The empty pelvis syndrome: a core data set from the PelvEx collaborative

BACKGROUND

Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored.

METHOD

Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition.

RESULTS

One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed.

CONCLUSIONS

EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.

Fenugreek derived diosgenin as an emerging source for diabetic therapy

Diabetes is a chronic metabolic disease that endangers the entire body's tissues and organs. Diabetes impairs glucose and insulin regulation in the human body by causing pancreatic cell damage. Diabetes modifies pathways such as serine/threonine protein kinase (Akt) and Protein kinase C (PKC)/- glucose transporter 4 (GLUT4), peroxisome proliferator-activated receptor (PPAR) glucose absorption, and inhibits α-amylase and α-glucosidase, Sodium/glucose cotransporter 1 (SGLT-1), and Na+-K+-ATPase activity. Diabetes may also be caused by a decrease in the expression of sterol regulatory element binding protein 1 (SREBP-1) and its target genes, fatty acid synthase (FAS), stearoyl-CoA desaturase-1 (SCD-1), and acetyl-CoA carboxylase α (ACC), as well as a decrease in the levels of C/EBP homologous protein (CHOP), Caspase12, and Caspase3 proteins. Diabetes has long been linked to diseases of the cardiovascular, nervous, skeletal, reproductive, hepatic, ocular, and renal systems. Diosgenin, a steroidal compound derived from fenugreek, aids in the prevention of diabetes by altering cellular pathways in favor of healthy bodily functions. Diosgenin is a new nutraceutical on the market that claims to cure diabetes in particular. This article focuses on diosgenin extraction and purification, fenugreek bioactive compounds, pharmacological properties of diosgenin, mode of action of diosgenin to cure diabetes, and dosages.

Potential applications of green-synthesized iron oxide NPs for environmental remediation

Water pollution is a significant issue worldwide due to an increase in anthropogenic activities. Heavy metals and dyes are among the most problematic contaminants that threaten the environment and negatively impact human health. Iron oxide nanoparticles (IONPs) synthesized using green methods have shown potential in these areas due to their significant adsorption capacity and photocatalytic potential. The size and morphology of biogenic IONPs can be tailored depending upon the concentration of the reducing medium and metal salt precursor. Green-synthesized IONPs have been found to be effective, economical, and environmentally friendly with their large surface area, making them suitable for removing toxic matter from contaminated water. Furthermore, they exhibit antibacterial potential against harmful microorganisms. The study emphasizes the importance of using such environmentally friendly tools to remove heavy metal ions and organic compounds from contaminated water. The underlying mechanism for the adsorption of heavy metal ions, photocatalytic degradation of organic compounds, and antimicrobial action has been explored in detail. The future prospective for the beneficial utilization of biogenic IONPs has also been signified to provide a detailed overview.

Biogenic synthesis of iron oxide nanoparticles using leaf extract of Spilanthes acmella: antioxidation potential and adsorptive removal of heavy metal ions

The sequestration of contaminants from wastewater, such as heavy metals, has become a major global issue. Multiple technologies have been developed to address this issue. Nanotechnology is attracting significant interest as a new technology, and numerous nanomaterials have been produced for sequestrating heavy metals from polluted water due to their superior properties arising from the nanoscale effect. This study reports biosynthesis of iron oxide nanoparticles (IO-NPs) and their applications for adsorptive sequestration of various metal ions from aqueous solutions. Biosynthesis of IO-NPs has been carried out by using leaf extract of Spilanthes acmella, a medicinal plant. FTIR analysis of the leaf extract and biosynthesized IO-NPs marked the role of various functional groups in biosynthesis of IO-NPs. FESEM analysis revealed the average size range of IO-NPs as 50 to 80 nm, while polydisperse nature was confirmed by DLS analysis. EDX analysis revealed the presence of Fe, O, and C atoms in the elemental composition of the NPs. The antioxidant potential of the biosynthesized IO-NPs (IC50 = 136.84 µg/mL) was confirmed by DPPH assay. IO-NPs were also used for the adsorptive removal of As3+, Co2+, Cd2+, and Cu2+ ions from aqueous solutions with process optimization at an optimized pH (7.0) using dosage of IO-NPs as 0.6 g/L (As3+ and Co2+) and 0.8 g/L (Cd2+ and Cu2+). Adsorption isotherm analysis revealed the maximum adsorption efficiency for As3+ (21.83 mg/g) followed by Co2+ (20.43 mg/g), Cu2+ (15.29 mg/g), and Cd2+ (13.54 mg/g) using Langmuir isotherm model. The biosynthesized IO-NPs were equally efficient in the simultaneous sequestration of these heavy metal ions signifying their potential as effective nanoadsorbents.

