Adenosine A2A and A2B receptor expression in neuroendocrine tumours: potential targets for therapy

The clinical management of neuroendocrine tumours is complex. Such tumours are highly vascular suggesting tumour-related angiogenesis. Adenosine, released during cellular stress, damage and hypoxia, is a major regulator of angiogenesis. Herein, we describe the expression and function of adenosine receptors (A(1), A(2A), A(2B) and A(3)) in neuroendocrine tumours. Expression of adenosine receptors was investigated in archival human neuroendocrine tumour sections and in two human tumour cell lines, BON-1 (pancreatic) and KRJ-I (intestinal). Their function, with respect to growth and chromogranin A secretion was carried out in vitro. Immunocytochemical data showed that A(2A) and A(2B) receptors were strongly expressed in 15/15 and 13/18 archival tumour sections. Staining for A(1) (4/18) and A(3) (6/18) receptors was either very weak or absent. In vitro data showed that adenosine stimulated a three- to fourfold increase in cAMP levels in BON-1 and KRJ-1 cells. The non-selective adenosine receptor agonist (adenosine-5'N-ethylcarboxamide, NECA) and the A(2A)R agonist (CGS21680) stimulated cell proliferation by up to 20-40% which was attenuated by A(2B) (PSB603 and MRS1754) and A(2A) (SCH442416) receptor selective antagonists but not by the A(1) receptor antagonist (PSB36). Adenosine and NECA stimulated a twofold increase in chromogranin A secretion in BON-1 cells. Our data suggest that neuroendocrine tumours predominantly express A(2A) and A(2B) adenosine receptors; their activation leads to increased proliferation and secretion of chromogranin A. Targeting adenosine signal pathways, specifically inhibition of A(2) receptors, may thus be a useful addition to the therapeutic management of neuroendocrine tumours.

On the mean and variance of the writhe of random polygons

We here address two problems concerning the writhe of random polygons. First, we study the behavior of the mean writhe as a function length. Second, we study the variance of the writhe. Suppose that we are dealing with a set of random polygons with the same length and knot type, which could be the model of some circular DNA with the same topological property. In general, a simple way of detecting chirality of this knot type is to compute the mean writhe of the polygons; if the mean writhe is non-zero then the knot is chiral. How accurate is this method? For example, if for a specific knot type K the mean writhe decreased to zero as the length of the polygons increased, then this method would be limited in the case of long polygons. Furthermore, we conjecture that the sign of the mean writhe is a topological invariant of chiral knots. This sign appears to be the same as that of an "ideal" conformation of the knot. We provide numerical evidence to support these claims, and we propose a new nomenclature of knots based on the sign of their expected writhes. This nomenclature can be of particular interest to applied scientists. The second part of our study focuses on the variance of the writhe, a problem that has not received much attention in the past. In this case, we focused on the equilateral random polygons. We give numerical as well as analytical evidence to show that the variance of the writhe of equilateral random polygons (of length n) behaves as a linear function of the length of the equilateral random polygon.

Preparation and magnetic properties of cylindrical NiFe films and antidot arrays

Continuous NiFe (Permalloy) cylindrical films and arrays of cylindrical NiFe antidots 7 nm thick have been prepared by sputtering onto cylindrical aluminum wires and onto wires anodized to form a porous anodic alumina layer. The antidots are arranged in a close-packed pattern determined by the hexagonal pore arrangement in the porous alumina, with period 103 nm and diameter 42 nm. Hysteresis loops were measured at different angles with respect to the cylinder axis and indicate an easy plane normal to the radius of the wire. The antidots enhance the coercivity compared to the continuous cylindrical film.

A performance analysis of echographic ultrasonic techniques for non-invasive temperature estimation in hyperthermia range using phantoms with scatterers

Optimization of efficiency in hyperthermia requires a precise and non-invasive estimation of internal distribution of temperature. Although there are several research trends for ultrasonic temperature estimation, efficient equipments for its use in the clinical practice are not still available. The main objective of this work was to research about the limitations and potential improvements of previously reported signal processing options in order to identify research efforts to facilitate their future clinical use as a thermal estimator. In this document, we have a critical analysis of potential performance of previous ultrasonic research trends for temperature estimation inside materials, using different processing techniques proposed in frequency, time and phase domains. It was carried out in phantom with scatterers, assessing at their specific applicability, linearity and limitations in hyperthermia range. Three complementary evaluation indexes: technique robustness, Mat-lab processing time and temperature resolution, with specific application protocols, were defined and employed for a comparative quantification of the behavior of the techniques. The average increment per degrees C and mm was identified for each technique (3 KHz/ degrees C in the frequency analysis, 0.02 rad/ degrees C in the phase domain, while increments in the time domain of only 1.6 ns/ degrees C were found). Their linearity with temperature rising was measured using linear and quadratic regressions and they were correlated with the obtained data. New improvements in time and frequency signal processing in order to reveal the potential thermal and spatial resolutions of these techniques are proposed and their subsequent improved estimation results are shown for simulated and measured A-scans registers. As an example of these processing novelties, an excellent potential resolution of 0.12 degrees C into hyperthermia range, with near-to-linear frequency dependence, could be achieved. Specifically defined "numerical" and physical multi-scatter phantoms are described, which mimic ultrasound velocity in tissues of about 1560 m/s @ 35 degrees C and have a quasi-uniform internal scattering structure designed to assure standard signal patterns adequate for processing comparisons in the same time and sound velocity conditions for all the techniques analyzed, and to obtain easily repeatable multi-pulse echo-patterns. A perfect lineal dependence (100% of correlation coefficient) between the unitary average increment measured by each technique and temperature rising was observed while working with simulated A-scan registers, where all the parameters are under an accurate control. Nevertheless a very small quadratic tendency appeared in the results obtained from experimental echo registers, which are more similar to a real tissues case. It would be an interesting future work to analyze the behavior of these techniques in real tissues in order to confirm or reject this light quadratic tendency. Finally, new methods were detailed and applied in order to precisely quantify the advantages of each estimation technique; their respective intrinsic limitations were also underlined.

