Correlation of Technical and Adjunctive Factors with Quantitative Tumor Reduction in Children Undergoing Selective Ophthalmic Artery Infusion Chemotherapy for Retinoblastoma

BACKGROUND AND PURPOSE

Selective ophthalmic artery infusion chemotherapy has improved ocular outcomes in children with retinoblastoma. Our aim was to correlate quantitative tumor reduction and dichotomous therapeutic response with technical and adjunctive factors during selective ophthalmic artery infusion chemotherapy for retinoblastoma. An understanding of such factors may improve therapeutic efficacy.

MATERIALS AND METHODS

All patients with retinoblastoma treated by selective ophthalmic artery infusion chemotherapy at a single center during a 9-year period were reviewed. Only first-cycle treatments for previously untreated eyes were studied. Adjunctive factors (intra-arterial verapamil, intranasal oxymetazoline external carotid balloon occlusion) and technical factors (chemotherapy infusion time, fluoroscopy time) were documented by medical record review. Quantitative tumor reduction was determined by blinded comparison of retinal imaging acquired during examination under anesthesia before and 3-4 weeks after treatment. The dichotomous therapeutic response was classified according to quantitative tumor reduction as satisfactory (≥ 50%) or poor (<50%).

RESULTS

Twenty-one eyes met the inclusion criteria. Patients ranged from 2 to 59 months of age. Adjuncts included intra-arterial verapamil in 15, intranasal oxymetazoline in 14, and external carotid balloon occlusion in 14. Quantitative tumor reduction ranged from 15% to 95%. Six showed poor dichotomous therapeutic response. A satisfactory dichotomous therapeutic response was correlated with intra-arterial verapamil (P = .03) in the aggregate cohort and in a subgroup undergoing treatment with single-agent melphalan at a dose of <5 mg (P = .02). In the latter, higher average quantitative tumor reduction correlated with intra-arterial verapamil (P < .01).

CONCLUSIONS

Intra-arterial verapamil during selective ophthalmic artery infusion chemotherapy is correlated with an improved therapeutic response, particularly when treating with lower doses of single-agent melphalan.

The K-INBRE symposium: a 10-institution collaboration to improve undergraduate education

The Kansas-IDeA Network of Biomedical Research Excellence (K-INBRE) is an infrastructure-building program funded by the National Institute of General Medical Sciences. Undergraduate education, through undergraduate research, is a key component of the program. The K-INBRE network includes 10 higher education institutions in Kansas and northern Oklahoma, with over 1,000 student participants in 16 yr. Since 2003, the K-INBRE has held an annual state-wide research symposium that includes national and regional speakers and provides a forum for undergraduates to give platform and poster presentations. The symposium is well attended by K-INBRE participants and has grown to a size of over 300 participants per year from all 10 K-INBRE schools. Two surveys were distributed to students and mentors to assess the impact of the symposium on student learning. Surveys (153) were distributed to students who participated in K-INBRE from 2013 through 2015 with a 51% response rate. Mentors were surveyed with a response of 111 surveys out of 161. Survey results indicate that students and mentors alike find the symposium to be beneficial and enriching of the student experience. Almost 80% of student respondents indicated that their participation in the symposium fostered appreciation of research. In short, the K-INBRE symposium provides a unique opportunity for students to gain experience in collecting, preparing, and communicating research in a professional environment. The collaborative experience of the annual K-INBRE symposium, the impact it has on student learning, and how it has influenced the research culture at our 10 institutions will be described.

Constraints on Ultrahigh-Energy Cosmic-Ray Sources from a Search for Neutrinos above 10 PeV with IceCube

We report constraints on the sources of ultrahigh-energy cosmic rays (UHECRs) above 10^{9}  GeV, based on an analysis of seven years of IceCube data. This analysis efficiently selects very high- energy neutrino-induced events which have deposited energies from 5×10^{5}  GeV to above 10^{11}  GeV. Two neutrino-induced events with an estimated deposited energy of (2.6±0.3)×10^{6}  GeV, the highest neutrino energy observed so far, and (7.7±2.0)×10^{5}  GeV were detected. The atmospheric background-only hypothesis of detecting these events is rejected at 3.6σ. The hypothesis that the observed events are of cosmogenic origin is also rejected at >99% CL because of the limited deposited energy and the nonobservation of events at higher energy, while their observation is consistent with an astrophysical origin. Our limits on cosmogenic neutrino fluxes disfavor the UHECR sources having a cosmological evolution stronger than the star formation rate, e.g., active galactic nuclei and γ-ray bursts, assuming proton-dominated UHECRs. Constraints on UHECR sources including mixed and heavy UHECR compositions are obtained for models of neutrino production within UHECR sources. Our limit disfavors a significant part of parameter space for active galactic nuclei and new-born pulsar models. These limits on the ultrahigh-energy neutrino flux models are the most stringent to date.

