HCG contamination of alglucerase: clinical implications in low-dose regimen

Alglucerase (Ceredase) is currently the treatment of choice for patients with symptomatic Gaucher disease. The contamination of this placental enzyme with human chorionic gonadotropin (hCG) has raised concern regarding possible endocrinological complications. We examined 32 patients treated with low-dose alglucerase and 27 untreated patients as controls, and found no significant clinical differences between the two groups: no prepubertal children were affected, no menstrual irregularities were reported, and all hCG levels were well within normal range. Conversely, our finding of a statistically significant difference between the groups underscores the importance of initiating parallel studies of hCG contamination in patients receiving high-dose protocol.

Update on nasopharyngeal carcinoma in northern Israel

PURPOSE

Because Israel is one of the world's intermediate risk areas for nasopharyngeal carcinoma (NPC), we continue to analyze retrospectively all referred cases.

PATIENTS AND METHODS

We previously reported our work with 49 NPC patients, and we now extend our analysis to include an additional 26 patients. All our 75 patients were treated between 1968 and 1991 at the Northern Israel Oncology Center in Haifa. They were typical in the preponderance of male sex (74%), Mediterranean origin (80%) and late stage presentation (91%). All patients received a combination of photon and electron radiotherapy to the tumor site, base of skull and neck, with an average dose to the nasopharynx of 6095 cGy. Nearly 40% of the patients received combined modality treatment (CMT), i.e., cisplatin-based chemotherapy prior to radiotherapy.

RESULTS

There was an overall complete response (CR) of 88%, with 44% of the patients experiencing recurrence. Serious complications occurred in 5%. We found a 5-year survival rate of 48% and a 10-year survival rate of 44%, with some indication that CMT was advantageous to later-stage patients with non-keratinizing histologies, but not to earlier stages nor to those with keratinizing squamous cell carcinoma (SCC). Pediatric patients had better survival rates.

CONCLUSIONS

1. The somewhat better survival performance of Arabs and Sephardic Jews may reflect their greater tendency to have the non-keratinizing histological variants (lymphoepithelioma and undifferentiated carcinoma). 2. Ethnicity was consistently prognostic, both as risk and survival factors. 3. The role of CMT in advanced non-keratinizing NPC should be explored in future randomized trials.

Treatment of muscle invasive bladder cancer. Is there a role for neoadjuvant chemotherapy?

PURPOSE

Because 5-year survival with advanced bladder cancer is still poor, the search for optimal treatment continues as dose the necessity of clarifying goals of treatment.

PATIENTS AND METHODS

We compared the outcome of 3 different but widely accepted treatment protocols for bladder cancer in order to find which, if any, was superior, with particular emphasis upon the performance of the newest treatment, neoadjuvant chemotherapy. Data on 224 bladder patients treated at our institution (1975 to 1991) with 1 of the 3 protocols was analyzed. Those protocols were: 1. radiotherapy > 60 Gy (143 patients); 2. low dose radiotherapy followed by cystectomy (25 patients); 3. chemotherapy followed by either definitive radiotherapy or surgery (56 patients). Because the latter group was also a chronologically newer group with a shorter possible follow-up, we compared all treatments on the basis of 2-year survival, using Kaplan-Meier life tables. We briefly reviewed those modalities which are bladder-sparing because of the significance to quality of life of this factor.

RESULTS

Two-year survival figures for the patients were: 63% for those who received only radiotherapy; 72% for those undergoing cystectomy: 68% for the group to whom neoadjuvant chemotherapy was administered. The differences were not statistically significant. However, 23% of those patients treated neoadjuvantly were alive with intact bladders at 2 years.

CONCLUSION

These results do not suggest that a superior survival advantage is associated with any of these 3 protocols and neoadjuvant chemotherapy, in particular, cannot be seen as conferring a new and important survival advantage. However, neoadjuvant chemotherapy followed by radiotherapy does permit bladder conservation and, given that life span will often be reduced, the importance of helping to keep the remainder of the patient's life as comfortable as possible, can hardly be overestimated.

