The American Orthopaedic Association's Own the Bone® database: a national quality improvement project for the treatment of bone health in fragility fracture patients.

The American Orthopaedic Association initiated the Own the Bone (OTB) quality improvement program in 2009. Herein we show that the data collected through this program is similar to that collected in other large studies. Thus, the OTB registry functions as an externally valid cohort for studying fragility fracture patients. INTRODUCTION: The American Orthopedic Association initiated the Own the Bone (OTB) quality improvement program in 2009 to improve secondary prevention of fragility fractures. In this study, we present a summary of the data collected by the OTB program and compare it to data from other large fragility fracture registries with an aim to externally validate the OTB registry. METHODS: The OTB registry contained 35,038 unique cases of fragility fracture as of September, 2016. We report the demographics, presenting fracture characteristics, past fracture history, and bone mineral density (BMD) data and compare these to data from large fragility fracture studies across the world. RESULTS: Seventy-three percent of the patients in the OTB registry were female, Caucasian, and post-menopausal. In 54.4% of cases, patients had a hip fracture; spine fractures were the second most common fracture type occurring in 11.1% of patients. Thirty-four percent of the patients had a past history of fragility fracture, and the most common sites were the spine and hip. The average femoral neck T-score was - 2.06. When compared to other studies, the OTB database showed similar findings with regard to patient age, gender, race, BMI, BMD profile, prior fracture history, and family history of fragility fractures. CONCLUSION: OTB is the first and largest multi-center voluntary fragility fracture registry in the USA. The data collected through the OTB program is comparable to that collected in international studies. Thus, the OTB registry functions as an externally valid cohort for further studies assessing the clinical characteristics, interventions, and outcomes achieved in patients who present with a fragility fracture in the USA.

Primary stimulation and measurement of antibody production to sheep red blood cells in vitro.

A method for the primary stimulation and measurement of antibody production to sheep red blood cells in vitro has been described. In this system when mouse spleen cells are incubated with sheep erythrocytes large complement-dependent plaques are formed. The number and size of plaques increases from day 1 to day 3 of incubation with an average of 4.4 plaque areas per 1 x 10(6) cells plated at day 3. There is a linear relationship between the number of spleen cells plated and the number of plaques formed. Plaque formation is inhibited by colchicine, actinomycin D, and rabbit anti-mouse globulin. This system offers a possible means for the direct in vitro measurement of the number of cells in a population susceptible to antigenic stimulation by sheep erythrocytes.

The enhancing effect of bone marrow cells on the primary immune response of the isolated perfused spleen.

The addition of bone marrow cells or peripheral lymphocytes to the isolated pig spleen markedly enhanced the primary antibody response after 3-day perfusion and antigenic challenge in vitro. The splenic preparation without added cells or with the addition of marrow cells to an irradiated spleen gave a limited response. Contributory evidence is provided that at least two distinct cell types are needed for antibody production. For optimal antibody response by an isolated perfused spleen, marrow cells or peripheral lymphocytes should be added to the system.

EGFR regulation by microRNA in lung cancer: correlation with clinical response and survival to gefitinib and EGFR expression in cell lines.

BACKGROUND: Allelic loss in chromosome 3p is one of the most frequent and earliest genetic events in lung carcinogenesis. We investigated if the loss of microRNA-128b, a microRNA located on chromosome 3p and a putative regulator of epidermal growth factor receptor (EGFR), correlated with response to targeted EGFR inhibition. Loss of microRNA-128b would be equivalent to losing a tumor suppressor gene because it would allow increased expression of EGFR. PATIENTS AND METHODS: We initially showed that microRNA-128b is a regulator of EGFR in non-small-cell lung cancer (NSCLC) cell lines. We tested microRNA-128b expression levels by quantitative RT-PCR, genomic copy number by quantitative PCR, and mutations in the mature microRNA-128b by sequencing. We determined whether microRNA-128b loss of heterozygosity (LOH) in 58 NSCLC patient samples correlated with response to gefitinib and evaluated EGFR expression and mutation status. RESULTS: We determined that microRNA-128b directly regulates EGFR. MicroRNA-128b LOH was frequent in tumor samples and correlated significantly with clinical response and survival following gefitinib. EGFR expression and mutation status did not correlate with survival outcome. CONCLUSION: Identifying microRNA regulators of oncogenes could have far-reaching implications for lung cancer patients including improving patient selection for targeted agents, development of novel therapeutics, or development as early biomarkers of disease.

