Τετάρτη 2 Νοεμβρίου 2016
Role of isotocin in regulation of the hypophysiotropic dopamine neurons in the preoptic area of the catfish, Clarias batrachus
Abstract
Dopamine (DA) has emerged as the potent inhibitory neuromodulator of LH secretion and reproduction in teleosts. The DA neurons located in the anterior subdivision of nucleus preopticus periventricularis (NPPa) in the preoptic area (POA) innervate the pituitary gland and regulate the LH cells. Although reduction in the inhibitory DAergic tone is crucial for stimulatory action of GnRH on LH cells, the role of other hypothalamic factors is suggested but not fully understood. Nonapeptide, isotocin (IST) has emerged as a likely candidate that may also influence the LH cell function. IST neurons reside in the nucleus preopticus and innervate LH cells. While IST treatment dramatically elevated LH secretion, the IST levels in brain peaked during spawning. In a pilot study on the catfish, Clarias batrachus, we observed a dense network of IST-immunoreactive (IST-ir) fibers in NPPa, the region known to harbor hypophysiotropic DA neurons. Application of double immunofluorescence method showed dense IST-ir fiber network around the tyrosine hydroxylase (TH)-ir neurons in NPPa region. A great majority of the TH-ir neurons in NPPa were contacted by IST-ir fibers during spawning phase. The NPPa therefore seems to be a site for intense interaction of DA and IST. The IST-ir fiber innervation in NPPa showed reproduction phase-dependent changes. The percent fluorescent area of IST-ir fibers showed gradual increase from the resting through prespawning phases (Resting: 7.5 ± 1.04; Preparatory: 8.6 ± 0.8; Prespawning: 15.5 ± 1.4) reaching a peak in spawning phase (28 ± 2.3; P<0.001). Compared to spawning phase, a drastic reduction in IST-ir fibers in the NPPa was observed during the postspawning phase (8.4 ± 0.9; P<0.001). Superfused slices of the POA of C. batrachus treated with IST peptide resulted in a significant reduction in TH-immunoreactivity in the NPPa [Control: 45.3 ± 4.2; IST peptide (5 μM): 29.4 ± 4.7; P<0.05]. We suggest that the intense interaction between IST and DA in the NPPa, most probably of the inhibitory nature, may be critical to the regulation of LH cells and reproduction in teleosts.
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Dehydroepiandrosterone (DHEA) heightens aggression and increases androgen receptor and aromatase mRNA expression in the brain of a male songbird
Abstract
Dehydroepiandrosterone, DHEA, is a testosterone/estrogen precursor and known modulator of vertebrate aggression. Male song sparrows (Melospiza melodia morphna) show high aggression during breeding and non-breeding life history stages when circulating DHEA levels are high, and low aggression during molt when DHEA levels are low. We previously showed that androgen receptor and aromatase mRNA expression are higher during breeding and/or non-breeding in brain regions associated with reproductive and aggressive behavior, but DHEA's potential role in mediating these seasonal changes remained unclear. Here, non-breeding male song sparrows were captured and held in the laboratory on short days (8L:16D), and implanted with subcutaneous DHEA-filled or empty (control) implants for 14 days. DHEA implants increased aggression in a laboratory-based simulated territorial intrusion. Brains of DHEA-implanted birds showed higher aromatase mRNA expression in the preoptic area (POA) and higher androgen receptor mRNA expression in the periventricular nucleus of the medial striatum (pvMSt) and ventromedial nucleus of the hypothalamus (VMH). The DHEA-induced increases in aromatase expression in the POA and androgen receptor expression in the pvMSt are consistent with previously reported seasonal increases in these markers associated with naturally elevated DHEA levels. This suggests that DHEA facilitates seasonal increases in aggression in non-breeding male song sparrows by up-regulating steroid signaling/synthesis machinery in a brain region-specific fashion.
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Targeting corticotropin-releasing factor (CRF) projections from the oval nucleus of the BNST using cell-type specific neuronal tracing studies in mouse and rat brain
Abstract
The bed nucleus of the stria terminalis (BNST) is known to play a critical role in mediating the behavioral and autonomic responses to stressors. The oval nucleus of the BNST (BNSTov) contains cell bodies that synthesize the stress hormone, corticotropin releasing factor (CRF). Although afferent fibers originating from the BNSTov have been shown to innervate several key structures of the neuroendocrine and central autonomic system, the question remains as to whether, some of these fibers are CRF-positive. To directly address this question, we injected a "floxed" anterograde tracer (rAAV5/EF1a-DIO-mCherry) into the BNSTov of CRFp3.0CreGFP transgenic mice, which express a green fluorescent protein (GFP) under the control of the CRF promoter. Serial sections were then analyzed for the presence of double-labeled fibers in potential projection sites. To determine whether CRF neurons in the rat BNSTov send comparable projections, we infused rat BNSTov with an AAV in which the human synapsin promoter drives enhanced GFP expression. We then used CRF immunoreactivity to examine double-labeled fluorescent fibers and axon terminals in projection sites from brain sections of the AAV-infused rats. We have observed several terminal fields in the mouse and rat brain with double-labeled fibers in the Dorsal raphe nucleus (DRD), the Paraventricular nucleus of the hypothalamus, and to a lesser extent in the Ventral tegmental area. We found double-labeled terminal boutons in the nucleus accumbens shell, prelimbic cortex, and posterior basolateral nucleus of the amygdala. The most intense double-labeling was found in midbrain, including substantia nigra pars compacta, red nucleus, periaqueductal gray, pontine nuclei, as well as DRD. The results of our study indicate that CRF neurons are the output neurons of the BNSTov and they send projections to the centers of neuroendocrine and autonomic regulation, but also regions modulating reward and motivation, vigilance, motor function, as well as affective behavior.
This article is protected by copyright. All rights reserved.
