Mutational analysis of the promoter region of the alpha 27 gene of herpes simplex virus 1 within the context of the viral genome.

In herpes simplex virus 1-infected cells, the first set of genes to be expressed (alpha genes) is induced by the alpha gene trans-inducing factor (alpha TIF), a virion structural protein. The cis-acting site in the 5' untranscribed domain of alpha genes was previously reported to be the sequence 5'-GYATGNTAATGARATTCYTTGNGGG noncoding (where Y is a pyrimidine, R is a purine, N is any base), which binds a host protein designated alpha H1 (also termed the octamer binding protein, OTF-1, Oct-1, etc.) and which, together with this and possibly other proteins, forms complexes with alpha TIF. To determine the role of the various components of this cis-acting site and of other sequences shared by the alpha genes, we constructed 17 mutants spanning 110 nucleotides of the promoter domain of the alpha 27 gene and made a series of chimeric genes. Each chimeric gene embodying one set of these mutations was inserted into the viral genome and measurements were made of (i) accumulated mRNA under conditions in which only alpha genes were expressed and (ii) the capacity of the mutated sequence to form complexes containing alpha TIF and alpha H1 proteins. We report that (i) transversions in the "TAAT" sequence abolished both complex formation and induction of the chimeric alpha gene, (ii) mutations in the octamer binding site sequence upstream from TAAT or of the downstream GARAT abolished alpha TIF complex formation and also reduced alpha mRNA accumulation, (iii) mutations in a "CAAT" box also reduced expression of mRNA without affecting the formation of DNA-protein complexes containing alpha TIF, and (iv) mutations in sequences immediately downstream from TAATGARAT and in a pair of GA-rich elements reduced alpha mRNA expression whereas mutations between these elements had no effect on the accumulation of the mRNA. The results are consistent with the conclusion that both the alpha H1 octamer binding site ATGNTAAT and the GARAT sequence play a significant role in the induction of alpha genes. For optimal gene expression, however, additional elements downstream from the GARAT sequence and in other regions of the alpha promoter must be present.     

Rheumatoid arthritis

RA is a common disease with a worldwide prevalence of about 1% with an annual incidence of about 3/10,000 adults. It is two to three times more common in women. There is some evidence that over the last few decades the disease is declining in incidence or severity. Patients with RA have a reduced life expectancy and a one in three chance of becoming disabled, depending on the severity of the disease at onset. The cause of the disease is unknown, although genetic factors account for up to 30% of disease susceptibility. The most important genetic factors are related to HLA-DR4 and DR1, which may have identical regions conferring the risk of disease. Many infectious agents have also been implicated in the etiology of RA, although there is no good epidemiologic evidence to support the laboratory findings. Hormonal and reproductive factors are known to play a major role in disease pathogenesis. Both pregnancy and the oral contraceptive pill are believed to be protective against development of the disease, although they may act by delaying or modifying the course of the disease rather than conferring "immunity".     

Phase II evaluation of esorubicin (4′ deoxydoxorubicin) in pancreatic adenocarcinoma: A Southwest Oncology Group study

Summary Esorubicin (4 deoxydoxorubicin) is a new analogue of the anthracycline, doxorubicin. This compound lacks the hydroxyl group at 4 position on the amino sugar of the anthracycline. Phase II study was designed to determine the clinical response rate and to define the qualitative and quantitative toxicities of esorubicin in patients with adenocarcinoma of the pancreas. Fifty-eight patients with inoperable adenocarcinoma of the pancreas were entered on the study, 47 were evaluable for response, and 57 were evaluable for toxicity. The dose of esorubicin was 30 mg/m² for good risk patients and 25 mg/m² for poor risk patients every 21 days and administered IV push through a side arm of a running IV. Diphenhydramine, 50 mg is administered IM prior to the administration of the drug to block local venous reaction. Subsequent doses of esorubicin were modified according to granulocyte and platelet nadirs and the drug was not administered until recovery of platelets (> 100,000/ul) and wbc (> 3000/ul). Three partial responses, 20 stable, and 31 with increased disease were observed. Forty-seven had severe granulocytopenia (< 250), and two patients had severe thrombocytopenia (< 25,000). One patient experienced a decrease in left ventricular ejection fraction with a total dose of 180 mg/m². The dose of esorubicin in this study demonstrated that the drug has minimal activity in adenocarcinoma of the pancreas but the toxicity is tolerable. Search should continue for single agents with activity in this disease.     

