Something Old, Something New

Between 1970 and 1980, Blumenthal and Danziger published a series of works in which they criticized the mythical accounts of Wundt in history text-books. The source of these accounts was E.G. Boring's History of Experimental Psychology (1929/1950). Subsequent generations of textbook writers had merely copied from other textbooks without consulting original sources. Boring's flawed account had become increasingly distorted as it was passed on from one generation to the next. How did the textbook writers of the 1980s respond to this challenge? This work examines some of the changes which were made and the explanations which were given for them.

Was Wundt a `Nazi'?

This article examines the widespread view that the Volkerpsychologie of Lazarus, Steinthal and Wundt was in some way related to the racial psychology of the Nazis. This was suggested in Gordon Allport's `Historical Background of Modern Social Psychology'. I discuss Allport's essay in order to show that this is nothing more than an ugly rumor. Volkerpsychologie was a cultural psychology. It was heavily criticized by racial psychologists and was used by Franz Boas in order to undermine their theories. I conclude by examining the source of Allport's `mistake'.

Abstract P5-05-04: Intraductal delivery of RNAi-based therapeutics to gene targets identified through computational systems modeling

We utilize a computational systems biology approach to identify gene targets with the potential to serve as targets for therapeutic RNAi. Inferred gene regulatory network models were constructed using whole transcriptome expression profiling for progressive stages of mammary tumorigenesis in FVB C3(1)-SV40Tag mice. These computational models predicted key mediator transcription factors that are critical for hyperplasia and ductal filling in the early stages of disease progression. Putative mediator transcription factors were targeted by RNAi first in a mammary spheroid assay. Based on their ability to restore lumen formation and normal apical-basal polarization to mammary tumor cells, two transcription factors, Hoxa1 and Hoxb13, were selected for validation in vivo. siRNA targeting each of these transcription factors was formulated with lipidoid nanoparticles and delivered to the mammary gland via intraductal injection. Silencing Hoxa1 resulted in a significant reduction in tumor incidence in FVB C3(1)-SV40Tag. This represents a novel strategy to achieve localized silencing of a target gene in the mammary epithelium.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-05-04.

Abstract 1207: Molecular determinants of CXCR4 trafficking dictate the metastatic potential in breast cancer

The G-protein-coupled CXC chemokine receptor 4 (CXCR4) was shown to be a major determinant in organ-specific metastasis for various cancers. The C-terminus of the receptor contains phosphorylation/ubiquitination sites and residues that interact with adaptor proteins which couple to the endocytosis machinery. Post-endocytic events that lead to a decision between degradation and recycling are hitherto poorly understood.

We used fluorescently tagged receptor molecules stably expressed in breast cancer cells to establish that mutations in the protein kinase C (PKC) site of CXCR4 affect not only the cellular equilibrium between ESCRT-mediated degradation and recycling pathways but also the invasive properties. Importantly, the obtained in vitro results excellently translate to a murine model of breast cancer, in which we found that mutation of the PKC motif influences the metastatic potential. Furthermore, by using fluorescence lifetime imaging (FLIM) to measure direct protein-protein interactions via Förster resonance energy transfer (FRET) we show for the first time that ligand-dependent dimerization of CXCR4 receptors is a crucial mechanistic step in the above processes.

Our findings reveal a new mechanism whereby the penetrance of a mutated receptor that exhibits resistance to its desensitization and confers an enhanced cancer migratory phenotype, is reduced through the dimerization with its wildtype counterpart.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1207. doi:10.1158/1538-7445.AM2011-1207

Partially covered self-expandable metallic stents for benign biliary strictures due to chronic pancreatitis

BACKGROUND AND STUDY AIMS

Benign biliary strictures (BBS) may occur in patients with chronic pancreatitis and may lead to secondary biliary cirrhosis or recurrent cholangitis. Although surgical diversion may provide definitive therapy, it can be associated with significant morbidity. Endoscopic therapy with plastic stents has been used as an alternative to surgery but has resulted in unsatisfactory long-term outcomes. We evaluated the temporary placement of partially covered self-expandable metallic stents (PCMS) in patients with BBS due to chronic pancreatitis.

PATIENTS AND METHODS

A total of 20 patients with BBS due to chronic pancreatitis underwent temporary placement of PCMS over a 6-year period. The primary outcome of interest was the proportion of patients with stricture resolution persisting 6 months after stent removal. Secondary outcomes included the stent failure rate, number of endoscopic sessions required to achieve biliary drainage, total duration of stenting, and complication rate.

RESULTS

Adequate biliary drainage was achieved in 19 patients with PCMS (95%). Eighteen of the 20 patients (90%) had persistent stricture resolution 6 months after PCMS removal. In two of the 20 patients (10%), PCMS stenting failed and these patients underwent alternative therapies. Complications occurred in four patients (20%). Median duration of PCMS placement was 5 months, requiring a median of two endoscopic procedures.

CONCLUSION

In this series of patients with BBS due to chronic pancreatitis, temporary PCMS placement achieved persistent stricture resolution in the majority of patients with acceptable complication rates. Comparative trials evaluating temporary PCMS placement and plastic stenting in patients with BBS due to chronic pancreatitis are needed.

