IL-18-binding protein protects against lipopolysaccharide- induced lethality and prevents the development of Fas/Fas ligand-mediated models of liver disease in mice

IL-18-binding protein (IL-18BP) is a natural IL-18 inhibitor. Human IL-18BP isoform a was produced as fusion construct with human IgG1 Fc and assessed for binding and neutralizing IL-18. IL-18BP-Fc binds human, mouse, and rat IL-18 with high affinity (K(D) 0.3-5 nM) in a BIAcore-based assay. In vitro, IL-18BP-Fc blocks IL-18 (100 ng/ml)-induced IFN-gamma production by KG1 cells (EC(50) = 0.3 microg/ml). In mice challenged with an LD(90) of LPS (15 mg/kg), IL-18BP-Fc (5 mg/kg) administered 10 min before LPS blocks IFN-gamma production and protects against lethality. IL-18BP-Fc administered 10 min before LPS blocks IFN-gamma production induced by LPS (5 mg/kg) with ED(50) of 0.005 mg/kg. Furthermore, IL-18BP-Fc (5 mg/kg) abrogates LPS (5 mg/kg)-induced IFN-gamma production even when administered 6 days before LPS but shows no effect when administered 9 or 12 days before LPS. Given 10 min before LPS challenge to mice primed 12 days in advance with heat-killed Propionibacterium acnes, IL-18BP-Fc prevents LPS-induced liver damage and IFN-gamma and Fas ligand expression. Given at the moment of priming with P. acnes, IL-18BP-Fc decreases P. acnes-induced granuloma formation, macrophage-inflammatory protein-1alpha and macrophage-inflammatory protein-2 production and prevents sensitization to LPS. IL-18BP-Fc also prevents Con A-induced liver damage and IFN-gamma and Fas ligand expression as well as liver damage induced by Pseudomonas aeruginosa exotoxin A or by anti-Fas agonistic Ab. In conclusion, IL-18BP can be engineered and produced in recombinant form to generate an IL-18 inhibitor, IL-18BP-Fc, endowed with remarkable in vitro and in vivo properties of binding and neutralizing IL-18.

[Effects of supplementing calcium, iron and zinc on the fetus development and growth during pregnancy]

OBJECTIVES

The purpose of the present study is to determine the effects of supplementing the biscuits fortified with calcium (Ca), iron (Fe) and zinc (Zn) for pregnant women from the 5th month of gestation until delivery on the growth and development of fetus and to explore the best way to improve infant growth.

METHODS

A total of 313 healthy and primary pregnant women were enrolled and divided into five study groups based on their order visiting the hospitals for prenatal care. Each woman of the study groups was given three pieces of biscuit fortified with VD, Ca and VD, Ca, Zn and VD (Ca + Zn + VD), Ca, Fe, VC and VD (Ca + Fe + VD), Ca, Fe, VC, Zn and VD (Ca + Fe + Zn + VD), respectively, from the 5th month of gestation until delivery (24 weeks in total) daily. The fortified levels were 10 micrograms Ca from carbonate calcium, 10 mg Zn from lactate zinc, 10 mg Fe from ferrous lactate, and 50 mg VC, respectively. A parturient women was selected from the same hospital as control after one trial subject for each study groups selected. Placenta was weighed and umbilical cord venous blood and placenta tissue samples were collected after delivery for measuring Ca and other trace elements. Body weight and height of the new-born babies were measured.

RESULTS

The weight of placenta in control group (551.1 +/- 64.2) g was significantly (P < 0.05) heavier than other trial groups with Ca + Fe + Zn + VD (467.1 +/- 36.6) g, but contents of Ca and other trace elements in placenta of the control group were lower, which probably because of the lower nutrients intake of mothers in control group that would result in a compensation enlargement of placenta to get enough nutrients for fetus from mother. The Hb level in cord venous blood was significantly higher than that of maternal blood. There was no significant difference in activity of alkaline phosphatase between cord venous blood and material blood. The contents of Ca, Fe and Zn in cord venous plasma were all significantly higher than those in maternal plasma. Birth weight and height in Ca + Fe + Zn + VD group were the highest in all the groups, with birth weight of (3.53 +/- 0.33) kg, as compared with (3.28 +/- 0.54) kg in the control group. There was significant correlation between birth weight, weight for age and intake of Ca, Fe and Zn during pregnancy.

CONCLUSION

Supplementation of Ca + Fe + Zn + VitD during pregnancy is the best way to improve infant development and growth, based on the current Recommended Dietary Allowances (RDA) for pregnant women.

