Development of a new in vitro model for the study of benign prostatic hyperplasia

BACKGROUND

The search for novel agents for the treatment of the lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) is dependent on an increased understanding of the pathophysiology of the disease. Unfortunately, in vitro and animal models have been of limited value.

METHODS

This article describes a novel model system in which the interactions of the stromal and epithelial components of the prostate gland can be determined.

RESULTS

The coculture system provides a simple model of the cellular interactions occurring in the adult human prostate.

CONCLUSIONS

This coculture system could potentially be used to determine the precise molecular site of action of agents such as terazosin on prostatic apoptosis.

Initial sequencing and analysis of the human genome

The human genome holds an extraordinary trove of information about human development, physiology, medicine and evolution. Here we report the results of an international collaboration to produce and make freely available a draft sequence of the human genome. We also present an initial analysis of the data, describing some of the insights that can be gleaned from the sequence.

Long-term results of combined-modality therapy for locally advanced breast cancer with ipsilateral supraclavicular metastases: The University of Texas M.D. Anderson Cancer Center experience

PURPOSE

To determine outcomes in local-regional control, disease-free survival, and overall survival in patients with locally advanced breast cancer (LABC) who present with ipsilateral supraclavicular metastases and who are treated with combined-modality therapy.

PATIENTS AND METHODS

Seventy patients with regional stage IV LABC, which is defined by our institution as LABC with ipsilateral supraclavicular adenopathy without evidence of distant disease, received treatment on three prospective trials of neoadjuvant chemotherapy. All patients received neoadjuvant chemotherapy with cyclophosphamide, doxorubicin, and fluorouracil, or cyclophosphamide, doxorubicin, vincristine, and prednisone. Patients then received local therapy that consisted of either total mastectomy and axillary lymph node dissection (ALND) or segmental mastectomy and ALND before or after irradiation. Patients with no response to neoadjuvant chemotherapy were treated with surgery and/or radiotherapy. After completion of local therapy, chemotherapy was continued for four to 15 cycles, followed by radiotherapy. Patients older than 50 years who had estrogen receptor-positive tumors received tamoxifen for 5 years.

RESULTS

Median follow-up was 11.6 years (range, 4.8 to 22.6 years). Disease-free survival rates at 5 and 10 years were 34% and 32%, respectively. The median disease-free survival was 1.9 years. Overall survival rates at 5 and 10 years were 41% and 31%, respectively. The median overall survival was 3.5 years. The overall response rate (partial and complete responses) to induction chemotherapy was 89%. No treatment-related deaths occurred.

CONCLUSION

Patients with ipsilateral supraclavicular metastases but no other evidence of distant metastases warrant therapy administered with curative intent, ie, combined-modality therapy consisting of chemotherapy, surgery, and radiotherapy. Patients with ipsilateral supraclavicular metastases should be included in the stage IIIB category of the tumor-node-metastasis classification because their clinical course and prognosis are similar to those of patients with stage IIIB LABC.

Prevalence of asthma and other allergic diseases in an adolescent population: association with gender and race

OBJECTIVES

To estimate the prevalence and severity of asthma in an adolescent population by sex and race.

METHODS

Cross-sectional, population-based survey of school children.

SETTING

Midwestern city experiencing damage from the 1993 Mississippi River flood.

PARTICIPANTS

2,693 children attending grades 7 to 12.

MEASUREMENTS

Questions from the International Study of Asthma and Allergies in Childhood (ISAAC).

RESULTS

Two thousand six hundred ninety-three children were surveyed, for a response rate of 90%. In this population, 16.4% reported having ever been diagnosed with asthma; 25% reported wheezing in the last 12 months; 32% reported symptoms of rhinitis in the last 12 months; and 22% reported ever having hay fever. The prevalence rate for current asthma was 12.6%. Female students had significantly greater prevalence rates for current asthma (16.4% vs 9.0%, OR = 1.85); ever-diagnosed asthma (18.5% vs 14.3%, OR = 1.36); wheezing > or = 4 times in the last 12 months (12.0% vs 5.6%, OR = 1.95); current rhinitis (38.7% vs 25.4%, OR = 1.73); and hay fever (26.4% vs 18.4%, OR = 1.57). All associations with sex remained significant, except ever-diagnosed asthma, after controlling for other known risk factors in logistic regression. African-Americans had higher prevalence rates than other races with differences reaching statistical significance for ever-diagnosed asthma and current asthma; however, these relationships did not remain significant after controlling for other known risk factors in logistic regression.

