Surfing for back pain patients: the nature and quality of back pain information on the Internet

STUDY DESIGN: A prospective, systematic review of web sites related to back pain. OBJECTIVE: To assess the nature and quality of back pain-related information on the World Wide Web during a 2-year period. SUMMARY OF BACKGROUND DATA: The Internet has become a rich source of medical information. Limited knowledge is available, however, about the quality of online resources. Although previous systematic reviews on medical-related web sites found problems in varying degrees with the credibility of information, no such review was conducted to assess the back pain-related sites. METHODS: A search of web sites was conducted in November 1996 using five search engines (AltaVista, Infoseek, Lycos, Yahoo, and Magellan) and two key terms ("back pain" and "back problems"). A sample of sites was evaluated by two independent reviewers. Each site was described by the type and nature of the sponsor, target audience, and content. Overall quality was assessed in terms of evidence-based information available. RESULTS: Seventy-four web sites were reviewed in 1996, and nine of them (12.2%) were identified as high-quality sites. Advertising was the focus of 80.8% of the sites. Eleven sites (14.9%) were found to be discontinued 1 year later, and 20 (27.0%) were not accessible by the reviewers at the 2-year follow-up evaluation. Of the remaining 54 sites, 44.4% were produced by for-profit companies, and most sites targeted people with back pain (63.0%). Only seven out of the nine high-quality sites held their ratings at the 2-year follow-up evaluation. CONCLUSION: Most back pain-related web sites can be classified as advertising. The quality varied considerably, resulting in difficulties for patients to find useful information in this field. The increasing number of people seeking medical information on the Web creates a need for more high quality sites. Further, systematic review of web sites should be encouraged to monitor the accuracy of Internet publication.     

Adamantylamide dipeptide as effective immunoadjuvant in rabbits and mice

In the search for more potent and less toxic immunomodulators, adamantylamide dipeptide (AdDP) was synthesized by the covalent union of amantadine with the L-alanyl-D-isoglutamine residue of muramyldipeptide (MDP). The present experiments demonstrate the ability of AdDP, co-administered with a protein immunogen, to raise or enhance a humoral response in immunized animals. BALB/c mice were immunized either by the intraperitoneal (ip) or oral route with ovalbumin (Ova) alone or combined with either AdDP or CpG oligonucleotide (ODN-CpG), a proved adjuvant. A clear adjuvant dose-response relationship was observed on the increment of Ova-specific serum antibody titers when AdDP was used as adjuvant, irrespectively of the administration route. The IgG isotype analysis showed that AdDP promotes a consistent increment in IgG1 antibodies associated with a dominant Th2 response pattern. When administered by the oral route, AdDP was at least as efficient as ODN-CpG as adjuvant. Similar results were obtained in rabbits immunized by the oral route, suggesting that the adjuvanticity of AdDP is not restricted to the murine system. In conclusion, AdDP was shown to be a powerful and non-toxic adjuvant at both systemic and mucosal levels, which makes it a promising tool for vaccine development.     

Use of live bacterial vaccine vectors for antigen delivery: potential and limitations

Most infectious agents are restricted to the mucosal membranes or their transit through the mucosa constitutes a critical step in the infection process. Therefore, the elicitation of an efficient immune response, not only at systemic, but also at mucosal level, after vaccination is highly desirable, representing a significant advantage in order to prevent infection. This goal can be only achieved, when the vaccine formulation is administered by the mucosal route. However, soluble antigens given by this route are usually poorly immunogenic. Among the available approaches to stimulate efficient mucosal responses, the use of bacterial carriers to deliver vaccine antigens, probably, constitutes one of the most successful strategies. The potential and limitations of the most extensively studied bacterial carrier systems will be discussed.     

Neuropsychological Profile of Stuttering Children

The purpose of this study was to analyze the cognitive profile of stuttering children. A sample of 290 children was obtained from an elementary school in Bogota (Colombia) (149 boys, 141 girls). Three right-handed boys were classified as stutterers. In general, performance in stuttering children was similar to the performance in the total sample. Statistically significant differences in two test scores were observed, with a higher performance in the stuttering group: Finger Tapping Test with the left hand and Quantitative Concepts from the Woodcock Psychoeducational Battery. These results do not support the existence of any cognitive deficit in stuttering children when using standard neuropsychological testing procedures. However, in two of three stuttering children, some developmental abnormalities were mentionded by their parents (hyperactivity associated with inattention in one child and difficulties in learning to read in the other child). It is proposed that these developmental abnormalities might be the result of the emotional and communication difficulties generally associated with stuttering. These results, on the other hand, support a bihemispheric control of fine movements, as has been frequently mentioned in stuttering research.     

Protective immune response against Streptococcus pyogenes in mice after intranasal vaccination with the fibronectin-binding protein SfbI

Despite the significant impact on human health of Streptococcus pyogenes, an efficacious vaccine has not yet been developed. Here, the potential as a vaccine candidate of a major streptococcal adhesin, the fibronectin-binding protein SfbI, was evaluated. Intranasal immunization of mice with either SfbI alone or coupled to cholera toxin B subunit (CTB) triggered efficient SfbI-specific humoral (mainly IgG) and lung mucosal (14% of total IgA) responses. CTB-immunized control mice were not protected against challenge with S. pyogenes (90%-100% lethality), whereas SfbI-vaccinated animals showed 80% and 90% protection against homologous and heterologous challenge, respectively. Multiple areas of consolidation with diffused cellular infiltrates (macrophages and neutrophils) were observed in lungs from control mice; the histologic structure was preserved in SfbI-vaccinated animals, which occasionally presented focal infiltrates confined to the perivascular, peribronchial, and subpleural areas. These results suggest that SfbI is a promising candidate for inclusion in acellular vaccines against S. pyogenes.     

Modulation of host cell signalling by enteropathogenic and Shiga toxin-producing Escherichia coli.

The majority of Escherichia coli strains are harmless symbionts in the intestinal tract. However, there are several pathogenic forms, which are responsible for various diseases in humans and live stock. In this review we discuss the interactions between Shiga toxin-producing E. coli and enteropathogenic E. coli and their target host cells, describing their strategies to activate specific cellular signalling pathways which lead to subversion of critical physiological functions. We mainly concentrate on those pathogenic mechanisms that are dependent on a functional type III secretion system, but we also briefly discuss additional factors that contribute to the specific pathogenic profiles of Shiga toxin-producing E. coli and enreropathogenic E. coli.     

Oleoylethanolamide affects food intake and sleep–waking cycle through a hypothalamic modulation

Oleoylethanolamide (OEA) is an endogenous molecule related to endocannabinoids (eCBs) that induces satiety. It binds to the peroxisome-proliferator-activated receptor alpha (PPARα). PPARα is involved in feeding regulation and it has been proposed to play a role in sleep modulation. The objective of the present work is to show if this molecule modifies the sleep–waking cycle through central mechanisms. We have found that the peripheral administration of OEA reduces food intake and increases waking with a concomitant reduction of rapid eye movement sleep. Additionally, this treatment produces deactivation of the lateral hypothalamus, as inferred from the c-Fos expression evaluation. Finally, intra-lateral hypothalamus injection of OEA has mirrored the effects induced by this molecule when it is peripherally administered. In conclusion, we show for the very first time that OEA can modify the sleep–waking cycle and food intake, apparently mediated by the lateral hypothalamus.