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This article explains the various types of powers of attorney which may be used in the health care setting in Oklahoma. In conjunction with the new Oklahoma Rights of the Terminally Ill or Persistently Unconscious Act, the legislature made significant changes to the statues governing powers of attorney. The effective date of this new legislation was September 1, 1992.
OBJECTIVE: The purpose of the study was to find out what people in rural Oklahoma know and understand about managed care. METHODS: A fourteen-statement survey instrument was developed. A panel of managed care professionals were asked to participate to provide a "standard" to compare the responses of the general public. The survey was administered to the general public in five rural communities and to recipients of the Oklahoma AHEC Newsletter. RESULTS: Overall, the panel tended to agree and created an industry profile useful in comparison to the responses of the general public: (1) 55-65% of the respondents answered I Don't Know or Neither Agree nor Disagree to statements using the term "managed care" and only 15-20% of the public respondents answered I Don't Know to statements not including the term, "managed care." (2) 25-30% of the general public answered in accordance with the managed care panel. (3) Over 50% of the public respondents Agreed that changes are necessary in the health sector. CONCLUSIONS: The results of this survey suggest that rural Oklahomans are uninformed about the concept of managed care and need to become better informed.
OBJECTIVE: To determine the prevalence of anti-ribosomal P (anti-P) proteins in several groups of patients with juvenile-onset systemic lupus erythematosus (SLE) in comparison with the prevalence in adult SLE. METHODS: Serum samples were pooled together from 3 cohorts of patients with juvenile-onset SLE in 3 different medical centers and from a miscellaneous group of juvenile-onset SLE patients whose samples were sent by regional physicians. Sera were studied for the presence of anti-P using 2 assays: Western blot with ribosomes as antigen, and an enzyme-linked immunosorbent assay with the COOH-terminal 22 amino acids of the ribosomal P protein in a multiantigenic peptide format as antigen. Sera found positive by both tests were considered positive for anti-P antibodies. Findings from similar studies involving a large cohort of patients with adult-onset SLE from Oklahoma City were used for comparison. RESULTS: The prevalence of anti-P antibodies in the pooled sample of juvenile-onset SLE sera was 45 of 108, or 42%, while in the adult cohort from Oklahoma City, 20 of 260, or 7.7%, were positive for anti-P (odds ratio [OR] 9.6, P < 10(-8) by Fisher's exact test). In addition, it was shown that 12 of 13 patients with both anti-P and anti-double-stranded DNA (anti-dsDNA) in the juvenile SLE cohort had nephritis, while only 8 of 22 patients without both antibodies were nephritic (OR 21.0, P < 10(-8)). It was also shown that in 9 illustrative cases, the levels of anti-P and anti-dsDNA antibodies usually varied together and in concordance with the clinical activity as measured by the SLE Disease Activity Index (SLEDAI). Finally, anti-P-positive and anti-P-negative patients had a similar prevalence of anti-dsDNA, anti-Ro/SSA, and anti-La/SSB antibodies, but patients with anti-P had a higher prevalence of anti-U1 RNP and anti-Sm (P = 0.041 and P = 0.0385, respectively, by Fisher's exact test). CONCLUSION: Antibodies to ribosomal P protein are more prevalent in juvenile-onset SLE than in adult-onset SLE. Levels of antibodies to ribosomal P protein vary with the clinical disease activity as measured by the SLEDAI, often in concordance with the levels of anti-dsDNA. The presence of both anti-P and anti-dsDNA antibodies was powerfully associated with nephritis in the cohort of patients for whom comprehensive clinical and serologic data were available.