Disseminated intravascular coagulation, antithrombin III, and complement in meningococcal infections

Serial assessments of some blood coagulation factors, antithrombin III (AT III), and complement were made in 18 patients with meningococcal (mgc) infection. All patients displayed laboratory evidence of activation of the blood clotting system. Two patients showed clinical signs of disseminated intravascular coagulation. Only AT III differed significantly between patients with and without complications. There was no correlation between changes in blood clotting, activation of the complement system and the course or duration of the disease. These results do not enable one t identify patients who need specific prophylactic therapy. Controlled clinical trials, including administration of heparin, dextran, aprotinin, and others, are still required to ensure optimal treatment in fulminant mgc infections.

Mortality from all causes and circulatory disease by country of birth in England and Wales 2001-2003

BACKGROUND

Differences in mortality by country of birth in England and Wales in people under 70 years of age have been demonstrated previously. Changes in age distribution of migrants and in migration patterns have occurred subsequently.

METHODS

All-cause and circulatory disease mortality for people aged 20 years and over in England and Wales by country of birth were examined using population data from the 2001 Census and mortality data for 2001-2003. Indirect standardization was used to estimate sex-specific standardized mortality ratios (SMRs) and 95% confidence intervals (CI) in comparison to mortality for England and Wales as a whole.

RESULTS

SMRs for all-cause mortality were statistically significantly higher than the national average for people born in Ireland, Scotland, East Africa and West Africa and lower for people born in China and Hong Kong. SMRs for circulatory disease were highest among people born in Bangladesh and lowest among people born in China and Hong Kong. Patterns of ischaemic heart disease and cerebrovascular disease mortality differed by country of birth.

CONCLUSIONS

Mortality, particularly due to ischaemic heart disease and stroke, differs markedly by country of birth in all age groups including the > or =70-year-old group.

Covered self-expandable metal stents in pancreatic malignancy regardless of resectability: a new concept validated by a decision analysis

BACKGROUND AND STUDY AIMS

The current treatment model for the management of malignant biliary obstruction is to place a plastic stent for unstaged pancreatic cancer. In patients with unresectable disease but a life expectancy of more than 6 months, self-expandable metal stents (SEMS) are favored because of their more prolonged patency. We analyzed the efficacy and cost-effectiveness of covered SEMS (CSEMS) in patients with pancreatic cancer and distal biliary obstruction without regard to surgical resectability.

PATIENTS AND METHODS

Between March 2001 and March 2005, 101 consecutive patients with obstructive jaundice secondary to pancreatic cancer underwent placement of a CSEMS. Patients with resectable tumor were offered pancreaticoduodenectomy. A model was developed to compare the costs of CSEMS and polyethylene and DoubleLayer stents.

RESULTS

A total of 21 patients underwent staging laparoscopy, of whom 16 had a resection (76%). The 85 patients who did not have a resection had a mean survival of 5.9 months (range 1-25 months) and a mean CSEMS patency duration of 5.5 months (range 1-16 months). Life-table analysis demonstrated CSEMS patency rates of 97% at 3 months, 85% at 6 months, and 68% at 12 months. In a cost model that accounted for polyethylene and DoubleLayer stent malfunction and surgical resections, initial CSEMS placement (3177 euros per patient) was a less costly intervention than either DoubleLayer stent placement (3224 euros per patient) or polyethylene stent placement with revision (3570 euros per patient).

CONCLUSIONS

Covered SEMS are an effective treatment for distal biliary obstructions caused by pancreatic carcinoma. Their prolonged patency and removability makes them an attractive option for biliary decompression, regardless of resectability. The strategy of initial covered SEMS placement might be the most cost-effective strategy in these patients.

Mortality from all cancers and lung, colorectal, breast and prostate cancer by country of birth in England and Wales, 2001-2003

Mortality from all cancers combined and major cancers among men and women aged 20 years and over was compared by country of birth with that of the whole of England and Wales as the reference group. Population data from the 2001 Census and mortality data for 2001-2003 were used to estimate standardised mortality ratios. Data on approximately 399 000 cancer deaths were available, with at least 400 cancer deaths in each of the smaller populations. Statistically significant differences from the reference group included: higher mortality from all cancers combined, lung and colorectal cancer among people born in Scotland and Ireland, lower mortality for all cancers combined, lung, breast and prostate cancer among people born in Bangladesh (except for lung cancer in men), India, Pakistan or China/Hong Kong, lower lung cancer mortality among people born in West Africa or the West Indies, higher breast cancer mortality among women born in West Africa and higher prostate cancer mortality among men born in West Africa or the West Indies. These data may be relevant to causal hypotheses and in relation to health care and cancer prevention.

Expression and characterization of six clinically relevant uroporphyrinogen decarboxylase gene mutations

The functional consequence of six uroporphyrinogen decarboxylase (UROD) gene mutations found in Danish patients with familial porphyria cutanea tarda was investigated. Wild-type UROD and the 6 mutants (3 missense, 1 nonsense and 2 frameshift mutants) were cloned and expressed using the prokaryotic gGEX-6P system, in which the protein is produced in fusion with glutathione S-transferase (GST). Enzymatic activity of the purified recombinant mutant fusion proteins ranged from undetectable to less than 12% of the recombinant wild-type protein. Mutant proteins cleaved from the GST part did not retain any catalytic activity. These observations can be ascribed to the structure/function relationships of the enzyme, and the fact that the enzyme is a dimer in its active form. Although the clinical manifestation of familial porphyria cutanea tarda is complex, the findings support the notion that different mutations may affect individuals differently.

