Reye's syndrome. Salicylate metabolism, viral antibody levels, and other factors in surviving patients and unaffected family members

To investigate possible etiologic factors for Reye's syndrome (RS), five survivors and their unaffected family members were studied. This study showed low salicylate levels among the patients with RS compared with siblings and parents when challenged with three doses of aspirin. Thus, the patients with RS, three to ten years after having had RS, exhibited normal or increased ability to metabolize aspirin. We found significantly higher antibody levels to influenza A and varicella among the patients with RS, further supporting the importance of these viral infections in the etiology of the syndrome.

Survey on the management of febrile seizures

A survey regarding the management of the child with febrile seizures was mailed to 10 000 child neurologists, neurologists, pediatricians, and family and general practitioners. The response rate varied by specialty; overall, slightly more than half the physicians responded. One third or less of physicians prescribed anticonvulsive therapy only at the time of febrile illness, although this practice was much less common among recent graduates. If children had lengthy or focal seizures, the majority of physicians in all specialties either prescribed long-term treatment or referred for consultation. Long-term daily anticonvulsant therapy was prescribed most frequently by child neurologists and least often by general practitioners, who most often referred for consultation. Rate of hospitalization also differed according to specialty. The results of the survey indicate that the management of a child with febrile seizures may differ depending on the specialty of the attending physician.

Protection of Chinese hamster ovary cells from hyperthermic killing by cycloheximide or puromycin

Cycloheximide (CHM) and puromycin (PUR) were used at various concentrations up to maxima of 10 micrograms/ml and 100 micrograms/ml, respectively, which inhibited protein synthesis by 95% without any cytotoxicity. The drugs were added to the cells for a maximum period of 7 h, with various combinations for treatment before, during, and after heating. Maximum protection, i.e., a 10,000-fold increase in survival from 5 X 10(-6) to 5 X 10(-2) after 4 h at 43 degrees C, required both 1-2 h of treatment before heating and 1-2 h of treatment during heating. For treatments at 45.5 degrees C, the protection was less, i.e., a 100-fold increase in survival from 10(-5) to 10(-3). Little or no protection was observed if after treatment, the drug was removed before heating, or if the drug was added at the start of heating and left on for 5 min to 3 h after heating. For both drugs, the amount of protection increased as inhibition of protein synthesis increased. However, the amount of protection from the drugs was the same only at about 95% inhibition; at 60-85% inhibition, CHM afforded more protection than PUR. Therefore, the modes of action of the drugs might be common at high drug concentrations, but different when intermediate concentrations are used.

Schizophrenia and cerebral laterality

Investigators have suggested that schizophrenic patients have reversals of abnormal structural abnormalities and abnormal left hemisphere function. The authors attempted to know of the pattern of cerebral asymmetry in schizophrenic patients and controls on the computerized tomography scans of thirty right-handed schizophrenic patients and thirty right-handed control subjects. Compared to thirty right-handed controls, the schizophrenic patients had a significantly increased frequency of frontal and occipital reversals. This result suggests that reversals of neuroanatomical asymmetries, and by implicating the abnormalities of lateralization, are relevant to some schizophrenics. Statistics were done by the Chi square method.

Radiation-enhanced resistance to oxygen: a possible relationship to radiation-enhanced longevity

Shortly after gamma-irradiation, flour beetles (Oklahoma strain of Tribolium confusum) exhibited a decline in resistance to oxygen toxicity. Beginning about two weeks after irradiation, however, the LD50 exposure time in pure oxygen was much greater than that of nonirradiated beetles, and this enhanced resistance persisted for about 6 months. The magnitude of the enhancement was a function of dose, and decreased with increasing age at irradiation. These characteristics of a radiation-enhanced resistance to a stress are comparable to the characteristics of radiation-enhanced longevity in Tribolium, in that after irradiation mortality rate is less than that of controls for about 6 months, the magnitude of the effect is dose-dependent, and older beetles are refractory to the effect. Irradiation under anoxic conditions reduced the development of oxygen resistance to the same degree that it reduced acute radiation lethality, suggesting that the amount of biological damage is the critical factor. These results are discussed in terms of the "induced repair" theory of radiation-enhanced longevity of insects.

