Non-fermi-liquid behavior of electron-spin fluctuations in an elemental paramagnet

We report for the first time, the observation of non-Fermi-liquid scaling behavior in an elemental paramagnetic metal. Both the dynamical susceptibility and the resistivity of beta-Mn are shown to display non-Fermi-liquid scaling over a relatively large temperature range at ambient pressure. The temperature dependence of the resistivity in beta-Mn is consistent with the existence of an antiferromagnetic zero-temperature phase transition or "quantum critical point." Since there is no site disorder in this pure element, we show that non-Fermi-liquid behavior observed in beta-Mn is not a consequence of summing over different local atomic environments, but a much more fundamental phenomenon.

Prospects for targeting protein kinase C isozymes in the therapy of drug-resistant cancer--an evolving story

The seminal discovery in 1988 that selective protein kinase C (PKC) activators induce multidrug resistance (MDR) in human cancer cells spawned several years of intensive investigations; these studies were primarily directed at the question of whether isozyme-selective PKC antagonism could reverse MDR phenotypes produced in cancer cells by P-glycoprotein and other ATP-binding cassette (ABC) transporters. The first section of this commentary provides a succinct overview of those studies. In the second section, we evaluate why the enthusiasm for studies of the involvement of PKC in transport-related drug resistance is currently diminished, and we offer an assessment of whether the PKC/MDR field should be revisited. The final section of the commentary highlights recent developments in studies of PKC targeting in experimental cancer therapeutics, which continues to be a vibrant field. Highlights include the sensitization of cancer cells to radiation- and drug-induced apoptosis by PKC inhibition.

Electron arc irradiation of the postmastectomy chest wall with CT treatment planning: 20-year experience

PURPOSE

Since 1980, electron arc irradiation of the postmastectomy chest wall has been the preferred radiotherapy technique at the University of Utah for patients with advanced breast cancer. We report the results of this technique in 156 consecutive Stage IIA-IIIB patients treated from 1980 to 1998.

METHODS

CT treatment planning was used in all patients to identify chest wall thickness and internal mammary lymph node depth. Computerized dosimetry was used to deliver total doses of 50 Gy in 5-1/2 weeks to the chest wall and the internal mammary lymph nodes with electron arc therapy. Patients were assessed for local, regional, and distant control of disease and for survival. Univariate and multivariate proportional hazards were modeled using a hierarchical nonproportional semiparametric model testing the following prognostic factors: age, stage, tumor size, number of positive lymph nodes, estrogen receptor status, and dose. End points evaluated included disease-free survival, cause-specific survival, and overall survival.

RESULTS

Eighty-one percent of patients were at high risk for local-regional failure because of > T2 primary tumor or > 3 positive axillary lymph nodes. The median number of positive lymph nodes was 5, and the median tumor size was 3.5 cm. Actuarial 10-year local-regional control and overall survival were 95% and 52%, respectively. In multivariate analysis, the only factor prognostic for disease-free survival, cause-specific survival, and overall survival was the number of positive lymph nodes (p < 0.001). The 10-year rates of local-regional control for patients with 0, 1-3, 4-9, and > or = 10 involved lymph nodes were 100%, 98%, 93%, and 89%, respectively. The only rates of acute and chronic radiotherapy toxicity > or = 2 by RTOG/EORTC criteria were skin related and observed in 44% and 10% for acute and late reactions, respectively.

CONCLUSION

These data demonstrate excellent local-regional control rates with electron arc therapy of the postmastectomy chest wall in patients with advanced breast cancer. Our 20-year experience with electron arc radiotherapy has demonstrated the safety and efficacy of this technique. The advantage of this technique is that the internal mammary lymph node chain can be easily encompassed while the dose to heart and lung is minimized; it also obviates match lines in areas of high risk.

Utilisation of nutrients by embryos of the enigmatic Australian viviparous skink Niveoscincus coventryi

The Eugongylus species group of Australian lygosomine skinks provides an unparalleled opportunity to study the evolution of placentotrophy. Viviparity and placentotrophy have evolved in two lineages, currently recognised as the genera Pseudemoia and Niveoscincus. The genus Niveoscincus is important because it is the only lineage of squamates in which variation in placental morphology and in the pattern of embryonic nutrition is known. Niveoscincus coventryi has the least complex placental morphology among species currently assigned to the genus. We quantified the net uptake of nutrients across the placenta of N. coventryi for comparison with other species in the genus and with other viviparous and oviparous lizards. The pattern of embryonic nutrition of N. coventryi is similar to other viviparous lizards with simple placentae in that there is no net uptake of dry matter during development but there is a net uptake of water, calcium, potassium, and sodium. There is no net uptake of lipid, nitrogen (an index of protein), or magnesium. We conclude that N. coventryi is predominantly lecithotrophic. Further, if N. coventryi is the sister taxon to Tasmanian Niveoscincus, then the distribution of patterns of embryonic nutrition among members of this clade suggests that the evolution of placentotrophy occurred during radiation of this lineage in Tasmania.

