Thioredoxin, a putative oncogene product, is overexpressed in gastric carcinoma and associated with increased proliferation and increased cell survival

Human thioredoxin is a putative oncogene that may confer both a growth and survival advantage to tumor cells. Overexpressed thioredoxin mRNA has been found in both primary human lung and colorectal cancers. To determine the intratumor distribution and amount of thioredoxin protein in human primary carcinomas, we developed an immunohistochemical assay for thioredoxin in paraffin-embedded tissue. We then studied 10 patients with primary high-risk gastric carcinoma. To further relate thioredoxin protein overexpression to cell death and survival, we used a paraffin-based in situ end-labeling (ISEL) assay. To delineate proliferation, we used the nuclear proliferation antigen detected by Ki-67. In this survey, we found that thioredoxin was localized to tumor cells and overexpressed compared with normal gastric mucosa in 8 of 10 gastric carcinomas. The thioredoxin was found at high levels in 5 of the 8 overexpressing carcinomas. The overexpression of thioredoxin was typically found in both a nuclear and cytoplasmic location in the neoplastic cells. There was a significant positive correlation (P = .0061) with cancer cell proliferation measured by Ki-67. There was a significant negative correlation (P = .0001) with DNA damage measured by the ISEL assay, suggesting decreased apoptosis and increased carcinoma cell survival. Thus, human primary gastric tumors that are highly expressive of thioredoxin have both a higher proliferative rate and a higher survival rate than tumors that do not express thioredoxin. With these newly developed assays in hand, it is now feasible to question whether this thioredoxin-related combined growth and survival advantage translates into poor clinical outcome.

Vascular access for haemodialysis--an epidemiological study of the Catalan Renal Registry

BACKGROUND

Vascular access (VA) continues to cause problems in a proportion of haemodialysis (HD) patients. VA complications are a major cause of hospitalization, with the resulting financial consequences and human suffering. The purpose of the study was to assess the types and duration of function of different modalities of VA in Catalunya and to relate them to treatment characteristics, to study the characteristics of patients who necessitated more than four VAs and to describe the factors associated with the start of HD using a catheter.

METHODS

The Catalan Renal Registry, using a questionnaire, sampled the data of all patients alive on December 31, 1997 (n=3073). Data were analysed using the chi2 test, ANOVA and logistic regression.

RESULTS

In 85.8% of HD patients in Catalunya, an AV fistula was used, in 8.5% a vascular graft and in 5.6% a catheter. In 48% of incident HD patients in 1997, a catheter was necessary due to lack of an AV fistula. The use of grafts increases with progressive time on dialysis, reaching > 10% amongst patients on dialysis for >7 years. The average time of function for AV fistula was 4 years, for grafts 2 years and for catheters 9 months. A total of 39.1% of patients required only one VA during the entire time on HD, 29.9% two, 14.4% three, and 16.5% four or more. The duration of VA function decreases with age. In patients with autosomal dominant polycystic kidney disease and glomerulonephritis, the duration of VA function exceeds 4 years; it is 3 years in patients with vascular disease and 25 months in diabetic patients.

CONCLUSIONS

The most frequent modality of VA used in Catalunya is the AV fistula. It is used more frequently in male than in female patients. Approximately half of the patients have no VA at the time of start of renal replacement therapy. Age, duration of dialysis treatment and diabetes have an adverse effect on the duration of VA function. Repeated VA failure concerns a minority of patients.

A dysfunctional desmin mutation in a patient with severe generalized myopathy

Mice lacking desmin produce muscle fibers with Z disks and normal sarcomeric organization. However, the muscles are mechanically fragile and degenerate upon repeated contractions. We report here a human patient with severe generalized myopathy and aberrant intrasarcoplasmic accumulation of desmin intermediate filaments. Muscle tissue from this patient lacks the wild-type desmin allele and has a desmin gene mutation encoding a 7-aa deletion within the coiled-coil segment of the protein. We show that recombinant desmin harboring this deletion cannot form proper desmin intermediate filament networks in cultured cells, nor is it able to assemble into 10-nm filaments in vitro. These findings provide direct evidence that a mutation in desmin can cause human myopathies.

Diabetic patients on renal replacement therapy: analysis of Catalan Registry data. Renal Registry Committee

PURPOSE OF STUDY

In recent years, a progressive increase in the need of renal replacement therapy has been noted for patients with diabetes mellitus. The present report is based on an analysis of the data of the 'Registre de Malats Renals de Catalunya' (RMRC). It was the aim to identify (i) the incidence and prevalence of diabetic patients on renal replacement therapy, (ii) associated diseases, (iii) the relative risk of different modes of treatment, and (iv) the rate of death compared to non-diabetic patients on renal replacement therapy and in the general population.