CONCLUSIONS

Our prevalence rates were similar to those reported by other studies that used the ISAAC questionnaire. Female students reported significantly more asthma, wheezing, rhinitis, and hay fever than male students. Female students also reported more severe symptoms and a greater number of emergency room and hospital admissions.

Challenges and directions for Medicare ESRD payment policy

Since the inception of the ESRD program in 1973, Medicare has been challenged to provide access to high-quality care to beneficiaries with ESRD while trying to contain program payments. Despite implementing policies to control the growth in spending for outpatient dialysis and shifting the risk of certain ESRD beneficiaries to private payers, annual ESRD program payments have grown faster than overall Medicare spending. Some stakeholders contend that these policies have adversely affected beneficiaries' access to high-quality care. Refining the payment systems for caring for beneficiaries with ESRD in traditional Medicare and managed care plans may provide some respite to the growth in ESRD program spending in the short-term. In the long run, ESRD program spending may not be effectively controlled until changes are made in the delivery of health care services to this population.

People focus on optimistic scenarios and disregard pessimistic scenarios while predicting task completion times

Task completion plans normally resemble best-case scenarios and yield overly optimistic predictions of completion times. The authors induced participants to generate more pessimistic scenarios and examined completion predictions. Participants described a pessimistic scenario of task completion either alone or with an optimistic scenario. Pessimistic scenarios did not affect predictions or accuracy and were consistently rated less plausible than optimistic scenarios (Experiments 1-3). Experiment 4 independently manipulated scenario plausibility and optimism. Plausibility moderated the impact of optimistic, but not pessimistic, scenarios. Experiment 5 supported a motivational explanation of the tendency to disregard pessimistic scenarios regardless of their plausibility. People took pessimistic scenarios into account when predicting someone else's completion times. The authors conclude that pessimistic-scenario generation may not be an effective debiasing technique for personal predictions.

Melting of the rare earth metals and f-electron delocalization

Melting curves for Pr, Nd, Sm, Gd, and Y were measured in a diamond-anvil-cell to nearly 100 GPa and 4000 K. f-electron volume collapses are observed as triple points for Pr (24 GPa and 1400 K) and Gd (65 GPa and 3100 K). These pressures coincide with the volume collapses observed at room temperature. For Nd and Sm, the f-electron volume collapse has not been observed at room temperature but appears at approximately 2000-2500 K as a broad minimum in the melting curve, similar to that of Ce, near 50 GPa (Nd) and 70 GPa (Sm). The melting curve of Y goes smoothly along the entire rare earth sequence.

People focus on optimistic scenarios and disregard pessimistic scenarios while predicting task completion times

Task completion plans normally resemble best-case scenarios and yield overly optimistic predictions of completion times. The authors induced participants to generate more pessimistic scenarios and examined completion predictions. Participants described a pessimistic scenario of task completion either alone or with an optimistic scenario. Pessimistic scenarios did not affect predictions or accuracy and were consistently rated less plausible than optimistic scenarios (Experiments 1-3). Experiment 4 independently manipulated scenario plausibility and optimism. Plausibility moderated the impact of optimistic, but not pessimistic, scenarios. Experiment 5 supported a motivational explanation of the tendency to disregard pessimistic scenarios regardless of their plausibility. People took pessimistic scenarios into account when predicting someone else's completion times. The authors conclude that pessimistic-scenario generation may not be an effective debiasing technique for personal predictions.

The selectivity and specificity of the actions of the lipido-sterolic extract of Serenoa repens (Permixon) on the prostate

PURPOSE

To investigate the effects of the phytotherapeutic agent, Permixon(R), on primary cultures of fibroblast and epithelial cells from the prostate, epididymis, testes, kidney, skin and breast and to determine the selectivity and specificity of the action of the drug.

MATERIALS AND METHODS

All primary cultures were examined by electron microscopy before and following treatment with Permixon(R) (10 microg./ml.). In addition the apoptotic index was assessed by flow cytometry employing propidium iodide as a fluorophore. The impact of the drug on 5alpha-reductase (5alphaR) isoenzymes was also tested utilizing a pH specific assay.

