Effect of simultaneous vaccination with H1N1 and GAD-alum on GAD65-induced immune response

AIMS/HYPOTHESIS

A European Phase III trial of GAD formulated with aluminium hydroxide (GAD-alum) failed to reach its primary endpoint (preservation of stimulated C-peptide secretion from baseline to 15 months in type 1 diabetes patients), but subgroup analysis showed a clinical effect when participants from Nordic countries were excluded, raising concern as to whether the mass vaccination of the Swedish and Finnish populations with the Pandemrix influenza vaccine could have influenced the study outcomes. In the current study, we aimed to assess whether Pandemrix vaccination affects the specific immune responses induced by GAD-alum and the C-peptide response.

METHODS

In this secondary analysis, we analysed data acquired from the Swedish participants in the Phase III GAD-alum trial who received subcutaneous GAD-alum vaccination (two doses, n = 43; four doses, n = 46) or placebo (n = 48). GAD autoantibodies (GADA) and H1N1 autoantibodies, GAD₆₅-induced cytokine secretion and change in fasting and stimulated C-peptide levels from baseline to 15 months were analysed with respect to the relative time between H1N1 vaccination and the first injection of GAD-alum.

RESULTS

GADA levels at 15 months were associated with the relative time between GAD-alum and Pandemrix administration in participants who received two doses of the GAD-alum vaccine (p = 0.015, r = 0.4). Both in participants treated with two doses and four doses of GAD-alum, GADA levels were higher when the relative time between vaccines was ≥210 days (p < 0.05). In the group that received two doses of GAD-alum, levels of several GAD₆₅-induced cytokines were higher in participants who received the H1N1 vaccination and the first GAD-alum injection at least 150 days apart, and the change in fasting and stimulated C-peptide at 15 months was associated with the relative time between vaccines. Neither of these effects were observed in individuals who received four doses of GAD-alum.

CONCLUSIONS/INTERPRETATION

In individuals who received two doses of GAD-alum, receiving the Pandemrix vaccine closer to the first GAD-alum injection, i.e. <150 days, seemed to affect both GAD₆₅-induced immune response and C-peptide preservation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00723411.

GAD-treatment of children and adolescents with recent-onset type 1 diabetes preserves residual insulin secretion after 30 months

BACKGROUND

This study aimed to analyse data from two different studies (phase II and phase III) regarding the safety and efficacy of treatment with alum formulated glutamic acid decarboxylase GAD65 (GAD-alum) at 30 months after administration to children and adolescents with type 1 diabetes.

METHODS

The phase II trial was a double-blind, randomised placebo-controlled study, including 70 children and adolescents who were followed for 30  months. Participants received a subcutaneous injection of either 20 µg of GAD-alum or placebo at baseline and 1 month later. During a subsequent larger European phase III trial including three treatment arms, participants received two or four subcutaneous injections of either 20 µg of GAD-alum and/or placebo at baseline, 1, 3 and 9  months. The phase III trial was prematurely interrupted at 15 months, but of the 148 Swedish patients, a majority completed the 21 months follow-up, and 45 patients completed the trial at 30 months. Both studies included GAD65 auto-antibodies-positive patients with fasting C-peptide ≥ 0.10 nmol/l. We have now combined the results of these two trials.

RESULTS

There were no treatment related adverse events. In patients treated with 2 GAD-alum doses, stimulated C-peptide area under the curve had decreased significantly less (9  m: p  <  0.037; 15 m: p  <  0.032; 21 m: p  <  0.003 and 30  m: p <  0.004), and a larger proportion of these patients were also able to achieve a peak stimulated C-peptide > 0.2  nmol/L (p  <  0.05), as compared with placebo.

CONCLUSION

Treatment with two doses of GAD-alum in children and adolescents with recent-onset type 1 diabetes shows no adverse events and preserves residual insulin secretion.

Caries risk assessment. A systematic review

OBJECTIVE

To assess the ability of multivariate models and single factors to correctly identify future caries development in pre-school children and schoolchildren/adolescents.

STUDY DESIGN

A systematic literature search for relevant papers was conducted with pre-determined inclusion criteria. Abstracts and full-text articles were assessed independently by two reviewers. The quality of studies was graded according to the QUADAS tool. The quality of evidence of models and single predictors was assessed using the GRADE approach.

RESULTS

Ninety original articles fulfilled the inclusion criteria. Seven studies had high quality, 35 moderate and the rest poor quality. The accuracy of multivariate models was higher for pre-school children than for schoolchildren/adolescents. However, the models had seldom been validated in independent populations, making their accuracy uncertain. Of the single predictors, baseline caries experience had moderate/good accuracy in pre-school children and limited accuracy in schoolchildren/adolescents. The period of highest risk for caries incidence in permanent teeth was the first few years after tooth eruption. In general, the quality of evidence was limited.

CONCLUSIONS

Multivariate models and baseline caries prevalence performed better in pre-school children than in schoolchildren/adolescents. Baseline caries prevalence was the most accurate single predictor in all age groups. The heterogeneity of populations, models, outcome criteria, measures and reporting hampered the synthesis of results. There is a great need to standardize study design, outcome measures and reporting of data in studies on caries risk assessment. The accuracy of prediction models should be validated in at least one independent population.

Cellular and humoral immune responses in type 1 diabetic patients participating in a phase III GAD-alum intervention trial

OBJECTIVE

GAD formulated in aluminum hydroxide (GAD-alum) has previously been shown to induce preservation of residual insulin secretion in recent-onset type 1 diabetes, but recent phase II and III GAD-alum trials failed to reach primary outcomes. The European phase III study was therefore closed after 15 months, and only a minority of patients completed the 30 months of follow-up.

RESEARCH DESIGN AND METHODS

This study aimed to characterize cellular and humoral responses in the Swedish patients (n = 148) participating in the phase III trial, receiving four (4D) or two (2D) GAD-alum doses or placebo. Serum GAD65 antibody (GADA) levels, GADA IgG1-4 subclass distribution, cytokine secretion, and proliferative responses in peripheral blood mononuclear cells (PBMCs) were analyzed.

RESULTS

The GAD65-induced cytokine profile tended to switch toward a predominant Th2-associated profile over time both in the 2D and 4D group. The groups also displayed increased GADA levels and PBMC proliferation compared with placebo, whereas GADA IgG subclass distribution changed in 4D patients.