Proliferating cell nuclear antigen in blast crisis cells of patients with chronic myeloid leukemia.

A nuclear antigen associated with cell proliferation [proliferating cell nuclear antigen (PCNA)] and blast transformation is recognized by autoantibodies in the sera of some patients with systemic lupus erythematosus; these autoantibodies are precipitating antibodies and also react in immunofluorescence, a technique that was used to determine if PCNA might be expressed in leukocytes of patients with chronic myeloid leukemia (CML) during certain phases of their disease. At all times, a strong relationship was seen between the percentage of cells stained by anti-PCNA antibody and the percentage of blast cells in peripheral blood leukocytes (r) = 0.865, P less than .001. However, during blast crisis, certain cells that morphologically looked like myelocytes, metamyelocytes, and some cells with segmented nuclei stained with anti-PCNA serum. This staining, which remained nuclear in location, was less intense than in blast cells, suggesting low density of the antigen in these nonblast cells. This phenomenon was not observed in myelocytes or metamyelocytes obtained from patients in remission. These initial studies demonstrated that anti-PCNA can be used as a reagent to detect blast cells in CML crisis and also has the capability to detect PCNA in other cells associated with blast crisis.

Antinuclear, antinucleolar, and anticytoplasmic antibodies in patients with malignant melanoma.

Immunofluorescence was used to examine antibodies to cellular antigens in the sera of patients with malignant melanoma. Sera from 60 melanoma patients and from 33 control individuals (13 normal subjects and 20 disease controls) were studied. Ninety % of the melanoma sera were found to have antinuclear antibodies when epithelial cell lines or melanoma lines were used as substrates for their detection, compared to 18% in the control group. Antinucleolar antibodies and anticytoplasmic antibodies were present in 32 and 17%, respectively, in malignant melanoma but none in the controls. Antinuclear and antinucleolar antibodies could be classified into different types according to different patterns of staining and susceptibility of antigens to digestion with DNase, RNase, and trypsin. Certain types of antibodies, such as those showing granular nuclear staining, appeared to be associated with less advanced stages of malignant melanoma, whereas those showing nucleolar and large speckled nuclear staining were associated with more advanced stages of the disease.

Autologous bone marrow transplantation in the therapy of small cell carcinoma of the lung.

Ten patients with small cell carcinoma of the lung were entered into a chemotherapeutic treatment program consisting of cyclophosphamide, vincristine, Adriamycin, and 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea. Two courses of combination chemotherapy were administered to each patient followed by a third course with the same doses of drugs used on Course 2 but with autologous bone marrow transplantation given 24 to 48 hr after drug infusion. No differences could be detected between Courses 2 and 3 in terms of the magnitude, timing, or degree of myelosuppression. Serial bone marrow biopsies documented a progressive decline in granulocyte-macrophage colony-forming units in culture per mg bone marrow medullary core from 138 +/- 179 (S.D.) prior to chemotherapy to 7 +/- 11 after the marrow transplant recovery (p = 0.05). These data suggest that autologous bone marrow transplantation does not reduce the myelosuppression seen following the drugs used in this study at the dosages used. Autologous bone marrow transplantation may be useful only in the setting of marrow lethal therapy. Its usefulness in shortening recovery time from nonlethal therapy appears questionable.

Phase II trial of piritrexim in metastatic melanoma using intermittent, low-dose administration.