Identification of potentially effective antisense oligodeoxyribonucleotide (ODN) sequences for inhibiting plasminogen activator inhibitor-2 (PAI-2) production by monocytes

OBJECTIVE

Monocyte fibrinolytic activity may influence thrombus resolution. The balance between uPA and PAI-2 could determine the fibrinolytic activity of the monocyte. Inhibiting PAI-2 production using specific antisense sequences might alter this balance. Selecting effective sequences is a problem as prediction of the secondary structure of target mRNA is difficult. This study reports the modification of a cell free system for rapid antisense screening.

METHODS

Five 18-19 mer oligodeoxynucleotides (ODN), sequences A, B, K, T and Q, and their matched scrambled controls were designed and screened using a modified rabbit reticulocyte lysate transcription and translation system (RRL). Intracellular uptake of ODNs was confirmed by fluorescence microscopy, scanning laser confocal microscopy and fluorimetry. Monocytes were transfected with a liposome/ODN complex using sequences A, B, A + B combined, or T and PAI-2 levels measured by ELISA. Inhibition of PAI-2 production was calculated as a percentage of control levels (baseline and scrambled).

RESULTS

(i) RRL System--Sequence A was the most effective inhibitor of PAI-2 production in this system (median 63%) compared with sequences, B median 9%, K median 14%, T median 11% and Q median -8% respectively (n = 3). Sequence A was the only sequence, which always inhibited PAI-2. This was confirmed using fluorescently labelled protein (n = 2). (ii) Monocyte transfection--Fluorescence microscopy and fluorimetry showed that intracellular delivery of labelled antisense was only achieved when a liposome was used. Transfection of monocytes extracted from 5 subjects showed that sequence A significantly reduced PAI-2 production (mean % 41.4, sem 9.1) compared with sequences B (mean% 3.4, sem 8.9, p = 0.04), A + B (mean % 0.4, sem 7.8, p = 0.04), and T (mean % 5.4, sem 4.9, p = 0.01). Further studies using sequence A on cells from 10 subjects showed a significant reduction in monocyte PAI-2 production (27.6 ng/ml, sem 3.9) compared with matched scrambled controls (mean 38.3 ng/ml, sem 4.5, p = 0.0112) and baseline (mean 51.4 ng/ml, sem 6.7, p = 0.0009).

CONCLUSION

Use of the RRL screening system allowed the selection of a novel antisense sequence, which significantly reduced PAI-2 production in monocytes.

Identification of Potentially Effective Antisense Oligodeoxyribonucleotide (ODN) Sequences for Inhibiting Plasminogen Activator Inhibitor-2 (PAI-2) Production by Monocytes

Monocyte fibrinolytic activity may influence thrombus resolution. The balance between uPA and PAI-2 could determine the fibrinolytic activity of the monocyte. Inhibiting PAI-2 production using specific antisense sequences might alter this balance. Selecting effective sequences is a problem as prediction of the secondary structure of target mRNA is difficult. This study reports the modification of a cell free system for rapid antisense screening.

Five 18-19 mer oligodeoxynucleotides (ODN), sequences A, B, K, T and Q, and their matched scrambled controls were designed and screened using a modified rabbit reticulocyte lysate transcription and translation system (RRL). Intracellular uptake of ODNs was confirmed by fluorescence microscopy, scanning laser confocal microscopy and fluorimetery. Monocytes were transfected with a liposome/ODN complex using sequences A, B, A + B combined, or T and PAI-2 levels measured by ELISA. Inhibition of PAI-2 production was calculated as a percentage of control levels (baseline and scrambled).

(i) RRL System – Sequence A was the most effective inhibitor of PAI-2 production in this system (median 63%) compared with sequences, B median 9%, K median 14%, T median 11% and Q median –8% respectively (n = 3). Sequence A was the only sequence, which always inhibited PAI-2. This was confirmed using fluorescently labelled protein (n = 2). (ii) Monocyte transfection Fluorescence microscopy and fluorimetry showed that intracellular delivery of labelled antisense was only achieved when a liposome was used. Transfection of monocytes extracted from 5 subjects showed that sequence A significantly reduced PAI-2 production (mean % 41.4, sem 9.1) compared with sequences B (mean% 3.4, sem 8.9, p = 0.04), A + B (mean % 0.4, sem 7.8, p = 0.04), and T (mean % 5.4, sem 4.9, p = 0.01). Futher studies using sequence A on cells from 10 subjects showed a significant reduction in monocyte PAI-2 production (27.6 ng/ml, sem 3.9) compared with matched scrambled controls (mean 38.3 ng/ml, sem 4.5, p = 0.0112) and baseline (mean 51.4 ng/ml, sem 6.7, p = 0.0009).

Use of the RRL screening system allowed the selection of a novel antisense sequence, which significantly reduced PAI-2 production in monocytes.

Expanding the genetic code of Escherichia coli

A unique transfer RNA (tRNA)/aminoacyl-tRNA synthetase pair has been generated that expands the number of genetically encoded amino acids in Escherichia coli. When introduced into E. coli, this pair leads to the in vivo incorporation of the synthetic amino acid O-methyl-l-tyrosine into protein in response to an amber nonsense codon. The fidelity of translation is greater than 99%, as determined by analysis of dihydrofolate reductase containing the unnatural amino acid. This approach should provide a general method for increasing the genetic repertoire of living cells to include a variety of amino acids with novel structural, chemical, and physical properties not found in the common 20 amino acids.

