The drug discovery programs of the National Cancer Institute and the pharmaceutical industry recently have provided oncologists with a wide array of new chemotherapeutic agents that have considerable potential for breast cancer treatment. Foremost among these new agents are the taxanes, of which paclitaxel and docetaxel, the only members of this class currently in clinical use, have been associated with impressive response rates in patients with metastatic disease. Importantly, they display some evidence clinically of not being cross-resistant with the anthracyclines. Efforts now are being directed toward optimizing dose and schedule in the metastatic setting while integrating these agents into standard adjuvant regimens. Other agents that have undergone Phase II testing in breast cancer include vinorelbine, edatrexate, and losoxantrone. It remains to be determined, however, whether these drugs possess substantial advantages over other members of their class. Newer compounds, such as pyrazoloacridine, ICI D1694, topoisomerase-I inhibitors, temozolomide, penclomidine, fumagillin (TNP-470), and differentiators like the retinoids, hold substantial promise because of their unique mechanisms of action; however, Phase II testing of these agents is just beginning. Although alternative approaches to treatment, such as gene therapies, monoclonal antibodies, and growth factor inhibitors, are likely to have a positive impact, it is probable that progress will best be made by combining these strategies with chemotherapy. Therefore, continuation of the search for more effective chemotherapeutic agents should remain a high priority.

Antineoplastic Agents↗

PubMed1994

Treatment of patients with carcinoma of the thyroid invading the airway.

OBJECTIVE: To determine if complete resection (vs incomplete resection) improved survival of patients with thyroid carcinoma invading the airway. DESIGN: Retrospective, nonrandomized end point study. SETTING: Tertiary care referral centers. PATIENTS: All patients who had invasion of the airway by thyroid carcinoma and underwent some type of surgical resection. INTERVENTIONS: Surgical resection. MAIN OUTCOME MEASURE: Survival. RESULTS: Complete resection showed significantly better survival than incomplete resection (P = .0136). CONCLUSION: Complete resection of thyroid carcinoma invading the airway offers improved survival compared with incomplete resection.

Carcinoma, Papillary↗

PubMed1994

Treatment of aphthous ulcers in AIDS patients.

From 1987 to 1992, 240 acquired immunodeficiency syndrome (AIDS) patients with oral, laryngeal, and pharyngeal ulcers were evaluated. In 180 patients, ulcers resolved in less than 2 weeks without treatment. Of the 60 patients whose ulcers persisted for more than 2 weeks, 24 were culture positive for herpes simplex virus, Cryptococcus organisms, cytomegalovirus, or Mycobacterium organisms and were treated accordingly. The remaining 36 patients were diagnosed as having major aphthous ulcers. The usual sites for these ulcers were the floor of the mouth, tonsillar fossa, and epiglottis. The most common symptoms were pain and weight loss. The patients were treated with intralesional injection with triamcinolone acetonide and examined weekly. Ulcers were reinjected biweekly as needed. Response to treatment was evaluated by pain relief, ulcer healing, and weight gain. All patients reported pain relief within 2 days of initial injection. Most had marked reduction in ulcer size and subsequent weight gain, and many experienced total resolution of symptoms and complete healing.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Ozone stimulates release of platelet activating factor and activates phospholipases in guinea pig tracheal epithelial cells in primary culture.

