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Biomedical subjects

R M Clark

Publications and source records attributed to R M Clark.

At least 37 records · Page 2Linked to original sources

A novel candidate gene for mouse and human preaxial polydactyly with altered expression in limbs of Hemimelic extra-toes mutant mice.

Polydactyly is a common malformation of vertebrate limbs. In humans a major locus for nonsyndromic pre-axial polydactyly (PPD) has been mapped previously to 7q36. The mouse Hemimelic extra-toes (Hx) mutation maps to a homologous chromosome segment and has been proposed to affect a homologous gene. To understand the molecular changes underlying PPD, we used a positional cloning approach to identify the gene or genes disrupted by the Hx mutation and a closely linked limb mutation, Hammertoe (Hm). High resolution genetic mapping identified a small candidate interval for the mouse mutations located 1.2 cM distal to the Shh locus. The nonrecombinant interval was completely cloned in bacterial artificial chromosomes and searched for genes using a combination of exon trapping, sample sequencing, and mapping of known genes. Two novel genes, Lmbr1 and Lmbr2, are entirely within the candidate interval we defined genetically. The open reading frame of both genes is intact in mutant mice, but the expression of the Lmbr1 gene is dramatically altered in developing limbs of Hx mutant mice. The correspondence between the spatial and temporal changes in Lmbr1 expression and the embryonic onset of the Hx mutant phenotype suggests that the mouse Hx mutation may be a regulatory allele of Lmbr1. The human ortholog of Lmbr1 maps within the recently described interval for human PPD, strengthening the possibility that both mouse and human limb abnormalities are due to defects in the same highly conserved gene.

Amino Acid Sequence↗

A comparison of lycopene and astaxanthin absorption from corn oil and olive oil emulsions.

The effect of different oils on the absorption of carotenoids was investigated in mesenteric lymph duct cannulated rats. Sixteen treatment emulsions containing increasing concentrations of either lycopene (LYC) or astaxanthin (AST) (5, 10, 15, 20 micromol/L) were prepared with olive oil or corn oil and continuously infused into the duodenum of the rat. Absorption of carotenoids into the mesenteric lymph duct was determined. Absorption of LYC and AST from both oils increased with the amount infused into the duodenum. The average recovery of AST in the lymph from the olive oil emulsion was 20% but was decreased to 13% from emulsions containing corn oil. Lycopene was not as well absorbed as AST. The average recovery of LYC was 6% from olive oil emulsions but only 2.5% when infused with corn oil. The LYC used in this study was isolated from tomato paste and was primarily in the all-trans form. We did not observe any significant isomerization of all-trans LYC to 9-cis LYC during absorption. We conclude that the type of oil with which a carotenoid is consumed can influence its absorption.

Animals↗

Excess vitamin E decreases canthaxanthin absorption in the rat.

The recent attention given to the possible role of alpha-tocopherol (alpha-Toc) and carotenoids in the prevention and treatment of a variety of illnesses resulted in segments of the population increasing their consumption of these nutrient/antioxidants. Once consumed, alpha-Toc and carotenoids are thought to follow the same absorptive pathway and may influence each other's absorption, particularly when taken in large doses. The purpose of this study was to determine if alpha-Toc and the carotenoid, canthaxanthin (CTX), interact during absorption. Rats were intraduodenally infused with corn oil emulsions containing combinations of alpha-Toc (0 or 300 mumol/L) and CTX (5, 10, 15, 20 mumol/L) in a 2 x 4 factorial arrangement. Absorption was determined by measuring recovery of CTX and alpha-Toc in the mesenteric lymph. The amount of CTX in the lymph increased significantly with the amount infused into the duodenum. The overall efficiency of CTX absorption from emulsions without alpha-Toc averaged 12% with individual animals having a range of 8 to 18%. Efficiency of absorption was not related to concentration of CTX infused. When alpha-Toc (300 mumol/L) was added to the oil emulsion, the absorption of CTX was decreased by at least 50%. Recovery of alpha-Toc in the lymph averaged ca. 10% and was not affected by CTX. These results suggest that concurrent consumption of a large dose of alpha-Toc may influence carotenoid bioavailability.

