Dendritic cells transfected with interleukin-12 and tumor-associated antigen messenger RNA induce high avidity cytotoxic T cells

Dendritic cells (DC) transfected with messenger RNA (mRNA) encoding tumor-associated antigens (TAA) are able to induce potent tumor-specific T-cell responses directed to a broad spectrum of tumor-associated epitopes. The in vitro generation of DC possessing all the features crucial for the induction of type 1 immune responses, such as mature state, migratory potential and interleukin-12 (IL-12p70) production is complicated. Particularly migratory potential is inversely correlated with IL-12p70 production after maturation with prostaglandin E2 (PGE2), which is included in maturation cocktails currently used in most vaccination trials. Here, we show that transfection of PGE2 matured DC with a single mRNA strain encoding for ubiquitin followed by a TAA which was linked to IL-12 by a self-cleaving 2A sequence, produced biological active IL-12p70 and were able to present the transfected TAA up to 72 h after transfection. Furthermore, use of the anti-reverse cap analog for in vitro transcription of the IL-12 mRNA enabled constitutive IL-12p70 production for up to 5 days. These transfected mature DC migrated efficiently towards lymph node derived chemokines. DCs constitutively expressing IL-12p70, generate TAA-specific cytotoxic T cells with an high functional avidity, independent of CD4+ T-cell help.

Volume change during the formation of nanoporous gold by dealloying

We report a macroscopic shrinkage by up to 30 vol % during electrochemical dealloying of Ag-Au. Since the original crystal lattice is maintained during the process, we suggest that the formation of nanoporous gold in our experiments is accompanied by the creation of a large number of lattice defects and by local plastic deformation.

Evaluation of a new Spin-echo diffusion-weighted sequence on a 0.35 T open magnetic resonance imaging (MRI)-system: first experiences within 3 h after acute stroke

In acute stroke, diffusion-weighted magnetic resonance imaging helps to select patients who are eligible for thrombolysis, but is almost exclusively implemented on closed-bore scanners, which make monitoring of patients difficult. We developed and tested a cardiac gated Spin-echo diffusion-weighted sequence with prescan finetrim and motion correction on an open system with 0.35 T. Nineteen stroke patients appropriate for thrombolytic therapy by clinical criteria were enrolled in a prospective study on an intention-to-treat basis. In all but one patient, computed tomography and magnetic resonance imaging including the new diffusion-weighted sequence were performed within 3 h after symptom onset. Images were evaluated for acute cerebral ischemia and hemorrhage by two radiologists blinded to clinical information. Magnetic resonance imaging required a mean total acquisition time of 26 min. Sensitivity for early infarction was 94% in diffusion-weighted imaging and 73% in computed tomography. Six patients were excluded from thrombolysis due to an infarct size of more than 1/3 of the territory of the middle cerebral artery exclusively diagnosed with diffusion-weighted imaging. Hemorrhage was recognised by both, magnetic resonance imaging and computed tomography. We conclude that in acute stroke, diffusion-weighted imaging with an open system at 0.35 T is practicable. The implemented sequence reliably demonstrated the size of the infarction and improved the selection of patients who are eligible for thrombolysis.

Balance of force at curved solid metal-liquid electrolyte interfaces

We analyze the simultaneous mechanical and chemical equilibrium at the interface between a fluid electrolyte and a solid conductor in terms of a continuum theory, with attention to surfaces of varying orientation and of arbitrary curvature. On top of the variable which is conjugate to the surface stress, the tangential strain, we introduce an additional degree of freedom for the surface deformation, the surface stretch, to account for the observation of a reversible normal relaxation of the top atomic layer as a function of the electrochemical potential. We derive relations between the materials constants of the surface, for instance, the pressure dependence of the electric potential at constant superficial charge density, and discuss experiments-using cantilevers or porous solids-by which they can be measured.

