Percutaneous coronary intervention in patients with peripheral artery disease and adverse cardiovascular adverse event and bleeding

Background

Peripheral artery disease (PAD) increase the risk of comorbidity and mortality in coronary artery disease (CAD).

Objectives

We evaluate influence of PAD on prognosis in patients undergoing percutaneous coronary intervention (PCI).

Methods

We analyzed all consecutive patients included in our dedicated local registry for PCI between January 2011 and December 2016. Presence of PAD was defined by decreased ankle-brachial index (<0.9). Major adverse cardiovascular event (MACE) was defined as a composite of cardiovascular death, non-fatal myocardial infarct, revascularization, and ischemic stroke. Major bleeding was defined as Bleeding Academic Research Consortium 3 or 5.

Results

Among the 4,747 patients who underwent the PCI, 12.9% (n=610) of PAD were identified. Old age (>60 years), renal dysfunction, reduced ejection fraction, and presence of PAD were predictors with both MACE and major bleeding event. Among them, presence of PAD was an independent risk factor of MACE and major bleeding (MACE, HR 8.26, 95% CI 2.33- 29.41, p=0.036; major bleeding, HR 3.11, 95% CI 1.10–10.63, p=0.040, respectively). The MACE and major bleeding rate at 5-year was significantly increased in patients with PAD (MACE, 30.0% vs. 15.8%, log rank test p<0.001; major bleeding, 6.7 vs. 3.6%, log rank test p=0.003, respectively) (Figure).

Conclusion

Presence of PAD was strongly associated with higher rate of long-term MACE and major bleeding. These findings could have a clinical relevance in requiring individualized pharmacologic strategies to reduce the burden of cardiovascular disease.

Funding Acknowledgement

Type of funding sources: None.

Impact of active and stable cancer on survival in patients undergoing percutaneous coronary intervention

Background

With advances in treatment of ischemic heart disease and cancer treatment, use of percutaneous coronary intervention (PCI) in cancer survivors and patients with active cancer (AC) is expanding.

Objectives

The purpose of this study was to determine the impact of cancer on survival and major cardiovascular events (MACE) in a long-term, single-center cohort of patients treated with PCI.

Methods

Patients treated with PCI between January 2010 and December 2017 were grouped as follows: controls (patients without cancer), stable cancer (SC), and AC. AC was included patients with cancer diagnosed within the past 6 months, patients who had cancer-related therapy within the past 6 months, active metastatic disease, or active recurrence of the cancer. The primary endpoints were 5-year survival and a secondary endpoint was 5-year MACE.

Results

A total of 6,743 patients (age 66±12 years, 68.4% men) treated with PCI were included: 6,404 (95.0%) controls, 245 (3.6%) SC, and 94 (1.4%) AC. Predominant malignancies were gastrointestinal (37.4%), lung (22.7%), and genitourinary cancer (14.7%). No differences were observed between patients with AC, SC and controls regarding 5-year MACE (total MACE, 33.2% vs. 28.1% vs. 17.5%, p=0.072; cardiac death, 13.6% vs. 9.1% vs. 6.7%, p=0.066; non-fatal myocardial infarction, 2.9% vs. 7.5% vs. 7.8%, p=0.820; revascularization, 17.9% vs. 17.6% vs. 11.6%, p=0.794, respectively). Patients with AC and SC had reduced 5-year survival compared with controls (62.0% vs. 81.5% vs. 89.8%, p<0.001) (Figure). AC was associated with a 1.76 (95% CI 1.22 to 2.54, p=0.002) fold increased risk of all-cause 5-year mortality in multivariable adjusted models.

Conclusions

Cumulative incidence of 5-year survival was discriminated by concurrent status of cancer following PCI. Individualized decision making is needed in the routine practice of PCI regarding concurrent cancer-specific treatment and prognosis.

Funding Acknowledgement

Type of funding sources: None.

P1416 Clinical importance of consecutive transthoracic echocardiography in the patients with hypertrophic cardiomyopathy

Funding Acknowledgements

nothing

OnBehalf

nothing

Background

prediction of outcomes Hypertrophic cardiomyopathy (HCM) have been robustly analyzed with echocardiography. However, there is limited data of serial follow-up (FU) transthoracic echocardiography (TTE) to predict outcomes in patients with HCM.

Objectives

This study aim is to discover clinical predictors associated with consecutive TTE follow-up in patients with HCM.

Methods

From 2010 to 2016, 162 patients with HCM were enrolled retrospectively. Concentric LVH and others systolic disease related to wall thickness were excluded. Index TTE (baseline) was measured when firstly admitted in our hospital. FU TTE was analyzed at the end of follow-up, defined as the last recorded value in patients who did not develop events or the last recorded value before events developed.

Results

The average of FU TTE and clinical FU period was 3.7 ± 2.0 years. Clinical outcomes were defined as stroke, syncope, heart failure, arrhythmia and death. Interestingly, only baseline TR V max was a predictor for clinical outcome whereas the others echo parameters were not associated with events (Table 1). KM curve showed the TR Vmax ≥2.5m/s was also significant (log rank = 0.008, Fig 1.)

Conclusions Our study showed short-term FU TTE did not bring clinician with clinical benefits in the aspect of prediction for events. Only baseline TR V max was good correlation with cardiovascular outcomes and even in the survival analysis.

