0039 The Clinical Utility of Dim Light Melatonin Onset in Treatment of Delayed Sleep-Wake Phase Disorder: Preliminary Findings

Introduction

Delayed sleep-wake phase disorder (DSWPD) is common, debilitating, and challenging to treat. In an ongoing randomized trial, we are comparing exogenous melatonin treatment outcomes in DSWPD participants for whom dim light melatonin onset (DLMO) is measured objectively vs. estimated.

Methods

Thus far, 13 participants (27±6 years old, 67% female) have completed a randomized, controlled, double-blind 4-week trial of 0.5 mg of exogenous melatonin timed to either 3 h before measured DLMO (M-DLMO, n = 6) or 3 h before DLMO estimated at 2 h before average sleep onset time based on at least 7 days of wrist actigraphy and sleep diary (E-DLMO, n = 7). All participants met International Classification of Sleep Disorders-3 diagnostic criteria for DSWPD and were otherwise healthy. Participants completed 4 weekly treatment sessions with a blinded psychologist; time of melatonin administration and bed-rise schedule were advanced up to 1 h/week. A validated home saliva collection kit measured DLMO in all participants. Between-group t-tests and Hedges’ g effect sizes (ES) were calculated at post-treatment for the following outcomes: DLMO; Pittsburgh Sleep Quality Index (PSQI) global score; Morningness-Eveningness Questionnaire (MEQ); and the actigraphy parameters sleep efficiency (SE) and clock time of sleep onset and offset. A paired-sample t-test compared the measured vs. estimated DLMO at baseline.

Results

The M-DLMO group had a 65±88 mins DLMO advance vs. 27±30 mins in the E-DLMO group (ES=0.51 p=.381). PSQI scores were similar between groups (M-DLMO=6.67±2.06, E-DLMO=7.1± 1.57, ES=-0.24, p=.646), as were MEQ scores (M-DLMO=43±4.98, E-DLMO=48±12.72, ES=-0.47, p=.387). Sleep onset time (M-DLMO=0:32±1:02, E-DLMO=0:31±1:38, ES=0.01, p=.98) and offset time (M-DLMO=8:05±1:03, E-DLMO=8:08±2:14, ES=-0.02, p=.968) were similar between the groups, although sleep was more efficient in M-DLMO vs. E-DLMO (84%±3% vs. 76%±10%, ES=0.94, p=.096). On average, baseline measured DLMO occurred 123±83 mins earlier than estimated DLMO (p=.001).

Conclusion

We are continuing to enroll participants in this trial. Preliminary results suggest some potential benefit of measuring the DLMO, but results will need to be clarified in a larger sample.

Support

American Sleep Medicine Foundation Strategic Research Award

Evidence for adult age-invariance in associative false recognition

Older people are more prone to memory distortions and errors than young people, but do not always show greater false recognition in the Deese-Roediger-McDermott (DRM) task. We report two preregistered experiments investigating whether recent findings of age-invariant false recognition extend to designs in which studied items are blocked. According to (Tun, P. A., Wingfield, A., Rosen, M. J., & Blanchard, L. (1998). Response latencies for false memories: Gist-based processes in normal aging. Psychology and Aging, 13(2), 230-241.), age effects on false recognition in the DRM task are due to a greater reliance on gist processing which is enhanced under blocked study conditions. Experiment 1 assessed false recognition in an online variant of the DRM task where words were presented visually, with incidental encoding. The results showed Bayesian evidence against greater false recognition by older adults, whether lures were semantically associated with studied lists, or perceptually related (presented in the same distinctive font as studied lists) or both. Experiment 2 used a typical DRM procedure with auditory lists and intentional encoding, closely reproducing (Tun, P. A., Wingfield, A., Rosen, M. J., & Blanchard, L. (1998). Response latencies for false memories: Gist-based processes in normal aging. Psychology and Aging, 13(2), 230-241.) Experiment 2 but omitting an initial test of recall. The results showed evidence against an age-related increase in critical lure false recognition under these conditions. Together, the data suggest that older people do not make more associative memory errors in recognition tests than young people.

