Assessment of outcome prediction models for patients with localized prostate carcinoma managed with radical prostatectomy or external beam radiation therapy

BACKGROUND

A clinical staging system for localized prostate carcinoma that provides reliable information on which management decisions regarding an individual patient can be based is lacking. This study compared the abilities of all published proposed clinical staging systems to predict time to prostate specific antigen (PSA) failure after radical prostatectomy or external beam radiation therapy for clinically localized prostate carcinoma.

METHODS

A total of 1441 clinically localized prostate carcinoma patients who were managed with radical prostatectomy at the University of Pennsylvania in Philadelphia (n = 688) or the Brigham and Women's Hospital in Boston (n = 288) or with external beam radiation therapy at the Joint Center for Radiation Therapy in Boston (n = 465) were entered into this study. Patients who received adjuvant or neoadjuvant hormonal or radiation therapy were excluded. Akaike's Information Criterion (AIC) and Schwartz Bayesian Criterion (SBC) estimates, which are comparative measures, were calculated for each clinical staging system. Pairwise comparisons of the AIC and SBC estimates for the most predictive clinical staging systems were performed using a formal bootstrap technique with 2000 replications.

RESULTS

Both the staging system based on the risk score and the staging system based on the calculated volume of prostate carcinoma and PSA (cVCa-PSA) optimized the prediction of time to posttreatment PSA failure. The cVCa-PSA system, however, provided a more clinically useful stratification of outcome.

CONCLUSIONS

Improved clinical staging for patients with localized prostate carcinoma may be possible with parameters obtained during routine evaluation. Validation by other investigators is underway.

The feasibility of a syringe-needle-exchange program in Vietnam

Since the beginning of the HIV/AIDS epidemic, syringe-exchange programs have been established in a number of developed countries and have proven effective in reducing the transmission of HIV. Very few similar programs have been established in developing countries. This study reports on the feasibility of establishing a syringe-exchange program in Vietnam. Process data collected since the beginning of the program indicate the feasibility of establishing such a program as well as highlight a number of important issues. These issues are: 1) Acceptability of the program in the community which has been achieved through workshops with key community people including the local police; 2) training and recruitment of ex-user outreach workers; 3) the distribution of clean syringes and needles through outreach services rather than at established exchange sites; 4) the establishment of appropriate methods for the collection of used injection equipment. Further research is needed to examine the efficacy of the program in reducing risks and acceptability of the program in the larger society.

Interferon-alpha associated arthritis

We describe a patient who developed progressive inflammatory polyarthritis after treatment with interferon-alpha (IFN-alpha) for chronic hepatitis C infection. Rechallenge with the drug caused worsening of the arthritis, but withdrawal did not result in remission. Preexisting autoantibodies and HLA-DR4 were detected in this serum and are thought to be relevant in the etiology of IFN-alpha associated autoimmune disease.

New-onset juvenile dermatomyositis: comparisons with a healthy cohort and children with juvenile rheumatoid arthritis

OBJECTIVE

To determine, in a case-control study, if patients with new-onset juvenile dermatomyositis (juvenile DM) have increased symptoms prior to onset, exposure to certain environmental conditions, frequency of familial autoimmune diseases, or antibody titers, compared with 2 control groups.

METHODS

A structured interview with the families of 80 children with juvenile DM, 40 children with juvenile rheumatoid arthritis (JRA), or 23 healthy children, from the same geographic area as the children with juvenile DM, was conducted. All children's sera were tested for antibody to Toxoplasma gondii, herpes simplex virus (HSV), or coxsackievirus B (CVB).

RESULTS

A high proportion of children with juvenile DM had constitutional symptoms 3 months before the disease-onset date (P = 0.013 versus control children). Children with JRA had more relatives with rheumatoid arthritis (P = 0.0001) and pernicious anemia (P = 0.003) than did children with juvenile DM or healthy children. Among children < or =7 years of age, elevated enteroviral titers were more frequent in those with juvenile DM (81%) and in healthy controls (90%) than in those with JRA (64%), suggesting a common environmental exposure. Titers to T gondii, HSV, or CVB 1-6 were normal.

CONCLUSION

Frequencies of familial autoimmune disease, exposure to environmental factors, or elevated antibody titers to T gondii, HSV, or CVB are not increased in juvenile DM. Children with juvenile DM do have symptoms of illness 3 months before the disease-onset date, and young patients have elevated enteroviral titers, as do young geographic controls.

