Tonsillar metastasis: A rare presentation of gastric carcinoma

Metastatic carcinoma of the tonsil is uncommon. Tonsillar metastases rarely become apparent before the diagnosis of the primary neoplasm. We describe only the second reported case of tonsillar metastasis as a presenting feature of gastric carcinoma. A review of the literature is also discussed.

Clinical findings, consanguinity, and pedigrees in children with anophthalmos in southern India

This study aimed to describe clinical findings, pedigrees, and possible environmental risk factors in children with clinical anophthalmos and remnant microphthalmos in either eye in southern India. Twenty-four children (14 male, 10 female; mean age 10.3 years, age range 1.3 to 18 years,) were recruited from schools for the blind, hospitals, and community-based rehabilitation programmes in Andhra Pradesh, India, over 1 year. Family members were examined, and mothers interviewed. Fifteen children had anophthalmos and nine had remnant microphthalmos in one or both eyes. Twelve children had associated systemic findings, of which six were major and six were minor abnormalities. Information on consanguinity was available in 19 children, 12 of whom had consanguineous parents. Five children had a positive family history. Two mothers had a history of night blindness, and one had a history of pesticide exposure during pregnancy. High rates of consanguinity suggest a genetic recessive aetiology.

The clinician's role in meeting patient information needs: suggested learning outcomes

BACKGROUND

Patients have always fulfilled their information needs from a variety of different sources over time. Clinician-patient consultations are one part of that process. Some patients have increasing opportunities to obtain information through new sources such as the internet, touch-screens, and patient-held records. Others remain poorly informed.

OBJECTIVES

To identify learning outcomes for clinicians in meeting patient information needs and working with well-informed patients.

DESIGN

Four-stage multicentre multidisciplinary qualitative study.

SETTING AND SUBJECTS

(1) Semistructured interviews with 20 clinicians in Glasgow; (2) semistructured interviews with 52 clinicians in Nottingham and London; (3) testing of consensus by postal questionnaire and Delphi method amongst 37 clinicians in medicine, nursing and the professions allied to medicine, and (4) conference to discuss results.

RESULTS

46 learning outcomes were identified in the eight areas of: placing a higher priority on patient information and education; understanding the patient's information needs and environment; understanding the emotional aspects of learning; developing patient understanding; helping patients to understand about health care and health care information; learning from the patient; knowing about information sources and their use, and issues of multidisciplinary working.

CONCLUSIONS

The suggested learning outcomes provide the basis for wider discussion, for possible inclusion in curricula both at undergraduate and continuing education levels, and as the basis for the development of new educational materials.

Randomised trial of personalised computer based information for patients with schizophrenia

OBJECTIVES

To compare use, effect, and cost of personalised computer education with community psychiatric nurse education for patients with schizophrenia.

DESIGN

Randomised trial of three interventions. Modelling of costs of alternatives.

PARTICIPANTS

112 patients with schizophrenia in contact with community services; 67 completed the intervention.

INTERVENTIONS

Three interventions of five educational sessions: (a) computer intervention combining information from patient's medical record with general information about schizophrenia; (b) sessions with a community psychiatric nurse; (c) "combination" (first and last sessions with nurse and remainder with computer).

MAIN OUTCOME MEASURES

Patients' attendance, opinions, change in knowledge, and psychological state; costs of interventions and patients' use of NHS community services; modelling of costs for these three, and alternative, interventions.

RESULTS

Rates of completion of intervention did not differ significantly (71% for combination intervention, 61% for computer only, 46% for nurse only). Computer sessions were shorter than sessions with nurse (14 minutes v 60 minutes). More patients given nurse based education thought the information relevant. Of 20 patients in combination group, 13 preferred the sessions with the nurse and seven preferred the computer. There were no significant differences between groups in psychological outcomes. Because of the need to transport patients to the computer for their sessions, there was no difference between interventions in costs, but computer sessions combined with other patient contacts would be substantially cheaper.

CONCLUSIONS

The computer based patient education offered no advantage over sessions with a community psychiatric nurse. Investigation of computer use combined with other health service contacts would be worth while.

