Clinical significance of combined examination of pretreatment serum CYFRA21-1 and SCCAg in cervical cancer patients

BACKGROUND AND OBJECTIVE

Cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) can be used for the quantitative examination of fragment of cytokeratin 19, and is a valuable tumor marker in various malignancies. This study was to investigate the significance of pretreatment serum CYFRA21-1 and squamous cell carcinoma antigen (SCCAg) in diagnosis and their correlations to the clinicopathologic features of cervical carcinoma.

METHODS

One hundred cervical carcinoma patients underwent pretreatment serum CYFRA21-1 and SCCAg evaluation; 20 healthy women were subjected as control. The specificity and sensitivity of CYFRA21-1 and SCCAg as diagnostic indexes were analyzed; their correlations to clinicopathologic features were investigated through univariate and multivariate analyses.

RESULTS

The specificity of CYFRA21-1 and SCCAg in diagnosing cervical cancer were both 100%. The sensitivity of CYFRA21-1 and SCCAg in diagnosing cervical cancer were 36.0% and 47.0% respectively, without significant difference. The combined examination of CYFRA21-1 and SCCAg elevated the sensitivity to 60.0%, which was significantly higher than that of examining CYFRA21-1 alone. Univariate analysis showed elevation of CYFRA21-1 was related with FIGO stage and tumor size; elevation of SCCAg was related with pathologic type, tumor size, deep stromal invasion and pelvic node metastasis. Multivariate analysis showed that elevation of CYFRA21-1 had no relationship with any factors, while elevation of SCCAg was related with deep stromal invasion and pelvic node metastasis. The sensitivity of SCCAg in predicting pelvic node metastasis and deep stromal invasion were significantly higher than those of CYFRA21-1 (75.0% vs. 29.2%, p = 0.001; 55.8% vs. 26.9%, p = 0.024), and the addition of CYFRA21-1 to SCCAg could not significantly improve the sensitivity compared with SCCAg alone (79.2% vs. 75.0%, p > 0.05; 63.5% vs. 55.8%, p > 0.05).

CONCLUSION

The value of pretreatment serum CYFRA21-1 as predictor of pelvic node metastasis and deep stromal invasion is less significant compared with that of SCCAg. For cervical squamous cell cancer, SCCAg is the preferred tumor marker.

Aromatase inhibitors in ovarian cancer: is there a role?

Estrogen plays a role in ovarian tumorigenesis. Aromatase is the enzyme required for the synthesis of estrogen via conversion of androgen to estrogen, which is the major source of estrogen in postmenopausal women. Aromatase is present in normal ovaries and other tissues (e.g., fat and muscle) as well as in 33-81% tumor tissues of ovarian cancer. Aromatase inhibitors (AIs) block estrogen synthesis by inhibiting aromatase activity. In patients with recurrent ovarian cancer, single-agent AI therapy has been shown to elicit clinical response rates of up to 35.7% and stable disease rates of 20-42%. Given the limited treatment options for recurrent ovarian cancer and the favorable safety profile and convenient use, AI is a rational option for prolonging platinum-free interval in recurrent ovarian cancer. Further studies are required to determine the efficacy of combination treatment with AIs and biological agents, determine the benefit of AIs for treating special types of ovarian cancer (e.g., endometrioid type), and identify biomarkers for targeted patient selection. This review summarizes the current epidemiologic, preclinical, and clinical data regarding estrogen's role in ovarian cancer, the expression and regulation of aromatase in this disease, the development and characteristics of the three generations of AIs, and the preclinical and clinical studies of AIs in the treatment of ovarian cancer.

[Clinical analysis of 12 cases of uterine carcinosarcoma]

BACKGROUND & OBJECTIVE

Uterine carcinosarcoma, also known as malignant mixed mullerian tumors, is an uncommon neoplasm that carries a poor prognosis. This study was to analyze the clinical manifestation, diagnosis, treatment and prognosis of this disease.

METHODS

Clinical data of 12 uterine carcinosarcoma patients, diagnosed in Cancer Center of Sun Yat-sen University from 1978 to 2004, were analyzed.

RESULTS

Of the 12 cases of uterine carcinosarcoma, 2 were in the cervix, 10 in the corpus uteri. The main clinical manifestation of cervical carcinosarcoma was contact vaginal bleeding. Carcinosarcoma in the corpus uteri manifested abnormal vaginal bleeding and postmenstrual bleeding. Diagnosis depended on pathology. Twelve patients undergone operation. Eight patients received chemotherapy and 2 received radiotherapy after operation. One cervical carcinosarcoma patient died within 2 year. The 1-, 3-, and 5-year survival rates of the 12 patients were 80.0%, 50.0%, and 50.0%,respectively.

