Improving accuracy of quantifying nitrate removal performance and enhancing understanding of processes in woodchip bioreactors using high-frequency data

Woodchip bioreactors have gained popularity in many countries as a conservation practice for reducing nitrate load to freshwater. However, current methods for assessing their performance may be inadequate when nitrate removal rates (RR) are determined from low-frequency (e.g., weekly) concurrent sampling at the inlet and outlet. We hypothesised that high-frequency monitoring data at multiple locations can help improve the accuracy of quantifying nitrate removal performance, enhance the understanding of processes occurring within a bioreactor, and therefore improve the design practice for bioreactors. Accordingly, the objectives of this study were to compare RRs calculated using high- and low-frequency sampling and assess the spatiotemporal variability of the nitrate removal within a bioreactor to unravel the processes occurring within a bioreactor. For two drainage seasons, we monitored nitrate concentrations at 21 locations on an hourly or two-hourly basis within a pilot-scale woodchip bioreactor in Tatuanui, New Zealand. A novel method was developed to account for the variable lag time between entry and exit of a parcel of sampled drainage water. Our results showed that this method not only enabled lag time to be accounted for but also helped quantify volumetric inefficiencies (e.g., dead zone) within the bioreactor. The average RR calculated using this method was significantly higher than the average RR calculated using conventional low-frequency methods. The average RRs of each of the quarter sections within the bioreactor were found to be different. 1-D transport modelling confirmed the effect of nitrate loading on the removal process as nitrate reduction followed Michaelis-Menten (MM) kinetics. These results demonstrate that high-frequency temporal and spatial monitoring of nitrate concentrations in the field allows improved description of bioreactor performance and better understanding of processes occurring within woodchip bioreactors. Thus, insights gained from this study can be used to optimise the design of future field bioreactors.

Abstract P4-20-03: Collateral damage from metastatic breast cancer – Preliminary results

BACKGROUND: Historically, research efforts have focused on developing new treatments, education, and support programs for metastatic breast cancer (MBC) patients. Less emphasis has been placed on understanding quality of life (QoL) issues for this underserved population. However, when faced with a metastatic diagnosis, managing, and minimizing the collateral damage resulting from sequential and often continuous treatments is critical to improving quality of life. Through this preliminary analysis, our aim is to understand the unique experience of MBC and identify potential areas of critical need.

METHODS: The Health of Women (HOW) Study™ is an online study for women and men, with and without a history of breast cancer, aimed at identifying causes of breast cancer. The (HOW) Study periodically releases new questionnaires and is currently comprised of ten questionnaires collecting information on personal and family health history, lifestyle, environmental exposures, breast cancer diagnosis and treatment, and QoL. Over 53,000 people are enrolled in (HOW), of which, 11,508 have completed the QoL questionnaire. Areas covered included chronic conditions, symptoms, moods and feelings, reproductive health, daily activities, patient-provider communication, and social and financial concerns. QoL measures were compared between participants with no history of breast cancer (NoHx), with non-metastatic breast cancer (non-MBC), and with MBC.

RESULTS: Of the 11,508 respondents, 3,965 reported a diagnosis of breast cancer—of those, 205 were metastatic. The majority were female (99%) and non-Hispanic White (95%). MBC were younger (28%<50 years, 65% 50-69 years) than non-MBC (20%<50 years, 69% 50-69 years; p<0.05). Overall, participants with MBC reported a lower QoL (20% excellent, 10% poor) than non-MBC (41% excellent, 3% poor) and NoHx participants (44% excellent, 2% poor; p<0.05). MBC and non-MBC participants did not differ on hot flashes, vaginal problems or fertility concerns. However, MBC participants were more likely than non-MBC participants to report: 1) Symptoms — including digestive, mouth and nose, hair and skin, eye, pain, fatigue and night sweats — significantly affecting their lives; 2) Problems with concentration, mood swings, anxiety, depression, memory, and sleeping; 3) Attributing each symptom and/or problem to their breast cancer treatment; 4) Problems performing daily activities; 5) Better communication with their clinical team; 6) Severe financial concerns including difficulty with medical expenses, losing one's job and/or health insurance, not meeting the financial needs of one's family and not being able to pursue career of choice; and 7) Severe social concerns including feeling dependent, isolated, and being treated differently (all p-values<0.05).

