Four-year Prostate-specific Antigen Response Rate as a Predictive Measure in Intermediate-risk Prostate Cancer Treated With Ablative Therapies: The SPRAT Analysis.

AIMS: There is a lack of early predictive measures of outcome for patients with intermediate-risk prostate cancer (PCa) treated with stereotactic body radiotherapy (SBRT). The aim of the present study was to explore 4-year prostate-specific antigen response rate (4yPSARR) as an early predictive measure. MATERIALS AND METHODS: Individual patient data from six institutions for patients with intermediate-risk PCa treated with SBRT between 2006 and 2016 with a 4-year (42-54 months) PSA available were analysed. Cumulative incidences of biochemical failure and metastasis were calculated using Nelson-Aalen estimates and overall survival was calculated using the Kaplan-Meier method. Biochemical failure-free survival was analysed according to 4yPSARR, with groups dichotomised based on PSA <0.4 ng/ml or ≥0.4 ng/ml and compared using the Log-rank test. A multivariable competing risk analysis was carried out to predict for biochemical failure and the development of metastases. RESULTS: Six hundred and thirty-seven patients were included, including 424 (67%) with favourable and 213 (33%) with unfavourable intermediate-risk disease. The median follow-up was 6.2 years (interquartile range 4.9-7.9). The cumulative incidence of biochemical failure and metastasis was 7 and 0.6%, respectively; overall survival at 6 years was 97%. The cumulative incidence of biochemical failure at 6 years if 4yPSARR <0.4 ng/ml was 1.7% compared with 27% if 4yPSARR ≥0.4 ng/ml (P < 0.0001). On multivariable competing risk analysis, 4yPSARR was a statistically significant predictor of biochemical failure-free survival (subdistribution hazard ratio 15.3, 95% confidence interval 7.5-31.3, P < 0.001) and metastasis-free survival (subdistribution hazard ratio 31.2, 95% confidence interval 3.1-311.6, P = 0.003). CONCLUSION: 4yPSARR is an encouraging early predictor of outcome in patients with intermediate-risk PCa treated with SBRT. Validation in prospective trials is warranted.

Heterotopic gastric mucosa causing significant esophageal stricture in a 14-year-old child.

Esophageal heterotopic gastric mucosa (HGM) is not uncommon and can be seen in up to 10% of the general population among numerous reports and epidemiologic studies which have been essentially performed in adult population. Pediatric data are still limited. Diagnosis requires clinician awareness of symptomatic cases who present with dysphagia or swallowing difficulties, and thorough endoscopic examination is crucial. Early detection of cases provides favorable clinical outcome and may prevent potential significant or serious long-term consequences such as esophageal stricture or web, Barrett's esophagus or malignant transformation in pediatric population. We reported a 14-year-old male who presented with 1-year history of gradually worsening dysphagia and was found to have two salmon-colored patches, which resemble gastric mucosa, in the proximal esophagus causing significant esophageal stricture. Gastric cardiac-type mucosa with acute and chronic inflammation was documented on biopsy. After several sessions of balloon dilation and endoscopic treatment, the HGM and esophageal stricture resolved and he became asymptomatic.

Genetic and cellular mechanisms in chromium and nickel carcinogenesis considering epidemiologic findings.

Genetic and environmental interactions determine cancer risks but some cancer incidence is primarily a result of inherited genetic deficits alone. Most cancers have an occupational, viral, nutritional, behavioral or iatrogenic etiology. Cancer can sometimes be controlled through broad public health interventions including industrial hygiene and engineering controls. Chromium and nickel are two human carcinogens associated with industrial exposures where public health measures apparently work. Carcinogenic mechanisms of these metals are examined by electron-spin-resonance-spectroscopy and somatic-mutation-and-recombination in Drosophila melanogaster in this report. Both metals primarily affect initiation processes in cancer development suggesting important theoretical approaches to prevention and followup.

Mesenchymal stem cells from rat visceral fat exhibit multipotential differentiation in vitro.

