The top 100 most cited manuscripts in bladder cancer: A bibliometric analysis (review article).

BACKGROUND: Bladder cancer is one of the top 10 frequently occurring neoplasms worldwide and is responsible for over 150,000 deaths per annum. Bibliometric analysis helps further our knowledge of bladder cancer research, topics and trends. It is useful to identify the most influential articles and its impact pertinent to this field that has helped mould our understanding and management of bladder cancer. MATERIALS AND METHODS: Search terms related to bladder cancer were compiled and used to interrogate the Thompson Reuters Web of Science indexing database. The 100 most cited manuscripts in the English language were identified and further evaluated by theme, manuscript type, journal, year of publication, author and institution. RESULTS: The Web of Science search returned a total of 47,381 manuscripts. The median number of citations among the top 100 was 515, ranging from 2257 to 352. The greatest number of manuscripts in the top 100 were published in the Journal of Urology (n = 15), followed by the Journal of Clinical Oncology (n = 14) and European Urology (n = 13). The most cited paper (Stein et al. Journal of Clinical Oncology 2001, 2257 citations) reported on the long term outcomes from a large cohort of patients that underwent radical cystectomy and bilateral pelvic lymphadenectomy for transitional cell carcinoma. The most prevalent theme was the pathobiology of bladder cancer (n = 37) followed by oncological treatment (n = 17). The majority of manuscripts were of original research (n = 79) mainly based on basic science study design and published from institutions in the USA. CONCLUSION: The pathobiology and oncological treatment of bladder cancer were the areas with most citations within the top 100. This bibliometric analysis has identified influential articles in the field on bladder cancer, which provides a useful guide to authors as to what type of article constitutes a highly citable publication in this subject.

Bifunctional DNA alkylator 1,3-bis(2-chloroethyl)-1-nitrosourea activates the ATR-Chk1 pathway independently of the mismatch repair pathway.

The presence of DNA damage initiates signaling through the ataxia-telangiectasia mutated kinase (ATM) and the ATM- and the Rad3-related kinase (ATR), which phosphorylate, thus activating, the checkpoint kinases (Chk) 1 and 2, which leads to cell cycle arrest. The bifunctional DNA alkylator 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) is cytotoxic primarily by inducing DNA monoadducts and ultimately, interstrand cross-links, which block DNA replication. In this study, we investigated the activation of the ATR-Chk1 pathway in response to BCNU treatment and the dependence of this response on the DNA mismatch repair (MMR) capacity. Medulloblastoma cells were exposed to low and moderate doses of BCNU, and the effects on this DNA damage signaling pathway were examined. In response to BCNU, Chk1 was found to be phosphorylated at serine 345 and exhibited increased kinase activity. Caffeine and wortmannin, which are broad-spectrum inhibitors of ATM and ATR, reduced this phosphorylation. Cell cycle analysis further revealed an accumulation of cells in the S phase in response to BCNU, an effect that was attenuated by caffeine. Small interfering RNA knockdown of ATR also reduced Chk1 phosphorylation after exposure to BCNU. However, knockdown of ATM had no effect on the observed Chk1 phosphorylation, suggesting that ATR was primarily responsible for Chk1 activation. Analysis of Chk1 activation in cells deficient in MMR proteins MutLalpha or MutSalpha indicated that the DNA damage response induced by BCNU was independent of the MMR apparatus. This MMR-independent activation seems to be the result of DNA interstrand cross-link formation.

The gene expression profiles of medulloblastoma cell lines resistant to preactivated cyclophosphamide.

