Is the 'safe zone' identified in preoperative computed tomography helpful for choosing optimal implant for fixation of radial head fracture?

The purpose of this study is to assess the clinical significance of the radiologic safe zone based on computed tomography and to compare the outcomes of three different implants for fixation of isolated radial head fractures. We retrospectively reviewed 367 patients who underwent internal fixation for isolated radial head fractures. We newly defined two subtypes of Mason type II fractures associated with the radiographic safe zone (IIA, two-part fracture allowing for safe fixation of plate; IIB, two-part fracture not allowing for safe fixation). 170 patients (CCS group, n = 82; HCS group, n = 31; plate group, n = 57) were investigated with no significant differences in demographics. The range of pronation and supination at 1 month postoperatively (P = 0.04 and P = 0.04) and the range of supination at 6 and 12 months postoperatively (P = 0.03 and P = 0.03) were significantly smaller in the plate group. In Mason type IIB fractures, the average MEPS was higher in the CCS and HSC groups than in the plate group (P = 0.01 and P = 0.02). And the average DASH score was lower in the CCS and HCS groups (P < 0.01 and P < 0.01). Evaluation of the radiologic safe zone is potentially helpful in selecting better surgical fixation option. For type III fractures, 2.3-mm cortical screws would be a better option than Acutrak screws. Plates would not be suitable for type IIB radial head fractures.

Increased risk of cardiovascular diseases in patients with chronic rhinosinusitis: a longitudinal follow-up study using a national health screening cohort

BACKGROUND

Chronic rhinosinusitis (CRS) is one of the most common chronic inflammatory diseases and is characterized by sinonasal inflammation that lasts longer than 12 weeks. Whether the effect of chronic inflammation caused by CRS on cardiovascular diseases (CVDs) is similar to its effect on other inflammatory disorders has not been thoroughly evaluated. We aimed to demonstrate whether CRS patients have a higher prevalence of CVDs, including stroke and ischemic heart disease (IHD).

METHODOLOGY

We compared the prevalence of various comorbidities between CRS and control participants through a case-control cohort study from 2002 to 2015 that included 514,866 participants. CRS (n=6,552) and control (n=26,208) participants who were over 40 years old were selected by matching age, sex, income, and area of residence at a 1:4 ratio.

RESULTS

A stratified Cox proportional hazards model was utilized to assess the hazard ratio (HR) of CRS for stroke and IHD. The HRs for stroke and IHD were significantly increased in CRS patients compared to controls after adjusting for obesity, alcohol consumption, smoking, systolic and diastolic blood pressure, fasting blood glucose, total cholesterol, hemoglobin, and Charlson Comorbidity Index (CCI) scores. The HR of stroke was significantly higher in the absence of nasal polyps than in the presence of nasal polyps. The HR of IHD was significantly increased in the CRS group regardless of the presence of nasal polyps.

CONCLUSIONS

This study showed that CRS participants had a significantly higher prevalence of stroke and IHD.

Association between air pollution and chronic rhinosinusitis: a nested case-control study using meteorological data and national health screening cohort data

BACKGROUND

Inconsistent results about the effect of air pollution on chronic rhinosinusitis (CRS) have been reported. This study aimed to evaluate the impact of meteorological conditions/air pollution on the prevalence of CRS in adult Koreans.

METHODOLOGY

The data from the Korean National Health Insurance Service-Health Screening Cohort from 2002 through 2015 were used. A CRS group (defined as ICD-10 codes J32, n=6159) was matched with a control group (n=24,636) in 1:4 ratios by age, sex, income, and region of residence. The meteorological conditions and air pollution data included the daily mean, highest, and lowest temperature (°C), daily temperature range (°C), relative humidity (%), ambient atmospheric pressure (hPa), sunshine duration (hr), and the rainfall (mm), SO2 (ppm), NO2 (ppm), O3 (ppm), CO (ppm), and PM10 (μg/m3) levels before the CRS diagnosis. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for CRS were analyzed using logistic regression analyses.

RESULTS

When the NO2 level increased by 0.1 ppm, the odds for CRS increased 5.40 times, and when the CO level increased by 1 ppm and PM10 increased by 10 μg/m3, the odds for CRS decreased 0.75 times and 0.93 times, respectively. Other meteorological conditions, such as the mean/highest/lowest temperature, temperature range, rainfall and other air pollution, such as SO2 and O3, were not statistically significant. NO2 for 90 days before the index date increased the risk of CRS in all subgroups, except for the nasal polyp and older age subgroups.

CONCLUSION

CRS is related to high concentrations of NO2.

Increased risk of chronic otitis media in chronic rhinosinusitis patients: a longitudinal follow-up study using a national health screening cohort

BACKGROUND

Chronic rhinosinusitis (CRS) and chronic otitis media (COM) share pathophysiological mechanisms such as bacterial infection, biofilm, and persistence of the obstruction state of ventilation routes. However, only a few studies have investigated the relationship between these two diseases nationwide and in the general population. The purpose of this study was to determine whether the incidence of COM in patients with CRS differed from that of a matched control from the national health screening cohort.

METHODS

Data from the Korean Health Insurance Review and Assessment Service-National Patient Samples were collected from 2002 to 2015. Participants who were treated ≥ ≥ ≥2 times and underwent head and neck computed tomography evaluation were selected. A 1:4 matched CRS group (n=8,057) and a control group (n=32,228) were selected. The control group included participants who were never treated with the ICD-10 code J32 from 2002 to 2015. The CRS group included CRS patients with/without nasal polyps.

RESULTS

The incidence of COM was significantly higher in the CRS group than in the control group. In a subgroup analysis, the incidence of COM in all age groups and in men and women was significantly higher in the CRS group than in the control group. More, CRS increased the risk of COM.

CONCLUSIONS

A significant association was observed between CRS and COM. This indicates that CRS patients have a high risk of developing COM.

High-Intensity Physical Activity with High Serum Vitamin D Levels is Associated with a Low Prevalence of Osteopenia and Osteoporosis: A Population-Based Study

We found that combination of high-intensity PA and high 25(OH)D levels was associated with low prevalence of osteoporosis/osteopenia. In addition, the prevalence of osteoporosis was lower in the low PA with high 25(OH)D levels than in the moderate or high PA with low 25(OH)D levels.

INTRODUCTION

The aim of this study was to explore the association of physical activity (PA) and serum 25-hydroxyvitamin D (25[OH]D) levels with osteopenia/osteoporosis.

METHODS

The Korean National Health and Nutrition Examination Survey data from 2008 to 2011 were used in this study. Data from 6868 individuals were selected. Each individual's level of PA was classified as 'low', 'moderate', or 'high'. Serum 25(OH)D levels were classified as 'low' or 'high'. Accordingly, the combined PA and 25(OH)D groups were divided into 6 groups. Bone mineral density (BMD) was classified as 'normal (T score ≥ - 1.0)', 'osteopenia (- 2.5 < T score < - 1.0)' or 'osteoporosis (T score ≤ - 2.5)'. Crude and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated using multinomial logistic regression models.

