Second-line chemotherapy with mitomycin C and S-1 in patients with advanced gastric cancer

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Background: S-1, a fourth generation oral fluoropyrimidine that mimics infusional 5-fluorouracil, has demonstrated activity against advanced gastric cancer. Based on a single agent activity and in vitro synergy between mitomycin C (MMC) and 5-fluorouracil, we conducted a phase II study to assess the efficacy and tolerability of the combination of S-1 and MMC as second-line chemotherapy for previously treated, advanced gastric cancer. Methods: Patients with measurable gastric cancer, progressive after at least one prior chemotherapy for metastatic disease, were treated with MMC 7 mg/m2 on day 1 and S-1 40 mg/m2 twice daily as an intermittent regimen of 4 weeks of treatment followed by a 2-week rest. Treatment was repeated every 6 weeks, for up to 4 cycles. Objective response rate was the primary endpoint and was evaluated every 2 cycles of chemotherapy. With a single-stage phase II design, at least 25 patients were required. Results: Of the 26 patients registered, 24 patients were evaluable for response and 26 for safety. Eighteen patients (69%) were previously treated with 5-fluorouracil-based chemotherapy, and 10 (39%) were treated with taxanes. The patients’ median age was 55 years (range, 38–73) and 7 (27%) had an ECOG performance status of 2. A total of 64 chemotherapy cycles were delivered (median, 2; range, 1–4). In an intent-to-treat analysis, 6 patients (23%) achieved a partial response, which maintained for 3.5 months. The median progression-free and overall survivals were 4.4 months (95% CI, 1.7–7.2) and 5.4 months (95% CI, 3.4–7.4), respectively. Major toxic effects included stomatitis, diarrhea and fatigue, but were generally mild and manageable. No patient developed hemolytic reaction. Conclusions: Second-line chemotherapy with MMC and S-1 is an effective regimen for advanced gastric cancer with an acceptable toxicity profile and a convenient administration schedule.

No significant financial relationships to disclose.

Prolonged restaurant-associated outbreak of multidrug-resistant Salmonella Typhimurium among patients from several European countries

This report concerns a prolonged restaurant-associated outbreak of infection caused by a multidrug-resistant (ASSuT) strain of Salmonella Typhimurium, phage-type U302, which took place during July and August 2003 and affected people from Denmark and neighbouring countries who had attended a specific restaurant. The outbreak comprised 67 laboratory-verified cases and ten probable cases; however, the actual number of patients was estimated to be more than 390. The outbreak strain was isolated from a buffet which was probably contaminated by an assistant chef who was found to excrete the epidemic strain. An attack rate of 7.3% was estimated and long incubation periods were observed, including one extreme instance of 27 days. This outbreak underscores the importance of conscientious personal hygiene, including frequent washing of hands, for professionals handling food.

Treatment of arsenic in Bangladesh well water using a household co-precipitation and filtration system

Laboratory and field tests were conducted to evaluate the effectiveness of a household filtration process and investigate the effects of phosphate and silicate on the removal of arsenic from Bangladesh groundwater by ferric hydroxides. Fe/As ratios of greater than 40 (mg/mg) were required to reduce arsenic to less than 50 microg/L in Bangladesh well water due to the presence of elevated phosphate and silicate concentrations. The household filtration process included co-precipitation of arsenic by adding a packet (approximately 2 g) of ferric and hypochlorite salts to 20 L of well water and subsequent filtration of the water through a bucket sand filter. A field demonstration study was performed to test the treatment system in seven households in Bangladesh in March and April 2000. Experimental results obtained from the participating families proved that the household treatment process removed arsenic from approximately 300 microg/L in the well water to less than 50 microg/L. The participating families liked this simple and affordable process and used it to prepare clean water for drinking and cooking. A larger scale field test is currently underway.

Fas- and tumor necrosis factor-mediated apoptosis uses the same binding surface of FADD to trigger signal transduction. A typical model for convergent signal transduction

FADD is known to function as a common signaling conduit in Fas- and tumor necrosis factor (TNF)-mediated apoptosis. The convergent death signals from the Fas receptor and TNF receptor 1 are transferred to FADD by death domain interactions triggering the same cellular event, caspase-8 activation. In this work, we investigated whether the same binding surface of FADD is used for both signaling pathways by using FADD death domain mutants. Mutations in helices alpha2 and alpha3 of the FADD death domain, the interacting surface with the Fas death domain, affected TNF-mediated apoptosis to various extents. This indicated that TNF-mediated apoptosis uses the same binding surface of the FADD death domain as Fas-mediated apoptosis. The binding specificity is not the same, however. Some mutations affected the binding affinity of the Fas death domain for the FADD death domain, but did not influence TNF-mediated apoptosis and vice versa. Interestingly, all mutants tested that affected TNF-mediated apoptosis have structural perturbations, implying that the structural integrity, involving helices alpha2 and alpha3 in particular, is critical in TNF-mediated apoptosis. Our results suggest that different signaling molecules use a similar structural interaction to trigger the same cellular event, such as caspase-8 recruitment, which could be typical in convergent signal transduction.

