Studies of detrusor-sphincter synergia and dyssynergia during micturition in rats via fractional Brownian motion

In normal humans, the bladder is supposed to empty by a synergistic contraction of the detrusor and relaxation of the sphincter during micturition. By contrast, suprasacral spinal cord injury (SCI) patients usually will have both of them contract simultaneously and result in the so-called detrusor-sphincter dyssynergia. In this study, the cystometrograms of the detrusor and the electromyograms of external urethral sphincter of intact and SCI female Wistar rats are used to investigate the detrusor-sphincter synergia and dyssynergia during micturition. Due to the statistical self-similarity of the waveforms, the cystometrogram is modeled as discrete-time fractional Brownian motion and the electromyogram as discrete-time fractional Gaussian noise. Fractal dimensions of both of them are calculated and used as indices in the investigation of synergia. Results indicate that, for intact rats, the sphincter muscle is not only active but also recruited in a synchronous fashion with the detrusor. Furthermore, clear-cut measure using the fractal dimensions can be used to diagnose detrusor-sphincter synergia and dyssynergia.

Familial breast cancer in southern Taiwan

The purpose of this study is to evaluate whether there are pathobiologic differences and differences in overall rates survival between familial and non-familial breast cancer patients in Taiwan. A retrospective study was performed evaluating 76 familial breast cancer patients in 69 families, which included two BRCA1 related cases and six BRCA2 related cases. Patients were compared with 425 non-familial sporadic cases. Familial breast cancer patients had similar ages and stages as non-familial patients (mean, 46.6 years vs 48.9 years, p = 0.306). However, the familial breast cancer patients with BRCA1 and BRCA2 related cases presented at lower stages (p = 0.034) and younger ages than non-familial patients (mean, 45.1 years vs 48.9 years P = 0.042). The occurrence of infiltrating ductal carcinoma and lobular carcinoma in situ was not significantly different in the two groups. Mucinous carcinoma was represented with 6.7% (4/76) and 1.3% (1/76) medullary carcinoma. The overall grade of familial breast cancer, including BRCA1 and BRCA2 related cases in 8 infiltrating ductal carcinoma, was significantly higher than that of controls. The mean follow up was 4.5 years for familial breast cancers. Five- and 10-year overall survival rates were 69% and 61% for those with a family history, compared with 86% and 64% for those in the control group (p = 0.644). There were no statistically significant differences in disease-free survival rates between the two groups at 5 or 10 years (69% vs 78% in 5 years; 48% vs 58% in 10 years) (p = 0.862). Despite the younger ages and earlier stages at presentation in familial breast cancer patients with BRCA1 and BRCA2 related cases, the familial breast cancer patients had higher grade patholobiologic characteristics, but similar prognoses when compared with sporadic breast cancer patients. Owing to the limited number of familial cases in this study, more cases and longer follow up are needed.

Combination chemotherapy with tamoxifen, ifosfamide, epirubicin and cisplatin in extensive-disease small-cell lung cancer

BACKGROUND

A study of tamoxifen, ifosfamide, epirubicin and cisplatin (TIEP) chemotherapy was conducted in patients with extensive-disease, small-cell lung cancer (SCLC) to assess response and toxicity.

METHODS

From November, 1997, to February, 1999, 11 patients were treated, including six chemo-naïve patients and five patients previously treated with cisplatin plus etoposide (EP). The treatment regimen included tamoxifen 60 mg twice daily orally on days 1 to 3, ifosfamide 3 g/m2 intravenous (i.v.) infusion for 60 minutes with mesna on day 2, epirubicin 50 mg/m2 i.v. bolus on day 2 and cisplatin 60 mg/m2 i.v. for 60 minutes on day 2, every 4 weeks for up to six cycles.