The distribution of BrK alpha/RbK alpha peak intensity ratio in human whole blood samples. Comparison between normal and colorectal cancer cases

A preliminary study was conducted to compare the BrK alpha/RbK alpha peak intensity ratio in colorectal cancer (CRC) patients and healthy subjects (controls) in Israel. Blood samples were obtained from 61 CRC patients and 124 controls. The controls represent a normal population from different areas in Israel. Three hundred microliters of wet whole blood samples were analyzed by the EDXRF method. A weighted mean of 2.45 +/- 0.38 Br/Rb ratio was obtained for CRC patients, as compared with 3.28 +/- 0.40 Br/Rb ratio for controls. The mean value for controls represents only 112 subjects, since 12 individuals of the control group suffered from some other diseases and therefore were not included for the mean value calculation in this group. The results indicate that the Br/Rb ratio in CRC patients is significantly lower (p < 0.05) than in controls. No significant difference was found in Br/Rb ratio correlated to age and sex. It was not possible to draw final conclusion concerning the relationship between the Br/Rb ratio and the malignancy stage, since there was a relatively small number of cases in each stage under investigation.

Biochemical characterization of the mechanisms involved in the 5-hydroxytryptamine-induced increase in rat atrial rate

Several possible mechanisms for 5-hydroxytryptamine (5-HT)-induced tachycardia in rat have been suggested: an activation of 5-HT1C or 5-HT2 receptors, an indirect sympathomimetic effect or a mechanism independent of 5-HT2 receptor stimulation. The aim of this study was to investigate the involvement of these mechanisms in the 5-HT-induced increase in rat atrial rate using biochemical methods. Indeed, the 5-HT1C and 5-HT2 receptors are linked to phosphoinositide hydrolysis and the noradrenaline (NA) released by 5-HT can stimulate the beta 1-adrenergic receptors linked to adenylate cyclase stimulation. The effect of varying concentrations of 5-HT on inositol phospholipid hydrolysis and adenylate cyclase activity of the rat isolated atria were measured. 5-HT (2 microM) did not modify total inositol phosphate (IP) production, while 5-HT 10 and 50 microM increased it 2-fold. The 5-HT2 antagonist ketanserin (1 microM) abolished IP accumulation induced by 5-HT microM), which indicates that this accumulation is 5-HT2 and not 5-HT1C receptor-mediated. Moreover, cyclic AMP (cAMP) formation was enhanced by 5-HT (5, 10, 20 and 50 microM). When atria were incubated 10 min with the beta-adrenergic receptor antagonist nadolol (1 microM), the increase in the cAMP level induced by 5-HT, whatever its concentration (10, 20 or 50 microM), was inhibited. Treating rats with reserpine (2.5 mg/kg, i.p., 48 and 24 hr before experimentation), which caused NA depletion in the heart, seemed to reduce the stimulating effect of 5-HT 10 and 50 microM on adenylate cyclase activity. Thus, the 5-HT-induced increase in cAMP is indirectly due to the activation of the beta-adrenergic receptors by the NA released by 5-HT. It is concluded that 5-HT stimulates both phosphoinositide turnover and adenylate cyclase activity in the rat isolated atria by activation of 5-HT2 receptors and by an indirect sympathomimetic effect.

Low-dose enzyme replacement therapy for Gaucher's disease: effects of age, sex, genotype, and clinical features on response to treatment

Although alglucerase therapy has become the treatment of choice for symptomatic patients with Gaucher's disease, the low-dose/high-frequency regimen introduced as a means to reduce the high cost of treatment has raised major controversy. We evaluated the efficacy and safety of low-dose alglucerase in 29 patients with Gaucher's disease who completed 6 to 28 months of therapy. All received intravenous alglucerase at a monthly dose of 30 units/kg, given usually in equal doses 3 times a week. All patients responded well to treatment. The hematological improvement and the reduction in organomegaly were satisfactory. No correlation was found between age, sex, genotype, previous splenectomy, or severity score index and the response to treatment. Patients with a greater degree of hepatomegaly tended to have a more pronounced decrease in liver size, although this reduction did not reach statistical significance. We confirmed that a low-dose/high-frequency regimen of alglucerase was as effective as a high-dose/low-frequency protocol in the treatment of Gaucher's disease, even in the severely ill. Whenever cost is an issue, we recommend using this low-dose regimen.

