Cannabigerolic acid, a major biosynthetic precursor molecule in cannabis, exhibits divergent effects on seizures in mouse models of epilepsy

Background and Purpose

Cannabis has been used to treat epilepsy for millennia, with such use validated by regulatory approval of cannabidiol (CBD) for Dravet syndrome. Unregulated artisanal cannabis‐based products used to treat children with intractable epilepsies often contain relatively low doses of CBD but are enriched in other phytocannabinoids. This raises the possibility that other cannabis constituents might have anticonvulsant properties.

Experimental Approach

We used the Scn1a^+/− mouse model of Dravet syndrome to investigate the cannabis plant for phytocannabinoids with anticonvulsant effects against hyperthermia‐induced seizures. The most promising, cannabigerolic acid (CBGA), was further examined against spontaneous seizures and survival in Scn1a^+/− mice and in electroshock seizure models. Pharmacological effects of CBGA were surveyed across multiple drug targets.

Key Results

The initial screen identified three phytocannabinoids with novel anticonvulsant properties: CBGA, cannabidivarinic acid (CBDVA) and cannabigerovarinic acid (CBGVA). CBGA was most potent and potentiated the anticonvulsant effects of clobazam against hyperthermia‐induced and spontaneous seizures, and was anticonvulsant in the MES threshold test. However, CBGA was proconvulsant in the 6‐Hz threshold test and a high dose increased spontaneous seizure frequency in Scn1a^+/− mice. CBGA was found to interact with numerous epilepsy‐relevant targets including GPR55, TRPV1 channels and GABA_A receptors.

Conclusion and Implications

These results suggest that CBGA, CBDVA and CBGVA may contribute to the effects of cannabis‐based products in childhood epilepsy. Although these phytocannabinoids have anticonvulsant potential and could be lead compounds for drug development programmes, several liabilities would need to be overcome before CBD is superseded by another in this class.

Intracerebroventricular and intravenous administration of growth hormone secretagogue L-692,585, somatostatin, neuropeptide Y and galanin in pig: dose-dependent effects on growth hormone secretion

Central regulation of growth hormone (GH) secretion by the GH secretagogue, L-692,585 (585), was determined in Yorkshire barrows (40-45kg BW) with intracerebroventricular (icv) stainless steel cannulas placed by stereotaxic coordinates and indwelling external jugular vein (iv) cannulas for injecting 585 or saline during 3h serial blood sampling. Dose-dependent effects of 585 were determined by icv injections of saline vehicle, 3, 10, and 30microg/kg BW by once daily increment. A switchback study of iv and icv 585 treatment determined central and peripheral regulation of GH secretion by the secretagogue at 30microg/kg BW. When administered icv, 585 increased GH concentration in a dose-dependent manner, with a return to baseline by 60min. GH secretion was attenuated by increased numbers of icv 585 injections (p<0.05); however, it was not affected by increased numbers of iv 585 injections. Icv administration of somatostatin (SRIF) decreased (p<0.05) GH secretion compared with saline-treated controls, and decreased (p<0.05) peak GH response when given in combination with 585 as compared with 585 alone. Porcine galanin (pGAL) modestly increased (p<0.05) GH levels compared with saline controls, but when given icv in combination with 585 peak GH response was lower (p<0.05) compared with 585 alone. Porcine neuropeptide Y (pNPY) administered icv was without effect on GH levels compared with saline controls and decreased (p<0.05) peak GH response when given in combination with 585 as compared with 585 alone. The pharmacological actions by icv administration indicate that the GH secretagogue and neuropeptides act at the level of both porcine pituitary and hypothalamus.

Review: neuropathology of acute phase encephalitis lethargica: a review of cases from the epidemic period

INTRODUCTION

Encephalitis lethargica (EL), an epidemic disease of the early 20th century, has continued to be diagnosed sporadically since that time, including a report of 20 new cases in 2004. Many of the recent case reports state that the primary neuropathology of acute EL consists of inflammatory changes and lesions within the midbrain, basal ganglia and substantia nigra. However, the neuropathology of acute EL cases from the epidemic period was actually much more widespread.

METHODS

In order to characterize the neuropathology of acute phase EL, we developed a database of EL pathology based on 112 cases from the years 1915 to 1940, of which most died within 2 weeks of EL onset.

RESULTS

Our analysis revealed that cortical damage was prevalent in 75% of the 112 cases; damage to the meninges and brainstem occurred in approximately half of the cases; and the substantia nigra was damaged in only 13% of these acute cases. We also found that after 1921, damage to cranial nerve nuclei was not reported. An analysis of the neuropathology and clinical symptoms revealed little correlation.

CONCLUSIONS

Based on these findings, putative modern cases of acute EL with MRI/CT indicated lesions confined solely to the midbrain, brainstem, and/or basal ganglia should not be considered, consistent with that reported during epidemic period.

Exogenous glucagon effects on health and reproductive performance of lactating dairy cows with mild fatty liver

Severe fatty liver, a metabolic disease of dairy cows in early lactation, results in decreased health and reproductive performance, but can be alleviated by treatment with i.v. injections of glucagon. Mild fatty liver in cows effects on health and reproductive performance were determined by treatment with 14-day s.c. injections of glucagon at 7.5 or 15 mg/day. Multiparous Holstein cows (n=32) were grouped into Normal and Susceptible based on liver triacylglycerol concentrations (>1% liver tissue biopsy wet weight) at day 8 postpartum (day 0=day of parturition). Susceptible cows (n=24) were assigned randomly to three groups and s.c. injected with 0mg glucagon [60 ml 0.15M NaCl] [n=8] (same for Normal cows), 2.5 mg glucagon, or 5 mg glucagon every 8 h for 14 days, beginning day 8 postpartum. Mild fatty liver resulted in an increased number of days with elevated body temperature during the injection period, an increased incidence of mastitis after glucagon treatment, increased days to first estrus and insemination, increased days before conception occurred, and decreased conception rate. In cows with mild fatty liver, glucagon (15 mg/day) decreased the number of days with elevated body temperature and the incidence of mastitis after hormone treatment. From these results, we suggest that mild fatty liver is detrimental to health and reproduction of dairy cows and, furthermore, that exogenous glucagon decreases some of these detrimental effects.

Lack of Estrogenic or Antiestrogenic Actions of Soy Isoflavones in an Avian Model: The Japanese Quail

Isoflavones are soy compounds that possess weak estrogenic and antiestrogenic activities. In addition, phytochemicals, including isoflavones, may play a role in regulating seasonal reproductive cycles. As soy is a common constituent in poultry diets, the effect of these compounds on the reproductive system of production birds may be of concern. The present study examined the putative effects of soy isoflavones supplemented into the diet at 1 and 5% using endpoints of growth and reproduction in the Japanese quail. Isoflavones did not exert an effect on growth, feed intake, growth:feed, or the weight of the estrogen-sensitive immature oviduct in female quail. Furthermore, isoflavones did not influence the growth of the oviduct stimulated by exogenous estradiol. Similarly, isoflavones did not influence growth, feed intake, or growth:feed in male quail. However, isoflavones at 1%, but not 5%, in the diet reduced photoperiod-induced testis development 40% vs. control. In contrast, isoflavones did not influence testis regression stimulated by exogenous estradiol in sexually maturing male quail. The present results suggest that isoflavones may exert modest endocrine disruptor-like effects on reproduction in male, but not female, quail.

Evaluation of corn furan fatty acid putative endocrine disruptors on reproductive performance in adult female chickens

Based on evidence from rodent models, it was hypothesized that furan fatty acids found in corn would inhibit reproduction in the laying hen. An isomeric mixture of furan fatty acids [9, (12)-oxy-10,13-dihydroxystearic acid and 10, (13)-oxy-9,12-dihydroxystearic acid] was administered for a period of 3 wk via the diet (1 and 3 ppm) at levels greater than those in corn to 20-wk-old pullets. There were no overt indications of acute or chronic toxicity (no effects on mortality, feed intake, or average daily gain). Similarly, there was no dose-dependent effect on reproductive parameters [egg production, egg weight, shell thickness, ovarian weight, number or weight of large yolky preovulatory follicles, and number of small yellow follicles (4-8 mm in diameter)]. The present data do not suggest that furan fatty acids are a cause of concern to the poultry industry.

Lack of effects of atrazine on estrogen-responsive organs and circulating hormone concentrations in sexually immature female Japanese quail (Coturnix coturnix japonica)

The widely used herbicide, atrazine, has been reported to exhibit reproductive toxicity in rats and amphibians. The present studies investigate toxicity of atrazine in Japanese quail and its ability to influence reproduction in sexually immature females. Atrazine was administered in the diet at concentrations from 0.001 to 1000 ppm (approximately 109 mg kg-1 per day) or systemically via daily subcutaneous injections (1 and 10 mg kg-1) or Silastic implants. Atrazine did not cause overt toxicity in sexually immature female quail (no effects on change in body weight, feed intake, mortality or on circulating concentrations of the stress hormone, corticosterone). It was hypothesized that if atrazine were to have estrogenic activity or to enhance endogenous estrogen production, there would be marked increases in the weights of estrogen sensitive tissues including the oviduct, the liver and the ovary together with changes in gonadotropin secretion. However, atrazine had no effect on either liver or ovary weights. Atrazine in the diet increased oviduct weights at 0.1 and 1 ppm in some studies. These effects were not consistently observed and were not significant when data from studies were combined. Systemic administration of atrazine had no effect on oviduct weights. Dietary (concentrations from 0.001 to 1000 ppm) and systemically administered atrazine had no effect on circulating concentrations of luteinizing hormone (LH). The present studies provide evidence for a lack of general or reproductive toxicity of atrazine in birds.

