[Effects of manganese, zircon and lithium alone on rat liver lipid peroxidation]

Lipid peroxide (LPO) in rat liver was detected by malondiadehyde (MDA) colorimetry. The effect of manganese, zircon and lithium alone on lipid peroxidation in rat liver was also studied. The results showed that manganese and zircon at the doses of (9.862-1.972) x 10(-4) and (0.1972-9.862) x 10(-5) nmol/L respectively decreased LPO in rat liver(P < 0.01). Lithium inhibited lipid peroxidation at the dose of (19.72-1.972) x 10(-4) nmol/L, and induced lipid peroxidation at higher concentration.

Elevated breast cancer risk in irradiated BALB/c mice associates with unique functional polymorphism of the Prkdc (DNA-dependent protein kinase catalytic subunit) gene

Female BALB/c mice are unusually radiosensitive and more susceptible than C57BL/6 and other tested inbred mice to ionizing radiation (IR)-induced mammary tumors. This breast cancer susceptibility is correlated with elevated susceptibility for mammary cell transformation and genomic instability following irradiation. In this study, we report the identification of two BALB/c strain-specific polymorphisms in the coding region of Prkdc, the gene encoding the DNA-dependent protein kinase catalytic subunit, which is known to be involved in DNA double-stranded break repair and post-IR signal transduction. First, we identified an A --> G transition at base 11530 resulting in a Met --> Val conversion at codon 3844 (M3844V) in the phosphatidylinositol 3-kinase domain upstream of the scid mutation (Y4046X). Second, we identified a C --> T transition at base 6418 resulting in an Arg --> Cys conversion at codon 2140 (R2140C) downstream of the putative leucine zipper domain. This unique PrkdcBALB variant gene is shown to be associated with decreased DNA-dependent protein kinase catalytic subunit activity and with increased susceptibility to IR-induced genomic instability in primary mammary epithelial cells. The data provide the first evidence that naturally arising allelic variation in a mouse DNA damage response gene may associate with IR response and breast cancer risk.

Long-term care hospitals under Medicare: facility-level characteristics

Though accounting for only a small percentage of total Medicare spending, long-term care hospitals (LTCHs) (defined as having an average length of stay [LOS] of 25 days or more) have been growing, in number and in Medicare expenditures, at a rapid rate in recent years. Because they have not been widely studied, we conducted research to describe the characteristics of this increasingly important Medicare provider type. We found that most LTCHs specialize in the provision of respiratory care or rehabilitation. Information from this study can help inform the development of a Medicare prospective payment system for LTCHs.

Technetium-99 in the Irish marine environment

Technetium-99 activity concentrations in seawater and biota from Irish coastal waters are presented. Time series measurements of 99Tc in seawater and Fucus vesiculosus from the western Irish Sea show that activity concentrations have increased in line with the increase in discharges of 99Tc from Sellafield. The peak in activity concentrations in both seawater and Fucus vesiculosus occurred in 1997 approximately two years after the peak in 99Tc discharges. The highest activity concentration recorded in Fucus vesiculosus showed a 29-fold increase over the mean concentration for the period 1988-1993. Technetium-99 activity concentrations were measured in fish, lobsters, prawns, mussels and oysters landed at major fishing ports on the east and northeast coasts of Ireland between 1996 and 1998. Concentration factors for 99Tc in the brown seaweed Fucus vesiculosus and certain species of fish, crustaceans and molluscs from the Irish Sea were estimated. In general, these concentration factors were higher than those in the literature which were derived from laboratory studies, but agreed well with values which were based on field studies. The mean committed effective doses to Irish typical and heavy seafood consumers due to 99Tc in the period 1996-1998 were 0.061 and 0.24 microSv, respectively.

Archaeal promoter-directed expression of the Halobacterium salinarum catalase-peroxidase gene

The Halobacterium salinarum catalase-peroxidase gene was subcloned into shuttle vectors pWL102 and pWL202 and expressed under the control of different archaeal promoters. When Hbt. salinarum was transformed with the catalase-peroxidase gene under the control of its own promoter, catalase-peroxidase activity increased twofold. Catalase-peroxidase activity increased threefold when Hbt. salinarum was transformed with the catalase-peroxidase gene under the control of a tRNA promoter. This bifunctional enzyme in Hbt. salinarum was not induced by environmental stresses such as H2O2, intense light, darkness, high temperature, low temperature, redox inhibitors, heavy metals, or ions.