Duplex ultrasound evaluation for dialysis access selection and maintenance: a practical guide

Detailed case directed history and examination is the mainstay of dialysis access modality selection, ie site and type of access, as well as for maintenance of dialysis access for longevity. As a logical step following history and physical examination, duplex ultrasound evaluation (DUE) is the most cost effective and non-invasive screening tool for evaluation for access placement and for assessment of an established access. Pre-operative vascular mapping allows selection of the optimal dialysis access modality and site. In established accesses, duplex ultrasound testing will diagnose the majority of vascular access complications and direct proper surgical or interventional radiology management. This review outlines a practical decision-making algorithm using DUE for choosing and managing the dialysis access.

Objects are highlighted by spatial attention

Selective attention may be focused upon a region of interest within the visual surroundings, thereby improving the perceptual quality of stimuli at that location. It has been debated whether this spatially selective mechanism plays a role in the attentive selection of whole objects in a visual scene. The relationship between spatial and object-selective attention was investigated here through recordings of event-related brain potentials (ERPs) supplemented with functional magnetic brain imaging (fMRI). Subjects viewed a display consisting of two bar-shaped objects and directed attention to sequences of stimuli (brief corner offsets) at one end of one of the bars. Unattended stimuli belonging to the same object as the attended stimuli elicited spatiotemporal patterns of neural activity in the visual cortex closely resembling those elicited by the attended stimuli themselves, albeit smaller in amplitude. This enhanced neural activity associated with object-selective attention was localized by use of ERP dipole modeling and fMRI to the lateral occipital extrastriate cortex. We conclude that object-selective attention shares a common neural mechanism with spatial attention that entails the facilitation of sensory processing of stimuli within the boundaries of an attended object.

Objects Are Highlighted by Spatial Attention

Selective attention may be focused upon a region of interest within the visual surroundings, thereby improving the perceptual quality of stimuli at that location. It has been debated whether this spatially selective mechanism plays a role in the attentive selection of whole objects in a visual scene. The relationship between spatial and object-selective attention was investigated here through recordings of event-related brain potentials (ERPs) supplemented with functional magnetic brain imaging (fMRI). Subjects viewed a display consisting of two bar-shaped objects and directed attention to sequences of stimuli (brief corner offsets) at one end of one of the bars. Unattended stimuli belonging to the same object as the attended stimuli elicited spatiotemporal patterns of neural activity in the visual cortex closely resembling those elicited by the attended stimuli themselves, albeit smaller in amplitude. This enhanced neural activity associated with object-selective attention was localized by use of ERP dipole modeling and fMRI to the lateral occipital extrastriate cortex. We conclude that object-selective attention shares a common neural mechanism with spatial attention that entails the facilitation of sensory processing of stimuli within the boundaries of an attended object.

Fumonisins in foods from Cordoba (Argentina), presence and genotoxicity

Fumonisins B(1), B(2)yB(3) (FB(1), FB(2)yFB(3)), are a group of toxins produced by different mold species, Fusarium moniliforme and Fusarium proliferatum being the most important ones. Its compounds were tested in chromosome aberrations (CA), sister chromatid exchange (SCE), and micronucleus (MN) in human lymphocytes, and, in Allium cepa (onion), the chromosomal aberrations (CA) assay was used. Moreover, the presence of fumonisins and their producer moulds was determined in different food substrata in Cordoba city, Argentina. Cytogenetic studies using FB(1), FB(2) and FB(3) levels gave positive results for the higher concentrations (5 and 10mug/g) with FB(1). As regards the cytogenetic aspect of FB(1), we found an increase in the incidence of genetic damage measured by chromosomal aberrations, sister chromatid exchange, micronuclei and chromosomal aberrations in Allium cepa. These results indicate that human lymphocytes cells and plants cells (Allium cepa) have a very sensitive cellular response to the mycotoxin fumonisin B(1) as observed at the highest concentrations.

In vivo mammary tumourigenesis in the Sprague-Dawley rat and microdosimetric correlates

Standard methods for risk assessments resulting from human exposures to mixed radiation fields in Space consisting of different particle types and energies rely upon quality factors. These are generally defined as a function of linear energy transfer (LET) and are assumed to be proportional to the risk. In this approach, it is further assumed that the risks for single exposures from each of the radiation types add linearly. Although risks of cancer from acute exposures to photon radiations have been measured in humans, quality factors for protons and ions of heavier atomic mass are generally inferred from animal and/or cellular data. Because only a small amount of data exists for such particles, this group has been examining tumourigenesis initiated by energetic protons and iron ions. In this study, 741 female Sprague-Dawley rats were irradiated or sham irradiated at approximately 60 days of age with 250 MeV protons, 1 GeV/nucleon iron ions or both protons and iron ions. The results suggest that the risk of mammary tumours in the rats sequentially irradiated with 1 GeV/nucleon 56Fe ions and 250 MeV protons is less than additive. These data in conjunction with earlier results further suggest that risk assessments in terms of only mean LETs of the primary cosmic rays may be insufficient to accurately evaluate the relative risks of each type of particle in a radiation field of mixed radiation qualities.