Evaluation of the effects of North Carolina's 0.08% BAC law

This study was conducted to determine whether the lowered BAC limit for drivers in North Carolina resulted in fewer alcohol-related motor vehicle crashes. We used time-series analysis to examine several indicators of alcohol involvement in both injury and fatal crashes between 1991 and 1996. Data from NC crash files as well as the Fatality Analysis Reporting System (FARS) are used. We also examined several indicators used in previous research on lower BAC limits using a before-after design to compare North Carolina with 37 states that did not change their BAC limit for 24 months before and after the BAC limit was lowered. When controlling for the pre-existing downward trend in drinking driver crashes, along with other pertinent factors such as amount of travel and number of weekends per month, there was no evidence of either a significant shift or a change in the downward trend of alcohol-related crashes associated with the lowered BAC limit. In conclusion, although the lower BAC limit was actively enforced and a substantial proportion of drinkers were aware of the new BAC limit, the drinking-driving population in North Carolina, at the time the lower limit took effect in October 1993, was simply unresponsive to this change.

Surgical treatment of atrial fibrillation using radiofrequency energy

BACKGROUND

The Maze III procedure for atrial fibrillation (AF) is effective but has not been used widely due to its complexity, bleeding risk, and added operative time. Surgical radiofrequency ablation may simplify the procedure and make intraoperative correction of AF more accessible and widely performed.

METHODS

Endocardial pulmonary venous isolation was performed on 48 patients with AF undergoing concurrent operation using temperature-controlled radiofrequency energy delivered through a hand-held flexible probe. Additional right-sided lesions were made at the surgeon's discretion.

RESULTS

Forty-two patients were appropriate for analysis (6 died). These patients had an AF duration of 4.8 +/- 6.4 years. At a mean follow-up of 138 +/- 96 days, 34 patients were in sinus rhythm. We were unable to demonstrate a difference in outcome based on AF duration, left atrial size, or addition of right-sided lesions.

CONCLUSIONS

Radiofrequency atrial ablation was effective in 81% of patients with AF at restoring sinus rhythm at an average follow-up of 4 months. This procedure is simple to perform and should broaden the number of patients that receive an AF treatment procedure during concurrent cardiac operation.

Phase II evaluation of bryostatin-1 in metastatic melanoma

In this phase II study we assessed the efficacy of bryostatin-1 (NSC 339555) in metastatic melanoma patients when given intravenously either once a week at a dose of 25 microg/m2 per day over 24 h for 3 weeks or at 40 microg/m2 per day over 72 h every 2 weeks. Treatment courses were repeated every 4 weeks. Patients who had received one prior chemotherapy regimen for advanced melanoma, with or without biotherapy, were randomized to one or the other bryostatin-1 dose schedules until 12 patients were registered to each arm. Because there was one confirmed response among the 12 patients who received the 72 h dose schedule, 25 more patients were added to that arm. No prophylactic medications were given. Objective tumour measurements were used to assess the efficacy of the regimen. The National Cancer Institutes common toxicity criteria were used to grade reactions. In total, 49 patients with metastatic melanoma, none having symptomatic brain metastasis, were studied. Of these, 12 patients received the 24 h bryostatin-1 regimen, while the remaining 37 received the 72 h regimen. One patient receiving the 72 h regimen had a partial response lasting over 7 months. Muscle pain occurred in over 90% of the patients and was the dose-limiting side effect of the 72 h regimen. Grade 3/4 nausea and vomiting were more common on the 24 h regimen than on the 72 h one (35% versus 5% of patients). There was no therapy-related thrombocytopenia. Neutropenia was mild and mainly limited to patients receiving the 72 h regimen. Bryostatin-1 has limited activity against melanoma when given by 72 h intravenous infusion.

