Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care

OBJECTIVE

The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis.

METHODS

We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded.

RESULTS

We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers.

CONCLUSION

In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.

Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry

BACKGROUND

Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months.

METHODS

We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed.

RESULTS

We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05).

CONCLUSION

While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.

Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis

BACKGROUND

Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry.

METHODS

In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months.

RESULTS

One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability.

CONCLUSION

High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.

Abstract P6-17-28: Outcomes of real-world use of eribulin plus trastuzumab for HER2-positive metastatic breast cancer

Background

Eribulin mesylate is approved for the treatment of metastatic breast cancer (mBC) after two prior chemotherapy regimens including an anthracycline or a taxane in either the metastatic or adjuvant setting. Eribulin in combination with trastuzumab (E+T) has demonstrated tolerability and anti-tumor activity in phase I and II trials but is not FDA-approved for the treatment of HER2-positive mBC. Case series and retrospective research have noted the use of E+T in clinical practice. We sought to describe patient characteristics and long-term outcomes of treatment with E+T for HER2-positive mBC patients treated outside of clinical trials in the US.

Methods

US-based community oncologists from an open network of over 7,000 oncologists, hematologists, and urologists were invited to participate in identifying HER2-positive mBC patients treated with E+T between 01/01/11 and 12/31/13 outside of clinical trials. Data were collected from 03/18/2016 until 09/01/2016. Providers completed an electronic case report form (CRF) by abstracting data on disease characteristics, treatment patterns, disease response (per provider assessment), adverse events (Aes), and date of death. Duration of treatment and overall survival (OS) were calculated from the initiation of the E+T regimen. The target sample size was 60 patients and patients were selected according to resource available for chart data abstraction.

Results

Twenty-three providers submitted CRFs for 62 total patients. After data collection, 59 of 62 submitted records were validated for analysis. At mBC diagnosis, 69.4% of patients were ER/PR negative and 42.4% of patient had de novo stage IV disease. At initiation of E+T, the median age was 57 years and 81.4% were ECOG-OS 0/1. Mean length of follow-up from the initiation of any therapy was 33.6 months. Twenty-two (37.3%) patients initiated E+T as their first- or second-line of treatment; those remaining were in third-line or greater. At initiation of E+T, 72.8% of patients had prior treatment with trastuzumab in combination with chemotherapy, 25.4% had prior trastuzumab in combination with pertuzumab and chemotherapy, and 16.9% had received TDM-1. Mean duration of E+T treatment was 5.2 months (SD=2.4). A response (complete [CR] or partial [PR]) was recorded by the providers for 64.4% of patients (not independently verified). The most common Aes reported were fatigue (67.8%), weakness (50.8%), decreased appetite (28.8%), decreased hemoglobin (27.1%), peripheral neuropathy (25.4%), and neutropenia (18.6%). At the end of the study period, 34 patients (57.6%) were deceased; the median OS from the initiation of E+T was 23.9 months (95% CI: 17.8-30.4).

Conclusions

In a small cohort of patients treated with E+T in the community setting, the observed response rate of 64.4% (CR+PR) was comparable to that of a prior phase II trial of E+T which reported an ORR with first-line E+T of 71.2% overall, 77.4% among T-naïve and 61.9% in T-pretreated patients. Further research is warranted to examine the tolerability and efficacy of E+T for metastatic HER2-positive breast cancer patients in different treatment settings.

Citation Format: Mougalian SS, Copher R, McAllister L, Radtchenko J, Wang EC, Broscious M, Yu H-T, Kish J. Outcomes of real-world use of eribulin plus trastuzumab for HER2-positive metastatic breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-28.

Abstract P5-15-16: Utilization and outcomes of eribulin in triple negative metastatic breast cancer: Real-world findings

Background

Triple-negative breast cancer (TNBC) accounts for 10-20% of all breast cancers (BCs) and a significant proportion of all BC deaths. Eribulin is approved for the treatment of metastatic BC (MBC) after treatment with two prior regimens. A pooled analysis of two phase III studies of eribulin in women with TNBC patients found a 26% reduction in the risk of death vs. controls. Treatment patterns of eribulin and clinical outcomes associated with early vs. late use among TNBC patients treated in community oncology practices have not been evaluated.