RESULTS

The AORs (95% CIs) for osteopenia were 0.64 (0.50-0.83) in the high PA with high 25(OH)D group and 0.69 (0.53-0.88) in the moderate PA with high 25(OH)D group. The AORs (95% CIs) for osteoporosis were increased in the groups in ascending order as follows: high PA with high 25(OH)D (0.40 [0.28-0.57]) < moderate PA with high 25(OH)D (0.47 [0.33-0.66]) < low PA with high 25(OH)D (0.59 [0.42-0.83]) < high PA with low 25(OH)D (0.70 [0.49-1.00]) < moderate PA with low 25(OH)D (0.76 [0.53-1.07]) < low PA with low 25(OH)D. This result was consistent in males but not evident in females.

CONCLUSION

We suggest that the combination of high-intensity PA and high 25(OH)D levels is positively associated with high BMD.

Psoriasis is associated with an increased risk of osteoporosis: follow-up and nested case-control studies using a national sample cohort

A total of 25,306 psoriasis participants were matched to 101,224 controls, and the occurrence of osteoporosis was analyzed. Additionally, 79,212 osteoporosis patients were matched to 79,212 controls and a previous history of psoriasis was analyzed. Psoriasis increased the risk of osteoporosis among participants aged ≥ 40 years.

INTRODUCTION

The aim of the present study was to evaluate the association between psoriasis and osteoporosis using two different studies.

METHODS

Data from the Korean National Health Insurance Service-Health Screening Cohort of participants aged ≥ 40 years were collected from 2002 to 2013. Psoriasis and osteoporosis were included using International Classification of Diseases (ICD)-10 codes. In study I (a follow-up study), a total of 25,306 psoriasis participants were matched to 101,224 controls with respect to age, sex, income, and region of residence, and the occurrence of osteoporosis was analyzed. Crude (simple) and adjusted hazard ratios (HRs) were analyzed using a stratified Cox proportional hazard model. In study II (a nested case-control study), a total of 79,212 osteoporosis patients were matched to 79,212 controls and a previous history of psoriasis was analyzed. Crude and adjusted odds ratios (ORs) were analyzed using a conditional logistic regression analysis. Subgroup analyses were conducted according to age group and sex.

RESULTS

The adjusted HR of osteoporosis was 1.09 (95% confidence interval [CI] = 1.05-1.13, P < 0.001) in study I. In the subgroup analysis according to age and sex, the results were consistent except for ≥ 60-year-old women. The adjusted OR of psoriasis was 1.21 (95% CI = 1.16-1.27, P < 0.001) in study II. All subgroups demonstrated high adjusted ORs of osteoporosis for psoriasis.

CONCLUSIONS

Psoriasis increased the risk of osteoporosis among participants aged ≥ 40 years in Korea.

Blindness increases the risk for hip fracture and vertebral fracture but not the risk for distal radius fracture: a longitudinal follow-up study using a national sample cohort

The risks for hip fracture and vertebral fracture, but not the risk for distal radius fracture, were significantly higher in the blindness group than in the control group with a maximum 12-year follow-up.

PURPOSE

To evaluate the influence of visual impairment on the risk for osteoporotic fractures at common sites: hip, thoracic/lumbar vertebra, and distal radius.

METHODS

This longitudinal follow-up study used a database of a national sample cohort from 2002 to 2013 provided by the Korean National Health Insurance Service. Of a total of 1,125,691 subjects, 3918 patients with visual impairment and age ≥ 50 years were enrolled in a 1:4 ratio; 15,672 control participants were matched for age, sex, income, and region of residence. Stratified Cox proportional-hazards models were used to evaluate the crude and adjusted (for steroid medication, rheumatoid arthritis, depression, osteoporosis, diabetes mellitus, and stroke history) hazard ratios (HRs) for each fracture site. Fracture diagnoses were based on the ICD-10 codes: hip fracture (S720, S721, S722), vertebral fracture (S220, S320), and distal radius fracture (S525).

RESULTS

The HRs for hip and vertebral fracture were significantly higher in the blindness group (adjusted HR = 2.46, p < 0.001 for hip fracture; adjusted HR = 1.42, p = 0.020 for thoracic/lumbar vertebral fracture) than in the matched control group. However, the HR for distal radius fracture was not higher in the blindness group. The HRs for all three fracture sites were not significantly higher in the non-blindness visual impairment group after adjustment.

CONCLUSION

The risks for hip fracture and vertebral fracture were significantly higher in the blindness group. However, the risk for distal radius fracture was not related to visual impairment including blindness.

Association between benign paroxysmal positional vertigo and osteoporosis: two nested case-control studies

Benign paroxysmal positional vertigo (BPPV) was related to a 1.28 times higher risk of osteoporosis. In addition, osteoporosis was associated with a 1.34 times higher risk of BPPV. This bidirectional relation was maintained after adjusting past medical histories and lifestyle factors, including obesity, smoking, and alcohol consumption. To our knowledge, this is the first study to explore the reciprocal association between BPPV and osteoporosis. In subgroup analyses, only women showed a reciprocal association between BPPV and osteoporosis.

INTRODUCTION

A previous population cohort study suggested an association between osteoporosis and benign paroxysmal positional vertigo (BPPV). This study aimed to investigate the bidirectional association between BPPV and osteoporosis.

METHODS

The Korean National Health Insurance Service-Health Screening Cohort data from 2002 to 2013 were used. In study I, the 50,897 osteoporosis patients were 1:1 matched with control I participants for age, sex, income, and region of residence. The previous histories of BPPV were analyzed in both groups using conditional logistic regression analysis. In study II, 9621 BPPV patients were 1:4 matched with control II participants. The previous histories of osteoporosis were analyzed in both groups using conditional logistic regression analysis. According to age and sex, subgroup analyses were achieved in both studies I and II.

RESULTS

A total of 1.6% (822/50,897) of osteoporosis patients and 1.3% (644/50,897) of control I participants had BPPV. The osteoporosis patients demonstrated a 1.28 times higher chance of developing BPPV (95% confidence intervals [95% CI] = 1.16-1.42, P < 0.001). In study II, 21.2% (2040/9621) of BPPV patients and 17.6% (6790/38,484) of control II participants had osteoporosis. The BPPV patients showed 1.34 times higher chance of having osteoporosis (95% CI = 1.26-1.43, P < 0.001). In the analysis of the women subgroup, these relations were reliable.

CONCLUSION

Osteoporosis patients had increased odds of having BPPV. On the other hand, BPPV patients had increased odds of having osteoporosis. This bidirectional relation was consistent only in the women subgroup.

Mortality and cause of death postoperatively in patients with a hip fracture

Aims

The aim of this study was to compare the rate of mortality and causes of death in Korean patients who undergo surgery for a fracture of the hip, up to 11 years after the injury, with a control group from the general population.

Materials and Methods

National cohort data from Korean Health Insurance Review and Assessment Service – National Sample Cohort were used. A ratio of 1:4 matched patients with a fracture who underwent surgery (3383, fracture group) between 2003 and 2012, and controls (13 532) were included. The matches were processed for age, gender, income, and region of residence. We also undertook analyses of subgroups according to age and gender. The mean follow-up was 4.45 years (1 to 11).

