Primary lateral sclerosis-like picture in a patient with a remote history of anti-N-methyl-D- aspartate receptor (anti-NMDAR) antibody encephalitis

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a well-recognised disorder, first fully characterised in 2007. The long-term sequelae reported thus far include relapses with typical, as well as partial aspects of the well-defined neuropsychiatric syndrome. Rarely, isolated atypical symptoms (diplopia, ataxia and tremor) have been reported as relapse phenomenon. We report a case of a patient with a remote history of likely anti-NMDAR encephalitis with the longest follow-up reported in the literature to date (22 years). The relapse presentation was of a purely upper motor neuron syndrome with a primary lateral sclerosis-like picture.

https://ift.tt/2JttmXd

Raised intracranial pressure with bilateral anterior uveitis

We report the rare case of a 5-year-old boy with an infective cause of papilloedema and bilateral uveitis secondary to Mycoplasma pneumoniae. The patient presented with generalised headache and malaise. MRI showed signs of raised intracranial pressure and lumbar puncture opening pressure was 43 cmH₂O.

Lumbar puncture did not reveal any infective organisms. Blood tests showed raised inflammatory markers. The patient was started on prednisolone, acetazolamide and intravenous cefotaxime. Following an improvement, the patient was discharged.

However, the patient re-presented 2 weeks later with bilateral anterior uveitis. With the combination of papilloedema and bilateral uveitis, M. pneumoniae infection was suspected. Tests confirmed recent mycoplasma infection. Topical dexamethasone and oral azithromycin were given and symptoms improved.

Vision remained normal throughout. At 1-year follow-up, the patient remains well. The authors would like to highlight a rare infectious cause of papilloedema in young children.

https://ift.tt/2LDafqc

Acute hepatitis E superinfection leading to chronic hepatitis B reactivation

Reactivation of chronic hepatitis B (CHB) can be associated with significant morbidity and mortality. There are many different causes of hepatitis B reactivation. This case describes an Asian woman with stable CHB presenting with significant hepatitis flare with markedly elevated serum aminotransferases and hepatitis B virus DNA level. The clinical symptoms were subtle with fatigue and vague right upper quadrant tenderness. We ruled out drug-associated hepatotoxicity and screened for common causes of acute hepatitis. Interestingly, she was noted to have reactive anti-hepatitis E virus (HEV) IgM at initial presentation followed by anti-HEV IgG positivity a month later. The serological pattern confirmed the diagnosis of acute hepatitis E. The combination of antiviral therapy for hepatitis B and resolution of acute hepatitis E resulted in normalisation of serum aminotransferases. This case illustrates the importance of taking a careful history and having a high index of suspicion for various aetiologies when evaluating patients with reactivation of CHB.

https://ift.tt/2Js9pQw

Common anaesthetic agent causing an uncommon side effect

Description

A 30-year-old man was brought to our trauma centre with a history of road traffic accident 1 hour back. He had sustained a right both bone forearm fracture and surgery in the form of open reduction internal fixation with plating was planned. The preoperative routine haematological and biochemical investigations revealed normal values and the patient was posted for surgery after achieving preanaesthetic fitness. General anaesthesia was induced with fentanyl and propofol 100 mg and maintained with nitrous oxide and vecuronium. Intraoperative period was uneventful with the fractures being treated with a 7-hole dynamic compression plate (DCP) for radius and a 6-hole DCP for ulna. Glycopyrrolate and neostigmine were used for the reversal of neuromuscular blockade. The patient was extubated successfully and transferred to the postoperative ward. Two to 3 hours postsurgery, the nursing staff noticed green-coloured urine, thereby alarming them and the other medical personnel (figure 1). Urinary tract infection (UTI) was suspected. After a thorough re-evaluation of the patient and...

https://ift.tt/2HCobOQ

Effects of soil improvement technology on soil quality in solar greenhouse

Abstract

Currently, cucumber cultivation is mainly through monoculture, as continuous culture leads to the decrease of crop yield and soil quality. In order to improve soil quality to achieve continuous monocultures, soil physicochemical properties, microbial biomass, content of phenolic compounds, and the size of bacterial, fungal, ammonia-oxidizing bacteria (AOB), and Fusarium oxysporum were first evaluated in cucumber monoculture solar greenhouse. Soil improvement technology, including catch wheat (CW), calcium cyanamide disinfection (LN), and straw reactor technology (SR) during summer fallow period, was compared with conventional fallow (CK). Results showed that CW, LN, and SR all significantly increased soil pH, and LN and SR increased soil electrical conductivity (EC); however, CW decreased soil EC. Meanwhile, LN increased soil available N content significantly and SR increased available P content significantly. CW had negative effect on the accumulation of soil available nutrients, conversely, CW and SR had positive effect on the accumulation of microbial biomass carbon (MBC). All the treatments increased the total phenol content in the soil compared with CK. While CW increased the size of bacteria, AOB in the soil inhibited fungal and wilt pathogen size. LN also increased the size of soil bacteria and reduced the size of fungi. The comprehensive evaluation of all treatments showed that CW could control soil nutrient loss and improve the continuous cropping soil, making the soil transform from fungi to bacteria type. All the treatments accelerate the accumulation of phenolic compound, while whether or not developing autotoxicity requires further investigation.

https://ift.tt/2JGH749

Role of organic fouling layer on the rejection of trace organic solutes by nanofiltration: mechanisms and implications

Abstract

To investigate how the organic fouling layers on nanofiltration (NF) membrane surface and the strong matrix effect (particularly by Ca²⁺) influence the rejection of trace organic compounds (TOrCs), filtration experiments with two TOrCs, bisphenol A (BPA) and sulfamethazine (SMT), were carried out with virgin and organic-fouled NF membrane. Organic fouling layer on the membrane was induced by sodium alginate (SA) at different concentrations of Ca²⁺. The results indicated that NF membrane maintained consistently rejection of TOrCs with little influence by membrane fouling at lower Ca²⁺ concentration. In contrast, organic fouling caused at higher concentration of Ca²⁺ observably restrained the rejections of both BPA and SMT. Furthermore, based on the cake-enhanced concentration polarization (CECP) model, the rejection of TOrCs was divided to the real rejection and the mass transfer coefficient. Moreover, it was found that the decrease in rejection resulted by organic fouling was due to the real rejection that was restrained by fouling layer with irregular impact on the mass transfer coefficient. Although the mechanism of trace compounds rejection was complex, the controlling factors varied among foulants. Nevertheless, the steric effect of the cake layer played an important role in determining solute rejection by organic-fouled NF membrane.

https://ift.tt/2JzolIA

Plant species diversity for vegetation restoration in manganese tailing wasteland