Vacuum disk and facet phenomenon in a dog with cauda equina syndrome

A 7-year-old castrated male Rottweiler was evaluated for an 18-month history of bilateral hind limb lameness, signs of pain on rising, and mild ataxia. A gas-filled lumbosacral disk space (vacuum disk phenomenon) was revealed by use of computed tomography. Additional smaller gas bubbles were in the periphery of the disk and between the degenerated L5-L6 dorsal articular facets (vacuum facet phenomenon). Vacuum disk and facet phenomena have been described in humans with degenerative disk and vertebral articular facet joint disease; gas attracted from surrounding tissues accumulates within clefts of the degenerated disk or in unstable facet joints. Vacuum disk phenomenon has been reported in dogs and indicates degenerative disk disease. The phenomenon is more commonly observed by use of computed tomography, compared with conventional radiography, and can be elicited by hyperextension of the vertebral column.

A low CD34+ cell dose results in higher mortality and poorer survival after blood or marrow stem cell transplantation from HLA-identical siblings: should 2 x 10(6) CD34+ cells/kg be considered the minimum threshold?

We studied the effect of the CD34+ cell dose on transplant-related mortality (TRM) and survival in 39 patients randomized to receive lenograstim-mobilized PBSCT (n = 20) or BMT (n = 19) from HLA-identical siblings. Both marrow and blood were harvested, and one infused in a double-blind fashion. The median nucleated (7.0 vs 3.2 x 10(8)/kg; P < 0.0001), CD34+ (3.7 vs 1.5 x 10(6)/kg; P = 0.002), CFU-GM (42 vs 19 x 10(4)/kg; P = 0.002), and CD3+ (1.9 vs 0.3 x 10(8)/kg; P < 0.0001) cell doses with PBSCT were higher. Thirteen patients (6 BMT and 7 PBSCT) experienced TRM at 15-733 days (median 57); 10 of 20 receiving <2 x 10(6) CD34+ cells/kg compared with three of 19 receiving > or =2. Eight of 20 patients receiving <2 x 10(6) CD34+ cells/kg are alive compared with 14 of 19 receiving > or =2. In Cox analysis, CD34+ cell dose > or =2 x 10(6)/kg was associated with lower TRM (RR 0.2, P = 0.01), and higher overall (RR 3.7, P = 0.01) and event-free (RR 3.2, P = 0.02) survival. Other cell populations and the source of stem cells did not affect TRM or survival. We conclude that 2 x 10(6) CD34+ cells/kg may be the ideal minimum cell dose for allogeneic transplantation although lower doses do not preclude successful therapy. Since the likelihood of obtaining this threshold CD34+ cell number is significantly greater from blood than marrow, PBSCT may be preferable to marrow for allografts from HLA-identical siblings.

A comparative evaluation of Humphrey perimetry and the multi-channel pattern visual evoked potentials

PURPOSES

To compare the multi-channel pattern visual evoked potentials to Humphrey perimetry in the assessment of central visual function in primary open angle glaucoma.

METHODS

The multi-channel checkerboard reversal PVEPs waves to full-field and half-field stimulus of 25 normal persons and 74 patients with primary open angle glaucoma were recorded and analyzed, All patients were examined using Humphrey Field Analyzer. The area of visual field corresponding to the area of retina stimulated during multi-channel PVEPs testing were analysed, straight-line correlation and regression analyses of the various multi-channel PVEPs parameters and the total dB losses were performed.

RESULTS

The multi-channel PVEPs demonstrated a low detection rate compared with Humphrey perimetry in the early glaucoma, absolute latency and field loss were correlated in the late stage of glaucoma, and absolute amplitude and field loss were not correlated.

CONCLUSIONS

In relation to signalling "early" loss the multi-channel PVEPs was inferior to Humphrey perimetry, in late loss of primary open angle glaucoma, multi-channel PVEPs can provide a valuable, objective complement to Humphrey perimetry.

