Textile Aging Characterization on New Generations of Explanted Commercial Endoprostheses: A Preliminary Study.

OBJECTIVE/BACKGROUND: The goal of the present study was to assess the aging phenomena on second-generation textile endoprostheses (EPs) through explant analysis and to establish a preliminary classification of observed defects and material damages. METHODS: From January 2011 to June 2016 110 second- and recent-generation EPs were collected as a part of a European collaborative retrieval program. The analysis focused on the first 41 consecutive commercial EPs collected between 2011 and 2014 and made from polyethylene terephthalate. Explants were submitted to a standardized evaluation protocol, which included data recording, eye-naked evaluation, cleaning of organic remnants, and structural analysis under numerical optical microscopy. Observations were reported using a classification based on 15 features evaluating the fabric, the stitches between the fabric and the stents, and the stents. The total surface area of the holes within the fabric was measured. RESULTS: EPs were implanted for thoracic and abdominal procedures in 12 and 29 cases, respectively. The mean ± SD duration of implantation was 34 ± 26 months (range 2 days-8 years). Sixty-four percent of the samples demonstrated at least one defect caused by compression damage potentially related to the insertion of the EP within the delivery system, which promoted holes and tears. Ninety-five percent of all EPs demonstrated at least one type of abrasion on the stitches. The degradation of the stitches and the number of ruptures increased with duration of implantation. Stent degradation was rare and consisted of corrosion and rupture. Cumulated holed surface area increased with time and was measured up to 13.5 mm2. CONCLUSION: Various aging-related phenomena on commercial textile EPs were identified and classified. Main damaging mechanisms were related to compression and abrasion leading to tears and holes in the fabric and rupture of stitches.

Cytosolic phospholipase A2-alpha associates with plasma membrane, endoplasmic reticulum and nuclear membrane in glomerular epithelial cells.

Eicosanoids mediate complement-dependent glomerular epithelial injury in experimental membranous nephropathy. The release of arachidonic acid from phospholipids by cytosolic phospholipase A(2) (cPLA(2)) is the rate-limiting step in eicosanoid synthesis. The present study examines the association of cPLA(2) with membranes of organelles. Glomerular epithelial cells were disrupted by homogenization in Ca(2+)-free buffer; organelles were separated by gradient centrifugation. The distribution of cPLA(2) and organelles was analysed by immunoblotting with antibodies against cPLA(2) and organelle markers, or by enzyme assay. In cells incubated with or without the Ca(2+) ionophore ionomycin plus PMA, cPLA(2) co-localized with plasma membrane, endoplasmic reticulum and nuclei, but not with mitochondria or Golgi. A greater amount of cPLA(2) was associated with membranes in stimulated cells, but membrane-associated cPLA(2) was readily detectable under resting conditions. The pattern of association of cPLA(2) with membrane in cells treated with antibody and complement was similar to that in cells stimulated with ionomycin plus PMA; however, complement did not enhance the membrane association of cPLA(2) protein. To determine the functional role of membrane association of cPLA(2), phospholipids were labelled with [(3)H]arachidonic acid. Cells were then incubated with or without antibody and complement and were fractionated. Complement induced a loss of radioactivity from the plasma membrane, endoplasmic reticulum and nuclei, but not from the mitochondrial fraction. Thus the release of arachidonic acid by cPLA(2) is due to the hydrolysis of phospholipids at multiple subcellular membrane sites, including the endoplasmic reticulum, plasma membrane and nucleus.

The first syntheses of the 1-oxo-2-oxa-5-azaspiro[3.4]octane ring system found in oxazolomycin.

[reaction: see text] L-Proline was utilized to prepare an optically active 1-oxo-2-oxa-5-azaspiro[3.4]octane for the first time. The synthesis of the racemic system, using a tandem aldol-lactonization reaction, is also described. Ruthenium tetroxide oxidation of these compounds afforded the corresponding spiro beta-lactone gamma-lactams.

Complement-induced phospholipase A2 activation in experimental membranous nephropathy.