Abstract

Vegetation restoration is one of the most effective measures to restore degraded ecosystem in mining wasteland. A field experiment was conducted to study the effects of some site treatments' three different approaches on the benefits of selective vegetation in the manganese mine. Three different approaches included (1) exposed tailings, the control treatment (tailing site); (2) soil covering of 10-cm thickness (external-soil site), and (3) soil covering of 10-cm thickness, soil ameliorating (adding fowl dung), and seeding propagation of Cynodon dactylon (Linn.) Pers. (rehabilitation site). The results indicated that 18 herb species were taken from 8 families and 4 woody plants in three sites after 1 year. After 3 years, 29 species from 14 families were observed in 3 sites. Meanwhile, compared with tailing site, the plant species of rehabilitation site was more than tailing site, and the plant abundance of external-soil site was similar to rehabilitation site. It was worthy to be mentioned that the plant species of external-soil site and rehabilitation site had a better effect on the plant community coverage of herb layer as compared with tailing site. In summary, the plant species of rehabilitation site had the most species diversity and could be recommended as the ve-restoration modes in manganese tail wasteland.

https://ift.tt/2JIGuHi

Clinical implications of the FEF25-75 variability in childhood asthma,

Publication date: Available online 10 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Jin-Kyung Kong, Soo-Hyun Lee, Jae-Yub Jung, Sang-Yong Eom, Youn-Soo Hahn




https://ift.tt/2HBUDAU

Specific growth inhibitors of Ralstonia solanacearum, Xanthomonas oryzae pv. oryzae, X. campestris pv. campestris, and Clavibacter michiganensis subsp. michiganensis

Publication date: Available online 10 June 2018
Source:Microbiological Research
Author(s): Geofrey Sing'ombe Ombiro, Taku Sawai, Yoshiteru Noutoshi, Yuta Nishina, Hidenori Matsui, Mikihiro Yamamoto, Kazuhiro Toyoda, Yuki Ichinose
Plant pathogenic bacteria cause huge yield losses in crops globally. Therefore, finding effective bactericides to these pathogens is an immediate challenge. In this study, we sought compounds that specifically inhibit the growth of Ralstonia solanacearum. As a result, we identified one promising compound, 1-(4-bromophenyl)-6-methoxy-2,3,4,9-tetrahydro-1H-β-carboline, which inhibited the growth of R. solanacearum (Rs1002) from a pilot library of 376 chemicals provided from RIKEN. We further obtained its structural analogues and assessed their ability to inhibit Rs1002 growth. Then we identified five compounds, named ralhibitins A to E, that specifically inhibit growth of Rs1002 at >5 µg/ml final concentration. The most effective compounds, ralhibitins A, C, and E completely inhibited the growth of Rs1002 at 1.25 µg/ml. In addition, ralhibitins A to E inhibited growth of Xanthomonas oryzae pv. oryzae but not the other bacteria tested at a final concentration of 10 µg/ml. Whereas, ralhibitin E, besides inhibiting R. solanacearum and X. oryzae pv. oryzae, completely inhibited the growth of X. campestris pv. campestris and the Gram-positive bacterium Clavibacter michiganensis subsp. michiganensis at 10 µg/ml. Growth inhibition by these compounds was stable at pH 6–9 and after autoclaving. Because Rs1002 grew in the culture medium in which ralhibitins were incubated with the ralhibitin-insensitive bacteria, the unaffected bacteria may be able to inactivate the inhibitory effect of ralhibitins. These results suggest that ralhibitins might be potential lead compounds for the specific control of phytopathogenic bacteria.



https://ift.tt/2xZ4L7k

Clinical implications of the FEF25-75 variability in childhood asthma,

Although forced expiratory flow between 25% and 75% of vital capacity (FEF25-75) is one of the standard results in spirometry reports, current guidelines provide no recommendations for its use in the assessment of asthma. By contrast, forced expiratory volume in the first second (FEV1) is recommended as a principle spirometric parameter to assess airflow limitation by these guidelines. However, FEF25-75 was shown to be more sensitive indicator of symptomatic asthma than FEV1 in children1,2 and better correlated with air trapping in asthmatic subjects than FEV1.

https://ift.tt/2HBed0g

Zumba-induced Takotsubo cardiomyopathy: a case report

Takotsubo cardiomyopathy or stress cardiomyopathy is characterized by transient left ventricular apical ballooning in the absence of coronary occlusion. The underlying pathophysiological mechanism is still unc...

https://ift.tt/2JHJPGs

Time to epileptiform activity and EEG background recovery are independent predictors after cardiac arrest

Publication date: Available online 9 June 2018
Source:Clinical Neurophysiology
Author(s): E. Westhall, I. Rosén, M. Rundgren, J. Bro-Jeppesen, J. Kjaergaard, C. Hassager, H. Lindehammar, J. Horn, S. Ullén, N. Nielsen, H. Friberg, T. Cronberg
ObjectiveInvestigate the temporal development of EEG and prognosis.MethodsProspective observational substudy of the Target Temperature Management trial. Six sites performed simplified continuous EEG-monitoring (cEEG) on comatose patients after cardiac arrest, blinded to treating physicians. We determined time-points of recovery of a normal-voltage continuous background activity and the appearance of an epileptiform EEG, defined as abundant epileptiform discharges, periodic/rhythmic discharges or electrographic seizure activity.Results134 patients were included, 65 had a good outcome. Early recovery of continuous background activity (within 24 hours) occurred in 72 patients and predicted good outcome since 55 (76%) had good outcome, increasing the odds for a good outcome seven times compared to a late background recovery. Early appearance of an epileptiform EEG occurred in 38 patients and 34 (89%) had a poor outcome, increasing the odds for a poor outcome six times compared to a late debut. The time to background recovery and the time to epileptiform activity were highly associated with outcome and levels of neuron-specific enolase. Multiple regression analysis showed that both variables were independent predictors.ConclusionsTime to epileptiform activity and background recovery are independent prognostic indicators.SignificancePatients with early background recovery combined with late appearance of epileptiform activity may have a good outcome.



https://ift.tt/2kYFbWu

Efficacy and safety of immunological adjuvants. Where is the cut-off?

