Maternal passive smoking during pregnancy and foetal developmental toxicity. Part 2: histological changes

1. Evidence has been accumulating on the growth suppressing effects of maternal passive smoking on foetus. Reviewing all literature released during the last two decades and screening for all possible variables such as previous smoking history, maternal age and weight gain, parity and length of gestation, placental weight, and diet, we found no reason to doubt the role of passive smoking during pregnancy in the induction of growth retardation. However, no literature indicates whether these birthweight deficits might hint at other possible hidden abnormalities in tissues. To verify this question, we performed an experiment on rats. 2. We have already reported that pups born to rats with previous exposure to cigarette's sidestream smoke during pregnancy showed a significant and dose-dependent growth retardation. Those pregnant rats were exposed each in a 150 dm3 glass chamber to diluted sidestream smoke of either 1, 2, 3 or 4 commercial blond filter brand cigarettes during either first, second or third week of pregnancy. We have selected a part of each group of pups at random and examined for possible histological changes of lung, liver, stomach, kidney and intestinal tissues. 3. Compared to controls, lung tissues of newborns of smoke exposed mothers showed an enhanced incidence of apoptosis, mesenchymal changes, and hyperplasia of bronchial muscles. Pronounced abnormal changes in haematopoiesis and proliferation of bile duct cells were the most variations from norm observed in liver tissues of exposed pups. Immature glomeruli of kidney, epithelhypoplasia of stomach, and hypoplasia of intestinal villi were common among newborns of exposed mothers than among controls. 4. These results indicate that passive smoking upon pregnancy causes abnormal morphological changes in internal tissues of newborns. At present, we can draw no conclusion as to whether these histological changes will result in functional malformations or possibly late effects, although they should be expected.

Maternal passive smoking during pregnancy and fetal developmental toxicity. Part 1: gross morphological effects

1. Prenatal exposure of human fetus to tobacco smoke through maternal passive smoking has been epidemiologically linked to reduced birth weight, enhanced susceptibility to respiratory diseases and changes in immune system. However, no data exists indicating teratogenicity of involuntary smoking. Since sidestream smoke of cigarettes makes the most constituent of whole smoke inhaled by nonsmokers, we performed experiments to determine whether passive inhalation of sidestream smoke by rats causes malformations in newborns. 2. Pregnant 230 - 300 g Wistar rats were each placed in a 150 dm3 glass chamber with two holes, each 3 cm in diameter in two opposite walls to provide unforced exchange of fresh air. A third hole was connected to an automatic smoking machine. The head of a commercial filter blond cigarette (13 mg Tar, 0.9 mg Nicotine) was introduced to the chamber through this later hole. Cigarettes were smoked by smoking machine at the rate and volume resembling human smoking and the mainstream smoke was separately collected and discarded. Each rat thus received the sidestream smoke self-diluted in the chamber air. Experiments were performed with either 1, 2, 3 or 4 cigarettes/day during either first, second or third week of a total 21-day pregnancy period. The interval between smoking of cigarettes was 2 h. 3. COHb in blood of negative controls was about 1.2% and after exposure to 1 or 4 cigarettes were 6% and 12.2%, respectively. A dose-dependent reduction of birth weight was observed in newborns (P<0.001); bitemporal diameters and body lengths were reduced accordingly. No macroscopically visible gross anomaly could be observed. After removing the fat tissue and staining the skeleton with alizarin, a widespread ossification retardation could be observed in all exposed groups regardless of the dose. Such a retardation was not limited to a particular bone. 4. These results support epidemiologic data on developmental toxicity of passive smoking and further provide evidence on an unfavorable osteopathic effect of sidestream exposure of mother on fetal development.

Phase I trial of anti-CD3-stimulated CD4+ T cells, infusional interleukin-2, and cyclophosphamide in patients with advanced cancer

PURPOSE

We performed a phase I trial to determine whether in vivo expansion of activated CD4+ T cells was possible in cancer patients. 111Indium labeling was used to observe trafficking patterns of the infused stimulated CD4+ T cells. The influence of cyclophosphamide (CTX) dosing on immunologic outcome was also examined.

