A familial deletion of 10p12.1 associated with thrombocytopenia

Thrombocytopenia can be inherited or acquired from a variety of causes. While hereditary causes of thrombocytopenia are rare, several genes have been associated with the condition. In this report, we describe an 18-year-old man and his mother, both of whom have congenital thrombocytopenia. Exome sequencing in the man revealed a 1006 kb maternally inherited deletion in the 10p12.1 region (arr[GRCh37] 10p12.1(27378928_28384564)x1) of uncertain clinical significance. This deletion in the THC2 locus includes genes ANKRD26, known to be involved in normal megakaryocyte differentiation, and MASTL, which some studies suggest is linked to autosomal dominant thrombocytopenia. In the family presented here, the deletion segregated with the congenital thrombocytopenia phenotype, suggesting that haploinsufficiency of one or both genes may be the cause. To our knowledge, this is the first report of a deletion of the THC2 locus associated with thrombocytopenia. Future functional studies of deletions of the THC2 locus may elucidate the mechanism for this phenotype observed clinically.

The androgen receptor is a therapeutic target in desmoplastic small round cell sarcoma

Desmoplastic small round cell tumor (DSRCT) is an aggressive, usually incurable sarcoma subtype that predominantly occurs in post-pubertal young males. Recent evidence suggests that the androgen receptor (AR) can promote tumor progression in DSRCTs. However, the mechanism of AR-induced oncogenic stimulation remains undetermined. Herein, we demonstrate that enzalutamide and AR-directed antisense oligonucleotides (AR-ASO) block 5α-dihydrotestosterone (DHT)-induced DSRCT cell proliferation and reduce xenograft tumor burden. Gene expression analysis and chromatin immunoprecipitation sequencing (ChIP-seq) were performed to elucidate how AR signaling regulates cellular epigenetic programs. Remarkably, ChIP-seq revealed novel DSRCT-specific AR DNA binding sites adjacent to key oncogenic regulators, including WT1 (the C-terminal partner of the pathognomonic fusion protein) and FOXF1. Additionally, AR occupied enhancer sites that regulate the Wnt pathway, neural differentiation, and embryonic organ development, implicating AR in dysfunctional cell lineage commitment. Our findings have direct clinical implications given the widespread availability of FDA-approved androgen-targeted agents used for prostate cancer.

Androgen receptor can promote tumour progression in desmoplastic small round cell tumour (DSRCT), an aggressive paediatric malignancy that predominantly affects young males. Here, the authors show that DSRCT is an AR-driven malignancy and sensitive to androgen deprivation therapy

Multimodality Treatment of Desmoplastic Small Round Cell Tumor: Chemotherapy and Complete Cytoreductive Surgery Improve Patient Survival

Purpose: Desmoplastic small round cell tumor (DSRCT), which harbors EWSR1-WT1 t(11;22)(p13:q12) chromosomal translocation, is an aggressive malignancy that typically presents as intra-abdominal sarcomatosis in young males. Given its rarity, optimal treatment has not been defined.Experimental Design: We conducted a retrospective study of 187 patients with DSRCT treated at MD Anderson Cancer Center over 2 decades. Univariate and multivariate regression analyses were performed. We determined whether chemotherapy, complete cytoreductive surgery (CCS), hyperthermic intraperitoneal cisplatin (HIPEC), and/or whole abdominal radiation (WART) improve overall survival (OS) in patients with DSRCT. Critically, because our institutional practice limits HIPEC and WART to patients with less extensive, potentially resectable disease that had benefited from neoadjuvant chemotherapy, a time-variant analysis was performed to evaluate those adjunct treatment modalities.Results: The pre-2003 5-year OS rate of 5% has substantially improved to 25% with the advent of newer chemotherapies and better surgical and radiotherapy techniques (HR, 0.47; 95% CI, 0.29-0.75). Chemotherapy response (log rank P = 0.004) and CCS (log rank P < 0.0001) were associated with improved survival. Although WART and HIPEC lacked statistical significance, our study was not powered to detect their potential impact upon OS.Conclusions: Improved 3- and 5-year OS were observed following multidisciplinary treatment that includes Ewing sarcoma (ES)-based chemotherapy and complete tumor cytoreductive surgery, but few if any patients are cured. Prospective randomized studies will be required to prove whether HIPEC or WART are important. In the meantime, chemotherapy and CCS remain the cornerstone of treatment and provide a solid foundation to evaluate new biologically targeted therapies. Clin Cancer Res; 24(19); 4865-73. ©2018 AACR.

Clinical Activity of Pazopanib in Patients with Advanced Desmoplastic Small Round Cell Tumor

BACKGROUND

Desmoplastic small round cell tumor (DSRCT) is an aggressive, often fatal soft tissue sarcoma that lacks an optimal salvage regimen. We retrospectively reviewed data from 29 pretreated DSRCT patients who received pazopanib at MD Anderson Cancer Center after failure of standard chemotherapies.

SUBJECTS, MATERIALS, AND METHODS

Medical records of patients treated from January 2012 to December 2016 were reviewed and regression analyses were performed. Median progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method and differences in survival were assessed by a log-rank test. A landmark statistical analysis was used to assess OS at a predefined 12-week time point following pazopanib initiation.

