A Multimedia Strategy to Integrate Introductory Broad-Based Radiation Science Education in US Medical Schools

US physicians in multiple specialties who order or conduct radiological procedures lack formal radiation science education and thus sometimes order procedures of limited benefit or fail to order what is necessary. To this end, a multidisciplinary expert group proposed an introductory broad-based radiation science educational program for US medical schools. Suggested preclinical elements of the curriculum include foundational education on ionizing and nonionizing radiation (eg, definitions, dose metrics, and risk measures) and short- and long-term radiation-related health effects as well as introduction to radiology, radiation therapy, and radiation protection concepts. Recommended clinical elements of the curriculum would impart knowledge and practical experience in radiology, fluoroscopically guided procedures, nuclear medicine, radiation oncology, and identification of patient subgroups requiring special considerations when selecting specific ionizing or nonionizing diagnostic or therapeutic radiation procedures. Critical components of the clinical program would also include educational material and direct experience with patient-centered communication on benefits of, risks of, and shared decision making about ionizing and nonionizing radiation procedures and on health effects and safety requirements for environmental and occupational exposure to ionizing and nonionizing radiation. Overarching is the introduction to evidence-based guidelines for procedures that maximize clinical benefit while limiting unnecessary risk. The content would be further developed, directed, and integrated within the curriculum by local faculties and would address multiple standard elements of the Liaison Committee on Medical Education and Core Entrustable Professional Activities for Entering Residency of the Association of American Medical Colleges.

Developmental nutrition affects the structural integrity of a sexually selected weapon

Males in many species engage in physical combat over access to mates, and sexual selection has led to the evolution of weapons to enhance contest performance. The size of these often-elaborate structures is known to be exquisitely sensitive to nutrition. However, we know very little about the degree to which nutrition affects other attributes of animal weapons that can be crucial to fighting. In this study, we investigated the impact of natural dietary variation on weapon structural integrity in a fighting insect, Narnia femorata (Hemiptera: Coreidae). Males in this species display their enlarged, spiny hind legs to other males, and these legs serve as weapons in aggressive physical contests where they are used to strike and squeeze opponents. N. femorata feeds on the fruit of prickly pear cactus and sets up territories on this plant. In North Central Florida the prickly pear Opuntia mesacantha spp. lata blooms and begins to produce fruits in April and May. N. femorata has multiple, overlapping generations while the green fruits slowly ripen over the next several months. We examined insects reaching adulthood at two nearby time points in this range, June and July, to test the influence of the nutrition provided by ripening green cactus fruit on weapon size and its ability to resist puncture. We also raised insects on cactus with red, ripe fruit for comparison. We found a striking effect of cactus fruit phenology on weapons. Insects raised with the more mature green fruit (those in the second cohort) had 71% larger weapon area and 4.4 times greater puncture resistance than those raised on the early green fruit (those in the first cohort). In contrast, insects raised on red, ripe fruit were moderate in size, had high puncture resistance, and they changed little phenotypically from the first to second cohort. Increased structural integrity of the hind femur weapon was associated with the increased body size that came with better nutrition. This pattern highlights that cuticle thickness increased or its material properties changed when weapons were larger. Importantly, effects of nutrition on puncture resistance also transcended size. Insects of the same size had greater structural integrity if they received superior nutrition. Sexually selected weapons are often used as visual signals to conspecifics before fights, and this work hints that the size of the weapons may be a poor signal of weapon performance when nutrition is variable.

The tale of the shrinking weapon: seasonal changes in nutrition affect weapon size and sexual dimorphism, but not contemporary evolution

Sexually selected traits are often highly variable in size within populations due to their close link with the physical condition of individuals. Nutrition has a large impact on physical condition, and thus, any seasonal changes in nutritional quality are predicted to alter the average size of sexually selected traits as well as the degree of sexual dimorphism in populations. However, although traits affected by mate choice are well studied, we have a surprising lack of knowledge of how natural variation in nutrition affects the expression of sexually selected weapons and sexual dimorphism. Further, few studies explicitly test for differences in the heritability and mean-scaled evolvability of sexually selected traits across conditions. We studied Narnia femorata (Hemiptera: Coreidae), an insect where males use their hind legs as weapons and the femurs are enlarged, to understand the extent to which weapon expression, sexual dimorphism and evolvability change across the actual range of nutrition available in the wild. We found that insects raised on a poor diet (cactus without fruit) are nearly monomorphic, whereas those raised on a high-quality diet (cactus with ripe fruit) are distinctly sexually dimorphic via the expression of large hind leg weapons in males. Contrary to our expectations, we found little evidence of a potential for evolutionary change for any trait measured. Thus, although we show weapons are highly condition dependent, and changes in weapon expression and dimorphism could alter evolutionary dynamics, our populations are unlikely to experience further evolutionary changes under current conditions.

A public health perspective on the U.S. response to the Fukushima radiological emergency

On 11 March 2011, northern Japan was struck by first a magnitude 9.0 earthquake off the eastern coast and then by an ensuing tsunami. At the Fukushima Dai-ichi Nuclear Power Plant (NPP), these twin disasters initiated a cascade of events that led to radionuclide releases. Radioactive material from Japan was subsequently transported to locations around the globe, including the U.S. The levels of radioactive material that arrived in the U.S. were never large enough to cause health effects, but the presence of this material in the environment was enough to require a response from the public health community. Events during the response illustrated some U.S. preparedness challenges that previously had been anticipated and others that were newly identified. Some of these challenges include the following: (1) Capacity, including radiation health experts, for monitoring potentially exposed people for radioactive contamination are limited and may not be adequate at the time of a large-scale radiological incident; (2) there is no public health authority to detain people contaminated with radioactive materials; (3) public health and medical capacities for response to radiation emergencies are limited; (4) public health communications regarding radiation emergencies can be improved to enhance public health response; (5) national and international exposure standards for radiation measurements (and units) and protective action guides lack uniformity; (6) access to radiation emergency monitoring data can be limited; and (7) the Strategic National Stockpile may not be currently prepared to meet the public health need for KI in the case of a surge in demand from a large-scale radiation emergency. Members of the public health community can draw on this experience to improve public health preparedness.

