Excited-Band Coherent Delocalization for Improved Optical Lattice Clock Performance

We implement coherent delocalization as a tool for improving the two primary metrics of atomic clock performance: systematic uncertainty and instability. By decreasing atomic density with coherent delocalization, we suppress cold-collision shifts and two-body losses. Atom loss attributed to Landau-Zener tunneling in the ground lattice band would compromise coherent delocalization at low trap depths for our ^{171}Yb atoms; hence, we implement for the first time delocalization in excited lattice bands. Doing so increases the spatial distribution of atoms trapped in the vertically oriented optical lattice by ∼7 times. At the same time, we observe a reduction of the cold-collision shift by 6.5(8) times, while also making inelastic two-body loss negligible. With these advantages, we measure the trap-light-induced quenching rate and natural lifetime of the ^{3}P_{0} excited state as 5.7(7)×10^{-4}  E_{r}^{-1} s^{-1} and 19(2) s, respectively.

Racial and Ethnic Disparities in Health-Related Quality of Life in Older Adults with Non-Hodgkin Lymphoma

PURPOSE/OBJECTIVE(S)

To investigate whether health-related quality of life (HRQOL) disparities exist among different racial and ethnic groups in older patients with Non-Hodgkin Lymphoma (NHL), pre- and post-diagnosis.

MATERIALS/METHODS

Using the Surveillance, Epidemiology, and Ends Results-Medicare Health Outcomes Survey (SEER-MHOS) linked database, we included individuals 65 years and older with NHL and reported ethnicities of Whites, Asian, Black, and Hispanic, diagnosed from 1998-2019. HRQOL data within 24 months before and after diagnosis were measured by the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the SF-36® and VR-12 instruments. The total combined score (TCS) is reflected by both the PCS and MCS. Multivariate analyses (MVA) adjusted for sex, age, marital status, education, income, year of diagnosis, number of comorbidities, limitations in activities of daily living (ADLs), national region, treatment type (post-diagnosis cohort only), stage, and histology.

RESULTS

We identified 2506 patients in the pre-diagnosis and 1903 patients in the post-diagnosis cohorts. In the pre-diagnosis cohort, univariate analysis (UVA) revealed that Whites had higher MCS scores than Asians (53.4 vs 50.2, p = 0.001), Blacks (53.4 vs 48.3, p<0.001), and Hispanics (53.4 vs 49.9, p<0.001). It was also revealed that Whites had higher PCS scores than Blacks (40.5 vs 37.4, p = 0.005), Whites had higher TCS scores than Blacks (93.4 vs 85.1, p<0.0001) and Hispanics (93.4 vs 87.3, p<0.0001), and Asians had higher TCS scores than Blacks (90.5 vs 85.1, p = 0.012). MVA revealed the following: Whites had higher MCS scores than Asians (52.3 vs 50.0, p = 0.038), Blacks (52.3 vs 49.1, p = 0.002), and Hispanics (52.3 vs 49.8, p = 0.005); Whites had higher TCS scores than Blacks (92.5 vs 87.9, p<0.006) and Hispanics (92.5 vs 88.6, p = 0.006); and Asians had higher TCS scores than Blacks (92.6 vs 87.9, p = 0.045). In the post-diagnosis cohort, UVA revealed that Whites had higher PCS scores than Hispanics (36.2 vs 34.1, p = 0.046); Whites had higher MCS scores than Asians (51.3 vs 48.8, p = 0.035), Blacks (51.3 vs 48.7, p = 0.033), and Hispanics (51.3 vs 46.7, p<0.0001); Whites had higher TCS scores than Blacks (87.0 vs 82.3, p = 0.021) and Hispanics (87.0 vs 78.5, p<0.0001); and Asians had higher TCS scores than Hispanics (86.5 vs 78.5, p = 0.001). MVA revealed that Whites had higher MCS scores than Hispanics (47.6 vs 44.0, p = 0.002); Whites had higher TCS scores than Hispanics (83.5 vs 76.5, p<0.0001), and Asians had higher TCS scores than Hispanics (83.7 vs 76.5, p = 0.006).

CONCLUSION

HRQOL disparities exist among different racial and ethnic groups in older patients with NHL. Pre-diagnosis, Whites had better mental HRQOL compared to Asians, Blacks, and Hispanics. Whites also had better overall HRQOL as compared to Blacks and Hispanics, and Asians had better overall HRQOL than Blacks. Post-diagnosis, Whites had better mental and overall HRQOL than Hispanics, and Asians had overall better HRQOL than Hispanics.

Subrecoil Clock-Transition Laser Cooling Enabling Shallow Optical Lattice Clocks

Laser cooling is a key ingredient for quantum control of atomic systems in a variety of settings. In divalent atoms, two-stage Doppler cooling is typically used to bring atoms to the μK regime. Here, we implement a pulsed radial cooling scheme using the ultranarrow ^{1}S_{0}-^{3}P_{0} clock transition in ytterbium to realize subrecoil temperatures, down to tens of nK. Together with sideband cooling along the one-dimensional lattice axis, we efficiently prepare atoms in shallow lattices at an energy of 6 lattice recoils. Under these conditions key limits on lattice clock accuracy and instability are reduced, opening the door to dramatic improvements. Furthermore, tunneling shifts in the shallow lattice do not compromise clock accuracy at the 10^{-19} level.

Using Donor-Derived Cell-Free DNA for Assessment of Myocardial Injury in Heart Transplant Recipients After SARS-CoV2 Infection

Purpose

A link between SARS-CoV2 infection and myocardial injury has been described. Our center utilizes non-invasive surveillance with gene expression profiling and donor-derived cell-free DNA (dd-cfDNA) in heart transplant (HTx) patients who are either stable or in whom invasive surveillance is contraindicated. We evaluated whether HTx recipients diagnosed with SARS-CoV2 infection demonstrated evidence of myocardial allograft injury using dd-cfDNA.

