Examination of the transcription factor NtcA-binding motif by in vitro selection of DNA sequences from a random library

A recursive in vitro selection among random DNA sequences was used for analysis of the cyanobacterial transcription factor NtcA-binding motifs. An eight-base palindromic sequence, TGTA-(N(8))-TACA, was found to be the optimal NtcA-binding sequence. The more divergent the binding sequences, compared to this consensus sequence, the lower the NtcA affinity. The second and third bases in each four-nucleotide half of the consensus sequence were crucial for NtcA binding, and they were in general highly conserved. The most frequently occurring sequence in the middle weakly conserved region was similar to that of the NtcA-binding motif of the Anabaena sp. strain PCC 7120 glnA gene, previously known to have high affinity for NtcA. This indicates that the middle sequences were selected for high NtcA affinity. Analysis of natural NtcA-binding motifs showed that these could be classified into two groups based on differences in recognition consensus sequences. It is suggested that NtcA naturally recognizes different DNA-binding motifs, or has differential affinities to these sequences under different physiological conditions.

Total fibronectin in maternal plasma as a predictor for preeclampsia

OBJECTIVE

To assess the ability of measuring total maternal plasma fibronectin in predicting the risk of developing preeclampsia.

METHOD

In a cohort of 657 initially normotensive pregnant nulliparous women blood samples were collected at 26, 30 and 34 weeks of gestation. After delivery 3 groups were selected for measurement of total plasma fibronectin. The first group comprised 24 women who developed preeclampsia; the second 21 women who developed gestational hypertension, and the third 89 age-matched controls who remained normotensive.

RESULTS

In women who developed preeclampsia the fibronectin levels were higher at 26 (p < 0.01), 30 (p < 0.001) and 34 weeks of gestation (p < 0.001) than in pregnant controls. In the general population of pregnant nulliparous women the estimated risk of subsequent preeclampsia correlated with the fibronectin level at each measurement. In women with fibronectin levels within the 25th percentile at the 26th week of gestation, the risk was </=1.9% and within the 90th percentile >/=6.2%. The change in fibronectin levels between 26 and 34 weeks of gestation was the only variable that remained statistically associated with preeclampsia (p = 0.0002) in multivariate analysis. In this model the risk figures for the corresponding percentiles were </=1.0 and >/=5.8%, respectively.

CONCLUSION

Longitudinal assessment of the change in total fibronectin levels predicted preeclampsia slightly better than cross-sectional analysis of fibronectin at any gestational age. Nevertheless, measurement of total fibronectin in maternal plasma could not be proven to be a useful clinical predictor for preeclampsia in a general obstetric population of nulliparous women.

Functional assessment in vitro of human-complement-dependent antibody-induced cytotoxicity of neoplastic cells

The complement system is one potential cytotoxic effector mechanism that might be effective in immunotherapy of cancer using monoclonal antibodies (mAb) directed against tumor antigens. In order to evaluate the treatment outcome from trials using mAb in cancer patients, assessment of complement-dependent cytotoxicity (CDC) may therefore be of interest. Here we describe the elaboration of a CDC assay in vitro using a rat hepatoma cell line, H4-II-E, as target cells sensitised with mAb F12, directed against the tumor-associated ganglioside antigen fucosyl-GMI. Sensitised cells were incubated with various concentrations of fresh serum as complement source for 48 h and cytotoxicity was then assessed by the tetrazolium bromide (MTT) test. A large variation in CDC efficacy was observed between individual serum donors. No differences in CDC could be seen between healthy donors and cancer patients. The CDC showed a strong correlation to the serum concentrations of complement factor C4, supporting the validity of the assay. Our results suggest that there may be significant variations in complement function within and between individuals that might influence the outcome of clinical mAb therapy. The H4/F12 CDC assay described here, together with measurement of individual complement factors. such as C4, should be further validated in cancer patients at various disease stages and phases of treatment.

