A novel variant in the tropomyosin 3 gene presenting as an adult-onset distal myopathy - a case report

BACKGROUND

We report a patient with a novel c.737 C > T variant (p.Ser246Leu) of the TPM3 gene presenting with adult-onset distal myopathy.

CASE PRESENTATION

A 35-year-old Chinese male patient presented with a history of progressive finger weakness. Physical examination revealed differential finger extension weakness, together with predominant finger abduction, elbow flexion, ankle dorsiflexion and toe extension weakness. Muscle MRI showed disproportionate fatty infiltration of the glutei, sartorius and extensor digitorum longus muscles without significant wasting. Muscle biopsy and ultrastructural examination showed a non-specific myopathic pattern without nemaline or cap inclusions. Genetic sequencing revealed a novel heterozygous p.Ser246Leu variant (c.737C>T) of the TPM3 gene which is predicted to be pathogenic. This variant is located in the area of the TPM3 gene where the protein product interacts with actin at position Asp25 of actin. Mutations of TPM3 in these loci have been shown to alter the sensitivity of thin filaments to the influx of calcium ions.

CONCLUSION

This report further expands the phenotypic spectrum of myopathies associated with TPM3 mutations, as mutations in TPM3 had not previously been reported with adult-onset distal myopathy. We also discuss the interpretation of variants of unknown significance in patients with TPM3 mutations and summarise the typical muscle MRI findings of patients with TPM3 mutations.

Unique Clinical, Radiological and Histopathological Characteristics of a Southeast Asian Cohort of Patients with Limb-Girdle Muscular Dystrophy 2G/LGMD-R7-Telethonin-Related

AIM

We describe a cohort of five patients with limb-girdle muscular dystrophy (LGMD) 2G/LGMD-R7 in a South-east Asian cohort.

BACKGROUND

LGMD2G/LGMD-R7-telethonin-related is caused by mutations in the TCAP gene that encodes for telethonin.

METHODS

We identified consecutive patients with LGMD2G/LGMD-R7-telethonin-related, diagnosed at the National Neuroscience Institute (NNI) and National University Hospital (NUH) between January 2000 and June 2021.

RESULTS

At onset, three patients presented with proximal lower limb weakness, one patient presented with Achilles tendon contractures, and one patient presented with delayed gross motor milestones. At last follow up, three patients had a limb girdle pattern of muscle weakness and two had a facioscapular humeral pattern of weakness. Whole body muscle MRI performed for one patient with a facioscapular-humeral pattern of weakness showed a pattern of muscle atrophy similar to facioscapular-humeral dystrophy. One patient had histological features consistent with myofibrillar myopathy; electron microscopy confirmed the disruption of myofibrillar architecture. One patients also had reduced staining to telethonin antibody on immunohistochemistry.

CONCLUSION

We report the unique clinical and histological features of a Southeast Asian cohort of five patients with LGMD2G/LGMD-R7-telethonin-related muscular dystrophy and further expand its clinical and histopathological spectrum.

Phase IV clinical trial with a single treatment arm to evaluate bronchopulmonary penetration of isavuconazole in pulmonary transplant recipients (PBISA01): Study protocol clinical trial. (Preprint)

Background

Aspergillosis is the most frequently observed invasive fungal disease (IFD) in lung transplant recipients. Isavuconazole (ISA) has shown a better safety profile and noninferiority to voriconazole in the treatment of patients with IFD.

Objective

The aim of this study is to describe the bronchopulmonary pharmacokinetic profile of oral ISA by analyzing the degree of penetration in the epithelial lining fluid and alveolar macrophages in patients receiving lung transplantation with a diagnosis of IFD.

Methods

A total of 12 patients aged ≥18 years receiving a lung transplant with an IFD diagnosis and indication for ISA treatment and follow-up bronchoscopy will be included in the study. After 5 days of treatment with ISA and before the treatment is discontinued, the patients will be randomized (1:1:1:1) to perform the scheduled bronchoscopy at various times after the administration of ISA (2, 4, 8, and 12 hours). In total, 4 blood samples will be obtained per patient: at 72 hours after treatment initiation, on the day of the bronchoscopy, at the time of the bronchoalveolar lavage (simultaneously), and at 7 days after treatment initiation, to analyze tacrolimus and ISA plasma levels. ISA concentrations will be measured in plasma, epithelial lining fluid, and alveolar macrophages by a high-performance liquid chromatography/UV coupled to fluorescence method.