Methods

HTx recipients were included if they had dd-cfDNA testing (AlloSure; CareDx Inc., Brisbane, CA) within 60 days of their initial SARS-CoV2 diagnosis. Data on hospitalization, therapy, and clinical outcomes was captured. Dd-cfDNA results at the assay limit of detection (LOD, <0.12%) were set equal to the LOD.

Results

Between 3/2020 and 6/2021, we identified 12 HTx recipients with SARS-CoV2 and dd-cfDNA results within the specified time period; median age was 55 (IQR 28 - 64.5) with infection occurring 506.5 days (IQR 176 - 803.5) after transplant. Mean dd-cfDNA was 0.13 ± 0.03%, assessed 26 (IQR 20 - 35) days after infection. Prior results, available for 9 patients and obtained a median of 33 (IQR 27 - 59) days prior to infection, did not differ from post-infection values (0.13 ± 0.02%, p = 0.66). Following diagnosis, 8 (67%) patients were hospitalized; 5 had mycophenolate held, 2 received steroids, 2 received convalescent plasma, 4 received remdesivir, and 1 received monoclonal Ab therapy. At a median follow-up time of 304 (IQR 212.5 - 331) days after diagnosis, all twelve patients were alive with good allograft function (mean ejection fraction 59 ± 4.8%); interval clinically-relevant immunologic outcomes included one episode of rejection (pAMR1) and three (25%) findings of de novo donor-specific antibodies (dnDSA).

Conclusion

In this single-center pilot study assessing myocardial injury among HTx recipients within 2 months of SARS-CoV2 infection, the majority of patients had low dd-cfDNA results (<0.15%) and demonstrated good intermediate-term (6-12 months) graft function. While limited by sample size and protocol-based inclusion criteria, our findings suggest that sustained myocardial injury in HTx recipients after SARS-CoV2 infection may not be common. The impact of SARS-CoV2 infection on immunologic outcomes including rejection and dnDSA in this population merit further study.

Broadband near-field infrared spectroscopy with a high temperature plasma light source

Scattering-type scanning near-field optical microscopy (S-SNOM) has enormous potential as a spectroscopy tool in the infrared spectral range where it can probe phonon resonances and carrier dynamics at the nanometer lengths scales. However, its applicability is limited by the lack of practical and affordable table-top light sources emitting intense broadband infrared radiation in the 100 cm^-1 to 2,500 cm^-1 spectral range. This paper introduces a high temperature plasma light source that is both ultra-broadband and has much more radiant power in the infrared spectral range than conventional, table-top thermal light sources such as the globar. We implement this plasma lamp in our near-field optical spectroscopy set up and demonstrate its capability as a broadband infrared nano-spectroscopy light source by obtaining near-field infrared amplitude and phase spectra of the phonon resonances of SiO₂ and SrTiO₃.

Predictive value of cord blood bilirubin for hyperbilirubinemia in neonates at risk for maternal-fetal blood group incompatibility and hemolytic disease of the newborn

OBJECTIVE

To determine the predictive ability of cord blood bilirubin (CBB) for hyperbilirubinemia in a population at risk for maternal-fetal blood group incompatibility and hemolytic disease of the newborn.

STUDY DESIGN

This is a single center retrospective case-control study. Cases received phototherapy; controls did not. Cases were matched 1:3 to controls by gender and treating physician. Inclusion criteria included: ≥35 weeks gestation, CBB, and one or more total serum bilirubin (TSB) concentrations. The primary outcome was CBB. Secondary outcomes were a TSB >75th percentile, length of stay, and neonatal intensive care unit admission. The prognostic ability of CBB for phototherapy and TSB >75th percentile was assessed using area under the receiver operating characteristic (ROC) curve. Logistic regression analyses were performed to determine predictors for phototherapy and TSB >75th percentile.

RESULT

When compared to controls (n = 142), cases (n = 54) were more likely to have a positive Coombs' test (82% vs. 41% , p <  0.001) and TSB >75th percentile (85% vs. 21% , p <  0.001). When compared to controls, cases had a higher mean (±SD) CBB (2.5 ± 0.5 vs. 1.8 ± 0.4 mg/dL, p <  0.001). The area under the ROC curve (±SEM) for CBB for phototherapy and TSB >75th percentile was 0.87 ± 0.03 (p <  0.001, 95% CI 0.82, 0.93) and 0.87 ± 0.03 (p <  0.001, 95% CI 0.82, 0.92), respectively.

CONCLUSION

In this study, the mean CBB concentration was higher in neonates who received phototherapy compared to those who did not. CBB concentrations may help predict severe hyperbilirubinemia and phototherapy in a population at risk for hemolytic disease of the newborn.

Abstract P4-07-07: Evaluating Rad51/geminin protein expression as an indicator of homologous recombination deficiency in breast cancer models

Background: Homologous recombination deficiency (HRD) in cancer cells can occur due to mutations (germline or sporadic), methylation or other epigenetic causes. HRD leads to a defect in the conservative, error-free DNA repair mechanism and is associated with enhanced susceptibility to DNA targeting chemotherapy. Currently functional HRD assays are not broadly available for clinical use. Many of the HRD assays used in the experimental setting require fresh frozen tissue for optimal results, or require specialized expertise to interpret the results. We evaluated an immunohistochemical (IHC) assay using formalin fixed paraffin embedded (FFPE) tissue to measure protein expression of Rad51 and geminin, a cell proliferation marker, to assess HRD in breast cancer cell line models and clinical breast cancer samples. We hypothesize that Rad51, which is involved in the later stages of HR, can serve as a functional marker of HRD.

