Intranasal administration of human growth hormone (hGH) in combination with a membrane permeation enhancer in patients with GH deficiency: a pharmacokinetic study

Recombinant human GH (hGH) combined with a permeation enhancer for the nasal mucosa, sodium tauro-24,25-dihydrofusidate (STDHF), was administered intranasally (in) in six patients with classical GH deficiency. Three different doses were tested (0.2, 0.4, and 0.8 IU/kg BW). The concentration of STDHF was 1% in all doses. As a comparison, all patients received a sc injection of hGH (0.1 IU/kg BW). Blood samples were obtained at frequent intervals for up to 8 h (in doses) or 24 h (sc dose) and analyzed for the plasma concentration of hGH. All three i.n. doses gave a rapid increase in hGH with peak maxima (Cmax) at 20-30 min, and a decline to baseline within 2-3 h. In contrast, the sc dose resulted in a Cmax 2-3 h after the injection, followed by a plateau phase for 2-3 h. The baseline was reached 12-14 h after administration. The uptake [area under the curve (AUC)] was considerably lower for all three in doses, i.e. 1.6-3% of the AUC obtained with the sc dose. However, the Cmax varied between 5.7 +/- 1.4% (0.8 IU/kg BW) and 15.8 +/- 2.1% (0.4 IU/kg BW) of the maximal peak with the sc dose. Of the in doses, 0.4 IU/kg BW resulted in the highest AUC and Cmax. A self-rating protocol was also used to estimate nasal sensations for up to 2 h after dosing. All sensations (itching, burning, sneezing, and running of the nose) were transient and tolerable. This study demonstrates that hGH can be administered intranasally in combination with STDHF. The in dosing results in a plasma peak of hGH very similar to the physiological endogenous peak. No side-effects were noted, other than a transient nasal irritation. Therefore, the nasal route for hGH administration offers a more physiological and more convenient alternative to injections for the treatment of GH deficiency.

Cost effectiveness of primary stroke prevention in atrial fibrillation: Swedish national perspective

OBJECTIVE

To assess the potential effects of primary prevention with anticoagulants or aspirin in atrial fibrillation on Swedish population.

DESIGN

Analysis of cost effectiveness based on the following assumptions: about 83,000 people have atrial fibrillation in Sweden, of whom 22,000 would be potential candidates for treatment with anticoagulants and 55,000 for aspirin treatment; the annual 5% stroke rate is reduced by 64% (with anticoagulants) and 25% (with aspirin); incidence of intracranial haemorrhage of 0.3%, 1.3%, or 2.0% per year; direct and indirect costs of a stroke of Kr180,000 and Kr90,000; estimated annual cost of treatment is Kr5030 for anticoagulants and Kr100 for aspirin.

SETTING

Total Swedish population.

MAIN OUTCOME MEASURES

Direct and indirect costs of stroke saved, number of strokes prevented, and cost of preventive treatment.

RESULTS

Depending on the rate of haemorrhagic complications 34 to 83 patients would need to be treated annually with anticoagulants to prevent one stroke; 83 patients would need to be treated with aspirin. Giving anticoagulant treatment only would reduce costs by Kr60 million if the incidence of intracranial haemorrhage were 0.3% but would imply a net expense if the complication rate exceeded 1.3%. The total savings from giving anticoagulant (22,000 patients) and aspirin (55,000 patients) treatment would be Kr175 million per year corresponding to 2 million pounds per million inhabitants each year.

CONCLUSIONS

Treatment with anticoagulants and, if contraindications exist, with aspirin is cost effective provided that the risk of serious haemorrhage complications due to anticoagulants is kept low.

