Protective properties of Avène Thermal Spring Water on biomechanical, ultrastructural and clinical parameters of human skin.

BACKGROUND: Thermal Spring Water (TSW) has been recognized to have beneficial effects on skin; however, the mechanisms underlying these are not completely elucidated. AIMS: We compared the effects of Avène TSW with mineral-rich (MR) TSW on the biomechanical properties of the skin using mechanistic ex vivo assays and clinical studies. METHODS: Ex vivo studies included the effect of both TSWs on the structure of the surface of human skin explants using scanning electron microscopy (SEM); mineral elemental content on the skin surface using SEM coupled to energy dispersing X-ray spectroscopy; and the stress properties of the stratum corneum (SC) when exposed to dehydration. Human clinical studies were conducted to compare the soothing effect of TSWs after a dermatological chemical peeling of face skin and to evaluate the overall sensitive scale of consumers using Avène TSW for 7 days. RESULTS: Both TSWs preserved surface skin ultrastructure; however, crystals formed from MR-TSW were needle-like and formed small grains, present in clusters heterogeneously spread over the surface. Needle crystals were mainly composed of calcium, while small clusters were mainly composed of sulphur. By contrast, Avène TSW-formed crystals composed of sodium and chlorine only were regular in shape and homogeneously distributed across the skin surface. Peak stress of SC layers was increased by MR-TSW, whereas Avène TSW showed a comparatively reduced effect on dehydration and stress. The difference in the two TSW types was reflected in clinical findings comparing postpeeling redness after TSW application. Avène TSW significantly decreased postpeeling redness, while MR-TSW increased it. The overall sensitive scale of consumers was decreased by 47% using Avène TSW for 7 days. CONCLUSIONS: Avène TSW decreases postpeeling redness and soothes sensitive skin in human volunteers. Mechanistic studies suggested that differences in biomechanical effects could be linked to differences in calcium content of the TSW.

Posterior interosseous nerve palsy in rheumatoid arthritis: case report and literature review.

Posterior interosseous nerve (PIN) palsy, presenting with a loss of digital extension, is a rare neurological complication of rheumatoid arthritis (RA). It may be caused by nerve entrapment, vasculitis or drug toxicity. There is no consensus regarding the treatment of PIN palsy in RA. We present a case in which the diagnosis of PIN palsy was confounded by previous surgical intervention. It represents the first report of PIN palsy treated with anti-TNF-alpha therapy leading to full recovery without surgical intervention. We highlight the importance of electrophysiological studies in elucidating the underlying cause and hence the treatment. We suggest that the apparent success of surgical intervention in the literature may be misleading, but new pharmacological advances may obviate the need for surgery where electrophysiology demonstrates vasculitis as the cause. A literature review is presented and a treatment algorithm proposed.

A practical definition of conduction block in IvIg responsive multifocal motor neuropathy.

BACKGROUND: Multifocal motor neuropathy with conduction block (MMN) can be mistaken for motor neurone disease or other lower motor neurone syndromes, but is treatable with intravenous immunoglobulin (IvIg). Formal electrophysiological criteria for conduction block (CB) are so stringent that substantial numbers of patients may miss out on appropriate treatment. METHODS: Electrophysiological data were collected from 10 healthy volunteers and compared to data from 10 patients who satisfied the clinical criteria for MMN and who responded to IvIg. This produced a definition of CB in MMN patients which was compared with existing definitions to assess "miss rates". RESULTS: Mean values for compound muscle action potential area, amplitude, and duration were calculated in normal subjects. Results beyond 3 SD of their respective means were considered abnormal. Using these criteria, CB in the context of MMN was defined as a reduction in negative peak area >23% along a distal nerve segment or >29% across a proximal segment; or a reduction in amplitude >32% across a distal segment or >33% across a proximal segment. All IvIg responsive patients had at least one nerve segment showing such CB. Employing some criteria from the literature would have denied treatment to over 30% of responsive patients. CONCLUSION: In the clinical setting of suspected MMN, less stringent criteria for CB can improve the diagnosis of this treatable disorder. Exclusions on grounds of temporal dispersion may be over-restrictive. A little over one third of CBs occur proximally.

