[Effects of ubenimex ( bestatin) on the immunity of patients with squamous cell lung carcinoma treated with chemotherapy]

BACKGROUND

To evaluated the effects of ubenimex on immunity of patients with squamous cell lung cancer.

METHODS

Fifty-six patients with inoperable squamous cell lung carcinoma were randomly divided into the experimental group ( EG, received chemotherapy combined with ubenimex 30mg p. o. daily for 6 months) or the control group ( CG, received chemotherapy alone) at 3:2 ratio. Lymph ocyte counting ( LC) , OKT₄ /T₈ ratio, activity of NK cell, IL-2 value and the level of soluble interleukin-2 receptor were determined. The regimen was CAP: cyclophosphamide and adriamycin and cisplatin.

RESULTS

Fifty-two patients were evaluable to be analysed and 32 in the EG and 20 in the CG respectively. The overall response rate at 6 months after treatment was 56% ( 18/ 32) in the EG and 45% ( 9/ 20) in the CG, which was no significant difference between the two groups. Three months and 6 months after treatment, OKT₄ /T₈ ratio, activity of NK cell and IL-2 value of the patients in the EG were significantly increased with the values of 1. 50±0. 29 and 1. 63±0. 39, 35. 1%±7. 3% and 35. 8%±5. 0%, 12±2 IU/ ml and 13±3 IU/ ml respectively compared with those before treatment with the values of 1. 34±0. 32, 33. 6%±5. 5%, 11±2 IU/ ml respectively ( P < 0. 05) and the SIL-2R level was significantly decreased with the values of 596±140 IU/ ml and 581±138 IU/ ml respectively compared with those before treatment 660±173 IU/ ml ( P < 0. 05) . Whereas in the CG there were no significant changes observed except for the SIL-2R level with the value of 532±78 IU/ ml at 6 months after treatment vs 645±189 IU/ ml before treatment. The IL-2 level of the patients in the EG significantly increased compared with those in the CG ( P < 0. 05) at 6 months after treatment ( 13±3 IU/ ml vs 11±3 IU/ ml) .

CONCLUSIONS

Ubenimex may increase the OKT₄ / T₈ ratio, the NK cell activity and the IL-2 value and decrease the SIL-2R level of patients with squamous cell lung carcinoma. Further studies on larger cases and long period of follow-up will be needed before definite conclusion can be drawn.

[An approach to achieve classification of QRS waves with wavelet multiresolution analysis and fractal dimension]

This paper discussed the theoretical analysis of multiresolution ECGs decomposition and expounds the calculation of the fractal dimension. Based on Mallat's multiresolution analysis and fractal dimension of the series, a new approach to classify the QRS complex was provided: the QRS complex was decomposed with a quadratic spline wavelet. At scale 4, the fractal dimension of the decomposed series was calculated, the values of modulus maxima of wavelet transform and the fractal dimension were used as discriminatory criteria to classify QRS. The method was simple and had high anti-noise ability.

[Anisodamine in prevention and treatment of sepsis of severely burned patients]

OBJECTIVE

To observe the preventive effect of anisodamine on possible sepsis of patients with major burns and the effect of anisodamine on patients with sepsis.

METHODS

Forty-two patients with extensive burn admitted to our burn institute from April 1998 to November 1999 were divided randomly into two groups: treatment group (T group) and control group (C group). In the T group, all 20 patients received fluid resuscitation regimen with anisodamine, and in the C group, 22 patients received the regimen with no anisodamine. A tonometry catheter was positioned in the stomach, connecting with the automatic gas analysis machine (Datex-Engstrom Corporation, Dutch) for determining gastric intramucosal pH (pHi). The plasma concentrations of diamine oxidase (DAO) and endotoxin were measured. Correlation analysis between pHi, DAO and endotoxin were made respectively during early stage of postburn. All the parameters in 7 patients with sepsis before and after administration of anisodamine were compared with those in 6 patients with sepsis without use of anisodamine.

