Modelling of ultraviolet light inactivation kinetics of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, Clostridium difficile spores and murine norovirus on fomite surfaces

AIMS

Quantitative data on the doses needed to inactivate micro-organisms on fomites are not available for ultraviolet applications. The goal of this study was to determine the doses of UV light needed to reduce bacteria and murine norovirus (MNV) on hard surface fomites through experimentation and to identify appropriate models for predicting targeted levels of reduction.

METHODS AND RESULTS

Stainless steel and Formica laminate coupons were selected as they are common surfaces found in healthcare settings. Test organisms included methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), Clostridium difficile and MNV. The fomites were inoculated with 10⁵ -10⁷ bacteria or virus and exposed to a range of UV doses. The order of resistance to UV irradiation was virus, bacterial spore and vegetative cell. The best fitting inactivation curves suggested nonlinear responses to increasing doses after a 3-4 log reduction in the test organisms. The average UV doses required for a 3 log reduction in the C. difficile, MRSA and VRE were 16 000, 6164 and 11 228 (mJ-s cm^-2 ) for stainless steel, respectively, and 16 000, 11 727 and 12 441 (mJ-s cm^-2 ) for Formica laminate, respectively.

CONCLUSIONS

Higher UV light doses are required to inactivate bacteria and viruses on hard surfaces than in suspension. Greater doses are needed to inactivate bacterial spores and MNV compared to vegetative bacteria.

SIGNIFICANCE AND IMPACT OF THE STUDY

Quantitative data and models on UV light doses needed to inactivate bacteria and MNV on hard surfaces are now available. The generalizable results of this study can be used to estimate required UV dosages to achieve targeted levels of inactivation based on estimated levels of contamination or to support quantitative microbial risk assessments.

Effect of Tempol on the prevention of irradiation-induced mucositis in miniature pigs

OBJECTIVE

The goals of this study were to (i) establish a useful miniature pig (minipig) model for irradiation-induced oral mucositis and (ii) evaluate the effect of Tempol to prevent its development.

METHODS AND MATERIALS

Minipigs were irradiated with 6 Gy for five consecutive days targeting the entire oral cavity. To prevent radiation damage, minipigs were treated with 30 mg kg^-1 Tempol 10 min before irradiation (n = 4), while the radiation-alone group was similarly injected with saline (n = 4). Lesions were graded using an oral mucositis score and visual inspection every 3 days, and biopsy of multiple sites was performed at day 18. Weight and chest and abdominal circumferences were measured every 3 days.

RESULTS

Lesions began about 12 days after the first irradiation fraction and healed about 30 days after irradiation. Epithelial thickness was calculated on the lingual and buccal mucosa on the 18th day after the first irradiation fraction. Tempol provided modest protection from ulceration after irradiation using this treatment strategy.

CONCLUSIONS

This study established a useful large animal model for irradiation-induced oral mucositis and showed modest beneficial effects of Tempol in limiting tissue damage. The latter finding may be potentially valuable in preventing oral mucositis in patients receiving irradiation for head and neck cancers.

Oxidative stress in oral diseases

Oxidative species, including reactive oxygen species (ROS), are components of normal cellular metabolism and are required for intracellular processes as varied as proliferation, signal transduction, and apoptosis. In the situation of chronic oxidative stress, however, ROS contribute to various pathophysiologies and are involved in multiple stages of carcinogenesis. In head and neck cancers specifically, many common risk factors contribute to carcinogenesis via ROS-based mechanisms, including tobacco, areca quid, alcohol, and viruses. Given their widespread influence on the process of carcinogenesis, ROS and their related pathways are attractive targets for intervention. The effects of radiation therapy, a central component of treatment for nearly all head and neck cancers, can also be altered via interfering with oxidative pathways. These pathways are also relevant to the development of many benign oral diseases. In this review, we outline how ROS contribute to pathophysiology with a focus toward head and neck cancers and benign oral diseases, describing potential targets and pathways for intervention that exploit the role of oxidative species in these pathologic processes.

CD44 is prognostic for overall survival in the NCI randomized trial on breast conservation with 25 year follow-up

CD44 is a transmembrane glycoprotein involved in numerous cellular functions, including cell adhesion and extracellular matrix interactions. It is known to be functionally diverse, with alternative splice variants increasingly implicated as a marker for tumor-initiating stem cells associated with poor prognosis. Here, we evaluate CD44 as a potential marker of long-term breast cancer outcomes. Tissue specimens from patients treated on the National Cancer Institute 79-C-0111 randomized trial of breast conservation versus mastectomy between 1979 and 1987 were collected, and immunohistochemistry was performed using the standard isoform of CD44. Specimens were correlated with patient characteristics and outcomes. Survival analysis was performed using the log rank test. Fifty-one patients had evaluable tumor sections and available long-term clinical follow up data at a median follow up of 25.7 years. Significant predictors of OS were tumor size (median OFS 25.4 years for ≤2 cm vs. 7.5 years for >2 cm, p = 0.001), nodal status (median OS 17.2 years for node-negative patients vs. 6.7 years for node positive patients, p = 0.017), and CD44 expression (median OS 18.9 years for CD44 positive patients vs. 8.6 years for CD44 negative patients, p = 0.049). There was a trend toward increased PFS for patients with CD44 positive tumors (median PFS 17.9 vs. 4.3 years, p = 0.17), but this did not reach statistical significance. These findings illustrate the potential utility of CD44 as a prognostic marker for early stage breast cancer. Subgroup analysis in patients with lymph node involvement revealed CD44 positivity to be most strongly associated with increased survival, suggesting a potential role of CD44 in decision making for axillary management. As there is increasing interest in CD44 as a therapeutic target in ongoing clinical trials, the results of this study suggest additional investigation regarding the role CD44 in breast cancer is warranted.

Resistance exercise and lipoproteins in postmenopausal women

The specific aims of this study were to quantify the effects of 12 weeks of resistance training, as well as a single session of resistance exercise on lipids and lipoproteins in obese, postmenopausal women. 21 obese, postmenopausal women, not on hormone replacement therapy (age=65.9 ± 0.5 yr; BMI=32.7 ± 0.8 kg/m(2)), were randomly assigned to control (n=12) and exercise (n=9) groups matched for age and BMI. For 12 weeks, 3 days/week, the exercise group performed 10 whole body resistance exercises (3 sets at 8-RM). Fasting (10 h) blood samples were collected immediately prior to and 24 h after the first and last exercise and control session. Serum was assayed for concentrations of total cholesterol, triglycerides, LDL-C, HDL-C, HDL 2-C, HDL 3-C, non-HDL-C and TC:HDL and LDL:HDL ratios. The exercise group exhibited a significant (P<0.01) improvement in muscular strength, but no change in BMI, body mass or body composition post-training. Total cholesterol, LDL-C and non-HDL-C were significantly (P<0.05) lower in the exercise compared to the control group following the 12 weeks of resistance training. Whole body resistance training provides obese, postmenopausal women a non-pharmacological approach for the reduction of lipid and lipoprotein-cholesterol concentrations.

Evaluation of sub-microsecond recovery resonators for in vivo electron paramagnetic resonance imaging

Time-domain (TD) electron paramagnetic resonance (EPR) imaging at 300MHz for in vivo applications requires resonators with recovery times less than 1 micros after pulsed excitation to reliably capture the rapidly decaying free induction decay (FID). In this study, we tested the suitability of the Litz foil coil resonator (LCR), commonly used in MRI, for in vivo EPR/EPRI applications in the TD mode and compared with parallel coil resonator (PCR). In TD mode, the sensitivity of LCR was lower than that of the PCR. However, in continuous wave (CW) mode, the LCR showed better sensitivity. The RF homogeneity was similar in both the resonators. The axis of the RF magnetic field is transverse to the cylindrical axis of the LCR, making the resonator and the magnet co-axial. Therefore, the loading of animals, and placing of the anesthesia nose cone and temperature monitors was more convenient in the LCR compared to the PCR whose axis is perpendicular to the magnet axis.

