Regional and annual patterns in respiratory virus co-infection etiologies and antibiotic prescriptions for pediatric mycoplasma pneumoniae pneumonia

OBJECTIVE

Mycoplasma pneumoniae (M. pneumoniae) pneumonia is the second-most common cause of community-acquired pneumonia (CAP). This study aimed at investigating into the prevalence of macrolide-resistant M. pneumoniae (MRMP) with respiratory virus co-infection and the antibiotic prescriptions in children with CAP in four provinces in Korea, and to assess the variations in the findings across regions and throughout the year.

PATIENTS AND METHODS

This prospective study was conducted in 29 hospitals in Korea between July 2018 and June 2020. Among the enrolled 1,063 children with CAP, all 451 patients with M. pneumoniae underwent PCR assays of M. pneumoniae and respiratory viruses, and the presence of point mutations of residues 2063 and 2064 was evaluated.

RESULTS

Gwangju-Honam (88.6%) showed the highest prevalence of MRMP pneumonia, while Daejeon-Chungcheong (71.3%) showed the lowest, although the differences in prevalence were not significant (p=0.074). Co-infection of M. pneumoniae pneumonia and respiratory virus was observed in 206 patients (45.4%), and rhinovirus co-infection (101 children; 22.2%) was the most frequent. The prevalence of MRMP pneumonia with respiratory virus co-infection and the antibiotic prescriptions differed significantly among the four provinces (p < 0.05). The monthly rate of MRMP pneumonia cases among all cases of M. pneumoniae pneumonia and tetracycline or quinolone prescriptions did not differ significantly among the four regions (trend p > 0.05) during the study period.

CONCLUSIONS

The prevalence of M. pneumoniae pneumonia with virus co-infection and antibiotic prescriptions could differ according to region, although the MRMP pneumonia rate showed no difference within Korea.

Factors related with metastasis of right retroesophageal lymph nodes in papillary thyroid cancer

AIM

Right retroesophageal lymph nodes (RRLNs) should be involved in central lymph nodes (CLNs) dissection in patients with papillary thyroid cancer (PTC). This study assessed the incidence and factors related to RRLNs metastasis.

METHODS

From January 2008 to March 2010, 129 patients who underwent total thyroidectomy with CLNs dissection including RRLNs were enrolled. The predictive value of RRLNs metastasis was assessed.

RESULTS

Twenty six (20.1%) of 129 patients exhibited nodal metastasis in RRLNs. Metastasis of RRLNs was associated with large tumor size (>1 cm; P<0.01), multiplicity (P=0.03), preoperative LN enlargement (P<0.01), metastasis of non-retroesophageal lateral LN (P<0.01) and large number of CLNs metastases (P<0.01) in univariate analysis. Multivariate analysis revealed that tumor size (>1 cm) and metastasis of non-retroesophageal lateral LN were independent correlates of RRLNs metastases.

CONCLUSION

RRLNs may be removed during operation for PTC, particularly in patients with tumor >1 cm and lateral LN metastases.

Abstract P2-05-02: Clinical significance of microRNA regulator Lin28 expression in patient with early breast cancer

Lin28 is an RNA-binding protein that is highly expressed in human embryonic stem (ES) cells. It can facillatate the reprogramming of human somatic cells to pluripotency with other stem cell marker proteins (Oct4, Nanog and Sox2). Lin28 regulates the processing of microRNAs including let-7 (Mirlet7) and translation of specific subset of cell cycle-related genes such as IGF-2, OCT4. Recently, it has been suggested that Lin28 expression may contribute to breast cancer metastasis in an animal model (Dangi-Garimellaet al., 2009).

To define clinical impact of Lin 28 in breast cancer, we investigated Lin28 expression in tumors from patients with early breast cancer who underwent curative resection of tumor.

To define prognostic impact of Lin 28 in breast cancer, we investigated Lin28 expression in patients with early breast cancer who underwent curative resection of tumor. In all, 950 slides from paraffin-embedded tissue were available for analysis by Lin28 expression by immunohistochemistry (IHC), and 78 cases (13.2%) were identified as Lin28-positive. Lin28 positivity was significantly associated with more advanced stage (P &lt; .001), lymph node involvement (P&lt; .001), absence of estrogen receptor expression (P = .002), negative progesterone receptor expression (P = .017), HER2 overexpression (P&lt; .001), higher histologic grade (P = .008), and higher tumor grade (P = .012). The Lin28 positive patients with early breast cancer demonstrated substantially poorer relapse free survival (Lin28+ positive vs. Lin28−(P = 0.013) and trends toward poorer overall survival.

Taken together, a sub-population of breast cancer with Lin28 expression is significantly associated with aggressive tumor phenotype and poor clinical outcome.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-05-02.

Abstract P4-03-01: Distance of breast cancer from the skin influence axillary nodal metastasis

Background: In breast cancer, axillary lymph node status is one of the most important prognostic variables and a crucial component to the staging system. Moreover, cancers underlying skin are willing to access to the lymphatics and cause lymphatic dissemination. Therefore, there seems an association between proximity of breast cancer to the skin and the incidence of axillary node positivity or local recurrence.

The aim of this study was to determine whether distance of breast cancers from the skin affects the the clinical and pathologic features including the likelihood of axillary nodal metastases, ipsilateral breast cancer recurrence, and recurrence free survival.

