Evaluation of a mucoadhesive lipid-based bioerodable tablet compared with Biotène mouthwash for dry mouth relief--a pilot study

OBJECTIVE

Salivary gland impairment is a major problem that can result in hyposalivation and a decrease in quality of life. Causes for mouth dryness can be grossly classified into three major groups: iatrogenic, immunogenic, and metabolic. At present, insufficient therapies exist to ease morbidity in this growing number of affected individuals. A need for new products to relieve oral dryness is mandatory. The aim of this study was to evaluate a mucoadhesive lipid-based bioerodable tablet as a novel device to decrease signs and symptoms associated with mouth dryness.

METHOD AND MATERIALS

Twenty xerostomic patients were divided into two groups. In group 1, the mucoadhesive tablet was applied to the hard palate, while in group 2, Biotène mouthwash was applied and served as a control. Sialometry measurements, as well as a questionnaire assessing mouth dryness, were obtained before and after treatment.

RESULTS

Application of the mucoadhesive tablets resulted in a significant reduction in the sensation of the mouth dryness (P = .016) compared to Biotène. Moreover, a 1.5-fold increase in unstimulated whole saliva flow was obtained after 30 minutes in the treatment group.

CONCLUSION

A lipid-based mucoadhesive tablet has a beneficial role in reducing the sensation of dryness in patients with xerostomia.

[Experimental study of the wound-healing effect of new drug compositions intended for the therapy of esophageal burns]

The anti-inflammatory and wound-healing effects of new formulations for the treatment of esophageal burns have been studied in Chinchilla rabbits with model chemical burns of skin. The healing process was evaluated according to the clinical and morphological criteria on the 3rd, 7th, 10th, 14th, and 21st day. It is established that the new drugs accelerate the regeneration of skin tissue in comparison to that in the control and reference groups of animals. At the late stage of skin regeneration, this is manifested by reliable differences in the degrees of cicatrization and tissue collagenization. Two hydrophilic polymer-based drug compositions, which are successively applied in accordance with the burn process development, exhibit pronounced anti-inflammatory and skin-regenerative effects. These formulations can be recommended for the therapy of esophageal burns.

Extracorporeal Whole Blood Immunoadsorption of Autoimmune Myasthenia Gravis by Cellulose Tryptophan Adsorbent

Whole blood immunoadsorption (WBIA) system, using an adsorbent to remove pathogenic antibodies of myasthenia gravis (MG), was studied. Cellulose-tryptophan adsorbent was synthesized and its adsorption capacity of binding with acetylcholine receptor in the plasma of MG patient was evaluated. Experimental autoimmune myasthenia gravis (EAMG) rabbits were induced by Ta183-200 peptide. The rabbits underwent extracorporeal whole blood adsorption for 2 h. Results showed no significant damages on blood cells and no changes in the concentration of electrolytes. Total protein decreased by 12.0% (P < 0.05), and globulin protein decreased 23.9 +/- 5.6% (P < 0.05). The mean overall removal of antibodies against Ta183-200 was 41.12%. The percentage of decrement of compound muscle action potential in 3, 5, 10Hz of EAMG rabbits all dropped down after the treatment. In conclusion, the adsorbent is biocompatible, was safe for whole blood immunoadsorption, and can remove antibodies in an MG patient effectively. Whole blood immunoadsorption improved clinical manifestation and neuromuscular function of the EAMG rabbits.

[Efficacy of cellulose on functional constipation]

OBJECTIVE

To assess the clinical efficacy and safety of cellulose on functional constipation.

METHODS

A prospective, self-controlled, multicenter clinical trial of cellulose was conducted for 2 weeks in 240 patients with functional constipation according to the Rome III( criteria. Symptoms and characters of feces before and after the treatment were observed and evaluated according to a score scheme.

