Woven bone overview: structural classification based on its integral role in developmental, repair and pathological bone formation throughout vertebrate groups

Cortical bone development is characterised by initial formation of woven bone followed by deposition of lamellar bone on the woven scaffold. This occurs in normal bone formation as an integral obligate self-assembly pattern throughout all vertebrate groups, with specific temporal and spatial features. It also occurs in repair bone, modified by the biophysical/mechanical environment, and in pathological bone, modified by the specific disorder and its severity. Two spatially distinct osteoblast cell populations synthesise woven and lamellar bone: mesenchymal osteoblasts surround themselves circumferentially with collagen in a random array to form woven bone; surface osteoblasts align themselves in a linear array on the woven bone surface (or adjacent lamellar bone) to synthesise parallel-fibred lamellar bone. Four specific stages of woven bone formation are defined: stage I, early differentiation of pre-osteoblasts from undifferentiated mesenchymal cells; stage II, mesenchymal osteoblasts surrounding themselves in a 360° arc with randomly oriented matrix fibres; stage III, woven matrix acting as a scaffold on which surface osteoblasts begin to synthesise bone in parallel-fibred lamellar conformation; stage IV, progressive relative diminution of woven bone in the woven bone/lamellar bone complex. Stages II and IV are further subdivided (in a, b and c) by shifting cell area/matrix area and woven bone/lamellar bone relationships. The under-appreciated biological significance of woven bone is that it initiates formation de novo at sites of no previous bone. This information allows for targeted assessment of molecular-biophysical mechanisms underlying woven bone formation and their utilisation for initiating enhanced bone formation.

Milk glucose-6-phosphate dehydrogenase activity and glucose-6-phosphate are associated with oxidative stress and serve as indicators of energy balance in dairy cows

Schematic model to explain the changes in milk G6P/glucose ratio in early lactation.

Acetabular changes associated with avascularnecrosis of the femoral head in a piglet model

Objectives

An experimental piglet model induces avascular necrosis (AVN) and deformation of the femoral head but its secondary effects on the developing acetabulum have not been studied. The aim of this study was to assess the development of secondary acetabular deformation following femoral head ischemia.

Methods

Intracapsular circumferential ligation at the base of the femoral neck and sectioning of the ligamentum teres were performed in three week old piglets. MRI was then used for qualitative and quantitative studies of the acetabula in operated and non-operated hips in eight piglets from 48 hours to eight weeks post-surgery. Specimen photographs and histological sections of the acetabula were done at the end of the study.

Results

The operated-side acetabula were wider, shallower and misshapen, with flattened labral edges. At eight weeks, increased acetabular cartilage thickness characterised the operated sides compared with non-operated sides (p < 0.001, ANOVA). The mean acetabular width on the operated side was increased (p = 0.015) while acetabular depth was decreased anteriorly (p = 0.007) and posteriorly (p = 0.44). The cartilage was thicker, with delayed acetabular bone formation, and showed increased vascularisation with fibrosis laterally and focal degenerative changes involving chondrocyte hypocellularity, chondrocyte cloning, peripheral pannus formation and surface fibrillation.

Conclusions

We demonstrate that femoral head AVN in the young growing piglet also induced, and was coupled with, secondary malformation in acetabular shape affecting both articular and adjacent pelvic cartilage structure, and acetabular bone. The femoral head model inducing AVN can also be applied to studies of acetabular maldevelopment, which is less well understood in terms of developing hip malformation.

Cite this article: Bone Joint Res 2014;3:130–8.

Progression of spinal deformity in wheelchair-dependent patients with Duchenne muscular dystrophy who are not treated with steroids

We determined the frequency, rate and extent of development of scoliosis (coronal plane deformity) in wheelchair-dependent patients with Duchenne muscular dystrophy (DMD) who were not receiving steroid treatment. We also assessed kyphosis and lordosis (sagittal plane deformity). The extent of scoliosis was assessed on sitting anteroposterior (AP) spinal radiographs in 88 consecutive non-ambulatory patients with DMD. Radiographs were studied from the time the patients became wheelchair-dependent until the time of spinal fusion, or the latest assessment if surgery was not undertaken. Progression was estimated using a longitudinal mixed-model regression analysis to handle repeated measurements.

Scoliosis ≥ 10° occurred in 85 of 88 patients (97%), ≥ 20° in 78 of 88 (89%) and ≥ 30° in 66 of 88 patients (75%). The fitted longitudinal model revealed that time in a wheelchair was a highly significant predictor of the magnitude of the curve, independent of the age of the patient (p <  0.001). Scoliosis developed in virtually all DMD patients not receiving steroids once they became wheelchair-dependent, and the degree of deformity deteriorated over time.

In general, scoliosis increased at a constant rate, beginning at the time of wheelchair-dependency (p < 0.001). In some there was no scoliosis for as long as three years after dependency, but scoliosis then developed and increased at a constant rate. Some patients showed a rapid increase in the rate of progression of the curve after a few years – the clinical phenomenon of a rapidly collapsing curve over a few months.

A sagittal plane kyphotic deformity was seen in 37 of 60 patients (62%) with appropriate radiographs, with 23 (38%) showing lumbar lordosis (16 (27%) abnormal and seven (11%) normal).

This study provides a baseline to assess the effects of steroids and other forms of treatment on the natural history of scoliosis in patients with DMD, and an approach to assessing spinal deformity in the coronal and sagittal planes in wheelchair-dependent patients with other neuromuscular disorders.

Cite this article: Bone Joint J 2014;96-B:100–5.

Amyloid beta peptides in plasma in early diagnosis of Alzheimer's disease: A multicenter study with multiplexing

We measured concentrations of Abeta peptides 1-42 and 1-40, and their ratio in plasma of patients carefully categorized clinically and neurochemically as having AD or other dementias with a newly commercially available multiplexing assay, characterized by reasonable laboratory performance (intra-assay imprecision in the range of 1.3-3.8% for Abeta1-42, and 1.8-4.1% for Abeta1-40, inter-assay imprecision for Abeta1-42, Abeta1-40, and Abeta1-42/Abeta1-40 concentration ratio in the range of 2.3-11.5%, 2.2-10.4% and 4.2-9.7%, respectively). Patients with AD or mild cognitive impairment of AD type (MCI-AD) whose clinical diagnosis was supported with CSF biomarkers (n=193) had significantly lower Abeta1-42 plasma concentrations (p<0.007), and Abeta1-42/1-40 ratios (p<0.003) compared to patients with other dementias and MCI of other types (n=64). No significant differences between persons with MCI of AD type and patients with early AD were observed, or between MCI of other types versus patients with early dementia of other types. Our findings reconfirm the hypothesis that alterations of biomarker concentrations occur early in a preclinical AD stage and that these alterations are also reflected in plasma.

Malignant Fibrous Histiocytoma of Bone: An Ultrastructural Study

An ultrastructural study of a case of malignant fibrous histiocytoma of bone in a 16-year-old skeletally mature female is presented. There were multiple metastatic bone lesions and a marked hypercalcemia. The cell population was similar to that found in soft tissue malignant fibrous histiocytoma lesions and comprised undifferentiated cells, fibroblastlike cells, histiocytes, and multinucleated giant cells. Occasional myofibroblasts and transitional cells with histiocytic and fibroblastic components were seen. The histiocytes were characterized by prominent Golgi bodies. Although there were many fibroblastlike cells, the rough endoplasmic reticulum was rarely as extensive or as well organized as in normal fibroblasts. The giant cells did not have the ultrastructural characteristics of osteoclasts, i.e., the clear zones and ruffled borders. Zonula adherens (belt desmosome) junctions were seen, but in general, intercellular junctions were poorly developed as to length and extent.

