Transrectal ultrasound for intraoperative interstitial needle guidance in cervical cancer brachytherapy.

OBJECTIVE: This study aimed to prospectively assess the visibility of interstitial needles on transrectal ultrasound (TRUS) in cervical cancer brachytherapy patients and evaluate its impact on implant and treatment plan quality. MATERIAL AND METHODS: TRUS was utilized during and after applicator insertion, with each needle's visibility documented through axial images at the high-risk clinical target volume's largest diameter. Needle visibility on TRUS was scored from 0 (no visibility) to 3 (excellent discrimination, margins distinct). Quantitative assessment involved measuring the distance between tandem and each needle on TRUS and comparing it to respective magnetic resonance imaging (MRI) measurements. Expected treatment plan quality based on TRUS images was rated from 1 (meeting all planning objectives) to 4 (violation of High-risk clinical target volume (CTVHR) and/or organ at risk (OAR) hard constraints) and compared to the final MRI-based plan. RESULTS: Analysis included 23 patients with local FIGO stage IB2-IVA, comprising 41 applications with a total of 230 needles. A high visibility rate of 99.1% (228/230 needles) was observed, with a mean visibility score of 2.5 ±â€¯0.7 for visible needles. The maximum and mean difference between MRI and TRUS measurements were 8 mm and -0.1 ±â€¯1.6 mm, respectively, with > 3 mm discrepancies in 3.5% of needles. Expected treatment plan quality after TRUS assessment exactly aligned with the final MRI plan in 28 out of 41 applications with only minor deviations in all other cases. CONCLUSION: Real-time TRUS-guided interstitial needle placement yielded high-quality implants, thanks to excellent needle visibility during insertion. This supports the potential of TRUS-guided brachytherapy as a promising modality for gynecological indications.

Clinical and imaging findings in cervical cancer and their impact on FIGO and TNM staging - An analysis from the EMBRACE study.

OBJECTIVE: To investigate differences in local tumour staging between clinical examination and MRI and differences between FIGO 2009, FIGO 2018 and TNM in patients with primary cervical cancer undergoing definitive radio-chemotherapy. METHODS: Patients from the prospective observational multi-centre study "EMBRACE" were considered for analysis. All patients had gynaecological examination and pelvic MRI before treatment. Nodal status was assessed by MRI, CT, PET-CT or lymphadenectomy. For this analysis, patients were restaged according to the FIGO 2009, FIGO 2018 and TNM staging system. The local tumour stage was evaluated for MRI and clinical examination separately. Descriptive statistics were used to compare local tumour stages and different staging systems. RESULTS: Data was available from 1338 patients. For local tumour staging, differences between MRI and clinical examination were found in 364 patients (27.2%). Affected lymph nodes were detected in 52%. The two most frequent stages with FIGO 2009 are IIB (54%) and IIIB (16%), with FIGO 2018 IIIC1 (43%) and IIB (27%) and with TNM T2b N0 M0 (27%) and T2b N1 M0 (23%) in this cohort. CONCLUSIONS: MRI and clinical examination resulted in a different local tumour staging in approximately one quarter of patients. Comprehensive knowledge of the differential value of clinical examination and MRI is necessary to define one final local stage, especially when a decision about treatment options is to be taken. The use of FIGO 2009, FIGO 2018 and TNM staging system leads to differences in stage distributions complicating comparability of treatment results. TNM provides the most differentiated stage allocation.

31P nuclear magnetic resonance study of the metabolic pools of adenosine triphosphate in cultured bovine adrenal medullary chromaffin cells.

