Prolonged use of pegylated liposomal doxorubicin in gynecologic malignancies.

Pegylated liposomal doxorubicin (PLD) is a palliative treatment option for patients with recurrent gynecologic malignancies. It has an appealing toxicity profile and responses can be prolonged. There is no consensus as to the level of cardiac toxicity. Current label warnings, National Comprehensive Cancer Network (NCCN) guidelines, and extrapolation of prescribing guidelines from doxorubicin, may limit PLD's use in patients with baseline cardiac comorbidities, limit the lifetime dosing of an effective palliative treatment, or lead to over-use of unnecessary cardiac testing. This case series describes the experience of 18 patients using prolonged courses of PLD for gynecologic malignancies with no cardiac toxicity.

Cervical cancer in women over 65: An analysis of screening.

OBJECTIVE: Evaluate the characteristics and screening history of patients diagnosed with cervical cancer over age 65. METHODS: A retrospective review of 34 patients who were diagnosed with cervical cancer after the age of 65 at a single community cancer center between 2006 and 2016 was performed. Data collected included screening history, method of detection, stage, and survival. RESULTS: Between 2006 and 2016, 346 women were diagnosed with cervical cancer at a single community cancer center, 34 (9.8%) of them were over 65 years old. 30 had known screening histories and could be evaluated. 15 women had adequate screening prior to being diagnosed with cervical cancer, indicating that 50% of women who developed cervical cancer after age 65 in this population followed screening guidelines and still developed disease. CONCLUSIONS: Women over 65 make up a significant portion of women diagnosed with cervical cancer. As many as half of all cervical cancers over age 65 occur in women who get recommended screening, and some of these may be prevented or detected early if screening was extended beyond age 65.

Epithelioid angiosarcoma of the vulva: A case report.

•Vulvar angiosarcoma in a patient with pelvic radiation and chronic lymphedema•Epithelioid histologic staining positive for vimentin, ERG, CD31•Gross appearance of violaceous hyperpigmentation of the mons pubis.

Ethical considerations regarding disparities pertaining to kidney transplant patients.

Racial and ethnic disparities exist throughout the US health-care system, including in the field of solid-organ transplant. There are disparities in access to health care, health outcomes, and access to transplant centers. Addressing this issue requires equity in pretransplant care, increased education and referral throughout the transplant process, and research funds targeted to the study of problems pertinent to transplantation in certain patient populations.

In vitro and in vivo effects of West Nile virus propagated in cells of different passage.

Tissue cultures are used to propagate viruses for use in mosquito infection studies and to detect live virus in field-collected specimens. Microscopic evaluation of cytopathic effects is used to visualize virus presence. In this study, both low-passage (LP; n = 35) and high-passage (HP; n = 218) lines of African green monkey kidney (Vero) cells were infected with West Nile virus, and virus growth kinetics were quantitated over different incubation periods (IPs) (2, 6, 10, 24, 48, 72, and 96 h postinfection). Virus titers were significantly (P < 0.05) higher in the HP compared with LP line 24, 48, and 96 h postinfection. No differences were observed in plaque morphology between the LP and HP lines. Culex pipiens quinquefasciatus were fed infectious blood meals created using supernatant from the 2 lines and maintained at 28 degrees C for a 12-day IP. Although the virus dose was higher (P < 0.05) in the HP compared with the LP line, there were no significant differences in mosquito infection or dissemination rates at the end of the IP. The significance of these observations for assessing virus presence and pathogenicity is discussed.

The sub-energetic gamma-ray burst GRB 031203 as a cosmic analogue to the nearby GRB 980425.

Over the six years since the discovery of the gamma-ray burst GRB 980425, which was associated with the nearby (distance approximately 40 Mpc) supernova 1998bw, astronomers have debated fiercely the nature of this event. Relative to bursts located at cosmological distance (redshift z approximately 1), GRB 980425 was under-luminous in gamma-rays by three orders of magnitude. Radio calorimetry showed that the explosion was sub-energetic by a factor of 10. Here we report observations of the radio and X-ray afterglow of the recent GRB 031203 (refs 5-7), which has a redshift of z = 0.105. We demonstrate that it too is sub-energetic which, when taken together with the low gamma-ray luminosity, suggests that GRB 031203 is the first cosmic analogue to GRB 980425. We find no evidence that this event was a highly collimated explosion viewed off-axis. Like GRB 980425, GRB 031203 appears to be an intrinsically sub-energetic gamma-ray burst. Such sub-energetic events have faint afterglows. We expect intensive follow-up of faint bursts with smooth gamma-ray light curves (common to both GRB 031203 and 980425) to reveal a large population of such events.

