Estradiol inhibits transcription of the human glycoprotein hormone alpha-subunit gene despite the absence of a high affinity binding site for estrogen receptor

Chronic administration of estradiol inhibits transcription of the gene encoding the alpha-subunit of pituitary glycoprotein hormones. Here, we show, using transfection analyses and a filter binding assay, that 1500 basepairs of proximal 5' flanking sequence of the human alpha-subunit gene lack a functional estrogen response element when transfected into heterologous cell lines, and fail to bind estrogen receptor purified from calf uterus. Yet, this same region of the alpha-subunit gene confers estradiol responsiveness (transcriptional suppression) to the bacterial chloramphenicol acetyltransferase gene in transgenic mice. A smaller promoter fragment of the bovine alpha-subunit gene also confers responsiveness to estradiol in transgenic mice, suggesting that the same element may mediate the steroid responsiveness of both promoters. Furthermore, regulation by estradiol of the chimeric human or bovine alpha-chloramphenicol acetyltransferase genes is pituitary specific, underscoring the physiological significance of these studies. Based on these results, we conclude that estradiol regulates expression of the alpha-subunit gene in vivo through a mechanism that does not involve high affinity binding of estrogen receptor to the alpha-subunit gene. Whether this mechanism is manifest at the level of the pituitary or hypothalamus remains to be determined.

Pancreatic secretion of zinc and copper in normal subjects and in patients with chronic pancreatitis

Pancreatic secretion of zinc and copper in duodenal juice were measured in 7 healthy persons and in 9 patients with chronic pancreatitis. Stimulation with cholecystokinin and secretin increased secretion of zinc in healthy persons but not in patients. Copper secretion was not influenced. In patients with chronic pancreatitis, the correlations between zinc secretion, and amylase and trypsin secretion were significant while in healthy subjects they were not. Possibly pancreatic zinc secretion in the duodenal juice might be used as a measure of exogenic pancreatic function, and determination of zinc in duodenal juice may replace enzyme determinations in the diagnosis of chronic pancreatitis.

A cis-acting element located between the cAMP response elements and CCAAT box augments cell-specific expression of the glycoprotein hormone alpha subunit gene

Several cis-acting elements interact through their cognate trans-acting factors to confer placenta-specific expression to the alpha subunit gene of glycoprotein hormones. These elements include two tandemly arranged cAMP response elements (CREs, located between base pairs (bp) -146 and -111 relative to the transcription start site), an upstream regulatory element (URE, located between -180 and -150), and a CCAAT box (located between bp -100 and -80). Here, we identify a new regulatory region, junctional regulatory element (JRE), with critical nucleotides located between the CREs and CCAAT box (bp -120 to -100). Although the binding site of the JRE abuts the 3' CRE, methylation interference assays indicate that no overlap occurs between the contact points of the proteins that bind to the JRE and CRE. This new regulatory element is highly conserved across species and contains a palindromic binding site for a 50-kDa nuclear factor(s) which is distinct from the factors that bind the URE, CRE, and CCAAT box of the alpha subunit gene. Finally, gene transfer studies suggest that, although JRE binding activity is found in several cell types, this element acts relatively cell-specifically. We conclude that this element and its cognate trans-acting factor act in conjunction with the complexes formed over the URE, CREs, and CCAAT box to enhance the placenta-specific activity of the alpha subunit promoter.

Ethanol in pancreatic juice after oral and intravenous administration

Six patients with a drain in the main pancreatic duct were studied. Ethanol was given orally with individually adjusted doses aiming at a blood value of 0.8/1000 (17.6 mmol/l). Concentrations of ethanol in venous blood and pancreatic juice were recorded for three hours. Similar studies were made when ethanol was administered as an intravenous priming dose followed by a maintenance infusion. After orally administered ethanol, pancreatic juice values were higher than those in blood for a short period of time. The relations between median concentrations and time were incongruous curves consistent with a significant treatment by time interaction. Intravenous administration resulted in a similar pattern, but the interaction was not statistically significant. These findings indicate that the human pancreas may secrete ethanol.

