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The development of specific receptor antagonists, especially dopamine and serotonin, has broadened and strengthened the options available for the treatment of nausea and vomiting. In addition to the availability of these specific receptor antagonists, the use of combination regimens has become a major improvement in the ability to reduce side effects of many treatment protocols.
Patients with CPS often display recent memory deficits. Typically, general intelligence, perceptual skills, language, remote memory, and primary memory are all normal. However, the ability to learn new combinations of cognitively complex material is deficient. This deficit may be specific for verbal material (e.g., as a difficulty with learning to recall a response word given an unrelated cue word), for nonverbal material (e.g., as a difficulty in drawing a complex figure from memory), or for both verbal and nonverbal material. Because these characteristics are typical of memory deficits after MTL damage, it is reasonable to suspect that these deficits in patients with epilepsy also reflect MTL damage. In many cases, MTL damage is apparent from neuroimaging studies, whereas seizure semiology suggests MTL onset. In these patients, the same pathology might be the cause of both the ictus and memory deficits. In other cases, memory impairment appears to be secondary to seizures. This suggestion is supported by cases where prolonged complex partial status resulted in a permanent global amnesia. Cases with shorter-lasting memory deficits were also presented. Neuropsychological testing revealed specific recent-memory deficits that cleared 2 weeks after a flurry of CPS and 24 hr after a single seizure. Depth recordings have demonstrated that MTL electrographic seizures can occur without subjective manifestations. When these are evoked by local electrical stimulation, a profound inability to learn new material may be observed during the afterdischarge. Similarly, artificially induced MTL spike-and-wave complexes interfere with the memory for simultaneously presented complex visual scenes. Recent evidence suggests that all of the above phenomena may reflect the engagement by epileptiform processes of the association-cortex (AC)-MTL circuits used in normal human memory. In recent memory tasks, cognitive evoked-potential components N4 and P3 are generated in the MTL and to a lesser degree in related AC regions. The N4/P3 are strongly modulated by familiarity in recent memory. This modulation is eliminated by anterior temporal lobectomy. The typical slow wave following spontaneous MTL interictal spikes has the same MTL voltage topography, and thus probably similar synaptic generators, as the cognitive P3 potential. Furthermore, MTL spike-and-wave complexes can be evoked in recent memory tasks at a fixed latency equal to that of the N4.(ABSTRACT TRUNCATED AT 400 WORDS)
The medical records and histopathology of 250 patients who underwent cervical conization between January 1979 and December 1982 were reviewed. Two hundred thirty (92%) had endometrial curettage at the time of cervical conization. Abnormal findings were present in 7 (3%) of the 230 curettings. Limiting the performance of endometrial curettage at the time of conization to patients meeting specific criteria would have reduced the number of combined procedures by 75% without jeopardizing our ability to detect significant pathology. Endocervical curettage was performed on 221 (88%) of the 250 patients undergoing conization. The endocervical curettings were not a good predictor of the involvement of the cone margins with neoplasia. Only 7 (20%) of 35 patients with involved endocervical margins had a positive endocervical curettage. While the cone margins predicted residual carcinoma in the hysterectomy specimen with a sensitivity of 1.0, the sensitivity of the endocervical curettings for predicting residual carcinoma was 0.5. Although endocervical curettings can detect an invasive cancer not detected in the cone specimen, a negative endocervical curettage does not rule out invasive cancer above the excision line.