RESULTS

All patients were evaluated for toxicity and response rate. As expected, the major toxicity was myelosuppression. Grade 3 or 4 leukopenia or neutropenia occurred in all patients during treatment. Two patients (18.2%) experienced fever in association with the neutropenia, one of whom died of sepsis. Grade 3 anemia occurred in two patients (18.2%) during treatment. Toxicities other than neutropenia and anemia were limited. After two cycles of treatment, five of six chemo-naïve patients (83%), and one of five previously treated patients (20%) attained a partial response (overall 54.5%, 95% confidence interval 25%-83.9%). Median survival time was 8.5 and 6 months in chemo-naïve and previously EP-treated patients, respectively. The response rate and median survival time in chemo-naïve patients did not improve compared with a previous study of ifosfamide plus etoposide undertaken 4 years earlier.

CONCLUSIONS

Although TIEP is an active combination regimen with an acceptable toxicity profile in Chinese patients with extensive-disease SCLC, it showed no remarkable benefit compared with other regimens used in chemo-naïve patients. The 20% response rate and median survival of 6 months in EP-treated patients deserve further study.

Pharmacodynamic and pharmacokinetic studies of anthraquinone 2-carboxylic acid on passive cutaneous anaphylaxis in rats

The objectives of this study are to describe the inhibitory effect of 9,10-anthraquinone 2-carboxylic acid (AQCA) on IgE-mediated passive cutaneous anaphylaxis (PCA) reaction, and the pharmacokinetics of AQCA. Pharmacodynamic assessments were performed at 0.5, 1 and 2 mg/kg (i.v.) and 5, 10 and 20 mg/kg (p.o) dose levels. In separate groups, pharmacokinetics were assessed at 5 mg/kg (i.v.) and 5, 10, and 20 mg/kg (p.o.) dose levels. Intravenous and oral administration of AQCA inhibited the PCA reaction in rats in a dose-dependent manner. The PCA-inhibitory activity of AQCA (20 mg/kg) lasted more than 12 hrs after oral administration. The oral bio-availability decreased with increasing dosage, from 96% (5 mg/kg) to 81% (10 and 20 mg/kg). The absorption after oral administration was prolonged with Tmax values ranging from 1 to 6 h; while t(1/2) (4.8-16 h) values appeared to be comparable. These results suggest that AQCA has a potent and long acting anti-PCA activity. It is likely to be therapeutically useful in the treatment of asthma.

Integration of computer-assembled digital images and text data as evidence for the oncological record

Digitally created visual images of pertinent patient data have been integrated with text information to formulate a visual evaluation and summary sheet (VESS) using computer processing. The VESS incorporates images of a patient's physical appearance, radiological images, pharmacokinetic graphs, and text information into a 1-page document of the patient's condition. Thus, computer processing of digital images and other information helps to refine patient data presentation, analysis, interpretation, and communication. This form of data management is especially valuable in oncological research, where clinical trials demand rapid, ongoing assessment of results and analysis of large amounts of data. The VESS is an effective mechanism for monitoring both the progress of individual patients and the endpoints of the overall clinical trial.

Cardiac metastasis from a transitional cell carcinoma: a case report

We report the case of a patient with a metastatic tumor in the right ventricle, apparently derived from a transitional cell carcinoma. The patient presented with severe hypoxemia as a result of right-to-left shunt due to the position of the tumor and a patent foramen ovale. The clinical course of this case is presented and the pathophysiology of the physiological effects caused by the metastatic tumor is discussed. The literature concerning cardiac metastases is reviewed.

Brain tumor demarcation using optical spectroscopy; an in vitro study

Optical spectroscopy for brain tumor demarcation was investigated in this study. Fluorescence and diffuse reflectance spectra were measured from normal and tumorous human brain tissues in vitro. A fluorescence peak was consistently observed around 460 nm (+/- 10 nm) emission from both normal and tumorous brain tissues using 337 nm excitation. Intensity of this fluorescence peak (F460) from normal brain tissues was greater than that from primary brain tumorous tissues. In addition, diffuse reflectance (Rd) between 650 and 800 nm from white matter was significantly stronger than that from primary and secondary brain tumors. A good separation between gray matter and brain tumors was found using the ratio of F460 and Rd at 460 nm (Rd460). Two empirical discrimination algorithms based on F460, Rd625, and F460/Rd460 were developed. These algorithms yielded an average sensitivity and specificity of 96% and 93%, respectively.

