Biomedical subjects
Publications and source records attributed to A Molina.
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This paper reports a retrospective analysis of renal replacement therapy in patients over 60 years-of-age admitted to regional unit in Newcastle upon Tyne during a 7-year period. The changing age patterns of referral for management of end-stage renal failure have been reviewed, including the morbidity and mortality of this age-group managed for end-stage renal failure by haemodialysis, peritoneal dialysis and transplantation. The results show an alarming increase in the number of referrals aged over 60 years (> 36% in 4 years). Associated medical problems, methods of treatment and management (including special needs), and the effects of the rapidly increasing proportion of elderly patients on renal services are described.
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Urea kinetics and the use of KT/V has become a useful tool for assessing adequacy of small solute removal in HD. Clinical data supporting the benefit of urea kinetic analysis in CAPD patients had been lacking. Using the standards of KT/V for hemodialysis, many CAPD patients would be underdialyzed but, most studies show no significant difference in morbidity or mortality between CAPD and HD patients. We studied retrospectively, 102 patients (48 M, 54 F), aged 54.6 +/- 14.8 (range 14-82), on CAPD 24.4 +/- 23.9 months (0-120) from 6 hospitals. Clinical and biochemical parameters, co-morbidity, mortality, and hospital admission rate were registered. During the follow-up (1 year), a significant decrease of residual renal function (Kr) from 1.74 +/- 1.86 to 1.31 +/- 1.67 (p < 0.01) was noticed. The KT/V also decreased from 2.00 +/- 0.47 to 1.89 +/- 0.36 (p < 0.01) without change in BUN or plasma creatinine levels. The normalized protein catabolic rate (NPCR) decreased from 0.98 +/- 0.28 to 0.93 +/- 0.30 (p < 0.05) and serum albumin from 3.7 +/- 0.5 to 3.5 +/- 0.6 (p < 0.001). There was a positive correlation between NPCR and KT/V (r = 0.44, p < 0.05) and between NPCR with serum BUN (r = 0.27, p < 0.05). There was no correlation between KT/V and NPCR neither with hospitalization rate nor clinical symptoms index. The latter, however, showed a positive correlation with the co-morbidity index.(ABSTRACT TRUNCATED AT 250 WORDS)
Resident glomerular macrophages from normal rats were isolated and grown through long-term cultures in order to obtain confluent cell monolayers. These cells have a secretory function as revealed by the production of a cytokine with a molecular weight similar to interleukin-1 (IL-1). The demonstration that rat glomerular macrophages secrete an IL-1-like cytokine emphasizes the role of these cells in a number of glomerular secretory functions, including some which have been commonly attributed only to mesangial contractile cells.
Thirty patients with recurrent and/or metastatic head and neck cancer were treated with sequentially administered methotrexate (MTX) and piritrexim (PTX). The treatment schedule consisted of intravenous (IV) MTX (50 mg/m2) administered on day 1 and oral PTX (75 mg/m2) administered twice daily on days 8 to 12. Courses were repeated every 21 days with dose escalation in subsequent courses aimed at achieving Grade 1 toxicity. Two patients were not evaluable for response, 5 (17%; 95% confidence interval, 4% to 30%) had a partial response (PR), 10 had stable disease, and 13 had progressive disease. All five responses were seen in patients with regional lymph nodes as measurable disease. The median time to progression for all patients was 1.4 months, and the median survival was 6.7 months. Generally, this regimen was well tolerated with only mild toxicity seen during cycle 1 in the majority of patients. Dose escalation in subsequent cycles was possible in a high percentage of patients. Although the overall response rate and survival figures in this Phase II trial were disappointing, the doses and schedule used in this trial may have been suboptimal as reflected by the low incidence of moderate to severe toxicity. Additional evaluation of this combination of drugs in a more aggressive schedule may be warranted.
Administration of 10 mM dimethylsulfoxide inhibits oxygen uptake in in vitro rat brain slices incubated in a Krebs-Ringer phosphate pH 7.4 solution containing 10 mM glucose. The effect is inverted when excessive potassium is added to the solution and the amount of sodium chloride is substituted by choline chloride. Using 10 mM, we observed a decrease in oxygen uptake in rat heart slices incubated in a Krebs-Ringer phosphate solution containing 131.8 mM Na+, 105.4 mM K+ and no calcium. Dimethylsulfoxide 10 mM, 1 mM and 0.1 mM does not alter the Na+/K+ ATPase activity nor the ouabain insensitive ATPase activity in in vitro preparations of rat brain, kidney and heart.
