Determinants of accrual of women to a large, multicenter clinical trials program of human immunodeficiency virus infection. The AIDS Clinical Trials Group

To determine factors influencing the enrollment of women in a large multicenter human immunodeficiency virus (HIV) clinical trials program in the United States, we analyzed enrollment and demographic data of the AIDS Clinical Trials Group (ACTG) during the period 1987-90. Women comprised 6.7% of 11,909 ACTG participants enrolled in 1987-90. Women entering ACTG trials were significantly more likely to be white (48.5%) and less likely to have ever used i.v. drugs (22.6%) than U.S. women reported to have AIDS (26.5% were white; 51.0% had ever used i.v. drugs, p < 0.0001). In a multiple logistic regression model, specific attributes of individual trials did not influence enrollment of women with the exception that trials that targeted asymptomatic persons had greater enrollment of women. There was wide variation among research units in the percentage of women enrolled (1.0-37.5%), and evidence of significant regional variation in the ability of units to recruit available women. Units with female principal or coprincipal investigators had more than twice the percentage of female enrollment as units headed by men (10.8 vs. 5.3%, p < 0.001). Enrollment of women in a large HIV clinical trials program was low and appeared to be influenced more by demographic and geographic factors that attributes of specific trials. An apparent positive influence of female leadership on the enrollment of women warrants further study.

New cyanocyclines from a cyanide-treated broth of Streptomyces lusitanus

Organic extracts of Streptomyces lusitanus, the producer of the anticancer antibiotic naphthyridinomycin [1], were found to contain two additional compounds active in an antibiotic screen. As with 1, these reacted with NaCN added at the end of the fermentation. One of the addition products has been named cyanocycline B [3] and is derived from N-desmethylnaphthyridinomycin [4], while the other has been named cyanocycline C [5], and is derived from the hydroquinone 6 of 1. Cyanocycline C is unstable and was characterized after conversion to the dimethyl derivative with CH2N2 in the presence of TFA. The implications of these metabolites for the biosynthesis of 1 are discussed. A third new antibiotic, cyanocycline D [8] was isolated from the cyanide-treated broth and proved to be an artifact in which the oxazolidine ring had been opened by cyanide. The potential relevance of the formation of 8 to the reaction of 1 with DNA is also discussed.

Clinicopathologic analysis of 60 cases of basal cell carcinoma

An analysis of 60 cases of basal cell carcinoma is reported. Among the 60 patients were 29 men and 31 women (1:1.1). Their ages ranged from 22 to 88, with an average of 58.8 years. The courses were from 2 months to more than 20 years, with 50% being less than 5 years. The head and face were the main sites involved. The etiology, clinical appearance, pathologic classification, and clinical therapy of the basaloma are discussed briefly. To minimize the patient's psychological burden, and according to the low rate of metastasis, we suggest that the tumor be designated basaloma or basal cell epithelioma rather than basal cell carcinoma.

Transfection of the mullerian inhibiting substance gene inhibits local and metastatic tumor-growth

Mullerian Inhibiting Substance (MIS), a gonadal growth factor important in sexual differentiation, has antiproliferative activity against several human carcinoma cell lines. In this study, we examine the effect of MIS-transfection on the growth characteristics of Chinese hamster ovary (CHO) and human ocular melanoma (OM431) cells, compared to wild-type lines and a CHO line transfected with a noncleavable, inactive MIS mutant. MIS-transfection inhibited proliferation of CHO cells in double-layer agarose, tumor spheroid, and murine subrenal capsule assays, as well as growth of CHO and OM431 cells in pulmonary metastasis studies. These results anticipate further study of targeted gene therapy of certain human tumors with MIS gene constructs.