Methods: Between January 2003 and December 2009, data were collected prospectively regarding 1005 consecutive breast cancer patients who underwent surgical treatment. The exclusion criteria were non-invasive carcinoma (e.g. Ductal Carcinoma In Situ), prior breast surgery, previous radiotherapy or neo-adjuvant chemotherapy and previous endocrine therapy. The distance of the tumor from the skin surface was measured from the skin to the most anterior hypoechoic leading edge of the lesion.

Results: A total of 891 patients were included in the statistical analysis, 603(68%) had no axillary nodal metastasis, 288(32%) had axillary nodal metastasis. Distance of breast cancer from the skin less than 3mm induced more axillary nodal metastasis (P = 0.039). However, there was no statistical significant correlation between distance of breast cancer from the skin less than 3mm and ipsilateral breast tumor recurrence (P = 0.788) or recurrence-free survival (P = 0.353).

Conclusion: Breast cancers located closer to the skin have a higher incidence of axillary nodal metastasis. When evaluating a breast cancer patient and considering the risk of nodal metastasis the distance of the tumor from the skin should be considered.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-03-01.

P3-07-07: Effect of Sentinel Lymph Node Biopsy without Axillary Lymph Node Dissection on Overall Survival in Patients with T1 or T2 Node-Positive Breast Cancer: A Report from the Korean Breast Cancer Society

Introduction: Sentinel lymph node biopsy (SLNB) is accepted as an alternative method to axillary lymph node dissection for staging axillary lymph node status in clinically node-negative breast cancer. Current practical guidelines recommend that axillary lymph node dissection (ALND) should be performed in cases with sentinel node metastasis, and most of node-positive patients should receive adjuvant systemic therapy to reduce locoregional/distant recurrence and to improve overall survival irrespective of the number of lymph node metastasis. However, patients with ALND are more likely to develop lymphedema than those with SLNB alone, and appropriate systemic chemotherapy or hormone therapy significantly reduce locoregional and distant recurrence in early breast cancer patients. For this reason, the previous prospective study, American College of Surgeon Oncology Group Z0011 trial, was conducted and it suggested that there is no difference in overall survival between node-positive patients who received breast conserving treatment with SLNB alone and those with ALND after SLNB. This study is aimed to evaluate the difference of survival between node-positive patients who underwent SLNB alone and those who received ALND after SLNB using the Korean Breast Cancer Society registry.

Methods: In 87671 patients with breast cancer in the registry, we enrolled 2581 patients who meet the eligible criteria in the study. All enrolled patients had T1 or T2 breast cancer, and received mastectomy or breast conserving treatment followed by documented adjuvant systemic therapy between Jan. 2001 and Apr. 2011. Log-rank test and Cox-proportional hazard model were used to access the difference of overall survival according to the axillary procedure.

Results: There were 197 patients with SLNB alone and 2384 patients with ALND after SLNB, respectively. Smaller tumor size, lower number of nodal metastasis, and higher proportion of breast conserving surgery were shown in patients with SLNB alone than in those with ALND after SLNB. There was no significant difference in overall survival between 2 groups in the log-rank test. ALND after SLNB showed no significant improvement on overall survival in Cox-propotional hazard model adjusted by tumor size, number of nodal metastasis, and operation type (P=0.78, HR=0.73, 95% CI=0.08−6.62).

Conclusion: The current study suggests that ALND after SLNB in cases with sentinel lymph node metastasis may not influence on the improvement of overall survival and supports the results of Z0011 trial. Further validation studies are necessary to expand the understanding of the role of performing SLNB alone in patients with node-positive breast cancer.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-07.

A case of small cell lung cancer treated with chemoradiotherapy followed by photodynamic therapy

Here, we present the case of a 51-year-old man with limited-stage small cell lung cancer (LS-SCLC) who received concurrent chemoradiotherapy and photodynamic therapy (PDT). The patient was diagnosed as having LS-SCLC with an endobronchial mass in the left main bronchus. Following concurrent chemoradiotherapy, a mass remaining in the left lingular division was treated with PDT. Clinical and histological data indicate that the patient has remained in complete response for 2 years without further treatment. This patient represents a rare case of complete response in LS-SCLC treated with PDT.

Optical spectroscopy of PPV-based block copolymers of nanostructured supramolecular organic semiconductor

The third-order nonlinearity of a PPV-based nanostructured supramolecular organic semiconductor (DBAB), with an electron donor (D) connected to an electron acceptor (A) via nonconjugated and flexible bridge (B) units, was investigated in this work at both near-resonant (532 nm) and nonresonant (1064 nm) wavelength by using degenerate four-wave mixing. The second hyperpolarizabilities of D, A, and DBAB at 532 nm were found to be approximately 2.42 x 10(-43) m2/V2, 7.75 x 10(-44) m2/V2, and 1.80 x 10(-43) m2/V2 in copolarization geometry, and approximately 1.59 x 10(-43) m2/V2, 2.59 x 10(-44) m2/V2, and 1.18 x 10(-43) m2/V2 in orthogonal polarization geometry, respectively. The second hyperpolarizabilities of DBAB at 1064 nm were approximately 1.66 x 10(-46) m2/V2 and approximately 8.77 x 10(-47) m2/V2 for parallel and orthogonal polarization cases.

