[Study on the relationship between HIV drug resistance and CD4(+)T cell counts among antiretroviral therapy patients with low viral load]

Objective: To explore drug resistance of different viral loads, and investigate the relationship between drug resistance and CD4(+)T cell counts in patients with HIV antiretroviral therapy (ART) in China from 2003 to 2015. Methods: Data were extracted from the Chinese National HIVDR Surveillance database from 2003 to 2015. For this study, the data collected were as follows: having received ART for ≥12 months; 18 years or older; demographic characteristics, information of ART, CD4(+)T cell counts, viral load (VL) and HIV drug resistance of a total of 8 362 patients were collected. Multi-variables non-conditional logistic regression model was used to study the relationship between viral load, HIV drug resistance and CD4(+)T cell counts. Results: Participants with age of (41.8±10.5) years were enrolled in this study. Among them, 59.9% (5 009 cases) were men. The percentage of CD4(+)T cell counts <200 cells/μl in the total population was 17.9% (1 496 cases), the highest was in VL ≥1 000 copies/ml with drug resistance, which was 43.0% (397/923) , followed by VL 50-999 copies/ml with drug resistance, which was 31.1% (69/222), and the lowest was in VL 50-999 copies/ml without drug resistance 13.2% (273/2 068). Compared to VL 50-999 copies/ml without drug resistance, VL<50 copies/ml, VL 50-999 with drug resistance, VL≥1 000 copies/ml without drug resistance, and VL ≥1 000 copies/ml with drug resistance, the OR (95%CI) of CD4 <200 cells/μl were 0.9 (0.7-1.0), 3.2 (2.3-4.4), 2.6 (2.1-3.2), and 4.9 (4.0-5.9), respectively. Among 222 patients with VL 50-999 and HIVDR, the most frequent antiretroviral drugs were EFV and NVP, both of which were NNRTI, and whose percentage both were 94.1% (209 cases). The most frequent mutations were M184V/I (NNRTI), and the percentage was 26.1% (58 cases). The second one was K103N (NNRTI), and the percentage was 22.5% (50 cases). The percentage of V32L/E (PI) and V82A (PI) were lower, they were 0.9% (2 cases) and 0.5% (1 case) respectively. Conclusion: Decreased CD4(+)T cell counts were associated with HIV drug resistance at low viraemia. In the case of low viral load, the most vulnerable were the NNRTI antiviral drugs such as EFV and NVP.

The impact of using an intraoperative goal directed fluid therapy protocol on clinical outcomes in patients undergoing total pancreatectomy and islet cell autotransplantation

BACKGROUND

Patients undergoing total pancreatectomy and islet cell autotransplant (TPIAT) for treatment of pancreatitis are at risk for complications of over and under resuscitation. We hypothesized that using a goal directed fluid therapy (GDFT) protocol might impact clinical outcomes.

MATERIALS AND METHODS

A consecutive series of adult patients undergoing TPIAT were managed intraoperatively using either standard fluid therapy (SFT, n = 44) or GDFT (n = 23) as part of a pilot study between January 2013 and May 2015. Patient characteristics, intraoperative, and postoperative data were recorded prospectively, then retrospectively analyzed for differences between the groups.

RESULTS

The GDFT group had lower total fluid resuscitation (3,240 cc vs 5,173 cc, p < 0.0001) and transfusion requirements (1.0 cc/kg vs 3.3 cc/kg, p = 0.050) compared to the SFT group. The pre to postop nadir hemoglobin change was significantly less for GDFT (4.2 vs 5.1 gm/dl, p = 0.021) despite less transfusion.

CONCLUSIONS

Compared to SFT, using an intraoperative GDFT protocol in TPIAT patients was associated with significantly decreased intraoperative fluid resuscitation, blood transfusion and less postoperative dilutional anemia, without any difference in complications of underresuscitation. This pilot study suggests that GDFT is likely safe and further investigation is warranted.

B-type natriuretic peptide in the management of heart failure

OBJECTIVE

To review the current literature on the use of B-type natriuretic peptide in the diagnosis and management of heart failure.

DATA SOURCES

Literature search of PubMed was performed up to September 2007.

STUDY SELECTION

Key words for the literature search were 'heart failure' and 'B-type natriuretic peptide'.

DATA EXTRACTION

Original papers and review articles related to the use of B-type natriuretic peptide in the diagnosis and management of heart failure.

DATA SYNTHESIS

Heart failure is common in Hong Kong, and is associated with significant morbidity and mortality. Heart failure is often misdiagnosed. B-type natriuretic peptide may be regarded as a quantitative marker of heart failure; its levels have good diagnostic accuracy and can be measured with a rapid and simple bed-side assay and are useful in the assessment of patients with acute dyspnoea. Factors, such as obesity and renal impairment, alter B-type natriuretic peptide levels. Measurement of B-type natriuretic peptide facilitates improved medical outcomes, is cost-effective, and constitutes a good prognostic indicator for death and cardiac events.

