Comparative study of the osteoblastic activity of two implant systems (Endopore versus Entegra) utilizing single photon emission computed tomography (SPECT): experimental study in pigs model

Implantology has been an important component of dental management for over forty years, and during that period, many configurations of implant materials and methods have been developed. As empirical and clinical research yield new implant materials, there has been need to test and compare these materials to provide the most cost-effective and efficient implants. Evaluation of efficiency of implants has relied heavily on histological and radiological methods, but these one-dimensional measurement methods fail to evaluate the osteoblastic activity and osseointegration properties of putative implants. In this report, we describe the use of a quantitative single photon emission computed tomography (SPECT) as a tool for comparing the osseointegrating capabilities of two types of implants.

Infliximab for the treatment of psoriasis in the U.K.: 9 years' experience of infusion reactions at a single centre

BACKGROUND

Infliximab is an antitumour necrosis factor-α chimeric monoclonal antibody that is an established treatment for severe chronic plaque psoriasis. The recommended administration of a 2-h infusion followed by 2 h of monitoring is practised due to the potential occurrence of infusion reactions. However, accelerated infusions and shortened monitoring periods are used in patients with rheumatological disorders and inflammatory bowel disease without an increase in adverse events.

OBJECTIVES

To review the standard infliximab infusion protocol, the incidence of acute infusion reactions, the use of concomitant methotrexate and the clinical relevance of the 2-h postinfusion monitoring period.

METHODS

A retrospective case note and pharmacy database review of all infliximab infusions administered to patients with psoriasis at a tertiary dermatology centre was carried out.

RESULTS

Fifty-nine consecutive patients received a total of 858 infliximab infusions (range 1-43 infusions per patient) between January 2001 and June 2010. The incidence of infusion reactions was 1.5%, affecting 16.9% of patients and occurring between the first and eleventh infusions. Mild, moderate and severe acute reactions occurred in 0.6% (n=5), 0.3% (n=3) and 0.3% (n=3) of infliximab infusions, respectively. Thirty-three patients (56%) received concomitant systemic treatments during part of or throughout the infliximab treatment, including 24 (41%) on methotrexate (5-20 mg weekly). The prevalence of infusion reactions in patients receiving infliximab alone was 27% compared with 4% in those receiving concomitant methotrexate (P=0.05). All infusion reactions were managed as per our trust protocol with only one infusion reaction occurring in the postinfusion period (10 min after infusion completion).

CONCLUSION

The risk of infusion reactions in our cohort of patients was low, with the majority occurring early in the treatment cycle. Concomitant methotrexate may reduce this risk. A shortened postinfusion monitoring period can be safely considered.

Infliximab for the treatment of psoriasis in the U.K.: 9 years' experience of infusion reactions at a single centre

BACKGROUND

Infliximab is an antitumour necrosis factor-α chimeric monoclonal antibody that is an established treatment for severe chronic plaque psoriasis. The recommended administration of a 2-h infusion followed by 2 h of monitoring is practised due to the potential occurrence of infusion reactions. However, accelerated infusions and shortened monitoring periods are used in patients with rheumatological disorders and inflammatory bowel disease without an increase in adverse events.

OBJECTIVES

To review the standard infliximab infusion protocol, the incidence of acute infusion reactions, the use of concomitant methotrexate and the clinical relevance of the 2-h postinfusion monitoring period.

METHODS

A retrospective case note and pharmacy database review of all infliximab infusions administered to patients with psoriasis at a tertiary dermatology centre was carried out.

RESULTS

Fifty-nine consecutive patients received a total of 858 infliximab infusions (range 1-43 infusions per patient) between January 2001 and June 2010. The incidence of infusion reactions was 1.5%, affecting 16.9% of patients and occurring between the first and eleventh infusions. Mild, moderate and severe acute reactions occurred in 0.6% (n=5), 0.3% (n=3) and 0.3% (n=3) of infliximab infusions, respectively. Thirty-three patients (56%) received concomitant systemic treatments during part of or throughout the infliximab treatment, including 24 (41%) on methotrexate (5-20 mg weekly). The prevalence of infusion reactions in patients receiving infliximab alone was 27% compared with 4% in those receiving concomitant methotrexate (P=0.05). All infusion reactions were managed as per our trust protocol with only one infusion reaction occurring in the postinfusion period (10 min after infusion completion).