Results

Enrollment for the PBISA01 trial began in October 2020 and was completed in October 2021. All samples will be analyzed once recruitment is complete, and the results are expected to be published in October 2022.

Conclusions

There are no clinical studies that analyze the bronchopulmonary penetration of ISA. Bronchoalveolar lavage performed routinely in the follow-up of lung transplant recipients constitutes an opportunity to analyze the bronchopulmonary penetration of ISA.

Trial Registration

European Clinical Trials Register 2019-004240-30; www.clinicaltrialsregister.eu/ctr-search/trial/2019-004240-30/ES

International Registered Report Identifier (IRRID)

DERR1-10.2196/37275

Stem cell transplantation into the intraventricular space via an Ommaya reservoir in a patient with amyotrophic lateral sclerosis

Stem cells have been highlighted for a possible clinical trial in amyotrophic lateral sclerosis (ALS), and have been employed in SOD1 mice and ALS patients. Human trials for stem cell transplantations have used intrathecal route by lumbar puncture. However, stem cells introduced via lumbar injection would tend to sink downwards rather than ascending to the brain and cervical and thoracic spinal cord. Therefore, we adopted for intraventricular injection via an Ommaya reservoir, and wished to test the practicality of intraventricular stem cell injection in ALS. In the case presented autologous mesenchymal stromal cells (MSCs) were isolated from the bone marrow of a male patient with ALS who underwent insertion of an Ommaya reservoir. Expanded MSCs (hBM-MSCs: dose of 1 X 106 cells/kg) were suspended in autologous CSF and directly transplanted into the ALS patient's lateral ventricle via the Ommaya reservoir. Clinical, laboratory, and radiographic evaluation of the patient revealed no serious adverse effects related to the stem cell therapy. Intraventricular injection with an optimized number of cells is safe, and is a potential route for stem cell therapy in patients with ALS. Intraventricular injection via an Ommaya reservoir makes repetitive injection of stem cells easy and reliable even in far advanced ALS patients.

Wide thumb and the first web reconstruction using a neurovascularised instep free flap

Deformed hands result in palmar defects of the thumb. The sensate instep free flap can be used for wide palmar coverage of the thumb. Three hands with palmar defects of the thumb extended to the first web space underwent soft-tissue reconstruction using a neurovascular instep free flap. These flaps provided sensate coverage with static two-point discrimination values of 8-15 mm. Key pinch strengths of reconstructed thumbs were nearly half of those on the normal side. Donor foot morbidity was minimal with no hyperkeratosis. The neurovascular instep free flap supplies sensate, similar pliable and tough glabrous skin to the palmar surface of the thumb extended to the first web area.

Low rate of total hip replacement as reflected by a low prevalence of hip osteoarthritis in South Korea

OBJECTIVE

We attempted to estimate the rate of total hip replacement (THR) using a national database and the prevalence of hip osteoarthritis (OA) from the reading of intravenous pyelograms (IVPs) in a Korean population.

MATERIALS

Reimbursement records from all hospitals in South Korea were extracted from the Health Insurance Review Agency (HIRA) database. Records with both the procedure code corresponding to THR and containing the diagnosis code for hip OA were selected. We estimated the age- and sex-specific rates of THR from 2002 to 2006. Hip joints from 580 subjects older than 70 years old who underwent an IVP were assessed for the presence of OA.

RESULTS

The rate of THR increased with age, reaching a peak over the age of 65-69 years, with the age-standardized risk ratios in women vs men of approximately 1.5. Although the rate of THR increased over the 5-year study period, it was significantly lower than that of total knee replacement (TKR) in Korean population (THR vs TKR 1:15.9). The prevalence of hip OA in the IVP cohort was 1.2% (1.7% for men and 0.7% for women).