Methods: The MCF-7 human breast cancer cell line was used as a model with intact HR. Western blotting of total cell lysates from cells grown in culture was performed to confirm HR response following treatment with DNA damaging chemotherapeutic agents, cisplatin and doxorubicin. Paclitaxel, a microtubule targeting agent, was used as a negative control. Mice with MCF-7 xenograft tumors were also treated with cisplatin, or doxorubicin at two dose levels (low and high) and various time points post treatment to assess the dose and time response to HR markers. Tumors from mice treated with paclitaxel were used as a negative control. Xenograft tumors were fixed and analyzed by IHC using an antibody specific for total Rad51 and geminin expression. DNA damage was also assessed in a portion of the tumor using a pulse gel electrophoresis assay. We also analyzed FFPE breast cancer clinical samples from patients with BRCA1 mutations for Rad51 and geminin expression.

Results: In MCF-7 grown in vitro, total Rad51 was elevated as soon as 4 hours following exposure to doxorubicin and cisplatin, but not in response to paclitaxel treatment. In xenograft tumors, baseline Rad51 and geminin expression were relatively high illustrating proficient HR in an actively proliferating tumor model. Rad51 expression increased post treatment with cisplatin and doxorubicin as early as 6hrs and peaked at 16-24hrs. Geminin expression correlated well with expression of Rad51 at baseline and in time response to treatment. Pulse gel electrophoresis in paired tumor samples confirmed DNA damage was occurring compared to vehicle control treated tumors. However, this technique did not show a strong dose or time response. Five breast tumors from patients with known BRCA1 mutations were stained for Rad51 and geminin expression. High geminin expression and low Rad51 expression was noted in the majority of these tumors.

Conclusions: An IHC assay using FFPE tissue to measure Rad51/geminin is a promising method to assess HRD in breast cancer. Further analytical and clinical validation of this approach is ongoing.

Citation Format: Chalasani P, Nagy D, Livingston RB, Weterings E, Nagle R, Singh S, Barnes M, Grogan T, Ridder R, Baker AF, Kandavel S. Evaluating Rad51/geminin protein expression as an indicator of homologous recombination deficiency in breast cancer models. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-07-07.

The use of renal replacement therapy in critically ill pediatric small bowel transplantation candidates and recipients: Experience from one center

Outcomes for pediatric SBT patients requiring perioperative RRT in the PICU remain unknown. The objectives were to document our center's experience with PICU SBT patients receiving perioperative RRT and to identify variables predictive of survival to discharge. A retrospective chart review of patients (ages, 0-18 yr) between January 1, 2000 and December 31, 2011 that received RRT within a SBT perioperative period and were transplanted at our university-affiliated, tertiary care children's hospital was performed. Six SBT patients received perioperative RRT (ages, 5-12 yr). Three patients (50%) survived to hospital discharge. Among survivors, RRT was required for a total of 1-112 days (mean, 49.7 days). All three survivors survived to hospital discharge without renal transplantation and free of RRT. There was a trend toward increased survival among older patients receiving RRT (p = 0.05). Survivors had a higher I-125 GFR prior to PICU admission (p = 0.045). A higher I-125 GFR prior to PICU admission among survivors may support this test's utility during SBT evaluation. In our experience, a high survival rate and freedom from RRT at the time of discharge support RRT use in the SBT population.

P5-11-10: Reproducibility and Robustness of the FDA Approved INFORM HER2 Dual ISH DNA Probe Cocktail Assay

Background: Amplification and/or HER2 overexpression is associated with poor clinical outcome for patients with invasive breast carcinoma. Determination of HER2 status dictates eligibility of patients for trastuzumab (Herceptin) therapy, which has been shown to improve prognosis. We present data from the inter-observer reproducibility and robustness studies of the FDA approved INFORM HER2 Dual ISH DNA Probe Cocktail (HER2 Dual ISH) assay, which is an alternative to FISH. The assay is fully automated and is scored using light microscopy providing morphological context.

Methods: Ninety-five human invasive breast carcinoma specimens (a mix of amplified and non-amplified cases) were stained in a study, using the HER2 Dual ISH assay. The slides were enumerated by two qualified readers. The same cohort was stained using Path Vysion FISH and read by one qualified reader.

To verify the robustness of the HER2 Dual ISH assay, customer selectable options for factors known to impact the staining quality and intensity, which can be varied for troubleshooting, were tested on human invasive breast carcinoma cases and xenografts. The slides were evaluated by one qualified reader.

For both studies all assay steps were fully automated on a VENTANA BenchMark XT automated slide stainer using silver metallographic and red colorimetric detections for Dual ISH.

Results: In the inter-observer study the first pass staining success rate was &gt;93% for the HER2 Dual ISH assay, while the FISH first pass staining success rate was 59%. Some cases were rescued after a second attempt, which yielded a second pass staining success rate of 80% for FISH and 97% for HER2 Dual ISH. The negative, positive and overall agreement rates and 95% confidence intervals for the 61 clinical samples of this cohort that were enumerable with both FISH and the HER2 Dual ISH assay are 94.7 (75.4−99.1), 95.2 (84.2−98.7), 95.1 (86.5−98.3) and 89.5 (68.6−97.1), 97.6 (87.7−99.6), 95.1 (86.5−98.3) for reader A vs. FISH and reader B vs. FISH respectively. The positive and negative agreement rates for the inter-observer reproducibility of the HER2 Dual ISH assay were 94.7 and 97.6 %, respectively. In robustness testing, the recommended staining protocol was shown to be effective. All conditions tested resulted in appropriate staining (except for mildest cell conditioning and protease options). Conclusion: The fully automated FDA approved INFORM HER2 Dual ISH assay is robust, reproducible and concordant with the manual FISH assay in determining HER2 status in invasive breast carcinoma.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-11-10.

