[The structure, function and mutation of Rb gene promoter in normal individuals and retinoblastoma patients]

OBJECTIVE

To investigate the DNA sequence of the 5' untranslated region of the Rb gene in normal individuals and retinoblastoma patients and identify the elements involved in transcription regulation of Rb gene.

METHODS

SSCP analysis and direct genomic DNA sequencing were used to identify variations or alterations in DNA of normal adult WBC and tumor DNA of retinoblastoma patients. The different DNA fragments located in the 5' untranslated region of Rb gene were amplified and inserted into an expression plasmid with a CAT reporter gene. The capacity of transcription regulation of isolated DNA fragments was determined by CAT assay.

RESULTS

A 240 bp DNA fragment located between -327(-)-87 bp upstream of the first starting codon was shown to be the sequence with essential promoter function. The Sp1/RBF-1, ATF and E2F binding sites were present in this region and positive and negative elements were found further upstream and downstream. Four of 5 naturally occurring mutations were identified in either Sp1/RBF-1 or ATF binding sites from 302 patients with retinoblastoma. All these mutants had reduced CAT activity. However, 100 cases of normal adults did not show any variant DNA sequence in the same region.

CONCLUSION

The promoter DNA sequence of Rb gene is quite stable. Its variation usually leads to reduction in promoter activity which may be associated with genetic susceptibility to retinoblastoma.

Genomics and transcription analysis of human TFIID

TFIID, a multisubunit protein comprised of TBP (TATA box-binding protein) and TAF(II)s (TBP-associated factors), has a central role in transcription initiation at class II promoters. TAF(II)s role as mediators of regulatory transcription factors, such as pRb and p53, and their involvement in signal transduction pathways suggest that some may participate in the control of cell proliferation and differentiation: therefore, they could be considered potential protooncogenes or antioncogenes. With the aim of starting to analyse these potential roles, we have determined the genomic position of nine human TAF(II) genes (TAF[II]250, TAF[II]135, TAF[II]100, TAF[II]80, TAF[II]55, TAF[II]43, TAF[II]31, TAF[II]28, TAF[II]20/15) and of two previously unknown sequences related to TAF(II)250 and TAF(II)31, respectively. Except for those encoding TAF(II)250 and TAF(II)31, these genes are present in a single copy and, with the exclusion of those for TAF(II)43 and TAF(II)28 (both at 6p21), are localized in different segments of the genome. Indeed, six of them map to a chromosomal region commonly altered in specific neoplasias, which defines them as candidates for involvement in oncogenesis. Our experiments also demonstrate that TAF(II) transcripts are synthesized ubiquitously, mostly at low levels similar to those of TBP. Interestingly, the amount of the major mRNA species detected by TAF(II)20/15 cDNA is higher, which suggests that the polypeptide it encodes may also perform functions independently of TFIID. TAF(II) isoforms, indicated by additional bands on Northern blots, may play a role in modulation of TFIID function. These data will be useful for analysing variations of TAF(II) mRNA phenotype during cell proliferation, differentiation and development, both normal and pathological.

A cofactor, TIP30, specifically enhances HIV-1 Tat-activated transcription

Replication of HIV-1 requires the viral Tat protein, which increases the extent of transcription elongation by RNA polymerase II after activation at the single viral long terminal repeat (LTR) promoter. This effect of Tat on transcription requires Tat interactions with a 5' region (TAR) in nascent transcripts as well as Tat-specific cofactors. The present study identifies a cellular protein, TIP30, that interacts with Tat and with an SRB-containing RNA polymerase II complex both in vivo and in vitro. Coexpression of TIP30 specifically enhances transactivation by Tat in transfected cells, and immunodepletion of TIP30 from nuclear extracts abolishes Tat-activated transcription without affecting Tat-independent transcription. These results implicate TIP30 as a specific coactivator that may enhance formation of a Tat-RNA polymerase II holoenzyme complex.

Enhanced gamma-glutamyl transpeptidase expression and selective loss of CuZn superoxide dismutase in hepatic iron overload

