Communication of healthcare professionals: Is there ageism?

Elderspeak is often used when talking to older individuals and is characterised by a slower and/or louder speech, a patronising tone, etc. A part of the reason of such communication can be found in the actual context of negative view of ageing. However, the link between view of ageing and elderspeak has never been objectively studied in oncology. Therefore, 40 healthcare professionals (physicians and medical students) record a podcast where they have to explain an endocrine therapy to two fictional patients (40- vs. 70-year old). Results show that when participants explained the treatment to the older patient, they used shorter utterances and made more repetitions. They also evoked fewer side effects such as sexual issues. Moreover, reduction in length of utterances and of word-per-minute rate was observed for older patient when participants have a positive view of ageing but for both patients when they have a negative view of ageing. In conclusion, physicians and medical students used elderspeak when they explained a treatment to older patients. Participants with a more negative view of ageing also unconsciously talked slower and made shorter utterances to a 40 -year-old patient.

Eµ and 3'RR IgH enhancers show hierarchic unilateral dependence in mature B-cells.

Enhancer and super-enhancers are master regulators of cell fate. While they act at long-distances on adjacent genes, it is unclear whether they also act on one another. The immunoglobulin heavy chain (IgH) locus is unique in carrying two super-enhancers at both ends of the constant gene cluster: the 5'Eµ super-enhancer promotes VDJ recombination during the earliest steps of B-cell ontogeny while the 3' regulatory region (3'RR) is essential for late differentiation. Since they carry functional synergies in mature B-cells and physically interact during IgH locus DNA looping, we investigated if they were independent engines of locus remodelling or if their function was more intimately intermingled, their optimal activation then requiring physical contact with each other. Analysis of chromatin marks, enhancer RNA transcription and accessibility in Eµ- and 3'RR-deficient mice show, in mature activated B-cells, an unilateral dependence of this pair of enhancers: while the 3'RR acts in autonomy, Eµ in contrast likely falls under control of the 3'RR.

Development and characterization of lyophilized DNA vaccine formulations.

The potential applications of using plasmid DNA for immunization and other gene therapy approaches have been discussed in an increasing number of publications in the past few years. Injection of mouse muscle with naked DNA (plasmid DNA in saline) resulted in significant episomal expression from a number of encoded reporter genes such as firefly luciferase, chloramphenicol acetyltransferase, and ß-galactosidase (1). DNA vaccination has been shown to induce neutralizing antibodies against the gene product, helper T-cell responses of the Th1 phenotype, and cytotoxic T lymphocyte responses (2). Vaccination with plasmid DNA stimulates immunogenicity and provides protection against various infectious diseases in pre-clinical animal models. Examples include hepatitis B in chimpanzees (3), bovine herpes virus in mice (4), influenza A virus in ferrets (5), human immunodeficiency virus in rhesus monkeys (6), Mycobacterium tuberculosis in mice (7,8), malaria in mice (9,10), and genital herpes simplex virus in guinea pigs (11). Recently, DNA vaccines for the protection against influenza (Merck Research Laboratories, Rahway, NJ), malaria (Vical Inc., San Diego, CA), and HIV (Apollon Inc., Philadelphia, PA), have entered phase I human clinical trials. Rapid progress has been made in the areas of adjuvants for DNA vaccines (12), route of immunization (13), industrial scale fermentation and pharmaceutical grade purification (14). One major interest in the commercial development of DNA vaccines, especially for developing countries, is to increase DNA vaccine stability at room temperature, to reduce the requirement for costly cold storage, and to extend product shelf-life.

Quantitation of host cell DNA contaminate in pharmaceutical-grade plasmid DNA using competitive polymerase chain reaction and enzyme-linked immunosorbent assay.

The rising interest in gene therapy for the treatment of numerous disorders necessitates the need for the large-scale production of therapeutic biopharmaceuticals that meet stringent purity standards. Residual host cell DNA in recombinant pharmaceuticals has been identified as a potential risk factor that must be quantitated carefully both during the manufacturing process and in the final product. We describe a PCR method to quantitate contaminating levels of host cell DNA in clinical plasmid DNA preparations intended for human gene therapy. The quantitation is based on the coamplification of two similar templates, the target DNA and a synthetic competitor, and the quantitation of the resulting PCR products. The competitor is identical to the target DNA PCR product except for a 29-bp internal replacement. As a result, the two PCR products can easily be distinguished from each other. The competitive nature of the assay allows the use of the ratio of the target DNA PCR product to the competitor DNA PCR product to determine the original amount of target DNA in a sample. The primers used in this assay anneal to a conserved region of the E. coli 23S rRNA gene. One of the primers is biotinylated, allowing the PCR products to be detected colorimetrically after their capture on microtiter plates. The capture is accomplished by differential hybridization to target and competitor-specific probes covalently attached to wells of microtiter plates. The entire assay is performed in less than 2 hr postamplification. This method represents an attractive alternative to Southern blot analysis, which is the currently established method for DNA quantitation.