CONCLUSIONS: Participants with MBC had a considerably diminished QoL compared to non-MBC and NoHx participants. We identified key areas of concern and multiple areas of collateral damage not standard in research assessment. Our next steps are to use these data to develop a formal, qualitative questionnaire that includes newly identified collateral damage issues, and expand our sample of MBC. The combined data will guide us in developing recommendations for improving the QoL for people with MBC.

Citation Format: Love SM, Bernstein L, Obidegwu A, Ottenbacher A, Eshraghi L, Clague J. Collateral damage from metastatic breast cancer – Preliminary results [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-20-03.

Methamphetamine Users Have Increased Dental Disease: A Propensity Score Analysis

Methamphetamine (MA) users are assumed to have a high burden of tooth decay. Less clear is how the distribution and severity of dental caries in MA users differ from the general population. Using a covariate-balancing propensity score strategy, we investigated the differential effects of MA use on dental caries by comparing the patterns of decayed, missing, and filled teeth in a community sample of 571 MA users with a subset of 2,755 demographically similar control individuals selected from a National Health and Nutrition Examination Survey (NHANES) cohort. Recruited over a 2-y period with a stratified sampling protocol, the MA users underwent comprehensive dental examinations by 3 trained and calibrated dentists using NHANES protocols. Propensity scores were estimated with logistic regression based on background characteristics, and a subset of closely matched subjects was stratified into quintiles for comparisons. MA users were twice as likely to have untreated caries (odds ratio [OR] = 2.08; 95% confidence interval [95% CI]: 1.55 to 2.78) and 4 times more likely to have caries experience (OR = 4.06; 95% CI: 2.24 to 7.34) than the control group of NHANES participants. Additionally, MA users were twice as likely to have 2 more decayed, missing, or filled teeth (OR = 2.08; 95% CI: 1.29 to 2.79) than the NHANES participants. The differential involvement of the teeth surfaces in MA users was quite distinctive, with carious surface involvement being highest for the maxillary central incisors, followed by maxillary posterior premolars and molars. Users injecting MA had significantly higher rates of tooth decay compared with noninjectors (P = 0.04). Although MA users experienced decayed and missing dental surfaces more frequently than NHANES participants, NHANES participants had more restored surfaces, especially on molars. The high rates and distinctive patterns of dental caries observed could be used 1) to alert dentists to covert MA use in their patients and 2) as the basis for comprehensive management strategies.

Identification of lead sources in residential environments: Sydney Australia

Interior and exterior dust, soil and paint were analysed at five brick urban Sydney homes over 15 months to evaluate temporal variations and discriminate sources of lead (Pb) exposure. Exterior dust gauge Pb loading rates (μg/m(2)/28 days), interior vacuum dust Pb concentrations (mg/kg) and interior petri-dish Pb loading rates (μg/m(2)/28 days), were correlated positively with soil Pb concentrations. Exterior dust gauge Pb loading rates and interior vacuum dust Pb concentrations peaked in the summer. Lead isotope and Pb speciation (XAS) were analysed in soil and vacuum dust samples from three of the five houses that had elevated Pb concentrations. Results show that the source of interior dust lead was primarily from soil in two of the three houses and from soil and Pb paint in the third home. IEUBK child blood Pb modelling predicts that children's blood Pb levels could exceed 5 μg/dL in two of the five houses.

Abstract P3-06-18: The health of women study: A novel approach to the cohort study

PURPOSE: The purpose of the Health of Women (HOW) Study is to examine risk factors for breast cancer and factors that may contribute to long-term survivorship through an innovative online system that allows for participant engagement and data sharing with the research community.