Bone development and its relation to fracture repair. The role of mesenchymal osteoblasts and surface osteoblasts

Bone development occurs by two mechanisms: intramembranous bone formation and endochondral bone formation. Bone tissue forms by eventual differentiation of osteoprogenitor cells into either mesenchymal osteoblasts (MOBL), which synthesize woven bone in random orientation, or surface osteoblasts (SOBL), which synthesize bone on surfaces in a well oriented lamellar array. Bone repair uses the same formation patterns as bone development but the specific mechanism of repair is determined by the biomechanical environment provided. Bone synthesis and maintenance are highly dependent on the blood supply of bone and on cell-cell communication via the lacunar-canalicular system. Recent investigations highlight the molecular cascades leading to cell differentiation, the components of the structural proteins such as the various collagens, and tissue vascularization. The patterning of bone matrix from an initial woven to an eventual lamellar orientation is essential for bone to develop its maximum strength. This review demonstrates the repetitive nature of woven to lamellar bone formation as mediated by MOBLs and SOBLs in both normal vertebrate bones and bone repair. Repair, using endochondral, primary, direct and distraction osteogenesis mechanisms, is reviewed along with the associated molecular, vascular, and biophysical features.

Changes in Milk Composition as Affected by Subclinical Mastitis in Sheep

The mechanism of the effects of glandular-level subclinical mastitis in dairy sheep on milk yield and on its composition as expressed in curd yield was studied. Thirty-six Israeli-Assaf dairy sheep with one udder half infected with identified coagulase-negative staphylococci and the contralateral gland free of bacteria were chosen. The milk yield of the infected halves was significantly lower than that of the uninfected ones (0.36 vs. 0.76 kg/milking). The somatic cell count and N-acetyl-beta-D-glucosaminidase activity were significantly higher in the infected halves than in the uninfected ones. The plasminogen activator and plasmin (PL) activities were significantly higher in the infected glands than in the uninfected ones, whereas plasminogen (PLG) activity and the ratio PLG:PL were significantly lower in the infected glands. Concentrations of Ca2+ did not differ, whereas Ca2+ activity was significantly lower and proteose peptone concentration was 2.4 times as high in the infected glands than in the uninfected ones. Curd yield was significantly lower in the infected glands than in the uninfected ones.

Infusions of casein hydrolyzates into the mammary gland disrupt tight junction integrity and induce involution in cows

Milk stasis triggers local stimuli, which make the tight junctions leak and trigger involution. The aim of the study was to test the hypothesis that casein hydrolyzates compromise tight junction integrity and dry-off milk secretion in dairy cows. Six repeated doses of casein hydrolyzates after each milking during 3 d caused drastic changes in mammary secretion and composition, which were associated with irreversible cessation of milk secretion. No such changes were recorded in the control glands that had been treated with nonhydrolyzed casein. Treatment with casein hydrolyzates disturbed tight junction integrity within 8 h (as indicated by changes in Na+ and K+ concentrations), reduced the concentrations of lactose precipitously, activated the plasmin activator-plasminogen-plasmin system, and induced the secretion of immunoglobulin type G and lactoferrin. At the end of the 3-d treatments, we stopped milking the experimental and control glands. Milk composition 19 d later was similar in the experimental and control glands and was consistent with the composition expected in fully involuted glands. We conclude that casein hydrolyzates are among the milk-borne factors that cause the disruption of tight junction integrity and induce involution in cows. The process induced by casein hydrolyzate was more rapid and synchronized than the involution induced at drying-off.

Primary gamma-sarcoglycanopathy (LGMD 2C): broadening of the mutational spectrum guided by the immunohistochemical profile

An important step in the diagnostic evaluation of a patient with recessive limb-girdle muscular dystrophy is the immunohistochemical analysis of the components of the sarcoglycan complex in a muscle biopsy specimen. Even though a primary mutation in any of the four sarcoglycan genes (alpha-, beta-,gamma-, delta-sarcoglycan) may cause secondary deficiencies in all the other sarcoglycan proteins, more specific immunohistochemical patterns have emerged with the potential to guide and abbreviate the necessary molecular genetic investigations. In gamma-sarcoglycan mutations, the pattern consists of absent or prominently reduced gamma-sarcoglycan immunoreactivity in combination with reduced but detectable immunoreactivity for the other components, with preservation of delta-sarcoglycan. In five consecutive patients, this pattern was able to predict primary gamma-sarcoglycan mutations. Five different mutations were found, including a recurrent novel splice mutation, a large deletion of the entire gene and a novel missense mutation (Leu90Ser). The mutation Cys283Tyr, previously restricted to Gypsy populations was found in compound heterozygosity with del521T, common in north Africa. The variety of known and novel mutations found indicates that the immunohistochemical profile of gamma-sarcoglycan mutations is not restricted to a particular mutation or type of mutation, but rather is a general reflection of the effect of gamma-sarcoglycan mutations on the composition of the sarcoglycan complex. Complete immunohistochemical analysis with all available sarcoglycan antibodies, therefore, is a useful tool to guide the molecular genetic investigations that are necessary to arrive at the correct genetic diagnosis in a given case.

Thermal effects of focused ultrasound energy on bone tissue

The effects of focused ultrasound (US) at therapeutic acoustic power levels were studied in vivo on the bone-muscle interface in rabbit thighs. The purpose of this study was to provide direction in establishing safety guidelines for treating tissue masses using focused US on or near bone. A positioning device was used to manipulate a focused US transducer (1.5 MHz) in a magnetic resonance imaging (MRI) scanner. This system was used to sonicate the femurs of 10 rabbits at acoustic power levels of 26, 39, 52 and 65 W for 10 s. The rabbits were euthanized either 4 h or 28 days after the sonications and the bone samples were harvested for histology examinations. In the femurs studied, acoustic power levels from 39 to 65 W resulted in soft tissue damage characterized grossly by coagulated tissue and bone damage depicted by yellow discoloration. Histologic examination of lesions from sonications from 39 to 65 W demonstrated that osteocyte damage and necrosis, characterized by pyknotic cells and empty lacunae, occurred within the ablation area extending through the bone. The follow-up MR images demonstrated an increase in the amount of damage in the femurs at 28 days posttreatment in comparison to images taken immediately after treatment. Focused US directed at the femur caused immediate significant thermal damage to bone in the form of osteocyte necrosis extending through the (approximately) 1 cm bone in this study. The results suggest that, when focused US energy is directed at or near bone-muscle interfaces, precautions should be taken to avoid thermal damage to the bone that can compromise its strength for extended periods.

Novel and recurrent mutations in lamin A/C in patients with Emery-Dreifuss muscular dystrophy

Emery-Dreifuss muscular dystrophy (EDMD) is characterized by slowly progressive muscle wasting and weakness; early contractures of the elbows, Achilles tendons, and spine; and cardiomyopathy associated with cardiac conduction defects. Clinically indistinguishable X-linked and autosomal forms of EDMD have been described. Mutations in the STA gene, encoding the nuclear envelope protein emerin, are responsible for X-linked EDMD, while mutations in the LMNA gene encoding lamins A and C by alternative splicing have been found in patients with autosomal dominant, autosomal recessive, and sporadic forms of EDMD. We report mutations in LMNA found in four familial and seven sporadic cases of EDMD, including seven novel mutations. Nine missense mutations and two small in-frame deletions were detected distributed throughout the gene. Most mutations (7/11) were detected within the LMNA exons encoding the central rod domain common to both lamins A/C. All of these missense mutations alter residues in the lamin A/C proteins conserved throughout evolution, implying an essential structural and/or functional role of these residues. One severely affected patient possesed two mutations, one specific to lamin A that may modify the phenotype of this patient. Mutations in LMNA were frequently identified among patients with sporadic and familial forms of EDMD. Further studies are needed to identify the factors modifying disease phenotype among patients harboring mutations within lamin A/C and to determine the effect of various mutations on lamin A/C structure and function.