Searches for Sterile Neutrinos with the IceCube Detector

The IceCube neutrino telescope at the South Pole has measured the atmospheric muon neutrino spectrum as a function of zenith angle and energy in the approximate 320 GeV to 20 TeV range, to search for the oscillation signatures of light sterile neutrinos. No evidence for anomalous ν_{μ} or ν[over ¯]_{μ} disappearance is observed in either of two independently developed analyses, each using one year of atmospheric neutrino data. New exclusion limits are placed on the parameter space of the 3+1 model, in which muon antineutrinos experience a strong Mikheyev-Smirnov-Wolfenstein-resonant oscillation. The exclusion limits extend to sin^{2}2θ_{24}≤0.02 at Δm^{2}∼0.3  eV^{2} at the 90% confidence level. The allowed region from global analysis of appearance experiments, including LSND and MiniBooNE, is excluded at approximately the 99% confidence level for the global best-fit value of |U_{e4}|^{2}.

Evidence for Astrophysical Muon Neutrinos from the Northern Sky with IceCube

Results from the IceCube Neutrino Observatory have recently provided compelling evidence for the existence of a high energy astrophysical neutrino flux utilizing a dominantly Southern Hemisphere data set consisting primarily of ν(e) and ν(τ) charged-current and neutral-current (cascade) neutrino interactions. In the analysis presented here, a data sample of approximately 35,000 muon neutrinos from the Northern sky is extracted from data taken during 659.5 days of live time recorded between May 2010 and May 2012. While this sample is composed primarily of neutrinos produced by cosmic ray interactions in Earth's atmosphere, the highest energy events are inconsistent with a hypothesis of solely terrestrial origin at 3.7σ significance. These neutrinos can, however, be explained by an astrophysical flux per neutrino flavor at a level of Φ(E(ν))=9.9(-3.4)(+3.9)×10(-19)  GeV(-1) cm(-2) sr(-1) s(-1)(E(ν)/100  TeV(-2), consistent with IceCube's Southern-Hemisphere-dominated result. Additionally, a fit for an astrophysical flux with an arbitrary spectral index is performed. We find a spectral index of 2.2(-0.2)(+0.2), which is also in good agreement with the Southern Hemisphere result.

Revision of ploidy status of Dioscorea alata L. (Dioscoreaceae) by cytogenetic and microsatellite segregation analysis

Dioscorea alata is a polyploid species with several ploidy levels and its basic chromosome number has been considered by most authors to be x = 10. Standard chromosome counting and flow cytometry analysis were used to determine the chromosome number of 110 D. alata accessions of the CIRAD germplasm collection. The results revealed that 76% of accessions have 2n = 40 chromosomes, 7% have 2n = 60 chromosomes and 17% have 2n = 80 chromosomes. Progenies were produced from 2n = 40 types of D. alata and the segregation patterns of six microsatellite markers in four different progenies were analysed. The Bayesian method was used to test for diploid versus tetraploid (allo- and autotetraploid) modes of inheritance. The results provided the genetic evidence to establish the diploidy of plants with 2n = 40 chromosomes and to support the hypothesis that plants with 2n = 40, 60 and 80 chromosomes are diploids, triploids and tetraploids, respectively, and that the basic chromosome number of D. alata is x = 20. The findings obtained in the present study are significant for effective breeding programs, genetic diversity analysis and elucidation of the phylogeny and the species origin of D. alata.

Key features of successful BNR operation

Biological phosphorus removal has come of age after having been introduced with the treatment plants for the city of Johannesburg, South Africa, in 1974. There is a large number of plants in the world today and a great variety of basin configurations is used. Generally, we see excellent performance with the right wastewater characteristics and the correct design and operation, but there are still some issues not fully understood that have led to the perception that biological phosphorus removal is unreliable and unpredictable. These issues include nitrates in the feed, excessive return activated sludge recycle rates, secondary release of phosphorus and toxicity. This paper focuses on some of the issues that still frustrate designers and plant operators. There are also many claims for excellent removal by plants that appear not to conform to the established requirements for biological phosphorus removal. There is normally an explanation if the full picture is considered. The conclusion is that biological phosphorus removal is predictable and reliable if the process is properly understood.

Rapid detection of autoantibodies to dsDNA with the particle gel immunoassay (ID-PaGIA)

OBJECTIVE

To describe a new particle agglutination test for the detection of autoantibodies to double stranded DNA (dsDNA).

PATIENTS AND METHODS

Serum samples were collected from 40 unselected healthy blood donors and 200 patients with systemic lupus erythematosus (SLE) or a positive antinuclear antibody screen, or both. The samples were tested in the presence of red high density polystyrene particles coated with purified human dsDNA using the gel technique (Micro Typing System, ID-PaGIA, particle gel immunoassay). The results were compared with those obtained by the two standard anti-dsDNA antibody detection methods, Crithidia luciliae immunofluorescence test (CLIF) and enzyme linked immunosorbent assay (ELISA).

RESULTS

The three anti-dsDNA assays exhibited an overall agreement of 87% and significant correlation with each other (p<0.0001). In the SLE group (n=71), 45 patients (63%) were found to be positive by ID-PaGIA compared with only 11/129 (9%) patients in the non-SLE group. Thus the ID-PaGIA had a sensitivity of 63%, and a specificity of 92% for SLE. In comparison, the standard detection methods showed sensitivities of 62% (CLIF) and 70% (ELISA) and specificities of 99% (CLIF) and 84% (ELISA) for SLE. Anti-dsDNA reactivity in the agglutination assay correlated closely with the quantities of antibody obtained by CLIF (r=0.81, p<0.0001) and ELISA (r=0.73, p<0.0001).

