Immunohistochemical localization of lysosomal cathepsin D in schwannomas

The immunohistochemical localization of cathepsin D (CD) was demonstrated for the first time in 54 schwannomas (32 intra- and 22 extracranial; 47 benign and 7 malignant) and 5 normal nerve fibers. Granular or vesicular CD-reactive structures were observed in all normal Schwann cells. All tumors contained CD-reactive tumor cells, although the population of CD-reactive tumor cells, the density, intracellular localization, and morphology of CD-reactive structures, and the intensity of CD immunoreactivity varied from case to case, portion to portion, and cell to cell, differing variously from those in normal Schwann cells. The variations were greater in malignant than in benign schwannomas. In mildly degenerate tumor cells, CD immunoreactivity was increased, possibly in response to the increased intracellular degenerate proteins, suggesting that the mechanism of induction of lysosomal proteases preserved in normal cells is not affected by the process of neoplastic transformation. In lesions of severe degeneration or necrosis, CD immunoreactivity was lost in most tumor cells but was strong in macrophages invading the lesions and perivascular regions. CD immunoreactivity was observed at various intensities in tumor cells in the Antoni type A area but not in most tumor cells in the Antoni type B area, suggesting that Antoni type B lesions show degenerative changes. The presence of CD-reactive tumor cells in all tumors examined and strong CD immunoreactivity observed at the invasion front of tumors in some cases of benign or malignant schwannoma suggests the possible role of CD in tumor invasion in some cases.

Cyclopia in one of discordant twins: a case report

Cyclopia is an uncommon congenital anomaly resulting from arrest of the development of the anterior end of the neural plate. It is always associated with abnormalities of the brain. Cyclopia has never been reported in one twin only. In this report, we describe a case of cyclopia in a female infant with normal karyotype who was one of discordant twins. The infant died perinatally. The parents were healthy and not sanguineously related. Prenatal imaging studies revealed cyclopia, holoprosencephaly and hypognathia. Postmortem examinations revealed one orbit, one eyeball and absence of the nose. The central nervous system included rudimentary cerebral hemispheres with fusion of the two lateral ventricles and the third ventricle forming a single large cavity. The superior aspect of each cerebral hemisphere consisted of only a transparent membrane. The olfactory bulb nad tract was absent. The optic nerves were not identified.

[Analysis of chromosome karyotype of Lycium chinense Mill]

The chromosome karyotypes of wild Lycium chinese and its cultivated breeds for vegetable have been studied. The Chromosome 12 of both has a satellite. The former, with 24 chromosomes and 1B karyotype, is a diploid and its karyotype formula is 2n = 2x = 24 = 18m + 6sm. The chromosome number of the latter is 48. As a tetrploid, it has 2B karyotype and a karyotype formula 2n = 4x = 48 = 36m + 12sm.

Cloning, human chromosomal assignment, and adipose and hepatic expression of the CL-6/INSIG1 gene

Rat CL-6 is the most highly insulin-induced gene in a liver cell line and is expressed in proliferating liver during regeneration and development. CL-6 is now denoted INSIG1 (insulin-induced gene 1). Human INSIG1 was isolated and found to be 80% identical to the rat gene within the translated region. It was located on human chromosome 7 within band q36. The human INSIG1 promoter conferred a high level of expression in both liver and fibroblast cell lines. INSIG1 expression was upregulated at the transcriptional level in rat regenerating liver and induced in a model of murine adipocyte differentiation, suggesting that INSIG1 may play a role in growth and differentiation of tissues involved in metabolic control.

HRS/SRp40-mediated inclusion of the fibronectin EIIIB exon, a possible cause of increased EIIIB expression in proliferating liver

Serine-arginine (SR)-rich proteins are believed to be important in mediating alternative pre-mRNA splicing. HRS/SRp40 expression is elevated in liver cell proliferation during development, regeneration, and oncogenesis. We tested whether HRS expression correlates with the appearance of alternatively spliced fibronectin transcripts during liver growth. HRS was highly expressed during the proliferative phase of liver development, correlating with expression of the fibronectin EIIIB alternative exon. In regenerating liver, HRS protein was induced in a time course consistent with the observed increase in fibronectin transcripts containing the EIIIB exon, particularly in nonparenchymal liver cells. Furthermore, in an in vivo assay, HRS, and not other SR proteins, directly mediated EIIIB exon inclusion in the fibronectin transcript. This alternative splicing was dependent on a purine-rich region within the EIIIB exon to which HRS specifically bound. We have established that HRS has the potential to contribute to the regulation of fibronectin pre-mRNA splicing during liver growth. Changes in fibronectin forms may be important in modifying liver architecture during the proliferative response, thus providing a potential mechanism by which SR proteins may participate in cellular growth control.

