Longitudinal trends using a point-of-care gelatin-based model for ultrasound-guided central venous catheter insertion

Ultrasound (US)-guided central venous catheter (CVC) insertion is a procedure that carries the risk of significant complications. Simulation provides a safe learning atmosphere, but most CVC simulators are not available outside of simulation centers. To explore longitudinal trends in US-guided CVC insertion competency in internal medicine (IM) interns, we studied the use of a low-fidelity, gelatin-based, US-guided CVC insertion simulation model combined with a simulation curriculum. This prospective observational study of IM interns was performed over the course of one academic year. Interns (n = 56) underwent model-based, US-guided procedure simulation training program and a repeated training course prior to their intensive care unit (ICU) rotation. CVC insertion competency at different timepoints was recorded. Survey data about intern experience and attitudes were also collected. Out of the 56 interns initially trained, 40 were included in the final analysis. Across all outcomes, interns experienced skill atrophy between initial training and the beginning of their ICU month. However, by the end of the month, there was a significant improvement in competency as compared to initial procedural training, which then waned by the end of the intern year. Attitudes toward the model were generally positive and self-reported confidence improved throughout the course of the year and correlated with objective measures of competency. Over the course of their intern year, which included simulation training using a gelatin-based model, interns demonstrated consistent competency trends. The use of a gelatin-based CVC insertion simulation model warrants further study as an adjunctive aid to existing simulation training.

Thrombolysis and use of argatroban for the treatment of massive pulmonary embolism following anticoagulation failure in a patient with COVID-19

Purpose

Successful use of alteplase and argatroban to treat a patient with coronavirus disease 2019 (COVID-19)–associated massive pulmonary embolism with cardiac arrest is reported.

Summary

This case report describes a 42-year-old male with COVID-19 who developed a massive pulmonary embolism resulting in cardiac arrest after suspected failure of low-molecular-weight heparin therapy for a deep venous thrombosis. Administration of two 50-mg doses of intravenous alteplase resulted in return of spontaneous circulation, and low-dose argatroban was used as follow-up anticoagulation therapy without complications. This is the first case report of use of argatroban in a patient with COVID-19 with cardiac arrest–associated massive pulmonary embolism after failure of previous anticoagulation efforts.

Conclusion

Argatroban may be used as an alternate anticoagulation strategy in COVID-19 patients who fail low-molecular weight therapy. A risk versus benefit discussion should be had regarding appropriateness of therapy as well as dosing. More data is needed to understand the unique hypercoagulable condition in COVID-19 patients as well as research that further highlights the role of argatroban and bivalirudin therapy in this patient population.

Pharmacologic Treatment of Intensive Care Unit Delirium and the Impact on Duration of Delirium, Length of Intensive Care Unit Stay, Length of Hospitalization, and 28-Day Mortality

OBJECTIVE

To determine whether treatment of delirium affects outcomes.

PATIENTS AND METHODS

A retrospective cohort study of patients admitted to the medical intensive care unit (ICU) from July 1, 2015, through June 30, 2016, was conducted. Patients with ICU delirium, defined by a positive Confusion Assessment Method for the ICU score, were included. Patients were stratified into 4 treatment groups based on exposure to melatonin and antipsychotic agents during ICU stay: no pharmacologic treatment, melatonin only, antipsychotics only, and both melatonin and antipsychotics. A time-dependent cause-specific hazards model with death as a competing risk was used to evaluate the effect of melatonin or antipsychotic drug use for delirium on duration of ICU delirium, length of ICU stay, and length of hospitalization. A logistic regression was used to evaluate 28-day mortality. Covariates significantly associated with exposure to melatonin and antipsychotics were included in the minimally adjusted model. Covariates significantly associated in the minimally adjusted model were included in a final adjusted model.

RESULTS

A total of 449 admissions to the medical ICU were included in the analysis. Exposure to melatonin or antipsychotic agents did not reduce the duration of ICU delirium, ICU/hospital length of stay, or 28-day mortality. However, antipsychotic use only was associated with longer hospitalization.