Animals↗

A comparison of lycopene and canthaxanthin absorption: using the rat to study the absorption of non-provitamin A carotenoids.

The purpose of this study was to validate the use of the mesenteric lymph duct cannulated rat to study the absorption of carotenoids which do not have provitamin A activity. The absorption of two carotenoids, a hydrocarbon carotenoid (lycopene) and a xanthophyll carotenoid (canthaxanthin), were investigated. In the first experiment, lipid emulsions containing lycopene (LYC) or canthaxanthin (CTX) were continuously infused into the duodenum, and lymph was collected for analysis at 2-h intervals. The time course for absorption of carotenoids and triacylglycerol (TAG) was similar. Carotenoids and TAG reached steady-state concentrations in the lymph by 6 h. There was no evidence for a delayed release of either carotenoid from the intestine relative to TAG. During a second experiment, emulsions containing increasing concentrations of LYC or CTX (5, 10, 15, 20 mumol/L) were infused. The LYC and CTX in the lymph increased in a dose-dependent manner. The average efficiency of CTX absorption was 16% while the efficiency of LYC absorption averaged only 6%. Efficiency of carotenoid absorption was not related to concentration infused. Finally, to test whether LYC and CTX interact during absorption both were added to a lipid emulsion at equal concentrations (20 mumol/L) and infused. The carotenoids did not significantly affect each other's absorption. These results demonstrate the usefulness of the rat as an animal model to study the absorption of non-provitamin A carotenoids.

Animals↗

Application of a Finnish mutagenicity model to drinking waters in the U.S.

Recent epidemiological studies conducted in Finland have reported a positive correlation between the mutagenicity of chlorinated drinking waters and certain human cancers. In these studies, past exposure to drinking water mutagenicity was assessed using a model developed by Vartiainen et al. [1] based on data collected in Finland. In this model, mutagenicity, as determined in the Ames assay, is a function of the total organic carbon (TOC) concentration of the water, chlorine dose, and to a minor extent, the concentration of ammonia. A study has been initiated to assess the applicability of this model to source waters and water treatment practices in the United States. Water samples were collected from three full-scale treatment plants and one pilot-scale plant. All the plants used chlorine exclusively for disinfection. One full-scale plant used ground water. Surface water sources were used by the other plants. TOC and ammonia concentrations were determined analytically and chlorine doses were obtained from the treatment plants. The water samples were concentrated by XAD resin adsorption for testing in the Ames assay. The observed levels of mutagenicity in the finished waters were 1.5 to 2-fold higher than those predicted using the model as specified in Vartiainen et al. [1]. Consequently, further validation is needed prior to widespread use of the Finnish model to assess exposure to mutagenicity in chlorinated drinking waters in the United States.

Ammonia↗

A community waterborne outbreak of salmonellosis and the effectiveness of a boil water order.

OBJECTIVES: A 1993 large water-borne outbreak of Salmonella typhimurium infections in Gideon, Mo, a city of 1100 with an unchlorinated community water supply, was investigated to determine the source of contamination and the effectiveness of an order to boil water. METHODS: A survey of household members in Gideon and the surrounding township produced information on diarrheal illness, water consumption, and compliance with the boil water order. RESULTS: More than 650 persons were ill; 15 were hospitalized, and 7 died. Persons consuming city water were more likely to be ill (relative risk [RR] = 9.1, 95% confidence interval [CI] = 2.9, 28.4), and the attack rate increased with increased water consumption. S. typhimurium was recovered from samples taken from a city fire hydrant and a water storage tower. Persons in 31% (30/ 98) of city households had drunk unboiled water after being informed about the boil water order, including 14 individuals who subsequently became ill. Reasons for noncompliance included "not remembering" (44%) and "disbelieving" (25%) the order. CONCLUSIONS: Communities with deteriorating water systems risk widespread illness unless water supplies are properly operated and maintained. Effective education to improve compliance during boil water orders is needed.

Data Collection↗

Randomized clinical trial of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer: an update. Ontario Clinical Oncology Group.