High-yield production of pBR322-derived plasmids intended for human gene therapy by employing a temperature-controllable point mutation.

Production of large quantities of highly purified plasmid DNA is essential for gene therapy. A low-copy-number pBR322-derived plasmid (VCL1005) was converted to a high-copy-number plasmid (VCL1005G/A) by incorporating a G-->A mutation that affects initiation of DNA replication from the ColE1 origin of replication. Because the phenotypic effect of this mutation is enhanced at an elevated temperature, a further increase in yield was achieved by changing the growth temperature from 37 degrees C to 42 degrees C at mid-log phase during batch and fed-batch fermentation. The combined effect of the single base-pair change and the elevated growth temperature produced an overall yield of 2.2 grams of plasmid DNA available for recovery from a 10-liter fed-batch fermentation compared to 0.03 grams from a 10-liter batch fermentation, a 70-fold increase in yield. The plasmid DNA isolated from this process contained lower levels of RNA and chromosomal DNA contaminants, simplifying downstream processing.

An improved plasmid DNA expression vector for direct injection into skeletal muscle.

In previous work, the direct injection of 50 micrograms of a plasmid DNA vector encoding firefly luciferase (VR1205) into murine quadriceps muscle produced an average of 6.5 ng of luciferase per muscle at 7 days postinjection. In this report, various elements of the VR1205 vector were modified to increase gene expression levels or to eliminate undesired viral sequences. Expression of the modified vectors was then compared to VR1205 using the intramuscular injection assay. In general, modifications to promoter, enhancer, and intronic sequences either decreased luciferase expression levels or had no effect. However, modifications to the polyadenylation and transcriptional termination sequences, plasmid backbone elements, and the luciferase gene itself each increased luciferase expression levels. The best-expressing vector, designated VR1255, contained a combination of these incrementally beneficial changes. A single intramuscular injection of 50 micrograms of VR1255 produced 300 ng of luciferase at 7 days postinjection, an expression level 46-fold higher than the VR1205 vector (or 22-fold higher, excluding modifications to the luciferase gene) and 154-fold higher than a commercially available luciferase expression vector. Thus, VR1255 represents an improved plasmid DNA vector that may be useful for gene therapy applications.

Plasmid DNA gene therapy: studies with the human interleukin-2 gene in tumor cells in vitro and in the murine B16 melanoma model in vivo.

The plasmid DNA vector pVCL-1102 containing the coding sequence for the human IL-2 gene was evaluated for expression in tumor cells in vitro and in vivo. In vitro transfection of murine B16 tumor cells with pVCL-1102 resulted in the expression of 36,000 IU (5.7 micrograms) of biologically active IL-2/10(6) cells/48 h. In vitro transfection of human tumor lines and primary cultures from human biopsies with pVCL-1102 resulted in the expression of 1,289 to 9345 IU of IL-2/10(6) cells/48 h and 30 to 794 IU of IL-2/10(6) cells/48 h, respectively. In vivo, direct intratumor injection of pVCL-1102 resulted in retention of intact plasmid DNA in the tumor tissue and IL-2 secretion by cell cultures derived from the injected tumors. Formulation of pVCL-1102 with the cationic lipid DMRIE/DOPE inhibited DNA degradation and enhanced in vivo transfection efficiency over plasmid DNA alone. Antitumor activity of the pVCL-1102/DMRIE/DOPE complex was evaluated in a B16 melanoma model in mice. An IL-2-specific effect could not be demonstrated in a subcutaneous model because the intratumor injection of plasmid DNA lacking the IL-2 coding sequence also resulted in a significant reduction in tumor volume. However, an IL-2-specific effect was observed when B16 cells were transfected in vitro prior to implantation into the mouse. Transient transfection of B16 cells with pVCL-1102 rendered the cells less tumorigenic in vivo and produced a significant reduction in tumor volume. These data demonstrate that a plasmid DNA expression vector can be used to deliver the IL-2 gene to tumor cells in vitro and in vivo, resulting in the expression of significant levels of IL-2 protein. These data also illustrate the need for the use of appropriate controls when evaluating the in vivo biological activity of plasmid DNA in murine tumor models.

[Neonatal rhinopharyngeal obstruction due to craniopharyngioma]. / Obstruction rhinopharyngée néonatale par craniopharyngiome.

