Treatment planning for brachytherapy: an integer programming model, two computational approaches and experiments with permanent prostate implant planning

An integer linear programming model is proposed as a framework for optimizing seed placement and dose distribution in brachytherapy treatment planning. The basic model involves using 0/1 indicator variables to describe the placement or non-placement of seeds in a prespecified three-dimensional grid of potential locations. The dose delivered to each point in a discretized representation of the diseased organ and neighbouring healthy tissue can then be modelled as a linear combination of the indicator variables. A system of linear constraints is imposed to attempt to keep the dose level at each point to within specified target bounds. Since it is physically impossible to satisfy all constraints simultaneously, each constraint uses a variable to either record when the target dose level is achieved, or to record the deviation from the desired level. These additional variables are embedded into an objective function to be optimized. Variations on this model are discussed and two computational approaches--a branch-and-bound algorithm and a genetic algorithm--for finding 'optimal' seed placements are described. Results of computational experiments on a collection of prostate cancer cases are reported. The results indicate that both optimization algorithms are capable of producing good solutions within 5 to 15 min, and that small variations in model parameters can have a measurable effect on the dose distribution of the resulting plans.

Morvan's fibrillary chorea: a paraneoplastic manifestation of thymoma

Morvan's fibrillary chorea is a rare disease characterised by symptoms which include neuromyotonia, cramping, weakness, pruritus, hyperhidrosis, insomnia, and delirium. The first case of Morvan's fibrillary chorea to be associated with clinical manifestations of myasthenia gravis with thymoma, psoriasis, and atopic dermatitis is reported. Muscle histopathology disclosed chronic denervation and myopathic changes and in vitro electrophysiology demonstrated both presynaptic and postsynaptic defects in neuromuscular transmission. Serum antibodies to acetylcholine receptors, titin, N-type calcium channels, and voltage gated potassium channels were detected. Plasmapheresis, thymectomy, and long term immunosuppression induced a dramatic resolution of symptoms. The association of thymoma with other autoimmune disorders and autoantibodies, and prolonged and sustained remission with chronic immunosuppression, place Morvan's fibrillary chorea on the range of neurological diseases arising as a paraneoplastic complication of cortical thymomas.

Tuberculin PPD RT23: has it lost some of its potency?

PPD RT23 is a tuberculin that is used worldwide. Korea has been using 1TU RT23 for its nationwide tuberculosis prevalence surveys at five-yearly intervals since 1965, and found a drop in its potency after the 1975 survey. This finding draws attention to the interpretation of tuberculin survey data observed with RT23 at different time periods.

Cohort analyses of the treatment of smear-positive pulmonary tuberculosis patients under programme conditions in Korea, 1983-1994

SETTING

Cohort analyses of the results of sputum smear-positive pulmonary tuberculosis patients registered in health centres in Korea under programme conditions from 1983 to 1994.

OBJECTIVE

To assess the overall treatment results and their annual changing trend.

DESIGN

Retrospective sample surveys of the nationwide treatment results of registered new smear-positive and retreatment patients.

RESULTS

The numbers of registered smear-positive pulmonary tuberculosis patients have decreased steadily, from over 35000 in 1983 to about 14000 in 1994. Over 90% of health centres, and 60-80% of registered patients, were covered in the cohort analyses. The overall cure rate for all patients was 56% in 1983; this improved to around 80% in the last three years of the period studied, owing to increased use of short-course chemotherapy. Over 5000 patients per year required retreatment during the first four years; this number decreased steadily to less than 700 in 1994, due to the reduction in initial treatment failures.

CONCLUSION

The overall treatment results have improved significantly in Korea, due to the application of short-course chemotherapy.

Generators of short latency human somatosensory-evoked potentials recorded over the spine and scalp

Somatosensory evoked potentials (SEPs) are most commonly obtained after stimulation of the median nerve and the posterior tibial nerve. SEPs reflect conduction of the afferent volley along the peripheral nerve, dorsal columns, and medial lemniscal pathways to the primary somatosensory cortex. Short-latency SEPs are recorded over the spine and scalp. After posterior tibial nerve stimulation, the following waveforms are recorded: N22, W3, the dorsal column volley, N29, P31, N34, and P37. After median nerve stimulation, the brachial plexus volley, dorsal column volley (N11), N13, P14, N18, N20, and P22 potentials are recorded. We discuss the current state of knowledge about the generators of these SEPs. Such information is crucial for proper interpretation of SEP abnormalities.