Biochemical characterization of a beta cell membrane fraction antigenic for autoreactive T cell clones

The two NOD-derived T cell clones, BDC-2.5 and BDC-6.9, are CD4+, Vbeta4+, islet-specific, and diabetogenic. These two T cell clones show different response patterns to whole islet cell antigen, but were found to respond to the same fraction isolated from beta granule membranes. The clones were used to follow the antigenic activity in the biochemical purification of a beta cell membrane detergent lysate subjected to HPLC anion exchange (IEX) and size exclusion chromatography (SEC). Antigenic activity could be retained after lysis in only one detergent (octyl-beta-glucoside) among several tested. In order to detect solubilized antigen, beta membrane proteins were covalently linked to microlatex beads prior to being added to T cell proliferation assays, a technique that eliminated detergent toxicity and resulted in increased assay sensitivity. To purify the antigen, membrane proteins were absorbed onto an anion exchange column and after elution using a salt gradient, activity for the clones was found in a fraction containing 0.15-0.2 M NaCl. Subsequent analysis of this material by size exclusion chromatography provided an apparent molecular weight of the antigen to be between 50 and 80 kDa. Further attempts to purify the protein by SDS-PAGE resulted in loss of antigenic activity. It is possible that the elusive nature of this protein is a clue to its importance as an autoantigen.

Reactivity of monoclonal antibodies with ganglioside antigens in human small cell lung cancer tissues

Gangliosides on tumor cells have been suggested as potential target antigens for specific immunotherapy in various types of cancer including small cell lung cancer (SCLC). In this study we have compared the expression of three gangliosides that have been described as tumor-associated antigens, FucGM1, GM2 and GD3 in SCLC tissue specimens collected at autopsy, using a double-layer immunofluorescence staining method and specific monoclonal antibodies (Mabs) directed against these ganliosides. We found expression of FucGM1, GD3 and GM2 in (70% (n=20), 60% (n=15) and 40% (n75% of the tumor cells in all lesions from the same patient (five of eight cases). Our results indicate that FucGM1 is a relevant ganglioside antigen in SCLC, and suggest that specific immunotherapy involving more than one ganglioside antigen in SCLC should at least include FucGM1 and GD3.

Women physicians and stress

Most women physicians enjoy better than average physical health and lead satisfying and productive lives. However, higher than average rates of depression, anxiety, marital problems, and substance abuse have been reported by some, but not all, authors. This quantitative survey of 196 women physicians and qualitative focus groups with 48 other women physicians was conducted to determine perceptions of their health, stress, satisfaction, knowledge, and abuse rates in medical practice. Eight specialties plus family practice physicians participated. The average age was 44.1 years (SD 8.8, range 23-77). Seventy-four percent of women physicians were married, with children. Specialists and family physicians were similar in all demographic characteristics except that family physicians were more significantly likely to be divorced, separated, or widowed (p < or = 0.01). Specialists perceived their personal physical health to be better than that of family doctors (p < or = 0.05), and family physicians rated their medical knowledge better than that of specialists (p < or = 0.0001). Women physicians over age 50 or with children over age 19 reported the best mental health (p < or = 0.0001 and 0.003, respectively). Overall, 49% of women physicians reported usually having high levels of stress, 44% felt mentally tired, and 17% took antidepressant drugs. Seventy-three percent reported verbal abuse at work (71% in the last year), and 33% reported physical assault at work (11% in the last year). Focus groups identified three major sources of stress: high expectations, multiple roles, and work environment. These results are discussed and compared with the literature. Both personal and systemic strategies are required to solve the problems identified. Women physicians can facilitate the adoption of some of these strategies by sharing information about successes, challenges, and solutions.

Tirapazamine plus cisplatin versus cisplatin in advanced non-small-cell lung cancer: A report of the international CATAPULT I study group. Cisplatin and Tirapazamine in Subjects with Advanced Previously Untreated Non-Small-Cell Lung Tumors

PURPOSE

A phase III trial, Cisplatin and Tirapazamine in Subjects with Advanced Previously Untreated Non-Small-Cell Lung Tumors (CATAPULT I), was designed to determine the efficacy and safety of tirapazamine plus cisplatin for the treatment of non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

Patients with previously untreated NSCLC were randomized to receive either tirapazamine (390 mg/m(2) infused over 2 hours) followed 1 hour later by cisplatin (75 mg/m(2) over 1 hour) or 75 mg/m(2) of cisplatin alone, every 3 weeks for a maximum of eight cycles.

