The relation of flow cytometry to clinical and biologic characteristics in women with node negative primary breast cancer

Flow cytometry (FC) analysis including DNA index (ploidy status) and cell kinetics (%S and %S + G2/M) was done on frozen tissue of the primary lesions of 101 women with node negative (N-) breast cancer who were studied prospectively. Currently, 19% (19/101) of the patients have recurred. No significant relations have been found between recurrence or survival and age, estrogen/progesterone receptor status, tumor size, and tumor type. The DNA index (ploidy) was not related to any clinical variable, time to recurrence, or survival. Aneuploid tumors did, however, have significantly higher %S phase activity. Patients with %S activity less than or equal to the median value were significantly different from those patients with %S above the median. They were older and had a higher frequency of ER/PR positive and well- or moderately differentiated tumors. Patients with %S + G2/M greater than the median value showed shorter time to recurrence (P = .055) and shorter survival (P = .006), whereas %S alone was significantly associated only with survival. Multivariate analysis showed that neither DNA index nor cell kinetics was significantly associated with time to relapse. DNA index was not significantly associated with survival; %S was of borderline significance whereas %S + %G2/M was a significant independent predictor of survival. Although FC data may provide independent information related to survival in N-women, additional research in a larger number of patients is needed to define its precise role in patient management.

Cutaneous manifestations of gastrointestinal disorders. Part II

The cutaneous manifestations of inflammatory bowel disorders, vascular disorders of the gastrointestinal tract, celiac disease, and bowel-associated dermatosis-arthritis syndrome are reviewed. The significance of these signs, guidelines for their management, and investigations are discussed.

Evaluation of the safety and efficacy of repeated sedations for the radiotherapy of young children with cancer: a prospective study of 1033 consecutive sedations

PURPOSE

A prospective observational study to examine our current practice of either conscious sedation (C.S.) or general anesthetic (G.A.) for children undergoing radiation therapy (we use the term sedation to include both C.S. and G.A.). Specifically, the study examines the reasons for selection of patients, choice of drugs, safety and effectiveness of the procedure, side effects of repeated daily sedation, and compliance of the family with the regimen.

METHODS AND MATERIALS

Recorded data included patient demographics, sedation technique, time for various stages of the procedure, breathing support required, sedation outcome, and complications.

RESULTS

One hundred ninety-eight consecutive children underwent 4232 procedures involving either simulation or radiation treatment, an average of 21 procedures each. Seventy-four (37%) required sedation for a total of 1033 procedures, an average of 14 sedations each. For those patients who received sedation, the age ranged from 9 months to 14 years (median, 3.8) and 96% had a mold, (85% of the head and neck). The doctor's assessment of the need for sedation was correct 89% of the time. Thirty-seven percent required sedation at the start of treatment, but, even after 30 fractions, 15% still required sedation. Presedation status correlated with successful sedation and treatment (p = 0.0001). Ninety-six percent had some form of i.v. access, usually a portacath (76%); 883 sedations were performed with G.A. and 148 with C.S.; 93% of sedations were completed satisfactorily, 5% with some difficulty, and the patient was unable to be treated in 2%. With G.A., satisfactory sedation was achieved 97% of the time, whereas, with C.S., satisfactory sedation was achieved only 68% of the time. There were no complications for 97% of observations. Not one serious complication occurred. An endotracheal tube was used only twice during G.A. For C.S., the results for chloral hydrate, meperidine, and midazolam were, respectively, at least one complication, 23%, 0%, 5%; satisfactory sedation for treatment, 60%, 60%, 82%; and unable to treat 20%, 13%, 5%. For G.A., only 1 patient was unable to be treated. The median time from start of medication to the end of radiation treatment was a median of 10 min (75% complete within 15 min) for G.A., vs. 30 min (75% complete in 50 min) for C.S. On multivariate analysis, the only significant factor predicting a successful outcome was a G.A. using propofol (odds ratio, 20.6), vs. C.S. using either chloral hydrate, meperidine, or midazolam. (p = 0.0001).

CONCLUSION

In this study, there were no serious complications of sedation in 1033 procedures. As a result of the study, we developed improved methods for better preparation of the patient and family to try to reduce the need for sedation, and reduce the indications for C.S., while confirming the safety and efficacy of a G.A. with propofol for children needing sedation for daily radiation therapy.

