Management of Calculi in A Donor Kidney

INTRODUCTION

We evaluated the safety and efficacy of ex vivo ureteroscopy (ExURS) and extracorporeal shock wave lithotripsy (ESWL) as means of rendering a donated kidney stone-free in living related and deceased donor renal transplantation.

MATERIAL AND METHODS

Three cases with calculi in donor kidneys were managed; 1 was from a living related donor and 2 were from deceased donors. Immediately after cold perfusion, ExURS was performed with iced saline solution in 2 cases. Access to the collecting system was via the ureteral stump. Calculi were fragmented with pneumatic intracorporeal lithotripsy and fragments were removed with forceps. Posttransplantation ESWL was given to 1 patient for migration of a small lower caliceal calculus in the upper ureter in 1 allograft of a dual-kidney transplantation.

RESULTS

Access to the renal collecting system and stone fragmentation was technically successful in both cases. Indwelling ureteral stents were kept during transplantation in all cases. There were no intraoperative or postoperative ureteral complications. Following ESWL, stone was fragmented and cleared on its own within a week. At mean follow up of 2.2 years no new stone formed in any recipient or donor.

CONCLUSIONS

ExURS was technically feasible to render a stone-bearing kidney stone- free without compromising ureteral integrity or renal allograft function. ESWL could be performed at a later date.

Exposure to chronic noise and fractionated X-ray radiation elicits biochemical changes and disrupts body weight gain in rat

The aim was to assess the developmental and biochemical effects resulting from separate and combined exposures to radiation and noise in adult male Sprague-Dawley rats. For 21 days, animals were exposed daily (1) to whole-body 121 kVp X-ray exposure (cumulative dose=5 Gy), (2) to random intermittent noise band-limited between 0.4 and 20 kHz; 2 h day(-1) 86 decibels (dB) and (3) to combined exposures. Control animals were housed under ambient noise conditions 55 dB A-weighted (dBA) and sham-exposed to X-rays. Body weight gain was significantly reduced in animals exposed to either X-rays or noise, and the loss was more pronounced in animals exposed to both conditions. Neither plasma adrenocorticotropic hormone (ACTH) nor corticosterone was altered by the treatment conditions. This study corroborated previous reports that ionizing radiation exposure increased plasma levels of 8-hydroxy-2'-deoxyguanosine (8-OHDG), but no effect was observed in animals co-exposed to chronic noise. Plasma big-endothelin-1 (Big ET-1) was significantly reduced in animals exposed to a combination of noise and X-rays. The results indicated that (1) adaptation to chronic noise appeared to occur at the level of the hypothalamic pituitary adrenal (HPA) response, in spite of a compromise in overall body weight gain; and (2) ionizing radiation exposure might alter systems activated by stressor exposure and/or act independently to influence health outcomes.

Laser extraction of entrapped leads

Removing entrapped pacing and defibrillator leads has been greatly simplified by making use of the excimer laser extractor. Sixty-two leads were successfully removed, although where appropriate, portions of the lead remained in place in 10 cases. There were two serious complications, one tear of the superior vena cava during an ICD extraction and one tear of the atrium during an atrial lead extraction. Both were controlled successfully through emergency sternotomy. Although extracting entrapped leads has been much simplified by making use of the laser extractor, the process is not free of serious complications. Those involved in explanting leads should be aware of the outcomes and be prepared for emergent management.

Dosimetric implications of atmospheric dispersal of tritium near a heavy-water research reactor facility

An estimate of the tritium dose to the public in the vicinity of the heavy water research reactor facility at AECL-Chalk River Laboratories, Ontario, Canada, has largely been accomplished from analyses on regularly-collected samples of air, precipitation, drinking water and foodstuffs (pasture, fruit, vegetables and milk) and environmental dose models. To increase the confidence with which public doses are calculated, tritium doses were estimated directly from the ratio of tritiated species in urine samples from members of the general public. Single cumulative 24 h urine samples from a few adults living in the vicinity of the heavy-water research reactor facility at Chalk River Laboratories, Canada were collected and analysed for tritiated water and organically bound tritium. The participants were from Ottawa (200 km east), Deep River (10 km west) and Chalk River Laboratories. Tritiated water concentrations in urine ranged from 6.5 Bq.l-1 for the Ottawa resident to 15.9 Bq.l-1 for the Deep River resident, and were comparable to the ambient levels of tritium-in-precipitation at their locations. The ultra-low levels of organically bound tritium in urine from these same individuals were measured by 3He-ingrowth mass spectrometry and were 0.06 Bq.l-1 (Ottawa) and 0.29 Bq.l-1 (Deep River). For Chalk River Laboratories workers, tritiated water concentrations in urine ranged from 32 Bq.l-1 to 9.2 x 10(4) Bq.l-1, depending on the ambient levels of tritium in their workplace. The organically bound tritium concentrations in urine from the same workers were between 0.08 Bq.l-1 and 350 Bq.l-1. With a model based on the ratio of tritiated water to organically bound tritium in urine, the estimated dose arising from organically bound tritium in the body for the Ottawa and Deep River residents was about 26% and 50%, respectively, of the body water tritium dose. The workers in a reactor building at Chalk River Laboratories had less than 10% dose contribution from organically bound tritium, but had higher overall tritium dose due to frequent intakes of tritiated water vapour in the workplace. The results of this study suggest that most of the tritium dose to workers at Chalk River and general population near Chalk River is the result of tritiated water intakes and not due to dietary intake of organically bound tritium.

