CXCR3 ligands in pleural fluid as markers for the diagnosis of tuberculous pleural effusion

SETTING

A tertiary care academic medical centre.

OBJECTIVE

To evaluate the clinical usefulness of C-X-C motif chemokine receptor 3 (CXCR3) ligands in tuberculous pleural effusion (TPE).

DESIGN

We recruited 336 patients with pleural effusion due to various causes. Concentrations of interferon-gamma (IFN-γ) and the CXCR3 ligands CXCL9 and CXCL11 were determined using enzyme immunoassays; adenosine deaminase (ADA) activity was measured in pleural fluid and serum.

RESULTS

TPE was diagnosed in 106 patients. Non-TB conditions included lung cancer (n = 95), para-pneumonic effusion (n = 52), non-lung malignancy (n = 30), other exudate (n = 24) and transudate (n = 29) disorders. All marker levels in serum samples and pleural fluid were significantly higher in the TPE group. Analyses of receiver operating characteristic curves for differentiating TPE from non-TB effusions produced the following results for the area under the curve (AUC) for CXCL9, CXCL11, IFN-γ and ADA, respectively: 0.982, 0.952, 0.982, and 0.952. Marker AUCs in lymphocytic exudates were also high. Combining the levels of CXCL9, IFN-γ and ADA in pleural fluid improved the diagnostic performance. Serum levels of CXCL9 had the highest AUC (0.848) for diagnosing TPE.

CONCLUSION

Levels of CXR3 ligands in pleural effusion are useful for diagnosing TPE.

Serum CXCR3 ligands as biomarkers for the diagnosis and treatment monitoring of tuberculosis

SETTING

Tertiary care academic medical centre.

OBJECTIVE

To evaluate the clinical utility of CXC chemokine receptor 3 (CXCR3) ligands in the diagnosis and monitoring of tuberculosis (TB).

DESIGN

Presumptive TB patients (active TB, 256; non-TB disease, 52) and 201 healthy controls were enrolled. The serum levels of interferon-gamma (IFN-γ) and CXCR3 ligands (CXCL9, a monokine induced by IFN-γ [MIG] and CXCL11, an IFN-inducible T-cell α chemoattractant [I-TAC]) were measured using enzyme-linked immunosorbent assay. An IFN-γ release assay (IGRA) was also performed. Serial samplings were performed in 19 TB patients at baseline and at 1, 2, 3, 6 and 12 months after treatment initiation.

RESULTS

All marker levels were higher in TB patients than in controls and non-TB patients. The area under the curve (AUC) for differentiating between all TB patients and controls was 0.96 (95%CI 0.94-0.98) for CXCL9, 0.84 (95%CI 0.80-0.87) for CXCL11 and 0.61 (95%CI 0.57-0.66) for IFN-γ. CXCL9 levels afforded particularly high discriminatory power between TB patients and IGRA-positive controls (AUC = 0.95, 95%CI 0.92-0.97). The levels of CXCR3 ligands decreased significantly during follow-up, and these changes were correlated with treatment response.

CONCLUSION

CXCR3 ligands CXCL9 and CXCL11 may be useful surrogate markers for the diagnosis and follow-up of TB.

CXCR3 ligands as clinical markers for pulmonary tuberculosis

SETTING

A tertiary care academic medical centre.

OBJECTIVE

To evaluate the clinical usefulness of CXC chemokine receptor 3 (CXCR3) ligands in active pulmonary tuberculosis (TB).

DESIGN

Patients with various pulmonary diseases and healthy controls were recruited into this cross-sectional study. Plasma levels of interferon-gamma (IFN-γ) and the CXCR3 ligands (CXCL9 [monokine induced by IFN-γ, MIG], CXCL10 [IFN-γ-inducible 10-kDa protein, IP-10] and CXCL11 [IFN-inducible T-cell α chemoattractant, I-TAC] were measured using enzyme immunoassays.