Host cell invasion by trypanosomes requires lysosomes and microtubule/kinesin-mediated transport

Invasion of mammalian cells by the protozoan parasite Trypanosoma cruzi occurs by an actin-independent mechanism distinct from phagocytosis. Clusters of host lysosomes are observed at the site of parasite attachment, and lysosomal markers are detected in the vacuolar membrane at early stages of the entry process. These observations led to the hypothesis that the trypanosomes recruit host lysosomes to their attachment site, and that lysosomal fusion serves as a source of membrane to form the parasitophorous vacuole. Here we directly demonstrate directional migration of lysosomes to the parasite entry site, using time-lapse video-enhanced microscopy of L6E9 myoblasts exposed to T. cruzi trypomastigotes. BSA-gold-loaded lysosomes moved towards the cell periphery, in the direction of the parasite attachment site, but only when their original position was less than 11-12 microns from the invasion site. Lysosomes more distant from the invasion area exhibited only the short multi-directional saltatory movements previously described for lysosomes, regardless of their proximity to the cell margins. Specific depletion of peripheral lysosomes was obtained by microinjection of NRK cells with antibodies against the cytoplasmic domain of lgp 120, a treatment that aggregated lysosomes in the perinuclear area and inhibited T. cruzi entry. The microtubule-binding drugs nocodazole, colchicine, vinblastine, and taxol also inhibited invasion, in both NRK and L6E9 cells. Furthermore, microinjection of antibodies to the heavy chain of kinesin blocked the acidification-induced, microtubule-dependent redistribution of lysosomes to the host cell periphery, and reduced trypomastigote entry. Our results therefore demonstrate that during T. cruzi invasion of host cells lysosomes are mobilized from the immediately surrounding area, and that availability of lysosomes at the cell periphery and microtubule/kinesin-mediated transport are requirements for parasite entry.

Treatment retention in women's residential chemical dependency treatment: the effect of admission with children

In the United States there has been an increased interest in the development of treatment programs that admit chemically dependent women with their children. The Salvation Army Family Treatment Services in Honolulu, Hawaii has had a long history of admitting women both with and without their children to long-term residential treatment. This has provided an opportunity to study the differences in treatment retention between these two groups. Subjects were 130 females who participated in treatment between 1988 and 1993. Analyses were conducted to determine whether there were different outcomes for women with children in treatment and women without children in treatment, with regard to type of discharge and length of time in treatment. Results were significant and clearly indicated better retention rates for women who participated in treatment with their children.

Noninvasive arterial occlusion using MRI-guided focused ultrasound

The purpose of this work was to test the hypothesis that reproducible and sustainable arterial occlusion can be induced by focused ultrasound energy deposition noninvasively within deep tissue. An MRI-compatible focused ultrasound transducer was used to sonicate a branch of the renal artery (diameter about 0.6 mm) in vivo (nine rabbits). An intravenous MRI contrast agent bolus was injected about 30 min and up to 7 days after the sonication. After follow-up, in vitro magnification x-ray angiograms were obtained and the kidneys were fixed in formaldehyde for histologic study. The ultrasound pulses resulted in complete cessation of blood flow, as shown by the gradient echo images. In seven of the nine rabbits, a wedge-shaped unenhanced area was seen at the part of the kidney that was perfused by the vessel after the contrast agent injection. This area extended laterally (outside of the sonicated volume) to the cortical surface of the kidney. The x-ray angiograms showed that the artery was completely occluded. Postmortem histologic evaluation showed an infarcted tissue volume corresponding to the wedge shape seen in the images. This study showed that appropriately focused ultrasound can be used to close arteries noninvasively. This finding has significant clinical potential.

Surface-modified nanocrystalline ceramics for drug delivery applications

Drug delivery systems comprised of various types of carriers have long been the object of pharmacological investigation. The search has been stimulated by the belief that carriers will lead to reduced drug toxicity, dosage requirements, enhanced cellular targeting and improved shelf-life. Among the carriers investigated are complex polymeric carbohydrates, synthetic proteins and liposomal structures. For the past four years, we have been experimenting with a radically new class of carriers comprised of surface-modified nanocrystalline ceramics. While the ceramics provide the structural stability of a largely immutable solid, the surface modification creates a glassy molecular stabilization film to which pharmacological agents may be bound non-covalently from an aqueous phase with minimal structural denaturation. As a consequence of maintained structural integrity and owing to concentration effects afforded by the surfaces of the nanocrystalline materials, drug activity following surface immobilization is preserved. We have used successfully surface-modified nanocrystalline ceramics to deliver viral antigens for the purpose of evoking an immune response, oxygenated haemoglobin for cell respiration and insulin for carbohydrate metabolism. The theoretical principles, technical details and experimental results are reviewed. Surface-modified nanocrystalline materials offer an exciting new approach to the well-recognized challenges of drug delivery.