CONCLUSIONS

Primary surgery is the main treatment for uterine carcinosarcoma. The prognosis of uterine carcinosarcoma is associated with surgicopathologic stage and treatment modalities.

[Diagnostic value of multiple tumor marker detection for mature and immature teratoma of the ovary]

BACKGROUND & OBJECTIVE

It is difficult to differentially diagnose mature cystic teratoma (MCT) and immature teratoma (IT) of the ovary before operation. This study was to evaluate the value of multiple tumor marker detection in differential diagnosis of ovarian MCT and IT.

METHODS

Clinical data of 272 patients with ovarian teratoma, diagnosed pathologically and treated at Cancer Center of Sun Yat-Sen University from Jan. 1995 to Dec. 2005, were reviewed. Of the 272 patients, 254 had MCT and 18 had IT. The serum levels of carbohydrate antigen 125 (CA125), CA153, CA199, neuron-specific enolase (NSE), alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) in MCT and IT were compared.

RESULTS

Of the 254 patients with MCT, the median age was 30, the mean serum levels of CA125, CA153, CA199, NSE, AFP and CEA were 25.5 x 103 u/L, 11.8 x 103 u/L, 106.6 x 103 u/L, 12.6 microg/L, 2.7 microg/L and 2.5 microg/L. Of the 18 patients with IT, the median age was 23, the mean serum levels of these tumor markers were 140.3 x 103 u/L, 16.8 x 103 u/L, 112.0 x 103 u/L, 18.0 microg/L, 369.5 microg/L and 3.2 microg/L. Both the serum levels and positive rates of CA125, CA153 and AFP were significantly higher in IT than in MCT (P<0.05). When detected alone to differentially diagnose MCT and IT, the specificity of CA125, CA153, AFP were high, and the sensitivity of CA125 was the best (50.0%). The sensitivity was elevated to 71.4% by combined detection of CA125, CA153 and AFP.

CONCLUSION

Combined detection of tumor markers, especially CA125, CA153 and AFP, may be helpful for differential diagnosis of ovarian MCT and IT.

[Predictive value of in vitro MTT assay chemosensitivity test of cytotoxic drug activity in cervical cancer]

BACKGROUND & OBJECTIVE

In recent years, the neoadjuvant chemotherapy for cervical cancer has evoked more and more attention and has been used widely. But the chemosensitivity of individuals to various antitumor drugs is different. This study was to investigate the chemosensitivity of cervical cancer cells to antitumor drugs using in vitro MTT assay chemosensitivity test.

METHODS

The sensitivity of fresh human cervical cancer cells from 32 patients to 9 cytotoxic drugs was tested using in vitro MTT assay.

RESULTS

The cytotoxic activities of the 9 drugs for cervical cancer were in sequence from high to low as follows: liposomal paclitaxel, taxol, carboplatin (CBP), ifosfamide (IFO), etoposide (VP-16), 5-fluorouracil (5-FU), cisplatin (DDP), bleomycin (BLM), and cyclophosphamide (CTX). Generally, cervical cancer cells were more sensitive to paclitaxel, taxol, and CBP than to other drugs (P<0.05) with inhibition rates of 56.56%, 55.66%, and 46.81%, respectively. Stage Ib1 cervical cancer cells were more sensitive to taxol, paclitaxel, and CBP than to other drugs with inhibition rates of 58.71%, 53.00%, and 49.25%, respectively; stage Ib2 cervical cancer cells were more sensitive to paclitaxel and taxol than to other drugs with inhibition rates of 65.26% and 50.06%. Both moderately and poorly differentiated squamous cell cancer cells were more sensitive to taxol, paclitaxel, and CBP than to other drugs with inhibition rates of 52.01%, 49.21%, and 40.02% for the former, and 60.02%, 61.16%, and 48.75% for the latter.

CONCLUSIONS

MTT assay, a sensitive and widely used chemosensitivity testing method, is helpful in sensitive drug screening and neoadjuvant chemotherapy regimen selection for cervical cancer. Cervical cancer cells are more sensitive to paclitaxel, taxol, and CBP than to other tested drugs in this study.

