Factors related to dropout in a study of head and neck cancer patients after surgery

The extent and nature of dropout was assessed in a longitudinal study whose objective was to define and quantify the functional effects of oral surgical resection and reconstruction on speech and swallowing function in patients with head and neck cancer. Of 150 patients who were enrolled to be followed up with speech and swallow assessments for 1 year after surgery, 113 (75%) dropped out and 37 (25%) returned to complete the study at the final 12-month evaluation point. In general, those completing the study had a smaller resection than the patients who dropped out before the 12-month evaluation. Fifty percent of the dropout was accounted for by medical reasons, 23% by administrative reasons, and 27% by patient-specific reasons (i.e., reasons known only to the patient). Analysis of the dropout categories revealed that higher cancer stage, larger volume of resection, and having a flap surgical closure versus a primary closure or skin graft increased a patient's chance of dropping out. A larger volume of resection was also related to an increased chance of being a patient-specific dropout. Patients who reported no or low alcohol usage had a greater chance of completing follow-up than being a patient-specific dropout.

Use of hydroxyurea in psoriasis

Hydroxyurea is an effective treatment in chronic plaque psoriasis that is relatively simple to prescribe. Dose-related bone marrow toxicity is the principal side-effect of therapy although clinically significant complications are few, provided that blood counts are monitored carefully. In contrast with many other second-line agents, renal and liver disease do not necessarily preclude treatment, and there are few drug interactions likely to be of clinical relevance in dermatology. Recent studies on the use of hydroxyurea for sickle cell disease may provide more information on predicting the maximal tolerated dose and potential hazards of long-term therapy in nonmalignant disease and perhaps revive interest in the drug's use in dermatology.

Measurement of plasma ibuprofen by gas chromatography-mass spectrometry

A gas-chromatography-mass spectrometry (GC-MS) method for the determination of plasma ibuprofen was developed. Plasma samples from cystic fibrosis (CF) patients receiving high-dose ibuprofen therapy were analyzed by GC-MS and the result compared to analysis by high-performance liquid chromatography (reference method). Analysis of ibuprofen was sensitive to at least 5 mg/L, and the method was linear to 200 mg/L. Within-run variations of plasma samples were 4.6% (131.7 +/- 6.0 mg/L) and 5.4% (44.4 +/- 2.4 mg/L), respectively. The between-run variation was 9.3% (45.4 +/- 4.2 mg/L) and 7.4% (88.0 +/- 6.5 mg/L). This method is suited for routine clinical use for the monitoring of plasma ibuprofen levels in treatment of CF. It may be particularly applicable in pediatric laboratories, which are likely to possess GC-MS capability.

Incidence and patient characteristics associated with silent aspiration in the acute care setting

Coughing is a physiologic response to aspiration in normal healthy individuals. However, there are published records that report no cough in response to aspiration (i.e., silent aspiration) in dysphagic patients. In this retrospective study, for more than 2 years in two acute care hospitals we examined frequency of the cough response in patients identified as aspirators by using videofluoroscopy. One thousand one hundred one patients underwent videofluorographic evaluation of their swallowing during this 2-year period; 469 aspirated; 276 were silently aspirating. Two hundred twenty-four of these silent aspirators aspirated once during a swallow and 52 silently aspirated more than once during a swallow. These two groups of patients were analyzed separately. Univariate (chi-square and Fisher's exact tests) and multivariate (logistic regression) analyses were conducted to assess the relationship of silent aspiration to age, gender, medical diagnosis, timing of aspiration, and etiology of aspiration. In univariate analysis, age (p < 0.001), gender (p < 0.004), and medical diagnosis (p = 0.05) were significantly associated with silent aspiration in the group who aspirated once during a swallow. No significant associations were seen in the group of patients who aspirated more than once during a swallow.

HPLC detection of fetal blood in meconium: improved sensitivity compared with qualitative methods

We describe an HPLC-based method for the detection and quantification of fetal hemoglobin in stools of newborns. The new procedure is an alternative to the classic qualitative test for adult hemoglobin in meconium based on the differential stability of hemoglobin species in dilute base (Apt test). The HPLC method, based on a commercial device for hemoglobin characterization (Bio-Rad Variant), readily separates fetal and adult hemoglobin from non-hemoglobin components of meconium. To validate the method, blood and meconium were mixed in various proportions and then prepared for analysis with extraction in saline. The HPLC method accurately identified hemoglobin species even when the blood constituted only 5 mL per 100 g of the meconium specimen, and nearly quantitative recovery of hemoglobin was obtained at a blood content of 20 mL per 100 g of the meconium. Analysis time was 6.5 min, and preparation of sample was simple. HPLC detection of fetal blood in stools or other specimens markedly improves detection/characterization of blood in meconium.

Effect of granulocyte macrophage-colony stimulating factor on Langerhans cells in normal and healthy atopic subjects

Granulocyte macrophage-colony stimulating factor (GM-CSF) is a multipotent cytokine produced by many cutaneous cell types including keratinocytes. Langerhans cells (LC) represent the major antigen-presenting cells in skin, and in vitro studies demonstrate that GM-CSF is of pivotal importance in LC. Healthy volunteers (n = 3 non-atopic, n = 3 with atopy) received recombinant human GM-CSF (0. 05 microg/mL) by intradermal injection for 3 days to the same site. Diluent was injected in a similar manner as control. Biopsies were taken 24 h after the final injection and examined immunohistochemically for LC and inflammatory cell markers. Compared with control sites, intradermal GM-CSF resulted in shortening of dendritic cell processes and redistribution of LC in the epidermis; numbers of CD1a + cells in the epidermis were significantly decreased (P < 0.005), while those in the dermis were significantly increased (P < 0.05) following intradermal GM-CSF when compared with controls. Double labelling studies on epidermal CD1a + cells indicated de novo expression of intercellular adhesion molecule (ICAM)-1 and increased expression of HLA-DR following GM-CSF (P < 0. 005, P < 0.005, respectively). Additional findings included a marked mixed inflammatory cell infiltrate in the dermis and increased expression of the endothelial cell adhesion molecules E-selectin and ICAM-1. These data indicate that in normal human skin, GM-CSF induces changes in the phenotype and distribution of CD1a + cells consistent with LC functional maturation and exit from the epidermis to the dermis. As these events are central to the initiation of cutaneous inflammation, GM-CSF may potentially play a critical role in the pathogenesis of inflammatory dermatoses.