CONCLUSION

The rate of THR was significantly lower than that of TKR in Korean population. Hip OA prevalence among the IVP subjects was 1.2%. Further studies on factors that account for the low prevalence of hip OA among Asians need to be conducted.

Haemodynamic effects of oxytocin given as i.v. bolus or infusion on women undergoing Caesarean section

BACKGROUND

The cardiovascular effects of oxytocin in animal models and women undergoing Caesarean section include tachycardia, hypotension and decrease in cardiac output. These can be sufficient to cause significant compromise in high-risk patients. We aimed to find a simple way to decrease these risks whilst retaining the benefits of oxytocin in decreasing bleeding after delivery. Method. We recruited 30 women undergoing elective Caesarean section. They were randomly allocated to receive 5 u of oxytocin either as a bolus injection (bolus group) or an infusion over 5 min (infusion group). These women had their heart rate and intra-arterial blood pressure recorded every 5 s throughout the procedure. The haemodynamic data, along with the estimated blood loss, were compared between the groups.

RESULTS

Marked cardiovascular changes occurred in the bolus group; the heart rate increased by 17 (10.7) beats min(-1) [mean (sd)] compared with 10 (9.7) beats min(-1) in the infusion group. The mean arterial pressure decreased by 27 (7.6) mm Hg in the bolus group compared with 8 (8.7) mm Hg in the infusion group. There were no differences in the estimated blood loss between the two groups.

CONCLUSION

We recommend that bolus doses should be used with caution, and further studies should ascertain if oxytocin is equally effective in reducing blood loss when given at a slower rate.

Ocular flutter induced only by optokinetic stimulation

Ocular flutter (OF) refers to occasional bursts of involuntary horizontal oscillation around the point of fixation, characterised by rapid horizontal repetitive oscillation without intersaccadic interval in electro-ocular recording. In spite of numerous reports of OF, there has been no previous report describing OF developed by simply looking at moving objects. We report a patient with olivopontocerebellar atrophy (OPCA), with OF induced only by optokinetic stimulation (OKS). A 65-year-old man, with OPCA complained of dizziness and oscillopsia occurring only with a specific type of eye movement. The electro-oculographic recording showed a decreased gain of pursuit, catch-up saccade, and decreased velocity of saccade, and OF was induced only by OKS of more than 40 degrees /second. In OPCA, partial loss of omnipause neurons and/or abnormal firing of burst neurons, especially those involved in optokinetic movement, could be the cause of OF occurring only with OKS.

Tensile bond strengths of fourth- and fifth-generation dentin adhesives with packable resin composites

PURPOSE

Placement of packable composites would be simplified if a single-bottle dentin bonding agent, rather than the more complex, multiple-bottle dentin bonding agents, involving multiple steps, could be used successfully with adequate bond strength. This study was designed to compare the tensile bond strengths to extracted human dentin of four single-bottle (fifth-generation) and four multiple-bottle (fourth-generation) dentin bonding agents with four packable composites.

MATERIALS AND METHODS

Packable composites (P60, 3M Dental Products Division; ALERT, Jeneric-Pentron; Pyramid Dentin, Bisco; and Clearfil AP-X, Kuraray America) were tested for in vitro tensile bond strength to human dentin with their single-bottle and their multiple-bottle dentin bonding agents. Bond strengths were measured using a truncated cone tensile test, with a bonding diameter of 3 mm, after storage of specimens in water at 37 degrees C and 100% relative humidity for 24 hours, and using a testing machine at a crosshead speed of 0.5 mm per minute.

RESULTS

Means and standard deviations (n = 10) of tensile bond strengths (MPa) for the single-bottle system were P60, 21.3 MPa (6.7); ALERT, 26.6 MPa (4.2); Pyramid Dentin, 14.8 MPa (4.4); and Clearfil AP-X, 18.6 MPa (3.7). For the multiple-bottle system they were P60, 20.0 MPa (8.6); ALERT, 20.6 MPa (6.2); Pyramid Dentin, 16.0 MPa (3.4); and Clearfil AP-X, 17.8 MPa (6.0). Two-way analysis of variance showed significant differences among composites but no significant differences between single-bottle and multiple-bottle bonding agents. The Tukey-Kramer interval (p < .05) for comparisons of bond strengths among composites was 4.8 MPa.