Results

The prevalence of hypertension, diabetes, and stroke was significantly higher in the fracture group and dyslipidemia in the controls. Both crude and adjusted hazard ratios (HR) for the rate of mortality in the fracture group were > 2 (crude HR 2.03, 95% confidence interval (CI) 1.91 to 2.17, p < 0.001; adjusted HR 2.07, 95% CI 1.94 to 2.21, p < 0.001). The HRs were also > 2 for both men and women, and for both those aged ≥ 50 years and < 50 years. However, for those aged < 50 years, they were insignificant. The rates of mortality due to all 11 major causes of death classified following Korean standard classification of diseases were significantly higher in the fracture group compared with the control group, except those in the mental and behavioral disorders category.

Conclusion

The rate of mortality in the fracture group was significantly higher than in the control group up to 11 years after the surgery. The rate of death due to almost every major cause was significantly higher in the fracture group compared with the control group. Cite this article: Bone Joint J 2018;100-B:436–42.

Crosstalk analysis in homogeneous multi-core two-mode fiber under bent condition

We analyze the inter-core crosstalk in homogeneous multi-core two-mode fibers (MC-TMFs) under bent condition by using the coupled-mode equations. In particular, we investigate the effects of the intra-core mode coupling on the inter-core crosstalk for two different types of MC-TMFs at various bending radii. The results show that the inter-core homo-mode crosstalk of LP(11) mode is dominant under the gentle fiber bending condition due to its large effective area. However, as the fiber bending becomes tight, the intra-core mode coupling is significantly enhanced and consequently makes all the inter-core crosstalk levels comparable to each other regardless of the mode. A similar tendency is observed at a reduced bending radius when the difference in the propagation constants between modes is large and core pitch is small.

Engineering of a lipid-polymer nanoarchitectural platform for highly effective combination therapy of doxorubicin and irinotecan

We developed a highly stable lipid-polymer nanoarchitectural platform for effective combination therapy of doxorubicin and irinotecan in the polyelectrolyte complex nanoparticle core, followed by incorporation of the whole assembly into a lecithin bilayer.

Simple carrier-phase estimator for high-speed RSOA-based coherent WDM PON

It has been recently reported that reflective semiconductor optical amplifiers (RSOAs) can be used as phase modulators for the cost-effective implementation of the high-speed wavelength-division-multiplexed passive optical networks (WDM PONs). For the detection of the phase-shift-keying (PSK) signal generated by using an RSOA, we should be able to estimate its carrier phase accurately at the digital coherent receiver. However, when the baud rate of this PSK signal is set to be much higher than the RSOA's modulation bandwidth, the conventional M-th power algorithm cannot estimate its carrier phase accurately. To solve this problem, we develop a simple carrier-phase estimation technique for the high-speed (>10 Gb/s) PSK signals generated by using bandwidth-limited RSOAs. This technique estimates the carrier phase of the PSK signal by measuring the angular direction of the opening occurred in the trajectory of the phasor diagram. By using the proposed technique, we demonstrate the upstream transmission of the 25.78-Gb/s quadrature phase-shift-keying (QPSK) signal generated by using an RSOA (3-dB bandwidth: 3.2 GHz) in a 60-km reach coherent WDM PON.

Optical performance monitoring technique using software-based synchronous amplitude histograms

We propose and demonstrate a simple technique to monitor both the optical signal-to-noise ratio (OSNR) and chromatic dispersion (CD) by using the software-based synchronous amplitude histogram (SAH) analysis. We exploit the software-based synchronization technique to construct SAHs from the asynchronously sampled intensities of the signal. The use of SAHs facilitates the accurate extraction of the monitoring parameters at the center of the symbol. Thus, unlike in the case of using the technique based on the asynchronous amplitude histogram (AAH), this technique is not affected by the transient characteristics of the modulated signals. The performance of the proposed monitoring technique is evaluated experimentally by using 10-Gbaud quadrature phase-shift keying (QPSK) and quadrature amplitude modulation (QAM) signals over wide ranges of OSNR and CD. We also evaluate the robustness of the proposed technique to the signal's transient characteristics.

Efficacy and safety of topical glycopyrrolate in patients with facial hyperhidrosis: a randomized, multicentre, double-blinded, placebo-controlled, split-face study

BACKGROUND

Although facial hyperhidrosis has been frequently associated with a diminished quality of life, various conservative modalities for its management are still far from satisfactory.

OBJECTIVE

To evaluate the antiperspirant efficacy and safety of the topical glycopyrrolate on facial hyperhidrosis at specified posttreatment intervals.

METHODS

Thirty-nine patients with facial hyperhidrosis were enrolled and treated with 2% topical glycopyrrolate on one-half of the forehead, whereas the other half of the forehead was treated with a placebo. All patients applied topical glycopyrrolate or placebo once a day for nine successive days. Each evaluation included weighing sweat and assessing the Hyperhidrosis Disease Severity Scale (HDSS) score and any adverse effects.

RESULTS

Compared with the placebo-treated sides, topical glycopyrrolate-treated sides showed a reduction in the rate of sweat production at the forehead of 25.16 ± 10.30% (mean ± SD) at 90 min after the first application (day 1), 29.63 ± 7.74% at 24 h after the first application (day 2) and 36.68 ± 11.41% at 24 h after eight additional successive daily applications (day 10) (all P < 0.025). There was a little more decrease in HDSS score with the topical glycopyrrolate-treated half of the forehead, but the difference was not statistically significant (P > 0.025). No serious adverse events were reported during the course of this study. Only one patient developed a transient headache after treatment.

CONCLUSION

Topical glycopyrrolate application appears to be significantly effective and safe in reducing excessive facial perspiration.

Achievable capacity improvement by using multi-level modulation format in trench-assisted multi-core fiber system

We evaluate the impacts of using multi-level modulation formats on the transmission capacity of the multi-core fiber (MCF) having trench-assisted index profile and hexagonal layout. For this evaluation, we utilize the spectral efficiency per unit area, defined as the spatial spectral efficiency (SSE). The results show that the SSE improvement achievable by using the higher-level modulation format can be reduced due to its lower tolerance to the inter-core crosstalk. We also evaluate the effects of using large effective area on the transmission capacity of the trench-assisted MCF. The results show that the use of large effective area can decrease this capacity due to the increased inter-core crosstalk and lengthened cable cutoff wavelength, although it can help increase the transmission distance. Thus, it is necessary to optimize the effective area of MCF by considering both the SSE and transmission distance. However, the results indicate that the effect of using different effective areas on the SSE-distance product is not significant, and it is not useful to increase the effective area of the trench-assisted MCF to be larger than ~110 μm(2).