AP-1 (Fos/Jun) transcription factors in hematopoietic differentiation and apoptosis

A combination of in vitro and in vivo molecular genetic approaches have provided evidence to suggest that AP-1 (Fos/Jun) transcription factors play multiple roles in functional development of hematopoietic precursor cells into mature blood cells along most, if not all, of the hematopoietic cell lineages. This includes the monocyte/macrophage, granulocyte, megakaryocyte, mastocyte and erythroid lineages. In addition, studies using c-fos knockout mice have established a unique role for Fos, as a member of the AP-1 transcription factor complex, in determining the differentiation and activity of progenitors of the osteoclast lineage, a population of bone-forming cells which are of hematopoietic origin as well. Evidence has also accumulated to implicate AP-1 (Fos/Jun) transcription factor complexes as both positive and negative modulators of distinct apoptotic pathways in many cell types, including cells of hematopoietic origin. Fos/Jun have been implicated as positive modulators of apoptosis induced in hematopoietic progenitor cells of the myeloid lineage, a function that may relate to the control of blood cell homeostasis, as well as in programmed cell death associated with terminal differentiation of many other cell types, and apoptosis associated with withdrawal of growth/survival factors. On the other hand, the study of apoptosis induced in mammalian cells has implicated AP-1 in the protection against apoptosis induced by DNA-damaging agents. However, evidence to the contrary has been obtained as well, suggesting that AP-1 may function to modulate stress-induced apoptosis either positively or negatively, depending on the microenvironment and the cell type in which the stress stimulus is induced.

How reproducible are flow cytometry data from paraffin-embedded blocks?

The purpose of this technical report is to determine the reproducibility of flow cytometry data for ploidy and cell cycle kinetics using paraffin-embedded blocks of breast cancer tissue. One block from each of 39 tumors was studied in this report with each block having multiple sections analyzed independently. All of these sections gave ploidy analyses, while only 34 gave cell kinetic values. The standard deviation for the DNA index value in the multiple analysis study was less than 0.1 in all but three cases. The cell kinetic values gave larger variability, and the actual values were dependent on the method of analysis. Comparison of the variability for each method of analysis could not predict which procedure was superior. These results would indicate that ploidy is a reproducible value, while cell kinetic parameters should only be used as an indicator of proliferative activity that has been normalized to the mean or median of a large set of observations processed and analyzed by the same procedure.

Cytogenetic comparison of two poorly differentiated human lung squamous cell carcinoma lines

This paper presents a cytogenetic analysis of two established but early-passage (passages 5 and 18) cell lines derived from histologically similar, poorly differentiated lymph node metastases of squamous cell carcinoma of the lung. The cell lines showed 3 shared marker chromosomes, del(1)(q11), del(2)(p11.1) and del(2)(q11.1). One of the lines (DLKP) had 8 additional markers including structural rearrangements such as translocations and isochromosomes. Five additional markers (including two deletions of chromosome 3) were found in DLRP. A notable feature of DLRP was the high incidence of telomeric association evident in the majority of metaphase plates. Over-representation of chromosome 7 was a characteristic feature of metaphases derived from DLKP, and identification of i(21q) in this cell line was an unusual finding. The results indicate significant cytogenetic heterogeneity between these early-passage cell lines derived from two apparently histologically similar tumors.

The use of flow cytometry for the prognosis of stage II adjuvant treated breast cancer patients

Characterization of breast cancer cells by histology, flow cytometry, and steroid receptors was performed on 197 Stage II breast node positive cancer patients given adjuvant chemotherapy, plus tamoxifen for patients with positive hormone receptors. Histologic and steroid receptor assays were performed using standard techniques; flow cytometric analysis was performed from paraffin-embedded blocks obtained from the primary tumor. Quality control studies on reproducibility, tissue heterogeneity, and analysis procedures have been included. Of the 197 patients studied, aneuploidy was found in 102 (52%); the median %S value was 8% with a range of 0.4% to 38%. Our results demonstrated that number of positive nodes, receptor status, and grade were of prognostic value. Cell cycle kinetic data were not of independent prognostic value in this series. However, ploidy could differentiate in prognosis in the receptor-negative subgroup. Patients with receptor-negative tumors had a significantly better overall survival if the tumor was diploid in nature. Cell kinetics was not significantly prognostic for either receptor subgroup, although patients with higher %S tended to have better relapse-free and overall survival. This is in disagreement with other studies and may demonstrate that treatment has confounded our results and diminished the ability of flow cytometry data to help predict outcome.

Cutaneous manifestations of gastrointestinal disorders. Part I

This article reviews the cutaneous manifestations of gastrointestinal tract diseases. In part I, the gastrointestinal tract polyposis syndromes and gastrointestinal tract malignancies will be discussed. The cutaneous manifestations of inflammatory bowel disorders, vascular disorders of the gastrointestinal tract, celiac disease and bowel-associated dermatosis-arthritis syndrome will be discussed in part II. For each entity, a brief summary of the gastrointestinal tract (and other extracutaneous) manifestations is given. This is followed by a detailed discussion of the cutaneous signs. Current guidelines for the investigation and management of these diseases are presented.