CONCLUSIONS

Both 2D and 4D patients displayed GAD65-specifc cellular and humoral effects after GAD-alum treatment, but at different time points and magnitudes. No specific immune markers could be associated with treatment efficacy.

Cellular and humoral immune responses in type 1 diabetic patients participating in a phase III GAD-alum intervention trial

OBJECTIVE

GAD formulated in aluminum hydroxide (GAD-alum) has previously been shown to induce preservation of residual insulin secretion in recent-onset type 1 diabetes, but recent phase II and III GAD-alum trials failed to reach primary outcomes. The European phase III study was therefore closed after 15 months, and only a minority of patients completed the 30 months of follow-up.

RESEARCH DESIGN AND METHODS

This study aimed to characterize cellular and humoral responses in the Swedish patients (n = 148) participating in the phase III trial, receiving four (4D) or two (2D) GAD-alum doses or placebo. Serum GAD65 antibody (GADA) levels, GADA IgG1-4 subclass distribution, cytokine secretion, and proliferative responses in peripheral blood mononuclear cells (PBMCs) were analyzed.

RESULTS

The GAD65-induced cytokine profile tended to switch toward a predominant Th2-associated profile over time both in the 2D and 4D group. The groups also displayed increased GADA levels and PBMC proliferation compared with placebo, whereas GADA IgG subclass distribution changed in 4D patients.

CONCLUSIONS

Both 2D and 4D patients displayed GAD65-specifc cellular and humoral effects after GAD-alum treatment, but at different time points and magnitudes. No specific immune markers could be associated with treatment efficacy.

Regulatory T cell phenotype and function 4 years after GAD-alum treatment in children with type 1 diabetes

Glutamic acid decarboxylase (GAD)(65) formulated with aluminium hydroxide (GAD-alum) was effective in preserving insulin secretion in a Phase II clinical trial in children and adolescents with recent-onset type 1 diabetes. In addition, GAD-alum treated patients increased CD4(+) CD25(hi) forkhead box protein 3(+) (FoxP3(+)) cell numbers in response to in-vitro GAD(65) stimulation. We have carried out a 4-year follow-up study of 59 of the original 70 patients to investigate long-term effects on the frequency and function of regulatory T cells after GAD-alum treatment. Peripheral blood mononuclear cells were stimulated in vitro with GAD65 for 7 days and expression of regulatory T cell markers was measured by flow cytometry. Regulatory T cells (CD4(+) CD25(hi) CD127(lo)) and effector T cells (CD4(+) CD25(-) CD127(+)) were further sorted, expanded and used in suppression assays to assess regulatory T cell function after GAD-alum treatment. GAD-alum-treated patients displayed higher frequencies of in-vitro GAD(65) -induced CD4(+) CD25(+) CD127(+) as well as CD4(+) CD25(hi) CD127(lo) and CD4(+) FoxP3(+) cells compared to placebo. Moreover, GAD(65) stimulation induced a population of CD4(hi) cells consisting mainly of CD25(+) CD127(+) , which was specific of GAD-alum-treated patients (16 of 25 versus one of 25 in placebo). Assessment of suppressive function in expanded regulatory T cells revealed no difference between GAD-alum- and placebo-treated individuals. Regulatory T cell frequency did not correlate with C-peptide secretion throughout the study. In conclusion, GAD-alum treatment induced both GAD(65) -reactive CD25(+) CD127(+) and CD25(hi) CD127(lo) cells, but no difference in regulatory T cell function 4 years after GAD-alum treatment.

Decreased GAD(65)-specific Th1/Tc1 phenotype in children with Type 1 diabetes treated with GAD-alum

AIM

The balance between T helper cell subsets is an important regulator of the immune system and is often examined after immune therapies. We aimed to study the immunomodulatory effect of glutamic acid decarboxylase (GAD) 65 formulated with aluminium hydroxide (GAD-alum) in children with Type 1 diabetes, focusing on chemokines and their receptors.

METHODS

Blood samples were collected from 70 children with Type 1 diabetes included in a phase II clinical trial with GAD-alum. Expression of CC chemokine receptor 5 (CCR5) and CCR4 was analysed on CD4+ and CD8+ lymphocytes after in vitro stimulation with GAD(65) using flow cytometry, and secretion of the chemokines CCL2, CCL3 and CCL4 was detected in peripheral blood mononuclear cell supernatants with Luminex.

RESULTS

Expression of Th1-associated CCR5 was down-regulated following antigen challenge, together with an increased CCR4/CCR5 ratio and CCL2 secretion in GAD-alum-treated patients, but not in the placebo group.

CONCLUSION

Our results suggest that GAD-alum treatment has induced a favourable immune modulation associated with decreased Th1/Tc1 phenotypes upon antigen re-challenge, which may be of importance for regulating GAD(65) immunity.

Radiological diagnosis of periapical bone tissue lesions in endodontics: a systematic review

This systematic review evaluates the diagnostic accuracy of radiographic methods employed to indicate presence/absence and changes over time of periapical bone lesions. Also investigated were the leads radiographic images may give about the nature of the process and the condition of the pulp in nonendodontically treated teeth. Electronic literature search included the databases PubMed, Embase and CENTRAL from January 1950 to June 2011. All languages were accepted provided there was an abstract in English. The MeSH terms were 'Cone beam computed tomography (CBCT)', 'Radiography, panoramic', 'Periapical diseases', 'Dental pulp diseases', 'Sensitivity and specificity', 'receiver operating characteristics (ROC) curve', 'Cadaver', 'Endodontics' and 'Radiography dental'. Two reviewers independently assessed abstracts and full text articles. An article was read in full text if at least one of the two reviewers considered an abstract to be potentially relevant. Altogether, 181 articles were read in full text. The GRADE approach was used to assess the quality of evidence of each radiographic method based on studies of high or moderate quality. Twenty-six studies fulfilled criteria set for inclusion. None was of high quality; 11 were of moderate quality. There is insufficient evidence that the digital intraoral radiographic technique is diagnostically as accurate as the conventional film technique. The same applies to CBCT. No conclusions can be drawn regarding the accuracy of radiological examination in identifying various forms of periapical bone tissue changes or about the pulpal condition.

