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Biomedical subjects

G M Clark

Publications and source records attributed to G M Clark.

At least 91 records · Page 5Linked to original sources
PubMed1998

Insulin-like growth factor-binding protein-3 and breast cancer survival.

Insulin-like growth factors (IGFs) are potent mitogens involved in the regulation of cell proliferation and apoptosis. The action of IGFs is mediated through a specific cell membrane receptor (IGF-IR), and the interactions between IGFs and this receptor are regulated by IGF-binding proteins (IGFBPs). IGFBP-3 is one such protein which either suppresses or enhances the actions of IGFs. Findings from most in vitro studies suggest that IGFBP-3 inhibits breast cancer cell growth and facilitates apoptosis, but clinical studies have found that high levels of IGFBP-3 in breast cancer tissues are associated with unfavourable prognostic indicators of the disease, such as large tumour size, low levels of steroid hormone receptors, elevated S-phase fraction and DNA aneuploidy. To further examine the role of IGFBP-3 in breast cancer recurrence and survival, we conducted the following nested case-control study. From a cohort of 1,000 women treated surgically for primary breast cancer, we consecutively selected 100 patients who developed recurrent disease after surgery and 100 age- and year of diagnosis-matched patients who had no relapse. Concentrations of IGFBP-3 in breast tissue extracts were determined with an ELISA. Inverse correlations of IGFBP-3 were revealed with estrogen receptor expression and patient age but not with tumour size or S-phase fraction. Levels of IGFBP-3 in breast tissues were slightly higher in the recurrent patients than in controls, but the differences were not statistically significant. No significant association was found between IGFBP-3 and breast cancer recurrence. Survival analysis, however, indicated that the risk of death was increased with higher IGFBP-3 levels, and the association was independent of other prognostic markers. In conclusion, our results demonstrate that high levels of IGFBP-3 are associated with unfavourable prognostic features of breast cancer.

Aged↗
PubMed1998

Intracellular responses of the rat anteroventral cochlear nucleus to intracochlear electrical stimulation.

The anteroventral cochlear nucleus (AVCN) is the first central processing site for acoustic information. The influence and extent of convergent auditory nerve input to AVCN neurons was investigated using brief (<0.2 ms) intracochlear electrical activation of spiral ganglion cells. In 40 neurons recorded in vivo, the major intracellular response to stimulation was an excitatory postsynaptic potential (EPSP) with short latency (approximately 1 ms) and fast rise time (<1 ms). Graduated EPSP amplitude increases were also seen with increasing stimulation strength resulting in spike generation. Hyperpolarization followed excitation in most neurons, its extent distinguished three response types: Type I showed no hyperpolarization; Type II and Type III displayed short (<10 ms) and long (>19 ms) duration hyperpolarization, respectively. Hyperpolarization was attributed to an inhibitory postsynaptic potential (IPSP) in addition to spike after hyperpolarization. Neurobiotin filling identified Type I and II neurons as stellate and Type III as bushy cells. These results suggests that AVCN neurons receive direct, possibly convergent, excitatory input from auditory nerves emanating from spiral ganglion cells with hyperpolarization resulting from polysynaptic inhibitory input.

Animals↗
PubMed1998

Analysis of loss of heterozygosity in 399 premalignant breast lesions at 15 genetic loci.