Discovery of the 'porosome'; the universal secretory machinery in cells

The release of neurotransmitters at the nerve terminal for neurotransmission, release of insulin from β-cells of the endocrine pancreas for regulating blood glucose levels, the release of growth hormone from GH cells of the pituitary gland to regulate body growth, or the expulsion of zymogen from exocrine pancreas to digest food, are only a few examples of key physiological processes made possible by cell secretion. It comes as no surprise that defects in cell secretion are the cause for numerous diseases, and have been under intense investigation for over half century. Only in the last decade, the molecular machinery and mechanism of cell secretion has become clear. Cell secretion involves the docking and transient fusion of membrane-bound secretory vesicles at the base of plasma membrane structures called porosomes, and the regulated expulsion of intravesicular contents to the outside, by vesicle swelling. The discovery of the porosome in live cells, its morphology and dynamics at nanometer resolution and in real time, its isolation, its composition, and its structural and functional reconstitution in lipid membrane, are complete. The molecular mechanism of secretory vesicle fusion at the base of porosomes, and the regulated expulsion of intravesicular contents during cell secretion, are also resolved. In this minireview, the monumental discovery of the porosome, a new cellular structure at the cell plasma membrane, is briefly discussed.

In ovo exposure to a triazine herbicide: effects of atrazine on circulating reproductive hormones and gonadal histology in young Japanese quail

The triazine herbicide, atrazine, has come under scrutiny for its reported feminizing effects in amphibians. To date, there is little information concerning the effects of atrazine on reproduction in avian species. The current study examined the putative reproductive toxicity of atrazine after exposure in ovo. Atrazine at 504, 246, and 123 microg/kg was administered to Japanese quail eggs before incubation. The eggs were hatched and the birds raised to 14 days of age. Indices of hatchability, sex ratios, and growth were determined. Furthermore, circulating concentrations of reproductive hormones (estradiol, progesterone, and testosterone) and gonadal histology were examined. Atrazine at 504 microg/kg decreased 14-day hatchling weight by 13.1% versus controls. However, no detrimental effects on hatchability or sex ratios were observed. In female birds, atrazine at 504 microg/kg decreased ovarian weights and circulating concentrations of progesterone to 48.3% and 73.3%, respectively, versus control. However, concentrations of estradiol and testosterone did not differ from controls. In male quail, at all doses tested, atrazine had no effect on gonadal weights or circulating concentrations of estradiol, testosterone, or progesterone. Moreover, no incidences of left ovotestis formation were observed. In contrast, 10 ng/kg ethinylestradiol (a positive control) induced the formation of a left ovotestis in four of eight birds analyzed. The current results may suggest that exposure to atrazine in ovo at concentrations above ecologic relevance exerts effects on the reproductive system of young Japanese quail. However, no evidence is presented that atrazine induces feminization of the testis in male quail.

Physiology of ghrelin and related peptides

Growth hormone (GH) released from pituitary under direct control of hypothalamic releasing (i.e., GHRH) and inhibiting (i.e., sst or SRIF) hormones is an anabolic hormone that regulates metabolism of proteins, fats, sugars and minerals in mammals. Cyril Bowers' discovery of GH-releasing peptide (GHRP-6) was followed by a search for synthetic peptide and nonpeptide GH-secretagogues (GHSs) that stimulate GH release, as well as a receptor(s) unique from GHRH receptor. GHRH and GHSs operate through distinct G protein-coupled receptors to release GH. Signal transduction pathways activated by GHS increase intracellular Ca2+ concentration in somatotrophs, whereas GHRH increases cAMP. Isolation and characterization of ghrelin, the natural ligand for GHS receptor, has opened a new era of understanding to physiology of anabolism, feeding behavior, and nutritional homeostasis for GH secretion and gastrointestinal motility through gut-brain interactions. Other peptide hormones (i.e., motilin, TRH, PACAP, GnRH, leptin, FMRF amide, galanin, NPY, NPW) from gut, brain and other tissues also play a role in modulating GH secretion in livestock and lower vertebrate species. Physiological processes, such as neurotransmission, and secretion of hormones or enzymes, require fusion of secretory vesicles at the cell plasma membrane and expulsion of vesicular contents. This process for GH release from porcine somatotrophs was revealed by atomic force microscopy (AFM), transmission electron microscopy (TEM) and immunohistochemical distribution of the cells in pituitary during stages of development.

The anterior pituitary gland: lessons from livestock

There has been extensive research of the anterior pituitary gland of livestock and poultry due to the economic (agricultural) importance of physiological processes controlled by it including reproduction, growth, lactation and stress. Moreover, farm animals can be biomedical models or useful in evolutionary/ecological research. There are for multiple sites of control of the secretion of anterior pituitary hormones. These include the potential for independent control of proliferation, differentiation, de-differentiation and/or inter-conversion cell death, expression and translation, post-translational modification (potentially generating multiple isoforms with potentially different biological activities), release with or without a specific binding protein and intra-cellular catabolism (proteolysis) of pituitary hormones. Multiple hypothalamic hypophysiotropic peptides (which may also be produced peripherally, e.g. ghrelin) influence the secretion of the anterior pituitary hormones. There is also feedback for hormones from the target endocrine glands. These control mechanisms show broadly a consistency across species and life stages; however, there are some marked differences. Examples from growth hormone, prolactin, follicle stimulating hormone and luteinizing hormone will be considered. In addition, attention will be focused on areas that have been neglected including the role of stellate cells, multiple sub-types of the major adenohypophyseal cells, functional zonation within the anterior pituitary and the role of multiple secretagogues for single hormones.

Functional and phylogenetic analyses of a melanocortin-4 receptor mutation in domestic pigs

The melanocortin-4 receptor (MC4R), a G protein-coupled seven-transmembrane receptor, which is expressed in the brain, plays an important role in the control of mammalian energy homeostasis. A missense mutation (Asp298Asn) was identified in the porcine MC4R gene, which is associated with growth and food intake traits. The Asn298 mutation occurs within a highly conserved motif, NPLIY, of all members of G protein-coupled receptors; whereas, Asp298 is conserved in all five melanocortin receptor subtypes. Functional analysis of the porcine MC4R variant was performed with an in vitro gene expression system in 293 cells. Ligand binding (NDP-alphaMSH) did not differ between Asp298 and Asn298 MC4R proteins. However, the Asn298 MC4R variant was unable to stimulate cAMP production in response to NDP-alphaMSH stimulation; whereas, the Asp298 variant could stimulate cAMP accumulation. These results demonstrate that the Asp298 is required for normal MC4R signaling to the adenylyl cyclase. Sequencing of the MC4R gene of seven diverse genera within the Suiformes that include Hippopotamidae (hippos), Tayassuidae (peccaries) and Suidae (pigs), revealed 62 nucleotide variations in MC4R. Phylogenetic relationships of MC4R variations are consistent with those previously described from morphological and physiological data among the subfamilies of the Suiformes. These findings revealed that a single missense mutation (Asp298Asn) of aspartic acid (Asp) to asparagine (Asn) in MC4R gene decreased cAMP content and MC4R signaling, but with no difference in the ligand binding was associated with growth and feed intake traits in domestic pigs.