Isolation of protective somatic antigen from Vibrio cholerae (Ogawa) ribosomal preparations

Ribosomal preparations from Vibrio cholerae Ogawa and Inaba are protective immunogens for mice challenged with either serotype. Column chromatography of ribosomal fractions separated protective antigen from the ribosomes. The antigen is a heterogeneous colloid which contains protein, lipid, and carbohydrate in the ratio 3:1:1. Amino acid composition is that of a slightly acidic protein with no unusual complement of amino acids. The lipid component consists of several longchain fatty acids and of phosphatidyl ethanolamine. The major sugars identified were glucose and galactose. The colloid can be dissolved by treatment with chelating agents and sodium dodecyl sulfate. Purification of the solubilized material or of the colloid was unsuccessful.

β-AMINOCROTONONITRILE: I. GEOMETRICAL ISOMERISM AND SOME REACTIONS

The low-melting form of β-aminocrotononitrile is a mixture of two components, one of which is the high-melting isomer. Isomerization reactions between the high- and low-melting forms occur very easily, reactions in solution being subject to acid–base catalysis. Self-condensation of β-aminocrotononitrile gives 4-amino-1,3-dicyano-2-methylpenta-1,3-diene which readily cyclizes to 2-amino-5-cyano-4,6-lutidine.

Citrate anticoagulation during in vivo simulation of slow hemofiltration

Citrate anticoagulation has been used as an alternative to heparin for hemodialysis in high-risk patients; however, its use in hemofiltration has not been well studied. We examined citrate in 6 patients placed on slow hemofiltration for up to 6 h duration. During the experiments, the systemic citrate level increased from a baseline average of 0.15 to 0.55 mmol/l, and then decreased to 0.27 mmol/l. The citrate was freely filtered. The systemic total and ionized calcium decreased very slightly and no untoward effects were noted. Anticoagulation was successful. This preliminary study suggests that citrate anticoagulation can be used in slow hemofiltration.

A fast and sensitive colorimetric assay for IL-6 in hepatoma cells based on the production of a secreted form of alkaline phosphatase (SEAP)

Structure-function studies of cytokines require that simple, sensitive and reliable biological assays are available. A well known property of interleukin-6 (IL-6) is that of being able to induce transcription from several liver-specific promoters in human hepatoma cells. However, the available assays of IL-6 in hepatoma cells, which are either based on the detection of increased expression of endogenous acute phase response genes or on the activation of reporter genes transfected under the control of IL-6 responsive promoters, are not very sensitive and are time consuming. We have established a new assay for IL-6 in hepatoma cells which is based on the transfection of an IL-6 inducible promoter/secreted alkaline phosphatase (SEAP) gene fusion and which measures the inducible production and release of SEAP in the culture medium. SEAP activity is measured with a simple colorimetric assay that requires no cell manipulation, thus allowing a large set of samples to be analysed simultaneously. The CRP/SEAP assay can be used in studies on the structure-function relationships of human IL-6.

Validation of genetically engineered bioluminescent surfactant resistant bacteria as toxicity assessment tools

Bacteria are useful organisms for measuring acute and chronic toxicity. The most popular toxicity tests utilize the inhibition of bioluminescence as an indication of toxicity. An extensive toxicity database on pure chemical compounds has been created using the bioluminescent microorganism, Vibrio fischeri. However, the use of the Microtox assay in applications for environmental samples is not always successful, due to the test organism. Because the genes for bioluminescence have been cloned from V. fischeri, environmentally relevant test strains can be readily constructed. In this study, surfactant-resistant bioluminescent bacterial strains were constructed by transferring a broad host range plasmid containing the bioluminescent genes under the regulation of a constitutive promoter into strains from several bacterial genera. Two test strains, Stenotrophomonas 3664 and Alcaligenes eutrophus 2050, were approximately 400 times more resistant to the nonionic surfactant polyoxyethylene 10 lauryl ether than V. fischeri and are useful for toxicity reduction evaluations of remediation processes which use surfactants for solubilization of hydrophobic pollutants. The use of these strains as alternative test organisms in the Microtox assay was evaluated using nonpolar narcosis as the baseline toxicity mechanisms. The two test strains and V. fischeri indicated linear fits of EC50 values with the octanol/water partition (Kow) for five nonpolar narcotic compounds in acute assays (r2>0.9) with a slope of approximately 1. For all three strains, the y-intercept values were approximately the same, indicating that sensitivity did not vary. These results indicate that the nonpolar narcosis baseline toxicity mechanism may be useful as a general tool to validate the functioning of genetically engineered bioluminescent microorganisms.

Loperamide modifies Escherichia coli, heat-stable enterotoxin-induced intestinal secretion

We have shown previously that loperamide, an opiate analogue, inhibits cholera-toxin- and prostaglandin E2-induced secretion in the rat small intestine. In these studies loperamide modified secretion induced by partially purified Escherichia coli, heat-stable enterotoxin in infant mice. The drug was effective whether administered before or after established secretion. These experiments provide further suggestive evidence that loperamide has a broad spectrum of antisecretory activity.