Veno-occlusive disease of the liver after busulfan, melphalan, and thiotepa conditioning therapy: incidence, risk factors, and outcome

The purpose of this study was to determine the incidence of veno-occlusive disease (VOD) after a high-dose regimen of busulfan, melphalan, and thiotepa and the risk factors for a more severe outcome. We followed 253 consecutive patients with malignant disorders who received autologous transplants after stem cell harvest followed by 12 mg/kg busulfan, 100 mg/m2 melphalan, and 500 mg/m2 thiotepa. Diagnosis of VOD was based on weight gain, hepatomegaly, and jaundice. Risk factors for moderate or severe VOD were identified using logistic regression models. VOD occurred in 70 of 253 patients (28%), of whom 31 (12%) had moderate and 11 (4%) severe VOD. The median day of onset of hyperbilirubinemia was day 9, significantly later than the onset of jaundice after our cyclophosphamide-based regimens (p < 0.001). Resolution of weight gain and jaundice, followed by their reappearance several weeks later, occurred in 23 of 70 patients with VOD and was an adverse prognostic sign. Risk factors for moderate or severe VOD were a diagnosis of lymphoma or myeloma (odds ratio [OR] 2.65 compared with breast cancer), tumor involvement in the liver (OR 3.95), fever in the month before transplant (OR 3.32), and prior radiation therapy (OR 2.70). We conclude that VOD after busulfan, melphalan, and thiotepa was less frequent and less severe and developed later than VOD after our historical cyclophosphamide-based regimens. Significant risk factors included a diagnosis other than breast cancer, hepatic metastases, persistent fever, and prior radiation therapy. This study suggests that alkylating agents of comparable overall toxicity differ in their liver toxicity.

Molecular analysis of HLA-DR gene expression induced by IFN-gamma in malignant melanoma cell lines

Human leukocyte antigen (HLA) class II molecules are polymorphic cell surface glycoproteins that are crucial for the cellular interaction in immune response. The expression of class II molecules is regulated in a tissue-specific and cytokine-inducible manner, and is mainly restricted to the antigen presenting cells. However, some tumor cells also express class II molecules, and in some class-II-negative tumor cells, class II expression is inducible by interferon (IFN)-gamma. However, their expression varies, even though the tumor cells originate from the same histological origin; some tumor cells show strong expression, others show weak or no expression. To determine whether this differential expression of class II molecules on tumor cells is transcriptionally regulated, FACS analysis and Northern hybridization were performed using a panel of melanoma cell lines, IGR3, Malme-3M, SK-Mel-24, and SK-Mel-28 to analyze the cell surface expression and mRNA transcription rate of HLA-DR before and after treatment with IFN-gamma. FACS analysis showed that before IFN-gamma treatment, IGR3 and Malme-3M cells barely expressed HLA-DR. On the contrary, almost all of the SK-Mel-24 cells (> 90%) and a relatively high rate (> 50%) of SK-Mel-28 cells expressed HLA-DR. After IFN-gamma treatment, HLA-DR expression was induced in Malme-3M cells and SK-Mel-28 cells which displayed elevated levels of HLA-DR expression in a time-dependent manner. However, IGR3 cells never responded to IFN-gamma. Northern analysis showed that treatment with IFN-gamma led to the steady-state mRNA augmentation of the HLA-DR gene in Malme-3M and SK-Mel-28, whereas in IGR3, IFN-gamma did not augment the transcriptional rate of the HLA-DR gene. To further clarify this differential modulation, sequencing analysis of PCR product of the HLA-DR proximal promoter region was done, since the transcription rate of the class II gene is controlled by the well-conserved proximal promoter region. Six independent clones from PCR products of the HLA-DRA proximal promoter region and 16 clones from PCR products of the HLA-DRB proximal promoter region were isolated from the above cell lines and sequenced. Comparison of the nucleotide sequences of all 6 clones of DRA promoter showed that the sequences are extremely similar in both regulatory sequences and their intervening sequences. Sixteen clones of HLA-DRB promoter showed sequence variations such as substitution and insertion/deletion, and these 16 clones could be further grouped into 6 homologues with sequence homology. These data established that the melanoma cell lines studied here showed a differential susceptibility to IFN-gamma on the modulation of HLA-DR molecules, that this modulation is transcriptionally regulated, and that the difference in promoter activity by sequence variation might contribute to such a differential transcriptional regulation at the promoter level.

