Fabrication of Cu Micromembrane as a Flexible Electrode

A Cu micromembrane is successfully fabricated and validated as a porous flexible electrode. The Cu micromembrane is prepared by functionalizing individual polypropylene (PP) fibers in a polypropylene micromembrane (PPMM) using a mixture of polydopamine (PDA) and polyethyleneimine (PEI). The mixture of PDA and PEI provides adhesive, wetting, and reducing functionalities that facilitate subsequent Ag activation and Cu electroless plating. Scanning electron microscopy reveals conformal deposition of Cu on individual PP fibers. Porometer analysis indicates that the porous nature of PPMM is properly maintained. The Cu micromembrane demonstrates impressive electrical conductivities in both the X direction (1.04 ± 0.21 S/cm) and Z direction (2.99 ± 0.54 × 10^-3 S/cm). In addition, its tensile strength and strain are better than those of pristine PPMM. The Cu micromembrane is flexible and mechanically robust enough to sustain 10,000 bending cycles with moderate deterioration. Thermogravimetric analysis shows a thermal stability of 400 °C and an effective Cu loading of 5.36 mg/cm². Cyclic voltammetric measurements reveal that the Cu micromembrane has an electrochemical surface area of 277.8 cm² in a 1 cm² geometric area (a roughness factor of 227.81), a value that is 45 times greater than that of planar Cu foil.

Electrophoretic fabrication of a robust chitosan/polyethylene glycol/polydopamine composite film for UV-shielding application

The film-forming process of chitosan composite films is an important issue because it affects their experimental design, chemicals used, and feasibility of large-scaled fabrication. In this work, electrophoresis is employed to produce chitosan composite films with significantly reduced processing time and environmentally friendly chemicals. With the addition of hydrogen peroxide and polyethylene glycol, the parasitic hydrogen bubble formation during the electrophoresis of chitosan and polydopamine is effectively inhibited that leads to the formation of a defectless chitosan/polyethylene glycol/polydopamine composite film which could be removed from the substrate readily. In addition, the chitosan/polyethylene glycol/polydopamine composite film reveals significantly improved tensile strength and a slower decomposition rate as compared to those of chitosan film and chitosan/polyethylene glycol composite film. This is attributed to the strong interaction between chitosan and polydopamine. Lastly, the chitosan/polyethylene glycol/polydopamine composite film exhibits excellent UV-shielding ability without compromising its visible transparency.

Prognosis and clinicopathologic features in patients with gastric stump cancer after curative surgery

Background

Gastric stump ("remnant") cancer is the development of a malignancy related to previous gastric surgery. Prognosis in gastric stump cancer, compared with that in primary gastric cancer, is still controversial.

Methods

From January 1988 to December 2012 at a single medical centre in Taiwan, 105 patients with gastric stump cancer, including 85 with previous peptic ulcer disease and 20 with previous gastric cancer, were analyzed for clinicopathologic characteristics and overall survival (os).

Results

The 5-year os rates for patients with gastric stump cancer and with primary gastric cancer were 51.2% and 54.5% respectively (p = 0.035). Analysis of clinicopathologic characteristics indicated that, compared with patients having primary gastric cancer, those with gastric stump cancer had more lymph node metastasis (p < 0.001) and had been diagnosed at a more advanced stage (p = 0.047). Multivariate analysis with os as an endpoint showed that age [p = 0.015; hazard ratio (hr): 2.300; 95% confidence interval (ci): 1.173 to 4.509], tumour size (p = 0.037; hr: 1.700; 95% ci: 1.031 to 2.801), stromal reaction (p = 0.021; hr: 1.802; 95% ci: 1.094 to 2.969), and pathologic N category (p = 0.001; hr: 1.449; 95% ci: 1.161 to 1.807) were independent predictors in gastric stump cancer. The os rates for patients with gastric stump cancer who previously had gastric cancer or peptic ulcer disease were 72.9% and 50.0% respectively (p = 0.019). The Borrmann classification was more superficial (p = 0.005), lymph node metastases were fewer (p = 0.004), and staging was less advanced (p = 0.025) in patients with gastric stump cancer who previously had gastric cancer than in their counterparts who previously had peptic ulcer disease.

Conclusions

Survival is poorer in patients with gastric stump cancer who previously had peptic ulcer disease than in those who previously had primary gastric cancer. Patients with gastric stump cancer who previously had gastric cancer and could receive curative gastrectomy tended to have a better prognosis because of a more superficial Borrmann classification. Regular follow-up in patients who have undergone gastric surgery is recommended for the early detection of gastric stump cancer.

Composite NiCoO2/NiCo2O4 inverse opals for the oxygen evolution reaction in an alkaline electrolyte

The inverse opals exhibit a 3D ordered macroporous framework, which provides an excessive surface area and facile mass transport. A conformal NiCoO_x functional coating further renders these materials with increased reactivity in OER catalysis.

Serous cystadenocarcinoma of the spleen

The commonly seen primary malignant neoplasms of the spleen are angiosarcoma and lymphoma. We present a case of serous cystadenocarcinoma of the spleen. It was presumed to be originated from dropped nonmalignant ovarian tissue, which was accidentally implanted to the splenic surface during hysterectomy and bilateral salpingooophorectomies for torsion of right fallopian tube 9 and half years ago and transformed into serous cystadenocarcinoma later. Computed tomography demonstrated a multilocular predominantly cystic tumor with internal soft tissue components in the spleen.

Necrotizing granulomatous inflammation of the liver

A 73-year-old patient with necrotizing granulomatous inflammation of the liver is presented. The computed tomography demonstrated 2 hypodense tumors with progressive enhancement in the liver. They became nearly isodense to the normal hepatic parenchyma on the delayed phase.