Liver injury caused by iron overload is presumed to involve lipid peroxidation and the formation of products such as 4-hydroxynonenal (4HNE), which has been implicated in hepatic fibrogenesis. Cellular antioxidants that modulate the formation and detoxification of compounds such as 4HNE may represent important protective mechanisms involved in the response to iron overload. This study examines the relationship between 4HNE, collagen content, and antioxidant defenses in the livers of rats fed carbonyl iron for 10 weeks. Iron-loading resulted in significant increases in iron (8.8-fold), 4HNE (1.7-fold), and hydroxyproline (1.5-fold). Total glutathione content was unchanged by iron, but gamma-glutamyl transpeptidase activity (GGT) increased sixfold and CuZn superoxide dismutase (CuZnSOD) activity decreased >9%. GGT colocalized with iron deposition and was associated with increased GGT mRNA. Decreased CuZnSOD activity was paralleled by a reduction in CuZnSOD protein on Western blot and immunohistochemistry, but no decrease in CuZnSOD mRNA. Glutathione S-transferase (GST) and Mn superoxide dismutase (MnSOD) activities were also significantly increased by iron loading. These results demonstrate that iron overload significantly alters the expression of antioxidant enzymes associated with glutathione (GGT and GST) and superoxide metabolism (CuZnSOD and MnSOD). Furthermore, the localized induction of GGT may enhance detoxification of lipid peroxidation-derived aldehydes via glutathione-dependent pathways in iron-loaded hepatocytes. These alterations in antioxidant defenses may represent an adaptive response, limiting accumulation 4HNE, and thus, stimulation of collagen synthesis, accounting for the mild fibrogenic response seen in this model of iron overload.

Synthesis and differential turnover of the CYS3 regulatory protein of Neurospora crassa are subject to sulfur control

The transcription factor CYS3 of Neurospora crassa is a positive regulator of the sulfur regulatory circuit which contains many structural genes involved in sulfur metabolism. Expression and degradation of the CYS3 protein are precisely regulated in a sulfur-dependent manner. cys-3 expression was found to be fully repressed by high concentrations of methionine or inorganic sulfate present in the culture medium and to be derepressed when these favored sulfur sources were limited. cys-3 transcripts could be readily detected within 2 h after derepression, whereas the CYS3 protein was not found until after 4 h. CYS3 is stable, with a half-life greater than 4 h under low-sulfur conditions when it is required for cell growth. However, it is degraded relatively quickly when methionine or inorganic sulfate becomes available. Upon sulfur repression, cys-3 transcripts disappeared within 30 min with an estimated half-life of 5 min whereas CYS3 protein almost entirely disappeared in 1 h with a half-life of approximately 10 min. These results suggest that a selective elimination of CYS3 is a highly regulated process. Site-directed mutagenesis showed that Lys-105 of CYS3 is important for its instability. The change of this single residue from lysine to glutamine resulted in a prolonged half life of CYS3 and impaired responsiveness of CYS3 degradation to sulfur level changes.

Subunit composition determines E2F DNA-binding site specificity

The product of the retinoblastoma (Rb) susceptibility gene, Rb-1, regulates the activity of a wide variety of transcription factors, such as E2F, in a cell cycle-dependent fashion. E2F is a heterodimeric transcription factor composed of two subunits each encoded by one of two related gene families, denoted E2F and DP. Five E2F genes, E2F-1 through E2F-5, and two DP genes, DP-1 and DP-2, have been isolated from mammals, and heterodimeric complexes of these proteins are expressed in most, if not all, vertebrate cells. It is not yet clear whether E2F/DP complexes regulate overlapping and/or specific cellular genes. Moreover, little is known about whether Rb regulates all or a subset of E2F-dependent genes. Using recombinant E2F, DP, and Rb proteins prepared in baculovirus-infected cells and a repetitive immunoprecipitation-PCR procedure (CASTing), we have identified consensus DNA-binding sites for E2F-1/DP-1, E2F-1/DP-2, E2F-4/DP-1, and E2F-4/DP-2 complexes as well as an Rb/E2F-1/DP-1 trimeric complex. Our data indicate that (i) E2F, DP, and Rb proteins each influence the selection of E2F-binding sites; (ii) E2F sites differ with respect to their intrinsic DNA-bending properties; (iii) E2F/DP complexes induce distinct degrees of DNA bending; and (iv) complex-specific E2F sites selected in vitro function distinctly as regulators of cell cycle-dependent transcription in vivo. These data indicate that the specific sequence of an E2F site may determine its role in transcriptional regulation and suggest that Rb/E2F complexes may regulate subsets of E2F-dependent cellular genes.

Platelet-activating factor induces cyclooxygenase-2 gene expression in corneal epithelium. Requirement of calcium in the signal transduction pathway

PURPOSE

To investigate the effect of the inflammatory mediator platelet-activating factor (PAF) in the induction of the inducible prostaglandin H synthase-cyclooxygenase-2 (COX-2) gene expression in corneal epithelium.

