Endothelial nitric oxide synthase gene polymorphisms in Behçet's disease and rheumatic diseases with vasculitis

OBJECTIVE

To assess potential associations between Korean Behçet's disease (BD) or other rheumatic diseases with vasculitis and two polymorphisms of the endothelial nitric oxide synthase (eNOS) gene, which include the Glu298Asp polymorphism in exon 7 and a variable number of tandem repeats (VNTR) polymorphism in intron 4.

METHODS

65 patients with BD, 27 with rheumatic diseases with vasculitis, and 80 controls were studied. Analyses of the Glu298Asp polymorphism in exon 7 and VNTR polymorphism in intron 4 of the eNOS gene were made by the polymerase chain reaction (PCR)-restriction fragment length polymorphism technique and PCR genotyping, respectively. Additionally, HLA-B51 typing was performed in the BD group and controls by a two step PCR sequence-specific primers method.

RESULTS

Significant differences in Glu298Asp genotype frequencies were found between the BD or vasculitis groups and the controls (BD group v controls: p(corr)=0.006; vasculitis group v controls: p<0.001). The Asp298 frequency was much higher in the BD and vasculitis groups than in the controls. Even after stratification of the BD group based on the results of HLA-B51 testing, a significant association of the Glu298Asp polymorphism was still found (p=0.002, Mantel-Haenszel weighted odds ratio 4.3, 95% confidence interval 1.7 to 10.9). Distribution of the genotype frequencies in two eNOS gene polymorphisms was similar in connective tissue diseases-associated vasculitis and primary vasculitic syndromes. In contrast, distribution of alleles and genotypes of VNTR polymorphism did not differ between BD or vasculitis groups and the controls.

CONCLUSION

The Glu298Asp polymorphism in exon 7 of the eNOS gene seems to be a susceptibility gene for Korean BD and other rheumatic diseases.

The prevalence of atopy and atopic diseases in Behçet's disease

OBJECTIVE

The prevalence of Th-2 cell-mediated diseases, such as atopic diseases, has been noted to be low in Th-1 cell-mediated diseases. This study was undertaken to assess the prevalence of atopy and atopic diseases in Behçet's disease (BD), a Th-1 cell-mediated disease, and to investigate the clinical association between the atopy and the development of severe manifestations in BD.

METHODS

We examined 70 consecutive BD patients and 113 controls without BD or other inflammatory rheumatic diseases. The cumulative history of severe manifestations in BD patients was investigated during the disease course. A skin prick test was performed in all the subjects, and atopy was defined as present when the size of one or more allergen-induced wheals was equal to or larger than that caused by histamine. Atopic diseases were defined as present when there were relevant responses for atopic diseases on the questionnaires in the subjects with atopy. In addition, serum IgE levels and peripheral blood eosinophil counts were measured.

RESULTS

The prevalence of atopy and atopic diseases was significantly lower in BD patients than in controls. Other atopy parameters, such as serum IgE levels and peripheral blood eosinophil counts, were also significantly lower in BD patients when compared with controls. However, atopy, serum IgE levels, and peripheral blood eosinophil counts did not differ significantly between BD patients with and without severe manifestations.

CONCLUSION

The prevalence of Th-2 cell-mediated conditions, such as atopy and atopic diseases, appeared to be lower in BD, a Th-1 cell-mediated disease. In addition, a Th-1 and Th-2 balance may not influence the development of severe manifestations in BD.

Relationship between plasma glucose concentrations and Native Hawaiian Ancestry: The Native Hawaiian Health Research Project

OBJECTIVE

To investigate the relationship between fasting glucose and 2 h glucose with percentage of Hawaiian ancestry and ethnic admixture.

DESIGN

Cross-sectional epidemiological study of type 2 diabetes and heart disease risk factor prevalence among Native Hawaiians.

SUBJECTS

A total of 578 Native Hawaiians residing in two rural communities were examined between 1993 and 1996. Sample sizes in statistical analyses varied due to missing data and selection criteria based on ethnic ancestry.