P2427The development of a computational fluid dynamics pipeline for the study of tetralogy of Fallot and coarctation of the aorta in a developing world context

Background

Tetralogy of Fallot (ToF) and coarctation of the aorta (CoA) each constitute approximately 7% of congenital heart disease (CHD) births worldwide. Compared to developed countries, developing countries have a disparate level of access to prompt diagnosis and treatment for these diseases. Computational fluid dynamics (CFD) approaches implemented on routinely available non-invasive imaging data may yield low-cost improvements to the management of these patients.

Purpose

The purpose of this research is to develop a patient-specific computational pipeline that allows the modelling of blood flow in diseased arteries of patients suffering from ToF and CoA. The project aims to prove the feasible use of broadly available imaging techniques - CT angiograms (CTA) and echocardiographs (echo) - for achieving this in low-to-middle income countries. The capability of the pipeline will be demonstrated through a qualitative study of the effects of different systemic to pulmonary shunt configurations used in the palliative treatment of ToF. In addition, the effects of idealised stent configurations on the blood flow through the aorta of a patient with CoA will be studied.

Methods

A retrospective search through the hospital database was conducted to select suitable CTA data for a CoA and ToF case. Data for patient A, a five-month-old child with typical CoA, and patient B, a twelve-month-old child with typical ToF who had a central shunt in place, was found. Echo data was obtained for patient A through an investigation protocol which focused on CFD application whereas there was no echo data available for patient B. As a result, idealised volume flow rate data was implemented for patient B. Geometries for patient A and patient B were extracted and volume discretisation was implemented for grid independence testing. The Navier-Stokes governing equations for fluid flow were solved using the open source software, OpenFOAM, for the transient case where inlet volume flow rate was defined for four cardiac cycles. Figure 1 shows key features of the flow in the shunt and pulmonary branches (A), the aortic arch (B), the inlet at the ascending aorta (C) and the descending aorta (D) for the geometry extracted from the data set of patient B.

Figure 1. Key flow features of patient B

Results and discussion

We have implemented CFD models which are able to qualitatively assess the favourable or unfavourable impact of different approaches to ToF and CoA repairs on the characteristics of blood flow in the aorta and pulmonary arteries. An echo investigation protocol has been developed and successfully applied. CTA studies have been shown as feasible sources of geometry data in spite of the restriction on quality by the important requirement for low doses of radiation in paediatric patients. This project represents progress towards an advanced tool that may be broadly implemented in both well-resourced and minimally-resourced hospitals.

Acknowledgement/Funding

National Research Fund, British Heart Foundation, Newton Fund (UK MRC, South African Medical Research Council), University of Cape Town

Src family kinases Fyn and Lyn are constitutively activated and mediate plasmacytoid dendritic cell responses

Plasmacytoid dendritic cells (pDC) are type I interferon-producing cells with critical functions in a number of human illnesses; however, their molecular regulation is incompletely understood. Here we show the role of Src family kinases (SFK) in mouse and human pDCs. pDCs express Fyn and Lyn and their activating residues are phosphorylated both before and after Toll-like receptor (TLR) stimulation. Fyn or Lyn genetic ablation as well as treatment with SFK inhibitors ablate pDC (but not conventional DC) responses both in vitro and in vivo. Inhibition of SFK activity not only alters TLR-ligand localization and inhibits downstream signalling events, but, independent of ex-vivo TLR stimulation, also affects constitutive phosphorylation of BCAP, an adaptor protein bridging PI3K and TLR pathways. Our data identify Fyn and Lyn as important factors that promote pDC responses, describe the mechanisms involved and highlight a tonic SFK-mediated signalling that precedes pathogen encounter, raising the possibility that small molecules targeting SFKs could modulate pDC responses in human diseases.

pH responsive highly branched poly(N-isopropylacrylamide) with trihistidine or acid chain ends

Thermally responsive highly branched poly(N-isopropyl acrylamide)s (HB-PNIPAM) were prepared and end-functionalised to give polymers with acid or trihistidine end groups. ​The ionisation of the end groups affects the swelling of desolvated globules.

