Spontaneous recovery of hindlimb movement in completely spinal cord transected mice: a comparison of assessment methods and conditions

STUDY DESIGN

To compare results obtained with a variety of locomotor rating scales in Th9/10 spinal cord transected (Tx) mice.

OBJECTIVES

To assess spontaneous recovery with a variety of rating scales to find the most sensitive methods for assessing recovery levels in Tx mice and differences associated with gender and condition.

SETTING

Laval University Medical Center, Neuroscience Unit & Laval University, Department of Anatomy and Physiology, Quebec City, Quebec, Canada.

METHODS

Scales including the Basso, Beattie and Bresnahan (BBB), the Basso Mouse Score (BMS), the Antri, Orsal and Barthe (AOB), the Motor Function Score (MFS) and the Averaged Combined Score (ACOS) were used to assess, in open-field and treadmill conditions, spontaneous locomotor recovery in male and female Tx mice.

RESULTS

The ACOS scale revealed a progressive increase of spontaneous recovery during 5-weeks post-Tx. The other methods detected a progressive increase for the first 2-3 weeks post-Tx without any significant progress in weeks 4 and 5. Generally, scores obtained with each method were nonsignificantly different between males and females or between open-field and treadmill conditions.

CONCLUSION

These results further confirm the existence of a limited but significant increase of locomotor function recovery, occurring without intervention, in Tx animals. Although each method could detect small levels of recovery, the ACOS method was discriminative enough to detect progressive changes up to 5 weeks post-Tx. In conclusion, the ACOS rating scale was the most discriminative method for assessing the spontaneous return of hindlimb movements found in Tx mice, both in open-field and treadmill conditions.

Effects of food and formulation on the relative bioavailability of bismuth biskalcitrate, metronidazole, and tetracycline given for Helicobacter pylori eradication

AIMS

To evaluate the effects of food and formulation on the pharmacokinetics of bismuth biskalcitrate, metronidazole and tetracycline when combined in a new 3-in-1 single capsule (BMT) for eradication of Helicobacter pylori.

METHODS

In a randomized, 3 x 3 cross-over design, 23 healthy males received one dose of BMT in the fed and fasting states and equivalent doses of the three drugs given together but as separate capsules while fasting. Bioequivalence was evaluated according to 90% confidence intervals (CIs) of ratios of geometric least square means for C(max), AUC(t), and AUC(infinity).

RESULTS

With respect to food, none of the three drugs met bioequivalence guidelines. Bismuth had lower limit CIs ranging from 12% for C(max) to 25% for AUC(infinity). The corresponding values for tetracycline were 59% and 51%. Metronidazole had a lower limit CI of 74% for C(max). With respect to formulation, bismuth had lower limits of CIs ranging from 39% for C(max) to 50% for AUC(t) and higher limits of 146% for AUC(t), metronidazole met bioequivalence guidelines, and tetracycline had lower limits of CIs between 72% for AUC(t) and 74% for AUC(infinity).

CONCLUSIONS

Food significantly decreased the relative bioavailability of each drug but formulation was without effect. This decrease may be beneficial when a local gastric action is needed, as confirmed by a near 90% eradication rate when this combined capsule is administered with food to treat gastro-duodenal local infection by H. pylori.

Biological monitoring of exposure to organophosphate pesticides in children living in peri-urban areas of the Province of Quebec, Canada

OBJECTIVE

This study was undertaken to assess the exposure to organophosphate (OP) pesticides in children from peri-urban areas of the Province of Quebec, Canada, through measurements of semi-specific alkylphosphate (AP) metabolites.

METHODS

Eighty-nine children aged between 3 and 7 years were recruited via pamphlets sent to day-care centers. A first morning urine void was collected early in the spring of 2003 prior to summertime, which is the usual period of outdoor pesticide use. During summertime, up to five more first morning voids were repeatedly collected, at 72-h intervals, over a 13-day period. The potential determinants of exposure were assessed by a questionnaire at the time of urine collection.

