Outcome of T cell-depleted transplantation after conditioning with an intensified regimen in patients aged 50 years or more is comparable with that in younger patients

One hundred and thirty-one patients were transplanted for AML-CR1, ALL-CR1 or CML-CP1 after conditioning with 120 mg/kg body weight cyclophosphamide and 2 x 4.5 Gy TBI. Conditioning was intensified with the addition of 42 mg/m2 idarubicin. Grafts were T cell-depleted using counterflow centrifugation. Donors were HLA-identical siblings. We compared outcome of BMT in 109 patients aged less than 50 (median, 35) years with that of 22 patients with an age of 50 years or more (median, 53 years). For the patients aged <50 years, 2-year probabilities of treatment-related mortality, relapse, survival and leukemia-free survival were 26% (95% CI, 17% to 35%), 26% (95% CI, 17% to 35%), 64% (95% CI, 55% to 73%), and 56% (95% CI, 47% to 65%). For the patients aged > or =50 years, these figures were 13% (95% CI, 0% to 30%), 24% (95% CI, 6% to 42%), 66% (95% CI, 46% to 86%), and 67% (95% CI, 47% to 87%), respectively. Outcome did not differ significantly between the two age groups. TRM was within the range of that reported in the literature for recipients of T cell-depleted grafts. We conclude that T cell-depleted transplantation after a conditioning regimen that was intensified with the addition of idarubicin is feasible in patients aged > or =50 years. For this age group of patients, results of nonmyeloablative regimens should be compared with that obtained with T cell-depleted grafts.     

Hypochlorhydria and hypergastrinaemia in rheumatoid arthritis.

In order to evaluate the incidence and aetiology of hypergastrinaemia 53 patients with seropositive rheumatoid arthritis were examined for gastric acid secretion, fasting serum gastrin concentration, circulating parietal cell antibodies, and some parameters of the activity of inflammation of rheumatoid arthritis. The basal and maximum acid output was found to be subnormal in this group (P less than 0.01), and in 11 of these patients (23%) the fasting serum gastrin levels were raised (P less than 0.05). This hypergastrinaemia correlated strongly with maximum acid output. Only in cases of achlorhydria or hypochlorhydria (maximum acid output less than 2 mmol/l) was the serum gastrin level markedly raised. Two out of 5 patients with achlorhydria were found to have circulating parietal cell antibodies, and 1 had decreased absorption of vitamin B12. No relationship was found between serum gastrin and duration or activity of rheumatoid arthritis; nor was there a relationship between basal serum gastrin and the various antirheumatic drugs administered.     

Clodronate. A randomized study in the treatment of cancer-related hypercalcemia

Malignancy-associated hypercalcemia is a common and recalcitrant problem. Current modes of therapy are often ineffective or prohibitively toxic. Clodronate disodium is a diphosphonate capable of inhibiting bone resorption resulting in a hypocalcemic effect. In this randomized, placebo-controlled study, we investigated the effect of hydration only (Rx-1) vs the effect of hydration plus either intravenously administered clodronate disodium, 4 mg/kg of body weight per day for three days (Rx-2) or intravenously administered clodronate disodium, 12 mg/kg of body weight given once only (Rx-3). By the third day of observation, Rx-2 produced a significant 2.8 mg/dL (0.70 mmol/L) reduction in serum calcium levels, whereas Rx-1 and Rx-3 did not produce a significant hypocalcemic effect when compared with baseline values. There were no toxicities observed. Intravenously administered clodronate appears to be an excellent agent for the acute treatment of malignancy-associated hypercalcemia.     

Risk factors for cardiac autonomic neuropathy in type 1 diabetes mellitus

Aims/hypothesis Cardiac autonomic neuropathy (CAN) is associated with increased morbidity and mortality in type 1 diabetes. Apart from glycaemic control, risk factors for CAN have not been extensively studied.Methods As part of the EURODIAB Prospective Complications Study, CAN—defined as either a loss of heart rate variability or postural hypotension on standing—was assessed at baseline and follow-up (7.3±0.6 years from baseline) in patients with type 1 diabetes.Results Follow-up measurements were available for 956 participants without CAN at baseline (age at baseline 31.3±8.9 years, duration of diabetes 13.5±8.3 years). During follow-up, 163 (17%) subjects developed CAN, yielding an incidence of 23.4 per 1,000 person-years. Blood pressure, weight, the presence of cardiovascular disease, albuminuria, distal symmetrical polyneuropathy (DSP) and retinopathy at baseline were associated with the incidence of CAN after adjustment for sex, duration of diabetes and HbA₁c. In a multivariate regression model, baseline factors associated with an increased risk of developing CAN were age [odds ratio (OR)=1.3 per decade, 95% CI 1.1–1.7], HbA₁c (OR=1.2 per percentage point, 95% CI 1.1–1.4), systolic blood pressure (OR=1.1 per 10 mmHg, 95% CI 1.0–1.3), feeling faint on standing (OR=2.0, 95% CI 1.2–3.2), DSP (OR=1.9, 95% CI 1.2–3.0) and retinopathy (OR=1.7, 95% CI 1.1–2.6).Conclusion/interpretation This study confirms the importance of exposure to hyperglycaemia as a risk factor for CAN. A small set of variables, including HbA₁c, hypertension, DSP and retinopathy, predict the risk of CAN. Clinical trials are needed to address the impact of intensive antihypertensive treatment on CAN in type 1 diabetes.     

