Association of Blast Exposure in Military Breaching with Intestinal Permeability Blood Biomarkers Associated with Leaky Gut

Injuries and subclinical effects from exposure to blasts are of significant concern in military operational settings, including tactical training, and are associated with self-reported concussion-like symptomology and physiological changes such as increased intestinal permeability (IP), which was investigated in this study. Time-series gene expression and IP biomarker data were generated from "breachers" exposed to controlled, low-level explosive blast during training. Samples from 30 male participants at pre-, post-, and follow-up blast exposure the next day were assayed via RNA-seq and ELISA. A battery of symptom data was also collected at each of these time points that acutely showed elevated symptom reporting related to headache, concentration, dizziness, and taking longer to think, dissipating ~16 h following blast exposure. Evidence for bacterial translocation into circulation following blast exposure was detected by significant stepwise increase in microbial diversity (measured via alpha-diversity p = 0.049). Alterations in levels of IP protein biomarkers (i.e., Zonulin, LBP, Claudin-3, I-FABP) assessed in a subset of these participants (n = 23) further evidenced blast exposure associates with IP. The observed symptom profile was consistent with mild traumatic brain injury and was further associated with changes in bacterial translocation and intestinal permeability, suggesting that IP may be linked to a decrease in cognitive functioning. These preliminary findings show for the first time within real-world military operational settings that exposures to blast can contribute to IP.

Neurotrauma Biomarker Levels and Adverse Symptoms Among Military and Law Enforcement Personnel Exposed to Occupational Overpressure Without Diagnosed Traumatic Brain Injury

IMPORTANCE

There is a scientific and operational need to define objective measures of exposure to low-level overpressure (LLOP) and concussion-like symptoms among persons with specialized occupations.

OBJECTIVE

To evaluate serum levels of neurotrauma biomarkers and their association with concussion-like symptoms reported by LLOP-exposed military and law enforcement personnel who are outwardly healthy and cleared to perform duties.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study, conducted from January 23, 2017, to October 21, 2019, used serum samples and survey data collected from healthy, male, active-duty military and law enforcement personnel assigned to operational training at 4 US Department of Defense and civilian law enforcement training sites. Personnel aged 18 years or older with prior LLOP exposure but no diagnosed traumatic brain injury or with acute blast exposure during sampling participated in the study. Serum samples from 30 control individuals were obtained from a commercial vendor.

MAIN OUTCOMES AND MEASURES

Serum levels of glial fibrillary acidic protein, ubiquitin carboxyl hydrolase (UCH)-L1, neurofilament light chain, tau, amyloid β (Aβ)-40, and Aβ-42 from a random sample (30 participants) of the LLOP-exposed cohort were compared with those of 30 age-matched controls. Associations between biomarker levels and self-reported symptoms or operational demographics in the remainder of the study cohort (76 participants) were assessed using generalized linear modeling or Spearman correlations with age as a covariate.

RESULTS

Among the 30 randomly sampled participants (mean [SD] age, 32 [7.75] years), serum levels of UCH-L1 (mean difference, 4.92; 95% CI, 0.71-9.14), tau (mean difference, 0.16; 95% CI, -0.06 to 0.39), Aβ-40 (mean difference, 138.44; 95% CI, 116.32-160.56), and Aβ-42 (mean difference, 4.97; 95% CI, 4.10-5.83) were elevated compared with those in controls. Among the remaining cohort of 76 participants (mean [SD] age, 34 [7.43] years), ear ringing was reported by 44 (58%) and memory or sleep problems were reported by 24 (32%) and 20 (26%), respectively. A total of 26 participants (34%) reported prior concussion. Amyloid β-42 levels were associated with ear ringing (F1,72 = 7.40; P = .008) and memory problems (F1,72 = 9.20; P = .003).

CONCLUSIONS AND RELEVANCE

The findings suggest that long-term LLOP exposure acquired during occupational training may be associated with serum levels of neurotrauma biomarkers. Assessment of biomarkers and concussion-like symptoms among personnel considered healthy at the time of sampling may be useful for military occupational medicine risk management.

