Flurbiprofen versus naproxen in the treatment of rheumatoid arthritis

The efficacy and safety of flurbiprofen (Ansaid, Upjohn), 100 mg twice daily, were compared with those of naproxen, 250 mg twice daily, in a six-week, double-blind, randomized study involving 133 patients with rheumatoid arthritis. Patients completing the six-week treatment phase were then treated with flurbiprofen, 100 mg twice daily, during a six-week open-label phase. In the double-blind phase, both treatment groups showed improvement from baseline and, in general, the arthritic condition of all patients was significantly less severe while receiving treatment. In the open-label phase, the patients in whom therapy was switched from naproxen to flurbiprofen reported greater improvement compared with baseline than they did at the end of the double-blind phase. Statistically significant differences between medication groups were few. At weeks four and six, grip strength for the naproxen group increased from baseline by a marginal amount compared with the flurbiprofen group. Global evaluations of disease improvement by patients and physicians and proximal interphalangeal joint size showed trends in favor of flurbiprofen. In the double-blind phase, 29.4 percent of flurbiprofen-treated patients (n = 20) and 23.1 percent of naproxen-treated patients (n = 15) experienced side effects, most of which were gastrointestinal in origin. In the open-label phase, 81.0 percent of the patients (n = 87) satisfactorily completed the six weeks of flurbiprofen treatment. Based on this study, 100 mg of flurbiprofen administered twice daily was as effective as 250 mg of naproxen twice daily in the treatment of rheumatoid arthritis.

Double-blind comparison of flurbiprofen and sulindac for the treatment of osteoarthritis

In this double-blind, randomized trial involving 143 patients with osteoarthritis of the hip and/or knee, the efficacy and safety of twice-daily dosing with flurbiprofen (Ansaid, Upjohn), which has a half-life of 5.5 hours, were compared with those of sulindac, which has a half-life of 7.8 hours. Patients were treated with flurbiprofen (50 mg orally twice a day) or sulindac (150 mg orally twice a day) for six weeks. Based on evaluations by both patients and physicians, there were no statistically significant differences between the two treatment groups in most of the efficacy parameters studied. In addition, there were no statistically significant differences between the two treatment groups in the incidence or type of side effects, which were primarily gastrointestinal in origin. This study indicates that flurbiprofen, taken as 50 mg twice daily, is equally as effective as 150 mg of sulindac twice a day in the treatment of osteoarthritis.

Evidence for multiple serotonergic influences on LH release in ovariectomized rats and for modulation of their relative effectiveness by estrogen

Both opiates and serotonin (5HT) are known to inhibit LH release in ovariectomized rats, and estrogen has been shown to reverse certain serotonergic effects. Therefore studies were undertaken to compare the effects of morphine and the serotonin agonist 5-methoxy-N,N-dimethyltryptamine (5MEODMT) on LH release in ovariectomized rats with and without estrogen priming. Serial blood samples were collected via jugular cannulae before and 5, 15, 30 and 60 min after intravenous administration of morphine, 5MEODMT or both to rats receiving no pretreatment, or a serotonin receptor antagonist (methysergide, METH; or ketanserin, KET) 60 min earlier. In the absence of estrogen, morphine inhibited LH release, and the response was delayed by METH or abolished by KET, suggesting mediation by serotonin2 (5HT2) receptors. 5MEODMT alone failed to alter the release of LH significantly, but apparently activated both stimulatory and inhibitory serotonergic systems. Blockade of 5HT2 receptors with KET enabled an inhibitory system to prevail. No significant changes in LH concentrations were observed following combined administration of morphine and 5MEODMT. Similarly, in estrogen-primed rats morphine appeared to activate both inhibitory (5HT2) and stimulatory (5HT1) systems, resulting in no net change unless the inhibitory system had been antagonized by KET. Administration of 5MEODMT alone or in combination with morphine resulted in a strong stimulatory effect which appeared to be mediated by 5HT1 receptors. These results suggest the existence of a multiplicity of serotonergic influences on the release of LH in the rat, not only in terms of particular species of 5HT receptors, but also in neuronal connectivity.(ABSTRACT TRUNCATED AT 250 WORDS)

Reversal by estrogen of the effect of dorsal raphe stimulation on release of LH but not prolactin

