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Unstable angina responds to integrelin
THE LANCET
SCIENCE AND MEDICINE
Helicobacter infection is common in US children
T
he first US population-based study of Helicobacter pylori prevalence estimates that nearly one-quarter of all children are infected with the bacteria. Importantly, the study shows that even in developed countries, such as the USA, H pylori is acquired in early life (J Infect Dis 1996; 174: 1120–23). This information should be of use in deciding whether and when to immunise children once vaccines become available The researchers, led by Mary Staat (Children’s Hospital Medical Center, Cincinnati, USA), determined the prevalence of H pylori infection in 2581 children aged between 6–19 years old by measuring anti-H pylori IgG antibody concentrations. The study was part of the National Health and Nutrition Examination Survey designed to provide data on the health and nutritional status of the civilian, non-institutionalised population through household surveys and standardised physical examinations. The researchers found that 24·8% of participants had evidence of H pylori infection. Infection was strongly associated with increasing age and ethnicity—17·0% of nonHispanic whites were infected, com-
pared with 40·1% of non-Hispanic blacks, and 42·0% of Mexican Americans. The investigators believe that a representative sampling of the US population accounts for the higher average prevalence reported in their study than in previous studies that suggested that only 5–15% of children were infected. In the study, the infection rate was higher among children from low-income families. The education level of the head of the household was also an important predictor of infection. And among Mexican Americans, birth outside the USA and Canada was an important independent risk factor for infection with H pylori. This new information will help design future vaccination protocols, say the researchers. “In order to decide whether you should vaccinate everyone you have to work out what the local prevalence of infection is”, explains Robert Logan (Queen’s Medical Centre, Nottingham, UK). “It may be that it is more cost effective to screen the population and just treat those who are infected.”
esearchers have succeeded in transferring a normal gene into skin cells grown from patients with lamellar ichthyosis (LI), a rare skin disease, and then using the corrected cells to regenerate normal human skin in a murine model. These results, according to the US investigators, “demonstrate a potential future approach to therapeutic gene delivery in human skin” (Nat Med 1996; 2: 1263–67). Moreover, the results “confirm a major role for TGase1 [keratinocyte transglutaminase 1] in epidermal differentiation”. The team obtained primary keratinocytes from four patients with LI. Using a retroviral vector, they transduced the cells with TGase1 and grew them in vitro. Both genetically engineered and untreated cells were grafted to mice that can grow human skin. “Clinical hyper-
Vol 348 • November 9, 1996
W
omen are more likely to get significant pain relief from kappaopioid analgesics than men, writes Jon Levine (San Francisco, USA) in Nature Medicine (1996; 2: 1248–50). 20 women and 28 men were given either nalbuphine or butorphanol, both kappa-opioids, to relieve pain after tooth extraction. Despite more initial pain women, had a better response to the analgesia. Says Levine,“If this holds up with multidose studies and other pain syndromes, it’s reasonable to consider kappa-opioids underused in women and overused in men”. µ-opioids are thought to be more effective than kappa-opioids, he notes, but, “this may be because the drug research was done mainly with men”. Peter Glass (Durham, USA), who has found sex differences after anaesthesia, cautions that “causes for the differences must be sought . . . The analgesic response in women may have been longer; this doesn’t necessarily mean the drug was more efficacious”.
Unstable angina responds to integrelin
I
keratosis was seen in all cases” of skin regenerated from untreated cells, but transduced cells from the same patients “were clinically indistinguishable” from normal skin. However, the effect was shortlived, and the authors note that “time-dependent loss of virally delivered transgene expression . . . constitutes a continuing and major challenge in therapeutic cutaneous gene delivery”. “It’s very exciting that they can take a gene, put it in abnormal tissue, and get a normal phenotype”, says Richard Granstein, chairman of the dermatology department at New York Hospital-Cornell Medical Center. “There are many hurdles to overcome before the technique moves into the clinic, but this represents a major step forward.”
n a trial comparing aspirin, lowdose integrelin, and high-dose integrelin for treatment of unstable angina, patients receiving high-dose integrelin had fewer, shorter episodes of angina than other patient groups (Circulation 1996; 94: 2083–89). Integrelin, a cyclic heptapeptide, prevents platelet aggregation by binding to the platelet fibrinogen receptor glycoprotein llb/llla. All 169 patients completing the research protocol received standard medical therapy for unstable angina in addition to the test drug. The number and duration of ischaemic episodes was measured over the first 24 hours of treatment by continuous electrocardiography. Patients on high-dose integrelin had a mean of 0·24 (SD 0·11) ischaemic events per 24 hours, whereas patients on aspirin had 1·0 (0·33) events (p<0·05), and patients on low-dose integrelin had 0·83 (0·32) events. The high-dose integrilin group also had shorter ischaemic episodes than the aspirin group (8·4 [5·3] min vs 26·23 [9·8] min, p=0.01). Bleeding complications were few, mostly ecchymoses at sites of intravenous lines.