Characterization of the "helix clamp" motif of HIV-1 reverse transcriptase using MALDI-TOF MS and surface plasmon resonance

A helix-turn-helix motif in the crystal structure of human immunodeficiency virus type 1 reverse transcriptase (HIV-1 RT) was proposed to be a conserved nucleic acid binding domain among several nucleotide polymerizing enzymes (Hermann, T.; Meier, T.; Götte, M.; Heumann, H. Nucleic Acids Res. 1994, 22, 4625-4633). The sequence of this domain is homologous to 259KLVGKL-(X)16KLLR284 of HIV-1 RT, which acts as a "helix clamp" grasping the template-primer (T-P) complex. We characterized the helix clamp motif using MALDI-TOF MS and surface plasmon resonance (BIAcore). Our studies showed that the "helix clamp" has a nucleic acid binding function that may not be sequence specific. This evidence suggests that ionic interactions between the helix clamp and oligonucleotide backbone are not solely responsible for binding. Secondary and tertiary structures of the protein may also play a significant role in nucleic acid binding. The association and dissociation constants, ka and kd, for the binding of single-stranded oligonucleotide to the helix clamp were determined to be 7.03 x 10(3) M(-1) s(-1) and 1.22 x 10(3) s(-1), respectively.

Allogeneic blood and bone-marrow stem-cell transplantation in haematological malignant diseases: a randomised trial

BACKGROUND

Autologous transplantation with peripheral blood stem cells (PBSC) results in faster haematopoietic-cell repopulation than with bone marrow. We prospectively compared bone marrow and PBSC for allogeneic transplantation.

METHODS

Adult HLA-identical sibling donors provided bone marrow and lenograstim-mobilised PBSC. 39 patients with malignant haematological disorders were infused with either bone marrow (n=19) or PBSC (n=20) after standard conditioning regimens in a double-blind, randomised fashion. The identity of the infused products for all patients remained masked until 1 year after the last patient had received transplantation.

FINDINGS

The PBSC group had significantly faster neutrophil recovery to 0.5x10(9)/L (median 17.5 vs 23 days, p=0.002), and platelet recovery to 20x10(9)/L (median 11 vs 18 days, p<0.0001) and to 50x10(9)/L (median 20.5 vs 27 days, p=0.02) than the bone-marrow group. PBSC patients were discharged from hospital earlier than were bone-marrow patients (median 26 vs 31 days, p=0.01). At 4 weeks after transplantation, absolute lymphocytes (0.48 vs 0.63, p=0.08) and CD25 cells (0.04 vs 0.08, p=0.007) were higher in the PBSC group, and the proportion of patients with absolute lymphopenia (74% vs 33%, p=0.03) and CD4 lymphopenia (59% vs 24%, p=0.05) was significantly higher in the bone-marrow group. There was no significant difference in the occurrence of acute or chronic graft-versus-host disease and overall survival. The probability of relapse was significantly higher in the bone-marrow group than in the PBSC group (p=0.01); all five relapses occurred among bone-marrow recipients.

INTERPRETATION

Our small study indicates that PBSCs are better than bone marrow for allogeneic transplantation from HLA-identical siblings in terms of faster haematopoietic and immune recovery, and have the potential to reduce disease recurrence.

Comparison of marrow and blood cell yields from the same donors in a double-blind, randomized study of allogeneic marrow vs blood stem cell transplantation

Forty healthy adult donors underwent marrow (BM) as well as peripheral blood (PBSC) stem cell collections for their HLA-identical adult siblings with hematologic malignancies. BM was harvested on day 1 (target 3 x 108 nucleated cells/kg, 10 microg/kg lenograstim (glycosylated G-CSF) administered on days 2-6, and a single leukapheresis performed on day 6. The blood volume processed was the higher of 200% donor blood volume or 10 liters. The total nucleated cell (TNC) yields from PBSC were 1.1- to 4.3-fold higher than BM (median 7.0 vs 3.1 x 10(8)/kg, P < 0.0001). Although BM contained a higher proportion of CD34+cells (1.3% vs 0.7%, P < 0. 0001) and a comparable proportion of CD3+ cells (median 29% vs 26%, P = 0.4), the absolute numbers of CD34+ and CD3+ cells and their subsets were several times higher in PBSC. There was a poor correlation between BM and PBSC CD34 and TNC numbers, but a significant correlation between BM and PBSC CD3 numbers. Only five of 40 BM harvests contained >/=2 x 10(6) CD34+ cells/kg compared with 35 of 40 PBSC harvests (P < 0.0001). We conclude that the numbers of progenitor and immunocompetent cells in PBSC are several times higher than in BM. It is possible to collect adequate numbers of progenitor cells from blood after lenograstim stimulation more frequently than from marrow, and donors yielding low quantities of progenitor cells from BM usually deliver better quantities from PBSC. Bone Marrow Transplantation (2000) 25, 501-505.