Mechanism of action of the growth hormone secretagogue, L-692,585, on isolated porcine somatotropes

The effects of a GH secretagogue, L-692,585 (L-585), and human GH-releasing hormone (hGHRH) on calcium transient and GH release were investigated in isolated porcine pituitary cells using calcium imaging and the reverse hemolytic plaque assay (RHPA). Somatotropes were functionally identified by the application of hGHRH. All cells that responded to hGHRH responded to L-585 application. Perfusion application of 10 microM hGHRH and L-585 for 2 min resulted in an increase in intracellular calcium concentrations ([Ca(2+)](i)) of 53+/-1 nM (mean+/-S.E.M.) (P < 0.01) and 68+/-2 nM (P < 0.01) respectively. The L-585 response was characterized by an initial increase in [Ca(2+)](i) followed by a decline to a plateau level above the baseline. Concurrent calcium imaging with RHPA indicated that the L-585-evoked increase in [Ca(2+)](i) coincided with GH release. L-585 significantly increased the percentage of plaque-forming cells (24+/-3 vs 40+/-6%; P < 0.05) and mean area of plaques (1892+/-177 vs 3641+/-189 micro m(2); P < 0.01) indicating increased GH release. Substance P (SP) analogue ([d -Arg(1),d -Phe(5),d -Trp(7,11)]-SP) blocked, and the hGHRH receptor antagonist ((Phenylac-Tyr(1),d -Arg(2), p-chloro-Phe(6), Homoarg(9), Tyr (Me)(10), Abu(15), Nle(27),d -Arg(28), Homoarg(29))-GRF (1-29) amide) decreased the stimulatory effect of hGHRH. These failed to block the stimulatory effect of L-585, suggesting a different receptor for L-585 from the GHRH receptor. The hGHRH-induced calcium transients and initial peak increase induced by L-585 were significantly decreased by removal of calcium from the bathing medium or the addition of nifedipine, an L-calcium channel blocker. The plateau component of L-585-induced calcium change was abolished by removal of calcium and nifedipine. These results suggest an involvement of calcium channels in GH release. Either SQ-22536, an adenylate cyclase inhibitor, or U73122, a phospholipase C (PLC) inhibitor, blocked the stimulatory effects of hGHRH and L-585 on [Ca(2+)](i) transient, indicating the involvement of adenylate cyclase-cAMP and PLC-inositol triphosphate pathways. These results further suggested that calcium mobilization from internal stores during the first phase of the L-585 response induced an increase in [Ca(2+)](i) whereas calcium influx during the second phase is a consequence of somatotrope depolarization.

Neonatal Meishan pigs show POU1F1 genotype effects on plasma GH and PRL concentration

Chinese Meishan pigs develop rapidly with onset of puberty at less than 100 days of age, and have a smaller placental size and larger litter size as compared with British/Continental breeds. POU1F1 is a member of the POU-domain family gene and is a positive regulator for growth hormone (GH), prolactin (PRL), and thyroid-stimulating hormone beta (TSHbeta) in several mammalian species. To investigate the role of POU1F1 in controlling pig growth and reproduction traits, Meishan (MS) pigs segregating a MspI POU1F1 polymorphism were used to determine differences of GH and PRL at both mRNA and circulating hormone concentrations. Animals from nine litters were used to collect pituitary (n=60) and/or blood samples (n=80) at day 0, 15, and 30 after birth, and all animals were genotyped (CC, CD, DD) for the MspI POU1F1 polymorphism. Reverse transcriptase-polymerase chain reaction (RT-PCR) with standard curve quantification was used to quantify mRNA levels for GH, PRL, and two alternative POU1F1 transcripts, POU1F1-alpha, and POU1F1-beta. Radioimmunoassays were done to determine the circulating concentration of GH and PRL in blood plasma. Our results indicated a significant effect of POU1F1 genotype on circulating levels of both GH and PRL at birth, but not thereafter. The DD neonates had lower levels of GH, but higher levels of PRL, than other genotypes. POU1F1-alpha mRNA decreased (P<0.05) from days 0 to 30, which paralleled decreases (P<0.05) in GH mRNA as well as PRL and GH plasma levels over the same period. POU1F1-beta mRNA levels did not significantly change over this period. Correlations were significant between POU1F1-alpha mRNA and both GH mRNA and GH plasma concentration levels, as well as between the two POU1F1 mRNA isoforms. Results from this study add to our understanding of the role of POU1F1 in controlling pig development and reproduction.

Caspase-3 activation and caspase-like proteolytic activity in human perinatal hypoxic-ischemic brain injury

Human perinatal hypoxic-ischemic brain injury is an important cause of death and morbidity. One relatively common pattern of perinatal injury involves selective neuronal death in the ventral gray matter of the pons and in the subiculum of the hippocampal formation, classically termed 'pontosubicular neuronal necrosis' (PSN). The vulnerable neurons undergo karyorrhectic condensation of their nuclear chromatin and exhibit in situ end labeling for DNA fragmentation, leading to the recent reclassification of cell death in PSN as apoptotic. Caspase activation plays a central role in apoptosis and caspase-3 appears to be an especially important effector enzyme in neuronal apoptosis. In this study we performed immunohistochemistry on brain sections from six postmortem cases of PSN using two polyclonal antisera; CM1, a specific marker of caspase-3 activation, and fractin, which specifically recognizes a neoepitope at a caspase cleavage site in actin, and is therefore a marker of caspase-like proteolytic activity. Numerous CM1- and fractin-immunolabeled neurons were seen in the nuclei pontis and subiculum in each case, and the great majority showed karyorrhectic morphology. The immunostaining involved the nuclei and cytoplasm of these cells and the proximal portions at least of their neuritic processes. Some neurons exhibited a more extensive pattern of dendritic fractin labeling. Frequent CM1- and fractin-immunoreactive axonal segments were also seen. The identification of caspase-3 activation and caspase-like proteolytic activity in PSN cases in this study suggests that caspase inhibitors may potentially have a therapeutic neuroprotective role in human perinatal hypoxic-ischemic brain injury.

Physiological regulation of maternal behavior in heifers: roles of genital stimulation, intracerebral oxytocin release, and ovarian steroids

We tested the hypotheses that 1) epidural anesthesia at parturition would block both peripheral and central release of oxytocin and eliminate the development of maternal behavior in primiparous heifers and 2) estradiol priming, genital stimulation, and appropriate neonatal stimuli would induce maternal behavior in nulliparous heifers. In experiment 1, primiparous crossbred heifers (n = 13) with cannulas in the third cerebroventricle (IIIV) were assigned randomly to receive epidural treatments of saline (SAL; n = 6) or lidocaine HCl (EPI; n = 7) at the onset of labor induced between Days 270 and 280 of gestation. Epidural anesthesia blocked (P < 0.001) both central and peripheral release of oxytocin and markedly reduced (P < 0.05) or eliminated licking behaviors during a 3-h period following parturition as compared with SAL. Following approximately 1 wk of controlled daily suckling, during which calves were permitted access only to the inguinal region of their dams (three times daily for 10 min each time), a second maternal behavior test was performed. Although licking behavior remained markedly reduced (P < 0.001) in the EPI compared with the SAL groups, all heifers accepted their calf at the udder. In experiments 2-4, neither estradiol priming in ovariectomized heifers nor estradiol plus progesterone in intact heifers resulted in an induction of maternal behaviors following genital stimulation and presentation of a neonate wetted with amniotic fluid. Pelvic sensory deficits apparently block oxytocin release and disturb both short-latency and long-term maternal behaviors but do not result ultimately in rejection of the calf. Combinations of hormonal, sensory, olfactory, and visual cues observed previously to induce maternal behavior in nulliparous ewes do not appear adequate for induction of maternal behavior in nulliparous heifers.

Secretion of dopamine and norepinephrine in hypophyseal portal blood and prolactin in peripheral blood of Holstein cattle

The objective was to test the hypothesis that dopamine regulates prolactin (PRL) secretion by determining acute changes in catecholamine concentrations in hypophyseal portal blood of cattle, and their relation to peripheral blood concentration of PRL in hypophyseal stalk-transected (HST) and sham-operated controls (SOC). Holstein heifers (606 +/- 21 kg BW; mean +/- SE) were subjected to neurosurgery for 8 h to collect hypophyseal portal blood with a stainless steel cannula designed with a cuff placed under the pituitary stalk and peripheral blood via a jugular vein catheter. PRL plasma concentration was measured by radioimmunoassay, and dopamine and norepinephrine in portal plasma by radioenzymatic assay. During anesthesia before HST or SOC, PRL plasma concentration ranged from 20-40 ng/ml throughout 255 min. PRL abruptly increased and remained above 90 ng/ml after HST compared with a steady decrease to <20 ng/ml in SOC heifers throughout 440 min. Within 5 min after severing the hypophyseal stalk, dopamine in portal blood (>8 ng/ml) was significantly increased (P < 0.05) compared with peripheral blood (<2 ng/ml). Norepinephrine concentration in portal blood was significantly greater (P < 0.05) than in peripheral blood during the first 60 min. The sustained high PRL level in peripheral plasma after severing the hypophyseal stalk stimulated hypothalamic dopamine secretion from hypophyseal portal vessels during the prolonged period of blood collection. Norepinephrine concentration in these cattle was greater in hypophyseal portal than in peripheral blood, implicating both an important hypothalamic source of the catecholamine as well as an adrenal gland contribution during anesthesia.