Randomized double-blind comparison of tolfenamic acid and paracetamol in migraine

In a double-blind cross-over study we compared tolfenamic acid with paracetamol in out-patients with common migraine (migraine without aura). Each patient was treated during (at least) 4 attacks with one of the following alternatives: tolfenamic acid 200 mg, tolfenamic acid 400 mg, paracetamol 500 mg or paracetamol 1000 mg in a randomized sequence. The same sequence of treatments was applied to (preferably) 4 more attacks. Dosage was repeated after 2 h if the attack had not abated. Escape medication was allowed after 4 h if the treatment was inefficient. A total of 83 patients were admitted to the study, but 3 dropped out, while 10 completed less than 4 attacks. Seventy completed 4 attacks, and 58 completed all 8. The total number of attacks treated was 545. We found a significant superiority of tolfenamic acid over paracetamol with regard to effect on pain after 2 h (p less than 0.01), patients' global evaluation (p less than 0.001), and use of escape medication (p less than 0.02). The trend was the same for duration of attacks, confinement to bed during attack and nausea, but the results were not statistically significant. There was no significant difference between the smaller and the larger dose of either drug nor between the need for escape medication, although the trend favoured tolfenamic acid. Side effects were few. Tolfenamic acid is evidently valuable in treatment of migraine.

The human alpha subunit glycoprotein hormone gene utilizes a unique CCAAT binding factor

Placenta-specific expression of the gene encoding the alpha subunit of glycoprotein hormones involves the interaction of at least two different cis-acting elements: the upstream regulatory element (URE), which binds a placenta-specific trans-acting factor; and two tandem cAMP-response elements (CREs), which bind a ubiquitous protein (CRE-binding protein). To identify additional elements required for promoter activity, we used block replacement mutagenesis to produce a series of 10-base pair transversion mutations throughout the proximal promoter-regulatory region of the human alpha subunit gene. Transient expression of these constructs in choriocarcinoma cells enabled the identification of several closely spaced transcriptional control elements in addition to the previously identified URE and CREs. Gel mobility shift assays, methylation interference analyses, and UV cross-linking permitted identification of a factor that binds specifically to a canonical CCAAT box contained within the proximal promoter-regulatory of the human alpha subunit gene. This factor, which we refer to as alpha subunit CCAAT-binding factor (alpha CBF), is found in a variety of cell types and appears to be distinct from the previously characterized CCAAT-binding factors CTF/NF1, C/EBP, CP1, and NF-Y. We suggest that interaction of alpha CBF with factors binding to the URE and CREs may be required for maximal activity of the alpha subunit promoter in placental cells.

Amplification of the transcriptional signal mediated by the tandem cAMP response elements of the glycoprotein hormone alpha-subunit gene occurs through several distinct mechanisms

cAMP stimulates transcription of the human glycoprotein hormone alpha-subunit gene in choriocarcinoma cells. Combined treatment with phorbol esters potentiates this effect. Tandem cAMP response elements (CREs) in the proximal 5'-flanking sequence mediate the effect of cAMP. In this report, we show that the CREs can also mediate the synergistic effect of phorbol esters. In addition to serving as an inducible cis-acting element, the two CREs act synergistically to increase basal transcription. We now provide direct evidence via equilibrium binding studies that tandem CREs bind their trans-acting factors cooperatively. However, the level of cooperativity is insufficient to explain the high degree of transcriptional synergism, suggesting that another element in the alpha-subunit promoter may be required for complete synergism. In support of this hypothesis, we show that synergism is drastically reduced when the CREs are removed from the context of their native promoter and linked to a heterologous promoter. Thus, amplification of the transcriptional signal mediated by the tandem CREs occurs through at least three distinct mechanisms. First, at the level of signal transduction by convergence of the A- and C-kinase pathways; second, through homotropic interactions of trans-acting factors binding to tandem CREs; and finally through heterotropic interaction of the two CREs with another, as yet, undefined cis-acting element(s) in the human alpha-subunit promoter.

Effects of beta-carotene repletion on beta-carotene absorption, lipid peroxidation, and neutrophil superoxide formation in young men

The chemopreventive effects of beta-carotene are usually attributed to its antioxidant properties. To determine the effects of beta-carotene supplementation on different parameters of oxidative metabolism, 15 normal young male subjects (18-30 yrs) were placed on a carotenoid-free liquid diet for two weeks prior to entry into the study. Blood was then measured for five carotenoids, retinol, retinyl palmitate, retinol-binding protein, alpha-tocopherol, vitamin C, zinc, lipid peroxides, and neutrophil superoxide production. Absorption tests were performed with 15 mg of beta-carotene to determine absorption curves for each subject. Subjects were then divided into two groups and given either 15 (n = 7) or 120 (n = 8) mg of beta-carotene daily for four weeks along with the same carotenoid-free liquid diet. The absorption test and the blood measurements were repeated. After repletion with beta-carotene, serum lipid peroxide levels decreased in both groups (p less than 0.05), but no other changes were noted in either the neutrophil superoxide production or in the levels of any of the vitamins measured. In contrast to vitamin E, the superoxide scavenging ability of beta-carotene apparently does not contribute to its effects in lowering serum lipid peroxide levels.

