A Cross-Sectional Study of Vitamin D, Glycemic Control, and Inflammatory Cytokines in Children and Adolescents With Type 1 Diabetes Mellitus

Background: Vitamin D deficiency is markedly prevalent in children and adolescents with type 1 diabetes mellitus (T1DM). Despite accumulating evidence to support the link between vitamin D deficiency and both impaired glucose metabolism and altered immune responses in vitro and in vivo, it is not known whether vitamin D deficiency is linked to poor glycemic control and/or systemic levels of inflammatory cytokines in children and adolescents with T1DM. Aims: The purpose of this study was to examine the relationship between 25-hydroxyvitamin D (the functional indicator of vitamin D status) and HbA1c (the standardized index of glycemic control); and to determine whether inflammatory cytokines IL-6, IL-8, and IL-10 mediate this relationship in metabolically stable children and adolescents with T1DM. Methods: A cross-sectional design was used to examine these relationships in a convenience sample of 197 children and adolescents with T1DM 7-18 years, recruited from the Diabetes Center for Children at the Children’s Hospital of Philadelphia. Non-fasting serum levels of 25-hydroxyvitamin D, IL-6, IL-8, IL-10, and blood glucose were measured. Data on socio-demographic and disease-related variables including HbA1c were abstracted from medical records. Age- and sex-specific body mass index standard deviation scores (BMI z-score) were calculated. General linear modeling was used to examine the hypothesized relationships between primary variables, while controlling for select socio-demographic and disease-related covariates. Results: Mean HbA1c was 8.6±1.4%; 22.8% subjects had poor glycemic control. Mean 25-hydroxyvitamin D was 54.6±17.8nmol/L; 90.0% subjects had 25-hydroxyvitamin D levels less than 75nmol/L. Mean serum IL-6 was highest in overweight/obese adolescent females (1.57±1.29pg/ml). Mean serum IL-10 was highest in African Americans with poor glycemic control (15.2±22.5pg/ml). Serum levels of IL-8 were not detected in this sample. 25-hydroxyvitamin D was not associated with HbA1c (β=0.008; P=0.108), nor with IL-6 (β=-0.005; P=0.175) or IL-10 (β=0.004; P=0.356). IL-6 was not associated with HbA1c (β=0.09; P=0.418). IL-10 was significantly associated with HbA1c (β=0.21; P=0.008). Conclusions: In this study sample of metabolically stable children and adolescents with T1DM, neither 25-hydroxyvitamin D nor IL-6 were significantly associated with HbA1c. IL-10 was significantly associated with HbA1c. Clinical controlled trials are needed to confirm these results and assess the effect of varied doses of vitamin D supplements on inflammatory cytokines and ultimately measure the effect of inflammatory cytokines on HbA1c in T1DM

Neural Circuits Underlying Motor Facilitation during Observation of Implied Motion

In the present study we used single and paired-pulse Transcranial Magnetic Stimulation (TMS) to evaluate the effect of implied motion on primary motor cortex microcircuits. We found that observation of the implied motion of a static image increases MEP amplitude and reduces short-interval intracortical inhibition (SICI), without significant modulation of intracortical facilitation and sensory-motor integration. Our results add to the existing literature on the activation of the observation-execution matching system and describe a selective modulation of GABAergic cortical microcircuits during observation of implied motion

Balloon Valvuloplasty of Aortic Valve Stenosis in Childhood: Midterm Results in a Children’s Hospital, Mansoura University, Egypt

Background Balloon valvuloplasty was established as an alternative to surgery for treatment of aortic valve stenosis in childhood. Acute complications after balloon dilatation including aortic insufficiency or early death were described. Aim of Work To analyze early outcome and midterm results of balloon aortic valvuloplasty (BAV) in Children's Hospital, Mansoura University, Egypt. Subjects and Methods Between April 2005–June 2008, all consecutive patients of age <18 years treated for aortic valve stenosis (AVS) with BAV were analyzed retrospectively. The study included 21 patients; 17 males, and 4 females. Their age ranged from the neonatal period to 10 years (mean age 5.6 ± 3.7 years). Patients with gradient ≥50 mmHg and aortic valve insufficiency (AI) up to grade I were included. All patients had isolated aortic valve stenosis except 3 patients (14.3%) had associated aortic coarctation. Six patients (28.6%) had bicuspid aortic valve. All patients had normal myocardial function except one (4.8%) had FS 15%. The duration of follow up was (mean ± SD: 18.5 ± 11.7 months). Results Femoral artery approach was used in 20 patients (95.2%) and carotid artery in one neonate (4.8%). Balloon/annulus ratio was 0.83 ± 0.04. Significant reduction in pressure gradient was achieved (mean 66.7 ± 9.8 mmHg to 20.65 ± 2.99 mmHg) ( P < 0.001). Nine patients (42.8%) developed grade I AI, 2 patients (9.5%) developed grade II AI and 1 patient (4.8%) developed grade III AI. Two early deaths (9.5%); one died due to heart failure caused by grade IV AI and a neonate died because of severely compromised LV function. One patient (4.8%) had femoral artery occlusion necessitating anticoagulation. Patients remained free from re-intervention during follow up. Conclusion Balloon valvuloplasty of aortic valve stenosis significantly reduces gradient with low morbidity and mortality in children

Depollution: A matter of catalyst and reactor design

International audienc

Comparison Between The Efficacy of Different Medical Herbs on Cryptosporidium spp.