Long-lasting immune responses 4 years after GAD-alum treatment in children with type 1 diabetes

A phase II clinical trial with glutamic acid decarboxylase (GAD) 65 formulated with aluminium hydroxide (GAD-alum) has shown efficacy in preserving residual insulin secretion in children and adolescents with recent-onset type 1 diabetes (T1D). We have performed a 4-year follow-up study of 59 of the original 70 patients to investigate long-term cellular and humoral immune responses after GAD-alum-treatment. Peripheral blood mononuclear cells (PBMC) were stimulated in vitro with GAD₆₅. Frequencies of naïve, central and effector memory CD4+ and CD8+ T cells were measured, together with cytokine secretion, proliferation, gene expression and serum GAD₆₅ autoantibody (GADA) levels. We here show that GAD-alum-treated patients display increased memory T-cell frequencies and prompt T-cell activation upon in vitro stimulation with GAD₆₅, but not with control antigens, compared with placebo subjects. GAD₆₅-induced T-cell activation was accompanied by secretion of T helper (Th) 1, Th2 and T regulatory cytokines and by induction of T-cell inhibitory pathways. Moreover, post-treatment serum GADA titres remained persistently increased in the GAD-alum arm, but did not inhibit GAD₆₅ enzymatic activity. In conclusion, memory T- and B-cell responses persist 4 years after GAD-alum-treatment. In parallel to a GAD₆₅-induced T-cell activation, our results show induction of T-cell inhibitory pathways important for regulating the GAD₆₅ immunity.

Extended evaluation of the safety and efficacy of GAD treatment of children and adolescents with recent-onset type 1 diabetes: a randomised controlled trial

AIMS/HYPOTHESIS

The aim of this study was to investigate the safety and efficacy of alum formulated glutamic acid decarboxylase GAD(65) (GAD-alum) treatment of children and adolescents with type 1 diabetes after 4 years of follow-up.

METHODS

Seventy children and adolescents aged 10-18 years with recent onset type 1 diabetes participated in a phase II, double-blind, randomised placebo-controlled clinical trial. Patients identified as possible participants attended one of eight clinics in Sweden to receive information about the study and for an eligibility check, including a medical history. Participants were randomised to one of the two treatment groups and received either a subcutaneous injection of 20 μg of GAD-alum or placebo at baseline and 1 month later. The study was blinded to participants and investigators until month 30. The study was unblinded at 15 months to the sponsor and statistician in order to evaluate the data. At follow-up after 30 months there was a significant preservation of residual insulin secretion, as measured by C-peptide, in the group receiving GAD-alum compared with placebo. This was particularly evident in patients with <6 months disease duration at baseline. There were no treatment-related serious adverse events. We have now followed these patients for 4 years. Overall, 59 patients, 29 who had been treated with GAD-alum and 30 who had received placebo, gave their informed consent.

RESULTS

One patient in each treatment group experienced an episode of keto-acidosis between months 30 and 48. There were no treatment-related adverse events. The primary efficacy endpoint was the change in fasting C-peptide concentration from baseline to 15 months after the prime injection for all participants per protocol set. In the GAD-alum group fasting C-peptide was 0.332 ± 0.032 nmol/l at day 1 and 0.215 ± 0.031 nmol/l at month 15. The corresponding figures for the placebo group were 0.354 ± 0.039 and 0.184 ± 0.033 nmol/l, respectively. The decline in fasting C-peptide levels between day 1 and month 1, was smaller in the GAD-alum group than the placebo group. The difference between the treatment groups was not statistically significant. In those patients who were treated within 6 months of diabetes diagnosis, fasting C-peptide had decreased significantly less in the GAD-alum group than in the placebo-treated group after 4 years.

CONCLUSION/INTERPRETATION

Four years after treatment with GAD-alum, children and adolescents with recent-onset type 1 diabetes continue to show no adverse events and possibly to show clinically relevant preservation of C-peptide.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00435981

FUNDING

The study was funded by The Swedish Research Council K2008-55X-20652-01-3, Barndiabetesfonden (The Swedish Child Diabetes Foundation), the Research Council of Southeast Sweden, and an unrestricted grant from Diamyd Medical AB.

GAD-alum treatment induces GAD65-specific CD4+CD25highFOXP3+ cells in type 1 diabetic patients

Type 1 diabetes results from autoimmune destruction of insulin producing pancreatic β-cells. We have shown that treatment with alum-formulated glutamic acid decarboxylase 65 (GAD-alum) preserved residual insulin secretion and induced antigen-specific responses in children with recent onset type 1 diabetes. The aim of this study was to further investigate the immunomodulatory effect of GAD-alum, focusing on CD4(+)CD25(high) cells and their association to cytokine secretion. Samples obtained 21 and 30months after the initial injection of GAD-alum or placebo were included in the present study. GAD(65)-stimulation enhanced the percentage of CD4(+)CD25(high)FOXP3(+) cells, but reduced the percentage of CD4(+)CD25(+) cells, in samples from the GAD-alum treated group. Further, the GAD(65)-induced secretion of IL-5, -10, and -13 correlated with the expression of CD4(+)CD25(high)FOXP3(+) cells, but inversely with CD4(+)CD25(+) cells. These new data suggest that GAD-alum treatment induced GAD(65)-specific T cells with regulatory features.

Early induction of GAD(65)-reactive Th2 response in type 1 diabetic children treated with alum-formulated GAD(65)

BACKGROUND

We have previously shown that two injections of 20 µg alum-formulated glutamic acid decarboxylase 65 (GAD(65)) (GAD-alum; Diamyd(®)) in children with recent-onset type 1 diabetes lead to preservation of residual insulin secretion. In vitro cytokine production at the 15 months' follow-up indicated immunomodulation. In the present study, we took advantage of peripheral blood mononuclear cells, cryopreserved during early follow-ups, to investigate whether the immunomodulatory effect of GAD-alum was apparent earlier after treatment, preceding the changes previously reported at 15 months.

METHODS

Peripheral blood mononuclear cells from 70 type 1 diabetic children, randomly assigned GAD-alum (n = 35) or placebo (n = 35), that had been frozen at baseline (n = 27) and after 1 (n = 58), 3 (n = 67) and 9 (n = 66) months, were stimulated in vitro with GAD(65), tyrosine phosphatase-like protein IA-2 peptide, insulin peptide, GAD-alum, alum formulation or phytohaemagglutinin. Interleukin (IL)-5, -6, -10, -12, -13, -17, tumour necrosis factor and interferon-γ were measured in cell supernatants and serum samples using Luminex. Expression of FOXP3 and transforming growth factor-β was determined by real-time reverse transcription polymerase chain reaction.