Luminescence techniques and characterization of the morphology of polymer latices

Five poly(n-butyl methacrylate), PBMA, latex dispersions have been prepared, each incorporating a different fluorescent label, via a two-stage seeded emulsion polymerization. The resultant latices contain ca. 35% by weight total solids and are of 80 (+/-10) nm diameter as determined by photon correlation spectrometry. Luminescence spectroscopic techniques, namely fluorescence (and phosphorescence) excited state lifetime measurements in addition to time-resolved anisotropy experiments have provided useful information regarding the morphology, microviscosity and water permeability of the resultant particles. A picture of the PBMA colloid emerges of an interior which is highly viscous and water impermeable in nature. Indeed, the environment is protective enough to sustain room temperature stabilized phosphorescence from both an acenaphthylene and 9-phenanthrylmethyl methacrylate labeled dispersion through simple nitrogen purging of the solutions. However, the current spectroscopic measurements should be viewed with the knowledge that each luminescent label may fashion its own distinctive microenvironment within the latex during polymerization.

Luminescence techniques and characterization of the morphology of polymer latices. 3. An investigation of the microenvironments within stabilized aqueous latex dispersions of poly(n-butyl methacrylate) and polyurethane

Fluorescence techniques (including time-resolved anisotropy measurements, TRAMS) have been used to probe differences in morphology between two stabilized aqueous latex dispersions (poly(n-butyl methacrylate), PBMA, and polyurethane, PU). Use of the emission characteristics of probes such as pyrene and phenanthrene dispersed within particles reveals that the PU latices are more heterogeneous in nature: evidence exists, particularly from quenching measurements and TRAMS, that voids and channels of water permeate the PU structure, resulting in a relatively soft, open particle, swollen by ingress of the bulk aqueous phase. Fluorescence measurements indicate that PBMA colloids, however, are composed of relatively hard, hydrophobic particles. In addition, TRAMS are considered to be a valuable tool both for probing the morphological characteristics of such dispersions and in estimating the average particle size.

Modulation of beta-amyloid production and fibrillization

Alzheimer's disease (AD) is the most common cause of dementia in old age and presently affects an estimated 4 million people in the U.S.A. and 0.75 million people in the U.K. It is a relentless, degenerative brain disease, characterized by progressive cognitive impairment. In the final stages of the disease, patients are often bedridden, doubly incontinent and unable to speak or to recognize close relatives. Pathological changes of Alzheimer's disease include extensive neuronal loss and the presence of numerous neurofibrillary tangles and senile plaques in the brain. The senile plaques contain amyloid fibrils derived from a 39-43-amino-acid peptide referred to as beta-amyloid or A beta. The basic theory of the so-called 'amyloid hypothesis' is that the deposition of aggregated forms of A beta in the brain parenchyma triggers a pathological cascade of events that leads to neurofibrillary tangle formation, neuronal loss and the associated dementia [1]. Here we discuss progress towards the identification of inhibitors of A beta production and fibrillization.

Structure-based design of non-peptide HIV protease inhibitors

A number of structurally novel P2-ligands have been designed and synthesized. Incorporation of these ligands in the (R)-(hydroxyethyl)sulfonamide isostere provided a series of potent non-peptidyl HIV protease inhibitors.

Fluorescence anisotropy: a method for early detection of Alzheimer beta-peptide (Abeta) aggregation

Time-resolved anisotropy measurements (TRAMS) have been used to study the aggregation of the beta-amyloid (Abeta) peptide which is suspected of playing a central role in the pathogenesis of Alzheimer's Disease (AD). The experiments, which employ small quantities of fluorescently-labelled Abeta, in addition to the untagged peptide, have shown that the sensitive TRAMS technique detects the presence of preformed "seed" particles in freshly prepared solutions of Abeta. More importantly, as 100 microM solutions of Abeta containing tagged Abeta at a concentration level of either 0.5 or 1 microM are incubated, the TRAMS prove capable of detection of the peptide aggregation process through the appearance of a continuously increasing "residual anisotropy" within the time-resolved fluorescence data. The method detects Abeta aggregation in its earliest stages, well before complexation becomes apparent in more conventional methods such as the thioflavin T fluorescence assay. The TRAMS approach promises to provide a most attractive route for establishment of a high-throughput procedure for the early detection of the presence of amyloid aggregates in the screening of biological samples.