The papers in this issue were presented at a symposium during the 25th Annual Meeting of the American Society of Primatologists held in Oklahoma City, Oklahoma, in June 2002. This symposium brought together many of the scientists who have contributed to our knowledge of ruffed lemur ecology, behavior, and conservation in the past decade. One objective was to share and compare key findings about ruffed lemurs (Varecia) resulting from long-term field studies at various sites in Madagascar. A second objective was to cross-fertilize work being done in the wild with that being done in captivity, with the aim of advancing a common conservation mission for this critically endangered genus. Varecia is a prime candidate for synthetic assessments such as these because it has now been studied in both the northern and southern reaches of its geographic range, and has also been the focus of a captive-to-wild reinforcement project. The papers in this issue contribute to 1) the establishment of reference ranges for a suite of physiological parameters in healthy wild Varecia populations; 2) environmental enrichment aimed at preserving species-typical behaviors in captivity; 3) an understanding of how forest structure, floristic composition, and fruiting phenology in areas with differing disturbance histories correlate with the natural occurrence and abundance of Varecia; 4) primary knowledge concerning dominance relations between the sexes and group leadership in wild Varecia; and 5) primary knowledge concerning how wild Varecia, with their unusual reproductive pattern and heavy reliance on fruit, modulate their activity budgets seasonally and in tandem with reproductive stages.
The USDA Agricultural Research Service (ARS) funded a demonstration project (1998-2002) for areawide IPM for stored wheat in Kansas and Oklahoma. This project was a collaboration of researchers at the ARS Grain Marketing and Production Research Center in Manhattan, Kansas, Kansas State University, and Oklahoma State University. The project utilized two elevator networks, one in each state, for a total of 28 grain elevators. These elevators stored approximately 31 million bushels of wheat, which is approximately 1.2% of the annual national production. Stored wheat was followed as it moved from farm to the country elevator and finally to the terminal elevator. During this study, thousands of grain samples were taken in concrete elevator silos. Wheat stored at elevators was frequently infested by several insect species, which sometimes reached high numbers and damaged the grain. Fumigation using aluminum phosphide pellets was the main method for managing these insect pests in elevators in the USA. Fumigation decisions tended to be based on past experience with controlling stored-grain insects, or were calendar based. Integrated pest management (IPM) requires sampling and risk benefit analysis. We found that the best sampling method for estimating insect density, without turning the grain from one bin to another, was the vacuum probe sampler. Decision support software, Stored Grain Advisor Pro (SGA Pro) was developed that interprets insect sampling data, and provides grain managers with a risk analysis report detailing which bins are at low, moderate or high risk for insect-caused economic losses. Insect density was predicted up to three months in the future based on current insect density, grain temperature and moisture. Because sampling costs money, there is a trade-off between frequency of sampling and the cost of fumigation. The insect growth model in SGA Pro reduces the need to sample as often, thereby making the program more cost-effective. SGA Pro was validated during the final year of the areawide program. Based on data from 533 bins, SGA Pro accurately predicted which bins were at low, moderate or high risk. Only in two out of 533 bins did SGA Pro incorrectly predict bins as being low risk and, in both cases, insect density was only high (> two insects kg(-1)) at the surface, which suggested recent immigration. SGA Pro is superior to calendar-based management because it ensures that grain is only treated when insect densities exceed economic thresholds (two insects kg(-1)). This approach will reduce the frequency of fumigation while maintaining high grain quality. Minimizing the use of fumigant improves worker safety and reduces both control costs and harm to the environment.
OBJECTIVE: The goal of this work was to review patients with early-stage cervical cancer undergoing radical hysterectomy, comparing Pfannenstiel and vertical midline incisions for surgical feasibility, complications, and length of stay. METHODS: Patients were identified by searching our institutional database. Data were collected from review of each patient's medical record, including demographics, cancer stage, histology, procedural information, length of stay, and complications. Associations between variables were studied using chi(2) and two-tailed t tests. Multivariate analysis was performed using logistic regression. RESULTS: Between March 1996 and June 2000, 113 patients from the University and Presbyterian Hospitals, Oklahoma City, Oklahoma, underwent radical hysterectomy and pelvic and paraortic lymph node dissection with records available for review. Group 1 consisted of 40 patients who had vertical incisions and group 2 consisted of 73 patients who had Pfannenstiel incisions. There was no difference in race, number of previous abdominal surgeries, distribution of stage, histology, percentage of type III hysterectomies, estimated blood loss, nodal counts, pathologic margin positivity, and postoperative complications among the two groups. Group 2 were younger (41.6 vs 46.5, P = 0.02) and had a lower average QI than group 1 (24.9 vs 28.9, P = 0.001). Group 2 also had a shorter average hospital stay (4.6 days vs 5.8 days, P = 0.04) and shorter operative time (215 min vs 273 min, P = 0.09). Multivariate analysis resulted in Pfannenstiel incisions (P = 0.002), younger age (P = 0.004), and smaller body mass index (P = 0.01) being significant predictors of length of stay. CONCLUSIONS: Pfannenstiel incisions are feasible without increased morbidity and equal nodal retrieval as compared with vertical midline incisions in patients with early-stage cervical cancer. Pfannenstiel incisions may offer an advantage besides cosmesis in the form of shorter operating room time and earlier discharge from the hospital.