Heat acclimation and HSP-72 expression in exercising humans

The purpose of this research was to determine the effect of a 7-day heat acclimation protocol on HSP-72 expression in human skeletal muscle, and to examine the relationships between molecular and physiological markers of heat acclimation. Ten recreationally active male subjects (age = 23.3 +/- 2.81 yrs, VO(2peak) = 3.85 +/- 0.11 L . min (-1)) completed a 7-day heat acclimation protocol consisting of cycling at 75 % of VO(2peak) in a hot environment (39.5 degrees C, 27 % RH). Muscle biopsies were obtained on days 1 (HTT1) and 7 (HTT2) prior to, 6 h post, and 24 h postexercise to measure HSP-72 protein via SDS-PAGE and silver staining. Core rectal temperatures (T(C)), intramuscular temperatures (T(IM)), skin temperatures (T(SK)), heart rate (HR), oxygen uptake (VO(2)), sweat rate (SR), and plasma cortisol were measured. TC, HR, and plasma cortisol were significantly lower in HTT2 than HTT1 (p < or = 0.05). No significant differences were seen for VO(2), TIM, TSK, or SR when comparing HTT2 with HTT1 (p < or = 0.05). No significant time or day x time interactions were detected for HSP-72 expression (24.48 +/- 2.55 vs. 25.04 +/- 1.43 ng/microg protein for HTT1 and HTT2, respectively, p < or = 0.05). Evidence of heat acclimation was seen at the physiological level; however, no evidence of enhanced thermotolerance at the cellular level was indicated by HSP-72 expression.

Relationship between locking-bolt torque and load pre-tension in the Ilizarov frame

The wire-bolt interface in an Ilizarov frame has been mechanically tested. The optimal torque to be applied to the frame locking-bolts during physiological loading has been defined. The set-up configuration was as is used clinically except a copper tube was used to simulate bone. The force-displacement curves of the Ilizarov wires are not altered by locking-bolt torque. The force in the bone model at which pre-tension is lost increases as the locking-bolts are tightened to 14 Nm torque, but decreases if torque exceeds 14 Nm. Thus, 14 Nm is the optimal locking-bolt torque in frame. The relationship between pre-tension versus load for different locking-bolt torques arises because at low and high clamping torques poor wire holding and plastic deformation respectively occur. Wire damage was seen under light and electron microscopy. Clinically, over or under-tightening locking-bolts will cause loss of pre-tension, reduction in frame stiffness and excessive movement at the fracture site, which may be associated with delayed union.

Transcriptional responses to ionizing radiation reveal that p53R2 protects against radiation-induced mutagenesis in human lymphoblastoid cells

The p53 protein has been implicated in multiple cellular responses related to DNA damage. Alterations in any of these cellular responses could be related to increased genomic instability. Our previous study has shown that mutations in p53 lead to hypermutability to ionizing radiation. To investigate further how p53 is involved in regulating mutational processes, we used 8K cDNA microarrays to compare the patterns of gene expression among three closely related human cell lines with different p53 status including TK6 (wild-type p53), NH32 (p53-null), and WTK1 (mutant p53). Total RNA samples were collected at 1, 3, 6, 9, and 24 h after 10 Gy gamma-irradiation. Template-based clustering analysis of the gene expression over the time course showed that 464 genes are either up or downregulated by at least twofold following radiation treatment. In addition, cluster analyses of gene expression profiles among these three cell lines revealed distinct patterns. In TK6, 165 genes were upregulated, while 36 genes were downregulated. In contrast, in WTK1 75 genes were upregulated and 12 genes were downregulated. In NH32, only 54 genes were upregulated. Furthermore, we found several genes associated with DNA repair namely p53R2, DDB2, XPC, PCNA, BTG2, and MSH2 that were highly induced in TK6 compared to WTK1 and NH32. p53R2, which is regulated by the tumor suppressor p53, is a small subunit of ribonucleotide reductase. To determine whether it is involved in radiation-induced mutagenesis, p53R2 protein was inhibited by siRNA in TK6 cells and followed by 2 Gy radiation. The background mutation frequencies at the TK locus of siRNA-transfected TK6 cells were about three times higher than those seen in TK6 cells. The mutation frequencies of siRNA-transfected TK6 cells after 2 Gy radiation were significantly higher than the irradiated TK6 cells without p53R2 knock down. These results indicate that p53R2 was induced by p53 protein and is involved in protecting against radiation-induced mutagenesis.

Development of functional electron paramagnetic resonance imaging

The potential use of electron paramagnetic resonance imaging (EPRI) to obtain physiological information noninvasively is reviewed. EPR, a spectroscopic technique similar to nuclear magnetic resonance (NMR), is useful in detecting and characterizing free radical species. The ability to obtain information about tissue redox and oxygen status using nontoxic free radical spin probes is presented. The capability to encode this information spatially using magnetic field gradients, similar to magnetic resonance imaging (MRI), gives this technique the ability to overlay functional information of tissue with anatomic information. The noninvasive and quantitative nature of EPRI makes it a potentially useful technique for obtaining physiological information from tumors. The requirements for the magnetic field strengths are approximately 600 times lower than that for proton MRI at an identical frequency, making this a low-cost diagnostic tool.

Tailored sinc pulses for uniform excitation and artifact-free radio frequency time-domain EPR imaging

A method to generate shaped radiofrequency pulses for uniform excitation of electron spins in time-domain radio frequency (RF) electron paramagnetic resonance (EPR) imaging is presented. A commercial waveform generator was integrated with the transmit arm of the existing time-domain RF-EPR spectrometer to generate tailored excitation pulses with sub-nano second resolution for excitation with a 90 degrees flip-angle. A truncated sinc [sin(x)/x] pulse, tailored to compensate for the Q-profile (RF frequency response) of the resonator, was shown to yield images from phantom objects as well as in vivo images, with minimal distortion. These studies point to the advantages in using shaped sinc pulses to achieve improved uniform excitation over a relatively wide bandwidth region in time-domain RF-EPR imaging (RF-FT-EPRI).

The effect of pre-exercise cooling on high intensity running performance in the heat

The purpose of this study was to determine the effect of pre-exercise cooling on high intensity, moderate duration running performance and thermoregulatory responses in a hot environment (38 degrees C, 40 %RH). On separate days, 11 male subjects completed two treadmill runs to exhaustion at 100% of maximal aerobic power with (CL) and without (CT) pre-exercise cooling. Cooling consisted of 20 min of standing rest in a 22 degrees C environment with fan cooling (4.0 m x sec -1) and water spraying (50 ml x min -1) applied to both anterior and posterior body surfaces. Core temperature (T(c)) was determined with an esophageal T(es) probe, and skin temperatures (T(sk)) were measured using surface thermistors positioned at four sites. Finger prick blood samples were taken before and after exercise for the determination of blood lactate. Heart rates and ratings of thermal sensations and comfort were also recorded. Time to exhaustion was significantly shorter in the CL condition (368.9 +/- 56.2) compared to the CT condition (398.8 +/- 55.5 sec). Peak T(es) (37.51 +/- 0.57 vs. 38.56 +/- 0.30 degrees C for CL and CT, respectively), T(sk) (34.18 +/- 1.22 vs. 36.15 +/- 0.70 degrees C for CL and CT, respectively), rates of heat gain (0.20 +/- 0.05 vs. 0.28 +/- 0.05 degrees C x min -1 for CL and CT, respectively), and net heat storage (238.4 +/- 109.6 vs. 531.9 +/- 78.3 kJ for CL and CT, respectively) were all lower in the CL compared to CT throughout the treadmill runs. There were no differences in lactate accumulation between the two conditions. Based on these data, it can be concluded that pre-exercise cooling influences thermoregulatory responses during high intensity, moderate duration exercise; however, performance is impaired compared to a control trial in which no cooling procedures were employed.