Multi-frame super-resolution algorithm for complex motion patterns

Multi-frame super-resolution algorithms offer resolution enhancement for sequences of images with sampling limited resolution. However, classical approaches have been constrained by the accuracy of motion estimation while nonlocal approaches that use implicit motion estimation have attained only modest resolution improvement. In this paper, we propose a new multi-frame optical flow based super-resolution algorithm, which provides significant resolution enhancement for image sequences containing complex motion. The algorithm uses the standard camera image formation model and a variational super-resolution formulation with an anisotropic smoothness term adapting to local image structures. The key elements enabling super-resolution of complex motion patterns are the computation of two-way optical flow between the images and use of two corresponding uncertainty measures that approximate the optical flow interpolation error. Using the developed algorithm, we are able to demonstrate super-resolution of images for which optical flow estimation experiences near breakdown, due to the complexity of the motion patterns and the large magnitudes of the displacements. In comparison, we show that for these images some conventional super-resolution approaches fail, while others including nonlocal super-resolution technique produce distortions and provide lower (1-1.8 dB) image quality enhancement compared to the proposed algorithm.

Murder by radiation poisoning: implications for public health

On November 23, 2006, former Russian military intelligence officer Alexander Litvinenko died in a London hospital. Authorities determined he was deliberately poisoned with the radionuclide Polonium-210 (210Po). Police subsequently discovered that those involved in this crime had--apparently inadvertently--spread 210Po over many locations in London. The United Kingdom Health Protection Agency (HPA) contacted many persons who might have been exposed to 210Po and provided voluntary urine testing. Some of those identified as potentially exposed were U.S. citizens, whom the HPA requested that the Centers for Disease Control and Prevention (CDC) assist in contacting. CDC also provided health care professionals and state and local public health officials with guidance as to how they might respond should a Litvinenko-like incident occur in the U.S. This guidance has resulted in the identification of a number of lessons that can be useful to public health and medical authorities in planning for radiological incidents. Eight such lessons are discussed in this article.

The Fukushima radiological emergency and challenges identified for future public health responses

On 11 March 2011, northern Japan was rocked by first a magnitude 9.0 earthquake off the eastern coast and then an ensuing tsunami. The Fukushima Daiichi Nuclear Power Plant complex was hit by these twin disasters, and a cascade of events was initiated that led to radionuclide releases causing widespread radioactive contamination of residential areas, agricultural land, and coastal waters. Radioactive material from Japan was subsequently transmitted to locations around the globe, including the U.S. The levels of radioactive material that arrived in the U.S. were never large enough to be a concern for health effects, but the presence of this material in the environment was enough to create a public health emergency in the U.S. The radiation safety and public health communities in the U.S. are identifying challenges they faced in responding to this incident. This paper discusses three of those challenges: (1) The growing shortage of trained radiation subject matter experts in the field of environmental transport and dosimetry of radionuclides; (2) the need to begin expressing all radiation-related quantities in terms of the International System of Units; and (3) the need to define when a radiation dose is or is not one of "public health concern." This list represents only a small subset of the list of challenges being identified by public health agencies that responded to the Fukushima incident. However, these three challenges are fundamental to any radiological emergency response. Addressing them will have a significant positive impact on how the U.S. responds to the next radiological emergency.

Federal interagency communication strategies for addressing radiation emergencies and other public health crises

Federal agencies have a variety of roles and responsibilities related to communicating with the public before, during, and after a radiological emergency. To better understand the various efforts currently underway, the Radiation Studies Branch of the Centers for Disease Control and Prevention convened a roundtable of representatives from federal agencies with responsibility for communicating with the public about radiation emergencies. Roundtable participants shared valuable information about efforts underway to develop information and messages for a variety of audiences and agreed that continued interagency coordination and dialogue about communication before, during, and after an event are needed. The group suggested several strategies for future collaborative efforts and indicated a desire to continue working together to develop and assess messages for radiological emergency preparedness and response. The group also recommended that more work be done to determine whether messages need to be packaged or tailored for specific special populations and suggested that more research be conducted to answer questions about specific audience/cultural needs around communicating radiation risks. Since this roundtable, attendees have continued to work together to develop and test messages for the public.

Many tests of significance: new methods for controlling type I errors

There have been many discussions of how Type I errors should be controlled when many hypotheses are tested (e.g., all possible comparisons of means, correlations, proportions, the coefficients in hierarchical models, etc.). By and large, researchers have adopted familywise (FWER) control, though this practice certainly is not universal. Familywise control is intended to deal with the multiplicity issue of computing many tests of significance, yet such control is conservative--that is, less powerful--compared to per test/hypothesis control. The purpose of our article is to introduce the readership, particularly those readers familiar with issues related to controlling Type I errors when many tests of significance are computed, to newer methods that provide protection from the effects of multiple testing, yet are more powerful than familywise controlling methods. Specifically, we introduce a number of procedures that control the k-FWER. These methods--say, 2-FWER instead of 1-FWER (i.e., FWER)--are equivalent to specifying that the probability of 2 or more false rejections is controlled at .05, whereas FWER controls the probability of any (i.e., 1 or more) false rejections at .05. 2-FWER implicitly tolerates 1 false rejection and makes no explicit attempt to control the probability of its occurrence, unlike FWER, which tolerates no false rejections at all. More generally, k-FWER tolerates k - 1 false rejections, but controls the probability of k or more false rejections at α =.05. We demonstrate with two published data sets how more hypotheses can be rejected with k-FWER methods compared to FWER control.