Salicylazosulfapyridine (Salazopyrin) effect on endotoxin-induced production of interleukin-1-like factor from human monocytes in vitro

Monocytes (M phi) were simultaneously preincubated with salicylazosulfapyridine (Salazopyrin) (SAZ), 0.78-12.5 mM, and lipopolysaccharide from E. coli, 1 X 10(-9) g/ml. Presence of SAZ resulted in a dose-dependent decrease in the co-stimulatory activity in M phi culture supernatants, corresponding to a 50% reduction by SAZ, 2.0 mM. Co-stimulatory activity was estimated by the mitogen-induced thymocyte proliferation assay (THY assay). The results indicate an inhibitory effect of SAZ in vitro on the production of IL-1 and other possible co-stimulatory factors. This inhibitory effect was not due to decreased M phi viability, production of suppressive substances, or to drug interference with the THY assay. Equimolar preincubations with sulfapyridine, 5-aminosalicylic acid and N-acety-1-5-aminosalicylic acid were without effect on the production of co-stimulatory factors.

Bromazepam in generalized anxiety. Randomized, multi-practice comparisons with both chlorprothixene and placebo

Bromazepam was compared with placebo and with chlorprothixene in a randomized, double-blind group-comparative multicenter trial in general practice. Two hundred and forty-five patients with generalized anxiety disorder (DSM-III 1980) were treated for 2 weeks with two daily doses of bromazepam, 3 mg or chlorprothixene, 15 mg or placebo. Median reductions in Hamilton Anxiety rating were 12 (bromazepam), 10.3 (chlorprothixene) and 7.3 (placebo). The study revealed significant superiority of bromazepam over placebo (median differences 3.3, 95% confidence limits: 0.3 and 6.1) but not over chlorprothixene (median difference 1.4, 95% confidence limits -0.8 and +3.5). Significantly higher rates of tiredness, sedation and hypersomnia were found on bromazepam and chlorprothixene compared to placebo. Tolerance was rated as "at least good" in 85.6% on bromazepam, in 86% on chlorprothixene and in 87.8% on placebo. Neither previous psychopharmacological treatment nor presence of psychosocial stress were of perceptible influence. Bromazepam and chlorprothixene are both superior to placebo in generalized anxiety states treated in general practice, but spontaneous improvements/placebo effects are substantial.

The diagnosis of ruptured breast implants

This study is a retrospective review of 18 patients treated by the authors and 14 reported patients with ruptured breast implants. A history of trauma was absent in 11 patients; 17 patients had closed capsulotomies. The physical findings of ruptured implants were nodules, decreased breast size, asymmetry, tenderness, and a softer texture. Mammograms were 90 percent accurate when silicone had migrated. In seven of eight false-negative mammograms, silicone was contained within the fibrous capsule. Mammography signs of rupture are summarized. The diagnosis of ruptured implants should be facilitated by recognition of the clinical presentations and radiographic signs.

Dissociation of changes in plasma cholesterol and hepatic cholesterol synthesis, assessed by precursors in bile, after jejunoileal bypass with 3:1 and 1:3 jejunoileal ratio

Hepatic cholesterol synthesis, assessed by the biliary content of post-squalene cholesterol precursors relative to cholesterol, was related to fasting plasma cholesterol fractions in obese patients before (n = 7) and after jejunoileal bypass surgery with either a 3:1 ratio (n = 15) or a 1:3 ratio (n = 14) between jejunum and ileum left in function. The content of precursors increased after bypass surgery, and more so with a 3:1 than with a 1:3 jejunoileal ratio. However, the two types of bypass resulted in similar reductions in plasma concentrations of total cholesterol and low-density lipoprotein cholesterol. Within the unoperated group and the 3:1 bypass group the precursor content and plasma cholesterol levels were, as expected, inversely correlated, but within the 1:3 bypass group there were either weaker or even positive correlations. These findings suggest that the link between stimulation of hepatic cholesterol synthesis and reduction in plasma cholesterol may depend on the length of jejunum and ileum left in function.

