Suppression of in vitro IgM rheumatoid factor production by diphtheria toxin interleukin 2 recombinant fusion protein (DAB 486IL-2) in patients with refractory rheumatoid arthritis

OBJECTIVE: To investigate the effect of diphtheria toxin interleukin 2 recombinant fusion protein (DAB 486IL-2) on in vitro synthesis of immunoglobulin and rheumatoid factor (RF) in patients with severe refractory rheumatoid arthritis (RA) enrolled in a phase II, double blind, placebo controlled study. METHODS: Anticoagulated venous blood samples were obtained before (Day 1) and after (Day 28) intravenous infusion of either DAB 486IL-2 at 0.075 mg/kg/day (12 patients) or saline placebo (10 patients) on Days 1-5. Peripheral blood leukocytes (PBL) were prepared by density gradient centrifugation, cultured in the presence and absence of pokeweed mitogen (PWM) for one week, and culture supernatants assayed for immunoglobulins and IgM RF by ELISA. RESULTS: Compared to placebo treated patients, PWM induced IgM RF synthesis by PBL decreased after treatment with DAB 486IL-2 (p = 0.043). However, there was no apparent correlation with clinical improvement. PWM induced IgM, IgA, and IgG synthesis also tended to decrease, although the changes did not attain statistical significance. In contrast, PWM induced IgM RF, IgM, IgA, and IgG synthesis by PBL from patients treated with placebo tended to increase during the observation period. Spontaneous immunoglobulin and IgM RF production by PBL from either the DAB 486IL-2 or placebo patients remained stable. CONCLUSION: These observations raise the possibility that DAB 486IL-2 may diminish B cell function either directly or indirectly through effects on T cell function, but the change may not correspond to clinical response.     

In vitro displacement of phenytoin from protein binding by nonsteroidal antiinflammatory drugs tolmetin, ibuprofen, and naproxen in normal and uremic sera

Displacement of phenytoin (90% bound to albumin) by other highly albumin-bound drugs like salicylate has been well documented. Other widely used nonsteroidal antiinflammatory drugs like tolmetin, ibuprofen, and naproxen are also strongly bound to albumin and can potentially displace phenytoin. However, phenytoin-ibuprofen interaction has been poorly studied in the past, and interaction of phenytoin with tolmetin or naproxen has not been studied before. For normal serum pool (albumin 3.7 g/dl), we observed significant increases in free phenytoin concentrations only with antiinflammatory drug concentrations at the upper end of therapeutic or above therapeutic concentrations. However, for the uremic pool (albumin 2.9 g/dl), displacement of phenytoin was significant even at the lower end of therapeutic concentrations of those antiinflammatory drugs. Of the three antiinflammatory drugs we studied, ibuprofen caused the highest displacement of phenytoin.     

Control of locomotion in the marine mollusc Clione limacina. XI. Effects of serotonin

The locomotor activity in the marine mollusc Clione limacina has been found to be strongly excited by serotonergic mechanisms. In the present study putative serotonergic cerebropedal neurons were recorded simultaneously with pedal locomotor motoneurons and interneurons. Stimulation of serotonergic neurons produced acceleration of the locomotor rhythm and strengthening of motoneuron discharges. These effects were accompanied by depolarization of motoneurons, while depolarization of the generator interneurons was considerably lower (if it occurred at all). Effects of serotonin application on isolated locomotor and non-locomotor pedal neurons were studied. Serotonin (5 x 10(-7) to 1 x 10(-6) M) affected most pedal neurons. All locomotor neurons were excited by serotonin. This suggests that serotonergic command neurons exert direct influence on locomotor neurons. Effects of serotonin on nonlocomotor neurons were diverse, most neurons being inhibited by serotonin. Some effects of serotonin on locomotor neurons could not be reproduced by neuron depolarization. This suggests that, along with depolarization, serotonin modulates voltage-sensitive membrane properties of the neurons. As a result, serotonin promotes the endogenous rhythmical activity in neurons of the C. limacina locomotor central pattern generator.     

Effects of prenatal androgenization and postnatal steroid treatment on growth hormone, insulin-like growth factor I and II, insulin, thyroxine, and triidothyronine concentrations in beef heifers

