Abstract P5-14-14: Benefit of Metallic Marker for Tumor Localization in Breast Cancer Patients Treated with Breast Conservative Surgery after Neoadjuvant Treatment. Comparative Study of Tumor Localization Markers

Background: One of the benefits of neoadjuvant chemotherapy (NAC) is its ability to convert patients ineligible for breast conservative treatment (BCT) to be candidates for this treatment. The key to surgical planning for BCT after NAC is tumor localization. Tumor marking prior to NAC can be performed using skin tattoo or metallic marker. The objective of this study is to compare both types of tumor localization and to assess which technique improve BCT in achieving a complete resection while preserving the cosmetic outcome in patients with breast cancer after NAC. Material and Methods: One hundred and forty nine patients with breast cancer treated with BCT after NAC between 1999 and 2009 were eligible for the study. The skin tattoo group (TG) included 118 patients. The size and position of the tumor mass was marked on the skin surface with a China ink tattoo. The metallic marker group (MG) included 31 patients. The metallic marker was implanted in the center of the tumor under mammogram, ultrasound or MRI guidance. Both markers were placed before starting NAC. After completion of NAC a multidisciplinary team evaluated the cases for BCT. Clinicopathological data, volume of tumor excised, volume of lumpectomy, and margins statuses were analyzed and comparisons made between patients in the TG and the MG. Results: Median age of the patients in the TG was 54 years (range, 36-84) and 55 years (range 34-82) in the MG. Clinical stage was similar between groups, patients in TG had 53,4 % stage IIA, 25,4 % stage IIB and 15,3 % stage IIIA and in the MG 29 % stage IIA, 32,3 % stage IIB, 25,8 % stage IIIA and 9,7 % stage IIIB.

Mean tumor volume was 15,9 cm3 in the TG and 28 cm3 in the MG (p=0,051). After NAC treatment, 63 patients (53%) in TG and 14 patients (45 %) in MG had a complete clinical response (P>0,5); partial clinical response was found in 53 patients (44 %) in TG and in 17 patients (54 %) in the MG (P>0,5).

Pathological response was complete in 33 patients (28%) in TG and in 10 patients (32 %) in MG (p=0,3); and partial in 72 patients (61 %) in TG and 20 patients (64 %) in MG (p=0,3).

Mean pathological tumor volume was not statistically significant between groups (5 cm3 in TG and 15 cm3 in MG). Lumpectomy volume was bigger in the TG (370 cm3 vs. 330 cm3, P<0,004). There were no statistically significant differences when comparing margin status and frequency of second surgeries for positive margins.

Discussion: Lumpectomy in patients with metallic marker in the tumor after NAC allows lower excision of breast tissue without compromising margins. Having similar pathologic complete and partial response between groups, skin tattoo in patients with BCT after NAC leads to excise larger volume of tissue adding no benefits to the surgery. With the increasing pathologic complete responses with neoadjuvant treatments, patients who are candidates for BCT after NAC will benefit from marking the tumor with metallic markers prior to NAC.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-14-14.

Drought-mortality relationships for tropical forests

*The rich ecology of tropical forests is intimately tied to their moisture status. Multi-site syntheses can provide a macro-scale view of these linkages and their susceptibility to changing climates. Here, we report pan-tropical and regional-scale analyses of tree vulnerability to drought. *We assembled available data on tropical forest tree stem mortality before, during, and after recent drought events, from 119 monitoring plots in 10 countries concentrated in Amazonia and Borneo. *In most sites, larger trees are disproportionately at risk. At least within Amazonia, low wood density trees are also at greater risk of drought-associated mortality, independent of size. For comparable drought intensities, trees in Borneo are more vulnerable than trees in the Amazon. There is some evidence for lagged impacts of drought, with mortality rates remaining elevated 2 yr after the meteorological event is over. *These findings indicate that repeated droughts would shift the functional composition of tropical forests toward smaller, denser-wooded trees. At very high drought intensities, the linear relationship between tree mortality and moisture stress apparently breaks down, suggesting the existence of moisture stress thresholds beyond which some tropical forests would suffer catastrophic tree mortality.

Regulation of serotonin transporter activity by adenosine in intestinal epithelial cells

Serotonin plays a critical role in the regulation of intestinal physiology. The serotonin transporter (SERT) expressed in the intestinal epithelium determines 5-HT availability and activity. The serotoninergic system and SERT activity have been described as being altered in chronic intestinal pathologies such as inflammatory diseases. Adenosine has also been shown to be involved in a variety of intestinal functions and to play a central role in the regulation of inflammatory responses of injured tissue. Since the modulation of SERT by adenosine in the intestine remains unknown, the aim of the present work was to study the effect of adenosine on SERT activity and expression and to determine the molecular mechanism involved. The study has been carried out using human enterocyte-like Caco-2 cells which endogenously express SERT. The results show that adenosine diminishes SERT activity in both the apical and basal membranes by acting in the intrinsic molecule with no alteration of either SERT mRNA or protein levels. The effect of adenosine appears to be mediated by A(2) receptors and activation of the cAMP/PKA signalling pathway. Moreover, the adenosine effect did not seem to involve the activation of AMP activated protein kinase. Adenosine effects are reached at high concentrations, which suggests that adenosine modulation of SERT may be significant under conditions of inflammation and tissue injury.