RESULTS

A total of 446 patients with NSCLC (17% with stage IIIB disease and pleural effusions; 83% with stage IV disease) were entered onto the study. Karnofsky performance status (KPS) was >/= 60 for all patients (for 10%, KPS = 60; for 90%, KPS = 70 to 100). Sixty patients (14%) had clinically stable brain metastases. The median survival was significantly longer (34.6 v 27. 7 weeks; P =.0078) and the response rate was significantly greater (27.5% v 13.7%; P <.001) for patients who received tirapazamine plus cisplatin (n = 218) than for those who received cisplatin alone (n = 219). The tirapazamine-plus-cisplatin regimen was associated with mild to moderate adverse events, including acute, reversible hearing loss, reversible, intermittent muscle cramping, diarrhea, skin rash, nausea, and vomiting. There were no incremental increases in myelosuppression, peripheral neuropathy, or renal, hepatic, or cardiac toxicity and no deaths related to tirapazamine.

CONCLUSION

The CATAPULT I study shows that tirapazamine enhances the activity of cisplatin in patients with advanced NSCLC and confirms that hypoxia is an exploitable therapeutic target in human malignancies.

Self-reported health in relation to medical health and gender-specific problems in women

Self-reported health was studied in relation to physiological measures, gender-specific problems, and clinical evaluation in 61 middle-aged women employed in a male-dominated industry. Using self-reported somatic health as the dependent variable, 50% of the variability was explained by the dimension workplace culture and the ratio low-density lipoprotein/high-density lipoprotein. Some women who reported good health were diagnosed with distress but showed no ill-health factors. However, they reported experiences of gender-specific problems more often than the women who were diagnosed as being healthy. We concluded that self-report scales seem not to be enough to identify people who look healthy on standard health scales but who use psychological defenses. Differentiating methods such as gender-specific questions, physiological ratio-measures, and clinical judgment seem to be important for distinguishing genuine from illusory mental or physical health.

Psychosocial support in rehabilitation after orthopedic injuries

OBJECTIVE

Several studies have shown that psychosocial factors play a significant role in the recovery process after injuries. The aim of this study was to investigate whether psychosocial support would have a beneficial effect on outcome.

METHODS

A total of 151 patients with orthopedic injuries were randomized into an intervention group and a control group. The intervention group was offered a psychosocial support program during the early phase of rehabilitation.

RESULTS

One year after the injury, patients in the control group had an excess risk of having psychiatric complaints compared with patients in the intervention group (odds ratio = 2.74). They also reported a poorer quality of life according to Short Formula 36 Health Survey subscores for General Health (odds ratio = 2.3) and Vitality (odds ratio = 2.45). The length of the sick leave period did not differ between the groups.

CONCLUSION

Psychosocial support during the early phase of rehabilitation after orthopedic injuries may have a beneficial effect on outcome when measured as quality of life.

Cyanobacterial diversity in geographically related and distant host plants of the genus Gunnera

The diversity among 45 cyanobacterial isolates from 11 different Gunnera species originating from different geographical areas was examined. By means of polymerase chain reaction (PCR) fingerprinting with short tandemly repeated repetitive (STRR) sequences as primers, ten groups of symbiotic cyanobacteria and five unique isolates not belonging to a particular group were identified. Most groups were restricted to one geographical area, indicating a limited distribution of related cyanobacterial strains. An extensive cyanobacterial diversity was found both within and between the 11 different Gunnera species. Within a particular plant and even within the same stem gland, more than one cyanobacterial strain at a time could be present. These results indicate a low specificity in Gunnera-Nostoc symbiosis.

Expression and purification of the transcription factor NtcA from the cyanobacterium Anabaena PCC 7120

The transcription factor NtcA from the cyanobacterium Anabaena PCC 7120 was heterologously expressed in Escherichia coli. In order to optimize the expression of NtcA, random silent mutations were introduced at the 5' end of the DNA encoding the protein. To get as high a yield of pure protein as possible, different strategies of expression as well as purification conditions were used. Under optimal expression conditions, a high-level expression clone of NtcA was coexpressed with GroEL-ES at 37 degrees C. A hexahistidine tag was added to the N-terminus of the protein in order to allow purification on an IMAC affinity column. Expression followed by one purification step using IMAC affinity chromatography gave a yield of 30-40 mg pure NtcA protein per liter of bacterial culture. Gel-shift experiments showed that the recombinant NtcA was active in binding a DNA sequence containing an NtcA-specific site.