CONCLUSIONS

The new particle gel agglutination test is a sensitive and specific immunoassay. It is a simple test procedure that might be well suited as a rapid screening method.

Procalcitonin, a donor-specific predictor of early graft failure-related mortality after heart transplantation

BACKGROUND

To date, donor-specific markers to predict outcome after heart transplantation (HTx) are unknown. Increased procalcitonin (PCT) levels have been found in infectious inflammation with systemic reactions and/or poor organ perfusion but have not been studied in heart donors. We evaluated PCT as a predictor of early graft failure-related mortality after HTx.

METHODS AND RESULTS

PCT and C-reactive protein (CRP) serum concentrations were measured in samples collected immediately before pericardium opening from 81 consecutive brain-dead multiple-organ donors. Donors for high-urgency-status recipients (n=2) were excluded from analysis. The remaining donors were retrospectively divided into 2 groups: donors for recipients who died within 30 days after HTx, after an early graft failure (group II, n=8), and all other donors (group I, n=71). No differences in donor and recipient demographic characteristics were found between groups. Areas under the receiver operating characteristic curves for graft failure-related mortality were 0.71 for PCT and 0.64 for CRP. A PCT value >2 ng/mL as a predictor of graft failure-related mortality had a specificity of 95.8% and sensitivity of 50.0%. The odds ratio for graft failure-related mortality for recipients of hearts from donors with PCT levels >2 ng/mL was 22.7 (unadjusted, 95% CI 3.7 to 137.8, P=0.0007) and 43.8 (after adjustment for prespecified potential confounders, 95% CI 1.4 to 1361.0, P=0.031).

CONCLUSIONS

A PCT level >2 ng/mL in a cardiac donor at the time of explantation appears to predict early graft failure-related mortality.

Severe 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) intoxication: clinical and laboratory effects

A variety of health effects have been attributed to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), but little information is available on the course of a verified high-level TCDD intoxication. In this paper we describe two cases of heavy intoxication with TCDD and present a 2-year follow-up including clinical, biochemical, hematologic, endocrine, and immunologic parameters monitored in two women, 30 and 27 years of age, who suffered from chloracne due to TCDD intoxication of unknown origin. Patient 1, who had the highest TCDD level ever recorded in an individual (144,000 pg/g blood fat), developed severe generalized chloracne, whereas in the second patient, despite heavy intoxication (26,000 pg/g blood fat), only mild facial acne lesions occurred. Both patients initially experienced nonspecific gastrointestinal symptoms. In Patient 1 we observed a moderate elevation of blood lipids, leukocytosis, anemia, and secondary amenorrhoea. The laboratory parameters in Patient 2 were all normal. Despite the high TCDD levels, apart from chloracne, only few clinical and biochemical health effects were observed within the first 2 years after TCDD intoxication.

Renal thrombotic microangiopathy associated with interferon-alpha treatment of chronic myeloid leukemia

Recent reports have documented the development of renal thrombotic microangiopathy in patients with chronic myeloid leukemia (CML) who have undergone treatment with interferon-alpha. The pathogenesis of the renal lesion in such cases remains unclear. We report the case of a patient with chronic myeloid leukemia who developed renal failure and nephrotic syndrome while being treated with hydroxyurea and interferon-alpha. The renal biopsy showed features of chronic thrombotic microangiopathy. The patient had serologic and functional evidence of anti-phospholipid antibody. Interferon-alpha is known to cause induction of multiple autoantibodies. We propose that in the context of CML, interferon-alpha treatment can induce pathogenic anti-phospholipid antibodies that result in renal thrombotic microangiopathy. This has important implications for patients with CML receiving immune-stimulating therapy because it suggests that prospective monitoring of such patients for anti-phospholipid antibody might identify those at risk of developing thrombotic microangiopathy. Furthermore, patients with established anti-phospholipid antibody syndrome in this context might benefit from intervention such as early anticoagulation.

Ethylene glycol intoxication: pathophysiology, diagnosis, and emergency management

Acute ethylene glycol intoxication is a medical emergency that, if not diagnosed correctly and treated aggressively, will lead to serious neurologic, cardiopulmonary, and renal dysfunction, and may result in death. Ethylene glycol toxicity is characterized by severe metabolic acidosis with high anion and osmolal gaps, and calcium oxalate crystals in the urine. Early recognition of ethylene glycol intoxication and rapid, aggressive use of large amounts of sodium bicarbonate, ethanol infusion, and hemodialysis may improve survival.

Influence of women's work status on the well-being of Indian couples

BACKGROUND

In urban India, working women are expected to continue to discharge their traditional domestic duties; the likely result is compromised well-being due to role strain. Husbands of working women may also experience pressures and hence poorer well-being. Well-being in working couples, particularly husbands, is little researched in developing countries.

METHOD

The Subjective Well-Being Inventory was administered to 46 'one-working, (only husband employed) and 51 'both-working' (both spouses employed) randomly selected urban, middle-class couples.