RESULTS

The mean age at pazopanib treatment was 27.5 years (range, 6.3-50.1 years). According to RECIST 1.1 criteria, 16 patients (55%) had stable disease, 1 patient (3%) had partial response, 1 patient (3%) had complete response, and 11 patients (38%) had progressive disease. Estimated median PFS was 5.63 months (95% confidence interval [CI]: 3.23-7.47). Median OS was 15.7 months (95% CI: 10.3-32.4). As of December 2016, 11 patients (38%) were still alive, with a median follow-up time of 16.8 (range 3.8-30.1) months. Doses between 400 and 800 mg were included. Pazopanib was well tolerated and 23 (79%) of the patients continued it until progression or death, 4 discontinued because of side effects, and 2 were still on pazopanib at the time of data analysis.

CONCLUSION

In the largest study conducted to date in DSRCT, pazopanib was well tolerated and clinically active in heavily pretreated patients who otherwise lack good treatment options.

IMPLICATIONS FOR PRACTICE

Desmoplastic small round cell tumor (DSRCT) is a rare, extremely aggressive soft tissue sarcoma subtype that most commonly occurs in adolescent and young adult males. No DSRCT-specific therapies exist, and for lack of a better treatment approach, current therapies have relied upon U.S. Food and Drug Administration-approved drugs like pazopanib that exhibit clinical activity in other sarcoma subtypes. This article describes the largest experience to date using pazopanib as salvage treatment in heavily pretreated DSRCT patients. Pazopanib was well tolerated and clinically active, surpassing predefined metrics proposed by the European Organization for Research and Treatment of Cancer indicative of "active" sarcoma drugs (5.63 months progression-free survival [PSF], with 62% of the study population achieving progression-free survival at 12 weeks).

Necrotizing fasciitis attended in the Emergency Department in a tertiary Hospital: Evaluation of the LRINEC scale

AIM

To describe mortality and complications of patients seen in the emergency room, diagnosed with necrotizing soft tissue infection (NSTI) and the correlation of such complications with the Laboratory Risk Indicator for Necrotizing fasciitis scale (LRINEC).

METHODS

Retrospective observational study including patients with a diagnosis of NSTI in the emergency room of a tertiary hospital over 7 years. The results are shown as median, interquartile range and absolute range for quantitative variables. In the case of qualitative variables, the results are shown as absolute and relative frequency. The comparison between the categories of the LRINEC scale was performed through a post-hoc comparison from a non-parametric ANOVA analysis. Comparisons between LRINEC groups in the qualitative variables were performed using Fisher's Exact test.

RESULTS

24 patients with a mean age of 51.9 years were identified. The LRINEC scale was used on 21 patients: in 10, the value indicated low risk (<6), in 4 it indicated intermediate risk (6 or 7) and in 7 it indicated high risk (≥8). The amputation rate in patients with low, intermediate and high risk was 10%, 25% and 66% respectively with a mortality of 4.2%. There was an increase in hospital stay between the low and high level of the scale (p=0,007).

CONCLUSIONS

In general, a change in the prognosis between the medium and high levels of the LRINEC scale could not be recorded, but was recorded in hospital stay between the low and the high level, practically tripling the median of days of hospital stay.

An emission processing system for air quality modelling in the Mexico City metropolitan area: Evaluation and comparison of the MOBILE6.2-Mexico and MOVES-Mexico traffic emissions

This article describes the High-Elective Resolution Modelling Emission System for Mexico (HERMES-Mex) model, an emission processing tool developed to transform the official Mexico City Metropolitan Area (MCMA) emission inventory into hourly, gridded (up to 1km²) and speciated emissions used to drive mesoscale air quality simulations with the Community Multi-scale Air Quality (CMAQ) model. The methods and ancillary information used for the spatial and temporal disaggregation and speciation of the emissions are presented and discussed. The resulting emission system is evaluated, and a case study on CO, NO₂, O₃, VOC and PM_2.5 concentrations is conducted to demonstrate its applicability. Moreover, resulting traffic emissions from the Mobile Source Emission Factor Model for Mexico (MOBILE6.2-Mexico) and the MOtor Vehicle Emission Simulator for Mexico (MOVES-Mexico) models are integrated in the tool to assess and compare their performance. NO_x and VOC total emissions modelled are reduced by 37% and 26% in the MCMA when replacing MOBILE6.2-Mexico for MOVES-Mexico traffic emissions. In terms of air quality, the system composed by the Weather Research and Forecasting model (WRF) coupled with the HERMES-Mex and CMAQ models properly reproduces the pollutant levels and patterns measured in the MCMA. The system's performance clearly improves in urban stations with a strong influence of traffic sources when applying MOVES-Mexico emissions. Despite reducing estimations of modelled precursor emissions, O₃ peak averages are increased in the MCMA core urban area (up to 30ppb) when using MOVES-Mexico mobile emissions due to its VOC-limited regime, while concentrations in the surrounding suburban/rural areas decrease or increase depending on the meteorological conditions of the day. The results obtained suggest that the HERMES-Mex model can be used to provide model-ready emissions for air quality modelling in the MCMA.

MLVA typing of Mycoplasma hyopneumoniae bacterins and field strains

Because of the lack of information about both the genetic characteristics of Mycoplasma hyopneumoniae commercial vaccines and their relationship with field strains, the authors attempted to identify genetic subtypes of some M hyopneumoniae bacterins, and to compare them with M. hyopneumoniae field strains. Six commercial M hyopneumoniae bacterins and 28 bronchoalveolar lavages from pigs at slaughter from three herds were analysed by Multiple-Locus Variable number tandem repeat Analysis (MLVA) on p146R1, p146R3, H4, H5 and p95 loci. The results obtained showed the presence of more than one M hyopneumoniae genotype in some pigs and also in one of the bacterins analysed. It is also worth noting that MLVA typing allowed the distinction among circulating field strains and also when comparing them with vaccine strains, which, knowing the relatedness among them, could be useful in the research of the efficacy of the vaccines.