Luteinizing hormone secretion as affected by hypophyseal stalk transection and estradiol-17beta in ovariectomized gilts

The objectives were to determine hypothalamic regulation of pulsatile luteinizing hormone (LH) secretion in female pigs and the biphasic feedback actions of estradiol-17beta (E(2)-17beta). In the first study, the minimum effective dosage of E(2)-17beta that would induce estrus in ovariectomized gilts was determined to be 20microg/kg body weight. In the second study, ovariectomized gilts were assigned randomly on day 0 to treatments: (a) hypophyseal stalk transection (HST), (b) cranial sham-operated control (SOC), and (c) unoperated control (UOC). On day 3, gilts from each group received a single i.m. injection of either E(2)-17beta (20microg/kg body weight) or sesame oil. Blood was collected from an indwelling jugular cannula at 15min intervals for 3h before (day -2) and after treatment (day 2) from HST, SOC and UOC gilts. On day 3, blood was collected at 2h intervals for 12h after E(2)-17beta or sesame oil injection and at 4h intervals thereafter for 108h. Pulsatile LH secretion in all gilts 2 days after ovariectomy exhibited a frequency of 0.9+/-0.06peaks/h, amplitude of 1.3+/-0.13ng/ml, baseline of 0.8+/-0.07. Serum LH concentrations from SOC and UOC gilts were similar on day 2 and profiles did not differ from those on day -2. In HST gilts pulsatile LH release was abolished and mean LH concentration decreased compared with controls (0 versus 0.9+/-0. 06peaks/h and 0.77+/-0.03 versus 1.07+/-0.07ng/ml, respectively; P<0. 05). E(2)-17beta or sesame oil did not affect serum LH concentration in HST gilts, and LH remained constant throughout 120h (0.7+/-0. 07ng/ml). In SOC and UOC control gilts, E(2)-17beta induced a 60% decrease (P<0.05) in LH concentration within 12h, and LH remained low until 48h, then increased to peak values (P<0.05) by 72h, followed by a gradual decline to 120h. Although pituitary weight decreased 31% in HST gilts compared with controls (228 versus 332mg, P<0.05), an abundance of normal basophils was evident in coronal sections of the adenohypophysis of HST comparable to that seen in control gilts. The third and fourth studies determined that hourly i. v. infusions of LHRH (2microg) and a second injection of E(2)-17beta 48h after the first had no effect on the positive feedback action of estrogen in UOC. However, in HST gilts that received LHRH hourly, the first injection of E(2)-17beta decreased (P<0.05) plasma LH concentrations while the second injection of E(2)-17beta failed to induce a positive response to estrogen. These results indicate that both pulsatile LH secretion and the biphasic feedback action of E(2)-17beta on LH secretion depend on hypothalamic regulatory mechanisms in the gilts. The isolated pituitary of HST gilts is capable of autonomous secretion of LH; E(2)-17beta will elicit direct negative feedback action on the isolated pituitary gland if the gonadotropes are supported by exogenous LHRH, but E(2)-17beta at high concentrations will not induce positive feedback in isolated pituitaries. Thus, the direct effect of E(2)-17beta on the pituitary of monkeys cannot be mimicked in pigs.

The significance of thrombocytosis in patients with locally advanced cervical carcinoma: a Gynecologic Oncology Group study

OBJECTIVE

The aim of this study was to determine the incidence of thrombocytosis and its possible impact on survival probability among women with locally advanced cervical carcinoma.

METHODS

The database of 294 patients with Stages IIB-IVA cervical carcinoma without periaortic node metastasis who were treated with standardized radiation therapy and concurrent hydroxyurea or misonidazole was analyzed. Pretreatment platelet counts were available for 291 patients who are the subject of this study.

RESULTS

Thrombocytosis (platelet count >400 x 10(9)/liter) was present in 86 (29.6%) of the 291 patients. A multivariate Cox proportional hazards model showed that patients without extrapelvic disease and with thrombocytosis had a 55% greater chance of dying than those without thrombocytosis (relative risk = 1.55, 95% confidence interval 1.08-2.21). Patients with thrombocytosis had larger tumors and more frequently had bilateral parametrial involvement, tumor fixation to the sidewall, and positive pelvic lymph nodes than patients without thrombocytosis. Thrombocytosis was not found to be a prognostic factor in patients with positive pelvic nodes. However, in patients with negative pelvic nodes, the presence or absence of thrombocytosis was related to survival.

CONCLUSION

Thrombocytosis is a frequent finding among patients with advanced cervical carcinoma and seems to be related to tumor burden. Among patients with locally advanced cervical carcinoma who had negative pelvic nodes, those with thrombocytosis had a poorer survival.

Caspase-cleaved actin (fractin) immunolabelling of Hirano bodies

Hirano bodies are eosinophilic rod-like inclusions that are found predominantly in neuronal processes in the hippocampal CA1 sector with increasing age and are particularly numerous in Alzheimer's disease. They contain a variety of cytoskeletal epitopes, especially actin and actin-binding proteins. Actin cleavage by cysteinyl aspartate-specific proteases (caspases) is a feature of apoptosis. Cleavage at aspartate 244 generates N-terminal 32 kDa and C-terminal 15 kDa actin fragments. This has led to the development of a rabbit polyclonal antibody specific for caspase-cleaved actin, directed to the last five C-terminal amino acids of the 32 kDa fragment of actin ('fractin'). Fractin immunohistochemistry was performed on hippocampal sections from Alzheimer's disease and control cases containing numerous Hirano bodies, in addition to immunolabelling with CM1 antiserum which recognizes activated caspase-3. The Hirano bodies showed strong diffuse fractin immunoreactivity. They did not label with CM1 antiserum, perhaps reflecting too low a level of activated caspase-3 for immunodetection, or involvement of a different member of the caspase family. The finding of fractin immunoreactivity of Hirano bodies suggests that caspase-like cleavage of actin may play a role in their formation and further supports caspase-like activity in neuronal processes, distinct from that associated with acute perikaryal apoptosis.

Pregnancy, parturition, and lactation in hypophyseal stalk-transected beef heifers

Progesterone secretion is crucial for maintaining pregnancy to parturition in mammalian species, and in cattle the corpus luteum is the primary source of this hormone. This study determined the roles of prolactin (PRL), growth hormone (GH) and luteinizing hormone (LH) in the luteotropic process in beef heifers hypophyseal stalk-transected (HST, n=7) or sham operated (sham operated controls, SOC, n=9) during midgestation. The main finding was that endogenous PRL and GH maintained progesterone secretion in HST heifers in a similar manner to that in SOC throughout pregnancy. Serum PRL averaged 37 vs 187 and GH 2 vs 4 ng/ml in HST heifers compared with SOC, whereas LH abruptly decreased to undetectable levels after HST compared with a modest 0.4 ng/ml in SOC heifers. The second finding was that parturition and lactation occurred in HST heifers with calf delivery induced to occur at the same time as SOC. Milk production in HST animals was severely limited, and postpartum estrus obliterated compared with SOC. The suckling stimulus sustained milk ejection in HST heifers in spite of diminished PRL, GH, thyroid stimulating hormone, thyroxine and tri-iodothyronine secretion. The results suggest that PRL, GH and possibly placental lactogen are luteotropic during pregnancy in cattle.

Clinical significance of a cytologic diagnosis of atypical glandular cells of undetermined significance

OBJECTIVE

To assess the clinical significance of a cytologic diagnosis of atypical glandular cells of undetermined significance (AGUS) and determine the most appropriate evaluation of these patients.

STUDY DESIGN

Between 1993 and 1995, 44,217 Papanicolaou smears were evaluated at Allegheny University Hospitals, Medical College of Pennsylvania Campus. There were 108 (0.24%) cases of AGUS smears during that time. No clinical information was available for 14 patients, and 19 were lost to follow-up. The charts of the remaining 75 cases were retrospectively reviewed.

RESULTS

Tissue specimens were available for 62 of the 75 patients. There were 26 (42%) with no significant histopathologic findings, 13 (21%) with polyps, 5 (8%) cases of endometrial hyperplasia, 2 (3%) with endometrial adenocarcinoma, 12 (19%) with cervical intraepithelial neoplasia (CIN), 1 (2%) with adenosquamous carcinoma of the cervix, 2 (3%) with cervical adenocarcinoma in situ and 1 (2%) case of metastatic breast cancer. The total number of patients with significant histopathology other than polyps was 23 (37%). The median age of the patients was 49 years. There were more cases of endometrial hyperplasia and endometrial cancer (19%) in women 49 years or older than in younger women; only one (3%) case of endometrial hyperplasia was detected in the younger age group (P = .057). Patients who underwent more-aggressive evaluation (colposcopy and biopsies plus endometrial sampling, cone biopsy or hysterectomy) had greater numbers of abnormal histopathologic findings (55%) than patients who underwent endometrial sampling only (21%) or those who underwent colposcopy and biopsy only (33%). This difference approaches statistical significance (P = .057). A significant proportion of patients with a history of CIN and a cytologic diagnosis of AGUS were found to have CIN (47%), while 8% of those with no history of CIN were found to have CIN (P = .002). Fifty percent of patients with a history of cancer (all had breast cancer) and AGUS had abnormal histopathology. Patients with a subclassification of AGUS "favor neoplasia" had a greater proportion of significant histopathology (72%) as compared to AGUS "unspecified" (26%) and AGUS "favor reactive" (20%) (P = .003).

CONCLUSION

A significant proportion of women with a cytologic diagnosis of AGUS have abnormal histopathology. Heightened awareness should be raised in patients with AGUS and a history of CIN or cancer and in those with the AGUS subclassification "favor neoplasia."