Human subcutaneous fat-derived stem cells were recently shown to have the potential to differentiate in vitro into a variety of cell types, including adipocytes, osteoblasts, chondrocytes, and myoblasts (Zuk et al., Tissue Eng. 2001;7:211-228). Subcutaneous adipose tissue may therefore prove to be an easily acquired and abundant source of stem cells. Presently it is unclear whether mammals such as rats (which possess small or nonexistent subcutaneous fat pads) contain mesenchymal stem cells within the visceral fat of the abdominal cavity, or whether the visceral fat of any species contains stem cells. In this study we isolated and expanded a pool of mesenchymal cells from visceral fat of adult Sprague-Dawley rats and induced their differentiation in vitro into adipocytes, osteoblasts, neural cells, and chondrocytes. The differentiated phenotypes were verified by morphology as well as detection and expression of tissue-specific protein and mRNA. We conclude that despite well-documented differences in the metabolic and biochemical properties among anatomically distinct depots of fat, the visceral fat of rats contains adult mesenchymal stem cells with developmental potential similar to those isolated from subcutaneous fat in humans. Therefore, animals such as rats provide both a source of fat-derived stem cells and an immunocompetent, autologous host animal in which to investigate the capacity of the fat-derived cells to differentiate and form tissues in vivo.

Combining Drosophila melanogaster somatic-mutation-recombination and electron-spin-resonance-spectroscopy data to interpret epidemiologic observations on chromium carcinogenicity.

Lung cancers are significantly increased among workers exposed to chromate (Cr6+, Cr3+), chromium pigments (Cr6+) and chromium plating (Cr6+). Chromium lung burdens and cancer risk increase proportionately with duration of employment at long latencies. However, this epidemiologic information alone is insufficient in determining whether Cr6+ or Cr3+ are equally important in causing cancer. We have attempted to combine epidemiologic data with data from the Drosophila melanogaster somatic-mutation-recombination-test and from the in vitro electron-spin-resonance spectroscopy study to demonstrate that following somatic recombination plays a more important role than somatic mutation in chromium carcinogenesis. Cr4+ is more important than Cr5+ or Cr6+ in inducing somatic recombination while Cr6+ produces more and bigger clones than Cr4+ in somatic mutation. Cr3+ produces negative results in this fruit-fly wing-spot-assay. When the larvae and flies exposed to Cr6+ and Cr4+ are examined by ESR, only Cr5+ and Cr3+ are found. Thermodynamic parameters deltaE, deltaH, and deltaS are also estimated from these latter experiments to explain the relative importance of Cr6+, Cr4+, Cr3+ in chromium carcinogenesis among exposed industrial workers.

Multilineage cells from human adipose tissue: implications for cell-based therapies.

Future cell-based therapies such as tissue engineering will benefit from a source of autologous pluripotent stem cells. For mesodermal tissue engineering, one such source of cells is the bone marrow stroma. The bone marrow compartment contains several cell populations, including mesenchymal stem cells (MSCs) that are capable of differentiating into adipogenic, osteogenic, chondrogenic, and myogenic cells. However, autologous bone marrow procurement has potential limitations. An alternate source of autologous adult stem cells that is obtainable in large quantities, under local anesthesia, with minimal discomfort would be advantageous. In this study, we determined if a population of stem cells could be isolated from human adipose tissue. Human adipose tissue, obtained by suction-assisted lipectomy (i.e., liposuction), was processed to obtain a fibroblast-like population of cells or a processed lipoaspirate (PLA). These PLA cells can be maintained in vitro for extended periods with stable population doubling and low levels of senescence. Immunofluorescence and flow cytometry show that the majority of PLA cells are of mesodermal or mesenchymal origin with low levels of contaminating pericytes, endothelial cells, and smooth muscle cells. Finally, PLA cells differentiate in vitro into adipogenic, chondrogenic, myogenic, and osteogenic cells in the presence of lineage-specific induction factors. In conclusion, the data support the hypothesis that a human lipoaspirate contains multipotent cells and may represent an alternative stem cell source to bone marrow-derived MSCs.

A novel device for the simple and efficient refinement of liposuctioned tissue.

In short, our device allows a surgeon who is harvesting adipose tissue for autologous fat transplantation to immediately, easily, efficiently, and sterilely isolate adipose tissue from the unwanted waste components that are associated with primary liposuction effluent. It does so by "trapping" the fat tissue contained within raw liposuction effluent. Once the tissue fraction has been separated, the device design then allows for direct implantation or subsequent washing/rinsing of the tissue with saline/buffer of choice in preparation for tissue reimplantation.