BACKGROUND: Usual ductal hyperplasia (UDH), atypical ductal hyperplasia (ADH), and ductal carcinoma in situ (DCIS) are risk factors for invasive breast cancer (IBC), suggesting that these lesions may be direct precursors of IBC. To identify genetic changes that may be important in the early development of precursor lesions and their progression to malignant or invasive disease, we examined 399 putative precursors (211 UDH, 51 ADH, 81 non-comedo DCIS, and 56 comedo DCIS) for loss of heterozygosity (LOH) at 15 polymorphic genetic loci known to exhibit high rates of loss in IBC. We also assessed the sharing of LOH by putative precursors and synchronous cancers. METHODS: The polymerase chain reaction was used to analyze DNA from microdissected archival specimens. RESULTS AND CONCLUSIONS: In hyperplasias from noncancerous breasts (i.e., without DCIS and/or IBC in analyses of hyperplasias), LOH at any given locus was rare (range, 0%-15%), although 37% of UDH and 42% of ADH lesions showed loss for at least one locus, suggesting that the development of hyperplasias can involve many different tumor suppressor genes. In DCIS from noncancerous breasts (i.e., without IBC in analyses of DCIS), LOH was common, with 70% of noncomedo lesions and 79% of comedo lesions showing at least one loss. In DCIS, substantial rates of loss (up to 37%) were observed at loci on chromosomes 16q, 17p, and 17q, suggesting that inactivated tumor suppressor genes in these regions may be important in the development of noninvasive breast cancer. When DCIS lesions from cancerous and noncancerous breasts were compared, substantially more LOH was observed in the cancerous breasts at a few loci (on chromosomes 2p, 11p, and 17q), suggesting that genetic alterations in these regions may be important in the progression to invasive disease. Among specimens harvested from cancerous breasts, 37% of UDH, 45% of ADH, 77% of noncomedo DCIS, and 80% of comedo DCIS lesions shared LOH with synchronous cancers at one locus or more, supporting the idea that the putative precursors and the cancers are genetically related.

Breast Diseases↗
PubMed1998

bcl-2 and apoptosis in lymph node positive breast carcinoma.

BACKGROUND: Because bcl-2 can block apoptosis in vitro, and because lower levels of apoptosis might lead to malignant cell accumulation and therefore to a more aggressive clinical course, the authors tested the hypothesis that high bcl-2 and low apoptosis would result in a worse prognosis for breast carcinoma patients. METHODS: Primary breast tumor specimens from 979 patients with positive axillary lymph nodes were evaluated for bcl-2 protein expression by immunohistochemistry (IHC). Apoptosis was evaluated by using IHC to detect 3' DNA fragments end-labeled with biotinylated uridine. Results were analyzed with respect to patient characteristics, prognostic factors, and clinical outcome. Median follow-up was 61 months. RESULTS: High bcl-2 expression was significantly associated with a number of favorable prognostic factors, including a lower number of positive lymph nodes, absence of p53 protein accumulation, estrogen receptor (ER) and progesterone receptor (PR) positivity, diploidy, and a lower proliferative rate. However, although bcl-2 is generally considered a negative regulator of apoptosis, in these tumors there was no significant association between bcl-2 and apoptosis. Patients with high bcl-2 expression had significantly improved disease free survival (DFS) (P < 0.0001) and overall survival (OS) (P < 0.0001). In a multivariate analysis, bcl-2 expression was independently associated with better DFS (P = 0.004). Regarding apoptosis, the presence of > or = 1% apoptotic cells was significantly associated with a greater number of positive lymph nodes, p53 protein expression, ER and PR negativity, aneuploidy, and a higher proliferation rate, although there was no significant association with a worse clinical outcome when this dichotomized cutoff was used. CONCLUSIONS: For lymph node positive breast carcinoma patients, high bcl-2 expression is associated with a number of good prognostic factors and is independently associated with better clinical outcome. Apoptosis is associated with a number of poor prognostic factors but not with a significantly worse outcome.

Apoptosis↗
PubMed1998

Muscimol suppression of the dorsal cochlear nucleus modifies frequency tuning in rats.

The cochlear nucleus is composed of three sub-nuclei: the dorsal (DCN), anteroventral (AVCN) and posteroventral cochlear nucleus (PVCN). Intrinsic connections from the DCN to the AVCN are inhibitory and organised tonotopically. In this investigation, this pathway and its possible role in frequency tuning was examined using in vivo extracellular recordings. Extracellular recordings were made from 191 units in the AVCN, 69 of which were recorded after suppression of DCN by application of the GABA agonist Muscimol (15 ng, 0.26 mM). Tuning curves were plotted and characteristic frequency (CF) and response threshold (measured in dB SPL) were determined for each unit. Units recorded post-Muscimol showed significantly broader tuning characteristics and lower thresholds. Primary-like and transient chopper neurons contributed to this decrease in threshold suggesting that they receive 'on' CF inhibitory drive from the DCN. Sustained chopper units did not show a significant decrease in response threshold after Muscimol; however, there was a tendency for broader tuning and a significant increase in CF tone evoked maximum discharge rate and chopping frequency suggesting that the DCN may play a role in regulating the temporal firing of these units in addition to providing lateral inhibition. These results suggest that the DCN to AVCN pathway may aid in fine tuning frequency information.