BACKGROUND: In the passive Heymann nephritis (PHN) model of membranous nephropathy, C5b-9 induces glomerular epithelial cell (GEC) injury and proteinuria, which is partially mediated by eicosanoids. By analogy, in cultured rat GEC, sublytic C5b-9 injures plasma membranes and releases arachidonic acid (AA) and eicosanoids, due to activation of phospholipase A2 (PLA2). This study addresses the mechanisms of PLA2 activation. METHODS: PLA2 expression was assessed with the polymerase chain reaction or immunoblotting, and activity was determined using an in vitro assay or by measurement of free AA. RESULTS: Under basal conditions, GEC in culture expressed a relatively low level of cytosolic PLA2 (cPLA2) protein, while mRNAs of groups IB, IIA and V secretory PLA2s (sPLA2) were not detectable. Incubation of GEC with sublytic C5b-9 induced 1.5- to 2.0-fold increases in free [3H]AA at 40 minutes, and three and 24 hours. C5b-9 did not increase cPLA2 protein, and did not induce group IB, IIA or V sPLA2 mRNAs. Stable overexpression of cPLA2 in GEC amplified the C5b-9-induced increases in free [3H]AA, while analogous overexpression of group IIA sPLA2 had no effect. PLA2 activity was increased in glomeruli of rats with PHN, and this enhanced activity was characterized as cPLA2. There were no differences in cPLA2 protein expression between PHN and control glomeruli. CONCLUSIONS: Release of AA by C5b-9 in GEC in culture and in vivo is mediated by cPLA2, and the mechanism is consistent with post-translational regulation of cPLA2 activity. C5b-9 does not induce expression or stimulate activity of sPLA2 isoforms in GEC.

Cyclooxygenases-1 and 2 couple to cytosolic but not group IIA phospholipase A2 in COS-1 cells.

Phospholipases A2 (PLA2) and cyclooxygenases (COX) are important enzymes responsible for production of potent lipid mediators, including prostaglandins (PG) and thromboxane A2. We investigated coupling between PLA2 and COX isoforms by using transient transfection in COS-1 cells. Untransfected cells, incubated with or without phorbol ester + the Ca2+ ionophore ionomycin, generated trivial amounts of PGE2. In cells co-transfected with cytosolic PLA2 (cPLA2) and COX-1 or COX-2, phorbol ester + ionomycin markedly stimulated PGE2 production. There was no preferential coupling of cPLA2 to either of the COX isoforms. In contrast, group IIA secretory PLA2 (sPLA2) co-transfected with COX-1 or COX-2 did not lead to an increase in PGE2 production, despite high levels of sPLA2 enzymatic activity. Transfection of cPLA2 did not affect basal free arachidonic acid (AA) levels. Phorbol ester + ionomycin stimulated release of AA in cPLA2-transfected COS-1 cells, but not in untransfected cells, whereas sPLA2 transfection (without stimulation) led to high basal free AA. Thus, AA released by cPLA2 is accessible to both COX isoforms for metabolism to PG, whereas AA released by sPLA2 is not metabolized by COX.

Complement C5b-9 induces receptor tyrosine kinase transactivation in glomerular epithelial cells.

In the passive Heymann nephritis (PHN) model of membranous nephropathy, C5b-9 induces glomerular epithelial cell (GEC) injury and proteinuria, which is partially mediated via production of eicosanoids. Using rat GEC in culture, we demonstrated that sublytic C5b-9 induced tyrosine phosphorylation of the epidermal growth factor receptor (EGF-R), Neu, fibroblast growth factor receptor-2, and hepatocyte growth factor receptor. In addition, C5b-9 stimulated increases in tyrosine(204) phosphorylation of extracellular signal-regulated kinase-2 (ERK2), as well as free [(3)H]arachidonic acid (AA) and prostaglandin E(2) (PGE(2)). Phosphorylated EGF-R bound the adaptor protein, Grb2, and the EGF-R-selective tyrphostin, AG1478, blocked the C5b-9-induced ERK2 phosphorylation, [(3)H]AA release, and PGE(2) production by 45 to 65%, supporting a functional role for EGF-R kinase in mediating the activation of these pathways. Glomeruli isolated from rats with PHN demonstrated increases in ERK2 tyrosine(204) phosphorylation and PGE(2) production, as compared with glomeruli from control rats, and these increases were partially inhibited with AG1478. Thus, C5b-9 induces transactivation of receptor tyrosine kinases, in association with ERK2 activation, AA release, and PGE(2) production in cultured GEC and glomerulonephritis in vivo. Transactivated tyrosine kinases may serve as scaffolds for assembly and/or activation of proteins, which then lead to activation of the ERK2 cascade and AA metabolism.