Purification and characterization of the tyrosinase isozymes of pine needles

Three tyrosinase isozymes were purified to electrophoretic homogeneity from pine needles. The molecular weight of the three isozymes (P1, P2 and P3) were approximately 65,000, 50,000 and 45,000, and the pI values were 6.2, 5.9 and 5.3, respectively. The three isozymes have a number of common properties. These include amino acid composition, substrate specificity, response to inhibition. The amino acid compositions of the three isozymes showed the characteristic high contents of glycine, serine and glutamic acid residues. The three isozymes exhibited high substrate specificity towards pyrogallol. The K(m) values of the three isozymes for L-DOPA ranged from 8.7 to 10 mM. L-ascorbic acid and beta -mercaptoethanol, glutathione and sodium diethyldithiocarbamate notably inhibited the enzymatic activities.

Induction of ICAM-1, HLA-DR molecules by IFN-gamma and oncogene expression in human bladder cancer cell lines

It is well known that the expression level of the ICAM-1 and MHC is frequently altered in accordance with tumor progression, and the expression of oncogenes is significantly related to tumorigenesis, tumor progression, and/or metastatic potential. In this study, to investigate the relationship between the alteration in ICAM-1 and MHC expression with the tumor grade and/or cell differentiation, we examined the expression of ICAM-1 and HLA-DR before and after treatment with IFN-gamma in 4 human bladder cancer cell lines. We also analyzed the expression of c-Ha-ras and c-myc. Using flow cytometry, highly constitutive expression of ICAM-1 was detected in all cell lines tested except RT4 (grade I, well-differentiated, superficial). IFN-gamma was found to somewhat induce the expression of ICAM-1 in all cell lines except RT4. The constitutive expression of HLA-DR was not detected in any of the cell lines tested by flow cytometry and Northern blot. HLA-DR expression was induced by IFN-gamma in RT4 and J82 (grade III, anaplastic, invasive). Codon 12 point mutation of c-Ha-ras (GGC-->GTC; Gly-->Val) was detected in T24 (grade III, epidermoid, superficial) through single-strand conformation polymorphism, and sequencing analysis. Another point mutation at codon 27 was detected in TCCSUP (grade IV, distant metastatic), but this mutation was found to be silent (CAT-->CAC; His). Expression of c-myc was detected in J82 and TCCSUP by Northern blot. These findings, along with the clinical and pathological characteristics of the patients from whom the cell lines were established, might suggest that the expression of ICAM-1 seems to be associated with cell differentiation, and the inducibility of HLA-DR by IFN-gamma seems to be associated with the degree of malignancy. Expression of c-myc seems to be associated with invasiveness. However, a significant correlation between c-Ha-ras activation and tumor grade could not be observed.

Utilization of Chinese medicine in Taiwan

This article examines the use of Chinese medicine in Taiwan. Based on a national sample survey, the authors investigated how Chinese medicine is being used and factors that are associated with its use among the Taiwanese. Results of the study suggest that Chinese medicine use among this population depends on health conditions, and that having a regular source of care for Chinese medicine as well as a preference for Chinese medicine are two predictors for its use. Policies on the integration of Chinese medicine or other traditional medicine into the modern healthcare system are recommended.

The pentanucleotide ATTGG, the "inverted CCAAT," is an essential element for HLA class I gene transcription

The HLA class I genes, HLA-A, -B, and -C, contain an inverted CCAAT sequence (ATTGG) located 20 bp upstream of the canonical CCAAT and approximately 70 bp upstream of the transcription initiation site. We have investigated the transcriptional function of the class I inverted CCAAT sequence using the HLA-normal cell line, HeLa. Deletion, mutation, or inversion of the inverted CCAAT sequence abrogated or reduced the activity of the class I promoter, as assessed by luciferase reporter gene assays in transient gene expression experiments. This activity coincided with occupancy of the inverted CCAAT motif, as tested by electrophoretic mobility shift assays using the wild-type sequence and mutated variants of the sequence. The ATTGG-binding protein was not CP2, NF-1, or other known CCAAT-binding proteins, but the complex may contain a CP1/NF-Y-like protein. Our results indicate that this inverted CCAAT sequence is an essential element for the expression of HLA class I genes and that its transcriptional activity depends upon the sequence, position, and orientation of the pentanucleotide.

