Chronic low back pain: a mini-review on pharmacological management and pathophysiological insights from clinical and pre-clinical data

Abstract

Globally, low back pain (LBP) is one of the most common health problems affecting humans. The lifetime prevalence of non-specific LBP is approximately 84%, with the chronic prevalence at about 23%. Chronic LBP in humans is defined as LBP that persists for more than 12 weeks without a significant pain improvement. Although there are numerous evidence-based guidelines on the management of acute LBP, this is not the case for chronic LBP, which is regarded as particularly difficult to treat. Research aimed at discovering new drug treatments for alleviation of chronic mechanical LBP is lacking due to the paucity of knowledge on the pathobiology of this condition, despite its high morbidity in the affected adult population. For a debilitating condition such as chronic LBP, it is necessary to assess the sustained effects of pharmacotherapy of various agents spanning months to years. Although many rodent models of mechanical LBP have been developed to mimic the human condition, some of the major shortcomings of many of these models are (1) the presence of a concurrent neuropathic component that develops secondary to posterior intervertebral disc puncture, (2) severe model phenotype, and/or (3) use of behavioural endpoints that have yet to be validated for pain. Hence, there is a great, unmet need for research aimed at discovering new biological targets in rodent models of chronic mechanical LBP for use in drug discovery programs as a means to potentially produce new highly effective and well-tolerated analgesic agents to improve relief of chronic LBP. On a cautionary note, it must be borne in mind that because humans and rats display orthograde and pronograde postures, respectively, the different mechanical forces on their spines add to the difficulty in translation of promising rodent data to humans.

The potential accumulation of polycyclic aromatic hydrocarbons in phytoplankton and bivalves in Can Gio coastal wetland, Vietnam

Abstract

Polycyclic aromatic hydrocarbons (PAHs) are one of the most important classes of anthropogenic persistent organic contaminants in the marine environment. This review discusses a whole range of findings that address various aspects of the bioaccumulation of PAHs in two common marine biota (phytoplankton and bivalves) globally and especially for Can Gio coastal wetland, Vietnam. The published information and collected data on the bioconcentration and accumulation mechanisms of PAHs as well as implications for Can Gio coastal wetland are compiled for phytoplankton and bivalves. PAHs are still released to Can Gio coastal environments from various sources and then transported to coastal environments through various physical processes; they may enter marine food chains and be highly accumulated in phytoplankton and bivalves. Thus, PAHs' bioaccumulation should be considered as one important criterion to assess the water's quality, directly linked to human health due to seafood consumption. Ecologically, Can Gio coastal wetland plays an important role to the South Vietnam key economic zone. However, it is also an area of potential PAHs inputs. With the abundant phytoplankton and bivalves in Can Gio coastal wetland, the PAHs bioaccumulation in these biota is inevitably detected. Thus, further study on the bioavailability of these contaminants is urgently needed in order to mitigate their negative effects and protect the ecosystems.

Elucidation of contamination sources for poly- and perfluoroalkyl substances (PFASs) on Svalbard (Norwegian Arctic)

Abstract

A combination of local (i.e. firefighting training facilities) and remote sources (i.e. long-range transport) is assumed to be responsible for the occurrence of per- and polyfluoroalkyl substances (PFASs) in Svalbard (Norwegian Arctic). However, no systematic elucidation of local PFASs sources has been conducted yet. Therefore, a survey was performed aiming at identifying local PFAS pollution sources on the island of Spitsbergen (Svalbard, Norway). Soil, freshwater (lake, draining rivers), seawater, meltwater run-off, surface snow and coastal sediment samples were collected from Longyearbyen (Norwegian mining town), Ny-Ålesund (research facility) and the Lake Linnévatnet area (background site) during several campaigns (2014–2016) and analysed for 14 individual target PFASs. For background site (Linnévatnet area, sampling during April to June 2015), ΣPFAS levels ranged from 0.4 to 4 ng/L in surface lake water (n = 20). PFAS in meltwater from the contributing glaciers showed similar concentrations (~ 4 ng/L, n = 2). The short-chain perfluorobutanoate (PFBA) was predominant in lake water (60–80% of the ΣPFASs), meltwater (20–30%) and run-off water (40%). Long-range transport is assumed to be the major PFAS source. In Longyearbyen, five water samples (i.e. 2 seawater, 3 run-off) were collected near the local firefighting training site (FFTS) in November 2014 and June 2015, respectively. The highest PFAS levels were found in FFTS meltwater run-off (118 ng/L). Perfluorooctane sulfonic acid (PFOS) was the most abundant compound in the FFTS meltwater run-off (53–58% PFASs). At the research station Ny-Ålesund, seawater (n = 6), soil (n = 9) and freshwater (n = 10) were collected in June 2016. Low ΣPFAS concentrations were determined for seawater (5–6 ng/L), whereas high ΣPFAS concentrations were found in run-off water (113–119 ng/L) and soil (211–800 ng/g dry weight (dw)) collected close to the local FFTS. In addition, high ΣPFAS levels (127 ng/L) were also found in freshwater from lake Solvatnet close to former sewage treatment facility. Overall, at both FFTS-affected sites (soil, water), PFOS was the most abundant compound (60–69% of ΣPFASs). FFTS and landfill locations were identified as major PFAS sources for Svalbard settlements.

