Effect of subcutaneous granulocyte colony-stimulating factor injectate volume on drug efficacy, site complications, and client comfort.

PURPOSE/OBJECTIVES: To determine the effect of administering 1.6 ml (480 mcg) of granulocyte colony-stimulating factor (G-CSF) in one subcutaneous injection or two injections of 0.8 ml each. DESIGN: Experimental. SETTING: 27-bed bone marrow transplant intensive care unit of a metropolitan, university medical center in the southwestern United States. SAMPLE: Nonprobability; 76 women who received high-dose chemotherapy for breast cancer followed by hemopoietic rescue. METHODS: Subjects were randomized into an experimental group that received one injection per 480 mcg dose and a control group that received two injections per 480 mcg dose administered by research associates using a standardized injection technique. MAIN RESEARCH VARIABLES: Injectate volume. The number of days post-transplant until the absolute neutrophil count (ANC) returned to 1,000/mm3, the incidence and surface area in mm2 of site complications, and scores on Tursky's Quantified Pain Descriptor immediately following the injection(s). FINDINGS: No significant difference existed between the two groups in ANC recovery time, frequency or size of site complications, or intensity, reaction, or sensation of discomfort reported. CONCLUSIONS: Administering 1.6 ml doses of G-CSF in one injection instead of two does not result in slower ANC recovery, induration, more frequent or larger bruises or areas of erythema, or greater client discomfort. IMPLICATIONS FOR NURSING PRACTICE: Administering one injection instead of two may decrease patients' anxiety, the nursing time needed for preparation and administration of injections, patient instruction for self-administration, the potential for contamination of vials or loss of dose, and the cost of supplies.

High expression of neutral endopeptidase in idiopathic diffuse hyperplasia of pulmonary neuroendocrine cells.

Idiopathic diffuse hyperplasia of pulmonary neuroendocrine cells (IDHPNC) is a clinicopathological entity characterized by a diffuse hyperplasia of neuroendocrine cells involving distal bronchi and bronchioles. The pathogenesis of this syndrome remains unknown. The hyperplastic neuroendocrine (NE) cells contain multiple neuropeptides, including the bombesinlike peptides (BLP), which are likely important in the pathogenesis of the disorder by stimulating proliferation of fibroblasts in a paracrine fashion and the NE cells themselves in an autocrine manner. Neutral endopeptidase (NEP) is a cell-surface enzyme that hydrolyzes BLP and other bioactive peptides. Low or undetectable NEP is present in many primary lung cancers and cell lines. Low NEP expression could increase neuropeptide-induced autocrine effects by increasing local levels of neuropeptides. We hypothesized that IDHPNC was associated with low or absent NEP expression. NEP expression was assayed in patients with IDHPNC (n = 3) and was compared with expression in patients with idiopathic pulmonary fibrosis (n = 5), hypersensitivity pneumonitis (n = 5), and normal lung (n = 4) using immunohistochemistry, ELISA, activity assay, and Western blot analysis. By these assays, NEP expression was highest in lungs affected by IDHPNC. NEP mRNA, as assessed in IDHPNC lung tissue by RT-PCR, was the expected size and free of mutation between bp 238-2437. Therefore, IDHPNC is unlikely to be the result of a defect in NEP expression. The apparent increase in NEP expression in lung tissue from patients with IDHPNC may reflect a compensatory increase that partly counteracts abundant neuropeptides, including BLP, present in this disorder.

Neutral endopeptidase: variable expression in human lung, inactivation in lung cancer, and modulation of peptide-induced calcium flux.