Infectivity of entomopathogenic nematodes (Steinernematidae, Heterorhabditidae) to mushroom phorid fly (Megaselia halterata) larvae

Abstract

Ten isolates of entomopathogenic nematodes were screened for infectivity to phorid larvae in beakers of spawned mushroom compost. The sex ratio of emerging flies was unaffected by nematode application. Compared to untreated controls, three isolates (Steinernema D1, Steinernema C1 and S. feltiae A2) reduced phorid numbers. These isolates were tested further at two dose rates (50 000 and 100 000 infective juveniles per beaker) and three fly densities. Compared to the untreated control, all isolates reduced the numbers of flies emerging from the compost; there was a positive dose response but no significant differences between isolates. The nematodes were also bioassayed at three dose rates (100, 200 and 400 infective juveniles per dish) against individual phorid larvae, in dishes of agar containing mushroom mycelium. LD50 values indicated no significant differences in pathogenicity between the isolates. Le pouvoir infestant de nématodes entomopathogènes (Steinernematidae, Heterorhabditidae) envers les larves de la mouche phoride des champignons (Megaselia halterata) - Dix isolats de nématodes entomopathogènes ont été testés pour leur pouvoir infestant envers des larves de phorides dans des béchers contenant du compost avec du blanc de champignon. Le quotient sexuel des mouches émergentes n'est pas affecté par la présence du nématode. En comparaison avec un témoin non traité, trois isolats (Steinernema D1, Steinernema C1 et S. feltiae A2) réduisent le nombre de phorides. Ces isolats ont été ensuite testés à deux doses (50 000 et 100 000 juvéniles infestants par bécher) et trois densités de mouches: en comparaison du témoin non traité, tous les isolats réduisent le nombre de mouches émergeant du compost; si la dose influe sur les résultats, il n'y a pas de différence significative entre les isolats. Les nématodes ont été testés à trois doses (100, 200 et 400 juvéniles infestants par récipient) envers une seule larve de phoride, sur agar contenant du mycelium de champignon. La valeur LD50 n'indique aucune différence significative entre les isolats en ce qui concerne leur pouvoir pathogène.

Use of a monoclonal antibody in a field evaluation of the persistence and infectivity of Steinernema n. sp. D1 (Nematoda: Steinernematidae)

