Did carbon dioxide emission regulations inhibit investments? A provincial panel analysis of China

Abstract

Investments, especially fixed asset investments, greatly affect carbon dioxide (CO₂) emissions. When investments are concentrated in regions with high CO₂ emissions and high fossil energy consumption, the CO₂ emission reduction targets in these areas are difficult to reach in the short term, and the cost of CO₂ emission abatement is high. The current CO₂ emission regulations focus on existing production activities and consumption behaviors. However, whether an investment, which may affect CO₂ emissions in the long term, is effectively inhibited by CO₂ emission regulations has not been investigated in previous studies. Using panel data from 30 provinces in China between 2003 and 2012, we tested whether the amount of provincial investment was constrained or promoted by the provincial CO₂ emission regulations by creating a panel model with provincial samples. The results revealed that CO₂ emission regulations did not inhibit the growth of an investment, but they stimulated investments to varying degrees in different provinces. A relatively positive result is that provinces with stronger CO₂ emission regulations exhibited a relatively small contribution to investment promotion, while provinces with weaker CO₂ reduction policies demonstrated a relatively large contribution to investment growth. We also found that investment was correlated with the growth rate of the gross domestic product (GDP) in the northeastern and western provinces. Finally, we proposed policy implications based on the utilization of policy tools from the perspectives of investment, energy structure, and local protectionism.

https://ift.tt/2O5HeFN

Pitfalls in anaphylaxis

Purpose of review Anaphylaxis is an acute medical emergency characterized by sudden presentation of life-threatening respiratory and cardiovascular symptoms. Rapid diagnosis of anaphylaxis is crucial to implement an appropriate treatment and management plan. However, mistakes in the diagnosis of anaphylaxis may occur because of the limited time during which the diagnosis must be made, the stressful environment of the emergency room, the often aspecific or incomplete clinical features of early anaphylaxis and the lack of useful laboratory markers. Recent findings Several disorders may mimick anaphylaxis and cause wrong or delayed diagnosis increasing chances of fatal outcomes. In addition, certain clinical situations, like general anesthesia, may complicate detection of early signs of anaphylaxis. Drugs like beta-blockers, angiotensin converting enzyme-inhibitors, antihistamines or steroids may hide or blunt initial clinical manifestations of anaphylaxis. Summary A careful evaluation of clinical signs in all organs is mandatory to quickly establish and confirm a diagnosis of anaphylaxis. Alternative diagnosis should be considered, particularly in the case of unresponsive patients. Avoiding pitfalls in anaphylaxis diagnosis will help to establish rapidly effective treatments and would further reduce the rate of fatal events. Correspondence to Massimo Triggiani, MD, PhD, Division of Allergy and Clinical Immunology University of Salerno, Via S. Allende Baronissi, Fisciano, Salerno, Italy. Tel: +39 089 965056; fax: +39 089 965056; e-mail: mtriggiani@unisa.it Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2uR91ko

Erythematous Bullous Patch in a Patient With Myelodysplastic Syndrome: Answer

No abstract available

https://ift.tt/2uFvrpv

Juvenile-Onset Early-Stage Mycosis Fungoides–Associated Follicular Mucinosis: A Case Report

Abstract: We report a juvenile case of mycosis fungoides with prominent follicular mucinosis (FM). The patient was a 9-year old boy who presented with a 2-month history of enlarging alopecic patch with fine scales on the scalp. Dermatologic examination revealed orange-tan slightly palpable plaques with follicular prominence on his trunk. The patient and his family were not aware of these asymptomatic truncal plaques. Histopathologic examination of both—scalp and trunk—lesions revealed folliculotropic lymphocytic infiltration with mucin. Immunohistochemical study showed that lymphocytic infiltration was CD4 dominant. Flow cytometry analyses of peripheral blood were normal. Any abnormal populations and Sézary cells were not observed on blood smear. Polymerase chain reaction testing showed monoclonality for the T-cell receptor4-[Latin Small Letter Rams Horn] gene. Our patient had the clinical and histopathological diagnosis of follicular mycosis fungoides–associated follicular mucinosis.

https://ift.tt/2zUwOWA

CD34 and BerEP4 Are Helpful to Distinguish Basaloid Tricholemmoma From Basal Cell Carcinoma

Abstract: Tricholemmoma, a benign follicular neoplasm with outer root sheath differentiation, typically comprises clear or pale cells, and when multiple is pathognomic of Cowden's syndrome. The tumor is probably underrecognized and in basaloid examples can be difficult to distinguish from basal cell carcinoma (BCC). We studied 55 tricholemmomas (including 15 basaloid cases) and compared immunohistochemical profile with nodular BCC from our archives. Basaloid and non–basaloid tricholemmomas had similar staining characteristics. BerEP4 was focally positive (range 10%–20%) in only 3/39 (7.7%) tricholemmomas compared with widespread positivity in BCC (90.8%, 139 of 151 cases with ≥50% tumor area stained). CD34 was expressed, usually focally (median 20%, range 10%–90%), in 52/53 (98.1%) tricholemmomas and was negative in all 21 BCCs stained. EMA staining lacked sensitivity or specificity in differentiating tricholemmoma from BCC. Five or more Merkel cells were found in 7/17 (40.1%) tricholemmomas and 1/23 (4.3%) nodular BCCs studied. In summary, immunohistochemistry is helpful in distinction between tricholemmoma, including difficult basaloid examples (BerEP4 negative or focal, CD34 positive) compared with BCC (BerEP4 widespread in most cases, CD34 negative). The presence of 5 or more Merkel cells is a relatively specific but not a particularly sensitive discriminator.

https://ift.tt/2uFvD8d

Melanocytic Nevus Does Not Metastasize!

No abstract available

https://ift.tt/2LAuQMk

Subcutaneous Panniculitis-Like T-Cell Lymphoma Versus Lupus Erythematosus Panniculitis: Distinction by Means of the Periadipocytic Cell Proliferation Index

Abstract: The distinction between subcutaneous panniculitis-like T-cell lymphoma (SPTCL) and lupus erythematosus (LE) panniculitis is remarkably challenging. Rimming by lymphocytes with an elevated Ki-67 cell proliferation index has been forwarded as a potential diagnostic finding in biopsies of SPTCL but has not been rigorously compared with biopsies from patients with LE panniculitis. Nineteen and 17 examples of SPTCL and LE panniculitis, respectively, were evaluated for periadipocytic rimming by lymphocytes expressing Ki-67, CD8, and βF1 and for attributes associated with LE, including clusters of CD123-positive cells. The identification of periadiopocytic rimming using Ki-67, CD8, and βF1 held sensitivity of 79%, 100%, and 89.5% and specificity of 100%, 52.9%, and 88.2%, respectively (P

https://ift.tt/2uFvyRX

Cutaneous Angiosarcoma of the Eyelid Mimicking Morbihan Disease

Background: Cutaneous angiosarcoma presents clinically in numerous ways, and can be mistaken for a different clinical entity, particularly when arising at unusual anatomic locations such as the eyelid. Case Presentation: A 57-year-old woman presented with a 1-year history of eyelid swelling. Concurrent imaging was also suggestive of an edematous process. Multiple superficial biopsies showed nonspecific dermal inflammation and interstitial edema. A diagnosis of Morbihan disease (chronic and idiopathic lymphedema of the eyelid) was rendered, and the patient was treated with compression and local therapy without clinical improvement. Three years after initial presentation, a diagnostic blepharoplasty was performed revealing a deep dermal vascular proliferation composed of anastomosing vascular channels with an atypical endothelial lining. A diagnosis of cutaneous angiosarcoma was ultimately made. Conclusions: This case illustrates a unique presentation of cutaneous angiosarcoma and the implications of different biopsy techniques in acquiring the correct diagnosis.

https://ift.tt/2LBLUBx

Cutaneous Squamous Cell Carcinoma With Sclerosing Features: An Uncommon and Potentially Aggressive Variant

Abstract: Sclerosing squamous cell carcinoma (SCC), also known as "desmoplastic" SCC, is a rare subtype of cutaneous malignancy. This variant is clinically significant because it is associated with an increased risk of local recurrence and metastasis. We herein present 16 examples of sclerotic SCC of the skin in 8 men and 3 women, with a median age of 66 years. The most common site of origin for this tumor is the skin of the head and neck, including the scalp (5 tumors in 2 different patients), forehead (3 cases), nasal ala (2 cases), neck (2 cases in the same patient), ear (2 cases), cheek (1 case), and chest (1 case). Microscopically, sclerosing SCCs are characterized by cellular cords, nests, and islands, as well as scattered single cells infiltrating densely desmoplastic and collagenized connective tissue. The differential diagnosis principally includes sclerosing basal cell carcinoma, microcystic adnexal carcinoma, and desmoplastic trichoepithelioma. The main goals of this study are to further characterize these lesions pathologically, and increase general awareness of this SCC subtype.

https://ift.tt/2uDhqZD

Lymph Node Metastasis With Both Components of Combined Cutaneous Squamous Cell Carcinoma/Merkel Cell (Neuroendocrine) Carcinoma

No abstract available

https://ift.tt/2LBLPhd

Polymorphous Sweat Gland Carcinoma: An Immunohistochemical and Molecular Study

Abstract: Polymorphous sweat gland carcinoma is an uncommon low-grade malignant adnexal tumor with a marked predilection for the distal extremities. Histologically, the lesions are characterized by a cellular proliferation showing a combination of growth patterns, including trabecular, solid, tubular, cribriform, or adenoid cystic and pseudopapillary. The immunohistochemical and molecular profile of these tumors has not yet been properly addressed. We have studied 3 cases of polymorphous sweat gland carcinoma using a broad panel of immunohistochemical markers including cytokeratin AE1/AE3, CK5/6, MOC31, p40, p63, p16, chromogranin, synaptophysin, CD56, MIB-1, estrogen receptor, progesterone receptor, androgen receptor, BER-EP4, smooth muscle actin, epithelial membrane antigen, carcinoembryonic antigen, CD117, S100 protein, HBME-1, DOG1, vimentin, and mammaglobin. We also examined for the MYB-NFIB fusion by fluorescent in situ hybridization (ISH) and for human papilloma virus by ISH. Our studies show that cytokeratin AE1/AE3, CK5/6, p40, p63, p16, chromogranin, and CD56 stains were positive in all 3 cases. All 3 cases were negative for MYB-NFIB fusion by fluorescent ISH which rules out adenoid cystic carcinoma. DNA ISH studies for high-risk human papilloma virus were negative in all cases. MIB-1 proliferation index was very high (30%–70% nuclear positivity), supporting a malignant phenotype. The positivity for chromogranin and CD56 suggests partial neuroendocrine differentiation. The differential diagnosis includes metastases from internal malignancies, basal cell carcinoma, and other benign and malignant adnexal neoplasms such as adenoid cystic carcinoma, ductal eccrine carcinoma, and microcystic carcinoma. Positivity for p16 in combination with chromogranin and CD56 may be potentially good markers for differentiating this tumor from other adnexal tumors.