Somatostatin inhibits (d-Arg6, Pro9-NEt) salmon gonadotropin-releasing hormone- and dopamine D1-stimulated growth hormone release from perifused pituitary cells of chinese grass carp, ctenopharyngodon idellus

In this study, a heterologous radioimmunoassay (RIA) for grass carp GH has been validated and used to monitor the kinetics of GH release from perifused grass carp pituitary cells. To establish the anatomical specificity of GH antiserum used in this RIA, immunohistochemical staining was performed in grass carp pituitary sections. Somatotrophs recognized by this GH antiserum were located mainly in the proximal pars distalis without overlapping with gonadotrophs located in the same area or with lactotrophs located in the rostral pars distalis. The immunoreactivity of somatotrophs was abolished by preabsorbing GH antiserum with purified grass carp GH, suggesting that the possibility of a cross-reactivity of antiserum with other grass carp pituitary hormones is unlikely. Using 125I-labeled carp GH as the RIA tracer, parallelism was observed among the displacement curves of grass carp GH standard, grass carp serum, and culture medium conditioned by grass carp pituitary cells, suggesting that this RIA can be used to quantitate grass carp GH levels in biological samples. Using an in vitro column perifusion system, a superactive gonadotropin-releasing hormone (GnRH) analog (d-Arg6, Pro9-NEt)-sGnRH(sGnRHa, 0.3-30 nM), dopamine (DA, 0.1-10 muM), and the nonselective DA agonist apomorphine (0.1-10 muM) stimulated GH release from grass carp pituitary cells in a dose-dependent manner. The GH-releasing effect of DA was mimicked by the D1 agonists SKF38393 (0.1-10 muM) and SKF77434 (0.1-10 muM), but not by the D2 agonist LY171555 (3 muM). In addition, the GH response to DA (1 muM) was blocked by the D1 antagonist SCH23390 (5 muM) but not by the D2 antagonist (+/-) sulpiride (5 muM), suggesting that the GH-releasing action of DA is mediated through receptors resembling mammalian D1 receptors. Somatostatin-14 (SRIF14, 0.01-100 nM), unlike sGnRHa and DA, induced a dose-dependent suppression on basal GH release. At a high dose (100 nM), SRIF14 also abolished the GH responses to sGnRHa (100 nM), DA (10 muM), and the D1 agonist SKF38393 (3 muM). These results, as a whole, provide evidence that GH release in the grass carp is under the direct regulation of GnRH, DA, and SRIF at the pituitary cell level. The present study also suggests that DA D1 receptors are present in grass carp pituitary cells mediating the GH-releasing action of DA.

Cloning and sequencing of cDNA encoding bovine tumor necrosis factor (TNF)-receptor I

Tumor necrosis factor (TNF) is a multipotent cytokine produced by activated macrophages and lymphocytes and its activity is mediated by specific cell surface receptors, TNF-RI and TNF-RII. We have isolated and analyzed a cDNA encoding bovine TNF-RI gene and compared it with known TNF-RI sequences from other species. The cDNA sequence for the coding region of bovine TNF-RI shows 80% homology with porcine TNF-RI and 77% with human TNF-RI. The cDNA sequence of bovine TNF-RI codes for 471 amino acids and shows 75% and 67% identity with the amino acid sequences of porcine TNF-RI and human TNF-RI, respectively. The predicted bovine TNF-RI amino acid sequence consists of a signal peptide, an extracellular domain, a transmembrane region and a cytoplasmic tail. The extracellular region contains four repeated cysteine rich domains, which are conserved in all species. Northern blot results show that bovine TNF-RI gene is expressed in neutrophils and mononuclear leukocytes.

Expression of adhesion molecules on neutrophils of periparturient cows and neonatal calves

OBJECTIVE

To determine expression of the beta 2-integrin (CD18) family of adhesion molecules and L-selectin (CD62L) on neutrophils from periparturient cows and calves.

ANIMALS

8 periparturient Holstein cows and 9 Holstein calves.

PROCEDURE

Constitutive CD18 and CD62L expression on neutrophils was determined by flow cytometry, using specific monoclonal antibodies. Platelet-activating factor was used to activate neutrophils in vitro to measure down-regulation of CD62L and up-regulation of CD18 on activated neutrophils.

RESULTS

Mean values for constitutive and platelet-activating factor-stimulated CD18 expression on neutrophils from cows and calves were highest at parturition, then decreased during the first 24 hours after parturition on calf neutrophils, whereas CD62L expression decreased markedly by 9 to 24 hours after parturition on cow and calf neutrophils. Constitutive amounts of CD18 and CD62L on cow neutrophils returned to prepartum values by day 3 after parturition. Amounts of CD18 expression on calves' neutrophils recovered by 1 week of age, but did not reach original birth values, whereas CD62L expression exceeded birth values by day 3 after parturition. Cows had leukocytosis (neutrophilia), with a doubling of circulating neutrophils 9 hours after calving that was inversely correlated with CD62L expression on neutrophils.