Electrical stimulation of the dorsal raphe nucleus (DRN) was administered to rats 2-4 weeks after ovariectomy and at least 7 days following implantation of a bipolar electrode. During stimulation the concentration of luteinizing hormone (LH) decreased whereas that of prolactin (Prl) increased in serial plasma samples obtained from the unanesthetized animals via a cannula chronically implanted in the right external jugular vein. Administration of estradiol benzoate (5 micrograms/100 g BW) for 2 days prior to the experiment reversed the effect of stimulation on LH but augmented the Prl response, suggesting modulation by estrogen of the relative effectiveness of opposing pathways ascending from DRN to influence LH release. It is also apparent that LH and Prl release are controlled by distinct mechanisms since estrogen exerted opposite influences on the responses of these two hormones to stimulation of DRN.

Catacandins, novel anticandidal antibiotics of bacterial origin

Two novel antibiotics, catacandin A and catacandin B, were isolated from the fermentation broth of the bacterium, Lysobacter gummosus, by extraction and adsorption, reverse-phase and gel filtration chromatography. On the basis of their physico-chemical properties, they are acyltetramic acids that are easily distinguishable from others in this class. Catacandin A and catacandin B possess good anticandidal activity.

An autoradiographic study of rabbit ovarian surface epithelium before and after ovulation

Morphologic studies suggest that the proliferative activity of the ovarian surface epithelium (OSE) may vary during the reproductive life cycle. To further investigate this phenomenon, rabbit ovaries obtained before and after induction of ovulation with human chorionic gonadotropin (hCG) were incubated in medium containing 3H-methylthymidine and processed for autoradiography. Before ovulation, the labeling index (LI) of OSE cells varied from 0.04% to 0.22%. Twelve hours after hCG, the maximal LI (9.02 +/- 0.38%) was seen in OSE cells adjacent to the ovulatory stigma. The LI remained elevated at Days 1 and 5 post-hCG in OSE cells overlying corpora lutea. At Day 12, numerous papillary processes were observed at the apex of each corpus luteum. The maximal LI (16.44 +/- 1.31%) had now shifted to the OSE cells covering these processes. Eighteen days after hCG stimulation, the LI of OSE cells near the corpora lutea had returned to preovulatory levels. A slight increase in the LI of OSE cells not associated with ovulatory sites was also observed after ovulation. This study shows that a significant fraction of OSE cells undergoes DNA synthesis throughout most of the postovulatory period.

The provision of sterilization services by private physicians

Obstetrician-gynecologists are 4-5 times more likely to perform female sterilizations, and urologists are 2-3 times more likely to perform vasectomies, than are general surgeons or general or family practitioners. Catholics are less likely to perform either procedure than are non-Catholics. Participation in a group practice and having a practice in the North Central region of the country are associated with carrying out a larger average number of both male and female sterilizations. More than half of female sterilizations are performed as inpatient hospital procedures, and most of the remainder are done in hospitals on an outpatient basis. Two-thirds of vasectomies, on the other hand, are performed in doctors' offices, while most of the rest are performed as hospital outpatient procedures. About one vasectomy in 12, however, is performed on an inpatient basis--possibly because general anesthesia is used, or the procedure is performed along with other surgery. The average cost for an inpatient female sterilization in 1982 was $1,335. The cost for a hospital outpatient sterilization was not much less than that. The total cost of a vasectomy ranged from an average of $511 for an inpatient procedure to $240 for one performed in the office. The average cost is higher when the sterilization is performed by an obstetrician-gynecologist or a urologist than when the service is provided by a general surgeon or general/family practitioner. Fifty-eight percent of physicians performing female sterilizations accept Medicaid reimbursement, and 12 percent reduce their fees to accommodate low-income patients. The proportions for doctors who perform vasectomies are 51 percent and 12 percent.(ABSTRACT TRUNCATED AT 250 WORDS)

Two new inhibitors of phospholipase A2 produced by Penicillium chermesinum. Taxonomy, fermentation, isolation, structure determination and biological properties

Plastatin and the known fungal metabolite, luteosporin, have been isolated from fermentations of Penicillium chermesinum as inhibitors of porcine pancreatic phospholipase A2 (PLA2). Structure 1 for plastatin was deduced from its spectroscopic properties. Plastatin and luteosporin inhibited pancreatic PLA2 competitively with Ki values of 0.89 microM and 12.8 microM, respectively. PLA2 preparations from Naja naja and Crotalus adamanteus were not significantly inhibited by plastatin and luteosporin.