BACKGROUND: Breast-conservation surgery is now commonly used to treat breast cancer. Postoperative breast irradiation reduces cancer recurrence in the breast. There is still controversy concerning the necessity of irradiation of the breast in all patients. PURPOSE: We present an update of results from a randomized clinical trial designed to examine the efficacy of breast irradiation following conservation surgery in the treatment of women with axillary lymph node-negative breast cancer. The patients were enrolled from April 1984 through February 1989. Initial results were published in 1992 after a median follow-up time of 43 months. It was reported that recurrence of cancer in the breast occurred in 5.5% of the patients who received breast irradiation compared with 25.7% of those who did not. No difference in survival was detected between the two treatment groups. Now that the median patient follow-up has reached 7.6 years, the trial end points have been re-examined and an attempt has again been made to identify a group of patients at low risk for recurrence of cancer in the breast. METHODS: Eight hundred thirty-seven patients with node-negative breast cancer were randomly assigned to receive either radiation therapy (n = 416) or no radiation therapy (n = 421) following lumpectomy and axillary lymph node dissection. The cumulative local recurrence rate as a first event, distant recurrence (i.e., occurrence of metastasis) rate, and overall mortality rate for the treatment groups were described by the Kaplan-Meier method and compared with the use of the logrank test. The Cox proportional hazards model was used to adjust the observed treatment effect for the influence of various prognostic factors (patient age, tumor size, estrogen receptor level, and tumor histology) at study entry on the outcomes of local breast recurrence, distant recurrence, and overall mortality. All P values resulted from the use of two-tailed statistical tests. RESULTS: One hundred forty eight (35%) of the nonirradiated patients and 47 (11%) of the irradiated patients developed recurrent cancer in the breast (relative risk for patients in the former versus the latter group = 4.0; 95% confidence interval = 2.83-5.65; P < .0001). Ninety-nine (24%) of the patients in the former group have died compared with 87 (21%) in the latter group. Age (< 50 years), tumor size (> 2 cm), and tumor nuclear grade (poor) continued to be important predictors for local breast relapse. On the basis of these factors, we were unable to identify a subgroup of patients with a very low risk for local breast cancer recurrence. Tumor nuclear grade, as previously reported, and tumor size were important predictors for mortality. CONCLUSIONS: Breast irradiation was shown to reduce cancer recurrence in the breast, but there was no statistically significant reduction in mortality. A subgroup of patients with a very low risk for local breast recurrence who might not require radiation therapy was not identified.

Adult↗

Ovarian irradiation and prednisone following surgery and radiotherapy for carcinoma of the breast.

Following mastectomy, patients aged 35 to 76 years with operable breast cancer underwent postoperative irradiation of the chest wall and regional lymph nodes. They were then assigned at random to receive no further therapy (NT), ovarian irradiation (R) 2000 rads in 5 days, or ovarian irradiation in the same dosage plus prednisone (R + P) 7.5 mg daily for up to five years. A total of 703 eligible patients received the randomly assigned treatment. The median follow up was 21 years with a range of 14 to 25 years. Overall, there was a delay in recurrence (p = 0.03) and survival was prolonged (p = 0.19) for patients who received R, but in neither case was the difference significant after adjusting for the multiplicity in our data. Overall, patients who received R + P experienced a significant delay in recurrence (p = 0.0003) and a significantly prolonged survival (p = 0.005), even after adjusting for multiple comparisons. In premenopausal patients who received R, the recurrence of breast cancer was delayed and survival prolonged, but not significantly. In premenopausal women aged 45 years or more, R + P therapy significantly prolonged survival (p = 0.0004), while the delay in recurrence although significant (p = 0.02) was only marginally so after allowance for multiple comparisons. No value was demonstrated for ovarian irradiation with or without prednisone therapy in postmenopausal patients. A new finding in this review was that contralateral breast cancer as the first failure was reduced by R + P compared to NT in the overall group.

Adult↗

Long chain polyunsaturated fatty acids and bovine luteal cell function.