Inhalation of ozone (O3) has been associated with development of inflammation in the respiratory airways and a variety of alterations in pulmonary function. Epithelial cells lining the airways are the first cells with which inhaled O3 comes into contact and thus represent a potential major target of acute O3 toxicity. In addition, upon appropriate stimulation or injury, these cells are capable of releasing a spectrum of secondary mediators that could relate to the pathogenesis of O3-associated lesions. We exposed organotypically cultured guinea pig primary tracheal epithelial (GPTE) cells in an air/liquid interface to photochemically generated O3 in vitro and monitored effects of O3 exposure on activation of phospholipases A2 (PLA2), C (PLC), and D (PLD), as well as release of the humoral mediator, platelet activating factor (PAF). PLA2 acts on ether-linked phosphatidylcholine, which upon further metabolism forms PAF;PLC acts on inositol phospholipids to produce inositol phosphates and diacylglycerol; and PLD generates phosphatidic acid. GPTE cell cultures exposed to O3 (0.05-1.0 ppm) for 1 hr displayed an elevated total release of PAF (apical+basolateral). Maximal stimulation in both apical and total release of PAF occurred at 1.0 ppm O3 (405 +/- 47 and 282 +/- 23% of air control values, respectively, n = 7). The 1.0 ppm O3-induced increased PAF release was significantly inhibitable by the PLA2 inhibitor mepacrine (1 mM), suggesting a connection between PAF release and PLA2 activation. O3 exposure activated PLC in GPTE cells in a concentration- (0.1-1.0 ppm) and time-dependent (10-60 min) manner to produce a significant accumulation of inositol-1,4,5-triphosphate, with maximal accumulation at 1.0 ppm O3 for 1 hr (417 +/- 121% of air control, n = 6). PAF receptor antagonists Ro 24-4736 (1 microM) and Ro 41-5036 (1 microM) did not affect O3-stimulated inositol phosphate accumulation. PLD also was activated in GPTE cells exposed to 1.0 ppm O3 for 1 hr (169 +/- 80% of air control, n = 5). These results suggest that GPTE cells respond to O3 exposure in vitro by increasing production and/or release of PAF via a mechanism that may involve activation of PLA2, PLC, and PLD. Epithelial-derived mediators, such as PAF, may play a role in the pathogenesis of lesions associated with inhalation of O3.

Animals↗

PubMed1994

Relationship between functional properties and structure of ovalbumin.

The effects of ovalbumin (OVA) denaturation using urea, guanidinium chloride (GdnHCl), sodium dodecyl sulphate (SDS), cetylpyridinium chloride (CPC), 3-[(3-cholamidopropyl)dimethylammonio]-1-propanesulfonate (CHAPS), and 5 different cationic detergents with various side chains, HCl, and CH3COOH were observed. Progressive unfolding in ovalbumin was measured as a function of fluorescent light intensity, peak response and shift in the maximum of emission. Kinetic measurements demonstrated that the rate of denaturation usually followed a double exponential decay pattern, but at small concentrations of urea and acids first-order reaction was indicated. The reversibility of the unfolding-folding transitions was confirmed from tryptophan fluorescence and circular dichroism (CD) measurements. Differences in secondary structure were observed and changes of alpha-helical content were calculated. Polyacrylamide gel electrophoresis (PAGE) with and without sodium dodecyl sulphate (SDS-PAGE) showed differences in the structure of native and denatured ovalbumin. Native protein samples in PAGE demonstrated smaller number and larger mobilities of subunits than denatured ones with different reductants, such as SDS and 2-mercaptoethanol (2 ME). Scanning of SDS protein patterns showed the appearance of aggregated forms in region of 45 kD.

Circular Dichroism↗

PubMed1994

Adenosine and AICA-riboside fail to enhance microvascular endothelial preservation.