Micromanipulation of chromosomes in PTK2 cells using laser microsurgery (optical scalpel) in combination with laser-induced optical force (optical tweezers)

An optical scalpel and optical tweezer have been combined to perform intracellular microsurgery and micromanipulation in vivo. When only laser microsurgery was performed on metaphase chromosomes, the dissected sister chromatid fragments drifted off to either the side of the spindle or completely off the spindle. At anaphase the fragments separated and the two arms generally moved to their respective daughter cells. When the chromosome arm was cut during anaphase A and B, the distal chromosome fragment separated from the rest of the chromosome and moved toward the pole, following the proximal chromosome fragment. Distal chromosome fragments laser-dissected during metaphase were held together throughout anaphase using the optical trap. Optical trapping of dissected chromosome fragments during anaphase A and B inhibited movement of the chromosome fragment to its pole. As a result, the trapped chromosome fragments were (1) incorporated into the opposite daughter cell, (2) lost in the cleavage furrow during cytokinesis, or (3) eventually incorporated into the correct daughter cell. These results indicate that optical traps are effective in holding laser-dissected chromosome fragments throughout mitosis. This new tool should be useful for studies on chromosome movement and cell genetics.

Dual immunologic property of S-100 protein in normal eyes and eyes with retinoblastoma: a histopathological and immunohistochemical study of 88 cases

To ascertain the cell types expressing S-100 protein in eyes with retinoblastoma, a follow-up study was made on 88 formalin-fixed and paraffin-embedded retinoblastoma specimens histopathologically and immunohistochemically, using antibodies against S-100 protein. In normal retinas and morphologically normal retinas with retinoblastoma, both astrocytes and ganglion cells were stained positively for S-100 protein. In the retinoblastomas, not only the reactive astrocytes in most cases, but also large tumor cells with large cell bodies, prominent nucleoli and well-differentiated figures were positive for S-100 proteins in 2 cases. These large tumor cells were thought to be neuronal and were called ganglion-like cells because they were morphologically and immunohistochemically compatible with the large ganglion cells in normal retina. The results indicate that in eyes with retinoblastoma, S-100 protein has both neuronal and glial immunologic properties and could have a limited value as a glial marker for the histogenesis study of retinoblastoma.

A fluorimetric enzyme assay for the diagnosis of Sanfilippo disease type D (MPS IIID)

4-Methylumbelliferyl-alpha-N-acetylglucosamine 6-sulphate was synthesized and shown to be a substrate for the lysosomal N-acetylglucosamine-6-sulphate sulphatase (GlcNAc-6S sulphatase). Fibroblasts and leukocytes from 3 different Sanfilippo D patients showed < 1% of mean normal GlcNAc-6S sulphatase activity. The enzymatic liberation of the fluorochrome from 4-methyl-umbelliferyl-alpha-N-acetylglucosamine 6-sulphate requires the sequential action of the GlcNAc-6S sulphatase and alpha-N-acetylglucosaminidase. A normal level of alpha-N-acetylglucosaminidase activity was insufficient to complete the hydrolysis of the reaction intermediate 4-methylumbelliferyl-alpha-N-acetylglucosaminide formed by the GlcNAc-6S sulphatase. A second incubation in the presence of excess alpha-N-acetylglucosaminidase is needed to avoid underestimation of the GlcNAc-6S sulphatase activity.

Differential effects of interleukin-7 and interleukin-2 on T-cell receptor gamma delta-expressing cells within CD4-CD8- postnatal human thymocytes

Highly purified CD4-8- double-negative (DN) human thymocytes proliferated significantly more in response to interleukin (IL)-7 than to IL-2 in a dose-dependent fashion. Both IL-7 and IL-2 promoted the appearance of T-cell receptor (TCR) gamma delta-expressing cells in single cell suspension culture of DN thymocytes. While IL-7 exerted a vigorous growth-stimulating effect on TCR gamma delta-bearing DN thymocytes, IL-2 preferentially maintained the viability of gamma delta thymocytes without promoting their strong proliferation. In both instances, the major subset of gamma delta thymocytes expressed V delta 1 rather than V delta 2 as a variable delta-chain element on their surface. These results reveal differential effects of IL-7 and IL-2 on TCR gamma delta-bearing human thymocytes and underline the importance of both ILs in the development of DN thymocytes.