Effect of foliar-applied iron complexed with lysine on growth and cadmium (Cd) uptake in rice under Cd stress

Abstract

Contamination of soils with cadmium (Cd) is a serious problem worldwide. Rice (Oryza sativa L.) is reported to accumulate relatively higher Cd contents in consumable parts and is considered a main source of Cd toxicity to humans from rice-derived products. The aim of this pot trial was to investigate the effect of foliar-applied iron (Fe) complexed with lysine on growth, photosynthesis, Cd concentration in plants, oxidative stress, and activities of antioxidants of rice in soil contaminated with Cd. Rice seedlings (30-day-old) were transferred to the soil, and after 2 weeks, different concentrations of Fe-lysine (0, 1.5, 3.0, 4.5, 6.0, and 7.5 mg L⁻¹) were applied as a foliar spray once in a week for 4 weeks and plant samples were taken after 10 weeks of growth in the soil under ambient conditions. Foliar supply of Fe-lysine complex significantly enhanced the plant height, dry weights of plants, concentration of chlorophyll, and gas exchange attributes in Cd-stressed rice. Fe-lysine decreased the Cd concentrations in plants while increasing the Fe concentrations in rice seedlings being maximum with Fe-lysine of 6.0 mg L⁻¹. Electrolyte leakage decreased while activities of key antioxidant enzymes increased with Fe-lysine compared to the control. According to the present results, Fe-lysine complex can effectively be used to reduce Cd concentrations in rice and probably in other crop species.

Effect of Pseudomonas fluorescens and pyoverdine on the phytoextraction of cesium by red clover in soil pots and hydroponics

Abstract

With the aim of improving the phytoextraction rate of cesium (Cs), the effect of Pseudomonas fluorescens ATCC 17400 and its siderophore pyoverdine (PVD) on the uptake of Cs by red clover was studied in soil pots. This work also provides a mechanistic understanding of the Cs-bacteria (or PVD)-illite-plant interactions by using a simplified experimental design, i.e., hydroponics with either Cs in solution or Cs-spiked illite in suspension. For soil spiked with 11.2 mmol kg⁻¹ (1480 mg kg⁻¹) of Cs, 0.43% of total Cs was taken up by red clover in 12 days (119 μmol g⁻¹ (16 mg g⁻¹) of Cs dry matter in roots and 40 μmol g⁻¹ (5 mg g⁻¹) in shoots). In hydroponics with Cs in solution (0.1 mmol L⁻¹ or 13 mg L⁻¹), 75% of Cs was taken up vs. only 0.86% with Cs-spiked illite suspension. P. fluorescens and PVD did not increase Cs concentrations in aboveground parts and roots of red clover and even decreased them. The damaging effect of PVD on red clover growth was demonstrated with the biomass yielding 66% of the control in soil pots (and 100% mortality after 12 days of exposition) and only 56% in hydroponics (78% with illite in suspension). Nonetheless, PVD and, to a lesser extent, P. fluorescens increased the translocation factor up to a factor of 2.8. This study clearly showed a direct damaging effect of PVD and to a lower extent the retention of Cs by biofilm covering both the roots and illite, both resulting in the lower phytoextraction efficiency.

Lead exposure is associated with risk of impaired coagulation in preschool children from an e-waste recycling area

Abstract

Environmental lead exposure leads to various deleterious effects on multiple organs and systems, including the hematopoietic system. To explore the effects of lead exposure on platelet indices in preschool children from an informal, lead-contaminated electronic waste (e-waste) recycling area, we collected venous blood samples from 466 preschool children (331 from an e-waste area (Guiyu) and 135 from a non-e-waste area (Haojiang)). Child blood lead levels (BLLs) were determined by graphite furnace atomic absorption spectrophotometry, while platelet indices were quantified using a Sysmex XT-1800i hematology analyzer. Higher blood lead levels are observed in e-waste lead-exposed preschool children. Significant relationships between high blood lead levels (exceeding current health limits) and elevated platelet count (PLT), plateletcrit (PCT), mean platelet volume (MPV), and platelet large cell ratio (P-LCR) were also uncovered. Furthermore, the median PLT and PCT levels of children from the exposed group both exceeded the respective recommended maximum reference range value, whereas the reference group did not. Location of child residence in Guiyu and BLLs were both risk factors related to platelet indices. These results suggest that high blood lead exposure from e-waste recycling may increase the risk of an amplified coagulation process through the activation of platelets in preschool children.

The Janus head of Bachelard’s phenomenotechnique: from purification to proliferation and back

Abstract

The work of Gaston Bachelard is known for two crucial concepts, that of the epistemological rupture and that of phenomenotechnique. A crucial question is, however, how these two concepts relate to one another. Are they in fact essentially connected or must they be seen as two separate elements of Bachelard's thinking? This paper aims to analyse the relation between these two Bachelardian moments and the significance of the concept of phenomenotechnique for today. This will be done by examining certain historical uses of the concepts of Bachelard have been used from the 1960s on. From this historical perspective, one gets the impression that these two concepts are relatively independent from each other. The Althusserian school has exclusively focused on the concept of 'epistemological break', while scholars from Science & Technology Studies (STS), such as Bruno Latour, seem to have only taken up the concept of phenomenotechnique. It in fact leads to two different models of how to think about science, namely the model of purification and the model of proliferation. The former starts from the idea that sciences are rational to the extent that they are purified and free from (epistemological) obstacles. Scientific objectivity, within this later model, is not achieved by eradicating all intermediaries, obstacles and distortions, but rather exactly by introducing as many relevant technical mediators as possible. Finally, such a strong distinction will be criticized and the argument will be made that both in Bachelard's and Latour's thought both concepts are combined. This leads to a janus-headed view on science, where both the element of purification (the epistemological break) and the element of proliferation (phenomenotechnique) are combined.