Extranodal natural killer/T-cell lymphoma, nasal type in Taiwan: a relatively higher frequency of T-cell lineage and poor survival for extranasal tumors

Extranodal natural killer (NK)/T-cell lymphoma, nasal type, is a predominantly extranodal lymphoma associated with Epstein-Barr virus occurring most frequently in the upper aerodigestive tract. There are limited reports on cellular origin and prognostic factors. We retrospectively investigated 73 cases with a median age of 54 years and a male-female ratio of 2.0:1. The upper aerodigestive tract (nasal group) was the most common site of involvement (51 cases; 70%). The other organs (n = 22; extranasal group) included the skin (12 cases; 16%) and gastrointestinal tract (5; 7%). Of the 70 cases with complete staging, 71% had stage I/II disease. All cases were positive for Epstein-Barr virus by in situ hybridization. Using immunohistochemistry and clonality assay for T-cell receptor gene rearrangement, these tumors were classified into NK (n = 39; 53%), T (n = 13; 18%), and indeterminate lineage (n = 21; 29%). The only clinicopathological difference among these 3 groups was rare CD5 expression in the NK-cell group. Nasal tumors were more frequently of NK-cell origin, and extranasal tumors were equally of either T- or NK-cell origin. The 5-year overall survival rate was 35.6%. The overall survival time was shorter in the extranasal group, although there was no statistical difference in age, sex, and histologic or immunophenotypic features between the 2 groups. Excluding the cases with indeterminate lineage, 75% of cases were of NK lineage; and 25%, T lineage. Extranasal tumors were more aggressive than their nasal counterparts. A prospective national study is warranted for a better understanding of the clinicopathological and genetic features of this uncommon tumor and the prognostic factors.

Development of multiple complications in type 2 diabetes is associated with the increase of multiple markers of chronic inflammation

Patients with type 2 diabetes (T2DM) are known at risk for developing cardiovascular disease (CVD), nephropathy, and cancer. We were interested to find out whether multiple markers associated with chronic inflammation are detectable in patients with T2DM and are increased in patients with T2DM who developed additional clinical complications. A sequence of multiple risk markers for atherogenesis, associated with chronic inflammation, was measured in patients with T2DM before and after the development of clinical complications. We found that multiple clinical complications frequently developed simultaneously in patients with T2DM. At the early stage of T2DM, only low levels and low percent elevations of multiple risk markers were detected. However, both the level and the percent elevation of these markers were found to increase with disease progression and the development of clinical complications. We believe that chronic inflammation not only contributes to the pathogenesis of T2DM but also continues to increase in T2DM patients who are developing additional clinical complications. It appears that these multiple markers are potentially useful not only for monitoring the progression of T2DM but also predicting the risk of developing macro- and microvascular disease, nephropathy, and cancer.

Skp2 Overexpression Is Highly Representative of Intrinsic Biological Aggressiveness and Independently Associated with Poor Prognosis in Primary Localized Myxofibrosarcomas

PURPOSE

Two SCF(Skp2) ubiquitin ligase-related proteins, Skp2 and cyclin-dependent kinase subunit 1 (Cks1), are involved in posttranscriptional degradation of p27(Kip1) tumor suppressor. We analyzed the prognostic utility of p27(Kip1) and its interacting cell cycle regulators in myxofibrosarcomas.

EXPERIMENTAL DESIGN

Clinicopathologic features and tissue microarray-based immunohistochemical expression of p27(Kip1), Skp2, Cks1, cyclin E, cyclin A, Ki-67, and minichromosome maintenance protein 2 (Mcm2) were assessed in 70 primary myxofibrosarcomas and correlated with clinical outcomes. Skp2 mRNA expression and the relationship between Skp2 and p27(Kip1) proteins were examined in six cases by semiquantitative reverse transcription-PCR and Western blotting, respectively.

RESULTS

High indices of Skp2 (> or =10%), cyclin A (> or =10%), and Mcm2 (> or =50%) were adverse prognosticators at the univariate level. Furthermore, co-overexpression of Skp2 and cyclin A identified highly lethal cases in the entire cohort [P < 0.0001 for disease-specific survival (DSS), P = 0.0004 for overall survival (OS)] and the lower-grade subset (Fédération Nationale des Centres de Lutte Contre le Cancer grade 1 and 2; P = 0.0006 for DSS, P = 0.0093 for OS). In multivariate analyses, Skp2 overexpression overshadowed most intrinsic clinicopathologic factors and independently correlated with worse metastasis-free survival (P = 0.0012), DSS (P = 0.0234), and OS (P = 0.0056). Notably, positive margins independently predicted inferior local recurrence-free survival (P = 0.0012) and also negatively affected metastasis-free survival (P = 0.0471), DSS (P = 0.0152), and OS (P = 0.0173). Reverse transcription-PCR showed up-regulation of Skp2 mRNA in four cases and Western blotting displayed a matched expression pattern of Skp2.

CONCLUSIONS

Margin status and intrinsic property of myxofibrosarcomas both affect patient survival. Skp2 overexpression is highly representative of the biological aggressiveness of myxofibrosarcomas and plays an important prognostic role.

Malignant eccrine spiradenoma: a case report with pulmonary metastasis

Malignant eccrine spiradenoma is an extremely rare sweat gland tumor. It may develop de novo or arise in pre-existing benign eccrine spiradenoma. However, most tumors are presented in the latter mode. The case of a 50-year-old man with malignant transformation from previously existing benign eccrine spiradenoma over his right lateral thigh is reported. Evidence for this diagnosis includes two distinct morphological components. One is the well demarcated, small round to oval benign eccrine spiradenoma and the other is the malignant element with sarcomatoid differentiation. Some foci of transition between the benign eccrine spiradenoma and the sarcomatoid part are evident and represents that the latter may arise from the former. Whether different morphological patterns influence the patients' outcome is still doubtful. However, the malignant eccrine spiradenoma is thought to have the capacity of metastasis and lethal potentiality.

Malacoplakia of the ovary, fallopian tube and uterus: a case associated with diabetes mellitus

Malacoplakia is a chronic xanthogranulomatous inflammation that most commonly affects the urinary tract and the gastrointestinal system of middle-aged women. It is rarely encountered in a female genital tract, and only a handful of cases of malacoplakia of the ovary have been described. We report an unusual case of malacoplakia extensively involving the ovary, fallopian tube and uterus of a 47-year-old woman with poorly controlled diabetes mellitus. Escherichia coli was cultured from the ovarian lesion. To our knowledge, such an extensive female genital malacoplakia associated with diabetes mellitus has not been reported before. Widespread or atypical site malacoplakia occurring in a patient with systemic disease may result from a diminution of macrophagocytic function, either under the influence of the systemic illness or related to corticosteroid excess. We propose that diabetes mellitus without appropriate medical control may have resulted in impaired leukocyte function which, when combined with E. coli infection, led to the development of extensive malacoplakia in the genital tract of this patient.