RESULTS

Already 1 month after the first injection, GAD(65)-induced IL-5 and IL-13 together with FOXP3 were enhanced in GAD-alum-treated patients compared to those with placebo. The in vitro response at 3 and 9 months was characterized by a broader range of cytokines in the treated group. Notably, only the T-helper 2-associated cytokines IL-5 and IL-13 together with FOXP3 increased continuously over time.

CONCLUSIONS

Treatment with GAD-alum in type 1 diabetic children induced an early T-helper 2 immune enhanced response to GAD(65), followed by a wider spectrum of cytokines at 3 and 9 months.

Impaired CD4 and CD8 T cell phenotype and reduced chemokine secretion in recent-onset type 1 diabetic children

Although the role of the T cell-mediated autoimmune reaction in type 1 diabetes (T1D) is conclusive, studies including data from human circulating CD4(+) and CD8(+) lymphocytes subsets during the disease onset and posterior development are scarce. Further, chemokines and chemokine receptors are key players in the migration of pathogenic T cells into the islets of non-obese diabetic mice developing T1D, but few studies have investigated these markers in human T1D patients. We studied the expression of T helper 1 (Th1)- and Th2-associated chemokine receptors, and the two isoforms of CD45 leucocyte antigen on CD4(+) and CD8(+) lymphocytes from T1D and healthy children, as well as the secretion of chemokines in cell supernatants in peripheral blood mononuclear cells. Our results showed increased expression of CCR7 and CD45RA and reduced CD45RO on CD8(+) cells among recent-onset T1D patients. The percentages of CD4(+) cells expressing CXC chemokine receptor 3 (CXCR3), CXCR6 and CCR5, and the secretion of interferon-gamma-induced protein-10, monocyte chemoattractant protein-1, macrophage inflammatory protein (MIP)-1alpha and MIP-1beta was lower among diabetics. Low expression of Th1-associated receptors and secretion of chemokines, together with an increased amount of CD8(+) cells expressing CD45RA and CCR7 in T1D patients therefore might represent suboptimal Th function in T1D, leading to impaired T cytotoxic responses or alternatively reflect a selective recruitment of Th1 cells into the pancreas.

GAD treatment and insulin secretion in recent-onset type 1 diabetes

BACKGROUND

The 65-kD isoform of glutamic acid decarboxylase (GAD) is a major autoantigen in patients with type 1 diabetes mellitus. This trial assessed the ability of alum-formulated GAD (GAD-alum) to reverse recent-onset type 1 diabetes in patients 10 to 18 years of age.

METHODS

We randomly assigned 70 patients with type 1 diabetes who had fasting C-peptide levels above 0.1 nmol per liter (0.3 ng per milliliter) and GAD autoantibodies, recruited within 18 months after receiving the diagnosis of diabetes, to receive subcutaneous injections of 20 microg of GAD-alum (35 patients) or placebo (alum alone, 35 patients) on study days 1 and 30. At day 1 and months 3, 9, 15, 21, and 30, patients underwent a mixed-meal tolerance test to stimulate residual insulin secretion (measured as the C-peptide level). The effect of GAD-alum on the immune system was also studied.

RESULTS

Insulin secretion gradually decreased in both study groups. The study treatment had no significant effect on change in fasting C-peptide level after 15 months (the primary end point). Fasting C-peptide levels declined from baseline levels significantly less over 30 months in the GAD-alum group than in the placebo group (-0.21 vs. -0.27 nmol per liter [-0.62 vs. -0.81 ng per milliliter], P=0.045), as did stimulated secretion measured as the area under the curve (-0.72 vs. -1.02 nmol per liter per 2 hours [-2.20 vs. -3.08 ng per milliliter per 2 hours], P=0.04). No protective effect was seen in patients treated 6 months or more after receiving the diagnosis. Adverse events appeared to be mild and similar in frequency between the two groups. The GAD-alum treatment induced a GAD-specific immune response.

CONCLUSIONS

GAD-alum may contribute to the preservation of residual insulin secretion in patients with recent-onset type 1 diabetes, although it did not change the insulin requirement. (ClinicalTrials.gov number, NCT00435981.)

In vitro effects of antipsychotics on human platelet adhesion and aggregation and plasma coagulation

1. Several studies suggest an association between venous thromboembolism and the use of antipsychotic drugs, especially clozapine, but the biological mechanisms are unknown. It has been suggested that antipsychotic drugs enhance aggregation of platelets and thereby increase the risk of venous thrombosis. The purpose of the present study was to examine the effects of clozapine and its main metabolite, N-desmethyl clozapine, as well as olanzapine, risperidone and haloperidol, on platelet adhesion and aggregation and on plasma coagulation in vitro. 2. Blood was collected from healthy subjects free of medication. Platelet adhesion to different protein surfaces and aggregation were measured in microplates. The coagulation methods of activated partial thromboplastin time (APTT) and prothrombin time were performed in platelet-poor plasma. 3. Clozapine was the only compound that increased platelet adhesion and aggregation and shortened APTT. The effect appeared at therapeutic concentrations and was significant but weak. 4. This weak effect of clozapine on haemostasis may explain, in part, the association of this compound and venous thromboembolism.

Environmental tobacco smoke exposure in public places of European cities

BACKGROUND

Exposure to environmental tobacco smoke (ETS) has important public health implications. The results of the first European multi-centre study that measured ETS exposure in a range of public places (transport, educational settings, and leisure facilities such as bars and restaurants) are presented.

METHOD

Nicotine vapour phase was measured using ETS passive samplers containing a filter treated with sodium bisulfate.

RESULTS

Bars and discos are the places with the highest concentrations of nicotine from ETS, median ranging from 19 to 122 microg/m(3). Restaurants had the next highest values. Concentrations of nicotine generally range from 0.1-5 microg/m(3) in airports, and from 0.5-10 microg/m(3) in train stations. Nicotine was also found in schools and universities, yet schools tended to have the lowest concentrations compared to all the other public places sampled. In hospitals levels were generally below 5 microg/m(3).

CONCLUSIONS

Although there is some variability between cities, this study shows that tobacco smoke is present in most of the studied public places. The study also showed that in areas where smoking is prohibited, concentrations of nicotine are lower than in areas where smoking is allowed but they are not zero. The results of this study indicate that policies should be implemented that would effectively reduce levels of tobacco smoke in public areas.