Paulo Freire and Philosophy for Children: A Critical Dialogue

Abstract

This paper is an attempt to connect the Brazilian Paulo Freire's well known educational thinking with the "philosophy for children" movement. It considers the relationship between the creator of philosophy for children (P4C), Matthew Lipman and Freire through different attempts to establish a relationship between these two educators. The paper shows that the relationship between them is not as close as many supporters of P4C have claimed, especially in Latin America. It also considers the context of Educational Policies in our time and why Freire's understanding of the politics of education makes it impossible to be Freirean and at the same time be neutral or favorable to the actual status quo. Finally, after presenting Lipman's understanding of the relationship between philosophy, education and democracy and their connection to capitalism, it proposes ways to begin the political path of philosophizing with children inspired by Paulo Freire's educational thinking. As a result, a more politically committed path to doing philosophy with children is offered.

Durable Complete Responses in Some Recurrent High Grade Glioma Patients Treated with Toca 511 & Toca FC

Abstract

Background

Vocimagene amiretrorepvec (Toca 511) is an investigational gamma-retroviral replicating vector encoding cytosine deaminase that, when used in combination with extended-release 5-fluorocytosine (Toca FC), results preclinically in local production of 5-fluorouracil, depletion of immune-suppressive myeloid cells, and subsequent induction of anti-tumor immunity. Recurrent high grade glioma (rHGG) patients have a high unmet need for effective therapies that produce durable responses lasting more than 6 months. In this setting, relapse is nearly universal and most responses are transient.

Methods

In this Toca 511 ascending-dose phase I trial (NCT01470794), HGG patients who recurred after standard of care underwent surgical resection, received Toca 511 injected into resection cavity wall followed by orally administered cycles of Toca FC.

Results

Among 56 patients, durable complete responses were observed. A subgroup was identified based on Toca 511 dose and entry requirements for the follow-up phase III study. In this subgroup, which included both IDH1-mutant and -wildtype tumors, the durable response rate is 21.7%. Median duration of follow-up for responders is 35.7+ months. As of August 25, 2017, all responders remain in response and are alive, 33.9+ to 52.2+ months after Toca 511 administration, suggesting a positive association of durable response with overall survival.

Conclusions

Multi-year durable responses have been observed in rHGG patients treated with Toca 511 & Toca FC in a phase I trial and the treatment will be further evaluated in a randomized phase III trial. Among IDH1 mutant patients treated at first recurrence, there may be an enrichment of complete responders.

Primary investigation of the antialgal activity of shrimp shell on Microcystis aeruginosa

Abstract

This study aimed to explore the application potential of an eco-friendly waste—shrimp shell in Microcystis aeruginosa (M. aeruginosa) control—for the first time. Four treatments with different doses (0.75, 1.5, 3.0, and 6.0 g/L) were built to investigate the effects of shrimp shell on the growth, cell viability, physiological changes, and microcystins (MCs) release of M. aeruginosa cells. The water quality after shrimp shell treatment was also detected. Results showed that the growth of M. aeruginosa was effectively inhibited by shrimp shell, and the inhibition rates were dose-dependent within 7 days. Though shrimp shells at high doses could inhibit the cell growth greatly, the MC release was accelerated as they led to the cells lysis. While with the low shrimp shell dose (0.75 g/L), both satisfied inhibition effect and low MC release could be achieved simultaneously. For the water quality, we found that the turbidity and TN was not affected obviously with low dosage of shrimp shell, but it resulted in the increasing of COD_Mn and TP contents. In summary, the shrimp shell can be used as an effective algicide to control algal blooms but its adverse effect on COD_Mn and TP of water should be further solved.

Photodynamic therapy corrects abnormal cancer-associated gene expression observed in actinic keratosis lesions and induces a remodeling effect in photodamaged skin

Actinic keratoses (AK) are lesions formed from proliferations of transformed neoplastic keratinocytes in the epidermis, resulting from cumulative ultraviolet radiation (UVR) from sun exposure [1,2]. Lesions are found on sites of sun-exposed skin such as the face, balding scalp, chest, forearms and back of the hand. AKs may present on a patient as visible lesions, of which 5-10% have the potential to transform into squamous cell carcinoma (SCC) [3,4]. In Organ Transplant Recipients (OTR) as a consequence of long-term immunosuppressive therapy, the risk of developing cutaneous SCC is much higher, with an almost 250-fold increase compared with immunocompetent individuals [5,6].

Chronic Obesity and Incident Hypertension in Latina Women Are Associated with Accelerated Telomere Length Loss over a 1-Year Period

Metabolic Syndrome and Related Disorders, Ahead of Print.

Can Posting Be a Catalyst for Dating Violence? Social Media Behaviors and Physical Interactions

Violence and Gender, Ahead of Print.

Robust path planning for flexible needle insertion using Markov decision processes

Abstract

Purpose

Flexible needle has the potential to accurately navigate to a treatment region in the least invasive manner. We propose a new planning method using Markov decision processes (MDPs) for flexible needle navigation that can perform robust path planning and steering under the circumstance of complex tissue–needle interactions.

