A randomized, controlled trial comparing skin health effects and comfort of two adult incontinence protective underwear.

BACKGROUND/PURPOSE: It is important to confirm product use effects on skin health for products intended for prolonged skin contact. This study compared experimental and marketed reference adult incontinence protective underwear. METHODS: Randomized, single-blind (examiner), parallel study evaluating skin health effects in predominantly obese incontinent women normally using protective underwear (approximately 20% Type II Diabetes). Subjects wore experimental or marketed reference protective underwear daily, 14 consecutive days. Visual skin grading, transepidermal water loss (TEWL) assessed before, after 1 and 2 weeks of product wear. Overall assessment of comfort assessed. RESULTS: Of the 122 subjects (60 experimental and 62 marketed reference), 22 were diabetic and 88 were postmenopausal. Under the conditions of this study, there were no statistically significant differences in overall change from baseline for visual grading and TEWL between the experimental product and the marketed reference product for all subjects. Changes from baseline for skin erythema and skin marking were generally small for both products for all subjects as well as for both diabetics and non-diabetics. There were no serious adverse events (AEs), and no withdrawals due to AEs. Overall comfort assessments of size and fit were 'just right,' and skin comfort in the leg, waist and crotch areas were 'comfortable' or 'very comfortable' for both products. CONCLUSIONS: In-use 14-day testing demonstrated few statistical differences between experimental product with unique odor neutralizing technology and currently marketed product for skin assessments and comfort. Both products were comfortable and well-tolerated.

Survey of resistance of herpes simplex virus to acyclovir in northwest England.

Acyclovir (ACV) has been used for more than 15 years in the management of herpes simplex virus (HSV) and varicella-zoster virus (VZV) disease. The present survey was undertaken to assess the level of ACV resistance in the population. More than 2,000 HSV isolates from both immunocompetent and immunocompromised patients in northwest England were collected over a 2-year period and tested for sensitivity to ACV. These studies suggested a prevalence of resistance of approximately 0.1 to 0.6% in immunocompetent individuals, with no apparent difference in prevalence between treated and untreated groups. In line with previous studies, the prevalence of resistance in treated immunocompromised individuals was approximately 6%.

The medial amygdaloid nucleus modifies social behavior in male rats.

Electrical stimulation of the medial amygdaloid nucleus (AME) produces a behavioral state in male rats that resembles the postejaculatory interval, but electrical recording from cells in the AME shows that they become active earlier in sexual behavior, around the time that the male first appears to become aware of estrus in the female. In an attempt to resolve which feature of sexual behavior was mediated by the AME, we stimulated the structure bilaterally in freely behaving males using voltage levels too low to produce the postejaculatory interval. We found that electrical activation of this kind facilitated sexual behavior when it would not otherwise occur (i.e., in the presence of a nonestrous female). However, the stimuli suppressed sexual behavior when it would normally occur (i.e., in the presence of a nonestrous female). We discuss alternative interpretations of the results in the context of a general model for the central organization of sexual behavior in males.

Neutralization epitopes of human rhinovirus type 2.

Fourteen neutralizing monoclonal antibodies recognizing human rhinovirus (HRV) type 2 have been used to select a total of 51 virus escape mutants. Cross-resistance analysis of the mutants, together with RNA sequencing and identification of amino acid substitutions, have revealed three neutralization sites on the virus surface. Two of these appear to correspond to the NIm-IA and NIm-II sites described for HRV-type 14, although there are also substantial differences. The third site has not been described previously.

Cartilaginous choristoma of the tongue. A case report and literature review.

Lingual cartilaginous choristomas are rare tumors. They are usually seen in adults as an asymptomatic mass on the lateral surface of the tongue. The histology is benign, with mature adipocytes or myxoid tissue and islands of cartilage within a well-defined capsule. Simple excision is curative. Because of the rarity of this lesion, we remind readers of its existence and present a review of the literature.

Insulin internalization and intracellular protein degradation: a quantitative correlation.

We have recently demonstrated that internalization of insulin is essential for insulin's action upon intracellular proteolysis (Draznin and Trowbridge 1982). In this study we have investigated the quantitative relationship between the rate of insulin internalization and its ability to inhibit intracellular proteolysis. We have used the acidification technique to separate surface bound 125I-insulin (sur) from internalized ligand (In). The In/Sur ratio plotted as a function of time permits the calculation of the rate of insulin internalization (K-e) (Draznin, Trowbridge and Ferguson 1984). Insulin in a dose dependent manner increased the rate of C14-glucose incorporation into glycogen and inhibited the rate of degradation of intracellular proteins prelabelled in vivo with C14-valine. When insulin internalization was blocked by phenylarsine oxide (10(-5) M), the amount of surface bound ligand and its effect on glucose incorporation into glycogen were unaffected whereas insulin's effect on intracellular proteolysis was markedly diminished. There was a direct and significant correlation between K-e and insulin induced inhibition of intracellular proteolysis (r = .72, P less than .05). The correlation between the amount of internalized insulin and intracellular proteolysis was also significant (r = .84, P less than .01).

