Test of an educational brochure on advance directives designed for well-elderly people

The aim of this study was to test an advance directive brochure designed especially for well-elderly people. The brochure was developed using information from literature on preparing educational materials and from information gained from well-elderly focus groups. The information sought was in regard to what they knew and what they wanted to know about advance directives and what they found appealing in brochures on advance directives. Twenty well-elderly people participated in the study. Prior to data collection, the brochure was given to 10 nurses who were asked to evaluate it according to the Bernier Instructional Design Scale 2. Out of a possible 280 points, the brochure received 244. The participants in the study were asked to read the brochure and answer 15 questions about the content, user friendliness, and attractiveness of the brochure. The overall results were positive. The first five questions had to do with the appearance of the brochure. All 20 participants responded favorably to these questions. The next 10 questions had to do with understanding the content. A simple percentage was used to calculate the results. The participants understood 90.5% of the content. Based on these results, the brochure should be used in future intervention research and in discussions regarding the education of well-elderly people and the drafting of advance directives.

The cytotoxicity of copper(II) complexes of 2-acetyl-pyridyl-4N-substituted thiosemicarbazones

A series of 2-acetyl-pyridyl-4N-substituted thiosemicarbazones copper(II) complexes was evaluated for their cytotoxic mode of action in a variety of human and rodent tumor cell cultures. It was determined that these compounds may induce cytotoxicity by affecting several metabolic pathways including a reduction in de novo purine synthesis, and inhibition of IMP dehydrogenase, and DNA polymerase alpha activities. Selected compounds also demonstrated the ability to inhibit L1210 DNA topoisomerase II activity at micromolar concentrations. These agents were able to antagonize etoposide-induced formation of cleavable complexes as measured by K+/SDS precipitation and in vitro cleavage reactions.

In vitro evaluation of combination chemotherapy against human tumor cells (Review)

Combination therapy with multiple drugs or with multiple modalities is common practice in the treatment of cancer. The purpose of using drugs in combinations is to increase the therapeutic efficacy, decrease toxicity toward the host and minimize or delay the development of drug resistance. Presently used clinical protocols for cancer combination therapy are mainly obtained empirically or from clinical trials. Accumulation of experience from clinical trials is invaluable but is a slow and expensive process. Also, due to heterogeneous patient populations exposed to different environments, human clinical data frequently cannot be used for quantitative synergy determinations. Therefore, in vitro quantitative drug combination studies with cultured tumor cells are becoming imperative either as prospective studies or as adjuvant assessment for combination therapy. In recent years, a variety of in vitro assays have been developed to examine cytotoxicity or biochemical effects of drugs on cultured tumor cells. These methods can, not only quickly predict the potential therapeutic effects of the combined agents, but also provide the information or clues to the possible mechanisms of drug interactions. In addition, with the better understanding of various antineoplastic drugs and the development of new technologies to characterize actions of the drugs, the in vitro study of combination therapy is no longer limited to the measurement of cytotoxic effects. Instead, many other studies, such as cell cycle analyses, detection of apoptosis and biochemical analyses of drug interactions have also become common methods for the in vitro evaluation of combination drug therapy.

Station 16.3: a high-resolution single-crystal diffraction facility at the SRS, Daresbury

SRS station 16.3 is now a fully scheduled user facility for high-resolution and high-energy single-crystal X-ray diffraction. It is based on a large three-axis diffractometer, designed and constructed at Daresbury for a wide range of physics and materials science applications. Served by wiggler 16 (a 6 T superconducting wavelength-shifter), the station has access to a broad spectrum of photon energies, extending to over 50 keV, and is designed for simple polarization-state tuning by motorized height adjustment of all optical components. This paper outlines the key design features and some of the science projects carried out during the first year of operation.