Abstract

At the end of a mushroom cropping house trial designed to determine the infectivity, to phorid flies, of the entomopathogenic nematode Steinernema D1 (isolate IOW45), the spent, nematode-infested substrate was deposited as a stack on the edge of a field. The introduced population of Steinernema D1 (IOW45) was monitored by bi-monthly sampling for eight months. The infectivity, to Galleria mellonella larvae, of nematodes extracted from cores of substrate taken from the stack, was determined. There was a decline (P < 0.01) in the numbers of nematodes extracted on each of the sample dates. After the first sample was taken, fewer (P < 0.001) nematodes were recovered from the top layer of the stack than from the bottom or middle layers. Nematode infectivity declined (P < 0.001) over the first two months in the field and then remained at a constant low level until month 8, when no G. mellonella were parasitised. After removal of the stack, subsequent soil samples taken from plots that had been underlying, or adjacent to it, were baited with G. mellonella larvae. Samples of the haemolymph taken from larvae that died in the soil were tested with a monoclonal antibody specific to the bacterial symbiont (Xenorhabdus sp.) of Steinernema D1 (IOW45). Using this method, Steinernema D1 (IOW45) was detectable in soil that had been underlying the compost stack for as long as 12 months after compost deposition. Utilisation d'anticorps monoclonaux pour l'évaluation au champ de la persistanceet du pouvoir infestant de Steinernema n. sp. D1 (Nematoda: Steinernematidae) - A la fin d'un essai sur une culture de champignons sous abri, essai destiné à déterminer le pouvoir infestant du nématode entomopathogène Steinernema D1 (isolat IOW45) envers des Diptères Phoridae, le substrat utilisé, infesté de nématodes, a été rassemblé en une meule, au coin du champ. La population de Steinernema D1 (IOW45) a ensuite été évaluée par des prélèvements bimensuels pendant 8 mois. Le pouvoir infestant des nématodes envers des larves de Galleria mellonella a été déterminé en prélevant des carottes dans la meule de substrat. Il s'est révélé que le nombre de nématodes extraits diminue (P < 0,01) au cours des prélèvements successifs. Après le premier prélèvement, il est récupéré moins de nématodes (P < 0,001) au sommet de la meule qu'au milieu ou au bas de celle-ci. Au champ, le pouvoir infestant du nématode décroit (P < 0,001) pendant les 2 premiers mois et reste ensuite au même niveau jusqu'au huitième mois où aucun G. mellonella n'est plus parasité. Après enlèvement de la meule, des échantillons supplémentaires dans le sol situé sous la meule ou à proximité de celle-ci ont été pourvus d'appâts (larves de G. mellonella). Des échantillons d'hémolymphe provenant de larves mortes dans le sol ont été testés à l'aide d'un anticorps monoclonal spécifique de la bactérie symbiote (Xenorhabdus sp.) de Steinernema D1 (IOW45). En utilisant cette méthode, Steinernema D1 (IOW45) peut être détecté dans le sol situé sous la meule pendant une période d'au moins 2 mois après l'enlèvement du compost.

Scale-up of an oil/water cream containing 40% diethylene glycol monoethyl ether

The purpose of this study was to scale up an oil/water (o/w) cream formulation containing 40% diethylene glycol monoethyl ether (DGME), developed via 300-g laboratory batches in a 2(5-2) fractional factorial design, to 7-kg batch sizes in a Brogli-10 homogenizer. The o/w cream was manufactured via a standard phase-inversion process in the Brogli-10 homogenizer. Partitioning studies of DGME were conducted in test tubes at ambient temperature and after 24 hr at 70 degrees C in a convection oven. Phase height was measured by vernier calipers. Microscopy studies of excipients with and without treatment with water or a DGME/water mixture were conducted with a Nikon microscope after equilibration at 35 degrees C for 24 hr. During creation of the 7-kg pilot-scale batches, congealed material was observed between the sweep agitation blade and the discharge port, where the Brogli-10 homogenizer is not temperature jacketed. Factors that increased the amount of congealed material were higher temperatures during primary emulsification and longer cooling times. Partitioning studies revealed that DGME resides in the aqueous external phase of this formulation. Microscopy studies revealed that DGME in the external phase of this cream has a profound impact on the solubility of certain solid, waxy excipients (e.g., cetyl alcohol and polyoxyethylene-2-stearyl ether) at 35 degrees C. From this study, it appears that DGME resides in the external phase of the o/w cream. During manufacturing, it is hypothesized that the presence of DGME in the external phase alters the solubility of certain solid, waxy excipients in the formula such that they no longer primarily reside in the internal oil phase. On cooling, these materials precipitate or congeal in the external phase. The fractional factorial experimental design at the 300-g laboratory scale did not predict the issues encountered during scale-up. Differences between laboratory scale and pilot plant scale that explain why this phenomenon was not seen during laboratory scale are differences in cooling times, nonjacketed or "cold spots" in the Brogli-10 homogenizer, and a low proportion of congealed material in relation to the total batch size (< 1.5%).