Serial TTE and changed values Total N = 162 index TTE (baseline) FU TTE Change of FU per year event no event p-value event no event p-value event no event p-value IVDd, mm 14 ± 4 15 ± 5 0.500 15 ± 5 14 ± 5 0.758 0.23 ± 0.51 -0.07 ± 1.27 0.200 LVIDd, mm 47 ± 5 48 ± 6 0.256 47 ± 7 48 ± 6 0.560 -0.22 ± 2.79 0.10 ± 2.27 0.444 LVEF, % 62 ± 5 61 ± 7 0.379 61 ± 6 61 ± 10 0.927 -0.43 ± 3.10 -0.04 ± 4.94 0.620 LAVI 43 ± 9 43 ± 8 0.879 57 ± 27 58 ± 23 0.849 0.53 ± 14.5 3.11 ± 7.2 0.134 EA ratio 0.9 ± 0.6 0.9 ± 0.6 0.782 1.0 ± 0.8 0.9 ± 0.6 0.595 -0.02 ± 0.76 0.003 ± 0.027 0.594 DT,ms 196 ± 58 201 ± 62 0.603 203 ± 91 217 ± 89 0.370 17 ± 57 5 ± 40 0.154 septal e` 4.4 ± 2.1 4.2 ± 1.6 0.585 4.4 ± 1.6 4.6 ± 1.7 0.438 0.24 ± 0.91 0.05 ± 0.65 0.190 E of e` 17 ± 11 17 ± 23 0.993 15 ± 9 15 ± 6 0.726 -0.48 ± 4.42 -1.66 ± 22.78 0.728 TR velocity 2.6 ± 0.5 2.4 ± 0.4 0.012 2.7 ± 0.6 2.6 ± 0.4 0.604 0.05 ± 0.30 0.04 ± 0.18 0.905 Max wall thickness 17 ± 3 18 ± 3 0.137 17 ± 4 17 ± 3 0.888 -0.01 ± 2.19 -0.18 ± 1.14 0.522

Abstract P1416 Figure. TR Vmax and CV outcomes in the KM curve

The 100 most-cited articles on non-tuberculous mycobacterial infection from 1995 to 2015

SETTING

Citation analyses aid in assessing quality, trends and future directions of research fields.

OBJECTIVE

To identify the most influential articles on infections caused by non-tuberculous mycobacteria (NTM) in the last 20 years.

DESIGN

We performed a cited reference search of the Web of Science database from 1995 to 2015. The 100 most cited articles on NTM infections were analysed.

RESULTS

The top 100 articles were cited 114-1471 times, and were published from 1995 to 2013. Sixty-five were laboratory-based, basic science articles, with the major topics being pathophysiology (n = 20) and molecular methods for NTM identification (n = 15). Among the 35 non-laboratory studies, major topics were clinical management (n = 15) and epidemiology (n = 14). The top article was a clinical treatise on the management of NTM disease, published in 2007. Although there was a correlation between article rank and journal impact factor (P = 0.043, ρ = -0.202), the five articles from the journals with highest impact factors did not rank among the top 10 articles.

CONCLUSION

A large proportion of influential articles on NTM infection are basic scientific studies, and the most influential articles are not always published in high-impact journals.

A pilot study of tandem high-dose chemotherapy with stem cell rescue as consolidation for high-risk neuroblastoma: Children's Oncology Group study ANBL00P1

Increasing treatment intensity has improved outcomes for children with neuroblastoma. We performed a pilot study in the Children’s Oncology Group (COG) to assess feasibility and toxicity of a tandem myeloablative regimen without total body irradiation (TBI) supported by autologous CD34 selected peripheral blood stem cells. Forty-one patients with high-risk neuroblastoma were enrolled; eight patients did not receive any myeloablative consolidation procedure, and seven received only one. Two patients out of 41 (4.9%) experienced transplant-related mortality. CD34 selection was discontinued after subjects were enrolled due to serious viral illness. From the time of study enrollment, the overall 3-year event-free survival (EFS) and overall survival (OS) were 44.8±9.6% and 59.2±9.2% (N=41). These results demonstrate that tandem transplantation in the cooperative group setting is feasible and support a randomized comparison of single versus tandem myeloablative consolidation with PBSC support for high-risk neuroblastoma.

Assessing the environmental performance of English arable and livestock holdings using data from the Farm Accountancy Data Network (FADN)

Agri-environment schemes (AESs) have been implemented across EU member states in an attempt to reconcile agricultural production methods with protection of the environment and maintenance of the countryside. To determine the extent to which such policy objectives are being fulfilled, participating countries are obliged to monitor and evaluate the environmental, agricultural and socio-economic impacts of their AESs. However, few evaluations measure precise environmental outcomes and critically, there are no agreed methodologies to evaluate the benefits of particular agri-environmental measures, or to track the environmental consequences of changing agricultural practices. In response to these issues, the Agri-Environmental Footprint project developed a common methodology for assessing the environmental impact of European AES. The Agri-Environmental Footprint Index (AFI) is a farm-level, adaptable methodology that aggregates measurements of agri-environmental indicators based on Multi-Criteria Analysis (MCA) techniques. The method was developed specifically to allow assessment of differences in the environmental performance of farms according to participation in agri-environment schemes. The AFI methodology is constructed so that high values represent good environmental performance. This paper explores the use of the AFI methodology in combination with Farm Business Survey data collected in England for the Farm Accountancy Data Network (FADN), to test whether its use could be extended for the routine surveillance of environmental performance of farming systems using established data sources. Overall, the aim was to measure the environmental impact of three different types of agriculture (arable, lowland livestock and upland livestock) in England and to identify differences in AFI due to participation in agri-environment schemes. However, because farm size, farmer age, level of education and region are also likely to influence the environmental performance of a holding, these factors were also considered. Application of the methodology revealed that only arable holdings participating in agri-environment schemes had a greater environmental performance, although responses differed between regions. Of the other explanatory variables explored, the key factors determining the environmental performance for lowland livestock holdings were farm size, farmer age and level of education. In contrast, the AFI value of upland livestock holdings differed only between regions. The paper demonstrates that the AFI methodology can be used readily with English FADN data and therefore has the potential to be applied more widely to similar data sources routinely collected across the EU-27 in a standardised manner.

The RNA interference of amino acid transporter LAT1 inhibits the growth of KB human oral cancer cells

BACKGROUND

Amino acid transporters are essential for growth and proliferation in all living cells. Among the amino acid transporters, the system L amino acid transporters are the major nutrient transport system responsible for the Na+-independent transport of neutral amino acids, including several essential amino acids. The L-type amino acid transporter 1 (LAT1) is overexpressed to support cell growth in malignant tumors. Double-stranded RNA-mediated RNA interference (RNAi) analysis can be used in a wide variety of eukaryotes to induce the sequence-specific inhibition of gene expression. The current study attempted to investigate the effects of silencing LAT1 expression with small interfering RNA (siRNA) on cell growth in the KB human oral squamous cell carcinoma.

