Detection of micrometastasis by cytokeratin 20 RT-PCR is limited due to stable background transcription in granulocytes

The reverse transcription polymerase chain reaction (RT-PCR) amplification of cytokeratin 20 (CK20) mRNA is considered a promising candidate method for the detection of circulating tumour cells in bone marrow and peripheral blood of cancer patients. In this study we have investigated the diagnostic specificity of the CK20 mRNA detection in samples from healthy donors (HD; n = 33), intensive care units patients (ICU; n = 20) and bone marrow obtained from patients suffering from chronic inflammatory diseases (CID; n = 14). RNAs purified from stabilized lysates showed positive results in 24% of the HD group (8/33), 35% of the ICU group (8/20) and in 40% of the CID group (5/14). The use of Ficoll gradients to separate nucleated cells completely restored the specificity of this CK20 RT-PCR assay. The CK20-expressing cells are positively identified to belong to the granulocyte fraction of leucocytes, which appear to express the gene on a background level. Our results demonstrate for the first time that CK20 mRNA expression is not limited to epithelium. Its occurrence in normal granulocytes has to be considered in tests designed to detect circulating cancer cells or micrometastases.

A Danish national cohort of 730 infants born after intracytoplasmic sperm injection (ICSI) 1994-1997

This national cohort study included all clinical pregnancies obtained after intracytoplasmic sperm injection (ICSI) registered in Denmark between January 1994 and July 1997 at five public and eight private fertility clinics. Laboratory and clinical data were obtained from the fertility clinics. The couples answered a questionnaire regarding the pregnancy and the health of the child (response rate 94%). Data validation was carried out through discharge charts. The mean age of the women was 32.1 years. In 84.2% of couples, male factor was the main reason for performing ICSI, and in 4.8% epididymal spermatozoa were used. The mean number of embryos replaced was 2.3 (range 1-3) and in 95% of cases fresh embryos were transferred. Only 183 women (28.5%) underwent prenatal diagnosis, resulting in 209 karyotypes with seven (3.3%) chromosome aberrations. Six major chromosomal abnormalities (2.9%) and one inherited structural chromosome aberration (0.5%) were found, but no sex chromosome aberrations. The frequency of multiple birth, Caesarean section rate, gestational age, preterm birth, and birth weight were comparable with previous studies. The perinatal mortality rate was 13.7 per 1000 children born with a gestational age of 24 weeks or more. In 2.2% (n = 16) of the liveborn infants, and in 2.7% (n = 20) of all infants, major birth defects were reported by the parents. Minor birth defects were found in nine liveborn infants (1.2%). In conclusion, the results of this study on outcome of ICSI pregnancies are in line with earlier reports, except that no sex chromosome abnormalities were found.

Genomic structure, chromosomal location, and mutation analysis of the human CDC14A gene

Human CDC14A is a dual-specificity phosphatase that shares sequence similarity with the recently identified tumor suppressor, MMAC1/PTEN/TEP1. By radiation hybrid mapping, we localized CDC14A to chromosome band 1p21, a region that has been shown to exhibit loss of heterozygosity in highly differentiated breast carcinoma and malignant mesothelioma. We have mapped the exon-intron structure of CDC14A gene and found an in-frame ATG at 14 codons upstream of the previously reported start site (GenBank Accession No. AF000367). In screening a panel of 136 cDNAs from tumor cell lines for coding mutations, we have identified a 48-bp in-frame deletion in the cDNA of the breast carcinoma cell line, MDA-MB-436. This deletion is the result of an acceptor splice site mutation (AG to AT) in intron 12 that causes the skipping of exon 13 in the gene. Loss of expression of the wildtype allele in the same breast cell line supports the possibility that CDC14A may be a tumor suppressor gene that is targeted for inactivation during tumorigenesis.