Crystalloid cardioplegia may cause coronary microvascular endothelial dysfunction during cardiopulmonary bypass. The perioperative administration of either adenosine or AICA-riboside (acadesine, 5-aminoimidazole-4-carboxamide-1-ribofuranoside) has been associated with improved myocardial functional preservation and improved coronary blood flow after ischemic arrest. To examine if this enhanced recovery of myocardial function and perfusion may be related to improved endothelial preservation, pigs were placed on cardiopulmonary bypass and the hearts were arrested with plain cold, hyperkalemic (K+ = 25 mmol/L) crystalloid cardioplegia, or cardioplegic solution containing either 0.1 mmol/L adenosine or 50 mumol/L AICA-riboside, which causes the release of endogenous adenosine. AICA-riboside (375 mg) also was infused over 30 minutes before cardioplegia in the later group. After 1 hour of ischemic cardioplegia, hearts were reperfused for 1 hour while the pigs were weaned from cardiopulmonary bypass. Coronary arterioles (90 to 190 microns in diameter) from both subepicardial and subendocardial regions of the left ventricle were studied in vitro in a pressurized, no-flow state with videomicroscopy. After contraction of vessels by 25% to 40% of the baseline diameter, drugs were applied extraluminally. Relaxation of control arterioles to serotonin was slightly greater in vessels from the subendocardial region compared with vessels from the subepicardial region, and subendocardial arterioles were more affected by cardioplegia than were subepicardial vessels. In contrast, relaxations of control microvessels to bradykinin and the calcium ionophore A23187 were similar in the two transmural myocardial regions. Responses to bradykinin and A23187 were significantly and similarly reduced after ischemic arrest with plain crystalloid cardioplegia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗

PubMed1994

Polarized release of lipid mediators derived from phospholipase A2 activity in a human bronchial cell line.

The release of arachidonic acid (AA) and platelet activating factor (PAF) from airway epithelial cells may be an important mediating factor in lung physiological and inflammatory processes. The type of lung response may be determined by the directional release of AA and PAF. We used the human bronchial epithelial cell line, BEAS2B (S6 subclone; BEAS), to investigate the polarized release of AA and PAF from lung epithelial cells. BEAS, grown on Transwell filters, were prelabeled with either 3H-AA or 3H-lyso-PAF. 3H-AA products and 3H-PAF were analyzed by high performance liquid chromatography and thin layer chromatography, respectively. BEAS incubated with melittin (2-4 micrograms/ml for 15 min) had an increased release (compared to vehicle-incubated cells) of both free 3H-AA and 3H-PAF into the apical compartment but not into the basolateral compartment. Treatment of the BEAS cells with the phospholipase A2 (PLA2) inhibitor mepacrine (1 mM) prior to, and during, incubation with melittin inhibited the increase in 3H-AA and 3H-PAF release into the apical compartment by 65% and 100%, respectively. Exposure of BEAS cells to ozone (O3; 1.0 ppm for 15 min) increased the release of polar 3H-AA products as well as 3H-PAF into both the apical and basolateral compartments. Mepacrine did not significantly inhibit the O3-induced release of polar 3H-AA products or 3H-PAF into either the apical or basolateral compartments. These data suggest the direction of the release of 3H-AA (or 3H-AA products) and 3H-PAF is stimulus-specific and that PLA2 involvement in the release of the lipids is also dependent on the stimulus. The directional release of AA, AA products, and PAF may be important in the airways responses to various agonists and oxidants.

Arachidonic Acid↗

PubMed1994

Acrylamide increases in vitro calcium and calmodulin-dependent kinase-mediated phosphorylation of rat brain and spinal cord neurofilament proteins.

Male Sprague-Dawley rats were administered a daily i.p. dose of 0.70 mmol/kg body weight of acrylamide, propionamide (a non-neurotoxic structural analog of acrylamide) or deionized water. Animals were sacrificed when signs of severe neurotoxicity were apparent. Neurofilaments (NFs) and endogenous kinase were isolated from the brain and spinal cord by axonal floatation. Increased in vitro Ca2+/calmodulin-dependent phosphorylation of endogenous and exogenous NF proteins and autophosphorylation of Ca2+/calmodulin protein kinase II (CaM kinase II, EC 2-7-1-37) were observed in samples from both brain and spinal cord of acrylamide-treated animals compared with controls. There was no significant difference between samples isolated from propionamide-treated animals and controls. Increased calmodulin binding to brain supernatant CaM kinase II was also observed as a result of acrylamide treatment. There was no significant difference observed in the amount of antibody binding to the alpha-subunit of brain supernatant CaM kinase II between treated or control animals. These results suggest that increased CaM kinase II-dependent phosphorylation of cytoskeletal proteins may be involved in the mechanisms of acrylamide-induced neurotoxicity.

