Serum bone sialoprotein as a marker of tumour burden and neoplastic bone involvement and as a prognostic factor in multiple myeloma

To test the potential of immunoreactive BSP, a non-collagenous bone matrix component, as a clinical guide in patients with plasma cell dyscrasias, serum BSP concentrations were measured in 62 patients with newly diagnosed multiple myeloma (MM) followed over a period of 4 years, in 46 patients with monoclonal gammopathy of undetermined significance (MGUS), in 71 patients with untreated benign vertebral osteoporosis (OPO), and in 139 healthy adults. Results were compared with clinical and laboratory data, including serum osteocalcin (OC), and urinary pyridinoline (PYD) and deoxypyridinoline (DPD) as markers of bone turnover. In MM, serum BSP, and urinary PYD and DPD were higher than in healthy controls and in MGUS or OPO (P< 0.001). BSP levels correlated with the bone marrow plasma cell content (r = 0.40, P< 0.001), and serum beta2-microglobulin (r = 0.31, P < 0.01). The differentiation of MM from healthy controls and from MGUS or OPO was highest for BSP. After chemotherapy, BSP reflected the response to treatment and correlated with the change in monoclonal protein (r = 0.55, P< 0.001). MM patients with normal baseline BSP levels survived longer than patients with initially elevated BSP values (P< 0.001, log rank test). Only serum monoclonal protein and BSP were independent predictors of survival. We conclude that in MM, BSP levels are associated with skeletal involvement and tumour cell burden. The quantification of serum BSP may be a non-invasive method for the diagnosis and follow-up, and may improve the prognostic value of conventional staging in MM.

Subarachnoid sufentanil for early postoperative pain management in orthopedic patients: a placebo-controlled, double-blind study using spinal microcatheters

BACKGROUND

Continuous spinal anesthesia is frequently used for intraoperative anesthesia but rarely for postoperative pain management. Because even small doses of local anesthetics can be associated with motor deficits, subarachnoid opioid injection may be an alternative.

METHODS

Eighty patients randomly received a subarachnoid injection of 10 microg sufentanil, 5 mg bupivacaine, 2.5 microg sufentanil plus 2.5 mg bupivacaine, or saline through 28-gauge spinal microcatheters for early postoperative pain relief after major lower-limb surgery (n = 20 in each group). Hemodynamic and respiratory parameters, pain scores, and motor function were monitored, and sufentanil concentrations in plasma and cerebrospinal fluid were measured. Ten additional patients received up to three repetitive injections of 10 microg sufentanil over 24 h.

RESULTS

All drugs provided excellent pain relief within 15 min after injection, lasting 128 +/- 61 min with sufentanil, 146 +/- 74 min with bupivacaine, and 167 +/- 78 min with the mixture. Patients receiving bupivacaine showed the highest cephalad extension of sensory block (median, T6) and the most intense motor block, whereas patients given only sufentanil had no motor deficit. The duration of analgesia was shorter after subsequent sufentanil injection (100-115 min) than after the first injection (198 +/- 70 min). Six of 50 patients with sufentanil experienced a short episode of respiratory depression within 30 min after the first injection. Cerebrospinal fluid concentrations of sufentanil peaked at 5 min after injection (183 +/- 167 ng/ml) but were at the level of detection in the plasma.

CONCLUSIONS

Sufentanil injected through microspinal catheters provided profound pain relief without impairing motor function when compared with bupivacaine. However, close monitoring remains mandatory in this setting.

Features of vestibuloocular reflex modulations induced by altered gravitational forces in tadpoles (Xenopus laevis)

In Xenopus laevis tadpoles, we studied the static vestibuloocular reflex (rVOR) in relation to modifications of the gravitational environment to find basic mechanisms of how altered gravitational forces (AGF) affect this reflex. Animals were exposed to microgravity during space flight or hypergravity (3g) for 4 to 12 days. Basic observations were that (1)the development of the rVOR is significantly affected by altered gravitational conditions, (2) the duration of 1g-readaptation depends on the strength of the test stimulus, (3) microgravity induces malformations of the body which are related to the rVOR depression. Future studies are based on the hypotheses (1) that the vestibular nuclei play a key roll in the adaptation to AGF conditions, (2) that the stimulus transducing systems in the sense organ are affected by AGF conditions, and (3) that fertilized eggs will be converted to normal adults guided by physiological and morphological set points representing the genetic programs. Developmental retardation or acceleration, or otherwise occurring deviations from standard development during embryonic and postembryonic life will activate genes that direct the developmental processes towards normality.