The pentanucleotide ATTGG, the "inverted CCAAT," is an essential element for HLA class I gene transcription

The HLA class I genes, HLA-A, -B, and -C, contain an inverted CCAAT sequence (ATTGG) located 20 bp upstream of the canonical CCAAT and approximately 70 bp upstream of the transcription initiation site. We have investigated the transcriptional function of the class I inverted CCAAT sequence using the HLA-normal cell line, HeLa. Deletion, mutation, or inversion of the inverted CCAAT sequence abrogated or reduced the activity of the class I promoter, as assessed by luciferase reporter gene assays in transient gene expression experiments. This activity coincided with occupancy of the inverted CCAAT motif, as tested by electrophoretic mobility shift assays using the wild-type sequence and mutated variants of the sequence. The ATTGG-binding protein was not CP2, NF-1, or other known CCAAT-binding proteins, but the complex may contain a CP1/NF-Y-like protein. Our results indicate that this inverted CCAAT sequence is an essential element for the expression of HLA class I genes and that its transcriptional activity depends upon the sequence, position, and orientation of the pentanucleotide.

Treatment of hepatic venocclusive disease with recombinant human tissue plasminogen activator and heparin in 42 marrow transplant patients

The purpose of this report is to review the Fred Hutchinson Cancer Research Center experience of treating patients with venocclusive disease of the liver (VOD) after marrow transplantation using recombinant human tissue plasminogen activator (rh-tPA) and heparin. The charts of 42 patients who had received rh-tPA and heparin for the treatment of VOD between February 1991 and December 1995 were reviewed. Response to rh-tPA and heparin was defined as a reduction in total serum bilirubin by 50% within 10 days of starting treatment. Total serum bilirubin, percent weight gain, and serum creatinine before, after, and at the start of rh-tPA and heparin were examined to determine whether these laboratory values distinguished patients who responded to treatment from those who did not. We also evaluated whether evidence of multiorgan failure (requirement for supplemental oxygen, requirement for hemodialysis, requirement for mechanical ventilation) or whether the calculated probability of a fatal outcome from VOD could discriminate responders from nonresponders. In addition, the incidence and outcome of bleeding as a major complication of thrombolytic therapy was examined. Twelve patients responded to rh-tPA and heparin and 30 patients did not. There were no statistically significant differences between responders and nonresponders in the day treatment was started, dose of rh-tPA, total serum billirubin, and percent weight gain before, after, or at the start of treatment, or the calculated probability of dying from VOD on the day treatment with rh-tPA and heparin was begun. More nonresponding patients required dialysis or mechanical ventilation (11 of 30) before or at the start of rh-tPA and heparin than responding patients (0 of 12), P = .0183. Serum creatinine was greater at the start of treatment in nonresponding patients (1.9 +/- 1.3 mg/dL) than in responding patients (1.1 +/- 0.4 mg/dL), P = .0794. Ten patients had severe bleeding episodes, which resulted in death in three patients and may have contributed to death in an additional three patients. Treatment for VOD using rh-tPA and heparin was successful in 29% of patients but was associated with a significant risk of life-threatening hemorrhage. Requirement for supplemental oxygen, dialysis, or mechanical ventilation before the start of treatment were prognostic indicators of no response to thrombolytic therapy. We do not recommend treatment using tPA and heparin in patients with severe VOD who have already developed multiorgan dysfunction.

The practice of Chinese medicine in Taiwan

This paper examines the practice of Chinese medicine in Taiwan. Using a national sample survey of Chinese medicine physicians, supplemented by another national survey of Chinese medicine hospitals and government records, the authors study the education and training background of Chinese medicine physicians, their mode of practice, their productivity measured by patient visits, and the practice characteristics of Chinese medicine hospitals. Moreover, the authors investigate the relationship between the resource input, the public health insurance contract, and the number of patient visits Chinese medicine physicians provided. Results of this study are used to make several recommendations on the appropriate way of integrating the practice of Chinese medicine into the modern health care system. Many of these recommendations may also be applicable to other countries that are contemplating integrating traditional or alternative medicine into their health care systems.