Cartilaginous path of physeal fracture-separations: evaluation with MR imaging--an experimental study with histologic correlation in rabbits

PURPOSE

To define the transverse levels of intracartilaginous fractures by using magnetic resonance (MR) imaging and histologic analysis in experimental physeal fracture-separations.

MATERIALS AND METHODS

Physeal fracture-separations were evaluated with MR imaging in 28 distal femurs and 28 proximal tibias of 22 immature rabbits. The intraphyseal transverse level of injury was graded as juxtaepiphyseal (germinal or proliferative zones) or juxtametaphyseal (hypertrophic zone or zone of provisional calcification). Histologic sections from 23 specimens were studied to assess correlations. We assessed nonenhanced and gadolinium-enhanced T1-weighted, intermediate-weighted, T2-weighted, and spoiled gradient-recalled-echo T1-weighted images.

RESULTS

In all MR studies, the injury was visible as a cleft of signal intensity lower than the signal intensity of the physeal cartilage. Juxtaepiphyseal extension, seen in 18 (64%) of 28 fractures, was more frequent in the undulating central part of the distal femoral physis than in the flatter proximal tibial physis (P =.008). In 20 of 23 specimens, MR imaging and histologic findings had excellent correlation for the detection of fracture level and morphology.

CONCLUSION

The course and level of injury within the cartilage in physeal fracture-separations can be defined with MR imaging. Extension into the juxtaepiphyseal physis, a potential risk factor for growth arrest, is detectable with MR imaging; MR imaging and histologic findings correlate well.

A mutation in the alpha 3 chain of type IX collagen causes autosomal dominant multiple epiphyseal dysplasia with mild myopathy

Multiple epiphyseal dysplasia (MED) is a degenerative cartilage condition shown in some cases to be caused by mutations in genes encoding cartilage oligomeric matrix protein or type IX collagen. We studied a family with autosomal dominant MED affecting predominantly the knee joints and a mild proximal myopathy. Genetic linkage to the COL9A3 locus on chromosome 20q13.3 was established with a peak log(10) odds ratio for linkage score of 3.87 for markers D20S93 and D20S164. Reverse transcription-PCR performed on the muscle biopsy revealed aberrant mRNA lacking exon 3, which predicted a protein lacking 12 amino acids from the COL3 domain of alpha3(IX) collagen. Direct sequencing of genomic DNA confirmed the presence of a splice acceptor mutation in intron 2 of the COL9A3 gene (intervening sequence 2, G-A, -1) only in affected family members. By electron microscopy, chondrocytes from epiphyseal cartilage exhibited dilated rough endoplasmic reticulum containing linear lamellae of alternating electron-dense and electron-lucent material, reflecting abnormal processing of mutant protein. Type IX collagen chains appeared normal in size and quantity but showed defective cross-linking by Western blotting. The novel phenotype of MED and mild myopathy is likely caused by a dominant-negative effect of the exon 3-skipping mutation in the COL9A3 gene. Patients with MED and a waddling gait but minimal radiographic hip involvement should be evaluated for a primary myopathy and a mutation in type IX collagen.

Stunting syndrome in broilers: effect of electrolytes in drinking water on performance and intestinal glucose transport

Posthatched naive or inoculated male broiler chicks were kept in separate rooms. An inoculum was prepared from intestines of stunting-syndrome affected broiler chicks. Tap water was supplied from 2 L cups, 1 cup per pen. In the Ist experiment, the naive chicks were provided with tap water only and the inoculated ones had free access to tap water or to an electrolyte solution. In the 2nd experiment, the naive and inoculated birds had free access to water in addition to an electrolyte solution. Supplementation was provided up to 3 weeks of age; thereafter all chicks had access to tap water only. Water or electrolyte consumption and body weight (BW) were determined. Total water intake of inoculated chicks was higher than that of naive counterparts (P<0.001). Electrolyte supplementation increased drinking (P<0.001) in inoculated birds more than in naive ones. At 1 week old the weight of the inoculated birds was about 64% of the weight of naive ones; at the age of 4 and 6 weeks it was about 74% and 86% respectively. Compensatory growth was most apparent in the inoculated chicks provided with electrolyte solution. At the age of 6 weeks, the latter exceeded the BW of the exclusively water supplied counterparts by 327 g. Electrolyte supplementation up to the age of 3 weeks had no effect on the naive counterparts. Osmolality was reduced slightly, but very significantly by inoculation; electrolyte supply had no effect on this variable. Sodium concentration in the plasma was higher in the inoculated birds. Plasma albumin was markedly reduced by inoculation on weeks 1 and 2. Whereas the inoculated chicks supplied with electrolytes resumed the level plasma albumin level of the naive chicks on week 3, an over-compensation occurred in the inoculated-water-supplied (IW) group, and they surpassed the naive chicks significantly. Blood hematocrit increased significantly with age; inoculation, age and/or electrolyte supplementation had no effect on this variable. Sodium-dependent glucose transport rates were enhanced in vesicles obtained from inoculated chicks as compared to naive ones. While electrolyte supplementation had no effect on glucose active transport in naive chicks, electrolyte supplementation decreased rates of glucose active transport in inoculated ones. These data demonstrate that electrolyte supplementation during the early age may be used to enhance the tolerance of broiler chicks to stunting-syndrome by improving food and water consumption, and subsequently growth rate during and after cessation of electrolyte supply.

Eye Movement Desensitization and Reprocessing (EMDR) and the anxiety disorders: clinical and research implications of an integrated psychotherapy treatment

Four recent, independent, rigorously controlled studies of Eye Movement Desensitization and Reprocessing (EMDR) have reported that 84 to 100% of single-trauma victims no longer maintain the posttraumatic stress disorder diagnosis after the equivalent of three 90-minute sessions. The rapidity of EMDR treatment effects makes many ancillary research opportunities available. Specifically, the increased number of cases resolved in a relatively short period of time allows investigation of neurophysiological phenomena, patterns of cognitive and emotional processing, component analyses of a large range of procedural factors, and evaluation of the efficacy of application to diverse clinical populations. Unfortunately, some research has been conducted that has been severely hampered by insufficient treatment fidelity and lack of clinical validity. Consequently, this article will attempt to describe the procedures and protocols that are believed to contribute to EMDR's clinical effects and are, therefore, suggested for the EMDR treatment and research of the anxiety disorders. This is particularly relevant given the misconceptions that have abounded due to the unfortunate naming of the procedure after the eye movements, which have proved to be only one of many useful types of stimulation, and only one of many components of this complex, integrated treatment.

Epiphyseal and physeal cartilage vascularization: a light microscopic and tritiated thymidine autoradiographic study of cartilage canals in newborn and young postnatal rabbit bone

The vascular pattern of newborn and early postnatal epiphyseal and physeal cartilage is integral to long bone development and differs from later postnatal patterns. In the present study, we supplement light microscopic histology with tritiated thymidine autoradiography to help assess the position of cartilage canals and the dynamics of cartilage vascularity in relation to growth. Tritiated thymidine labeling studies to assess cell proliferation activity were done by using 2 microc/g body weight intraperitoneal injections into newborn and 3-, 4-, and 7-day-old New Zealand white rabbits that were killed 1 hr after the injection. Proximal humeral, distal femoral, and third metatarsal epiphyses were assessed by routine histology and serial section autoradiography. Cartilage canals were seen in each epiphysis. Transphyseal vessels were seen in each epiphysis continuous from the epiphysis to the metaphysis or were present within the physis traversing the proliferating and hypertrophic cell zones. Histologic sections showed vessels from the perichondrium continuous with those of the epiphyseal cartilage canals at proximal humeral, distal femoral, and metatarsal epiphyses. Serial sections showed vascular buds and connective tissue cells lying in indentations at the periphery of and present within the epiphyseal cartilage. Autoradiographic studies showed extensive labeling of vessel wall cells and surrounding connective tissue cells of the cartilage canals (a) within the epiphyseal cartilage, (b) traversing the physis, and (c) within the epiphyseal cartilage but continuous with the perichondrial vessels. The labeling was always far more extensive than in the surrounding chondrocytes and was always present throughout the entire extent of the canals. In conclusion, the cell labeling activity strongly supports an active dynamic phenomenon underlying the vascularization of epiphyseal and physeal cartilage.

