D.A. Rew

Measurement of in vivo proliferation in human colorectal mucosa using bromodeoxyuridine.

In vivo bromodeoxyuridine (BrdUrd) labelling of the human large bowel was performed and a detailed histochemical localisation of label in sections of crypts was undertaken using a monoclonal antibody to BrdUrd containing DNA. Flow cytometric studies on extracted nuclei were also performed (data presented elsewhere). The average crypt in the human large bowel (excluding the rectum) was 82 cells in height and 41 cells in circumference, with a total of about 2000 cells (assuming a topographical correction factor of 0.6). Ten per cent of the cells were replicating their DNA--that is, were in the S phase of the cell cycle--and 0.4% were in mitosis. The median position for the labelling index versus cell position frequency plot is at the 20th cell position--at a quarter of the crypt height. The lower and upper limits of the cell proliferation are given by the 5th and 95th percentiles at cell positions 4 and 43 respectively. The peak labelling index is about 30% and it occurs at cell position 15. The labelling index at the crypt base, the probable stem cell zone, is about 14%, suggesting that these cells have a longer cell cycle. Taking a value of 8.6 hours for the duration of the S phase (deduced from the flow cytometric data) and assuming a growth fraction of 1.0 for the mid-crypt, these data provide an estimate of about 30 hours for the cell cycle time. The rectal crypts are about the same size but contain about 30% fewer S phase cells. The data also yielded a per cent BrdUrd labelled mitosis curve.

Proliferation in human gastrointestinal epithelium using bromodeoxyuridine in vivo: data for different sites, proximity to a tumour, and polyposis coli.

The distribution of DNA synthesising cells in the crypts of the epithelium in human small and large bowel after injection of bromodeoxyuridine into patients has been studied in relation to the position of the cells in the crypt using immunohistochemistry. Different sites of normal epithelium have been studied. The ileum has a shorter crypt and a very significantly smaller total cell population size. However, it has similar peak labelling index (LI) values to the colon, while the rectum has a lower peak LI value. The mean position of the label occurs at the 17th cell position in the ileum and at about the 22nd position in both the colon and rectum. The overall mean LI is significantly higher in the ileum at 17.8%, intermediate in the colon at 10.3%, and lowest in the rectum at 8.5%. There is thus an inverse relation between the likelihood of developing a tumour and the rate of cell proliferation as measured by the LI. Assuming a value of 8.6 hours for the duration of S, the data suggest that the cell cycle time in the mid crypt region is about 30 hours for the ileum and colon and about 37 hours for the rectum. Samples taken adjacent (within 1 cm) to a tumour show a general dampening of proliferative activity at all cell positions compared with samples taken more than 5 cm from a tumour. This is illustrated by the average LI, which is about 5.4% in the colon adjacent to a tumour compared with 10% distant; comparable values for the rectum are 4.6% and 8.5%. Samples taken from two patients with polyposis coli show distributions with a significant difference in skewness compared with normal colon and a general shifting of the distribution to the right, that is to higher cell positions. There is a significant increase in the mean cell position and the position of the peak LI in the polyposis coli samples.

Study of the proliferation in human gastric mucosa after in vivo bromodeoxyuridine labelling.

Studies to measure human gastric crypt or gland cell proliferation may have a number of practical clinical applications in relation to both benign and malignant gastric conditions. Bromodeoxyuridine (BrdUrd) labels human gastric mucosal cells in the S phase. Computer aided data analysis of labelled mucosa allows static proliferative indices to be estimated, including the crypt labelling index (LI), the peak labelling position, the distribution of labelled cells and indirectly the crypt growth fraction. Multiparameter flow cytometric analysis of labelled nuclei allows the S phase duration (Ts) of mucosal cells to be estimated. Specimens of histologically normal gastric body (GB, n = 16) and antral mucosa (GA, n = 10) were obtained from 25 patients with gastric carcinomas who received a bolus dose of 250 mg BrdUrd between 3.0 and 15.7 hours before surgery. Tissue sections were stained by an immunohistochemical method and subjected to detailed counting of up to 50 longitudinal crypts per specimen. The total crypt labelling index was calculated by a grid counting method. A significant difference existed between the proliferative compartments of gastric antral and body mucosa measured by a number of criteria. The median lengths of the crypts were 137 cells (GB) and 188 cells (GA). The median peak labelling positions were cell 26 (GB) and cell 61 (GA) from the crypt orifice. The mean crypt labelling indices were 2.8% (GB) and 4.8% (GA). The mean Ts of GA cells was 7.7 hours and of GB cells was 10.8 hours.

Advances in cell kinetics.

times a day. These three agents have not yet been compared directly in a single study. What is needed is the most effective drug with the simplest method of administration and control and the smallest risk of adverse effects. In these days of cost effectiveness the modest cost of prophylactic treatment must be measured against the considerable risk of thromboembolic complications of hip surgery if no prophylaxis is given, with the cost of the increased length of stay in hospital, morbidity, and mortality. How long anticoagulants should be continued postoperatively has not been determined; most series have recorded late presentations of thromboembolic complications after discharge from hospital. What is inescapable is the need for prophylaxis. J PARKER-WILLIAMS Consultant Haematologist ROGER VICKERS Consultant Orthopaedic Surgeon St Georges Hospital, London SW17 OQT

Near-clinical applications of laser scanning cytometry.

Biological samples from human tissues are characterized by complexity and heterogeneity. The ability to make rapid, reliable, quantitative fluorochromatic measurements on clinical samples allows the development of new and practical assays that could influence diagnosis and treatment in a variety of clinical applications. Laser scanning cytometry (LSC) is a very versatile and adaptable technology that allows for the quantitative analysis of cell samples that are unsuitable for flow cytometry by virtue of their presentation and context. Crucially, it allows the direct visualization of cells and rare events and the correlation of imagery with fluorochromatic measurements. In this chapter, we describe early experiments in the study of cytotoxic drug uptake and resistance in human tumor cells and in the study of sputum cells from asthmatic patients, which harness the specific capabilities of LSC to practical clinical problems.

Small RNAs: a new class of genome regulators and their significance.

The discovery of new functions for RNA and a new category of RNA molecules offers significant insights into the regulation of the genome. This may have considerable implications for the understanding and manipulation of cancer biology.

Understanding Outcomes in Cancer Surgery Through Time Structured Patient Records

To discuss the importance of time and to introduce the concept of the time structured electronic patient record (EPR) in surgical oncology. An essay based upon the NC Misra Oration given to the Indian Association for Surgical Oncology National Conference in Lucknow, September 2011. The time structured EPR offers new insights into the contributions of multidisciplinary cancer therapeutic inputs to clinical outcomes. Indian surgical oncologists are well placed to lead in the application of modern information technology concepts to improve our understanding of cancer.

Of digital mice and men.

This article reports the arising from the recent publication of the mouse genome.

Quaternary basic man

This article is one of a series of educational features on contemporary developments in cell and molecular sciences of relevance to cancer specialists. It describes significant aspects of the human genome and related technologies, as revealed in the publication of draft sequences by two consortia in 2001.

Clinical Outcomes in the Google Era: The PB Desai Oration, ASICON 2013.

This article is based upon the PB Desai Oration which was given by the author in Ahmedabad on 28th December 2013 at the National Congress of the Association of Surgeons of India at the invitation of the Executive Board of the Indian Association for Surgical Oncology.