To determine the validity of ultrasonic nebulization of distilled water (UNDW, "fog") in comparison with methacholine challenge, in the assessment of toluene diisocyanate (TDI) asthma, we evaluated 75 subjects exposed to TDI with work-related respiratory symptoms. Subjects were submitted to bronchial challenge with methacholine at first, thereafter to UNDW inhalation and to specific challenge with TDI. The diagnosis of TDI-asthma was made in 30 of 75 patients (40 percent) who developed a bronchoconstrictive response to the specific challenge (reactors). Sensitivity and specificity of UNDW alone, methacholine alone, and of the combination of the two tests were determined with the results of the specific challenge with TDI as the "gold standard." Both frequency and severity of bronchoconstrictive response to UNDW (FEV1 decrease > or = 15 percent) and the degree (PD15 FEV1) and frequency of bronchial hyperresponsiveness to methacholine were significantly higher in TDI reactors than in nonreactors. The UNDW had higher specificity (82.2 percent vs 51.1 percent) but lower sensitivity (40 percent vs 76.7 percent) than methacholine. The combination in parallel (positivity of any of the two challenges) of methacholine and UNDW challenge did not change sensitivity to a great extent (80 percent vs 76.7 percent), whereas combination in series (positivity of both challenges) had considerably greater specificity (86.7 percent vs 51.1 percent) than methacholine alone. We conclude that in the assessment of TDI-asthma, the validity of UNDW challenge alone is limited since it is insufficiently sensitive. Instead, combining UNDW and methacholine challenge when methacholine is positive improves our ability in identifying subjects with TDI-asthma diagnosed with the specific challenge. This procedure constitutes a first objective confirmation of a suggestive history of TDI-asthma that is useful for clinical purposes. However, especially for medicolegal purposes, the definitive diagnosis requires the specific challenge.
OBJECTIVE: The induction of transplantation tolerance across xenogeneic barriers by bone marrow transplantation holds great promise, but engraftment of xenogeneic stem cells has been difficult to achieve. Part of this difficulty is due to species-specific differences in regulatory cytokines and elements of the stromal microenvironment, which we studied here. MATERIALS AND METHODS: We developed a system where fresh bone marrow cells from swine and human are cultured on human bone marrow stroma in order to study these limiting factors in a clinically relevant species combination. RESULTS: We report here the ability of recombinant swine interleukin (IL)-3 and c-kit ligand (KL) to specifically enhance swine hematopoietic chimerism in this system. In the absence of exogenous swine cytokines, there were about half as many swine progenitors as human progenitors at 1, 2, and 4 weeks of culture. When used alone, swine IL-3 led to a notable but transient increase in the relative ratio of swine progenitors, while addition of swine KL increased the ratio of swine progenitors only modestly and only at later time points. In contrast, when swine IL-3 and KL were added together, there was a two- to fourfold increase in the ratio of swine to human progenitors at all times tested. CONCLUSION: These data demonstrate that both swine IL-3 and KL are needed for prolonged enhancement of swine progenitor chimerism under these conditions, and suggest that the species specificity of either one or both of these cytokines may represent an important barrier to prolonged engraftment of swine bone marrow in humans.
Transtympanic electrocochleography (TT ECoG) was conducted in 61 patients (61 ears) with the clinical diagnosis of Meniere's disease and 15 patients (21 ears) with cochlear hearing loss of other aetiologies to assess the ability of the method to separate different cochlear disorders. The click-evoked summation potential/action potential (SP/AP) ratio and the 1 and 2 kHz burst-evoked SP amplitudes were evaluated. Based on the TT ECoG results from 13 normal hearing subjects (15 ears) the upper limit of each variable was determined, above which a value was considered pathological, i.e. indicative of endolymphatic hydrops. The results showed that the sensitivity of the SP/AP ratio was 62% and specificity 95%. When evaluating the combinations of TT ECoG parameters with logistic regression, SP/AP ratio and 1 kHz burst-evoked SP amplitude were shown to increase the discriminating ability of TT ECoG significantly. Inclusion of the 1 kHz burst-evoked SP amplitudes increased sensitivity to 82%, without changing specificity. Inclusion of the 2 kHz burst had no effect on sensitivity or specificity.