MEASUREMENTS

Percentage of Hawaiian ancestry and non-Hawaiian ethnic admixture, assessed by self-report. Fasting and 2 h post glucose challenge plasma glucose levels. Anthropometric measures (height, weight, waist and hip circumferences). Self-report of diet and physical activity. Medical history.

RESULTS

Increased Hawaiian blood quantum was significantly associated with increased fasting glucose (P=0.0047), increased body mass index (BMI; P<0.0001), waist-to-hip ratio (WHR; P=0.0103), and age (P<0.0001), but not with leisure time physical activity and total dietary caloric intake. This association was attenuated after adjusting for BMI and WHR, but not by age-adjustment alone. However, when the effects of descent from other ethnic groups was examined in a subset of participants, full-Hawaiians had significantly higher fasting glucose concentrations (7.28 mmol/l) than part-Hawaiians after adjustments for age, gender, BMI and WHR. In contrast, part-Hawaiians of predominantly Asian ancestry had the highest 2 h glucose concentrations (7.62 mmol/l).

CONCLUSION

These results suggest that ethnic admixture may be an important, but extremely complex, factor concerning the high prevalence of type 2 diabetes observed among this population. The complexity of this relationship may have obscured the relationship between ancestry and glucose tolerance in earlier observations of this population.

FcgammaRIIa/IIIa polymorphism and its association with clinical manifestations in Korean lupus patients

The aim of this study was to determine the distribution of the FcgammaRlla and FcgammaRIIIa polymorphisms and their association with clinical manifestations in Korean lupus patients. Three hundred SLE (systemic lupus erythematosus) patients (48 male, 252 female) meeting 1982 ACR criteria and 197 Korean disease-free controls were enrolled. Genotyping for FcgammaRlla 131 R/H and FcgammaRIIIa 176 F/V was performed by PCR of genomic DNA using allele-specific primers and the FcgammaRIIIa genotype was confirmed by direct sequencing of PCR product in some cases. There was significant skewing in the distribution of the three FcgammaRIIa genotypes between the SLE and the controls (P=0.002 for R/R131 vs R/H131 and H/H131, OR 2.5 (95% Cl 1.4-4.5), but not in FcgammaRIIIa genotypes. FcgammaRIIa-R allele was a significant predictor of lupus nephritis, as compared with SLE patients without nephritis (P=0.034 for R131 vs H131, OR 1.4 (95% Cl 1.03-1.9)), but proliferative nephritis (WHO class III and IV) was less common in patients with FcgammaRlla-R/R131 and in FcgammaRIIa-R allele. In 300 SLE patients, high binding allele combination H131/V176 was less common in SLE with nephritis than in SLE without nephritis. Hemolytic anemia was less common in R131/F176 allele combination among four FcgammaRIIa/FcgammaRIIIa allelic combinations. Male SLE patients showed a higher frequency of renal involvement, serositis, thrombocytopenia, malar rash and discoid rash than female SLE, and male SLE had a higher frequency of FcgammaRIIa-R/R131 or R131-allele than male controls, but FcgammaRIIa or FcgammaRIIIa genotypes had no association with renal involvement in male SLE patients. FcgammaRIIa-H/H131 showed a higher frequency of hemolytic anemia and less pulmonary complications in male SLE. Female SLE patients showed higher frequency of any hematologic abnormality, lymphopenia, anticardiolipin antibody (+) and anti-Ro antibody (+) than male SLE, and had earlier onset of first symptoms. There was no skewing in FcgammaRIIa or FcgammaRIIIa genotypes between female SLE and female controls, but FcgammaRIIa-R131 allele showed skewing between female SLE with nephritis and female SLE without nephritis. The age at onset of thrombocytopenia was earlier in FcgammaRIIa R/R131 among three FcgammaRIIa genotypes, and serositis in FcgammaRIIIa-F/F176 among three FcgammaRIIIa genotypes. FcgammaRIIa-R131 homozygote was a major predisposing factor to the development of SLE and FcgammaRIIa-RI31 homozygote and R131 allele were a predisposing factor, and H131/V176 was a protective allele combination in lupus nephritis. In contrast to other ethnic patients, in our study cohort, clinical manifestation was different between male and female, and FcgammaRIIa and FcgammaRIIIa showed somewhat different clinical associations between the genders.

