POS1445 EARLY DETECTION OF AXIAL PSORIATIC ARTHRITIS IN PATIENTS WITH PSORIASIS: A PROSPECTIVE, MULTICENTER STUDY

Background

In the absence of reliable serological and/or imaging biomarkers that can support an early diagnosis of psoriatic arthritis (PsA) in patients with psoriasis (PsO), and considering the known diagnostic delay there is a need for screening tools for detection of early PsA. While different validated screening/referral tools focusing on peripheral manifestations of PsA exist, validated referral algorithms for PsA with axial involvement (also referred to as axial PsA - axPsA) are still missing.

Objectives

In this prospective, multicenter study we applied a dermatologist-centered screening tool and a structured rheumatologic examination including magnetic resonance imaging (MRI) of sacroiliac joints (SIJs) and spine to detect axPsA in patients with psoriasis (PsO).

Methods

Patients with PsO were systematically screened by their dermatologist for eligibility for referral to a rheumatology clinic. Eligible patients were ≥ 18 years with a confirmed diagnosis of PsO who reported having chronic back pain (≥ 3 months) with onset prior to 45 years of age and who had not been treated with any biologic or targeted synthetic DMARD 12 weeks prior to screening. For those patients who qualified for referral a rheumatologic investigation including clinical, laboratory and genetic assessments as well as imaging with conventional radiography and MRI of sacroiliac joints and spine was performed. The primary outcome of the study was the proportion of patients diagnosed with axPsA among all referred PsO patients.

Results

In total 355 patients were screened at 14 dermatology sites, of whom 151 (42.5%) qualified for referral to rheumatology clinic and 100 (28.2%) were seen by a rheumatologist. The diagnosis of axPsA was confirmed in 14 patients (3/14 with both, axial and peripheral involvement) and the diagnosis of peripheral PsA (pPsA) without axial involvement was made in five patients. The ASAS classification criteria for axSpA were fulfilled in nine (64.3%) of the patients diagnosed with axPsA. All but one patient diagnosed with PsA (13/14 with axPsA and 5/5 with pPsA) fulfilled the CASPAR criteria for PsA.

Patient characteristics are presented in Table 1. All patients diagnosed with axPsA had active inflammatory and/or structural (post)inflammatory changes in the sacroiliac joints and/or spine on imaging. In five patients (35.7%), MRI changes indicative of axial involvement were found only in the spine as illustrated in Figure 1.

Table 1.

Clinical characteristics of all referred patients with PsO and suspicion of axSpA.

Patient characteristicpPsA (N=5)axPsA (N=14)No PsA (N=81)p-value1Age (years) – Mean (SD)42.8 (9.0)46.2 (13.6)45.7 (13.3)0.883Female – n (%)2 (40.0)9 (64.3)45 (55.6)0.543PASI – Mean (SD)3.3 (2.1)4.3 (4.9)4.0 (4.5)0.971Inflammatory back pain – n (%)5 (100.0)8 (57.1)36 (44.4)0.379HLA-B27 positive – n (%)04 (28.6)12 (14.8)0.204Elevated CRP (>5 mg/L) – n (%)1 (20.0)5 (35.7)11 (13.6)0.041Peripheral arthritis, current (last 7 days) – n (%)5 (100.0)3 (21.4)3 (3.7)0.012Radiographic sacroiliitis as per mNY criteria – n (%)04 (28.6)1 (1.2)<0.001Active inflammation, sacroiliac joint (MRI) – n (%)08 (57.1)0<0.001Structural (post)inflammatory changes, sacroiliac joint (MRI) – n (%)08 (57.1)0<0.001Active inflammation, spine (MRI) – n (%)013 (92.9)0<0.001Structural (post)inflammatory changes, spine (MRI) – n (%)08 (57.1)0<0.001

1Statistically significant differences between the axPsA and No PsA groups of patients were determined by using Mann–Whitney U test for continuous data and Chi-square test for categorical data

Figure 1.

Imaging features of axial involvement in PsO patients diagnosed with axPsA

Conclusion

Our study revealed that applying a dermatologist-centered screening tool may be useful for the early detection of patients with a high probability of PsA (and specifically axPsA) in PsO patients. Given the high prevalence of isolated spinal involvement (without SIJs), imaging of the entire axial skeleton may be required as a part of diagnostic procedure in patients with suspected axPsA.

Acknowledgements

Caroline Höppner, Rebecca Bolce, David Sandoval, Hagen Russ, Burkhard Muche, Judith Rademacher, Hildrun Haibel, Laura Spiller and all cooperating dermatologists.