[Effects of supplementing of calcium, iron and zinc on women's health during pregnancy]

OBJECTIVES

To determine the effects of supplementing biscuits fortified with calcium (Ca) and vitamin D (VD), iron (Fe), vitamin C (VC) and zinc (Zn) to pregnant women from the 5th month of gestation until delivery on their health, and to explore a way to improve their Ca, Fe and Zn nutritional status during pregnancy.

METHODS

A total of 313 healthy and primary pregnant women were enrolled and divided into five study groups based on their order visiting the hospitals for prenatal care. Each woman of the study groups was given three pieces of biscuit fortified with VD, Ca and VD, Ca, Zn and VD (Ca + Zn + VD), Ca, Fe, VC and VD (Ca + Fe + VD), Ca, Fe, VC, Zn and VD (Ca + Fe + Zn + VD), respectively, from the 15th month of gestation until delivery (24 weeks in total) daily. The fortified levels were 10 micrograms VD, 400 mg Ca from carbonate calcium, 10 mg Zn from lactate zinc, 10 mg Fe from ferrous lactate, and 50 mg VC, respectively. A parturient women was selected from the same hospital as control after one trial subject for each study groups selected.

RESULTS

The daily dietary intakes of Ca, Zn and Fe in pregnant women were only 47.7%, 54.7% and 86.7% of the Recommended Dietary Allowances for Chinese. Incidence of anemia for mid-term pregnant women was 35.2%, and Fe-supplementation could significantly improved their hemoglobin level (P < 0.05). Prevalence of anemia in the groups of Ca + Fe + Zn + VD and Ca + Fe + VD was 35.3% and 40.7%, respectively, before Fe supplementation and reduced to zero and 4.0%, respectively, after Fe supplementation. Whereas, prevalence of anemia in the other groups without Fe supplementation still kept in a relatively high level. In the groups supplemented with Ca, their plasma Ca level increased, especially with the best results in Ca + VD group. Plasma level of Zn declined with length of gestation, which could be improved by Zn supplementation. Serum level of alkaline phosphatase activity increased a little bit with length of gestation. There was no significant difference in radial and ulnar bone mineral density (BMD) between trial groups and controls two months after delivery. Maternal radial and ulnar BMD correlated significantly with their dietary Ca intakes in Ca + VD group.

CONCLUSION

The best way to improve maternal nutritional status is supplementation of Ca + Fe + Zn + VitD, based on the Recommended Dietary Allowances for Chinese.

Technical note: reference values of haematocrit in young people and relationship with altitude

The purpose of this paper is to provide scientific basis for a unified standard reference value of haematocrit in young people in China. The reference values of haematocrit levels in healthy young people have been collected according to the Wintrobe methods; the relationship between the reference values of haematocrit in young people and altitude has been tested in this paper. It has been found that the reference value of haematocrit in young people increases when the altitude gradually increases, and such relationship is quite significant, The method of mathematical univariate regression analysis is used to deduce two regression equations: Y1 = 44.3 + 0.00357X +/- 3.7, and Y2 = 39.7+0.00318X +/- 2.6. If the altitude value of a s known, the particular area of China is known, the reference value of haematocrit in young people there can be calculated by means of the regression equations. Furhermore depending on the altitude, China can be divided into three districts: Qingzang District, Central District and Eastern District.

Elimination of latently HIV-1-infected cells by lymphoblasts armed with bifunctional antibody

The Fab' fragment of a monoclonal antibody (mAb) to CD3 and the F(ab')2 fragment of a mAb to human immunodeficiency virus 1 (HIV-1) gp41 were combined to generate a bifunctional antibody (BFA). The mAb to gp41 (IV1-4G6) has previously been shown to react with a number of HIV-1 strains and T-lymphoblastoid cells (TLBC) armed with the BFA (BFA-TLBC) effectively inhibited HIV-1 in primarily cultured lymphoblasts infected with the clinically isolated virus which was reactive to the mAb. Although BFA-TLBC could not cause cytolysis of 51Cr-labeled latently infected cells (OM-10.1) in 6 hr incubation, cocultivation of OM-10.1 cells with BFA-TLBC for 3 days or more eliminated the latently infected cells making the cells susceptible to BFA-TLBC. Therefore, BFA-TLBC may be beneficial for HIV-infected patients in eradicating latently infected cells which can not be eliminated even with highly active antiretroviral therapy (HAART).

Changes in serum leptin levels in chronic renal failure patients with metabolic acidosis

OBJECTIVE

To examine the relationship between serum leptin levels (SLL) and metabolic acidosis in patients with chronic renal failure (CRF).