Hydration, not silicone, modulates the effects of keratinocytes on fibroblasts

Topical silicone gel or silicone cream with occlusive dressing has proved to be an efficacious method for the treatment and prevention of hypertrophic scars and keloids, but how this action is triggered remains unknown. Hydration of the epidermis and/or the cellular effects of the released low-molecular-weight silicone oil have been suggested as possible mechanisms. In order to further elucidate the mechanism, we used an in vitro keratinocyte-fibroblast coculture model to investigate the cellular effects of silicone and hydration. In this model, the condition of clinical usage of topical silicone gel or cream or the condition of hydration exerted by occlusive dressing could be mimicked. The model consisted of two chambers separated by a semipermeable membrane, in which a fully differentiated stratified epithelium is present in the upper chamber and medium and monolayer fibroblasts are located in the lower chamber. The keratinocytes were nourished from the basal side only, while the apical surface was submerged in silicone oil, paraffin, Hanks' balanced salt solution, or medium (hydration); or it was exposed to air (control). In the hydration-treated group, the proliferation of fibroblasts measured as [3H]thymidine incorporation and their collagen, glycosaminoglycan production was significantly inhibited when compared with the controls, but exposure of the keratinocyters to silicone oil or paraffin did not influence fibroblast behavior. The results suggest that hydration, not silicone, modulates the in vitro keratinocyte-fibroblast interaction. This may be one possible mechanism by which topical silicone or occlusive dressing treatment may affect the development of hypertrophic scars and keloids.

The role of lipid peroxidation in menadione-mediated toxicity in cardiomyocytes

The role of lipid peroxidation in menadione-mediated toxicity was studied in neonatal rat cardiomyocytes. Incubation of cardiomyocytes with menadione resulted in depleted cellular glutathione levels, increased intracellular Ca2+ and increased lipid peroxidation which all occurred prior to cell degeneration. Pre-treatment of cells with cysteine suppressed the menadione-induced cell degeneration and prevented changes in glutathione levels, intracellular Ca2+, and lipid peroxidation. Pre-treatment of cells with fura-2 acetoxymethyl ester, a Ca2+ chelator, reduced menadione-induced cell degeneration and lipid peroxidation but it did not block cellular glutathione depletion. Pre-treatment of cells with deferoxamine mesylate, an iron chelator, also reduced both menadione-induced cell degeneration and lipid peroxidation; however, it did not prevent the menadione-induced increase in intracellular Ca2+, nor the depletion of glutathione. Thus, the inhibition of menadione-induced lipid peroxidation by deferoxamine mesylate prevented cell degeneration even though intracellular Ca2+ remained elevated and glutathione remained depleted. The protective effects of deferoxamine mesylate and fura-2 AM on menadione's toxicity were inhibited by addition of FeCl3 to cells. Ferric ions did not inhibit the protective effect of cysteine. These data suggest that menadione-induced cardiomyocyte degeneration is directly linked to iron-dependent lipid peroxidation and less tightly coupled to elevation in intracellular Ca2+ or depletion of glutathione.

Practice-education synergy: a research focus on continuity of care

In this article we have described one focus of an ongoing partnership between a VHA medical center and a university-based school of nursing: to improve patient outcomes through a research program focused on patient-centered continuity of care. A nursing effectiveness and patient outcomes matrix was introduced as a framework to guide variable identification, including nursing-specific outcomes. Opportunities and challenges inherent in developing this program of research were discussed. The synergy of a successful practice-education collaboration not only strengthens the links between practice and education but may also directly affect patient-centered outcomes of nursing care.

Induction of ICAM-1 and HLA-DR expression by IFN-gamma in malignant melanoma cell lines

Two human malignant melanoma cell lines, Malme-3M and SK-Mel-28, were analyzed for their ability to induce the expression of intercellular adhesion molecule 1 (ICAM-1) and human leukocyte antigen (HLA)-DR molecules on their cell surfaces as well as at the transcriptional level before and after treatment with interferon (IFN)-gamma. Both cell lines demonstrated a high percentage (> 99%) of ICAM-1 expression regardless of IFN-gamma treatment. Before IFN-gamma treatment, Malme-3M cells barely expressed HLA-DR molecules (< 2%) and SK-Mel-28 cells demonstrated a relatively high percentage (> 50%) of HLA-DR expression. Both cell lines displayed elevated levels of HLA-DR expression in a time dependent manner after IFN-gamma treatment. However, these two cell lines have been shown to respond differentially to IFN-gamma. The molecular mechanism underlying such a differential behavior was investigated, and HLA-DR gene regulation was studied at the transcriptional level. Treatment with IFN-gamma led to the steady-state mRNA augmentation of the HLR-DR gene. The HLA-DRA mRNA augmentation was similar in both cell lines, whereas in Malme-3M, IFN-gamma did not augment the rate of transcription of the HLA-DRB gene as much as in SK-Mel-28. Data from this study established the fact that the melanoma cell lines displayed a differential susceptibility to IFN-gamma on the modulation of HLA-DR molecules, and this modulation was transcriptionally regulated.

