RESUMEN
INTRODUCTION: Cysts originating from cervical lymphatic ducts are very rare affections. However, they play an important role in the differential diagnosis of supraclavicular masses. The aetiology remains unclear. Practically all cases arise from the thoracic duct; those affecting the right lymphatic duct are encountered very exceptionally. CASE REPORT: In the presented case report of a right lymphatic duct cyst, we analyzed the possible reasons for the diametrically differing incidence of cysts arising from the thoracic duct and those related to the right lymphatic duct. DISCUSSION: The cysts manifest themselves clinically as an otherwise asymptomatic supraclavicular swelling. The diagnosis is based on imaging. High T-lymphocytes and triglyceride levels in an aspirate are pathognomonic. There is no uniform opinion on the therapy. The majority of authors recommend surgical removal. Lymphatic vessels entering the cyst must be intraoperatively ligated to prevent lymph leakage.
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Vasos Linfáticos , Linfocele , Adulto , Humanos , Linfocele/diagnóstico , Linfocele/cirugía , Masculino , CuelloRESUMEN
OBJECTIVES: To investigate the correlation between preoperative non-echo planar diffusion-weighted (non-EPI DWI) MR imaging with surgical findings of recidivous middle ear cholesteatoma after canal wall up (CWU) and canal wall down (CWD) mastoidectomy. BACKGROUND: The detection of recidive cholesteatoma after CWU and after CWD procedures, when the trepanation cavity is spontaneously closed by soft tissue, is possible by second-look and revision surgery. However, many cases prove to be negative of the disease. To avoid unnecessary operational risks we adopted a novel imaging method to evaluate its potential in the detection of recidivous cholesteatoma. MATERIAL AND METHODS: The prospective study included 27 cases. Fifteen cases were revised after CWD and 12 cases were second-look surgeries after CWU procedures. All patients underwent the MR protocol: T2-weighted, T1-weighted and non-EPI DWI. The finding on MR correlated with peroperative presence of cholesteatoma. RESULTS: Non-EPI DWI sequence showed an increased signal intensity in 16/27 (59 %) cases. This correlated with surgical findings in all 7 patients after CWU and in 8 patients after CWD. The overall sensitivity, specificity, positive and negative predictive values of non-EPI DWI were 83.3 %, 88.8 %, 93.8 % and 72.7 %, respectively. DWI presented a sensitivity of 100 % and specificity of 85.7 % in the subgroup of patients after CWD mastoidectomy. CONCLUSION: Residual and/or recurrent cholesteatoma can be accurately detected by DWI MR. It can be used as a screening method to select patients, who are indicated to second-look or revision surgery after CWU and CWD mastoidectomy (Tab. 1, Fig. 3, Ref. 49).
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Colesteatoma del Oído Medio/diagnóstico por imagen , Colesteatoma del Oído Medio/cirugía , Imagen de Difusión por Resonancia Magnética , Conducto Auditivo Externo/diagnóstico por imagen , Conducto Auditivo Externo/cirugía , Imagen Eco-Planar , Complicaciones Posoperatorias/diagnóstico por imagen , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Apófisis Mastoides/diagnóstico por imagen , Apófisis Mastoides/cirugía , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Estudios Prospectivos , Recurrencia , Reoperación , Sensibilidad y Especificidad , Adulto JovenRESUMEN
Recent research suggests that multinodular recurrent pleomorphic adenoma (PA) might result from cell migration through lymphatics. Lymphangiogenesis in malignancies is mediated by vascular endothelial growth factors C and D (VEGF-C/D). We studied the expression of VEGF-C/D in PA by immunohistochemistry as well as lymphatic vessel density (LVD). In 6 non-recurrent, 4 primary-to-recur, and 10 recurrent PAs, VEGF-C/D expression was assessed by immunohistochemistry. Staining was scored in terms of staining intensity (0 = absent to 3 = strong), and the percentage of positive tumor cells (scored as 0 (0-19 %), 1 (20-39 %), 2 (40-50 %), and 3 (60-100 %)) and a sum score were calculated. Intra- and peritumoral LVD was assessed by counting of LV after immunostaining, using