Causal somatic mutations in urine DNA from persons with the CLOVES subgroup of the PIK3CA-related overgrowth spectrum

Congenital lipomatous overgrowth with vascular, epidermal, and skeletal (CLOVES) anomalies and Klippel-Trenaunay (KTS) syndromes are caused by somatic gain-of-function mutations in PIK3CA, encoding a catalytic subunit of phosphoinositide 3-kinase. Affected tissue is needed to find mutations, as mutant alleles are not detectable in blood. Because some patients with CLOVES develop Wilms tumor, we tested urine as a source of DNA for mutation detection. We extracted DNA from the urine of 17 and 24 individuals with CLOVES and KTS, respectively, and screened 5 common PIK3CA mutation hotspots using droplet digital polymerase chain reaction. Six of 17 CLOVES participants (35%) had mutant PIK3CA alleles in urine. Among 8 individuals in whom a mutation had been previously identified in affected tissue, 4 had the same mutant allele in the urine. One study participant with CLOVES had been treated for Wilms tumor. We detected the same PIK3CA mutation in her affected tissue, urine, and tumor, indicating Wilms tumors probably arise from PIK3CA mutant cells in patients with CLOVES. No urine sample from a participant with KTS had detectable PIK3CA mutations. We suggest that urine, which has the advantage of being collected non-invasively, is useful when searching for mutations in individuals with CLOVES syndrome.

Workshop on intraspinal transplantation and clinical application

The following general conclusions were reached at the workshop: 1. Laboratory studies suggest a potential benefit of cellular transplant therapy for SCI. 2. Some evidence supporting the safety of human fetal transplants is available from clinical studies of transplants in Parkinson's disease and SCI. 3. Assessment criteria and methodology are available, including imaging approaches, validated neurologic scoring systems, detailed electrophysiologic studies of conduction and spinal cord reflexes, and functional scoring approaches. 4. More controlled animal studies are needed (a) to demonstrate efficacy and to evaluate the necessity for immunosuppressive therapy and the overall safety of intraspinal transplantation, (b) to obtain more supporting evidence (e.g., electrophysiologic, histopathologic, MRI, molecular) that would provide insights into ways that transplanted tissue could mediate function, (c) to provide guidance for the procurement, harvesting, preparation, storage, and other logistics related to the use of human cells for transplantation into the spinal cord, (d) to define more thoroughly the cell type(s) that would be most likely to have benefit and the conditions that affect their viability, migration, gene expressions, and proliferation after transplantation, (e) to determine the most optimal time after injury for transplantation, and (f) to clarify patient selection characteristics that might optimize success (i.e., complete vs incomplete injuries, spinal level involved, age of recipient).

Outcome measures for clinical trials involving traumatically brain-injured patients: report of a conference

A conference was held in Houston, Texas, on October 8-9, 1991, to develop recommendations for outcome measures for clinical trials in traumatic brain injury. Participants, all experts in this area, discussed and agreed on treatments for patients with severe brain injury (Glasgow Coma Score [GCS] < or = 8) and moderate brain injury (GCS, 9-12). A parallel trial design was recommended rather than a factorial, sequential, or crossover design. It was agreed that stratifying randomization based on motor score alone or on a combination of motor score and age would result in increased power. Acute stage measurements, such as cerebral blood flow, cerebrospinal fluid biochemistry, and evoked potentials, were recommended only when they satisfied a specific hypothesis. Functional outcome measures were recommended as the primary outcome measure for severe brain injury (GCS, 3-8). Either the Glasgow Outcome Scale or Disability Rating Scale, measured at 6 months after injury, were recommended as the primary outcome measure for severe brain injury (GCS, < or = 8). For patients with moderately severe brain injury (GCS, 9-12), the Disability Rating Scale at 3 months after injury was recommended as the primary outcome measure. The Neurobehavioral Rating Scale appears to be a satisfactory instrument for measuring behavioral changes. Specific neuropsychological measures were recommended as supplementary outcome measures for both severe and moderate brain injury, consistent with a 1.5-hour period available for testing.