The role of biopsy pathology, quantitative nuclear morphometry, and biomarkers in the preoperative prediction of prostate cancer staging and prognosis

The focus of this review is to survey pretreatment biopsy and patient-derived information applicable to predicting pathological stage and prognosis of men with a diagnosis of prostate cancer. Various sources of clinical and pathological information that may contribute to building decision support tools (DSTs) for application by the urologist to manage prostate cancer patients are presented. These DSTs use serum biomarkers and objective, well-established, pathology information extracted by experienced pathologists from needle-core tissue samples that describe tumor size, grade, and location. Other valuable data can be derived from the biopsy tissue, such as computer-assisted image cytometry-derived DNA ploidy and nuclear morphometry informatics, as well as select tissue biomarker results that may provide supplemental prognostic information. Also discussed are the technical and clinical limitations of these DSTs with respect to the prediction accuracy. A commercially available pretreatment prediction algorithm (UroScore, Oklahoma City, OK) was applied to predict the disease organ confinement status of the prostate cancer test case. Finally, the authors present existing and future applications of computer-derived computational solutions for incorporating all patient history, clinical laboratory, and pathology information into algorithms that can generate patient-specific predictive probability estimates of stage, recurrence, and progression.

Talisman or taboo: the controversy of the suicide-prevention contract

The suicide-prevention contract is a widely used but overvalued clinical and risk-management technique. The scant information on this topic in the psychiatric and mental health literature is reviewed, along with the literature on collateral subjects including suicide prediction, medicolegal aspects of treating suicidal patients, the therapeutic alliance, and countertransference with suicidal patients. A group of 112 psychiatrists and psychologists was surveyed about their use of suicide-prevention contracts; the majority of them had never received any formal training on the topic. A combination of factors--the unpredictability of suicide, the many different antecedents to completed suicides, the complex psychological reactions of clinicians (including fear of litigation), the incongruity between clinical and legal usages of the contract concept, and the hazards that come of collapsing a complex treatment process into a few words--limit the applicability of suicide-prevention contracts. We reason that the use of these contracts is based upon subjective belief rather than on objective data or formal training. We recommend an alternative approach to suicide risk management rooted in the well-known and well-defined principles of informed consent.

Effects of alkyl amine carboxyboranes on L1210 DNA fragmentation and nucleic acid metabolism

Amine-carboxyboranes with varying alkyl chain lengths were observed to be potent cytotoxic agents inhibiting the growth of a number of histological types of murine, rat, and human tumors. These agents preferentially reduced L1210 DNA synthesis with marked inhibition of the activities of regulatory enzymes of the purine pathway. Other enzyme activities which were marginally reduced were DNA polymerase alpha, ribonucleoside reductase, dihydrofolate reductase, t-RNA polymerase, and nucleoside kinases. Pyrimidine nucleotide pools were not reduced but DNA strand scission occurred after 24 h incubation with the agents. The amine-carboxyboranes were not DNA topoisomerase II inhibitors at 100 microM. The agents did not cause DNA protein linked breaks themselves; nevertheless, VP-16 [etoposide] induced DNA protein linked breaks were increased two fold in the presence of the agents suggesting synergistic effects. The amine-carboxyboranes decreased protein kinase C mediated phosphorylation of L1210 topoisomerase II protein, potentially decreasing its enzymatic catalytic activity. Thus, the amine-carboxyboranes did not function like VP-16 in affording cleavable products but were synergistic with VP-16 in causing DNA fragmentation. The agents were also additive with VP-16 in reducing tumor cell number, soft-agar colony growth and DNA synthesis and in producing DNA strand scission.

The cytotoxicity of 2-formyl and 2-acetyl-(6-picolyl)-4N-substituted thiosemicarbazones and their copper(II) complexes

2-Acetyl-(6-picolyl)-4N-substituted thiosemicarbazones and their copper(II) complexes were shown to be potent antineoplastic and cytotoxic agents against murine and human cultured cells. Numerous derivatives were as active against solid tumor growth as clinically useful agents. The agents inhibited L1210 DNA and RNA syntheses with inhibition of key regulatory enzyme activities of the purine pathway as well as nucleoside kinase activities. d[NTP] pools were reduced and DNA strand scission occurred. These agents were DNA topoisomerase II inhibitors with lower IC50 values than that of VP-16. However, they did not cause L1210 DNA protein linked breaks and actually protected against those breaks afforded by VP-16. The agents were not synergistic with VP-16 in reducing cell growth or DNA synthesis although they did reduce growth of L1210 cells in agar suspended media.