CONCLUSIONS

For single-bottle agents, bond strengths were ranked as ALERT > P60, P60 = Clearfil, P60 > Pyramid, and Clearfil = Pyramid. For multiple-bottle agents, there were no significant differences in bond strengths among the composites.

CLINICAL SIGNIFICANCE

Single-bottle bonding agents provide similar in vitro bond strengths for use with packable composites as do the same manufacturers' multiple-bottle bonding agents.

Spinocerebellar ataxia type 6 and episodic ataxia type 2 in a Korean family

Spinocerebellar ataxia type 6 (SCA6), episodic ataxia type 2 (EA2) and familial hemiplegic migraine (FHM) have been known as allelic disorders, which are caused by the alteration of the alpha1A voltage-dependent calcium channel subunit. Expansions of the CAG repeat in the CACNA1A gene on the short arm of the chromosome 19 induce SCA6, and point mutations in the same gene are responsible for EA2 and FHM. In recent studies, both SCA6 and EA2 have been concurrently found in families with 26 CAG repeats without previously reported point mutations either in coding sequences or in intron-exon junctions. We describe a Korean family with CAG26 repeats in the CACNA1A gene. Some of the affected family members had progressive ataxia typical of SCA6 whereas others had episodic vertigo responsive to acetazolamide typical of EA2. Our family support that SCA6 and EA2 are allelic disorders with a high phenotypic variability.

A high-resolution add-on in-lens attachment for scanning electron microscopes

A compact add-on objective lens for the scanning electron microscope (SEM) has been designed and tested. The lens is < 35 mm high and can be fitted on to the specimen stage as an easy-to-use attachment. Initial results show that it typically improves the spatial resolution of the SEM by a factor of three. The add-on unit is based upon a permanent magnet immersion lens design. Apart from the extra attachment to the specimen stage, the SEM with the add-on lens functions in the normal way. The in-lens unit can comfortably accommodate specimen heights up to 10 mm. The new add-on lens unit opens up the possibility of operating existing SEMs in the high-resolution in-lens mode. By using a deflector at the top of the add-on lens unit, it can also operate as a quantitative multichannel voltage contrast spectrometer, capable of recording the energy spectrum of the emitted secondary electrons. Initial experiments confirm that a significant amount of voltage contrast can be obtained.

Changes in expression of sodium cotransporters and aquaporin-2 during ischemia-reperfusion injury in rabbit kidney

Ischemic renal injury is associated with defects in transport functions of the proximal tubules and urinary concentration ability. To determine whether alterations in expression of various transporter genes contribute to an impairment in renal functions, the expression of various solute transport genes was analyzed in renal cortex and medulla of rabbits with ischemic acute renal failure. Rabbits were subjected to 60 min of renal pedicle clamping followed by 24, 48, or 72 h of reperfusion. Urine volume and glomerular filtration rate were markedly decreased, which were accompanied by an increase in serum creatinine level and fraction Na+ excretion. Glucosuria and phosphaturia were evident during reperfusion periods. These alterations in renal functions were persisted to 72 h after reperfusion. The Na+-dependent uptakes of glucose and phosphate by brush border membrane vesicles were inhibited by 24 h of reperfusion. mRNA levels for Na+-glucose, Na+-phosphate, and Na+-succinate cotransporter analyzed by RT-PCR were not changed by 60 min of ischemia alone, but were significantly reduced by 24 h of reperfusion. mRNA levels for apical Na+-K+-2Cl- cotransporter, NaCl cotransporter, and turea transporter in the medulla were not changed during reperfusion. Protein levels for AQP2 in the medulla, but not AQP1 in the cortex, analyzed by Western blot were significantly reduced at 24 h after reperfusion. These results suggest that reductions in expression of Na+-cotransporter genes in the proximal tubules may be important factors in the impairment in Na+-dependent reabsorption of solutes and that decrease in AQP2 protein may be involved in defect in urinary concentration ability in rabbits with ischemic acute renal failure.