A controlled trial of trimethoprim-sulfamethoxazole or aerosolized pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. AIDS Clinical Trials Group Protocol 021

BACKGROUND

Pneumocystis carinii pneumonia (PCP) continues to be the most common index diagnosis in the acquired immunodeficiency syndrome (AIDS), but it is not clear which of several available agents is the most effective in preventing a recurrence of PCP.

METHODS

We conducted a comparative, open-label trial in 310 adults with AIDS who had recently recovered from an initial episode of PCP and had no treatment-limiting toxic effects of trimethoprim-sulfamethoxazole or pentamidine. All the patients were treated with zidovudine and were randomly assigned to receive either 800 mg of sulfamethoxazole and 160 mg of trimethoprim once daily or 300 mg of aerosolized pentamidine administered every four weeks by jet nebulizer. The participants were followed for a median of 17.4 months.

RESULTS

In the trimethoprim-sulfamethoxazole group (n = 154) there were 14 recurrences of PCP, as compared with 36 recurrences (including 1 extrapulmonary recurrence) in the aerosolized-pentamidine group (n = 156). The estimated recurrence rates at 18 months were 11.4 percent with trimethoprim-sulfamethoxazole and 27.6 percent with pentamidine (P < 0.001). The risk of a recurrence (adjusted for initial CD4 cell count) was 3.25 times higher in the pentamidine group (P < 0.001, 95 percent confidence interval, 1.72 to 6.16). There were no significant differences between the groups in survival or in hematologic or hepatic toxicity. Crossovers from trimethoprim-sulfamethoxazole to aerosolized pentamidine were more common than the reverse (27 vs. 4 percent), partly because of the study protocols for the management of leukopenia. There were 19 serious bacterial infections in the trimethoprim-sulfamethoxazole group and 38 in the pentamidine group. The time to a first bacterial infection was significantly greater for those assigned to trimethoprim-sulfamethoxazole (P = 0.017).

CONCLUSIONS

In patients with AIDS who are receiving zidovudine, trimethoprim-sulfamethoxazole is more effective than aerosolized pentamidine in conventional doses for the prevention of recurrent pneumocystis infection.

A reassessment of histologic classification and an immunohistochemical study of 88 retinoblastomas. A special reference to the advent of bipolar-like cells

BACKGROUND

Despite perpetual efforts of investigators, the histogenesis of retinoblastoma is still in dispute and histologic classification satisfactorily predictive of prognosis does not seem to be in use.

METHODS

The authors studied 88 cases of retinoblastoma clinicopathologically and immunohistochemically, paying special attention to the presence of a "bipolar-like cell" element that would be used as one of the criteria for the diagnosis of differentiated retinoblastoma.

RESULTS

Twelve cases of retinoblastoma with the bipolar-like cell element in the absence of rosettes and 41 cases of the tumor with rosettes were classified as differentiated retinoblastomas. The other 35 cases without rosettes or bipolar-like cells were classified as undifferentiated tumors. Tumor cells forming rosettes usually had positive results for synaptophysin and neuron-specific enolase (NSE) and negative results for glial fibrillary acidic protein (GFAP) and S-100 protein; however, undifferentiated cells had negative results for these four antibodies. The bipolar-like cells had positive results for synaptophysin and NSE but negative results for GFAP and S-100 protein. Twelve tumors with bipolar-like cells that lacked rosettes showed no optic nerve invasion, and the patients had a significantly better prognosis (100% 5-year survival rate) than 35 patients with undifferentiated tumors (71% 5-year survival rate) (P < 0.01).

CONCLUSIONS

The findings support a neuronal origin of the tumor and indicate that, not only the rosettes symbolizing the photoreceptor differentiation, but also other neuronal elements, such as bipolar-like cells, can be used as criteria for histologic classification of retinoblastoma.

