Dietary advice based on food-specific IgG results

Abstract Purpose -To provide evidence that elimination diet based on food-specific IgG test results is an effective, reliable and valid aid to the management of chronic medical conditions. Design/methodology/approach -A postal survey, commissioned by Allergy UK, was carried out with 5,286 subjects reporting a wide range of chronic medical conditions, who had taken a foodspecific IgG enzyme-linked immunosorbant assay blood test. Questionnaires, issued three months after the results, were analysed to investigate the effect of eliminating the foods identified by the test. To check for response bias, a separate group of patients who had not responded were interviewed by telephone. The analysis and reporting of the data was carried out at the University of York. Findings -Of patients who rigorously followed the diet 75.8 per cent had a noticeable improvement in their condition. Of patients who benefited from following the recommendations 68.2 per cent felt the benefit within three weeks. Those who reported more than one condition were more likely to report noticeable improvement. 81.5 per cent of those that dieted rigorously and reported three or more co-morbidities showed noticeable improvement in their condition. For those who dieted rigorously and reported high benefit, 92.3 per cent noticed a return of symptoms on reintroduction of the offending foods. Originality/value -These data provide evidence for the use of elimination diet based on foodspecific IgG blood test results as an aid to management of the symptoms of a range of chronic medical conditions

Amplified antimicrobial action of chlorhexidine encapsulated in PDAC-functionalized acrylate copolymer nanogel carriers

We have developed and tested a novel functionalised nanocarrier for chlorhexidine (CHX) which provides a very strong enhancement of its antimicrobial action. The nanocarrier was based on lightly-cross-linked acrylate copolymer nanogel particles loaded with CHX followed by a surface functionalisation with the cationic polyelectrolyte poly(diallyldimethylammonium chloride (PDAC). We explored the antimicrobial effect of the PDAC-coated CHX-loaded nanogel carriers on E. coli, S. auresus, C. cerevisiae and C. reinhardtii and discovered that it is much higher than that of solution with equivalent overall concentration of free CHX. Our experiments also showed a marked increase of the cationic CHX-loaded nanocarriers antimicrobial action on these microorganisms at shorter incubation times compared with the non-coated CHX-loaded nanogel particles at the same CHX concentration and other conditions. We attribute the increase in the antimicrobial activity of the cationically-functionalised nanogel carrier to its electrostatic adhesion to the microbial cells walls which allows much higher CHX concentration to be delivered directly onto the cell surface. The results of this study can be used for development of novel more efficient antialgal, antifungal and antbacterial formulations based on cationically functionalised nanogels. Our method can also be used for boosting the effect of other cationic antimicrobial agents by encapsulating them in cationically-functionalised nanogel carriers. This nanotechnological approach could lead to developing more effective antimicrobial and disinfecting agents, dental formulations for plaque control, wound dressings, antialgal/antibiofouling formulations and novel antifungal agents

Estrogen promotes cutaneous wound healing via estrogen receptor β independent of its antiinflammatory activities

Post-menopausal women have an increased risk of developing a number of degenerative pathological conditions, linked by the common theme of excessive inflammation. Systemic estrogen replacement (in the form of hormone replacement therapy) is able to accelerate healing of acute cutaneous wounds in elderly females, linked to its potent antiinflammatory activity. However, in contrast to many other age-associated pathologies, the detailed mechanisms through which estrogen modulates skin repair, particularly the cell type–specific role of the two estrogen receptors, ERα and ERβ, has yet to be determined. Here, we use pharmacological activation and genetic deletion to investigate the role of both ERα and ERβ in cutaneous tissue repair. Unexpectedly, we report that exogenous estrogen replacement to ovariectomised mice in the absence of ERβ actually delayed wound healing. Moreover, healing in epidermal-specific ERβ null mice (K14-cre/ERβL2/L2) largely resembled that in global ERβ null mice. Thus, the beneficial effects of estrogen on skin wound healing are mediated by epidermal ERβ, in marked contrast to most other tissues in the body where ERα is predominant. Surprisingly, agonists to both ERα and ERβ are potently antiinflammatory during skin repair, indicating clear uncoupling of inflammation and overall efficiency of repair. Thus, estrogen-mediated antiinflammatory activity is not the principal factor in accelerated wound healing