RESULTS

Of the 936 diabetic patients starting renal replacement therapy during the period 1984-1994, 24.8% were classified as DN and IDDM, 65.7% as DN and NIDDM, and in 9.5%, diabetes accompanied renal failure from standard primary renal disease. The incidence of diabetic patients has increased from 3 per million population (pmp) in 1984 to 26.6 pmp in 1994. At any given age the risk of requiring renal replacement therapy with diabetes was 1.5-fold higher in males than in females. Of diabetic patients who were < 45 years of age, 55% received a renal transplant and > 50% lived with a simultaneous kidney/pancreas graft. For diabetic patients above this age, haemodialysis was the most prevalent form of treatment. Morbidity in diabetic patients was higher than in the overall RMRC population. Cardiac and vascular disease were the most prominent complications. Mortality of diabetic patients on renal replacement therapy was twice that of the overall population of RMRC and 16-fold higher than in the general population of Catalunya. The risk of death increased with age and was higher in patients with reduced functional autonomy. Transplanted patients had a smaller risk than patients on haemodialysis or CAPD. Survival has increased for patients starting treatment after 1990 compared to the period 1984-1989.

CONCLUSION

In conclusion, diabetes mellitus is one of the main causes leading to renal replacement therapy in Catalunya. Diabetic patients are more multimorbid than the rest of the population of the Registre de Malats Renals de Catalunya. These observations call for the institution of primary or secondary prevention.

Feasibility and results of bone marrow transplantation after remission induction and intensification chemotherapy in de novo acute myeloid leukemia. Catalan Group for Bone Marrow Transplantation

PURPOSE

To evaluate prospectively the feasibility and results of bone marrow transplantation (BMT) after induction and intensification chemotherapy (CT) in patients with de novo acute myeloid leukemia (AML).

PATIENTS AND METHODS

A total of 159 patients less than 51 years of age were treated. Induction CT consisted of daunorubicin 60 mg/m2 for 3 days, cytarabine (ARA-C) 100mg/m2 for 7 days, and etoposide 100 mg/m2 for 3 days. The first intensification therapy included mitoxantrone 10 mg/m2 for 3 days and ARA-C 1.2 g/m2 every 12 hours for 4 days. Amsacrine (100 or 150 mg/m2 for 3 days) and ARA-C (1.2 g/m2 every 12 hours for 2 or 4 days) were given as the second intensification therapy. Depending on the availability of a human leukocyte antigen (HLA)-identical sibling, the intention of treatment after CT was allogeneic BMT (allo-BMT) or autologous BMT (ABMT).

RESULTS

Complete remission (CR) was obtained in 120 patients (75%) and partial remission (PR) in 11 (7%), while 15 patients (10%) were refractory and 13 (8%) died during induction. There was a trend for better leukemia-free survival (LFS) at 4 years for patients assigned to the ABMT group (50% +/- 6%) compared with the allo-BMT group (31% +/- 7%) (P = .08). This difference in LFS reached statistical significance when considering only transplanted patients (63% +/- 3% at 4 years after ABMT and 38% +/- 11% after allo-BMT, P = .02). The favorable results in patients who received ABMT (no toxic deaths and 37% +/- 7% probability of relapse at 4 years) contrast with the poor outcome of allografted patients (11 patients with transplant-related mortality).

CONCLUSION

Our study reflects the difficulties in the completion of a therapeutic strategy that include BMT and suggests that intensification before BMT may be useful in the setting of ABMT, but this approach was associated with a high mortality rate in allo-BMT patients.

Effect of task complexity on mental performance during immersion hypothermia

The effect of task complexity on the decrement in mental performance during immersion hypothermia was studied. Psychometric tests of varying length and complexity were administered: 1) prior to cold water immersion (baseline); 2) soon after immersion to the neck in cold (8 degrees C) water but prior to any decrease in core temperature; and 3) after 55 to 80 min of immersion when core temperature had decreased 2-4 degrees C. Results indicated that tests placing relatively minimal cognitive demands on individuals, such as auditory attention, the Benton visual recognition test and forward digit span, were unaffected by either initial cold water immersion or central cooling. On the other hand, tests requiring relatively greater mental manipulation and short term memory (i.e., backward digit span) or processing and analysis (i.e., Stroop test) showed a slight improvement upon cold water immersion (perhaps related to increased arousal and/or learning) but a significant decrement following central cooling of 2-4 degrees C. Thus, relatively simple tasks were unaffected by central cooling, whereas more complex tasks were adversely affected. Cold water immersion itself did not interfere with performance of any tasks. Central nervous system cooling probably interferes with mental processing although discomfort and/or the physiological and physical effects of cold on the neuromuscular aspects of speech, required for responses to some of the tasks, may also affect performance.