Optimization of municipal sludge and grease co-digestion using disintegration technologies

Many drivers tend to foster the development of renewable energy production in wastewater treatment plants as many expectations rely upon energy recovery from sewage sludge, for example through biogas use. This paper is focused on the assessment of grease waste (GW) as an adequate substrate for co-digestion with municipal sludge, as it has a methane potential of 479-710 LCH(4)/kg VS, as well as the evaluation of disintegration technologies as a method to optimize the co-digestion process. With this objective three different pre-treatments have been selected for evaluation: thermal hydrolysis, ultrasound and enzymatic treatment. Results have shown that co-digestion processes without pre-treatment had a maximum increment of 128% of the volumetric methane productivity when GW addition was 23% inlet (at 20 days of HRT and with an OLR of 3.0 kg COD/m(3)d), compared with conventional digestion of sewage sludge alone. Concerning the application of the selected disintegration technologies, all pre-treatments showed improvements in terms of methane yield (51.8, 89.5 and 57.6% more for thermal hydrolysis, ultrasound and enzymatic treatment, respectively, compared with non-pretreated wastes), thermal hydrolysis of GW and secondary sludge being the best configuration as it improved the solubilization of the organic matter and the hydrodynamic characteristics of digestates.

Spiral calcium waves: implications for signalling

Spiral patterns of intracellular Ca2+ release demonstrate a direct relationship between increasing wavefront curvature and increasing propagation velocity. An equally important phenomenon is the annihilation of colliding Ca2+ waves, which reveals an underlying refractory period during which further Ca2+ release is temporarily inhibited. Treatment of intracellular Ca2+ release as an excitable medium accounts for both observations. This theoretical framework is analogous to the more familiar concept of electrical excitability in neuronal membranes. In this analogy, the inositol 1,4,5-trisphosphate receptor ion channel plays a role analogous to that of Na+ channels while Ca(2+)-induced Ca2+ release provides the mechanism for excitation. Furthermore, Ca(2+)-ATPases play a role similar to that of the K+ channels in neuronal excitation, that is, they return the system to rest. We demonstrated that overexpression of a sarco/endoplasmic reticulum Ca(2+)-ATPase increases the frequency of Ca2+ wave activity. More recent experiments reveal a strong dependence of the propagation velocity on wavelength as predicted by the dispersion relation of excitability. This important result accounts for an observed correlation between wave frequency and spatial dominance of Ca2+ foci and suggests a new mechanism for the encoding of signal information.

Organic matter release in low temperature thermal treatment of biological sludge for reduction of excess sludge production

Thermal treatment applied in association with a biological system allows for a significant reduction in excess sludge production (approximately 50%). In general, heat treatment is described as a sludge disintegration technique. This paper offers a thorough study on the impact of heat treatment, at temperatures below 100 degrees C, on the solubilisation of the sludge COD and its biodegradability. Discontinuous heating experiments were performed on activated and digested sludge. At all temperatures tested the released COD for digested sludge was systematically higher than that for activated sludge (15 and 40%, respectively, at 95 degrees C for 40 min of contact time). For the first 30 min, a 1st order kinetic, with respect to the residual COD, was systematically found. In the range of 40-95 degrees C, digested sludge had a lower activation energy than activated sludge (26 kcal/mol compared to 70-160 kcal/mol). COD solubilisation is thus more positively influenced by temperature in the case of activated sludge. This may be due to the significant difference in the ratio of protein/carbohydrate in digested and activated sludge (1-5 and 0.2-0.7, respectively). The increase in the COD/TKN ratio in the solubilised fraction after thermal treatment of activated sludge suggests a preferential solubilisation of proteins over carbohydrates. Respirometric tests performed on the solubilised COD showed that whatever the sludge origin, only 40-50% of released COD is biodegradable at a conventional hydraulic retention time (i.e., 24 h). Hence, heat treatment would act more through organic matter solubilisation rather than by a biodegradability increase.

Understanding the mechanisms of thermal disintegrating treatment in the reduction of sludge production

Among the technologies aimed at reducing sludge production, the combination of thermal treatment at 95 degrees C of sludge and the activated sludge process is a promising route. The feasibility of such a combined process is demonstrated (up to 60% sludge reduction) and the impacts of operating conditions on its efficiency are presented. Major emphasis was put on understanding the complex phenomena occurring within the thermal treatment: release and biodegradability of sludge organic matter, impact on the biological activity (decay, maintenance requirements, etc.). These effects were taken into account for the development of an ASM1-based model. Comparison between the modeling approach and experimental data (continuous and batch) showed that thermal treatment had three major issues partly explaining the reduction of sludge production: (i) a low release of organics; (ii) an immediate and reversible biological inactivation associated with additional maintenance energy requirements; and (iii) a potential inert production.

