Immunology and disease control: a systems approach

The application of system theory (or more precisely, differential equations) to immunology and disease, in general, is presented here. Particular results from U.S.-Russian research collaboration depict the potential role of such systematic analysis for more effective health care and disease control. In particular, some emphasis is given to control of influenza. After a brief systematic overview of immunology, a simple infectious disease model is developed to explain four basic forms of disease: subclinical, acute, lethal and chronic. Then, disease treatment is studied.     

Relationship of immune response to heat-shock protein A and characteristics of Helicobacter pylori-infected patients

This study assessed the minimum dose of clonidine required to prolong the duration of both anesthesia and analgesia after axillary brachial plexus blockade. Eighty patients scheduled for elective hand surgery were divided into eight groups in a randomized, double-blind fashion. An axillary brachial plexus block was performed with 40 mL 1% mepivacaine plus 1:200,000 epinephrine. The control group received no clonidine. In the other groups, increasing doses of clonidine (0.1, 0.2, 0.3, 0.4, 0.5, 1, and 1.5 micrograms/kg) were added to the local anesthetic solution. Onset time, duration of anesthesia and analgesia, postoperative pain score, intake of analgesics, and adverse effects were recorded. The eight groups were comparable in terms of onset time, postoperative pain score, and analgesic requirement. The minimum dose of clonidine required to significantly prolong the duration of analgesia and anesthesia was, respectively, 0.1 and 0.5 microgram/kg. No side effects (sedation, drowsiness, bradycardia, arterial hypotension) were reported. We conclude that the dose of clonidine required to prolong significantly the duration of both anesthesia and analgesia after axillary brachial plexus blockade is 0.5 microgram/kg and that, at this dose, clonidine may be used without important reported side effects even in outpatients.     

Development, behaviour and temperament: a prospective study of infants conceived through in-vitro fertilization

The development, behaviour and temperament of 65 singleton infants conceived through in-vitro fertilization (IVF) and 63 matched controls were compared at 1 year postpartum. Primiparous women were recruited during pregnancy and their infants' development was assessed at 1 year. In addition, test-taking behaviour was evaluated by an examiner using the Bayley behaviour rating scale and mothers completed a behaviour problem checklist and temperament scale. Mental, motor, speech and social development were appropriate for age, with no significant group differences. While receptive language development was in the normal range, IVF infants scored lower than control infants. Across both groups, mothers reported low levels of behaviour difficulty and mean temperament ratings were in the general population range. There were no group differences in observed test-taking behaviour. However, IVF mothers rated their children at a higher level of behaviour difficulty and more reactive than the ratings given by control mothers. Overall, singleton children conceived through IVF demonstrate appropriate general development at 1 year of age. The higher reported behaviour difficulty experienced by IVF mothers may reflect their concerns about the well-being and adjustment of their child during the first year.     

Hematological investigations in conditions of long-term space flights

In the nearly 15-month mission aboard MIR the cosmonaut-physician and members of three crews (MIR-15, -16, and -17) carried out a program of hematological investigations. Most of the changes related to the red blood system and included reduction in hemoglobin and hematocrit. Erythrocytes had decreased concentration and took on abnormal forms. There were also signs of altered metabolism of erythrocytes. Of interest are phase-by-phase variations in the levels of erythrocytes in the course of long-term stay in microgravity, and absence of a convincing correlation between hemoglobin, erythrocyte and hematocrit levels. But for lymphocytosis that returned to the norm already on the first day of recovery, no material changes occurred to the leukocyte profile. Investigations at the landing site displayed erythropenia, decreased reticulocytes and ensuing reticulocyte reaction, and gradual regain of the erythrocyte number that can be viewed as a normal physiological reaction of the blood system to the set of factors of spaceflight and early readaptation. Besides, the investigations showed a large individually of blood reactions to prolonged stay in space flight.     

The origin of lower extremity deep vein thrombi in acute venous thrombosis

A nested PCR-based test was developed for the detection of Listeria monocytogenes in blood specimens from patients with listeriosis. Two pairs of oligonucleotide primers were designed to amplify a 1395-bp and a 453-bp fragment of the iap gene of L. monocytogenes. Amplified products were analysed with gel electrophoresis and stained with ethidium bromide. The PCR method described could be routinely used to diagnose listeriosis.     

The tetravalent guanylhydrazone CNI-1493 blocks the toxic effects of interleukin-2 without diminishing antitumor efficacy

The use of interleukin 2 (IL-2) as an antineoplastic agent has been limited by the serious toxicities that accompany the doses necessary for a tumor response. Elevation of nitric oxide (NO) and tumor necrosis factor (TNF) both have been implicated in IL-2 toxicities. CNI-1493, a tetravalent guanylhydrazone, is an inhibitor of macrophage activation including the synthesis of TNF and other cytokines. Doses of CNI-1493 as low as 1 mg/kg/day conferred complete protection against fatal toxicity of IL-2 with IL-2 doses tenfold higher than the safely tolerated level in Sprague-Dawley rats. Moreover, typical pathologic changes in the lungs, kidneys, and the liver caused by IL-2 infusion were blocked by cotreatment with CNI-1493. When animals bearing established hepatomas were given IL-2 and CNI-1493 combination therapy, 10 of 10 hepatomas regressed from 1 cm3 to <1 mm3. Intracytoplasmic TNF levels were increased in normal tissues from IL-2 treated animals, and treatment with CNI-1493 maintained TNF at control levels. The degree of apoptosis measured by terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling staining of tumors following IL-2 therapy was not reduced compared with IL-2 cotreated with CNI-1493. In contrast, apoptosis in the liver and lung parenchyma following IL-2 therapy was blocked completely by cotreatment with CNI-1493. Taken together, these data showed that low and infrequent doses of CNI-1493 markedly protected animals from IL-2 systemic toxicities whereas not affecting tumor response to IL-2 therapy. With the protection afforded by CNI-1493 treatment, IL-2 therapy dose levels could be increased to provide significant antitumor effects in animals with established hepatomas.     

Results of an experiment on the transition to the family practice service

The California Dental Association has developed a program--Quality Improvement through Lifelong Learning or QUIL3--that enables a dentist to privately and confidentially determine whether he or she meets current clinical practice standards and has the requisite knowledge to practice dentistry competently. Using the concept of continuous quality improvement (CQI), this innovative program was two years in development and attempts to positively and proactively address issues associated with dental performance. QUIL3 is an initial step.