CONCLUSION

The risk of infusion reactions in our cohort of patients was low, with the majority occurring early in the treatment cycle. Concomitant methotrexate may reduce this risk. A shortened postinfusion monitoring period can be safely considered.

Effect of sample storage on blood crossmatching in horses

BACKGROUND

Blood samples banked for up to 1 month are typically used to perform pretransfusion testing in humans and small animals, but this has not been validated using blood from horses.

HYPOTHESIS

Compatibility of equine blood samples is repeatable using fresh samples, and reproducible using donor blood samples stored for up to 4 weeks.

ANIMALS

Six healthy adult horses.

METHODS

Randomized, blinded experimental study. Immunologic compatibility of the blood of all horses was assessed using a major and minor saline agglutination and hemolysin crossmatch using blood samples refrigerated for 0-4 weeks and fresh blood from the same horses. Crossmatch results were scored and then compared to identify changes of compatibility in each of the 4 tests. In addition, repeatability of the crossmatch technique itself was assessed by performing 6 iterations of this procedure in immediate succession with fresh blood from 3 horses.

RESULTS

No significant difference in crossmatch results was found using fresh blood (P = .39-1.00). Reproducibility was poor using blood stored for 1-4 weeks, especially in tests using stored erythrocytes (major antigen crossmatches), with significant differences from baseline at all weeks (P < .05); 13 of these differences were positive, indicating poorer compatibility.

CONCLUSIONS AND CLINICAL IMPORTANCE

Equine blood crossmatching is repeatable using fresh blood, although decreased apparent compatibility after storage makes exclusion of compatible donors more likely than mistaken administration of incompatible blood. These data suggest that fresh samples should be collected from potential donors before crossmatching equine blood.

Induction of endometriosis alters the peripheral and endometrial regulatory T cell population in the non-human primate

BACKGROUND

Endometriosis is a gynecological condition that is characterized by extreme abdominal pain and also decreased fertility. Regulatory T cells (Tregs) have immunosuppressive activity critical for embryonic implantation and likewise the acceptance of tissue engraftment. Utilizing the induced non-human primate (Papio anubis) model of endometriosis, we hypothesize that endometriosis decreases the peripheral and endomet rial Treg profile, whereas ectopic lesions have increased Treg localization.

METHODS

Peripheral blood and endometrium were obtained throughout the menstrual cycle prior to and after induction of disease. Animals were randomly assigned to control (n = 7) or diseased (n = 16) treatment groups. Endometriosis was induced by i.p. injection of autologous menstrual tissue for 2 consecutive months during menses. Peripheral blood and endometrial tissue were collected at d9-11PO at 1, 3, 6, 9, 12 and 15 months post-induction of disease for fluorescence-activated cell sorting, quantitative RT-PCR and immunohistochemistry. Ectopic lesions were excised at 1 and 6 months post-inoculation and also harvested at necropsy (15 months) and processed for RNA of IHC. Identification of Tregs through analysis of FOXP3 expression was conducted utlilizing several methodologies. Differences were determined by non-parametric statistical analysis between all treatment groups and time points.

RESULTS

In control animals, the proportion of peripheral natural Tregs (nTregs) was reduced (P < 0.05) during the mid- and late secretory stages of the menstrual cycle compared with menses. The induction of disease decreased peripheral Treg expression at early time points (P < 0.05) and this remained low throughout the time course, compared with the pre-inoculatory level of an individual. FOXP3 gene expression and Treg populations were also decreased in the eutopic endometrium (P < 0.05) compared with control animals, whereas these parameters were increased in ectopic lesions (P < 0.05), compared with the eutopic endometrium.