Platelet endothelial cell adhesion molecule-1 (PECAM-1/CD31): alternatively spliced, functionally distinct isoforms expressed during mammalian cardiovascular development

The establishment of the cardiovascular system represents an early, critical event essential for normal embryonic development. An important component of vascular ontogeny is the differentiation and development of the endothelial and endocardial cell populations. This involves, at least in part, the expression and function of specific cell surface receptors required to mediate cell-cell and cell-matrix adhesion. Platelet endothelial cell adhesion molecule-1 (PECAM-1, CD31) may well serve such a function. It is a member of the immunoglobulin superfamily expressed by the entire vascular endothelium in the adult. It is capable of mediating adhesion by a heterophilic mechanism requiring glycosaminoglycans, as well as by a homophilic, glycosaminoglycan independent, mechanism. It has been shown to regulate the expression of other adhesion molecules on naive T cells. This report documents by RT-PCR and immunohistochemical analysis the expression of PECAM-1 during early post implantation mouse embryo development. PECAM-1 was expressed by early endothelial precursors first within the yolk sac and subsequently within the embryo itself. Interestingly, embryonic PECAM-1 was expressed as multiple isoforms in which one or more clusters of polypeptides were missing from the cytoplasmic domain. The sequence and location of the deleted polypeptides corresponded to exons found in the human PECAM-1 gene. The alternatively spliced isoforms were capable of mediating cell-cell adhesion when transfected into L-cells. The isoforms differed, however, in their sensitivity to a panel of anti-PECAM-1 monoclonal antibodies. These data suggest that changes in the cytoplasmic domain of PECAM-1 may affect its function during cardiovascular development, and are consistent with our earlier report that systematic truncation of the cytoplasmic domain of human PECAM-1 resulted in changes in its ligand specificity, divalent cation and glycosaminoglycan dependence, as well as its susceptibility to adhesion blocking monoclonal antibodies. This is the first report of naturally occurring alternatively spliced forms of PECAM-1 having possible functional implications.

Membrane attachment sites for the membrane cytoskeletal protein 4.1 of the red blood cell

The identity of the membrane binding sites for the membrane cytoskeletal protein 4.1 of the human red blood cell has been investigated. Exhaustive proteolysis of the membrane with a range of proteases led to the elimination of only some 60% of all binding sites. The predominant integral membrane protein, band 3, as well as glycophorin A, was totally digested at levels of proteolysis that were essentially without effect on the number of 4.1 binding sites. Proteolysis caused scission of the polypeptide chain of glycophorin C (together with the minor product, glycophorin D, of the same gene), but left a fragment from the region of the C-terminus still attached to the membrane. We have found a low-molecular weight protein, possessing an epitope (recognized by an antibody directed against the cytoplasmic domain of glycophorin C) in common with this proteolytic fragment, in cells of a Leach phenotype, which are characterized by lack of extracellular epitopes of glycophorin C. When these membranes were extracted at low ionic strength to dissociate the membrane cytoskeleton, approximately half the content of 4.1 was liberated, compared with only some 25% from normal membranes. Cells of a different variant of the Leach phenotype, which are totally devoid of glycophorin C, lost close to 70% of their 4.1 under these circumstances. The Rh(D) transmembrane protein, which interacts with the membrane cytoskeleton, is also resistant to proteolysis of the cytoplasmic membrane surface, but Rhnull cells, devoid of this protein, showed no decreased retention of 4.1. The results suggest that glycophorin C (with D) may contain two types of binding site for 4.1, which would be sufficient in number to account for all the strong binding of 4.1 on normal membranes; modulation of binding at one of the sites by another protein or by lipid is not excluded. A possible site for reinitiation of translation overlapping the premature stop codon in the mutant expressing the truncated glycophorin C can be discerned.

Comparative mapping of 9 human chromosome 22q loci in the laboratory mouse

We present a comparative map of genes on human chromosome 22q and homologous loci in the mouse genome. Gene order in humans was established using a panel of somatic cell hybrids. Genetic maps spanning homologous segments on three mouse chromosomes were generated using an interspecific backcross. The conserved linkage between human chromosome 22 and mouse chromosome 16 includes two closely linked loci, Comt and IgI-1. The second conserved linkage involves human chromosome 22 and mouse chromosome 11 and contains two genetically and physically linked loci, Lif and Nfh. Finally, conserved synteny involving mouse chromosome 15 and human chromosome 22 spans 30 cM and contains five loci (Acr, Bzrp, Dia-1, Il2rb and Pdgfb). Loci within this conserved synteny have been sublocalized to different portions of human chromosome 22. The order of genes on mouse chromosome 15 and human chromosome 22 provides further evidence for chromosomal rearrangements within the conserved synteny that have occurred since the divergence of lineages leading to mice and humans.

A microplate system for ABO and Rh(D) blood grouping

A microplate system for performing ABO and Rh(D) blood group determinations with a Kemble Kemtek 1000SP liquid handling processor, an Anthos 2001 microplate reader, an IBM Personal System 2 microcomputer, and Sanguin Forma software is described. The performance of this Kemble/Anthos/IBM/Sanguin microplate system for ABO and D grouping was evaluated by testing 10,042 routine blood donor samples in parallel with the forward-grouping channels of a Technicon AutoAnalyzer blood grouping system. Manual techniques were used to perform ABO reverse groupings and to resolve all ABO forward- and reverse-grouping discrepancies. D-negative test results were investigated and confirmed manually by the indirect antiglobulin test. Of the 10,042 samples tested, 97.3 percent were grouped correctly. There were 266 samples whose results were flagged as no type determined, of which 124 were ABO tests and 142 were Rh tests. In addition, 30 weak D samples missed by both automated systems were detected by manual indirect antiglobulin test. The system is flexible and easy to maintain and operate.