Placental nutrition in the Tasmanian skink, Niveoscincus ocellatus

Niveoscincus ocellatus is an important species in historical analyses of the evolution of viviparity because it is the species upon which the type II chorioallantoic placenta was based. Here we describe the net nutrient uptake across the placenta of N. ocellatus for comparison with other species of skinks with complex placentae. N. ocellatus is highly placentotrophic, with neonates being 1.68-times larger in dry matter than the fresh eggs. There is an increase of nitrogen from 6.3 +/- 0.2 mg to 9.2 +/- 0.6 mg, and ash from 3.8 +/- 0.3 mg to 6.7 +/- 0.6 mg. The increase in ash is made up by a more than two-fold increase in the amounts of calcium, potassium and sodium. There is no significant difference in lipids in the neonates compared to fresh eggs, so considerable lipid must have crossed the placenta to provide energy for embryonic development. N. ocellatus is significantly more placentotrophic than Niveoscincus metallicus, which also has a complex chorioallantoic placenta. Discovery of substantial placentotrophy in this genus confirms that two lineages of Australian lygosomine skinks (represented by the genera Pseudemoia and Niveoscincus) have evolved this pattern of embryonic nutrition and supports the hypothesis that the evolution of reptilian placentotrophy involves specialisations in addition to structural modifications of the chorioallantoic placenta.

Evolution of placentation among squamate reptiles: recent research and future directions

Squamate reptiles are uniquely suited to study of evolution of reproductive mode and pattern of embryonic nutrition. Viviparous species have evolved from oviparous ancestors on numerous occasions, patterns of nutritional provision to embryos range widely from lecithotrophy, at one end of a continuum, to placentotrophy at the other, and structure and function of the maternal-embryonic relationship is highly constrained resulting in parallel evolutionary trajectories among taxa. Embryos of oviparous species primarily receive nourishment from yolk, but also mobilize a significant quantity of calcium from the eggshell. Most viviparous species also are predominantly lecithotrophic, yet all viviparous species are placentotrophic to some degree. Similarities in embryonic development and nutritional pattern between oviparous species and most viviparous species suggest that the pattern of nutrition of oviparous squamates is an exaptation for the evolution of viviparity and that placentotrophy and viviparity evolve concomitantly. The few species of squamates that rely substantially on placentotrophy have structural modifications of the interface between the embryo and mother that are interpreted as adaptations to enhance nutritional exchange. Recent studies have extended understanding of the diversity of embryonic nutrition and placental structure and have resulted in hypotheses for transitions in the evolution of placentotrophy, yet data are available for few species. Indirect tests of these hypotheses, by comparison of structural-functional relationships among clades in which viviparity has evolved, awaits further study of the reproductive biology of squamates.

Comparison of nutrient transport across the placenta of lizards differing in placental complexity

We have reviewed published and new quantitative data on the net uptake of nutrients by embryos of oviparous and viviparous lizards that vary in chorioallantoic placental complexity to better understand the evolution of complex placentae. We assessed net nutrient uptake during embryonic development by measuring the total dry mass, or the mass of separate nutrients, in the egg at about the time of ovulation and in the neonate. There is no significant difference in the fresh egg to neonate dry mass ratio of oviparous and viviparous species that have simple placentae, indicating that there is little, if any, net uptake of nutrients by viviparous species with simple chorioallantoic placentae. In contrast, there is significant uptake of dry matter and individual nutrients across the placenta of species with complex chorioallantoic placentae. Species of the genus Niveoscincus have a range of placentae and nutrient uptakes, even among populations of one species, suggesting that further studies among populations of single species are required. Data are available for relatively few clades, and all the data for the three most complex chorioallantoic placental types are derived from a single genus. Thus, further research on new genera of lizards is required to overcome the potentially confounding effects of phylogeny in our analyses.

Effects of resveratrol on the autophosphorylation of phorbol ester-responsive protein kinases: inhibition of protein kinase D but not protein kinase C isozyme autophosphorylation

The natural product resveratrol is a potent antagonist of phorbol ester-mediated tumor promotion and in vitro cellular responses to phorbol-ester tumor promoters, but it is only weakly inhibitory against the phosphorylation of conventional exogenous substrates by phorbol ester-responsive protein kinase C (PKC) isozymes. In this report, we compare the effects of resveratrol against the autophosphorylation reactions of PKC isozymes versus the novel phorbol ester-responsive kinase, protein kinase D (PKD). We found that resveratrol inhibits PKD autophosphorylation in a concentration-dependent manner, but has only negligible effects against the autophosphorylation reactions of representative members of each PKC isozyme subfamily (cPKC-alpha, -beta(1), and -gamma, nPKC-delta and -epsilon, and aPKC-zeta). Resveratrol was comparably effective against PKD autophosphorylation (IC(50) = 52 microM) and PKD phosphorylation of the exogenous substrate syntide-2 (IC(50) = 36 microM). The inhibitory potency of resveratrol against PKD is in line with the potency of resveratrol observed in cellular systems and with its potency against other purified enzymes and binding proteins that are implicated in the cancer chemopreventive activity of the polyphenol. Thus, PKD inhibition may contribute to the cancer chemopreventive action of resveratrol.