Somatostatin receptors are biologically active before they are inserted into the plasma membrane.

We have examined the biological activity of intracellular somatostatin (SRIF) receptors in cultured rat anterior pituitary cells. We used digitonin-permeabilized cells to introduce free SRIF intracellularly and chloroquine-treated cells to promote intracellular accumulation of SRIF via a receptor-mediated pathway. At a concentration of 0.001%, digitonin (3-min incubation at 37 C) allowed [125I]SRIF to enter the cells without affecting cell viability. Autoradiography of [125I]SRIF demonstrated its association with secretion vesicles (28%), nuclei (25%), and other intracellular organelles. An acid wash technique that removes cell surface-bound ligand revealed that both digitonin-permeabilized cells and chloroquine-treated cells accumulated approximately twice as much intracellular SRIF as did control cells. The biological activities of intracellular SRIF accumulated via two different pathways, receptor mediated and through digitonin-produced pores in the plasma membrane, were different. In chloroquine-treated cells, the accumulation of intracellular SRIF did not result in its additional biological effect. SRIF inhibited GH-releasing factor-induced GH release from 578 +/- 12 to 168 +/- 9 ng/10(6) cells X 30 min, which did not differ from the control value. Cells incubated with digitonin demonstrated normal basal (160 +/- 9 ng/10(6) cells X 30 min) and GH-releasing factor-stimulated GH release (564 +/- 11 ng/10(6) cells X 30 min). However, the inhibitory action of SRIF in these cells was approximately 30% greater (98 +/- 8 ng/10(6) cells X 30 min) than that in either control or chloroquine-treated cells, suggesting that SRIF freely admitted intracellularly produces additional biological activity. These observations confirm the presence of the intracellular receptors and suggest that these receptors exist in a biologically active form.

Mechanisms of the fasting-induced dissociation of insulin binding from its action in isolated rat hepatocytes.

Fasting leads to an increase in insulin binding to isolated rat hepatocytes from 12 to 17%. This increase was accounted for by changes in the affinity of insulin receptors without alteration in their number. In contrast, the responsiveness of hepatocytes to insulin was markedly diminished in fasted rats. Both basal and insulin-stimulated rates of 14C-glucose incorporation into glycogen were significantly decreased in fasted animals. When insulin-induced 14C-glucose incorporation into glycogen was expressed as a percent above the basal rate, hepatocytes isolated both from control and fasted animals showed the same magnitude of maximal response (66 +/- 13% in fed and 59 +/- 12% in fasted animals, respectively). However, more insulin must be bound to hepatocytes isolated from fasted animals in order to elicit the same percent of insulin's maximal effect. Incubation of 'fed' hepatocytes in the serum obtained from fasted rats significantly diminished their responsiveness to insulin. An addition of insulin (100 ng/ml), glucose (10 mM) and antibodies to glucagon (1:100) eliminated the inhibitory effect of 'fasted' serum on 'fed' hepatocytes. A 48-hour fast increased significantly the microviscosity (decreased fluidity) of hepatocyte plasma membranes and altered membrane phospholipid composition. These changes correlated with enhanced insulin binding to isolated membranes. Moreover, in response to insulin, plasma membranes isolated from 'fasted' hepatocytes generated only one half the amount of the second messenger (PDH activator) observed in membranes of fed animals. The amount of PDH activator generated by incubation of plasma membranes with insulin correlated inversely with both insulin binding and membrane microviscosity. We conclude that 1) fasting induces both coupling defect and post-receptor changes in insulin's action; 2) both extracellular and intracellular factors contribute to fasting-induced dissociation of insulin binding from insulin action; 3) insulin/glucagon ratio may influence hepatocyte responsiveness to insulin; 4) alterations in plasma membrane fluidity and phospholipid composition may alter insulin binding and contribute to its dissociation from the subsequent action; 5) membranes isolated from 'fasted' hepatocytes generate less mediator of insulin action than do membranes isolated from 'fed' hepatocytes.

Quantitative studies of the rate of insulin internalization in isolated rat hepatocytes.