Mice heterozygous for the ATM gene are more sensitive to both X-ray and heavy ion exposure than are wildtypes

Previous studies have shown that the eyes of ATM heterozygous mice exposed to low-LET radiation (X-rays) are significantly more susceptible to the development of cataracts than are those of wildtype mice. The findings, as well as others, run counter to the assumption underpinning current radiation safety guidelines, that individuals are all equally sensitive to the biological effects of radiation. A question, highly relevant to human space activities is whether or not, in similar fashion there may exist a genetic predisposition to high-LET radiation damage. Mice haplodeficient for the ATM gene and wildtypes were exposed to 325 mGy of 1 GeV/amu 56Fe ions at the AGS facility of Brookhaven National Laboratory. The fluence was equivalent to 1 ion per lens epithelial cell nuclear area. Controls consisted of irradiated wildtype as well as unirradiated wildtype and heterozygous mice. Prevalence analyses for stage 0.5-3.0 cataracts indicated that not only cataract onset but also progression were accelerated in the mice haplo-deficient for the ATM gene. The data show that heterozygosity for the ATM gene predisposes the eye to the cataractogenic influence of heavy ions and suggest that ATM heterozygotes in the human population may also be radiosensitive. This may have to be considered in the selection of individuals who will be exposed to both HZE particles and low-LET radiation as they may be predisposed to increased late normal tissue damage.

Chromosome spatial clustering inferred from radiogenic aberrations

PURPOSE

Analysing chromosome aberrations induced by low linear energy transfer (LET) radiation in order to characterize systematic spatial clustering among the 22 human autosomes in human lymphocytes and to compare their relative participation in interchanges.

MATERIALS AND METHODS

A multicolour fluorescence in situ hybridization (mFISH) data set, specifying colour junctions in metaphases of human peripheral blood lymphocytes 72 h after in vitro exposure to low LET radiation, was analysed separately and in combination with previously published results. Monte Carlo computer simulations and mathematical modelling guided data analysis.

RESULTS AND CONCLUSIONS

Statistical tests on aberration data confirmed two clusters of chromosomes, [1, 16, 17, 19, 22] and [13, 14, 15, 21, 22], as having their members being on average closer to each other than randomness would predict. The first set has been reported previously to be near the centre of the interphase nucleus and to be formed mainly by gene-rich chromosomes, while the second set comprises the nucleolus chromosomes. The results suggest a possible interplay between chromosome positioning and transcription. A number of other clusters suggested in the literature were not confirmed and considerable randomness of chromosome-chromosome juxtapositions was present. In addition, and consistent with previous results, it was found that chromosome participation in interchanges is approximately proportional to the two-thirds power of the DNA content.

Effects of heavy ions on visual function and electrophysiology of rodents: the ALTEA-MICE project

ALTEA-MICE will supplement the ALTEA project on astronauts and provide information on the functional visual impairment possibly induced by heavy ions during prolonged operations in microgravity. Goals of ALTEA-MICE are: (1) to investigate the effects of heavy ions on the visual system of normal and mutant mice with retinal defects; (2) to define reliable experimental conditions for space research; and (3) to develop animal models to study the physiological consequences of space travels on humans. Remotely controlled mouse setup, applied electrophysiological recording methods, remote particle monitoring, and experimental procedures were developed and tested. The project has proved feasible under laboratory-controlled conditions comparable in important aspects to those of astronauts' exposure to particle in space. Experiments are performed at the Brookhaven National Laboratories [BNL] (Upton, NY, USA) and the Gesellschaft für Schwerionenforschung mbH [GSI]/Biophysik (Darmstadt, FRG) to identify possible electrophysiological changes and/or activation of protective mechanisms in response to pulsed radiation. Offline data analyses are in progress and observations are still anecdotal. Electrophysiological changes after pulsed radiation are within the limits of spontaneous variability under anesthesia, with only indirect evidence of possible retinal/cortical responses. Immunostaining showed changes (e.g. increased expression of FGF2 protein in the outer nuclear layer) suggesting a retinal stress reaction to high-energy particles of potential relevance in space.

Detection of microlesions induced by heavy ions using liposomes filled with fluorescent dye

In cells irradiation by heavy ions has been hypothesized to produce microlesions, regions of local damage. In cell membranes this damage is thought to manifest itself in the form of holes. The primary evidence for microlesions comes from morphological studies of cell membranes, but this evidence is still controversial, especially since holes also have been observed in membranes of normal, nonirradiated, cells. However, it is possible that damage not associated with histologically discernable disruptions may still occur. In order to resolve this issue, we developed a system for detecting microlesions based on liposomes filled with fluorescent dye. We hypothesized that if microlesions form in these liposomes as the result of irradiation, then the entrapped dye will leak out into the surrounding medium in a measurable way. Polypropylene vials containing suspensions of vesicles composed of either dipalmitoyl phosphatidylcholine, or a combination of egg phosphatidylcholine and cholesterol were irradiated at the Brookhaven National Laboratory using 56Fe ions at 1 GeV/amu. In several cases we obtained a significant loss of the entrapped dye above the background level. Our results suggest that holes may form in liposomes as the result of heavy ion irradiation, and that these holes are large enough to allow leakage of cell internal contents that are at least as large as a 1 nm diameter calcein molecule.