Emerging approaches to the tissue engineering of fat.

The eventual development of tissue-engineered fat equivalents for reconstructive and augmentation purposes will be most welcome by nearly every surgical discipline and prove to be especially useful for plastic surgeons. The clinical applications for which tissue-engineered fat will be particularly useful are vast and varied and can be loosely categorized into reconstructive, cosmetic, corrective, and orthotic indications. In this article, the authors discuss the emerging tissue-engineering strategies for fat, including the procurement of autologous cells, cell growth and differentiation, implantation and engraftment, polymer scaffolds, and implant integration and histogenesis.

Modulation by temperature of the genotoxic potency of cisplatin in Drosophila wing spot assay.

Effects of temperature on genotoxic potency of cisplatin were studied in the Drosophila wing spot assay. A fixed concentration of 0.05 mM cisplatin was evaluated for genotoxicity at 4 temperatures (18, 20, 25, and 29 degrees C). The compound was found to be a positive inducer of all three endpoints at all temperatures when compared to the water controls. While no effect of temperature was found on the percentages of cisplatin-treated wings with small spots, there were significant effects for large spots and twin spots. The capacity of cisplatin to induce both large spots and twin spots tended to increase with rising temperature. A significant linear regression was obtained in regard to temperature and number of cisplatin-induced large spots per wing. The lack of any effect of temperature on induced small spots provides additional evidence that small spots may be qualitatively different from large spots and twin spots. The observed enhancement by higher temperature of cisplatin's genotoxic potency is likely due in part to increased cellular uptake of the mutagen. Wide temperature fluctuations should be avoided when conducting the wing assay. Although the customary temperature for performing the assay has been within the range 24-25 degrees C, the optimum temperature for maximizing genotoxic potency (and sensitivity of the assay) may be nearer 27 degrees C.

Inhibition of peripheral blood mononuclear cell proliferation by cardiac glycosides.

INTRODUCTION: Prior studies have shown that ouabain, a cardiac glycoside that inhibits the sodium, potassium adenosine triphosphatase (Na+,K+ ATPase) enzyme, downregulates phytohemagglutinin (PHA)-induced peripheral blood mononuclear cell (PBMNC) proliferation. OBJECTIVE: This study examined and compared the effects of both ouabain and digoxin, a cardiac glycoside used therapeutically in humans, on PBMNC proliferation. METHODS: Peripheral blood mononuclear cells were isolated from healthy human subjects, incubated for 72 hours with and without PHA (2%) in the presence and absence of ouabain (10(-12) M to 10(-4) M) or digoxin (10(-9) M to 10(-6) M), and pulsed with 3H thymidine. RESULTS: For PHA-stimulated PBMNCs in the ouabain-treated group (n = 10 subjects), the mean (+/-STD) % uptake (% 3H thymidine uptake in absence of ouabain) was 80.5 +/- 6.0 at 10(-12) M ouabain, 73.1 +/- 8.4 at 10(-10) M, 47.89 +/- 13.1 at 10(-8) M, 6.9 +/- 3.2 at 10(-6) M, and 3.4 +/- 1.6 at 10(-4) M. For PHA-stimulated cells in the digoxin-treated group (n = 9 subjects), the mean (+/-STD) % uptake (% 3H thymidine uptake in absence of digoxin) was 89.8 +/- 9.8 at 10(-9) M digoxin, 92.6 +/- 8.2 at 10(-8) M, 54.3 +/- 19.8 at 10(-7) M, and 1.0 +/- 2.4 at 10(-6) M. Repeated measures ANOVA demonstrated a significant effect of concentration of both glycosides on PBMNC proliferation (P < .01). The inhibitory effect was reversible, but was largely abbrogated if ouabain was added after 48 hours of incubation with PHA. Further, the inhibitory effect extended to PBMNCs stimulated with recall antigen (tetanus) and to fractionated PBMNCs (CD4+, CD8+ and CD19+) stimulated with mitogens. Additionally, dose-response inhibitory effects of glycosides on PBMNC Na+,K+ ATPase enzyme activity and interleukin-2 (IL-2) secretion by PHA-stimulated PBMNC were also noted. Neither glycoside had an effect on spontaneous PBMNC proliferation (no PHA) or trypan blue exclusion. CONCLUSIONS: These studies demonstrate that both cardiac glycosides inhibited PHA-induced PBMNC proliferation, possibly via Na+,K+ ATPase inhibition, but not via cell toxicity. The concentration range over which inhibition was observed was similar for both glycosides. The results raise the possibility that therapeutic or toxic doses of digoxin could have an effect on cell-mediated immunity in vivo.