Disclosure of Interests

Fabian Proft: None declared, Susanne Lüders: None declared, Theresa Hunter Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Gustavo Luna: None declared, Valeria Rios Rodriguez: None declared, Mikhail Protopopov: None declared, Katharina Meier: None declared, Georgios Kokolakis: None declared, Kamran Ghoreschi: None declared, Denis Poddubnyy: None declared

Single-Cell Chromatin Analysis of Mammary Gland Development Reveals Cell-State Transcriptional Regulators and Lineage Relationships

Technological improvements enable single-cell epigenetic analyses of organ development. We reasoned that high-resolution single-cell chromatin accessibility mapping would provide needed insight into the epigenetic reprogramming and transcriptional regulators involved in normal mammary gland development. Here, we provide a single-cell resource of chromatin accessibility for murine mammary development from the peak of fetal mammary stem cell (fMaSC) functional activity in late embryogenesis to the differentiation of adult basal and luminal cells. We find that the chromatin landscape within individual cells predicts both gene accessibility and transcription factor activity. The ability of single-cell chromatin profiling to separate E18 fetal mammary cells into clusters exhibiting basal-like and luminal-like chromatin features is noteworthy. Such distinctions were not evident in analyses of droplet-based single-cell transcriptomic data. We present a web application as a scientific resource for facilitating future analyses of the gene regulatory networks involved in mammary development.

Abstract ES10-2: Understanding breast cancer using a developmental perspective

Parallels among embryonic development, stem cells, and cancer have long been recognized. We identified, isolated, and characterized stem cells that first become committed to a mammary fate during embryogenesis; we refer to these cells as fetal mammary stem cells (fMaSCs). Lineage tracing, in vitro sphere formation, and in vivo transplantation studies by our group and many others all confirm that cells in the embryo are the bipotent progenitors of the mammary gland. There is debate, however, on whether such bipotent cells persist into the adult, or whether the luminal and basal lineages are maintained by unipotent progenitors. To gain insight into the relationships between fMaSCs and breast cancer, and to investigate their potential persistence in the adult, we have applied bulk and single cell RNA-sequencing (sc-RNA-seq) and single nucleus ATAC-sequencing (snATAC-seq) throughout mammary development. The results to be discussed demonstrate that fMaSC transcriptomes are heterogeneous, but all share co-expression of genes associated with luminal and basal cell fates. This fits a model in which the bipotent state is created by a balance of lineage specifiers. We also find that the fMaSC transcriptome is highly enriched in basal-like human breast cancers and identify potential embryonic pathways that correlate with poor prognosis. We used a variety of computational tools to infer the gene expression programs that ensue when fMaSCs commit to luminal and basal states. The data from scRNA-seq and snATAC-seq demonstrate that the transitions are gradual, not precipitous, and that luminal and basal cells exhibit significant transcriptomic and epigenetic heterogeneity. This challenges the notion that the mammary gland consists of discrete cell types defined by rigid transcriptomic parameters, and reveals a potential for intrinsic phenotypic plasticity of normal mammary cells. Using the combined databases, we identified Sox10 as a significantly differentially expressed cell state regulator. We show that tumors are heterogeneous with regard to Sox10 expression, and that locally invasive cells tend to express high Sox10 levels. Elevated Sox10 correlates with acquisition of a neural-crest like, EMT-related state. Implications for interception of metastasis by targeting neural crest-like cells will be discussed. Finally, we have generated a web resource that is available to the scientific community to enable the transcription and epigenetic characteristics of any gene of interest to be tracked through mammary development (https://wahl-labsalk.shinyapps.io/Mammary_snATAC/).

Citation Format: GM Wahl, Z Ma, C Chung, C Dravis, BT Spike, RR Giraddi, O Balcioglu, C Fan, B Hagos, R Heinz, Herrera-Valdez J, X Hou, J Hwang, R Lasken, G Luna, NE Lytle, EM Mehrabad, M Novotny, CM Perou, O Poirion, S Preissl, B Ren, T Reya, CL Trejo, KT Varley. Understanding breast cancer using a developmental perspective [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr ES10-2.

Abstract 5169: Pancreatic tumorigenesis evokes mechanisms of tissue injury and repair

Despite numerous advances in our understanding of pancreatic ductal adenocarcinoma (PDA) genetics and biology, this disease is expected to become the second leading cause of cancer-related deaths in the U.S. by 2020. These statistics largely reflect the fact that by the time PDA is detected, it has already spread, making the study of early events in tumorigenesis invaluable. Harold Dvorak is credited with suggesting that tumors behave as wounds that do not heal, specifically that they are able to induce the stroma required for their maintenance and growth. Decades of research have provided an array of molecular mechanisms supporting this hypothesis. When injured, the pancreas undergoes acinar to ductal metaplasia (ADM) where digestive enzyme-producing acinar cells transdifferentiate to ductal cells; a process thought to allow for tissue healing and repair. Though a number of insightful studies have been conducted to determine the underlying mechanisms of this process, it is still incompletely understood. Using a number of high-resolution imaging techniques and lineage tracing models, we have found that chronic pancreatic injury is sufficient to induce formation of a number of differentiated cell types during ADM, including tuft cells, which are absent from the normal pancreas and may function in tissue repair.