Weekly high-dose 5-fluorouracil (5-FU), leucovorin (LV) and bimonthly cisplatin in patients with advanced gastric cancer

BACKGROUND

A phase II clinical trial was performed to evaluate the activity and toxicity of bimonthly cisplatin and weekly 24-h infusion of high-dose 5-fluorouracil and leucovorin in patients with advanced gastric cancer.

PATIENTS AND METHODS

From September 1997 to March 1998, 23 chemo-naive patients of advanced gastric cancer were enrolled in this study. The regimen consisted of weekly 24-h infusion of 5-FU (2,600 mg/m2) and LV 150 mg and bimonthly cisplatin (25-50 mg/m2) bolus for 12 weeks followed by a 2-week break.

RESULTS

There were 10 male and 13 female patients with a median age of 52 years. A total of 428 chemotherapy treatments were given with a mean of 11. Seventeen patients were evaluable for response. There were 41% (7/17) partial response, 18% (3/17) stable disease and 41% (7/17) progressive disease. The grade III or IV toxicity included anorexia 35% (8/23), fatigue 26% (6/23), vomiting 17% (4/23) and mucositis 9% (2/23). One patient developed perforated duodenal stump after chemotherapy. One patient died of hyperammonemia-related coma. The median times to disease progression and overall survival were 3.5 and 7 months, respectively.

CONCLUSIONS

This regimen showed modest activity against gastric cancer. However, there was no survival advantage and there was greater toxicity than with weekly high-dose 5-FU-LV alone.

Prevalence of porcine proliferative enteropathy and its control with tylosin in Korea

Porcine proliferative enteropathy(PPE) is an enteric disease been caused by Lawsonia intracellularis. It has become one of the critical problems in the pig industry. To investigate the prevalence of PPE in Korea, serum samples of 828 pigs from 65 herds were tested using indirect immunofluorescence antibody technique(IFA). The infection rate in individual pigs varied from 44 to 69%, whereas 100% in pig farms. The infection frequency was 57, 44.9, and 59.4% according to age respectively. Administration of tylosin in feed at a concentration of 110 ppm for 14 days reduced the infection rate of the farms. These data indicated that the high prevalence of PPE may be controlled by tylosin.

Ultrasound-guided core needle biopsy as an initial diagnostic test for palpable breast masses

PURPOSE

To determine the role of ultrasound (US)-guided core needle biopsy as an initial diagnostic test for palpable breast masses.

MATERIALS AND METHODS

Ninety-eight consecutive patients, each with a palpable breast mass, were referred for US-guided core biopsy by a multidisciplinary team of physicians who specialize in the care of breast diseases. All palpable breast masses were clearly visible on high-resolution US. Ninety-nine core needle biopsies were performed under local anesthesia with use of freehand technique, mostly in an outpatient setting. Core needle path through each mass was documented in two orthogonal sections. A mean of 3.4 tissue core samples (range, 1-7) were obtained in each patient.

RESULTS

Core needle biopsy resulted in the diagnosis of 66 malignancies, two cases of atypical ductal hyperplasia (ADH), and 30 benign diseases of the breast. Surgery with curative intent was performed in 63 breast malignancies and excisional biopsies were performed for 10 benign diseases (two cases of ADH and eight benign lesions). Twenty-five breast masses were managed nonoperatively: chemotherapy was performed in three locally advanced breast cancers and 3-year follow-up was conducted for 22 benign lesions. Malignancies were correctly diagnosed in all cases. No malignancy was discovered at surgery or during clinical follow-up of ADH and no benign breast lesions were diagnosed by core needle biopsy. US-guided core needle biopsy is 100% sensitive and specific for palpable breast malignancies, with no false-positive results. A puncture site ecchymosis was the only morbidity or complication noted.

CONCLUSION

US-guided core needle biopsy is a safe and accurate first diagnostic test for palpable breast masses that require tissue proof.

