Atopic dermatitis: Is innate or adaptive immunity in control? A clinical perspective

Atopic dermatitis (AD) is a chronic inflammatory skin disease with barrier defects and immune dysregulations. The pathogenesis of AD involves the physical barrier as well as epithelial cells, which are considered a vital part of the innate immunity of the skin. The importance of filaggrin mutations in the pathogenesis of AD has also been well-established with reproducible results around the world in multiple studies and ethnic groups. This protein plays an important role in skin barrier functions and further reaffirms barrier defects as one of the primary causes of AD. The main epithelial cells, keratinocytes, function as a major sentinel for the skin in detecting danger signals or microbial pathogens, and trigger downstream immune responses. In AD, these cells express TSLP, IL-33 and IL-25, which lead to downstream systemic production of type 2 cytokines. In spite of major advances in our understanding of the innate immunity of AD, recent success in the systemic therapeutics of AD have focused on targeting the products of the adaptive immunity, particularly cytokines produced by T cells. In addition to type 2 cytokines, type 17 cytokines have also been implicated in the pathogenesis of AD. The current review examines the implications of these cytokines in AD from clinical perspectives

Effects of Escherichia coli vaccination in gilts on piglet performance in a farm in Perak

This study aimed to observe the effects of Escherichia coli (Neocoliporvaccine – Merial) vaccination on diarrhoea percentages, growth parameters (average weight per piglet and average daily gain) and mortality rate in new-born piglets. A field trial was conducted in 35 litters of piglets from gilts selected from a farm in Perak. They were randomly allocated into Treatment (16 litters from E. coli vaccinated gilts) and Control (19 litters) groups respectively. Body weights of the piglets were measured at days 1, 7, 14 and 21 of age and the episodes of diarrhoea and piglet mortality were monitored daily for each pen. The Treatment group had significantly lower Day 1 neonatal diarrhoea percentage (p 0.05)in the overall diarrhoea percentages (1 - 14 days) and weekly growth parameters between both groups. Environmental stress and inevitable routine treatment of diarrhoea with antimicrobials within the farm may have affected the significance of the diarrhoea percentages and growth parameters in this study. In conclusion, E. coli vaccination in gilts was shown to significantly reduce piglet mortality from Day 1 to Day 7 and neonatal diarrhoeal percentageson1-day-old piglets under typical farm conditions in this pilot study in Malaysia

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

First measurements of hadronic decays of the Z boson

We have observed hadronic final states produced in the decays of Z bosons. In order to study the parton structure of these events, we compare the distributions in sphericity, thurst, aplanarity, and number of jets to the predictions of several QCD-based models and to data from lower energies. The data and models agree within the present statistical precision

Initial measurements of Z-boson resonance parameters in e+e- annihilation

We have measured the mass of the Z boson to be 91.11±0.23 GeV/c^2, and its width to be 1.61-0.43+0.60 GeV. If we constrain the visible width to its standard-model value, we find the partial width to invisible decay modes to be 0.62±0.23 GeV, corresponding to 3.8±1.4 neutrino species

Update on Atopic Dermatitis: Diagnosis, Severity Assessment, and Treatment Selection

© 2019 American Academy of Allergy, Asthma & Immunology Atopic dermatitis (AD) is one of the most common inflammatory skin diseases affecting children and adults. The intense pruritus and rash can be debilitating, significantly impairing quality of life. Until recently, treatment was largely nonspecific and, in severe disease, sometimes ineffective and/or fraught with many side effects. Now, multiple agents targeting specific disease pathways are available or in development. Two new therapies, crisaborole and dupilumab, have become available since 2016, and dupilumab has dramatically improved outcomes for adults with severe AD. This article provides an overview of AD, including strategies for differential diagnosis and assessment of disease severity to guide treatment selection. Key clinical trials for crisaborole and dupilumab are reviewed, and other targeted treatments now in development are summarized. Two cases, representing childhood-onset and adult-onset AD, are discussed to provide clinical context for diagnosis, severity assessment, and treatment selection and outcomes