Production of Escherichia coli heat labile toxin (LT) B subunit in soybean seed and analysis of its immunogenicity as an oral vaccine.

The B subunit of the heat labile toxin of enterotoxigenic Escherichia coli (LTB) was used as a model immunogen for production in soybean seed. LTB expression was directed to the endoplasmic reticulum (ER) of seed storage parenchyma cells for sequestration in de novo synthesized inert protein accretions derived from the ER. Pentameric LTB accumulated to 2.4% of the total seed protein at maturity and was stable in desiccated seed. LTB-soybean extracts administered orally to mice induced both systemic IgG and IgA, and mucosal IgA antibody responses, and was particularly efficacious when used in a parenteral prime-oral gavage boost immunization strategy. Sera from immunized mice blocked ligand binding in vitro and immunized mice exhibited partial protection against LT challenge. Moreover, soybean-expressed LTB stimulated the antibody response against a co-administered antigen by 500-fold. These results demonstrate the utility of soybean as an efficient production platform for vaccines that can be used for oral delivery.

Health experience of 122 submarine crewmembers during a 101-day submergence.

INTRODUCTION: The artificial environment encountered in submarine duty may affect the health of crewmembers. Previous studies of submariner health have not examined self-treatment habits or the incidence of minor health problems for which no care is sought from a health care provider. Our study examined patterns of minor medical problems and self-treatment among the crew of one submarine over a period of continued submergence for 101 d. METHODS: Study data were obtained from three self-administered serial surveys of 122 medically screened U.S. Navy personnel onboard a submerged nuclear-powered submarine at the beginning, middle, and end of the study. RESULTS: During the first half of the study, 82% had medical complaints, most commonly runny nose, difficulty sleeping, and backache. In the second half, 77% listed complaints, most commonly difficulty sleeping. Despite readily available medical care, self-medication for minor unreported health problems was common, with use of products such as non-steroidal anti-inflammatory drugs, multi-vitamins, health supplements, topical preparations, and antihistamine/decongestants. DISCUSSION: Planning for medical care in isolated environments should include consideration of inreported minor medical problems and self-treatment patterns.

Surgery and permanent 125I seed paraspinal brachytherapy for malignant tumors with spinal cord compression.

PURPOSE: To evaluate the functional outcome, predictors of response, and toxicity from spinal surgery and 125I brachytherapy in patients with malignant tumors resulting in spinal cord compression. METHODS AND MATERIALS: Between July 1985 and September 2001, after surgical resection, 30 patients underwent 31 intraoperative paraspinal brachytherapy procedures at Barrow Neurological Institute. Twenty-four (with 25 procedures) had follow-up at our clinic and form the basis for this report. Surgical procedures were based on the location of the impinging lesion: corpectomy or spondylectomy in 13 cases and laminectomy in 12. Permanent 125I seeds in absorbable suture were placed with open exposure after resection. RESULTS: Spinal cord compression was cervical in 4 (16%), thoracic in 14 (56%), and lumbar in 7 (28%) of the 25 cases. One patient underwent two separate procedures at different spinal sites. Of the 25 brachytherapy sites, 22 also received external beam radiotherapy (EBRT): 5, EBRT with a planned brachytherapy boost; 4, brachytherapy and prompt EBRT after recovery; and 13, brachytherapy as salvage for local failure after prior EBRT. Three had no EBRT: 1 had lymphoma treated with chemotherapy, 1 had remote previous EBRT for a childhood tumor, and 1 refused EBRT. The mean follow-up was 19.8 months. The 2- and 3-year actuarial local control rate was 87.4% and 72.9%, respectively. Four sites (16.0%) experienced local failure. The mean time to recurrence for these 4 patients was 20.3 months. Three of the four had failed prior EBRT, with surgery and brachytherapy used for salvage. The 2- and 3-year actuarial overall survival rates were 24.0% and 16.0%, mean 19.2 months. An ambulatory function score was assigned pre- and postoperatively: I, normal ambulation; II, abnormal not requiring assistance; III, abnormal requiring assistance; and IV, unable to ambulate. All patients with score I, 91% of those with score II, 67% of those with score III, and 67% of those with score IV were ambulatory after the procedure; 84% had either normal or improved ambulation postoperatively. Morbidity was restricted to four postoperative events: one cerebrospinal fluid leak, two wound infections treated in situ without removal of seeds or instrumentation, and one pulmonary embolus. No myelopathies or other neurologic sequelae were encountered. CONCLUSION: This is the largest series in the literature exploring surgery and 125I brachytherapy in the treatment of malignant spinal cord compression. We found this to be well tolerated and to result in durable local control and ambulatory function. Our results suggest a benefit to aggressive local therapy in selected patients with spinal cord compression.