Microalgal bioactive metabolites as promising implements in nutraceuticals and pharmaceuticals: inspiring therapy for health benefits

The rapid increase in global population and shrinkage of agricultural land necessitates the use of cost-effective renewable sources as alternative to excessive resource-demanding agricultural crops. Microalgae seem to be a potential substitute as it rapidly produces large biomass that can serve as a good source of various functional ingredients that are not produced/synthesized inside the human body and high-value nonessential bioactive compounds. Microalgae-derived bioactive metabolites possess various bioactivities including antioxidant, anti-inflammatory, antimicrobial, anti-carcinogenic, anti-hypertensive, anti-lipidemic, and anti-diabetic activities, thereof rapidly elevating their demand as interesting option in pharmaceuticals, nutraceuticals and functional foods industries for developing new products. However, their utilization in these sectors has been limited. This demands more research to explore the functionality of microalgae derived functional ingredients. Therefore, in this review, we intended to furnish up-to-date knowledge on prospects of bioactive metabolites from microalgae, their bioactivities related to health, the process of microalgae cultivation and harvesting, extraction and purification of bioactive metabolites, role as dietary supplements or functional food, their commercial applications in nutritional and pharmaceutical industries and the challenges in this area of research.

Graphical abstract

Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline

This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.

Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative

AIM

At presentation, 15-20% of patients with rectal cancer already have synchronous liver metastases. The aim of this study was to determine the surgical and survival outcomes in patients with advanced rectal cancer who underwent combined pelvic exenteration and liver (oligometastatic) resection.

METHOD

Data from 20 international institutions that performed simultaneous pelvic exenteration and liver resection between 2007 and 2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival.

RESULTS

Of 128 patients, 72 (56.2%) were men with a median age of 60 years [interquartile range (IQR) 15 years]. The median size of the liver oligometastatic deposits was 2 cm (IQR 1.8 cm). The median duration of surgery was 406 min (IQR 240 min), with a median blood loss of 1090 ml (IQR 2010 ml). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major postoperative complication. The 5-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection (P = 0.006).

CONCLUSION

Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.

SAT0626-HPR EXPLORING THE RELATION BETWEEN PAIN AND ACTIVITY AND PARTICIPATION BASED ON ICF IN CHILDREN AND ADOLESCENTS WITH JUVENIL IDIOPATIK ARTRIT: A PILOT STUDY

Background:

Functional limitation and inactivation are the most important problems in children with Juvenil Idiopatik Artrit (JIA).

Objectives:

The aim of this study was to link and allocate items of Childhood Health Assessment Questionnaire (CHAQ) with activity and participation based on International Classification of Functioning, Disability and Health (ICF). The other aim was to examine the relationship between the pain and activity and participation determined on the basis of CHAQ with Juvenil Idiopatik Artrit (JIA).

Methods:

Thirty-seven children and adolescents (26 girls, 11 boys, mean age=11.75±4.04 years) were included. The mean BMI of the participants was 19.61±4.52 kg / cm2. Inclusion criteria: To be diagnosed with JIA according to ILAR classification. Being in the 6-18 age range. To be stable in drug use for at least 3 months or longer. Exclusion criteria:The presence of another disease. Intraarticularsteroid injection or surgery in any joint in last 3 months. Evaluations were made by the same pediatric rheumatologist and physiotherapist (PT) by face to face interview method. Pain was evaluated by use of Numeric Rating Scale (NRS) (0=no, 10=worst) and disability by CHAQ. As CHAQ score increases, disability increases. CHAQ has 8 categories. The highest score for any question determines the score for that category. The items of CHAQ were linked with ICF codes and allocated with the ICF components by three PT. Original scoring of CHAQ allocated to ICF components was used in order to calculate scores of activity and participation in accordance with clinical data for 37 JIA. The 20th item in the “Reach” category is not included in the calculation as it contains the body function component of ICF. The data was analyzed using Pearson’s correlation coefficient.