Growth cartilage: normal appearance, variants and abnormalities

The cartilaginous structures in the growing ends of the bone have a complex anatomy. MR imaging allows exquisite depiction of these structures. The normal anatomy and biochemical features of the zones of cartilage are reviewed. Based on an analysis of signal characteristics, it is possible to optimize the use of pulse sequences to study the normal structures and abnormalities of growing bone.

Musculoskeletal trauma in children

MR imaging has facilitated the study of pediatric injuries by demonstrating the extraosseous and cartilaginous component of these lesions. In injuries to the epiphysis and physis, osteochondral injuries and avulsion injuries, the cartilaginous component is usually the most important part of the lesion. Stress fractures and other injuries to the marrow also can be demonstrated with MR imaging. In the context of musculoskeletal injuries in children, MR imaging is most valuable in demonstrating the extent of injuries to radiographically occult areas.

Osteogenesis imperfecta

Osteogenesis imperfecta (OI) is a genetically determined disorder of connective tissue characterized by bone fragility. The disease state encompasses a phenotypically and genotypically heterogeneous group of inherited disorders that result from mutations in the genes that code for type I collagen. The disorder is manifest in tissues in which the principal matrix protein is type I collagen (mainly bone, dentin, sclerae, and ligaments). Musculoskeletal manifestations are variable in severity along a continuum ranging from perinatal lethal forms with crumpled bones to moderate forms with deformity and propensity to fracture to clinically silent forms with subtle osteopenia and no deformity. The differential diagnosis includes other entities with multiple fractures, deformities, and osteopenia. Classification is based on the timing of fractures or on multiple clinical, genetic, and radiologic features. Molecular genetic studies have identified more than 150 mutations of the COL1A1 and COL1A2 genes, which encode for type I procollagen. Various systemic treatments have been attempted; however, these interventions have been ineffective or inconclusive or are still experimental. Gene therapy has the potential to increase the synthesis of type I collagen in mild variants and to correct mutations in severe variants, but there are a great number of technical difficulties to overcome. The goals of treatment of OI are to maximize function, minimize deformity and disability, maintain comfort, achieve relative independence in activities of daily living, and enhance social integration. Attainment of these goals requires a team approach to tailor treatment needs to the severity of the disease and the age of the patient. Nonoperative management is the mainstay of orthopaedic treatment, with the goals of preventing and treating fractures and enhancing locomotion. Operative intervention is indicated for recurrent fractures or deformity that impairs function.

Developing epiphysis: MR imaging characteristics and histologic correlation in the newborn lamb

PURPOSE

To correlate magnetic resonance (MR) signal characteristics of developing regions at the ends of bones with the histologic findings.

MATERIALS AND METHODS

In 36 newborn lamb epiphyses (including cartilage of the epiphysis and physis, and bone of the secondary ossification center and juxtaphyseal metaphysis), signal intensity and thickness of cartilaginous regions seen on MR images were correlated with architecture and thickness of zones shown in corresponding histologic sections. Possible effects of T2, magnetization transfer, fat or water content, chemical shift, and anisotropy on differences in regional signal intensity were evaluated.

RESULTS

MR imaging depicted five regions between the secondary ossification center and the metaphysis corresponding histologically to (a) zone of provisional calcification of the secondary ossification center, (b) physis of the secondary ossification center, (c) epiphyseal cartilage, (d) physis, and (e) zone of provisional calcification. The thickness of regions shown on T1- and T2-weighted images correlated with that of histologic zones (r = .9). T2 signal intensity and relaxation time were greater in physeal than in epiphyseal cartilage (P < .01). No regional differences due to fat or water content, magnetization transfer, chemical shift, or anisotropy were found.

CONCLUSION

MR imaging findings differentiate epiphyseal and physeal regions and correlate with histologic findings. T2 is slower in physeal than in epiphyseal cartilage, probably reflecting differences in water binding.

Gadolinium-enhanced MR imaging of pediatric patients after reduction of dysplastic hips: assessment of femoral head position, factors impeding reduction, and femoral head ischemia

OBJECTIVE

We describe gadolinium-enhanced MR imaging of position and vascular enhancement of the femoral head in pediatric patients who have undergone reduction of hip dislocation.

SUBJECTS AND METHODS

Within 24 hr of hip reduction and spica casting, we performed 25 gadolinium-enhanced MR studies in 18 infants and young children (15 girls, three boys) with 23 dysplastic hips. All but two patients underwent closed reductions. We evaluated intraoperative arthrograms for obstacles to reduction and subsequent radiographs for avascular necrosis.

RESULTS

MR images showed that all femoral heads were in their respective acetabula, but several structures interfered with concentric reduction. Obstacles to reduction included a pulvinar (n = 16), infolding of the capsule (n = 9), interposition of the labrum (n = 2), and a hypertrophied ligamentum teres and transverse ligament (n = 2). All 50 femoral heads showed enhancement: 35 normally, 10 homogeneously but less than on the contralateral femoral head or the ipsilateral greater trochanter, and five with areas of focally decreased enhancement. Hips that showed decreased enhancement had undergone greater degrees of abduction (r = .38, p < .01).

CONCLUSION

Gadolinium-enhanced MR imaging can reveal abnormalities of hip position and proximal femoral epiphyseal and physeal vascularity that can occur after hip reduction. Abnormalities of enhancement were more frequent in patients who had greater femoral abduction. The effect of decreased epiphyseal vascular enhancement is still uncertain.

Phase II study of "dose-dense" high-dose chemotherapy treatment with peripheral-blood progenitor-cell support as primary treatment for patients with advanced ovarian cancer

PURPOSE

We performed a pilot phase II study to evaluate the potential for delivery of rapidly sequenced high-dose chemotherapy treatments rescued with autologous peripheral-blood progenitor cells (PBP) in patients with previously untreated, advanced ovarian cancer.

PATIENTS AND METHODS

A single cycle of mobilization was used, primed with cyclophosphamide (CPA)/paclitaxel (Txl) and filgrastim (granulocyte colony-stimulating factor [G-CSF]), followed by three cycles of high-dose carboplatin (CBDCA)/Txl and one cycle of high-dose melphalan (MEL), each rescued by PBP. We then analyzed the outcome for a total of 56 consecutive patients treated with high-dose chemotherapy as part of this program.

RESULTS

In the phase II pilot, 21 patients were enrolled. There were no treatment-related deaths through 98 high-dose treatments, although 34 treatments were complicated by hospitalization, primarily for neutropenic fever. Seventy-six percent of patients experienced grade 3 to 4 gastrointestinal toxicity and 62% experienced grade 2 to 3 neuropathy. Five of 15 (33%) patients who underwent second-look surgery attained a pathologic complete response. In the overall analysis, 56 patients were reviewed. Forty-four patients were assessable for response by second-look surgery or clinical progression. Fifteen of 44 patients achieved a pathologic complete response (34%). The pathologic complete response rate in optimal-disease patients was 12 of 22 (55%), while only three of 22 (13%) suboptimal stage III and IV patients achieved a pathologic complete response.

CONCLUSION

The Gynecologic Oncology Group has initiated a pilot phase II trial of this approach in patients with optimally debulked stage III ovarian cancer. There is no evidence to support the use of this or other aggressive regimens outside of a clinical trial.