Preliminary results of bedside inferior vena cava filter placement: safe and cost-effective

The use of inferior vena cava filters (IVCFs) is increasing in patients at high risk for venous thromboembolism; however, there is considerable controversy related to their cost. We inserted eight percutaneous IVCFs at the bedside. The hospital charges for bedside IVCF insertion were substantially lower compared with those for IVCF insertion performed in the Radiology Department or operating room. There was one death (unrelated to the procedure) and one asymptomatic caval occlusion believed to be caused by thrombus trapping. Bedside IVCF insertion is safe and cost-effective in selected patients. This practice averts the potential complications associated with transporting critically ill patients.

Sodium-independent lysine uptake by the BeWo choriocarcinoma cell line

Transport of L-lysine by a cultured placental trophoblast cell line was investigated by characterization of L-[3H]lysine uptake. In the mononuclear form of the BeWo clone b30 choriocarcinoma cell, at least two sodium-independent systems are present. Concentration dependence data were fitted by a two system model with Km values (+/- s.e.) of 2 +/- 0.7 and 94 +/- 31 microM and Vmax values (+/- s.e.) of 0.7 +/- 0.3 and 25 +/- 6.0 nM/mg DNA/min. A portion of sodium-independent uptake was inhibited by the sulphydryl modifying reagent N-ethylmaleimide (NEM). Following NEM treatment, the data were fitted by a single system with Km = 10 +/- 2 microM AND Vmax = 5.1 +/- 0.8 nM/mg DNA/min. In the absence of sodium, NEM-resistant uptake was sensitively inhibited by leucine whereas NEM-sensitive uptake was not inhibited by leucine. It is concluded that like placental basal membrane, the mononuclear BeWo cell possesses two sodium-independent L-lysine transport systems. The high-capacity, NEM-sensitive, leucine-insensitive system resembles the widespread system y+. The high-affinity, NEM-resistant, leucine-sensitive system resembles system b(0,+).

Identification of two leucine-sensitive lysine transport activities in human placental basal membrane

The recent demonstration of multiple high-affinity leucine-sensitive cationic transport systems prompted this investigation of their role in lysine uptake in basal cell membrane. Transport of lysine by basal membrane was saturable at both 22 and 37 degrees C and linear in time to 1 min and 30 sec, respectively. At 22 degrees C, at least two systems were active. The portion of uptake inhibited by the sulphydryl binding reagent N-ethylmaleimide (NEM) but not by leucine in the absence of sodium had a high K(m) and high Vmax and was attributed to system y+. NEM-insensitive uptake was fitted by a one-system model with K(m) (+/- s.e.) of 4 +/- 1 microM and a Vmax of 0.9 +/- 0.1 pmol/mg protein/min. This component was completely inhibited by leucine in the absence of sodium but not by glutamine in the presence of sodium. Therefore, it was attributed to system bo,+. At 37 degrees C, at least three systems were active. For essentially the same reasons as above the NEM inhibitable uptake was attributed to system y+. NEM-insensitive uptake was fitted by a one-system model with K(m) of 26 +/- 7 microM and Vmax of 11.1 +/- 2.8 pmol/mg protein/30 sec. Inhibition studies, however, indicated its heterogeneity. NEM-insensitive saturable uptake was only partially inhibited by either leucine in the absence of sodium (system bo,+) or by glutamine in the presence of sodium (system y+L). It is concluded that the NEM-insensitive portion of lysine uptake at 37 degrees C represents activity of both system bo,+ and the temperature-sensitive system y+L. As a previous investigation indicates, only one of these (system y+L) is present in the more specialized microvillous membrane. The demonstration of functional differences in the high affinity leucine transporters of basal and microvillous membrane in this and our previous investigations suggest that the two membranes possess different transport or modifier proteins.

Extraction of glyceric and glycolic acids from urine with tetrahydrofuran: utility in detection of primary hyperoxaluria

Primary hyperoxaluria (PH) is an autosomal recessive metabolic abnormality characterized by excessive oxalate excretion leading to nephrocalcinosis and progressive renal dysfunction. Type I primary hyperoxaluria (PH I) results from a deficiency of alanine:glyoxylate aminotransferase, whereas type II disease has been traced to a deficiency of D-glycerate dehydrogenase. The two syndromes are often distinguished on the basis of organic acids that are coexcreted with oxalate: glycolate and L-glycerate in type I and type II disease, respectively. Routine organic acid analysis with diethyl ether extraction followed by gas chromatographic analysis failed to detect normal and increased concentrations of these diagnostic metabolites. Subsequent extraction of urine with tetrahydrofuran (THF), however, extracted 75% of added glycerate, 42% of added glycolate, and 75% of added ethylphosphonic acid (internal calibrator). THF extraction was analytically sensitive enough to allow determination of normal excretion of glycolate (14-72 micrograms/mg creatinine) and glycerate (0-5 years, 12-177 micrograms/mg creatinine and > 5 years, 19-115 micrograms/mg creatinine). Four of five patients with PH I and both patients with type II disease were correctly identified. Thus, THF extraction is a convenient adjunct to routine organic acid analysis and facilitates the detection of PH.

Visual loss as a complication of spine surgery. A review of 37 cases

STUDY DESIGN

Thirty-seven patients who experienced visual loss after spine surgery were identified through a survey of the members of the Scoliosis Research Society and a review of the recent literature.