METHODS: The HOW Study is conducted through online and mobile phone platforms. Questionnaires are developed in our custom built survey tool and are available for completion on the study's website. The system allows for automated skip patterns within questionnaires and collection of data directly into a SQL database. The cohort is open to anyone 18 years or older; recruitment sources include the Love/Avon Army of Women and the general public. Participants will be given the opportunity to pose questions they would like to see answered. The HOW Study is also a novel resource allowing outside researchers to submit questions to be incorporated into HOW questionnaires and creating a data sharing platform that facilitates researcher access to HOW data after an application process.

RESULTS: The HOW Study launched October 2012 and currently has 41,800 participants from across the nation and the globe. We have released 1 baseline questionnaire and breast cancer-specific questionnaires to capture diagnosis and treatment with greater than 90% completion rate for each.

CONCLUSION: We have shown that we can recruit and engage participants in an online cohort study. We believe that this study has the potential to transform epidemiologic research by engaging both participants and the research community. Our second baseline questionnaire will launch in the summer of 2013, which will give us the opportunity to increase enrollment and assess retention.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-06-18.

Variants of uncertain significance in BRCA testing: evaluation of surgical decisions, risk perception, and cancer distress

Studies suggest that patients carrying a BRCA variant of uncertain significance (VUS) may have lingering confusion concerning results interpretation. Counseling for uninformative BRCA-negative (UN) results is thought to be more straightforward, despite the fact that both results lead to similar methods of empiric cancer risk counseling. This study compared surgical choices and perceptions between 71 patients with VUS results and 714 patients with UN results. All patients underwent genetic counseling because of a personal or family history of breast or ovarian cancer between 1997 and 2010, and completed a 2-year follow-up survey. Risk-reducing mastectomy rates in both groups were 7% (p = 1.00) and risk-reducing oophorectomy rates were 5% and 3%, respectively (p = 0.42). The VUS group reported less cancer distress reduction than the UN group (23.0% vs 35.8%, respectively, p = 0.043). Over 90% of both groups found the counseling process helpful. Overall, the study suggests that VUS results disclosed in genetic counseling did not cause excessive surgery or exaggerated cancer distress, though patients with a VUS found counseling somewhat less informative or reassuring. Future research on communication of VUS results, including pre-and post-test counseling, is essential for full realization of the potential for genomic medicine.

Abstract PD08-06: Significant Clinical impact of recurrent BRCA1 and BRCA2 (BRCA) mutations in Mexico

Background: Breast cancer (BC) is the most commonly diagnosed cancer and the leading cancer cause of death in Hispanic women. Although the incidence of breast cancer in Hispanics is less than that for non-Hispanic white women, our studies on the prevalence of deleterious mutations in the BRCA genes among high-risk Hispanics in the US suggest that BRCA mutations may account for a higher proportion of BC in this population. However, a lack of research on BRCA mutations in Hispanics has limited the implementation of prevention efforts and the scope of comparative studies of genetic factors that influence BC and ovarian cancer (OC) risk within Hispanic populations – this is especially true of Mexico where there has been little access to clinical BRCA gene analyses.

Objective/Methods: We used an economic panel assay (HISPANEL) on a mass spectroscopy platform (Sequenom) to analyze DNA from 189 cancer cases (92 unselected OC; 97 BC) from the National Cancer Institute in Mexico City for recurrent BRCA mutations, including a large rearrangement (BRCA1 ex9-12del) that we hypothesize is a Mexican founder mutation.

Results: Overall, 14% (27/189) harbored a germline BRCA mutation (25 BRCA1, 2 BRCA2) detected by the HISPANEL (17% in OC; 11% in BC). BRCA1 ex9-12del was detected in 9.8% (9/92) of unselected OC cases, representing 56% of the 16 BRCA mutations. It also represented 36% (4/11) of the BRCA mutations detected in the BC cases. Mean age at onset of BC for BRCA-associated cases (n = 11) was 46 years old (range 31–63); 8/11 were triple negative BC (TNBC) – a BRCA mutation was detected in 24% (8/34) of all TNBC cases.