Use of epidemiological data and direct bioassay for prioritization of affected populations in a large-scale radiation emergency

Following a radiation emergency, evacuated, sheltered or other members of the public would require monitoring for external and/or internal contamination and, if indicated, decontamination. In addition, the potentially-impacted population would be identified for biodosimetry/bioassay or needed medical treatment (chelation therapy, cytokine treatment, etc.) and prioritized for follow-up. Expeditious implementation of these activities presents many challenges, especially when a large population is affected. Furthermore, experience from previous radiation incidents has demonstrated that the number of people seeking monitoring for radioactive contamination (both external and internal) could be much higher than the actual number of contaminated individuals. In the United States, the Department of Health and Human Services is the lead agency to coordinate federal support for population monitoring activities. Population monitoring includes (1) monitoring people for external contamination; (2) monitoring people for internal contamination; (3) population decontamination; (4) collecting epidemiologic data regarding potentially exposed and/or contaminated individuals to prioritize the affected population for limited medical resources; (5) administering available pharmaceuticals for internal decontamination as deemed necessary by appropriate health officials; (6) performing dose reconstruction; and (7) establishing a registry to conduct long-term monitoring of this population for potential long-term health effects. This paper will focus on screening for internal contamination and will describe the use of early epidemiologic data as well as direct bioassay techniques to rapidly identify and prioritize the affected population for further analysis and medical attention.

Educating medical staff about responding to a radiological or nuclear emergency

A growing body of audience research reveals medical personnel in hospitals are unprepared for a large-scale radiological emergency such as a terrorist event involving radioactive or nuclear materials. Also, medical personnel in hospitals lack a basic understanding of radiation principles, as well as diagnostic and treatment guidelines for radiation exposure. Clinicians have indicated that they lack sufficient training on radiological emergency preparedness; they are potentially unwilling to treat patients if those patients are perceived to be radiologically contaminated; and they have major concerns about public panic and overloading of clinical systems. In response to these findings, the Centers for Disease Control and Prevention (CDC) has developed a tool kit for use by hospital medical personnel who may be called on to respond to unintentional or intentional mass-casualty radiological and nuclear events. This tool kit includes clinician fact sheets, a clinician pocket guide, a digital video disc (DVD) of just-in-time basic skills training, a CD-ROM training on mass-casualty management, and a satellite broadcast dealing with medical management of radiological events. CDC training information emphasizes the key role that medical health physicists can play in the education and support of emergency department activities following a radiological or nuclear mass-casualty event.

The roles of medical health physicists in a medical radiation emergency

Medical health physicists working in a clinical setting will have a number of key roles in the event of a nuclear or radiological emergency, such as a terrorist attack involving a radiological dispersal device or an improvised nuclear device. Their first responsibility, of course, is to assist hospital administrators and facility managers in developing radiological emergency response plans for their facilities and train staff prior to an emergency. During a hospital's response to a nuclear or radiological emergency, medical health physicists may be asked to (1) evaluate the level of radiological contamination in or on incoming victims; (2) help the medical staff evaluate and understand the significance to patient and staff of the levels of radioactivity with which they are dealing; (3) orient responding medical staff with principles of dealing with radioactive contaminants; (4) provide guidance to staff on decontamination of patients, facilities, and the vehicles in which patients were transported; and (5) assist local public health authorities in monitoring people who are not injured but who have been or are concerned that they may have been exposed to radioactive materials or radiation as a result of the incident. Medical health physicists may also be called upon to communicate with staff, patients, and the media on radiological issues related to the event. Materials are available from a number of sources to assist in these efforts. The Centers for Disease Control and Prevention (CDC) is developing guidance in the areas of radiological population monitoring, handling contaminated fatalities, and using hospital equipment for emergency monitoring. CDC is also developing training and information materials that may be useful to medical health physicists who are called upon to assist in developing facility response plans or respond to a nuclear or radiological incident. Comments on these materials are encouraged.

DLK1: increased expression in gliomas and associated with oncogenic activities

DLK1 (delta-like) is a transmembrane and secreted protein in the epidermal growth factor-like homeotic family. Although expressed widely during embryonic development, only a few tissues retain the expression in adults. Neuroendocrine tumors often highly express this protein; therefore, we hypothesized that brain tumors might also express it. This study found that the expression of DLK1 in gliomas was higher than that in normal brain (P < 0.05). After stable transfection of a DLK1 cDNA expression vector into GBM cell lines, their proliferation was increased. Furthermore, they lost contact inhibition, had enhanced anchorage-independent growth in soft agar, and had significantly greater capacity to migrate. Western blot studies showed that expression of cyclin D1, CDK2, and E2F4 were increased, and Rb levels were decreased in these cells. DLK1 was found on the cell surface and secreted in the medium from the transfected GBM cells. DLK1-enriched condition medium stimulated the growth of glioblastoma multiforme cell lines and explants. DLK1 antibody blocked cell growth stimulated by DLK1. In summary, these results suggest that DLK1 may play a role in the formation or progression of gliomas.

Dlk1 in normal and abnormal hematopoiesis

Dlk1 (Pref-1) is a transmembrane and secreted protein, which is a member of the epidermal growth factor-like family, homologous to Notch/Delta/Serrate. We have found by real-time RT-PCR that Dlk1 mRNA levels were high in CD34(+) cells in 10 of 12 MDS samples compared with CD34(+) cells from 11 normals. Also, Dlk1 mRNA was elevated in mononuclear, low density bone marrow cells from 11/38 MDS patients, 5/11 AML M6 and 2/4 AML M7 samples. Furthermore, 5/6 erythroleukemia and 2/2 megakaryocytic leukemia cell lines highly expressed Dlk1 mRNA. Levels of Dlk1 mRNA markedly increased during megakaryocytic differentiation of both CMK megakaryoblasts as well as normal CD34(+) hematopoietic stem cells. High serum levels of Dlk1 occurred in RA (4/10) and essential thrombocythemia (2/10) patients. Functional studies showed that forced expression of Dlk1 enhanced proliferation of K562 cells growing in 1% fetal bovine serum. Analysis of hematopoiesis of Dlk1 knockout mice suggested that Dlk1 contributed to granulocyte, megakaryocyte and B-cell clonogenic growth and was needed for generation of splenic B-cells. In summary, Dlk1 is overexpressed in selected samples of MDS (especially RA and RAEB) and AML (particularly M6, M7), and it appears to be associated with normal development of megakaryocytes and B cells.