Single-agent gemcitabine: an active and better tolerated alternative to standard cisplatin-based chemotherapy in locally advanced or metastatic non-small cell lung cancer

This randomized study was designed to determine the response rates, survival and toxicities of single-agent gemcitabine (GEMZAR) and a combination of cisplatin/etoposide in chemonaive patients with non-resectable, locally advanced or metastatic non-small cell lung cancer (NSCLC). Gemcitabine 1000 mg/m2 was given as a 30-min intravenous infusion on days 1, 8, 15 of a 28-day cycle, cisplatin 100 mg/m2 on day 1, and etoposide 100 mg/m2 on days 1 (following cisplatin), 2 and 3. Major eligibility criteria included histologically confirmed non-small cell lung cancer, measurable disease, Zubrod performance status 0-2, no prior chemotherapy, no prior radiation of the measured lesion, and no CNS metastases. One hundred and forty-seven patients were enrolled, 72 in the gemcitabine and 75 in the cisplatin/etoposide arm. Patient characteristics were well-matched across both arms. Sixty-seven gemcitabine and 72 cisplatin/etoposide patients were qualified for efficacy analysis. There were no complete responses, but 12 partial responses in the gemcitabine arm and 11 in the cisplatin/etoposide arm, for protocol-qualified response but 12 partial responses in the gemcitabine arm and 11 in the cisplatin/etoposide arm, for protocol-qualified response rates of 17.9% (95%, CI: 9.6-29.2%,) and 15.3% (95% CI: 7.9-25.7%,), respectively. Median survival times were 6.6 months (95% CI: 4.9-7.3 months) for gemcitabine and 7.6 months (95% CI: 5.4-9.3 months) for cisplatin/etoposide. The 1-year survival probability estimate was 26% for gemcitabine and 24% for cisplatin/etoposide. There were no statistically significant between-group differences in time-to-event measures, but patients in the gemcitabine arm had a greater probability of achieving a tumour response after 2 months (probability estimate: 8 vs. 0%,) and of the response lasting at least 6 months (73 vs. 45%,). Clinical and haematologic toxicity was more pronounced in the cisplatin/etoposide arm. Quality-of-life measures indicated a significant worsening of symptomatology in the cisplatin/etoposide arm for hair loss, nausea and vomiting, and appetite loss. This randomized study provides further evidence that single-agent gemcitabine is an active and effective therapy for patients with non-resectable. locally advanced or metastatic NSCLC and good performance status, and that it is better tolerated than the combination cisplatin/ etoposide.

Psychotic disorders among inpatients with abuse of cannabis, amphetamine and opiates. Do dopaminergic stimulants facilitate psychiatric illness?

We have studied the occurrence of dual diagnoses (psychoses as well as abuse of either amphetamine, cannabis or opiates) during a 15-year period, among patients treated at Huddinge Hospital, Stockholm, Sweden. The purpose of the study is to evaluate if the different drugs were coupled to different rates of psychiatric co-morbidity. During the period in question, 461, 425 and 371 different patients respectively had been admitted at least once due to dependency on amphetamine, cannabis and opiates. Approximately 30% of the patients with a pure abuse of amphetamine or cannabis and less than 6% of the opiate abusers had been diagnosed at least once with any of the psychoses studied. Comparing the frequency of psychoses among mixed and pure abusers of illegal drugs, with and without a concomitant abuse of alcohol, we found that the co-morbidity rate for mixed opiate abusers increased significantly from 7.2 to 20.2% when alcohol abuse was also present. For abusers of amphetamine and cannabis (both pure and mixed), no differences in co-morbidity rates were seen when an abuse of alcohol was added to that of the drugs. It is difficult to find an explanation for the significant difference between the co-morbidity of pure abuse of amphetamine or cannabis on the one hand and opiates on the other. In conclusion, our findings show that the distribution of psychotic illness is high among abusers of amphetamine and cannabis, in contrast to the generally lower co-morbidity among abusers of opiates. Although these findings are consistent with earlier studies that have shown a propensity for developing psychoses among abusers of amphetamine and cannabis, one should bear in mind that this study is based on inpatients, and is not necessarily representative for all abusers of the drugs in question.

