Developmental dynamics of RNA translation in the human brain

The precise regulation of gene expression is fundamental to neurodevelopment, plasticity and cognitive function. Although several studies have profiled transcription in the developing human brain, there is a gap in understanding of accompanying translational regulation. In this study, we performed ribosome profiling on 73 human prenatal and adult cortex samples. We characterized the translational regulation of annotated open reading frames (ORFs) and identified thousands of previously unknown translation events, including small ORFs that give rise to human-specific and/or brain-specific microproteins, many of which we independently verified using proteomics. Ribosome profiling in stem-cell-derived human neuronal cultures corroborated these findings and revealed that several neuronal activity-induced non-coding RNAs encode previously undescribed microproteins. Physicochemical analysis of brain microproteins identified a class of proteins that contain arginine-glycine-glycine (RGG) repeats and, thus, may be regulators of RNA metabolism. This resource expands the known translational landscape of the human brain and illuminates previously unknown brain-specific protein products.

Locus specific epigenetic modalities of random allelic expression imbalance

Most autosomal genes are thought to be expressed from both alleles, with some notable exceptions, including imprinted genes and genes showing random monoallelic expression (RME). The extent and nature of RME has been the subject of debate. Here we investigate the expression of several candidate RME genes in F1 hybrid mouse cells before and after differentiation, to define how they become persistently, monoallelically expressed. Clonal monoallelic expression is not present in embryonic stem cells, but we observe high frequencies of monoallelism in neuronal progenitor cells by assessing expression status in more than 200 clones. We uncover unforeseen modes of allelic expression that appear to be gene-specific and epigenetically regulated. This non-canonical allelic regulation has important implications for development and disease, including autosomal dominant disorders and opens up therapeutic perspectives.

Spen links RNA-mediated endogenous retrovirus silencing and X chromosome inactivation

The Xist lncRNA mediates X chromosome inactivation (XCI). Here we show that Spen, an Xist-binding repressor protein essential for XCI , binds to ancient retroviral RNA, performing a surveillance role to recruit chromatin silencing machinery to these parasitic loci. Spen loss activates a subset of endogenous retroviral (ERV) elements in mouse embryonic stem cells, with gain of chromatin accessibility, active histone modifications, and ERV RNA transcription. Spen binds directly to ERV RNAs that show structural similarity to the A-repeat of Xist, a region critical for Xist-mediated gene silencing. ERV RNA and Xist A-repeat bind the RRM domains of Spen in a competitive manner. Insertion of an ERV into an A-repeat deficient Xist rescues binding of Xist RNA to Spen and results in strictly local gene silencing in cis. These results suggest that Xist may coopt transposable element RNA-protein interactions to repurpose powerful antiviral chromatin silencing machinery for sex chromosome dosage compensation.

Identification of the Human Skeletal Stem Cell

Stem cell regulation and hierarchical organization of human skeletal progenitors remain largely unexplored. Here, we report the isolation of a self-renewing and multipotent human skeletal stem cell (hSSC) that generates progenitors of bone, cartilage, and stroma, but not fat. Self-renewing and multipotent hSSCs are present in fetal and adult bones and can also be derived from BMP2-treated human adipose stroma (B-HAS) and induced pluripotent stem cells (iPSCs). Gene expression analysis of individual hSSCs reveals overall similarity between hSSCs obtained from different sources and partially explains skewed differentiation toward cartilage in fetal and iPSC-derived hSSCs. hSSCs undergo local expansion in response to acute skeletal injury. In addition, hSSC-derived stroma can maintain human hematopoietic stem cells (hHSCs) in serum-free culture conditions. Finally, we combine gene expression and epigenetic data of mouse skeletal stem cells (mSSCs) and hSSCs to identify evolutionarily conserved and divergent pathways driving SSC-mediated skeletogenesis. VIDEO ABSTRACT.

Nanokelvin DC and AC Meissner-transition-edge temperature detectors

Based upon a superconducting transition edge sensor (TES), the Meissner-TES is a relatively new type of high resolution cryogenic thermometer which employs the magnetic transition of a superconductor to measure temperature. We have improved the signal-to-noise for DC sensing by a factor of 30 compared to our prior effort and developed a new AC mode which uses an oscillating magnetic field and a lock-in technique with much lower magnetic noise than the DC mode. The thermometer was tuned in situ over a range of operating temperatures 10-50 times larger than the transition width of the superconductor, using an applied persistent magnetic field. The DC mode can have sensitivity better than 1 nK for 100 s averaging, and the AC mode has sensitivity better than 120 nK for very small applied magnetic fields near 14 nT and 100 s averaging. The Meissner-TES can be applied to high resolution temperature control, high sensitivity infrared sensing, optical power scale realization, and the study of temperature-dependent phase transitions.

Mechanoresponsive stem cells acquire neural crest fate in jaw regeneration

During both embryonic development and adult tissue regeneration, changes in chromatin structure driven by master transcription factors lead to stimulus-responsive transcriptional programs. A thorough understanding of how stem cells in the skeleton interpret mechanical stimuli and enact regeneration would shed light on how forces are transduced to the nucleus in regenerative processes. Here we develop a genetically dissectible mouse model of mandibular distraction osteogenesis-which is a process that is used in humans to correct an undersized lower jaw that involves surgically separating the jaw bone, which elicits new bone growth in the gap. We use this model to show that regions of newly formed bone are clonally derived from stem cells that reside in the skeleton. Using chromatin and transcriptional profiling, we show that these stem-cell populations gain activity within the focal adhesion kinase (FAK) signalling pathway, and that inhibiting FAK abolishes new bone formation. Mechanotransduction via FAK in skeletal stem cells during distraction activates a gene-regulatory program and retrotransposons that are normally active in primitive neural crest cells, from which skeletal stem cells arise during development. This reversion to a developmental state underlies the robust tissue growth that facilitates stem-cell-based regeneration of adult skeletal tissue.

