Evaluation of a pen device for self-administration of recombinant human FSH in clomiphene citrate-resistant anovulatory women undergoing ovulation induction

This open-label multicentre study evaluated ease of use, safety, and efficacy of a pen device for self-administration of recombinant follicle-stimulating hormone (rFSH) in 43 subjects undergoing ovulation induction. Follitropin beta was administered subcutaneously with the Follistim Pen within 3 days of onset of menses. A 75 IU starting dose could be increased by 25 or 50 IU on days 8 and 15 if no ovarian response was observed. Human chorionic gonadotrophin (HCG; 10,000 IU) was administered when one follicle > or =18 mm or two to three follicles > or =15 mm were observed. Subjects received standardized instruction for the pen device and subject comprehension was recorded as subjects practised and prepared injections. Ease of use was also evaluated by questionnaire. Forty-four subjects enrolled; 43 were treated with rFSH and 41 were treated with HCG. The comprehension questionnaire revealed that during the mock injection, 100% of subjects properly loaded the cartridge into the pen device, while 95% selected the correct dose and 100% self-injected the medication prescribed. During the second actual injection, 100% of subjects comprehended these pen-related steps. The ease-of-use questionnaire showed that 100% of the subjects rated the overall experience of self-administering with the pen as 'very good' to 'good'. Mean duration and total amount of follitropin beta were 11.4 +/- 4.2 days and 1070.3 +/- 580.3 IU respectively. Ovulation rate was 95%. Biochemical and ongoing pregnancy rates per attempt were 34.9 and 30.2% respectively. Three subjects experienced serious adverse events [asthma; ovarian hyperstimulation syndrome (OHSS) and pain; OHSS]. In conclusion, the pen device provides an easy, safe, and effective way for women to self-administer follitropin beta during ovarian stimulation.

Administration of recombinant human FSH (solution in cartridge) with a pen device in women undergoing ovarian stimulation

This study evaluated the first multiple-use pen device for the self-administration of recombinant FSH. The pen device is used for the subcutaneous injection of a pre-mixed ready-to-use solution of follitropin beta from a multiple-dose cartridge, and has flexible dosing capabilities. In the ease-of-use questionnaire, 90% of subjects rated the overall experience of self-injecting follitropin beta using the pen device as 'very good' (on day 6). The comprehension questionnaire revealed that prior to the first injection and during the second injection, the follitropin beta cartridge was properly loaded into the pen device by 96.7 and 100% of the subjects respectively. The questionnaire also showed that the correct dose was selected and self-administered by 98.3 and 100% of the subjects respectively. Biochemical and ongoing pregnancy rates per attempt were 56.7 and 45.0% respectively. The pen device is safe, effective, and easy to use for self-administering recombinant FSH during ovarian stimulation.

Spectral karyotyping analysis of head and neck squamous cell carcinoma

OBJECTIVES/HYPOTHESIS

The genetic content of head and neck squamous cell carcinomas is ill defined. Spectral karyotyping (SKY) is a new technique that allows the simultaneous detection of all chromosomal translocations by labeling each individual chromosome with different fluorescent agents. In the current study we used SKY to analyze cell lines and a primary tumor derived from head and neck squamous cell carcinomas (HNSCC) to delineate recurrent translocations and breakpoints.

STUDY DESIGN

Spectral karyotyping analysis of head and neck cancer.

METHODS

Two cell lines (MDA886 and MSK922) and one primary tumor in short-term culture were subjected to metaphase growth arrest with colcemide in their exponential growth phase and fixed onto glass slides. Painting probes for each of the autosomes and the sex chromosomes were generated from flow-sorted human chromosomes using sequence-independent DNA amplification. The probes were labeled using a polymerase chain reaction-based reaction and hybridized to metaphase preparations for 2 days at 37 degrees C. Biotinylated probes were detected using avidin Cy5 and digoxigenin-labeled probes with an anti-mouse digoxigenin antibody followed by goat anti-mouse antibody conjugated to Cy5.5. Chromosomes were counterstained with 4,6-diamino-2-phenyliodole (DAPI), and a minimum of five metaphases were captured and analyzed for each case. Breakpoints on the SKY-painted chromosomes were determined by comparison of corresponding DAPI banding.

RESULTS

Spectral karyotyping analysis revealed a complex pattern of chromosomal abnormalities. A total of 66 translocations were identified in the three cases, with one new recurrent translocation at (der(4)t(4;20)(q35;?)). Nine complex translocations, involving three or more chromosomes, were identified in these cases. Overall, 96 breakpoints were assigned to metaphase chromosomes and another 74 breakpoints could not be assigned. Breakpoints most commonly involved chromosomes in genetic rearrangements were 1, 3, 5, 8, 13, 16, and 17.

CONCLUSIONS

Spectral karyotyping analysis reveals the true complexity of chromosomal aberrations in cell lines derived from head and neck squamous cell carcinomas. The use of SKY, in combination with other techniques, may allow for a more complete assessment of the genetic abnormalities of head and neck cancers and serve as a starting point for gene identification.

Second-harmonic tomography of tissues

A novel noninvasive second-harmonic-generation tomographic method of mapping the structure of animal tissues by use of 100-fs laser pulses at 625nm is described. Subsurface structures were measured with this approach, which is potentially a symmetry-sensitive tool for optical histological reconstruction.