Permanent prostate seed implant brachytherapy: report of the American Association of Physicists in Medicine Task Group No. 64

There is now considerable evidence to suggest that technical innovations, 3D image-based planning, template guidance, computerized dosimetry analysis and improved quality assurance practice have converged in synergy in modern prostate brachytherapy, which promise to lead to increased tumor control and decreased toxicity. A substantial part of the medical physicist's contribution to this multi-disciplinary modality has a direct impact on the factors that may singly or jointly determine the treatment outcome. It is therefore of paramount importance for the medical physics community to establish a uniform standard of practice for prostate brachytherapy physics, so that the therapeutic potential of the modality can be maximally and consistently realized in the wider healthcare community. A recent survey in the U.S. for prostate brachytherapy revealed alarming variance in the pattern of practice in physics and dosimetry, particularly in regard to dose calculation, seed assay and time/method of postimplant imaging. Because of the large number of start-up programs at this time, it is essential that the roles and responsibilities of the medical physicist be clearly defined, consistent with the pivotal nature of the clinical physics component in assuring the ultimate success of prostate brachytherapy. It was against this background that the Radiation Therapy Committee of the American Association of Physicists in Medicine formed Task Group No. 64, which was charged (1) to review the current techniques in prostate seed implant brachytherapy, (2) to summarize the present knowledge in treatment planning, dose specification and reporting, (3) to recommend practical guidelines for the clinical medical physicist, and (4) to identify issues for future investigation.

Development of rabbit embryos during a 96-h period of in vitro culture after superovulatory treatment under conditions of elevated ambient temperature

The effects of elevated ambient temperature on the response to exogenous gonadotropins were evaluated in female New Zealand White rabbits exposed to 33+/-1 degrees C (mean +/- SE) and 10-30% relative humidity (8 h/day) during a 5-day period. Does were treated with pFSH (0.3 mg/0.3 ml Standard Armour) twice daily during three consecutive days with a minimum interval of 8 h between injections. Six hours after the last FSH injection all does were removed from the experimental chamber, given hCG (25 IU/kg) and paired overnight. Nineteen hours after pairing, embryos were flushed from the reproductive tracts, evaluated, and subjected to in vitro culture during a 96-h period. The ovulatory responses to exogenous gonadotropins and fertilization rates did not differ significantly under conditions of elevated ambient temperature, whereas fewer blastocysts and increased number of degenerate embryos were observed after culture. We conclude that although hyperthermia was induced during exposure to elevated ambient temperature, it did not alter the ovulatory responses to gonadotropin treatment and plasma concentrations of FSH and LH compared with does in a thermoneutral environment. Exposure of donor rabbits to elevated ambient temperature before mating, however, increased embryonic degeneration.

Long-term growth after hypophyseal stalk transection and hypophysectomy of beef calves

Hypothalamic hormones regulate episodic and basal secretion of hormones from the anterior pituitary gland that affect metabolism and growth in cattle. This study focused on long-term growth in young calves subjected to hypophysectomy (HYPOX), hypophyseal stalk transection (HST), and sham operation control (SOC). Cross-bred (Hereford x Aberdeen Angus) and Hereford, and Aberdeen Angus calves were HYPOX (n = 5), HST (n = 5), or SOC (n = 8) at 146 +/- 2 days of age, whereas another group was HST (n = 5) or SOC (n = 7) at 273 +/- 5 days of age. Body weight was determined every 21 days from birth to 1008 days of age. Anterior vena cava blood was withdrawn at 4-day intervals from day 64-360 for RIA of GH, TSH, T4, T3, and LH, and at 20-min intervals for 480 min to determine episodic hormone secretion. Daily feed intake was determined in HST and SOC calves during an 80-day period. Birth weight averaged 35 +/- 1 kg (+/- SE) and was 142 +/- 4 kg at 126 days and 208 +/- 8 kg at 252 days before surgery. From day 146-1008, growth was arrested (P < 0.001) in HYPOX (0.06 +/- 0.01 kg/day) compared with SOC (0.50 +/- 0.04 kg/day) calves. Growth continued but at a significantly lower rate (P < 0.05) in calves HST at 146 days (0.32 +/- 0.07 kg/day) and 273 days (0.32 +/- 0.06 kg/day) compared with SOC (0.50 +/- 0.09 kg/day). Growth continued to be impaired to 1008 days, but more so in those HST at 146 days (432 +/- 43 kg BW) than 273 days (472 +/- 5 kg BW) and less (P < 0.05) than SOC (586 +/- 37 kg BW). Daily feed intake was consistently less (P < 0.05) in HST compared with SOC calves. Although episodic GH secretion was abolished and peripheral serum GH concentration remained consistently lower in HST (2.4 ng/ml) than SOC (5.5 ng/ml; P < 0.01), the calves continued to grow throughout 1008 days. Peripheral serum TSH concentration was less (P < 0.05) HST compared with SOC calves. There was an abrupt decrease (P < 0.001) in serum T4 (4-fold) and T3 (3-fold) concentration after surgery that remained to 360 days in HST compared with SOC calves. At the time calves were killed, pituitary gland weight was markedly reduced (P < 0.001) in HST (0.18 +/- 0.01 g/100 kg BW) compared with SOC (0.54 +/- 0.03 g/100 kg BW). Histological examination of pituitary glands from HST calves indicated the persistence of secretory GH and TSH cells in the same areas of the adenohypophysis as SOC calves. Coronal sections of the gland stained with performic acid-Alcian blue-periodic acid-Schiff-orange G, revealed GH and TSH secreting cells in HST calves similar to controls. These results indicate that long-term growth continues, but at a slower rate, after hypophyseal stalk transection of immature calves in spite of complete abolition of episodic GH secretion and consistently decreased basal secretion of GH, TSH, T4, and T3 compared with sham-operated animals. Growth was abolished after hypophysectomy of immature calves in which circulating GH and TSH was undetectable.

Functional fitting of interstitial brachytherapy dosimetry data recommended by the AAPM Radiation Therapy Committee Task Group 43. American Association of Physicists in Medicine

This work was undertaken to expedite implementation of the AAPM Task Group 43 recommendations, which call for significant modifications in the way dose is calculated for interstitial sources of 192Ir, 125I, and 103Pd as well as significant changes in the dose rate constant for 125I sources. The TG43 recommendations include a new formalism for dose calculation at points defined by the radial distance, r, from the source center and the angle, theta, that such a radius makes with the source axis. For each source type, values are tabulated for the radial dose function, the anisotropy function, and the anisotropy factor. The TG43 report includes fitting functions for the radial dose function in the form of polynomials, which are poorly behaved outside the range of fitted data. No functions are offered for the anisotropy function data or the anisotropy factor data, both of which could profit from some smoothing by such functions. We have found a double exponential fit to the radial dose function that not only approximates the data adequately but also appropriately approaches zero for very large distances. The anisotropy function is conveniently fit with a form of type 1 - f(r,theta)cos(theta)e(cr), which is exactly 1 at theta=90 degrees and approaches 1 for large r (for c<0), where f(r,theta) is a selected polynomial in the two variables. The form chosen for the anisotropy factor was 1 - (a+br)e(cr), which appropriately approaches 1 for large r (and c<0). Functional fits of these types are expected to facilitate implementation of TG43 recommendations, in that they may be either incorporated into dose algorithms or used to generate lookup tables of either the x, y or the r, theta format.

Evaluation and management of nonmelanoma skin cancer. The military perspective

As the incidence of melanoma skin cancer continues to increase in this country, so does the need for early detection and treatment of these tumors. This article discusses a military skin cancer screening clinic that encourages patient participation and the criteria and statistics regarding the different treatment modalities we employ to treat these skin cancers.

State institutions: thirty years of depopulation and closure

Over the past 30 years, a number of social, political, and economic forces have influenced public policy decisions regarding residential services for persons with mental retardation and other developmental disabilities (MR/DD). One of the most striking outcomes of these forces has been a steady decrease of persons with MR/DD residing in state institutions. In this paper we show the changes over the past 30 years in state institutional populations, interstate variability, movement of individuals into and out of state institutions, costs of state institutional care, and state institution closures as a result of social policy.