Measuring resident satisfaction in residential aged care

PURPOSE

The aims of this study were to assess the factor structure, reliability, and validity of an existing Resident Satisfaction Questionnaire (RSQ) and to develop a short-form RSQ for regular use in residential aged care settings.

DESIGN AND METHODS

A cross-sectional survey design was adopted to collect the required information, with facilities being selected using stratified random sampling. Both exploratory and confirmatory factor analyses were conducted on a sample of 1,146 residents in 70 residential aged care facilities in Western Australia.

RESULTS

The RSQ is confirmed to be a reliable, valid, context-relevant, and easy-to-use instrument for assessing residents' satisfaction with their residential aged care facilities. Resident satisfaction, as assessed via the RSQ, was found to be a multidimensional construct comprising six factors-Room, Home, Social Interaction, Meals Service, Staff Care, and Involvement.

IMPLICATIONS

A 24-item short version of the RSQ can be constructed based on the six-factor resident satisfaction measurement model and used as a regular monitoring tool of resident satisfaction for quality improvement purposes.

Semiquantitative immunohistochemical analysis for hypoxia in human tumors

OBJECTIVE

The goal of this study was to develop a semiquantitative scoring system for measuring hypoxia in human tumors by an immunohistochemical marker approach.

METHODS AND MATERIALS

Eighteen patients diagnosed with squamous cell carcinoma of the uterine cervix or head and neck were infused intravenously with a solution of pimonidazole hydrochloride at a dose of 0.5 gm/m2. Twenty-four hours later, four biopsies on average from each tumor were fixed in formalin, processed into paraffin blocks, and sectioned. Tissue sections were immunostained for the presence of pimonidazole adducts. Microscopic images (x200) of immunostaining were captured and quantitated by standard image analysis. Images with known amounts of hypoxia spanning ranges of > 0% to 5%, > 5% to 15%, > 15% to 30%, and >30% were assigned scores of +1, +2, +3, and +4, respectively. Three observers then used this calibrated scoring system to analyze hypoxia in tumor sections in a blinded fashion.

RESULTS

Excellent interobserver reproducibility was obtained with the calibrated, semiquantitative, immunohistochemical assay for hypoxia in squamous cell carcinomas.

CONCLUSION

The calibrated, semiquantitative assay shows promise as an approach to simplifying the quantitation of human tumor hypoxia by immunohistochemical techniques.

Invasive oxygen measurements and pimonidazole labeling in human cervix carcinoma

PURPOSE

This study was designed to compare tumor hypoxia assessed by invasive O2 sensitive electrodes and pimonidazole labeling in primary human cervix carcinomas.

METHODS AND MATERIALS

Twenty-eight patients with primary cervix carcinomas (FIGO Stage Ib-IVa) were investigated. Both invasive pO2 measurements and pimonidazole labeling were obtained in all patients. Before treatment, patients were given pimonidazole as a single injection (0.5 g/m2 i.v.). Ten to 24 h later, oxygenation measurements were done by Eppendorf histography, and after this procedure biopsies were taken for pimonidazole-binding analysis. Tumor oxygen partial pressure (pO2) was evaluated as the median tumor pO2 and the fraction of pO2 values < or = 10 mmHg (HF10). Biopsies were formalin fixed and paraffin embedded, and hypoxia was detected by immunohistochemistry using monoclonal antibodies directed against reductively activated pimonidazole. Pimonidazole binding was evaluated by a semiquantitative scoring system.

RESULTS

Both Eppendorf measurements and pimonidazole binding showed large intra-and intertumor variability. A comparison between pimonidazole binding expressed as the fraction of fields at the highest score and HF10 showed a trend for the most well-oxygenated tumors having a low fraction of fields; however, the correlation did not reach statistical significance (p = 0.43, r = 0.165; Spearman's rank correlation test).

CONCLUSION

Hypoxia measured in human uterine cervix carcinomas is heterogeneously expressed both within and between tumors when assessed by either invasive pO2 measurements or pimonidazole binding. Despite a trend that tumors with high pO2 values expressed less pimonidazole binding, no correlation was seen between the two assays in this preliminary report.

Familial defective apolipoprotein B-100: detection and haplotype analysis of the Arg(3500)-->Gln mutation in hyperlipidemic Chinese

Familial defective apolipoprotein (apo) B-100 (FDB) is caused by R3500Q mutation of the apo B gene resulting in decreased binding of LDL to the LDL receptor. Two other apo B mutations, R3500W and R3531C, affecting binding are known to date. We screened the apo B gene segment around codon 3500 by heteroduplex analysis and single strand conformation polymorphism (SSCP) analysis in a total of 373 hyperlipidemic individuals. Two single-base mutations were detected and confirmed by DNA sequencing. One mutation, ACA(3528)-->ACG change, resulted in degenerate codon with no amino acid substitution. The other mutation, CGG(3500)-->CAG mutation, resulted in an Arg(3500)-->Gln substitution (R3500Q). The prevalence of heterozygote in this selected population was 0.3% (95% confidence interval, 0.01-1.5%) for the R3500Q mutation, and 2.4% (95% confidence interval, 1.1-4.5%) for the previously described R3500W mutation. The results suggest that the R3500Q mutation is not a significant factor contributing to moderate hypercholesterolemia in Chinese (P=0.027). Family studies of the R3500Q carrier revealed a further two individuals heterozygous for the mutation, both of whom were hypercholesterolemic. Analysis of the R3500Q allele using six diallelic markers and the 3'HVR marker revealed a haplotype which was the same as that reported in a Chinese American but differed from that reported in a Chinese Canadian. Our data support limited multiple recurrent origins for R3500Q in Chinese population.

