Cervical dysplasia treatment: key issues for developing countries

Many developing countries face serious obstacles that have hindered establishment of successful cervical cancer control programs. Various countries are now seeking to strengthen cytology services and identify simple low-cost screening strategies; but any real gains in reducing cervical cancer incidence and mortality will also require effective treatment of women with preinvasive disease. Despite a trend toward conservative outpatient approaches for treating cervical dysplasia in industrialized countries, clinicians in many developing countries still rely primarily on invasive inpatient methods such as cone biopsy and hysterectomy. For women who could be treated with less invasive methods, these procedures tend to pose unnecessary risks and entail high costs that put them beyond the reach of many patients. Outpatient therapy, employing methods such as cryotherapy and the loop electrosurgical excision procedure (LEEP), combined with proper follow-up, is appropriate for dealing with visible lesions on the ectocervix when invasive cancer and endocervical involvement have been ruled out. Cryotherapy and LEEP hold out particular promise for developing countries because of their effectiveness, lack of side-effects, simplicity, and low cost. Cure rates range from 80% to 95%, depending on the method used and the severity of the lesions. However, each method has advantages and disadvantages that demand consideration. Various ways of reducing the number of follow-up visits, including the two-visit "see and treat" approach, are also available for use in areas where women's access to health services may be limited. A recent survey by the Program for Appropriate Technology in Health (PATH) affirmed the tendency to rely on cone biopsy and hysterectomy. It also found that in many places all degrees of preinvasive disease were treated, rather than only high-grade or severe conditions; that respondents in Latin America, the Caribbean, and Asia tended to use cryotherapy and LEEP more widely than other low-cost methods; that LEEP was preferred over cryotherapy in Latin America; and that colposcopes and other basic equipment needed to provide treatment were not consistently or widely available in some settings.

Deficient cellular cyclic AMP may cause both cardiac and skeletal muscle dysfunction in heart failure

Deficient myocardial cyclic AMP concentrations contribute to abnormal Ca2+ handling and systolic and diastolic dysfunction in chronic heart failure (CHF). We tested the hypothesis that decreased cyclic AMP in skeletal muscle of animals with failure may contribute to the weakness and easy fatiguability also common in patients with CHF. We compared intracellular Ca2+ signaling and contractility in skeletal muscle preparations from rats 6 weeks after myocardial infarction-induced CHF versus sham-operated controls. Bundles of 100 to 200 cells were dissected from the extensor digitorum longus (EDL) muscle of control and CHF rats. Muscles from CHF rats exhibited depressed tension development compared with control muscles during twitches. Treatment with 2mM dibutyryl cyclic AMP returned tension and Ca2+ towards normal levels. There was no evidence of cellular atrophy in the CHF rats. In conclusion, EDL skeletal muscle from rats with CHF had intrinsic abnormalities in excitation-contraction coupling that could be reversed with cyclic AMP supplementation as previously reported for the heart. This suggests that deficient cyclic AMP levels may contribute to both cardiac and skeletal muscle dysfunction in CHF.

Chemical reactivity of the 18F electrophilic reagents from the 18O(p,n) 18F gas target systems

A comprehensive evaluation of the reactivity of 18F electrophilic fluorinating agents derived from the 18O(p,n)18F reaction conducted in target bodies made of aluminum, silver, copper, nickel, and gold-plated copper is reported. Two representative electrophilic reactions, namely addition across a double bond and substitution on an aromatic ring (fluorodemercuration and fluorodestannylation), were tested with the 18F activity generated in the [18O]O2 target systems. Identical reactions were also conducted with analogous nonradioactive fluorinating agents as control experiments. The products of all these reactions were analyzed by NMR spectroscopy. Results of these experiments clearly showed that 18F activities recovered from aluminum, silver, and copper target bodies were better suited for radiochemical syntheses, irrespective of the irradiation protocols employed. The 18F activity from a gold-plated target was suitable only for addition reactions. Further, the fluorodemercuration reaction essentially failed with the single-step irradiation technique conducted in nickel and gold-plated targets. In contrast, the fluorodestannylation reaction was quite successful with the 18F reagents recovered from all the target bodies and irradiation protocols.