Experiments were conducted to determine the effects of exogenous polyunsaturated fatty acids (PUFA) on the production of progesterone and prostanoids by dispersed bovine luteal cells and to characterize endogenous luteal fatty acids throughout the estrous cycle. The addition of eicosapentaenoic acid (20:5, n3) resulted in a dose-dependent reduction of progesterone production and an increase in production of prostaglandin (PG) F2 alpha (PGF2 alpha) (p < 0.05). Nordihydroguaiaretic acid abolished the inhibitory effects of 20:5, n3 on progesterone production, while indomethacin did not alter these effects. The addition of 10 micrograms docosahexaenoic acid (22:6, n3) resulted in a suppression of progesterone synthesis (p < 0.05) and reduced PGF2 alpha synthesis. The addition of 0.1, 1, and 10 micrograms docosatetraenoic acid (22:4, n6) inhibited basal progesterone production, whereas only the highest dose decreased LH-stimulated synthesis of progesterone. The addition of 22:4, n6 resulted in increased PGF2 alpha synthesis (p < 0.05) and in lowered synthesis of prostacyclin (p < 0.05). Variations in luteal fatty acids were confirmed by an experiment in which endogenous fatty acids were characterized throughout the estrous cycle. The percentages and ratios of PUFA were altered throughout the estrous cycle. In summary, PUFA have potent inhibitory effects on the production of progesterone and PGI2 in vitro and may play a role in bovine luteal cell function by mechanisms yet to be determined.

Animals↗

Cyclical mastopathy and premenopausal breast cancer risk. Results of a case-control study.

Cyclical mastopathy (CM) is a common clinical syndrome of premenstrual breast swelling and tenderness. Its symptoms are relieved by reduction in dietary fat intake and, because fat intake may be associated with breast cancer risk, it was hypothesized that CM may also be related to breast cancer risk. This case-control study included 192 premenopausal women with a recent history of axillary node-negative breast cancer and 192 age-matched premenopausal controls. Subjects provided information on diet and risk factors, and they recorded breast symptoms prospectively during one menstrual cycle. Symptoms in the noncancerous breast of cases and the matched (right or left) breast of controls were examined. A cyclical pattern of symptoms was identified in both groups; breast tenderness scores were similar postmenstrually (p = 0.31) but were significantly higher premenstrually in the case group (p = 0.03). Cases also had a greater premenstrual increase in breast tenderness than controls (p = 0.03). When the effects of other risk factors for breast cancer were included in multivariate analyses, the association of cyclical tenderness with breast cancer persisted (p = 0.05), the odds ratio for severe tenderness being 3.32. Thus, we have identified an association of cyclical breast tenderness with breast cancer risk in premenopausal women. The association persists after consideration of diet and the effects of other breast cancer risk factors.

Adult↗

Lymphatic fatty acids from rats fed human milk and formula supplemented with fish oil.

Absorption of long-chain polyunsaturated fatty acids from human milk and formula supplemented with fish oil was studied to determine if the distribution route into lymphatic triacylglycerol (TAG) and phospholipid (PL) varies with the dietary source. Rats were intraduodenally infused with human milk or formula containing graded amounts of fish oil (0, 0.5, or 1.0 g/100 mL), and the mesenteric lymph was collected. Arachidonic acid (20:4n-6) levels in lymphatic TAG and PL were highest from animals fed human milk. In the animals infused with formula containing fish oil, as the amount of eicosapentaenoic acid (EPA, 20:5n-3) infused increased, there was essentially an equal increase in EPA associated with both lymphatic TAG and PL. Animals intraduodenally infused with human milk or formula without fish oil had only minor levels (less than 1%) of EPA in the lymph. In the fish oil-treated animals, as the amount of docosahexaenoic acid (DHA, 22:6n-3) infused increased, there was a 16-fold increase in DHA associated with lymphatic TAG, but only a 3-fold increase in DHA associated with lymphatic PL. The highest level of DHA in rats infused with human milk was observed in lymphatic PL. Hence, fish oil can be added to formula as a source of long-chain polyunsaturated fatty acids, but the distribution of fatty acids into lymphatic TAG and PL is not the same as that observed with human milk.

Animals↗

Effect of hypoinsulinemia on growth in the fetal rabbit.