the D2-40 antibody. All but one sample were VEGF-C negative. The differences in VEGF-D expression between non-recurrent, primary-to-recur, and recurrent PAs were not significant (p>0.05). VEGF-D expression did not correlate with peritumoral LVD (p>0.05). Our study revealed a significant difference between intra- and peritumoral LVD values when comparing individual and all sample groups (p=0.01). The lack of VEGF-C expression and of significant differences in VEGF-D expression and peritumoral LVD between patients with non-recurrent, primary-to-recur, and recurrent PAs does not support the lymphangiogenic local spread hypothesis
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Adenoma Pleomórfico/patología , Vasos Linfáticos/patología , Recurrencia Local de Neoplasia/patología , Neoplasias de las Glándulas Salivales/patología , Factor C de Crecimiento Endotelial Vascular/análisis , Factor D de Crecimiento Endotelial Vascular/análisis , Adenoma Pleomórfico/química , Adulto , Anciano , Femenino , Humanos , Inmunohistoquímica , Metástasis Linfática , Masculino , Persona de Mediana Edad , Neoplasias de las Glándulas Salivales/químicaRESUMEN
BACKGROUND: Erdosteine was originally developed as a mucolytic agent. It is a multimechanism substance with anti-bacterial, anti-oxidant, and most importantly anti-inflammatory effects. Given similar mechanisms of action (suppression of cytokines, including tumor necrosis factor α), it could become a reasonable alternative to currently used treatments with macrolides or steroids. OBJECTIVE: To assess efficacy and safety of erdosteine in the treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP). METHODOLOGY: A prospective non-interventional post-authorisation study comparing patients treated with erdosteine only or the combination of erdosteine and nasal corticosteroid spray for CRSwNP. The end-points were pre- and post-treatment changes in endoscopic score and subjective evaluation of CRSwNP related symptoms using a 22-item Sinonasal Outcome Test questionnaire. Patients underwent nasal endoscopy and filled the questionnaire before and after the treatment. RESULTS: No patient experienced any adverse effect during the study. A comparison of pre- and post-treatment endoscopic findings and questionnaire values revealed significant reduction in both patient groups, with a significantly better response in the erdosteine only group. CONCLUSION: Based on this pilot study, erdosteine seems effective in the treatment of CRSwNP and might become a reasonable alternative to currently used medication. The therapeutical role of erdosteine needs to be further assessed.
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Expectorantes/uso terapéutico , Pólipos Nasales/tratamiento farmacológico , Rinitis/tratamiento farmacológico , Sinusitis/tratamiento farmacológico , Tioglicolatos/uso terapéutico , Tiofenos/uso terapéutico , Adulto , Anciano , Antiinflamatorios/uso terapéutico , Enfermedad Crónica , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Furoato de Mometasona , Pólipos Nasales/complicaciones , Proyectos Piloto , Pregnadienodioles/uso terapéutico , Estudios Prospectivos , Rinitis/complicaciones , Sinusitis/complicaciones , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Intramuscular haemangiomas of the digastric muscle are often misdiagnosed due to their low incidence and non-specific manifestation. Only two out of six previously reported cases were diagnosed correctly before excision. Ultrasound may not reveal their vascularity, and fine-needle aspiration biopsy is unhelpful as it reveals only blood. METHODS: A case of intramuscular haemangioma of the posterior belly of the digastric muscle is described. Previously reported cases are reviewed. Investigations used to diagnose the lesions and reasons for their common failure are discussed. RESULTS: Core-needle biopsy led to the correct histological diagnosis, and magnetic resonance imaging precisely located the lesion within the digastric muscle. CONCLUSION: Core-needle biopsy was safely used in the diagnosis of an intramuscular haemangioma. The combination of core-needle biopsy and meticulous review of magnetic resonance imaging enables accurate diagnosis pre-operatively.