Does compression of the base of the penis improve the efficacy of intracavernosal injection of prostaglandin E1 for impotence? A randomized controlled study

The objective of this study was to evaluate the effect on erections of impeding venous blood flow following intracavernosal injections of prostaglandin E1. Dispersion of injected X-ray contrast medium indicated that application of the RMRI penile clamp to the base of the penis retarded venous outflow. The clamp was then tested in impotent men to determine whether their erectile response was enhanced. Erectile response was assessed using a Rigiscan monitor, palpation of the penis by a staff nurse and the patient's subjective impression. The results demonstrate that there is no significant improvement in erectile response following venous compression.

Collaboration: a concept analysis

Collaboration is a complex phenomenon, yet one that is of significance to nursing. This concept analysis presents definitions and defining characteristics of collaboration so that the concept may be used in the creation of operational definitions, or to develop and evaluate tools for measuring collaboration. Antecedents, consequences and empirical referents of collaboration are explored. Model, contrary and related cases are presented to clarify this concept further.

Perceptions of collaborative practice between Navy nurses and physicians in the ICU setting

BACKGROUND: Despite strong evidence for the benefits of collaborative practice between nurses and physicians, this model remains the exception rather than the rule. OBJECTIVES: To examine the extent to which Navy nurses and physicians perceive that collaborative practice exists in the ICU, and to examine the difference in perceived use of collaborative practice by Navy nurses and physicians in the ICU. METHODS: Ninety nurses and 49 physicians working in ICUs at the Navy's four teaching hospitals and aboard the Navy's two hospital ships deployed in Southwest Asia were surveyed using the Collaborative Behavior Scale-Part I and the Collaborative Practice Scales. RESULTS: There was a significant difference between nurses' and physicians' perceptions of collaborative practice behavior. Physicians reported that collaborative practice behavior existed to a greater extent than did nurses in the study. There was no significant difference between nurses' and physicians' perceived use of collaborative practice behavior. CONCLUSIONS: Navy ICU nurses and physicians perceived that they were involved in collaborative practice behavior at a moderate level. Physicians, however, reported perceiving collaborative practice to a greater extent than did nurses. Further research, in different populations, is required to test the theorized constructs of the instruments used to measure perceptions of collaborative practice behavior in this study.

Perceptions of collaborative practice between Navy nurses and physicians in the ICU setting

BACKGROUND

Despite strong evidence for the benefits of collaborative practice between nurses and physicians, this model remains the exception rather than the rule.

OBJECTIVES

To examine the extent to which Navy nurses and physicians perceive that collaborative practice exists in the ICU, and to examine the difference in perceived use of collaborative practice by Navy nurses and physicians in the ICU.

METHODS

Ninety nurses and 49 physicians working in ICUs at the Navy's four teaching hospitals and aboard the Navy's two hospital ships deployed in Southwest Asia were surveyed using the Collaborative Behavior Scale-Part I and the Collaborative Practice Scales.

RESULTS

There was a significant difference between nurses' and physicians' perceptions of collaborative practice behavior. Physicians reported that collaborative practice behavior existed to a greater extent than did nurses in the study. There was no significant difference between nurses' and physicians' perceived use of collaborative practice behavior.

CONCLUSIONS

Navy ICU nurses and physicians perceived that they were involved in collaborative practice behavior at a moderate level. Physicians, however, reported perceiving collaborative practice to a greater extent than did nurses. Further research, in different populations, is required to test the theorized constructs of the instruments used to measure perceptions of collaborative practice behavior in this study.

Cellular thiols as a determinant of responsiveness to menadione in cardiomyocytes

The role of intracellular thiols in menadione-mediated toxicity was studied in neonatal rat cardiomyocytes. The sensitivity of cardiomyocytes to menadione was greater than that of skeletal muscle cells and 3T3 fibroblasts. Before cell degeneration, menadione induced marked depletion of intracellular thiols and an increase of oxidized glutathione. The sensitivity of these cells to menadione correlated with the level of depletion of intracellular thiols. After incubation of cardiomyocytes with menadione, glutathione reductase activity was inhibited and lipid peroxidation was increased. Both dicumarol (an inhibitor of DT-diaphorase) and diethyldithiocarbamate (an inhibitor of superoxide dismutase) enhanced the capacity of menadione to induce cellular damage and to cause depletion of intracellular glutathione. Decreasing intracellular glutathione by pretreatment of cells with N-ethylmaleimide or buthionine sulphoximine also increased menadione-induced cell degeneration. Preincubation with cysteine or dithiothreitol suppressed the capacity of menadione to damage the cells. Menadione-induced lipid peroxidation was also suppressed by the same treatment. These results show that the oxidative stress induced by menadione in cardiomyocytes results in the depletion of glutathione and protein thiols. Both DT-diaphorase and superoxide dismutase can protect cells from the toxicity of menadione. Cellular thiols are determinants of the responsiveness to menadione.

