Brachial Artery Vasospasm From Sequential Use of Intravenous Promethazine and Dihydroergotamine for Treatment of Status Migrainosus: A Case Report

Promethazine, a common antiemetic, can cause severe tissue injury with intravenous (IV) injection. Dihydroergotamine (DHE), commonly used for the acute treatment of migraine, can cause arterial vasoconstriction. We report a rare complication of brachial artery vasospasm in a patient receiving IV promethazine and DHE sequentially through the same midline IV catheter. A 40-year-old woman with history of migraine headaches and Raynaud phenomenon was admitted for treatment of status migrainosus with scheduled IV DHE infusions. While receiving the DHE infusions, IV promethazine was added to the patient’s regimen to treat nausea. During an infusion of DHE, the patient developed acute pain near the catheter insertion site due to active extravasation of IV DHE. An arterial Doppler ultrasound demonstrated stenosis in the right brachial artery near the region of infusion. The patient ultimately required balloon angioplasty and intra-arterial injection of nitroglycerin to restore adequate blood flow. We hypothesize that caustic injury to the right brachial vein from IV promethazine predisposed the patient to the extravasation of DHE, which, in turn, caused adjacent brachial artery vasospasm. This case suggests the need for careful consideration, if not strict avoidance, of the use of concurrent IV promethazine and DHE.

BLEPHARITIS AND HELICOBACTER-ASSOCIATED GASTRODUODENAL DISEASES (REVIEW)

The aim of the study was to find the relationship between the inflammatory process on the eyelids (blepharitis) and Helicobascter pylori infection. The data of numerous studies are analyzed, which give grounds to suggest a possible pathogenetic or mediated role of H. pylori infection in the development and course of inflammatory eye diseases. Fundamental in these studies are the release of harmful compounds in the exhaled air of patients with H. pylori, such as ammonia, hydrogen nitrate and hydrogen cyanide, the restoration of impression cytology after H. Pylori eradication, the presence of H. pylori in the lacrimal fluid. In this regard, the authors conclude that there are three main possible pathogenetic mechanisms for the association between H. Pylori infection and blepharitis: chronic inflammation, endothelial dysfunction, and oxidative stress.

Pelomyxa doughnuta sp. nov. (Archamoebea, Pelobiontida) with an unusual nucleus-glycogen association

We described Pelomyxa doughnuta sp. nov. and examined it with the use of light, electron and immunofluorescence microscopy as well as cytochemical methods. The cells of P. doughnuta sp. nov. are usually binuclear, although cells with one, three or four nuclei are sometimes found in the population. A unique feature of the new species is a dense capsule around the nucleus. It consists of a continuous layer of glycogen 5-20 µm thick. The tubulin cytoskeleton is mainly represented by perinuclear microtubules. P. doughnuta sp. nov. has a filamentous glycocalyx and strongly reduced components of flagellar apparatus. Obligate prokaryotic endocytobionts of two morphotypes are present in the cytoplasm.

The duration of rest and feeding greatly affects the re-breeding of ectoparasites: Hirudo verbana, Hirudo medicinalis and Hirudo orientalis

Ectoparasitic leeches have many biologically active substances in their body, which are able to show various therapeutic effects, which makes them very relevant in the study. Among them, the most common are medicinal leeches: Hirudo verbana, Hirudo medicinalis and Hirudo orientalis. They are listed in the Red Book as a vulnerable species, so their population is mostly supported in biolabs. Therefore, the search for different methods of their preservation is relevant. The aim of the work was to test the effect of the duration of rest and feeding of animals for re- reproduction, which will increase their population. For the study, three experimental animal groups were formed: 1 control - the animals were fed a week after the first reproduction, re-reproduction occurred not earlier than 2 months; 2 experimental - selected animals that remained clitellum after the first reproduction and again sent to the peat-soil environment for reproduction without rest and feeding; 3 experimental - selected animals that remained clitellum after the first reproduction, fed after 1 week, after another 1-2 weeks again sent to the peat-soil medium for reproduction. As a result of the study, the restoration of the physiological state after the first dilution in the first and third groups was registered. In the second group, the animals are depleted as a result of defective offspring, mortality of them and their offspring.

The influence of the planting time and conditions on the reproductive properties of Hirudo verbana and Hirudo medicinalis

Factors that affect on the sexual behavior of leeches not only in nature, but also in artificial conditions remain largely unexplored. We did not find data on the behavior of medicinal leeches, which are not placed in time from the aquatic environment in the peat-soil conditions after the appearance of clitella on their bodies. Therefore, the study of this problem has become relevant. For the study, four experimental animals groups were formed: 1 control - medicinal leeches (H. verbana), which were allowed to breed immediately after the appearance of clitella; 2 experimental - medicinal leeches (H. verbana), which were kept in an aqueous medium after the appearance of clitella for a month and then allowed to breed; 3 control - medicinal leeches (H. medicinalis), which were allowed to breed immediately after the appearance of clitella; 4 experimental - medicinal leeches (H. medicinalis), which were kept in an aqueous medium after the appearance of fertilization belts for a month then allowed to breed. The 400 sexually mature healthy medical leeches of two types aged 1.5-2 years were used in experiments. Initially, four individuals were placed into 4-liter containers for sexual intercourse, and after the appearance of differentiated fertilization zones, the control groups were immediately allowed to breed in a peat-soil environment. The experimental groups were left in the same containers for a month and then the survived leeches were allowed to breed. As a result of our research, we found mortality in the experimental groups. From the first week, we found that mortality before breeding of H. verbana was 15.6 ± 2.1% and of H. medicinalis - 14.3 ± 1.5%. Also, 92 ± 0.9% leeches from experimental group died in pet-soil environment sometimes even without cocoon deposition. The experimental group had defective cocoons, but mostly dead offspring.

