Engraftment and outcomes of patients receiving myeloablative therapy followed by autologous peripheral blood stem cells with a low CD34+ cell content

Engraftment kinetics after high-dose chemotherapy (HDC) were evaluated in patients receiving autologous peripheral blood stem cell (PBSC) infusions with a low CD34+ cell content. Forty-eight patients were infused with < 2.5 x 10(6) CD34+ cells/kg; 36 because of poor harvests and 12 because they electively received only a fraction of their harvested cells. A median of 2.12 x 10(6) CD34+ cells/kg (range, 1.17-2.48) were infused following one of seven different HDC regimens. All patients achieved absolute neutrophil counts > or = 0.5 x 10(9)/l at a median of day 11 (range, 9-16). Forty-seven patients achieved platelet counts > or = 20 x 10(9)/l at a median of day 14 (range, 8-250). Nine of 47 (19%) had platelet recovery after day 21, 4/47 (9%) after day 100 and one died on day 240 without platelet recovery. Twenty-six patients (54%) died of progressive disease in 51-762 days; 22 (46%) are alive at a median of 450 days (range, 94-1844), 17 (35%) of whom are surviving disease-free at a median of 494 days (range, 55-1263). No patient died as a direct consequence of low blood cell counts. These data demonstrate that PBSC products containing 1.17-2.48 x 10(6) CD34+ cells/kg resulted in relatively prompt neutrophil recovery in all patients but approximately 10% had delayed platelet recovery.

Structure, function, and expression of SEL-1, a negative regulator of LIN-12 and GLP-1 in C. elegans

Previous work indicated that sel-1 functions as a negative regulator of lin-12 activity, and predicted that SEL-1 is a secreted or membrane associated protein. In this study, we describe cell ablation experiments that suggest sel-1 mutations elevate lin-12 activity cell autonomously. We also use transgenic approaches to demonstrate that the predicted signal sequence of SEL-1 can direct secretion and is important for function, while a C-terminal hydrophobic region is not required for SEL-1 function. In addition, by analyzing SEL-1 localization using specific antisera we find that SEL-1 is localized intracellularly, with a punctate staining pattern suggestive of membrane bound vesicles. We incorporate these observations, and new information about a related yeast gene, into a proposal for a possible mechanism for SEL-1 function in LIN-12 turnover.

Prevalence and demographic correlates of symptoms of last year dependence on alcohol, nicotine, marijuana and cocaine in the U.S. population

The prevalence of last year use of alcohol, cigarettes, marijuana and cocaine in the U.S. population and conditional prevalence of a proxy measure of last year dependence among last year users of each drug class were assessed as a function of age, gender and ethnicity. Analyses were based on three aggregated waves (1991, 1992 and 1993) of the nationally representative samples of the general population aged > or = 12 interviewed in the National Household Surveys on Drug Abuse (n = 87915). An approximation of DSM-IV drug-specific last year dependence for each drug class was derived from self-reported symptoms of dependence, data on frequency and quantity of use and drug-related problems reported for the last year. Descriptive and multivariate analyses were conducted. The inclusion of cigarettes among the drugs, the large number of cases and the wide age range of respondents (> or = 12) enable us to make drug, age, gender and ethnic comparisons not otherwise possible in any other data set. The proxy measure of dependence, however, has limitations. The five major findings are that: (1) nicotine is the most addictive of the four drugs we examined; (2) among female last year users of alcohol and marijuana, adolescents are significantly more at risk for dependence than any other age group of women; (3) conditional prevalences of last year dependence on alcohol, marijuana and cocaine are higher among adolescent females than adolescent males but significantly different only for cocaine; (4) among adults, the rates of dependence are higher among males than among females for alcohol and marijuana, but lower for nicotine; and (5) among last year users, whites are more likely than any other ethnic group to be dependent on nicotine and blacks to be dependent on cocaine.