The ALTEA/ALTEINO projects: studying functional effects of microgravity and cosmic radiation

The ALTEA project investigates the risks of functional brain damage induced by particle radiation in space. A modular facility (the ALTEA facility) is being implemented and will be operated in the International Space Station (ISS) to record electrophysiological and behavioral descriptors of brain function and to monitor their time dynamics and correlation with particles and space environment. The focus of the program will be on abnormal visual perceptions (often reported as "light flashes" by astronauts) and the impact on retinal and brain visual structures of particle in microgravity conditions. The facility will be made available to the international scientific community for human neurophysiological, electrophysiological and psychophysics experiments, studies on particle fluxes, and dosimetry. A precursor of ALTEA (the 'Alteino' project) helps set the experimental baseline for the ALTEA experiments, while providing novel information on the radiation environment onboard the ISS and on the brain electrophysiology of the astronauts during orbital flights. Alteino was flown to the ISS on the Soyuz TM34 as part of mission Marco Polo. Controlled ground experiments using mice and accelerator beams complete the experimental strategy of ALTEA. We present here the status of progress of the ALTEA project and preliminary results of the Alteino study on brain dynamics, particle fluxes and abnormal visual perceptions.

Computer analysis of mFISH chromosome aberration data uncovers an excess of very complicated metaphases

PURPOSE

To analyse spectra of chromosome aberrations induced in vitro by low LET radiation, in order to characterize radiation damage mechanisms quantitatively.

METHODS

Multiplex fluorescence in situ hybridization (mFISH) allows the simultaneous identification of each homologous chromosome pair by its own colour. mFISH data, specifying number distributions for colour junctions in metaphases of human peripheral blood lymphocytes 72 hours after exposure in vitro to a 3 Gy gamma-ray dose, were combined with similar, previously published results. Monte Carlo computer implementations of radiobiological models for chromosome aberration production guided quantitative analyses, which took into account distribution of cells among different metaphases and lethal effects or preferential elimination of some aberrations at cell division.

RESULTS AND CONCLUSIONS

Standard models of DNA damage induction/repair/misrepair explain the main trends of the data as regards the fraction of metaphases having a particular number of colours involved in colour junctions. However, all standard models systematically under-predict the observed fraction of metaphases where a large number of different chromosomes participate in aberrations. An early appearance of chromosomal instability could explain most of the discrepancies.

Sensory and motor attentional modulation during the manual gap effect in humans: a high-density ERP study

The present study investigated reaction time (RT) and event-related potential (ERP) differences between gap and step conditions using visual stimulation and manual responses. RTs during the gap condition were facilitated with respect to those of the step condition. The ERPs, which were obtained from electrodes placed at 58 scalp sites, showed differences when the gap and step conditions were compared for the following components: an early positive component centred at the vertex, an enhanced P1 component, a frontal negativity, a negative lateralized motor potential, and an increased P3. All these results suggest that the facilitation induced by the gap is mediated by a modulation of the neural circuits involved in sensory, motor, and cognitive functions.

Fluorodeoxyuridine improves imaging of human glioblastoma xenografts with radiolabeled iododeoxyuridine

Use of radiolabeled nucleotides for tumor imaging is hampered by rapid in vivo degradation and low DNA-incorporation rates. We evaluated whether blocking of thymidine (dThd) synthesis by 5-fluoro-2'-deoxyuridine (FdUrd) could improve scintigraphy with radio-dThd analogues, such as 5-iodo-2'-deoxyuridine (IdUrd). We first show in vitro that coincubation with FdUrd substantially increased incorporation of [125I]IdUrd and [3H]dThd in the three tested human glioblastoma lines. Flow cytometry analysis showed that a short coincubation with FdUrd (1 h) produces a signal increase per labeled cell. We then measured biodistribution 24 h after i.v. injection of [125I]IdUrd in nude mice s.c. xenografted with the three glioblastoma lines. Compared with animals given [125I]IdUrd alone, i.v. preadministration for 1 h of 10 mg/kg FdUrd increased the uptake of [125I]IdUrd in the three tumors 4.8-6.8-fold. Compatible with previous reports, there were no side effects in mice observed for 2 months after receiving such a treatment. The tumor uptake of [125I]IdUrd was increased < or =13.6-fold when FdUrd preadministration was stepwise reduced to 1.1 mg/kg. Uptake increases remained lower (between 1.7- and 5.8-fold) in normal proliferating tissues (i.e., bone marrow, spleen, and intestine) and negligible in quiescent tissues. DNA extraction showed that 72-80% of radioactivity in tumor and intestine was bound to DNA. Scintigraphy of xenografted mice was performed at different times after i.v. injection of 3.7 MBq [125I]IdUrd. Tumor detection was significantly improved after FdUrd preadministration while still equivocal after 24 h in mice given [125I]IdUrd alone. Furthermore, background activity could be greatly reduced by p.o. administration of KClO4 in addition to potassium iodide. We conclude that FdUrd preadministration may improve positron or single photon emission tomography with cell division tracers, such as radio-IdUrd and possibly other dThd analogues.