Solubility and stability of melatonin in propylene glycol and 2-hydroxypropyl-beta-cyclodextrin vehicles

The physicochemical properties of melatonin (MT) in propylene glycol (PG) and 2-hydroxypropyl-beta-cyclodextrin (2-HPbetaCD) vehicles were characterized. MT was endothermally decomposed as determined by differential scanning calorimetry (DSC). Melting point and heat of fusion obtained were 116.9+/-0.24 degrees C and 7249+/-217 cal/mol, respectively. MT as received from a manufacture was very pure, at least 99.9%. The solubility of MT in PG solution increased slowly until reaching 40% PG and then steeply increased. Solubility of MT increased linearly as concentration of 2-HPbetaCD without PG increased (R(2)=0.993). MT solubility in the mixtures of PG and 2-HPbetaCD also increased linearly but was less than the sum of its solubility in 2-HPbetaCD and PG individually. The MT solubility was low in water, simulated gastric or intestinal fluid but the highest in the mixture of PG (40 v/v%) and 2-HPbetaCD (30 w/v%) although efficiency of MT solubilization in 2-HPbetaCD decreased as the concentration of PG increased. MT was degraded in a fashion of the first order kinetics (r(2)>0.90). MT was unstable in strong acidic solution (HCl-NaCl buffer, pH 1.4) but relatively stable in other pH values of 4 approximately 10 at 70 degrees C. In HCl-NaCl buffer, MT in 10% PG was more quickly degraded and then slowed down at a higher concentration. However, the degradation rate constant of MT in 2-HPbetaCD was not changed significantly when compared to the water. The current studies can be applied to the dosage formulations for the purpose of enhancing percutaneous absorption or bioavailability of MT.

Phasor monitoring of DxPSK signals using software-based synchronization technique

We develop a novel phasor monitor to obtain the constellation diagram from asynchronously sampled data measured by using the delay-detection technique. This phasor monitor consists of three parts; a phase-adjustment-free delay-interferometer, an optical front-end made of three photodetectors, and analog-to-digital (A/D) convertors, and a digital signal processor. We operate the A/D convertor at the sampling rate much slower than the symbol rate and acquire the data asynchronously. However, despite the use of such a slow and asynchronous sampling rate, we obtain the clear eye and constellation diagrams by utilizing the software-based synchronization technique based on a novel phased-reference detection algorithm. Thus, the proposed phasor monitor can be implemented without using high-speed A/D convertors and buffer memories, which have been the major obstacles for the cost-effective realization of the phasor monitor. For a demonstration, we realize the proposed phasor monitor by using an A/D converter operating at 9.77 MS/s and used it for the constellation monitoring and bit-error-rate (BER) estimation of 10.7-Gsymbol/s differential quadrature phase-shift keying (DQPSK) and differential 8-ary phase-shift keying (D8PSK) signals.

Seasonal variations of marine algal community in the vicinity of Uljin nuclear power plant, Korea

Three marine algal sites were examined seasonally in an area of thermal discharge from the Uljin nuclear power plant in Korea to assess possible impacts from thermal stress. Quadrat samples were taken at three sites: cooling water intake, outfall and Chukbyon. The degree of wave exposure increased from intake, outfallto Chukbyon. Percent cover and biomass were response variables. All sites were, by numbers red algae, followed by brown and green algae. Over the year the maximum species diversity was also found at the Chukbyon (2.39), but the minimal one (1.67) was observed at the outfall. Seasonally generally among algal form-functional groups, filamentous and coarsely branched algae were most abundant throughout the year at the three sites. The numberof species in the jointed calcareous groups increased remarkably at the outfall. Based on these results, species richness appears tobe strongly affected by wave exposure and thermal stress. The higher proportion of calcareous form groups at the outfall sites indicates that these species are better adapted morphologically to thermal stress such as high temperatures.

The effect of beta-cyclodextrin complexation on the bioavailability and hepatotoxicity of clotrimazole

Clotrimazole, a poorly water-soluble antimycotic agent, is a promising therapeutic agent for various diseases including cancer and sickle cell anemia. The oral bioavailability and hepatic toxicity of clotrimazole were compared with its beta-cyclodextrin inclusion form which was prepared by the spray-drying method. The inclusion complex gave significantly higher initial plasma concentrations, Cmax and AUC than did clotrimazole alone, indicating that the drug from the inclusion compound could be more easily absorbed in rats. Furthermore, mice treated with the inclusion compound showed significantly higher GOT/GPT values compared to clotrimazole alone. The inclusion compound also induced hypertrophy of hepatic cells by fat accumulation and disappearance of hepatic sinusoids, indications of pathological changes of liver, suggesting that the inclusion compound could induce more severe tissue damage in the liver than clotrimazole alone. Thus, hepatotoxicity of clotrimazole seems to be correlated with the enhanced oral bioavailability by inclusion complexation. Our results suggest that, in the development of a novel oral product, appearance or enhancement of hepatic toxicity must be considered along with oral bioavailability.

In vitro skin penetration and pharmacodynamic evaluation of prostaglandin E1 ethyl ester, a vasoactive prodrug of prostaglandin E1, formulated into alcoholic hydrogels

Alcoholic hydrogels containing prostaglandin E1 ethyl ester (PGE1-EE), a prodrug of PGE1 as a therapeutic agent for erectile dysfunction, were formulated. The prodrug was stable against chemical hydrolysis in aqueous solution (pH 7.4), devoid of esterase activities, but was hydrolyzed to the parent drug in rat skin homogenates within 240 min. In the rat skin penetration study for 24 h, the steady-state flux values (microg/cm2/h) of PGE1-EE and PGE, from alcoholic hydrogels having 20% ethanol content were 7.6 and 1.8, respectively. PGE1-EE was superior to PGE, from a skin penetration point of view due to its increased lipophilicity. The fastest skin penetration rate was obtained for PGE1-EE in 20% alcoholic hydrogel together with limonene or cineole. These formulations increased the flux of PGE1-EE up to about 4-fold compared to control hydrogel in the absence of penetration enhancers. In the pharmacodynamic study using a cat, alcoholic hydrogel with limonene or cineole showed a significant effect in terms of increasing intracavernosal pressure compared to control hydrogel. Therefore, the transdermal alcoholic hydrogel formulation of PGE1-EE with limonene or cineole can be a promising transdermal delivery system to overcome inconvenience associated with frequent intracavernosal injections for the treatment of erectile dysfunction.

Effects of hwangryunjihwang-tang on in vitro ertilization and ovulation in mice fed a high-fat diet

It has been generally accepted that hwangryunjihwang-tang (h-tang) is a useful prescription for treating polydipsia and to prevent obesity induced by a high-fat diet. The aim of this study was to clarify whether h-tang improved reproductive dysfunction caused by obesity in mice. Mice were fed a high density protein and lipid diet for 4 weeks, followed by administration of h-tang at 480 mg/kg body weight per day for 4 days. Thereafter, changes of body weight, ovulation rate, in vitro and in vivo fertilization, embryonic development and implantation rate were measured. H-tang markedly reduced the body weight of obese mice fed a high-fat diet, but not mice fed a normal diet. H-tang significantly improved ovulation rates, in vitro and in vivo fertilization rates and embryonic development. These results indicate pharmacological reversal of reproductive dysfunction caused by obesity, perhaps by adjusting internal secretions and metabolic functions.

Time course of expression of mRNA of inducible nitric oxide synthase and generation of nitric oxide by ultraviolet B in keratinocyte cell lines

BACKGROUND

Nitric oxide (NO), the ubiquitous free radical, has been implicated in the pathogenesis of various inflammatory diseases, including sunburn and ultraviolet (UV) radiation-induced pigmentation, and it also seems to play an important part in host defence against bacterial infection.

OBJECTIVES

The purpose of this study was to determine the time course of production of NO and time course of expression of inducible NO synthase (iNOS) by UVB irradiation and lipopolysaccharide (LPS) stimulation in keratinocyte cell lines. Furthermore, we intended to elucidate the relationship between iNOS and NO in various stimulated conditions.