Conclusions: The remarkable frequency of the BRCA1 ex9-12del mutation, accounting for 56% of BRCA mutations in the OC cases and 36% of BC cases, supports our hypothesis of regional origin of this Mexican founder mutation approximately 1,474 years ago. Similar to our experience in the Mexican American population, the HISPANEL, which includes recurrent BRCA mutations found in women of Hispanic ancestry, appears to have high sensitivity and thus is likely to have clinical utility while reducing overall genotyping cost among underserved women in Mexico. Both in the US Hispanic populations and in Mexico, the prevalence of the Mexican founder mutation make it a significant public health issue, and presents an opportunity for cost effective in BC and OC prevention.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD08-06.

Menopausal Hormone Therapy influences Lung Cancer Survival but not Lung Cancer Risk: Results from the California Teachers Study

Purpose: Most studies have shown a protective or null effect of postmenopausal hormone therapy (HT) on lung cancer risk, whereas the recent post-hoc analysis of the Women's Health Initiative (WHI) showed that estrogen+progestin (E+P) decreased lung cancer survival. Given the substantial clinical implications, it is vital that the risk and survival associations be validated.

Methods: We examined the associations between HT use and lung cancer risk and survival among 60,592 postmenopausal women enrolled in the prospective California Teachers Study cohort. Between 1995 and 2007, 727 women (184 never smokers) were diagnosed with lung cancer; 441 of these died as of December 31, 2007. Age-stratified, multivariable Cox proportional hazards regression was used to calculate hazard ratios (HR).

Results: After adjusting for potential confounders, various measures of HT use were not associated with lung cancer risk. However, any HT use (vs. no use) was associated with a statistically significant increase in lung-cancer-specific survival [HR, 0.70; 95% confidence interval (CI), 0.56-0.87]. Among women who only used E, statistically significant increases in lung cancer survival were seen for recent use (HR, 0.59; 95% CI, 0.43-0.80), but not former use; use of only E+P was not associated with survival. Shorter duration of recent E-only use was associated with improved survival (0-5 years of use: HR, 0.29, 95% CI, 0.12-0.68; 5-15 years of use: HR, 0.60, 95% CI, 0.35-1.05; >15 years of use: HR, 0.58, 95% CI, 0.39-0.88) (trend P = 0.005). Similarly, women who reported recently using E-only for 0-5 years had a median survival time of 42.1 months versus women who reported 5-15 years of use (31 months), >15 years of use (19.1 months), or no HT use (15.6 months) (log-rank P = 0.009). Among former users of HT, a statistically significant 63% (95% CI, 0.16-0.87) decrease in lung-cancer-specific death was observed for E-only use <5 years prior to baseline, but not for E-only use >5 years prior to baseline or E+P-only use.

Conclusions: Contrary to the recent finding that lung cancer survival is poorer among women in WHI taking E+P, our results suggest no effect of E+P. By contrast, postmenopausal E-only use, specifically recent use, is associated with increased lung cancer survival.

Stress long-axis function in coronary artery spasm

In a patient with prior myocardial infarction who had complained of frequent angina repeat arteriograms proved normal coronary arteries. Both ECG exercise testing and thallium scanning excluded ischemia. Resting echocardiogram showed increased distal septal and right ventricular apical myocardial echo intensity. Dobutamine stress echo demonstrated right ventricular and posteroseptal abnormalities consistent with ischemia. Repeat angiogram with ergonovine confirmed distal right coronary spasm.

Systemic platelet effects of contrast media: implications for cardiologic research and clinical practice

BACKGROUND

Angiographic contrast media cause platelet activation and decrease aggregability in vitro. We have previously shown in vitro a significant antiplatelet effect of contrast media at the concentrations obtained locally in the coronary artery during angioplasty. It is not known, however, whether a systemic effect is present.

METHOD

Thirty patients undergoing diagnostic coronary angiography were prospectively randomized to receive the nonionic medium iohexol, ionic low-molecular-weight medium ioxaglate, or ionic high-molecular-weight medium diatrizoate. Platelet aggregability was measured before and after the investigation with whole blood electrical impedance aggregometry (WBEA) with collagen agonist and the PFA-100 (Dade, Miami, Fla) platelet function analyzer with combined shear, collagen, and adenosine diphosphate as agonists.