Insulin is an important regulatory hormone in the control of fetal growth. In a fetal rabbit model, a non-ruminant species, the effects of insulin deprivation on glucose, growth and protein metabolism were studied. The fetuses of 10 pregnant New Zealand white rabbits in one uterine horn received a subcutaneous injection on day 25 of gestation (term = 30 days) of 0.1 mg streptozotocin (STZ)/gm fetal weight. The fetuses in the opposite horn received a sham injection of buffer. The dams were then killed on day 29. The fetal insulin concentration was depressed by 38%, and the serum glucose concentration was elevated by 28% in animals given STZ when compared to control animals. Fetal weights, carcass weights and skeletal growth, as measured by crown-rump length and tibial length of STZ-treated fetuses, were significantly reduced by 7-13%. However, organ weights were not significantly different, except for the kidneys which were 17% lighter. Protein and mineral contents of the carcasses were also reduced compared to the control fetuses. Thus, insulin deprivation in fetal rabbits results in significant growth impairment in a pattern similar to that of human asymmetric intrauterine growth retardation.

Animals↗

Phase II study of vorozole (R83842), a new aromatase inhibitor, in postmenopausal women with advanced breast cancer in progression on tamoxifen.

This Phase II study was designed to determine the efficacy and tolerability of vorozole (R83842), a new nonsteroidal aromatase inhibitor, in postmenopausal women with advanced breast cancer in progression being treated with tamoxifen, and to correlate these effects with the hormonal profile and plasma drug levels. Twenty-nine eligible women with estrogen receptor-positive or unknown disease were treated with 2.5 mg vorozole once daily p.o. until disease progression. All 29 are evaluable for toxicity and 27 for response as assessed by International Union Against Cancer (UICC) criteria. After a median follow-up of 8 months, 3 patients (11%) had partial remission of their disease for 14, 15, and 16 months and 14 patients had disease stabilization for 7-24 months (median, 12). Patients with a normal carcinoembryonic antigen level (</=3 mm/liter), those without bone metastases, older women, and those with a long disease-free interval were most likely to benefit from treatment. Estradiol decreased from pretreatment levels of 9. 2-85 pm/liter (mean, 24) to below detection (9.2 pm/liter) and estrone from 64-311 pm/liter (mean, 144.3) to 19-116 pm/liter (mean, 57) after 1 month. Serum follicle-stimulating and luteinizing hormone levels rose from 9-74 IU/liter (mean, 35.3) and 3.3-38 IU/liter (mean, 17.8) to 10-102 IU/liter (mean, 44.6) and 1.6-70 IU/liter (mean, 24.2) and sex hormone-binding globulin fell from 27-138 nm/liter (mean, 65.4) to 15-109 nm/liter (mean, 53.8) after 1 month of treatment. Corresponding levels of androstenedione, dehydroepiandrosterone, free testosterone, and 17alpha-hydroxyprogesterone were unaffected. An adrenocorticotropic hormone stimulation test was normal in 18 patients 1 month after treatment commenced. Trough drug levels (measured by gas chromatography) ranged from 6.5-95 ng/ml (median, 24.5) at 1 month of treatment. Possible treatment-related side effects were mild and included malaise, anorexia and nausea, hot flashes, fluid retention, vaginal infection, alopecia, lightheadedness, and one allergic reaction which caused lip swelling. Vorozole, given orally, is a clinically active well-tolerated new treatment for breast cancer. Selective suppression of estrogen confirms its action as a specific aromatase inhibitor. Further trials to confirm its relative efficacy in postmenopausal disease and to explore its application in other settings are indicated.

Aged↗

Lymphatic fatty acids from rats fed human milk and formula containing coconut oil.

Human milk and infant formula containing coconut/soy oil were infused into the duodenum of rats to determine the incorporation of capric, lauric, myristic and palmitic acids into lymphatic triacylglycerol (TAG). The proportion of capric and lauric acids in the lymphatic TAG reflected the fatty acid composition of the diet. Based on positional analysis, it appears that more than 50% of the capric and lauric acids could have been absorbed from the intestine as sn-2 monoacylglycerols. In the rats fed human milk, 50% of palmitic acid in lymphatic TAG was in the sn-2 position. Because of the nonrandom distribution of palmitic acid in the lymphatic TAG, the nonspecific lipase in human milk, i.e., bile salt-stimulated lipase, did not appear to be a factor in milk lipid digestion.