Acoustic Stimulation↗
PubMed1998

Synergy between TGF-beta 3 and NT-3 to promote the survival of spiral ganglia neurones in vitro.

Transforming growth factor-betas (TGF-betas) have been implicated in normal inner ear development and in promoting neuronal survival. Early rat post-natal spiral ganglion cells (SGC) in dissociated cell culture were used as a model of auditory innervation to test the trophic factors TGF-beta3 and neurotrophin-3 (NT-3) for their ability, individually or in combination, to promote neuronal survival. The findings from this study suggest that TGF-beta3 supports neuronal survival in a concentration-dependent manner. Moreover TGF-beta3 and NT-3-potentiated spiral ganglion neuronal survival in a synergistic fashion.

Animals↗
PubMed1998

Muscimol suppression of the dorsal cochlear nucleus impairs frequency discrimination in rats.

The cochlear nucleus is composed of three sub-nuclei: the dorsal (DCN), anteroventral (AVCN) and posteroventral cochlear nucleus (PVCN). In addition to connections between these sub-nuclei, each nucleus receives frequency specific tonotopically organised input from the cochlea. Evidence suggests that connections from the DCN to the AVCN are inhibitory and organised tonotopically but the functional significance of this pathway has yet to be elucidated. The possible role of this pathway in frequency discrimination using a T-maze behavioural paradigm and DCN suppression was examined. Five rats were trained on a two choice frequency discrimination task. Once frequency difference limens for 10-30% performance above chance were determined, rats had cannulae implanted bilaterally over the DCN. After recovery rats were tested on the behavioural task with nothing, saline and the GABA agonist muscimol injected into the DCN via the cannulae. Muscimol alone significantly reduced the rats ability to perform the task. This performance decrease was attributed to an inability to discriminate high frequency and not low frequency tones suggesting that place and not temporal coding of sound was compromised by DCN suppression. These results are consistent with the hypothesis that inhibitory drive from the DCN to AVCN may be crucial for the fine tuning of frequency information.

Acoustic Stimulation↗
PubMed1998

Effects of hypesthesia on oral behaviors of the orthognathic surgery patient.

PURPOSE: The purpose of this study was to compare orthognathic surgery patients with and without significant hypesthesia with respect to perceived problems with specific oral behaviors. PATIENTS AND METHODS: Data from 116 patients 6 months after bilateral sagittal split osteotomy (BSSO) and mandibular advancement were analyzed. Tactile sensation in the right and left mental nerve areas was determined using monofilaments and brush strokes (von Frey hairs). The right infraorbital region was used as a control. A difference of 450 mg of force between the control and test sites was considered significant hypesthesia. Patients rated their level of subjective problems with swallowing liquids or solids, smiling, spitting, kissing, speaking, eating, and drooling on a scale from 1 (none to mild) to 7 (extreme). A value of 5 or greater was considered significant impairment. RESULTS: Hypesthesia was shown in 23 patients (19.8%) with the monofilaments and in 29 patients (25.0%) using brush stroke direction. In each of these two groups, a significant correlation was observed between hypesthesia and difficulty in chewing and kissing. No correlation was observed between any of the remaining seven oral behaviors and hypesthesia. CONCLUSION: These findings suggest that only certain oral behaviors are affected by hypesthesia of the mental nerve.

Adolescent↗
PubMed1998

Reduction in excitability of the auditory nerve following acute electrical stimulation at high stimulus rates: III. Capacitive versus non-capacitive coupling of the stimulating electrodes.

