Evaluating the Nickel Content in Metal Alloys and the Threshold for Nickel-Induced Allergic Contact Dermatitis

Many patients are currently suffering from nickel (Ni)-induced allergic contact dermatitis (ACD). There have been few Korean studies dealing with the threshold of Ni-induced ACD and quantifying the total amount of Ni in the metal alloys. The aim of this study is to evaluate the amount of Ni leached from metal alloys and Ni contents in metal alloys, and to estimate the threshold of Ni-induced ACD. All the earrings we examined leached below 0.5 µg/cm2/week, the upper limit of European Union (EU) regulation, but the other metal alloys leached a much higher amount of Ni than the limit. Likewise, all the earrings we examined contained less than 0.05% Ni (500 µg/g), the upper limit of EU regulation, but the other metal alloys exceeded this limit. Twenty Ni-sensitive subjects, who were patch-tested with various concentrations of Ni sulphate, showed positive reactions to 5% and 1% Ni sulphate, 10 subjects showed positive reactions to 0.01%, and the most sensitive subject showed reaction even to 0.0001%. The subjects in this study were more sensitive to Ni than those in the previous studies done in Europe. Taken together, strictly regulating the Ni-containing alloys that are made in Korea is needed to lower the occurrence of Ni-induced ACD

Role of retinoic receptors in lung carcinogenesis

Several in vitro and in vivo studies have examined the positive and negative effects of retinoids (vitamin A analogs) in premalignant and malignant lesions. Retinoids have been used as chemopreventive and anticancer agents because of their pleiotropic regulator function in cell differentiation, growth, proliferation and apoptosis through interaction with two types of nuclear receptors: retinoic acid receptors and retinoid X receptors. Recent investigations have gradually elucidated the function of retinoids and their signaling pathways and may explain the failure of earlier chemopreventive studies

The impact of plasma 25-hydroxyvitamin D on pulmonary function and exercise physiology in cystic fibrosis: a multicentre retrospective study

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this recordBackground 25‐hydroxyvitamin D (25OHD) may exert immunomodulatory effects on respiratory health, which may translate to improvements in exercise physiology. Thus, we aimed to investigate whether plasma 25OHD is associated with lung function and aerobic fitness in people with cystic fibrosis (pwCF). Methods A multi‐centre retrospective review of pwCF (>9 years old) attending the Royal Hospital for Sick Children (Edinburgh) or Wessex CF‐Unit (Southampton) was performed between July 2017 to October 2019. Demographic and clinical data were collected. Plasma 25OHD measured closest in time to clinical cardiopulmonary exercise testing (CPET) and/or spirometry (forced expiratory volume FEV1% predicted) was recorded. Pancreatic insufficiency was diagnosed based on faecal elastase of <100 µg/g. We performed multiple‐regression analysis with aerobic fitness outcomes [peak oxygen uptake (VO2peak)] and FEV1% predicted as primary outcomes. Results Ninety pwCF [mean±SD age: 19.1±8.6 years, 54 (60%) children, 48 (53%) males and 88 (98%) Caucasian] were included. 25OHD deficiency and insufficiency was 15 (17%) and 44 (49%) respectively. 25OHD deficiency and insufficiency was significantly associated with pancreatic insufficiency (χ2(4.8); p = 0.02). Plasma 25OHD was not significantly associated with FEV1% predicted [R2 = 0.06; p= 0.42; 95%; CI (‐0.09 ‐ 0.19)] or VO2peak [R2= 0.04; p= 0.07; 95% CI (‐011 ‐ 0.005)] in all pwCF. However, 25OHD was significantly associated with both FEV1% [R2= 0.15; p= 0.02; 95% CI (1.99 ‐ 2.64)] and VO2peak [R2= 0.13; p= 0.05; 95% CI (‐0.26 – (‐0.005)] in the paediatric cohort. Conclusion We showed that 25OHD is associated with improved lung function and aerobic fitness in children and adolescents with CF. Mechanistic and high‐quality prospective studies including both lung function and aerobic fitness as primary outcomes are now warranted.NHS Lothian Research and Development Offic

Using a learning health system to understand the mismatch between medicines supply and actual medicines use among adults with cystic fibrosis

Background Studies in separate cohorts suggest possible discrepancies between inhaled medicines supplied (median 50-60%) and medicines used (median 30-40%). We performed the first study that directly compares CF medicine supply against use to identify the cost of excess medicines supply. Methods This cross-sectional study included participants from 12 UK adult centres with ≥1 year of continuous adherence data from data-logging nebulisers. Medicine supply was measured as medication possession ratio (MPR) for a 1-year period from the first suitable supply date. Medicine use was measured as electronic data capture (EDC) adherence over the same period. The cost of excess medicines was calculated as whole excess box(es) supplied after accounting for the discrepancy between EDC adherence and MPR with 20% contingency. Results Among 275 participants, 133 (48.4%) were females and mean age was 30 years (95% CI 29-31 years). Median EDC adherence was 57% (IQR 23-86%), median MPR was 74% (IQR 46-96%) and the discrepancy between measures was median 14% (IQR 2-29%). Even with 20% contingency, mean potential cost of excess medicines was £1,124 (95% CI £855-1,394), ranging from £183 (95% CI £29-338) for EDC adherence ≥80% to £2,017 (95% CI £1,507-2,526) for EDC adherence <50%. Conclusions This study provides a conservative estimate of excess inhaled medicines supply cost among adults with CF in the UK. The excess supply cost was highest among those with lowest EDC adherence, highlighting the importance of adherence support and supplying medicine according to actual use. MPR provides information about medicine supply but over-estimates actual medicine use