A collaborative practice model for critical care

Collaborative practice behavior is a concern for healthcare providers and administrators, because it is associated with positive outcomes for both patients and staff in the intensive care unit. Despite the documented benefits derived from collaborative practice, it remains the exception rather than the dominant pattern for nurse-physician interactions. National concern for quality care and rising healthcare costs mandates that collaborative practice behaviors between nurses and physicians replace competition as the means for resolving differences. The purpose of this article is to describe collaborative practice, propose a theoretical framework for collaborative practice and discuss the development, implementation and evaluation of a collaborative practice model.

A collaborative practice model for critical care

Collaborative practice behavior is a concern for healthcare providers and administrators, because it is associated with positive outcomes for both patients and staff in the intensive care unit. Despite the documented benefits derived from collaborative practice, it remains the exception rather than the dominant pattern for nurse-physician interactions. National concern for quality care and rising healthcare costs mandates that collaborative practice behaviors between nurses and physicians replace competition as the means for resolving differences. The purpose of this article is to describe collaborative practice, propose a theoretical framework for collaborative practice and discuss the development, implementation and evaluation of a collaborative practice model.

Validating a compendium of goals and objectives for educating CNS students in ambulatory care

In fall 1990, the Department of Veterans Affairs launched a Pilot Ambulatory Care and Education program that has as its major goal the shift from a traditional inpatient specialty-based focus of patient care and health professional education to a more forward-looking outpatient generalist-based focus of care and education. The generalist and specialist focus of the CNS role has been introduced in this innovative ambulatory care program. Formal and informal educational opportunities for interdisciplinary team members and students abound. This article describes the development and validation of a compendium of goals and objectives for educating CNS students in ambulatory care.

Endoscopic surgery training: application of an in vitro trainer and in vivo swine model

The development of endoscopic surgical procedures is changing general surgery, with many operations such as cholecystectomy, appendectomy, and hernia repair being performed using laparoscopic surgical techniques. Training and credentialing of surgeons are key issues for the safe and ethical introduction of these new procedures. This article reviews techniques employed at our institution for laparoscopic surgical training and certification including didactic instruction, an in-vitro model for learning instrumentation and hand-eye coordination, and in-vivo training using the porcine animal model.

Effect of cytokines on the expression of cell adhesion molecule and on the adhesion of melanoma cells to endothelial cells

We examined the role of cell adhesion molecules (CAM) by which tumor cells bind to the endothelial cells using human umbilical vein endothelial cells (HUVEC) and cultured melanoma cells. Endothelial cells from human umbilical veins were isolated and examined for CAM expression and its modulation by tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), interleukin-6 (IL-6) or interferon-gamma (IFN-gamma). The expression of intercellular adhesion molecule 1 (ICAM-1) on HUVEC was increased by TNF-alpha, IL-1 and IFN-gamma when measured by ELISA or flow cytometric (FACS) analysis. IL-6 did not increase ICAM-1 expression on HUVEC. Two melanoma cell lines, Malme-3M and SK-Mel-28, showed increased expression of ICAM-1 after treatment with TNF-alpha, IL-1 and IFN-gamma in FACS analysis. IFN-gamma induced increased expression of HLA-DR only in SK-Mel-28 melanoma cells, not in Malme-3M melanoma cells. Neither HUVEC nor melanoma cells expressed lymphocyte function-associated antigen 1 (LFA-1) in either the basal (i.e., cytokine untreated) condition or the cytokine treated condition. Melanoma cells showed minimal increment in adhesion to TNF-alpha or IL-1 treated HUVEC than to cytokine untreated HUVEC. HUVEC and melanoma cells did not express LFA-1 and increased ICAM-1 expression by TNF-alpha, IL-1 and IFN-gamma treatment in FACS analysis did not coincide with minimal increase of melanoma cells adhesion to cytokine treated HUVEC. These results suggest that adhesion between melanoma cells and HUVEC is probably mediated by molecular interaction other than ICAM-1/LFA-1.