A novel multifunctional labeling reagent for enhanced protein characterization with mass spectrometry

Individual peptides with lysine at the C-terminus as well as protein tryptic digests were reacted with 2-methoxy-4,5-dihydro-1H-imidazole, converting lysine residues to their 4,5-dihydro-1H-imidazol-2-yl derivatives. The mass spectra of derivatized digests exhibit a greater number of more intense features than their underivatized counterparts, thus increasing the information obtained in peptide mapping experiments. Additionally, MS/MS spectra of the derivatized peptides are greatly simplified in comparison to their native species, yielding primarily an easily interpretable series of y-ions. Finally, this novel label also enables differential quantitation studies, as a stable isotopic form containing four deuterium atoms can readily be produced.

Determination of porphobilinogen deaminase activity in human erythrocytes: pertinent factors in obtaining optimal conditions for measurements

Determination of porphobilinogen deaminase (PBGD; EC 4.3.1.8) activity in erythrocytes can contribute to the identification of patients suspected of acute intermittent porphyria. PBGD catalyses the polymerization of four molecules of porphobilinogen (PBG) to the highly unstable 1-hydroxymethylbilane. The 1-hydroxymethylbilane is transformed into uroporphyrinogen III by uroporphyrinogen III synthase. When this enzyme is inactivated, 1-hydroxymethylbilane cyclizes non-enzymatically to uroporphyrinogen I, which can be oxidized to uroporphyrin I. PBGD activity can be measured by quantitation of uroporphyrin I formed from PBG under conditions where this is the only end product. The purpose of the present study was to define the optimal conditions for quantitating PBGD activity in human erythrocytes. The preanalytical factors examined were: anticoagulants and methods for disruption of the erythrocytes. The analytical factors examined were: duration of preincubation, reaction time, reaction temperature, pH, ionic strength and conditions for the oxidation of uroporphyrinogen I to uroporphyrin I. Based on the results, we propose an optimized method for determination of PBGD activity in erythrocytes.

Activity and immunohistochemical localization of porphobilinogen deaminase in rat tissues

Porphobilinogen deaminase (PBGD) is an enzyme involved in the synthesis of heme. Acute intermittent porphyria (AIP) is an inherited disease resulting from a reduced activity of PBGD. The symptoms seem to be due to a neurological dysfunction. Attacks of AIP are often provoked by conditions where the PBGD activity becomes insufficient as a result of an increased synthesis of heme in the liver. How this affects the nervous tissue is still unknown. It may well be that a reduced activity of PBGD in other tissues than the liver is of importance too. The aim of the present study was to examine the activity and the immunohistochemical localization of PBGD in the following tissues of wistar female rats: brain, heart, submandibular gland, liver, kidney, pancreas, ovary, stomach, duodenum, jejunum, ileum, colon and musculature. The PBGD activity varied considerably among the tissues. It was highest in the liver, 14 pkat/g, and lowest in the jejunum, 0.7 pkat/g. The immunohistochemical localization of PBGD was studied by antibodies raised against a 40 amino acid synthetic peptide that corresponds to a segment in the C-terminal part of PBGD. The study demonstrated that the PBGD immunoreactivity was not evenly distributed among the various cell types in a given tissue. Immunohistochemical reactions were pronounced in Kupffer cells in the liver, in smooth muscle cells of arteries and arterioles, in distal and collecting tubules in the kidney, in nerve axons in the brain and in ganglionic cells in the intestine. Especially, the immunohistochemical reaction in nerve cells is notable considering the nervous dysfunction in AIP.

Porphyrins, porphyrin metabolism and porphyrias. II. Diagnosis and monitoring in the acute porphyrias

The acute porphyrias constitute a group of metabolic disorders engaging enzymes in the haem synthetic chain and generally following dominant inheritance patterns. Some gene carriers are vulnerable to a range of exogenous and endogenous factors, which may trigger neuropsychiatric symptoms. Early diagnosis is of prime importance since it makes way for counselling with the aim to block the development of acute, as well as late, disease. The medical and psycho-social consequences of a porphyria diagnosis are considerable and the freedom for maldiagnosis correspondingly small. The strain imposed upon the diagnostic process makes management in specialized laboratories necessary. Inadvertent handling of the diagnostic procedures in laboratories lacking in knowledge, experience and technical competence is repeatedly the reason for harmful underdiagnosis and overdiagnosis. Gene diagnosis of the carrier condition, principally within reach in all types of acute porphyria, is of incomparable versatility and accuracy. However, despite recent great achievements in the molecular biology of porphyric disease, genomic procedures cannot replace biochemical methods in monitoring the activity and progress of the disease, or the effects of therapy. The classical methods are also useful when it comes to screening for the associated disease states. In these tasks, professional handling of the methods and skillful interpretation of the results are of paramount importance. Knowledge of the limitations and pitfalls of the procedures is a guard against maldiagnosis, which may be fatal. In the article the main diagnostic challenges are discussed; the strategy for early detection of the gene carrier state, the recognition and surveillance of the acute porphyric crisis, the evaluation of subacute/subchronic symptoms, the differential diagnoses of the cutaneous porphyrias and the monitoring of late complications.