Measurement of glutathione in activated sludges

Thermal, electric, mechanical or oxidative stress seem a promising way to reduce the production of excess activated sludge during biological wastewater treatment. However, the adaptation and the resistance of the sludge microbial ecosystem to stress conditions is a major question as it may definitively limit the effect of some treatments. Defence mechanisms developed by aerobic organisms, in particular, in response to oxidative stress involve various antioxidant activities and compounds such as glutathione. An HPLC method was developed for measuring reduced and total glutathione (GSH and GSHt) in perchloric acid sludge extracts. The method was sensitive, highly specific and validated for linearity, precision and recovery. Considering the extraction yield and the oxidation of GSH during extract storage, the measured GSH concentration was estimated to represent 60% of the GSH content from activated sludges. GSHt ranged from 0.32 to 3.34micromolg(-1) volatile solids and the GSH/GSHt ratio ranged from 32% to 91%. Measurements performed on sludges stressed in precise conditions selected to reach a reduction of sludge production showed a decrease of GSH and GSHt concentrations with thermal, mechanical, electric and ozone stress.

Suppurative mediastinitis after open-heart surgery: a comparison between cases caused by Gram-negative rods and by Gram-positive cocci

OBJECTIVE: To compare clinical characteristics and risk factors of suppurative postsurgical mediastinitis according to its etiology. METHODS: Suppurative postsurgical mediastinitis developed in 45 (2.5%) of 1779 patients who underwent open-heart surgery at the Hospital Virgen del Rocío in Seville, Spain, from 1986 to 1996. Microbiological diagnosis was available in 42 patients. RESULTS: Gram-negative rods were isolated in 19 cases and Gram-positive cocci in 23 cases. Seventeen isolates (38%) were sensitive to the antimicrobial agent used perioperatively. Patients with Gram-negative rod infection had a longer duration of bypass (127plus minus36 min versus 96plus minus34 min, p<0.01), and a worse postoperative condition. Longer mechanical ventilation (4plus minus7 days versus 1plus minus2 days, p<0.05) and concomitant infection in a remote site (pulmonary and/or urinary infection) were more frequently observed in this group than in patients with Gram-positive infections (58% versus 22%, p<0.05). Twenty patients (51%) were bacteremic. The mortality rate was 20% (five of 45). CONCLUSIONS: Preventable postoperative remote-site infection may lead to mediastinitis, especially if Gram-negative rods are involved.

Feasibility study of mechanically disintegrated sludge and recycle in the activated-sludge process

The action mechanisms and performances of a combined system associating activated sludge and mechanical treatment (High Pressure Homogenizer) were evaluated for urban wastewater. Discontinuous experiments showed that the energy applied at the first pass was high enough to modify the sludge particulate fraction (high COD release) but without cell lysis. The applied shear forces led to a progressive cell break up (maximal COD release 90% total COD). Continuous experiments showed less than 20% reduction in sludge production (compared to a control run under the same loading conditions Y(TSS) = 0.35 g TSS x g(-1) COD(removed)) through the application of mechanical treatment (stress frequency = 0.2 d(-1)). Recycling of mechanical treated sludge to the aeration tank induced a slight increase in effluent TSS, but the biological performance seemed to be maintained. Significant improvements in sludge settling characteristics were observed.

Minimization of sludge production in biological processes: an alternative solution for the problem of sludge disposal

A combined system associating activated sludge and ozonation was evaluated for the treatment of urban wastewater. Experiments have shown that 70% reduction in sludge production can be reached (compared to a reference system running in low loaded conditions Y(obs) = 0.28 g VSS.g COD(-1)) by applying an ozone dosage of 0.05 g O3/g VSS(treated) Recycling of the ozonated sludge to the aeration tank induces a slight increase in effluent COD, but the biological treatment performance is maintained. Nitrification capabilities are not altered by the sludge reduction process and active biomass measurements revealed that autotrophic biomass seems to be less affected than the heterotrophs. Significant improvements in sludge settling characteristics are observed.

A comparative study between mechanical, thermal and oxidative disintegration techniques of waste activated sludge

The release performances of an organic and mineral activated sludge matrix were studied for a wide range of disintegration treatments like mechanical, thermal, thermal-chemical and oxidative disintegration techniques. The maximal COD release was 35% of total COD after 24 hours contact time at 95 degrees C. A limiting value of 60% COD release was obtained for 500 and 700 bars after 10 passes. Concerning theoxidative disintegration techniques (O3 and H2O2), a limiting value of around 60-65% of TOC release was observed. Therefore, it was hypothesised that thermal and mechanical treatments allow mainly for breaking apart the micro-organisms while the oxidative treatment destroys the sludge flocs and disrupts the micro-organisms. A release effect of the mineral fraction is observed only oxidative disintegration techniques.

Control of IP(3)-mediated Ca2+ puffs in Xenopus laevis oocytes by the Ca2+-binding protein parvalbumin