Native cellular fluorescence and its application to cancer prevention

Native cellular fluorescence (NCF) represents the innate capacity of tissues to absorb and emit light of specified wavelengths. Recent advances in optical engineering and computer technology have provided the, opportunity to measure NCF characteristics of various tissues in vivo. This report will briefly review the current status of NCF analysis of various neoplastic tissues. The status of investigations involving the upper aerodigestive tract will be discussed. Though initial results demonstrate that neoplastic tissues can be discriminated from normal mucosa by NCF analysis, the biologic basis of this difference remains uncertain. This report will also emphasize that the ability to screen for cancer in aerodigestive mucosa may be enhanced through the assessment of multiple emission and excitation wavelengths. The true nature of the cellular fluorophores responsible for these mucosal spectral characteristics should be more fully defined in coming years.

The clinical pathology of heartwater. III. Changes in blood clotting, blood calcium, blood protein, haematocrit and white-cell counts in sheep with experimentally induced heartwater

Studies to evaluate changes in blood clotting, blood calcium and protein, the haematocrit and white-cell counts were undertaken in seven sheep with experimentally induced heartwater. A marked decline in thrombocyte count was recorded during the acute stage of the disease. This was associated with increases in both prothrombin time (PT) and activated partial thromboplastin time (APTT); fibrinogen increased while there was no detectable increase in fibrinogen degradation products (FDP). At the same time total serum protein (TSP), albumin and globulin dropped very sharply; total calcium showed a progressive drop but ionized calcium rose initially and was followed by a terminal decline. The total leucocyte count showed a terminal increase while the haematocrit dropped progressively.

The analysis of natural killer cell activity by flow cytometry

A flow cytometric assay was used to detect the lytic and binding capacities of both fresh peripheral blood lymphocytes and purified Leu-19+ natural killer cells against head and neck cancer cell lines. Results demonstrated that natural killer cell-mediated cytotoxicity and effector-target conjugate formation evaluated by flow cytometry was significantly correlated with the standard chromium 51 release assay and the single-cell microscopic assay, respectively. The sorted Leu-19+ natural killer cells demonstrated higher lytic capacity with a corresponding higher binding rate compared with the unsorted peripheral blood lymphocytes and sorted Leu-19- cells. Flow cytometric analysis of natural killer cell activity (a rapid, simple, and quantifiable procedure) is an alternative to the standard chromium 51 release assay.

Ca2+ absorption in the pars recta of cortical S2 rabbit proximal tubules: role of diffusion

Individual partes rectae of cortical S2 proximal tubules were dissected from rabbit kidneys and perfused in vitro. The bath was a protein-free, plasmalike solution, whereas the perfusate simulated "late" proximal tubular fluid (high [Cl-], low [HCO3-], absence of Na+-cotransported solutes). Transepithelial voltages at the perfusion and collection ends were measured simultaneously in doubly cannulated tubules. Ionized calcium concentrations in perfusates, collectates, and the bath were calculated from measurements of calcium ion activities made in situ with Ca2+-selective microelectrodes. Epithelial calcium permeability was estimated from the bath-to-lumen movement of 45Ca. Total calcium concentrations of perfused and collected fluids were measured by continuous-flow microcolorimetry. Under these conditions there was a lumen-positive transepithelial voltage that was equal at both ends of the tubules. Luminal [Ca2+] [corrected], which decreased along the length of the tubule, was greater than that of the bath. Using the measured calcium permeability, we calculated the diffusional component of the net calcium absorptive flux from the mean transepithelial delta [Ca2+] and the measured transepithelial voltage. We found that ionic diffusion accounted for the net flux, suggesting that diffusion is the primary mechanism of calcium absorption in this segment of the rabbit nephron.

Recurrent reversible acute renal failure from amphotericin

A patient with cryptogenic cirrhosis and disseminated sporotrichosis developed acute renal failure immediately following the administration of amphotericin B on four separate occasions. The abruptness of the renal failure and its reversibility within days suggests that there was a functional component to the renal dysfunction. We propose that amphotericin, in the setting of reduced effective arterial volume, may activate tubuloglomerular feedback, thereby contributing to acute renal failure.

Ventricular tachycardia in acute rheumatic fever

A 19-year-old man presented with fever, migratory polyarthritis, and palpitations; a diagnosis of acute rheumatic fever was made. Twenty-four-hour ambulatory cardiac monitoring (Holter) performed during the patient's hospitalization revealed ventricular tachycardia. Although disturbances in cardiac conduction and rhythm are common during the acute phase of rheumatic fever, malignant ventricular arrhythmias, to our knowledge, have not been described. Recognition of this occurrence emphasizes the need for continuous cardiac monitoring in selected patients.

Sodium-potassium-ATPase activity is influenced by ethnic origin and not by obesity

Previous investigations have suggested that red-cell ouabain binding (an indirect measure of sodium-potassium-ATPase activity) is lower in severely obese patients than in normal controls. We now confirm that ouabain binding measures sodium-potassium-ATPase activity, and we demonstrate that the level of this activity is genetically determined. The activity of this enzyme differs in various ethnic and racial groups, relatively high levels being encountered in non-Jewish white subjects, particularly those with some Scandinavian ancestry. On the other hand, black, Asian, and Jewish white subjects have lower sodium-potassium-ATPase activity. In contrast, no difference was found in red-cell sodium-potassium-ATPase activity between severely obese and normal persons, nor could we confirm a putative effect of food intake on the level of the red-cell enzyme. We suggest that in most earlier studies in which differences were found between normal and severely obese persons, those differences could have been due to differences in the ethnic origins of the obese and control populations.