BACKGROUND AND PURPOSE: The goals of this study were to compare the ability of statewide and institutional models of stroke risk after coronary artery bypass (CAB) to predict institution-specific results and to examine the potential additive stroke risk of combined CAB and carotid endarterectomy (CEA) with these predictive models. METHODS: An institution-specific model of stroke risk after CAB was developed from 1975 consecutive patients who underwent nonemergent CAB from 1994 to 1999 in whom severe carotid stenosis was excluded by preoperative duplex screening. Variables recorded in the New York State Cardiac Surgery Program database were analyzed. This model (model I) was compared with a published model (model II) derived from analysis of the same variables using New York statewide data from 1995. Predicted and observed stroke risks were compared. These formulas were applied to 154 consecutive combined CAB/CEA patients operated on between 1994 and 1999 to determine the predicted stroke risk from CAB alone and thereby deduce the maximal added risk imputed to CEA. RESULTS: Risk factors common to both models included age, peripheral vascular disease, cardiopulmonary bypass time, and calcified aorta. Additional risk factors in model I also included left ventricular hypertrophy and hypertension. Risk factors exclusive to model II included diabetes, renal failure, smoking, and prior cerebrovascular disease. Our observed stroke rate for isolated CAB was 1.7% compared with a rate predicted with model II (statewide data) of 1.56%. The observed stroke rate for combined CEA/CAB was 3.9%. When the Stony Brook model (model I) based on patients without carotid stenosis was used, the predicted stroke rate was 2.8%. When the statewide model (model II), which included some patients with extracranial vascular disease, was used, the predicted stroke rate was 3.4%. The differences between observed and predicted stroke rates were not statistically significant. CONCLUSIONS: Estimation of stroke risk after CAB was similar whether statewide data or institution-specific data were used. The statewide model was applicable to institution-specific data collected over several years. Common risk factors included age, aortic calcification, and peripheral vascular disease. The observed differences in the predicted stroke rates between models I and II may be due to the fact that carotid stenosis was specifically excluded by duplex ultrasound from the patient population used to develop model I. Modeling stroke risk after CAB is possible. When these models were applied to patients undergoing combined CAB/CEA, no additional stroke risk could be ascribed to the addition of CEA. Such models may be used to identify groups at increased risk for stroke after both CAB and combined CAB/CEA. The ultimate place for CEA in patients undergoing CAB will be defined by prospective randomized trials.
56 tender points were examined in 100 patients and 50 age- and sex-matched healthy volunteers using a dolorimeter. 24 of the 56 points were especially selected according to ability of discrimination, best possible distribution on the body, and easy localization. All 56 points as well as the 24 specially selected points were examined as to their sensitivity and specificity in the diagnosis of generalized tendomyopathy. The sensitivity and the specificity for both point-combinations were acceptable. The sensitivity and specificity of the 24 points were superior to the 56 points in the case of discrimination ability. A 100% sensitivity and specificity could not, however, be achieved. It remains to be considered if functional and vegetative symptoms must still be used to support the diagnosis of generalized tendomyopathy (fibromyalgia).
32P-cyclophosphamide was found to combine with gamma-globulin fractions of immune sera. Immune sera incubated with 32P-cyclophosphamide retained ability to react specifically with homologous antigen in vitro in the system: MN antigens of human erythrocytes + rabbit anti-MN antibody, and probably reacted selectively with target antigens in vivo in the system: antigens of guinea pig kidney tissue + rabbit antibodies against these antigens. Hemagglutination, passive hemagglutination and precipitation in agar gel tests were used in the experiments. Ability to combine of the immune antibody + 32P-cyclophosphamide complex with homologous antigens was evaluated by measurements of radioactivity of studied materials (erythrocyte agglutinates and organ homogenates). The results indicate feasibility of using immune antibodies as carriers of cytostatic agents.
Although studies have suggested that B cell membrane-associated IgM and IgD may function differently in the generation of humoral immune responses, this difference has proven difficult to define precisely. Toward a better understanding of the function of these antigen receptors, we compared the ability of F(ab')2 fragments of antibodies specific for mouse Fab, IgM, and IgD to induce early changes in B cell physiology that are indicative of cell activation. Specifically, we assessed the ability of membrane IgM (mIgM) or membrane IgD (mIgD) or both in combination to transduce signals that result in membrane depolarization, increased I-A expression, G0 to G1 transition, and thymidine uptake. Results indicate that at low levels of anti-receptor antibody (0.01 to 0.1 microgram/ml) both isotypes transduce signals for the induction of membrane depolarization and increased I-A expression by a significant proportion of B cells, i.e., Ig+ cells. Higher concentrations of ligand (5 to 25 micrograms/ml) are required to induce a significant proportion of cells to undergo G0 to G1 transition and increase thymidine uptake. At optimal concentrations, anti-IgM and anti-IgD induce membrane depolarization and increased I-A expression by 80 to 90% of B cells. Although mIgM also transduces signals sufficient for G0 to G1 transition by 80 to 90% of B cells, mIgD transduces signals sufficient for G0 to G1 by only about 40% of B cells. A similar difference exists for the induction of thymidine uptake. Thus, results suggest that membrane Ig may transduce two different signals depending upon the amount of ligand that they bind. Although in some B cells mIgD can transduce both signals resulting in membrane depolarization and progression into G1, in most cells mIgD transduces only the first signal, resulting in membrane depolarization and increased I-A expression.