PATIENTS AND METHODS

Patients with advanced solid tumors or non-Hodgkin's lymphoma received CTX at 300 or 1,000 mg/m2 intravenously (i.v.). Leukapheresis was performed to harvest peripheral-blood mononuclear cells (PBMCs) either just before the CTX dose, or when the patient was either entering or recovering from the leukocyte nadir induced by CTX. An enriched population of CD4+ T cells was obtained by negative selection. The CD4+ T cells were activated ex vivo with anti-CD3, cultured with interleukin-2 (IL-2) for 4 days, and adoptively transferred. After adoptive transfer, patients received IL-2 (9.0 x 10(6) IU/m2/d) by continuous infusion for 7 days.

RESULTS

The absolute number of CD4+, CD4+/DR+, and CD4+/CD45RO+ T cells increased in a statistically significant fashion in all cohorts after the first course of therapy. The degree of CD4 expansion was much greater than CD8 expansion, which resulted in a CD4:CD8 ratio that increased in 26 of 31 patients. The greatest in vivo CD4 expansion occurred when cells were harvested as patients entered the CTX-induced nadir. One complete response (CR), two partial responses (PRs), and eight minor responses were observed. Trafficking of 111Indium-labeled CD4 cells to subcutaneous melanoma deposits was also documented.

CONCLUSION

CD4+ T cells can be expanded in vivo in cancer patients, which results in increased CD4:CD8 ratios. The timing of pheresis in relation to CTX administration influences the degree of CD4 expansion. Tumor responses with this regimen were observed in a variety of tumors, including melanoma and non-Hodgkin's lymphoma; a high percentage of patients had at least some tumor regression from the regimen that produced the greatest CD4+ T-cell expansion.

Looking at care from the inside out: a conceptual approach to geriatric care

Today, managing care from the "outside in" is the predominant model for changing health care. The risk of this outside-in approach is that the health care system may lose sight of the people and communities for which it serves and cares. In this article, an "inside-out" model for viewing health care in a geriatric population is presented from the perspective of patients and providers, placing the provider in a proactive rather than reactive role. By focusing attention on the outcomes or value a patient is experiencing, providers are challenged to consider new ways of managing care.

Efficacy and safety of tolterodine in patients with detrusor instability: a dose-ranging study

OBJECTIVE

To investigate the efficacy and safety of tolterodine, a new antimuscarinic agent, and define the optimum dosage in patients with symptoms of detrusor instability (urgency, increased frequency of micturition and/or urge incontinence).

PATIENTS AND METHODS

A double-blind, placebo-controlled, multicentre study was carried out; after a 1-week run-in period to establish baseline values, 81 patients were randomized to receive placebo or tolterodine 0.5, 1, 2 or 4 mg twice daily for 2 weeks. Micturition (diary) variables, urodynamics and subjective urinary symptoms were assessed after 2 weeks' treatment.

RESULTS

A per-protocol analysis of efficacy in 64 patients showed dose-related improvements in recorded micturition and urodynamic variables, e.g. at a dosage of 2 mg twice daily, the frequency of micturition, episodes of incontinence and pad use were reduced by 20%, 46% and 29%, respectively, while the volume at first contraction increased by 89 mL. The 4 mg dosage was associated with a large increase in residual urinary volume and an increased incidence of dry mouth. The incidence of adverse events (mainly mild or moderate antimuscarinic effects) was comparable with placebo at tolterodine dosages of < or = 2 mg. No serious adverse events were observed and tolterodine had no clinically significant impact on electrocardiographic or laboratory findings.

CONCLUSION

The results indicate that tolterodine offers an effective treatment for the symptoms of detrusor instability. The optimum dosage appears to be 1-2 mg twice daily.

Model sclerotization studies. 4. Generation of N-acetylmethionyl catechol adducts during tyrosinase-catalyzed oxidation of catechols in the presence of N-acetylmethionine

Incubation of catechol with mushroom tyrosinase in the presence of N-acetylmethionine resulted in the generation of an adduct. This product was identified to be N-acetylmethionyl catechol, on the basis of spectral characteristics and well-characterized chemical reaction of o-benzoquinone with N-acetylmethionine. Enzyme-catalyzed oxidation of catechol and the subsequent nonenzymatic addition of the resultant quinone to N-acetylmethionine accounted for the observed reaction. That the reaction is not confined to catechol alone, but is of general occurrence, can be demonstrated by the facile generation of similar adducts in incubation mixtures containing N-acetylmethionine, tyrosinase, and different N-acetylmethionines, such as 4-methylcatechol and N-acetyldopamine. Attempts to duplicate the reaction with insect cuticular phenoloxidases were not successful, as the excess N-acetylmethionine used in the reaction inhibited their activity. Nevertheless, occurrence of this nonenzymatic reactivity. Nevertheless, occurrence of this nonenzymatic reaction between N-acetylmethionine and mushroom tyrosinase-generated quinones indicates that a similar reaction between enzymatically generated quinones in the cuticle with protein-bound methionine moiety is likely to occur during in vivo quinone tanning as well.