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Neoplasias de Cabeza y Cuello/diagnóstico , Hemangioma/diagnóstico , Músculos del Cuello/patología , Adulto , Angiografía , Biopsia con Aguja Fina , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/patología , Hemangioma/diagnóstico por imagen , Hemangioma/patología , Humanos , Imagen por Resonancia Magnética , Cuidados Preoperatorios , UltrasonografíaRESUMEN
The insect digestive system is the first line of defence protecting cells and tissues of the body from a broad spectrum of toxins and antinutritional factors in its food. To gain insight into the nature and breadth of genes involved in adaptation to dietary challenge, a collection of 20 352 cDNAs was prepared from the midgut tissue of cowpea bruchid larvae (Callosobruchus maculatus) fed on regular diet and diets containing antinutritional compounds. Transcript responses of the larvae to dietary soybean cystatin (scN) were analysed using cDNA microarrays, followed by quantitative real-time PCR (RT-PCR) confirmation with selected genes. The midgut transcript profile of insects fed a sustained sublethal scN dose over the larval life was compared with that of insects treated with an acute high dose of scN for 24 h. A total of 1756 scN-responsive cDNAs was sequenced; these clustered into 967 contigs, of which 653 were singletons. Many contigs (451) did not show homology with known genes, or had homology only with genes of unknown function in a Blast search. The identified differentially regulated sequences encoded proteins presumptively involved in metabolism, structure, development, signalling, defence and stress response. Expression patterns of some scN-responsive genes were consistent in each larval stage, whereas others exhibited developmental stage-specificity. Acute (24 h), high level exposure to dietary scN caused altered expression of a set of genes partially overlapping with the transcript profile seen under chronic lower level exposure. Protein and carbohydrate hydrolases were generally up-regulated by scN whereas structural, defence and stress-related genes were largely down-regulated. These results show that insects actively mobilize genomic resources in the alimentary tract to mitigate the impact of a digestive protease inhibitor. The enhanced or restored digestibility that may result is possibly crucial for insect survival, yet may be bought at the cost of weakened response to other stresses.
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Cistatinas/toxicidad , Sistema Digestivo/metabolismo , Regulación de la Expresión Génica/efectos de los fármacos , Glycine max/química , Gorgojos/metabolismo , Animales , Perfilación de la Expresión Génica , Genes de Insecto/genética , Datos de Secuencia Molecular , Extractos Vegetales/toxicidad , Gorgojos/genéticaRESUMEN
Insects are capable of readjusting their digestive regimes in response to dietary challenge. Cowpea bruchids (Callosobruchus maculatus) strongly induce C. maculatus cathepsin B-like cysteine protease 1 (CmCatB1) transcripts when fed diet containing a soybean cysteine protease inhibitor soyacystatin N (scN). CmCatB1 shares significant sequence similarity with cathepsin B-like cysteine proteases. In this study, we isolated another cDNA, namely CmCatB2 that encodes a protein sequence otherwise identical to CmCatB1, but lacking a 70-amino-acid internal section. CmCatB1 and CmCatB2 probably resulted from alternate splicing events. Only the CmCatB1 transcript, however, exhibited differential expression in response to dietary scN. Further, this expression was only detectable in larvae, which is the developmental stage associated with food ingestion. The scN-activated and developmentally regulated CmCatB1 expression pattern suggests it may have a unique function in insect counter-defence against antinutritional factors. Heterologously expressed recombinant CmCatB1 protein exhibited enzymatic activity in a pH-dependent manner. Activity of the protein was inhibited by both the cysteine protease inhibitor E-64 and the cathepsin B-specific inhibitor CA-074, verifying its cathepsin B-like cysteine protease nature. Interestingly, the enzymatic activity was unaffected by the presence of scN. Together, we have provided functional evidence suggesting that CmCatB1 confers inhibitor-insensitive enzymatic activity to cowpea bruchids, which is crucial for insect survival when challenged by dietary protease inhibitors.