Production of [18F]F2 using the 16O(3He,p)18F reaction

For the first time, the 16O(3He,p)18F reaction has been used for the production of 18F electrophilic reagents. The predominant reactive chemical specie recovered in the single-step postirradiation gases was [18F]F2. Decay curve and Ge(Li) analyses established the main radionuclidic impurities in this nuclear reaction as 11C and 15O. Recovery of the 18F activity was exceptionally high, approaching 90% using an electroformed nickel target body. Consistent 18F recoveries for this nuclear reaction (approximately 70%) were realized with a novel aluminum target body. The utility of the [18F]F2 recovered from this oxygen gas target system in radiopharmaceutical preparations is demonstrated by the successful synthesis of 6-[18F]fluoro-L-dopa (11.0 mCi at EOB) via a fluorodemercuration method.

Identification and quantitation of gaseous compounds of fluorine generated in [18F]F2 target systems

The first direct evidence for the chemical identity of the electrophilic fluorinating agents generated in 20Ne(d, alpha)18F (single-step), 18O(p,n)18F (single-step and two-step) and 16O(3He2+, p)18F (single-step) gas target systems, utilizing aluminum, silver, copper, nickel and gold plated copper target bodies, has been established with multinuclear NMR and mass spectral techniques. The major components of the reactive fraction from these targets were also quantitated using 19F NMR. Fluorine-19 NMR data of the reactive fraction of all proton and 3He2+ irradiated oxygen gas target systems showed the presence of oxygen difluoride in various proportions. Samples from the single-step method contained up to 20% OF2 while those from the two-step process had 0-5%. Fluorine nitrate (FONO2) was observed only as a minor component (0-3%) in the reactive fraction. The presence of OF2 and FONO2 was further confirmed by 17O and 15N NMR, respectively, using [17O]O2 and [15N]N2 spiked oxygen gas targets. The NMR results were supported by mass spectral data collected with a residual gas analyzer (RGA). Both 19F NMR and mass spectroscopy showed CF4 as the only major inert component in the single-step oxygen target products. As expected, the 19F NMR and mass spectral data showed that the reactive fraction of the neon gas target constituted only F2 and the inert fraction comprised of CF4 and NF3.

Metals suitable for fluorine gas target bodies: first use of aluminum for the production of [18F]F2

A comprehensive evaluation of different metals (aluminum, silver, copper, nickel, and gold-plated copper) was undertaken for the fabrication of target bodies with straight and conical bore shapes for the production of [18F]F2 via the 20Ne(d,alpha)18F nuclear reaction. Of these metals, aluminum, silver and copper have never been used for the production of [18F]F2. All these target bodies were easily passivated using a mild beam-induced plasma technique in the presence of 1% F2 in neon or argon. The recovery of 18F activity was higher with electroformed nickel and silver bodies, probably due to favorable thermal conductivities. Aluminum proved to be a useful material for fluorine gas targets. The consistent recovery of 18F activities, ease and low cost of manufacturing and low nuclear activation properties all make aluminum an ideal choice for fluorine gas targetry. To our knowledge, this investigation is the first to highlight the use of aluminum as a target body material for the routine production of [18F]F2. A reasonable mechanism based on the Langmuir-Rideal surface atom recombination is also proposed for the behavior of [18F]F2 recovery from a nickel target body.

Proton irradiation of [18O]O2: production of [18F]F2 and [18F]F2 + [18F] OF2

The production of 18F electrophilic reagents via the 18O(p,n)18F reaction has been investigated in small-volume target bodies made of aluminum, copper, gold-plated copper and nickel, having straight or conical bore shapes. Three irradiation protocols-single-step, two-step and modified two-step-were used for the recovery of the 18F activity. The single-step irradiation protocol was tested in all the target bodies. Based on the single-step performance, aluminum targets were utilized extensively in the investigation of the two-step and modified two-step irradiation protocols. With an 11-MeV cyclotron and using the two-step irradiation protocol, > 1Ci [18F]F2 was recovered reproducibly from an aluminum target body. Probable radical mechanisms for the formation of OF2 and FONO2 (fluorine nitrate) in the single-step and modified two-step targets are proposed based on the amount of ozone generated and the nitrogen impurity present in the target gases, respectively.