https://ift.tt/2uDhmJn

Erythematous Bullous Patch in a Patient With Myelodysplastic Syndrome: Challenge

No abstract available

https://ift.tt/2LAoZGI

Langerhans Cell Histiocytosis Associated With Underlying Hematolymphoid Disorders in Adults: Report of 2 Cases and Review of the Literature

Abstract: Langerhans cell histiocytosis (LCH) is an uncommon disorder characterized by proliferation of abnormal LCs usually affecting children and adolescents. LCH in adults first presenting in the skin is rare. Although LCH and even LCH with a second malignancy may be more common in children, cutaneous LCH with a second hematologic malignancy has been more commonly identified in adults. The authors report 2 new cases of LCH in adult patients with underlying myelodysplasia and follicular lymphoma. The specimens were examined by routine microscopy and immunohistochemical stains for S100 protein and CD1a. Patients were elderly men with established diagnoses of follicular lymphoma and myelodysplasia, presented with follicular lesions and erythematous plaques involving intertriginous areas. Histologic examination revealed collections of mononuclear cells in upper dermis, which demonstrated strong positivity for S100 and CD1a, confirming their identity as LCs. BRAF analysis returned negative for detection of BRAF V600E mutation in both patients. The authors have recently encountered 2 cases of adult patients with skin-limited LCH predated by other lymphoproliferative disorders. The association between LCH and hematopoietic disorders may be explained by a common bone marrow precursor that is differentiating along different cell lines. Cutaneous LCH may be associated with underlying lymphoproliferative disorders and should be considered in the differential diagnosis of cutaneous eruptions in patients with hematopoietic disorders. Clinical follow-up evaluation of patients diagnosed with LCH for peripheral blood abnormalities and lymphadenopathy or "B symptoms" may be prudent in patients not already carrying a diagnosis of an underlying hematologic disorder.

https://ift.tt/2uF0VvZ

Fibrous Papule: A Histopathologic Review

Abstract: Fibrous papule (FP) is a common benign lesion located primarily in the nose. Although its histogenesis has been marred with controversies in the past, the dermal dendrocyte is now largely accepted to be the putative cell of origin. Histopathologic diagnosis of an FP is straightforward in most cases, which shows characteristics of an angiofibroma. Several histologic variants have been described, recognition of which is important to avoid a misdiagnosis and inappropriate treatment. This review presents a historical perspective into the histogenesis, discusses the histopathologic features and potential diagnostic pitfalls of classic FP, and lists the various histologic variants and their differential diagnoses.

https://ift.tt/2zXVEok

Cholesterol Clefts in Basal Cell Carcinoma: An Under-Recognized Association

Abstract: Cholesterol clefts have rarely been described in cutaneous tumors other than lipid-rich tumors. However, they seem to be a relatively common phenomenon in basal cell carcinoma (BCC). This study was undertaken to determine the frequency of cholesterol cleft deposition in BCCs, and to identify associated histopathologic and clinical features. Twenty-eight of 249 BCC cases reviewed showed features of cholesterol cleft. Mean disease duration in those with cholesterol cleft was significantly longer than in those without cholesterol cleft (5.58 vs. 3.29 years, respectively; P = 0.013). Sex and age distributions, and average tumor longest diameter (11.6 vs. 9.41 mm) were no different for those with or without cholesterol clefts. The most common anatomical location was the nose in both those with and without cholesterol clefts. BCCs without cholesterol clefts more frequently involved the periauricular and perioral areas, and areas other than the head and neck, such as the trunk and lower extremities (P = 0.087). Histopathologic features of necrosis (26/28, 92.86%), keratinization (19/28, 67.86%), and pigment deposition (18/28, 64.29%) were found to be associated with cholesterol clefts. Cholesterol clefts were intratumorally located in 27/28 cases (96.43%), and stromally located in 2 cases (7.14%); intravascularly located cholesterol clefts were observed in no case. In conclusion, this study shows that cholesterol clefts are relatively common in BCC, and suggests that cholesterol crystal deposition could be associated with longer disease duration and microtrauma.

https://ift.tt/2uF0VMv

A Painful Firm Plaque on the Midback of a 53-Year-Old Woman: Answer

No abstract available

https://ift.tt/2zUwrLG

Pseudomyogenic Hemangioendothelioma: Case Report and Review of the Literature

Abstract: Pseudomyogenic hemangioendothelioma (PHE; epithelioid sarcoma-like hemangioendothelioma) is a rare entity, with 129 reported cases. It is a rarely metastasizing, low-grade vascular tumor that can histologically mimic epithelioid sarcoma and often presents as multiple discontinuous nodules in the extremities. PHEs characteristically and consistently show immunoreactivity for cytokeratins and endothelial markers. We present a case in the thigh of a 65-year-old-man with a 3-month history of painful lesions in the dermis and review the published literature. In our case, the lesion exhibited the characteristic histologic findings and immunoprofile of a PHE: a solid proliferation of spindled to epithelioid cells with abundant eosinophilic cytoplasm and frequent rhabdoid cells. Cytologic atypia and mitotic figures were inconspicuous. The tumor cells were immunoreactive for CD31, ERG, AE1/3, and CK7 and negative for D2-40, P53, HMB45, desmin, CD34, SMA, EMA, and S100 protein. A balanced reciprocal translation between chromosomes 7 and 19 was present; this translocation seems unique to PHE. PHE is a unique and commonly misdiagnosed entity; therefore, we review the literature to describe the characteristics of this tumor.

https://ift.tt/2uD72B3

Multiple Tumors on the Extremities: Answer

No abstract available

https://ift.tt/2LCTJqO

Small Vessel Vasculitis in Herpes Zoster—Discussion of Current Aspects of Varicella Zoster Virus Vasculopathy

Abstract: Varicella zoster virus (VZV) vasculopathy was initially described as herpes zoster ophthalmicus with contralateral hemiplegia in 1896. VZV is able to infect endothelial cells directly, leading to a thickened intima and vascular remodeling due to inflammation. Therefore, a spectrum of vasculopathies is induced, ranging from a discrete capillaritis-to-granulomatous vasculitis and obliterative angiitis. Cutaneous vasculitic changes sui generis with leukocytoclasia, cell debris, vascular damage, and endothelial swelling are very rare feature of herpetic infections in skin biopsies. We report an immunocompetent patient who presented with a rare form of cutaneous VZV infection of the upper leg characterized by vasculitic changes of the small vessels without typical herpetic epidermal features or neural involvement. Intriguingly, the vasculitis appeared prior to the characteristic vesicular rush without any pain symptoms. Because VZV can cause vasculopathic damage mainly within the central nervous system in immunocompetent and immunosuppressed patients, we recommend continuous clinical controls to recognize central symptoms that are related to VZV vasculopathy or giant cell arteriitis.

https://ift.tt/2uG1e9I

CD4 and CD30 Coexpression in a Cutaneous Manifestation of Systemic Mastocytosis—A Pitfall

No abstract available

https://ift.tt/2Lz2SQV

Moulages: Art and History of Medicine

Abstract: The aim of this article is to introduce the museum we have at the Pathology Department, School of Medicine of the National University of Rosario, Argentina. The origin dates from to 1922 when Dermatology Professor Dr. Enrique P. Fidanza bought moulages at L'Hôpital Saint-Louis in Paris for the purpose of teaching. The collection included around 100 moulages and was worth approximately 1000 dollars. These pieces were exhibited at the Dermatology Department for many years and later moved to the Pathology Department where some pieces started being repaired, whereas others have deteriorated. The collection is composed of 100 moulages done by a French craftsman by the name of Niclet and 258 made by Argentine craftsmen including Alba Ramirez and G. Rouzaut, among others. The pieces are classified according to different dermatological diseases such as: the different stages of syphilis, lupus, benign and malignant neoplasm, infectious diseases, etc.

https://ift.tt/2uCoFAU

A Painful Firm Plaque on the Midback of a 53-Year-Old Woman: Challenge

No abstract available

https://ift.tt/2zY2ZUN

Intrathoracic scapular dislocation following lung cancer resection

Abstract

A 64-year-old man underwent right upper lobectomy combined resection with third-fifth rib for lung cancer and reconstruction of chest wall using Dual Mesh. Six days after surgery, he experienced acute severe pain in the right shoulder. The purulent drainage through the drainage tube was also found. Chest CT showed that the inferior angle of the scapula protruded into the right intrathoracic cavity. We performed a removal of Mesh. Although we did not want to use synthetic materials because of infection, we performed titanium plate fifth rib fixation to avoid the recurrent dislocation of the scapula. After the redo surgery, continuous lavages with physiologic saline of the thoracic cavity was also performed. Patient is now doing well without recurrences of cancer, infection and scapular dislocation, 14 months after the redo surgery.

https://ift.tt/2uSoIIa

Concomittant fibrous dysplasia with aneurysmal bone cyst formation within the skull, humerus and rib

Abstract

Polyostotic fibrous dysplasia (FD) is a rare pathology characterized by the abnormal and gradual replacement of normal bone (calcium hydroxylapatite of osteoid matrix) with fibrous connective tissue. Aneurysmal bone cyst (ABC) is a tumor-like benign lesion with blood-filled cavities that can affect virtually any bone in the body. We report on a 20-year-old male presenting with an extremely rare pathology of FD with ABC formation of the skull, fourth rib and humerus. Our case report represents a novel literary addition to rare FD with ABC pathologies. Optimal diagnosis of this rare pathology can be achieved by a full body evaluation for clinical and radiographic FD with or without ABC, and optimal treatment for this rare pathology is the maximum surgical excision of the tumor and/or soft tissue.

https://ift.tt/2LmMFld

Case report: irreducible medial subtalar dislocation with incarcerated anterior talar head fracture in a young patient

Abstract

Subtalar dislocations are rare injuries that typically occur from high-energy injuries. All subtalar dislocations should be attempted to be closed reduced, however, ~32% are irreducible requiring open reduction. We present an irreducible medial subtalar dislocation following a motor vehicle accident with no associated fractures demonstrated on radiograph. However, open reduction revealed an incarcerated anterior talar head fracture that was reduced and stabilized with retrograde K-wires.

https://ift.tt/2JG9Wtt

Food protein-induced eosinophilic enteritis with intestinal stricture in a neonate: a case report and review of the literature

Abstract

The case of a 21-day-old boy with eosinophilic enteritis with intestinal stricture due to a food protein-induced allergy is reported herein. For the first 4 days of life, he was both breast-fed and formula-fed, after which he was exclusively breast-fed. At the age of 24 days, he underwent laparotomy to investigate the possibility of intestinal obstruction for bilious vomiting, and an ileal stricture was detected and resected. Pathologic analysis showed the presence of eosinophil accumulation in the lesions presented more than 20 eosinophils per high-power field and the eosinophils were oriented towards the epithelium and diffusely distributed throughout the tissue, but the margins of resection showed a few infiltration of eosinophiles. Allergen-specific lymphocyte stimulation testing showed a markedly increased lymphocyte response to lactoferrin. He was finally diagnosed as eosinophilic enteritis with intestinal stricture due to a food protein-induced allergy. The patient remained asymptomatic during a follow-up period of 12 months.

https://ift.tt/2LxrPQh

Total arch replacement as treatment for repeated cerebral infarctions due to unstable plaque simultaneously in the innominate artery and left subclavian artery: a case report

Abstract

We report a case of total arch replacement in a patient who suffered repeated cerebral infarctions due to unstable plaque simultaneously in the innominate and left subclavian arteries.

https://ift.tt/2JI35Q9

Clinical and diagnostic significance of serum immunoglobulin A rheumatoid factor in primary Sjogren’s syndrome

Abstract

Objectives

The aim of this study was to investigate the diagnostic accuracy of rheumatoid factor (RF) isotype for the detection of primary Sjogren's syndrome (pSS) and evaluate the clinical and serological associations of immunoglobulin (Ig) A RF in patients with pSS.