Asunto(s)
Catepsina B/metabolismo , Proteínas de Insectos/metabolismo , Insectos/enzimología , Insectos/inmunología , Empalme Alternativo/efectos de los fármacos , Secuencia de Aminoácidos , Animales , Secuencia de Bases , Catepsina B/química , Catepsina B/genética , Secuencia Conservada , Cistatinas/farmacología , Regulación del Desarrollo de la Expresión Génica/efectos de los fármacos , Glicosilación/efectos de los fármacos , Concentración de Iones de Hidrógeno/efectos de los fármacos , Proteínas de Insectos/química , Proteínas de Insectos/genética , Insectos/genética , Isoenzimas/química , Isoenzimas/genética , Isoenzimas/metabolismo , Datos de Secuencia Molecular , Proteínas Recombinantes/biosíntesis , Proteínas de Soja/farmacología , Especificidad por Sustrato/efectos de los fármacosRESUMEN
The aim of the study was to investigate relationship between activity of superoxide dismutase (SOD), malondialdehyde (MDA) and tumor necrosis factor alpha (TNFalpha) and between Ala-9Val polymorphism in the gene encoding MnSOD (SOD2) and the initial stage and prognosis of the head and neck squamous cell carcinoma (HNSCC). Prospective study cohort comprised 88 patients who underwent surgical treatment for the diagnosis of HNSCC (53 patients were diagnosed with locoregional metastatic spread (N+) at the time of diagnosis). After the initial surgery subjects were followed for the subsequent period of 26 months during which 14 manifested relapse. Genotypes were detected by the PCR-based methodology. Activity of p-SOD, ery-SOD and TNFalpha were determined by ELISA, and the concentration of MDA by high performance liquid chromatography. Genotype and allele frequencies of the Ala-9Val differed neither between groups defined according to the stage of primary disease (TNM), nor between relapse vs. remission groups after the follow-up (p>0.05). Activity of p-SOD was significantly higher in T3/4 stage compared to T1/2 (p=0.01) and was also higher in N+ compared to N0 patients (p=0.002). Carriers of the Ala/Ala genotype had higher p-SOD activity (p=0.04). There was no significant difference in DFI between SOD2 genotype groups (p>0.05), however, the Ala/Ala group exhibited the shortest median DFI. In conclusion, our results suggest that increased p-SOD at the time of the initial treatment for HNSCC is connected with greater extent and nodal metastatic spread of the initial disease and with an earlier relapse of the disease. Progression of the disease might be further modified by the presence of Ala/Ala genotype of the SOD2. Activity of p-SOD could thus offer diagnostic as well as prognostic value.
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Carcinoma de Células Escamosas/enzimología , Eritrocitos/enzimología , Neoplasias de Cabeza y Cuello/enzimología , Recurrencia Local de Neoplasia/enzimología , Superóxido Dismutasa/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/secundario , Estudios de Cohortes , Femenino , Genotipo , Neoplasias de Cabeza y Cuello/genética , Neoplasias de Cabeza y Cuello/patología , Humanos , Metástasis Linfática/patología , Masculino , Malondialdehído/metabolismo , Persona de Mediana Edad , Recurrencia Local de Neoplasia/genética , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Estrés Oxidativo , Polimorfismo Genético , Estudios Prospectivos , Superóxido Dismutasa/sangre , Superóxido Dismutasa/genética , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Cowpea bruchids, when challenged by consumption of the soybean cysteine protease inhibitor scN, reconfigure expression of their major CmCP digestive proteases and resume normal feeding and development. Previous evidence indicated that insects selectively induced CmCPs from subfamily B, that were more efficient in autoprocessing and possessed not only higher proteolytic, but also scN-degrading activities. In contrast, dietary scN only marginally up-regulated genes from the more predominant CmCP subfamily A that were inferior to subfamily B. To gain further molecular insight into this adaptive adjustment, we performed domain swapping between the two respective subfamily members B1 and A16, the latter unable to autoprocess or degrade scN even after intermolecular processing. Swapping the propeptides did not qualitatively alter autoprocessing in either protease isoform. Incorporation of either the N- (pAmBA) or C-terminal (pAmAB) mature B1 segment into A16, however, was sufficient to prime autoprocessing of A16 to its mature form. Further, the swap at the N-terminal mature A16 protein region (pAmBA) resulted in four amino acid changes. Replacement of these amino acid residues by the corresponding B1 residues, singly and pair-wise, revealed that autoprocessing activation in pAmBA resulted from cumulative and/or coordinated individual effects. Bacterially expressed isolated propeptides (pA16 and pB1) differed in their ability to inhibit mature B1 enzyme. Lower inhibitory activity in pB1 is likely attributable to its lack of protein stability. This instability in the cleaved propeptide is necessary, although insufficient by itself, for scN-degradation by the mature B1 enzyme. Taken together, cowpea bruchids modulate proteolysis of their digestive enzymes by controlling proCmCP cleavage and propeptide stability, which explains at least in part the plasticity cowpea bruchids demonstrate in response to protease inhibitors.