Long-term effects of ketoconazole in the treatment of residual or recurrent Cushing's disease

Ketoconazole is an imidazole derivative used to treat systemic and superficial mycoses by inhibiting sterol synthesis in fungi. The drug impairs steroid hormone synthesis by blocking mitochondrial P450-dependent enzyme systems. Because of its potent inhibitory effects on adrenal steroidogenesis, ketoconazole is valuable in controlling hypercortisolism. We investigated the effects of long-term treatment of this drug on three patients who had residual or recurrent Cushing's disease after surgical treatment. Ketoconazole was administered orally and adjusted according to individual response and 24-hour urinary free cortisol excretion levels. All three patients had good clinical and biochemical responses to ketoconazole therapy without adverse effects. The 24-hour urinary free cortisol levels were kept around 114.8+/-52.4 microg/24 h, 143.0+/-59.9 microg/24 h, and 122.9+/-79.9 microg/24 h, respectively (reference range, 35 to 120 microg/24 h). All three patients had follow-up magnetic resonance imaging or computed tomography of the pituitary gland, which revealed no significant changes in the sellar region. Daily ketoconazole doses ranged from 200 to 1200 mg per day. Follow-up periods were 65, 86, and 83 months, respectively. In conclusion, ketoconazole is valuable in the long-term treatment of residual or recurrent Cushing's disease when surgical treatment is contraindicated or unsuccessful.

The effects of glurenorm on plasma glucose and lipids in patients with type 2 diabetes mellitus

BACKGROUND

The effects of sulfonylureas on plasma glucose, lipids, and macrovascular complications are of interest. This study was designed to investigate the effects of glurenorm on plasma glucose and lipids in patients with type 2 diabetes mellitus.

METHODS

Nineteen patients, 15 men and 4 women, with an age range of 38-69 years, and with type 2 diabetes mellitus, were studied. Plasma glucose, glycated hemoglobin, and lipids were compared before and 3 months after glurenorm treatment.

RESULTS

Fasting and postprandial plasma glucose, and HbA1c significantly improved after 3 months of glurenorm treatment. The mean (+/- SD) triglyceride level of 10 patients with mild to moderate hypertriglyceridemia decreased from 279 +/- 66 to 219 +/- 100 mg/dl (p = 0.054). The total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) of 14 hypercholesterolemic patients did not change significantly. Their mean body weight increased significantly from 65.7 +/- 9.6 to 67.2 +/- 9.9 kg (p = 0.002).

CONCLUSION

Glurenorm was effective for glycemic control but caused weight gain in type 2 diabetic patients. Triglycerides in hypertriglyceridemic patients, and total cholesterol, LDL-C, and HDL-C in hypercholesterolemic patients did not improve after glurenorm treatment.

A clinical study of hypoxia and metallothionein protein expression in squamous cell carcinomas

The objective was to discover whether the oxygen-regulated protein, metallothionein, is expressed in the hypoxic cells of squamous cell carcinomas. Twenty patients with squamous cell carcinoma of the uterine cervix or head and neck were infused with a solution of the hypoxia marker, pimonidazole hydrochloride, at a dose of 0.5 g/m2. The following day, biopsies were collected, formalin fixed, paraffin embedded, and sectioned at 4 microm. Sections from each biopsy were immunostained for pimonidazole binding, metallothioneins I and II, involucrin, and proliferating cell nuclear antigen. A total of 84 biopsies were analyzed. Sixty-four of 84 biopsy sections contained hypoxia. Of the hypoxia-containing sections, 43 of 64 or 67% showed no microregional overlap between hypoxia and metallothionein; 7 of 64 showed overlap; and 14 of 64 showed a combination of overlap and no overlap. On a tumor-by-tumor basis, 5 of 7 head and neck and 7 of 13 cervix tumors showed no overlap between metallothionein and hypoxia at the microregional level. Ranges for the percentage of the area of hypoxia in head and neck (<0.9 to 17%) and cervix (<0.1 to 14%) tumors were similar. In the hypoxia-containing sections, immunostaining for involucrin, a molecular marker for differentiation, overlapped with that for hypoxia in 82% of the cases. The majority of hypoxic cells in squamous cell carcinomas do not express metallothionein protein, although metallothionein is induced by hypoxia in human tumor cells in vitro. Hypoxic cells in human tumors tend to be in regions immunostaining for involucrin, and it seems possible that differentiation of hypoxic cells in squamous cell carcinomas might affect metallothionein I and II expression.

Effects of prolonged ACTH-stimulation on adrenocortical accumulation of lipofuscin granules in aged rats

Subcellular deposition of lipofuscin granules is a marker of aging. Human and rodent adrenal cortices accumulate lipofuscin granules with age, but the mechanism that leads to the accumulation is not known. The ultrastructural appearance of lipofuscin granules resembles that of secondary lysosomes. Since adrenocortical subcellular events are predominantly influenced by ACTH action, we therefore studied the effect of prolonged ACTH-stimulation on adrenocortical accumulation of secondary lysosome-like granules, designated herein as lipofuscin granules. Using aged Fischer 344 male rats as a model, we found that a 7 day ACTH stimulation exerts a reducing effect on adrenocortical lipofuscin accumulation. Thus, adrenocortical accumulation of lipofuscin granules with age in vivo may not be an irreversible process.

