Gene expression profiles of bladder cancers: evidence for a striking effect of in vitro cell models on gene patterns.

In order to assess the effect of in vitro models on the expression of key genes known to be implicated in the development or progression of cancer, we quantified by real-time quantitative PCR the expression of 28 key genes in three bladder cancer tissue specimens and in their derived cell lines, studied either as one-dimensional single cell suspensions, two-dimensional monolayers or three-dimensional spheroids. Global analysis of gene expression profiles showed that in vitro models had a dramatic impact upon gene expression. Remarkably, quantitative differences in gene expression of 2-63-fold were observed in 24 out of 28 genes among the cell models. In addition, we observed that the in vitro model which most closely mimicked in vivo mRNA phenotype varied with both the gene and the patient. These results provide evidence that mRNA expression databases based on cancer cell lines, which are studied to provide a rationale for selection of therapy on the basis of molecular characteristics of a patient's tumour, must be carefully interpreted.

Safety of plasma-based sterilization: surface modifications of polymeric medical devices induced by Sterrad and Plazlyte processes.

Plasma-based sterilization is a promising alternative to the use of pure ethylene oxide (EO), for low-temperature clinical sterilization of medical instruments and devices. However, few studies have been published that evaluate its safety in terms of possible damage to materials, particularly polymers. The objective of this work was to evaluate polymer surface modifications induced by commercial plasma-based sterilizers, in comparison with pure EO: Samples from 5 polymer-based devices were subjected to 1, 5, and 10 sterilization cycles by Sterrad-100, Plazlyte, and pure EO. Surface analysis was carried out by X-ray photoelectron spectroscopy (XPS), dynamic contact angle measurements (DCA), and scanning electron microscopy (SEM). Surface oxidation and wettability changes were observed on all samples sterilized by plasma-based techniques, the degree of modifications depending on the sterilizer (Sterrad, Plazlyte) and the type of polymer. Drastic changes of surface appearance were also observed by SEM on PVC samples sterilized by Plazlyte and by pure EO. Possible repercussions on safety are discussed.

Effect of gas composition on spore mortality and etching during low-pressure plasma sterilization.

The aim of this work was to investigate possible mechanisms of sterilization by low-temperature gas plasma: spore destruction by plasma is compared with etching of synthetic polymers. Bacillus subtilis spores were inoculated at the bottom of glass vials and subjected to different plasma gas compositions (O(2), O(2)/Ar, O(2)/H(2), CO(2), and O(2)/CF(4)), all known to etch polymers. O(2)/CF(4) plasma exhibited much higher efficacy than all other gases or gas mixtures tested, with a more than 5 log decrease in 7.5 min, compared with a 2 log decrease with pure oxygen. Examination by scanning electron microscopy showed that spores were significantly etched after 30 min of plasma exposure, but not completely. We speculate about their etch resistance compared with that of synthetic polymers on the basis of their morphology and complex coating structure. In contrast to so-called in-house plasma, sterilization by Sterrad(R) tended to increase the observed spores' size; chemical modification (oxidation), rather than etching, is believed to be the sterilization mechanism of Sterrad(R).

Attitudes toward risk factor behavior of relatives of cancer patients.

BACKGROUND: Targeted health promotion requires an identifiable subpopulation which is accessible, at increased risk, receptive to input, and receptive to change. Relatives of recently diagnosed cancer patients may meet these criteria and have not previously been investigated as recipients of preventive education regarding smoking and diet. METHODS: This study investigates these factors, beliefs regarding perceived susceptibility to cancer, and attitudes toward behavior change in 101 relatives of 50 patients with smoking-related cancers, breast cancer, and other diet-related cancers. Congruence of attitudes between patients and relatives, another possible factor in changing health behaviors, also was assessed. RESULTS: Access to relatives of patients was very high, as was their willingness to discuss these issues (99% of relatives contacted participated in the survey). Relatives' ratings of relevant risk factors were generally higher than those of patients; ratings of their own vulnerability were moderate. Within diagnostic groups, there was high concordance of belief between patients and relatives for certain types of risk, such as heredity for breast cancer (r = 0.81) and smoking for smoking-related cancers (r = 0.52), but not for dietary factors. CONCLUSIONS: The high level of access suggests that relatives may be receptive to discussing issues of behavior risk and change. They are at least as aware as patients of cancer risk factors. Spontaneous behavior change was very low. They may therefore be good candidates for targeted health promotion regarding cancer risk.

