Improved intramuscular blood flow and normalized metabolism in lateral epicondylitis after botulinum toxin treatment.

Lateral epicondylitis is a common cause of elbow pain, and decreased microcirculation in extensor carpi radialis brevis (ECRB) has recently been suggested to contribute to the symptoms. The purpose of this pilot study was to investigate the treatment response after injection of botulinum toxin type A. Ten patients with unilateral epicondylitis and decreased intramuscular blood flow in ECRB participated. Handgrip, 2-pinch grip and muscle strength during radial deviation and dorsal extension of the wrist were recorded. Perceived pain during contraction was evaluated with the Visual Analogue Scale (VAS) and function in daily activities was assessed using the Disability of Arm, Shoulder and Hand instrument (DASH) and the Canadian Occupational Performance Measure instrument (COPM). Intramuscular blood flow was recorded by laser Doppler flowmetry, and microdialysis was used to analyze muscle metabolism. The difference in intramuscular blood flow between the control and the affected side had decreased 3 and 12 months after treatment (P=0.03). Lactate concentration at the 12-month follow-up had decreased (P=0.02); perceived pain was reduced and function in daily activities had improved. Injection of botulinum toxin is an alternative treatment for epicondylitis. Symptom relief may be due to enhanced microcirculation causing an aerobic metabolism.

Decreased intramuscular blood flow in patients with lateral epicondylitis.

The purpose of this pilot study was to investigate intramuscular microcirculation in extensor carpi radialis brevis (ECRB) in patients with lateral epicondylitis. Ten patients with unilateral epicondylitis, mean duration of symptoms of 39 (12-96) months participated. The diagnosis was based on clinical examination and none was under treatment for the last 6 months. Isometric handgrip strength, 2-pinch grip strength and muscle strength during radial deviation and dorsal extension were determined. Functional perceived pain was evaluated by a modified behaviour rating scale and perceived pain during contraction by visual analogue scale. Intramuscular and skin blood flow was recorded by a laser-Doppler flowmetry system technique (LDF) during stable temperature condition. Intramuscular blood flow was significantly lower in the affected side, 22.7+/-9.8 perfusion units (PU), as compared with 35.2+/-11.9 PU in the control side (P=0.01). There was no difference in skin blood flow or temperature between the affected and the control side. A positive correlation was found between the duration of symptoms and the difference in intramuscular blood flow between the affected and the control arm (r=0.65, P=0.06). The present data indicate that decreased microcirculation and anaerobic metabolism in ECRB may contribute to the lateral epicondylitis symptoms.

Formation of mutagenic urinary metabolites from 1-nitropyrene in germ-free and conventional rats: role of the gut flora.

1-Nitropyrene (NP), an environmental pollutant, a potent mutagen and an animal carcinogen, undergoes reduction, acetylation, ring-hydroxylation and conjugation in the rat in vivo to form mutagenic metabolites which are excreted in the urine. In order to investigate the role of the gut flora in the generation of these metabolites, germ-free rats of the AGUS strain, and conventional AGUS rats matched for sex and age, were injected i.p. with NP labelled with 14C. The germ-free rats excreted significantly less of the dose in urine than did the conventional rats. When urines were examined for mutagenicity with the Ames plate incorporation assay, the highest mutagenic activity was seen in the presence of S9 in 8-24 h urine from conventional rats. The conventional urines exceeded the germ-free urines by 10-fold in their content of 6-hydroxy-1-acetamidopyrene (NAAP-6-OH), previously identified as the predominant contributor to the mutagenicity of the urines of rats dosed with NP and excreted mainly as its beta-glucuronide conjugate. Conventional Charles River CD rats treated orally with D-glucaro-1,4-lactone, an inhibitor of beta-glucuronidase activity, excreted somewhat less NP-derived 14C in their urines over 48 h than did matched untreated rats, and their 8-24 h urines contained less than half as much of the mutagenic NAAP-6-OH as was found in the urines of the control rats. These results indicate that the gut flora are necessarily involved in the formation of NAAP-6-OH, and that both nitroreduction and the hydrolysis of glucuronides released for enterohepatic recirculation are essential in generating mutagenic metabolites from NP.

Glycosphingolipid patterns of the gastrointestinal tract and feces of germ-free and conventional rats.