Ethanol-induced mitogen activated protein kinase activity mediated through protein kinase C

The aim of this study was to determine the pathway(s) by which ethanol activates mitogen-activated protein kinase (MAPK) signaling and to determine the role of Ca2+ in the signaling process. MAPK signaling was determined by assessing MAPK activity, measuring phosphorylated extracellular signaling-regulated kinase (pp 44 ERK-1 and pp 42 ERK-2) expression and ERK activity by measuring ERK-2-dependent phosphorylation of a synthetic peptide as a MAPK substrate in rat vascular smooth muscle cells. Ethanol activated extracellular signal-regulated kinase expression (ERK 1 and 2) could be observed when vascular smooth muscle cells (VSMCs) were stimulated for 5 min or less, but was inhibited when cells are treated for 10 min or more with 1-16 mM of ethanol. Maximum ethanol-induced MAPK activity was observed within 5 min with 4 or 8 mM. Ethanol stimulated MAPK activity was blocked by the protein kinase C (PKC) inhibitor (GF109203X) and epidermal growth factor (EGF) receptor antagonist (PD153035) by 41 +/- 24 and 34 +/- 12.3%, respectively. The calcium channel blocker, diltiazem and the chelating agent, BAPTA, reduced the activation of MAPK activity by ethanol, significantly. The data demonstrate that ethanol-stimulated MAPK expression is mediated partially through both the EGF-receptor and PKC intermediates and that activation through the PKC intermediate is calcium-dependent.

[How to increase the optimal rate of secondary cytoreductive surgery in recurrent epithelial ovarian cancer]

BACKGROUND & OBJECTIVE

Optimal secondary cytoreduction is of prognostic importance for recurrent epithelial ovarian cancer. To increase the optimal rate of secondary cytoreductive surgery in these patients is helpful for improving the prognosis of recurrent epithelial ovarian cancer patients. In this retrospective study, we investigated how to increase the optimal rate of secondary cytoreductive surgery in recurrent epithelial ovarian cancer patients.

METHODS

The clinical data of 54 patients with recurrent epithelial ovarian cancer were analyzed retrospectively, who received secondary cytoreductive surgery during March 1 1997 to March 31 2003 in Cancer Center, Sun Yat-sen University. Nineteen patients had tumors only in pelvis, and 35 patients both in pelvis and abdomen. Single tumor was found in 16 patients and multiple tumors in 38 patients. Thirty-eight patients had ascites and 16 patients no ascites. Preoperative chemotherapy was given to 20 cases, and responses were observed in 12 patients and no response in 8. Multivariate logistic regression was carried out to investigate the relationship of residual diseases of secondary cytoreduction with age, time to recurrence, recurrent sites, ascites, and preoperative salvage chemotherapy.

RESULTS

Optimal surgical cytoreduction was obtained in 81.5% (44/54) of the patients, with no macroscopic residual diseases in 53.7% (29/54) and residual diseases <or=2 cm in 27.8% (15/54). Logistic regression showed that recurrent sites and ascites were the significant factors for residual diseases after secondary cytoreductive surrey (both P <or= 0.05). Optimal cytoreduction was obtained in 100% (12/12) of the patients whose salvage chemotherapy before secondary cytoreduction was effective and in 37.5% (3/8) cases whose chemotherapy before secondary cytoreduction was ineffective (P<or=0.05, Chi(2) test). Complicated surgical procedures involving gastrointestinal tract, urinary tract, liver or spleen were carried out in 40.7% (22/54) of the patients. Post-operation complications occurred in 16.6% (9/54) and post-operation death rate was 1.9% (1/54).

CONCLUSION

It could be helpful for obtaining optimal secondary cytoreduction and avoiding helpless laparotomy to select patients properly according to the border of recurrent tumor, recurrent site, with or without ascites and the response of salvage chemotherapy before secondary cytoreduction and to do careful preoperative preparations.

Capillary electrophoresis-electrospray mass spectrometry for the characterization of high-mannose-type N-glycosylation and differential oxidation in glycoproteins by charge reversal and protease/glycosidase digestion

The characterization of high-mannose-type N-glycosylation by capillary electrophoresis-electrospray mass spectrometry (CE-ESI MS) was described. In addition to the use of a cationic noncovalent capillary coating, strong acidic buffer, and charge reversal to increase the glycoform resolving power, N-glycosidase F (PNGase F) combined with a basic protease and alpha-mannosidase combined with an acidic protease were used to analyze the high-mannose-type N-glycosylation in ribonuclease B (RNase B) and in a novel C-type lectin from the venom of Trimeresurus stejnegeri (TSL). The structures of oligosaccharide, glycosylation sites, and glycoform distributions were determined simultaneously, and the differential oxidation of Met residues in glycopeptides obtained from TSL protease digestion was also characterized successfully by CE-MS/MS. The results showed that the oligosaccharide attached to RNase B has a structure of GlcNAc2Man5 approximately 9, and that attached to TSL has a structure of GlcNAc2Min5 approximately 8. The glycoform distributions in these glycoproteins are quite different, with the GlcNAc2Man5 type predominant in RNase B, and the GlcNAc2Man8 type, in TSL This method may be useful not only for the characterization of glycosylation sites and glycan structures, but also for the determination of the relative abundance of individual glycoforms.