The role of high technology in maintaining esthetic restorations

Computer technology has revolutionized the way the world does business, allowing us to work faster, smarter, and more efficiently than ever before. Within dentistry, that translates to x-rays that use significantly smaller amounts of ionizing radiation, automated periodontal charting and storage devices, and imaging systems. Perhaps the greatest bottom-line benefit, especially in esthetic dentistry, is that these state-of-the-art developments enable dentists and hygienists to more effectively communicate with patients. The future of any restoration is based on the patient's motivation and ability to maintain an efficient oral hygiene routine. Esthetic restorations demand more vigorous home care programs to maximize their esthetic and functional life expectancy. With computerized images on screen, patients can better visualize the treatment that has been done and come to a realization that the restoration's success rests squarely on their shoulders.

Observations on pathology trends in 62,537 prostate biopsies obtained from urology private practices in the United States

OBJECTIVES

To evaluate pathology trends of 62,537 first-time prostate needle-core biopsies submitted by office-based urologists, processed at a single pathology laboratory.

METHODS

Prostate biopsy cases obtained over a 2-year period were assessed. Patient information included age, digital rectal examination (DRE) status, and prostate-specific antigen (PSA) serum levels. Biopsy pathology results included the number of tissue samples per case, Gleason score, presence of Gleason grades 4 or 5, percent of biopsy length with evidence of cancer, number of samples with cancer per biopsy, and determination of DNA ploidy status using microspectrophotometry.

RESULTS

Adenocarcinoma, suspicious lesions, and isolated high-grade prostatic intraepithelial neoplasia (PIN) were diagnosed in 38.3%, 2.9%, and 4.1% of the biopsies, respectively. For each serum PSA and age range assessed, the positive biopsy rate and incidence of critical pathologic features increased consistently. The average percentage of biopsy length with evidence of tumor, the percentage of cases with Gleason grades 4 or 5, and the percentage of cases with an abnormal DNA ploidy all decreased significantly over the 2-year period (P <0.01).

CONCLUSIONS

The number of tissue cores and anatomic sites (locations) being sampled per biopsy are increasing. The tumor size detected and percentage of cases with Gleason grades 4 and 5 are decreasing. There has been a slight increase in the number of biopsies performed on men younger than 60 years of age and a slight decrease in biopsies performed on men older than 70 years of age. The decline in meaningful pathologic features observed in biopsies over time may be clinically relevant to improved disease management.

Feeding behavior of black fly larvae and retention of fine particulate organic matter in a high-gradient blackwater stream

We studied the feeding behavior of black fly larvae and aspects of fine particulate organic matter (FPOM) retention in four riffles in a high-gradient blackwater stream in northeastern Minnesota, U.S.A., using fluorescent particulate dyes as tracers of FPOM. Radiant Red and Radiant Deep Green dye particles were added sequentially to the stream above the upper riffle during two sequential 10-min pulses separated by a 5-min interval with no dye addition. Gut analyses showed that green particles were ingested progressively more at downstream riffles well after the dye pulse had passed, but red particles showed the opposite pattern. Samples of Cladophora sp. collected at the same intervals showed that green dye particles were preferentially retained over red ones by filamentous algae, and thus would have been more available than red particles to larvae functioning as collector-gatherers. Our work strongly suggests that collector-gatherer behavior, in addition to collector-filterer behavior, is important for obtaining very fine particles by larval black flies. Our work also shows that although fluorescent dye particles are useful tracers of very fine particulate organic matter for feeding studies, the two similar-sized but different-colored particles used in this study behaved differently in terms of retention on Cladophora sp. By analogy, other similar-sized FPOM, which would be more heterogeneous chemically and physically than the dye particles, might also be expected to exhibit diverse behavior, affecting its availability to consumers.