Binge drinking disturbs hepatic microcirculation after transplantation: prevention with free radical scavengers

Disturbances in hepatic microcirculation increase graft injury and failure; therefore, this study evaluates the effects of ethanol on microcirculation after liver transplantation. Donor rats were given one dose of ethanol (5 g/kg) by gavage 20 h before explantation, and grafts were stored in University of Wisconsin solution for 24 h before implantation. Acute ethanol treatment decreased 7-day survival of grafts from about 90 to 30%, increased transaminase release nearly 4-fold, and decreased bile production by 60%. Moreover, portal pressure increased significantly and liver surface oxygen tension decreased about 50%, indicating that ethanol disturbs hepatic microcirculation. Pimonidazole, a 2-nitroimidazole hypoxia marker, was given i.v. to recipients 30 min after implantation, and grafts were harvested 1 h later. Ethanol increased hepatic pimonidazole binding about 3-fold, indicating that ethanol led to hypoxia in fatty grafts. Ethanol also significantly increased free radicals in bile. Catechin (30 mg/kg i.v. upon reperfusion), a free radical scavenger, and Carolina Rinse solution, which contains several agents that inhibit free radical formation, minimized disturbances in microcirculation and prevented pimonidazole adduct formation significantly. These treatments also blunted increases in transaminase release and improved survival of fatty grafts. Destruction of Kupffer cells with GdCl(3) (20 mg/kg i.v. 24 h before explantation) or inhibition of formation of leukotrienes with MK-886 (50 microM in University of Wisconsin or rinse solution) also minimized hypoxia and improved survival after transplantation. Taken together, these results demonstrate that ethanol disturbs hepatic microcirculation, leading to graft hypoxia after transplantation, most likely by activating Kupffer cells and increasing free radical production.

Patient perceived quality-of-care in hospital in the context of clinical pathways: development of an approach

Clinical pathways have been introduced in many hospitals with the aims of improving efficiency, reducing costs, and improving the quality and outcomes of care. However, there is a shortage of research evidence regarding the extent to which they do in fact achieve such aims. This paper describes the development and testing of a patient-perceived quality-of-care questionnaire for use in relation to the assessment of clinical pathways. Issues of validity and reliability are addressed and illustrative examples of results for two pilot hospitals are presented.

Comparisons among pimonidazole binding, oxygen electrode measurements, and radiation response in C3H mouse tumors

Pimonidazole binding was compared with oxygen electrode measurements and with measurements of the radiobiologically hypoxic fraction in C3H mammary tumors in which oxygenation was manipulated by means of subjecting tumor-bearing CDF1 mice to air breathing, carbogen breathing, oxygen breathing, hydralazine injection or tumor clamping. Hypoxia measured by pimonidazole binding could be correlated with both pO2 (r2 = 0.81) and radiobiologically hypoxic fraction (r2 = 0.85) in this system. The scope and limitation of pimonidazole as an immunohistochemical marker for tumor hypoxia is discussed.

Preliminary studies on target antigens for the diagnosis of Trichomonas vaginalis infection

Trichomonas vaginalis, a parasitic protozoa residing in the human urogenital tract, causes one of the most common sexually transmitted diseases, trichomoniasis. Clinical diagnosis of T. vaginalis infection mainly involves a wet-mount microscopic examination, and a culture method, and both of which are either laborious or time-consuming. An immunodiagnostic strategy is under development, which is based on the fact that T. vaginalis releases various protein factors, notably proteinases, into the culture medium, some of which can also be detected in vaginal washes. These factors are closely related to the clinical presentation of trichomonad vaginitis, and thusly may serve as potential earmarks for diagnosis. We have attempted to identify the most appropriate target antigen(s) by screening and analyzing the profile of T. vaginalis antigens existing in patient's vaginal secretion, using the antiserum raised against the total secretory antigens from T. vaginalis cultures. Two T. vaginalis antigens with molecular weights near 110 KDa have been demonstrated to be useful antigens as the diagnostic markers.

Relationship of hypoxia to metallothionein expression in murine tumors

PURPOSE

To investigate if metallothionein, an endogenous chemo- and radioprotectant, is expressed in hypoxic cells in mouse C3H mammary carcinomas and if that expression responds to acute changes in tumor hypoxia.

METHODS AND MATERIALS

C3H mammary tumors were established in the hind legs of female CDF1 mice. The mice were then subjected to air breathing (chronic hypoxia), carbogen breathing (acute decrease in hypoxia), or hydralazine injection (acute increase in hypoxia). Ninety minutes after the start of the experiment, tumors were excised, fixed in formalin, and sectioned. Hypoxic cells and metallothionein-containing cells were quantitated by image analysis. Pimonidazole hydrochloride and an IgG1 mouse monoclonal antibody were used to detect hypoxia, and a mouse antimetallothionein monoclonal antibody (DAKO) was used to detect Type I and II metallothionein in sets of contiguous tissue sections.

RESULTS

The distribution of immunostaining intensity for metallothionein was the same in all three groups-heavy in hypoxic cells and light in other regions of the tumors. The acute increase in hypoxia caused by hydralazine injection was accompanied by an increase in metallothionein expression (p = 0.04). Carbogen breathing largely eliminated pimonidazole binding, but metallothionein expression persisted in the tumors of carbogen-breathing mice.

CONCLUSIONS

Hypoxic cells in C3H mammary carcinomas strongly express metallothionein. Metallothionein expression is responsive to acute increases in hypoxia brought about by hydralazine injection. The effectiveness of hydralazine in enhancing the activation of bioreductive cytotoxins might be offset by the increased expression of metallothionein. The persistence of metallothionein in tumors of carbogen-breathing mice might contribute to a residual radioresistance in the tumors.

Effects of prolonged ACTH-stimulation on adrenocortical cholesterol reserve and apolipoprotein E concentration in young and aged Fischer 344 male rats