[CA 125 in diagnosis and prognosis of epithelial ovarian cancer]

In 59 women with epithelial ovarian cancer serum CA 125 was determined and they were then followed for 3 years. In those with active disease, mean serum CA 125 (289 units/ml) and positivity rate (85%) were significantly higher than in those without evidence of disease (44 units/ml and 17%, p = 0.001 and p < 0.001, respectively). Actuarial 3-year survival curves were calculated according to CA 125 serum level. 91% of those with CA 125 lower than 35 units/ml survived 3 years, as compared to 40% of those with CA 125 levels higher than 35 units/ml (p < 0.01). In ovarian cancer CA 125 serum level correlates with the state of the disease and can be used in the prediction of 3-year survival.

Granulosa cell tumor of the ovary: a study of 18 cases

In a study of 18 patients diagnosed with ovarian granulosa cell tumor between 1961 and 1992, clinical and pathologic findings were evaluated. Of the 18 patients, 15 (83.3%) were diagnosed in Stage I and three (16.7%) in Stage III or IV. Six patients (33.3%) underwent conservative surgery and in 12 (66.7%) total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. At follow-up three patients (16.6%) had died of disease, three, 16 and 288 months, respectively, after initial surgery. The actuarial 5-year survival rate for Stage I was 100%, while that for Stages III and IV combined was 33.3% (P < 0.05). It is concluded that for patients with Stage IA, unilateral oophorectomy seems to be adequate treatment and for those with more than Stage IA, surgery should include total abdominal hysterectomy and bilateral salpingo-oophorectomy. Postoperative adjuvant chemotherapy is advocated for patients in whom spread of tumor beyond the ovaries has occurred.

Effect of ketanserin on monoamines and neuropeptide Y in brain and peripheral tissues of normotensive (WKY) and spontaneously hypertensive (SHR) rats

The effect of one intraperitoneal (i.p.) injection of ketanserin (K) (20mg/kg) on the levels of monoamines and neuropeptide Y (NPY) in some central and peripheral tissues was examined in normotensive (WKY) and spontaneously hypertensive (SHR) rats. In WKY rats, K induced a depletion of norepinephrine (NE) in the hypothalamus, the medulla, the atria and the caudal artery together with a decrease in dopamine level (DA) in the hypothalamus and in serotonin level (5-hydroxytryptamine, 5-HT) in the medulla. The reduction reached 25% to 35%. In SHR, NE and DA levels in the hypothalamus, and NPY levels in the caudal artery were lower than in WKY, while NE was higher in the adrenals. After treatment with K, NE, 5-HT, 5-HIAA (5-hydroxyindoleacetic acid) and NPY in the medulla were increased by about 30% to 50% while NE in the caudal artery was reduced by about the same value as in WKY. These results indicate that K-induced release of monoamines is not linked to NPY release. Moreover, monoamine and NPY sensitivity to K differ in SHR and WKY rats.

Palestinian and Jewish Israeli-born immigrants in the United States

"This article considers both Arab and Jewish emigration from Israel to the United States, relying on the 5 percent Public Use Microdata Sample (PUMS) of the 1980 U.S. census. Using the ancestry and language questions to identify Jews and Arabs, we found that over 30 percent of Israeli-born Americans are Palestinian-Arab natives of Israel, the West Bank, and Gaza Strip. While the Jews are of higher educational levels, hold better jobs and enjoy higher incomes than their Arab counterparts, both groups have relatively high socioeconomic characteristics. Both have high rates of self-employment, particularly the Palestinian-Arabs, who appear to serve as middlemen minority in the grocery store business in the cities where they reside. The fact that nearly a third of Israeli-born immigrants are Arabs accounts for the occupational diversity previously observed of Israelis in America but does not account for their income diversity as much as does differences between early and recent immigrants."