In cell cultures of quail, chick, or mouse skeletal muscle, both myogenic and fibrogenic cells synthesize and secrete type-IV collagen, a major structural component of the basal lamina. Type-IV collagen, together with laminin, forms characteristic patches and strands on the surface of developing myotubes, marking the onset of basement-membrane formation. The pattern for type-IV collagen and laminin is unique to these proteins and is not paralleled by other matrix proteins, such as fibronectin or type-I or -III collagen. In the present study, we used species-specific antibodies to either mouse or chick type-IV collagen to demonstrate the ability of fibroblast--derived type-IV collagen to incorporate in the basal lamina of myotubes. In combination cultures of embryonic quail skeletal myoblasts and mouse muscle fibroblasts, antibodies specific for mouse type-IV collagen revealed the deposition of type-IV collagen on the surface of quail myotubes in the pattern typical of the beginning of basement-membrane formation. Control cultures consisting of only quail muscle cells containing myoblasts and fibroblasts demonstrated no such reaction with these antibodies. Deposits of mouse type-IV collagen were also observed on the surface of quail myotubes when conditioned medium from mouse muscle fibroblasts was added to quail myoblast cultures. Similarly, in combination cultures of mouse myoblasts and chick muscle fibroblasts, chick type-IV-collagen deposits were identified on the surface of mouse myotubes. These results indicate that type-IV collagen synthesized by muscle fibroblasts may be incorporated into the basal lamina forming on the plasmalemma of myotubes, and may explain ultrastructural studies by Lipton on the contribution of fibroblasts to the formation of basement membranes in skeletal muscle.
The monoclonal antibody SZ1 is of interest for two reasons: it was used to define complex formation between glycoprotein (GP) Ib and GP IX, and its epitope is likely to be identical to that recognized by most quinine- and quinidine-dependent autoantibodies that cause thrombocytopenia. To determine the location of the epitope for SZ1 within the GP Ib-IX complex (which consists of three subunits: GP Ib alpha, GP Ib beta, and GP IX), we tested the ability of the antibody to bind transfected cells that expressed different combinations of complex subunits, and compared this binding to the binding of antibodies of known specificity. SZ1 bound to cells that expressed the entire GP Ib-IX complex in the same pattern as did AN51 (an antibody specific for GP Ib alpha). However, unlike AN51, SZ1 did not bind alpha beta cells (ie, cells that express GP Ib alpha and GP Ib beta, but not GP IX), but did bind to beta IX and alpha IX cells. We then compared the binding patterns of SZ1 and FMC25, an antibody specific for GP IX. Both bound virtually identically to cell lines that expressed every combination of two of the three GP Ib-IX complex subunits. However, the epitopes of the two antibodies were not identical, because fixation with 4% paraformaldehyde of cells that expressed GP IX destroyed the SZ1 epitope while maintaining the FMC25 epitope. Because of the ability of SZ1 to block the binding of many quinine- and quinidine-dependent antibodies, these data strongly suggest that GP IX is the component of the GP Ib-IX complex recognized by those antibodies.