Pathogen Survival in Precooked Beef Products and Determination of Critical Control Points in Processing

Surfaces of precooked, roast beef slices were inoculated with Clostridium perfringens , Staphylococcus aureus , Escherichia coli , Salmonella typhimurium , or Listeria monocytogenes , vacuum packaged and then stored at 3°C for 70 d to determine survival of pathogens under extended refrigerated storage in the presence of a natural competing microflora. S. typhimurium and L. monocytogenes remained present on the slices for the duration of the experiment. Numbers of S. aureus did not decrease significantly (P>0.05), and counts of C. perfringens decreased steadily over the 70-d storage period. Numbers of E. coli also declined, but more rapidly than the other pathogens during initial storage of the product. Total bacterial numbers for both uninoculated (control) and inoculated slices were similar. Samples obtained at selected locations in the processing sequence of a commercial restructured beef product contained L. monocytogenes at most sampling locations prior to heat processing, but not after heating. Salmonella was occasionally isolated from the product prior to heating. Total bacterial numbers decreased as processing day progressed, as did counts for S. aureus , E. coli , and coliforms. Counts of S. aureus and total bacterial numbers increased after the cooked product was removed from the package and coated with a seasoning mix. Data collected in this study support the designation of the following locations as critical control points: initial bacterial levels on raw products, cooking temperature and time, proper cooling after cooking, sanitation after opening the package (rubbing with seasonings and rebagging), and temperature control of the final product.

Regional brain glucose uptake in genetically diabetic C57BL/KsJ mice: modulation by the opiate antagonist, nalmefene

A novel opiate antagonist, Nalmefene (0.5 or 5.0 mg/kg/day) was tested for its ability to modulate regional brain glucose uptake rates in genetically diabetic C57BL/KsJ mice, which normally exhibit a depressed CNS carbohydrate metabolism relative to age-matched controls. Daily Nalmefene treatment had no effect on circulating blood glucose levels in either normal or diabetic mice over a 7-week test period. However, all brain regions, except the olfactory bulbs, exhibited normalized glucose uptake rates in diabetic mice relative to controls. These data suggest a role for opiate antagonists in the modulation of CNS glucose metabolism during hyperglycemic states.

The effect of alcohol on nocturnal gastroesophageal reflux

The effect of 120 mL (4 oz) of scotch whiskey (40% alcohol) on nocturnal gastroesophageal reflux was studied by ambulatory esophageal pH monitoring. Seventeen healthy volunteers were studied on two occasions, using a computerized radiotelemetric esophageal pH monitoring system. The subjects were given the alcohol during the second session, three hours after the evening meal, and went to bed at their usual time. Seven of the 17 subjects had prolonged supine reflux episodes on the night of alcohol ingestion. These lasted an average of 47.1 minutes (23.2 to 91.8 minutes) and occurred on an average of 3 1/2 hours after ingestion of whiskey and 1.4 hours after lying down. None of the subjects had these episodes on the control night. There was also a significant acidic shift in the cumulative percentage of data points below a pH of 3 and a pH of 4 in the supine position on the night of alcohol ingestion compared with the control night. This study has shown that there was a significant exposure of the distal esophagus to acid and that the normal acid clearance of the esophagus in the supine position was impaired after only moderate amounts of alcohol.

Peripheral nerve as an osmometer: role of endoneurial capillaries in frog sciatic nerve

The sciatic nerve of the frog was perfused in vivo with isotonic Ringer solution followed by Ringer made hypertonic by addition of sucrose or of NaCl. Nerve diameter and endoneurial hydrostatic pressure fell during hypertonic Ringer perfusion. Using a model that describes the elastic and osmotic properties of the nerve, sigma sLp, the product of the osmotic reflection coefficient at endoneurial capillaries for s equals sucrose or NaCl (which approximates 1), and of capillary hydraulic conductivity, was found to equal 73 X 10(-13) cm3 X s-1 X dyn-1. The nerve is elastic. It has a compliance K of 3.7 X 10(-5) cm2 X mmHg-1, corresponding to a modulus of elasticity E of the perineurium equal to 1.2 X 10(6) dyn X cm-2. The results indicate that the nerve behaves as an osmometer during vascular perfusion, due to the low permeability of endoneurial capillaries to small solutes such as NaCl and sucrose. A low capillary hydraulic conductivity limits bulk water flow between blood and nerve, and a low compliance limits nerve swelling and edema.

Hydrophilic cyclodextrin derivatives enable effective oral administration of steroidal hormones

Condensation products of beta-cyclodextrin with propylene oxide or epichlorohydrin, which are amorphous and thus very soluble in water, were used to form complexes with testosterone, progesterone, and estradiol. Sublingual/buccal administration of tablets of these complexes led to effective absorption and entry of the hormones into the systemic circulation, followed by gradual elimination; rapid first-pass loss was avoided. beta-Cyclodextrin itself, its 2,6-dimethyl derivative, and a nonionic detergent did not enable effective buccal absorption. Absorption from the GI tract of hormones complexed with hydrophilic cyclodextrins was also less effective. Effective absorption of drugs from the oral cavity requires (a) that the drug and solubilizer form a complex of the inclusion type which dissolves completely and rapidly and (b) that the solubilizer neither enters nor damages oral tissue.