Repeated passage of soil-borne wheat mosaic virus (SBWMV; wild-type Oklahoma field isolate; designated Okl-0) by manual inoculation resulted in deletion of part of SBWMV RNA2. Deletion was apparent in the population of RNA2 molecules after only 11 weeks in primary inoculated wheat plants (called Okl-1) and after 5 passages (Okl-5; 20 weeks) no full-length RNA2 remained. The extent of deletion in the Oklahoma isolate was compared with that in the previously studied Lab 1 (Nebraska) isolate. RNA2 from Okl-1, Okl-7, and Lab 1 were analyzed by RT-PCR amplification using sets of primer pairs which spanned all portions of the intact molecule. Lab 1 and the new stable isolate, Okl-7, were found to be deleted for 1058 and 759 nt, respectively, within the region encoding the coat protein-readthrough domain. However, the Okl-7 deletion was in a different position from the Lab 1 deletion. This suggests that deletions of SBWMV RNA2 which occur during serial manual inoculation are not directed toward production of a conserved, truncated form of the 84-kDa extended coat protein, but might reflect an RNA sequence-dependent event.
Plants mechanically inoculated with soil-borne wheat mosaic virus (SBWMV, Oklahoma isolate) generated several deleted forms of RNA2, the smaller genomic RNA (3593 nt). Four naturally deleted forms were cloned by RT-PCR methods and the sequences around each deletion site were compared. SBWMV RNA2 molecules were deleted for 519, 759, 964, or 1030 nt, respectively, each within the coat protein-readthrough domain. No common sequences were found flanking the 5'- and 3'-sites of deletion; however, the 5'-site of each deletion lay in the region between genome coordinates 1417-1465. The delta 759nt clone isolated from virus-infected plants after a single mechanical passage was identical to a clone described previously (J. Chen, S. A. MacFarlane, and T. M. A. Wilson, 1994, Virology 202, 921-929) which became the dominant, stable form of SBWMV RNA2 after five or more serial mechanical transfers. In this study, a total of 33 independent, RT-PCR clones with an apparent deletion of 759 nt, isolated after one to seven mechanical passages, were also sequenced and their precise deletion sites were compared. Twenty-six clones contained the original "stable," 759-nt deletion, whereas 7 clones, which were found only during the first four passages, had deletions at one of four alternative sites. After the fifth mechanical passage the stable 759-nt deletion dominated. The results also show that, in general, the smaller deletions are not intermediates in the larger deletion process. The complete nucleotide sequence of SBWMV RNA2 (Oklahoma) is also reported.