1. Elementary events of Ca2+ release (Ca2+ puffs) can be elicited from discrete clusters of inositol 1,4,5 trisphosphate receptors (IP(3)Rs) at low concentrations of IP(3). Ca(2+) puffs have rarely been observed unless elicited by either hormone treatment or introduction of IP(3) into the cell. However, cells appear to have sufficient concentrations of IP(3) (0.1-3.0 microM) to induce Ca2+ release under resting conditions. 2. Here, we investigated Ca2+ puff activity in non-stimulated Xenopus oocytes using confocal microscopy. The fluorescent Ca2+ dye indicators Calcium Green 1 and Oregon Green 488 BAPTA-2 were injected into oocytes to monitor basal Ca2+ activity. 3. In this preparation, injection or overexpression of parvalbumin, an EF-hand Ca(2+)-binding protein (CaBP), induced Ca2+ puffs in resting Xenopus oocytes. This activity was inhibited by heparin, an IP(3)R channel blocker, and by mutation of the Ca(2+)-binding sites in parvalbumin. 4. Ca2+ puff activity was also evoked by injection of low concentrations of the Ca2+ chelator EGTA, but not by calbindin D(28k), another member of the EF-hand CaBP superfamily. 5. BAPTA and the Ca2+ indicator dye Oregon Green 488 BAPTA-1 evoked Ca2+ puff activity, while the dextran conjugate of Oregon Green 488 BAPTA-1 did not. These data indicate that a Ca(2+) buffer must be mobile in order to increase Ca2+ puff activity. 6. Together, the data indicate that some IP(3)Rs spontaneously release Ca2+ under resting concentrations of IP(3). These elementary Ca2+ events appear to be below the level of detection of current imaging techniques. We suggest that parvalbumin evokes Ca2+ puffs by coordinating the activity of elementary IP(3)R channel openings. 7. We conclude that Ca2+ release can be evoked not only by hormone-induced increases in IP(3), but also by expression of mobile cytosolic CaBPs under resting concentrations of IP(3).

Characterization of an N-system amino acid transporter expressed in retina and its involvement in glutamine transport

We report here on the characterization of a mouse N-system amino acid transporter protein, which is involved in the transport of glutamine. This protein of 485 amino acids shares 52% sequence homology with an N-system amino acid transporter, mouse N-system amino acid transporter (mNAT) and its orthologs. Because this protein shares a high degree of sequence homology and functional similarity to mNAT, we named it mNAT2. mNAT2 is predominately expressed in the retina and to a slightly lesser extent in the brain. In the retina, it is located in the axons of ganglion cells in the nerve fiber layer and in the bundles of the optic nerve. Functional analysis of mNAT2 expressed in Xenopus oocytes revealed that the strongest transport activities were specific for l-glutamine. In addition, mNAT2 is a Na(+)- and pH-dependent, high affinity transporter and partially tolerates substitution of Na(+) by Li(+). Additionally, mNAT2 functions as a carrier-mediated transporter that facilitates efflux. The unique expression pattern and selective glutamine transport properties of mNAT2 suggest that it plays a specific role in the uptake of glutamine involved in the generation of the neurotransmitter glutamate in retina.

Beneficial and detrimental effects of intensive glycaemic control, with emphasis on type 2 diabetes mellitus

Diabetes mellitus is a major health problem in the world. Several clinical trials have shown that some of the major complications of diabetes mellitus can be partially prevented or delayed by intensive glycaemic control. However, there are benefits and risks in aiming for near normal blood glucose levels. Intensive glycaemic control delays the onset and progression of retinopathy, nephropathy and neuropathy. Epidemiological and observational studies have shown that cardiovascular events may be correlated with the severity and duration of diabetes mellitus, but major randomised trials have only shown weak and nonsignificant benefits of intensive glycaemic management in decreasing event rates. A modest improvement in lipid profile results from blood glucose control although, in the majority of cases, not enough to reach current targets. Detrimental effects of intensive glycaemic control include bodyweight gain and hypoglycaemia. Controversial issues in the management of patients with diabetes mellitus include the unproven increase in cardiovascular morbidity from sulphonylureas and hyperinsulinaemia, and the still unknown long term effects of newer oral antihyperglycaemic agents alone or in combination with traditional therapies (such as sulphonylureas and metformin). It is important to individualise management in setting glycaemic goals. Control of cardiovascular risk factors through blood pressure and lipid control and treatment with aspirin (acetylsalicylic acid) and ACE inhibitors have consistently shown benefits in the prevention of both macro- and microvascular complications in patients with diabetes mellitus; these measures deserve priority.

A Phe 486 thyrotropin receptor mutation in an autonomously functioning follicular carcinoma that was causing hyperthyroidism

Hot nodules are rarely found to be carcinomas. We report a case of a nonmetastatic follicular carcinoma that presented as a hot nodule that was causing hyperthyroidism. A base substitution (ATC for TTC) was found in codon 486 of the TSH receptor gene and this resulted in the substitution of an isoleucine for a phenylalanine in the first extracellular loop of the receptor. This was absent in the deoxyribonucleic acid from the surrounding normal thyroid tissue indicating its somatic origin. This mutation, which was previously reported to activate both cyclic adenosine monophosphate and the inositol phosphate-diacylglycerol cascades, may have been responsible for the constitutive activation of the thyrotropin receptor and resulting hyperfunction of this follicular carcinoma.

Identification and characterization of an amino acid transporter expressed differentially in liver

Cellular metabolic needs are fulfilled by transport of amino acids across the plasma membrane by means of specialized transporter proteins. Although many of the classical amino acid transporters have been characterized functionally, less than half of these proteins have been cloned. In this report, we identify and characterize a cDNA encoding a plasma membrane amino acid transporter. The deduced amino acid sequence is 505 residues and is highly hydrophobic with the likely predicted structure of 9 transmembrane domains, which putatively place the amino terminus in the cytoplasm and the carboxy terminus on the cell surface. Expression of the cRNA in Xenopus laevis oocytes revealed strong transport activities specific for histidine and glutamine. This protein is a Na(+)- and pH-dependent transporter and tolerates substitution of Na(+) by Li(+). Furthermore, this transporter is not an obligatory exchanger because efflux occurs in the absence of influx. This transporter is expressed predominantly in the liver, although it is also present in the kidney, brain, and heart. In the liver, it is located in the plasma membrane of hepatocytes, and the strongest expression was detected in those adjacent to the central vein, gradually decreasing towards the portal tract. Because this protein displays functional similarities to the N-system amino acid transport, we have termed it mNAT, for murine N-system amino acid transporter. This is the first transporter gene identified within the N-system, one of the major amino acid transport systems in the body. The expression pattern displayed by mNAT suggests a potential role in hepatocyte physiology.