The Caenorhabditis elegans sel-1 gene, a negative regulator of lin-12 and glp-1, encodes a predicted extracellular protein

The Caenorhabditis elegans lin-12 and glp-1 genes encode members of the LIN-12/NOTCH family of receptors. The sel-1 gene was identified as an extragenic suppressor of a lin-12 hypomorphic mutant. We show in this report that the sel-1 null phenotype is wild type, except for an apparent elevation in lin-12 and glp-1 activity in sensitized genetic backgrounds, and that this genetic interaction seems to be lin-12 and glp-1 specific. We also find that sel-1 encodes a predicted extracellular protein, with a domain sharing sequence similarity to predicted proteins from humans and yeast. SEL-1 may interact with the LIN-12 and GLP-1 receptors and/or their respective ligands to down-regulate signaling.

The thrombin receptor in human platelets is coupled to a GTP binding protein of the G alpha q family

The thrombin receptor is a G protein-coupled receptor, but the G proteins functionally coupled to this receptor in human platelets are not yet definitively identified. Thrombin stimulation of platelets leads to phospholipase C-mediated increases in intracellular calcium, and previous studies have suggested that the thrombin receptor is coupled to members of the Gq family. We now demonstrate direct GTPase activation by thrombin receptor activation peptide (TRAP) in human platelet membranes, and specific inhibition of TRAP-activated GTPase by antibodies to Gq. These data demonstrate functional coupling of the thrombin receptor to a member of the Gq family.

1994 draft DSM-IV criteria for alcohol use disorders: comparison to DSM-III-R and implications

In 1994, DSM-IV will be published, with new criteria for alcohol abuse and dependence. Implications of the changes in criteria for alcohol use disorders were investigated by comparing the diagnoses made by the DSM-IV criteria and DSM-III-R criteria. The study was conducted in a sample of 424 patients in an inpatient alcohol rehabilitation unit in the New York metropolitan area. DSM-III-R and DSM-IV criteria showed similar results and high agreement for any alcohol use disorder (abuse and dependence combined). Alcohol dependence was also consistently diagnosed with DSM-III-R and DSM-IV criteria. Agreement between DSM-III-R and DSM-IV abuse diagnoses was very low. Compared with DSM-III-R, DSM-IV classified over three times as many patients as alcohol abusers, although those with alcohol dependence still overwhelmingly dominated the sample. With some fluctuations, the results were stable over Black, Hispanic, and White subgroups of patients. The direction of the findings was consistent with results from a national general population survey in that the prevalence of alcohol abuse increased in both studies. However, the clinical results alone would not have suggested the marked changes in relative prevalence of abuse and dependence that occurred in the general population when DSM-IV criteria were used in place of DSM-III-R. Research on diagnostic criteria limited to patient samples omits important information on the implications of changing aspects of the diagnostic criteria. The need for a coherent theory of alcohol abuse is highlighted.

Validity of the bi-axial dependence concept: a test in the US general population

According to the "bi-axial" concept of alcohol dependence, the Alcohol Dependence Syndrome (ADS) constitutes an axis or dimension of alcohol difficulties, while other alcohol-related problems (social, legal, etc.) constitute one or more separate dimensions. The validity of the bi-axial distinction was investigated in a stratified probability sample of 3212 US current drinkers who were interviewed in their households. Indicators of the Alcohol Dependence Syndrome and potentially distinct alcohol-related problems were covered in a structured interview administered by carefully trained interviewers. This interview provided extensive coverage of drinking patterns and problems. Aspects of the ADS covered included narrowing, salience, tolerance, withdrawal, withdrawal relief/avoidance and compulsion/control. Other alcohol problems included difficulties with work, health, the law, general social difficulties and problems in marriage/home life. Confirmatory and exploratory factor analyses were used to determine whether a single factor (dimension) or two or more factors fit the data best. Using all methods, we found that one general factor explained the structure of the data better than a two-factor model or other models for males, females, blacks and whites. Thus, the utility of this approach to distinguishing between types of alcohol problems was challenged, raising some questions about abuse/dependence distinctions in various nomenclatures.