Human T-lymphotropic virus type II (HTLV-II) prevalence is very low among the general U.S. population, intermediate among American Indians, and high among injecting drug users and their sexual partners. However, the transmission dynamics underlying this distribution are not well described. We obtained blood specimens from 493 blood donors found to be seropositive for HTLV-II at blood centers in five U.S. cities. Nested polymerase chain reaction was used to amplify a 672-bp region of the HTLV-II long terminal repeat region, and restriction fragment length polymorphism (RFLP) analysis was performed to classify each virus into subtypes as defined by Switzer et al. (1995, J. Virol. 69, 621-632). Associations between RFLP subtype and other characteristics were analyzed using multivariable logistic regression. HTLV-II subtype a0 was independently associated with age over 30 years (odds ratio (OR) = 2.12, 95% confidence interval (CI) 1.13-3.99) and with Black race/ethnicity (OR = 2.00, 95% CI 1.10-3.65 versus Hispanic race/ethnicity). Conversely, HTLV-II RFLP subtypes b4 and b5 were significantly more common among American Indian (OR = 3.77, 95% CI 1.23-11.57) and Other race/ethnicity (OR = 4.22, 95% CI 1.25-14.27, both versus Black race/ethnicity) and at the Oklahoma City blood center (OR = 3.57, 95% CI 1.08-11.84 compared to Washington, DC/Baltimore). There may have been at least two transmission foci of HTLV-II in the United States: a modest HTLV-II subtype a0 epidemic of unknown source in the 1960s and 1970s spread predominantly among Black persons in several geographic areas and a smaller focus of HTLV-II subtypes b4/b5 among non-Black individuals in Oklahoma and perhaps in other areas not examined by this study.
Mortality among 4740 diabetic men and women aged 35-55 years participating in the WHO Multinational Study of Vascular Disease in Diabetics has been studied. Ten of the original centres (Warsaw, Berlin, Havana, Arizona, Oklahoma, Hong Kong, Switzerland, London, Tokyo, Zagreb) were able to identify the life/death status of their study participants on 1 January 1983, giving an average follow-up period of six to seven years. All-cause mortality rates in males varied about threefold among the ten participating centres with the highest rates in Warsaw, Berlin and Havana and the lowest rates in Tokyo and Zagreb. All-cause mortality rates for females varied about fourfold with the highest rates in Warsaw and Oklahoma and the lowest rates in Tokyo. The proportion of deaths ascribed to circulatory disease varied among the centres ranging from 32% for males and 0% for females in Tokyo to 67% for males and 47% for females in London. There was an excess all-cause mortality in males compared to females for all centres except Zagreb. This excess also applied to circulatory diseases in general, ischaemic heart disease in particular and occurred in both insulin-dependent and non-insulin-dependent diabetic patients. Death rates for insulin-dependent diabetic patients were generally higher than those for non-insulin-dependent patients.
Feed samples of corn, pelleted feed, and oats associated with equine leucoencephalomalacia (ELEM) were obtained from North Carolina, Illinois, Indiana, and Oklahoma. These samples contained a high colony density of Fusarium moniliforme Sheldon which ranged from 64 to 87% of the total fungi. Fifty-nine F. moniliforme strains were isolated. Isolates of F. moniliforme in feed samples from Illinois, Indiana, and Oklahoma were cultured on corn. The fermented corn, mixed with regular feed and fed to one-day-old ducklings, effected a high mortality coefficient (average 55%). Methanol extracts of corn fermented with each of 14 representative F. moniliforme isolates from North Carolina feed were toxic to mice and some caused rabbit skin necrosis. Vomitoxin (deoxynivalenol), T-2 toxin, zearalenone, and moniliformin were not detected in feed samples or fermented corn. However, 4 to 10 ng of aflatoxin B1 per gram of feed was present in the four North Carolina samples. Bikaverin (C20H14O8), a characteristic red pigment of Fusarium sp., was found in the North Carolina feed samples. This is the first report of bikaverin in feed samples associated with ELEM.
Students from six colleges and universities in five states in the U.S. (New York, New Jersey, Oklahoma, Texas, and Nevada) were surveyed concerning their gambling behavior and the rate of pathological gambling. Type of gambling varied by state, with students in the northeast and Nevada gambling more than students in Oklahoma and Texas. Over 90% of males and 82% of females had gambled. One third of the males and 15% of females gambled once a week or more. Rates of pathological gambling ranged from 8% in New York to 4% in Nevada. The incidence of pathological gambling was high among males, Hispanics, Asians, and Italian-Americans (compared with among other whites), students with non-traffic arrests, those with parents who have gambling problems, and those who abuse alcohol and other drugs. Pathological gambling was only weakly correlated with age, religion, lower grade point average in school, overeating, living in neighborhoods that are "poorer than most," family income, and parental drug use. It was not correlated with academic year in college, marital status, parental occupation, parental alcohol, and bulimic behavior. The implications of the findings for further research and social policy are discussed.