Drought sensitivity of the Amazon rainforest

Amazon forests are a key but poorly understood component of the global carbon cycle. If, as anticipated, they dry this century, they might accelerate climate change through carbon losses and changed surface energy balances. We used records from multiple long-term monitoring plots across Amazonia to assess forest responses to the intense 2005 drought, a possible analog of future events. Affected forest lost biomass, reversing a large long-term carbon sink, with the greatest impacts observed where the dry season was unusually intense. Relative to pre-2005 conditions, forest subjected to a 100-millimeter increase in water deficit lost 5.3 megagrams of aboveground biomass of carbon per hectare. The drought had a total biomass carbon impact of 1.2 to 1.6 petagrams (1.2 x 10(15) to 1.6 x 10(15) grams). Amazon forests therefore appear vulnerable to increasing moisture stress, with the potential for large carbon losses to exert feedback on climate change.

[Pulmonary alveolar proteinosis: report of two cases and review of the literature]

Pulmonary alveolar proteinosis is a rare disease characterized by extensive radiological and tomographic pulmonary lesions and a variable clinical picture ranging from pulmonary insufficiency to spontaneous remission. Among its three described forms, the so called Idiopathic or Adult form is responsible for more than 80% of published cases. It's physiopathology depends on an autoimmune process directed against the GM-CSF (Granulocite Macrophage- Colony Stimulating Factor) that induces a functional defect of the macrophage with consequent intraalveolar accumulation of surfactant. Pulmonary and extrapulmonary infections, are common, often with unusual pathogens. Diagnosis can be made from the combination of clinical, radiological and bronchoalveolar lavage data, although sometimes histopathologic material is needed for confirmation. Total pulmonary lavage is currently the treatment of choice. Mortality is usually low and related mostly to infectious complications. We hereby describe our experience with two patients.

Exchange and reduction of Cu2+ ions in clinoptilolite

The ion-exchange and reduction processes for Cu(2+) ions in clinoptilolite from the Caimanes deposit (Moa, Cuba) were studied at different temperatures. The ion-exchange studies were done to determine the kinetic parameters of Cu(2+) removal from solution by this clinoptilolite modified previously to NH(+)(4) form, and thermodynamic parameters of Cu(2+) elution from zeolite using NH(4)Cl solution. The results show that temperature increase favors the exchange and that it is a reversible process. The external diffusion rate appreciably increases with temperature, while, the internal diffusion coefficient rises relatively little. This means that besides ion exchange other processes (such as precipitation of the low-solubility phase and/or salt adsorption) occur, which cause copper removal from solution and affect the intracrystalline diffusion of the ions. For steric reasons the exchange of [Cu(H(2)O)(6)](2+) ions from a solution must occur with a number of water molecules n smaller than 6 (6 > n > or = 0). Cu(2+) reduction by hydrogen and the formation of Cu-particles in the clinoptilolite were verified. The Cu(2+) reduction mechanism is complex, indirect, and sensitive to reduction temperature; consequently, Cu(+)(n) states intermediate between Cu(2+) and Cu(0) should be present in the reduced samples.

Chaos suppression through asymmetric coupling

We study pairs of identical coupled chaotic oscillators. In particular, we have used Roessler (in the funnel and no funnel regimes), Lorenz, and four-dimensional chaotic Lotka-Volterra models. In all four of these cases, a pair of identical oscillators is asymmetrically coupled. The main result of the numerical simulations is that in all cases, specific values of coupling strength and asymmetry exist that render the two oscillators periodic and synchronized. The values of the coupling strength for which this phenomenon occurs is well below the previously known value for complete synchronization. We have found that this behavior exists for all the chaotic oscillators that we have used in the analysis. We postulate that this behavior is presumably generic to all chaotic oscillators. In order to complete the study, we have tested the robustness of this phenomenon of chaos suppression versus the addition of some Gaussian noise. We found that chaos suppression is robust for the addition of finite noise level. Finally, we propose some extension to this research.

Epidemiology of transfusion-transmitted infections among multi-transfused patients in seven hospitals in Peru

BACKGROUND

Transfusion-transmitted infections (TTIs) constitute a major health problem worldwide where routine screening of blood or blood products is improperly done, and where non-medical injecting medications and/or drug use are prevalent. Prevalence and risk factors vary by geographic location and by the specific TTI (including HIV-1, HBV, HCV and HTLV-I).

OBJECTIVE

To determine the prevalence and risk factors associated with TTIs among a sample of multi-transfused adult patients in Peru.

STUDY DESIGN

A cross-sectional multi-center study was conducted across seven major hospitals in Peru from February 2003 to September 2004. Self-reported behavior information (medical procedures, number of sexual partners, and drug use history) was analyzed, along with a review of exposure history from hospital medical records. Prevalences were calculated by TTI for different exposures, along with unadjusted and adjusted odds ratios for infection risk.

RESULTS

Overall, 192 (54.7%) of 351 multi-transfused patients were found infected with one or more TTIs. Number of transfusion units, years of transfusion history (6 or more), and number of treatment facilities (2 or more) were associated with HCV infection. Hemodialysis history was a common risk factor associated with HBV, HCV and HTLV-I infection. HIV infection was associated only with total number of transfusion units received.

CONCLUSIONS

High prevalences of HBV and HCV infection were found among Peruvian multi-transfused patients and were associated with a past history and number of blood transfusions, as well as with past hemodialysis procedures. TTIs continue to represent a significant public health problem in Peru. Continued vigilant attention to blood safety procedures, including universal screening and health care provider education, is recommended.