DNA Methylation Patterns of Chronic Explosive Breaching in U.S. Military Warfighters

Background: Injuries from exposure to explosions rose dramatically during the Iraq and Afghanistan wars, which motivated investigation of blast-related neurotrauma. We have undertaken human studies involving military "breachers" -exposed to controlled, low-level blast during a 3-days explosive breaching course. Methods: We screened epigenetic profiles in peripheral blood samples from 59 subjects (in two separate U.S. Military training sessions) using Infinium MethylationEPIC BeadChips. Participants had varying numbers of exposures to blast over their military careers (empirically defined as high ≥ 40, and conversely, low < 39 breaching exposures). Daily self-reported physiological symptoms were recorded. Tinnitus, memory problems, headaches, and sleep disturbances are most frequently reported. Results: We identified 14 significantly differentially methylated regions (DMRs) within genes associated with cumulative blast exposure in participants with high relative to low cumulative blast exposure. Notably, NTSR1 and SPON1 were significantly differentially methylated in high relative to low blast exposed groups, suggesting that sleep dysregulation may be altered in response to chronic cumulative blast exposure. In comparing lifetime blast exposure at baseline (prior to exposure in current training), and top associated symptoms, we identified significant DMRs associated with tinnitus, sleep difficulties, and headache. Notably, we identified KCNN3, SOD3, MUC4, GALR1, and WDR45B, which are implicated in auditory function, as differentially methylated associated with self-reported tinnitus. These findings suggest neurobiological mechanisms behind auditory injuries in our military warfighters and are particularly relevant given tinnitus is not only a primary disability among veterans, but has also been demonstrated in active duty medical records for populations exposed to blast in training. Additionally, we found that differentially methylated regions associated with the genes CCDC68 and COMT track with sleep difficulties, and those within FMOD and TNXB track with pain and headache. Conclusion: Sleep disturbances, as well as tinnitus and chronic pain, are widely reported in U.S. military service members and veterans. As we have previously demonstrated, DNA methylation encapsulates lifetime exposure to blast. The current data support previous findings and recapitulate transcriptional regulatory alterations in genes involved in sleep, auditory function, and pain. These data uncovered novel epigenetic and transcriptional regulatory mechanism underlying the etiological basis of these symptoms.

Overpressure Exposure From .50-Caliber Rifle Training Is Associated With Increased Amyloid Beta Peptides in Serum

Background: Overpressure (OP) is an increase in air pressure above normal atmospheric levels. Military personnel are repeatedly exposed to low levels of OP caused by various weapon systems. Repeated OP may increase risk of neurological disease or psychological disorder diagnoses. A means to detect early phase effects that may be relevant to brain trauma remain elusive. Therefore, development of quantitative and objective OP-mediated effects during acute timeframes would vastly augment point-of-care or field-based decisions. This pilot study evaluated the amplitude of traumatic brain injury (TBI)–associated biomarkers in serum as a consequence of repeated OP exposure from .50-caliber rifle use over training multiple days.

Objective: To determine the acute temporal profile of TBI-associated serum biomarkers and their relationship with neurocognitive decrements or self-reported symptoms among participants exposed to low-level, repeated OP from weapons used in a training environment.

Methods: Study participants were enrolled in .50-caliber sniper rifle training and exposed to mild OP (peak pressure 3.8–4.5 psi, impulse 19.27–42.22 psi-ms per day) for three consecutive days (D1–D3). Defense automated neurobehavioral assessment (DANA) neurocognitive testing, symptom reporting, and blood collection were conducted 2–3 h before (pre-) and again 0.45–3 h after (post-) OP exposure. The TBI-associated serum biomarkers, glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase-L1 (UCH-L1), neurofilament light (Nf-L), tau, and amyloid beta peptides (Aβ-40 and Aβ-42) were measured using digital ELISAs.

Results: Serum GFAP decreased on D1 and D3 but not D2 after OP exposure. Nf-L was suppressed on D3 alone. Aβ-40 was elevated on D2 alone while Aβ-42 was elevated each day after OP exposure. Suppression of GFAP and elevation of Aβ-42 correlated to OP-mediated impulse levels measured on D3.

Conclusions: Acute measurement of Aβ-peptides may have utility as biomarkers of subconcussive OP caused by rifle fire. Fluctuation of GFAP, Nf-L, and particularly Aβ peptide levels may have utility as acute, systemic responders of subconcussive OP exposure caused by rifle fire even in the absence of extreme operational deficits or clinically defined concussion.

Brain-related proteins as serum biomarkers of acute, subconcussive blast overpressure exposure: A cohort study of military personnel