Effects of topical fluoride treatment on tensile bond strength of pit and fissure sealants

Clinicians often do not place pit and fissure sealants immediately after topical fluoride treatment because fluoride treatment might reduce bonding to enamel. The effect of NaF, SnF2, and APF on the in-vitro bond strength of two sealants to enamel was determined. The fluoride treatments and control (artificial saliva) were applied to enamel surfaces for four minutes and rinsed. A filled sealant (FluoroShield) and an unfilled sealant (Concise) were bonded to the etched enamel and debonded in tension using a universal testing machine. NaF increased the bond strength of the unfilled sealant; SnF2 and APF had no significant effect. NaF and APF decreased the bond strength of filled sealant while SnF2 had no significant effect. The bond strength of the filled sealant was higher than or equal to that of the unfilled sealant. Exposure of enamel to NaF, SnF2, or APF prior to placement of unfilled or filled sealants has no effect on in vitro bond strength between the enamel and the sealants.

Fluoride content in caffeinated, decaffeinated and herbal teas

The fluoride contents of infusions prepared from 44 different brands and types of teas were measured. Fluoride concentrations ranged from 0.34 to 3.71 ppm (mean = 1.50 ppm) in caffeinated tea infusions, 0.02-0.14 ppm (mean = 0.05 ppm) in herbal tea infusions, and 1.01-5.20 ppm (mean = 3.19) in decaffeinated tea infusions. This is the first report of the fluoride content of decaffeinated teas. The mean fluoride content of decaffeinated tea infusions is significantly (p < 0.01) higher than the corresponding caffeinated tea. The use of mineral water containing a naturally high fluoride level during the process of decaffeination is the most likely explanation of the above observation.

Histocompatibility antigens and habitual abortion

Eighty-five couples with habitual abortion were studied: 43 were primary aborters (i.e., had no advanced pregnancy beyond 20 weeks gestation), and 42 were secondary aborters. The only significant finding in primary female aborters was a reduction in the incidence of B35. In contrast, in secondary female aborters there was a reduction in the incidence of DR3 and A1/B8/DR3 and an increase in the degree of homozygosity of HLA B. In the male partners of primary aborters, there was a reduced incidence of DR3 and A1/B8/DR3. In addition, in male partners of both primary and secondary aborters, there was increased HLA-B homozygosity and increased frequency of DR4-5 phenotype. Increased sharing of HLA antigens between partners was not found to be significantly different from the control population. These findings emphasize that primary and secondary female aborters form distinct populations, which could explain differences in immunological responses to various antigens, including fetal-related antigens. The closely related findings in female secondary aborters and male partners of primary aborters are intriguing but cannot be explained. Whether or not these genetic markers bear any relationship to reproductive success remains to be determined.

Immunogenetic studies in habitual abortion

Recent evidence suggests that immunological factors could play a role in the aetiology of habitual abortion. In this study, 71 couples with habitual abortion (i.e. more than 3 successive abortions) were investigated. Sharing of HLA-A, B, DR between partners was not found to be significantly increased. Anti-HLA antibodies in women against their partners' lymphocytes were found in 18.3%. After immunization with 10(7)-10(8) lymphocytes obtained from husband or unrelated donor, there was a seroconversion rate of 61% in those without antibodies initially. This was not dependent on the number of cells injected, source of cells, degree of sharing of HLA antigens or whether the couple were primary aborters (i.e. having had no advanced pregnancy), or secondary aborters. Seven pregnancies have resulted following the immunization procedure so far, 5 occurring in cross-match positive patients and 2 in cross-match negative. Growth retarded infants resulted from the pregnancy of 1 primary aborter and 2 secondary aborters.

Correlation between cytoplasmic steroid receptors and tumour differentiation and invasion in endometrial carcinoma

The incidence and levels of cytoplasmic steroid receptors were studied in 155 endometrial carcinomas: oestrogen receptors (ER) were measured in all samples, progesterone receptors (PR) in 148 and androgen receptors (AR) in 118. Well-differentiated adenocarcinomas were significantly more likely to contain ER, PR and AR than were poorly-differentiated tumours, and mean values of ER and PR content were significantly higher in well-differentiated adenocarcinomas than in less-differentiated tumours. Receptor profiles in adenosquamous carcinomas and clear-cell carcinomas were similar to those in adenocarcinomas. Deeply invasive tumours were significantly less likely to be ER, PR or AR positive and, even when positive, such tumours had significantly lower mean levels of ER and PR. Poorly-differentiated tumours were significantly more likely to be ER-negative PR-positive than well-differentiated adenocarcinomas and adenosquamous carcinomas.