CONCLUSIONS AND CLINICAL RELEVANCE

Low amounts of CD62L and CD18 on calf neutrophils and of CD62L on neutrophils from cows for several days after parturition may result in impaired inflammatory response. Low CD62L expression may contribute to increased susceptibility to disease.

The seventh nationwide tuberculosis prevalence survey in Korea, 1995

SETTING

Nationwide random sample survey for tuberculosis prevalence in Korea in 1995.

OBJECTIVE

To investigate the prevalence of tuberculosis infection, morbidity and drug resistance, and BCG coverage, and to compare the findings with those of the previous six surveys.

DESIGN

The following investigations were performed: tuberculin test, BCG scar screening, chest miniature radiography (70 x 70 mm) for those aged over five years, sputum direct smear, culture and drug susceptibility test, and a questionnaire to obtain history of antituberculosis chemotherapy and symptoms.

RESULTS

The coverages of the 1995 survey were as follows: tuberculin 87.0%, radiology 88.4%, bacteriology 98.3%. The observed tuberculin positivity (> or =10 mm in diameter) of subjects aged under 30 was 15.5%. The prevalence of pulmonary tuberculosis per 100000 has decreased in the last 30 years: direct smear positive from 686 to 93, smear and/or culture positive from 940 to 219, active tuberculosis from 5065 to 1032. Rates of drug resistance have also fallen: of those with no previous chemotherapy from 26.2% to 5.8%, of those with history of chemotherapy from 55.2% to 25.0%, and in total from 38.0% to 9.9%. BCG scar prevalence of infants (aged under one year) was 87.7%, and of those under 30 it was 91.8% in 1995.

CONCLUSION

Tuberculosis prevalences and the drug resistance rates have decreased significantly.

Molecular cloning of leukotactin-1: a novel human beta-chemokine, a chemoattractant for neutrophils, monocytes, and lymphocytes, and a potent agonist at CC chemokine receptors 1 and 3

A new member of human beta-chemokine cDNA was isolated and named leukotactin-1 (Lkn-1). Lkn-1, along with murine macrophage inflammatory protein-related protein-1 and -2, defines a subgroup of beta-chemokines based on two conserved cysteines in addition to the four others conserved in all beta-chemokines. The putative mature Lkn-1 is composed of 92 amino acids with a calculated m.w. of 10,162. The Lkn-1 gene was mapped to human chromosome 17, region q12. Recombinant Lkn-1 was a potent chemoattractant for neutrophils, monocytes, and lymphocytes and induced calcium flux in these cells. Lkn-1 specifically induced calcium flux in CCR1- and CCR3-expressing HOS cell lines. Lkn-1 suppressed colony formation by human granulocyte-macrophage, erythroid, and multipotential progenitor cells stimulated by combinations of growth factors. Hence, we have isolated and characterized a human C6 beta-chemokine that is a potent agonist at CCR1 and CCR3 and shows broad biologic activities, including leukocyte chemoattraction.

Molecular cloning of leukotactin-1: a novel human beta-chemokine, a chemoattractant for neutrophils, monocytes, and lymphocytes, and a potent agonist at CC chemokine receptors 1 and 3

A new member of human beta-chemokine cDNA was isolated and named leukotactin-1 (Lkn-1). Lkn-1, along with murine macrophage inflammatory protein-related protein-1 and -2, defines a subgroup of beta-chemokines based on two conserved cysteines in addition to the four others conserved in all beta-chemokines. The putative mature Lkn-1 is composed of 92 amino acids with a calculated m.w. of 10,162. The Lkn-1 gene was mapped to human chromosome 17, region q12. Recombinant Lkn-1 was a potent chemoattractant for neutrophils, monocytes, and lymphocytes and induced calcium flux in these cells. Lkn-1 specifically induced calcium flux in CCR1- and CCR3-expressing HOS cell lines. Lkn-1 suppressed colony formation by human granulocyte-macrophage, erythroid, and multipotential progenitor cells stimulated by combinations of growth factors. Hence, we have isolated and characterized a human C6 beta-chemokine that is a potent agonist at CCR1 and CCR3 and shows broad biologic activities, including leukocyte chemoattraction.