RESULTS

In the 240 patients, the frequencies of defecation increased and the characters of feces was improved significantly after 2-week treatment. There were no adverse reactions observed throughout the clinical trial. The total efficacy was 82.1% at day 7 and 90.7% at day 14. The satisfactory rate of doctors was 83.8% and of patients was 83.8%.

CONCLUSION

Cellulose is effective and safe in the treatment of chronic functional constipation.

[Effect of enterosorption on immunologic parameters of patients with colorectal cancer in the postoperative period]

Our investigation was carried out on an assumption that end results among patients radically-treated for colorectal cancer might be improved by use of enteroabsorption. The study group included 17, controls--13 patients with diagnostically verified stage I-III tumors. Mixed sorbent (microcellulose + polysorb) (6g) was administered, once a week, on the average of 20 days after operation. Immunological vigor was assayed 3 weeks after surgery: immunoglobulin levels--by turbodimetric method, cellular profile of lymphocytes--monoclonal antibodies to cell markers CD3, CD4, CD8, CD16 and CD22. As a result of adjuvant treatment CD22 (B-lymphocytes) concentration increased significantly--from 17.70 to 21.66 (22%), while CD16 (innate killers) both in absolute numbers (19%) and by percentage points (9%). Circulating immunocomplex levels in the sorbent-treatment group were significantly lower (37.44 ths units) than in control (48 ths units) (average 28%). No relapse or metastases were reported in either group.

[Antimicrobial activity determination of the preparations used in comprehensive treatment of patients with parodontitis]

Determination of antimicrobic activity of the preparations of Metrogyl denta, Cholisal and Solcoseryl on the complex culture of microorganisms employing the developed procedure was carried out. Degree of the antimicrobic action manifestation of each preparation was revealed.

Effect of a cellulose-containing weight-loss supplement on gastric emptying and sensory functions

CM3, a highly cross-linked cellulose in capsule form, expands in the stomach to a size several fold of its original volume. It is purported to induce a prolonged feeling of satiation and a delay in gastric emptying, thus promoting weight loss. We examined whether CM3 delays gastric emptying (using the stable isotope (13)C-octanoic breath test) and whether it influences subjective feelings of appetite sensations (using visual analog scales, VASs). We performed a double-blind randomized placebo-controlled crossover trial in 19 moderately obese but otherwise healthy subjects (mean age 55 +/- 9 years, BMI 31.1 +/- 4.6 kg/m(2)). The subjects were treated with six capsules of CM3 or matching placebo 30 min before a standardized solid meal. Breath collection and VASs were performed over 4 h every 15 min and 30 min, respectively. Half-excretion time of (13)CO(2) in breath, indicating gastric emptying half time, was the primary outcome parameter. The study was powered to detect a change in gastric emptying of 20-30 min. Mean (13)CO(2) half-excretion time changed from 2.3 +/- 0.4 to 2.4 +/- 0.33 h (mean difference +6 min, 95% confidence interval (CI) -3 to +15 min; P = 0.17). Appetite sensations (hunger, satiation, fullness, prospective food consumption, desire to eat something sweet, salty, savory, or fatty) changed over time during the course of the postprandial phase but were not influenced by CM3 (repeated measures ANOVA). In obese subjects, acute administration of the weight-loss supplement CM3 does not delay gastric emptying and does not influence subjective appetite sensations.

The use of a Cissus quadrangularis/Irvingia gabonensis combination in the management of weight loss: a double-blind placebo-controlled study

AIM

To evaluate the effects of two formulations, Cissus quadrangularis-only and a Cissus quadrangularis/Irvingia gabonensis combination, on weight loss in overweight and obese human subjects.

METHODS

The study was a 10 week randomized, double-blind, placebo-controlled design involving 72 obese or overweight participants (45.8% male; 54.2% female; ages 21-44; mean age = 29.3). The participants were randomly divided into three equal (n = 24) groups: placebo, Cissus quadrangularis-only, and Cissus quadrangularis/Irvingia gabonensis combination. Capsules containing the placebo or active formulations were administered twice daily before meals; no major dietary changes nor exercises were suggested during the study. A total of six anthropomorphic and serological measurements (body weight, body fat, waist size; total plasma cholesterol, LDL cholesterol, fasting blood glucose level) were taken at baseline and at 4, 8 and 10 weeks.