Neurology trial registrations on ClinicalTrials.gov between 2007 and 2018: A cross-sectional analysis of characteristics, early discontinuation, and results reporting

BACKGROUND

Increasing neurological disease burden and advancing treatment options require clinical trials to expand the evidence base of clinical care. We aimed to characterize neurology clinical trials registered between October 2007 and April 2018 and identify features associated with early discontinuation and results reporting.

METHODS

We compared 16,994 neurology (9.4%) and 163,714 non-neurology comparison trials registered to ClinicalTrials.gov. Trials therapeutic focus within neurology was assigned via combination programmatic and manual review. We performed descriptive analyses of trial characteristics, cox regression of early discontinuation, and multivariable logistic regression for results reporting within 3 years of completion.

RESULTS

Most neurology trials were academic-funded (58.5%) followed by industry (31.9%) and US-government (9.6%). Neurology trials focused more on treatment than prevention compared to non-neurology studies. Of neurology trials, 11.3% discontinued early, and 32.2% of completed trials reported results by April 30, 2018. In multivariable analysis accounting for time-to-event, neurology trials were at lower risk of discontinuation than non-neurology trials (adjusted hazard 0.83, p < 0.0001). Both academic and government-funded trials had greater risk of discontinuation than industry (adjusted hazard 0.57 and 0.46, respectively). Among completed trials, government-funded studies (adjusted odds ratio 2.12, p < 0.0001) had highest odds of results reporting while academic trials reported less (adjusted odds ratio 0.51, p < 0.0001).

CONCLUSIONS

Funding source is associated with trial characteristics and outcomes in neurology. Improvements in trial completion and timely dissemination of results remain urgent goals for the field.

Using Multiple Decomposition Methods and Cluster Analysis to Find and Categorize Typical Patterns of EEG Activity in Motor Imagery Brain-Computer Interface Experiments

In this study, the sources of EEG activity in motor imagery brain–computer interface (BCI) control experiments were investigated. Sixteen linear decomposition methods for EEG source separation were compared according to different criteria. The criteria were mutual information reduction between the source activities and physiological plausibility. The latter was tested by estimating the dipolarity of the source topographic maps, i.e., the accuracy of approximating the map by potential distribution from a single current dipole, as well as by the specificity of the source activity for different motor imagery tasks. The decomposition methods were also compared according to the number of shared components found. The results indicate that most of the dipolar components are found by the Independent Component Analysis Methods AMICA and PWCICA, which also provided the highest information reduction. These two methods also found the most task-specific EEG patterns of the blind source separation algorithms used. They are outperformed only by non-blind Common Spatial Pattern methods in terms of pattern specificity. The components found by all of the methods were clustered using the Attractor Neural Network with Increasing Activity. The results of the cluster analysis revealed the most frequent patterns of electrical activity occurring in the experiments. The patterns reflect blinking, eye movements, sensorimotor rhythm suppression during the motor imagery, and activations in the precuneus, supplementary motor area, and premotor areas of both hemispheres. Overall, multi-method decomposition with subsequent clustering and task-specificity estimation is a viable and informative procedure for processing the recordings of electrophysiological experiments.

Revising the pathways of the Li reaction with organic carbonates

The metallic lithium electrode has major concerns such as extremely high reactivity and nonuniform needle-like electrodeposition, limiting its wide application as a negative electrode in secondary batteries. Its reactions with the electrolyte leading to solid electrolyte interphase (SEI) formation play an important role, and controlling its composition and properties can help to overcome both difficulties. Even though solid electrolyte interphase chemistry and properties seem to be well known, many surface chemistry experiments reported are not perfect with respect to the purity needed for Li studies and can be interpreted alternatively. Here, we studied reactions between lithium and propylene carbonate and ethylene carbonate in model reactions realized in an ultra-high vacuum. In addition to the already reported reaction pathway yielding lithium carbonate and semicarbonate, our theoretical (DFT) modeling confirms the preference of alternative routes. Along with the most beneficial final lithium carbonates, dilithium 1,2-dialkoxide (DD) can form barrierlessly as a final product by two-electron transfer. Experimental XPS/NEXAFS studies of gas phase and solid-gas model reactions revealed that in both cases DD is the main reaction product. Understanding of the discovered reaction pathway can also be essential for reactions in liquid electrolytes, although the low electric conductivity of the SEI makes it less probable.

Education Research: A novel resident-driven neurology quality improvement curriculum

OBJECTIVE

To describe and assess the effectiveness of a neurology resident quality improvement curriculum focused on development of practical skills and project experience.

METHODS

We designed and implemented a quality improvement curriculum composed of (1) a workshop series and (2) monthly resident-led Morbidity, Mortality, & Improvement conferences focused on case analysis and project development. Surveys were administered precurriculum and 18 months postcurriculum to assess the effect on self-assessed confidence with quality improvement skills, attitudes, and project participation. Scholarship in the form of posters, presentations, and manuscripts was tracked during the course of the study.