Tuft cells are solitary chemosensory cells found throughout the hollow organs of the respiratory and digestive tracts. Their expression of taste, neuronal, and inflammatory cell signaling factors is thought to enable monitoring of intraluminal homeostasis and local response via effectors. Previous studies demonstrate that, in mice, tuft cells are absent from the normal pancreas, but transdifferentiate from the acinar cell epithelium in response to oncogenic Kras expression. Interestingly, while they increase during the genesis of pancreatic intraepithelial neoplasia (PanIN), they are not detected in PDA. Tuft cell formation is also characteristic of human pancreatitis and PanIN. These data suggest a conserved, transient, but currently undefined role for tuft cells in early tumorigenesis. Here, we employ novel mouse models to elucidate this role and to identify consequences of tuft cell ablation. These studies suggest that an important function of tuft cells involves production of immune-modulatory factors in response to injury and oncogenesis. Consistent with this, we show that pancreas-specific Pou2f3 ablation eliminates tuft cell formation and enhances disease progression. Collectively, these data suggest that neoplastic lesions that form in response to oncogenic mutation evoke the cellular heterogeneity that occurs during ADM in response to tissue injury. We conclude that tuft cells and, by inference, the associated metaplastic and neoplastic lesions, play a protective role early in pancreatic injury and tumorigenesis.

Citation Format: Kathleen E. DelGiorno, Chi-Yeh Chung, Raj Giraddi, Eugene Ke, H. Carlo Maurer, Maya Ridinger-Saison, Wahida H. Ali, Crystal Tsui, Cynthia Ramos, Razia Naeem, Makoto Ohmoto, Linjing Fang, Gidsela Luna, Conor Fitzpatrick, Caz O'Connor, Uri Manor, Ichiro Matsumoto, Kenneth P. Olive, Geoffrey M. Wahl. Pancreatic tumorigenesis evokes mechanisms of tissue injury and repair [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5169.

Epigenetic and Transcriptomic Profiling of Mammary Gland Development and Tumor Models Disclose Regulators of Cell State Plasticity

Cell state reprogramming during tumor progression complicates accurate diagnosis, compromises therapeutic effectiveness, and fuels metastatic dissemination. We used chromatin accessibility assays and transcriptional profiling during mammary development as an agnostic approach to identify factors that mediate cancer cell state interconversions. We show that fetal and adult basal cells share epigenetic features consistent with multi-lineage differentiation potential. We find that DNA-binding motifs for SOX transcription factors are enriched in chromatin that is accessible in stem/progenitor cells and inaccessible in differentiated cells. In both mouse and human tumors, SOX10 expression correlates with stem/progenitor identity, dedifferentiation, and invasive characteristics. Strikingly, we demonstrate that SOX10 binds to genes that regulate neural crest cell identity, and that SOX10-positive tumor cells exhibit neural crest cell features.

Lgr5 is a marker for fetal mammary stem cells, but is not essential for stem cell activity or tumorigenesis

The search for the bipotent mammary stem cells that drive mammary development requires markers to enable their prospective isolation. There is general agreement that bipotent mouse mammary stem cells are abundant in late fetal development, but their existence in the adult is vigorously debated. Among markers useful for mammary stem cell identification, the Wnt co-receptor Lgr5 has been suggested by some to be both "necessary and sufficient" for bipotency and transplantation of adult mammary stem cell activity, though other studies disagree. Importantly, the relevance of Lgr5 to the bipotency of fetal mammary stem cells has not been studied. We show here that expression of a fluorescent protein driven by the endogenous Lgr5 promoter enables significant fetal mammary stem cell enrichment. We used lineage tracing to demonstrate embryonic cells expressing Lgr5 are bipotent, while their adult counterparts are myoepithelial restricted. Importantly, our data conclusively demonstrate that Lgr5 is dispensable for both fetal and adult mammary stem cell activity and for the development of mammary tumors.

The MIT D-lab electricity-free PortaTherm™ incubator for remote testing with the QuantiFERON®-TB Gold In-Tube assay

BACKGROUND

Use of the QuantiFERON®-TB Gold In-Tube assay (QFT-GIT) in remote areas is limited by the need to incubate blood samples within 12 h of collection. PortaTherm™ is a portable, electricity-free, phase-change incubator previously used for field collection of microbiological samples.

OBJECTIVE

To determine whether the PortaTherm can be used for the reliable incubation of QFT-GIT samples, thus enabling QFT-GIT use in settings distant from laboratory facilities.

METHODS

In a prospective comparative study in Peru, blood samples were collected from 50 participants and processed in three parallel QFT-GIT tests per participant; two were incubated in a conventional incubator; the third was incubated in the PortaTherm.

RESULTS

All 150 QFT-GIT tests gave definitive results, and for 46 of the 50 participants all three tests were concordant, eight of which were positive. Four participants had one discordant result: two due to discordance of a conventional incubator QFT-GIT result, and two due to discordant PortaTherm QFT-GIT results.

CONCLUSION

The QFT-GIT inter-incubator variability between the PortaTherm and conventional incubator was no greater than the intra-incubator variability for the conventional incubator, indicating that the PortaTherm is a suitable tool for incubating QFT-GIT whole blood samples in remote settings where access to a laboratory or electricity is limited.

MODS accreditation process for regional reference laboratories in Peru: validation by GenoType® MTBDRplus

SETTING

Although considerable effort has been put into the development and evaluation of new diagnostics for tuberculosis (TB) and multidrug-resistant TB (MDR-TB), little attention has thus far been paid to the technical aspects of initiating quality-assured routine service use. For implementation of the microscopic-observation drug susceptibility (MODS) methodology in the Peruvian reference laboratory network, a laboratory accreditation process was devised; MODS results from an expert reference laboratory (Universidad Peruana Cayetano Heredia [UPCH]) were used as the standard against which implementing laboratory MODS results were judged to ensure that, prior to use for patient care, implementing laboratories achieved the same high performance with MODS as previously demonstrated in the research laboratory.