Follow-up study of endodontic status in an adult Swedish population

The purpose of this study was to examine changes in the endodontic status of selected teeth in a population over time, in order to get a long-term perspective of endodontically treated teeth. A random sample of the adult Swedish population was selected in 1974 and offered a clinical and radiographic examination. Eleven years later 351 of the selected persons attended a follow-up examination (1985). In radiographs, covering the mandibular premolar and molar regions, the status of 1974 was directly compared, tooth by tooth, with the status of 1985. The results showed that a number of endodontically treated teeth with an apical periodontitis healed during the observation period. During the same period, approximately the same number of endodontically treated teeth presented with a new apical periodontitis. This finding suggested that cross-sectional studies could provide reliable information on the long-term success rate of endodontic treatment at the population level. The periapical lesions that persisted or developed during the observation period were strongly related to incomplete root canal obturation, which is in agreement with observations in follow-up studies from teaching and specialist clinics.

Effects of Balance Training in Elderly Evaluated by Clinical Tests and Dynamic Posturography

All persons aged 70 through 75 years (N = 457) in a Swedish community were invited to participate in a 9 week balance training study. Out of 55 interested subjects, 15 were chosen at random for a study group; 15 matched controls were also selected. Before and after the investigation period the balance function was assessed by clinical balance tests and dynamic posturography. In the clinical balance tests, the training group significantly improved their balance standing on one leg with eyes closed as well as standing on one leg while shaking the head; they also walked 15 m back and forth faster. In the dynamic posturography the training group significantly improved their equilibrium scores in the 3 most difficult test conditions. The results of the control group were unchanged except for one test condition in the dynamic posturography. The differences in one-leg standing with head shaking, walking 2 × 15 m, and the equilibrium score using sway-referenced platform in dynamic posturography were proved to be attributable to the training. The first investigation in all 29 subjects formed normative dynamic posturography data for the age group 70 through 75 years. The normative posturographic data of this age group differed from previously obtained data in the age groups 20 through 59 and 60 through 69 years. It is concluded that elderly may improve their balance by regular balance training exercises for as short a period as 9 weeks. This might prove to be of great value in improving balance and thereby preventing accidental falls and subsequent fractures in elderly.

Analysis of caprine mycoplasmas and mycoplasma infections in goats using two-dimensional electrophoresis and immunoblotting

Seven strains of mycoplasma have been characterized by two-dimensional polyacrylamide gel electrophoresis in combination with immunoblotting. The two-dimensional patterns of the strains were compared and similarities and differences are discussed. Hyperimmune rabbit antisera were used in the immunoblotting experiment to study the immunological cross-reactivity between the species. Sera from goats, naturally and experimentally infected with mycoplasma, were also used in the immunoblotting experiment to study the immune responses of the infected animals.

Determination of creatinine in serum by high-performance liquid chromatography: a comparison of three ion-exchange methods

Three ion-exchange high-performance liquid chromatographic methods for the determination of creatinine in serum have been compared. In method 1 a strong cation exchanger was used. In method 2 a reversed-phase column was given strong cation-exchange properties by the addition of N-methyloleoyl taurate to the mobile phase. In method 3 a weak cation exchanger was used. Elution was with a pH gradient in methods 1 and 2, and isocratic elution was used in method 3. The imprecision was similar for the three methods and varied between 0.9 and 2.5% as studied within-day and between 1.4 and 3.2% from day-to-day. The lowest coefficient of variation was obtained around the upper reference limit. Analytical recoveries were quantitative for the three methods. The method with N-methyloleoyl taurate showed no advantages over the conventional strong cation exchanger. With the weak cation exchanger no interferences were detected from compounds investigated, but with the strong cation exchanger a slight interference was obtained with uric acid. We prefer the weak cation-exchange method because of its simplicity, higher throughput and absence of interference from hitherto tested compounds.

A review of the Rett syndrome with a theory of autism

In a review of results of clinical observations, girls from 2:03 (yrs:mos) at stages III and IV of the Rett syndrome (RS) and autistic children from 4:01 with or without severe mental retardation were compared as to their behavioral traits. Signs of concordance between the extremely low mental, affective and motor developmental levels, such as in the expression of the eyes, are a prominent feature of RS, whereas signs of higher cortical functions that are in contrast with insufficient relations to objects, people and space are a prominent characteristic in autism. It is argued that insistence on sameness, avoidance of social stimuli and self-injurious stereotypies of autistic children are neurotic reactions based on their insufficient object relations. On the basis of the clinical findings a theory is proposed, according to which there exists a system for involuntary contributions to the affective engagement in perception, which is insufficiently developed in autism and in earlier stages of RS. Regarding its structure and function, it is analogous to the phylogenetically old extrapyramidal system and its necessary involuntary emotional contributions to all voluntary movements and postures.