Covering uninsured adults through Medicaid: lessons from the Oregon health plan

The Oregon Health Plan (OHP), Oregon's section 1115 Medicaid waiver program, expanded eligibility to all residents living below poverty. We use survey data, as well as OHP administrative data, to profile the expansion population and to provide lessons for other States considering such programs. OHP's eligibility expansion has proved a successful vehicle for covering large numbers of uninsured adults, although most beneficiaries enroll for only a brief period of time. The expansion population, particularly childless adults, is relatively sick and has high service use rates. Beneficiaries are also likely to enroll when they are in need of care.

Feasibility and assessment of non-invasive in vivo redox status using electron paramagnetic resonance imaging

PURPOSE

To test the feasibility of electron paramagnetic resonance imaging (EPRI) to provide non-invasive images of tissue redox status using redox-sensitive paramagnetic contrast agents.

MATERIAL AND METHODS

Nitroxide free radicals were used as paramagnetic agents and a custom-built 300 MHz EPR spectrometer/imager was used for all studies. A phantom was constructed consisting of four tubes containing equal concentrations of a nitroxide. Varying concentrations of hypoxanthine/xanthine oxidase were added to each tube and reduction of the nitroxide was monitored by EPR as a function of time. Tumor-bearing mice were intravenously infused with a nitroxide and the corresponding reduction rate was monitored on a pixel-by-pixel basis using 2D EPR of the tumor-bearing leg and normal leg serving as control. For animal studies, nitroxides were injected intravenously (1.25 mmol/kg) and EPR projections were collected every 3 min after injection using a magnetic field gradient of 2.5 G/cm. The reduction rates of signal intensity on a pixel-by-pixel basis were calculated and plotted as a redox map. Redox maps were also collected from the mice treated with diethylmaleate (DEM), which depletes tissue thiols and alters the global redox status.

RESULTS

Redox maps obtained from the phantoms were in agreement with the intensity change in each of the tubes where the signals were decreasing as a function of the enzymatic activity, validating the ability of EPRI to accurately access changes in nitroxide reduction. Redox imaging capability of EPR was next evaluated in vivo. EPR images of the nitroxide distribution and reduction rates in tumor-bearing leg of mice exhibited more heterogeneity than in the normal tissue. Reduction rates were found to be significantly decreased in tumors of mice treated with DEM, consistent with the depletion of thiols and the consequent alteration of the redox status.

CONCLUSION

Using redox-sensitive paramagnetic contrast agents, EPRI can non-invasively discriminate redox status differences between normal tissue and tumors.

Feasibility and assessment of non-invasive in vivo redox status using electron paramagnetic resonance imaging

PURPOSE

To test the feasibility of electron paramagnetic resonance imaging (EPRI) to provide non-invasive images of tissue redox status using redox-sensitive paramagnetic contrast agents.

MATERIAL AND METHODS

Nitroxide free radicals were used as paramagnetic agents and a custom-built 300 MHz EPR spectrometer/imager was used for all studies. A phantom was constructed consisting of four tubes containing equal concentrations of a nitroxide. Varying concentrations of hypoxanthine/xanthine oxidase were added to each tube and reduction of the nitroxide was monitored by EPR as a function of time. Tumor-bearing mice were intravenously infused with a nitroxide and the corresponding reduction rate was monitored on a pixel-by-pixel basis using 2D EPR of the tumor-bearing leg and normal leg serving as control. For animal studies, nitroxides were injected intravenously (1.25 mmol/kg) and EPR projections were collected every 3 min after injection using a magnetic field gradient of 2.5 G/cm. The reduction rates of signal intensity on a pixel-by-pixel basis were calculated and plotted as a redox map. Redox maps were also collected from the mice treated with diethylmaleate (DEM), which depletes tissue thiols and alters the global redox status.

RESULTS

Redox maps obtained from the phantoms were in agreement with the intensity change in each of the tubes where the signals were decreasing as a function of the enzymatic activity, validating the ability of EPRI to accurately access changes in nitroxide reduction. Redox imaging capability of EPR was next evaluated in vivo. EPR images of the nitroxide distribution and reduction rates in tumor-bearing leg of mice exhibited more heterogeneity than in the normal tissue. Reduction rates were found to be significantly decreased in tumors of mice treated with DEM, consistent with the depletion of thiols and the consequent alteration of the redox status.

CONCLUSION

Using redox-sensitive paramagnetic contrast agents, EPRI can non-invasively discriminate redox status differences between normal tissue and tumors.

The relationship between the sequence identities of alpha helical proteins in the PDB and the molecular similarities of their ligands

This paper considers the relationship between the percentage sequence identities of protein chains and the molecular similarities of the ligands they bind. Among a set of alpha helical proteins from the PDB, it is found that related proteins tend to bind similar ligands. Furthermore, the property of binding similar ligands can be used to define the categories of "like" and "unlike" pairs of protein chains, separated by an approximate cutoff at a sequence identity of, or somewhat above, 45%. Similarly, the property of binding related protein chains can be used to define "low" and "high" similarity pairs of ligand residues, with a cutoff at a Tanimoto score of 0.70. The ligands bound to two "like" protein chains are five times more likely to be of high similarity than would be expected if protein sequence identity and ligand molecular similarity were independent variables. Nonetheless, the nature of the PDB means that it is unclear whether the same conclusions would be reached with a data set representing an unbiased sample of all protein-ligand complexes in a living cell. The construction of an appropriate data set for such a study represents a significant challenge.

Is Smad3 a major player in signal transduction pathways leading to fibrogenesis?

Transforming growth factor (TGF)-beta plays a central role in fibrosis, contributing both to the influx and activation of inflammatory cells, as well as to activation of fibroblasts to elaborate extracellular matrix. In the past few years, new insight has been gained into signal transduction pathways downstream of the TGF-beta receptor serine-threonine kinases with the identification of a family of evolutionarily conserved Smad proteins. Two receptor-activated Smad proteins, Smad2 and Smad3, are phosphorylated by the activated TGF-beta type I receptor kinase, after which they partner with the common mediator, Smad4, and are translocated to the nucleus to where they participate in transcriptional complexes to control expression of target genes. We have shown in wound healing studies of mice null for Smad3, that loss of this key signaling intermediate interferes with the chemotaxis of inflammatory cells to TGF-beta as well as with their ability to autoinduce TGF-beta. Moreover, studies with mouse embryo fibroblasts null for Smad3 show that TGF-beta-dependent induction of c-Jun and c-Fos, important in induction of collagen as well as in autoinduction of TGF-beta, is mediated by Smad3. Based on these observations, we hypothesize that loss of Smad3 will confer resistance to fibrosis and result in reduced inflammatory cell infiltrates, reduced autoinduction of TGF-beta, important to sustain the process, and reduced elaboration of collagen. Preliminary observations in a model of radiation-induced fibrosis confirm this hypothesis and suggest that inhibitors of Smad3 might have clinical application both to improve wound healing and to reduce fibrosis.