Treatment of underlying atrial fibrillation: paced rhythm obscures recognition

OBJECTIVES

The purpose of this study was to evaluate the rate of recognition of atrial fibrillation (AF), use of warfarin and prevalence of cerebrovascular accident (CVA) in paced versus unpaced patients during admission to a tertiary care teaching hospital.

BACKGROUND

The presence of AF underlying a continuously paced rhythm may be under recognized and result in a lower rate of anticoagulation and higher incidence of CVA.

METHODS

The identification of AF on 12 lead electrocardiogram (ECG) and telemetry, "optimal use" of anticoagulants that is, warfarin or aspirin, when warfarin is contraindicated and history of prior CVA was studied in three groups: 1) group A with continuously paced rhythm on ECG and telemetry (n = 30), 2) group B with intermittently paced rhythm on ECG and telemetry (n = 59), and 3) group C with persistent AF and no permanent pacemaker (n = 50).

RESULTS

The identification and documentation of AF was significantly lower in the continuously paced group A (20%) versus the intermittently paced group B (44%). Both groups A and B were substantially lower than unpaced controls. "Optimal use" of anticoagulants was significantly lower in group A (40%) compared with groups B (78%) and C (72%) but was not different between groups B and C. The prevalence of prior CVA was not significantly different between the three groups.

CONCLUSIONS

All ECGs in patients with paced rhythm should be examined closely for underlying AF to prevent under-recognition and under-treatment with anticoagulants.

Oxidant-induced S-glutathiolation inactivates protein kinase C-alpha (PKC-alpha): a potential mechanism of PKC isozyme regulation

Protein kinase C (PKC) isozymes are subject to inactivation by reactive oxygen species (ROS) through as yet undefined oxidative modifications of the isozyme structure. We previously reported that Cys-containing, Arg-rich peptide-substrate analogues spontaneously form disulfide-linked complexes with PKC isozymes, resulting in isozyme inactivation. This suggested that PKC might be inactivated by oxidant-induced S-glutathiolation, i.e., disulfide linkage of the endogenous molecule glutathione (GSH) to PKC. Protein S-glutathiolation is a reversible oxidative modification that has profound effects on the activity of certain enzymes and binding proteins. To directly examine whether PKC could be inactivated by S-glutathiolation, we used the thiol-specific oxidant diamide because its oxidant activity is restricted to induction of disulfide bridge formation. Diamide weakly inactivated purified recombinant cPKC-alpha, and this was markedly potentiated to nearly full inactivation by 100 microM GSH, which by itself was without effect on cPKC-alpha activity. Diamide inactivation of cPKC-alpha and its potentiation by GSH were both fully reversed by DTT. Likewise, GSH markedly potentiated diamide inactivation of a PKC isozyme mixture purified from rat brain (alpha, beta, gamma, epsilon, zeta) in a DTT-reversible manner. GSH potentiation of diamide-induced cPKC-alpha inactivation was associated with S-glutathiolation of the isozyme. cPKC-alpha S-glutathiolation was demonstrated by the DTT-reversible incorporation of [(35)S]GSH into the isozyme structure and by an associated change in the migration position of cPKC-alpha in nonreducing SDS-PAGE. Diamide treatment of NIH3T3 cells likewise induced potent, DTT-reversible inactivation of cPKC-alpha in association with [(35)S] S-thiolation of the isozyme. Taken together, the results indicate that PKC isozymes can be oxidatively inactivated by S-thiolation reactions involving endogenous thiols such as GSH.

Ontogeny of the extraembryonic membranes of the oviparous lizard, Eumeces fasciatus (Squamata: scincidae)

Oviposited eggs of Eumeces fasciatus contain embryos in the limb bud stage. Amniogenesis is complete and two yolk sac membranes, vascular trilaminar omphalopleure (choriovitelline membrane) and bilaminar omphalopleure, enclose the yolk vesicle. A small allantoic vesicle contacts the chorion. The choriovitelline membrane is the primary vascular system. Blood islands, sites of hematopoiesis, are associated with omphalomesenteric vessels of the choriovitelline membrane. The bilaminar omphalopleure, which contacts the eggshell over the abembryonic hemisphere of the egg, lies external to an isolated yolk mass and yolk cleft and is not vascularized. The definitive yolk sac (splanchnopleure) is formed when the extraembryonic coelom and allantoic vesicle intrude into the choriovitelline membrane. Omphalomesenteric vessels are retained with the yolk sac splanchnopleure and the associated hematopoietic sites are present throughout incubation. The chorioallantoic membrane reaches the equator of the egg, entirely supplanting the choriovitelline membrane, after 25% of incubation is completed. Further growth of the allantois is stalled until 65% of incubation is completed when rapid expansion of the allantoic vesicle, in conjunction with resorption of the isolated yolk mass, supplants the bilaminar omphalopleure. As a result, the chorioallantoic membrane completely envelopes the egg for the final 35% of incubation. This developmental event is coincident with published reports for the timing of increased growth and metabolism of embryos. As the isolated yolk mass regresses, intravitelline cells associated with the yolk cleft invade and resorb the yolk to form a large cavity. The wall of this cavity is a germinal epithelium that produces cells that fill the cavity. This structure appears to be a site of hematopoiesis previously undescribed in vertebrates.

