Effect of neurological dysfunction on health-related quality of life in patients with high-grade glioma

The purpose of the study was to assesshealth-related quality of life (HQL) in patients withhigh-grade malignant glioma of the brain. The EORTCcore Quality of Life Questionaire (QLQ-C30) and aBrain Cancer Module (BCM20) were administered at baselineand several weeks later (follow-up) to 105 patientswith either recently-diagnosed (n=41) or recurrent(n=64) malignant glioma. In addition, theattending neurologists completed a standard neurological examination, amodified Barthel Activities of Daily Living Index (BADLI)and the Karnofsky Performance Scale (KPS). In apreliminary step, the QLQ-C30 was found to haveacceptable reliability (internal consistency and test-retest reliability). Newly-diagnosedpatients and those with a KPS of 80–100had significantly better physical, role and cognitive functioningand global quality of life with less fatigue,visual disorder, motor dysfunction, communication deficit, weakness ofboth legs and trouble controlling the bladder thandid those with recurrent disease and those witha KPS of 50–70. Similarly, those capable ofindependent activities of daily living, as reported onthe BADLI, had higher functioning scores and lessfatigue than did those who were not independent.Patients with dysphasia, mental confusion or motor deficiton neurological examination reported significantly lower levels ofphysical, role, cognitive, emotional and social functioning andglobal quality of life than did patients nothaving these difficulties. They also had significantly moresymptoms. In patients with deteriorating neurological status betweenbaseline and follow-up, there was a marked declinein cognitive, physical, role, emotional and social functioningand global quality of life and an increasein fatigue. Thus, there are significant differences inHQL between patients with newly-diagnosed and recurrent braincancer and between patients with differing KPS andBADLI scores. In addition, the HQL scores providedetails not provided by the KPS and theBADLI. Deterioration in neurological function is accompanied bysignificant deterioration in a range of HQL domainsand in global quality of life.     

Diabetes insipidus in children. III. Anterior pituitary dysfunction in idiopathic types

Seventeen patients with idiopathic diabetes insipidus occurring in childhood were observed from 4 to 26 years (mean duration 15 1/2 years). The diagnosis of idiopathic diabetes insipidus was based on routine clinical examination and careful, repeated neuroradiologic investigations. Anterior pituitary dysfunction was present in some of these patients. Growth hormone deficiency was present in six children, insufficient thyroid stimulating hormone secretion after thyrotropin-releasing hormone stimulation was demonstrated in one, and abnormal response to a metyrapone test in two. Elevated prolactin and TSH values were present in three and two patients, respectively. Some of these abnormalities were transitory. The presence of anterior pituitary dysfunction in idiopathic diabetes insipidus indicates that the destructive process is not localized to vasopressin synthesizing cells but may also involve other parts of the hypothalamus.     

Patients' experiences using a computerized program with a touch-sensitive video monitor for the assessment of health-related quality of life.

This study assessed patients' experiences using a computerized program with a touch-sensitive video monitor (TSVM) for the assessment of health-related quality of life (HRQoL). A software program was developed for a computerized form of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, the QLQ-C30. One hundred and seventy-eight patients completed the QLQ-C30, followed by a structured interview designed to assess perceived difficulties with the use of the TSVM. Patients were asked to evaluate the ease of use of different aspects of the TSVM system (using the touch-sensitive screen, entering the patient identification number, reading the screen and following the on-screen instructions). The majority of patients found all aspects of the TSVM system very easy to use. A few patients (1–2%) admitted finding any aspect of the TSVM use somewhat difficult and none ranked any aspect as very difficult. There were no unanswered items in the QLQ-C30. All patients found the amount of time spent on answering the questionnaire acceptable, (the mean time to complete was 6.8 min with a median of 5 min) and 96% stated they were willing to complete a similar questionnaire on a future occasion. From the patients' perspective the TSVM system appears to be a highly acceptable approach for the collection of HRQoL data in clinical practice.     