DESIGN

SLL in control patients and in predialysis patients with CRF were measured and compared. SLL before and after correction of acidosis in patients with CRF were also compared.

PATIENTS AND CONTROLS

Twenty-five patients with CRF (10 men and 15 women) aged 51.2 +/- 10.4 years and control patients (healthy subjects, 23 men and 25 women) aged 42.1 +/- 12.6 years were studied.

INTERVENTION

Five percent sodium bicarbonate (NaHCO(3), 2 to 3 mL/kg) was intravenously infused on the morning of the first day of treatment. NaHCO(3) was taken orally at a dosage of 50 to 200 mg/kg/d for 3 to 5 days thereafter.

MAIN OUTCOME MEASURE

SLL before and after NaHCO(3) treatment was measured by radioimmunoassay, and blood gas was measured before and after correction of metabolic acidosis in patients with CRF.

RESULTS

SLL in the normal control group (n = 48) was 10.04 +/- 7.0 ng/mL and was realated to body mass index (BMI) (P =.0331). SLL in men (n = 23) was lower than that in female controls (n = 25, P <.01). SLL in patients with CRF (n = 25) before (plasma HCO(3)(-), 13.03 +/- 3.05 mmol/L) and immediately after improvement of metabolic acidosis (plasma HCO(3)(-), 18.35 +/- 4.21 mmol/L) was 14.52 +/- 9.27 ng/mL and 15.34 +/- 11.89 ng/mL (P >.05), respectively. SLL measured 3 to 5 days after treatment for metabolic acidosis (plasma HCO(3)(-), 20.46 +/- 4.03 mmol/L) was 19.33 +/- 14.58 ng/mL, which was significantly higher than that in the normal control group and that in acidotic patients before NaHCO(3) treatment (P <.01).

CONCLUSIONS

SLL in acidotic patients with CRF were comparable to that in control subjects, and SLL was significantly increased after correction of metabolic acidosis in patients with CRF. The preliminary results suggest that hyperleptinemia in patients with CRF may be masked by metabolic acidosis and that metabolic acidosis may inhibit leptin synthesis or secretion. Further studies are needed to clarify the mechanisms.

Over-expression of beta-1,4-galactosyltransferase I, II, and V in human astrocytoma

PURPOSE

beta-1,4-Galactosyltransferase (beta-1,4-GalT) I, II, and V are the enzymes responsible for the biosynthesis of N-acetyllactosamine on N-glycans by transferring UDP-galactose to the terminal N-acetylglucosamine (N-GlcNAc) residues with the formation of a beta-1,4-linkage. Neoplasms undergo various changes in the carbohydrate of their glycoconjugates, indicating the possible changes in glycosyltransferases themselves.

METHOD

Therefore, we compared the expression of beta-1,4-GalTs between astrocytoma and normal brain tissues.

RESULTS

Our reverse-transcription polymerase chain reaction (RT-PCR) results showed that beta-1,4-GalT I transcript was absent in normal adult brain but detectable in grade II, III, and IV astrocytomas; the level of beta-1,4-GalT II transcript was increased in grade II, III, and IV astrocytomas while only a trace amount was found in normal brain; beta-1,4-GalT V transcript existed in normal brain and increased in the process of astrocytoma progress, with the highest level in grade IV astrocytoma. By Ricinus communis agglutinin-1 (RCA-1) lectin blot assay, we also found the more extensive galactosylated bands in astrocytomas compared with normal brain. A major 61kD protein was galactosylated in astrocytoma but not in normal brain tissues.

CONCLUSION

These results indicate that the increase of galactosylation in astrocytomas may be caused by the alterations of gene expression of beta-1,4-GalT I, II, and V and that the malignant degree of astrocytoma is correlated with the expression of beta-1,4-GalT V.

Protein adducts of 1,4-benzoquinone and benzene oxide among smokers and nonsmokers exposed to benzene in China

Hemoglobin (Hb) and albumin (Alb) adducts of the benzene metabolites benzene oxide (BO) and 1,4-benzoquinone (1,4-BQ) were analyzed by gas chromatography-mass spectrometry in 43 exposed workers and 44 unexposed controls from Shanghai, China, as part of a larger cross-sectional study of benzene biomarkers. When subjects were divided into controls (n = 44) and workers exposed to </=31 ppm (n = 21) and >31 ppm (n = 22) of benzene, median 1,4-BQ-Alb adducts were 2110, 5850, and 13,800 pmol/g Alb, respectively (correlation with exposure: Spearman r = 0.762; P < 0.0001); median BO-Alb adducts were 106, 417, and 2400 pmol/g Alb, respectively (Spearman r = 0.877; P < 0.0001); and median BO-Hb adducts were 37.1, 50.5, and 136 pmol/g Hb, respectively (Spearman r = 0.757; P < 0.0001). To our knowledge, this is the first observation that adducts of 1,4-BQ are significantly correlated with benzene exposure. When compared on an individual basis, Alb adducts of 1,4-BQ and BO and Hb adducts of BO were highly correlated with each other and with urinary phenol and hydroquinone (P < 0.0001 for all of the comparisons). Although detectable in the assays, Hb adducts of 1,4-BQ and both Hb and Alb adducts of 1,2-BQ produced erratic results and are not reported. Interestingly, cigarette smoking increased Alb adducts of 1,4-BQ but not of BO, suggesting that benzene from cigarette smoke was not the primary contributor to the 1,4-BQ adducts.