MATERIALS AND METHODS

The effects of silencing LAT1 expression with siRNA KB on cell growth were examined using RT-PCR, Western blot analysis, amino acid transport measurement and the MTT assay.

RESULTS

In the RT-PCR and Western blot analyses, the siRNA of LAT1 inhibited the expressions of LAT1 mRNA and protein. The uptake of [14C]L-leucine was also inhibited by the siRNA of LAT1. In the MTT assay, the siRNA of LAT1 inhibited the growth of the KB cells in a time-dependent manner, indicating that this growth inhibition was induced by the LAT1-mediated blocking of neutral amino acid transport.

CONCLUSION

The transport of neutral amino acids, including several essential amino acids, into the KB human oral squamous cell carcinoma is mainly mediated by LAT1. Furthermore, LAT1 could be a new target for the inhibition of cancer cell growth.

Determination of environmental factors influencing methane oxidation in a sandy landfill cover soil

It is advantageous to use coarse soils as landfill cover because they allow better aeration of the biologically active zone. In this study, therefore, patterns of methane oxidation were investigated under various environmental conditions including soil moisture content, temperature, and the addition of NH4+ in a sandy landfill cover soil. The kinetics of CH4 oxidation was also studied at different moisture contents and temperatures. Soil moisture content of 10% (wt/wt) resulted in the maximum CH4 oxidation rate (19.2-22.4 nmol gsoil DW(-1) min(-1)). A Vmax value was not significantly different when the moisture content was more than 10%, but a Km value increased from 5.23 to 75.24 microM as the moisture content increased. The ratio of Vmax to Km was the highest at 10% moisture content. The CH4 oxidation rate increased as the incubation temperature increased, and Q10 values and optimum temperature were determined to be 2.57-2.69 and 30 degrees C, respectively. Both Vmax and Km values decreased at the temperatures below and above 30 degrees C. The addition of various levels of NH4+ resulted in increased or decreased CH4 oxidation rates, however, the initiation of appreciable CH4 oxidation was delayed with increasing amounts of NH4+ application in all samples tested. Among the environmental variables tested, moisture content control seems to be the most important and an efficient means of managing methane oxidation when sandy soils are used in landfill cover.

Deep soft tissue infections in the neutropenic pediatric oncology patient

PURPOSE

Necrotizing fasciitis and myonecrosis can be rapidly fatal without prompt and aggressive medical and surgical therapy. We reviewed our experience with necrotizing fasciitis and myonecrosis in neutropenic pediatric oncology patients to describe associated clinical characteristics and outline therapeutic interventions.

PATIENTS AND METHODS

A retrospective chart review was performed for all cases of deep soft tissue infection found in neutropenic pediatric oncology patients during an 11-year period.

RESULTS

Seven cases of necrotizing fasciitis and/or myonecrosis associated with chemotherapy-induced neutropenia were diagnosed during the study period. Deep soft tissue infection was diagnosed a median of 14 days after the initiation of chemotherapy. All of the patients presented with fever and pain, generally out of proportion to associated physical findings. Most patients (86%) also had tachycardia and subtle induration at the site of soft tissue infection. The pathogenic organism in four of seven patients originated in the gastrointestinal tract. Patients were treated with antibiotics, surgical debridements, granulocyte colony-stimulating factor, and hyperbaric oxygen. Granulocyte transfusions were administered if there were no signs of neutrophil recovery. Five patients survived their deep soft tissue infection.

CONCLUSIONS

The diagnosis of necrotizing fasciitis and/or myonecrosis should be considered in any neutropenic patient with fever, tachycardia, and localized pain out of proportion to the physical findings. Appropriate therapy includes broad-spectrum intravenous antibiotics and urgent surgical intervention. Granulocyte colony-stimulating factor should be administered to all patients to enhance neutrophil recovery. Granulocyte transfusions should be considered if a prolonged period of neutropenia is anticipated.

Phase I topotecan preparative regimen for high-risk neuroblastoma, high-grade glioma, and refractory/recurrent pediatric solid tumors

We evaluated the toxicity and maximum tolerated dose of topotecan in a novel myeloablative regimen as treatment for high-risk pediatric tumors. Patients received an assigned topotecan dosage in combination with fixed doses of carboplatin and thiotepa, followed by autologous hematopoietic stem cells infusion. Topotecan dose was escalated in cohorts of four patients until the maximum tolerated dose of topotecan was defined or until accrual of 30 patients. Pharmacokinetics of topotecan were examined, and event-free survival was estimated. We describe preliminary results following treatment of 25 pediatric patients with high-risk solid tumors.

Foot screening technique in a diabetic population

Foot complications are a well known factor which contribute to the morbidity of diabetes and increases the chance of amputation. A total of 126 consecutive diabetic patients were evaluated by diabetic foot screening. Forty-one patients showed an impaired protective sense when tested with Semmes-Weinstein monofilament 5.07 (10 g), and 92% of them showed peripheral polyneuropathy in nerve conduction study (NCS). The mean vibration score of the Rydel-Seiffer graduated tuning fork in patients with peripheral polyneuropathy in nerve conduction (NCV) study was 5.38+/-2.0, which was significantly different from that of patients without polyneuropathy in NCS. Among the deformities identified on examination, callus, corn, and hallux valgus were the greatest. While checking the ankle/ brachial index (ABI), we also evaluated the integrity of vasculature in the lower extremities. After extensive evaluation, we classified the patients into eight groups (category 0,1,2,3,4A,4B,5,6). The result of this study suggested that the Semmes-Weinstein monofilament test, Rydel-Seiffer graduated tuning fork test, and checking the ankle/brachial index were simple techniques for evaluating pathologic change in the diabetic foot by office screening, and that this screening based on treatment-oriented classification helps to reduce pedal complications in a diabetic population.