Incubated reminiscence effects

Reminiscence, the recall of material that was not successfully recalled on a previous attempt, was examined in three experiments as a function of the interest (incubation) interval. Incubation intervals inserted between successive recall tests resulted in increased reminiscence, but the effect was seen primarily in the first retested minute. Neither the duration of the initial test (1-4 min), nor the incubation activity (maze problems vs. rest) affected this incubated reminiscence effect. The results support models in which recall tests cause output interference, but incubation intervals reduce it.

Plasma cells in multiple myeloma express a natural killer cell-associated antigen: CD56 (NKH-1; Leu-19)

Bone marrow samples from 55 patients with multiple myeloma (MM) and 23 patients with monoclonal gammopathy of undertermined significance (MGUS) were evaluated with a broad panel of monoclonal antibodies. Plasma cells from 78% (43/55) of patients with MM strongly expressed the natural killer cell antigen CD56 (NKH-1, Leu-19). Of the 23 patients with MGUS, none showed strong CD56 reactivity, although three had weak reactivity in less than 20% of plasma cells. Myeloma cells expressing CD56 did not coexpress the CD57 or CD16 antigens. Patients with CD56-positive plasma cells had both indolent and aggressive disease. However, the 12 CD56-negative patients had predominantly aggressive disease with an unexpected preponderance of kappa Bence Jones only myeloma (5/10[50%] evaluable patients). Polyclonal plasma cells from non-neoplastic tissue sites (normal bone marrows, lymph nodes, tonsillar biopsies, and gut-mucosa biopsies) showed a near absence of CD56. We conclude that isolated, strong CD56 expression is common in MM, but not in MGUS or reactive plasma cells. The potential biologic importance of CD56 positivity in myeloma is reviewed.

Children and adults learn family-resemblance categories analytically

3 experiments examined the modes of processing used by children and adults in learning family-resemblance categories. The materials were cartoon faces (Experiments 1 and 2) and bugs (Experiment 3) divided into categories that possessed no single defining attributes, but rather several characteristic attributes that were each partially predictive of category membership. The categories were structured so that a holistic mode of processing in which the individual did not selectively weight any given attributes could have led to success. Nevertheless, preschoolers (Experiments 2 and 3), first and third graders (Experiment 1), and adult college students (all experiments) all exhibited primarily analytic modes of learning that consisted of single- and dual-attribute approaches. Although the proportion of analytic learners among the preschoolers was lower than among the adults in Experiment 3, in no case were holistic modes of learning evident. The results are discussed in terms of their implications for young children's apparent relative success in learning natural categories. It is suggested that children's success in learning real-world categories may be based, in part, on an interaction between a basically analytic processing style and natural category structures that provide many partially informative attributes.

T-cell antigen-positive multiple myeloma

We report the simultaneous expression of T-cell antigens on the myeloma cells from six patients with multiple myeloma (MM). These six patients come from a total population of 215 samples (115 direct samples, clinical incidence of 5.2%) of plasmacytic malignancies immunotyped at the University of Arizona. Four patients expressed T helper antigen (Leu 3, CD4), one expressed T-cell antigen receptor (Leu 4, CD3), and one expressed E-rosette antigen receptor (Leu 5, CD2). The presenting clinical features, histology, and plasma cell morphology showed no differences from multiple myeloma patients who did not express T-cell antigen. However, although the survival duration ranged from 5 to 93 mo overall, survival from demonstration of T antigen expression was very short, (2 to 7+ mo), with five of six (80%) patients dying less than or equal to 5 mo after study. The reason for T antigen expression is unknown. It may indicate that myeloma can arise from a normally minor subpopulation of B cells involved with immunoregulation; conversely, it could be a coincidental aberrancy associated with malignant change in the plasma cells.