Inhibition of N-acetyltransferase activity and DNA-2-aminofluorene adducts by glycyrrhizic acid in human colon tumour cells

Glycyrrhizic acid (GA) was tested for inhibition of arylamine N-acetyltransferase (NAT) activity in a human colon tumour (adenocarcinoma) cell line (colo 205). Two assay systems were performed, one with cellular cytosols (9000g supernatant), the other with intact colon tumour cell cultures. The NAT activity in a human colon tumour cell line was inhibited by GA in a dose-dependent manner in both types of systems examined. The data also indicated that GA decreased the apparent values of K(m) and V(max) of NAT enzymes from human colon tumour cells in both examined systems. The DNA-2-aminofluorene adduct formation in human colon tumour cells were inhibited by GA. This report is the first to demonstrate that GA does inhibit human colon tumour cell NAT activity and DNA adduct formation.

A phase II trial of tamoxifen, ifosfamide, epirubicin, and cisplatin combination chemotherapy for inoperable non-small-cell lung cancer

A phase II trial of tamoxifen, ifosfamide, epirubicin, and cisplatin (TIEP) chemotherapy was conducted in patients with chemonaive inoperable non-small-cell lung cancer (NSCLC) to assess response and toxicity. From October 1997 to August 1998, 19 patients were treated. The treatment schema included tamoxifen 60 mg twice daily by mouth on days 1 to 3, ifosfamide 3 g/m2 intravenous infusion (IV) 60 minutes with mesna on day 2, epirubicin 50 mg/m2 IV bolus on day 2, and cisplatin 60 mg/m2 IV 60 minutes on day 2 every 4 weeks for up to six cycles. All patients were evaluable for response and toxicity. The major toxicity was myelosuppression; grade 3 or 4 leukopenia or neutropenia occurred in 14 of 19 (73.7%) patients during treatment, and 6 patients (31.6%) experienced fever in association with the neutropenia; no toxic deaths occurred. Grade 3 anemia occurred in six patients (31.6%) during the treatment. Grade 3 or 4 nausea/vomiting occurred in only one patient. Toxicities other than neutropenia and anemia were minimal. After two cycles of treatment, 9 of 19 patients attained a partial response (47.4%, 95% confidence interval 24.9%-69.9%) in this study. The median time to disease progression was 6 months and median survival time was 12 months. We conclude that TIEP is an active combination regimen with an acceptable toxicity profile in Chinese patients with inoperable NSCLC.

Effect of a urinary preparation on liver injury by short-term carbon tetrachloride treatment in rats

The hepatoprotective effect of a preparation of human urine (PHU) was assessed against short-term carbon tetrachloride (CCl4) treatment in rats. Significant prevention of liver injury by PHU was found after CCl4 treatment, judging by the changes of serum biochemical parameters, and hepatic protein and triglyceride contents. The increased liver lipid peroxidation, and decreased liver vitamin C concentrations observed after CCl4 treatment were significantly prevented by PHU administration. The increase in liver glutathione (GSH) contents observed after CCl4 treatment was further increased by PHU treatment. Liver catalase activity decreased after CCl4 treatment, while liver superoxide dismutase and GSH-peroxidase activities did not change. PHU administration further inhibited the decrease in liver catalase activity after CCl4 treatment. These results indicate that PHU administration can prevent liver injury induced by CCl4 in rats by inhibiting enhanced lipid peroxidation and by improving disrupted active oxygen metabolism in the injured liver.

The status of the do-not-resuscitate order in Chinese clinical trial patients in a cancer centre

OBJECTIVE

To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients.

DESIGN

Retrospective descriptive study.

SETTING

A cancer clinical trials unit in a large teaching hospital.

PATIENTS

From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied.

MAIN MEASUREMENT

Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated.

RESULTS

DNR orders were written for 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patients were taken home to die, a more likely occurrence if the patient was over 75 years (odds ratio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge.

CONCLUSIONS

DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom.