Seasonal regulation of prolactin secretion in hypophyseal stalk transected beef calves

Seasonal regulation of prolactin secretion was investigated in crossbred beef heifer calves. Calves were randomly assigned to hypophyseal stalk transection (HST, n = 6) or sham-operation control (SOC, n = 6) groups and fitted 1 day before surgery with an indwelling external jugular catheter. Prolactin (PRL), growth hormone (GH), thyroid stimulating hormone (TSH), thyroxine (T4), and tri-iodothyronine (T3) in peripheral serum were measured by radioimmunoassay in samples obtained before and after HST or SOC. During the first 8 days after HST, PRL concentrations remained significantly greater than SOC, but then decreased in both HST and SOC calves to 4 +/- 2 (+/- SE) and 10 +/- 3 ng/ml, respectively (P < 0.001). PRL remained low in both HST and SOC groups for three months after surgery. By four months, HST calves had lower basal PRL (5 +/- 1 ng/ml) than observed in SOC (40 +/- 4 ng/ml), and seasonal changes in PRL blood concentration also were attenuated by HST. Although HST reduced PRL secretion, it did not abolish the effect of seasonal changes (P < 0.01); circulating PRL concentration increased six-fold by shifts in photoperiod and temperature from winter to summer in these stalk-transected calves. The SOC group had higher serum GH during the winter (3.8 +/- 0.8) than in July (1.3 +/- 0.03 ng/ml). The HST group had the opposite profile of GH concentration, however, with concentrations being higher during May through July. Thyroid stimulating hormone secretion was partly sustained after stalk transection possibly by negative feedback of reduced circulating thyroxine and tri-iodothyronine. These results in both hypophyseal stalk-transected and sham-operated beef calves maintained in a natural environment strongly suggest that hypothalamic regulation of PRL secretion by adenohypophyseal cells is extremely sensitive to seasonal changes throughout the year. Additionally, immediately after HST, PRL blood concentration remains significantly greater than in SOC calves but eventually decreases to low blood concentration in HST calves, and unlike that seen after HST in primates. Regardless, basal PRL serum concentration responds to seasonal changes, but a less distinct change in basal GH serum concentration in HST calves than seen in the SOC calves.

Antiporcine relaxin (antipRLX540) treatment decreases relaxin plasma concentration and disrupts delivery in late pregnant pigs

Antibody against porcine relaxin (antipRLX540; 1:950,000) was produced in sheep and used to determine the effect on relaxin and progesterone secretion, and on parturition in late pregnant pigs. In group 1, Yorkshire gilts with normal estrous cycles were bred on the second observed estrus and fitted with an indwelling jugular cannula and an intraperitoneal cannula on day 100 of pregnancy. Gilts were infused at 6-h intervals with antipRLX540 (n = 10) or PBS (n = 10) beginning on day 103 until parturition. From days 103 to 120, daily blood samples (10 ml) were collected for RIA of relaxin, progesterone, and prolactin. In group 2, bred gilts were randomly assigned to antipRLX540 (n = 11), relaxin (n = 5), and PBS (n = 8) treatment on days 111, 113, and 115. Blood was collected twice daily from day 108 to 120, and every 20 min on days 111, 113, and 115 beginning 60 min before treatment and continuing 180 min. Parturition in gilts given antipRLX540 occurred on day 112.7 compared with day 114.0 in relaxin-treated gilts and day 114.3 in PBS controls (P < 0.05). Duration of delivery from first to last piglet was greatly delayed in antipRLX540 gilts (240 min) compared with PBS controls ([117 min] P < 0.005). Average number of stillborns was greater in antipRLX540- than in PBS-treated controls (2.4 vs. 1.0; P < 0.05). Relaxin concentration in peripheral plasma was lower in antipRLX540-treated gilts from day 105 to 110, but on day 113 the antipRLX540-treated group had a greater relaxin peak release compared with PBS-treated animals (P < 0.05). Plasma progesterone concentrations were similar in antipRLX540- and PBS-treated gilts throughout the period of the study. In group 2, by day 113, progesterone decreased in antipRLX540-treated gilts compared with relaxin- and PBS-treated gilts. Prolactin levels were similar in both antipRLX540- and PBS-treated gilts; however, from 1 to 3 days postpartum the antipRLX540 group had higher prolactin concentration (P < 0.05). The results indicate that antipRLX540 decreased circulating plasma concentrations of unbound or free relaxin during the last 10 days of pregnancy in Yorkshire gilts. AntipRLX540 markedly increased both the duration of delivery of piglets and the average number of stillbirths in this litter-bearing species compared with PBS-treated controls. This study provides strong evidence that increasing circulating concentrations of relaxin during late pregnancy is crucial for unimpaired parturition in the pig.

Gonadotropin-releasing hormone secretion into third-ventricle cerebrospinal fluid of cattle: correspondence with the tonic and surge release of luteinizing hormone and its tonic inhibition by suckling and neuropeptide Y

Objectives of the current studies were to characterize the pattern of GnRH secretion in the cerebrospinal fluid of the bovine third ventricle, determine its correspondence with the tonic and surge release of LH in ovariectomized cows, and examine the dynamics of GnRH pulse generator activity in response to known modulators of LH release (suckling; neuropeptide Y [NPY]). In ovariectomized cows, both tonic release patterns and estradiol-induced surges of GnRH and LH were highly correlated (0.95; p < 0.01). Collectively, LH pulses at the baseline began coincident with (84%) or within one sampling point after (100%) the onset of a GnRH pulse, and all estradiol-induced LH surges were accompanied by corresponding surges of GnRH. A 500- microg dose of NPY caused immediate cessation of LH pulses and lowered (p < 0.001) plasma concentrations of LH for at least 4 h. This corresponded with declines (p < 0.05) in both GnRH pulse amplitude and frequency, but GnRH pulses were completely inhibited for only 1.5-3 h. In intact, anestrous cows, GnRH pulse frequency did not differ before and 48-54 h after weaning on Day 18 postpartum, but concentrations of GnRH (p < 0.05) and amplitudes of GnRH pulses (4 of 7 cows) increased in association with weaning and heightened secretion of LH. We conclude that the study of GnRH secretory dynamics in third-ventricle CSF provides a reasonable approach for examining the activity and regulation of the hypothalamic pulse generator in adult cattle. However, data generated using this approach must be interpreted in their broadest context. Although strong neurally mediated inhibitors of LH pulsatility (suckling; NPY) had robust effects on one or more GnRH secretory characteristics in CSF, only high doses of NPY briefly abolished GnRH pulses. This implies that the GnRH signal received at the hypophyseal portal vessels under these conditions may differ quantitatively or qualitatively from those in CSF, and theoretically would be undetectable or below a biologically effective threshold when LH pulses are absent.

Three-dimensional lookup tables for Henschke applicator cervix treatment by HDR 192IR remote afterloading

PURPOSE

We have generated three-dimensional (3D) lookup tables for dosimetric analysis and optimization of high-dose rate (HDR) gynecological treatments using the Henschke applicator. The new dosimetry data have been compared with two-dimensional (2D) data currently in use. The 3D dosimetry tables have been implemented in an existing cervix treatment-planning system and have been evaluated through analysis of clinical cases.

METHODS AND MATERIALS

A general Monte Carlo N-Particles (MCNP) transport code was used to compute absorbed dose distributions around the intrauterine tandem and tungsten-shielded ovoid separately. The dosimetry data are represented in the x-y coordinate system for the intrauterine tandem table. The 3D table for the ovoid contains a radial dose function and an anisotropy function, as formulated in the spherical coordinate system. Absorbed dose at a spatial point is calculated by applying bilinear interpolation for the anisotropy function and linear interpolation for the radial dose function. The geometry factor for a finite line source is used. 3D dose calculations and optimization were performed for 20 treatments of 10 patients. The absorbed dose to critical structures, bladder and rectum, was compared by applying both the 2D table currently in use and the new tables.

RESULTS

The new 2D table for the intrauterine tandem yields doses different by less than 10% from those with the current table. The 3D table for the shielded ovoids shows as large as a factor of 4 reduction of dose behind the shield compared with the present 2D table. This shielding effect leads to 21.6 +/- 9.3% and 20.0 +/- 6.6% dose reduction at rectum and bladder, respectively, for actual treatments.

CONCLUSION

Our analysis indicates a need for patient-specific 3D dosimetry to permit more accurate dosimetric evaluation of HDR cervix treatments using shielded applicators. We have also shown that a Monte Carlo simulation code enabled us to derive the lookup tables necessary for 3D planning.

Experimental and Monte Carlo dosimetry of the Henschke applicator for high dose-rate 192Ir remote afterloading

We have performed extensive computational and experimental dosimetry of the Henschke applicator with respect to high dose-rate 192Ir brachytherapy using a GAMMAMED remote afterloader. Our goal was to generate clinically useful two- and three-dimensional look-up tables. Dose measurements of the Henschke applicator involved using TLD chips placed in a polystyrene phantom. Monte Carlo simulations were performed using the MCNP code. The computational models included the detailed geometry of 192Ir source, tandem tube, and shielded ovoid. The measured dose rates were corrected for the dependence of TLD sensitivity on the distance of measurement points from the source. Transit dose delivered during source extension to and retraction from a given dwell position was estimated by Monte Carlo simulations, and a correction was applied to the experimental values. For the applicator tandem, the ratio of dose rates obtained by MCNP to those measured by TLD chips ranges from 0.92 to 1.10 with an average of 0.98 and a standard deviation of 0.02. The measured and calculated dose rates at 1 cm on the transverse axis are 1.10 cGy U-1 h-1. For the shielded ovoid, the ratio ranges from 0.88 to 1.16 with an average of 1.00 and a standard deviation of 0.07. Causes of the discrepancy between the Monte Carlo and TLD results were identified. We found that the combined uncertainty of measured dose rates due to these causes is 5.6% for the applicator tandem and 8.4% for the shielded ovoid. Therefore, the results of the Monte Carlo simulation are considered to have been validated by the measurements within the uncertainty involved in the calculation and measurements.