Isolation, Tissue Distribution, and Molecular Characterization of Toxoplasma gondii From Free-Range Chickens From Guatemala

The prevalence of Toxoplasma gondii in free-ranging chickens is a good indicator of the prevalence of T. gondii oocysts in the soil because chickens feed from the ground. The prevalence of T. gondii in 50 free-range chickens (Gallus domesticus) from Guatemala was determined. Antibodies to T. gondii were assayed by the modified agglutination test (MAT). Antibodies were found in 37 (74%) chickens with titers of 1:5 (11), 1:10 (7), 1:20 (11), 1:40 (1), 1:80 (1), 1:160 (3), 1:1,280 (2), and 1:2,560 (1). Hearts, pectoral muscles, and brains of 19 chickens with MAT titers of 1:20 or more were bioassayed individually in mice. Tissues from the remaining 31 chickens with titers of 1:10 or lower were pooled and fed to 4 T. gondii-free cats (13 chickens with titers of less than 1:5 to 1 cat, 11 chickens with titers of 1:5 to 2 cats, and 7 chickens with titers of 1:10 to 1 cat). Feces of cats were examined for oocysts; they did not shed oocysts. Toxoplasma gondii was isolated from 8 chickens with MAT titers of 1:20 or more (from 1 of 11 chickens with a titer of 1:20 and all 7 chickens with a titer of 1:80 or more) from the heart, brain, and pectoral muscle (3); heart and pectoral muscle (1); and heart alone (4). Genotyping of these 8 isolates with the SAG2 locus indicated that 5 were type III and 3 were type 1. This is the first report of isolation of T. gondii from chickens from Guatemala.

Defect-enhanced anomaly in frequency synchronization of asymmetrically coupled spatially extended systems

We analytically establish and numerically show that anomalous frequency synchronization occurs in a pair of asymmetrically coupled chaotic space extended oscillators. The transition to anomalous behaviors is crucially dependent on asymmetries in the coupling configuration, while the presence of phase defects has the effect of enhancing the anomaly in frequency synchronization with respect to the case of merely time chaotic oscillators.

The condition for pseudo-first-order kinetics in enzymatic reactions is independent of the initial enzyme concentration

The linearization of the Michaelis-Menten reaction by pseudo-first-order kinetics is revised. A phase-plane analysis allows the derivation of a new condition for its validity that is directly linked to the reaction efficiency, and contrary to widely established knowledge, is independent of the initial enzyme concentration.

Synchronization of spatially extended chaotic systems in the presence of asymmetric coupling

In a recent paper [Phys. Rev. Lett. 91, 064103 (2003)]] we described the effects of asymmetric coupling configurations on the synchronization of spatially extended systems. In this paper, we report the consequences induced by the presence of asymmetries in the coupling scheme on the synchronization process of a pair of one-dimensional fields obeying complex Ginzburg-Landau equations. While synchronization always occurs for large enough coupling strengths, asymmetries have the effect of enhancing synchronization and play a crucial role in setting the threshold for the appearance of the synchronized dynamics, as well as in selecting the statistical and dynamical properties of the synchronized motion. We analyze the process of synchronization in the presence of asymmetries when the dynamics is affected by the presence of phase singularities, and show that defects tend to anchor one system to the other. In addition, asymmetry controls the number of synchronized defects that are present in the dynamics. Possible consequences of such asymmetry induced effects in biological and natural systems are discussed.

Convective instabilities of synchronization manifolds in spatially extended systems

We study the stability properties of anticipating synchronization in an open chain of unidirectionally coupled identical chaotic oscillators. Despite being absolutely stable, the synchronization manifold is unstable to propagating perturbations. We analyze and characterize such instabilities drawing a qualitative and quantitative comparison with the convective instabilities typical of spatially extended systems.

Fertilizable oocytes reconstructed from patient's somatic cell nuclei and donor ooplasts

The only assisted reproduction treatment now available for women with ovarian failure or irreparable oocyte defects is oocyte donation. However, some women experience psychological barriers to the recourse to donor oocytes, related to the lack of contribution of their proper genes to the progeny. A pilot study in humans suggests that this problem may be overcome by the development of techniques for haploidization of somatic cell nuclei, allowing the formation of new oocytes bearing the complete nuclear genome of the patient. Somatic cell nuclei were obtained from cumulus cells of a patient who failed to produce fertilizable oocytes and were transferred into enucleated oocytes (ooplasts) from a donor. Out of six ooplasts injected with the somatic cell nuclei and fertilized with spermatozoa from the patient's husband, signs of haploidization were detected in three oocytes, two of which subsequently started embryonic development and were cryopreserved for eventual future transfer to the genetic mother. These data show that human oocytes can be used for both reprogramming and haploidization of somatic cell nuclei, allowing reconstruction of genetically own oocytes for patients without, or with seriously disturbed, ovarian function.

16K prolactin induces NF-kappaB activation in pulmonary fibroblasts

The amino-terminal 16 kDa fragment of prolactin (16K PRL) promotes the expression of the inducible isoform of nitric oxide synthase (iNOS) accompanied by the production of nitric oxide (NO) by rat pulmonary fibroblasts. The present study was designed to elucidate whether the mechanism by which 16K PRL promotes iNOS expression involves the activation of nuclear factor-kappa B (NF-kappaB), a key transcription factor for iNOS induction. 16K PRL stimulated DNA-binding activity of NF-kappaB in pulmonary fibroblasts as demonstrated by gel shift assays. Likewise, fluorescence immunocytochemistry showed that 16K PRL promotes nuclear translocation of the p65 subunit of NF-kappaB. Finally, treatment with 16K PRL induced the degradation of the NF-kappaB inhibitor kappaB-beta (IkappaB-beta), and such degradation was prevented by blocking IkappaB-beta phosphorylation. Altogether, these results show that 16K PRL activates NF-kappaB nuclear translocation via the phosphorylation and degradation of IkappaB-beta. These findings are consistent with NF-kappaB being part of the signal transduction pathway activated by 16K PRL to induce iNOS expression.