Electron paramagnetic resonance for small animal imaging applications

Magnetic resonance imaging (MRI) provides high-resolution morphological images useful in diagnostic radiology to differentiate between normal and abnormal/pathological states in tissues. More recently, emerging developments in MRI have added a functional/physiological dimension to anatomical images. Electron paramagnetic resonance (EPR), a magnetic resonance technique similar to nuclear magnetic resonance, detects paramagnetic species such as free radicals. Like MRI, EPR can be implemented as an imaging technique for small animals and potentially human applications. Because of the low abundance of naturally occurring paramagnetic species, exogenous paramagnetic species are needed for in vivo EPR imaging (EPRI). The image data from EPRI contain both spatial distribution of paramagnetic species and spectral information. Hence, spatially encoded functional information such as tissue oxygen status and redox status can be extracted and coregistered with the spatial distribution of the spin probe, to the anatomy, or both by suitable means. Ultimately, the images obtained from EPRI may be used to overlay the functional information (containing spatial tissue physiology information) onto detailed anatomical maps. With its ability to enable whole animal imaging in mice, EPRI will be a useful imaging technique that complements other techniques such as MRI and positron emission tomography in obtaining valuable functional/physiological images.

Is Smad3 a major player in signal transduction pathways leading to fibrogenesis?

Transforming growth factor (TGF)-beta plays a central role in fibrosis, contributing both to the influx and activation of inflammatory cells, as well as to activation of fibroblasts to elaborate extracellular matrix. In the past few years, new insight has been gained into signal transduction pathways downstream of the TGF-beta receptor serine-threonine kinases with the identification of a family of evolutionarily conserved Smad proteins. Two receptor-activated Smad proteins, Smad2 and Smad3, are phosphorylated by the activated TGF-beta type I receptor kinase, after which they partner with the common mediator, Smad4, and are translocated to the nucleus to where they participate in transcriptional complexes to control expression of target genes. We have shown in wound healing studies of mice null for Smad3, that loss of this key signaling intermediate interferes with the chemotaxis of inflammatory cells to TGF-beta as well as with their ability to autoinduce TGF-beta. Moreover, studies with mouse embryo fibroblasts null for Smad3 show that TGF-beta-dependent induction of c-Jun and c-Fos, important in induction of collagen as well as in autoinduction of TGF-beta, is mediated by Smad3. Based on these observations, we hypothesize that loss of Smad3 will confer resistance to fibrosis and result in reduced inflammatory cell infiltrates, reduced autoinduction of TGF-beta, important to sustain the process, and reduced elaboration of collagen. Preliminary observations in a model of radiation-induced fibrosis confirm this hypothesis and suggest that inhibitors of Smad3 might have clinical application both to improve wound healing and to reduce fibrosis.

Adaptation to eccentric exercise: neutrophils and E-selectin during early recovery

The purpose was to determine the responses of blood neutrophils and E-selectin concentrations during early recovery (<24hr) from 2 bouts of eccentric exercise. Subjects (N=9) completed 2 bouts of eccentric arm exercise using their non-dominant arm (Bout 1 and Bout 2) and 1 non-exercise control condition. The exercise bouts were separated by 4 weeks, and the control condition preceded bout 1. Neutrophil concentrations were significantly higher at 3, 6, and 9-hr post-exercise for Bout 1 relative to Bout 2 and control. No significant changes in blood E-selectin concentrations were observed. Isometric strength deficit was similar for Bout 1 and Bout 2 at 5 min and 3 hr post exercise and was significantly great for Bout 1 relative to Bout 2 at 6, 9, and 24-hr post-exercise. The adaptation to eccentric exercise is associated with a lower concentration of blood neutrophils during early recovery. The neutrophilia associated with novel eccentric arm exercise precedes secondary changes in isometric strength and is not associated with changes in the concentration of blood E-selectin.

The influence of different external cooling methods on thermoregulatory responses before and after intense intermittent exercise in the heat

The purpose of this study was to determine the effect of different cooling methods on thermoregulation before and after intermittent anaerobic exercise in the heat (38 degrees C). On separate days, 10 men completed 4 conditions consisting of 2 sets of six 30-second sprints (with 30 seconds of rest) at 125% of maximal aerobic power with each set of sprints followed by a cooling procedure. The 4 conditions were the following: passive cooling at room temperature (22 degrees C; PRC), fan cooling (4.0 m x s(-1), 22 degrees C; FAC), fan cooling with water spraying (50 ml x min(-1); FWC), and a noncooling passive recovery in the heat chamber (38 degrees C; PCC). Each set of 6 sprints was followed by a 12-minute cooling period; after the second 12-minute period, cooling continued until esophageal temperature (Tes) was reduced by 1.0 degrees C. Tes and mean skin temperatures (Tsk) were taken before and during exercise and during all cooling phases. Cooling rates (mean +/- SEM) after the second set of sprints (based on Tes) were greater (p < 0.05) in PRC (0.043 +/- 0.007) than in the other conditions (FWC = 0.027 degrees +/- 0.005 degrees, FAC = 0.03 degrees +/- 0.004 degrees, and PCC = 0.021 degrees +/- 0.003 degrees C per minute). Overall decreases in heat content, however, were greater in the FWC (-332.2 +/- 27.8) and FAC (-129.9 +/- 14.7 kJ) conditions compared with the PRC condition (29.0 +/- 14.9 kJ). The time required to lower Tes by 1.0 degrees C with PRC (22.8 +/- 1.8) was less than with FAC (30.4 +/- 2.7 minutes). Finally, the rate of increase in Tes during the second set of sprints was less in the FAC and FWC conditions (0.15 degrees +/- 0.01 degrees and 0.11 degrees +/- 0.01 degrees C per minute) compared with the PCC and PRC conditions (0.19 degrees +/- 0.01 degrees and 0.18 degrees +/- 0.01 degrees C per minute), suggesting differences in pre-exercise cooling. Based on cooling rates and the time required to lower Tes by 1.0 degrees C, PRC was the most effective method of cooling. The conclusion is different, however, when taking into account changes in heat content since the FAC and FWC conditions were more effective in dissipating heat and in preventing heat gain during the second set of sprints

Impact of the Oregon Health Plan on children with special health care needs

OBJECTIVE

Although an increasing number of Medicaid children are enrolled in Medicaid managed care plans, little is known about how children with special health care needs fare under such programs. Of particular concern is the ability of such children to navigate a managed care system and gain access to specialty and other services. This study compares the managed care experiences of children with and without special care needs in the Oregon Health Plan.

METHODOLOGY

Telephone surveys were conducted with a sample of parents of children enrolled in the Oregon Health Plan. Three groups of children were sampled: Supplemental Security Income (SSI) children with disabilities, children with asthma, and children without special health care needs. Descriptive and multivariate analyses were conducted to determine the impact of Medicaid managed care on access and satisfaction.

RESULTS

Children with disabilities in managed care plans did not experience any more difficulty accessing needed specialty care than did those without special health care needs. Children with asthma, however, reported higher levels of unmet need. There were no differences in access between children with disabilities enrolled in managed care and those children with disabilities remaining in fee-for-service.

CONCLUSIONS

Unlike SSI children with disabilities, children who were not SSI-eligible but had asthma seemed to have difficulty obtaining some services. These children were not eligible for the same consumer protections afforded SSI children by Oregon. If states want to enroll all children with special health care needs into managed care programs, they must develop mechanisms for identifying such children and ensuring that they receive medically necessary services.

A decision model and cost-effectiveness analysis of colorectal cancer screening and surveillance guidelines for average-risk adults

OBJECTIVES

Guidelines for colorectal cancer screening and surveillance in people at average risk and at increased risk have recently been published by the American Gastroenterological Association. The guidelines for the population at average risk were evaluated using cost-effectiveness analyses.

METHODS

Since colorectal cancers primarily arise from precancerous adenomas, a state transition model of disease progression from adenomatous polyps was developed. Rather than assuming that polyps turn to cancer after a fixed interval (dwell time), such transitions were modeled to occur as an exponential function of the age of the polyps. Screening strategies included periodic fecal occult blood test, flexible sigmoidoscopy, double-contrast barium enema, and colonoscopy. Screening costs in 1994 dollars were estimated using Medicare and private claims data, and clinical parameters were based upon published studies.