Severe hemophilia A in a female by cryptic translocation: order and orientation of factor VIII within Xq28

We report studies of a female with severe hemophilia A resulting from a complex de novo translocation of chromosomes X and 17 (46,X,t(X;17)). Somatic cell hybrids containing the normal X, the der(X), or the der(17) were analyzed for coagulation factor VIII (F8C) sequences using Southern blots and polymerase chain reaction. The normal X, always late replicating, contains a normal F8C gene, whereas the der(X) has no F8C sequences. The der(17) chromosome containing Xq24-Xq28 carries a functional G6PD locus and a deleted F8C allele that lacks exons 1-15. Also, it lacks the DXYS64-X locus, situated between the F8C locus and the Xq telomere. These results indicate that a cryptic breakpoint within Xq28 deleted the 5' end of F8C, but left the more proximal G6PD locus intact on the der(17) chromosome. As the deleted segment includes the 5' half of F8C as well as the subtelomeric DXYS64 locus, F8C must be oriented on the chromosome with its 5' region closest to the telomere. Therefore, the order of these loci is Xcen-G6PD-3'F8C-5'F8C-DXYS64-Xqtel. The analysis of somatic cell hybrids has elucidated the true nature of the F8C mutation in the proband, revealing a more complex rearrangement (three chromosomes involved) than that expected from cytogenetic analysis, chromosome painting, and Southern blots. A 900-kb segment within Xq28 has been translocated to another autosome. Hemophilia A in this heterozygous female is due to the decapitation of the F8C gene on the der(17) and inactivation of the intact allele on the normal X.

Chronic pancreatitis in Jamaica

Thirty-five patients with chronic pancreatitis (CP) treated over a 15-year-period were studied. There were 29 men and 6 women with a mean age of 47 years (range 21-67). Twenty-seven (77%) were chronic alcoholics, two (6%) had gallstones, one had stenosis of the Ampulla of Vater and in five (14%) no obvious cause was found. Thirty patients (86%) presented with abdominal pain. Chronic diarrhoea was present in 8 (23%), and steatorrhoea was documented in 6 of these. Fifteen (43%) had pancreatic calcifications. Five developed pseudocysts and 16 (46%) developed diabetes mellitus. Twelve patients required surgery. Three continue to have severe recurrent relapses of pain but the majority (91%) have had a relatively stable course with medical management.

Postoperative haemodynamic and pharmacological responses in patients with positive technetium pyrophosphate single-photon emission computed tomography following CABG

The aim of this prospective study was to evaluate the postoperative haemodynamic variables and medication requirements in patients with perioperative myocardial infarction (PMI), following elective coronary artery bypass graft (CABG) surgery, as documented by technetium pyrophosphate scintigraphy using single-photon emission computed tomography (TcPPi-SPECT). A high-dose fentanyl anaesthetic technique was applied. Twelve of 58 patients (21%) developed PMI with an infarcted myocardial mass of 35.7 +/- 3.9 g. Over the 48 hr postoperative period, patients with positive TcPPi-SPECT (n = 12) did not differ from those with negative TcPPi-SPECT (n = 46) in mean heart rate (below 100 bpm), systolic blood pressure (100-120 mmHg) or central venous pressure (8-16 mmHg). However, patients with positive TcPPi-SPECT had higher pulmonary artery diastolic pressures at 5-8 hr after surgery. No differences were found in the incidence and dosage requirements for postoperative sedative or vasoactive drugs (morphine, diazepam, propranolol, lidocaine, nitroglycerin and nitroprusside) between the two groups. There was no difference in the incidence of dopamine requirement between the groups (positive-scan: 16.7%, negative-scan: 13.0%). However, the dopamine dosage for inotropic support was higher in the positive TcPPi-SPECT group over 24 hr (318.5 +/- 125.2 mg vs 71.2 +/- 24.7 mg, P less than 0.05) and 48 hr (869.1 +/- 19.0 mg vs 142.3 +/- 49.4 mg, P less than 0.001) periods after surgery. We postulate that careful control of postoperative haemodynamic variables did not prevent but may limit the extent of PMI in elective CABG patients.

Molecular basis for elliptocytosis associated with glycophorin C and D deficiency in the Leach phenotype

Glycophorin C (GPC) and glycophorin D (GPD) are highly glycosylated integral membrane proteins of human erythrocytes encoded by the same gene and associated with expression of Gerbich blood group system antigens. GPC/D deficiency (the Leach phenotype) is a rare condition usually found after identification of Gerbich blood group system antibodies in persons undergoing prenatal or pretransfusion evaluation. In all cases, the Leach phenotype has been associated with elliptocytosis. Characterization of the molecular basis of this phenotype in three previously uninvestigated families has shown that the most common genetic basis of GPC/D deficiency is deletion of exons 3 and 4 of the GPC gene. However, in one family, the Leach phenotype appeared due to a deletion of one nucleotide in exon 3, causing a frameshift mutation in the messenger RNA and premature generation of a stop codon. The GPC and GPD protein sequences are therefore interrupted in the extracellular domain and probably intracellularly degraded.