Myelokathexis, a congenital disorder of severe neutropenia characterized by accelerated apoptosis and defective expression of bcl-x in neutrophil precursors

Myelokathexis is a congenital disorder that causes severe chronic leukopenia and neutropenia. Characteristic findings include degenerative changes and hypersegmentation of mature neutrophils and hyperplasia of bone marrow myeloid cells. The associated neutropenia can be partially corrected by treatment with granulocyte colony-stimulating factor (G-CSF) or granulocyte-macrophage colony-stimulating factor (GM-CSF). These features led us to propose that accelerated apoptosis of neutrophil precursors might account for the neutropenic phenotype. Blood and bone marrow aspirates were obtained from 4 patients (2 unrelated families) with myelokathexis before G-CSF therapy and from 2 of the affected persons after G-CSF therapy (1 microg/kg per day subcutaneously for 3 weeks). Bone marrow was fractionated using immunomagnetic bead cell sorting into CD34(+), CD33(+)/CD34(-), and CD15(+)/CD34(-)/CD33(- )cell populations. Examination of these cells by flow cytometry and electron microscopy revealed abundant apoptosis in the CD15(+) neutrophil precursor population, characterized by enhanced annexin-V binding, extensive membrane blebbing, condensation of heterochromatin, and cell fragmentation. Colony-forming assays demonstrated significant reduction in a proportion of bone marrow myeloid-committed progenitor cells. Immunohistochemical analysis revealed a selective decrease in bcl-x, but not bcl-2, expression in the CD15(+)/CD34(-)/CD33(-)cell population compared with similar subpopulations of control bone marrow-derived myeloid precursors. After G-CSF therapy, apoptotic features of patients' bone marrow cells were substantially reduced, and the absolute neutrophil counts (ANC) and expression of bcl-x in CD15(+)/CD34(-)/CD33(-)cells increased. The authors concluded that myelokathexis is a disease characterized by the accelerated apoptosis of granulocytes and the depressed expression of bcl-x in bone marrow-derived granulocyte precursor cells. These abnormalities are partially corrected by the in vivo administration of G-CSF. (Blood. 2000;95:320-327)

Unidirectional single-mode Nd:YAG laser with a planar semimonolithic ring cavity

Unidirectional single-mode operation of a diode-pumped Nd:YAG laser with a planar semimonolithic ring cavity has been demonstrated at 1064 nm. The semimonolithic cavity consists of a laser active medium placed in a magnetic field, a crystal quartz plate, and an output coupling mirror, which form an optical diode by acting as a Faraday rotator, a reciprocal polarization rotator, and a partial polarizer, respectively. A single-mode output power of 155 mW and a slope efficiency of 17% were obtained with a 1.2-W diode laser at 809 nm. A laser linewidth of less than 100 kHz is inferred from a beat note frequency spectrum between two identical laser systems and continuous tuning to greater than 2 GHz was observed.

Down-regulation of apurinic/apyrimidinic endonuclease expression is associated with the induction of apoptosis in differentiating myeloid leukemia cells

The human DNA repair enzyme apurinic/apyrimidinic endonuclease (APE/ref-1) is a multifunctional protein in the DNA base excision repair (BER) pathway that is responsible for repair of apurinic/apyrimidinic (AP) sites in DNA. DNA repair and programmed cell death both function using different mechanisms to protect the organism from the consequences of extensive cellular damage; however, little is known about the relationship of the DNA BER repair pathway to apoptosis. We have determined the relationship of a BER DNA repair enzyme, APE, to apoptosis using the myeloid leukemia cell line HL-60, which can be induced to differentiate down the granulocytic or monocytic/ macrophage pathway. Treatment of HL-60 cells with retinoic acid/DMSO (granulocytic) or phorbol 12-myristate 13-acetate (monocytic) results in apoptosis and in down-regulation of APE expression at both the RNA and protein levels. Moreover, double-labeling experiments using APE immunohistochemistry and the terminal deoxyribonucleotidyl transferase-mediated dUTP-fluorescein nick end labeling assay for apoptosis demonstrate that individual cells undergoing apoptosis lose expression of APE regardless of their state of differentiation. Blocking apoptosis by overexpression of the bcl-2 proto-oncogene in HL-60 cells or by a bcr-abl-related mechanism in K562 cells and subsequent differentiation results in morphological differentiation but no loss of APE expression. These studies establish that down-regulation of APE expression is associated with programmed cell death in cells of the myeloid lineage.

Preresection chemotherapy improves survival for children with Askin tumors

OBJECTIVE

To test whether patients with Askin tumor treated with aggressive neoadjuvant chemotherapy have a better clinical outcome.

DESIGN

Retrospective case series.

SETTING

Pediatric referral center.

PATIENTS

All children diagnosed with malignant small-cell tumors of the chest wall (Askin tumor) and treated from 1975 to September 1987 (phase 1, n = 6) and from September 1987 to the present (phase 2, n = 9).

MAIN OUTCOME MEASURES

Survival as a function of extent of disease and response to therapy as measured by tumor volume, survival, and recurrence.

RESULTS

All phase 2 patients had significant reduction of tumor volume and improved survival by Kaplan-Meier estimates compared with phase 1 patients. No phase 1 patients are still alive.

CONCLUSION

Patients with Askin tumor treated with aggressive preresection chemotherapy have smaller tumors to resect and improved survival.

Cytokine regulation of apoptosis in hematopoietic precursor cells

Cytokines are known to influence hematopoietic precursor cell survival. Apoptosis (a programmed cell death pathway) has been identified as the key factor limiting hematopoietic precursor cell survival and cytokines have been demonstrated to induce or prevent apoptosis in a variety of hematopoietic precursor cell populations. Whether a specific cytokine inhibits or suppresses apoptosis depends on cytokine-mediated modulation of target cell cytokine receptors, cell death regulator genes such as bcl-2 family members, Fas receptor, and other pathways. Finally, the intracellular pathways of cytokine receptor-mediated control of apoptosis have begun to be unraveled, implicating specific intracellular receptor domains and protein kinases in the regulation of apoptosis and hematopoietic precursor cell survival.