A followup study of ibuprofen users

We followed up 13,230 members of the Group Health Cooperative of Puget Sound under the age of 65 years who were presumed to have taken ibuprofen as out patients. All hospitalizations that occurred within 3 months after a prescription for ibuprofen was filled were reviewed. We found no instances of serious uncommon illness which could be attributed to this drug with any reasonable degree of certainty. In particular, there were no cases of acute liver or kidney disease noted within 3 months of exposure to ibuprofen.

Muscle cell electrical hyperpolarization and reduced exercise hyperkalemia in physically conditioned dogs

Contracting muscle cells release K ions into their surrounding interstitial fluid, and some of these ions, in turn, enter venous plasma. Thereby, intense or exhaustive exercise may result in hyperkalemia and potentially dangerous cardiotoxicity. Training not only reduces hyperkalemia produced by exercise but in addition, highly conditioned, long-distance runners may show resting hypokalemia that is not caused by K deficiency. To examine the factors underlying these changes, dogs were studied before and after 6 wk of training induced by running on the treadmill. Resting serum [K] fell from 4.2 +/- 0.2 to 3.9 +/- 0.3 meq/liter (P less than 0.001), muscle intracellular [K] rose from 139 +/- 7 to 148 +/- 14 meq/liter (P less than 0.001), and directly measured muscle cell membrane potential (Em) in vivo rose from -92 +/- 5 to -103 +/- 5 mV (P less than 0.001). Before training, resting Em of isolated intercostal muscle in vitro was -87 +/- 5 mV, and after incubation in 10(-4) M ouabain, Em fell to -78 +/- 5 mV. After training, resting Em of intercostal muscle rose to -95 +/- 4, but fell to -62 +/- 4 mV during incubation in 10(-4) M ouabain. The measured value for the Em was not completely explained by the increased ratio of intracellular to extracellular [K] or by the potassium diffusion potential. Skeletal muscle sarcolemmal Na,K-ATPase activity (microM inorganic phosphate mg-1 protein h-1) increased from 0.189 +/- 0.028 to 0.500 +/- 0.076 (P less than 0.05) after training, whereas activities of Mg2+ -dependent ATPase and 5'nucleotidase did not change. In untrained dogs, exercise to the point of exhaustion elevated serum [K] from 4.4 +/- 0.5 to 6.0 +/- 1.0 meq/liter (P less than 0.05). In trained dogs, exhaustive exercise was associated with elevation of serum [K] from 3.8 +/- 0.3 to 4.2 +/- 0.4 (NS). The different response of serum [K] to exercise after training was not explainable by blood pH. Basal insulin levels rose from 7.0 +/- 0.7 microU/ml in the untrained dogs to 9.9 +/- 1.0 microU/ml (P less than 0.05) after training. Although insulin might have played a role in the acquired electrical hyperpolarization, the reduced exercise-produced hyperkalemia after training was not reversed by blockade of insulin release with somatostatin. Although the fundamental mechanisms underlying the cellular hyperpolarization were not resolved, our observations suggest that increased Na-K exchange across the sarcolemmal membrane, the increase of Na,K-ATPase activity and possibly increased electrogenicity of the sodium pump may all play a role in the changes induced by training.

Growth characteristics of rabbit ovarian mesothelial (surface epithelial) cells

This study analyzes the morphology and growth characteristics of rabbit ovarian mesothelial (surface epithelial) cells explanted in vitro. Best cell growth and expression of differentiation were obtained using a polystyrene substrate, 100% air, and a nutrient composed of 85% medium 199 and 15% fetal bovine serum. Surface epithelia gave rise to cell outgrowths within 36 h of explantation and formed confluent epithelial monolayers after 1 week. Cells exhibited a marked proliferative activity as indicated by: (a) a labeling index of 80% at day 4, and of 40% at days 10 and 38; (b) a cell doubling time of 30-36 h during the logarithmic phase of growth; and (c) an estimated 24 cell population doublings during 6 weeks. Confluent cultures contained cells complexed by desmosomes and tight junctions and displaying numerous microvilli, intracellular lumina, and focal cilia. Cells organized often into nests and gland-like spaces and developed occasional hemicysts. High-density cultures developed also a multilayered configuration, villous processes, epithelial invaginations or crypts, and focal cytological features suggestive of steroidogenesis. This study shows that rabbit ovarian surface epithelial cells can be maintained in vitro with a high degree of differentiation. This model is being used to investigate the pathobiology of ovarian surface epithelium.