Analgesic and pulmonary effects of continuous intercostal nerve block following thoracotomy

This study examined the beneficial effects and potential systemic toxicity from continuous intercostal nerve block by repeated bolus injections of bupivacaine. In this double-blind, randomized study, 20 post-thoracotomy patients were assigned to receive four doses of either: 20 ml 0.5% bupivacaine with epinephrine 5 micrograms.ml-1 (bupivacaine group, n = 10), or 20 ml preservative-free saline (placebo group, n = 10) through two indwelling intercostal catheters every six hours. Patients receiving intercostal bupivacaine injections had greater decreases in visual analogue pain scores (VAS) (P less than 0.05) and lower 24 hr morphine requirements, 16.6 +/- 4.6 mg vs 35.8 +/- 7.2 mg, than patients in the placebo group (P less than 0.05). Higher post-injection values of forced expiratory volume in one second, forced vital capacity and peaked expiratory flow rate were also observed in the bupivacaine group (P less than 0.01). Repeated intercostal bupivacaine administration did lead to systemic accumulation, but the peak bupivacaine level after 400 mg was low at 1.2 +/- 0.2 microgram.ml-1. Thus, the technique of continuous intercostal nerve block described in this study is an effective treatment for the control of post-thoracotomy pain.

Age-related cognitive recovery after general anesthesia

This study was designed to quantify the rate of mental recovery in elderly and young patients after general anesthesia for intraabdominal surgery (cholecystectomy). Forty patients (25-83 yr) were given four tests assessing neuropsychological function once preoperatively and on five occasions postoperatively. Two of the four neuropsychological tests showed impairment in scores in the elderly patients on the first postoperative day (Symbol Digit Modalities Test, P less than 0.004; The Trail Making Test, P less than 0.03). In addition, one of the tests (Symbol Digit Modalities Test) showed a deterioration in the younger patients (P less than 0.05). The changes that did occur in these tests on the first postoperative day reverted to baseline levels thereafter. There were no significant changes in the remaining two tests, the Mini Mental State Test or the Digit Span Test, at any time in either group. We conclude that postoperative mental deterioration is no greater in elderly than in young patients.

The antithrombotic properties of human prothrombin fragment 1.2 in mice

We have investigated the antithrombotic properties of prothrombin fragment 1.2 (F1.2) in this study. To do this, we established the minimum concentration of human placental tissue factor or human alpha-thrombin that was lethal in mice within 5 min after intravenous injection. Prothrombin F1.2 protected the mice from the lethal effect of tissue factor or alpha-thrombin in a dose dependent manner, with 500 micrograms (14 nmoles) of prothrombin F1.2 per mouse being the minimum amount required to protect all mice from the lethal effect of either thrombogenic stimulus. The minimum dose of heparin which protected mice from the lethal effect of thrombin or tissue factor was 6 units or approximately 3.3 nmoles. The observation that prothrombin F1.2 has antithrombotic properties suggests prothrombin F1.2 can modulate coagulation in vivo, as it has previously been shown to do in vitro.

Suramin prevents binding of interleukin 2 to its cell surface receptor: a possible mechanism for immunosuppression

Suramin, a polysulfonic naphthalene antihelminthic drug, inhibits proliferation of a variety of T-cell lines in vitro and induces immunosuppression in some human patients and thymic atrophy and splenic depletion in mice. Recent clinical trials indicate that suramin has activity against human tumors, indicating that it will be necessary to understand the mechanism by which suramin induces immunosuppression. The T-cell growth factor, interleukin 2 (IL2), is the major growth factor involved in regulating lymphoid differentiation and proliferation and thus regulates, to a major degree, the magnitude and duration of the immune response. We demonstrate herein that suramin induces a concentration-dependent decrease in binding of 125I-labeled IL2 to its receptor complex on human and murine T-lymphocytes. Binding of 125I-labeled IL2 to both Mr 75,000 and 55,000 IL2 binding molecules was inhibited by suramin. Similar concentrations of suramin were required to inhibit binding of 125I-labeled IL2, IL2-induced tyrosine phosphorylation, and IL2-induced proliferation, suggesting that these processes may be linked. With murine cells, suramin-induced growth inhibition could be overcome completely by increasing the concentration of IL2, suggesting that suramin inhibited growth by competing for the IL2 receptor. With human cells, growth inhibition by suramin could only be partially overcome by increasing the concentration of IL2, suggesting that an additional growth-inhibiting mechanism is present. The ability of suramin to prevent binding of IL2 to its receptor was used to confirm that prolonged interaction of IL2 with its receptor is required to induce cell proliferation. Since IL2 plays a role in lymphocyte proliferation and differentiation, the ability of suramin to inhibit binding of IL2 to its receptor may explain, in part, the in vivo immunosuppressive activities of suramin.