RESULTS

Methylphosphate metabolites were detectable in 98.2% of the 442 samples analyzed while ethylphosphates were detected in 86.7% of the samples. The geometric mean concentration (GM) of the total AP metabolites was 61.7 mug/g creatinine (range: 2.7-1967.3 mug/g creatinine). The difference in urinary AP concentrations between samples collected during spring and summer was non-significant (P=0.08). There was also no significant difference in the mean AP concentrations between summer samples of individuals living in municipalities where outdoor pesticide use is or is not restricted (P=0.25). However, the presence of a pet in the house was associated with an increase in AP concentrations during spraying season (P=0.02). Pesticides were seldom used, as reported by the questionnaire. A significant correlation was also observed (P<0.001) between the urinary AP concentrations in samples provided by siblings at the same time period.

CONCLUSIONS

Mean concentrations of AP were generally higher than those reported in other studies. The observed exposure apparently occurred mainly through the dietary ingestion of OP residues. These data raise questions on the levels of OP residues in Quebec food and the possibility that our participants consumed more fruits and vegetables than those in other studies.

A motor resonance mechanism in children? Evidence from subdural electrodes in a 36-month-old child

The presence of a neural mechanism matching execution and observation of actions in the adult human brain is well established. In children, however, description of a resonance motor mechanism is still preliminary. In the present study, we recorded electroencephalographic signals from a subdural 64-contact grid electrode in a 36-month-old child with epilepsy. Spectral analysis was performed on sequences where the child drew with her right hand, watched an experimenter drawing with his right hand or was at rest. Contact sites corresponding to sensorimotor areas were discovered where absolute power was decreased during both observation and execution of hand/arm actions. These data suggest the presence of a mirror neuron system early in the developing brain.

Leukotrienes and isocyanate-induced asthma: a pilot study

BACKGROUND

The role of leukotrienes (LTs) in the pathophysiology of isocyanate-induced asthma is not well known.

OBJECTIVE

We sought to characterize the type of airway inflammation induced by exposure to isocyanates and to investigate whether exposure to isocyanates induced an increase in LT receptor cysteinyl leukotriene ((CysLT)(1), CysLT(2) and leukotriene B(4) receptor (BLT(1))) expression, as well as a release of LT (LTC(4) and leukotriene B(4) (LTB(4))) and IL-8 in both asthmatics with isocyanate-induced asthma and healthy subjects.

METHODS

We investigated eight subjects with isocyanate-induced asthma and eight healthy subjects. Both groups underwent specific inhalation challenges to isocyanates in the laboratory. Induced sputum was collected before and after exposure to isocyanates. CysLT(1), CysLT(2) and BLT(1) expression was assessed by flow cytometry, whereas LTC(4), LTB(4) and IL-8 were measured in the sputum supernatants by enzyme immunoassay.

RESULTS

Exposure to isocyanates induced an increase in sputum neutrophils only in subjects with occupational asthma. There was a significant increase in CysLT(1) and BLT(1) receptor expression, as well as a release of LTB(4) and IL-8 after exposure to isocyanates compared with the baseline, only in subjects with isocyanate-induced asthma, whereas there was no increase in LTC(4). Exposure to isocyanates did not induce any change in LT receptor expression nor in the levels of LTC(4), LTB(4) and IL-8, in healthy subjects.

CONCLUSION

The neutrophilia observed after exposure to isocyanates is likely to be related to the release of LTB(4), probably enhanced by the increased expression of BLT(1) on neutrophils as well as by the release of IL-8. The significance of the increase of CysLT1 receptor expression on neutrophils is unknown and needs further investigation.

Clinical characteristics at initial presentation and impact of dual therapy on the outcome of bacteremic Streptococcus pneumoniae pneumonia in adults

BACKGROUND

Approximately 10% of patients hospitalized with community-acquired pneumonia (CAP) are bacteremic. Bacteremic Streptococcus pneumoniae pneumonia (BSPP) is the number one cause of mortality, representing up to 70% of all CAP deaths. In fact, all CAP guidelines have identified this issue as one of the most important issues when establishing their recommendations.