Relationship of common laboratory parameters to the activity of Crohn's disease in children.

The Pediatric Crohn's Disease Activity Index (PCDAI) has been proposed as a simple instrument to aid in the classification of patients by disease severity. The PCDAI includes subjective patient reporting of symptoms, physical examination, nutritional parameters, and several common laboratory tests (hematocrit, erythrocyte sedimentation rate, albumin). In this report we examine the relationship of each of the laboratory parameters to the PCDAI, as well as to a modified Harvey-Bradshaw Index score and physician global assessment of disease activity. Data were gathered from the clinical and laboratory observations from 133 children and adolescents at 12 pediatric gastroenterology centers in North America. A statistically significant relationship (p less than 0.05) was noted between each of the laboratory tests and the PCDAI for patients with either disease limited to the small bowel or in those with colonic involvement. For patients with disease limited to the small bowel, a statistically significant (p less than 0.05) relationship was also noted between the three laboratory parameters and the modified Harvey-Bradshaw Index and global assessment. For patients with large-bowel involvement, the erythrocyte sedimentation rate was statistically related to the modified Harvey-Bradshaw Index and global assessment (p less than 0.01), as was hematocrit to global assessment (p less than 0.01). Although the laboratory parameters used in the PCDAI appear to generally reflect disease activity in most patients, no single laboratory test is adequate to reflect disease activity in all patients. Future work will need to identify additional laboratory measures to reflect the inflammatory process and serve as important adjuncts in the assessment of disease activity.

Development and validation of a pediatric Crohn's disease activity index.

Clinical and laboratory observations of 133 children and adolescents with Crohn's disease were used to validate an index of severity of illness previously developed by a group of senior pediatric gastroenterologists at a research forum in April 1990. This pediatric Crohn's disease activity index (PCDAI) included (a) subjective reporting of the degree of abdominal pain, stool pattern, and general well-being; (b) presence of extraintestinal manifestations, such as fever, arthritis, rash, and uveitis; (c) physical examination findings; (d) weight and height; and (e) hematocrit, erythrocyte sedimentation rate, and serum albumin. Independent evaluation of each patient by two physician-observers was performed at the time of a visit, and each physician completed a PCDAI index and a modified Harvey-Bradshaw index and made a "global assessment" of disease activity as none, mild, moderate, or severe. Excellent interobserver agreement was noted for the PCDAI, modified Harvey-Bradshaw index, and global assessment. There was a strong correlation between global assessment and both the PCDAI or modified Harvey-Bradshaw. Increasing PCDAI scores were noted with increasing disease severity, and significant differences in scores were noted between the severity groups. We propose that the PCDAI could be used in multicenter projects to facilitate patient stratification by disease severity and that longitudinal PCDAI scores might provide a numerical measure of response to therapeutic regimens.

Sodium thiosulfate inhibits cisplatin-induced mutagenesis in somatic tissue of Drosophila.

The antitumor agent cisplatin was evaluated for genotoxicity in the somatic tissue of Drosophila melanogaster in combination with the nucleophilic compound sodium thiosulfate (STS). Third instar larvae transheterozygous for mwh and flr3 were grown on media containing (1) water, (2) 200 mM STS, (3) 0.05 mM cisplatin in 200 mM STS, or (4) 0.05 mM cisplatin. Wings of surviving adults were scored for the presence of twin spots and both small and large single spots; 200 mM STS was nongenotoxic in the assay. Whereas 0.05 mM cisplatin significantly induced all three endpoints, 0.05 mM cisplatin in combination with 200 mM STS was found to have no genotoxic activity. Hence, STS possessed antimutagenic activity in the wing-spot assay and completely inhibited cisplatin-induced mutagenesis and mitotic recombination.