The total expression profiles of two medulloblastoma cell lines resistant to the preactivated form of cyclophosphamide (4-hydroperoxycyclophosphamide, 4-HC) were examined using the Affymetrix GeneChip U133A array. Our primary objective was to look for possible genes, other than the well-studied aldehyde dehydrogenases (ALDH) that may be involved in cyclophosphamide (CP) resistance in medulloblastomas. We present here the lists of the most highly upregulated [30 for D341 MED (4-HCR); 20 for D283 MED (4-HCR)] and downregulated [19 for D341 MED (4-HCR); 15 for D283 MED (4-HCR)] genes which may be involved in conferring CP-resistance to the two medullobalstoma cell lines. The lists of genes from the two sublines almost had no overlap, suggesting different mechanisms of CP-resistance. One of the most noteworthy upregulated gene is TAP1 [90-fold increase in D341 MED (4-HCR) relative to D341 MED]. TAP1, a protein belonging to the ABC transporter family is normally involved in major histocompatibility class I (MHC I) antigen processing. This suggests the possible role of multidrug resistance (MDR), albeit atypical (which means it does not involve the usual MDR1 and MRP glycoproteins), in medulloblastoma's CP-resistance. Apart from TAP1, a number of other genes involved in MHC1 processing were upregulated in D341 MED (4HCR). D341 MED (4-HCR) also had a 20-fold increase in the expression of the aldo-keto reductase gene, AKR1B10, which may deactivate the reactive cyclophosphamide metabolite, aldophosphamide. For D283 MED (4-HCR), the most notable increase in expression is that of ALDH1B1, a member of the aldehyde dehydrogenase (ALDH) family of proteins.

An inguinal hernia that was not meant to be: a female with seminoma.

Complete androgen insensitivity is a rare X-linked disorder characterised by a female phenotype in a chromosomally male individual. It usually presents at puberty with primary amenorrhoea or as an inguinal mass in a female infant. Treatment includes bilateral orchidectomy and hormone replacement therapy. We present the case of a 31-year-old female with complete androgen insensitivity and a presumed inguinal hernia. We discuss the importance of early diagnosis, emphasise the consequences of misdiagnosis, and raise the question of whether such patients have been appropriately managed in the past.

Immunoassay for urothelial cancers that detects DNA replication protein Mcm5 in urine.

Cancer-screening tests for internal organs are severely constrained by low specificity or sensitivity, cost, and morbidity. We report a non-invasive immunofluorometric assay for detection of urothelial cancers based on ectopic expression of the DNA replication protein Mcm5.

Multiple DNA repair mechanisms and alkylator resistance in the human medulloblastoma cell line D-283 Med (4-HCR).

PURPOSE: We have previously reported preferential repair of DNA interstrand crosslinks in the 4-hydroperoxycyclophosphamide-resistant human medulloblastoma cell line D-283 Med (4-HCR). We now report further studies that explored the potential mechanisms underlying this repair. METHODS: Limiting dilution assays and Western, Southern, and Northern blots were used to compare specific differences between D-283 Med (4-HCR) and its parental line D-283 Med. RESULTS: D-283 Med (4-HCR) was cross-resistant to melphalan and 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU), with O6-alkylguanine-DNA alkyltransferase (AGT) levels of 466+/-164 fmol/mg protein; AGT levels in the parental line, D-283 Med, were 76+/-96 fmol/mg. The increase in AGT activity was not a result of gene amplification. Depleting AGT with O6-benzylguanine partially restored sensitivity to BCNU. Both cell lines were deficient in the human mismatch protein MutLalpha. ERCC4 mRNA and poly(ADP-ribose) polymerase levels were similar in both cell lines, and ERCC1 mRNA levels were 2- to 2.5-fold lower in D-283 Med (4-HCR). Topoisomerase I levels were 2- to 2.5-fold higher in D-283 Med compared with D-283 Med (4-HCR). CONCLUSION: These results, while illustrating the multiple differences between D-283 Med and D-283 Med (4-HCR), do not explain the enhanced DNA interstrand crosslink repair seen in D-283 Med (4-HCR).

Modulation of cyclophosphamide activity by O6-alkylguanine-DNA alkyltransferase.