Variation of the surface stress-charge coefficient of platinum with electrolyte concentration

We report an experimental study of the variation of surface stress with surface charge density for nanoporous Pt immersed in aqueous solutions of NaF of various concentration. As the concentration is reduced, we find initially an increase in the magnitude of the surface stress-charge coefficient, followed by saturation at a value of -1.9 V. Since specific adsorption is expected to be reduced as the solution becomes more dilute, the results support the notion that changes in the bonding at the metal surface play a decisive role in determining the change in the surface stress during double-layer charging.

Microinvasive resectional sympathectomy using the harmonic scalpel. A more effective procedure with fewer side effects for treating essential hyperhidrosis of the hands, face or axillae

Compensatory sweating remains one of the most unpredictable and debilitating complications of sympathectomy for hyperhidrosis. There appears to be a significant difference in compensatory sweating rates seen between the different techniques utilized to treat hyperhidrosis. Resectional techniques have historically resulted in excellent symptom relief with relatively low levels of severe post-op compensatory sweating. The advent of video-assisted approaches to the treatment of hyperhidrosis has led to other procedures including ablation/cautery, cutting and clipping of the nerve all of which report compensatory sweating rates between 70 and 100%. We have developed a minimally invasive video-assisted approach to sympathetic nerve resection. We studied 486 patients with severe essential hyperhidrosis affecting the hands, feet, axillae and face in variable combinations, who underwent bilateral resection of T2 and T3 for hand, facial or head sweating. 100% relief of sweating was noted in all cases. For axillary sweating the addition of T4 resection has resulted in complete relief of axillary hyperhidrosis symptoms. In this patient population our overall compensatory sweating rate has been approximately 18% with significant compensatory sweating occurring in less than 2% of patients.

Analysis of the CD4+ T cell responses to house dust mite allergoid

BACKGROUND

Modified allergen extracts (allergoids) with reduced IgE-binding capacity are successfully used in immunotherapy of atopic allergy. Their reduced T-cell stimulatory capacity is less well studied and is a subject of the present study.

METHODS

We compared the ability of native house dust mite extract (Dermatophagoides pteronyssinus; HDM) and the glutaraldehyde-modified allergoid (HDM-GA) to induce the proliferation and cytokine production by fresh PBMC and by DC-stimulated polyclonal Th cells and HDM-specific Th cell clones.

RESULTS

Freshly isolated T cells showed a partially reduced responsiveness to HDM-GA, differentially pronounced in different donors. HDM-specific Th cell clones prepared from three donors showed either a complete loss of reactivity to HDM-GA, or completely preserved responsiveness. The frequency of nonreactive clones was donor-dependent (2/3, 3/10 and 1/10). GA modification of HDM did not interfere with the cytokine production profile of HDM-specific T cell clones.

CONCLUSIONS

The reduced stimulatory potential of HDM-GA results mainly from a loss of certain Th cell epitopes, rather than impaired allergen uptake and presentation, or induction of suppressive factors. Varying frequencies of allergoid-nonreactive HDM-specific Th cells may result in differential responses of individual patients to immunotherapy.

Charge-induced reversible strain in a metal

Dimension changes on the order of 0.1% or above in response to an applied voltage have been reported for many types of materials, including ceramics, polymers, and carbon nanostructures, but not, so far, for metals. We show that reversible strain amplitudes comparable to those of commercial piezoceramics can be induced in metals by introducing a continuous network of nanometer-sized pores with a high surface area and by controlling the surface electronic charge density through an applied potential relative to an electrolyte impregnating the pores.