RESULTS

Precurriculum, 83% of neurology residents felt that instruction in quality improvement was important, but most rated their confidence level with various skills as low. Following implementation of the curriculum, residents were significantly more confident in analyzing a patient case (odds ratio, 95% confidence interval) (2.4, 1.9-3.1), proposing system changes (3.1, 2.3-3.9), writing a problem statement (9.9, 6.2-13.5), studying a process (3.1, 2.3-3.8), identifying resources (3.1, 2.3-3.8), identifying appropriate measures (2.5, 1.9-3.0), collaborating with other providers to make improvements (4.9, 3.5-6.4), and making changes in a system (3.1, 2.3-3.8). Project participation increased from the precurriculum baseline (7/18, 39%) to the postcurriculum period (17/22, 77%; p = 0.023). One hundred percent of residents surveyed rated the curriculum positively.

CONCLUSIONS

Our multifaceted curriculum was associated with increased resident confidence with quality improvement skills and increased participation in improvement projects. With adequate faculty mentorship, this curriculum represents a novel template for preparing neurology residents for meeting the expectations of improvement in practice and offers scholarship opportunities.

Spontaneous remission in diffuse large cell lymphoma: a case report

Background

Spontaneous remission in solid malignancies has been documented. However, spontaneous remission in aggressive diffuse large b cell lymphoma is exceedingly rare. Previous reports of lymphoma remission suggest that not yet fully characterized tumor-intrinsic and microenvironment mechanisms cooperate with spontaneous regression.

Case description

Here, we report the case of an 88-year-old white woman with diffuse large b cell lymphoma (follicular lymphoma transformed) who achieved morphologic spontaneous remission 3 months after her diagnostic core biopsy. We examined 16 similar cases of diffuse large b cell lymphoma suggesting that spontaneous remission is preferentially observed in elderly patients soon after their biopsy microtrauma, especially if malignancies are Epstein–Barr virus driven and activated B-cell type.

Conclusion

Our case and reported analysis highlight that anti-tumor adaptive T cell responses are potentially augmented in a subset of patients leading to lymphoma regression. In these patients, it is possible that “primed” innate anti-tumor T cell immunity is enhanced in immunogenic lymphoma subtypes after tissue biopsy. Our case and analysis not only reinforce the role of innate T cell anticancer immunity, but also originates potential proof of concept for investigation of unexplored pathways that could favorably impact T cell therapy.

BINP electron-positron facilities

The present status of two operating BINP electron-positron colliders VEPP-2000 and VEPP-4M is given.

De novo recruitment of Polycomb-group proteins in Drosophila embryos

Polycomb-group (PcG)-mediated transcriptional repression of target genes can be delineated into two phases. First, following initial repression of target genes by gene-specific transcription factors, PcG proteins recognize the repressed state and assume control of the genes' repression. Second, once the silenced state is established, PcG proteins may maintain repression through an indefinite number of cell cycles. Little is understood about how PcG proteins initially recognize the repressed state of target genes and the steps leading to de novo establishment of PcG-mediated repression. We describe a genetic system in which a Drosophila PcG target gene, giant (gt), is ubiquitously repressed during early embryogenesis by a maternally expressed transcription factor, and show the temporal recruitment of components of three PcG protein complexes: PhoRC, PRC1 and PRC2. We show that de novo PcG recruitment follows a temporal hierarchy in which PhoRC stably localizes at the target gene at least 1 h before stable recruitment of PRC2 and concurrent trimethylation of histone H3 at lysine 27 (H3K27me3). The presence of PRC2 and increased levels of H3K27me3 are found to precede stable binding by PRC1.

Homonymous Hemianopia and Vision Restoration Therapy

Homonymous hemianopia from stroke causes visual disability. Although some patients experience spontaneous improvement, others have limited to no change and may be left with a severe disability. Current rehabilitation strategies are compensatory and cannot restore function. Animal studies suggest that central nervous system plasticity could allow for redirection of lost visual function into undamaged areas of cortex. A commercial therapy system was developed, from which claims of visual field expansion were disputed by independent researchers. The treatment remains controversial with seemingly contradictory data being generated. Continued research is underway to demonstrate the (non-)efficacy of this treatment method.

Behavioral and neuronal recording of the nucleus accumbens in adolescent rats following acute and repetitive exposure to methylphenidate

The nucleus accumbens (NAc) has been shown to play a key role in the brain's response to methylphenidate (MPD). The present study focuses on neuronal recording from this structure. The study postulates that repetitive exposure to the same dose of MPD will elicit in some rats behavioral sensitization and in others tolerance. Furthermore, the study postulates that NAc neuronal activity recorded from animals expressing behavioral tolerance after repetitive MPD exposure will be significantly different from NAc neuronal activity recorded from animals expressing behavioral sensitization after repetitive MPD exposure at doses of 0.6, 2.5, 5.0, and 10.0 mg/kg. To test this, behavioral and neuronal activity was recorded concomitantly from the NAc of freely behaving adolescent rats (postnatal day 40) before and after acute and repetitive administration of four different MPD doses. Comparing the acute MPD effect to the repetitive MPD effect revealed that the acute response to MPD exhibited dose-response characteristics: an increase in behavioral activity correlated with increasing MPD doses. On the other hand, following repetitive MPD exposure, some animals exhibited attenuated behavior (tolerance), while others exhibited further increases in the recorded behavior (sensitization). Moreover, the neuronal activity following repetitive MPD exposure recorded in animals exhibiting behavioral sensitization was significantly different from neuronal activity recorded in animals exhibiting behavioral tolerance. This implies that when studying the effects of repetitive MPD administration on adolescent rats, it is advisable to simultaneously record both neuronal and behavioral activity and to evaluate all data based on the animals' behavioral response to the repetitive MPD exposure.