PURPOSE: The human medulloblastoma cell line D283 Med (4-HCR), a line resistant to 4-hydroperoxycyclophosphamide (4-HC), displays enhanced repair of DNA interstrand crosslinks induced by phosphoramide mustard. D283 Med (4-HCR) cells are cross-resistant to 1,3-bis(2-chloroethyl)- -nitrosourea, but partial sensitivity is restored after elevated levels of O6-alkylguanine-DNA alkyltransferase (AGT) are depleted by O6-benzylguanine (O6-BG). Studies were conducted to define the activity of 4-HC and 4-hydroperoxydidechlorocyclophosphamide against D283 Med (4-HCR) after AGT is depleted by O6-BG. METHODS: Limiting dilution and xenograft studies were conducted to define the activity of 4-HC and 4-hydroperoxydidechlorocyclophosphamide with or without O6-BG. RESULTS: The activity of 4-HC and 4-hydroperoxydidechlorocyclophosphamide against D283 Med (4-HCR) was increased after AGT depletion by O6-BG preincubation. Similar studies with Chinese hamster ovary cells, with or without stable transfection with a plasmid expressing the human AGT protein, revealed that the AGT-expressing cells were significantly less sensitive to 4-HC and 4-hydroperoxydidechlorocyclophosphamide. Reaction of DNA with 4-HC, phosphoramide mustard, or acrolein revealed that only 4-HC and acrolein caused a decrease in AGT levels. CONCLUSIONS: We propose that a small but potentially significant part of the cellular toxicity of cyclophosphamide in these cells is due to acrolein, and that this toxicity is abrogated by removal of the acrolein adduct from DNA by AGT.

Analysis of DNA mismatch repair proteins in human medulloblastoma.

During replication, the primary function of the eukaryotic DNA mismatch repair (MMR) system is to recognize and correct mismatched base pairs within the DNA helix. Deficiencies in MMR have been reported previously in cases of hereditary nonpolyposis colorectal cancer and sporadic tumors occurring in a variety of tissues including gliomas. Furthermore, recent evidence indicates that the MMR system may be involved in mediating therapeutic sensitivity to alkylating agents. In this study, 22 neoplastic tissue samples from 22 patients who underwent surgical resection for medulloblastoma, a common cerebellar tumor of childhood, were assayed for the presence or absence of MMR polypeptides using Western blot and immunohistochemical techniques. Results from these experiments indicate that the MMR system is not commonly deficient in medulloblastoma.

Repair analysis of 4-hydroperoxycyclophosphamide-induced DNA interstrand crosslinking in the c-myc gene in 4-hydroperoxycyclophosphamide-sensitive and -resistant medulloblastoma cell lines.

Cyclophosphamide is one of the most active agents in the treatment of medulloblastoma. However, development of resistance to this alkylator frequently occurs and is the harbinger of tumor progression and death. In order to understand the biochemical basis of this resistance, we generated a panel of medulloblastoma cell lines in our laboratory that were resistant to 4-hydroperoxycyclophosphamide (4-HC). Previously, we have shown that elevated levels of aldehyde dehydrogenase and glutathione mediate cellular resistance to 4-HC. The present study was conducted to identify the third unknown mechanism mediating the resistance of cell line D283 Med (4-HCR) to 4-HC, testing the hypothesis that this resistance is mediated by an increased repair of DNA interstrand crosslinks (ICLs). The doses of 4-HC that produced a one- and two-log cell kill of D283 Med cells were 25 and 50 microM, respectively, compared with values of 125 and 165 microM in D283 Med (4-HCR), the resistant cell line. The formation and disappearance of 4-HC-induced DNA ICLs at the c-myc gene were subsequently studied by DNA denaturing/renaturing gel electrophoresis and Southern blot analysis. 4-HC-induced DNA ICLs in the c-myc gene exhibited a dose-dependent relationship. The percentage of the c-myc gene that was crosslinked was approximately 1-3% at a dose of 100 microM. More than 50% of the DNA crosslinking in D283 Med (4-HCR) cells was removed by 6 h after drug treatment, whereas, in D283 Med cells, more than 90% of the DNA crosslinking was still present at 6 h. These findings suggest that the increased repair of DNA ICLs in D283 Med (4-HCR) may contribute significantly to its resistance to 4-HC.

The use of the CO2 laser for lingual frenectomy and excisional biopsy.

With the availability of CO2 laser technology, surgical cases that were previously referred out of the general dental practice to specialists can now be treated by the general dentist, with less difficulty than is commonly associated with traditional surgical procedures. This article will demonstrate two cases using the CO2 laser: lingual frenectomy and excisional biopsy.