CONCLUSION

Antipsychotic drugs for the treatment ICU delirium may not provide the benefit documented in earlier literature. Further investigation on patient selection, type of antipsychotic, and dosing is needed.

Improving Quality of Life in Patients at Risk for Post-Intensive Care Syndrome

Objective

To improve quality of life (QOL) in patients at risk for post-intensive care syndrome (PICS).

Patients and Methods

We conducted a mixed-method, prospective, observational, pre-post interventional study in an adult medical and mixed medical/surgical/transplant intensive care unit (ICU) at a tertiary academic hospital. Preintervention included patients admitted from October 1 through October 31, 2016, and postintervention included patients admitted from January 15 through February 14, 2017. First, a multidisciplinary team of stakeholders identified barriers associated with decreased QOL in patients at risk for PICS. Next, interventions were designed and implemented. The effect of interventions was assessed using a mixed-method analysis. The qualitative analysis used a modified grounded theory approach. The quantitative analysis included assessment of preexisting symptoms and risk factors associated with PICS. The 36-Item Short-Form Health Status Survey (SF-36), which surveys physical and mental composite scores, was used to assess QOL.

Results

Barriers identified were lack of awareness and understanding of PICS. Interventions included educational videos, paper and online education and treatment materials, and online and in-person support groups for education and treatment. After interventions, the qualitative analysis found that patients who participated in the interventions after hospital discharge showed improved QOL, whereas education during hospitalization alone was not effective. The quantitative analysis did not find improvement in QOL, as defined by SF-36 physical or mental composite scores.

Conclusion

Interventions targeted to patients after hospitalization may offer subjective improvement in QOL for those at risk for PICS.

Practical Implementation of Failure Mode and Effects Analysis for Extracorporeal Membrane Oxygenation Activation

Extracorporeal membrane oxygenation (ECMO) is used to treat severe hypoxemic respiratory failure and as a rescue therapy for patients with cardiopulmonary arrest within a narrow window of time. A failure modes and effects analysis (FMEA) was conducted to analyze the clinical and operational processes leading to delays in initiating ECMO. FMEA determined these highest-risk failure modes that were contributing to process failure: (1) ECMO candidacy not determined in time, (2) no or incomplete evaluation for ECMO prior to consult or arrest, (3) ECMO team not immediately available, and (4) cannulation not completed in time. When implemented collectively, a total of 4 interventions addressed more than 95% of the system failures. These interventions were (1) ECMO response pager held by a team required for decision, (2) distribution of institutionally defined inclusion/exclusion criteria, (3) educational training for clinicians consulting the ECMO team, and (4) establishment of a mobile ECMO insertion cart.

Extremely Elevated Erythrocyte Sedimentation Rates: Associations With Patients' Diagnoses, Demographic Characteristics, and Comorbidities

OBJECTIVE

To study associations between extreme erythrocyte sedimentation rate (ESR) elevations (≥100 mm/h) and diseases, age, sex, race, Charlson Comorbidity Index (CCI), and C-reactive protein (CRP) level.

PATIENTS AND METHODS

This was a retrospective cohort study of 4807 patients with extreme ESR values examined at Mayo Clinic, Rochester, Minnesota, from January 1, 2002, through December 31, 2011. Independent variables included diseases (infection, autoimmune, malignancy, renal disease, or miscellaneous), subcategories of diseases, patient demographic characteristics (age, sex, and race), CRP level, and CCI. The Wilcoxon rank sum test was used to assess comparisons of ESR between patients with and without disease as well as relationships between extreme ESR values and demographic characteristics of patients within disease categories. Associations between ESR and CRP level were determined using the Pearson correlation coefficient.

RESULTS

The leading diagnosis associated with extreme ESR elevations (n [%]) was infection (1932 [40]), followed by autoimmune (1839 [38]) and malignancy (1736 [36]) (P<.01). Extreme elevations in ESR varied by sex, with higher ESRs in men (mean, 117±13.3 mm/h) than in women (mean, 115.9±12.5 mm/h) (P=.008). Extreme ESR elevations correlated inversely with the CCI (P=.008) and did not correlate with the CRP level. There were no correlations between extreme elevations in ESR and age or race.