Publication date: September 2018
Source:Biomedicine & Pharmacotherapy, Volume 105
Author(s): Alexander Batista-Duharte, Damiana Téllez Martínez, Iracilda Zeppone Carlos
Research over the past several decades has provided insight into the mode of action of adjuvants. However, the main focus of attention has been the efficacy in the induction of protective immunogenicity, while less effort has been devoted to the study of toxicity mechanisms. Evidences suggest that several mechanisms that are responsible for the immunostimulating effects are, at the same time, responsible of the adverse effects. In this context, it is often very difficult to establish the boundaries between immunostimulation and immunotoxicity to reach the ideal balance of efficacy/safety. During decades, hundreds of adjuvants and adjuvant formulations have been proposed as immunostimulants for vaccines but very few have been used in human vaccines due to toxicity concerns. In this review, relevant aspects about immunotoxicology of adjuvants, based on clinical and experimental studies are discussed. Some effects are only observed under hyperstimulating regimens using non-approved adjuvants for human use, but these are nonetheless useful to understanding basic principles of adjuvant toxicity. The acute local and systemic reactions, during the first hours and those that can be observed after the third day of vaccination in the inoculation site and systemically are discussed.



https://ift.tt/2l4H8AJ

Rituximab Treatment Of Pemphigus Foliaceus- A Retrospective Study Of 12 Patients

Publication date: Available online 9 June 2018
Source:Journal of the American Academy of Dermatology
Author(s): Irene Palacios-Álvarez, Constanza Riquelme-Mc Loughlin, Laia Curto-Barredo, Pilar Iranzo, Irene García-Díez, Agustín España




https://ift.tt/2JAk0oB

How long does laser hair removal last?

Laser hair removal is a popular long-term option for removing unwanted body hair. But is laser hair removal permanent, and how long would it take for hair to regrow? In this article, we look at how long laser hair removal lasts, the chances of regrowth, plus the costs and side effects of laser hair removal procedures.

https://ift.tt/2sMmyJP

How long does laser hair removal last?

Laser hair removal is a popular long-term option for removing unwanted body hair. But is laser hair removal permanent, and how long would it take for hair to regrow? In this article, we look at how long laser hair removal lasts, the chances of regrowth, plus the costs and side effects of laser hair removal procedures.

https://ift.tt/2sMmyJP

Anti-angiogenic treatment (Bevacizumab) improves the responsiveness of photodynamic therapy in colorectal cancer

Publication date: Available online 9 June 2018
Source:Photodiagnosis and Photodynamic Therapy
Author(s): Cheng-Liang Peng, Hua-Ching Lin, Wei-Lun Chiang, Ying-Hsia Shih, Ping-Fang Chiang, Tsai-Yueh Luo, Chun-Chia Cheng, Ming-Jium Shieh
Photodynamic therapy (PDT) is a new treatment utilizing the combined action of photosensitizers and light for the treatment of various cancers. The mechanisms for tumor destruction after PDT include direct tumor cell kill by singlet oxygen species (OS), indirect cell kill via vascular damage, and an elicited immune response. However, it has been reported that many cellular activators, including vascular endothelial growth factor (VEGF), are produced by tumor cells after PDT. In this study, we demonstrate that meta-tetra(hydroxyphenyl) chlorin (mTHPC)-based photodynamic therapy combined with bevacizumab (Avastin™), an anti-VEGF neutralizing monoclonal antibody that blocks the binding of VEGF to its receptor, can enhance the effectiveness of each treatment modality. We evaluated the efficacy of bevacizumab-based anti-angiogenesis in combination with PDT as well as the resulting VEGF levels in a mouse model of human colon cancer. Enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry (IHC) were performed to assess VEGF concentrations in the various treatment groups, and confocal imaging and high performance liquid chromatography (HPLC) analyses were used to measure the distribution and concentration of mTHPC in tumors. Our results demonstrate that combination of PDT followed by bevacizumab significantly elicits a greater tumor response whereas bevacizumab treatment prior to PDT led to a reduced tumor response. Immunostaining and ELISA analyses revealed a lower expression of VEGF in tumors treated with combination therapy of PDT followed by bevacizumab. However, bevacizumab treatment decreased the accumulation of mTHPC in tumors 24 h after administration, which complemented the results of decreased anti-tumor efficacy of bevacizumab followed by PDT.



https://ift.tt/2JsbOL5

Pediatric recurrent acute mastoiditis: Risk factors and insights into pathogenesis

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Józef Mierzwiński, Justyna Tyra, Karolina Haber, Maria Drela, Anna Sinkiewicz, Michael David Puricelli
ObjectivesRecurrent acute mastoiditis is repeatedly reported in the literature, but data to understand the pathogenesis, update treatment recommendations and inform future trials are sparse due to the infrequency of the disease.MethodsA retrospective chart review from 2001 to 2016 was conducted including 73 children treated for acute mastoiditis. A follow-up survey was attempted for each patient. Bacteriology, method of treatment, hospital course, complications, and otologic history were analyzed. A chi-squared test, Fisher's exact test and Mann-Whitney U test compared recurrent acute mastoiditis to single acute mastoiditis cases. Additionally, a comprehensive PubMed search and review of world literature addressing recurrent pediatric acute mastoiditis was performed for comparative purposes.ResultsAmong 73 children with acute mastoiditis, six (8%) experienced recurrent acute mastoiditis. Streptococcus pneumoniae was the only bacteria isolated in this group. History of recurrent acute otitis media (>4 per year) prior to the first episode of acute mastoiditis was identified in 24% with single episode of acute mastoiditis and 83% with recurrent mastoiditis (p < 0.05). Fewer intracranial/intratemporal complications were identified among recurrent mastoiditis patients (p < 0.05). In a group of patients treated with more extensive surgical communication during mastoidectomy for primary acute mastoiditis (wide mastoidectomy with broad attic exposure and posterior tympanotomy) no recurrence was observed.ConclusionWe identify multiple risk factors associated with recurrence and provide early data supporting anatomic predisposition to the development of recurrent acute mastoiditis. More aggressive opening between the mastoid cavity and middle ear may prevent recurrent acute mastoiditis episodes.



https://ift.tt/2HzrCpy

Understanding sociodemographic factors related to health outcomes in pediatric obstructive sleep apnea

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Deborah X. Xie, Ray Y. Wang, Edward B. Penn, Sivakumar Chinnadurai, Chevis N. Shannon, Christopher T. Wootten
Objectives(1) To examine relationships between socioeconomic status (SES) and successful treatment of pediatric obstructive sleep apnea (OSA) with adenotonsillectomy (T&A).(2) To explore sociodemographic factors and medical comorbidities that separate OSA and refractory OSA populations in children.MethodsWe retrospectively reviewed pediatric OSA patients (ages 0–18). Patients evaluated for OSA by pediatric otolaryngology between January 2014 and December 2015 were included. OSA was defined as requiring T&A. Refractory OSA (ROSA) was defined as recurring, polysomnography-proven, OSA after T&A, ultimately requiring another intervention, such as a multi-level airway operation. Clinical data were complemented with sociodemographic data. ZIP codes were used to approximate median household income.ResultsOur cohort included 105 ROSA and 53 OSA patients. These patients came from similar rates of single parent households and coverage by public insurance. Median household income for OSA patients was $47,086 (IQR $36,395-$60,196), compared to $45,696 (IQR $37,669-$56,203) for ROSA patients. Over 60% of all patients fell below the national household income average. Nearly half of the cohort resided in the three largest metro counties closest to our institution. These patients represented higher rates of single-parent households (p = 0.045) and public insurance (p = 0.002), and trends towards lower rates of ROSA (p = 0.138).ConclusionOur results identified sociodemographic factors that may influence healthcare compliance and subsequently overall health outcomes. We identified no statistically significant difference in measures of SES between patients with refractory vs non-refractory OSA. Patients living closest to our medical center had lowest rates of ROSA, suggesting that access to care may affect outcomes of pediatric OSA.