Nonlinear optical properties of mushroom-shaped CdSe/CdS coreshells

The third-order nonlinear optical susceptibilities of mushroom-shaped CdSe/CdS coreshells as a function of concentration have been investigated using polarization- and concentration-resolved degenerate four-wave mixing in a resonant region. The effective third-order nonlinear optical susceptibilities, /chi(3)xxxx/ and /chi(3)xyyx/ of CdSe/CdS coreshells were estimated to be approximately 1.86 x 10(-21)-1.03 x 10(-20) m2/V2, and approximately 0.45 x 10(-21)-6.15 x 10(-21) m2/V2, respectively, for various concentrations of approximately 0.64 x 10(-3)-4.95 x 10(-3) mol/m3. The second hyperpolarizabilities, /<gammah>xxxx/ and /<gammah>xyyx/, of CdSe/CdS coreshells were extracted to be approximately 2.37 x 10(-41) m5/V2 and approximately 1.29 x 10(-41) m5/V2, respectively.

Cytokine balance in kidney tissue from lupus nephritis patients

OBJECTIVE

To identify the balance of Th1/Th2 cytokine expression in the kidney and evaluate the difference in cytokine balance between patients with lupus nephritis WHO classes IV and V.

METHODS

The expression of the CD40 molecule on cultured human mesangial cells was assessed by flow cytometry after stimulation with interferon gamma (IFN-gamma) or other cytokines. Frozen sections of kidney tissue from 10 patients with lupus nephritis and two non-SLE patients (with minimal-change disease) were stained with monoclonal antibodies for interleukin (IL)-4, IL-10, IL-12, IFN-gamma, CD4, CD8, CD40, CD68 and CD40L.

RESULTS

CD40 expression of cultured mesangial cells was up-regulated by IFN-gamma, but was not down-regulated in the presence of the Th2 cytokines IL-4 and IL-10. In the glomeruli, CD40 expression and the ratios of IFN-gamma-/IL-10-, IL-12-/IL-4- and (IFN-gamma+IL-12)/(IL-4+IL-10)-positive cells were significantly higher in class IV than in class V lupus nephritis (P < 0.05). Also CD40, IFN-gamma and the activity index derived from the renal biopsy were closely correlated.

CONCLUSION

IFN-gamma may contribute to the pathogenesis of proliferative glomerulonephritis by the up-regulation of CD40 and the activation of the cellular immune response in human lupus.

The production of tumour necrosis factor-alpha is decreased in peripheral blood mononuclear cells from multidrug-resistant tuberculosis patients following stimulation with the 30-kDa antigen of Mycobacterium tuberculosis

The clearance of intracellular bacteria requires the appropriate induction of proinflammatory cytokines and chemokines to recruit macrophages and T cells to the site of infection. In this study, we investigated the production of tumour necrosis factor (TNF)-alpha, interleukin (IL)-8 and interferon (IFN)-gamma by the peripheral blood mononuclear cells (PBMC) of patients with multidrug-resistant tuberculosis (MDR-TB) in response to in vitro stimulation with the 30-kDa antigen of Mycobacterium tuberculosis. The results were compared with those from cases of newly diagnosed TB (N-TB) and TB with treatment failure (TF-TB), and healthy tuberculin reactors (HTR). The most significantly depressed TNF-alpha levels were found in MDR-TB patients. IFN-gamma production was depressed significantly in all groups of TB patients compared with the HTR group. TNF-alpha secretion in response to the 30-kDa antigen was unchanged by coculturing with recombinant human interferon (rhIFN)-gamma, and was increased dramatically following IL-10 neutralization with an anti-human IL-10 antibody. The IL-8 levels were depressed significantly in MDR-TB patients compared with N-TB patients, but were similar to the IL-8 levels in TF-TB patients. Furthermore, rhTNF-alpha directly increased IL-8 secretion, and neutralizing antibody to TNF-alpha inhibited IL-8 production by the PBMC of MDR-TB patients that were stimulated with the 30-kDa antigen. Taken together, these data suggest that the PBMC of MDR-TB patients typically show TNF-alpha depression in response to the 30-kDa antigen, and this effect is modulated by IL-10. In addition, we highlight the role of TNF-alpha in IL-8 secretion in MDR-TB patients.

Monocyte chemotactic protein-1 production in patients with active pulmonary tuberculosis and tuberculous pleurisy

OBJECTIVE

The role of monocyte chemotactic protein (MCP)-1 in human pulmonary and pleural tuberculosis (TB) was assessed by examining its production in clinical samples from patients with active pulmonary TB and tuberculous pleurisy (TBP).

METHODS

Serum was obtained from 26 active pulmonary TB patients [14 early TB (E-TB), and 12 chronic refractory TB (CR-TB)] and 15 healthy tuberculin reactors (HTRs). The monocytes and peripheral blood mononuclear cells (PBMCs) were separated and stimulated with purified protein derivatives (PPD) or the 30-kDa antigen of Mycobacterium tuberculosis. Pleural exudates were isolated from 25 patients with TBP and 24 non-TBP patients [malignancy and congestive heart failure (CHF)]. The MCP-1 levels were measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS

In sera, the MCP-1 levels of TB patients were similar to those of HTRs. For monocytes, CR-TB patients spontaneously expressed more MCP-1, compared with HTRs and E-TB patients. In addition, MCP-1 production of PPD- or 30-kDa antigen-stimulated monocytes was significantly elevated in CR-TB patients than that from E-TB. Interestingly, the E-TB patients had significantly depressed MCP-1 production by PBMCs in response to PPD or 30-kDa, compared with HTRs and CR-TB patients. In pleural effusions, MCP-1 levels were significantly higher in patients with TBP than in patients with CHF, but lower than in malignant effusions.

CONCLUSIONS

The data suggest that MCP-1 production is not uniquely elevated systemically in TB patients, although MCP-1 production might be elevated by monocytes in the chronic phase of TB or with a local pleural infection.