Using a heat and sonicated Mycobacterium paratuberculosis Cordoba antigen (COA1) and the commercial protoplasmic-antigen (PPA-3) as antigens, an ELISA for detecting goat antibodies was standardized. When 2 reference populations, 1 positive (17 goats) and the other negative (63 goats) to disease, were used, this test showed 87.5% sensitivity and 93.6% specificity for COA1, and 88.2 and 95.2%, respectively for PPA-3. Absorption with M phlei was performed; no significant differences were found for COA1, but a lower sensitivity was found with PPA-3. This test was not especially affected by cross-reactivity with other mycobacterial disease because when 9 goats with M bovis infection were included in the M paratuberculosis control group, the specificity was only slightly different for absorbed (94.4%) and nonabsorbed sera (91.7%) for COA1, and (93.1 and 94.4%, respectively) for PPA-3. This test was used to study the percentage of seropositive goats for M paratuberculosis in 3 herds with different prevalences. Among 251 goats in southern Spain (Huelva), 40% were found positive for COA1 and 41% for PPA-3. Among 242 goats studied in southern Spain (Córdoba), 10.0% were positive for COA1 and 13.0% for PPA-3. In the Canary Island population of 176 goats, 3% were positive for COA1 and 0.5% for PPA-3. According to the accuracies of both positive and negative predictions, our test could be applied to populations with high prevalence to prevent additions to the herd and to cull infected animals (with 40% prevalence, the positive and negative predictive values are 90%), and to prevent adding infected animals to populations with moderate or low prevalence.
We have studied antifolate-resistant rodent cell lines with respect to dihydrofolate reductase gene expression and expression of the "classic" multidrug resistance phenotype by flow cytometry. Using a series of antifolate-resistant and colchicine-resistant Chinese hamster ovary cell lines obtained by single-step and stepwise selection protocols, we show that viable cell staining with fluoresceinated methotrexate and daunorubicin correlates well with drug resistance and expression of dihydrofolate reductase protein and the "classic" MDR phenotype in these cell lines. We show that flow cytometric analysis makes it possible to rapidly assess the potentially complex drug resistance phenotype(s) of cells selected with hydrophilic and lipophilic antifolates.
The authors performed immunohistochemical and cytogenetic studies in a 73-year old man with malignant angioendotheliomatosis. The patient was referred for evaluation of fever of unknown origin, hepatic failure, and neurologic deterioration. Examination of a muscle biopsy revealed numerous, noncohesive atypical mononuclear cells within small vessels. These cells stained positively with a pan-leukocyte marker CD45(PD7/26/16) and with a B-cell marker L26 but negatively with Factor VIII-related antigen, an endothelial cell marker. Peripheral blood obtained before chemotherapy was cultured and analyzed by the G-band method. A new translocation and numerous chromosomal aberrations were identified. The major cell line karyotype was 53,XY, +X, +5q?,-6, +i(6p), +7, -10, +11, -12, +12p-, +12p-, +18, +mar1, +mar2, t(1;3)(p22;p21),3q+,8p+. This is the first cytogenetic study performed in a case of malignant angioendotheliomatosis. Our findings demonstrate that the neoplastic cells in this disorder circulate in the peripheral blood and provide further evidence that malignant angioendotheliomatosis is a diffuse intravascular neoplasm of lymphoid origin. Furthermore, the authors conclude that this malignant lymphoproliferative disorder should be reclassified as a primary intravascular (angiotropic) lymphoma.
Twenty-two alloantisera that detected eleven specificities in two loci of the goat (SD1 and SD2) were studied on ovine lymphocytes from 55 Spanish Merino sheep by microlymphocytotoxicity assay. All the sera detected antigenic variability in sheep although this variability was not comparable to that described in the goat. No pancytotoxic sera were found. Agglutinating and hemolytic antibodies present in the sera were not related to any antigen present in erythrocytes and lymphocytes. Furthermore these samples were typed with sixteen ovine alloantisera and no relationship between specificities detected by ovine sera and the antigenic variability detected by goat alloreactives was found.