Results:

Mean score of NRS was 3.52±2.34. Mean activity and participation score of CHAQ was 0.51±0.58, 0.70±1.10, respectively. Based on expert distinction, activity and participation categories of ICF were covered 24 and 5 items of CHAQ, respectively. Pain had moderate correlation with activity (r=0.595; p=0.002) and participation (r=0.604; p=0.001) for CHAQ. Activity had high correlation with participation (r=0.702; p=0.000).

Conclusion:

Pain in children and adolescents with JIA is an important parameter affecting activity and participation. Pain should be evaluated in all aspects due to the limitation of both activity and participation. CHAQ largely contains the activity component of ICF. The development of new questionnaire is needed to assess the participation of JIA children and adolescents in more detail.

References:

[1]Schanberg LE. Widespread pain in children: when is it pathologic? Arthritis Rheum 2003;48:2402-2405.

Table 1.

Linking and allocating items of CHAQ

ItemsICF CodeICF ComponentDRESSING & GROOMINGDress, including tying shoelaces and doing buttons?d5402AShampoo his/her hair?d5100ARemove socks?d5403ACut fingernails?d520AARISINGStand up from a low chair or floor?d4103AGet in and out of bed or stand up in crib?d4100AEATINGCut his /her own meat?d550ALift a cup or glass to mouth?d4402AOpen a new cereal box?d440AWALKINGWalk outdoors on flat ground?d450AClimb up five steps?d4551AHYGIENEWash and dry entire body?d510ATake a tub bath?dd410AGet on and off the toilet or potty chair?d4103ABrush teeth?d5201AComb/brush hair?d5202AREACHReach and get down a heavy object from just above his/her head?d4452ABend down to pick up clothing or a piece of paper from the floor?d4105APull on a sweater over his/her head?d5400ATurn neck to look back over shoulder?b7101Body FunctionGRIPWrite or scribble with pen or pencil?d170AOpen car doors?d4450AOpen jars which have been previously opened?d4453ATurn faucets on and off?d4402APush open a door when he/she to turn a door knob?d4453AACTIVITIESRun errands and shop?d6200PGet in and out of car or toy car or school?d4702PRide bike or tricycle?d4750PDo household choresd6402PRun and play?d9201P

A:Activity, P:Participation

Disclosure of Interests:

None declared

AB0985 THE EFFECT OF GENDER ON CHILDREN AND ADOLESCENTS WITH FAMILIAL MEDITERRANEAN FEVER

Background:

In the literature, it was reported that children with with Familial Mediterranean fever (FMF) have lower functional capacity and muscle strength than healthy children. With reduced functional capacity, daily activities are negatively affected. The individual starts to adopt an inactive lifestyle and decreases in muscle strength are observed. A vicious circle occurs and results in exacerbation of symptoms and worse quality of life.

Objectives:

The aim of this study is to investigate the effect of gender on dynamic muscular endurance, physical activity and quality of life with FMF.

Methods:

Forty-eight children and adolescents (26 girls, 22 boys, mean age=12.43±3.04 years, age range=7-18 years) were included. Exclusion criteria:The presence of another disease. Intraarticularsteroid injection or surgery in any joint in the last 3 months. Evaluations were made by the same pediatric rheumatologist and physiotherapist by face to face interview method. Dynamic muscle endurance was evaluated by use of curl up test (30 sec), push up test (30 sec) and one-legged stationary hop test (15 sec); physical activity level by Physical Activity Questionnaire and quality of life by Pediatric Quality of Life Inventory (PedsQL) 3.0 Arthritis Module. Physical Activity Questionnaire contains nine items and evaluates physical activities in last seven days and frequency of these activities. As score increases, level of physical activity increases. In this study, child and parent forms of PedsQL were used to evaluate the quality of life. High scores mean high quality of life. Independent Samples Test was used in the analysis because the data fit the normal distribution.

Results:

Difference was significant in Physical Activity Questionnaire (p=0.028) in favor of girl gender whereas in child form (p=0.017) and parent form (p=0.040) of PedsQL (p=0.003) in favor of boy gender.

Conclusion:

We see that the physical activity are lower in children and adolescents with FMF who have a gender of girls and, accordingly, lower quality of life. Therefore, we believe that these individuals should increase their physical activities.

