Intra-atrial myxomas, clinical-pathologic correlation based on two case studies including historical review

The two cases of left-sided myxomas are reported with both patients having had uneventful cardiac surgery. One patient had an uneventful recovery and is doing well, whereas the second patient (female) had a complicating cerebrovascular accident. This patient was thought to have myxoma embolization; however, histopathologic verification could not be obtained. This latter patient had of course a higher risk of developing thromboembolization, due to the concomitant valve surgery procedure. The clinical, operative and pathologic studies confirm the lesions as primary myxomas and support and amplify the diagnostic concept of those lesions being of neoplastic nature, and countermand the previously commonly held concept of the thrombotic nature of myxomas. The nature of the myxoma is the primitive mesenchymal vasoformative cells of the atrial subendocardium, which is equivalent to the subendocardial cushion cell.

Potential role of molecular mimicry between Helicobacter pylori lipopolysaccharide and host Lewis blood group antigens in autoimmunity

Helicobacter pylori is involved in gastritis, gastric and duodenal ulcers, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. Earlier studies already suggested a role for autoimmune phenomena in H. pylori-linked disease. We now report that lipopolysaccharides (LPS) of H. pylori express Lewis y, Lewis x, and H type I blood group structures similar to those commonly occurring in gastric mucosa. Immunization of mice and rabbits with H. pylori cells or purified LPS induced an anti-Lewis x or y or anti-H type I response, yielding antibodies that bound human and murine gastric glandular tissue, granulocytes, adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma cells. Experimental oral infections in mice or natural infection in humans yielded anti-Lewis antibodies also. The beta chain of gastric (H+,K+)-ATPase, the parietal cell proton pump involved in acid secretion, contained Lewis y epitopes; gastric mucin contained Lewis x and y antigenic determinants. Growth in mice of a hybridoma that secretes H. pylori-induced anti-Lewis y monoclonal antibodies resulted in histopathological evidence of gastritis, which indicates a direct pathogenic role for anti-Lewis antibodies. In conclusion, our observations demonstrate that molecular mimicry between H. pylori LPS and the host, based on Lewis antigens, and provide understanding of an autoimmune mechanism for H. pylori-associated type B gastritis.

Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group

BACKGROUND

Postmenopausal osteoporosis is a serious health problem, and additional treatments are needed.

METHODS

We studied the effects of oral alendronate, an aminobisphosphonate, on bone mineral density and the incidence of fractures and height loss in 994 women with postmenopausal osteoporosis. The women were treated with placebo or alendronate (5 or 10 mg daily for three years, or 20 mg for two years followed by 5 mg for one year); all the women received 500 mg of calcium daily. Bone mineral density was measured by dual-energy x-ray absorptiometry. The occurrence of new vertebral fractures and the progression of vertebral deformities were determined by an analysis of digitized radiographs, and loss of height was determined by sequential height measurements.

RESULTS

The women receiving alendronate had significant, progressive increases in bone mineral density at all skeletal sites, whereas those receiving placebo had decreases in bone mineral density. At three years, the mean (+/- SE) differences in bone mineral density between the women receiving 10 mg of alendronate daily and those receiving placebo were 8.8 +/- 0.4 percent in the spine, 5.9 +/- 0.5 percent in the femoral neck, 7.8 +/- 0.6 percent in the trochanter, and 2.5 +/- 0.3 percent in the total body (P < 0.001 for all comparisons). The 5-mg dose was less effective than the 10-mg dose, and the regimen of 20 mg followed by 5 mg was similar in efficacy to the 10-mg dose. Overall, treatment with alendronate was associated with a 48 percent reduction in the proportion of women with new vertebral fractures (3.2 percent, vs. 6.2 percent in the placebo group; P = 0.03), a decreased progression of vertebral deformities (33 percent, vs. 41 percent in the placebo group; P = 0.028), and a reduced loss of height (P = 0.005) and was well tolerated.

CONCLUSIONS

Daily treatment with alendronate progressively increases the bone mass in the spine, hip, and total body and reduces the incidence of vertebral fractures, the progression of vertebral deformities, and height loss in postmenopausal women with osteoporosis.

