DNA fragmentation as a consequence of cell cycle traverse in doxorubicin- and idarubicin-treated human lymphoma cells

We have studied some of the factors involved in the cytotoxic actions of the anticancer anthracycline antibiotics doxorubicin (DOX) and idarubicin (IDA) towards human B-cell lymphoma cells in vitro. IDA was found to accumulate within cells to a greater degree than the related drug DOX for both short (1 h) and long-term (24 h) exposures. Both agents showed a similar capacity for trapping topoisomerase II in intact cells, but cross-linking activity was significantly lower than that induced by the specific poison VP16. IDA was four- to eight fold more potent for the induction of cytostasis and cell cycle arrest and for the instigation of DNA breakdown as a prelude to the full expression of apoptosis. Inhibition of DNA fragmentation at higher drug doses was linked closely with the inhibition of S-phase traverse. The findings suggest that DOX and IDA act in a similar fashion, the latter agent being more effective due to enhanced intracellular accumulation. We conclude that the presence of drug and topoisomerase II-associated DNA damage is not sufficient to induce DNA fragmentation; rather, unregulated commitment to S-phase traverse is an important factor in the activation of programmed cell death.

Use of a vibrating electrode to measure changes in calcium fluxes across the cell membranes of oxidatively challenged Aplysia nerve cells

A self-referencing and non-invasive Ca(2+)-sensitive vibrating electrode was used to assess the effects of hydrogen peroxide-induced oxidative challenges on the efflux and influx of calcium across the plasma membrane of single nerve cells cultured from abdominal ganglion of Aplysia californica. A reduced net efflux of Ca2+ from the cell soma occurred immediately after the addition of hydrogen peroxide (0.0025 mM, 0.005 mM or 0.01 mM) to the culture medium, indicating damage to the cell membrane or Ca2+ transport mechanism. There then followed a marked efflux, the extent and duration of which was related to the concentration of hydrogen peroxide used and which may reflect compensatory activity by the Ca2+ regulatory mechanisms in the plasmalemma. No morphological changes were observed in cells challenged with 0.0025 mM hydrogen peroxide and the enhanced rate of Ca2+ efflux rapidly decreased to pre-exposure values. Sustained and enhanced Ca2+ effluxes from those cells exposed to 0.005 mM or 0.01 mM hydrogen peroxide were also consistent with regulatory pumping of Ca2+ out of the cell although contraction and blebbing of neurites and swelling of the soma may indicate that a proportion of the efflux arose from release of Ca2+ from disrupted intracellular stores. The vibrating electrode is a useful additional technique for the study of the pathogenesis of neurological conditions, as ionic fluxes across single nerve cells exposed to physiologically-relevant concentrations of free radicals can be monitored non-invasively for prolonged periods.

Comparison of muscle activation patterns in adductor and abductor spasmodic dysphonia

Patients with adductor and abductor spasmodic dysphonia were compared with normal controls on speech items particularly difficult for the two patient groups. Intrinsic and extrinsic laryngeal muscles were measured during adduction for voicing and for a glottal stop, and during abduction after a vowel and after a glottal stop. Muscle activity was measured while the patients attempted the speech items, with considerable difficulty, but not during periods of complete voice loss. Muscle activity at rest, activity increases for speech, and percent changes for adduction and abduction did not differ from normal in either patient group. The results demonstrated normal muscle activation levels and changes for speech in the patients, and suggested that symptoms occur when spasmodic bursts intrude on an otherwise normal pattern.

The central slip tenodesis test for early diagnosis of potential boutonnière deformities

Disruption of the central slip is the primary defect leading to boutonnière deformity. In the closed injury early diagnosis of this lesion is rarely achieved due to the limitations of current methods and difficulties encountered in assessing a painful finger. We describe a simple, non-invasive method of diagnosis which can be carried out on all patients and with minimal discomfort. This test is also beneficial in monitoring the progress of conservative management of central slip disruption.