PURPOSE: To estimate the prevalence of type 2 diabetes and impaired fasting glucose (IFG) and to study several potential risk factors for type 2 diabetes among Oklahoma Cherokees aged 5 to 40 years. METHODS: A random sample of 2205 members of the Cherokee Nation of Oklahoma aged 5 to 40 years was recruited. Demographic, clinical, and laboratory data were collected. Type 2 diabetes and IFG were determined using the 1997 American Diabetes Association (ADA) criteria. Relationships between type 2 diabetes and potential risk factors were examined by univariate and multivariate regression methods. RESULTS: According to ADA criteria, the age-adjusted prevalence proportions of type 2 diabetes were 4.3% in females and 4.8% in males. Among the 89 individuals who had type 2 diabetes, 31 were newly diagnosed. Thirty-two (1.5%, 18 females and 14 males) were found to have IFG. The prevalence of type 2 diabetes and IFG increased with age, number of parents with diabetes, obesity, degree of Indian heritage, high triglyceride value, and low HDL cholesterol. CONCLUSIONS: The increasing prevalence of type 2 diabetes in young American Indians is alarming. The findings must be disseminated to the Indian communities and their health care providers. Preventive measures and early detection programs must be designed and implemented for children and adolescents in this population.
PURPOSE: To evaluate the effect of the Morcher capsular tension ring (CTR) on refractive outcome in patients having cataract extraction by phacoemulsification complicated by zonular instability. SETTING: Dean A. McGee Eye Institute, Oklahoma City, Oklahoma, USA. METHODS: A retrospective case-control series of 19 eyes of 19 patients with a CTR were compared with a control population of 24 eyes without zonular instability having routine cataract surgery. A subset of 9 patients with a CTR in 1 eye but milder zonular instability in the contralateral eye not requiring a CTR was analyzed. The main outcome measures were the mean arithmetic and absolute refractive prediction errors (ArRPE, AbRPE) and variances used to gauge accuracy and precision. RESULTS: The CTR and control groups were compared using SRK/T and Holladay 2. There was no statistically significant difference in ArRPE or AbRPE, but lower variances in eyes with a CTR were identified. The CTR subset demonstrated a trend toward more accurate outcomes when using Holladay 2 but not SRK/T when compared with contralateral eyes without a CTR. Both formulas showed lower variances in the CTR eyes than in the contralateral eyes. CONCLUSIONS: In this small population, there was no consistent effect on refractive outcome when a Morcher CTR was placed that would necessitate modification of intraocular lens power calculations. The eyes with a CTR had refractive outcomes as accurate as and more precise than the outcomes in the contralateral eyes with milder zonular instability and the control population of eyes without zonular instability in either eye. The Morcher CTR is not only a tool to assist in complicated cataract surgeries, but a device that can deliver more accurate and precise refractive outcomes.