TLC-Asthma: an integrated information system for patient-centered monitoring, case management, and point-of-care decision support

A great deal of successful work has been done in the area of EMR development, implementation, and evaluation. Less work has been done in the area of automated systems for patients. Efforts to link data at multiple levels - the patient, the case manager, and the clinician have been rudimentary to-date. In this paper we present a model information system that integrates patient health information across multiple domains to support the monitoring and care of children with persistent asthma. The system has been developed for use in a multi-specialty group practice and includes three primary components: 1) a patient-centered telephone-linked communication system; 2) a web-based alert reporting and nurse case-management system; and 3) EMR-based provider communication to support clinical decision making at the point-of-care. The system offers a model for a new level of connectivity for health information that supports customized monitoring, IT-enabled nurse case-managers, and the delivery of longitudinal data to clinicians to support the care of children with persistent asthma. Systems like the one described are well-suited, perhaps essential, technologies for the care of children and adults with chronic conditions such as asthma.

Triboelectric simulation of pacemaker malfunction

We report the occurrence of a triboelectric phenomenon (static electricity) that mimicked malfunction of a contemporary pacemaker by creating an electrocardiograpic artifact virtually identical to the pacemaker stimuli. The diagnosis was established by observing a subtle overshoot of the questionable deflection that was absent from pacemaker stimuli.

Estimates of doses from global fallout

This paper summarizes information about external and internal doses resulting from global fallout and presents preliminary estimates of doses resulting from intermediate fallout in the contiguous United States. Most of the data on global fallout were extracted from the reports of the United Nations Scientific Committee on the Effects of Atomic Radiation, in which the radiation exposures from fallout have been extensively reviewed at regular intervals. United Nations Scientific Committee on the Effects of Atomic Radiation estimated the average effective doses received by the world's population before 2000 to be about 0.4 mSv from external irradiation and 0.6 mSv from internal irradiation, the main radionuclide contributing to the effective dose being 137Cs. Effective doses received beyond 2000 result mainly from the environmentally mobile, long-lived 14C and amount to about 2.5 mSv summed over present and future generations. Specific information about the doses from fallout received by the United States population is based on the preliminary results of a study requested by the U.S. Congress and conducted jointly by the Centers for Disease Control and Prevention and the National Cancer Institute. Separate calculations were made for the tests conducted at the Nevada Test Site and for the high-yield tests conducted mainly by the United States and the former Soviet Union at sites far away from the contiguous United States (global tests). The estimated average doses from external irradiation received by the United States population were about 0.5 mGy for Nevada Test Site fallout and about 0.7 mGy for global fallout. These values vary little from one organ or tissue of the body to another. In contrast, the average doses from internal irradiation vary markedly from one organ or tissue to another; estimated average thyroid doses to children born in 1951 were about 30 mGy from Nevada Test Site fallout and about 2 mGy from global fallout.

Cyr61, a member of CCN family, is a tumor suppressor in non-small cell lung cancer

Cysteine-rich protein 61 (Cyr61) is a member of a family of growth factor-inducible immediate-early genes. It regulates cell adhesion, migration, proliferation, and differentiation and is involved in tumor growth. In our experiments, the role of Cyr61 in non-small cell lung cancer (NSCLC) was examined. Expression of Cyr61 mRNA was decreased markedly in four of five human lung tumor samples compared with their normal matched lung samples. NSCLC cell lines NCI-H520 and H460, which have no endogenous Cyr61, formed 60-90% fewer colonies after being transfected with a Cyr61 cDNA expression vector than cells transfected with the same amount of empty vector. After stable transfection of a Cyr61 cDNA expression vector, proliferation of both H520-Cyr61 and H460-Cyr61 sublines decreased remarkably compared with the cells stably transfected with empty vector. The addition of antibody against Cyr61 partially rescued the growth suppression of both H520-Cyr61 and H460-Cyr61 cells. Cell cycle analysis revealed that both H520-Cyr61 and H460-Cyr61 cells developed G(1) arrest, prominently up-regulated expression of p53 and p21(WAF1), and had decreased activity of cyclin-dependent kinase 2. The increase of pocket protein pRB2/p130 was also detected in these cells. Notably, both of the Cyr61-stably transfected lung cancer cell lines developed smaller tumors than those formed by the wild-type cells in nude mice. Taken together, we conclude that Cyr61 may play a role as a tumor suppressor in NSCLC.

Evaluation of accuracy and reliability of indirect calorimetry for the measurement of resting energy expenditure in healthy dogs

OBJECTIVE

To assess accuracy and reliability of open-flow indirect calorimetry in dogs.

ANIMALS

13 clinically normal dogs.

PROCEDURE

In phase 1, oxygen consumption per kilogram of body weight (VO2/kg) was determined in 6 anesthetized dogs by use of open-flow indirect calorimetry before and after determination of VO2/kg by use of closed-circuit spirometry. In phase 2, four serial measurements of VO2 and carbon dioxide production (VCO2) were obtained in 7 awake dogs by use of indirect calorimetry on 2 consecutive days. Resting energy expenditure (REE) was calculated.

RESULTS

Level of clinical agreement was acceptable between results of indirect calorimetry and spirometry. Mean VO2/kg determined by use of calorimetry before spirometry was significantly greater than that obtained after spirometry. In phase 2, intraclass correlation coefficients (ICC) for REE and VO2 were 0.779 and 0.786, respectively, when data from all 4 series were combined. When the first series was discounted, ICC increased to 0.904 and 0.894 for REE and VO2, respectively. The most reliable and least variable measures of REE and VO2 were obtained when the first 2 series were discounted.