Stroke rate is markedly reduced after carotid endarterectomy by avoidance of protamine

PURPOSE

Postoperative neurologic injury remains a significant risk of carotid endarterectomy. Mechanisms include embolization of debris and formation of thrombus on the newly endarterectomized surface. We hypothesized that the risk of postoperative neurologic injury would be lower in those patients who did not receive protamine for reversal of heparin anticoagulation.

METHODS

We reviewed 348 consecutive primary carotid endarterectomies performed since January 1, 1986, to determine the relationship between surgical outcomes and reversal of heparin anticoagulation. Patients undergoing additional simultaneous cardiovascular procedures were excluded. One hundred ninety-three patients received protamine after completion of the endarterectomy. The remaining 155 patients did not receive any protamine.

RESULTS

All patients in both groups survived to discharge. There were no strokes in those patients who did not receive any protamine; however, the stroke rate in the protamine group was 2.6% (5 of 193), p < 0.045. The incidence of hematoma requiring reexploration was 1.0% (2 of 193) and 1.9% (3 of 155) in the protamine and no-protamine groups, respectively (p = NS). Intraoperative shunting was used more frequently in the no-protamine group (84% vs 67%, p < 0.001), and patch angioplasty was performed more frequently in the protamine group (35% vs 15%, p < 0.001). However, neither shunting nor patching significantly influenced stroke rates.

CONCLUSIONS

We conclude that carotid endarterectomy without reversal of heparin anticoagulation is associated with a reduced postoperative stroke rate without a significant increase in morbidity rates.

Inhibition of redox cycling of methoxatin (PQQ), and of superoxide release by phagocytic white cells

The iodonium compounds diphenyleneiodonium and diphenyliodonium, and the amine compounds, 4,5-dimethyl phenylene diamine, N,N-dimethyl 1,4-phenylene diamine, 1,2-diamino-4,5-methyleneoxybenzene, and aminomalononitrile inhibit methoxatin's (PQQ's) redox activity in vitro, that is, the methoxatin-coupled oxidation of glycine and reduction of nitroblue tetrazolium to formazan. The compounds mentioned above also inhibit phorbol myristate acetate (PMA) stimulated superoxide release by phagocytic white cells--determined mainly as the superoxide dismutase sensitive reduction of ferricytochrome C. Related compounds, 3,4-diaminopyridine and 4-dimethylamino-benzylamine, did not inhibit redox activity of PQQ in vitro, nor did they inhibit PMA stimulated superoxide production in monocytes or neutrophils. Thus, there is a correlation between an agent's ability to inhibit PQQ redox cycling and its ability to inhibit superoxide release by phagocytes. The findings are a further indication that PQQ is involved in the respiratory burst of phagocytic cells.

Last occurrence and survival during winter of the arbovirus vector Culicoides brevitarsis at the southern limits of its distribution

Linear regression analysis was used to describe the decline in numbers of Culicoides brevitarsis Kieffer into winter with monthly maximum, average and minimum temperatures at the southern limits to its distribution in New South Wales. From this, low temperature thresholds were derived when C brevitarsis would be absent from the field. The low minimum threshold +/- 2 SE (95% Confidence Interval) of 8.1 +/- 0.3 degree C was used with historical temperature data to estimate the last month that the species should occur (March to June) and the mean number of months (2 to 6.5) below the threshold at 17 selected sites. Probability for survival during winter at these sites was estimated from years when the number of consecutive months below the threshold was < or = 2 months. This varied from zero to 51% depending on the location of the site. Last occurrence was 0.7 months later on average and absolute probabilities for survival ranged from zero to 100% when the temperatures were increased by an arbitrary 2 degrees C.