Host specificity in the Richelia-diatom symbiosis revealed by hetR gene sequence analysis

The filamentous heterocyst-forming cyanobacterium Richelia intracellularis forms associations with diatoms and is very abundant in tropical and subtropical seas. The genus Richelia contains only one species, R. intracellularis Schmidt, although it forms associations with several diatom genera and has considerable variation in size and morphology. The genetic diversity, and possible host specificity, within the genus Richelia is unknown. Using primers against hetR, a gene unique for filamentous cyanobacteria, specific polymerase chain reaction (PCR) products were obtained from natural populations of R. intracellularis filaments associated with three diatom genera. Phylogenetic analyses of these sequences showed that they were all in the same clade. This clade contained only the R. intracellularis sequences. The genetic affiliation of hetR sequences of R. intracellularis to those of other heterocystous cyanobacteria strongly suggests that it was not closely related to endosymbiotic Nostoc spp. hetR sequences. Sequences from R. intracellularis-Hemiaulus membranaceus sampled in the Atlantic and Pacific Oceans were almost identical, demonstrating that the genetic relatedness was not dependent on geographical location. All sequences displayed a deep divergence between symbionts from different genera and a high degree of host specificity.

An intraindividual clinical comparison of 2 metal-ceramic systems

PURPOSE

It has been questioned whether the surface and color of the ceramic and the metal-ceramic bond strength of a titanium-ceramic system are comparable to those of a conventional noble alloy-ceramic system. It was therefore the aim of this study to carry out an intraindividual clinical comparison between crowns fabricated according to the Procera system (titanium copings veneered with a low-fusing ceramic) and noble-alloy copings veneered with a medium-fusing ceramic.

MATERIALS AND METHODS

Twenty-one crown pairs were fabricated for eighteen patients; three of the patients were each provided with two crown pairs. After 2 years nineteen crown pairs in sixteen patients could be compared. Clinical examinations were performed by two calibrated dentists who are long experienced in prosthetic dentistry. The crowns were rated according to the California Dental Association system. In addition, Bleeding Index and Margin Index were evaluated.

RESULTS

After 2 years the quality of surface and color of the ceramic material seemed to have deteriorated more in titanium-ceramic crowns than in conventional metal-ceramic crowns, although the difference was not statistically significant. Regarding anatomic form, margin integrity, Bleeding Index, and Margin Index the differences between the two crown systems were small.

CONCLUSION

The low-fusing ceramics have been subject to improvements during the last few years. Their bond strength to titanium seems to be comparable to that of conventional metal-ceramic systems. However, in the long run one problem may be the surface and color stability of low-fusing ceramics. To make extended long-term comparisons between the two metal-ceramic systems possible the present patient material will be followed for a longer period than the current 2 years.

A cross-sectional validation study of Self-Evaluation of Communication Experiences after Laryngeal Cancer--a questionnaire for use in the voice rehabilitation of laryngeal cancer patients

A psychometric evaluation of the questionnaire 'Self-Evaluation of Communication Experiences after Laryngeal Cancer' (S-SECEL) addressing communication dysfunction in patients with laryngeal cancer was carried out. Ninety-three patients with laryngeal cancer were studied. For comparison of response patterns and external validation, 21 patients with non-small cell lung cancer (NSCLC) and 26 patients with hoarseness, caused by benign laryngeal disease, were included in the analysis. The patients completed three questionnaires; the S-SECEL, the Sickness Impact Profile (SIP) and the Hospital Anxiety and Depression scale (HAD). The S-SECEL questionnaire was well-accepted by the patients, compliance was satisfactory, and missing value rates were low. The reliability of the S-SECEL was satisfactory for the Environment and Attitude subscales, whereas the General subscale did not reach the reliability levels recommended for group comparisons. In general, the response pattern in the three diagnostic groups and the pattern of correlations between the S-SECEL scores and the SIP- and HAD-subscales and dimensions lent support to the construct validity of the S-SECEL.