[System study of endangerment medicinal animals in China]

OBJECTIVE

Establishing system study of endangerment medicinal animals is essential for the protection of certain species of medicinal wild fauna.

METHOD

It was analyzed and summed up according to the study and protection actuality of endangerment medicinal animal in recent years.

RESULT AND CONCLUSION

It was essential to research endangerment medicinal animals for realizing modernization, industrialization, internationalization and stabilization development of Chinese Materia Medica.

Activation of NF-kappa B by nontypeable Hemophilus influenzae is mediated by toll-like receptor 2-TAK1-dependent NIK-IKK alpha /beta-I kappa B alpha and MKK3/6-p38 MAP kinase signaling pathways in epithelial cells

Nontypeable Hemophilus influenzae (NTHi) is an important human pathogen in both children and adults. In children, it causes otitis media, the most common childhood infection and the leading cause of conductive hearing loss in the United States. In adults, it causes lower respiratory tract infections in the setting of chronic obstructive pulmonary disease, the fourth leading cause of death in the United States. The molecular mechanisms underlying the pathogenesis of NTHi-induced infections remain undefined, but they may involve activation of NF-kappa B, a transcriptional activator of multiple host defense genes involved in immune and inflammatory responses. Here, we show that NTHi strongly activates NF-kappa B in human epithelial cells via two distinct signaling pathways, NF-kappa B translocation-dependent and -independent pathways. The NF-kappa B translocation-dependent pathway involves activation of NF-kappa B inducing kinase (NIK)--IKK alpha/beta complex leading to I kappa B alpha phosphorylation and degradation, whereas the NF-kappa B translocation-independent pathway involves activation of MKK3/6--p38 mitogen-activated protein (MAP) kinase pathway. Bifurcation of NTHi-induced NIK-IKK alpha/beta-I kappa B alpha and MKK3/6--p38 MAP kinase pathways may occur at transforming growth factor-beta activated kinase 1 (TAK1). Furthermore, we show that toll-like receptor 2 (TLR2) is required for NTHi-induced NF-kappa B activation. In addition, several key inflammatory mediators including IL-1 beta, IL-8, and tumor necrosis factor-alpha are up-regulated by NTHi. Finally, P6, a 16-kDa lipoprotein highly conserved in the outer membrane of all NTHi and H. influenzae type b strains, appears to also activate NF-kappa B via similar signaling pathways. Taken together, our results demonstrate that NTHi activates NF-kappa B via TLR2-TAK1-dependent NIK--IKK alpha/beta-I kappa B alpha and MKK3/6--p38 MAP kinase signaling pathways. These studies may bring new insights into molecular pathogenesis of NTHi-induced infections and open up new therapeutic targets for these diseases.

[Effects of heat stress on DA mediated PI signal transduction system in rat striatum]

Objective. To study the effects of heat stress on dopamine (DA) and related phosphatidylinositol (PI) signal transduction system members: PLA2, PI, Ca2+ in rat striatum. Method. Male Wistar rats were randomly divided into control group and heat stressed group. Heat stressed rats were placed in small hot chambers and taken out as soon as their rectal temperatures (Tr) reached the preset temperature. Then the animals were killed and their striatums were taken out. Fluorospectrophotometry, HPLC, Fura-2/AM fluoresence labelled method and acidalkaline titration were used to measure the content of DA, PI, [Ca2+]i and the enzyme activity of PLA2. Result. During heat stress, when rats' Tr reached 41.0 degrees C or higher, with increase of Tr, DA content increased continuously. When Tr = 43.0 degrees C, DA content was significantly higher than control. When Tr = 41.0 degrees C PLA2 activity was higher than control significantly, PI content of heat stressed group decreased significantly than control. [Ca2+]i increased significantly when Tr = 42.0 degrees C as compared with control. But if DA receptor2 (D2R) antagonist was given an hour before heat stress, [Ca2+]i decreased and Tr took a longer time to get to 42.0 degrees C. Conclusion. During heat stress, DA mediated PI signal transduction system was activated. The increase of [Ca 2+]i might be mediated by D2R, and D2R antagonist may improve thermotolerance.