Materials and methods

RF levels were measured in 77 and 37 patients with pSS and idiopathic sicca symptoms, respectively, using ELISA and analysed with respect to clinical and laboratory disease characteristics. Receiver operating characteristic curves were used to determine and compare the diagnostic accuracy of IgA RF with other diagnostic tests.

Results

Serum levels of IgA RF were significantly higher in patients with pSS than in those with idiopathic sicca symptoms. IgA RF showed sensitivity, specificity, positive, and negative predictive values of 83.1, 78.4, 88.9, and 69.0%, respectively, for pSS diagnosis. IgA RF was associated with xerostomia, severe sialoscintigraphic grade, low unstimulated salivary flow rate (USFR), antinuclear antibody, high IgG and IgM/G RF levels, and low C3 levels in patients with pSS. IgA RF titres had positive correlations with sialoscintigraphic grade and IgG and IgG/M RF levels and had negative correlations with USFR and C3 levels.

Conclusion

Our findings confirmed the potential of IgA RF to distinguish pSS from idiopathic sicca symptoms. The presence of IgA RF in patients with pSS was associated with significantly worse exocrine function and active serologic profile. No association between IgA RF and extra-glandular manifestations was noted.

Clinical relevance

IgA RF should be the predictive and diagnostic marker in patients with pSS.

https://ift.tt/2LsUfut

Cosmetics, Vol. 5, Pages 46: Cytoprotection of Antioxidant Biocompounds from Grape Pomace: Further Exfoliant Phytoactive Ingredients for Cosmetic Products

Cosmetics, Vol. 5, Pages 46: Cytoprotection of Antioxidant Biocompounds from Grape Pomace: Further Exfoliant Phytoactive Ingredients for Cosmetic Products

Cosmetics doi: 10.3390/cosmetics5030046

Authors: Daniela F. Maluf Melissa M. Gonçalves Rebeca W. O. D'Angelo Ana B. Girassol Ana P. Tulio Yasmine M. Pupo Paulo V. Farago

The goal of this study was to investigate the efficacy and the safety of grape pomace (Vitis labrusca L.) obtained from the winemaking process as an antioxidant raw material for cosmetic formulations. Grape pomace was dried and submitted to extraction with solvents. The extracts were filtered and freeze-dried. The extraction carried out with 75% acetone-water showed a better yield (1.9 g·g−1). High performance liquid chromatography (HPLC) analysis confirmed the presence of ellagic acid as an active biocompound in the extracts. The Total phenolic content of freeze-dried extracts reached 69.83 ± 1.02 mg for 75% acetone-water system. Antioxidant activity determined by the 2,2-Diphenyl-1-picrylhydrazyl (DPPH) method revealed there was no statistical difference between the extract (EC50 6.9 ± 0.21) and butylated hydroxytoluene (BHT) (EC50 7.6 ± 0.71). Results of cytotoxicity showed that extracts from grape pomace were safe, even at the highest concentration tested (200 mg·mL−1) against the 3T3 cell line. Scanning Electron Microscopy (SEM) analysis revealed that there were no morphological cell changes of cells treated. Cytoprotection of cells towards the oxidation promoted by the peroxide solution was observed in the lowest concentration tested (0.73 mg·mL−1). Grape pomace from the winemaking process revealed a significant antioxidant activity attributed to its biocompounds. The safety and efficacy of extracts of grape pomace as raw material for cosmetic formulations was proposed through cell culture assays.

https://ift.tt/2O56agw

The impact of economic growth on CO 2 emissions in Australia: the environmental Kuznets curve and the decoupling index

Abstract

Australia is the sixth largest country in the world, celebrating its 26th consecutive year without a recession. However, the country is one of the ten largest emitters of greenhouse gases, mainly caused by energy use. As such, Australia is facing a trade-off between economic growth and reducing carbon dioxide (CO₂) emissions. This paper empirically analyses the relationship between economic growth and CO₂ emissions in Australia, based on annual data from 1965 to 2016, considering the consumption of the fossil fuels oil and coal and renewable energy. This analysis is performed using the environmental Kuznets curve (EKC) and the Decoupling Index (DI). The EKC is assessed by employing the autoregressive distributed lag model. In addition, a robustness check is provided through the vector error correction model, which allows for the employment of the Granger causality test. The results show that in Australia, there is evidence for the EKC hypothesis, and that the country is undergoing increasing relative decoupling. These results mean that economic growth causes CO₂ emissions and consequently environmental degradation. To achieve environmental targets and reduce the rate of CO₂ emissions while continuing to grow, Australia needs to implement measures and policies to cut CO₂ emissions, such as energy demand management and control, energy efficiency, reducing fossil fuel consumption, and investing in renewable energy technology.

https://ift.tt/2LtYUwm

Different pollutant removal efficiencies of artificial aquatic plants in black-odor rivers

Abstract

Black-odor rivers have become a prominent environmental problem, especially for developing countries. A laboratory experiment was conducted to determine the optimum operating parameters of artificial aquatic plants (AAP) to provide a theoretical and scientific basis for their application in black-odor rivers. The purification mechanism of operating parameters for AAP was also explored at the micro-organic and genetic levels by high-throughput sequencing. Chemical oxygen demand (COD) and ammonia nitrogen (NH₄⁺-N) were measured in systems with different AAP lengths and pH. After 24 days, the best removal efficiencies of APP for COD and NH₄⁺-N were 90.07 and 82.40% for 100 cm and 90.70 and 91.90% for pH values of 8.0–9.0, respectively. High-throughput sequencing analysis revealed that the relative abundance of Flavobacterium in the AAP was 7.80% at 50 cm, while the proportion increased to 29.30% at 100 cm. The abundance of microorganisms improved continuously with increased length, and the ratio of Acinetobacter increased obviously at pH 8.0–9.0 relative to pH 6.0–7.0. Furthermore, the AAP were used in Qihe Artificial Wetland in Shandong Province, China. The results revealed that the average removal efficiencies of AAP for COD and NH₄⁺-N were 27.75 and 14.34%, respectively, in the artificial wetland. Therefore, AAP was beneficial to the growth of bacteria and could be used in the treatment of black-odor rivers.

https://ift.tt/2uOWgqA

Inhibition of 1, 4-dioxane on the denitrification process by altering the viability and metabolic activity of Paracoccus denitrificans

Abstract

1,4-Dioxane is an emerging pollutant, which widely exists in natural environments and poses potential risks to the living organisms. However, its effect on the denitrification process is still unknown. In this study, the effects of 1,4-dioxane on the denitrification process were therefore investigated by using Paracoccus denitrificans as the model denitrifier. The obtained results showed that the exposure of 1,4-dioxane exhibited remarkable lag or inhibition on the denitrification process, especially with high dose. In the control without 1,4-dioxane exposure, Paracoccus denitrificans showed high denitrification efficiency (98.5%). However, the efficiency decreased to 78.5, 63.9, and 9.3% with 0.50, 0.75, and 1.0% (v/v) 1,4-dioxane dose, respectively. The dose-induced inhibition of denitrification by 1,4-dioxane could be partially attributed to the negative effects on proliferation and viability of functional microorganisms by conjugating and disrupting the cell membranes. Furthermore, 1,4-dioxane caused biotoxicity to the intracellular activities of denitrifiers via disturbing carbon source utilization and interfering the key enzymes responsible for glycolysis. The decrease of microbial viability and activity inevitably resulted in the decline of key enzymes (NAR, NIR, NOR, and N₂OR) closely related with denitrification process, which could be the direct reason for the decrease of denitrification performance.

https://ift.tt/2LtVbif

Consultation diagnoses and procedures billed among recent graduates practicing general otolaryngology – head & neck surgery in Ontario, Canada

An analysis of the scope of practice of recent Otolaryngology – Head and Neck Surgery (OHNS) graduates working as general otolaryngologists has not been previously performed. As Canadian OHNS residency program...

https://ift.tt/2Lt657K

Absence of host NF-κB p50 induces murine glioblastoma tumor regression, increases survival, and decreases T-cell induction of tumor-associated macrophage M2 polarization

Abstract

High-grade gliomas harbor abundant myeloid cells that suppress anti-tumor immunity and support tumor growth. Targeting transcription factors, such as NF-κB p50, that mediate suppressive myeloid M2 polarization may prove therapeutic. GL261-Luc glioblastoma cells were inoculated into wild-type and p50^−/− mice, followed by analysis of tumor growth, survival, tumor myeloid cells, and T cells. The absence of host p50 slows tumor growth and enables regression in 30% of recipients, leading to prolonged survival. Tumors developing in p50^−/− mice possess a greater concentration of tumor-infiltrating myeloid cells (TIMs) than those in wild-type mice. TIMs are predominantly F4/80^hi macrophages which, along with tumor-associated microglia, express increased pro-inflammatory M1 and reduced immune-suppressive M2 markers. In p50^−/− mice, total tumor CD4 T cells are threefold more abundant, whereas CD8 T-cell numbers are unchanged, and both produce increased IFNγ and Granzyme B. Naïve splenic p50^−/− CD8 T cells manifest increased activation, whereas naïve p50^−/− and WT CD4 T cells show similar Th1, Th2, and Th17 polarization. Antibody targeting CD4, but not CD8, fully obviates the p50^−/− survival advantage. Combined CD4 and CD8 T-cell depletion reverses myeloid M2 polarization in wild-type hosts, without affecting myeloid M1 polarization in p50^−/− hosts. Finally, gliomas grow similarly in p50(f/f) and p50(f/f);Lysozyme-Cre mice, the latter having reduced p50 specifically in myeloid cells and tumor microglia. Thus, high-grade glioma T cells play a key role in directing M2 polarization of tumor myeloid cells, and reducing NF-κB p50 in both tumor myeloid cells and T cells may contribute to glioma therapy.

https://ift.tt/2O7Vmyb

Recurring acute urticaria and abdominal pain: Consider a diagnosis of alpha-galactose anaphylaxis

Publication date: Available online 20 July 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): A. Deschamps Huvier, F. Tetart, O. Bauvin, J. Martinet, P. Joly

Summary

Background

Food urticaria is common and generally benign, and it may be of viral or idiopathic aetiology. A food origin of the allergy is frequently sought but rarely found. Mammalian meat anaphylaxis, or alpha-galactose (α-gal) anaphylaxis, is a rare and recently discovered entity.