OBJECTIVE

To evaluate the validity of MODS-based accreditation and the concordance of MODS drug susceptibility testing (DST) with molecular testing.

DESIGN

Head-to-head comparison of MODS DST results from implementing Peruvian regional reference laboratories and the accrediting expert MODS laboratory (UPCH) with GenoType® MTBDRplus DST.

RESULTS

The concordance of phenotypic MODS rifampicin (RMP) DST with GenoType MTBDRplus was respectively 97.4%, 97.9% and 97.1% for the two implementing regional laboratories and UPCH, and respectively 94.7%, 95.7% and 94.6% for isoniazid (INH) DST.

CONCLUSION

High and consistent levels of MODS/MTBDRplus concordance for INH and RMP DST confirm the validity of the use of rapid methods as reference standards for accreditation.

Changes induced by UV radiation during virgin olive oil storage

The effects of UV radiation on the chemical and sensory characteristics of virgin olive oils (cv. Arbequina and Picual) were assessed. Even small doses of UV radiation induced oxidation of the virgin olive oil samples. Total phenols and fatty acids contents decreased during the process as well as the intensity of the bitter and fruity sensory attributes, while the intensity of the rancid sensory attribute notably increased. Acetaldehyde, 2-butenal, 2-pentenal, octane, octanal, hexanal, nonanal, and 2-decenal were the volatile compounds most affected, showing an important increase during the irradiation process. Nonanal, hexanal, and pentanal showed high correlation with the rancid sensory attribute (90%, 86%, and 86%, respectively). 2-Decenal and nonanal concentrations allowed us to predict the alteration level of the samples by mean of multiple Ridge regression.

Impact of transient correction of increased adrenocortical activity in hypothalamo-damaged, hyperadipose female rats

OBJECTIVE

To explore the effects of transient correction of enhanced corticoadrenal activity in monosodium L-glutamate (MSG)-damaged female rats on peripheral insulin sensitivity and in vitro retroperitoneal (RP) adipocyte function.

DESIGNS

A dose of 4 mg/g body weight (BW) of MSG or vehicle (CTR) was i.p. injected, once every 2 days, between days 2 and 10 of age, in female rats. Intact and 21 day-operated (sham or adrenal enucleation (AE)) rats from both (CTR and MSG) groups were used for experimentation on day 120 of age. Circulating levels of several hormones, in basal and after i.v. high-glucose load conditions, and RP adiposity morphology and function were then evaluated.

RESULTS

MSG rats developed increased adrenocortical function, hyperadiposity, hyperleptinemia, hyperinsulinemia and decreased peripheral insulin sensitivity. These characteristics were fully reversed after transient correction of corticoadrenal hyperactivity induced by AE. In addition, in vitro experimentation with isolated RP adipocytes indicated that cells from intact MSG animals displayed decreased sensitivity to insulin and dexamethasone stimulation of leptin secretion. Interestingly, adipocyte dysfunction in MSG rats was fully abrogated after AE-induced transient correction of insulinemia, leptinemia and adrenocortical activity. Importantly, the reversion of these metabolic abnormalities, induced by AE for 21 days, in MSG animals did occur, despite no significant changes in BW values.

CONCLUSION

Our results support that the changes in adipocyte characteristics and peripheral insulin resistance, developed in this pseudo-obese female rat model, are mainly due to increased glucocorticoid production. Importantly, appropriate correction of the enhanced adrenocortical activity fully reversed these abnormal functions.

Behavioral profile of SB 269970, a selective 5-HT(7) serotonin receptor antagonist, in social encounters between male mice

The 5-HT(7) receptor is targeted by several antipsychotics, such as pimozide or clozapine, which have demonstrated antiaggressive properties in laboratory animal models. Likewise, 'in situ' hybridization and autoradiography studies have revealed moderate to high densities of 5-HT(7) receptors in limbic areas and hypothalamus, which have long been involved in the control of aggression. However, to date there is no evidence concerning the role of this receptor in the regulation of aggression. This study was designed to examine the effects of SB 269970 (1, 2, 4, 8, 16 and 32 mg/kg, i.p.), a selective 5-HT(7) receptor antagonist, on agonistic behavior elicited by isolation in mice. Individually housed mice were exposed to anosmic standard opponents 15 min after drug administration and encounters were videotaped and evaluated using an ethopharmacologically-based analysis. The results indicated that SB 269970 did not produce any significant behavioral changes, suggesting that 5-HT(7) receptors might not be involved in the modulation of aggression. Further studies with other selective ligands for these receptors are needed to confirm these findings.

A multicenter phase II study of the efficacy and safety of docetaxel plus cisplatin in Asian chemonaïve patients with metastatic or locally advanced non-small cell lung cancer

AIMS

To evaluate the efficacy and safety of docetaxel-cisplatin in patients with metastatic or locally advanced non-small cell lung cancer (NSCLC).

