China
Africa
Explore chapters and articles related to this topic
Analyzing and integrating a body of knowledge: Systematic reviews and meta-analysis of evidence
Published in Milos Jenicek, Foundations of Evidence-Based Medicine, 2019
Some proportional expression, conceptually close to etiological fraction or protective efficacy ratio, is represented by Einarson et al.'s 41 formula for computation of the effect size from the frequencies of outcomes (qualitative data) as already quoted in Section 11.3. They evaluated therapeutic efficacy of intradiscally-injected chymopapain in herniated lumbar disc sufferers. Elsewhere, Wortman and Yeaton67 evaluated the effectiveness of coronary artery bypass graft surgery by comparing numbers of angina-free subjects in surgically and medically treated patients. An angina-free period represented a ‘quality-of-life benefit’ in their study. Their formula for calculating the quality-of-life benefit (QLB) was:
Animal Models and Imaging of Intervertebral Disc Degeneration
Published in Raquel M. Gonçalves, Mário Adolfo Barbosa, Gene and Cell Delivery for Intervertebral Disc Degeneration, 2018
Marion Fusellier, Johann Clouet, Olivier Gauthier, Catherine Le Visage, Jerome Guicheux
Chymopapain is a proteolytic enzyme derived from the papaya latex that selectively cleaves the noncollagenous protein connections of proteoglycans in a dose-dependent manner. It has been shown to provoke degeneration in an in vitro organ culture model (Chan et al. 2013). Chymopapain treatment has been tested on rabbits (Gullbrand et al. 2016) and dogs (Kudo, Sumi, and Hashimoto 1993; Lü et al. 1997). It induces severe degeneration with rapid proteoglycan decrease and concomitant disc space narrowing and spine instability. It has been shown that NP contained degenerated notochordal cells after chymopapain treatment. Later, the center of the NP was replaced by fibrocartilage tissue (Kudo, Sumi, and Hashimoto 1993). The degeneration induced by chymopapain is greater than chondroitinase-induced degeneration in the dog (Lü et al. 1997) but is strongly dependent on the dose.
Contact Urticaria, Dermatitis, and Respiratory Allergy Caused by Enzymes
Published in Ana M. Giménez-Arnau, Howard I. Maibach, Contact Urticaria Syndrome, 2014
Stanciu Monica, Denis Sasseville
Chymopapain: A proteolytic enzyme closely related to papain and extracted from the same source, chymopapain has found applications in chemonucleolysis to treat herniated discs in the lumbar spine. Injected under local anesthesia, the enzyme dissolves the bulging nucleus pulposus that compresses nerve roots, thus relieving the pain of intractable sciatalgia. The risk of anaphylaxis from chemonucleolysis is estimated at 1%, and the risk of death at 0.14%.[25] In 2003, the sale of Chymodiactin was discontinued in the United States. Sagona et al. demonstrated cross-reactivity between papain and chymopapain.[26] Six patients with positive prick tests to papain also had positive RAST to both papain and chymopapain. The same study showed that 2 weeks after chemonucleolysis, the serum of 12 patients was RAST positive to both enzymes. Hypersensitivity reactions after chymopapain injection can be immediate in patients already sensitized, or can occur 2 to 24 days later, denoting acquisition of hypersensitivity and specific IgE antibodies from the procedure.[27–29] Moneret-Vautrin preoperatively evaluated 700 candidates for chemonucleolysis with a careful history of papain exposure and atopy, and prick testing with chymopapain.[30] Chemonucleolysis was not performed in the 23 patients with positive tests, whereas the remaining 677 were successfully treated without anaphylaxis. Prick tests after 6 weeks and 6 months after the procedure showed acquired sensitization in 36% of the treated patients.
Intervertebral Disc Degeneration Models for Pathophysiology and Regenerative Therapy -Benefits and Limitations
Published in Journal of Investigative Surgery, 2022
Yidian Wang, Jihe Kang, Xudong Guo, Daxue Zhu, Mingqiang Liu, Liang Yang, Guangzhi Zhang, Xuewen Kang
The height of the IVD is highly dependent on the balance of water, collagen, and PGs content, and the imbalance of these three factors will lead to the decline of IVD height. When more than a certain dose, chymopapain and similar enzymes such as collagenase, trypsin, papain, or chondroitinase ABC can be used as rapid inducers of IVD degeneration [56, 59, 85]. In this case, the degree of IVD degeneration is related to the dose or concentration of the enzyme. At higher doses, most of the NP were digested and IVD height decreased significantly, similar to the late stage of IDD [85, 86]. At lower doses, most of the NP were retained, including the NPCs, which can simulate the middle or early stage of IDD [59, 63]. Based on this model, a variety of tissue engineering strategies are used in IDD research. Rosenzweig et al. [56] reported a thermal response hyaluronic acid hydrogel, which coated autologous NPCs, and had a good effect on the repair of trypsin-induced early bovine tail IDD. This suggests that the enzyme digestion model can be used as a good screening platform to detect the efficacy of potential therapies, so as to provide insights before conducting in vivo animal studies.
LTE: comment on “Incidence of allergic reactions to crotalidae polyvalent immune fab”
Published in Clinical Toxicology, 2020
Spencer C. Greene, Liliana Morales-Perez, Michael Pallini, Carlos Vences, Jennifer Carnell
On the first page of the CroFab® package insert, allergies to papain, chymopapain, other papaya extracts, and the pineapple enzyme bromelain are prominently listed in the “Warnings and Precautions” section [3]. CroFab does not contain latex, although in a later section of the insert it is mentioned that some latex allergens share antigenic structures with papain.