A European perspective on psychiatric nursing and violent incidents: management, education and service organisation

The topic of violent incidents and its importance to inpatient psychiatric nursing practice is well recognised in the academic literature. However the awareness and profile of the issue in different European countries is highly variable. In this paper five European countries are compared: Italy, Norway, the Netherlands, Sweden and the UK. Contextual factors are likely to determine the perception, recognition and acknowledgement of the problem. Those described in detail here are the organisation of psychiatric inpatient services, the training of psychiatric nurses, and the methods used by those nurses to control and contain disturbed patients. For each of these factors large variations exist between the countries considered. The conclusion is drawn that there is much scope for useful comparative research.

Longitudinal changes in visual acuity and visual ability in a cohort followed from the age of 70 to 88 years

PURPOSE

To assess the change in visual acuity (VA) for distance and near and to correlate VA to changes in visual ability in a longitudinal study group followed from 70 to 88 years.

METHODS

In the population-based study H70 in Gothenburg, Sweden, 958 subjects from the original cohort were eye examined at age 70 and the surviving subjects were reexamined at age 82 (n=203) and at 88 years (n=129). Evaluation of change in visual function between age 82 and 88 was made in 66 subjects who took part in all three eye examinations.

RESULTS

The VA in the subsample (n=66) showed minimal difference compared to the cross-sectional groups. At age 70 nearly 100% of both sexes had VA> or =0.8. At age 82 about 50% and at age 88 about 25% had this VA level. Males retained a slightly better visual acuity compared to women. VA< or =0.3 was found in about 10% at age 82 and in >20% at age 88. Reading ability remained high, but at 82 years 1.6% and at 88 years 10.5% could benefit from adjustment of their near glasses. Visual ability corresponded well to VA at age 82, but not at 88 years. Women lost the ability for most tasks, whereas men showed small changes.

CONCLUSIONS

The majority of old people had good distance and near vision. A deterioration in visual acuity did not necessarily mean a negative change in visual ability. This emphasizes the importance of relating objective and subjective findings regarding VA and visual impairment to functional ability of the oldest of the elderly.

Functional outcome and quality of life in patients with Type B ankle fractures: a two-year follow-up study

OBJECTIVES

To compare a specific score designed for ankle fractures with a general quality-of-life instrument as an outcome measure, and to describe the two-year results for patients with Type B ankle fractures.

DESIGN

Follow-up study.

SETTING

Large teaching hospital, Sweden.

PATIENTS

Fifty-three patients, aged nineteen to sixty-three years, treated operatively for Type B ankle fractures. Forty-one patients completed the follow-up.

MAIN OUTCOME MEASUREMENTS

Olerud Molander Ankle Score (OMA score), Short Form-36 Health Survey (SF-36), and a visual analogue scale (VAS).

RESULTS

A significant correlation was found between the OMA score and SF-36 subscores for physical functioning, physical and emotional role function, social functioning, and bodily pain (p < 0.05). VAS for physical symptoms correlated with the OMA score and with all SF-36 subscores (p < 0.001). The mean OMA score was 84 (standard deviation = 22.5); 64 percent of patients scored 90 or more. Patients with an OMA score <90 more often had a B3-type fracture (p < 0.05) and more often considered themselves as not recovered compared with patients with an OMA score > or =90 (p < 0.001). Only thirteen patients (36 percent) reported a complete recovery. Sixteen patients (44 percent) had work-related problems and twenty-two (61 percent) had some problems with sport activities. The SF-36 subscores for physical functioning, physical and emotional role function, vitality, and mental health were lower compared with an average Swedish population (p < 0.05).

CONCLUSIONS

Our results suggest that the SF-36 Health Survey may be useful in measuring outcome after an ankle fracture, that disability, i.e., self-perceived limitations in everyday life, is common after B-type ankle fractures.