Patients and methods

Herein, we report a case of alpha-galactose (α-gal) anaphylaxis in a 60-year-old woman presenting four episodes of acute urticaria with signs of anaphylaxis occurring a few hours after meals containing mammalian meat (beef meat, pork meat and offal). The diagnosis was confirmed by a positive gelatine prick-test and the presence of α-gal IgE.

Discussion

In the event of acute urticaria associated with systemic symptoms, in particular gastrointestinal signs, allergy to α-galactose should be considered.

Résumé

Introduction

L'urticaire aiguë est fréquente et le plus souvent bénigne, d'étiologie virale ou idiopathique. Une origine allergique alimentaire est souvent cherchée et rarement trouvée. L'allergie aux viandes de mammifères, ou allergie à l'alpha-galactose (α-gal), est une entité rare de découverte récente.

Observation

Nous rapportons une observation d'allergie à l'α-galactose chez une femme de 60 ans ayant présenté quatre épisodes d'urticaire aiguë avec signes d'anaphylaxie apparus à distance des repas, après l'ingestion de viande de mammifères (viande de bœuf, viande et abats de porc). Le diagnostic a été confirmé par la positivité du prick-test à la gélatine et la présence d'IgE α-gal.

Discussion

Devant une urticaire aiguë associée à des symptômes systémiques, notamment signes digestifs, il faut savoir évoquer une allergie à l'α-galactose.

https://ift.tt/2NtVPtx

Th17 activation by dendritic cells stimulated with gamma-irradiated Streptococcus pneumoniae

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Hyun Young Kim, Sun Kyung Kim, Ho Seong Seo, Soyoung Jeong, Ki Bum Ahn, Cheol-Heui Yun, Seung Hyun Han

Abstract

Dendritic cells (DCs) play an important role in antigen presentation, which is an essential step for the induction of antigen-specific adaptive immunity. Inactivated bacterial whole cell vaccines have been widely used to prevent many bacterial infections because they elicit good immunogenicity due to the presence of various antigens and are relatively inexpensive and easy to manufacture. Recently, gamma-irradiated whole cells of nonencapsulated Streptococcus pneumoniae were developed as a broad-spectrum and serotype-independent multivalent vaccine. In the present study, we generated gamma-irradiated S. pneumoniae (r-SP) and investigated its capacity to stimulate mouse bone marrow-derived DCs (BM-DCs) in comparison with heat-inactivated and formalin-inactivated S. pneumoniae (h-SP and f-SP, respectively). r-SP showed an attenuated binding and internalization level to BM-DCs when compared to h-SP or f-SP. r-SP weakly induced the expression of CD80, CD83, CD86, MHC class I, and PD-L2 compared with h-SP or f-SP. Furthermore, r-SP less potently induced IL-6, TNF-α, and IL-23 expression than h-SP or f-SP but more potently induced IL-1β expression than h-SP or f-SP in BM-DCs. Since Th17-mediated immune responses are known to be important for the protection against pneumococcal infections, r-SP-primed DCs were co-cultured with splenocytes or splenic CD4⁺ T cells. Interestingly, r-SP-sensitized BM-DCs markedly induced IL-17A⁺ CD4⁺ T cells whereas h-SP- or f-SP-sensitized BM-DCs weakly induced them. Collectively, these results suggest that r-SP could be an effective pneumococcal vaccine candidate eliciting Th17-mediated immune responses by stimulation of DCs.

https://ift.tt/2JGrWUp

Harare children’s hospital airway symposium and pentafrica conference 2018

Publication date: Available online 20 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Clemence Chidziva, Titus Dzongodza, Cameline Nyamarebvu, Shazia Peer, Christopher Prescott, Naboth Matinhira, Peter J. Koltai

https://ift.tt/2NuuOGe

Urinary polycyclic aromatic hydrocarbons and allergic sensitization in a nationwide study of children and adults in the U.S.

Publication date: Available online 20 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Franziska Rosser, Yueh-Ying Han, Erick Forno, Juan C. Celedón

https://ift.tt/2Lo1uDT

Real-time cardiac MRI with radial acquisition and k-space variant reduced-FOV reconstruction

Publication date: Available online 20 July 2018

Source: Magnetic Resonance Imaging

Author(s): Yu Y. Li, Shams Rashid, Yang J. Cheng, William Schapiro, Kathleen Gliganic, Ann-Marie Yamashita, John Tang, Marie Grgas, Michelle Mendez, Elizabeth Haag, Jianing Pang, Bernd Stoeckel, Christianne Leidecker, Jie J. Cao

Abstract

This work aims to demonstrate that radial acquisition with k-space variant reduced-FOV reconstruction can enable real-time cardiac MRI with an affordable computation cost. Due to non-uniform sampling, radial imaging requires k-space variant reconstruction for optimal performance. By converting radial parallel imaging reconstruction into the estimation of correlation functions with a previously-developed correlation imaging framework, Cartesian k-space may be reconstructed point-wisely based on parallel imaging relationship between every Cartesian datum and its neighboring radial samples. Furthermore, reduced-FOV correlation functions may be used to calculate a subset of Cartesian k-space data for image reconstruction within a small region of interest, making it possible to run real-time cardiac MRI with an affordable computation cost. In a stress cardiac test where the subject is imaged during biking with a heart rate of >100 bpm, this k-space variant reduced-FOV reconstruction is demonstrated in reference to several radial imaging techniques including gridding, GROG and SPIRiT. It is found that the k-space variant reconstruction outperforms gridding, GROG and SPIRiT in real-time imaging. The computation cost of reduced-FOV reconstruction is ~2 times higher than that of GROG. The presented work provides a practical solution to real-time cardiac MRI with radial acquisition and k-space variant reduced-FOV reconstruction in clinical settings.

https://ift.tt/2LefcKv

Novel decision algorithm for the diagnosis of silicone gel breast implant ruptures

Abstract

Background

The main complications of breast implantation are caused by capsular contracture and implant rupture. Although the evaluation of implant rupture is primarily driven by patient symptoms, including change in breast shape, size, or firmness, most patients with breast implant rupture do not clinically manifest significant symptoms, thereby developing a so-called silent rupture. For all these reasons, its diagnosis generally relies on imaging techniques such as mammography, ultrasound, and magnetic resonance imaging.

Methods

We conducted a retrospective non-randomized study, carried out between March 2013 and August 2017. In this study, we evaluated 30 symptomatic patients who underwent mono or bilateral prosthetic breast reconstruction, a total of 51 implants after skin-sparing mastectomy or nipple-sparing mastectomy for breast cancer and following breast implant removal or replacement due to suspicious rupture or capsule contraction.

Results

Ultrasound suspected ruptures in 32/51 (62.7%) implants, while 19/51 implants resulted intact upon ultrasound examination. The sensitivity and specificity of ultrasound were 90 and 80% respectively. Magnetic resonance imaging suspected ruptures in 30/51 (58.8%) implants, while 21/51 (41.1%) implants resulted intact. The magnetic resonance imaging sensitivity and specificity were 87 and 85%, respectively.

Conclusions

Ultrasound evaluation may be the first level exam in case of suspicious symptomatic breast implant rupture. Importantly, our results demonstrate that magnetic resonance imaging could be avoided in all those cases where an extracapsular rupture has been diagnosed using ultrasound.

Level of Evidence: Level IV, diagnostic study.

https://ift.tt/2mvPgLr

Evaluating the OGG1 rs1052133 and rs293795 polymorphisms in a sample of rural workers from Central Brazil population: a comparative approach with the 1000 Genomes Project

Abstract

Brazilian population is one of the largest consumers of pesticides in the world, especially the Central Brazil population. Thus, the aim of this study was to evaluate the frequency of genotypes, alleles, haplotypes, and the linkage disequilibrium (DL) of the OGG1 gene in rural workers from Central Brazil, comparing with the populations of the 1000 genome. Three hundred thirty healthy individuals not related and randomly selected were included in this study. We obtained genomic DNA from peripheral blood lymphocytes. The 748-bp OGG1 gene was amplified by PCR and sequenced. Of the 330 individuals, 215 (65%) were males and 115 (35%) were females. There were no differences in the distribution of the rs1052133 and rs293795 with age and sexes. Haplotypes containing only conserved T/C alleles were the most common in our population. The frequency of the mutant alleles of rs1052133 and rs293795, in our population, was 20% and 30%, respectively, and it is noteworthy, worldwide, that mutant alleles are commonly associated to an increased risk for the development of cancer, specially due to direct or indirect contact to pesticides, as occurs in rural workers of Central Brazil population.

https://ift.tt/2LbI1XS

Case 22-2018: A 64-Year-Old Man with Progressive Leg Weakness, Recurrent Falls, and Anemia

Presentation of Case. Dr. Molly E. Wolf (Medicine): A 64-year-old man was admitted to this hospital because of progressive leg weakness, recurrent falls, and anemia. The patient had been in his usual state of health until 8 months before this admission, when fatigue on exertion and subjective leg…

https://ift.tt/2mwo67a

Case 21-2018: A 61-Year-Old Man with Grandiosity, Impulsivity, and Decreased Sleep

Presentation of Case. Dr. Samuel J. Boas (Psychiatry): A 61-year-old man was brought to the emergency department of this hospital by his family because of concerns about grandiosity, impulsivity, decreased sleep, and increased alcohol use. The patient had a history of alcohol-use disorder; he had…

https://ift.tt/2uuSrXi

CD4 T cell loss and Th2 and Th17 bias are associated with the severity of severe fever with thrombocytopenia syndrome (SFTS)

Publication date: Available online 20 July 2018

Source: Clinical Immunology

Author(s): Meng-Meng Li, Wen-Jing Zhang, Xiu-Fang Weng, Ming-Yue Li, Jia Liu, Yan Xiong, Shu-E Xiong, Cong-Cong Zou, Hua Wang, Meng-ji Lu, Dong-Liang Yang, Cheng Peng, Xin Zheng

Abstract

Severe fever with thrombocytopenia syndrome (SFTS) is a newly emerging infectious disease caused by a novel bunyavirus with high mortality. Immune suppression is thought to be crucial in disease progression. However, data on immune responses during SFTS are scarce. This study aimed to evaluate the changes in CD4 T-cell subsets throughout the entirety of infection and analyse their relationships with disease severity in SFTS patients. In parallel with CD4 T-cell depletion, decreased Th1, Th2 and Treg numbers, but comparable Th17-cell numbers, were observed in deceased patients compared with those in surviving patients. Additionally, increased Th2 and Th17-cell percentages in the residual CD4 T-cell population led to aberrant Th2/Th1 and Th17/Treg ratios, which were positively correlated with disease severity. Collectively, our data indicated that CD4 T-cell deficiency, Th2 and Th17 bias were closely correlated with the severity of SFTS, indicating therapeutic potential of early immune interventions to ameliorate disease severity.

https://ift.tt/2NxiLIb

Socioeconomics of Atopic Dermatitis-Can We Afford New Treatments?