IL-18 production in human pulmonary and pleural tuberculosis

Interleukin-18 (IL-18) has multiple important pro-inflammatory effects, including the induction of interferon-gamma (IFN-gamma) in various diseases. In this study, we investigated the IL-18-producing activities in human pulmonary and pleural tuberculosis (TB) in response to purified protein derivative (PPD) antigen (Ag) from Mycobacterium tuberculosis. The most significant IL-18 production was found in chronic refractory TB (CRTB) patients. However, IFN-gamma production in CRTB patients was significantly less than that in healthy tuberculin reactors or in patients with tuberculous pleurisy (TBP). Elevated levels of both IL-18 and IFN-gamma were found in pleural fluids from TBP patients. In vitro production of IL-18 was dramatically decreased following an 18 h stimulation with PPD. However, IFN-gamma was markedly increased in pleural mononuclear cells from TBP patients after in vitro stimulation with PPD. The mesothelial cell type was the main source of pro-IL-18 in pleural cells from TBP patients, suggesting an important role for these cells in TBP. Taken together, these data indicate that IL-18 is elevated in peripheral blood mononuclear cells from CRTB patients, as well as at the site of TBP, indicating a possible role for IL-18 in both protective immunity and pathologic responses in human TB.

Radiologic changes of cervical spine in ankylosing spondylitis

Ankylosing spondylitis (AS) is characterised by its effects on the axial skeleton. The cervical spine is also vulnerable to the disease process. Our aim was to determine the frequency of radiologic changes to the cervical spine and their correlation with clinical variables. We also used the Bath Ankylosing Spondylitis Radiology Index (BASRI) system, which is one of the reliable scoring systems of radiography, to score the global radiologic changes to the cervical and lumbar spine and the hip joints in our AS cohort. There were 181 patients with anteroposterior and lateral full-flexion views on radiography of the cervical spine here included in the study. A radiologist examined the radiologic changes to all anatomical compartments of the cervical spine in detail and graded them according to the BASRI system. We used the clinical and demographic data of our AS cohort to determine their relation to the radiographic changes. Eighty-eight patients (48.6%) showed radiological changes to the cervical spine; to the discovertebral joint 35.9%; the apophyseal joint 26.0%; atlantoaxial articulation 22.1% (atlantoaxial subluxation 13.8%); the costovertebral joint 18.2%; and to the posterior ligamentous attachment 11.6%. Using the BASRI system, 73 patients (40.3%) showed radiologic changes to the cervical spine and were graded as score 1 (1.7%), 2 (22.7%), 3 (6.6%) or 4 (9.4%). Among those graded as normal by the BASRI system, 17 showed some changes the cervical spine, such as atlantoaxial joint subluxation or narrowing, and severe osteoporosis with no other radiographic changes. Current age, disease duration, inflammatory back pain and cervical symptoms were associated with the radiographic changes to the cervical spine. The BASRI-cervical spine score correlated with the BASRI-lumbar spine and hip joint score, sacroiliitis, disease duration, and duration of inflammatory back pain and cervical symptoms. Our data suggest that radiographic changes to the cervical spine are frequent in AS, and can be predicted in the patients with old age, long duration of disease and inflammatory back pain, and cervical symptoms. Also, the BASRI scoring system showed similar results as a detailed assessment of the cervical spine in our study.

Mutations of tumor necrosis factor-related apoptosis-inducing ligand receptor 1 (TRAIL-R1) and receptor 2 (TRAIL-R2) genes in metastatic breast cancers

Several lines of evidence suggest that apoptosis dysregulation plays an important role in cancer metastasis. In this study, to explore the possibility that the mutations of death receptors are involved in the metastasis mechanism, we analyzed the death domains of Fas and tumor necrosis factor-related apoptosis-inducing ligand-receptor 1 and -2 (TRAIL-R1 and -R2) genes for the detection of somatic mutations in 57 breast cancers with (n = 34) or without (n = 23) metastasis to the regional lymph nodes. We found seven mutations (three TRAIL-R1 and four TRAIL-R2 mutations), and these mutations were detected only in the breast cancers with metastasis. Furthermore, we also analyzed the allelic losses of chromosome 8p21-22, where TRAIL-R1 and R2 reside in the same series of breast cancers, and found that the allelic losses were significantly higher in metastatic breast cancers. We expressed the tumor-derived TRAIL-R1 and TRAIL-R2 mutants in 293 cells and found that apoptosis was suppressed. These data suggest that TRAIL-R1 and R2 genes are relevant to the frequent loss of chromosome 8p21-22 in breast cancer and that the inactivating mutations of TRAIL-R1 and -R2 genes play a role in the metastasis of breast cancer.

Seronegative spondyloarthropathy initiated by physical trauma

We undertook this study to demonstrate the pattern of onset and the course of arthritis on the traumatised joint in spondyloarthropathy (SpA) initiated by physical trauma. Among 288 patients with SpA, 12 (4.2%) whose arthropathies were associated with trauma were reviewed retrospectively. There were seven patients with ankylosing spondylitis (AS), three with juvenile onset AS and two undifferentiated SpA. The type of trauma was direct injury to the joint and injuries at other sites, except in spinal surgery, for example. In eight cases the initial evidence of disease was peripheral arthritis. The disease first occurred in traumatised joints in five cases. Only three cases showed recurrent inflammatory episodes in the traumatised joints throughout the disease course. SpA initiated by trauma initially manifested as peripheral arthritis at the traumatised joints in about half of the cases. Inflammatory episodes preferentially involved other joints apart from the traumatised joints throughout the whole course of the disease.