Expression of the glycoprotein hormone alpha-subunit gene in the placenta requires a functional cyclic AMP response element, whereas a different cis-acting element mediates pituitary-specific expression

The single-copy gene encoding the alpha subunit of glycoprotein hormones is expressed in the pituitaries of all mammals and in the placentas of only primates and horses. We have systematically analyzed the promoter-regulatory elements of the human and bovine alpha-subunit genes to elucidate the molecular mechanisms underlying their divergent patterns of tissue-specific expression. This analysis entailed the use of transient expression assays in a chorionic gonadotropin-secreting human choriocarcinoma cell line, protein-DNA binding assays, and expression of chimeric forms of human or bovine alpha subunit genes in transgenic mice. From the results, we conclude that placental expression of the human alpha-subunit gene requires a functional cyclic AMP response element (CRE) that is present as a tandem repeat in the promoter-regulatory region. In contrast, the promoter-regulatory region of the bovine alpha-subunit gene, as well as of the rat and mouse genes, was found to contain a single CRE homolog that differed from its human counterpart by a single nucleotide. This difference substantially reduced the binding affinity of the bovine CRE homolog for the nuclear protein that bound to the human alpha CRE and thereby rendered the bovine alpha-subunit promoter inactive in human choriocarcinoma cells. However, conversion of the bovine alpha CRE homolog to an authentic alpha CRE restored activity to the bovine alpha-subunit promoter in choriocarcinoma cells. Similarly, a human but not a bovine alpha transgene was expressed in placenta in transgenic mice. Thus, placenta-specific expression of the human alpha-subunit gene may be the consequence of the recent evolution of a functional CRE. Expression of the human alpha transgene in mouse placenta further suggests that evolution of placenta-specific trans-acting factors preceded the appearance of this element. Finally, in contrast to their divergent patterns of placental expression, both the human and bovine alpha-subunit transgenes were expressed in mouse pituitary, indicating differences in the composition of the enhancers required for pituitary- and placenta-specific expression.

CRE-binding proteins interact cooperatively to enhance placental-specific expression of the glycoprotein hormone alpha-subunit gene

The 18-bp direct repeat occurring between positions -146 and -111 in the 5'-flanking region of the human alpha-subunit gene serves two functions: it mediates the transcriptional effect of cAMP and it acts in conjunction with an adjacent cis-acting element (URE) to confer properties of placental-specific expression to the alpha-subunit promoter. Functional activity of the URE and CRE requires binding of a trans-acting factor; each element binds a different factor. Analysis of saturation isotherms provides good evidence that cooperativity is involved in binding of CREB to the 18-bp direct repeat. This cooperativity could account for the synergistic effect of two CRE on both basal and cAMP-stimulated transcription. It remains to be determined whether heterotropic cooperativity is involved in binding of trans-acting factors to the URE and CRE. A major difference between the 5'-flanking region of the human alpha-subunit gene and comparable regions from bovine, rat, and mouse alpha-subunit genes is that the latter contain a single CRE homolog which appears incapable of binding the trans-acting factor that binds to the human alpha CRE. Lack of a functional CRE provides at least one explanation for inactivity of the bovine alpha-subunit promoter in choriocarcinoma cells and probably in bovine placenta as well. Yet, the same bovine promoter-regulatory region that lacks a functional CRE is capable of conferring pituitary-specific expression to the CAT gene in transgenic mice (data not shown). This suggests that the CRE is not required for pituitary-specific expression of the bovine alpha-subunit gene. Instead, another cis-acting element(s) must confer this property to the alpha-subunit promoter. While it is tempting to suggest that bovine, rat, and mouse alpha-subunit genes are not regulated by cAMP because of their inactive CRE homolog, it is also quite possible that other CRE are located further upstream. Accordingly, it will be of interest to obtain additional 5'-flanking sequence and determine whether functional homologs of the human alpha CRE are present in the bovine, rat, and mouse alpha-subunit genes, or whether another class of cis-acting elements provide cAMP-responsiveness.

Assessment of pain: a comparison between patients and doctors

In a trial based on 52 patients admitted because of acute abdominal pain, we compared the assessment of pain intensity by doctors and patients according to a visual analogue scale. We found significant differences with regard to the median score of the doctors (3.4 cm) compared to the patients (6.1 cm). The correlation was 0.64 while the differences in dispersion were insignificant. Our findings indicate that it is far from unimportant who makes the pain assessment--the patient who experiences it or the doctor who evaluates it--but they also suggest that the differences could be a matter of scaling.