Exposure assessment to alpha- and beta-pinene, delta(3)-carene and wood dust in industrial production of wood pellets

The main aim of the study was to measure the exposure to monoterpenes (alpha- and beta-pinene and Delta(3)-carene) and wood dust during industrial production of wood pellets and briquettes. Additional aims were to compare the results from wood dust sampled on a filter with real time measurements using a direct reading instrument and to identify peak exposures to dust. Twenty-four men working at six companies involved in industrial production of wood pellets and briquettes participated in the study. Monoterpenes were measured by diffusive sampling and wood dust was measured as total dust. A data logger (DataRAM) was used for continuous monitoring of dust concentration for 18 of the participants. The sampling time was approximately 8 h. The personal exposure to monoterpenes ranged from 0.64 to 28 mg/m(3) and a statistically significant (Kruskal-Wallis test, P = 0.0002) difference in levels of monoterpenes for workers at different companies was seen. In the companies the personal exposure to wood dust varied between 0.16 and 19 mg/m(3) and for 10 participants the levels exceeded the present Swedish occupational exposure limit (OEL) of 2 mg/m(3). The levels of wood dust during the morning shift were significantly (Mann-Whitney test, P = 0.04) higher compared with the afternoon shift. Continuous registration of dust concentration showed peak values for several working operations, especially cleaning of truck engines with compressed air. For 24 workers in six companies involved in industrial production of wood pellets the personal exposure to monoterpenes was low and to wood dust high compared with the present Swedish OEL and previous studies in Swedish wood industries. Since the DataRAM can identify critical working tasks with high wood dust exposure a reduction in exposure levels could probably be achieved by changes in working routines and by the use of protective equipment.

The basic reality of mind and spongiform diseases

A change in handedness (chirality) in some amino acids appears to be the basic physical change in degradation-resistant proteins (prions) found in conditions such as Creutzfeldt-Jacob disease (CJD), Alzheimer's disease (AD), bovine spongiform encephalopathy (BSE) and ovine scrapie. The affected structures are primarily innervated by cholinergic nerves. Much evidence suggests that these so-called prions (here named chirons) are harmless, non-infectious products. The importance of the cholinergic system allows a new simplified interpretation of these conditions. The main steps are the acetylcholine-cholinesterase splitting of body water with release of free protons in solution, followed by electron dissipation, dioxygen activation and Ca-fluxes. Abiotic physics conserves parity and symmetry by equal amounts of L- and D-forms of molecules. In contrast, the asymmetric pattern of life must be homochiral. Such biomolecules dissolve in water and are thus able to interact in cholinergic hydrodynamics. It is supposed that the instability of the composite weak force by beta-decay causes changes in chirality. These extremely rare events are not frequent enough to explain disease pathology. Experimental, accidental, surgical and abusive inoculations will propagate chirons according to the physical law of self-replication, which also occurs in test tubes without added biological products. Chirons will not be degraded into amino acids in the alimentary canal and will, because they are indigestible, leave the body with the faeces. Chirons are inert also to the immune system and will be engulfed without reaction by phagocytosing cells. They are then stored away in tissues, where they do no harm (if not detected and suspected to be deleterious, thereby causing pathogenic anxiety). The cholinergic system reacts to all kinds of integrity threats and it is this reaction which I propose causes the so-called prion diseases. This pathology seems generally valid, and is here exemplified in AD, CJD, and Kuru disease. It is the cholinergic reaction and not the agent per se that is pathogenic. This is also true of viral infections where the interaction between viral infection and response may explain the enigmatic epidemiology of many neurodegenerative diseases. Intensity and duration of challenges will determine pathophysiology. The new variant of CJD, vCJD, is assumed to result from mutation of a slow virus agent into a more intense variant, which will give disease in younger patients. The pathology is primary protonic, with overactivity in most sub-systems of either enhancing or inhibiting character, but also functional failure or cell death by membrane damage and acidification, for instance in the CNS. The practical results of this proposal will be alleviation of the current BSE crisis. The important main aspects are: chirons are not infectious proteins but inert physical by-products; they are indigestible and not immunogenic, so beef is safe; properly processed and handled meat and bone-meal are not likely to transmit neurodegenerative diseases; chirons cannot even serve as markers in neurologic diseases.

The major fluvoxamine metabolite in urine is formed by CYP2D6

OBJECTIVE

Previous studies have shown that fluvoxamine is metabolized by CYP1A2 and CYP2D6, but there is no information on the impact the various CYP enzymes have on the different metabolic pathways of fluvoxamine biotransformation. The present study was designed to investigate this issue.

METHODS

The major fluvoxamine metabolite, the 5-demethoxylated carboxylic acid metabolite, was analyzed in urine from 50 healthy volunteers after intake of a single oral dose of 50 mg fluvoxamine, and the formation clearance for the metabolite (CLm) was calculated. Of the subjects, 28 were non-smoking CYP2D6 and CYP2C19 extensive metabolizers (EMs), 12 were smokers and were thus considered to have an induced CYP1A2 activity, 5 were CYP2D6 poor metabolizers (PMs), and 5 were CYP2C19 PMs. In 11 of the non-smoking EMs, 200 mg caffeine was given at another occasion in order to calculate oral caffeine clearance as a measure of CYP1A2 activity. In addition, CLm was calculated in ten other subjects given increasing doses of fluvoxamine for 4 weeks.

RESULTS

Oral clearance of fluvoxamine was significantly higher in smokers, and significantly lower in CYP2D6 PMs than in non-smoking EMs. CLm was 78% lower in CYP2D6 PMs than in the EMs. Smoking and being a CYP2C19 PM did not influence CLm. There was no significant correlation between oral caffeine clearance and CLm. CLm decreased with increasing fluvoxamine dosage, but the decrease in oral clearance was even higher.

CONCLUSION

These results indicate that CYP2D6 catalyzes the major metabolic pathway of fluvoxamine, whereas CYP1A2 seems to catalyze other less important pathways. Both the CYP2D6 and the CYP1A2 pathways seem to be saturated in parallel with increasing fluvoxamine dosage.

A comparison of discectomy and arthroscopic lysis and lavage for the treatment of chronic closed lock of the temporomandibular joint: a randomized outcome study

PURPOSE

The study compared the efficacy of discectomy or arthroscopic lysis and lavage in patients with chronic closed lock of the temporomandibular joint (TMJ) in a prospective, randomized clinical trial.

PATIENTS AND METHODS

Twenty-two patients with a clinical diagnosis of chronic closed lock were prospectively randomized to either discectomy or arthroscopic lysis and lavage. The individual outcome in each patient was evaluated with a visual analog scale for pain and a questionnaire concerning mandibular functional impairment. The clinical evaluation included measurement of maximum interincisal opening and protrusion, recording of clicking and crepitation, and palpation for tenderness of the TMJ and jaw muscles. Recordings were made before the operation (baseline) and at the 1-year follow-up.