OBJECTIVES

Records were reviewed in an attempt to identify preoperative and intraoperative risk factors and to assess the likelihood of recovery.

SUMMARY OF BACKGROUND DATA

Postoperative blindness after spine surgery has been documented in case reports or small series. The authors report the largest group of such cases to date and the first to allow conclusions regarding risk and prognosis.

METHODS

Letters were sent to members of the Scoliosis Research Society requesting copies of medical records concerning patients who experienced postoperative visual deficits after spine surgery. An additional 10 well-documented recent cases were identified from published reports.

RESULTS

Patients with visual loss had a mean age of 46.5 years. Surgery included instrumented posterior fusion in 92% of the cases, with an average operative time of 410 minutes and blood loss of 3500 mL. Most cases had significant intraoperative hypotension, with a mean drop in systolic blood pressure from 130 to 77 mm Hg. However, comparison with a matched group of patients with no visual symptoms showed no differences in the hematocrit or blood pressure values. Visual loss occurred because of ischemic optic neuropathy, retinal artery occlusion, or cerebral ischemia. Eleven cases were bilateral, and 15 patients had complete blindness in at least one eye. Most deficits were permanent.

CONCLUSIONS

The authors conclude that blindness after spine surgery is more common than has been recognized previously. Most cases are associated with complex instrumented fusions.

Oral sensory discrimination of fluid viscosity

This study was designed to investigate the ability of normal young adult volunteers to sensorially identify Newtonian fluids of specified viscosities. Twenty subjects, 10 men and 10 women between the ages of 18 and 29 years participated. Seven stimuli, consisting of combinations of corn syrup and water, with viscosities ranging from 2 to 2,240 centipoise (cP) were prepared and characterized using a coaxial rotational viscometer. Subjects were presented with two anchor stimuli representing the extremes of the range of viscosities as a basis from which the experimental stimuli were judged. The seven experimental stimuli were randomly presented to each subject 10 times. The accuracy with which the subjects identified the viscosity of the fluid was significant at p < 0.01. The pattern of response was not significantly different across subjects nor gender. There were no differences in performance throughout the duration of the study. The repeat presentation of the anchor points did not significantly affect performance. Further research on oral perception of viscosity, and the processes that mediate changes in swallow physiology resulting from changes in viscosity is required.

Spatial polarization of insulin-like growth factor receptors on the human syncytiotrophoblast

The expression of IGF receptors on the maternal-facing, microvillous membrane (MVM) surface and the fetal-facing, basal membrane (BM) surface of the syncytiotrophoblast was studied using standard ligand binding assays, covalent cross-linking techniques, and immunoblot analysis. Scatchard analysis of [125I]IGF-I and -II binding revealed the presence of both high and low affinity binding sites associated with each membrane preparation that did not clearly distinguish between the two membrane preparations. Cross-linking analysis, however, demonstrated type I and type II IGF receptors associated primarily with MVM, suggesting that nonreceptor binding sites may contribute to total membrane binding. Ligand blot analysis revealed that BM are uniquely associated with 29- and 24-kD IGF binding proteins (IGFBPs). [125I]QAYL-IGF-I, having reduced affinity for IGFBPs, was therefore used to study receptor-specific binding. Approximately 5-fold more type I IGF receptors were shown to be associated with MVM than BM by Scatchard and cross-linking analyses. This was confirmed by immunoblot analysis. By contrast, immunoblot analysis revealed approximately 50-100% more type II IGF receptor protein associated with BM, whereas cross-linking to [125I]IGF-II revealed a MVM predominance. In the presence of 5 mM mannose 6-phosphate, however, a substantial increase in [125I]IGF-II cross-linked to the type II IGF receptor was observed in BM but not MVM consistent with immunoblot analysis. These data demonstrate that type 1 and unoccupied type II IGF receptors are expressed primarily on the maternal-facing. MVM surface of the syncytiotrophoblast.

A survey for torovirus in New Zealand cats with protruding nictitating membranes

Faecal samples from 51 cats were examined by negative stain electron microscopy to investigate a possible association between the syndrome of bilateral protrusion of the nictitating membranes and torovirus infection. Although toroviruses were not observed in any sample, other viruses or virus-like particles were observed in faeces from one of 15 cats with the syndrome, six of 21 cats which had experienced prior episodes of the syndrome and four of 15 healthy control cats. The findings of this study do not support the hypothesis that the syndrome is associated with torovirus infection.

Speciation of arsenic oxides using laser desorption/ionization time-of-flight mass spectrometry

Positive and negative ion mass spectra of arsenic trioxide (As2O3) and arsenic pentaoxide (As2O5) have been obtained by single-step laser desorption/ionization time-of-flight mass spectrometry. Pulsed UV radiation at 266 nm was used for the simultaneous desorption and ionization of the solid sample. High-mass cluster ions that are unique to the oxidation state of each oxide sample appear in the negative ion mass spectra. The As2O3 produces As3O5-, while the As2O5 yields As3O8-. The formation of unique negative cluster ions presents the capability for arsenic oxidation state speciation by laser desorption/ionization mass spectrometry. The ability of time-of-flight mass spectrometry to examine the relative amounts of each arsenic oxide present in a series of mixtures is discussed. Application of our speciation technique to a model incinerator sample is demonstrated.

Mesenteric vasculitis associated with Sézary syndrome

A 71 year old lady with Sézary syndrome presented with chronic diarrhoea and cramping abdominal pains. A small bowel meal x ray examination showed two mid-ileal strictures. At laparotomy the small intestine was found to be sub-acutely obstructed and resection of a 15 cm ileal stricture and stricturoplasty of a second, 10 cm stricture were performed. Histological examination of the stricture revealed a mesenteric vasculitis with secondary ischaemic changes in the small bowel wall. Mesenteric vasculitis causing small bowel stricture may be associated with Sézary syndrome.