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Escarabajos/metabolismo , Sistema Digestivo/enzimología , Regulación Enzimológica de la Expresión Génica , Inhibidores de Proteasas/metabolismo , Precursores de Proteínas/metabolismo , Animales , Secuencia de Bases , Estabilidad de Enzimas/genética , Cinética , Datos de Secuencia Molecular , Mutagénesis Sitio-Dirigida , Precursores de Proteínas/genética , Estructura Terciaria de Proteína , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismo , Alineación de Secuencia , Análisis de Secuencia de ADNRESUMEN
Upon challenge by the soybean cysteine protease inhibitor soyacystatin N (scN), cowpea bruchids reconfigure their major digestive cysteine proteases (CmCPs) in adaptation to the inhibitor and resume normal feeding and development. We have previously shown that CmCPB transcripts were 116.3-fold more abundant in scN-adapted bruchid guts than in unadapted guts, while CmCPA transcripts were only 2.5-fold higher. In order to further elucidate the functional significance of this differential regulation, we expressed three CmCPA and one CmCPB isoforms (A9, A13, A16 and B1) using a bacterial expression system, and characterized their activities. In contrast to the precursors of CmCPAs (proCmCPAs), proCmCPB1 exhibited more efficient autocatalytic conversion from the latent proenzyme to its active mature protease form, and demonstrated higher intrinsic proteolytic activity. Among proCmCPAs, dependence on exogenous enzymatic processing varies: while maturation of proCmCPA13 and proCmCPA16 was impaired in the absence of external proteolytic activity, proCmCPA9 appeared to utilize a two-step autoprocessing mechanism. Although all CmCPs are scN-sensitive, scN was degraded by CmCPB1 when outnumbered by the protease, but scN remained intact in the presence of excessive CmCPA9. These results provide further evidence that differential expression of CmCPs under scN challenge brings about adaptation to the inhibitor. High induction of unique cysteine protease isoforms with superior autoprocessing and proteolytic efficacy represents a strategy cowpea bruchids use to cope with dietary scN.
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Escarabajos/enzimología , Cistatinas/metabolismo , Sistema Digestivo/metabolismo , Regulación Enzimológica de la Expresión Génica , Péptido Hidrolasas/metabolismo , Secuencia de Aminoácidos , Animales , Cartilla de ADN , ADN Complementario/genética , Immunoblotting , Isoenzimas , Datos de Secuencia Molecular , Péptido Hidrolasas/genética , Alineación de Secuencia , Análisis de Secuencia de ADN , Proteínas de SojaRESUMEN
Cowpea bruchid, when fed on a diet containing the soybean cysteine protease inhibitor soyacystatin N (scN), activates an array of counter-defence genes to adapt to the negative effects of the inhibitor and regain its normal rate of feeding and development. A collection of 1920 cDNAs was obtained by differential subtraction with cDNAs prepared from guts of the 4th instar larvae of scN-adapted (reared on scN-containing diet) and scN-unadapted (reared on regular scN-free diet) cowpea bruchids. Subsequent expression profiling using DNA microarray and Northern blot analyses identified ninety-four transcript species from this collection that are responsive to dietary scN. scN-adapted insects induced genes encoding protein and carbohydrate digestive enzymes, probably to help meet their carbon and nitrogen requirements. Up-regulation of antimicrobial and detoxification protein genes may represent a generalized defence response. Genes down-regulated by scN reflected physiological adjustments of the cowpea bruchids to scN challenge. A large portion of the responsive genes, presumably involved in carrying out the counter-defence response, were of unknown function. The full-length cDNA of an scN-inducible cathepsin B-like cysteine protease was obtained. Its transcriptional response to scN during larval development contrasts with the pattern of the cathepsin L family, the major digestive enzymes. These results suggest cathepsin B-like cysteine proteases may play a crucial role in cowpea bruchid adaptation to dietary scN.