A phase II trial of intraperitoneal cisplatin and etoposide as consolidation therapy in patients with Stage II-IV epithelial ovarian cancer following negative surgical assessment

PURPOSE

To determine the efficacy of three courses of intraperitoneal (i.p.) cisplatin (CDDP) and etoposide (VP-16) as consolidation therapy following pathologically negative second-look surgical reassessment for Stage IIC-IV epithelial ovarian cancer (EOC).

PATIENTS AND METHODS

Between September 1988 and April 1996, 40 patients were treated with three cycles of i.p. CDDP (100 mg/m2)/VP-16 (200 mg/m2) as consolidation therapy. Survival was compared to that of a group of 46 contemporaneous patients undergoing observation only.

RESULTS

Median age of the 36 eligible patients was 52 years (range 30-70 years). Stage distribution was II (3), III (31), and IV (2); histologic grade was 1 (2), 2 (7), 3 (25), and not recorded (2); and residual disease at completion of initial surgery was none/microscopic in 13/36 (36%) patients. Median age of the 46 patients who did not receive consolidation was 52 years (range, 27-80 years); stage distribution was II (18), III (26), and IV (2); histologic grade was 1 (5), 2 (12), 3 (28), and not recorded (1). With a median follow-up of 36 months in both groups, 14/36 (39%) of the protocol group have recurred compared with 25/46 (54%) of those undergoing observation alone. Median disease-free survival (DFS) for the observed patients is 28.5 months and has not been reached in the consolidation group. Disease-free survival distribution between the two groups was compared using the log-rank test and was found to be significant (P = 0.03). Multivariate analysis revealed that the only significant predictor of improved DFS was protocol treatment (P < 0.01).

CONCLUSION

Intraperitoneal consolidation with CDDP/VP-16 following negative second-look reassessment in patients with advanced EOC resulted in a significant increase in DFS compared to nonprotocol patients treated concurrently who underwent observation alone.

Stunting syndrome in broilers: effect of stunting syndrome inoculum obtained from stunting syndrome affected broilers, on broilers, leghorns and turkey poults

Responses to stunting syndrome (SS) infective material obtained from affected broilers and administered per os were monitored for 3 wk in a fast-growing commercial broiler population, in slow-growing Leghorn chicks, and in turkey poults. At 2 and 3 wk, the size of the gastrointestinal tract (GIT) segments, the pH of the GIT contents, and the activities of digestive enzymes in the intestinal contents and of disaccharidases on the jejunum mucosae were determined. Inoculation affected the genetic stocks differently. In broiler chicks, growth and feed utilization were markedly reduced. In contrast, inoculation of Leghorns was accompanied by improved feed intake and growth rate. Performance of poults was affected only slightly, albeit significantly. The effect of inoculation on the pH of crop and intestinal contents in Leghorn chicks was opposite to that found in broiler chicks, i.e., a significant increase in the crop and small intestinal pH in the former vs a significant decrease in inoculated broilers. Although inoculation of the broiler chicks did not affect the pH in the proventriculus, in Leghorn chicks it was reduced by 25%. In poults, inoculation did not significantly affect GIT contents pH. The GIT segments were markedly enlarged in broiler chicks, whereas in Leghorn chicks the opposite trend was observed; namely, intestinal segment weights were significantly reduced. In poults, inoculation caused a reduction in the intestinal segments and gizzard weight at 3 wk. During this same period, the liver and pancreas relative weights were dramatically increased in broiler chicks. A higher relative heart weight at 2 wk was observed in broilers and poults; this trend persisted to Week 3 in poults but not in broiler chicks. In broiler chicks, a nonsignificant reduction was observed for all enzymes assayed at 3 wk and for chymotrypsin at 2 wk. In Leghorn chicks, inoculation was accompanied by a marked and significant increase in the activity of chymotrypsin during both periods. In poults, inoculation caused a marked increase in the activities of amylase during Week 2 and 3, and trypsin at 3 wk. Maltase and saccharase activities in the jejunum of broiler chicks were slightly depressed a t 2 and 3 wk, the depression being significant at 2 wk for maltase and at 3 wk for saccharase. In the Leghorn chicks, inoculation caused a twofold increase in the activities of both enzymes. As in Leghorns, inoculation of poults with SS infective material caused a marked increase in the activities of the disaccharidases. The different responses to SS inoculation in the different genetic stocks are discussed.

The response of patients with Duchenne's muscular dystrophy to neuromuscular blockade with vecuronium

BACKGROUND

The authors hypothesized that patients with Duchenne's muscular dystrophy (DMD) are more sensitive to nondepolarizing muscle relaxants.

METHODS

Eight children with DMD and eight healthy children having orthopedic procedures were studied. Anesthesia consisted of thiopental, 60% nitrous oxide in 40% oxygen, and intravenous fentanyl and midazolam. Using electromyography, the ulnar nerve was stimulated and the electromyographic train-of-four ratio (TOFr) of the first dorsal interosseous muscle was recorded every 60 s. After baseline TOFr recording, all patients received 50 microg/kg vecuronium and the TOFr at 3 min was compared. Vecuronium (10 microg/kg) was then administered every minute until TOFr was < or =0.1. The TOFr was followed until TOFr was > or =0.01. Then 10 microg/kg of vecuronium were administered to maintain TOFr < or = 0.1. At the conclusion of the procedure, TOFr was allowed to recover to 0.25, and then neostigmine and glycopyrrolate were administered. Data are presented as medians and ranges.

RESULTS

The initial dose of vecuronium resulted in greater TOFr depression in patients with DMD than in controls (0.14 vs. 0.86). Less vecuronium was needed to produce TOFr < or = 0.1 in the patients with DMD than in the control patients (55 microg/kg vs. 95 microg/kg). Recovery time for the TOFr to > or =0.1 after the initial dose was longer in the patients with DMD than in the controls (28 vs. 20 min; P = 0.03), and the maintenance dose of vecuronium was less in patients with DMD (0.6 vs. 1.3 microg x kg[-1] min[-1]; P < 0.01). The time for TOFr recovery from 0.1 to 0.25 was 36 min in the patients with DMD and 6 min in the controls (P < 0.01). After neostigmine, the TOFr was 1.0 in the controls and 0.91 (P = 0.03) in the patients with DMD.

CONCLUSION

There is increased sensitivity to vecuronium from neuromuscular blockade in patients with DMD.

Infantile phosphofructokinase deficiency with arthrogryposis: clinical benefit of a ketogenic diet

We report a 2-year-old boy with phosphofructokinase deficiency presenting in the newborn period with congenital arthrogryposis and severe myopathy, who has had significant improvement on a ketogenic diet since its institution at 4 months of age. We provide a rationale for use of this treatment and hypothesize it may be beneficial in other patients with phosphofructokinase deficiency and progressive muscular involvement. Confirmation awaits further clinical trials in carefully selected patients.