METHODS

Rabbit corneas were incubated in organ culture with or without carbamyl PAF (cPAF, 100 nM). The effects of PAF antagonist BN50730 (10 microM), protein synthesis inhibitor cycloheximide (CHX; 30 micrograms/ml), RNA synthesis inhibitor actinomycin D (50 micrograms/ml), and tumor promoter phorbol ester (TPA); (100 nM) were tested. Total RNA for corneal epithelium was analyzed by Northern blot analysis using mouse COX-2 cDNA fragments labeled with 32P as probes. Western blots were performed using mouse monoclonal antibodies. Primary cultures of rabbit corneal epithelium were loaded with the fluorescent dye fluo-3 AM and changes in intracellular calcium concentration [Ca2+]i were analyzed by laser scanning confocal microscopy.

RESULTS

Platelet-activating factor induction of COX-2 expression was detectable by Northern blot analysis at 2 hours, peaked at 4 hours, and remained increased for as long as 8 hours. At 16 hours, there was a marked increase in COX-2 expression. The effect was abolished by the PAF antagonist. TPA also induced COX-2 gene expression. Neither PAF-nor TPA-induced expression was inhibited by CHX. In a Ca(2+)-free medium, there was a 50% inhibition of COX-2 gene induction by PAF. The calcium ionophore A23187 also caused an increase in expression of COX-2 messenger RNA; this did not occur in Ca(2+)-free medium. Confocal microscopy imaging showed that after the addition of PAF, there was a transient increase in [Ca2+]i in corneal epithelial cells that peaked between 30 and 60 seconds. The increase was inhibited in the presence of BN50730 or in a Ca(2+)-free medium. A23187 also caused a transient increase in [Ca2+]i that was not altered in cells previously treated with PAF or BN50730.

CONCLUSIONS

PAF may enhance prostaglandin synthesis in the corneal epithelium by increasing COX-2 gene expression. This increase is by means of transcriptional activation of the gene and results in increased COX-2 protein formation. Influx of Ca2+ due to PAF stimulation is required to induce the COX-2 gene. A PAF antagonist abolishes all PAF effects and could be of therapeutic value by modulating ocular inflammation at the level of COX-2 gene expression.

In vivo neurogenesis is inhibited by neutralizing antibodies to basic fibroblast growth factor

While extracellular growth factors govern neuronal precursor mitosis in culture, little is known about their roles in regulating neurogenesis in vivo. Previously, we reported that subcutaneously administered basic fibroblast growth factor (bFGF) promoted neuroblast proliferation in P1 rat brain, in regions in which bFGF and FGF receptors are expressed during development. To define the role of endogenous bFGF in neurogenesis, we employed a neutralizing monoclonal antibody to the factor. In culture, bFGF-induced granule precursor proliferation was progressively inhibited by increasing concentrations of antibody. In contrast, heat-inactivated or nonneutralizing anti-bFGF antibodies were ineffective. The inhibition was specific for bFGF, since EGF-induced [3H]dT incorporation was not altered. To study effects in vivo, neutralizing antibody was administered to newborn rats via the cisterna magnum. Four hours after injection, DNA synthesis in cerebellum and hippocampus was decreased by 53% and 63%, respectively, suggesting that endogenous bFGF was involved in brain development. To define effects on neurogenesis specifically, granule cell precursors were isolated after antibody treatment. [3H]dT incorporation in granule precursors was decreased by 50%, indicating that the neutralizing antibody inhibited neuroblast proliferation in vivo. In contrast, no reduction was observed using nonneutralizing or the heat-inactivated antibodies. The inhibition of precursor proliferation following immunoneutralization of bFGF in vivo suggests that the endogenous factor normally regulates brain neurogenesis.

Effects of garlic thioallyl derivatives on growth, glutathione concentration, and polyamine formation of human prostate carcinoma cells in culture

This study investigated whether naturally occurring garlic derivatives and synthetic S-cysteinyl compounds that resemble garlic constituents have antiproliferative effects on human prostate carcinoma (LNCaP) cells. Studies also examined whether S-allylmercaptocysteine and S-allylcysteine affect two important molecular targets, namely reduced glutathione and polyamines. Results showed that S-allylmercaptocysteine (50 mg/L) diminished LNCaP cell growth whereas the antiproliferative effect of S-allylcysteine was not as pronounced. Studies using synthetic S-cysteinyl analogues revealed that growth inhibition was most effective with compounds containing a disulfide or an active diallyl moiety. Marginal to no inhibitory effect was observed with monosulfinic analogues. Both S-allylmercaptocysteine and S-allylcysteine caused an increase in LNCaP cell reduced glutathione concentrations. Putrescine and spermine concentrations decreased and spermidine increased 3 d after S-allylmercaptocysteine treatment. At 5 d after S-allylmercaptocysteine treatment, polyamine concentrations were similar to those of saline-treated controls. Diminished cell growth and altered polyamine concentrations suggest that S-allylmercaptocysteine may impede the polyamine synthesizing enzyme, ornithine decarboxylase, either by enhancing the formation of reduced glutathione, a known inhibitor of ornithine decarboxylase, or by reacting directly with ornithine decarboxylase at its nucleophilic thiol moiety. Because S-allylcysteine also increases reduced glutathione formation but does not significantly inhibit growth, the latter mechanism may be more likely for this compound. These data provide further evidence that nonessential nutrients derived from garlic may modulate tumor growth. Further research is required on effects of garlic derivatives in vivo before information from the present studies can be used to assist in the development of effective nutritional strategies for preventing progression of prostate cancer.