Laser desorption/ionization time-of-flight mass spectrometry of nitrated polycyclic aromatic hydrocarbons

Mass spectra of four nitrated polycyclic aromatic hydrocarbons (nitro-PAHs), 9-nitroanthracene, 1-nitropyrene, 2-nitro-9-fluorenone, and 2-nitrofluorene, have been investigated using single-step laser desorption/ionization time-of-flight mass spectrometry. Pulsed UV radiation at 266 or 213 nm was used for desorption and ionization of solid samples deposited on an aluminum probe. The positive molecular ion which was observed for each nitro-PAH was of greater relative intensity when 213 nm radiation was used. A strong [M - NO]+ peak was observed in all spectra, and an intense NO+ signal accompanied the [M - NO]+ signal when 213 nm was used but was only weakly present when 266 nm was used. Comparison of the various spectra suggests that nitro-PAHs undergo an excited state nitro-nitrite rearrangement, followed by loss of NO. Multiphoton ionization of the NO fragment appears to be the principal route of formation of NO+ during laser desorption/ionization when 213 nm radiation is used. The presence of the carbonyl group in 2-nitro-9-fluorenone leads to unique and prominent fragments involving losses of CO from the carbonyl bridge.

Type I insulin-like growth factor receptors in the BeWo choriocarcinoma cell (b30 clone) during cell differentiation

The expression of insulin-like growth factor (IGF) receptors in the differentiating human trophoblast was studied using the b30 clone of the BeWo choriocarcinoma cell line (BeWob30) as a model system. This clonally derived cell line differentiates over 48-72 h, in culture, to form syncytiotrophoblasts when intracellular cAMP levels are elevated by exposure to 100 microM forskolin (FSK). IGF receptors were studied at various times during the differentiation process by measuring the specific binding of [125I]-IGF-I and [125I]-IGF-II to attached cells. First, [125I]-IGF-I bound to a single class of binding sites in the untreated cells (KD approximately 1-2 x 10-10 M) that exhibited binding specificity characteristic of the type I IGF receptor (IGF-I > or = IGF-II > > Insulin). FSK treatment resulted in a two- to threefold increase in the number of these binding sites. Increased receptor expression was observed as early as 24 h after FSK treatment and remained elevated for at least 72 h. Next, [125I]-IGF-II bound to two classes of binding sites in the untreated cells, a high-affinity (KD approximately 2.5 x 10(-10) M), low-capacity site and a low-affinity (KD approximately 6 x 10(-9) M), high-capacity site. The Bmax and KD of the high-affinity site suggested that it represented the type I IGF receptor. Competition studies revealed that 15-20 per cent of total [125I]-IGF-II binding only was sensitive to IGF-I competition in the untreated cells. After FSK treatment, however, unlabelled IGF-I inhibited 60-70 per cent of specific [125I]-IGF-II binding. Scatchard analysis revealed a two- to fourfold increase in the number of both binding sites with no change in their respective binding affinities. Cross-linking analysis demonstrated that [125I]-IGF-II bound to two structurally distinct binding sites in the untreated BeWob30 cell consistent with both the type I and II IGF receptors. After FSK treatment, however, there was an increase in the relative amount of [125I]-IGF-II associated with the higher affinity type I IGF receptor. The BeWob30 cells expressed no insulin receptors at any stage of differentiation. These data demonstrate that the BeWob30 choriocarcinoma cell line expresses both type I and II IGF receptors. Induction of cell differentiation is associated with an increase in type I IGF receptors expressed at the cell surface. These receptors bind IGF-II with high-affinity, providing additional binding capacity for locally available IGF-II. These data are consistent with specific roles for the type I IGF receptor in regulating differentiated trophoblast cell function. Furthermore, the early rise in type I IGF receptor number suggests they may play a regulatory role in the differentiation process itself.

Radioimmunoassay of leptin in human plasma

Recent studies suggest that leptin, the ob gene product absent in ob/ob mice, is a negative regulator of adiposity. We developed an RIA to measure human leptin in plasma or serum. The minimum detectable concentration by the assay is 0.5 microg/L leptin and the limit of linearity is 100 microg/L. Recovery of leptin added to serum was 99-104% over by the linear range of the assay. The RIA agreed reasonably well with rough quantification by Western blot (RIA = 0.90 blot + 3.7 microg/L, Sy/x = 10.9 microg/L). CVs within- and between-run ranged from 3.4% to 8.3% and from 3.6% to 6.2%, respectively. Variation in plasma leptin concentrations in specimens collected on consecutive mornings was large (CVs of 10.9% and 22.5%). After an overnight fast, leptin concentrations were similar to those 1-2 h after 1-2 meals. Plasma leptin concentrations in specimens from 83 lean and obese adults correlated directly with body mass index (BMI; kg/m2): r = 0.72, P <0.001. Correlations were significantly improved by separating results by gender (men r = 0.84, women r = 0.87; p <0.001). The increase in leptin concentrations with increasing BMI was greater in women than in men (slope 2.53 vs 0.97 microg/L per unit BMI, respectively). Leptin concentrations determined in lean subjects (BMI between 18 and 25) were higher in women (7.36 +/- 3.73 microg/L) than in men (3.84 +/- 1.79 microg/L) (P <0.001). Plasma leptin varied little with age and no significant difference was observed between whites and blacks. We conclude that: (a) plasma leptin concentrations are accurately and precisely measured by this new RIA; (b) leptin concentrations vary little due to short-term fasting, age, or race; but (c) plasma leptin concentrations are gender specific.