Teratogenicity in vitro of two deacetylated metabolites of N-hydroxy-2-acetylaminofluorene

In previous studies [E. Faustman-Watts, J. C. Greenaway, M. J. Namkung, A. G. Fantel, and M. R. Juchau (1983) Teratology 27, 19–28] an embryo culture system was utilized to investigate the role of biotransformation in the embryotoxicity of 2-acetylaminofluorene. For this investigation, the capacity of two deacteylated metabolites of N-hydroxy-2-acetylaminofluorene (N-OH-AAF) to produce malformations in cultured whole rat embryos is reported. The relative capacities of N-hydroxy-2-aminofluorene (N-OH-AF) and 2-nitrosofluorene (NF) to elicit embryotoxic effects, including embryolethality, malformations, growth retardation, and alterations in macromolecular content, were assessed and compared with effects produced by N-OH-AAF and bioactivated 2-acetylaminofluorene (AAF). Qualitatively similar patterns of malformations were produced by NF and N-OH-AF. At initial concentrations greater than 60 μm, both deacetylated compounds caused abnormalities in axial rotation (flexure), decreased viability, and decreases in embryonic DNA and protein content. Both chemicals were active in the absence of a bioactivating system. AAF produced a different spectrum of defects, and was active only in the presence of a complete monooxygenase system. The malformations produced by bioactivated AAF included abnormally open neural tubes; flexure abnormalities were rarely observed. The primary defect elicited by N-OH-AAF was prosencephalic hypoplasia. This chemical was active without an added bioactivating system. Temporal studies demonstrated that exposure of embryos to NF (128 μm) for as little as 2 hr was sufficient to elicit embryotoxic effects. None of the individual metabolites appeared to be solely responsible for the interruptions of neural tube closure produced by bioactivated AAF.     

Regulatory effects of senescence marker protein 30 on the proliferation of hepatocytes

Senescence marker protein 30 (SMP 30) is preferentially expressed in the liver. One of its remarkable functions is the protection of cells against various injuries by enhancement of membrane calcium-pump activity. We analyzed the role of SMP 30 in hepatocyte proliferation. SMP 30 expression was decreased initially, then increased along with hepatic regeneration, after carbon tetrachloride (CCl4) administration. SMP 30 expression was decreased in the necrotic phase and then gradually increased. Its increase was slightly delayed just after the mitotic phase. These results lead us to speculate that mitoses of hepatic cells induce enhanced SMP 30 expression. In contrast, administration of lead nitrate (LN) as a hepatic mitogen induced a more stable increase of SMP 30 expression. To estimate the effect of SMP 30 on cell proliferation, we evaluated hepatic mitosis in wild-type and SMP 30-deficient knockout (KO) mice after CCl4 administration. We found an increase in mitotic numbers in hepatocytes of KO mice. This result suggests that SMP 30 has a suppressive effect on cell proliferation. Suppressive activity of SMP 30 cDNA was shown in cultured hepatoblastic cells. Our results suggest that SMP 30 performs a regulatory function in liver regeneration.     

The production of tumour necrosis factor-alpha is decreased in peripheral blood mononuclear cells from multidrug-resistant tuberculosis patients following stimulation with the 30-kDa antigen of Mycobacterium tuberculosis

The clearance of intracellular bacteria requires the appropriate induction of proinflammatory cytokines and chemokines to recruit macrophages and T cells to the site of infection. In this study, we investigated the production of tumour necrosis factor (TNF)-alpha, interleukin (IL)-8 and interferon (IFN)-gamma by the peripheral blood mononuclear cells (PBMC) of patients with multidrug-resistant tuberculosis (MDR-TB) in response to in vitro stimulation with the 30-kDa antigen of Mycobacterium tuberculosis. The results were compared with those from cases of newly diagnosed TB (N-TB) and TB with treatment failure (TF-TB), and healthy tuberculin reactors (HTR). The most significantly depressed TNF-alpha levels were found in MDR-TB patients. IFN-gamma production was depressed significantly in all groups of TB patients compared with the HTR group. TNF-alpha secretion in response to the 30-kDa antigen was unchanged by coculturing with recombinant human interferon (rhIFN)-gamma, and was increased dramatically following IL-10 neutralization with an anti-human IL-10 antibody. The IL-8 levels were depressed significantly in MDR-TB patients compared with N-TB patients, but were similar to the IL-8 levels in TF-TB patients. Furthermore, rhTNF-alpha directly increased IL-8 secretion, and neutralizing antibody to TNF-alpha inhibited IL-8 production by the PBMC of MDR-TB patients that were stimulated with the 30-kDa antigen. Taken together, these data suggest that the PBMC of MDR-TB patients typically show TNF-alpha depression in response to the 30-kDa antigen, and this effect is modulated by IL-10. In addition, we highlight the role of TNF-alpha in IL-8 secretion in MDR-TB patients.     