Transmyocardial laser revascularization dose response: enhanced perfusion in a porcine ischemia model as a function of channel density

BACKGROUND

Transmyocardial laser revascularization (TMR) appears to provide symptomatic relief to patients with ischemic heart disease, but evidence that TMR enhances perfusion to ischemic myocardium remains limited. Furthermore, it is uncertain whether there exists a TMR dose-response relationship that is a function of channel number. We therefore compared restoration of blood flow as analyzed by rest and stress 99mTc-sestamibi scans and histologic grading of neovascularization after 50-channel, 25-channel, or 10-channel TMR using the excimer laser in an established model of porcine myocardial ischemia.

METHODS

Yorkshire swine underwent a thoracotomy and placement of an ameroid constrictor around the proximal circumflex coronary artery. Three weeks later, the animals underwent resting and adenosine stress 99mTc-sestamibi scans for evaluation of ischemia immediately before repeat thoracotomy and TMR with either 50 channels (n = 4), 25 channels (n = 4), or 10 channels (n = 4) in the circumflex territory. The animals underwent repeat perfusion analyses 4 weeks later, after which the animals were sacrificed and the hearts were perfusion fixed for histologic evaluation of neovascularization.

RESULTS

All animals survived to sacrifice. Semiquantitative analyses of the sestamibi perfusion scans 4 weeks after lasing demonstrated significant improvement (p < 0.04) in stress-induced ischemia in the 50-channel TMR animals, but not in the 25- or 10-channel TMR groups, as compared with scans obtained immediately before lasing. A computerized image analysis of perfusion scans similarly demonstrated an improvement in the area of ischemia of 42% +/- 22% in the scans obtained 4 weeks after lasing compared with scans obtained immediately before lasing in the 50-channel group (p < 0.004), but only a 12% +/- 9% improvement in the 25-channel group and an 8% +/- 4% improvement in the 10-channel group (p > 0.05). Histologic assessment of neovascularization demonstrated significantly greater number of microvessels per low-power field in the 50- versus the 25- and 10-channel groups (p < 0.001).

CONCLUSIONS

In an animal model of myocardial ischemia, TMR appears to enhance myocardial perfusion. A dose-response relationship related to channel number may be of significance when evaluating the efficacy of various treatment strategies.

Shear-induced degradation of linear polyacrylamide solutions during pre-electrophoretic loading

Electrophoretic channels are filled with a polymer matrix prior to their use in DNA separations. This process, called gel-loading, can be accomplished manually, using syringes, or can be automated through the use of small pumps or vacuum. The injection rate is constrained by the desire to minimize shear-induced degradation of the polymer molecules. Currently, the community lacks quantitative data with which to gauge the range of flow rates that prevent polymer degradation. In this study, measurements of the zero shear rate viscosity of linear polyacrylamide (LPA) solutions are used to determine the LPA molecular weight before and after gel-loading. The results indicate molecular degradation in polymer solutions even when injected at minimal flow rates of 1 microL/min. To correlate these rheological observations of shear-induced degradation with subsequent electrophoretic performance, the degraded solutions were used as sieving matrixes for DNA sequencing analysis. The decreases in electrophoretic resolution and increases in peak widths between sheared and nonsheared LPA solutions are related to the degradation in molecular weight experienced by the polymer solutions.

Early lung cancer action project: initial findings on repeat screenings

BACKGROUND

The Early Lung Cancer Action Project (ELCAP) was designed to evaluate the usefulness of annual computed tomography (CT) screening for lung carcinoma. With the baseline results having been reported previously, the focus of the current study was on the early results of the repeat screenings.

METHODS

A cohort of 1000 high-risk individuals was recruited for baseline and annual repeat CT screening. At last follow-up, a total of 1184 annual repeat screenings had been performed. A positive result from the screening test was defined as newly detected, one to six noncalcified pulmonary nodules with interim growth. The diagnostic workup of the individuals was guided by recommendations supplied by the ELCAP investigators to the collaborating clinicians.

RESULTS

Of the 1184 repeat CT screenings, the test result was positive in 30 (2.5%). In 2 of these 30 cases, the individual died (of an unrelated cause) before diagnostic workup and the nodule(s) resolved in another 12 individuals. In the remaining 16 individuals, the absence of further growth was documented by repeat CT in 8 individuals and further growth was documented in the remaining 8 individuals. All eight individuals with further nodular growth underwent biopsy and malignancy was diagnosed in seven. Six of these seven malignancies were nonsmall cell carcinomas (five of which were Stage IA and one of which was Stage IIIA) and the one small cell carcinoma was found to be of limited stage. The median size dimension of these malignancies was 8 mm. In another two subjects, symptoms prompted the interim diagnosis of lung carcinoma. Neither of these malignancies was nodule-associated but rather were endobronchial; one was a Stage IIB nonsmall cell carcinoma and the other was a small cell carcinoma of limited stage.

CONCLUSIONS

False-positive screening test results are uncommon and usually manageable without biopsy; compared with no screening, such screenings permit diagnosis at substantially earlier and thus more curable stages. Annual repetition of CT screening is sufficient to minimize symptom-prompted interim diagnoses of nodule-associated malignancies.

Early lung cancer action project: initial findings on repeat screenings

BACKGROUND

The Early Lung Cancer Action Project (ELCAP) was designed to evaluate the usefulness of annual computed tomography (CT) screening for lung carcinoma. With the baseline results having been reported previously, the focus of the current study was on the early results of the repeat screenings.