The effect of treatment upon temporal dispersion in IvIg responsive multifocal motor neuropathy.

BACKGROUND: Multifocal motor neuropathy with conduction block (MMN) is a treatable disorder that can be mistaken for other lower motor neurone syndromes. Existing electrophysiological diagnostic criteria for MMN are restrictive. In particular, many are cautious about diagnosing conduction block (CB) in the presence of abnormal temporal dispersion (TD). OBJECTIVE: To study the significance of TD in MMN, its relationship to CB in intravenous immunoglobulin (IvIg) responsive patients, and its utility in detecting a treatment response. METHODS: We compared pre- and post-treatment changes in CB and TD in nine patients who satisfied clinical and electrophysiological criteria for MMN and responded to IvIg. RESULTS: TD improved in one or more nerve segments in eight of nine patients tested. There was marked improvement in 65% of all nerve segments, and 60% of those segments with CB. By comparison, significant improvement in CB occurred in only 33% of segments. Of segments with significantly better CB after treatment, all but one showed similar improvements in TD. Such changes were not related to the degree of TD before treatment, being seen in segments with abnormal as well as normal TD. There was no correlation between improvements seen in TD and CB. CONCLUSION: We believe that TD should be considered an inherent feature of MMN. Improvement in TD is an independent marker of electrophysiological improvement in this disorder and is likely to be more useful than CB. When MMN is clinically suspected, the use of stringent criteria for CB in the presence of TD should be avoided.

Inhibition of N-myc expression and induction of apoptosis by iron chelation in human neuroblastoma cells.

Neuroblastoma is the second most common solid malignancy of childhood. Enhanced expression of the amplified N-myc gene in the tumor cells may be associated with poor patient prognosis and may contribute to tumor development and progression. The use of deferoxamine mesylate (DFO), an iron chelator, to treat neuroblastoma is being investigated in national clinical studies. We show here by TUNEL assay and DNA laddering that DFO induces apoptosis in cultured human neuroblastoma cells, which is preceded by a decrease in the expression of N-myc and the altered expression of some other oncogenes (up-regulating c-fos and down-regulating c-myb) but not housekeeping genes. The decrease in N-myc expression is iron-specific but does not result from inhibition of ribonucleotide reductase, because specific inhibition of this iron-containing enzyme by hydroxyurea does not affect N-myc protein levels. Nuclear run-on and transient reporter gene expression experiments show that the decrease in N-myc expression occurs at the level of initiation of transcription and by inhibiting N-myc promoter activity. Comparison across neuroblastoma cell lines of the amount of residual cellular N-myc protein with the extent of apoptosis measured as pan-caspase activity after 48 h of iron chelation reveals no correlation, suggesting that the decrease in N-myc expression is unlikely to mediate apoptosis. In conclusion, chelation of cellular iron by DFO may alter the expression of multiple genes affecting the malignant phenotype by multiple pathways. Given the clinical importance of N-myc overexpression in neuroblastoma malignancy, decreasing N-myc expression by DFO might be useful as an adjunct to current

Steroid responsive polyneuropathy in a family with a novel myelin protein zero mutation.

OBJECTIVE: To report a novel hereditary motor and sensory neuropathy (HMSN) phenotype, with partial steroid responsiveness, caused by a novel dominant mutation in the myelin protein zero (MPZ) gene. Most MPZ mutations lead to the HMSN type I phenotype, with recent reports of Déjérine-Sottas, congenital hypomyelination, and HMSN II also ascribed to MPZ mutations. Differing phenotypes may reflect the effect of particular mutations on MPZ structure and adhesivity. METHODS: Clinical, neurophysiological, neuropathological, and molecular genetic analysis of a family presenting with an unusual hereditary neuropathy. RESULTS: Progressive disabling weakness, with positive sensory phenomena and areflexia, occurred in the proband with raised CSF protein and initial steroid responsiveness. Nerve biopsy in a less severely affected sibling disclosed a demyelinating process with disruption of compacted myelin. The younger generation were so far less severely affected, becoming symptomatic only after 30 years. All affected family members were heterozygous for a novel MPZ mutation (Ile99Thr), in a conserved residue. CONCLUSIONS: This broadens the range of familial neuropathy associated with MPZ mutations to include steroid responsive neuropathy, initially diagnosed as chronic inflammatory demyelinating polyneuropathy.