DGGE analysis of the coproporphyrinogen oxidase gene: two new mutations in DNA from Danish patients with hereditary coproporphyria

The knowledge of at least 21 different mutations and several polymorphisms in the coproporphyrinogen oxidase (CPO) gene demonstrates that the molecular basis of hereditary coproporphyria is heterogeneous. We developed a DGGE-based assay for the analysis of exons 2 to 7, including 14-96 nucleotides of the flanking intronic sequences of the CPO gene. To render it suitable for the clinical diagnostic laboratory, we designed the assay to allow use of identical PCR conditions and the same DGGE gel for analyses of all the regions. Using this assay, and subsequent sequencing of gene regions containing interallelic variations, two novel mutations in the CPO gene were identified: a missense mutation (607G-->A), leading to the substitution of an alanine with a threonine, and a nonsense mutation (1281G-->A), giving rise to a stop codon 28 codons upstream to the wild-type stop codon.

On target: a model to teach baccalaureate nursing students to apply critical thinking

As nurses enter the 21st century, problem solving and critical thinking are critical to successful clinical practice. Studies have revealed that thought professionals may have critical thinking knowledge, they do not always use it in everyday practice. This article presents an education model that faculty members can use to teach baccalaureate nursing students to think critically and incorporate research findings into clinical practice. The model offers a four-semester plan that can be integrated into programs of study.

Tenure: viable or a dinosaur?

This article discusses the history of tenure in academia as well as the current pros and cons of the tenure system. A review of nursing and non-nursing literature reveals that the most important goal confronting the nation's universities and colleges today is to find more creative ways to define scholarly work and incorporate it into promotion and tenure guidelines. The author presents arguments for and against tenure, reviews the impact of tenure in nursing, and offers recommendations and solutions to the tenure dilemma in nursing.

[Alcohol consumption and liver enzymes in persons 30-50 years of age. Cross-sectional study from Ebeltoft]

In a representative population sample of 905 persons we examined the prevalence of raised levels of liver-derived enzymes and its possible association with self-reported alcohol consumption adjusted for smoking and BMI applying logistic regression analyses. A large proportion of 12% (women 8%; men 16%) presented raised liver-derived enzymes. Below 21 units per week (one unit equals 12 grams of alcohol) there was no association with self-reported alcohol consumption. However, the risk of abnormal liver enzymes increased with higher consumption for both sexes; if the intake was above 28 units per week, the odds ratio for raised liver enzymes increased dramatically. Whether this subclinical biochemical liver condition is an early marker of alcohol-related liver damage remains to be seen, but the long-term consequences of the reported alcohol consumption and the frequency of raised liver enzymes require follow-up.

Alcohol consumption and serum liver-derived enzymes in a Danish population aged 30-50 years

BACKGROUND

Based on the increased consumption of alcohol in Denmark the aim of this study was to measure prevalence of abnormal liver-derived enzymes in a homogeneous Danish population and possible associations with alcohol consumption, smoking and body mass index (BMI).

METHOD

In a representative population sample of 905 people (aged 30-50) from the baseline survey of the Ebeltoft Health Promotion Project in Denmark, we examined prevalence of abnormal liver-derived enzymes and its possible association with self-reported alcohol consumption, smoking and BMI, applying logistic regression analyses.

RESULTS

In a significant proportion, 12% (women 8%; men 16%) of the cohort we found raised levels of liver-derived enzymes associated with moderate self-reported alcohol intake adjusted for BMI and smoking. If the intake was higher than moderate, i.e. > 28 units per week (one unit equals 12 g of alcohol), the odds ratio (OR) for raised liver enzymes increased further; S-gamma-glutamyltransferase (GGT) (OR: for women 24.4; men 18.4). S-aspartate-aminotransferase (ASAT) (24.2; 5.8) and S-alanine-aminotransferase (ALAT) (27.2; 3.0). Furthermore, daily smoking increased the risk of raised liver enzymes in women (OR: 3.4-4.2), and obesity (BMI > or = 30 kg/m2) in men showed a positive association with all three enzymes (OR: 3.0-9.0).

CONCLUSIONS

The occurrence of raised liver-derived enzymes was frequent in the Danish population sample and associated with moderate self-reported alcohol consumption adjusted for BMI and smoking.

Iopentol (Imagopaque 250) compared with diatrizoate (Urografin 219) in endoscopic retrograde cholangio-pancreatography (ERCP). A clinical trial assessing safety (adverse events and S-pancreatic iso-amylase) and diagnostic information (VAS)