Modulation of stress protein (hsp27 and hsp70) expression in CD4+ lymphocytic cells following acute infection with human immunodeficiency virus type-1

This study was designed to assess the impact of acute human immunodeficiency virus (HIV-1) infection on host intracellular expression of the heat shock family of stress proteins (hsps). Experimental conditions were established wherein CD4+ lymphocytic cell lines undergo a synchronous HIV-1 infection cycle. During the early phase of infection, HIV-1 mRNA expression was restricted to singly and multiply spliced subspecies, with no genomic viral RNA present until 30 hr following infection. In contrast, hsp27 and hsp70 mRNA transcription appeared as early as 3-8 hr following viral infection. No corresponding induction was observed in mock-infected cells. Notably, hsp27 and hsp70 mRNA transcripts were down-regulated by 24 hr, concomitant to the first appearance of full-length genomic HIV-1 mRNA. Hsp27 and hsp70 mRNA transcripts reemerged at end stages of the viral replicative cycle, coincident to virion release and CD4 cell death. Similarly, a transient induction of de novo hsp27 protein expression occurred between 12 and 24 hr. The generated hsp27 stress response was viral dose-related, suppressed by heat-inactivation of virus, and abrogated by neutralizing antibodies to HIV-1. Acute infection did not alter levels of hsp60, hsp70, and hsp90 protein synthesis. However, two-dimensional Western blot analysis did show the appearance of novel hsp70 homologues between 6 and 24 hr following infection. CEM.NKR, Jurkat, H9, and MT-2 cells showed similar patterns of viral-associated modulation of host hsp27 and hsp70 protein and RNA expression. Thus, host hsp27 and hsp70 stress pathways are selectively implicated in the HIV-1 viral life cycle.

Pain as a predictor of outcome in patients with operable pancreatic carcinoma

BACKGROUND

The purpose of our study was to evaluate the relationship between pain and resectability and survival in patients with operable pancreatic carcinoma.

METHODS

Pain, pain intensity, and pain location were prospectively assessed in newly diagnosed patients with operable adenocarcinoma of the pancreas. Patients were evaluated before their first operation at a large tertiary care cancer center. Pain factors were then correlated with outcomes of surgery, including resectability and survival.

RESULTS

Seventy-seven patients with operable pancreatic carcinoma were evaluated before operation. With the Memorial Pain Assessment Card and a demographic questionnaire, an analysis of analgesic use and pain prevalence and intensity were quantitated. Twenty-two (29%) of 77 patients reported no pain. Fifty-five had mild to severe pain. Moderately severe or greater pain (Memorial Pain Assessment Card Tursky scores of 5 or greater or visual analogue self-assessment pain intensity scores greater than 30) was found in 20 patients. Twenty-six (34%) patients had resectable disease. Of the 51 patients who did not have resections, 35 had metastatic disease. Locoregional unresectable disease without metastases was found in 16 patients. Resectability was correlated with the presence of pain (p = 0.04). The median survival for all patients was 6.7 months. Not surprisingly, patients undergoing resection had a significantly better median survival than did those whose disease was unresectable (5.5 versus 15.1 months). Pain before operation significantly predicted survival (median survival for those with pain, 5.7 months; for those without pain, 15 months; p = 0.003). Even among patients who underwent resection, the presence of pain was associated with a worse survival (21.9 months versus 9.2 months; p = 0.045). In a multivariate analysis the two significant variables were inability to undergo resection and presence of any pain.

CONCLUSIONS

The presence of pain in newly diagnosed patients with potentially operable pancreatic cancer is an ominous predictor of resectability and of survival. Even if the patient can undergo resection, the presence of preoperative pain is associated with a poor prognosis. Patients with operable pancreatic cancer who present with pain, even those whose evaluation shows a likelihood of resectability, are at high risk for recurrence with an impaired survival compared with those patients without pain.

