Mycophenolate mofetil in the treatment of lupus nephritis

Lupus nephritis is a complication of systemic lupus erythematosus, which has significant morbidity and mortality. The accepted standard of treatment for severe lupus nephritis is cyclophosphamide for induction of remission. This has significant adverse effects including severe infection and amenorrhea. In addition, although cyclophosphamide induces remission, long-term mortality does not seem to be altered. Mycophenolate mofetil (MMF) is an immunosuppressive agent originally used in solid organ transplantation, which has been compared with cyclophosphamide in trials for lupus nephritis. Randomized trials with MMF have been relatively small, although pooled data seem to suggest that it is at least as effective as cyclophosphamide in inducing remission. In addition, MMF has also been associated with a reduced risk of infection and amenorrhea, although this finding is not universal. MMF appears to be associated with more diarrhea compared with cyclophosphamide. MMF is likely to be a useful treatment for lupus nephritis, although available trial data are limited due to the small size of previous studies. A large trial (the Aspreva Lupus Management Study) is currently underway to attempt to establish the place of MMF in treatment of lupus nephritis

Effect Of Seasonal Rainfall And Other Environmental Changes, On Snail Density And Infection Rates With Schistosoma mansoni Fifteen Years After The Last Snails\' Study In Kigungu, Entebbe, Uganda

Background: The last study on snail population density in relation to rainfall pattern in Kigungu canoe landing and recreational sites on Lake Victoria shore was earlier carried out about fifteen years ago. This study also reviewed the influence of other environmental factors on the snails\' infection rate. Objective: To reassess the density dynamic of Biomphalaria (B) choanomphala and Biomphalaria (B) pfeifferi, which act as the intermediate host for S. mansoni and Bulinus (B) globosus, and Bulinus (B) tropicus, which act as intermediate host for S. haematobium. Design: Retrospective study. Setting: Busy canoe landing sites along Lake Victoria in Kigungu fishing village were selected for the snail sampling. Results: Nine thousand one hundred and ninety four B. choanomphala were collected over the study period. The numbers of B. choanomphala collected in each year was 4742 (51.6%) and 4452 (48.4%) in 2004 and 2005 respectively. Of the 4742 B.Choanomphala collected in 2004, 82 (1.7%) shed human cercariae and 329 (6.7%) shed non-human cercariae. Whereas in 2005, out of 4452 B. choanomphala collected 302 (6.85%) shed non-human cercariae and 82 (1.8%) shed human cercariae. Similarly, 4173 B. pfeifferi were also collected in the same period. Out of which 2224 (53.3%) were collected in 2004 and 1949 (46.7%) in 2005. For B. pfeifferi, 42 (1.9%) out of 2224 snails collected in 2004 shed human cercariae and 246 (11.1%) shed non-human cercariae. While in 2005, 33 out of 1949 snails (1.7%) shed human cercariae and 159 (8.2%) shed non-human cercariae. Other snails of medical importance collected included 292 B. globosus and 3094 B. tropicus. None of the Bulinus spp. collected shed any human cercariae but 37 (2.1%) and 30 (2.3%) B. tropicus shed non-human cercariae in 2004 and 2005 respectively. In 2004 and 2005, the area received, 1729mm and 1959mm of rainfall respectively. The mean rainfall during the year was 144.05 mm and 163.3 mm in 2004 and 2005 respectively. There was a negative correlation between rainfalls and snail density dynamic. Conclusion: We have found in this study that in spite of the bush clearing of the papyrus swamps which originally was the major habitats for B. choanomphala, B. pfeifferi and the Bulinus spp the intermediate host for schistosome at all canoe landing sites at Kigungu, these snails are still present. Moreover, that their population density dynamic and infection rate are inversely proportional to the rainfall pattern. East African Medical Journal Vol. 85 (11) 2008: pp. 556-56

Development of a device to simulate tooth mobility

Objectives: The testing of new materials under simulation of oral conditions is essential in medicine. For simulation of fracture strength different simulation devices are used for test set-up. The results of these in vitro tests differ because there is no standardization of tooth mobility in simulation devices. The aim of this study is to develop a simulation device that depicts the tooth mobility curve as accurately as possible and creates reproducible and scalable mobility curves. Materials and methods: With the aid of published literature and with the help of dentists, average forms of tooth classes were generated. Based on these tooth data, different abutment tooth shapes and different simulation devices were designed with a CAD system and were generated with a Rapid Prototyping system. Then, for all simulation devices the displacement curves were created with a universal testing machine and compared with the tooth mobility curve. With this new information, an improved adapted simulation device was constructed. Results: A simulations device that is able to simulate the mobility curve of natural teeth with high accuracy and where mobility is reproducible and scalable was developed