To get a grasp of the socioeconomics of atopic dermatitis (AD), we need to understand its prevalence in the population, its burden, co-morbidities, and costs, both direct and indirect. Only then can we extrapolate whether it makes sense for society to cover new, more costly treatments in the management of this condition. AD affects a large percentage of the pediatric and adult population in the United States. 1 Generally, this chronic inflammatory condition of the skin has no mortality, which has to weigh into assessing the socioeconomics of this disorder.

https://ift.tt/2Nu47Bw

Atopic dermatitis in US adults - epidemiology, association with marital status and atopy

Atopic Dermatitis (AD) prevalence and risk factors in the US-population are not fully elucidated. A study from the 2010 National Health Interview Survey (NHIS) found that 10.2% of US adults reported having "dermatitis, eczema, or any other red, inflamed skin rash"1 in the past 12 months, likely overestimating AD prevalence by including other rashes. Further, 3.2% reported having rash with asthma and/or hay fever1, likely underestimating AD prevalence by excluding intrinsic AD or those with remote history of atopic disease.

https://ift.tt/2O6Jf4y

Differences in egg and milk food challenge outcomes based on tolerance to the baked form

Previous studies suggest inclusion of baked egg and milk in the diet of egg or cow's milk (CM) allergic children may positively impact native tolerance. Differences in native food reactivity based on historical baked tolerance, however, is not fully understood. Objective: To assess differences in native egg and CM oral food challenge (OFC) outcomes based on presenting history of tolerance and exposure to these foods in the baked form.

https://ift.tt/2NtATmn

Characterization of the mature form of a β-defensin-like peptide, Hoa-D1, in the lobster Homarus americanus

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Giap H. Vu, Daniel Do, Cindy D. Rivera, Patsy S. Dickinson, Andrew E. Christie, Elizabeth A. Stemmler

Abstract

We report on the characterization of the native form of an American lobster, Homarus americanus, β-defensin-like putative antimicrobial peptide, H. americanus defensin 1 (Hoa-D1), sequenced employing top-down and bottom-up peptidomic strategies using a sensitive, chip-based nanoLC-QTOF-MS/MS instrument. The sequence of Hoa-D1 was determined by mass spectrometry; it was found to contain three disulfide bonds and an amidated C-terminus. The sequence was further validated by searching publicly-accessible H. americanus expressed sequence tag (EST) and transcriptome shotgun assembly (TSA) datasets. Hoa-D1, SYVRScSSNGGDcVYRcYGNIINGAcSGSRVccRSGGGYamide (with c representing a cysteine participating in a disulfide bond), was shown to be related to β-defensin-like peptides previously reported from Panulirus japonicas and Panulirus argus. We found Hoa-D1 in H. americanus hemolymph, hemocytes, the supraoesophageal ganglion (brain), eyestalk ganglia, and pericardial organ extracts, as well as in the plasma of some hemolymph samples. Using discontinuous density gradient separations, we fractionatated hemocytes and localized Hoa-D1 to hemocyte sub-populations. While Hoa-D1 was detected in semigranulocytes and granulocytes using conventional proteomic strategies for analysis, the direct analysis of cell lysates exposed evidence of Hoa-D1 processing, including truncation of the C-terminal tyrosine residue, in the granulocytes, but not semigranulocytes. These measurements demonstrate the insights regarding post-translational modifications and peptide processing that can be revealed through the MS analysis of intact peptides. The identification of Hoa-D1 as a widely-distributed peptide in the lobster suggests the possibility that it may be pleiotropic, with functions in addition to its proposed role as an antimicrobial molecule in the innate immune system.

https://ift.tt/2zXiv3f

TGF-β activity in cow milk and fermented milk products: An in vitro bioassay with oral fibroblasts

Publication date: November 2018

Source: Archives of Oral Biology, Volume 95

Author(s): Layla Panahipour, Alexandra Stähli, Nadja Haiden, Reinhard Gruber

Abstract

Objective

Milk is a rich source of transforming growth factor (TGF)-β which supports intestinal mucosal homeostasis of infants. Milk may also have beneficial effects on the integrity of the oral cavity, its being part of the gastrointestinal tract. However, it is unclear if milk and fermented milk products provoke a TGF-β response in oral cells.

Material and Methods

Human gingival fibroblasts were exposed to pasteurized cow milk, yoghurt, sour milk, buttermilk and whey, followed by a reverse transcriptase polymerase chain reaction of the TGF-β target genes interleukin11 (IL11), proteoglycan4 (PRG4), and NADPH oxidase 4 (NOX4). Immunoassays were performed for IL11 and TGF-β in cell culture supernatant and milk products, respectively. Signaling was investigated with the TGF-β receptor type I kinase inhibitor SB431542.

Results

We report here that pasteurized cow milk and the aqueous fractions of yoghurt, sour milk, buttermilk and whey enhanced the expression of IL11, NOX4 and PRG4 in gingival fibroblasts. Moreover, IL11 protein levels in the respective supernatant were significantly increased. Cow milk, yoghurt, sour milk and buttermilk contain approximately 1–2 ng TGF-β1, whereas active TGF-β1 is hardly detectable in whey. SB431542 reduced the response of gingival fibroblasts to pasteurized cow milk and fermented milk products based on IL11 release into the supernatant.

Conclusions

These results demonstrate that gingival fibroblasts respond to pasteurized cow milk and to fermented milk products with an increased expression of TGF-β target genes.

https://ift.tt/2uAXqqk

The effect of intratympanic steroid injection frequency in idiopathic sudden sensorineural hearing loss

Publication date: Available online 20 July 2018

Source: American Journal of Otolaryngology

Author(s): Eric M. Sugihara, Michel A. Evans, Miles Neumann, Seilesh C. Babu

Abstract

Purpose

To evaluate the effect of intratympanic steroid injection frequency on hearing outcomes for patients with idiopathic sudden sensorineural hearing loss.

Materials and methods

A retrospective chart review was performed from 2007 to 2015 at a neurotology tertiary referral center. Adults who met academy criteria for idiopathic sudden sensorineural hearing loss within two months of onset and negative imaging were grouped based on injection frequency. Injection schedules were every 1–4 (group 1), 5–10 (group 2), or 11–30 (group 3) days. All patients had at least two injections with Dexamethasone 10 mg/ml. All patients had pre- and post-injection audiograms.

Results

Seventy patients met inclusion criteria (group 1, n = 21; group 2, n = 29; group 3, n = 20). There was no significant difference between group demographics or baseline audiometric data. Mean gains were significant and similar between groups for pure tone average (group 1 = −23.6 ± 22.0 dB; group 2 = −19.7 ± 18.4 dB; group 3 = −24.9 ± 24.7 dB; p = 0.67) and word recognition score (group 1 = +26.3 ± 34.8%; group 2 = +23.3 ± 29.9%; group 3 = +33.4 ± 28.9%; p = 0.53).

Conclusions

Frequency of intratympanic steroid injections does not significantly affect hearing outcomes. Following injection therapy, hearing outcomes improved regardless of prior or concomitant oral steroid regimen. Earlier time to initiating injections yielded a higher rate of hearing improvement. Long term hearing outcomes >6 months did not show significant additional improvement.

https://ift.tt/2NtY6EW

Van Wyk-Grumbach syndrome with hemangioma in an infant

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


https://ift.tt/2uR6p6e

Topical micronutrients in atopic dermatitis—An evidence‐based review

Dermatologic Therapy, EarlyView.


https://ift.tt/2NuFrJg

Highly‐focused ultrasound in non‐invasive body contouring: Long‐term follow‐up in Korean patients

Dermatologic Therapy, EarlyView.


https://ift.tt/2O6nkui

The 13th International Pan Arab League of Dermatology Conference Held Jointly with the Ninth Dermopolitan Congress Jordan at the Dead Sea, Jordan

Dermatologic Therapy, EarlyView.


https://ift.tt/2NuFm8q

Oral Isotretinoin for the treatment of Aripiprazol‐induced acneiform rash

Dermatologic Therapy, EarlyView.


https://ift.tt/2O3xBao

PDT and BF‐200 ALA: The therapy option for the treatment of Poikiloderma of Civatte

Dermatologic Therapy, EarlyView.


https://ift.tt/2NuFchk

10th International Conference of Jordanian Society of Dermatology, Venereology, Dermatosurgery & Laser, Amman, Kingdom of Jordan

Dermatologic Therapy, EarlyView.


https://ift.tt/2O6EgRx

Intralesional 5‐fluorouracil to treat extensive molluscum contagiosum in an immunocompromised patient: A novel therapeutic modality

Dermatologic Therapy, EarlyView.


https://ift.tt/2L9D2qE

Topical micronutrients in atopic dermatitis—An evidence‐based review

Dermatologic Therapy, EarlyView.


https://ift.tt/2NuFrJg

Highly‐focused ultrasound in non‐invasive body contouring: Long‐term follow‐up in Korean patients

Dermatologic Therapy, EarlyView.


https://ift.tt/2O6nkui

The 13th International Pan Arab League of Dermatology Conference Held Jointly with the Ninth Dermopolitan Congress Jordan at the Dead Sea, Jordan

Dermatologic Therapy, EarlyView.


https://ift.tt/2NuFm8q

Oral Isotretinoin for the treatment of Aripiprazol‐induced acneiform rash

Dermatologic Therapy, EarlyView.


https://ift.tt/2O3xBao

PDT and BF‐200 ALA: The therapy option for the treatment of Poikiloderma of Civatte

Dermatologic Therapy, EarlyView.


https://ift.tt/2NuFchk

10th International Conference of Jordanian Society of Dermatology, Venereology, Dermatosurgery & Laser, Amman, Kingdom of Jordan

Dermatologic Therapy, EarlyView.


https://ift.tt/2O6EgRx

Intralesional 5‐fluorouracil to treat extensive molluscum contagiosum in an immunocompromised patient: A novel therapeutic modality

Dermatologic Therapy, EarlyView.


https://ift.tt/2L9D2qE

Clinical features, diagnosis and therapy of pituicytoma: an update

Abstract

Background

Pituicytomas (PTs) are extremely rare, low-grade glial tumors closely related to the neurohypophyseal axis. Definite conclusions concerning the optimal diagnostic and therapeutic approach to these neoplasms are lacking to date, as most of this information has been presented as case reports.

Methods

Retrospective review of case reports published in the scientific literature to date, including a new illustrative example treated in our department.

