Multifactorial audit of invasive cervical cancer: key lessons for the National Screening Programme.

AIMS--To audit factors associated with the development of invasive cervical cancer. METHODS--Twenty cases of invasive cervical cancer in one health district for 1991-93 were audited by multifactorial analysis. RESULTS--The average age was 53 years with 20% (4/20) aged over 65 years. Of the patients, 45% (9/20) were identified by a cervical smear, with 40% (8/20) from the National Screening Programme (NSP) and 5% (1/20) opportunistically; 30% (6/20) had not received a smear, 10% (2/20) being aged under 65 and 20% 65 or over. Those with no smear had all been hospital patients during the previous five years. No response to a smear invitation occurred in 5%. In 20%, there had been a true negative smear two to five years previously. Inappropriate laboratory diagnosis or inappropriate clinical management occurred in 30% and 15% (3/20), respectively. In 20%, two or more factors were present in the same patient. CONCLUSIONS--Why cervical cancer occurs after a true negative smear requires research and women aged over 65 with no smear must be targeted. Failsafe systems should incorporate inadequate smears and smear adequacy should be given priority in quality assurance (QA) and training. False negative reports must be minimised but accepted as an inherent part of the NSP and not an automatic indicator of poor laboratory performance. Comprehensive national QA standards are required, to which providers must conform. Postcoital bleeding is an absolute indication for a smear and, when appropriate, opportunistic smears offered at all hospital attendance. Cervical cancer audit must be guaranteed access to all clinical and laboratory information and be seen as a means to improve the effectiveness and quality of the NSP.     

Molecular characterization of Kaposi's sarcoma associated herpesvirus (KSHV) from patients with AIDS-associated Kaposi's sarcoma in Sao Paulo, Brazil.

BACKGROUND: Kaposi's sarcoma (KS) is caused by Kaposi's sarcoma associated herpesvirus (KSHV/HHV-8), the eighth Herpesvirus found to infect humans. The molecular epidemiology of KSHV is related closely to ethnicity and geographical location of studied populations. There is little epidemiological and molecular information about KSHV strains circulating in Brazil. OBJECTIVES: To characterize KSHV strains isolated from AIDS patients with Kaposi's sarcoma (AIDS-KS) in Sao Paulo, Brazil, and to examine associations between KSHV subtypes, ethnicity and HIV risk categories. METHODS: AIDS-KS patients were recruited consecutively at the largest AIDS reference hospital in Sao Paulo. Fragments (420 bp) of the VR1 and VR2 regions of KSHV open reading frame (ORF) K1 were amplified by nested PCR and sequenced directly. RESULTS: We analysed 37 samples from 33 patients, and found subtypes A-C in 48%, 21% and 30% of patients respectively, including two patients infected with subtype A5, a first report from Brazil. Sexual orientation was associated with subtype: 12/14 (86%) patients with subtype A were male homo/bisexual, compared with 3/8 (38%) among patients infected with subtype C (P = 0.05). A higher proportion of male patients with subtype C were of Caucasian origin (7/8 (87%)), compared with 7/16 (44%) among male patients with subtype A (P = 0.08). CONCLUSIONS: This first detailed report of KSHV subtypes among AIDS-KS patients in Brazil reports the first isolation of KSHV subtype A5 in this country, and suggests KSHV strain transmission between different ethnic groups, and association of specific strains with sexual orientation.     

Hyperexcitability and reduced low threshold potassium currents in auditory neurons of mice lacking the channel subunit Kv1.1

A low voltage-activated potassium current, I _KL, is found in auditory neuron types that have low excitability and precisely preserve the temporal pattern of activity present in their presynaptic inputs. The gene Kcna1 codes for Kv1.1 potassium channel subunits, which combine in expression systems to produce channel tetramers with properties similar to those of I _KL, including sensitivity to dendrotoxin (DTX). Kv1.1 is strongly expressed in neurons with I _KL, including auditory neurons of the medial nucleus of the trapezoid body (MNTB). We therefore decided to investigate how the absence of Kv1.1 affected channel properties and function in MNTB neurons from mice lacking Kcna1 . We used the whole cell version of the patch clamp technique to record from MNTB neurons in brainstem slices from Kcna1 -null (−/−) mice and their wild-type (+/+) and heterozygous (+/−) littermates. There was an I _KL in voltage-clamped −/− MNTB neurons, but it was about half the amplitude of the I _KL in +/+ neurons, with otherwise similar properties. Consistent with this, −/− MNTB neurons were more excitable than their +/+ counterparts; they fired more than twice as many action potentials (APs) during current steps, and the threshold current amplitude required to generate an AP was roughly halved. +/− MNTB neurons had excitability and I _KL amplitudes identical to the +/+ neurons. The I _KL remaining in −/− neurons was blocked by DTX, suggesting the underlying channels contained subunits Kv1.2 and/or Kv1.6 (also DTX-sensitive). DTX increased excitability further in the already hyperexcitable −/− MNTB neurons, suggesting that −/− I _KL limited excitability despite its reduced amplitude in the absence of Kv1.1 subunits.     