References:

[1]Gualano B, S´a Pinto AL, Perondi B, Leite Prado DM, Omori C, Almeida RT, Sallum AM, Silva CA. Evidence for prescribing exercise as treatment in pediatric rheumatic diseases. Autoimmun Rev 2010;9(8):569-573.

[2]Alayli G, Durmus D, Ozkaya O, Sen HE, Nalcacioglu H, Bilgici A, Kuru O. Functional Capacity, Strength, and Quality of Life in Children and Youth With Familial Mediterranean Fever. Pediatric Physical Therapy 2014;26(3):347-352.

Table 1.

Demographic characteristics

VariablesGirls (n=26)Boys (n=22)M±SDM±SDAge (years)12.96±2.9111.86±3.24Body weight (kg)42.76±12.5540.17±11.89Height (m)1.50±0.131.48±0.15BMI (kg/m2)18.25±2.9017.85±3.39Age of onset (years)7.57±4.077.22±3.99Dose of colchicine (per day)1.18±0.601.63±0.68Duration of treatment (years)5.30±2.904.61±3.34C-reactive protein (mg/dl)0.88±2.281.25±2.91Pras et al severity score6.35±2.685.31±2.60n (%)n (%)FMF in the family (Yes/No)4(15.4)/16(61.5)12(54.5)/10(45.5)Arthritis (Yes/No)9(34.6)/17(65.4)6(27.3)/16 (72.7)Arthralgia (Yes/No)20(76.9)/6(23.1)14(63.6)/ 8(36.4)Knee (Yes/No)6(23.1)/20(76.9)7(31.8)/15 (68.2)Elbow (Yes/No)1(3.8)/25(96.2)0(0)/22(100)Ankle (Yes/No)6(23.1)/20(76.9)7(31.8)/15(68.2)Hand (Yes/No)1(3.8)/25(96.2)1(4.5)/21(95.5)Table 2.

Comparison of data in terms of gender

VariablesGirls (n=26)Boys (n=22)p*M±SDM±SDCurl Up Test (repeat)10.70±3.5812.80±3.660.075Push Up Test (repeat)10.55±5.0611.75±6.290.511One-legged Stationary Hop Test (repeat)37.60±12.7435.35±6.020.480Physical Activity Questionnaire16.93±5.7020.70±5.770.028PedsQL- child form19.15±13.4810.68±9.380.017PedsQL- parent form22.30±17.8513.04±11.060.040

Disclosure of Interests:

None declared

New strategies and designs in pancreatic cancer research: consensus guidelines report from a European expert panel

Although the treatment of pancreatic ductal adenocarcinoma (PDAC) remains a huge challenge, it is entering a new era with the development of new strategies and trial designs. Because there is an increasing number of novel therapeutic agents and potential combinations available to test in patients with PDAC, the identification of robust prognostic and predictive markers and of new targets and relevant pathways is a top priority as well as the design of adequate trials incorporating molecular-driven hypothesis. We presently report a consensus strategy for research in pancreatic cancer that was developed by a multidisciplinary panel of experts from different European institutions and collaborative groups involved in pancreatic cancer. The expert panel embraces the concept of exploratory early proof of concept studies, based on the prediction of response to novel agents and combinations, and randomised phase II studies permitting the selection of the best therapeutic approach to go forward into phase III, where the recommended primary end point remains overall survival. Trials should contain as many translational components as possible, relying on standardised tissue and blood processing and robust biobanking, and including dynamic imaging. Attention should not only be paid to the pancreatic cancer cells but also to microenvironmental factors and stem/stellate cells.

Role of 7,8-dimethoxycoumarin in anti-secretary and anti-inflammatory action on pyloric ligation-induced gastritis in rats

The present study was designed to investigate the effect of 7,8-dimethoxycoumarin (DMC) isolated from ethyl acetate extract of Citrus decumana peels on gastritis in rats. Isolation of 7,8-DMC from ethyl acetate extract of C. decumana peels was done by column and preparative thin layer chromatography using different solvents on polarity basis. Furthermore, effect of 7,8-DMC (50, 75, and 100 mg/kg, i.p.) in pyloric ligation-induced gastritis was studied in rats. The highest dose of 7,8-DMC showed significant decrease in the gastric volume, total acidity, ulcerative index, thiobarbituric acid reactive species levels, and myeloperoxidase activity, whereas there was an increase in the glutathione level. However, the lowest and medium doses did not produce significant results as compared to omeprazole and N-acetyl cysteine-treated groups. Compound 7,8-DMC (100 mg/kg) showed ameliorative effect on gastric inflammation and may be used as a therapeutic agent in the treatment of gastritis.