Analysis of liver lymphoid cell subsets pre- and post-in vivo administration of human recombinant interleukin 2 in a C57BL/6 murine system

The systemic administration of high dose recombinant interleukin 2 (RIL-2) can mediate significant reductions in the number of hepatic metastases in a murine system. This effect is sensitive to host irradiation. Both large granular (LGLs) and small (SLs) lymphocytes have been implicated as the cells mediating the antitumor effect. Utilizing selective Percoll fractionation of liver nonparenchymal lymphoid cells, we have attempted to determine the cell types involved in tumor immunotherapy of murine liver metastases during RIL-2 administration. At a RIL-2 dose of 25,000 units given i.p. three times a day, the total number of lymphoid cells seen in murine livers reached a peak on day 6 after the onset of RIL-2 therapy, lasting until day 10 and ranging from 25 to 29 times baseline values. Both LGLs and SLs were identified and SLs made up over one-half the cells present in murine livers. Phenotypic analysis of LGLs and SLs revealed that during exposure to RIL-2, bands 5 + 6 SLs expressed the Thy-1.2, Lyt-2, and Lyt-1 antigens to a greater degree than LGLs. LGLs exposed to RIL-2 demonstrated a decrease in the expression of the asialo GM1 antigen during exposure to RIL-2; however, the 49H.8 antigen normally expressed on natural killer cells and not on circulating T-cells was found only on LGLs. The role of murine liver LGLs and SLs needs to be further characterized.

The human ATP synthase beta subunit gene: sequence analysis, chromosome assignment, and differential expression

In humans, the functional F0F1-ATP synthase beta subunit gene is located on chromosome 12 in the p13----qter region. Other partially homologous sequences have been detected on chromosomes 2 and 17. The bona fide beta subunit gene has 10 exons encoding a leader peptide of 49 amino acids and a mature protein of 480 amino acids. Thirteen Alu family DNA repeats are found upstream from the gene and in four introns. The gene has four "CCAAT" sequences upstream and in close proximity to the transcriptional initiation site. A 13-bp motif is found in the 5' nontranscribed region of both the beta subunit gene and an ADP/ATP translocator gene that is expressed in high levels in cardiac and skeletal muscle. Analysis of the beta subunit mRNA levels reveals marked differences among tissues. The highest levels are found in heart, lower levels in skeletal muscle, and the lowest levels in liver and kidney. These findings suggest that the tissue-specific levels of ATP synthase beta subunit mRNA may be generated through transcriptional control.

A novel human alloantibody in the Gerbich system

A Gerbich-negative Leach phenotype individual was identified on the basis of distinct morphological, biochemical, and serological characteristics of her red blood cells. This individual has produced an antibody which was reactive with the various Gerbich phenotypes including Ge:-2,3 (Yus type) and Ge:-2,-3 (Ge type) cells; only her own and Leach phenotype cells were non-reactive. It is suggested that this antibody represents an example of a new specificity, one which defines the Leach phenotype, in the Gerbich system.

Comparison of perioperative mental function after general anaesthesia and spinal anaesthesia with intravenous sedation

This study compared the postoperative mental function in 44 elderly patients following general anaesthesia (GA) or spinal anaesthesia (SA) with sedation for transurethral resection of prostate. The Mini-Mental State (MMS) was done preoperatively and postoperatively at six hours, one day, three days, five days and one month. The geriatric mental status examination was performed preoperatively and one month after the anaesthetic. There was no significant intergroup difference in the MMS score in the preoperative, six hours, one day, three days, five days and 30 days postoperative scores between the GA and SA with sedation groups. A significant intragroup difference between preoperative and postoperative MMS score was detected in the GA group (P less than 0.02) and in the SA group with sedation (P less than 0.03). In the GA group, the significant decrease in MMS score occurred at 6 h postoperatively (P less than 0.002) whereas in the SA group with sedation, MMS score also decreased significantly at 6 h (P less than 0.005). In conclusion, there was no significant difference in perioperative mental function between the general and spinal anaesthetic groups when supplemental IV sedation was given. In both groups, perioperative mental function decreased significantly at 6 h postoperatively.

Cognitive impairment after neuroleptanalgesia in cataract surgery

This study was undertaken to evaluate the mental recovery of patients following cataract operations under neuroleptanalgesia. Mental function was assessed by Mini-Mental State (MMS) preoperatively and at 6 and 24 hours postoperatively. Preoperatively, 18.7% of the elderly had cognitive impairment of mental function while none in the younger group had any impairment (P less than 0.02). At six hours postoperatively, 29.7% of the elderly had cognitive impairment compared with 4% of the younger group (P less than 0.01). At 24 hours postoperatively, the percentage of elderly and younger patients with cognitive impairment had returned to preoperative levels. Baseline score and age were found to be significant predictors (P less than 0.004) of the 6-hour score and 24-hour score. In conclusion, cognitive impairment of mental function occurred in patients undergoing cataract operation with retrobulbar block and intravenous sedation at 6 hours postoperatively; MMS has the potential for use as a screening preoperative test for outpatients to identify those at risk for developing cognitive impairment.

