Chemotherapy for prostate cancer

Androgen deprivation in patients with metastatic prostate cancer produces palliation of symptoms, reduction in PSA levels, and temporary regression of tumor in most patients. Following a brief period of disease regression that lasts an average of eighteen to twenty-four months, the disease becomes hormone refractory and progresses. Second line hormonal manipulation includes anti-androgen withdrawal, glucocorticoids, estrogens, aminogluthetimide, and ketoconazole. The response from these drugs is usually very short. Once these measures have been exhausted, the clinician is left with limited treatment options that include radionuclides and cytotoxic chemotherapy. It is the objective of this article to review the experience with chemotherapy in prostate cancer and then to discuss the role of radionuclide agents, emerging agents, and herbal therapies.

194 ESTABLISHMENT OF GOAT EMBRYONIC STEM CELL-LIKE LINES DERIVED FROM IN VIVO-PRODUCED BLASTOCYST-STAGE EMBRYOS

Pluripotent embryonic stem cells (ESC) derived from the inner cell mass (ICM) of mammalian blastocysts provide AN unlimited number of cells that can be used in gene targeting and be of great value to agriculture and medicine. Embryonic stem cells with capacity for germ line transmission have been verified only in mouse despite many efforts to derive ESC from other mammalian species. The methods for the derivation, propagation and differentiation of ESC from domestic animals have not been fully established. The objective of this study was the generation and initial characterization of goat embryonic stem cells (GESC) derived from in vivo-produced blastocyst-stage embryos. Goat compact morulae and blastocysts were collected from superovulated adult Saanen crossbreed donors 7 days after insemination with a fertile male. Embryos were collected by uterine flushing using a 12Fr. Foley catheter by means of a laparoscopically assisted mid-ventral laparotomy under general anesthesia. Twenty eight in vivo-derived blastosyst-stage embryos were cultured on a goat fetal fibroblast feeder layer (inactivated by Mitomycin C) in a medium of DMEM containing 0.1 mm �-mercaptoethanol, 0.1 mm MEM nonessential amino acids, 200 mm l-glutamine, and 10% FCS. Following three days in culture 25 of 28 embryos hatched. Ten embryos attached to the feeder layer, nine degenerated, and nine embryos were floating in the medium and expanding in size. After 5-7 days in culture four of the tehn attached embryos appeared with a prominent an ICM outgrowth and 3 of the nine floating embryos formed structures resembling ICM disc surrounded by trophectoderm cells. The ICM and the embryonic discs were isolated mechanically and cultured on goat feeder cells in DMEM medium containing 10 ng/mL horse leukemia inhibitory factor (hLIF) and 10% FCS. The ICM and embryonic disc outgrew into colonies on Day 4 post-culture. Compact colonies of cells from these outgrowths were isolated mechanically and passed onto fresh goat feeder cells every 4-5 days with the addition of 10 ng/mL hLIF to the culture media. Established colonies at passage 6 were tested for immunoreactivity against alkaline phosphatase (AP) and Oct-1 using standard protocols. The result was the estabilshment of embryonic stem cell-like colonies (57%) from both ICM and embryonic discs cultured on goat fetal fibroblast feeder cells. Colonies forming from these outgrowths (50%) of either ICM or embryonic disc stained positive for both AP and Oct-4. Embryoid bodies formed from colonies of either ICM or embryonic disc in suspension (DMEM containing 10% FCS with no hLIF). Two cell lines (one from ICM and one from embryonic disc) have been maintained so far through passage 8 and have been cryopreserved. These GESC-like lines will be used in further characterization and ultimately in transgenic animal production studies.

Improved outcome for children with disseminated adenoviral infection following allogeneic stem cell transplantation

Adenovirus (AdV) infections are a frequent cause of morbidity and mortality following allogeneic stem cell transplantation (SCT), and disseminated infection is associated with high mortality, particularly in paediatric SCT. Here, we describe an approach to reduce mortality from adenoviraemia by combining prospective monitoring for the occurrence of adenoviraemia using a sensitive polymerase chain reaction method, early antiviral therapy and prompt withdrawal of immunosuppression. A total of 155 consecutive paediatric SCT procedures were prospectively monitored, of which 113 (73%) transplants involved donors other than matched siblings and 126 (83%) employed T-cell depletion. Adenoviraemia was detected in 26/155 (17%) transplants and developed exclusively in patients who had received T-cell-depleted grafts. Withdrawal of immunosuppression coupled with early antiviral therapy led to resolution of adenoviraemia in 19/26 (81%) patients with only five patients succumbing to disseminate AdV infection. Survival from adenoviraemia was associated with lymphocyte recovery to above 0.3x10(9)/l. Mortality was closely linked with the absence of lymphocyte recovery because of profound T-cell depletion of the graft with CD34+ magnetic-activated cell sorting. Mortality from disseminated AdV infection was 5/26 (19%) in this study, which is significantly lower than previously reported.