Lymphedema-distichiasis syndrome without FOXC2 mutation: evidence for chromosome 16 duplication upstream of FOXC2

A patient with the classical phenotype of Lymphedema-Distichiasis syndrome (OMIM 153400) is described who showed no mutations in the sequence of FOXC2. Accordingly, a Gene Chip 250k array analysis was undertaken with dense SNP genotyping of the genomic region surrounding the FOXC2 locus on Chromosome 16 followed by copy number evaluation by real time PCR. The latter assay showed evidence of a duplicated region 5' of FOXC2 that could be causative for the patient's striking phenotype, which included both distichiasis and a hyperplastic refluxing lymphatic vascular and lymph node phenotype associated with pubertal onset lymphedema, scoliosis and strabismus.

Phase I/II study of the P-glycoprotein modulator PSC 833 in patients with acute myeloid leukemia

PURPOSE

To determine the maximum-tolerated dose, pharmacokinetic interaction, and activity of PSC 833 compared with daunorubicin (DNR) and cytarabine in patients with poor-risk acute myeloid leukemia.

PATIENTS AND METHODS

Patients received ara-C 3 g/m(2)/d on 5 consecutive days, followed by an IV loading dose of PSC 833 (1.5 mg/kg) and an 84-hour continuous infusion escalating from 6, 9, or 10 mg/kg/d. Daunorubicin was administered as a 72-hour continuous infusion at 34 or 45 mg/m2/d [corrected]. Responding patients received consolidation chemotherapy with DNR pharmacokinetics performed without PSC-833 on day 1, and with PSC-833 on day 4. Response was correlated with expression of P-glycoprotein and lung resistance protein (LRP), and in vitro sensitization of leukemia progenitors to DNR cytotoxicity by PSC 833.

RESULTS

All 43 patients are assessable for toxicity and response. Grade 3 or greater hyperbilirubinemia (70%) was the only dose-dependent toxicity. Four patients (9%) succumbed to treatment-related complications. Twenty-one patients (49%) achieved a complete remission or restored chronic phase, including 10 of 20 patients treated at the maximum-tolerated dose of 10 mg/kg/d of PSC-833 and 45 mg/m(2) of DNR. The 95% confidence interval for complete response was 33.9% to 63.7%. Administration of PSC 833 did not alter the mean area under the curve for DNR, although clearance decreased approximately two-fold (P =.04). Daunorubicinol clearance decreased 3.3-fold (P =.016). Remission rates were not effected by mdr-1 expression, but LRP overexpression was associated with chemotherapy resistance.

CONCLUSION

Combined treatment with infused PSC 833 and DNR is well tolerated and has activity in patients with poor risk acute myeloid leukemia. Administration of PSC 833 delays elimination of daunorubicinol, but yields variable changes in DNR systemic exposure.

Concomitant oncoprotein detection with fluorescence in situ hybridization (CODFISH): a fluorescence-based assay enabling simultaneous visualization of gene amplification and encoded protein expression

We sought the validation of a three-color fluorescence-based system that simultaneously profiles Her2/neu oncogene copy by fluorescence in situ hybridization (FISH) and Her-2/neu encoded protein by the use of a versatile alkaline phosphatase chromogen fast red K in either fluorescence or bright-field mode. Nuclei were counterstained with DAPI. Nineteen infiltrating ductal carcinomas of breast were comprehensively evaluated for Her-2/neu amplification/overexpression by direct and indirect FISH using digoxigenin (DigFISH) and direct fluorescently labeled probes, autoradiographic RNA:RNA in situ hybridization, and immunohistochemistry using monoclonal antibody CB11. CODFISH results correlated well with DigFISH, direct-label FISH, mRNA expression, and oncoprotein expression as assessed with CB11, and enabled simultaneous visualization of gene copy and protein. In addition, qualitative immunohistochemistry may be followed by CODFISH gene copy enumeration to clarify ambiguous cases.

An update on "special stain" histochemistry with emphasis on automation

For nearly 100 years, pathologists have utilized "special histochemical stains" to assist in tissue-based diagnosis. As illustrated in Figures 1 and 2, histochemical stains have been used to identify infectious microorganisms (e.g., Mycobacterium tuberculosis with acid-fast bacillus (AFB) stain), to detail inflammatory stromal or structural alterations (e.g., fibrosis in liver cirrhosis with Masson trichrome), to identify microanatomic sites of disease (e.g., basement membrane in glomerulonephritis with Jones methenamine silver), to identify abnormal chemical deposits (e.g., iron in hemochromatosis with Prussian blue stain), or abnormal immune deposits (e.g., amyloid via Congo red stain). The current surgical pathology laboratory may employ a repertoire of 20 to 25 "special stains" to ensure the full diagnostic complement. While the diagnostic repertoire and the biochemical recipes for the stains are now a well-established, codified part of surgical pathology, there is an ever-moving, leading edge of new developments including new reagents, applications, and methods. This review seeks to update the reader on some of the new applications including both new reagents and methods. Particular emphasis will be placed on the recent technologic advance of automating special stains in kinetic-mode (1-4). The authors consider in turn: 1. In brief, the "news" (recent literature review) of new staining applications; 2. In greater detail, two new applications for detection of Microsporidia and Helicobacer pylori; 3. The new technologic advancement of kinetic mode automation of special stains.