RESULTS

There were changes in the morphology of prostate cells after treatment including accumulation of lipid in the cytoplasm and damage to the nuclear and mitochondrial membranes; no similar changes were observed in other cells. Permixon(R) increased the apoptotic index for prostate epithelial cells by 35% and 12% in the prostate stromal/fibroblast. A lesser apoptotic effect was demonstrated in skin fibroblast (3%) whereas none of the other primary cultures showed any increase in apoptosis when compared with the controls. Permixon(R) was also an effective inhibitor of both 5alphaR type I and II isoenzymes in prostate cells, but other cells showed no inhibition of 5alphaR activity following treatment with the plant extract.

CONCLUSIONS

This investigation demonstrated the selectivity of the action of Permixon(R) for prostate cells. The morphological changes in the prostate are accompanied by an increase in the apoptotic index along with an inhibition in the activity of the nuclear membrane bound 5alphaR isoenzymes. No similar changes were observed in any of the other cells under investigation.

Factors controlling the expression of 5alpha-reductase in human prostate: A possible new approach for the treatment of prostate cancer

The functional activity of the 5alpha-reductase isoenzyme in the human prostate is gradually depleted as the gland undergoes transformation from the normal to the metastatic state. There are two isoforms of this enzyme expressed in the prostate and recent studies have demonstrated that the type II isoenzyme is the one most affected by the onset of neoplasia. To elucidate the mechanism(s) responsible for the down-regulation of the isoenzyme activity, we re-examined the nature of the interaction between stroma and epithelial cells in the human prostate. We noted that the control of the isoenzyme expression in the epithelial cells was regulated by a paracrine factor specific to the prostate fibroblast. In the absence of this factor the human prostate loses its capacity to express the 5alpha-reductase type II isoenzyme - a characteristic manifested simultaneously with the loss of differentiation in the tissues. This finding presents a totally new concept to the control of 5alpha-reductase in the human prostate and offers a possibility for an interesting and alternative approach to the management of prostate cancer.

Formation of three-dimensional protein-lipid aggregates in monolayer films induced by surfactant protein B

This study focuses on the structural organization of surfactant protein B (SP-B) containing lipid monolayers. The artificial system is composed of the saturated phospholipids dipalmitoylphosphatidylcholine (DPPC) and dipalmitoylphosphatidylglycerol (DPPG) in a molar ratio of 4:1 with 0.2 mol% SP-B. The different "squeeze-out" structures of SP-B were visualized by scanning probe microscopy and compared with structures formed by SP-C. Particularly, the morphology and material properties of mixed monolayers containing 0.2 mol% SP-B in a wide pressure range of 10 to 54 mN/m were investigated revealing that filamentous domain boundaries occur at intermediate surface pressure (15-30 mN/m), while disc-like protrusions prevail at elevated pressure (50-54 mN/m). In contrast, SP-C containing lipid monolayers exhibit large flat protrusions composed of stacked bilayers in the plateau region (app. 52 mN/m) of the pressure-area isotherm. By using different scanning probe techniques (lateral force microscopy, force modulation, phase imaging) it was shown that SP-B is dissolved in the liquid expanded rather than in the liquid condensed phase of the monolayer. Although artificial, the investigation of this system contributes to further understanding of the function of lung surfactant in the alveolus.

Analysis of lung surfactant model systems with time-of-flight secondary ion mass spectrometry

An often-used model lung surfactant containing dipalmitoylphosphatidylcholine (DPPC), dipalmitoylphosphatidylglycerol (DPPG), and the surfactant protein C (SP-C) was analyzed as Langmuir-Blodgett film by spatially resolved time-of-flight secondary ion mass spectrometry (TOF-SIMS) to directly visualize the formation and composition of domains. Binary lipid and lipid/SP-C systems were probed for comparison. TOF-SIMS spectra revealed positive secondary ions (SI) characteristic for DPPC and SP-C, but not for DPPG. SI mapping results in images with domain structures in DPPC/DPPG and DPPG/SP-C, but not in DPPC/SP-C films. We are able to distinguish between the fluid and condensed areas probably due to a matrix effect. These findings correspond with other imaging techniques, fluorescence light microscopy (FLM), scanning force microscopy (SFM), and silver decoration. The ternary mixture DPPC/DPPG/SP-C transferred from the collapse region exhibited SP-C-rich domains surrounding pure lipid areas. The results obtained are in full accordance with our earlier SFM picture of layered protrusions that serve as a compressed reservoir for surfactant material during expansion. Our study demonstrates once more that SP-C plays a unique role in the respiration process.