METHODS

Normal human keratinocytes (NHK), HaCaT cells and PAM212 cells were irradiated with UVB at a dose of 50 mJ cm-2 and 100 mJ cm-2. Separately, the cell lines were stimulated with 20 micro g of LPS. NO was measured by the Griess assay and iNOS mRNA was isolated by reverse transcriptase-polymerase chain reaction at 12, 24, 48 and 72 h after stimulation.

RESULTS

The generation of NO was induced by UVB irradiation and LPS stimulation. NO production was significantly increased at 72 h after irradiation of UVB 100 mJ cm-2 in NHK, and at 48 and 72 h in HaCaT cells. In PAM212 cells, NO production was significantly increased at 12, 24, 48 and 72 h by UVB 100 mJ cm-2 and at 72 h by LPS. Induction of iNOS mRNA peaked at 48 h and then decreased to basal level at 72 h when treated with UVB irradiation. The time course of production of NO was approximately correlated with the timing of induction of iNOS mRNA.

CONCLUSIONS

These results suggest that the expression of iNOS mRNA is upregulated by UVB irradiation, and that NO produced by this inducible enzyme may play a part as a mediator or an immunomodulator in UV-induced skin reactions such as sunburn reaction and photo-induced immune alterations.

Color image detection by biomolecular photoreceptor using bacteriorhodopsin-based complex LB films

A biomolecular photoreceptor consisting of bacteriorhodopsin (bR)-based complex Langmuir-Blodgett (LB) films was developed for color image detection. By mimicking the functions of the pigments in retina of human visual system, biomolecules with photoelectric conversion function were chosen and used as constituents for an artificial photoreceptor. bR and flavin were deposited onto the patterned (9-pixelized) ITO glass by LB technique. A 9-pixel biomolecular photoreceptor was fabricated with a sandwich-type structure of ITO/LB films/electrolyte gel/Pt. Since each functional molecule shows its own response characteristic according to the light illumination in the visible region, the simplified knowledge-based algorithm for interpretation of the incident light wavelength (color) was proposed based on the basic rule describing the relationship between the photoelectric response characteristics and the incident light wavelength. When simple color images were projected onto the photoreceptor, the primary colors in visible light region, red, green, and blue were clearly recognized, and the projected color images were fairly well reproduced onto the color monitor by the proposed photoreceptor with the knowledge-based algorithm. It is concluded that the proposed device has a capability of recognizing the color images and can be used as a model system to simulate the information processing function of the human visual system.

Visual information processing using bacteriorhodopsin-based complex LB films

Image extraction and visual information processing using bacteriorhodopsin (bR)-based bioelectronic devices is presented. Image extraction was achieved using a photoreceptor consisting of bR and spiropyran films. The undesired signals from the photoreceptor were automatically eliminated from the whole signal by spiropyran films acting as an optical noise filter that increases the target signal to an undesired signal ratio. For the information processing, the photoreceptor consisting of bR and lipid films deposited with different configurations was used and the target signals were processed to achieve the pattern recognition. The pattern recognition was based on not only the response variability of bacteriorhodopsin, induced by different film configurations, but also on the initial learning process. The input patterns were predicted by simple calculation with the known signals through the initial learning process.

Effect of sodium chloride on the gelation temperature, gel strength and bioadhesive force of poloxamer gels containing diclofenac sodium

Liquid suppository systems composed of poloxamers and bioadhesive polymers were easy to administer to the anus and mucoadhesive to the rectal tissues without leakage after the dose. However, a liquid suppository system containing diclofenac sodium could not be developed using bioadhesive polymers, since the drug was precipitated in this preparation. To develop a liquid suppository system using sodium chloride instead of bioadhesive polymers, the physicochemical properties such as gelation temperature, gel strength and bioadhesive force of various formulations composed of diclofenac sodium, poloxamers and sodium chloride were investigated. The mixtures of P 407 (15%) and P 188 (15-20%) existed as a liquid at room temperature, but gelled at physiological temperature. Diclofenac sodium significantly increased the gelation temperature and weakened the gel strength and bioadhesive force, while sodium chloride did the opposite. Furthermore, the poloxamer gels with less than 1.0% of sodium chloride, in which the drug was not precipitated, were inserted into the rectum of rabbits without difficulty and leakage, and retained in the rectum of rats for at least 6 h. Our results suggested that a thermosensitive liquid suppository system with sodium chloride and poloxamers was a more physically stable and convenient rectal dosage form for diclofenac sodium.

Terfenadine-beta-Cyclodextrin inclusion complex with antihistaminic activity enhancement

Terfenadine, an antihistaminic drug, has relatively low bioavailability after oral administration due to its limited solubility in water. To enhance the antihistaminic activity of terfenadine, the terfenadine-beta-cyclodextrin (1:2) inclusion complex was prepared by the neutralization method. The solubility and dissolution of the inclusion complex were carried out, and its antihistaminic activity was then evaluated and compared with terfenadine powder by the passive subcutaneous anaphylaxis method in rats. The formation constant of the inclusion complex was higher at lower pH, while its formation ratio was 1:2 irrespective of pH. For terfenadine, it improved the solubility 200 times and the dissolution rate 5 times. It gave a low histamine level at 30 min, followed by a sustained low level until 60 min, while terfenadine powder gave a low histamine level at 60 min, suggesting that it had faster and more effective antihistaminic activity than terfenadine powder in rats due to fast dissolution and absorption of terfenadine. It is concluded that this inclusion complex enhanced the antihistaminic activity of terfenadine following the enhanced solubility and dissolution of terfenadine.

Development of a novel dosage form for intramuscular injection of titrated extract of Centella asiatica in a mixed micellar system

Titrated extract of Centella asiatica (TECA), a drug used in treating systemic scleroderma, is poorly water-soluble. A conventional dosage form for the intramuscular injection of TECA, propylene glycol (PG)-based TECA solution, causes severe pain after intramuscular injection. To improve the solubility of TECA and reduce pain after injection, mixed micellar systems composed of 10% surfactant mixture (Tween 20 and Tween 85) and 90% phosphate-buffered saline, pH 7.0 (PBS) were prepared. As the ratio of Tween 20 to Tween 85 increased from 0:10 to 10:0, the solubility of TECA in the mixed micellar systems increased from 7- to 26-fold compared to that in PBS (pH 7.0). The droplet size of micelles gradually decreased with the increasing ratio of Tween 20 to Tween 85 from 0:10 to 4:6, followed by an abrupt decrease in size above the ratio of 6:4. Furthermore, the micellar systems prepared with Tween 20 and Tween 85 at the ratio of 6:4, 8:2 or 10:0 could solubilize TECA more than 10 mg/ml and the resultant droplet sizes were less than 2 microm. No significant changes were observed in the droplet sizes and asiaticoside contents in these micellar formulations during storage, indicating these systems are stable for at least 60 days. Their osmotic pressures were remarkably lower than those of PG-based TECA solution and similar to that of saline solution, irrespective of dilution ratios. Most importantly, they markedly reduced the number of writhes compared with PG-based TECA solution after injection to mice. All of these results suggest that these three TECA micellar formulations prepared with Tween 20 and Tween 85 improved the solubility of TECA and reduced pain following injection, possibly due to the decrease in osmotic pressure. Thus, these micellar formulations composed of optimum ratios of Tween 20 and Tween 85 may have a potential as dosage forms for the intramuscular injection of a poorly water-soluble TECA.