A common origin for cosmic explosions inferred from calorimetry of GRB030329.

Past studies have suggested that long-duration gamma-ray bursts have a 'standard' energy of E(gamma) approximately 10(51) erg in the ultra-relativistic ejecta, after correcting for asymmetries in the explosion ('jets'). But a group of sub-energetic bursts, including the peculiar GRB980425 associated with the supernova SN1998bw (E(gamma) approximately 10(48) erg), has recently been identified. Here we report radio observations of GRB030329 that allow us to undertake calorimetry of the explosion. Our data require a two-component explosion: a narrow (5 degrees opening angle) ultra-relativistic component responsible for the gamma-rays and early afterglow, and a wide, mildly relativistic component that produces the radio and optical afterglow more than 1.5 days after the explosion. The total energy release, which is dominated by the wide component, is similar to that of other gamma-ray bursts, but the contribution of the gamma-rays is energetically minor. Given the firm link of GRB030329 with SN2003dh, our result indicates a common origin for cosmic explosions in which, for reasons not yet understood, the energy in the highest-velocity ejecta is extremely variable.

The bright optical afterglow of the nearby gamma-ray burst of 29 March 2003.

Past studies of cosmological gamma-ray bursts (GRBs) have been hampered by their extreme distances, resulting in faint afterglows. A nearby GRB could potentially shed much light on the origin of these events, but GRBs with a redshift z

Early optical emission from the gamma-ray burst of 4 October 2002.

Observations of the long-lived emission--or 'afterglow'--of long-duration gamma-ray bursts place them at cosmological distances, but the origin of these energetic explosions remains a mystery. Observations of optical emission contemporaneous with the burst of gamma-rays should provide insight into the details of the explosion, as well as into the structure of the surrounding environment. One bright optical flash was detected during a burst, but other efforts have produced negative results. Here we report the discovery of the optical counterpart of GRB021004 only 193 seconds after the event. The initial decline is unexpectedly slow and requires varying energy content in the gamma-ray burst blastwave over the course of the first hour. Further analysis of the X-ray and optical afterglow suggests additional energy variations over the first few days.

Effect of physico-chemical modification on the immunogenicity of Haemophilus influenzae type b oligosaccharide-CRM(197) conjugate vaccines.

Haemophilus influenzae type b (Hib) poly-ribosyl-ribityl phosphate (PRP) oligosaccharide-CRM(197) conjugate vaccines from two different manufacturers (Hib A and Hib B) were subjected to adverse storage conditions and used to establish correlates between physico-chemical characteristics and immunogenicity. There were manufacturer-specific differences in the effect of freezing or freeze-thawing on the carrier protein conformation and the anti-CRM(197) or anti-PRP IgG response in rabbits whereas both conjugates showed similar stability when stored at elevated temperatures. Both oligosaccharide-CRM(197) conjugate vaccines formed apparent 'aggregates' of non-specifically associated higher molecular weight material when subjected to elevated temperatures or repeated freeze-thawing. Following subcutaneous injection of samples into CBA mice and New Zealand White rabbits, the amount of IgG raised against CRM(197) was significantly lower for samples incubated at 37 or 55 degrees C compared with those kept at 4 degrees C, consistent with the less well-folded conformation of the carrier protein observed at elevated temperatures. Moreover, there was a parallel reduction in the amount of IgG raised against PRP and the level of bactericidal antibodies induced by vaccines A and B stored at 55 degrees C consistent with the observed depolymerisation of the oligosaccharide chains. Carrier protein conformational changes resulting from storage under adverse conditions did not affect the immunogenicity to Hib PRP in laboratory animals unless associated with loss of bound saccharide presumably because the carrier protein retains continuous T(H) cell epitopes which are unaffected by conformational changes.

Air emission flux from contaminated dredged materials stored in a pilot-scale confined disposal facility.