Influence of temperature on the infectivity of entomopathogenic nematodes (Steinernema and Heterorhabditis spp.) to larvae and pupae of the vine weevil Otiorhynchus sulcatus (Coleoptera: Curculionidae)

Abstract

The susceptibilities of early and late instar vine weevil larvae and pupae to three species of entomopathogenic nematodes, indigenous to the UK, were tested in a series of bioassays. Steinernema kraussei (isolates L017 and L137), S. feltiae (the commercial product Nemasys®) and Heterorhabditis megidis (the commercial product Nemasys® H, reared both in vivo in Galleria mellonella larvae and in vitro), were tested at 6, 10 and 18°C for 2 weeks (early instars of O. sulcatus) or 3 weeks (late instars and pupae of O. sulcatus). Nematodes were applied to over 3800 larvae or pupae and there were over 400 untreated controls. Each insect was examined subsequently to determine mortality, and parasitised specimens were dissected to establish whether adult nematodes had developed. Differences in pathogenicity between H. megidis reared in vitro and in vivo were demonstrated. S. kraussei (L137) was consistently the most virulent nematode isolate at low temperatures. The results revealed a significant (P < 0.001) effect of temperature on small larvae of O. sulcatus, but also showed differential levels of mortality, not due to nematodes, for both small larvae and pupae. The use of Abbott's correction for control mortality is challenged and the validity of competing risks theory examined.In einer Reihe von Biotests wurde die Anfälligkeit von frühen und späten Larvenstadien sowie Puppen des Rüsselkäfers Otiorhynchus sulcatus gegenüber drei in UK einheimischen entomopathogenen Nematoden untersucht. Steinernema kraussei (isolate L017 und L137), S. feltiae (Handelsprodukt Nemasys®) und Heterorhabditis megidis (Handelsprodukt Nemasys® H, beide in vivo an Larven von Galleria mellonella und in vitro gezüchtet) wurden bei 6, 10 and 18°C für zwei Wochen (frühe Stadien von O. sulcatus) oder drei Wochen (späte Stadien und Puppen von O. sulcatus) geprüft. Über 3800 Larven oder Puppen wurden mit Nematoden behandelt, daneben gab es über 400 unbehandelte Kontrollen. Anschliessend wurde jedes Insekt untersucht, um die Mortalität zu bestimmen. Parasitierte Exemplare wurden aufpräpariert um festzustellen, ob sich adulte Nematoden entwickelt hatten. Zwischen in vitro und in vivo kultivierten H. megidis konnten Unterschiede in der Pathogenität festgestellt werden. S. kraussei (L137) war bei niedrigen Temperaturen durchgehend das virulenteste Isolat. Die Ergebnisse zeigten eine signifikante (P < 0.001) Wirkung der Temperatur auf kleine Larven von O. sulcatus. Sie zeigten für kleine Larven und Puppen aber auch unterschiedliche Mortlitätsgrade an, die nicht auf Nematoden zurückgingen. Die Anwendung von Abbott's Korrektur zur Prüfung der Mortalität wird kritisch hinterfragt, die Gültigkeit der Theorie der “competing risks” wird geprüft.

Vitamin E-TPGS increases absorption flux of an HIV protease inhibitor by enhancing its solubility and permeability

PURPOSE

To investigate the effect of vitamin E-TPGS, d-alpha-tocopheryl polyethylene glycol 1000 succinate, on the solubility and permeability of amprenavir, a potent HIV protease inhibitor.

METHODS

The aqueous solubility of amprenavir was measured as a function of vitamin E-TPGS concentration. Directional transport through Caco-2 cell monolayers was determined in the presence and absence of vitamin E-TPGS and P-glycoprotein inhibitors. Absorption flux was estimated from Caco-2 cell permeability and aqueous solubility.

RESULTS

The solubility of amprenavir in a pH 7 buffer at 37 degrees C was 0.036+/-0.007 mg/mL. The solubility linearly increased with increasing vitamin E-TPGS concentration (above 0.2 mg/mL). Polarized transport was demonstrated in the basolateral to apical direction, exceeding apical to basolateral transport by a factor of 6. The active efflux system was inhibited by vitamin E-TPGS and known P-glycoprotein inhibitors verapamil and GF120918.

CONCLUSIONS

The solubility of amprenavir was improved in the presence of vitamin E-TPGS through micelle solubilization. Vitamin E-TPGS inhibits the efflux system and enhances the permeability of amprenavir. Overall, vitamin E-TPGS enhanced the absorption flux of amprenavir by increasing its solubility and permeability. The enhancement is essential to the development of the novel soft gelatin capsule formulation of amprenavir for use in the clinic.