Role of extracellular matrix and Ras in regulation of glomerular epithelial cell proliferation.

Signals from extracellular matrix (ECM) to growth factor receptors regulate glomerular epithelial cell (GEC) proliferation. Epidermal growth factor (EGF), basic fibroblast growth factor, hepatocyte growth factor (HGF), or thrombin stimulated proliferation of GECs when the cells were adherent to collagen matrices, but not plastic substratum. Furthermore, EGF, HGF, or thrombin activated p42 mitogen-activated protein (MAP) kinase in collagen-adherent GECs, whereas activation was weak in GECs on plastic. To further examine the interaction of ECM with the Ras-MAP kinase cascade, GECs were stably transfected with a constitutively active Ras mutant (V12Ras). Low or moderate levels of V12Ras expression did not affect basal MAP kinase activity but, unlike parental GECs, in clones that express V12Ras, EGF was able to induce proliferation and activate MAP kinase when these cells were adherent to plastic. In parental and V12Ras-transfected GECs, MAP kinase activation was inhibited by cytochalasin D. Thus, adhesion of GECs to ECM facilitates proliferation and MAP kinase activation by mitogens acting via tyrosine kinase or non-tyrosine kinase receptors. Activation of pathway(s) downstream of V12Ras supplants signals from ECM that enable proliferation. These signals may involve the actin cytoskeleton.

Complement activates phospholipases and protein kinases in glomerular epithelial cells.

BACKGROUND: In rat membranous nephropathy, complement C5b-9 induces glomerular epithelial cell (GEC) injury and proteinuria, which in some models is partially mediated by eicosanoids. In cultured rat GEC, sublytic C5b-9 injures plasma membranes and releases arachidonic acid (AA) and eicosanoids, due to activation of cytosolic phospholipase A2 (cPLA2). In this study, we address the role of protein kinases in cPLA2 activation. METHODS: GEC were stably transfected with cDNAs of wild-type (wt) cPLA2, and serine505-->alanine mutant (cPLA2-SA505), which lacks the mitogen-activated protein kinase (MAPK) phosphorylation site. RESULTS: Complement stimulated protein kinase C (PKC) activity in GEC, and activated p42 (but not p38) MAPK. Overexpression of either cPLA2-wt or cPLA2-SA505 markedly amplified the release of [3H]AA by C5b-9. Depletion of PKC blocked the complement-dependent activation of cPLA2-wt or cPLA2-SA505, but inhibition of the p42 MAPK pathway had no effect. Epidermal growth factor was a strong activator of p42 MAPK, but stimulated PKC activity weakly. Unlike complement, activation of cPLA2-wt by epidermal growth factor was dependent on PKC, and was augmented significantly by p42 MAPK. Stable overexpression of phospholipase C-gamma 1 in GEC amplified C5b-9-induced production of [3H]inositol phosphates and [3H]diacylglycerol, an endogenous activator of PKC, and complement stimulated tyrosine phosphorylation of phospholipase C-gamma 1. CONCLUSIONS: C5b-9 induces activation of cPLA2 that is dependent on the diacylglycerol-PKC pathway. The role of p42 MAPK in cPLA2 activation becomes redundant in the presence of relatively potent PKC activation.

Activation of phospholipase A2 by complement C5b-9 in glomerular epithelial cells.