RESULTS

Twenty patients completed the study. Discectomy and arthroscopic lysis and lavage significantly reduced pain and improved mandibular function. Discectomy reduced pain somewhat more effectively than arthroscopic lysis and lavage. The clinical recordings at the 1-year follow-up indicated similarly good outcomes after both procedures.

CONCLUSION

Both discectomy and arthroscopic lysis and lavage are effective surgical methods for treatment of chronic closed lock of the TMJ. Considering that arthroscopic lysis and lavage is a minimally invasive outpatient procedure, it should be used as the first choice in surgical treatment of this condition.

Cholinergic regulation of biological hydrodynamics

The structures of biological life are formed in water. Their function depends on changes in the entropy of water. It is regulated by the cholinergic system. The initiating event is the ChE-splitting of water with liberation of free protons. They will draw electrons from the fairly inert dioxygen. The induced oxygen reactivity will give liberation and transfer of electrons and hydrodynamic pH-dependent changes in protein configurations. A multitude of sub-systems will be activated. The sequence of events normally ends with the formation of water, thus preventing uncontrolled radical chain reactions. Cholinergic receptors appear as restricting units of the general disordering entropy tendency. ChE-induced hydrodynamics is propagated to the inner of cells by the water soluble protons and the electrolytes. Especially Ca appear to have a strong influence on the hydrodynamic dipole moment of water. Because water is an integral structure of DNA genetics also will be influenced. Conditions caused by deprivation of oxygen or of reactive oxygen and disorders by hyperactivity and inactivity are briefly discussed. The CNS takes the shape of a large-scale quantum computer with a function far beyond our ability of immediate perception. The atomic nuclear proportions of quantum bits (qubits) will admit the functional one-cell unit of immune memory cells. Cholinergic hydrodynamics appear to substantiate the much discussed chaos theory.

Research-overview article: membrane lipolysis and cholinergic priority

Cholinergic drugs and antigenic and toxicological challenges induced lipolysis in twelve sheep. A lipolytic end product, the PGF2alpha metabolite, was found to be a reliable non-specific cholinergic marker. The lipolytic membrane alterations supported the concept of a general priority of the cholinergic system. A main feature is the breaking of molecular stability in dynamic hydrogen-bond interactions. Both acetylcholine and dioxygen reactivity are apparently moderated by cholinesterases. Free radicals appeared to be normal intermediates of catabolism, serving to neutralize excess protons. Antioxidants regenerate molecular oxygen, and so counteract part of excess activated oxygen. Intrinsic reactivity against its own structures characterizes the immuno-cholinergic system. Genetic priority could be assumed for cholinergic constituents and constitutions. A broad spectrum of etiologies was suggested. Lasting or repeated challenges may cause heterochiral conversions of vital proteins. The priority aspect of cholinergism also suggested methods to rank among the multitude of secondary biomolecules.

Physical bioenergetics of degradation-resistant proteins in diseases and aging

The characteristics of degradation-resistant proteins (prions) suggested a primary physical and then bioenergetic conversion by a fundamental chiral change in one or a few amino acids. The insolubility of heterochiral proteins (chirons) results in protein dysfunction. These inert proteins are logically neither contagious or transmissible, nor of genetic nature. Conformational species of chirons will arise by varied position and kind of converted amino acid(s). Cellular damage will depend on intensity and duration of activity in the cholinergic and immune systems, which are characterized by very high localization specificity and genetic variability. The long-term pathological changes will be general shrinking, sclerotizing and wasting as in AIDS and aging. The impaired immune function and the continuous gene activation may result in proliferation and tumorigenesis. Comparison between infections revealed possible routes of transmission and pathophysiology in spongifom encephalopathies in man and animals. Also, a plausible epidemiology was suggested for these diseases in ruminants (BSE and scrapie) in the UK. Preventive and therapeutic measures are briefly discussed. The headlines of the present concept were naturally related to basic conditions of life given by quantum physics, intrinsic membrane entropy and the dimension of time.

Temporomandibular arthropathy: correlation between clinical signs and symptoms and arthroscopic findings

The clinical signs and symptoms of temporomandibular arthropathy were correlated with arthroscopic features of temporomandibular joint disease in 200 consecutive patients. The diagnostic accuracy of the selected clinical signs and symptoms was also tested with arthroscopy as the standard, and sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) were calculated. Pronounced osteoarthrosis was more frequently associated with joint crepitus (P < 0.001). Adhesions were more frequently associated with reduced maximum protrusion (P < 0.001). Crepitation was the only clinical sign that showed acceptable values for SE, SP, PPV, and NPV, and only in diagnosing advanced osteoarthrosis. The values for mild osteoarthrosis were low.

Determination of hyaluronan and galactosaminoglycan disaccharides by high-performance capillary electrophoresis at the attomole level. Applications to analyses of tissue and cell culture proteoglycans

A rapid, highly sensitive and reproducible HPCE method is described for the determination of all non- and variously sulphated disaccharides present in hyaluronan and vertebrate chondroitin sulphates and dermatan sulphates. Following chondroitinase digestion of glycosaminoglycans or proteoglycans, the non-, di- and tri-sulphated delta-disaccharides are completely separated and readily determined within 14 min on a fused-silica capillary in 15 mM sodium dihydrogen orthophosphate, pH 3.00, using reversed polarity at 20 kV and detection at 232 nm. The determination of the various delta-disaccharides derived from either glucuronic or iduronic acid and the presence of glucuronic and iduronic clustered structures in dermatan sulphate can also easily be made, using digests with chondroitinase AC or B. A linear detector response was obtained for the entire interval tested (up to 10 mg/l of delta-disaccharides). Concentrations as small as 32, 65, 100 and 250 pmol/l (22, 38, 50 and 98 ng/l) of tri-, di- and nonsulphated delta-disaccharides, respectively, can be reliably detected.