Structure of bacteriophage T4 fibritin: a segmented coiled coil and the role of the C-terminal domain

BACKGROUND

Oligomeric coiled-coil motifs are found in numerous protein structures; among them is fibritin, a structural protein of bacteriophage T4, which belongs to a class of chaperones that catalyze a specific phage-assembly process. Fibritin promotes the assembly of the long tail fibers and their subsequent attachment to the tail baseplate; it is also a sensing device that controls the retraction of the long tail fibers in adverse environments and, thus, prevents infection. The structure of fibritin had been predicted from sequence and biochemical analyses to be mainly a triple-helical coiled coil. The determination of its structure at atomic resolution was expected to give insights into the assembly process and biological function of fibritin, and the properties of modified coiled-coil structures in general.

RESULTS

The three-dimensional structure of fibritin E, a deletion mutant of wild-type fibritin, was determined to 2.2 A resolution by X-ray crystallography. Three identical subunits of 119 amino acid residues form a trimeric parallel coiled-coil domain and a small globular C-terminal domain about a crystallographic threefold axis. The coiled-coil domain is divided into three segments that are separated by insertion loops. The C-terminal domain, which consists of 30 residues from each subunit, contains a beta-propeller-like structure with a hydrophobic interior.

CONCLUSIONS

The residues within the C-terminal domain make extensive hydrophobic and some polar intersubunit interactions. This is consistent with the C-terminal domain being important for the correct assembly of fibritin, as shown earlier by mutational studies. Tight interactions between the C-terminal residues of adjacent subunits counteract the latent instability that is suggested by the structural properties of the coiled-coil segments. Trimerization is likely to begin with the formation of the C-terminal domain which subsequently initiates the assembly of the coiled coil. The interplay between the stabilizing effect of the C-terminal domain and the labile coiled-coil domain may be essential for the fibritin function and for the correct functioning of many other alpha-fibrous proteins.

PAF antagonists as possible inhibitors of corneal epithelial defects and ulceration

The extracellular matrix (ECM) plays a crucial role in cell adhesion, differentiation and wound-healing. Its stability is tightly controlled by enzymes that regulate the metabolism of its components (e.g collagen, fibronectin, laminin). We have found that in the cornea, a potent lipid inflammatory mediator platelet-activating factor (PAF) activates the expression of two metalloproteinases (MMP-1 and MMP-9) as well as urokinase-plasminogen activator (uPA). uPA is of particular interest because, as a serine protease, it is at the top of the protease cascade. PAF may contribute to the destruction of the ECM and the formation of epithelial defects and corneal ulcers by activating uPA and then proteases. We also investigated how several PAF antagonists with different binding affinities can block the expression of the uPA gene. Our results suggest that PAF antagonists with affinities for intracellular binding sites and/or specific structures derived from triazolobenzodiazepine could be of therapeutic use to limit the breakdown of the ECM and the development of ulcer formation.

Effect of radix Salviae miltiorrhizae on extracellular adenosine and evaluation of its protective efficacy in ischemic reperfusion rat--microdialysis, HPLC and histopathologic studies

The effects of Radix Salviae Miltiorrhizae (RSM) on extracellular adenosine (Ade) and its metabolites, i.e. inosine, hypoxanthine and xanthine, were studied with microdialysis and HPLC techniques during cerebral ischemia-reperfusion induced by 4-vessel occlusion in rat brain. Histological examination of hippocampus was performed 6 h after reperfusion. ECF (extracellular fluid) adenosine and its metabolites were compared between the controls (n = 6) and RSM-treated rats (n = 6). Basal level of Ade and its metabolites release were not greatly affected by pretreatment with RSM, and no significant difference as compared with the sham-operated (n = 6). Ade and its metabolites were dramatically increased after ischemia, and decreased near basal-level and its metabolites remained high at the end of reperfusion. In the RSM-treated animals, the tendency of changes of Ade and its metabolites was just the same as in the controls, but the magnitudes of changes were significantly lower at some different time points. In sham-operated animals, no changes were observed at different time points both during ischemia (30 min.) and reperfusion (60 min.). Histopathological findings demonstrated that RSM pretreatment results in better histologic preservation of the pyramidal cells in the postischemic reperfusion CA1 sector both qualitatively and quantitatively. These results indicated that RSM protects against cerebral ischemia reperfusion injury.