A phase II trial of piritrexim (2,4-diamino-6[2,5-dimethoxybenzyl]-5-methyl pyrido-[2,3d] pyrimidine, 301U74; PTX) was conducted for patients with metastatic malignant melanoma using an intermittent, low-dose oral administration schedule. PTX was administered at a starting dose of 25 mg orally three times per day for 5 days weekly for 3 weeks followed by 1 week of rest. Thirty-one patients were entered onto the study. Among 31 patients assessable for response, there were two complete responses (CRs) and five partial responses (PRs) for a response rate (CR plus PR) of 23% (95% confidence limit, 10% to 42%). Five responses occurred in soft tissue lesions, and two responses occurred in lung lesions. The initial dose schedule was well tolerated. The dose-limiting toxicity was myelosuppression. PTX administered in this schedule appears to be active against malignant melanoma. Further clinical trials to confirm these results are underway.

Perforation of the great vessels during central venous line placement.

BACKGROUND: Placement of central venous lines for the administration of a variety of therapies has become common practice. The most severe complication of this procedure is perforation of a large vessel, with bleeding, infusion of fluids into an extravascular site, and death. It is not clear from currently available data how often this occurs, what risk factors are associated, and how this complication can be avoided. METHODS: We reviewed the records of all patients who were identified as having perforation of a major vessel during central venous line placement occurring between 1986 and 1993 at the University Hospital, the major teaching facility of the University of Colorado Health Sciences Center, Denver. Data collected included the age and sex of the patient, diagnosis, type of catheter and site of placement, operator means and time to the diagnosis of perforation, and outcome. RESULTS: Eleven such complications were identified and 10 of them are reviewed in detail. The overall incidence was less than 1%. Most complications occurred when the right subclavian vein approach was attempted, and they were thought to result from guidewire kinking during advancement of a vessel dilator. All medical specialties and levels of training were involved. Four of 10 patients died of immediate or subsequent complications of the perforation. CONCLUSIONS: Perforation of a great vessel is an uncommon, but often fatal, complication of central venous line placement. It occurs most often, when using the right subclavian vein approach, from guidewire kinking. Physicians performing this procedure should have formal training in central venous catheterization and be aware of this complication, its presumed cause, diagnosis, and treatment.

Stem cell kinetics in humans: studies during autologous nonfrozen bone marrow transplantation.

Multiple blood and bone marrow determinations of CFU-C were carried out during autologous bone marrow infusion in four patients treated with high dose chemotherapy. A rise in blood CFU-C was seen during the infusion while bone marrow CFU-C increased after several hours.

Autologous bone-marrow and peripheral blood buffy coat cell infusion in the treatment of chronic myeloid and acute leukemia.

Autologous marrow infusion has been attempted in three patients with chronic myeloid leukemia (two in blast crisis, one with severe myelofibrosis and pancytopenia) and one patient with acute lymphatic leukemia. One patient with blast crisis of CML expired prior to marrow infusion. One patient with myelofibrotic phase of CML is alive seven months post marrow infusion. The other two patients expired 6 and 16 days post marrow infusion. Bone-marrow repopulation is feasible in the face of severe myelofibrosis.

Colony stimulating activity in normal human serum tested against human bone marrow.

Two hundred and thirty normal human sera have been tested for colony stimulating factor (CSF) under carefully controlled conditions using human bone marrow and the semi-solid agar-gel technique. It has been shown that CSF can be detected in most sera when incorporated into underlayers to remove potential inhibitors. The effect of storage temperature on serum CSF has been determined. Storage at 4 degrees, --15 degrees, and --66 degrees for up to 80 days resulted in only a mild decrease in CSF levels. After 240 days of storage, CSF values fell to 50% of that found before storage. Repeated freeze-thawing of serum has not been shown to decrease CSF levels when done in Pyrex glassware. These studies will serve as a baseline for those wishing to study human serum CSA in hematopoietic disorders.