We describe the development of resistance to trimetrexate and piritrexim (BW 301U) by a stepwise selection protocol in Chinese hamster ovary cells. Selection in trimetrexate resulted in initial resistance as a result of dihydrofolate reductase gene amplification. Several trimetrexate-resistant variants that display 250-340-fold and 25-50-fold resistance to lipophilic and hydrophilic antifolates, respectively, were established. Increased antifolate resistance was associated with a prominent overexpression of dihydrofolate reductase as determined from the elevated folate reductase activity, cellular labeling with fluorescein-methotrexate, and steady-state mRNA levels as a result of a consistent dihydrofolate reductase gene amplification. However, upon subsequent incremental increases in trimetrexate, further resistance was also associated with amplification of the multidrug resistance gene. This resulted in overexpression of P-glycoprotein and a subsequent 20-50-fold collateral resistance to pleiotropic drugs such as adriamycin, actinomycin D, vinca alkaloids, etoposide, and colchicine. In contrast, initial resistance following selection with low piritrexim concentrations resulted from an unknown mechanism(s) not involving overproduction of either dihydrofolate reductase or P-glycoprotein. This piritrexim resistance was shared with trimetrexate but not with methotrexate. Upon further selection with piritrexim, resistant variants emerge with amplified dihydrofolate reductase but not with multidrug resistance genes. These variants were subsequently resistant to both hydrophilic and lipophilic folate antagonists but retained sensitivity to pleiotropic drugs. The pattern of resistance with methotrexate, trimetrexate, and piritrexim shared a common mechanism, dihydrofolate reductase gene amplification, but differed regarding the additional amplification of the multidrug resistance gene in trimetrexate-resistant cells as well as the emergence of an additional unknown mechanism(s) of resistance to lipid-soluble antifolates upon initial selection in piritrexim.
We describe a bioassay for the quantitation of plasma methotrexate and trimetrexate levels employing intact cells. This assay is based on the intracellular saturation of dihydrofolate reductase with fluorescein-methotrexate (F-MTX) and its dose-dependent displacement by methotrexate or trimetrexate as monitored by flow cytometry. Serially diluted methotrexate-containing plasma, representing a wide chemotherapeutic range, produces F-MTX displacement curves similar to those of standard methotrexate solutions. There is no interference by normal plasma components such as folate and its reduced forms. Plasma methotrexate or trimetrexate concentration is the product of the 50% displacing concentration of standard antifolate (IC50) and the reciprocal of the plasma dilution which yields the same displacement. F-MTX competition with standard methotrexate displayed linear displacement from 18.0 +/- 3.1 to 33.7 +/- 1.5 nM (n = 10). The standard trimetrexate calibration curve was linear from 0.28 +/- 0.03 to 1.5 +/- 0.33 nM (n = 8). Thus, the bioassay sensitivities for methotrexate and trimetrexate are at least 18 and 0.3 nM, respectively. Comparison of methotrexate levels in 10 plasma specimens from cancer patients determined by the clinical enzyme inhibition assay and by our bioassay showed a high degree of correlation (r = 0.987).