Specific interactions and potential functions of human TAFII100

Human transcription initiation factor TFIID contains the TATA-binding protein (TBP) and several TBP-associated factors (TAFs). To investigate the structural organization and function of TFIID, we have cloned and expressed a DNA encoding the third largest human TFIID subunit, hTAFII100. Immunoprecipitation studies demonstrate that hTAFII100 is an integral subunit that is associated with all transcriptionally-competent forms of TFIID. They further suggest that at least part of the N-terminal region lies on the surface of TFIID, while a C-terminal region containing conserved WD-40 repeats appears inaccessible. Both in vivo and in vitro assays indicate that hTAFII100 interacts strongly with the histone H4-related hTAFII80 and the histone H3-related hTAFII31, as well as a stable complex comprised of both hTAFII80 and hTAFII31. Apparently weaker interactions of hTAFII100 with TBP, hTAFII250, hTAFII28, and hTAFII20, but not hTAFII55, also have been observed. These results suggest a role for hTAFII100 in stabilizing interactions of TAFs, especially the histone-like TAFs, in TFIID. In addition, functional studies show that anti-hTAFII100 antibodies selectively inhibit basal transcription from a TATA-less initiator-containing promoter, relative to a TATA-containing promoter, suggesting a possible core promoter-specific function for hTAFII100.

Randomized trial of breast self-examination in Shanghai: methodology and preliminary results

BACKGROUND

The efficacy of breast self-examination in helping to reduce mortality from breast cancer has not been rigorously demonstrated.

PURPOSE

To assess efficacy, a large, randomized trial was initiated in Shanghai, China.

METHODS

From October 1989 to October 1991, 267040 current and retired female employees associated with 520 factories in the Shanghai Textile Industry Bureau were randomly assigned on the basis of factory to either a self-examination instruction group (133375 women) or a control group (133665 women). The women were born within the period from 1925 through 1958. Women in the instruction group were given intensive training in breast self-examination, including the use of silicone breast models and personalized instruction, plus two subsequent reinforcement sessions and multiple reminders to practice the technique. Women in the control group were asked to attend training sessions on the prevention of low back pain. All women have been followed for the development of breast diseases and for death from breast cancer.

RESULTS

A high level of participation during the first 4-5 years of the trial was documented among women in the instruction group. Randomly sampled women in this group demonstrated greater proficiency in detecting lumps in breast models than did randomly sampled women in the control group. Approximately equal numbers of breast cancers were detected in the two groups (331 in the instruction group and 322 in the control group) through 1994, which is the last year for which case-finding efforts have been completed. The breast cancers detected in the instruction group were not diagnosed at an appreciably earlier stage or smaller size than those in the control group. More benign breast lesions were detected in the instruction group than in the control group (1457 versus 623, respectively), suggesting a higher index of suspicion for women who received training. Cumulative breast cancer mortality rates through 5 years from entry into the study were nearly equivalent for the two groups.

CONCLUSIONS

Breast self-examination has not led to a reduction in mortality from breast cancer in this study cohort in the first several years since the trial began. A shift toward the diagnosis of disease at a less advanced stage in women given instruction has also not been demonstrated. Longer follow-up of participants in this trial is required before final assessment can be made of the efficacy of breast self-examination.

IMPLICATIONS

At this time, there is insufficient evidence to recommend for or against the teaching of breast self-examination.

Endometrial thickness in tamoxifen-treated patients: correlation with clinical and pathologic findings

OBJECTIVE

This study was performed to evaluate sonographic measurements of endometrial thickness in postmenopausal breast cancer patients being treated with tamoxifen and to correlate endometrial thickness with pathology, symptoms, and duration of tamoxifen treatment.

MATERIALS AND METHODS

Pelvic sonograms and medical records of 91 postmenopausal breast cancer patients being treated with tamoxifen were retrospectively reviewed. Histologic results were available in 46 patients (51%). Endometrial thickness was measured in anteroposterior dimension and was considered normal when less than 8 mm. Endometrial thickness was then correlated with histopathologic findings, symptoms, and duration of tamoxifen treatment.

RESULTS

Forty-seven examinations (52%) showed endometrial thickness of less than 8 mm and 44 examinations (48%) showed endometrial thickness of 8 mm or more. Endometrial biopsy was performed in 10 women (21%) in whom the endometrial thickness was less than 8 mm, revealing seven normal endometria, one endometrial polyp, and two insufficient samples. Endometrial biopsy was performed in 36 women (82%) in whom endometrial thickness was 8 mm or more, revealing three cases with more than one diagnosis. In this group, diagnoses included 14 normal endometria, 12 endometrial polyps, four endocervical polyps, three hyperplasias, two endometrial cancers, one papillary syncytial metaplasia, one cystic change, one inflammatory debris, and one insufficient sample. Postmenopausal bleeding prompted 20 studies, 12 of which revealed endometrial thickness of 8 mm or more. We found no difference in endometrial thickness of patients who had bleeding versus those who had no bleeding. Endometrial thickness increased with the duration of tamoxifen treatment. Seventy-three women being treated with tamoxifen for less than 5 years had a median endometrial thickness of 5 mm, and 44% of biopsies yielded abnormal results. Eighteen women receiving tamoxifen 5 years or longer had a median endometrial thickness of 14 mm, and 58% of endometrial biopsies in this group were abnormal. The two endometrial cancers occurred in women who were treated with tamoxifen for 6 years. Correlation between duration of tamoxifen use and endometrial thickness was significant (p < .026).