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Hyponatraemia secondary to nivolumab-induced primary adrenal failure
Summary
Checkpoint inhibitors, such as ipilimumab and pembrolizumab, have transformed the prognosis for patients with advanced malignant melanoma and squamous non-small-cell lung cancer, and their use will only expand as experience is gained in a variety of other malignancies, for instance, renal and lymphoma. As the use of checkpoint inhibitors increases, so too will the incidence of their unique side effects, termed immune-related adverse events (irAEs), which can affect dermatological, gastrointestinal, hepatic, endocrine and other systems. Nivolumab is a monoclonal antibody that blocks the human programmed death receptor-1 ligand (PD-L1) found on many cancer cells and is licensed for the treatment of advanced malignant melanoma. We describe the first case of nivolumab-induced adrenalitis resulting in primary adrenal failure presenting with hyponatraemia in a 43-year-old man with malignant melanoma. The case highlights the potentially life-threatening complications of checkpoint inhibitors and the need for patient education and awareness of irAEs among the wider clinical community because such side effects require prompt recognition and treatment.
Learning points:Nivolumab can cause primary adrenal insufficiency.
Not all cases of hyponatraemia in patients with malignancy are due to SIADH.
Any patient on a checkpoint inhibitor becoming unwell should have serum cortisol urgently measured and if in doubt hydrocortisone therapy should be initiated.
Although hyponatraemia can occur in patients with ACTH deficiency, the possibility of primary adrenal failure should also be considered and investigated by measurement of renin, aldosterone and ACTH.
Patients receiving checkpoint inhibitors require education on the potential risks of hypocortisolaemia.
PET imaging demonstrated bilateral increased activity consistent with an autoimmune adrenalitis.
http://ift.tt/2ezSRCP
Robotic Assisted Laparoscopic Prostatectomy Performed after Previous Suprapubic Prostatectomy
Operative management of prostate cancer in a patient who has undergone previous open suprapubic simple prostatectomy poses a unique surgical challenge. Herein, we describe a case of intermediate risk prostate cancer in a man who had undergone simple prostatectomy ten years prior to presentation. The patient was found to have Gleason 7 prostate cancer on MRI fusion biopsy of the prostate for elevated PSA and underwent an uncomplicated robot assisted laparoscopic radical prostatectomy.
http://ift.tt/2fdTUtE
Pediatric Isolated Sinonasal Schwannoma: A New Case Report and Literature Review
Schwannomas of the paranasal sinus are uncommon. Less than 4% of schwannomas involve the nasal cavity and paranasal sinuses, even less in the pediatric age group. A case of schwannoma arising in maxillary sinus in a 2.5-year-old Chinese boy is reported. The basis for discussion of this case is the exceptional rarity of sinonasal schwannoma in pediatric patients.
http://ift.tt/2eUA9bS
Hyponatraemia secondary to nivolumab-induced primary adrenal failure
Summary
Checkpoint inhibitors, such as ipilimumab and pembrolizumab, have transformed the prognosis for patients with advanced malignant melanoma and squamous non-small-cell lung cancer, and their use will only expand as experience is gained in a variety of other malignancies, for instance, renal and lymphoma. As the use of checkpoint inhibitors increases, so too will the incidence of their unique side effects, termed immune-related adverse events (irAEs), which can affect dermatological, gastrointestinal, hepatic, endocrine and other systems. Nivolumab is a monoclonal antibody that blocks the human programmed death receptor-1 ligand (PD-L1) found on many cancer cells and is licensed for the treatment of advanced malignant melanoma. We describe the first case of nivolumab-induced adrenalitis resulting in primary adrenal failure presenting with hyponatraemia in a 43-year-old man with malignant melanoma. The case highlights the potentially life-threatening complications of checkpoint inhibitors and the need for patient education and awareness of irAEs among the wider clinical community because such side effects require prompt recognition and treatment.
Learning points:Nivolumab can cause primary adrenal insufficiency.
Not all cases of hyponatraemia in patients with malignancy are due to SIADH.
Any patient on a checkpoint inhibitor becoming unwell should have serum cortisol urgently measured and if in doubt hydrocortisone therapy should be initiated.
Although hyponatraemia can occur in patients with ACTH deficiency, the possibility of primary adrenal failure should also be considered and investigated by measurement of renin, aldosterone and ACTH.
Patients receiving checkpoint inhibitors require education on the potential risks of hypocortisolaemia.
PET imaging demonstrated bilateral increased activity consistent with an autoimmune adrenalitis.
http://ift.tt/2ezSRCP
Increased frequency of the PTPN22W* variant in primary Sjogren's Syndrome: Association with low type I IFN scores
Publication date: Available online 1 November 2016
Source:Clinical Immunology
Author(s): Nikolaos I. Vlachogiannis, Adrianos Nezos, Athanasios G. Tzioufas, Michael Koutsilieris, Haralampos M. Moutsopoulos, Clio P. Mavragani
Recent data suggest the association of the autoimmune gene variant PTPN22W* with dampened type I Interferon (IFN) responses, seen in a subset of primary Sjogren's Syndrome (pSS) patients. We sought to explore the potential contribution of PTPN22W* in this setting. PTPN22W* was identified in DNA samples derived from 352 pSS patients and 482 healthy controls (HC). Type I IFN score was determined in available peripheral blood cDNA of 164 pSS patients by Real-Time PCR. Increased prevalence of the PTPN22W* variant was detected in pSS patients compared to HC [9.7% vs 5.0%, p-value: 0.02]. Of interest, only the low but not the high type I IFN pSS subgroup displayed higher PTPN22W* rates compared to HC (12.2% vs 5.0%, p-value: 0.03). PTPN22W* risk variant increases susceptibility for pSS, particularly the low type I IFN subset implying the presence of distinct genetic backgrounds among low and high type I IFN autoimmune subgroups.