Radioimmunoassay of leptin in human plasma

Recent studies suggest that leptin, the ob gene product absent in ob/ob mice, is a negative regulator of adiposity. We developed an RIA to measure human leptin in plasma or serum. The minimum detectable concentration by the assay is 0.5 microg/L leptin and the limit of linearity is 100 microg/L. Recovery of leptin added to serum was 99-104% over by the linear range of the assay. The RIA agreed reasonably well with rough quantification by Western blot (RIA = 0.90 blot + 3.7 microg/L, Sy/x = 10.9 microg/L). CVs within- and between-run ranged from 3.4% to 8.3% and from 3.6% to 6.2%, respectively. Variation in plasma leptin concentrations in specimens collected on consecutive mornings was large (CVs of 10.9% and 22.5%). After an overnight fast, leptin concentrations were similar to those 1-2 h after 1-2 meals. Plasma leptin concentrations in specimens from 83 lean and obese adults correlated directly with body mass index (BMI; kg/m2): r = 0.72, P &lt;0.001. Correlations were significantly improved by separating results by gender (men r = 0.84, women r = 0.87; p &lt;0.001). The increase in leptin concentrations with increasing BMI was greater in women than in men (slope 2.53 vs 0.97 microg/L per unit BMI, respectively). Leptin concentrations determined in lean subjects (BMI between 18 and 25) were higher in women (7.36 +/- 3.73 microg/L) than in men (3.84 +/- 1.79 microg/L) (P &lt;0.001). Plasma leptin varied little with age and no significant difference was observed between whites and blacks. We conclude that: (a) plasma leptin concentrations are accurately and precisely measured by this new RIA; (b) leptin concentrations vary little due to short-term fasting, age, or race; but (c) plasma leptin concentrations are gender specific.

Eosinophil infiltration into human skin is antigen-dependent in the late-phase reaction

Eosinophils play a critical role in late-phase reaction allergic inflammatory responses, although the factors responsible for selective tissue eosinophilia are currently ill-defined. To determine whether recruitment of eosinophils is allergen-specific, or a feature of inflammation in allergic individuals, we have examined cutaneous cell infiltrates and endothelial cell adhesion molecule expression in atopic subjects 6 h (n = 8) and 24 h (n = 7) following ultraviolet-B (UVB) irradiation, or intradermal injection of late-phase reaction allergens or diluent control, using standard immunohistochemical techniques. The numbers of eosinophils were increased significantly, when compared to controls, at both 6 h (P < 0.01) and 24 h (P < 0.05), following intradermal allergen challenge, whereas no significant increase in eosinophils was observed following UVB irradiation. UVB and allergen both induced significant increases in neutrophils, monocytes and T cells at 24 h compared to control sites. An increased expression of endothelial cell adhesion molecules, E-selectin and intercellular adhesion molecule-1 (ICAM-1), was observed in both models of inflammation. Vascular cell adhesion molecule-1 (VCAM-1) was induced weakly on some biopsies following allergen, and not at all following UVB. These data indicate that eosinophil infiltration in susceptible individuals is a specific property of allergen. Although this study would support the postulated role of VCAM-1 in selective eosinophil recruitment, given its variable and weak expression, additional factors are likely to be involved.

Functional expression of the plasma membrane serotonin transporter but not the vesicular monoamine transporter in human placental trophoblasts and choriocarcinoma cells

We investigated the functional expression of the plasma membrane serotonin transporter and the vesicular monoamine transporter in choriocarcinoma cells and normal trophoblasts. The RBL 2H3 cells, a rat basophilic leukaemia cell line, which express both transporters were used for comparison. The choriocarcinoma cells JAr and BeWo were found to possess the plasma membrane serotonin transporter as assessed by the presence of serotonin transport activity in intact cells that was Na(+)-dependent and was sensitive to inhibition by tricyclic and non-tricyclic antidepressants. The activity of the vesicular monoamine transporter in these cells was determined by measuring serotonin transport in digitonin-permeabilized cells. The transport in permeabilized cells was very slow, was not stimulated by ATP and was insensitive to inhibition by reserpine. Under similar conditions, the vesicular monoamine transporter activity was demonstrable in RBL cells, which was stimulated by ATP and was inhibitable by reserpine, bafilomycin A1 (an inhibitor of the V-type H(+)-pump) and carbonyl cyanide p-trifluoromethoxy phenylhydrazone (a protonophore which dissipates transmembrane H+ gradients). In corroboration with these findings, mRNA transcripts hybridizable to the vesicular monoamine transporter cDNA probe were detectable in RBL cells but not in JAr choriocarcinoma cells. Similarly, there was no evidence for the expression of the vesicular monoamine transporter as assessed by Northern blot analysis in normal trophoblasts which were maintained in culture to differentiate to form multinucleated syncytial cells. It is concluded that the trophoblasts and choriocarcinoma cells express the plasma membrane serotonin transporter but not the vesicular monoamine transporter.

Endosseous implants for total support and retention of a complete mandibular removable prosthesis

This is a clinical report illustrating and discussing the use of endosseous root-form implants, both anterior and posterior to the mental foramen, in support of three separate Hader bars which in turn provide total occlusal support, resistance, and retention for a conventionally fabricated full mandibular overdenture. Principles of design, advantages, and disadvantages are listed.

Weak extremely-low-frequency magnetic field-induced regeneration anomalies in the planarian Dugesia tigrina

We recently reported that cephalic regeneration in the planarian Dugesia tigrina was significantly delayed in populations exposed continuously to combined parallel DC and AC magnetic fields. This effect was consistent with hypotheses suggesting an underlying resonance phenomenon. We report here, in a parallel series of investigations on the same model system, that the incidence of regeneration anomalies presenting as tumor-like protuberances also increases significantly (P < .001) in association with exposure to weak 60 Hz magnetic fields, with peak intensities ranging between 1.0 and 80.0 microT. These anomalies often culminate in the complete disaggregation of the organism. Similar to regeneration rate effects, the incidence of regeneration anomalies is specifically dependent upon the planaria possessing a fixed orientation with respect to the applied magnetic field vectors. However, unlike the regeneration rate effects, the AC magnetic field alone, in the absence of any measurable DC field, is capable of producing these anomalies. Moreover, the incidence of regeneration anomalies follows a clear dose-response relationship as a function of AC magnetic field intensity, with the threshold for induced electric field intensity estimated at 5 microV/m. The addition of either 51.1 or 78.4 microT DC magnetic fields, applied in parallel combination with the AC field, enhances the appearance of anomalies relative to the 60 Hz AC field alone, but only at certain AC field intensities. Thus, whereas our previous study of regeneration rate effects appeared to involve exclusively resonance interactions, the regeneration anomalies reported here appear to result primarily from Faraday induction coupling. These results together with those reported previously point to two distinct physiological effects produced in regenerating planaria by exposure to weak extremely-low-frequency (ELF) magnetic fields. They further suggest that the planarian, which has recently been identified elsewhere as an excellent system for use in teratogenic investigations involving chemical teratogens, might be used similarly in teratogenic investigations involving ELF magnetic fields.