https://ift.tt/2sQPUqH

Identification of key genes in cleft lip with or without cleft palate regulated by miR-199a-5p

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Gang Chen, Meng-Xue Li, Heng-Xue Wang, Jia-Wei Hong, Jun-Yu Shen, Qi Wang, Qiao-Mei Shi, Xing Ge, Zhen Ding, Jin-Peng Zhang, Li-Chun Xu
BackgroundCleft lip with or without cleft palate (CL/P) is one of the most common congenital defects, which etiology involves both genetic and environmental factors. Previous studies have shown that miR-199a-5p may mediate the occurrence of CL/P. However, the key target genes regulated by miR-199a-5p are not clear. In this study, we employed a systematic bioinformatics analysis of target genes regulated by miR-199a-5p which may be involved in CL/P.MethodsThe miRBase, Human miRNA tissue atlas, miRecords, miRpathDB, miRWalk, miRTarBase, DIANA-TarBase (v7.0), Literature search, DAVID software, Cytoscape plugin ClueGO + Cluepedia app, MalaCards, TargetScanhuman7.1, Venny 2.1, STRING and GEO databases were comprehensive employed to identify the key genes regulated by miR-199a-5p associated with CL/P.ResultsTotal 429 experimentally validated target genes were obtained from five miRNAs related databases. Expressions of miR-199a-5p and its experimentally validated target genes were elevated in bone, brain and skin. KEGG pathway analysis revealed that the target genes were enriched in focal adhesion, microRNAs in cancer and hippo signaling pathway. Biological process categorization revealed that significant portions of the target genes were grouped as transcription, DNA-templated. Total eight intersection genes were identified by using MalaCards and TargetScanhuman7.1. The target gene transforming growth factor alpha (TGFA) of miR-199a-5p involved in CL/P is screened and verified.ConclusionMiR-199a-5p may mediate CL/P by regulating key target gene TGFA. The study may contribute to a better understanding of the etiology of CL/P.



https://ift.tt/2HBSHs0

Time effects of high particulate events on the critical conversion point of ground-level ozone

Publication date: August 2018
Source:Atmospheric Environment, Volume 187
Author(s): Norrimi Rosaida Awang, Nor Azam Ramli, Syabiha Shith, Noor Faizah Fitri Md Yusof, Nazatul Syadia Zainordin, Nurulilyana Sansuddin, Nurul Adyani Ghazali
Particulate matter (PM), especially those with an aerodynamic particle size of less than 10 μm (PM10), is typically emitted from transboundary forest fires. A large-scale forest fire may contribute to a haze condition known as a high particulate event (HPE), which has affected Southeast Asia, particularly Peninsular Malaysia, for a long time. Such event can alter the photochemical reactions of secondary pollutants. This work investigates the influence of PM on ground-level ozone (O3) formation during HPE. Five continuous air quality monitoring stations from different site categories (i.e., industrial, urban and background) located across Peninsular Malaysia were selected in this study during the HPEs in 2013 and 2014. Result clearly indicated that O3 concentrations were significantly higher during HPE than during non-HPE in all the sites. The O3 diurnal variation in each site exhibited a similar pattern, whereas the magnitudes of variation during HPE and non-HPE differed. Light scattering and atmospheric attenuation were proven to be associated with HPE, which possibly affected O3 photochemical reactions during HPE. Critical conversion time was used as the main determining factor when comparing HPE and non-HPE conditions. A possible screening effect that resulted in the shifting of the critical transformation point caused a delay of approximately of 15–30 min. The shifting was possibly influenced by the attenuation of sunlight in the morning during HPE. A negative correlation between O3 and PM10 was observed during the HPE in Klang in 2013 and 2014, with −0.87. Essentially, HPE with a high PM concentration altered ground-level O3 formation.



https://ift.tt/2sSrfRC

Evaluation of two neck ultrasound measurements as predictors of difficult direct laryngoscopy: A prospective study

BACKGROUND Unpredictable difficult laryngoscopy remains a challenge for anaesthesiologists, especially if difficult ventilation occurs during standard laryngoscopy. Accurate airway assessment should always be performed, but the common clinical screening tests have shown low sensitivity and specificity with a limited predictive value. Ultrasound-based airway assessment has been proposed recently as a useful, simple, noninvasive bedside tool as an adjunct to clinical methods, but to date, few studies are available about the potential role of ultrasound in difficult airway evaluation, and these are mostly limited to specific groups of patients. OBJECTIVES The aim of this study was to determine the correlation between the sonographic measurements of anterior cervical soft tissues thickness and Cormack–Lehane grade view at direct laryngoscopy in patients with normal clinical screening tests. DESIGN Prospective, single blinded, observational study. SETTING Operating theatre of a teaching hospital from May 2017 to September 2017. PATIENTS A total of 301 patients at least 18 years of age undergoing elective surgery under general anaesthesia with tracheal intubation were included in the study. OUTCOME MEASURES Pre-operative evaluation was performed before surgery, demographic variables were collected and clinical screening tests to predict a difficult airway were performed. Patients with predicted difficult intubation were excluded. A 10 to 13-MHz linear ultrasound transducer was placed in the transverse plane and the thickness of the anterior cervical soft tissues was measured at two levels [thyrohyoid membrane (pre-epiglottic space) and vocal cords (laryngeal inlet)] with the patient's head in a neutral position. At each level, the distance from the skin in the median axis and the surrounding area was measured. The laryngoscopic view was graded by a different anaesthetist with more than 5 years of experience with direct laryngoscopy, blinded to the ultrasound assessments. RESULTS The 'pre-epiglottic space thickness' at the level of thyrohyoid membrane was measured as the median distance from skin to epiglottis (mDSE) and the pre-epiglottic area was calculated; the mDSE cut-off value of 2.54 cm (sensitivity 82%, specificity 91%) and the pre-epiglottic area cut-off value of 5.04 cm2 (sensitivity 85%, specificity 88%) were the best predictors of a Cormack–Lehane grade at least 2b at direct laryngoscopy and of difficult intubation. The cut-off value of mDSE showed greater sensitivity in female patients (94 vs. 86%) and greater specificity in male patients (92 vs. 83%). No correlation was found between difficult laryngoscopy and ultrasound assessments at the level of the vocal cords. CONCLUSION Airways ultrasounds might be considered as a predictor of restricted/difficult laryngoscopy and unpredicted difficult intubation. TRIAL REGISTRATION CERM 2016-0405. Correspondence to Stefano Falcetta, Clinic of Anaesthesia and Intensive Care Unit, Ospedali Riuniti Ancona, Via Conca 71, 60126 Ancona, Italy Tel: +39 3479639676; e-mail: falmed@libero.it © 2018 European Society of Anaesthesiology

https://ift.tt/2HCmRvo

Evaluation of two neck ultrasound measurements as predictors of difficult direct laryngoscopy: A prospective study