Inhalation of methyl bromide gas induces mitotic recombination in somatic cells of Drosophila melanogaster.

The fumigant methyl bromide was evaluated for genotoxicity in the somatic wing-spot assay of Drosophila melanogaster. Third instar larvae trans-dihybrid for mwh and flr3 were exposed to varying concentrations (0-16 mg/l) of the gas for 1 h. Following this exposure via inhalation, the larvae were placed into vials containing Instant Medium. 7 days after the exposure, the adult flies in the vials were collected, and their wings were scored under 400X magnification for the presence of clones of cells possessing malformed wing-hairs. Such clones appeared as mwh-flr3 twin spots and single spots of either mwh or flr3 phenotype. Exposure to methyl bromide was found to result in the positive induction of both twin spots and large (greater than 2 cells) single spots. For each endpoint, a significant exponential association was obtained between concentration and frequency of spots per wing. Methyl bromide was found to be a negative inducer of small (1-2 cells) single spots at all concentrations except 16 mg/l where a positive effect was observed. Because twin spots arise exclusively from mitotic recombination, methyl bromide was identified as having recombinogenic activity in the somatic tissue of Drosophila larvae.

Relationships between structures and mutagenic potencies of 16 heterocyclic nitrogen mustards (ICR compounds) in Salmonella typhimurium.

16 heterocyclic nitrogen mustards (ICR compounds), which were synthesized for use as possible antitumor agents by Creech and coworkers, were tested for mutagenicity in Salmonella typhimurium strains TA1535, TA1536, TA1537, TA1538, TA98 and TA100. The compounds were incorporated into the top agar at 5 doses: 0.5, 1, 2.5, 5 and 10 micrograms/plate. All of the compounds were negative in TA1535 except ICR 449, which was positive in all 6 strains. The other 15 compounds were positive in the remaining strains with the following exceptions: ICR 371 and 355 were negative in TA100; ICR 445 was negative in TA98 and TA100; and ICR 360 was negative in TA1537, TA1538, TA98 and TA100. Good qualitative agreement was observed between the mutagenic and antitumor activities of the 16 compounds, and between the mutagenic and carcinogenic activities of the 5 compounds that have been tested for carcinogenicity by Peck and coworkers. However, no significant correlation was found between mutagenic potency in Salmonella and antitumor potency in mice for the 16 compounds. Also, for the 5 compounds that have been tested for carcinogenicity, no significant correlation was found between their mutagenic potency in Salmonella and their carcinogenic potency in mice. In Salmonella, the secondary (2 degrees) amines generally were more mutagenic than their tertiary (3 degrees) amine homologs, although the opposite result has been reported in certain eukaryotes. Relationships between structures and potencies for the different nuclei of the 16 ICR compounds are discussed, as are similarities and differences in strain sensitivities. We conclude that the Salmonella his reversion test is not a good predictor of the antitumor and carcinogenic potencies of these ICR compounds.

Survival and biochemical characteristics of stored red cells preserved with citrate-phosphate-dextrose-adenine-one and two and prepared from whole blood maintained at 20 to 24 degrees C for eight hours following phlebotomy.

Studies were conducted to evaluate the characteristics of red cells stored for 35 days following preparation from units of whole blood anticoagulated with citrate-phosphate-dextrose-adenine-one and two (CPDA-1 and CPDA-2) and maintained at 20 to 24 degrees C for 8 hours after phlebotomy. The mean (+/- 1 SD) 24-hour survival for transfused CPDA-1 autologous red cells with hematocrit levels of 78.1 +/- 2.3 percent was 78.0 +/- 8.1 percent (n = 9). The 24-hour survival of red cells from units preserved with CPDA-2 with hematocrit levels of 79.3 +/- 4.5 percent was 74.8 +/- 8.6 percent (n = 15). This difference in survival was not significant. Red cells from control units stored for 1 day showed a 24-hour survival of 91.9 +/- 4.2 percent (n = 7). During the 8-hour holding, red cell adenosine triphosphate levels increased by 15 to 25 percent in units drawn into both CPDA-1 and CPDA-2. After the initial 8-hour period, the red cell 2,3 diphosphoglycerate levels were 54 +/- 12 percent (mean +/- 1 SD) of initial levels in units drawn into CPDA-1 and 58 +/- 8 percent of initial levels in units drawn into CPDA-2. Following 35 days of storage, units of red cells prepared from whole blood drawn into CPDA-1 and CPDA-2 had comparable plasma cation and ammonia levels and similar amounts of cell-free hemoglobin. These data indicate that red cells can be stored satisfactorily for 35 days when prepared from whole blood held at 20 to 24 degrees C for 8 hours.