Lung fibrosis in Sprague-Dawley rats, induced by exposure to manual metal arc-stainless steel welding fumes

To investigate the disease process of pneumoconiosis induced by welding-fume exposure, a lung fibrosis model was established by building a stainless steel arc welding fume generation system and exposing male Sprague-Dawley rats for 90 days. The rats were exposed to welding fumes with concentrations of 57-67 mg/m3 (low dose) and 105-118 mg/m3 (high dose) total suspended particulates for 2 h per day in an inhalation chamber for 90 days. The concentrations of the main metals, Fe, Mn, Cr, and Ni, were measured in the welding fumes, plus the gaseous compounds, including nitrous gases and ozone, were monitored. During the exposure period, the animals were sacrificed after the initial 2-h exposure and after 15, 30, 60, and 90 days. Histopathological examinations were conducted on the animals' upper respiratory tract, including the nasal pathway and conducting airway, plus the gas exchange region, including the alveolar ducts, alveolar sacs, and alveoli. When compared to the control group, the lung weights did not increase significantly in the low-dose group, yet in the high-dose group there was a significant increase from day 15 to day 90. The histopathological examination combined with fibrosis-specific staining (Masson's trichrome) indicated that the lungs in the low-dose group did not exhibit any progressive fibrotic changes. Whereas, the lungs in the high-dose group exhibited early delicate fibrosis from day 15, which progressed into the perivascular and peribronchiolar regions by day 30. Interstitial fibrosis appeared at day 60 and became prominent by day 90, along with the additional appearance of pleural fibrosis. Accordingly, it would appear that a significant dose of welding-fume exposure was required to induce lung fibrosis.

Gender discrepancy observed between chemotherapy-induced emesis and hiccups

The aim of this paper was to describe striking gender differences observed between emesis and hiccups in patients receiving cisplatin-based chemotherapy (CT) and one of two dexamethasone-containing anti-emetic regimens. Four hundred patients were evaluated in a crossover study with two arms. Patients in arm A received three doses of ondansetron 8 mg i.v. at 4-h intervals plus dexamethasone 20 mg i.v. from the start of CT, followed by dexamethasone 5 mg i.v. every 12 h, until CT was complete, after which dexamethasone was discontinued. For patients in arm B the treatment was the same as in arm A except that the three doses of ondansetron 8 mg i.v. were given at 24-h intervals. There were 363 patients in arm A and 358 patients in arm B. Vomiting/nausea/hiccups were observed in 30.3%/41.6%/23.7% of patients in arm A and 28.8%/39.1%/23.7% of patients in arm B, respectively. Comparison showed that the rates for complete control of vomiting and nausea on days 1 through 6 were significantly lower in women (P<0.0001 and =0.0004 in arm A and P<0.0001 and <0.0001 in arm B, respectively). Men had a significantly higher incidence of hiccups (P<0.0001 in both arms), but no apparent associations with age, cisplatin dose, tumor type, and the presence of vomiting and nausea during CT were found. Hiccups usually began 24 h after cisplatin administration and persisted for some days. Women had significantly higher rates of vomiting and nausea. The cause of the gender discrepancy is unknown.

Osteonecrosis and bone infarction in association with Behcet's disease: report of two cases

We describe two cases with Behcet's disease (BD) developing osteonecrosis or bone infarction. One patient developed the extensive bone infarction of the left knee without the use of corticosteroids. The other patient had osteonecrosis at the right femoral head. He had had a past history of significant corticosteroid administration to treat several complications of BD such as central nervous system involvement, uveitis, gastrointestinal involvement, and pulmonary involvement. Anticardiolipin (aCL) antibodies were positive in these two patients. One was IgG type, and the other was IgM type. However, it remains unclear that there is relationship between the presence of aCL antibodies and occurrence of osteonecrosis.