Wideband infrared trap detector based upon doped silicon photocurrent devices

We have designed, fabricated, and measured infrared trap detectors made from arsenic-doped silicon (Si:As) blocked impurity band (BIB) photodetectors. These trap detectors are composed of two detectors in a wedge geometry, with an entrance aperture diameter of either 1 or 3 mm. The detectors were calibrated for quantum efficiency against a pyroelectric reference detector using a Fourier transform spectral comparator system, and etalon effects and spatial uniformity of the traps were also quantified. Measurements of the traps at a temperature of 10 K show that nearly ideal external quantum efficiency (>90%) can be attained over much of the range from 4 to 24 μm, with significant responsivity from 2 to 30 μm. The traps exhibited maximum etalon oscillations of only 2%, which is about 10 times smaller amplitude than those of the single Si:As BIB detectors measured under similar conditions. Spatial nonuniformity across the entrance apertures of the traps was about 1%. The combination of high detectivity, wideband wavelength coverage, spectral flatness, and spatial uniformity make these trap detectors an excellent reference detector for spectrally resolved measurements and radiometric calibrations over the near- to far-infrared wavelength range.

Promoter of lncRNA Gene PVT1 Is a Tumor-Suppressor DNA Boundary Element

Noncoding mutations in cancer genomes are frequent but challenging to interpret. PVT1 encodes an oncogenic lncRNA, but recurrent translocations and deletions in human cancers suggest alternative mechanisms. Here, we show that the PVT1 promoter has a tumor-suppressor function that is independent of PVT1 lncRNA. CRISPR interference of PVT1 promoter enhances breast cancer cell competition and growth in vivo. The promoters of the PVT1 and the MYC oncogenes, located 55 kb apart on chromosome 8q24, compete for engagement with four intragenic enhancers in the PVT1 locus, thereby allowing the PVT1 promoter to regulate pause release of MYC transcription. PVT1 undergoes developmentally regulated monoallelic expression, and the PVT1 promoter inhibits MYC expression only from the same chromosome via promoter competition. Cancer genome sequencing identifies recurrent mutations encompassing the human PVT1 promoter, and genome editing verified that PVT1 promoter mutation promotes cancer cell growth. These results highlight regulatory sequences of lncRNA genes as potential disease-associated DNA elements.

Mechanistic insights in X-chromosome inactivation

X-chromosome inactivation (XCI) is a critical epigenetic mechanism for balancing gene dosage between XY males and XX females in eutherian mammals. A long non-coding RNA (lncRNA), XIST, and its associated proteins orchestrate this multi-step process, resulting in the inheritable silencing of one of the two X-chromosomes in females. The XIST RNA is large and complex, exemplifying the unique challenges associated with the structural and functional analysis of lncRNAs. Recent technological advances in the analysis of macromolecular structure and interactions have enabled us to systematically dissect the XIST ribonucleoprotein complex, which is larger than the ribosome, and its place of action, the inactive X-chromosome. These studies shed light on key mechanisms of XCI, such as XIST coating of the X-chromosome, recruitment of DNA, RNA and histone modification enzymes, and compaction and compartmentalization of the inactive X. Here, we summarize recent studies on XCI, highlight the critical contributions of new technologies and propose a unifying model for XIST function in XCI where modular domains serve as the structural and functional units in both lncRNA-protein complexes and DNA-protein complexes in chromatin.This article is part of the themed issue 'X-chromosome inactivation: a tribute to Mary Lyon'.

Free-living human cells reconfigure their chromosomes in the evolution back to uni-cellularity

Cells of multi-cellular organisms evolve toward uni-cellularity in the form of cancer and, if humans intervene, continue to evolve in cell culture. During this process, gene dosage relationships may evolve in novel ways to cope with the new environment and may regress back to the ancestral uni-cellular state. In this context, the evolution of sex chromosomes vis-a-vis autosomes is of particular interest. Here, we report the chromosomal evolution in ~ 600 cancer cell lines. Many of them jettisoned either Y or the inactive X; thus, free-living male and female cells converge by becoming ‘de-sexualized’. Surprisingly, the active X often doubled, accompanied by the addition of one haploid complement of autosomes, leading to an X:A ratio of 2:3 from the extant ratio of 1:2. Theoretical modeling of the frequency distribution of X:A karyotypes suggests that the 2:3 ratio confers a higher fitness and may reflect aspects of sex chromosome evolution.

Multicellular life relies on a group of cells working together for a common interest. To study these cells, researchers take them out of the organism and grow them in the laboratory. Instead of growing as part of organs and tissues, the cells normally have a free-living lifestyle. Because multicellular life evolved from single-celled organisms, laboratory-grown cells can be considered as life forms that are evolving backward from a multicellular to a single-celled existence.

Normally, the cells that make up most of the tissues in the human body have 22 pairs of chromosomes known as autosomes and a pair of sex chromosomes. The cells of women have two X sex chromosomes, one of which is inactive, while those of men have one X and one Y chromosome. However, free-living single cells do not need to distinguish between male and female cells.

Xu, Peng, Chen et al. have now studied the chromosomes of cancer cells taken from over 600 people and grown in the laboratory. As the cells evolved in response to their free-living lifestyle, they became ‘de-sexualized’; male cells lost their Y chromosome, while female cells abandoned their inactive X chromosome. The cells then evolved toward a new state in which they possessed two active X chromosomes and three sets of autosomes. This new configuration suggests that the current X chromosome to autosome ratio may not be optimal for fitness and hence sheds some light on how mammalian sex chromosomes evolved.

It is currently thought that as cancerous tumors grow, their cells evolve to favor their own interests over the common interests of the rest of the organism. In this way, they develop characteristics more like those of single cells. Further research is therefore needed to investigate whether changes occur to the chromosomes of cancer cells growing within the body, and whether this gives them an advantage over normal cells.