Involvement of cdc2-mediated phosphorylation in the cell cycle-dependent regulation of p185neu

We previously reported cell cycle-dependent negative regulation of p185neu (decreased tyrosine phosphorylation and kinase activity, with electrophoretic mobility retarded by serine/threonine phosphorylation) in M phase and the escape of mutation-activated p185neu* from this regulation. Our present results showed that retardation of electrophoretic mobility occurs independently of the cells' transformed status. We found that normal p185neu lost its ability to dimerize in the M phase. We demonstrated a physical association between cdc2 (a serine/threonine kinase, active in M phase) and p185neu. We showed that the carboxy terminal portion of p185neu is phosphorylated in vitro by cdc2. Many phosphopeptides (at least three phosphoserine residues) unique to the M phase were identified, and the in vivo and in vitro phosphopeptide patterns were superimposable. In contrast, mutation-activated p185neu* dimerized in the M phase with no changes in electrophoretic mobility, failed to associate with cdc2 and no unique phosphoserine residues could be identified in the M phase (data not shown), consistent with the escape of p185neu* from cell cycle-dependent regulation. Our results suggest that this escape is an intrinsic property of the mutation-activated p185neu* independent of its ability to transform cells. Our results also suggest the involvement of serine/threonine kinases such as cdc2 in the cell cycle-dependent negative regulation of p185neu.

A screening method of SH2 domain ligands and blockers using a solid phase binding

We have developed a high throughput screening method for SH2 domain binding ligands and blockers. This method measures directly the binding of a 3H-labeled phosphopeptide derived from the sequence around tyrosine317 in the human Shc (SpYVNVK) to the SH2 domain of Grb2, which is precoated as glutathione S-transferase fusion proteins on solid phase. The optimum concentration for the fusion protein coating was 300 ng/100 microl/well for SH2 domain binding. Although an 8-h incubation at 4 degrees C for the coating of fusion protein was required to reach a maximum binding, even a 2-h coating produced 84% of the maximum binding. Saturation of ligand peptide binding in our assay system was observed at 10 pmol/well for the SH2 domain. However, 2 pmol/well showed consistent and reproducible results for the binding when the incubations were performed for 8 h at 4 degrees C. Competitive binding inhibition studies with various unlabeled phosphopeptides imply that the binding assay is highly specific to peptide sequences and able to screen possible ligands or blockers of signal transduction pathway mediated by Grb2 SH2 binding. In conclusion, our new method for SH2 domain binding is easy, rapid, and most of all inexpensive. These advantages over existing assay methods make this method especially suitable for a high throughput application, such as the screening for anticancer drug candidates.

Mitosis-specific negative regulation of epidermal growth factor receptor, triggered by a decrease in ligand binding and dimerization, can be overcome by overexpression of receptor

The function of epidermal growth factor receptor (EGFR) was found to be negatively regulated in M phase in which it showed less phosphotyrosine content and reduced intrinsic kinase activity accompanied by retarded electrophoretic mobility owing to total hyperphosphorylation. Ligand-induced autophosphorylation and downstream signaling of EGFR were tightly suppressed in M phase due to a decrease in ligand binding affinity and the inability of epidermal growth factor (EGF) to induce receptor dimerization. There was no change in the number of surface-exposed EGF receptors between G0/G1 and M phases of the cell cycle. Hyperphosphorylation (due to serine and/or threonine phosphorylation) correlates with the unresponsiveness of cells to EGF-mediated stimulation of tyrosine phosphorylation in cells that express the normal or basal level of EGFR. This M phase-specific negative regulation was overcome by overexpression of EGFR, which was responsive to ligand throughout the cell cycle and revealed ligand-induced signaling in the M phase. These findings indicate that EGFR does not respond to ligand stimulation in M phase and suggest that a negative regulation of ligand-receptor interactions in M phase may control the normal function of receptor tyrosine kinase and that receptor overexpression will disrupt this cell cycle-dependent regulation of receptor tyrosine kinases.

Role of antiribosomal P protein antibodies in the diagnosis of lupus isolated to the central nervous system

BACKGROUND

When lupus presents with isolated central nervous system findings, the usual serologic markers are often absent and diagnostic difficulty with a delay in treatment is common.

OBJECTIVE

To report the usefulness of antiribosomal P protein antibodies in the diagnosis of lupus isolated to the central nervous system when results of tests for anti-double-stranded DNA antibodies are negative.

DESIGN

Case report.

SETTING

University medical center.

PATIENT

The patient was evaluated and treated on referral and follow up for 1 year.