Altered gravitational forces affect the development of the static vestibuloocular reflex in fish (Oreochromis mossambicus)

Young fish (Oreochromis mossambicus) were exposed to microgravity (micro g) for 9 to 10 days during space missions STS-55 and STS-84, or to hypergravity (hg) for 9 days. Young animals (stages 11-12), which had not yet developed the roll-induced static vestibuloocular reflex (rVOR) at micro g- and hg-onset, and older ones (stages 14-16), which had already developed the rVOR, were used. For several weeks afterwards, the rVOR was recorded after termination of mug and hg. Here are the main results: (1) In the stage 11-12 fish, the rVOR gain (response angle/roll angle) measured for roll angles 15 degrees, 30 degrees, and 45 degrees was not affected by microgravity if animals were rolled from the horizontal to the inclined posture, but was increased significantly if animals were rolled in the opposite manner. The rVOR amplitude (maximal eye movement during a complete 360 degrees roll) of micro g animals increased significantly by 25% compared to 1g controls during the first postflight week, but decreased to the control level during the second postflight week. Microgravity had no effect in stage 14-16 fish on either rVOR gain or amplitude. (2) After 3g exposure, both rVOR gain and amplitude were significantly reduced for both stage 11-12 and stage 15 fish. One g readaptation was completed during the second post-3g week. Hypergravity at 2 or 2.5 g had no effect. (3) Hypergravity at all three levels tested (2g, 2.5g, and 3g) accelerated the morphological development as assessed by external morphological markers. Exposure to micro g- or 3g-periods during an early developmental period modifies the physiological properties of the neuronal network underlying the static rVOR; in susceptible developmental stages, these modifications include sensitization by microgravity and desensitization by hypergravity.

Syntheses and structural analysis of 10-monoxy- and -dioxy-5-N-substituted iminothianthrene derivatives and the stereochemical change on their sulfur atom under acidic and thermal conditions

5-(N-p)-Toluenesulfonyl)iminothianthrenes, whose sulfur atoms are oxidized to a sulfoxide or sulfone at the 10-position, were hydrolysed readily in high yield to N-unsubstituted-sulfilimines by using concentrated H2SO4. During hydrolysis, 10-monoxy-5-N-unsubstituted-sulfilimines were obtained as a separable mixture of the cis and trans isomers. The stereochemical interconversion of these compounds was studied under both hydrolytic and thermal conditions and their structures were elucidated by using X-ray crystallography.

Bis[N-phenyl(dicyclohexylthiophosphinoyl)thiomethanamido-S, S']copper(II)

The ligands in [Cu(C(19)H(27)NPS(2))(2)] adopt an S,S'-chelation mode leading to an S(4) donor set which defines a square-planar geometry about the Cu atom, which lies on an inversion centre.

(Benzoxazole-2-thiolato-S)(benzoxazole-2-thione-S)bis(triphenylphosph ine)copper(I)

The Cu atom in [Cu(C(7)H(4)NOS)(C(7)H(5)NOS)(C(18)H(15)P)(2)] is tetrahedrally coordinated by a P(2)S(2) donor set. One S atom is derived from neutral benzoxazole-2-thione and the other from the deprotonated form of the ligand. The two sulfur ligands are connected via an N-H.N interaction, leading to the formation of an eight-membered ring.