Hawaiian health practitioners in contemporary society

Hawaiian medical practices in Hawai'i became fragmented and deteriorated following the arrival of Western civilization. With the resurgence of Hawaiian pride, interest has risen to preserve what remains of Hawaiian healing methods. The purpose of this study is to determine the extent to which Hawaiian healing modalities are still in existence and practiced in the 1990s by Hawaiian health practitioners. Twenty-five Hawaiian health practitioners on the island of O'ahu agreed to in-depth interviews on their specific training and current practices of Hawaiian healing. Data collection included demographic characteristics, cultural attributes, training patterns, healing modalities, motivation to practice, spirituality and health, use of Hawaiian medicines, and training of haumana (students). Common practices as well as differences between practitioners and specialties were explored. This study found that a small, but substantive, component of Hawaiian healing is practiced by a growing number of Hawaiian practitioners. Content analyses identified two major components of Hawaiian healing: (1) attributes of Hawaiian culture, and (2) elements of spirituality in health and healing. Three significant modalities remain: ho'olomilomi, massage; la'au lapa'au, herbal medicine; and ho'oponopono, conflict resolution. Seventeen or 68% reported being skilled in more than one healing modality and 56% were training haumana. All practitioners reported apprenticeships under one or more master healers or a recognized elder healer--often a family member. Prior to, and after, the administration of any healing modality, spiritual blessings were administered by all practitioners to initiate the healing process and end the healing session. Hawaiian values--such as lokahi, harmony between man, nature, and the gods--are essential for holistic health. Without lokahi, there is illness. In summary, this study provides data that previously did not exist on contemporary Hawaiian health practitioners. Public health planners and health care professionals may find this information useful in developing culturally competent health programs for Hawaiian clients or patients.

HLA-B51 and its allelic types in association with Behçet's disease and recurrent aphthous stomatitis in Korea

OBJECTIVE

This case-control study was undertaken to evaluate the association of HLA-B51 antigen and its allelic types with Behçet's disease (BD) and with recurrent aphthous stomatitis (RAS), to investigate the degree of this association with diagnostic types and clinical variables of BD.

METHODS

The DNA typing of HLA-B51 by nested PCR-SSP was performed in 61 patients with BD, 56 patients with RAS, and in 70 healthy controls. Also, blind quality control study was done to assess the accuracy of nested PCR-SSP in HLA-B51-positive and negative BD patients on the microlymphocytotoxicity. In addition, direct DNA sequencing analysis was carried out in HLA-B51-positive individuals.

RESULTS

The outcome of nested PCR-SSP showed 100% concordance with those of the microlymphocytotoxicity. The prevalence of HLA-B51 in patients with BD was 55.7%, 16.1% in patients with RAS, and 15.7% in healthy controls. According to the diagnostic types of BD, all ten patients with complete BD had HLA-B51 antigen, and 47.1% in patients with incomplete BD (p = 0.002). In addition, the prevalence of HLA-B51 was statistically significant in patients with BD who had uveitis (p = 0.003) or erythema nodosum (p = 0.042). Direct DNA sequencing analysis revealed that the major allelic types in BD, RAS, and in healthy control were mostly HLA-B*51011.

CONCLUSIONS

Compared to patients with RAS or healthy controls, prevalence of HLA-B51 in the Korean patients with BD was much higher. The BD patients with B51 seemed to be susceptible for manifesting uveitis, erythema nodosum, and the full-blown syndrome as complete BD. Therefore the presence of HLA-B51 antigen in BD patients would be a genetic marker for the severe disease. In addition, there was no difference on the major allelic types of HLA-B51 in BD, RAS, and in healthy control.

p16(INK4a) Promoter hypermethylation of non-tumorous tissue adjacent to gastric cancer is correlated with glandular atrophy and chronic inflammation