Results

116 cases were collected. PTs had a higher prevalence in the fifth and sixth decades of life, with a slight male predominance. Main symptoms, which tended to be progressive, included visual field defects and pituitary–hypothalamic dysfunction. Radiologically, PTs were found anywhere along the hypothalamic–pituitary axis mimicking other, more frequent tumors growing in this anatomical region. Surgical treatment included both transcranial or transsphenoidal approaches, and resulted in gross total resection and morbidity rates of 46.8 and 59%, respectively; the latter essentially consisted in anterior and posterior pituitary dysfunction, with limited impact on daily quality of life.

Conclusions

Due to both low frequency and the absence of pathognomonic clinical and/or radiological features, formulating a suspicion diagnosis of PT represents a considerable challenge even for experienced professionals. The indication for treatment should be made on an individual basis, but it is inescapable in the presence of a visual field defect. The surgical approach has to be tailored according to the topography of the tumor and preoperative symptoms; the greatest challenges in accomplishing a gross total removal are represented by the degree of adherence and vascularization of the PT.

https://ift.tt/2LqiGsl

Scoring the tumor-stroma ratio in colon cancer: procedure and recommendations

Abstract

The tumor-stroma ratio (TSR) has been reported as a strong, independent prognostic parameter in colon cancer as well as in other epithelial cancer types, and may be implemented to routine pathology diagnostics. The TSR is an easy technique, based on routine hematoxylin and eosin stained histological sections, estimating the amount of stroma present in the primary tumor. It links tumors with high stromal content to poor prognosis. The analysis time is less than 2 min with a low inter-observer variation. Scoring of the TSR has been validated in a number of independent international studies. In this manuscript, we provide a detailed technical description of estimating the TSR in colon cancer, including examples, pitfalls, and recommendations.

https://ift.tt/2uRCx9w

Ein neu entwickeltes Biofeedbackprogramm zum Gesichtsmuskeltraining für Patienten mit Fazialisparese

Zusammenfassung

Hintergrund

Patienten mit einer Fazialisparese sind in ihrer Lebensqualität deutlich eingeschränkt. Ist kein irreversibler Nervenschaden erkennbar, wird zunächst neben einer medikamentösen Therapie mit Kortison ein intensives Training der Gesichtsmuskulatur empfohlen. Dazu haben die Autoren einen digitalen Biofeedbackspiegel mit Bewegungsverstärkung entwickelt, um das vegetative Nervensystem indirekt zu beeinflussen.

Fragestellung

Ziel dieser Arbeit war es, die Zuverlässigkeit des Biofeedbackprogramms im Vergleich zur klinischen Einteilung nach House-Brackmann zu evaluieren.

Methoden

Das Biofeedbacksystem ähnelt einem Spiegel und nutzt den Vorteil der Steigerung der körperlichen Selbstkontrolle. Es spiegelt nicht nur das Bild des Patienten wider, sondern potenziert die Bewegung durch Videoverarbeitung und eine Lupenfunktion. Die Gesichtsbewegungen des Patienten werden gefilmt und in Echtzeit verstärkt. Kleinste Bewegungen können sichtbar gemacht und gemessen werden, sodass der Patient ein direktes Feedback über Nervenregenerationen erhält. Dies kann die Motivation zum täglichen Gesichtsmuskeltraining steigern und die Compliance verbessern.

Ergebnisse

Die Einschränkung der Lebensqualität wurde mithilfe der Fragebögen Facial Clinimetric Evaluation Scale (FaCE) und Facial Disability Index (FDI) evaluiert und objektiviert und belegte, dass die Selbstwahrnehmung der Patienten mit einer schlechten Lebensqualität assoziiert war.

Schlussfolgerung

In der vorliegenden Studie zeigte die Messung der Gesichtsbewegungen eine gute Übereinstimmung mit der klinischen Einteilung nach House-Brackmann. Das Biofeedbacksystem ist eine zuverlässige Unterstützung im Rahmen der Regenerationsphase bei Patienten mit Fazialisparese.

https://ift.tt/2muWi39

Mechanics of antigen extraction in the B cell synapse

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Katelyn M. Spillane, Pavel Tolar

Abstract

B cell encounter with antigen displayed on antigen-presenting cells leads to B cell immune synapse formation, internalisation of the antigen, and stimulation of antibody responses. The sensitivity with which B cells detect antigen, and the quality and quantity of antigen that B cells acquire, depend upon mechanical properties of the immune synapse including interfacial tension, the strength of intermolecular bonds, and the compliance of the molecules and membranes that participate in antigen presentation. In this review, we discuss our current understanding of how these various physical parameters influence B cell antigen extraction in the immune synapse and how a more comprehensive understanding of B cell mechanics may promote the development of new approaches to stimulate the production of desired antibodies.

https://ift.tt/2Loi4ng

CD11c + MHCII lo GM-CSF-bone marrow-derived dendritic cells act as antigen donor cells and as antigen presenting cells in neoepitope-elicited tumor immunity against a mouse fibrosarcoma

Abstract

Dendritic cells play a critical role in initiating T-cell responses. In spite of this recognition, they have not been used widely as adjuvants, nor is the mechanism of their adjuvanticity fully understood. Here, using a mutated neoepitope of a mouse fibrosarcoma as the antigen, and tumor rejection as the end point, we show that dendritic cells but not macrophages possess superior adjuvanticity. Several types of dendritic cells, such as bone marrow-derived dendritic cells (GM-CSF cultured or FLT3-ligand induced) or monocyte-derived ones, are powerful adjuvants, although GM-CSF-cultured cells show the highest activity. Among these, the CD11c⁺ MHCII^lo sub-set, distinguishable by a distinct transcriptional profile including a higher expression of heat shock protein receptors CD91 and LOX1, mannose receptors and TLRs, is significantly superior to the CD11c⁺ MHCII^hi sub-set. Finally, dendritic cells exert their adjuvanticity by acting as both antigen donor cells (i.e., antigen reservoirs) as well as antigen presenting cells.

https://ift.tt/2zVunD7

Low-Level EMF Stimulation for Paroxysmal Atrial Fibrillation

Conditions:   Atrial Fibrillation;   Catheter Ablation;   Autonomic Imbalance
Interventions:   Device: Low-level Pulsed EMF;   Device: Sham Stimulation
Sponsor:   Daniel Sohinki
Not yet recruiting

https://ift.tt/2msMpD0

Study to Evaluate Safety & Tolerability of AGI-134 in Solid Tumour

Conditions:   Superficial, Palpable, Unresectable/Metastatic Solid Tumour;   Metastatic Colorectal Cancer;   Squamous Cell Carcinoma of the Head and Neck
Interventions:   Drug: AGI-134;   Drug: AGI-134 + Pembrolizumab
Sponsor:   Agalimmune Ltd.
Not yet recruiting

https://ift.tt/2uPn61K

A Study to Assess the Safety, Tolerability, Pharmacokinetics and Pharmacodynamics of AZD8233 in Healthy Male Subjects With Increased Elevated LDL-C Levels.

Condition:   Hypercholesterolemia
Intervention:   Drug: AZD8233
Sponsors:   AstraZeneca;   Parexel
Not yet recruiting

https://ift.tt/2mvStdR

Low-Level EMF Stimulation for Paroxysmal Atrial Fibrillation

Conditions:   Atrial Fibrillation;   Catheter Ablation;   Autonomic Imbalance
Interventions:   Device: Low-level Pulsed EMF;   Device: Sham Stimulation
Sponsor:   Daniel Sohinki
Not yet recruiting

https://ift.tt/2msMpD0

Study to Evaluate Safety & Tolerability of AGI-134 in Solid Tumour

Conditions:   Superficial, Palpable, Unresectable/Metastatic Solid Tumour;   Metastatic Colorectal Cancer;   Squamous Cell Carcinoma of the Head and Neck
Interventions:   Drug: AGI-134;   Drug: AGI-134 + Pembrolizumab
Sponsor:   Agalimmune Ltd.
Not yet recruiting

https://ift.tt/2uPn61K

A Study to Assess the Safety, Tolerability, Pharmacokinetics and Pharmacodynamics of AZD8233 in Healthy Male Subjects With Increased Elevated LDL-C Levels.

Condition:   Hypercholesterolemia
Intervention:   Drug: AZD8233
Sponsors:   AstraZeneca;   Parexel
Not yet recruiting

https://ift.tt/2mvStdR

Correction to: Age-specific reference values and cut-off points for anti-müllerian hormone in infertile women following a long agonist treatment protocol for IVF

Unfortunately, the first author name was incorrectly published in the original publication. The complete correct name should read as follows.

https://ift.tt/2LyrgSW

Arsenic forms in phytoextraction of this metalloid in organs of 2-year-old Acer platanoides seedlings

Abstract

The aim of the study was to estimate the significance of the role of arsenite (As(III)), arsenate (As(V)), and dimethylarsinic acid (DMA) presence in modified Knop medium in the efficiency of phytoextraction of arsenic (As) in Acer platanoides root, stem, and leaves. The addition of particular As forms in single, double, and triple experimental systems was associated with a lower increase of seedling biomass compared to control plants (system free of As forms addition). Depending on As forms and their concentration in solution, negative symptoms from slight visible changes (inorganic forms separately or jointly), through smaller and discolored leaves (after DMA addition), and finally to their withering (after high DMA addition) were observed. Changes of color and shape for root systems exposed to particular As forms separately or jointly were also observed, in spite of the fact that there were no significant changes in biomass of seedlings growing in all experimental systems. The highest mean concentrations of As in root, stem, and leaves (590, 70, and 140 mg kg⁻¹ dry weight (DW), respectively) were observed in plants growing under different experimental systems. The highest bioconcentration factor values were 10.8 for plants exposed to 0.06 mM of As(III) and DMA, while the highest translocation factor (1.0) was recorded for plants growing under the same As forms (0.6 and 0.06 mM, respectively). The obtained results indicate that the presence of particular As forms not only determines As phytoextraction and transport of this metalloid form but also has a decisive influence on plant morphology and survivability. As regards the practical aspects of phytoremediation, the kind of As forms present in substrate are more important than their total concentration.

https://ift.tt/2JFI0Wm

Atopic dermatitis in US adults - epidemiology, association with marital status and atopy

Publication date: Available online 20 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Tammy Hua, Jonathan I. Silverberg

https://ift.tt/2JEoqtI

Consultation diagnoses and procedures billed among recent graduates practicing general otolaryngology – head & neck surgery in Ontario, Canada

Abstract

Background

An analysis of the scope of practice of recent Otolaryngology – Head and Neck Surgery (OHNS) graduates working as general otolaryngologists has not been previously performed. As Canadian OHNS residency programs implement competency-based training strategies, this data may be used to align residency curricula with the clinical and surgical practice of recent graduates.

Methods

Ontario billing data were used to identify the most common diagnostic and procedure codes used by general otolaryngologists issued a billing number between 2006 and 2012. The codes were categorized by OHNS subspecialty. Practitioners with a narrow range of procedure codes or a high rate of complex procedure codes, were deemed subspecialists and therefore excluded.