A fast method to estimate kinetic constants for enzyme inhibitors

We present a method to determine the reaction type and kinetic constants for enzyme inhibitors that decreases the number of experimental assays by at least a factor of five. It is based on a new theoretical formalism in terms of concentrations that dismisses the requirement of estimating initial velocities. Expressions for the time evolution of the concentrations of all the reactants are also given.

Assisted reproduction with in-vitro-cultured testicular spermatozoa in cases of severe germ cell apoptosis: a pilot study

BACKGROUND

Apoptosis-related cell damage is known to compromise success rates of assisted reproduction with ejaculated spermatozoa. This study was undertaken to determine whether the frequency of apoptosis-related cell damage and reproductive performance of testicular spermatozoa from men with non-obstructive azoospermia can be improved by in-vitro culture.

METHODS

Testicular tissue samples were cultured for 2 days in the presence of 50 IU/l FSH and 1 micromol/l testosterone. The frequency of spermatozoa showing DNA strand breakage and plasma membrane phosphatidylserine externalization was compared in before-culture and after-culture samples. The after-culture samples were used in assisted reproduction attempts.

RESULTS

In a group of 11 azoospermic patients with at least two previous intracytoplasmic sperm injection (ICSI) failures, the incidence of DNA strand breakage was high in living testicular spermatozoa from before-culture samples, but significantly lower in after-culture samples (96 versus 30%, P < 0.001). The same applied to the incidence of phosphatidylserine externalization in the motile sperm subpopulation from the before-culture and after-culture samples (83 versus 6%, P < 0.001). Seven ongoing clinical pregnancies (six with fresh embryos and one with cryopreserved embryos) were established.

CONCLUSIONS

Severe testicular sperm apoptosis may become a new indication for testicular tissue in-vitro culture before ICSI.

[Total and fecal coliforms, some enterobacteria staphylococcus sp. and moulds in salads for hot dogs sold in Maracay, Venezuela]

Fast food sold on the streets are good vehicle to transmit gastrointestinal diseases to consumers because they are highly manipulated. The vegetables are a good media for pathogens growth. Raw vegetables salads for hot dog sold in Maracay were studied. Total and fecal Coliforms and Staphylococcus sp. were quantified by the Most Probable Number Technique, Coliforms and Staphylococcus isolated were partially identified. Also the mould population was quantified and identified. Microbial growth was correlated with pH and acidity measurements. MPN/g of Total Coliforms was 1.44 x 10(5) and 4.57 x 10(4) for fecal Coliforms. E. coli was no detected. 87 isolated from the Coliforms were partially identified as Citrobacter freundii variety 1 (45.09% of the isolated), C. freundii variety II (21.57%), Enterobacter aerogenes variety I (17.65%) and E. aerogenes variety II (15.69%); Staphylococcus sp. 3.93 x 10(6) MPN/g and all of its isolated (52) were coagulase negative. The mould population was 4.5 x 10(4) ufc/g, Penicillium sp., Aspergillus, sp., Fusarium sp. were partially identified. The salads presented a pH of 5.92 and an acidity of 0.78 ml of NaOH.

Absorption of unlabeled reduced iron of small particle size from a commercial source. A method to predict absorption of unlabeled iron compounds in humans

The absorption of a commercial brand of small-particle reduced iron was evaluated in 10 normal subjects. For each subject, the hemoglobin incorporation method was used to measure the true absorption of 60 mg of iron from either ferrous sulfate or ferric ammonium citrate. The iron tolerance test (ITT) was also studied for these two compounds and for reduced iron. This procedure consisted of measuring the area under the curve of plasma iron elevations at specified times for 6 hours, or the peak plasma iron, corrected by the plasma iron disappearance rate obtained from measuring plasma iron at specified times for 4 hours after the slow intravenous injection of 0.4 mg of iron as ferric citrate. Only the ITT was used to measure the absorption of 60 mg of reduced iron. Reference dose iron ascorbate absorption was measured in each subject. The absorption of ferric ammonium citrate and reduced iron was expressed as percent of dose and also as absorption percent of that of ferrous sulfate. Mean % geometric "true absorptions" were 39.0 for reference dose, 10.4 for FeSO4 and 2.4 for ferric ammonium citrate. The later was 23% that of FeSO4. By ITT the mean geometric % absorptions were 7.9, 3.7 and 3.2 for FeSO4, ferric ammonium citrate and reduced iron respectively, or 47 and 41% of that of FeSO4. We propose that the true absorption of the commercial brand of reduced iron tested was 20% that of FeSO4 based on the relation between the ITT results of reduced iron and the ITT and true absorption values of ferric ammonium citrate in relation to FeSO4. The use of this method for measuring absorption of unlabeled iron compounds is discussed.