Nosological comparisons of DSM-III-R and DSM-IV alcohol abuse and dependence in a clinical facility: comparison with the 1988 National Health Interview Survey results

The purpose of this study was to compare DSM-III-R and proposed formulations of DSM-IV diagnoses of alcohol use disorders in a clinical sample with the same assessment methods used in a large national survey previously reported. Issues included the number of symptoms required for abuse and dependence diagnoses, the effects of requiring evidence of physiological dependence to make the dependence diagnosis (Option 1 vs. Option 2), whether to require a duration criterion, and the concept of alcohol abuse. The diagnostic criteria proposed in the 1991 DSM-IV options book were the criteria investigated in this study. Concordance between DSM-III-R and DSM-IV was closest when the form of DSM-IV used was most similar to DSM-III-R. The duration criterion had much less effect on a dependence diagnosis in this clinical sample than in the general population. DSM-IV Option 2 for alcohol dependence excluded a number of cases from the dependence diagnosis who received such a diagnosis under DSM-III-R and DSM-IV Option 1. Abuse continued to function as a residual category, especially noticeable under increasingly restrictive definitions of dependence, and was rare in both the clinical and general population sample. Implications of the findings for research and other purposes are discussed.

The dimensionality of alcohol abuse and dependence: factor analysis of DSM-III-R and proposed DSM-IV criteria in the 1988 National Health Interview Survey

Decisions on the final version of the DSM-IV alcohol abuse and dependence criteria will be determined largely by the APA's substance abuse field trials, conducted primarily in treated, clinical samples. Among the major objectives of the field trials are to study the boundaries between abuse and dependence, and to identify specific criteria that define the abuse category. The decisions on revisions of the abuse and dependence criteria in DSM-IV should, however, be informed by data from non-treated or general population samples as well. The present study addresses the field trial objectives using recent data from a large general population survey, the 1988 National Health Interview Survey (NHIS88). The paper reports on factor analyses to assess the dimensions underlying the DSM-III-R and DSM-IV dependence and abuse criteria as operationalized in the NHIS88. The focus of the analyses is on whether models with more than one dimension are needed and if so, the correspondence of the dimensions to criteria sets defined in the DSM-III-R and DSM-IV. The analyses show that a two-dimensional model is required. The dimensions are interpreted as abuse and dependence, but the sets of criteria that define each of the dimensions show important deviations from the criteria sets used in the DSM definitions.

Protein CVermont: symptomatic type II protein C deficiency associated with two GLA domain mutations

This study investigates type II protein C deficiency in a family with manifestations of both arterial and venous thrombosis. Of 64 members of the kindred, 14 have been tested and 7 have PC deficiency. Among affected individuals (n = 7), mean protein C levels by different assays were as follows: enzyme-linked immunosorbent assay (ELISA), 3.8 micrograms/mL (2.1 to 4.3 micrograms/mL); amidolytic with venom activator, 115% (60% to 140%); clotting with venom activator, 42% (23% to 59%). The mean ratio of clotting to amidolytic assays for the affected individuals was 0.37 compared with a normal range of 0.8 to 1.2. Thus, the affected individuals have normal total protein C and their activated protein C has a normal active site assessed by chromogenic substrate; however, they have markedly diminished clotting activity. Immunoassay and chromatography data suggested an abnormality of carboxylation in the gamma carboxyglutamic acid (Gla) domain. Polymerase chain reaction amplification and direct DNA sequencing of exon 2 from genomic DNA of affected individuals showed two nucleotide substitutions. One of the mutations (A----C) results in Glu20----Ala, thereby eliminating a site for vitamin K-dependent gamma-carboxylation. The other substitution (G----A) results in a Val34----Met mutation. DNA sequencing of the other exons from affected individuals has shown no further difference from that of the wild-type gene. The former mutation also removes a Bgl II restriction endonuclease site, which has allowed us to confirm the mutation in affected individuals by direct digestion and Southern hybridization of genomic DNA from family members. This is the first reported family with documented Gla domain mutations in the protein C gene.

Self-help materials for anxiety: a randomized controlled trial in general practice

The efficacy of a self-help package in treating chronic anxiety was evaluated in a randomized controlled trial in which the intervention group received self-help materials in the form of an audiotape and booklet, in addition to their current treatment. The intervention was successful in terms of mean depression scores (P = 0.01), anxiety scores (P = 0.04) and general health questionnaire scores (P = 0.02) which were significantly lower for the intervention group than for the controls. In addition, the depression scores fell faster for the intervention group than for the controls. The overall mean reduction in three months in adjusted depression scores was approximately two points greater for the intervention group than for the controls (P = 0.02). Clinicians welcomed the package as a valuable addition to the therapies available for managing chronic anxiety problems. Further studies should include larger sample sizes, taking into account the non-response to postal questionnaires over time.