[Clinical efficacy of lamivudine in the treatment of chronic hepatitis B]

OBJECTIVE

To study the clinical efficacy and safety of lamivudine in the treatment of chronic hepatitis B.

METHODS

72 patients with hepatitis B were randomly assigned into lamivudine (n = 54) and placebo groups (n = 18) for 12 weeks. Then, all the patients received lamivudine 100 mg daily until week 104. Clinical symptoms, liver function tests, serum HBV DNA and YMDD mutation were evaluated.

RESULTS

HBV DNA response rate of lamivudine group was higher than that of placebo group after 12 weeks treatment (61% vs 6%, P < 0.01). ALT sustained normalization rate of lamivudine group was higher than that of placebo group (65% vs 11%, P < 0.05). At week 52 and week 104, HBV DNA response rate was 78% and 36% respectively, whereas the normalization rate of ALT was 39% and 33% respectively. Proportion of HBeAg/anti-HBe seroconversion was both 6.1% at week 52 and 104. Overall YMDD mutation rate was 13.7% at week 52 and 39.7% at week 104. The incidence of adverse effects was similar for lamivudine and placebo group at week 12. There was no severe drug-related adverse events during 104 weeks treatment.

CONCLUSION

Lamivudine 100 mg daily could suppress HBV replication rapidly and be well tolerated. However, in some cases, YMDD mutation may lead to HBV DNA breakthrough.

Stimulatory effects of B7-related protein-1 on cellular and humoral immune responses in mice

Inducible costimulator (ICOS) and B7-related protein-1 (B7RP-1) constitute a receptor-ligand pair involved in T cell costimulation. In this study, the stimulatory effects of B7RP-1 on cellular and humoral immune responses were investigated giving mice a construct with the extracellular domain of murine B7RP-1 fused with human IgG1 Fc (B7RP-1-Fc). B7RP-1-Fc stimulated contact hypersensitivity (CH) given near either the time of sensitization or challenge with oxazolone. When given near challenge time, B7RP-1-Fc stimulated CH more than a construct containing the extracellular domain of murine B7.2 and Fc (B7.2-Fc). B7RP-1-Fc increased the number of cells in lymph nodes draining the skin sensitized with oxazolone, especially activated T cells. B7RP-1-Fc also increased the ability of the cells in these lymph nodes to induce CH when transfused into naive mice. B7RP-1-Fc stimulated the production of anti-keyhole limpet hemocyanin (KLH) Ab, increasing anti-KLH IgG, IgG2a, and IgE, whereas B7.2-Fc did not affect this production. B7RP-1-Fc also increased the number of cells in lymph nodes draining the skin immunized with KLH and their production of IFN-gamma, IL-4, and IL-10 in response to KLH. Finally, B7RP-1-Fc increased the presence of eosinophils in the bronchoalveolar lavage and lungs of mice sensitized and challenged with OVA so to mount an asthmatic reaction. B7RP-1-Fc stimulates both cellular and humoral immune responses in vivo by increasing number and function of T and B cells reacting to Ag exposure.

Biomarker risk assessment and bladder cancer detection in a cohort exposed to benzidine

BACKGROUND

Cancer screening with highly sensitive, specific biomarkers that reflect molecular phenotypic alterations is an attractive strategy for cancer control. We examined whether biomarker profiles could be used for risk assessment and cancer detection in a cohort of Chinese workers occupationally exposed to benzidine and at risk for bladder cancer.

METHODS

The cohort consisted of 1788 exposed and 373 nonexposed workers, followed from 1991 through 1997. We assayed urothelial cells from voided urine samples for DNA ploidy (expressed as the 5C-exceeding rate [DNA 5CER]), the bladder tumor-associated antigen p300, and a cytoskeletal protein (G-actin). Workers were stratified into different risk groups (high, moderate, and low risk) at each examination based on a predefined biomarker profile. For workers who developed bladder cancer, tumor risk assessment was analyzed from samples collected 6-12 months before the cancer diagnosis. The associations between risk group and subsequent development of bladder cancer were analyzed by Cox proportional hazards regression analysis and logistic analysis, after adjustment. All statistical tests were two-sided.