Methods

This method enhances the robustness of flexible needle steering from three different perspectives. First, the method considers the problem caused by soft tissue deformation. The method then resolves the common needle penetration failure caused by patterns of targets, while the last solution addresses the uncertainty issues in flexible needle motion due to complex and unpredictable tissue–needle interaction.

Results

Computer simulation and phantom experimental results show that the proposed method can perform robust planning and generate a secure control policy for flexible needle steering. Compared with a traditional method using MDPs, the proposed method achieves higher accuracy and probability of success in avoiding obstacles under complicated and uncertain tissue–needle interactions. Future work will involve experiment with biological tissue in vivo.

Conclusion

The proposed robust path planning method can securely steer flexible needle within soft phantom tissues and achieve high adaptability in computer simulation.

The phosphorus fractions and adsorption-desorption characteristics in the Wuliangsuhai Lake, China

Abstract

The phosphorus (P) fractions and adsorption-desorption characteristics in the Wuliangsuhai Lake were investigated through molybdenum blue/ascorbic acid method and indoor simulation experiments, respectively. The results showed that the highest total phosphorus concentration in overlying water (W-TP) was found in S1 which was in the hypereutrophic type. The mean concentration of particulate organic phosphorus (POP) was the most abundant P fraction (31.35% of the W-TP). The results of TP contents in sediments (S-TP) indicated that the most sampling sites were in the mild level of pollution. The contents of calcium-bound P (HCl-P) and residual P (Res-P) fractions together comprised 83.03–98.10% of the S-TP. Pseudo-second-order models fitted well with the adsorption-desorption kinetic of P fractions. The Langmuir and Freundlich models well described the adsorption isotherm of P fractions. The results of adsorption-desorption of P fractions indicated that the adsorption capacity was strong, the chemical adsorption was dominant, and the sediments was a source of P. Accordingly, we concluded that the Wuliangsuhai Lake was in the moderate pollution level, and the sediments as a source could desorb P in natural aquatic environment.

Evans on transparency: a rationalist account

Abstract

Gareth Evans famously observed that he can answer the question 'Do you think there is going to be a third world war?' by attending to "precisely the same outward phenomena as I would attend to if I were answering the question 'Will there be a third world war?'" (The varieties of reference, Oxford University Press, Oxford, p 225, 1982). I argue that this observation follows from two independently plausible ideas in philosophy of mind. The first is about rationality and consciousness: it is that to be rational is in part to be required to believe that you are in a conscious state if you are in one, at least if various background conditions are met. The second is about consciousness and attention: it is that consciousness in a belief state consists in its subject engaging, to a sufficient extent, in a certain sort of world-directed attention. I also argue that this suggestion is superior to others that have been made in the literature regarding Evan's observation. 

Sequential surgical signatures in micro-suturing task

Abstract

Purpose

Surgical processes are generally only studied by identifying differences in populations such as participants or level of expertise. But the similarity between this population is also important in understanding the process. We therefore proposed to study these two aspects.

Methods

In this article, we show how similarities in process workflow within a population can be identified as sequential surgical signatures. To this purpose, we have proposed a pattern mining approach to identify these signatures.

Validation

We validated our method with a data set composed of seventeen micro-surgical suturing tasks performed by four participants with two levels of expertise.

Results

We identified sequential surgical signatures specific to each participant, shared between participants with and without the same level of expertise. These signatures are also able to perfectly define the level of expertise of the participant who performed a new micro-surgical suturing task. However, it is more complicated to determine who the participant is, and the method correctly determines this information in only 64% of cases.

Conclusion

We show for the first time the concept of sequential surgical signature. This new concept has the potential to further help to understand surgical procedures and provide useful knowledge to define future CAS systems.

Propolis modulates NOS2/arginase-1 pathway in tropomyosin-induced experimental autoimmune uveitis

Abstract

In this study, we evaluated the preventive and curative effects of ethanolic extract of Propolis (EEP) during α-Tropomyosin-induced uveitis in an experimental model using Wistar rats, through the regulation of inducible nitric oxide synthase (NOS2) and arginase-1. In this context, rats received daily injection of EEP (100 mg/kg) for 5 days prior to immunization or for 9 days commencing 5 days post immunization with α-Tropomyosin extract, then were sacrificed at day 14. Histological examination, NOS2, arginase-1, and nuclear factor-κB (NF-κB) expression were evaluated in the retinas. Plasmatic production of nitric oxide (NO), urea, IL-4, and TNF-α was assessed. We have found that treatment with EEP substantially reduced the retinal histological damages induced by α-Tropomyosin. In the same context, a significant decrease of NO and TNF-α levels was noticed. Interestingly, EEP down-modulated NOS2 and NF-κB expression in retina. Also, an increase in urea and IL-4 levels was concomitant to an up-modulation of arginase-1 expression. Hence, it appears that EEP attenuated retinal damages through the induction of Th2 response and the inhibition of NF-κB/NOS2 pathway.

Allergic contact cheilitis in an adolescent to Ricinus communis seed oil (castor oil) in a lip balm

Contact Dermatitis, EarlyView.