An improved ATAC-seq protocol reduces background and enables interrogation of frozen tissues

We present Omni-ATAC, an improved ATAC-seq protocol for chromatin accessibility profiling that works across multiple applications with substantial improvement of signal-to-background ratio and information content. The Omni-ATAC protocol generates chromatin accessibility profiles from archival frozen tissue samples and 50-μm sections, revealing the activities of disease-associated DNA elements in distinct human brain structures. The Omni-ATAC protocol enables the interrogation of personal regulomes in tissue context and translational studies.

ATAC-see reveals the accessible genome by transposase-mediated imaging and sequencing

Spatial organization of the genome plays a central role in gene expression, DNA replication, and repair. But current epigenomic approaches largely map DNA regulatory elements outside of the native context of the nucleus. Here we report assay of transposase-accessible chromatin with visualization (ATAC-see), a transposase-mediated imaging technology that employs direct imaging of the accessible genome in situ, cell sorting, and deep sequencing to reveal the identity of the imaged elements. ATAC-see revealed the cell-type-specific spatial organization of the accessible genome and the coordinated process of neutrophil chromatin extrusion, termed NETosis. Integration of ATAC-see with flow cytometry enables automated quantitation and prospective cell isolation as a function of chromatin accessibility, and it reveals a cell-cycle dependence of chromatin accessibility that is especially dynamic in G1 phase. The integration of imaging and epigenomics provides a general and scalable approach for deciphering the spatiotemporal architecture of gene control.

Structural organization of the inactive X chromosome in the mouse

X-chromosome inactivation (XCI) involves major reorganization of the X chromosome as it becomes silent and heterochromatic. During female mammalian development, XCI is triggered by upregulation of the non-coding Xist RNA from one of the two X chromosomes. Xist coats the chromosome in cis and induces silencing of almost all genes via its A-repeat region, although some genes (constitutive escapees) avoid silencing in most cell types, and others (facultative escapees) escape XCI only in specific contexts. A role for Xist in organizing the inactive X (Xi) chromosome has been proposed. Recent chromosome conformation capture approaches have revealed global loss of local structure on the Xi chromosome and formation of large mega-domains, separated by a region containing the DXZ4 macrosatellite. However, the molecular architecture of the Xi chromosome, in both the silent and expressed regions,remains unclear. Here we investigate the structure, chromatin accessibility and expression status of the mouse Xi chromosome in highly polymorphic clonal neural progenitors (NPCs) and embryonic stem cells. We demonstrate a crucial role for Xist and the DXZ4-containing boundary in shaping Xi chromosome structure using allele-specific genome-wide chromosome conformation capture (Hi-C) analysis, an assay for transposase-accessible chromatin with high throughput sequencing (ATAC-seq) and RNA sequencing. Deletion of the boundary disrupts mega-domain formation, and induction of Xist RNA initiates formation of the boundary and the loss of DNA accessibility. We also show that in NPCs, the Xi chromosome lacks active/inactive compartments and topologically associating domains (TADs), except around genes that escape XCI. Escapee gene clusters display TAD-like structures and retain DNA accessibility at promoter-proximal and CTCF-binding sites. Furthermore, altered patterns of facultative escape genes indifferent neural progenitor clones are associated with the presence of different TAD-like structures after XCI. These findings suggest a key role for transcription and CTCF in the formation of TADs in the context of the Xi chromosome in neural progenitors.

Serotonergic functions in man

Abundant preclinical evidence suggests that serotonin-containing neural systems may participate in the regulation of both extrapyramidal and neuroendocrine function. In an attempt to examine these possibilities in man, patients with various neurologic disorders received drugs believed to facilitate or inhibit serotonergic function. Extrapyramidal signs in patients with parkinsonism or Huntington's disease showed no consistent change with L-tryptophan or parachlorophenylalanine. Unexpectedly, L-5-hydroxytryptophan, given in combination with a peripheral decarboxylase inhibitor, caused a worsening of parkinsonian akinesia and rigidity. Fenfluramine, at doses which appeared to diminish central serotonin but not dopamine turnover, had no consistent effect on the severity of involuntary movements in patients with Huntington's chorea, but did produce a significant rise in plasma prolactin.

m(6)A RNA modification controls cell fate transition in mammalian embryonic stem cells

N6-methyl-adenosine (m(6)A) is the most abundant modification on messenger RNAs and is linked to human diseases, but its functions in mammalian development are poorly understood. Here we reveal the evolutionary conservation and function of m(6)A by mapping the m(6)A methylome in mouse and human embryonic stem cells. Thousands of messenger and long noncoding RNAs show conserved m(6)A modification, including transcripts encoding core pluripotency transcription factors. m(6)A is enriched over 3' untranslated regions at defined sequence motifs and marks unstable transcripts, including transcripts turned over upon differentiation. Genetic inactivation or depletion of mouse and human Mettl3, one of the m(6)A methylases, led to m(6)A erasure on select target genes, prolonged Nanog expression upon differentiation, and impaired ESC exit from self-renewal toward differentiation into several lineages in vitro and in vivo. Thus, m(6)A is a mark of transcriptome flexibility required for stem cells to differentiate to specific lineages.

Experimental measurements and noise analysis of a cryogenic radiometer

A cryogenic radiometer device, intended for use as part of an electrical-substitution radiometer, was measured at low temperature. The device consists of a receiver cavity mechanically and thermally connected to a temperature-controlled stage through a thin-walled polyimide tube which serves as a weak thermal link. With the temperature difference between the receiver and the stage measured in millikelvin and the electrical power measured in picowatts, the measured responsivity was 4700 K/mW and the measured thermal time constant was 14 s at a stage temperature of 1.885 K. Noise analysis in terms of Noise Equivalent Power (NEP) was used to quantify the various fundamental and technical noise contributions, including phonon noise and Johnson-Nyquist noise. The noise analysis clarifies the path toward a cryogenic radiometer with a noise floor limited by fundamental phonon noise, where the magnitude of the phonon NEP is 6.5 fW/√Hz for the measured experimental parameters.