BACKGROUND Unpredictable difficult laryngoscopy remains a challenge for anaesthesiologists, especially if difficult ventilation occurs during standard laryngoscopy. Accurate airway assessment should always be performed, but the common clinical screening tests have shown low sensitivity and specificity with a limited predictive value. Ultrasound-based airway assessment has been proposed recently as a useful, simple, noninvasive bedside tool as an adjunct to clinical methods, but to date, few studies are available about the potential role of ultrasound in difficult airway evaluation, and these are mostly limited to specific groups of patients. OBJECTIVES The aim of this study was to determine the correlation between the sonographic measurements of anterior cervical soft tissues thickness and Cormack–Lehane grade view at direct laryngoscopy in patients with normal clinical screening tests. DESIGN Prospective, single blinded, observational study. SETTING Operating theatre of a teaching hospital from May 2017 to September 2017. PATIENTS A total of 301 patients at least 18 years of age undergoing elective surgery under general anaesthesia with tracheal intubation were included in the study. OUTCOME MEASURES Pre-operative evaluation was performed before surgery, demographic variables were collected and clinical screening tests to predict a difficult airway were performed. Patients with predicted difficult intubation were excluded. A 10 to 13-MHz linear ultrasound transducer was placed in the transverse plane and the thickness of the anterior cervical soft tissues was measured at two levels [thyrohyoid membrane (pre-epiglottic space) and vocal cords (laryngeal inlet)] with the patient's head in a neutral position. At each level, the distance from the skin in the median axis and the surrounding area was measured. The laryngoscopic view was graded by a different anaesthetist with more than 5 years of experience with direct laryngoscopy, blinded to the ultrasound assessments. RESULTS The 'pre-epiglottic space thickness' at the level of thyrohyoid membrane was measured as the median distance from skin to epiglottis (mDSE) and the pre-epiglottic area was calculated; the mDSE cut-off value of 2.54 cm (sensitivity 82%, specificity 91%) and the pre-epiglottic area cut-off value of 5.04 cm2 (sensitivity 85%, specificity 88%) were the best predictors of a Cormack–Lehane grade at least 2b at direct laryngoscopy and of difficult intubation. The cut-off value of mDSE showed greater sensitivity in female patients (94 vs. 86%) and greater specificity in male patients (92 vs. 83%). No correlation was found between difficult laryngoscopy and ultrasound assessments at the level of the vocal cords. CONCLUSION Airways ultrasounds might be considered as a predictor of restricted/difficult laryngoscopy and unpredicted difficult intubation. TRIAL REGISTRATION CERM 2016-0405. Correspondence to Stefano Falcetta, Clinic of Anaesthesia and Intensive Care Unit, Ospedali Riuniti Ancona, Via Conca 71, 60126 Ancona, Italy Tel: +39 3479639676; e-mail: falmed@libero.it © 2018 European Society of Anaesthesiology

https://ift.tt/2HCmRvo

It is finally time for adjuvant therapy in melanoma

Publication date: Available online 9 June 2018
Source:Cancer Treatment Reviews
Author(s): S. Napolitano, G. Brancaccio, G. Argenziano, E. Martinelli, F. Morgillo, F. Ciardiello, T. Troiani
Although melanoma is amenable to early detection, there has been no decline in the mortality rate of this disease and the prognosis of patients with high-risk primary melanoma or with macroscopic nodal involvement remains poor. The best option for patients with higher-risk melanoma is to receive effective adjuvant therapy in order to reduce their chances of recurrence. Multiple systemic therapeutic agents have been tested as adjuvant therapy for melanoma with durable benefits seen only with interferon- to date. More recently ipilimumab at the high dose of 10 mg/kg has shown a significant improvement in terms of Relapse free survival and Overall survival for stage III melanoma patients but at a significant cost in terms of immune-related toxicities. More recently, novel treatment options have emerged. The results from the latest trials with immunotherapy (PD-1 inhibitors) and molecular targeted therapy (BRAF inhibitor + MEK inhibitor) have revolutionized the management of adjuvant treatment for melanoma. As the results from these trials will mature in the next years, a change in the landscape of adjuvant treatment for melanoma is expected, resulting in new challenges in treatment decisions such as optimizing patients' selection through predictive and prognostic biomarkers, and management of treatment related adverse events, in particular immune related toxicities.



https://ift.tt/2sJGBso

High-sensitivity quantification of serum androstenedione, testosterone, dihydrotestosterone, estrone and estradiol by gas chromatography–tandem mass spectrometry with sex- and puberty-specific reference intervals

Publication date: Available online 9 June 2018
Source:The Journal of Steroid Biochemistry and Molecular Biology
Author(s): Carina Ankarberg-Lindgren, Jovanna Dahlgren, Mats X. Andersson
BackgroundAndrogen and estrogen determinations serve as important diagnostic markers in a variety of clinical conditions. However, one challenge is to enhance assay sensitivity for determination in the lowest range, such as in prepubertal children.We here present a recently developed gas chromatography–tandem mass spectrometry (GC-MS/MS) method for determination of androstenedione (A4), dihydrotestosterone (DHT), testosterone (T), estrone (E1), and estradiol (E2) in children, which we have compared with the sensitive radioimmunoassays; E2 extraction-RIA and T-RIA.MethodsSteroids were extracted in ethyl acetate n-hexane solution from serum spiked with isotopically labeled internal standard and derivatized sequentially with pentafluorobenzyl bromide, pentafluorobenzyl hydroxylamine and pentafluoropropionic acid anhydride and analyzed by GC-MS/MS using a triple quadrupole mass spectrometer operated in negative chemical ionization mode. Leftover routine samples (n = 414) were used to evaluate the concordance between GC-MS/MS and RIAs and the validity of GC-MS/MS for pediatrics; of these samples, 101 were from seemingly healthy children. Pubertal stage was recorded for reference interval evaluation.ResultsLower limit of detection for A4, T, DHT, E1, and E2 were 0.1 nmol/L, 0.1 nmol/L, 27 pmol/L, 9 pmol/L, and 2 pmol/L, respectively. Good agreement was found between GC-MS/MS and T-RIA (r = 0.98) as well as between GC-MS/MS and E2 extraction-RIA (r = 0.98, for E2 concentrations above 14 pmol/L). In boys, T and DHT increased significantly from prepuberty throughout pubertal development, and in girls the same increase was observed for E1 and E2. The greatest increase in A4 for both genders, as well as E1 and E2 in boys and T and DHT in girls, occurred in mid to late puberty.ConclusionsWe report the development of a GC-MS/MS method sensitive enough to accurately determine serum levels of androgens and estrogens in children.