Methods

Physicians from the Cardinal Health Oncology Research Network completed an electronic case report form (CRF) on up to 7 TNBC patients treated with eribulin between 01/01/11 and 12/31/13. Adult female patients with pathologically confirmed metastatic disease and not participating in any interventional clinical trial were included. Providers indicated the usage of chemotherapy, either alone or in combination, by line of therapy (LOT) up to the LOT of eribulin initiation. Reported data points include: clinical parameters (eg, site of metastases, ECOG performance status, and comorbidities), treatment events (eg, LOT start/end date and rationale for discontinuation), and outcomes (eg, clinical response and date of death). Dosing, adverse events, use of supportive care medications, and hospitalization were also captured during eribulin treatment. Use of eribulin in LOT 1/LOT 2 was considered early; LOT 3+ was considered late. All comparisons are univariate.

Results

An interim analysis was performed on 123 TNBC patients (planned sample size of 250) collected from 26 providers. Patient mean age at eribulin treatment initiation was 55.0 years. Mean follow-up duration was 27 mo (SD = 11.9) from initiation of first line metastatic treatment until date of last visit, death, or loss to follow-up. Overall, 74.0% were deceased, 85.4% had received at least 3 LOTs in the metastatic setting, and 45.4% were stage IV at diagnosis. Most women were prescribed eribulin in a later LOT (61.8%), 3 (2.4%) patients received eribulin in LOT1 and 44 in LOT2 (36.7%). Among patients with known treatment start and end dates (87.0%), mean duration of treatment (DOT) was 6.2 mo (SD = 3.3), median 5.8 mo among early recipients and 5.5 mo (SD = 5.7), median 4.1 mo, among later recipients (p = 0.39). Early users were more likely (p = 0.05) to have a complete/partial response (71.1% vs. 47.7%) and less likely to have progressive disease (7.1% vs. 12.3%). In comparing eribulin users to all other therapies, eribulin users had a significantly longer DOT in LOT2 (5.9 vs. 4.7 mo, p = 0.01) and LOT3 (5.8 vs. 3.6 mo, p = 0.03). In LOT3, eribulin users were significantly more likely to have complete/partial response (54.2% vs. 18.8%) and less likely to have to have progressive disease (4.2% vs. 37.5%) compared to all other observed LOT3 therapies.

Conclusions

This interim analysis indicates longer DOT for patients treated with eribulin for TNBC in LOT2 and LOT3 and a more favorable response rate compared to all other agents used in each LOT, respectively, among patients treated in community oncology practices. Full results will be available at the conference.

Citation Format: Kish JK, Mougalian SS, Copher R, McAllister L, Zhixiao W, Broscious M. Utilization and outcomes of eribulin in triple negative metastatic breast cancer: Real-world findings [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-15-16.

Application of the principles of evidence-based practice in decision making among senior management in Nova Scotia's addiction services agencies

BACKGROUND

Competency profiles for occupational clusters within Canada's substance abuse workforce (SAW) define the need for skill and knowledge in evidence-based practice (EBP) across all its members. Members of the Senior Management occupational cluster hold ultimate responsibility for decisions made within addiction services agencies and therefore must possess the highest level of proficiency in EBP. The objective of this study was to assess the knowledge of the principles of EBP, and use of the components of the evidence-based decision making (EBDM) process in members of this occupational cluster from selected addiction services agencies in Nova Scotia.

METHODS

A convenience sampling method was used to recruit participants from addiction services agencies. Semi-structured qualitative interviews were conducted with eighteen Senior Management. The interviews were audio-recorded, transcribed verbatim and checked by the participants. Interview transcripts were coded and analyzed for themes using content analysis and assisted by qualitative data analysis software (NVivo 9.0).

RESULTS

Data analysis revealed four main themes: 1) Senior Management believe that addictions services agencies are evidence-based; 2) Consensus-based decision making is the norm; 3) Senior Management understand the principles of EBP and; 4) Senior Management do not themselves use all components of the EBDM process when making decisions, oftentimes delegating components of this process to decision support staff.