Acid and non-acid glycosphingolipids of stomach, small and large intestine, and stimulated feces of germ-free and conventional rats of the same stain have been isolated and characterized. The glycosphingolipid patterns of the intestinal organs were chemically and immunologically very similar between the two groups of rats and relatively unaffected by the presence of an intestinal microbial flora. The major exception was the presence of hematoside with N-glycoloylneuraminic acid (NeuGc) (NeuGc alpha 2----3Gal beta 1----4Glc beta 1----1Cer) in the stomach of conventional rats not found in the stomach of germ-free animals. Glycosphingolipids of stimulated feces of germ-free animals were derived from epithelial cells mainly of the small intestine and showed no signs of degradation. Glycosphingolipids of feces of conventional rats completely retained the pattern of blood group A-, B-, and H-active glycolipids as found in sterile feces but contained less of hematoside and more of lactosylceramide. This effect was probably due to degradation by bacteria, as demonstrated in vitro with the production of lactosylceramide after treatment of the isolated acid glycolipids of sterile feces with neuraminidase from Clostridium perfringens. The amount of total non-acid glycosphingolipids per dry weight was similar for stomach, was 50% higher for small intestine, and 300% higher for large intestine of germ-free animals compared to conventional animals. Due to the presence of large amounts of mucins the dry sterile feces contained 12% less non-acid glycolipids than conventional feces. However, calculated per rat per day the germ-free animal excreted more of non-acid glycosphingolipids (1.8 and 1.2 mg, respectively).

Isolation and characterization of a mucin-degrading strain of Peptostreptococcus from rat intestinal tract.

A mucin-degrading microorganism was isolated from the intestinal tract by serial sectioning from the serosal side of the caecum wall from a conventional rat. The ability of degrading the intestinal water-soluble mucin was present both in vivo after monocontamination of germ-free rats and in vitro, when adding the microbe to Mucin medium. The morphology, Gram-positive cocci single or in short chains and the very weak biochemical activities allow us to place this strain in the species Peptostreptococcus micros.

Influence of intestinal microflora on the tryptic activity during lactation in rats.

On comparing germ-free and conventional rats, inactivation of the tryptic activity was found to take place in the caecum of conventional adult rats only. A microbial intestinal inactivation of the tryptic activity was established in suckling conventional rats within 10 days after birth. At 3 weeks of age, suckling germ-free rats were found to have less faecal tryptic activity than their early-weaned littermates.

Strain differences in faecal tryptic activity of germ-free and conventional rats.

Regardless of diet (semi-synthetic or lab chow) or strain (AGUS or SD), germ-free rats have tryptic activity in their faeces, whereas conventional rats never do. The activity in faeces from germ-free AGUS rats was significantly higher than from SD rats.

The establishment of some microflora associated biochemical characteristics in feces from children during the first years of life.

This report presents a new approach to the study of the colonization of the digestive tract after birth. We have examined the development of four microflora associated characteristics, MACs, defined as the recording of any anatomical structure, biochemical or physiological function in the macroorganism, which has been influenced by the microflora. These MACs may create a basis for later investigations into the impact of diarrheal diseases and antibiotic therapy. The following biochemical characteristics were studied in feces from children of 0-61 months of age: conversion of cholesterol to coprostanol and bilirubin to urobilins, inactivation of trypsin and degradation of mucin. These results indicate establishment of microbes capable of converting bilirubin to urobilins within the second year of life. The mucin degrading and cholesterol converting microbes are established in most of the children during the same period. Tryptic activity was found to be absent in meconium, present in feces from all children up to 21 months of age, and absent in 6 out of 15 children in the age group 46-61 months. The study indicates that the establishment of the MACs in the digestive tract is a remarkably long drawn out process.

Clindamycin-induced alterations in intestinal microflora-associated characteristics in rats.

Conventional Sprague-Dawley rats were treated with clindamycin, 40 mg/kg/day and 0.04 mg/kg/day, for 5 days. At a dose of 40 mg/kg/day, microflora-associated characteristics (MACs), such as shape, color, and consistency of feces, proteolytic activity, electrophoretic pattern, and cholesterol and bilirubin metabolism were transformed into values like those found in germfree rats: germfree animal characteristics (GACs). The effect on the proteolytic activity lasted longest. It did not disappear until one or two enemas with cecal contents from intact conventional rats were administered. At a dose of 0.04 mg/kg/day, effects on the proteolytic activity and cholesterol metabolism were seen. With the exception of one rat, the effect on proteolytic activity did not disappear until one or two enemas were given. The results indicate that clindamycin, even in very small daily doses, has a profound and long-lasting influence on many intestinal MACs in rats.

Methods for determination of conjugated bilirubin in rat faeces.

Conjugated bilirubin was prepared from the faeces of germ-free (GF) rats by three different preparative methods. The bilirubin conjugate preparations were coupled with diazotized ethyl anthranilate and the formed ethyl anthranilate azopigments were quantified spectrophotometrically and separated by thin-layer chromatography (tlc). The most polar azopigment was purified by tlc and subjected to ammonolysis followed by tlc of the released saccaride. As a result of this procedure, only glucuronic acid was detected as the conjugating saccaride thus indicating that the most polar azopigment prepared from GF rat faeces was the delta ethyl anthranilate azopigment. Reference azopigments were prepared from GF rat small intestinal contents and subjected to separation by tlc. The azopigment pattern was very similar to the pattern obtained with the faecal azopigment preparations and a maximum of ten separated azopigment spots were detected. The findings indicated that, in addition to bilirubin glucuronides, other bilirubin conjugates with unknown structure are excreted with the faeces of GF rats. One of the preparative methods used for the preparation of conjugated bilirubin from GF rat faeces was tested on faeces from conventional (CONV) rats. From these preparations, no ethyl anthranilate azopigments were formed, thus indicating that faeces from CONV rats is devoid of conjugated bilirubin.