Objectives: The study was planned to show the effect of different medicinal plants extracts on Cryptosporidium spp. Materials and Methods: The experimental study was performed in laboratory mice to show the efficacy of different medical plants extracts (Achillea fragrantissima, Artemisea herba-alba, Cardaria draba, Mentha longifolia , Olea europea, Prosopis farcta, Punica granatum, Teucrium polium and Ziziphus spina-charisti on shedding of Cryptosporidium spp. oocysts. Results: In a study on the effect of medical plant extracts on the shedding of oocysts in mice, it was found that different medical plants extracts decrease the shedding of Cryptosporidium oocysts in mice. Using 250 mg / kg B.W., route it was shown that the efficacy of Prosopis farcta (67.6 %) followed by Artemesia herba alba (57.7 %), Cardaria draba (35.9 %) and the lowest was Teucrium polium (12.7 "/o) but Mentha longifolia had no effect. It was also shown that the efficacy of medical plants extracts (500 mg / kg B.W.) was higher than (250 mg / kg B.W.) in shedding of the parasite oocysts. In a study of the effect of plant extracts on the development of oocysts of Cryptosporidium in the macrophage in Rpm medium, it was found that the efficacy of Punica granatum (75.9%) was highest, followed by Prosopis farcta (67.1%) and Artimesia herba- alba (55%). Conclusions: The medical plant extracts have an effect on Cryptosporidium spp. Infection in albino mice. The possibility of studying the therapeutic research on Cryptospridium spp. in RPM medium

Cost per responder for ixekizumab and other biologic drugs approved for the treatment of moderate-to-severe plaque psoriasis in Italy

This analysis was aimed at estimating the cost per responder as measured by number needed to treat of ixekizumab as compared with other biologic drugs approved in Italy for the treatment of moderate-to-severe plaque psoriasis. The clinical efficacy was assessed in terms of number needed to treat, based on a network meta-analysis of published efficacy data as measured by Psoriasis Area and Severity Index response (PASI75, PASI90, and PASI100) for relevant biologic comparators. The cost was based on the number of administrations dispensed in the first (induction plus maintenance period) and the second (maintenance period only) year of treatment and the ex-factory price net of discounts of each biologic drug. The cost per responder was adopted as a cost-effectiveness indicator. Independent of the Psoriasis Area and Severity Index response (PASI75, PASI90, and PASI100) used and the year of treatment considered, the cost per number needed to treat for ixekizumab appeared consistently to be the lowest. For example, considering first-year costs and PASI75, the cost per responder for ixekizumab was €16,388, compared to adalimumab (€22,574), etanercept (branded original: €32,420; biosimilar: €21,432), secukinumab (€17,937), and ustekinumab (€20,014). The differences in the cost per responder between ixekizumab and the comparators increased when higher Psoriasis Area and Severity Index response levels were considered. This economic assessment confirmed that ixekizumab is a cost-efficient option from the perspective of the Italian National Health Service for the treatment of moderate-to-severe plaque psoriasis

Flares in patients with Systemic Lupus Erythematosus (SLE)

Objective: Systemic lupus erythematosus (SLE) is characterised by relapses and remissions. This study describes the frequency, type and time to flare in a cohort of SLE patients. Methods: SLE patients with one or more “A” or “B” BILAG2004 systems meeting flare criteria (“new” or ”worse” items) and requiring an increase in immunosuppression were recruited from nine UK centres and assessed at baseline and monthly for nine months. Subsequent flares were defined as: severe (any “A” irrespective of number of “Bs”), moderate (≥2 “Bs” without any “As”) and mild (one “B”). Results: Of the 100 patients, 94% were female, 61% white Caucasians, mean age (SD) was 40.7 years (12.7) and mean disease duration (SD) 9.3 years (8.1). A total of 195 flares re-occurred in 76 patients over 781 monthly assessments (flare rate of 0.25/patient-month). There were 37 severe flares, 32 moderate flares and 126 mild flares. By month one, 22% had a mild/moderate/severe flare and 22% had a severe flare by 7 months. The median time to any “A” or “B” flare was 4 months. Severe/moderate flares tend to be in the system/s affected at baseline whereas mild flares can affect any system. Conclusion: In a population with active SLE we observed an ongoing rate of flares from early in the follow-up period with moderate-severe flares being due to an inability to fully control the disease. This real-world population study demonstrates the limitations of current treatments and provides a useful reference population from which to inform future clinical trial design

Implementation Critical Success Factors (CSFs) for ERP: Do they contribute to implementation success and post-implementation performance?

Extent: 55 p.Frequent commentaries in the literature have stated that certain critical success factors (CSFs) have to be accomplished in an organisation for an Enterprise Resource Planning (ERP) system project to be successful. In this study we argue and demonstrate empirically that success in implementing an ERP system and in gaining performance improvement should be conceptualised as two separate dependent variables. The distinction is made because the former aspect is based upon project delivery outcomes, while the latter assesses post-ERP project performance. We question whether some factors labelled as 'critical' success factors for ERP projects are in practice actually critical for achieving success in implementation and improving output performance. To examine this we report an empirical study that has investigated whether four major CSFs are in practice critical for achieving organisational performance improvements, and the role that successful implementation may play in influencing the relationship between CSFs and improvements in organisational performance. A conceptual model was devised and then analysed using structural equation modelling, based on data collected from 217 organisations. We found that some CSFs were not critical to achieve success in ERP implementation but were critical to help an organisational achieve performance improvement from an ERP system. Additionally, we also found that achieving successful ERP system implementation mediates the degree to which a CSF affects output performance improvement. The managerial and research implications of these findings are discussed and the limitations of the study noted.Jiwat Ram, David Corkindale, Ming-Lu W