CONCLUSIONS

Senior Management possess an understanding of the principles of EBP, however, when making decisions they often delegate components of the EBDM process to decision support staff. Decision support staff are not defined as an occupational cluster in Canada's SAW and have not been ascribed a competency profile. As such, there is no guarantee that this group possesses competency in EBDM. There is a need to advocate for the development of a defined occupational cluster and associated competency profile for this critical group.

The influence of motivation in recruitment and retention of rural and remote allied health professionals: a literature review

INTRODUCTION

Recruitment and retention of allied health professionals (AHPs) to remote and rural Australia is challenging and correlates with poorer health status of remote and rural residents. While much has been written about the recruitment and retention problem, this study took a new approach by reviewing the literature describing the motivation of AHPs to work in remote and rural areas and then analyzing the findings from the perspective of motivation theory using Herzberg's extrinsic and intrinsic classification. Intrinsic motivation incentives are known to contribute to job satisfaction and come from within the individual, for example the pleasure derived from autonomy or challenge at work. In contrast, extrinsic motivation incentives are provided by the job and include such factors as salary and professional development provisions. Extrinsic incentives are important because they prevent job dissatisfaction. Job satisfaction has been shown to be linked with increased retention.

METHOD

Thirty-five articles, including 26 from Australia, met the inclusion criteria. The key findings related to motivation from each article are outlined and the results classified into the extrinsic-intrinsic framework. The incentives are then further analyzed as having a positive or a negative influence.

RESULTS

In total, 38 different incentives were described a total of 246 times. Of the total, almost half (n=115) comprised extrinsic incentives with a negative influence, with poor access to professional development, professional isolation and insufficient supervision the most frequently reported. Rural lifestyle and diverse caseloads were the most frequently mentioned positive extrinsic incentives, while autonomy and community connectedness were the most cited positive intrinsic incentives. Negative intrinsic incentives were mentioned least frequently (n=18); however, of these, feeling overwhelmed and that your work was not valued by the community were the most commonly reported.

CONCLUSIONS

The results demonstrate the significant burden of extrinsic incentives with a negative influence that are perceived by AHPs in remote and rural areas. The high turnover rate of AHPs in remote and rural areas is likely to be, in part, due to the job dissatisfaction from these disincentives. More positive intrinsic incentives were reported than negative. This suggests the potential for intrinsic incentives, known to contribute to job satisfaction, to be mediating the extrinsic disincentives. The policy implications of this work include the importance of addressing extrinsic disincentives. Simultaneously, the existing intrinsic incentives need to be nurtured and developed. Organizations that implement strategies to enhance both extrinsic and intrinsic motivation incentives are more likely to successfully address their AHP workforce shortage.

Bacillus circulans endophthalmitis

An 80-year-old woman presented with right endophthalmitis, characterized by chalky white deposits covering her posterior capsule. This occurred 17 months after uncomplicated right cataract surgery. A three-port pars plana vitrectomy and partial posterior capsulectomy isolated Bacillus circulans, and the patient made a rapid and full recovery on topical cephalothin and prednisolone acetate 1%. The case demonstrates that, unlike endophthalmitis due to other Bacillus spp., B. circulans endophthalmitis does not necessarily follow a fulminant course. It is the first report describing a subacute presentation, and response to posterior capsulectomy and simple antibiotic therapy It is also the first description of B. circulans causing white plaques in the posterior capsule, a finding characteristic of chronic endophthalmitis and previously considered pathognomonic of Proprionibacterium acnes endophthalmitis.

