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We investigate a prototypical single-molecule switch marrying force spectroscopy and molecular electronics far from the thermodynamic limit. We use molecular dynamics to simulate a conducting atomic force microscope mechanically manipulating a molecule bound to a surface between a folded state and an unfolded state while monitoring the conductance. Both the complexity and the unique phenomenology of single-molecule experiments are evident in this system. As the molecule unfolds/refolds, the average conductance reversibly changes over 3 orders of magnitude; however, throughout the simulation the transmission fluctuates considerably, illustrating the need for statistical sampling in these systems. We predict that emergent single-molecule signatures will still be evident with conductance blinking, correlated with force blinking, being observable in a region of dynamic bistability. Finally, we illustrate some of the structure-function relationships in this system, mapping the dominant interactions in the molecule for mediating charge transport throughout the pulling simulation.

A coarse-grained, rigid-rod model that includes steric interactions and an internal dipole is used to study monolayers of surfactant molecules tethered to a flat interface. Monte Carlo simulations are performed in the canonical ensemble for a range of high-density configurations with varying degrees of dipole strength. Both a melting transition and a tilting transition are observed, and the dependence of the transitions on the surfactant molecules' internal dipoles is examined. Simulation results indicate that at high packing densities, the monolayers exist in a frustrated state due to dipole-dipole repulsions and steric interactions. Tilting of the surfactant molecules increases the magnitude of the dipole-dipole attractions and lowers the overall system energy, but is limited by steric repulsions. In simulations with higher dipole strengths, the melting and tilting transitions are found to be coupled. The formation of nanodomains with increased collective tilt and positional order in these systems suggests a possible mechanism for the coupling.

The effects of molecular conformation on conductance in oligosilane-bridged metal-molecule-metal junctions are studied theoretically using density functional theory combined with a nonequilibrium Green's function approach. Varying the internal SiSiSiSi dihedral angles in hexasilane diamine chains changes the conductance by up to 3 orders of magnitude. This conformational dependence is due to the effects of sigma-delocalization on the positions of the highest occupied molecular orbital (HOMO) energies. The conductance values for the different conformations are related to electron transfer rates in donor-bridge-acceptor systems, and the effect of shifting the injection energy is examined. The transport properties are found to be extremely sensitive to the alignment between the HOMO energies and Fermi level of the gold electrodes.

Using a dissymmetrically-perturbed particle-in-a-box model, we demonstrate that the induced optical activity of chiral monolayer protected clusters, such as Whetten's Au28(SG)16 glutathione-passivated gold nanoclusters (J. Phys. Chem. B, 2000, 104, 2630-2641), could arise from symmetric metal cores perturbed by a dissymmetric or chiral field originating from the adsorbates. This finding implies that the electronic states of the nanocluster core are chiral, yet the lattice geometries of these cores need not be geometrically distorted by the chiral adsorbates. Based on simple chiral monolayer protected cluster models, we rationalize how the adsorption pattern of the tethering sulfur atoms has a substantial effect on the induced CD in the NIR spectral region, and we show how the chiral image charge produced in the core provides a convenient means of visualizing dissymmetric perturbations to the achiral gold nanocluster core.

Two patients with poor-prognosis leukemia were treated with high-dose cytosine arabinoside (Ara-C), 3 g/m2, for induction. Both patients developed serious jaundice in the second posttreatment week. Clinically, the jaundice was characterized by conjugated hyperbilirubinemia, normal amino transferase levels, significant elevation of alkaline phosphatase, and no evidence of obstruction. Microscopic examination of the liver showed only passive congestion with blood, and no bile lakes or plugs. This was believed to be most consistent with drug-induced intrahepatic cholestasis, possibly as a result of injury to the hepatocyte transport system.

We have previously reported an algorithm that invokes several imaging modalities in the early detection of metastatic and benign disease of the spine in patients with cancer (J Clin Oncol 4:576, 1986). The development of new lesions (shown by Tc99m bone scans) in cancer patients with normal neurological examinations is further evaluated with plain radiographs, spinal computed tomography (CT), and CT myelography (CT-M). Of 60 patients in the original study, 28% were diagnosed as having only benign disease and the remainder had spinal metastases. Thecal sac impingement was seen in 47% of patients with metastatic disease and disruption of the posterior vertebral cortex was noted in all patients with epidural compression. We now report the 2-year follow-up of 55 of these patients. Without treatment, the 17 patients diagnosed with benign disease have shown no evidence of local failure in the spine and median survival is greater than 27 months. Thirty-eight patients diagnosed with spinal metastases had a median survival time of 16.9 months. Radiation therapy directed by CT-M findings provided pain relief in 78% of patients with back pain and metastatic disease. No patient, including 19 with thecal sac impingement, developed clinical myelopathy. These results demonstrate the usefulness of an imaging algorithm for the early identification and distinction of spinal metastatic disease and benign disease in patients with cancer.

Prednimustine, an ester of chlorambucil and prednisolone, was evaluated for efficacy and toxicity in a selected group of leukemia patients with a poor prognosis. Disease subsets consisted of patients with acute non-lymphocytic leukemia (ANLL) over age 60; ANLL refractory to standard therapy; smouldering leukemia; and refractory anemia with excess blasts (RAEB). In agreement with previous studies, toxicity from Prednimustine was relatively mild, consisting primarily of infrequent myelosuppression, gastrointestinal side-effects, and mild hyperglycemia. This study did not, however, confirm previously reported remission rates in ANLL: in 41 evaluable patients only two complete remissions were achieved. Both occurred in the subset of patients with smouldering leukemia. We conclude that Prednimustine has limited activity in this patient population.