Asunto(s)
Adaptación Fisiológica , Escarabajos/metabolismo , Cistatinas/metabolismo , Inhibidores de Cisteína Proteinasa/metabolismo , Sistema Digestivo/metabolismo , Regulación de la Expresión Génica , Secuencia de Aminoácidos , Animales , Secuencia de Bases , Northern Blotting , Catepsina B/genética , Escarabajos/genética , ADN Complementario/genética , Perfilación de la Expresión Génica , Larva/metabolismo , Datos de Secuencia Molecular , Análisis de Secuencia por Matrices de Oligonucleótidos , Alineación de Secuencia , Análisis de Secuencia de ADN , Proteínas de SojaRESUMEN
The soybean cysteine protease inhibitor, soyacystatin N (scN), negatively impacts growth and development of the cowpea bruchid, Callosobruchus maculatus[Koiwa et al. (1998) Plant J 14: 371-379]. However, the developmental delay and feeding inhibition caused by dietary scN occurred only during the early developmental stages (the 1st, 2nd and 3rd instars) of the cowpea bruchid. The 4th instar larvae reared on scN diet (adapted) exhibited rates of feeding and development which were comparable to those feeding on an scN-free diet (unadapted) prior to pupation. Total gut proteolytic capacity at this larval stage significantly increased in the scN-adapted insects. The elevated enzymatic activity was attributed to a differential expression of insect gut cysteine proteases (representing the major digestive enzymes), and of aspartic proteases. scN degradation by the gut extract was observed only in adapted bruchids, and this activity appeared to be a combined effect of scN-induced cysteine and aspartic proteases. Thirty cDNAs encoding cathepsin L-like cysteine proteases were isolated from insect guts, and they were differentially regulated by dietary scN. Our results suggest that the cowpea bruchid adapts to the challenge of scN by qualitative and quantitative remodelling of its digestive protease complement, and by activating scN-degrading protease activity.
Asunto(s)
Escarabajos/fisiología , Cistatinas/metabolismo , Cistatinas/farmacología , Inhibidores de Cisteína Proteinasa/metabolismo , Inhibidores de Cisteína Proteinasa/farmacología , Fabaceae/enzimología , Secuencia de Aminoácidos , Animales , Northern Blotting , Southern Blotting , ADN/química , ADN/genética , Dieta , Biblioteca de Genes , Datos de Secuencia Molecular , Filogenia , ARN/química , ARN/genética , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Alineación de Secuencia , Proteínas de SojaRESUMEN
Griffonia simplicifolia lectin II (GSII) is a plant defensive protein that significantly delays development of the cowpea bruchid Callosobruchus maculatus (F.). Previous structure/function analysis by site-directed mutagenesis indicated that carbohydrate binding and resistance to insect gut proteolysis are required for the anti-insect activity of this lectin. However, whether there is a causal link between carbohydrate binding and resistance to insect metabolism remains unknown. Two proteases principally responsible for digestive proteolysis in third and fourth instar larvae of C. maculatus were purified by activated thiol sepharose chromatography and resolved as cathepsin L-like proteases, based on N-terminal amino acid sequence analysis. Digestion of bacterially expressed recombinant GSII (rGSII) and its mutant protein variants with the purified gut proteases indicates that carbohydrate binding, presumably to a target ligand in insect gut, and proteolytic resistance are independent properties of rGSII, and that both facilitate its efficacy as a plant defensive molecule.