Intratumoral delivery of IL-12 gene by polyvinyl polymeric vector system to murine renal and colon carcinoma results in potent antitumor immunity

We have utilized a nonviral, polymeric interactive non-condensing (PINC) gene delivery system to deliver IL-12 to two different types of murine tumors, an immunogenic renal cell carcinoma, Renca, and a non-immunogenic colon cell carcinoma, CT26. The delivery of IL-12/polyvinyl pyrrolidone (PVP) complexes into Renca led to the expression of IL-12 (146 +/- 89 pg/mg) and IFN-gamma (160 +/- 82 pg/mg) from explanted tumors in culture supernatants. Treated tumors showed increased infiltration of NK, CD4+ and CD8+ T cells and up-regulation of MHC class I molecules on leukocytes in both tumors and lymph nodes. Fifty per cent of tumor-bearing mice rejected Renca or CT26 tumors following IL-12/PVP treatments given at optimal doses of 24 and 48 micrograms, respectively. While polymorphonuclear cells (PMNs) were partially involved in the development of the antitumor immune response elicited by IL-12/PVP treatment, CD8+ T cells were found to be the primary effectors. In contrast, CD4+ T cells did not appear to play a significant role in the development of tumor specific immunity. Finally, mice that rejected the tumors following IL-12/PVP treatment were protected against a second challenge with the same tumor. These data provide evidence that a nonviral IL-12 gene delivery system is well tolerated and generates a potent immune response against established tumors.

Analysis of peak magnitude and duration of analgesia produced by local anesthetics injected into sympathetic ganglia of complex regional pain syndrome patients

OBJECTIVE

Pain-relieving effects of lidocaine/bupivicaine local anesthetic (LA) and saline (S) block of sympathetic ganglia (stellate block, 4 patients; lumbar sympathetic block, 3 patients) were compared in 7 complex regional pain syndrome (CRPS) patients on a double-blind crossover basis to evaluate the diagnostic and therapeutic value of local anesthetic sympathetic blocks.

DESIGN

Patients rated their pain on a visual analog scale before and after blocks and were tested for mechanical allodynia one-half hour after blocks. Thereafter, they rated their pain intensity in diaries four times a day for 7 days. Each patient received two blocks, S and LA, and served as his own control.

RESULTS

Both S and LA injections of sympathetic ganglia produced large reductions in pain intensity in 6 of 7 patients 30 minutes after block. These large reductions were accompanied by the reversal of mechanical allodynia in both S and LA. The mean difference between initial peak reduction in pain intensity produced by saline (68.7%) and active local anesthetic (74.4%) did not approach statistical significance. In striking contrast, the mean duration of pain relief was reliably longer in the case of LA (3 days, 18 hours) as compared with S ( 19.9 hours), a difference that occurred in all 7 patients. In a larger sample of 41 CRPS patients, signs of sympathetic efferent blockade, including Homer' s syndrome or skin surface temperature change, were not predictive of initial peak magnitude of pain relief from sympathetic blockade but were predictive of duration of pain reduction.

CONCLUSION

The combination of these results provides evidence that duration of pain relief is affected by injection of local anesthetics into sympathetic ganglia. These results indicate that both magnitude and duration of pain reduction should be closely monitored to provide optimal efficacy in procedures that use local anesthetics to treat CRPS.

Long-term outcome of brain manganese deposition in patients on home parenteral nutrition

Manganese intoxication has been described in children on long term parenteral nutrition presenting with liver and nervous system disorders. Cases are reported of a brother and sister on long term parenteral nutrition with hypermanganesaemia and basal ganglia manganese deposition, detected by magnetic resonance imaging (MRI), without overt neurological signs. Following reduction of manganese intake, basal ganglia manganese was monitored by repeated MRI, and neurological and developmental examinations. An MRI intensity index of the globus pallidus declined over a three year period from 0.318 and 0.385 to 0.205 and 0.134 with concomitant falls in whole blood manganese from 323 and 516 to 226 and 209 nmol/l (normal range, 73-210 nmol/l). Unlike adult experience these children developed normally without neurological signs. In conclusion, deposited manganese is removed from neural tissue over time and the prognosis is good when neurological manifestations and liver disease are absent.