Repeated exposure to blast overpressure remains a major cause of adverse health for military personnel who, as a consequence, are at a higher risk for neurodegenerative disease and suicide. Acute, early tracking of blast related effects holds the promise of rapid health assessment prior to onset of chronic problems. Current techniques used to determine blast-related effects rely upon reporting of symptomology similar to that of concussion and neurocognitive assessment relevant to operational decrement. Here, we describe the results of a cross sectional study with pared observations. The concentration of multiple TBI-related proteins was tested in serum collected within one hour of blast exposure as a quantitative and minimally invasive strategy to augment assessment of blast-exposure effects that are associated with concussion-like symptomology and reaction time decrements. We determined that median simple reaction time (SRT) was slowed in accordance with serum Nf-L, tau, Aβ-40, and Aβ-42 elevation after overpressure exposure. In contrast, median levels of serum GFAP decreased. Individual, inter-subject analysis revealed positive correlations between changes in Nf-L and GFAP, and in Aβ-40 compared to Aβ-42. The change in Nf-L was negatively associated with tau, Aβ-40, and Aβ-42. Participants reported experiencing headaches, dizziness and taking longer to think. Dizziness was associated with reaction time decrements, GFAP or NfL suppression, as well as Aβ peptide elevation. UCH-L1 elevation had a weak association with mTBI/concussion history. Multiplexed serum biomarker quantitation, coupled with reaction time assessment and symptomology determined before and after blast exposure, may serve as a platform for tracking adverse effects in the absence of a head wound or diagnosed concussion. We propose further evaluation of serum biomarkers, which are often associated with TBI, in the context of acute operational blast exposures.

Load shift of the intervertebral disc after a vertebroplasty: a finite-element study

Infiltrating osteoporotic cancellous bone with bone cement (vertebroplasty) is a novel surgical procedure to stabilize and prevent osteoporotic vertebral fractures. Short-term clinical and biomechanical results are encouraging; however, so far no reports on long-term results have been published. Our clinical observations suggest that vertebroplasty may induce subsequent fractures in the vertebrae adjacent to the ones augmented. At this point, there is only a limited understanding of what causes these fractures. We have previously hypothesized that adjacent fractures may result from a shift in stiffness and load following rigid augmentation. The purpose of this study is to determine the load shift in a lumbar motion segment following vertebroplasty. A finite-element (FE) model of a lumbar motion segment (L4-L5) was used to quantify and compare the pre- and post-augmentation stiffness and loading (load shift) of the intervertebral (IV) disc adjacent to the augmented vertebra in response to quasi-static compression. The results showed that the rigid cement augmentation underneath the endplates acted as an upright pillar that severely reduced the inward bulge of the endplates of the augmented vertebra. The bulge of the augmented endplate was reduced to 7% of its value before the augmentation, resulting in a stiffening of the IV joint by approximately 17%, and of the whole motion segment by approximately 11%. The IV pressure accordingly increased by approximately 19%, and the inward bulge of the endplate adjacent to the one augmented (L4 inferior) increased considerably, by approximately 17%. This increase of up to 17% in the inward bulge of the endplate adjacent to the one augmented may be the cause of the adjacent fractures.

Material changes in osteoporotic human cancellous bone following infiltration with acrylic bone cement for a vertebral cement augmentation

Bone cement infiltration can be effective at mechanically augmenting osteoporotic vertebrae. While most published literature describes the gain in mechanical strength of augmented vertebrae, we report the first measurements of viscoelastic material changes of cancellous bone due to cement infiltration. We infiltrated cancellous core specimen harvested from osteoporotic cadaveric spines with acrylic bone cement. Bone specimen before and after cement infiltration were subjected to identical quasi-static and relaxation loading in confined and free compression. Testing data were fitted to a linear viscoelastic model of compressible material and the model parameters for cement, native cancellous bone, and cancellous bone infiltrated (composite) with cement were identified. The fitting demonstrated that the linear viscoelastic model presented in this paper accurately describes the mechanical behaviour of cement and bone, before and after infiltration. Although the composite specimen did not completely adopt the properties of bulk bone cement, the stiffening of cancellous bone due to cement infiltration is considerable. The composite was, for example, 8.5 times stiffer than native bone. The local stiffening of cancellous bone in patients may alter the load transfer of the augmented motion segment and may be the cause of subsequent fractures in the vertebrae adjacent to the ones infiltrated with cement. The material model and parameters in this paper, together with an adequate finite-element model, can be helpful to investigate the load shift, the mechanism for subsequent fractures, and filling patterns for ideal cement infiltration.

[Effect of the parents' dental fear on the child's oral health]

There are various factors which influence the oral status, among them the dental fear. Dental anxious individuals are likely to have more missing teeth and fewer filled ones. This study examined the association between dental anxiety and oral health status in parents and indirectly in children. The authors found that there is positive correlation between dental fear and missing teeth in the older generation. These tendency can also be seen in younger ones.

[Attention deficit hyperactivity disorder. Literature review for the pediatric dentist]

The purpose of this review was to give a complete summary of the ADHD (Attention Deficit Hyperactivity Disorder) for dentists, especially for those who deal with dental traumatology. Children with ADH disorder show symptoms of restlessness, hyperactivity, impulsive behaviour and inattention often resulting in serious dental accidents. The article summarizes the literary data concerning ADH-Syndrome, presents a typical case and also deals with the dental considerations.