Management of the suicidal patient with schizophrenia

No matter what the course of treatment determined to be most appropriate, suicidal behavior must be considered thoroughly, and it must be conveyed to the patient that the clinician can assist him or her through this period of increased distress. Hopelessness must be viewed as a symptom with the assumption that a more meaningful sense of purpose will emerge despite the chronic and potentially limiting nature of schizophrenia. Most people with schizophrenia are not suicidal, and most who are suicidal can be offered interventions that will reduce their symptomatology and thereby dissipate their suicidal behavior.

Construction of a full-length Ca2+-sensitive adenylyl cyclase/aequorin chimera

Ca2+-sensitive adenylyl cyclases are key integrators of Ca2+ and cAMP signaling. To selectively probe dynamic changes in [Ca2+]i at the plasma membrane where adenylyl cyclases reside, a full-length, Ca2+-inhibitable type VI adenylyl cyclase/aequorin chimera has been constructed by a two-stage polymerase chain reaction method. The expressed adenylyl cyclase/aequorin chimera was appropriately localized to the plasma membrane, as judged by biochemical fractionation and functional analysis. The chimera retained full adenylyl cyclase activity and sensitivity to inhibition by physiological [Ca2+]i elevation. The aequorin portion of the chimeric construct was also capable of measuring changes in [Ca2+] both in vitro and in vivo. When the plasma membrane-tagged aequorin and cytosolic aequorin were compared in their measurement of [Ca2+]i, they showed contrasting sensitivities depending on whether the [Ca2+]i originated from internal stores or capacitative entry. This is the first full-length enzyme-aequorin chimera that retains the full biological properties of both aequorin and a Ca2+-sensitive adenylyl cyclase. This novel chimeric Ca2+ sensor provides the unique ability to directly report the dynamics of [Ca2+]i that regulates this Ca2+-sensitive enzyme under a variety of physiological conditions. Since this chimera is localized to the plasma membrane, it can also be used to assess local changes in [Ca2+]i at the plasma membrane as distinct from global changes in [Ca2+]i within the cytosol.

Exploring the TPQ as a possible predictor of antidepressant response to nefazodone in a large multi-site study

Subjects in the midst of a major depressive episode completed the Tridimensional Personality Questionnaire (TPQ) prior to beginning an open trial of nefazodone. A multiple regression analysis was used to further examine the finding of Joyce et al. (1994; Temperament predicts clomipramine and desipramine response in major depression, J. Affect. Disord. 30 (1994) 35-46) that a model involving TPQ Reward Dependence and Harm Avoidance scores, and their interaction, significantly predicted treatment response. The model was found to have significant predictive value (R2 = 0.011, P = 0.0053), but to account for a trivial 1.1% of the variance. Individuals with high Reward Dependence scores had a significantly lower response rate when response was defined as a 60% reduction from baseline HAM-D score. Although the clinical utility of the present findings is uncertain, this line of investigation attempting to link temperament to pharmacological response represents a potentially useful future strategy.

Stability of diagnosis of obsessive-compulsive disorder in the Epidemiologic Catchment Area study

OBJECTIVE

This study examined the 1-year temporal stability of a National Institute of Mental Health Diagnostic Interview Schedule (DIS) lifetime diagnosis of obsessive-compulsive disorder in the Epidemiologic Catchment Area (ECA) study.

METHOD

In that study, 20,862 individuals, aged 18 years and over, at five sites were evaluated by lay interviewers using the DIS (wave 1). All of those who were available 12 months later were reinterviewed (wave 2). In the present study, the temporal stability of wave 1 obsessive-compulsive disorder diagnoses at wave 2 was examined, as well as relationships with comorbid diagnoses. The consistency of reports of "new-onset" illness was also examined. Factors contributing to these measures were evaluated.

RESULTS

The temporal stability of the diagnosis of obsessive-compulsive disorder was very low. Subjects with a stable diagnosis of obsessive-compulsive disorder had a higher rate of both obsessions and compulsions, an earlier age at onset, and more comorbid anxiety, affective, and alcohol abuse/dependence disorders at initial assessment. The originally reported 1-year incidence estimates for obsessive-compulsive disorder primarily reflect data from subjects at wave 2 who reported the onset of symptoms as preceding the wave 1 interview. Older and less-educated subjects had significantly higher error rates in reporting onset.