Megestrol acetate in advanced, progressive, hormone-insensitive cancer. Effects on the quality of life: a placebo-controlled, randomised, multicentre trial

A randomised double-blind placebo-controlled multicentre trial was performed to investigate the effects of megestrol acetate (MA) on the quality of life (QoL), appetite, weight and survival of patients with advanced, incurable, hormone-insensitive cancer. QoL was assessed at the start of treatment and at 4, 8 and 12 weeks, using the EORTC-QLQ-C30 instrument. 255 patients were randomised to 320 mg of MA daily or placebo for 12 weeks. 244 patients were assessable at baseline, 190 at 4 weeks (placebo 94; MA 96), 150 at 8 weeks (placebo 69; MA 81) and 112 at 12 weeks (placebo 55; MA 57). A beneficial effect of MA on appetite loss was observed at week 4 (P < 0.0001) and possibly at week 8 (P = 0.058). Further weight loss during treatment was significant only in the placebo group. In the first 8 weeks, changes in mean global QoL were small and similar in both groups. By 12 weeks the decrease in mean global QoL was more pronounced in the MA group (P = 0.028), which was related to a deterioration in physical function, while psychosocial function was not affected. Survival was not affected by MA, and side-effects were mild. The results show that MA has a beneficial effect on appetite and that it may retard weight loss with no adverse impact on survival and with mild toxicity. However, MA does not appear to improve global QoL as measured by the EORTC QLQ-C30.

Patients with recurrent injuries--psychosocial characteristics and injury panorama

Accidents are often considered to be a direct function of exposure to risk, but this study implies that there are subgroups of patients that expose themselves to more risks than others. Based on a consecutive series of moderately injured patients this study aimed to compare patients with repeated trauma episodes with patients with single trauma. The study showed that the former had experienced more violence during their lives, had a less favourable psychosocial situation and more often reported psychiatric problems and alcohol abuse compared with the latter, confirming the clinical knowledge that injury recurrence is associated with risk factors such as alcohol abuse, pre-existing psychopathology and a propensity towards violence.

Molecular cloning of a pancreatic islet-specific glucose-6-phosphatase catalytic subunit-related protein

A pancreatic islet-specific glucose-6-phosphatase-related protein (IGRP) was cloned using a subtractive cDNA expression cloning procedure from mouse insulinoma tissue. Two alternatively spliced variants that differed by the presence or absence of a 118-bp exon (exon IV) were detected in normal balb/c mice, diabetic ob/ob mice, and insulinoma tissue. The longer, 1901-bp full-length cDNA encoded a 355-amino acid protein (molecular weight 40,684) structurally related (50% overall identity) to the liver glucose-6-phosphatase and exhibited similar predicted transmembrane topology, conservation of catalytically important residues, and the presence of an endoplasmic reticulum retention signal. The shorter transcript encoded two possible open reading frames (ORFs), neither of which possessed His174, a residue thought to be the phosphoryl acceptor (Pan CJ, Lei KJ, Annabi B, Hemrika W, Chou JY: Transmembrane topology of glucose-6-phosphatase. J Biol Chem 273:6144-6148, 1998). Northern blot and reverse transcription-polymerase chain reaction analysis showed that the mRNA was highly expressed in pancreatic islets and expressed more in beta-cell lines than in an alpha-cell line. It was notably absent in tissues and cell lines of non-islet neuroendocrine origin, and no other major tissue source of the mRNA was found. During development, it was expressed in parallel with insulin mRNA. The mRNA was efficiently translated and glycosylated in an in vitro translation/membrane translocation system and readily transcribed into COS 1, HIT, and CHO cells using cytomegalovirus or Rous sarcoma virus promoters. Whereas the liver glucose-6-phosphatase showed activity in these transfection systems, the IGRP failed to show glucose phosphotransferase or phosphatase activity with p-nitrophenol phosphate, inorganic pyrophosphate, or a range of sugar phosphates hydrolyzed by the liver enzyme. While the metabolic function of the enzyme is not resolved, its remarkable tissue-specific expression warrants further investigation, as does its transcriptional regulation in conditions where glucose responsiveness of the pancreatic islet is altered.

A longitudinal clinical study of Procera ceramic-veneered titanium copings

PURPOSE

The purpose of the present paper was to study the long-term clinical results with ceramic-veneered Procera titanium copings.