The insulin-like growth factor 1 receptor gene is normally biallelically expressed in human juvenile tissue and tumours

We have examined insulin-like growth factor 1 receptor (IGF1R) gene expression for evidence of imprinting in 15 informative patients with embryonal tumours. Biallelic expression was observed in all but one sample of normal juvenile kidney and liver, and in 9/10 associated Wilms' tumours, 3/3 hepatoblastomas and 2/2 adrenal tumours. A single patient with Beckwith-Wiedemann Syndrome (BWS) demonstrated monoallelic expression of the maternally derived IGF1R allele in normal kidney, associated Wilms' tumour and in peripheral blood lymphocytes. The observed biallelic expression of the IGF1R gene in all but one patient strongly suggests that the human gene is not normally imprinted.

A 46 kDa NTPase common to rat liver nuclear envelope, mitochondria, plasma membrane, and endoplasmic reticulum

A 46 kDa ATP binding polypeptide of the nuclear envelope, virtually identical to the nuclear envelope NTPase putatively involved in mRNA efflux [6], is present in all rat liver cell membranes. Its presence in nuclear envelope is not the result of cross contamination during isolation.

Tubed radial fascial flap and reconstruction of the flexor apparatus in the forearm

A reversed radial forearm fascial flap has been used as a vascularized tube through which tendon grafts may glide and in which nerve grafts may rest. It may have applications in the treatment of the severely damaged flexor system at wrist level. A further advantage of this technique is that it does not [corrected] sacrifice the radial artery in an already injured hand.

Survey of physician practice behaviors related to diabetes mellitus in the U.S. Physician adherence to consensus recommendations

OBJECTIVE

To summarize the frequency of physician adherence to consensus recommendations for prevention of diabetic complications.

RESEARCH DESIGN AND METHODS

Survey data from a nationwide stratified probability sample of primary-care physicians were analyzed. Adherence to recommendations were reported by physician specialty, age-group, and type of diabetes treated.

RESULTS

Adherence was high for eye exams, blood pressure measurements, neurological and circulatory exams, and laboratory procedures using blood. Adherence was low for examination of the teeth and gums, examination of the feet, and laboratory procedures involving the collection of urine. Internists generally had the highest adherence rates and pediatricians the lowest. Reported adherence decreased with physician age. Adherence was higher for the management of individuals with IDDM than for those with NIDDM.

CONCLUSIONS

Recommendations for the care of diabetic individuals need to be more widely implemented. Recommendations targeted specifically to pediatricians may be necessary.

Three non-overlapping regions of chromosome arm 11p allele loss identified in infantile tumors of adrenal and liver

Tumor and constitutional chromosome arm 11p genotypes were compared in 6 hepatoblastoma (HB) patients and 2 adrenal adenoma (AA) patients, with one HB patient and both AA patients displaying clinical features associated with the Beckwith-Wiedemann syndrome (BWS). Using up to 14 chromosome 11 polymorphic markers, loss of constitutional heterozygosity (LOH) was demonstrated in both AA patients and in 4 of 6 HB patients. This identified three distinct and non-overlapping regions of 11p within which LOH occurred, which were defined as lying distal to the gamma-globin locus (11p15.5), proximal to the gamma-globin locus but distal to 11p13 (LOH being detected at 11p15.1), and restricted to the 11p13 region. Specific LOH within each 11p15 region was observed in HB, and this represents the first demonstration by a single study of LOH clearly affecting separate regions of chromosome band 11p15 in a particular tumor type. One AA showed LOH restricted to 11p13 loci, implicating the involvement of the WT1 gene. The second AA patient presented with genitourinary abnormalities and we therefore examined sequences coding for 3 zinc finger domains of WT1 in both AAs. No point mutations were identified in sequence from either patient. Nonetheless our results indicate that 3 separate 11p loci may be significant in the development of tumors which arise in association with BWS.