RESULTS

Twenty-eight bladder cancers were diagnosed in exposed workers and two in nonexposed workers. For risk assessment, DNA 5CER had 87.5% sensitivity, 86.5% specificity, an odds ratio (OR) of 46.2 (95% confidence interval [CI] = 8.1 to 867.0), and a risk ratio (RR) of 16.2 (95% CI = 7.1 to 37.0); p300 had 50.0% sensitivity, 97.9% specificity, an OR of 40.0 (95% CI = 9.0 to 177.8), and an RR of 37.9 (95% CI = 16.8 to 85.3). The risk of developing bladder cancer was 19.6 (95% CI = 8.0 to 47.9) times higher in workers positive for either the DNA 5CER or p300 biomarkers than in workers negative for both biomarkers and 81.4 (95% CI = 33.3 to 199.3) times higher in workers positive for both biomarkers. G-actin was a poor marker of individual risk.

CONCLUSIONS

Occupationally exposed workers at risk for bladder cancer can be individually stratified, screened, monitored, and diagnosed based on predefined molecular biomarker profiles.

Novel structures and properties of gold nanowires

The structures of free-standing gold nanowires are studied by using molecular-dynamics-based genetic algorithm simulations. Helical and multiwalled cylindrical structures are found for the thinner nanowires, while bulk-like fcc structures eventually form in the thicker nanowires up to 3 nm in diameter. This noncrystalline-crystalline transition starts from the core region of nanowires. The vibrational, electronic, and transport properties of nanowires are investigated based on the optimal structures. Bulklike behaviors are found for the vibrational and electronic properties of the nanowires with fcc crystalline structure. The conductance of nanowires generally increases with wire diameter and depends on the wire structure.

[Changes in the activity of platelet L-arginine/nitric oxide pathway in hypercholesterolemia patients]

OBJECTIVE

To investigate the changes of the platelet L-arginine (L-Arg)/nitric oxide (NO) pathway in hypercholesterolemia patients.

METHODS

The platelet NO production in 21 hypercholesterolemia (HC) patients and 26 normal individuals was assayed by spectrum, the NOS activity and the transportation of L-Arg were determined by (3)H-labelled L-Arg.

RESULTS

The NO production in hypercholesterolemic platelets [(24.06 +/- 3.70) nmol/10(8) platelets] was decreased significantly as compared with normal controls [(28.39 +/- 4.45) nmol/10(8) platelets] (P < 0.01), and so did the NOS activity [(1.46 +/- 0.47) pmol/10(8) platelets] vs (1.81 +/- 0.50) pmol/10(8) platelets]. The transportation of L-Arg by hypercholesterolemia platelets also decreased significantly than that by normal controls. The Vmax in the former [(46.84 +/- 3.39) pmol x (10(7) platelets)(-1) x min(-1)] was significantly lower than that in the latter [(53.89 +/- 3.45) pmol x (10(7) platelets)(-1) x min(-1)]. There was no difference between the two groups in K(d) (P > 0.05).

CONCLUSIONS

The activity of the L-arg/NO pathway in hypercholesterolemia platelets is decreased significantly as compared with normal controls, implying that it is probably one of the reasons for the hyperactivity of hypercholesterolemia platelets.

Local structure evolution of FexNi77-xCu(1-)Nb2P14B6 soft magnetic materials by mechanical alloying

Mechanically alloyed Fe(x)Ni77-xCu1Nb2P14B6 soft magnetic materials have been prepared with different atomic compositions. The alloy structures are investigated by X-ray absorption fine structure (XAFS). The results show that mechanical alloying (MA) can drive the Fe(x)Ni77-xCu1Nb2P14B6 powder mixture to produce amorphous alloy while the atomic concentration of Fe element is about and over 40%. On the contrary, the MA Fe(x)Ni77 xCu1Nb2P14B6 is a solid solution with a fcc-like structure in the region of lower Fe atomic concentration (<22%), preserving a medium-range order around Ni and Fe atoms. Moreover, we have found that the local structure geometry of Fe atom is similar to that of Ni atom for all the MA Fe(x)Ni77-xCu1NbP14B6 samples. It indicates that the local structures of Fe and Ni atoms in a Fe(x)Ni77-xCu1Nb2P14B6 sample only depend on the x value of element Ni after ball milling.