Some of the most significant therapeutic leads and agents used for the treatment of cancer target microtubule dynamics. Paclitaxel is an exceptional example that is currently used for treating a wide range of tumors. New, non-taxane microtubule stabilizers, including several epothilones, are advancing through clinical trials. Laulimalide is a potent microtubule stabilizer that binds to tubulin at a site that does not overlap the taxane-binding site. It is active against paclitaxel-resistant cancer cells. Notwithstanding its therapeutic potential, laulimalide is relatively unstable, rearranging to a more stable but less active isomer. The goal of this study was to evaluate the ability of laulimalide and two designed laulimalide analogues, C16-C17-des-epoxy laulimalide (LA1) and C20-methoxy laulimalide (LA2), to inhibit cell proliferation in combination with other tubulin-binding and non-tubulin-binding antiproliferative antimitotic agents. The synthetic laulimalide analogues retain the mechanism of action of the natural compound but do not share its instability. We studied the ability of the laulimalides to act synergistically with paclitaxel, 2-methoxyestradiol, and monastrol, an Eg5 kinesin inhibitor. The results show that all three of the laulimalides acted synergistically with paclitaxel and 2-methoxyestradiol to inhibit proliferation with the analogues exhibiting significantly larger synergistic effects. The combination of laulimalide and monastrol was not synergistic and provided only additive effects. The laulimalide analogues LA1 and LA2 had a greater degree of synergy with both paclitaxel and 2-methoxyestradiol than was observed with laulimalide. Our results show that the laulimalides together with other tubulin-binding antimitotic agents provide synergistic antiproliferative actions. The data are consistent with the previously reported ability of laulimalide and paclitaxel to act synergistically to polymerize tubulin in vitro. These important findings suggest that specific combinations of microtubule-targeting agents should be considered for clinical utilities as they have excellent potential to improve clinical response.
Dendritic cells (DC) have been shown to be efficient antigen-presenting cells (APC) and, as such, could be considered ideal candidates for cancer immunotherapy. Immature DC (iDC) efficiently capture surrounding antigens; however, only mature DC (mDC) prime naive T lymphocytes. Clinical trials using DC-based tumor vaccines have achieved encouraging, but limited, success, possibly due to the use of immature or incompletely mature DC. Thus, it was apparent that a method capable of generating large numbers of fully functional iDC, their pulsing with desired form of tumor antigens and the subsequent complete and reproducible maturation of iDC is needed. Therefore, we compared two different methods of producing large numbers of iDC. Both protocols yielded comparable numbers of cells with an iDC phenotype with phagocytic function. We next determined which of the clinically applicable activators could induce the complete and reproducible maturation of DC, in order to define the most suitable combination for future clinical trials. Only a combination of TNFalpha + Poly (I:C), or a previously described cytokine cocktail of TNFalpha + IL-1beta + IL-6 + prostaglandin E2, induced the complete activation of the whole DC population, as assessed by the cell surface expression of CD83 and costimulatory molecules. The matured DC were functionally superior to iDC in their ability to stimulate the proliferation of allogeneic lymphocytes and autologous keyhole limpet hemocyanin (KLH)-specific T lymphocytes. Furthermore, only the combination of TNFalpha + Poly (L:C) activated DC to produce large amounts of biologically active p70 IL-12. Thus DC maturation by TNFalpha + Poly (I:C) could efficiently bias T cell response towards Th1 response. Implementation of our results into clinical protocols used for DC generation could be beneficial for future immunotherapy trials.
BACKGROUND: Mixed hematopoietic chimerism is a reliable means of tolerance induction, but its utility has not been demonstrated in discordant xenogeneic combinations because of the difficulty in achieving lasting hematopoietic engraftment. Miniature swine are likely to be suitable organ donors for humans. To evaluate the ability of mixed chimerism to induce swine-specific tolerance in widely disparate xenogeneic recipients, this study aimed to achieve long-lasting chimerism in a pig to mouse combination. METHODS: Immunodeficient transgenic mice were developed by crossing transgenic founders carrying porcine interleukin-3, granulocyte macrophage-colony stimulating factor, and stem cell factor genes with severe combined immunodeficient mice or non-obese diabetic/severe combined immunodeficient mice. Swine bone marrow transplantation was performed in these mice, and porcine chimerism was followed for 20 weeks. RESULTS: Whereas swine cells became undetectable in all non-Tg littermates by 7 weeks, high levels of porcine hematopoietic chimerism, including the presence of porcine class II+ cells in the host thymus were maintained in Tg mice for >20 weeks. Colony-forming assays revealed the presence of large numbers of swine hematopoietic progenitor cells in the marrow of these mice at 20 weeks after bone marrow transplantation. CONCLUSIONS: These transgenic mice demonstrate for the first time that spontaneous migration of marrow donor antigen-presenting cells to an intact recipient thymus can occur and that porcine stem cells can persist in this highly disparate species combination. These data therefore support the feasibility of the eventual goal of tolerance induction by mixed chimerism in discordant xenogeneic combinations.