BCL-2, a novel regulator of apoptosis

The bcl-2 gene has a unique function among mammalian oncogenes as a negative regulator of apoptosis. Its expression pattern in embryonic and adult tissues is consistent with a role in maintaining in vivo survival of specific cell types. The biochemical function of bcl-2 is unknown, but its localization to mitochondrial and microsomal membranes suggests several possibilities. bcl-2 is protective against oxidative stress in mammalian cells and can be replaced by antioxidants in a factor-deprivation model of apoptosis. These results are consistent with a model of apoptotic death involving oxidative stress in a central pathway. The recent discovery of several bcl-2-related genes, some of which also inhibit apoptosis and others that unexpectedly promote apoptosis, has shed new light on several aspects of bcl-2 action.

Primitive human hematopoietic precursors express Bcl-x but not Bcl-2

Bcl-2 and its homologue, bcl-xL, encode membrane-associated proteins that suppress programmed cell death of hematopoietic cell lines after growth factor withdrawal, and are expressed in hematopoietic precursor cells. To better understand the maintenance of long-term survival in the hematopoietic stem cell population, we evaluated the expression patterns of Bcl-2 and Bcl-x in primitive hematopoietic precursor populations. Hematopoietic precursor cells expressing CD34 (CD34+) and lacking maturation-linked surface antigens (lin-) were isolated from adult human bone marrow using two-color immunofluorescence cell sorting and fractionated on the basis of forward light scatter characteristics into blast-sized and small to medium lymphocyte-sized cell populations. Bcl-2 expression was shown in 78% to 90% of CD34+ lin- blast-sized cells versus less than 10% of small to medium lymphocyte-sized CD34+ lin- cells by immunohistochemical analysis. Small to medium lymphocyte-sized CD34+ lin- cells were further enriched for primitive precursors by selecting cells that lacked expression of CD38 (CD34+ lin- CD38-). In parallel experiments, only 1% to 4% of CD34+ lin- CD38- cells expressed Bcl-2, whereas 45% to 56% of these cells generated colony-forming cells. In contrast, > or = 94% of cells in all bone marrow subpopulations studied expressed Bcl-x protein. Both alternatively spliced bcl-x transcripts, bcl-xL and bcl-xs, were present. Our data show that the most primitive hematopoietic precursors express Bcl-x but not Bcl-2. Thus, the functional bcl-2 homologue, bcl-xL, may be essential for the long-term survival of the hematopoietic stem cell population.

Effect of ivermectin on infection with gastro-intestinal nematodes in Sierra Leone

Levels of intestinal nematode infections were assessed six months after a two year trial of ivermectin for efficacy against onchocerciasis had ended. In the trial the inhabitants of six villages in Sierra Leone were offered treatment with ivermectin or placebo at six monthly intervals for four rounds in total. Quantitative faecal egg counts were carried out on stool samples provided by 202 subjects, all of whom had received all four rounds of treatment, in two of the villages (Dodo and Mogibisi). These data were analysed by a novel procedure in which a 3-way ANOVA with negative binomial errors enabled village and host gender influences on the outcome of treatment to be identified. Necator americanus was the most common species showing an overall prevalence of 90% but a higher intensity in Mogibisi relative to Dodo, particularly among male subjects. Neither prevalence nor intensity of infection were altered in ivermectin-treated compared with placebo-treated subjects. Trichuris trichiura was the least common species with a prevalence of 15%. It was concluded that there was no significant protection from infection with this species among the ivermectin relative to the placebo-treated subjects. Ascaris lumbricoides, with an overall prevalence of 39%, was more common among female (50%) compared with male (27%) villagers. Prevalence was not significantly affected by ivermectin but the intensity of infection declined by 91.3% in Dodo whilst in Mogibisi intensity was only reduced by 14.6%.(ABSTRACT TRUNCATED AT 250 WORDS)

Dysregulated bcl-2 expression inhibits apoptosis but not differentiation of retinoic acid-induced HL-60 granulocytes

The bcl-2-proto-oncogene appears to contribute to the development of certain malignancies by inhibiting programmed cell death (apoptosis). Mature granulocytes show a markedly limited life span and rapidly undergo apoptosis. To further define the relationship between apoptosis and granulocyte differentiation, we used retroviral vector-mediated gene transduction to introduce the normal bcl-2 gene into the HL-60 myeloid leukemia cell line and determined the response of these bcl-2-transduced HL-60 cells to the induction of granulocyte differentiation by retinoic acid (RA). Although the bcl-2-transduced HL-60 cells showed the same differentiative response to RA as did the parental HL-60 cells, the life span of the RA-induced, bcl-2-transduced HL-60 granulocytes was markedly prolonged compared with that of the RA-induced parental HL-60 granulocytes. DNA fragmentation studies indicate that this prolonged life span resulted from diminished apoptosis in the bcl-2-transduced cells. These studies indicate that bcl-2 is involved in regulating apoptosis in maturing granulocytes. Because bcl-2 over-expression did not interfere with RA-induced granulocyte differentiation, it appears that granulocyte differentiation and apoptosis are under distinct and separate regulatory controls.