RESULTS

With WBEA, with iohexol no difference in impedance change was seen: (medians and ranges) before, 9.8 Omega (4.8-19.2 Omega) versus after, 9.6 Omega (2-19.2 Omega) (P not significant [NS]). With ioxaglate a significant fall was seen: before, 8.6 Omega (6.4-15.2 Omega) versus after, 6.6 Omega (0-12.4 Omega) (P =.004). With diatrizoate a significant and greater fall was seen: before, 10.8 Omega (6.4-17.6 Omega) versus after, 6.6 Omega (0-10.8 Omega) (P =.002). With PFA, no difference in closure time was seen with any medium: iohexol before, 99 seconds (79-142 seconds) versus after, 142 seconds (63-128 seconds) (P NS); ioxaglate before, 120 seconds (75-258 seconds) versus after, 95 seconds (74-258 seconds) (P NS); and diatrizoate before, 114.5 seconds (65-250 seconds) versus after, 100.5 seconds (72-300 seconds) (P NS).

CONCLUSIONS

Ionic but not nonionic contrast media have a systemic antiplatelet effect at diagnostic angiographic doses when measured with WBEA. Such an effect has not been shown before. This may explain the observed improved clinical outcome with ionic contrast media but also might confound platelet studies in coronary angioplasty.

Femoral haemostasis after transcatheter therapeutic intervention: a prospective randomised study of the angio-seal device vs. the femostop device

BACKGROUND

A number of haemostatic devices are available to facilitate early haemostasis following transfemoral interventional procedures.

METHODS AND RESULTS

We have prospectively compared 150 patients (age: 57+/-12 years, mean+/-S.D.) who were randomly assigned to either external compression using the FemoStop device or direct closure of the arterial puncture using the Angio-Seal device. The Angio-Seal was deployed in the catheter laboratory after the conclusion of the procedure. Patients, randomised to FemoStop, had their sheath removed when the activated clotting time (ACT) was less than 100 s before applying the device. The primary endpoint was the composite of bleeding, haematoma formation, bruise, requirement for blood transfusion, clinical indication for ultrasound examination at 2 h and 24 h following the procedure and crossover to either method at 2 and 24 h after the device deployment. The 95% of the Angio-Seal and 96% of FemoStop patients were discharged on the day following the procedure. An increased number of patients in the Angio-Seal group reached a clinical end-point within the first 2 h (45% vs. 3%, P<0.0001). This difference became insignificant at 24 h (25% vs. 30%, P=0.6).

CONCLUSION

Although less comfortable, the overall efficacy of the FemoStop appeared to be higher than that of the Angio-Seal device.

Non-elective intra-coronary stenting: are the clinical outcomes comparable to elective stenting at 6 months?

The aim of this study was to compare prospectively the clinical outcome of patients treated with intra-coronary stents as a non-elective/bailout procedure for acute or threatened vessel closure, with those undergoing elective stenting at 6 months. Sixty-four patients (60.2+/-11.7 y) who underwent non-elective stenting for abrupt or threatened vessel closure and/or sub-optimal results were prospectively compared with 68 patients (62+/-10.0 y) who were stented electively. All patients had broadly similar pre-procedural clinical profiles. However, patients in the elective group had a higher incidence of previous PTCA (10.2% vs. 0%, P = 0.01) and bypass surgery (30.9% vs. 6.3%, P = 0.0003) compared with the non-elective group. A total of 158 stents (1.19 per patient) were implanted in 132 patients with a procedural success rate of 99.3%. At 6 months follow-up there was no statistical difference in the primary composite end-point of death, myocardial infarction and the need of repeat revascularisation (10.9% vs. 5.8%, P = 0.35) between the two groups. However, patients in the non-elective group showed a higher incidence of unstable angina compared with the elective group (25% vs. 1.4%, P = 0.0004). The findings of this study suggest that stents (single or multiple) can be effectively implanted in non-elective situations with no increase in the incidence of death, non-fatal myocardial infarction, and the need of repeat revascularisation at 6 months compared with elective stenting.