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Acetilglucosamina/metabolismo , Escarabajos/enzimología , Cisteína Endopeptidasas/metabolismo , Glicoconjugados/metabolismo , Lectinas/metabolismo , Lectinas de Plantas , Secuencia de Aminoácidos , Animales , Catepsina L , Catepsinas/metabolismo , Cisteína Endopeptidasas/aislamiento & purificación , Sistema Digestivo/metabolismo , Humanos , Hidrólisis , Ligandos , Datos de Secuencia MolecularRESUMEN
Two separate trials compared controlled-release (CR) oral oxycodone (administered every 12 hours) with immediate-release (IR) oxycodone (4 times a day) to determine whether patients with chronic pain could be titrated to stable pain control as readily with the CR as with the IR formulation. In one study, 48 patients with cancer pain were randomized to open-label titration with either CR or IR oxycodone (maximum dose, 400 mg/day) for a period of up to 21 days. In a study of similar design, 57 patients with low back pain were titrated with either CR or IR oxycodone (maximum dose, 80 mg/day) for a period of up to 10 days. The majority of patients in both studies were converted to oxycodone from other opioid analgesics. Results of both studies showed no difference between CR and IR oxycodone with respect to both the percentage of patients achieving stable pain control, the time to achieve stable pain control, and the degree of pain control achieved. Among cancer patients, 85% achieved stable analgesia, 92% with the CR formulation and 79% with the IR formulation. Among noncancer patients, 91% achieved stable pain control, 87% with the CR formulation and 96% with the IR formulation. The most commonly reported adverse effects in both studies were similar for the two formulations and were those anticipated with opioids: nausea, vomiting, constipation, somnolence, dizziness, and pruritus. Nausea and vomiting were the most frequently cited reasons for treatment discontinuations. These studies suggest that dose titration can be accomplished as readily with oral CR oxycodone as with IR oxycodone in patients with chronic, moderate to severe pain.
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Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Oxicodona/administración & dosificación , Oxicodona/uso terapéutico , Dolor/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/efectos adversos , Enfermedad Crónica , Preparaciones de Acción Retardada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oxicodona/efectos adversosRESUMEN
OBJECTIVE: To compare the efficacy and safety of controlled-release oxycodone given every 12 hours with immediate-release oxycodone given four times daily in patients with persistent back pain. DESIGN: Randomized, double-blind, active-controlled, two-period crossover trial. PATIENTS: Fifty-seven adult outpatients with stable, chronic, moderate-to-severe low back pain despite analgesic therapy were enrolled; 47 were randomized; 11 discontinued for side effects, most commonly nausea and vomiting. INTERVENTIONS: Controlled-release oxycodone tablets given every 12 hours; immediate-release oxycodone tablets given four times daily; dose titration with controlled-release or immediate-release for up to 10 days; double-blind treatment for 4-7 days each. OUTCOME MEASURES: Patients' pain scores (0 = none, 1 = slight, 2 = moderate, 3 = severe). RESULTS: Pain intensity decreased from moderate to severe at baseline to slight at the end of titration with both oxycodone formulations. The daily oxycodone dose was 40 mg or less in 68% of patients. During double-blind treatment, mean pain intensity was maintained at 1.2 (0.1 SE) with controlled-release and at 1.1 (0.1 SE) with immediate-release oxycodone. The most common adverse events were constipation, nausea, pruritus, somnolence, and dizziness. CONCLUSIONS: Controlled-release oxycodone given every 12 hours was comparable with immediate-release oxycodone given four times daily in efficacy and safety, and it provides convenient, twice-daily, around-the-clock treatment for selected patients with persistent back pain that is inadequately controlled by nonopioids or as-needed opioid therapy.
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Analgésicos Opioides/administración & dosificación , Dolor de Espalda/tratamiento farmacológico , Oxicodona/administración & dosificación , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/uso terapéutico , Dolor de Espalda/fisiopatología , Enfermedad Crónica , Preparaciones de Acción Retardada , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oxicodona/efectos adversos , Oxicodona/uso terapéutico , Volumetría , Resultado del TratamientoRESUMEN
Griffonia simplicifolia leaf lectin II (GSII), a plant defense protein against certain insects, consists of an N-acetylglucosamine (GlcNAc)-binding large subunit with a small subunit having sequence homology to class III chitinases. Much of the insecticidal activity of GSII is attributable to the large lectin subunit, because bacterially expressed recombinant large subunit (rGSII) inhibited growth and development of the cowpea bruchid, Callosobruchus maculatus (F). Site-specific mutations were introduced into rGSII to generate proteins with altered GlcNAc binding, and the different rGSII proteins were evaluated for insecticidal activity when added to the diet of the cowpea bruchid. At pH 5.5, close to the physiological pH of the cowpea bruchid midgut lumen, rGSII recombinant proteins were categorized as having high (rGSII, rGSII-Y134F, and rGSII-N196D mutant proteins), low (rGSII-N136D), or no (rGSII-D88N, rGSII-Y134G, rGSII-Y134D, and rGSII-N136Q) GlcNAc-binding activity. Insecticidal activity of the recombinant proteins correlated with their GlcNAc-binding activity. Furthermore, insecticidal activity correlated with the resistance to proteolytic degradation by cowpea bruchid midgut extracts and with GlcNAc-specific binding to the insect digestive tract. Together, these results establish that insecticidal activity of GSII is functionally linked to carbohydrate binding, presumably to the midgut epithelium or the peritrophic matrix, and to biochemical stability of the protein to digestive proteolysis.