The efficacy and safety of the non-ionic contrast medium iopentol, 250 mg I/ml (Imagopaque, Nycomed Imaging AS, Oslo, Norway) were evaluated and compared to those of the ionic contrast medium diatrizoate 219 mg I/ml (Urografin, Schering AG, Berlin, Germany). The trial was carried out as a randomized, double-blind comparative two-group study. One hundred and sixteen patients completed the study: 59 received iopentol and 57 received diatrizoate, the contrast medium used according to routine hospital procedure for ERCP. Demographic data and details of the ERCP procedure were comparable for the two contrast medium groups. Safety was assessed by monitoring serum pancreatic iso-amylase and by recording adverse events. Efficacy was evaluated through assessment of the diagnostic information and the quality of radiographs. Twenty-one of the patients receiving iopentol and 27 of the patients receiving diatrizoate reported adverse events during the ERCP procedure. Pain was the kind of procedure-related event most frequently reported. Three patients experienced serious adverse events with a fatal outcome 2, 10 and 12 days after the ERCP procedure, respectively. The principal investigator concluded for all three serious adverse events that any causal relationship with the contrast medium injected was unlikely. A mean change in serum pancreatic iso-amylase after contrast medium injection was noted in both contrast medium groups. However, statistical analysis did not show any significant difference between mean changes for the two groups. The efficacy results, both in terms of diagnostic information and quality of radiographic visualisation, were comparable for the two contrast media. In conclusion, the study did not show any statistically significant differences between the two contrast media as regards safety or efficacy in ERCP.

Optimizing nursing through reorganization: mandates for the new millennium

The issues surrounding health care reform are mandating change for every health care profession. Nursing as it has been configured over the last several decades will not work for the millennium. This article discusses the recommendations specific to nursing for accommodating the health care needs of the American people reported by the most recent study of the Pew Health Care Commission. The authors present a three-level nursing care delivery model based on educational preparation.

[The initial results on the radiobiological comparability of continuous LDR irradiation and PDR irradiation using a guinea pig skin animal model]

AIMS

The classic continuous low dose rate (LDR) brachytherapy was very important in such cases with a higher risk of severe especially late radiation reactions. From clinical experiences and radiobiological considerations it is known, that the therapeutic ratio of LDR is higher than HDR. Another way to combine the therapeutic ratio of LDR and the possibility of optimisation is the use of pulse dose rate (PDR) technique. The PDR-technique is a method, which can be compared with continuous LDR-therapy. PDR should have biological effects equivalent to conventional LDR.

MATERIAL AND METHODS

We have tried to compare the classic continuous LDR-technique with 2 PDR-regimes by means of the guinea pig skin model. In this test series we involved 20 female animals with an initial weight of 400 to 500 g. We compared radiation reactions of following regimes: 1. Continuous LDR regimen with a cobalt-60 source with an activity of 5.5 mCi 30 Gy in 60 hours. 2. PDR regimen 0.5 Gy hourly, pulse length minimal 10 minutes, 30 Gy in 60 hours with an Ir-192 source with an activity of nearly 40 mCi. 3. PDR-regimen 0.8 Gy hourly with 9 hours night break (10.00 p. m. to 7.00 a. m.). The radiation reaction was controlled by the help of an evaluation table in which the criteria of radiation reaction were classified according to the degree of seriousness. The observation time is now minimal 14 and maximal 24 months.

RESULTS

The findings shows a significant coincidence of early and late radiation reactions of the skin fields irradiated with the continuous LDR-technique and fields irradiated with the PDR-technique. There was not a difference of the radiation reactions between PDR-irradiation with and without night break.

CONCLUSIONS

Generally it is possible to compare the radiation reactions of PDR-irradiation and the classic continuous LDR-brachytherapy. It is also possible to use a PDR-regimen with a night break of 9 hours. But results must be calculated for each tissue of interest, in our test consequently for guinea pig skin.

Parathyroid hormone in blood pressure and volume homeostasis in healthy subjects, hyperparathyroidism, liver cirrhosis and glomerulonephritis. A possible interaction with angiotensin II and atrial natriuretic peptide

In order to elucidate a participation of intact parathyroid hormone (PTH(1-84)) in blood pressure (BP) and body fluid homeostasis, we studied fluctuations of PTH(1-84) during manipulations of BP in hyperparathyroid and healthy subjects, and during manipulations of blood volume in patients with glomerulonephritis or liver cirrhosis and in controls. Angiotensin II induced BP elevation was associated with increased values of PTH(1-84) both in healthy subjects (12-25 ng l-1, medians, p < 0.01), in patients with primary hyperparathyroidism (94-125 ng l-1, p < 0.01), in patients with low calcium due to end stage renal disease before requirement of dialysis (95-151 ng l-1, p < 0.02), and in patients with tertiary hyperparathyroidism (221-264 ng l-1, p < 0.05), but not in dialysis patients without hypercalcaemia (126-174 ng l-1, NS). The changes could not be attributed to reduction of serum calcium, but probably to the increase of plasma angiotensin II, which was positively correlated to the increase of serum PTH(1-84) in the healthy subjects (p = 0.619, n = 15, p < 0.05) and in the patients with primary hyperparathyroidism (p = 0.549, n = 18, p < 0.05). Noradrenaline induced BP elevation did not have a similar effect on PTH(1-84), and changes of PTH(1-84) were not related to changes of BP. Volume depletion after furosemide injection, also accompanied by increased levels of angiotensin II, resulted in elevation of PTH(1-84) in controls, cirrhotics, patients with glomerulonephritis without the nephrotic syndrome, but not in nephrotic patients. Volume depletion induced by bolus injection of atrial natriuretic peptide (ANP) was associated with decreased PTH(1-84) in healthy subjects (20-18 ng l-1, p < 0.02), but not in patients with nephrotic syndrome and liver cirrhosis. Volume expansion induced by albumin infusion caused increased plasma levels of ANP, but PTH(1-84) was unaltered. Thus, angiotensin II may be able to stimulate, and ANP to inhibit release of PTH(1-84), and PTH(1-84) may be involved in the regulation of BP and body fluid homeostasis. BP changes or changes in blood volume per se do not seem to influence PTH(1-84) levels.