CONCLUSION

We found that almost all patients have an identifiable etiology for extreme ESR elevations and that infection is the most common disease association. Unlike previous research, we identified higher ESRs in men than in women and no associations with age, race, and comorbid illness. These findings may enhance the diagnostic evaluation of patients with extreme ESR elevations.

Failure mode and effects analysis to reduce risk of anticoagulation levels above the target range during concurrent antimicrobial therapy

PURPOSE

A failure mode and effects analysis (FMEA) was conducted to analyze the clinical and operational processes leading to above-target International Normalized Ratios (INRs) in warfarin-treated patients receiving concurrent antimicrobial therapy.

METHODS

The INRs of patients on long-term warfarin therapy who received a course of trimethoprim-sulfamethoxazole, metronidazole, fluconazole, miconazole, or voriconazole (highly potentiating antimicrobials, or HPAs) between September 1 and December 31, 2011, were compared with patients on long-term warfarin therapy who did not receive any antimicrobial during the same period. A multidisciplinary team of physicians, pharmacists, and a systems analyst was then formed to complete a step-by-step outline of the processes involved in warfarin management and concomitant HPA therapy, followed by an FMEA.

RESULTS

Patients taking trimethoprim-sulfamethoxazole, metronidazole, or fluconazole demonstrated a significantly increased risk of having an INR of >4.5. The FMEA identified 134 failure modes. The most common failure modes were as follows: (1) electronic medical records did not identify all patients receiving warfarin, (2) HPA prescribers were unaware of recommended warfarin therapy when HPAs were prescribed, (3) HPA prescribers were unaware that a patient was taking warfarin and that the drug interaction is significant, and (4) warfarin managers were unaware that an HPA had been prescribed for a patient.

CONCLUSION

An FMEA determined that the risk of adverse events caused by concomitantly administering warfarin and HPAs can be decreased by preemptively identifying patients receiving warfarin, having a care process in place, alerting providers about the patient's risk status, and notifying providers at the anticoagulation clinic.

Chromosomal mapping of chicken mega-telomere arrays to GGA9, 16, 28 and W using a cytogenomic approach

Four mega-telomere loci were mapped to chicken chromosomes 9, 16, 28, and the W sex chromosome by dual-color fluorescence in situ hybridization using a telomeric sequence probe and BAC clones previously assigned to chicken chromosomes. The in-common features of the mega-telomere chromosomes are that microchromosomes are involved rather than macrochromosomes; in three cases (9, 16, 28) acrocentrics are involved with the mega-telomeres mapping to the p arms. Three of the four chromosomes (9, 16, W) encode tandem repeats which in two cases (9 and 16) involve the ribosomal DNA arrays (the 5S and 18S-5.8S-28S gene repeats, respectively). All involved chromosomes have a typical-sized telomere on the opposite terminus. Intra- and interindividual variation for mega-telomere distribution are discussed in terms of karyotype abnormalities and the potential for mitotic instability of some telomeres. The diversity and distribution of telomere array quantity in the chicken genome should be useful in contributing to research related to telomere length regulation - how and by what mechanism genomes and individual chromosomes establish and maintain distinct sets of telomere array sizes, as well as for future studies related to stability of the chicken genome affecting development, growth, cellular lifespan and disease. An additional impact of this study includes the listing of BAC clones (26 autosomal and six W BACs tested) that were cytogenetically verified; this set of BACs provide a useful tool for future cytogenetic analyses of the microchromosomes.