Endosomal structure and APP biology are not altered in a preclinical mouse cellular model of Down syndrome

Individuals who have Down syndrome (trisomy 21) are at greatly increased risk of developing Alzheimer’s disease, characterised by the accumulation in the brain of amyloid-β plaques. Amyloid-β is a product of the processing of the amyloid precursor protein, encoded by the APP gene on chromosome 21. In Down syndrome the first site of amyloid-β accumulation is within endosomes, and changes to endosome biology occur early in Alzheimer’s disease. Here, we determine if primary mouse embryonic fibroblasts isolated from a mouse model of Down syndrome can be used to study endosome and APP cell biology. We report that in this cellular model, endosome number, size and APP processing are not altered, likely because APP is not dosage sensitive in the model, despite three copies of App

What influences the speed of prototyping? An empirical investigation of twenty software startups

It is essential for startups to quickly experiment business ideas by building tangible prototypes and collecting user feedback on them. As prototyping is an inevitable part of learning for early stage software startups, how fast startups can learn depends on how fast they can prototype. Despite of the importance, there is a lack of research about prototyping in software startups. In this study, we aimed at understanding what are factors influencing different types of prototyping activities. We conducted a multiple case study on twenty European software startups. The results are two folds, firstly we propose a prototype-centric learning model in early stage software startups. Secondly, we identify factors occur as barriers but also facilitators for prototyping in early stage software startups. The factors are grouped into (1) artifacts, (2) team competence, (3) collaboration, (4) customer and (5) process dimensions. To speed up a startups progress at the early stage, it is important to incorporate the learning objective into a well-defined collaborative approach of prototypingComment: This is the author's version of the work. Copyright owner's version can be accessed at doi.org/10.1007/978-3-319-57633-6_2, XP2017, Cologne, German

Delirium: Issues in diagnosis and management

Delirium is a disturbance of consciousness, cognition and perception that occurs frequently in medically ill patients. Although it is associated with increased morbidity and mortality, it is often not recognized and treated by physicians. Literature searches were conducted using MEDLINE with the following keywords/ phrases: delirium, acute confusion and management. Additional articles identified by hand-searching in major journals of medicine and psychiatry, and a review of references cited within these sources supplemented the search. In this article, the available published literature regarding the diagnosis, prevention and treatment of delirium is systematically reviewed. Prevention and treatment strategies do not need to be complex or expensive but require well-coordinated interventions from multiple disciplines, including nursing, psychiatry, neurology and primary care, as well as the cooperation and significant effort of family and friends. Atypical antipsychotic agents offer some advantages over haloperidol and in a limited number of studies appear safe and effective for delirium.D\ue9lire est une perturbation. de conscience, cognition et de perception qui se produit fr\ue9quemment en m\ue9dicalement malades. M\ueame s\u2019il est associ\ue9 \ue0 une augmentation de la morbidit\ue9 et mortalit\ue9, Il est souvent pas reconnus et trait\ue9 par les m\ue9decins. Litt\ue9rature recherches ont \ue9t\ue9 effectu\ue9es en utilisant MEDLINE avec les mots cles/phrases suivantes: d\ue9lire, confusion aigue, et de Gestion. Articles suppl\ue9mentaires identifi \ue9 \ue0 la main dans les grandes feuilles de m\ue9decine et de psychiatrie, la recherche et d\u2019un examen des r\ue9f\ue9rences cit\ue9es dans ces sources compl\ue9t\ue9 la recherche. Dans cet article, le disponible publi\ue9 litt\ue9rature concernant le diagnostic, la pr\ue9vention et traitement de d\ue9lire est syst\ue9matiquement examin\ue9. La pr\ue9vention et strat\ue9gies de traitement ne doivent pas \ueatre complexes ou on\ue9reux mais n\ue9cessite interventions bien coordonn\ue9es de plusieurs disciplines, y compris les soins infi rmiers, psychiatrie, neurologie et de soins primaires, ainsi que la coop\ue9ration et effort important de la famille et amis. Agents antipsychotiques atypiques offre certains avantages sur Halop\ue9ridol et dans un nombre limit\ue9 d\u2019\ue9tudes s\u2019affi chent sans danger effi cace et de d\ue9lire