OBJECTIVE

To assess the impact of dual antibiotic therapy in patients with BSPP.

PATIENTS AND METHODS

All cases of BSPP in patients 18 years of age and older who were hospitalized from 1995 to 2000 were retrospectively analyzed. The standard initial therapeutic regimen used was cefuroxime with or without a macrolide from 1995 to 1997, and ceftriaxone and azithromycin or clarithromycin from 1998 to 2000. During the 1995 to 1997 period, only 16% of the patients initially received a macrolide, whereas all patients in the 1998 to 2000 period received a macrolide at admission.

RESULTS

Ninety-five patients (49 men, 46 women) with a mean age of 63 years (range 20 to 98 years) were included in the present study. The mean pneumonia severity index at admission was 113 for the monotherapy cohort and 114 for the dual therapy group. At admission, 30.5% of patients had a leukocyte count greater than 20 109/L, 11.5% had a systolic blood pressure less than 90 mmHg, 44.2% had a respiratory rate greater than 30 breaths/min and 33.6% had nausea/vomiting, necessitating some form of therapy or preventing the patient from eating. In addition, 16.8% had no fever at admission. Overall, 72.5% became afebrile within 48 h. Fifteen (15.8%) patients died (four within the first 72 h). The mortality rate was significantly higher in the monotherapy group (11 of 42 patients; 25.6%) than in the dual therapy cohort (four of 53 patients; 7.5%) (OR 0.23; 95% CI 0.07 to 0.74). Antibiotic resistance was not associated with increased mortality.

CONCLUSION

The combination of ceftriaxone plus a macrolide significantly reduced the mortality rate compared with monotherapy (cefuroxime) in patients with CAP that have the highest mortality rate.

Influence of omeprazole on bioavailability of bismuth following administration of a triple capsule of bismuth biskalcitrate, metronidazole, and tetracycline

The objective of this study was to determine the impact of omeprazole on bismuth (Bi) bioavailability when given in a three-in-one capsule containing bismuth biskalcitrate, metronidazole, and tetracycline. Thirty-four healthy volunteers were randomly assigned to receive three capsules (each containing bismuth biskalcitrate 140 mg + metronidazole 125 mg + tetracycline 125 mg) qid alone x 6 days or the same treatment + omeprazole (OM) 20 mg bid. Blood was drawn at intervals for 24 hours after the last dose. After the last dose, mean (CV) C(min) for plasma bismuth was 2882 pg/mL (36%) and 1195 pg/mL (23%) (p< 0.001), with and without OM, respectively. Mean (CV) C(max) was 25493 pg/mL (69%) and 8061 pg/mL (28%) (p < 0.001) with and without OM, respectively. AUC(0-24) increased by 2.9 in presence of OM (p < 0.001). Adverse events in both groups were usually mild and of a gastrointestinal nature, and all had resolved by the end of the trial. This study confirms an interaction between Bi biskalcitrate and OM. Risk of Bi toxicity, seen after long-term use of Bi compounds, is minimal here because plasma levels of Bi remained well below the toxic levels of 50 microg/L, and the treatment period with this triple capsule + OM is only 10 days, a substantially lower number of days compared to that which might produce Bi toxicity.

An In Vivo Evaluation of the Mycobacterial Filtration Efficacy of Three Breathing Filters Used in Anesthesia

Background

The use of breathing filters (BFs) has been recommended to protect the anesthesia apparatus in proven or suspected cases of tuberculosis. Some investigators have also suggested the use of BF to alleviate the need to change anesthesia breathing circuits after each case. This study evaluated the filtration efficacy of three different BFs to prevent mycobacterial contamination of breathing circuits in a model that uses a test animal.