Cardiogenic shock secondary to mitral stenosis treated by balloon mitral valvuloplasty

Percutaneous balloon mitral valvuloplasty is a well-established elective treatment for mitral stenosis in selected patients; it has been used to treat cardiogenic shock secondary to aortic stenosis but has not been previously used for cardiogenic shock secondary to mitral stenosis. We describe a case of cardiogenic shock secondary to severe mitral stenosis, treated by balloon mitral valvuloplasty.

McArdle's disease: a rare frameshift mutation in exon 1 of the muscle glycogen phosphorylase gene

We have previously discovered a common nonsense mutation in exon 1 of the myophosphosphorylase gene in patients with McArdle's disease, but this failed to explain all cases. We now report a second mutation (G-->TT) in one patient, also in exon 1. This mutation causes a shift in the reading frame which results in the replacement of Val15 by Phe. A further 10 amino acids of mis-sense protein are synthesised before a stop codon is reached.

McArdle's disease: a nonsense mutation in exon 1 of the muscle glycogen phosphorylase gene explains some but not all cases

McArdle's disease is an inherited disease that results from a lack of functional muscle glycogen phosphorylase. We report here the identification of a C to T transition in exon 1 of the muscle phosphorylase gene found in all patients studied. This base pair mutation results in the substitution of a stop codon (TGA) for the codon (CGA) for Arg49 in the mature protein, and generates a novel restriction site for NlaIII. Of sixteen McArdle's patients, ten are homozygous for this mutation; the remainder are heterozygous. Additional unidentified mutations must lead to the McArdle's phenotype in the latter group of patients.

Inhaled platelet-activating factor causes pulmonary neutrophil sequestration in normal humans

Inhaled platelet-activating factor (PAF) causes bronchoconstriction and transient peripheral neutropenia in humans. We studied eight normal subjects to investigate whether inhaled PAF caused pulmonary neutrophil sequestration. All subjects received autologous 99mTc-red cells as a blood pool marker, seven received 111In-neutrophils, and one received 111In-platelets. Six subjects inhaled 48 micrograms of PAF. There was immediate pulmonary sequestration of 111In-neutrophils, maximal (218% baseline) at 6 min (p less than 0.001), returning to normal by 3 h. There was no change in circulating platelet count or pulmonary 111In-platelet transit. Methacholine inhalation caused equivalent bronchoconstriction to PAF, but it had no effect on neutrophil count or pulmonary 111In-neutrophil activity. We have demonstrated pulmonary neutrophil, but not platelet, sequestration after PAF. This supports a role for PAF as an inflammatory mediator in humans. This may be a useful model for exploring pulmonary neutrophil kinetics and preinflammatory processes.

Comparison of three different methods used to achieve local anesthesia for fiberoptic bronchoscopy

A patient's tolerance of fiberoptic bronchoscopy depends on the effectiveness of local anesthesia. This study compares the three different methods of local anesthesia in common use After sedation, patients (n = 53) received either 4 ml of 2.5 percent cocaine by intratracheal injection (TI) (n = 18), by bronchoscopic injection (BI) (n = 19), or had 4 ml of 4 percent lidocaine delivered by nebulizer 20 min before the procedure (NEB) (n = 16). Patients and bronchoscopists scored the procedure using visual analog (VAS) and severity scales. Objective measurements of cough counts and episodes of stridor were recorded by phonopneumography. Patients' VAS scores showed a clear preference for the transtracheal method compared with either bronchoscopically injected cocaine (p less than 0.001) or nebulized lidocaine (p less than 0.001). Patients also reported that the TI method produced less cough during intubation of the larynx and inspection of the airways (BI and NEB, p less than 0.01). The TI method was also preferred by the bronchoscopists (BI and NEB, p less than 0.001); they reported less cough and easier tracheal intubation. The mean cough count was significantly lower for the TI group, 49 (43) compared with 95 (52) for BI (p less than 0.01), and 81 (43) for the NEB group (p less than 0.05). Patients' and bronchoscopists' VAS showed significant correlation with cough (r = 0.63-69, p less than 0.01). Stridor occurred in only two patients after TI, compared with 15 in the other two groups. Extra local anesthesia was required by 16 patients after BI, by all the NEB group, but by only one patient after TI. Subjective and objective measurement shows that 4 ml of 2.5 percent cocaine injected into the trachea produced excellent local anesthesia for fiberoptic bronchoscopy, there were no extra complications, and it was the method preferred by both patients and bronchoscopists.