Posttransplant lymphoproliferative disorders: a fine-needle aspiration biopsy study

Fine-needle aspiration biopsy (FNAB) has been used with high sensitivity and specificity in the diagnosis of both Hodgkin's and non-Hodgkin's lymphoma. However, studies of FNAB of posttransplant lymphoproliferative disorders (PTLDs) are rare. The clinical course of 593 allograft recipients (cardiac, 288; renal, 250; lung, 50; and heart/lung, 5) was reviewed. Twenty-six patients developed PTLD with an overall incidence of 4.4%. Of these patients, 12 underwent FNAB. Their age ranged from 33-67 yr (mean, 55 yr). The interval between transplantation and FNAB ranged between 2-14 mo (average, 8.4 mo). The lungs were the most common site aspirated (7 cases), followed by lymph nodes (3 cases) and other extranodal sites (2 cases, liver and paraspinal mass). The cytologic features of these aspirates could be classified into two categories: a polymorphous smear composed of a spectrum of mature and immature lymphocytes with scattered plasma cells and histiocytes; and a monotonous population of large lymphoid cells consistent with malignant lymphoma, large-cell type. Surgical biopsies were available in 10 (83.3%) cases and confirmed the FNAB diagnosis. In summary, FNAB appears to be a highly sensitive and specific diagnostic tool in patients with PTLD.

[Effects of the double chamber intra-aortic balloon pumping on the renal circulation]

The effects of the double chamber intra-aortic balloon (DIAB) and the single chamber intra-aortic balloon (SIAB) on the hemodynamic parameters in the kidney were studied. No negative effect of both cases was observed. Before and after removing the renal nerve system, the DIAB was used and the results had been compared. The pulse produced by pumping activized the renal nerve system and reduced the renal vascular resistance. Therefore the reduction of the renal vascular resistance is an important reason for increasing the renal blood flow during intra-aortic balloon pumping.

Localization of BRCA1 and a splice variant identifies the nuclear localization signal

Inherited mutations in BRCA1 confer susceptibility to breast and ovarian neoplasms. However, the function of BRCA1 and the role of BRCA1 in noninherited cancer remain unknown. Characterization of alternately spliced forms of BRCA1 may identify functional regions; thus, we constructed expression vectors of BRCA1 and a splice variant lacking exon 11, designated BRCA1 delta 672-4095. Immunofluorescence studies indicate nuclear localization of BRCA1 but cytoplasmic localization of BRCA1 delta 672-4095. Two putative nuclear localization signals (designated NLS1 and NLS2) were identified in exon 11; immunofluorescence studies indicate that only NLS1 is required for nuclear localization. RNA analysis indicates the expression of multiple, tissue-specific forms of BRCA1 RNAs; protein analysis with multiple antibodies suggests that at least three BRCA1 isoforms are expressed, including those lacking exon 11. The results suggest that BRCA1 is a nuclear protein and raise the possibility that splicing is one form of regulation of BRCA1 function by alteration of the subcellular localization of expressed proteins.