Effects of doxazosin on hemorheological, hemodynamic and lipid parameters in patients with essential hypertension

It is known from previous studies that hemorheological parameters are altered in patients with essential hypertension. The hemorheological and hemodynamical effects of doxazosin, a selective alpha-1-adrenoreceptor blocker agent, was examined in twenty patients (mean age: 54+/-10 years) with essential hypertension. Hemorheologic (hematocrit, fibrinogen, plasma and whole blood viscosity) and hemodynamic (cardiac output and index, total peripheral resistance) parameters and plasma lipids were determined. The measurements were carried out before the beginning of the treatment, after 1 week and after 12 weeks treatment periods. Besides significant reduction of blood pressure and total peripheral resistance (p < 0.001), a decrease in cholesterol (p < 0.001) and triglyceride (p < 0.01) levels and a beneficial effect on hemorheological parameters was detected. Fibrinogen and plasma viscosity decreased significantly (p < 0.01). Hematocrit value was also lower after one week (p < 0.001), then an increase could be seen. Whole blood viscosity showed similar changes as hematocrit, but the degree of its final increase was slighter, which was supported by the significantly lower value of corrected blood viscosity (p < 0.05).

[Goltz syndrome - a case report]

The Goltz (Goltz-Gorlin) syndrome or focal dermal hypoplasia is a relatively rare disease. Its clinical manifestation shows a great variety. The syndrome characterized by anomalies of cutaneous, osseous, dental and ocular structures. The authors present the case of a six-year-old girl with typical anomalies of Goltz-Gorlin syndrome with special respect to the dental problems.

[Reproducibility of the laser fluorescence method for the diagnosis of occlusal caries. Clinical study]

The aim of the study was to assess the reproducibility of recently developed laser fluorescence method for occlusal caries detection in vivo. 71 non-cavitated premolar and molar teeth were examined repeatedly by three dentists using DIAGNOdent (KaVo) instrument. The presence of caries has been established on the classification of Lussi, created on the basis of "in vitro" investigations. The reproducibility of the measurements were expressed in rank correlation of Spearman. The intra- and interexaminer reliability was also determined by Kappa statistics. The Spearman correlation coefficiencies were fairly high (0.738-0.949) The intraobserver and interobserver coincidencies reflected by Kappa values (0.60-0.88 and 0.44-0.77, respectively) were also convincing.

Suprasplenic, transperitoneal approach for laparoscopic adrenalectomy on the left side

BACKGROUND

There are several minimally invasive means of exposing the adrenal glands. Each of them has its own advantages and disadvantages. A new approach was introduced for laparoscopic adrenalectomy on the left side.

PATIENTS AND METHODS

Between June 1997 and January 2000, 23 transperitoneal unilateral laparoscopic adrenalectomies on the left side were performed. In 4 of these cases, only enucleation of a well-circumscribed adenoma was done. In a semilateral position, the gland was approached through the splenophrenic ligament with partial mobilization of the spleen. The left adrenal gland was quickly and safely exposed, thus avoiding the complications of transmesocolic exposure. There was no need for extensive mobilization of the spleen or the pancreas.

RESULTS

In 20 cases the laparoscopic operation was successfully performed. In 3 cases conversion was necessary because of bleeding. The estimated blood loss was on average 150 ml. The mean operation time was 84 min, the mean postoperative stay 4.5 days. No other major complications were observed.

CONCLUSION

This new method is a safe and quick technique for left-sided laparoscopic adrenalectomy, and it can be an alternative to the existing ones.

[Oxidative stress and antioxidant defense in alcoholic liver disease and chronic hepatitis C]

In the past decade it became accepted that free radicals, lipid peroxidation and antioxidant defense play a role in various tissues damages, thus in certain liver diseases as well. Since only limited data have been reported concerning the oxidative stress in viral hepatitis, a comparative study was performed in patients (pts) with chronic hepatitis C and alcoholic liver disease. In addition, the effects of a flavonolignan drug silymarin were assessed. 10 pts with chronic hepatitis C, 5 pts with alcoholic hepatitis and 13 pts with alcoholic cirrhosis have been investigated. Biochemical liver tests (serum bilirubin, aminotransferases, ALT, AST, lactate dehydrogenase (LDH), pseudocholinesterase, prothrombin), malandialdehyde (MDA) levels in plasma and red blood cell (RBC) hemolysate, superoxide radical generating capacity of stimulated polymorphonuclear granulocytes (PMN), plasma concentrations of reduced (GSH) and oxidized (GSSG) glutathione, vitamin A, luteine and beta carotene, furthermore RBC superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase activities were determined. The level of plasma MDA--as the marker of lipid peroxidation--was highest in alcoholic cirrhosis (five times of normal) (p < 0.05), the RBC hemolysate MDA was most elevated in chronic hepatitis C (p < 0.05). The mean PMNs' superoxide radical generating capacity was 116.6% of normal control in alcoholic hepatitis, where the mean GSH level was the lowest (89.8% of normal). Plasma vitamin A content was lowest in alcoholic cirrhosis (68% of control) (p < 0.05). SOD activity was elevated in both chronic hepatitis C and alcoholic cirrhosis, where GPx activity was decreased (p < 0.05). There was a correlation between LDH and SOD activities (r = 0.77, p = 0.015). Silymarin treatment of one month duration resulted in normalization of serum bilirubin in 55% of treated pts, AST became normal in 45%, and RBC hemolyzate MDA level normalized in similar rate. A significant increase in both GSH and retinoids was found. Alterations in oxidative stress and antioxidant defense system were shown in chronic hepatitis C, not only in alcoholic liver disease. The parameters of lipid peroxidation and antioxidant defense may be useful surrogate markers for monitoring pts with liver disease during hepatoprotective treatment.