Interleukin-6 regulation of matrix metalloproteinase (MMP-2 and MMP-9) and tissue inhibitor of metalloproteinase (TIMP-1) expression in malignant non-Hodgkin's lymphomas

We showed previously that human malignant non-Hodgkin's lymphomas (NHL) degrade extracellular matrix (ECM) components through the action of metalloproteinases and that elevated expression of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) correlated with a poor clinical outcome in patients with NHL. In the present study we sought to investigate whether there is any correlation between the expression of gelatinases (MMP-2 and MMP-9), TIMP-1, and the expression of cytokines and growth factors such as interleukin-1beta (IL-1beta), IL-6, IL-10, tumor necrosis factor alpha (TNF-alpha), transforming growth factor beta (TGFbeta), and basic fibroblast growth factor (bFGF) in human NHL. In lymphoma tissues obtained from 32 patients, elevated expression of IL-6 correlated significantly with elevated messenger RNA (mRNA) levels of MMP-9, MMP-2, and TIMP-1. Moreover, in human lymphoid cell lines of B- and T-cell origin (Raji, Jurkat, and NC-37), IL-6 stimulated production of MMP-9 and MMP-2 but not TIMP-1. In the Matrigel invasion assay IL-6 significantly upregulated transmigration of Raji and Jurkat cells, which in turn was inhibited by recombinant human TIMP-1 and anti-MMP-9 and MMP-2 antibodies. We postulate that IL-6 may play a role in the clinical aggressiveness of human NHL by stimulating MMP production.

Expression of p53 protein in actinic keratosis, adjacent, normal-appearing, and non-sun-exposed human skin

Nonmelanoma skin cancer, including both squamous cell carcinoma and basal cell carcinoma, is a significant and increasing health problem in the United States. The precursor lesion of cutaneous squamous cell carcinoma, actinic keratosis (AK), is a major risk factor for nonmelanoma skin cancer, and it is also a marker of long-term sun exposure. AKs themselves can serve as biomarkers in chemopreventive studies, but in addition, they may contain phenotypic and genetic alterations that are related to the process of UV-induced skin carcinogenesis. One of these alterations, the tumor suppressor gene p53, is altered early in UV-induced skin carcinogenesis in humans. p53 protein expression was measured by immunohistochemistry in biopsies from AKs, tissue immediately adjacent to AKs (AK-adjacent), normal-appearing upper medial arm skin, and non-sun-exposed skin from 19 subjects. There was a significant difference and a progressively increasing mean p53 labeling index in total epidermis (basal and suprabasal layers) between upper medial arm skin (0.9 +/- 1.8%) and AK-adjacent (12.1 +/- 14.4%; P = 0.0004) and between AK (27.7 +/- 21.3%) and AK-adjacent skin (P = 0.04), whereas upper medial arm skin was marginally different from non-sun-exposed skin (0.1 +/- 0.2; P = 0.05). This pattern of p53 expression was also seen when epidermis was separated into basal and suprabasal layers. We conclude that epidermal p53 protein expression is associated with histological evidence of chronic sun damage.

Human gene therapy for melanoma: CT-guided interstitial injection

OBJECTIVE

Our intent is to describe the role of CT in the intratumoral injection of Allovectin-7 (Vical, San Diego, CA), an allogeneic class I major histocompatibility complex antigen, HLA-B7, formulated with cationic lipid, in the treatment of metastatic malignant melanoma.

MATERIALS AND METHODS

Ten patients with metastatic malignant melanoma were treated with gene therapy in which we used CT-guided intratumoral injection of plasmid DNA containing the HLA-B7 gene. This therapy was part of a phase I gene therapy trial in patients with metastatic melanoma. CT guidance was chosen as an accurate way to direct gene delivery in patients with deep, impalpable lesions. Tumor locations included pulmonary, mediastinal, hepatic, adrenal, and paracaval sites. Patients in the CT protocol underwent baseline CT studies. Examinations were repeated 2, 4, and 8 weeks after gene therapy and thereafter at 3-month intervals. Both injected and noninjected tumors were measured. CT-guided injections of 10, 50, or 250 micrograms of plasmid DNA were performed with 22-gauge spinal needles. Injection volumes were between 1.0 and 4.0 ml, depending on tumor size. CT-guided core biopsy specimens were obtained (with 18- or 20-gauge needles) from the selected tumor before therapy and 2, 4, and 8 weeks after therapy to assess HLA-B7 plasmid DNA and gene expression. Peripheral blood was analyzed for cytotoxic T lymphocytes directed against HLA-B7.

RESULTS

CT-guided intratumoral injections were successful in delivering genetic material to all patients with impalpable tumors. Significant responses (as defined by a decrease of 25% or more in the product of the length and width of the injected tumor) were observed in six of the 10 patients. One of these six patients who had a solitary lesion remains free of disease 19 months after gene therapy. HLA-B7 protein expression was detected in 89% of biopsy specimens, and plasmid DNA and messenger RNA were detected in 56% and 22% of biopsy specimens, respectively.

CONCLUSION

CT provides a safe, accurate, and efficacious way to monitor and assess tumor progression and response, and it provides guidance for biopsies and intratumoral injections during gene therapy. Significant responses in injected tumors of six of the 10 patients in our study suggest that further clinical trials of this gene therapy are warranted.

Phase I study of direct gene transfer of an allogeneic histocompatibility antigen, HLA-B7, in patients with metastatic melanoma

PURPOSE

To determine the safety, toxicity, and efficacy of direct intratumoral injection of an allogeneic major histocompatibility complex (MHC) class I gene, HLA-B7, in a cationic lipid vector (Allovectin-7; Vical Inc, San Diego, CA) in patients with metastatic melanoma.

PATIENTS AND METHODS

Seventeen HLA-B7-negative patients were treated with intralesional injection of Allovectin-7. Twelve patients received a single intralesional injection containing 10 micrograms (four patients), 50 micrograms (five patients), or 250 micrograms (three patients) of plasmid DNA. Five patients received two or three injections of 10 micrograms DNA to a single tumor site at 2-week intervals. Tumor biopsies pretherapy and 2 and 4 weeks after gene injection were obtained to determine expression of the plasmid by polymerase chain reaction (PCR), reverse transcriptase (RT)-PCR, flow cytometry, and immunohistochemistry.