Mutation tests in Neurospora crassa. A report of the U.S. Environmental Protection Agency Gene-Tox Program.

Many mutation tests have been developed in Neurospora crassa during the almost 40 years of its use in mutation research. These tests detect two major classes of mutation: gene mutation and meiotic nondisjunction. Within the first class, forward- and reverse-mutation tests have been used. The forward-mutation tests include those that detect mutations at many loci and at specific loci. Both kinds of forward-mutation tests have been done in homokaryons (n) and heterokaryons (n + n'). From the publications that were not rejected by our pre-established criteria, data were extracted for 166 chemicals that had been tested for mutagenicity. Only 6 of the 166 chemicals have been tested in one or more gene mutation test and the meiotic nondisjunction test; these 6 chemicals were positive in the first and negative in the second. Of the 102 chemicals tested in one or more gene mutation tests, 94 were positive and 8 were negative. Of the 70 chemicals tested in the meiotic nondisjunction test, 7 were positive and 63 were negative. Two tests, the ad-3 forward-mutation test and the meiotic nondisjunction test, have been used most frequently. These two tests are especially important for hazard evaluation, because each detects a class of mutations that is likely to be deleterious or lethal in the F1 - disomics by the meiotic nondisjunction test and multilocus deletions by the ad-3 forward-mutation test in heterokaryons. Generally, direct-acting chemicals are mutagenic in the gene mutation tests, but few chemicals that required metabolic activation have been tested. Only 31 of the 166 chemicals tested in N. crassa have been tested for carcinogenicity. Among these chemicals, there is a good association between mutagenicity in gene mutation tests and carcinogenicity but a poorer association between meiotic nondisjunction and carcinogenicity; however, only a small number of chemicals has been tested in the meiotic nondisjunction test. Further use and development of certain mutation tests in N. crassa are desirable.

Four crossmatch methods to select platelet donors.

We employed four crossmatch techniques to select platelet donors for refractory patients. Forty-four donor-recipient pairs were studied in 32 patients. Analysis of effectiveness of platelet transfusions revealed that only 18 percent of transfusions gave a borderline response; the remainder were either effective or not effective at all. The corrected predictive values of three crossmatch tests were as follows: enzyme-linked immuno-specific assay, 81 percent; platelet immunofluorescence test, 73 percent; and lymphocytotoxicity, 70 percent (p greater than 0.05). The predictive value of these tests did not differ in HLA-matched versus unmatched platelet transfusions. Donor selection by lymphocytotoxicity compatibility did not appear to be useful if donors were selected by either of the other two methods. The fourth test, antiglobulin-modified lymphocytotoxicity, offered no advantage over lymphocytotoxicity. Our data suggest that platelet crossmatching assays are a useful adjunct to the selection process for the platelet donor in addition to ABO, Rh, and HLA matching.

Isolation and characterization of resident macrophages from guinea pig and human intestine.

The evaluation of mucosal cellular immune function in the gastrointestinal tract has focused on properties of lymphocytes. We describe methods for use in guinea pig and human tissue that will now permit the maintenance and in vitro study of intestinal macrophages. This study characterizes the resident gastrointestinal macrophage population in the two species and shows that morphologic and ultra-structural characteristics are similar to macrophages from other tissues. Histochemically, the cells are esterase positive and peroxidase negative. They possess surface receptors for immunoglobulin G and complement, and are phagocytic via the Fc receptor.

Intestinal malakoplakia in childhood: case report and review of literature.

We report the clinical and pathologic features of primary intestinal malakoplakia in a 14-year-old boy. The transmural involvement of small bowel, chronicity of the disease, and development of fistulas simulated chronic inflammatory bowel disease, specifically Crohn's disease. The diagnosis of malakoplakia was only possible by tissue biopsy. The clinical and pathologic differential diagnosis is briefly reviewed.