AIDS, Kaposi sarcoma, and the lymphatic system: update and reflections

Based on ongoing basic and clinical investigations, further evidence is presented that the AIDS-Kaposi sarcoma (AIDS-KS) complex involves a progressive disturbance of the blood-lymph circulatory loop of fluid, macromolecules, and migrating cells. We first surveyed the spectrum of vascular abnormalities including Kaposi sarcoma (KS) found in the AIDS/ARC population, then non-invasively imaged lymphatic system abnormalities in AIDS-KS by whole body lymphangioscintigraphy, and finally examined the biologic behavior of AIDS-KS cells in long-term tissue culture. These observations are viewed in terms of the lymphatic and blood vascular route of entry and transport of free and cell-associated virus and other opportunistic pathogens as well as poorly understood host endothelial-immune system interactions.     

IgM anti-dsDNA antibodies in systemic lupus erythematosus: negative association with nephritis

Antibodies against dsDNA of the IgM class were measured in sera of 352 patients with systemic lupus erythematosus, 81 blood donors and 189 patients with rheumatoid arthritis using a new ELISA based on human recombinant dsDNA as antigen. IgM anti-dsDNA antibodies were found in 52.3% of the sera from patients with systemic lupus erythematosus, but in none of the sera from 81 normal controls and 189 patients with rheumatoid arthritis. The association of these autoantibodies with 31 clinical and 37 laboratory parameters was calculated. There was a highly significant negative correlation between IgM anti-dsDNA antibodies and nephritis as well as all the laboratory parameters indicating renal disease (elevated serum creatinine concentration, proteinuria, erythrocyte casts in the urine). IgM anti-dsDNA antibodies indicate protection of lupus patients against the development of lupus nephritis. Further experiments will show whether application of IgM anti-dsDNA antibodies is effective in treating lupus nephritis. Received: 10 August 1998 / Accepted: 11 September 1998     

Method to quantify accuracy of position feedback signals of a three-dimensional two-photon laser-scanning microscope

Two-photon laser-scanning microscopy enables to record neuronal network activity in three-dimensional space while maintaining single-cellular resolution. One of the proposed approaches combines galvanometric x-y scanning with piezo-driven objective movements and employs hardware feedback signals for position monitoring. However, readily applicable methods to quantify the accuracy of those feedback signals are currently lacking. Here we provide techniques based on contact-free laser reflection and laser triangulation for the quantification of positioning accuracy of each spatial axis. We found that the lateral feedback signals are sufficiently accurate (defined as <2.5 µm) for a wide range of scan trajectories and frequencies. We further show that axial positioning accuracy does not only depend on objective acceleration and mass but also its geometry. We conclude that the introduced methods allow a reliable quantification of position feedback signals in a cost-efficient, easy-to-install manner and should be applicable for a wide range of two-photon laser scanning microscopes.OCIS codes: (180.6900) Three-dimensional microscopy, (180.4315) Nonlinear microscopy, (170.0180) Microscopy, (170.2520) Fluorescence microscopy, (180.2520) Fluorescence microscopy     

kappa gene diversity among the clonal progeny of pre-B lymphocytes.

Some clonal pre-B cell lines, when transformed by Abelson murine leukemia virus, are able to rearrange and express kappa light chain genes. We have analyzed the light chains expressed in sets of early B-cell subclones derived from two pre-B cell clones. Each subclone makes an indistinguishable mu heavy chain, while the kappa gene rearrangements and proteins synthesized were distinct. All members of one set of subclones expressed a V kappa 21 kappa light chain. Only one of the members of the other two sets of subclones expressed V kappa 21. Thus, a single pre-B-cell clone can select a kappa variable region from more than one family. In each subclone of the set that expressed V kappa 21 light chain the same member appears to be used. The differences detected in the expressed proteins can best be explained by primary sequence alterations in the rearranged V kappa 21 segment. These sequence alterations have resulted in a restriction site polymorphism in the expressed V kappa 21 gene and charge and size differences in the expressed proteins. These data suggest that diversification of kappa light chains can occur at the pre-B- to early B-cell stage of development.