Dose to the cell nucleus from exposure to tritiated pump oil or formaldehyde

A Monte Carlo simulation of tritium decays in a cell composed of two parts, a nucleus and surrounding cytoplasm, was developed to evaluate the beta-radiation dose to the nucleus. A dose modifying factor (DMF), which is a ratio of the average nuclear dose to the whole-tissue dose, after skin-contact exposure of rats to tritiated pump oil or tritiated formaldehyde was estimated. Biokinetic data characterizing the retention of tritium in liver were available in the form of tritium-specific activities and biological half-times for tritiated water and five macromolecular species (DNA, RNA, acid-soluble fraction, acid-insoluble protein, and lipids). The spatial distribution of tissue-free water and macromolecular species in the nucleus and cytoplasm of rat liver cells was based on published data. In the case of exposure to tritiated pump oil, tritium incorporated into lipids provides the largest percentage (60%) of the absorbed dose to the nucleus. For the tritiated-formaldehyde exposure, the tritium dose to the nucleus is overwhelmingly contributed by tritiated water (58%) and in acid-insoluble proteins (40%). For both these tritiated organic exposures, the tritium-labeled DNA has a negligible effect on the DMF. The DMF for the tritiated pump oil and formaldehyde exposures was estimated as 0.81 and 1.05, respectively: the DMF of both exposures was close to unity. Given the other uncertainties in tritium dosimetry, our results suggest that for these skin-contact exposures a uniform distribution of tritium in tissue is an adequate assumption for dosimetry.

Dose contribution from metabolized organically bound tritium after chronic tritiated water intakes in humans

Our earlier study of acute tritiated water intakes in humans has demonstrated that the dose contribution from metabolized organically bound tritium is less than 10% of the body water dose. To further demonstrate that the dose contribution from the organically bound tritium per unit intake of tritiated water is the same, regardless of whether the intake is acute (all at once) or chronic (spread over time), urine samples from six male radiation workers with chronic tritiated water intakes were collected and analyzed for tritium. These workers have a well-documented dose history and a well-controlled tritium bioassay database, providing assurance that their tritium intakes were in the form of tritiated water. Each month for a full calendar year, urine samples were collected from each exposed worker. The monthly concentration of tritiumin-urine for each exposed worker was no lower than 10(4) Bq L(-1) but no higher than 10(5) Bq L(-1). These urine samples were analyzed for tritiated water and organically bound tritium to determine the ratio of these tritiated species in urine. The average ratio of tritiated water to organically bound tritium in urine for each exposed worker was 330 +/- 129 (range, 297-589). In calculating the dose to these workers, we assumed that, under steady-state conditions, the ratio of the specific activity of tritium (3H activity per gH) in the organic matter and water fractions of urine is representative of the ratio of the specific activity of tritium in the organic matter and water fractions of soft tissue. A mathematical model was developed and used to estimate the dose increase from the metabolized organically bound tritium based on the ratio of tritiated water to organically bound tritium in urine. The resulting average dose from the organically bound tritium was 6.9 +/- 3.1% (range, 4.7-9.9%) of the body water dose for the six male workers, and agrees well with the value obtained from our acute tritiated water intakes study in humans. The observed dose contribution from organically bound tritium, relative to body water dose, is in agreement with current recommendations of assigning 10% of total body water dose for organically bound tritium in soft tissues after tritiated water intakes.

A TATA element is required for tRNA promoter activity and confers TATA-binding protein responsiveness in Drosophila Schneider-2 cells

In contrast to yeast and mammalian systems, which depend principally on internal promoter elements for tRNA gene transcription, insect systems require additional upstream sequences. To understand the function of the upstream sequences, we have asked whether the Bombyx mori tRNACAla and tRNASGAla genes, which are absolutely dependent on these sequences in vitro, also require them for transcription in vivo. We introduced wild-type and mutant versions of the Bombyx tRNAAla genes into Drosophila Schneider-2 cells and found that the tRNACAla gene is efficiently transcribed and that its transcription depends strongly on the distal segment of its upstream promoter. In contrast, the tRNASGAla gene is inefficiently transcribed, and this inefficiency results from lack of a specific sequence within the distal tRNACAla upstream promoter. This sequence, 5'-TTTATAT-3', is sufficient to increase the activity of the tRNASGAla promoter to that of the tRNACAla promoter. Moreover, promoters containing the 5'-TTTATAT-3' element are stimulated by increased levels of cellular TATA-binding protein. Together these results indicate that, in insect cells, a TATA-like element is specifically required to form functional TATA-binding protein-containing complexes that promote efficient transcription of tRNA genes.

Regulation of RNA polymerase I-dependent promoters by the hepatitis B virus X protein via activated Ras and TATA-binding protein