Anti-inflammatory effects of a titanium-peroxy gel: role of oxygen metabolites and apoptosis

Polymorphonuclear neutrophils (PMN) are among the first inflammatory cells to arrive at an implant interface, where they encounter with the foreign material and may produce reactive oxygen species (ROS). During the interaction between titanium and ROS, titanium-peroxy (Ti-peroxy) compounds may be formed. We used a Ti-peroxy gel, made from titanium and hydrogen peroxide, to study the effects of Ti-peroxy compounds on PMN. In the absence of serum, the Ti-peroxy gel decreased the oxidative response of PMN to yeast and PMA and reduced PMN apoptosis without inducing necrosis. These effects could not be ascribed to the release of hydrogen peroxide from the Ti-peroxy gel, because a steady-state hydrogen peroxide producing system failed to mimic the effects of the gel. The effects were similarly unaffected when PMN were preincubated with beta(2)-integrin antibodies, questioning the involvement of adhesion molecules. Nevertheless, when a filter was used to separate the Ti-peroxy gel from the cells, the gel effect on PMN life span was abolished, pointing to a contact-dependent mechanism. In the presence of serum, the Ti-peroxy gel had no effect on the PMN oxidative response and life span, but appeared rather inert. In summary, this study demonstrates that the Ti-peroxy gel has potentially anti-inflammatory properties through a combined peroxide and physical contact effect, supporting the notion that interactions between titanium and inflammatory cells are responsible for the good performance of titanium in vivo.     

Large-scale molecular and tissue microarray analysis of mesothelin expression in common human carcinomas

The 40-kilodalton processed glycoprotein, mesothelin, is highly expressed in epithelial mesotheliomas and adenocarcinomas of the ovary (serous papillary) and pancreas, but its expression in a large series of other common carcinomas has not been completely explored. In the present study, we used oligonucleotide and tissue microarrays to profile the expression of the mesothelin gene (MSLN) and encoded protein, respectively. Among 150 carcinomas of multiple anatomic sites, we found the highest average expression of MSLN in serous carcinomas of the ovary and adenocarcinomas of the pancreas, consistent with previous reports, as well as measurable but less-striking expression in pulmonary, gastric/esophageal, and colorectal adenocarcinomas. On tissue microarrays containing 621 carcinomas derived from the same and additional sites as those profiled by gene expression, mesothelin immunoreactivity was highest in cancers of the ovary (serous papillary, endometrioid, and undifferentiated) and pancreas, with less frequent staining seen in adenocarcinomas of the endometrium, lung, and stomach/esophagus. Some immunopositivity was observed in 42% of pulmonary adenocarcinomas, including 18% that had >50% of tumor cells that were immunoreactive. Some 14% of breast and 30% of colorectal adenocarcinomas showed immunopositivity, but no case contained >50% tumor cells that were immunoreactive. Mesothelin was either entirely absent or present in <5% of carcinomas of the prostate, bladder/ureter, liver, kidney, and thyroid. Overall, we observed good concordance between the results obtained by oligonucleotide and tissue microarrays. This large study of the MSLN gene and protein expression in common carcinomas provides data for future investigations that evaluate the utility of mesothelin/megakaryocyte potentiating factor as a potential serum tumor marker or target of immunotoxin-based therapy in human cancers.     

Detection of somatic mutations in man: evaluation of the microtitre cloning assay for T-lymphocytes

A method of detecting 6-thioguanine-resistant lymphocytes bythe cloning of T-lymphocytes in microtitre wells is evaluatedfor its usefulness in population monitoring. Factors shown toaffect the cloning efficiency of lymphocytes include the strainand irradiation level of the lymphoblastoid feeder cells andthe use of a pre-incubation period in bulk culture without mitogenicstimulus before plating at limiting dilutions. Cord blood sampleshave markedly lower mutant frequencies than adult blood samples.The adult range was 8.0 x 10^–7 to 1.8 x 10^–5. Sevenmales and seven females aged between 23 and 47 years were sampled.No effect of sex or age was found. Individual samples whichwere divided at collection and treated separately did not varyfrom each other, but repeat samples taken at different timesshowd up to a 2-fold variation. The application of this methodin population monitoring is discussed.     

Influence of cutaneous sensitization with oxazolone on recruitment of myelogenous stem cells in the thymus

Cutaneous sensitization of CBA mice with oxazolone was followed 3 days later by increased cell proliferation in the regional lymph nodes and spleen, as measured by incorporation of radiolabelled 5-iodo-2'-deoxyuridine. The thymus was reduced in weight and contained fewer proliferating cells. Other mice were part-body irradiated, with shielding of the anterior three-quarters of the body, and injected with CBA-T6T6 bone marrow cells. Half of them were subsequently sensitized with oxazolone. The frequency of dividing cells of bone marrow origin in the thymus of sensitized and control animals was estimated cytologically 3–70 days later. There was a significant tendency for sensitized mice to have more dividing cells of donor origin in the thymus than controls.     

Detection of penicillin tolerance in streptococci.

"Tolerance" to penicillin in streptococci was investigated by two different techniques. Of 70 strains examined, 35 appeared tolerant in conventional titrations and 31 appeared tolerant when tested by a recently-described disc method. There was 88% agreement between the two methods, but the disc test failed to detect tolerance shown by titrations in six strains of streptococci, including three beta-haemolytic strains belonging to Lancefield's group D. A significant relationship was observed between tolerance and Eagle's optimum dosage effect: 71% of tolerant strains examined displayed the Eagle effect, whereas only 17% of non-tolerant strains exhibited the effect.     

Plasma steroid concentrations during alternate-day treatment with prednisone

Plasma steroid concentrations were measured in asthmatic children 24 and 48 hours after administration of alternate-day treatment with prednisone, and the results were compared with those of control patients who did not receive corticosteroid treatment as well as those of patients who were treated with prednisone each day. It was found that 24 hours after administration of prednisone in any dose, plasma steroid concentrations were significantly lower than those of the control group. The degree of suppression in plasma steroid concentration was less marked in patients who received treatment on alternate days than in those who received the same doses of prednisone each day. Within 48 hours after administration of alternate-day treatment, plasma steroid concentrations approached the values observed in the control group and were independent of the magnitude of the prednisone dose. Although alternateday steroid treatment was associated with transient and incomplete suppression of pituitary-adrenal function, patients whose therapy was changed from a daily to an alternate-day regimen sometimes exhibited prolonged suppression of adrenal cortical function.