RESULTS

Cost per life-year saved was $12,636 for flexible sigmoidoscopy every 5 years and $14,394 for annual fecal occult blood testing. The assumption made for polyp dwell time critically affected the attractiveness of alternative screening strategies.

CONCLUSIONS

Sigmoidoscopy every 5 years and annual fecal blood testing were the two most cost-effective strategies, but with low compliance, occult blood testing was less cost-effective. Lowering colonoscopy costs greatly improved the cost-effectiveness of colonoscopy every 10 years.

Cellular sites of H2O2-induced damage and their protection by nitroxides

While the exact mechanism of H2O2-induced cytotoxicity is unknown, there is considerable evidence implicating DNA as a primary target. A recent study showed that a cell-impermeable nitroxide protected mammalian cells from H2O2-induced cell killing and suggested that the protection was mediated through cell membrane-bound or extracellular factors. To further define the protective properties of nitroxides, Chinese hamster V79 cells were exposed to H2O2 with or without cell-permeable and impermeable nitroxides and selected metal chelators. EPR spectroscopy and paramagnetic line broadening agents were used to distinguish between intra- and extracellular nitroxide distribution. To study the effectiveness of nitroxide protection, in the absence of a cell membrane, H2O2-mediated damage to supercoiled plasmid DNA was evaluated. Both deferrioxamine and Tempol cross the cell membrane, and inhibited H2O2-mediated cell killing, whereas the cell-impermeable DTPA and nitroxide, CAT-1, failed to protect. Similar protective effects of the chelators and nitroxides were observed when L-histidine, which enhances intracellular injury, was added to H2O2. In contrast, when damage to plasmid DNA was induced (in the absence of a cell membrane), both nitroxides were protective. Collectively, these results do not support a role for membrane-bound or extracellular factors in mediating H2O2 cytotoxicity in mammalian cells.

Comparison of control of Listeria by nitric oxide redox chemistry from murine macrophages and NO donors: insights into listeriocidal activity of oxidative and nitrosative stress

The physiological function of nitric oxide (NO) in the defense against pathogens is multifaceted. The exact chemistry by which NO combats intracellular pathogens such as Listeria monocytogenes is yet unresolved. We examined the effects of NO exposure, either delivered by NO donors or generated in situ within ANA-1 murine macrophages, on L. monocytogenes growth. Production of NO by the two NONOate compounds PAPA/NO (NH2(C3H6)(N[N(O)NO]C3H7) and DEA/NO (Na(C2H5)2N[N(O)NO]) resulted in L. monocytogenes cytostasis with minimal cytotoxicity. Reactive oxygen species generated from xanthine oxidase/hypoxanthine were neither bactericidal nor cytostatic and did not alter the action of NO. L. monocytogenes growth was also suppressed upon internalization into ANA-1 murine macrophages primed with interferon-gamma (INF-gamma) + tumor necrosis factor-alpha (TNF-alpha or INF-gamma + lipid polysaccharide (LPS). Growth suppression correlated with nitrite formation and nitrosation of 2,3-diaminonaphthalene elicited by stimulated murine macrophages. This nitrosative chemistry was not dependent upon nor mediated by interaction with reactive oxygen species (ROS), but resulted solely from NO and intermediates related to nitrosative stress. The role of nitrosation in controlling L. monocytogenes was further examined by monitoring the effects of exposure to NO on an important virulence factor, Listeriolysin O, which was inhibited under nitrosative conditions. These results suggest that nitrosative stress mediated by macrophages is an important component of the immunological arsenal in controlling L. monocytogenes infections.

Concurrent paclitaxel and radiation in the treatment of locally advanced head and neck cancer

PURPOSE

To determine the feasibility of an organ preservation regimen consisting of infusional paclitaxel administered concurrently with radiotherapy to patients with locally advanced head and neck squamous cell carcinoma (HNSCC).

PATIENTS AND METHODS

Thirty-three previously untreated patients with stage III or IV tumors were enrolled onto the study. Paclitaxel was administered as a 120-hour continuous infusion every 3 weeks during the course of radiation therapy. Sixteen patients received a paclitaxel dose of 105 mg/m(2), and 17 patients received 120 mg/m(2). Radiation was delivered in a standard format at 1.8 Gy/d to a total dose of 70.2 to 72 Gy.

RESULTS

Three months after therapy, a 76% complete response (CR) at the primary site and a 70% overall CR was achieved. At 36 months, locoregional control was 55.7%, overall survival was 57.8%, and disease-free survival was 51.1%. The median survival duration for all 33 patients was greater than 50 months at the time of this report. Local toxicities including mucositis, dysphagia, and skin reactions were severe but tolerable. All patients retained functional speech, and all but four patients were swallowing food 3 months after treatment. Steady-state plasma concentrations for paclitaxel were not achieved during a 120-hour infusion, suggesting a nonlinear process. Tumor volume quantified by pretreatment computerized tomography imaging was associated with likelihood of response and survival.

CONCLUSION

Paclitaxel administered as a 120-hour continuous infusion in combination with radiotherapy is a feasible and promising treatment for patients with advanced HNSCC.

Multifunctional antioxidant activity of HBED iron chelator

The use of N,N'-bis (2-hydroxybenzyl) ethylenediamine-N,N'-diacetic acid (HBED) for iron chelation therapy is currently being tested. Besides its affinity for iron, bioavailability, and efficacy in relieving iron overload, it is important to assess its anti- and/or pro-oxidant activity. To address these questions, the antioxidant/pro-oxidant effects of HBED in a cell-free solution and on cultured Chinese hamster V79 cells were studied using UV-VIS spectrophotometry, oximetry, spin trapping, and electron paramagnetic resonance (EPR) spectrometry. The results indicate that HBED facilitates Fe(II) oxidation but blocks O2(.-)-induced reduction of Fe(III) and consequently pre-empts production of .OH or hypervalent iron through the Haber-Weiss reaction cycle. The efficacy of HBED as a 1-electron donor (H-donation) was demonstrated by reduction of the 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonate)-derived nitrogen-centered radical cation (ABTS(.+)), accompanied by formation of a short-lived phenoxyl radical. HBED also provided cytoprotection against toxicity of H2O2 and t-BuOOH. Our results show that HBED can act both as a H-donating antioxidant and as an effective chelator lacking pro-oxidant capacity, thus substantiating its promising use in iron chelation therapy.

Magnetic resonance imaging for in vivo assessment of tissue oxygen concentration

Magnetic resonance imaging (MRI) provides high-resolution morphological images useful in diagnostic radiology to differentiate normal from abnormal/pathological states. More recently, emerging developments in MRI seek to add a functional/physiological dimension to the anatomic images to provide better understanding of the physiology of pathological conditions. Three MRI methods offer the promise of providing important physiologic information, such as oxygen status and redox capability of tissues, and these are discussed in the context of their potential usefulness to radiation oncology. The techniques include blood oxygen level-dependent (BOLD) MRI, Overhauser enhanced MRI (OMRI), and electron paramagnetic resonance imaging (EPRI). BOLD MRI provides information of tumor oxygen status by using the differences in MRI images from tumors obtained when breathing air or carbogen. Deoxyhemoglobin serves as an endogenous BOLD MRI contrast agent. OMRI utilizes the enhancement of proton MRI images by a nontoxic free radical contrast agent. The advantages of this technique are the very low magnetic fields used and its capability to provide quantitative information of tissue oxygen concentration. EPRI also uses free radical contrast agents and can provide redox and oxygen status differences between tumor and normal tissues. Some of the contrast agents used in EPRI have been identified as radiation protectors. The images obtained from each of the technologies may ultimately be used to overlay their respective views (containing spatial tissue physiology information) onto detailed anatomic maps.