Toothbrushing and transient bacteremia in patients undergoing orthodontic treatment

A study was made to determine the extent of bacteremia experienced by patients undergoing orthodontic treatment with fixed appliances during periods of routine oral hygiene--namely, brushing the teeth. Sixteen orthodontic patients made up the population--11 who practiced good oral hygiene and five who demonstrated poor oral hygiene. Blood was drawn aseptically from the median cubital vein of the subjects before and 15 minutes after brushing the teeth. An aliquot of each blood specimen was added to separate blood culture bottles and incubated at 37 degrees C for a period of up to 5 days. Blood was also used to determine the immune status of the subjects. Anaerobic bacteria were recovered from the blood of nine of the 16 patients studied; aerobic bacteria were not recovered. A negative blood culture before brushing and positive blood culture after brushing were expected but did not occur. Some subjects showed bacteremia before brushing and a negative blood culture after brushing. Others showed bacteremia before and after brushing. The unexpected results could be attributed to the patients eating and/or brushing before starting the test. The study showed the capacity of specific anaerobic bacteria to remain in the bloodstream for a 15-minute period. It also demonstrated a presence of bacteria in the bloodstream before the test began.

A rapid, simple synthesis and purification of abscisic Acid glucose ester

A simple and rapid technique was developed to synthesize abscisic acid glucose ester. The free acid of abscisic acid (ABA) was combined with CsHCO(3) to form the Cs salt of ABA. The Cs salt of ABA was then combined with acetobromo-alpha-d-glucose tetraacetate, and the tetraacetate derivative of abscisic acid glucose ester was formed. Acetate groups were selectively removed from the glucose moiety with a crude enzyme preparation derived from Helianthus annuus seeds. Abscisic acid glucose ester was purified via silica gel column chromatography and identified by micro NMR.

Synthetic inhibitors of carboxypeptidase N

Further to explore the functions of carboxypeptidase N (CPN) in vivo, we undertook two studies to find CPN inhibitors of high potency and relatively long duration of action. In each study we examined for inhibition of hydrolysis of [3H]benzoyl-Ala-Arg using pure bovine serum CPN or human serum. In the first such study we synthesized a series of acyl amino acids and acyl di - and tripeptides containing arginine, lysine or both. All proved to be weak inhibitors (Ki = 10(-3) to 10(-4) M). N alpha-carbamoyl-Arg was the strongest: Ki = 3.5 X 10(-5) M. In the second study we prepared S-acyl (thio ester) derivatives of the highly potent CPN inhibitor 2-mercaptomethyl-3-guanidinoethylthiopropionic acid (2-MGP), as certain S-acyl groups markedly increase the duration of captopril, another mercapto-containing compound. Acetyl-, Boc-phenylalanyl-, phenylalanyl-, benzoyl-alanyl-, alanyl-, and Boc-alanyl-2-MGP retained the high potency of 2-MGP in vitro. Although Ala-2-MGP exerted maximum effects in vivo, like those of 2-MGP, the duration of action of Ala-2-MGP was slightly shorter than that of 2-MGP. These results indicate that the mercapto group of 2-MGP can be taken up in some forms of thioester linkage and still remain virtually the full potency of 2-MGP itself. Thus, it appears that a free mercapto function is not essential for the action of 2-MGP.

Assessment of methods for cytomegalovirus antibody testing of blood donations

As part of a programme to establish a panel of individuals with high titres of anticytomegalovirus (CMV) IgG for the production of CMV Ig, the CMV serostatus of 139 normal blood donors was determined by indirect haemagglutination assay, enzyme immunoassay, and complement fixation. The indirect haemagglutination assay was the most accurate and convenient method for the detection of CMV antibody negative donations. Plasma for production of hyperimmune CMV IgG could best be selected by an IgG-specific enzyme immunoassay procedure.

A third example of haemolytic auto-anti-Vel

A non-transfused, 43 year old Caucasian female presented with acute haemolytic anaemia and splenomegaly. Sections of bone marrow showed erythroid hyperplasia. The patient's red blood cells gave a negative reaction with polyspecific antiglobulin serum, but a positive reaction with specific anti-IgM. A heat eluate prepared from her red cells showed anti-Vel specificity. Her serum agglutinated only Vel-positive cells including her own. All papain pre-treated red cells including her own and Vel-negative cells were completely haemolysed at 37 degrees C. The percentage of haemolysis of Vel-positive cells was greater than that of Vel-negative cells.