Tolerance to endotoxin prevents mortality in infected thermal injury: association with attenuated cytokine responses

Endotoxin, a lipopolysaccharide (LPS), is a bacterial cell wall product instrumental in producing deleterious host responses to infection. This LPS appears to act, in part, by triggering release of endogenous mediators such as cytokines. Repeated exposures to endotoxin produce attenuated responses to this molecule. To examine the mechanisms and biologic consequences of this tolerance to LPS, Wistar rats were subjected to a 14-day course of LPS administration. Tolerance to LPS with regard to anorexia, weight loss, and acute-phase responses was noted. Attenuation of these physiologic responses was accompanied by abrogation of circulating cytokine appearance in response to endotoxin, suggesting that tolerance to LPS is in part due to a decreased production of cytokines. Tolerance to LPS also diminished the response to a subsequent infected thermal injury, as measured by food intake, body weight, fibrinogen levels, and mortality. Thus, clinical conditions involving repeated exposure to LPS may modify the host's responses to subsequent injury. The attenuated responses to injury accompanying the decreased production of cytokines further implicate cytokines in the pathogenesis of injury and disease.

Tumour location influences local cytokine production and host metabolism

To determine whether the location of tumour growth influences host cytokine and metabolic responses, experimental subcutaneous (SQ) and liver (LIV) tumours were compared in Buffalo rats. An LIV tumour that was only 1 +/- 1% (P < 0.05 versus SQ) of body weight produced similar anorexia, weight loss, acute phase response, and systemic cytokine responses as are SQ tumour that was 10 +/- 2% of body weight. Neither tumour-bearing group had abnormal liver function tests or evidence of obstructive biliary pathology. Tumour necrosis factor (TNF) was detected by western analysis in both tumour as well as histologically normal liver remote from the tumour in the LIV group but not in livers of animals in freely fed and SQ groups. The proximity of the tumour to competent tissue macrophage populations, such as hepatic Kupffer cells, may be sufficient to induce cachexia. Hence, tumour location may be as important as tumour burden in determining the host's response to cancer.

Micromanipulation of mitotic chromosomes in PTK2 cells using laser-induced optical forces ("optical tweezers")

To study the potential use of optical forces to manipulate chromosome movement, we have used a Nd:YAG laser at a wavelength of 1.06 microns focused into a phase contrast microscope. Metaphase and anaphase chromosomes were exposed while being monitored by video microscopy. The results indicated that when optical forces were applied to late-moving metaphase chromosomes on the side closest to the nearest spindle pole, the trapped chromosomes initiated movement to the metaphase plate. The chromosome velocities were two to eight times the normal rate depending on the chromosome size, geometry, and trapping site. At the initiation of anaphase, a pair of chromatids could be held by the optical trap and kept motionless throughout anaphase while the other pairs of chromatids separated and moved to opposite spindle poles. As a result, the trapped chromosome either was incorporated into one of the daughter cells or was lost in the cleavage furrow, or the two chromatids eventually separated and moved to their respective daughter cells. If the trap was removed at the beginning of anaphase B, the chromosome moved back to the poles. Our experiments demonstrate that the laser-induced optical force trap is a potential new technique to study noninvasively the mitotic spindle of living cells.

Microsurgically generated discontinuities provoke heritable changes in cellular handedness of a ciliate, Stylonychia mytilus