Effect of first treatment with aminobisphosphonates pamidronate and ibandronate on circulating lymphocyte subpopulations

Up to 60% of patients receiving their first infusion of the bisphosphonate pamidronate experience an acute-phase reaction. In this study, we used flow cytometry to determine the effects of pamidronate treatment on circulating lymphocyte subpopulations, and we investigated whether pamidronate and ibandronate treatment affect lymphocyte subpopulations differently. Twenty patients received a pamidronate infusion, 20 patients received intravenously injected ibandronate, and 10 controls received a clodronate infusion. Pamidronate treatment was followed by a significant increase in median body temperature at the 10-hour measurement and a significant decrease in counts of circulating lymphocytes, natural killer cells, T cells, and CD4+ and CD8+ T-cell subsets. Ibandronate treatment did not affect median body temperature, and it was associated at the 10-hour measurement with maximum increases in total lymphocyte count, B cells, T cells, and CD4+ and CD8+ T-cell subsets. Thus, there is a substantial difference in the hematologic response to initial treatments with pamidronate and ibandronate. Clodronate treatment did not induce changes in body temperature or significantly affect the number of circulating T cells and NK cells. The reduction in lymphocyte subsets after initial pamidronate therapy might be mediated by the release of tumor necrosis factor alpha, whose source in the acute-phase reaction could be T cells.

Self-Assembly of a Radially Functionalized Hexagonal Molecule: Hexakis(4-hydroxyphenyl)benzene

Two different porous hydrogen-bonded networks are formed by self-assembly of the radially substituted host 1. In the network of type A, formed by 1 small middle dot4 Et(2)O, all OH groups of 1 are involved in hydrogen bonding, and the molecular sheets are stacked without translation to generate extended channels that accommodate the Et(2)O molecules. Four OH groups of 1 are involved in the type B network of 1 small middle dot4 DMF, and lateral translation of the sheets in an ABAB sequence generates large chambers, each of which contains four DMF molecules.

Selective changes in EGF receptor expression and function during the proliferation, differentiation and apoptosis of mammary epithelial cells

Epidermal growth factor (EGF) is a multifunctional regulator of mammary epithelial cells (MEC) that transduces its signals through the EGF receptor (EGFR). To clarify the role of the EGFR in the mammary gland, EGFR expression, localization and function were examined during different developmental stages in rats. Immunoblot analysis demonstrated high levels of EGFR during puberty, pregnancy and involution as well as at sexual maturity, and low levels throughout lactation. An immunohistochemical assay was used to show that EGFR was distinctly expressed in a variety of cell types throughout mammary glands from virgin rats and rats during pregnancy and involution, and was down-regulated in all cell types throughout lactation. To examine the relationship between EGFR expression and function, primary MEC were cultured under conditions that induced physiologically relevant growth, morphogenesis and lactogenesis. Cultured MEC expressed an in vivo-like profile of EGFR. EGFR was high in immature MEC, down-regulated in functionally differentiated MEC, and then up-regulated in terminally differentiated and apoptotic MEC. An inhibitor of the tyrosine kinase domain of EGFR was used to demonstrate that EGFR signaling was required for growth and differentiation of immature MEC, and for survival of terminally differentiated MEC, but not for maintaining functional differentiation.

Novel serum markers of bone resorption: clinical assessment and comparison with established urinary indices

Although urinary measurements of collagen degradation provide valid estimates of bone resorption, their clinical application is hampered by pronounced analytical and biological variability. Therefore, immunoassays for the determination of such parameters in serum have been developed. In this study, we assessed the performance of three new serum markers of bone turnover, i.e., C-terminal and N-terminal telopeptides of type I collagen (S-CTX and S-NTX) and bone sialoprotein. Results were compared with urinary total pyridinoline, total deoxypyridinoline, and urinary C-terminal telopeptides of type I collagen (U-CTX) and urinary N-terminal telopeptides of type I collagen (U-NTX). The study population included healthy men (n = 27), premenopausal (n = 30) and postmenopausal (n = 31) women, patients with hepatic dysfunction (HF, n = 24), renal failure (RF, n = 30), breast cancer without (BC-, n = 24) and with (BC+, n = 30) bone metastases, primary vertebral osteoporosis (OPO, n = 27), primary hyperparathyroidism (PHPT, n = 16), active Paget's disease of bone (n = 18), multiple myeloma (MM, n = 18), and patients with hypercalcemia of malignancy before and after treatment with pamidronate (HOM, n = 28). Changes in urinary and serum markers were similar in most metabolic bone diseases. However, differentiation between healthy controls and OPO, or PHPT, was improved by the serum markers. In MM, all serum and urinary markers were elevated (p < 0. 05 vs. controls). In BC+, skeletal involvement was reflected by significant increments in all indices (p < 0.01 vs. BC-), except U-CTX and S-CTX. In HOM, pamidronate-induced changes in biomarkers were most pronounced for U-CTX and S-CTX and S-NTX. HF and RF were associated with elevated levels of all serum markers (p < 0.05 vs. controls). In conclusion, measurements in serum reflect bone resorption to the same extent as the urinary indices. Since serum markers circumvent some of the limitations of urinary measurements, their use potentially improves the assessment of skeletal disorders.