Annealed crystallization of ultrafine amorphous NiB alloy studied by XAFS

XAFS has been used to investigate the local structure evolutions of ultrafine amorphous NiB alloy during the annealed crystallization process. A nanocrystalline Ni phase with the local structure of crystalline Ni-like and a crystalline Ni3B, have been produced for ultrafine amorphous NiB alloy under the annealed temperature of 573 K. The results rule out Rojo et al.'s devitrification mechanism of Ni80B20 amorphous alloy in which they considered that an amorphous pure Ni phase is formed in the first exothermic process. However, our results are almost identical with Riveiro et al.'s conclusion in which the intermediate state is interpreted as two metastable crystalline phases of Ni3B and Ni-rich NiB alloy. With the annealed temperature going onto 773 K, the ultrafine NiB sample is further decomposed and crystallized into crystalline Ni with long-range order.

Urinary benzene as a biomarker of exposure among occupationally exposed and unexposed subjects

Urinary benzene (UB) was investigated as a biomarker of exposure among benzene-exposed workers and unexposed subjects in Shanghai, China. Measurements were performed via headspace solid phase microextraction of 0.5 ml of urine specimens followed by gas chromatography-mass spectrometry. This assay is simple and more sensitive than other methods (detection limit 0.016 microg benzene/l urine). The median daily benzene exposure was 31 p.p.m. (range 1.65-329 p.p.m.). When subjects were divided into controls (n = 41), those exposed to < or =31 p.p.m. benzene (n = 22) and >31 p.p.m. benzene (n = 20), the median UB levels were 0.069, 4.95 and 46.1 microg/l, respectively (Spearman r = 0.879, P < 0.0001). A linear relationship was observed between the logarithm of UB and the logarithm of benzene exposure in exposed subjects according to the following equation: ln(UB, microg/l) = 0.196 + 0.709 ln (exposure, p.p.m.) (r = 0.717, P < 0.0001). Considering all subjects, linear relationships were also observed between the logarithm of UB and the corresponding logarithms of four urinary metabolites of benzene, namely t,t-muconic acid (r = 0.938, P < 0.0001), phenol (r = 0.826, P < 0.0001), catechol (r = 0.812, P < 0.0001) and hydroquinone (r = 0.898, P: < 0.0001). Ratios of individual metabolite levels to total metabolites versus UB provide evidence of competitive inhibition of CYP450 enzymes leading to increased production of phenol and catechol at the expense of hydroquinone and muconic acid. Among control subjects UB was readily detected with a mean level of 0.145 microg/l (range 0.027-2.06 microg/l), compared with 5.63 microg/l (range 0.837-26.38 microg/l) in workers exposed to benzene below 10 p.p.m. (P < 0.0001). This suggests that UB is a good biomarker for exposure to low levels of benzene.

Clinical application of botulinum toxin in otolaryngology, head and neck practice (brief review)

Botulinum toxin (Botox) is useful in controlling the symptoms of patients with movement disorders. Application of Botox serves to (1) inhibit hypertonicity, (2) enhance the action of the antagonistic muscles, and (3) avoid an impingement in order to reestablish "the balance of forces". In accordance with the principles mentioned above, Botox can be used to treat dystonias of the larynx (adductor laryngeal spasmodic dysphonia, abductor laryngeal spasmodic dysphonia), laryngeal granulomas, laryngeal joint dislocation, cricopharyngeal spasm, and posterior glottic synechiae. In addition, extra-laryngeal disorders such as blepharospasm, hemifacial spasm, oromandibular dystonia, and spasmodic torticollis respond well to Botox. The effects of Botox are reversible and have specific localized activity. Hence, Botox has served as a powerful diagnostic method in exploring the underlying mechanism of various types of dystonias and provides some therapeutic benefits before pursuing surgical options. Here we review the literature and describe our experiences with Botox, including such topics as preparing and storing Botox, identifying the target muscles under EMG-guidance, choosing an appropriate dose, and outlining the applications of Botox in Otolaryngology, Head and Neck Surgery practice.

Osteogenic protein-1 (bone morphogenetic protein-7) in the treatment of tibial nonunions

BACKGROUND

The role of bone morphogenetic proteins (BMPs) in osseous repair has been demonstrated in numerous animal models. Recombinant human osteogenic protein-1 (rhOP-1 or BMP-7) has now been produced and was evaluated in a clinical trial conducted under a Food and Drug Administration approved Investigational Device Exemption to establish both the safety and efficacy of this BMP in the treatment of tibial nonunions. The study also compared the clinical and radiographic results with this osteogenic molecule and those achieved with fresh autogenous bone.