Accelerated ultraviolet radiation-induced carcinogenesis in hepatocyte growth factor/scatter factor transgenic mice

The dramatic rise in incidence of malignant melanoma experienced by populations both within the United States and throughout the world over the last several decades has been attributed to enhanced exposure to the UV spectrum of sunlight radiation. This hypothesis can now be tested using genetically engineered mouse models predisposed to malignant melanoma. Here we use melanoma-prone transgenic mice inappropriately expressing hepatocyte growth factor/scatter factor (HGF/SF) in the skin as an experimental model system to ascertain the consequences of a chronic regimen of suberythemal UV radiation on melanoma genesis. HGF/SF is a multifunctional regulator capable of stimulating growth, motility, invasiveness, and morphogenetic transformation in cells, including melanocytes, expressing its receptor tyrosine kinase Met. HGF/SF transgenic mice demonstrate ectopic interfollicular localization and accumulation of melanocytes within the truncal dermis, epidermis, and junction and if untreated develop primary cutaneous melanoma with a mean onset age of approximately 21 months. Transgenic mice and their wild-type littermates subjected to UV radiation three times weekly using FS40 sunlamps (60% UVB and 40% UVA), with daily UV doses graded from 2.25 to 6.0 kJ/m2, developed skin tumors with a mean onset age of 26 and 37 weeks, respectively (P < 0.001, Kaplan-Meier log rank test). However, the repeated doses of suberythemal UV radiation used in this study failed to accelerate melanoma genesis, instead inducing the development of nonmelanoma tumors that included squamous cell carcinomas, squamous papillomas, and sarcomas. The conspicuous absence of melanocytic tumors occurred despite the immunohistochemical detection of a significant stimulation (P < 0.001) in melanocyte-specific bromodeoxyuridine incorporation in response to only 2 weeks of UV irradiation (total UV dose of 13.5 kJ/m2), resulting in 2.6- and 4.6-fold increases in the number of melanocytes in the dermis and epidermis, respectively. These data indicate that chronic suberythemal UV radiation preferentially favors the development of nonmelanocytic over melanocytic neoplasms in this transgenic animal, consistent with the pathogenesis proposed for sun exposure-associated skin cancer based on retrospective studies in the human population. Our findings suggest that the HGF/SF transgenic mouse will be useful as an experimental model for determining the consequences of exposure to various regimens of UV radiation and for elucidating the mechanisms by which such consequences are realized.

Death effector domain of a mammalian apoptosis mediator, FADD, induces bacterial cell death

FADD is a mammalian pro-apoptotic mediator consisting of the N-terminal death effector domain (DED) and the C-terminal death domain (DD). The N-terminal 88-residue fragment of murine FADD was defined as the stable structural unit of DED, as determined by proteolytic digestion and conformational analysis. This domain induced bacterial as well as mammalian cell death, whereas the full-length or DD of FADD did not. The Escherichia coli cells expressing FADD-DED showed elongated cell morphology and an increased level of nicked chromosomal DNA and mutation. The lethality of FADD-DED was abolished by co-expression of thioredoxin and superoxide dismutase or relieved by the addition of vitamin E as a reducing agent and under anaerobic growth conditions. The toxicity of FADD-DED was genetically suppressed by various oxidoreductases of E. coli. All these results suggest that the death effector domain of mammalian FADD induced bacterial cell death by enhancing cellular levels of reactive oxygen species (ROS).

The solution structure of FADD death domain. Structural basis of death domain interactions of Fas and FADD

A signal of Fas-mediated apoptosis is transferred through an adaptor protein Fas-associated death domain protein (FADD) by interactions between the death domains of Fas and FADD. To understand the signal transduction mechanism of Fas-mediated apoptosis, we solved the solution structure of a murine FADD death domain. It consists of six helices arranged in a similar fold to the other death domains. The interactions between the death domains of Fas and FADD analyzed by site-directed mutagenesis indicate that charged residues in helices alpha2 and alpha3 are involved in death domain interactions, and the interacting helices appear to interact in anti-parallel pattern, alpha2 of FADD with alpha3 of Fas and vice versa.