Regulation of hematopoiesis by microvascular endothelium

The bone marrow microenvironment is a complex three dimensional structure where hematopoietic stem cells proliferate, mature, migrate into the sinusoidal space, and enter the circulation in an exquisitely regulated fashion. Stromal cells within the BM microenvironment provide a suitable environment for self-renewal, proliferation and differentiation of hematopoietic stem cells. Within the hematopoietic microenvironment, whether it is embryonic yolk sac, fetal liver, or adult bone marrow, microvascular endothelium not only acts as a gatekeeper controlling the trafficking and homing of hematopoietic progenitors, but also provides cellular contact and secretes cytokines that allows for the preservation of the steady state hematopoiesis. Recently, homogenous monolayers of bone marrow endothelial cells (BMEC) have been isolated and cultivated in tissue culture. Long-term coculture studies have shown that BMEC monolayers are unique type of endothelium and can support long-term proliferation of hematopoietic progenitor cells particularly megakaryocytic and myeloid progenitor cells by constitutive elaboration of lineage-specific cytokines such as G-CSF, GM-CSF, M-CSF, Kit-ligand, IL6, FLK-2 ligand, and leukemia inhibitory factor. Direct cellular contact between hematopoietic progenitor cells and BMEC monolayers through specific adhesion molecules including beta1, beta2 integrins and selectins play a critical role in trafficking and possibly proliferation of hematopoietic stem cells. Dysfunction of microvascular endothelial cells within the hematopoietic microenvironment may result in stem cell disorders and progression to aplastic anemias, and contribute to graft failure during bone marrow transplantation. Further studies on the role of microvascular endothelium in the regulation of hematopoietic stem cell homing and proliferation may enhance our understanding of the pathophysiology of stem cell and leukemic disorders.

Variable conformation of GAP junctions linking bone cells: a transmission electron microscopic study of linear, stacked linear, curvilinear, oval, and annular junctions

There is a marked variability in the conformation of bone cell gap junctions in newborn murine cortical bone as defined by transmission electron microscopy (TEM). Studies were done in newborn BALB/c mouse and Sprague-Dawley rat femurs and tibias. Femoral and tibial cortices were dissected into 1 mm3 fragments and prepared in standardized fashion using modified Karnovsky fixation, 7.5% EDTA decalcification, 1% osmium tetroxide-sym collidine buffer with 1% lanthanum nitrate postfixation, Epon resin, 60 nm sections, lead citrate/uranyl acetate staining, and examination at 60 kV. Previous TEM descriptions of bone junctions have, with rare exceptions, noted only isolated linear or mildly curvilinear structures. In this study we noted gap junctional shapes on thin-section TEM preparations of osteoblasts and osteocytes to be extremely variable and complex encompassing linear, curvilinear, stacked linear, oval, and annular conformations. Multiple observations revealed linear gap junctions linking surface osteoblast cell bodies; linear, curvilinear, stacked linear, and oval junctions linking osteoblast processes in osteoid; linear and curvilinear junctions where cell processes joined with osteocyte cell bodies and each of the five conformations linking osteocyte processes within canaliculi. The annular junctions were found within osteoblast and osteocyte cytoplasm and in osteocyte cell processes within canaliculi. The annular junctions are intracellular, degenerating structures which appear as ultrastructural markers of gap junction involution. The more complex shapes reported here must be considered in (1) interpreting quantitative studies using freeze-fracture replicas, thin sections, and confocal microscopy immunolabeled junction connexin-43 components and (2) assessing gap junction biogenesis and turnover. 3-D reconstruction of bone junctions will enhance our understanding of these complex conformations.

Salvage weekly paclitaxel in recurrent ovarian cancer

The objectives of this study were to determine the toxicity and phase II dose of weekly paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) administration and to describe our initial experience with salvage weekly intravenous paclitaxel in women with advanced recurrent ovarian carcinoma. We conducted a phase I trial of paclitaxel administered as a 1-hour infusion in advanced ovarian cancer patients, using doses of 40 to 100 mg/m2/wk. As a follow-up study, we retrospectively reviewed the medical records of 45 patients with advanced, recurrent epithelial ovarian cancer treated between January 1, 1996, and October 30, 1996, with single-agent weekly intravenous paclitaxel (60 to 100 mg/m2, 1-hour infusions). Response for patients with measurable disease was based on improvements in physical examination or a greater than 50% reduction in the perpendicular diameters of all lesions in serial computed tomography. Since many of the patients did not have measurable disease, some evaluations of response to therapy were based on decline in serum carbohydrate antigen-125 according to published criteria. In our phase I study, 18 patients received 194 weekly courses of therapy at doses of 40, 50, 60, 80, and 100 mg/m2. The dose-limiting toxicity was defined as two or more patients with treatment delay or grade 3 toxicity (National Cancer Institute common toxicity criteria) at the same dose level. Treatment was delayed in two of three patients (for neutrophil counts < 1,500/microL at the 100 mg/m2 dose level); therefore, a phase II dose of 80 mg/m2/wk is recommended. No patient required hospitalization for neutropenia/fever. In the retrospective cohort review, the median patient age was 55 years (range, 32 to 79 years). All patients were heavily pretreated with multiple systemic chemotherapy regimens, including paclitaxel, with a median of four regimens (range, one to eight) before receiving weekly paclitaxel. Patients received a median of nine cycles of weekly paclitaxel (range, three to 37), with a median interval of 8 months (range, 1 to 32 months) between the last paclitaxel treatment and the institution of weekly therapy. Response was noted in 13 of 45 (28.9%) patients, with a median of seven treatments to achieve response. Chemotherapy was generally well tolerated, with treatments completed on a weekly schedule and only one hospitalization for nadir fever. We conclude that weekly intravenous paclitaxel is an active and well-tolerated regimen in heavily pretreated women with recurrent ovarian carcinoma. Prior therapy with paclitaxel does not preclude response to this regimen. A phase II trial of weekly paclitaxel in paclitaxel-refractory patients is under way.

Adjuvant therapy in gynecologic malignancies. Ovarian, cervical, and endometrial cancer

While surgery is the primary treatment for the management of gynecologic malignancies, adjuvant chemotherapy and radiation therapy play a critical role in survival for many patients. In this article, we discuss the feasibility and effectiveness of adjuvant therapy for ovarian, cervical, and endometrial cancers, and discuss current recommendations.

High-intensity intravenous cyclophosphamide and cisplatin, interim surgical debulking, and intraperitoneal cisplatin in advanced ovarian carcinoma: a pilot trial with ten-year follow-up

PURPOSE

This trial was undertaken to study the effect of intensified intravenous cyclophosphamide/cisplatin and interim surgical debulking, followed by intraperitoneal cisplatin on surgically defined complete remission rate and survival in advanced ovarian cancer.

PATIENTS AND METHODS

Forty patients with stage IIB through IV ovarian cancer were entered and 36 were evaluable for response and survival and approximately 10 years. Following a first laparotomy for diagnosis and debulking, the patients received two cycles, spaced 28 days apart, of intravenous cisplatin 30-40 mg/m2/day with hypertonic saline for 4 to 5 days and cyclophosphamide 200 mg/m2/day for 5 days. A second laparotomy was done to further debulk remaining cancer and to place an intraperitoneal catheter. Four cycles of intraperitoneal cisplatin at 50 or 100 mg/m2 were administered 21 days apart and followed by a third laparotomy to define response and plan any further therapy.

RESULTS

The surgically confirmed complete response rate was 47% and median survival is 68.3 months for this group. Ten of the 17 patients (58.8%) relapsed following complete response at a median of 19.5 months (range, 5-98). Both aggressive chemotherapy and surgery seemed to play a role in inducing this high complete response rate. Traditional prognostic factors, including stage and diameter of largest residual disease, had little apparent effect on likelihood of complete response or survival, whereas tumor grade had a more significant effect on survival. Nadir fever was experienced by 33% of patients but peripheral neuropathy was dose limiting.

CONCLUSION

In the context of recent data failing to support any clinical benefit to modest increases in dose escalations of cisplatin or carboplatin, in this trial the high complete response rate suggests that the multimodality approach (i.e., interval surgical debulking and intraperitoneal cisplatin) is worthy of further study. The high relapse rate among complete responders and the unacceptable neurotoxicity also suggest that modifications could improve the results. The use of newer agents and further intensification (substituting carboplatin for cisplatin and the use of paclitaxel) with stem cell support are two examples.