MATERIALS AND METHODS

One hundred and twenty-two patients (with 124 tibial nonunions) were enrolled in a controlled, prospective, randomized, partially blinded, multi-center clinical trial between February, 1992, and August, 1996, and were followed at frequent intervals over 24 months. Each patient was treated by insertion of an intramedullary rod, accompanied by rhOP-1 in a type I collagen carrier or by fresh bone autograft. Assessment criteria included the severity of pain at the fracture site, the ability to walk with full weight-bearing, the need for surgical re-treatment of the nonunion during the course of this study, plain radiographic evaluation of healing, and physician satisfaction with the clinical course. In addition, adverse events were recorded, and sera were screened for antibodies to OP-1 and type-I collagen at each outpatient visit.

RESULTS

At 9 months following the operative procedures (the primary end-point of this study), 81% of the OP-1-treated nonunions (n = 63) and 85% of those receiving autogenous bone (n = 61) were judged by clinical criteria to have been treated successfully (p = 0.524). By radiographic criteria, at this same time point, 75% of those in the OP-1-treated group and 84% of the autograft-treated patients had healed fractures (p = 0.218). These clinical results continued at similar levels of success throughout 2 years of observation, and there was no statistically significant difference in outcome between the two groups of patients at this point (p = 0.939). All patients experienced adverse events. Forty-four percent of patients in each treatment group had serious events, none of which were related to their bone grafts. More than 20% of patients treated with autografts had chronic donor site pain following the procedure.

CONCLUSIONS

rhOP-1 (BMP-7), implanted with a type I collagen carrier, was a safe and effective treatment for tibial nonunions. This molecule provided clinical and radiographic results comparable with those achieved with bone autograft, without donor site morbidity.

[Posterior semicircular canal occlusion with microwave assisted technique in guinea pigs]

OBJECTIVE

To study the effectiveness of posterior semicircular canal occlusion with microwave assisted technique.

METHOD

Posterior semicircular canal occlusion with microwave assisted technique was performed in 20 guinea pigs. Electronystagmography (ENG) and auditory brainstem response (ABR) were recorded preoperatively and postoperatively. Morphological changes were observed under light microscopy.

RESULT

Left and right nystagmus returned symmetrical on the 3rd postoperative day. Two ears showed normal symmetrical nystagmus to icc-water stimulation on preoperation and the 30th postoperative day. There were no significant changes of the thresholds of ABR before and after surgery. Histopathological findings revealed that posterior semicircular canal was completely occluded, and that Organ of Corti and crista ampullaris were normal.

CONCLUSION

Posterior semicircular occlusion with microwave technique is suggested as an effective and safe treatment for the benign paroxysmal positional vertigo.

Regeneration of articular cartilage chondral defects by osteogenic protein-1 (bone morphogenetic protein-7) in sheep

The efficacy of osteogenic protein-1 (OP-1; BMP-7) in regeneration of articular cartilage was examined by creating knee chondral defects in sheep. With a specially designed instrument in both knees, two 10 mm (diameter) chondral defects were created: one in the trochlea and the other on the femoral condyle. The recombinant BMP was delivered via an extra-articulary positioned mini-osmotic pump, which was fixed to the femoral diaphysis above the knee joint, and connected by a polyethylene tubing to the articular space. Prior to use, the compatibility of OP-1 with mini-osmotic pumps was tested in vitro by measuring aggregation/precipitation and modification of the released protein by size exclusion and reversed phase HPLC. The average amount of aggregation was 15% and about 5% of OP-1 was modified. However, the biological activity of OP-1 released from pumps over a period of 2 weeks at 37 degrees C was equal to ROS cell assay OP-1 standard. Following surgery, a total of 55 microg (low dose) or 170 microg (high dose) OP-1 in acetate buffer (pH 4.5) was slowly released from the pump over a period of 2 weeks. The pumps connected to control knees were filled with acetate buffer as a vehicle. Twelve animals were operated, six of which were treated with the low OP-1 dose, and six with the high OP-1 dose. Three sheep of each group were killed either at 3 or 6 months following surgery, based on arthroscopical evaluation. The chondral defects in the control knees remained empty during the observation period. At 3 months following surgery, defects treated with both OP-1 doses were filled with connective tissue and cartilage. At 6 months following surgery, both doses of OP-1 stimulated regeneration in treated knees. The boundaries between new and old cartilage were well fused and mechanically resisted animals' weight bearing. The regenerated cartilage was rich in proteoglycans and type II collagen, as demonstrated by toluidine blue staining and immunohistochemistry. No signs of endochondral bone formation above the bony tidemark were observed. We suggest that a recombinant bone morphogenctic protein stimulates ingrowth of mesenchymal cells into the chondral defects which then transform into newly formed articular cartilage-like tissue.