[Genitourinary rhabdomyosarcoma in childhood]

We present the result obtained by GICOP in the treatment of 12 genitourinary rhabdomyosarcoma, located in vagina-uterus (5), bladder-prostate (4) and paratesticular (3). The age of the patients ranging from 1 to 15 years. Embryonal rhabdomyosarcoma was the most common histologic type (58 for 100) being the major number of cases in stadium II. The treatment was based in the combination of chemotherapy protocolised with vincristine, d-actinomycin, cyclophosphamide (VAC), vincristine, adriamycin (VAC-VAD) and/or iphosphamide, vincristine, d-actinomycin (IVA), use of radiotherapy, marrow auto-transplantation and radical surgery avoidance. Complete remission was achieved in 11 out of 12 cases (92 for 100), relapsing in 5 cases (38 for 100) of which 4 (80 for 100) achieved a second remission. An 82 for 100 disease free survival was achieved in a 5 year period.

Myelomonocytic antigen positive multiple myeloma

In a four year span, between 1983 and 1987, 215 bone marrow and cell culture samples from 125 myeloma patients were immunotyped and coexpression of myelomonocytic and plasma cell antigens occurred in 16 (13%). We employed both immunohistochemical and flow cytometry methods including coplots and double labelling. Three types of myeloma cases were found: (1) those with isolated myeloid antigen coexpression, usually Leu M1 or esterase (BE, CE) positive (11 cases); (2) those with multiple myeloid antigens (Leu M1, M3, M5, MY7, BE, CE) (four cases); and (3) one case beginning as 1 and ending as 2. Isolated myeloid antigen expression was generally associated with typical features of myeloma with survival close to the anticipated median (33 months), while multiple myeloid antigen expression was associated with more aggressive disease and shorter survival duration (median survival 16 months). The latter subgroup also had other poor prognostic factors including high labelling index and common acute lymphoblastic leukemia antigen (CALLA) positivity. Other features found overall were frequent abnormal karyotypes (seven of 12 abnormal) and coexpressed IgA (eight of 16); all IgA+ cases also coexpressed Leu M1. We conclude that there is an unusual and unexpected predilection for coexpression of myelomonocytic antigens in myeloma cells. The reasons are not immediately obvious. Whether the coexpression indicates that myeloma cells truly have latent multilineage potential or just aberrantly coexpress other hematopoietic antigens as a manifestation of malignancy remains to be explained. However, a cell line established from the bone marrow of one patient is a valuable scientific tool allowing detailed analysis of these questions.

Myelomonocytic myeloma cell line (LB 84-1)

A human cell line (LB 84-1) has been established from the bone marrow of a patient with Bence-Jones myeloma. Coexpression of plasma cell (Leu[CD38]) and myelomonocytic antigens (Leu MI[CD15], Leu M5 [CD11c], MY7 [CD13] plus butyrate and chloracetate esterase) proved to be an unusual but sustained feature of this cell line. The plasma cell phenotype with multinuclearity was retained. Shared major chromosomal abnormalities (del [5] [p14], t[5;?] [q35;?], del [6] [q21], and del 7[q32]) between the direct and cell line karyotypes affirmed the LB 84-1 cell as being derived from the original patient myeloma clone. The mechanisms potentially responsible for the aberrant coexpressed phenotype are discussed. This myelomonocytic myeloma cell line will hopefully prove to be a valuable tool for the study of the genotypic and phenotypic evolution of human myeloma.

What makes a vibble a vibble? A developmental study of category generalization

Young children appear to know when a novel label for a novel object is a common noun. The present study was concerned with the properties of a named object that children assume to be true of other members of the category that is specified by such a noun. Preschoolers, second graders, and college students were shown drawings of objects and given nonsense labels for those objects. They then viewed other objects that varied from the labeled ones along 4 particular attributes and were asked to decide if those other objects should also receive the same label. Preschoolers focused mostly on single attributes in making category decisions, and their choices of attributes were evenly distributed among the 4 types. Older individuals primarily exhibited multiple attribute rules. The results are discussed in terms of developmental differences in the modes of processing that are used and in the types of knowledge that are brought to bear on the word learning situation.

Delineation of a novel pre-B cell component in plasma cell myeloma: immunochemical, immunophenotypic, genotypic, cytologic, cell culture, and kinetic features