Differential effects of dexamethasone and RU 486, an antigestagen and antiglucocorticoid, on progesterone and relaxin secretion in hysterectomized pigs with aging corpora lutea

Pregnancy lasts about 114 days in pigs. Porcine corpora lutea produce not only progesterone but also relaxin (RLX), a peptide hormone that plays a critical role in suppressing uterine motility during pregnancy and in remodelling connective tissues in preparation for imminent parturition. Progesterone concentrations in peripheral blood remain elevated (approximately equal to 25 ng ml-1) for the major part of pregnancy and decrease just before parturition. The decrease in progesterone coincides with the peak prepartum RLX release. Glucocorticoid or antiglucocorticosteroid steroid, RU 486, administration during late pregnancy can induce parturition in the pig. Peak release of RLX and a coincident decrease of progesterone in the circulating blood can also occur in the complete absence of fetuses and uterus in the pig. The effects of glucocorticoid or antiglucocorticoidsteroid administration to such hysterectomized pigs on the secretion of RLX and progesterone were examined in this experiment. Unmated Yorkshire gilts were hysterectomized on days 6-8 (estrus = day 0) and given dexamethasone (total of 30 mg day-1; 2 times i.m. at 0800 and 1600 h) from days 110-118; control animals received vehicle injection during this period. RU 486 (4 mg kg1 body weight) was orally administered once daily (days 111-115) at 0800 h; placebo-treated controls were given the same amount of feed without the drug at this time. RLX concentrations in blood were markedly suppressed (P < 0.01) during dexamethasone treatment (3 +/- 0.9 ng ml-1; mean +/- S.E.) whereas a peak release of RLX (17 +/- 2.8 ng ml-1) occurred in the control group on day 113. In contrast, progesterone concentrations (14 +/- 2.5 ng ml-1) were unaffected by dexamethasone treatment compared with the controls (15 +/- 2.0 ng ml-1; P > 0.82). Upon withdrawal of dexamethasone on day 118, RLX plasma concentrations began to increase and peaked at 14 +/- 2.1 ng ml-1 (P < 0.01) on day 120. In contrast, the antiglucocorticosteroid given to hysterectomized pigs bearing aging corpora lutea caused a marked elevation in circulating levels of progesterone and delayed RLX release until after the end of drug treatment on day 115. Average weights of corpora lutea collected at day 12 were similar between treated and control groups (427 +/- 7 vs. 433 +/- 6 mg; P > 0.68). Results indicate that a synthetic glucocorticoid, dexamethasone, suppresses RLX secretion without causing luteolysis and such suppression is reversible; progesterone secretion remained unaffected. In contrast, the antiglucocorticoid, RU 486, raised progesterone plasma concentration and delayed RLX peak release but did not suppress it during treatment. This experiment provides further evidence that relaxin and progesterone secretion from aging corpora lutea of pigs are regulated through separate mechanisms, and adrenal glucocorticoids may be involved in such a regulation process.

Prostaglandin F2alpha-induced luteolysis of aging corpora lutea in hysterectomized pigs

Prostaglandins primarily of uterine origin play an important role in parturition. Hysterectomy of nongravid pigs early in the luteal phase maintains luteal function until about Day 150, whereas the duration of normal pregnancy is about 114 days. A precisely timed peak release of relaxin and coincident decrease in progesterone secretion in unmated hysterectomized gilts are similar to hormonal changes that occur a few hours before parturition. It is hypothesized that prostaglandin F2alpha (PGF2alpha) in hysterectomized pigs mimics abrupt changes in ovarian and pituitary hormone secretion seen before normal parturition and in early lactation. Unmated Yorkshire gilts were hysterectomized on Days 6-8 of a normal estrous cycle, and at 1200 h on Day 113, they were given an i.m. injection of 30 mg PGF2alpha-trihydroxymethylaminomethane (THAM) salt or PBS. None of these gilts expressed behavioral estrus immediately after PGF2alpha or vehicle treatment. On Day 113, PGF2alpha increased peak relaxin (60 ng/ml) compared with that of controls (34 ng/ml; p < 0.01), whereas progesterone decreased abruptly (4 vs. 16 ng/ml in PGF2alpha and PBS; p < 0.01). Prolactin remained at < 5 ng/ml from Day 98 to 120 in controls but peaked at 33 ng/ml immediately after PGF2alpha treatment on Day 113, and then decreased to levels similar to those of controls on Day 120. Sequential bleeding revealed an acute growth hormone release (4.5 ng/ml) immediately after PGF2alpha injection and return to basal levels (< 0.6 ng/ml) on Days 114-120. PGF2alpha induced abrupt shifts in progesterone, relaxin, prolactin, and growth hormone secretion in hysterectomized gilts that mimicked hormone changes seen in late pregnancy, parturition, and early lactation. These findings provide new insight into the role of PGF2alpha in abruptly changing hormone secretions by aging corpora lutea and the pituitary gland even in the absence of conceptuses or the uterus in the pig.

A system for nonradiographic source localization and real-time planning of intraoperative high dose rate brachytherapy

We have developed a system for source localization and real-time planning of interstitial volume implants for intraoperative radiation therapy (IORT) using high dose rate remote afterloading techniques. Source localization is realized by using an electromagnetic tracking device, which consists of a transmitter coil, a receiver coil, and a signal processing unit, to generate the coordinates and orientation of the receiver. A drawback of the device is its sensitivity to adjacent metallic objects. Localization accuracy was evaluated in an operating room environment, where the metallic objects closest to the receiver are surgical retractors (that, incidentally, preclude radiographic localization). For achievable separation distances, we found an rms error of 0.7 mm in determining the distance between points 2 cm apart, thereby demonstrating the feasibility of the method. The receiver is mounted on a plastic block from which projects a long stylet and the transmitter is located at about 50 cm from the receiver. The stylet is inserted sequentially into source catheters to obtain the location and orientation data that serve as input to treatment planning software. The planning program optimizes source dwell time to make calculated dose conform to the dose prescribed on an ellipsoidal surface to an extent consistent with a certain level of dose uniformity inside the target volume. A least squares method is used that involves minimizing the objective function by a matrix method (nonnegative least squares). We have demonstrated that dwell time optimization can be performed in a short time and that the approach is adequate for the IORT application.

Code of practice for brachytherapy physics: report of the AAPM Radiation Therapy Committee Task Group No. 56. American Association of Physicists in Medicine

Recommendations of the American Association of Physicists in Medicine (AAPM) for the practice of brachytherapy physics are presented. These guidelines were prepared by a task group of the AAPM Radiation Therapy Committee and have been reviewed and approved by the AAPM Science Council.

Implant brachytherapy: a novel treatment for recurrent orbital rhabdomyosarcoma

BACKGROUND

Orbital rhabdomyosarcoma is the most common primary malignancy of the orbit in childhood. Tumor resection and exenteration were the preferred treatment modalities for rhabdomyosarcoma. In the past 20 years, however, combined local radiation and systemic chemotherapy have shown excellent survival results. Tumor recurrence after any of the aforementioned therapies is almost always fatal. We have developed a novel treatment for recurrent disease that has resulted in long-term survival for three patients.

METHODS

Three patients with recurrent orbital rhabdomyosarcoma were previously treated with primary radiation and chemotherapy. At the time of recurrence, exenteration and localized brachytherapy were performed. An individually molded poly(methylmethacrylate) (Lucite; E. I. du Pont de Nemours & Co., Wilmington, Del.) device loaded with radioactive iodine seeds delivered localized high-dose radiation, 6000 cGy over 6 days, to the orbit without irradiating the brain.

RESULTS

All patients are alive and free of disease with follow-up ranging from 4 years and 4 months to 8 years and 4 months.

CONCLUSION

A novel technique of delivering localized radiation to the orbit of three children with recurrent orbital rhabdomyosarcoma appears curative.

Relaxin-induced expression of Fos in the forebrain of the late pregnant rat

Relaxin, administered parenterally, has been shown to increase the release of oxytocin (OT) into the circulation and increase the firing rate of OTergic neurons. The objective of the present study was to determine if relaxin administration can result in the expression of a transcription factor, suggesting that it alters transcriptional activity within OTergic neurons at the level of the hypothalamus. Primigravid rats were ovariectomized and a jugular cannula was inserted on day 11 of gestation (g11). Pregnancy was maintained by implanting 17 beta-estradiol and progesterone caplets subcutaneously at the time of ovariectomy. At gl9, rats were challenged with intravenous relaxin or isotonic saline and the brains were removed for study. Immunohistochemistry was performed on coronal brain sections, utilizing Fos as a marker of cellular activation. In the group receiving relaxin, Fos-like immunoreactivity (Fos-IR) was abundant only in the supraoptic (SON) and paraventricular nuclei (PVN) of the hypothalamus as well as in the subfornical organ (SFO). In contrast, Fos-IR in the group given isotonic saline was lacking in these three brain regions. A double label study using antibodies against Fos and OT demonstrated that a majority of the Fos-labeled cells in the hypothalamus were OTergic. Because Fos can act as a transcription factor, we interpret these data to indicate that transcription within OTergic cells is altered following relaxin administration, with abundant Fos-IR being limited to the SON and PVN of the hypothalamus and the SFO during late pregnancy in the rat.