Validation of the behavioural activity rating scale (BARS): a novel measure of activity in agitated patients

We report psychometric results of the Behavioural Activity Rating Scale (BARS) using data from three Phase III clinical trials of intramuscular ziprasidone in acutely agitated patients with psychosis (Studies 1 and 2) or in stable psychotic patients (Study 3). Convergent validity and divergent validity were assessed with baseline data from Studies 1 and 2 in subjects with acute agitation. To investigate convergent validity, we sought Pearson and Spearman correlation of BARS scores with scores on the Clinical Global Impression of Severity (CGI-S) Scale and a predefined cluster of agitation-related items from the Positive and Negative Syndrome Scale (PANSS). For divergent validity, we sought Pearson and Spearman correlation between BARS scores and a predefined cluster of PANSS items measuring negative symptoms. Discriminant validity was investigated with the help of subjects with moderate psychopathology (Study 3). Wilcoxon rank-sum and two-sample t tests determined whether mean (or median) BARS scores differed between subjects with acute agitation (Studies 1 and 2) and moderate psychopathology (Study 3). Responsiveness to treatment effect and rater reliability were also evaluated. In Study 2, Pearson correlation coefficients of BARS scores with PANSS agitation items and CGI-S were moderate (convergent validity) and statistically significant (P<0.005). The correlation between BARS scores and PANSS negative component scores was low (divergent validity). Treatment effect size was larger for BARS than for PANSS agitation items and CGI-S (responsive to treatment differences). Virtually perfect inter- and intra-rater reliability was achieved. Study 1 produced similar results. BARS showed psychometrically valid properties for measurement of behavioral activity in acutely agitated patients with psychosis.

Insulin-sensitizing effect of rosiglitazone (BRL-49653) by regulation of glucose transporters in muscle and fat of Zucker rats

Thiazolidinediones (TZDs), a class of antidiabetic agents, are specific agonists of peroxisome proliferator activator receptor (PPARgamma). However, their mechanisms of action, and the in vivo target tissues that mediate insulin sensitization are not well understood. The aim of this study was to investigate the role of glucose transporters (GLUT-1 and GLUT-4) in the TZD insulin-sensitizer action. The effects of rosiglitazone treatment were studied using Zucker (fa/fa) rats after 7 days of oral dosing (3.6 mg/kg/d). Rosiglitazone lowered (approximate 80%) basal plasma insulin levels in obese rats and substantially corrected (approximately 50%) insulin resistance based upon results from hyperinsulinemic euglycemic clamp studies. GLUT-4 protein levels were reduced (approximately 75%) in adipose tissue of obese rats and treatment with rosiglitazone normalized them. Interestingly, GLUT-1 protein content was increased in adipose tissue ( thick approximate 150%) and skeletal muscle (approximately 50%) of obese rats and treatment with rosiglitazone increased it even more by 5.5-fold in fat and by 2.5-fold in muscle. Consistent with these results, basal (GLUT-1-mediated) transport rate of 3-O-methyl-D-glucose into isolated epitrochlearis muscle was elevated in response to rosiglitazone. Incubation of fully differentiated 3T3-L1 adipocytes with the drug for 7 days increased the levels of GLUT-1 protein, but did not affect GLUT-4 levels. In conclusion, rosiglitazone may improve insulin resistance in vivo by normalizing GLUT-4 protein content in adipose tissue and increasing GLUT-1 in skeletal muscle and fat. While the drug has a direct effect on GLUT-1 protein expression in vitro without a direct effect on GLUT-4 suggests that direct and indirect effects of rosiglitazone on glucose transporters may have an important role in improving insulin resistance in vivo.

Management of the neck in N0 squamous cell carcinoma of the oral cavity

Mortality in treated squamous cell carcinoma of the oral cavity is most often owing to locoregional failure. In an attempt to improve survival, an aggressive approach to surgical management is often favoured. Although it is generally accepted that the N0 neck should be treated if the risk of micrometastatic disease exceeds 20%, there is little direct support in the literature for this position. A retrospective review of all patients presenting with T1-2, N0 squamous cell carcinoma of the oral cavity treated at the Cancer Control Agency of British Columbia from 1985 to 1994 was conducted. Patients were followed for a minimum of 5 years with documentation of patterns of recurrence and disease-specific survival relative to initial management. The decision regarding management of the neck was frequently made to accommodate treatment of the primary site or reconstructive strategies. Thirteen percent of patients with T1, N0 disease underwent prophylactic neck dissection. No significant difference in outcome was noted in this group. Thirty-three percent of patients with T2, N0 disease underwent prophylactic neck dissection. There was a trend toward improved 5-year survival and lower recurrence rates in the group whose necks were treated, but the difference was not found to be statistically significant. In conclusion, this review showed a trend toward increased survival with prophylactic treatment of the neck in T2, N0 squamous cell carcinoma of the oral cavity, but a larger study would be needed to show a statistically significant benefit.