METHODS

Chemotherapy-naïve patients with histologically confirmed TNM stage III or IV NSCLC were recruited from 12 Asian trial centers. Patients received docetaxel (75 mg/m2) and cisplatin (75 mg/m2) every 3 weeks for 6 cycles.

RESULTS

130 of 146 patients were evaluable for efficacy (60% stage IV). Three complete and 58 partial responses were observed (overall response rate: 46.9%; 95% CI: 38.3-55.5%). Median time to progression was 6.9 months and median survival was 14.0 months; 1-year survival was 59.5%. Grade 3/4 neutropenia, thrombocytopenia and anemia occurred in 69.2%, 6.2% and 18.5% of patients, respectively. Grade 3/4 vomiting was observed in 13.7% and grade 3/4 neurosensory effects were observed in 2.7% of patients. There was one case of treatment-related death due to sepsis.

CONCLUSION

Docetaxel-cisplatin is an effective and well-tolerated treatment in Asian patients with NSCLC.

Effects of L-741,741, a selective dopamine receptor antagonist, on anxiety tested in the elevated plus-maze in mice

Dopamine systems are involved in modulation of anxiety. Although the action of D1/5, D2 and D3 receptor antagonists on anxiety has been documented in different animal models, little is known about the influence of D4 dopamine antagonists. The aim of this study was to examine the effects of L-741,741 (0.75, 1.5 and 3 mg/kg i.p.), a selective D4 dopamine receptor antagonist, on anxiety tested in the elevated plus-maze. Forty-eight albino adult male mice of the OF.1 strain were used. Animals were randomly allocated to one control group receiving physiological saline and dymethyl-sulphoxide (DMSO) (10%) and three experimental groups receiving L-741,741 injections. Tests were performed 30 min after injections for a duration of 5 min. A number of classical parameters were collected: i) open arm duration; ii) closed arm duration; iii) central platform duration; iv) open arm frequency; v) closed arm frequency; vi) central platform frequency; and vii) number of rearings. L-741,741 did not produce any significant behavioral changes under present test conditions, suggesting that the dopamine D4 receptor might not be involved in the modulation of anxiety-related behaviors in the plus-maze.

Intentional injury treated in community hospitals

BACKGROUND

The impact of intentional injury in major metropolitan trauma centers has been established. Nonaccidental injury has become an increasingly important component of trauma care in mid-sized urban areas. To determine the medical and economic impact of personal violence in the Spokane, Washington, community we undertook a 5-year retrospective review.

PATIENTS AND METHODS

Trauma registries were used to identify all victims of intentional injury admitted between May 1, 1994, and April 31, 1999. Demographic data, blood alcohol, mechanism, injury severity, hospital course, and outcome were abstracted from the registries. Financial data were obtained from hospital financial offices.

SETTING

Spokane, Washington, has a population of 200,000 with 400,000 in the metropolitan area. Trauma patients are triaged to hospitals according to Washington Administrative Code guidelines, supervised by central medical control. The two level II and two level III facilities are staffed by private practice surgeons and serve a referral area of 650,000.

RESULTS

Five hundred eighty-one intentional injury patients were admitted. This represented 15% of all significant injuries. Males accounted for 80% of the patients and 84%were Caucasian. The mean patient age was 30 years, only one quarter were listed as employed. Sixteen percent of the injuries were self-inflicted, gunshot was the most common mechanism (39%). Alcohol was involved in one half of the injuries. Sixty-three patients died, 39 died prior to intensive care unit admission. Hospital stay averaged 6.4 days, with a mean hospital charge of $18,000. Hospitals were reimbursed at 67%. Surgeons collected 31% of billed fees. Fewer than one third of patients had any form of private insurance.

CONCLUSIONS

Intentional injury is a significant component of trauma care in our community. Patients are seriously injured and the fatality rate is high. Care is expensive and poorly funded.

Hormone coexpression in the adult toad endocrine pancreas: double-label immunofluorescence under basal conditions and after glucose injection

We have investigated the type and frequency of hormone coexpression in the endocrine pancreas of amphibians both under basal conditions and after sustained glucose loading. Adult male specimens of the wild toad Bufo arenarum were injected with a 50% (w/v) glucose solution (2 g/100 g) for 2 days, while control animals received an equal volume of the vehicle. Serum glucose levels were measured at the time of sacrifice and the pancreatic free lobe was processed for light microscopy. A double-labeling immunofluorescence study was performed for the detection of insulin (I), glucagon (G), somatostatin (S), and pancreatic polypeptide (PP). Heterospecific antisera against the following hormone combinations were used for their detection and immunocytochemical localization: I+G, I+PP, G+PP, S+G, and S+PP; visualization of the reacted IgG's was effected by fluorescein- and rhodamine-conjugated species-specific antibodies as fluorophores. Intracellular hormone coexpression was found to occur in the combinations G+PP, S+G, and S+PP. Moreover, glucose administration caused, together with a marked hyperglycemia (123 +/- 17 vs 23 +/- 1 mg/dl; P < 0.05), a decrease in the fraction of cells containing both G and PP together (from 106.3 +/- 8.1 to 26 +/- 4 cell/mm2) along with a reciprocal rise in the number of cells possessing G alone (from 128.7-152.3 to 235.9-274 cell/mm2). The fewer number of cells coexpressing either of the other two hormone combinations, however, were unaffected by glucose injection. With respect to the simultaneous measurement of I+G and I+PP, no cells were detected with both hormones of either pair, and the I-containing cells were more frequent in each instance in the control toads (264.8 +/- 22.3 to 269.2 +/- 27 cell/mm2). For both combinations, however, this value diminished significantly in the glucose-treated animals (108 +/- 2 cell/mm2 for I+G and 112.1 +/- 7. 8 cell/mm2 for I+PP). While the G-containing cells became more numerous (rising to 235.9 +/- 12.4, 274 +/- 26, and 250.4 +/- 23.7 cell/mm2 for I-G, G-PP, and G-S combinations, respectively), the PP- and S-containing cells remained unaffected. We conclude that the copresence of different hormones within the same cell is a relatively common finding in the non-I-secreting elements of the adult toad pancreas and that the proportions of specific cell types are affected by glucose administration. We thus propose that intracellular hormonal coexpression in this fashion may well represent a rapid and efficient regulatory mechanism for compensating for the metabolic stress imposed by glucose loading.