On the fine structure of the pes Hippocampi major (with plates XIII-XXIII). 1886

We have provided a translation of Golgi's original paper on the mammalian hippocampus (first published in 1883 and reprinted numerous times), along with a preface on its historical context. Golgi believed that this part of the cerebral hemisphere showed best the exact relationship between nerve cells and nerve fibers, the most important problem in 19th century neuroscience.

Some differences between English plural noun inflections and third singular verb inflections in the input: the contributions of frequency, sentence position, and duration

Grammatical inflections such as the English plural noun -s and third person singular verb -s are acquired at different points in time by young children. This finding is typically attributed to factors such as relative semantic salience or the distinction between lexical and functional categories. In this study input frequency, sentence position, and duration were examined as possible contributing factors. In both conversations with and stories aimed at young children, noun plural inflections were found to be more frequent than third singular verb inflections, especially in sentence-final position. Analysis of the speech of four mothers reading stories to their two-year-old children confirmed that duration differences also exist in the input. Because fricatives were lengthened in sentence-final position and plural nouns were much more likely to appear in these positions than were third singular verb forms, plural nouns were significantly longer than third singular inflections on average. The possible implications of these findings for language learnability theories and accounts of grammatical deficits in specific language impairment are discussed.

Serum prolactin concentrations in the captive female African elephant (Loxodonta africana): potential effects of season and steroid hormone interactions

Research was conducted to determine whether seasonal changes in prolactin secretion occur in nonpregnant female African elephants and to examine potential functional interrelationships between secretion of prolactin, cortisol, and progesterone. Weekly blood samples were taken for 18 months from four female African elephants and the sera were analyzed by RIA for progesterone, cortisol, and prolactin concentrations. There was no significant effect of season on serum concentrations of prolactin. Estrous cycles averaged 14 weeks in length and were composed of a 9-week luteal phase and a 5-week follicular phase (based on progesterone concentrations consistently >200 and <200 pg/ml, respectively). Estrous cycle synchronicity was evident between pairs of elephants. Serum concentrations of prolactin (3.91 +/- 0.69 ng/ml; range: 0.84-15.8 ng/ml) were significantly lower during the luteal, compared with the follicular, phase (P < 0.0001; t test) and were positively correlated with serum concentrations of cortisol (r = 0.14; P < 0.05). Mean (+/-SE) serum concentration of cortisol was 5.7 +/- 1.3 ng/ml (range: 1.4-19.3 ng/ml), and concentrations of this adrenal steroid were negatively correlated with progesterone concentrations (r = -0.15; P < 0.01). Increased serum concentrations of prolactin detected during the follicular phase suggest that this hormone may be regulated by ovarian estrogens and may play a role in modulating ovarian function in the elephant.

Solving stubborn-wound problem could save millions, team says

Why do some wounds refuse to heal? A team in London, Ont., is attempting to determine the cellular and molecular clues that could lead to better treatment of recalcitrant wounds.

Reliability of taurine concentrations measured in single urine samples obtained from dogs eight hours after eating

OBJECTIVE

To evaluate the reliability of taurine concentrations measured in a single urine sample obtained from dogs 8 hours after eating, compared with taurine concentrations measured in 24-hour urine samples.

ANIMALS

18 healthy Beagles.

PROCEDURE

After emptying the urinary bladder by transurethral catheterization, dogs were fed a canned maintenance diet. Approximately 8 hours later, urine, plasma, and serum samples were obtained for determination of fractional urinary excretion of taurine and urine taurine-to-creatinine concentration ratios (Utaur:Ucr). Results were compared with 24-hour urinary taurine excretion rate.

RESULTS

Unbound and total fractional urinary taurine excretion correlated well with unbound and total 24-hour urinary taurine excretion. However, bound fractional urinary taurine excretion correlated poorly with bound 24-hour urinary taurine excretion. Unbound and total Utaur:Ucr correlated well with unbound and total 24-hour urinary taurine excretion. However, bound Utaur:Ucr correlated poorly with bound 24-hour urinary taurine excretion.

CONCLUSION AND CLINICAL RELEVANCE

Fractional urinary excretion of unbound and total taurine, and unbound and total Utaur:Ucr are reliable indicators of 24-hour urinary unbound and total taurine excretion in healthy dogs. However, determination of 24-hour urinary taurine excretion is recommended for evaluating urinary bound taurine concentrations of dogs.