CONCLUSION

The majority of women being treated with tamoxifen were asymptomatic, but 48% of sonograms revealed an endometrial thickness of 8 mm or more. Endometrial polyps, the most common abnormality, were diagnosed in 33% of biopsies performed for endometrial thickness of 8 mm or more. Endometrial thickness showed no correlation with symptoms, but we found a statistically significant correlation between increased endometrial thickness and duration of tamoxifen treatment that was longer than 5 years.

[Allergic bronchopulmonary aspergillosis successfully treated with itraconazole]

A 67-year-old man was admitted to our hospital because of coughing, a low-grade fever, and abnormal shadows on a chest X-ray film. He had had asthma as a child, but had no asthmatic symptoms on admission. A CT scan showed collapse of the right middle lobe and mucoid impactions in the lingula. Bronchoscopy revealed thick mucus obstructing the right middle-lobe bronchus and the left upper-lobe bronchus. The eosinophil count and the IgE level were abnormally high. Aspergillus fumigatus was detected in his sputum. Tests for immediate skin reaction and precipitating antibody to aspergillus antigen were positive. After treatment with itraconazole he became asymptomatic. Radiographic abnormalities had resolved by 1 month after the start of treatment; a high resolution CT scan obtained after clinical improvement revealed central bronchiectasis. In this patient with allergic bronchopulmonary aspergillosis, a course of itraconazole alone was followed by satisfactory improvement.

Acylation-stimulating protein (ASP) regulates glucose transport in the rat L6 muscle cell line

Acylation-stimulating protein (ASP), a human plasma protein, is a potent stimulator of triglyceride synthesis and glucose transport in both human adipocytes and fibroblasts. The purpose of the present in vitro study was to examine the effect of ASP on glucose transport in muscle cells. ASP stimulated 2-deoxy-glucose transport (2-DG) in differentiated rat L6 myotubes in a time (30 min to 24 h) and concentration dependent manner (97% increase). The magnitude of the ASP effect on glucose transport was comparable to the time- and concentration-dependent effects seen with insulin (125% increase), but was additive to insulin, pointing to involvement of differential signalling pathways. ASP stimulation was dependent on cell differentiation in that glucose transport increased by only 12% in myoblasts, comparable to the effect of insulin in myoblasts (15% increase) demonstrating selective responsiveness of the differentiated myotubes to ASP and insulin. The mechanism for the ASP induced increase in glucose transport was also examined. ASP increased the Vmax for 2-DG transport by 183% (4.02 vs. 1.42 nmol/mg cell protein/30 s; ASP vs. Control, respectively). This could be explained by an increased translocation of glucose transporters (GLUT 1, GLUT 4 and GLUT 3) to the plasma membrane surface as demonstrated by Western analysis (+43% P < 0.05, +30% P < 0.05, and +49% P < 0.05, respectively). The effects of ASP were equal to those of insulin (+47%, +26% and +53% for GLUT 1, GLUT 4 and GLUT 3, respectively) and in all cases were paralleled by comparable glucose transport increases under the same incubation conditions. After long-term stimulation (24 h), Western analysis indicated that ASP had a permissive effect on insulin stimulated increases in total GLUT3 and GLUT4 cellular transporter content. These results suggest that muscle is also responsive to ASP and that ASP may play a role in glucose metabolism in both muscle and adipose tissue.

[Dynamic study on blood lead levels of pregnant women and infants in a district of Beijing]

Under strict quality control, the authors investigated the levels of PbB among 270 women from early pregnancy to delivery and their infants. The mean PbB levels of the first three months of pregnancy and delivery is 45.0 microg/L and 64.8 microg/L respectively. Analysis shows an increase of mean PbB level in the period of gestation, and a significant increase in the last three months. The mean PbB level of umbilical cord is 51.9 microg/L (10.4% umbilical cord PbB > 100 microg/L). The mean PbB level of infants increases with the months, it increases significantly after six months. Regression analysis confirmed the positive correlation between the PbB levels of first three and second three months of gestation, the PbB of delivery and umbilical cord, the PbB of umbilical coral and infants. The correlation coefficient of the PbB level of delivery and umbilical cord, the PbB level of infants at six months and at twelve months is 0.80 and 0.47 respectively.