Safe electrical stimulation of neural tissue is typically achieved using charge-balanced biphasic current pulses, which are designed to minimize the generation of direct current (DC) and the production of harmful electrochemical products. However, due to the kinetics of the charge injection process, neural stimulators must also use capacitive coupling or electrode shorting techniques, to ensure DC levels are minimal. Previous studies have reported a reduction in excitability of the auditory nerve following acute simulation at high rates and intensities. Elevated levels of DC were reported in these studies despite using charge-balanced biphasic pulses and electrode shorting. The present study was designed to investigate the extent to which DC contributed to these stimulus induced reductions in auditory nerve excitability. Adult guinea pigs were bilaterally implanted and unilaterally stimulated for two hours using charge-balanced biphasic current pulses and stimulus rates of 200, 400 or 1000 pulses/s (pps) at a stimulus intensity well above clinical levels (0.34 microC/phase). DC levels were controlled using either electrode shorting, or electrode shorting with capacitive coupling. Electrically evoked auditory brainstem responses (EABRs) were recorded before and periodically following the acute stimulation. It was found that the extent of reduction in the EABR amplitude was a function of stimulus rate. While there was little change in the EABR following stimulation at 200 pps, significant post-stimulus reductions in the EABR amplitude were observed at stimulus rates of 400 and 1000 pps during the three hour post-stimulus monitoring period. Stimulation using capacitively coupled electrodes, which eliminated all DCs, showed reductions in EABR amplitudes similar to those observed following stimulation using electrode shorting alone. While there was no significant difference in the extent of reduction in EABR amplitudes for capacitive coupling versus electrode shorting at stimulus rates of 200 pps (P > 0.05) and 400 pps (P > 0.05), there was a significant difference at 1000 pps (P< 0.001). The present findings indicate that the major component of the stimulus induced reductions observed in auditory nerve excitability appear to be associated with stimulus induced neuronal activity, although elevated levels of DC ( > 2.5 microA) can also contribute to these changes. However, although statistically significant, the effects of DC are very small compared to the effects of high rate, high intensity stimulation per se.

Animals↗
PubMed1998

Research advances for cochlear implants.

Considerable progress has been made with speech processing for multiple-channel cochlear implants, with a mean open-set CNC word score of 40% for electrical stimulation alone for the Nucleus SPEAK strategy. Further advances should be achieved through the following: beam-forming dual microphone systems for hearing in noise; better reproduction of the coding of sound frequencies; and taking advantage of plasticity in the central auditory pathways in young children. The reproduction of frequency coding will be facilitated with speech processors such as the Nucleus 24 system which can provide higher stimulus rates, and a new generation of electrode arrays where a greater number of electrodes lie close to the spiral ganglion cells.

Animals↗
PubMed1998

A phase I and pharmacokinetic trial of terephthalamidine (NSC 57155) as a 120-hour continuous infusion.

In this phase I study, terephthalamidine was administered as a 120-hour continuous infusion repeated every 21 days. Thirteen patients received 27 courses of terephthalamidine at four dose levels ( 14, 28, 46, and 70 mg/m2/day). Dose-limiting toxicity consisted of profound and intractable anorexia, weight loss and prostration in all patients. Toxicity was delayed and accompanied by hyponatremia and hypokalemia. No hematologic or other toxicity was documented. One patient with adenocarcinoma of the lung had a 40% decrease in mediastinal lymph nodes and resolution of a pleural effusion lasting 2 months. Pharmacokinetic analysis by HPLC was performed in all patients during their first course. The harmonic mean terminal half-life for terephthalamidine was 23 hours with a plasma clearance of 1.7 1/hr/m2. Both plasma concentrations achieved during infusion (r2 = 0.9) and area under the curve (AUC) (r2 = 0.8) were proportional to increase in dose (p < 0.002). Renal excretion accounted for 64% of the total cumulative dose, with an average renal clearance of 1.16 1/hr/m2. Due to the unacceptable toxicity seen at all doses with this schedule, no further studies are recommended unless the mechanism of toxicity is better understood and can be prevented.