Cochlear implants: the head-on collision between medical technology and the right to be deaf

The debate over using cochlear implants to help deaf people communicate with those who can hear continues to rage. Some have welcomed the new technology, but others say the deaf have their own culture and do not need to be "cured".

Radiation-induced apoptosis is not enhanced by expression of either p53 or BAX in SW626 ovarian cancer cells

The p53 protein is known to play a central role in mediating G1 arrest or apoptosis in response to ionizing radiation in some cell types. It has been proposed that the link between p53 and induction of apoptosis is provided in part by p53-mediated upregulation of BAX. In this study, we used the human SW626 ovarian cancer cell line, which lacks functional p53, to further investigate the relationship between wildtype p53, BAX, and apoptosis. SW626 cells expressing a temperature sensitive (ts) p53 mutant did not undergo G1 arrest or apoptosis and did not exhibit enhanced sensitivity to radiation at the permissive temperature of 32 degrees C. The tsp53 protein was functional in these cells as evidenced by rapid induction of p21 at 32 degrees C, but not at 37 degrees C. Interestingly, restoration of wildtype p53 function at 32 degrees C was not associated with BAX upregulation. In addition, stable overexpression of BAX in SW626 cells was not capable of enhancing apoptotic cell death in response to radiation. Thus, failure of p53 to upregulate BAX is not the sole reason for its inability to promote radiation-induced apoptosis in SW626 cells. Taken together, our data suggest that neither p53 nor BAX upregulation is sufficient for the induction of apoptosis in response to genotoxic damage in some cell types.

In vivo inhibition of CD44 limits intra-abdominal spread of a human ovarian cancer xenograft in nude mice: a novel role for CD44 in the process of peritoneal implantation

Ovarian cancer cells frequently metastasize by implanting onto the peritoneal mesothelial lining of the abdominal cavity. Data obtained from in vitro adhesion studies have suggested a possible role for the CD44 molecule in this process. The purpose of the present study was to determine the in vivo role of CD44 in ovarian cancer metastasis by using a nude mouse xenograft model of peritoneal implantation. Three groups of 10 athymic female nude mice each received an i.p. inoculum of 10 x 10(6) cells from a CD44-positive human ovarian cancer cell line (36M2) in the presence of either anti-D144 antibody (Ab; nonreactive IgG1), anti-DF3 Ab (reactive IgG1 Ab that does not inhibit in vitro binding), or neutralizing anti-CD44 Ab (IgG1). The number of peritoneal and diaphragmatic implants at 5 weeks for anti-D144 and anti-DF3-treated groups was 103 +/- 17 and 120 +/- 20, respectively (mean +/- SE; P > 0.2). In contrast, animals treated with anti-CD44 Ab experienced a significant reduction in the number of tumor implants (35 +/- 4; P < 0.002). Anti-CD44 Ab was not inhibitory to the growth of 36M2 cells in vitro and did not inhibit s.c. tumor growth in vivo, suggesting that the observed effect was related to inhibition of peritoneal implantation. These data suggest that the CD44 molecule plays an important in vivo role in ovarian cancer cell implantation and that strategies to inhibit CD44 function may represent a novel approach to limiting the intra-abdominal spread of this highly lethal tumor.

BAX enhances paclitaxel-induced apoptosis through a p53-independent pathway

To investigate the role of BAX in chemotherapy-induced apoptosis, we transfected the SW626 human ovarian cancer cell line, which lacks functional p53, with a cDNA encoding for murine BAX. Immunoblotting revealed that BAX transfectants expressed a mean of 10-fold increased levels of BAX compared with neo-transfected control clones, with similar levels of BCL-2 and BCL-xL. The cytotoxicity of paclitaxel, vincristine, and doxorubicin was significantly enhanced in BAX transfectants compared with control clones, whereas the cytotoxicity profile of carboplatin, etoposide, and hydroxyurea was unchanged. Increased paclitaxel-induced cytotoxicity of BAX clones was associated with enhanced apoptosis, as assessed by morphologic and flow cytometric criteria. These data suggest that sufficient levels of BAX may bypass the need for upstream molecules such as p53 in the process of chemotherapy-induced apoptosis.