Cell biology of tubotympanum in relation to pathogenesis of otitis media - a review

The sterility of the eustachian tube and tympanic cavity of normal individuals is maintained not only by the adaptive immune system, but also by the mucociliary system and the antimicrobial molecules of innate immunity. Mucin production and periciliary fluid homeostasis are essential for normal mucociliary function and dysfunction of this system is an important risk factor for otitis media. The secreted antimicrobial molecules of the tubotympanum include lysozyme, lactoferrin, beta defensins, and the surfactant proteins A and D (SP-A, SP-D). Defects in the expression or regulation of these molecules may also be the major risk factor for otitis media.

[Treatment of ischemic necrosis of femoral head by the transfer of vascular pedicled iliac periosteum]

OBJECTIVE

To investigate the therapeutical effect of treatment of ischemic necrosis of femoral head by the transfer of vascular pedicled iliac periosteum.

METHODS

From June 1983 to August 1997, 106 cases with ischemic necrosis of femoral head (II stage in 64 cases, III stage in 39 cases, IV stage in 3 cases) were treated by the transfer of vascular pedicled iliac periosteum with ascending branch of lateral femoral circumflex vessel or deep circumflex iliac vessel pedicle.

RESULTS

Followed up 2 years and 4 months to 16 years, there were excellent in 54 cases, better in 38 cases, moderate in 9 cases, poor in 5 cases, and 86.8% in excellent rate according to the criterion of the therapeutical effect on the repair and reconstruction of adult ischemic necrosis of femoral head.

CONCLUSION

Treating ischemic necrosis of femoral head by the transfer of vascular pedicled iliac periosteum has the advantage of constant pedicle, easily drawing materials and reliable therapeutical effect.

Tumor-derived EMMPRIN (extracellular matrix metalloproteinase inducer) stimulates collagenase transcription through MAPK p38

EMMPRIN (extracellular matrix metalloproteinase inducer) stimulates fibroblast metalloproteinases (MMP) 1, 2 and 3 (Kataoka et al. (1993) Cancer Res. 53, 3154-3158). Here we focus on MMP-1, showing that in lung tumors, MMP-1's cognate mRNA is strongly expressed in stromal fibroblasts adjacent to EMMPRIN-expressing tumor cells. In vitro, EMMPRIN upregulates MMP-1 mRNA expression in a concentration-dependent manner, with a peak accumulation at 24 h. The response is genistein-sensitive, suggesting it is dependent on tyrosine kinase activity. Analysis of tyrosine phosphorylation-dependent MAP kinases ERK 1/2, SAPK/JNK, and p38 showed that the activity of p38 but not that of the other 2 kinases was elevated in response to EMMPRIN. That p38 activity was required for EMMPRIN stimulation of MMP-1 was evident from results showing that the p38 inhibitor SB203580 blocked this response. This is the first available information regarding the mechanism by which tumor-associated molecules upregulate MMP synthesis in stromal fibroblasts.

Activation of NF-kappaB via a Src-dependent Ras-MAPK-pp90rsk pathway is required for Pseudomonas aeruginosa-induced mucin overproduction in epithelial cells

Cystic fibrosis (CF) is an autosomal recessive disorder, the most common lethal genetic disease in Caucasians. Respiratory disease is the major cause of morbidity and mortality. Indeed, 95% of CF patients die of respiratory failure. Pseudomonas aeruginosa, an opportunistic pathogen, chronically infects the lungs of over 85% of CF patients. It is ineradicable by antibiotics and responsible for airway mucus overproduction that contributes to airway obstruction and death. The molecular mechanisms underlying this pathology are unknown. Here we show that P. aeruginosa activates a c-Src-Ras-MEK1/2-MAPK-pp90rsk signaling pathway that leads to activation of nuclear factor NF-kappaB (p65/p50). Activated NF-kappaB binds to a kappaB site in the 5'-flanking region of the MUC2 gene and activates MUC2 mucin transcription. These studies bring new insight into bacterial-epithelial interactions and more specifically into the molecular pathogenesis of cystic fibrosis. Understanding these signaling and gene regulatory mechanisms opens up new therapeutic targets for cystic fibrosis.