The chicken telomerase RNA gene: conservation of sequence, regulatory elements and synteny among viral, avian and mammalian genomes

Telomerase RNA (TR) is essential for telomerase activity and the maintenance of telomere length in proliferating cell populations. The objective of the present research was to define the cytogenetic and molecular genomic organization of chicken TR (chTR). The chTR exists as a single copy gene (TERC, alias TR), mapping to chromosome 9 (GGA9). The loci on the q arm of GGA9 map to three chromosomes in human with five of the nine GGA9q loci mapping to HSA3q. Sequencing of the chTERC locus (3,763 bp) from the UCD 001 genome (Red Jungle Fowl) included: 604 bp 5', 465 coding, and 2,694 bp 3' (from -604 to +3159). Sequence analysis included homology searches conducted on several levels including comparisons among different chicken genotypes, Marek's disease virus (MDV) sequences, plus human and murine. We provide evidence for distal 5' and 3' sequence homology between chTERC and the MDV genome among other known regions of homology (promoter and coding), elaborate on 5' transcription factor binding motifs among the various genomes as well as show type and number of TERT-related motifs 3' of chicken TR (e.g., Sp1, c-Myb, c-Myc, AP2, among others). Surrounding the gene are more than 25 Sp1 sites, over 20 oncogene transcription factor binding motifs and numerous hormonal and other specialized binding motifs. Knowledge of 5' and 3' chTERC regulatory elements will be useful for investigating normal control mechanisms during growth and development as well as investigating the potential for dysregulation of this important gene during oncogenesis, especially among different genotypes.

Telomeres in the chicken: genome stability and chromosome ends

Telomeres are the complex nucleoprotein structures at the termini of linear chromosomes. Telomeric DNA consists of a highly conserved hexanucleotide arranged in tandem repeats. Telomerase, a ribonucleoprotein of the reverse transcriptase family, specifies the sequence of telomeric DNA and maintains telomere array length. Numerous studies in model organisms established the significance of telomere structure and function in regulating genome stability, cellular aging, and oncogenesis. Our overall research objectives are to understand the organization of the telomere arrays in chicken in the context of the unusual organization and specialized features of this higher vertebrate genome (which include a compact genome, numerous microchromosomes, and high recombination rate) and to elucidate the role telomeres play in genome stability impacting cell function and life span. Recent studies found that the chicken genome contains three overlapping size classes of telomere arrays that differ in location and age-related stability: Class I 0.5 to 10 kb, Class II 10 to 40 kb, and Class III 40 kb to 2 Mb. Some notable features of chicken telomere biology are that the chicken genome contains ten times more telomeric DNA than the human genome and the Class III telomere arrays are the largest described for any vertebrate species. In vivo, chicken telomeres (Class II) shorten in an age-related fashion and telomerase activity is high in early stage embryos and developing organs but down-regulates during late embryogenesis or postnatally in most somatic tissues. In vitro, chicken cells down-regulate telomerase activity unless transformed. Knowledge of chicken telomere biology contributes information relevant to present and future biotechnology applications of chickens in vivo and chicken cells in vitro.

Correlation of structure and triboluminescence for tetrahedral manganese(II) compounds

To investigate the structural basis of triboluminescence, several known tetrahedrally coordinated Mn(II) complexes have been synthesized according to literature methods and their crystal structures have been determined by X-ray diffraction. Among them, (MePh(3)P)(2)[MnCl(4)] (2), a = 15.4804(4) A, cubic, space group P2(1)3, Z = 4; (Et(4)N)(2)[MnBr(4)] (4), a = 13.362(1) A, c = 14.411(1) A, tetragonal, space group P42(1)m, Z = 4; MnBr(2)(OPPh(3))(2) (7), a = 9.974(1) A, b = 10.191(3) A, c = 10.538(2) A, alpha = 65.32(1) degrees, beta = 63.49(1) degrees, gamma = 89.44(2) degrees, triclinic, space group P1, Z = 1; and MnBr(2)(OAsPh(3))(2) (10), a = 17.816(3) A, b = 10.164(1) A, c = 18.807(3) A, orthorhombic, space group Pca2(1), Z = 4 were reported to be triboluminescent and (Me(4)N)(2)[MnCl(4)] (3), a = 9.016(3) A, b = 36.90(2) A, c = 15.495(3) A, beta = 90.72(3) degrees, monoclinic, space group P2(1)/n, Z = 12, and MnI(2)(OAsPh(3))(2) (11), a = 10.094(4) A, b = 10.439(2) A, c = 34.852(2) A, alpha = 83.17(4) degrees, beta = 86.09(2) degrees, gamma = 75.16(3) degrees, triclinic, space group P1, Z = 4, were reported to be not triboluminescent. The result supports the correlation between space group acentricity and triboluminescence activity.