[Trans-surgical ablation of atrial flutter in patients treated with closure of atrial septal defect. Pilot project]

Atrial flutter is one of the most common arrhythmias in patients with atrial septal defect, after surgery 14% of patients can develop it and may be associated with high morbidity. In this study we performed prophylactic and therapeutic ablation of atrial flutter during atrial septal closure surgery drawing 4 lines; line 1, isthmus cavo-tricuspid, the area between the inferior vena cava and the tricuspid ring; line 2, the area between coronary sinus ostium and inferior vena cava; line 3, the area between tricuspid valve annulus and coronary sinus ostium; and line 4, the area between lateral atriotomy and atrial septal defect. Twenty-one patients were included, 6 (28.5%) patients had atrial flutter before surgery and 15 (71.4%) were in sinus rhythm. There were no new cases of atrial flutter, but at six months follow up 2 (33.3%) patients recidivated with atrial flutter. One patient developed high degree atrio-ventricular block and a pacemaker had to be implanted. Older age at the time of surgery and high systolic pulmonary pressure were significantly higher in those patients with atrial flutter before surgery and in patients with arrhythmias recurrence. Ablation of atrial flutter during atrial septal closure surgery can be a good option for the treatment and prevention of atrial arrhythmias, but more studies are still needed.

[Trends of etiology of acute bacterial meningitis in Chilean children from 1989 to 1998. Impact of the anti-H influenzae type b vaccine]

BACKGROUND

Acute bacterial meningitis still has a high mortality and rate of complications.

AIM

To assess the impact of anti H influenzae vaccination on the epidemiology of acute bacterial meningitis in Chilean children.

MATERIAL AND METHODS

A retrospective study of hospital discharge records of patients with acute bacterial meningitis. Causative agents were studied globally, by hospital and by age group. The changes in etiology from 1989 to 1995 were also assessed. Between 1996 and 1998, only those patients with acute bacterial meningitis caused by H influenzae were recollected.

RESULTS

In the period prior to vaccination (1989-1995), 1000 cases were registered. The main causative agents were N meningitidis in 33.8%, H influenzae type b in 21.9% and S pneumoniae in 15.4%. The incidence of H influenzae decreased in the period from 36.4 to 9.9% (p < 0.001) and the incidence of N meningitidis increased from 22.9 to 52.1% (p < 0.001). The incidence of S pneumoniae did not change significantly. H influenzae predominated in children between 4 and 24 months of age and N meningitidis predominated in children over 25 months of age. In the period after the introduction of vaccination (1995-1998), there was a further decrease in the incidence of H influenzae from 10 to 2% (p < 0.001). Until 1997, there was a considerable increase in the incidence of N meningitidis, specially in children over 25 months of age. It declined in 1998 to 38%.

CONCLUSIONS

There was a reduction in the incidence of acute bacterial meningitis caused by H influenzae prior to the introduction of the vaccine against H influenzae type b. The decrease was more pronounced after the introduction of the vaccine.

Age-related differences in the use of cardiac medications in patients with coronary artery disease

BACKGROUND

Benefits of aspirin and beta-blocker use in patients with coronary artery disease and angiotensin-converting enzyme (ACE) inhibitors in those with left ventricular systolic dysfunction are well documented in all age groups.

OBJECTIVE

To investigate whether aspirin, beta-blockers, and ACE inhibitors are equally used in geriatric (> or =65 years) versus younger (<65 years) patients with coronary artery disease.

SETTING

University-affiliated major academic hospital.

METHODS

Records of 402 patients with coronary artery disease were analyzed for use of aspirin, beta-blockers, and ACE inhibitors. One hundred thirty patients with contraindications to use of these agents were excluded.

RESULTS

Of 272 study patients, 85% were using aspirin and 71% beta-blockers. Among the patients with left ventricular systolic dysfunction, 79% were using ACE inhibitors. One hundred forty-seven patients were of geriatric age, whereas 125 were of younger age. No significant difference in the use of aspirin (82% versus 89%, P = 0.10), beta-blockers (71% versus 70%, P = 0.85), or ACE inhibitors (86% versus 69%, P = 0.13) was found between geriatric and younger patients. This lack of difference in use of cardiac medications between geriatric and younger patients persisted on gender-based subgroup analysis. On decade-of-age-based analysis, aspirin use was not equally distributed among all the decades of age (P < 0.005), but beta-blocker use was.

CONCLUSION

Results of this study demonstrate equal use of aspirin, beta-blockers, and ACE inhibitors in geriatric versus younger patients with coronary artery disease. Aspirin use was not equally distributed among all the decades of age.

A new sterigmatocystin-producing Emericella variant from agricultural desert soils

An unusual, sterigmatocystin-producing taxon with characteristics of both Emericella nidulans (anamorph Aspergillus nidulans) and Emericella rugulosa (anamorph Aspergillus rugulovalvus, formerly A. rugulosus) was isolated repeatedly during a mycofloral survey of desert cotton field soils where aflatoxin is a chronic problem. Members of this taxon had ascospores with smooth convex walls like E. nidulans but grew slowly like E. rugulosa; moreover, they were similar to an industrial echinocandin B-producing strain which had been classified as "Aspergillus nidulans var. roseus." These new desert isolates were compared with "A. nidulans var. roseus" and representative wild-type isolates of E. nidulans and E. rugulosa using traditional morphological characters, secondary metabolite profiles of mycelial extracts, and Southern blot analysis of genomic DNA. The desert isolates and "A. nidulans var. roseus shared morphological, physiological and molecular characters with E. rugulosa. These isolates constitute a new non-rugulose variant of E. rugulosa.

Absorption of iron from unmodified maize and genetically altered, low-phytate maize fortified with ferrous sulfate or sodium iron EDTA

BACKGROUND

Reducing the phytate content in grains by genetic manipulation is a novel approach to increasing nonheme-iron absorption from mixed diets. Fractional iron absorption from a genetically modified strain of low-phytate maize (LPM) increased significantly, by 50%.