Chemokine inhibition in rat stab wound brain injury using antisense oligodeoxynucleotides

Traumatic injury to the central nervous system (CNS) results in the breakdown of the blood-brain barrier and recruitment of hematogenous cells at the site of injury. The role of chemokines in this process has been well recognized and they have been regarded as promising targets for development of anti-inflammatory therapies. The expression of monocyte chemoattractant protein (MCP-1), in particular, has been closely linked to macrophage infiltration following trauma in rat brain. In this study we determined whether inhibition of MCP-1 following stab wound injury would reduce macrophage infiltration. Stab wound injured Sprague-Dawley rats were infused with MCP-1 sense or antisense oligonucleotides using an Alzet miniosmotic pump (1 microl/h for 3 days). Three days following injury, widespread gliosis was observed in both groups of rats as judged by glial fibrillary acidic protein (GFAP) immunoreactivity. Immunohistochemistry showed significantly less staining for MCP-1 in antisense treated animals. In addition, the number of macrophages were reduced by 30% in the antisense compared to the sense treated animals (P < 0.05). These results demonstrate that modulation of MCP-1 expression in stab wound injury directly affects monocytic infiltration and provide a basis for MCP-1 inhibition as a therapeutic strategy for controlling inflammatory events of traumatic brain injury.

Mucin gene (MUC 2 and MUC 5AC) upregulation by Gram-positive and Gram-negative bacteria

Bacterial infection of the lung is associated with mucin overproduction. In partial explanation of this phenomenon, we recently reported that supernatant from the Gram-negative organism Pseudomonas (P.) aeruginosa contained an activity that upregulated transcription of the MUC 2 mucin gene [J.-D. Li, A. Dohrman, M. Gallup, S. Miyata, J. Gum, Y. Kim, J. Nadel, A. Prince, C. Basbaum, Transcriptional activation of mucin by P. aeruginosa lipopolysaccharide in the pathogenesis of cystic fibrosis lung disease, Proc. Natl. Acad. Sci. U.S.A., 94 (1997) 967-972]. The purpose of the present study was to determine whether mucin genes other than MUC 2 are so regulated and whether Gram-positive organisms also contain mucin stimulatory activity. Results from in situ hybridization and RNase protection assays showed that P. aeruginosa upregulates MUC 5AC as well as MUC 2 in both bronchial explants and cultured airway epithelial cells. The upregulation of both genes by P. aeruginosa can be mimicked by lipopolysaccharide (LPS) and can be blocked by the tyrosine kinase inhibitor genistein. In addition, both genes are upregulated by a variety of Gram-positive as well as Gram-negative organisms showing the same rank order of potency. These data indicate the existence of a general mechanism by which epithelial cells respond to the presence of bacteria by increasing mucin synthesis.

Serum and egg yolk IgG antibody titers from laying chickens vaccinated with Pasteurella multocida

Through determining the serum and egg yolk antibody titers in immunized laying hens to Pasteurella multocida regularly, the growth-decline trend of the egg yolk antibody levels was found to be similar to that of the serum antibody levels (r = 0.94), but the growth and decline of the egg yolk antibody seemed to be delayed 3-6 days compared with that of the serum antibody, and the egg yolk antibody titers were generally lower than those of the serum antibody (P < 0.01). Serum and egg yolk antibody levels declined 3 and 6 days, respectively, after booster immunizations. The higher the antibody levels were before booster immunization, the more they declined.

Sp1 protein contributes to airway-specific rat MUC 2 mucin gene transcription

We have shown increases in the abundance of airway mucin mRNA during the pathogenesis of chronic obstructive pulmonary disease in rat models (Jany et al., 1991) and now seek to determine the underlying mechanisms. As transcriptional modulation may be involved, we provide here a functional analysis of the 5' flanking region of a rat mucin gene (MUC 2). Using deletion mutants to bp -859, we constructed expression cassettes in CAT vectors and transfected them into two MUC 2-expressing cell lines, SPOC 1, a rat airway epithelial cell line and IEC-6, a rat intestinal epithelial cell line, and into one MUC 2 non-expressing cell line, FR, a rat skin fibroblast cell line. Results indicated that nucleotides -59 to -40 mediated high level expression in SPOC 1, but not in the other cells. Used as a probe in gel shift assays, fragment -59/-40 formed complexes of differing mobilities when incubated with nuclear protein extracts from the three cell types. Mutation of the putative Sp1 binding site in the probe sequence interfered with protein binding in all three cell types, but anti-Sp1 antibody supershifted a band formed only by airway cell extracts. A model of airway cell-specific MUC 2 transcription is proposed.