Mast cell number and phenotype in chronic idiopathic urticaria

BACKGROUND

Increased levels of histamine have been previously demonstrated in patients with chronic idiopathic urticaria.

OBJECTIVE

The purpose of the study was to determine whether increased numbers of mast cells are present in lesional skin from such patients.

METHODS

Mast cells have been quantified in lesional (n = 11) and nonlesional (n = 9) skin from patients with chronic idiopathic urticaria and compared with site-matched skin from healthy control subjects (n = 10). Mast cells were identified by using a sensitive, double-labeling immunohistochemical technique with specific monoclonal antibodies to mast cell tryptase and chymase and quantified under light microscopy.

RESULTS

No significant differences in mast cell numbers from lesional, nonlesional, or control skin were observed (p > 0.1, Student's t test). In both patients with urticaria and control subjects, more than 99% of cutaneous mast cells contained tryptase and chymase.

CONCLUSIONS

These data indicate that increased skin histamine in chronic idiopathic urticaria is not caused by increased mast cells and may alternatively reflect an increase in histamine content per mast cell, enhanced mast cell activation, or recruitment of basophils into skin in patients with chronic idiopathic urticaria.

A new digoxin immunoassay substantially free of interference by digoxin immunoreactive factor

We have evaluated the new Roche digoxin "On Line" procedure for use in a pediatric population with particular interest in the potential for interference by digoxin-like immunoreactive factor (DLIF). An initial study comparing digoxin values obtained with the new Roche procedure with determinations on an Abbott TDx, American Dade Stratus, and COBAS-FARA using Microgenics Cedia reagents, found good correlations with these established methods. The Roche method was suitably precise and utilized either serum or plasma. Interference by DLIF was assessed by analyzing specimens from patients not receiving digoxin but likely to contain DLIF, with the argument that non-zero values represent cross-reactivity of anti-digoxin antibodies with DLIF endogenous to these specimens. When specimens from neonates, women with second/third trimester pregnancies, and patients with renal and liver failure were assayed with the Roche, Stratus, and TDx methods, all three methods measured DLIF in some specimens, but the Roche method possessed the lowest overall DLIF interference. The modest extent of DLIF interference and the requirement of a small amount of specimen make the Roche method superior in monitoring digoxin in a pediatric population.

Lysine uptake by human placental microvillous membrane: comparison of system y+ with basal membrane

Transport of lysine by microvillous membranes was investigated by characterization of L-[3H]lysine uptake in membrane vesicles isolated from human placentas. At least one Na(+)-independent system was observed at 22 degrees C and two systems at 37 degrees C. Lysine concentration dependence data were fit by a one- or two-system model with a Michaelis-Menten constant (Km) of 124 +/- 28 microM and a maximum velocity (Vmax) of 33.1 +/- 7.7 pmol.mg protein-1.min-1 at 22 degrees C and with Km values of 1 +/- 0.6 and 245 +/- 51 microM and Vmax values of 0.14 +/- 0.07 and 45.8 +/- 8.7 pmol.mg protein-1.30 s-1 at 37 degrees C. In the presence of N-ethylmaleimide, the uptake (37 degrees C) data were fit by a one-system model with kinetic parameters similar to the lower Km system. Uptake of L-lysine in the absence of Na+ was inhibited completely by L-arginine, L-histidine, and L-homoarginine. In the presence of Na+, uptake was inhibited completely by these same three amino acids and L-leucine but only partially by other neutral amino acids. To compare directly microvillous and basal membrane from the same placenta, we examined the inhibition of 20 microM lysine uptake in the presence of Na+. Inhibition by L-leucine was similar in the two membranes. However, L-homoserine, L-alanine, and L-phenylalanine over a wide concentration range inhibited substantially less in microvillous (at both temperatures) than in basal membrane.(ABSTRACT TRUNCATED AT 250 WORDS)

Diffuse plane xanthomatosis and acquired palmoplantar keratoderma in association with myeloma

We report a patient with diffuse plane xanthomatosis, acquired palmoplantar keratoderma, and myeloma. Although diffuse plane xanthomatosis is a recognized manifestation of paraproteinaemia, keratoderma is not. However, successful treatment of the myeloma in our patient coincided with a dramatic improvement in the keratoderma, suggesting a genuine association between the two disorders.

Analytical artifacts in hematocrit measurements by whole-blood chemistry analyzers

Compact analyzers suited to near-patient testing estimate hematocrit by measuring the conductivity of undiluted blood. We evaluated the accuracy of hematocrit determination of one such analyzer (Instrumentation Laboratory BGE analyzer) against an automated cell counter (EPC) and packed cell volume (PCV) microhematocrit. When specimens (n = 34) from outpatient and ward patients were analyzed with all three methods, the BGE analyzer correlated well with both EPC and PCV hematocrit determinations (BGE = 1.00 PCV + 0.3%, S(y)/x = 2.0%), suggesting that all three methods are similar in performance for most patients. However, a patient with increased plasma osmolality showed significant decreases in BGE and PCV hematocrits relative to the EPC method. The differences in hematocrit measurements could be reproduced by adding solutes to blood in vitro or by modifying the plasma osmolality of rats in vivo. Samples from patients undergoing cardiac surgery, whose blood had large changes in protein concentration, showed discrepancies between hematocrits by conductivity and other methods; similar effects could be produced by changes in protein concentration or in vitro addition of polyethylene glycol. We conclude that conductivity measurements provide accurate hematocrit results for physiologically normal subjects but not for some intensive-care and surgical patients.

