Lumbosacral epidural lipomatosis: MRI grading

Lumbosacral epidural lipomatosis (LEL) is characterized by excessive deposition of epidural fat (EF). The purpose of our retrospective study was to quantify normal and pathologic amounts of EF in order to develop a reproducible MRI grading of LEL. In this study of 2528 patients (1095 men and 1433 women; age range 18–84 years, mean age 47.3 years) we performed a retrospective analysis of MRI exams. We obtained four linear measurements at the axial plane parallel and tangent to the superior end plate of S1 vertebral body: antero-posterior diameter of dural sac (A-Pd DuS), A-Pd of EF, located ventrally and dorsally to the DuS, and A-Pd of the spinal canal (Spi C). We calculated (a) DuS/EF index and (b) EF/Spi C index. We developed the following MRI grading of LEL: normal, grade 0: DuS/EF index ≥1.5, EF/Spi C index ≤40%; LEL grade I: DuS/EF index 1.49–1, EF/Spi C index 41–50% (mild EF overgrowth); LEL grade II: DuS/EF index 0.99–0.34, EF/Spi C index 51–74% (moderate EF overgrowth); LEL grade III: DuS/EF index ≤0.33, EF/Spi C index ≥75% (severe EF overgrowth). The MRI exams were evaluated independently by three readers. Intra- and interobserver reliabilities were obtained by calculating Kappa statistics. The MRI grading showed the following distribution: grade 0, 2003 patients (79.2%); LEL grade I, 308 patients (12.2%); LEL grade II, 165 patients (6.5%); and LEL grade III, 52 patients (2.1%). The kappa coefficients for intra- and interobserver agreement in a four-grade classification system were substantial to excellent: intraobserver, kappa range 0.79 [95% confidence interval (CI), 0.65–0.93] to 0.82 (95% CI, 0.70–0.95); interobserver, kappa range 0.76 (95% CI, 0.62–0.91) to 0.85 (95% CI, 0.73–0.97). In LEL grade I, there were no symptomatic cases due to fat hypertrophy. LEL grade II was symptomatic in only 24 cases (14.5%). In LEL grade III, all cases were symptomatic. A subgroup of 22 patients (42.3%) showed other substantial spinal pathologies (e.g., disk herniation). By means of simple reproducible measurements and indexes MRI grading enables a distinction between mild, moderate, and severe EF hypertrophy. Kappa statistics indicate that LEL can be reliably classified into a four-grade system by experienced observers.     

THE HYDROLYSIS OF HYALURONIC ACID BY BACTERIAL ENZYMES

An improved method is described for preparing the enzyme which hydrolyzes the polysaccharide acid contained in vitreous humor, umbilical cord, synovial fluid, and the mucoid phase of group A hemolytic streptococci. Preparations have been obtained from pneumococci, group A hemolytic streptococci, Clostridium welchii, and from splenic tissue, which display the same specific activity. Evidence is presented to show that the hydrolytic enzyme is not the same as that responsible for the lysis of pneumococci. In pneumococci and hemolytic streptococci the major portion of the enzyme is bound to the cell structure. The enzyme from Clostridium welchii is associated with other carbohydrate-splitting enzymes in the culture medium and not with the bacterial cells. It is suggested that the disappearance of the mucoid capsule of group A hemolytic streptococci is due to enzymatic hydrolysis of the acid polysaccharide. The relation between enzyme activity and the virulence and invasiveness of group A hemolytic streptococci is briefly considered.     

Biosimilars in psoriasis: Clinical practice and regulatory perspectives in Latin America

Latin American countries view biosimilar agents as an effective approach to curtail health‐care expenditures while maintaining the safety and efficacy profile of their branded innovator comparators. To understand the complexities of the regulatory landscape and key therapeutic issues for use of biosimilars to treat moderate to severe psoriasis in Latin America, the International Psoriasis Council convened dermatology experts from Argentina, Brazil, Chile, Colombia and Mexico in October 2015 to review the definition, approval, marketing and future of biosimilars in each country and develop a consensus statement. The regulatory framework for marketing approval of biosimilars in Latin America is currently a mosaic of disparate, country‐specific, regulatory review processes, rules and standards, with considerable heterogeneity in clarity and specificity. Regulations in Argentina, Brazil, Chile and Mexico have undergone multiple refinements whereas Colombia is finalizing draft guidelines. Verification of the similarity in quality, safety and efficacy of biosimilars to the innovator biologic remains a key challenge for policy makers and regulatory authorities. Other key regulatory challenges include: naming of agents and traceability, pharmacovigilance, extrapolation of indications, and interchangeability and substitution. An urgent need exists for more Latin American countries to establish national psoriasis registries and to integrate their common components into a multinational psoriasis network, thereby enhancing their interpretative power and impact. A Latin American psoriasis network similar to PSONET in Europe would assist health‐care providers, pharmaceutical companies, regulators and patients to fully comprehend specific products being prescribed and dispensed and to identify potential regional trends or differences in safety or outcomes.     