CONCLUSIONS

Determination of B-type natriuretic peptide levels is useful in the assessment of patients with acute dyspnoea, to exclude or diagnose heart failure, to facilitate improved medical outcomes, and is cost-effective. In addition, it is a good long-term prognostic indicator and can be used to guide heart failure treatment.

Nonvolatile memory devices with NiSi2/CoSi2 nanocrystals

Metal-oxide-semiconductor structures with NiSi2 and CoSi2 nanocrystals embedded in the SiO2 layer have been fabricated. A pronounced capacitance-voltage hysteresis was observed with a memory window about 1 V under low programming voltage. The retention characteristic can be improved by using HfO2 layer as control oxide. The processing of the structure is compatible with the current manufacturing technology of semiconductor industry.

Industrial wideband noise reduction for hearing aids using a headset with adaptive-feedback active noise cancellation

High-intensity noises are a health hazard for industrial workers, and hearing protection is necessary to prevent hearing loss. Passive methods, such as ear muffs, are ineffective against low-frequency noise. Moreover, many hearing-impaired workers must wear hearing aids to enable communication at their workplace, and such aids can amplify ambient noise. To overcome this problem, the present study developed a headset equipped with a digital signal processing system to implement adaptive-feedback active noise cancellation (AFANC) to reduce low-frequency noise. The proposed AFANC headset was effective against wideband industrial noise, with a maximum noise spectrum power reduction of 30 dB. Furthermore, when used with a hearing aid, it improved the speech signal-to-noise ratio by up to 14 dB. These results suggest that a headset with AFANC would be useful for hearing protection in workplaces with high levels of low-frequency industrial noise, especially for hearing-impaired workers.

Assessment of bone biopsy needles for sample size, specimen quality and ease of use

OBJECTIVE

To assess whether there are significant differences in ease of use and quality of samples among several bone biopsy needles currently available.

DESIGN

Eight commonly used, commercially available bone biopsy needles of different gauges were evaluated. Each needle was used to obtain five consecutive samples from a lamb lumbar pedicle. Subjective assessment of ease of needle use, ease of sample removal from the needle and sample quality, before and after fixation, was graded on a 5-point scale. The number of attempts necessary to reach a 1 cm depth was recorded. Each biopsy specimen was measured in the gross state and after fixation.

RESULTS

The RADI Bonopty 15 g and Kendall Monoject J-type 11 g needles were rated the easiest to use, while the Parallax Core-Assure 11 g and the Bard Ostycut 16 g were rated the most difficult. Parallax Core-Assure and Kendall Monoject needles had the highest quality specimen in the gross state; Cook Elson/Ackerman 14 g and Bard Ostycut 16 g needles yielded the lowest. The MD Tech without Trap-Lok 11 g needle had the highest quality core after fixation, while the Bard Ostycut 16 g had the lowest. There was a significant difference in pre-fixation sample length between needles (P<0.0001), despite acquiring all cores to a standard 1 cm depth. Core length and width decrease in size by an average of 28% and 42% after fixation.

CONCLUSION

Bone biopsy needles vary significantly in performance. Detailed knowledge of the strengths and weaknesses of different needles is important to make an appropriate selection for each individual's practice.

Multiple organ dysfunction syndrome

Multiple organ dysfunction syndrome, including acute respiratory distress syndrome (ARDS) and renal failure, is described, its clinical features outlined, its origins in tissue oxidative stress following severe infections, surgical trauma, ionizing radiation, high-dosage drugs and chemicals, severe hemorrhage, etc., are defined, and its prevention and treatment prescribed.

High-yield expression and purification of human interferon alpha-1 in Pichia pastoris

For several years, interferon alpha-1, also known as interferon alpha-D, has been studied for treatment of various viral diseases, such as hepatic fibrosis caused by hepatitis B, herpes simplex virus keratitis, and bovine respiratory diseases in calves. Currently, recombinant human interferon alpha-D (rHuIFNalphaD) is expressed intracellularly in Escherichia coli or secreted by Bacillus subtilis and Saccharomyces cerevisiae. In this report, we describe the process of obtaining a relatively high-yield secretion of biologically active recombinant rHuIFNalphaD using the Pichia pastoris system. The process produced as high as 0.7 mg of purified protein per 20 ml of shake culture of rHuIFNalphaD with better bioactivity than the commercially available rHuIFNalphaD molecule produced in E. coli.

Extremely small sample size in some toxicity studies: an example from the rabbit eye irritation test

The conventional sample-size equations based on either the precision of estimation or the power of testing a hypothesis may not be appropriate to determine sample size for a "diagnostic" testing problem, such as the eye irritant Draize test. When the animals' responses to chemical compounds are relatively uniform and extreme and the objective is to classify a compound as either irritant or nonirritant, the test using just two or three animals may be adequate.