RESULTS

We describe a patient with acute onset of psychosis followed by coma and focal clonic movements with undetectable DNA antibodies. Serum antiribosomal P protein antibody levels were elevated. Steroid therapy was followed by marked clinical improvement and a decrease in antibody titer.

CONCLUSION

Antiribosomal P protein antibodies provide an important confirmatory test for the diagnosis of lupus isolated to the central nervous system when results of tests for anti-double-stranded DNA antibodies are negative.

Mixed integer programming optimization models for brachytherapy treatment planning

Mixed integer programming is proposed as an approach for generating treatment plans for brachytherapy. Two related but distinct, mixed integer programming models are tested on data from eight prostate cancer patients. The results demonstrate that in some cases, "good" treatment plans can be obtained in less than five CPU minutes.

Bacterial growth, inflammatory cytokine production, and neutrophil recruitment during coliform mastitis in cows within ten days after calving, compared with cows at midlactation

OBJECTIVE

To define causes of increased susceptibility to coliform mastitis after parturition.

ANIMALS

12 healthy Holstein cows assigned to 2 groups. Group-1 cows (n = 6) had calved between 6 and 10 days earlier. Group-2 cows (n = 6) were in midlactation.

PROCEDURE

Cows from each group were paired and challenge exposed with Escherichia coli in 1 mammary gland. Mastitis severity was determined by bacterial concentration in milk, pyrexia, and milk production. Measures of host defense were neutrophil chemotaxis, adhesion molecule expression, leukocyte recruitment, and cytokine production.

RESULTS

After challenge exposure, group-1 cows had more rapid E coli growth, higher peak bacterial concentration, and higher fever. Leukocyte recruitment was poor in 1 group-1 cow that had peracute mastitis. In contrast, leukocyte recruitment in 5 other group-1 cows began sooner than that in group-2 cows. In these group-1 cows, prechallenge-exposure milk somatic cell counts (SCC) were significantly lower than those in group-2 cows. Prechallenge-exposure SCC were correlated to stimulated CD18 expression (R2 = 0.79), and both measures correlated inversely with bacterial growth rate (R2 = -0.75). Values for tumor necrosis factor alpha, interleukin 1, and interleukin 8 in group-1 cows after challenge exposure were greater than or equal to those in group-2 cows.

CONCLUSIONS

Weak leukocyte recruitment to the mammary gland is associated with increased severity of coliform mastitis. Impaired production of cytokines measured is not a cause of increased susceptibility to coliform mastitis in early lactation.

CLINICAL RELEVANCE

Low milk SCC after calving may increase susceptibility to severe coliform mastitis.

Cloning and sequencing of a cDNA encoding bovine intercellular adhesion molecule 3 (ICAM-3)

A cDNA encoding a putative bovine intercellular adhesion molecule (ICAM)-3, a ligand of the leukocyte integrin LFA-1 (CD11a/CD18), was sequenced and compared with human ICAM sequences. The 1635-bp bovine sequence codes for a protein of 544 amino acids (aa). This putative bovine ICAM-3 has five immunoglobulin (Ig)-like domains similar to human ICAM-1 and ICAM-3, and belongs to the Ig gene superfamily. The overall identities of the deduced aa sequence with those of human ICAM-3 and ICAM-1 are 61% and 58%, respectively. The predicted number and positions of Cys residues are all conserved between the bovine and human ICAM 3 aa sequences.

Overexpression and simple purification of a truncated, immunologically reactive GST-HCV core (1-123) fusion protein

A full-length and a truncated gene for the core protein of hepatitis C virus (HCV) were linked to the gene for glutathione S-transferase (GST), and the expression of each GST-HCV core fusion protein was analyzed. The truncated GST-HCV core (1-123) fusion protein was expressed as a mostly soluble and partly insoluble form comprising more than 50% of the total protein in Escherichia coli after induction by isopropylthio-beta-D-galactoside (IPTG), while the full length GST-HCV core (1-191) fusion protein was not expressed, suggesting that the hydrophobic carboxy terminal region in the core protein affects its expression. In addition, the GST-HCV core (1-123) fusion protein purified by GST-agarose chromatography reacted specifically with an anti-HCV serum from a patient.

An optimization model for constrained discriminant analysis and numerical experiments with iris, thyroid, and heart disease datasets

A nonlinear 0/1 mixed integer programming model is presented for a constrained discriminant analysis problem. The model enables controlling misclassification probabilities by placing restrictions on the numbers of misclassifications allowed among the training entities and incorporating a "reserved-judgment" region to which entities whose classifications are difficult to determine may be allocated. A linearization of the model is given, and preliminary numerical results for two medical and one non medical domain are presented.