A novel pre-B cell component in direct and cultured myeloma bone marrow material has been delineated by using immunochemistry and flow cytometry techniques. Our phenotypic studies suggest a novel hybrid expression of pre-B and plasma cell antigens with coexpression of cytoplasmic mu, common acute lymphoblastic leukemia antigen, terminal deoxynucleotidyl transferase, and plasma cell antigens (PCA-1 and PC-1). This suggests that myeloma pre-B-like cells are aberrant malignant cells and not normal pre-B lymphocytic counterparts. With the advantage of a pure and stable source of these cells from M3 culture to allow molecular characterization, we performed one- and two-dimensional gel electrophoresis and Western blotting. We found that the cytoplasmic mu in myeloma pre-B-like cells has a molecular weight of 74,000 daltons and an isoelectric point of 6.3 and that it is strikingly homogeneous and discrete in size and charge compared with standard secretory mu, which suggests an aberrant, mutant, or monoclonal form of mu. Monoclonality was further evidenced by heavy- and light-chain immunoglobulin gene rearrangements demonstrated with JH and C kappa probes. We also established that this novel myeloma pre-B component is a major proliferative element as determined by double-labeling experiments with phenotype coupled to labeling/proliferative indexes. Our stimulatory studies indicate some capacity of these cells to mature on exposure to phorbol esters. These myeloma pre-B cells may represent the stem cell or self-renewal component in myeloma. Our establishment of these cells in long-term culture offers a considerable asset in studying the immature cells, which may be critical to the immortalization of myeloma.

Classifying color materials: children are less holistic than adults

Much recent research indicates that children respond to materials which are separable for adults as though those materials were integral. The present studies examined differences between 5-year-olds and adults in the processing of integral materials. In Study 1, both children and adults made a majority of similarity classifications for those materials. However, the children were found to make fewer of those integral similarity classifications and more dimensional classifications than adults for materials varying in the integral dimensions of chroma and value. In Study 2, children's similarity judgments were also indicative of greater separability of those dimensions. For both children and adults, similarity ratings given in Study 2 were predictive of classification behavior in Study 1. Age differences in similarity ratings were also predictive of age differences in classification. The overall pattern of results is consistent with the idea that children's perception is neither more nor less holistic than that of adults. Whether children or adults are found to be more holistic depends on the nature of the material presented. With integral materials, young children respond in a manner which appears less holistic than that of adults.

Severe aplastic anaemia following hepatitis A

A 3-year-old child developed severe aplastic anaemia following hepatitis A. Since no HLA-compatible donor was available, he was treated with oxymetholone, antithymocytic globulin and methylprednisolone, but no haematologic recovery was observed and he consequently died of pneumonia. Although the association of aplastic anaemia and hepatitis A has already been recognized, this patient represents the first case of aplastic anaemia in which the previous hepatitis A has been well documented.

Establishment of two new myeloma cell lines from bilateral pleural effusions: evidence for sequential in vivo clonal change

Two new human myeloma cell lines have been established from a 36-year-old woman with refractory IgG kappa multiple myeloma in whom bilateral malignant pleural effusions developed. The malignant plasma cells from each effusion were set up in a liquid culture using an L-15 medium containing catalase, glutathione, selenous acid, ascorbic acid, insulin, transferrin, additional glutamine hydrocortisone, and 2-mercaptoethanol and designated as M-3 medium. Two IgG kappa cell lines, LB -831 and LB-832, were established and proved to be Epstein-Barr virus negative using the internal repeat sequence DNA probe. Characteristic plasma cell morphology was evident by light and electron microscopy. Immunotyping revealed an IgG kappa , B1+, B2-, Ia (HLA-DR)+, CALLA+ phenotype for each cell line as well as for the original pleural fluid and bone marrow myeloma cells. The supernatants also contained IgG kappa, beta 2 microglobulin, and large amounts of osteoclast-activating factor (indicating bone-resorbing activity). Cytogenetic analysis of the LB-831 cell line revealed a nearly triploid highly abnormal karyotype with numerous clonal chromosomal abnormalities involving chromosomes 1, 3, 5, 7, 13, and 15; several structurally abnormal marker chromosomes; and a putative homogeneously staining region on chromosome 7p at band p22. Analysis of the LB-832 cell line revealed several additional clonal abnormalities. These additional cytogenetic changes suggest that in vivo sequential clonal evolution occurred in this patient. Therefore, two new but related cell lines have been established, which should prove useful for further biological studies.

Congenital methemoglobin-reductase (cytochrome b5 reductase) deficiency associated with mental retardation in a Spanish girl

Methemoglobinemia and mental retardation associated with NADH-diaphorase deficiency was found in a 2-year-old girl of Spanish origin. She showed no NADH-diaphorase activity in either erythrocytes or leukocytes, but electrophoretic studies of the hemolysate showed traces of an enzyme with normal mobility. Cytochrome b5 reductase activity was also found to be absent in the leukocytes of the propostius. Intermediate NADH-diaphorase activity was found in erythrocytes and leukocytes in her parents and her sister in accordance with the autosomal recessive mode of inheritance of this enzymopathy. The relationship between a generalized cytochrome b5 reductase deficiency and the progressive neurological involvement in our patient is discussed briefly.