In rat membranous nephropathy, C5b-9 induces glomerular epithelial cell (GEC) injury and proteinuria, which is partially mediated by eicosanoids. In cultured rat GEC, sublytic C5b-9 injures plasma membranes and releases arachidonic acid (AA) and eicosanoids, due to activation of phospholipase A2 (PLA2). To address mechanisms of PLA2 activation, GEC were stably transfected with cDNAs of wild-type cytosolic PLA2 (cPLA2-wt), or group II secretory PLA2, producing overexpression of PLA2 activity. Sublytic C5b-9 markedly increased free [3H]AA in cPLA2-wt-transfected GEC, but only trivial increases were evident in secretory PLA2-transfected, or neo (control) GEC. In cPLA2-wt-transfected GEC, reduction of extracellular free Ca2+ or down-regulation of protein kinase C inhibited [3H]AA release. To further address the regulation of cPLA2, we stably expressed a mutant cPLA2 in which the Ca2+-dependent lipid binding domain was deleted (deltaCaLB). In GEC that express cPLA2-deltaCaLB, the C5b-9-induced increase in free [3H]AA was comparable with neo, despite expression of cPLA2-deltaCaLB at levels similar to cPLA2-wt. We then stably expressed another cPLA2 mutant (cPLA2-srcmyr) in which the CaLB domain was replaced by the N-terminal myristoylation domain of c-Src. cPLA2-srcmyr is permanently membrane associated. At low extracellular free Ca2+, C5b-9 increased free [3H]AA significantly in GEC that express cPLA2-srcmyr, while in neo GEC, the change was negligible. Thus, C5b-9 activates the cPLA2 isoform. Activation is dependent on the CaLB domain, and is mediated by phosphorylation, Ca2+ influx, and membrane association.

Receptor protein tyrosine kinases in perinatal developing rat kidney.

We have identified receptor protein tyrosine kinases (PTKs) that are expressed and/or activated during kidney development. mRNA from fetal rat kidneys in late gestation (embryonic day 21), was used to prepare a cDNA template for polymerase chain reaction amplification with primers based on conserved regions of PTKs, and products were subcloned and sequenced. Among 346 clones, we identified epidermal growth factor receptor (EGF-R), Tie-2, platelet-derived growth factor receptor (PDGF-R)-alpha, PDGF-R beta, Flk-1, Flt-4, fibroblast growth factor receptor (FGF-R)-1, FGF-R3, FGF-R4, Met, and RYK/Nbtk-1. PTK expression was studied by immunoprecipitation and immunoblotting of kidney membrane proteins with specific antibodies. EGF-R, PDGF-R alpha, FGF-R1, FGF-R3, Met, and in some cases Tie-2 protein expression was greater in fetal kidneys, as compared with kidneys from 12-week-old adult rats (controls). Flk-1, PDGF-R beta, and FGF-R4 proteins were expressed comparably, however, Flt-4 was not detected. As a reflection of receptor PTK activity, we assessed endogenous tyrosine phosphorylation, and in vitro autophosphorylation. EGF-R and PDGF-R alpha displayed activity in fetal, but not adult kidneys. FGF-R3 and Flk-1 were active in some fetal kidneys, and the other PTKs were not active. Thus, in late gestational rat kidney, there are distinct patterns of receptor PTK expression and activity. EGF-R, PDGF-R alpha, FGF-R3 and Flk-1 are among the PTKs that are activated, and they may mediate perinatal development of renal epithelial, interstitial, or vascular structures.

Prevalence and characteristics of chronic sensory problems in burn patients.

Problems of pain and paresthesia in the healed wounds of burn patients are an understudied and poorly documented phenomenon. This descriptive study was designed to examine the prevalence and characteristics of these chronic sensory problems 1 year or more postburn. Four hundred and thirty patients were sent questionnaires which assessed the frequency and intensity of the problems, influencing factors and impact on patients' lives. These problems were assessed by rating scales (visual analogue and categorical scales) and the McGill Pain Questionnaire (MPQ). The response rate was 67%. Over one-third of the participants (36.4%) complained of pain while the prevalence of paresthetic sensations was 71.2%. More than half of the symptomatic patients experienced sensory problems every week sufficient to interfere with daily living. No relationships were found between these sensory problems and the patients' age or sex, burn etiology, or length of time elapsed since injury. Burn severity was related to the frequency of the problems. Discussion emphasizes the need for adequate treatment of these problems and suggests further research issues.

Extracellular matrix stimulates production and breakdown of inositol phospholipids.