Aspects of the release of superoxide by leukocytes, and a means by which this is switched off

Although great progress has been made in understanding the respiratory burst of leukocytes that produce superoxide (O2-), it is possible that a component or components, might have been overlooked. Furthermore, O2- production and its sequels, though cardinal in bactericidal action, might ultimately be damaging to the host's own cells. It is important, therefore, that a biologic mechanism exist to turn off O2- production by stimulated leukocytes. This article offers evidence that methoxatin (PQQ), a redox-cycling orthoquinone, might be involved in O2- production by leukocytes. This is based on the fact that inhibitors of O2- production, such as diphenylene iodonium (DPI) and 4,5-dimethylphenylene diamine (DIMPDA), were shown to sequester PQQ in leukocytes, i.e., to form adducts with that substance. Addition of PQQ to cells blocked with the inhibitors partially restored O2- release. With respect to turning off cellular O2- release, a factor was observed to be released to the medium by old macrophages (14 days old, but not by those less than 7 days old). Such conditioned medium, when added to stimulated neutrophils or macrophages, blocked O2- release. This factor was sensitive to proteases, exhibited molecular sizes of 3 and 11 kDa, and its action was independent of the nature of the stimulus applied to the leukocytes. It was partially purified by column (sizing) chromatography and HPLC. It seems to be a general modulator of the release of reactive oxygen species by phagocytes and is irrespective of phagocytic cellular type, or species from which the cells were derived.

Methoxatin (PQQ) in guinea-pig neutrophils

PQQ, also called methoxatin, has been isolated from guinea-pig neutrophils. The organic cations diphenyleneiodonium (DPI) and diphenyliodonium (BPI) and the aromatic o-diamine 4,5-dimethylphenylenediamine (DIMPDA) sequester synthetic PQQ and inhibit its redox-cycling activity in a model system. Standards were made of adducts of tritiated PQQ with unlabeled DIMPDA and of unlabeled PQQ with tritiated DPI or DIMPDA. PQQ adducts were isolated from guinea-pig neutrophils with each of the tritiated inhibitors. They were separated and defined by high-performance liquid chromatography (HPLC). Tiron, a disodium benzene disulphonic acid, broke the DPI-PQQ adduct isolated from neutrophils and released free PQQ. Both DPI and DIMPDA, as well as BPI, blocked O2.- release by stimulated neutrophils. The blockade exerted by these inhibitors was released by the addition of PQQ to the cell suspensions. The data demonstrate the presence of PQQ in guinea-pig neutrophils and suggest that it has a possible role, direct or indirect, in the O2.(-)-producing respiratory burst.

Characterization of the glycine-dependent redox-cycling activity in animal fluids and tissues using specific inhibitors and activators: evidence for presence of PQQ

Pyrroloquinoline quinone, a redox cofactor first isolated from bacteria, efficiently catalyzes the nonenzymatic oxidation of glycine in the presence of nitroblue tetrazolium. We report that certain metallic cations and heterocyclic aromatic cations, like the N-methyl phenazonium cation and aryl-iodonium compounds, strongly and specifically inhibit this redoxcycling activity. The inhibition by metal cations is reversed by Tiron and that of the aromatic cations by Tiron and thyroxine. These inhibitors and activators affect authentic PQQ and the redox-activity of putative PQQ isolated from biological sources in a similar manner. This indicates that pyrroloquinoline quinone occurs naturally in animal tissues and fluids.

Effect of streptozotocin-diabetes on the level of VIP mRNA in myenteric neurones

The effect of streptozotocin-induced diabetes on the production of vasoactive intestinal polypeptide messenger RNA in the myenteric neurones of 8 weeks diabetic rat intestine was examined using in situ hybridization. Total ganglion cell number per length (mm) of tissue section was measured using NADH diaphorase histochemistry. Although ganglion cells were more numerous in the control preparations compared with diabetic samples, a significantly greater number of vasoactive intestinal polypeptide messenger RNA-containing cells was detected in the diabetic tissues. These observations suggest that there is either a decrease in the breakdown of vasoactive intestinal polypeptide messenger RNA or an increase in its synthesis in myenteric neurones of diabetic rat intestine.