Neutral endopeptidase (NEP; CALLA, CD10, EC 3.4.24.11) is a cell surface endopeptidase that hydrolyses bioactive peptides, including the bombesin-like peptides, as well as other neuropeptides. Bombesin-like peptides and other neuropeptides are autocrine growth factors for both small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Low expression of NEP has been reported in SCLC and NSCLC cell lines. NEP inhibition has been shown to increase proliferation in one cell line. To date, NEP expression has not been quantitatively evaluated in normal adult lung, SCLC or NSCLC tumors, paired uninvolved lung from the same patient, or in other pulmonary neoplasms such as mesotheliomas and carcinoids. We examined the expression of NEP in these tissues and human cell lines using immunohistochemistry, flow cytometry, enzyme activity, ELISA, Western blot, and reverse transcription (RT)-PCR. Uninvolved lung tissue from different individuals displayed considerable variation in NEP activity and protein. By immunohistochemistry, NEP expression was detectable in alveolar and airway epithelium, fibroblasts of normal lung, and in mesotheliomas, whereas it was undetectable in most SCLC, adenocarcinoma, squamous cell carcinoma, and carcinoid tumors of the lung. NEP activity and protein levels were lower in all SCLC and adenocarcinoma tumors when compared to adjacent uninvolved lung, often at levels consistent with expression derived from contaminating stroma. NEP expression and activity were reduced or undetectable in most SCLC and lung adenocarcinoma cell lines. NEP mRNA by RT-PCR was not expressed or was in low abundance in the majority of lung cancer cell lines. The majority of lung tumors did not express NEP by RT-PCR as compared with normal adjacent lung. In addition, recombinant NEP abolished, whereas an NEP inhibitor potentiated, the calcium flux generated by neuropeptides in some lung cancer cell lines, demonstrating potential physiological significance for low NEP expression. NEP, therefore, is a signal transduction and possibly a growth modulator for both SCLC and NSCLC, emphasizing the role of neuropeptides in the pathogenesis of the major histological forms of lung cancer.

The tri-spade drill for endosseous dental implant installation.

Many aspects of endosseous dental implant practice have been addressed over the past several decades. While most of this attention has centered on the dental implant body itself and, most recently, on various aspects of prosthetic restoration, the installation armamentarium for site preparation and implant placement has been neglected. Drills, in particular, have received minimal attention, with most drills currently used for implant placement being identical, or nearly identical, to century-old wood or metal cutting instruments. The tri-spade drill design represents an innovation that has evolved from analysis of currently used implant drills, drill mechanics, and the mechanical and physical properties of bone, in consideration of the clinical realities of contemporary endosseous implant placement. The tri-spade drill design, which features three cutting edges, is much more stable in the hands of the practicing clinician. It reduces crestal chatter upon entry into the bone site (a stable drilling situation), resulting in a more perfectly prepared final hole for placement of a cylindrical root-form dental implant. The drill tip angle is designed specifically for use with bone; the reaming action associated with the sharpened cutting edges adjacent to the large side flutes also allows for efficient debris removal. The tri-spade drill design represents an incremental increase in the dental implant armamentarium and efficacy for the installation of endosseous cylindrical dental implants.

Use of common morphemes by hearing-impaired children exposed to a system of manual English.

Severely hearing-impaired children (11 boys, 9 girls), whose educational procedures included the use of Seeing Essential English (SEE) were given an experimental task designed to test their use of 8 common inflectional morphemes: plural /s/, possessive /s/, present tense singular /s/, past tense /ed/, present progressive /ing/, adjectival and adverbial /ly/, comparative /er/, and superlative /est/. Each child read 20 sentences composed of primer and first grade level words, and circled 1 of 4 word choices to fill in a missing word in each sentence. All 4 word choices had the same root. Responses were analyzed relative to chronological age, sex, degree of hearing loss, duration of exposure to SEE, reading level, and consistency of teacher usage of SEE. Performance appeared to be most dependent on sex, reading level, and teacher consistency. Although these factors were confounded, results indicate that teacher consistency in usage of SEE may be the major determiner of performance on the task.

Comprehension of inflectional morphemes by deaf children exposed to a visual English sign system.

A test of morpheme-based concepts was administered to 67 deaf children who were exposed to Seeing Essential English (SEE). Results indicated that these children show the following order of acquisition for the inflectional morphemes tested: plural -s, past tense -ed, present progressive -ing, possessive -'s, third person present indicative -s, comparative -er, superlative -est, and present perfect -en. There were no effects of sex, age, or school from which the subjects were selected. The main contribution to the subjects' performances were their lengths of exposure to SEE.