Reduction of superoxide dismutase activity correlates with visualization of edema by T2-weighted MR imaging in focal ischemic rat brain

This study investigated the correlation between in vivo serial T2-weighted magnetic resonance (MR) imaging and changes in superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities, and water, sodium ion (Na+), and potassium ion (K+) contents measured in vitro using rat brain following right middle cerebral artery occlusion in conjunction with bilateral common carotid artery (CCA) occlusion. One hour later the left CCA was released. Serial MR images showed edema developed from the outer cortex towards the center. The T2 signal intensity of the injured right cortex increased with time compared to that of the contralateral cortex. Increased Na+ and water and decreased K+ contents occurred in the injured cortex, indicating that serial T2-weighted MR imaging reflects the changes in water content and Na+ and K+ concentrations determined by biochemical techniques. GSH-Px activity was little changed. Total SOD in the injured cortex decreased 1 hour after ischemia and remained low throughout the experiment. In contrast, SOD activity in the noninfarcted left cortex also decreased after 1 hour but returned to normal after 2 hours of ischemia. Our results suggest that oxygen free radicals are important in developing ischemic brain edema and cerebral infarction.

[beta]-Aminobutyric Acid Induces the Accumulation of Pathogenesis-Related Proteins in Tomato (Lycopersicon esculentum L.) Plants and Resistance to Late Blight Infection Caused by Phytophthora infestans

Tomato (Lycopersicon esculentum L.) plants were sprayed with aqueous solutions of isomers of aminobutyric acid and were either analyzed for the accumulation of pathogenesis-related (PR) proteins or challenged with the late blight fungal agent Phytophthora infestans. The [beta] isomer of aminobutyric acid induced the accumulation of high levels of three proteins: P14a, [beta]-1,3 glucanase, and chitinase. These proteins either did not accumulate or accumulated to a much lower level in [alpha]- or [gamma]-aminobutyric acid-treated plants. Plants pretreated with [alpha]-, [beta]-, and [gamma]-aminobutyric acid were protected up to 11 d to an extent of 35, 92, and 6%, respectively, against a challenge infection with P. infestans. Protection by [beta]-aminobutyric acid was afforded against the blight even when the chemical was applied 1 d postinoculation. Examination of ethylene evolution showed that [alpha]-aminobutyric acid induced the production of 3-fold higher levels of ethylene compared with [beta]-aminobutyric acid, whereas [gamma]-aminobutyric acid induced no ethylene production. In addition, silver thiosulfate, a potent inhibitor of ethylene action, did not abolish the resistance induced by [beta]-aminobutyric acid. The results are consistent with the possibility that [beta]-aminobutyric acid protects tomato foliage against the late blight disease by a mechanism that is not mediated by ethylene and that PR proteins can be involved in induced resistance.

[The emergence of a professional identity among Quebec nurses, 1890-1927]

As part of an important Western trend, the professionalization of Quebec nurses was initially characterized by the enormous challenge of rallying all nurses into adhering to a single professional model. The story starts in 1895 when an elite corps of English-Protestant nurses established the Canadian Nurses Association. These graduates of the Montreal General Hospital were quite active within the English Canadian nursing movement promoting the ideal of the trained nurse, conceived by Florence Nightingale in England. They also fought for professional registration, in keeping with the American trend. The task of rallying French Catholics to the cause of registration soon proved difficult however, as disparities between schools and associations as well as between linguistic and religious groups became apparent. The 1920 Nurses Registration Bill did not put an end to the conflict, unfortunately. By an immediate and controversial alliance, French Catholic physicians and nurses attempted to contest the law which penalized them. If the alliance between them proved beneficial to French-Catholic nurses then, it cost the latter their professional autonomy.