Effects of the prostaglandin E2 analogue enprostil on the carbon tetrachloride-induced necrosis of liver cells in mice

Female mice, eight weeks old, were injected with carbon tetrachloride (CCl4) (10 mg subcutaneously). Groups of mice (n = 10-30) were then injected with enprostil (E) 2, 20 or 50 micrograms/kg body weight (bw) intraperitoneally 15 min and two h after, or E 100 micrograms/kg bw two h after the CCl4 injection. The mice were killed after 24, 48 or 72 h. Plasma activity concentrations of alanine aminotransferase (ALAT) were determined in blood specimens from the iliac veins. The extent of liver cell necrosis in histological sections was recorded on a 100 mm Visual Analogue Scale (VAS) and measured using the electronic Mini Mop method. In the group given the highest single dose of E (100 micrograms/kg) a significant lowering of the CCl4-induced liver cell necrosis was found after 24 h. No significant differences were found after 48 and 72 h. In the other groups injected with lower doses of E after CCl4, no significant differences were found compared to groups injected with CCl4 alone.

Implicit and explicit memory in young, old, and demented adults

Previous study of scopolamine and memory (Grober et al., 1989) showed that young adults given moderate or high doses of scopolamine maintained maximum cued recall in spite of a dose-dependent decrement in free recall when memory was assessed by cued selective reminding (CSR), a procedure which circumvents inattention and induces semantic processing. Intact recall by CSR indicates either that scopolamine impairs memory indirectly through effects on attention and information processing or that it impairs explicit memory but not implicit memory. In the present study which was done to determine if CSR reflects explicit or implicit memory, a free association test was used to estimate implicit memory after CSR was administered; explicit memory was estimated with a final trial of cued recall. Data from young, nondemented, and demented adults indicate that CSR reflects explicit memory supporting the interpretation of the previous study that scopolamine does not produce direct impairment of explicit memory.

Validation of a semiquantitative food frequency questionnaire developed in Denmark

In 1989, a self-administered food frequency questionnaire, including 92 food items and 40 portion-size photographs, was validated against two times seven days of weighed diet records. A total of 144 subjects, aged 40-64 years, from the general population in Copenhagen were included. Correlations between mean calorie-adjusted intakes from the two-week diet records and the food-frequency questionnaire ranged from 0.27 for vitamin A to 0.71 for calcium. In general, higher correlation coefficients were observed for men than for women. On average, about 70% of subjects were classified in the same (+/- 1) quintile in the food frequency questionnaire and the diet records. Of those subjects belonging to the lowest quintile, estimated from the diet records, 42% fell in the same quintile and 68% into the lowest two quintiles in the food frequency questionnaire. Findings were similar for the upper tail of the distribution. Gross misclassification, observed in the highest and lowest quintile, was found for 4% and 7% of the subjects, respectively. It is concluded that this food frequency questionnaire is a useful instrument for categorizing individuals according to their intake of nutrients and energy.

Effect of the prostaglandin E1 analogue misoprostol on the carbon tetrachloride-induced injury of rat liver cells in culture

Previous investigators have reported a protective effect of some prostaglandins and of the prostaglandin E2 analogue enprostil on carbon tetrachloride (CCl4)-induced injury of liver cells. In the present study liver cells were isolated from the rat liver by collagenase perfusion and suspended in F-10 medium, containing 20% foetal bovine serum, 1% gentamicin, and 1% glutamine. In the first study cells were cultured in T-flasks with 3 ml suspension of 6 x 10(6) cells/ml, and in the second study (extended dose response) cells were cultured in tissue culture wells with 0.5 ml cell suspension. Misoprostol was added to groups of cultures 15 min before CCl4, 2 microliters/ml, and the number of living cells was counted 45 min after the first addition. The number of living cells was compared with those of other groups with CCl4 only and control groups. In the first experiment misoprostol was given in doses of 200, 400, and 800 ng/ml medium and in the second experiment in 0.1, 1, 10, 100, and 1000 ng/ml medium. CCl4 is an agent well known to be toxic to liver cells, and in cultures to which only CCl4 was added, the number of living cells was significantly reduced compared with controls. When 0.1 ng misoprostol was added before CCl4, no significant difference in the number of living cells was shown compared with cultures with CCl4 only. On the other hand, misoprostol given in doses from 1 ng to 1000 ng before CCl4 resulted in a higher number of living cells, indicating a protective effect.