Effects of cutaneous aspirin on the human stomach and duodenum

Oral aspirin blocks cyclooxygenase in platelets, lowering serum thromboxane concentrations. Oral aspirin also blocks cyclooxygenase in the gastrointestinal mucosa, lowering prostaglandin production and increasing the risk of gastrointestinal ulceration and bleeding. Aspirin placed on the skin also inhibits cyclooxygenase in platelets, but aspirin absorption through skin is slow, which may minimize the gastrointestinal effects. Our objectives in this study were 1) to compare the pharmacokinetic and pharmacodynamic effects of cutaneous and oral aspirin in healthy volunteers and 2) to compare the effects of cutaneous aspirin on gastroduodenal mucosal prostaglandin E2 and F2 alpha content and on mucosal damage, using endoscopy. The bioavailability of cutaneous aspirin was 4%-8% that of oral aspirin. Cutaneous aspirin (750 mg/day for 10 days) significantly lowered serum thromboxane (by 85%) and gastric and duodenal prostaglandins (by 49%-71%); placebo had no effect. Moreover, cutaneous aspirin, but not placebo, resulted in significant gastric mucosal injury. These findings demonstrate that even tiny amounts of aspirin in the blood (2 microM) have inhibitory effects on prostaglandin production in the human stomach and duodenum that result in gastric mucosal damage, even without direct exposure of the stomach to aspirin.

Rural attachments for students in the health professions: are they worthwhile?

In the period 1991-96, 156 undergraduates from 14 health disciplines at the University of Sydney completed rural attachments in rural and remote areas of Australia as part of the Rural Careers Project. On return from their attachment, students were encouraged to write a brief report of their experiences. Ninety-two available reports were analysed as one means of assessing the success of the attachments with respect to informing students about rural health issues and stimulating their interest in rural careers after graduation. A content analysis of the students' written comments about their perceptions and experiences was completed. Students were extremely positive about the value of the attachments and expressed more positive than negative comments regarding their perceptions of rural life and work. The results show that rural attachments are indeed worthwhile learning opportunities.

Enrichment for loci identical-by-descent between pairs of mouse or human genomes by genomic mismatch scanning

Mapping genes that underlie complex genetic traits, including genes that determine susceptibility to common diseases, requires an efficient method for high-resolution genotyping. Single-nucleotide differences between pairs of allelic sequences from unrelated individuals occur approximately once in every kilobase. Genomic mismatch scanning (GMS), by analyzing numerous single-nucleotide polymorphisms in a single genome-wide step, offers a potentially powerful and efficient approach to linkage analysis. GMS, originally developed in a yeast system, is shown here to be applicable to the more complex mouse and human genomes.

Public opinion on tobacco use, its taxes and public policy

Public opinion is an important vehicle in shaping legislative efforts and public policy related to tobacco use and related taxes. This study examined public opinion about policy related to tobacco use and raising tobacco taxes in a Midwestern state. The American Lung Association of Indiana provided a grant to sponsor this project. A structured questionnaire was developed, field tested and revised for the final data collection procedure. A sample of 800 adult subjects was randomly selected and telephone interviewed by the Indiana University Center for Survey Research. The collected data were subjected to descriptive and inferential statistics. The data revealed a good representative sample of adult males and females for various age groups and socioeconomic backgrounds. Among other findings, 29% were currently smokers, 23% were former smokers, and 47.5% never smoked. More than 90% support a requirement that public places have nonsmoking areas. About 85% favor an increase in cigarette taxes to pay for health education and tobacco-related research. The relationship of the subjects' gender, education and income to their opinion about the various aspects of tobacco, taxes and related policies were examined.

Speech and language outcomes in preschool-aged survivors of neonatal intensive care

This paper reports on the second stage of a longitudinal follow-up of the speech and language outcomes in a cohort of children who required neonatal intensive care. From 3 years of age, when the first stage was completed, to preschool age, the rate for major overall communication problems rose from 13% to 17%. However, when children with frank neurological or intellectual problems were excluded, this figure dropped to 8%. The impact of perinatal, medical and environmental variables on speech and language outcomes was again investigated. Differences were found between those that were important at 3 years of age and those that were important at preschool age. New variables emerged as contributing to language expression, including gender and the perinatal variables, gestational age and respiratory distress syndrome. Maternal education level was even more important to language comprehension at preschool age than at 3 years of age. Factors that might explain improvement, or lack of improvement, in speech and language skills are discussed.