Value of computer-assisted quantitative nuclear grading in differentiation of normal urothelial cells from low and high grade transitional cell carcinoma

OBJECTIVE

To evaluate the ability of computer-assisted quantitative nuclear grading (QNG) using a microspectrophotometer and morphometry software to differentiate Feulgen-stained nuclei captured from normal urothelium, low grade transitional cell carcinoma (LG-TCC) and high grade transitional cell carcinoma (HG-TCC) cytology specimens.

STUDY DESIGN

Feulgen-stained nuclei from a series of normal volunteers (urologic disease-free history) and from biopsy-confirmed cases of LG-TCC and HG-TCC were evaluated using a CAS-200 image analysis system. Thirty-eight nuclear morphometric descriptors (NMDs) were measured for each nucleus using a software conversion system. Backwards stepwise logistic regression analysis was applied to assess which of the NMDs contributed to QNG statistical models that could differentiate between nuclei from normals vs. LG-TCC, normals vs. HG-TCC, and LG-TCC vs. HG-TCC. Receiver operating characteristic curves and areas under the curve (AUC), as well as cell classification accuracy, were used to assess these differences.

RESULTS

Statistically significant differences (P < .0001) were observed between all three categories. In the LG-TCC vs. normals, the QNG solution model required 16/38 features, with an AUC = 93%, a sensitivity = 85%, specificity = 86%, positive predictive value (PPV) = 87% and negative predictive value (NPV) = 84%. The QNG solution model for normals vs. HG-TCC required 12/38 nuclear features yielding an AUC = 99%, sensitivity = 99%, specificity = 98%, PPV = 98% and NPV = 99%. The QNG solution model for LG-TCC vs. HG-TCC required 17/38 nuclear features, with an AUC = 99%, sensitivity = 96%, specificity = 97%, PPV = 97% and NPV = 96%.

CONCLUSION

Computer-assisted QNG cell classifiers based upon the measurement of 38 nuclear features, including size, shape and chromatin organization, are capable of differentiating normal urothelial nuclei from LG-TCC and HG-TCC nuclei as well as LG-TCC from HG-TCC nuclei. The QNG cell classifier has shown conclusively that there are morphometric differences between normal urothelial and LG-TCC nuclei that may not be apparent to the naked eye and that it may be useful in helping the pathologist determine the presence or absence of LG-TCC in bladder cytology specimens.

Comparative analysis of DNA content in polyomavirus-infected urothelial cells, urothelial dysplasia and high grade transitional cell carcinoma

OBJECTIVE

To characterize the DNA content pattern in cytologically confirmed polyomavirus (PV)-infected urothelial cells and to compare it with DNA ploidy changes in cytologically diagnosed urothelial dysplasia and high grade transitional cell carcinoma.

STUDY DESIGN

We selected 200 bladder cytology specimens consisting of four groups with 50 patients each in the following cytologic categories: (1) no evidence of malignancy or dysplasia (controls), (2) PV, (3) urothelial dysplasia (UD), and (4) high grade transitional cell carcinoma (TCC-HG). For each case, two slides with 25-mm filter imprints were stained, one using the Papanicolaou method and the other using the Feulgen staining method. The DNA index (DI), proliferative activity (S + G2M) and degree of hyperploidy (> 5C) were evaluated using an image analysis system.

RESULTS

Using the Wilcoxon rank-sum test, statistically significant differences in the DI were found between the PV and UD groups (P = .008) and between the PV and TCC-HG groups (P < .0001). There was no significant difference in the DI between the PV and control groups. The S + G2M fraction for the PV group significantly differed from the control, UD and TCC-HG groups (all P < .0001). Between all four groups, the degrees of hyperploidy were significantly different as well (all P < .0001).

CONCLUSION

Cytologically confirmed PV-infected urothelial cells demonstrated a unique DNA content pattern with mildly elevated proliferative activity and a significantly dispersed hyperploid DNA content pattern. DNA analysis can help to differentiate PV infection from dysplasia and high grade carcinoma.