The hepatitis B virus (HBV) X protein is essential for viral infectivity, and evidence indicates that it is a strong contributor to HBV-mediated oncogenesis. X has been shown to transactivate a wide variety of RNA polymerase (Pol) II-dependent, as well as RNA Pol III-dependent, promoters. In this study, we have investigated the possibility that X modulates RNA Pol I-dependent rRNA transcription. In both human hepatoma Huh7 and Drosophila Schneider S2 cell lines, X expression stimulated rRNA promoter activity. Extracts prepared from X-expressing cells stably transfected with an X gene also exhibited an increased ability to transcribe the rRNA promoter. The mechanism for X transactivation was examined by determining whether this regulatory event was dependent on Ras activation and increased TATA-binding protein (TBP) levels. Our previous studies have demonstrated that X, and the activation of Ras, produces an increase in the cellular levels of TBP (H.-D. Wang, A. Trivedi, and D. L. Johnson, Mol. Cell. Biol. 17:6838-6846, 1997). Expression of a dominant negative form of Ras blocked the X-mediated induction of the rRNA promoters, whereas expression of a constitutively activated form of Ras mimicked the enhancing effect of X on rRNA promoter activity. When TBP was overexpressed in either Huh7 or S2 cells, a dose-dependent increase in rRNA promoter activity was observed. To analyze whether the increase in TBP was modulating rRNA promoter activity indirectly, by increasing activity of RNA Pol II-dependent promoters, a Drosophila TBP cDNA was constructed with a mutation that eliminated its ability to stimulate RNA Pol II-dependent promoters. Transient expression of wild-type TBP in S2 cells increased the activities of specific RNA Pol I- and Pol II-dependent promoters. Expression of the mutant TBP protein failed to enhance the activity of the RNA Pol II-dependent promoters, yet the protein completely retained its ability to stimulate the rRNA promoter. Furthermore, the addition of recombinant TBP to S2 extracts stimulated rRNA promoter activity in vitro. Together, these results demonstrate that the HBV X protein up-regulates RNA Pol I-dependent promoters via a Ras-activated pathway in two distinct cell lines. The enhanced promoter activity can, at least in part, be attributed to the X- and Ras-mediated increase in cellular TBP, a limiting transcription component.

Multiple initiations in the c-myc replication origin independent of chromosomal location

At supramolecular resolution, DNA synthesis begins at preferred replication origins in the chromosomes of metazoan cells. To characterize one of these origins in detail, the initiation of replication was examined in the HeLa c-myc origin. Polymerase chain reaction (PCR) amplification of size-fractionated nascent chromosomal DNAs revealed multiple replication initiation sites over a 12-kb region spanning the c-myc origin, including the transcribed region and the 5' and 3' flanking DNA of the gene. Two of the start sites for chromosomal replication occurred inside a 2.4-kb region of the origin that exhibits autonomously replicating sequence (ARS) activity. When a plasmid containing the 2.4-kb ARS region was transfected into HeLa cells, PCR mapping of nascent plasmid DNA confirmed that the plasmid replicated semiconservatively and autonomously and that replication did not initiate at random sites but rather began at multiple sites in a limited zone overlapping the c-myc DNA insert. Within the resolution of the PCR assay, the same sites that were used in the chromosomal c-myc origin were used in the 2.4-kb ARS fragment. The locations of replication start sites determined by PCR are considered in the context of other functional and structural elements of the c-myc origin.

Tritium concentrations inside the homes of occupationally exposed workers: dosimetric implications

The average tritiated water concentration in the indoor air of the occupationally exposed worker's residence (55 Bq m(-3), range 53-59 Bq m(-3)) was higher than the indoor air of control residences (0.7 Bq m(-3), range 0.4-0.8 Bq m(-3)). The worker had an average concentration of tritium-in-urine of 30 kBq L(-1) from chronic intakes of occupational levels of tritiated water. Higher residential concentrations of tritiated water vapor were due to tritium transferred by the worker. Urine samples from an adult co-occupant were collected and had tritiated water concentrations between 89 and 345 Bq L(-1). These concentrations were higher than for individuals (range, 6-32 Bq L(-1)) living in other residences having similar outdoor and indoor concentrations of tritiated water in air. The range of measured tritiated water in urine was in agreement with the prediction of biokinetic models for tritium intakes as recommended by the International Commission on Radiological Protection Publication 56. The tritiated water vapor in the indoor air of the exposed worker's residence contributed about 96% of the daily tritium intakes. The annual average tritium dose to the family member (7 microSv) was well below the International Commission on Radiological Protection Publication 60 recommended annual dose limit (1 mSv) for members of the public. We conclude that, for a few members of the public living near a heavy-water research reactor facility, daily intakes of tritium will relate to tritiated water dispersed by the exposed worker, as well as to tritium transported by the atmosphere from the reactor site.

Presacral teratoma presenting with congenital urinary ascites

Congenital teratomas occur most frequently in the sacrococcygeal region. Most grown into a large perineo-sacral swelling that is conspicuous externally. Infrequently, the neoplasm is contained almost entirely within the pelvis in the presacral space. Congenital urinary ascites is observed in patients with obstructive uropathy; posterior urethral valves in a newborn is one of the most prominent causes of urinary ascites. We report a case of presacral teratoma leading to rupture of the urinary bladder due to outflow obstruction and causing urinary ascites. The ascites was drained, the bladder was repaired, and the teratoma was successfully excised. A review of the literature did not reveal any similar case.

Hepatitis B virus X protein induces RNA polymerase III-dependent gene transcription and increases cellular TATA-binding protein by activating the Ras signaling pathway