5-fluorouracil iontophoretic therapy for Bowen's disease

BACKGROUND

Topical 5-fluorouracil (5-FU) is an accepted therapy for Bowen's disease. Recurrences with this method have been attributed to deep follicular involvement and poor patient compliance because of the prolonged treatment time required.

OBJECTIVE

We sought to determine whether iontophoresis of 5-FU is an effective therapy for Bowen's disease.

METHODS

Twenty-six patients with biopsy-proven Bowen's disease received eight 5-FU iontophoretic treatments in 4 weeks. Local excision was done 3 months after the last treatment. The specimens were step-sectioned and evaluated for any histologic evidence of bowenoid changes.

RESULTS

Only 1 of 26 patients showed histologic evidence of Bowen's disease 3 months after treatment.

CONCLUSION

5-FU iontophoresis appears to be a safe, effective, and well-tolerated therapy for Bowen's disease.

Enhancement of 131I-mediated cytotoxicity by caffeine

In cell culture, caffeine has been shown to enhance the lethality of DNA-damaging agents including ultraviolet rays, X-irradiation, and alkylating agents. We have previously reported a Phase I clinical trial demonstrating the feasibility of intraperitoneal radioimmunotherapy in patients with refractory ovarian cancer using 131I-labeled monoclonal antibody OC125. We are now exploring the possibility of using caffeine to enhance the toxicity of 131I-irradiation in target cells. As an in vitro model we tested this hypothesis using Chinese hamster ovary (CHO) cells exposed to 131I-labeled human serum albumin at various doses (4 to 70 microCi/ml) for 24 hr followed by 24 hr of incubation with caffeine. Cytotoxicity was measured by clonogenic survival and a nuclear fragmentation assay. The results show that caffeine, at a concentration of 7.7 mM, significantly enhances the cytotoxicity of 131I-irradiation.

Continuous infusion of relaxin on periparturient progesterone, oxytocin and relaxin plasma concentrations and time of parturition in beef heifers

These studies were designed to determine whether continuous i.v. infusion of increasing dosages of porcine relaxin during late pregnancy in beef heifers would influence circulating blood concentrations of relaxin, progesterone and oxytocin, and time of onset of parturition. Beef heifers were bred by artificial insemination and, on Day 277, fitted with indwelling jugular cannulas for hormone infusion and blood sampling from Day 277 to Day 286. Intravenous infusion of purified porcine relaxin (pRLX, 3000 U mg-1) was started in heifers (n = 8) at increasing dosages (200 U h-1 on Days 277 and 278, 300 U h-1 on Days 279 and 280, 500 U h-1 on Day 281, 600 U h-1 on Day 282, and 700 U h-1 on Days 283-286). Phosphate-buffered saline (PBS, 10 ml h-1) was infused during these same times to control animals (n = 6). Relaxin treatment steadily increased the circulating plasma concentration of immunoreactive relaxin to more than 120 ng ml-1 compared with less than 0.5 ng ml-1 in PBS-treated controls. Relaxin infusion in increasing dosages over the treatment time was associated with a significant decrease (P < 0.01) in plasma progesterone concentration compared with the PBS controls. The rate of change in progesterone levels between pRLX and PBS groups differed (P < 0.05) at 300 U h-1, 600 U h-1 and 700 Uh-1 dosage intervals, respectively. Plasma levels of oxytocin at 4 h intervals remained similar (P > 0.05) during the pretreatment period and throughout continuous infusion of pRLX and PBS. Mean concentrations of oxytocin in PBS control heifers peaked at 0.95 pgml-1 during the corresponding infusion of 700 Uh-1 pRLX, which peaked at 0.77 pgml-1. Although continuous i.v. infusion of relaxin resulted in a decrease in circulating blood levels of progesterone, it did not significantly reduce the interval between the beginning of pRLX treatment and parturition compared with the PBS-infused control heifers. These results indicate that continuous i.v. infusion of high levels of porcine relaxin resulted in a decrease in progesterone secretion in late pregnant beef heifers.

Relaxin and estrogen synergistically accelerate growth and development in the uterine cervix of prepubertal pigs

This study was designed to determine the development and growth-promoting effects of relaxin with or without estrogen on the uterine cervix of prepubertal gilts. Twenty littermate gilts of similar body weight (33 +/- 3 kg; mean +/- SE) at 80 days of age were randomly assigned to four treatments: Vehicle (CONTROL, 1 ml PBS and 1 ml vegetable oil, n = 5); Relaxin (Relaxin, in PBS, 1 ml, 167 micrograms ml-1, n = 5); Estradiol Benzoate (EB, in vegetable oil, 1 ml, 2 mg ml-1, n = 5); and Relaxin plus EB (Relaxin + EB, at the same doses, n = 5), total six intramuscular injections for all treatments. Twenty four hours after the last injection, hysterectomy was performed, and the uterine tissues were immediately frozen at -80 degrees C. Samples were taken from the middle portions of the cervix and the uterine horns and dried to a constant weight to determine the dry weight and water concentration. Homogenates of uterine horns and cervices were analyzed for concentrations and contents of protein, hydroxyproline (collagen index) and DNA. Relaxin alone had no significant effect on any parameters (i.e., wet weight, Relaxin vs.

CONTROL

36 +/- 5 vs. 28 +/- 3 g uterus-1, dry weight 5.6 +/- 0.6 vs. 4.4 +/- 0.4 g uterus-1). EB alone increased significantly (P < 0.05) wet weight of the uterus (EB vs.

CONTROL

85 +/- 23 vs. 28 +/- 3 g uterus-1), dry weight (EB vs.

CONTROL

14.5 +/- 3 vs. 4.4 +/- 0.4 g uterus-1), and hydroxyproline content (EB vs.

CONTROL

47.2 +/- 13 vs. 12.6 +/- 4 mg cervix-1). In the presence of EB, relaxin treatment increased all measurements compared with CONTROL (i.e., wet weight, Relaxin + EB vs. EB: 136 +/- 34 vs. 28 +/- 3 g uterus-1). Compared with EB, Relaxin + EB significantly (P < 0.05) increased the uterine wet weight (Relaxin + EB vs. EB: 136 +/- 34 vs. 85 +/- 23 g uterus-1), the hydroxyproline content (Relaxin + EB vs. EB: 91 +/- 29 vs. 47 +/- 13 mg cervix-1), and DNA content (Relaxin + EB vs. EB: 8.1 +/- 2 vs. 5.4 +/- 1 mg cervix-1). These results indicate that the growth-promoting effects of relaxin on the uterus and cervix may be, at least partly, estrogen-dependent and that the growth and development of the uterus and cervix can be accelerated by a combination of relaxin and estrogen treatment.

Pregnancy rates per artificial insemination for cows and heifers inseminated at a synchronized ovulation or synchronized estrus

Two synchronization protocols were tested for lactating dairy cows and heifers. Nulliparous dairy heifers (13 to 23 mo; n = 155) and primiparous and multiparous dairy cows (60 to 289 d postpartum; n = 310) were assigned randomly to two treatments. Controls received 25 mg of PGF2 alpha and were artificially inseminated according to the a.m.-p.m. rule following detected estrus. All controls that were not detected in estrus were injected with 25 mg of PGF2 alpha at 14-d intervals until artificial insemination (AI) at a detected estrus or until timed AI at 72 to 80 h after a third sequential injection of PGF2 alpha. Treated cows and heifers received a protocol that used GnRH and PGF2 alpha to synchronize ovulation (Ovsynch). Cows and heifers that were treated with Ovsynch were injected i.m. with 100 micrograms of GnRH at a random stage of the estrous cycle. Seven days later, cows and heifers in this group received 25 mg of PGF2 alpha followed by a second injection of 100 micrograms of GnRH 30 to 36 h later. Subsequently, the treated cows and heifers received AI 16 to 20 h after the second injection of GnRH. Pregnancy rates per AI were similar (38.9% vs. 37.8%) for control cows and cows treated with the Ovsynch protocol, respectively. However, pregnancy rate per AI was greater for control heifers (74.4%) than for heifers treated with Ovsynch (35.1%). Evaluation of serum progesterone concentrations at each hormonal injection indicated that the first injection of GnRH synchronized luteal function of lactating dairy cows but not of heifers. In summary, one fixed-time AI at a synchronized ovulation provided similar pregnancy rates per AI as did AI following the a.m-p.m. rule after estrus had been induced by PGF2 alpha in lactating cows, but the fixed-time AI was not effective for heifers because of the lack of synchronization.