Measurement of intracellular calcium

To a certain extent, all cellular, physiological, and pathological phenomena that occur in cells are accompanied by ionic changes. The development of techniques allowing the measurement of such ion activities has contributed substantially to our understanding of normal and abnormal cellular function. Digital video microscopy, confocal laser scanning microscopy, and more recently multiphoton microscopy have allowed the precise spatial analysis of intracellular ion activity at the subcellular level in addition to measurement of its concentration. It is well known that Ca2+ regulates numerous physiological cellular phenomena as a second messenger as well as triggering pathological events such as cell injury and death. A number of methods have been developed to measure intracellular Ca2+. In this review, we summarize the advantages and pitfalls of a variety of Ca2+ indicators used in both optical and nonoptical techniques employed for measuring intracellular Ca2+ concentration.

Thyrotropin-Secreting Pituitary Adenoma Responsive To Bromocriptine Therapy

OBJECTIVE

To describe a case of a thyrotropin-secreting pituitary adenoma that responded to bromocriptine therapy by suppression of thyrotropin and tumor shrinkage.

METHODS

We present the clinical course, laboratory data, and radiographic findings in a 32-year-old woman with a thyrotropin-secreting pituitary adenoma before and after treatment with bromocriptine.

RESULTS

The patient's pituitary tumor was detected after she had been treated with radioactive iodine for thyrotoxicosis presumed to be due to Graves' disease. After thyroid ablation, the thyrotropin levels could not be brought into the normal range, even while the patient was receiving supraphysiologic doses of orally administered levothyroxine. Magnetic resonance imaging of the pituitary, along with hormonal workup, confirmed the diagnosis of a thyrotropin-secreting pituitary adenoma. Because the tumor was not threatening vital structures and was considered incurable by operation, medical therapy was elected. A trial of bromocriptine was initiated at 15 mg/day and increased to 30 mg/day in three divided doses. Follow-up hormonal studies showed that thyrotropin levels declined into the suppressed range, and repeated magnetic resonance imaging scans showed substantial shrinkage of the pituitary lesion.

CONCLUSION

Thyrotropin-secreting tumors may respond hormonally and structurally to bromocriptine therapy. In patients with such tumors, a trial of dopamine agonists at high dose may be considered before initiation of more invasive medical treatment.

Impact of mitochondrial Ca2+ cycling on pattern formation and stability

Energization of mitochondria significantly alters the pattern of Ca2+ wave activity mediated by activation of the inositol (1,4,5) trisphosphate (IP3) receptor (IP3R) in Xenopus oocytes. The number of pulsatile foci is reduced and spiral Ca2+ waves are no longer observed. Rather, target patterns of Ca2+ release predominate, and when fragmented, fail to form spirals. Ca2+ wave velocity, amplitude, decay time, and periodicity are also increased. We have simulated these experimental findings by supplementing an existing mathematical model with a differential equation for mitochondrial Ca2+ uptake and release. Our calculations show that mitochondrial Ca2+ efflux plays a critical role in pattern formation by prolonging the recovery time of IP3Rs from a refractory state. We also show that under conditions of high energization of mitochondria, the Ca2+ dynamics can become bistable with a second stable stationary state of high resting Ca2+ concentration.

In vivo expression of a variant human U6 RNA from a unique, internal promoter

We previously isolated a variant of the human U6 small nuclear RNA gene (87U6) and demonstrated that transcription of this gene is controlled by a novel internal promoter. It has now been shown that two blocks of sequence within the coding region are both necessary and sufficient to direct expression of 87U6 in transcription assays performed in vitro. In addition, 87U6 is expressed in vivo and can assemble into snRNP complexes. Specific primer extension assays on total RNA from HeLa cells shows that 87U6 RNA is present in these cells. Also, microinjection of plasmid encoded 87U6 genes into Xenopus laevis oocyte nuclei results in the expression of this variant RNA. Immunoprecipitation with anti-Sm antibodies suggests that 87U6 RNA assembles into a snRNP particle with U4 snRNA. Finally, the variant snRNA is capped with the U6 specific gamma-monomethyl phosphate cap when incubated in HeLa extracts. These data suggest that 87U6 RNA may function in the splicing process, in a manner similar to the wild-type U6 RNA. The recent observations of a minor class of mRNA introns that are spliced by a distinct collection of snRNP particles suggest an important role for variant snRNAs in the splicing of transcripts with alternative splice junctions.

Differential modulation of SERCA2 isoforms by calreticulin

In Xenopus laevis oocytes, overexpression of calreticulin suppresses inositol 1,4,5-trisphosphate-induced Ca2+ oscillations in a manner consistent with inhibition of Ca2+ uptake into the endoplasmic reticulum. Here we report that the alternatively spliced isoforms of the sarcoendoplasmic reticulum Ca2+-ATPase (SERCA)2 gene display differential Ca2+ wave properties and sensitivity to modulation by calreticulin. We demonstrate by glucosidase inhibition and site-directed mutagenesis that a putative glycosylated residue (N1036) in SERCA2b is critical in determining both the selective targeting of calreticulin to SERCA2b and isoform functional differences. Calreticulin belongs to a novel class of lectin ER chaperones that modulate immature protein folding. In addition to this role, we suggest that these chaperones dynamically modulate the conformation of mature glycoproteins, thereby affecting their function.