CONCLUSIONS

The DIS diagnosis of obsessive-compulsive disorder has poor validity, leaving the true incidence and prevalence of the disorder unknown. Older and less-educated subjects require special attention in the design of instruments for use with community samples.

Oxytocin mediates acquisition of maternally associated odor preferences in preweanling rat pups

Three studies assessed the role of central oxytocin systems in maternal affiliation in preweanling rats. Fifteen-day-old rats were found to approach on odor faster and spend more time in contact with an odor when it had been paired with the mother on the previous day than when the odor was not paired with the mother, provided that the pairing occurred after either intracerebral administration of oxytocin (0.5 microgram) or saline. However, if rats were administered an oxytocin antagonist (OTA) prior to odor-mother pairing, neither the decreased odor approach latency nor the increased odor preference was apparent in the odor-mother group. OTA treatment did not attenuate a single-trial odor aversion learning task, nor did it disrupt interaction with the anesthetized mother. Results are discussed in terms of a possible reward-satiety role for oxytocin in the infant-mother context.

Important elements of outpatient care: a comparison of patients' and physicians' opinions

OBJECTIVE

To compare patients' and physicians' opinions on the importance of discrete elements of health care as determinants of the quality of outpatient care.

DESIGN

Analysis of results of a mailed survey.

SETTING

Community-based internal medicine practices.

PARTICIPANTS

74 general internists and 814 patients randomly selected from the practices of these internists.

MEASURES

125 elements of care that covered nine domains were identified: physician clinical skill, physician interpersonal skill, support staff, office environment, provision of information, patient involvement, nonfinancial access, finances, and coordination of care. Participants rated each element on its importance to high-quality care on a 4-point scale: 1 = not important; 2 = of medium importance; 3 = of high importance; and 4 = essential. Patients' and physicians' ratings were compared for individual elements of care and for elements aggregated into domains.

RESULTS

Survey response rates were 93% for physicians and 60% for patients. In an element-by-element comparison of ratings, ratings by the two groups differed substantially for 58% of the attributes. The most striking difference was seen in the domain of provision of information (median ratings, 3.56 for patients and 2.85 for physicians; P < 0.001). Ratings by the two groups also differed in the domains of clinical skill (3.75 for patients and 3.35 for physicians; P < 0.001), nonfinancial access (3.00 for patients and 2.87 for physicians; P < 0.001), and finances (3.00 for patients and 2.80 for physicians; P = 0.006). When relative rankings of the domains were compared, both groups agreed that clinical skill is most important; however, patients ranked provision of information second in importance whereas physicians ranked it sixth.

CONCLUSIONS

Patients and physicians agreed that the most crucial element of outpatient care is clinical skill, but they disagreed about the relative importance of other aspects of care, particularly effective communication of health-related information. These differences in perception may influence the quality of interactions between physicians and patients.

Neonatology in the 'Pearl of the East'

Clinicians practising in different regions of the world are often impressed at marked differences in disease patterns witnessed. The bases of most obvious differences are usually socio-economic and genetic, but culture and environment can be equally important. Documenting and assessing such differences is more than just a passing interest. Globalization has resulted in significant movement of people from one area to another. During the past decade, many young Chinese families have emigrated to Australia, Europe and North America for social and political reasons. Clinicians in these regions will need to be aware of the "Chinese disease patterns'. This overview highlights some of the more striking differences seen in neonatal medicine between the East (Hong Kong) and the West (Australia/Europe/North America). In addition to the immediate clinical relevance, it is hoped that this review can provide a background from which fruitful research ideas may emerge and to stimulate interest for trainee neonatologists who wish to seek sabbatical experience in Hong Kong.

Laboratory probing of oncogenes from human liquid and solid specimens as markers of exposure to toxicants

Recent discoveries regarding the mechanistic role of oncogenes and tumor suppressor genes in cancer development have opened a new era of molecular diagnosis. It has been observed repeatedly that genetic lesions serve as tumor markers in a broad variety of human cancers. The ras gene family, consisting of three related genes, H-ras, K-ras, and N-ras, acquires transforming activity through amplification or mutation in many tissues. If not all, then most types of human malignancies have been found to contain an altered ras gene. Because the ras oncogenes actively participate in both early and intermediate stages of cancer, several highly specific and sensitive approaches have been introduced to detect these genetic alterations as biomarkers of exposure to carcinogens. There is also mounting evidence that implicate chemical-specific alterations of the p53 tumor suppressor gene detected in most human tumors. Therefore, it seems a reliable laboratory approach to identify both altered p53 and ras genes as biomarkers of human chronic or intermittent exposure to toxicants in a variety of occupational settings.