Methods

Ten Pall BB25A (pleated hydrophobic) (Pall Canada Ltd., Mississauga, Ontario, Canada), six DAR Barrierbac S (felted electrostatic; Mallinckrodt DAR, Mirandola, Italy), and six Baxter Airlife (felted electrostatic; Baxter Canada, Mississauga, Ontario, Canada) BFs were studied. For each BF tested, 20 ml of a high concentration suspension of Mycobacterium chelonae (range, 2.0 x 10 to 9.0 x 10 colony-forming units/ml) was nebulized during 2 h at the proximal end of the endotracheal tube of anesthetized pigs. At the end of the nebulization period, the BFs were sampled for culture. The titer reduction value (number of microorganisms challenging the BF divided by the number of microorganisms recovered downstream of the BF) and the removal efficiency (difference between the number of microorganisms challenging the BF and the number of microorganisms recovered downstream of the BF, divided by the number of microorganisms challenging the BF) were calculated.

Results

The median titer reduction values were 5.6 x 10, 6.0 x 10, and 8.0 x 10 (P &lt; 0.0005), and the median removal efficiencies were greater than 99.999%, greater than 99.999%, and 100% (P = not significant) for the DAR Barrierbac S, the Baxter Airlife, and the Pall BB25A, respectively.

Conclusions

Among the three BFs studied, only the Pall BB25A completely prevented the passage of M. chelonae, thus protecting the anesthesia breathing circuit from mycobacterial contamination.

Changes in immunological and virological parameters in HIV-1 infected subjects following leukapheresis

In order to assess immune responses during HIV-1 therapeutic immunization, a large number of blood mononuclear cells (PBMC) are needed. Clinical tolerance and safety, as well as changes in immunological and virological parameters, were assessed, following leukapheresis in HIV-1 infected subjects with CD4(+) cell count >200 x 10(6)/l. PBMC were collected using a Fenwal CS3000 cell separator in 29 subjects with mean CD4(+) cell counts of 503 x 10(6)/l (range 172-1,119) and viral load of 2.5 log(10) copies/ml (range <1.7-5.4). Twenty-four (83%) subjects were on antiretroviral therapy while 5 (17%) were untreated. The blood volume processed was 7 L over a period of 3 hours. A mean value (+/- standard error) of 82 +/- 26 x 10(9)/l lymphocytes was collected by a single apheresis in a mean volume of 200 +/- 1.8 ml, containing 9.0 +/- 1.3 x 10(9)/l CD4(+) and 10.2 +/- 1.3 x 10(9)/l CD8(+) cells. The leukapheresis procedures were well tolerated and no immediate or delayed side effects were observed within 90 days of follow-up. No changes from blood pre-leukapheresis values were detected for white blood cells, lymphocytes, monocytes, CD8(+), CD34(+), naive and memory CD4(+) cell counts immediately after, 1 h, 7 days, or within 90 days after leukapheresis. However, absolute CD4(+) cell counts and percentage significantly increased from pre-leukapheresis values after 1 h (530 +/- 43 vs. 700 +/- 75 cell x 10(6)/l; 32.6 +/- 1.6 vs. 36.9 +/- 1.9%; P < 0.001 for both paired t-tests) before returning to pre-leukapheresis levels on day 7. No significant changes in viral load from pre-leukapheresis levels in treated or untreated subjects were detected at any time points. We conclude that leukapheresis in HIV-1 infected subjects with CD4(+) cell counts >200 x 10(6)/l is safe and induces a transient increase in the absolute and percentage of CD4(+) cell count without enhancing viral replication.

Rectal tissue, plasma and urine concentrations of mesalazine after single and multiple administrations of 500 mg suppositories to healthy volunteers and ulcerative proctitis patients

OBJECTIVE

Patients with ulcerative proctitis may have rectal mucosal properties different from healthy volunteers. This project compared the pharmacokinetics of rectally administered mesalazine in these two populations.