Our previous studies have shown that the hepatitis B virus protein, X, activates all three classes of RNA polymerase III (pol III)-dependent promoters by increasing the cellular level of TATA-binding protein (TBP) (H.-D. Wang et al., Mol. Cell. Biol. 15:6720-6728, 1995), a limiting transcription component (A. Trivedi et al., Mol. Cell. Biol. 16:6909-6916, 1996). We have investigated whether these X-mediated events are dependent on the activation of the Ras/Raf-1 signaling pathway. Transient expression of a dominant-negative mutant Ras gene (Ras-ala15) in a Drosophila S-2 stable cell line expressing X (X-S2), or incubation of the cells with a Ras farnesylation inhibitor, specifically blocked both the X-dependent activation of a cotransfected tRNA gene and the increase in cellular TBP levels. Transient expression of a constitutively activated form of Ras (Ras-val12) in control S2 cells produced both an increase in tRNA gene transcription and an increase in cellular TBP levels. These events are not cell type specific since X-mediated gene induction was also shown to be dependent on Ras activation in a stable rat 1A cell line expressing X. Furthermore, increases in RNA pol III-dependent gene activity and TBP levels could be restored in X-S2 cells expressing Ras-ala15 by coexpressing a constitutively activated form of Raf-1. These events are serum dependent, and when the cells are serum deprived, the X-mediated effects are augmented. Together, these results demonstrate that the X-mediated induction of RNA pol III-dependent genes and increase in TBP are both dependent on the activation of the Ras/Raf-1 signaling cascade. In addition, these studies define two new and important consequences mediated by the activation of the Ras signal transduction pathway: an increase in the central transcription factor, TBP, and the induction of RNA pol III-dependent gene activity.

Dose contribution from metabolized organically bound tritium after acute tritiated water intakes in humans

Urine samples from eight male radiation workers who had an unplanned acute tritiated water intake were measured for tritium-in-urine up to 300 d post-exposure. During the first month or so post-exposure, these individuals increased their fluid intakes to accelerate the turnover rate of tritium in the body for dose mitigation. Their daily fluid intakes reverted to normal levels in the latter period of the study. A non-linear regressional analysis of the tritium-in-urine data showed that the average biological half-life of tritium in body water, with standard deviation, was 6.3 +/- 1.0 d (range, 5.0-8.1 d) and 8.4 +/- 2.0 d (range, 6.2-12.8 d) during the respective periods of increased fluid intake and the later period of normal fluid intake. A longer term component of tritium excretion was also observed with average biological half-life of 74 +/- 18 d (range, 58-104 d), indicating the incorporation of tritium, and its retention, in the organic fractions of the body. A mathematical model was developed and used to estimate the dose increase from the metabolized organically bound tritium on the basis of the kinetics of tritium-in-urine. The model accounts for a change in the rates of urinary excretion caused by variable fluid intakes. The average dose to the body, for the eight male workers, due to the metabolized organically bound tritium was estimated to be 6.2 +/- 1.3% (range, 3.5% to 8.9%) of the committed effective dose due to tritium in the body water. This value for the dose increase from organically bound tritium is in the range of the current recommendations of the International Commission on Radiological Protection, i.e., organically bound tritium incorporated into the body contributes about 10% of the dose to the body water following tritiated water intakes.

An RNA polymerase III-defective mutation in TATA-binding protein disrupts its interaction with a transcription factor IIIB subunit in drosophila cells

A subunit of the Drosophila RNA polymerase III transcription factor IIIB (TFIIIB) complex has been identified using antibodies directed against the analogous human protein, hIIIB90. This protein has an apparent molecular mass of 105 kDa and has been designated dTAFIII105. Drosophila S-2 cell extracts that were immunodepleted of dTAFIII105 were substantially reduced in their capacity to support tRNA gene transcription. A protein (far Western) blot analysis revealed that dTAFIII105, present in a TFIIIB fraction, directly interacts with TATA-binding protein (TBP). Coimmunoprecipitation assays demonstrated that this protein associates with TBP in S-2 cell extracts. Our previous studies have identified a mutation at position 332 within Drosophila TBP that changes a highly conserved arginine residue to a histidine residue, which renders it specifically defective in its ability to support RNA polymerase III transcription in S-2 cells (Trivedi, A., Vilalta, A., Gopalan, S., and Johnson, D. L. (1996) Mol. Cell. Biol. 16, 6909-6916). We further demonstrate that extracts prepared from a stable cell line expressing epitope-tagged wild-type TBP exhibit an increase in tRNA gene transcription, whereas extracts derived from cells expressing the mutant TBP protein do not. Coimmunoprecipitation assays and far Western blot analysis demonstrate that this mutation in TBP abolishes its ability to stably interact with dTAFIII105. Thus, we have identified both a Drosophila protein that is directly associated with TBP in the TFIIIB complex, dTAFIII105, and an amino acid residue within the highly conserved carboxyl-terminal region of TBP that is critical for dTAFIII105-TBP interactions.

TATA-binding protein is limiting for both TATA-containing and TATA-lacking RNA polymerase III promoters in Drosophila cells

We have investigated the role of the TATA-binding protein (TBP) in modulating RNA polymerase (Pol) III gene activity. Epitope-tagged TBP (e-TBP) was both transiently and stably transfected in Drosophila Schneider S-2 cells to increase the total cellular level of TBP. Analysis of the transcripts synthesized from cotransfected tRNA and U6 RNA genes revealed that both types of RNA Pol III promoters were substantially stimulated by an increase in e-TBP in a dose-dependent manner. Furthermore, a TBP-dependent increase in the levels of endogenous tRNA transcripts was produced in the stable line induced to express the e-TBP. We further determined whether the ability of increased TBP to induce RNA Pol III gene expression was due to a direct effect of increased TBP complexes on RNA Pol III gene promoters or an indirect consequence of enhanced expression of RNA Pol II genes. A TBP expression plasmid (e-TBP332), containing a mutation within the highly conserved carboxy-terminal domain, was both transiently and stably transfected into S-2 cells. e-TBP332 augmented the transcription from two RNA Pol II gene promoters indistinguishably from that observed when e-TBP was expressed. In contrast, e-TBP332 was completely defective in its ability to stimulate either the tRNA or U6 RNA gene promoters. In addition, increasing levels of a truncated TBP protein containing only the carboxy-terminal region failed to induce either the tRNA or U6 RNA gene promoter, whereas it retained its ability to stimulate an RNA Pol II promoter. Thus, the TBP-dependent increase in RNA Pol II gene activity is not sufficient for enhanced RNA Pol III gene transcription; rather, a direct effect on RNA Pol III promoters is required. Furthermore, these results provide the first direct evidence that the amino-terminal region of TBP is important for the formation or function of TBP-containing complexes utilized by TATA-less and TATA-containing RNA Pol III promoters. Together, these studies demonstrate that TBP is limiting for the expression of both classes of RNA Pol III promoters in Drosophila cells and implicate an important role for TBP in regulating RNA Pol III gene expression.