Stylonychia mytilus is a dorsoventrally flattened ciliate with compound ciliary structures arranged in a specific manner on the cell surface. In mirror-image (MI) doublets of this ciliate, two nearly complete sets of ciliary structures are arrayed side-by-side, one in a normal or ‘right-handed’ (RH) arrangement, the other in a reversed or ‘left-handed’ (LH) arrangement. MI-doublets exist in two forms, one with the RH component on the right, the LH component on the left, and feeding structures near the center (‘buccal-adjoining MI-doublet’); the other with the RH component on the left, the LH component on the right, and feeding structures on the lateral edges (‘buccal-opposing MI-doublet’). We describe an operation that can generate either type of MI-doublet. This operation interchanges large anterior and posterior regions of the cell, transposing the original posterior region anteriorly (P—A) and the original anterior region posteriorly (A—P), while retaining the original anteroposterior polarity of each region. Two sets of new ciliary structures then are formed in mirror-image arrangement, with the set in the P—A region oriented normally and the set in the A—P region undergoing a reversal of polarity along its anteroposterior axis. This sometimes creates end-to-end MI forms, but more commonly produces side-by-side MI-doublets through a folding together of the P—A and A—P regions. This folding occurs because one lateral edge of the cell had been removed during the operation; if the left edge was removed, the complex folds to the left and forms a buccal-adjoining MI-doublet, whereas if the right edge was removed, the complex folds to the right and forms a buccal-opposing MI-doublet. Both types can reorganize and later divide true-to-type, although the ‘buccal-opposing’ type is by far the more stable of the two. The generation of mirror-image forms is dependent on the prior abnormal juxtaposition of regions from opposite ends of the cell, and involves a coordinated respecification of large-scale organization. We interpret this response to be a consequence of intercalation of missing intervening positional values in the zone of posterior-anterior abutment.

Reconstruction of the external genitals and repair of skin defects of the perineal region using three types of lateral groin flap

Three types of lateral groin flap have been applied to reconstruct the external genitals and to repair skin defects in the perineal region. A single lateral groin flap was used to construct a vagina for 2 patients who had congenital absence of vagina. A composite flap containing iliac crest bone was applied to reconstruct the penis in 11 patients: 8 suffered traumatic amputation and 3 had congenital micropenis. A coaxial pedicle flap of the lateral groin and abdominal area was used to repair skin defects of the penis and scrotum after resection of the elephantiasis caused by recurrent erysipelas in 2 patients, and to relieve postburn scar contracture in the perineal region in another. Using this operative technique, 14 flaps survived completely with satisfactory results; 70% of one composite flap was lost as a result of hematoma. In the single-flap group, the distal portion (3 x 5 cm) of one flap necrosed and was resected and resurfaced with a free skin graft; the final result was good.

Identification of a novel tumor necrosis factor alpha/cachectin from the livers of burned and infected rats

Tumor necrosis factor alpha (TNF-alpha)/cachectin is a monocyte/macrophage-derived cytokine implicated as a proximal mediator of many of the catastrophic host responses to infection or endotoxin. However, circulating levels of TNF-alpha/cachectin have only been episodically detected in hospitalized patients with life-threatening bacterial infections. In the present report, increased quantities of immune-reactive TNF-alpha/cachectin were recovered from the livers of rats 3 days following a lethal burn and infection. Two species of TNF-alpha/cachectin were detected, one of approximately 29 kd and the other 17 kd, as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. In murine peritoneal macrophages and rat Kupffer cells stimulated in vitro with endotoxin, a 29-kd cell-associated and 17-kd secreted form were also detected. We conclude that the increased appearance in vivo of a 29-kd form of TNF-alpha/cachectin from the livers of lethally burned and infected rats represents a novel cell-associated form of the protein.

A study of the immunofunction in patients of coronary heart disease with the fundamental deficiency and outward excess syndrome

The fundamental deficiency and outward excess syndrome of coronary heart disease can be classified into Qi Yang deficiency with blood stasis (QYD) and Yin deficiency with blood stasis (YD). The patients showed disturbances in immunofunction manifested as marked increase of serum IgG, CIC, IC-IgG and IC-C3 levels and the percentage of B cells in the peripheral blood, while the percentages of OKT3+, OKT4+ and OKT8+ cells markedly decreased, especially the percentage of OKT8+ cells, resulting in an increase of the ratio of T4/8 and imbalance between TS and TH. The authors deem that the fundamental deficiency of coronary heart disease is related to the low cellular immunity, especially the imbalance between TS and TH cells, while outward excess of coronary heart disease is related to hyperactivity of humoral immunity.