Incidence of abdominal wall hernia in aortic surgery

BACKGROUND

True aneurysms of the abdominal aorta and its branches are at least in part due to defects in the structural integrity of the arterial wall. Whether the defect is isolated to the vascular wall is unclear. If the structural weakness involves other tissues, patients with aneurysmal disease should have a higher incidence of collagen and fascial defects, such as abdominal and inguinal hernias.

METHOD

We reviewed 100 patients who underwent elective aortic reconstruction for aneurysmal or occlusive disease. All patients were operated on by the same group of vascular surgeons, through a midline incision, with fascia closed using running absorbable suture. Midline incisional and inguinal hernias were identified, and all patients were followed up for at least 1 year. Comparisons between groups were made for established risk factors for ventral hernias.

RESULTS

Incisional hernias occurred in 18 of 58 (31%) aneurysm patients, compared with 5 of 42 (12%) occlusive disease patients (P = 0.025). Inguinal hernias occurred in 11 of 58 (19%) aneurysm patients versus 2 of 42 (5%) occlusive disease patients (P = 0.037). Risk factors were equally distributed between the two groups. Neither the size of the aneurysm nor the presence of an iliac artery aneurysm affected the incidence of abdominal wall hernias in the aneurysm patients.

CONCLUSION

This study emphasizes the increased incidence of abdominal wall hernias in patients undergoing aortic surgery for aneurysm disease compared with aortoiliac occlusive disease. The size of the aneurysm and the association of an iliac artery aneurysm did not affect the incidence of hernias among these patients. Genetic and biochemical abnormalities are considered as possible explanations.

Cost-effective carotid endarterectomy

BACKGROUND

Carotid endarterectomy is the most common vascular procedure performed, with an annual cost of $1.2 billion. Efforts to control the cost associated with this procedure include limiting preoperative studies, avoiding admissions to the intensive care unit, and encouraging early postoperative discharge.

METHODS

To determine our surgical results and the cost associated with this procedure, we reviewed our experience at a single hospital and compared our cost data with those of other local facilities.

RESULTS

During an 18-month period we performed 65 carotid endarterectomies at one community hospital. The average per-patient hospital cost was $8,060, which was $3,510 less than the average cost at the other facilities in our city. The median length of postoperative stay in our hospital was 1 day. One patient died and there was 1 postoperative stroke.

CONCLUSIONS

Limited utilization of the intensive care unit and short postoperative stays reduced the overall hospital costs. Our 1.5% mortality and stroke rates demonstrate that these cost-saving measures can be implemented without adversely affecting patient outcome.

Puncturing the pulseless femoral artery: a simple technique that uses palpation of anatomic landmarks

PURPOSE

The authors report a simple technique in which palpation of anatomic landmarks is used to localize the pulseless common femoral artery.

MATERIALS AND METHODS

A finger is placed immediately lateral to the pubic tubercle and inferior to the inguinal ligament to palpate the point allowing the most posterior depression. Anatomically, this depression lies between the iliopsoas muscle laterally and the pectineus muscle medially. The femoral vein lies in the floor of this depression, and 1.5 cm lateral to the depression lies the femoral artery.

RESULTS

This anatomic relationship and its usefulness for locating the common femoral artery were verified by puncture and dissection of nine cadaveric groins and successful puncture of 19 pulseless arteries of 17 patients.

CONCLUSION

The described technique was found to be quick, simple, and reliable and is now the authors' method of choice for puncturing the pulseless femoral artery.

[Preparation and analysis of dehydrated mixtures of vegetables and underutilized fish species flours: I. Dehydrated mixtures of cereal-fish]

For the purpose of providing possible solutions to the malnutrition problems affecting those populations where cereals and tubers form an important portion of their daily intake, products were prepared from dehydrated mixtures of cereals and under-utilized fish, but which contain high-quality protein. Two cereals were selected for our experiments: rice and corn, and a marine under-utilized fish species (Macrodon ancyclodon). The minced fish muscle recovered by mechanical deboning was mixed with the cereal, obtaining mixtures with 5%, 10% and 15% fish on a dry basis. Feeding experiments using Wistar weaning rats were then carried out to evaluate the most important characteristics. An amino acid profile which reflected high-quality protein was obtained, as evidenced by the excellent PER, NPU, NPR and digestibility values determined. The dehydrated mixtures of fish/cereal flour prepared with 5% and up to 10% fish (dry basis), did not present any odour, but as of the 15% level, fish odour was perceived. Therefore, the use of dehydrated mixtures of fish/cereal flours with up to 10% fish in preparing food products, is recommended, since these would be of great help in solving the scarcity of good-quality protein, particularly in the developing countries.