Early versus deferred zidovudine monotherapy: impact on AIDS-free time and survival in the multicenter AIDS cohort study

The objective of this study was to compare the time to AIDS and to death between men receiving zidovudine therapy before or not before the diagnosis of AIDS. For the time to AIDS comparison, 821 men receiving zidovudine therapy before the diagnosis of AIDS were pair matched with men who did not receive zidovudine therapy until after diagnosis on their CD4 cell count (+/- 75 cells/mm3), haemoglobin level (+/- 0.75 g/dl), number of clinical symptoms and study visit at the time of initiation of zidovudine therapy and were monitored for a median of 2.08 years. For the time to death comparison, 186 men who received zidovudine therapy prior to AIDS diagnosis were pair matched on the same variables to men who received zidovudine therapy only after the AIDS diagnosis, and were monitored for a median of 2.88 years. Only men with < 350 CD4 cells/mm3 who received zidovudine therapy prior to AIDS diagnosis remained AIDS free significantly longer than their pair match who did not (P < 0.0001). The median extension of time to AIDS was 0.61 years for men with < 200 CD4 cells/mm3 and 1.13 years for men with 200-349 CD4 cells/mm3. Cox regression analysis showed a significantly increased time to AIDS for the men with < 350 CD4 cells/mm3, both before and after adjustment for the use of prophylactic drugs against Pneumocystis carinii pneumonia. No difference was seen in the time to death between men receiving zidovudine therapy before or only after AIDS diagnosis. Zidovudine treatment of asymptomatic HIV-1-infected men provides significant benefit to men with < 350 CD4 cells/mm3 by extending AIDS-free time, but does not extend survival. The analytical technique used is applicable to other observational studies of treatment.

Detection of minimal residual disease in leukemia using polymerase chain reaction and restriction analysis

OBJECTIVE

To investigate the relationship between the clinical outcome of childhood acute lymphoblastic leukemia and the status of minimal residual disease after termination of therapy.

METHODS

A total of 18 children with acute lymphoblastic leukemia were studied. Eleven cases were treated with chemotherapy, the other 7 with autologous peripheral blood stem cell transplantation (ABSCT) or autologous bone marrow transplantation (ABMT). The outcome of the 18 patients was obtained by clinical follow-up. Minimal residual disease was detected by means of the polymerase chain reaction (PCR) and restriction analysis.

RESULTS

Minimal residual disease was detected in 9 patients after completion of therapy. Three out of the 9 patients relapsed within 3 to 6 months. Among the other 9 patients with no detectable minimal residual disease, no one relapsed.

CONCLUSIONS

PCR detection of minimal residual disease after termination of therapy can identify patients at risk for relapse in future. Minimal residual disease that cannot be detected after termination of therapy may be one of the important factors for long-term disease-free survival.

Mechanism of anti-beta-adrenoceptor antibody mediated myocardial damage in dilated cardiomyopathy

Antibodies against beta(1)-adrenoceptor can be detected in serum of patients with dilated cardiomyopathy (DCM), which have beta-agonist-like activity, and induce a positive chronotropic effect on cardiac myocytes by its persistence at full strength. Effects of the antibodies against beta-adrenoceptor from sera of patients with DCM on myocardial cytotoxicity and cytoplasmic free Ca(2+)-concentration ([Ca2+]i) were observed in the cultured single layer SD rat ventricular cells by using the cytotoxicity assay and fluorescent Ca(2+)-indicator fura-2/AM. The positive sera of the anti-beta-adrenoceptor antibodies from patients with DCM markedly enhanced myocardial [Ca2+]i. Betaloc, a beta(1)-receptor blocker, might inhibit the increase of the antibody-mediated myocardial [Ca2+]i, and the sera from healthy donors had no effect on myocardial [Ca2+]i. Our results suggest that the anti-beta-adrenoceptor antibody might increase myocardial [Ca2+]i and result in myocardial damage. The antibodies might activate receptor-gating Ca(2+)-channel, thereby causing myocardial [Ca2+]i rise and calcium overload. Early use of betaloc is recommended in the treatment of dilated cardiomyopathy.

Field trials of combined use of two species of mermithid nematodes to control Anopheles and Culex breeding in China

The field tests of combined use of Romanomermis yunanensis 2000-3000 larvae per sq m and Romanomermis sp 1000-2000 larvae per sq m in rice fields. Ponds and streams in four cities of China, resulted in 60.8-95.5% parasitism in Culex tritaeniorhynchus, Cx. quinquefasciatus, Anopheles sinensis and An. anthropophagus. This successful use of two species of Romanomermis together not only curb mosquito nuisance it also controls the major vectors of malaria, filariasis and encephalitis B in China.