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Postoperative Cognitive Dysfunction and Noncardiac Surgery

Postoperative cognitive dysfunction (POCD) is an objectively measured decline in cognition postoperatively compared with preoperative function. POCD has been considered in the anesthetic and surgical literature in isolation of cognitive decline which is common in the elderly within the community and where it is labeled as mild cognitive impairment, neurocognitive disorder, or dementia. This narrative review seeks to place POCD in the broad context of cognitive decline in the general population. Cognitive change after anesthesia and surgery was described over 100 years ago, initially as delirium and dementia. The term POCD was applied in the 1980s to refer to cognitive decline assessed purely on the basis of a change in neuropsychological test results, but the construct has been the subject of great heterogeneity. The cause of POCD remains unknown. Increasing age, baseline cognitive impairment, and fewer years of education are consistently associated with POCD. In geriatric medicine, cognitive disorders defined and classified as mild cognitive impairment, neurocognitive disorder, and dementia have definitive clinical features. To identify the clinical impact of cognitive impairment associated with the perioperative period, POCD has recently been redefined in terms of these geriatric medicine constructs so that the short-, medium-, and long-term clinical and functional impact can be elucidated. As the aging population present in ever increasing numbers for surgery, many individuals with overt or subclinical dementia require anesthesia. Anesthesiologists must be equipped to understand and manage these patients. Accepted for publication May 3, 2018. Funding: Institutional and/or departmental. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Lisbeth A. Evered, PhD, Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, PO Box 2900 Fitzroy, Victoria 3065, Australia. Address e-mail to lis.evered@svha.org.au. © 2018 International Anesthesia Research Society

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A Prospective Observational Study of Anesthesia-Related Adverse Events and Postoperative Complications Occurring During a Surgical Mission in Madagascar

BACKGROUND: Two-thirds of the world's population lack access to safe anesthesia and surgical care. Nongovernmental organizations (NGOs) play an important role in bridging the gap, but surgical outcomes vary. After complex surgeries, up to 20-fold higher postoperative complication rates are reported and the reasons for poor outcomes are undefined. Little is known concerning the incidence of anesthesia complications. Mercy Ships uses fully trained staff, and infrastructure and equipment resources similar to that of high-income countries, allowing the influence of these factors to be disentangled from patient factors when evaluating anesthesia and surgical outcomes after NGO sponsored surgery. We aimed to estimate the incidence of anesthesia-related and postoperative complications during a 2-year surgical mission in Madagascar. METHODS: As part of quality assurance and participation in a new American Society of Anesthesiologists Anesthesia Quality Institute sponsored NGO Outcomes registry, Mercy Ships prospectively recorded anesthesia-related adverse events. Adverse events were grouped into 6 categories: airway, cardiac, medication, regional, neurological, and equipment. Postoperative complications were predefined as 16 adverse events and graded for patient impact using the Dindo-Clavien classification. RESULTS: Data were evaluated for 2037 episodes of surgical care. The overall anesthesia adverse event rate was 2.0% (confidence interval [CI], 1.4–2.6). The majority (85% CI, 74–96) of adverse events occurred intraoperatively with 15% (CI, 3–26) occurring in postanesthesia care unit. The most common intraoperative adverse event, occurring 7 times, was failed regional (spinal) anesthesia that was due to unexpectedly long surgery in 6 cases; bronchospasm and arrhythmias were the second most common, occurring 5 times each. There were 217 postoperative complications in 191 patients giving an overall complication rate of 10.7% (CI, 9.3–12.0) per surgery and 9.4% (CI, 8.1–10.7) per patient. The most common postoperative complication was unexpected return to the operating room and the second most common was surgical site infection (39.2%; CI, 37.0–41.3 and 33.2%; CI, 31.1–35.3 of all complications, respectively). The most common (42.9%; CI, 40.7–45.1) grade of complication was grade II. There was 1 death. CONCLUSIONS: This study adds to the scarce literature on anesthesia outcomes after mission surgery in low- and middle-income countries. We join others in calling for an international NGO anesthesia and surgical outcome registry and for all surgical NGOs to adopt international standards for the safe practice of anesthesia. Accepted for publication April 30, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website. Reprints will not be available from the authors. Address correspondence to Michelle C. White, MBChB, Department of Anesthesia, Great Ormond Street Hospital for Children, London WC1N 3JH, UK. Address e-mail to doctormcw@gmail.com. © 2018 International Anesthesia Research Society

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Adjusting the Ventilator? Not Only Size Matters!

No abstract available

https://ift.tt/2LBbC8W

Miller’s Anesthesia Review

No abstract available

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Evidence Review Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery: Focus on Anesthesiology for Total Knee Arthroplasty

Enhanced recovery after surgery (ERAS) has rapidly gained popularity in a variety of surgical subspecialities. A large body of literature suggests that ERAS leads to superior outcomes, improved patient satisfaction, reduced length of hospital stay, and cost benefits, without affecting rates of readmission after surgery. These patterns have been described for patients undergoing elective total knee arthroplasty (TKA); however, adoption of ERAS to orthopedic surgery has lagged behind other surgical disciplines. The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute (AI) for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery. The program comprises a national effort to incorporate best practice in perioperative care and improve patient safety, for over 750 hospitals and multiple procedures over the next 5 years, including orthopedic surgery. We have conducted a full evidence review of anesthetic interventions to derive anesthesiology-related components of an evidence-based ERAS pathway for TKA. A PubMed search was performed for each protocol component, focusing on the highest levels of evidence in the literature. Search findings are summarized in narrative format. Anesthesiology components of care were identified and evaluated across the pre-, intra-, and postoperative phases. A summary of the best available evidence, together with recommendations for inclusion in ERAS protocols for TKA, is provided. There is extensive evidence in the literature, and from society guidelines to support the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery goals for TKA. Accepted for publication March 22, 2018. Funding: This project was funded under contract number HHSP233201500020I from the Agency for Healthcare Research and Quality and the US Department of Health and Human Services. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website. The opinions expressed in this document are those of the authors and do not reflect the official position of Agency for Healthcare Research and Quality or the US Department of Health and Human Services. Reprints will not be available from the authors. Address correspondence to Christopher L. Wu, MD, Department of Anesthesiology, Hospital for Special Surgery/Weill Cornell Medical College, 535 E 70th St, New York, NY 10021. Address e-mail to wuch@hss.edu. © 2018 International Anesthesia Research Society

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In Response

No abstract available

https://ift.tt/2JEXwWB

In Response

No abstract available

https://ift.tt/2HAnjdH

Perioperative Care of the Elderly Patient

No abstract available

https://ift.tt/2JGRNzO

The Future of Activated Clotting Time?