Placental nutrition in the viviparous lizard Niveoscincus metallicus: the influence of placental type

The ion, energy, lipid, nitrogen and fat-soluble vitamin contents of freshly ovulated eggs and neonates of the viviparous lizard Niveoscincus metallicus were measured to quantify uptake of nutrients across the placenta. This species is particularly interesting because it has a chorio-allantoic placenta that is intermediate in complexity compared to viviparous species that have been the focus of other studies. Newly ovulated eggs have a wet mass of 79.6+/−4.6 mg and a dry mass of 41.8+/−2.8 mg, compared to the neonates that have a wet mass of 224.2+/−8.2 mg and dry mass of 37.9+/−1.2 mg. Thus, there is no significant net uptake of dry matter across the placenta. Neonates have significantly less lipid (6.2+/−0.4 mg) than eggs (12.7+/−0.5 mg), but no significant difference in nitrogen (4.1+/−0.3 mg) compared to eggs (4.5+/−0.2 mg). Energy densities reflect the protein and lipid composition and the relative dry masses of the eggs and neonates. There is significantly more energy (1029.1+/−80.0 J) in the egg than in the neonate (858.2+/−38.6 J). The increase in the ash content of the neonates (2.9+/−0.2 mg) compared to fresh eggs (2.1+/−0.3 mg) was not significant, even though there was an approximately threefold increase in the amount of sodium (0.11+/−0.01 mg in neonates, 0.34+/−0.01 mg in eggs) and potassium (0.12+/−0.017 in neonates, 0.40+/−0.01 mg in eggs) in neonates compared to eggs. There was no significant uptake of calcium and magnesium during development. The egg lipids consisted of triacylglycerol (66.7+/−2.3 %), phospholipid (18.9+/−0.7 %), cholesteryl ester (4.9+/−1.6 %) and free cholesterol (5.6+/−1.5 %). The egg phospholipid contained comparatively high proportions of arachidonic and eicosapentanoic acids but low levels of docosahexaenoic acid (DHA), whereas the phospholipid of the neonate was greatly enriched in DHA. In the egg, the predominant vitamin E was (α)-tocopherol (62.6+/−3.4 mg g(−)(1)), although there was some (γ)-tocotrienol (3.5+/−0.3 mg g(−)(1)), and vitamin A was present (1.5+/−0.2 mg g(−)(1)). The ratio of neonate dry mass to egg dry mass of N. metallicus (0.91) lies between that of species with type I (0.78) and type III (1.70) chorio-allantoic placentae, confirming our conclusion that the placenta of N. metallicus is functionally intermediate, as well as intermediate in complexity, between these other two types.

Resveratrol preferentially inhibits protein kinase C-catalyzed phosphorylation of a cofactor-independent, arginine-rich protein substrate by a novel mechanism

Resveratrol, a polyphenolic natural product abundantly present in grape skins, is a candidate cancer chemopreventive agent that antagonizes each stage of carcinogenesis and inhibits protein kinase C (PKC), a key mediator of tumor promotion. While resveratrol has been shown to antagonize both isolated and cellular forms of PKC, the weak inhibitory potency observed against isolated PKC cannot account for the reported efficacy of the polyphenol against PKC in cells. In this report, we analyze the mechanism of PKC inhibition by resveratrol. Our results indicate that resveratrol has a broad range of inhibitory potencies against purified PKC that depend on the nature of the substrate and the cofactor dependence of the phosphotransferase reaction. Resveratrol weakly inhibited the Ca2+/phosphatidylserine-stimulated activity of a purified rat brain PKC isozyme mixture (IC(50) = 90 microM) by competition with ATP (K(i) = 55 microM). Consistent with the kinetic evidence for a catalytic domain-directed mechanism, resveratrol inhibited the lipid-dependent activity of PKC isozymes with divergent regulatory domains similarly, and it was even more effective in inhibiting a cofactor-independent catalytic domain fragment (CDF) of PKC generated by limited proteolysis. This suggested that regulatory features of PKC might impede resveratrol inhibition of the enzyme. To explore this, we examined the effects of resveratrol on PKC-catalyzed phosphorylation of the cofactor-independent substrate protamine sulfate, which is a polybasic protein that activates PKC by a novel mechanism. Resveratrol potently inhibited protamine sulfate phosphorylation (IC(50) = 10 microM) by a mechanism that entailed antagonism of the activation of PKC by protamine sulfate and did not involve competition with either substrate. On the basis of the presence of PKC isozymes at subcellular sites rich in polybasic proteins, it has been proposed that certain endogenous polybasic PKC substrates may activate PKC in cells by the same mechanism as protamine sulfate. Our results suggest that antagonism by resveratrol of the phosphorylation of cellular PKC substrates that resemble protamine sulfate in their interactions with PKC may contribute to the efficacy of resveratrol against PKC in cells.