RESULTS

Toxicities were related to technical aspects of the injections or biopsies. These included pain, hemorrhage, pneumothorax, and hypotension. Two patients were hospitalized overnight for observation. Seven patients (50%) had tumor responses insofar as the injected nodule decreased > or = 25% by radiologic or physical examination. One patient with a single site of disease achieved a complete remission. Ninety-three percent of the patients' post-gene therapy biopsies contained HLA-B7 plasmid DNA, mRNA, or protein.

CONCLUSION

Intratumoral injection of the allogeneic histocompatibility gene, HLA-B7, in a lipid vector can be performed safely at plasmid DNA doses < or = 250 micrograms. The safety profile and biologic activity of this therapy warrants further studies to define the mechanism of action, predictors of response, and antitumor efficacy of this approach.

Evaluation of proliferating cell nuclear antigen as a surrogate end point biomarker in actinic keratosis and adjacent, normal-appearing, and non-sun-exposed human skin samples

The incidence of nonmelanoma skin cancer, including both squamous cell carcinoma and basal cell carcinoma, is a significant health problem in the United States. Actinic keratosis (AK), the precursor of cutaneous squamous cell carcinoma, is a major risk factor for nonmelanoma skin cancer. In addition, AKs are tissue targets for the identification of biomarkers for use in chemopreventive studies. The biomarker addressed in this study is epidermal cell proliferation, as quantitated by proliferating cell nuclear antigen (PCNA). Shave biopsies were obtained from AKs, tissue immediately adjacent to AKs, normal-appearing, upper-medial arm skin, and non-sun-exposed skin from 19 subjects. When any degree of PCNA staining was considered positive (semiquantitative 1-4 scale), there was a significant difference and a progressively increasing mean PCNA labeling index (LI) in the total epidermis (basal and suprabasal layers), beginning with non-sun-exposed buttock skin, with the lowest LI (2.5 + or - 1.6%), followed by upper-medial arm skin (12.3 + or - 7.4%; P = 0.0015), skin adjacent to AKs (19.2 + or - 12.2%; P = 0.0218), and finally, AKs with the highest LI (34.6 + or - 20.1%; P = 0.0017). This same pattern was observed when the epidermis was separated into basal and suprabasal layers, with the exception of a nonsignificant result for upper-medial arm skin compared with adjacent skin in the basal layer (P = 0.3981). PCNA LIs were also analyzed separately by staining intensity (i.e., scores of 1-4). The PCNA LI in skin with varying degrees of sun damage and/or histological atypia is a candidate surrogate end point biomarker for skin cancer chemoprevention studies.

Comparison of proliferating cell nuclear antigen versus the more standard measures of rectal mucosal proliferation rates in subjects with a history of colorectal cancer and normal age-matched controls

Measurement of proliferation rates by the more standard in vitro uptake techniques of [3H]thymidine and 5'-bromo-2'-deoxyuridine (BrdUrd) labeling indices (LIs) were compared to proliferating cell nuclear antigen (PCNA) in rectal mucosal biopsies from 16 subjects with resected colorectal cancer and 14 normal age-matched controls. Correlation coefficients for BrdUrd versus PCNA, [3H]thymidine versus PCNA, and BrdUrd versus [3H]thymidine were 0.691, 0.876, and 0.770, respectively. No significant differences (P > 0.05) were detected in total mean LIs between the LI methods for the normal group. In contrast, total PCNA LIs were found to be significantly different in the resected cancer patients when compared to either BrdUrd (P = 0.005) or [3H]thymidine (P < 0.001). A significant difference (P = 0.010) in total PCNA LI but not in total [3H]thymidine or BrdUrd LIs was also observed between normal controls and resected colorectal cancer subjects. Compartmental analysis of the cancer group versus the normals showed a significant difference in compartments 1 and 3 for PCNA LIs only. The reproducibility of two PCNA LI counts was excellent (r = 0.9). In addition, the reliability of mean LIs were > 0.8 with the exception of [3H]thymidine in the normal group (0.7). These study results demonstrate that PCNA LIs in human rectal mucosal biopsies are correlated highly with other more commonly used cellular proliferation measurements; however, PCNA LIs were found to be significantly higher than the other two methods in the resected colorectal cancer subjects.

Osteoid osteoma diagnosis and management with low morbidity

Wide excision, a recommended treatment for osteoid osteoma, creates needless resection of surrounding bone and causes difficult intraoperative nidus identification. Less bone resection is required by successively burring through the reactive bone to identify the nidus, which is then removed with curettes and burrs. This burr-down technique requires precise preoperative anatomic localization by thin section (1-1.5 mm) computed tomography (CT) scans. In a consecutive series of 19 osteoid osteomas, 18 were accurately diagnosed before operation, using a combination of clinical findings, plain roentgenograms, and CT scans. The burr-down technique was successfully used in 15 cases, and four were treated with wide excision. There have been no local recurrences. The follow-up period for all 19 patients was at least six months. No bone grafts were required in the burr-down group in nonspinal locations; there have been no fractures despite early return to unrestricted activity. The burr-down technique was associated with less postoperative immobilization, a shorter duration of protected weight bearing, and an earlier return to activity. The burr-down technique is recommended for accessible osteoid osteoma lesions.