Speech and language outcomes 3 years after neonatal intensive care

Although major handicap rates have been documented in children who required neonatal intensive care, minor handicap rates, including speech and language problems, have received less attention. This paper reports the first stage of a longitudinal study of 118 children, which investigated the speech and language outcomes at 3 years of age. Differences from the normal population were found for the articulation measure, but not for the language comprehension and expression measures used. A major overall communication problem was determined to exist in 13% of the children. The impact of perinatal, medical and environmental variables was investigated. Variables such as low birthweight, short gestational age and mechanical ventilation, found to be important in other studies, had no significant impact on the speech and language outcomes of this cohort of 3 years old. However, for children who had experienced respiratory distress syndrome, there was an effect on articulation and language expression. Paediatric complications and maternal education level had the largest effects on language comprehension and expression, suggesting they were the persistent variables which most contributed to speech and language outcomes at 3 years of age.

Dynamic expression of the cell adhesion molecule fasciclin I during embryonic development in Drosophila

A number of different cell surface glycoproteins expressed in the central nervous system (CNS) have been identified in insects and shown to mediate cell adhesion in tissue culture systems. The fasciclin I protein is expressed on a subset of CNS axon pathways in both grasshopper and Drosophila. It consists of four homologous 150-amino acid domains which are unrelated to other sequences in the current databases, and is tethered to the cell surface by a glycosyl-phosphatidylinositol linkage. In this paper we examine in detail the expression of fasciclin I mRNA and protein during Drosophila embryonic development. We find that fasciclin I is expressed in several distinct patterns at different stages of development. In blastoderm embryos it is briefly localized in a graded pattern. During the germ band extended period its expression evolves through two distinct phases. Fasciclin I mRNA and protein are initially localized in a 14-stripe pattern which corresponds to segmentally repeated patches of neuroepithelial cells and neuroblasts. Expression then becomes confined to CNS and peripheral sensory (PNS) neurons. Fasciclin I is expressed on all PNS neurons, and this expression is stably maintained for several hours. In the CNS, fasciclin I is initially expressed on all commissural axons, but then becomes restricted to specific axon bundles. The early commissural expression pattern is not observed in grasshopper embryos, but the later bundle-specific pattern is very similar to that seen in grasshopper. The existence of an initial phase of expression on all commissural bundles helps to explain the loss-of-commissures phenotype of embryos lacking expression of both fasciclin I and of the D-abl tyrosine kinase. Fasciclin I is also expressed in several nonneural tissues in the embryo.

Alternative splicing of micro-exons creates multiple forms of the insect cell adhesion molecule fasciclin I

Fasciclin I is a homophilic cell adhesion molecule in insects that is dynamically expressed on a subset of axon pathways in the embryonic nervous system, and on a variety of other cells and tissues during development. The fasciclin I protein consists of four homologous 150 amino acid domains. In this article, we describe the complete sequence of the Drosophila fasciclin I (fasI) gene. The gene consists of 15 exons and is distributed over 14 kilobases of DNA. We examine the structure and temporal expression pattern of multiple fasciclin I mRNAs that differ in the lengths of their 3' untranslated regions. We also show that a highly conserved sequence at the end of the second domain can be altered by the addition of three or six amino acids that are encoded by two alternatively spliced 9 base pair (bp) micro-exons. In grasshopper fasciclin I mRNAs, there are 9 bp and 6 bp insertions at the same position. The first of these insertions is identical in sequence to the first fly micro-exon. The grasshopper insertions are not found together in the same mRNA, so grasshopper fasciclin I species differ by the addition of three or two extra amino acids to the second domain. The alternatively spliced mRNAs are differentially expressed during embryogenesis, and all three of them are present in nerve cord preparations. We suggest that the amino acids inserted by alternative micro-exon splicing may alter the binding specificity of fasciclin I.

Characterization and cloning of fasciclin I and fasciclin II glycoproteins in the grasshopper

Monoclonal antibodies were previously used to identify two glycoproteins, called fasciclin I and II (70 and 95 kDa, respectively), which are expressed on different subsets of axon fascicles in the grasshopper (Schistocerca americana) embryo. Here the monoclonal antibodies were used to purify these two membrane-associated glycoproteins for further characterization. Fasciclin II appears to be an integral membrane protein, whereas fasciclin I is an extrinsic membrane protein. The amino acid sequences of the amino terminus and fragments of both proteins were determined. Using synthetic oligonucleotide probes and antibody screening, we isolated genomic and cDNA clones. Partial DNA sequences of these clones indicate that they encode fasciclins I and II.