METHODS

A cohort of 1000 high-risk individuals was recruited for baseline and annual repeat CT screening. At last follow-up, a total of 1184 annual repeat screenings had been performed. A positive result from the screening test was defined as newly detected, one to six noncalcified pulmonary nodules with interim growth. The diagnostic workup of the individuals was guided by recommendations supplied by the ELCAP investigators to the collaborating clinicians.

RESULTS

Of the 1184 repeat CT screenings, the test result was positive in 30 (2.5%). In 2 of these 30 cases, the individual died (of an unrelated cause) before diagnostic workup and the nodule(s) resolved in another 12 individuals. In the remaining 16 individuals, the absence of further growth was documented by repeat CT in 8 individuals and further growth was documented in the remaining 8 individuals. All eight individuals with further nodular growth underwent biopsy and malignancy was diagnosed in seven. Six of these seven malignancies were nonsmall cell carcinomas (five of which were Stage IA and one of which was Stage IIIA) and the one small cell carcinoma was found to be of limited stage. The median size dimension of these malignancies was 8 mm. In another two subjects, symptoms prompted the interim diagnosis of lung carcinoma. Neither of these malignancies was nodule-associated but rather were endobronchial; one was a Stage IIB nonsmall cell carcinoma and the other was a small cell carcinoma of limited stage.

CONCLUSIONS

False-positive screening test results are uncommon and usually manageable without biopsy; compared with no screening, such screenings permit diagnosis at substantially earlier and thus more curable stages. Annual repetition of CT screening is sufficient to minimize symptom-prompted interim diagnoses of nodule-associated malignancies.

Viral strain identification in varicella vaccinees with disseminated rashes

BACKGROUND

Approximately 15% of recipients of live attenuated varicella vaccine may develop mild breakthrough varicella months to years after immunization. Although some vaccinees will develop zoster, it is less common in recipients of vaccine than in those who have had natural varicella.

OBJECTIVE

To determine the varicella-zoster virus (VZV) strain responsible for breakthrough varicella and zoster in recipients of varicella vaccine.

METHODS

A PCR assay capable of distinguishing wild-type from vaccine strain VZV was performed on samples from skin lesions from vaccinees with breakthrough varicella and zoster.

RESULTS

All of 57 vaccinees with breakthrough varicella, clinically diagnosed on the basis of a generalized maculopapular or vesicular rash, in which there was amplifiable DNA [corrected], had wild-type VZV infection based on analysis of viral DNA. The Oka vaccine strain of VZV was not identified in any of these cases. In contrast, in 32 patients with zosteriform rashes, the vaccine strain was identified in 22 samples, and the wild-type strain was identified in 10 samples.

CONCLUSIONS

Wild-type virus was identified in all generalized rashes occurring after the immediate 6-week postvaccination period. When reactivation of vaccine strain occurred, it presented as typical zoster. We find no evidence that reactivation of vaccine virus occurs with the clinical picture of generalized rash.

Conservation of the respiratory syncytial virus SH gene

Respiratory syncytial virus (RSV) encodes a short (64 or 65 amino acids) hydrophobic (SH) protein whose function in viral replication and pathogenesis is not understood. We carried out molecular epidemiological studies of the SH gene during the 1998-1999 seasonal epidemic in New Haven, Connecticut. Strains circulating during the epidemic were related to viruses identified worldwide. The SH gene transcriptional control signals were conserved in 70 (98.6%) of 71 isolates that we sequenced. The deduced amino acid sequence of the SH protein was nearly identical to subgroup A and subgroup B reference strains that were isolated in 1961 and 1962, respectively. Twenty-six (96.3%) of 27 subgroup A strains contained 0 or 1 amino acid substitution, compared with that of the reference A2 strain. Most subgroup B isolates (38 [86.4%] of 44 strains) contained 0, 1, or 2 amino acid substitutions, compared with that of the reference B18537 strain.

Impaired expression of the uncoupling protein-3 gene in skeletal muscle during lactation: fibrates and troglitazone reverse lactation-induced downregulation of the uncoupling protein-3 gene

The expression of uncoupling protein (UCP)-3 mRNA in skeletal muscle is dramatically reduced during lactation in mice. The reduction in UCP-3 mRNA levels lowers the amount of the UCP-3 protein in skeletal muscle mitochondria during lactation. Spontaneous or abrupt weaning reverses the downregulation of the UCP-3 mRNA but not the reduction in UCP-3 protein levels. In lactating and virgin mice, however, fasting increases UCP-3 mRNA levels. Changes in UCP-3 mRNA occur in parallel with modifications in the levels of free fatty acids, which are reduced in lactation and are upregulated due to weaning or fasting. Modifications in the energy nutritional stress of lactating dams achieved by manipulating litter sizes do not influence UCP-3 mRNA levels in skeletal muscle. Conversely, when mice are fed a high-fat diet after parturition, the downregulation of UCP-3 mRNA and UCP-3 protein levels due to lactation is partially reversed, as is the reduction in serum free fatty acid levels. Treatment of lactating mice with a single injection of bezafibrate, an activator of the peroxisome proliferator-activated receptor (PPAR), raises UCP-3 mRNA in skeletal muscle to levels similar to those in virgin mice. 4-chloro-6-[(2,3-xylidine)-pirimidinylthio] acetic acid (WY-14,643), a specific ligand of the PPAR-alpha subtype, causes the most dramatic increase in UCP-3 mRNA, whereas troglitazone, a specific activator of PPAR-gamma, also significantly increases UCP-3 mRNA abundance in skeletal muscle of lactating mice. However, in virgin mice, bezafibrate and WY-14,643 do not significantly affect UCP-3 mRNA expression, whereas troglitazone is at least as effective as it is in lactating dams. It is proposed that the UCP-3 gene is regulated in skeletal muscle during lactation in response to changes in circulating free fatty acids by mechanisms involving activation of PPARs. The impaired expression of the UCP-3 gene is consistent with the involvement of UCP-3 gene regulation in the reduction of the use of fatty acids as fuel by the skeletal muscle and in impaired adaptative thermogenesis, both of which are major metabolic adaptations that occur during lactation.