Rapid detection of herpes simplex virus in clinical specimens by use of a capture biotin-streptavidin enzyme-linked immunosorbent assay

A sensitive enzyme-linked immunosorbent capture assay with biotin and streptavidin (capture B/SA ELISA) was developed to detect herpes simplex virus (HSV) antigen. Rabbit anti-HSV antibody (immunoglobulin G fraction) was coated on flat-bottom, irradiated, 96-well polystyrene microtiter plates and served to capture HSV antigen. Clinical specimens from patients with genital herpes were added. Biotin-linked rabbit anti-HSV immunoglobulin G was used as the second antibody. The antigen-antibody complex was detected with alkaline phosphatase-conjugated streptavidin, which linked to the biotin. With clinical specimens, the test had a sensitivity of 95.6% and a specificity of 91.4% when compared with the tissue culture method. The presence of HSV antigen in specimens devoid of infectivity was confirmed by blocking the reaction with unlabeled rabbit and human antibody to HSV. The level of antigen detected by the capture B/SA ELISA did not necessarily correlate with the infectivity titer of the specimens. HSV antigens could be detected by the capture B/SA ELISA when the virus infectivity was destroyed at 37 degrees C, by UV irradiation, or by Triton X-100 treatment, but not when hypochlorite treatment was used. Greater sensitivity was obtained when HSV-1- and HSV-2-specific antibody reagents were used simultaneously in each test. The capture B/SA ELISA provides a relatively rapid method (4.5 h) which is quite sensitive and specific when compared with other non-tissue culture, direct assay methods.

Quick and simple approximation of sample sizes for comparing two independent binomial distributions: different-sample-size case

Given the ratio, k, of two sample sizes, sample sizes for comparing two independent proportions can be approximated from the sample size for the equal-sample-size design. The proposed method is compared to the method of Fleiss , Tytun and Ury (1980, Biometrics 36, 343-346). Methods for choosing the ratio are also presented.

Evaluation of various plastic microtiter plates with measles, toxoplasma, and gamma globulin antigens in enzyme-linked immunosorbent assays

Seventeen lots of microtiter plates which differed in lot, batch, plastic type, or manufacturer were evaluated as solid-phase carriers in enzyme-linked immunosorbent assays for antibodies to measles, toxoplasma, and human gamma globulin. Most plates of polystyrene or polyvinyl chloride were found to give acceptable binding. The final choice depended on the antigen to be attached. Variations in binding between lots, batches, and types of plastic were found. Well-to-well variation was found to be of greater statistical significance than edge effect and should be a consideration in selection of a plate lot for enzyme-linked immunosorbent assays. Lots of plates should be pretested by the investigator to determine whether there is good binding of the antigen to be used and whether there is low plate-to-plate and well-to-well variation.

Reduced mutant yield at high doses in the Salmonella/activation assay: the cause is not always toxicity

In the Salmonella/activation assay developed by Ames et al [1973, 1975] toxicity is not measured, though it is recognized by the loss of a cloudy appearance on the plate. One approach to the measurement of toxicity is described here and uses a microscope-linked automated colony counter to estimate the number of microcolonies formed by histidine auxotrophs that stop growing after the depletion of histidine. This technique was used to evaluate the effect of toxicity on the revertant count for 16 mutagens, most of which were chosen because, from previous experience, their dose-response curves manifested a maximum at an intermediate dose tested. One of the sixteen, 2-nitrofluorene, was not toxic up to the maximum dose tested. The relationship between mutation and toxicity for the remaining fifteen allowed them to be grouped into two categories: (1) compounds that induced decreases in survival at the same dose at which the number of mutants decreased, and (2) compounds that induced toxicity, but survival was reduced at dose levels higher than those required to reduce the number of mutants. Possible explanations for this reduction of mutant counts occurring with little apparent concomitant increase in toxicity are examined. These results may be significant for attempts to estimate mutagenic potency and, to a lesser extent, construct mathematical models of the Ames test.

Mathematical model of L5178Y mouse lymphoma forward mutation assay

A mathematical model of the biological protocol for the Mouse Lymphoma L5178Y Forward Mutation Bioassay is presented. The model relates the mutant progenitor frequency (MPF), the number of cells per million surviving cells with DNA damage after exposure to the chemical, to the mutant frequency (MF), the number of TFT-resistant cells per million survivors. For a given expression time, the deterministic relationship is linear and the proportionality constant depends on the relative suspension growth factor (rg) and relative cloning efficiencies (rc) of mutants to those of wild type cells: MF = (rg X rc) X MPF. Experimental noise leads to variations in the values of rg and rc and lack of reproducibility in the system. If mutant progenitors and their progeny grow as well as wild-type cells and if all of the parental mutant progenitors express the mutant phenotype, then rg = 1/2 and rc = 1. Biological mechanisms, such as differential growth characteristics of mutant and wild-type cells or DNA repair, can make the mutant frequency an inaccurate estimate of the MPF. For the assay to be useful as a screen for the mutagenic activity of chemicals, rg X rc has to be reasonably constant from chemical to chemical.