Animals↗

A lack of correlation among fatty acids associated with different lipid classes in human milk.

The fatty acids associated with triacylglycerol, cholesteryl ester, phosphatidylethanolamine, phosphatidylcholine and sphingomyelin in human milk were compared. Ten milk samples were selected for lipid class analysis based on their total lipid polyunsaturated/saturated fatty acid ratio (P/S ratio). The P/S ratio of the selected milk samples ranged from 0.3 to 0.8. Linoleic acid was the predominant fatty acid in milk to affect the P/S ratio. The percentage of linoleic acid in milk triacylglycerol was correlated (r = 0.84, P < 0.05) with the total milk lipid P/S ratio. Linoleic acid esterified to cholesterol was not correlated with total milk lipid P/S ratio but was correlated (r = -0.66, P < 0.05) with the quantity of lipid in the milk. Linoleic acid in the phospholipid classes did not correlate with shift in P/S ratio of the total milk lipid or linoleic acid content of other lipid classes.

Cholesterol Esters↗

Radiotherapy alone in breast cancer. Analysis of tumor and lymph node radiation doses and treatment-related complications. The experience of the Gustave-Roussy Institute and the Princess Margaret Hospital.

This retrospective analysis was conducted on breast cancer patients treated by radiotherapy alone at The Princess Margaret Hospital and at the Institut Gustave-Roussy. These patients had either operable tumors, but were unfit for general anesthesia, or had inoperable tumors due to local contraindications to surgery. Previous results showed that a radiation dose increase of 15 Gy can decrease the relative risk of tumor or lymph node recurrence twofold. In this third report, the same data were analyzed to determine the treatment-related complication rates and to correlate these to the radiation dose levels. Overall results were analyzed on 453 patients, but detailed analyses on complications were conducted on 372 patients not developing local recurrence in the first 6 months of follow-up. Each complication was graded on a 3-level previously defined scale. Most frequent complications were skin changes of different degrees, which were usually asymptomatic. More disabling complications were arm edema, impaired shoulder mobility, rib fractures and brachial plexopathy. The incidence of disabling complications was low. The only factor significantly increasing the risk of complications was the radiation dose level to the tumor and axilla. Technical factors such as overlapping fields should also be taken into account. As the more effective control of tumor and lymph nodes obtained in patients treated with higher radiation doses is counterbalanced by an increase in the complication rate, the dose to be delivered for each patient should be carefully chosen according to individual risk factors.

Arm↗

Delayed lactogenesis in women with insulin-dependent diabetes mellitus.

Breast milk lactose, total nitrogen, conductivity, osmolality, and intake by infants of 33 women with insulin-dependent diabetes mellitus (IDDM), 33 control women without diabetes, and 11 reference women were determined in a 3-mo study of lactation. Milk of women with IDDM had significantly lower lactose and higher total nitrogen (2-3 d postpartum), and their infants had significantly less milk intake (7-14 d postpartum) than did control or reference women. Total nitrogen was negatively correlated with milk lactose for women with IDDM at all times and for control women through day 14 postpartum. The data indicate delayed lactogenesis for women with IDDM, which was more likely to occur with poor metabolic control. Differences in milk composition of women with IDDM do not preclude them from breast-feeding their infants.

Diabetes Mellitus, Type 1↗

Inactivation of Escherichia coli by titanium dioxide photocatalytic oxidation.

Titanium dioxide in the anatase crystalline form was used as a photocatalyst to generate hydroxyl radicals in a flowthrough water reactor. Experiments were performed on pure cultures of Escherichia coli in dechlorinated tap water and a surface water sample to evaluate the disinfection capabilities of the reactor. In water devoid of significant amounts of inorganic-radical scavengers, rapid cell death was observed with both pure cultures and members of the indigenous flora in a natural water sample.

Escherichia coli↗