Targeting ErbB3-mediated stromal-epithelial interactions in pancreatic ductal adenocarcinoma

Background:

We sought to investigate the role of ErbB3-mediated signalling on the interaction between pancreatic cancer-associated fibroblasts (CAF) and carcinoma cells in an effort to disrupt tumourigenic pancreatic ductal adenocarcinoma (PDAC) stromal–epithelial cross-communication.

Methods:

Primary CAF cultures were established from human PDAC surgical specimens. AsPC-1 pancreatic cancer cell murine subcutaneous xenografts were developed in the presence and absence of CAF and were subsequently treated with epidermal growth factor receptor (EGFR) inhibitors (erlotinib) and ErbB3 inhibitors (MM-121, monoclonal ErbB3 antibody).

Results:

Cancer-associated fibroblasts were found to secrete neuregulin-1 (NRG-1), which promoted proliferation via phosphorylation of ErbB3 and AKT in AsPC-1 PDAC cells. This signalling cascade was effectively inhibited both in vitro and in vivo by specific ErbB3 blockade with MM-121, with greater degree of tumourigenesis inhibition when combined with erlotinib. The CAF–AsPC-1 pancreatic cancer xenografts reached significantly greater tumour volume than those xenografts lacking CAF and were resistant to the anti-tumour effects of EGFR inhibition with erlotinib.

Conclusion:

Cancer-associated fibroblasts-derived NRG-1 promote PDAC tumourigenesis via ErbB3-AKT signalling and overcomes single-agent EGFR inhibition. Disruption of this stromally mediated tumourigenic mechanism is best obtained through combined EGFR-ErbB3 inhibition with both erlotinib and MM-121. We have identified the NRG-1/ErbB3 axis as an attractive molecular target for the interruption of tumourigenic stromal–epithelial interactions within the PDAC microenvironment.

Brain-computer interface based on generation of visual images

This paper examines the task of recognizing EEG patterns that correspond to performing three mental tasks: relaxation and imagining of two types of pictures: faces and houses. The experiments were performed using two EEG headsets: BrainProducts ActiCap and Emotiv EPOC. The Emotiv headset becomes widely used in consumer BCI application allowing for conducting large-scale EEG experiments in the future. Since classification accuracy significantly exceeded the level of random classification during the first three days of the experiment with EPOC headset, a control experiment was performed on the fourth day using ActiCap. The control experiment has shown that utilization of high-quality research equipment can enhance classification accuracy (up to 68% in some subjects) and that the accuracy is independent of the presence of EEG artifacts related to blinking and eye movement. This study also shows that computationally-inexpensive bayesian classifier based on covariance matrix analysis yields similar classification accuracy in this problem as a more sophisticated Multi-class Common Spatial Patterns (MCSP) classifier.

A phase I study evaluating the role of the anti-epidermal growth factor receptor (EGFR) antibody cetuximab as a radiosensitizer with chemoradiation for locally advanced pancreatic cancer

PURPOSE

(1) To determine the safety of the epidermal growth factor receptor (EGFR) antibody cetuximab with concurrent gemcitabine and abdominal radiation in the treatment of patients with locally advanced adenocarcinoma of the pancreas. (2) To evaluate the feasibility of pancreatic cancer cell epithelial-mesenchymal transition (EMT) molecular profiling as a potential predictor of response to anti-EGFR treatment.

METHODS

Patients with non-metastatic, locally advanced pancreatic cancer were treated in this dose escalation study with gemcitabine (0-300 mg/m(2)/week) given concurrently with cetuximab (400 mg/m(2) loading dose, 250 mg/m(2) weekly maintenance dose) and abdominal irradiation (50.4 Gy). Expression of E-cadherin and vimentin was assessed by immunohistochemistry in diagnostic endoscopic ultrasound fine-needle aspiration (EUS-FNA) specimens.

RESULTS

Sixteen patients were enrolled in 4 treatment cohorts with escalating doses of gemcitabine. Incidence of grade 1-2 adverse events was 96%, and incidence of 3-4 adverse events was 9%. There were no treatment-related mortalities. Two patients who exhibited favorable treatment response underwent surgical exploration and were intraoperatively confirmed to have unresectable tumors. Median overall survival was 10.5 months. Pancreatic cancer cell expression of E-cadherin and vimentin was successfully determined in EUS-FNA specimens from 4 patients.

CONCLUSIONS

Cetuximab can be safely administered with abdominal radiation and concurrent gemcitabine (up to 300 mg/m(2)/week) in patients with locally advanced adenocarcinoma of the pancreas. This combined therapy modality exhibited limited activity. Diagnostic EUS-FNA specimens could be analyzed for molecular markers of EMT in a minority of patients with pancreatic cancer.

Midrapidity antiproton-to-proton ratio in pp collisons at sqrt[s]=0.9 and 7 TeV measured by the ALICE experiment

The ratio of the yields of antiprotons to protons in pp collisions has been measured by the ALICE experiment at sqrt[s]=0.9 and 7 TeV during the initial running periods of the Large Hadron Collider. The measurement covers the transverse momentum interval 0.45<p_{t}<1.05  GeV/c and rapidity |y|<0.5. The ratio is measured to be R_{|y|<0.5}=0.957±0.006(stat)±0.014(syst) at 0.9 TeV and R_{|y|<0.5}=0.991±0.005(stat)±0.014(syst) at 7 TeV and it is independent of both rapidity and transverse momentum. The results are consistent with the conventional model of baryon-number transport and set stringent limits on any additional contributions to baryon-number transfer over very large rapidity intervals in pp collisions.