The p16(INK4a) tumor suppressor gene can be inactivated by promoter region hypermethylation in many tumor types including gastric cancers. However, p16(INK4a) promoter hypermethylation in the surrounding non-tumorous tissues of gastric cancers has not been studied in detail. We therefore examined 46 gastric cancers, corresponding adjacent non-tumorous tissue samples and 8 gastric tissue samples of chronic gastritis by performing methylation-specific polymerase chain reaction, and we analyzed p16(INK4a) protein expression using immunohistochemistry and Western blot. p16(INK4a) promoter hypermethylation was observed in 43% of gastric cancers and 59% of adjacent non-tumorous tissues; however, none of the samples retrieved from the chronic gastritis patients displayed p16(INK4a) promoter hypermethylation. Gastric cancers showed an inverse correlation between vascular invasion and p16(INK4a) promoter hypermethylation, and adjacent non-tumorous tissues displayed a close association among the grade of chronic inflammation, presence of glandular atrophy and p16(INK4a) promoter hypermethylation. p16(INK4a) expression was markedly decreased in samples with p16(INK4a) promoter hypermethylation when compared with samples without p16(INK4a) promoter hypermethylation. These results suggest that p16(INK4a) promoter hypermethylation is an early and frequent event in gastric carcinogenesis and may serve as a new prognostic biomarker for the risk of gastric cancers.

Depressive symptoms and cigarette smoking among Native Hawaiians

The present study estimated the prevalence of depressive symptoms and cigarette smoking and examined the relationship between depressive symptoms and cigarette smoking among native Hawaiians. Cross-sectional data from 524 rural, native Hawaiian from the Native Hawaiian Health Research Project are presented. Depressive symptoms were measured using the self-report Centre for Epidemiological Studies--Depression Scale. Information on smoking behavior and sociodemographic variables was collected. The prevalence of depressive symptoms was 15%, and significantly higher among participants with lower educational attainment. The prevalence of current smokers was 32%, and significantly higher among younger adults and participants with lower educational attainment. Regression analyses reported a significant relationship between CES-D scores and smoking status as well as between CES-D scores and number of cigarettes smoked daily. However, when education and age were included in the regression models, the relationships were attenuated. The findings and implications of this study are discussed.

A case of nodular scleritis in association with Behcet's disease

Approximately 50% of patients with scleritis are known to be associated with systemic connective tissue diseases or vasculitic diseases such as rheumatoid arthritis (RA), Wegener's granulomatosis, relapsing polychondritis, and systemic lupus erythematosus. The patients with scleritis in association with Behcet's disease (BD) have been rarely described in the literature. We report a 46-year-old female patient with BD who developed the nodular scleritis.

Classical malignant rhabdoid tumor of central nervous system in 9-year-old Korean

A Malignant rhabdoid tumor (MRT) arising in the right temporoparietal lobe of a 9-year-old boy is described along with the results of an immunohistochemical study. The patient initially sought medical attention for a ptosis and right sided headache. The child underwent a subtotal resection of the tumor, followed by radiotherapy and systemic chemotherapy, but died three years after surgery. A MRT, a primary neoplasm of the central nervous system (CNS), is an entity of unknown histogenesis with a dismal prognosis, which only occurs in early childhood. Histologically similar tumors with more varied morphological features have been designated as an atypical teratoid/rhabdoid tumor. However, a classical MRT is extremely rare in the CNS and our case represents a classical CNS MRT.

Complications of urinary diversion after pelvic exenteration for gynecological malignancy

A series of 21 patients who underwent pelvic exenteration for local advanced or recurrent gynecological malignancies and urinary diversions was retrospectively reviewed. The major disease process was carcinoma of the cervix. Early complications included sepsis with wound infection and dehiscence in 4 patients, intestinal insuffency in 2 patients, 4 urinary fistulas and 3 ureteral obstructions. Six patients had a late urinary complication of stenosis of the ureterointestinal anastomosis; stones in the urinary reservoir and pyelonephritis were also noted. Factors responsible for these complications are identified and discussed with a view to reducing the morbidity related to urinary diversion in such patients.