Efficacy of arthroscopic lysis and lavage in patients with chronic locking of the temporomandibular joint

This prospective 1-year follow-up investigated the efficacy of temporomandibular joint lysis and lavage in relation to arthroscopic diagnoses. The study comprised 42 patients. Clinical evaluation was performed before surgery and at regular intervals up to 1 year postoperatively. Diagnostic arthroscopy and immediately subsequent lysis and lavage were performed under local anesthesia in all patients. Only unilateral upper compartment arthroscopies were executed. The results were evaluated according to the 1984 criteria of the American Association of Oral and Maxillofacial Surgeons. Osteoarthrosis was diagnosed arthroscopically in 30 joints (71%), 21 of which (70%) had more pronounced changes. Synovitis, mainly of a mild, localized type, was diagnosed in 39 joints (93%). More pronounced synovitis was found arthroscopically in 12 (31%). Adhesions were found in 20 joints (48%) and were significantly correlated with joints displaying osteoarthrosis (P < 0.001). The overall success rate for arthroscopic lysis and lavage was 50% (21/42 joints). The best response to lysis and lavage was in joints with arthroscopic diagnosis of pronounced synovitis (8/12 joints; 67%). All 21 joints regarded as unsuccessful were operated with diskectomy without implants. The success rate at 1-year follow-up was 18 joints (86%).

Temporomandibular joint osteoarthrosis. Correlation of clinical and arthroscopic findings with degree of molar support

The prevalence of temporomandibular joint (TMJ) osteoarthrosis and synovitis was compared in 60 patients with painful chronic locking of the TMJ. Thirty patients had reduced molar occlusion, and as controls, 30 age-matched fully dentate patients were examined. Assessment comprised clinical examination (crepitation), tomography (sclerosis and erosions), and arthroscopy (cartilage involvement) of the TMJ. Arthroscopic signs of osteoarthrosis and synovitis were frequent in both groups. The highest frequency of osteoarthrosis was diagnosed by arthroscopy. With regard to clinical signs and symptoms, tomographic signs of osteoarthrosis, and arthroscopic diagnoses, no statistical differences were found between fully dentate subjects and those with reduced molar occlusion. The results do not support the concept that prevention of TMJ osteoarthrosis is an indication for prosthetic replacement of lost molars.

Metabolic turnover of sulfated glycosaminoglycans and proteoglycans in rabbit temporomandibular joint cartilages with experimentally induced osteoarthrosis

Osteoarthrosis-like changes were induced by means of experimental disk perforation in the right temporomandibular joint of rabbits. The turnover of proteoglycans and glycosaminoglycans was studied 16 weeks later, using 35SO4. Tissues were sampled 1 day and 7 days after injection of the sulfate. The corresponding tissues from the left untreated joint were used as controls. After isolation of the glycosaminoglycans the incorporation of 35SO4 was estimated by scintillating counting. The extracted proteoglycans were analyzed, using gel electrophoresis, and the distribution of radioactivity was determined by autoradiography, followed by densitometry. Both the synthesis and rate of degradation of the proteoglycans were increased in the experimental disk, compared with those of the control. The net result of these metabolic changes seemed to be losses of small proteoglycans, whereas a slow increase in the number of larger ones may have occurred. The turnover rates of 4- and 6-sulfate increased, although their ratio remained unchanged at this stage of the osteoarthrosis-like process. In the condylar cartilage the turnover of large and small proteoglycans was also increased. The increase was most marked among those containing 6-sulfated galactosaminoglycans. The results concerning the experimental condylar cartilage indicated a decrease in the largest proteoglycan population, whereas the proportion of small proteoglycans was increased.

Diskectomy in treatment of internal derangement of the temporomandibular joint. Follow-up at 1, 3, and 5 years

The efficacy of temporomandibular joint diskectomy without implants was evaluated clinically in patients with internal derangements. Seventy-two patients were examined preoperatively and 1 year postoperatively; 40 were also examined 3 years postoperatively and 15 at 5 years after surgery. Success rates were calculated according to a modification of the criteria established in 1984 by the American Association of Oral and Maxillofacial Surgery. The success rate was 83% at the 1-year follow-up. Temporomandibular joint pain was alleviated and chewing capacity was normalized in 60 patients. The outcome in 12 patients was classified as unsuccessful, mainly on the basis of residual muscle and joint pain. At the 3-year follow-up only two patients were classified as unsuccessful and none at the 5-year follow-up. Unsuccessful patients had higher frequencies of muscle soreness and osteoarthrosis than successful patients. Postoperative complications were infrequent and minor.

Human and experimental osteoarthrosis of the temporomandibular joint. Morphological and biochemical studies

Osteoarthrosis is a common disease of the temporomandibular joint. The frequency and sites of location were studied in autopsies and they were classified according to age, sex and state of dentition. There was no differences related to sex, but the osteoarthrotic lesions were more severe and frequent in joints of specimens from subjects of high age without teeth of their own. The single most affected joint component was the disk which may be due to a limited regenerative ability of this joint component. The glycosaminoglycans of the extracellular matrix of human, osteoarthrotic disks were examined by high-performance liquid chromatography and compared to normal controls. The total glycosaminoglycan content of the arthrotic disks was lower whereas the proportions of iduronic acid and 4-sulfated galactosaminoglycans were higher. The development of osteoarthrosis-like lesions in the temporomandibular joint of rabbits was studied. Sixteen weeks after the surgical disk perforation, osteoarthrosis-like lesions in both the condylar cartilage and the remaining disk tissue were seen with light microscopy. These lesions were also accompanied by changes in the components of the extracellular matrix. Unlike human arthrotic disks, these tissues showed an elevated content of glycosaminoglycans, evidenced by also an increase in proteoglycans. This increase was mostly confined to large proteoglycans in the disk, while a larger proportion of small proteoglycans than in the respective control tissue was found in the adjacent condylar cartilage. Virtually no aggregability was found in normal or degenerated disk tissue. About 50% of the monomers in the normal condylar cartilage were capable of forming aggregates, while this aggregating proportion decreased slightly in the degenerated tissue. The metabolic mechanism underlying these changes in the proteoglycan content was studied using 35SO4 labeling. In the experimental disk tissue, the population of large proteoglycans had a slightly increased rate of synthesis and a slightly slower degradation rate than in the normal disks whereas the small proteoglycans had higher anabolic and catabolic rates than the controls. However, the amount of newly-synthesized small proteoglycans were unable to compensate for the simultaneous degradation. As a result the proportion of large proteoglycans increased. In the experimental condylar cartilage, all proteoglycans showed similarly increased rates of synthesis. However, here the degradation rate of the two large proteoglycan fractions greatly exceeded that of the synthesis. This resulted in a lowered proportion of these monomers in the experimental tissue, as compared to the control.(ABSTRACT TRUNCATED AT 400 WORDS)

An experimental model of osteoarthrosis in the temporomandibular joint of the rabbit

Degenerative changes in the temporomandibular joint were induced in 24 rabbits by surgical perforation of the disk. The incongruence obtained between the joint surfaces caused a gradual increase in macroscopic and microscopic changes, including gross remodeling, loss of tissue volume, and altered cell morphology within a 16-week observation period. These changes occurred concurrently with major alterations in the composition of the matrix, as demonstrated by increase in the glycosaminoglycan content of both condylar cartilage and disk and by loss of hydroxyproline in the disk. The lesions in the disk tissue were clearly discernible, whereas those in the condylar cartilage were less extensive. The described method is concluded to give alterations in the temporomandibular tissues, as seen in degenerative joint disease of an early stage.