RESULTS

Compared to the placebo group, the two active groups showed a statistically significant difference on all six variables by week 10. The magnitude of the differences was noticeable by week 4 and continued to increase over the trial period.

CONCLUSION

Although the Cissus quadrangularis-only group showed significant reductions on all variables compared to the placebo group, the Cissus quadrangularis/Irvingia gabonensis combination resulted in even larger reductions. This apparently synergistic formulation should prove helpful in the management of obesity and its related complications.

Effects of cellulose supplementation on fecal consistency and fecal weight

We investigated the effects of cellulose supplementation on fecal consistency and fecal weight. About 26 women were classified into two groups-normal defecation and constipation groups. All subjects ate the following meals during the experiment: ordinary meals (first week), experimental meals (second week), and experimental meals mixed with 4 g (third week) and 8 g (fourth week) cellulose. The experimental meal contained 16.7 g fiber. Fecal weights, fecal water content, fecal consistency, and defecation frequency were measured during the experimental period. As a result, in the normal defecation group, the mean fecal weight was 222.9 g day(-1) in the first week, and thereafter decreased. Although 20/24 g of fiber intake in the third/fourth week increased the fecal weight to over 150 g, the fecal consistency was still lower than the optimal consistency of around 300 g cm(-2). However, these changes were not observed in the constipated group.

[Holisal in the complex treatment of periodontal disease]

The aim of our research was to evaluate efficiency of medicine Cholisal in complex treatment of periodontitis. During the research 36 patients with periodontitis (from 18 to 36 years old) were examined and treated. The patients were divided into 3 groups according to severity of periodontitis. Each group included 12 patients. For studying the efficiency of treatment both objective and subjective data was used. In case of mild severity of disease clinical indices were: HI=2,1+/-0,75; Ghi=1,4+/-0,67; Gi=1,7+/-0,78, PI=0,8+/-0,34. In case of moderate severity of disease clinical indices were: HI=2,57+/-1,02; GHI=2,18+/-0,81; GI=1,95+/-0,8, PI=3,9+/-1,1. In case of severe disease - HI=3,9+/-1,25, GHI=2,5+/-0,8, GI=2,9+/-1,2, PI=7,8+/-1,62. Clinical study has shown that Cholisal enables successful treatment of periodontitis. It has prolonged, antiinflamatory, deodorant and analgesic effect. Our investigation revealed that xolisale can be recommended in complex treatment of periodontal disease.

Injections d'acide polylactique: intérêt dans la correction des lipoatrophies faciales chez les patients VIH+ sous trithérapie

BACKGROUND

The aim of the study was to evaluate the mean-term efficacy and tolerance of the polylactic acid injections (New-Fill) for the correction of facial lipoatrophy occurring in HIV-positive patients under tri-therapy.

MATERIAL AND METHOD

The patients were managed at the University Hospitals of Besançon and Strasbourg (France) from January 2002 to December 2005 for a prospective study. The patients were consecutively included in this study once their consent was obtained. Patients not stabilized by their antiretroviral treatment were excluded. Facial lipoatrophy was classified in four clinical stages (stage I: mild, stage II: moderate, stage III: important, stage IV: severe) after a clinical examination. The polylactic acid solution was prepared according to the manufacturer's recommendations, and injected in a retrotracing manner in the hypoderm at the rate of one 5 ml flask per side, with an interval of one month. The number of sessions varied according to the severity of the stage. Treatment efficacy, assessed after a minimal follow-up of one year, was established clinically by comparing the initial and final photographs (changes in the clinical stage) and by the patient's and surgeon's satisfaction rate (from zero to ten). Treatment tolerance was established on the painfulness of injections and on socioprofessional constraints reported by the patients and made on a visual analogical scale. The occurrence of adverse-effects was checked. Finally, we compared the cost of the treatment with that of lipostructure.