Endoscopic therapy for chronic pancreatitis

When endoscopic therapy is used for the treatment of patients with painful chronic pancreatitis, extracorporeal shock wave lithotripsy (ESWL) can be proposed as a first-line approach when obstructive ductal stone(s) induce upstream dilation of the main pancreatic duct. Stone fragmentation by ESWL is followed by endoscopic ductal drainage using pancreatic sphincterotomy, fragmented stone(s) extraction, and pancreatic stenting in case of ductal stricture. After completion of endoscopic pancreatic ductal drainage, long-term clinical benefit can be expected for two thirds of the patients. Best clinical results are associated with absence or cessation of smoking and with early treatment in the course of chronic pancreatitis, while alcohol abuse increases the risks of diabetes, steatorrhea and mortality. The complications of chronic pancreatitis are mainly the development of pseudocyst secondary to the downstream ductal obstruction, and biliary obstruction caused by fibrotic changes in the head of the pancreas. Successful endoscopic pseudocyst drainage is currently obtained in most patients, and carries a low complication rate. Biliary stenting is a safe and effective technique for the short-term treatment of symptomatic bile duct stricture due to chronic pancreatitis, but permanent resolution is obtained in only 25% of cases. In conclusion, endoscopic management is now considered to be the preferred interventional treatment of chronic pancreatitis, for patients selected on the basis of the anatomical changes caused by the disease. This treatment is generally safe, minimally invasive, often effective for years, does not prevent further surgery, and can be repeated.

HIV-1 infection is facilitated in T cells by decreasing p56lck protein tyrosine kinase activity

Several studies have suggested an important role for the protein tyrosine kinase p56lck (Lck) in HIV infection; however, the exact nature of this role remains unclear. Using a series of well characterized Jurkat-derived cell lines having a wide range of Lck kinase activity, our results showed that, while the entry of HIV-1 into these cell lines was similar, the kinetics of virus production by these cells were very different. Cells expressing a kinase-inactive Lck showed accelerated viral replication, whereas, cells expressing Lck with normal or elevated enzymatic activity showed a delay in virus replication that was proportional to the initial level of endogenous Lck activity. The cell line having the highest initial Lck kinase activity showed the slowest rate of productive HIV-1 infection. Analysis of 2-LTR circles revealed that this inhibitory effect of Lck was not due to inhibition of reverse transcription of HIV-1 genome or migration of the proviral DNA into the nuclei. This affect of Lck was confirmed in additional studies that used either the S1T cell line lacking completely Lck or where the Lck activity was altered in Jurkat cells prior to infection. S1T cells showed a 3- to 12-fold increase in the level of infection compared to Jurkat cells despite similar CD4 and chemokine coreceptor expression and cell doubling times. Pretreatment of Jurkat with an antisense lck oligodeoxynucleotide inhibited the synthesis of functional Lck and facilitated the viral replication by the cells as did expressing a dominant-negative mutant Lck which increased the productive infection>3-fold. Conversely, whereas IL-16 had no affect on productive infection in S1T cells that lack Lck, IL-16 pretreatment of Jurkat cells resulted in an immediate (within 5 min) and sustained and gradual (over 5 h) increase in Lck activity that resulted in a reduction of HIV-1 replication that paralleled the increasing Lck kinase activity. These results show that the enzymatic activity of Lck kinase can affect viral replication, that a lack of, or decreased Lck activity facilitates viral replication. Conversely, Lck can mediate a delay in HIV-1 infection that is proportional to the initial endogenous Lck enzyme activity.

Localized Castleman's disease and nephrotic syndrome not responsive to resection plus colchicine therapy

We describe one patient with localized Castleman's disease (CD) of the mixed hyaline vascular and plasma cell type located at the mesentery of the small bowel, associated with systemic amyloidosis and nephrotic syndrome. A true nephrotic syndrome has rarely been reported in patients with CD. In the literature, it has been suggested that clinical and laboratory manifestations generally improved after surgical resection of the tumor. However, in our case, clinical and laboratory findings did not regress after operation followed by colchicine therapy.