A prospective randomized trial of tacrolimus and prednisone versus tacrolimus, prednisone and mycophenolate mofetil in primary adult liver transplantation: a single center report

BACKGROUND

Tacrolimus (TAC) and mycophenolate mofetil (MMF) are currently approved immunosuppressants for prevention of rejection in liver transplantation (LTx). They have different modes of action and toxicity profiles, but the efficacy and safety of MMF in primary liver transplantation with TAC has not been determined.

METHODS

An Institutional Review Board-approved, open-label, single-center, prospective randomized trial was initiated to study the efficacy and toxicity of TAC and steroids (double-drug therapy (D)) versus TAC, steroids, and MMF (triple-drug therapy (T)) in primary adult LTx recipients. Both groups of patients were started on the same doses of TAC and steroids. Patients randomized to T also received 1 gm MMF twice a day.

RESULTS

Between August 1995 and May 1998, 350 patients were enrolled at a single center-175 in the D and 175 in the T groups. All patients were followed until May 1998, with a mean follow-up of 33.8+/-9.1 months. Using an intention-to-treat analysis, the 1-, 2-, 3-, and 4-year patient survival was 85.1%, 81.6%, 78.6%, and 75.8%, respectively, for D and 87.4%, 85.4%, 81.3%, and 79.9%, respectively, for T. The 4-year graft survival was 70% for D and 72.1% for T. Although the rate of acute rejection in the first 3 months was significantly lower for T than for D (28% for triple vs. 38.9% for double, P=0.03), the overall rate of rejection for T at the end of 1 year was not significantly lower than for the D (38.9% triple vs. 45.2% double). The median time to the first episode of rejection was 14 days for D versus 24 days for T (P=0.008). During the study period, 38 of 175 patients in D received MMF to control ongoing acute rejection, nephrotoxicity, and/or neurotoxicity. On the other hand, 103 patients in the T discontinued MMF for infection, myelosuppression, and/or gastrointestinal disturbances. The need for corticosteroids was less after 6 months for T and the perioperative need for dialysis was lower with use of MMF.

CONCLUSION

This final report confirms similar patient survival and graft survival up to 4 years with a trend towards fewer episodes of rejection, lower need for steroids, and better perioperative renal function. However, the complex nature of LTx patients and their posttransplantation course prevents the routine application of MMF.

Telomerase suppression by chromosome 6 in a human papillomavirus type 16-immortalized keratinocyte cell line and in a cervical cancer cell line

BACKGROUND

High-risk human papillomavirus (HPV) types play a major role in the development of cervical cancer in vivo and can induce immortalization of primary human keratinocytes in vitro. Activation of the telomere-lengthening enzyme telomerase constitutes a key event in both processes. Because losses of alleles from chromosome 6 and increased telomerase activity have been observed in high-grade premalignant cervical lesions, we analyzed whether human chromosome 6 harbors a putative telomerase repressor locus that may be involved in HPV-mediated immortalization.

METHODS

Microcell-mediated chromosome transfer was used to introduce chromosomes 6 and 11 to the in vitro generated HPV type 16 (HPV16)-immortalized keratinocyte cell line FK16A and to the in vivo derived HPV16-containing cervical cancer cell line SIHA: Hybrid clones were analyzed for growth characteristics, telomerase activity, human telomerase reverse transcriptase (hTERT) and HPV16 E6 expression, and telomere length. FK16A hybrid clones were also transduced with an hTERT-containing retrovirus to examine the effect of ectopic hTERT expression on growth. Statistical tests were two-sided.