The local anesthetics dibucaine and tetracaine inhibit the (Ca2+ + Mg2+)-ATPase from skeletal muscle sarcoplasmic reticulum [DeBoland, A. R., Jilka, R. L., & Martonosi, A. N. (1975) J. Biol. Chem. 250, 7501-7510; Suko, J., Winkler, F., Scharinger, B., & Hellmann, G. (1976) Biochim. Biophys. Acta 443, 571-586]. We have carried out differential scanning calorimetry and fluorescence measurements to study the interaction of these drugs with sarcoplasmic reticulum membranes and with purified (Ca2+ + Mg2+)-ATPase. The temperature range of denaturation of the (Ca2+ + Mg2+)-ATPase in the sarcoplasmic reticulum membrane, determined from our scanning calorimetry experiments, is ca. 45-55 degrees C and for the purified enzyme ca. 40-50 degrees C. Millimolar concentrations of dibucaine and tetracaine, and ethanol at concentrations higher than 1% v/v, lower a few degrees (degrees C) the denaturation temperature of the (Ca2+ + Mg2+)-ATPase. Other local anesthetics reported to have no effect on the ATPase activity, such as lidocaine and procaine, did not significantly alter the differential scanning calorimetry pattern of these membranes up to a concentration of 10 mM. The order parameter of the sarcoplasmic reticulum membranes, calculated from measurements of the polarization of the fluorescence of diphenylhexatriene, is not significantly altered at the local anesthetic concentrations that shift the denaturation temperature of the (Ca2+ + Mg2+)-ATPase.(ABSTRACT TRUNCATED AT 250 WORDS)
We are studying mechanisms of resistance to hydrophilic and lipophilic antifolates in cultured mammalian cells. We determined the cytotoxicity of methotrexate and the lipid-soluble antifolate trimetrexate to various human carcinoma cells and their doxorubicin-resistant sublines. These multidrug-resistant cells were 17-fold to 26-fold more resistant to trimetrexate but as sensitive to methotrexate as their parental cells. Verapamil and quinidine, which are known to modulate the degree of pleiotropic drug resistance, reversed the cross-resistance to trimetrexate but did not alter methotrexate toxicity in multidrug-resistant cells. By flow cytometry, we show that multidrug-resistant Chinese hamster ovary cells retained eightfold more fluorescein-methotrexate bound to dihydrofolate reductase upon competition with trimetrexate than the drug-sensitive cells did. However, methotrexate displaced fluorescein-methotrexate equally well in sensitive and multidrug-resistant cells. Furthermore, verapamil produced dose-dependent displacement of fluorescein-methotrexate from the multidrug-resistant cells in the presence of low concentrations of trimetrexate but had no significant effect on displacement of fluorescein-methotrexate from sensitive cells. Hamster cells that overproduce dihydrofolate reductase by 93-fold were 145-fold and 96-fold more resistant to methotrexate and trimetrexate, respectively, than their sensitive parental cells. This form of antifolate resistance was not altered by verapamil or quinidine. We conclude that the cross-resistance to trimetrexate in cells that do not overproduce dihydrofolate reductase is associated with the multidrug-resistant phenotype. Possible implications of trimetrexate resistance in cancer chemotherapy are discussed.
A new cell line, SUP-HD1, was established from the pleural effusion of a patient with nodular sclerosing Hodgkin's disease (NSHD). The SUP-HD1 cells had the characteristic morphology of Reed-Sternberg cells and contained acid phosphatase and nonspecific esterase. The cells lacked the Epstein-Barr virus (EBV) genome and reacted with monoclonal antibodies (MoAbs) against CD15 (Leu-M1), CD25 (Tac), CD71 (OKT9), Ki67, and HLA-Dr. However, the SUP-HD1 cells were nonreactive with MoAbs that specifically identify T lymphocytes, B lymphocytes, and macrophage/myeloid cells. Karyotype analysis of the cell line showed clonal abnormalities involving 1p13, 7p15, 8q22, and 11q23, chromosomal locations, at which breakpoints have been reported in HD. Southern blot analysis demonstrated rearrangement of the immunoglobulin heavy chain and kappa light chain genes as well as the gene for the beta chain of the T-cell receptor (TCR). Transcriptional analysis showed expression of RNAs for kappa light chain, interferon-gamma (IFN-gamma), and interleukin-2 receptor (IL-2R) but not IL-2. The SUP-HD1 cells lacked cytoplasmic and surface immunoglobulin heavy chain, but a small amount of cytoplasmic kappa light chain was detected. The presence of nuclear factor kappa B (NF kappa B), a B-lymphocyte-associated transcription factor, was demonstrated in stimulated and unstimulated cells. In addition, the SUP-HD1 cell line, produced IFN-gamma, a T-lymphocyte-associated lymphokine. Based on these data, the SUP-HD1 cells appear to be aberrant lymphocytes with characteristics of both activated B and T lymphocytes. Elaboration of lymphokines such as IFN-gamma by the malignant cells may represent one explanation for the unique clinical and pathologic features of HD.
A patient is presented who was operated for an intestinal obstruction and developed in the immediate postoperative period Boerhaave's syndrome. Subtotal esophagectomy with bipolar exclusion was performed. We discuss the advantages of radical surgery, even in advanced cases, if the size of the lesion justifies it, as compared to more conservative therapeutic attitudes.
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