Dispersion tests and adjustments for survival and case-control studies

Cox and Snell have pointed out that when the empirical variance of a measured response y is quite different from its nominal variance under an assumed probability model, standard errors that are not adjusted for the discrepancy may yield misleading inferences. This article describes a test for assessing departures from nominal dispersion in survival analysis and case-control studies. Also, a robust procedure for adjusting standard errors for these models is given.

Intrinsic reinnervation--myth or reality?

A clinical and electromyographic study of major nerve transections at the wrist in 22 patients has shown that electrical recovery nearly always occurs in the intrinsic muscles, despite the absence of clinically detectable function. There appears to be a level of electrical reinnervation above which clinically detectable intrinsic muscle power is usually present. This level would appear to be 50% of the contralateral maximum evoked muscle action potential; above this the "myth" of clinical recovery becomes a reality.

The influence of proficiency level, transfer distality, and gender on the contextual interference effect

This study examined the impact of high and low proficiency level, transfer distality, and gender on the contextual interference effect with an open skill. Subjects were separated into two levels of proficiency based on performance on a pretest similar to the experimental task. Analysis of error scores during acquisition indicated that the partitioning of subjects according to ability level had been successful. Transfer distality was varied by presenting subjects with two tasks varying in similarity to the acquisition task. Analysis of absolute constant, constant, variable, and total error scores in transfer strongly suggested that subjects' consistency rather than response bias was affected by the experimental variables. The findings suggested that, for the task used in this study, proficiency level does not account for gender differences in the contextual interference effect, as the effect was only reliably found for females. For coincident timing skills, it appears that there may be two distinct conclusions drawn from the results of this study: contextual interference only benefits female subjects' consistency and the effect of contextual interference increases with the distality of transfer, regardless of the subjects' proficiency level.

A blood-derived attachment factor enhances the in vitro growth of two glial cell types from adult cockroach

Reactive glial cells from chemically-lesioned areas of the central nervous system (CNS) of adult cockroaches (Periplaneta americana) have been grown in vitro on a substrate of fibronectin. This paper reports the enhancement of growth that is achieved when blood cells, serum, or medium conditioned by a 2-h incubation with blood cells are used as an alternative substrate. Glial cells rapidly grew out from connective explants to form extensive radial mats of cells linking up with those from adjacent explants on each of the blood-derived substrates. In addition to supporting the growth of reactive glial cells, characterised by their long, thin, branching morphology, these substrates also revealed the presence of a second type of glial cell, not previously found on fibronectin. Such cells, derived from ganglionic explants, behaved in a very different way to the reactive glia, initially spreading out to form a flattened sheet of phase-bright cells, before migrating away over the culture surface. The growth-enhancing effects of this blood-derived factor may play a role in the events following damage to the insect CNS, where it is known that the entry of blood cells into the lesion site is an important precursor to the rapid and structured repair seen in this system.

Magnetic resonance imaging in the staging of bladder cancer

Magnetic resonance imaging (MRI) scans were performed on 55 bladder cancer patients on whom clinicopathological staging was available from transurethral resection and cystectomy specimens. The overall accuracy of MRI scanning in this group was 84%, although true concordance rates are debatable without open surgical correlation. In the subgroup of 25 patients who had accurate open surgical correlation (from cystectomy, laparotomy or post mortem) the concordance rate was 76% with MRI. Errors occurred mainly in the T3 group of tumours, with 2 being overstaged and 2 being understaged out of a total of 12 in the open surgical correlation group (66% accuracy). Difficulties were also encountered in staging tumours at the bladder base, with an error rate of 22% (2 of 9) for T4 tumours in this area. With regard to lymph node staging there was a 100% (5 of 5) specificity in defining pathologically involved nodes but there was a false negative rate of 15% (3 of 19). Although it has many advantages over CT scanning, MRI produces a significant error rate in terms of over- and under-staging invasive tumours. There are difficulties associated with detecting minimal involvement of adjacent organs and lymph nodes as well as determining the exact depth of muscle penetration. Improvements may come in the future with the use of contrast enhancement agents such as gadolinium as well as more advanced machines.