Prophylactic oral amiodarone compared with placebo for prevention of atrial fibrillation after coronary artery bypass surgery

BACKGROUND

Postoperative atrial fibrillation occurs in 20% to 40% of patients undergoing coronary artery bypass grafting (CABG) and contributes to delayed recovery, increased length of stay, and increased hospital cost. Measures at preventing postoperative atrial fibrillation have had mixed results. We report a double-blind trial comparing oral amiodarone with placebo for the prevention of atrial fibrillation after CABG.

METHODS AND RESULTS

All patients undergoing CABG were considered eligible. Exclusion criteria included bradycardia (<50 beats/min), prior Atrial fibrillation, concurrent therapy with antiarrhythmic drugs, or concomitant valve surgery. Patients were given 2 g of amiodarone (73 patients) or placebo (70 patients) in divided doses 1 to 4 days before surgery and 400 mg daily for 7 days postoperatively. Atrial fibrillation occurred in 24.7% (18 of 43) of patients receiving amiodarone and 32. 8% (23 of 70) of patients receiving placebo (P =.30). Heart rate at onset of atrial fibrillation was 133.4 +/- 26.6 beats/min for amiodarone compared with 152.9 +/- 31.6 beats/min for placebo (P =. 04). Duration of atrial fibrillation was 10.2 +/- 8.1 hours for amiodarone compared with 16.2 +/- 27.5 hours for placebo (P =.67). Patients receiving both beta-blockade and amiodarone had a 16.7% incidence of atrial fibrillation compared with 31.9% in the remaining patients (P =.10). Atrial fibrillation was associated with an increased cost of $7011 compared with those who remained in sinus rhythm ($23,869 +/- $20,894 vs $16,857 +/- $5401 in sinus rhythm). Hospital cost of those taking amiodarone was $18,895 +/- $13,267 compared with $18,839 +/- $11,537.18 for placebo (P =.42).

CONCLUSION

Postoperative CABG atrial fibrillation is associated with prolonged hospital stay and increased cost. Prophylactic oral amiodarone did not statistically alter the incidence or duration of atrial fibrillation after CABG, although favorable trends were noted. Hospital cost was not affected by therapy with amiodarone.

A peptide substrate-based affinity label blocks protein kinase C-catalyzed ATP hydrolysis and peptide-substrate phosphorylation

Studies focused on the cAMP-dependent protein kinase (PKA) have led to the identification of conserved active-site residues involved in Ser/Thr protein kinase catalysis and have ruled out a role for Cys residues in the catalytic mechanism. Protein kinase C (PKC) is a Ser/Thr protein kinase isozyme family. We recently reported that the peptide-substrate analog N-biotinyl-Arg-Arg-Arg-Cys-Leu-Arg-Arg-Leu (N-biotinyl-RRRCLRRL) spontaneously forms intermolecular disulfide bridges with the active-site region of PKC isozymes concomitant with inactivation of histone kinase catalysis. Because Cys does not participate in PKC catalysis, one can analyze the active-site topology of PKC by examining which catalytic reactions are sterically hindered when the inactivator peptide is tethered to Cys in the active-site region of the enzyme. In this report, we show that N-biotinyl-RRRCLRRL inactivates the bulky PKC-catalyzed histone phosphorylation reaction, the comparatively less bulky PKC-catalyzed phosphorylation of a series of octapeptide, hexapeptide, and pentapeptide substrates, the intramolecular autophosphorylation reaction of PKC, and the least bulky PKC-catalyzed reaction, ATP hydrolysis, in a dithiothreitol-sensitive manner with comparable efficacy. Our results provide evidence that the covalent linkage of N-biotinyl-RRRCLRRL to the active-site region of PKC sterically hinders PKC catalysis, even in the absence of peptide and protein substrates.