31P NMR was used to resolve and determine the relative quantity and mobility of ATP in the cytosolic and vesicular compartments of isolated adrenomedullary chromaffin cells. The cells were cultured on microcarrier beads and superfused with an oxygenated medium--thereby permitting dense suspensions of viable cells to be maintained in the NMR probe for extended time periods. Under these conditions, distinct 31P signals could be seen for ATP within the vesicular and the cytosolic pools. Comparison of the integrated areas of the beta-phosphate resonances from the two ATP pools indicated 77% of the endogenous ATP was in the vesicular pool. From this observation and the assumption that the concentration of ATP in the vesicle is 87.5 mM, the concentration of ATP calculated to be in the cytoplasmic pool was approximately 4 mM. The pH in the vesicle determined from the chemical shift of the gamma-phosphate resonance of vesicular ATP was 5.84 +/- 0.17 (n = 6), slightly higher than the intragranular pH measured in hypoxic cells (5.57 +/- 0.15, n = 8). Spin-lattice relaxation times of ATP 31P resonances in the vesicular pool were from 12 to 14 times shorter than the ATP resonances in the cytosol, corresponding to a decrease in molecular mobility due to incorporation of ATP within a catecholamine-storage complex.

1,25-Dihydroxyvitamin D3 decreases expression of HLA class II molecules in a melanoma cell line.

An HLA class II-positive melanoma cell line, DU-Mel 17, was treated with three compounds known to induce differentiation in various cell lines. Neither retinoic acid nor dibutyryl cAMP altered levels of DR alpha mRNA, but 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) significantly decreased the level of DR alpha mRNA 48 h after treatment. Optimal effect of the hormone on DR alpha mRNA was reached by 72 h. DU-Mel 17 cells were responsive to 1,25(OH)2D3 in a dose-dependent manner, and a reduction in DR alpha mRNA was seen at concentrations as low as 5 x 10(-13) M. The action of 1,25(OH)2D3 on DR alpha mRNA levels was dependent on protein synthesis as evidenced by inhibition of its effect upon addition of cycloheximide. Both DR and DQ protein levels on the surface of DU-Mel 17 were beginning to decline by 72 h after 1,25(OH)2D3 treatment, and by 96 h these proteins were decreased by 65%. 1,25(OH)2D3 was not capable of altering expression of class II molecules on three different class II-positive B lymphoblastoid cell lines, although one of these lines was shown to express the receptor for 1,25(OH)2D3. These findings are important because 1) there is no known physiologic regulator that actively down-regulates class II molecules that are present in and/or on cells, 2) levels of mRNA derived from a very limited number of genes are known to be altered by 1,25(OH)2D3, and 3) they support the contention that 1,25(OH)2D3 may alter the differentiation state of these cells and the activity of the normal counterpart of these cells in an immune response.

Evidence for the release of newly acquired ascorbate and alpha-aminoisobutyric acid from the cytosol of adrenomedullary chromaffin cells through specific transporter mechanisms.

Primary cultures of bovine adrenomedullary cells actively take up ascorbic acid and alpha-aminoisobutyric acid (AIB). Following a brief incubation with L-[14C] ascorbic acid and alpha-[methyl-3H]aminoisobutyric acid, cells stimulated with the nicotinic agonist 1,1-dimethyl-4-phenylpiperazinium iodide or by membrane depolarization with high [K+] or veratridine released newly acquired ascorbic acid (NA-ascorbate) and AIB. NA-ascorbate and endogenous catecholamines are differentially released under a variety of conditions suggesting that release of both substances cannot originate from the same subcellular compartment. In contrast, the release profile for NA-ascorbate and AIB, a putative cytosolic marker, suggest that both of these molecules are released from a cytosolic compartment. Cells permeabilized with the detergent digitonin release catecholamines only in the presence of external Ca2+, whereas release of NA-ascorbate and AIB is Ca2+-independent and time- and detergent concentration-dependent. If the osmolality of the external medium is made either hyper- or hypoosmotic, 1,1-dimethyl-4-phenylpiperazinium iodide-induced release of endogenous catecholamines is inhibited. Release of NA-ascorbate and AIB, however, is progressively inhibited with increasing osmolality and enhanced with decreasing osmolality. Furthermore, differential release of NA-ascorbate and AIB as compared to soluble acetylcholinesterase, which is apparently released form the cisternae of the endoplasmic reticulum, was also observed. To determine the mechanism by which NA-ascorbate and AIB are released from the cell, the requirements for their maximal release were investigated. Release of NA-ascorbate and AIB was sensitive to inhibitors (both metabolic and transport) and to changes in the external ionic environment. The metabolic inhibitors carbonyl cyanide p-trifluoromethoxyphenylhydrazone and KCN (when incubated simultaneously with 2-deoxyglucose) inhibited NA-ascorbate and AIB release by greater than 75%. In contrast, the Na+-K+-ATPase inhibitor ouabain enhanced veratridine-induced release of NA-ascorbate by nearly 100% and had an even greater effect on AIB release. Changes in the external ionic environment (i.e. Na+ and/or Cl- substitution) inhibited both NA-ascorbate and AIB release to varying degrees. Substitution of Cl- by various anions inhibited NA-ascorbate and AIB release to a much greater degree than endogenous catecholamine release. Complete substitution of NaCl with sucrose inhibited release of NA-ascorbate and AIB release by greater than 80%, while Na+ substituted with Li+ inhibited release of all three molecules by about 50%.(ABSTRACT TRUNCATED AT 400 WORDS)