Increased frequency of autoantibodies in men with sperm antibodies

Autoantibodies to thyroid microsomes were more frequent in 102 infertile men with complement-dependent sperm-immobilizing activity (sperm immobilization test [SIT] ) in serum (11.8%) than in a control group of 277 men of comparable ages and semen quality without sperm antibodies (4.3%, P less than 0.05). Frequencies of organ-specific antibodies (antigastric parietal cell, antithyroglobulin, and antithyroid microsome) in 57 men with genital tract obstructions and positive SIT were similar to those for control subjects, and there were no significant differences in the frequencies of non-organ-specific autoantibodies (antinuclear antibody, rheumatoid factor, antimitochondrial, and anti-smooth muscle) in the three groups. Because in men without genital tract obstruction antithyroid microsomal autoantibodies were more common with sperm antibodies than without, the possibility of a genetic factor in the causation of sperm autoimmunity should be considered.

Sperm antibodies, immunoglobulins, and complement in human follicular fluid

The levels of immunoglobulins (IgG, IgA, IgM), complement (C3, C4, C1EI) and sperm antibodies were determined in plasma and follicular fluid samples from 26 patients undergoing in vitro fertilization (IVF) treatment. The results show that IgG, IgA, C3, C4, and C1EI concentrations in follicular fluid are similar to plasma concentrations (63.1-96.1% of plasma levels). The follicular fluid concentration of IgM was severely reduced, however, being only approximately 10% of plasma concentrations. Sperm antibody titres were compared in three patients using sperm agglutination, immobilization, and immunobead binding. The titres in plasma and follicular fluid were similar, apart from antibodies of IgM class, which were undetectable in follicular fluid.

Oncofetal antigens in ovarian cyst fluids

The levels of five oncofetal antigens were measured in ovarian cyst fluids. Significantly raised levels of carcinoembryonic antigen (CEA), human chorionic gonadotropin, beta 2-microglobulin, and alpha-fetoprotein were found in ovarian cyst samples. Human placental lactogen was not detectable in any samples. Mucinous cyst fluids demonstrated higher levels of CEA than serous fluids in both malignant and benign conditions. We could not distinguish between malignant and benign conditions with any of the markers. Except for CEA, there is no difference in values between mucinous and serous cystadenocarcinomas.

Prognostic significance of oncofetal antigens in patients with ovarian cancer

The prognostic significance of elevated oncofetal antigens, namely carcinoembryonic antigen (CEA), alphafetoprotein (AFP), and beta subunit of human chorionic gonadotrophin (beta HCG) were studied in 39 patients with cancer of the ovary. At low cut-off levels, (CEA greater than 2.5 micrograms/l, AFP greater than 5 micrograms/l, and beta HCG greater than 3 IU/l) the median survival was 21 months in patients with one or more positive markers compared to greater than 43 months in patients without markers. At high cut-off points (namely CEA greater than 10 micrograms/l, AFP greater than 10 micrograms/l and beta HCG greater than 10 IU/l), the median survival of patients having one or more positive markers was 10 months compared to greater than 46 months in patients with no markers. Using linear regression and Logrank analysis, the difference between the observed and expected death rate was significant (P less than 0.05 at low cut-off levels, and less than 0.01 at high cut-off levels). These results indicate that patients who have one or more positive oncofetal markers on presentation are likely to have a significantly worse prognosis than patients without markers. Moreover, higher levels of oncofetal markers are associated with correspondingly worse prognosis.