Asthma Over the Age of 65: All's Well That Ends Well

Publication date: May–June 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 3
Author(s): Alan P. Baptist, Paula J. Busse
Asthma in older adults (often classified as those 65 years or older) is relatively common, underdiagnosed, and suboptimally treated. It is an important health problem, as the population of the United States continues to age. Unfortunately, asthma morbidity and mortality rates are highest in this age group. Alterations in the innate and adaptive immune responses occur with aging, and contribute to pathophysiologic differences and subsequent treatment challenges. The symptoms of asthma may differ from those in younger populations, and often include fatigue. There are unique factors that can complicate asthma management among older adults, including comorbidities, menopause, caregiver roles, and depression. Pharmacologic therapies are often not as effective as in younger populations, and may have greater side effects. Spirometry, peak flow measurements, and asthma education are typically underused, and may contribute to delays in diagnosis as well as worse outcomes. There are specific strategies that health care providers can take to improve the care of older adults with asthma.

Rethinking Access to Care

Publication date: May–June 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 3
Author(s): Peter J. Gergen

Safety of multi-dose immunotherapy vials after routine use

Publication date: Available online 9 May 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Priya Nath, John Freiler, Robert Anthony Gomez

Behavioral Interventions for Asthma: What Kind of Exercise and Diets Should We Be Prescribing?

Publication date: May–June 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 3
Author(s): Simon L. Bacon, Peter G. Gibson

The Use of Telemedicine for Penicillin Allergy Skin Testing

Publication date: Available online 8 May 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Mary L. Staicu, Anne Marie Holly, Kelly M. Conn, Allison Ramsey
BackgroundPenicillin skin testing (PST) is increasingly utilized as a tool to evaluate penicillin allergy in patients with a reported history. The limited availability of allergists, however, may be an impeding factor.ObjectiveWe sought to assess the clinical utility of telemedicine to facilitate PST.MethodsPenicillin allergic inpatients receiving systemic antibiotics were prospectively identified between April and August 2017. Qualifying patients underwent PST performed by a trained Allergy/Immunology physician assistant (PA). Upon completion of PST, a telemedicine consultation, through the use of real-time interactive video conferencing (Microsoft Lync 2013, Redmond, WA), was performed remotely by an allergist. Patients were surveyed regarding their satisfaction with the telemedicine experience.ResultsFifty patients consented to PST through a telemedicine consultation. The average total time to complete a consultation was 128 minutes (SD ± 33). Of this, average PA travel time was 46 minutes (36%) with the remaining time spent on clinical services (82 minutes, 64%). The average physician telemedicine time per patient was 5 minutes (SD ± 2). Patients rated their experience as an average of 4.5 on a scale of 1 (highly unsatisfied) to 5 (highly satisfied). Of the 46 PST-negative patients, 33 were transitioned to a β-lactam antibiotic which reduced the use of vancomycin, metronidazole, aztreonam, aminoglycosides, and clindamycin (p<0.05). More than $30,000 was saved throughout the study period.ConclusionTelemedicine is an effective and novel approach to facilitate PST in the inpatient setting and carries a high degree of patient satisfaction. This method has the potential to optimize and improve access to Allergy/Immunology resources.

CME Exam: Taming Asthma in School-Aged Children: A Comprehensive Review

Publication date: May–June 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 3

Tiotropium add-on therapy improves lung function in children with symptomatic moderate asthma

Publication date: Available online 8 May 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Christian Vogelberg, Michael Engel, István Laki, Jonathan A. Bernstein, Olaf Schmidt, Georges El Azzi, Petra Moroni-Zentgraf, Ralf Sigmund, Eckard Hamelmann

Depressed mood modulates impact of chronic rhinosinusitis symptoms on quality of life

Publication date: Available online 8 May 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Raphael G. Banoub, Lloyd P. Hoehle, Katie M. Phillips, Brian J. Schulman, David S. Caradonna, Stacey T. Gray, Ahmad R. Sedaghat
BackgroundIt is unknown how severity of depressed mood affects the well-recognized relationship between chronic rhinosinusitis (CRS) symptom burden and decreased general health-related quality of life (QOL).ObjectiveTo determine if depressed mood would affect the relationship between CRS symptom burden and decreased general health-related QOL.MethodsFor this cross-sectional study, 610 participants with CRS were prospectively recruited. CRS symptom burden was measured with the 22-item Sinonasal Outcomes Test (SNOT-22). General health-related QOL was measured with the EuroQol 5-dimensional health utility value (EQ-5D HUV) and visual analog scale (EQ-5D VAS). Depressed mood was measured using the Patient Health Questionnaire-2 (PHQ-2). Participants were stratified as having well-controlled CRS symptoms (SNOT-22<35) and poorly-controlled CRS symptoms (SNOT-22≥35). Good general health-related QOL was determined as EQ-5D HUV≥0.9 or EQ-5D VAS≥80, in contrast to low general health-related QOL.ResultsIn participants with well-controlled CRS symptoms, both SNOT-22 and PHQ-2 were significantly and negatively associated with good general health-related QOL (p<0.020 in all cases using multivariable regression). In participants with poorly-controlled CRS symptoms, PHQ-2 was significantly and negatively associated with good general health-related QOL using EQ-5D HUV (adjusted odds ratio [OR]= 0.37, 95%CI: 0.22–0.62, p<0.001) or EQ-5D VAS (adjusted OR= 0.74, 95%CI: 0.57–0.96, p=0.024). In contrast, SNOT-22 was not associated with general health-related QOL in these patients.ConclusionDepressed mood modulates the association between CRS symptom burden and general health-related QOL. Our results suggest a threshold of CRS symptom burden or control, beyond which depressed mood—not CRS symptom burden—drives the association with general health-related QOL.