CONCLUSIONS AND CLINICAL RELEVANCE

Open-flow indirect calorimetry may be used clinically to obtain a measure of VO2 and an estimate of REE in dogs. Serial measurements of REE and VO2 in clinically normal dogs are reliable, but a 10-minute adaption period should be allowed, the first series of observations should be discounted, multiple serial measurements should be obtained, and REE.

Frequent loss of heterozygosity in the region of D1S450 at 1p36.2 in myelodysplastic syndromes

To understand the underlying mechanisms in myelodysplastic syndromes (MDS) by identifying target tumor suppressor genes, we performed a detailed deletional mapping of the short arm of chromosome 1 in 38 paired samples of bone marrow and peripheral blood obtained from individuals with MDS by PCR amplification of a total of 23 highly informative microsatellite sequences. We identified the commonly deleted region between D1S508 and D1S244. LOH of this region was found in five patients (13%). In addition, LOH at 1p was associated with a poor clinical outcome, suggesting that the deletion of a gene in this region may be involved in the course of this disease. By analyzing the chromosomal map of this region, we found TNFRSF12 as a candidate tumor suppressor gene. However, our search for mutations in this gene did not identify somatic mutations in MDS. Our findings are consistent with the possible existence of an as-yet unknown tumor suppressor gene in this region that is altered in MDS.

Dietary chloride as a possible determinant of the severity of exercise-induced asthma

Dietary sodium chloride (NaCl) has been shown to alter the severity of exercise-induced asthma, but it is not known if the sodium and chloride ions have independent effects in this regard. The hypothesis tested in the present study was that both a low sodium, low chloride diet and a high sodium, low chloride diet would improve post-exercise pulmonary function in subjects with exercise-induced asthma (EIA) compared to a normal NaCl diet (NSD); but that neither of these diets would have an effect on post-exercise pulmonary function in control (non-EIA) subjects. Eight subjects who suffered from EIA and eight subjects who did not (control) took part in a double-blind crossover study. Pre- and post-exercise pulmonary function was assessed after 2 weeks on a NSD, a low NaCl diet (LSD, low sodium, low chloride) or a sodium bicarbonate diet (NaHCO3 diet, high sodium, low chloride). A 1 week washout period occurred between diets. Altering dietary sodium or chloride had no effect on pre-exercise (baseline) pulmonary function in either group or on post-exercise pulmonary function in control subjects. However, both the LSD and the NaHCO3 diet lessened the deterioration in post-exercise pulmonary function in EIA subjects. Comparing results from pre- to post-exercise, forced expiratory volume in 1 s (FEV1) at 15 min post-exercise differed significantly (P < 0.05) between diets [mean (SEM) 7 (4)% on the LSD, 14 (4)% on the NaHCO3 diet, and 19 (2)% on the NSD]. Similar patterns were observed for forced vital capacity (FVC), forced expiratory flow rate at 25%-75% FVC and peak expiratory flow rate. The NaHCO3 diet lessened the deterioration of post-exercise pulmonary function, but not to the extent of LSD. These data suggest that both sodium and chloride contribute to the worsening of EIA symptoms seen after consuming a normal or high NaCl diet.

Analysis of the CHK2 gene in lymphoid malignancies

The CHK2 gene encodes a protein kinase that is important for the regulation of cell cycle arrest after DNA damage. CHK2 acts downstream of ataxia teleangiecstasia mutated (ATM), modulates the function of p53 and may help mediate cell cycle arrest at G2/M by phosphorylation of Cdc25C. Recently, the human homolog of the checkpoint kinase Cds1 (CHK2) has been suggested to be a tumor suppressor gene. Heterozygous germline mutations have been reported in Li-Fraumeni syndrome (LFS), a highly penetrant familial cancer phenotype, and in sporadic colon cancer. LFS is associated with the development of lymphoid malignancies, especially childhood ALL. Therefore, we analyzed the DNA from 143 lymphoid malignancies to determine whether they had mutations of the CHK2 gene. The 14 exons of CHK2 were studied by polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) and sequencing of aberrantly migrating bands. One missense mutation changing serine to phenylalanine (codon 428) in an evolutionarily highly conserved domain was found in a non-Hodgkin's aggressive lymphoma. Another point mutation in the non-coding region was identified in one of adult T-cell leukemias (ATL) samples. This result suggests that mutation of the CHK2 gene may rarely be involved in the development of selected lymphomas.

Mutational analysis of the peroxisome proliferator-activated receptor gamma gene in human malignancies

Peroxisome proliferator-activated receptor gamma (PPARgamma) plays an important role in adipocyte differentiation and is expressed in many human malignancies, including those from prostate, breast, as well as colon. It regulates differentiation and/or cell growth of these cells. However, expression of this nuclear hormone receptor in other types of cancer, especially in hematological malignancies, remains to be fully elucidated. The PPARgamma gene has been mapped to chromosome band 3p25, where chromosomal abnormalities are observed in a variety of human malignancies. Furthermore, a recent study revealed that the PPARgamma gene is functionally mutated in sporadic colon cancer cells. Therefore, PPARgamma could be an important tumor suppressor gene. This prompted us to investigate the expression and mutational status of the PPARgamma gene in cancers of a variety of tissues. A total of 159 samples were interrogated for their expression of PPARgamma as measured by reverse transcription-polymerase chain reaction and/or Western blot analysis. In each of the samples, expression of PPARgamma was detectable. In addition, a total of 397 clinical samples and cell lines including colon, prostate, breast and lung cancers, and leukemias were analyzed for mutations of the PPARgamma gene by either reverse transcription-polymerase chain reaction-single-strand conformation polymorphism or polymerase chain reaction-single-strand conformation polymorphism analysis. No abnormalities were detectable in any of the human malignancies. On the other hand, shifted bands were easily detectable when using positive controls, which harbored the same sequence alterations reported previously in colon cancer cells. Taken together, PPARgamma is expressed in a variety of cancers, and mutation of the PPARgamma gene is a very rare event in human malignancies.