The effect of calfhood vaccination with strain 19 on the serological diagnosis and eradication of bovine brucellosis

Data from 42,224 cattle from 694 herds collected during the brucellosis eradication campaign were used to examine the effects of calfhood strain 19 vaccination. The prevalence to infection in vaccinated herds was 1.8% compared with 9.1% in non-vaccinated herds (p less than 0.005). The mean titre in the former group was lower (p less than 0.001). Vaccinated herds required 3.3 herd tests to achieve a provisionally free status compared with 4.8 in non-vaccinated herds (0.001 less than p less than 0.005). Vaccination did not significantly reduce the number of herd test in herds with less than 100 breeding females. In tests after the initial herd test only 0.5% reactors were found in vaccinated herds compared with 6.9% in non-vaccinated herds (p less than 0.005). There were 0.9% false positive to the Rose Bengal plate test in non-vaccinated and 2.1% in vaccinated animals (p less than 0.005) in non-infected herds. In infected herds this percentage was 3.0% and 4.2% respectively by (p less than 0.05). In the non-infected herds there were 0.04% false positives to the complement fixation tests out of 10,506 non-vaccinated cattle tested and 0.2% out of 24,734 vaccinated cattle.

Oncofoetal antigens in cancer of the cervix and ovary

The incidence of oncofoetal antigens has been reported to be increased in patients with gynaecological cancers. In this study the incidence of CEA, AFP, and hCG (beta subunit) were studied in patients with adenocarcinoma of the ovary, adenocarcinoma of the cervix, and squamous-cell carcinoma of the cervix. Using a low cut-off point (CEA 2.5 microgram/l, AFP 5 microgram/l, and hCG 3 i.u./l) there is an unacceptably high proportion of control patients having one or more positive tests (42-54%) compared to cancer-bearing patients (67%). The specificity of the tests can be increased to over 95% by increasing the cut-off point to CEA 10 microgram/l, AFP 10 microgram/l, and hCG 10 i.u./l). Although this reduces the sensitivity considerably, the incidence of false positives in the control population is reduced to nil in non-cancer patients and to 2% in cancer patients tested when free of tumour, compared to 17% of patients with cancer of the ovary, 33% with adenocarcinoma of the cervix, and 6% with squamous-cell carcinoma of the cervix. Patients with adenocarcinoma of the cervix were clearly distinguishable from those with squamous-cell carcinoma of the cervix by these tests. There was also a significant correlation between AFP and hCG levels in adenocarcinoma of the cervix (r = 0.53, P less than 0.05).

The Production of beta 1-specific pregnancy glycoprotein (SP1) by the amnion

Using indirect immunofluorescence, beta 1-specific pregnancy glycoprotein (SP1) was localised to the amnion cells, as well as to trophoblastic cells. Cultures of fragments of amnion incubated with 3H-leucine for up to 72 h demonstrated that protein was synthesized by the amnion. Using antisera specific to SP1 it was shown that after 72 h incubation about 50% of the total protein could be precipitated. These studies demonstrate that the amnion cells are actively involved in the synthesis of SP1 and could account for the high level of this glycoprotein in amniotic fluid.

Control of concanavalin A receptor mobility by cytoplasmic actin in human tumour cells

Tissue culture monolayers of seven human intracranial tumours comprising 2 astrocytomas, 3 meningiomas, 1 secondary squamous cell carcinoma and 1 secondary adenocarcinoma were examined by a double immunofluorescent staining technique to demonstrate Concanavalin A (Con A) surface receptors and cytoplasmic actin in the same cell. Tumour cells, treated with fluoresceinisothiocyanate-labelled Con A (FITC-Con A) showed staining in cell margins or in a random distribution over the cell surface. Incubating the cells with FITC-Con A at 37 degrees for increasing periods of time resulted first in staining of clusters and later of perinuclear globules. Cells, pretreated with 4% paraformaldehyde at 4 degrees for 10 min or with cytochalasin B at 37 degrees for 30 min showed staining restricted to cell margins. In the cytochalasin B-treated cells, the peripheral staining was in the form of coarse clusters. Double fluorochrome studies showed that the anti-actin antibody (AAA) staining occurred in sites closely related to those stained by FITC-Con A both in untreated as well as in cytochalasin B-treated cells. The findings suggest that Con A receptors, as an example of a stable cell membrane determinant in human tumour cells, are associated with actin and that their mobility on the cell surface is dependent on an intact cytoplasmic actin system.