A space-time delay neural network for motion recognition and its application to lipreading

Motion recognition has received increasing attention in recent years owing to heightened demand for computer vision in many domains, including the surveillance system, multimodal human computer interface, and traffic control system. Most conventional approaches classify the motion recognition task into partial feature extraction and time-domain recognition subtasks. However, the information of motion resides in the space-time domain instead of the time domain or space domain independently, implying that fusing the feature extraction and classification in the space and time domains into a single framework is preferred. Based on this notion, this work presents a novel Space-Time Delay Neural Network (STDNN) capable of handling the space-time dynamic information for motion recognition. The STDNN is unified structure, in which the low-level spatiotemporal feature extraction and high-level space-time-domain recognition are fused. The proposed network possesses the spatiotemporal shift-invariant recognition ability that is inherited from the time delay neural network (TDNN) and space displacement neural network (SDNN), where TDNN and SDNN are good at temporal and spatial shift-invariant recognition, respectively. In contrast to multilayer perceptron (MLP), TDNN, and SDNN, STDNN is constructed by vector-type nodes and matrix-type links such that the spatiotemporal information can be accurately represented in a neural network. Also evaluated herein is the performance of the proposed STDNN via two experiments. The moving Arabic numerals (MAN) experiment simulates the object's free movement in the space-time domain on image sequences. According to these results, STDNN possesses a good generalization ability with respect to the spatiotemporal shift-invariant recognition. In the lipreading experiment, STDNN recognizes the lip motions based on the inputs of real image sequences. This observation confirms that STDNN yields a better performance than the existing TDNN-based system, particularly in terms of the generalization ability. In addition to the lipreading application, the STDNN can be applied to other problems since no domain-dependent knowledge is used in the experiment.

Tagged tumor cells reveal regulatory steps during earliest stages of tumor progression and micrometastasis

Histochemical marker genes were used to "tag" mouse fibrosarcoma or human neuroblastoma cells, providing a better understanding of their subsequent progression and metastasis mechanisms in nude mice. Micrometastases in the lung were initiated from clusters of 2-6 cells rather than single cells in most cases; tumor cells were also visualized binding to the endothelium of small blood vessels to initiate these micrometastases. Shortterm, these mechanisms relied heavily on fluidity of cell surface proteins, rather than nuclear events. Micrometastases in some organs were transient and never became established. Angiogenesis was visualized in both primary tumor systems via "fixation" of the animal's circulation; very small microvessels were growing toward the primary tumor as soon as 48-72 hours post-injection. Marker genes were also valuable for quantitating genetic instability of specific tumor cell populations and potential gene regulatory mechanisms operating in specific organ sites. These latter studies have direct relevance to the significance of N-myc oncogene amplification in neuroblastoma during progression and CD44 gene plasticity of expression in fibrosarcoma during metastasis. Marker gene-tagged single tumor cells can now be analyzed for gene regulatory events in virtually any organ and in combination with laser capture microdissection and other high-resolution methodologies, providing insight into the very earliest gene-regulatory events during micrometastasis.

tie-1 protein tyrosine kinase: a novel independent prognostic marker for gastric cancer

Protein tyrosine kinases (PTKs) are a major class of proto-oncogenes that are involved in tumor progression. The purpose of this study was to establish a comprehensive PTK expression profile in gastric cancers, with the objective of identifying possible biomarkers for gastric cancer progression. We have designed degenerate primers according to the consensus catalytic motifs to amplify PTK molecules from gastric cancers by reverse transcriptase-PCR methods. The PTK expression profile was established by sequencing analysis of the cloned PCR products. We have identified 17 PTKs from a gastric adenocarcinoma. Two receptor PTKs, tie-1 and axl, were selected for in situ immunohistochemistry studies because of their higher expression level and their described roles in adhesion, invasion, and angiogenesis. Among the 97 gastric adenocarcinoma tissues examined, we observed positive immunohistochemical staining of tie-1 PTK in 69 and positive staining of axl kinase in 71 tissues. Statistical analysis with clinicopathological features indicates that tie-1 kinase expression is inversely correlated with patients' survival, whereas axl fails to show similar clinical significance. Our results illustrate the utility of tyrosine kinase gene family profiling in human gastric cancers and show that tie-1 tyrosine kinase may serve as a novel independent prognostic marker for gastric adenocarcinoma patients.