Can Diet Modification Be an Effective Treatment in Aspirin-Exacerbated Respiratory Disease?

Publication date: May–June 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 3
Author(s): Brian D. Modena, Andrew A. White

Oral Allergy Syndrome in Shrimp and House Dust Mite Allergies

Publication date: Available online 8 May 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Karen Thursday S. Tuano, Carla M. Davis

Explaining the amount and consistency of medical care and self-management support in asthma: a survey of primary care providers in France and the United Kingdom

Publication date: Available online 9 May 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Marijn de Bruin, Alexandra L. Dima, Nathalie Texier, Eric van Ganse
BackgroundThe quality of asthma primary care may vary between countries, health care practices, and health care professionals (HCPs). Identifying and explaining such differences is critical for health services improvement.ObjectivesTo examine the quality of asthma primary care in France and United Kingdom, and identify within-country and between-country predictors amenable to intervention.MethodsAn online questionnaire to capture asthma medical care and self-management support, practice characteristics, and psychosocial determinants, was completed by 276 HCPs. Mokken Scaling analyses were used to examine item structure and consistency. Hierarchical regression analyses were used to identify predictors of the amount (number of asthma care activities HCPs delivered) and consistency (the degree to which HCPs deliver similar care) of asthma medical care and self-management support.ResultsOn average, HCPs reported delivering 74,2% of guideline-recommended care. Consistency of medical care and self-management support was lower among HCPs delivering a lower amount of care (r=.58 and r=.57, p<.001). UK HCPs provided more and more consistent asthma self-management support –but not medical care- than French HCPs, which was explained by the presence of practice nurses in the UK. More training, positive social norms, and higher behavioural control explained better quality of care across all HCPs.ConclusionsUsing carefully-developed questionnaires and advanced psychometric analyses, this study suggests that involving practice nurses, making social expectations visible, and providing more training to enhance skills and confidence in asthma care delivery could enhance the amount and consistency of asthma primary care. This needs to be corroborated in a future intervention trial.

The Health and Economic Outcomes of Peanut Allergy Management Practices

Publication date: Available online 8 May 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Marcus Shaker, Matthew Greenhawt
BackgroundPeanut allergy is managed with strict avoidance, epinephrine carriage, and promptly treating reactions.ObjectivesAssess the health and economic benefits of pre-emptively injecting epinephrine for peanut ingestion in the absence of any symptoms, and avoiding products with peanut precautionary allergen labeling (PAL).MethodsWe used Markov modeling and simulations, assuming a base-case 10-fold fatality risk increase for less conservative management, with sensitivity analysis investigating 100-1,000-fold increased fatality risk, incorporating risks of accidental exposures, reactions, fatality, and family costs of food allergy. Using low-dose threshold challenges was evaluated to exclude subjects highly reactive to PAL items.ResultsBased on these assumptions, small reductions in per-patient fatality risk resulted from pre-emptive epinephrine injection without symptoms present (1x10^-4 fewer per-patient fatalities), with incremental costs of $1,193 per patient, $11,681,501/life-year saved, and $110,270,820/death prevented vs. waiting for symptoms before use, but this was not cost-effective even assuming 1000-fold risk ($107, 971/QALY) or quality of life (QoL). There were small reductions in per-patient fatality risk (1.7 x10^-4 fewer per-patient fatalities) for PAL avoidance vs. universal PAL consumption, with incremental costs of $3,342.05 per patient, $19,325,994/life-year saved, and $182,434,277/death prevented vs. allowing PAL consumption. PAL avoidance was not cost-effective when assuming 1000-fold risk or considering QoL. Incorporating a single, supervised low-dose challenge of 1.5mg of peanut protein to exclude children reactive to PAL consumption was cost-effective.ConclusionsCommonly recommended practices of pre-emptive epinephrine injection in the absence of symptoms, or universal avoidance of PAL were not cost-effective when compared with administering epinephrine upon symptom development or allowing PAL consumption.

CME Exam: The Tempest: Difficult to Control Asthma in Adolescence

Publication date: May–June 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 3

Long-term Clinical Outcomes of High Dose Mepolizumab Treatment for Hypereosinophilic Syndrome

Publication date: Available online 8 May 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Fei Li Kuang, Michael P. Fay, JeanAnne Ware, Lauren Wetzler, Nicole Holland-Thomas, Thomas Brown, Hector Ortega, Jonathan Steinfeld, Paneez Khoury, Amy D. Klion
BackgroundConventional therapies for hypereosinophilic syndromes (HES) have variable efficacy and carry significant long-term toxicities. Anti-IL5 (mepolizumab) therapy has a glucocorticoid (GC)-sparing effect in GC-sensitive HES, but the efficacy of mepolizumab in treatment-refractory HES patients with severe disease has not been examined to date.ObjectiveTo identify predictors of response to mepolizumab in subjects with severe treatment-refractory HES and compare long-term outcomes in these subjects to HES subjects treated with conventional therapies.MethodsRetrospective analysis of clinical and laboratory data from 35 HES subjects treated with mepolizumab and 55 HES subjects on conventional therapy, all followed at a single center.ResultsPeak eosinophilia, GC sensitivity, pulmonary involvement, HES clinical subtype and pre-treatment serum IL-5 correlated with mepolizumab response. Despite evidence of more severe disease at baseline, mepolizumab-treated subjects had comparable long-term clinical outcomes to HES subjects treated with conventional therapies and reported improvements in therapy-related comorbidities. Subjects managed with mepolizumab monotherapy had fewer disease flares than HES subjects on conventional therapies or mepolizumab-treated HES subjects requiring additional HES therapies.ConclusionsThis study confirms that mepolizumab is an effective and well-tolerated therapy for HES, but suggests that response is more likely in GC-responsive subjects with idiopathic or overlap forms of HES. A primary benefit of treatment is reduction of comorbidity due to discontinuation or reduction of conventional HES therapies. Although subjects who completely discontinued GC had the most benefit, high dose mepolizumab was a safe and effective salvage therapy for severe, treatment-refractory HES.