OBJECTIVES: The purpose of this study was to assess the effect of community-wide performance measurement and feedback on key processes and outcomes of carotid endarterectomy (CEA). METHODS: Complete medical record (hospital chart) review for indications, care processes, and outcomes was performed on a random sample of Medicare patients undergoing CEA in 10 states (Arkansas, Georgia, Illinois, Indiana, Iowa, Kentucky, Michigan, Nebraska, Ohio, Oklahoma) during baseline (Jun 1, 1995 to May 31, 1996) and remeasurement (Jun 1, 1998 to May 31, 1999) periods. In addition to review of the index hospital stay, hospital admissions within 30 days of the procedure were reviewed and the Medicare enrollment database queried to identify out-of-hospital deaths, to determine 30-day outcome results. The baseline data by state were provided to the Medicare Quality Improvement Organizations (QIOs) in the respective states, and quality improvement initiatives were encouraged. RESULTS: We reviewed 9945 primary CEA alone procedures, 236 CEA and coronary artery bypass grafting (CABG) procedures, and 380 repeat CEA operations during the baseline period (B), and 9745 primary CEA alone procedures, 233 CEA and CABG procedures, and 401 repeat CEA operations during the remeasurement period (R). There was a significant decrease in the combined event rate (30-day stroke or mortality) for CEA alone procedures between baseline and remeasurement (B, 5.6%; R, 5.0%). A decrease occurred in each of the indication strata; transient ischemic attack or stroke (B, 7.7%; R, 6.9%), nonspecific symptoms (B, 5.9%; R, 5.4%), and no symptoms (B, 4.1%; R, 3.8%). The combined event rate also decreased for CEA and CABG (B, 17.4%; R, 13.3%) and repeat CEA operations (B, 6.8%; R, 5.7%). The remeasurement period state-to-state variation in combined event rate for CEA alone ranged from 2.7% (Georgia) to 5.9% (Indiana) for all indications combined, from 4.4% (Georgia) to 10.9% (Michigan) in patients with recent transient ischemia or stroke, from 1.4% (Georgia) to 6.0% (Oklahoma) in patients with no symptoms, and from 3.7% (Georgia) to 7.9% (Indiana) in patients with nonspecific symptoms. There were significant increases in preoperative antiplatelet administration (62%-67%; P <.0001) and patching (29%-45%; P =.05) from baseline to remeasurement in the CEA alone subset. Preoperative antiplatelet administration and patching were associated with improved outcomes in the combined baseline and remeasurement data. CONCLUSIONS: Community-wide quality improvement initiatives with performance measurement and confidential reporting of provider level data can lead to improvement in important care processes and outcomes. There is considerable variation between states in outcome and process, and thus continued room for improvement. Quality improvement projects that include standardized confidential outcome reporting should be encouraged. Preoperative antiplatelet therapy administration and patching rates should be considered as evidence-based performance measures.
BACKGROUND: Routine contralateral groin exploration in infants and children with a clinically detected inguinal hernia is the subject of much debate. The detection of a patent processus vaginalis by transinguinal laparoscopy has proven advantageous. However, controversy remains regarding the true incidence of a contralateral patent processus vaginalis as well as which of these will actually develop into a clinically apparent hernia. METHODS: From January 1997 through December 1999, 358 infants and children (aged 1 to 157 months, mean 32) were treated in the three University of Oklahoma teaching hospitals in Tulsa, Oklahoma, for inguinal hernia. The findings at laparoscopic exploration of the contralateral side were recorded to determine the incidence of contralateral patency as it relates to a child's age, gender, and side of the initial clinical diagnosis. RESULTS: The overall incidence of a patent processus vaginalis on contralateral examination was 33% (117 of 358). All patent processus vaginalis were repaired. Bilateral inguinal hernia was significantly more common in younger patients (present in 50% if less than 1 year, 45% if less than 2 years, 37% if less than 5 years, and 15% if greater than 5 years of age; P <0.05). In boys, the incidence was 49%, 45%, and 32% in those under 1 year of age, under 2 years of age, and in total, respectively. In girls, the incidence was 59%, 50%, and 37% in those under 1 year of age, under 2 years of age, and in total, respectively. The side of the clinically detected hernia did not influence the laparoscopic findings of a contralateral hernia with 30% (50 of 169) positive findings on left inguinal exploration versus 31% (28 of 90) positive findings on right inguinal exploration. CONCLUSIONS: The high incidence of a contralateral patent processus vaginalis warrants routine laparoscopic exploration in infants and children undergoing unilateral inguinal hernia repair, especially those less than 5 years of age. The use of transinguinal laparoscopic explorations avoids unnecessary open exploration in 66% of infants and children undergoing inguinal hernia repair.