METHODS

In two separate studies, nine patients with ulcerative proctitis and 16 healthy volunteers received a single 500 mg mesalazine suppository and then 500 mg every 8 h for 5 days. Blood samples were collected for 12 h in healthy volunteers and 30 h in patients, and urine for 24 h in healthy volunteers and 30 h in patients. Rectal biopsies were performed 8 h after the last dose.

RESULTS

After a single dose to patients, mean mesalazine half-life (s.d.) was 5.0 (3.6) h. At steady-state, means (s.d.) were 89.1 (78.9) ng/mL for C(min), 361.1 (240.8) ng/mL for C(max), and 7.1 (7.3) h for half-life. Mean (range) rectal mesalazine concentrations were 167 (1.4-541.6) ng/mg tissue. After a single dose in healthy volunteers, mean (s.d.) half-life was 4.0 (4.7) h. At steady-state, means (s.d.) were 22.4 (61.6) ng/mL for C(min), 359.4 (166.3) ng/mL for C(max), and 0.9 (0.5) h for half-life.

CONCLUSION

Mesalazine is released in the rectum of patients, with a bioavailability of about 40%. Tissue distribution is also appreciable. Both parameters appear higher than in healthy volunteers.

Cost-benefit and cost-effectiveness analysis of a disability prevention model for back pain management: a six year follow up study

AIMS

To test the long term cost-benefit and cost-effectiveness of the Sherbrooke model of management of subacute occupational back pain, combining an occupational and a clinical rehabilitation intervention.

METHODS

A randomised trial design with four arms was used: standard care, occupational arm, clinical arm, and Sherbrooke model arm (combined occupational and clinical interventions). From the Quebec WCB perspective, a cost-benefit (amount of consequence of disease costs saved) and cost-effectiveness analysis (amount of dollars spent for each saved day on full benefits) were calculated for each experimental arm of the study, compared to standard care.

RESULTS

At the mean follow up of 6.4 years, all experimental study arms showed a trend towards cost benefit and cost effectiveness. These results were owing to a small number of very costly cases. The largest number of days saved from benefits was in the Sherbrooke model arm.

CONCLUSIONS

A fully integrated disability prevention model for occupational back pain appeared to be cost beneficial for the workers' compensation board and to save more days on benefits than usual care or partial interventions. A limited number of cases were responsible for most of the long term disability costs, in accordance with occupational back pain epidemiology. However, further studies with larger samples will be necessary to confirm these results.

Pregnancy planning and folic acid supplement use: results from a survey in Quebec

BACKGROUND

To decrease the risk of neural tube defects, all women planning pregnancy or capable of becoming pregnant should take folic acid supplements. The aim of the study was to describe the association between pregnancy planning and vitamin supplement use.

METHODS

A total of 1,858 pregnant women registered for a prenatal ultrasound examination in the Montérégie region, Province of Quebec, Canada, completed a questionnaire between November 1997 and May 1998. Pregnancy planning was described by six ordinal variables, which were included in a nonlinear principal component analysis. The main dimension representing the intensity of pregnancy planning was used as the dependent variable in a multivariate linear regression model, and as a basis for assessing vitamin use according to four levels of planning.

RESULTS

A majority of women scored high for intensity of pregnancy planning. Planning intensity score increased with age and was higher among women who attended university, had a family income greater than CAD $30,000, and were married. Vitamin use in the period prior to conception occurred with a frequency of 27.5%, increasing moderately with planning intensity scores. Overall, only 13.5% of fetuses were exposed to adequate doses of folic acid.

CONCLUSION

A promotion campaign selectively targeting women likely to plan a pregnancy could have a significant impact in reducing neural tube defect incidence.

Discriminative and predictive validity assessment of the quebec task force classification

STUDY DESIGN

A prospective cohort study of workers with low back pain who had been absent from work for more than 4 weeks was conducted.

OBJECTIVE

To assess the discriminative and predictive validity of the Quebec Task Force Classification for workers during the subacute phase of disability from back pain.