A 54-year-old man with plasma cell myeloma had sustained bleeding develop after prophylactic hip hemiarthroplasty. Routine coagulation studies revealed significant prolongation of the prothrombin time, activated partial thromboplastin time, and thrombin time. Further evaluation showed failure of the activated partial thromboplastin time to correct in a 1:1 mixture with pooled normal plasma, correction of the prolonged thrombin time by addition of protamine, and a normal reptilase time. A purified preparation of the immunoglobulin component of patient plasma produced the same pattern of coagulation abnormalities, suggesting the paraprotein possessed heparin-like anticoagulant activity. This appears to be a rare mechanism of bleeding diathesis in plasma cell myeloma.

New lesions were shown by Tc99m bone scans to have developed in sixty patients with known metastatic cancer or high-risk primary cancer and normal neurologic examinations; they were further evaluated with plain radiographs, spinal computed tomography (CT), and CT myelography (CT-M) according to an algorithm. Three groups were identified based on plain radiographs: group 1 (normal radiograph), group 2 (compression fracture as indicated by radiograph), group 3 (evidence of metastasis as indicated by radiograph). In group 1 (n = 18), spinal CT revealed that 33% of the patients had benign disease and 67%, metastases; epidural compression was seen in 25% of the patients with metastasis as indicated by CT-M. In group 2 (n = 26), CT-M disclosed that 38% had a benign compression fracture and 62% had metastases and that 63% of the patients with metastases had an epidural compression. In group 3 (n = 16), spinal CT revealed that 15 patients had metastases (one patient had benign disease). Epidural cord compression was seen in 47% of the patients with metastatic disease. In all groups, the presence of cortical bone discontinuity around the neural canal (seen in 31 patients) was highly associated with epidural compression (seen in 20 patients). Our approach allowed the early and accurate diagnosis of spinal metastasis and epidural tumor as well as the diagnosis of benign disease and was useful in planning optimal local therapy.

Twenty patients with known metastatic cancer or high-risk primary cancer developed new lesions on Tc 99m bone scans and had normal plain radiographs. Spinal computed tomography (CT) was performed on all new bone-scan-positive lesions in minimal examination time. Fifteen patients had extensive metastatic vertebral disease and received local radiotherapy. One patient with new metastatic vertebral disease on CT was treated only with chemotherapy and developed acute spinal cord compression. Four patients had discogenic disease or degenerative disease but no evidence of metastases. Radionuclide bone scans are more sensitive but less specific than plain radiographs in detecting early bone metastases. Early and accurate diagnosis of metastasis is particularly important in the axial spine to prevent epidural compression and fracture. Spinal CT is valuable for identifying the presence and extent of vertebral metastases, as well as the presence of benign disease in cancer patients.

Prolymphocytic leukemia is a rare lymphoproliferative disorder characterized by marked lymphocytosis, massive splenomegaly, minimal lymphadenopathy, and poor prognosis. Previous reports have noted very short survival, and poor response to single agent alkylator chemotherapy. A small number of reports have shown response to combination chemotherapy regimens including Adriamycin (doxorubicin). A case of prolymphocytic leukemia with serial responses to combination chemotherapy and splenectomy resulting in significant prolongation of survival is reported.

Although increased efficacy has been described with a five-day schedule of high-dose cisplatin (CDDP) in hypertonic saline, severe myelosuppression and cumulative neurotoxicity have limited the usefulness of this therapy. In order to evaluate a possible dose-response relationship in non-small-cell lung cancer (NSCLC), 17 patients with metastatic disease were treated with a modified dose schedule delivering the same total dose (200 mg/m2) in a divided day 1 and 8 schedule. During a pilot study, a total of 47 cycles of therapy were administered, with a median of three cycles per patient and a median total cumulative dose of 600 mg/m2. Nine of 17 patients received at least 600 mg/m2. While nephrotoxicity was similar to previous reports of the five-day schedule, the incidence and severity of myelosuppression and peripheral neuropathy were markedly reduced. Using this modified schedule, severe myelosuppression did not occur. Clinically severe peripheral neuropathy developed in only one patient (6%). The overall response rate was 47% (eight of 17 patients). Plasma platinum pharmacokinetics during five cycles of the modified day 1 and 8 schedule were compared with pharmacokinetics of the five-day schedule. Accumulation of plasma ultrafiltrate platinum occurred in the five-day schedule, but not in the day 1 and 8 schedule. This difference in pharmacokinetics is one possible explanation for the reduced toxicity of this modified schedule. Although the degree of activity seen in this pilot study is encouraging, the efficacy of high-dose CDDP in NSCLC remains to be defined. In view of reduced myelosuppression and neurotoxicity, further trials with this modified schedule are indicated.

Twenty-one patients with refractory chronic lymphocytic leukemia (CLL) were entered into this Northern California Oncology Group (NCOG) study of prednimustine, an ester of chlorambucil and prednisolone. All patients had active disease and were refractory to standard alkylating agent chemotherapy. Treatment consisted of prednimustine 100 mg/m2/day orally for 3 consecutive days every 2 weeks. By strict response criteria used in this study there was one complete remission (CR), no partial remissions (PR), and three cases of clinical improvement (CI) in 18 evaluable patients, for a total response rate of 22%. The median duration of response is 20+ months, with two patients continuing to respond. Toxicity of this intermittent prednimustine regimen consisted primarily of mild to moderate thrombocytopenia and neutropenia. No episodes of treatment-associated infection or hemorrhage occurred, and nonhematologic toxicity was minor. Using strict response criteria, this study fails to confirm previous reports of high response rates for prednimustine in patients with CLL refractory to standard therapy. The significance of the response category of clinical improvement in CLL is demonstrated by the substantial improvement in objective parameters and the long duration of response. This study also emphasizes the need for standardization of response criteria for this disease.