Transcriptional activation of mucin by Pseudomonas aeruginosa lipopolysaccharide in the pathogenesis of cystic fibrosis lung disease

An unresolved question in cystic fibrosis (CF) research is how mutations of the CF transmembrane conductance regulator, a Cl ion channel, cause airway mucus obstruction leading to fatal lung disease. Recent evidence has linked the CF transmembrane conductance regulator mutation to the onset and persistence of Pseudomonas aeruginosa infection in the airways, and here we provide evidence directly linking P. aeruginosa infection to mucus overproduction. We show that P. aeruginosa lipopolysaccharide profoundly upregulates transcription of the mucin gene MUC 2 in epithelial cells via inducible enhancer elements and that this effect is blocked by the tyrosine kinase inhibitors genistein and tyr-phostin AG 126. These findings improve our understanding of CF pathogenesis and suggest that the attenuation of mucin production by lipopolysaccharide antagonists and tyrosine kinase inhibitors could reduce morbidity and mortality in this disease.

Transcriptional regulation of the lysozyme gene in airway gland serous cells

Lysozyme is expressed in serous, but not mucous, cells of the tracheobronchial glands and thereby constitutes a marker of the serous cell lineage in these glands. To identify DNA regulatory elements and transcription factors mediating the commitment of progenitor cells to the serous cell lineage, we have characterized the regulatory activity and DNA-protein interactions of the 5'-flanking region of the bovine lysozyme gene lys 5a. Results obtained from these studies indicate that although approximately 94 bp of 5'flanking DNA are necessary for high level expression in transient transfection assays, an evolutionarily conserved promoter within 66 bp of the transcription start site is sufficient to confer serous cell-specific expression. Farther upstream, within 6.1 kb of the 5' flanking region, are 4 silencers. Analysis of the serous cell-specific lysozyme promoter by electrophoretic mobility shift assay (EMSA) revealed the presence of binding sites for 3 serous cell nuclear proteins, designated LSF1, LSF2 and LSF3. Binding of LSF2 and LSF3 was localized to a 20-mer subdomain (-50/-30) of the cell-specific promoter using binding competition assays. More accurate identification of the protein binding site(s) was achieved through the use of mutagenesis, which implicated the motif 5' AAGGAAT 3' (-46/-40) in both protein binding and serous cell-specific transcriptional activity. This motif has previously been identified as a binding site for ets protein transcription factors, suggesting that serous cell-specific regulation of lys 5a transcription is partly controlled by the binding of ets-like protein(s) to the motif 5'AGGAAGT3'.

Systemic hypoxia dehydrates the space surrounding photoreceptors in the cat retina

PURPOSE

To assess the effects of systemic hypoxia and hyperoxia on the volume of the subretinal space (SRS).

METHODS

The authors measured the concentration of the extracellular space marker tetramethylammonium (TMA+) in the intact cat eye using double-barreled ion-selective microelectrodes. The retina was loaded with TMA+ by a single intravitreal injection. Systemic hypoxia was induced by adding nitrogen to the breathing mixture, and hyperoxia was induced by adding oxygen.

RESULTS

Hypoxia produced a slow increase in dark- adapted [TMA+]0, which was prominent in amplitude in the distal portion of the retina, suggesting a shrinkage of the SRS. This effect was essentially proportional to the decrease in arterial oxygen tension (PaO2) below the normoxic level. Dark-adapted (TMA+)0 began to increase at a PaO2 of 60 to 80 mm Hg and was enhanced by 13% to 15% at a PaO2 of 40 mm Hg. Because of its slow onset, the size of the increase also was related to the duration of hypoxia. The light-evoked decrease in (TMA+)0 in the SRS was larger in amplitude during hypoxia than in normoxia. This difference increased with severity of hypoxia, beginning at approximately the same PaO2 as the increase in dark-adapted (TMA+)0. Interestingly, the hypoxic increase in amplitude depended on light intensity, i.e., it was proportionally greater at lower intensities versus higher ones. Background illumination suppressed the hypoxia-induced increase in (TMA+)0 in SRS, inhibiting it by approximately 50% at levels of hypoxia down to a PaO2 of 40 mm Hg. Systemic hyperoxia produced the reverse effect of hypoxia. Between two extreme states, e.g., illumination during hyperoxia (PaO2 > 200 mm Hg) versus severe hypoxia in darkness (PaO2 approximately 40 mm Hg), extracellular volume may change more than 4-fold.