Closed reduction of a dislocation of a constrained acetabular component

A constrained acetabular liner occasionally is used in management of chronic instability after total hip arthroplasty. If dislocation occurs out of a constrained liner, open reduction is indicated. A case is presented of closed reduction of a femoral component into a constrained liner.

Mutations in the mitotic check point gene, MAD1L1, in human cancers

Aneuploidy is a characteristic of the majority of human cancers, and recent studies suggest that defects of mitotic checkpoints play a role in carcinogenesis. MAD1L1 is a checkpoint gene, and its dysfunction is associated with chromosomal instability. Rare mutations of this gene have been reported in colon and lung cancers. We examined a total of 44 cell lines (hematopoietic, prostate, osteosarcoma, breast, glioblastoma and lung) and 133 fresh cancer cells (hematopoietic, prostate, breast and glioblastoma) for alterations of MAD1L1 by RT-PCR-SSCP and nucleotide sequencing. Eight mutations consisting of missense, nonsense and frameshift mutations were found, together with a number of nucleotide polymorphisms. All the alterations in cell lines were heterozygous. Frequency of mutations was relatively high in prostate cancer (2/7 cell lines and 2/33 tumor specimens). We placed a mutant truncated MAD1L1, found in a lymphoma sample, into HOS, Ht161 and SJSA cell lines and found that it was less inhibitory than wild type MAD1L1 at decreasing cell proliferation. Co-expression experiments showed that the mutant form had a dominant-negative effect. Furthermore, this mutant impaired the mitotic checkpoint as shown by decreased mitotic indices in HOS cells expressing mutant MAD1L1 after culture with the microtubule-disrupting agent, nocodazole. Our results suggest a pathogenic role of MAD1L1 mutations in various types of human cancer.

Tumor necrosis factor alpha polymorphism associated with increased susceptibility to development of adult T-cell leukemia/lymphoma in human T-lymphotropic virus type 1 carriers

Human T-lymphotropic virus type 1 (HTLV-1) is etiologically associated with adult T-cell leukemia/lymphoma (ATL). Nevertheless, most individuals infected with HTLV-1 do not develop ATL. To attempt to identify genetic factors promoting the progression to ATL, we investigated in HTLV-1 carriers the relationship between susceptibility to ATL and several polymorphisms: the three "decreased-detoxifying" polymorphisms in GSTM1, GSTT1, and CYP1A1, the "proapoptotic" polymorphism in BCL2, and the five "high-production" polymorphisms in tumor necrosis factor alpha (TNF-alpha) using PCR-based genotyping assays. ATL patients (n = 71) were younger than HTLV-1 carriers (n = 80; 57 +/- 12 versus 63 +/- 10 years; P = 0.0017). MALE:female ratio in ATL patients was higher than in carriers (52:19 versus 19:61, respectively; P < 0.0001), probably reflecting a higher incidence of HTLV-1 infection in females and a higher incidence of development of ATL in males. We found that the frequency of the TNF-alpha-857T allele, reported to be associated with high transcriptional activity of the promoter/enhancer region of the TNF-alpha gene, was enriched in individuals with ATL compared with healthy carriers (18.3% versus 8.8%, respectively; odds ratio, 2.34; 95% confidence interval, 1.2-4.7). None of the other four TNF-alpha polymorphisms was a significant indicator of risk of development of ATL, although odds ratios (ATL versus carrier) of all of the TNF-alpha polymorphisms were higher than 1.0. Furthermore, analysis of polymorphisms for GSTM1, GSTT1, CYP1A1, and BCL2 showed no significant difference between ATL patients and healthy carriers. Genetic polymorphism leading to increased TNF-alpha production may enhance susceptibility to ATL among HTLV-1 carriers. Alternatively, but less likely, the HLA loci might be an important factor because the TNF-alpha gene lies within the class III region of the MHC; however, the 857T allele is not in linkage disequilibrium with HLA alleles associated with ATL development.

Breast cancer. Cyr61 is overexpressed, estrogen-inducible, and associated with more advanced disease

To identify genes involved in breast cancer, polymerase chain reaction-selected cDNA subtraction was utilized to construct a breast cancer-subtracted library. Differential screening of the library isolated the growth factor-inducible immediate-early gene Cyr61, a secreted, cysteine-rich, heparin binding protein that promotes endothelial cell adhesion, migration, and neovascularization. Northern analysis revealed that Cyr61 was expressed highly in the invasive breast cancer cell lines MDA-MB-231, T47D, and MDA-MB-157; very low levels were found in the less tumorigenic MCF-7 and BT-20 breast cancer cells and barely detectable amounts were expressed in the normal breast cells, MCF-12A. Univariate analysis showed a significant or borderline significant association between Cyr61 expression and stage, tumor size, lymph node positivity, age, and estrogen receptor levels. Interestingly, expression of Cyr61 mRNA increased 8- to 12-fold in MCF-12A and 3- to 5-fold in MCF-7 cells after 24- and 48-h exposure to estrogen, respectively. Induction of Cyr61 mRNA was blocked by tamoxifen and ICI182,780, inhibitors of the estrogen receptor. Stable expression of Cyr61 cDNA under the regulation of a constitutive promoter in MCF-7 cells enhanced anchorage-independent cell growth in soft agar and significantly increased tumorigenicity and vascularization of these tumors in nude mice. Moreover, overexpression of Cyr61 in MCF-12A normal breast cells induced their tumor formation and vascularization in nude mice. In summary, these results suggest that Cyr61 may play a role in the progression of breast cancer and may be involved in estrogen-mediated tumor development.