RESULTS

In one-working as well as both-working families, wives experienced less well-being than their husbands. Working wives experienced more confidence in coping than non-working wives. Husbands in both-working families experienced better social support but less social contact, less mental mastery, and poorer perceived health than husbands in one-working families. Few or no sociodemographic variables were associated with well-being.

CONCLUSIONS

Employment may benefit women but stress their husbands.

Time course of PCDD/PCDF/PCB concentrations in breast-feeding mothers and their infants

PCDD/PCDF/PCB concentrations were measured in samples from four mothers (at delivery and during lactation) and their infants (at birth and the end of first year of life). For two of these mothers it was the second delivery and breast-feeding period, and additional data were available from first lactation period and the first-born infant at the age of 11 to 12 months. Five of the six infants were fully breast-fed for at least 17 weeks. In four of them a distinct PCDD/PCDF/PCB accumulation was observed at the end of the first year of life: concentrations in blood fat were 1.5 to 3.6 times higher than maternal levels measured at the same time. Due to decreasing maternal body burdens during lactation, PCDD/PCDF concentrations at 11 to 12 months of life were only about half as high in the second infant as in the first one at the same age. During second pregnancy, no important change of the concentrations was observed in maternal blood.

Evaluation of the age-dependent development of lymphocyte surface receptors in children

Components and functions of the immune system change during postnatal development, not only in the first years of life, but well through adolescence and even into adult life. These age-dependent changes within the immune system greatly complicate any attempt to assess pathological alterations of immunologic variables in children. The need for studies on possible substance-induced changes, including risk assessment of environmental chemicals, has increased the necessity to establish reference ranges for certain immunologic variables against which an abnormal developmental status can be evaluated. In the present study age-related changes of surface receptors on peripheral white blood cells were studied in 82 children, aged between 2 months and 17 years. The blood samples were triple labeled with monoclonal antibodies followed by a whole blood lysis technique and were subsequently analyzed by flow cytometry. Complex statistical analyses were performed in order to determine probability ranges for some immunological variables. In this paper we describe the age-dependent development of components involved in major maturational processes, including the appearance and varying expression of adhesion receptors (CD11a, CD18, CD28, CD29, CD44, CD49d and CD54) on CD4+ "helper" cells and CD8+ "suppressor and cytotoxic" cells. A clear-cut increase of high epitope density expression of the integrins on both CD4+ and CD8+ cells was noted. These results suggest that the components of immune T cells for performing adhesion by interacting with other cells and many matrix components are largely acquired during postnatal development. Maximal levels of adhesion receptor expression are reached at different ages depending on the specific T cell subpopulation.

Characteristics of rectal carcinomas that predict the presence of lymph node metastases: implications for patient selection for local therapy

BACKGROUND AND OBJECTIVES

It has been estimated that approximately 5% of middle and low rectal adenocarcinomas are amenable to local therapy. However, these treatment modalities are limited by their failure to identify and treat regional nodal metastases.

METHODS

This study was undertaken to evaluate the role of tumor size, depth of penetration into the rectal wall, degree of histologic differentiation, DNA ploidy status, and their combination on the presence or absence of metastases in perirectal lymph nodes. Logistic regression was used to quantitatively predict the probability of positive lymph nodes.

RESULTS

Tumor size did not correlate with the presence of nodal involvement; however, worsening degree of differentiation, increasing depth of wall penetration and aneuploidy did statistically correlate with the presence of nodal metastases. For any combination of tumor traits, aneuploidy markedly increased the probability of positive lymph nodes over that observed with diploid tumors.

CONCLUSIONS

The combination of degree of differentiation, depth of penetration, and ploidy status may be used to identify patients whose tumors may be adequately treated with local measures. For any combination of tumor traits, aneuploidy markedly increased the probability of positive lymph nodes over that observed with diploid tumors.

Comparative study on age-dependent development of surface receptors on peripheral blood lymphocytes in children and young nonhuman primates (marmosets)

General conformity was found concerning age-dependent changes in the major subsets (CD4, CD8, CD2, CD20) and the adhesion molecules CD11a and CD29 on peripheral blood lymphocytes in children and young marmosets (Callithrix jacchus). Differences exist in the expression of the surface receptors CD45RA and CD56. Taking the total number of white blood cells into account, an age-related increase in the absolute numbers of peripheral blood lymphocytes was found in marmosets whereas in children, an age-dependent decrease was observed. The definition of reference ranges for different stages of maturation in children and young marmosets may serve as a basis on which comparative risk assessment of possible effects on lymphocyte subsets after pre- or perinatal drug exposure can be estimated.

Intake, fecal excretion, and body burden of polychlorinated dibenzo-p-dioxins and dibenzofurans in breast-fed and formula-fed infants

To assess toxicokinetics of polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs), oral intake and fecal excretion were measured in two breast-fed infants and one formula-fed infant during the 1st y of life. The intake of these compounds was up to 50 times higher in the breast-fed infants. In these children, fecal excretion of the main tetra- to hexachlorinated congeners was less than 9% of the intake at age of 1 and 5 mo, indicating almost complete intestinal absorption during breast-feeding. In contrast, distinctly higher fecal excretion rates were observed for the hepta- and octachlorinated compounds. Despite much lower PCDD/PCDF intake after weaning, concentrations in stool fat did not decrease substantially. We conclude that concentrations in fecal fat more or less reflect those in body fat. Additionally, PCDD/PCDF concentrations were measured in blood fat of all infants (and in a second formula-fed baby) at the age of 11 mo. International toxicity equivalent (I-TEq) concentrations in the formula-fed infants were less than 25% of maternal values and about 10 times lower than in the infants breast-fed for 6-7 mo. In the latter, a distinct accumulation was found for the tetra- to hexachlorinated congeners compared with maternal concentrations. We conclude that accumulation of PCDDs and PCDFs in infants is as high as expected on the basis of intake data and assuming complete absorption and negligible elimination during the 1st y of life.