NiTi shape memory alloys treated by plasma-polymerized tetrafluoroethylene. A physicochemical and electrochemical characterization.

NiTi alloy specimens were plasma cleaned and then coated with a thin film of plasma-polymerized tetrafluoroethylene (TFE) in a Radio-Frequency reactor. The corrosion protection provided by these films was studied by potentiodynamic tests performed in Hank's physiological solution. Surface properties which determine biocompatibility were characterized by X-ray photoelectron spectroscopy (XPS). The results showed that the surface of untreated NiTi was mostly composed by oxygen, carbon, titanium oxide (TiO2) with traces of nickel oxides (NiO and Ni2O3) and metallic Ni. The passivity of untreated NiTi was found to be unstable in the simulated human body media. After plasma treatment, the NiTi surface contained only carbon and fluor. The plasma-polymerized thin film was found to stabilize the NiTi passivity and to increase its pitting potential. This treatment provides a good protection against dissolution of nickel from NiTi alloys.

Meditation, melatonin and breast/prostate cancer: hypothesis and preliminary data.

The objective of this study was to test the hypothesis that the regular practice of mindfulness meditation is associated with increased physiological levels of melatonin. Melatonin may be related to a variety of biologic functions important in maintaining health and preventing disease, including breast and prostate cancer. Previous studies have shown melatonin production is photosensitive and we suggest here that it also may be psychosensitive. A cross-sectional study of 12-hour (20:00-08:00) urinary 6-sulphatoxymelatonin was conducted from which we analyzed data from 8 women who regularly meditate (RM) and 8 women who do not meditate (NM). All samples were collected in the homes of study participants. Volunteers were recruited to provide 12-hour overnight samples of urine. All subjects collected the samples on one night during the same 1-week period. There was no explicit intervention. However, all RM were either graduates of, or teachers in, the University of Massachusetts Stress Reduction and Relaxation Program. The main outcome measure was the total excretion of urinary 6-sulphatoxymelatonin. Multiple linear regression (Proc GLM in SAS) was performed to test the effect of meditation (RM vs NM) on 6-sulphatoxymelatonin. The results of the study were that after controlling for the non-significant effect of menstrual period interval, we found an effect of meditation group (RM vs NM: b = 1.983; F = 6.78; p = 0.02) and age (for each integer year: b = 0.169; F = 8.41; p = 0.01). The conclusion is that study results are consistent with our hypothesis and indicate that melatonin might be a useful parameter in testing similar psycho-social interventions.(ABSTRACT TRUNCATED AT 250 WORDS)

A complication involving a braided hook-wire localization device.

At the authors' institution, needle localization of breast lesions with a braided hook wire involves the wire being cut 1-2 cm from the point of entry before dissection, to avoid contamination of the sterile field with the nonsterile portion of wire. During dissection, the wire is brought through the skin into the area of dissection. In one patient, fragments of wire filaments were left within the breast. Braided hook wires must be cut cleanly, the cut surface should be wiped before dissection, and the surgical area should be cleansed before closure.

[Syndrome combinations as meta-syndromes in configuration frequency analysis]. / Syndromkombinationen als Metasyndrome in der KFA.

The paper defines metasyndromes as syndrome combinations. Within the framework of Configural Frequency Analysis the authors propose using a single test for identifying patterns of syndromes rather than applying simultaneous tests for identifying singular syndromes. The authors describe and illustrate the method using the "classical data" that describe symptom patterns under LSD (Lienert, 1971). The rationale of the new procedure is to combine independent tests as was proposed by Wartmann and Wette (1952) as a means for meta analysis.

Aesthetic results following partial mastectomy and radiation therapy.

This study was undertaken to determine the aesthetic changes inherent in partial mastectomy followed by radiation therapy in the treatment of stage I and stage II breast cancer. A retrospective analysis of breast cancer patients treated according to the National Surgical Adjuvant Breast Project Protocol B-06 was undertaken in 57 patients from 1984 to the present. The size of mastectomy varied between 2 x 1 cm and 15 x 8 cm. Objective aesthetic outcome, as determined by physical and photographic examination, was influenced primarily by surgical technique as opposed to the effects of radiation. These technical factors included orientation of resections, breast size relative to size of resection, location of tumor, and extent and orientation of axillary dissection. Regarding cosmesis, 80 percent of patients treated in this study judged their result to be excellent or good, in comparison to 50 percent excellent or good as judged by the plastic surgeon. Only 10 percent would consider mastectomy with reconstruction for contralateral disease. Asymmetry and contour abnormalities are far more common than noted in the radiation therapy literature. Patients satisfaction with lumpectomy and radiation, however, is very high. This satisfaction is not necessarily based on objective criteria defining aesthetic parameters, but is strongly influenced by retainment of the breast as an original body part.