Glycosaminoglycans in normal and osteoarthrotic human temporomandibular joint disks

Glycosaminoglycans in normal and osteoarthrotic temporomandibular joint disks were studied by means of high-performance liquid chromatography methods. Normal disk tissue contains galactosaminoglycans (chondroitin sulfate and dermatan sulfate) as the main polysaccharides and with smaller amounts of hyaluronate and heparan sulfate. The galactosaminoglycans are mainly sulfated in 6-position, and some of the disaccharides contain iduronic acid. There was a slight general variation in glycosaminoglycan concentration with increasing age. In the severely arthrotic disks the content of glycosaminoglycans was considerably lower than in normal disk tissue. This decrease was far more extensive than that observed in relation to age in normal tissue. The 4/6-sulfate ratio of the galactosaminoglycans was increased, whereas the proportion of iduronic acid was markedly decreased.

Origin and significance of acetylcholine and choline in plasma and serum from normal and paretic cows

Before the onset of bovine paresis a stage of hyperactivity and hypersensitivity was observed in clinical as well as in immunologically provoked cases. By gas chromatographic analysis of choline (Ch) in plasma and serum from four immunologically provoked cows this stage was verified to be an initial immuno-cholinergic hyperactivation. In the first hour after antigen challenge with 0.5 mg nematode AChE there was a very sharp rise in Ch mainly from agonist-stimulated and phospholipase mediated phosphatidylcholine (PC) breakdown. A secondary massive influx of Ca into cells was mirrored in a 1 mmol/l depression of serum-Ca values during the first hours. The hyperagonism mediated Ca-translocation brought water into cells, resulting in reduced plasma volume. The generally supposed mechanism of secondary, Ca-mediated cell damage and cell death was initiated and sometimes resulted in "Downers" with persisting paralysis. All acetylcholine (ACh)-stimulated parts from CNS to the periphery are irregularly involved explaining the very varied clinical appearance of bovine paresis, and the influence on for instance the autonomous nerve system, adrenals and pancreas. In the experimental group, ACh in plasma showed a sharp fall within the first hour, while there were fairly constant values of serum-ACh in the first four hours, possibly indicating some antibody protection. When paresis was established between 15-28 hours after challenge the general anergetic state was characterised by low ACh-levels. Also in a larger field group ACh-levels were significantly depressed in paretic compared to healthy cows. The unexpected finding in this group was considerably higher levels of ACh and especially Ch in serum compared to plasma. The origin of ACh and Ch had to be blood cells. Preliminary gas chromatographic analysis has confirmed ACh-synthesis by leucocytes and an integrated immuno-cholinergic system of great importance can be anticipated. The general feature of bovine paresis is updated by immune-etiological, pathophysiological, blood chemical, clinical-experimental and nomenclature considerations. The exact mechanism of pathogenesis is not revealed in this investigation, though many circumstances favour an anti-Id mediated hyperagonism. Other types of investigations and above all more basic knowledge of distribution and functional character of cholinergic components on immune cells are required.

Effect of reserpine on the brain uptake of carbon 11 methamphetamine and its N-propagyl derivative, deprenyl

The enantiomers of methamphetamine (MAMP) and its N-propagyl derivative, deprenyl, were labelled with carbon 11, and the tissue distribution of these labelled compounds in mice was studied. Both enantiomers of 11C-MAMP rapidly entered into the brain and then disappeared according to a single exponential curve. The enantiomers of 11C-deprenyl were also rapidly distributed to various organs in the same manner. With regard to elimination, however, a stereoselective, long-term retention of radioactivity in the brain, heart and lung, due to its irreversible binding with monoamine oxidase B, was observed for L-11C-deprenyl. In reserpinized mice, the initial brain uptake of both the L and D forms of 11C-MAMP was significantly decreased. On the other hand, the brain uptake of both enantiomers of 11C-deprenyl was slightly increased by pretreatment with reserpine. A significant and non-stereoselective elevation of the lung uptake of 11C-deprenyl was also seen in reserpinized mice. In addition, both the relative tissue distribution and ratios of radioactivity in the brain compared with blood or heart at 1 and 5 min after the injection of 11C-labelled methanol in mice were not changed by reserpine. These results indicate that the transport or binding processes of these amines rather than the blood flow might be altered by reserpine. There would be an important role of the pKa values of amines in both processes. The reduction of brain uptake as well as the change in ratio between brain and heart of L-11C-MAMP in reserpinized mice 1 min after injection were reversed by treatment with amphetamine in a dose-related manner.(ABSTRACT TRUNCATED AT 250 WORDS)

Regulation of bone sialoprotein mRNA by steroid hormones

In this report we demonstrate an increase in the steady-state level of bone sialoprotein (BSP) mRNA in rat calvaria and a rat osteosarcoma cell line (ROS 17/2.8) after treatment with the synthetic glucocorticoid, dexamethasone. In contrast, 1.25-dihydroxyvitamin D3 reduced the amount of BSP mRNA in calvaria and inhibited the dexamethasone induction in ROS 17/2.8 cells. The increase in BSP mRNA is most likely due to an increase in the transcriptional rate. The stability of mRNA was unchanged after dexamethasone treatment with a half-life of approximately 5 h. Nuclear transcription experiments with nuclei isolated from ROS 17/2.8 cells showed an increased BSP mRNA synthesis in cells treated with dexamethasone.

The temporomandibular joint: a comparison of clinical and arthroscopic findings

Clinical signs and symptoms of temporomandibular joint arthropathy were evaluated by comparison of clinical findings with arthroscopic findings in 62 temporomandibular joints of 55 patients. The arthroscopic frequency of osteoarthritis was high and was often combined with a mild localized synovitis.