Developmental expression of alpha-synuclein in rat hippocampus and cerebral cortex

Alpha-synuclein is an evolutionary highly conserved neuronal protein localized in presynaptic nerve terminals. The protein has been suggested to be involved in the pathogenesis of neurodegenerative diseases, but little is known about the physiological function of the protein. In the present study we used newborn, three, 14, 93 and 710-day-old rats to examine the expression of alpha-synuclein messenger RNA and protein during development of the hippocampus and cerebral cortex. Using in situ hybridization and an S1 nuclease protection assay, we found a high expression of alpha-synuclein messenger RNA during early postnatal development, followed by a marked decrease between postnatal days 14 and 93. In contrast, the amount of alpha-synuclein protein, as determined by immunoblotting, continued to increase throughout development and remained at a high level for at least two years. The persistent high expression of alpha-synuclein protein throughout development suggests that the protein is involved in maintaining synaptic function. Furthermore, the discrepancy between the levels of alpha-synuclein messenger RNA and protein after postnatal day 14 indicates that the amount of alpha-synuclein is determined by post-transcriptional regulation, and not by messenger RNA expression alone. To estimate the changes of alpha-synuclein expression per synapse, we compared the developmental expression of alpha-synuclein with synaptophysin, a well-established synaptic marker. The alpha-synuclein/synaptophysin messenger RNA and protein ratio was high during early development, but low in adult (postnatal day 93) and old (postnatal day 710) rats. This could indicate a higher expression of alpha-synuclein per synapse during early development.

Bacterial pathogens in chronic otitis media with effusion in Alaska Native children

This study examined the bacterial pathogens and the presence of possible risk factors for the development of chronic otitis media with effusion (OME) in a group of Alaska Native children. Middle ear aspirates were collected from 128 children < 6 years of age requiring tympanocentesis between 1987 and 1989. Bacterial pathogens were cultured from 40% of 209 fluids. Predominant isolates, after contamination of the outer ear was controlled for, were Haemophilus influenzae (21%; 84% of these were nontypeable), Streptococcus pneumoniae (8.1%; serotypes 6B, 10A, 11A, 14, 18B, 18C, 19A, and 23F), Staphylococcus epidermidis (3.8%), and Moraxella (Brahmanella) catarrhalis (2.9%). Pneumococcal-C-polysaccharide (PnC) was detectable in 3 of 135 (2.2%) aspirates that did not grow Streptococcus pneumoniae. Combining culture and PnC assay results evidence of pneumococcal infection was found in almost 10% of aspirates tested. There was not a significant difference in the number of episodes of acute otitis media after the first year of life based on the age at the first episode (< 6 mo, > or = 6 mo). However, 88% of infants in the study had their first acute otitis media episode before 1 year of age.

Immunogenicity of a combined hepatitis B and Haemophilus influenzae type b conjugate vaccine in Alaska Native infants

Hepatitis B and Haemophilus influenzae b (Hib), prevalent diseases in Alaska Native infants, have been reduced 95% following universal vaccination. Therefore, we were interested in studying a new combined Hib and hepatitis B vaccine in this population.

METHOD

Healthy Alaska Native infants free from Hib and hepatitis B exposure were randomized into four groups, three with different lots of bivalent Hib and hepatitis B vaccine, and one with Hib and hepatitis B monovalent controls. The Hib component had 7.5 micrograms of polyribosylribitol phosphate polysaccharide (PRP) bound to 125 micrograms of Neisseria meningitidis outer membrane protein complex (OMP); the hepatitis B component was 5 micrograms of recombinant hepatitis B surface antigen. The vaccines were given at 2 months, 4 months, and 12-15 months of age.

RESULTS

There were no differences in the responses to the bivalent compared to the monovalent controls except for a lower Hib anti-PRP level at 12-15 months in the bivalent recipients; this did not persist after the booster.

CONCLUSION

A combined Hib and hepatitis B vaccine appears immunogenic. The recommended schedule for the Hib component (PRP-OMP) of 2 months, 4 months, and 12-15 months appears to promote an optimal response to the hepatitis B component as well.