Sibutramine metabolites increase glucose transport by cultured rat muscle cells

BACKGROUND

The anti-obesity agent sibutramine, a serotonin and noradrenaline reuptake inhibitor (SNRI), has been shown to reduce insulin resistance and improve glycaemic control in obese-diabetic ob/ob mice and overweight type 2 diabetic patients.

OBJECTIVE

To investigate whether sibutramine or its metabolites act directly on muscle cells to improve glucose uptake and insulin action.

DESIGN

Uptake of the non-metabolized glucose analogue 2-deoxyglucose was measured in cultured L6 rat muscle cells after incubation with sibutramine, its two pharmacologically active metabolites and related agents.

RESULTS

Sibutramine itself (10(-8)-10(-6) M) did not significantly affect 2-deoxyglucose uptake during incubations up to 72 h. The primary amine metabolite M2 (10(-7) and 10(-6) M) increased basal and insulin-stimulated 2-deoxyglucose uptake (by 12% and 34%) after 24 h incubation. These effects of M2 were lost by 72 h incubation. However, the secondary amine metabolite M1 (10(-6) M) increased basal and insulin-stimulated 2-deoxyglucose uptake (by 50%) after 72 h incubation, although M1 was ineffective after 24 h. M2 stimulated 2-deoxyglucose uptake in the presence of LY-294,002 (an inhibitor of phosphatidylinositol 3-kinase) but the effect of M2 was inhibited by cytochalasin B, which acutely blocks glucose transporters. Incubations with serotoninergic, noradrenergic and dopaminergic agents, or agents known to stimulate release or inhibit reuptake of these substances in nervous tissues indicated that the sibutramine metabolites were not affecting 2-deoxyglucose uptake via mechanisms associated with their SNRI properties.

CONCLUSIONS

Sibutramine metabolites can improve insulin-sensitive 2-deoxyglucose uptake by cultured muscle cells independently of SNRI effects.

Status of high-dose chemotherapy for breast cancer: a review

The purpose of this review is to analyze the current status of high-dose chemotherapy (HDCT) with autologous stem cell transplantation for patients with breast cancer. Current results from the major prospective phase 2 and phase 3 trials in metastatic breast cancer (MBC) and high-risk primary breast cancer (HRPBC) are reviewed. Prognostic factors and future research directions are also discussed. The encouraging results of phase 2 trials suggested a benefit for HDCT in HRPBC and some categories of patients with MBC. Some investigators have argued that patient selection might have been a critical factor in those studies. Recently reported randomized trials in patients with chemosensitive MBC have included only small numbers of patients in complete remission and thus have not adequately addressed the relative value of HDCT versus maintenance standard-dose chemotherapy in this patient subset. Although initial results of 2 studies have been reported, most randomized phase 3 studies of HDCT in HRPBC require longer follow-up before definitive conclusions can be made about its efficacy in this setting. We conclude that the role of HDCT for HRPBC or MBC patients has not yet been fully defined. Longer follow-up of the ongoing randomized trials is necessary, and their mature results will help clarify this important question. In the meantime, it is imperative that research continues, to enhance the efficacy of the procedure. This may come through incorporating more active drugs into HDCT regimens and combining HDCT with novel strategies aimed at eradication of posttransplantation minimal residual disease.

Multicenter evaluation of the BDProbeTec ET System for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urine specimens, female endocervical swabs, and male urethral swabs

The performance of the Becton Dickinson BDProbe Tec ET System Chlamydia trachomatis and Neisseria gonorrhoeae Amplified DNA Assays (BD Biosciences, Sparks, Md.) was evaluated in a multicenter study. Specimens were collected from 2,109 men and women, with or without symptoms, attending sexually transmitted disease, family planning, and obstetrics and gynecology clinics. Both swab and urine samples were collected, and the results obtained from 4,131 specimens were compared to those from culture and the LCx nucleic acid amplification test (Abbott Industries, Abbott Park, Ill.). PCR and cytospin of the culture transport medium with chlamydia direct fluorescent antibody staining were used to adjudicate chlamydia culture-negative results. Sensitivity and specificity were calculated both with and without use of the amplification control (AC), with little apparent difference in the results. Without the AC result, sensitivity for C. trachomatis and N. gonorrhoeae were 92.8 and 96.6%, respectively, for cervical swabs and 80.5 and 84.9% for urine from women. C. trachomatis and N. gonorrhoeae sensitivities were 92.5 and 98.5%, respectively, for male urethral swabs and 93.1 and 97.9% for urine from men. This amplified DNA system for simultaneous detection of chlamydial and gonococcal infections demonstrated superior sensitivity compared to chlamydia culture and has performance characteristics comparable to those of other commercially available nucleic acid-based assays for these organisms.