We studied internalization of 125I-labelled insulin in isolated rat hepatocytes. Using the acidification technique, we were able to dissociate the ligand from its cell-surface receptors, and thus to separate internalized from surface-bound insulin. Because during the first 5 min of incubation of 125I-labelled insulin with freshly isolated hepatocytes there is no loss of internalized label, the ratio of the amount of internalized ligand to the amount of cell-surface-bound ligand may serve as an index of insulin internalization. Within the first 10 min of insulin's interaction with hepatocytes, the plot of the above ratio as a function of time yields a straight line. The slope of this line is referred to as the endocytic rate constant (Ke) for insulin and denotes the probability with which the insulin-receptor complex is internalized in 1 min. At the insulin concentration of 0.295 ng/ml, the Ke is 0.049 min-1. It is independent of insulin concentration until the latter exceeds 1 ng/ml. At the insulin concentration of 3.2 ng/ml, the Ke accelerates to 0.131 min-1. With the Ke being the probability of insulin-receptor-complex internalization, 4.9% of occupied insulin receptors will be internalized in 1 min at an insulin concentration of 0.295 ng/ml, and 13.1% of occupied insulin receptors will be internalized in 1 min at 3.2 ng/ml. When the insulin concentration decreases from 3.2 to 0.3 ng/ml, the Ke decreases accordingly. The half-time of occupied receptor internalization is 15.4 min at the lower insulin concentration and 5.3 min at the higher insulin concentration.

Effects of in vivo and in vitro alcohol administration on insulin binding and glycogenesis in isolated rat hepatocytes.

Chronic alcohol ingestion was accompanied by a mild decrease in insulin binding (from 11.7 to 8.9% per 1 X 10(6) cells) that was accounted for by changes in the dissociation constant of insulin's binding sites. The basal rate of 14C-glucose incorporation into glycogen was reduced both in alcoholic and pair-fed animals. Insulin stimulated 14C-glucose incorporation into glycogen in control (72% above basal rate) and pair-fed (76% above basal rate) animals. In contrast, only a minimal stimulation of glucose incorporation into glycogen (30%) induced by insulin was observed in alcoholic animals. Hepatocyte responsiveness to insulin was restored when the animals were switched back to normal dry food diet. When the hepatocytes were incubated with 50 mM alcohol for 1 h at 37 degrees C (in vitro experiments) insulin binding remained unchanged. There was a mild but significant decrease in insulin's ability to enhance glucose incorporation into glycogen. The anti-catabolic effect of insulin was unaffected by alcohol. In summary, chronic alcohol ingestion causes significant but reversible changes in post-receptor events of insulin's action.

Inhibition of intracellular proteolysis by insulin in isolated rat hepatocytes. Possible role of internalized hormone.

The mechanism of insulin's action upon intracellular proteolysis in isolated hepatocytes was studied. At 37 degrees C insulin inhibited intracellular degradation of intracellular proteins in a dose-dependent manner. A maximal 40% inhibition of intracellular proteolysis was achieved at an insulin concentration of 500 ng/ml with a half-maximal inhibition observed at 2.5 ng/ml of insulin. Insulin inhibited intracellular proteolysis both in the presence and in the absence of amino acids in the incubation mixture. Low concentrations of trypsin (10 micrograms/ml) mimicked insulin's effect upon glucose incorporation into glycogen, but not on intracellular proteolysis. Four protease inhibitors (phenylmethylsulfonyl fluoride (0.5 mM), p-nitrophenyl-p-guanidinobenzoate (0.25 mM), p-tosyl-L-arginine methyl ester (1 mM), and N alpha-p-tosyl-L-lysine chloromethyl ketone (1 mM) blocked the stimulatory effect of insulin upon [14C]glucose incorporation into glycogen, but did not affect the inhibitory action of insulin upon intracellular proteolysis. These results suggest that the mechanism of insulin's action upon intracellular proteolysis differs from that involved in stimulation of glycogenesis. Low temperature (15 degrees C) and short time exposure (10 min) of the hepatocytes to insulin eliminated the inhibitory effect of insulin on intracellular proteolysis. Similarly, insulin's effect on intracellular proteolysis was eliminated by dansylcadaverine, a transglutaminase inhibitor that blocked insulin internalization. In contrast, dansylcadaverine had no effect on insulin's ability to stimulate [14C]glucose incorporation into glycogen. These experiments strongly suggest the necessity of insulin internalization for its inhibitory effect on endogenous protein degradation.

Methylmalonic aciduria without vitamin B12 deficiency in an adult sibship.

Two brothers 62 and 70 years old, without evidence of vitamin B12 lack, excreted 12 to 115 mg of methylmalonic acid daily (normal, less than 9 mg per day). Neither had anemia or hepatic dysfunction, and serum vitamin B12 concentrations ranged from 369 to 800 pg per milliliter. The propositus, the younger brother, continued to excrete excessive methylmalonate, 103 to 115 mg per day, after 2000 mug of parenterally administered vitamin B12 at the fifth and 11th months of study. Leukocyte activities of the cobalamin-linked enzyme methylmalonyl coenzyme A mutase were respectively reduced in the propositus and his brother, to 0.04 and 0.11 nmoles of 3-(14)-C Ls methylmalonyl coenzyme A metabolized per hour per milligram of leukocyte protein (normal, 0.286 +/- 0.079 [S.D.]). These activities were not enhanced by 2 mug of 5'-deoxyadenosylcobalamin added to the assays. A heritable benign form of adult methylmalonic aciduria rather than vitamin B12 lack best explains these findings.