RESULTS

The study included 846 subjects: 201 patients with active pulmonary TB, 389 with other pulmonary diseases, and 256 controls. CXCR3 ligand levels were higher in TB patients than in controls and all other disease groups, whereas the IFN-γ levels did not differ. The area under the curve (AUC) for differentiating active TB from all other groups was 0.797 for CXCL9, 0.726 for CXCL10, 0.846 for CXCL11 and 0.534 for IFN-γ. The AUC for differentiating active TB from controls was 0.926 for CXCL9, 0.818 for CXCL10, 0.865 for CXCL11 and 0.575 for IFN-γ. CXCR3 levels correlated with sputum acid-fast bacilli smear grades and the radiographic extent of pulmonary TB.

CONCLUSION

CXCR3 ligands may be useful surrogate markers for diagnosing active TB and for assessing TB patients clinically.

Unique features of non-obstructive emphysema and pure airway obstruction

SETTING

Emphysema without airway obstruction or airway obstruction without emphysema are often detected clinically, although they are commonly co-existent. We therefore tested the hypothesis that non-obstructive emphysema and pure airway obstruction have unique features.

METHODS

A case-control observation study was undertaken retrospectively in a patient cohort at a single centre. Among 2662 subjects who underwent chest computed tomography and pulmonary function tests, we enrolled 90 patients with non-obstructive emphysema, 119 with pure airway obstruction, 81 with obstructive emphysema and 2031 subjects as normal controls. The features of the four groups were analysed and compared.

RESULTS

Higher serum homocysteine (13.4 ± 7.4 vs. 11.6 ± 4.6 mol/l), higher rate of osteoporosis (15.8% vs. 4.5%), higher leukocyte count, higher male ratio, lower serum albumin and lower body mass index were observed in subjects with non-obstructive emphysema than in controls (P < 0.05). In multiple logistic regression analysis of groups without airway obstruction, osteoporosis, hyperhomocysteinaemia, hypoalbuminaemia and higher leukocyte count were independent factors associated with non-obstructive emphysema (P < 0.05).

CONCLUSION

Hyperhomocysteinaemia, hypoalbuminaemia, osteoporosis and higher leukocyte count were independent predictors of non-obstructive emphysema.

Conductance features in point contact Andreev reflection spectra

Point contact Andreev reflection (PCAR) spectroscopy is a common technique for determining the spin polarization of a ferromagnetic sample. The polarization is extracted by measuring the bias dependence of the conductance of a metallic/superconducting point contact. Under ideal conditions, the conductance is dominated by Andreev reflection and the Blonder-Tinkham-Klapwijk (BTK) model can be used to extract a value for the polarization. However, PCAR spectra often exhibit unwanted features in the conductance that cannot be appropriately modelled with the BTK theory. In this paper we isolate some of these unwanted features and show that any further extraction of the spin polarization from these non-ideal spectra proves unreliable. Understanding the origin of these features provides an objective criterion for rejection of PCAR spectra unsuitable for fitting with the modified BTK model.

Low expression of bax predicts poor prognosis in patients with locally advanced esophageal cancer treated with definitive chemoradiotherapy

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Background: The present study evaluated the prognostic significance of apoptosis-related proteins, p53, bcl-2, bax, and galectin-3 in patients with locally advanced esophageal cancer treated with definitive chemoradiotherapy (CRT). Methods: Sixty-three patients with locally advanced esophageal cancer (stage II-IV) were treated with definitive CRT using 5-fluorouracil and cisplatin combined with radiotherapy. Pretreatment tumor biopsy specimens were analyzed for p53, bcl-2, bax, and galectin-3 expression by immunohistochemistry. Results: High expression of bax, p53, bcl-2, and galectin-3 was observed in 67%, 47%, 24%, and 29% of patients, respectively. The median overall survival (OS) of total patients was 14 months with 16% of 3-year OS. High expression of p53, bcl- 2, and galectin-3 did not demonstrate correlation with clinicopathologic characteristics, including patient outcome. Low expression of bax was significantly correlated with clinical complete response (p=0.023). Low expression of bax was also associated with poor OS (median, 8 months vs. 16 months; P=0.0008) in univariate analysis. In multivariate analysis, low expression of bax was the most significant independent predictor of poor OS (p=0.01) followed by clinical complete response and low radiation dose. Conclusions: Low expression of bax was significantly associated with the poor survival of patients with locally advanced esophageal cancer treated with CRT using 5-fluorouracil and cisplatin. Immunohistochemical staining for bax with a pretreatment biopsy specimen might be useful to select the optimal treatment options for these patients.