Does occasional movement make pecking devices more attractive to domestic chicks?

1. Previous studies have shown that a bunch of string is a particularly attractive pecking stimulus for chicks and adult laying hens. Because movement is thought to be an important attribute of enrichment objects, this study determined whether occasional movement would affect the attractiveness of this device. 2. In experiment 1 the responses of pair-housed chicks to string were compared when devices in adjacent cages were either linked (so that pecking or pulling at the string in one cage moved the adjoining one) or not (separate). In experiment 2 the devices in half the cages were jigged remotely by the experimenter whereas the others remained static. In both cases, the string devices were introduced into the cages for 10 min on each of 5 consecutive days. 3. No treatment effects were apparent in experiment 1 when pooled data was analysed but comparison of responses on days 1 and 5 revealed that only the chicks presented with non-linked devices showed increased interest with repeated exposure. 4. Chicks given static devices in experiment 2 pecked sooner, more often and longer at them than did those exposed to similar ones that were jigged regularly by the experimenter. Jigged devices attracted slightly more pecking with repeated exposure, which may have reflected familiarity-induced fear-reduction, but chick responses showed no apparent changes from day 2 onwards. Conversely, rather than showing habituation, the chicks pecked progressively more at the static devices with repeated presentation. 5. The present results show that chicks pecked readily at bunches of white string, thus confirming its attractive properties but that static devices were more attractive than those incorporating occasional movement. These and previous findings are discussed in terms of their implications for the development of effective environmental enrichment.

The nonsense-mediated decay pathway and mutually exclusive expression of alternatively spliced FGFR2IIIb and -IIIc mRNAs

Exons IIIb and IIIc of the FGFR2 gene are alternatively spliced in a mutually exclusive manner in different cell types. A switch from expression of FGFR2IIIb to FGFR2IIIc accompanies the transition of nonmalignant rat prostate tumor epithelial cells (DTE) to cells comprising malignant AT3 tumors. Here we used transfection of minigenes with and without alterations in reading frame and with and without introns to examine how translation affects observed FGFR2 splice products. We observed that nonsense mutations in other than the last exon led to a dramatic reduction in mRNA that is abrogated by removal of downstream introns in both DTE and AT3 cells. The mRNA, devoid of both IIIb and IIIc exons (C1-C2), is a major splice product from minigenes lacking an intron downstream of the second common exon C2. From these observations, we suggest that repression of exon IIIc and activation of exon IIIb inclusion in DTE cells lead to the generation of both C1-IIIb-C2 and C1-C2 products. However, the C1-C2 product from the native gene is degraded due to a frameshift and a premature termination codon caused by splicing C1 and C2 together. Derepression of exon IIIc and repression of exon IIIb lead to the generation of both C1-IIIc-C2 and C1-C2 products in AT3 cells, but the C1-C2 product is degraded. The C1-IIIb-IIIc-C2 mRNA containing a premature termination codon in exon IIIc was present, but at apparently trace levels in both cell types. The nonsense-mediated mRNA decay pathway and cell type-dependent rates of inclusion of exons IIIb and IIIc result in the mutually exclusive expression of FGFR2IIIb and IIIc.