A comparison of the effect of salmeterol and salbutamol in normal subjects

1. The effects of salmeterol hydroxynaphthoate (50 micrograms, 8.3 x 10(-8) M) and salbutamol (200 micrograms, 3.5 x 10(-7) M) on sGaw were compared in a double-blind, placebo-controlled, randomised study in 10 normal subjects. 2. SGaw increased by 29% (14-43) (mean (CI)), 5 min after salmeterol and by 35% (19-51) at 15 min compared with an increase of 32% (14-51) and 37% (10-63) after salbutamol and 4% (-3-11) and 8% (0-16) after placebo. 3. The mean area under the sGaw-time curve (AUC480) after salmeterol inhalation was 22,500 kPa-1 (10,100-39,500) compared with 14100 kPa-1 (8020-24,500) after salbutamol and 5300 kPa-1 (1500-10,400) after placebo. 4. Salmeterol produced a significantly prolonged bronchodilator effect compared with salbutamol in normals.

Allergen-induced changes in the nasal mucous membrane in seasonal allergic rhinitis: effect of nedocromil sodium

We have obtained biopsy specimens of the nasal mucous membrane before and during the grass-pollen season in 22 patients with seasonal allergic rhinitis to grass pollen to assess the effects on cellular infiltration of natural exposure to allergen. Biopsy sections were examined by light microscopy, and quantitative assessment was made of numbers of mast cells and eosinophils. The patients were divided into 11 who were treated with placebo and 11 patients who were treated with topical nedocromil sodium. In the group as a whole, there was a significant (p less than 0.001) increase in mast cell density in tissue sections from biopsy specimens obtained during the season compared with out of season (median values, 55.0 and 15.5 cells per square millimeter, respectively). There was also a significant (p less than 0.02) increase in the density of eosinophil infiltration during the season compared with out of season (median values, 6.3 and 0 cells per square millimeter, respectively). Treatment with nedocromil sodium significantly (p less than 0.02) inhibited the accumulation of mast cells but not eosinophils. Compared with the placebo-treated group, the group treated with nedocromil demonstrated a significant (p less than 0.025) reduction in the requirements for treatment with concomitant medication (terfenadine tablets and xylometazoline/antazoline eye drops). These results indicate that natural exposure to allergen in patients with seasonal allergic rhinitis is accompanied by infiltration of mast cells and eosinophils into the nasal mucous membrane. The clinical efficacy of nedocromil sodium in this condition may be related to inhibition of infiltration by mast cells.

Thin-fiber cutaneous innervation and its intraepidermal contribution studied by labeling methods and neurotoxin treatment in rats

Sensory nerves innervating rat distal limb skin were labeled by axonal transport of an enzyme-lectin conjugate injected into lumbar dorsal root ganglia (DRG), with emphasis on tracing the course of the thin axons. Selective neonatal neurotoxin destruction of most unmyelinated sensory or sympathetic axons was achieved by treatment with capsaicin (CAP) and 6-hydroxydopamine (6-OHDA), respectively. The relationship of substance P-immunoreactive (SPI) axons to the patterns of axonal transport-labeled thin axons was compared in normal and neurotoxin-treated animals. SPI is restricted to a limited population of unmyelinated axons, and electron-microscopic observation reveals its total absence in myelinated axons. SPI fibers of sensory origin, as determined by CAP susceptibility, can be traced into the epidermal stratum spinosum, in relation to guard hair follicles, mast cells, and a specific class of small blood vessels. These morphological features are not eliminated by neurotoxin sympathectomy, and some are inferred to contribute to the initial events associated with the neurogenic vasodilation and plasma extravasation associated with the inflammatory response. A re-evaluation of the concept of "free nerve endings" is suggested in the context of the variety of afferent and efferent patterns displayed by sensory peptidergic unmyelinated axons, their putative nociceptive role, and the functional diversity of sensory C fibers.