Binding of a new opiate antagonist, nalmefene, to rat brain membranes

Nalmefene (6-methylene-naltrexone) is a potent, orally active, opiate antagonist. IC50's were obtained for nalmefene, naloxone and naltrexone using radiolabelled prototype ligands for mu, kappa and delta receptors in homogenates of rat brain minus cerebellum. Nalmefene antagonized the bindings of [3H]-dihydromorphine, [3H]-ethylketocyclazocine and [3H]-D-ala-D-leu enkephalin with IC50's in the low nanomolar range. At the central mu receptor, nalmefene bound with an IC50 of 1.0 nM, equal to that of naltrexone and approximately four times lower than that of naloxone. At central kappa and delta sites the IC50's for nalmefene were somewhat lower than those of naltrexone and considerably lower than those of naloxone. All three antagonists had sodium indices less than 1.0. These results indicate that nalmefene is a universal opiate antagonist, has no agonist character at the central mu site and binds more effectively to central opiate receptors than either naloxone or naltrexone.

Sciatic nerve blood flow measured by laser Doppler flowmetry and [14C]iodoantipyrine

Blood flow was examined in sciatic nerves of pentobarbital-anesthetized rats by means of laser Doppler flowmetry (LDF) and intravenous [14C]iodoantipyrine infusion. Continuous LDF signals demonstrated slow oscillations and acute, pressure-related changes in flow. The steady-state LDF signal was related linearly to nerve blood flow, as measured with [14C]iodoantipyrine, in intact nerves and nerves stripped of the epineurium. In 14 intact nerves, nerve blood flow averaged 0.27 +/- 0.03 (SE) ml X min-1 X g-1, whereas it averaged 0.13 +/- 0.01 in 5 stripped nerves. Autoradiographs of [3H]-nicotine-infused nerves and intra-arterial injection of 57Co-labeled microspheres demonstrated that flow was not uniform throughout the nerve cross section. The results indicate that LDF can be used to examine nerve blood flow in vivo, demonstrate a linear relation between the LDF signal and flow, and establish absolute values for blood flow in intact and stripped nerves of the anesthetized rat.

Computerized 24-hour ambulatory esophageal pH monitoring and esophagogastroduodenoscopy in the reflux patient. A comparative study

Ambulatory 24-hour esophageal pH monitoring and esophagogastroduodenoscopy were performed in 72 patients with symptoms suggestive of gastroesophageal reflux. Additionally, 22 asymptomatic healthy volunteers underwent pH monitoring. In patients with classic reflux symptoms and endoscopic esophagitis, a mean of 5.41 minutes/hour of reflux below pH 4 was found compared to 0.70 minutes/hour in controls (p less than 0.0001). The mean number and duration of reflux events in this group were 1.51 events/hour and 4.0 minutes/event, compared with 0.31 events/hour and 2.26 minutes/event in volunteers (p less than 0.001, p less than 0.01). A new system for ambulatory esophageal pH monitoring is presented using a pH-sensitive radiotelemetry pill or a pH probe and computerized methods for ambulatory data collection, analysis, and storage. An overall sensitivity of 76% was obtained with a 91% selectivity for detection of acid reflux in 51 patients having classic symptoms of gastroesophageal reflux. Ambulatory pH monitoring was positive for acid reflux in seven of 11 patients with normal endoscopic findings. Conversely, eight of 12 patients with normal pH monitoring had endoscopic esophagitis. In 19 patients presenting with atypical symptoms or previous gastric surgery, endoscopic findings were normal in 15. Nine of these 15 were identified as acid refluxers by pH monitoring. A combined approach using both pH monitoring and endoscopy is warranted for maximal detection and quantification of disease. A clear clinical role for pH monitoring is seen in the early diagnosis of acid reflux, particularly in patients having normal endoscopic findings with nonspecific gastrointestinal complaints or previous gastric operations.