Developmental instability in japanese quail genetically selected for contrasting adrenocortical responsiveness

Differences in developmental instability were assessed with Japanese quail of two lines that had been genetically selected over several generations for reduced (low stress, LS) or exaggerated (high stress, HS) plasma corticosterone response to brief mechanical restraint. At 32 wk of age, three bilateral traits were selected for study in each quail line. The characteristics chosen were length of the metatarsus (shank length, SHL), diameter of the shank (SHD) perpendicular to the spur, and distance between the auditory canal and the nares (face length, FL). Significantly greater bilateral trait size variances were associated with the measurement of SHL (P < 0.0088) and FL (P < 0.0016) in the HS line than in the LS line. SHD variances did not differ (P = 0.22) in quail of the HS and LS lines. These findings suggest that developmental instability (i.e., fluctuating asymmetry, FA) is more pronounced in HS quail than in LS quail. Previous studies have shown that not only do quail of the HS line show greater adrenocortical responsiveness to a wide range of stressors but that they are also more easily frightened than LS birds. Therefore, the line differences in FA found here may reflect the birds' differential responsiveness to chronic social and physical environmental stressors. The present findings also support previous suggestions that measuring asymmetries in bilateral traits could be an additional and valid method of assessing stress and of comparing phenotypic stability in selected populations.

Is there a role for Chlamydia pneumoniae in hemodialysis vascular access thrombosis?

Significant evidence suggests that Chlamydia pneumoniae has a major role in occlusive vascular disease. Vascular access thrombosis in chronic hemodialysis patients is a frequent problem; the underlying pathological state is stenosis caused by endothelial hyperplasia. There is presently no literature concerning C pneumoniae in vascular access thrombosis. We embarked on a study to evaluate the possible role of C pneumoniae in access failure. Ten consecutive patients with thrombosed polytetrafluoroethylene (PTFE) conduit arteriovenous fistulae undergoing surgical thrombectomy and revision were studied. We sought to detect C pneumoniae using both culture and polymerase chain reaction (PCR) methods. An excisional biopsy of the stenotic vein segment just above the anastomosis with the PTFE graft was obtained at surgery. Vein samples weighing at least 30 mg were aseptically placed in transport media and stored at 4 degrees C for up to 24 hours. The samples then were sonicated, inoculated in Hep-2 cell culture vials containing confluent monolayers, and passaged three times over 2 weeks. Detection was by direct fluorescent antibody staining. Both culture and PCR were performed in an active chlamydia research laboratory. None of the 10 samples was positive for C pneumoniae by culture or PCR. Based on our preliminary pilot study, we do not believe C pneumoniae has a major role in endothelial hyperplasia and consequent graft loss in the hemodialysis patients we studied.

Incidence of and risk factors for proliferative retinopathy and its association with blindness among diabetes clinic attenders

BACKGROUND

Proliferative diabetic retinopathy (PDR), a prevalent late-stage complication of diabetes, is associated with severe visual loss. The objectives of this report were to estimate the incidence of and risk factors for PDR using routinely collected data from a clinical information system at University Hospital Nottingham for insulin- and non-insulin-dependent (insulin-treated and non-insulin-treated) diabetes separately. We also attempted to assess the risk of blindness in these diabetes clinic attenders.

METHODS

During a mean (standard deviation (SD)) follow-up period of 5.1 (2.9) (range 0.5-12.4) years, 3482 diabetic patients (1915 male and 1567 female) from three outpatient clinics at University Hospital, Nottingham were examined. The mean (SD) age of the participants was 49.3 (17.9) years with a mean duration of diabetes of 7.1 (8.7) years at registration.

RESULTS

Among the 3482 patients who attended the clinic at least twice in the period 1979-1992, and who were free of PDR at registration, the overall incidence of PDR was 16.2 per 1000 person-years, based on 17,618 person-years of follow-up. The incidence rate of PDR was nearly three times as high among patients with non-proliferative diabetic retinopathy (NPDR) as in those without any retinopathy (42.1 vs. 15.0 per 1000 person-years). Based on a Cox's Proportional Hazards Model, significant independent predictors of PDR recorded at baseline were glycosylated haemoglobin (HbA1), systolic blood pressure, and longer duration of diabetes for patients without PDR or any retinopathy among insulin-dependent patients. Longer duration of diabetes was the only independent predictor of PDR for patients without PDR or any retinopathy in both insulin- and non-insulin-treated non-insulin-dependent patients. These clinic-based data clearly indicate the higher risk of PDR in non-insulin-dependent patients. Gender, age, BMI, creatinine, proteinuria and cigarette smoking, had no significant independent association with PDR when other covariates were considered in all groups. The risk of blindness was greater among those with PDR than those with NPDR in all three types of diabetes, but was substantial even for those without retinopathy.