Analysis of Treatment Results for Floor‐of‐Mouth Cancer

Objective This study reports the results of treating floor‐of‐mouth cancer with five different treatment modalities with long‐term follow‐up. Study Design Retrospective study of 280 patients with floor‐of‐mouth cancer treated in the Department of Otolaryngology—Head and Neck Surgery at Washington University Medical School (St. Louis, MO) from 1960 to 1994. Methods Patients with biopsy‐proven squamous cell carcinoma of the floor of mouth who were previously untreated were treated with curative intent by one of five modalities and were all eligible for 5‐year follow‐up. The treatment modalities included local resection alone, composite resection alone (with neck dissection), radiation therapy alone, local resection with radiation therapy, and composite resection with radiation therapy. Multiple diagnostic, treatment, and follow‐up parameters were studied using standard statistical analysis to determine statistical significance. Results The overall 5‐year disease‐specific survival (DSS) was 56% with death due to tumor in 44% of patients. The 5‐year cumulative disease‐specific survival (CDSS) was 0.61 (Kaplan‐Meier probability) with a mean of 8.3 years and a median of 9.7 years. The DSS by treatment modality included local resection (76%), composite resection (63%), radiation therapy (43%), local resection with radiation therapy (61%), and composite resection with radiation therapy (55%). Overall, there was no significant difference in DSS by treatment modality. Recurrence at the primary site (41%) was the most common site of treatment failure. Nineteen percent of patients had recurrence in the neck. Eighty‐eight percent of initial recurrences occurred within 60 months after the onset of treatment. Metastasis to a distant site occurred in 30% of patients. Twenty percent of these patients had second primary cancers, and 53% of these patients died of their second primary cancers. Conclusions Significantly improved 5‐year DSS was seen in the patients with clear margins, early clinical tumor stage, and negative nodes. Significantly decreased 5‐year survival was seen in the patients with involved margins, advanced clinical tumor stage, positive nodes, and tumor recurrence. Patients with no clinically positive nodes (cN0) can be observed safely for regional nodal disease and subsequent positive nodes can be treated as they occur with no adverse affect on survival. Because of high recurrence rates at the primary site and neck, and an increased rate of both distant metastasis and the development of second primary cancers, patients should be monitored closely for a minimum of at least 5 years.     

Risk factors for typhlitis

A case-control study was undertaken to identify risk factors for typhlitis in patients with hematological malignancies. A data base file with a total of 410 episodes of fever and neutropenia in patients cared for between May 1987 and 1996 was reviewed. Typhlitis was defined as a symptom complex of fever, intense abdominal pain and tenderness in the presence of neutropenia. Five cases of typhlitis were identified. Three controls for every patient were randomly selected from the same cohort. Diarrhea and jaundice were more frequent in patients than in controls (p=0.03). The presence of mucositis, prolonged duration of profound neutropenia and idarubicin treatment proved to be risk factors for typhlitis.     

Quinolone prophylaxis in neutropenic patients - efficacy versus resistance

To assess the efficacy of quinolones in the prophylaxis of infections in neutropenic patients with acute non-lymphocytic leukemia, and to evaluate the emergence of quinolone resistance in two University Hospitals in Brazil, we retrospectively compared 101 consecutive episodes of neutropenia managed with quinolone prophylaxis between 1989 and November 1993, and 26 previous episodes without prophylaxis, and reviewed the results of in vitro sensitivity of Gram-negative strains to quinolones in the same period. Prophylaxis with quinolones resulted in less episodes of bacteremias (21% vs. 69%, p=10(-7)), including Gram-negative bacteremias (6% vs. 38%, p=10(-5)), with no statistically significant difference in the death rate (18% vs. 31%, p=0.14, 95% confidence interval -6-32). The resistance of Gramnegative strains to quinolones rose from 7% to 18% between 1990 and 1993 (p=10(-5)). The resistance against ceftazidime and amikacin, the agents used in the empirical antibiotic therapy, increased in the same proportion as the quinolones. Given the limited benefit of quinolones as prophylaxis and the increasing number of quinolone-resistant Gram-negative strains observed in our hospitals, the use of quinolones as prophylaxis must be seriously questioned. A stricter control of the use of quinolones in these hospitals might decrease resistance.     