Correction of high astigmatism with astigmatic keratotomy combined with laser in situ keratomileusis

PURPOSE

To evaluate the efficacy, predictability, and stability of a combined procedure, arcuate keratotomy and laser in situ keratomileusis (LASIK), for the correction of high astigmatism.

SETTING

Instituto de Microcirugía Ocular (IMO), Barcelona, Spain.

METHODS

Fifteen eyes of 11 patients with naturally occurring astigmatism (NOA) (86. 66%) or surgically induced astigmatism (SIA) (13.34%) between -3.00 and -8.00 diopters (D) who had astigmatic keratotomy were studied. The patients had a secondary procedure, LASIK, to correct the residual refractive error.

RESULTS

Mean baseline spherical equivalent refraction was -2.47 D +/- 3.69 (SD) and mean refractive cylinder, -4.59 +/- 1.66 D. Twelve months after LASIK, mean spherical equivalent was -0.09 +/- 1.50 D and the mean refractive cylinder, -1. 21 +/- 1.07 D. The mean cylindrical correction attempted in the NOA group was -4.05 +/- 1.19 D and in the SIA group, -7.00 +/- 1.41 D. Postoperatively, the values were -1.50 +/- 1.17 D and -1.62 +/- 0.17 D, respectively. Twelve months after LASIK, the uncorrected visual acuity (UCVA) was 0.5 +/- 0.1. The UCVA in the NOA group (0.50 +/- 0. 08) was better than in the SIA group (0.32 +/- 0.10). The efficacy index was 0.96 overall. Best corrected visual acuity deteriorated by 1 Snellen line in 1 case (6.6%) but improved by 1 and 2 Snellen lines in 4 cases (26.6%) and 2 cases (13.3%), respectively. All procedures were completed without adverse reactions intraoperatively or postoperatively.

CONCLUSION

This combined technique was effective in the treatment of high astigmatism, with excellent results compared with the results of each procedure alone. Because of its high predictability, we strongly recommend the technique in cases with astigmatism higher than 3.0 D, particularly in those with astigmatism higher than 5.0 D.

Changes in plasma norepinephrine and endothelin levels and metabolic profile after AT1-receptor blockade in human hypertension

In essential hypertensive subjects, acute and chronic administration of losartan was followed by favorable neurohormonal (norepinephrine, endothelin-1) and metabolic changes (microalbuminuria).

Special techniques in transthoracic needle biopsy of pulmonary nodules

We believe that each aspect of the performance of TNB needs to be considered carefully. Meticulous attention to detail allows any nodule in the chest to successfully undergo biopsy. There are techniques of needle tip repositioning that can be quite helpful for obtaining diagnostic material from lung lesions, particularly small nodules. A strong working relationship with pathologists experienced in lung cytology is a vital element of any successful biopsy program. Techniques available to the pathologist allow for quick and decisive determination of the adequacy of the aspirated specimen and help guide the radiologist performing the procedure. Newer cytopathologic techniques help the pathologist make more complex diagnoses from the aspirated material. Finally, techniques used to minimize complications should be considered by the operator before the performance of the biopsy.

The short interspersed repetitive element of Trypanosoma cruzi, SIRE, is part of VIPER, an unusual retroelement related to long terminal repeat retrotransposons

The short interspersed repetitive element (SIRE) of Trypanosoma cruzi was first detected when comparing the sequences of loci that encode the TcP2beta genes. It is present in about 1,500-3,000 copies per genome, depending on the strain, and it is distributed in all chromosomes. An initial analysis of SIRE sequences from 21 genomic fragments allowed us to derive a consensus nucleotide sequence and structure for the element, consisting of three regions (I, II, and III) each harboring distinctive features. Analysis of 158 transcribed SIREs demonstrates that the consensus is highly conserved. The sequences of 51 cDNAs show that SIRE is included in the 3' end of several mRNAs, always transcribed from the sense strand, contributing the polyadenylation site in 63% of the cases. This study led to the characterization of VIPER (vestigial interposed retroelement), a 2,326-bp-long unusual retroelement. VIPER's 5' end is formed by the first 182 bp of SIRE, whereas its 3' end is formed by the last 220 bp of the element. Both SIRE moieties are connected by a 1,924-bp-long fragment that carries a unique ORF encoding a complete reverse transcriptase-RNase H gene whose 15 C-terminal amino acids derive from codons specified by SIRE's region II. The amino acid sequence of VIPER's reverse transcriptase-RNase H shares significant homology to that of long terminal repeat retrotransposons. The fact that SIRE and VIPER sequences are found only in the T. cruzi genome may be of relevance for studies concerning the evolution and the genome flexibility of this protozoan parasite.

[Arteriovenous malformations in the jaws. The place of intravascular therapy. Apropos of 14 cases]

PURPOSE

To analyze arteriovenous malformations (AVMs) of maxillo-mandibular arcades seen in our department since 1977, and to determine adequate treatment.