RESULTS

The incidence of sepsis in the T group was lower (20.0%) than that in C group (40.9%). The gastric pHi value in the early period of postburn was significantly higher in the T group than in the C group (P < 0.05). Concurrently, the plasma concentrations of DAO and endotoxin were significantly lower in the T group than in the C group (P < 0.05 or 0.01). A significant negative correlation was seen between the gastric pHi and respective values of DAO, endotoxin (P < 0.05 or 0.01). There were a decrease in gastric pHi, and an increase in plasma DAO and endotoxin level in patients with septic episode; however all the parameters after administration of anisodamine were improved compared with those in septic patients without use of anisodamine.

CONCLUSIONS

Intestinal ischemic injury plays an important role in provoking sepsis during early postburn period. Anisodamine is effective in restoring intestinal circulation both in the shock phase and after the development of sepsis.

[A clinical study on PA-MSHA vaccine used for adjuvant therapy of lymphoma and lung cancer]

The objective of this study was to evaluate the effectiveness and safety of pseudomonas aeruginosa MSHA vaccine (PA-MSHA vaccine) used as an immune modulator. The study was carried out after the design of a non-blind, randomized controlled trial. The malignant lymphoma patients were divided into experiment group (45 cases) and control group (43 cases). Likewise were distributed the lung cancer patients: 44 cases in experiment group and 45 cases in control group. The two experiment groups received chemotherapy + PA-MSHA vaccine. The two control groups were given chemotherapy alone. The results showed that the clinical efficacy rate was 95.56% for the exp. group and 69.77% (P < 0.01) for the control group of the malignant lymphoma cases; the clinical efficacy rate was 59.09% for the exp. group and 42.22% (P < 0.01) for the control group of the lung cancer cases. The infection rate was 17.78% for the exp. group and 37.21% (P < 0.05) for the control group of the malignant lymphoma cases; the infection rate was 15.91% for the exp. group and 40.00% (P < 0.05) for the control group of the lung cancer cases. The comprehensive immune effectiveness rates for the exp. group and control group of the malignant lymphoma cases were 77.78% and 23.26% (P < 0.01) respectively. The comprehensive immune effectiveness rates for the exp. group and control group of the lung cancer cases were 84.09% and 35.56% (P < 0.01) respectively. Adverse reactions were found in 5 cases, of which, one was given medical care while the others automatically recovered. These results indicate that PA-MSHA vaccine, as a new kind of immune modulator, can improve the effectiveness of treatment for tumor with low adverse reaction rate.

A pilot study of low dose hydroxyurea as a novel resistance modulator in metastatic renal cell cancer

Mechanisms of chemoresistance in renal cell carcinoma include P-glycoprotein, overexpression of multidrug resistance-1 (mdr1) gene, and unstable chromosomal aberrations. In vitro exposure of resistant tumor cells to low dose hydroxyurea causes loss of chromosomal aberrations, decrease in the mdr1 gene copies, and increased sensitivity to vinblastine. Patients received continuous hydroxyurea 500 mg every Monday, Wednesday and Friday. Vinblastine 5 mg/m2 was given intravenously on days 1 and 8 every 21 days. Seventeen patients with a median age of 63 (range 40-80) received a median of 3 courses of vinblastine (range 1-14). Toxicities included: > or = grade 3 non-hematologic toxicity (1) and febrile neutropenia (2). No treatment related mortality occurred. Three patients (17.6%) had partial responses. The median survival was 38.0 weeks (95% CI = 26.9-49.1 weeks). The addition of hydroxyurea given at the dose of 500 mg orally three times weekly had no major impact on the expected antitumor effect of vinblastine.

[Effect of escharectomy and skin grafting of minipigs during burn shock stage on postburn energy expenditure]

OBJECTIVE

To determine the changes in resting energy expenditure (REE) of minipigs in normal and postburn stage, and the effect of escharectomy during burn shock stage on energy expenditure.