Sclerotic bone metastases from sarcomatoid renal cell carcinoma

We present a case of sarcomatoid renal cell carcinoma with multiple sclerotic skeletal metastatic lesions. Renal cell carcinoma is frequently metastatic at presentation, with a high incidence of skeletal involvement, classically described as osteolytic. However, sclerotic or osteoblastic metastatic skeletal lesions from renal cell carcinoma are rare, with only two previous reports identified in the literature, neither of which involved the sarcomatoid variant of renal cell carcinoma. In our case the sclerotic metastases were characterized by bone scan, computed tomography (CT), magnetic resonance imaging (MRI), and histologic analysis.

Characterization of a Rac1 signaling pathway to cyclin D(1) expression in airway smooth muscle cells

We examined the importance of the Rho family GTPase Rac1 for cyclin D(1) promoter transcriptional activation in bovine tracheal myocytes. Overexpression of active Rac1 induced transcription from the cyclin D(1) promoter, whereas platelet-derived growth factor (PDGF)-induced transcription was inhibited by a dominant-negative allele of Rac1, suggesting that Rac1 functions as an upstream activator of cyclin D(1) in this system. Rac1 forms part of the NADPH oxidase complex that generates reactive oxygen species such as H(2)O(2). PDGF stimulated a substantial increase in intracellular reactive oxygen species, as measured by the fluorescence of dichlorofluorescein-loaded cells, and this was blocked by the glutathione peroxidase mimetic ebselen. Pretreatment with ebselen, catalase, and the flavoprotein inhibitor diphenylene iodonium each attenuated PDGF- and Rac1-mediated cyclin D(1) promoter activation, while having no effect on the induction of cyclin D(1) by mitogen-activated protein kinase/extracellular signal-regulated kinase (ERK) kinase-1 (MEK1), the upstream activator of ERKs. Antioxidant treatment also inhibited PDGF-induced cyclin D(1) protein expression and DNA synthesis. Overexpression of an N-terminal fragment of p67(phox), a component of NADPH oxidase which interacts with Rac1, attenuated PDGF-induced cyclin D(1) promoter activity, whereas overexpression of the wild-type p67 did not. Finally, Rac1 was neither required nor sufficient for ERK activation. Taken together, these data suggest a model by which two distinct signaling pathways, the ERK and Rac1 pathways, positively regulate cyclin D(1) and smooth muscle growth.

Catalytic activation of extracellular signal-regulated kinases induces cyclin D1 expression in primary tracheal myocytes

We have demonstrated that extracellular signal-regulated kinases (ERKs) and cyclin D1 are required for bovine tracheal myocyte DNA synthesis. We hypothesized that catalytic activation by ERKs may regulate cyclin D1 expression in these cells. To test this hypothesis, we examined the effects of two inhibitors of ERKs and two reagents that increase the level of activated ERKs on cyclin D1 protein abundance and promoter activity. ERK activity was inhibited either by PD98059, a synthetic inhibitor of mitogen-activated protein kinase (MAPK)/ERK kinase (MEK), the upstream signaling intermediate required and sufficient for ERK activation, or by transient transfection with a dominant-negative mutant of MEK1 (MEK-2A). The level of activated ERKs was increased by transient transfection with either a constitutively active form of MEK1 (MEK-2E) or wild-type ERK2 (MAPKwt). Cyclin D1 expression was assessed either by immunoblot or cotransfection with the full-length cyclin D1 promoter subcloned into a luciferase reporter. We found that pretreatment of bovine tracheal myocytes with PD98059 significantly attenuated platelet- derived growth factor (PDGF)-induced cyclin D1 protein abundance. Furthermore, transfection with MEK-2A reduced PDGF-induced cyclin D1 promoter activity. Finally, transfection with either MEK-2E or MAPKwt induced cyclin D1 promoter activity in the absence of growth factor treatment. We conclude that catalytic activation of ERKs regulates cyclin D1 expression in airway smooth-muscle cells.

Hydrogen peroxide activates extracellular signal-regulated kinase via protein kinase C, Raf-1, and MEK1

We have previously demonstrated that hydrogen peroxide (H2O2) treatment of bovine tracheal myocytes increases the activity of extracellular signal-regulated kinases (ERK), serine/threonine kinases of the mitogen-activated protein (MAP) kinase superfamily thought to play a key role in the transduction of mitogenic signals to the cell nucleus. Moreover, H2O2-induced ERK activation was partially reduced by pretreatment with phorbol 12,13-dibutyrate, which depletes protein kinase C (PKC). In this study, we further examined the signaling intermediates responsible for ERK activation by H2O2 in airway smooth muscle, focusing on MAP kinase/ERK kinase (MEK), a dual-function kinase which is required and sufficient for ERK activation in bovine tracheal myocytes; Raf-1, a serine/threonine kinase known to activate MEK; and PKC. Pretreatment of cells with inhibitors of MEK (PD98059), Raf-1 (forskolin), and PKC (chelerythrine) each reduced H2O2-induced ERK activity. In addition, H2O2 treatment significantly increased both MEK1 and Raf-1 activity. No activation of MEK2 was detected. Together these data suggest that H2O2 may stimulate ERK via successive activation of PKC, Raf-1, and MEK1.