Fine structure of the glomerular basement membrane and immunolocalization of five basement membrane components to the lamina densa (basal lamina) and its extensions in both glomeruli and tubules of the rat kidney

Electron microscopic immunostaining was used to examine the localization of type IV collagen, laminin, entactin , heparan sulfate proteoglycan, and fibronectin within the basement membranes of the rat kidney. In preliminary experiments, various methods of processing formaldehyde-fixed kidney were compared using antilaminin antiserum and the indirect immunoperoxidase method. Little or no laminin immunostaining of the glomerular basement membrane was present in sections unless they had been frozen-thawed; and even in this case, the immunostaining was light in comparison to that of basement membranes in adjacent tubules. However, when frozen-thawed sections were treated with 0.5% sodium borohydride, immunostaining was then as strong in glomerular as in tubular basement membranes. Accordingly, this treatment was applied to frozen-thawed sections before immunostaining for any of the substances under study. Immunostaining of the glomerular basement membrane for each of the five substances was fairly uniform throughout the lamina densa (also called basal lamina), but uneven in the lamina lucida interna and externa (also called lamina rara interna and externa) in which stained bands extended from the lamina densa. Similarly in the basement membranes of tubules, immunostaining for the five substances was localized to the lamina densa and bands extending into the lamina lucida. When the ultrastructure of the glomerular basement membrane was examined, three structures were found: (1) a network of 4-nm-thick "cords," which seems to be the main component; the cords are closely packed in the lamina densa and more loosely arranged in the lamina lucida interna and externa; (2) straight, hollow 7-10-nm-thick structures referred to as " basotubules "; and (3) 3.5-nm elements composed of minute paired rods, referred to as "double pegs." The distribution of the cords, but not that of the other two structures, was related to the immunostaining pattern. It is concluded that (1) to fully reveal the antigenicity of the glomerular basement membrane, frozen-thawed sections must be treated with sodium borohydride prior to immunostaining, possibly because this basement membrane is more compact than the others; and (2) in both glomerular and tubular basement membranes, type IV collagen, laminin, entactin , heparan sulfate proteoglycan and fibronectin are colocalized in the lamina densa and its extensions to the laminae lucidae . Since the distribution of the cords corresponds to that of immunostaining, it is likely that the five substances are present within the cords.

The upper and lower bounds of rate constants for general mammillary compartment systems

The upper and lower bounds of rate constants for general mammillary three and four compartment systems have been derived. It is further proposed that the midpoints of the bounds can be used as initial estimates for parameter estimation. Numerical examples are given demonstrating the closeness of the calculated midpoints to the "known" rate constants of both the three and four compartment systems.

Detection of anti-varicella-zoster virus antibodies in blood donors by automated passive haemagglutination

1,219 normal blood donors were screened for anti-varicella-zoster virus antibodies by automated passive haemagglutination (APH) on a Technicon 15-channel AutoAnalyzer. 98 samples (8%) were positive by APH and 92% of these were shown to have antibody titres greater than or equal to 1/16 by indirect immunofluorescence assay (IFA). Parallel testing on an additional 265 donors revealed that 11 (4%) individuals had IFA titres greater than 1/16 and 6 of these 11 donors were identified by APH. Thus, APH is an effective means of rapidly detecting units of plasma acceptable for production of varicella-zoster immunoglobulin.

Biliary lipid synthesis and secretion in gallstone patients before and during treatment with chenodeoxycholic acid

The interrelationships between biliary lipid secretion and the hepatic activities of the rate-limiting enzymes for bile acid and cholesterol synthesis have not been investigated in patients with gallstones before and during desaturation therapy. Liver biopsies for enzyme assays and biliary lipid secretion measurements were performed in 12 patients with gallstones before chenodeoxycholic acid therapy and in nine of these patients at 9 months of therapy. Six nongallstone control patients underwent only the lipid secretion measurements. In the patients with gallstones before treatment, all of whom had saturated bile, increased cholesterol secretion correlated directly with increased HMGCoAR activity, whereas bile acid and phospholipid secretion rates were significantly lower than in controls. During desaturation in response to chenodeoxycholic acid, biliary cholesterol and phospholipid secretion rates decreased significantly, and bile acid secretion was unchanged. Concomitantly, both HMGCoAR and cholesterol 7alpha-hydroxylase activities decreased significantly, but the correlation between HMGCoAR and cholesterol secretion was lost. Furthermore, no correlation was found between cholesterol 7alpha-hydroxylase activity and bile acid secretion during therapy. Enzyme assays were performed on single liver samples obtained at the same time of day but 48 hr before the lipid secretion measurements. That correlations between data obtained under these conditions are valid remains to be proved. In conclusion, the mechanism of biliary cholesterol saturation in patients with gallstones probably is related primarily to increased hepatic cholesterol synthesis, whereas desaturation during chenodeoxycholic acid therapy involves altered relationships among hepatic enzyme activities and biliary lipid secretions.

Phenobarbital specific antibody production: preparation of 5-phenyl-5-(4-aminobutyl) barbituric acid-bovine serum albumin conjugate

The aminobutyl derivative of phenobarbital, 5-phenyl-5-(4-aminobutyl)barbituric acid hydrochloride, was synthesized through two synthetic pathways for the preparation of immunogen in production of phenobarbital specific antibody. The produced antiserum had high titer, specificity, affinity and sensitivity (0.5ng/ml), when examined by radioimmunoassay.