BACKGROUND: Craniopharyngioma, the most common tumor of the sellar and suprasellar regions in childhood, can exceptionally develop in the infrasellar area. CASE REPORT: A premature girl (GA: 30 weeks) weighing 1240 g required intubation and ventilation because she suffered from a neonatal respiratory distress syndrome. Nasal endoscopy showed total obstruction of rhinopharynx by a tumor resembling adenoid tissue. This tumor was successfully excised and its histological examination showed a craniopharyngioma. CONCLUSION: A wide range of intranasal tumors has to be examined, endoscopy and CT scan are necessary for a precise localization and to eliminate meningocele.

Direct gene transfer for treatment of human cancer.

Genetic instability within malignant cells gives rise to mutant proteins which can be recognized by the immune system. Recognition of tumor-associated antigens by T lymphocytes could thus contribute to the elimination of neoplastic cells. We have developed a molecular genetic intervention for the treatment of malignancies based upon the knowledge that foreign major histocompatibility complex (MHC) proteins expressed on the cell surface are efficient at stimulating an immune response. Expression of this foreign MHC gene within tumors induced a cytotoxic T cell response to the introduced gene. More importantly, the immune system recognized tumor-specific antigens on unmodified tumor cells as foreign. Growth of the tumors diminished, and in many cases, there was complete regression. This research provides evidence that direct gene transfer in vivo can induce cell-mediated immunity against specific gene products, and offers the potential for effective immunotherapy for the treatment of cancer and infectious diseases in man. Our laboratory conducted a phase I clinical trial to determine the safety and efficacy of this treatment in humans. These studies suggest that direct gene transfer provides a safe and feasible approach for the treatment of human cancer. More recent developments using combination gene therapy and the initiation of a second human trial with improvements on this technology have been implemented. Finally, we have begun to define mechanisms of resistance to immune recognition by established malignancies.

Cancer gene therapy using plasmid DNA: purification of DNA for human clinical trials.

A production method has been developed for the purification of pharmaceutical-grade plasmid DNA for in vivo gene therapy. This method has been applied to the purification of VCL-1005, which is a eukaryotic plasmid expression vector that codes for the production of the HLA-B7 protein. Purified VCL-1005 is formulated with a cationic lipid and injected directly into established tumors of HLA-B7-negative patients with advanced cancers to heighten the patient's immune response against the cancer. The purification of pharmaceutical-grade plasmid DNA requires the development of highly reproducible and scaleable processing methods that meet regulatory standards similar to those required for the manufacture of recombinant protein pharmaceuticals. Defined pharmaceutical standards of purity, potency, efficacy, and safety are routinely met by the process described in this study. The scaleable purification method described here is a combination of highly reproducible unit operations; alkaline lysis, precipitation, and size-exclusion chromatography. The advantages over existing DNA purification methods include improved plasmid purity and the elimination of undesirable process additives such as toxic organic extractants and animal-derived enzymes. The overall process yield of purified plasmid DNA from fermentation through final column purified product is greater than 50%. Contaminating Escherichia coli DNA levels are reproducibly below 1% as measured by Southern analysis. Endotoxin levels are less than 0.03 endotoxin units/micrograms plasmid DNA and residual protein is undetectable. This process was used to produce 100 mg of VCL-1005 for use in an active clinical protocol.

Recognition and progression of coal workers' pneumoconiosis in the collieries of northern France.

In France, both active and retired coal miners take part in medical surveillance programs. Those compensated for pneumoconiosis are registered and receive annual chest X-rays and regular lung function assessments. A longitudinal study was done among 2719 pneumoconiotics from the Nord-Pas de Calais region Compensation Register, who received first compensation between 1942 and 1987 to study progression of CSWP. Chest radiographs taken at time of compensation and in 1987 were examined by three independent readers. There was a change over time in the characteristics of pneumoconiosis at the time of first compensation toward a low profusion of irregular opacities. In the period from 1982 to 1987, 645 pneumoconiotics developed progressive massive fibrosis (PMF). The occurrence of PMF was related to the date of compensation and the profusion of small opacities at detection (after controlling for time to follow-up). Two profiles for changes in coal workers' simple pneumoconiosis (CWSP) were observed: the first in the group of subjects with mild pneumoconiosis at compensation, who did not reach category 2 at follow-up and had a low attack rate of PMF; and the second in the group of those compensated for category 1/2 pneumoconiosis or higher, who reached severe CWSP and had a twofold attack rate for PMF at follow-up. The changes observed in the characteristics of pneumoconiosis at first compensation between 1942 and 1987 suggest a lessening of disease severity.

[Bilateral breast tuberculosis: a case report. Review of the literature]. / Tuberculose mammaire bilatérale: un cas. Revue de la littérature.

We report a case of bilateral tuberculosis of the breast that presented as masses and where the diagnosis could only be made from the histology. The outcome was good following antibiotics and antituberculous treatment. Tuberculosis of the breast is a very rare infection. The incidence of the disease is 0.025% of all disease of the breast treated surgically. The basis of treatment at the present time is antituberculous antibiotic treatment and surgery for any residual masses.