Analytical artifacts in hematocrit measurements by whole-blood chemistry analyzers

Compact analyzers suited to near-patient testing estimate hematocrit by measuring the conductivity of undiluted blood. We evaluated the accuracy of hematocrit determination of one such analyzer (Instrumentation Laboratory BGE analyzer) against an automated cell counter (EPC) and packed cell volume (PCV) microhematocrit. When specimens (n = 34) from outpatient and ward patients were analyzed with all three methods, the BGE analyzer correlated well with both EPC and PCV hematocrit determinations (BGE = 1.00 PCV + 0.3%, S(y)/x = 2.0%), suggesting that all three methods are similar in performance for most patients. However, a patient with increased plasma osmolality showed significant decreases in BGE and PCV hematocrits relative to the EPC method. The differences in hematocrit measurements could be reproduced by adding solutes to blood in vitro or by modifying the plasma osmolality of rats in vivo. Samples from patients undergoing cardiac surgery, whose blood had large changes in protein concentration, showed discrepancies between hematocrits by conductivity and other methods; similar effects could be produced by changes in protein concentration or in vitro addition of polyethylene glycol. We conclude that conductivity measurements provide accurate hematocrit results for physiologically normal subjects but not for some intensive-care and surgical patients.

Weak extremely-low-frequency magnetic fields and regeneration in the planarian Dugesia tigrina

Extremely-low-frequency (ELF), low-intensity magnetic fields have been shown to influence cell signaling processes in a variety of systems, both in vivo and in vitro. Similar effects have been demonstrated for nervous system development and neurite outgrowth. We report that regeneration in planaria, which incorporates many of these processes, is also affected by ELF magnetic fields. The rate of cephalic regeneration, reflected by the mean regeneration time (MRT), for planaria populations regenerating under continuous exposure to combined DC (78.4 muT) and AC (60.0 Hz at 10.0 muTpeak) magnetic fields applied in parallel was found to be significantly delayed (P << 0.001) by 48 +/- 1 h relative to two different types of control populations (MRT approximately 140 +/- 12 h). One control population was exposed to only the AC component of this field combination, while the other experienced only the ambient geomagnetic field. All measurements were conducted in a low-gradient, low-noise magnetics laboratory under well-maintained temperature conditions. This delay in regeneration was shown to be dependent on the planaria having a fixed orientation with respect to the magnetic field vectors. Results also indicate that this orientation-dependent transduction process does not result from Faraday induction but is consistent with a Ca2+ cyclotron resonance mechanism. Data interpretation also permits the tentative conclusion that the effect results from an inhibition of events at an early stage in the regeneration process before the onset of proliferation and differentiation.

A new plastic evacuated tube with plasma separator

A new plastic-walled, evacuated blood collection tube (Terumo Venoject II) with plasma separator was evaluated for characteristics related to the use of plastic in place of glass. Plastic tubes were highly resistant to breakage through handling mishaps or failure during centrifugation. Higher centrifugation speed (13,600g) was well tolerated, and centrifugation times as short as 3 minutes at 13,600g effectively cleared plasma of cellular components, at high plasma yield. Plastic tubes were nearly completely combustible under incineration conditions commonly used for medical waste, and plastic tubes effectively retained vacuum during the typical shelf life of evacuated blood collection tubes. Collection of carbamezepine specimens in plastic tubes decreased levels an average of 6.8% compared to a heparinized glass tube control under conditions approximating routine use; levels of other drugs (phenytoin, phenobarbital, valproic acid, theophylline, and cyclosporine) were less significantly affected. This modest decrease appeared to result from a combination of an immediate interaction with the plastic surface of the tubes and a time-dependent interaction with the olefin-based separator. Modest but clear benefits, including reduction in specimen breakage, reduced centrifugation time and reduced solid waste after incineration derive from the use of plastic in place of glass in evacuated blood collection tubes.

Low-vision consultants: an innovative approach

1. There is a growing population of persons suffering from visual impairments, and their needs must be addressed as their numbers increase. 2. Professionals in the field of ophthalmology have an obligation to meet the challenge of an increasing population of visually impaired persons by offering comprehensive service delivery to their patients. 3. The development of the low-vision consultant has yielded very positive results in the physical, psychological, and social rehabilitation of visually impaired patients.

Detection of autoantibodies to amylase by ELISA: comparison of detection of macroamylase and free autoantibody

New ELISAs for detecting macroamylase or free autoantibodies to amylase were tested with 48 samples that had been characterized by gel chromatography and electrophoresis. The macroamylase ELISA, with anti-IgG or anti-IgA for detection, detected macroamylase in 28 of 33 samples known to contain macroamylase (85% sensitivity), whereas the ELISA for free autoantibody to amylase was positive for only 11 samples. Specificities of both ELISAs were 93%. Among 28 true positives detected with the macroamylase ELISA, 22 contained IgA, 3 contained IgG, and 3 contained both immunoglobulins. Detection of IgM added no true positives. ELISA responses (y) were proportional to log [macroamylase concentration by chromatography (x)] from 0 to 1200 U/L: y = 5.15 x + 1.66; r = 0.72; Sy x = 1.65. As new tools for detecting macroenzymes consisting of enzyme-autoantibody complexes, the ELISAs show that some autoantibodies are detected more sensitively as antibody-antigen complexes than as free antibody.