Mutation analysis of the DNA-damage checkpoint gene CHK2 in myelodysplastic syndromes and acute myeloid leukemias

Checkpoint genes code for a family of proteins which sense DNA damage in eukaryotic cells. They play an important role in the control of the cell cycle. The human CHK2 is a homolog of the yeast G(2) checkpoint kinases known as CDS1 and RAD53. The CHK2 may be a tumor suppressor gene because it was found to be mutated in some individuals with the Li-Fraumeni syndrome. These cases had a normal, non-mutated p53 gene. We performed a mutational analysis of the CHK2 gene using polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) in 41 bone marrow samples from individuals with myelodysplastic syndrome (MDS) and 41 samples of acute myeloid leukemias (AML). We found a novel G to C transversion resulting in a change from Ala to Gly at codon 507 of CHK2 in one MDS sample, but normal cells from this individual did not have the abnormality. In addition, we demonstrated a previously described polymorphism at codon 84 (A to G at nucleotide 252) of exon 1 of CHK2 in three of 41 MDS and three of 41 AML patients. The presence of a CHK2 mutation in MDS highlights the importance of alterations of cell cycle checkpoint genes in this disease.

Detection of free radicals in ischemic and reperfused canine gracilis muscle flaps by use of spin-trapping electron paramagnetic resonance spectroscopy

OBJECTIVE

To determine whether free radicals are produced in ischemic and reperfused canine skeletal muscle, whether free radicals can be detected from effluent blood by use of spin-trapping electron paramagnetic resonance (EPR) spectroscopy, and whether free radical-induced skeletal muscle damage is detectable by use of light microscopy.

ANIMALS

6 healthy mixed-breed dogs.

PROCEDURES

Dogs were anesthetized and both gracilis muscles were isolated, leaving only the major vascular pedicle intact. Ischemia was induced in 1 flap for 4 hours; the contralateral flap served as the control. Ischemic flaps were then reperfused for 15 minutes. alpha-Phenyl-N-tert-butylnitrone, a spin-trapping agent, was administered intravenously to each dog 1 hour prior to reperfusion. Following reperfusion, effluent blood samples from muscle flaps were obtained and processed for EPR spectroscopy. Muscle biopsy specimens were obtained for histologic evaluation, and dogs were euthanatized.

RESULTS

Spin adducts were not detected in blood from control flaps. However, spin adducts were detected in all ischemic-reperfused muscle flaps. Principal signals identified were characteristic of oxygen- and carbon-centered radicals. Significantly more muscle damage was detected in ischemic-reperfused flaps, compared with control flaps.

CONCLUSIONS AND CLINICAL RELEVANCE

Free radicals may be an important component of injury induced by ischemia and reperfusion of canine skeletal muscle. Spin-trap adducts of free radicals can be detected in effluent blood of canine muscle flaps by use of spin-trapping EPR spectroscopy. Spin-trapping EPR spectroscopy may be useful for the study of antioxidants and free radical scavengers in attenuating ischemia and reperfusion-mediated skeletal muscle damage.

Simian virus 40 is present in human lymphomas and normal blood

Many independent studies have demonstrated Simian virus 40 (SV40) in normal and neoplastic human tissues. Clonal integration of virus in the DNA of several thyroid and bone tumors suggests a direct role for SV40 in some cancers. However, in most cases the role of SV40 remains unclear. This study determined the presence of SV40, by amplification followed by hybridization, in 266 normal and neoplastic blood and lymphoid samples. Amplification detected SV40 in 14% of non-autoimmune deficiency syndrome (AIDS) lymphomas, 28% of AIDS related lymphoma and 16% of peripheral blood lymphocytes from non-cancerous patients. No SV40 was detected in leukemia samples. Direct Southern blotting of SV40+ samples detected no virus, consistent with less than one viral genome in ten cells. Sequence analysis of SV40 in blood and lymphoid samples found sequences distinct from laboratory strains of SV40. The presence of limited quantities of SV40 in a small proportion of both normal and neoplastic tissues is suggestive of an adventitious presence with no apparent direct role in blood and lymphoid cancers.

Long-term clinical and radiographic results of a pegged tibial baseplate in primary total knee arthroplasty

Tibial baseplates of total knee arthroplasty components use stems, fins, and pegs to augment fixation. A pegged design without a stem offers flexibility in tray orientation and ease of revision. These advantages would not be important if stemless designs resulted in a higher rate of aseptic loosening. This article presents an average 10.5-year follow-up of a system offering a pegged tibial baseplate. Good or excellent results in 91% of patients are cited with a revision rate for aseptic loosening of 1%. A pegged design may offer advantages without a higher rate of complications when compared with stemmed implants.

Kidney transplantation in dogs with naturally occurring end-stage renal disease

Renal allografts were performed between unrelated donors and 15 dogs with naturally occurring end-stage renal disease. Donor selection was based on compatible dog erythrocyte antigen typing and cross-matching. An immunosuppressive protocol consisting of rabbit antidog antithymocyte serum, cyclosporin-A, azathioprine, and prednisone was used to control postoperative rejection of the donated kidney. Although seven animals died because of technical failures or rejection episodes, a median survival time of eight months has been achieved, with two dogs living for longer than five years after surgery. Long-term survivors have died from a variety of problems not related to renal allograft rejection.

Detection of free radicals in reperfused dog skin flaps using electron paramagnetic resonance spectroscopy: a pilot study

This is a preliminary investigation of the usefulness of spin-trapping electron paramagnetic resonance (EPR) in detecting oxygen-derived free radicals after reperfusion of ischemic skin flaps. Fourteen island skin flaps approximately 12 cm long by 6 cm wide based on the caudal superficial epigastric vessels were isolated in seven dogs. Seven of the paired skin flaps were subjected to 4 hours of arterial and venous occlusion. The opposite skin flap on each dog served as a perfused control. Spin trapping-EPR was able to detect radical adducts in five of the seven reperfused skin flaps. Hyperfine splitting constants of the radical adducts from the blood of three of the flaps confirmed biologically derived free radical production. Contaminating EPR signals from free radicals created in the manufacture of plastics probably masked any biologically derived radical adducts in the remaining flaps. The authors conclude that EPR-spin trapping may be a valuable tool in the study of the importance of oxygen-derived free radicals in the failure of skin flaps subjected to transient ischemia.