MEK1 is required for PDGF-induced ERK activation and DNA synthesis in tracheal myocytes

We tested whether activation of mitogen-activated protein kinase/ extracellular signal-regulated kinase kinase-1 (MEK1) is required and sufficient for extracellular signal-regulated kinase (ERK) activation in airway smooth muscle cells. First, we transiently cotransfected bovine tracheal myocytes with an epitope-tagged ERK2 and a dominant-negative or a constitutively active form of the gene encoding MEK1 and assessed ERK2 activation by in vitro phosphorylation assay. Expression of the dominant-negative MEK1 inhibited platelet-derived growth factor (PDGF)-induced ERK2 activation, whereas expression of the constitutively active MEK1 induced ERK2 activation, suggesting that MEK1 is required and sufficient for ERK activation in these cells. Next, we assessed the effect of PD-98059, a synthetic MEK inhibitor, on PDGF-induced MEK1 and ERK activation. PD-98059 (10 microM) inhibited MEK1 and ERK activation, confirming that MEK1 is required for ERK activation in bovine tracheal myocytes. PD-98059 had no effect on Src or Raf-1 activity, evidence that PD-98059 is a specific inhibitor of MEK in this system. Finally, PD-98059 reduced PDGF-induced [(3)H]thymidine incorporation in a concentration-dependent manner, suggesting that catalytic activation of MEK1 and ERKs is required for DNA synthesis. We conclude that MEK1 is required for PDGF-induced ERK activation in bovine tracheal myocytes and that MEK1 and ERKs are required for PDGF-induced DNA synthesis in these cells.

Studies in surgical trauma: oxidative stress in ischaemia-reperfusion of rat liver

1. Hypovolaemic shock associated with surgical trauma has been studied in a rat liver ischaemia-reperfusion model by determination of oxidative stress, lipid peroxidation and tissue infiltration of polymorphonuclear leucocytes. 2. Liver ischaemia alone resulted in slight liver oedema and polymorphonuclear leucocyte infiltration, a slight increase in thiobarbituric acid-reacting substances (an index of lipid peroxidation) and decreases in liver reduced glutathione and total radical-trapping antioxidant parameter, indices of oxidative stress. Ischaemia plus 30 min of reperfusion further increased liver oedema, polymorphonuclear leucocyte infiltration and thiobarbituric-acid reacting substances, and further decreased liver reduced glutathione and total radical-trapping antioxidant parameter. 3. After 60 and 90 min of reperfusion, oedema (40% increase), polymorphonuclear leucocyte infiltration (40-fold increase) and thiobarbituric-acid reacting substances (20-fold increase) were maximal, and liver reduced glutathione (75-95% decrease) and total radical-trapping antioxidant parameter (85-90% decrease) were at a minimum. 4. All parameters were exacerbated by 24 h starvation. Liver reduced glutathione closely paralleled total radical-trapping antioxidant parameter, and ischaemia alone depleted both by 30% in fed rats and 50% in fasted rats. 5. Oxidative stress and lipid peroxidation were associated more with the period of reperfusion and polymorphonuclear leucocyte infiltration. Polymorphonuclear leucocyte infiltration into lung also occurred after 90 min of liver reperfusion. 6. Possible mechanisms of hepatic ischaemia-reperfusion-induced oxidative stress are discussed.

Role of tissue glutathione in prevention of surgical trauma

1. Surgical trauma has been associated with pre-anaesthesia fasting, anaesthetic toxicity, haemorrhage, hypovolaemic shock, and other pathological phenomena. Tissue glutathione (GSH), thiobarbituric acid-reacting substances (TBAR), and radical-trapping activity (RTA) have been determined at various time intervals after fasting, anaesthesia, and also after hepatic ischaemia and reperfusion as a model for haemorrhage and hypovolaemic shock. 2. Light ether anaesthesia of rats resulted in an immediate (5 min) and progressive decrease in liver and kidney total glutathione (GSH and GSSG), which was much greater in animals that had been fasted for 20 h. TBARs, a measure of lipid peroxidation, in rat liver and kidney increased as total GSH decreased. Fasting (20 h) alone decreased tissue GSH by 50%, and increased TBAR 100%; fasting plus 30 min of ether anaesthesia decreased tissue glutathione by 80 to 85%, and increased TBAR by some 600%. 3. Liver ischaemia alone decreased total liver GSH by 20% in the fed rat, and 50% in the fasted rat. Ischaemia, followed by reperfusion, decreased liver total GSH by 70% in the fed rat, and 90% in the fasted rat. The ratio of GSH/GSSG decreased from 16 in control animals to 7 in the fasted ischaemic rat, then to 1 in the fasted, ischaemic rat reperfused for 90 min. RTA of liver closely paralleled liver total GSH levels. TBAR was increased by ischaemia alone (50-100%), but more (400%) by 90 min reperfusion. 4. A complex series of molecular mechanisms including: (1) GSH depletion; (2) induction of CYP2E1 activity; (3) generation of reactive oxygen species; (4) lipid peroxidation; (5) cytokine release; and (6) leucocyte activation, are advanced to account for the toxic phenomena of surgical trauma and multiple system organ failure.