Cisplatin and radiation sensitivity in human head and neck squamous carcinomas are independently modulated by glutathione and transcription factor NF-kappaB

BACKGROUND

Response to neoadjuvant cisplatin-based chemotherapy has been used to predict overall response to chemoradiation therapy and to select patients with head and neck squamous cell carcinoma (HNSCC) for organ preservation therapy in NCI and VA cooperative group trials. However, different molecular determinants have been reported to contribute to sensitivity of cells to cisplatin and radiation, including glutathione (GSH), and activation of nuclear factor-kappaB (NF-kappaB), a transcription factor that regulates cytoprotective genes. We have reported that NF-kappaB is constitutively activated in HNSCC, but the relationship of NF-kappaB to GSH and to cisplatin and radiation sensitivity in HNSCC is unknown.

METHODS

We examined human HNSCC lines to define the relationship of cisplatin and radiation sensitivity to intracellular GSH and NF-kappaB and determined whether HNSCC could be sensitized to these modalities by lowering the concentration of glutathione with L-buthionine sulfoximine or inhibiting activation of NF-kappaB by expression of a degradation-resistant mutant inhibitor-kappaBalpha.

RESULTS

Cisplatin resistance did not predict radiation resistance in three HNSCC cell lines, UM-SCC-9, 11B, and, 38. Resistance to cisplatin correlated with intracellular GSH, and depletion of GSH by treatment with L-BSO sensitized UM-SCC-9 cells to cisplatin but not radiation. Conversely, radiation resistance was correlated with activation of NF-kappaB. Expression of a mutant Inhibitor-kappaB after gene transfer inhibited NF-kappaB and sensitized UM-SCC-9 cells to radiation but not cisplatin.

CONCLUSIONS

GSH and transcription factor NF-alphaB can contribute independently to cisplatin and radiation sensitivity of human HNSCC. These results highlight the need to define molecular determinants of chemotherapy and radiation sensitivity for use in the selection of patients and as novel targets for therapy in future chemoradiation therapy trials for organ preservation in patients with HNSCC.

S-nitrosoglutathione reduces nonocclusive thrombosis rate following balloon overstretch injury and intracoronary irradiation of porcine coronary arteries

PURPOSE

Intracoronary radiation (IR) suppresses neointima formation following balloon injury in animal models. High doses of radiation exacerbate thrombosis and delay re-endothelialization. The free radical nitric oxide (NO) has been reported to inhibit platelet aggregation, reduce neointimal hyperplasia, and stimulate re-endothelialization. This study examined the effects of a chemical NO donor on neointima formation, thrombosis, and healing of irradiated porcine coronary arteries.

METHODS AND MATERIALS

Vascular lesions were created in the coronary arteries of 59 domestic swine by overstretch balloon injury. Arteries were then left untreated or were treated with intracoronary gamma-radiation using Iridium-192 in each artery to deliver 5 or 15 Gy at 2 mm from the center of the source. The chemical NO donor S-nitrosoglutathione (GSNO) was infused i.v. at a rate of 250 microg/min for 10 min before injury, followed by a continuous infusion for 60 min. Animals were euthanized at 14 days and their arteries were analyzed for histomorphometric indices of proliferation and thrombosis.

RESULTS

A dose of 15 Gy reduced the ratio of intimal area to medial fracture length (IA/FL) versus control (0.06 +/- 0.05 0.54 +/- 0.10 [p < 0. 001]) but increased the nonocclusive thrombosis rate compared to controls (85% vs. 30%; p < 0.05). A low dose of 5 Gy did not affect neointima formation. Treatment with GSNO reduced thrombosis in all treated groups: control, 15%; 5 Gy, 18%; and 15 Gy, 35% (p < 0.05) without affecting neointima formation.

CONCLUSION

Systemic administration of GSNO during balloon injury and IR was tolerated well by the swine and resulted in reduction of the thrombosis rate, especially at high doses, without apparent effect on neointima formation.

Postexercise rehydration: effect of Na(+) and volume on restoration of fluid spaces and cardiovascular function

Our purpose was to study the interaction between Na(+) content and fluid volume on rehydration (RH) and restoration of fluid spaces and cardiovascular (CV) function. Ten men completed four trials in which they exercised in a 35 degrees C environment until dehydrated by 2. 9% body mass, were rehydrated for 180 min, and exercised for an additional 20 min. Four RH regimens were tested: low volume (100% fluid replacement)-low (25 mM) Na(+) (LL), low volume-high (50 mM) Na(+) (LH), high volume (150% fluid replacement)-low Na(+) (HL), and high volume-high Na(+) (HH). Blood and urine samples were collected and body mass was measured before and after exercise and every hour during RH. Before and after the dehydration exercise and during the 20 min of exercise after RH, cardiac output was measured. Fluid compartment (intracellular and extracellular) restoration and percent change in plasma volume were calculated using the Cl(-) and hematocrit/Hb methods, respectively. RH was greater (P < 0.05) in HL and HH (102.0 +/- 15.2 and 103.7 +/- 14.7%, respectively) than in LL and LH (70.7 +/- 10.5 and 75.9 +/- 6.3%, respectively). Intracellular RH was greater in HL (1.12 +/- 0.4 liters) than in all other conditions (0.83 +/- 0.3, 0.69 +/- 0.2, and 0.73 +/- 0.3 liter for LL, LH, and HH, respectively), whereas extracellular RH (including plasma volume) was greater in HL and HH (1.35 +/- 0.8 and 1.63 +/- 0.4 liters, respectively) than in LL and LH (0.83 +/- 0.3 and 1.05 +/- 0.4 liters, respectively). CV function (based on stroke volume, heart rate, and cardiac output) was restored equally in all conditions. These data indicate that greater RH can be achieved through larger volumes of fluid and is not affected by Na(+) content within the range tested. Higher Na(+) content favors extracellular fluid filling, whereas intracellular fluid benefits from higher volumes of fluid with lower Na(+). Alterations in Na(+) and/or volume within the range tested do not affect the degree of restoration of CV function.

Electrostatic factors in DNA intercalation

The factors that determine the binding of a chromophore between the base pairs in DNA intercalation complexes are dissected. The electrostatic potential in the intercalation plane is calculated using an accurate ab initio based distributed multipole electrostatic model for a range of intercalation sites, involving different sequences of base pairs and relative twist angles. There will be a significant electrostatic contribution to the binding energy for chromophores with a predominantly positive electrostatic potential, but this varies significantly with sequence, and somewhat with twist angle. The usefulness of these potential maps for understanding the binding of intercalators is explored by calculating the electrostatic binding energy for 9-aminoacridine, ethidium, and daunomycin in a variety of model binding sites. The electrostatic forces play a major role in the positioning of an intercalating 9-aminoacridine and a significant stabilizing role in the binding of ethidium in its sterically constrained position, but the intercalation of daunomycin is determined by the side-chain binding. Sequence preferences are likely to be determined by a complex and subtle mixture of effects, with electrostatics being just one component. The electrostatic binding energy is also unlikely to be a major determinant of the twist angle, as its variation with angle is modest for most intercalation sites. Overall, the electrostatic potential maps give guidance on how positively charged chromophores can be chemically adapted by heteroatomic substitution to optimise their binding.

Radiation, radicals, and images

Nitroxide stable free radicals exhibit varied chemical and biological properties. Their biological applications have been greatly expanded over the past few years. Not only have they been shown to exhibit potent antioxidant and radioprotective properties, but also they can serve as in vivo functional imaging probes that non-invasively report on the oxygen status and redox properties of tissue, which may have utility in clinical biomedical research.