Oxytocin mediates acquisition of maternally associated odor preferences in preweanling rat pups

Three studies assessed the role of central oxytocin systems in maternal affiliation in preweanling rats. Fifteen-day-old rats were found to approach on odor faster and spend more time in contact with an odor when it had been paired with the mother on the previous day than when the odor was not paired with the mother, provided that the pairing occurred after either intracerebral administration of oxytocin (0.5 microgram) or saline. However, if rats were administered an oxytocin antagonist (OTA) prior to odor-mother pairing, neither the decreased odor approach latency nor the increased odor preference was apparent in the odor-mother group. OTA treatment did not attenuate a single-trial odor aversion learning task, nor did it disrupt interaction with the anesthetized mother. Results are discussed in terms of a possible reward-satiety role for oxytocin in the infant-mother context.

Genotoxicity of wood dust in a human embryonic lung cell line

Wood dust exposure has been found to be an occupational hazard, being linked to an enhanced incidence of various neoplasias. Here we performed an experiment to evaluate the ability of solvent extracts of natural woods to induce chromosome aberrations in respiratory cells in culture. Human embryonic lung cells, MRC-5, grown in Dulbecco's medium were exposed to various concentrations of the dust extracts of pesticide-free (untreated) beech, oak and pine woods. Three concentrations per extract with and without metabolic activation (S9) and 100 metaphase cells per dose were examined for possible structural aberrations. Although no dose-dependent activity could be found with any extract in the presence of S9, most aberrations observed were of the chromatid type caused by oak wood. Dose-dependent chromosomal breaks caused by oak and chromatid breaks caused by both beech and oak were observed in the absence of S9. These data might support the early hypothesis that hard wood dust per se contains some in vivo genotoxic and thus possibly carcinogenic components.

Paediatric treatment costs and the HIV epidemic

As the AIDS epidemic puts additional strains on the already overburdened health care systems in sub-Saharan Africa, it becomes more important to estimate the cost of the epidemic in terms of health personnel and drug treatments. A retrospective review of 250 randomly selected paediatric admissions to a referral hospital in Malawi was undertaken. Groupings of "possible/probable AIDS" and "probably not AIDS" were used in a comparative analysis of treatment costs. Estimated costs of treatments were significantly lower than those calculated in a study from Zimbabwe using different methodology. Meningitis was the most expensive condition to treat and accounted for a greater percentage of overall cost than either acute respiratory infection, diarrhoeal disease or measles.

Cellular adaptation to chronic cadmium exposure: intracellular localization of metallothionein protein in human trophoblast cells (JAr)

Trophoblast cells are the first embryonic cells that modulate the transfer of a variety of compounds (oxygen, amino acids, xenobiotics, metals) from the maternal to the fetal circulation in the human placenta. Human placental exposure to the toxic metal, cadmium (Cd) results in a decrease in the production of human chorionic gonadotropin (hCG), a decrease in the maternal to fetal transport of zinc (Zn), and trophoblastic necrosis. Thus, the ability of trophoblast cells to adapt to exposure to the toxic metal Cd has been considered crucial. In this study, the expression and intracellular localization of metallothionein (MT), a small molecular weight, metal binding protein, was examined in trophoblast cells (JAr) grown in normal media and in cells exposed chronically (6 months) to 2 microM CdCl2. Conventional and confocal fluorescence microscopy were used to examine the intracellular localization of MT protein in control cells and cells grown chronically in Cd. In unexposed trophoblast cells, MT protein was primarily perinuclear with low level, punctate expression in the cytosol. Following both chronic and 24 hour exposure to Cd, MT protein levels were increased (at least 3-fold in both chronic and acute exposures) and the protein was now concentrated inside the nucleus with a lacy, cytoskeletal pattern of expression in the cytosol. To determine if the nuclear accumulation of MT protein was dependent on new protein synthesis, control cells were exposed to CdCl2 (2 microM) and cycloheximide (2 micrograms/. ml) for 24 hours.(ABSTRACT TRUNCATED AT 250 WORDS)