Regulation of ClC-2 chloride channels in T84 cells by TGF-α

The almost ubiquitously expressed ClC-2 chloride channel is activated by hyperpolarization and osmotic cell swelling. Osmotic swelling also activates a different class of outwardly rectifying chloride channels, and several reports point to a link between protein tyrosine phosphorylation and activation of these channels. This study examines the possibility that transforming growth factor-α (TGF-α) modulates ClC-2 activity in human colonic epithelial (T84) cells. TGF-α (0.17 nM) irreversibly inhibited ClC-2 current in nystatin-perforated whole cell patch-clamp experiments, whereas a superimposed reversible activation of the current was observed at 8.3 nM TGF-α. Both effects required activation of the intrinsic epidermal growth factor receptor (EGFR) tyrosine kinase activity, of phosphoinositide 3-kinase, and of protein kinase C. With microspectrofluorimetry of the pH-sensitive fluorescent dye 2′,7′-bis(2-carboxyethyl)-5(6)-carboxyfluorescein, TGF-α was shown to reversibly alkalinize T84 cells at 8.3 nM but not at 0.17 nM, suggesting that 8.3 nM TGF-α-induced alkalinization activates ClC-2 current. This study indicates that ClC-2 channels are targets for EGFR signaling in epithelial cells.

Two mild cystic fibrosis-associated mutations result in severe cystic fibrosis when combined in cis and reveal a residue important for cystic fibrosis transmembrane conductance regulator processing and function

The number of complex cystic fibrosis transmembrane conductance regulator (CFTR) genotypes identified as having double-mutant alleles with two mutations inherited in cis has been growing. We investigated the structure-function relationships of a severe cystic fibrosis (CF)-associated double mutant (R347H-D979A) to evaluate the contribution of each mild mutation to the phenotype. CFTR mutants expressed in HeLa cells were analyzed for protein biosynthesis and Cl(-) channel activity. Our data show that R347H is associated with mild defective Cl(-) channel activity and that the D979A defect leads to misprocessing. The mutant R347H-D979A combines both defects for a dramatic decrease in Cl(-) current. To decipher the molecular mechanism of this phenotype, single and double mutants with different charge combinations at residues 347 and 979 were constructed as charged residues were involved in this complex genotype. These studies revealed that residue 979, located in the third cytoplasmic loop, is critical for CFTR processing and Cl(-) channel activity highlighting the role of charged residues. These results have also important implications for CF, as they show that two mutations in cis can act in concert to alter dramatically CFTR function contributing to the wide phenotypic variability of CF disease.

A modelling study of feedforward activation in human erythrocyte glycolysis

Though feedforward activation (FA) is a little known principle of control in metabolic networks, there is one well-known example; namely, the activation of pyruvate kinase (PK) by fructose-1,6-biphosphate (FBP) in glycolysis. The effects of this activation on the enzyme's kinetics are well characterised, but its possible role in glycolytic control has not been determined, and, experimentally, there is as yet no direct way of modifying the enzyme to remove just the FBP activation without affecting other aspects of the enzyme's kinetics. Given this limitation, we used a detailed numerical simulation of human erythrocyte glycolysis to simulate the effects of selective removal of the activation of PK by FBP on steady-state metabolite concentrations and on the dynamic response of glycolytic flux to a sudden increase of the cell's demand for ATP. Our modelling results predict that in the absence of FA steady-state levels of metabolites within the activation loop, i.e. from FBP to phosphoenolpyruvate, would be four- to thirteen-fold higher than normal, whereas levels of ATP and metabolites outside the loop, i.e. glucose-6-phosphate, fructose-6-phosphate and pyruvate, would be lower than normal. Existing clinical evidence in a patient with haemolytic anaemia, correlated with a lack of activation of PK by FBP (Paglia D.E., Valentine W.N., Holbrook C.T., Brockway R., Blood (1983) 62 972-979), is consistent with this prediction. In response to changing demand for ATP, the model predicts that the corresponding change of glycolytic flux would entail changes of metabolite concentrations in the absence of FA, but that in its presence the levels of metabolites within the activation loop remain essentially unperturbed. Thus, our results suggest that by stabilising metabolite pools in the face of variable glycolytic flux, FA may serve to avoid perturbations of the oxygen affinity of haemoglobin (sensitive to the levels of 2,3-phosphoglycerate) and of cell osmolality that would otherwise occur during variations in the cell's demand for ATP. In addition, by significantly raising the steady-state setpoint of intermediate metabolite pools, the productivity index (ratio of glycolytic flux to total metabolites in the pathway) of glycolysis would fall almost four-fold in the absence of forward activation.