Weight-for-Height, Body Fat, and Development in Children in the East Asia and Pacific Region

Importance: Weight-for-height z score (WHZ) is a standard indicator of children’s nutritional status even though it does not fully reflect body fat. Objective: To examine the combined association of WHZ and body fat with early development in the East Asia and Pacific region. Design, Setting, and Participants: Children from the East Asia–Pacific Early Child Development Scales validation study, with full data available regarding their nutritional status and outcomes, were included in this cross-sectional analysis. In brief, a multilevel stratified random sampling was used to select representative samples from each participating country in the study. WHZ and body fat were independently trichotomized using established references and were combined to form a 9-category exposure variable. Data collection was performed between 2012 and 2014, and the analyses were conducted in June 2021. Main Outcomes and Measures: The binary outcome variable of not being developmentally on track (hereafter referred to as poor development) was defined as a score less than the 25th percentile in the following domains: cognitive, language, socioemotional, motor development, and total development score. Poisson regression models were used to analyze the associations between the combined categories and poor development, adjusted for sociodemographic factors. Results: A total of 6815 children (mean [SD] age, 4.02 [0.8] years; 3434 girls [50.4%]) had full data available and were included in this study. Compared with children with normal weight and normal fat, those with wasting and low body fat had the highest likelihood of total poor development (prevalence ratio, 1.47; 95% CI, 1.28-1.70), followed by those with normal weight but low fat (prevalence ratio, 1.23; 95% CI, 1.11-1.36). Similar associations were found in language, cognitive, and socioemotional development, but not in motor development. Conclusions and Relevance: Poor development was more commonly found in children with low body fat independent of WHZ (wasted or normal weight). Early public health strategies may consider using a combination of WHZ and body fat as an indicator of poor development

Three-dimensional jamming and flows of soft glassy materials

Various disordered dense systems such as foams, gels, emulsions and colloidal suspensions, exhibit a jamming transition from a liquid state (they flow) to a solid state below a yield stress. Their structure, thoroughly studied with powerful means of 3D characterization, exhibits some analogy with that of glasses which led to call them soft glassy materials. However, despite its importance for geophysical and industrial applications, their rheological behavior, and its microscopic origin, is still poorly known, in particular because of its nonlinear nature. Here we show from two original experiments that a simple 3D continuum description of the behaviour of soft glassy materials can be built. We first show that when a flow is imposed in some direction there is no yield resistance to a secondary flow: these systems are always unjammed simultaneously in all directions of space. The 3D jamming criterion appears to be the plasticity criterion encountered in most solids. We also find that they behave as simple liquids in the direction orthogonal to that of the main flow; their viscosity is inversely proportional to the main flow shear rate, as a signature of shear-induced structural relaxation, in close similarity with the structural relaxations driven by temperature and density in other glassy systems.Comment: http://www.nature.com/nmat/journal/v9/n2/abs/nmat2615.htm

Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study

OBJECTIVES: To describe the impact of the COVID-19 pandemic on outpatient appointments for children and young people. SETTING: All National Health Service (public) hospitals in England. PARTICIPANTS: All people in England aged <25 years. OUTCOME MEASURES: Outpatient department attendance numbers, rates and modes (face to face vs telephone) by age group, sex and socioeconomic deprivation. RESULTS: Compared with the average for January 2017 to December 2019, there was a 3.8 million appointment shortfall (23.5%) for the under-25 population in England between March 2020 and February 2021, despite a total rise in phone appointments of 2.6 million during that time. This was true for each age group, sex and deprivation fifth, but there were smaller decreases in face to face and total appointments for babies under 1 year. For all ages combined, around one in six first and one in four follow-up appointments were by phone in the most recent period. The proportion of appointments attended was high, at over 95% for telephone and over 90% for face-to-face appointments for all ages. CONCLUSIONS: COVID-19 led to a dramatic fall in total outpatient appointments and a large rise in the proportion of those appointments conducted by telephone. The impact that this has had on patient outcomes is still unknown. The differential impact of COVID-19 on outpatient activity in different sociodemographic groups may also inform design of paediatric outpatient services in the post-COVID period