Guidelines for medical and health information sites on the internet: principles governing AMA web sites. American Medical Association.

Access to medical information via the Internet has the potential to speed the transformation of the patient-physician relationship from that of physician authority ministering advice and treatment to that of shared decision making between patient and physician. However, barriers impeding this transformation include wide variations in quality of content on the Web, potential for commercial interests to influence online content, and uncertain preservation of personal privacy. To address these issues, the American Medical Association (AMA) has developed principles to guide development and posting of Web site content, govern acquisition and posting of online advertising and sponsorship, ensure site visitors' and patients' rights to privacy and confidentiality, and provide effective and secure means of e-commerce. While these guidelines were developed for the AMA Web sites and visitors to these sites, they also may be useful to other providers and users of medical information on the Web. These principles have been developed with the understanding that they will require frequent revision to keep pace with evolving technology and practices on the Internet. The AMA encourages review and feedback from readers, Web site visitors, policymakers, and all others interested in providing reliable quality information via the Web.

Varying occurrence of vocal cord paralysis in a family with autosomal dominant hereditary motor and sensory neuropathy.

A white British family with the axonal form of hereditary motor and sensory neuropathy (HMSN, type II) contained one member who developed a recurrent laryngeal nerve palsy at the age of 41 years, in addition to 4 years of symptomatic polyneuropathy and an abducens nerve palsy. Neither of the other family members (the mother and sister) with electrophysiologically confirmed polyneuropathy had any neuropathic symptoms in the limbs or laryngeal or respiratory muscle involvement. An autosomal dominant pattern of inheritance is likely. This is a second report of this rare form of HMSN (type IIC) in which there is associated laryngeal or respiratory muscle weakness. This family differs from the two previously reported pedigrees in which laryngeal or diaphragm weakness had commenced within the first two decades. The discovery of asymptomatic family members attests to the diagnostic value of clinical and electrophysiological study of first-degree relatives when laryngeal or bulbar symptoms develop in the context of chronic axonal polyneuropathy. HMSN type IIC should be distinguished from the more common forms of HMSN - type IIA, in which axonal polyneuropathy is restricted to the limbs, and type IIB, which is of early onset and associated with foot ulceration.

Osmotic balance in the eggs of the turtle Chelodina rugosa during developmental arrest under water.

The tropical Australian turtle Chelodina rugosa normally lays its hard-shelled eggs in mud, under shallow freshwater, during the monsoon season. The eggs undergo developmental arrest until the water recedes and oxygen is able to diffuse into the embryo. This period of arrest can exceed 12 wk without embryonic mortality. To understand how the eggs avoid osmotic absorption of water leading to shell rupture and embryonic death, this study investigates the solute concentrations and volumes of the albumen and yolk compartments during submergence in distilled water. The albumen loses considerable sodium through the shell, particularly during the first week, and its osmotic concentration drops from 234 mmol/kg at laying to about 23 mmol/kg. Meanwhile, water from the albumen slowly moves through the vitelline membrane into the yolk compartment, which enlarges at a constant rate until it approaches the inside of the shell at about 22 wk. Osmotic uptake dilutes yolk solutes, decreasing the osmotic concentration from 281 mmol/kg at laying to 132 mmol/kg at 157 d. Loss of embryonic viability is associated with contact of the vitelline membrane with the inside of the shell. The principal adaptation of this species for protracted developmental arrest under water is a vitelline membrane of such low permeability to water that the expansion of the yolk compartment occurs about 10 times more slowly than in other chelonians.

Identification of epitope recognized by an anti-c-myc monoclonal antibody that cross-reacts with E. coli sigma factor using phage display libraries.