http://ift.tt/2f0Wa6w
Increased frequency of the PTPN22W* variant in primary Sjogren's Syndrome: Association with low type I IFN scores
Publication date: Available online 1 November 2016
Source:Clinical Immunology
Author(s): Nikolaos I. Vlachogiannis, Adrianos Nezos, Athanasios G. Tzioufas, Michael Koutsilieris, Haralampos M. Moutsopoulos, Clio P. Mavragani
Recent data suggest the association of the autoimmune gene variant PTPN22W* with dampened type I Interferon (IFN) responses, seen in a subset of primary Sjogren's Syndrome (pSS) patients. We sought to explore the potential contribution of PTPN22W* in this setting. PTPN22W* was identified in DNA samples derived from 352 pSS patients and 482 healthy controls (HC). Type I IFN score was determined in available peripheral blood cDNA of 164 pSS patients by Real-Time PCR. Increased prevalence of the PTPN22W* variant was detected in pSS patients compared to HC [9.7% vs 5.0%, p-value: 0.02]. Of interest, only the low but not the high type I IFN pSS subgroup displayed higher PTPN22W* rates compared to HC (12.2% vs 5.0%, p-value: 0.03). PTPN22W* risk variant increases susceptibility for pSS, particularly the low type I IFN subset implying the presence of distinct genetic backgrounds among low and high type I IFN autoimmune subgroups.
http://ift.tt/2f0Wa6w
Evidence on Financing and Budgeting Mechanisms to Support Intersectoral Actions Between Health, Education, Social Welfare and Labour Sectors [Internet].
Intersectoral collaboration between health and the social welfare, education or labour sectors can help to influence social determinants of health. Funding of such collaborations can be problematic as these sectors may be subject to very different regulatory structures, incentives and goals. This review found 51 documents on the use of different financial mechanisms to facilitate intersectoral collaboration for health promotion, involving at least two of these sectors. A systematic search of the evidence identified approaches used, including discretionary earmarked funding, recurring delegated financing allocated to independent bodies and mechanisms for joint budgeting between two or more sectors. Many of these examples are implemented at a regional or local, rather than national, level and their success is influenced by factors including organizational structures, management, culture and trust. Potential facilitators include regulatory and legislative frameworks providing incentives, clear accountability for actions and the identification of specific benefits to all participating sectors.
http://ift.tt/2fhEzqn
How do Variations in Definitions of “Migrant” and their Application Influence the Access of Migrants to Health Care Services? [Internet].
Variations in definitions used for "migrant" and for different groups of migrants in different areas can affect health system policies and migrant access to health care. This systematic review explored this issue using evidence from academic peer-reviewed and grey literature in 169 publications in English or Russian from 2010 to 2015 that focused on primary care or both primary and secondary care (including screening services and emergency departments). There is currently no universally accepted definition for migrant at an international level and the heterogeneity of definitions used limits comparability of routinely collected data. Legal status was one of the most significant factors determining access to affordable and adequate health services for migrants in a country. Identifying preferred terms for migrants, seeking consensus on important migration-related variables for collection across health information systems and progressing towards universal access to health care across the WHO European Region are recommended as policy options.
http://ift.tt/2enyiMh
Public Health Aspects of Mental Health Among Migrants and Refugees: A Review of the Evidence on Mental Health Care for Refugees, Asylum Seekers and Irregular Migrants in the WHO European Region [Internet].
The increasing number of refugees, asylum seekers and irregular migrants poses a challenge for mental health services in Europe. This review found that these groups are exposed to risk factors for mental disorders before, during and after migration. The prevalence rates of psychotic, mood and substance use disorders in these groups are variable but overall are similar to those in the host populations; however, the rates of post-traumatic stress disorder in refugees and asylum seekers are higher. Poor socioeconomic conditions are associated with increased rates of depression five years after resettlement. These groups encounter barriers to accessing mental health care. Good practice for mental health care includes promoting social integration, developing outreach services, coordinating health care, providing information on entitlements and available services, and training professionals to work with these groups. These actions require resources and organizational flexibility.
http://ift.tt/2fhCKcN
Cultural Contexts of Health: The Use of Narrative Research in the Health Sector [Internet].
Narrative (storytelling) is an essential tool for reporting and illuminating the cultural contexts of health – that is, the practices and behaviour that groups of people share and which are defined by customs, language and geography. This report reviews the literature on narrative research, offers some quality criteria for appraising such research and gives three detailed worked case examples: diet and nutrition, well-being, and mental health in refugees and asylum seekers. Storytelling (and story interpretation) belongs to the humanistic disciplines and is not a pure science, although established techniques of social science can be applied to ensure rigour in sampling and data analysis. The case studies illustrate how narrative research can convey the individual experience of illness and well-being, thereby complementing (and sometimes challenging) epidemiological and public health evidence.
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Tackling obesity in areas of high social deprivation: clinical effectiveness and cost-effectiveness of a task-based weight management group programme – a randomised controlled trial and economic evaluation.
A peer-support weight management programme for obese adults led to more weight loss at 12 months than usual best practice, with a low cost per QALY.
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A systematic review and economic evaluation of bisphosphonates for the prevention of fragility fractures.
The study found that bisphosphonates are effective in preventing fragility fractures. However, the benefit-to-risk ratio in the lowest risk patients may be debatable given the low absolute quality-adjusted life-year gains and the potential for adverse events.
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The relationship between biomarkers of fungal allergy and lung damage in asthma
Abstract
Background
Immunological biomarkers are key to the diagnosis of allergic bronchopulmonary aspergillosis (ABPA) and fungal sensitisation, but how these relate to clinically relevant outcomes is unclear.
Objectives
To assess how fungal immunological biomarkers are related to fixed airflow obstruction and radiological abnormalities in moderate to severe asthma.
Methods
Cross-sectional study of 431 asthmatics. Inflammatory biomarkers, lung function and an IgE fungal panel to colonising filamentous fungi, yeasts and fungal aeroallergens were measured. CT scans were scored for the presence of radiological abnormalities. Factor analysis informed the variables used in a k-means cluster analysis. Fixed airflow obstruction and radiological abnormalities were then mapped to these immunological variables in the cluster analysis.
Results
329 (76.3%) subjects were sensitised to ≥1 fungi. Sensitisation to A. fumigatus and/or P.chrysogenum was associated with a lower post-bronchodilator FEV1 compared to those not sensitised to fungi ((73.0 (95%CI 70.2-76)vs 82.8 (95%CI 78.5-87.2) % predicted, p<0.001), independent of atopic status (p=0.005)), and an increased frequency of bronchiectasis (54.5%, p<0.001), tree-in-bud (18.7%, p<0.001) and collapse/consolidation (37.5%, p=0.002). Cluster analysis identified three clusters: (i) hypereosinophilic (n=71, 16.5%), (ii) high immunological biomarker load and high frequency of radiological abnormalities (n=34, 7.9%), (iii) low levels of fungal immunological biomarkers (n=326, 75.6%).