EFFECT OF HABITAT AND FORAGING HEIGHT ON BAT ACTIVITY IN THE COASTAL PLAIN OF SOUTH CAROLINA

Double-crested cormorant (Phalacrocorax auritus) populations on the Great Lakes expanded greatly during the past 2 decades. On Lake Erie, the number of breeding cormorants increased from 174 birds (87 nests) in 1979 to 26,542 (13,271 nests) in 2000. In 2000, 81% of the breeding population was on 2 western-basin islands (East Sister and Middle Islands). The plant communities on these islands represent some of the last remnants of Carolinian vegetation in Canada. Our study is the first to quantitatively assess the relationship between the distribution of nesting cormorants and forest health. On East Sister Island, 2 measures of forest cover were obtained using infrared aerial photographs and ground-based measurements of leaf area index. These measures of forest cover were correlated (rs = 0.70, P < 0.001), which validated the use of remotely sensed data to assess forest cover. Cormorant nest density was negatively correlated with tree cover on both East Sister and Middle Islands. Temporal comparisons of Middle Island data indicated a reduction in tree cover from 1995 to 2001, and these reductions coincided with a large increase in the island's cormorant population. Although correlational in nature, our results suggest that cormorants may be detrimentally affecting island forests

The impact of the SARS‐CoV‐2 pandemic and COVID‐19 on lung transplantation in the UK: Lessons learned from the first wave

BACKGROUND: Lung transplantation is particularly susceptible to the impact of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, and evaluation of changes to practice is required to inform future decision-making. METHODS: A retrospective review of the UK Transplant Registry (UKTR) and national survey of UK lung transplant centers has been performed. RESULTS: There was geographic variation in the prevalence of COVID-19 infection across the UK. The number of donors fell by 48% during the early pandemic period. Lung utilization fell to 10% (compared with 24% for the same period of 2019). The number of lung transplants performed fell by 77% from 53, March to May 2019, to 12. Seven (58%) of these were performed in a single-center, designated "COVID-light." The number of patients who died on the lung transplant waiting list increased, compared to the same period of 2019 (p = .0118). Twenty-six lung transplant recipients with confirmed COVID-19 infection were reported during the study period. CONCLUSION: As the pandemic continues, reviewing practice and implementing the lessons learned during this period, including the use of robust donor testing strategies and the provision of "COVID-light" hospitals, are vital in ensuring the safe continuation of our lung transplant program

Organ Transplants From Deceased Donors With Primary Brain Tumors and Risk of Cancer Transmission

IMPORTANCE: Cancer transmission is a known risk for recipients of organ transplants. Many people wait a long time for a suitable transplant; some never receive one. Although patients with brain tumors may donate their organs, opinions vary on the risks involved. OBJECTIVE: To determine the risk of cancer transmission associated with organ transplants from deceased donors with primary brain tumors. Key secondary objectives were to investigate the association that donor brain tumors have with organ usage and posttransplant survival. DESIGN, SETTING, AND PARTICIPANTS: This was a cohort study in England and Scotland, conducted from January 1, 2000, to December 31, 2016, with follow-up to December 31, 2020. This study used linked data on deceased donors and solid organ transplant recipients with valid national patient identifier numbers from the UK Transplant Registry, the National Cancer Registration and Analysis Service (England), and the Scottish Cancer Registry. For secondary analyses, comparators were matched on factors that may influence the likelihood of organ usage or transplant failure. Statistical analysis of study data took place from October 1, 2021, to May 31, 2022. EXPOSURES: A history of primary brain tumor in the organ donor, identified from all 3 data sources using disease codes. MAIN OUTCOMES AND MEASURES: Transmission of brain tumor from the organ donor into the transplant recipient. Secondary outcomes were organ utilization (ie, transplant of an offered organ) and survival of kidney, liver, heart, and lung transplants and their recipients. Key covariates in donors with brain tumors were tumor grade and treatment history. RESULTS: This study included a total of 282 donors (median [IQR] age, 42 [33-54] years; 154 females [55%]) with primary brain tumors and 887 transplants from them, 778 (88%) of which were analyzed for the primary outcome. There were 262 transplants from donors with high-grade tumors and 494 from donors with prior neurosurgical intervention or radiotherapy. Median (IQR) recipient age was 48 (35-58) years, and 476 (61%) were male. Among 83 posttransplant malignancies (excluding NMSC) that occurred over a median (IQR) of 6 (3-9) years in 79 recipients of transplants from donors with brain tumors, none were of a histological type matching the donor brain tumor. Transplant survival was equivalent to that of matched controls. Kidney, liver, and lung utilization were lower in donors with high-grade brain tumors compared with matched controls. CONCLUSIONS AND RELEVANCE: Results of this cohort study suggest that the risk of cancer transmission in transplants from deceased donors with primary brain tumors was lower than previously thought, even in the context of donors that are considered as higher risk. Long-term transplant outcomes are favorable. These results suggest that it may be possible to safely expand organ usage from this donor group

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project

Background and objectives: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia. Methods: Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement. Results: Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29. Conclusion: By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome