Molecular characterization of cell substratum attachments in human glial tumors relates to prognostic features.

Glioma cell attachments to substratum play crucial roles in the invasion by glioma cells of normal brain tissue. These attachments are mediated through interactions between extracellular matrix (ECM) components, integrins, focal adhesion-linked molecules, and the actin cytoskeleton. In the present study, we investigate the molecular elements involved in cell substratum attachments in human glial tumors and their potential relationships to prognostic features. We used 10 human glioma cell lines, for which we characterized glial differentiation by means of quantitative RT-PCR for nestin, vimentin, and GFAP mRNA. We quantitatively determined the amounts of laminin, fibronectin, vitronectin, and thrombospondin secreted by these glioma cell lines in vitro, as well as the amount of each of the eight beta integrin subunits and the adhesion complex-related molecules, including talin, vinculin, profilin, zyxin, alpha-actinin, paxillin, and VASP. After quantification of the levels of migration and invasion of these 10 cell lines in vitro and, through grafts into the brains of nude mice, of their biological aggressiveness in vivo, it appeared that the levels of the beta 5 integrin subunit and alpha-actinin were directly related to biological aggressiveness. These experimental data were clinically confirmed because increasing immunohistochemical amounts of the beta 5 integrin subunit and alpha-actinin were directly related to dismal prognoses in the case of astrocytic tumors. In addition, we show that the beta 4 integrin subunit are expressed significantly more in oligodendrogliomas than in astrocytic tumors. A potential role for the beta 8 integrin subunit in glioma cell substratum attachments is also emphasized.

Galectin-1 is highly expressed in human gliomas with relevance for modulation of invasion of tumor astrocytes into the brain parenchyma.

Protein (lectin)-carbohydrate interaction is supposed to be relevant for tumor cell behavior. The aims of the present work are to investigate whether galectin-1 modulates migration/invasion features in human gliomas in vitro, whether it can be detected in human gliomas immunohistochemically, and whether its expression is attributable to certain glioma subgroups with respect to invasion and prognosis. For this purpose, we quantitatively determined (by computer-assisted microscopy) the immunohistochemical expression of galectin-1 in 220 gliomas, including 151 astrocytic, 38 oligodendroglial, and 31 ependymal tumors obtained from surgical resection. We also xenografted three human glioblastoma cell lines (the H4, U87, and U373 models) into the brains of nude mice in order to characterize the in vivo galectin-1 expression pattern in relation to tumor invasion of the normal brain parenchyma. In addition, we characterized the role in vitro of galectin-1 in U373 tumor astrocyte migration and kinetics. Our data reveal expression of galectin-1 in all human glioma types with no striking differences between astrocytic, oligodendroglial, and ependymal tumors. The level of galectin-1 expression correlated with the grade in the group of astrocytic tumors only. Furthermore, immunopositivity of high-grade astrocytic tumors from patients with short-term survival periods was stronger than that of tumors from patients with long-term survivals. In human glioblastoma xenografts, galectin-1 was preferentially expressed in the more invasive parts of these xenografts. In vitro experiments revealed that galectin-1 stimulates migration of U373 astrocytes.

Comparative study of the clinical effectiveness of a pyrethrin-based pediculicide with combing versus a permethrin-based pediculicide with combing.

In a randomized, evaluator-blinded clinical trial, 190 patients were treated for Pediculus humanus capitis infestations with a pyrethrin-piperonyl-butoxide pediculicide (RID; Py-PB) and a permethrin pediculicide (NIX; PM). A total of 160 patients were evaluable for nit-combing speed, 156 patients were evaluable for efficacy at day 7, and 150 patients were evaluable for efficacy at day 14. Both Py-PB and PM showed 100% efficacy at day 7. At day 14, one patient in the PM group had an apparent reinfestation. The Py-PB group had significantly lower mean combing times (P=0.04), but because the PM group had more nits, the two groups were not significantly different in combing speed expressed as seconds per nit. Multiple regression and covariance analyses suggested that the greater speed of the Py-PB comb might have been masked by this baseline difference. Three patients had mild adverse experiences (Py-PB: erythema, PM: erythema and tingling sensation). No patients were removed from the study because of adverse events. In conclusion, this controlled clinical study demonstrated that both Py-PB and PM provided 100% efficacy following a single application. Differences attributable to comb design favored the Py-PB "rake" comb, but this requires additional evaluation and confirmation.

A prospective clinical comparison of two intravenous polyurethane cannulae.

Tissue irritation, as evidenced by phlebitis, associated with Optiva (Johnson & Johnson Medical) and Insyte (Becton Dickinson) polyurethane cannulae was studied. The integrity of the cannulae on removal, the incidence of infection at the cannula site and the factors which influence phlebitis were also examined. One thousand and eight patients had a polyurethane cannula placed for induction of anaesthesia for cardiac surgery. After surgery, the cannula was examined every 24 hours. If evidence of phlebitis occurred, the cannula was removed and sent for culture. All remaining cannulae were removed at 72 hours and the site examined daily for a further three days. There were 503 Optiva and 505 Insyte cannulae studied. The distributions between the two cannulae with respect to patient characteristics, gauge of cannula, number of attempts and difficulty of insertion, cannula site and anaesthetist inserting were similar. The early removal rate for both groups was 47%. Overall phlebitis rate with Optiva was 31% and Insyte 33%. This difference is not statistically significant. The cumulative phlebitis rate increased with time but did not differ between the two types of cannulae. Minor tip distortion or shaft kinking of the cannulae occurred in 16.2% of Optiva and 23.5% of Insyte. This difference is statistically significant and may relate to the slightly more acute taper at the Optiva cannula tip. Both cannulae were similar in clinical performance.