The in situ kinetics of dopamine beta-hydroxylase in bovine adrenomedullary chromaffin cells. Intravesicular compartmentation reduces apparent affinity for the cofactor ascorbate.

The Km of dopamine beta-hydroxylase for its cofactor, ascorbic acid, was determined in situ in primary cultures of bovine adrenomedullary chromaffin cells and in isolated chromaffin vesicles. A range of intravesicular ascorbate concentrations in chromaffin cell cultures (1.1-31.2 mM) was achieved by varying the number and concentration of ascorbate additions to the culture media. The rate of octopamine synthesis from tyramine displayed a Michaelis-Menten relationship with respect to ascorbate concentration and an apparent Km of dopamine beta-hydroxylase for ascorbate of 15.0 +/- 2.0 mM was determined. In isolated chromaffin vesicles, with an initial intravesicular ascorbate concentration of approximately 10 mM, ascorbate consumption during beta-hydroxylation occurred as a first order process. This indicated that dopamine beta-hydroxylase was not saturated at this initial ascorbate concentration. When isolated chromaffin vesicles were prepared with different intravesicular ascorbate concentrations, the rate of octopamine synthesis displayed a Michaelis-Menten relationship with respect to ascorbate with an apparent Km of 17.0 +/- 5.0 mM. Ascorbate consumption also occurred as a first order process in ascorbate-loaded chromaffin-vesicle ghosts which had initial ascorbate concentrations of approximately 30 mM but which were depleted of other small molecules such as catecholamines. These results indicate that the in situ Km of dopamine beta-hydroxylase for ascorbate (approximately 15 mM) is 25-fold higher than it is for the purified or partially purified enzyme assayed under optimal conditions in vitro (0.6 mM). The factor(s) which decreases the enzyme affinity for ascorbate, relative to in vitro, resides in the chromaffin vesicle interior and is also retained in chromaffin-vesicle ghosts. The mechanism of this effect remains to be determined. The Km value determined in these experiments is close to the estimated intravesicular ascorbate concentration of bovine chromaffin granules in vivo (4), suggesting that the availability of ascorbate could become a factor in regulating the rate of dopamine beta-hydroxylation.

Role of ascorbic acid in dopamine beta-hydroxylation. The endogenous enzyme cofactor and putative electron donor for cofactor regeneration.