Recovery of CFU-C after freezing of normal and leukemic human bone marrow.

Studies have been carried out to determine the viability of leukemic and normal human bone marrow, cryopreserved in liquid nitrogen at -196 degrees C, using changes in total cell numbers and granulocyte colony forming ability in vitro. These studies have shown that there is considerable variability in the recovery of CFU-C from individual specimens. When the overall recovery, in all patients, is taken into account, there is a gradual decline in CFU-C numbers to about 60% after 24 months of freezing. CFU-C recovery is closely correlated with recovery of total cell numbers.

Colony growth of normal human bone marrow in agar-gel.

A study of the colony forming ability of 99 normal human bone marrows using the semi-solid agar technique is presented. Feeder layers of 10(6) normal human peripheral white blood cells were used as the stimulus, and were overlaid with 2 X 10(5) bone marrow cells. The presence of human plasma either in feeder layers or bone marrow overlays inhibited colony formation when compared with studies performed with cells washed free of plasma. The number of colonies grown varied, but not significantly when the same marrow was grown on feeder layers from different donors. The inhibitory effect of normal human plasma was also demonstrated when unwashed and washed bone marrow cells were plated over feeder layers with no stimulus. Further confirmation of the inhibition by normal human plasma was made in 10 cases by the addition of 0.1 ml plasma to cultures of washed marrow over washed feeder layers. These data suggest that optimum results from in vitro culture of normal human bone marrow can be obtained only when all plasma is washed from both the feeder layer cells and the marrow cells before culturing.

Interleukin-1 enhances murine granulopoiesis in vivo.

Interleukin-1 (IL-1), a monokine involved in host response to infection and inflammation, has recently been shown to stimulate production of granulocyte-monocyte colony-stimulating factors (CSFs) from a variety of cell types in vitro. The purpose of this study was to investigate the effects of human IL-1 on granulopoiesis in vivo. CF1 female mice were injected with a single dose of either highly purified human IL-1 or recombinant human IL-1 alpha (rIL-1 alpha). Heat-inactivated IL-1 or rIL-1 alpha served as controls. Physiologic doses of the IL-1 preparations were initially established by evaluating neutrophil egress from bone marrow (BM). Significant peripheral neutrophilia developed 3 h after injection of 10 U (doubling units) purified IL-1, in association with decreased marrow neutrophils. Significant neutrophilia occurred 6 h after injection of 5 x 10(3) U (half-maximal units) rIL-1 alpha. Serum colony-stimulating activity (CSA) and BM colony formation (CFU-GM) were subsequently measured in standard agar culture at various times following injection. A significant rise in CSA occurred between 3 and 6 h after injection of purified IL-1, and a significant increase in BM CFU-GM developed 48 h after injection. Similar increases in CSA and CFU-GM occurred following injection of rIL-1 alpha. These results suggest that IL-1 may play an important role in the regulation of granulopoiesis in vivo by enhancing the production of CSFs required for myeloid proliferation.

Liquid storage of bone marrow.

A program of nonfrozen autologous bone marrow rescue was used to treat patients with refractory nonhematological neoplasms. In vitro storage of bone marrow cells and CFU-C suggests that storage at 4 degrees or 10 degrees for periods up to five days can be undertaken with only minor loss of CFU-C. However, since the loss occurred in a gradual fashion, shorter duration of storage would probably be better. Hematological recovery after high dose chemotherapy occurred faster in patients given more CFU-C and those with shortest duration of storage prior to reinfusion.

Effect of melatonin on human skin color.