Genetic engineering of structural protein polymers.

Genetic and protein engineering are components of a new polymer chemistry that provide the tools for producing macromolecular polyamide copolymers of diversity and precision far beyond the current capabilities of synthetic polymer chemistry. The genetic machinery allows molecular control of chemical and physical chain properties. Nature utilizes this control to formulate protein polymers into materials with extraordinary mechanical properties, such as the strength and toughness of silk and the elasticity and resilience of mammalian elastin. The properties of these materials have been attributed to the presence of short repeating oligopeptide sequences contained in the proteins, fibroin, and elastin. We have produced homoblock protein polymers consisting exclusively of silk-like crystalline blocks and elastin-like flexible blocks. We have demonstrated that each homoblock polymer as produced by microbial fermentation exhibits measurable properties of crystallinity and elasticity. Additionally, we have produced alternating block copolymers of various amounts of silk-like and elastin-like blocks, ranging from a ratio of 1:4 to 2:1, respectively. The crystallinity of each copolymer varies with the amount of crystalline block interruptions. The production of fiber materials with custom-engineered mechanical properties is a potential outcome of this technology.

Purification and biochemical characterization of recombinant hirudin produced by Saccharomyces cerevisiae.

Recombinant hirudin was produced by the yeast Saccharomyces cerevisiae using the alpha-pheromone prepro sequence to direct its secretion into the culture medium. The secreted hirudin was isolated to greater than or equal to 95% purity as measured by 205-nm absorbance integration from a reverse-phase chromatogram. One major activity peak corresponding to the complete, correctly processed molecule and two minor activity peaks corresponding to C-terminally truncated forms were identified. The primary structure of the major peak, determined by N-terminal sequencing of tryptic peptides, was that predicted from the cDNA sequence, and the molecular mass analyzed by fast atom bombardment mass spectrometry (FAB-MS) was 6892.6 (calculated 6892.5). UV spectral analysis suggested that, in contrast to the natural molecule, recombinant hirudin produced by S. cerevisiae is not sulfated.

Glutamate excretion triggering mechanism: a reinvestigation of the surfactant-induced modification of cell lipids.

Lipid alterations induced by surfactants to trigger glutamate excretion were investigated with an industrial strain of Corynebacterium glutamicum. The lipid composition of this strain was determined for cultures in a synthetic medium and in a complex medium. A distribution of complex lipids between the cell wall and the cell membrane is proposed. Depending on growth conditions, 70-85% of the cell fatty acids had saturated chains in cells grown with surfactants. In the synthetic medium up to 80% of the straight-chain fatty acids may have come from the acylated surfactant added to the induce excretion. In industrial fermentation, the maximal excretion rate corresponded to the highest saturated fatty acid content of cells. It was shown by radioactive labelling in the synthetic medium that the addition of the acylated surfactant induced the degradation of more than 50% of the phospholipids. Some phospholipid synthesis occurred at that time using the surfactant (saturated) fatty acids, but the membrane did nor recover its previous phospholipid content. A model is proposed to explain the mechanism of glutamate excretion triggering by surfactants.

[Intraepithelial cervical neoplasia: incidence of associated condylomatous lesions. Results of CO2 laser treatment]. / Néoplasies cervicales intra-épithéliales (C.I.N.): incidence des lésions condylomateuses associées. Résultats du traitement par le laser CO2.

The present study reports our results using the CO2 Laser destruction of cervical intra-epithelial neoplasia (CIN) and points out the relationship with condylomatous lesions. 97 patients were selected and evaluated by cytology, colposcopy and directed punch biopsy. The cytologic criteria used for identification of virus infection are now well recognized. 12 CIN were overdiagnosed and lesions reclassified as condyloma. 85 CIN were studied. Epithelial changes suggestive of a condylomatous lesion were found in 27 cases (31.7%) and respectively 11.5% of CIN I, 37.8% of CIN II and 45.5% of CIN III. Further studies are required to evaluate the significance of condylomatous-CIN association. 70 women were treated by CO2 Laser including 24 CIN I, 32 CIN II and 14 CIN III. The primary failure rate for CIN I was 9.1%, CIN II 12.2%, CIN III 30.7%. However after a second treatment the total success rate was 93.8%. These data may give impetus for active management of precancerous lesions of the cervix.

[Epidemiology of asbestos-induced mesotheliomas in inhabitants of the Saint-Etienne area. Apropos of 35 cases]. / Epidémiologie des mésothéliomes asbestosiques dans la région stéphanoise. A propos de 35 cas.

The 35 cases reviewed in this study provided evidence that apart from occupational dust hazards there could be a risk of asbestos dust contamination which is not related to working conditions but occurs through urban and industrial pollution.