Incidence of post-transplant malignancy among 674 solid-organ-transplant recipients at a single center

We evaluated the post-transplant course of the entire solid-organ-transplant population at our institution to determine the frequency, incidence and specific type of post-transplant malignancies which occurred at a single center. Of 674 solid-organ-transplant recipients (305 renal, 307 heart, 54 lung, 8 heart/lung), we detected 79 malignancies (48 heart, 28 renal, 2 lung, 1 heart/lung), representing an overall cancer frequency of 11.7%, 15.6% for heart and 9.2% for renal transplant recipients. The frequency in both transplant groups was higher than that reported previously in the multicenter data in the literature (about 6%); we also noted a shorter interval to malignancy (27 vs. 61 months). The most common malignancies overall were skin/lip carcinomas and post-transplant lymphoproliferative disorder (PTLD). The frequency of PTLD was higher in non-renal (6.5%) than renal (0.7%) transplant recipients and statistical analysis confirmed a significant higher incidence of all malignancies (p = 0.0032) and of PTLD (p = 0.0001) in heart and lung recipients as opposed to renal transplant recipients. The frequency of total skin/lip carcinomas was essentially equal in the heart and renal transplant groups (6%), and statistical analysis showed no significant difference in incidence of this general type of malignancy; however, there was a marked disparity in interval to squamous cell carcinoma (SCC) between renal and heart transplant recipients (27 versus 59 months). This was associated with an apparent increase in the rate of occurence of SCC after 60 months in heart transplant recipients, a finding not previously reported in the multicenter data in the literature. We did not demonstrate a significant effect of the withdrawal of prophylactic OKT3 from the immunosuppression regimen of heart transplant recipients on the incidence of all tumors, PTLD or skin/lip tumors.

Intake and fecal excretion of PCDDs, PCDFs, HCB and PCBs (138, 153, 180) in a breast-fed and a formula-fed infant

Intake and fecal excretion of PCDDs, PCDFs, HCB and PCBs (IUPAC Nos. 138, 153, 180) were measured in a breast-fed and a formula-fed infant at the age of 1 and 5 months. As expected, the intake of these compounds was clearly higher in the breast-fed infant. In this baby an almost complete absorption was observed for lower chlorinated PCDDs and PCDFs and also for HCB and PCBs, whereas for hepta- and octachlorinated PCDDs and PCDFs fecal excretion was considerably higher (from 20% up to nearly 100% of the intake). Due to low concentrations in diet and feces of the formula-fed infant an evaluation was possible only for a few compounds at the age of 5 months. These values were in the same range when compared with those of the breast-fed infant. For collection of feces new cotton diapers were used which were pre-extracted in order to reduce the levels of polychlorinated compounds. Unexpectedly, after washing the tissue a much higher contamination was observed which made a calculation of fecal excretion rates in the formula-fed infant at the age of 1 month impossible.

Flow cytometry as a prognostic predictor in gastric linitis plastica

Gastric linitis plastica (GLP) is a diffusely infiltrating carcinoma of the stomach that is usually diagnosed in an advanced stage and associated with poor prognosis. Recent studies to evaluate ploidy of these tumors are not conclusive. We undertook a retrospective study of 43 surgically treated patients with GLP (27 males, 16 females, mean age 65 years) to see if ploidy could be used to predict outcome. Flow cytometric DNA analysis was performed on paraffin-embedded tissue using the modified Hedley technique. Mean follow-up interval was 11 months (1-72 months) with 18 (42%) alive at end of study. The remaining 25 (58%) died with a mean survival of 7 months. Lymph node status was positive in 31 (70%) and negative in 12 (30%) of patients. Twenty-nine (67%) of tumors were diploid; 14 (33%) were aneuploid. Statistical analysis revealed overall survival correlated significantly (P = 0.04) only with lymph node status. Diploid tumors had 18 (60%) positive and 11 (40%) negative lymph nodes, whereas aneuploid tumors had 13 (93%) positive and 1 (7%) negative nodes. DNA content correlated significantly (P = 0.05) with lymph node status, but not with overall survival. Tumors with positive lymph nodes were 18 (51%) diploid and 13 (42%) aneuploid; tumors with negative nodes were 11 (92%) diploid and 1 (8%) aneuploid.

CONCLUSIONS

The majority of GLP tumors manifest diploid characteristics, and the presence or absence of lymph node metastasis is a major determinant in overall survival.