RESULTS

Twenty-five patients were included (mean age: 44, sex-ratio: 23 male/2 female patients). The mean body mass index was 21. The mean CD4 cell count was 600/mm(3). The mean HIV-1 RNA was 276 copies/ml. The severity of the lipoatrophy was stage one in two patients (8%), stage two in 12 patients (48%), stage three in nine patients (36%), and stage four in two patients (8%). The mean number of sessions was 5.2. The mean follow-up time was 26 months. In 76% of the cases we observed a complete correction of lipoatrophy (100% of stages I, 92% of stages II, 66% of stages III, 0% of stages IV). However, among stages II, III, and IV that were incompletely corrected, an improvement was noticed in all patients (grading to an inferior stage, at least). The mean satisfaction rate was 8/10 by patients and 7.2/10 by surgeons. In six patients (24%) a renewal of the treatment was proposed because of inadequate results. The painfulness of injections was rated at 3.3/10 and constraints at 3/10 by patients. One single case of visible and palpable sub-cutaneous granuloma was noticed in a patient at the end of the follow-up period (18 months).

DISCUSSION

The use of polylactic acid is a safe and efficient procedure for the treatment of facial lipo-atrophy in HIV-infected patients, however severe the clinical stage may be, after a two-year follow-up period. We recommend hypodermic (and not dermic) injections to prevent adverse effects. This treatment is not more expensive then lipo-structure and the progressive correction is considered as an important advantage by patients. Considering our results, the simplicity of the procedure, and the low rate of complications observed, the injection of poly-lactic acid has become our first intention treatment for this condition.

Percutaneous Treatment of Lumbar Intervertebral Disk Hernias With Radiopaque Gelified Ethanol

STUDY DESIGN

Prospective clinical trial.

OBJECTIVE

Demonstrate the safety and efficacy of gelified ethanol in the percutaneous treatment of lumbar disk hernias.

SUMMARY OF BACKGROUND DATA

After the commercial withdrawal of Chymopapain, the need for new substances to treat intervertebral disk hernias was evident. Good results were obtained with pure ethanol, but this substance was difficult to handle. We decided to use a similar substance mixed with ethylcellulose to increase its viscosity and enhanced with radiopaque material.

METHODS

Two hundred seventy-six consecutive patients sent to be treated of a lumbar intervertebral disk hernia percutaneously were included in this preliminary study and treated with radiopaque gelified ethanol (RGE) and intra-articular steroids. Three groups were set, group A for patients to be treated only with RGE and groups B and C for difficult cases presenting a narrow canal, foraminal hernia, or hiperalgic sleepless hernia, treated with RGE plus another intradiscal technique, automatized percutaneous diskectomy for group B and radiofrequency nucleoplasty for group C.

RESULTS

Very good or good results were obtained in 202 (91.4%) of the 221 patients in group A. Of the 44 patients in group B, 37 patients (84%) presented very good or good results and in 9 (82%) of the 11 patients of group C, we obtained similar results. There was no allergic complication in any of our patients. Short-term follow-up with magnetic resonance showed little or no changes in the intervertebral disk but there was discordance with clinical signs. Long-term follow-up magnetic resonance showed a dramatic reduction in hernia volume.

CONCLUSIONS

This preliminary study shows the efficacy and inocuity of this new substance that could take over the Chymopapain therapeutic field.

South Africa's experience of the closure of the cellulose sulphate microbicide trial

The researchers who conducted the cellulose sulphate microbicide trial share the lessons they learned from the trial's early closure.