Effects of prior therapy on the in vitro proliferative potential of stem cell factor plus filgrastim-mobilized CD34-positive progenitor cells

The quantity of hematopoietic progenitors in an apheresis collection is defined by the number of CD34(+) cells or granulocyte macrophage colony-forming units present. These parameters are believed to give roughly equivalent information on graft quality. We here report that the in vitro proliferative potential of r-metHuSCF (stem cell factor) plus filgrastim (granulocyte colony-stimulating factor; r-metHuG-CSF) mobilized peripheral blood (PB) CD34(+) cells obtained from previously heavily treated non-Hodgkin's lymphoma patients inversely correlates with extent of prior therapy. CD34(+) cells were enriched using the CellPro Ceprate system and placed in liquid culture for 4 weeks in the presence of either r-metHuSCF, IL-3, IL-6, filgrastim (S36G), or S36G plus erythropoietin (S36GE) with a weekly exchange of media and cytokines with reestablishment of culture at the starting cell concentration (Delta assay) and enumeration of progenitors. Starting with 4 x 10(4) CD34(+) cells from apheresis samples from patients who had received <10 cycles of prior chemotherapy, progenitors were detectable in culture at 4 weeks 81% of the time as compared to 14% with CD34(+) cells from patients who had received >10 cycles and 5% for >10 cycles plus radiotherapy. The total number of progenitors generated over the duration of culture (area under the curve) was calculated using the trapezoidal rule as a novel measure of the proliferative potential of the enriched PB CD34(+) cell population. The median area under the curve of CD34(+) cells from patients receiving <10 cycles of prior chemotherapy was 7.4 and 5.7 (x10(5)) using S36G or S36GE, respectively, 1.8 and 1.9 if the patients received >10 cycles of prior chemotherapy, and 1.4 and 1.2 if the patients received >10 cycles of prior chemotherapy plus radiotherapy (P < 0.001). These data show that prior therapy impacts on the quality of PB CD34(+) cells as measured by their ability to generate committed progenitors over a number of weeks in liquid culture.

Normal gadolinium-enhanced MR images of the developing appendicular skeleton: Part 2. Epiphyseal and metaphyseal marrow

OBJECTIVE

We have studied how gadolinium enhancement of T1-weighted MR images affects the expected normal differences in signal intensity between metaphyseal hematopoietic and epiphyseal fatty marrow. We have also analyzed how enhancement affects the expected normal changes in the MR images of the marrow due to fatty conversion.

MATERIALS AND METHODS

We analyzed gadolinium-enhanced MR images of normal distal femurs in 18 immature rabbits that were 5-11 weeks old and of normal proximal femurs in 18 infants, children, and young adults who were 2 months to 21 years old. In all subjects, we studied the change with age in signal intensity and enhancement ratio of the epiphyseal and metaphyseal marrow. In the rabbits, marrow composition and transformation were histologically verified.

RESULTS

On unenhanced T1-weighted MR images of the rabbits and of the infants, children, and young adults, epiphyseal signal intensity always exceeded metaphyseal signal intensity; however, the enhancement ratio was always greater in the metaphysis. The signal intensity in metaphyseal and epiphyseal marrow on unenhanced MR images increased with age. However, enhancement ratios decreased with age in both areas. In the rabbits, histologic studies showed more fatty marrow in the epiphysis than in the corresponding metaphysis and an age-related increase in marrow fat at both sites.

CONCLUSION

In the marrow of the extremities, gadolinium enhancement is greater in the (hematopoietic) metaphysis than in the (fatty) epiphysis. In both areas, enhancement decreases as the marrow becomes more fatty. On T1-weighted images, administration of a gadolinium-containing contrast agent reduces the normal contrast between hematopoietic and fatty marrow and obscures the changes in marrow signal intensity due to fatty conversion.

Normal gadolinium-enhanced MR images of the developing appendicular skeleton: Part I. Cartilaginous epiphysis and physis

OBJECTIVE

We have used gadolinium-enhanced MR imaging to define the expected normal appearance of the developing cartilaginous epiphyses and physes in neonates, infants, and children and to define the changes with maturity in epiphyseal vascular pattern.

MATERIALS AND METHODS

We analyzed gadolinium-enhanced MR images of 80 normal epiphyses in 48 neonates, infants, and children who were 1 month to 15.5 years old. We studied the differences in enhancement ratios for the epiphyses and physes and the epiphyseal vascular pattern at various development stages. We correlated the MR imaging findings with histologic and injection studies of immature epiphyses.

RESULTS

Gadolinium enhancement allowed differentiation between physeal and epiphyseal cartilage and revealed epiphyseal vascular canals. Enhancement proved to be greater in the physeal than in the epiphyseal cartilage (p < .001). In the unossified epiphysis, the vascular canals were mainly parallel. After the development of the secondary ossification center, these canals came to have a radial pattern (p < .0001). Comparison with cadaveric specimens confirmed how, with age, the arrangement of these canals changed. Also, physeal enhancement decreased with physeal closure.

CONCLUSION

Gadolinium-enhanced MR imaging reveals differential enhancement of the physis, epiphyseal vascular canals, and epiphyseal cartilage. The pattern of epiphyseal vessels and degree of enhancement of the physis change with maturity.

Dose escalation of paclitaxel with high-dose carboplatin using peripheral blood progenitor cell support in patients with advanced ovarian cancer

A phase I study of escalating doses of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) given in combination with high-dose carboplatin was conducted to identify the antitumor efficacy and maximum tolerated dose of paclitaxel in patients who had received sequential cycles of paclitaxel/cyclophosphamide as prior treatment for ovarian carcinoma. Eighteen patients with advanced ovarian cancer were treated in this study. Induction therapy consisted of two cycles of cyclophosphamide 3.0 g/m2 plus high-dose paclitaxel 300 mg/m2 plus filgrastim and leukapheresis to harvest peripheral blood progenitor cells, followed by four courses of rapidly cycled high-dose carboplatin with planned dose escalation of paclitaxel (150, 200, 250, and 300 mg/m2) rescued with peripheral blood progenitor cells. The study was amended after accrual of 11 patients, and the remaining seven patients received a single cycle of induction therapy with paclitaxel/cyclophosphamide, followed by four courses of rapidly cycled high-dose carboplatin with planned dose escalation of paclitaxel through levels 200 and 250 mg/m2. All 18 patients have completed therapy. Of the 15 who are evaluable for response, the pathologic complete response was 33% (five of 15 patients). The administration of escalating doses of paclitaxel in combination with high-dose carboplatin following sequential cycles of paclitaxel/cyclophosphamide induction resulted in significant nonhematopoietic toxicity. Induction with a single cycle of paclitaxel/cyclophosphamide resulted in excellent progenitor cell mobilization, and significantly ameliorated the toxicity of this approach. The response rates thus far obtained are promising and warrant further evaluation.