[Determination of content of chlorpromazine hydrochloride in compound metamizole sodium microenema by acid-dye colorimetric method]

An acid-dye colormetric method was described for the determination of chlorpromazine hydrochloride in the compound preparation. The method was based on the reaction of chlorpromazine hydrochloride with methyl orange, to form a yellow complex, which then was extracted by chloroform and exhibited a maximum absorption at 424 nm. The optimal conditions for determination were selected by orthogonal design test. The linear range of this method was 20-120 micrograms/ml (r = 0.9997). The average recovery of the three sample solutions of different concentrations was 99.72% +/- 0.46% (n = 6). The other ingredients of preparation do not interfere with chlorpromazine determination. This method is more sensitive and accurate and can be used for quality control of this compound preparation.

Using multiple decrement models to estimate risk and morbidity from specific AIDS illnesses. Multicenter AIDS Cohort Study (MACS)

A simple non-parametric approach is developed to simultaneously estimate net incidence and morbidity time from specific AIDS illnesses in populations at high risk for death from these illnesses and other causes. The disease-death process has four-stages that can be recast as two sandwiching three-state multiple decrement processes. Non-parametric estimation of net incidence and morbidity time with error bounds are achieved from these sandwiching models through modification of methods from Aalen and Greenwood, and bootstrapping. An application to immunosuppressed HIV-1 infected homosexual men reveals that cytomegalovirus disease, Kaposi's sarcoma and Pneumocystis pneumonia are likely to occur and cause significant morbidity time.

Ryanodine-sensitive component of calcium transients evoked by nerve firing at presynaptic nerve terminals

Whether Ca2+ released from stores within the presynaptic nerve terminals also contributes to the Ca2+ elevation evoked by action potentials was tested in intact bullfrog sympathetic ganglia. Intraterminal Ca2+ transients (Delta[Ca2+]i) were evoked by electrical shocks to the presynaptic nerves at 20 Hz and were monitored by fura-2 fluorimetry. Ca2+ released through intraterminal ryanodine-sensitive channels accounted for 46% of the peak Ca2+ elevation. Moreover, in half of the terminals when intraterminal release was blocked by ryanodine, Delta[Ca2+]i reached a plateau at 200 +/- 24 nM. Because 20 Hz is a frequency favorable for the release of a neuropeptide, luteinizing hormone releasing hormone (LHRH) from these presynaptic nerve terminals, and because the threshold level for LHRH release is 186 nM, intraterminal Ca2+ release during nerve firing is likely to play a major role in regulating LHRH release. The intraterminal ryanodine channels were facilitated by caffeine as in other tissue. The releasable ryanodine-sensitive store could elevate the intraterminal [Ca2+] by an amount as high as 1.6 microM at a rate as fast as 250 nM/sec. The store could be refilled within 100 sec after a maximal discharge of its content by 20 Hz firing. Oscillation of [Ca2+]i evoked by 20 Hz nerve firing occurred in normal Ringer solution, in ryanodine, and in caffeine with a periodicity of approximately 10 sec. Besides the facilitatory effects on the ryanodine-sensitive channels, caffeine also had inhibitory effects on Delta[Ca2+]i via its action on a different process.

Longitudinal relation between smoking and white blood cells

Higher white blood cell counts in smokers compared with nonsmokers have been well documented, but the longitudinal relation between changes in smoking and changes in white blood cells has not been well described. Since 1984, data have been collected semiannually by the Multicenter AIDS Cohort Study (MACS), a four-center prospective cohort study of acquired immunodeficiency syndrome (AIDS) in homosexual men. The study population includes 2,435 participants who were human immunodeficiency virus (HIV) seronegative as of September 1994 and who contributed 20,918 person-visits for this analysis. For individuals who modified their smoking behavior, changes in white blood cell counts occurred primarily during the first 6 months following changes in the amount of cigarettes smoked. Among former smokers who resumed smoking, the extent of the increase in white blood cell count depended on the number of cigarettes smoked. Specifically, increases of 241, 340, and 740 cells/microliter were observed for smokers who resumed smoking < 1, 1 to < 2, and > or = 2 packs/day, respectively. Conversely, smokers who quit smoking had a decrease of white blood cell count: -32, -629, and -1,122 cells/microliter for men who previously smoked < 1, 1 to < 2, and > or = 2 packs/day, respectively. Long-term ex-smokers, however, still had higher white blood cell counts than did never smokers. There was a high within-individual correlation of white blood cell count in persons who reported a consistent level of smoking (i.e., average correlations between two white blood cell counts 6 years apart were 0.51 for never smokers, 0.48 for ex-smokers, 0.56 for men who smoked < 1 pack/day, and 0.43 for men who smoked > or = 1 pack/day). These analyses indicate an acute effect of changes in smoking on changes in white blood cell count, a residual effect of having been a smoker, and high long-term tracking for white blood cell count.