Quantitative imaging and sigmoidoscopy to assess distribution of rectal microbicide surrogates

Understanding the distribution of microbicide and human immunodeficiency virus (HIV) within the gastrointestinal tract is critical to development of rectal HIV microbicides. A hydroxyethylcellulose-based microbicide surrogate or viscosity-matched semen surrogate, labeled with gadolinium-DTPA (diethylene triamine pentaacetic acid) and 99mTechnetium-sulfur colloid, was administered to three subjects under varying experimental conditions to evaluate effects of enema, coital simulation, and microbicide or semen simulant over 5 h duration. Quantitative assessment used single photon emission computed tomography (SPECT)/computed tomography (CT) and magnetic resonance imaging (MRI) imaging, and sigmoidoscopic sampling. Over 4 h, radiolabel migrated cephalad in all studies by a median (interquartile range) of 50% (29-102%; P<0.001), as far as the splenic flexure (approximately 60 cm) in 12% of studies. There was a correlation in concentration profile between endoscopic sampling and SPECT assessments. HIV-sized particles migrate retrograde, 60 cm in some studies, 4 h after simulated ejaculation in our model. SPECT/CT, MRI, and endoscopy can be used quantitatively to facilitate rational development of microbicides for rectal use.

Terminated microbicide trial to be investigated

After the termination of a Phase III topical microbicide trial in January, an investigation will now be carried out to determine what went wrong.

Sculptra (Injectable Poly-L-Lactic Acid)

As contemporary antiviral therapy provides patients who have HIV effective long-term management of their disease, the prevalence of facial HIV-associated lipoatrophy is increasing. Sculptra (Dermik Laboratories, Berwyn, Pennsylvania) (injectable poly-L-lactic acid) is US Food and Drug Administration approved for the treatment of HIV-associated lipoatrophy and has been shown to increase skin thickness for up to 2 years. The number of treatment sessions depends on the volume of deficiency to be treated. As is true for any cosmetic treatment, expectations must be carefully managed, especially considering the frequent need for multiple Sculptra treatments. The few adverse events resulting from poly-L-lactic acid injections consist mainly of subcutaneous nodule formation and local bruising.

Evolution in Techniques: Lip Augmentation

Lip augmentation is an increasingly popular procedure. With increasing demand from patients comes an increasing challenge to surgeons to evolve techniques that are suited to the particular concerns, desires, and anatomy of each patient. In the past, options were limited to only a few filler substances and relatively few surgical options. Today new filler products continue to rapidly evolve and become available to surgeons and are often directly marketed to patients via various media formats. Tissue grafts and autologous fat grafting are also giving surgeons options for lip enhancement that were limited in the past. Options for permanent lip augmentation with newly advanced alloplastic implants are now available to help patients achieve a more natural look and feel. The challenge for surgeons of any level of experience is to weigh the advantages and disadvantages of each newly emerging technique and incorporate these into his or her armamentarium. I will outline the evolution of my lip augmentation techniques, emphasizing the use of Advanta for permanent lip augmentation, and the rationale behind this evolution.

Injectable Success: From Fillers to Botox®

The educated consumer seeks minimal downtime options to address the early signs of aging. These signs include a deepening of facial folds, an increase in muscle-induced wrinkling, and even a loss of facial volume. The use of fillers both dermal and subdermal and the use of the neurotoxin Botox have grown tremendously. The increase demand for these nonsurgical options for facial rejuvenation has created an added responsibility for physicians to remain current in injection technique and product safety. My technique has evolved, along with the predictability of the current fillers and our understanding of the actions of these products, from a safe and conservative fellowship base. A successful injector is one who understands the limitations and possibilities of the available fillers as well as the neurotoxin Botox. The happy patient is one who finds that doctor.