A prospective clinical comparison of two intravenous polyurethane cannulae.

Tissue irritation, as evidenced by phlebitis, associated with Optiva (Johnson & Johnson Medical) and Insyte (Becton Dickinson) polyurethane cannulae was studied. The integrity of the cannulae on removal, the incidence of infection at the cannula site and the factors which influence phlebitis were also examined. One thousand and eight patients had a polyurethane cannula placed for induction of anaesthesia for cardiac surgery. After surgery, the cannula was examined every 24 hours. If evidence of phlebitis occurred, the cannula was removed and sent for culture. All remaining cannulae were removed at 72 hours and the site examined daily for a further three days. There were 503 Optiva and 505 Insyte cannulae studied. The distributions between the two cannulae with respect to patient characteristics, gauge of cannula, number of attempts and difficulty of insertion, cannula site and anaesthetist inserting were similar. The early removal rate for both groups was 47%. Overall phlebitis rate with Optiva was 31% and Insyte 33%. This difference is not statistically significant. The cumulative phlebitis rate increased with time but did not differ between the two types of cannulae. Minor tip distortion or shaft kinking of the cannulae occurred in 16.2% of Optiva and 23.5% of Insyte. This difference is statistically significant and may relate to the slightly more acute taper at the Optiva cannula tip. Both cannulae were similar in clinical performance.

Community study of infant mortality in San Diego County.

Infant mortality in San Diego County (USA) in 1988 was 6.9 per 1000 live births. This rate had remained unchanged since 1980. It rose to 8.3 in 1989 and fell to 7.0 in 1990. This study describes the results of an investigation into the causes of infant mortality during 1985. A total of 333 infant deaths were recorded. Nearly half the neonatal deaths were related to perinatal causes and more than half the post-neonatal deaths were attributed to the Sudden Infant Death Syndrome. Two-thirds of all infant deaths occurred in the neonatal period. The contribution of factors in the maternal background and those related to care during labour, as well as postnatally, is described.

Pediatric injury prevention.

Pediatric injuries are the leading cause of childhood death and disability and are responsible for more childhood deaths than all other diseases combined. The panel summarized the principles of pediatric injury prevention and reviewed the incidence, epidemiology, and prevention of six common pediatric injuries.

A population-based study of nonfatal childhood injuries.

A random-digit-dialing telephone survey was used to assess the frequency and associated characteristics of childhood poisoning, burns, and head injuries in 1,213 San Diego County households having at least one child 14 years of age or younger at the time of the telephone interview in 1980. The survey population was representative of the general San Diego County population with regard to socioeconomic status and geographic distribution. The frequency of injuries judged to be serious enough to require medical care and the median ages for each injury were head injury, 4.2% and 5.5 years; burns 4.0% and 2 years; and poisonings, 3.4% and 2 years. Forty-four percent of all poisonings were related to drugs, of which aspirin was the single most common medication. Hot liquids or hot surfaces were responsible for 52% of burns. The majority of head injuries (65%) were caused by falls, usually outside the home. Education was positively associated with poisonings, and income was negatively associated with burns. Children of caretakers working outside the home did not have higher injury rates than those whose caretakers were not so employed. Differences in caretaker attitudes were few, and may reflect the experience of having an injury, rather than factors preceding it. The advantages and limitations of this method of assessing childhood injury in populations are discussed.

The pediatrician as advocate.

Pediatricians' success in the role of advocate can be associated with fewer injuries to children. The authors emphasize the importance of pediatrician advocacy for injury prevention, including preventive health maintenance, education, community organization, professional education, development of emergency medical services, and legislation and regulation.

Injury prevention in the community: a systems approach.

Injury prevention requires a coordinated political, medical, individual, and community effort. Comprehensive strategies for planning, implementing, and evaluating injury prevention programs are set forth by the authors.

Establishment of a regional poison center.

Since its inception in 1972, the San Diego Poison Center has made considerable progress towards achieving its goal of developing a poison care system which will decrease incidence, morbidity, and cost of poisonings. A systems approach has been developed to care for patients at all levels of severity. Subregional centers have been identified and linked to the poison center. Education of the region's emergency medical personnel and the public have been actively pursued. Calls to the center have increased from 6829 in 1972 to 25,949 in 1976. Eighty-five percent of poisoning calls in 1976 were managed at home over the telephone. A follow-up call at 24 hours for each case revealed that less than 1% sought additional medical care. The percent of all emergency department visits resulting from poisoning in a tracer group (children under age 12 leaving emergency department asymptomatic) dropped from 6.1% in 1971 to 1.9% in 1976. The percent of hospital admissions due to poisoning in children under 10 years also dropped by 40% between 1971 and 1974. Estimated cost savings to the community by preventing emergency department visits alone each year covers the cost of operation of the poison center itself.