Effects of neonatal chlordecone exposure on pituitary-adrenal function in adult Fischer-344 rats

Fischer-344 rat pups of either sex were injected on day four of age with 1 mg/pup chlordecone (CLD) or DMSO vehicle. At 77-78 days of age, the rats were subjected to a repeated stress-induced analgesia (SIA) paradigm. A white noise (conditioned stimulus; CS) was paired with scrambled footshock for approximately one-half of the rats, while the remaining rats were exposed to the CS only. Conditioning occurred over a seven day period, one trial per day. On day 8 all rats received the CS only; 15 min later, the rats were sacrificed and serum and adrenals collected for corticosterone and/or prolactin measurements. Although prior neonatal exposure to CLD had no effect on the acquisition of the conditioned response or the responsiveness of the adrenocortical system to the CS, basal levels of serum and adrenal corticosterone were generally depressed in CLD-exposed males. Basal serum prolactin levels were decreased and increased in CLD-exposed males and females, respectively. These data suggest that neonatal CLD exposure may serve as a chemical stressor that produces long-lasting alterations in basal pituitary-adrenocortical function. The expression of these effects also appeared to be sex-dependent.

The harmful effects of ethanol on ion transport and cellular respiration

The deleterious effects of ethanol on a variety of tissues may result largely from altered ion permeabilities and transport. Clinically relevant ethanol concentrations in blood increase the sodium permeability of the plasma membrane and depress active sodium transport by suppressing Na, K-ATPase activity. As a result, intracellular sodium concentration increases. The total tissue content of calcium increases. Important transport mechanisms deranged by ethanol probably include those regulating calcium-sodium and hydrogen-sodium exchange at the plasma membrane and calcium uptake by the sarcoplasmic reticulum. A modest decline in magnesium content of muscle occurs after chronic exposure to ethanol. This also has been associated with accumulation of calcium. After days to weeks of sustained ethanol intake, sodium pump activity, active sodium transport and tissue oxygen consumption increase. The cell membrane potential, initially lowered by alcohol, increases to supraphysiological levels. This is likely an electrogenic effect of increased sodium transport in response to a sodium leak. Eventually the earlier derangements in tissue composition, including retention of sodium, chloride, and calcium, and reductions in magnesium, potassium, and phosphate, slowly undergo correction. This biphasic response of injury and adaptation appears to depend upon adequate nutrition and the absence of other factors that can adversely affect cell function. That the Na, K-ATPase activity and oxygen consumption remain elevated suggests an ongoing sodium leak of the sarcolemmal membrane. Chronic ethanol-induced cell necrosis may be related to the increased intracellular calcium that accompanies the increase in sodium permeability. Conceivably, critically elevated concentrations of calcium in the cytoplasm may activate autolytic enzymes that in turn may be responsible for structural damage to the cell.

Hypothalamic-pituitary adrenal (HPAA) axis function in adult Fischer-344 rats exposed during development to neurotoxic chemicals perinatally

The major objective of these experiments was to determine long-term effects on the hypothalamic-pituitary adrenal axis (HPAA) of adult rats exposed during development to chlordecone, an organochlorine insecticide. Chlordecone was administered to mothers prenatally plus the first 12 days of the neonatal period (6 ppm in the diet) or neonatally via a single subcutaneous injection to rats at 4 days of age (1 mg/pup in 20 micrograms of DMSO). DMSO (20 microliters/pup) and dexamethasone (100 micrograms/pup in 20 microliters saline) were also injected on day 4. HPAA function was evaluated at 70-80 days of age. Responsiveness of the HPAA to a repeated stressor was evaluated by exposing rats of each treatment group to a 7-day stress-induced analgesia (SIA) paradigm consisting of a daily 15 sec foot-shock (0.9 mA) exposure which was preceded by a 15 sec white noise conditioned stimulus. The behavioral response to daily stress was evaluated by measuring tail-flick latencies immediately before and/or after each stress exposure. The conditioned response to stress was evaluated 24 hours after the last of 7 daily foot-shock sessions in which rats of each treatment and experimental group were exposed to the shock chamber only. All rats were killed 15 minutes after the final session and tissue (serum and adrenals) were removed and frozen for later chemical analysis; serum and adrenal corticosterone (CS) and serum prolactin (Prl) levels were measured. Perinatal exposure to chlordecone did not significantly alter the behavioral and/or neuroendocrine responses to stress. Ambient hormone levels (both CS and Prl), however, were uniformly attenuated by chlordecone.(ABSTRACT TRUNCATED AT 250 WORDS)