Inflammatory aneurysms of the abdominal aorta

The treatment of inflammatory aneurysms of the abdominal aorta presents a formidable challenge to the surgeon. The retroperitoneal inflammatory reaction obliterates normal tissue planes, limiting access to the infrarenal aorta. During a 70-month period 25 (6%) of 439 patients operated on for abdominal aortic aneurysms were found to have the inflammatory type. These patients were more likely to be symptomatic than patients with noninflammatory aneurysms and they were more likely to be male. Although surgical repair of the aneurysms required longer aortic occlusion time and more blood replacement, the outcome was similar to that for patients treated for noninflammatory aneurysms.

Effect of cupric ions on the initiation protein synthesis rate in the human endometrium

The effect of cupric ions on the initiation protein synthesis rate of the human endometrium was studied. Addition of copper to the complete ribosomal system decreased the binding of [3H]Met-tRNA(i) to the isolated ribosomes with a plateau at about 70% inhibition with concentrations higher than 150 microM. The initiation activity was GTP-dependent with a maximum at 2 mM. This activity was very rapid, requiring 5 min to complete the reaction. Incubation of isolated initiation factors with copper (300 microM) inhibited the formation of the ternary complex. When the complete system was reconstituted with salt-washed ribosomes after ternary complex formation, no significant change on the inhibition pattern was observed. Addition of initiation factors to 5-min preincubated salt-washed ribosomes with 300 microM copper, after the elimination of excess copper, induced only a 12% decrease on Met-tRNA(i) binding. This effect was not modified by the presence of Sparsomycin, an elongation inhibitor. It was concluded that copper interferes with the initiation process, probably at the ternary complex formation level.

A twelve-year survey of cervicothoracic vascular injuries

This study of a large series of victims of trauma to the cervicothoracic great vessels confirms the lethal potential of these injuries: more than half of victims of such injuries died. The optimal management of patients potentially harboring such vascular damage appears to include skilled prehospital resuscitation and rapid transport to a trauma center, a high index of diagnostic suspicion, a low threshold for the performance of contrast arteriography, aggressive surveillance for associated neurologic and aerodigestive tract injuries, and timely technical repair, including liberal indications for sternotomy or thoracotomy to assure vascular control.

Drug use in trauma victims

We examined the prevalence and characteristics of drug use in a large sample of fatally and nonfatally injured trauma victims. Routinely collected urine specimens from 452 emergency room patients and 160 persons autopsied at the Medical Examiner's Office (MEO) were analyzed for the presence of marijuana, cocaine, opiates and benzodiazepines using EMIT enzyme immunoassays. Blood alcohol levels were also measured. Tests were positive for at least one drug in 40.3% of the ER and 18.7% of the MEO samples. Marijuana was the most commonly detected drug in both groups. Specimens were more likely to be positive in younger persons and in males, and in victims of assaults and traffic accidents. Alcohol was present in the blood in more than one third of ER and MEO samples. Only 39.8% of ER samples and 52.3% of MEO samples were negative for both alcohol and drugs.

[Functional properties and possible uses of a hydrolysate of pepitona (Arca zebra) in the preparation of foods]

The present study revealed that the drum-drying and spray-drying procedures used on the pepitona (Arca zebra) hydrolysate, as well as the storage time, exert a deteriorative significant effect on the functional properties of both hydrolysates. The greatest and more significant losses of the majority of such properties occur during the first two months of storage period. Thus, in the case of foaming capacity, losses ranging from 17% to 34% were detected in the drum-dried hydrolysate, and of 38% to 49% in the hydrolysate dehydrated using a spray drier, during the first two months of storage. The emulsifying capacity was also altered in 14% of the hydrolysate dehydrated in a drum drier, and in 25% of the hydrolysate dehydrated using a spray drier. Sensory evaluation tests demonstrated the potential of both hydrolysates for use as supplements of conventional foods such as cookies and extruded products.

[Determination of processing conditions for obtaining a pepitona (Arca zebra) hydrolysate for human consumption]

For the purpose of obtaining two protein hydrolysates from peptiona (Arca zebra), to be used as nutritional ingredients in accepted food items destined for human consumption, the enzymes bromelain and papain were studied. The effect of adding each of these proteases, on the rate of hydrolysis and conversion extent of insoluble pepitona protein to soluble nitrogen, were examined. Distilled water was added to the raw material to give a 2:1 ratio of solvent to pepitona, and mixed to produce a slurry at a pH of 6.4-6.5, with a total nitrogen value of 0.97% (w/v). Optimum conditions of hydrolysis were found to be two hours at 40 degrees C for both enzymes, at a pH of 7 and 0.3 g enzyme/100 g pepitona for papain, and a 0.2 g enzyme/100 g pepitona at pH 6.4 normally found in pepitona in the case of bromelain.