Compositional changes and apoprotein A-I metabolism of plasma high density lipoprotein in estrogenized chicks

The effect of estrogen on compositional changes, apolipoprotein (apo) A-I metabolism and the morphology of plasma high density lipoprotein (HDL) were investigated in chicks. The administration of 17 beta-estradiol (25 mg/kg body weight) to growing male chicks (8-week-old) markedly reduced the concentrations of plasma HDL components, except for triglyceride (TG). At the same time, levels of TG, total cholesterol (TC) and phospholipid (PL) in plasma were greatly elevated. The respective values for TG, TC, PL and protein in HDL were 13.9, 89.3, 154.1 and 231.7 (mg/dL) in the control, and 39.0, 35.1, 113.8 and 160.0 (mg/dL) in chicks upon estrogen treatment for one day. In vivo kinetic studies showed that the fractional catabolic rate of HDL apo A-I was significantly higher (p less than 0.05) in estrogen-treated chicks than in control birds, indicating an increased efficiency of HDL removal in the former. The production rate of HDL apo A-I also was significantly lower (p less than 0.05) in estrogen-treated chicks. Sodium dodecyl sulfate-acrylamide gel electrophoresis followed by laser scanning densitometry of HDL apolipoproteins in estrogen-treated chicks revealed a reduction of apo A-I and the occurrence of new apolipoproteins which had been absent in HDL of untreated birds. The HDL particles showed that the mean particle size of HDL became larger upon estrogen treatment. Particles with diameters between 70 and 123 A were predominant in HDL of control chicks, while particles with diameters between 97 and 143 A were most abundant in HDL of estrogen-treated chicks.

Protein damage and lipid peroxidation: effects of diethyl maleate, bromotrichloromethane and vitamin E on ammonia, urea and enzymes involved in ammonia metabolism

Changes in ammonia and urea were investigated as potential marker products of free radical damage to protein and subsequent metabolism of those damaged proteins in vivo. Both serum and liver lipid peroxidation products as measured by thiobarbituric-acid-reactive substances (TBARS) were increased by feeding rats a vitamin-E-deficient diet. The acute injection of diethyl maleate and bromotrichloromethane (DEM/BrCCl3) increased TBARS in liver of rats fed a vitamin-E-deficient diet. The concentrations of ammonia and urea in the serum and liver did not correlate with lipid peroxidation. The activities of liver glutaminase and arginase were decreased by DEM/BrCCl3 treatment in rats fed vitamin-E-deficient diet. Glutamate-ammonia ligase activity was decreased by vitamin-E-deficient diet but not by DEM/BrCCl3 treatment. Ornithine carbamoyltransferase, arginosuccinate synthase, argininosuccinate lyase and glutamate dehydrogenase (NAD(P)+) were not affected by dietary vitamin E or by DEM/BrCCl3. The data suggest that the concentrations of ammonia and urea, major by-products of nitrogen metabolism, are unchanged by the oxidant damage and lipid peroxidation, and that their control in vivo is a dynamic equilibrium of various metabolic pathways.

Effects of estrogen on very-low-density lipoprotein triacylglycerol metabolism in chicks

Estrogen administration (25 mg/kg body weight) in chicks resulted in a marked elevation of plasma very-low-density lipoprotein (VLDL) triacylglycerol (TG). To determine whether the VLDL produced from estrogen (E)-treated birds is catabolized differently from VLDL of control birds, VLDL-TG kinetic studies were conducted. The [14C]TG-labeled VLDL was prepared by intravenous injection of [14C]palmitate into control and E-treated chicks. The [14C]TG-labeled VLDL prepared from the control (C-VLDL-TG) and E-treated chicks (E-VLDL-TG) were then reinjected into fed and fasted chicks with or without E-treatment. The metabolism of VLDL-TG was found to be different, depending upon whether its donor was the control of E-treated chick. The fractional catabolic rate (FCR) of E-VLDL-TG was significantly (P less than 0.05) lower than that of C-VLDL-TG in both fed and fasted chicks. Compared to the fed state, fasting resulted in significantly (P less than 0.05) increased FCRs of both C-VLDL-TG and E-VLDL-TG. The turnover rate of VLDL-TG was significantly higher in E-treated chicks than in their respective controls. In addition, the endogenously produced VLDL-TG differed in their affinity for lipoprotein lipase in which E-VLDL-TG had a higher Km value for the enzyme than C-VLDL-TG. On agarose gel electrophoresis, the VLDL of E-treated chicks showed beta-mobility and it eluted into two peaks on agarose gel filtration, whereas VLDL of control chicks had a pre-beta-mobility on the former and it eluted into a single peak on the latter. SDS-gel electrophoresis also revealed that the apolipoprotein composition of VLDL from control and E-treated chicks was notably different from each other. Present findings suggest that estrogen treatment results not only in an increased secretion of VLDL but also in the production of different VLDL particles, thereby affecting their clearance from the plasma.

Estrogen induces hyperlipidemia in fasted chicks

To determine whether the estrogen-induced hyperlipidemia is affected by fasting, male growing chicks were administered subcutaneously a single dose of 17 beta-estradiol (25 mg/kg body wt), and the hormone treatment lasted for 2 days with or without feed (Experiment 1). In the second experiment, chicks were initially fasted for 1 or 3 days, and then treated with the same dosage of 17 beta-estradiol as in Experiment 1 for 2 days without feed. Plasma and liver lipids, and the activities of hepatic malic enzyme, glucose-6-phosphate dehydrogenase, and hormone-sensitive lipase in the adipose tissue were determined. Compared with fed control chicks, estrogen treatment in fed birds resulted in a marked elevation of plasma lipids, especially triglyceride during the 2-day period (137 vs 2263 mg/dl). In fasted chicks, the present finding that estrogen also induced a marked hyperlipidemia is noteworthy. Upon estrogen treatment (Experiment 1), the level of plasma triglyceride in fasted birds increased about 16 times over that of the fasted control group (133 vs 2093 mg/dl). Even in chicks fasted for 5 days (Experiment 2), estrogen treatment resulted in a persistent hypertriglyceridemia (75 vs 1369 mg/dl). In fed chicks, estrogen treatment also induced a fatty liver with massive accumulation of triglyceride, but the liver of estrogen-treated/fasted chicks appeared to be normal. In both fed and fasted chicks, malic enzyme was found to be the major NADPH producing enzyme in the liver. Upon fasting, both malic enzyme and glucose-6-phosphate dehydrogenase activities decreased significantly (P less than 0.05). In fed chicks, the total activities of both enzymes increased with estrogen treatment, whereas the effect of hormone on these enzymes was less obvious in fasted chicks. The hormone-sensitive lipase activity in the adipose tissue was much lower in fed chicks compared with that of fasted birds (0.15 vs 0.33 nmol of oleic acid released/min/mg protein). Estrogen treatment in fed chicks had no effect on the hormone-sensitive lipase activity, but its activity was enhanced by the hormone treatment in fasted chicks. The present finding that hyperlipidemia persisted in estrogenized chicks during the fasting seems to indicate the complex nature of this hormonal influence on lipid metabolism.