Long-term trajectories of mild asthma in adulthood and risk factors of progression

Publication date: Available online 7 May 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Wenjia Chen, J Mark FitzGerald, Larry D. Lynd, Don D. Sin, Mohsen Sadatsafavi
BackgroundThe majority of asthma patients have mild disease. However, the clinical course of mild asthma and risk factors for progression are not well studied.ObjectiveTo examine the long-term trajectories of mild asthma and the effects of early-stage risk factors on the subsequent disease course.MethodsFrom the administrative health data of British Columbia, Canada, we identified patients 14 to 45 years of age with newly diagnosed mild asthma between January 1997 and December 2012. For each follow-up year, we categorized a patient's asthma severity into mild/dormant, moderate, or severe based on the intensity of asthma medications and occurrence of exacerbations. Ordinal logistic regression was used to estimate the probability of severity or all-cause death in the next year as a function of a patient's severity history in the past three years and selected baseline risk factors.ResultsThe study included 70,829 patients with incident mild asthma (62% female, mean age 31 years). Over 10 years, 8% of these patients transitioned to moderate or severe asthma. Inappropriate use of rescue medications and older age were the most influential determinants for progression from mild asthma (odds ratios: 1.79 [95% CI: 1.68, 1.90], p<0.001, 1. 24 per ten-year increase in age [95% CI: 1.22, 1.27] , p<0.001), whereas the presence of allergic rhinitis had no significant effects (OR=0.95 [95% CI: 0.91, 1.00], p=0.063).ConclusionMild asthma remains largely stable over time. However, potentially modifiable factors such as inappropriate use of rescue medications are associated with a worsened prognosis.

Asthma: Overdiagnosed, Underdiagnosed, and Ineffectively Treated

Publication date: May–June 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 3
Author(s): Ann Chen Wu, Paul A. Greenberger

Montelukast Reduces Symptom Severity and Frequency in Patients with Angioedema-predominant Chronic Spontaneous Urticaria

Publication date: Available online 5 May 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Ayobami T. Akenroye, Conor McEwan, Sarbjit S. Saini

Challenges for the Clinician: Physical Activity Among Severe Asthmatic Patients with Comorbid Obesity

Publication date: May–June 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 3
Author(s): Sheniz Moonie, Mary Beth Hogan

On-Demand Intranasal Corticosteroids for Treatment of Seasonal Allergic Rhinitis in Children

Publication date: Available online 4 May 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Allison Hicks, Maureen Egan

Can a Diet with Low Proinflammatory Potential Help with Asthma?

Publication date: May–June 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice, Volume 6, Issue 3
Author(s): Augusto A. Litonjua

Assessing the use of sand, peat soil, and pine bark for the attenuation of polar pesticides from agricultural run-off: a bench-scale column experiment

Abstract

Biofilters have been shown to be efficient for removing pollutants from different water effluents, but little information is available about their capacity to remove highly polar pesticides from agricultural run-off waters. In this study, we assess the capacity of three different biofilter-supporting materials (sand, peat soil, and pine bark) to remove five phenoxyacid herbicides (mecoprop, dicamba, MCPA, dichlorprop and 2,4-D) and five non-ionic pesticides (atrazine, simazine, fenitrotion, diazinon, and alachlor) from real agricultural run-off waters. The experimental design included three columns 120 cm in length and 15 cm in diameter, each filled with 100 cm of one of the selected supporting materials. After 30 days of acclimation, the columns were fed with agricultural run-off water spiked at 10 μg L⁻¹ with each of the studied pesticides for 20 days at a hydraulic loading rate (HLR) of 0.32 m day⁻¹. The results show that the sand filter was the best supporting material for removing phenoxyacid herbicides (77% on average), whereas peat soil and pine bark were best for removing non-ionic pesticides (72% on average). The attenuation of mecoprop and dichlorprop correlated negatively with the enantiomeric fraction. Therefore, this study shows that the use of waste-to-product materials in biofilter systems is a good solution for removing pollutants from agricultural run-off waters.

W.E.W. Roediger: Causative factors of ulcerative colitis and Crohn’s disease: an exploratory guide

Abstract

This monograph provides the background for new developments in gastroenterological pharmacology, particularly focussing on the two chronic inflammatory bowel diseases, ulcerative colitis (UC) and Crohn's disease (CD). These currently cause significant morbidity but largely elude satisfactory treatment. This is a challenge to drug designers and experimental physiologists alike. Their efforts will be much enhanced by further understanding the aspects of molecular pathogenesis and physiological dysregulation outlined in this valuable and timely survey.