OBJECTIVE

We assessed iron absorption from porridges prepared from the same LPM (lpa-1-1 mutant) and unmodified wild-type maize (WTM), both of which were fortified with either ferrous sulfate or sodium iron EDTA.

DESIGN

Porridges providing 3.4 mg Fe were fortified with either ferrous sulfate or sodium iron EDTA to provide an additional 1 mg Fe/serving. In 14 nonanemic women, iron absorption was measured as the amount of radioiron incorporated into red blood cells (extrinsic tag method) 12 d after consumption of the study diets.

RESULTS

No significant effect of phytate content on iron absorption was found when porridge was fortified with either sodium iron EDTA or ferrous sulfate. Fractional absorption of iron from WTM porridge fortified with sodium iron EDTA (5.73%) was 3.39 times greater than that from the same porridge fortified with ferrous sulfate (1.69%). Fractional absorption of iron from the sodium iron EDTA-fortified LPM porridge (5.40%) was 2.82 times greater than that from LPM porridge fortified with ferrous sulfate (1.91%) (P<0.0001 for both comparisons, repeated-measures analysis of variance). Thus, the previously identified benefit of LPM was no longer detectable when maize porridge was fortified with additional iron.

CONCLUSION

Iron was absorbed more efficiently when the fortificant was sodium iron EDTA rather than ferrous sulfate, regardless of the type of maize.

[Sudden death in intermittent Wolff Parkinson White syndrome]

Sudden death is a rare condition in asymptomatic patients with asymptomatic intermittent Wolff Parkinson syndrome (WPW); for this reason it is believed that these patients should not undergo to radiofrequency ablation. We report an asymptomatic 44 year old man who developed ventricular fibrillation with a pre-excited RR interval less than 200 msec during atrial fibrillation, as a first manifestation of WPW syndrome. The Holter monitoring showed intermittent pre-excitation at low heart rate (70 bpm). During the electrophysiological study a successfully radiofrequency catheter ablation of a right posteroseptal accessory pathway was performed. We concluded that intermittent pre-excitation may not be used to identify patients who are at risk of sudden death. Radiofrequency catheter ablation should be recommended in those patients with a very high success rate, and a low incidence of serious complications.

The activity (calcium oscillator?) responsible for human oocyte activation after injection with round spermatids is associated with spermatid nuclei

OBJECTIVE

To compare the oocyte-activating ability of whole human round spermatids and their isolated nuclei.

DESIGN

Prospective study using sibling oocytes from patients undergoing spermatid conception and intracytoplasmic sperm injection treatment cycles.

SETTING

Private assisted reproduction laboratories and a university department.

PATIENT(S)

Couples with male infertility.

INTERVENTION(S)

Sibling oocytes were injected either with whole round spermatids or with their isolated nuclei, followed by artificial triggering of oocyte activation with calcium ionophore. Other sibling oocytes were injected either with isolated spermatid cytoplasm or with whole mature spermatozoa.

MAIN OUTCOME MEASURE(S)

Numbers of activated oocytes and cleaving embryos.

RESULT(S)

After oocyte activation was boosted with calcium ionophore, whole spermatids and isolated spermatid nuclei were equally effective in supporting oocyte activation and the formation of pronuclei, whereas no control oocyte was activated under the same conditions after injection of isolated spermatid cytoplasmic compartments. Cleavage rates were lower after the injection of isolated spermatid nuclei than after the injection of whole spermatids.

CONCLUSION(S)

The factor responsible for human oocyte activation after round spermatid injection is associated with spermatid nuclei. The requirement for the artificial trigger (calcium ionophore) suggests that this factor is identical to the male gamete activity previously characterized as calcium oscillator.

Birth of healthy twins after fertilization with in vitro cultured spermatids from a patient with massive in vivo apoptosis of postmeiotic germ cells

OBJECTIVE

To examine whether the results of assisted reproduction with the use of elongated spermatids from a man with incomplete arrest of spermiogenesis and a high frequency of apoptosis among postmeiotic germ cells can be improved by germ cell in vitro culture.

DESIGN

Case report.

SETTING

Private assisted reproduction centers and a university department.

PATIENT(S)

Man with incomplete spermiogenesis failure.

INTERVENTION(S)

Testicular spermatid extraction, in vitro culture of testicular biopsy samples, intraoocyte injection of elongated spermatids, embryo culture, and transfer.

MAIN OUTCOME MEASURE(S)

Fertilization rate, embryo morphology, and pregnancy.

RESULT(S)

An assisted reproduction attempt with viability-selected elongated spermatids from a fresh testicular biopsy sample resulted in a poor fertilization result and embryo quality. Further analysis of the sample used in this attempt showed a high incidence of apoptosis among postmeiotic germ cells. A second attempt was then performed with in vitro culture of testicular cells for 24 hours before spermatid injection. This procedure led to a significant decrease in the frequency of apoptosis among viability-selected spermatids, to improvement of the fertilization rate and embryo quality, and to the birth of healthy twins.

CONCLUSION(S)

In vitro culture of testicular biopsy samples before assisted reproduction with elongated spermatids may improve the efficacy of treatment in cases of massive in vivo apoptosis of postmeiotic germ cells.