Replicated item level factor analysis of the full MMPI

We completed a comprehensive factor analysis of the full MMPI item pool by using recent advances in computational facilities. Nearly 20,000 MMPI protocols were collected for the analysis, however, we discarded invalid records and protocols with more than 50 missing items. Analyses were computed on a developmental sample of 5,506 subjects and a cross-validation sample of 5,632. Twenty-one replicated factors were found by using an orthogonal varimax solution. The rotated factors were submitted to several experts on MMPI for factor naming. The consensus obtained on the item factors suggests that this analysis provides an unambiguous picture of the major content dimensions in the MMPI item pool.

Muraceins--muramyl peptides produced by Nocardia orientalis as angiotensin-converting enzyme inhibitors. II. Isolation and structure determination

Three new muramyl peptides ( muraceins A, B and C) have been isolated from fermentations of Nocardia orientalis as inhibitors of angiotensin-converting enzyme (ACE). Structures 1 and 2, for muraceins A and B respectively, were deduced from their spectroscopic properties. Muracein C, 3, was shown to be a muramyl pentapeptide containing N-acetylmuramic acid, alanine, glutamic acid, serine and diaminopimelic acid in a 1:2:1:1:1 ratio based on the 1H NMR integration.

Surface morphology of ovarian mesothelium (surface epithelium) and of other pelvic and extrapelvic mesothelial sites in the rabbit

The morphology of the ovarian mesothelium (surface epithelium) and of other pelvic and extrapelvic mesothelia was investigated in the rabbit by use of scanning electron microscopy. Villous processes of varied architectural complexity and surface epithelial crypts were found in the ovary but not in the mesothelial linings of the oviduct, uterus, liver, or pelvic and abdominal walls. Both ovarian and extraovarian mesothelial cells possessed abundant microvilli. Fully developed individual cilia and ciliary tufts were seen exclusively in ovarian mesothelia, while abortive or blunted cilia were rarely seen in pelvic but not in extrapelvic mesothelia. A distinct transition in surface configuration was present in contiguous mesothelia. In fact, ovarian mesothelia containing numerous villous processes, crypts, and cuboidal to low columnar cells merged with oviduct and fat mesothelia displaying only flat or low cuboidal cells. Villous processes were often lined by a stratified or pseudostratified epithelium and this histology resembled that of ovarian surface papillomas. Processes were more numerous in smaller ovaries than in larger ovaries where interstitial tissue and corpora lutea were prominent. This study underscores the unique architecture and morphogenetic behavior of the ovarian mesothelium. It also suggests that local factors and/or reproductive patterns may have a role in regulating the growth and development of this important ovarian component.

Bacterial production of 7-formamidocephalosporins isolation and structure determination

Two new 7-formamidocephalosporins have been isolated as their acetyl derivatives (SQ 28,516 and SQ 28,517) from fermentations of a Flavobacterium sp. SC 12,154. Structure 1 was deduced for SQ 28,516 from its spectroscopic properties while structure 2 was proposed for SQ 28,517. SQ 28,516 exhibits weak antibacterial activity.

SQ 28,332, a new monobactam produced by a Flexibacter sp. Taxonomy, fermentation, isolation, structure determination and biological properties

A new monobactam SQ 28,332 has been isolated from fermentations of a Flexibacter sp. and the structure 3 was deduced from its spectroscopic properties. SQ 28,332 exhibits weak antibacterial activity.

MMPI clinical and content norms for a mixed psychiatric adolescent population

Presented a set of MMPI norms for a mixed psychiatric group of adolescents (N = 1022). Normative information is stratified according to five age categories and includes means and standard deviations for the validity, clinical, and 48 content scales. The usefulness of these norms for clinicians is discussed.