Marilynn Larkin
David H Frankel
Janet Fricker
Gene transfer yields skin-deep beauty
R
Gender dictates response to opioids
1301
SCIENCE AND MEDICINE
Helicobacter infection is common in US children
T
he first US population-based study of Helicobacter pylori prevalence estimates that nearly one-quarter of all children are infected with the bacteria. Importantly, the study shows that even in developed countries, such as the USA, H pylori is acquired in early life (J Infect Dis 1996; 174: 1120–23). This information should be of use in deciding whether and when to immunise children once vaccines become available The researchers, led by Mary Staat (Children’s Hospital Medical Center, Cincinnati, USA), determined the prevalence of H pylori infection in 2581 children aged between 6–19 years old by measuring anti-H pylori IgG antibody concentrations. The study was part of the National Health and Nutrition Examination Survey designed to provide data on the health and nutritional status of the civilian, non-institutionalised population through household surveys and standardised physical examinations. The researchers found that 24·8% of participants had evidence of H pylori infection. Infection was strongly associated with increasing age and ethnicity—17·0% of nonHispanic whites were infected, com-
pared with 40·1% of non-Hispanic blacks, and 42·0% of Mexican Americans. The investigators believe that a representative sampling of the US population accounts for the higher average prevalence reported in their study than in previous studies that suggested that only 5–15% of children were infected. In the study, the infection rate was higher among children from low-income families. The education level of the head of the household was also an important predictor of infection. And among Mexican Americans, birth outside the USA and Canada was an important independent risk factor for infection with H pylori. This new information will help design future vaccination protocols, say the researchers. “In order to decide whether you should vaccinate everyone you have to work out what the local prevalence of infection is”, explains Robert Logan (Queen’s Medical Centre, Nottingham, UK). “It may be that it is more cost effective to screen the population and just treat those who are infected.”
esearchers have succeeded in transferring a normal gene into skin cells grown from patients with lamellar ichthyosis (LI), a rare skin disease, and then using the corrected cells to regenerate normal human skin in a murine model. These results, according to the US investigators, “demonstrate a potential future approach to therapeutic gene delivery in human skin” (Nat Med 1996; 2: 1263–67). Moreover, the results “confirm a major role for TGase1 [keratinocyte transglutaminase 1] in epidermal differentiation”. The team obtained primary keratinocytes from four patients with LI. Using a retroviral vector, they transduced the cells with TGase1 and grew them in vitro. Both genetically engineered and untreated cells were grafted to mice that can grow human skin. “Clinical hyper-
Vol 348 • November 9, 1996
W
omen are more likely to get significant pain relief from kappaopioid analgesics than men, writes Jon Levine (San Francisco, USA) in Nature Medicine (1996; 2: 1248–50). 20 women and 28 men were given either nalbuphine or butorphanol, both kappa-opioids, to relieve pain after tooth extraction. Despite more initial pain women, had a better response to the analgesia. Says Levine,“If this holds up with multidose studies and other pain syndromes, it’s reasonable to consider kappa-opioids underused in women and overused in men”. µ-opioids are thought to be more effective than kappa-opioids, he notes, but, “this may be because the drug research was done mainly with men”. Peter Glass (Durham, USA), who has found sex differences after anaesthesia, cautions that “causes for the differences must be sought . . . The analgesic response in women may have been longer; this doesn’t necessarily mean the drug was more efficacious”.
Unstable angina responds to integrelin
I
keratosis was seen in all cases” of skin regenerated from untreated cells, but transduced cells from the same patients “were clinically indistinguishable” from normal skin. However, the effect was shortlived, and the authors note that “time-dependent loss of virally delivered transgene expression . . . constitutes a continuing and major challenge in therapeutic cutaneous gene delivery”. “It’s very exciting that they can take a gene, put it in abnormal tissue, and get a normal phenotype”, says Richard Granstein, chairman of the dermatology department at New York Hospital-Cornell Medical Center. “There are many hurdles to overcome before the technique moves into the clinic, but this represents a major step forward.”
n a trial comparing aspirin, lowdose integrelin, and high-dose integrelin for treatment of unstable angina, patients receiving high-dose integrelin had fewer, shorter episodes of angina than other patient groups (Circulation 1996; 94: 2083–89). Integrelin, a cyclic heptapeptide, prevents platelet aggregation by binding to the platelet fibrinogen receptor glycoprotein llb/llla. All 169 patients completing the research protocol received standard medical therapy for unstable angina in addition to the test drug. The number and duration of ischaemic episodes was measured over the first 24 hours of treatment by continuous electrocardiography. Patients on high-dose integrelin had a mean of 0·24 (SD 0·11) ischaemic events per 24 hours, whereas patients on aspirin had 1·0 (0·33) events (p<0·05), and patients on low-dose integrelin had 0·83 (0·32) events. The high-dose integrilin group also had shorter ischaemic episodes than the aspirin group (8·4 [5·3] min vs 26·23 [9·8] min, p=0.01). Bleeding complications were few, mostly ecchymoses at sites of intravenous lines.
Marilynn Larkin
David H Frankel
Janet Fricker
Gene transfer yields skin-deep beauty
R
Gender dictates response to opioids
1301