The role(s) of ascorbic acid in dopamine beta-hydroxylation was studied in primary cultures of bovine adrenomedullary chromaffin cells and in isolated bovine adrenomedullary chromaffin vesicles. Dopamine beta-hydroxylase activity was assessed by measuring the rate of conversion of tyramine to octopamine. The ascorbic acid content of chromaffin cells declined with time in culture and the dopamine beta-hydroxylase activity of ascorbate-depleted cells was low. Ascorbate additions to ascorbate-depleted cells increased both the intracellular ascorbate concentrations and the rates of dopamine beta-hydroxylation. Ascorbate uptake into the cells was rapid; however, the onset of enhanced octopamine synthesis by added ascorbate was delayed by several hours and closely followed the time course for accumulation of the newly taken up ascorbate into the chromaffin vesicle. The amount of octopamine synthesized by the chromaffin cells exceeded the intracellular ascorbate content and ascorbate levels were maintained during dopamine beta-hydroxylation in the absence of external ascorbate. This suggests an efficient recycling of ascorbate. In contrast to intact cells, ascorbic acid was depleted during octopamine synthesis in isolated chromaffin vesicles. The molar ratio of octopamine formed to ascorbate depleted was close to unity. Thus, the recycling of intravesicular ascorbate depends on an extravesicular factor(s). The depletion of intravesicular ascorbate during dopamine beta-hydroxylation was prevented by the addition of nonpermeant extravesicular electron donors such as ascorbate or glucoascorbate. This suggests that intravesicular ascorbate is maintained in the reduced state by electron transport across the vesicle membrane. These results are compatible with the hypothesis that both intra- and extravesicular ascorbate participate in the regulation of dopamine beta-hydroxylase. Intravesicular ascorbate is the cofactor for the enzyme. Cytosolic ascorbate is most likely the electron donor for the vesicle-membrane electron transport system which maintains the intravesicular cofactor concentration.

Kinetics of tyramine transport and permeation across chromaffin-vesicle membranes.

Tyramine permeates chromaffin-granule membranes via a reserpine-insensitive mechanism. The rate is unsaturable and increases with pH, indicating permeation of the unprotonated form of the amine. Reserpine-insensitive dopamine uptake is at least 10 times slower, consistent with dopamine's lesser lipophilicity. Dopamine is transported into chromaffin-granule membrane vesicles via a saturable, reserpine-sensitive, proton-linked mechanism. Tyramine inhibits dopamine transport with a Ki of 5-10 microM. Tyramine is not accumulated nearly as well as dopamine because inward transport is opposed by outward permeation. Nevertheless, the velocity of reserpine-sensitive tyramine transport can be deduced from the steady-state level of tyramine accumulation and the rate of permeation. Vmax for tyramine transport is about one-third of the value for dopamine transport. Therefore, two aromatic hydroxyls are not needed for monoamine transport but are required for efficient accumulation and storage.

Electron transfer across the chromaffin granule membrane.

Membrane vesicles (ghosts) containing ascorbic acid were prepared from bovine chromaffin granules. When ferricyanide or ferricytochrome c were added to the external medium, a membrane potential (interior positive) developed across the ghost membrane. This membrane potential could not be elicited from ascorbate-free ghosts or by ferrocyanide added instead of ferricyanide. These results indicate that the chromaffin-granule membrane has a transmembrane electron carrier with a midpoint potential between that of ascorbate (+85 mV) and that of cytochrome c (+255 mV). The most likely candidate is cytochrome b-561 (+140 mV).

Mechanisms of proton-linked monoamine transport in chromaffin granule ghosts.

In bovine chromaffin granules, an inwardly directed H+-translocating ATPase can create either a transmembrane pH gradient (inside acidic) or a transmembrane difference in electrical potential (inside positive). Both the pH gradient delta pH and the membrane potential delta psi can drive monoamine uptake into chromaffin granule membrane vesicles (ghosts). The monoamine concentration gradient is proportional to the square of the [H+] gradient and to exp(F delta psi/RT). This implies that monoamine uptake occurs via a proton antiport or exchange diffusion mechanism with a stoichiometry of two protons per cationic amine.

Multiple effects of reserpine on chromaffin-granule in membranes.