Hospital in the Home project: Royal Prince Alfred Hospital

The Central Sydney Area Health Service has developed and piloted a Hospital in the Home program as an alternative to inpatient admission. Hospital in the Home offers the opportunity for increased productivity of existing hospital services, and advantages for patients in terms of satisfaction and improved or comparable clinical outcomes. Having developed treatment protocols and established a core Hospital in the Home team, a wider demonstration project across three hospitals within the Central Sydney Area Health Service is proposed.

Retrospective statistical analysis of coagulation parameters after 250 liver transplantations

Extensive transfusion of blood components as a typical feature of OLT has been described by many authors. The perioperative requirement for transfusion, however, follows a downward trend, although the indications for OLT have been extended. Functional disturbances such as hyperfibrinolysis or platelet dysfunction, demonstrated by laboratory tests, such as platelet counts, PT, aPTT, TT, fibrinogen, and ATIII are often used to direct the transfusion of blood components, although preoperative data give insight only into the insufficient function of the old liver, which will be explanted and replaced by the donor graft. We have described a retrospective statistical analysis of laboratory data, clinical data, and perioperative blood requirements from 250 liver transplantations performed in our hospital from 1988 to 1992. The OLT was performed according to the usual surgical methods using a venovenous bypass system. Intraoperatively, volume was restored with packed RBC and FFP according to hemodynamic data, hemoglobin, and diuresis; clotting data were not used as indications for blood replacement. This analysis demonstrated that neither preoperative nor intraoperative clotting parameters were able to allow a prediction of the intraoperative requirement for transfusion of blood components; these findings parallel those of previous reports. With respect to other studies showing that perioperative transfusion rates correlated with postoperative infections and mortality, we strongly suggest that perioperative clotting measures as indicators for transfusion requirement should be analyzed with caution. Whether other diagnostic methods such as TEG are useful alternatives has to be determined.

Transient renal medullary hyperechogenicity in ultrasound studies of neonates: is it a normal phenomenon and what are the causes?

A prospective ultrasound study of the renal morphology of 51 neonates with no clinical signs of renal impairment showed transient medullary hyperechogenicity of varying intensity in 37%. These findings were made in the first few postnatal days, were not accompanied by any other echographic changes, and disappeared again within the first week of life. They were encountered twice as often in full-term as in premature babies. In parallel with this phenomenon, the concentration of Tamm-Horsfall protein, calcium, and uric acid, and the osmolality were determined in the daily urine of 44 of these neonates. The analyses did not provide any definite clues as to the etiology of the ultrasound findings. It is therefore suggested that the term "Tamm-Horsfall nephropathy or proteinuria" should no longer be used for such sonographic phenomena in the neonatal kidney, but rather, they should be regarded as normal. Furthermore, the term "tubular stasis nephropathy" should be reserved for cases with clinically demonstrable impairment of renal function.

Can woodland caribou and the forest industry coexist: The Ontario scene

Ontario is in the process of developing a strategy to improve the likelihood of woodland caribou (Rangifer tarandus caribou) and the forest industry coexisting in the province. This strategy is described within a set of proposed Timber Management Guidelines for the Provision of Woodland Caribou Habitat. The proposed guidelines advocate managing for large blocks of suitable winter habitat across caribou range, large cutovers to regenerate caribou winter habitat and the protection of traditional calving areas and travel routes. Summer habitat will be provided by the resulting mosaic. The forest industry can provide a sustainable supply of woodland caribou habitat that was traditionally maintained by wildfire.

[Non-invasive detection of left ventricular diastolic function in variously trained endurance athletes during a marathon run with pulsed Doppler sonography]

To evaluate left ventricular (LV) diastolic function in long distance runners LV filling parameters were assessed by Doppler echocardiography during marathon race in 23 male subjects. On the basis of their personal record the athletes were divided into two groups: 12 endurance athletes (END; 218 min over 42 km) aged 34 years (29/37, median and 25%/75%-percentiles) and 11 ultra endurance athletes (ULTRA; 152 min over 42 km) aged 32 years (28/37). At rest 21 healthy untrained subjects (UT) aged 33 years (28/37) served as control group. In long distance runners the values for LV mass and LV mass index were significantly higher in END with 210 (168/253) g rsp. 110 (87/135) g/m2 and in ULTRA with 225 (179/267) g rsp. 118 (93/142) g/m2 as compared to UT with 129 (105/162) g rsp. 68 (57/79) g/m2 (p less than 0.001 each). Doppler-derived mitral flow was characterized by the early passive (E wave) and late (A wave) diastolic inflow. In particular atrial filling fraction (AFF) as the relative atrial contribution to LV filling was measured. At rest and at km 21 we saw a normal filling behaviour (AFF = 27% bzw. 28%) in both groups of long distance runners with an AFF of 27 (26/29)% in END and an AFF of 28 (26/29) in ULTRA. In END AFF rose to 42 (38/47)% at km 42 (p less than 0.001) and remained significantly elevated with 37 (35/42)% until 30 min post marathon (p less than 0.05). Only 60 min post exercise AFF returned to baseline values with an AFF of 28 (25/39)% in END. In contrast at km 42 in ULTRA AFF was significantly lower and at baseline levels with 26 (25/29)% compared to END (p less than 0.001) and did not significantly change in the further course of the post running period.