Previous studies have shown the pineal hormone melatonin to influence mammalian coat color and amphibian skin color when administered exogenously. It has also been suggested that melatonin can be employed effectively to inhibit progress of neoplastic disease in both animals and humans. In the present study, we set out to investigate the effect of melatonin on human skin color in an effort to uncover its mechanism of action as an antimelanoma agent. We followed seven patients receiving orally administered melatonin over a mean duration of 19 months, and four controls who were not receiving melatonin, for an average of 12 months using monthly reflectometry measurements in three sites to determine skin color. There was no significant change in skin color among patients receiving melatonin, and no difference relative to controls. On the basis of these data, we conclude that melatonin has no effect on human skin pigmentation, and that the demonstrated effectiveness of melatonin in mediating malignant melanoma growth is not related to suppression of normal melanogenesis.

On the disulfiram-like activity of moxalactam.

A three-way crossover study was undertaken in 10 healthy subjects to characterize the reported disulfiram-like activity of moxalactam and to assess its influence on ethanol and acetaldehyde metabolism. On different occasions separated by at least 2 wk subjects were given in random order: 0.5 gm/kg ethanol orally, 0.5 gm/kg ethanol followed in 1 hr by 1.0 gm IV moxalactam, and 1.0 gm IV moxalactam every 8 hr for four doses followed by 0.5 gm/kg ethanol. Mean ethanol elimination rates of 13.1 +/- 0.76, 10.1 +/- 1.11, and 10.9 +/- 1.06 mg/dl/hr (mean +/- SEM) were observed in the three protocols, respectively. Corresponding mean estimated acetaldehyde clearance rates were 103.7 +/- 15.55, 92.8 +/- 13.79, and 97.3 +/- 10.41 l/min (mean +/- SEM). While no consistent moxalactam effect on ethanol or acetaldehyde elimination was observed, two subjects experienced mild disulfiram-like reactions to ethanol after moxalactam pretreatment. In one subject this reaction was associated with markedly elevated blood acetaldehyde concentrations. We conclude that moxalactam pretreatment may induce a disulfiram-like reaction after ethanol ingestion in some, probably due to inhibition of aldehyde dehydrogenase, and that alcoholic beverages are contraindicated in patients receiving moxalactam. We suggest, however, that such reactions will not occur when moxalactam is given after ethanol ingestion.

Positive tetracycline control of expression of p15INK4B from an Epstein-Barr autonomous plasmid in a human melanoma cell line.

Homozygous deletions in the region of chromosome 9p21 are frequent in human melanoma. Mutations in the p16INK4A cyclin-dependent kinase inhibitor (CDI) gene at this locus have implicated the product of this gene as a tumor suppressor. Less attention has been focused on the homologous, closely linked p15INK4B gene. To facilitate study of the phenotypic effects of restoring expression of the latter in aggressive melanoma cells lacking INK4 expression, we inserted the cDNA encoding p15INK4B into an autonomously maintained plasmid under positive tetracycline control ('TET ON' system). Similarly regulated luciferase and herpes thymidine kinase sequences were used as controls. We demonstrate that this system enabled efficient, and reasonably uniform, induction of p15INK4B expression in a human melanoma cell line exposed to the tetracycline derivative, doxycycline. Flow cytometry showed that this induction resulted in substantial accumulation of cells in the G0/G1 phase of the cell cycle. This system will facilitate detailed analysis of the cell cycle inhibitory mechanisms of this CDI in human melanoma cells.

Familial leukemia and aplastic anemia associated with monosomy 7.

A kindred is described in which eight of 14 patients in one generation had acute nonlymphocytic leukemia or aplastic anemia either alone or terminating in acute nonlymphocytic leukemia. The proband and two siblings in one branch of this kindred presented with aplastic anemia, whereas acute nonlymphocytic leukemia was the presenting feature in the other two branches. Karyotypic evolution from a normal karyotype to monosomy 7 was demonstrated in the proband, and group C monosomy was seen in two other patients. The proband's serum sample inhibited in vitro growth of normal bone marrow colonies. The occurrence of hematologic disease in this kindred appears to be the result of a maternally transmitted trait, and persons younger than 30 years of age appear to have the highest risk of hematologic disease.