Nanog-independent reprogramming to iPSCs with canonical factors

It has been suggested that the transcription factor Nanog is essential for the establishment of pluripotency during the derivation of embryonic stem cells and induced pluripotent stem cells (iPSCs). However, successful reprogramming to pluripotency with a growing list of divergent transcription factors, at ever-increasing efficiencies, suggests that there may be many distinct routes to a pluripotent state. Here, we have investigated whether Nanog is necessary for reprogramming murine fibroblasts under highly efficient conditions using the canonical-reprogramming factors Oct4, Sox2, Klf4, and cMyc. In agreement with prior results, the efficiency of reprogramming Nanog (-/-) fibroblasts was significantly lower than that of control fibroblasts. However, in contrast to previous findings, we were able to reproducibly generate iPSCs from Nanog (-/-) fibroblasts that effectively contributed to the germline of chimeric mice. Thus, whereas Nanog may be an important mediator of reprogramming, it is not required for establishing pluripotency in the mouse, even under standard conditions.

How safe is it to manage diverticular colovesical fistulation non-operatively?

AIM

Colovesical fistula (CVF) is an uncommon condition. Diagnosis and management varies according to presentation and aetiology. The identification of patients suitable for conservative management and their outcome following this approach has not been well documented.

METHODS

The clinical outcomes of all patients diagnosed with a CVF over a 7-year period from an uro-radiological database were reviewed. Cases secondary to diverticular disease were analysed with respect to the approach by which they were managed: those treated surgically and those managed conservatively.

RESULTS

Sixty-two patients (32 men) were diagnosed with CVF of whom 53 (85%) had diverticular disease. Twenty-seven (mean age 69 years, range 42-90) underwent surgery (with a stoma in 59%) with a 30-day mortality of 15%. Those managed conservatively (n = 26) were older (mean age 76 years, range 39-87) and frailer (62% American Society of Anesthesiologists Grades III and IV). At 1 and 3 years following diagnosis there was no difference in mortality between these two groups and only one death was as a consequence of urosepsis.

CONCLUSION

Many patients with CVF secondary to diverticular disease can be safely managed non-operatively.

Characterization of the optical properties of an infrared blocked impurity band detector

Si:As blocked impurity band detectors have been partially deprocessed and measured by Fourier transform spectroscopy to determine their transmittance and reflectance at cryogenic temperatures over the wavelength range 2 μm to 40 μm. A method is presented by which the propagation constants can be extracted from an inversion of the transmittance and reflectance data. The effective propagation constants for the active layer from 2 μm to 20 μm were calculated as well as the absorption cross section of arsenic in silicon, which agrees well with previous results from the literature. The infrared absorptance of the full detector was determined, and the analytical method also provides an estimate of absorption in the active layer alone. Infrared absorptance of the active layer is compared to the quantum yield measured by photoelectric means on similar detectors. The optical methods outlined here, in conjunction with standard electronic measurements, could be used to predict the performance of such detectors from measurements of the blanket films from which they are to be fabricated.

A small-molecule inhibitor of tgf-Beta signaling replaces sox2 in reprogramming by inducing nanog

The combined activity of three transcription factors can reprogram adult cells into induced pluripotent stem cells (iPSCs). However, the transgenic methods used for delivering reprogramming factors have raised concerns regarding the future utility of the resulting stem cells. These uncertainties could be overcome if each transgenic factor were replaced with a small molecule that either directly activated its expression from the somatic genome or in some way compensated for its activity. To this end, we have used high-content chemical screening to identify small molecules that can replace Sox2 in reprogramming. We show that one of these molecules functions in reprogramming by inhibiting Tgf-beta signaling in a stable and trapped intermediate cell type that forms during the process. We find that this inhibition promotes the completion of reprogramming through induction of the transcription factor Nanog.

Basaloid carcinoma of the prostate: a case report and review of the literature

Malignant tumours arising from the basal cells of the prostate gland are extremely rare, and the majority of reports in the literature suggest a relatively indolent clinical course. We report a case of infiltrative basaloid carcinoma of the prostate in a 68-year old man that did not respond to systemic chemotherapy. It is essential that this aggressive disease is differentiated from more indolent basaloid proliferations, as metastatic spread can occur and outcome may be poor.

Aspect-ratio scaling and the stiffness exponent theta for Ising spin glasses

We introduce the technique of aspect-ratio scaling to study the scale dependence of interfacial energies in Ising spin glasses, and we show how one can use it to determine the stiffness exponent theta in a clean way, with results that are independent of the domain-wall-forcing boundary conditions imposed on the system. In space dimension d = 2 we obtain theta = -0.282(3) for a Gaussian distribution of exchange interactions.

Serial interleukin 6 measurements in the early diagnosis of neonatal sepsis

The objective of the present study was to evaluate serial interleukin 6 (IL6) levels in the early diagnosis of neonatal sepsis. Subjects included 255 neonates from the Neonatal Unit of Johannesburg Hospital evaluated for suspected sepsis between February and May 1998. All infants had IL6, full blood count (FBC), C reactive protein (CRP) and blood cultures done at presentation. CRP and IL6 were repeated after 24 h. Infants were categorized into groups according to the likelihood of infection on the basis of clinical presentation, CRP, FBC and culture results, i.e., group 1 (no infection) to group 4 (definite infection). IL6 was compared between the groups by the U-test of Mann-Whitney; stepwise logistic regression was done to establish the best predictors of infection, sensitivity, specificity, positive and negative predictive values were determined. The initial IL6 level was significantly raised in those infants with possible infection [880.67 pg/ml (2966.04), p value 0.0104], probable infection [422.62pg/ml (4077.7), p value 0.0021] and definite infection [11164.39pg/ml (24139.77), p value 0.0000] as compared to those infants without infection [58.65 (182.4)]. The best predictors of infection were the combination of the initial IL6 value and CRP value after 24 h (goodness of fit 97.7 per cent). An initial IL6 value below 20 pg/ml gave a negative predictive value of 90.18 per cent. It is concluded that an IL6 value done at the time of presentation of signs and symptoms suggestive of infection is useful in the early diagnosis of neonatal sepsis. In particular, an initial IL6 value below 20 pg/ml may allow antibiotics to be withheld in a number of infants evaluated for sepsis. There is no benefit in serial determination of IL6 in the diagnosis of neonatal sepsis.