Functional characterization of L-alanine transport in a placental choriocarcinoma cell line (BeWo)

The substrate selectivity of the neutral amino acid transport systems of the b30 clone of the choriocarcinoma cell line (BeWo) were characterized. Three transport systems were identified in undifferentiated (without forskolin) and two transport systems in differentiated syncytial cells (with forskolin). In the undifferentiated b30 cells were two sodium-dependent systems with one having substrate selectivity patterns resembling system A (e.g. sensitive to MeAIB and a broad range of neutral amino acids) and the other resembling system ASC (e.g. MeAIB insensitive and inhibited by alanine, serine and cysteine). In addition a sodium-independent system was identified with characteristics resembling system l. The differentiated syncytial cells possessed the system A and system l-like activities but not the system ASC-like activity of the system A-like or system l-like activities. The b30 clone is apparently an appropriate model for placental neutral amino acid transport systems.

Detection of autoantibodies to amylase by ELISA: comparison of detection of macroamylase and free autoantibody

New ELISAs for detecting macroamylase or free autoantibodies to amylase were tested with 48 samples that had been characterized by gel chromatography and electrophoresis. The macroamylase ELISA, with anti-IgG or anti-IgA for detection, detected macroamylase in 28 of 33 samples known to contain macroamylase (85% sensitivity), whereas the ELISA for free autoantibody to amylase was positive for only 11 samples. Specificities of both ELISAs were 93%. Among 28 true positives detected with the macroamylase ELISA, 22 contained IgA, 3 contained IgG, and 3 contained both immunoglobulins. Detection of IgM added no true positives. ELISA responses (y) were proportional to log [macroamylase concentration by chromatography (x)] from 0 to 1200 U/L: y = 5.15 x + 1.66; r = 0.72; Sy x = 1.65. As new tools for detecting macroenzymes consisting of enzyme-autoantibody complexes, the ELISAs show that some autoantibodies are detected more sensitively as antibody-antigen complexes than as free antibody.

Na+/Ca2+ exchange, Ca2+ binding, and electrogenic Ca2+ transport in plasma membranes of human placental syncytiotrophoblast

To transfer a large amount of Ca2+ to the fetus, the basal (fetal-facing) plasma membrane (BPM) of human placenta must be equipped with various extrusion mechanisms. We studied one such mechanism, Na+/Ca2+ exchange, as well as related membrane potential effects and binding properties of the two membranes. Na+/Ca2+ exchange was present in BPM and absent in microvillous (maternal-facing) membrane. Uptake and efflux of Ca2+ in BPM were enhanced by Na+ when it was present on the opposite side of the membranes. Na(+)-gradient-dependent Ca2+ uptake was saturable with a Km of 19 microM and a Vmax of 0.8 nmol/min/mg. The Na+/Ca2+ exchange in BPM and the facilitated diffusion transporters in both BPM and microvillous membrane are electrogenic processes. Ca2+ binding in both BPM and microvillous membrane was affected by various monovalent cations and enhanced by Na+ more than by K+. In vivo, together with other sequestration mechanisms, Na+/Ca2+ exchange may play an important role in transsyncytial transfer and in regulating intracellular Ca2+, which is essential for a variety of physiologic mechanisms.

Selective expression of the high-affinity isoform of the folate receptor (FR-alpha) in the human placental syncytiotrophoblast and choriocarcinoma cells

The folate receptor (FR), an essential component in the process of folate uptake in various cells, is known to exist in three isoforms, FR-alpha, FR-beta and FR-gamma, with differential tissue expression. Transfer of folate across the human placenta from mother to fetus involves participation of a folate receptor expressed in the syncytiotrophoblast, but the isoform identity of this receptor has not been established. Based on the tissue/cell type from which these isoforms have been cloned, it is currently believed that FR-alpha is the isoform expressed in adult tissues whereas FR-beta is the isoform expressed in fetal tissues including placenta. The present study, undertaken primarily to establish the isoform identity of the FR expressed in the placental syncytiotrophoblast, does not support this currently prevailing nomenclature. Reverse transcription coupled with polymerase chain reaction (RT-PCR) of total/poly(A)+ RNA from placenta, cultured trophoblast cells and JAR choriocarcinoma cells with primer pairs specific for either FR-alpha or FR-beta reveals that while both isoforms are detectable in the whole placental tissue, only FR-alpha is present in the normal trophoblast cells and in the choriocarcinoma cells. Northern analysis with probes designed to distinguish between the mRNA transcripts coding for these two isoforms corroborate the RT-PCR findings. Furthermore, the nucleotide sequences of the PCR products obtained from the trophoblast cells and JAR cells are identical to the nucleotide sequence of the FR-alpha cDNA. These studies establish that it is the FR-alpha isoform, and not the FR-beta isoform, which is selectively expressed in the placental trophoblast cells. FR-beta, which is known to be present in the placenta, most likely arises from the maternal decidua normally associated with this tissue.

Glutamate oxidation by trophoblasts in vitro

Catabolism of uniformly and 1-14C-labeled glutamate was investigated in human placental cytotrophoblasts and syncytiotrophoblasts cultured on uncoated plastic or a fibrin matrix. Product-labeling experiments resulted in 14C incorporation into carbon dioxide and tricarboxylic acid cycle intermediates. 14C incorporation above background was not detected for the putative products, glutamine, amino acids, glutathione, and protein. Inhibitors of specific metabolic pathways were used to elucidate the routes of glutamate oxidation. Incorporation of 14C into carbon dioxide from [1-14C]glutamate was inhibited by the glutamate dehydrogenase inhibitor pyridine-2,6-dicarboxylic acid and aminotransferase inhibitor aminooxyacetic acid. Production of 14CO2 was higher for syncytiotrophoblast compared with cytotrophoblast and for cells on uncoated plastic compared with a fibrin matrix. Oxidation of glutamate was unaffected by added glutamine as high as 2 mM. The primary route of glutamate metabolism by placental trophoblast in vitro is oxidation to carbon dioxide utilizing both the transferase and deamination pathways.