Morphology of endoneurial blood vessels of frog sciatic nerve during vascular perfusion

In order to determine if increased injection pressures can alter the permeability and ultrastructure of blood vessels of the frog blood-nerve barrier, these vessels were examined following perfusion of the iliac artery at rates of 0.21 or 0.82 ml/min. At either perfusion rate, endoneurial blood vessel profiles were clearly evident and the surface area of these vessels amounted to 60% of the surface area of the perineurium. In all vessels a large number of vesicles were present within the endothelial cells. Many were attached by necks to one or the other plasma membrane, but no transcellular channels were evident. At the higher flow rate no changes in vesicles or junctions were seen, but blebs and blisters were evident at the luminal membranes of the endoneurial endothelium. When microperoxidase was perfused at 0.82 ml/min, reaction product frequently flooded the endothelial cells, was found as clumps on the cell surface, and was distributed within the endoneurial space. These changes represent the only ultrastructural evidence of endothelial cell damage and altered permeability in response to increased rate of perfusion.

Presence of a blood-nerve barrier within blood vessels of frog sciatic nerve

The morphological correlates of protein permeability in endoneurial blood vessels of the frog sciatic nerve were investigated. The endothelial cells of these vessels possess numerous free and anastomosing vesicles at both their lumenal and ablumenal surfaces. The cells are joined by junctions characterized by one or two areas of membrane apposition. However, vesicular transport, transcellular channels or open junctions are not found. The protein tracers horseradish peroxidase and microperoxidase remained confined in the vessels after intravascular injection. Likewise, if injected into the endoneurium, horseradish peroxidase did not enter the vascular lumen. The endothelium of frog endoneurial blood vessels forms an effective barrier to protein tracers.

Morphological correlates of permeability in the frog perineurium: vesicles and "transcellular channels"

Lanthanum, applied to the outside of the fixed sciatic nerve of Rana pipiens, did not enter the endoneurium, but was halted by functionally tight junctions at the inner layers of the perineurium. This component of the blood-nerve barrier consists of several concentric layers of cells interspersed with an extracellular matrix of amorphous ground substance, collagen fibrils, and fine filaments. Numerous vesicular profiles are closely associated with the surface membranes of all the cells. The application of lanthanum to fixed tissue revealed that these profiles are attached to the cell surface by narrow necks, and open to the extracellular space. The attenuated cells are filled by the vesicular structures, which often appear to overlap. Stereoscopic electron microscopy showed that these vesicles did not fuse with each other or with the apposing cell surface to form transcellular channels. Channel formation does not appear to contribute significantly to the permeability of any of the perineurial layers.

Axonal-ependymal associations during early regeneration of the transected spinal cord in Xenopus laevis tadpoles

The nature and organization of the cellular substrate supporting axonal outgrowth during early regeneration of the spinal cord following transection and/or segment removal were examined in Xenopus tadpoles. Longitudinal axonal compartments, formed by radial ependymal processes in unoperated spinal cords, were maintained within the rostral and caudal stumps throughout the early post-operative period. The first neuritic sprouts to appear near the cut ends of the cord were frequently associated with these processes. Between 5 and 7 days after transection either single or multiple cellular aggregates, which consisted primarily of ependyma, began occupying the lesion zone and were encompassed by numerous small fibres. Ependymal processes subsequently extended among the neurites within the lesion gap and re-established longitudinal axonal channels and a surrounding glia limitans. A concurrent outgrowth of fibres and ependyma from the rostral and caudal stumps was also initiated by 5-7 days following resection of the cord. Axons were seen further within the ablation gap at 10 and 12 days either coursing along the surfaces of the emerging ependyma or organized into small fascicles by the radial processes of these cells. Intermediate stages of axonal fasciculation by the underlying ependyma were also seen. In contrast with previous reports, axonal elongation beyond the cut ends of the cord did not consistently entail the formation of pre-existing ependymal channels. These observations provide additional evidence emphasizing the importance of the ependymal cell surface during axonal outgrowth in the regenerating spinal cord. Guided neuritic elongation, however, does not appear to be dependent upon the prior establishment of a specific type of cytoarchitecture.

Determination of sex by discriminant function analysis of postcranial skeletal measurements

Thieme and Schull [16] took measurements of seven postcranial traits from black skeletons of known sex to devise a method for accurately sexing human remains. With a linear discriminant function analysis of the data they obtained a 98.5% accuracy. The research reported here was designed to assess the accuracy of their method in the hands of other investigators using a sample of the same black population and its applicability to other populations of the same and different races. None of the samples used in this study were sexed with the same rate of accuracy either achieved or predicted by Thieme and Schull. However, two samples did reach 91% or better. Such results suggest that the methods employed have considerable value if used with appropriate precautions. Our multiple discriminant function analysis strongly indicates that neither side nor observer techniques affected the results. Sex accounts for a predominant fraction of the total variation among samples and race accounts for most of that remaining.