Total parenteral nutrition and bowel rest modify the metabolic response to endotoxin in humans

Intestinal mucosal atrophy, as induced by total parenteral nutrition (TPN) and/or prolonged bowel rest, is hypothesized to enhance bowel endotoxin (LPS) translocation and may alter host responses to infection. To examine the effect of TPN-induced bowel atrophy on the response to LPS, 12 healthy volunteers were randomized to receive either enteral feedings (ENT, n = 6) or seven days of TPN without oral intake (TPN, n = 6). Enteral or TPN feedings were terminated 12 hours before the study period when a constant dextrose infusion (50 mg/kg/hour) was initiated and continued throughout the subsequent study period. After placement of arterial, hepatic vein, and femoral vein catheters, metabolic parameters were determined before and for six hours after an intravenous E. coli LPS challenge (20 U/kg). Subsequent peak levels of arterial glucagon (ENT, 189 +/- 39 pg/mL; TPN, 428 +/- 48; p less than 0.01), arterial epinephrine (ENT, 236 +/- 52 pg/mL; TPN, 379 +/- 49; p less than 0.05) and hepatic venous cachectin/tumor necrosis factor (cachectin/TNF) (ENT, 250 +/- 56 pg/mL; TPN, 479 +/- 136; p less than 0.05) were significantly higher in the TPN group than in the ENT group. The extremity efflux of lactate (ENT, -16 +/- 4 micrograms/min-100cc tissue; TPN, -52 +/- 13; t = 2 hours; p less than 0.05) and of amino acids (ENT, -334 +/- 77 nmol/min-100cc tissue; TPN, -884 +/- 58; t = 4 hours; p less than 0.05) were higher in the TPN subjects after the endotoxin challenge. Circulating C-reactive Protein (CRP) levels measured 24 hours postendotoxin were also significantly higher in the TPN subjects (ENT, 1.7 +/- 0.2 mg/dL; TPN, 3.2 +/- 0.3; p less than 0.01). Hence the counter-regulatory hormone and splanchnic cytokine responses to LPS were enhanced after TPN and bowel rest. This is associated with a magnified acute-phase response, peripheral amino acid mobilization, and peripheral lactate production. Thus antecedent TPN may influence the metabolic alterations seen in infection and sepsis via both an exaggerated counter-regulatory hormone response as well as an enhanced systemic and splanchnic production of cytokines.

[Effects of kuo guan powder on immunologic functions in patients with ben-xu biao-shi syndrome in ischemic heart disease]

Ischemic heart disease (IHD) is correlated with the Immunodisturbances. In this study, the immunological effects of Kuo Guan No 1, a powder for aiding Qi and activating the blood, in 17 cases of Qi Yang Xu Xue Yu (QYXXY, ) syndrome, Kuo Guan No 2, powder for nourishing the Yin and activating the blood, in 14 cases of Yin-Xu Xue-Yu (YXXY, ) syndrome had been observed in one month treatment. After treatment with both powder of Kuo Guan No 1 and Kuo Guan No 2, the increased levels of IgG, CIC, IC-IgG and IC-C3 in serum and the numbers of B cells in peripheral blood lymphocyte (PBL) of the patients with Ben-Xu Biao-Shi (BXBS, ) syndrome of IHD angina were markedly decreased and showed no significant difference while compared with the normal controls (P greater than 0.05); the numbers of OKT+3, OKT+4 and OKT+8 cells in PBL, which were lower before treatment in both groups, were obviously increased and showed no marked difference with the controls (P greater than 0.05); the higher ratio of T4/T8 was lowered in group of YXXY syndrome, and showed no difference while compared with the controls (P greater than 0.05), but the ratio in QYXXY syndrome group was lowered than that in the controls (P less than 0.05). After the treatment with Kuo Guan No 1, the increased level of C3 in serum in QYXXY group was lowered down to that of the controls (P greater than 0.05). The results indicated that it is reasonable to consider that "Kuo Guan" powder is an immunoregulative preparation for patients with BXBS syndrome of IHD angina.