Counselors' reports of their use of self-disclosure with clients

Ninety-six counselors indicated the frequency of their use of 11 types of self-disclosure, which varied in intimacy from incidental information (age, race) to personal weaknesses. Positive emotional responses to clients were used most frequently, and opinions/attitudes were used least frequently. A factor analysis showed three factors to describe the data best. Factor 1 was represented by information related to the personal identify and experiences of the therapist. Factor 2 involved the emotional responses of the therapist to the client. Factor 3 was principally the disclosure of professional experiences and identity. Implications are considered.

Karyotype analysis of regenerated plants from callus cultures of interspecific hybrids of cultivated barley (Hordeum vulgare L.)

The karyotype of 82 regenerated plants from callus cultures of interspecific hybrids between cultivated barley (Hordeum vulgare L.) and seven polyploid wild barley species was examined by C-banding or Feulgen staining. The karyotypic changes observed in 46 plants included aneuploidy, double haploidy, amphidiploidy, deletions, inversions, extra C-bands, and extra euchromatic segments. Apparently, chromosome 5, 6, and 7 of H. vulgare were more frequently exposed to elimination or structural change than the other chromosomes of this species. Irradiation of calli seemed to enhance the occurrence of karyotypic variants.

Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study

From November, 1985, to June, 1988, 1007 outpatients with chronic non-rheumatic atrial fibrillation (AF) entered a randomised trial; 335 received anticoagulation with warfarin openly, and in a double-blind study 336 received aspirin 75 mg once daily and 336 placebo. Each patient was followed up for 2 years or until termination of the trial. The primary endpoint was a thromboembolic complication (stroke, transient cerebral ischaemic attack, or embolic complications to the viscera and extremities). The secondary endpoint was death. The incidence of thromboembolic complications and vascular mortality were significantly lower in the warfarin group than in the aspirin and placebo groups, which did not differ significantly. 5 patients on warfarin had thromboembolic complications compared with 20 patients on aspirin and 21 on placebo. 21 patients on warfarin were withdrawn because of non-fatal bleeding complications compared with 2 on aspirin and none on placebo. Thus, anticoagulation therapy with warfarin can be recommended to prevent thromboembolic complications in patients with chronic non-rheumatic AF.

[Scientific articles in Ugeskrift for Laeger during a 25-year period. Types of articles and experimental design]

The purpose of this study was to examine possible trends in the research designs used in Ugeskrift for Laeger during 25 years. The scientific articles in 12 issues of the journal selected at random from each of the years 1959, 1964, 1969, 1974, 1979, and 1984 were reviewed. From each article, the following information was obtained: type of article (original paper, case report, or review), origin of the paper and number of authors. For the original papers, it was noted whether it was a longitudinal or a cross-sectional study, and whether it was a cohort or a trohoc study. Furthermore the number of subjects and the use of control group, randomization and blinding were registered. The number of articles and the number of authors per article increased during the period. Contrary to similar studies of some widely circulated English-language journals, we could not demonstrate any increase of the frequency of studies with weak research design. On the other hand, no striking improvement was observed either. Most studies had no control group and randomization and blinding were used in less than 10% of the original papers. The present study does not permit an evaluation of whether the research designs used i Ugeskrift for Laeger are satisfactory.

[Scientific articles in Ugeskrift for Laeger during a 25-year period. Analysis and interpretation of research results]

During a period of 25 years from 1959 to 1984, no essential alteration in the employment of descriptive statistics was observed in the original articles in the Ugeskrift whereas analytical statistics was employed to an increasing extent. In all of these volumes, defective, incorrect or less suitable employment of statistics could be demonstrated. Common problems were: analyses of materials in which some patients participated once while others participated on several occasions; debatable analyses of data on ranking scales; employment of 2-group tests on several groups; insufficient analysis of cross-over trials; lack of confidence intervals, and circular reasoning.

Serum selenium and zinc concentrations in morbid obesity. Comparison of controls and patients with jejunoileal bypass

The concentrations of serum selenium and zinc (both in micromoles per litre) were determined in 18 patients 5-12 years after jejunoileal bypass and in 13 controls with untreated morbid obesity. Selenium concentrations were significantly lower in the operated patients than among controls, whereas there was no significant difference with regard to zinc. Ninety-five per cent confidence limits for the median difference between pre- and post-operative concentrations were 0.03-0.41 with regard to selenium and -0.3 to 2.7 with regard to zinc. Even though little is known about the clinical consequences of chronic selenium deficiency, substitution might prove beneficial.