[Preparation and nutritional characteristics of a hydrolysate from pepitona (Arca zebra)]

Two soluble products resulting from the hydrolysis of pepitona (Arca zebra) were prepared as flour. Papain at its optimum hydrolysis conditions, previously established, was the enzyme used (40 degrees C for two hours at a pH of 7 in the proportion of 0.3% weight/enzyme/100 g meat). The hydrolysate obtained was then subjected to two different dehydration techniques: drum drying at 121 degrees C and 18 seconds retention, and spray drying at 101 degrees C and 40 psi pressure. The products were then stored for a five-month period at a temperature of 25 degrees C +/- 2 degrees C, time during which chemical determinations were performed in both hydrolysates. Findings showed that the time of storage does exert a significant effect of deterioration on the products. The greater and more significant quality losses occur during the first two months. The dehydration techniques used also affect significantly the soluble nitrogen content, and non-protein nitrogen and soluble solids content, as well as color of pepitona hydrolysates. Spray-drying dehydration technique does not have a significant deteriorating effect. Biological studies undertaken demonstrated that the quality of both hydrolysates is satisfactory from the nutritional and amino acid composition points of view. A protein efficiency ratio (PER) of 2.27 and 2.29 was determined for the hydrolysate dehydrated by drum drier and for the dehydrated by spray drier, respectively. With regard to amino acid composition, both had satisfactory levels of essential amino acids, with a lysine content of 6.9 g/100 g protein for the hydrolysate dehydrated by drum drying, and 8.6 g/100 g protein for the other hydrolysate dehydrated by spray drying.

Hepatocellular carcinoma. A 5 year institutional experience

Liver cancer is the most common of all malignancies worldwide, its incidence reaching almost epidemic proportions in some countries. However, its significance in North America has generally been underemphasized. In a 5 year period, hepatocellular carcinoma was diagnosed in 35 adult patients in our institution. Preexisting liver inflammation was present in 27 of the patients (77 percent). Although most patients had symptoms, they included only poorly defined pain or cachexia in most cases, and 10 patients (29 percent) were totally asymptomatic at the time of diagnosis. Five patients presented with hemoperitoneum due to intraabdominal tumor rupture. Examinations useful in confirming the diagnosis included alpha-fetoprotein determination, liver scan, and computerized tomographic scanning. Eight patients (23 percent) had associated visceral or other malignancies. The outlook was poor, with a mean survival of 5 months, and only two patients survived more than 1 year. Hepatocellular carcinoma is uncommon but not at all rare in the Pacific Northwest. It arises from chronic liver inflammation, is diagnosed late, and has a grim prognosis. Prevention of various forms of chronic liver inflammation, and mass serial screening of populations at high risk for the development of hepatocellular malignancy will probably have the greatest role in reducing the lethality of this disease.

Re-evaluation of the role of spermatozoa as inducers of protein synthesis by the rabbit endometrium

The effect of spermatozoa as inducers of protein synthesis by the rabbit endometrium was studied. The presence of spermatozoa increased the leucine incorporation into proteins from 15.6 +/- 1.8 to 44.8 +/- 4.3 dpm X 10(-3)/mg DNA after 2 hr of incubation. There was no difference in the amount of incorporated leucine induced by live or by dead spermatozoa. Latex particles also induced an increase on protein synthesis (24 +/- 3.1 dpm X 10(-3)/mg DNA). These results seem to indicate that this increase in protein synthesis was nonspecific. The number of contaminant cells was always significantly greater in the recovered incubation medium after incubation with highly metabolically active sperm than with dead cells (230 +/- 85 and 86 +/- 33 X 10(-3) cells respectively). This leukocytic effect was smaller than that found in In vivo systems and may play a significant role on the proposed activity of sperm cells on the endometrium.

The effect of conspecifics on corticoadrenal response of rats to a novel environment

The effect of housing conditions and the presence of a conspecific on corticoadrenal response to a novel environment was studied in male Sprague-Dawley rats. The response to a novel environment was the same in rats housed in groups and rats housed alone for 20 days before testing, suggesting that isolation during adulthood did not affect corticoadrenal response to a novel environment. The presence of a nonfamiliar rat (proceeding from another home cage) did not modify corticoadrenal response to the novel environment but the presence of a rat proceeding from the same home cage induced a higher corticoadrenal response to this stressful stimuli. These results can be explained considering that rats exhibit greater emotional reactivity, as measured by adrenal function, in situations which combine familiar (the other rat) and novel (the box) elements than those completely unfamiliar.

[Attitudes and opinions of the Venezuelan toward fish as food]

A survey was carried out to obtain an overview of the consumers' attitudes and opinions towards fish in Venezuela. The city of Caracas was selected for this purpose because of its size (4,000,000 inhabitants, the largest in Venezuela). The survey showed that consumers had a high regard for the nutritional value of fish compared with competing foods, but considered it low in taste, and disliked bones and smell. The percentage of people that did not consume any form of fish was 17.5 and the percentage of people who consumed fish four times or more per month, was 44.2. Of the people interviewed, 62% preferred to purchase fish directly from fishermen.