Comparison of the sensitivity and precision of four skin test devices

Twenty volunteers were skin tested with seven concentrations of histamine phosphate and a glycerosaline control to determine the relative sensitivity and precision of four skin test devices: Greer Pen (GP), Greer DermaPIK (DP), Center Multi-Test (MT), and Morrow Brown needle (MB). The end points of the study were (1) wheal and flare response of each device, with a dose-response curve, (2) the time required to apply each set of eight tests, and (3) the volunteers' subjective assessment of each device. On a different day, 10 of the volunteers were tested to determine the precision of each device. Dose-response curves for half-log dilutions of histamine phosphate were produced with a glycerosaline control. The DP and GP induced wheal and flare responses discernible from that of the glycerosaline control at a lower concentration of histamine phosphate than the MB and MT. The DP took a shorter time to apply eight samples than any other device. The MB was preferred by the most volunteers, but any device tested on the upper half of the back was usually preferred over that tested on the lower half. When 5 mg/ml histamine phosphate was used, coefficients of variation for each device demonstrated that for wheals the precision of the DP, GP, and MT was similar (mean, 21.1%, 23.1%, and 24.5%, respectively). The MB was larger (mean, 59.9%). For flares, the precision of GP and DP was similar (mean, 22.0% and 23.5%, respectively), with the MT and MB larger (mean, 35.5% and 58.2%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Building a professional environment in long-term care. The role of clinical career development

1. To be successful, an organizational career development program must include a differentiation of the responsibilities for which the various parties (employer, employee, career counselor) will be held accountable. 2. Project outcomes revealed that the career mobility program was attractive to nursing personnel and facility management personnel alike. However, it was more attractive to nonlicensed than licensed personnel. 3. Of the staff who participated and were promoted, the majority remained in their jobs. The program was most successful in enhancing retention with personnel who received within-level promotions. 4. The process of career development requires collaboration and support from all levels of leadership and staff throughout the organization. A career development program, including a career mobility program with a strong career counseling component, can serve as a catalyst in professionalizing the long-term care work environment.

Insertional mutations in transgenic mice

Insertional mutagenesis represents a promising approach to the identification of new genes involved in mammalian development. In this paper, we have presented a brief review of the literature on the analysis of mutations caused by DNA and retroviral insertion into the mouse genome. We have discussed several methods that we and others have used to identify recessive insertional mutations among transgenic mouse lines. Finally, we have summarized the results of our studies to date on three recessive prenatal lethal mutations that we have identified.

Malignant mixed mesodermal tumors of the ovary. A report of 13 cases

The surgical pathology files at Thomas Jefferson University Hospital (TJUH) were reviewed for the period 1973-1984. Thirteen cases of primary ovarian malignant mixed mesodermal tumor (MMT) were found; however, material from only seven of these cases could be obtained for repeat review. No conclusions can be drawn regarding any impact on survival based on the histology. Treatment was highly varied reflecting the mix of physicians rendering treatment and the range of modalities used. Overall, survival was miserable. Six of the 13 patients (46.2%) survived 6 months or less, 10 of the 13 (76.9%) survived 12 months or less. No particular treatment modality seemed to offer enhanced survival unless aggressive cytoreductive surgery was performed. A plea is made for national cooperative groups to develop treatment protocols for this aggressive ovarian cancer.

Identification and management of clomiphene citrate responses

Clomiphene citrate (CC) is widely used for induction of ovulation; however, adequate time is rarely used to monitor patients on this form of therapy. Two hundred thirty-one infertility patients qualified for this study in 1155 cycles, during which basal body temperature charts were kept and the quality of cervical mucus was evaluated. Nine types of responses were classified: three ovulatory (O1, O2, O3), three anovulatory (A1, A2, A3), and three miscellaneous (M1, M2, M3). The overall, uncorrected pregnancy rate was 54.9%, and 79.2% showed ovulatory responses. The most common response was O1 (normal responses, 38.5%) with the highest pregnancy rates (92.1%). Poor estrogenic response with poor cervical mucus (CM) (O2) was fairly common (13.4%) and had poor pregnancy rates, even with the addition of estrogens (12.9%). It is suggested that this new classification of CC responses will help to identify and more efficiently manage patients undergoing this form of therapy.