Electrophysiological findings in dominant optic atrophy (DOA) linking to the OPA1 locus on chromosome 3q 28-qter

Pattern and flash visual evoked cortical potentials (PVEP, FVEP), and pattern electroretinograms, (PERG) were recorded in 13 affected individuals from 8 families with DOA. These were selected as representative from 87 affected members of 21 pedigrees with DOA who were examined, and who underwent genetic linkage analysis. Linkage to the OPA1 locus on chromosome 3q 28-qter was demonstrated in all families. VA ranged from 6/9 to HM: visual fields showed a variable centro-caecal defect; SLO (when performed) showed diffuse nerve fibre loss; MRI (when performed) showed small intra-orbital optic nerves. In 9/13 patients the PVEP was absent in one or both eyes. Most recordable PVEPs were of abnormal latency, but the delays were not marked (peak times 116-135 msec); amplitudes were low or subnormal. PERG fell within the normal range in 9 eyes of 7 patients. 14 eyes showed an abnormal N95:P50 ratio in keeping with ganglion cell dysfunction. Some severely affected eyes showed P50 component involvement, but in no eye was the PERG extinguished. Significant interocular asymmetries in at least one electrophysiological measure were present in 6/13 patients. Colour contrast thresholds were significantly elevated for all three colour confusion axes, with tritan being most affected.

Determinants of participation in an epidemiological study of preterm delivery

We describe the study design and patterns of participation for a cohort study of preterm delivery, focused on genital tract infections, nutrition, tobacco use, illicit drugs and psychosocial stress. Women are recruited at 24-29 weeks' gestation from prenatal clinics at a teaching hospital and a county health department. We recruited 57% of the first 1843 eligible women; 29% refused and 8% could not be contacted. White women were somewhat more likely to participate than African-American women (61% vs. 54% respectively). More notable differences were found comparing teaching hospital and health department clinics (71% vs. 47% participation respectively), with the health department clinic having a greater proportion refuse (24% vs. 33%) and more women who could not be contacted (4% vs. 11%). Participation was affected only minimally by day or timing of recruitment, but inability to contact diminished substantially as the study continued (13-0%). Refusals were largely unrelated to patient attributes. Lower education predicted inability to contact. Risk of preterm delivery was 14% among recruited women, 10% among women who refused, and 15% among women whom we were not able to contact, demonstrating that, overall, risk status was not lower among recruited women.

Accuracy of video imaging in mandibular surgery

Video imaging can simulate combined orthodontic-orthognathic surgical treatment to assist in treatment planning and patient education. Video imaging predictions were compared with actual posttreatment results for 18 patients who received orthodontic and mandibular orthognathic surgical treatments. Three untreated control subjects were also studied. The locations of 13 soft tissue landmarks relative to horizontal and vertical reference planes were compared between predictions and posttreatment photographs, and significant variation (+/- 5 mm) was found for many of the landmarks. Comparisons of various steps repeated during the prediction process were also completed to test for reproducibility. Relatively small differences, generally less than +/- 2 mm, were attributed to the process of linking the cephalogram and photograph and to the manual steps to create surgical treatment objectives. The largest proportion of the total variation, about 80%, was estimated to arise from inaccuracy inherent in the software program. Other contributions to the total variation likely came from physiologic facial changes over time and nonstandardized head positions in the photographs.

A standard protocol for the evaluation of laser treatment of the prostate. The British Laser Urological Evaluation Society (BLUES)

OBJECTIVES

To present a standardized protocol, suitable for general use, for the evaluation of laser treatment of the prostate.

METHODS

Many new operative treatments which are available to treat symptomatic prostatic enlargement are being accepted and offered to patients after scanty clinical evaluation, e.g. interventions using lasers. A consistent and standard protocol was developed, comprising data-recording sheets for patients' admission details, pre-operative assessments, operative details of laser ablation, post-operative in-patient progress and re-attendance, and subsequent out-patient follow-up.

RESULTS

The protocol was tested by the members of BLUES and fulfilled their requirement for easy use in any department of Urology. It provides a simple way of accurately recording relevant data within a structured format with the additional advantage of permitting results to be expressed uniformly.

CONCLUSION

The adoption of this protocol will allow valid comparisons of core data between studies assessing different procedures. The flexibility of the protocol enables it to be used, with minor modification, for the evaluation of any operative intervention aimed at relieving prostatic symptoms.

Steroid hormone receptor immunohistochemistry and amplification of c-myc protooncogene. Relationship to disease-free survival in breast cancer

BACKGROUND

It is important to develop parameters that aid in prognosticating which patients with breast cancer are more likely to have a rapid disease course and therefore might benefit from early aggressive therapies.

METHODS

Specimens from two groups of women, deliberately selected because their clinical courses differed greatly, were studied to detect amplification of the protooncogenes c-myc, int-2, and C-erbB-2/neu by slot-blot assay, the estrogen receptor (ER), and the progesterone receptor (PR) by both biochemical and immunohistochemical procedures (ERICA and PRICA). One group of 50 patients had a prolonged disease-free interval after initial surgery (mean, 6.4 years); the other group of 52 women had had rapid disease recurrence (mean, 1.4 years) or progression (5 patients died of disease within 1 year of diagnosis). The patients were selected from 1700 consecutively accessioned cases if they fit the study criteria and sufficient tissue was available for oncogene hybridization studies.