5-Fluorouracil interferes with paclitaxel cytotoxicity against human solid tumor cells

Paclitaxel, a naturally occurring antimitotic agent, has shown efficacy in the treatment of certain solid tumors, particularly metastatic breast carcinoma and drug-refractory ovarian cancers. Recent studies have demonstrated that paclitaxel, in addition to its effects on microtubules and cell cycle arrest, possesses significant cell-killing activity in solid tumor cells by the induction of apoptosis. However, the mechanism by which paclitaxel leads to cell death and its relationship with paclitaxel-induced mitotic arrest is presently unclear. In this study, we attempted to determine whether pre-arresting tumor cells at other phases of the cell cycle could affect paclitaxel-induced apoptosis. We found that 5-fluorouracil (5-FU), another antineoplastic agent that usually arrests tumor cells at the G1-S phase of the cell cycle, could significantly repress the cell-killing activity of paclitaxel in solid tumor cells, even when it was added simultaneously with paclitaxel. Further studies indicated that 5-FU actually inhibits the cytotoxic effects of paclitaxel on both mitotic arrest and apoptotic cell death, suggesting that 5-FU might interfere with paclitaxel cytotoxicity at an early stage, probably by preventing tumor cells from entering G2-M phase. Because recent clinical trials have used a combination of paclitaxel and 5-FU in the treatment of metastatic breast cancers, our results also suggest that the combination of these two drugs might not be as valuable in clinical chemotherapy.

Synthesis and antitumor activity of boronated dipeptides containing aromatic amino acids

N-[(Trimethylamine-boryl-carbonyl]-L-tryptophan methyl ester and N[(trimethylamine-boryl)-carbonyl]-L-histidine methyl ester were obtained by synthesis using triphenyl-phosphine/carbon tetrachloride or dicyclohexyl-carbodiimide as coupling agents, respectively. Both agents reduced L1210 lymphoid leukemia DNA, RNA, and protein syntheses with the largest reductions occurring in DNA synthesis. Reductions in DNA synthesis appear to be mediated by inhibition of key enzyme activities (i.e., DNA polymerase a, IMP dehydrogenase, and PRPP amido transferase). These agents had little effect on in vitro L1210 DNA topoisomerase II activity at 100 microM but were able to cause synergistic increases in protein-linked DNA breaks when combined with etoposide (VP16). It was shown that these agents significantly reduced protein kinase C mediated phosphorylation of human topoisomerase II in vitro. Thus, inhibition of topoisomerase II phosphorylation may be a mechanism by which these agents and VP-16 are synergistic in causing protein-linked DNA breaks.

Update on the appropriate staging evaluation for newly diagnosed prostate cancer

PURPOSE

Prostate cancer clinical staging methods and decision support tools were reviewed to assess their accuracy to predict pathological staging results and determine what comprises an appropriate clinical staging evaluation.

MATERIALS AND METHODS

The MEDLINE data base was searched and 238 abstracts were obtained. Data were extracted from 142 articles that evaluated the preoperative accuracy of digital rectal examination, prostate specific antigen, prostatic acid phosphatase, systematic biopsy parameters (including Gleason scoring), seminal vesicle biopsy, various imaging studies and pelvic lymphadenectomy versus pathological staging results. The sensitivity, specificity and accuracy rates were calculated and tabulated from the reported data on each method or decision support tools for organ confined, nonorgan confined and lymph node metastatic tumor.

RESULTS

Decision support tools based on logistic regression analysis, which combine several statistically independent staging parameters, had greater accuracy than any single clinical staging method alone. The most accurate decision support tools for clinical staging combined digital rectal examination (T stage), systematic biopsy parameters (including Gleason scoring) and prostate specific antigen.

CONCLUSIONS

The components that comprise the most accurate decision support tools for clinical staging represent an appropriate staging evaluation for the newly diagnosed prostate cancer patient in 1997. Limited use of radiographic imaging and seminal vesicle biopsy may be indicated in select patients to detect bone metastases, and plan pelvic lymphadenectomy and surgical therapy.