Asunto(s)
Insecticidas/farmacología , Lectinas/farmacología , Proteínas de Plantas/farmacología , Plantas/metabolismo , Sitios de Unión , Metabolismo de los Hidratos de Carbono , Insecticidas/metabolismo , Lectinas/metabolismo , Lectinas de Plantas , Proteínas de Plantas/metabolismoRESUMEN
During ripening of grape (Vitis labruscana L. cv Concord) berries, abundance of several proteins increased, coordinately with hexoses, to the extent that these became the predominant proteins in the ovary. These proteins have been identified by N-terminal amino acid-sequence analysis and/or function to be a thaumatin-like protein (grape osmotin), a lipid-transfer protein, and a basic and an acidic chitinase. The basic chitinase and grape osmotin exhibited activities against the principal grape fungal pathogens Guignardia bidwellii and Botrytis cinerea based on in vitro growth assays. The growth-inhibiting activity of the antifungal proteins was substantial at levels comparable to those that accumulate in the ripening fruit, and these activities were enhanced by as much as 70% in the presence of 1 m glucose, a physiological hexose concentration in berries. The simultaneous accumulation of the antifungal proteins and sugars during berry ripening was correlated with the characteristic development of pathogen resistance that occurs in fruits during ripening. Taken together, accumulation of these proteins, in combination with sugars, appears to constitute a novel, developmentally regulated defense mechanism against phytopathogens in the maturing fruit.
Asunto(s)
Antifúngicos/química , Frutas/microbiología , Frutas/fisiología , Hexosas/biosíntesis , Hongos Mitospóricos/efectos de los fármacos , Proteínas de Plantas/biosíntesis , Edulcorantes , Xylariales/efectos de los fármacos , Secuencia de Aminoácidos , Antifúngicos/farmacología , Antígenos de Plantas , Proteínas Portadoras/química , Hexosas/farmacología , Pruebas de Sensibilidad Microbiana , Hongos Mitospóricos/crecimiento & desarrollo , Datos de Secuencia Molecular , Proteínas de Plantas/química , Proteínas de Plantas/farmacología , Alineación de Secuencia , Homología de Secuencia de Aminoácido , Xylariales/crecimiento & desarrolloRESUMEN
NaCl (428 mM)-adapted tobacco (Nicotiana tabacum L. var Wisconsin 38) cells accumulate and secrete several antifungal chitinases. The predominant protein secreted to the culture medium was a 29-kD peptide that, based on internal amino acid sequence, was determined to be a class II acidic chitinase with similarity to PR-Q. The four predominant chitinases (T1, T2, T3, and T4) that accumulated intracellularly in 428 mM NaCl-adapted cells were purified. Based on N-terminal sequence analyses, two of these were identified as class I chitinase isoforms, one similar to the N. tomentosiformis (H. Shinshi, J.M. Neuhaus, J. Ryals, F. Meins [1990] Plant Mol Biol 14:357-368) protein (T1) and the other homologous to the N. sylvestris (Y. Fukuda, M. Ohme, H. Shinshi [1991] Plant Mol Biol 16:1-10) protein (T2). The other two proteins (T3 and T4) were determined to be novel chitinases that have sequence similarity with class I chitinases, but each lacks a chitin-binding domain. All four chitinases inhibited Fusarium oxysporum f. sp. lycopersici and Trichoderma longibrachiatum hyphal growth in vitro, although the isoforms containing a chitin-binding domain were somewhat more active. Conditions were established for the successful expression of soluble and active bacterial recombinant T2. Expression of soluble recombinant T2 was achieved when isopropyl beta-D-thiogalactopyranoside induction occurred at 18 degrees C but not at 25 or 37 degrees C. The purified recombinant protein exhibited antifungal activity comparable to a class I chitinase purified from NaCl-adapted tobacco cells.