Mechanism of improved corrosion resistance of Zn-containing dental amalgams

The aim of this study was to determine the mechanism of improved corrosion resistance of Zn-containing dental amalgams. Two Zn-containing conventional amalgams, their Zn-free counterparts, and three experimental amalgams (SnHg, ZnHg, and SnZnHg) were evaluated by the potentiodynamic polarization technique in 1% NaCl solution. The main difference between the two types of amalgams was found in their respective breakdown potentials at which passivity was destroyed. The breakdown potential of Zn-containing amalgams was about 200 mV more positive than that of the Zn-free amalgams. The improved stability of the Zn-containing amalgams has been attributed to the formation of a previously reported Zn stannate passive film which, according to the polarization data, is more resistant to the aggressive chloride ion than tin hydroxide that forms on Zn-free amalgams. The formation of Zn stannate was not found to affect the oxygen reduction reaction, the major cathodic reaction involved in the corrosion of dental amalgams.

Effects of estrogen-induced hyperlipidemia on the erythrocyte membrane in chicks

The effects of estrogen-induced hyperlipidemia on plasma lipid peroxidation, fatty acid composition and osmotic fragility of erythrocytes in chickens were studied. Young male chickens implanted with estrogen for three wk developed a marked hyperlipidemia. Plasma levels of triglyceride, cholesterol and phospholipid were elevated 68-, four- and 24-fold, respectively, over controls. There was also a two-fold increase in plasma lipid peroxidation measured by the thiobarbituric acid test. Vitamin E supplement (1,000 IU/kg diet) reduced the plasma lipid peroxidation to the control level, but had no effect on the plasma lipid content. Estrogen-induced hyperlipidemia resulted in changes in the fatty acid composition of membrane lipids of erythrocytes. The major changes were an increase in oleic acid from 10.0% to 14.2% and a decrease in linoleic acid from 31.3% to 26.0%. The erythrocytes with an altered membrane fatty acid composition were found to have an increased osmotic fragility. It was apparent that there was a direct correlation between the oleic acid content and the osmotic fragility of erythrocytes.

Changes in plasma lipids, lipoproteins, triglyceride secretion and removal in chicks with estrogen implants

Estradiol implants in chicks resulted in marked elevation of all major plasma lipids with greatest increase in triglyceride (TG) followed by phospholipid (PL) and cholesterol (C). During the two-wk period, plasma TG level in estrogen (E)-treated chicks increased to about 45 times that of controls (139.6 vs 6,368.3 mg/dl). The level of cholesterol also increased steadily during the same period, attaining nearly a six-fold increase in comparison with the control (150.7 vs 871.8 mg/dl), and the level of PL was markedly elevated from 209 to 2,861 mg/dl. Besides the induction of hyperlipidemia, E treatment also resulted in a notable alteration in the fatty acid composition of plasma lipids; there was an increase in oleic acid concomitant with a decrease in polyunsaturated fatty acids, particularly, linoleic acid. One day after implantation, the percentage of oleic acid in TG fraction increased from 39.2 to 43.7%, reaching 55.4% of the total fatty acids at day 14. In contrast, the levels of linoleic and arachidonic acid decreased significantly from 16.1 to 8.3% and 4.3 to 0.6%, respectively, during the same period. In cholesteryl ester (CE) and PL, the oleic acid level also increased from 25.2 to 47.3% in the former and from 11.9 to 29.6% in the latter, reflecting enhanced hepatic lipogenesis. Analysis of plasma lipoproteins in E-treated chicks revealed dramatic alterations in the concentrations of lipids and protein in individual lipoprotein fractions, especially very low density lipoprotein (VLDL) fraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Fecal steroid excretion in chickens with hereditary hyperlipidemia

Plasma lipids (cholesterol, triglycerides, and phospholipids; mg/dl) and the fecal excretion (mg/day) of neutral steroids and bile acids were studied in layers (L), hereditary nonlayer hens (NL), and roosters (R) fed a basal cholesterol-free grain diet ad libitum. Each group had significantly (P less than 0.05) different levels of plasma cholesterol, triglycerides, and phospholipids when compared to the other groups. The highest lipid values were found in the NL group (cholesterol, 798 +/- 89; triglycerides, 8914 +/- 679; phospholipids, 2458 +/- 112). There was no difference in the fecal excretion of neutral steroids between L and NL; however, fecal bile acid excretion by these two groups was significantly different (P less than 0.05) (L, 13.1 +/- 1.7 vs NL, 26.9 +/- 3.4). Fecal neutral steroid excretion by R was significantly greater (P less than 0.05) than that by either L or NL (L, 6.4 +/- 1.3; NL, 6.0 +/- 1.4; R, 14.4 +/- 1.2). While fecal excretion of bile acids by R (36.1 +/- 4.0) was also greater than that by either L or NL, only the difference between R and L was statistically significant (P less than 0.05). Since, in the steady state, fecal bile acid excretion is equal to its synthesis, these results suggest that bile acid metabolism in these animals can be affected by both sex and egg-laying status.

Immunological and histological study of guinea-pigs injected with insoluble human elastin

Guinea-pigs injected with insoluble human elastin in Freund's complete adjuvant developed delayed hypersensitivity to elastin as measured by skin testing. Circulating antibodies to both insoluble and soluble elastins were also found as well as an increase in lymphocyte stimulation by elastin. However, no histologically defined abnormalities were evident in the arterial vessels selected after 5 months.