Absence of constitutive EGF receptor activation in ovarian cancer cell lines

Previous investigators have noted that certain ovarian cancer cell lines secrete and respond to transforming growth factor-alpha (TGF-alpha), suggesting that endogenous activation of the epidermal growth factor (EGF) receptor through autocrine or paracrine mechanisms might contribute to the proliferative response. In order to determine whether autocrine stimulation was partly responsible for the proliferative response in ovarian cancer, we investigated whether the EGF receptor expressed by ovarian cancer cell lines was constitutively activated as assessed by the presence of tyrosine phosphorylation. A specific anti-phosphotyrosine antibody was used in conjunction with an immunoblotting technique in order to detect EGF receptor phosphorylation in ovarian cancer cell lines in the absence and presence of exogenous EGF. The effects of neutralising anti-EGF receptor antibody on the proliferation of ovarian cancer cell lines was also examined. We found no evidence for constitutive tyrosine phosphorylation of the p170 EGF receptor in eight epithelial ovarian cancer cell lines tested, although each line demonstrated inducible phosphorylation in response to exogenous EGF. The absence of constitutive EGF receptor activation was also noted when cells were grown under high density conditions, thus excluding a role for membrane-bound EGF or TGF-alpha in this process. Media conditioned by five ovarian cancer cell lines, as well as malignant ascites obtained from 12 different ovarian cancer patients, were not capable of stimulating EGF receptor phosphorylation. Finally, the proliferation of ovarian cancer cell lines was not significantly inhibited in the presence of neutralising anti-EGF receptor antibody. These data suggest that EGF receptor activation through autocrine pathways is not a major mechanism for the growth of many ovarian cancer cell lines. Other pathways of signal transduction which bypass the requirement for EGF receptor activation may be important in the proliferation for ovarian cancer cells. Such EGF receptor-independent pathways may limit the effectiveness of strategies designed to inhibit ovarian cancer cell growth through disruption of EGF receptor function.

Urolith analysis. Submission, methods, and interpretation

The detection, treatment, and prevention of the causes underlying urolithiasis depend on knowledge of the composition and structure of the entire stone. Therefore, proper and complete analysis of uroliths is an important part of proper patient care. This article discusses methods of urolith retrieval, proper sample submission, methods of urolith analysis, and interpretation of results.

Caregiver mental health and family health outcomes following critical hospitalization of a child

Changes in caregiver and family health and in family health behavior patterns were examined 9 weeks after the hospitalization of a child for an acute, first-time illness in a pediatric intensive care unit (PICU). Family and caregiver health included reports of physical, mental, role, and social functioning as well as perceptions of health, pain, and changes in health behavior patterns at 3-7 days after admission to PICU and 9 weeks later. A convenience sample of 20 primary caregivers (all mothers) of children aged 2 days to 17 years served as subjects for the study. Results showed a decrease in mental health scores of all subjects over the 9-week period. Further, those caregivers whose child was rated as having a greater potential for chronicity had a significantly greater decline and were in the range of poor mental health at the 9-week posttest. Seventy percent of subjects reported new health problems in the family posthospitalization, and 43% reported at least one change in family health behavior patterns. Implications for testing the efficacy of mental health nursing consultation and case management during and after critical childhood illness are discussed.

Luminescence studies of hydrophobically modified, water-soluble polymers. I. Fluorescence anisotropy and spectroscopic investigations of the conformational behaviour of copolymers of acrylic acid and styrene or methyl methacrylate

Fluorescence spectroscopy and anisotropy measurements have been used to study a series of styrene – acrylic acid, STY–AA, and methyl methacrylate – acrylic acid, MMA–AA, copolymers in dilute methanolic and aqueous solutions. Copolymerization of either STY or MMA with AA has little effect upon the rate of intramolecular segmental motion in methanol solutions. In aqueous media, intramolecular hydrophobic aggregation occurs and restricts the macromolecular dynamics to an extent dependent upon pH, nature of the comonomer, and copolymer composition. The hydrophobic domains formed in these copolymer systems can solubilize organic guests. In this respect, STY is a more powerful modifier of AA-based polymer behaviours than is MMA. In general, the hydrophobic modification increases the solubilization power of the resultant polymer. Furthermore, the copolymers retain their solubilization capacities to higher values of pH the more hydrophobic the comonomer and the greater its content in the copolymer. The interiors of the hydrophobic aggregates reduce the mobilities of occluded guests: the microviscosities of the domain interiors depend upon the nature of the hydrophobe, pH, and copolymer composition. Keywords: fluorescence, anisotropy, water-soluble polymers, acrylic acid, hydrophobic modification.