Adhesion of rat glomerular epithelial cells (GEC) to collagen stimulates production of D-myo-inositol 1,4,5-trisphosphate (IP3) and 1,2-diacylglycerol. This process is mediated via beta 1-integrins, and it modulates GEC proliferation. In this study, we address the changes in inositol-lipid turnover induced by GEC adhesion to extracellular matrix (ECM). The masses of both phosphatidylinositol 4,5-bisphosphate (PIP2) and IP3, as well as [3H]inositol phosphates, were increased in GEC adherent to collagen, compared with plastic substratum. Phosphatidylinositol-4-phosphate (PIP) 5-kinase activity was predominantly membrane associated and was enhanced in GEC on collagen. Phospholipase C (PLC) activity and PLC-gamma 1 protein were increased in membrane fractions of GEC adherent to collagen, compared with plastic. Stable overexpression of PLC-gamma 1 in GEC amplified the effect of ECM on the production of [3H]inositol phosphates. In addition, the PLC-gamma 1 that was membrane associated in collagen-adherent GEC was tyrosine phosphorylated. Thus production of IP3 in GEC adherent to ECM is associated with increased production of PIP2. Moreover, adhesion to ECM increases tyrosine phosphorylation and membrane association of PLC-gamma 1, which may facilitate PIP2 hydrolysis by increasing the catalytic activity of PLC-gamma 1 and the proximity of PLC-gamma 1 and its substrate. Understanding the process of ECM-induced inositol lipid production and breakdown in GEC may provide insights into the regulation of GEC proliferation and differentiated functions in normal conditions and during glomerular injury.

Complement C5b-9 activates cytosolic phospholipase A2 in glomerular epithelial cells.

In rat membranous nephropathy, complement C5b-9 induces glomerular epithelial cell (GEC) injury and proteinuria, which, in some models, is partially mediated by eicosanoids. By analogy, sublytic C5b-9 injures plasma membranes and releases arachidonic acid (AA) and eicosanoids in cultured rat GEC. In this study, we demonstrate that, in GEC, sublytic C5b-9 stably increased the activity of a high-molecular-mass cytosolic phospholipase A2 (PLA2), which we identified as "cPLA2." This increase was abolished with inhibitors of protein kinase C. C5b-9 did not affect low-molecular-mass membrane-associated or secretory PLA2 activities. In GEC that stably overexpress cPLA2 activity and protein (produced by transfection of cPLA2 cDNA), immunoblot analysis showed that sublytic C5b-9 induced a decreased mobility of cPLA2, consistent with cPLA2 phosphorylation. Incubation of cPLA2-transfected GEC with sublytic C5b-9 significantly increased production of free AA and prostaglandin E2, whereas, in control GEC, the C5b-9-induced changes in free AA and prostaglandin E2 were small. Furthermore, both C5b-9-dependent sublytic cytotoxicity and cytolysis were enhanced in GEC overexpressing cPLA2, compared with control cells. Thus C5b-9 increased cPLA2 activity, probably via phosphorylation involving a protein kinase C-dependent pathway. Phospholipid hydrolysis by cPLA2 resulted in release of substrate for eicosanoid synthesis and in enhancement of C5b-9-dependent GEC injury. Both processes may facilitate glomerular damage in membranous nephropathy.

Surgical adjuvant therapy for rectal cancer: present options.

Recent advances have been made with the publication of the results of GITSG and NCCTG trials, which demonstrated the significant improvement of survival by combined postoperative radiochemotherapy protocols for Stage II and III rectal cancer. These data show that systemic chemotherapy has a decisive role to play in this policy. Some of the advantages of preoperative irradiation compared with postoperative radiation therapy consist of the improvement of resectability of T4 tumors and the anal preservation for low-lying cancers. These data suggest that preoperative chemoradiotherapy should be applied not only to T4 tumors but also to all T3 tumors even when the transrectal extension is limited. The most usual protocol combines 5-fluorouracil (300-350 mg/m2/day) and leucovorin (20 mg/m2/day) for 5 days, followed by radiation therapy (30-35 Gy in 10 fractions within 12-15 days), with surgery taking place 4 to 8 weeks later, after the tumor has been restaged. Systemic therapy is continued for four more months. T2 cancers should not be excluded from the benefit of preoperative irradiation.

Factors involved in burn mortality: a multivariate statistical approach based on discriminant analysis.