A preliminary pharmacokinetic study of 111In-labeled 260F9 anti-(breast cancer) antibody in patients.

The pharmacokinetics of 111In-labeled 260F9, a murine monoclonal antibody directed against a breast-cancer-associated antigen, was determined in seven patients with advanced breast cancer. Six patients were administered 1 mg antibody containing 1 mCi 111In. The seventh patient was administered 20 mg unlabeled antibody followed by 1 mg 111In-labeled antibody all via a peripheral vein. Immunoprecipitation, HPLC and SDS-PAGE gels demonstrated the stability of radiolabel on the antibody. The serum clearance of the radiolabel closely fits (r2 greater than 0.95) a two-compartment model for the first six patients. The apparent volume of distribution of the radiolabel approximated to the plasma volume (31) and its mean residence time was 23.7 h. The radiolabel had an average t 1/2 beta of 22.9 +/- 12.21 h at the 1-mg dose. At the 20-mg dose one-compartment elimination kinetics were observed with the radiolabel and antibody showing similar mean residence times (36-41 h) and a t 1/2 beta of 26-28 h. Whole-body imaging showed that the blood-pool: liver ratio of radioactivity increased fourfold (at 48 h postinfusion) at the higher dose and the percentage of the injected dose of radioactivity in the liver decreased from 25% to 8% (24 h postinfusion). In one patient 7-14 times more radioactivity was localized in a breast tumor than in fat (normal breast). Over the first 25 h an average (cumulative) 7.5% of the total dose was excreted in urine. A study of 260F9 in CDF-1 mice demonstrated that the radiolabel remained associated with the antibody in serum. The antibody, however, cleared 60-fold slower in mice than in patients and showed an increased mean residence time of 191 h. The disparity in the pharmacokinetics of the antibody seen in the mouse and in the clinic, points to the different behavior shown by murine monoclonal antibodies in humans. This points to the need for preliminary studies of antibodies in patients for preclinical evaluations of their effectiveness as drug-targeting agents.

Breast cancer screening for primary care physicians.

Our 3 Step Primary Care Program is apparently successful. The first year program focused on 3 types of intervention: 1. Interventions to influence reinforcing factors (i.e. finding rapport among significant community leaders) 2. Interventions to alter predisposing factors (i.e. presenting informative material in a palatable memorable form) 3. Interventions to enable physicians to make change (through an innovative program of patient instructors and office practice changes). Next year's program will include reinforcing and enabling strategies: a repeat patient instructor encounter in the doctor's office and a more intensive office practice intervention. Final evaluation of the success of our physician intervention awaits completion of the program and evaluation of the change in breast health counselling, in the practice of breast physical exam and in the number of routine screening mammograms performed in this community.

Surgical management of necrotizing pancreatitis.

Necrotizing pancreatitis has a formidable mortality that may exceed 55% even when treated by surgical drainage. Standard surgical techniques for controlling pancreatic sepsis are often inadequate because the unique chronicity of pancreatitis results in persistent and ongoing inflammation and sloughing of necrotic retroperitoneal tissue that promotes further sepsis. Ten consecutive high-risk patients in whom standard surgical debridement and drainage had failed were treated with open packing of the pancreatic bed. This was followed by daily debridement dressing changes at the bedside in the surgical intensive care unit. Management of the open abdomen in the surgical intensive care unit using standard surgical techniques ensured optimum wound toilet, prevented recurrent intra-abdominal sepsis, was logistically acceptable, was well tolerated by critically ill patients, and allowed a higher salvage rate (80%) of high-risk patients than might otherwise be anticipated.

Humanities in surgery, a life threatening situation: communicating the diagnosis.

Surgeons should be able to communicate emotion-laden information to patients effectively. In most medical schools, there is an implicit assumption that students will learn communication skills through observation of appropriate role models. Young physicians often feel ill prepared to convey such information with sensitivity and understanding. University of Massachusetts Medical School's curriculum includes a program that addresses the communication skills involved in surgical practice and the ethical issues they raise. Videotaped vignettes of doctor-patient interactions culled from dramatic and documentary sources are viewed and discussed with students in small groups. These highly evocative vignettes are of live and role played doctor-patient encounters. The elements of communication are analyzed, as are psychosocial, existential, legal and ethical issues.