A pilot-scale field simulation was conducted to estimate the air emissions from contaminated dredged material stored in a confined disposal facility (CDF). Contaminated dredged material with a variety of organic chemicals, obtained from Indiana Harbor Canal, was used in the study. It was placed in an outdoor CDF simulator (i.e., a lysimeter of dimensions 4 ft x 4 ft x 2 ft). A portable, dynamic flux chamber was used to periodically measure emissions of various polynuclear aromatic hydrocarbons (PAHs). A weather station was set up to monitor and record the meteorological conditions during the experiment. The fluxes of several PAHs were monitored over time for 6 1/2 months. Initial 6-hr average fluxes varied from 2 to 20 ng/cm2/hr for six different PAHs. The flux values declined rapidly for all compounds soon after placement of the dredged material in the CDE Chemical concentrations derived from flux values were generally of low magnitude compared with ambient standards. Data obtained from the experiment were compared against those predicted using models for air emissions. Model simulations showed that initially the flux was largely from exposed pore water from saturated (wet) sediment, whereas the long-term flux was controlled by diffusion through the pore air of the unsaturated sediment. Model predictions generally overestimated the measured emissions. A rainfall event was simulated, and the dredged material was reworked to simulate that typical of a CDF operation. Increased flux was observed upon reworking the dredged material.

Non-pertussis components of combination vaccines: problems with potency testing.

Vaccines comprising combinations of diphtheria, tetanus and pertussis (DTP) with Haemophilus influenzae type b polysaccharide-protein conjugate (Hib), inactivated poliomyelitis virus (IPV) and hepatitis B virus (HBV) are already available, and new combinations using acellular pertussis components in a triple vaccine (DTaP) are under development. Evidence to date has shown that control of the efficacy, safety and stability of combination vaccines cannot be based on information already available on the individual components or existing licensed formulations. Several examples of immunological interference between components of a combination vaccine have been observed both in clinical trials and in laboratory tests. Examples of these for D, T and Hib components in DTP and DTaP combinations have been investigated.

Aneurysms of the pancreaticoduodenal arteries: a change in management.

Since the first report of an aneurysm involving the pancreaticoduodenal arteries a century ago, only 83 cases have been reported in our collective review of the English literature. Their presentation varies from indistinct abdominal pain to hemorrhagic shock, often making the diagnosis onerous. The mortality rate in this patient group has been significant, and in cases reported since 1980, the mortality rate remains at 17% (7 deaths/42 reported cases). Surgery has been, and continues to be, the cornerstone of therapy, with an incumbent mortality rate of 19% (5 deaths/26 patients treated surgically since 1980). This case report and 100-year review of the literature describes the causes, natural history, and historic management of pancreaticoduodenal artery aneurysms. Most importantly, it demonstrates the use of angiographic embolization in the definitive management of these aneurysms with no mortality.

Molecular cloning and functional expression of a rabbit renal organic cation transporter.

A cDNA encoding an organic cation transporter (rbOCT1) was isolated from rabbit kidney. The cDNA encodes a 554 amino acid protein that is highly homologous to other mammalian organic cation transporters. rbOCT1 mediated 3H-1-methyl-4-phenylpyridinium (3H-MPP+) transport in Xenopus laevis oocytes was saturable, sensitive to membrane potential, and inhibited by various organic cations. rbOCT1 mRNA transcripts are expressed in the kidney, liver, and intestine.

Cloning and functional expression of a human liver organic cation transporter.

Polyspecific organic cation transporters in the liver mediate the elimination of a wide array of endogenous amines and xenobiotics. In contrast to our understanding of the mechanisms of organic cation transport in rat liver, little is known about the mechanisms of organic cation transport in the human liver. We report the cloning, sequencing, and functional characterization of the first human polyspecific organic cation transporter from liver (hOCT1). hOCT1 (554 amino acids) is 78% identical to the previously cloned organic cation transporter from rat, rOCT1 [Nature (Lond.) 372:549-552 (1994)]. In Xenopus laevis oocytes injected with the cRNA of hOCT1, the specific uptake of the organic cation 3H-1-methyl-4-phenylpyridinium (3H-MPP+) was significantly enhanced (8-fold) over that in water-injected oocytes. Uptake of 3H-MPP+ was saturable (K(m) = 14.6 +/- 4.39 microM) and sensitive to membrane potential. Both small monovalent organic cations such as tetraethylammonium and N1-methylnicotinamide and bulkier organic cations (e.g., vecuronium and decynium-22) inhibited the uptake of 3H-MPP+. In addition, the bile acid taurocholate inhibited the uptake of 3H-MPP+ in oocytes expressing hOCT1. Northern analysis demonstrated that the mRNA transcript of hOCT1 is expressed primarily in the human liver, whereas the mRNA transcript of rOCT1 is found in rat kidney, liver, intestine, and colon [Nature (Lond.) 372:549-552 (1994)]. In comparison to rOCT1, hOCT1 exhibits notable differences in its kinetic characteristics and tissue distribution. The functional expression of hOCT1 will provide a powerful tool for elucidation of the mechanisms of organic cation transport in the human liver and understanding of the mechanisms involved in the disposition and hepatotoxicity of drugs.