Adult↗
PubMed1998

Time-dependence of hazard ratios for prognostic factors in primary breast cancer.

Some prognostic factors, such as steroid receptors, appear strongly related to outcome in early studies with short follow-up, but as follow-up matures the relationships appear to weaken. We investigated this phenomenon for several factors (tumor size, axillary lymph nodes, S-phase fraction, estrogen receptor (ER) status, and adjuvant therapy) in a large sample of breast cancer cases (N=2,873) with up to 17 years of follow-up for disease-free survival (DFS). Subjects in the study were identified from patients who had hormone receptor assays performed in our laboratory. Analysis of DFS included fitting a multivariate Cox proportional hazards model, testing for nonproportionality, and examining diagnostic plots. The assumption of proportional hazards was violated for several factors including ER, tumor size, and S-phase fraction. For ER, the hazard ratio was initially less than 1.0, indicating a good effect on prognosis, but increased at later times to values greater than 1.0, indicating a bad effect on prognosis. In contrast, the hazard ratios for tumor size and S-phase were initially high and decreased asymptotically toward 1.0 over time. Analysis of p53 expression in a subset of cases yielded qualitatively similar results. We conclude that several standard prognostic factors (ER, tumor size, S-phase fraction) and possibly other investigational factors have important but nonproportional effects on hazard. It is likely that violation of proportional hazards is common and not limited to breast cancer. Failure to recognize violations of proportional hazards can lead to both over- and under-estimation of the effects of important prognostic factors.

Adult↗
PubMed1998

S-phase fraction and breast cancer--a decade of experience.

During the past decade, more than 300 articles, abstracts, and book chapters have been published about S-phase fraction (SPF) determined by DNA flow cytometry and its clinical utility for patients with breast cancer. However, the use of SPF for making treatment decisions for breast cancer patients remains controversial. After reviewing 273 published articles, we conclude: 1) Despite different techniques and cutpoints, correlations between SPF and other prognostic markers are relatively consistent across studies; higher SPF is generally associated with worse tumor grade, absence of steroid receptors, larger tumors, and positive axillary lymph nodes. 2) Higher SPF is generally associated with worse disease-free and overall survival in both univariate and multivariate analyses; SPF values from laboratories that have conducted validation studies can be used, in combination with other factors, to estimate the prognosis of patients with primary breast cancer. 3) There is considerable variability among laboratories regarding assay methodology, cell-cycle analysis techniques, and cutpoints for classifying and interpreting SPF; use of SPF values from different laboratories is problematic, and there remains a need for standardization of these processes and well-designed confirmation studies. We conclude that measurement of SPF does have clinical utility for patients with breast cancer, but standardization and quality control must be improved before it can be routinely used in community settings.

Breast Neoplasms↗
PubMed1998

Aided speech recognition abilities of adults with a severe or severe-to-profound hearing loss.

Adults with severe or severe-to-profound hearing losses constitute between 11% and 13.5% of the hearing-impaired population. A detailed investigation of the speech recognition of adults with severe (n = 20) or severe-to-profound (n = 14) hearing loss was conducted at The University of Melbourne. Each participant took part in a series of speech recognition tasks while wearing his or her currently fitted hearing aid(s). The assessments included closed-set tests of consonant recognition and vowel recognition, combined with open-set tests of monosyllabic word recognition and sentence recognition. Sentences were presented in quiet and in noise at +10 dB SNR to replicate an environment more typical of everyday listening conditions. Although the results demonstrated wide variability in performance, some general trends were observed. As expected vowels were generally well perceived compared with consonants. Monosyllabic word recognition scores for both the adults with a severe hearing impairment (M = 67.2%) and the adults with a severe-to-profound hearing impairment (M = 38.6%) could be predicted from the segmental tests, with an allowance for lexical effects. Scores for sentences presented in quiet showed additional linguistic effects and a significant decrease in performance with the addition of background noise (from 82.9% to 74.1% for adults with a severe hearing loss and from 55.8% to 34.2% for adults with a severe-to-profound hearing loss). Comparisons were made between the participants and a group of adults using a multiple-channel cochlear implant. This comparison indicated that some adults with a severe or severe-to-profound hearing loss may benefit from the use of a cochlear implant. The results of this study support the contention that cochlear implant candidacy should not rely solely on audiometric thresholds.