Proximal jejunal obstruction due to eosinophilic gastroenteritis

Eosinophilic enteritis or gastroenteritis is a rare disease characterised by tissue eosinophilia which can affect different layers of bowel wall. It can affect any area of gastrointestinal tract from the esophagus to the rectum, although stomach and small intestine are sites most frequently reported. It is important to recognize this disease early and institute the necessary treatment. An eight year old girl presented with acute intestinal obstruction. Exploration revealed a structure of proximal jejunum. Histopathology demonstrated eosinophilic jejunitis. The case is reported owing to this rarity and relevant literature is reviewed.

GRIP1, a novel mouse protein that serves as a transcriptional coactivator in yeast for the hormone binding domains of steroid receptors

The yeast two-hybrid system was used to isolate a clone from a 17-day-old mouse embryo cDNA library that codes for a novel 812-aa long protein fragment, glucocorticoid receptor-interacting protein 1 (GRIP1), that can interact with the hormone binding domain (HBD) of the glucocorticoid receptor. In the yeast two-hybrid system and in vitro, GRIP1 interacted with the HBDs of the glucocorticoid, estrogen, and androgen receptors in a hormone-regulated manner. When fused to the DNA binding domain of a heterologous protein, the GRIP1 fragment activated a reporter gene containing a suitable enhancer site in yeast cells and in mammalian cells, indicating that GRIP1 contains a transcriptional activation domain. Overexpression of the GRIP1 fragment in mammalian cells interfered with hormone-regulated expression of mouse mammary tumor virus-chloramphenicol acetyltransferase gene and constitutive expression of cytomegalovirus-beta-galactosidase reporter gene, but not constitutive expression from a tRNA gene promoter. This selective squelching activity suggests that GRIM can interact with an essential component of the RNA polymerase II transcription machinery. Finally, while a steroid receptor HBD fused with a GAL4 DNA binding domain did not, by itself, activate transcription of a reporter gene in yeast, coexpression of this fusion protein with GRIP1 strongly activated the reporter gene. Thus, in yeast, GRIP1 can serve as a coactivator, potentiating the transactivation functions in steroid receptor HBDs, possibly by acting as a bridge between HBDs of the receptors and the basal transcription machinery.

Occupational levels of radiation exposure induce surface expression of interleukin-2 receptors in stimulated human peripheral blood lymphocytes

Interleukin-2 (IL-2) is a cytokine responsible for a variety of immune and non-immune stimulatory and regulatory functions, including the activation and stimulation of cytotoxic cells able to recognize and kill human tumour cells and T-cell proliferation and differentiation. We show that low doses of radiation, in the range commonly received by atomic radiation workers or as a result of minor medical diagnostic procedures (0.25 to 10 mGy), stimulate the expression of IL-2 receptors (IL-2R) on the surface of peripheral blood lymphocytes (PBL) taken from normal human donors. This stimulated surface expression after in vitro irradiation is an indirect effect, resulting from the secretion into the medium of a soluble factor from the irradiated cells. This factor can also stimulate IL-2R surface expression in unirradiated cells. Consequently, radiation stimulation of IL-2R expression in a large population of PBL shows a triggered-type response rather than being proportional to dose. These results demonstrate that normal human cells can respond to doses of radiation in the range of common occupational or medical exposures. The data also demonstrate a possible defence mechanism against environmental stress by which a radiation-exposed cell can use an indirect signalling mechanism to communicate with and influence the biological processes in an unexposed cell.

Inhibitory effects of naltrexone on the induction of parental behavior in juvenile rats

Juvenile rats are rapidly responsive to pups soon after weaning, displaying maternal-like behaviors such as licking, retrieving, grouping, and crouching over pups. As juveniles reach 30 days of age, they become less responsive to pups and show increased latencies to display the same parental behaviors. In light of previous data implicating opiates in the display of ongoing maternal behavior, we administered naltrexone, a long-acting opiate antagonist, beginning 5 and 9 days prior to and continuing throughout the period of behavioral testing, which started at 26 or 30 days of age. Male and female juveniles treated with 10 mg/kg of naltrexone SC for 9 days (days 21 to 29 of age) prior to and during behavioral testing (days 30 to 37) showed longer latencies to retrieve, group, and crouch over pups than did the vehicle-injected controls. These results suggest that opioids may have a stimulatory role in parental behavior during this prepubertal period.

School-based screening for tuberculous infection. A cost-benefit analysis

OBJECTIVE

To compare tuberculin screening of all kindergartners and high school entrants (screen-all strategy) vs screening limited to high-risk children (targeted screening).

DESIGN

Decision, cost-effectiveness, and cost-benefit analyses.

SETTING AND SUBJECTS

Students in a large urban and rural county.