Hemorheological and hemodynamic parameters in patients with essential hypertension and their modification by alpha-1 inhibitor drug treatment

Hemorheological factors play an important role in the pathogenesis of different cardiovascular diseases. The hemorheological and hemodynamic parameters in essential hypertension and their possible modification by antihypertensive treatment were examined in the following two studies. In the first study the fundus appearance and hemorheological parameters (plasma and whole blood viscosity (WBV), fibrinogen level) of 33 hypertensive patients (mean age: 55 years) were examined. The fundus appearance showed retinopathy in all the cases between stages I-III. All the measured hemorheological parameters of the examined patients were in the pathological range (WBV at 90 s(-1): 5.18 mPa s) and were significantly (p < 0.01) higher than in healthy controls (WBV at 90 s(-1): 4.18 mPa s). The hemorheological factors showed a parallel deterioration with the fundus appearance, namely their values were significantly (p < 0.01) higher in patients with a fundus appearance stage III (WBV at 90 s(-1): 6.02 mPa s) than stage I (WBV at 90 s(-1): 4.51 mPa s). These results show that there is a correlation between hemorheological parameters and fundus appearance in hypertensives, and this suggests that hemorheological factors may play a role in the development of hypertensive retinopathy. In the second study the hemorheological and hemodynamical effects of Doxazosin, a selective alpha-1-adrenoreceptor blocker agent, was examined in twenty patients (mean age: 54 years) with essential hypertension. Hemorheologic (hematocrit, fibrinogen, plasma and whole blood viscosity) and hemodynamic (cardiac output and index, total peripheral resistance) parameters and plasma lipids were determined. The measurements were carried out before the beginning of the treatment, after 1 week and after 12 weeks treatment periods. Besides significant reduction of blood pressure and total peripheral resistance (p < 0.001), a decrease in cholesterol (p < 0.001) and triglycerides (p < 0.01) levels and a beneficial effect on hemorheological parameters was detected. Fibrinogen and plasma viscosity decreased significantly (p < 0.01). Hematocrit value was also lower after one week (p < 0.001), then an increase could be seen. Whole blood viscosity showed similar changes as hematocrit, but the degree of its final increase was slighter, which was supported by the significantly lower value of corrected blood viscosity (p < 0.05). All these findings indicate that hemorheological factors may play a role in the pathogenesis and in the development of organ damages in hypertension.

[Experience with laparoscopic adrenalectomy in 25 cases]

Between July 1997, and April 1999 the authors performed 25 transperitoneal laparoscopic adrenalectomies. Conversion due to bleeding in 3 cases and due to unsuspected malignancy in 1 case was necessary. Complete resection was carried out in 22 cases. In 3 cases where a well circumscribed adenoma was visualized, only enucleation was performed. A new approach for left sided resection was also introduced. In the authors experience laparoscopy is an absolutely suitable intervention for the benign diseases of the adrenal glands. It assures a short, uncomplicated and painless postoperative period for the patients, with the same effectivity and safety compared to the conventional method.

[The role of salivary immunoglobulins (secretory IgA, IgM, IgG) in caries prevalence and primary B-cell deficiency]

The role of salivary immunoglobulins (IgA, IgM, IgG) in caries etiology is not yet clearly known. Our aim was to study whether there might be a connection between the amount of immunoglobulins in the saliva and caries prevalence. It was found that there was a significant difference (p < 0.05 or less) in secretory IgA, IgM, IgG levels, as well as DMF-T, DMF-S (approx) indices between selective IgA deficient, hypogammaglobulinemic, and healthy children, who had primary teeth.