Rapid, automated nucleic acid probe assays using silicon microstructures for nucleic acid concentration

A system for rapid point-of-use nucleic acid (NA) analysis based on PCR techniques is described. The extraction and concentration of DNA from test samples has been accomplished utilizing silicon fluidic microchips with high surface-area-to-volume ratios. Short (500 bp) and medium size (48,000 bp) DNA have been captured, washed, and eluted using the silicon dioxide surfaces of these chips. Chaotropic (GuHCl) salt solutions were used as binding agents. Wash and elution agents consisted of ethanol-based solutions and water, respectively. DNA quantities approaching 40 ng/cm2 of binding area were captured from input solutions in the 100-1000 ng/mL concentration range. For dilute samples of interest for pathogen detection, PCR and gel electrophoresis were used to demonstrate extraction efficiencies of about 50 percent, and concentration factors of about 10x using bacteriophage lambda DNA as the target. Rapid, multichannel PCR thermal cycling modules with integrated solid-state detection components have also been demonstrated. These results confirm the viability of utilizing these components as elements of a compact, disposable cartridge system for the detection of NA in applications such as clinical diagnostics, biowarfare agent detection, food quality control, and environmental monitoring.

Effects of amygdaloid lesions, hippocampal lesions, and buspirone on black-white exploration and food carrying in rats

Unlesioned rats exploring a black-white two compartment box spent most of the time in the covered, black half of the box and only little time in the uncovered, white half (67 s/5 min). Large radio-frequency lesions of the amygdala or hippocampus did not alter this pattern of exploration, but rats with hippocampus lesions were more active than the other two groups of rats. Treatment with the 5-HT1A receptor agonist buspirone (0.1 mg/kg, s.c.) increased the time that unlesioned rats spent in the uncovered compartment (103 s), an effect that was less pronounced in hippocampus-lesioned rats and completely abolished by amygdala lesions. In a food transport test, unlesioned rats that traveled from a home cage to an exposed food source consumed small and medium-sized pellets immediately at the food source. Larger pellets, however, were carried back to the home cage for consumption. Rats with amygdala lesions ate fewer pellets at the food source and tended to carry more pellets back to the home cage for consumption than unlesioned rats. Rats with hippocampus lesions carried fewer pellets back to the home cage and ate more pellets at the food source. Buspirone (0.5-1.5 mg/kg, s.c.) reduced the carrying of large food items to the home cage and increased consumption of these pellets at the food source in all groups of rats. These results suggest that neither the amygdala nor the hippocampus play an important role in controlling exploratory behavior in a black-white compartment box, but that the amygdala may have some role in mediating the effect of buspirone to increase exploration of the white/open compartment. Further, the amygdala and hippocampus have opposing influences on the transport of food items to a shelter, the amygdala suppressing food carrying, and the hippocampus enhancing it. Neither structure is essential for the effect of buspirone to reduce food carrying. The hypothesis that limbic structures mediate 'fear/anxiety' responses is discussed critically.

Recent findings in classification of osteogenesis imperfecta by means of existing dental symptoms

The findings are based on a clinical investigation conducted on forty-nine patients suffering from osteogenesis imperfecta (OI), as well as on a questionnaire study in which 117 osteogenesis imperfecta-affected persons or their parents were involved. The survey established pathological tooth discolorations as well as tooth abrasions. Dentinogenesis imperfecta (DI) was more frequently found in primary teeth than in permanent teeth. There were no gender-specific differences. Radiological abnormalities were found in both, abraded and/or discolored teeth, as well as in clinically normal appearing teeth. In most cases there were club-shaped extensions of the pulp chambers and obliterations of the root canals. The probability that dentinogenesis imperfecta occurs as an accompanying symptom of osteogenesis imperfecta was not dependent on the degree of skeletal severity. The self-assignment according to A and B forms of osteogenesis imperfecta types I and IV in accordance with the presence/absence of dental symptoms was contradictory, since the literature was based on varying classifications.

Resumption of mitosis during post-thaw culture: a key parameter in selecting the right embryos for transfer