OBJECTIVE: To evaluate a flow cytometric method to detect and quantitate serum anti-DNA antibodies using unfixed, swollen and decondensed human sperm nuclei and to examine the relationship between antibodies against sperm surface antigens to the presence of antibodies against nuclear antigens. DESIGN: Serum IgG and IgG subclass antibodies to decondensed sperm nuclei were detected by indirect immunofluorescence (IIF) flow cytometry. Sera were screened by IIF for anti-double-stranded DNA antibodies using the protozoan Crithidia luciliae as the substrate and for antinuclear antibodies using human epithelial (HEp 2) cells, respectively. All sera were assessed for antibodies against the sperm plasma membrane by an indirect immunobead test. SETTING: Infertility laboratory at the University of Oklahoma Health Sciences Center and rheumatology laboratory at the Oklahoma Medical Research Foundation. PATIENTS: Sera from 33 antisperm antibody-positive patients (5 subgroups), 33 patients with systemic lupus erythematosus (SLE; 6 subgroups), and 20 normal controls were selected. RESULTS: IgG antibodies against decondensed sperm nuclear DNA were detected in 11 (33.3%) of 33 antisperm antibody-positive patients versus 14 (42.4%) of 33 patients with SLE. Anti-DNA antibodies were most prevalent in vasectomized men and in antisperm antibody positive women with SLE. In the sera from patients with SLE, the presence of the anti-nuclear ribonucleoprotein antibody was associated with the presence of sperm head-directed antisperm antibodies. Anti-double-stranded DNA antibodies were found in 6 (18.1%) of 33 sera from patients with antisperm antibody and 17 (51.5%) of 33 sera from patients with SLE. Antinuclear antibodies were found in only 9 (27.2%) of 33 sera from patients with antisperm antibody and 30 (90.9%) of 33 sera from patients with SLE. All 20 of the control sera gave negative results in the three tests. Serum IgG reactivity to sperm nuclei was predominantly of the IgG1 and IgG3 subclasses. CONCLUSION: Anti-DNA is frequently found in either patients with antisperm antibodies or patients with SLE. Our results indicated that decondensed sperm nuclei can provide a specific substrate for screening serum anti-DNA antibodies.
PURPOSE: The antiproliferative effects of pharmacological agents used for androgen ablative therapy in prostate cancer, including goserelin, bicalutamide and cyproterone acetate (Fluka Chemie, Buchs, Switzerland), were tested in vitro. It was determined whether they affected prostate specific antigen mRNA and protein expression independent of growth inhibition. MATERIALS AND METHODS: Goserelin, bicalutamide (AstraZeneca, Zug, Switzerland) and cyproterone acetate were added to prostate specific antigen expressing, androgen dependent LNCaP and androgen independent C4-2 cell line (Urocor, Oklahoma City, Oklahoma) cultures. Proliferation was determined by the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazoliumbromide assay (Roche, Mannheim, Germany). Prostate specific antigen mRNA expression was assessed by quantitative real-time polymerase chain reaction. Secreted prostate specific antigen protein levels were quantified by microparticle enzyme-immunoassay. RESULTS: Goserelin inhibited cell growth and prostate specific antigen protein secretion in LNCaP and C4-2 cells. Prostate specific antigen mRNA expression was not decreased. Bicalutamide did not affect cell growth or prostate specific antigen mRNA expression in LNCaP or C4-2 cells, although it significantly decreased prostate specific antigen protein secretion in LNCaP and to a lesser extent in C4-2 cells. Cyproterone acetate decreased the growth of C4-2 but not of LNCaP cells. It did not affect prostate specific antigen mRNA or protein expression in either cell line. CONCLUSIONS: Prostate specific antigen expression does not necessarily correlate with cell growth. Without a substantial effect on cell growth bicalutamide lowers prostate specific antigen synthesis, whereas cyproterone acetate decreases cell growth with no effect on prostate specific antigen secretion. Prostate specific antigen expression may be influenced by growth inhibition but also by altered mRNA and protein levels depending on the agent, its concentration and the cell line evaluated. For interpreting clinical trials prostate specific antigen is not necessarily a surrogate end point marker for a treatment effect on prostate cancer cell growth.