CONCLUSIONS

Our data suggest that a reduction in peripheral Tregs may be a causative factor for endometriosis-associated infertility, while the increase in ectopic Treg expression may aid lesion development. Furthermore, endometriosis appears to disrupt Treg recruitment in both eutopic and ectopic endometrium.

Testing of veterinary clostridial vaccines: from mouse to microtitre plate

Vaccines to protect against clostridial diseases are among the most common veterinary biologicals. Each batch of these materials is subjected to a variety of toxicity and antigenicity tests. The potency of the final vaccine is then assessed by Toxin Neutralisation Test (TNT). All of these tests use mice and have lethal endpoints. Development of alternatives for potency testing was based on ELISAs able to measure antibody levels to the specific toxins relative to a standard serum with a defined unitage. These alternative assays were shown to correlate with the relevant TNTs and have been accepted by European Regulatory Authorities as batch release potency tests. Recently we have developed in vitro cell line alternatives for the toxicity and antigenicity tests for Cl. septicum using the VERO cell line. With this cell line it has been possible to develop in vitro assays which, when compared with the in vivo tests, gave correlations of 87% to 100%. Having shown proof of principle, similar cell line assays have been developed for Cl. novyi and Cl. perfringens types C and D.

Comparative study of osteoblastic activity of same implants (Endopore) in the immediate extraction site utilizing single photon emission computerized tomography: peri-implant autogeneous bone grafting with GTR versus no peri-implant bone grafting--experimental study in pig model

The study was designed to exploit the single photon emission computerized tomography (SPECT) to compare osteoblastic activity of two implant systems: an Endopore implant (Beaded implants) placed immediately into an extraction socket in conjunction with peri-implant autogenous grafting supplemented with a guided tissue regeneration (GTR) technique, and an Endopore implant placed immediately into the extraction socket without peri-implant grafting and GTR. Endopore implants of the same size (12 mm x 4.1 mm INT-Hex) were placed in fresh extraction sockets in the canine-tooth region of the pigs jaw. The implant on the right side had peri-implant bone grafting utilizing autogenous bone together with cytoplast resorbable GTR membrane, whilst the implant on the left side received no peri-implant bone grafting. Osteoblastic activity was evaluated 81 days (11 weeks and 4 days) post implantation using the SPECT imaging technique. The SPECT imaging revealed more osteoblastic activity on the side with peri-implant bone grafting as compared with the site without peri-implant bone grafting. The result suggests that peri-implant bone grafting with GTR around the immediate implant showed more osteoblastic activity and thus enhanced osseointegration when compared with the implant without bone grafting and GTR. Bone grafting and GTR should be encouraged as a standard procedure with dental implants.

A retrospective cohort study of the impact of biologic therapy initiation on medical resource use and costs in patients with moderate to severe psoriasis

BACKGROUND

Biologic therapy has become established as an important treatment option in patients with severe psoriasis, but is significantly more expensive in terms of drug costs than traditional treatment options. Relatively little is known about the total healthcare cost of treating severe psoriasis in daily clinical practice and what the budgetary impacts of such high-cost drugs are when compared with standard systemic therapy.

OBJECTIVES

To describe the impact of biologic therapy introduction on the use of medical resources, costs and where available, outcomes in patients with moderate to severe psoriasis.

METHODS

Data were extracted from case notes of a sequential patient cohort with psoriasis attending a tertiary referral severe psoriasis service and initiated on biologics (adalimumab, efalizumab, etanercept or infliximab) for treatment of their psoriasis. Data on hospital resource use (inpatient, outpatient, day ward, accident and emergency visits and phototherapy sessions) and drug usage (systemic nonbiologic and biologic psoriasis therapies and supportive drugs) were collected for 12 months prior to, and at least 6 months following initiation of biologic therapy. Outcome was measured using the Psoriasis Area and Severity Index (PASI). Differences in resource use and associated costs and outcomes, between 12 months before and after initiation of biologic therapy, were tested using Wilcoxon paired sign tests for continuous data and the McNemar test for categorical data. Confidence intervals (CI) around treatment costs were constructed using a 5000-sample bootstrap analysis.