Transverse myelitis in a patient with long-standing ankylosing spondylitis

Ankylosing spondylitis is reported to involve not only the joints but other organs as well. Among these extra-articular involvements, uncommon complications associated with nervous system such as single root lesions, compression of the myelum and cauda equina syndrome have also been documented. Here we present a patient with long-standing ankylosing spondylitis who developed spastic paraparesis. Extensive study to find the cause of a spastic paraparesis failed and therefore led to the conclusion that this patient was suffering from transverse myelitis. Similar reports in the past have been attributed to an association with multiple sclerosis; however, we suggest that the findings support the diagnosis of a rare complication of ankylosing spondylitis with an unknown etiology.

Serum pancreastatin levels predict response to hepatic artery chemoembolization and somatostatin analogue therapy in metastatic neuroendocrine tumors

INTRODUCTION

Neuroendocrine tumors often metastasize to the liver and present with disabling hormonal symptoms. Hepatic artery chemoembolization (HACE) combined with somatostatin therapy, pre-embolization, peri-embolization and post-embolization, at doses to control symptoms, is an aggressive approach that can relieve hormonal symptoms with minimal morbidity and mortality.

METHODS

Chemoembolization was performed using 30 mg of adriamycin, 50 mg of mitomycin, 12 ml of hexabrix, 10 ml of ethiodol, and 360-500-microm particles. Pancreastatin, a split product of chromogranin A, was measured pre-HACE and post-HACE in all patients.

RESULTS

Forty-three chemoebolization procedures were performed in 34 symptomatic patients from December 1995 to August 1999. Seventeen patients had intestinal primaries (50%), seven had pancreatic primaries (20%), five had bronchial primaries (15%), and five had unknown primaries (15%). Systemic pancreastatin levels were improved or stable in 31 patients (78%). Symptoms were improved in these 31 patients (78%). Systemic serotonin levels were improved or stable in 24 patients (60%). Radiographic improvement or stability was seen in 18 patients (45%). Procedural related morbidity included pain, fevers, nausea, vomiting, and transient elevations of liver function studies in 75-100% of patients. There was one procedural related mortality (2%). Less than 20% improvement in pancreastatin levels from baseline was associated with death in five of five patients (100%). This was not observed with serotonin levels.

CONCLUSION

Measurement of serum pancreastatin levels is an easy and useful method to predict success in patients who undergo HACE plus somatostatin therapy for metastatic neuroendocrine tumors to the liver. This therapeutic approach is effective in relieving symptoms in 78% of patients, with minimal major morbidity or mortality.

Secondary renal amyloidosis in adult onset Still's disease: case report and review of the literature

We report a 25-year-old Korean woman with Adult onset Still's disease (AOSD) presented with renal amyloidosis, which had developed four years after disease onset. We successfully treated her with prednisolone, colchicine and cyclophosphamide. A review of the literature uncovered about 10 cases, most of which were treated by various regimens that resulted in poor outcomes. Renal amyloidosis should be suspected in patients with AOSD who have unexplained proteinuria. Although the mechanism of renal amyloid deposition is not well known, earlier histopathologic diagnosis and choice of regimen may affect prognosis.

A case of parasymphyseal and associated insufficiency fractures of pubic rami in a patient with mixed connective tissue disease

Parasymphyseal insufficiency fractures are uncommon. Furthermore, none have been reported in systemic rheumatic diseases other than rheumatoid arthritis. In this article we report on parasymphyseal insufficiency fractures in a patient with mixed connective tissue disease.

High toxicity of sulfasalazine in adult-onset Still's disease

OBJECTIVE

Sulfasalazine (SSZ) is an anti-rheumatic drug that has been used to treat chronic arthritis. In many reports, the use of SSZ in children with systemic onset juvenile rheumatoid arthritis (JRA) revealed frequent side effects which required discontinuation of the drug. We examined whether there were frequent side effects of SSZ in patients with adult-onset Still's Disease (AOSD).

METHODS

From July 1990 to April 1998, we followed 41 AOSD patients. Ten were given SSZ for the treatment of arthritis and the side effects were studied. We also studied 109 consecutive patients with RA who had been given SSZ, as a control group. In addition, we retrospectively studied the side effects and efficacy of SSZ in both groups through their medical records.

RESULTS

Six patients (60%, p < 0.01) with AOSD experienced side effects ranging from mild ones like abdominal pain, nausea and vomiting, urticaria, and facial flushing to severe ones such as high fever, hypotension, and severe myelosuppression as well as fulminant hepatitis, which led to the death of one patient. However, 16 patients (14.7%) with RA stopped using SSZ due to mild side effects such as rash, urticaria, gastrointestinal troubles, mild leukopenia, and fever. Three AOSD patients (30%, p = 0.053) and 15 RA patients (13.8%) stopped using SSZ due to its inefficacy.

CONCLUSION

We conclude that SSZ appears to have frequent severe side effects in AOSD, as in systemic onset JRA. These potential adverse effects of SSZ should be considered when it is used to treat chronic arthritides with systemic symptoms. Further study of SSZ in the treatment of AOSD in a multi-center, placebo-controlled environment is needed.