The frequency of temporal-self and social comparisons in people's personal appraisals

Although past literature emphasizes the importance of social comparisons, in this study it was predicted that participants would often mention temporal comparisons in their self-descriptions. The first 3 studies revealed that participants report as many or more temporal-past comparisons than social comparisons. It was predicted that people would particularly favor temporal-past comparisons when they are interested in enhancing themselves. Temporal-past comparisons are gratifying, because they tend to indicate improvement over time. Social comparisons may be preferred when people are motivated to evaluate themselves accurately. These predictions were supported when self-evaluation and self-enhancement goals were explicitly manipulated (Study 4) or primed (Study 5).

Aetiology, outcome, and risk factors for mortality among adults with acute pneumonia in Kenya

BACKGROUND

Despite a substantial disease burden, there is little descriptive epidemiology of acute pneumonia in sub-Saharan Africa. We did this study to define the aetiology of acute pneumonia, to estimate mortality at convalescence, and to analyse mortality risk-factors.

METHODS

We studied 281 Kenyan adults who presented to two public hospitals (one urban and one rural) with acute radiologically confirmed pneumonia during 1994-96. We did blood and lung-aspirate cultures, mycobacterial cultures, serotype-specific pneumococcal antigen detection, and serology for viral and atypical agents.

FINDINGS

Aetiology was defined in 182 (65%) patients. Streptococcus pneumoniae was the most common causative agent, being found in 129 (46%) cases; Mycobacterium tuberculosis was found in 26 (9%). Of 255 patients followed up for at least 3 weeks, 25 (10%) died at a median age of 33 years. In multivariate analyses, risk or protective factors for mortality were age (odds ratio 1.51 per decade [95% CI 1.04-2.19]), unemployment (4.42 [1.21-16.1]), visiting a traditional healer (5.26 [1.67-16.5]), visiting a pharmacy (0.30 [0.10-0.91]), heart rate (1.64 per 10 beats [1.24-2.16]), and herpes labialis (15.4 [2.22-107]). HIV-1 seropositivity, found in 52%, was not associated with mortality. Death or failure to recover after 3 weeks was more common in patients with pneumococci of intermediate resistance to benzylpenicillin, which comprised 28% of pneumococcal isolates, than in those infected with susceptible pneumococci (5.60 [1.33-23.6]).

INTERPRETATION

We suggest that tuberculosis is a sufficiently common cause of acute pneumonia in Kenyan adults to justify routine sputum culture, and that treatment with benzylpenicillin remains appropriate for clinical failure due to M. tuberculosis, intermediate-resistant pneumococci, and other bacterial pathogens. However, interventions restricted to hospital management will fail to decrease mortality associated with socioeconomic, educational, and behavioural factors.

Perceived compliance with AZT dosing among a sample of African-American drug users

The purpose of this report was to present findings from a pilot study conducted to explore the associations between sociodemographic, drug use, and health belief factors and perceived compliance with zidovudine (AZT) among African-American drug users. Data were collected in Washington, DC, USA from individuals who were African-American; were recent or current drug injectors or crack smokers; were HIV-seropositive, and were receiving treatment for HIV infection. Participants were recruited through local organizations that provide services to HIV-infected persons. Participants were interviewed using a questionnaire that solicited sociodemographic, lifetime and current drug use, current sexual behaviours, health status, HIV and drug treatment history, and health belief data. Analyses were limited to individuals currently using an illicit substance and who had received AZT during their medical treatment. Parametric (Pearson's r) and nonparametric (Spearman's rho) statistics were used to assess correlations between perceived compliance with AZT dosing and independent variables. As the study was intended to be both descriptive and exploratory, the level of statistical significance was set at 0.10, rather than the customary 0.05. Antiretroviral medications recognized and recalled by participants are presented. The most commonly recalled medication was AZT. Slightly less than one-third of participants reported being completely compliant with an AZT regimen. Perceived compliance was found to be negatively associated with 5 variables: age, homelessness, number of injections in the previous 30 days, trading sex for drugs, and the perception that AIDS is no longer a serious disease since the development of new antiretroviral medications. Intensity of feelings of joy, fear, and the belief that taking more anti-HIV medications would result in better health were found to be positively correlated. Bivariate associations between perceived compliance and sociodemographic, drug use, sexual behaviour, and health belief variables suggest further avenues of study and potential points for intervention to increase compliance with antiretroviral medications among racial/ethnic minority drug users receiving treatment for HIV infection.