Bioavailability of cyclosporin A dispersed in sodium lauryl sulfate-dextrin based solid microspheres

The purpose of this work was to develop a solid dispersion system containing cyclosporin A (CsA) in order to improve the bioavailability of poorly water-soluble CsA. Solid dispersion systems that are spherical in shape (CsA-microspheres) were prepared with varying ratios of CsA/sodium lauryl sulfate/dextrin using a spray-drying technique. The effects of sodium lauryl sulfate (SLS) and dextrin on the dissolution of CsA dispersed in SLS-dextrin based solid microspheres were investigated. The bioavailability of CsA-microspheres was compared with CsA powder alone and commercial Sandimmun in dogs. SLS significantly enhanced the dissolution of CsA from microspheres, while dextrin did not affect this. The CsA-microspheres at the CsA/SLS/dextrin ratio of 1/3/1, which gave the highest dissolution rate of CsA among the formula treated, was selected as an optimal formula for oral delivery. This formula gave significantly higher blood levels, area under the drug concentration-time curve (AUC) and maximum blood concentration of drug (Cmax) of CsA in dogs compared with the CsA powder alone. The AUC, Cmax and time to reach maximum blood concentration (Tmax) of CsA with CsA-microspheres was not significantly different from those after oral administration of Sandimmun, suggesting the similar bioavailability to Sandimmun in dogs. Our study demonstrates that the CsA-microspheres prepared with SLS and dextrin, with improved bioavailability of CsA, would be useful to deliver a poorly water-soluble CsA and could be applicable to other poorly water-soluble drugs.

Physicochemical characterization and evaluation of buccal adhesive tablets containing omeprazole

The objective of this study was to develop an effective omeprazole buccal adhesive tablet with excellent bioadhesive force and good drug stability in human saliva. The omeprazole buccal adhesive tablets were prepared with various bioadhesive polymers, alkali materials, and croscarmellose sodium. Their physicochemical properties, such as bioadhesive force and drug stability in human saliva, were investigated. The release and bioavailability of omeprazole delivered by the buccal adhesive tablets were studied. As bioadhesive additives for the omeprazole tablet, a mixture of sodium alginate and hydroxypropylmethylcellulose (HPMC) was selected. The omeprazole tablets prepared with bioadhesive polymers alone had bioadhesive forces suitable for a buccal adhesive tablet, but the stability of omeprazole in human saliva was not satisfactory. Among alkali materials, only magnesium oxide could be an alkali stabilizerfor omeprazole buccal adhesive tablets due to its strong waterproofing effect. Croscarmellose sodium enhanced the release of omeprazole from the tablets; however, it decreased the bioadhesive forces and stability of omeprazole tablets in human saliva. The tablet composed of omeprazole/sodium alginate/HPMC/magnesium oxide/croscarmellose sodium (20/24/6/50/10 mg) could be attached on the human cheek without disintegration, and it enhanced the stability of omeprazole in human saliva for at least 4 h and gave fast release of omeprazole. The plasma concentration of omeprazole in hamsters increased to a maximum of 370 ng/ml at 45 min after buccal administration and continuously maintained a high level of 146-366 ng/ml until 6 h. The buccal bioavailability of omeprazole in hamsters was 13.7% +/- 3.2%. These results demonstrate that the omeprazole buccal adhesive tablet would be useful for delivery of an omeprazole that degrades very rapidly in acidic aqueous medium and undergoes hepatic first-pass metabolism after oral administration.

Do nonlinearities play a significant role in short term, beat-to-beat variability?

Numerous studies of short-term beat-to-beat variability in cardiovascular signals have not resolved the debate about the completeness of linear analysis techniques. This aim of this paper is to evaluate further the role of nonlinearities in short-term, beat-to-beat variability. We compared linear autoregressive moving average (ARMA) and nonlinear neural network (NN) models for predicting instantaneous heart rate (HR) and mean arterial blood pressure (BP) from past HR and BP. To evaluate these models, we used HR and BP time series from the MIMIC database. Experimental results indicate that NN-based nonlinearities do not play a significant role and suggest that ARMA linear analysis techniques provide adequate characterization of the system dynamics responsible for generating short-term, beat-to-beat variability.

Development of omeprazole buccal adhesive tablets with stability enhancement in human saliva

To develop an omeprazole buccal adhesive tablet, the absorption of omeprazole solutions from human oral cavity was evaluated and the physicochemical properties such as the bioadhesive forces of various omeprazole tablet formulations composed of bioadhesive polymers and alkali materials, and the stability of omeprazole tablets in human saliva were investigated. About 23% of the administered dose was absorbed from the oral cavity at 15 min after the administration of omeprazole solutions (1 mg/15 ml). A mixture of sodium alginate and HPMC was selected as the bioadhesive additive for the omeprazole tablet. Omeprazole tablets prepared with bioadhesive polymers alone had the bioadhesive forces suitable for buccal adhesive tablets, but the stability of omeprazole in human saliva was not satisfied. Among alkali materials, only magnesium oxide could be an alkali stabilizer for omeprazole buccal adhesive tablets due to its strong waterproofing effect. Two tablets composed of [omeprazole/sodium alginate/HPMC/magnesium oxide (20/24/6/50, mg/tab)] and [(20/30/0/50, mg/tab)] were suitable for omeprazole buccal adhesive tablets which could be attached to human cheeks without collapse and could be stabilized in human saliva for at least 4 h. It was concluded that these two formulae were potential candidates for the subject of further study for the development of omeprazole buccal adhesive tablets.

Development of terfenadine-pseudoephedrine double-layer tablet dissolution-equivalent to core tablet

The terfenadine-pseudoephedrine dosage form discussed here is the sustained-release core tablet composed of outer (fast-release) and inner (sustained-release) layers. To develop the double-layer tablet dissolution-equivalent to a core tablet, the fast-release and sustained-release layers were prepared using various disintegrants and polymers, respectively. The layer composed of terfenadine/pseudoephedrine/lactose/cornstarch/sodium bicarbonate/hydroxypropylcellulose (HPC)/sodium lauryl sulfate/microcrystalline cellulose (60/10/90/30/20/1/40/1/293 mg), which gave the fast disintegration time and high dissolved amounts of drugs, was selected as the fast-release layer. The dissolved amounts of pseudoephedrine from sustained-release layers increased more with a smaller ratio of ethylcellulose and hydroxypropylmethylcellulose (HPMC). Dissolution mechanism analysis showed the release of pseudoephedrine was proportional to the square root of time, indicating that drug might be released from the layers by Fickian diffusion. The layer composed of pseudoephedrine/ethylcellulose/HPMC (110/30/155 mg), which had similar dissolution amounts of pseudoephedrine as the inner layer of a core tablet, was selected as the sustained-release layer. Furthermore, the dissolved amounts of drugs from the core and double-layer tablets had deviations of less than 5% against the average dissolved amounts of drugs at each time. There was no significant difference between the dissolved amounts of drugs from these tablets at each time in pH 1.2, 4.0, and 6.8 (P > .05). Our results suggest that this double-layer tablet was a dissolution equivalent to the core tablet.