CONCLUSION

These data are of value in identifying those diabetes clinic attenders who may be most at risk.

Evaluation of nucleic acid amplification tests as reference tests for Chlamydia trachomatis infections in asymptomatic men

Urine ligase chain reaction (LCR) and PCR tests and urethral swab culture were compared for their abilities to detect Chlamydia trachomatis infection in 3,639 asymptomatic men by using one-, two-, and three-test reference standards. Frozen urine at four of five participating centers was also tested by a transcription-mediated amplification assay which was used as a reference test. LCR increased the yield of positive results by 27% and PCR increased the yield of positive results by 26% over the yield of positive results by culture (n = 295). LCR and PCR sensitivities were similar, ranging from 80.4 to 93.5%, depending on the reference standard. Culture sensitivity was substantially less. A multiple-test standard yielded LCR, PCR, and culture specificities of 99.6%, with or without discrepant analysis. Test performance varied among centers partly due to different interpretations of the testing protocols. The study confirms that urine LCR and PCR for the detection of C. trachomatis have substantially improved sensitivities over that of urethral swab culture for testing of asymptomatic men, enabling screening of this important target group. These tests, perhaps in combination, are also candidate reference tests for the conduct of test evaluation studies.

AMP decreases the efficiency of skeletal-muscle mitochondria

Mitochondrial proton leak in rat muscle is responsible for approx. 15% of the standard metabolic rate, so its modulation could be important in regulating metabolic efficiency. We report in the present paper that physiological concentrations of AMP (K(0.5)=80 microM) increase the resting respiration rate and double the proton conductance of rat skeletal-muscle mitochondria. This effect is specific for AMP. AMP also doubles proton conductance in skeletal-muscle mitochondria from an ectotherm (the frog Rana temporaria), suggesting that AMP activation is not primarily for thermogenesis. AMP activation in rat muscle mitochondria is unchanged when uncoupling protein-3 is doubled by starvation, indicating that this protein is not involved in the AMP effect. AMP activation is, however, abolished by inhibitors and substrates of the adenine nucleotide translocase (ANT), suggesting that this carrier (possibly the ANT1 isoform) mediates AMP activation. AMP activation of ANT could be important for physiological regulation of metabolic rate.

Multicenter evaluation of AMPLICOR and automated COBAS AMPLICOR CT/NG tests for Neisseria gonorrhoeae

The fully automated COBAS AMPLICOR CT/NG and semiautomated AMPLICOR CT/NG tests were evaluated in a multicenter trial for their ability to detect Neisseria gonorrhoeae infections. Test performance compared to that of culturing was evaluated for 2,192 matched endocervical swab and urine specimens obtained from women and for 1, 981 matched urethral swab and urine specimens obtained from men. Culture-negative, PCR-positive specimens that tested positive in a confirmatory PCR test for an alternative target sequence within the N. gonorrhoeae 16S rRNA gene were considered to be true positives. The overall prevalences of gonorrhea were 6.6% in women and 20.1% in men. The COBAS AMPLICOR and AMPLICOR formats yielded concordant results for 98.8% of the specimens and exhibited virtually identical sensitivities and specificities. The results that follow are for the COBAS AMPLICOR format. With the infected patient as the reference standard, the resolved sensitivities of PCR were 92.4% for endocervical swab specimens and 64.8% for female urine specimens. There were no significant differences in these rates between women with and without symptoms. Among symptomatic men, COBAS AMPLICOR sensitivities were 94.1% for urine and 98.1% for urethral swabs; for asymptomatic men, the results were 42.3 and 73.1%, respectively. In comparison, the sensitivities of culturing were 84.8% for endocervical specimens, 92.7% for symptomatic male urethral specimens, and only 46.2% for urethral specimens obtained from asymptomatic men. When PCR results were analyzed as if only a single test had been performed on a single specimen type, the resolved sensitivity was always higher. The resolved specificities of PCR were 99.5% for endocervical swab specimens, 99.8% for female urine specimens, 98.9% for male urethral swab specimens, and 99.9% for male urine specimens. The internal control revealed that 2.1% of specimens were inhibitory when initially tested. Nevertheless, valid results were obtained for 99.2% of specimens because 60.0% of the inhibitory specimens were not inhibitory when a second aliquot was tested. The COBAS AMPLICOR CT/NG test for N. gonorrhoeae exhibited high sensitivity and specificity with urethral swab and urine specimens from men and endocervical swab specimens from women and thus is well suited for diagnosing and screening for N. gonorrhoeae infection.