Irreversible loss of donor blood leucocyte activation may explain a paucity of transfusion-associated graft-versus-host disease from stored blood

Transfusion-associated graft-versus-host disease (TA-GVHD) is usually a fatal outcome of blood transfusion therapy, caused by viable leucocytes contained in the donor blood. Most cases of TA-GVHD occur when less than 4-d-old blood is transfused. We therefore examined the molecular changes that occur during storage that may account for the paucity of TA-GVHD following infusion of older blood. Leucocyte number and viability were essentially unchanged from freshly obtained blood, but the expression of cell-surface lymphocyte activation antigens (CD3, CD4, CD28, CD2, CD45) decreased rapidly within the first 24 h and continued to fall to less than 20% of original levels by d 9 of storage at 4 degrees C. The decrease in CD antigen expression directly correlated with a decreasing ability to induce activation of the T-lymphocyte cellular signal transduction pathway. As a result, cells became less responsive in a mixed lymphocyte culture (MLC) by d 3, with abrogation of the MLC responsiveness by d 5. Donor leucocytes stored for 4 d or less at 4 degrees C were able to partially re-express CD antigens and reconstitute their signalling pathway when placed at 37 degrees C. whereas those stored for more than 4 d were not. These irreversible changes result from a permanent downregulation of donor cell protein synthesis. These findings provide a mechanism to explain the paucity of TA-GVHD following transfusion of blood that is more than 4 d-old. Further study may show that aged blood provides additional assurances for the prevention of TA-GVHD; however, use of aged blood should not replace current protocols using irradiation.

Adenomatoid tumor of the uterus in a patient with chronic renal failure

A case of adenomatoid tumor of the uterus in a 34-year-old patient, who had received a renal transplant and was undergoing immunosuppresive therapy is presented. At surgery, there were a total of eight nodular intramural and subserous masses thought to be leiomyoma nodules, and tumor excision was unusually, hardly performed because the nodules were strictly adherent to the myometrium. All the specimens yielded the same pathological diagnosis - adenomatoid tumor. This case is unusual because of the multiple nodular pattern and its association with the immunocompromised status of the patient. Although adenomatoid tumors have not been shown to recur, we are in doubt in our case, because the uterus is still intact and the immunocompromised status of the patient might have a role in the extensive growth and also in the possibility of recurrence.

Aspirin and some other nonsteroidal anti-inflammatory drugs inhibit cystic fibrosis transmembrane conductance regulator protein gene expression in T-84 cells

Cystic fibrosis (CF) is caused by mutations in the CF gene, which encodes CF transmembrane conductance regulator protein (CFTR), a transmembrane protein that acts as a cAMP-regulated chloride channel The disease is characterized by inflammation but the relationship between inflammation, abnormal transepithelial ion transport, and the clinical manifestations of CF are uncertain. The present study was undertaken to determine whether three nonsteroidal anti-inflammatory drugs (NSAIDs) (aspirin, ibuprofen, and indomethacin) modulate CFTR gene expression in T-84 cells. Treatment with NSAIDs reduced CFTR transcripts, and decreased cAMP-stimulated anion fluxes, an index of CFTR function. However, the two phenomena occurred at different concentrations of both drugs. The results indicate that NSAIDs can regulate both CFTR gene expression and the function of CFTR-related chloride transport, and suggest that NSAIDs act via multiple transduction pathways.

The relationship between erythrocyte superoxide dismutase activity and plasma levels of some trace elements (Al, Cu, Zn) of dialysis patients

1. The effect of erythropoietin and some trace elements on superoxide dismutase (SOD) activity of dialysis patients have been studied. 2. SOD activity of dialysis patients was found to be decreased. 3. The effect of erythropoietin on SOD activity was not found in vitro. 4. Plasma and erythrocyte aluminum increased in dialysis patients, but no significant change in plasma copper was found. 5. Plasma zinc levels of dialysis patients were found to be decreased. 6. These results suggest that inhibition of erythrocyte SOD activity of dialysis patients may contribute to their anemia.