The natural history of alcohol abuse: implications for definitions of alcohol use disorders

Is the DSM-III-R category of alcohol abuse validly differentiated from the DSM-III-R category of alcohol dependence, or is abuse primarily a mild, prodromal condition that typically deteriorates into dependence? A 4-year longitudinal epidemiologic study of male drinkers provided data to answer this question. The study used identical questions at baseline and follow-up. At follow-up, 70% of the subjects who were initially classified as alcohol abusers were still abusers or were classified as remitted. This contrasted significantly with outcome in the subjects who initially reported alcohol dependence. Although additional research is needed, these results indicate that alcohol abuse often has a course distinct from that of alcohol dependence.

Multiple alcohol-related problems in the United States: on the rise?

Are drinking problems on the rise in the U.S. general population? Surveys of drinking practices and problems conducted in the United States in 1967, 1969, 1979 and 1984 included numerous questions on alcohol-related problems that were identical or nearly identical in wording. Using data from these surveys, we tested for ordered increases over time in the prevalence of an indicator of multiple problems, considered on both a current (1-year) and lifetime basis. We studied prevalence in men and women between the ages of 22 and 59 in all four surveys. Prevalence of the multiple problem indicator was rare, especially when considered on a current basis. However, relative increases in prevalence ranging from 53% to over 200% were found from 1967 to 1984 in the multiple problem indicator for men and women, for lifetime as well as current problems. With the exception of current problems in women (a very rare condition even in the 1984 survey), these changes were all statistically significant or showed a trend toward significance. When respondents were subgrouped by age, all subgroups still showed increases since 1967, although sample sizes decreased and significance tests of ordered increases over time were not so consistent.

Male and female differences in liver cirrhosis mortality in the United States, 1961-1985

Changes in the social roles of American women have led to questions about convergence in drinking practices and alcohol-related problems between men and women. To address this issue, we utilized mortality data for liver cirrhosis derived from United States death certificates for the years 1961 to 1985. Using age-adjusted rates, we found no evidence of a major shift toward convergence in cirrhosis mortality over this time period for the total population. When age-specific rates were examined, we found evidence for increasing divergence in liver cirrhosis mortality rates for those under the age of 55, whereas the general trend among the older age groups was toward convergence. Straightforward interpretation of the results is hampered by the lack of research in related areas, but the findings do suggest that greater public and professional education may serve a preventive purpose for older U.S. females.

Developmental expression of regionally specific cell surface antigens in the Xenopus gastrula

Molecular markers for specific cell lineages would be useful in studies of cellular differentiation. To isolate such markers monoclonal antibodies (MoABs) were raised against plasma membranes isolated from gastrulating Xenopus embryos. Those antibodies that recognized subsets of cells within the embryo were selected by indirect immunofluorescence. The analysis of eight such MoAbs is presented. Western blot analysis showed that all but one MoAb recognized a complex pattern of glycoconjugates associated with glycoproteins. All the antigens recognized by the MoAbs were maternal in origin and displayed similar spatial patterns of pregastrular expression. This pattern of immunoreactivity at the apical surface was inherited passively during cleavage by the resulting superficial blastomeres suggesting that ectodermal specific markers of maternal origin are pre-localized to the cortical ooplasm in mature oocytes. We suggest that these maternal components may be specific glycosyl transferases. Three different patterns of expression were observed during gastrulation as exemplified by MoAbs 1F10C1, 3A4D1, and 6F10B6. MoAb 6F10B6 was specific for both neural and non-neural epithelium. MoAb 3A4D1 was specific for non-neural epidermis. MoAb 1F10C1 appeared to recognize a protein epitope on an extracellular component expressed by the superficial and involuting epithelial cells. The pattern of expression for the 1F10C1 antigen suggests that it may play a role in facilitating the movement of the involuting cells during gastrulation.