Di- and Trinuclear Complexes with the Mono- and Dianion of 2,6-Bis(phenylamino)pyridine: High-Field Displacement of Chemical Shifts Due to the Magnetic Anisotropy of Quadruple Bonds

The monoanion of 2,6-bis(phenylamino)pyridine (HBPAP(-)) has been found to support quadruply bonded Cr(2)(4+) and Mo(2)(4+) units in Cr(2)(HBPAP)(4) (1) and Mo(2)(HBPAP)(4) (2). The corresponding dianion BPAP(2)(-) was able to stabilize the trinuclear complexes, (TBA)(2)Cr(3)(BPAP)(4) (3) and (TBA)(2)Ni(3)(BPAP)(4) (4), where TBA is the tetrabutylammonium cation. The dinuclear complexes have the typical paddlewheel configuration with Cr-Cr distances of about 1.87 A and a Mo-Mo distance of 2.0813(5) A and exhibit a high-field displacement of the corresponding N-H signals caused by the magnetic anisotropy of the quadruple bonds. For the trinuclear complexes, 3 has a linear chain of three chromium atoms arranged in an unsymmetrical fashion with two chromium atoms paired to give a quadruply bonded unit (Cr-Cr distance: 1.904(3) A) and an isolated, square planar Cr(II) unit at 2.589(3) A from the dimetal unit. On the other hand, the three nickel atoms in 4 are evenly spaced, having Ni.Ni distances of 2.3682(8) A. The trinuclear compounds show a twisted conformation with an overall torsion angle of about 30 degrees.

Tuning the metal-metal bonds in the linear tricobalt compound Co3(dpa)(4)Cl2: bond-stretch and spin-state isomers

Sixteen crystal structures have been determined for the Co3(dpa)(4)Cl2 (1) molecule in the following five crystalline solvates: 1.0.85(C2H5)(2)O.0.15CH2Cl2 (at 120, 213, 296 K); 1.C(4)H(8)O (at 120, 295 K); 1.C(6)H(6) (at 170, 213, 260, 316 K); 1.C(6)H(12) (at 120, 213, 295 K); and 1.1.75C(7)H(8).0.5C(6)H(14) (at 90, 110, 170, 298 K). For 1.0.85(C(2)H(5))(2)O.0.15CH2Cl2 the molecule of 1 is almost symmetrical at 120 K (Co-Co distances of 2.3191(3) and 2.3304(3) A) and remains so at 296 K (2.2320(3) and 2.3667(4) A). For 1.C(4)H(8)O the Co(3) chain is precisely symmetric at both 120 and 295 K though the Co-Co distances increase from 2.3111(4) to 2.3484(4) A as the temperature rises. Compound 1.C(6)H(6) is isomorphous with 1.C(4)H(8)O at 213 and 295 K and has rigorously symmetrical molecules at these two temperatures. Between 213 and 120 K the space group changes from Pccn to P2(1)/c, so that a symmetrical arrangement is no longer required and the two Co-Co distances then differ slightly (by 0.013 A). For 1.C(6)H(6) there is a phase change between 316 K (Pca2(1)) and 260 K (Pna2(1)). At all four temperatures, however, the molecule is almost symmetrical, with the two independent Co-Co distances never differing by more than 0.026 A. 1.1.75C(7)H(8).0.5C(6)H(14) contains, at all temperatures between 90 and 298 K, two crystallographically independent molecules, each of which is distinctly unsymmetrical at 298 K (Co-Co distances of 2.312(2) and 2.442(2) A for one and 2.310(2) and 2.471(2) for the other). In the first of these the distances converge to a much smaller separation (0.056 A) at 90 K while in the second the difference decreases to only 0.006 A at 90 K. Magnetic susceptibility measurements from 1.8 to 350 K indicate in each case that a gradual spin crossover, from a doublet to a quartet state, occurs over this temperature range.