RESULTS

The two groups differed statistically by stage, number of involved axillary lymph nodes, ERICA and PRICA results (P = 0.001), and amplification of c-myc (P = 0.003). The percentage of patients with rapid disease recurrence and progression increased from 0-93% when risk factors changed from best case (ERICA and PRICA results, positive; c-myc, not amplified; and axillary nodes, not involved) to worst case (ERICA and PRICA findings, negative; c-myc, amplified; and axillary nodes, involved).

CONCLUSIONS

Women with these worst-case parameters were more likely to have a recurrence sooner and rapidly progressive disease. They might benefit from early aggressive therapeutic measures.

Immunocytochemical estrogen and progestin receptor assays in breast cancer with monoclonal antibodies. Histopathologic, demographic, and biochemical correlations and relationship to endocrine response and survival

Breast cancer specimens from 600 women were assayed for estrogen receptors (ER) using an immunocytochemical assay (ICA) employing the monoclonal antiestrophilin antibody H222 Sp gamma. Results showed significant correlation with biochemical ER determinations as well as with tumor grade and menopausal status. In 449 cases, results of progesterone receptor assay by ICA using the monoclonal anti-PgR antibody KD 68, also correlated significantly with biochemical PgR measurements. The ERICA/PgRICA positivity was significantly more frequent in postmenopausal white women. Colloid carcinomas were most likely to be ERICA positive and PgRICA positive whereas medullary carcinomas were most often negative. In 47 patients with advanced mammary carcinoma, results of ERICA and PgRICA were more closely related to endocrine response than those of ER and PgR by dextran-coated charcoal assay (DCC). In 339 women with Stage I or Stage II breast cancer, ERICA was significantly associated with disease-free survival. Analysis by Cox's proportional hazard model, however, showed PgRICA to be the best predictor of survival and disease-free survival in 197 women at the same stages of disease. These data indicate that ICA is more predictive of prognosis than biochemical ER and PgR. The ease of ICA performance coupled with these results indicate that the method is an acceptable substitute for DCC in analyzing breast cancers for ER/PgR.

Effect of age on the in vitro reflection coefficient of the aortoiliac bifurcation in humans

The local reflection coefficient (r) at the aortoiliac junction was estimated in vessels removed at autopsy from 15 females and 31 males aged 2 months to 88 years by calculating the characteristic impedance (Zc) of the abdominal aorta and the two common iliac arteries. Zc was evaluated for each vessel by measuring cross-sectional area from radiographs and propagation velocity of an isolated pressure impulse generated by a solenoid-driven piston connected to the distal end of the abdominal aorta, and detected at several sites a known distance from the junction. Attenuation coefficients in the aorta were estimated from the peak amplitude of the impulse at these several sites. We observed significant decreases with age in abdominal aortic attenuation coefficient (gamma = 0.053-5 x 10(-4) age [yr], r = -0.42, p less than 0.005), and the area ratio (AR) of the junction (sum of the iliac cross-sectional areas/aortic cross-sectional area) (AR = 0.93-0.002 x age [yr], r = -0.31, p less than 0.05). Bifurcation angle (Angle) and aortic propagation velocity (caorta) increased significantly (angle = 40.2 + 0.26 x age [yr], r = 0.41, p less than 0.01; caorta (ms-1) = 7.59 + 0.175 x age [yr], r = 0.69, p less than 0.0001). No significant association between age and iliac propagation velocity was found. On the basis of area measurements alone, it has been argued that the observed decrease in area ratio with age causes r to become more positive. The lack of age-related changes in iliac propagation velocity (and hence stiffness), an observation confirmed by most of the few reports in the literature, and the large increase in abdominal aortic stiffness, however, greatly outweighed the area ratio changes and caused a significant decline in reflection coefficient from +0.3 in early life to -0.3 in old age. (Reflection coefficient = 0.30-0.0065 x age [yr], r = -0.68, p less than 0.0001). Between the ages of 30 and 60 years, its absolute value was less than 0.1, confirming in vivo work on subjects within this age range. In children, a significant positive reflection at the distal end of the aorta will amplify the pulse wave in this region. As this vessel becomes stiffer with increasing age, amplification will increase, whereas the increasingly negative value of r will partially offset this rise, reducing pulse pressure on either side of the junction.(ABSTRACT TRUNCATED AT 400 WORDS)

Immunocytochemical detection of progesterone receptor in breast cancer with monoclonal antibody. Relation to biochemical assay, disease-free survival, and clinical endocrine response

A new immunocytochemical assay for progesterone receptor (PgR-ICA) employing the monoclonal antibody JZB 39 was used to study tumors from two series of patients with breast cancer. In Series 1 assay results were in agreement with those of biochemistry in 76% of 338 cases (P less than 0.001) and in 54% of 101 cases in Series 2 (P less than 0.001). Agreement was better in Series 1 because it included fresher, previously untouched specimens. There were 70 patients in Series 1 with known clinical endocrine response. A negative assay correlated with disease progression in 45 of 57 patients, significantly better than with biochemistry (P = 0.013). In comparing 39 women with rapid disease progression with 39 free of disease at 5.1 years, those with PgR-ICA-positive tumors were over four times more likely to remain disease-free than those with negative results (P = 0.007). Product moment life-table analysis of 79 patients from Series 2 showed a significantly better cumulative survival for those with PgR-ICA-positive tumors (P = 0.047). These findings indicate that PgR-ICA should be of value in planning therapy and predicting disease course in breast cancer patients.