Cre-mediated seed-specific transgene excision in tobacco

Here we report the production of marker-free transgenic plants expressing phenolic compounds with high pharmacological value. Our strategy consisted in simultaneous delivery of lox-target and cre-containing constructs into the plant genome by cotransformation. In the Cre-vector, the cre recombinase gene was controlled by a seed-specific napin promoter. In the lox-target construct the selectable bar gene was placed between two lox sites in direct orientation, while a napin promoter driven vstI gene was inserted outside of the lox sites. Upon seed-specific cre induction the bar expression cassette was excised from the tobacco genome. Genetic and molecular analysis of T1 progeny plants indicated DNA excision in all 10 transgenic lines tested. RP-HPLC analysis demonstrated that the expression of the vstI gene resulted in accumulation of trans-resveratrol and its glycosylated derivative piceid in seeds of all marker free lines. These findings indicate that the seed-specific marker gene excision did not interfere with the expression of the gene of interest. Our data demonstrated the feasi of a developmentally controlled cre gene to mediate site-specific excision in tobacco very efficiently.

Bortezomib as brief neoadjuvant therapy for localized high-risk prostate cancer (PCa) followed by radical prostatectomy (RP)

5127

Background: Neoadjuvant therapy may provide an important paradigm for the discovery of active agents for the therapy of PCa. Bortezomib is a proteasome inhibitor with preclinical activity in PCa. A rationale can be made to study brief preoperative bortezomib before RP to determine feasibility and biologic activity. Methods: A phase II trial was designed to evaluate bortezomib 1.6mg/m2 as intravenous bolus weekly for 4 weeks followed by RP 24–72 hours after the last dose. Histological evidence of adenocarcinoma of the prostate was required with clinical stage T1c or T2a with Gleason 8–10 disease, or clinical stage T2b-T2c with Gleason grade 7 and PSA of >10 ng/mL, or clinical stage T3. Results: Accrual is complete with 40 patients enrolled, of whom 38 completed neoadjuvant bortezomib followed by RP and are evaluable. The median age was 60.2 years. No pathologic complete responses were noted. Cytopathic effects (cytolysis, nuclear pyknosis) were commonly seen compared to baseline tumor. Upregulation of apoptosis, proliferation and phosphorylated (p)-Akt have been previously reported in a subset of patients by our group (Ayala GE et al, Clin Cancer Res. 2008;14:7511–8). Two of 8 evaluable patients had a >50% decrease in serum PSA with bortezomib treatment; 3 others had PSA declines of 14%, 25%, and 45%, respectively; 1 patient had no change, and 2 displayed PSA increases. Therapy was feasible with generally manageable toxicities, and surgical morbidities did not increase. A comprehensive toxicity analysis will be presented. Feasibility of surgery, extraprostatic extension, positive margin and lymph node positive rates will be compared with matched historical controls and these data will be presented. Conclusions: Bortezomib is feasible as neoadjuvant therapy preceding RP for PCa and demonstrates biologic activity. Given the upregulation of proliferation and pAkt, the further evaluation of bortezomib may be warranted in randomized trials in combination with chemotherapy or Akt inhibitors.

[Table: see text]

IL-12 gene-modified bone marrow cell therapy suppresses the development of experimental metastatic prostate cancer

To investigate the immunomodulatory effects of interleukin-12 (IL-12) for treatment of metastatic prostate cancer, we administered adult bone marrow cells (BMC) that were genetically modified by retroviral vector-mediated IL-12 gene transduction in an experimental mouse model of prostate cancer metastasis. This therapy produced significant anti-metastatic effects in bone and lung and prolonged animal survival. Flow cytometric analysis indicated donor BMC could effectively home to bone and lung after treatment. Intensive infiltration of CD4 and CD8T cells in lung metastases and increased systemic natural killer and cytotoxic T lymphocyte activities indicated induction of a significant anti-metastatic immune response after treatment with IL-12 transduced BMC. Our results demonstrate the therapeutic potential of gene-modified BMC gene therapy.

Why and how are posture and movement coordinated?

In most motor acts, posture and movement must be coordinated in order to achieve the goal of the task. The focus of this chapter is on why and how this coordination takes place. First, the nature of posture is discussed. Two of its general functions are recognized; an antigravity role, and a role in interfacing the body with its environment such that perception and action can ensue. Next addressed is how posture is controlled centrally. Two models are presented and evaluated; a genetic and a hierarchical one. The latter has two levels; internal representation and execution. Finally, we consider how central control processes might achieve an effective coordination between posture and movement. Is a single central control process responsible for both movement and its associated posture? Alternatively, is there a dual coordinated control system: one for movement, and the other for posture? We provide evidence for the latter, in the form of a biomechanical analysis that features the use of eigenmovement approach.