This retrospective study of 701 thaw cycles analysed the clinical importance of whether or not embryos resumed mitosis during 24 h of post-thaw culture. A total of 3360 frozen embryos were thawed; 1922 embryos survived the freeze-thaw procedure with at least one intact blastomere and were then cultured for 24 h before transfer. All transfers were registered into either the 'cleaved embryo group' (n = 459), which was defined as transfers where at least one of the transferred embryos cleaved during the post-thaw culture period, or the 'non-cleaved embryo group' (n = 153), where none of the transferred embryos cleaved during the post-thaw culture period. A total of 1408 thawed embryos were transferred in 612 cycles; 459 embryo transfers were in the cleaved embryo group, resulting in an implantation rate of 10%, significantly higher than the 4% in the non-cleaved embryo group (P = 0.0003). A total of 130 pregnancies (28% per transfer) were obtained in the cleaved embryo group which was significantly higher than the 17 pregnancies (11% per transfer) obtained in the non-cleaved embryo group (P = 0.0001). However, the average number of transferred embryos was significantly higher in the cleaved embryo group (2.46 +/- 0.03) compared to the non-cleaved embryo group (1.82 +/- 0.07). No difference was found in the age of the women between the two groups. When analysing transfers where all transferred embryos had cleaved during the post-thaw culture period the clinical pregnancy rate increased significantly from 13% transferring two embryos to 36% transferring three embryos (P = 0.0136). In this latter subgroup an implantation rate as high as 17% was obtained. The overall multiple pregnancy rate was 16%. The multiple pregnancy rate was 19% in the cleaved embryo group. In conclusion, 24 h post-thaw culture may allow a better selection of the embryos and thereby we may be able to increase the implantation and pregnancy rates. This may enable us further to reduce the number of embryos transferred.

Medical negligence and wrongful birth actions: Australian developments

Wrongful birth actions aim to compensate litigants who are negligently deprived by health professionals of their right to reproductive choice. Access to safe and legal abortion is integral to the action and wrongful birth claims in the United Kingdom have been facilitated by the Abortion Act 1967 (as amended). The recent Australian case CES v Superclinics (1995) 38 NSWLR 47 shows how judicial confusion about the legality of abortion can result in judges condoning medical negligence. The Superclinics case also suggests that doctors are not required to provide pregnant women with the same standard of care as other patients. These developments show that law can become incoherent and health professionals can act negligently with impunity when reproductive choice does not have a secure legal foundation.

Embryo morphology or cleavage stage: how to select the best embryos for transfer after in-vitro fertilization

This retrospective study of 1001 in-vitro fertilization (IVF) cycles included a consecutive series of single transfers (n = 341), dual transfers (n = 410) and triple transfers (n = 250) where all the transferred embryos in each cycle were of identical quality score and identical cleavage stage. In our 2 day culture system, transfer of 4-cell embryos resulted in a significantly higher implantation rate and pregnancy rate (23 and 49%) compared with 2-cell embryos (12 and 22%) and 3-cell embryos (7 and 15%). Furthermore, the transfer of 4-cell embryos resulted in a significantly higher pregnancy rate compared with embryos that had cleaved beyond the 4-cell stage (28%). The implantation rate (21%) and pregnancy rate (43%) after transfer of embryos of score 1.0 were significantly higher than after transfer of embryos of score 2.0 (14 and 32% respectively). Transferring embryos of score 2.1 resulted in significantly higher implantation rates (26%) and similar pregnancy rates compared with score 1.0. Transferring embryos of score 2.2-3.0 resulted in a significantly lower implantation rate (5%) and pregnancy rate (15%). A striking finding was that embryos of quality score 2.0 had a significantly lower implantation rate compared with embryos of quality score 1.0 and 2.1 and a significantly lower pregnancy rate compared to embryos of quality score 1.0. We also found a lower implantation rate and pregnancy rate when transferring 3-cell embryos. These findings may indicate periods of increased sensitivity to damage during the cell cycle. In conclusion, these results substantiate the idea of the superiority of 4-cell embryos and demonstrate that minor amounts of fragments in the embryo may not be of any importance. These findings may call for a shift when weighing the two main morphological components (quality score and cleavage stage) in the sense that reaching a 4-cell cleavage stage even with the presence of a minor amount of fragments should be preferred to a 2-cell embryo with no fragments.

The complete amino acid sequence of human placental oxytocinase

The complete amino acid sequence of human placental oxytocinase (placental leucine aminopeptidase) has been determined by cDNA cloning and sequencing. Oxytocinase is a type II integral membrane protein of 1025 amino acid residues, consisting of an acidic intracellular region of 110 amino acids followed by a hydrophobic transmembrane segment of 22 residues and 893 extracellular residues containing the characteristic Zn2+ coordination sequence element His-Glu-Xaa-Xaa-His-(18 residues)-Glu found in gluzincins. Two sets of cDNA clones with different 5'-ends were isolated and suggested to represent different spliced products of 3.6 kb (mature mRNA) and 12 kb, respectively. Oxytocinase mRNA is present in large amounts in placenta, heart and skeletal muscle and in small amounts in brain, kidney, liver and pancreas. A conserved sequence element, the GAMEN motif, which distinguishes the aminopeptidase family among gluzincins from other gluzincins, has been identified.