Calorigenic actions of leptin are additive to, but not dependent on, those of thyroid hormones

We examined a possible mechanistic interaction between leptin and thyroid hormones in rats with hypothyroidism induced by thyroidectomy (TX) and propylthiouracil administration. In study 1, the TX rats were treated by vehicle (V, n = 9) or by recombinant murine leptin (L, 0.3 mg. kg(-1). day(-1), n = 9) or were pair-fed (PF, n = 9) against L. In study 2, the TX rats were all given 3, 3'5'-triiodo-L-thyronine (T(3)) replacement (T, 5 microg. kg(-1). day(-1)) to correct hypothyroidism. They were then subdivided into three groups, namely, vehicle (T+V, n = 9), leptin (T+L, n = 10), and pair-feeding (T+PF, n = 9), similar to study 1 except for T(3) (T). Reduced food consumption and weight gain in the TX rats were reversed by T(3) replacement. Leptin suppressed food intake in the TX rats regardless of T(3) replacement. O(2) consumption (VO(2)) and CO(2) production (VCO(2)) were reduced in TX rats (P < 0.05 vs. normal) but were normalized by either T(3) or leptin treatment. T+L additively increased VO(2) and VCO(2) (P < 0.05 vs. TX, T(3), and L). The respiratory exchange ratio was unaltered in TX rats, with and without T(3), but was significantly reduced by L or T+L treatments. These results indicate that the metabolic actions of leptin are not dependent on a normal thyroid status and that the effects of leptin and T(3) on oxidative metabolism are additive.

Benzene and lymphohematopoietic malignancies in China

While this study is larger than previous investigations and includes workers with a wide range of exposures to benzene, the estimates of risk, as measured by statistical confidence intervals, are still fairly broad, and would benefit from the larger numbers that could be provided by continued follow-up of this population. Nevertheless, the study confirms earlier findings of increased risk for ANLL and aplastic anemia among benzene-exposed workers, provides the first substantial evidence that MDS is linked to benzene exposure, and provides evidence that benzene increases risk for ANLL/MDS at lower levels of exposure than had previously been demonstrated. Currently we are evaluating the potential for extending the follow-up of workers included in this study. A new study would include expanded data collection for cases of hematopoietic malignancy and related disorders and for an appropriate control series.

Performance of a 2D image-based anthropometric measurement and clothing sizing system

Two-dimensional, image-based anthropometric measurement systems offer an interesting alternative to traditional and three-dimensional methods in applications such as clothing sizing. These automated systems are attractive because of their low cost and the speed with which they can measure size and determine the best-fitting garment. Although these systems have appeal in this type of application, not much is known about the accuracy and precision of the measurements they take. In this paper, the performance of one such system was assessed. The accuracy of the system was analyzed using a database of 349 subjects (male and female) who were also measured with traditional anthropometric tools and techniques, and the precision was estimated through repeated measurements of both a plastic mannequin and a human subject. The results of the system were compared with those of trained anthropometrists, and put in perspective relative to clothing sizing requirements and short-term body changes. It was concluded that image-based systems are capable of providing anthropometric measurements that are quite comparable to traditional measurement methods (performed by skilled measurers), both in terms of accuracy and repeatability.

[Establishment of the animal model of triple semicircular canal occlusion]

OBJECTIVE

To establish the animal model of triple semicircular canal occlusion(TCO) in guinea pigs.

METHODS

TCO was performed on 20 guinea pigs. Electronystagmography, auditory brainstem responses (ABR) and distortion product otoacoustic emissions(DPOAE) were recorded pre- and post-operatively. The non-operated ear was used as control.

RESULTS

There was spontaneous nystagmus towards non-operated side on the 1st postoperative day and no nystagmus to stimuli of sinusoidal angular acceleration in operated side. On the 30th postoperative day, left and right nystagmus returned symmetrical. Pre-operation, ice-water stimulation induced normal symmetric nystagmus in both sides. On the 30th postoperative day, ice-water stimulation only induced normal nystagmus in non-operated ear and failed in operated one. ABR thresholds increased approximately 10 dB post-operation. There were no significant changes of the amplitudes of DPOAE before and after surgery. Histologic examination revealed complete occlusion in the three semicircular canals with newly formed bone and connective tissue.

CONCLUSION

This study showed that the animal model of TCO was successfully established. These findings suggests that TCO might be a safe and simple procedure for the treatment of intractable peripheral vertigo.