Molecular size characterization of Haemophilus influenzae type b polysaccharide-protein conjugate vaccines.

Current vaccines against Haemophilus influenzae type b (Hib) consist of capsular polysaccharide, polyribosylribitol phosphate (PRP), chemically conjugated to a carrier protein. The stability of the conjugate is essential for vaccine efficacy, as the target population for this vaccine includes infants, who do not mount an immune response to free polysaccharide vaccines. A method has been developed for determining structural stability and batch-to-batch consistency of Hib vaccines by the application of fast protein liquid chromatography (FPLC). This FPLC method is fast, reproducible, and can be used to evaluate single human doses of Hib vaccines. We have shown that the FPLC elution profiles provide a suitable indicator of vaccine stability under normal and degradative conditions. The method may also be applicable to other conjugate vaccines such as meningococcal and pneumococcal protein-polysaccharide conjugates.

Physicochemical studies of the structure and stability of polysaccharide-protein conjugate vaccines.

This short review highlights some areas in which spectroscopic methods have been applied to monitor the structure and stability of both the carbohydrate and protein moieties of polysaccharide-protein conjugate vaccines, such as those now in widespread clinical use for protection against Haemophilus influenzae infection.

Randomized clinical trial of antithymocyte globulin induction in renal transplantation comparing a fixed daily dose with dose adjustment according to T cell monitoring.

Antithymocyte globulin (ATG) has been used successfully for induction therapy as well as for treatment of established allograft rejection. However, this therapy has often been associated with problems of overimmunosuppression and increased costs. In a randomized clinical trial, we compared the immunosuppressive benefits, complication rates, and treatment costs when ATG is given as a fixed daily dose or when the dose is adjusted daily according to its biologic effects on T cells. Forty-five recipients of cadaver renal allografts were randomized into two groups. In group 1 (n = 23), ATG (ATGAM) was administered in variable doses to maintain the absolute number of peripheral CD3 T cells at 50-100/microliters. In group 2 (n = 22), ATG was given at a fixed dose of 15 mg/kg/day. All patients received azathioprine and prednisone. ATG was discontinued at 7-14 days when cyclosporine was introduced. In both groups, CD2, CD3, CD4, CD8, and CD19 cells were measured by flow cytometry and the levels of cytokines IL-1 beta, IL-2R, ICAM-1, IL-6, IL-7, and levels of cytokines IL-1 beta, IL-2R, ICAM-1, IL-6, IL-7, and levels of cytokines IL-1 beta, IL-2R, ICAM-1, IL-6, Il-7, and IL-10 were measured by ELISA. In group 2, the levels of all T cell subsets were profoundly suppressed. In group 1, the number of CD3 and other T cells was maintained at about 100 cells/microliters, while the CD19 T cells remained unsuppressed. Cytokine levels were greatly suppressed in group 2 compared with group 1, except for IL-10 levels, which remained elevated in the latter group. Patient survival, graft function, and the incidence of acute and recurrent rejections were similar in the two groups. Bone marrow suppression and infective complications were greater in group 2 than in group 1. The mean daily dose and the total quantity of ATG used in group 1 were significantly smaller than in group 2, resulting in a savings of $2,398.00 per patient per treatment. It is concluded that monitoring of ATG by its biologic effects on T cells is a rational and safe method of regulating the dose of this important agent; in this way, it is possible to reduce the total amount of the drug given to patients with consequent reduction in undesirable complications as well as in the cost of treatment without loss of immunosuppressive benefits.