transport. In the present study,we describe blood oxygen affinity following three weeks of fasting and 48 h after feeding in the Burmese python (Python molurus). We also report simultaneous measurements of arterial blood gases and haematological parameters. Arterial blood was obtained from chronically implanted catheters,and blood oxygen-dissociation curves were constructed from oxygencontent measurements at known oxygen partial pressure(PO2) values at 2% and 5% CO2. Arterial pH remained constant at approximately 7.6 after feeding, but digestion was associated with an approximately 6 mmol l-1 increase in [HCO3-], while CO2 partial pressure(PCO2) increased from 2.21±0.13 kPa in fasted animals to 2.89±0.17 kPa at 48 h after feeding. Blood oxygen affinity in vivo was predicted on the basis of pH in vivoand the blood oxygen-dissociation curves obtained in vitro. The blood oxygen affinity in vivo increased during digestion, with P50 values decreasing from 4.58±0.11 kPa to 3.53±0.24 kPa. This increase was associated with a significant decrease in the red blood cell [NTP]/[Hb4] ratio (relationship between the concentrations of organic phosphates and total haemoglobin) and a significant decrease in mean cellular haemoglobin content, which is indicative of swelling of the red blood cells. Our data for blood oxygen affinity and arterial oxygen levels, together with previously published values of oxygen uptake and blood flows, allow for a quantitative evaluation of oxygen transport during digestion. This analysis shows that a large part of the increased metabolism during digestion is supported by an increased venous extraction, while arterial PO2(PaO2) and haemoglobin saturation do not vary with digestive status. Thus, we predict that venous PO2 (PvO2) is reduced from a fasting value of 5.2 kPa to 1.6 kPa during digestion.

Effects of temperature on the metabolic response to feeding in Python molurus

As ectothermic vertebrates, reptiles undergo diurnal and seasonal changes in body temperature, which affect many biological functions. In conjunction with a general review regarding the effects of temperature on digestion in reptiles, we describe the effects of various temperatures (20-35 degrees C) on the metabolic response to digestion in the Burmese python (Python molurus). The snakes were fed mice amounting to 20% of their body weight and gas exchange (oxygen uptake and CO(2) production) were measured until digestion had ended and gas exchange returned to fasting levels. Elevated temperature was associated with a faster and larger metabolic increase after ingestion, and the time required to return to fasting levels was markedly longer at low temperature. The factorial increase between fasting oxygen consumption (VO(2)) and maximal VO(2) during digestion was, however, similar at all temperatures studied. Furthermore, the integrated SDA response was not affected by temperature suggesting the costs associated with digestion are temperature-independent. Other studies on reptiles show that digestive efficiency is only marginally affected by temperature and we conclude that selection of higher body temperatures during digestion (postprandial thermophilic response) primarily reduces the time required for digestion.

Adrenergic control of the cardiovascular system in the turtleTrachemys scripta

Freshwater turtles, Trachemys scripta, like all non-crocodilian reptiles, are able to shunt blood between the pulmonary and systemic circulations owing to their undivided ventricle. The prevailing hypothesis is that the ratio of pulmonary and systemic resistances is the primary determinant of cardiac shunting in turtles. In the present study, we have examined the adrenergic influences on vascular resistances in the pulmonary and systemic circulations and the associated effects on cardiac shunts in turtles. To achieve this objective, systemic blood flow and pressures and pulmonary blood flow and pressures were measured simultaneously in anaesthetised turtles during bolus injections of α- andβ-adrenergic agonists and antagonists. Total cardiac output, systemic vascular resistance, pulmonary vascular resistance, heart rate and cardiac stroke volume were derived from these measurements. Anaesthetised turtles showed cardiovascular characteristics that were similar to those of non-apnoeic non-anaesthetised turtles, because anaesthesia blocked the cholinergically mediated constriction of the pulmonary artery that is normally associated with apnoea. As a result, the anaesthetised turtles exhibited a large net left-to-right shunt, and the adrenergic responses could be observed without confounding changes resulting from apnoea. Potent α-adrenergic vasoconstriction and weaker β-adrenergic vasodilation were discovered in the systemic circulation. Modest β-adrenergic vasodilation and possible weak α-adrenergic vasodilation were discovered in the pulmonary circulation. This adrenergically mediated vasoactivity produced the largest range of cardiac shunts observed so far in turtles. Regression analysis revealed that 97% of the variability in the cardiac shunts could be accounted for by the ratio of the pulmonary and systemic resistances. Thus, we conclude that, independent of whether the pulmonary vascular resistance is modulated(as during apnoea) or the systemic resistance is modulated with adrenergic mechanisms (as shown here), the consequences on the cardiac shunt patterns are the same because they are determined primarily by the ratios of the pulmonary and systemic resistance.