Stem cell transplantation for congenital immunodeficiencies using reduced-intensity conditioning

The optimal preparation for stem cell transplantation (SCT) in children with congenital immunodeficiencies is currently unknown. In all, 81 children with immunodeficiency underwent 82 SCTs using reduced-intensity conditioning (RIC). The incidence of significant GVHD was low; viral reactivation was prominent with an unexpected increase in EBV reactivation; immune reconstitution was similar between different donor groups and comparable to conventional SCT. Overall, 68/81 (84%) survive with no significant difference between donor types or between severe combined immunodeficiency (SCID) and non-SCID diseases. Findings suggest a significant survival advantage in the unrelated donor setting for RIC compared to conventional SCT.

28PREGNANCIES RESULTED FROM GOAT NT EMBRYOS PRODUCED BY FUSING COUPLETS IN THE PRESENCE OF LECTIN

The procedure of nuclear transfer (NT) using somatic cells remains inefficient partly due to low fusion rates between donor cells and recipient ooplasm. Lectin is a glycoprotein which specifically binds to carbohydrates to induce a tight contact of membrane to membrane (Booth et al., 2001 Cloning and Stem Cells, 3, 139–159). The purpose of this study was to examine the fusion rates and developmental competence of NT embryos following pre-incubation of couplets in medium containing lectin prior to electrical pulsing. Oocytes were collected by laparoscopic ovum pick-up from hormonally primed goats or by aspiration from culled goat ovaries, and cultured for maturation at 38.5°C, 5% CO2. At approximately 24h after the onset of IVM, the cumulus cells were stripped off by brief vortexing in medium containing 0.2% hyaluronidase. Oocytes with first polar bodies were selected for NT. Successful enucleation was confirmed by the absence of MII chromosomes in ooplasm by means of brief exposure of the Hoechst 33342-stained oocytes to UV light. Three cumulus-granulosa cell lines from transgenic goats were used as donor cells. They were cultured to confluency in DMEM+20% FCS for 6 days prior to NT. Individual donor cells were transferred into the perivitelline space of the enucleated oocytes. Couplets were incubated for 15 minutes in TCM199+10% FCS containing 75 or 150μgmL−1 lectin (L-9132 Sigma, St.Louis, MO, USA) prior to being subjected to electrical pulsing (lectin treatment) with one DC pulse at 2.4kV/cm (1st pulsing). The fusion rate was determined 40–60 minutes after the 1st electric pulsing. Non-fused couplets were exposed to a 2nd pulsing. Approximately 30 minutes later, non-fused couplets were exposed to a 3rd pulsing. Couplets without the lectin treatment served as controls. Reconstructed embryos were activated with 5μM ionomycin followed by 5h of incubation in 10μgmL−1 cycloheximide with 7.5μgmL−1 cytochalasin B. A group of 10 to 13 embryos was transferred into a recipient after 12 to 14h of culture in G1.3. Statistical analysis was performed using the χ2 analysis. Results are shown in the following table. This study demonstrated that fusion rate could be improved by pre-incubating couplets in the medium containing 150μgmL−1 lectin prior to electrical pulsing and the embryos derived from the lectin treatment could establish the early pregnancies.