Neurogenesis in neonatal rat brain is regulated by peripheral injection of basic fibroblast growth factor (bFGF)

Many major diseases of human brain involve deficiencies of select neuronal populations. As one approach to repair, we examined regulation of neurogenesis directly in vivo, employing postnatal day 1 (P1) cerebellar cortex, which is composed primarily of granule neurons and dividing precursors. We focused on basic fibroblast growth factor (bFGF), which stimulates precursor mitosis in culture and which is highly expressed in cerebellum during neurogenesis. Subcutaneous injection of bFGF increased [3H]thymidine ([3H]dT) incorporation, a marker for DNA synthesis, by 50% in whole cerebellar homogenates, suggesting that peripherally administered factor altered ongoing neural proliferation. Further, assay of isolated granule precursors revealed a 4-fold increase in [3H]dT incorporation following in vivo bFGF treatment, indicating that granule neuroblasts were the major bFGF-responsive population. Morphologic analysis indicated that twice as many granule precursors were in S-phase of the mitotic cycle after peripheral bFGF. To determine whether other neurogenetic populations respond to peripheral bFGF, we examined additional brain regions in vivo. bFGF stimulated DNA synthesis by 68% in hippocampus, and by > 250% in pontine subventricular zone (SVZ). In contrast, incorporation was not altered in basal pons or cerebral cortex, regions in which neurogenesis has already ceased. To define potential direct actions of peripherally administered factor, 125I-bFGF was used to study distribution. Intact 18 kDa 125I-bFGF was recovered from brain following peripheral injection, suggesting that the factor acted directly to stimulate mitosis in dividing neuroblasts. The stimulation of neuronal proliferation by exogenous bFGF suggests that the factor normally regulates neurogenesis, and provides new therapeutic approaches to promote functional recovery from nervous system diseases.

Inhibitory effect of 764-3 on Ca2+ uptake in rat brain synaptosomes

In an attempt to examine the effect of 764-3, a purified component extracted from Radix Salviae Miltiorrhizae (RSM), on calcium channel, Ca2+ uptake in rat brain synaptosome stimulated by high-K+ and Glutamate (Glu) was investigated by using radioisotope labeled 45CaCl2. It was found that 764-3 could decrease the uptake of Ca2+ induced by high-K+ (60 mM) and 0.1 mM glutamate in a concentration-dependent manner. The maximum inhibiting rates were 45.22 +/- 4.88% and 37.58 +/- 4.52%, respectively. The results indicated that neuroprotective effect of RSM on cerebral ischemic injury may be related to its blocking effects on calcium channel.

Thiamine status in patients receiving long-term home parenteral nutrition

OBJECTIVES

Clinical thiamine deficiency can occur in patients receiving total parenteral nutrition (TPN) without thiamine supplementation. Because considerable breakdown of thiamine may occur in the presence of bisulfite-containing amino acid solutions, subclinical thiamine deficiency may develop with the use of these solutions, even with appropriate thiamine supplementation. The current American Medical Association-Food and Drug Administration approved injectable multivitamin formula contains 3 mg of thiamine. This study was undertaken to determine whether this quantity of thiamine is sufficient to avoid clinical thiamine deficiency in long-term home TPN patients with negligible oral thiamine absorption and in the presence of bisulfite-containing amino acid solutions.

METHODS

Twenty-four long-term home TPN patients with oral caloric intakes below the norm were evaluated. Seventeen patients suffered from short bowel syndrome or radiation enteritis, and another three had draining gastrostomies that precluded all intestinal absorption. The duration of TPN therapy ranged between 1 and 164 months. Thiamine status was assessed by assaying thiamine pyrophosphate, transketolase activity, and blood thiamine levels.

RESULTS

All thiamine pyrophosphate and erythrocyte transketolase activity levels were within the normal range.

CONCLUSIONS

This study demonstrates that the currently recommended 3 mg of thiamine hydrochloride added to TPN solutions is adequate to maintain normal thiamine status. This should prevent the development of thiamine deficiency even in patients with compromised intestinal thiamine absorption, and in the presence of bisulfite-containing amino acid solutions.

Effect of radix Salviae miltiorrhizae on nitric oxide in cerebral ischemic-reperfusion injury

It has been postulated that nitric oxide (NO) is produced in significant amount on reperfusion of ischemic brain and could cause brain edema and cell death. This study was undertaken in an attempt to determine whether Radix Salviae Miltiorrhizae (RSM) could reduce cerebral NO contents in 4-vessel occlusion rat model after 30 min of global ischemia and 15 min of reperfusion. There was a significant increase in cerebral NO level in untreated animals as compared with sham-operated ones. By pretreatment with RSM the cerebral NO concentration was reduced to normal level. The possibilities of neuroprotective role of RSM in cerebral ischemic-reperfusion injury were discussed.