Immunosuppressive acidic protein serum levels in breast cancer patients in a reference to CA 15-3 levels

Immunosuppressive acidic protein (IAP) has been described as a tumor marker in a number of malignant diseases. To evaluate the clinical importance of IAP in breast cancer patients, IAP serum level was determined in 75 breast cancer patients, using single radial immunodiffusion. Serum samples were also tested for CA 15-3. Cut off value for IAP was determined according to IAP serum level in 50 patients with benign, non inflammatory, diseases, and was set as 725 microgram/ml. Mean IAP serum level (623 mcg/ml) and positivity rate (20%) in 24 breast cancer patients with active disease were similar to those in 51 breast cancer patients with no evidence of disease (590 mcg/ml and 18%). The mean CA 15-3 serum level and positivity rate were significantly higher in patients with active disease (200 units/ml, 67%), compared to patients with no evidence of disease (18.3 units/ml, 6%). In our experience IAP was not found to be an effective tumor marker in breast cancer.

Extreme Diel Fluctuations of Oxygen in Diffusive Boundary Layers Surrounding Stony Corals

The diffusive boundary layers surrounding sessile marine organisms have been implicated in controlling an organism's metabolism and growth. We studied boundary layers surrounding hermatypic corals by monitoring oxygen concentrations on a submillimetric scale. Oxygen concentration within the boundary layers varied from supersaturation during the day to anoxia at night, although the ambient water composition remained constant. Detailed mapping and oxygen measurements revealed diel oxygen fluctuations from supersaturation (373% air saturation) in the light to complete oxygen depletion at darkness in the massive coral Favia favus. Exposure to a 5-cm/s current reduced the boundary layer thickness from 2.44 mm to 1.90 mm, allowing more rapid oxygen exchange across the diffusive boundary layer. Similar patterns were found in the branching coral Stylophora pistillata. In massive corals, the thickness of the diffusive boundary layer was negatively correlated with the size of the polyp. We suggest that the distribution of corals in areas of differential turbulence is related to the thickness of the diffusive boundary layers surrounding them.

SIN1 interacts with a protein that binds the URS1 region of the yeast HO gene

Evidence has recently been mounting suggesting that a number of chromatin components previously thought to primarily or exclusively have structural function, also have a regulatory role in eukaryotic transcription. Notably, in yeast, histone H4 N-terminal sequence has been shown to be required for promoter activation of certain genes in vivo, and mutations in histone H3 (SIN2) or in SIN1 (which has some sequence similarity to HMG1) are able to suppress swi1, swi2, and swi3 mutations, restoring transcription to HO as well as a number of other genes. In this paper we report the identification of a novel protein or protein complex that specifically binds a short sequence in the HO regulatory region on the one hand, and on the other somehow appears to contact the SIN1 protein. We have shown that the DNA binding activity itself does not contain SIN1, since extracts from sin1 delta strains retain the activity. Interestingly, extracts made from cells carrying the dominant sin1-2 point mutation lack the binding activity. Furthermore, bacterially produced sin1-2 protein can dissociate a DNA/protein complex while a similarly produced SIN1 protein has no effect on the complex at similar concentrations. When the DNA sequence to which the protein complex binds is placed in a CYC1 promoter lacking a UAS (upstream activating sequence), it can serve as a weak UAS in a SIN1 dependent way. Our data imply that a sequence specific DNA binding protein(s) may mediate between the SIN1 protein and the basal transcription apparatus transcribing HO.

Stable assembly of PsaE into cyanobacterial photosynthetic membranes is dependent on the presence of other accessory subunits of photosystem I

We studied assembly of the PsaE subunit of photosystem I into photosynthetic membranes of cyanobacterial mutant strains that lack specific photosystem I subunits. Radiolabeled PsaE was incubated with photosynthetic membranes, and their binding and assembly were assayed by resistance to removal by chaotropic agents and proteolytic digestion. PsaE incorporated into the wild-type membranes was resistant to these treatments. In the absence of PsaD, it was resistant to proteolytic digestion, but was removed by NaBr. When the membranes were isolated from a mutant strain in which the psaF and psaJ genes have been inactivated, PsaE assembled in vitro could not be removed. PsaE could associate with the membranes of the strain DF in which the psaD, psaJ and psaF genes have been mutated. However, the radiolabeled PsaE associated with these membranes was removed both by the proteolytic as well as by the chaotropic agents. Characterization of PsaE present in vivo revealed similar results. These observations suggest that PsaD and PsaF/J may interact with PsaE and stabilize it in the photosystem I complex.