The effects of ether anaesthesia on oxidative stress in rats--dose response

Rats, with and without overnight fasting, were anaesthetised for 5, 15 and 30 min with diethyl ether, killed immediately and total glutathione (total GS), thiobarbituric acid-reacting substances (TBAR), radical-trapping activity (RTA), total cytochrome P450 (CYP), and 7-ethoxyresorufin O-deethylase (CYP1), 7-pentoxyresorufin O-dealkylase (CYP2B) and 4-nitrophenol hydroxylase (CYP2E1) activities of liver and kidney determined. Liver, after ether anaesthesia, but no fasting, showed 30-60% losses of total GS, RTA, and total CYP, after 5, 15 and 30 min of anaesthesia, while TBAR increased 10-, 20- and 35-fold for the same periods. Liver after ether anaesthesia and overnight fasting showed 50-85% losses of total GS, RTA and total CYP, for 0, 5, 15 and 30 min of anaesthesia, while TBAR increased 4-, 30-, 40- and 60-fold for the same periods of anaesthesia. Kidney changes were similar to those in liver. Liver CYP1 and CYP2B were decreased by 45% and 35%, respectively for 30 min of anaesthesia in fed rats, and by 80% and 30% respectively for 30 min of anaesthesia in fasted rats; in contrast, liver CYP2E1 was increased 30% by fasting alone and 70% by fasting plus 5 min of ether anaesthesia. Kidney CYP1 and CYP2B were similarly decreased by ether anaesthesia (70% and 50% respectively) in both fed and fasted rats, and CYP2E1 was similarly increased (by 40-90% in fed and 30-110% in fasted rats). The decrease in tissue total GS, RTA, total CYP, CYP1 and CYP2B, and the increase in lipid peroxidation products (TBAR), are all considered to be due to generation of reactive oxygen species and oxidative stress, associated with the increase in CYP2E1 activity that results from both fasting and exposure to diethyl ether.

Effects of ether anaesthesia and fasting on various cytochromes P450 of rat liver and kidney

Fed and fasted, male, Wistar albino rats exposed to light ether anaesthesia and killed immediately or after 30 or 120 min recovery were compared with non-anaesthetized rats for changes in liver and kidney cytochrome P450 (CYP) activities. In fed rats, liver total CYP (nmol/mg protein) decreased by 30% immediately after ether, but was restored to normal levels after 30 min recovery; in fasted rats, liver total CYP increased by 20% by fasting alone, then decreased by 65% immediately after ether, and recovered to only 70% of control at 2 hr after ether. Rat liver cytochrome P4501A (CYP1A; 7-ethoxyresorufin O-deethylase or EROD activity) and cytochrome P4502B (CYP2B; 7-pentoxyresorufin O-dealkylase or PROD activity) were decreased after ether anaesthesia, similar to those for total CYP. In contrast, rat liver cytochrome P4502E1 (CYP2E1), determined by p-nitrophenol hydroxylation, increased by 40% by ether anaesthesia alone, 70% by fasting alone and 140% by ether plus fasting; these increases were confirmed by the CYP2E1-mediated activation of nitrosopyrrolidine and by immunoblot analysis using antibody to CYP2E1. In rat kidney, losses of total CYP, CYP1A and CYP2B, and increases of CYP2E1, induced by ether anaesthesia, were much more marked in fasted (90% loss in total CYP, 30% increase in CYP2E1) than in fed rats (slight loss in total cytochrome P450, 30% increase in CYP2E1). As maximum losses of total CYP in liver of fasted rats exposed to ether occurred at the time of maximum increase of CYP2E1 and maximum rate of generation of reactive oxygen species (ROS), it is suggested that the increase of CYP2E1, resulting from its stabilization by fasting and ether, leads to generation of ROS, increase in lipid peroxidation and consequent loss of total CYP, associated with the hepatic and renal necrosis seen in ether intoxication and surgical trauma.

Criteria for in vitro alternatives for the eye irritation test

A proposal encompassing considerations and criteria for the development of in vitro alternatives to the eye irritation test has been developed and is presented here. Two factors need to be considered initially in developing an alternative test. The first is to determine whether the alternative assay is to be used as a screen or as a replacement for the eye irritation test. Less stringent acceptance criteria are required for an assay used as a screen than for that used as a replacement test. A screen is a preliminary test for the assessment of eye irritation. It is used for making preliminary decisions or establishing the direction for further testing. Screens answer fewer and less complex questions than a replacement test would, since the results from screens are usually confirmed by more definitive testing. A replacement test, however, must provide the same answers as in vivo methods for the assessment of eye irritation and must provide data for making a definitive toxicological assessment of eye irritation. The second factor to be considered is knowledge of the in vivo assay intended to be replaced. This knowledge should include the procedural aspects of the test and the regulatory information it provides. The following may be considered as criteria for in vitro tests used as screens or as replacements for the eye irritation test in rabbits: rationale (there should be a clear statement regarding the rationale for the use of a particular test in relation to the availability of other tests); relevance (the in vitro endpoint should have biological or physiological relevance to the effect to be detected in vivo); and validational (intralaboratory as well as interlaboratory validation must be conducted).