CONCLUSIONS

The observations of this study indicate that the space surrounding photoreceptors shrinks in response to hypoxia. This shrinkage should affect concentrations of all ions and metabolites located in the subretinal space.

Surgical management of the hypopharyngeal and cervical esophageal cancer

Between December 1979 and December 1992, 15 patients with hypopharyngeal and cervical esophageal cancer were treated surgically. Total pharyngolaryngectomy and partial cervical esophagectomy were performed and the defects were reconstructed with cervical skin flaps in 2 cases. The free jejunal segments were used in 6 cases following total pharyngolaryngectomy and cervical esophagectomy, cervical esophagectomy (larynx preserved) was repaired with free jejunal graft in 1 case. The pharyngogastric anastomosis following total pharyngolaryngoesophagectomy were performed in 4 cases, one of them, used pectoralis major myocutaneous flap for resection of soft tissue and skin of the neck. The pectoralis major myocutaneous flap and forearm free flap in 1 case respectively were used to reconstruct the deficits of total laryngectomy and partial pharyngectomy, and partial pharyngolaryngectomy. In our series, 1, 3, 5 years survival rates were 73.3% (11/15), 50% (6/12) and 55.6% (5/9), respectively. The advantages and disadvantages of a variety of operative procedures and the cervical lymph nodes management will be discussed.

Light-dependent hydration of the space surrounding photoreceptors in the cat retina

We have studied the effect of retinal illumination on the concentration of the extracellular space marker tetramethylammonium (TMA+) in the dark-adapted cat retina using double-barreled ion-selective microelectrodes. The retina was loaded with TMA+ by a single intravitreal injection. Retinal illumination produced a slow decrease in [TMA+]o, which was maximal in amplitude in the most distal portion of the space surrounding photoreceptors, the subretinal space. The light-evoked decrease in [TMA+]o was considerably slower and of a different overall time course than the light-evoked decrease in [K+]o, also recorded in the subretinal space. [TMA+]o decreased to a peak at 38 s after the onset of illumination, then slowly recovered towards the baseline, and transiently increased following the offset of illumination. It resembled the light-evoked [TMA+]o decreases previously recorded in the in vitro preparations of frog (Huang & Karwoski, 1990, 1992) and chick (Li et al., 1992, 1994) but was considerably larger in amplitude, 22% compared with 7%. As in frog, where it was first recorded, the light-evoked [TMA+]o decrease is considered to originate from a light-evoked increase in the volume of the subretinal space (or subretinal hydration). A mathematical model accounting for [TMA+]o diffusion predicted that the volume increase underlying the response was 63% on average and could be as large as 95% and last for minutes. The estimated volume increase was then used to examine its effect on K+ concentration in the subretinal space. We conclude that a light-dependent hydration of the subretinal space represents a significant physiological event in the intact cat eye, which should affect the organization of the interphotoreceptor matrix, and the concentrations of all ions and metabolites located in the subretinal space.

Calcium gradients and light-evoked calcium changes outside rods in the intact cat retina

We have studied light-evoked changes in extracellular Ca2+ concentration ([Ca2+]o) in the intact cat eye using ion-sensitive double-barreled microelectrodes. Two prominent changes in Ca2+ concentration were observed that differed in retinal location. There was a light-evoked increase in [Ca2+]o, accompanied by brief ON and OFF transients, which was maximal in the inner plexiform layer and was not further studied. There was an unexpected sustained light-evoked decrease in [Ca2+]o, of relatively rapid onset and offset, which was maximal in the distalmost region of the subretinal space (SRS). [Ca2+]o in the SRS was 1.0 mM higher than in the vitreous humor during dark adaptation and this transretinal gradient disappeared during rod-saturating illumination. After correcting for the light-evoked increase in the volume of the SRS, an increase in the total Ca2+ content of the SRS during illumination was revealed, which presumably represents the Ca2+ released by rods. To explain the light-evoked [Ca2+]o changes, we used the diffusion model described in the accompanying paper (Li et al., 1994b), with the addition of light-dependent sources of Ca2+ at the retina/retinal pigment epithelium (RPE) border and rod outer segments. We conclude that a drop in [Ca2+]o around photoreceptors, which persists during illumination and reduces a transretinal Ca2+ gradient, is the combined effect of the light-evoked SRS volume increase, Ca2+ release from photoreceptors, and an unidentified mechanism(s), which is presumably Ca2+ transport by the RPE. The relatively rapid onset and offset of the [Ca2+]o decrease remains unexplained. These steady-state shifts in [Ca2+]o should have significant effects on photoreceptor function, especially adaptation.