Genetic heterogeneity in hereditary breast cancer: role of BRCA1 and BRCA2

The common hereditary forms of breast cancer have been largely attributed to the inheritance of mutations in the BRCA1 or BRCA2 genes. However, it is not yet clear what proportion of hereditary breast cancer is explained by BRCA1 and BRCA2 or by some other unidentified susceptibility gene(s). We describe the proportion of hereditary breast cancer explained by BRCA1 or BRCA2 in a sample of North American hereditary breast cancers and assess the evidence for additional susceptibility genes that may confer hereditary breast or ovarian cancer risk. Twenty-three families were identified through two high-risk breast cancer research programs. Genetic analysis was undertaken to establish linkage between the breast or ovarian cancer cases and markers on chromosomes 17q (BRCA1) and 13q (BRCA2). Mutation analysis in the BRCA1 and BRCA2 genes was also undertaken in all families. The pattern of hereditary cancer in 14 (61%) of the 23 families studied was attributed to BRCA1 by a combination of linkage and mutation analyses. No families were attributed to BRCA2. Five families (22%) provided evidence against linkage to both BRCA1 and BRCA2. No BRCA1 or BRCA2 mutations were detected in these five families. The BRCA1 or BRCA2 status of four families (17%) could not be determined. BRCA1 and BRCA2 probably explain the majority of hereditary breast cancer that exists in the North American population. However, one or more additional genes may yet be found that explain some proportion of hereditary breast cancer.

[Experimental study of adoptive immunotherapy for adenoid cystic carcinoma of the salivary gland]

To study adoptive immunotherapy for adenoid cystic carcinoma of the salivary gland, we evaluate the influence of TNF-alpha or IFN-gamma on the activity of LAK cells when they acted at different stages of LAK cells killing target cells. The results in vitro experiment showed that ACC-2 was susceptible to LAK cytotoxicity. Both TNF-alpha and IFN-gamma could be an enhancer to augment IL-2-induced LAK cytotoxity against ACC-2, TNF-alpha should be used to induce LAK cells, but IFN-gamma is suitable to pretreat target cells ACC-2.

Role of tyrosine kinase pathways in ETB receptor activation of NHE3

Endothelin-1 (ET-1) binding to ETB receptors increases the activity of the apical membrane Na+/H+ antiporter (NHE3) of renal proximal tubule and cultured OKP cells. In OKPETB6 cells, a clonal cell line of OKP cells that overexpresses ETB receptors, ET-1-induced increases in Na+/H+ antiporter activity are mediated 50% by Ca2(+)-dependent pathways and 50% by tyrosine kinase pathways. ET-1 induces tyrosine phosphorylation of proteins of 68, 110, 125, 130, and 210 kDa. ET-1-induced tyrosine phosphorylation is mediated by the ETB receptor and is not dependent on increases in cell Ca2+ or protein kinase C. The 68-, 110-, 125-, and 130-kDa phosphoproteins are cytosolic, whereas the 210-kDa phosphoprotein is an integral membrane protein. Immunoprecipitation studies showed that the 68-kDa protein is paxillin and the 125-kDa protein is p125FAK (focal adhesion kinase). Cytochalasin D, which disrupts focal adhesions, prevented ET-1-induced tyrosine phosphorylation of paxillin, p110, p125FAK, and p130 but did not prevent tyrosine phosphorylation of p210 and did not prevent ET-1-induced increases in Na+/H+ antiporter activity. Thus 50% of ETB receptor-induced Na+/H+ antiporter activation is mediated by tyrosine kinase pathways, possibly involving p210. ETB receptor activation also induces tyrosine phosphorylation of focal adhesion proteins, but this is not required for antiporter activation.