Application of dry elixir system to oriental traditional medicine: taste masking of peonjahwan by coated dry elixir

Peonjahwan, an oriental traditional medicine composed of crude herbal drugs and animal tissues is bitter and poorly water-soluble. To mask the bitterness of peonjahwan and enhance the release of bilirubin, one of the crude active ingredients of peonjahwan, peonja dry elixir (PDE), was prepared using a spray-dryer after extracting the crude materials in ethanol-water solution. Coated peonja dry elixir (CPDE) was then prepared by coating the PDE with Eudragit acrylic resin. Panel assessed bitterness and release test of bilirubin from PDE and CPDE were carried out and compared with peonjahwan alone. PDE was found to have little effect upon the reduction of the bitterness of peonjahwan. However, the bitterness of CPDE was found to reduce to 1/4 of that of peonjahwan due to the encapsulation of crude active ingredients by the dextrin and Eudragit shell (P<0.05). The release rate of bilirubin from PDE and CPDE for 60 min increased about 3.5- and 2.5- fold, respectively, compared to peonjahwan at pH 1.2. It is concluded that CPDE, which masked the bitterness of peonjahwan and enhanced the release of bilirubin, is a preferable delivery system for peonjahwan.

Hair restoration surgery in patients with hypotrichosis of the pubis: the reason and ideas for design

BACKGROUND

Hypotrichosis of the pubis is not an uncommon condition, especially in oriental women. Besides the aesthetic problem, this condition may cause low self-esteem, social embarrassment, and psychologic problems to patients. There have been many efforts to correct this condition medically and surgically for decades. Among them hair restoration surgery is thought to be the only definitive therapeutic modality at present.

OBJECTIVE

Our purpose was to show the importance of preoperative evaluation of what type of pubic hair patterns the patients may seek and thereafter to make a design based on the patients' desire and physiologic feature of pubic hair for the natural-appearing results and satisfaction of the patients.

METHODS

Ten female patients were enrolled in this study aged between 23 and 48 years with pubic hair maturity index class I-III. For selection of a patients' favored pubic hair pattern, we provided photograph samples of pubic hair patterns that consisted of four types as previously documented: horizontal, sagittal, acuminate, and disperse. We restored hairless mons using a conventional one- to three-haired mini-micrograft technique.

RESULTS

Five patients belonged to the pubic hair maturity index class I, four to class II, and one to class III. Seven of 10 patients wanted a horizontal (inverted triangular) type, which is most commonly seen in young females, 2 patients wanted acuminate, and 1 wanted sagittal. Eight patients underwent a single-session operation, while two others underwent operations twice. The two patients requiring two operation sessions belonged to a group of class I pubic hair and desired acuminate-type hair. Most patients were satisfied with the results of their operations.

CONCLUSION

In designing a pubic hair graft, it is important to know the patients' desire and to make a design based on it for the satisfaction of the patients and for natural-appearing results. Before the procedure, dermatologic surgeons should have to consider a grafted hair line, the distribution, density, and directions of the hair shaft, and the angling of the hair to the skin.

Prolonged systemic delivery of streptokinase using liposome

To prolong the biological half-life of streptokinase, a thrombolytic agent, streptokinase-bearing liposome with and distearolyphosphatidyl ethanolamine-N-poly (ethylene glycol) 2000 (DSPE-PEG 2000) was prepared and evaluated. Streptokinase-bearing liposomes composed of distearolyphosphatidylcholine (DSPC), cholesterol and cholesterol-3-sulfate with DSPE-PEG 2000 was prepared by the freeze-thawing method and administered via femoral vein to rats (15,000 IU/kg). The activity of streptokinase in plasma was determined by the method based on the amidolytic activity of streptokinase-plasminogen complex. Pharmacokinetic parameters of streptokinase incorporated in liposomes were compared with those of streptokinase alone. The T1/2 and AUCinfinity of streptokinase incorporated in DSPC-PEG liposome increased 16.3- and 6.1-fold, respectively, compared with those of streptokinase alone. Streptokinase-bearing long-circulating liposome could increase the circulation time of streptokinase in blood and expect longer thrombolytic activity compared with streptokinase alone.

Epidural morphine plus ketamine for upper abdominal surgery: improved analgesia from preincisional versus postincisional administration

Increased postoperative pain may be caused by central nervous system plasticity, which may be related to actions of N-methyl-D-aspartic acid (NMDA) receptors on neurons in the dorsal horn of the spinal cord. Opioids act mainly on presynaptic receptors and reduce neurotransmitter release, while ketamine antagonizes NMDA receptors and prevents wind-up and long-term potentiation. Thus, we postulated that central nervous system sensitization would be prevented more effectively by the preoperative use of these two drugs simultaneously, and the effect of preemptive analgesia would be demonstrated. Ketamine, 60 mg, and morphine, 2 mg, were injected epidurally through an indwelling catheter that was inserted at the T7-8 interspace in 60 ASA physical status class 1-2 patients. The drugs were injected before induction of anesthesia (Group 1; n = 30) or immediately after removal of a surgical specimen (Group 2; n = 30). An additional 2 mg of morphine was injected when the patients complained of resting pain. The analgesic effect was assessed by the time from first analgesic injection to second dose and the number of patients who needed supplemental injections. Complications were also noted. The duration of analgesia was longer (P < 0.01) in Group 1 (31.1 +/- 16.0 h) than in Group 2 (21.1 +/- 12.0 h), and the proportion of patients who needed supplemental injections was decreased (P < 0.05) in Group 1 (56.7%) compared with Group 2 (90.0%). The incidence of adverse effects was not different between the two groups. In conclusion, preoperative administration of morphine and ketamine is more effective in reducing postoperative pain than it is when given during the operation.

Toxoplasma antibody titers by ELISA and indirect latex agglutination test in pregnant women

The seroepidemiologic studies on anti-Toxoplasma antibody titers were carried out using ELISA and indirect latex agglutination test. Among 899 sera prepared from pregnant women, 39 cases (4.3%) revealed positive reaction and 218 sera from middle school students showed 4 positive reaction (1.8%) by ELISA. By LAT (newly established by National Veterinary Research Institute. Korea), the sera of 7 pregnant women (0.8%) showed positive reaction. When 80 sera showing > or = 1:8 by LAT were used for comparing the results obtained from LAT and Toxotest-MT (Eiken Chemical Co., Japan), 7 cases and 8 sera were positive, respectively. All of 11 sera of proven toxoplasmosis patients showed positive reaction in both tests. Overall proportion of agreement between LAT kit and Toxotest-MT was 0.94 (kappa-index = 0.632, p < 0.011, and LAT was considered to be useful for the screening of toxoplasmosis.

Multiresolution segmentation of respiratory electromyographic signals

Analysis of respiratory electromyographic (EMG) signals in the study of respiratory control requires the detection of burst activity from background (signal segmentation), and focuses upon the determination of onset and cessation points of the burst activity (boundary estimation). This paper describes a new automated multiresolution technique for signal segmentation and boundary estimation. During signal segmentation, a new transitional segment is defined which contains the boundary between background and burst activity. Boundary estimation is then performed within this transitional segment. Boundary candidates are selected and a probability is attributed to each candidate, using an artificial neural network. The final boundary for a given transitional segment is the boundary estimate with the maximum a posteriori probability. This new method has proved accurate when compared to boundaries chosen by two investigators.