[Function of the central sterilization office at the Semmelweis Clinic of Conservative Dentistry and Prosthodontics]

In order to prevent cross-infection by blood borne and other pathogens central sterilization department has been constructed in the common building of the Depts. of Conservative Dentistry and Prosthodontics. Instrument sterilization is accomplished in six steps: (1) consolidation and transport of instruments, (2) cleaning, (3) packaging, (4) sterilization, (5) storage, (6) sterilizer monitoring. This process is performed by trained sterilization technicians to ensure that attending faculty, student dentists, clinical staff and patients are protected from cross-infection caused by contaminated dental instruments.

Reciprocal interactions between human cytomegalovirus and human T cell leukemia-lymphoma virus type I in monocyte-derived macrophages cultured in vitro

Infection of macrophages with human cytomegalovirus (HCMV) has been shown to be nonlytic and exclusively cell associated. Human T cell leukemia-lymphoma virus type I (HTLV-I) is capable of establishing productive infection in macrophages. We studied the interactions between HCMV and HTLV-I in monocyte-derived macrophages cultured in vitro. We found that coinfection of macrophages with HCMV and HTLV-I significantly enhanced HCMV replication, resulting in release of infectious HCMV from dually infected cells. On the other hand, HCMV inhibited HTLV-I replication in macrophages coinfected with both viruses. Reciprocal interactions between HCMV and HTLV-I were mediated by their trans-acting proteins. Results of transfection studies demonstrated that the tax gene product of HTLV-I alone was capable of upregulating HCMV production. In a transient gene expression assay the immediate-early 2 (IE2) protein of HCMV alone could inhibit HTLV-I replication, whereas the IE1 protein, which had no effect by itself, produced a synergistic inhibitory effect together with the IE2 protein. Results from this study suggest that in vivo double infection of macrophages with HCMV and HTLV-I may contribute to the dissemination of HCMV infection in patients suffering from HTLV-I-associated T cell leukemia-lymphoma.

The values of detection of free radical mediated reactions in patients

The peroxidative processes and individual antioxidant protection were measured in patients with different cardiovascular diseases. We concluded that monitoring of this system we were able to detect not only the actual changes of lipid peroxidation and antioxidant defence mechanisms, but additionally the therapeutic efficacy of the treatment.

Monitoring of plasma total antioxidant status in different diseases

The pathological increase of oxygen free radical generation has already been recognised in more than one hundred diseases. To gain information about the consequences of oxidative stress the investigation of plasma antioxidants seems to be plausible. In our study we used a new kit (RANDOX, England) for measurement of total antioxidant status (TAS) to determine whether it has diagnostic value in comparison with our earlier results of measuring other parameters of oxidative stress in the following diseases: i./In the group of patients with ischemic heart disease (n = 19) the TAS elevated from 1.08 +/- 0.13 to 1.16 +/- 0.11 mM after 2 weeks of cardioprotective drug administration showing the beneficial effect of drug treatment. ii./In the group of patients with essential hypertension (n = 47) its values were below the normal range (1.11 +/- 0.15 mM) at the time of the first investigation and increased gradually following antihypertensive treatment. iii./The changes of TAS values of patients who underwent open (n = 21) or laparoscopic (n = 21) cholecystectomy indicated the less surgical trauma following laparoscopic procedures. Our results suggest that determination of TAS is a valuable and reproducible method to detect the actual antioxidant status in patients.

Two parallel routes of the complement-mediated antibody-dependent enhancement of HIV-1 infection

OBJECTIVE

To study the mechanism of the complement-mediated antibody-dependent enhancement (C'-ADE) of HIV infection which may play a significant role in the progression of HIV-disease.

METHODS

In vitro complement activating and complement-mediated HIV-infection enhancing abilities of three human anti-gp41 monoclonal antibodies (MAb) were tested. C'-ADE was estimated using HIV-1IIIB and CR2 (CD21)-carrying MT-4 target cells. Normal human serum (NHS), purified C1q, C1q-deficient (C1qD) and C2-deficient (C2D) human sera were applied as complement sources.

RESULTS

All MAb mediated increased C1q binding to solid-phase gp41. All MAb had a marked dose-dependent and strictly complement-mediated HIV-infection enhancing effect. Mixtures of the MAb with purified C1q also significantly increased HIV-1 infection. C1qD serum had a markedly lower enhancing effect than NHS, which could be raised to normal level by addition of purified C1q. Pretreatment of the target cells with anti-CR2 antibodies only partially inhibited the enhancing effect of the MAb plus normal human serum.

CONCLUSION

These novel findings indicate that besides the well-known facilitation of entry of HIV-1 by the interaction between virus-bound C3 fragments and CR2 present on the target cells, fixation of C1q to intact virions also results in an enhanced productive HIV-1 infection in the MT-4 cell cultures.