RESULTS

The primary analysis population comprised 76 patients completing 12 months of biologic therapy: 71% males; mean age at time of study 47·3 years (range 23-74); mean duration of psoriasis 24·7 years (range 5·3-45·5). Significant reductions (P < 0·05) in the year following initiation of biologic therapy were observed for all hospital resource use categories, with mean annual costs reduced by £1682 (95% CI -3182 to -182·2; P = 0·05). Mean annual drug costs increased by £9456 (95% CI 8732-10,182; P < 0·001). Mean PASI fell by 8·9 points from 18·7 to 9·8 (95% CI -10·8 to -7·1; P < 0·001).

CONCLUSIONS

Total healthcare costs associated with treatment of severe psoriasis with biologic therapy are significantly greater than with traditional systemic therapy. However, some of these are offset by substantial reductions in the number and length of hospital admissions and use of photo- and systemic therapy, and result in significantly improved patient outcome (as inferred by improvement in PASI).

cDNA cloning of blue gourami (Trichogaster trichopterus) prolactin and its expression during the gonadal cycles of males and females

BACKGROUND

The blue gourami fish (Trichogaster trichopterus) provides a unique model for the study of reproduction endocrinology in teleost fish. Its oocyte development may be controlled easily, and the vitellogenic and final maturation phases may be separated artificially in the laboratory. Moreover, this gourami exhibits exclusive parental behavior.

AIM

The aim of the present study was to clone and sequence the blue gourami PRL (bgPRL) cDNA in order to enable the determination of its mRNA levels in the male and female blue gourami during the gonadal cycles.

MATERIALS AND METHODS

bgPRL was cloned by extracting total RNA from freshly excised pituitaries of gourami fish, followed by cDNA synthesis, rapid amplification of cDNA ends (RACE)-PCR and finally, sequencing. bgPRL mRNA expression was determined by realtime PCR, and results were normalized with 18S RNA.

RESULTS

When bgPRL was compared to PRLs of other fish, it had the most homology with PRL of Perciformes and the least with those of Anguilliformes. bgPRL was expressed during the entire gonadal cycle in males and females. The average levels of PRL mRNA in juvenile and low vitellogenetic females were lower than in mature females (at high vitellogenesis and maturation), but the differences were not significant. On the other hand, the PRL mRNA levels in mature reproductive males (nestbuilders) and non-reproductive (non-nest-builders) were significantly higher in comparison to young males.

CONCLUSIONS

The results of this study imply that PRL has a possible role in the endocrine control of gonadal development in fish, in addition to its role in reproductive behavior.

Intranasal sufentanil for cancer-associated breakthrough pain

The objective of this study was to demonstrate the efficacy, safety and patient acceptability of the use of intranasal sufentanil for cancer-associated breakthrough pain. This was a prospective, open label, observational study of patients in three inpatient palliative care units in Australia. Patients on opioids with cancer-associated breakthrough pain and clinical evidence of opioid responsiveness to their breakthrough pain were given intranasal (IN) Sufentanil via a GO Medical patient controlled IN analgesia device. The main outcome measures were pain scores, need to revert to previous breakthrough opioid after 30 min, number of patients who chose to continue using IN sufentanil, and adverse effects. There were 64 episodes of use of IN sufentanil for breakthrough pain in 30 patients. There was a significant reduction in pain scores at 15 (P < 0.0001) and 30 min (P < 0.0001). In only 4/64 (6%) episodes of breakthrough pain did the participants choose to revert to their prestudy breakthrough medication. Twenty-three patients (77%) rated IN sufentanil as better than their prestudy breakthrough medication. The incidence of adverse effects was low and most were mild. Our study showed that IN sufentanil can provide relatively rapid onset, intense but relatively short lasting analgesia and in the palliative care setting it is an effective, practical, and safe option for breakthrough pain.