Impact of Oregon's priority list on Medicaid beneficiaries

Since Oregon's controversial priority list was implemented in 1994, there has been only anecdotal evidence available on its possible impact on Medicaid beneficiaries. The authors surveyed over 1,400 beneficiaries to determine how often a service was denied because it was below the line, what kinds of services these represent, and any resulting health impact. About one third of all respondents reported that they had needed a service that Medicaid would not cover; in 38 percent of these cases, the reason was that the service was below the line. Frequently mentioned services included hernia repair, chiropractic treatment, dental splints, and newborn circumcision. About half of the respondents received the service anyway, often by paying for it themselves. Of those unsuccessful in getting the service, many reported that their health had worsened as a result. However, there was no evidence that getting (or not getting) the service had a causal impact on health status.

Radiation and the Apo2L/TRAIL apoptotic pathway preferentially inhibit the colonization of premalignant human breast cells overexpressing cyclin D1

The role of cyclin D1 overexpression in human breast premalignancy was investigated using immortal, nontumorigenic MCF-10A cells. Previous work documented that cyclin D1 overexpression promoted in vitro anchorage-independent colonization. We now report that the colonization of MCF-10A cyclin D1 transfectants was preferentially inhibited by gamma-radiation and specific classes of apoptosis inducers [Apo-2 ligand (Apo-2L), but not tumor necrosis factor alpha]. Antibody inhibition studies and semiquantitative PCR indicated that radiation inhibition of colonization was partially mediated via the Apo2L/TRAIL pathway. The apoptotic removal of cyclin D1-overexpressing, colonization-competent premalignant breast cells by Apo2L/TRAIL or other biologicals may represent a novel approach to the prevention of breast cancer.

Neuroprotection by the stable nitroxide Tempol during reperfusion in a rat model of transient focal ischemia

OBJECT

The use of thrombolytic agents in the treatment of stroke has yielded surprisingly modest success, possibly because of reperfusion injury mediated by reactive oxygen species (ROS). Therefore, scavenging ROS may be of therapeutic value in the treatment of stroke. Nitroxides are low-weight superoxide dismutase mimics, which allows them to act as cell-permeable antioxidants. In this study the nitroxide 4-hydroxy-2,2,6,6,-tetramethylpiperidine-1-oxyl (Tempol) is investigated to determine its ability to reduce reperfusion injury.

METHODS

Male Sprague-Dawley rats weighing between 280 g and 350 g underwent middle cerebral artery occlusion with an intraluminal suture for 60 minutes. Regional cerebral blood flow, blood pressure, cerebral temperature, and rectal temperature were monitored during the procedure. After reperfusion, the animals were randomized to groups receiving blinded intravenous administration of either Tempol (10 mg/kg; eight animals) or vehicle (eight animals) over the first 20 minutes of reperfusion (Study I). In a second study to determine dose dependency, animals were randomized to groups receiving Tempol (20 mg/kg; eight animals), low-dose Tempol (5 mg/kg; eight animals), or vehicle (eight animals; Study II). The rats were killed after 4 hours of reperfusion, and brain sections were stained with 2,3,5 triphenyltetrazolium chloride. Infarct volumes were measured using digital imaging. Animals receiving Tempol had significantly reduced infarct volumes at doses of 20 mg/kg and 10 mg/kg compared with controls (49.01+/-18.22% reduction [p = 0.003] and 47.47+/-34.57 [p = 0.02], respectively). No significant differences in the physiological variables measured were observed between groups.

CONCLUSIONS

Tempol provides significant neuroprotection after reperfusion in a rat model of transient focal ischemia. These results support the importance of ROS in reperfusion injury and encourage further study of this molecule as a therapeutic agent following thrombolysis.

Access to physicians' services for vulnerable Medicare beneficiaries

This article examines whether changes in physician reimbursement under the Medicare Fee Schedule (MFS) had differential impacts on access to care for vulnerable and nonvulnerable Medicare beneficiaries. The quasi-experimental research design takes advantage of cross-sectional differences in the magnitude of the MFS impact on payments. We selected a stratified random sample to ensure adequate representation of vulnerable group members and constructed service-specific measures of the MFS payment change. While we found few effects on access attributable to the MFS, we did find substantial utilization gaps between vulnerable and nonvulnerable subpopulations for primary care services, as well as for high-cost procedures during episodes of care for acute myocardial infarctions.

Evaluation of the hydroxylamine Tempol-H as an in vivo radioprotector

Nitroxides are stable free radical compounds that protect against the toxicity of reactive oxygen species in vitro and in vivo. Tempol (Aldrich, Milwaukee, WI, USA) is a cell-permeable hydrophilic nitroxide and has been shown to be an in vitro and in vivo radioprotector. The limitations of Tempol as a systemic radioprotector are that it causes substantial reductions in arterial blood pressure when administered intravenously and is associated with seizure activity. Furthermore, Tempol is rapidly reduced to its hydroxylamine form, Tempol-H, which limits the period of time the active form of the nitroxide is available for radioprotection. Based on initial pharmacological and blood pressure experiments performed in mice, we hypothesized that the systemic administration of Tempol-H in vivo would lead to an equilibration between Tempol and Tempol-H that would limit the toxicity of the nitroxide and provide in vivo radioprotection. Tempol-H was administered in increasing doses via an intraperitoneal route to C3H mice. The maximally tolerated dose was found to be 325 mg/kg. The whole-blood pharmacology of Tempol-H was investigated with electron paramagnetic resonance spectroscopy. These studies demonstrated the appearance of Tempol in whole blood immediately after intraperitoneal injection, suggesting that rapid oxidation of Tempol-H to Tempol takes place in vivo. Although the peak concentration of Tempol in whole blood after administration of Tempol-H did not reach the same levels as those observed when Tempol is administered, the whole-blood levels of Tempol were similar by 10 min after injection. Tempol-H provided protection against the lethality of whole-body radiation in C3H mice at 30 d with a dose modification factor of 1.3, which is similar to the results obtained with Tempol. Hemodynamic measurements in C3H mice after intravenous injection showed that Tempol-H produced little effect on blood pressure or pulse compared with Tempol. Tempol-H is a systemic in vivo radioprotector of C3H mice and is associated with less hemodynamic toxicity than Tempol.

Three-dimensional whole body imaging of spin probes in mice by time-domain radiofrequency electron paramagnetic resonance

Imaging of stable paramagnetic spin probes in phantom objects and in vivo was evaluated using a RF time domain EPR spectrometer/imager operating at 300 MHz. Projections were collected using static magnetic field gradients and images were reconstructed using filtered back-projection techniques. Results from phantom objects containing approximately 10(17) spins of stable paramagnetic probes with single narrow EPR spectra provide three-dimensional spatial images with resolution better than 2 mm. When the spin probe was administered to mice, the spin probe accumulation was temporally observed in the thoracic, abdominal, and pelvic regions. A three-dimensional image (from 144 projections) from a live mouse was collected in 5 min. Using fiducial markers, the spin probe accumulation in organs such as liver, kidney, and bladder could be observed. Differences in the oxygen status between liver and kidney were observed from the EPR images from mice administered with spin probe, by treating the time-domain responses with convolution difference approach, prior to image reconstruction. The results from these studies suggest that, with the use of stable paramagnetic spin probes and time-domain RF EPR, it is possible to perform in vivo imaging on animals and also obtain important spatially resolved physiologic information.

Racial variation in treatment for transient ischemic attacks: impact of participation by neurologists

OBJECTIVE

This study evaluates the role of neurologists in explaining African American-white differences in the use of diagnostic and therapeutic services for cerebrovascular disease.

DATA SOURCES/STUDY SETTING

Medicare inpatient hospital records were used to identify a random 20 percent sample of patients age 65 and over hospitalized with a principal diagnosis of TIA between January 1, 1991 and November 30, 1991 (n = 17,437).

STUDY DESIGN

Medicare administrative data were used to identify five outcome measures: noninvasive cerebrovascular tests, cerebral angiography, carotid endarterectomy, anticoagulant therapy (as proxied by outpatient prothrombin time tests), and the specialty of the attending physician (neurologist versus other specialist).