Bartonella koehlerae sp. nov., isolated from cats

Two of the 25 Bartonella isolates recovered during a prevalence study of Bartonella henselae bacteremia in domestic cats from the greater San Francisco Bay region were found to differ phenotypically and genotypically from all prior B. henselae isolates. These isolates, C-29 and C-30, which were recovered from the blood of two pet cats belonging to the same household, grew on chocolate agar as pinpoint colonies following 14 days of incubation at 35 degrees C in a candle jar but failed to grow on heart infusion agar supplemented with 5% rabbit blood. Additional phenotypic characteristics distinguished the isolates C-29 and C-30 from other feline B. henselae isolates. The restriction patterns obtained for C-29 and C-30 by citrate synthase PCR-restriction fragment length polymorphism (RFLP) analysis as well as by genomic RFLP could not be distinguished from each other but were distinctly different from that of the B. henselae type strain. In reciprocal reactions, DNAs from strains C-29 and C-30 were 97 to 100% related under optimal and stringent DNA reassociation conditions, with 0 to 0.5% divergence within related sequences. Labeled DNA from the type strain of B. henselae was 61 to 65% related to unlabeled DNAs from strains C-29 and C-30 in 55 degrees C reactions, with 5.0 to 5.5% divergence within the related sequences, and 31 to 41% related in stringent, 70 degrees C reactions. In reciprocal reactions, labeled DNAs from strains C-29 and C-30 were 68 to 92% related to those of the B. henselae type strain and other B. henselae strains, with 5 to 7% divergence. The 16S rRNA gene sequence of strain C-29 was 99.54% homologous to that of the type strain of B. henselae. On the basis of these findings, the two isolates C-29 and C-30 are designated a new species of Bartonella, for which we propose the name Bartonella koehlerae. The type strain of Bartonella koehlerae is strain C-29 (ATCC 700693).

Light-dependent suppression of the vestibulo-ocular reflex during development

In the fish Oreochromis mossambicus, light conditions affect the development of the roll-induced vestibuloocular reflex (rVOR). During development under continous light-dark conditions the rVOR amplitude, which is the maximum eye movement during a complete 360 degrees lateral roll, shows a secondary drop after a first peak at stage 17 by 64% (36.3 degrees at stage 17; 13.0 degrees at stage 20). This drop was shifted by 2 stages to older postembryonal stages and was 33% (29.2 degrees at stage 20; 19.5 degrees at stage 22) less pronounced in animals which were exposed to complete darkness for several days. Because the period of rVOR diminution is sensitive to light conditions, it is likely that outgrowing visual projection fibres reorganize the neuronal network underlying visual-vestibular behavior thus transiently suppressing the rVOR.