METHODS

Swine model with 35% TBSA III degree flame burn was used. Eighteen male minipigs were randomly divided into three groups: control group, escharectomy during burn shock stage group and escharectomy after burn shock stage group. REEs were monitored by means of Cardiorespiratory Diagnostic Systems (Medical Graphics Corporation, USA).

RESULTS

The levels of REE in escharectomy during burn shock stage group decreased early and were obviously lower than those in other two groups.

CONCLUSION

These findings suggest that escharectomy and skin grafting during burn shock stage could ameliorate hypermetabolism in major burn patients.

[Effect of escharectomy during burn shock stage on stress response]

OBJECTIVE

To investigate changes in hormones of plasma and the effect of escharectomy during burn shock stage on early stress response after burn.

METHODS

Sixteen male minipigs were subjected to a 35% TBSA III degree burn injury. The burned minipigs were randomly divided into two groups: escharectomy during burn shock stage group (S group) and escharectomy group after burn shock stage (N group). The sequential changes in plasma levels of insulin, glucagon, cortisol, GH, IGF-I, albumin were analyzed.

RESULTS

The serum concentration of insulin, glucagon, cortisol increased to some degree, whereas the serum concentration of GH, IGF-I decreased obviously after burn. As compared with the N group, no significant difference in the serum concentration of glucagon, cortisol, GH, IGF-I, was observed.

CONCLUSIONS

Escharectomy during burn shock stage could not aggravate stress response after burn.

[The effect of early escheractomy on expression of ICAM-1 and E-selectin mRNA of endothelial cells]

OBJECTIVES

To examine the effect of burned serum on change in endothelial cell ICAM-1 and E-selectin mRNA expression and whether these alterations can be corrected by the means of escharectomy during burn shock period.

METHODS

One hundred and seventy-six Wistar rats with 30% III degree TBSA on back were studied. Endothelial cell ICAM-1 and E-selectin mRNA were tested with the method of RT-PCR.

RESULTS

ICAM-1 and E-selectin expression showed an increase after stimulation by serum of 4 hours post burn, reaching peak levels 168 hours after injury. ICAM-1 and E-selectin expression levels could decrease to baseline within 168 hours in the rats which underwent escharectomy during shock stage, but kept higher than normal in rats without escharectomy or underwent 96 hours post burn.

CONCLUSIONS

These findings suggest that eschar can induce endothelial cells to express adhesion molecule. Early escharectomy is important to prevent adhesion molecule expression and SIRS.

[A clinical study on PA-MSHA vaccine in adjuvant therapy of lung cancer.]

BACKGROUND

To evaluate the effectiveness and safety of pseudomonas aeruginosa MSHA vaccine (PA-MSHA vaccine) used as immune modulator.

METHODS

The study was carried out by non-blinded randomized control trial. The lung cancer patients were divided into experimental group (44 cases) and control group (45 cases) . Both groups were given same chemotherapy , and the experimental group was injected PA-MSHA vaccine subdermally. After finishing the treatment , tumor response and infection rate were evaluated. Immune function was measured before , during and after the treatment respectively.

RESULTS

Clinical effective rate (CR + PR) was 59. 09 % in the experimental group , and 42. 23 % in the control group ( P < 0. 01) . Infection rate was 15. 91 % in the experimental group and 40 % in the control group ( P < 0. 05) . After the treatment , C3 and C4 , the ratio of CD4 to CD8 , NKcell activity and IL-2 level in the experimental group were significantly higher than those in the control group ( P < 0. 05) . Three cases in the experimental group had adverse reactions. One case had fever and was treated with antibiotics , while the other two with swelling in the injection site recovered automatically.

CONCLUSIONS

As a new kind of immune modulator , PA-MSHA vaccine can enhance immune function of lung cancer patient and prevent infection. It may improve chemotherapeutic effectiveness in adjuvant therapy of lung cancer with low adverse reaction rate.