A Simplified Approach to Midface Aging

We review herein our experience with subperiosteal midface-lifting under direct vision with a simple fixation technique. The technical aspects of the procedure are described in detail. A total of 121 patients underwent midface-lifting and meloplication with the 82/18 L-lactide/glycolide device (Coapt Endotine Midface ST 4.5; Coapt Technologies, Palo Alto, Calif) by both the senior (G.S.K.) and junior (R.N.H.) authors. The senior author's experience included 110 patients over a 26-month period. Thirty-two of these cases were isolated procedures. The other 78 were performed in conjunction with various procedures, most commonly rhytidectomy. There were no revisions during this period. Two cases of "puckering" were noted. Both were immediately corrected, one with fat injection and one with poly-L-lactic acid injection (Sculptra; Dermik Aesthetics, distributed by Besse Medical Supply, West Chester, Ohio). The junior author's experience included 11 cases over an 8-month period. Two cases of asymmetry were noted. One was corrected with fat injection, and the other required revision. Subperiosteal midface-lifting and meloplication using the Coapt Endotine Midface ST 4.5 device is a simple, effective technique that can be quickly learned and applied.

Clinical evaluation of endometriosis and differential response to surgical therapy with and without application of Oxiplex/AP* adhesion barrier gel

OBJECTIVE

To correlate parameters of endometriosis obtained during routine clinical evaluation with the subsequent formation of adhesions following surgical treatment by laparoscopy.

DESIGN

Randomized, controlled, double-blind, clinical trial.

SETTING

Tertiary referral centers for the treatment of endometriosis.

PATIENT(S)

Thirty-seven patients (65 with adnexa) with stage I-III endometriosis; endometrioma-only patients were excluded.

INTERVENTION

Laparoscopic surgical treatment of endometriosis, followed by randomization to Oxiplex/AP (FzioMed, Inc., San Luis Obispo, California) gel treatment (treated group) of adnexa, or surgery alone (control group); follow-up laparoscopy 6-10 weeks later.

MAIN OUTCOME MEASURE(S)

Adnexal Americn Fertility Society score, correlated with color and location of endometriosis, as well as stage of disease determined by masked review of videotapes.

RESULT(S)

Control patients with at least 50% red lesions had a greater increase in ipsilateral adnexal adhesion scores than patients with mostly black or white and/or clear lesions. Treated patients with red lesions had a greater decrease in adnexal adhesion scores than control patients. There was a correlation between baseline endometriosis stage and postoperative adhesion formation in control patients, but not treated patients.

CONCLUSION(S)

Patients with red endometriotic lesions had greater increases in their adhesion scores than patients with only black, white, and/or clear lesions. Oxiplex/AP gel was effective in reducing adhesions, compared to surgery alone, in all groups.

Regioselectively modified sulfated cellulose as prospective drug for treatment of malaria tropica

Adhesion of Plasmodium falciparum infected erythrocytes (IE) to placental chondroitin-4-sulfate (CSA) has been linked to the severe disease outcome of pregnancy-associated malaria. Consequently, sulfated polysaccharides with inhibitory capacity may be considered for therapeutic strategies as anti-adhesive drugs. During in vitro screening a regioselectively modified cellulose sulfate (CS10) was selected as prime candidate for further investigations because it was able to inhibit adhesion to CSA expressed on CHO cells and placental tissue, to de-adhere already bound infected erythrocytes, and to bind to infected erythrocytes. Similar to the undersulfated placental CSA preferred by placental-binding infected erythrocytes, CS10 is characterized by a clustered sulfate pattern along the polymer chain. In further evaluation of its effects on P. falciparum interactions with host erythrocytes, we now show that CS10 inhibits the in vitro asexual growth of parasites in erythrocytes. Furthermore, we show that CS10 interferes with C1 of the classical complement pathway but not with MBL of the lectin pathway. In order to gain insights into the possible interactions of CS10 with known parasite receptors at the molecular level, we designed 3D-structures of characteristic stretches of CS10. CS10 fragments with clustered sulfate groups showed complex patterns of hydrophobic and hydrophilic patches most likely suitable for interactions with protein binding partners. The significance of CS10 interactions with the complement system as well as its anti-malarial effect for prospective drug application are discussed.