Effect of patients' expectations on recovery from acute tonsillitis

To investigate whether the personal attention paid to a patient can affect his or her subjective recovery from acute tonsillitis, a controlled study was performed on 100 patients consulting a doctor for this disease. At the consultation a randomly assigned experimental group (n = 50) was given more detailed information about the diagnosis, treatment and prognosis and also a more extensive physical examination than a control group (n = 50). At a follow-up interview two days later significantly more of the experimental group felt that their symptoms had improved (P less than 0.005) than the control group, significantly more felt that the treatment had helped them (P less than 0.005) and significantly more felt they had received sufficient information about their illness and treatment (P less than 0.001). A deliberate attempt to maximize the expectation effect was thus shown to influence the clinical course of acute tonsillitis, recorded as the degree of subjective improvement.

Novel branched-chain fatty acids in certain fish oils

Methyl-branched fatty acids, which are usually minor components (equal or less than 0.1%) in fish oils, were concentrated in the non-urea-complexing fraction along with polyunsaturated fatty acids during the enrichment of omega-3 fatty acids from certain fish oils via the urea complexation process. The methyl-branched fatty acids in the omega-3 polyunsaturated fatty acid concentrates, which were prepared from three fish body oils, were characterized by gas chromatography and gas chromatography/mass spectrometry. Among the major branched-chain fatty acids expected and identified were the known isoprenoid acids--mainly 4,8,12-trimethyltridecanoic, pristanic, and phytanic--and the well-known iso and anteiso structures. Two novel phytol-derived multimethyl-branched fatty acids, 2,2,6,10,14-pentamethylpentadecanoic and 2,3,7,11,15-pentamethylhexadecanoic, were identified in redfish (Sebastes sp.) oil. These two fatty acids were absent in oils from menhaden (Brevoortia tyrannus) and Pacific salmon (mixed, but mostly from sockeye, Oncorhynchus nerka). The major branched-chain fatty acid in the salmon oil, 7-methyl-7-hexadecenoic acid, was also present to a moderate extent in menhaden oil. A novel vicinal dimethyl-branched fatty acid, 7,8-dimethyl-7-hexadecenoic was detected in all of the fish oils examined, but was most important in the salmon oil. Three monomethyl-branched fatty acids, 11-methyltetradecanoic acid, and 11- and 13-methylhexadecanoic, hitherto undescribed in fish lipids, were also detected in salmon, redfish and menhaden oils.

Endodontic status and suggested treatment in a population requiring substantial dental care

The purpose of this study was to analyse endodontic status and treatment suggested for Swedish citizens requiring substantial dental care. According to the Swedish dental insurance system, treatment plans including radiographs have to be submitted for approval if the estimated cost of treatment exceeds a certain level (USD 500 in 1977). A sample of 1094 treatment plans received during 1977 and 1978 was randomly selected. In the radiographs the number of remaining teeth was recorded, periapical condition was evaluated and the quantity and quality of previous endodontic treatment were estimated. In addition, treatment plans concerning the teeth with periapical lesions were studied. The results indicated that patients analysed in this study that needed expensive treatment had more missing teeth, more root-filled teeth and more teeth with periapical lesions than what has been reported in previous studies of samples supposed to accurately represent the Swedish population. However, the technical quality of the root fillings and the frequency of periapical lesions in root-filled teeth were the same as in previous studies, with high frequencies of inadequate root fillings and related unfavourable responses. Thus the patients in this study retained a significant need for endodontic treatment despite having already received a great deal of endodontic care. Further, it was found that nearly half of the observed periapical lesions would not be treated based on the submitted plans.