Processing of the beta-amyloid precursor protein in ex vivo human brain cells

We studied distribution and processing of the Alzheimer's beta-amyloid precursor protein (betaAPP) in immediately ex vivo human brain cells obtained during neurosurgical procedures. Immunoblotting and flow cytometry studies revealed that brain cells supported betaAPP as a transmembrane holoprotein. Brain cells in short-term suspension culture were competent to process betaAPP into Abeta as shown by [35S]methionine pulse-chase studies. Brain cell Abeta was immunoprecipitated as SDS-stable dimers and higher-order multimers. Cleavage of cell surface betaAPP with trypsin prior to metabolic labeling reduced cellular Abeta by approximately 50%. We conclude that plasmalemmal betaAPP in human brain cells is a source of cellular Abeta, presumably via endosomal-lysosomal processing.

Beta-amyloid precursor protein is detectable on monocytes and is increased in Alzheimer's disease

Using the anti-beta-amyloid precursor protein (betaAPP) monoclonal antibodies 4G8, 6E10 and 22C11 and flow cytometry, we report that human circulating peripheral blood monocytes display surface immunoreactivity for betaAPP. In contrast, circulating lymphocytes do not possess cell surface betaAPP immunoreactivity, despite similar levels of betaAPP expression. Immunoblotting analysis showed that monocytes, but not lymphocytes, possess an 82 kDa C-terminal betaAPP fragment consistent with a processed transmembrane species. Monocyte surface betaAPP was upregulated approximately threefold by activation with lipopolysaccharide and interferon-gamma, activation did not produce detectable betaAPP on the cell surface of lymphocytes. Surface betaAPP immunoreactivity was reduced in a normal aged population compared to normal young controls (Young = 81.07 +/- 13.67 mean fluorescence units, Aged = 36.74 +/- 3.81, p < 0.01), but was significantly increased in AD subjects compared to age-matched healthy controls (AD = 60.31 +/- 7.42, p < 0.05). Our data suggest that a proportion of peripheral A beta may be derived from monocyte/macrophages, and that defects in brain cell processing of betaAPP in AD may be shared by this readily accessible peripheral cell.

Intracerebral adenovirus-mediated p53 tumor suppressor gene therapy for experimental human glioma

Malignant gliomas of astrocytic origin are good candidates for gene therapy because they have proven incurable with conventional treatments. Although mutation or inactivation of the p53 tumor suppressor gene occurs at early stages in gliomas and is associated with tumor progression, many tumors including high-grade glioblastoma multiforme carry a functionally intact p53 gene. To evaluate the effectiveness of p53-based therapy in glioma cells that contain endogenous wild-type p53, a clinically relevant model of malignant human glioma was established in athymic nu/nu mice. Intracerebral, rapidly growing tumors were produced by stereotactic injection of the human U87 MG glioma cell line that had been genetically modified for tracking purposes to express the Escherichia coli lacZ gene encoding beta-galactosidase. Overexpression of the p53 gene by adenovirus-mediated delivery into the tumor mass resulted in rapid cell death with the eradication of beta-galactosidase-expressing glioma cells through apoptosis. In long-term experiments, the survival of mice treated with the p53 adenoviral recombinant was significantly longer than that of mice that had received control adenoviral recombinant. During the observation period of 1 year, a complete cure was achieved in 27% of animals after a single injection of p53 adenoviral recombinant, and 38% of the animals were tumor free in the group receiving multiple injections of p53 adenoviral recombinant into a larger tumor mass. These experiments demonstrate that overexpression of p53 in gliomas, even in the presence of endogenous functional wildtype p53, leads to efficient elimination of tumor cells. These results point to the potential therapeutic usefulness of this approach for all astrocytic brain tumors.

Coexistence of coronary aneurysms and total occlusion of coronary arteries in systemic lupus erythematosus

A 22-year-old woman with known SLE and chronic hepatitis B developed anginal pain. During this period there was serologic but no other clinical evidence of active SLE. Myocardial perfusion SPECT showed a severe reversible perfusion defect in the posterior wall, and coronary angiography revealed multiple coronary aneurysms in the left anterior descending artery and circumflex artery and total occlusion of the proximal right coronary artery. This case suggests that coronary aneurysms and total occlusion may represent a sequela of arteritis, or of a combination of underlying vasculitis and a recent thrombotic obstruction due to antiphospholipid syndrome.

Chemokine-enhanced migration of human peripheral blood mononuclear cells is antagonized by interferon beta-1b through an effect on matrix metalloproteinase-9

The increased migration of peripheral blood mononuclear cells (PBMNCs) across a fibronectin (FN) matrix in response to the chemokines RANTES, MIP-1 alpha and MCP-1 is antagonized by interferon-beta-1b (IFN beta-1b). MCP-1 treatment of PBMNCs elevates their mRNA level and secretion of a matrix degrading enzyme, matrix metalloproteinase (MMP)-9, which is abrogated by IFN beta-1b. The clinical benefits of IFN beta-1b treatment in multiple sclerosis patients may in part be a result of this drug's ability to decrease the migration of PBMNCs in spite of a chemotactic gradient. Furthermore, the elevation of MMP-9 production by PBMNCs may be an important mechanism of action of chemokines.

The assessment of nasality with a nasometer and sound spectrography in patients with nasal polyposis

With the development of computerized acoustic analysis systems, an objective measure of nasal speech has become readily available by means of a simple, noninvasive technique. In this study, we assessed the nasality in patients with multiple nasal polyposis before and after endoscopic sinus surgery. With the nasometer, we measured nasalance, which reflects the ratio of acoustic energy output of nasal sounds from the nasal and oral cavities, and the slope score of the nasogram curve. The nasalance scores of nasal sentences and the slope scores of the nasogram curves for all nasal consonants were significantly lower in patients with nasal polyposis than in healthy subjects. After surgery, however, the nasalance and slope scores increased significantly to the normal range. On the sound spectrographic analysis, the frequencies of the first nasal formant decreased slightly and the sound intensity increased slightly for all nasal consonants after surgery. However, no significant change was noticed in the frequencies of the second nasal formant. In conclusion, nasometric and sound spectrographic analyses are considered to be useful tools for objectively assessing the extent of nasality in patients with nasal airway obstruction.