The effect of sudden inversion stress on EMG activity of the peroneal and tibialis anterior muscles in the chronically unstable ankle

Residual symptoms resulting from recurrent episodes of inversion-type ankle sprains may be attributed to a decreased neuromuscular response of the peroneal or tibialis anterior muscles, thereby increasing the probability for reinjury. The purpose of this study was to examine the electromyographic (EMG) response time of the peroneal and tibialis anterior muscles in response to sudden plantar flexion/inversion stress in the chronically functional unstable and normal ankle. Subjects for this study consisted of 13 athletically active individuals (five males and eight females, mean age = 19.2 +/- 1.51 years) with a previous history of a unilateral inversion-type ankle sprain. A specially designed platform that allows each foot to drop into plantar flexion/inversion from a standing neutral position was used. Reaction time in milliseconds for the peroneal and tibialis anterior muscles to sudden plantar flexion/inversion was measured via surface EMG. A paired t test was performed with the Bonferroni-Dunn correction factor to determine differences between the peroneal and tibialis anterior as well as between the chronically unstable and contralateral normal ankle. The results indicated no significant differences between the stable and unstable ankles for the peroneal or the tibialis anterior muscles. The results also indicated no significant differences existed between the tibialis anterior and peroneal muscles in either the stable or unstable ankles. The findings from the present study suggest that self-reported functional ankle instability may not result in a diminished reflex response time of the peroneal and tibialis anterior muscles to sudden plantar flexion/inversion stress.

Cytotoxicity of copper complexes of 2-furaldehyde oxime derivatives in murine and human tissue cultured cell lines

The copper complexes of furan oxime derivatives were found to be potent cytotoxic agents in both murine and human tissue cultured cell lines which were either suspended or solid tumors. The ED50 values were frequently improved over the clinically useful antineoplastic agents. These copper complexes of 2-furaldehyde oximes were effective inhibitors of L1210 lymphoid leukemia DNA synthesis followed by RNA synthesis. Purine synthesis regulatory enzyme activities were markedly reduced by the compounds with marginal inhibition of t-RNA polymerase, and nucleoside kinases activities. L1210 DNA topoisomerase II activity was markedly reduced with IC50 values better than the standard VP-16, etoposide. Yet, the copper complexes caused no further protein linked breaks than VP-16 did, but did block phosphorylation activation of the topoisomerase II enzyme.

The bacillus subtilis dinR gene codes for the analogue of Escherichia coli LexA. Purification and characterization of the DinR protein

The Bacillus subtilis dinR gene encodes a 23-kDa protein that shares about 34% homology with the Escherichia coli LexA protein. We have purified the dinR gene product to near homogeneity, and we describe its activities. The purified DinR protein binds specifically to the promoter regions of three B. subtilis SOS genes: dinB, dinC, and recA. Electrophoretic mobility of DinR-promoter complexes in each case is identical to that of promoters bound by the B. subtilis SOS repressor (Lovett, et al., (1993) J. Bacteriol. 175, 6842-6849). Analysis of hydroxyl radical footprints of DinR bound to the dinC promoter indicates that DinR interacts with one side of the DNA providing access to the consensus operator site (5'-GAACN4GTTC-3') within two adjacent major grooves. Consistent with its proposed role as a transcriptional repressor, purified DinR displaces B. subtilis RNA polymerase from the recA promoter and represses transcription of the recA gene in vitro. We also show that purified DinR protein undergoes general base-catalyzed autodigestion as well as RecA-mediated cleavage at the peptide bond between Ala-91 and Gly-92. Corresponding to its cleavage by activated RecA following DNA damage, the level of DinR is significantly reduced in RecA+ B. subtilis cells following exposure to mitomycin C. Thus, the DinR protein is structurally and functionally analogous to the E. coli LexA protein, and accordingly, we propose renaming the protein B. subtilis LexA.