No significant financial relationships to disclose.

Effect of toothpaste on the plaque inhibitory properties of a cetylpyridinium chloride mouth rinse

BACKGROUND AND AIMS

Cetylpyridinium chloride (CPC) mouth rinses have moderate plaque inhibitory activity when used alone but rarely have shown adjunctive benefits to tooth brushing with toothpaste. Several explanations for this apparent anomaly can be proferred, including loss of antiseptic activity due to interactions with toothpaste ingredients. The aim of this study was to measure the effect of toothpaste on the plaque inhibitory properties of a CPC mouth rinse using paired rinses of CPC, toothpaste slurry (TP) and water (W).

METHODS

The study was a single blind, randomised, seven-treatment, cross over design balanced for residual effects, involving 21 healthy, dentate subjects. The paired rinses were: W-CPC, CPC-W, TP-CPC, CPC-TP, W-TP, TP-W and W-W. Rinsing with solutions or slurries was done for 60 s twice per day. On day 1, subjects were rendered plaque free, suspended tooth cleaning and commenced the allocated rinse regimen. On day 5, plaque was scored by index. A 2(1/2) day wash out of normal oral hygiene was allowed between each regimen.

RESULTS

The order from lowest to highest plaque scores was as follows: W-CPC = CPC-W < CPC-TP < TP-CPC < or = W-TP < TP-W < W-W. Several differences in pairs of treatments were statistically significant, the most relevant of which were significantly less plaque with W-CPC compared to TP-CPC, TP-W and W-TP, and significantly more plaque with W-W compared to all other regimens except TP-W.

CONCLUSIONS

Toothpaste, whilst possessing some plaque inhibitory activity, when used immediately before a CPC mouth rinse adversely affected the plaque inhibitory action of this antiseptic. This in part may explain the reported lack of adjunctive benefits of CPC rinses to normal oral hygiene practices and supports the suggestion, made for chlorhexidine rinses, that their use should follow toothpaste by at least 60 min.

An in vitro evaluation of the availability of cetylpyridinium chloride and chlorhexidine in some commercially available mouthrinse products

OBJECTIVES

To assess the comparative activity of mouthrinses containing cetylpyridinium chloride (CPC) and chlorhexidine using the propensity to cause extrinsic staining in vitro as the outcome variable.

METHODS

Saliva-coated clear acrylic specimens were exposed to cyclical staining regimens of either CPC or chlorhexidine followed by tea. Water and 0.2% chlorhexidine were used as negative and positive controls respectively. Staining cycles were repeated until an optical density of > 2 was reached by one of the products.

RESULTS

For CPC there was a highly significant difference in staining between the products. Two CPC products performed numerically little better than water. For the chlorhexidine products the 0.2% formulation produced the most staining although little more than the UK version of the 0.1% rinse. The French 0.1% rinse produced by the same manufacturer as the UK formulation showed markedly reduced staining potential although significantly greater than water.

CONCLUSION

This study, supported by previous in vitro and in vivo studies, indicates discrepancies in the availability of CPC and chlorhexidine in some mouthrinse products. Importantly, this may have an effect on the potential of some rinses to provide the expected plaque inhibitory activity.

The benefits of toothpaste--real or imagined? The effectiveness of toothpaste in the control of plaque, gingivitis, periodontitis, calculus and oral malodour

Toothbrushing with toothpaste is the most widely used method of home dental care for the populations of the Western world. The traditional role of toothpaste is primarily cosmetic, in aiding the cleaning of teeth and producing fresh breath. Today, however, formulations contain ingredients which may also help oral health by way of reducing dental plaque and improving gingival/periodontal health. This article provides a short review on the usefulness of these chemicals when used primarily in toothpastes.