Hyperplasia, hyperproliferation and decreased migration rate of colonic epithelial cells in mice fed a diet deficient in vitamin D

Low serum levels of vitamin D metabolites have been associated with an increased risk for colon cancer. To investigate the effects of vitamin D deficiency on the colon, 4-week-old mice were fed a diet either containing (100,000 IU/kg diet) or lacking this vitamin for 3 weeks. Food consumption and body weight gain were similar in both groups. Following injection with 3H-thymidine to label dividing cells, cellular proliferation and migration up the colonic crypt were determined autoradiographically. Although overall crypt lengths were similar in both groups, there was hyperplasia and hyperproliferation in crypts of the deficient animals. Also, their epithelial cells migrated up the crypt at a significantly slower rate (maximum 0.78 micron/h) than did those from control mice (1.42 microns/h). There was no difference in cellularity, proliferation or migration in duodenal epithelium. These results indicate that vitamin D deficiency significantly alters colonic but not duodenal epithelial cells.

The effect of erythromycin on resolution of symptoms among adults with pharyngitis not caused by group A streptococcus

OBJECTIVE

To determine the effect of treatment with erythromycin on the resolution of symptoms among adults with pharyngitis not caused by group A streptococcus (GAS).

DESIGN

Randomized, double-blind, placebo-controlled trial.

SETTING

Ambulatory setting (hospital-based general internal medicine practices, walk-in clinic, employee health service, and university health service).

PATIENTS

One hundred and eighty-six adults who met eligibility criteria and whose chief complaint included sore throat. Patients with positive cultures for GAS were excluded.

INTERVENTION

Ninety-three patients received erythromycin (333 mg three times daily for 10 days) and 93 control patients received placebo.

MEASUREMENTS AND MAIN RESULTS

Major outcome measurements included time to improvement in sore throat, time to improvement in cough, time to improvement in activity level, and subjective sense of well-being. The average age of the patients studied was 26.6 years; 35% were men. Patients given erythromycin had more rapid resolution of sore throat symptoms (hazard ratio 1.43: 95% confidence interval [CI] 1.00, 2.03: p = .049). Cough also resolved more rapidly in patients receiving erythromycin (hazard ratio 2.22: 95% CI 1.01, 4.88: p = .05). There were no differences between the two treatment groups in improvement of activity level or how sick patients felt in general. Most of the benefit in resolution of sore throat was conferred on patients who sought medical care within 2 days of onset.

CONCLUSIONS

Our results suggest that the benefit of erythromycin treatment for patients with non-GAS pharyngitis is small and of borderline statistical significance. Because of the small size of the effect and because widespread use of erythromycin could promote drug resistance, we do not recommend routine use of erythromycin in adult patients with this type of pharyngitis.

Interleukin-1 induced signalling: biphasic activation of mitogen-activated protein kinase kinase and mitogen-activated protein kinases in HeLa cells. Involvement of phosphoprotein phosphatases

Results of this study document a biphasic activation of protein kinases of the MAP kinase cascade-MEK and MAP kinases-upon interleukin-1 stimulation in human HeLa cells. The specific activities of both MEK and MAP kinases were increased within 1 min, declined rapidly to control levels and increased again after 15 min of interleukin-1 stimulation. Inhibition by okadaic acid of serine/threonine specific phosphatases resulted in a marked increase in interleukin-1 stimulated MEK and MAP kinase activities. Elevation by interleukin-1 of the specific activities of MEK and MAP kinases correlated with suppression of serine/threonine phosphatases in the late phase of stimulation. The data indicate, that enhanced phosphorylation of cellular proteins by enzymes of the MAP kinase cascade might represent a fine balance between activated protein kinases and repressed phosphoprotein phosphatase 2A in interleukin-1 stimulated HeLa cells.