Respiratory muscle activities after birth in asphyxiated preterm lambs

Laryngeal and pump muscle activities are important in the establishment and maintenance of functional residual capacity (FRC) after birth. The aim of this study was to determine the expiratory mechanisms by which laryngeal and diaphragmatic activities achieve the increments in FRC postnatally. Wire electrodes were placed in: the laryngeal abductor, a major laryngeal adductor, the inferior pharyngeal constrictor and the diaphragm of six fetal sheep. The lambs were delivered prematurely by cesarean section and a face mask with a pneumotachograph applied. A grunting respiratory pattern was characterized by severe expiratory airflow retardation, associated with laryngeal adductor activity. In grunting breaths, minimal volume loss at end-expiration and incremental increases in FRC occurred when the onset of diaphragmatic activity preceded the onset of laryngeal muscle activities associated with laryngeal opening. Thus the timing order of laryngeal and diaphragmatic muscle activities near end-expiration is a determinant of increments in FRC.

Laryngeal and diaphragmatic muscle activities and airflow patterns after birth in premature lambs

The nature and control of early neonatal respiratory patterns were determined in 10 premature, asphyxiated lambs. Severe retardation of early expiratory airflow (braking) characterized an initial pattern (A), but was absent in a final one (B). During a transition pattern (pattern T), pattern A and B airflow types occurred. Close temporal relationships between the airflow patterns and posterior cricoarytenoid (PCA), thyroarytenoid (TA), and diaphragm (D) integrated muscle activities were demonstrated quantitatively. Specifically, in pattern A, the duration of braked expiratory airflow was related to the durations of TA burst activity and the absence of PCA burst activity (r2 = 0.99). In pattern A, pH, but not arterial PCO2 or arterial PO2, differed from that in patterns T and B [7.01 +/- 0.14 (A), 7.11 +/- 0.12 (T), 7.19 +/- 0.08 (B) (P < 0.03)]. Within-breath airflow and respiratory muscle activity relationships and differences in neural and mechanical respiratory timing intervals between patterns suggested that neural feedback was important in the control of central pattern generation. Thus activities of PCA, TA, and D shape the early neonatal airflow patterns and are influenced mainly by neuromechanical, and not chemical, feedback.

Role of receptor complexes in resistance or sensitivity to growth inhibition by TGF beta in intestinal epithelial cell clones

Untransformed rat intestinal epithelial cells (IEC-18) were chemically mutagenized, selected in the presence of TGF beta 1, and cloned by limiting dilution. Two clones (4-5, 4-6) were resistant to growth inhibition by both TGF beta 1 and TGF beta 2. Another clone (4-1) was more sensitive to both TGF beta isoforms (relative to parental IEC-18 cells). IC50 values for TGF beta 1 and 2 in the 4-1 cells were at least 1/9 those of the parental cells; growth rates were reduced by 49% for TGF beta 1 and by 26% for TGF beta 2 in this clone. This increased sensitivity to TGF beta was explained by the 5- to 10-fold increase, relative to parental cells, in binding of TGF beta 1 and TGF beta 2 to both the type I and II receptors. In contrast, the resistance to growth inhibition by TGF beta in the 4-5 and 4-6 cells could not be explained by a decrease in either TGF beta binding affinities or in total number of receptors expressed, by the presence of serum binding components, or by occupation of receptor binding sites with autocrine TGF-beta 1. However, in comparison to TGF beta-sensitive cells (IEC-18, 4-1), the resistant cells displayed a higher ratio of type II relative to type I receptor binding by TGF-beta 1. Thus, a critical ratio of binding to receptor subtypes correlated with growth inhibition by TGF-beta 1. Resistance to TGF-beta 2 in the same clones did not appear to be receptor related. Thus, different mechanisms for resistance to TGF-beta 1 and TGF-beta 2 were observed within a given clone.

Inhibitory effects of transforming growth factor beta 1 on mitogenic response, transforming growth factor alpha, and c-myc in quiescent, well-differentiated colon carcinoma cells

Previously, we reported that exponentially proliferating cultures of well-differentiated human colon carcinoma cells responded to transforming growth factor beta 1 (TGF-beta) with growth inhibition, alterations in morphology, and increased secretion of the differentiation marker, carcinoembryonic antigen. Poorly differentiated cultures were unresponsive. Here we show that TGF-beta was ineffective in repressing nutrient-stimulated mitogenesis in quiescent, poorly differentiated cells. However, in quiescent, well-differentiated cells, TGF-beta repressed the mitogenic responses to both nutrients alone (by 90%) and to nutrients plus the exogenous stimulatory factors epidermal growth factor (E), insulin (I), and transferrin (T) (by 55-65%). Thymidine incorporation experiments indicated that TGF-beta reduced both the onset and peak mitogenic response to growth factors and/or nutrients in the well-differentiated cells. Additionally, TGF-beta repressed the growth factor (E + I + T)-stimulated upregulation of expression of both c-myc and of transforming growth factor alpha (TGF-alpha) mRNAs in quiescent, well-differentiated cells. TGF-beta also elicited a rapid (t1/2 approximately 1h) down-regulation of c-myc expression in the absence of prior growth factor (E + I + T) stimulation. In contrast, TGF-beta had no effect on c-myc or TGF-alpha mRNA expression in the poorly differentiated cells. The results suggest that TGF-beta exerts rapid inhibitory effects on proliferation-associated genes in quiescent and restimulated, well-differentiated cells. Expression of these genes (c-myc and TGF-alpha) may otherwise (in the absence of TGF-beta) play roles in the cellular signaling of mitogenic responses by growth stimulatory factors in well-differentiated colon carcinoma cells.

Evidence for c-myc in the signaling pathway for TGF-beta in well-differentiated human colon carcinoma cells

Previously, we described a model culture system for comparing responsiveness of poorly differentiated and well-differentiated human colon carcinoma cells to exogenous growth factors. While polypeptide growth stimulators elicited an up-regulation of c-myc, as well as a mitogenic response in the well-differentiated cells, the poorly differentiated cells were insensitive to exogenous growth stimulators. We now show, by thymidine incorporation experiments and autoradiographic analysis, that transforming growth factor beta 1 (TGF-beta) abrogated the mitogenic responses to the growth factors epidermal growth factor + insulin + transferrin (IC50 = 0.8 ng/ml), as well as to nutrients (basal medium; IC50 = 0.2 ng/ml) in the well-differentiated cells. The poorly differentiated cells did not respond to TGF-beta. Moreover, TGF-beta (10 ng/ml) completely abrogated the growth factor-stimulated up-regulation of c-myc in the TGF-beta responsive, well-differentiated colon carcinoma cells. Addition of TGF-beta to the TGF-beta-responsive, well-differentiated cells, at a time after c-myc had been transiently up-regulated in response to growth stimulatory factors, resulted in a loss of responsiveness to TGF-beta. Addition of TGF-beta to these cells at increasing time periods after EIT stimulation also resulted in a loss of the TGF-beta-induced repression of c-myc. The results suggest an important role for c-myc in the mechanism of action of TGF-beta in well-differentiated human colon carcinoma cells.