The benefits of toothpaste--real or imagined? Review of its role in tooth whitening

The market for whitening toothpastes in the UK is burgeoning at present, but little has been published about the modes of action or efficacy of such pastes. Much is known about how the individual ingredients work, but toothpaste formulations are complex and there is potential for interaction. Studies have been undertaken to compare the efficacy of various test products, but these have used different types of trial design and consequently direct comparisons are difficult, not least because there are several ways of measuring 'whiteness', and there is no consensus of opinion between workers in this field as to the best way to record it.

The propensity of individual saliva to cause extrinsic staining in vitro--a developmental method

OBJECTIVES

To detect any differences in the propensity of individual saliva to cause in vitro staining by chlorhexidine and tea.

METHODS

Unstimulated human saliva was collected on a daily basis and used to coat optically clear Perspex specimens. Specimens were subjected to the original chlorhexidine/tea staining model described by Prayitno and Addy (Journal of Periodontal Research 1979;14:397-402), and cycles repeated until a maximum optical density of two was reached.

RESULTS

Stain development increased incrementally with increasing cycles. Differences in chlorhexidine/tea staining between subjects were obvious by cycle 3 where the lowest 'stainer' had 56% less stain than the highest 'stainer'. Highly significant differences between subjects were seen during staining cycles 3-6, but not at cycles 7 and 8.

CONCLUSIONS

In vitro stain formation using saliva from different individuals occurred at differing rates when all other variables were standardised. The properties of saliva accounting for this are still unknown, and warrant further study.

The effect of toothpaste on the propensity of chlorhexidine and cetyl pyridinium chloride to produce staining in vitro: a possible predictor of inactivation

BACKGROUND/AIMS

Cationic antiseptics such as chlorhexidine (CHX) and cetyl pyridinium chloride (CPC) interact with dietary chromogens to produce extrinsic stain, and this can be used as a measure of activity of products. The aim of these studies in vitro was to determine if toothpaste influenced the tea staining effects of CHX and CPC as a predictor of action in vivo.

METHOD

Clear acrylic specimens were soaked in pooled human saliva followed by sequential 2-min soaks in pairs of agents, namely 0.05% CHX, 0.05% CPC, 0.2% CHX, water (W) and toothpaste slurry (TP). The combinations were; TP/CHX, CHX/TP, TP/CPC, CPC/TP, W/CHX, CHX/W, W/CPC, CPC/W, TP/W, W/TP, W/W. These treatments were followed by a 60 min soak in tea. Optical density readings were taken at baseline and after each of 8 cycles.

RESULTS

In the separate CHX and CPC studies by comparison with W/CHX, TP/0.05% CHX had little effect on staining, but TP/0.2% CHX showed a reduction in staining of 18%. 0.05% CHX/TP reduced staining by >40%, and 0.2% CHX by >78%. TP/CPC reduced staining by >26% and CPC/TP by 80%. Water after 0.2% CHX, 0.05% CHX and CPC reduced staining by 18%, 13% and 17% respectively. Little staining was seen with TP and W combinations. The data for CHX are in agreement with a study in vivo except TP followed by CHX reduced the activity of CHX.

CONCLUSION

Toothpaste appears to adversely affect the activity of CHX and CPC particularly if used immediately after the antiseptics. The data further supports the concept of separating the use of antiseptics until sometime after the use of toothpaste, and the idea of developing mouthwash friendly toothpastes.

Rebound severe methemoglobinemia from ingestion of a nitroethane artificial-fingernail remover

We describe life-threatening methemoglobinemia in a child who ingested a nitroethane artificial-fingernail remover initially mistaken to be an acetone-based polish remover. Nitroethane-induced methemoglobinemia may be delayed and recurrent; patients ingesting this substance may warrant close observation for at least 24 hours. Care givers are cautioned to determine the precise substance involved in ingestions of potentially toxic fingernail products.