[Rhinoslceroma in an elderly Danish woman]

A case of rhinoscleroma in an elderly Danish woman is presented. The characteristics of the disease are described. An 84-year old female presented with serous rhinorrhoea, swelling of the columella and the upper lip and granulomatous masses in the right inferior concha and the right maxillary sinus. The diagnosis was confirmed by histological studies. Until now no serological or bacteriological cultures have been positive. The patient recovered clinically after surgical debridement and three months of orally administered ciprofloxacin 500 mg twice daily. There remains, however, a sclerotic swelling in the columella and the upper lip. No obvious explanation as to how this patient had caught the disease could be found.

Intracytoplasmic sperm injection does not overcome an oocyte defect in previous fertilization failure with conventional in-vitro fertilization and normal spermatozoa

A cohort comprising a total of 447 oocyte aspirations due to male factors (n = 258) or to previous fertilization failure by IVF in the presence of normal sperm parameters (n = 189) was studied. We found a significantly reduced implantation and pregnancy rate per transfer in the group with previously failed IVF attempts compared to the male factor group (P < 0.001). No differences were found in age, number of oocytes retrieved, number of embryos transferred or quality of embryos scored at the time of transfer. However, the fertilization and cleavage rates were found to be reduced in the group with previous failed IVF cycles. It is therefore concluded that previous fertilization failure despite normal sperm parameters in an IVF cycle may not be alleviated by the intracytoplasmic sperm injection (ICSI) procedure. These patients might suffer from oocyte defects as well.

No sex difference occurs in hippocampus, food-storing, or memory for food caches in black-capped chickadees

A number of recent studies have described sex differences in the relative size of the hippocampus that are associated with sex differences in the use of space. Voles, kangaroo rats, and cowbirds all exhibit a sex difference in relative size of the hippocampal formation that is correlated with a sex difference in spatial behaviour. We wished to determine whether sex differences in the size of the hippocampus occur in the absence of a difference in the use of space, and whether the previously described correlations could be adventitious. Relative hippocampal size was determined in wild-caught black-capped chickadees (Parus atricapillus) following behavioural observations of food caching and spatial memory for cache sites. There was no indication of a sex difference in either relative size of the hippocampus or in food-caching behaviour and memory for cache sites. These results show that sex differences in relative size of the hippocampus do not occur as a matter of course, and are consistent with the hypothesis that sex differences in spatial behaviour and spatial ability are predictive of sex differences in the relative size of the hippocampus.

The utilization rate and pregnancy outcome of multifetal pregnancy reduction in the Nordic countries

OBJECTIVE

To review the utilization rate and pregnancy outcome of multifetal pregnancy reductions (MFR) in the Nordic countries during the period January 1986-June 1992.

STUDY DESIGN

All centers offering assisted conception in Denmark, Finland, Norway and Sweden were retrospectively surveyed by means of a questionnaire with regard to the number and methods used for MFR, pregnancy loss and the outcomes of the pregnancies. The response rate was 100%.

RESULTS

During the period studied, 185 births of triplets or higher multiples occurred in Sweden, 120 in Finland and 102 in Denmark. MFR was performed in 42 women (Sweden 26, Finland 10, Denmark 6) but not in Norway at all. This gives an estimated average utilization rate of 1/7 multiple births of three or more in Sweden, 1/17 in Denmark and 1/12 in Finland. The most frequently used method was intracardiac or intrathoracic injection of a potassium chloride solution in gestational weeks 9-12. One pregnancy was reduced from seven to four fetuses, two from five to three, 10 from five to two, one from four to three, 17 from four to two, one from four to one, five from three to two, four from three to one and one from two to one. Nine (21%) pregnancies terminated in a spontaneous abortion within one week (n = 2) to several weeks (n = 7) after the procedure. Of the remaining 33 (79%) pregnancies which continued to delivery, two fetuses died in utero in the second trimester, three infants died perinatally and one child had transverse limb reduction defects. A successful pregnancy defined by the discharge home of at least one infant occurred in 79% of the cases.

CONCLUSION

This study gives national estimates on the utilization rate of MFR. Although MFR is performed more frequently in Sweden than in Denmark and Finland, the overall figures remain low in the Nordic countries. The incidence of pregnancy loss in this study is somewhat higher than in several larger reported series, probably reflecting the learning curve of the procedure. It seems reasonable that MFR should be performed in only a few centers in the Nordic countries.