Generation of an integrated transcription map of the BRCA2 region on chromosome 13q12-q13

An integrated approach involving physical mapping, identification of transcribed sequences, and computational analysis of genomic sequence was used to generate a detailed transcription map of the 1. 0-Mb region containing the breast cancer susceptibility locus BRCA2 on chromosome 13q12-q13. This region is included in the genetic interval bounded by D13S1444 and D13S310. Retrieved sequences from exon amplification or hybrid selection procedures were grouped into physical intervals and subsequently grouped into transcription units by clone overlap. Overlap was established by direct hybridization, cDNA library screening, PCR cDNA linking (island hopping), and/or sequence alignment. Extensive genomic sequencing was performed in an effort to understand transcription unit organization. In total, approximately 500 kb of genomic sequence was completed. The transcription units were further characterized by hybridization to RNA from a series of human tissues. Evidence for seven genes, two putative pseudogenes, and nine additional putative transcription units was obtained. One of the transcription units was recently identified as BRCA2 but all others are novel genes of unknown function as only limited alignment to sequences in public databases was observed. One large gene with a transcript size of 10.7 kb showed significant similarity to a gene predicted by the Caenorhabditis elegans genome and the Saccharomyces cerevisiae genome sequencing efforts, while another contained a motif sequence similar to the human 2',3' cyclic nucleotide 3' phosphodiesterase gene. Several retrieved transcribed sequences were not aligned into transcription units because no corresponding cDNAs were obtained when screening libraries or because of a lack of definitive evidence for splicing signals or putative coding sequence based on computational analysis. However, the presence of additional genes in the BRCA2 interval is suggested as groups of putative exons and hybrid selected clones that were transcribed in consistent orientations could be localized to common physical intervals.

Occurrence of cytomegalovirus retinitis after human immunodeficiency virus immunosuppression

OBJECTIVE

To estimate the incidence and prevalence of cytomegalovirus retinitis (CMV-R) in late-stage human immunodeficiency virus type 1 disease.

DESIGN

Cohort study.

SETTING

The Multicenter AIDS Cohort Study, an ongoing 10-year study of human immunodeficiency virus type 1-infected homosexual men with semiannual visits and CD4+ cell testing.

STUDY PARTICIPANTS

Three hundred sixty-seven human immunodeficiency virus type 1-infected men from the Multicenter AIDS Cohort Study who were receiving zidovudine and Pneumocystis carinii prophylaxis and who had CD4+ cell counts fall below 0.10 x 10(9)/L (100/microL).

MAIN OUTCOME MEASURES

Kaplan-Meier-type estimates for various longitudinal quantifications of incidence and prevalence of CMV-R were obtained.

RESULTS

Among these 367 individuals, cytomegalovirus disease developed in 103, of whom 73 (71%) had ocular complications. At 4 years after the first CD4 cell count ( < 0.10 x 10(9)/L), the probability for these subjects to have (1) remained living without CMV-R was 11%, (2) died without experiencing CMV-R was 66%, (3) experienced CMV-R and be living was 6%, and (4) experienced CMV-R and died was 18%. During these 4 years, there was a 25% chance for the development of CMV-R and, on average, 0.211 person-years of CMV-R morbidity. Among those subjects in whom CMV-R developed, about 19% did have CMV-R before a CD4+ cell count of less than 0.05 x 10(9)/L ( < 50/microL) was observed, and 81% had CMV-R after the CD4+ cell count reached this threshold.

CONCLUSION

These estimates may be relevant to current clinical practice and help in allocating resources and planning for treatment and prophylaxis against cytomegalovirus disease.