Conclusions
IgE sensitisation to thermotolerant filamentous fungi, in particular A. fumigatus but not total IgE, is associated with fixed airflow obstruction and a number of radiological abnormalities in moderate to severe asthma. All patients with IgE sensitisation to A. fumigatus are at risk of lung damage irrespective of whether they meet the criteria for ABPA.
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The relationship between biomarkers of fungal allergy and lung damage in asthma
Abstract
Background
Immunological biomarkers are key to the diagnosis of allergic bronchopulmonary aspergillosis (ABPA) and fungal sensitisation, but how these relate to clinically relevant outcomes is unclear.
Objectives
To assess how fungal immunological biomarkers are related to fixed airflow obstruction and radiological abnormalities in moderate to severe asthma.
Methods
Cross-sectional study of 431 asthmatics. Inflammatory biomarkers, lung function and an IgE fungal panel to colonising filamentous fungi, yeasts and fungal aeroallergens were measured. CT scans were scored for the presence of radiological abnormalities. Factor analysis informed the variables used in a k-means cluster analysis. Fixed airflow obstruction and radiological abnormalities were then mapped to these immunological variables in the cluster analysis.
Results
329 (76.3%) subjects were sensitised to ≥1 fungi. Sensitisation to A. fumigatus and/or P.chrysogenum was associated with a lower post-bronchodilator FEV1 compared to those not sensitised to fungi ((73.0 (95%CI 70.2-76)vs 82.8 (95%CI 78.5-87.2) % predicted, p<0.001), independent of atopic status (p=0.005)), and an increased frequency of bronchiectasis (54.5%, p<0.001), tree-in-bud (18.7%, p<0.001) and collapse/consolidation (37.5%, p=0.002). Cluster analysis identified three clusters: (i) hypereosinophilic (n=71, 16.5%), (ii) high immunological biomarker load and high frequency of radiological abnormalities (n=34, 7.9%), (iii) low levels of fungal immunological biomarkers (n=326, 75.6%).
Conclusions
IgE sensitisation to thermotolerant filamentous fungi, in particular A. fumigatus but not total IgE, is associated with fixed airflow obstruction and a number of radiological abnormalities in moderate to severe asthma. All patients with IgE sensitisation to A. fumigatus are at risk of lung damage irrespective of whether they meet the criteria for ABPA.
This article is protected by copyright. All rights reserved.
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Identification of Phenotypic Clusters of Non-steroidal Anti-inflammatory Drugs Exacerbated Respiratory Disease
Abstract
Background
Clinical presentation of non-steroidal anti-inflammatory drugs exacerbated respiratory disease (NERD) is found to be heterogeneous. This study classified phenotypic clusters to determine NERD subtypes.
Methods
We performed 2-step cluster analysis using urticaria, chronic rhinosinusitis (CRS), and atopy, in a NERD cohort comprising 302 patients. Asthma exacerbation was defined as receiving at least 1 burst of intravenous steroid treatment and/or at least 2 bursts of oral steroid use (≥ 45 mg/3days) per year. The possession rate of anti-asthmatic medications was estimated during the follow-up period.
Results
There were 4 subtypes; subtype 1 (NERD with CRS / atopy and no urticaria), subtype 2 (NERD with CRS and no urticaria / atopy), subtype 3 (NERD without CRS / urticaria), and subtype 4 (NERD with urticaria). Significant differences were found between the 4 subtypes in the female proportion, baseline FEV1%, serum total IgE level, and sputum/peripheral eosinophil count. A higher frequency of asthma exacerbations was noted in subtype 1 compared to subtype 3. The possession rates of medium to high dose ICS/LABA showed significant differences among the 4 subtypes. Metabolomic analysis showed that the 4 subtypes of NERD had a higher serum LTE4 level than those with aspirin-tolerant asthma. The patients with subtypes 1 and 3 had a higher urine LTE4 level than those with subtype 2.
Conclusion
We found 4 distinct subtypes with different clinical/biochemical findings and asthma exacerbations in a NERD cohort. These findings suggest that stratified strategies by applying subtype classification may help achieve better outcomes in the management of NERD.
This article is protected by copyright. All rights reserved.
http://ift.tt/2eUm7a8
Identification of Phenotypic Clusters of Non-steroidal Anti-inflammatory Drugs Exacerbated Respiratory Disease
Abstract
Background
Clinical presentation of non-steroidal anti-inflammatory drugs exacerbated respiratory disease (NERD) is found to be heterogeneous. This study classified phenotypic clusters to determine NERD subtypes.
Methods
We performed 2-step cluster analysis using urticaria, chronic rhinosinusitis (CRS), and atopy, in a NERD cohort comprising 302 patients. Asthma exacerbation was defined as receiving at least 1 burst of intravenous steroid treatment and/or at least 2 bursts of oral steroid use (≥ 45 mg/3days) per year. The possession rate of anti-asthmatic medications was estimated during the follow-up period.
Results
There were 4 subtypes; subtype 1 (NERD with CRS / atopy and no urticaria), subtype 2 (NERD with CRS and no urticaria / atopy), subtype 3 (NERD without CRS / urticaria), and subtype 4 (NERD with urticaria). Significant differences were found between the 4 subtypes in the female proportion, baseline FEV1%, serum total IgE level, and sputum/peripheral eosinophil count. A higher frequency of asthma exacerbations was noted in subtype 1 compared to subtype 3. The possession rates of medium to high dose ICS/LABA showed significant differences among the 4 subtypes. Metabolomic analysis showed that the 4 subtypes of NERD had a higher serum LTE4 level than those with aspirin-tolerant asthma. The patients with subtypes 1 and 3 had a higher urine LTE4 level than those with subtype 2.