MATERIAL AND METHODS

Fourteen AVMs were reviewed to determine their revelation, their semiology, the treatment applied and the results that could be obtained. All these lesions were true AV shunts involving bone with or without soft tissue extension.

RESULTS

Eight patients belonged to the pediatric population. Six lesions were maxillary and 8 mandibular. All lesions were revealed during or after puberty by local swelling, pain, mass effect or bruit. Hemorrhage was the most frequent (71%) symptom. Teeth instability was detected in all these patients and was origin of the bleeding. The lesions were suspected clinically and confirmed radiologically. Angiography analyzed properly the architecture of the lesion (4 arteriovenous fistulas). Embolization was the clinical treatment in all patients: particles helped to stabilize the acute situations but failed to offer stable results, necessitating complementary embolizations and/or surgery (hemimandibulectomy in 2 patients). The use of acrylic glue (Histoacryl), injected percutaneously (5 patients), or transarterially in the AVM (4 patients)) provided cure in 6 of these lesions (43%) and long term stabilization for all the other AVMs. Teeth extraction could be performed thereafter in good conditions. Antibiotics and anti-inflammatory treatment helped to stabilize the evolutive risk of these lesions.

CONCLUSION

Embolization is the therapy of choice in these lesions. Appropriate use of glue offers a high rate of cure and/or clinical stabilizations and avoids unneeded surgery.

Combined surgery to correct high myopia: iris claw phakic intraocular lens and laser in situ keratomileusis

PURPOSE

To evaluate the results of combined surgery, implantation of an Artisan phakic iris claw intraocular lens (IOL) followed by laser in situ keratomileusis (LASIK) to correct high myopia.

METHODS

A prospective study of 6 patients (8 eyes) with high myopia who had Artisan phakic IOL implantation followed by LASIK was undertaken. The IOL was a standard -15.00-D, 6-mm diameter optical zone. Residual refractive error was corrected by LASIK. Mean follow-up was 16 +/- 4 months (range, 12 to 20 mo).

RESULTS

After the second procedure (LASIK), uncorrected visual acuity ranged from 0.4 to 0.63 (mean, 0.5 +/- 0.07) at 1 month and from 0.6 to 0.7 (mean, 0.62 +/- 0.04) at 12 months. Spectacle-corrected visual acuity improved 2 or more lines in 62.5% (5 eyes) from preoperative values. Mean postoperative spherical equivalent refraction was -0.68 +/- 0.23 at 1 month and -0.35 +/- 0.22 at 12 months after LASIK. All eyes were within +/-1.00 D of emmetropia following the LASIK portion of the two-stage procedure and 5 eyes were within +/-0.50 D. We had no major complications. No significant endothelial damage occurred.

CONCLUSIONS

The accurate refractive outcome, absence of major complications, stability of results, and most important, improvement in quality of vision (defined as no change in vision when illumination conditions varied, eg, at night) experienced by these highly myopic patients are reasons to continue using and improving this combined technique.

Cyclosporin A does not increase the oxidative susceptibility of low density lipoprotein in vitro

Accelerated atherosclerosis is the leading cause of morbidity in renal transplant recipients. The pathogenic mechanisms responsible for the progression of atherosclerosis in renal transplant recipients have not been elucidated. Cyclosporin A (CsA) is an immunosuppressive agent used post-transplant and may contribute to increased oxidative susceptibility of low density lipoprotein (LDL). There is a paucity of data testing the effect of CsA on LDL oxidation. Hence, the aim of this study was to test the effect of in vitro enrichment of LDL with CsA on LDL oxidation. LDL oxidation in presence of different concentrations of CsA was tested using metal-dependent (copper), metal-independent (AAPH) and cell-mediated (macrophages) oxidation systems. In all 3 systems, CsA had no significant effect on LDL oxidation. Also, pre-incubation of LDL with CsA did not affect LDL oxidation and LDL alpha tocopherol levels. Thus, the results of our studies with CsA indicate that it is not a direct pro-oxidant.

Production of carotenoids by phaffia rhodozyma growing on media made from hemicellulosic hydrolysates of eucalyptus globulus wood

Phaffia rhodozyma NRRL Y-17268 cells were proliferated in xylose-containing media made from Eucalyptus wood. Wood samples were subjected to acid hydrolysis under mild operational conditions, and hydrolysates were neutralized with lime. Neutralized hydrolysates were treated with charcoal for removing inhibitors and then supplemented with nutrients to obtain culture media useful for proliferation of the red yeast P. rhodozyma. A set of experiments carried out in orbital shakers proved that hydrolysates containing 16.6 g xylose/L supplemented only with 3 g peptone/L performed well as fermentation media. At the end of experiments, xylose was depleted and 10.5 g cells/L were obtained. Biomass was highly pigmented and volumetric carotenoid concentrations up to 5.8 mg carotenoids/L (with 4.6 mg astaxanthin/L) were reached. Further experiments in batch fermentors using concentrated hydrolysates (initial xylose concentrations within 16.6 and 40.8 g/L) led to good biomass concentrations (up to 23.2 g cells/L) with increased pigment concentration (up to 12.9 mg total carotenoids/L, with 10.4 mg astaxanthin/L) and high volumetric rates of carotenoid production (up to 0.079 mg/L.h). Copyright 1998 John Wiley & Sons, Inc.