Allelotype analysis of the myelodysplastic syndrome

Myelodysplastic syndromes (MDS) are a group of clonal hematologic disorders found predominantly in the elderly. The molecular mechanisms underlying the development of MDS remain obscure. In order to begin to identify tumor suppressor genes involved in these disorders, we performed a detailed microsatellite allelotype of chromosomal deletions associated with MDS. DNAs from both bone marrow and peripheral blood of 32 MDS patients were studied using 84 highly informative microsatellite markers on all autosomal arms, excluding the short arms of the acrocentric chromosomes. A high percentage of loss of heterozygosity (LOH) was identified on chromosome 5q (40% of informative cases), 7q (45%), 17p (23%) and 20q (20%), which corresponds to the most common cytogenetic abnormalities reported in MDS. In addition, a high incidence of LOH (> or =20%) was observed on chromosomal arms which had not been previously reported including 1p (36%), 1q (35%), and 18q (23%). This extensive allelotype analysis focuses attention on several novel genomic regions that probably contain novel tumor suppressor genes whose loss of function contributes to the development of MDS.

Evaluation of the invader assay, a linear signal amplification method, for identification of mutations associated with resistance to rifampin and isoniazid in Mycobacterium tuberculosis

We evaluated a recently described linear signal amplification method for sensitivity and specificity in detecting mutations associated with resistance to rifampin (RIF) and isoniazid (INH) in Mycobacterium tuberculosis. The assay utilizes the thermostable flap endonuclease Cleavase VIII, derived from Archaeoglobus fulgidus, which cleaves a structure formed by the hybridization of two overlapping oligonucleotide probes to a target nucleic acid strand. This method, termed the Invader assay, can discriminate single-base differences. Nine pairs of probes, encompassing five mutations in rpoB and katG that are associated with resistance to either RIF or INH, as well as the corresponding wild-type (drug-susceptible) alleles, were tested using amplified DNA. Fluorescent-labeled cleavage products, ranging from 4 to 13 nucleotides in length, depending on the genotype of the test sample, were separated by denaturing polyacrylamide (20 to 24%) gel electrophoresis and then detected by scanning. All nine alleles could be identified and differentiated on the basis of product size. Multiple mutations at a specific rpoB nucleotide in target PCR products could be identified, as could mutants that were present at > or =0.5% of the total population of target sequences. The Invader assay is a sensitive screen for some mutations associated with antituberculosis drug resistance in amplified gene regions.

An application of the NCRP screening techniques to atmospheric radon releases from the former feed materials production center near Fernald, Ohio. National Council on Radiation Protection and Measurements

The National Council on Radiation Protection and Measurements has published a series of screening models for releases of radionuclides to the environment. These models have been used to prioritize radionuclides being considered in environmental dose reconstructions. The NCRP atmospheric models are also accepted by the U.S. Nuclear Regulatory Commission for demonstrating compliance with the constraint on releases of airborne radioactive materials to the environment from licensees other than power reactors. This study tested the NCRP atmospheric techniques by comparing annual average predicted air concentrations of radon with measured radon concentrations at 14 locations 43 m to 598 m downwind of the former U.S. Department of Energy Feed Materials Production Center (FMPC) near Fernald, Ohio, for the period 2 July 1985 to 2 July 1986. Predictions were made using five different sets of meteorological data as input: (1) NCRP default values; (2) composite FMPC site data; (3) data from the Greater Cincinnati Airport; (4) data from the Dayton, Ohio, airport; and (5) data collected at Miami University, located near Oxford, Ohio. Following are the respective medians and ranges of the ratio of the predicted to observed annual radon air concentrations for each of these sources of meteorological data: (1) 5.2, 0.9-54; (2) 1.4, 0.1-8.2; (3) 0.7, 0.1-7.2; (4) 0.7, 0.1-8.4; and (5) 0.6, 0.1-10. The stated goal of the NCRP models is to predict doses that do not underpredict actual doses by greater than a factor of 10. In this comparison, all of the meteorological data produced air concentration predictions that meet this criteria. However, to ensure that final doses meet this criterion, one would need to carefully evaluate all assumptions used to calculate dose from each of these air concentrations.

Rb independent inhibition of cell growth by p15(INK4B)

The INK4 cyclin dependent kinase inhibitors (CDKI), such as p15(INK4B) and p16(INK4A), block cell cycle progression from G to S phase. This is mediated by inhibition of phosphorylation of proteins, including the retinoblastoma susceptibility protein (Rb), by cyclin dependent kinases. Ectopic over-expression of the p16(INK4A) CDKI can inhibit growth of cell lines depending on Rb status. Cell lines lacking Rb, with few exceptions, are resistant to growth inhibition by p16(INK4A). The effects of ectopic over-expression of p15(INK4B) in cell lines with and without wild type Rb were examined by measuring cell recovery. Proliferation was inhibited in cells lacking Rb as well as in cells with wild type Rb expression. Experiments analyzing the effectiveness of chimeric p15(INK4B)/p16(INK4A) proteins indicated that the Rb independent growth inhibition required N-terminal residues of p15(INK4B). Linker insertion mutation of p15(INK4B) showed that the inhibition was dependent on intact ankyrin structures. Double staining flow cytometry found that the growth inhibition correlated with a decrease in cells in G2/M phases of the cell cycle. These findings are consistent with Rb independent inhibition of the progression from G1 to S caused by overexpression of p15(INK4B).