Cytolytic (TIA-1+) tumor infiltrating lymphocytes in B cell non-Hodgkin's lymphomas. SWOG Central Repository Members

TIA-1 is a monoclonal antibody (mAb) that identifies cytolytic cells. We studied eleven B cell non-Hodgkin's lymphomas (NHL) of low grade, eleven B cell NHL of intermediate-high grade, and 10 benign lymphoid hyperplasias (BLH) to investigate potential differences in the number of host cytolytic tumor infiltrating lymphocytes (TILs). Frozen sections were immunostained with TIA-1 mAb and the number of immunoreactive cells (TIA-1+) per mm2 of tissue was quantitated within reactive or neoplastic lymphoid follicles or random areas of diffuse NHL. The number of TIA-1+ cells/mm2 was significantly higher in intermediate and high grade B cell NHL than in low grade NHL or BLH with means +/- se of 1377.8 +/- 173, 866.2 +/- 92.3 and 774.1 +/- 76.2, respectively (p < 0.0183 and p < 0.0125). There was no significant difference between BLH and low grade NHL. The increased number of TIA-1+ TILs in B cell NHL of intermediate and high grade suggests the possibility of a host cytolytic immune response versus the tumor. Paradoxically, B cell tumors of worst biological outcome contained more cytolytic TILs. Functional defects of host cytolytic TILs in NHL patients should be investigated in future studies.

Determination of T cell monoclonality in non-Hodgkin's lymphoma by frozen section immunohistology. The SWOG Central Repository Members

Monoclonal antibodies (mAb) reactive with seven distinct T cell receptor (TcR) alpha/beta variable region (V) families have become available. We investigated the potential utility of these mAb to establish T cell clonality (restrictive expression of one single V region family type) by frozen section immunohistology. We studied 40 non-Hodgkin's lymphomas (NHL) previously classified, immunophenotypically and genotypically by the South Western Oncology Group (SWOG) as 20 B and 20 T cell NHL. Frozen sections of each neoplasm were immunostained with the following mAb: beta-V5a, beta-V5b, beta-V6a, beta-V8a, beta-V12a, alpha/beta-Va and alpha-V2a. The large atypical lymphocytes of 18 of 20 T cell NHL showed no reactivity with the seven V region family mAb and only two showed exclusive immunoreactivity (one with anti-alpha V2a and the other with anti-beta V6a). All large atypical B cells in the 20 B cell NHL were non-reactive with the V region family mAb and each of the 40 neoplasms disclosed no or a trace reactivity in small host T cells. The results show that clonality can be determined in only a small percentage of T cell NHL (Sensitivity 10%, specificity 100%). Therefore, until new mAb become available, genotypic analysis remains the most sensitive and reliable method to establish T cell clonality.

Immunophenotyping in the management of gastric lymphoma

Primary gastric lymphoma is a rare tumor in which surgical resection plays a major role in improving the response rate and reducing the incidence of bleeding and perforation after chemotherapy. In 17 consecutive patients, the diagnosis of gastric lymphoma was made by immunophenotyping snap-frozen endoscopic biopsy specimens. All neoplasms were B-cell lymphomas. Pan B surface marker antigens were present in all patients. Levels of Ki-67, a nuclear marker of tumor proliferation, were greater than 45% in two of the four patients who died after progression of their lymphoma. All patients alive had Ki-67 levels of less than 30%. A lower proliferation index, as measured by Ki-67, appears to be associated with better prognosis. Ten of 11 patients treated by resection prior to chemotherapy had no complications. Immunophenotyping is the key in the differential diagnosis when considering malignant lymphoma with gastric carcinoma and benign conditions such as pseudolymphoma.

Optimization of immunocytochemical P-glycoprotein assessment in multidrug-resistant plasma cell myeloma using three antibodies

Seeking to optimize the immunocytochemical assay of P-glycoprotein, a 170-kilodalton (P-170) molecule associated with multidrug resistance, we experimented with a variety of antibodies (JSB-1, C219, and MRK-16), fixation conditions, and titers using both human myeloma cell lines and clinical myeloma specimens. Under optimized conditions, using all three antibodies and the cell lines as standards and controls, the ICC method proved sensitive, specific, reliable, rapid, and within the realm of everyday hospital laboratory expertise. The 3 anti-P-glycoprotein antibodies revealed different reactivities with P-170. Both C219 and JSB1 were optimized by fixation in cold acetone. With MRK-16 optimal results were obtained on unfixed or formalin fixed specimens. Under optimal fixation and titering conditions, low level (DOX 4) detection was possible. Given that the three antibodies differ in reactivity and recognize different P-170 epitopes, it follows that using the antibodies in a small panel is a useful strategy in increasing the likelihood of detecting true P-glycoprotein expression by the immunocytochemical method. In dilution experiments, the immunocytochemical method was as sensitive as RNase protection assay and more sensitive than Western blot detection. Immunocytochemistry coupled to computer-assisted single-cell densitometry, showed a strong correlation (R = 0.98) between cellular P-170 density and in vitro resistance to doxorubicin. Multidrug-resistant specific probes for RNA expression and Western blot assays confirmed the specificity of P-170 expression in both cell lines and clinical samples. Thus, a small panel of antibodies, under optimized immunocytochemical conditions, appears to have potential as a rapid, sensitive, clinically useful assay for multidrug resistance in myeloma.

Survivorship comparison of THARIES and conventional hip arthroplasty in patients younger than 40 years old

Early and high failure rates for conventional hip replacements in young and active patients are well documented. The hypothesis tested in this study is total hip articular replacement by internal eccentric shells (THARIES) resurfacing hip arthroplasty is a sufficiently durable alternative to conventional total hips in patients younger than 40 years old. Survivorship analysis techniques were applied to 106 THARIES and 98 conventional hip replacements. The primary outcome variable investigated was time to failure, as measured by the need for revision of the prosthesis in the absence of sepsis. Other definitions of prosthesis failure were also investigated. Analysis revealed that even within this young, high-risk population there were subpopulations with different risks for failure. The lowest risk patients comprised all rheumatoid arthritis (RA) and juvenile rheumatoid arthritis (JRA) patients, regardless of age. The intermediate risk patients comprised all non-RA, non-JRA patients older than 30 years of age and the highest-risk patients were all non-RA, non-JRA patients younger than 30 years of age. A comparison of THARIES and conventional prostheses within each of these three subpopulations revealed similar patterns of failure over time, with the conventional total hip replacement having significantly better hip function than the THARIES group only in the highest-risk population, when using a failure definition of revision surgery for aseptic loosening. A broader and more important conclusion was that all acrylic-fixed implants, THARIES or THRs are predicted to undergo early mechanical loosenings in younger-than-30, non-RA, non-JRA patients. In patients younger than 30 years age acrylic fixation of THA is inadvisable.