A broad-spectrum caspase inhibitor blocks concanavalin A-induced hepatitis in mice

Fulminant hepatic failure (FHF) is a clinical syndrome resulting from massive death of liver cells or sudden and severe impairment of liver function. The causes of FHF are diverse and the overall mortality is very high. Recently, it became clear that apoptosis of hepatocytes is the critical cause of acute hepatic failure in FHF. It is well known that a family of cysteine proteases called caspase is one of the key mediators of the apoptotic pathway. Thus, caspases are attractive potential targets for the treatment of disorders resulting from excessive apoptosis. In this report, we examined the activity of a new caspase inhibitor, Xyz 033 mp. This nonpeptide inhibitor showed broad-spectrum caspase-inhibiting activity and protected primary rat hepatocytes from apoptotic death. In a mouse model of FHF induced by concavalin A (Con A), Xyz 033 mp suppressed elevated AST and ALT and specifically reduced IL-1 beta concentration. Also, Xyz 033 mp rescued mice from lethal experimental hepatitis induced by Con A. In addition, histological examinations indicated that Xyz 033 mp protected hepatocytes from the fatal apoptogenic effect of Con A. These results suggest that Xyz 033 mp may be a candidate therapeutic agent for FHF caused by massive apoptotic death of hepatocytes.

Inhibition of cell growth and telomerase activity of breast cancer cells in vitro by retinoic acids

The effects of retinoic acid (RA) and its analogs, all-trans RA, 9-cis RA and 13-cis RA, were investigated in human breast cancer MCF-7 cells and immortalized breast epithelial cell line MCF-10A. RA inhibited the telomerase activity of MCF-7 cells in a wide range of concentrations. RA at 10 microM also inhibited the growth of MCF-7 cells in a time-dependent manner. However, no significant growth inhibition was found between untreated control and RA-treated MCF-10A cells. Moreover, a marked inhibition of telomerase activity by RA was detected early in MCF-7 cells (after 24 h of RA treatment), which was preceded by a reduction of hTERT mRNA expression (after 12 h of RA treatment). However, MCF-10A cells showed a reduction of telomerase activity and down-regulation of hTERT after 4 days of RA treatment. Simultaneous changes in hTERT mRNA expression and telomerase activity were found for MCF-10A cells. The expressions of hTR and hTEP1 telomerase component genes were not changed after RA treatment. These results indicate that the anti-breast cancer activity of RA could be mediated by its ability to down-regulate the expression of hTERT telomerase gene.

Anxiety and depression in Taiwanese cancer patients with and without pain

The purpose of this investigation was to compare anxiety and depression in Taiwanese cancer patients with and without pain. In 1998, a convenience sample of 203 hospitalized cancer patients, 77 with pain and 126 without pain, were assessed for anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Disease-related factors such as performance status, disease stage and perceived treatment effect were also assessed and controlled for their effect on anxiety and depression. The prevalence of both anxiety and depression in the pain group was significantly higher than that for the pain-free group. After controlling the effect of disease-related factors, patients' pain status had a significant effect on depression, but not on anxiety. Patients with pain had more depressive symptoms than patients without pain. Cancer patients' anxiety can be predicted significantly by functional status and perceived treatment effect. In addition to pain status, cancer patients' depression can be predicted by their functional status.

Single-agent docetaxel in metastatic breast cancer patients pre-treated with anthracyclines and paclitaxel: partial cross-resistance between paclitaxel and docetaxel

The purpose of this study was a retrospective analysis of docetaxel in a cohort of anthracyclines and paclitaxel pretreated patients with metastatic breast cancer. From July 1998 to June 1999, 24 consecutive patients were included for this study. The regimen consisted of docetaxel 75 mg/m2 in combination with a 3-day schedule of dexamethasone every 3 weeks until disease progression or unacceptable toxicity. The median age of patients was 53 (ranged 32-67) years with a median performance status of 2. Twenty of the 24 patients (84%) had measurable disease. The median number of organs involved was 2 (range 1-4). A total of 146 cycles chemotherapy were given with a mean of 6. There was a 25% (six of 24) overall response rate including one complete response, 37.5% stable disease and 37.5% progressive disease. The major toxicity included grade 3-4 leukopenia (41.7%) and eight episodes of infection. No treatment-related death was observed. The responders included patients refractory to or resistant to prior paclitaxel treatment. The median survival and median time to disease progression was 12 and 9 months, respectively. We conclude that docetaxel has a modest activity in breast cancer patients pre-treated with anthracyclines and paclitaxel, indicating a partial cross-resistance between paclitaxel and docetaxel.