Changes in the morphology of rat adrenal cortex with age include increased accumulations of lipid droplets and lipofuscin granules. Because glandular concentrations of cholesteryl esters (CE) and apolipoprotein (apo) E are also increased in parallel, the utilization or metabolism of lipid-droplet stored CE for steroidogenesis might be altered in aging cells. To explore this possibility, adrenocortical cholesterol storage and utilization were studied in 3-6 months-old (mo) (Y) rats and 20-23 mo (O) Fischer 344 male rats. Both groups received either adrenocorticotropin (ACTH1-39, Acthar gel) or gelatin alone daily for seven consecutive days. We found that: (a) the CE concentration in O rats, but not Y animals, was diminished by ACTH. The depleted CE in stimulated-O rats was replenished within five days post stimulation. Failure to deplete CE in stimulated-Y rats was not associated with an insufficient dose of the hormone, since stimulation of Y animals with higher doses of ACTH actually increased the CE concentration. In contrast, adrenocortical free cholesterol concentration remained constant during stimulation regardless of age. (b) The depleted CE in stimulated-O rats was principally comprised of cholesteryl adrenate, cholesteryl arachidonate and cholesteryl cervonate. The accumulated CE in stimulated-Y animals was primarily comprised of cholesteryl adrenate, cholesteryl arachidonate and cholesteryl oleate. (c) Whereas in stimulated-Y rats adrenal apoE concentration declined, the concentration in stimulated O animals was well maintained. (d) In vitro, adrenal homogenate or cytosolic fraction from stimulated-O rats displayed a higher capacity to hydrolyze exogenous CE than its Y counterpart. However, cholesterol esterification with external fatty acid substrates in adrenal homogenate or microsomal fraction was comparable in the two age-groups. Our findings revealed altered adrenocortical cholesterol reserve in O rats to cope with prolonged ACTH-stimulation. Changes in apoE levels and CE hydrolysis activity may be factors associated with this alteration. Depletion and accumulation of adrenocortical CE are reflected in parallel changes in cholesteryl adrenate and cholesteryl arachidonate, suggesting physiologic importance of these polyunsaturated fatty acids during sustained steroidogenesis.

Anterior chamber angles shallowing and intraocular pressure after topical pilocarpine

Pilocarpine has been well recognized as the drug of choice for acute angle-closure glaucoma. The purpose of this study is to clarify quantitatively the change of anterior chamber angle and depth with the passage of time after pilocarpine drop administration. Chamber angles of the four quadrants and chamber depths were measured in 18 normal subjects by Scheimpflug Video Image prior to and 30, 60, and 180 minutes after administration of one drop of 4% pilocarpine in one eye, while the opposite eye served as control. The anterior chamber angle and depth showed a significant shallowing at 30, 60 and 180 minutes after 4% pilocarpine administration with a maximal effect of -3.61 degrees and -0.15 mm at 30 minutes, respectively, while the reduction of intraocular pressure reached its maximal effect at 180 minutes. These facts should be well understood in the treatment of angle-closure glaucoma.

Marking hypoxic cells for complement and cytotoxic T lymphocyte-mediated lysis: using pimonidazole

Artificial antigens are created when 2-nitroimidazoles bind to hypoxic cells. These antigens have been used in the immunodetection of tumour hypoxia but they might also serve to stimulate immune lysis of hypoxic tumour cells by complement- and cell-mediated processes. In order to test this hypothesis, lymphocytes isolated from the spleens of C3H/HeN mice that had been immunised with pimonidazole-labelled 3152-PRO cells were subcultured and tested for their ability to lyse chromium-51 loaded, pimonidazole-labelled 3152-PRO cells in an in vitro assay. In a parallel study, commercially available, rabbit complement was tested for its ability to lyse pimonidazole-labelled V79-4 cells in the presence of monoclonal antibodies which recognise protein adducts of reductively activated pimonidazole. Complement-mediated cell lysis was measured by means of an MTT assay. Complement-mediated and cell-mediated lysis was observed at pimonidazole concentrations which, in themselves, do not produce cell killing.

Apolipoprotein E is increased in aged rat kidney

There is growing evidence to indicate that apolipoprotein (apo) E may be associated with age-related disorders and altered longevity in humans. Using rats as a model, we measured apoE in plasma, brain, heart, kidney, liver and spleen in aged (24-25 mo) and younger rats (6-8 mo). The results disclosed that: (a) the plasma concentrations of immunoreactive apoE in aged rats were higher than those in young animals by 70% (P < 0.01); (b) there was no age-related difference of apoE in the brain, heart, liver or spleen; (c) in contrast, the concentrations of apoE in the kidney of aged rats were markedly higher than those of young animals by 490% (P < 0.01). Our data suggest that, in the rat, age-related change in the organ concentrations of apoE is heterogeneous, and the selective increase in the kidney may have physiologic importance which merits further study.

Metabolism of fenbufen by cultured 3T3-L1 adipocytes: synthesis and metabolism of xenobiotic glycerolipids

The storage of xenobiotic compounds as glycerolipids and their subsequent mobilization was studied using fenbufen and differentiated 3T3-L1 cells in culture. Fenbufen was taken up from the incubation medium and incorporated into triacylglycerol, diacylglycerol, and phospholipids. The triacylglycerol was susceptible to digestion by pancreatic lipase. The xenobiotic phospholipid contained three species, one of which behaved as fenbufenoyl phosphatidylcholine as judged by TLC, HPLC, choline analysis, and mass spectroscopy. After incubation with radioactive fenbufen for 18 h, the cells were transferred to a chase medium where radioactivity was lost from the cells and appeared in the medium. The rate was three times higher when 10 microM isoproterenol was present; insulin had no effect. Non-esterified fenbufen and analogues of mono- and di-acylglycerol were secreted. Monofenbufenoylglycerol was characterized by its ability to be used as a substrate by purified monoacylglycerol acyltransferase. When oleic acid was used in place of fenbufen, the majority of the radioactivity released in a chase experiment was the non-esterified acid (over 90%) and neither mono- nor di-acylglycerol was detected. These data indicate that 3T3-L1 adipocytes can synthesize fenbufen-containing lipids and release them into the medium on hormonal stimulation. The secretion of mono- and di-acylglycerols may have unforeseen pharmacological or toxicological implications.

Developmental regulation of the catalytic subunit of the apolipoprotein B mRNA editing enzyme (APOBEC-1) in human small intestine

Apolipoprotein (apo) B mRNA editing is a site-specific cytidine deamination reaction responsible for the production of apoB-48 in mammalian small intestine. This process is mediated by an enzyme complex that includes the catalytic subunit, APOBEC-1. In the present study, it is shown that the developmental regulation of apoB mRNA editing in fetal human small intestine is closely mirrored by accumulation of APOBEC-1 mRNA. Similar results were obtained using Caco-2 cells, the data further suggesting that culture of these cells under conditions previously shown to promote differentiation produce an earlier and more marked induction of APOBEC-1 mRNA abundance. Complementary analysis of APOBEC-1 protein accumulation using immunocytochemical localization reveals its appearance to be temporally coordinated with the accumulation of APOBEC-1 mRNA and its distribution to be confined to villus-associated enterocytes. Previous studies demonstrated a close temporal association between the development of triglyceride synthesis and apoB mRNA editing in the rat liver and small intestine. Analysis of fatty acid CoA ligase, monoacylglycerol acyltransferase, and diacylglycerol acyltransferase activity in preparations of human liver and small intestine demonstrates activity of all three enzymes in the late first and early second trimester, suggesting that certain aspects of complex lipid biosynthesis in the human fetal small intestine and liver are regulated developmentally. The cues that modulate the post-transcriptional regulation of fetal human small intestinal apoB gene expression may thus include both temporal programming and events related to the emergence of lipid transport capability.