RESULTS

Introduction of human chromosome 6 but not of chromosome 11 to both cell lines yielded hybrid cells that demonstrated crisis-like features (i.e., enlarged and flattened morphology, vacuolation, and multinucleation) and underwent growth arrest after a marked lag period. In the chromosome 6 hybrid clones analyzed, telomerase activity and hTERT messenger RNA (mRNA) expression were statistically significantly reduced compared with those in the chromosome 11 hybrid clones (for telomerase activity, P =.004 for the FK16A hybrids and P =.039 for the SiHa hybrids; for hTERT mRNA expression, P =.003 for the FK16A hybrids). The observed growth arrest was associated with telomeric shortening. Ectopic expression of hTERT in FK16A cells could prevent the telomeric shortening-based growth arrest induced by chromosome 6.

CONCLUSIONS

Chromosome 6 may harbor a repressor of hTERT transcription, the loss of which may be involved in HPV-mediated immortalization.

The interaction of plectin with actin: evidence for cross-linking of actin filaments by dimerization of the actin-binding domain of plectin

Plectin is a major component of the cytoskeleton and is expressed in a wide variety of cell types. It plays an important role in the integrity of the cytoskeleton by cross-linking the three filamentous networks and stabilizing cell-matrix and cell-cell contacts. Sequence analysis showed that plectin contains a highly conserved actin-binding domain, consisting of a pair of calponin-like subdomains. Using yeast two-hybrid assays in combination with in vitro binding experiments, we demonstrate that the actin-binding domain of plectin is fully functional and preferentially binds to polymeric actin. The sequences required for actin binding were identified at the C-terminal end of the first calponin homology domain within the actin-binding domain of plectin. We found that the actin-binding domain of plectin is able to bundle actin filaments and we present evidence that this is mediated by the dimerization of this domain. In addition we also show that plectin and another member of the plakin family, dystonin, can heterodimerize by their actin-binding domains. We propose a new mechanism by which plectin and possibly also other actin-binding proteins can regulate the organization of the F-actin network in the cell.

Management and long-term follow-up of hepatic cysts

PURPOSE

To provide an algorithm for the management of hepatic cysts through an analysis of our series over 16 years.

METHOD

We reviewed the surgical management and outcome of patients with hepatic cysts between 1984 and 2000 at a single institution. Data were collected by chart review, telephone interview, and follow-up hepatic ultrasonography.

RESULTS

Forty-four patients (36 females, 8 males) underwent a total of 46 operations for hepatic cysts (mean size 12.0 +/- 5.2 cm) with a mean follow-up of 5.1 +/- 4.0 years. We treated 28 simple cysts, 4 polycystic liver disease (PCLD), 7 cystadenomas, 2 hydatid cysts, 1 cystadenocarcinoma, 1 endometrioma, and 1 hepatic foregut cyst. Operations included simple drainage, wide unroofing (open and laparoscopic), and hepatic resection. Four patients experienced a symptomatic recurrence after definitive treatment; 3 of these patients had PCLD. Four of the 7 patients with cystadenomas had undergone previous operations that required subsequent definitive resection without a recurrence.

CONCLUSIONS

The preoperative distinction between simple cysts and cystadenomas/cystadenocarcinomas can be difficult, yet the management is different. Unroofing is a safe and effective operation for patients with simple cysts. Patients with PCLD frequently have recurrences. Cystadenomas should be completely resected owing to the likelihood of recurrence after partial excision and the risk of eventual cystadenocarcinoma. We present a treatment algorithm for the preoperative evaluation and management of hepatic cysts based on the largest number of patients with the longest follow-up reported to date.