Breath-hold 3D MR angiography of the renal vasculature using a contrast-enhanced multiecho gradient-echo technique

OBJECTIVE

Significant evolution of contrast-enhanced MR angiography for evaluating vascular diseases in the abdomen has occurred during the past several years. The state-of-the-art gradient-echo imaging technique employs a short echo time (TE) and a short repetition time (TR) for rapid vascular imaging with contrast-enhanced MR angiography. However, because of the short TR (< or = 3-8 msec), the background stationary tissue becomes saturated, with resultant poor contrast resolution of visceral organs. The authors present a new approach to vascular imaging using a multiecho gradient-echo technique with a TR sufficiently long (41 msec) to image the renal vasculature and parenchyma without background tissue suppression.

METHODS

Twenty-four partitions (3D slab thickness = 72 mm) with an in-plane resolution of 224 x 256 were obtained in 21 seconds. Three measurements were performed with an interscan delay of 8 seconds. In the pulse sequence, the partition loop is defined as the innermost loop, in which Kz views are acquired centrically for a fixed Ky, followed by Ky views in a conventional linear or sequential order. The partition encodings are segmented to permit multiple encodings in which two TR loops were used to span a total of 24 echoes with 12 along the positive and 12 along the negative direction in k space. A large bandwidth of 650 Hz/pixel was used to keep the echo train length short, with an echo spacing of 1.86 msec. A frequency-selective fat saturation pulse was placed before slab-selective excitation. The other parameters in the pulse sequence were TR/TE/flip = 41/2.2/45; the field of view was 360 to 390 mm. Maximum intensity projections of each 3D contrast-enhanced measurement were performed. The vascular-to-background contrast, bowel-related magnetic susceptibility artifact, and background stationary signals were subjectively graded. The authors examined the utility of this technique in 16 randomly selected patients (3 normal, 13 abnormal) with varied renal vasculature and parenchymal abnormalities. Results were confirmed with conventional x-ray angiography, surgery, or clinical follow-up.

RESULTS

Vascular-to-background contrast was graded as very good (grade III/III) in all cases. The bowel-related magnetic susceptibility artifacts were not considered significant. Background visceral organ soft tissue contrast was not suppressed and was graded as good (grade III/III) in all cases. Eight hemodynamically significant (> 50% diameter) stenoses in seven patients were accurately assessed (one with fibromuscular dysplasia). Three patients with renal masses (two with renal cell carcinoma and one with renal lymphoma) were accurately assessed for arterial anatomy and venous extension. Other renal venous abnormalities seen were retroaortic renal vein (n = 1), chronic occlusion (n = 1), and accessories (total of five) (n = 1).

CONCLUSIONS

Rapid breath-hold contrast-enhanced MR angiography of the renal vasculature with a multiecho gradient-echo using a long TR depicted the renal vasculature with high vessel-to-background contrast without significant bowel-related susceptibility artifact and without background visceral organ tissue signal suppression, resulting in high background soft tissue contrast resolution.

Cyclosporine, methotrexate, and prednisone compared with cyclosporine and prednisone for prevention of acute graft-vs.-host disease: effect on chronic graft-vs.-host disease and long-term survival

Graft-vs.-host disease (GVHD) is a major predictor of outcome following allogeneic bone marrow transplantation (BMT). For patients alive at day 100 after BMT, the presence or absence of chronic GVHD is one of the most important determinants of survival and quality of life. We wished to determine the effects on chronic GVHD of two regimens used for the prophylaxis of acute GVHD: cyclosporine, methotrexate, and prednisone (CSA/MTX/PSE) and cyclosporine and prednisone (CSA/PSE). One hundred forty-nine evaluable patients were entered into the acute GVHD study. As of 31 March 1997, 63 months after the last patient underwent BMT, the median survival time was 4.5 years (range 0.09-9.9). The incidence of chronic GVHD was independent of the prophylactic regimen (55 vs. 54%), and extensive chronic GVHD occurred in 25 and 24% of patients receiving CSA/MTX/PSE and CSA/PSE, respectively. Of note, the median Karnofsky performance status of both groups was 100% (range 70-100%), reflecting the low incidence of extensive chronic GVHD. Survival rates free of chronic GVHD were 52 vs. 42% (p = 0.29) for patients receiving CSA/MTX/PSE vs. CSA/PSE. The incidence of relapse was also similar in both groups of patients. These data suggest that the combinations of CSA/MTX/PSE and CSA/PSE result in comparable chronic GVHD-free survival without an increase in leukemic relapse.