Studies of the oral bioavailability of alendronate

Clinical studies were performed to examine the oral bioavailability of alendronate (4-amino-1-hydroxy-butylidene-1,1-bisphosphonate monosodium). All studies, with the exception of one performed in men, involved postmenopausal women. Short-term (24 to 36 hours) urinary recovery of alendronate after an intravenous dose of 125 to 250 micrograms averaged about 40% in both men and women. In women, oral bioavailability of alendronate was independent of dose (5 to 80 mg) and averaged (90% confidence interval) 0.76% (0.58, 0.98) when taken with water in the fasting state, followed by a meal 2 hours later. Bioavailability was similar in men [0.59%, (0.43, 0.81)]. Taking alendronate either 60 or 30 minutes before a standardized breakfast reduced bioavailability by 40% relative to the 2-hour wait. Taking alendronate either concurrently with or 2 hours after breakfast drastically (> 85%) impaired availability. Black coffee or orange juice alone, when taken with the drug, also reduced bioavailability (approximately 60%). Increasing gastric pH, by infusion of ranitidine, was associated with a doubling of alendronate bioavailability. A practical dosing recommendation, derived from these findings and reflective of the long-term nature of therapy for a disease such as osteoporosis, is that patients take the drug with water after an overnight fast and at least 30 minutes before any other food or beverage.

Independence of the chaperone activity of protein disulfide isomerase from its thioredoxin-like active site

Protein disulfide isomerase (PDI) alkylated at thiols of the thioredoxin-like -CHC- active sites is devoid of isomerase activity, but its chaperone-like activity to increase the reactivation yield and prevent the aggregation of guanidine hydrochloride-denatured D-glyceraldehyde-3-phosphate dehydrogenase upon dilution is unimpaired. A peptide of 28 amino acids markedly inhibits both the enzyme and the chaperone activities of PDI. The above results indicate that the -CGHC- active site is necessary for the isomerase activity but not required for the chaperone activity of PDI, whereas the peptide binding site is essential for both activities.

Monitoring bone resorption in early postmenopausal women by an immunoassay for cross-linked collagen peptides in urine

A new immunoassay using an ELISA approach for measuring urinary excretion of cross-linked N-telopeptides of type 1 collagen was evaluated as a specific measure of bone resorption. The assay was applied to 65 early postmenopausal women who participated in a placebo-controlled trial of the aminobisphosphonate, alendronate sodium. Eight blood and urine samples were collected over a 9 month interval. Baseline cross-linked peptide excretion varied from 26 to 216 pmol BCE (bone collagen/mumol Cr. Within-subject variability (CV) for cross-linked peptide excretion was 20.2% over the 9 months in placebo-treated subjects, substantially less than that observed for other biochemical markers of bone resorption: 45, 53, and 63% for fasting urinary calcium and hydroxyproline and 24 h urinary lysylpyridinoline (HPLC assay), respectively. Baseline cross-linked peptide excretion correlated significantly (p < 0.001) with baseline total urine lysylpyridinoline and serum osteocalcin, but not with the other biochemical markers. Initial peptide excretion also correlated inversely with lumbar spine bone mineral density at entry (r = -0.26, p < 0.05). Treatment for 6 weeks with alendronate produced a dose-dependent suppression of cross-linked peptide excretion (0 +/- 8, 29 +/- 6, 56 +/- 5, and 64 +/- 3% for 0, 5, 20, and 40 mg, respectively, p < 0.01 versus placebo for treatment effect), with a return toward pretreatment values during follow-up. Measurement of the urinary cross-linked N-telopeptides of type I collagen by this new ELISA approach appears promising as a simple and reliable method to assess overall bone resorption.(ABSTRACT TRUNCATED AT 250 WORDS)