Placental ontogeny of the Australian scincid lizards Niveoscincus coventryi and Pseudemoia spenceri

Models for the evolution of placentation among squamate reptiles have been strongly influenced by early work on one lineage of Australian scincid lizards: one of three lineages that include species with specialized allantoplacentation. The discovery of two types of complex allantoplacentae among species currently assigned to the Eugongylus species group led Weekes ([1935] Proc. Zool. Soc. Lond., 2:625-645) to propose that a graded evolutionary sequence was exemplified by the morphological series of allantoplacental types that existed among Australian skinks. One of the model's strengths is the incorporation of testable inferences of the relationship between placental structure and function. However, descriptions of placental structure for some species are incomplete and subsequent taxonomic revisions have resulted in confusion concerning the species studied. One of the ambiguities is the identity of Lygosoma weekesae (Kinghorn [1929] Proc. Linn. Soc. N.S.W., 54:32-33), one of two species for which the most specialized type of allantoplacenta was defined. The distinguishing characteristic of this placental type is the presence of a structure known as a placentome. Subsequent to the original species description, Lygosoma weekesae was named a synonym for Pseudemoia spenceri (Rawlinson [1974] Mem. Natn. Mus. Vict., 35:87-96), yet the placental description (Weekes [1929] Proc. Linn. Soc. N.S.W., 54:34-60) is thought to be of Niveoscincus coventryi (Rawlinson [1975] Mem. Natn. Mus. Vic., 36:1-16). We describe placental ontogeny of N. coventryi and P. spenceri as a contribution to study of comparative placentation among lygosomatine skinks. We conclude that the placental description for L. weekesae could not have been N. coventryi, because a placentome is not a component of the allantoplacenta of N. coventryi. Further, the allantoplacenta of this species does not conform to previously defined categories for Eugongylus group skinks. The allantoplacenta of P. spenceri contains a placentome that is structurally congruous with the original description of placentation for L. weekesae (Weekes [1929] Proc. Linn. Soc. N.S.W., 54:34-60). Comparison of extraembryonic membrane and placental structure among the four viviparous and one oviparous species of Eugongylus group skinks for which data are available shows that each species exhibits characters that distinguish it from other species, while additional characters are shared among all, or some, species. Based on a recent phylogenetic hypothesis, the distribution of allantoplacental types among these species does not support Weekes' ([1935] Proc. Zool. Soc. Lond., 2:625-645) model of a graded sequence for the evolution of squamate placentation.

Response to radiation therapy and prognosis in breast cancer patients with BRCA1 and BRCA2 mutations

BACKGROUND AND PURPOSE

The purpose of this study is to evaluate overall survival in BRCA1 or BRCA2 breast cancer patients, describe presenting stage, review histologic findings and evaluate response to radiotherapy.

MATERIALS AND METHODS

A retrospective study was performed evaluating breast cancer patients with known mutations of BRCA1 or BRCA2. Patients from 12 different pedigrees were cross-referenced with the Utah Cancer Registry (UCR), histologic findings were verified and radiotherapy records were reviewed for acute response to treatment. Actuarial survival calculations were performed and patients were matched for age, date of diagnosis and tumor size.

RESULTS

Thirty breast cancer patients with BRCA1 mutations were found to have 34 breast cancers (four had bilateral metachronous lesions) and 20 breast cancer patients with BRCA2 mutations were found to have 22 breast cancers (two had bilateral metachronous disease). The median age at diagnosis was 49 years (range 21-77 years) and 42 years (range 23-83 years), respectively, for BRCA1 and BRCA2 patients. Unusual histologic types of breast cancers were represented with 7% (4/56) medullary and 5% (3/56) lobular carcinomas. Complete staging was possible for 63% (35/56) of cancers. Stages I, II, III and IV represented 26, 63, 6 and 6% of cancers, respectively. The most severe radiation reaction was moist desquamation which was self-limiting and developed in 29% (6/21) of irradiated patients. The mean follow-up was 9.8 and 7.5 years for BRCA1 and BRCA2 cancers, respectively. Kaplan-Meier survival analysis demonstrated 5-year survival values of 75% for BRCA1 patients, 73% for BRCA2 patients, 70% for matched controls and 69% for UCR controls. No statistically significant differences were evident between the groups at 5 or 10 years.

CONCLUSIONS

Despite their younger age at presentation, breast cancer patients harboring BRCAI or BRCA2 mutations present at a similar stage, display a normal acute reaction to radiotherapy and have a similar prognosis when compared with sporadic breast cancer patients.