Linear trichromium complexes with the anion of 2,6-di(phenylimino)piperidine

The anion of 2,6-di(phenylimino)piperidine (DPhIP) has been found to support linear chains of three metal atoms. Three new compounds, [Cr3(DPhIP)4Cl]Cl.(1).5CH2Cl2.0.5H2O (1.1.5CH2Cl2.0.5H2O), [Cr3(DPhIP)4(CH3CN)]- (PF6)2.H2O.4CH3CN (2.H2O.4CH3CN), and [Cr3(DPhIP)4(F)(CH3CN)](BF4)2.5CH3CN (3.5CH3CN), have been synthesized and characterized by X-ray crystallography. Compound 1 has a linear chain of three chromium atoms arranged in an unsymmetrical fashion, with two of them forming a quadruply bonded unit (Cr-Cr distance 1.932(2) A) and the third being a non-metal-metal-bound 5-coordinate unit (Cr...Cr distance 2.659(2) A). The fifth coordination site is occupied by a chloride ion, and another chloride ion is located in the interstices of the crystal. The trimetal unit in compound 2 is structurally similar to that in compound 1 except that the axial ligand in 2 is a CH3CN molecule. Compound 3 is an oxidation product prepared by reaction of 1 with AgBF4. Here, a square pyramidal CrIII unit, FCrN4, and a Cr-Cr quadruply bonded (Cr-Cr distance 1.968(2) A) unit, with an axially coordinated acetonitrile molecule, form the trichromium chain. The CrIII...CrII separation of 2.594(2) A in 3 is too long to be considered a bonding interaction.

Completion of the series of M2(hpp)4Cl2 compounds from W to Pt: the W, Os, and Pt compounds

The series of M2(hpp)4Cl2 complexes (hpp is the anion of 1,3,4,6,7,8-hexahydro-2H-pyrimido[1,2-a]pyrimidine) from M = W to M = Pt has been completed by the preparation and characterization of those with M = W, Os, and Pt. W(hpp)4Cl2 (1) has a W-W distance of 2.250(2) A, is diamagnetic, and can be assigned a W-W triple bond based on a sigma 2 pi 4 electron configuration. Os2(hpp)4Cl2 (2) has an Os-Os distance of 2.379(2) A and displays a temperature-independent paramagnetism. It can be assigned a sigma 2 pi 4 delta 2 delta*2 configuration. Pt2(hpp)4Cl2 has a Pt-Pt distance of 2.440(1) A and is diamagnetic. A bond order of 1, based on a configuration in which only the sigma* orbital is empty, is consistent with these data.

Linear trichromium complexes with direct Cr to Cr contacts. 2. Compounds with Cr3(dipyridylamide)4(3+) cores

Seven compounds having in common a Cr3(dpa)4(3+) core (dpa = di(2-pyridyl)amide ion) have been prepared and all shown to have an unsymmetrical chain of three Cr atoms. This chain can be described as a pair of quadruply bonded Cr(II) atoms to which a Cr(III) atom is attached. No symmetrical chain has been found, contrary to a previous preliminary report. The seven compounds have been well characterized crystallographically, and their short and long Cr to Cr distances (A, in parentheses) are: 1 [Cr3(dpa)4Cl2]Cl.2CH2Cl2.THF (2.12, 2.47), 2 [Cr3(dpa)4Cl2]AlCl4.CH2Cl2 (2.011, 2.555), 3 [Cr3(dpa)4Cl2]FeCl4.CH2Cl2 (2.009, 2.562), 4 [Cr3(dpa)4Cl2]I3.THF.2H2O (2.08, 2.49), 5 [Cr3(dpa)4Cl2]PF6.2CH2Cl2 (2.08, 2.48), 6 [Cr3(dpa)4(BF4)F]BF4.2CH2Cl2 (1.900, 2.595), 7 [Cr3(dpa)4ClF]BF4.CH2Cl2.C6H14 (2.039, 2.507). Magnetic susceptibility measurements on 1 and 2 reveal mueff = 3.85 +/- 0.05 muB from 10 to 300 K.