Deconjugation of bilirubin conjugates and urobilin formation by conventionalized germ-free rats.

The amounts of conjugated bilirubin and urobilins/urobilinogen were determined semiquantitatively in faeces of germ-free (GF) rats during GF condition and after conventionalization by oral administration of faeces suspension from conventional (CONV) rats. The amount of bilirubin conjugates, detected as their ethyl anthranilate azopigments, decreased rapidly 1 day after conventionalization. Thin-layer chromatography analysis of the corresponding faecal azopigment preparations showed that some azopigments started to disappear a few days after the conventionalization, indicating that their corresponding bilirubin conjugates were deconjugated by the bacteria in the intestine. On day 21 after conventionalization, only two azopigments were detected, namely the unconjugated and glucuronic acid conjugated dipyrroles of bilirubin, respectively, thus indicating the presence of only one bilirubin conjugate, the monoglucuronide. After 69 days no azopigments could be detected, indicating the total absence of conjugated bilirubin in these faeces samples. No urobilins were detected in faeces of the rats during their GF state, but these metabolites appeared in faeces one day after conventionalization and increased during a few days to a CONV level.

Intestinal water-soluble mucins in germfree, exgermfree and conventional animals.

Water-soluble intestinal mucins were investigated in germfree (GF), exgermfree (EXG) and conventional (CONV) rats and in GF and CONV mice. After agar gel electrophoresis, all GF animals had similar specific band patterns demonstrated by PAS and Toluidine Blue. These patterns, never seen in CONV animals, disappeared in GF animals infected either with intestinal contents from CONV rats or mono-infected with a mucin converting microorganism, labelled Peptostreptococcus N. The intestinal microflora seem to have a profound influence on the water-soluble mucins, and specific microorganisms appear to be involved in the conversion of these substances. Any CONV animal with a GF mucin pattern in the faeces must be considered to have a disturbance of the normal intestinal microflora.

Soya--a dietary source of the non-steroidal oestrogen equol in man and animals.

The dietary origin of the weak oestrogen equol (7-hydroxy-3-(4'-hydroxyphenyl)-chroman) present in human urine has been investigated using gas chromatography-mass spectrometry. Feeding experiments with different food constituents and monitoring the urinary excretion of equol revealed that soya food yields more than 0.1 mg urinary equol/g flour ingested. From this source the glucoside of daidzein (4',7-dihydroxyisoflavone) has been isolated and identified as a precursor of equol. Both equol and daidzein were characterized as monoglucuronide conjugates in human urine and the concentration of urinary equol exceeded the concentrations of the classical oestrogens by 100- to 1000-fold after ingestion of a single meal containing soya protein. The potential biological significance of this result is discussed.

Detection of bilirubin conjugates in faeces of germfree rats.

The presence of bilirubin conjugates in faeces from germfree (GF) and conventional (CONV) rats was tested after using affinity chromatography and Porapak Q chromatography as clean-up procedures. The bilirubin conjugates were detected as their ethyl anthranilate azopigments after separation by thin layer chromatography (tlc). Azopigments prepared from bile of GF and CONV rats served as a reference material for the tlc analysis. After tlc of the faecal azopigment preparations it was concluded that GF rat faeces contains bilirubin conjugates, while faeces from CONV rats is devoid of conjugated bilirubin. The findings suggest that the main bilirubin conjugates present in faeces from GF rats are of the glucuronic acid type.

Studies on the re-establishment of the intestinal microflora in germ-free rats with special reference to the metabolism of N-isopropyl-alpha-chloroacetanilide (propachlor).

Conventional rats metabolize 2-chloro-N-isopropylacetanilide (propachlor) mainly to various 2-methylsulphonylacetanilides and to residues in the faeces that are unextractable. Mercapturic acid pathway (MAP) metabolites of propachlor are the source of the methylsulphonyl sulphur and the insoluble faecal residues. Germ-free and antibiotic-treated rats quantitatively metabolized propachlor only to MAP metabolites, which were excreted in the urine and faeces (all water-soluble). Germ-free rats given enemas of caecal contents from conventional rats were qualitatively similar to conventional rats with respect to the metabolism of propachlor within 56 days of the inoculations i.e. they excreted 2-methylsulphonyl acetanilides in the urine and insoluble residues in the faeces. They approached quantitative similarity within 180 days. Antibiotic-treated rats spontaneously recovered the ability to metabolize propachlor as conventional rats, qualitatively within 6 days and quantitatively within 21 days. While differences occurred in the faecal metabolites of propachlor, biliary secretion of metabolites by germ-free rats was not different from that of conventional or antibiotic-treated rats.