Aging in rats is associated with an increase in adrenal apolipoprotein E

Extrahepatic tissues including the adrenal cortex are capable of synthesizing apolipoprotein E (apoE). Locally synthesized apoE is believed to affect cellular uptake, transport and redistribution of cholesterol within that organ. We and another laboratory have previously reported that the adrenal cortex of aged rats has an elevated cholesteryl ester content. The aim of this work was to investigate whether this elevation is accompanied by increased adrenal apoE levels in aged rats. A Western blotting technique with polyclonal goat anti-human-apoE antiserum was employed as a probe for studies. The results showed that: (a) anti-human-apoE antiserum not only detected apoE in human plasma and adrenal homogenate, but also cross-reacted with a protein (or proteins) resembling apoE in rat plasma and adrenal homogenate (or supernatant) with a molecular weight of 34,000-36,000; (b) rat adrenal apoE concentration (per unit weight of protein) increased with age; (c) the increase did not result from blood trapped in the gland, because after organ perfusion the adrenal of aged rats persistently exhibited 58% more apoE than that of young animals. In conclusion, rat adrenal apoE concentration appears to increase with age. Whether this increase mechanistically causes the accumulation of cholesteryl esters in the aged rat adrenal remains to be investigated.

Characterization of choline metabolism and secretion by human placental trophoblasts in culture

Choline is an essential nutrient for fetal development and may be utilized to form phospholipids such as phosphatidylcholine and sphingomyelin; to synthesize the neurotransmitter, acetylcholine; and to donate methyl groups after being oxidized to betaine. Since the majority of choline required for fetal growth must be transported by the placenta from the maternal circulation, we examined the ability of isolated human trophoblasts to metabolize choline and to release choline and its metabolites into culture medium. Cytotrophoblasts were isolated from normal, full-term human placentas and incubated with [14C]choline for 3 h; the cells were washed to remove extracellular radiolabel, and the changes in intracellular and medium choline pools were followed for an additional 24 h. During the incubation, choline rapidly reached steady state intracellularly and label was incorporated into betaine, phosphocholine, cytidylyldiphosphocholine, phosphatidylcholine, glycerophosphocholine, lysophosphatidylcholine, and sphingomyelin. All labeled choline metabolites in cells, except glycerophosphocholine, decreased at 6 and 27 h of incubation (3 and 24 h, respectively, after labeled choline was removed), and labeled metabolites appeared in media. By 24 h after labeled choline was removed, the major labeled metabolites in the media were choline (82%), betaine (11%), and glycerophosphocholine (5%). Small amounts of phosphatidylcholine (1%), and lysophosphatidylcholine (1%) were found. Acetylcholine was a very minor choline metabolite in these cells. When placental cells were incubated for 66 h after isolation, they formed syncytiotrophoblasts, which incorporated labeled choline into metabolites in a similar pattern to cytotrophoblasts. These data indicate that isolated trophoblast cells can metabolize choline to form all of its major metabolites and that several metabolites are released to the medium in significant amounts. Thus, our data suggest that the major metabolite supplied to the fetus may be choline, but that betaine and glycerophosphocholine may also be vehicles for transfer of choline equivalents from mother to fetus.

Antileukemic activity of Viva-Natural, a dietary seaweed extract, on Rauscher murine leukemia in comparison with anti-HIV agents, azidothymidine, dextran sulfate and pentosan polysulfate

An antileukemic activity of partially purified polysaccharide of an edible seaweed. Viva-Natural, against Rauscher murine retrovirus-induced erythroleukemia has been demonstrated. This antileukemic effect is compared with standard anti-human immunodeficiency virus (HIV) agents, azidothymidine (AZT), dextran sulfate and pentosan polysulfate. Pretreatment with Viva-Natural, as an immunomodulator, on day 3 prior to the virus inoculation demonstrated definite prophylactic activity, while pretreatment with the other three anti-HIV agents showed no prophylactic activity. The replication of Rauscher virus in BALB/3T3 cell cultures accompanied by direct cytopathic effect (syncytia formation) was suppressed in the presence of Viva-Natural or the other anti-HIV agents in the culture medium. In spite of the antiviral potentials of the four agents in vitro, only Viva-Natural and AZT demonstrated therapeutic efficacy against Rauscher leukemia in mice.

Tropic effect of dexamethasone on goldfish melanocytoma cells: induction of calcium-dependent but protein synthesis-independent morphological changes

Treatment of melanocytoma cells of goldfish origin with dexamethasone leads to rapid morphological changes, flattening of cell body and extension of dendrites. This effect is independent of protein synthesis but requires the presence of extracellular calcium, indicating that it is a "tropic effect" distinct from the typical "trophic effects" of steroid hormones that involve de novo protein synthesis.