Combination of adenovirus-mediated thymidine kinase gene therapy with cytotoxic chemotherapy in bladder cancer in vitro

We evaluated efficacy, toxicity and potential synergism of adenoviral-mediated thymidine kinase (tk)- ganciclovir (GCV) gene therapy in combination with 4 cytotoxic chemotherapeutic agents (doxorubicin, cisplatin, mitomycin C, and methotrexate) in 3 human bladder cancer cell lines. Cell lines were exposed to (1) 10 different concentrations of adenovirus expressing tk plus GCV; (2) 8 different concentrations of either doxorubicin, methotrexate, mitomycin C or cisplatin; or (3) combination treatment consisting of either low-, medium- or high-dose tk-GCV gene therapy plus 8 different concentrations of a single chemotherapeutic agent. Cell survival was determined using a MTT-based cell proliferation-assay. For most combinations, adding chemotherapy to tk-GCV gene therapy did not result in any therapeutic benefit. In some scenarios, we observed modest improvement with combinations of high-dose tk-GCV gene therapy and high-dose standard chemotherapy over tk-GCV monotherapy. Low concentrations of methotrexate enhanced the antitumor effects of low- and medium-dose tk-GCV gene therapy. Low level negative interference between tk-GCV gene therapy and chemotherapy occurred in some combinations but was overall negligible. In general, adding chemotherapy to tk-GCV gene therapy did not demonstrate significant therapeutic benefit in vitro. High doses of chemotherapeutic agents should be used in combination with tk-GCV gene therapy in order to take advantage of the occasional instance where modest improvement occurred with combination therapy. Additional studies exploring the role of methotrexate in enhancing the tk-GCV system are required. Investigation of other, potentially more synergistic chemotherapeutic agents in combination with tk-GCV is warranted.

Cholesterol overload promotes morphogenesis of a Niemann-Pick C (NPC)-like compartment independent of inhibition of NPC1 or HE1/NPC2 function

Cholesterol accumulation in an aberrant endosomal/lysosomal compartment is the hallmark of Niemann-Pick type C (NPC) disease. To gain insight into the etiology of the NPC compartment, we studied a novel Chinese hamster ovary cell mutant that was identified through a genetic screen and phenocopies the NPC1 mutation. We show that the M87 mutant harbors a mutation in a gene distinct from the NPC1 and HE1/NPC2 disease genes. M87 cells have increased total cellular cholesterol with accumulation in an aberrant compartment that contains LAMP-1, LAMP-2, and NPC1, but not CI-MPR, similar to the cholesterol-rich compartment in NPC mutant cells. We demonstrate that low-density lipoprotein receptor activity is increased 3-fold in the M87 mutant, and likely contributes to accumulation of excess cholesterol. In contrast to NPC1-null cells, the M87 mutant exhibits normal rates of delivery of endosomal cholesterol to the endoplasmic reticulum and to the plasma membrane. The preserved late endosomal function in the M87 mutant is associated with the presence of NPC1-containing multivesicular late endosomes and supports a role for these multivesicular late endosomes in the sorting and distribution of cholesterol. Our findings implicate cholesterol overload in the formation of an NPC-like compartment that is independent of inhibition of NPC1 or HE1/NPC2 function.

Recent advances in membrane microdomains: rafts, caveolae, and intracellular cholesterol trafficking

Cellular cholesterol homeostasis is a balance of influx, catabolism and synthesis, and efflux. Unlike vascular lipoprotein cholesterol transport, intracellular cholesterol trafficking is only beginning to be resolved. Exogenous cholesterol and cholesterol ester enter cells via the low-density lipoprotein (LDL) receptor/lysosomal and less so by nonvesicular, high-density lipoprotein (HDL) receptor/caveolar pathways. However, the mechanism(s) whereby cholesterol enters the lysosomal membrane, translocates, and transfers out of the lysosome to the cell interior are unknown. Likewise, the steps whereby cholesterol enters the cytofacial leaflet of the plasma membrane caveolae, rapidly translocates, leaves the exofacial leaflet, and transfers to extracellular HDL are unclear. Increasing evidence obtained with model and isolated cell membranes, transfected cells, genetic mutants, and gene-ablated mice suggests that proteins such as caveolin, sterol carrier protein-2 (SCP-2), Niemann-Pick C1 protein, steroidogenic acute regulatory protein (StAR), and other intracellular proteins mediate intracellular cholesterol transfer. While these proteins bind cholesterol and/or interact with cholesterol-rich membrane microdomains (e.g., caveolae, rafts, and annuli), their relative contributions to direct molecular versus vesicular cholesterol transfer remain to be resolved. The formation, regulation, and role of membrane microdomains in regulating cholesterol uptake/efflux and trafficking are unclear. Some cholesterol-binding proteins exert opposing effects on cellular cholesterol uptake/efflux, transfer of cholesterol out of the lysosomal membrane, and/or intracellular cholesterol trafficking to select membranous organelles. Resolving these cholesterol pathways and the role of membrane cholesterol microdomains is essential to our understanding not only of processes that affect cholesterol metabolism, but also of the abnormal regulation that may lead to disease (diabetes, obesity, atherosclerosis, neutral lipid storage, Niemann-Pick C, congenital lipoid adrenal hyperplasia, etc.).

In vitro dorsal root ganglia and human prostate cell line interaction: redefining perineural invasion in prostate cancer

BACKGROUND

Little is understood regarding mechanisms of perineural invasion in prostate cancer progression. We present a novel model system and data that indicate perineural invasion is an active, specific, and reciprocal interaction between nerves and prostate cancer cells.

METHODS

Mouse dorsal root ganglia (DRG) and human prostate cancer cells (Du-145, LNCaP, PC3) and stromal cells (HTS-40F) were co-cultured in Matrigel matrix. Control cultures consisted of prostate cancer and stromal cells only and DRG only. Neurite outgrowth, cell colony growth, neurite-colony contact, and retrograde extension were quantitated with dark phase microscopy and image analysis (Optimas 6.1).