Cardiac tamponade as an initial manifestation of systemic lupus erythematosus--single case report

We describe a case of pericardial tamponade as an initial manifestation of systemic lupus erythematosus (SLE). Although pericarditis or pericardial effusion is the common cardiac complication of SLE, tamponade is unusual. Treatment consists of pericardiocentesis, administration of high dose glucocorticoid an antimalarial drug.

Aneurysmal dilatation of ascending aorta and aortic insufficiency in juvenile spondyloarthropathy

Aortic insufficiency is a well-recognized complication of adult spondyloarthropathy but rare in juveniles, and no report is associated with aneurysmal dilatation at any age. We describe rapidly progressive aortic insufficiency with aneurysmal dilatation of ascending aorta in a 15-year-old boy with juvenile spondyloarthropathy, necessitating a Bentall operation.

Lymphocyte content of amyloid precursor protein is increased in Down's syndrome and aging

We quantified cellular amyloid precursor protein (APP) in ethanol-permeabilized peripheral lymphocytes from 13 subjects with Alzheimer's disease (AD), 11 subjects with Down's syndrome (DS), and 13 healthy elderly and 31 healthy young controls. APP content was analyzed by indirect immunofluorescence and flow cytometry, using the 22C11 monoclonal antibody (mAb) directed against an N-terminal domain of APP. Authenticity of 22C11 APP signal was confirmed by immunoblotting and flow cytometry studies with the mAb 6E10, directed against the A beta domain of APP. Consistent with gene dosage, patients with DS had 1.51-fold higher lymphocyte APP signal than age-matched normal young subjects (corrected p < 0.05). Both AD patients and elderly control groups had significantly increased lymphocyte APP signal compared to young controls (either comparison corrected p < 0.01). Indeed, increasing age in non-DS subjects was significantly correlated with lymphocyte APP (r = 0.508, p < 0.0001), such that APP immunoreactivity more than doubled from 20 to 80 years. Lymphocyte APP was nonsignificantly higher in AD vs. aged controls in this small sample. Increased cellular APP content in DS and aging may correspond to generalized alterations in expression or processing of this molecule, and suggests a novel determinant for the timing of AD onset.

Ubiquitin and Alzheimer's amyloid beta precursor protein colocalize to endosomes-lysosomes in cultured human cells

Chloroquine (CHQ)-sensitive cellular compartments, identified as endosomes-lysosomes (ELs), have been implicated in the proteolysis of amyloid beta precursor protein (A beta PP) in Alzheimer's disease. Here we show using immunocytochemistry and immunogold electron microscopy that not only A beta PP but also ubiquitin (Ub) co-localize to ELs in CHQ-treated human neuroblastoma (SK-N-SH) and glioblastoma (U-373). Immunoblotting analysis of cell lysates indicated a significant degree of CHQ-mediated interference in A beta PP metabolism in a time- and concentration-dependent manner. The implication is that abnormal intracellular accumulation of A beta PP and its C-terminal fragments beyond a certain threshold may trigger the Ub response. We hypothesize that Ub may play a role in A beta PP processing and/or trafficking to ELs, particularly in stress-related conditions.

Alzheimer's beta-amyloid precursor protein is expressed on the surface of immediately ex vivo brain cells: a flow cytometric study

Beta-amyloid precursor protein (beta APP) is ubiquitously expressed, but deposition of the beta APP proteolytic fragment A beta is virtually restricted to the brain, suggesting cell-specific processing of this molecule. Our laboratory has investigated expression of beta APP in mechanically dissociated, unfixed, immediately ex vivo cells from various mouse and rat organs by flow cytometry. Epitopes of predicted extracellular domains of beta APP recognized by the N-terminal 22C11 monoclonal antibody (mAb) and the juxtamembrane 4G8 mAb were not detectable on the surface of lymphoid cells, hepatocytes, or kidney cells. In contrast, surface 22C11 and 4G8 beta APP immunoreactivity was abundant on intact (propidium iodide-excluding) dissociated brain cells. The predicted C-terminal intracellular beta APP determinant recognized by the mAb Jonas was not detectable on the surface of intact brain cells, but was present in ethanol-permeabilized cells, consistent with a transmembrane configuration of beta APP in brain cells. Trypsinization of intact brain cells abolished cell surface immunoreactivity for 22C11, which was then reestablished by short-term culture. Augmentation of 22C11 and 4G8 surface immunoreactivity occurred when brain cells were cultured short-term in phenylarsine oxide, a general endocytosis inhibitor. By double staining protocols of brain cells with mAbs directed against beta APP ectodomain epitopes and the neuronal surface proteins Thy-1 or neural cell adhesion molecule (NCAM), we observed that all Thy-1+ and NCAM+ cells (approximately 50%) were immunoreactive for surface beta APP, but that some beta APP+ cells (approximately 20%) were negative for these neuronal markers. Our data suggest that neurons and a subpopulation of other brain cells, unlike peripheral cells, can support beta APP as a type 1 intrinsic membrane molecule with an intact ectodomain, and that beta APP surface abundance is regulated by an equilibrium between membranes vesicle insertion and endocytotic internalization. Transmembrane beta APP holoprotein may be a critical determinant of brain-predominant processing of beta APP to A beta, and may participate in a receptor/transducer function unique to brain cells.