Repeated screening for albumin-creatinine ratio in an unselected population. The Ebeltoft Health Promotion Study, a randomized, population-based intervention trial on health test and health conversations with general practitioners

Albumin-creatinine ration (ACR) has been correlated to increased morbidity and mortality in diabetic as well as in nondiabetic populations. We investigated the albumin-creatinine ratio in 898 randomly selected persons aged 30-50 years, 471 women and 424 men (year 0). ACR was remeasured 1 year later in 811 (90%) of these persons (year 1). This was done in the framework of a prospective, randomized, population-based intervention trial evaluating the effect of health test and health conversations in general practice. The mean age of the study population was 39.8 (range, 30-51) years with a mean body mass index of 24.3 (15.9-44.3) kg/m2. The 50th, 95th, and 99th percentiles of ACR were 0.6, 2.0, and 5.0 mg/mmol at year 0 and 0.5, 2.0, and 5.3 mg/mmol at year 1. There was no significant difference between ACR values at year 0 and year 1. ARC values were slightly higher in women than in men, 0.6, (0.2-20.4) mg/mmol versus 0.5 (0.2-16.3) mg/mmol (p < 0.001, median and range). Albumin concentrations were slightly higher in men than in women 8.0 (2.0-196.0) mg/mmol versus 6.5 (2.0-121.0) micrograms/mL, p < 0.001. The correlation between ACR values measured year 0 versus year 1 was 0.43, p < 0.001 (Spearman rho). The agreement from year 0 to year 1 between normal ACR values (< or = 2.5 mg/mmol) and abnormal values (> 2.5 mg/mmol) were 0.33 expressed by Cohen's kappa.(ABSTRACT TRUNCATED AT 250 WORDS)

alpha-Amylase in resectable lung cancer

Biochemical analysis and immunohistochemical techniques support the theory that hyperamylasaemia in lung cancer is due to amylase production in carcinoma cells. The vast majority of amylase-producing carcinomas are adenocarcinomas with amylase isoenzyme similar to the salivary type. This prospective study assesses alpha-amylase expression in resectable lung cancer. Seventy four patients with resectable lung cancer were studied. Amylase activity in tumour tissue was analysed and isoamylase identification performed. Immunohistochemical analysis was performed using a polyclonal rabbit antibody against human salivary amylase. Hyperamylasaemia occurred in 13 out of 70 patients. Increased amylase activity in tumour tissue was found in 10 out of 52 cases, of which only two were associated with hyperamylasaemia. With the exception of one large cell carcinoma and one squamous cell carcinoma, the tumours were adenocarcinomas. Immunohistochemical analysis revealed amylase expression in seven adenocarcinomas and two adenosquamous carcinomas. In conclusion, immunohistochemical amylase expression was restricted to carcinomas with adenomatous differentiation. Biochemical analysis confirmed amylase production in 5 of 7 cases examined, the tissue amylase isoenzymes being of salivary type. However, hyperamylasaemia and a slightly increased amylase activity in tumour tissue may be caused by factors other than amylase-producing carcinoma cells.

alpha-Amylase in resectable lung cancer

Biochemical analysis and immunohistochemical techniques support the theory that hyperamylasaemia in lung cancer is due to amylase production in carcinoma cells. The vast majority of amylase-producing carcinomas are adenocarcinomas with amylase isoenzyme similar to the salivary type. This prospective study assesses alpha-amylase expression in resectable lung cancer. Seventy four patients with resectable lung cancer were studied. Amylase activity in tumour tissue was analysed and isoamylase identification performed. Immunohistochemical analysis was performed using a polyclonal rabbit antibody against human salivary amylase. Hyperamylasaemia occurred in 13 out of 70 patients. Increased amylase activity in tumour tissue was found in 10 out of 52 cases, of which only two were associated with hyperamylasaemia. With the exception of one large cell carcinoma and one squamous cell carcinoma, the tumours were adenocarcinomas. Immunohistochemical analysis revealed amylase expression in seven adenocarcinomas and two adenosquamous carcinomas. In conclusion, immunohistochemical amylase expression was restricted to carcinomas with adenomatous differentiation. Biochemical analysis confirmed amylase production in 5 of 7 cases examined, the tissue amylase isoenzymes being of salivary type. However, hyperamylasaemia and a slightly increased amylase activity in tumour tissue may be caused by factors other than amylase-producing carcinoma cells.

[The methods and results of simultaneous radiochemotherapy with carboplatin in advanced cervical carcinomas]

PURPOSE

The frequency and the poor therapeutic results in advanced cervical cancer establish the demand for effectiveness of treatment. Recent clinical data have shown that simultaneous radiochemotherapy may yield high remission rates in squamous cell carcinomas of other organs.

PATIENTS AND METHODS

In our Department of Radiotherapy and Radiooncology of the University of Leipzig we treated since 1.6.1991 17 patients with advanced cancer of the uterine cervix with a simultaneous radiochemotherapy with carboplatin.