The effect of FSH on male germ cell survival and differentiation in vitro is mimicked by pentoxifylline but not insulin

High concentrations of FSH have been shown to boost in-vitro differentiation of germ cells from men with normal spermatogenesis and from some patients with in-vivo maturation arrest. This study shows that the differentiation-promoting effect of FSH is connected to protection against germ cell apoptosis and that both effects can be mimicked by the intracellular cyclic AMP (cAMP)-elevating drug pentoxifylline. On the other hand, a high concentration of insulin, supposed to act at the insulin-like growth factor I receptor, did not exert any effect either on differentiation or apoptosis of germ cells in vitro. These data show that the in-vitro effects of supraphysiological concentrations of FSH on human spermatogenesis are mediated by the classical FSH signal transduction pathway involving cAMP as a second messenger. Pentoxifylline may thus be useful as an alternative means for intracellular cAMP elevation in men with high circulating FSH concentrations leading to desensitization of the FSH receptor.

Immature germ cell conception-in vitro germ cell manipulation

Experimental studies in laboratory animals have shown that successful conception can be achieved by fertilizing oocytes with immature male germ cells. This gave rise to the concept that immature germ cells recovered from the testes of azoospermic men with maturation arrest may be used for assisted reproduction. However, in contrast to using germ cells recovered from healthy animals, clinical application to the treatment of male sterility is burdened by inherent defects in germ cells attributable to underlying testicular pathology. The recent introduction of in vitro germ cell culture/manipulation techniques makes it possible, in some cases, to overcome the in vivo maturation arrest by allowing an additional meiotic and post-meiotic differentiation and the selective harvesting of cells devoid of apoptosis-related nuclear and cytoplasmic damage. These techniques enabled the first births of normal infants fathered by azoospermic men with maturation arrest at the primary spermatocyte stage and improved the efficacy of assisted reproduction in men with maturation arrest at the round spermatid stage.

In-vitro maturation of immature human male germ cells

Both meiotic and postmeiotic maturation events have been observed to occur in human male germ cells during in-vitro culture. The temperature of 30 degrees C, medium supplementation with follicle-stimulating hormone and testosterone and the maintenance of the original cell-cell associations within explanted segments of the testicular seminiferous tubules are common features of the most efficient culture systems. The in-vitro maturation processes are markedly accelerated as compared to the in-vivo situation, probably due to the abrogation of a checkpoint controlling the full assembly of molecules needed for spermiogenesis. Moreover, both meiotic and postmeiotic maturation processes can be reactivated in vitro in some cases with a complete block of the same processes in vivo. Healthy babies were born after micromanipulation-assisted fertilization with in-vitro matured elongated spermatids from men with complete in-vivo maturation arrest at the round spermatid stage and at the primary spermatocyte stage.

In-vitro differentiation of germ cells from frozen testicular biopsy specimens

In some men with germ cell maturation arrest, spermatogenesis can be resumed during in-vitro culture of testicular biopsy samples. In this study, we examined whether similar differentiation events can be induced in cultured germ cells from cryopreserved testicular biopsy specimens. Fresh and cryopreserved aliquots of the same testicular biopsy samples were cultured in medium supplemented with FSH and testosterone. After 24 and 48 h of culture, the progression of spermatogenesis and the percentage of Sertoli cells with DNA damage, detected by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling (TUNEL), were evaluated. Spermatogenesis progressed in a similar way in fresh and cryopreserved aliquots over the first 24 h of culture. However, in contrast to fresh aliquots, no additional progress of spermatogenesis was detected between the 24 and 48 h time points. The percentage of TUNEL-positive Sertoli cells in fresh aliquots showed only a moderate increase after 24 h of culture, whereas most Sertoli cells from cryopreserved aliquots became TUNEL-positive during the same culture period. These data show that limited progression of spermatogenesis can be achieved by culturing cryopreserved testicular biopsy specimens for 24 h, but no additional benefit can be expected from prolonging the culture beyond this time point.

In-vitro spermatogenesis resumption in men with maturation arrest: relationship with in-vivo blocking stage and serum FSH

We have shown previously that germ cells recovered from some men with maturation arrest can resume spermatogenesis in vitro and give rise to late elongated spermatids. This study relates the ability of germ cells to differentiate in vitro to the stage at which spermatogenesis is blocked in vivo and to the patient's serum FSH concentration. The presence of germ cells at different stages of spermatogenesis was assessed, before and after culture, by classical cytology, by fluorescence in-situ hybridization and by immunocytochemistry with a germline-specific marker. The proportion of cases of maturation arrest at the primary spermatocyte, secondary spermatocyte and spermatid stage in which in-vitro resumption of meiosis was achieved was 24.3% (9/37), 100% (3/3) and 51.1% (23/45) respectively. Serum FSH concentrations were higher than normal in most cases. However, lower values were measured in patients in whom in-vitro spermatogenesis was achieved compared with those in whom no progression was detected. These data show that, under the conditions of this study, germ cells from men with very high serum FSH concentrations (>20 IU/l) are less likely to resume spermatogenesis in vitro than those coming from men with only moderate increase (10-20 IU/l).

Allelotype and loss of heterozygosity around the L-myc gene locus in primary lung cancers

L-myc S-allele was reported to be associated with metastasis of lung cancer, indicating the existence of a putative tumor suppressor gene around the L-myc locus, in linkage disequilibrium. The relationship between the S-allele and inactivation of some tumor suppressor gene should be indicated by allelic loss. Therefore, we examined the association between the L-myc S-allele and loss of heterozygosity at 11 loci around the L-myc locus (1p34.3) in primary lesions or other biological characteristics in lung cancer. No associations between the S-allele and allelic loss around the L-myc locus or other characteristics were found. According to the deletion map, three shortest regions of overlap between D1S230 and D1S76 were identified. While loss of heterozygosity at SRO1, between D1S2797 and MYCL1, showed no relationship with the pathological stage, it was more frequently observed in squamous cell carcinoma than adenocarcinoma (P=0.019), and associated with high telomerase activity (P=0.046), an indicator of cellular immortality. In conclusion, we found three shortest regions of overlap (SROs) from D1S2797 to pter, and a tumor suppressor gene, which might be associated with suppression of lung cancer development but not with L-myc S-allele, may exist in SRO1.