DEFINITIONS

High risk of tuberculosis infection was defined as birth in a county with a high prevalence of tuberculosis. Low risk was defined as birth in the United States.

OUTCOME MEASURES

Tuberculosis cases prevented for 10, 000 children screened. Net costs, net cost per case prevented, benefit-cost ratio, and incremental cost-effectiveness.

RESULTS

The screen-all strategy would prevent 14.9 cases per 10,000 children screened; targeted screening would prevent 84.9 cases per 10,000 children screened. The screen-all strategy is more costly than no screening; the benefit-cost ratio is 0.58. Targeted screening would result in a net savings; the benefit-cost ratio is 1.2. Screening all children is cost saving only if the reactor rate is 20% or greater. The cost per additional case prevented for screening all children compared with targeted screening (+34 666) is more than twice as high as treatment and contact tracing for a case of tuberculosis (+16 392).

CONCLUSIONS

Targeted screening of schoolchildren is much less costly than mass screening and is more efficient in prevention of tuberculosis.

Percutaneous absorption of tritium-gas-contaminated pump oil

One of the radiological problems encountered in tritium handling facilities is the hazards associated with tritium's ability to label and degrade organic materials. Experiments in which male hairless rats have been contaminated with tritium-gas-contaminated pump oil have demonstrated that tritium deposited on the skin provides an input of organically bound tritium and tritiated water in the body. The accumulation of organically bound tritium at the point of contact in the skin and in various tissues influenced tritium excretion in urine and feces. The retention of tritium in the body showed that tritium was mainly metabolized and assimilated as organically bound tritium. The distribution of tritiated water was rapid and uniform in the whole-body. Analyses of tritium excreted in animal urine and feces showed that a significant level of organically bound tritium was excreted shortly after exposure. The highest concentration of tritium activity was measured in the exposed area of the skin. An increased level of tritium accumulation in the liver and kidneys was seen. Dose calculations showed that the exposed skin had the highest dose, and the skin dose was primarily due to the retention of organically bound tritium at the point of contact. The interpretation of these data has indicated that the retention of short-term organically bound tritium in the skin may be a dominant factor for dosimetry purposes.

Clinical profile and management of post infarction left ventricular pseudoaneurysm

Three patients with left ventricular pseudoaneurysm are presented. Two patients had inferior and one had an anterolateral wall Q wave myocardial infarction. Echocardiography with Doppler colour imaging provided the diagnosis in one case, whereas the correct diagnosis was possible on left ventriculography in all. Successful surgery using patch closure of the defect in all patients and bypass grafting of the diseased coronary vessels was done in 2 cases. Angiographic follow-up in one case revealed excellent result and during 18 to 30 months of clinical follow-up, all patients are asymptomatic.

In vitro replication of plasmids containing human c-myc DNA

A chromosomal replication initiation zone was previously mapped in cell cultures to the 5' flanking DNA of the human c-myc gene. We have used an in vitro system to examine the replication of a plasmid, pNeo.Myc-2.4, containing 2.4 kb of the c-myc initiation zone. In vitro, pNeo.Myc-2.4 generated high levels of DpnI-resistant DNA above background incorporation into control plasmids. pNeo.Myc-2.4 replicated semiconservatively to produce supercoiled and relaxed plasmid monomers, and replicative intermediates. [32P]dCMP incorporated into pNeo.Myc-2.4 appeared in Okazaki fragments and low molecular weight strands which matured to full length plasmid DNA, whereas [32P]dCMP incorporated into control plasmids appeared as continuous smears on denaturing gels. Other assays also distinguished the processive replication of pNeo.Myc-2.4 from the dispersive labeling of control plasmids. A pNeo.Myc-2.4 replication time course showed a clear preference for initiation within a restriction fragment containing the c-myc DNA. Two-dimensional electrophoresis revealed that a restriction fragment bearing the c-myc origin zone generated an arc characteristic of replicative intermediates containing a central replication bubble, while vector fragments in the plasmid generated arcs of forked intermediates. Replication bubbles visualized by electron microscopy were centered within the replication initiation zone, approximately 1.4 kb upstream of c-myc promoter P1. Okazaki fragments radiolabeled during in vitro replication showed a switch in the asymmetry of template preference within the initiation zone identified by electron microscopy, two-dimensional electrophoresis and early labeling. These data show that bidirectional, semiconservative replication can originate preferentially in vitro in the 5' flanking DNA of the c-myc gene, and that replicative intermediates present at low levels can be distinguished from molecules generated by competing, repair-type processes.

Coronary artery reoperations using arterial conduits: immediate and early results

This study deals with results of coronary artery reoperations in 21 males aged 54.4 +/- 6.6 years. Native vessel coronary disease at first and second operation was nearly the same (2.7 +/- 0.6 vs 2.8 +/- 0.4 vessel, p = NS). Graft attrition and deterioration in left ventricular ejection fraction (55.9 +/- 9.2 initial vs 36 +/- 15 at reoperation, p < 0.001) necessitated reoperation in majority. Recurrence of angina (71%) and left ventricular failure (23.8%) were the clinical indicators for reoperation. Procedure was successful in 20 (95%) and had to be abandoned in 1 due to severe pericardial and sternal adhesions. Arterial grafts were utilised in 90% (18 cases, Group A and B). Total arterial revascularisation (Group A) was done in 9 (45%) using Y graft 6, combination of both mammary arteries 2, and by both mammary and inferior epigastric artery in 1. Group B patients had arterial grafts (bilateral IMA 1, Y graft 1, bilateral IMA + gastroepipolic 1, RIMA 4, and LIMA 2) in addition to a venous graft. Two patients (group C, 10%) had only venous grafts. There was no in hospital mortality or morbidity and at 10 +/- 5.2 months follow up, all are asymptomatic with negative stress test at 3 months followup in 8 cases. We conclude that coronary artery reoperations using arterial conduits can be performed safely with excellent immediate and early results.