Ca2+ wave dispersion and spiral wave entrainment in Xenopus laevis oocytes overexpressing Ca2+ ATPases

Complex, spatiotemporal patterns of intracellular Ca2+ release in Xenopus oocytes can be accounted for by the operation of two fundamental processes: Ca2+ release from the endoplasmic reticulum (ER) via the inositol 1,4,5-trisphosphate receptor (IP3R) with its inherent dependency on cytosolic Ca2+, and Ca2+ uptake via Ca2+ ATPases. Overexpression of sarco-endoplasmic reticulum Ca2+ ATPases (SERCAs) in Xenopus oocytes, increases IP3-induced Ca2+ wave frequency and amplitude [1-3]. This effect can be attributed to an increased removal of cytoplasmic Ca2+ and more efficient refilling of Ca2+ stores. By overexpressing SERCA isoforms, we report here that Ca2+ waves exhibit dispersion [4-6]. At wavelengths greater than 60 microns, wave velocity is constant. However, wave velocity and amplitude progressively decreases at smaller wavelengths. Below gamma approximately 20 microns, Ca2+ waves disperse and fail to propagate. In oocytes exhibiting both spiral and target patterns of Ca2+ release, spiral waves had higher frequencies and showed entrainment of the surrounding regions. These properties are characteristic of a classical excitable medium [4-6].

Synchronization of calcium waves by mitochondrial substrates in Xenopus laevis oocytes

In Xenopus oocytes, as well as other cells, inositol-1,4,5-trisphosphate (Ins(1,4,5)P3)-induced Ca2+ release is an excitable process that generates propagating Ca2+ waves that annihilate upon collision. The fundamental property responsible for excitability appears to be the Ca2+ dependency of the Ins(1,4,5)P3 receptor. Here we report that Ins(1,4,5)P3-induced Ca2+ wave activity is strengthened by oxidizable substrates that energize mitochondria, increasing Ca2+ wave amplitude, velocity and interwave period. The effects of pyruvate/malate are blocked by ruthenium red at the Ca2+ uniporter, by rotenone at complex I, and by antimycin A at complex III, and are subsequently rescued at complex IV by ascorbate tetramethylphenylenediamine (TMPD). Our data reveal that potential-driven mitochondrial Ca2+ uptake is a major factor in the regulation of Ins(1,4,5)P3-induced Ca2+ release and clearly demonstrate a physiological role of mitochondria in intracellular Ca2+ signalling.

Calreticulin inhibits repetitive intracellular Ca2+ waves

Inositol 1,4,5-trisphosphate (IP3)-mediated calcium (Ca2+) signaling is subject to cytosolic and luminal regulatory mechanisms. In Xenopus oocytes, Ca(2+)-sensitive gating of the IP3 receptor (IP3R) produces repetitive waves of Ca2+ release. We examined the role of the luminal Ca(2+)-binding protein calreticulin (CRT) in IP3-mediated Ca2+ signaling by using Ca2+ wave activity as a sensitive Ca2+ release assay. Overexpression of CRT inhibited repetitive IP3-induced Ca2+ waves. Deletion mutagenesis demonstrated that CRT inhibition was mediated by the high affinity-low capacity Ca(2+)-binding domain, which contributes little to Ca2+ storage. This novel function of CRT in intracellular Ca2+ signaling may be regulated by Ca2+ occupancy of the high affinity binding site.

[Structural and functional changes in the heart of the hypertensive patient. An echocardiographic study]

We studied 15 patients with essential hypertension (EH) in whom the diagnosis was corroborated with ambulatory blood pressure monitoring (ABPM). The blood pressure levels (BP) were compared with values obtained from healthy people (HP). We studied 31 HP with 2-D echocardiogram and the parameters of ventricular performance were compared with the values obtained from EH people. ABPM shown that the EH people has higher BP values than HP around 24 hs (EH loss the circadian rhythm of BP). On the other hand the EH had left ventricular hypertrophy (LVH) with normal systolic ventricular function (VF). The systolic wall stress was low because the LVH was inappropriate. The LVH as adaptative mechanism maintains normal the VF in spite of pressure overload without increasing MVO2. When the pressure overload is not eradicated in a variable amount of time the adaptative mechanisms slowly change to a pathologic process caused by collagen deposition in the interstitium of the heart. In advanced stages the remodeling process causes diastolic disfunction, myocardial ischemia, arrhythmias and death by heart failure or suddenly. This last stage is the real hypertensive heart disease.

Combined versus single effect of fosinopril and hydrochlorothiazide in hypertensive patients

The antihypertensive effect and safety of fosinopril and hydrochlorothiazide combined were compared with each drug singly and placebo in a controlled manner. After a 4- to 5-week placebo lead-in period, 67 mild to moderate essential hypertensive patients (seated diastolic blood pressure > or = 95 and < or = 110 mm Hg) were randomized in a double-blind fashion into four parallel treatment groups: 20 mg fosinopril plus 12.5 mg hydrochlorothiazide, 20 mg fosinopril, 12.5 mg hydrochlorothiazide, and placebo during 8 weeks. Patients were seen biweekly. Sitting diastolic blood pressure was the outcome variable defining therapeutic response. The efficacy of fosinopril plus hydrochlorothiazide as a combined therapy was superior to any single drug (P < .05) and placebo (P < .01) in the treatment of mild to moderate essential hypertension. Mean adjusted systolic/diastolic blood pressure decrements at week 8 were -18.8/-13.7, -12.9/-11.8, -8.5/-9.3, and -2.7/-6.9 mm Hg for the fosinopril plus hydrochlorothiazide, fosinopril, hydrochlorothiazide, and placebo groups, respectively. Clinical adverse events and laboratory changes documented throughout the study were similar to placebo and were mild in severity in all groups.