No abstract available

https://ift.tt/2LEoI5m

Dopamine alleviated acute liver injury induced by lipopolysaccharide/d-galactosamine in mice

Publication date: August 2018
Source:International Immunopharmacology, Volume 61
Author(s): Honghong Zhou, Li Tang, Yongqiang Yang, Ling Lin, Jie Dai, Pu Ge, Qing Ai, Rong Jiang, Li Zhang
Dopamine (DA), a crucial neurotransmitter, not only functions in the central nervous system but also plays important roles in the modulation of inflammation. Several studies suggest that DA might suppress the inflammatory response both in vitro and in vivo. In the present study, the potential effects of DA in a mouse model with lipopolysaccharide (LPS)/d-galactosamine (D-Gal)-induced acute liver injury were investigated. The results show that DA-treated LPS/D-Gal-exposed mice had reduced incidence of histologic lesions, lower plasma aminotransferases and improved the survival rates compared to LPS/D-Gal-exposed mice. Treatment with DA also suppressed LPS/D-Gal-induced production of TNF-α, phosphorylation of c-jun-N-terminal kinase (JNK), cleavage of caspase-3, up-regulation of hepatic caspase-3, caspase-8, and caspase-9 activities and reduced the count of TUNEL-positive hepatocytes. These data indicate that DA attenuated LPS/D-Gal-induced fulminant liver injury in mice, which implies that DA might have value for the prevention of inflammatory liver disease.



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Unraveling Endocrine FGF Signaling Complex to Combat Metabolic Diseases

Publication date: Available online 9 June 2018
Source:Trends in Biochemical Sciences
Author(s): Yongde Luo, Weiqin Lu, Xiaokun Li
Metabolic homeostasis is critical to cellular and organismal health. The newly revealed crystal structures of the endocrine factors FGF21 and FGF23, in association with the glycosidase coreceptor Klotho and transmembrane tyrosine kinase FGFR, set a platform for structure-based novel drug design against common metabolic disorders.



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A Case of Herpes Simplex Virus-1 Encephalitis from a Medicolegal Point of View

We present a case of herpes simplex virus-1 encephalitis (HSVE) and discuss the difficulty of early diagnosis and the possibility of a wrong or delayed diagnosis and treatment of this encephalitis. We show the importance of considering HSVE to pursue every case of suspicious medical liability.

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Wire localization of clip-marked axillary lymph nodes in breast cancer patients treated with primary systemic therapy

Publication date: Available online 9 June 2018
Source:European Journal of Surgical Oncology
Author(s): Steffi Hartmann, Toralf Reimer, Bernd Gerber, Johannes Stubert, Bernd Stengel, Angrit Stachs
IntroductionClipping and selective removal of initially suspicious axillary lymph nodes in breast cancer patients who have been sonographically down-staged by primary systemic therapy improves the accuracy of surgical staging and provides the opportunity for more conservative axillary surgery. This study evaluated whether preoperative ultrasound-guided wire localization of the clipped node is useful for routine clinical practice.Material and MethodsThis prospective, single-center feasibility trial included patients with invasive breast cancer (cT1-3N1-3M0) treated by primary systemic therapy. They underwent ultrasound-guided core needle biopsy and clip placement into the most suspicious axillary lymph node prior to chemotherapy. After primary systemic therapy the clipped lymph node was localized by a wire. All patients underwent target lymph node biopsy, completion axillary lymph node dissection and, if yiN0, axillary sentinel lymph node biopsy. The primary study endpoint was the identification rate of the target lymph node.ResultsAll patients (n=30) underwent successful clip insertion into the lymph node. After chemotherapy, the clipped target lymph node was visible by ultrasound in 83.3% (25/30). Wire localization was possible in 24 cases (80%), and the clipped node identification rate was 70.8% (17/24 cases). In 9/30 patients (30%) clipped node removal was not confirmed by intraoperative radiography.ConclusionUltrasound-guided wire localization of the target lymph node is not suitable for clinical practice because of limitations regarding clip visibility and selective surgical preparation of the target lymph node. Further prospective evaluation of alternative techniques is needed.



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Association of high 5-hydroxymethylcytosine levels with Ten Eleven Translocation 2 overexpression and inflammation in Sjögren's syndrome patients

Publication date: Available online 9 June 2018
Source:Clinical Immunology
Author(s): Carolina Lagos, Patricia Carvajal, Isabel Castro, Daniela Jara, Sergio González, Sergio Aguilera, María-José Barrera, Andrew F.G. Quest, Verónica Bahamondes, Claudio Molina, Ulises Urzúa, Marcela A. Hermoso, Cecilia Leyton, María-Julieta González
Here, we determined the 5-hydroxymethylcytosine (5hmC), 5-methylcytosine (5mC), Ten Eleven Translocation (TETs), and DNA methyltransferases (DNMTs) levels in epithelial and inflammatory cells of labial salivary glands (LSG) from Sjögren's syndrome (SS)-patients and the effect of cytokines on HSG cells. LSG from SS-patients, controls and HSG cells incubated with cytokines were analysed. Levels of 5mC, 5hmC, DNMTs, TET2 and MeCP2 were assessed by immunofluorescence. In epithelial cells from SS-patients, an increase in TET2, 5hmC and a decrease in 5mC and MeCP2 were observed, additionally, high levels of 5mC and DNMTs and low levels of 5hmC were detected in inflammatory cells. Cytokines increased TET2 and 5hmC and decreased 5mC levels. Considering that the TET2 gene.promoter contains response elements for transcription factors activated by cytokines, together to in vitro results suggest that changes in DNA hydroxymethylation, resulting from altered levels of TET2 are likely to be relevant in the Sjögren's syndrome etiopathogenesis.