Chemically and mechanically induced membrane fusion: non-activating methods for nuclear transfer in mature human oocytes

Most current studies of nuclear transfer in mammalian oocytes have used electrofusion to incorporate donor cell nuclei into enucleated oocyte cytoplasts. However, the application of electrofusion to human oocytes is hampered by the relative ease with which this procedure induces oocyte activation. Here we tested a previously described chemical fusion technique and an original mechanical fusion procedure in this application. Enucleated metaphase II oocytes were first agglutinated with karyoplasts originating from other metaphase II oocytes and then induced to fuse with the use of polyethylene glycol or by micromanipulation with an intracytoplasmic sperm injection (ICSI) micropipette. Both techniques yielded a high frequency of fusion and did not cause oocyte activation. Moreover, the reconstructed oocytes were easily activated by subsequent treatment with ionophore A23187 and 6-dimethylaminopurine. These techniques may be used in attempts to alleviate female infertility due to insufficiency of ooplasmic factors by nuclear transfer from patients' oocytes to enucleated donor oocyte cytoplasts. For eventual future use in human cloning, they would ensure prolonged exposure of transferred nuclei to metaphase promoting factor, which appears to be required for optimal nuclear reprogramming.

Time-dependent closed form solutions for fully competitive enzyme reactions

An analytic formalism developed earlier to describe the time evolution of the basic enzyme reaction is extended to fully competitive systems. Time-dependent closed form solutions are derived for the three nominal cases of competition: even, slow and fast inhibitors, allowing for the first time the complete characterization of the reactions. In agreement with previous work, the time-independent Michaelis-Menten approach is shown to be inaccurate when a fast inhibitor is present. The validity of the quasi-steady-state approximation on which the present framework is based is also revised.

[Knowledge of care activity: another professional factor associated with utilization?]

OBJECTIVES

To analyse the doctors' level of understanding of the use of resources in primary care and the relationship of their understanding to the proper use of resources.

SETTING

Primary care in the Autonomous Community of Murcia.

DESIGN

Descriptive, crossover study.

RESULTS

There was little concordance between the real data contributed by the unit of information and registration of primary care management and data calculated by the doctors themselves. The best-known parameters are frequency of attendance (kappa index = 0.11) and patient pressure (kappa = 0.39). The profile of the doctors did not in general relate to this degree of understanding; it was only observed in a tendency in older doctors (p < 0.001) to overvalue frequency of attendance. The doctors with less understanding used radiology resources more with 164 requests per 1000 inhabitants per year, made more specialist referrals (826 per thousand inhabitants per year) and prescribed more medicines (21 prescriptions per inhabitant per year). Likewise, doctors who used resources most tended to underestimate their use of resources (p < 0.001).

CONCLUSIONS

The doctor's understanding of his/her health-care activity and of the resources it involves is scant and independent of the doctor's professional characteristics. This is a factor, which we could call the professional factor, clearly related to resource use.

In vitro culture facilitates the selection of healthy spermatids for assisted reproduction

OBJECTIVE

To evaluate the potential usefulness of in vitro culture of germ cells for distinguishing between healthy and apoptotic spermatids.

DESIGN

Prospective study.

SETTING

Private assisted reproduction laboratories and a university department.

PATIENT(S)

Men with secretory azoospermia who were candidates for assisted reproductive treatment.

INTERVENTION(S)

Testicular biopsy samples were cultured in the presence of FSH and testosterone for 48 hours. Germ cell apoptosis before and after culture was evaluated by terminal deoxyribonucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling.

MAIN OUTCOME MEASURE(S)

The percentage of germ cells at different stages of spermatogenesis that showed apoptosis-related DNA damage.

RESULT(S)

In fresh samples, high levels of apoptosis were detected at those stages of spermatogenesis at which major developmental blocks occurred, with a maximum at the most advanced stage detected. In contrast, apoptotic cells were considerably less well represented at the most advanced stage after culture.

CONCLUSION(S)

In addition to the previously described facilitation of spermatid recognition and the progression of cytoplasmic maturation, in vitro culture of germ cells is useful to overcome the danger of inadvertent use of apoptotic spermatids for assisted reproduction.

In vitro fertilization by intracytoplasmic sperm injection

Intracytoplasmic sperm injection (ICSI) is the latest, and by far the most efficient, variant of micromanipulation-assisted fertilization, whereby a single spermatozoon is selected, aspirated into a microinjection needle and injected to the oocyte cytoplasm. The development of this technique is mainly linked to application in human assisted reproduction for which it enables fertilization with defective spermatozoa that would not otherwise be able to penetrate an oocyte by their proper means. Because ICSI by-passes many steps of the natural fertilization process, it offers an extremely interesting model for the study of basic mechanisms underlying fertilization. This is particularly true for oocyte activation, whose mechanism needs to be revisited in light of the current ICSI research. The massive application of ICSI in human infertility treatment also represents a huge laboratory in which the impact of different genetic and epigenetic anomalies of the male gamete on fertilization and embryonic development can be studied.