Projecting disease when death is likely

Projection disease incidence, prevalence, and net morbidity is often needed when individuals are likely to die, either disease free or after the disease has developed. Examples of this include remission of cancer or heart disease in elderly people who can die from these or other causes and occurrence of a particular acquired immune deficiency syndrome illness in human immunodeficiency virus type 1 (HIV-1) disease. Death is not an ancillary event but, rather, indicates either and end to disease morbidity or an end to risk to ever develop the disease. Thus, time to disease survival analyses that censor disease-free individuals at death can produce misleading results. The paper describes several useful quantifications of disease and death for this setting. A paradigm that utilizes Kaplan-Meier functions to estimate these quantities is introduced. The approach anchors on a four-stage disease/death model: stage A, living without disease; stage B, dead without ever developing disease; stage C, developed the disease and living; and stage D, dead after developing the disease. An application is made to projecting cytomegalovirus disease in a cohort of HIV-1-infected users of zidovudine and Pneumocystis prophylaxis from the Multicenter AIDS Cohort Study (MACS) during 1989-1993. At 3 years after a CD4+ count below 100/microliters, a man had an 18.7%, 46.3%, 5.3% or 29.9% chance, respectively, to be in stage A, B, C, or D. This man, on average, had 0.28 years of cytomegalovirus morbidity during these 3 years.

BRCA2 germline mutations in male breast cancer cases and breast cancer families

The breast cancer susceptibility gene, BRCA2 on chromosome 13q12-13, was recently isolated. Mutations in BRCA2 are thought to account for as much as 35% of all inherited breast cancer as wall as a proportion of inherited ovarian cancer. Many BRCA2-linked families also contain cases of male breast cancer. We have analysed germline DNA from 50 males with breast cancer (unselected for family history) and 26 individuals from site-specific female breast and breast-ovarian cancer families for mutations in BRCA2. All 17 breast-ovarian cancer families have been screened for BRCA1 coding region mutations and none were detected. Conformation-sensitive gel electrophoresis (CSGE) analysis of PCR-amplified DNA followed by direct sequencing was used to detect sequence variants. Three of eleven individuals carry the same mutation, all are of Ashkenazi Jewish descent, supporting the observation by Neuhausen et al. in this issue that there is a common mutation in this population. Eleven truncating mutations and nine polymorphisms were identified -- all were coding region variants. No loss-of-transcript mutations were identified in the sixteen samples for which this analysis was possible. Seven of the nine disease-associated mutations were detected in the 50 men with breast cancers; for thus in our series, BRCA2 mutations account for 14% of male breast cancer, all but one of which had a family history of male and/or female breast cancer.

Survival from early, intermediate, and late stages of HIV infection

OBJECTIVE

To estimate expected survival time among homosexual men infected with the human immunodeficiency virus type 1 (HIV-1) by (1) the calendar period before (1985-1988) and after (1989-1993) the widespread availability of acquired immunodeficiency syndrome (AIDS) treatments with antiretroviral and prophylactic interventions, and (2) stage of HIV disease.

DESIGN

A prospective cohort study. A group of HIV-1-infected homosexual men were followed from July 1985 through June 1993 and evaluated every 6 months for the presence of clinical symptoms and measurement of the CD4 cell count. To measure the effectiveness of AIDS therapies in this nonrandomized study, we used 2 calendar periods as proxy measures of relative intensity of exposure to antiretroviral therapy. Stage of infection was defined by CD4 cell count and presence of HIV-related clinical symptoms or AIDS.

SETTING AND STUDY PARTICIPANTS

Homosexual men infected with HIV-1 from the Multicenter AIDS Cohort Study.

MAIN OUTCOME MEASURE

Survival time based on stage of HIV infection.

RESULTS

The percentage of HIV-1-infected individuals free of AIDS and clinical symptoms at baseline who survived 2.5 years according to baseline CD4 cell counts of 0 to 0.100, 0.101 to 0.200, and 0.201 to 0.350 x 10(9)/L was 22%, 53%, and 83%, respectively, for the 1985-1988 calendar period, compared with 54%, 71%, and 91%, respectively, for men in the 1989-1993 calendar period. Among men free of AIDS with CD4 cell counts of greater than 0.350 x 10(9)/L, the relative hazard of mortality was 1.6 to 2.3 times higher for those with clinical symptoms compared with those free of clinical symptoms.

CONCLUSIONS

Survival of AIDS-free HIV-1-infected individuals with CD4 cell counts of less than 0.350 x 10(9)/L has improved since antiretroviral and HIV prophylactic treatments have become available, but the long-term prognosis remains poor.