[The evolution of carboxyhemoglobin during long-term closed-circuit anesthesia]

In 40 patients who underwent protracted orthodontic operations, the accumulation of carboxyhemoglobin (COHb) in the blood was studied. Mechanical ventilation during anesthesia was carried out in a closed system (group I, n = 20). Patients in a control group received mechanical ventilation with a constant fresh gas flow of 6 l/min (group II, n = 20). During closed-system ventilation, a constant rise of COHb was observed. Smokers had much higher COHb values than nonsmokers at the beginning of and during anesthesia. The relative increase of COHb in a defined time period was of the same magnitude for smokers and nonsmokers. Critical values for carbon monoxide (CO) intoxication were not measured. The mean rise was 0.05 g/100 ml COHb over 6 h. Two female patients had COHb rises of 0.29 g/100 ml and 0.18 g/100 ml over the same period. During ventilation with a high flow of fresh gas, the COHb level decreased in all patients. In nonsmokers, the value approached the physiological range of 0.4% to 0.8% COHb. A marked fall of COHb could also be observed in smokers; however, normal physiological values were not reached. Patients with low COHb tolerance (anemia, severe coronary heart disease, peripheral vascular disease) or with increased endogenous CO production (pregnancy, newborns, hemolytic disease, porphyria cutanea) should not undergo protracted ventilation in a closed circle system.

Topographical distribution of fluoride in iliac bone of a fluoride-treated osteoporotic patient

The electron microprobe was used to display the topographical distribution pattern of fluoride (F) at the microscopical level in the iliac bone of an osteoporotic patient treated with fluoride. Composite x-ray image of F K alpha emission revealed a high concentration of fluoride in the periosteal and endosteal bone layers, in the cancellous bone, and in certain osteons, which corresponded to the bone formed during the period of fluoride treatment. Fluoride was also concentrated around the Haversian canals in the vicinity of the capillary blood vessels by a diffusion process. Morphometric analysis showed that more cancellous bone than cortical bone is formed.

Liver cell necrosis and regeneration following injections of carbon tetrachloride. Effects of the thyrotropin-releasing hormone and somatostatin

Mice were given 10 micrograms somatostatin or 25 micrograms TRH intraperitoneally 10 min before s.c. injection of 2 or 20 mg CCl4. The extent of liver cell necrosis and nuclear size were measured by the electronic Mini Mop method and the extent of necrosis and nuclear pleomorphism were estimated by a visual linear analogue scale of 100 mm, and compared to plasma concentrations of ASAT and ALAT. Pre-treatment with TRH or somatostatin resulted in significant reduction in the extent of necrosis 24 h after CCl4-injections (25%), with a lowering of ASAT from 13209 +/- 2955 U/l to 5144 +/- 924 after TRH and to 6186 +/- 966 after somatostatin, and of ALAT from 14343 +/- 3209 to 7718 +/- 1727 and 6494 +/- 1253 U/l, respectively. After 3 days the necroses were reduced from 16.5 +/- 1.7% by the Minimop method to 1.4 +/- 0.5% (90%) in mice given CCl4 alone, and from 12.3 +/- 1.7% to 3.8 +/- 1.2% in mice pretreated with TRH, and from 12.3 +/- 1.8% to 3.8 +/- 1.7% (70%) in mice pretreated with somatostatin. The plasma concentrations of ASAT and ALAT were reduced correspondingly. After 5 days no necroses were seen, and the plasma ASAT and ALAT were normal. After 6 months of weekly injections of TRH or somatostatin before 20 mg CCl4 the liver cell nuclear size (10.5 and 9.7 0.3 mu 2) was similar to that after CCl4 alone (9.7 0.3 mu 2), and twice that of controls (4.6-5.4 0.1 mu 2). Liver cell necrosis was not seen. The plasma concentrations of ASAT (131 8.6-162 11.3) and ALAT (98 8-104 9 Iu/l) were similarly 2-3 times those in controls. TRH and somatostatin thus reduced liver cell injury and delayed regeneration after single injections of CCl4. After 6 months of weekly injections no effects were observed.

Prostaglandins and CCl4-induced liver cell mortality. The effect of the prostaglandin analogue enprostil

Prostaglandins have been reported to reduce the carbon tetrachloride (CCl4)-induced liver cell injury in rats. The object of the present experiments was to examine the effect of the prostaglandin E2 analogue enprostil on the survival of isolated liver cells exposed to CCl4. Liver parenchymal cells were isolated from rat livers by collagenase perfusion and released into a 'suspension' buffer. Aliquots of the cell suspension were incubated with 1 micrograms or 0.5 microgram CCl4, and to parallel test suspensions 20 ng enprostil was added 5-10 min before CCl4. Incubation was performed on ice, at room temperature, and at 37 degrees C. The average percentage of dead cells after CCl4 treatment was significantly reduced by pretreatment with enprostil at room temperature (1 microgram CCl4: 69 +/- 21% and 44 +/- 13%, respectively) and after 10 min of incubation at 37 degrees C (1 microgram Cl4: 56 +/- 25% and 37 +/- 27%; 0.5 microgram CCl4: 51 +/- 33% and 29 +/- 18%, respectively). When the liver cell mortality approximated 100% after long-term incubation at 37 degrees C, no protective effect of enprostil was observed.