Immunotopographic assessment of lymphoid and plasma cell malignancies in the bone marrow

To determine the utility of tissue section immunochemistry in the evaluation of bone marrow involved by lymphoid and plasma cell malignancies, snap-frozen, undecalcified bone marrow core and aspirate samples from 23 patients with these disorders were studied with a battery of monoclonal antibodies. With techniques that preserve architecture, difficult diagnostic cases characterized by core but not aspirate involvement, or the reverse, were resolved. By means of an extensive battery of monoclonal antibodies applied to serial sections, complex tumor cell phenotypes were established in all 23 cases. In addition to the identification of straightforward monoclonal surface immunoglobulin expression in small cleaved cell lymphomas (four cases), the battery approach added immunologic certainty in malignancies with unusual or difficult phenotypes: peripheral T-cell lymphomas with idiosyncratic antigen expression, and chronic lymphocytic leukemias and small cell lymphomas with faint surface immunoglobulin expression (four cases). For the chronic lymphocytic leukemias and the small cell lymphomas, the combined IgD+, B2+, B1+, Ia+, Leu-1+ phenotype taken as a whole had greater utility than any isolated marker. The acute lymphocytic leukemias and the myelomas studied demonstrate the wide range of B-cell antigens that must be detected to account for the variety of B-cell neoplasms encountered. Additionally, the previously undescribed phenotypic subset of CALLA+ myelomas, which is of prognostic relevance, was identified. Marrow frozen section immunotyping is a major asset in the evaluation of patients with lymphoma, leukemia, and myeloma when special care is accorded to tissue handling and to treatment of endogenous peroxidase/pseudoperoxidase and interstitial immunoglobulin.

Treatment of primary osteoarthritis of the hip. A comparison of total joint and surface replacement arthroplasty

Of 285 total hip arthroplasties (260 patients) performed for primary osteoarthritis during a six-year period, 135 were resurfaced using a Tharies prosthesis (total hip articular replacement with internal eccentric shells) and 150 were treated with the Trapezoidal-28 total hip replacement. From each of these two groups 100 hips (ninety-one patients in the Tharies group and eighty-six in the Trapezoidal-28 group) that had been followed for two to seven years were evaluated at the time of follow-up in accordance with a predetermined protocol. The patients were younger in the Tharies than in the Trapezoidal-28 group (average ages, fifty-eight and sixty-six years), included more men (sixty compared with thirty-five), and were more active postoperatively. The average follow-up was forty-seven months for the total joint-replacement group and thirty-eight months for the surface replacement group. At follow-up the ratings for pain, walking, and function according to the University of California at Los Angeles 10-point scale and the clinical results were identical in the two groups. Heterotopic ossification (Brooker grade III or IV) developed after thirteen Trapezoidal-28 and twenty-two Tharies arthroplasties. Radiographs made at six and twelve months and at final follow-up showed that the incidence of radiolucencies about the acetabular component was higher in the resurfacing group: fifty-seven with complete radiolucent lines after an average follow-up of thirty-eight months compared with thirty-six with complete lines after an average follow-up of forty-seven months. There were three failures in the joint-replacement group: a hematogenous staphylococcal deep infection that required a Girdlestone procedure, a femoral stem fracture that required revision, and loosening of an acetabular component for which revision was performed. There was also one dislocation, successfully treated by closed reduction. Similarly, in the resurfacing group there were three failures: two loose acetabular components, revised successfully, and one loose femoral component that necessitated total joint arthroplasty. Multivariate stepwise regression analysis showed that the factors that affected the final extent and width of the acetabular radiolucencies adversely after resurfacing were: any radiolucent lines that were visible at six months, a high level of physical activity after arthroplasty, and a thin superior cement mantle.(ABSTRACT TRUNCATED AT 400 WORDS)

Immunologic phenotype in 30 patients with diffuse large-cell lymphoma

Frozen sections of 30 diffuse large-cell ("histiocytic") lymphomas that had arisen in both nodal and extranodal sites were stained with immunoglobulin light-chain and heavy-chain reagents, with nonoclonal antibodies to THAT HAD ARISEN IN BOTH NODAL AND EXTRANODAL SITES WERE STAINED WITH IMMUNOGLOBULIN LIGHT-CHAIN AND HEAVY-CHAIN REAGENTS, WITH MONOCLONAL ANTIBODIES TO T and B-cell antigens, and with an esterase marker for macrophages. Fourteen lymphomas expressed immunoglobulin light chains and were shown to be monoclonal; F(ab')2 fragments were sometimes necessary to demonstrate their monoclonal nature. Mu (IgM) was the most frequently expressed heavy chain, but in many patients other heavy chains were found. None of the lymphomas stained with T-cell antibodies or the esterase; 15 did not stain for immunoglobulin, but 13 of these 15 did express Ia antigen. These immunologic markers identified eight different phenotypes. Retrospective clinical analysis of the patients suggested that those who were immunoglobulin-positive had more advanced disease and shorter survival, but confirmation of the clinical relevance of immunologic phenotype will require prospective studies.