CD44 variant expression is a common feature of epithelial ovarian cancer: lack of association with standard prognostic factors

PURPOSE

CD44 is a hyaluronic acid receptor that exists as a standard 90-kd form (CD44S) as well as several CD44 variant isoforms produced through alternative splicing. Expression of CD44 variants is associated with clinically aggressive behavior in some human tumors. The purpose of the present study is to define the expression of CD44 variant isoforms in ovarian cancer and to investigate whether the expression of these molecules is associated with adverse prognosis.

MATERIALS AND METHODS

Six specimens of normal ovarian surface epithelium (NOSE) and 31 separate cases of newly diagnosed ovarian cancer were studied by a combination of reverse-transcription polymerase chain reaction (RT-PCR) and immunoperoxidase staining. Clinical correlation was made between CD44 variant expression and stage (I/II v III/IV), residual disease (< or = 2.0- v > 2.0-cm mass), age (< or = 65 v > 65 years), histology (papillary serous v other), grade, and survival.

RESULTS

RT-PCR analysis revealed that NOSE predominantly expressed transcripts for CD44S, as well as a restricted pattern of transcripts characteristic of CD44 splice variants. CD44S and CD44 variant exon nine sequences (CD44-9v) were focally expressed in one of two NOSE specimens examined by immunoperoxidase staining. In comparison, the majority (71%) of ovarian cancer specimens expressed a complex pattern of CD44 splice variants by RT-PCR analysis. Immunoperoxidase studies revealed that the majority of ovarian cancer specimens expressed both CD44S and CD44-9v, whereas expression of sequences from variant exons 3, 4, and 6 was uncommon. There was no association between CD44 variant expression (transcript or protein) and stage, residual disease, age, histology, grade, or survival.

CONCLUSION

Expression of CD44S and CD44-9v is a common feature of epithelial ovarian cancer cells. The lack of a significant association between CD44 variant expression and prognosis suggests that other factors may be more important in determining the clinical behavior of this disease.

Living with renal failure

In this interpretive study, the experience of patients living with chronic renal failure was studied. Within the framework of Heideggerian phenomenology, a hermeneutic analysis revealed three themes and one constitutive pattern. The three themes were: taking on a new understanding of Being, maintaining hope and dwelling in dialysis. The constitutive pattern was "

CONTROL

The Meaning of Technology." The findings provide an understanding of living with renal failure that argues against the traditional understanding of noncompliant behaviors. The study makes visible the meaning of technology in the lives of renal patients and highlights the need for nurses to sustain meaningful human connections with patients.

A tissue-specific transcription factor containing a homeodomain specifies a pituitary phenotype

Multiple related cis-active elements required for cell-specific activation of the rat prolactin gene appear to bind a pituitary-specific positive transcription factor(s), referred to as Pit-1. DNA complementary to Pit-1 mRNA, cloned on the basis of specific binding to AT-rich cell-specific elements in the rat prolactin and growth hormone genes, encodes a 33 kd protein with significant similarity at its carboxyl terminus to the homeodomains encoded by Drosophila developmental genes. Pit-1 mRNA is expressed exclusively in the anterior pituitary gland in both somatotroph and lactotroph cell types, which produce growth hormone and prolactin, respectively. Pit-1 expression in heterologous cells (HeLa) selectively activates prolactin and growth hormone fusion gene expression, suggesting that Pit-1 is sufficient to confer a characteristic pituitary phenotype. The structure of Pit-1 and its recognition elements suggests that metazoan tissue phenotype is controlled by a family of transcription factors that bind to related cis-active elements and contain several highly conserved domains.