Treated and untreated suicide attempts in substance abuse patients

Suicidal behavior is a relatively common and serious problem in those with alcohol and drug problems. We compared demographic and clinical characteristics of 123 alcohol rehabilitation patients with and without a history of suicide attempts, using the Schedule for Affective Disorders and Schizophrenia-Lifetime version. Younger age was significantly related to suicide attempts, as were drug disorders, panic attacks, antisocial symptoms, and alcohol-related problems such as violence, withdrawal symptoms, and personal or occupational loss. Untreated suicide attempts were characterized by less serious suicidal intent and medical threat to life. However, alcohol- or drug-abusing individuals who have not sought treatment for suicidal behavior but who continue to drink or use drugs may be at special risk for completed suicide.

Cimetidine modulates natural killer cell function of patients with chronic lymphocytic leukemia

Peripheral blood natural killer (NK) activity in patients with B-cell chronic lymphocytic leukemia (B-CLL) is frequently low or absent. Because cimetidine (a histamine-2 antagonist) has been shown to alter human lymphocyte function in vitro, we decided to study cimetidine's effect on peripheral blood NK activity of patients with B-CLL and controls. We administered cimetidine orally (1.2 gm per day) to seven patients with B-CLL and 12 controls for up to 28 days. Peripheral blood NK activity of patients with B-CLL rose from a pretreatment level of 0.7 +/- 0.5 (mean +/- SEM) lytic units/10(6) cells (LU) to 8.7 +/- 2.4 LU (P less than 0.05) at day 28. Peripheral blood NK activity of controls decreased after 14 days of cimetidine treatment but returned to pretreatment levels by day 28. When peripheral blood cells from controls were exposed to cimetidine during in vitro incubation (10 micrograms/ml), mean NK activity was increased at 48 hours (54% +/- 22% increase over controls, n = 5, P less than 0.05). Single cell cytotoxicity assays revealed increased killing of target cells (but not effector-target conjugation) with cimetidine-exposed effector cells. These data suggest that cimetidine may be useful to augment peripheral blood NK activity for patients with B-CLL.

Interactions of medroxyprogesterone acetate with estrogen on the calcium-parathyroid axis in post-menopausal women

We studied the effect of medroxyprogesterone acetate (MPA) as a single agent and in combination with conjugated equine estrogens (E), on the calcium-parathyroid axis in healthy post-menopausal women. Twenty-six subjects, 2-22 yr post-menopause, were studied under basal conditions, and then following 10 days of MPA (10 mg/day), 30 days of E (0.625 or 1.25 mg/day), and an additional 10 days of E + MPA. As predicted, E decreased urinary excretion of calcium and hydroxyproline. MPA did not alter these excretion variables, either when given alone, or when added to E. Cyclic administration of MPA for 10 days is currently advocated to avoid the adverse endometrial consequences of unopposed estrogen. These data indicate that such a program does not interfere with the beneficial effect of estrogen on the calcium-parathyroid axis.

Alterations in coagulation and hemograms of horses given endotoxins for 24 hours via hepatic portal infusions

This experiment was designed to establish a model for the study of gastrointestinal disturbances as a result of prolonged endotoxin uptake in the horse. The hepatic portal vein of 7 horses was catheterized (through flank incisions) to give chronic hepatic portal infusions of lipopolysaccharide (LPS, endotoxin). Lipopolysaccharide was infused at a rate of 1 microgram/kg of body weight/hr for 24 hours. Two of the horses were infused with saline solution for 12 hours before LPS infusions were given. Lipopolysaccharide was shown to affect behavior and hematologic and coagulation values. The 1st hour was critical for the LPS-infused horses; yet by 4 hours, the horses had apparently become refractory to continued infusion of LPS. During the 1st hour, all horses collapsed without an accompanying hypotension. A decrease in polymorphonuclear leukocytes (neutrophils) was seen during this time and was accompanied by a shortening of the recalcification tests, 1-stage prothrombin time, and activated partial thromboplastin time. There was an increased concentration of circulating fibrinogen/fibrin degradatory products. All of the LPS-infused horses showed signs of hoof discomfort and either stood with the 4 feet together beneath the body or continually shifted their weight from one front foot to the other. Hoof temperature decreased approximately 3 degrees (C) during this time and remained decreased for the duration of the experiment.