MATERIALS AND METHODS

A total of 44 titanium copings (fabricated for 22 patients) veneered with a low-fusing ceramic were followed for 60 to 78 months. The clinical examinations were performed by licensed specialists in prosthetic dentistry. The crowns were rated according to the California Dental Association system. In addition, Bleeding Index and Margin Index were also evaluated.

RESULTS

In 3 crowns ceramic fractures necessitated their replacement. Two crowns had to be replaced because of caries. The ratings for surface and color had changed markedly, from excellent to acceptable. Regarding anatomic form, with the exception of the 3 fractured ceramic crowns, there were no obvious changes. The margin integrity, aside from the 2 crowned teeth with caries, was recorded as satisfactory (excellent or acceptable) for all other crowns; in fact, a large majority were rated excellent. Regarding Bleeding Index, there were no differences between crowned teeth and control teeth. Changes in Margin Index showed that the gingiva of the crowned teeth had retracted.

CONCLUSION

Of the various clinical factors evaluated, only surface and color-related to the low-fusing ceramic used for veneering-showed any obvious change during the follow-up period. Otherwise the veneered titanium copings had, in general, performed well.

Early death during chemotherapy in patients with small-cell lung cancer: derivation of a prognostic index for toxic death and progression

Based on an increased frequency of early death (death within the first treatment cycle) in our two latest randomized trials of combination chemotherapy in small-cell lung cancer (SCLC), we wanted to identify patients at risk of early non-toxic death (ENTD) and early toxic death (ETD). Data were stored in a database and logistic regression analyses were performed to identify predictive factors for early death. During the first cycle, 118 out of 937 patients (12.6%) died. In 38 patients (4%), the cause of death was sepsis. Significant risk factors were age, performance status (PS), lactate dehydrogenase (LDH) and treatment with epipodophyllotoxins and platinum in the first cycle (EP). Risk factors for ENTD were age, PS and LDH. Extensive stage had a hazard ratio of 1.9 (P = 0.07). Risk factors for ETD were EP, PS and LDH, whereas age and stage were not. For EP, the hazard ratio was as high as 6.7 (P = 0.0001). We introduced a simple prognostic algorithm including performance status, LDH and age. Using a prognostic algorithm to exclude poor-risk patients from trials, we could minimize early death, improve long-term survival and increase the survival differences between different regimens. We suggest that other groups evaluate our algorithm and exclude poor prognosis patients from trials of dose intensification.

Phase II study of gemcitabine and vindesine in patients with previously untreated non-resectable non-small-cell lung cancer

Because both vindesine and gemcitabine are active drugs in advanced non-small-cell lung cancer (NSCLC), with different modes of action and only partly overlapping toxicity, a phase II study was performed. Gemcitabine 1000 mg m(-2) was given on days 1, 8 and 15 every 4 weeks, while vindesine 3 mg m(-2) was administered weekly for 7 weeks, then every 2 weeks. A total of 42 patients with nonresectable NSCLC were included. The median age of patients was 56 years; 57% were men, 52% had adenocarcinoma, 31% squamous cell carcinoma and 17% had large-cell carcinoma. The performance status ranged from 0 to 2 with 83% in performance status 1. The majority (55%) had stage IV disease, while 40% had stage III B and 5% stage III A disease. WHO grade 3-4 leucopenia occurred in five patients (12%) and 9% had grade 4 neutropenia. Thrombocytopenia grade 3-4 was observed in six patients (15%). There were no septic death or bleeding episodes. One patient had a transient WHO grade 4 increase in bilirubin, and four patients had a decrease in glomerular filtration rate below the normal limit; one of these patients developed a non-reversible renal insufficiency. Ten patients (24%) complained of dyspnoea of uncertain mechanism, possibly involving bronchoconstriction. There were one complete and seven partial responses among 40 assessable patients (20%, 95% confidence limits 9-36%). Median response duration was 31 weeks (range 11-83 weeks) and median survival time 31 weeks (range 2-171 weeks). The current combination of gemcitabine and vindesine does not appear to be promising for further examination because of the toxicity and somewhat disappointing activity.