Histochemical estrogen binding. An independent predictor of recurrence and survival in stage II breast cancer

Cox's proportional hazards regression model was used to analyze the prognostic significance of multiple variables affecting recurrence and survival in patients with Stage II breast cancer. Among the variables were biochemical estrogen (ER) and progesterone receptor (PgR) values and results of a histochemical estrogen-binding assay using a fluoresceinated bovine serum albumin-estradiol conjugate where carrier and label were bound at position 17. In 190 cases ER and PgR were not found to be significantly associated with either disease recurrence or patient survival. On the other hand, patients with tumors that were demonstrably "rich" in estradiol ligand conjugate binding by histochemistry experienced both a longer disease-free interval (P less than 0.03) and survival (P less than 0.02) than did patients whose tumors were "poor" in conjugate binding or showed a heterogeneous population of positively and negatively stained cells. A patient with a tumor rich in estrogen binding was five times more likely to survive than a patient with a neoplasm that was poor in estrogen binding by histochemistry. These results indicate that the histochemical technique used provides new and independent parameters for determination of prognosis in Stage II breast cancer.

An evaluation of the effect of vincristine added to cyclophosphamide, 5-fluorouracil, methotrexate, and prednisone in advanced breast cancer

A multi-institutional randomized clinical trial was carried out to evaluate the effect of vincristine (V) added to cyclophosphamide, methotrexate, 5-fluorouracil, and prednisone (CMFP) for the treatment of metastatic breast cancer. There were 427 patients entered into the study and randomly assigned to one of the two treatments, i.e. the five drug therapy CMFPV or the four drug therapy CMFP. The differences in patient survival and tumor response between the two treatment groups were not statistically significant. The data were also analyzed using multivariate procedures to determine those factors ascertained at entry into the study which were predictors of survival or predictors of response to therapy. The one factor that predicted both response and survival was performance status. An additional important predictor of survival was sites of metastatic involvement. Other significant predictors of response were menopausal age, BUN, and hematocrit.

Methods of motivating the practice of breast self-examination: a randomized trial

A randomized trial of 1,733 women compared three methods of motivating the practice of breast self-examination (BSE): (a) cognitive teaching which emphasized factual knowledge; (b) affective teaching which stressed feelings, attitudes, and values; and (c) a mixed approach which combined features of both. Subjects returned for follow-up at 3, 12, and 24 months or at 6 and 12 months, at which times they completed questionnaires and were evaluated by nurses. They demonstrated how they performed BSE and palpated breast models for lumps. No differences were observed among the teaching groups for any of several indicators of BSE practice, such as frequency, knowledge about when to do BSE, technique, or number of lumps detected in the model. However, these measures were associated with women's initial confidence in practicing BSE. Women in all teaching groups improved their BSE technique over time. Women in this study practiced BSE more frequently and detected more lumps than reported in other studies. The better performance of subjects in the present study might be ascribed to the amount of time spent teaching and to reinforcement from repeated follow-ups. The affective and cognitive approaches were equally effective in motivating the practice of BSE.

Heterogeneity of estrogen binding sites in breast cancer: morphologic demonstration and relationship to endocrine response

Breast cancer specimens from 184 patients were analyzed for estrogen binding by two different histochemical techniques using conjugates of estradiol, bovine serum albumin, and fluorescein. In one conjugate estradiol was bound at position 6, in the other at position 17. Results were in agreement in 64% (p less than .001), but obvious differences in ligand distribution were noted. Results were also correlated with estrogen receptor (ER) analysis by dextran-coated charcoal assay (DCC) and were in accord in 65% and 67% of specimens respectively (p less than .001). In 114 cases, the tissue samples were also studied with the estrogen receptor immunocytochemical assay (ERICA) of Greene and his colleagues, which employs monoclonal antibodies to ER protein. Results were in accord with DCC in 86% (p less than .001). The pattern of staining with ERICA differed from that of either histochemical method. In 43 cases assay results were correlated with clinical endocrine response. Overall, the best statistical prognostic parameters were obtained with ERICA. Analysis of combined assay results revealed that patients with assays positive by all techniques were the most likely to respond to hormonal treatment (p less than .001), whereas if one or more assays were negative the chances for a good response were significantly less favorable. These data suggest that DCC and ERICA are both a measure of the same estrogen binding site (type I) while the histochemical methods apparently identify two other separate and distinct sites (putative type II sites). A degree of positive interaction may exist between these multiple estrogen binding sites.

Immunohistologic localization of estrogen receptors in breast cancer with monoclonal antibodies. Correlation with biochemistry and clinical endocrine response

Breast cancer specimens from 114 patients were assayed for the presence of estrogen receptors (ER) utilizing highly specific, monoclonal antiestrophilin antibodies and the peroxidase-antiperoxidase technique. Results were compared with conventional ER determinations by the dextran-coated charcoal method (DCC) and were in agreement as to positivity and negativity in 86%. Semiquantified immunocytologic assay results were in accord with the level of ER as measured by DCC in 66%. The tumors studied included 43 from patients with Stage IV disease where clinical response to hormonal manipulation was known. In the latter group, the immunohistologic method had a sensitivity similar to that of DCC but showed a superior positive predictive value and a significantly better specificity. These results indicate that this new method is a valuable laboratory tool, enabling prediction of hormone responsiveness in advanced mammary carcinoma and capable of performance at the community hospital level.