Cardiac toxicity following high-dose cyclophosphamide, cisplatin, and BCNU (STAMP-I) for breast cancer

We retrospectively evaluated 443 breast cancer patients treated with high-dose cyclophosphamide, cisplatin, and BCNU (STAMP-I) with autologous stem cell support to characterize the cardiac toxicity of this regimen. Patients had stage II-III (n = 243) or stage IV (n = 200) breast cancer. We observed an overall 5.1% incidence of cardiac complications, both clinical and subclinical, in the whole group: 4.9% in stage II-III and 5.5% in stage IV patients. Clinical cardiomyopathy (CMP) was observed in 1.6% of stage II-III patients (1 case of fatal grade 5 toxicity and 3 cases of grade 3 CMP) and in 3.5% of patients with stage IV disease (1 case of grade 4 and 6 cases of grade 3). The incidence of cardiac toxicity did not differ significantly between the groups. Prior radiation therapy to the mediastinum or left chest wall (P = .001) and advanced age (P = .01) were independent predictors of an increased risk of the appearance of this complication. No pharmacodynamic correlation was observed between any of the 3 drugs and cardiac toxicity.

Tobacco or oral health: past progress, impending challenge

BACKGROUND AND OVERVIEW

A number of significant events and research findings during the past 15 years have led to the dental profession's growing involvement in tobacco-use intervention activities. The author presents an overview of events and people responsible for the progress in furthering the cause of dentistry's activism in tobacco-use prevention and control.

CLINICAL IMPLICATIONS

Dentistry has led the health professions in establishing a protocol for the prevention of tobacco use, a health behavior that causes or contributes to various oral diseases and adverse conditions. Dentists practicing in the 21st century cannot ignore patients' tobacco use. Treatment prognoses for periodontal therapy, wound healing, dental implants, cosmetic treatments and cancer therapy all are compromised by patients' tobacco use. Dentists must know what to do and say to prevent patients' tobacco use and aid patients in its cessation.

Insulin-like effect of pinitol

D-pinitol (3-O-methyl-chiroinositol), an active principle of the traditional antidiabetic plant Bougainvillea spectabilis, is claimed to exert insulin-like effects. This study investigates the effect of D-pinitol on glucose homeostasis in animal models of diabetes, and on glucose transport by cultured muscle cells. Plasma glucose concentrations were measured in normal, obese-diabetic (ob/ob) and streptozotocin (STZ)-diabetic mice after oral (p.o.) and intraperitoneal (i.p.) administration of D-pinitol. Glucose transport was measured in L6 rat muscle cells by 2-deoxyglucose (2DG) uptake. In STZ-diabetic mice, 100 mg kg(-1) p.o. D-pinitol acutely decreased the hyperglycaemia (by 22% at 6 h). A similar decrease in plasma glucose (by 21%) was observed after 100 mg kg(-1) i.p. D-pinitol. Insulin concentrations and the rate of insulin-induced (1 unit kg(-1) actrapid i.p.) glucose disappearance were not altered by 100 mg kg(-1) p.o. D-pinitol. Chronic administration of D-pinitol (100 mg kg(-1) i.p. twice daily for 11 days) to STZ-diabetic mice maintained a reduction in plasma glucose concentrations from about 14 to 10 mmol l(-1). In normal non-diabetic and severely insulin resistant ob/ob mice, 100 mg kg(-1) p.o. D-pinitol did not significantly affect plasma glucose or insulin during acute studies. Incubation of L6 muscle cells with D-pinitol (10(-3) M) increased basal 2DG uptake by 41% after 10 min and by 34% after 4 h. The effect of D-pinitol was inhibited by the phosphatidylinositol 3-kinase inhibitor LY294002. D-pinitol did not increase insulin-stimulated 2DG uptake by L6 cells. The data support the view that D-pinitol can exert an insulin-like effect to improve glycaemic control in hypoinsulinaemic STZ-diabetic mice. D-pinitol may act via a post-receptor pathway of insulin action affecting glucose uptake.