The tranquilizer reserpine has several effects on adrenal medullary chromaffin-granule membrane vesicles (ghosts). At low concentrations (0.20 +/0 0.12 nmol/mg of membrane protein), reserpine inhibits proton-linked epinephrine uptake but does not affect transmembrane pH and electrical potential gradients. Reserpine apparently binds to and blocks the catecholamine translocator. At intermediate concentrations (14.3 +/- 4.8 nmol/mg of membrane protein), reserpine abolishes the ATP-dependent enhancement of 8-anilinonaphthalene-1-sulfonate fluorescence without affecting the ATP-dependent membrane potential. At high concentrations (550 +/- 390 nmol/mg of membrane protein), reserpine stimulates the efflux of epinephrine from preloaded chromaffin-granule ghosts. Because it is highly hydrophobic, reserpine partitions into the membrane and probably exerts a nonspecific detergent-like action. At high concentrations (74 +/- 25 nmol/mg of lipid), reserpine also increases the permeability of phospholipid vesicles to epinephrine. The effectiveness of reserpine in inhibiting epinephrine transport correlates with the reserpine/membrane ratio but not with the molar concentration. This may account for the larger variation in reports of effective reserpine concentrations.

Stoichiometry of H+-linked dopamine transport in chromaffin granule ghosts.

A proton-translocating adenosinetriphosphatase in adrenal medullary chromaffin granule ghosts can generate either a membrane potential (inside positive) or a pH gradient (inside acid). Dopamine uptake occurs in response to both the membrane potential and the pH gradient. The natural logarithm of the dopamine concentration gradient [In (Din/Dout)] is linearly related to the membrane potential with a slope of F/(RT). This dependence is not affected by the pH of the medium. In (Din/Dout) is linearly dependent on In ([H+]in/[H+]out) with a slope of 2. These results indicate that dopamine is taken up via an exchange diffusion or antiport mechanism. The stoichiometry of this exchange is two H+/dopamine cation and is independent of pH.

Amine transport in chromaffin granule ghosts. pH dependence implies cationic form is translocated.

Chromaffin granules have a translocator-mediated uptake system for the monoamines dopamine, serotonin, norepinephrine, and epinephrine. These substrates are predominantly cationic at physiological pH but they also exist in neutral, zwitterionic, and anionic forms. The cationic fraction is nearly pH-independent between pH 6.9 and pH 7.6. Over the same pH range, the neutral and zwitterionic fractions increase by a factor of 6.3 and the anionic fraction increases by a factor of 40. In chromaffin granule ghosts, the apparent Km values for dopamine and serotonin transport are independent of pH between 6.8 and 7.6. Consequently, the translocator probably binds the cationic form of the substrate. Vmax values for dopamine and serotonin uptake increase by a factor of 2 between pH 6.8 and pH 7.6.

Electrogenic epinephrine transport in chromaffin granule ghosts.

An ATP-dependent proton pump drives epinephrine transport in chromaffin granule ghosts. When ghosts are suspended in a medium free of permeant anions, ATP addition leads to an increase in membrane potential (interior positive) and epinephrine uptake but not to a change in intravesicular pH. Since ATP does not affect the pH gradient, the energy for transport must be drawn from the membrane potential (delta psi), and epinephrine uptake must result in a net efflux of positive charge. This can be achieved by an antiport (exchange diffusion) mechanism in which each catecholamine cation is taken up in exchange for more than one H+. Measurements indicate that the stoichiometry is close to 2 H+/epinephrine cation, so the equilibrium epinephrine gradient is theoretically [E]in/[E]out = ([H+]in/[H+]out)2eFdelta psi/(RT). In deenergized ghosts, the epinephrine concentration gradient equals the [H+] gradient. This is consistent with a situation in which the H+ concentration gradient is in equilibrium with the membrane potential as described by the Nernst equation. Then, in the equation above, the membrane potential term (eFdelta psi/(RT)) will exactly cancel one power of the [H+] gradient, leaving [E]in/[E]out equal to [H+]in/[H+]out.

Determination of copper and iron in human blood serum by energy dispersive x-ray analysis.

Human blood serum has been analyzed by X-ray fluorescence spectroscopy utilizing the effect of background reduction by total reflexion of the incident X-ray beam on an optical flat as sample support. For sample preparation a drop of 10 microliter serum was pipetted onto the support and dried to a thin film. The minimum detectable limit was about 1.5 mmol/l in 1000 s and the precision in the 20 mmol/l range of the metals was 3-5%.