CONCLUSION

Long distance runners show a normal LV filling behaviour at rest despite significant LV hypertrophy. In contrast to top class athletes (ULTRA) there is a shift of LV filling from early (E wave) to late (A wave) diastole in less trained runners (END) during marathon. Thus, the results indicate an impairment of early diastolic LV filling in amateur endurance athletes (END) during extreme physical exercise.

Persistence of various polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDDs and PCDFs) in hepatic and adipose tissue of marmoset monkeys

A defined mixture of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDDs and PCDFs) was subcutaneously administered to marmoset monkeys (Callithrix jacchus). Tissue concentrations in hepatic and adipose tissue were measured at different times after treatment (1-28 weeks). One week after application high concentrations could be detected for the 2,3,7,8-substituted congeners only. The percent of the administered dose in whole liver differed for the various 2,3,7,8-substituted congeners, ranging from 24.5 +/- 4.5% for 2,3,7,8-TCDD to 74.1 +/- 4.9% for 2,3,4,6,7,8-H6CDF. Therefore, the concentration ratio (liver/adipose tissue) was also very different, ranging from about 1 (2,3,7,8-T4CDD or 2,3,7,8-T4CDF) to greater than 10 in the case of some higher chlorinated PCDDs and PCDFs. Half-lives of PCDDs and PCDFs were very different for the various 2,3,7,8-substituted congeners. For the most toxic compound (2,3,7,8-T4CDD) a t/2 of about 8 weeks in hepatic tissue and about 11 weeks in adipose tissue was found when calculated from data obtained later than 6 weeks after injection. For 2,3,7,8-T4CDD and 1,2,3,7,8-P5CDD the decreases in hepatic concentrations were much faster during the first 6 weeks after administration (t/2 of 4 weeks). This was apparently due to redistribution phenomena. Half-life increased with increasing degrees of chlorination. In some cases (e.g. OCDD, OCDF) no significant decrease in tissue concentrations could be observed after 28 weeks. The shortest t/2 was determined for 2,3,7,8-T4CDF: shorter than 6 days in hepatic tissue and about 10 days in adipose tissue. Calculation of the body burden of the non-2,3,7,8-substituted PCDDs/PCDFs 1 week after injection revealed that all groups of isomers were present at less than 5%. Consequences of these findings for the use of TCDD-toxic-equivalency factors are discussed and a change in strategy is suggested.

Synchronous adenocarcinomas of jejunum and cecum following transverse colon carcinoma. A case study

A case of synchronous primary adenocarcinomas of the small and large bowel in a patient previously treated by transverse colectomy for cancerous polyps is presented. These new primaries were incidental findings during surgery for suspected recurrence of colonic carcinoma. Primary tumors of the small bowel are rare, and the diagnosis of primary adenocarcinoma of small bowel in the presence of primary adenocarcinoma of large bowel requires a high degree of suspicion and may well modify the prognostic outcome if detected early.

Anti-laminin receptor antibody targeting of liposomes with encapsulated doxorubicin to human breast cancer cells in vitro

The tumor cell laminin receptor is a cell-surface protein that binds laminin with high affinity (Kd = 1.0 nM). The putative ligand-binding domain of the laminin receptor has been molecularly cloned and sequenced. In the present study, we used the predicted amino acid sequence of the laminin receptor to generate synthetic peptide antigens and produced immunoglobulin M (IgM) anti-laminin receptor monoclonal antibodies. The disulfide bond group of the IgM molecule was used to couple the antibodies to the surface of liposomes encapsulating doxorubicin. The anti-laminin receptor monoclonal antibodies coupled to the liposomes bound avidly to the surface of MDA-MB-435S (MDA-435) human breast carcinoma cells, which have high numbers of laminin receptors. These antibody-coupled liposomes exhibited a low degree of binding to Hs 578Bst (Hs 578) normal human breast epithelial cells, which express a low number of laminin receptors. Excess liposomes competed for the binding of unbound laminin to the tumor cell surface, and excess laminin competed for binding with the liposomes. Antibody-coupled liposomes encapsulating doxorubicin were specifically more efficient in inhibiting colony formation by MDA-435 cells in vitro than unbound doxorubicin or liposomes without anti-laminin receptor monoclonal antibodies. Unbound doxorubicin inhibited thymidine uptake by 10%-20% in both Hs 578 and MDA-435 cells, whereas the antibody-coupled liposomes encapsulating doxorubicin inhibited thymidine uptake by 90% in MDA-435 cells but only 15% in Hs 578 cells. Thus, use of anti-laminin receptor monoclonal antibodies coupled with liposomes encapsulating doxorubicin represents a new strategy for selective targeting of doxorubicin to carcinoma cells with exposed laminin receptors.