Sex differences in the effects of testosterone and its metabolites on vasopressin messenger RNA levels in the bed nucleus of the stria terminalis of rats.

Male rats have about two times as many steroid-responsive vasopressin-immunoreactive (AVP-ir) neurons in the bed nucleus of the stria terminalis (BST) as female rats. This sex difference does not depend on differences in circulating hormone levels, since it persists in males and females that are treated with similar levels of testosterone. To analyze the cellular basis of this sex difference, we compared the effects of testosterone and its metabolites on AVP mRNA expression in the BST of males and females that were gonadectomized at 3 months of age. When rats received implants of Silastic tubing filled with testosterone, males had more cells that were labeled for AVP mRNA and more labeling per cell than females. When, in a second experiment, rats received implants of either empty tubing, or tubing with dihydrotestosterone (DHT), estradiol (E), or E plus DHT, hardly any labeled cells were found in rats with empty implants. E treatment significantly stimulated AVP mRNA expression in both sexes, but significantly more so in males, which had more cells that were labeled for AVP mRNA and more labeling per cell than females. DHT treatment by itself did not stimulate AVP mRNA expression, but when given in combination with E, it significantly increased the number of cells over that of animals treated with E alone. This increase was seen in males only. However, in both sexes, it increased the labeling per cell over that of animals treated with E only, but more so in males than in females.(ABSTRACT TRUNCATED AT 250 WORDS)

Sexual differentiation of vasopressin projections of the bed nucleus of the stria terminals and medial amygdaloid nucleus in rats.

The vasopressin-immunoreactive (AVP-ir) projections of the bed nucleus of the stria terminalis (BST) and medial amygdaloid nucleus (MA) are much denser in males than in females even if males and females are treated with similar amounts of testosterone. Previous studies have established that testosterone influences AVP-ir projections during development, but not whether these effects of testosterone were permanent. This study tested the effects of various hormonal manipulations during development on the ability of testosterone to influence the AVP immunostaining in cells of the BST and MA and of fibers in the lateral septum of adult rats. In the first experiment, male rats that were castrated at 3 months of age (control males) had more AVP-ir cells in the BST and a higher density of AVP-ir fibers in the lateral septum than neonatally castrated male rats, whose cell numbers and fiber density did not differ from female rats that were ovariectomized neonatally or at 3 months of age (control females). This suggested that testicular secretions influence sexual differentiation of AVP-ir fiber pathways after birth. The second experiment showed that males castrated at the day of birth or at 1 week after birth had less AVP-ir cells in the BST and MA and a lower AVP-ir fiber density in the lateral septum than male rats castrated at the third week after birth or control males. This indicated that testicular secretions influenced the differentiation of AVP-ir pathways around postnatal day 7. This was further confirmed in the third experiment, in which testosterone propionate treatment at the seventh postnatal day significantly raised AVP-ir fiber density in the lateral septum of neonatally gonadectomized male and female rats and fully restored the number of AVP-ir cells in the BST of neonatally castrated males. Combined, these data suggest that testosterone levels around the seventh postnatal day determine the sexual differentiation of AVP-ir projections to the lateral septum.

Antidromic activation of a peptidergic pathway in the limbic system of the male rat.

Stimulation of the medial amygdaloid nucleus (AME) produces a long-latency and long-lasting inhibition of pyramidal cells in both the dorsal and the ventral hippocampus. The inhibition is blocked by a specific antagonist to vasopressin, which is a candidate neurotransmitter in the system. Antidromic activation of the AME from the hippocampus occurs with a latency suggestive of the conduction velocity of small diameter unmyelinated fibers. Immunocytochemistry for vasopressin reveals small diameter, unmyelinated immunoreactive fibers in the vicinity of the stimulating electrode in the hippocampus, and immunoreactive cell bodies in the vicinity of the recording electrode in the AME.

Cyclophosphamide resistance in medulloblastoma.