Results

There were 108 recent graduates in a general practice identified. The most common diagnostic codes assigned to consultation billings were categorized as 'otology' (42%), 'general otolaryngology' (35%), 'rhinology' (17%) and 'head and neck' (4%). The most common procedure codes were categorized as 'general otolaryngology' (45%), 'otology' (23%), 'head and neck' (13%) and 'rhinology' (9%). The top 5 procedures were nasolaryngoscopy, ear microdebridement, myringotomy with insertion of ventilation tube, tonsillectomy, and turbinate reduction. Although otology encompassed a large proportion of procedures billed, tympanoplasty and mastoidectomy were surprisingly uncommon.

Conclusion

This is the first study to analyze the nature of the clinical and surgical cases managed by recent OHNS graduates. The findings demonstrated a prominent representation of 'otology', 'general' and 'rhinology' based consultation diagnoses and procedures. The data derived from the study needs to be considered as residency curricula are modified to satisfy competency-based requirements.

https://ift.tt/2uCq6zd

Dermoscopy of Cutaneous Lymphoproliferative Disorders: Where Are We Now?

The prompt identification of cutaneous lymphoproliferative disorders (CLD) has always been a challenge in dermatological practice, due to the rarity of this group of diseases, the heterogeneity in clinical presentation, and plenty of variants described in the literature so far. The strict cooperation between dermatologist and pathologist is the key element for the correct diagnosis of CLD deriving from the perfect integration of clinical and histopathological features. In this complex context, dermoscopy could play an adjuvant role in the achievement of the diagnosis, as it fits itself as the third diagnostic tool in the paraphernalia of the dermatologist between the clinical and histopathological examination. This review provides the state of art of dermoscopy of CLD.
Dermatology

https://ift.tt/2LoWWxk

Optic Neuritis Possibly Induced by Anti-PD-L1 Antibody Treatment in a Patient with Non-Small Cell Lung Carcinoma

Background: Recent immune therapy with checkpoint inhibitors (CPIs) has demonstrated remarkable antitumor effects on specific tumors, such as malignant lymphoma and non-small cell lung carcinoma. By contrast, CPIs cause an imbalance in the immune system, triggering a wide range of immunological side effects termed immune-related adverse effects (irAEs). Here, we report a rare case of optic neuritis and hypopituitarism during anti-programmed death-ligand 1 (PD-L1) antibody treatment. Case Presentation: A patient with non-small cell lung carcinoma received anti-PD-L1 antibody treatment every 3 weeks; however, the patient started experiencing headaches, general fatigue, anorexia, and diarrhea approximately 1 year after the initiation of the treatment. Moreover, sudden visual loss of the right eye occurred 1 week after the interruption of the anti-PD-L1 antibody treatment. MRI findings showed gadolinium enhancement in the left optic nerve, but no enlargement of the pituitary gland and stalk. Laboratory data showed decreased serum adrenocorticotropic hormone (ACTH), cortisol, and free T₄ levels, and a hormone tolerance test indicated hypopituitarism, hypothyroidism, and hypoadrenocorticism. The central scotoma caused by optic neuritis completely disappeared immediately after a course of steroid pulse therapy, and no recurrence occurred up to 2 years after initiation of the steroid pulse therapy while replacement therapy for hypothyroidism and hypoadrenocorticism was continued. Conclusions: The patient presented with optic neuritis and hypopituitarism, possibly due to irAEs of the anti-PD-L1 antibody treatment. Steroid pulse therapy was effective for optic neuritis, suggesting underlying immunological mechanisms. Neurological complications including optic neuritis should be considered when examining patients with cancer undergoing CPI treatment.
Case Rep Ophthalmol 2018;9:348–356

https://ift.tt/2muLfaf

The 10 fundamental principles of lay resuscitation: Recommendations by the German Resuscitation Council

No abstract available

https://ift.tt/2Lrmx8w

The 10 fundamental principles of lay resuscitation: Recommendations by the German Resuscitation Council

No abstract available

https://ift.tt/2Lrmx8w

Anatomical Study of Percutaneous Trigeminal Compressive Balloon Positioning on Merged 3-D Rotational X-Ray and Preprocedural Magnetic Resonance Imaging

Background: Percutaneous trigeminal rhizotomy or balloon compression for trigeminal neuralgia carries a potential risk for the brainstem, the carotid artery, and the basilar artery. Objective: To detail the relation of critical neural and vascular structures to expanded balloons used for percutaneous compression of the trigeminal ganglion. Method: A retrospective analysis of preprocedural magnetic resonance imaging (MRI) and procedural X-ray-based imaging for 9 patients detailed balloon proximity to the brainstem, carotid artery, and basilar artery. Results: Balloons extended 10.96 ± 5.54 mm (mean ± SD) posterior to the clival line. The average distance from the balloon to the brainstem was 6.89 mm, and that to the basilar artery was 12.12 mm (range: 0–18.2). The medial edge of the balloon was an average distance of 1.39 mm from the baseline position of the carotid lumen. Conclusion: Preprocedural MRI, merged with 3-D rotational angiography suite imaging, detailed the proximity of the balloon to critical neural and vascular structures. Our study found that the standard technique for percutaneous trigeminal compression, with balloon placement at an average depth of 10.96 mm posterior to the clival line, on average, provided an additional 6.89 mm of space before the brainstem would have been encountered, demonstrating safe positioning.
Stereotact Funct Neurosurg

https://ift.tt/2uOcrEt

Radiotherapy, tumor mutational burden, and immune checkpoint inhibitors: time to do the math

https://ift.tt/2L9Vv6h

Protective effects of SIRT6 against lipopolysaccharide (LPS) are mediated by deacetylation of Ku70

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Lin Zhang, Li Bai, Qihui Ren, Guohui Sun, Yajing Si

Abstract

Progression of pulpitis is facilitated by the immune system's response to bacteria, enhancing the production of inflammatory regulators. Bacterial lipopolysaccharide (LPS) is the major structural component of the outer wall of all Gram-negative bacteria and a potent activator of the immune system. Apoptosis is believed to play an important role in the inflammatory process of pulpitis. SIRT6 is a member of class III of histone deacetylases (HDACs), also called sirtuins (SIRTs). The role of SIRT6 in apoptosis in pulpitis is unknown. In this study, we found that the expression of SIRT6 in human dental pulp cells (hDPCs) was down-regulated by treatment with LPS. MTT and LDH assays revealed that overexpression of SIRT6 in hDPCs attenuated cell death induced by LPS. Consistently, our results demonstrated that SIRT6 was able to protect hDPCs from apoptosis. We found that SIRT6 could interact with Ku70, an important apoptosis regulator, by the immunoprecipitation (IP) experiment. SIRT6 physically binds to Ku70. Overexpression of SIRT6 reduced acetylation of Ku70 and promoted interaction of Ku70 with the proapoptotic protein Bax. These studies underscore an essential role of SIRT6 in the survival of hDPCs in stress situations.

https://ift.tt/2uO80JP

HMBOX1 in hepatocytes attenuates LPS/D-GalN-induced liver injury by inhibiting macrophage infiltration and activation

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Hengli Zhao, Qiuju Han, Nan Lu, Dongqing Xu, Zhigang Tian, Jian Zhang

Abstract

The HMBOX1 (Homeobox Containing 1) gene was first isolated from the human pancreatic cDNA libraries and is widely expressed in many tissues. Previously, we detected high expression of HMBOX1 in the liver, but its function was unclear. In this study, hepatocyte-specific HMBOX1 knockout mice (Hm^△hep mice) were generated and used to characterize the function of HMBOX1 in the LPS/D-GalN-induced acute liver failure model. HMBOX1-knockout exhibits exacerbated liver injury induced by LPS/D-GalN, accompanied with high levels of inflammatory cytokines both in the liver and in circulation. Further investigation demonstrated that HMBOX1 negatively regulates NF-κB signal transduction. Therefore, HMBOX1-knockout in hepatocytes promotes CCL2 expression through the activation of NF-κB signaling, which enhanced the infiltration of macrophages into the liver. In addition, the decrease of HMBOX1 in hepatocytes promotes the activation of macrophages, upregulating CD80 and MHCⅡ, as well as inflammatory factors TNF-α and IL-6. Importantly, overexpression of HMBOX1 rescued liver injury in Hm^△hep mice. These findings indicate that HMBOX1 in hepatocytes acts as a key immunosuppressive factor for inflammation and plays a critical protective role in LPS/D-GalN-induced liver injury.

https://ift.tt/2LmeSbF

Polymorphisms in the DAD1 and OXA1L genes are associated with asthma and atopy in a South American population

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Anaque de Oliveira Pires, Gerson de Almeida Queiroz, Milca de Jesus Silva, Raimon Rios da Silva, Hugo Bernardino Ferreira da Silva, Norma Vilany Queiroz Carneiro, Héllen Freitas Fonseca, Maria Borges Rabelo de Santana, Regina Santos Nascimento, Neuza Maria Alcântara-Neves, Gustavo Nunes de Oliveira Costa, Ryan dos Santos Costa, Maurício L. Barreto, Camila Alexandrina Figueiredo

Abstract

Atopic asthma, which is characterized by the chronic inflammation and morbidity of airways, is a disease of great complexity, and multiple genetic and environmental factors are involved in its etiology. In the first genome-wide association study (GWAS) conducted in Brazil for asthma, a positive association was found between atopic asthma and a variant (rs1999071), which is located between the DAD1 and OXA1L genes, although neither gene has previously been reported to be associated with asthma or allergies. The DAD1 gene is involved in the regulation of programmed cell death, and OXA1L is involved in biogenesis and mitochondrial oxidative phosphorylation. This study aimed to evaluate how polymorphisms in DAD1 and OXA1L are associated with asthma and markers of atopy in individuals from the Salvador cohort of the SCAALA (Social Change Asthma and Allergy in Latin America) program. The DNA of 1220 individuals was genotyped using the Illumina 2.5 Human Omni Bead chip. Logistic regression analyses were performed with PLINK 1.9 software to verify the association between DAD1 and OXA1L polymorphisms and asthma and atopic markers, adjusted for sex, age, helminth infections and ancestry markers, using an additive model. The DAD1 and OXA1L genes were associated with some of the evaluated phenotypes, such as asthma, skin prick test (SPT), specific IgE for aeroallergens, and Th1/Th2-type cytokine production. Using qPCR, as well as in silico gene expression analysis, we have demonstrated that some of the polymorphisms in both genes are able to affect their respective gene expression levels. In addition, DAD1 was over-expressed in asthmatic patients when compared with controls. Thus, our findings demonstrate that variants in both the DAD1 and OXA1L genes may affect atopy and asthma in a Latin American population with a high prevalence of asthma.

https://ift.tt/2uM64BH

Regenerative Medicine 3.TX: What Can We Learn About Organ Regeneration From Organ Replacement

No abstract available

https://ift.tt/2LBCs1f

A clinical decision support system can help facilitate living kidney donor assessments