Anticlastogenic effects of galangin against mitomycin C-induced micronuclei in reticulocytes of mice

We investigated the suppressive effect of galangin on the induction of micronucleated reticulocytes (MNRETs) by mitomycin C (MMC) in mouse peripheral blood. When galangin was given to mice 24 h before the intraperitoneal injection of MMC (1 mg/kg), a more marked decrease in the frequency of MNRETs was observed than in mice with simultaneous and post-treatment of galangin. On the other hand, when galangin was given to mice for 7 consecutive days before MMC injection, galangin showed potent anticlastogenic effects, even at the lowest dose level of 0.1 mg/kg. Results from our in vivo studies indicate that galangin is capable of suppressing the clastogenic activity of the direct acting MMC. Together with our earlier observations, it appears that galangin is capable of protecting cells from the toxic effects of a variety of hazardous chemicals. Therefore, galangin may be an useful chemopreventive compound.

Endobronchial Nd:YAG laser surgery

Thirty-six malignant and four benign endotracheal and endobronchial lesions were treated using Nd:YAG laser through flexible bronchoscope from November 1985 to July 1987 at the University Hospital in Louisville, Kentucky. Progressive dyspnea and hemoptysis were primary indications for the procedures. The majority of patients were treated under general anesthesia using intravenous agents. Most patients required two treatment sessions for complete endobronchial tumor ablation. The mean hospital stay was 48 hours. Two patients died postoperatively; one died of myocardial infarction and another of progressive respiratory failure. The mean survival was 13 weeks. Sixty-three percent of patients treated were improved as measured by Karnofsky Performance Status. Mean change in Performance Status between pre- and post-laser treatment was 100% (from 30 to 60). We conclude that therapeutic laser bronchoscopy is a useful adjunctive treatment in selected patients with obstructing or bleeding lung tumors.

Primary gastric lymphoma and pseudolymphoma

Eighteen patients with primary gastric lymphomas and two with pseudolymphomas treated at the University of Louisville affiliated hospitals were analyzed in order to develop a more precise understanding of these rare diseases. Abdominal pain and weight loss were the most common initial symptoms. Only one patient presented with an abdominal mass. Upper GI series were helpful but failed to show a definite abnormality in two of 18 cases. Endoscopic examinations in all 18 were compatible with malignancy on gross finding, but six out of 15 endoscopic biopsies were not conclusive. All four cases, which proved fatal in less than two years, showed serosal invasion and diffuse histological pattern. On the basis of our analysis, we suggest that in patients with abdominal pain and weight loss of more than two months duration an aggressive course of evaluation should include upper gastrointestinal x ray and repeated endoscopic biopsy. If symptoms persist, laparotomy and biopsy may be warranted even if endoscopic biopsy shows no neoplasm. Curative surgery is the treatment of choice, but radiation therapy should be added in patients with serosal involvement. Very careful histological assessment of pseudolymphomas is necessary, because they may contain malignant lymphoma.

Influence of column length and pore size on high-performance ion-exchange chromatography of estrogen and progestin receptors

A high-performance liquid chromatographic (HPLC) procedure has been evaluated to establish a routine test in the clinical laboratory for measuring the profiles of estrogen and progestin receptor isoforms in human breast and endometrial tumors. This procedure will be used to determine if there is a relationship between particular isoform profiles and response to various endocrine therapies. Evaluation of various HPLC modes has shown that high-performance ion-exchange chromatography (HPIEC) with silica-based anion exchangers offers a promising approach. In this paper, we have compared HPIEC columns of different lengths (10 and 25 cm) and pore sizes (300, 500 and 1,000 A) in order to obtain an optimal separation procedure. Because of receptor lability, all investigations were performed at 4 degrees C. The mobile phase consisted of 10-500 mM phosphate buffer, supplemented with the stabilizing agent, sodium molybdate at pH 7.4. Recoveries from each of the columns were between 70-100%. The length of the column did not influence significantly the retention time and salt concentration required for elution of receptor proteins. However, pore sizes appeared to alter these parameters. With a larger pore size (1,000 A), the retention of proteins was lower (elution with 50 mM phosphate) than that observed with the 500-A pore size column (elution with 100 mM phosphate) or of the 300-A pore size column (elution with 150 mM phosphate). Based solely on recovery patterns and peak shape, we conclude that separation of receptor isoforms on a 1,000-A, 25-cm column is best suited for clinical analysis.

Free amino acid levels in amyotrophic lateral sclerosis

To evaluate reports of abnormal levels of free amino acids (AA) in patients with amyotrophic lateral sclerosis (ALS), we studied serum, cerebrospinal fluid, and urine AA in 12 patients with ALS and 12 controls matched for age, sex, and severity of disability. ALS patients had statistically significant elevations in serum levels of tyrosine, total aromatic AA, and total basic AA. ALS patients also had statistically significant elevations in cerebrospinal fluid of total basic AA, lysine, essential AA, and leucine. The severity of ALS correlated inversely with acidic AA (glutamate and aspartate) and O-phosphoserine in cerebrospinal fluid. Activity of ALS correlated directly with serum aspartate and cerebrospinal fluid alanine. We conclude that subtle abnormalities of AA levels are present in ALS and that these are not due to age, sex, or disability. The pattern of distribution of AA levels differs from that in hepatic or renal disease and suggests defective membrane transport or poor cellular utilization of basic and essential AA in the central nervous system.