Stunting syndrome in broilers: effect of glucose or maltose supplementation on digestive organs, intestinal disaccharidases, and some blood metabolites

The effect of supplementing a cornsoybean diet (C) with glucose (G) or maltose (M) on young broilers (from hatch to 3 wk of age) affected by stunting syndrome (SS) was studied. Stunting syndrome was induced by orally administering an inoculum prepared from the intestines of SS broiler chicks. Relative to the M diet, the G diet improved growth and feed utilization and increased feed intake in naive (NA) control chickens. The C diet was intermediate in this respect. In contrast to the NA chickens, diet did not affect growth or feed utilization in SS chicks. Changes in the relative weights of the gastrointestinal tract segments were evident by 1 wk of age and hypertrophy of these segments persevered to 3 wk of age. Stunting syndrome infection was accompanied by a significant increase in pancreatic trypsin-specific activity during Weeks 1 and 2, and in chymotrypsin activity at 1 wk. During this time, amylase-specific activity was not affected. At 3 wk of age, the specific activities of amylase, trypsin, and chymotrypsin in the pancreas were lower in the inoculated vs control birds. Whereas no significant effect of SS was observed with activities of amylase in the intestinal contents, trypsin activity was higher in SS chicks at 1 wk, and that of chymotrypsin lower during Weeks 2 and 3. Relative to NA chicks, the maltase and saccharase activities of SS chicks were much lower during Week 1, but increased later on and were similar to NA chick values at 2 and 3 wk. Whereas the level of blood plasma proteins did not vary from 1 to 3 wk in the NA chicks, it increased gradually in SS chicks to a level that significantly exceeded that in their NA counterparts. Blood plasma glucose and triglyceride levels were slightly lower in the SS chicks (NS), and the blood plasma cholesterol level was significantly reduced during Week 2. Relative to NA chicks, SS infection caused a significant increase in plasma calcium during Weeks 2 and 3, accompanied by a significant reduction in blood plasma phosphorus at 2 wk only. No difference was observed in the blood plasma level of uric acid, which peaked in both treatments during Week 2, or in D-beta-hydroxybutyric acid level, which was quite stable during the experimental period. Stunting syndrome infection was accompanied by a dramatic increase in amylase and alkaline phosphatase activities in the blood plasma, and by a slight but significant decrease in activity of lactic dehydrogenase. Stunting syndrome was concluded to be an affliction not only of digestion but also of metabolism. The main depression in growth caused by SS inoculation is probably due to metabolic alterations beyond those of digestion and absorption.

Phase I and pharmacologic study of paclitaxel administered weekly in patients with relapsed ovarian cancer

PURPOSE

Paclitaxel has shown significant activity in advanced ovarian cancer. In vitro studies with paclitaxel have suggested that fractionated brief infusion schedules may be more effective than the standard 24-hour infusion. We commenced a phase I evaluation of escalating-dose paclitaxel (40, 50, 60, 80, 100 mg/m2) administered weekly as a 1-hour infusion in patients with recurrent ovarian cancer. All patients had received prior paclitaxel and cisplatin therapy. All patients received standard premedication.

PATIENTS AND METHODS

Eighteen patients are assessable on this phase I study. The mean age was 54 years (range, 48 to 74). The median number of prior chemotherapy regimens was three (range, two to five). The mean paclitaxel-free interval was 10.1 months (range, 1 to 24).

RESULTS

A total of 194 cycles of therapy were administered, with a mean of 10 (range, one to 12) per patient. No mucositis or grade III neuropathy was seen. Alopecia occurred in one out of 18 assessable patients. The mean neutrophil nadir was 4.0 x 10(9)/L. At the top dose level (100 mg/m2) delivered, dose-intensity was 90.75% of that planned and greater than two fold the standard dose-intensity. Partial responses were seen in four of 13 assessable patients (30%). Two patients with progression of disease on standard three-week paclitaxel schedules switched to a weekly schedule with demonstrated response. Increasing paclitaxel dose correlated with measured area under the curve (AUC) (R2 = .614). Dose-limiting toxicity was reached at 100 mg/m2 with two of three patients experiencing a treatment delay, thus defining a maximum-tolerated dose of 80 mg/m2 in this group of heavily pretreated patients on this weekly schedule.

CONCLUSION

(1) Paclitaxel administered as a 1-hour infusion is well tolerated; (2) this schedule of administration does not result in cumulative myelosuppression; and (3) this schedule of administration results in dose-intensive paclitaxel delivery with a favorable toxicity profile.

The effects of Flk-2/flt3 ligand as compared with c-kit ligand on short-term and long-term proliferation of CD34+ hematopoietic progenitors elicited from human fetal liver, umbilical cord blood, bone marrow, and mobilized peripheral blood

The Flk-2/flt3 ligand (FL) was evaluated and compared with c-kit ligand (KL) for its in vitro proliferative effects on CD34+ cells from human fetal liver, umbilical cord blood, bone marrow, and mobilized peripheral blood. Using a 7-day liquid culture system, FL in combination with interleukin-3 (IL-3), interleukin-6 (IL-6), and granulocyte colony-stimulating factor (G-CSF) was comparable with KL in combination with IL-3, IL-6, and G-CSF for the expansion of hematopoietic progenitors. When FL-containing cultures were assayed after 21 or 28 days, a greater number of progenitors were generated as compared with KL-containing cultures. Using bone marrow microvascular endothelial cells as support stroma, cultures supplemented with FL generated a greater number of progenitors in both the nonadherent and adherent layers at day 35. These data suggest that FL ligand, in combination with other cytokines, can be used for short-term ex vivo expansion of hematopoietic progenitors and facilitates the preservation and possible expansion of primitive cells capable of long-term generation of progenitors.

Errors of context and review of eye movement desensitization and reprocessing research

The development of eye movement desensitization and reprocessing (EMDR) has been marked by an emphasis on research, beginning with its introduction by a controlled study in 1989. However, misconceptions regarding the method abound. A recent inaccurate literature review demonstrates the need for more careful scrutiny. To date, 12 controlled studies have been completed in the area of PTSD, most of which support EMDR's efficacy. Nevertheless, a careful examination of a number of studies and of a recent literature review reveal the need for greater methodological rigor and higher clinical standards in both the research and research evaluation process.

Eye movement desensitization and reprocessing (EMDR): evaluation of controlled PTSD research

The completed controlled PTSD research on eye movement desensitization and reprocessing (EMDR) is placed within the context of other methods used in the treatment of post-traumatic stress disorder. A number of studies are presented that support EMDR as an empirically validated method. However, in several studies, clinical standards have not always been integrated with rigorous scientific methodology. The suggested standards include fidelity checks for the method being tested, the use of appropriate psychometrics, and assessment of co-morbidity factors. At the same time, because of common misconceptions about the method, a variety of problematic issues are discussed.

Congenital muscular dystrophy associated with merosin deficiency

"Classic" congenital muscular dystrophy is a heterogeneous group of disorders, characterized by early-onset muscle weakness and hypotonia, absence of overt cerebral or ocular symptoms, and muscle pathology consistent with a dystrophic process. A subset of patients with congenital muscular dystrophy have recently been found to be deficient in the extracellular matrix protein merosin. Consequently, we reviewed the clinical, pathologic, and immunohistochemical features of 12 patients (six males and six females) with classic congenital muscular dystrophy who have been seen at the Children's Hospital, Boston, over the past 15 years. There was marked clinical heterogeneity within this patient population, with age of independent ambulation ranging from 13 months to 6 years. Immunocytochemical analysis using antibodies to merosin, dystrophin, 43-kDa dystroglycan, adhalin, and laminin was normal in 11 of 12 patients. One patient had markedly abnormal staining for merosin; the majority of fibers were negative, although occasional fibers demonstrated patchy staining. Immunoblot analysis in this patient demonstrated markedly reduced levels of merosin (< 10% compared to controls and other patient), of apparently normal size. Clinically, this patient could be differentiated from the others by a marked elevation of serum creatine kinase (> 1000 U/L) and the presence of early white-matter changes on magnetic resonance imaging. The results of this study support the observation that abnormalities of merosin are present in a subgroup of patients with classic congenital muscular dystrophy. Although marked elevation of serum creatine kinase and white-matter changes on magnetic resonance imaging may serve to distinguish these patients from other patients with congenital muscular dystrophy, there remains a large proportion of patients in whom the underlying pathogenesis remains to be elucidated.

Treatment of resistant gestational choriocarcinoma with taxol: a report of two cases

Two patients with resistant gestational choriocarcinoma were treated w with Taxol after extensive prior chemotherapy including EMACO and platinum-based salvage chemotherapy. Both patients showed significant responses to Taxol. One patient relapsed in the brain and liver after treatment and died. Taxol was combined with carboplatin in the other patient who achieved sustained clinical and hormonal remission after craniotomy and excision of resistant disease in the brain.