Is primary CNS lymphoma really becoming more common? A population-based study of incidence, clinicopathological features and outcomes in Alberta from 1975 to 1996

BACKGROUND

The incidence of primary CNS lymphoma (PCNSL) is believed to be increasing in immunocompetent patients but this may not be universally true. The objective of this study was to determine in a population if the incidence of PCNSL is increasing, if the histologic subtypes are changing, and to describe the clinicopathologic and outcome characteristics of PCNSL.

PATIENTS AND METHODS

We identified all Alberta residents with a histologic diagnosis of PCNSL from 1 January 1975 to 31 December 1996 using the Alberta Cancer Registry. Annual age-standardized incidence rates (ASIR), clinicopathologic and outcome characteristics were determined.

RESULTS

There were 50 immunocompetent PCNSL patients; the median age was 64 and 30 were male. Their median survival was 10.15 months. Histology was available for review in 37 (74%) patients: 19 (51%) were diffuse large cell, 16 (43%) were immunoblastic and 2 (5%) were unclassifiable malignant lymphomas. The ASIR ranged from 0.178-1.631/10(6) and no change in ASIR was found (test for trend, P = 0.26) for gender or age. The ASIR of malignant gliomas did not change either but increased for all other non-Hodgkin's lymphoma (94.95-138.7610(6); test for trend, P = 0.0001) The number of brain biopsies increased from 1979-1985 (test for trend, P < 0.0001) but remained stable from 1986-1996 (test for trend, P = 0.99).

CONCLUSIONS

Unlike several other populations, PCNSL is not becoming significantly more common in Alberta. If this difference is real (i.e., not due to differences in cancer registry coding practices etc.) comparisons between Albertans and other populations in whom the incidence is rising may provide clues regarding the etiology of PCNSL.

Unique mode of GCC box recognition by the DNA-binding domain of ethylene-responsive element-binding factor (ERF domain) in plant

Ethylene-responsive element-binding proteins (EREBPs)have novel DNA-binding domains (ERF domains), which are widely conserved in plants, and interact specifically with sequences containing AGCCGCC motifs (GCC box). Deletion experiments show that some flanking region at the N terminus of the conserved 59-amino acid ERF domain is required for stable binding to the GCC box. Three ERF domain-containing fragments of EREBP2, EREBP4, and AtERF1 from tobacco and Arabidopsis, bind to the sequence containing the GCC box with a high binding affinity in the pM range. The high affinity binding is conferred by a monomeric ERF domain fragment, and DNA truncation experiments show that only 11-base pair DNA containing the GCC box is sufficient for stable ERF domain interaction. Systematic DNA mutation analyses demonstrate that the specific amino acid contacts are confined within the 6-base pair GCCGCC region of the GCC box, and the first G, the fourth G, and the sixth C exhibit highest binding specificity common in all three ERF domain-containing fragments studied. Other bases within the GCC box exhibit modulated binding specificity varying from protein to protein, implying that these positions are important for differential binding by different EREBPs. The conserved N-terminal half is likely responsible for formation of a stable complex with the GCC box and the divergent C-terminal half for modulating the specificity.

Compliance of clinical stage I nonseminomatous germ cell tumor patients with surveillance

PURPOSE

We evaluate compliance and its effect on the outcome of patients with clinical stage I nonseminomatous germ cell tumor who underwent post-orchiectomy surveillance at the Tom Baker Cancer Centre.

MATERIALS AND METHODS

From 1980 to 1994, 76 evaluable patients underwent surveillance at the Tom Baker Cancer Centre. The surveillance protocol consisted of clinical evaluation, chest x-ray and serum tumor marker measurements monthly in year 1, every 2 months in year 2, every 6 months in years 3 to 5 and yearly in years 6 to 10. Abdomen and pelvic computerized tomography (CT) were scheduled every 2 months in year 1 and every 4 months in year 2. Noncompliance was defined as missing 2 or more consecutive clinic visits, tumor marker measurements or chest x-rays or 1 or more CT scans.