SUMMARY OF BACKGROUND DATA

The Quebec Task Force Classification was designed for clinical decision making, prognosis establishment, quality of care evaluation, and scientific research in low back pain.

METHODS

For this study, 104 workers absent from work because of back pain were classified according to the first four categories of the Quebec Task Force Classification 4 weeks after their first day of work absence. They then were randomized into four treatment groups: standard care (control), clinical-rehabilitation intervention, occupational intervention, and the Sherbrooke model (a combination of the clinical-rehabilitation and occupational interventions). Functional status, pain level, and work status were assessed at baseline and after 1 year. Duration of full compensation and back-related costs were calculated over a mean follow-up period of 6.5 years. The discriminative validity of the Quebec Task Force Classification was evaluated using Kendall tau correlation coefficients. Predictive validity was evaluated using logistic regression analyses. Age, gender, comorbidities, body mass index, and treatment group were considered as potential confounders.

RESULTS

Significant but low correlation coefficients were found between Quebec Task Force Classification categories and functional status scores at baseline. Subjects classified as having distal radiating pain (categories 3 and 4) at baseline were more likely to have a lower functional status, higher pain level, and no return to regular work at the 1-year follow-up evaluation. They also were more likely to accumulate more days of full compensation and to cost more after a mean follow-up period of 6.5 years.

CONCLUSION

The Quebec Task Force Classification demonstrated good predictive ability by discriminating between subjects with and those without distal radiating pain.

Anesthesia breathing circuits protected by the DAR Barrierbac S breathing filter have a low bacterial contamination rate

PURPOSE

In order to reuse the same anesthesia breathing circuit for more than one patient, it has been proposed to add a breathing filter between the Y-piece and the artificial airway. The purpose of this study was to evaluate the in vivo bacterial filtration efficacy of an anesthesia filter in a usual clinical anesthesia setting.

METHODS

A sterile DAR Barrierbac S breathing filter was inserted at the Y-piece of a sterile single-use anesthesia breathing circuit before induction of general anesthesia. At the end of anesthesia, the breathing circuit connector of the filter and of the endotracheal tube connector were cultured separately on growth media (chocolate and blood agar). These were incubated for 48 hr and bacterial identification was conducted using standard methods.

RESULTS

Bacterial cultures were negative on both sides of the filter membrane of 1842 of the 2001 filters studied. Cultures were positive on the patient side of 104 filters. In two of those, the same bacteria were found on both the circuit side and the patient side of the filter. Therefore these data indicate a clinical effectiveness of 99.9% (confidence interval, CI 95%, 99.6-99.998%), and an in vivo filtration efficacy of 98.08% (CI 95%, 92.54-99.67%).

CONCLUSION

Using the upper limit of the CI, it can be assumed that the practice of using a sterile DAR Barrierbac S breathing filter for every patient while reusing the anesthesia breathing circuit would result in a cross contamination rate of the breathing circuit lower than once every 250 cases.

Biological monitoring of environmental exposure to polycyclic aromatic hydrocarbons in subjects living in the vicinity of a creosote impregnation plant

OBJECTIVE

This study was undertaken to evaluate the environmental exposure to polycyclic aromatic hydrocarbons (PAHs) in nonsmoking adult subjects living in the vicinity of a creosote impregnation plant in Delson, Canada. Urinary metabolites of naphthalene, alpha- and beta-naphthol, and pyrene metabolite 1-hydroxypyrene (1-OHP), were used as biomarkers of exposure.

METHODS

Morning and evening urine samples were collected in mid-August from 30 exposed individuals living at a distance of 50-360 m downwind of the plant and from a control group in the adjoining municipality residing at a distance of 1.9-2.7 km upwind of the plant. Metabolites were measured by gas chromatography/ mass spectrometry.