Family myths in romantic fiction

Three types of myths frequently appearing in contemporary romantic fiction deal with traditional family values, spousal relationships, and love. Several myths belonging to each type are illustrated and analyzed. It is argued that by naturalizing some behaviors and idealizing others, romantic novels not only may indoctrinate their readers with a patriarchal ideology but also may inculcate upon them pathogenic family processes.

Endothelin stimulates glucose uptake via activation of endothelin-A receptor in neonatal rat cardiomyocytes

Endothelin-1 (ET-1) is a 21 amino acid peptide that binds to G-protein-coupled receptors to evoke biological responses. Previously we have found that ET-1 stimulates glucose uptake in 3T3-LI adipocytes. In this report, we extend the studies to neonatal rat cardiomyocytes. ET-1, but not angiotensin-II (A-II), stimulated glucose uptake in a dose-dependent manner with an EC50 value at approximately 1 nM, and an approximately 2-fold stimulation at 100 nM. As a comparison, insulin stimulated glucose uptake in a dose-dependent manner with an EC50 value at 1 nM, and a 2.5-fold stimulation at 100 nM. Western blot analysis shows that ET-1 stimulated the translocation of insulin-responsive aminopeptidase (IRAP), an aminopeptidase in GLUT4 (glucose transporter)-containing vesicles, from the cytoplasm to the plasma membrane. The effect of ET-1 on glucose uptake was blocked by A-127722, an antagonist selective for the ET(A)-receptor. ET-1 treatment did not induce phosphorylation of insulin receptor-beta (IRbeta), insulin receptor substrate-1 (IRS-1) or Akt, but stimulated the phosphorylation of extracellular signal-regulated kinase (ERK1/2). The effect of ET-1 on glucose uptake was not inhibited by inhibitors for protein kinase C (PKC), protein kinase A (PKA) and phosphatidylinositol-3-kinase (PI3'-kinase). Our results show that ET-1 stimulates glucose uptake in neonatal rat cardiomyocytes via activation of the ET(A)-receptor.

Rhegmatogenous retinal detachment in retinoblastoma patients undergoing chemoreduction and cryotherapy

PURPOSE

To report the development of rhegmatogenous retinal detachment, with the retinal break adjacent to a cryotherapy scar, in three patients undergoing systemic chemotherapy for intraocular retinoblastoma.

METHOD

Case series.

RESULTS

Three patients with intraocular retinoblastoma were referred after poor response to systemic chemotherapy and local cryotherapy; three eyes of these three patients were noted to have rhegmatogenous retinal detachment and active retinoblastoma, with retinal breaks adjacent to cryotherapy scars.

CONCLUSION

Rhegmatogenous retinal detachment may result from retinal necrosis associated with cryotherapy in the setting of intraocular retinoblastoma treated with systemic chemotherapy and local cryotherapy.

Acute liver failure: clinical features, outcome analysis, and applicability of prognostic criteria

Acute liver failure (ALF) is an uncommon condition associated with high morbidity and mortality. We performed a retrospective analysis of patients evaluated for ALF. The aim of our study is to determine the clinical features and outcome of such patients and to assess the validity of King's College Hospital (KCH) prognostic criteria. One hundred seventy-seven patients were evaluated for ALF during a period of 13 years. Mean age was 39 years, and 63% were women. The causes included viral hepatitis (31%), acetaminophen toxicity (19%), idiosyncratic drug reactions (12%), miscellaneous causes (11%), and an indeterminate group (28%). Twenty-five patients (14%) recovered with medical therapy (group I), 65 patients (37%) died without orthotopic liver transplantation (OLT; group II), and 87 patients (49%) underwent OLT (group III). Patients in group II were older and often had advanced encephalopathy, whereas those in group I had less hyperbilirubinemia and often had hyperacute failure. KCH criteria had high specificity and positive predictive value but low negative predictive value for a poor outcome. We conclude that early prognostication is needed in patients with ALF to assist decision making regarding OLT. The fulfillment of KCH criteria usually predicts a poor outcome, but a lack of fulfillment does not predict survival.