The yield of wheat following lupins: effects of different lupin genotypes and management

More nitrogen is fixed by grain lupins (Lupinus sp.) than is removed in the harvested grain. Differences in residual N after different lupin species and genotypes (L. albus, L. cosentinii, L. angustifolius) and different agronomic treatments (harvesting, sowing dates, sowing rates and fertilizer treatments) were estimated using a simple nitrogen (N) balance. For six experiments, the relationship between the estimated residual N value and the yield of the following wheat crop was also examined. L. albus grew poorly on the infertile sandy soils and had the lowest estimated residual N value, whereas L. cosentinii had a high estimated residual N value and L. angustifolius was intermediate. Across sites and seasons, the estimated residual N value of L. angustifolius varied from 37 to 165 kg N/ha. For an individual experiment the greatest range for L. angustifolius was from 59 to 114 kg N/ha. Despite the wide range in residual N across genotypes, there was a poor relationship between estimated residual N value and yield of the following wheat crop. Except for lupin crops which grew poorly, the impact of agronomic treatment on the residual N from lupins had little effect on yield of the following wheat. On the basis of these results there seems to be no reason to manage the lupin crop for high residual N value, and any improvements to the nitrogen harvest index of lupins through breeding or management are not expected to reduce the residual effect.

Apolipoprotein (a) concentrations and susceptibility to coronary artery disease in patients with peripheral vascular disease

OBJECTIVE

To investigate the relation between apolipoprotein(a) concentrations and angiographically defined coronary artery disease in patients with atheromatous peripheral vascular disease.

DESIGN

40 consecutive patients were recruited at the time of admission for peripheral vascular surgery. All underwent clinical assessment and coronary arteriography. Apolipoprotein(a) concentrations were measured by an immunoradiometric assay.

SETTING

Tertiary referral centre.

SUBJECTS

Patients requiring surgical intervention for large vessel peripheral vascular disease.

MAIN OUTCOME MEASURES

Presence or absence and severity and distribution of angiographically defined coronary artery disease. Measurement of circulating contractions of apolipoprotein(a) and other lipid indices.

RESULTS

Coronary artery disease was absent in 11 patients (group 1), mild to moderate in 12 (group 2), and severe in 17 (group 3). The distribution of peripheral vascular disease and of standard lipid indices was similar in these three groups of patients. There was a significant difference in apolipoprotein(a) concentrations between the three groups, with concentrations progressively increasing with the severity of coronary artery disease (mean (95% confidence interval): group 1, 112 U/1 (52 to 242); group 2, 214 U/1 (129 to 355); group 3, 537 U/1 (271 to 1064) (analysis of variance p < 0.005). The prevalence of coronary artery disease was increased 7.4 fold in patients with apolipoprotein(a) concentrations that were greater than the cohort median (206 U/1) (p < 0.01).

CONCLUSIONS

The results show an association between apolipoprotein(a) concentrations and angiographically defined coronary artery disease in patients with large vessel peripheral vascular disease. The findings imply differences in the pathogenesis of coronary and peripheral atheroma and suggest that the measurement of apolipoprotein(a) may prove a useful additional tool in the risk factor assessment of patients undergoing peripheral vascular surgery.

A community health program for the elderly

The few existing health education programs for the elderly of a southeastern Pennsylvania community focused on illness rather than prevention. After several nurses conducted a survey of healthy seniors, they developed a stress-reduction program--a first step toward assisting the elderly to maintain health and independence.

Regioselective radiofluorodestannylation with [18F]F2 and [18F]CH3COOF: a high yield synthesis of 6-[18F]Fluoro-L-dopa

A protected 6-trimethylstannyl dopa derivative 6 has been synthesized for the first time as a precursor for the preparation of 6-[18F]fluoro-L-dopa. The tin derivative 6 readily reacted with electrophilic radiofluorinating agents such as [18F]F2 and [18F]AcOF. The [18F]fluoro intermediate 7 was easily hydrolyzed with HBr and the product 6-[18F]fluoro-L-dopa was isolated after HPLC purification in a maximum radiochemical yield of 25%, ready for human use. The various intermediates, the stannyl precursor 6 and the final product (after 18F decay) were all fully characterized by 1H, 13C, 19F and 119Sn NMR as well as high resolution mass spectroscopy.

Detection and quantitation of 17F formation during the cyclotron production of 13N

The positron emitter 17F has been identified for the first time as a radioactive contaminant formed during 13N production. It was determined that 17F made up 18% of the short-lived radioactivity previously thought to be exclusively 15O. Mathematical deconvolution of decay curve data was employed as a complement to radioanalytical techniques. The nuclidic composition of the effluents from the proton bombardment of (a) water, (b) dilute ethanol and (c) 13C powder/water slurry was determined and compared with previous literature values.