Ameliorative effect of an urinary preparation on acetaminophen and D-galactosamine induced hepatotoxicity in rats

The effect of oral administration of a preparation of human urine (PHU) on acute liver injury was examined in rats intoxicated with acetaminophen and D-galactosamine. The results indicated that PHU protected the liver from acetaminophen and D-galactosamine-induced injury as judged by morphological and biochemical observation. An increase in lipid peroxide concentrations and decrease in protein concentrations occurred in the liver by D-galactosamine injection, PHU administration significantly prevented these changes.

Tumor progression, micrometastasis, and genetic instability tracked with histochemical marker genes

Mouse fibrosarcoma (3T3 cells transfected with different oncogenes), human neuroblastoma, or human prostate carcinoma cells have been genetically-tagged with different histochemical marker genes (E. coli lacZ, placental alkaline phosphatase, or Drosophila alcohol dehydrogenase). Injection into athymic nude mice permits their tracking at all stages of primary tumor formation and micrometastasis to various organs at the single-cell level. Two different tumor classes, tagged with different marker genes, can be tracked together. Primary tumors display regional dominance of one tumor class with exclusion of other classes. During micrometastasis, tumor cells are detected binding to the endothelium of lung blood vessels, followed by establishment of multiple-cell micrometastases. Micrometastases in some organs are transient while in other organs there is differential expansion into overt metastases. Tagged tumors also reveal the timing of angiogenesis of developing primary tumors and overt metastases. In all three tumor systems, there are three classes of genetic stability of marker gene expression in clonal populations-high stability, intermediate stability, and high instability. Instability in marker gene expression in one tagged prostate carcinoma system does not depend on a hypermethylation mechanism, suggesting a genetic basis for loss of activity. Use of histochemical marker genes, combined with laser-capture microdissection and various PCR methods, can now be used to evaluate gene activities in single or multiple tumor cells in virtually any organ and primary tumor of the animal model system.

Post transplant CD8+ gammadelta T-cell lymphoma associated with human herpes virus-6 infection

Gammadelta T-cell lymphoma is a rare T-cell lymphoproliferative disorder that has been reported in both immunocompetent and immunocompromised persons. This report describes a forty eight year old patient who developed gammadelta T-cell lymphoma four years after undergoing living-related kidney transplantation. The lymphoma expressed CD2, CD3, CD7, CD8 and CD56, and the gammadelta T-cell receptor and did not express CD5, CD4 and the alphabeta T-cell receptor. In addition, HHV-6 was cultured from the patient's bone marrow, marking the first time that this virus has been associated with gammadelta T-cell lymphoma. Since all patients with gammadelta T-cell lymphoma described to date have responded poorly to standard combination chemotherapies, the patient was treated with the purine analogue 2-chlorodeoxyadenosine. While he responded transiently to treatment, long term remission was not achieved indicating that additional therapeutic approches still need to be developed, for the management of this disorder.

Efficacy of pelvic floor rehabilitation for treatment of genuine stress incontinence

To assess the clinical efficacy of a pelvic floor rehabilitation (PFR) program for treatment of genuine stress incontinence (GSI), we studied 72 patients with slight to moderate (2-10 g of urine loss per hour) or severe (11-50 g of urine loss per hour) GSI who underwent PFR. Objective and subjective assessments were performed before and 3, 6, 12, 18, and 24 months after the start of treatment. The overall success rate (complete cure or marked improvement in symptoms) was 61% (44/72) at the 2-year follow-up. The number of leakages per 24 hours and urine loss in the 1-hour pad test were significantly reduced, and vaginal muscle strength was significantly increased in successfully-treated patients. Significant changes were also observed in symptoms of micturition frequency and nocturia and in volume at first desire to void during cystometry in the treatment success group. Patient compliance with the exercise program was a significant predictor of success. The success rate during the 2-year follow-up period, estimated according to patient compliance, also differed significantly among groups, with good, moderate, and poor compliance. Patients experienced no serious adverse effects. These results show that the PFR program used in this study is an effective alternative to surgical intervention for the treatment of GSI in selected patients.