Characteristics of a specific radioimmunoassay for measurement of ferritin on the surface of peripheral mononuclear white blood cells in cancer patients

Using 125I-labeled rabbit anti-Hodgkin's spleen ferritin antibody (RHF), a simple radioimmunoassay has been developed for quantitation of ferritin on the surface of peripheral blood mononuclear white blood cells (PBM). This method makes use of a % specific binding determination (%SP) by measuring the amount of 125I-labeled RHF bound to 1 X 10(6) PBM in the presence and absence of soluble ferritin. To standardize this procedure, artificial ferritin positive control cells were prepared by covalently coupling ferritin to cultured acute lymphoblastic leukemia cells. These cells were tested on a daily basis in parallel with patient PBM's to ensure inter and intra-assay precision and remained stable for over two years. Characteristics of 125I-labeled RHF binding to control and patient PBM's were evaluated to determine the specificity of interaction and optimum binding parameters. %SP was linear in the range of 1 X 10(5) - 1 X 10(6) PBM's and was progressively inhibited by graded concentrations of soluble ferritin. F(ab')2 preparations of RHF were equally as effective as intact RHF in blocking 125I-labeled RHF binding confirming that 125I-labeled RHF was not binding non-specifically to PBM Fc receptors. Additional experiments describing kinetics and methods of standardization of new lots of 125I-labeled RHF are also described.

Measurement of ferritin-bearing peripheral mononuclear blood cells in cancer patients by radioimmunoassay

A radioimmunoassay has been developed to measure ferritin bound to the surface of isolated human peripheral blood mononuclear white blood cells (PBMs) in order to investigate the possible relationship of this phenomenon to breast and other forms of cancer. The assay measures the specific binding (%SP) of affinity-purified 125I-labeled rabbit anti-Hodgkin's spleen ferritin antibody to isolated patient PBMs. A preliminary prospective, preclinical trial on 300 patients was run which included: (a) normals, benign breast disease, and medical/surgical patients as non-cancer controls; (b) postoperative primary cancer and advanced cancer in clinical remission as post cancer controls; and (c) both early preoperative breast cancer patients and cancer patients with localized recurrences or active disseminated disease as test groups. The mean %SP for the non-cancer control groups was in the range of 4.3 to 5.1 (n = 187), which was identical to that for inactive cancer or postoperative cancer, which was no evidence of recurrence. Using a %SP normal cutoff level of 6.5, which resulted in a false-positive rate of approximately 10% for both non-cancer and post-cancer control groups, only 27% of early preoperative cancers (n = 22) gave elevated %SP values. These results suggest that measurement of ferritin-PBM is inappropriate for early disease diagnosis. In contrast, 91% of patients with advanced active breast cancer and 73% of those patients with other types of advanced cancers, including tumors of ovarian, lung, colon or esophageal origin, showed elevated %SP values more than double those of post-cancer controls. The mean %SP value in active advanced cancer was 10.8 for breast (n = 12) and 10.6 for all other solid tumors investigated (n = 34). Paired patient comparisons of ferritin-PBM and plasma carcinoembryonic antigen in breast cancer showed elevations in 91% of the patients for ferritin-PBM and 67% for carcinoembryonic antigen. Overall, these results suggest that patients with advanced cancer display elevated levels of ferritin on the surface of their PBMs and that this measurement may be a useful adjunct in monitoring and evaluating the clinical status of cancer patients.

Pulmonary cryptococcosis and Cushing's syndrome

Pulmonary cryptococcosis occurred in two patients with Cushing's syndrome, both of whom were successfully treated with amphotericin B and flucytosine. Excessive endogenous production of corticosteroids may have predisposed these patients to the development of opportunistic infection. Persons with Cushing's syndrome and a pulmonary infiltrate should be examined for infection with Cryptococcus neoformans in addition to an examination for ectopic adrenocorticotropic hormone production.

Five-day storage of platelet concentrates. II. In-vivo studies

Following in-vitro tests it was concluded that platelet concentrates stored for 5 days at 22 degrees C in polyolefin containers, coded PL732, should be as effective in clinical practice as similar concentrates stored in the standard PVC containers, coded PL146. These predictions have been confirmed by the following in-vivo tests; autologous survival studies in volunteers, determination of recovery, platelet increment calculations 1 and 24 h after transfusion and clinical appraisal after transfusion of haemorrhagic thrombocytopenic patients. Bacteriological cultures of the platelet concentrates were sterile after storage for more than 5 days. It can be concluded that the 5-day storage of platelet concentrates in these containers is a practical proposition.

The effects of patient delay and symptoms other than a lump on survival in breast cancer

This study examined the relationship of survival in breast cancer to delay in treatment and the presence of symptoms. Data were analyzed for 664 patients diagnosed from 1975-1979 at 15 hospitals in Brooklyn, New York. Pathologic risk factors were defined to classify breast cancer into less (Class I) or more aggressive (Class III) disease. Delay and survival were not significantly associated among women diagnosed with Class I disease. Delay was associated with poor survival for patients with Class III disease (P less than 0.001). The presence of symptoms other than a lump was associated with longer delay and poorer survival in patients with Class II and III disease. These findings suggest that the contradictory relationship between delay and survival reported by others may be due to variations in the proportions of slow and fast growing tumors and that fast growing tumors must be treated promptly for a successful result.

Immunohistologic and histochemical methods for detection of steroid binding in breast cancer: a reappraisal

A review of the current literature on immunohistologic and histochemical methods for the detection of steroid hormone binding sites in breast cancer, reveals that many, but not all of the criteria for establishing hormone-receptor binding interactions have been met. These include tissue specificity, binding between labeled ligands and soluble receptor in vitro, correlations between histochemical and biochemical assays, as well as between histologic procedures and tumor hormone responsiveness. However, histochemical binding phenomena do not appear to follow classical receptor dogma in regard to the concentration of ligand required, or specificity of binding as determined by competitive binding assays. It is concluded that these histologic techniques may be detecting classical receptor that may be reacting differently than would be expected from biochemical analyses, Types II and III binding sites, and/or organelle and membrane-bound receptors. Certainly no current method should presently be promoted as a laboratory method for the detection of classical receptor. New immunocytologic procedures employing specific, antireceptor sera currently under development, may obviate many of the criticisms leveled against earlier methods.