Conclusion
We found 4 distinct subtypes with different clinical/biochemical findings and asthma exacerbations in a NERD cohort. These findings suggest that stratified strategies by applying subtype classification may help achieve better outcomes in the management of NERD.
This article is protected by copyright. All rights reserved.
http://ift.tt/2eUm7a8
Treatment of chemically-induced oral ulcer using adipose-derived mesenchymal stem cell sheet
Abstract
Background
This study investigated the effects of mesenchymal stem cell (MSC) sheet transplantation on healing of chemically-induced oral ulceration in a rabbit animal model.
Methods
Oral mucosal ulcers were induced by topical application of filter paper soaked with 70% acetic acid to the anterior gingiva and buccal mucosa of 12 New Zealand white rabbits. The animals were randomly assigned to 2 groups: with (treatment group, n=6) or without (control group, n=6) cell sheets applied to ulcers. Gross findings were sequentially evaluated, and histologic examination was performed on day 7.
Results
Based on gross inspection, ulceration resolved before day 5 in the treatment group; however, in the control group, healing was incomplete on day 7. In the treatment group, the total area of the ulcer decreased significantly from day 2 to day 5 (p<0.001) and from day 5 to day 7 (p=0.020), whereas the area decreased significantly from day 5 to day 7 in the control group (p<0.001). Histologic and immunofluorescence examination revealed, full-thickness mucosa healing and complete basal cell coverage in the treatment group; in contrast, only partial healing was observed on day 7 in the control group.
Conclusions
Cell sheet technology using MSC can be an alternative treatment for oral ulcerations in that it can decrease healing time without invasive properties.
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A group of very preterm children characterized by atypical gaze patterns
Source:Brain and Development
Author(s): Mariko Sekigawa-Hosozawa, Kyoko Tanaka, Toshiaki Shimizu, Tamami Nakano, Shigeru Kitazawa
ObjectiveVery preterm (VP) children are at risk for social difficulties, including autism spectrum disorder (ASD). This study used eye tracking to determine viewing behaviors that may reflect these difficulties.DesignThe gaze patterns of 47 VP (mean gestational age: 28weeks, mean birth weight: 948g, and mean chronological age: 49months) were assessed while viewing dynamic social scenes and compared with those of 25 typically developing (TD) and 25 children with ASD. The temporo-spatial gaze patterns were summarized on a two-dimensional plane using multidimensional scaling (MDS) and the median of the TD children was used to characterize the gazes of the VP children. Time spent viewing the face was also compared.ResultsThe VP children formed two clusters: one had a mean MDS distance comparable to that of TD group (n=32; VP-small), and the other had a larger mean distance comparable to that of ASD group (n=15; VP-large). The VP-large were similar to the ASD group by spending significantly less time viewing the face. Their performance was comparable to the TD during the initial 1s, but they could not remain focused on the face thereafter.ConclusionsThe VP children were objectively classified into two groups based on gaze behaviors. One group was comparable to TD children, whereas the other had difficulty maintaining attention and exhibited atypical viewing behaviors similar to those of the ASD group. Our method may be useful in identifying VP children at higher risk for experiencing social difficulties.
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Iodine deficiency amongst pregnant women in South-West England
Abstract
Introduction
Iodine deficiency in pregnancy may impair foetal neurological development. The UK population is generally thought to be iodine sufficient; however recent studies have questioned this assumption. Our study aimed to explore the prevalence of iodine deficiency in a cohort of pregnant mothers from South-West England.
Methods
Urine samples were obtained from 308 women participating in a study of breech presentation in late pregnancy. They had no known thyroid disease and a singleton pregnancy at 36-38 weeks gestation. Samples were analysed for urinary iodine concentrations (UIC). Baseline data included: age, parity, smoking status, ethnicity, BMI at booking, prenatal vitamin use, and a dietary questionnaire. There was no difference in median UIC between women with (n= 156) or without (n=152) a breech presentation (p=0.3), so subsequent analyses were carried out as a combined group.
Results
Participants had a mean (SD) age 31(5) years, median (IQR) BMI 24.4(22.0, 28.3) kg/m2, 42% were primiparous, 10% smoked during pregnancy, 35% took iodine containing vitamins. 96% were Caucasian. Median (IQR) UIC was 88.0 (54.3, 157.5) μg/l, which is consistent with iodine deficiency by WHO criteria. A total of 224/308 (73%) of women had UIC values<150μg/l. Increasing milk intake was associated with higher UIC (p=0.021). There was no difference in median (IQR) UIC between those women who took iodine containing vitamins (n=108) and those who did not (n=200): 88(54, 168) vs 88(54, 150) μg/l, p=0.7.
Conclusion
Iodine deficiency in pregnancy is common in South-West England. Measures to develop optimum prevention and treatment strategies are urgently needed.
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Anti-Müllerian Hormone reflects the severity of Polycystic Ovary Syndrome
Abstract
Objective
To examine the relationship between Anti-Müllerian Hormone (AMH) and the severity of the phenotype of patients with Polycystic Ovary Syndrome (PCOS) and whether AMH can act as a diagnostic marker for PCOS?
Design
A prospective diagnostic utility study of AMH as a marker of PCOS.
Patients
A consecutive series of women presenting to a tertiary infertility clinic (n=164) plus a second series of women prepared for assisted conception treatments (n=89), recruited between June 2012 and May 2013.
Measurements
PCOS was diagnosed using the Rotterdam criteria. AMH was measured using the Generation II assay (Beckmann Coulter). The diagnostic utility of AMH was established using receiver operator characteristic (ROC) curves. Cut off values for the individual features of PCOS are proposed.
Results
There was a significant difference in serum AMH concentration in women with normal ovaries (13.2 pmol/L), polycystic ovary morphology (PCOM) alone (37.8 pmol/L) and PCOS (53.2 pmol/l). Follicle number, increasing cycle length and evidence of hyperandrogenism were all independently associated with serum AMH concentration (p<0.01). AMH was significantly affected by the different phenotypic presentations of PCOS with those with all components (PCOM, HA and OA) having the highest mean value (72.7 pmol/L (p<0.01)).