Arachidonic acid-induced swelling in incubated rat brain cortical slices. Effect of bovine serum albumin

The influence of bovine serum albumin (BSA) on the rat brain cortical swelling induced by sodium arachidonate and polyunsaturated fatty acids has been studied. Coincubation of arachidonate with BSA at a molar ratio of 5 (arachidonate/BSA) or less greater inhibited the arachidonate-induced swelling. As the molar ratio of arachidonate/BSA increased, the degree of swelling increased. The swelling was not reversed by BSA, although the BSA released 46% of the previously incorporated [3H]arachidonic acid from the cortical slices. The entry of [3H]arachidonate into the slice was completely abolished by 0.1 mM BSA or partially inhibited by exogenous arachidonate. It is concluded that the induction of brain swelling by arachidonate requires the intracellular transport of exogenous arachidonate.

Liver scanning in malignant genitourinary tumours

To assess the value of liver scanning as a routine pretreatment screening test for metastatic spread in patients with malignant genitourinary tumours, the authors reviewed the records of 68 such patients who underwent liver scanning. Of 74 scans obtained, 10 gave positive results. There was a 6% false-positive rate and in five of six true-positive scans other clinical and laboratory data indicated the presence of distant metastatic spread. The liver scan provided new information in only one case. The authors conclude that routine liver scanning before treatment is not warranted in patients with malignant genitourinary tumours.

Hypophosphatemia associated with coma

In three cases of severe hypophosphatemia profound coma was associated. Although the occurrence of hypophosphatemia appeared to coincide with a high rate of intravenous administration of glucose and water, two of the three patients had liver disease and the other had hypothermia. In two instances the neurologic status improved with intravenous phosphate therapy. These case reports emphasize the importance of early recognition and treatment of profound hypophosphatemia in critically ill patients.

Avian tumour virus interactions with chicken fibroblast membranes: partial characterization of initial attachment site activity

Exposure of chicken embryo fibroblasts (CEF) to trypsin solubilizes cell surface components, including the initial attachment site for avian tumour viruses (ATV). The soluble attachment site activity appears to interact directly with the ATV in vitro thereby interfering with the binding of at least two ATV subgroups to both intact CEF and CEF plasma membranes. A result of this interaction in vitro is reduced ATV infectivity, demonstrated by reduced transforming capacity of RSV (RAV-I).

Solid phase bovine thrombin. Preparation and properties

A new solid-phase thrombin (EC 3.4.21.5) was prepared through conjugation of the enzyme under mild conditions to a glass support bearing an active ester of N-hydroxysuccinimide. The immobilized enzyme retained 50 +/- 10% of the specific esterase activity of the parent soluble enzyme. The Km (apparent) for the esterase activity of the immobilized enzyme has a value of 5 mM, identical of the Km value of the parent-soluble enzyme. Only 6 +/- 1% of the specific proteolytic activity was retained and a higher Km (apparent) value of 67 muM was obtained for the insoluble enzyme compared to Km value of 12.5 muM for the parent soluble thrombin. Solid-phase thrombin prepared by the diazocoupling technique was previously reported to retain only 3% of the specific proteolytic activity. The observed loss of specific proteolytic activity can be attributed to steric interference, a change in charge characteristics, or both. Nevertheless, the present method of preparation has the advantages of rapidity and simplicity. It can readily be adapted to use for studying the fate of various complexes of fibrinogen, fibrin and their degradation products. It should also be useful for preparing radiolabeled autologous soluble fibrin for thrombus detection in patients undergoing active thrombosis.

Metabolism of the alpha-Pyridone Ring of Ricinine in Ricinus communis L

Chemically synthesized ricinine-3,5-(14)C was used to study the metabolism of this alkaloid in the plant which produces it, Ricinus communis L. In a time course study, ricinine-3,5-(14)C was administered to a series of castor plants (Ricinus communis L.) and the radioactivity recovered in the ricinine samples showed a decrease with increase in time. It was also observed that the alkaloid was translocated to the seed. The in vivo conversion of ricinine-3,5-(14)C to respiratory (14)CO(2) occurred in both light and dark and indicated that the alpha-pyridone ring of ricinine could be degraded.In a comparison of the ricinine content of the various tissues it was observed that in the yellow leaf only a trace amount of the alkaloid was present. Preliminary results indicated that the yellow leaf can also metabolize ricinine-3,5-(14)C to (14)CO(2).