No abstract available

https://ift.tt/2LalnPt

Deep Profiling of the CD8+ T cell Compartment identifies Activated cell subsets and Multifunctional Responses Associated with Control of Cytomegalovirus Viremia

Background Human cytomegalovirus (HCMV) is a common opportunistic pathogen in transplant recipients. Patterns of viremia and reactivation are influenced by the host immune response, including CD8+ T cells. However, the cellular deficits or phenotypic differences that account for differential outcomes during HCMV viremia are incompletely understood. Methods PBMCs were collected from 20 transplant recipients (10 viremia controllers and 10 noncontrollers) at onset of HCMV viremia and 4-weeks post. We utilized mass cytometry to perform in-depth characterization of cell-surface and intracellular CD8+ T cell markers and to compare frequencies of these cells between groups. Results Deep profiling identified 2 TCM subsets at onset and 5 TEMRA subsets at 4 weeks that were associated with control of HCMV viremia, in addition to 6 TEMRA subsets at onset and 4 weeks associated with relapsing or remitting HCMV viremia. In general, CD8+ T cell clusters associated with poorly controlled HCMV viremia lacked markers of activation or terminal differentiation including CD38, CD69, CD25, CD57 and HLA-DR. We also measured the production of 8 HCMV-specific effector molecules (TNFα, IFNγ, IL2, granzyme B, perforin, MIP1β, IL10 and CD107a) in CD8+ T cells. Viremia controllers had greater diversity of HCMV-specific multi-functional responses at both time points, including significantly higher frequencies of HCMV-specific TNFα+IFNγ+ CD8+ T cells at onset. These multifunctional cells had a phenotype consistent with activated TEM/TEMRA cells. Conclusions Uncontrolled CMV viremia is associated with specific clusters of memory T cell subsets and lower frequencies of HCMV-specific multifunctional CD8+ T cells. *Indicates joint senior authorship. Corresponding Author: Atul Humar MD MSc FRCPC, PMB 11-175, 585 University Avenue, Toronto, Canada M5G 2N2; tel: (416) 340-4241; fax (416) 340-4043; email: atul.humar@uhn.ca AUTHORSHIP PAGE Authors: Victor H. Ferreira – victor.ferreira@uhnresearch.ca Deepali Kumar – deepali.kumar@uhn.ca Atul Humar – atul.humar@uhn.ca Author Contributions: V.H.F. - participated in performance of the research, data analysis, and writing of the paper. D.K. – participated in research design, data interpretation, data collection, and writing of the paper. A.H. – participated in research design, data interpretation, data collection, and writing of the paper. Disclosure: A.H. has received a research grant from Roche and Qiagen, consulting fees from Astellas and Chimerix. D.K. has received research grants from Roche, Qiagen and Oxford Immunotec and consulting fees from Qiagen and Oxford Immunotec. Funding: This study was funded by the Canadian National Transplant Research Program (CNTRP). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2LBCk1L

Development of a clinical decision support system for living kidney donor assessment based on national guidelines

Background Live donor nephrectomy is an operation that places the donor at risk of complications without the possibility of medical benefit. Rigorous donor selection and assessment is therefore essential to ensure minimisation of risk and for this reason robust national guidelines exist. Previous studies have demonstrated poor adherence to donor guidelines. Methods We developed a clinical decision support system (CDSS), based upon national living donor guidelines, to facilitate the identification of contraindications, additional investigations, special considerations and the decision as to nephrectomy side in potential living donors. The CDSS was then tested with patient data from 45 potential kidney donors. Results The CDSS comprises 17 core tasks completed by either patient or nurse, and 17 optional tasks that are triggered by certain patient demographics or conditions. Decision rules were able to identify contraindications, additional investigations, special considerations and predicted operation side in our patient cohort. 17/45 patients went on to donate a kidney, of whom 7 had major contraindications defined in the national guidelines, many of which were not identified by the clinical team. Only 43% of additional investigations recommended by national guidelines were completed, with the most frequently missed investigations being oral glucose tolerance testing and routine cancer screening. Conclusions We have demonstrated the feasibility of turning a complex set of national guidelines into an easy-to-use machine-readable CDSS. Comparison with real-world decisions suggests that use of this CDSS may improve compliance with guidelines and informed consent tailored to individual patient risks. Corresponding Author, Mr Simon R Knight, Senior Clinical Lecturer and Honorary Consultant Transplant Surgeon, Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Churchill Hospital, Old Road, Oxford OX3 7LE. Tel: +44 1865 227 131, Mob: +44 7909 921 103. E-mail: simon.knight@nds.ox.ac.uk Authorship All authors made a significant contribution to the content of this manuscript, as per ICMJE recommendations. SRK conceived the study idea, participated in study design, provided clinical input to the decision support system (CDSS), coded the CDSS, entered and analysed patient data and wrote the manuscript. KNC participated in study design, coded the clinical decision support system and reviewed the manuscript. MS participated in study design, developed the openclinical.net platform, advised on the technical development of the clinical decision support system, provided the tools required for data analysis and reviewed the manuscript. NH provided clinical input to the content of the clinical decision support system and reviewed the manuscript JPH participated in study design, provided clinical input to the content of the clinical decision support system and reviewed the manuscript JF developed the openclinical.net concept, participated in study design, advised on the technical development of the clinical decision support system and reviewed the manuscript. Disclosures JF is a shareholder and Chief Scientific Officer of Deontics Ltd., a commercial company that makes use of the technologies described in this paper. He is also a cofounder of OpenClinical CIC. MS is a cofounder of both Deontics Ltd and OpenClinical CIC. KNC is a Medical AI advisor for OpenClinical CIC. SK, JH and NH have no conflicts of interest in relation to this work. Funding This work did not receive funding from any external sources. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2L8xoVD

Rethinking Regenerative Medicine From a Transplant Perspective (and Vice Versa)

No field in health sciences has more interest than organ transplantation in fostering progress in regenerative medicine (RM) because the future of no other field more than the future of organ transplantation will be forged by progress occurring in RM. In fact, the most urgent needs of modern transplant medicine - namely, more organs to satisfy the skyrocketing demand and immunosuppression-free transplantation -, cannot be met in full with current technologies and are at risk of remaining elusive goals. Instead, in the past few decades, groundbreaking progress in RM is suggesting a different approach to the problem. New, RM-inspired technologies among which decellularization, 3D printing and interspecies blastocyst complementation, promise organoids manufactured from patients' own cells and bear potential to render the use of currently used allografts obsolete. Transplantation, a field that has traditionally been immunology-based, is therefore destined to become a RM-based discipline. However, the contours of RM remain unclear, mainly due to the lack of a universally accepted definition, the lack of clarity of its potential modalities of application and the unjustified and misleading hype that often follows the reports of clinical application of RM technologies. All this generates excessive and unmet expectations and an erroneous perception of what RM really is and can offer. In this manuscript, we will (i) discuss these aspects of RM and transplant medicine, (ii) propose a definition of RM, and (iii) illustrate the state of the art of the most promising RM-based technologies of transplant interest. Disclosure: authors have no conflicts of interest to disclose Authorship Giuseppe Orlando conceived the work and the design of the manuscript, was responsible for its undertaking and completion, wrote the introduction, the paragraph on decellularization technology and the conclusions and approved the final draft Sean Murphy participated to the design of the manuscript, wrote the part on 3D printing and approved the final draft Benedetta Bussolati participated to the design of the manuscript, wrote the part on stem cells, regeneration and blastocyst complementation, and approved the final draft Marc Clancy participated to the design of the manuscript, wrote the part on ischemia-reperfusion and approved the final draft Paolo Cravedi wrote the part on the regenerative immunology. and approved the final draft Giovanni Migliaccio wrote the part on product development and translation, and approved the final draft Patricia Murray participated to the design of the manuscript, wrote the part on stem cells, regeneration and blastocyst complementation, and approved the final draft Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2LBrsk7

Production of a mouse monoclonal IgM antibody that targets the carbohydrate Thomsen-nouveau cancer antigen resulting in in vivo and in vitro tumor killing

Abstract

The construction of a tumor-associated carbohydrate antigen-zwitterionic polysaccharide conjugate, Thomsen-nouveau-polysaccharide A1 (Tn-PS A1, where Tn = d-GalpNAc), has led to the development of a carbohydrate binding monoclonal antibody named Kt-IgM-8. Kt-IgM-8 was produced via hybridoma from Tn-PS A1 hyperimmunized Jackson Laboratory C57BL/6 mice, splenocytes and the murine myeloma cell line Sp2/0Ag14 with subsequent cloning on methyl cellulose semi-solid media. This in-house generated monoclonal antibody negates binding influenced from peptides, proteins, and lipids and preferentially binds monovalent Tn antigen as noted by ELISA, FACS, and glycan array technologies. Kt-IgM-8 demonstrated in vitro and in vivo tumor killing against the Michigan Cancer Foundation breast cell line 7 (MCF-7). In vitro tumor killing was observed using an LDH assay that measured antibody-induced complement-dependent cytotoxicity and these results were validated in an in vivo passive immunotherapy approach using an MCF-7 cell line-derived xenograft model. Kt-IgM-8 is effective in killing tumor cells at 30% cytotoxicity, and furthermore, it demonstrated approximately 40% reduction in tumor growth in the MCF-7 model.

https://ift.tt/2uCgGnj

Small bowel perforation due to an adhesion ruptured by peritoneal insufflation

Abstract

Background:Despite the widespread use of laparoscopic cholecystectomy, technical complications unique to the laparoscopic approach may lead to significant postoperative morbidity and mortality. Case report: We report the first published case of small bowel fistula due to peritoneal insufflation that broke a thin string adhesion between the peritoneal wall and a jejunal segment, which lead to a focal perforation in a 75-year-old woman. Leakage of enteric fluid through the umbilical scar indicated this adverse event during the early postoperative period. The patient was immediately and successfully treated with a suture of the intestinal lesion. Conclusion: Peritoneal insufflation induced for laparoscopic procedures may break abdominal adhesions and lead to organs and vascular injuries, including small bowel perforation.

https://ift.tt/2JDcA38

Small bowel obstruction SBO after TAPP repair caused by a self-anchoring barbed suture device for peritoneal closure: case report

Abstract

A 50-year-old man underwent laparoscopic hernia repair for a groin hernia, presenting acute abdominal pain and bowel obstruction syndrome 1 day post surgery. Diagnostic laparoscopy was performed at postoperative the day after the hernioplasty and a volvulus was found. The residual end of the barbed V-LOC adopted in the peritoneal closure was incidentally hooked to the mesentery and caused a small bowel obstruction as a volvulus. The redundant V-LOC strand was released and cut superficial to the peritoneum. A detorsion of volvulus was preformed. Neither bowel ischemia nor significant bowel injury was noted. The following day he was discharged without complication. The residual 'free' barbel suture in the peritoneal cavity invited adhesion formations and subsequently the Bowel obstruction.

https://ift.tt/2Lrizgq