Conclusions
Serum AMH has the capacity to act as a diagnostic test for PCOS. Moreover, since its value rises with the more marked phenotypes, different cut-off values need to be used to differentiate those patients with polycystic ovarian morphology (PCOM), hyperandrogenism (HA) and oligoanovulation (OA).
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Health-Related Quality of Life in Adult Cochlear Implant Users: A Descriptive Observational Study
Cochlear implantation has a significant impact on patients' social life, performance of activities, and self-esteem. The objective of this retrospective study was to assess the health-related quality of life of cochlear implant users aged under and over 60 years by a self-report using the Glasgow Health Status Inventory and the Abbreviated Profile of Hearing Aid Benefit. It was observed that quality of life values increased very rapidly straight after implantation regardless of age. Bilateral cochlear implant users showed better results in environments with background noise and in a reverberant room than unilateral cochlear implant users. Quality of life improved independently of hearing performance benefits for patients over 60 years at implantation.
Audiol Neurotol 2016;21(suppl 1):36-42
http://ift.tt/2eUltt8
The Epidemiology of Cognitive Impairment in the Aging Population: Implications for Hearing Loss
Cognitive impairment and dementia are characterized by a progressive and devastating reduction in most cognitive abilities, functional independence, and social relationships. Dementia represents a substantial financial burden on society, one that is comparable to the financial burden of heart disease and cancer. Due to its insidious onset, cognitive impairment can be clinically silent for several years; therefore, diagnosis occurs late in the disease process, and treatment becomes almost useless. The identification of predictors of dementia may help identify the pathophysiological mechanisms underlying the disease and lead to the development of a more effective medical diagnosis and therapy, and thus an early treatment. Review of the literature suggests that in those individuals with less cognitive impairment (normal/predementia group), hearing loss has an association with language comprehension, and when cognitive impairment increases (moderate or severe dementia group), the contributing effect of hearing loss as a cognitive ability-impairing factor also increases. Greater understanding of the links between hearing impairment and cognition may have important implications for the screening and diagnosis of cognitive decline in older people with hearing impairment.
Audiol Neurotol 2016;21(suppl 1):3-9
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The Development of Remote Speech Recognition Tests for Adult Cochlear Implant Users: The Effect of Presentation Mode of the Noise and a Reliable Method to Deliver Sound in Home Environments
The number of cochlear implant (CI) users is increasing annually, resulting in an increase in the workload of implant centers in ongoing patient management and evaluation. Remote testing of speech recognition could be time-saving for both the implant centers as well as the patient. This study addresses two methodological challenges we encountered in the development of a remote speech recognition tool for adult CI users. First, we examined whether speech recognition in noise performance differed when the steady-state masking noise was presented throughout the test (i.e. continuous) instead of the standard clinical use for evaluation where the masking noise stops after each stimulus (i.e. discontinuous). A direct coupling between the audio port of a tablet computer to the accessory input of the sound processor with a personal audio cable was used. The setup was calibrated to facilitate presentation of stimuli at a predefined sound level. Finally, differences in frequency response between the audio cable and microphones were investigated.
Audiol Neurotol 2016;21(suppl 1):48-54
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Contributing Determinants to Hearing Loss in Elderly Men and Women: Results from the Population-Based Rotterdam Study
To contribute to a better understanding of the etiology in age-related hearing loss, we carried out a cross-sectional study of 3,315 participants (aged 52-99 years) in the Rotterdam Study, to analyze both low- and high-frequency hearing loss in men and women. Hearing thresholds with pure-tone audiometry were obtained, and other detailed information on a large number of possible determinants was collected. Hearing loss was associated with age, education, systolic blood pressure, diabetes mellitus, body mass index, smoking and alcohol consumption (inverse correlation). Remarkably, different associations were found for low- and high-frequency loss, as well as between men and women, suggesting that different mechanisms are involved in the etiology of age-related hearing loss.
Audiol Neurotol 2016;21(suppl 1):10-15
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Treatment for Hearing Loss among the Elderly: Auditory Outcomes and Impact on Quality of Life
The study aim was to determine the benefit of cochlear implantation and hearing aids in older adults diagnosed with hearing loss and to evaluate the index of depression, anxiety and quality of life after such treatments. A retrospective cohort comprised 117 patients older than 65 years and diagnosed with moderate to profound hearing loss who were included and classified into 2 groups (treated vs. non-treated). A battery of tests including auditory (pure-tone average, disyllabic words in quiet at 65 dB SPL) and findings from a series of questions relevant to quality of life were compared between both groups. Auditory outcomes for disyllabic words were 58.21% for the cochlear implant-treated group and 82.8% for the hearing aid-treated group. There was a positive effect on anxiety, depression, health status and quality of life in the cochlear implant group versus the profound hearing loss control group. We conclude that older adults with moderate to profound hearing loss gain benefit from hearing aids or cochlear implants not only in terms of improved hearing function, but also in terms of positive effects on anxiety, depression, health status and quality of life.
Audiol Neurotol 2016;21(suppl 1):29-35
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Speech Perception and Information-Carrying Capacity for Hearing Aid Users of Different Ages
Hearing impairment in the elderly is usually treated with conventional hearing aids; however, a large number of older people do not achieve sufficient speech recognition with hearing aids. The aim of the study was to describe speech perception with hearing aids in comparison to pure-tone hearing loss and maximum speech recognition scores for phonemically balanced words. Data from 392 hearing aid users with different degrees of hearing loss were evaluated retrospectively. In particular, pure-tone thresholds, the maximum monosyllabic word score, and the monosyllabic word score in quiet at conversational level with a hearing aid were analysed. The results showed that speech perception scores decline with increasing age. Even when corrected for pure-tone hearing loss, a significant decline in speech recognition scores after the age of 80 years was observed. Regarding the maximum monosyllabic word score, the effect is smaller but still observable; thus, speech recognition with hearing aids is significantly lower for older subjects. This can be attributed partially to the reduction of the information-carrying capacity in this group.