Acute pancreatitis during immunosuppression with tacrolimus following an allogeneic umbilical cord blood transplantation

Tacrolimus is increasingly used for graft-versus-host disease (GVHD) prophylaxis and therapy in the allogeneic stem cell transplant (allo-SCT) setting. Pancreatitis, previously described as a side-effect of cyclosporine, has not been reported in allo-SCT recipients receiving tacrolimus. We present here a case of acute pancreatitis in a 28-year-old patient with chronic myelogenous leukemia (CML) who received an unrelated umbilical cord blood transplant (UCBT) and tacrolimus for GVHD prophylaxis. On day +31 post-transplant, she developed severe acute pancreatitis with multiorgan failure, from which she recovered completely. Tacrolimus was the probable cause of pancreatitis in this patient.

Chlamydia pneumoniae serology: interlaboratory variation in microimmunofluorescence assay results

The lack of standardization in chlamydia serology has made interpretation of published data difficult. This study was initiated to determine the extent of interlaboratory variation of microimmunofluorescence (MIF) test results for the serodiagnosis of Chlamydia pneumoniae infections. Identical panels of 22 sera were sent to 14 laboratories in eight countries for the determination of IgG and IgM antibodies by MIF. Although there was extensive variation in the numeric titer values, the overall percentage agreement with the reference standard titers from the University of Washington was 80%. For results by serodiagnostic category, the best agreement was for four-fold rise in IgG titers, while the lowest agreement was for negative or low IgG titers. Agreement for IgM titers was 50%-95%. Four laboratories failed to discern false-positive IgM titers possibly because of the presence of rheumatoid factor. Further studies are underway to determine the source of interlaboratory variation for the MIF test.

T-maze behaviour in broiler chicks is not sensitive to right-left preferences, test order or time-of-day

There is substantial individual variation in the time taken by broiler chicks to traverse a T-maze and thereby reinstate visual contact with their companions. Chicks completing this task quickly (high performance, HP) subsequently grew faster in the laboratory and on farm, exhibited greater sociality, and showed less pronounced adrenocortical responses to a partial water immersion stressor than did their slower (low performance, LP) counterparts [Marin, R.H., Jones, R.B., 1999. Latency to traverse a T-maze at 2 days of age and later adrenocortical responses to an acute stressor in domestic chicks. Physiol. Behav. 66, 809-813.; Marin, R.H., Arce, A., Martijena, I.D., 1997. T-maze performance and body weight relationship in broiler chicks. Appl. Anim. Behav. Sci. 54, 197-205.; Jones, R.B., Marín, R.H., García, D.A., Arce, A., 1999. T-maze behaviour in domestic chicks: a search for underlying variables. Anim. Behav. 58, 211-217.]. Given its simplicity, rapidity and non-invasiveness, the T-maze test might represent a commercially attractive selection criterion for future breeding programmes if this behavioural trait exhibits sufficient genetic variability. However, it is first necessary to ensure that performance in the T-maze is not sensitive to potentially confounding variables, such as existing preferences to turn right or left at the junction of the maze, the order of testing, or the time of day. In the present study, 240 newly hatched, mixed-sex broiler chicks (Cobb) were randomly allocated to 12 groups of 20 upon receipt. When they were 2 days of age a group of 20 chicks was placed in the brood area of each of two T-mazes at 0830 h; the brood areas were positioned on either the right or the left sides of the mazes. After acclimatisation, one chick from each group was placed in the isolation chamber of the T-maze and we recorded the time it took to traverse the maze. This procedure was repeated until all 20 chicks and all 12 groups had been tested. The locations of the brood areas were rotated after each block of 20 tests. Testing was completed in the same day and two groups were tested at each of the following times: 0900, 1030, 1200, 1330. 1500, and 1630 h. Analyses of variance (ANOVA) revealed no detectable effects of: positioning the brood area on the right or the left side of the T-maze (F(1,200)=0.06, P<0.80), test order (F(19,200)=0.48; P<0.96), or time-of-day (F(5,234)=0.44; P<0.81). These findings strongly suggest that the future classification and possible selection of broiler chicks according to their T-maze responses are unlikely to be confounded by right-left preferences, test order, or the time of day.