This article suggests an alternative statistical model for studying the mortality of burned patients: discriminant analysis. This model was applied to our population of 532 patients among whom 71 died. It is not the first time that this model has been applied to assess burn mortality, although it is not frequently used for that application. We found four factors that are statistically significant: age, TBSA, inhalation injury and sex (female). Discriminant analysis allowed us to demonstrate an impressive correlation between death, age and TBSA; inhalation injury by itself and sex, the two other significant factors in our study, seem to have a minor influence on the final outcome of the burned patients and their predictive value is virtually nil. The advantages of this statistical model are compared with logistic regression, the commonly chosen statistical method.

Endocavitary irradiation in the conservative treatment of adenocarcinoma of the low rectum.

Early T1 and small T2 low rectal cancers may be controlled by endocavitary irradiation using the 50 kV Philips machine. The ambulatory treatment performed in the out-patient department consists of 4 applications within 6 weeks. Iridium-192 implant performed under local anesthesia is useful in many cases to give a booster dose to the tumor bed. In a series of 312 patients followed for greater than 5 years, the rates of local and nodal failure were 4.5% and 3.8%, respectively. The rate of death from cancer was 7.7%. After local excision endocavitary irradiation may be used as adjuvant therapy but it is safer to combine external beam and endocavitary irradiation. In the particular case of very poor risk patients with T2 or T3 tumors of the lower third of the rectum, a short course of external beam irradiation (30 Gy within 12 days) followed 2 months later by endocavitary irradiation may be a reliable procedure to prevent permanent colostomy in cases selected according to the patient's condition and the features of the residual disease. Of 67 patients followed for greater than 5 years, 3 patients died of distant metastasis and 5 patients died of local failures. These data, based on close collaboration with surgeons, suggest a reappraisal of the role of radiation therapy in the conservative management of rectal cancer.

Role of pre-operative irradiation for anal preservation in cancer of the low rectum.

Since 1979, 157 patients with T2, T3, or T4 cancer of the lower rectum have been treated by a short course of irradiation, 30 Gy within 12 days by cobalt 60 using 120 degrees arc rotation on a sacral field, followed by a 2-month rest before surgery. The operative specimens were tumor-free in 13% of patients, Dukes' A in 40% of patients, Dukes' B in 22% of patients, and Dukes' C in 25% of patients. Three (1.9%) patients died postoperatively. At 3 years (107 patients) and 5 years (74 patients) the rates of death of local failure were 7.5% and 9.5%, respectively. The 3-year and 5-year disease-free survival were 71% and 58%. Since 1983, the surgeons took advantage of the tumor regression to carry out sphincter-saving operation in 67 patients with T2, T3, and T4 tumors of the lower third of the rectum. The proportion of patients treated by restorative surgery instead of abdominoperineal resection has grown significantly during the past 4 years, from 22% to 71%. Diverting colostomy was performed in 10 patients. Anastomotic leakages were observed in 7 patients. Of 31 patients who underwent low anterior resection and were followed 3 to 7 years (mean 4.5 years), 5 patients died of distant metastasis and 3 patients are alive after segmental hepatectomy. One patient had local recurrence which was controlled by abdominoperineal resection. The rate of 3-year disease-free survival was 77%.(ABSTRACT TRUNCATED AT 250 WORDS)

Respective roles of radiotherapy and surgery in the management of epidermoid carcinoma of the anal margin. Series of 57 patients.

The study of 54 patients treated curatively by irradiation with or without surgery is reported. The crude and cancer-specific five-year survival rates are 59.2 percent and 79.7 percent. Three patients were treated palliatively. The great variation in histologic type, clinical appearance, disease stage, and patient status justifies the definition of a treatment strategy using radiotherapy, surgery, or a combination of the two methods. T1 and T2 squamous- or basal-cell carcinomas are suitable for local excision followed by irradiation or for irradiation alone. T3 tumors and Bowen's disease should be treated by irradiation first. Verrucous carcinoma is suitable for local surgery followed by irradiation. Mucoepidermoid carcinoma and T4 tumors are suitable for preoperative irradiation and delayed surgery. The optimal radiation technique consists of delivering a dose of 40 Gy in 17 days by cobalt-60 with bolus and in combination with concomitant chemotherapy (5-fluorouracil and mitomycin C). Prophylactic irradiation of the inguinal area is recommended in all NO tumors except for T1 lesions and basal-cell carcinomas.