Dental caries in urban and rural areas in Mozambique

The purpose of this study was to assess the level of dental caries among 11-13 year old children and adults in urban and rural areas in Mozambique. The survey comprised a total of 575 schoolchildren from 5 areas in the Maputo Province, and 239 adults from 2 of the areas. There was a gradual increase in caries prevalence among the children from 23 per cent in the most distant rural area to 65 per cent in the urban centre, with a corresponding increase in DMFT from 0.5 to 2.1. In adults from a rural village there was an increase in caries prevalence and experience with age from 69 per cent with a DMFT of 3.7 at the age of 25-34 years, to 94 per cent and a DMFT of 7.9 at 45-54 years. In the urban group aged 25-34 years, there was a caries prevalence of 93 per cent and an average DMFT of 8.1, with no further increase in caries level with age. It was concluded that there was a sociogeographic variation in caries levels strongly associated with the degree of exposure to markets, and that a recent increase in exposure to cariogenic factors had occurred in urban areas.

Blotting from PhastGel media after horizontal sodium dodecyl sulfate-polyacrylamide gel electrophoresis

An improved procedure, "thermoblotting", is described for transferring proteins by diffusion from PhastGel Gradient media to an immobilizing matrix after horizontal sodium dodecyl sulfate-polyacrylamide gel electrophoresis. After electrophoresis the gels were left on the separation bed of PhastSystem, the blotting matrix was applied and a transfer temperature was selected between 5-70 degrees C. An experimental series at fixed diffusion times showed that the transfer yield was significantly increased with temperature. The evaluation was done visually after staining of the blots with colloidal gold. An evaluation study comparing nitrocellulose, nylon, and polyvinylidenedifluoride of different pore sizes is also reported. Finally, the transfer efficiencies for 125I-labelled bovine serum albumin and soybean trypsin inhibitor were estimated using four different blotting procedures: two diffusion blotting techniques and two electrophoretic blotting techniques (tank vs. semi-dry).

Improved isolation of mycobacteria other than Mycobacterium tuberculosis on isoniazid-containing Löwenstein-Jensen medium

The benefit of including isoniazid-containing Löwenstein-Jensen medium for primary isolation of mycobacteria was evaluated in 3,726 clinical specimens. This media increased the primary isolation of mycobacteria other than Mycobacterium tuberculosis by 9.2%, facilitated macroscopical reading and aided presumptive identification of the isolated mycobacteria.

Pharmacokinetics and bioavailability of reduced and oxidized N-acetylcysteine

The pharmacokinetics and bioavailability of N-acetylcysteine (NAC) have been determined after its intravenous and oral administration to 6 healthy volunteers. According to a randomized cross-over design each subject received NAC 200 mg i.v. and 400 mg p.o., and blood samples were collected for 30 h. Reduced NAC had a volume of distribution (VSS) of 0.59 l.kg-1 and a plasma clearance of 0.84 l.h-1.kg-1. The terminal half-life after intravenous administration was 1.95 h. The oral bioavailability was 4.0%. Based on total NAC concentration, its volume of distribution (VSS) was 0.47 l.kg-1 and its plasma clearance was 0.11 l.h-1.kg-1. The terminal half-life was 5.58 h after intravenous administration and 6.25 h after oral administration. Oral bioavailability of total NAC was 9.1%.

Fast horizontal electrophoresis. I. Isoelectric focusing and polyacrylamide gel electrophoresis using PhastSystem

PhastSystem, an integrated system for horizontal electrophoresis and isoelectric focusing in small gels, including automated staining and destaining, is described. Buffers for electrophoresis are supplied to the gel from buffer strips made of agarose. The separation bed is cooled by Peltier elements. All conditions of significance to the results, both during separation and development, are controlled by a microprocessor. For separation, nine programs are available, each with 9 steps; for development, there are nine programs with 20 steps each. In this paper, we also report results using PhastSystem for purity checking and characterization of monoclonal antibodies after affinity chromatography and also for determining their digestion rate with papain.