Cognitive test performance and crash risk in an older driver population

This paper reports on the usefulness of five brief tests of cognitive function for identifying older drivers who may be at increased risk of crash involvement; it also examines the broader issue of whether impaired cognitive function is associated with increased crash risk in the older driver population. Data for the study were collected from 3238 drivers aged 65 and older applying for renewal of their North Carolina driver's license. The specific cognitive assessments examined include the Trail Making Test parts A and B, the Short Blessed Orientation-Memory-Concentration test of cognitive impairment, a modification of the American Association of Retired Persons 'Reaction Time' test, and a timed Traffic Sign Recognition test. Information on crash involvements during the 3-year period prior to testing was obtained by linkage with the North Carolina driver history file. Although the individual tests were not found to be particularly effective screening tools for identifying subsets of high risk drivers, cognitive test performance remained significantly associated with crash risk even after controlling for driver age, race and measures of driving exposure. Drivers who scored in the lowest 10% on the cognitive tests were approx. 1.5 times more likely to be in crashes than were drivers who scored in the highest 10%. Implications for the counseling and licensing of older drivers are discussed, along with recommendations for future research.

Prognosis of adenocarcinoma arising in Barrett's esophagus

BACKGROUND

The rising incidence of adenocarcinoma of the esophagus, as well as its association with Barrett's esophagus, has been reported previously. We report our experience in treating patients with adenocarcinoma arising in Barrett's esophagus.

METHODS

A retrospective review was performed of 70 consecutive patients with adenocarcinoma of the esophagus treated between November 1988 and April 1996 with preoperative chemoradiation and resection. Demographics, pathologic features, and survival were compared with patients who developed adenocarcinoma of the esophagus without Barrett's. Statistical analyses was performed using Student's t test, Fisher's exact test, and Kaplan-Meier where appropriate.

RESULTS

Thirty-two (46%) patients had adenocarcinoma arising in Barrett's esophagus. During the last 4 years, 72% (23 of 32) of patients with adenocarcinoma had coexistent Barrett's. No differences in patients with or without Barrett's with regard to age, sex, race, tumor location, preoperative chemotherapy, type of operation, or operative stage were observed. Tumors in patients with Barrett's were larger (p = 0.017), had better differentiation (p = 0.002), and were less likely to have a complete response to preoperative chemoradiation (p = 0.05). Actuarial survival, however, was better in the group with associated Barrett's esophagus (p = 0.033).

CONCLUSIONS

The incidence of adenocarcinoma of the esophagus arising in Barrett's esophagus appears to be increasing. It may be distinct clinically and biologically from adenocarcinoma of the esophagus that does not develop in association with Barrett's epithelium. Long-term survival was better in our patients with adenocarcinoma associated with Barrett's esophagus.

A system for postoperative visualization and analysis of left ventricular pressure-volume loops

A patient monitoring system for continuous real-time monitoring of left ventricular (LV) function in the postoperative setting was developed. Common hemodynamic parameters and LV functional indices are all calculated from left ventricular pressure-volume loops (PV-loops). Visualization of the PV-loops, along with the hemodynamic parameter derived from them, provides valuable insight into ventricular function and patient recovery. The pressure component is obtained via a pressure sensing catheter placed during surgery. Volume is measured via non-imaging radionuclide techniques using a modified Capintec-VEST. Following surgery and transfer to the recovery unit, the patient's blood is labeled with Tc-99m. A portable gamma camera is used to measure baseline ejection fraction (EF) and to aid in placing the VEST. The specific radioactivity of the blood is calibrated using the baseline EF and thermodilution cardiac output. To confirm the volume measurement accuracy of this technique six patients undergoing bilateral heart catheterization were studied. Single-plane cineventriculographic LV volumes were compared to those calculated from the VEST's time activity curve.

A new method for predicting crashworthiness

Consumer information concerning the predicted 'safeness' of a new car model is based on the results of crash tests. Unfortunately, because it allows comparisons only within size/weight groups, the information is somewhat incompatible with the normal car-purchase decision process since consumers often consider cars within different groups. In addition, based on past research, the association of the crash-test information with real-world crash outcomes is, at best, somewhat limited. The goal of this study was to explore a methodology for improving this information, a methodology which incorporates not only the crash-test information, but also information concerning real-world occupant injury experience in prior crashes involving similar vehicles ('clones'). The clone information included both driver injury severity in past clone crashes from the North Carolina accident file and various indicators of relative driver injury in clones extracted from published insurance-related data from the Highway Loss Data Institute (HLDI). Final models developed included both measures of the Head Index Criteria (HIC) from the crash test and some measure of clone performances as significant predictors. While the North Carolina clone data is intuitively 'cleaner' in that it describes injury level per crash rather than per insured year, the medical claims indices from the HLDI data consistently were shown to be the stronger predictors. Future research will need to look at ways of better combining the crash-test variables and of possible modifications to the HLDI indices. In general, the analyses generated encouraging results that appear to point to possible improvements in the crashworthiness information.