DATA COLLECTION/EXTRACTION METHODS

All Medicare claims were extracted for a 30-day period beginning with the date of admission.

PRINCIPAL FINDINGS

Even after adjusting for patient demographics, comorbidity, ability to pay, and provider characteristics, African American patients were significantly less likely to receive noninvasive cerebrovascular testing, cerebral angiography, or carotid endarterectomy, compared with white patients, and to have a neurologist as their attending physician. At the same time, patients treated by neurologists were more likely to undergo diagnostic testing and less likely to undergo carotid endarterectomy.

CONCLUSIONS

The findings suggest that African American patients with TIA may have less access to services for cerebrovascular disease and that at least some of this may be attributed to less access to neurologists. More research is needed on how patients at risk for stroke are referred to specialists.

Pre-exercise carbohydrate and fluid ingestion: influence of glycemic response on 10-km treadmill running performance in the heat

BACKGROUND

The purpose of this study was to determine the influence of ingesting solutions containing mixtures of carbohydrate (CHO) types on pre-exercise glycemic response, exercise-induced hypoglycemia, metabolic responses, and 10-km treadmill running performance in a warm environment.

METHODS

Ten trained runners completed 6, self-paced 10-km treadmill runs one hour after ingesting 900 ml of one of the following test solutions: a water placebo (WP), an 8 g 100 ml-1 high fructose corn syrup solution (HFG; 72 g CHO), a 6 g 100 ml-1 glucose solution (GLU; 54 g CHO), a 6 g.100 ml-1 sucrose/glucose mixture (SUG; 54 g CHO), or banana with water to equal 900 ml (BAN; approx. 54 g CHO). The sixth condition was 675 ml of an 8 g.100 ml-1 HFCS solution (LFG; 54 g CHO). Blood samples were taken prior to ingestion and every 15 min during rest and at 15 and 30 min, and at the end of the 10-km run. Blood was analyzed for glucose (BG) insulin (IN), glycerol, lactate, and percent change in plasma volume. Urine volume during the 1 hour of rest and change in body mass during exercise were also determined.

RESULTS

A significant (p < 0.05) correlation (r = -0.684) was seen between the pre-exercise glycemic response (PEGR = area under the resting BG curve) and the change in BG from pre-EX to 15 min of exercise. BG at 15 min of exercise was significantly higher in the WP (5.22 mM) versus the other conditions (HFG = 3.32, LFG = 3.91, GLU = 3.38, BAN = 3.74 & SUG = 3.63 mM). Pre-exercise IN was lower in the WP (6.54 U ml-1) condition versus the other conditions (HFG = 22.1, LFG = 16.2, GLU = 23.3, BAN = 18.8 & SUG = 12.8 U.ml-1). Ten km performance times were not different (WP = 41.87, HFG = 41.66, LFG = 41.79, GLU = 41.65, BAN = 41.53, and SUG = 41.75 min). A significantly greater body mass loss occurred due to urine production during the 60 min of rest in the WP compared to the other conditions. The degree of exercise-induced decline in blood glucose was related to the PEGR; however, the decline in BG did not affect 10-km running performance. In addition, there were no differences in the metabolic responses during exercise between the different CHO types, nor did the type of CHO influence running performance. Finally, the presence of CHO and/or electrolytes in the hydration solutions produced a better fluid retention during the 60-min pre-exercise rest period compared to water.

CONCLUSIONS

The results confirmed that if a competitive athlete consumed a breakfast prior to ingesting a CHO-electrolyte beverage, a practice that is common, the glycemic responses may be different.

Reduced hematopoietic function and enhanced radiosensitivity of transforming growth factor-beta1 transgenic mice

The cytokine transforming growth factor-beta1 (TGF-beta1) has been implicated in some tissue responses to radiation. Previous studies have demonstrated that exogenous TGF-beta1 increased the lethality of radiation in mice, but the effects of endogenous TGF-beta1 have not been investigated. To this end, we examined mice that are transgenic for active TGF-beta1 (Alb/TGF-beta1), over-expressed via an albumin promoter in the liver with resultant elevation of circulating levels of this cytokine. Alb/TGF-beta1 mice subjected to 8 Gy of total body irradiation at 3 or 5 weeks of age experienced significantly higher mortality than wild type age- and sex-matched controls by 1 to 2 weeks after irradiation. Alb/TGF-beta1 3 weeks of age also succumbed to 2 and 4 Gy of whole-body irradiation, while no mortality was observed in wild type mice. Four-week-old Alb/TGF-beta1 mice exhibited mild anemia and mild uremia. At one week after whole body irradiation with 2 Gy, 4-week-old Alb/TGF-beta1 mice had significantly reduced white blood cell counts, hematocrit, and platelet counts. Histopathologically, irradiated Alb/TGF-beta1 mice exhibited decreased bone marrow cellularity and decreased splenic extramedullary hematopoiesis. These results suggest that chronic over-expression of active TGF-beta1 is associated with increased radiosensitivity and that this effect may be mediated by increased sensitivity of bone marrow to the suppressive effects of radiation. Since TGF-beta1 levels can be greatly elevated in patients with certain tumors, these findings may be significant for radiotherapy. Int. J. Cancer (Radiat. Oncol. Invest.) 90, 13-21 (2000). Published 2000 Wiley-Liss, Inc.

Re-evaluating gadolinium(III) texaphyrin as a radiosensitizing agent

Gadolinium(III) texaphyrin (Gd-tex) was recently proposed as a radiosensitizing agent that combines preferential tumor uptake with detection of drug localization by magnetic resonance imaging (S. W. Young et al., Proc. Natl. Acad. Sci. USA, 93: 6610-6615, 1996). In view of the initial report on this compound, four radiobiology laboratories undertook independent efforts to further study radiosensitization by Gd-tex. In addition to repeating the previously reported studies on Gd-tex in HT-29 cells, we tested five other human tumor cell lines (U-87 MG, U251-NCI, SW480, A549, and MCF-7). These studies included a Gd-tex treatment period of 24 h before irradiation (as in the original publication), with concentrations of Gd-tex ranging from 20-500 microM. In neither the HT-29 cells nor any of the other five human cell lines did we see radiation sensitization by Gd-tex. Two cell lines (MCF-7 and U-87 MG) were further tested for radiosensitization by Gd-tex under hypoxic conditions. No radiosensitization was observed in either case. Finally, the radiation response of two tumor lines were assessed in vivo. Neither HT-29 xenografts in severe combined immunodeficient (SCID) mice nor RIF-1 tumors growing in C3H mice demonstrated radiosensitization after Gd-tex treatment before single or fractionated doses of radiation. Our results raise questions about the efficacy of Gd-tex as a radiosensitizing agent.

Parallel coil resonators for time-domain radiofrequency electron paramagnetic resonance imaging of biological objects

Resonators suitable for time-domain electron paramagnetic resonance spectroscopy and imaging at a radiofrequency capable of accommodating experimental animals such as mice are described. Design considerations included B(1) field homogeneity, optimal Q, spectral bandwidth, resonator ring-down, and sensitivity. Typically, a resonator with 25-mm diameter and 25-mm length was constructed by coupling 11 single loops in parallel with a separation of 2.5 mm. To minimize the resonator ring-down time and provide the necessary spectral bandwidth for in vivo imaging experiments, the Q was reduced predominantly by overcoupling. Capacitative coupling was utilized to minimize microphonic effects. The B(1) field in the resonator was mapped both radially and axially and found to be uniform and adequate for imaging studies. Imaging studies with phantom objects containing a narrow-line spin probe as well as in vivo objects administered with the spin probe show the suitability of these resonators for valid reproduction of the spin probe distribution in three dimensions. The fabrication of such resonators is simple and can be scaled up with relative ease to accommodate larger objects as well.