Various segments of Tn3 transposase were fused individually to beta-galactosidase, and the resulting fusion proteins were examined for their DNA binding ability by a nitrocellulose filter binding assay. Analyses of a series of the fusion proteins revealed that the N-terminal segment of the transposase (amino acid positions 1-242; the transposase gene encodes 1004 residues in all) had specific DNA binding ability for the 38 bp terminal inverted repeat (IR) sequence, and the central segment (amino acid positions 243-632) had non-specific DNA binding ability. Further analyses of each of the two regions revealed that the N-terminal segment could be divided into at least two subsegments (amino acid positions 1-86 and 87-242), neither of which had specific DNA binding ability, but which both possessed non-specific DNA binding ability. The central segment included two subsegments (amino acid positions 243-289 and 439-505) with non-specific DNA binding ability. These results and other observations suggest that Tn3 transposase has several domains including those responsible for non-specific DNA binding, and a combination of two or more domains gives rise to specific DNA binding activity. The C-terminal segment of the transposase (amino acid positions 633-1004), which is very well conserved among transposases encoded by Tn3 family transposons, had no DNA binding ability. This segment may represent the main part of the catalytic domain responsible for the initiation step of transposition.
Over the last decade or so a great deal of psychophysical research has attempted to delineate the principles by which local orientations and motions are combined across space to facilitate the detection of simple spatial contours. This has led to the development of "association field" models of contour detection which suggest that the strength of linking between neighbouring elements in an image, is determined by the degree to which they aligned along smooth (first-order) curves. To test this assumption we used a path detection paradigm to compare the ability of observers to identify the presence of contours defined by either spatial orientation, motion direction or by specific combinations of both types of visual attribute. The relative alignment of the local orientations and/or directions with respect to the axis of the depicted contour was systematically varied. For orientation-defined contours detection was best when the elements were aligned along (parallel with) the contour axis, approached chance levels for obliquely oriented elements and then improved for elements that were orthogonal to the contour axis (i.e., performance was a U-shaped function of degree of orientation misalignment). This pattern of results was found for both straight and curved contours and is not readily explicable in terms of current association field theories. For motion-defined contours, however, performance simply deteriorated as the relative directions of the constituent path elements were progressively misaligned with respect to the contour. Thus the rules by which local orientations are linked to define spatial contours are qualitatively different from those used for linking local directions and each may be mediated by distinct visual mechanisms. When both orientation and motion cues were simultaneously available, contour detection performance was generally enhanced, in a manner that is consistent with probability summation. We suggest that association field models of orientation linking may need to be extended in light of the present findings.
Targeted adoptive immunotherapy is an attractive option for prostate cancer given its accessible primary location, the presence of specific tissue and tumor antigens, and the acceptability of collateral destruction of healthy prostrate tissue. The "T-body" approach, which uses genetically programmed, patient-derived lymphocytes transfected with chimeric receptor genes, combines the effector functions of T lymphocytes and natural killer cells with the ability of antibodies to recognize predefined surface antigens with high specificity and in a non-MHC restricted manner. We evaluated the therapeutic efficacy of anti-erbB2 chimeric receptor-bearing human lymphocytes on human prostate cancer xenografts in a SCID mouse model. Local delivery of erbB2-specific T bodies to well-established s.c. and orthotopic tumors, together with systemic administration of interleukin-2, resulted in retardation of both tumor growth and prostate-specific antigen secretion, prolongation of survival, and complete tumor elimination in a significant number of mice. These preclinical studies demonstrate the therapeutic potential of the T-body approach for locally advanced or recurrent prostate cancer as an adjunct to, or after, conventional therapy.