Comorbidity and age as predictors of risk for early mortality of male and female colon carcinoma patients: a population-based study

BACKGROUND

Colon carcinoma primarily affects persons 65 years and older. Seventy-five percent of the incident tumors affect persons in this age group. Because of their advanced age, older patients already may be coping with other concomitant major physical illnesses. This article documents preexisting diseases in older colon carcinoma patients at diagnosis and evaluates the effects of their comorbidity burden on early mortality.

METHODS

Prevalence of comorbid conditions was assessed by a retrospective medical records review of an age-stratified random sample of male and female patients aged 55-64 years, 65-74 years, and 75+ years (males, n=799; females, n=811). Data were collected on comorbidity by the National Institute on Aging (NIA) and National Cancer Institute (NCI) and merged with NCI Surveillance, Epidemiology, and End Results (SEER) tumor registry data.

RESULTS

Hypertension, high impact heart conditions, gastrointestinal problems, arthritis, and chronic obstructive pulmonary disease emerged as the most prominent comorbid conditions in the NIA/NCI SEER Study sample. The prevalence of comorbidity in the number and type of conditions was similar for both men and women (e.g., 40% of each gender had > or = 5 comorbidities). Within 2 years of diagnosis, 28% (n=454) of the patients had died. The number of comorbid conditions was significant in predicting early mortality in a model including age, gender, and disease stage (P=0.0007). Certain comorbidities, classified as "current problem," added significantly to a basic model (e.g., heart problems, alcohol abuse, liver disease, and deep vein thrombosis).

CONCLUSIONS

Although disease stage at time of diagnosis of colon carcinoma is a crucial determinant of patient outcome, comorbidity increases the complexity of cancer management and affects survival duration. Cancer control and treatment research questions should address comorbidity issues pertinent to the age group primarily afflicted with colon carcinoma (i.e., the elderly).

Comorbidity and age as predictors of risk for early mortality of male and female colon carcinoma patients: a population-based study

BACKGROUND

Colon carcinoma primarily affects persons 65 years and older. Seventy-five percent of the incident tumors affect persons in this age group. Because of their advanced age, older patients already may be coping with other concomitant major physical illnesses. This article documents preexisting diseases in older colon carcinoma patients at diagnosis and evaluates the effects of their comorbidity burden on early mortality.

METHODS

Prevalence of comorbid conditions was assessed by a retrospective medical records review of an age-stratified random sample of male and female patients aged 55-64 years, 65-74 years, and 75+ years (males, n=799; females, n=811). Data were collected on comorbidity by the National Institute on Aging (NIA) and National Cancer Institute (NCI) and merged with NCI Surveillance, Epidemiology, and End Results (SEER) tumor registry data.

RESULTS

Hypertension, high impact heart conditions, gastrointestinal problems, arthritis, and chronic obstructive pulmonary disease emerged as the most prominent comorbid conditions in the NIA/NCI SEER Study sample. The prevalence of comorbidity in the number and type of conditions was similar for both men and women (e.g., 40% of each gender had > or = 5 comorbidities). Within 2 years of diagnosis, 28% (n=454) of the patients had died. The number of comorbid conditions was significant in predicting early mortality in a model including age, gender, and disease stage (P=0.0007). Certain comorbidities, classified as "current problem," added significantly to a basic model (e.g., heart problems, alcohol abuse, liver disease, and deep vein thrombosis).

CONCLUSIONS

Although disease stage at time of diagnosis of colon carcinoma is a crucial determinant of patient outcome, comorbidity increases the complexity of cancer management and affects survival duration. Cancer control and treatment research questions should address comorbidity issues pertinent to the age group primarily afflicted with colon carcinoma (i.e., the elderly).

A suicide disguised as a homicide: return to Thor Bridge

Suicides staged as homicides are uncommon. We present a case of a self-inflicted gunshot wound of the chest disguised by the victim as a homicide, using a method described by Sir Arthur Conan Doyle in his Sherlock Holmes story, "The Problem of Thor Bridge."