An eye irritation test protocol and an evaluation and classification system

An in vivo test protocol and an evaluation and classification system for the determination of eye irritation potential of chemicals and mixtures (substances) is proposed. The protocol uses two or three rabbits and reduces distress in test animals. The test substances are classified as non-irritant, irritant or severe irritant to meet regulatory needs. They may be classified on the basis of past experience with similar compounds or mixtures. Screens such as structure-activity relationships, pH extremes, validated and accepted in vitro tests, severe dermal irritation (primary dermal irritation index > or = 5) or severe dermal toxicity (lethality at < 200 mg/kg body weight) should be used to classify irritant or severe irritant materials when one or more of the screens can provide convincing evidence. For suspected severe irritant materials, the proposed in vivo test permits the use of one rabbit and instillation of 0.01 ml (0.01 g) of the test material into the cornea. Materials that are not classified irritant or severe irritant by screens or severe irritant by one rabbit test are tested in two or three rabbits; 0.1 ml (0.1 g) is instilled into the conjunctival sac. The responses (corneal opacity, iritis and conjunctival redness) are scored according to the modified Draize scoring system at 24, 48 and 72 hr and 7 days post-instillation. A rabbit is considered positive when corneal opacity of 1 or above, iritis of 1 or above or conjunctival redness of 2 or above is present at 24, 48 or 72 hr post-instillation. The material is classified as a severe irritant when the rabbit in the one-animal test or two or more rabbits in the standard test have responses of corneal opacity of 3 or above and iritis of 2 at 24, 48 or 72 hr, or positive responses on day 7 after instillation. The material is classified as an eye irritant when two or more rabbits are positive but the responses are not severe and they clear 7 days after instillation. The material is classified as a non-irritant when no more than one rabbit is positive. The opinions expressed in this article are those of the authors and do not necessarily reflect the views of US Federal agencies.

Scoring for eye irritation tests

Scoring of the rabbit eye test and the resulting evaluation and classification should provide useful information about the likelihood that a test material may cause injury on contact with the human eye. When an animal test is necessary, a rabbit eye test based on the following characteristics is proposed for deriving the maximum information from the fewest animals. The ocular effects of interest should include corneal opacity, iritis and conjunctival redness. Animals should be scored for each ocular effect at 24, 48 and 72 hr after the test substance is administered. If an animal is negative at all three scoring times, it can be removed from the test at 72 hr. If it shows a positive effect at a scoring time but the lesion clears at 72 hr, it can be removed at 72 hr. If it shows a positive effect that does not clear at 72 hr, it should be scored again on day 7 when the test ends. However, if an animal shows severe effects at one or more scoring times, it can be removed from the test at 72 hr. An animal is positive if any one of the following criteria is observed at 24, 48 or 72 hr: corneal opacity of 1 or above, iritis of 1 or above, or conjunctival redness of 2 or above. Severe ocular effects (noted at 24, 48 or 72 hr) that may endanger sight deserve special recognition for the classification of chemicals and include corneal opacity of 3 or above, or iritis of 2. This proposal is consistent with the opinions of the majority of respondents who attended the Workshop on Updating Eye Irritation Test Methods, Proposals for Regulatory Consensus. The most notable exception was the suggestion by respondents to add conjunctival chemosis as one of the scoring parameters.

Number of animals for sequential testing

US regulatory agencies have used six animals in eye irritation tests. Analyses of eye irritation tests on pesticides (n = 48), consumer products and cosmetics (n = 53), Marzulli and Ruggles database (n = 139), and cleaning products and ingredients (n = 30) have greatly extended previous investigations of the merit of reducing animal sample size in the eye test. Given the existing scoring system for positive animal responses (corneal opacity > or = 1, iritis > or = 1, conjunctival redness > or = 2 and conjunctival chemosis > or = 2), the accuracy of the classification systems currently used by these agencies was determined. The US Consumer Product Safety Commission, US Food and Drug Administration, and US Occupational Safety and Health Administration use a classification system by which a substance is designated as an irritant when at least four of six animals give a positive response. This decision rule leads to a very high accuracy of at least 99% with essentially no false positive and false negative judgments. In contrast, the system used by the US Environmental Protection Agency pesticide program, in which only one or more of six treated animals result in an irritant decision, has an accuracy of only 50-80% with very high false positive rates. Analyses indicated that test sample size could be reduced to three and still preserve very good accuracy, whereas two-animal and one-animal tests did not give satisfactory responses. A two-stage test, in which two animals are tested and evaluated in the first stage before the need for testing one more animal in the second stage is determined, also demonstrated good operating characteristics. Both the one-stage/three-animal test and the two-stage test deserve consideration.