Activation of the murine interleukin-12 p40 promoter by functional interactions between NFAT and ICSBP

Interleukin (IL)-12 is a heterodimeric cytokine that is critical for the development of a T-helper-1 immune response and immunity against intracellular pathogens. The IL-12 p40 gene product, expressed specifically in macrophages and dendritic cells, heterodimerizes with p35 to form bioactive IL-12, and heterodimerizes with p19 to comprise the cytokine IL-23. Regulation of the murine IL-12 p40 promoter is complex. Multiple cis-acting elements have been characterized that are involved in activation by bacterial products. However, molecular mechanisms through which interferon (IFN)-gamma and bacterial products synergistically activate IL-12 p40 gene expression are less clear. In this study, a composite NFAT/ICSBP binding site at -68 to -54 is identified that is functionally important for p40 promoter activation by lipopolysaccharide (LPS) and LPS plus IFN-gamma. DNA binding of NFAT and ICSBP is demonstrated on the endogenous promoter by chromatin immunoprecipitation. NFAT is required for ICSBP binding to this region. Overexpression of NFAT and ICSBP synergistically activates the p40 promoter. A dominant negative NFAT molecule attenuates LPS- and IFN-gamma-activated endogenous IL-12 p40 mRNA expression. A physical association between NFAT and ICSBP in the absence of DNA is detected by co-immunoprecipitation of endogenous proteins. Three NFAT domains are required for ICSBP interaction. Finally, in LPS- and IFN-gamma-activated RAW-264.7 cells, the association between NFAT and ICSBP is abrogated by IL-10 priming.

Blastocystis hominis--an emerging cause of diarrhoea in renal transplant recipients

Blastocystis hominis is an intestinal protozoan that is emerging as an important cause of diarrhea in the immunosuppressed population. We report two cases of diarrhea caused by this organism in renal transplant recipients. The infection was diagnosed promptly by careful stool examination and treated successfully with metronidazole. These case report highlights the fact that unusual parasites like Blastocystis hominis should be looked for and treated in cases of diarrhea occurring in renal transplant recipients. This reduces the rate of post-transplant morbidity and mortality.

Productivity losses from injury in China

OBJECTIVE

To examine the productivity losses and costs of injury and disease in China using an improved approach.

METHODS

Potentially productive years of life lost (PPYLL) were calculated for injury and four major disease groups (respiratory, cardiovascular, infectious, neoplastic).

DATA SOURCES

The mortality data are from the 1999 National Health Statistics Report and the morbidity data from the 1998 Second National Health Service Survey Report.

RESULTS

Injuries caused an annual PPYLL of 12.6 million years, more than for any disease group. The estimated annual economic cost of injury is equivalent to US dollars 12.5 billion, almost four times the total public health services budget of China. Motor vehicle fatalities accounted for 25% of the total PPYLL from all injury deaths.

CONCLUSION

Injury control and prevention programs merit priority to reflect the social and economic burden of injury in China.

Religious coping and psychological wellbeing in carers of relatives with schizophrenia

OBJECTIVE

To examine the use of religious coping and its relation to psychological wellbeing in carers of relatives with schizophrenia.

METHOD

Sixty carers of patients with an ICD-10 diagnosis of schizophrenia, were assessed on strength of religious belief, perceived burden, religious and other coping strategies and psychological wellbeing.

RESULTS

Coping strategies of denial and problem solving, strength of religious belief and perceived burden were significant predictors of wellbeing.

CONCLUSION

Strength of religious belief plays an important role in helping family members to cope with the stress of caring for a mentally ill relative. In addition to psychoeducation and problem solving coping, the role of religious coping in enhancing wellbeing of carers needs to be considered in family intervention programmes.

The role of half-transporters in multidrug resistance

ATP-binding cassette proteins comprise a superfamily of transporter proteins, a subset of which have been implicated in multidrug resistance. Although P-glycoprotein was described over 15 years ago, the recent expansion in the number of transporters identified has prompted renewed interest in the role of drug transporters in clinical drug resistance. These newly identified transporters include additional members of the MRP family, ABC2, and a new half-transporter, MXR/BCRP/ABCP1. This half-transporter confers high levels of resistance to mitoxantrone, anthracyclines, and the camptothecins SN-38 and topotecan. At 72 kDa, MXR localizes to the plasma membrane in cells which highly overexpress the protein either through gene amplification or though gene rearrangement. Future studies will be aimed at identifying an inhibitor, and attempting to translate recognition of this new transporter into a target for anticancer treatment.