Mechanisms of tumor resistance to 4-hydroperoxycyclophosphamide (4-HC) were studied by using a panel of human medulloblastoma cell lines either passaged in the laboratory for resistance to 4-HC or established from tumors showing clinical resistance to cyclophosphamide. Multiple distinct mechanisms of resistance were demonstrated. Daoy (4-HCR), a line that was 6-fold more resistant than Daoy, contained elevated levels of aldehyde dehydrogenase (ALDH). Most of the difference in sensitivity between the Daoy (4-HCR) and Daoy cell lines was abolished when 4-HC was replaced with phenylketocyclophosphamide, a 4-HC analogue that cannot be detoxified by ALDH. Thus, elevated levels of ALDH appear to play a role in the resistance of Daoy (4-HCR). Several of the cell lines [D283 Med (4-HCR), D341 Med (4-HCR), Daoy (4-HCR), D458 Med] contained elevated levels of glutathione (GSH). No changes in glutathione-S-transferase activity or isozyme pattern were observed, but in two of these three lines, the elevation in GSH was accompanied by elevated levels of gamma-glutamyl transpeptidase. To confirm the role of elevated GSH content in 4-HC resistance, the sensitivity of the cell lines to 4-HC was repeated after depletion of GSH by treatment with L-buthionine-S,R-sulfoximine. In medulloblastoma cell lines without other mechanisms of resistance, a linear relationship was seen between GSH content and resistance to 4-HC. Moreover, cells with GSH content greater than 5 nmol/mg protein and no other overriding mechanism of resistance could be sensitized to 4-HC treatment with L-buthionine-S,R-sulfoximine. Finally, D283 Med (4-HCR) cells had mild elevations in both ALDH and GSH content, but were resistant to phenylketocyclophosphamide and were not significantly sensitized by L-buthionine-S,R-sulfoximine. This cell line appears to demonstrate a third mechanism of resistance to 4-HC. These results suggest that 4-HC resistance in medulloblastoma can be multifactorial.

Effects of glutathione or polyamine depletion on in vivo thermosensitization.

Investigations with the melphalan-sensitive and -resistant human rhabdomyosarcoma xenografts TE-671 and TE-671 MR were performed to examine the effect of glutathione and polyamine modulation on thermosensitivity. Regimens of intraperitoneally injected and orally administered buthionine sulfoximine were utilized to achieve glutathione depletion to 8.7% and 13% of control levels in TE-671 and TE-671 MR, respectively. Animals treated with L-buthionine-S,R-sulfoximine and 42 degrees C or 43 degrees C hyperthermia for 70 min showed no detectable growth delays beyond those observed for hyperthermia alone. Hyperthermia at 42 degrees C of disaggregated TE-671 and TE-671 MR xenografts following growth in short-term culture was performed following preincubation with buthionine sulfoximine or 0.9% saline. Buthionine sulfoximine-mediated glutathione depletion produced a significant increase in hyperthermia-induced cytotoxicity only with TE-671 MR at 43 degrees C. Polyamine depletion was achieved with a 7-day orally administered course of MDL 72.175DA [(2R,5R)-6-heptyne,5-diamine dihydrochloride], an irreversible inhibitor of ornithine decarboxylase. Although this treatment caused significant depletion of intracellular putrescine and spermidine levels, spermine levels remained relatively unaffected. No significant growth delays were observed in either xenograft line for animals treated with MDL 72.175DA or MDL 72.175DA plus hyperthermia as compared with untreated controls. These results contrast with previous work performed in vitro showing synergism between glutathione or polyamine depletion and hyperthermia, and indicate that further studies are needed.

Successful laboratory growth and analysis of CUSA-obtained medulloblastoma samples. Technical note.

The development of the Cavitron ultrasonic surgical aspirator (CUSA) has facilitated neurosurgical intervention for removal of central or peripheral nervous system tumors adjacent to or within vital structures. However, laboratory studies defining the phenotypic and genotypic properties of these tumors, both in cell culture and as xenografts in immunoincompetent animals, require viable tumor fragments free of microbial or red blood cell contamination. This report describes the use of a readily available sterile trap with the CUSA which, in conjunction with centrifugation and ammonium chloride lysis of the bloody aspirate, allowed collection of concentrated viable human medulloblastoma tumor cells. These cells were successfully established in cell culture and as transplantable xenografts in athymic mice.