Cloning of Russian sturgeon (Acipenser gueldenstaedtii) growth hormone and insulin-like growth factor I and their expression in male and female fish during the first period of growth

In this study, the GH and IGF-I of the Russian sturgeon (rs), Acipenser gueldenstaedtii, were cloned and sequenced, and their mRNA gene expression determined. In addition, to improve our understanding of the GH function, the expression of this hormone was assessed in young males and females. Moreover, IGF-I expression was quantified in young males and compared to that in older ones. The nucleotide sequence of the rsGH cDNA was 980 bp long and had an open reading frame of 642 bp, beginning with the first ATG codon at position 39 and ending with the stop codon at position 683. A putative polyadenylation signal, AATAAA, was recognized 42 bp upstream of the poly (A) tail. The position of the signal- peptide cleavage site was predicted to be at position 111, yielding a signal peptide of 24 amino-acids (aa) and a mature peptide of 190 aa. When the rsGH aa sequence was compared with other species, the highest degree of identity was found to be with mammalians (66-70% identity), followed by anguilliformes and amphibia (61%) and other fish (39-47%). The level of rsGH mRNA was discovered to be similar in pituitaries of females and males of 5 age groups (1, 2, 3, 4, and 5- yr-old). In females and males, the levels did not change dramatically during the first 5 yr of growth. The partial nucleotide sequence of the rsIGF-I was 445 bp long and had an open reading frame of 396 bp, beginning with the ATG codon at position 50. The position of the signal-peptide cleavage site was predicted to be at position 187, yielding a signal peptide of 44 aa. The highest level of IGF-I mRNA expression was recorded in the kidney of adult sturgeons. The IGF-I mRNA expression levels in the intestine, pituitary gland, and liver were not significantly different. Low levels of expression were found in the brain, heart, and muscle. In most tissues, there was no significant difference between mRNA levels of one and 5-yr-old fish. In conclusion, based on the GH-sequence analysis, A. gueldenstaedtii is genetically distant from other teleosts. The expression of the GH mRNA was similar in males and females, and its level remained constant during the first 5 yr of growth. While the IGF-I mRNA expression differed amongst various tissues, the level in each tissue was similar in 1 and 5-yr-old fish.

Infliximab for severe, treatment-resistant psoriasis: a prospective, open-label study

BACKGROUND

Infliximab, a mouse-human chimeric monoclonal antibody directed against tumour necrosis factor-alpha, has been shown to be effective for moderate to severe psoriasis, but there are few data published on its use in recalcitrant, treatment-resistant disease or in combination with other antipsoriatic therapies.

OBJECTIVES

To report our experience with infliximab in the treatment of patients attending a tertiary referral service with severe recalcitrant disease.

METHODS

All patients attending a tertiary referral service for severe psoriasis who were treated with infliximab between 2002 and July 2005 were entered into a prospective, open-label study. Details on disease phenotype, clinical course and adverse events were recorded together with measures of disease severity [Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index, clinical photography] at baseline, weeks 2 and 6, and then at 2-monthly intervals throughout the treatment period.

RESULTS

Twenty-three patients were treated with infliximab during the study; one patient had pustular psoriasis and was therefore excluded from statistical analysis. All had severe disease (baseline PASI 26.5+/-6.7, mean+/-SD, n=22) and had received at least two systemic therapies for psoriasis in the past; 16 were taking one or more concomitant therapies at the time of treatment initiation. At week 10, 95% had achieved a 50% or greater improvement in baseline PASI (PASI 50), and 77% had achieved a 75% or greater improvement (PASI 75). Efficacy was sustained in the longer term, with eight of 10 patients on treatment for more than 11 months maintaining at least a PASI 50. Only one patient had treatment withdrawn due to lack of efficacy, two suffered severe systemic infections including extrapulmonary tuberculosis (splenic abscess) and cellulitis, and six have discontinued due to adverse effects including infusion reactions (two), severe thrombocytopenia (one), hepatitis (one) and malignancy (two).