Changing access to health services in urban China: implications for equity

The ongoing reform of public institutions and state-owned enterprises in urban China has had a profound impact on the financing, organization and provision of health services. Access to health care by the urban population has become more inequitable. One of the most pressing concerns is that those who have lost jobs have increasing difficulties accessing health care. Using the data from the national household health surveys conducted in 1993 and 1998, this paper presents empirical results of changing utilization of health care among different income groups. Over 16 000 households and 54 000 individuals in the urban areas were randomly selected to collect information on perceived need of and demand for health care and expenditures on the services. The findings show that the income gap between the highest and lowest income groups increased in real terms from 1993 to 1998. There was a significant decline in the population covered by the government insurance scheme (GIS) and the labour insurance scheme (LIS), while the proportion of the population who had to pay for services out-of-pocket increased from 28% in 1993 to 44% in 1998. There was no statistically significant change in self-reported illness in the 2 weeks prior to survey among the study population over the period. While it was found that more people who reported illness from each income group received medical treatment of some kind, there was a decline in seeking care from a health provider. Among those in the lowest income group who reported illness but did not obtain treatment of any kind, nearly 70% (as compared with 38% in 1993) claimed financial difficulty as the major reason in 1998. The use of in-patient services dropped significantly from 4.5% in 1993 to 3.0% in 1998. The decreased use of in-patient services was more serious in the lowest and lower income groups than in higher and highest income groups. The percentage of patients referred for hospital admission but not being hospitalized had a negative relationship with income level. We can conclude from the data analysis that access of the urban population, particularly the poor, to formal health services has worsened and become more inequitable since the early 1990s. Among possible reasons for this trend are the rapid rise of per capita expenditure on health services and the decline in insurance coverage.

Fatal graft-versus-host disease following HLA-mismatched donor lymphocyte infusion

We report the case of a 10-year-old boy with molecular relapse of CML following unrelated donor BMT who developed fatal grade 4 acute GVHD of the gut and liver following one antigen-mismatched donor lymphocyte infusion. Previous experience of donor lymphocyte infusion in the HLA-mismatched setting is reviewed and the role of adoptive immunotherapy in this situation is discussed.

Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy

BACKGROUND

Peripartum cardiomyopathy is a rare and sometimes fatal form of heart failure. Little is known about the outcomes of subsequent pregnancies in women who have had the disorder.

METHODS

Through a survey of members of the American College of Cardiology, we identified 44 women who had had peripartum cardiomyopathy and had a total of 60 subsequent pregnancies. We then reviewed the medical records of these women and interviewed the women or their physicians.

RESULTS

Among the first subsequent pregnancies in the 44 women, 28 occurred in women in whom left ventricular function had returned to normal (group 1) and 16 occurred in women with persistent left ventricular dysfunction (group 2). The pregnancies were associated with a reduction in the mean (+/-SD) left ventricular ejection fraction both in the total cohort (from 49+/-12 percent to 42+/-13 percent, P<0.001) and in each group separately (from 56+/-7 percent to 49+/-10 percent in group 1, P=0.002; and from 36+/-9 percent to 32+/-11 percent in group 2, P=0.08). During these pregnancies, a decrease of more than 20 percent in the left ventricular ejection fraction occurred in 21 percent of the women in group 1 and 25 percent of those in group 2, and symptoms of heart failure occurred in 21 percent of the women in group 1 and 44 percent of those in group 2. The mortality rate was 0 percent in group 1 and 19 percent in group 2 (P=0.06). In addition, the frequency of premature delivery was higher in group 2 (37 percent vs. 11 percent), as was that of therapeutic abortions (25 percent vs. 4 percent).

CONCLUSIONS

Subsequent pregnancy in women with a history of peripartum cardiomyopathy is associated with a significant decrease in left ventricular function and can result in clinical deterioration and even death.

[The curative effect of livostin spray on treating allergic rhinitis of children]

OBJECTIVE

To observe the effect of Livostin spray on children's allergic rhinitis and to search the mechanism of treating allergic rhinitis.

METHOD

113 patients were treated with Livostin spray (Livostin group) or normal saline spray (control group).

RESULT

The total efficiency of Livostin group in treating allergic rhinitis is above 95.1% and that of the control group is 25.0%. Initial time of starting effect of Livostin (72.1%) is in 1 minute, and that of the control group (mostly 23.1%) is in 3 minutes. The keeping curative effect time of Livostin spray is mostly (72.1%) above 5 hours and that of the control group is mostly (30.8%) in 3 hours. After 2 weeks, the eosinophilic granulocyte number in nose's secretion of Livostin group is obviously reduced (P < 0.05).

CONCLUSION

Livostin is better than control group in relieving symptoms, keeping curative effect and safety, so Livostin is one kind of effective drug in treating children's allergic rhinitis.