Acrylamide↗

PubMed1994

Caffeine as an analgesic adjuvant in tension headache.

Six randomized, double-blind, two-period crossover studies, conducted under similar protocols, compared the efficacy of two analgesic combinations containing caffeine with an acetaminophen 1000 mg control and with a placebo in outpatients with episodic tension-type headaches. In four studies, comprising 1900 patients, the caffeine-containing analgesic consisted of a combination of 500 mg acetaminophen, 500 mg aspirin, and 130 mg caffeine (APAP/ASA/CAF). In two studies, comprising 911 patients, the caffeine-containing analgesic consisted of a combination of 1000 mg acetaminophen and 130 mg caffeine (APAP/CAF). Patients self-medicated for moderate or severe headache pain, and with a self-rating record they rated their pain and its relief hourly for 4 hours. In all six studies, the caffeine-containing analgesics were significantly superior both to placebo and to 1000 mg acetaminophen, and acetaminophen was significantly superior to placebo. The significant analgesic adjuvant effect of caffeine was independent of patients' usual caffeine use or their caffeine consumption in the 4 hours before medication. For each treatment, the pooled analgesic responses for the four studies of APAP/ASA/CAF were virtually superimposable on the responses in the two APAP/CAF studies. The combinations produced more stomach discomfort, nervousness, and dizziness than acetaminophen or placebo.

Acetaminophen↗

PubMed1994

Cloning and expression of soluble epoxide hydrolase from potato.

Five cDNAs encoding a putative soluble epoxide hydrolase (sEH) from potato were isolated and characterized. The cDNAs contained open reading frames encoding 36 kDa polypeptides which were highly homologous to the carboxy terminal region of mammalian sEH. When one of the cDNAs was expressed in a baculovirus system a soluble 38 kDa protein with epoxide hydrolase activity was produced. The recombinant enzyme hydrolyzed a commonly used diagnostic substrate for the soluble form of mammalian EH. Inhibitor profiles of the recombinant potato and mammalian sEH were also similar. The expression of sEH in potato was found to be regulated by both developmental and environmental signals. Levels of mRNA for sEH were higher in meristematic tissue than in mature leaves. This mRNA was also observed to accumulate on wounding and application of exogenous methyl jasmonate.

Amino Acid Sequence↗

PubMed1994

Pilot study of the use of the ECFMG clinical competence assessment to provide profiles of clinical competencies of graduates of foreign medical schools for residency directors. Educational Commission for Foreign Medical Graduates.

PURPOSE: To conduct the first of a series of pilot projects of the clinical competence assessment (CCA) of the Educational Commission for Foreign Medical Graduates (ECFMG) in order to provide profiles of clinical competencies of graduates of foreign medical schools for residency directors in the United States and for governments and institutions in other countries. METHOD AND RESULTS: In September 1992 the first pilot project of the ECFMG CCA was conducted for a program director who wanted to evaluate ten first-year residents in a midwestern U.S. program. The CCA consists of integrated clinical encounters with ten standardized patients, 60 laser videodisc pictorials, and analysis of test items of previously completed ECFMG certification examinations. Profiles of the following clinical competencies were provided to the program director: data gathering (history and physical examination), interviewing and interpersonal skills, diagnosis and management skills, interpretation of diagnostic and laboratory procedures, written communication of information to the health care team, and spoken-English proficiency. The profiles were provided as individual scores compared with mean scores of a reference group of 525 first-year residents who took the CCA at four U.S. assessment centers, and as percentile scores with a range of one standard error of measurement. CONCLUSION: The individual performance data in this first pilot project were valuable to the program director, who used them to supplement scores on a written examination during the first residency year. The pilot project has shown the ECFMG CCA to be a useful tool for program directors to evaluate applicants and residents who are graduates of foreign medical schools.

Clinical Competence↗