Microflora associated with successful and failed orthodontic mini-implants

Objectives: Mini-implants are used for orthodontic bone anchorage. The reasons for a potential instability or loss of the mini-implants during treatment are multiple. Among other factors, colonization of implants with pathogenic bacteria is discussed. Therefore, the microflora associated with successful and failed mini-implants has been screened.
Material and methods: A total of 76 mini-implants collected from 25 patients were observed during regular orthodontic treatment. Bacterial samples of eight failed and – exemplarily – four successful (control) cases were subjected to a universal Bacteria -directed real-time quantitative polymerase chain reaction for quantification in combination with a microarray-based identification of 20 selected species.
Results: The failure rate in the present investigation was 10.5%. The bacterial analysis did not reveal any major difference in the total amount or species composition between control and failed mini-implants. However, Actinomyces viscosus was found in four (100%) and Campylobacter gracilis in three (75%) stable controls, whereas both species were rarely found (12.5%) in failed implants.
Conclusions: In the present study, the peri-implant sulcus surrounding failed orthodontic mini-implants did not show a specific aggressive bacterial flora.     

Second derivative spectrophotometric determination of trimethoprime and sulfamethoxazole in the presence of hydroxypropyl-beta-cyclodextrin (HP-beta-CD)

An easy and rapid second-derivative spectrophotometric method for the simultaneous analysis of trimethoprime (TMP) and sulfamethoxazole (SM) is described. These drugs have been used as antibacterial against a wide spectrum of organisms and combinations of these drugs are commonly used for the treatment of a variety of infections. The most advantageous approach of this method is the use of HP-beta-CD, which allows to improve the performance of the second-derivative ultraviolet spectrophotometry. For both compounds, a shift of the absorption bands and variations of their intensity were observed. The calibration graphs were linear in the concentration range of TMP (1.92-19.2 microg ml(-1)) and SM (1.60-16.5 microg ml(-1)), the correlation coefficient for the calibration graphs was better than 0.9994 and the precision was satisfactory (CV%< 4.96) in HP-beta-CD solutions. The proposed method was successfully applied to the assay of commercial tablets. The results were compared to those obtained by second-derivative ultraviolet spectrophotometry in the absence of HP-beta-CD. Thereby, the details of the statistical treatment of the analytical data are also presented.     

Intervention with adolescents and youngsters in prevention and health promotion

BACKGROUND: Over at least the past ten years, measures aimed at health promotion and prevention among young adults and teenagers have been being implemented from different public institutions and, in a certain sense, on a sectorial basis. The overall objective is to assess how the different measures carried out by different Public Institutions with regard to Health Promotion and Prevention have an impact on the actual conduct and practices of teenagers and young adults within the 14-25 age range in the Autonomous Community of Madrid. METHODS: A study based on a structural or qualitative methodology was conducted using the discussion group method, eight groups having been formed and their comments analyzed. RESULTS: The young adults do not feel any health-related prevention "system" as such exists on not considering themselves to be the object thereof. In the opinion of the young adults, disease, confined to the physical body, is conceived as being a short-lived, temporary and readily remedied based on the technological advances current medicine has to offer. On the contrary, the diseases related to the psychological perspective (mental disease dissociated with the area of the medical and connected to the individual/personal area) arouse interest in so much as young people are highly vulnerable to these diseases. CONCLUSIONS: Any measure aimed at generating identification and, therefore, the active response of young people must entail creating a connection between young people and health, which, not based exclusively in providing information, is capable of putting a space of control of the youths with regard to their harmful practices into play whilst at the same time highlighting their taking responsibility for their own actions. Considering we believe it best to "redefine" the term "prevention" in terms nearer to those of maintaining, improving or regaining (in short-lived cases) health, to thus connote the idea of physical and mental well-being.     

Acamprosate decreases the induction of tolerance and physical dependence in morphine-treated mice

The effects of acamprosate, a drug thought to interact with N-methyl-D-aspartate (NMDA) receptors in the central nervous system (CNS), were examined on the antinociceptive action of morphine, induction of tolerance to and physical dependence on morphine, and expression of the abstinence syndrome to the opiate in mice. For the induction of tolerance and dependence, morphine (300 mg/kg) was administered by means of a slow-release preparation. Single doses of acamprosate (50, 100, 200, or 400 mg/kg) administered 30 min before a test dose of morphine did not change the antinociceptive effects of morphine in drug-naive mice. The drug was also administered in repeated doses (50, 100, 200, or 400 mg/kg, 30 min before and 12 and 24 h after the priming dose of morphine) in order to evaluate its effects on the induction of tolerance; all doses assayed, except the 400 mg/kg, did not affect the intensity of tolerance. The acute administration of acamprosate (50, 100, 200, or 400 mg/kg, injected 30 min before naloxone to morphine-pretreated mice) did not affect the intensity of the abstinence behavior. However, the repeated administration of 100 mg/kg of acamprosate (30 min before and 12 and 24 h after the priming dose of morphine) decreased the intensity of physical dependence. The results of these studies suggest that acamprosate may have modulatory effects on glutamatergic neurotransmission participating in the adaptive mechanisms induced by chronic morphine treatment.