Does Socioeconomic Status Modify the Association Between Preterm Birth and Children's Early Cognitive Ability and Kindergarten Academic Achievement in the United States?

Abstract

Being born preterm and being raised in poverty are each linked with adverse cognitive outcomes. Using data from 5,250 singletons born in the US in 2001 and enrolled in the Early Childhood Longitudinal Study-Birth Cohort, we examined whether household socioeconomic status (SES) modified the association between preterm birth (PTB) and children's scores on cognitive assessments at 2 years and reading and mathematics assessments at kindergarten age. Gestational age was measured from birth certificates and categorized as early preterm, moderate preterm, late preterm, early term, and term. SES was measured at 9 months using a composite of parental education, occupation, and income. PTB was associated with 0.1–0.6 standard deviation (SD) deficits in 2-year cognitive ability and kindergarten mathematics scores, and with 0.1–0.4 SD deficits in kindergarten reading scores. Children living in the lowest (versus highest) SES quintile scored 0.6 SD lower on 2-year cognitive ability, 1.1 SD lower on kindergarten reading, and 0.9 SD lower on kindergarten mathematics. The association between PTB and cognitive outcomes did not differ by postnatal SES. However, children who were both born preterm and lived in lower SES households had the poorest performance on all three outcomes and therefore may represent a uniquely high risk group.

Evaluation of the Impact of a Rotavirus Vaccine Program on Pediatric Acute Gastroenteritis Hospitalizations: Estimating the Overall Effect Attributable to the Program as a Whole, and as a Per-Unit Change in Rotavirus Vaccine Coverage

Abstract

Estimation of the overall effect of a vaccine program is essential, but the effect is typically estimated for a whole program. We estimate the overall effect of the Quebec rotavirus vaccine program launched in November 2011, and the effect for each 10% increase in rotavirus vaccine coverage on pediatric, all-cause acute gastroenteritis hospitalizations. We implemented negative binomial regressions adjusted for seasonality, long-term trends, and infection dynamics, to estimate the effect of the vaccine program as: 1) a dichotomous variable, representing program presence/absence, and linear term to account for changes in trend in the post-program period, or 2) a continuous variable, representing rotavirus vaccine coverage. Using exposure 1), the vaccine program was associated with a 51.2% (95% confidence interval (CI): 28.5, 66.7) relative decline in adjusted weekly all-cause acute gastroenteritis hospitalization rates as of December 28, 2014. Using exposure 2), a 10% increase in rotavirus ≥1-dose coverage was associated with a 7.1% (95% CI: 3.5, 10.5) relative decline in adjusted weekly rates, with maximum coverage of 87.0% associated with a 47.2% (95% CI: 26.9, 61.9) relative decline. Estimation of the overall effect attributable to a change in vaccine coverage may be a useful addition to standard measurement of the overall effect.

The interaction of heavy metals and metalloids in the soil–plant system in the São Domingos mining area (Iberian Pyrite Belt, Portugal)

Abstract

São Domingos belongs among the most important historic Iberian Pyrite Belt Cu mines. The anthrosoil is contaminated by a very high content of heavy metals and metalloids. The study was focused on evaluating the interaction of some chemical elements (Ca, Mg, Fe, Mn, Cu, Pb, Zn, Ag, Cd, Ni, Co, As, Sb) in the system soil vs. five autochthonous dominant plant species: Pinus pinaster Aiton, Quercus rotundifolia Lam., Agrostis sp., Juncus conglomeratus L. and Juncus effusus L. The plants are heavily contaminated by Cu, Pb, As and Zn. The bioconcentration factor proved that they exhibit features of metal tolerant excluders. The trees are accumulators of Ag, whereas the graminoids are hyper-accumulators of Ag and Juncus effusus of Co. The translocation factor confirmed that the selected elements are immobilised in the roots except for Mn and Zn in Pinus pinaster and Mn in Quercus rotundifolia and Juncus conglomeratus. The bioaccumulation of Mn, Zn and Cu at low pH increases. The increased content of Ca and Mg in the soil inhibits, in the case of some metals and metalloids, their intake to plants. Although the studied plants, despite their fitness and vitality at the contaminated sites, are not suitable for phytoextraction (except Co and Ag), they can be used for phytostabilisation at the mining habitats.

The inhibition of Microcystis aeruginos by electrochemical oxidation using boron-doped diamond electrode

Abstract

Electrooxidation is used to study the inhibition behavior of Microcystis aeruginosa, a dominant algae species during water blooms mainly caused by non-point source pollution. The inhibitory effect of current density, A/V ratio, initial algae concentration, and algae growth phase on the growth of algae by electrochemical oxidation was investigated, respectively. Further, the effect of electrolysis on the photosynthesis of algae cells and the degradation of Microcystin-LR (MC-LR) in solution were also studied. The results showed that the inhibitory effect increased with the increase of current density and A/V ratio. The damage of cell structure and the leakage of intracellular substances were observed when the current density was 17 mA/cm². The intracellular chlorophyll a decreased significantly during the culture period. Only when the A/V ratio was 9.75 m⁻¹, the algal growth could be completely inhibited. The inhibitory effect of algae was decreased with the increase of initial algal concentration, and the inhibitory effect of algae in the log growth phase was better than that in the stationary phase. The degradation efficiency of total MC-LR was 91.7% at 90 min. Some other substances could be degraded simultaneously along with the degradation of MC-LR in electrochemical oxidation.