A 2 x 3 factorial arrangement of treatments was used to elucidate the mechanism(s) by which prenatal androgenization improves postnatal rate and efficiency of growth and composition of gain in beef heifers. Fifteen control (C) and 15 prenatally androgenized (PA) Angus x Simmental heifers (prenatal treatment, Pretrt) received no (N), estrogen (E), or estrogen and testosterone (ET) implants postnatally (postnatal treatment, Posttrt) to evaluate whether the postpubertal growth response after prenatal androgenization could be induced in prepubertal heifers. Blood was collected from the heifers at 6 +/- 1, 9 +/- 1, and 12 +/- 1 mo of age and analyzed from serum concentrations of growth hormone (GH), IGF-I, IGF-II, insulin, thyroxine (T4), and triiodothyronine (T3). Season of the year had a greater effect on hormone concentrations than either Pretrt or Posttrt, and there were no Pretrt x Posttrt interactions. Prenatal treatment, PA, had no effect on GH; however, Posttrt E and ET increased (P < .001) GH concentrations. Prenatal treatment, PA, increased (P < .05) IGF-I concentrations, and there was a nonsignificant increase (P = .11) in IGF-I concentrations with Posttrt E and ET. Concentrations of IGF-II were unaffected by Pretrt PA; however, they were lower (P < .01) in the Posttrt E and ET groups. Insulin, T4, T3, BW, and ADG were not affected by Pretrt and Posttrt. Concentrations of GH and IGF-I were increased in heifers that received Pretrt PA and(or) Posttrt E and ET in a manner to support improved growth performance; however, BW and ADG were similar. In prepubertal beef heifers, factors in addition to increased GH and IGF-I seem to be necessary for improved growth performance.     

Bacillary angiomatosis and bacillary peliosis in patients infected with human immunodeficiency virus: clinical characteristics in a case-control study

Clinical characteristics associated with bacillary angiomatosis and bacillary peliosis (BAP) in patients with human immunodeficiency virus (HIV) infection were evaluated in a case-control study; 42 case-patients and 84 controls were matched by clinical care institution. Case-patients presented with fever (temperature, > 37.8 degrees C; 93%), a median CD4 lymphocyte count of 21/mm3, cutaneous or subcutaneous vascular lesions (55%), lymphadenopathy (21%), and/or abdominal symptoms (24%). Many case-patients experienced long delays between medical evaluation and diagnosis of BAP (median, 4 weeks; range, 1 day to 24 months). Case-patients were more likely than controls to have fever, lymphadenopathy, hepatomegaly, splenomegaly, a low CD4 lymphocyte count, anemia, or an elevated serum level of alkaline phosphatase (AP) (P < .001). In multivariate analysis, a CD4 lymphocyte count of < 200/mm3 (matched odds ratio [OR], 9.9; P < .09), anemia reflected by a hematocrit value of < 0.36 (OR, 19.7; P < .04), and an elevated AP level of > or = 2.6 mukat/L (OR, 23.9; P < .05) remained associated with disease after therapy with zidovudine was controlled for. BAP should be considered an AIDS-defining opportunistic infection and should be included in the differential diagnosis for febrile, HIV-infected patients with cutaneous or osteolytic lesions, lymphadenopathy, abdominal symptoms, anemia, or an elevated serum level of AP.     

The effect of sequential administration of octreotide alone and octreotide/growth hormone simultaneously on buserelin stimulated ovarian steroid secretion in women with polycystic ovary syndrome

The site of S1-S2 root activation following percutaneous high-voltage electrical (ES) and magnetic stimulation were located by analyzing the variations of the time interval from M to H soleus responses elicited by moving the stimulus point from lumbar to low thoracic levels. ES was effective in activating S1-S2 roots at their origin. However supramaximal motor root stimulation required a dorsoventral montage, the anode being a large, circular surface electrode placed ventrally, midline between the apex of the xiphoid process and the umbilicus. Responses to magnetic stimuli always resulted from the activation of a fraction of the fiber pool, sometimes limited to the low-thresholds afferent component, near its exit from the intervertebral foramina, or even more distally. Normal values for conduction velocity in motor and 1a afferent fibers in the proximal nerve tract are provided.     

Biosynthesis of the unsaturated 14-carbon fatty acids found on the N termini of photoreceptor-specific proteins

In the vertebrate retina, a number of proteins involved in signal transduction are known to be N-terminal acylated with the unusual 14 carbon fatty acids 14:1n-9 and 14:2n-6. We have explored possible pathways for producing these fatty acids in the frog retina by incubation in vitro with candidate precursor fatty acids bearing radiolabels, including [3H]14:0, [3H]18:1n-9, [3H]18:2n-6, and [3H]18:3n-3. Rod outer segments were prepared from the radiolabeled retinas for analysis of protein-linked fatty acids, and total lipids were extracted from the remaining retinal pellet. Following saponification of extracted lipids, fatty acid phenacyl esters were prepared and analyzed by high pressure liquid chromatography (HPLC) with detection by continuous scintillation counting. Transducin, whose alpha-subunit (Gt alpha) is known to bear N-terminal acyl chains, was extracted from the rod outer segments and subjected to SDS-polyacrylamide gel electrophoresis and fluorography to detect radiolabeled proteins. Gt alpha was also subjected to methanolysis, and the resulting fatty acyl methyl esters were analyzed by HPLC. The identities of HPLC peaks coinciding with unsaturated species of both phenacyl esters and methyl esters were confirmed by reanalyzing them after catalytic hydrogenation. The results showed that 14:1n-9 can be derived in the retina from 18:1n-9 and 14:2n-6 from 18:2n-6, most likely by two rounds of beta-oxidation, but that neither is produced in detectable amounts from 14:0. Retroconversion of unsaturated 18 carbon fatty acids to the corresponding 14 carbon species showed specificity, in that 18:3n-3 was not converted to 14 carbon fatty acids in detectable amounts. Myristic acid (14:0), 14:1n-9, and 14:2n-6 were all incorporated into Gt alpha. A much less efficient incorporation of 18:1n-9 into Gt alpha was also observed, but no radiolabeling of Gt alpha was observed in retinas incubated with 18:3n-3. Thus, retroconversion by limited beta-oxidation of longer chain unsaturated fatty acids appears to be the most likely metabolic source of the unusual fatty acids found on the N termini of signal transducing proteins in the retina.     