可溶性CD40配体酶联检测试剂盒的研制及其运用

目的 :建立灵敏、特异和稳定的人可溶性CD4 0配体 (sCD4 0L)酶联检测试剂盒。方法 :采用鼠抗人CD4 0L单克隆抗体 1B1为包被抗体 ,识别人CD4 0L不同位点的单克隆抗体 4F1经琥珀酰羟基生物素 (BNHS)标记后为检测抗体 ,建立双抗体夹心的人sCD4 0L酶联检测方法。在此基础上 ,测定 2 0 0例健康供血员血清和血浆中sCD4 0L的含量。结果 :成功研制人sCD4 0L酶联检测试剂盒 ,灵敏度为 0 5ng ml。该试剂盒 4℃放置 3个月 ,离散度 (CV) <± 6 9% ,回收率为 94 7%～ 10 4 8% ,提示该检测系统具有良好的灵敏度、稳定性和准确性 ,与国外商品化试剂盒的分析结果相似。应用该试剂盒测得的健康供血员血清和血浆sCD4 0L含量分别为 9 5 6± 4 71、2 98± 1 13ng ml。结论 :研制成灵敏、特异和稳定的人sCD4 0L酶标检测试剂盒 ,能够对血清和血浆中sCD4 0L进行准确定量分析 ,并首次证实血清和血浆中sCD4 0L水平的差异性     

IFN-γ and CD25 drive distinct pathologic features during hemophagocytic lymphohistiocytosis

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The frequency of intratubular embryonal carcinoma: implications for the pathogenesis of germ cell tumours

AIMS: To define the frequency and distribution of intratubular embryonal carcinoma (IEC) in an attempt to shed light on the pathogenesis of non-seminomatous germ cell tumours (NSGCTs). Intratubular germ cell neoplasia of unclassified type (IGCNU) is common in NSGCT; however, IEC is rarely described. METHODS AND RESULTS: Sixty-two germ cell tumours were reviewed. Immunochemistry for CD30, placental alkaline phosphatase (PLAP) and c-kit was performed. The distribution, immunohistochemistry and morphology of the intratubular neoplasia were noted. All cases showed widespread IGCNU with PLAP and c-kit staining. CD30 showed strong focal intratubular positivity in 20/31 NSGCTs, 1/29 seminomas and 1/4 mixed seminomas/NSGCTs. In 17 of these cases, the CD30+ tubules were not easily identified as IEC on routine stains. These tubules were scanty in number and c-kit was negative, though some showed patchy PLAP staining. The cells within these tubules differed morphologically from IGCNU. CONCLUSIONS: IEC defined by CD30 positivity is not always easily identified on haematoxylin and eosin staining. We suggest that IEC is a common intermediate step between IGCNU and NSGCTs. The patchy and focal distribution of IEC suggests it may evolve quickly to invasive disease.     

Modifications of general parameters of immune activation in the sera of Sicilian patients with Boutonneuse fever

The serum levels of β₂-microglobulin (β₂-M), soluble HLA class I antigen (sHLA-I), soluble CD4 (sCD4) and CD8 (sCD8) were studied in 98 Sicilian patients with Boutonneuse fever (BF). In different stages of infection all markers were significantly increased in sera from Sicilian patients with acute BF compared with healthy controls. sCD8 and sHLA-I reached the peak in the second week after the onset of symptoms, whereas sCD4 and β₂-M reached the peak in the first week. Afterwards sCD8 decreased to the levels of controls within the third week, the other parameters decreased later and were unmodified until the third week of infection. Significant correlations were found between sCD4 and sCD8 and the sIL-2R, as well as between serum levels of β₂-M and sCD8. The reduction of CD3⁺ and CD4⁺ and the increase of CD8⁺ T cells in the blood indicate that these cells are involved in the response to rickettsia, and their activation might be in part responsible for the release of sCD4 and sCD8. Our data suggest that these soluble markers, indexes of immune activation of T cells both in the circulation and the affected tissues, may be used in monitoring BF evolution.