Audiol Neurotol 2016;21(suppl 1):16-20
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Rapid Positive Influence of Cochlear Implantation on the Quality of Life in Adults 70 Years and Older
The deteriorating ability to communicate has a negative impact on quality of life in the aging population. Cochlear implantation is increasingly used to treat hearing impairment and to restore the ability to communicate. Here, in a sample of 79 adults (70 years and older), we explored the effect of cochlear implantation on the health-related quality of life via the Nijmegen Cochlear Implant Questionnaire, auditory performance for speech recognition comparing scores on the Freiburg Monosyllabic Test and Oldenburg Inventory and tinnitus-related distress using the German version of the Tinnitus Questionnaire. We observed that the health-related quality of life and auditory performance increased significantly after cochlear implantation for the study cohort. After implantation, tinnitus-related distress declined significantly for the group. Our results support the concept of cochlear implantation treatment positively influencing the quality of life, restoring the auditory performance in older adults and reducing stress related to tinnitus. Importantly, positive effects were seen as early as 6 months after cochlear implantation, corroborating the rationale for cochlear implantation in adults 70 years and older.
Audiol Neurotol 2016;21(suppl 1):43-47
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Aging, Cognitive Decline and Hearing Loss: Effects of Auditory Rehabilitation and Training with Hearing Aids and Cochlear Implants on Cognitive Function and Depression among Older Adults
A growing interest in cognitive effects associated with speech and hearing processes is spreading throughout the scientific community essentially guided by evidence that central and peripheral hearing loss is associated with cognitive decline. For the present research, 125 participants older than 65 years of age (105 with hearing impairment and 20 with normal hearing) were enrolled, divided into 6 groups according to their degree of hearing loss and assessed to determine the effects of the treatment applied. Patients in our research program routinely undergo an extensive audiological and cognitive evaluation protocol providing results from the Digit Span test, Stroop color-word test, Montreal Cognitive Assessment and Geriatric Depression Scale, before and after rehabilitation. Data analysis was performed for a cross-sectional and longitudinal study of the outcomes for the different treatment groups. Each group demonstrated improvement after auditory rehabilitation or training on short- and long-term memory tasks, level of depression and cognitive status scores. Auditory rehabilitation by cochlear implants or hearing aids is effective also among older adults (median age of 74 years) with different degrees of hearing loss, and enables positive improvements in terms of social isolation, depression and cognitive performance.
Audiol Neurotol 2016;21(suppl 1):21-28
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Development of a Food Guide for the Vegetarians of Spain
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Susana Menal-Puey, Iva Marques-Lopes
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A Novel Weight-Loss Tool Designed for Adolescents with Intellectual Disabilities
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Maresa Weems, Laura Truex, Renee Scampini, Richard Fleming, Carol Curtin, Linda Bandini
http://ift.tt/2ezrZTb
Topical Treatment of Facial Seborrheic Dermatitis: A Systematic Review
Abstract
Background
Facial seborrheic dermatitis (SD), a chronic inflammatory skin condition, can impact quality of life, and relapses can be frequent. Three broad categories of agents are used to treat SD: antifungal agents, keratolytics, and corticosteroids. Topical therapies are the first line of defense in treating this condition.
Objective
Our objective was to critically review the published literature on topical treatments for facial SD.
Methods
We searched PubMed, Scopus, Clinicaltrials.gov, MEDLINE, Embase, and Cochrane library databases for original clinical studies evaluating topical treatments for SD. We then conducted both a critical analysis of the selected studies by grading the evidence and a qualitative comparison of results among and within studies.
Results
A total of 32 studies were eligible for inclusion, encompassing 18 topical treatments for facial SD. Pimecrolimus, the focus of seven of the 32 eligible studies, was the most commonly studied topical treatment.
Conclusion
Promiseb®, desonide, mometasone furoate, and pimecrolimus were found to be effective topical treatments for facial SD, as they had the lowest recurrence rate, highest clearance rate, and the lowest severity scores (e.g., erythema, scaling, and pruritus), respectively. Ciclopirox olamine, ketoconazole, lithium (gluconate and succinate), and tacrolimus are also strongly recommended (level A recommendations) topical treatments for facial SD, as they are consistently effective across high-quality trials (randomized controlled trials).
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CONTENTS 1
Source:Materials Today, Volume 19, Issue 8
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CONTENTS 2
Source:Materials Today, Volume 19, Issue 8
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Stepping into a new era
Source:Materials Today, Volume 19, Issue 8
Author(s): Stewart Bland
http://ift.tt/2fuUqXl
Birth weight and risk of paediatric Hodgkin lymphoma: Findings from a population-based record linkage study in California
Source:European Journal of Cancer, Volume 69
Author(s): Corey Triebwasser, Rong Wang, Andrew T. DeWan, Catherine Metayer, Libby Morimoto, Joseph L. Wiemels, Nina Kadan-Lottick, Xiaomei Ma
ObjectiveTo evaluate the relationship between birth weight (along with a variety of pre and perinatal characteristics) and the risk of paediatric Hodgkin lymphoma (HL) diagnosed at age <20 years.MethodWe linked California statewide birth records from 1978–2009 and cancer diagnosis data from 1988–2011 to conduct a population-based case–control study with 1216 cases and 4485 controls (matched on birth month and year, sex, and race/ethnicity). Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) of paediatric HL overall and by age of diagnosis, controlling for other perinatal factors.ResultsCompared to children with a normal birth weight (2500–3999 g), those who had a high birth weight (≥4000 g) had an increased risk of paediatric HL overall (OR = 1.23, 95% CI: 1.02–1.48) after adjusting for birth order, maternal age at the time of delivery, and paternal age at the time of delivery. The magnitude of association appeared larger for subgroups of children whose age of diagnosis was 0–10 years (OR = 1.56, 95% CI: 1.04–2.24) or 15–19 years (OR = 1.43, 95% CI: 1.11–1.83), while no association was observed in 11–14 year olds. Compared with firstborn children, those who were third or higher in birth order had a reduced risk of paediatric HL overall (OR = 0.80, 95% CI: 0.67–0.95), and this association also varied by age of diagnosis.ConclusionsIn this study with the largest number of paediatric HL cases, high birth weight was associated with an increased disease risk for most but not all ages of diagnosis. The different findings by age of diagnosis regarding both birth weight and birth order underscore the importance to stratify paediatric HL by age at diagnosis in future etiological investigations.