Age and sensitivity to oxygen in the flour beetle, Tribolium confusum

Sensitivity of Tribolium confusum males and females to pure oxygen at one atmosphere was measured as a function of adult age. Sensitivity to oxygen increased markedly with age; the reciprocal to the LD50 exposure time was a linear function of age. The sensitivity to oxygen increased more rapidly with age in males than in females; this may be related to the greater longevity of females in this species. Thus the LD50 exposure time represents an index of physiological age. Sublethal exposure to pure oxygen, unlike equivalent exposure to ionizing radiation, did not affect longevity. This suggests that the age-associated increase in oxygen sensitivity is a non-specific stress effect, rather than additivity of acute oxygen damage with cumulative atmosphere-induced lesions.

Oligoclonal IgG bands in cerebrospinal fluid in various neurological diseases

We studied the frequency of oligoclonal immunoglobulin G bands in the cerebrospinal fluid (CSF) of patients with various neurological diseases. We used a micromethod employing sodium dodecyl sulfate polyacrylamide gel electrophoresis that required only 50 microliters of unconcentrated CSF. Oligoclonal bands were detected in the CSF of 95% of the patients with multiple sclerosis, 90% with subacute sclerosing panencephalitis, and 100% with herpes simplex encephalitis, but less frequently in other central nervous system infections. No oligoclonal bands were detected in the CSF of patients with Parkinson, Huntington, Creutzfeldt-Jakob, or herniated disc diseases. Bands were detected in some patients with Alzheimer disease, cerebrovascular accident, idiopathic vertigo, idiopathic seizures, amyotrophic lateral sclerosis, polyneuropathy, and central nervous system glioma. Patients with other conditions infrequently had positive bands. The determination of oligoclonal bands is a useful aid in the diagnosis of multiple sclerosis, subacute sclerosing panencephalitis, and herpes simplex encephalitis. The presence of oligoclonal bands indicates an immunological response but is not diagnostic for a particular condition.

High concentrations of dimethylamine and methylamine in squid and octopus and their implications in tumour aetiology

The levels of the common secondary amines in various squid, in octopus and in 17 other seafoods were determined by HPLC. Ammonia and dimethylamine were found in all of the seafoods tested and some of them also contained methylamine and/or ethylamine. Particularly high levels of dimethylamine (946-2043 ppm) and methylamine (38-255 ppm) were detected in various species of squid and in the octopus. Reaction of nitrite in acidic medium with aqueous extract of squid yielded appreciable amounts of N-nitrosodimethylamine. The optimum pH for this reaction was around 2.4. Dimethylamine in dried squid tissues was readily extracted with water or 1% sodium carbonate solution. Heat treatment of dried squid at 200 degrees C was found to increase its amine content dramatically. It appeared that pyrolytic decarboxylation of some amino acids might cause this increase. Squid is a popular seafood in Japan and other oriental countries. The high incidence of stomach cancer in Japan and China is thought by epidemiologists to be associated with traditional Japanese and Chinese diets. Our present finding that squid and other seafoods contain unusually high levels of dimethylamine and other amines adds to the evidence that dietary factors may have an important role in the aetiology of stomach cancer and other gastro-intestinal tumours.

Teratogenic effects of valproic acid and diphenylhydantoin on mouse embryos in culture

Teratogenic effects of the anticonvulsant drugs valproic acid (VPA) and diphenylhydantoin (DPH) on the development of mouse embryos during early organogenesis were studied using the whole embryo culture technique. Embryos with one to seven somites were exposed in vitro to 50-375 micrograms/ml VPA or 15-135 micrograms/ml DPH for up to 42 hours and compared to control embryos cultured in 80% rat serum without either drug. For both VPA- and DPH-treated embryos, a dose-dependent increase in the frequency of abnormal embryos and a decrease in viability were found. VPA and DPH produced a similar pattern of defects. Drug-induced anomalies included open neural tubes in the cranial regions, abnormal body curvature, craniofacial deformities, and yolk sac defects. Ultrastructural changes were noted in the neuroepithelium of exencephalic VPA-treated embryos. Growth and development were retarded in embryos exposed to greater than 35 micrograms/ml DPH or greater than 50 micrograms/ml VPA as indicated by the decrease in protein and DNA content and the reduction in somite number, crown-rump length, and yolk sac diameter. On a molar basis DPH was potentially more teratogenic than VPA, which correlates with the higher lipid solubility of DPH. With VPA, susceptibility to the drug depended on the developmental stage; e.g., at 150 micrograms/ml VPA the frequency of malformations was 70% in embryos with one to four somites as compared to 35% in embryos with five to seven somites.