Alteration in pulmonary mechanics after coronary artery bypass surgery: comparison using internal mammary artery and saphenous vein grafts

Pulmonary function tests, arterial blood gas tensions and morbidity were compared in 50 patients undergoing coronary artery bypass graft surgery. Thirty patients had bilateral internal mammary grafts (Group 1), 5 patients had only saphenous vein grafts (Group 2) and 15 patients had a single arterial graft in addition to vein grafts (Group 3). Pleural effusion and wound infection were more common in patients with internal mammary artery grafts (p < 0.05). Patients in Group 2 required prolonged ventilation but this could be related to their underlying left ventricular dysfunction. Patients in all the three groups developed a severe restrictive ventilatory defect in the postoperative period and the degree of impairment was maximum in Group 1 patients (p < 0.01). These patients also had evidence of small airway obstruction. Thus an overall decrease in pulmonary function occurs in the postoperative period by 30 to 40% (p < 0.001). The derangement is greater in patients with arterial grafts, as a result of impaired blood supply, increase in pleural drains and additional surgical trauma secondary to mobilization of internal mammary arteries leading to delayed recovery. The awareness of these findings can be of great value in postoperative management of these patients. In addition, these observations should also be kept in mind while planning the choice of grafts in a patient undergoing coronary artery bypass graft surgery.

Iron-deficiency anaemia and physical performance in adolescent girls from different ethnic backgrounds

One hundred and fourteen 11-14-year-old schoolgirls from Wembley, Middlesex, were assessed for Fe status (haemoglobin (Hb), packed cell volume and mean corpuscular Hb concentration, height, weight, eating habits, and ethnic origin, and undertook a step test to assess physical performance. Overall, 20% of girls had Hb less than 120 g/l, ranging from 11% in White girls to 22-25% in girls of Asian origin. Prevalence of low Hb was 20% in vegetarians, higher in White vegetarians compared with non-vegetarians (23 v. 4%), but lower in the Indian vegetarians compared with non-vegetarians (17 v. 32%). Low Hb was present in 25% of girls who had tried to lose weight in the previous year, and was more common in girls from manual social class backgrounds than non-manual (24 v. 10%). At the start of the step test the twenty-three girls with low Hb had heart rates similar to those with normal Hb, but heart rates in the low Hb group were significantly elevated immediately after the step test, and still significantly elevated 1 min later. The present results confirm the findings of a previous study in White girls, and suggest that physical performance may be compromised at mild levels of anaemia.

Biological and biophysical techniques to assess radiation exposure: a perspective

Biological dosimeters measure biologically relevant effects of radiation exposure that are in some sense an estimate of effective dose, whereas biophysical indicators serve as surrogates of absorbed dose in a manner analogous to conventional thermoluminescent dosimeters (TLD). The biological and biophysical dosimeters have the potential to play an important role in assessing unanticipated or occupational radiation exposures. For example, where the exposure is large and uncertain (i.e. radiation accidents), accurate dose information can help in deciding the most appropriate therapy and medical treatment. Another useful area is that of lifetime accumulated dose determination, and the ability to distinguish between and integrate the exposures from natural and anthropogenic (medical X-rays, indoor radon, natural background radiation, occupational and non-occupational exposures). Also, the possibility to monitor individual response and differences in inherent or induced radiation sensitivity may have important implications for radiation protection. More commonly, this type of dosimetry could be used for routine monitoring to detect and quantify unsuspected exposure, for regulatory purposes or for epidemiological studies of the long-term effects of radiation exposure (e.g. in Japanese A-bomb survivors or in the population surrounding Chernobyl). This review is a comparative study of the existing techniques and their future prospects. It summarizes the sensitivity, reproducibility, limiting dose, dose-rate, energy, LET response, sources of variability and uncertainty, and other practical aspects of each bio-indicator. The strengths and weaknesses of each approach are evaluated on the basis of common criteria for particular applications, and are summarized for each assay both in the text and in tabular form, for convenience. It is clear that no single indicator qualifies to reliably measure occupational exposures at the current levels of sensitivity conventional dosimetry services provide. Most of the bio-techniques are applicable to the detection of relatively high radiation exposures at relatively short times after exposure. Some of the bio-indicators have been identified that are, or offer future prospects for becoming, appropriate bio-indicators for dosimetry needs. However, all methods are subject to biological and other variables that are presently uncontrolled, and represent a major source of uncertainty. These include variations in background signals not directly associated with radiation exposure, inter- and intra-individual variability of radiation response, and genetic and environmental effects. Although these factors contribute to the lack of confidence in biological dosimetry, promising bio-indicators may be applied to large populations to establish the inherent variability and confounding factors that limit quantitative data collection and analysis, and reduce reliability and reproducibility.

Skin-contact exposure to tritium-gas-contaminated stainless-steel surfaces

One of the radiation protection problems potentially encountered in tritium-handling facilities is contamination of metal surfaces. Experiments with hairless rats have demonstrated that when intact skin is brought into contact with tritium-gas-contaminated stainless-steel surfaces, tritium can be fixed as organically bound tritium (OBT) and as tritiated oxide (HTO) in the skin. The radiological hazard associated with this route of tritium uptake is determined by the retention and distribution of tritium in the skin and other organs. The experimental data suggest that the OBT in the skin serves as an input source to the rest of the body. The urinary excretion of tritium shows a biphasic excretion for OBT and a single-phase clearance for HTO from the body. The results indicate that the exposure from this mode of contamination results in long retention of tritium in the skin as well as in non-uniform distribution of tritium in organs and macromolecules. This information is useful in evaluating the possible dosimetric concerns from this mode of exposure.