RESULTS

Directional outgrowth of neurites was observed projecting into DU-145 colonies within 24 hr of co-culture. Cultures with the greatest number of DU-145 cells recruited significantly more neurites and established contact earlier, indicating this process was cell-seeding density dependent. Once neurite/DU-145 cell contact was established neurite growth diminished, suggesting an active neurite recruitment by DU-145 cells. Subsequent to neurite contact, DU-145 cells migrated along neurites in a retrograde fashion into the nerve/ganglion of origin (retrograde extension) establishing perineural invasion. In addition to perineural invasion, DU-145 colony growth was elevated in DRG co-cultures relative to DU-145-only control cell cultures. Similarly, the degree of neurite outgrowth was elevated in DRG-cell co-cultures relative to DRG-only control cultures. The same observations were made with LNCaP and PC3 cells, but interactions between stromal cells and nerves were not found.

CONCLUSIONS

This study shows the utility of the prostate cancer/DRG in vitro system to study specific mechanism of prostate cancer cell-nerve interaction. Moreover, these data suggest that perineural invasion mechanisms involve active and reciprocal interactions between carcinoma cells and adjacent nerve/ganglions in prostate cancer progression.

Blood flow velocity and pulsatility index differences in patients with unilateral migraine

OBJECTIVE

To evaluate blood flow velocity and pulsatility in unilateral migraine without aura during the headache-free period using transcranial Doppler (TCD) sonography.

METHODS

Patients with unilateral headache were recruited during the headache-free period. Maximum mean flow velocity (MFV) and pulsatility index (PI) were measured in the middle cerebral (MCA) and basilar arteries. Controls were headache-free individuals without cerebrovascular disease.

RESULTS

Twenty-five patients with right-sided migraine, 25 patients with left-sided migraine, and 19 controls were studied. The MCA PI was higher on the right headache side versus the left headache side (0.97 +/- 0.2 versus 0.86 +/- 0.1 cm/s, P =.02) and versus controls (0.9 +/- 0.2 cm/s, NS). The basilar artery MFV was higher in patients with right-sided headache versus left-sided headache (39.5 +/- 5.6 versus 34.7 +/- 8.2 cm/s, P =.02) and versus controls (38.2 +/- 8 cm/s, NS). No decrease in MFV with age was observed in patients with migraine.

CONCLUSIONS

Middle cerebral artery flow pulsatility and basilar artery velocity are higher in patients with right-sided migraine compared with left-sided migraineurs, during the headache-free period. Although these parameters were similar to controls, the differences found during the headache-free period in migraineurs may indicate vascular involvement predisposing to the unilateral headache recurrence.

Photosensitization-induced calcium overload in cardiac cells: direct link to membrane permeabilization and calcium influx

The purpose of the present study was to gain new insight regarding the role membrane permeabilization plays in the photosensitization-induced increase in intracellular calcium concentration. During continuous rose bengal photosensitization we monitored the contractile state (relaxed or hypercontracted) of isolated frog cardiac cells and assessed the photosensitization-induced membrane-leak conductance. We investigated the effects of irradiance, extracellular calcium concentration, intracellular chelation of calcium and substitution of tetraethylammonium (TEA) for extracellular sodium. We found that with 2 and 5 mM extracellular calcium cell hypercontracture occurred when leak conductance reached values on the order of 6-7 nS, independent of the illumination duration required to reach this conductance. With 0.5 mM calcium hypercontracture occurred when leak conductance reached values on the order of 11 nS. Chelation of intracellular calcium delayed the onset of cell hypercontracture and increased by two- to three-fold the leak conductance at the initiation of cell hypercontracture. Substitution of TEA for extracellular sodium did not affect the time to contracture onset but reduced leak conductance at contracture onset nearly three-fold. We discuss how our results support the conclusion that photosensitization induces an increase in intracellular calcium concentration via calcium influx through the transmembrane-permeability pathway opened by the photosensitization process.

Fenretinide therapy in prostate cancer: effects on tissue and serum retinoid concentration

PURPOSE

To examine the feasibility of using fenretinide (4-HPR) for the prevention and treatment of prostate cancer.

MATERIALS AND METHODS

We measured the impact of 4-HPR therapy on retinoid concentrations in vivo, in a mouse model of prostate cancer and clinically, in patients with prostate cancer who were given oral 4-HPR (200 mg/d) or placebo for 4 weeks before undergoing a radical prostatectomy.

RESULTS

Prostate tumors in mice treated with 4-HPR contained high levels of 4-HPR and of all-trans-retinoic acid (RA) and reduced levels of retinol (ROH). Patients given 4-HPR were found to have significantly higher concentrations of 4-HPR in the cancerous prostate as compared with the serum levels (463 nmol/L v 326 nmol/L; P =.049), but they were only 1/10 the levels found in mice and were far below the concentrations reported in human breast tissue. Serum and tissue ROH levels were reduced to less than half the concentrations found in untreated controls. RA concentrations in human serum and in cancerous prostates were not significantly affected by 4-HPR treatment, in contrast with the findings in mice.

CONCLUSION

The standard oral dose of 4-HPR proposed for breast cancer (200 mg/d) achieved only modest drug levels in the prostate and is unlikely to be effective for prostate cancer prevention or treatment. Higher doses need to be explored.