Effects of TRH on gastric acid secretion: a model for human study

The possible effects of TRH administration on different parameters of gastric function were studied in 10 patients with different gastrointestinal complaints. Basal (BAO) and pentagastrin stimulated (6 micrograms pentagastrin/kg bw sc) maximal (MAO) acid output were determined and serum levels of TSH, total and free thyroxine (T4 and FT4), triiodothyronine (T3) were measured. After determinations of BAO and MAO and the hormones indicated above, one group of patients received a TRH injection (0.2 mg protirelin) intravenously. The second group of patients was injected with atropine (atropinum sulfuricum, 1 mg, iv). At different times following the injections in both groups of patients BAO, MAO and serum levels of TSH, total and free T4, T3, gastrin were determined. Injection of TRH resulted in an increase in TSH and with some delay in thyroxine and gastric acid levels. Atropine treatment was followed by a decrease in gastric acid secretion and a small decrease in TSH and no changes in the values of the other studied hormones. The results suggest a complex interrelationship between TRH, vagal system and pentagastrin-dependent gastric acid secretion operating in human subjects.

[Megakaryocytic thrombopenic purpura associated with enamel hypoplasia]

Patients with platelet disorders usually bleed into superficial sites such as the skin, mucous membranes, genitourinary tract and gastrointestinal tract caused by thrombocytopenia or thrombocyte dysfunction. Thrombocytopenia is caused by one of three mechanisms-decreased marrow production, increased splenic sequestration, or accelerated destruction of platelets. We report a 9-year-old male patient with thrombocytopenic purpura, dyserythropoetic anaemia, freckles on the skin and nanosomia, resembling Fanconi's (constitutional) anaemia. Although many patients with constitutional anaemia own other bony abnormalities, it was not found in this case. On the other hand, the patient showed enamel hypoplasia. To our knowledge, this association has never been reported before. Laboratory diagnosis, clinical findings, dental abnormalities and treatment are presented in details.

Epstein-Barr virus permissively infects human syncytiotrophoblasts in vitro and induces replication of human T cell leukemia-lymphoma virus type I in dually infected cells

Epstein-Barr virus (EBV) and human immunodeficiency virus type 1 (HIV-1), as well as human T-cell leukemia-lymphoma virus type I (HTLV-I), may interact in the pathogenesis of human retroviral infections. The placental syncytiotrophoblast layer represents a barrier protecting the fetal compartment from exposure to retroviruses. We studied the interactions of EBV with HIV-1 and HTLV-I in human term syncytiotrophoblast cells to investigate the significance of double infections in transplacental transmission of human retroviruses. We found that syncytiotrophoblast cells could be productively infected with EBV. Dual infection of the cells with EBV and HTLV-I resulted in full replication cycle of otherwise latent HTLV-I. In contrast, the restricted permissiveness of syncytiotrophoblasts for HIV-1 was not influenced by coinfection of the cells with EBV. Infection of syncytiotrophoblast cells with EBV, but not HTLV-I, induced interleukin-2 and interleukin-6 secretion, and augmented secretion occurred on coinfection with both viruses. Coinfection of syncytiotrophoblast cells with EBV and HTLV-I induced tumor necrosis factor-beta and transforming growth factor-beta 1 secretion, but infection with either virus alone did not lead to secretion of these cytokines. Permissive replication cycle of HTLV-I was induced by the EBV immediate-early gene product Zta. Pseudotype formation between EBV and HTLV-I in coinfected syncytiotrophoblast cells was not found. Our data suggest that activation of HTLV-I gene expression by EBV in coinfected syncytiotrophoblast cells may be a mechanism for transplacental transmission of HTLV-I.

Insoluble glycogen, a metabolizable internal adsorbent, decreases the lethality of endotoxin shock in rats

Insoluble glycogen is an enzymatically modified form of naturally occurring soluble glycogen with a great adsorbing capacity. It can be metabolized by phagocytes to glucose. In this study we used insoluble glycogen intravenously in the experimental endotoxin shock of rats. Wistar male rats were sensitized to endotoxin by Pb acetate. The survival of rats were compared in groups of animals endotoxin shock treated and non-treated with insoluble glycogen. Furthermore, we have determined in vitro the binding capacity of insoluble glycogen for endotoxin, tumour necrosis factor alpha, interleukin-1 and secretable phospholipase A₂. Use of 10 mg/kg dose of insoluble glycogen could completely prevent the lethality of shock induced by LD₅₀ quantity of endotoxin in rats. All animals treated survived. Insoluble glycogen is a form of ‘metabolizable internal adsorbents’. It can potentially be used for treatment of septic shock.