Adolescent↗
PubMed1998

Chronic study on the neuronal excitability of the cochlear nuclei of the cat following electrical stimulation.

To examine the safety of auditory brainstem prosthesis, the cat cochlear nuclei were implanted and stimulated chronically with bipolar surface electrodes using charge-balanced biphasic current pulses at rates of 250 pulses/s. The stimulation was continuous 16 h/day for up to 12 weeks. The electrically-evoked auditory brainstem response (EABR) was used to monitor neuronal excitability of the cochlear nuclei following the chronic electrical stimulation. The body weight, respiration, and body temperature of the cats were monitored throughout the experiment. The amplitudes and latencies of the EABR waves were measured fortnightly and compared before, during and after the electrical stimulation. The results showed that the respiration, body weight and body temperature of the cats remained within normal limits during the chronic stimulation. During the stimulation, no change was found in the EABR waveform, but a decreased threshold and wider dynamic range were observed after the stimulation. There was no significant change in the amplitudes and latencies of the EABR waves after stimulation. The present findings suggest that chronic bipolar electrical stimulation with surface electrodes at rates of 250 pulses/s is safe for neuronal excitability of the cochlear nuclei in the cat.

Animals↗
PubMed1998

Acute study on the efficacy and safety of an auditory brainstem prosthesis.

Patients with profound binaural sensorineural hearing loss can be treated with cochlear implantation. In recent years, patients who have lost the integrity of the auditory nerve between the spiral ganglion and the cochlear nucleus in the brainstem, and cannot benefit from a cochlear implant, have reported auditory sensations following direct stimulation of the cochlear nucleus with an auditory brainstem prosthesis. To examine the safety and efficacy of such a prosthesis, the cochlear nuclei of guinea-pigs were acutely implanted and stimulated unilaterally with bipolar surface electrodes using the parameters of human implants. The activation of the central auditory pathway by the prosthesis was demonstrated using the 2-deoxyglucose technique. There was broad 2-deoxyglucose labelling in the ipsilateral cochlear nucleus and bilaterally in the inferior colliculi, indicating unusual stimulation of the ipsilateral ascending pathway. Histological examination was performed on all cochlear nuclei. The volumes of cochlear nuclei and the neuron sizes and density in the cochlear nuclei were analysed with three-dimensional reconstruction techniques, and comparisons were made between the stimulated and unstimulated sides. No histological difference, either by direct visual observation or by statistical comparisons, was observed between the stimulated cochlear nuclei and the control sides. These results suggest that in the acute case the auditory brainstem prostheses can safely and effectively activate the auditory pathway in guinea-pigs.

Acoustic Stimulation↗
PubMed1998

Intracochlear factors contributing to psychophysical percepts following cochlear implantation.

The performance of cochlear implant patients may be related to intracochlear, histopathological factors. We have performed detailed post-mortem examinations of five human, implanted cochleas and for each electrode correlated the psychophysical threshold, comfortable level and dynamic range with spiral ganglion cell survival, presence of fibrous tissue and/or new bone, and distance between the centers of the electrode bands and Rosenthal's canal. The psychophysical parameters were strongly interrelated. Threshold and comfort levels correlated with the distance between the electrodes and Rosenthal's canal. Threshold levels also correlated with the presence of intracochlear fibrous tissue and new bone, especially with the former. The dynamic range showed a negative correlation with intracochlear pathology, especially with new bone. Comfort levels and dynamic range were related to spiral ganglion cell survival. The distance between the electrodes and the modiolus increased with increasing levels of fibrous tissue and new bone. Spiral ganglion cell survival was decreased with increasing levels of fibrous tissue and new bone.

Adult↗