RESULTS

Excretion values of alpha- and beta-naphthol were significantly higher in the exposed group than in controls (P < 0.04), after accounting for possible confounding variables by multivariate analyses. The respective geometric mean concentrations (5th and 95th percentiles) of alpha-naphthol for the exposed and nonexposed groups were 2.04 (0.55-6.00) and 1.37 (0.39-7.02) micromol/mol creatinine for evening samples, and 2.49 (0.77-8.43) and 1.17 (0.37-6.88) micromol/mol creatinine for morning samples. Corresponding values for beta-naphthol were 1.78 (0.82-3.67) and 1.36 (0.63-5.07) micromol/mol creatinine for evening samples, and 1.94 (1.03-4.96) and 1.08 (0.49-5.05) micromol/mol creatinine for morning samples. On the other hand, no significant difference in 1-OHP excretion was observed between the exposed and the control group (P>0.5). The respective geometric mean concentrations (5th and 95th percentiles) of 1-OHP for these groups were 0.05 (0.01-0.17) and 0.06 (0.01-0.48) micromol/mol creatinine for evening samples, and 0.05 (0.02-0.12) and 0.05 (0.01-0.42) micromol/mol creatinine for morning samples.

CONCLUSIONS

The measurement of alpha- and beta-naphthol urinary concentrations appears to be an approach sufficiently sensitive to reveal differences in low exposure levels of volatile PAHs due to creosote impregnation plant emissions. However, uptake of pyrene due to the plant was too small to contribute significantly to 1-OHP excretion.

Evolution and transmission of stable CTL escape mutations in HIV infection

Increasing evidence indicates that potent anti-HIV-1 activity is mediated by cytotoxic T lymphocytes (CTLs); however, the effects of this immune pressure on viral transmission and evolution have not been determined. Here we investigate mother-child transmission in the setting of human leukocyte antigen (HLA)-B27 expression, selected for analysis because it is associated with prolonged immune containment in adult infection. In adults, mutations in a dominant and highly conserved B27-restricted Gag CTL epitope lead to loss of recognition and disease progression. In mothers expressing HLA-B27 who transmit HIV-1 perinatally, we document transmission of viruses encoding CTL escape variants in this dominant Gag epitope that no longer bind to B27. Their infected infants target an otherwise subdominant B27-restricted epitope and fail to contain HIV replication. These CTL escape variants remain stable without reversion in the absence of the evolutionary pressure that originally selected the mutation. These data suggest that CTL escape mutations in epitopes associated with suppression of viraemia will accumulate as the epidemic progresses, and therefore have important implications for vaccine design.

Anti-inflammatory activity of clarithromycin in adults with chronically inflamed sinus mucosa

In a phase IV, open-label study, 25 patients with clinically stable chronic sinusitis and persistent maxillary sinus inflammation were treated for 14 days with clarithromycin 500 mg twice daily. Biopsy specimens of the maxillary sinus mucosa were obtained pretreatment and evaluated for macrophages (CD68), eosinophils (MBP), elastase, interleukin-6 (IL-6), IL-8, tumor necrosis factor-alpha (TNF-alpha), and activity of eosinophils (EG2), as well as edema score. Clinical signs and symptoms were assessed pretreatment, at the end of treatment, and 1 and 2 weeks later. Statistically significant reductions (P < or = .05) from pretreatment were observed for all markers of sinus mucosal inflammation, including CD68, EG2, elastase, IL-6, IL-8, TNF-alpha, and edema score, with a trend to decreased total eosinophil count. Improvement was observed for all clinical signs and symptoms of chronic sinusitis--sinus pain, sinus headache, nasal congestion, nasal discharge, and mucopurulent discharge--up to 14 days after the end of treatment. Cultures to evaluate persistent infection with Chlamydia pneumoniae showed negative results. Significant reductions in various markers of sinus mucosal inflammation support the role of clarithromycin in modulating immunologic responses. Improvement of clinical signs and symptoms in patients with chronic inflammatory sinusitis not meeting criteria for known or presumed bacterial infection was also noted up to 2 weeks after completion of a 14-day course of clarithromycin.