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Reference data of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-CIPN20 Questionnaire in the general Dutch population
Source:European Journal of Cancer, Volume 69
Author(s): Floortje Mols, Lonneke V. van de Poll-Franse, Gerard Vreugdenhil, Antoinetta J. Beijers, Jacobien M. Kieffer, Neil K. Aaronson, Olga Husson
ObjectiveChemotherapy-induced peripheral neuropathy (CIPN) is a debilitating side-effect of chemotherapy. However, CIPN symptoms are also reported by patients not receiving chemotherapy. Normative data could help interpret CIPN among cancer patients. Our aim was to generate normative data for the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-CIPN20 Questionnaire designed to assess CIPN from the patients' perspective. The normative CIPN data have also been generated for stratified subgroups formed on the basis of sex, age and comorbidity.MethodsThe QLQ-CIPN20 and the Self-administered Comorbidity Questionnaire were administered to a representative panel of the Dutch-speaking population in the Netherlands.ResultsTwo thousand one hundred and two (78%) of those invited completed the questionnaires. The majority reported no CIPN symptoms (83–97%). Cronbach's alpha coefficients for the sum score, and sensory, motor and autonomic subscales were 0.87, 0.76, 0.82 and 0.49, respectively. Compared with men, women scored significantly worse on the sum score (men, 3.0 versus women, 4.3; p < 0.001), motor scale (2.7 versus 5.1; p < 0.001) and autonomic scale (3.8 versus 5.2; p < 0.01), but this difference was not clinically relevant. CIPN symptoms increased significantly with age among both men (for the sum score and all scales) and women (for the sum score, sensory and motor scale). Those with self-reported comorbidities reported significantly more CIPN symptoms, both statistically and clinically, than those without. For instance, they had a lower mean sum score (1.5) compared to those with asthma/chronic obstructive pulmonary disease (COPD; 6.9), diabetes (5.9), heart disease (8.0), hypertension (6.2), osteoarthritis (9.6) and rheumatoid arthritis (13.8).ConclusionsA low prevalence of neuropathy was observed in the normative population without cancer, although neuropathy did increase with age and the presence of comorbidities. These data (which is freely available) can aid in the interpretation of QLQ-CIPN20 scores and can help increase our understanding of the influence of age, sex and comorbid conditions on CIPN among cancer patients.
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Cosmetics, Vol. 3, Pages 38: Polyamide Microparticles Containing Vitamin C by Interfacial Polymerization: An Approach by Design of Experimentation
Vitamin C is widely use in cosmetics and pharmaceutics products for its active properties. However ascorbic acid shows unfavourable chemical instability such as oxidation leading to formulation problems. Therefore, carriers, such as micro- and nanoparticles, have been widely investigated as delivery systems for vitamin C to improve its beneficial effects in skin treatment. However, none of the previous studies have been able to produce microparticles with a high encapsulation entrapment of vitamin C. The aim of the present study is to use an experimental design to optimize the synthesis of polyamide microparticles for the delivery of ascorbic acid. The effect of four formulation parameters on microparticles properties (size and morphology, encapsulation efficiency and yield, release kinetics) were investigated using a surface response design. Finally, we were able to obtain stable microparticles containing more than 65% of vitamin C. This result confirms the effectiveness of using design of experiments for the optimisation of microparticle formulation and supports the proposal of using them as candidate for the delivery of vitamin C in skin treatment.
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Dysmorphic Facial Features and Other Clinical Characteristics in Two Patients with PEX1 Gene Mutations
Peroxisomal disorders are a group of genetically heterogeneous metabolic diseases related to dysfunction of peroxisomes. Dysmorphic features, neurological abnormalities, and hepatic dysfunction can be presenting signs of peroxisomal disorders. Here we presented dysmorphic facial features and other clinical characteristics in two patients with PEX1 gene mutation. Follow-up periods were 3.5 years and 1 year in the patients. Case was one-year-old girl that presented with neurodevelopmental delay, hepatomegaly, bilateral hearing loss, and visual problems. Ophthalmologic examination suggested septooptic dysplasia. Cranial magnetic resonance imaging (MRI) showed nonspecific gliosis at subcortical and periventricular deep white matter. Case was 2.5-year-old girl referred for investigation of global developmental delay and elevated liver enzymes. Ophthalmologic examination findings were consistent with bilateral nystagmus and retinitis pigmentosa. Cranial MRI was normal. Dysmorphic facial features including broad nasal root, low set ears, downward slanting eyes, downward slanting eyebrows, and epichantal folds were common findings in two patients. Molecular genetic analysis indicated homozygous novel IVS1-2A>G mutation in Case and homozygous p.G843D (c.2528G>A) mutation in Case in the PEX1 gene. Clinical findings and developmental prognosis vary in PEX1 gene mutation. Kabuki-like phenotype associated with liver pathology may indicate Zellweger spectrum disorders (ZSD).
http://ift.tt/2ecUuVL
European consensus-based (S2k) Guideline on the Management of Herpes Zoster – guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 1: Diagnosis
Abstract
Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available. The aim of this European project was the elaboration of a consensus-based guideline on the management of patients who present with HZ, considering different patient populations and different localizations. This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction of the incidence of postherpetic neuralgia and other complications. The guideline development followed a structured and predefined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument. The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence based Medicine, dEBM). The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology. Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects. The guideline was approved by the commissioning societies after an extensive internal and external review process. In this first part of the guideline, diagnostic means have been evaluated. The expert panel formally consented recommendations for the management of patients with (suspected) HZ, referring to the assessment of HZ patients, considering various specific clinical situations. Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application. In the setting of an international guideline, it is generally important to consider different national approaches and legal circumstances with regard to the regulatory approval, availability and reimbursement of diagnostic and therapeutic interventions.
http://ift.tt/2e1upha
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