The use of low-volume dosing in the eye irritation test

The Draize rabbit eye test was developed to provide a method for assessing the irritation potential of materials that might come in contact with human eyes. The method involves the instillation of 0.1 ml of a test liquid (100 mg solid) into the conjunctival sac of an animal's eye. A refinement of the Draize test is the low-volume eye test in which 0.01 ml of a substance is placed directly on the cornea of the eye. Studies indicate that the low-volume method provides a better correlation to human eye irritation experience for some substances. The Interagency Regulatory Alternatives Group (IRAG) proposes that the low-volume eye test can be used to substantiate the irritancy of suspect severe ocular irritants that have not been eliminated by various pre-eye test 'screens'. A substance testing positive by the low-volume method can be classified as an irritant; one that tests negative will require further testing by the use of the 0.1-ml volume procedure. For all other definitive testing, the Draize test (0.1 ml) should be used. Results from a questionnaire distributed at the IRAG workshop showed that many workshop participants thought that the low-volume test should be used as an eye irritation screening procedure.

Screening procedures for eye irritation

Screens aid in identifying some severe irritants or corrosives and eliminating them from consideration for in vivo eye irritation testing. Products may be evaluated for ocular irritation potential in a stepwise progression as follows: (1) products at pH extremes of 2 or below or of 11.5 or above may be considered to be ocular irritants; (2) based on chemical structure-activity considerations, some products may be judged to have ocular irritation potential; (3) validated and accepted in vitro systems may possibly be used as a screen in the future; (4) when a test material demonstrates severe acute dermal toxicity (lethality at < or = 200 mg/kg body weight), further testing for either dermal or ocular irritation may not need to be undertaken; (5) if a substance shows a primary dermal irritation index of 5 or above, it may be considered to be an ocular irritant; (6) materials that are not removed from consideration based on these proposed screens may then be considered for testing for ocular irritation in rabbits under accepted procedures. In a survey given to participants in the workshop, a high percentage believed that screens should be used. However, opinions on the use of the individual screens varied between the different interested groups attending, with the possible future use of in vitro screens for specific product lines having the highest percentage of agreement (57-100%).

Use of ophthalmic topical anaesthetics

Pretreatment of the eyes of rabbits with a topical anaesthetic can be viewed as a refinement of the test for eye irritation. It reduces pain at the time of test-material administration, decreases animal distress and permits easier application of the test agent to the eye. In some cases, however, use of an anaesthetic either alone or in combination with the test substance may alter ocular responses or provide little benefit. Although anaesthetic pretreatment may result in decreased pain at the time of test-compound administration, it does not affect possible pain after the effects of the anaesthetic have dissipated. Some anaesthetics are themselves irritating to eyes. In addition, anaesthetics reduce blinking and tearing, thereby maintaining the test-material concentration at the surface of the eye longer. Corneal permeability may also be increased with pretreatment use of an anaesthetic, and may bring the test agent into contact with more structures of the eye. Some anaesthetics delay healing after ocular injury. All of these varied effects may result in increased irritation to the eye. Overall, pretreatment with anaesthetics has usually resulted in a tendency for slightly higher irritation scores; eye irritancy classification is usually unaffected.

Autoxidative injury with loss of cytochrome P-450 following acute exposure of rats to fasting and ether anaesthesia

1. Exposure of fasted rats (20 h) to ether anaesthesia for 4 min resulted in increased exhalation of alkanes, an indication of lipid peroxidation in vivo. 2. Liver and kidney of the fasted rats anaesthetized with ether showed immediate 4-fold increases in luminol-amplified chemiluminescence, reaching maxima 30 min later, indicating the production of reactive oxygen species. 3. Liver and kidney cytosols of the fasted anaesthetized rats similarly showed immediate 4-fold increases of thiobarbituric acid-reactive material (malondialdehyde and other lipid peroxidation breakdown products) which attained maxima 60 min later. 4. Total cytochromes P-450 of liver and kidney of rats were decreased to 25-30% of control values after 20 h fasting and 4 min of ether anaesthesia, but were restored to normal levels 2 h later. Cytochrome P450 I (EROD activity) was decreased to 35-44% of control values by the ether anaesthesia and was restored to 80% of normal levels 2 h later. 5. Diether ether is known to be metabolized by cytochrome P450 IIE1 which is induced by fasting and by diethyl ether, and is possibly involved in the observed radical production, lipid peroxidation, and loss of cytochromes P-450.