BACKGROUND: During the epitope mapping of monoclonal antibodies specific for myc proteins, two E. coli proteins cross-reactive with an anti-c-myc monoclonal antibody (MYC-X-5/1) were identified. One of the proteins is approximately 90 kDa and the other is over 150 kDa in apparent molecular mass. The molecular masses of these cross-reactive proteins suggested that they may be subunits of E. coli RNA polymerase. OBJECTIVES: We have investigated whether or not the proteins cross-reactive with MYC-X-5/1 are subunits of E. coli RNA polymerase. In addition, we have attempted to determine the epitope of MYC-X-5/1. STUDY DESIGN: The reactivity of MYC-X-5/1 antibody was tested against highly purified E. coli RNA polymerase holo-enzyme preparations and the cell lysate made from E. coli carrying a multi-copy plasmid with an insert of the rpoD gene, the structural gene for the E. coli sigma subunit. The epitope of MYC-X-5/1 was determined by use of phage display of random peptide libraries. RESULTS: On immunoblotting assays, MYC-X-5/1 reacted with the 90-kDa protein in the E. coli RNA polymerase preparations and with the 90-kDa protein over-expressed in E. coli carrying the plasmid with the rpoD insert. In addition, we have deduced the epitope of the MYC-X-5/1 antibody to be residues 235-245 of the human c-myc protein. A highly similar sequence to this was also identified in residues 62-72 of the sigma subunit of E. coli RNA polymerase. CONCLUSION: These data demonstrated that the 90-kDa protein cross-reactive with MYC-X-5/1 is the sigma subunit of E. coli RNA polymerase. Furthermore, this study shows that random peptide libraries displayed on filamentous phage are useful tools for epitope mapping and defining cross-reactivities of monoclonal antibodies.

3,4-dihydroxyphenylalanine (dopa) metabolism and retinoic acid induced differentiation in human neuroblastoma.

In mature cells of the sympathetic nervous system and the adrenal gland, the activity of dihydroxyphenylalanine decarboxylase (DDC) is higher than that of tyrosine hydroxylase and 3,4-dihydroxyphenylalanine (dopa) does not accumulate in the cells. On the other hand, it is known that in some neuroblastoma cells there is a relative deficiency of DDC, resulting in accumulation and secretion of dopa. Such a relative deficiency of DDC is a characteristic of neural cells at an early stage of neural crest development, suggesting the neuroblastoma are cells arrested in early neural crest development. If this were the case, it is possible that agents such as retinoic acid (RA) could induce neuroblastoma to differentiate into mature cells with respect to their metabolism of catecholamines. We have measured the effect of RA on the metabolism of dopa and expression of tyrosine hydroxylase and DDC in human neuroblastoma cell lines, CHP-126, CHP-134, IMR-32, NB-69, and LA-N-5. When the cell cultures were treated with RA, they showed wide variations in response as measured by morphological change, growth inhibition, enzyme activities and enzyme expressions. The RA treatment modulated the activities of tyrosine hydroxylase and DDC, but does not increase DDC relative to tyrosine hydroxylase. It is concluded that RA does not induce biochemical differentiation of the neuroblastoma into mature cells even when there are extensive morphological changes and suppression of growth rate.

Changes in focal interictal epileptiform activity during and after the performance of verbal and visuospatial tasks in a patient with intractable partial seizures.

An 18-year-old male with intractable complex partial seizures is described in whom localised epileptiform discharges in the EEG were influenced in a specific manner by different cognitive tasks. The patient had impaired verbal skills but above average visuospatial ability, and seizures probably arising in the left temporal lobe. Comparison of verbal and visuospatial tasks showed that focal epileptiform activity was suppressed or enhanced depending on the nature of the immediate and preceding cognitive tasks. The finding of particular interest was the activity of a posterior temporal spike focus only during rest periods after verbal tasks, by contrast with an independent mid-to-anterior temporal focus that was suppressed during verbal tasks.

Cloning, analysis, and chromosomal localization of myoxin (MYH12), the human homologue to the mouse dilute gene.

The mouse dilute gene encodes a novel type of non-muscle myosin that structurally combines elements from both nonmuscle myosin type I and nonmuscle myosin type II. Phenotypically, mutations in the mouse dilute gene result not only in the lightening of coat color, but also in the onset of severe neurological defects shortly after birth. This may indicate that the mouse dilute gene is important in maintaining the normal neuronal function in the mouse. We report the isolation and sequencing of "myoxin" (MYH12), the human homologue of the mouse dilute gene, and its assignment to human chromosome 15.