[Cariologic and periodontal screening of children aged 7, 12 and 14 years in the city of Debrecen. II. Periodontal status and need for treatment]

The aim of present survey was to gain epidemiological data on periodontal condition of 7, 12 and 14 yrs old (40 children in 7, 92 children in 12 and 84 children in 14 yrs old groups) schoolchildren as assessed by the CPITN. The peridontal health of children proved to be very poor. Only 33.3% of 7 yrs old, 20.9% of 12 yrs and 13.1% of 14 yrs old children showed healthy gingiva. Bleeding on probing was observed in 66.7% of 7 yrs old group, in 19.8% of 12 and in 16.7% of 14 yrs old groups. The calculus prevalence was 0.0% of 7 yrs old children, 56.0% in 12 and 44.7% in 14 yrs old groups. Oral hygiene instruction was needed by 66.7% of 7, 79.1% of 12 and 86.9% of 14 yrs old children. Scaling was necessary in 11.1% of 7, 59.3% of 12 and 70.2% of 14 yrs old groups. Complex treatment was needed in none of the groups examined.

Solid tumors in children

A thorough understanding of the incidence, clinical presentation, treatment, prognosis, and psychosocial issues surrounding children with solid tumors enables the nurse to actively participate on the health care team. Although significant advances over the past two-and-a-half decades to improve the outcomes of children with cancer have occurred, there remains room for continued improvement, especially among children with advanced-stage nephroblastoma, neuroblastoma, HCC, and teratoma.

Nurse practitioners in acute care units

The launch of the UKCC's The Scope of Professional Practice and measures to reduce junior doctors' working hours have once again raised debate on what roles are appropriate for nurses. For many, the development of the nurse practitioner role, with its advanced skills and increased levels of autonomy, offers a very desirable template. Much can be learned from the experience of US nurses, and this article describes a relatively recent innovation--the development of the nurse practitioner role in the acute hospital setting. The role is not a physician substitute; rather, it strengthens and promotes a multidisciplinary approach to patient care and presents the nurse with an opportunity to improve the delivery of care provided in the inpatient environment. Most significantly, it remains a nursing role.

[Cariologic and periodontal screening of children aged 7, 12 and 14 years of age in Debrecen. I. Prevalence of caries and need for treatment]

A WHO survey was carried out earlier on caries prevalence in the 12-year olds. No data are available in the 7- and 14 year old children. The aim of this study was to investigate caries prevalence (DMFT, dmft numbers), percentage of caries free children and treatment needs in these three age-groups. The clinical examination was based on WHO's criteria. DMF numbers were 0,12, 2,11 and 2,51 in 7-, 12- and 14-year old, while dmf numbers were 0,79, 0,51 and 0,05 respectively. Percentage of caries-free children was 25% (aged 7), 3,3% (aged 12) and 3,6% (aged 14) in the primary teeth, 87,5% (aged 7), 3,3% (aged 12) and 0 (aged 14) in the permanent teeth. There is no treatment need in 27,5, 22,8 and 17,9% of studied groups. Extraction need was 0, 4,3 and 3,6% in 7-, 12- and 14-year-old. Restorations need was the following: one surface: 45, 65,2 and 71,4%, two surfaces 57,5%, 37, 52,4%, three surfaces: 35, 8,7, 16,7%, more than three surfaces or crown: 2,5, 1,1 and 2,4% at the age of 7, 12, 14 years. The number of DMF and dmf teeth was lower at the 12-year-old children than the previous Hungarian data.

1993 up & comers

The achievements of the healthcare industry in the 21st century will depend on the quality of its leadership. In recognition of the contributions of the new generation of healthcare executives, MODERN HEALTHCARE salutes its 1993 Up & Comers. They are a group of healthcare professionals, all 40 or younger, who have refused to be restricted by the ways of the past. Instead, they have contributed to efforts to improve the quality of medical care, expand access to the system and reconfigure the delivery system. The group, whose accomplishments are outlined in the following pages, were selected from a field of nearly 50 candidates nominated by MODERN HEALTHCARE's editorial staff and magazine readers.

[Dietary habits and oral hygiene in school children in the city of Debrecen]

Acid products formed by bacterial fermentation of dietary carbohydrates in the dental plaque, are required for the initiation of dental caries. The aim of the present study was to analyze nutritional and oral hygienic habits of 216 schoolchildren (108 boys and 108 girls) aged of 7, 12 and 14 years. In the studied population children brushed their teeth after meals in 42.5, 54.3 and 38.1% (in the 7, 12 and 14 year age groups respectively). The additional hygienic aids (interdental cleaning: 32.5, 42.4 and 34.5%, oral rinse: 7.5, 27.2 and 23.8%) were used only by a smaller part of the studied groups. Consumption of dairy products and fruits was satisfactory. The habit of drinking carbonic acid containing soft drinks was rather high (%). Some (2.5, 10.9 and 7.1%) of the children drink it several times a day. Fluoride containing Dentocar tablets were used only in 42.5, 3.3 and 1.2% in the studied groups.