Choice of lasers for laser angioplasty

Thrombi in test-tube, intraarterial thrombi and pig aorta wall were in vitro irradiated with continuous CO2 laser, short pulsal and ultrashort pulsal YAG laser (with pulse-width of 10 ns and 40 ps, respectively) and their double frequency laser and excimer laser with a wave-length of 308 nm and pulse-width of 20 ns. Their effect of vaporizing and ablating (photodecomposing) thrombi and their thermal injuring effect on adjacent tissues were compared and assessed in order to select optimal laser with little thermal injuring and more rapid vaporizing or ablating thrombi effect for laser angioplasty. The experimental results showed that excimer laser, ultrashort pulsal YAG laser and its double frequency laser, and double frequency laser of short pulsal YAG laser, with laser beam and blood vessel kept in a coaxial position, can effectively vaporize or ablate thrombi without thermal injury to vessel wall. So they may be used for laser angioplasty. Of them, especially, excimer laser and double frequency laser of ultrashort pulsal YAG laser have short wave-length and high peak power, and more effectively ablate thrombi than others, so they proved to be optimal lasers for laser angioplasty.

The use of blood in burn shock. Clinical and experimental study

We have given whole blood as one of the main constituents of burn shock resuscitation for the past 28 years. To appraise the value of using whole blood, we have summarized the clinical experience of 2630 burn patients. Overall mortality was 4.18%. The lethal area of the burn were 50% of the population is expected to die was 82.8% total body surface area and 57.4% third-degree burns. The incidence of renal failure, pulmonary edema, and gastrointestinal bleeding was 0.9%, 0.4%, and 0.6% respectively. To confirm the advantage of transfusion of whole blood, we have carried out a series of experimental studies. Two groups of 25 dogs with 25% total body surface area full-thickness burns were treated with two resuscitation regimens. Group I was treated with whole blood, and group II with no blood, during the shock phase. After 48 hours, the infusions were stopped. Measurements were made before the burn and 2, 24, 48, 72, and 144 hours after the burn injury. The animals were then killed for histologic studies. From our data, we concluded that whole blood used in burn shock did not increase hemoconcentration or viscosity; it improved anemia, oncotic pressure, hypoproteinemia, acid-base balance, oxygenation, hemodynamics, and myocardial contractility, promoted cardionatrin secretion, reduced edema of tissue, and protected viscera from degenerative changes and bacterial colonization.

Comparative toxicity and biotransformation of lindane in C57BL/6 and DBA/2 mice

DBA/2 mice, previously identified as "unresponsive" to aromatic hydrocarbons which induce microsomal enzymes in C57BL/6 mice, are more vulnerable to the convulsant effect of repeated doses of lindane than similarly treated C57BL/6 mice. Death in convulsions and higher blood and brain lindane concentrations indicate that less efficient disposition of lindane itself accounts for the greater vulnerability of the DBA/2 mice. The same two principal chlorophenolic metabolites of lindane were identified in the blood and tissues of both strains, but the time-courses of blood concentrations in response to repeated lindane dosing were different.

Postpartum cell-mediated immunity induced in the rat following perinatal exposure to iodine-131

Studies were undertaken with the intent to establish the degree of risk experienced by a mother and her immediate offspring in developing gastrointestinal cancer following exposure to iodine-131 during pregnancy. An indirect approach in the identification of tumor induction for risk determination was utilized in this study which relied upon the measurement of antitumor cell-mediated immunity (CMI) occurring in the host following exposure to the radionuclide. Fischer F344 inbred pregnant rats were selected as the animal model, and the radionuclide exposure was accomplished by a single intraperitoneal administration of iodine-131 [Na131] at the stage of 16-18 days of pregnancy; then at two months postpartum, the dams and pups were evaluated for the capacity of their peripheral blood lymphoid cells to express specific cytotoxic responses towards target cells consisting of cultured X-ray induced rat small bowel adenocarcinoma cells. The results indicate that an antitumor immunity was induced in the pups upon such a prenatal exposure, while none could be detected existing in their mothers. In addition, there appeared to be a possible sex or hormonal component as a preliminary consideration of the data suggested the male offspring were approximately 1.7 times more immunoresponsive to the perinatal insult. Threshold detection level for detecting such responses to the iodine-131 was found to be in the range of a 9.25 kBq (250 nCi) quantity of exposure. The implication of these preliminary findings based upon such indirect measurements is that the first generation may be at an increased risk to gastrointestinal cancer following peritanal exposure to iodine-131 in the later stage of pregnancy.

The efficiency of the multiple trial randomized response technique

It has been proven theoretically that repeated administration of two-related-question randomized response technique (RRT) substantially increases the efficiency by reducing the variance of the estimate. The realtive efficiency of RRT to direct question with various number of trials per respondent under various degrees of truthful response and various conditions has also been examined. However, if the respondent becomes more concerned about his anonymity, then the mean square error may be larger. A field study of limited scope conducted in Taichung, Taiwan indicated that this multiple trial RRT model is at least as feasible as, if not more feasible than, the conventional single trial RRT. There was no sign suggesting cooperation of respondents had deteriorated because each was asked to repeat the procedures three times. If the number of trials did not exceed three, we believe that the increase in the cost of survey and "exhaustion" of respondents from repeated administration of the same set of questions would be negligible. Hence, we believe that this multiple trial technique is a feasible and useful survey method for study of various contemporary social problems of sensitive nature. More field testing, particularly in different socio-cultural settings, is necessary however, before a general conclusion may be drawn.