P-values after repeated significance testing: a simple approximation method

The P-value after a repeated significance test is a useful measure of the strength of evidence against the null hypothesis. Its computation, however, requires a computer-intensive numerical integration method. The P-value is not conceptually straightforward, because it depends on how the sample space is ordered, which can be arbitrary. We look at two orderings of the sample space, one proposed by Tsiatis et al. and the other by Rosner and Tsiatis, and Chang. Although studies have shown that the latter ordering gives more reasonable confidence intervals than the former, the former gives a conservative and therefore more reasonable P-value. Both, however, should yield an identical P-value in most applications. In this paper we present a simple method of approximating P-values. We provide tables to implement the method for two to ten stages with alpha = 0.1, 0.05 and 0.01 for the Pocock and O'Brien-Fleming procedures. The proposed method can be applied to both orderings.

Influence of age and gender on the plasma profiles of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitory activity following multiple doses of lovastatin and simvastatin

The effects of age and of gender on the plasma profiles of HMG-CoA reductase inhibitors following separate once-a-day dosage regimens (17 days) of lovastatin (80 mg/day) and simvastatin (40 mg/day) were studied in hypercholesterolemic patients. In general, plasma concentrations of active and total HMG-CoA reductase inhibitors were higher in elderly individuals (age, 70 to 78 years) and in females for both drugs. However, the Tmax of these inhibitors was not significantly affected by either age or gender. Following the last dose of lovastatin, the mean steady-stage plasma concentrations of total and active HMG-CoA reductase inhibitors were 30-60% higher in the elderly than in young individuals (age, 19 to 30 years). Also, the mean plasma concentrations were 20-50% higher in female than in male patients. Similarly, following the last dose of simvastatin, the mean plasma concentrations of HMG-CoA reductase inhibitors were 40-60% higher in the elderly than in young patients and were 20-50% higher in female than in male patients. These age- and gender-related differences do not appear to be large enough to warrant modification of dosage regimens, because plasma concentrations of these inhibitors are not necessarily indicative of efficacy and the therapeutic windows for lovastatin and simvastatin are broad.

Confidence limits for low induced frequencies of oncogenic transformation in the presence of a background

The problem is addressed of assessing realistic confidence limits for oncogenic transformation rates when the incidence of transformation is small, and there is a background present. It is shown that the commonly used approximations for assessing the confidence interval on the radiation-induced transformation rate (t1) and the control rate (t2) are inadequate when only a small number of transformants are observed. Accurate techniques are described for these cases for the estimation of confidence limits of t1, t2 and also t1-t2.

Preparation and certification of human hair powder reference material

Human hair powder reference material was prepared and certified for elemental composition. Human scalp hair (from Japanese men) was washed in a non-ionic detergent solution in an ultrasonic cleaner, dried, ground in an agate ball mill, sieved through a polyethylene net, blended, bottled (1100 vials, 2 g each), and finally sterilized by 60Co radiation. The prepared material satisfied the homogeneity criteria for a reference material. We determined trace elements by inductively coupled plasma atomic emission spectrometry and atomic absorption spectrometry and investigated matrix interference effects. The material was certified by using the data obtained by various analytical techniques; certified values are provided for Ca, Cd, Cr, Cu, Fe, Hg, K, Mg, Mn, Na, Ni, Sr, and Zn. The elemental composition of this reference material is considered similar to normal values for the male Japanese population.

Preparation and certification of human hair powder reference material

Human hair powder reference material was prepared and certified for elemental composition. Human scalp hair (from Japanese men) was washed in a non-ionic detergent solution in an ultrasonic cleaner, dried, ground in an agate ball mill, sieved through a polyethylene net, blended, bottled (1100 vials, 2 g each), and finally sterilized by 60Co radiation. The prepared material satisfied the homogeneity criteria for a reference material. We determined trace elements by inductively coupled plasma atomic emission spectrometry and atomic absorption spectrometry and investigated matrix interference effects. The material was certified by using the data obtained by various analytical techniques; certified values are provided for Ca, Cd, Cr, Cu, Fe, Hg, K, Mg, Mn, Na, Ni, Sr, and Zn. The elemental composition of this reference material is considered similar to normal values for the male Japanese population.