The minimum duration of microgravity experience during space flight which affects the development of the roll induced vestibulo-ocular reflex in an amphibian (Xenopus laevis)

In tadpoles of Xenopus laevis, the effects of microgravity on the development of the roll-induced vestibuloocular reflex (rVOR) was investigated. Special attention was focused on sensitive periods and the minimum duration of microgravity exposure by which the development of the rVOR is affected. The peak-to-peak excursion (rVOR amplitude) of the rVOR characteristic for a lateral 360 degrees roll was used to describe microgravity effects. Fertilization of all eggs was performed 40 h before launch. Tadpoles were exposed to microgravity either during the first (MC-group) or second half of the mission (CM-group), or throughout the 9-day mission (MM-group). Inflight, 1G-gravity was simulated by a centrifuge (CC-group). After termination of the mission, the rVOR amplitude was only reduced in the MM-group with respect to the 1 G-inflight and 1 G-ground control by approximately 20-30% while both the MC- and CM-groups were not affected by the 4-day and 5-day microG exposure, respectively. However, CM-tadpoles like MM-tadpoles showed malformation of their body characterized by a dorsal bended tail. It disappeared in both groups within 2 weeks after landing. The difference between the rVOR amplitudes of the experimental groups disappeared within 5 weeks after landing. The results demonstrate that microgravity retards the development of the rVOR if it lasted longer than 4 days but that tadpoles are susceptible even for shorter periods as shown by the malformation of the body.

Serum-free media for the in vitro cultivation of Cowdria ruminantium

The in vitro culture of Cowdria ruminantium, the causative agent of heartwater in domestic ruminants, was first achieved in 1985; since then, most groups working with this culture system have used media which were supplemented with serum and, in addition, most of them contained tryptose phosphate broth. These undefined products vary from batch to batch and often fail to support the growth of C. ruminantium. We are therefore working towards the development of a completely chemically defined medium for Cowdria culture. We attempted the propagation of the Welgevonden stock of C. ruminantium in bovine endothelial cell cultures in a variety of serum-free culture media. Four synthetic media gave unsatisfactory results, these were: SFRE-199, Iscove's modified Dulbecco's medium, Dulbecco's modified Eagle's medium, and Leibovitz L-15. These media were all supplemented with a proprietary solution A (components solution A of the HL-1 medium kit, containing transferrin, testosterone, sodium selenite, ethanolamine, saturated and unsaturated fatty acids, and stabilizing proteins). Three other serum-free media did support the growth of C. ruminantium: a modified HL-1 medium, Dulbecco's modified Eagle's medium nutrient mixture Ham F-12 (DME/F-12), and RPMI 1640. The chemical composition of DME/F-12 and RPMI 1640 are published, but not that of the HL-1 medium. Each of these media was supplemented with proprietary solution A. Various supplements were investigated as alternative to the incompletely specified solution A; bovine lipoproteins and bovine transferrin were identified as essential supplements which effectively replaced compound solution A. C. ruminantium was propagated in the three growth-supportive media for at least 10 passages.

[Pathogenesis of hypotrophic and eutrophic preterm deliveries --a morphologic study of 212 cases]

The exact pathogenesis of prematurity and intrauterine growth retardation (IUGR) is still obscure in detail. Histological examination of placental tissue may be helpful. In a retro- and prospective study we examined 212 placentas including eutroph-term (n = 80 as controls), hypotroph-term (n = 68), eutroph-preterm (n = 53) and hypotroph-preterm (n = 11) deliveries, respectively. Placentas of the control group showed a significant higher weight, a higher utero-placental diameter and a smaller thickness. We observed villous dysmaturity in a significant higher frequency in risk groups, compared with controls (70-80% vs. 15%). Retarded villous maturity occurred in 38.2% in the hypotroph-term group and in 36.4% in the hypotroph-preterm group, respectively. Placentas of eutroph-preterm deliveries showed a prematurity of the villous tree in 47.2% Our own results and data from literature suggest, that the majority of prematurity and IUGR is not caused by placental dysmaturity itself. Fetal hypotrophy is sometimes caused by inadequate adaptation of the placental tissue due to a virtual slowly appeared disturbance, probably in the uterine maternal blood flow. After the adaptation of placental tissue the organ is able to secure the fetal nutrition supply. A second "hit", e.g. inflammation of the chorion may lead to prematurity. If the compensation of the dysbalance between fetal nutrition-supply and placental capacity is impossible the birth of a premature fetus, mostly dysmature, takes place.