Adipose differentiation related protein: expression, purification of recombinant protein in Escherichia coli and characterization of its fatty acid binding properties

Adipose differentiation related protein (ADRP) is a 53 kDa protein encoded by a cDNA originally cloned by differential hybridization from murine adipocytes. ADRP is induced during the early onset of the adipose differentiation program and is expressed at high level in mature adipocytes. We have demonstrated that ADRP stimulated the uptake of fatty acids thereby providing evidence for a functional role of ADRP in lipid metabolism. In the present paper, the murine ADRP has been expressed as a recombinant histidine-tagged protein in Escherichia coli, and purified from expressing cultures in order to examine its biochemical properties. We report here that the purified recombinant ADRP binds fatty acids and exhibits stoichiometric saturable binding of NBD-stearic acid with a K(d)=0.145+/-0.003 microM and a B(max)=0.99+/-0.05. Analysis of fluorescence emission spectra indicates that the polarity of the ADRP binding site is near epsilon approximately 23, close to that observed for fatty acid binding sites in other lipid binding proteins such as the liver fatty acid binding protein. The data presented here provide evidence that isolated ADRP purified in the experimental conditions described here can be used for functional studies.

Pressure control ventilation: three anesthesia ventilators compared using an infant lung model

We compared three ventilators-Servo 900C (Siemens Medical Systems, Danvers, MA), Aestiva 3000 (Datex-Ohmeda, Madison, WI), and NAD 6000 (North American Dräger, Telford, PA)-set to deliver pressure control ventilation using an infant test lung model. Ventilator settings were selected to test "near-maximum" settings that would be used for a neonatal patient (peak inspiratory pressure [PIP] 30 cm H(2)O) or older child (PIP 60 cm H(2)O). When adjusted for set inspiratory pressure and compliance, the average tidal volume (V(t)) produced by the NAD 6000 was 5.8 mL less than the Servo 900C (P: = 0. 103), and the average V(t) produced by the Aestiva 3000 was 18.9 mL less than the Servo 900C (P: < 0.001). The Servo 900C generated increased peak pressures, tending to overshoot the set maximum inflating pressures, especially during rapid respiratory rates with decreased inspiratory times. The Aestiva 3000 did not achieve the set PIP during testing conditions of decreased inspiratory times, and the NAD 6000 was not greatly affected by changes in inspiratory time. All three ventilators measured expiratory V(t) to be larger than the actual V(t) delivered to the lung; however, the NAD 6000 was more accurate.

IMPLICATIONS

There are differences in performance of ventilators when set to deliver pressure control ventilation to an infant test lung model.

Prognostic value of P53 nuclear accumulation and histopathologic features in T1 transitional cell carcinoma of the urinary bladder

OBJECTIVES

To determine whether molecular and histopathologic tumor features can predict disease progression in Stage T1 transitional cell carcinoma of the bladder.

METHODS

Tumor specimens from 43 patients were analyzed with respect to grade, presence of carcinoma in situ, invasion deep or superficial to the lamina propria's muscularis mucosa, p53 expression using DO-7 and PAb1801 antibodies, age, and sex. Flow cytometry was performed on 30 patients from whom there was adequate paraffin-embedded tissue to assess DNA ploidy. Seven patients underwent immediate cystectomy as primary treatment and 36 patients retained their bladders and were at risk of recurrence and progression.

RESULTS

The median follow-up was 79 months. Disease recurred in 17 patients (47.2%) and progressed in 6 (16.7%). Only 3 patients (7.0%) died of bladder cancer. None of the parameters investigated was statistically significant in predicting recurrence, progression, or survival. Only carcinoma in situ approached statistical significance (P = 0.0593) as a predictor of progression. Early cystectomy did not have a significant effect on cancer-specific survival (P = 0.3603). The concordance rate between the two p53 antibodies was 88% (P <0.0001).

CONCLUSIONS

Deep invasion of the lamina propria, p53 positive immunohistochemistry, high grade, and aneuploidy were not significant adverse prognostic factors for either disease progression or survival. Carcinoma in situ associated with Stage T1 transitional cell carcinoma may represent a biologically more aggressive cancer requiring early definitive therapy, but this hypothesis should be evaluated in prospective clinical studies.

Reduced infiltration of tumor-associated macrophages in human prostate cancer: association with cancer progression

Tumor-associated macrophages (TAMs) are highly active immune effector cells that may either positively or negatively regulate the growth of various malignant cells, depending on the biological context. However, the role of TAMs in human prostate cancer progression is unclear. TAMs were immunohistochemically labeled using a monoclonal (CD68) antibody in radical prostatectomy specimens derived from 81 prostate cancer patients. CD68-positive cells were counted with the aid of a microscope and expressed as macrophage index (MphiI), including TAMs/mm2 total tumor tissue (MphiItotal), TAMs/mm2 tumor stroma (MphiIstroma), and TAMs/mm2 cancer cell area (MphiIcancer). MphiIs were analyzed in association with patients' clinical and pathological stage, recurrence status, and histological grade of the cancer. There were significant inverse relationships between MphiItotal and MphiIstroma and clinical stage (P = 0.016 and P = 0.006, respectively). Reduced MphiItotal was also associated with the presence of positive lymph nodes (P = 0.010). Interestingly, although all of the MphiIs differed between Gleason score groups, only MphiIcancer was positively associated with Gleason score. Univariate analysis of MphiItotal and multivariate analysis of MphiItotal with specific pathological markers revealed that MphiItotal was an independent predictor for disease-free survival after surgery (Cox proportional hazard model, P = 0.044 and P = 0.007, respectively). For patients with high MphiItotal (> or = 185.8, the mean MphiItotal value), the disease-free probability 5 years after surgery was 0.75, which was significantly higher than for those with low MphiItotal (0.31, P = 0.0008). Additional immunohistochemical studies that evaluated cytotoxicity-related biomarkers in stroma-associated mononuclear cells suggested reduced functional activities in highly aggressive prostate cancer compared with less aggressive disease. Our results indicate that reduced MphiItotal is a novel prognostic marker for prostate cancer.