Biomechanical comparison of the dewar and interspinous cervical spine fixation techniques

STUDY DESIGN: This study evaluates and compares the stiffness of two cervical spine fixation techniques. OBJECTIVES: This biomechanical study was carried out to compare the interspinous and Dewar cervical spine fixation techniques. SUMMARY OF BACKGROUND DATA: Interspinous wiring is a commonly used method of fixation in the cervical spine. The Dewar technique is less commonly known and practiced, and clinical experience has suggested that it may be a more stable technique. METHODS: Cervical spine specimens stabilized with the interspinous and "Dewar" techniques were biomechanically tested in flexion and in torsion. Stiffness and energy absorption under moderate loads were compared. The Dewar technique uses contoured double corticocancellous iliac grafts as internal grafts/splints fixed to the spine with threaded pins and wire. The interspinous technique is a single interspinous wire loop. Eleven fresh human cervical spines were harvested from cadavers. The spines were destabilized at C4-C5 by sectioning all tissue except the anterior longitudinal ligament. Each fixation technique was applied alternatively and tested on each spine. RESULTS: In torsion testing (n = 5), the Dewar fusion was 61% stiffer than the interspinous technique (P < 0.02). Dewar: 11.3 N/mm (s.d. 4.9 N/mm) and interspinous: 8.4 N/mm (SD 3.3 N/mm). In flexion testing (n = 6), the Dewar technique was 35% stiffer than the interspinous technique (P < 0.10). Dewar: 655.4 Nmm/degree (SD 293 Nmm/degree) and interspinous: 406.8 Nmm/degree (SD 113.0 Nmm/degree). Energy absorption with the interspinous technique was greater in flexion (P < 0.10) and in torsion (P < 0.005), indicating more deformation with the interspinous technique. There was no statistically significant difference between the means of specimens tested first and those tested second independently of the fixation technique. CONCLUSIONS: These tests indicate that the Dewar cervical spine fixation is stiffer than the single interspinous wire in both flexion and particularly torsion. This project is the only biomechanical study of the Dewar technique that we are aware of, and the results support the clinical findings regarding the effectiveness of this technique.     

The psychophysiological specificity problem in panic attacks

Traumatic intrusion of permanent teeth is a relatively infrequent but serious type of dental injury, due to the complicated picture it involves. Various treatment approaches have been suggested, so far, regarding management of intrusive luxation. Techniques aiming to reposition the intruded tooth include observation for spontaneous reeruption, surgical as well as orthodontic repositioning. However, development of complications such as pulp necrosis, inflammatory root resorption, replacement resorption and ankylosis and loss of marginal bone support makes selection of the most favorable technique controversial. In this paper, a critical review of the existing treatment modalities is attempted and treatment approaches based on diagnostic parameters that are indicative of the severity of an intrusive injury are presented. Recommendations are made after taking into consideration experimental and clinical study findings and observations from other author's and our own clinical experience. Two cases of intrusive luxation in children are presented and management of the dental injuries as well as the complications which occurred are being discussed.     

Neuropsychological effects of exposure to naphtha among automotive workers

The association between exposure to naphtha and neurobehavioural measures was examined prospectively over one year among workers employed at an automotive plant that used naphtha to calibrate fuel injectors. The neurobehavioural tests included those that assess mood, basic intelligence, and functioning of the cerebral frontal lobes and limbic system and were designed so that acute, reversible, and chronic effects of solvent exposure could be assessed. Participants were 248 workers in June 1988, and the testing was repeated on 185 of these workers in 1989. Concentrations of naphtha at the plant ranged from six to 709 mg/m3, although exposure was greater in 1988 than in 1989. Duration of exposure for individual subjects ranged from 0.8 to 7.3 years. Cross sectional data analyses showed significant associations between level of exposure to naphtha and slower timed scores on trails A, and greater reports of negative affective symptoms on profile of mood states scales in 1988 but not 1989. Threshold model analyses of the 1989 data showed an association between score on visual reproductions immediate recall and daily exposure to naphtha at or above 1050 h x mg/m3. Models of chronic exposure showed no associations between chronic exposure and negative neurobehavioural outcome. Results suggest that naphtha produces mild acute reversible effects on function of the central nervous system at or above daily exposures of 540 h x mg/m3 (approximately 90 ppm/h).