Sequence analysis and neuronal expression of fasciclin I in grasshopper and Drosophila

The fasciclin I, II, and III glycoproteins are expressed on different subsets of axon bundles (fascicles) in insect embryos and are thus candidates for surface recognition molecules involved in growth cone guidance. Here we present the sequence of grasshopper fasciclin I and the identification and sequence of the Drosophila fasciclin I homolog. In both species, fasciclin I appears to be an extrinsic membrane protein with a signal sequence but no transmembrane region; the protein comprises four homologous domains of approximately 150 amino acids each. Antibodies against Drosophila fasciclin I reveal that it is expressed on the surface of a subset of commissural axon pathways in the embryonic central nervous system and on all sensory axon pathways in the peripheral nervous system. This pattern of expression is similar to that in grasshopper.

Physiology of the peaked finger pulse in normal and cold-sensitive subjects

A unique peaked digital pulse contour (DPC) is frequently observed in patients with cold sensitivity, but the pathophysiology of this pulse remains obscure. To investigate the responses of the DPC to cold exposure, finger blood pressure (FBP), finger blood flow (FBF), and finger skin temperature (FST) were measured in fingers of both hands of 13 normal subjects and in 16 patients with cold sensitivity. The ratio, FBP/FBF, was used to estimate small vessel resistance (SVR). One hand was immersed sequentially in water at 40 degrees, 30 degrees, 20 degrees, and 10 degrees C, while the other hand remained in room air. DPCs were classified as normal (N), intermediate (I), intermediate-peaked (IP), peaked (P), obstructive (O), and spastic obstructive (SO). At room temperature, fingers with I, IP, O, and SO pulses had increased SVRs and decreased FSTs, and those with O and SO had decreased FBP. On cold exposure IP pulses appeared in both hands of both normal and cold-sensitive subjects, but P pulses developed only on the cooled side. IP and P pulses were associated with an increase in SVR. We concluded that IP pulses are related to reflex sympathetic arteriolar vasoconstriction, that P pulses imply vasoconstriction produced directly by cold exposure, and that O, SO, or absent pulses are indicative of digital arterial vasospasm.

Liposome-cell interactions. A study of the interactions of liposomes containing entrapped anti-cancer drugs with the EMT6, S49 and AE1 (transport-deficient) cell lines

A study has been made to determine if the cytotoxicity observed when cells in culture were exposed to liposome-entrapped cytotoxic drugs was liposome mediated or resulted from leakage of drug from the liposomes with subsequent uptake of free drugs by the cells. In preliminary experiments with the EMT6 cell line in monolayer culture, the cytotoxicity observed when the cells were exposed to a range of concentrations of liposome-entrapped methotrexate, actinomycin D and cytosine arabinoside for a variety of liposome compositions was somewhat less than that observed when the cells were exposed to similar concentrations of free drug. We suspected that the cytotoxicity was mediated via uptake of free drug leaked from liposomes. This was confirmed in experiments involving the EMT6 and S49 cell lines in monolayer or suspension culture, respectively, in the absence and presence of the nucleoside transport inhibitor, 6-(4-nitrobenzyl)thio)-9-beta-D-ribofuranosylpurine. Additional experiments were performed in a transport-deficient mutant of the S49 cell line, the AE1 cell line. No evidence for liposome-mediated cell death could be found in these cell lines when tubercidin 5'-monophosphate was entrapped in either large or small unilamellar liposomes composed of egg phosphatidylcholine/cholesterol (2 : 1), bovine brain phosphatidylserine/egg phosphatidylcholine/cholesterol (8 : 2 : 5) or egg phosphatidylcholine/stearylamine/cholesterol (10 : 1 : 5). Considerable toxicity due to empty liposomes of a variety of compositions was observed in the S49 cell line at high lipid concentrations.