Elevated cholesterol metabolism and bile acid synthesis in mice lacking membrane tyrosine kinase receptor FGFR4

Heparan sulfate-regulated transmembrane tyrosine kinase receptor FGFR4 is the major FGFR isotype in mature hepatocytes. Fibroblast growth factor has been implicated in the definition of liver from foregut endoderm where FGFR4 is expressed and stimulation of hepatocyte DNA synthesis in vitro. Here we show that livers of mice lacking FGFR4 exhibited normal morphology and regenerated normally in response to partial hepatectomy. However, the FGFR4 (-/-) mice exhibited depleted gallbladders, an elevated bile acid pool and elevated excretion of bile acids. Cholesterol- and bile acid-controlled liver cholesterol 7alpha-hydroxylase, the limiting enzyme for bile acid synthesis, was elevated, unresponsive to dietary cholesterol, but repressed normally by dietary cholate. Expression pattern and cholate-dependent, cholesterol-induced hepatomegaly in the FGFR4 (-/-) mice suggested that activation of receptor interacting protein 140, a co-repressor of feed-forward activator liver X receptor alpha, may mediate the negative regulation of cholesterol- and bile acid-controlled liver cholesterol 7alpha-hydroxylase transcription by FGFR4 and cholate. The results demonstrate that transmembrane sensors interface with metabolite-controlled transcription networks and suggest that pericellular matrix-controlled liver FGFR4 in particular may ensure adequate cholesterol for cell structures and signal transduction.

Evaluation of the predictive value of Her-2/neu overexpression and p53 mutations in high-risk primary breast cancer patients treated with high-dose chemotherapy and autologous stem-cell transplantation

PURPOSE

To ascertain the predictive value of Her-2/neu overexpression and p53 mutations, assessed by immunohistochemistry, in high-risk primary breast cancer (HRPBC) treated with high-dose chemotherapy (HDCT).

PATIENTS AND METHODS

We obtained paraffin-embedded tumor blocks from 146 HRPBC patients previously enrolled at our program onto clinical trials of HDCT for four to nine involved axillary lymph nodes, > or = 10 involved axillary nodes, or inflammatory carcinoma. All patients received the same HDCT regimen, with cyclophosphamide, cisplatin, and carmustine (STAMP-I), followed by autologous stem-cell transplantation. Median follow-up was 42 months (range, 5 to 90 months). The same pathologist, blinded to clinical outcome, reviewed all immunostained slides.

RESULTS

Positive results for Her-2/neu and p53 were found in 44.5% and 34% of the patients, respectively. Positivity for Her-2/neu was significantly associated with increased risk of relapse and death. No correlation was found between p53 mutations and relapse-free survival (RFS) or overall survival (OS). Multivariate analyses included Her-2/neu overexpression and the following variables previously identified as independent predictors of outcome in this population: tumor size, nodal ratio (number of involved nodes/number of dissected nodes), and hormone receptor status. All four variables had independent value.

CONCLUSION

Her-2/neu overexpression is an independent negative predictor of RFS and OS in HRPBC treated with HDCT. Its inclusion in our previously described predictive model increases the predictive capacity of this model for the low-risk subgroup. In contrast, p53 mutations lack predictive value in this setting.