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Effect of high glucose on cytokine production by human peripheral blood immune cells and type I interferon signaling in monocytes: Implications for the role of hyperglycemia in the diabetes inflammatory process and host defense against infection

Publication date: Available online 9 June 2018
Source:Clinical Immunology
Author(s): Ronghua Hu, Chang-Qing Xia, Edward Butfiloski, Michael Clare-Salzler
The major metabolic feature of diabetes is hyperglycemia which has been linked to the diabetes inflammatory processes, and diabetes-related vulnerability to infection. In the present study, we assessed how glucose affected PBMCs in type I interferon (IFN) production and subsequent signaling. We found that the moderately elevated glucose promoted, and high glucose suppressed type I IFN production, respectively. Pre-exposure to high glucose rendered monocytes more sensitive to IFN-α stimulation with heightened signaling, whereas, instantaneous addition of high glucose did not exhibit such effect. Consistent with this finding, the mRNA levels of IFN-α-induced IRF-7 in PBMCs were positively correlated with HbA1c levels of diabetes patients. Additionally, we found that high glucose promoted the production of other proinflammatory cytokines/chemokines. This study suggests that hyperglycemia may affect the inflammatory process in diabetes via promoting proinflammatory cytokines, as well as the host defense against microbial infections through impeding type I IFN production and signaling.



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Estudio del daño otolítico en pacientes con vértigo posicional paroxístico benigno mediante potenciales vestibulares miogénicos evocados

Publication date: Available online 9 June 2018
Source:Acta Otorrinolaringológica Española
Author(s): Paula Martínez Pascual, Pedro Amaro Merino
IntroducciónLa fisiopatología del vértigo posicional paroxístico benigno (VPPB) se explica por la migración de otoconias de la mácula del utrículo a los canales semicirculares; no obstante, el papel del sáculo en esta entidad continúa en estudio. Nuestro objetivo es estudiar el daño otolítico en estos pacientes con potenciales vestibulares miogénicos evocados (VEMP) y relacionarlo con los resultados de la posturografía dinámica computarizada (PDC).Material y métodosPresentamos 79 pacientes diagnosticados de VPPB de manera consecutiva entre marzo y junio de 2017 a quienes se les realizó un estudio con VEMP oculares y cervicales y PDC. Seleccionamos los 67 pacientes con VPPB del canal semicircular posterior y los comparamos con un grupo control de 60 pacientes.ResultadosLos pacientes con VPPB presentaron VEMP cervicales alterados en el 49,25% de los casos, frente al 16,67% en el grupo control. La alteración en VEMP oculares fue del 61,19% en el grupo de VPPB, frente al 6,67% en el grupo control. La prevalencia de VEMP oculares anormales en pacientes con VPPB recurrentes fue estadísticamente significativa. No se halló correlación significativa con los resultados alterados de la PDC.ConclusionesLa disfunción sacular y utricular en los pacientes con VPPB medida mediante VEMP es mayor que en la población sana. Esta alteración puede estar relacionada con la inestabilidad residual que a veces experimentan estos pacientes.IntroductionBenign paroxysmal positional vertigo (BPPV) pathophysiology is based on otoconia migration from the utricle and saccule to the semicircular canals, however, the role of the saccule is still under study. Our aim is to study the otolith damage in these patients with vestibular evoked myogenic potentials (VEMPS) and correlate the results with those of computerised dynamic posturography (CDP).Material and methodsWe present 79 patients diagnosed with BPPV between March and June 2017. VEMPS and CDP studies were performed. We selected 67 patients with posterior semi-circular canal BPPV and we compared them with 60 healthy subjects.ResultsBPPV group had abnormal cervical VEMPS in 49.25% of patients compared to 16.67% in the control group. Ocular VEMPS were altered in 61.19% of the patients and 6.67% of the healthy subjects. Abnormal ocular VEMPS in patients with recurrent BPPV was statistically significant. There was no significant correlation with CDP results.ConclusionsUtricular and saccular dysfunction in BPPV patients proved by VEMPS is higher than in healthy individuals. This result may be related to symptoms of instability experienced by these patients occasionally.



https://ift.tt/2sJ0rUC

Association of high 5-hydroxymethylcytosine levels with Ten Eleven Translocation 2 overexpression and inflammation in Sjögren's syndrome patients

Publication date: Available online 9 June 2018
Source:Clinical Immunology
Author(s): Carolina Lagos, Patricia Carvajal, Isabel Castro, Daniela Jara, Sergio González, Sergio Aguilera, María-José Barrera, Andrew F.G. Quest, Verónica Bahamondes, Claudio Molina, Ulises Urzúa, Marcela A. Hermoso, Cecilia Leyton, María-Julieta González
Here, we determined the 5-hydroxymethylcytosine (5hmC), 5-methylcytosine (5mC), Ten Eleven Translocation (TETs), and DNA methyltransferases (DNMTs) levels in epithelial and inflammatory cells of labial salivary glands (LSG) from Sjögren's syndrome (SS)-patients and the effect of cytokines on HSG cells. LSG from SS-patients, controls and HSG cells incubated with cytokines were analysed. Levels of 5mC, 5hmC, DNMTs, TET2 and MeCP2 were assessed by immunofluorescence. In epithelial cells from SS-patients, an increase in TET2, 5hmC and a decrease in 5mC and MeCP2 were observed, additionally, high levels of 5mC and DNMTs and low levels of 5hmC were detected in inflammatory cells. Cytokines increased TET2 and 5hmC and decreased 5mC levels. Considering that the TET2 gene.promoter contains response elements for transcription factors activated by cytokines, together to in vitro results suggest that changes in DNA hydroxymethylation, resulting from altered levels of TET2 are likely to be relevant in the Sjögren's syndrome etiopathogenesis.



https://ift.tt/2kYwCLp

Effect of high glucose on cytokine production by human peripheral blood immune cells and type I interferon signaling in monocytes: Implications for the role of hyperglycemia in the diabetes inflammatory process and host defense against infection

Publication date: Available online 9 June 2018
Source:Clinical Immunology
Author(s): Ronghua Hu, Chang-Qing Xia, Edward Butfiloski, Michael Clare-Salzler
The major metabolic feature of diabetes is hyperglycemia which has been linked to the diabetes inflammatory processes, and diabetes-related vulnerability to infection. In the present study, we assessed how glucose affected PBMCs in type I interferon (IFN) production and subsequent signaling. We found that the moderately elevated glucose promoted, and high glucose suppressed type I IFN production, respectively. Pre-exposure to high glucose rendered monocytes more sensitive to IFN-α stimulation with heightened signaling, whereas, instantaneous addition of high glucose did not exhibit such effect. Consistent with this finding, the mRNA levels of IFN-α-induced IRF-7 in PBMCs were positively correlated with HbA1c levels of diabetes patients. Additionally, we found that high glucose promoted the production of other proinflammatory cytokines/chemokines. This study suggests that hyperglycemia may affect the inflammatory process in diabetes via promoting proinflammatory cytokines, as well as the host defense against microbial infections through impeding type I IFN production and signaling.



https://ift.tt/2xUf1xw