RESULTS

Compliance with clinical evaluations was 61.5% in year 1 and 35.5% in year 2, whereas compliance with CT was only 25% and 11.8% in years 1 and 2, respectively. By univariate analysis diagnosis before 1990 predicted noncompliance, while age, marital status and distance from the center did not. Recurrent disease was detected in 28 patients (37%) at a median of 5.5 months after orchiectomy (range 1 to 49.5). Among the 47 compliant patients 23 had relapse and none died. Among the 29 noncompliant patients 5 had relapse and 2 died with central nervous system disease.

CONCLUSIONS

Overall compliance with this surveillance program was poor but this study was too small to demonstrate whether poor compliance adversely affects overall survival.

[Mutations of APC gene MCR region in sporadic colorectal adenomas and carcinomas]

OBJECTIVE

Fifteen specimens of colorectal adenomas and 45 specimens of carcinomas and each of their normal mucosa were analyzed for the APC gene exon 15 MCR(mutation cluster region).

METHODS

Gene mutation was examined by PCR-SSCP technique.

RESULTS

In three out of 15 cases of adenomas(20.0%) and 10 out of 45 cases of carcinomas(22.2%), mutations at MCR was detected. In colorectal carcinoma, APC gene mutation was not related to size, location, histologic features and lymph node metastases. In MCR region, 1260-1359 codons gave a lowest mutation frequency, while 1339-1436 codons showed the highest mutation frequency.

CONCLUSION

APC gene mutation detected in colorecral adenomas indicates that the APC gene mutation is an early event in colorectal carcinogenesis. It helps early diagnosis of colorectal carcinoma.

[Observation of the serum acidic isoferritin levels in patients with hepatocellular carcinoma]

The levels of serum acidic isoferritin (SAIF) in 48 patients with hepatocellular carcinoma (HCC), 30 patients with hepatitis, 28 patients with liver cirrihosis, and 33 healthy subjects were measured by using enzyme-linked immunosorbent assay (ELISA--double-determinant). The result revealed that the SAIF values of HCC, HP and LC did not show normal distribution. The median values were 440 micrograms/L, 21 micrograms/L, 120 micrograms/L and, in normal subjects, 66 micrograms/L respectively. There were statistically significant differences between HCC and the control groups. The sensitivity of SAIF to HCC was 85.46%, with the cut-off point being 250 micrograms/L. SAIF was not correlated to AFP in HCC cases. The values of SAIF had no relationship with the volume of the tumors and the clinical stages. SAIF may be an available and useful serum marker and be beneficial to the diagnosis of early-staged HCC.

[A deep regional impedance method measuring the blood distribution in the lung]

A new deep regional impedance method to measure the blood distribution in the lung has been developed. Using a multi-electrode system, the method simultaneously detects impedance information of chest, and back including lung and the thorax, then extracts the impedance information directly from lung with a special data processing approach in order to eliminate thorax effect on the measurement. The salt pool experiment and the preliminary application of measuring the blood distribution in the lung have been made. The results show that the method raises the relative sensitivity and the distinguishability of the blood measurement in the lung, and as a new deep regional impedance measurement method, it has a good prospects of clinical application in the future.

[Detection of serum isoferritin level in 195 patients with cancer]

ELISA (double-determinant) was used to detect the serum isoferritin (SIF) levels in 42 patients with nasopharynx cancer (NPC), 38 with lung cancer (LC), 26 with esophageal cancer (EC) and 89 with other cancers, a total of 195 cases (151 males and 44 females). The results revealed that the positive rate of SIF in patients with cancer was 73.8% (144/195), among which, the positive rates in patients of stage I-II, stage III-IV, in patients not operated upon and in those after operation were 64.8%, 81.3%, 81.4% and 63.4%, respectively. Statistics was significantly different in SIF level between the stage I-II and III-IV groups, and between the un-operation and after operation groups (P < 0.001) by rank sum testing. The positive rates of NPC, LC and EC were 73.8%, 86.8% and 73.1%, respectively. The results have demonstrated that isoferritin is a malignant neoplasm associated antigen, and SIF level is related closely with the development of the tumor and operative treatment.