Reversible dedifferentiation and redifferentiation of a melanized cell line from a goldfish tumor

We reported previously the isolation of a melanized cell line that can undergo reversible dedifferentiation and redifferentiation. A heavily pigmented cell line, designated as P15, originally isolated by fish serum-induced melanization of some GEM 81 cells, cloned and serially passaged in fish serum medium, became noticeably less pigmented after several months in fetal calf serum medium and completely unpigmented after another year in the same medium. Addition of fish serum to the medium of this dedifferentiated cell line, designated P15D, induced pigmentation within a week. This re-induced pigmented cell line, designated as P15DI, became unpigmented when cultured in fetal calf serum medium for one month. We report here that the dedifferentiation of P15 occurs in two stages. One week after withdrawal of fish serum, the specific activity of tyrosinase of the culture dropped by approximately 70% and remained at this reduced level for at least one month. After one year, the specific activity of tyrosinase had dropped to a barely detectable level and the culture became completely unpigmented (P15D). Electron microscopic studies showed that the P15D cells have no melanosomes, probably no large vesicles for melanosome formation, but some dopa-positive trans-Golgi network (TGN). Addition of fish serum to the growth medium of P15 cultures led to a steady increase in the specific activity of tyrosinase, detectable after one day. There was also an increase in the amount of dopa-positive TGN within one day. Melanosomes first appeared after three days and became numerous after one week. Upon removal of fish serum, these re-induced cells (P15D1) underwent a rapid decrease in the specific activity of tyrosinase, reaching, after eight days, the basal level seen in P15D cells. We also report that a protein designated as p75 (Mr approximately 75,000), previously shown to be associated with melanosomes in two melanized cell types of goldfish origin, is present in all melanized cell lines, including P15 and P15DI but absent in unmelanized cell lines, including P15D.

Isolation of melanized cell lines with stable phenotypes from a goldfish erythrophoroma cell line and cryopreservation of these cells by the use of autologous serum

Cell lines with stable melanized phenotypes were isolated from a goldfish erythrophoroma cell line. These cell lines include several interesting phenotypes: a) reversible dedifferentiation and redifferentiation in response to withdrawal and addition of fish serum; b) irreversible dedifferentiation in response to withdrawal of fish serum; c) independence on fish serum for melanization; d) dependence on fish serum for growth; and e) pigment aggregation in response to epinephrine. We also report that cryopreservation of all the melanized cell lines, but not any of the unmelanized cell lines, requires the presence of fish serum. This raises the possibility that there may be advantages to use autologous serum for the cryopreservation of sensitive cell lines.

Phosphorylation of the carotenoid droplet protein p57 by the catalytic subunit of cyclic adenosine monophosphate-dependent protein kinase and the effect of fluoride

We have previously shown that the dispersion and aggregation of carotenoid droplets in goldfish xanthophores are regulated, respectively, by phosphorylation and dephosphorylation of a carotenoid droplet protein p57. There is a basal level of p57 phosphorylation of p57 in unstimulated cells, which is greatly stimulated by adrenocorticotropic hormone (ACTH) or cyclic adenosine monophosphate (cAMP) acting via cAMP-dependent protein kinase. We have also observed that, in permeabilized xanthophores, pigment dispersion can be induced when cAMP is replaced by fluoride. Since p57 has multiple phosphorylation sites, there is the question of whether all p57 phosphorylation is by cAMP-dependent protein kinase or whether phosphorylation by cAMP-independent protein kinase coupled with inhibition of phosphatase activity by fluoride can replace cAMP-dependent protein kinase and that the ability of fluoride to replace cAMP for pigment dispersion in permeabilized cells is probably due to activation of adenylcyclase. We also show that ACTH causes an approximately threefold increase in the level of cAMP in these cells.

Epinephrine-induced pigment aggregation in goldfish melanophoroma cells: apparent involvement of an unknown second messenger

Using a goldfish-derived melanized cell line, we attempted to determine the identity of the signal transduction system/second messenger for epinephrine-induced aggregation of melanosomes in a goldfish cell line. The results show that the second messenger is unknown. It is not 1) influx of extracellular calcium, 2) release of intracellular stored calcium via the phosphoinositide pathway, 3) cGMP, or 4) decrease of cAMP. These results suggest that there is an unknown second messenger for this activity of epinephrine.

Inhibition of acetate incorporation into lipids by adriamycin

Adriamycin (ADM) inhibits 14C-acetate incorporation into cardiomyocytes, with the ID50 being 0.9 microM. Incorporation into neutral lipids were inhibited except for cholesterol ester. Cholesterol and phospholipids demonstrated the strongest inhibition at 5 microM ADM.

The effects of aspirin and acetaminophen on tetrahymena pyriformis GL growth and macromolecular synthesis

The effect of aspirin and acetaminophen on Tetrahymena pyriformis GL is examined in this study. The concentration of drug which inhibited T. pyriformis GL growth in 24 hours, indicated as IC50, was 200 micrograms/ml and 580 micrograms/ml for aspirin and acetaminophen, respectively. Macromolecular incorporation study showed that aspirin at 100 micrograms to 400 micrograms/ml had essentially no effect on all parameters examined. Acetaminophen had a significant (P less than 0.01) suppression of 14C-thymidine, 14C-uridine and 14C-acetate uptake, but no effect on 14C-amino acid uptake at concentrations from 400 micrograms to 1200 micrograms/ml. T. pyriformis GL is a useful eukaryocytic single cell organism for drug action study.

Effects of adriamycin on the macromolecular synthesis in rat myocardiocytes and KB cells

Effects of adriamycin on cardiomyocytes and KB cells have been examined. Adriamycin inhibited DNA and RNA synthesis in both rat myocardial cells and KB cells. Protein synthesis was also inhibited but at a much higher dosage. In myocardiocytes, protein synthesis was dose-dependent with inhibition being almost complete at 100 microM. In contrast, inhibition of protein synthesis in KB cells leveled off at 50%.

Presence of prostaglandins (PGs) in Tetrahymena pyriformis, GL and the effect of aspirin

Tetrahymena pyriformis GL appears to require prostaglandins, either B, E or F series for growth, as demonstrated by the deleterious effect of aspirin. The latter inhibits prostaglandin synthetase (cyclooxygenase). Aspirin inhibited 50% growth of a 24 hr culture of T. pyriformis at a dose of approximately 200 micrograms/ml and completely inhibited at 600 micrograms/ml. Extraction with acid ethyl acetate: isopropanol solvent of 2.8 x 10(8) cells yielded 41.3 mg of lipid of which 62.8% and 34.5% were PGE2 and PGB, respectively. It is suggested that PGs are important for the growth of T. pyriformis and that the organism may be a useful source of natural PGs. Additionally, T. pyriformis may be useful in studies of the PGs pathway.