Immunological studies in frozen shoulder

This immunological study of 40 patients with frozen shoulder showed a pretreatment increase in immune complex levels, C-reactive protein, and decreased lymphocyte transformation to phytohemagglutinin and concanavalin A compared to a control group. Repeat estimations after 8 months showed that values tended to approach control levels.

Immunological studies in patients with rheumatoid arthritis receiving azathioprine and myocrisin in combination

Thirty-one patients with classical or definite rheumatoid arthritis (RA), on treatment with azathioprine and sodium aurothiomalate in combination were studied. Absolute lymphocyte counts and IgA levels were reduced but this did not reach statistical significance. Lymphocyte transformation with phytohaemagglutinin (PHA) showed no significant difference from a control group. However, antibody dependent cell-mediated cytotoxicity was significantly impaired compared to rheumatoid controls (p less than 0.001). There was no relation to the degree of impairment of ADCC and the current dose of azathioprine nor to the total dose or duration of therapy. Inhibiting material to cell-mediated cytotoxicity was present in the sera of 23 patients but its presence showed no relation to the degree of cytotoxicity exhibited by cells in the same patient. Our studies of cellular cytotoxicity have revealed alterations in cellular function possibly attributable to azathioprine.

Relationship of the erythrocyte sedimentation rate to acute phase proteins in polymyalgia rheumatica and giant cell arteritis

We have compared the erythrocyte sedimentation rate (ESR) with other acute phase proteins (C-reactive protein (CRP), alpha(1) antitrypsin, orosomucoid, and haptoglobin) in 108 patients with polymyalgia rheumatica and/or giant cell arteritis. There was good correlation between CRP and ESR, but the ESR was also found to have the highest correlation with disease activity. The additional measurement of CRP or other acute phase proteins may be of value in a minority of cases.

Circulating immune complexes in polymyalgia rheumatica and giant cell arteritis

Sera from patients with giant cell arteritis and/or polymyalgia rheumatica have been found to contain increased levels of circulating immune complexes (IC). Results with the polyethyleneglycol precipitation complement consumption (PEG-CC) assay have been correlated with disease activity. 44% of samples from an active untreated group (21 patients) had increased levels of ICs compared with 23% from an inactive treated group (49 patients). Further analysis of circulating ICs was performed by 125I-Clq binding, the PEG-C4 test, and 125I-conglutinin binding assays. Although we did not find a high correlation between IC levels and disease activity, isolation and analysis of the ICs may lead to further understanding of this disorder.

In vitro lymphocyte cytotoxicity to cultured human arterial smooth muscle cells in patients with giant cell arteritis and polymyalgia rheumatica

Lymphocytes from polymyalgia rheumatica patients and controls were cultured with allogenic human arterial smooth muscle cells in order to demonstrate any difference in cytotoxic response. Thirty to 40% of the muscle cell cultures were killed at 24 h by lymphocytes from both the patients and controls.

Lack of consistent peripheral blood lymphocyte transformation responses in polymyalgia rheumatica and giant cell arteritis

The in vitro transformation response of peripheral blood lymphocytes to human arterial and muscle homogenates has been studied in patients with polymyalgia rheumatica (PMR), giant cell arteritis (GCA) and in unrelated controls. Homogenates that stimulated PMR/GCA cells also stimulated controls. There was no greater stimulation to human or bovine elastin than to artery and muscle homogenates. Our results do not confirm a lymphocyte abnormality in these diseases.

Immunological and histological study of temporal arteries

Sixty-four temporal arteries were studied. 36 were from patients with clinically active temporal arteritis or polymyalgia rheumatica; 22 showed histological changes of temporal arteritis, 12 of which were in an active stage. 28 arteries, none of which showed histological changes, were taken at necropsy or from patients with unrelated disease. Extracellular immunoglobulin and complement deposition was seen in the artery biopsies showing active arteries and in 1 of the 10 biopsies with inactive arteritis. There was no immunoglobulin or complement deposition in the 14 patients with clinically active temporal arteritis and/or polymyalgia rheumatica, but with a normal artery biopsy. Patients with clinically active temporal arteritis were more likely to have a positive biopsy. Our results support the suggestion that the immune deposition is concurrent with an active histologically proven arteritis. Immunofluorescent examination does not appear to be a better diagnostic test than histological examination.

Cellular immunity and circulating antibody to herpes simplex virus in subjects with recurrent herpex simplex lesions and controls as measured by the mixed leukocyte migration inhibition test and complement fixation

Cellular immune responses and circulating antibody levels to herpes simplex virus were examined in patients with recurrent herpes simplex (HSV) infections and controls. Mixed leukocyte migration inhibition by herpes simplex antigen was less in affected patients than in controls but serum antibody levels were higher. There was no significant difference in leukocyte migration between patients with active or recent lesions and other herpes subjects, and the response in the mixed leukocyte migration test to phytohaemagglutinin (PHA) was similar in patients and controls. The data presented suggest that a localized defect in cell mediated immunity to herpes simplex virus may exist and be responsible for recurrent herpes simplex infections.

Cellular and circulating immunity to diabetic basement membrane, a negative finding

A linear deposition of IgG was seen by immunofluorescence on the glomerular basement membrane of a diabetic kidney. However, when the remaining kidney was subjected to elution with acidic buffer the eluate had no affinity for glomerular basement membrane. The leucocytes from normal and diabetic subjects were also tested for an in vitro cell-mediated response to diabetic and normal basement membrane. No difference was found between the reaction of leucocytes from diabetics and those from normal age- and sex-matched controls.

The effect of transfer factor on the in vitro migration of tuberculin stimulated white cells from sarcoid and normal subjects

In the mixed leukocyte migration test, white cells from Mantoux positive and Mantoux negative individuals and from patients with sarcoidosis responded similarly to tuberculin, there being no significant difference in the migration index of the three groups. The cells from patients with sarcoidosis, however, showed a depressed response to phytohaemagglutinin. Transfer factor prepared from an individual with a very positive Mantoux reaction did not have any significant effect on the migration index when added to the white cells from sarcoid patients either in the presence or absence of tuberculin.