CONCLUSIONS

Data from this open-label study suggest that infliximab is a rapidly effective treatment for patients with severe, treatment-resistant disease, although approximately 25% of patients had to discontinue therapy due to the development of serious adverse effects. Long-term follow-up, continued pharmacovigilance, and further controlled comparative studies will be required to evaluate fully the risks associated with infliximab in the context of this already difficult to treat population.

Prospective audit of short-term concurrent ketamine, opioid and anti-inflammatory (‘triple-agent’) therapy for episodes of acute on chronic pain

AIM

This prospective audit was undertaken in order to document the analgesic response and adverse effects of concurrent short-term ('burst') triple-agent analgesic (ketamine, an opioid and an anti-inflammatory agent--either steroidal or non-steroidal) administration, for episodes of acute on chronic pain. The clinical hypothesis in this study is that better pain control may be obtained by simultaneous multiple target receptor blockade.

METHOD

The response of 18 patients is reported. The pain and analgesic requirement data for the 24 h before starting triple-agent therapy were compared with the last 24 h on the triple-agent therapy. Patients were then classified as responders or non-responders.

RESULTS

According to stringent clinical criteria, 12 out of the 18 patients were classified as responders. The response rate was highest for somatic pain (7/9) and appeared to decrease with duration of prior uncontrolled pain. Only four out of the 18 patients reported adverse effects and all of these were minor.

CONCLUSIONS

The results suggest that this 'burst' triple-agent approach is safe and effective in an inpatient palliative care population during episodes of poorly controlled acute on chronic pain, and warrants further investigation to ascertain whether it gives superior results compared to the 'gold-standard' WHO ladder approach.

[Combined cardiac resynchronization and implantable cardioversion defibrillation]

OBJECTIVE

To examine the efficacy and safety of implantation of the device with combined cardiac resynchronization therapy (CRT) and implantable cardioversion defibrillation (ICD) capabilities.

METHODS

Eleven patients aged 48 - 80 (71.6 +/- 9.5) years, 7 male and 4 female, were included in the study. All patients had either a history of aborted sudden cardiac death, ventricular tachyarrhythmia, or induced ventricular tachycardia during cardiac electrophysiological study, whose left ventricular ejection fractions were 35% or less and QRS durations were 120 or longer. The patients were implanted a Medtronic INSYNC II MARQUIS(TH) 7289. All left ventricular leads were implanted in left lateral or left posterior lateral side-branches of coronary sinus. The procedures were performed in general anesthesia status. The AV interval was optimized guided by ECHO in all the patients in the day after the procedure.

RESULTS

All procedures were successfully completed without major complications. The fluoroscopy time was 19 - 73 (44.7 +/- 19.9) min. Atrial lead amplitude, resistance and threshold were 0.5 - 3.5 (2.47 +/- 0.77) mV, 410 - 749 (590 +/- 126) Omega and 0.9 - 3.0 (1.37 +/- 0.71) V respectively. Right ventricular septal lead amplitude, resistance and threshold were 6.8 - 15.8 (11.00 +/- 3.48) mV, 387 - 750 (586 +/- 116) Omega and 0.4 - 1.0 (0.69 +/- 0.21) V respectively. The amplitude, resistance and threshold of left ventricular leads were 1.2 - 25 (15.37 +/- 5.15) mV, 423 - 812 (602 +/- 125) Omega and 0.3 - 5.0 (1.62 +/- 1.59) V respectively. The defibrillation thresholds (DFT) of 20 J were obtained in 3 patients, 6 J in 3 patients, and 15 J, 12 J and 3 J in one patient respectively. One of the 11 patients with failed old device did not obtain successful DFT after lead and device replacement and was defibrillated externally during DFT test. The another one did not obtain successful DFT because of abnormal ST-T changes in ECG. All devices were programmed to maximum of 30 J and discharged from the hospital in 48 hours except the one who failed to obtain DFT. The patients with mitral regurgitation improved after the AV optimization.

CONCLUSIONS

Implantation of device with CRT and ICD features is safe even in aging patients. The long time outcomes of the clinical efficacy of this combined device remain to be observed.