Screening for dementia by memory testing

Enhanced cued recall provides a simple and clinically useful memory test for identifying dementia in the elderly. Because this test induces semantic processing and coordinates encoding and retrieval for maximum recall, genuine memory deficits due to impairment of specific memory processes can be distinguished from apparent memory deficits due to use of inefficient strategies or impairment of other cognitive processes. Since genuine memory deficits in the elderly are usually associated with dementia, their identification is highly predictive of clinical dementia. The present study validates the use of enhanced cued recall as a screening test for dementia in 70 aged subjects. All but one person with a pure amnesia were correctly classified. Enhanced cued recall correctly classified 97% of the 120 subjects in this and the previous study. Enhanced cued recall shows learning not revealed by free recall, providing more accurate measurement of memory, and distinguishes demented from nondemented elderly more accurately than either free recall or recognition.

Distribution of fluoride in calcified cartilage of a fluoride-treated osteoporotic patient

Subchondral bone and calcified cartilage from a femoral head of a 74-year-old osteoporotic woman treated for 30 months with sodium fluoride were analyzed. The fluoride content of the calcified tissues was determined by a specific ion electrode, and the topographic distribution pattern of fluoride was determined with an electron microprobe. The fluoride content in calcified cartilage (0.39% of ash) was higher than in neighboring subchondral bone (0.28% of ash). Line scan and X-ray images indicated a high concentration of fluoride in the outer layer of calcified cartilage lining the uncalcified cartilage, as well as in the inner layer of the subcortical endosteal bone. This study shows that calcified cartilage is an important site of fluoride deposition, and suggests that the accumulation of fluoride is related to the calcification process.

Calcium phosphate metabolism and bone disease in patients with homozygous thalassemia

Calcium and phosphate metabolism were studied in 22 patients with homozygous thalassemia. The overall results showed no significant difference for serum calcium, phosphorus, alkaline phosphatase, immunoreactive parathyroid hormone, or 25-hydroxyvitamin D between thalassemic and control children. However, during the winter, serum 25-hydroxycholecalciferol levels were very significantly decreased in thalassemic children. A study of the hands showed thin metacarpal cortices related to increased resorption. Histomorphometric study of four iliac bone biopsies showed normal osteoclastic resorption and decreased bone formation. Prussian blue staining and x-ray electron microprobe analysis showed iron deposits inside the bone. Whether this finding is critical in the pathogenesis of the bone disease in unknown.

Inhibition of prolactin secretion and synthesis by dopamine, noradrenaline and pilocarpine in cultured rat pituitary tumour cells

Clonal strains of rat pituitary tumour cells (GH3-cells) synthesize and secrete prolactin into a chemically defined culture medium. Short time treatment (0.5-2 hrs) of cell cultures with noradrenaline (10(-3) M) and dopamine (10(-3 M) reduced the spontaneous secretion of prolactin by 50% and 30%, respectively, while pilocarpine (10(-3) M) had no effect. Long-term treatment (20 hrs) with noradrenaline (10(-3)M) or with pilocarpine (10(-3) M) inhibited prolactin synthesis by 45% and 65% of control cultures, respectively. Neither compounds affected cell growth. The inhibitory effect of noradrenaline, but not that of pilocarpine, was completely reversed 4 hrs after cessation of treatment. Adrenaline, dopamine and acetylcholine in concentrations up to 10(-3) M did not change prolactin synthesis. In contrast thyroliberin treatment (2 X 10(-8)M) caused a 45% increase in prolactin secretion, and resulted in a 40% increase in hormone synthesis after treatment for 20 hrs. It is concluded that both noradrenaline and dopamine are able to inhibit prolactin section. Prolactin synthesis could be inhibited by noradrenaline and pilocarpine. How, only the effect of noradrenaline is easily reversible on cessation of treatment.

Minor elements in bone mineral and their effects on its solubility

Mineral substance deposited in bone tissue when either strontium or fluoride are present, is both qualitatively and quantitatively different from that deposited in their absence. The presence of these ions causes not only heteroíonic substitutions in the crystalline lattice of the apatite phase, but also important modifications of the percentage of crystalline mineral, of crystal size and perfection, and of quantity of mineral per unit volume. These modifications affect the in vitro and in vivo demineralization of bone tissue.