Interim recruitment goals in clinical trials

The recruitment rate or duration of a clinical trial must be so determined that the required number of patients may be assured within the given design frame. Establishing interim recruitment goals in clinical trials will not only help keep the clinical investigator from falling too far behind in recruitment but will also enable the sponsor of the study to decide in the early stages of the study whether the investigator can achieve the final recruitment goal. We propose statistical methods for determining a proper recruitment rate, duration and interim recruitment goals. A method of projecting the final recruitment at interims and a method of adjusting the recruitment duration at interims are discussed. Seasonal adjustment methods are also noted.

Small cell lung cancer: analysis of treatment factors contributing to prolonged survival

Seventy-one consecutive patients with small cell lung cancer (SCLC) were treated in the Radiation Oncology Branch of the National Cancer Institute using six different radiation regimens in combination with cyclophosphamide, vincristine and doxorubicin chemotherapy. Patients treated with concurrent chemotherapy-irradiation (CT-RT) experienced better local tumor control than patients treated with sequential CT-RT. Maximum survival with minimum toxicity occurred in the group given a three-week course of concurrent CT-RT. Although concurrent therapy appeared more toxic than sequential therapy, it also appeared to result in more effective tumor control. Precise details of the timing of CT and RT represent important variables in study design of combined modality therapy for SCLC. Carefully controlled clinical trials should be undertaken to define the optimal timing and sequencing of CT-RT, as well as the optimal dose of RT.

Small cell lung cancer: analysis of treatment factors contributing to prolonged survival

Seventy-one consecutive patients with small cell lung cancer (SCLC) were treated in the Radiation Oncology Branch of the National Cancer Institute using six different radiation regimens in combination with cyclophosphamide, vincristine and doxorubicin chemotherapy. Patients treated with concurrent chemotherapy-irradiation (CT-RT) experienced better local tumor control than patients treated with sequential CT-RT. Maximum survival with minimum toxicity occurred in the group given a three-week course of concurrent CT-RT. Although concurrent therapy appeared more toxic than sequential therapy, it also appeared to result in more effective tumor control. Precise details of the timing of CT and RT represent important variables in study design of combined modality therapy for SCLC. Carefully controlled clinical trials should be undertaken to define the optimal timing and sequencing of CT-RT, as well as the optimal dose of RT.

Prognostic factors in Burkitt's lymphoma: importance of total tumor burden

In 42 patients with African Burkitt's lymphoma, we have studied biochemical and clinical correlations with prognosis. Clinical stage and anti-EA titer were the best predictive factors, but lactic dehydrogenase (LDH) and uric acid (UA) concentrations also correlated with stage and prognosis, whereas lactic acid (LA), which was significantly elevated in Stage D, did not significantly correlated with prognosis or with LDH and UA levels. All of these factors with the possible exception of LA reflect the total body burden of tumor. We conclude that the tumor burden is the single most important prognostic factor in Burkitt's lymphoma, and that this is reflected directly by LDH and UA concentrations, and probably indirectly by anti-EA titer.

Two-stage plans for patient accrual in phase II cancer clinical trials

This paper considers two-stage patient-accrual plans for phase II trials of anticancer drugs. The purpose is to identify the therapeutic level of drugs as either above or below a reference response rate. Using such a plan, decisions concerning the future disposition of drugs can be made more formally and objectively. The tables used to implement the plan are prepared for a 20% reference response rate, due to its wide acceptance in the design of phase II clinical trials.

Analysis and interpretation of response rates for anticancer drugs

A statistical method for interpreting data on the efficacy of anticancer agents is proposed. Tables were prepared for the retrospective analysis of studies evaluating the activity of anticancer agents against individual tumor types. The number of responding patients and the number of patients entered in the study were used to more objectively and formally determine the future disposition of the drug. Several examples of clinical studies show that use of our tables allows a more satisfactory and reliable classification than is often currently reported.

Pyridinium- and quinolinium-2-dithioacetic acid zwitterions: antiradiation and anticancer activities

Pyridinium-, quinolinium-, and one pyrimidinium-2-dithioacetic acid zwitterions were prepared by condensation of the N-methyl heterocyclic anhydro bases with carbon disulfide. Reaction of the 2-methylpyridine methiodide anhydro base with carbon disulfide resulted in replacement of the 2-methyl group to give the 1-methylpyridinium-2-dithioacetic acid zwitterion. The 1,6-dimethylquinolinium-2-dithioacetic acid zwitterion showed appreciable anticancer activity against P-388 lymphocytic leukemia in mice, but the other zwitterions tested showed no activity. No antiradiation activity was found for 1-methyl-pyridinium-2-dithioacetic acid zwitterion.