Tumor-growth and drug-resistance - lessons from the treatment of hodgkins-disease (review)

The resistance of cancer cells to anti-neoplastic agents is a major attribute of malignancy. Kinetic drug resistance develops as the tumor burden increases, and is reversible when the cell mass can be reduced. Genetic drug resistance, in contrast, results in the acquisition of possibly irreversible resistance by random cell mutation. The latter mechanism, and one of its corollaries, that rapidly alternating drug regimens could prevent the advent of new resistant cell lines, have been the subject of many studies in the last decade. The endpoint to evaluate in such studies should be an increase in failure-free survival, since such prevention cannot have any influence in the complete remission rates. A review of the clinical trials in Hodgkin's disease suggests that failure-free survival rates are in fact improved with the alternating schedules. On the other hand, dose-intensification is presently under study as a means of overcoming kinetic drug resistance, thereby increasing the complete remission rates, and has recently proved effective in the prolongation of survival in different malignancies. Further understanding of the mechanisms of drug resistance and the prospective appraisal of the combination of both high-dose therapy and alternating drug treatments should result in a better outcome, mostly for patients with large tumor burdens or other high risk factors.     

Chorda tympani nerve transection, but not amiloride, increases the KCl taste detection threshold in rats

Water-restricted rats were trained to press one lever after KCl presentation and the other lever after distilled water. Water reinforcement was given after each correct response, and a time-out followed each incorrect response. Rats were trained and tested on KCl stimuli of varying concentrations. Threshold was defined as the KCl concentration corresponding to 1/2 the maximum asymptote of performance for each rat. The geometric mean KCl detection threshold for all rats was 0.033 M KCl. Rats that had the chorda tympani nerve (CT) bilaterally transected showed an average increase in KCl threshold of approximately 0.60 log10 units, whereas sham-operated rats showed no change. Control rats retested with 100 microM amiloride added to all KCl concentrations and water displayed no change in threshold. These results suggest that although the CT contributes significantly to the rat's sensitivity to KCl, amiloride-sensitive taste transduction pathways do not.     

The Effects of 10 Weeks Military Training on Heel Ultrasound and Bone Turnover

To measure the physiological changes in bone in response to strenuous exercise we performed a prospective study of male army recruits over 10 weeks of basic training. Measurements performed at the start and completion of training consisted of ultrasound (US) measurements of the heel: velocity of sound (VOS in m/seconds) and broadband ultrasound attenuation (BUA in dB/MHz) and bone turnover markers; osteocalcin (OC), bone-specific alkaline phosphatase (BALP), and tartrate-resistant acid phosphatase (TRAP). Forty subjects were recruited for the study and 26 completed training. Over the 10-week study period there was a significant 1.7% fall in mean VOS [mean paired difference (mpd) 27.2 m/second, SEM 9.5 (95% CI 7.5–46.8) P= 0.009] and a nonsignificant 3.4% increase in BUA (P= 0.159). There were significant falls in markers of bone formation OC [11.6%, mpd 0.11 μg/liter (95% CI 0.07–0.14) P < 0.001] and BALP [13.3%, mpd 3.49 U/liter (CI 0.80–6.18) P= 0.013] and a nonsignificant 9.5% fall in TRAP a marker of bone resorption. The 10 recruits subsequently injured had a significantly lower VOS on entry [mean difference 24.2 m/seconds (95% CI 4.6–43.7) P= 0.017] and nonsignificantly raised BUA and baseline levels of all bone markers. The ultrasound changes may be accounted for by increase in trabecular separation and a fall in trabecular connectivity due to microfracture. The decrease in bone markers implies a fall in bone turnover. Received: 26 June 1997 / Accepted: 26 August 1998     

Age-related regulation of mouse brain cortex adrenoceptors following camphor vapor exposition

The paper deals with the ability of adrenergic receptors (AR) of mouse brain cortex to be differentially regulated in response to single or multiple expositions to camphor vapor. The regulation of alpha- and beta-adrenoceptors has been studied in young and old Balb/c-nu mice. Results confirm the decrease of total beta-adrenoceptor density previously observed in untreated mice with advancing age; in addition, receptor density decreases in both young and old mice after a single exposition to camphor vapor, followed by an adaptation after multiple stimuli. The beta1, subtype is mainly responsible for density decrease in young animals, while both beta1, and beta2 subtypes contribute to the decrease in old mice. On the contrary, beta2 subpopulation gives the major contribution to the adaptive recovery in both young and old mice. alpha-Adrenoceptors also show an age-related decrease in the control group; after a single exposition they show an increased density with the exception of alpha1-subset in the young group. Repeated expositions lead to a rather general adaptive response towards pre-stimuli conditions. The differential behaviour of receptor subtypes in response to camphor vapor exposition can be related to the differential alterations of receptor characteristics observed during aging and also suggests a possible mechanism through which these alterations may occur.