Use of sugars and hair for ESR emergency dosimetry

ESR spectrometry of sugars and biological samples is being evaluated for emergency personnel dosimetry. Sugars are near tissue-equivalent, universally available in pure form and produce a simple, reproducible, low background signal. Of the sugars tested, sucrose and dextrose are the most sensitive and the ESR signals are proportional to X- or gamma-ray doses over the range of 0.5-10 Gy. There is little dependence on radiation energy or dose-rate, and the ESR signals remain stable for long periods post-irradiation. Human hair samples show considerable variability and signal complexity creating difficulties in dose assessment.

Chronic exposure to ionizing radiation as a tumor promoter in mouse skin

We have tested chronic exposure to 90Y beta radiation for its action as a complete tumor promoter, a stage I tumor promoter, or a stage II tumor promoter in SENCAR mouse skin. In skin initiated with a single application of 7,12,dimethylbenz[a]anthracene (DMBA, 10 nmol), chronic exposure to beta radiation as a complete promoter (0.5 Gy, twice/week, 13 weeks) produced no tumors and, when added to a complete chemical promoter (TPA), reduced tumor frequency about 30%. A similar result was observed when beta radiation was tested as a stage II promoter. DMBA-initiated mice that received chemical (12-O-tetradecanoylphorbol-13-acetate, TPA) stage I promotion followed by 13 weeks of beta-radiation exposure (0.5 Gy, twice/week) as stage II promotion produced essentially no tumors, and combining the same chronic beta-radiation exposure with chemical (mezerein) stage II promotion reduced tumor frequency about 20% when compared to a similar group that was not irradiated. Chronic beta-radiation exposure was tested two ways as a stage I tumor promoter in initiated skin that was subsequently treated with mezerein as a stage II promoter. Stage I promotion was shown to proceed with the passage of time, indicating this process occurs naturally in the absence of chemical or physical stimulation. Hyperthermia, previously shown to be a potent inhibitor of chemically stimulated stage I promotion, had no effect on the natural process, indicating at least some differences in mechanism between the two processes. The natural process was, in fact, inhibited by chemical tumor promoters, but not by radiation. In addition to the increase resulting from this natural process, tumor frequency was further increased slightly but significantly (12-15%, P less than or equal to 0.05) when chronic radiation exposure was given as a stage I promoter (0.5 Gy, twice/week, 13 weeks) subsequent to initiation, in spite of the expected 20% reduction resulting from this dose. Exposure of initiated animals to radiation (0.5 or 1.0 Gy, twice/week, 2 weeks) in addition to TPA as stage I promotion produced a similar increase in tumor frequency (P less than 0.02). At higher radiation doses, however, tumor frequency was reduced compared to unirradiated controls. In a third test as a stage I promoter, beta radiation (0.5 Gy twice/week, 4 weeks) was given prior to initiation with N-methyl-N'-nitro-N-nitrosoguanidine in animals subsequently promoted by TPA (twice/week, 13 weeks), and again the radiation slightly but significantly (P less than 0.03) increased tumor frequency compared to the unirradiated control group.(ABSTRACT TRUNCATED AT 400 WORDS)

Hemostatic technique for internal mammary artery anastomotic bleeding

When internal mammary artery is used for myocardial revascularization, a not uncommon occurrence is intraoperative bleeding from the internal mammary artery to coronary artery anastomosis. The conventional method of hemostasis of placing additional sutures across the suture line may produce anastomotic stenosis or may aggravate the bleeding by producing tears, especially as these additional sutures are placed on a beating heart. We describe a simple technique by which hemostasis can be achieved without the risk of anastomotic stenosis or aggravation of the bleeding, as it avoids placing sutures over the anastomotic suture line.

The involvement of topoisomerases and DNA polymerase I in the mechanism of induced thermal and radiation resistance in yeast

Either an ionizing radiation exposure or a heat shock is capable of inducing both thermal tolerance and radiation resistance in yeast. Yeast mutants, deficient in topoisomerase I, in topoisomerase II, or in DNA polymerase I, were used to investigate the mechanism of these inducible resistances. The absence of either or both topoisomerase activities did not prevent induction of either heat or radiation resistance. However, if both topoisomerase I and II activities were absent, the sensitivity of yeast to become thermally tolerant (in response to a heat stress) was markedly increased. The absence of only topoisomerase I activity (top1) resulted in the constitutive expression of increased radiation resistance equivalent to that induced by a heat shock in wild-type cells, and the topoisomerase I-deficient cells were not further inducible by heat. This heat-inducible component of radiation resistance (or its equivalent constitutive expression in top1 cells) was, in turn, only a portion of the full response inducible by radiation. The absence of polymerase I activity had no detectable effect on either response. Our results indicate that the actual systems that confer resistance to heat or radiation are independent of either topoisomerase activity or DNA polymerase function, but suggest that topoisomerases may have a regulatory role during the signaling of these mechanisms. The results of our experiments imply that maintenance of correct DNA topology prevents induction of the heat-shock response, and that heat-shock induction of a component of the full radiation resistance in yeast may be the consequence of topoisomerase I inactivation.