RESULTS

The rate of complete remission was 76%. Follow-up is available from six to 24 months. Severe or toxic side effects of the treatment we didn't observe. Eight (47%) patients live relapse-free.

CONCLUSIONS

In our opinion randomized studies are required to determine: What is better? Simultaneous radiochemotherapy or radiotherapy?

Unchanged noradrenaline reactivity and blood pressure after corrective surgery in primary hyperparathyroidism

In order to evaluate the role of the hyperparathyroid state for blood pressure and volume homeostasis, eight patients with primary hyperparathyroidism were studied before and after corrective surgery. Neither noradrenaline induced blood pressure changes nor basal blood pressure were affected by the operation, and the values were the same as in an age- and sex-matched control group. Noradrenaline infusion induced an increase in PTH(1-84) values before (72-86 ng l-1, medians, p < 0.02), in contrast to a decrease after (28 to 19 ng l-1, p < 0.05) operation for primary hyperparathyroidism. Basal plasma atrial natriuretic peptide was lower before than after removal of adenomata (3.2 vs. 4.8 pmol l-1, medians, p < 0.02). Cyclic 3'-5'-guanosine monophosphate was not significantly changed (4.7 vs. 5.5 nmol l-1). Aldosterone was higher before than after surgery (139 vs. 71 pmol l-1, p < 0.02), whereas angiotensin II was unaltered (20 vs. 9 pmol l-1). Arginine vasopressin was higher before than after the operation (0.9 vs. 0.7 pmol l-1, p < 0.05), but urinary excretion of prostaglandin E2 was unchanged. In conclusion primary hyperparathyroidism was not associated with changes in noradrenaline reactivity or basal blood pressure despite derangements of hormones adjusting sodium and water homeostasis. It is suggested that the hormonal changes may be secondary to a relative volume depletion.

Ki-S1, a novel proliferative marker: flow cytometric assessment of staining in human breast carcinoma cells

There is considerable interest in immunohistochemical markers of proliferation which are suitable for use on routinely fixed clinical material. The novel proliferation-associated antibody Ki-S1 shows promise in this respect. In this study we have: (i) defined the pattern of Ki-S1 labelling relative to the cell cycle phase; (ii) investigated the labelling pattern with Ki-S1 on a human breast cell line (ZR75) under varying proliferative conditions induced by serum deprivation and refeeding; (iii) examined in a flow cytometric study Ki-S1 staining in archival, clinical breast carcinoma samples. In exponentially growing cells Ki-S1 showed a marked cell cycle phase-specific variation in staining intensity which increased linearly through the S-phase, was high in G2 and reached its peak in mitosis. Ki-S1 staining intensity mirrored the changes in proliferative activity of ZR75 cells during serum deprivation and refeeding. In a small series of human breast carcinoma, Ki-S1 staining intensity correlated with S-phase fraction (SPF) derived from DNA profiles. The antigen labelled by Ki-S1 is extremely robust, resisting degradation by fixation and by an aggressive enzymic tissue disaggregation method. Ki-S1 warrants further investigation as a proliferation-related marker, particularly for routine clinical application.

Distribution of hydroxylated vitamin D metabolites [25OHD3 and 1,25(OH)2D3] in domestic pigs: evidence that 1,25(OH)2D3 is stored outside the blood circulation?

1. The distribution of 25-hydroxycholecalciferol (25OHD3) and 1,25-dihydroxycholecalciferol [1,25(OH)2D3] in various organs from domestic pigs was examined by HPLC. 2. Plasma levels of both metabolites corresponded to those found in healthy human subjects. 3. Tissue concentrations of 25OHD3 in fat, kidney, liver, and intestinal mucosa were low (< 1/3 of plasma levels), whereas tissue concentrations of 1,25(OH)2D3 exceeded plasma levels by factors 3-7, adipose tissue concentrations being the highest. 4. Substantial amounts of activated vitamin D are stored outside the blood-streams and may actively participate in vitamin D and calcium homeostasis.

Factors affecting inter-individual variation in human plasma cholinesterase activity: body weight, height, sex, genetic polymorphism and age

The influence of body weight, height, age and sex on plasma cholinesterase activity (ChE) in 650 males and 437 females with ChE-1 phenotype U (genotype ChEuChEu or ChEuChEs) or UA (genotype ChEuChEa) was studied in a multiple regression model. ChE was not influenced by age (p > 0.01), but, like other liver synthesized plasma enzymes, highly (p < 0.001) influenced by body weight and height. In a logarithmic scale ChE followed a linear model (R = 0.535, p < 0.001) with randomly distributed residuals, InChE = 3.286-0.308 x ChE-1 phenotype-0.104 x sex + 0.00765 x weight - 0.00723 x height (U = 1, UA = 2; male = 1, female = 2; kg; cm). A simplified model based on body-mass index (BMI = weight divided by squared height, kg/m2), InCHE = 2.016-0.308 x ChE-1 phenotype - 0.091 x sex + 0.0230 x BMI, showed the same goodness-of-fit (R = 0.533). In a non-logarithmic scale both multiple regression models failed to fit cases with high ChE activity. A model for a 'standardized' plasma ChE in which the effects of ChE-1 phenotype, sex, body weight and height are eliminated, is proposed to compare ChE in unmatched population groups when using this enzyme activity as a biomarker in environmental or occupational medicine.