[The correlation of atrial natriuretic peptide values with those of renin, angiotensin and aldosterone in hypertension patients below and above 50]

A comparison of ANP and RAA. In 6 healthy subjects < 50 y, 5 healthy subjects > 50 y, 44 patients with essential hypertension < 50 y, and 41 patients with essential hypertension > 50 y, was performed. ANP values in healthy subjects < 50 y, were means = 44 +/- 7 PG/ml, and means = 87.33 +/- 14 PG/ml in those > 50 y. (P < 0.01). 80% of hypertensives < 50 y, had normal values of ANP (means = 63.8 +/- 10 PG/ml) and 20% high values (means = 131 +/- 6 PG/ml) (P < 0.001). 70% of hypertensives > 50 y, had high ANP values (means = 260 +/- 114 PG/ml) and 30% normal values (means = 75 +/- 5 PG/ml) (P < 0.001). Values for RAA were low or normal in 96% of cases with high ANP values (P < 0.001), and 100% of the cases with high RAA values, had low or normal ANP values. (P < 0.0001). This correlation had an statistically significant value for groups over 50 years (high ANP values, low RAA values) (P < 0.001) and high RAA values with low or normal ANP values in groups below 50 y (P < 0.001). We observed no significant correlation between ANP values and LVH. According to our results, essential hypertensives < 50 y, have low or normal ANP values in the majority of cases (P < 0.001). Essential hypertensives over 50 y. Have high ANP values also in the majority of cases (P < 0.001). As previously reported, an inversely proportional ratio between RAA and ANP was found in our study. The significance of ANP in regulating blood pressure in the elderly is considered.

Increased frequency of calcium waves in Xenopus laevis oocytes that express a calcium-ATPase

When inositol 1,4,5-triphosphate (IP3) receptors are activated, calcium is released from intracellular stores in excitatory propagating waves that annihilate each other upon collision. The annihilation phenomenon suggests the presence of an underlying refractory period that controls excitability. Enhanced calcium-adenosine triphosphatase (ATPase) activity might alter the refractory period of calcium release. Expression of messenger RNA encoding the avian calcium-ATPase (SERCA1) in Xenopus laevis oocytes increased the frequency of IP3-induced calcium waves and narrowed the width of individual calcium waves. The effect of SERCA1 expression on calcium wave frequency was dependent on the concentration of IP3 and was larger at higher (1 microM) than at lower (0.1 microM) concentrations of IP3. The results demonstrate that calcium pump activity can control IP3-mediated calcium signaling.

The epsilon subunit confers fast channel gating on multiple classes of acetylcholine receptors

During vertebrate skeletal muscle development, multiple forms of long-open-time (slow-type) ACh receptor channels are replaced by at least two different types of short-open-time (fast-type) ACh receptors. Expression of ACh receptors in Xenopus oocytes indicates that the substitution of an epsilon subunit for a gamma subunit may account for both types of fast-gated channel types in adult muscle. Unlike the various forms of the embryonic receptor, in which functional diversity is achieved through alterations in subunit composition, the two major fast-gated forms expressed in oocytes have identical subunit composition. These findings provide a structural basis for both types of short-open-time ACh receptor types found in adult muscle.

Identification of two amino acid residues in the epsilon subunit that promote mammalian muscle acetylcholine receptor assembly in COS cells

We have used a species difference in epsilon subunits of the acetylcholine receptor (AChR) to investigate regions of the subunit protein that are important in receptor assembly. Upon transient transfection of COS cells, mouse epsilon subunit cDNA is approximately 10 times more effective than that of the rat in supporting expression of surface AChRs when the other subunits are from either mouse or rat. In cells transfected with only alpha and epsilon subunit cDNAs, the formation of an alpha epsilon heterodimer, a presumed assembly intermediate, is also less efficient with rat than with mouse epsilon subunit. By site-directed mutagenesis, we have found that these differences can be accounted for by 2 amino acid differences in the N-terminal domain at positions 106 and 115 of the rat and mouse epsilon subunits, suggesting that the region near these 2 amino acid residues is important for AChR assembly.

Multiple conductance classes of mouse nicotinic acetylcholine receptors expressed in Xenopus oocytes

Acetylcholine receptor (AcChoR) subunit mRNAs transcribed from mouse BC3H-1 cDNAs were injected into Xenopus oocytes and the expressed AcChoR channels were examined by single channel recording. Injection of alpha-, beta-, gamma-, and delta-subunit mRNAs produced two predominant channel classes with conductances of approximately 50 and approximately 12 pS, while infrequent openings of approximately 25-pS channels were also observed. Injection of alpha-, beta-, and gamma-subunit mRNAs produced a single class of approximately 12-pS AcChoR channels, which resembled the smallest conductance channels present in alpha beta gamma omega-injected oocytes. Assembly of delta-less channels may thus explain the lowest conductance AcChoR channels in alpha beta gamma delta-injected oocytes and might also account for similar channels that have been observed in vertebrate skeletal muscle.