Fractal geometry in urodynamics of lower urinary tract

The physiological signals are usually extremely complicated and difficult to analyze. Recently, investigators have tried the fractal dimension that can characterize roughness and self-similarity of them. It turns out that it is also suitable for obtaining the modalities of lower urinary tract during normal micturition. In this investigation, the external urethral sphincter electromyogram (EUS EMG) and the cystometrogram (CMG) of the Wistar rats under both room temperature and cold water stimulation of the bladder are studied. The modified relative differential box-counting (RDBC) method is used to calculate the fractal dimensions of EMG and CMG time series. According to the experimental results, the modalities of micturition for the Wistar rats can be characterized as normal if both the fractal dimensions of EMG and CMG are of low values during voiding. Furthermore, the technique is validated in identifying the dyssynergia of the bladder and EUS under cold water stimulation.

Idiopathic thrombocytopenic purpura preceding malignant lymphoma: report of one case

Idiopathic thrombocytopenic purpura (ITP) preceding malignant lymphoma is a rare condition. Most cases occur simultaneously with lymphoma or after it has been diagnosed. The case of a child with idiopathic thrombocytopenic purpura recovered after prednisolone treatment, but lymphoma developed four months later. The pathogenesis for idiopathic thrombocytopenic purpura evolving into malignant lymphoma is still unknown and further study is necessary.

Development of adenoids: a study by measurement with MR images

Magnetic resonance (MR) imaging, which is able to demonstrate the actual size of adenoids by differentiating them from other soft-tissue structures, can be effectively used to study the normal development of adenoids. To assess the normal development of adenoids and to understand their role in the nasopharyngeal airway compromise, the adenoids of 290 children who had MR examination for other reasons were measured by midsagittal T1-weighted spin-echo MR image. The maximal thickness of adenoids (A), anteroposterior depth of the nasopharynx (N) and the adenoid-nasopharynx (A/N) ratios were obtained using this method. The results showed that of the infants under the age of 3 months only 2 out of 11 adenoids (18%) could be identified. By 4 months of age, adenoids could be identified in 6 of 8 infants (75%). After 5 months of age, all adenoids were well demonstrated by MR imaging. The adenoids developed rapidly during infancy and reached a plateau between 2- and 14 years of age with a mean thickness ranging from 10.7 to 12.2 mm. Finally, the adenoids regressed rapidly after 15 years old. The A/N ratios, which could be used to assess the airway compromise, had a plateau between 2- and 7 years of age. After that, with the steady growth of the nasopharynx, the possible role of adenoid in airway compromise will become increasingly less significant in later childhood.

Effects of ibuprofen on arylamine N-acetyltransferase activity in human colon tumor cells

The inhibition of arylamine N-acetyltransferase (NAT) activity by ibuprofen was determined in a human colon tumour (adenocarcinoma) cell line. Two assay systems were employed, one with cellular cytosols (9000 g supernatant) and the other with intact colon tumour cell suspensions. The NAT activity in a human colon tumour cell line was inhibited by ibuprofen in a dose-dependent manner in both systems, i.e. the greater the concentration of ibuprofen in the reaction, the greater the inhibition of NAT activities in both systems. The data also indicated that ibuprofen decreases the apparent Km and Vmax of NAT enzyme from human colon tumour cells in both systems examined. This report is the first demonstration to show that ibuprofen affects human colon tumour cell NAT activity.

Effect of pretreatment of rats with an urinary preparation on liver injuries induced by carbon tetrachloride and alpha-naphthylisothiocyanate

The effect of oral administration of a preparation of human urine (PHU) on the progression of acute liver injury was examined in rats intoxicated with carbon tetrachloride (CCl4) and alpha-naphthylisothiocyanate (ANIT) PHU protected the liver from CCl4-induced injury as judged by morphological and biochemical observations. In contrast, PHU aggravated ANIT-induced injury as judged also by morphological and biochemical observation. PHU prevented the increase in hepatic glutathione (GSH) and lipid peroxidation induced by CCl4. But PHU enhanced the increase in hepatic GSH caused by ANIT. These results indicate that the effect of PHU on hepatic GSH concentrations is through an indirect pathway. Clinical application of PHU on hepatitis should be explored further.