Absorption and tissue distribution of various polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDDs and PCDFs) in the rat

A defined mixture of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDDs and PCDFs) was parenterally administered to rats and absorption and tissue distribution were measured: 1) Toluene/DMSO (1 + 2; v/v) proved to be a convenient vehicle for the subcutaneous administration of the various PCDDs and PCDFs. Seven days after application the rate of absorption was 90% of the administered dose or even higher for almost all of the PCDDs/PCDFs in the mixture. In a few cases only (e.g. OCDD) the rate was found to be 84-89%; 2) Seven days after subcutaneous administration all 2378-substituted congeners were found in the liver, whereas only a few non-2378-substituted congeners could be measured in minor quantities. The 2378-substituted congeners also predominated in adipose tissue; however, most of the non-2378-substituted congeners were also detected; 3) The amount deposited within the liver as percentage of the administered dose differed for the various 2378-substituted PCDDs and PCDFs, ranging from less than 10% for OCDD or 2378-T4CDF, and between 60 and close to 100% for 12378-P5CDD or the H6CDDs. Therefore, the concentration ratio (liver/adipose tissue) was also found to be very different, ranging from less than 3 in the case of 2378-T4CDD or 2378-T4CDF to greater than 40 in the case of 1234678-H7CDD, 23478-P5CDF, 123678-H6CDF, or 1234678-H7CDF; 4) Studies performed at the time period of ongoing absorption (13-14 h after injection) provided the first evidence that some of the non-2378-substituted congeners do reach substantial concentrations in hepatic tissue shortly after administration; 5) Subsequent to intraperitoneal injection of the same PCDD/PCDF mixture the concentrations within the liver were found to be almost identical with that found after subcutaneous injection. In contrast, much higher concentrations of the congeners were found in (abdominal) adipose tissue; 6) In the liver of untreated rats of the same strain no T4CDDs/T4CDFs or P5CDDs/P5CDFs were detectable under our experimental conditions.

Synchronous adenocarcinoma and carcinoid of the uterine cervix: immunohistochemical study of a case and review of literature

Mixed neoplasms, adenocarcinoma and carcinoid, have been reported to occur in several areas of the body, including gastrointestinal tract, breast, prostate, lung, skin, and kidney. Mixed tumors of the uterine cervix are very rare. Their histogenesis, immunohistochemical profile, and prognosis are not well established. Here, we report a case of a 49-year-old female with infiltrating adenocarcinoma of the cervix within which was found a separate nodule of small cell endocrine carcinoma.

Elimination of various polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDDs and PCDFs) in rat faeces

A defined mixture (of a composition characteristic of that present in incinerator fly ash) of polychlorinated dibenzo-p-dioxins and -furans (PCDDs and PCDFs) was subcutaneously administered to rats and the elimination of the unchanged congeners via faeces was measured. 1) All congeners administered could be found in faeces. 2) The rates of elimination via faeces were rather different for the different congeners. 3) The most toxic congeners, 2378-T4CDD and 12378-P5CDD, were present in unmetabolized form in faeces to less than 4% and less than 8% of the administered dose within the first week. Thus, parenteral administration clearly minimizes contamination of the animal quarters when compared with corresponding oral dosing. 4) The rate of unchanged elimination was apparently especially pronounced for the higher chlorinated PCDDs and PCDFs. The highest excretion rate was found for 1234678-H7CDD (up to 30% of administered dose). 5) No obvious differences were observed in the rates of elimination of the unchanged substances via faeces of the 2378-substituted or the non-2378-substituted isomers.

Pharmacokinetics and biological activity of 2,3,7,8-tetrachlorodibenzo-p-dioxin. 1. Dose-dependent tissue distribution and induction of hepatic ethoxyresorufin O-deethylase in rats following a single injection

Concentrations of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in rat liver and adipose tissue, and hepatic ethoxyresorufin O-deethylase (EROD) activity were studied subsequent to a single subcutaneous injection of TCDD. Two types of experiments were performed to study: (a) time-dependent changes following a single injection of 300 ng TCDD/kg body wt (points 1-4), and (b) dose-dependent changes measurable after 7 days following a single injection (points 5-7). 1. Absorption of TCDD following a single subcutaneous injection was about 90% after 3 days and 98% after 5 days. 2. Following a single dose of 300 ng TCDD/kg body wt peak concentrations were: liver (after 3 days): 4.7 +/- 0.9 ng/g wet wt, and adipose tissue (after 7 days): 0.82 +/- 0.07 ng/g wet wt. 3. T1/2 of TCDD in liver was 13.6 days over the total experimental period (from day 10 to 91 of the study), apparently with an initial faster phase: 11.5 days (from day 10 to 49), and a slower period at the end of the experiment: 16.9 days (from day 49 to 91); in adipose tissue the t1/2 was 24.5 days (from day 14 to 91 of the study). 4. Maximum induction of EROD in the liver was observed (14-fold at 300 ng TCDD/kg body wt) 3-7 days following the injection; the activity was decreased to about one third of the maximum 3 weeks after the injection; increase in total cytochrome P-450 at this dose was only about 1.4-fold at the induction maximum. 5. The ratio of the TCDD concentrations in liver and adipose tissue increased considerably between doses of 3 ng TCDD/kg body wt (ratio: about 0.74) and 3000 ng TCDD/kg body wt (ratio: about 7.7). 6. The extent of EROD induction in the liver increased dose dependently. A significant effect was first observed with a dose of 3 ng TCDD/kg body wt (activity about +32% above control activity). The corresponding tissue concentration was about 10 pg TCDD/g liver wet wt. 7. An almost perfect linear relationship exists (when using a double-log plot) between the hepatic TCDD concentration and the EROD activity for tissue concentrations ranging from 40 to 30,000 pg TCDD/g wet wt.