Relaxation of insulin-like growth factor II gene imprinting implicated in Wilms' tumour

Genomic imprinting has been implicated in the onset of several embryonal tumours but the mechanism is not well understood. Maternal chromosome 11p15 loss of heterozygosity and paternal chromosome 11 isodisomy suggest that imprinted genes are involved in the onset of Wilms' tumour and the Beckwith-Wiedemann syndrome. The insulin-like growth factor II (IGF2) gene located at 11p15.5 has been put forward as a candidate gene as it is maternally imprinted (paternally expressed) in the mouse, and is expressed at high levels in Wilms' tumours. We report here that the IGF2 gene is expressed from the paternal allele in human fetal tissue, but that in Wilms' tumour expression can occur biallelically. These results provide, to our knowledge, the first evidence that relaxation of imprinting may play a role in the onset of disease and suggest a new genetic mechanism involved in the development of cancer.

The 11p15.5 ribonucleotide reductase M1 subunit locus is not imprinted in Wilms' tumour and hepatoblastoma

We have utilized the polymerase chain reaction (PCR) to amplify a transcribed Taq1 polymorphism in the ribonucleotide reductase M1 subunit (RRM1) gene at chromosome 11p15.5, to investigate whether this locus is subjected to imprinting in embryonal tumours. The polymorphism was amplified from cDNA from 6 Wilms' tumours, one hepatoblastoma and corresponding samples of adjacent kidney or liver from individuals who were constitutionally heterozygous for the polymorphism. Taq1 digestion of PCR products revealed that both alleles were transcribed in all samples where both were present at the genomic level, indicating that the RRM1 locus is not subjected to imprinting in Wilms' tumour or hepatoblastoma.

Hand splintage following surgery for dystrophic epidermolysis bullosa

Patients with Epidermolysis Bullosa, a rare hereditary blistering skin disorder, pose many problems in view of the extreme fragility of their skin. Following surgical division of syndactylised digits hard acrylic splints have traditionally been provided. This paper presents a splint design which is quicker and safer to manufacture, is readily altered and better tolerated by the patient, and has led to improvement in the maintenance of surgical correction.

Viewpoint letters

How dare B McCarthy imply that being 'forced' to work in a nursing home is not a 'real job' for a nurse and leads to being 'deskilled', whatever that means? I agree that each field of nursing requires different skills, but there must also be a basic core of skills for each field in which one chooses to work, wherever that may be.

Effective multi-agent chemotherapy for advanced abdominal lymphoma and FAB L3 leukemia of childhood

Between June 1981 and May 1988, 51 children with diffuse undifferentiated, advanced (Murphy Stage III and IV) intra-abdominal non-Hodgkin's lymphoma were treated on an intensive multi-drug chemotherapy protocol without irradiation to the primary tumour. Therapy was completed for Stage III disease at one year, but Stage IV patients continued with a further year of therapy until January 1986, when it was reduced to one year. Central nervous system (CNS) prophylaxis consisted of eight doses of intrathecal MTX for all children, and 24 Gy cranial irradiation for Stage IV patients only. There were 42 patients with Stage III disease (III A n = 29 and III B n = 13) and nine patients with Stage IV disease, of whom eight had extensive bone marrow and extramedullary disease (FAB L3 ALL). No patient had CNS disease at presentation. Forty-eight of 51 children (94%) achieved a complete remission. Two children died during remission induction therapy and eleven children relapsed, mostly within eight months of diagnosis. All patients have completed therapy. Failure free survival is 76% for Stage III and 67% for Stage IV patients, with a median followup of 90 and 64 months, respectively. Subdividing Stage III patients into Stage III A and III B did not show significantly different survival (P = 0.9), but the number of patients in Stage III B is small. These results compare favourably with the most effective published protocols, and toxicity has been manageable.