Linear trichromium complexes with direct Cr to Cr contacts. 1. Compounds with Cr3(dipyridylamide)4(2+) cores

The preparation and structures of seven compounds that contain the Cr3(dpa)4(2+) core (dpa = the anion di(2-pyridyl)amide) are reported. The magnetic properties of several have been measured. In each case there are anionic ligands at each end of the Cr3(6+) chain, sometimes identical (2Cl-, 2CCPh-), sometimes different (Cl-, BF4-; Cl-, PF6-). Several of these compounds have a symmetrical arrangement of the three Cr atoms, with the two Cr-Cr distances equal at ca. 2.36 A, while others have an unsymmetrical arrangement. In the most extreme case the two Cr-Cr distances are 2.00 and 2.64 A. The electronic structures and the remarkable flexibility of the Cr3 arrangement are discussed.

Tumorigenicity and metastasis of human breast carcinoma cell lines in nude mice

There are few reports describing experimental models of the growth and metastasis of human breast carcinomas. This article discusses the tumorigenic and metastatic properties of two estrogen receptor-negative breast carcinomas injected into nude mice. Tumor growth in the mammary fatpad (m.f.p.) and the subcutis was compared in female nude mice. The injection of 10(5) viable cells of two human breast carcinoma cell lines (MDA-MB-231 and MDA-MB-435) gave a 100% tumor take rate in the m.f.p., whereas only 40% of the s.c. injections produced tumors and these occurred several weeks after the appearance of the m.f.p. tumors. Thus, the m.f.p. of nude mice is a favorable site for the growth of human breast carcinomas. MDA-MB-435 tumors produced distant metastases in 80% to 100% of recipients. The most common sites for metastasis were the lymph nodes and lungs, with a lower incidence of metastases in muscle (chest wall and thigh), heart, and brain. New variant cell lines were isolated from metastases in the lungs, brain, and heart. All the cell lines were tumorigenic in the m.f.p., and the lung- and heart-derived metastasis lines produced slightly more lung metastases than the original cell line. However, the brain metastasis variant produced significantly fewer lung metastases. Intravenous inoculation of the spontaneous metastasis-derived cell lines produced few lung colonies. Only cell variants isolated from experimental lung metastases showed enhanced lung colonization potential when reinjected i.v. Our results suggest that the estrogen receptor-negative MDA-MB-435 cell line injected in the m.f.p. of nude mice could be a valuable tool for analysis of the cellular and molecular basis of the metastasis of advanced breast cancer.

Organ distribution of experimental metastases of a human colorectal carcinoma injected in nude mice

The metastatic behavior of the HT-29 human colorectal carcinoma cell line was studied following injection into nude mice by different routes. After intrasplenic injection, experimental metastases formed in the livers of most mice. Variant lines were established in culture from the liver lesions and from tumors growing at the site of injection, the spleen. Cells of the HT-29 LMM line exhibited slightly enhanced ability to form liver metastases compared with cells of the non-selected parent line. When injected i.v., the HT-29 cells produced only a few small experimental metastases in the lungs, but in most of the mice macroscopic tumors were found in various lymph nodes and the interscapular fat. Analyses of the distribution of IdUrd-labeled cells did not reveal a preferential localization of the HT-29 cells in sites where metastases subsequently formed. This suggested that the growth of the human colon carcinoma cells in those sites might be the result of a stimulatory interaction between the tumor and host cells as opposed to growth in sites such as the lungs, where numerous cells arrested after i.v. injection but only a few, small metastases were seen 60 days later.