Soluble α2-macroglobulin receptor is increased in endotracheal aspirates from infants and children after cardiopulmonary bypass

ObjectiveCytokine dysregulation contributes to the systemic inflammatory response after cardiopulmonary bypass. Clearance of cytokine binding proteins may be important in the resolution of inflammation. Our aim was to determine whether the cytokine binding protein α2-macroglobulin and its soluble receptor were upregulated in endotracheal aspirates from infants and children undergoing cardiopulmonary bypass.MethodsSeventy tracheal aspirates were collected before and after cardiopulmonary bypass from 35 infants and children undergoing surgical correction of congenital heart defects. α2-Macroglobulin and the soluble α2-macroglobulin receptor were identified by Western blot. With the use of multi-analyte cytokine profiling, pro-inflammatory and anti-inflammatory cytokines were quantified, normalized to total protein, and expressed as ratios. Paired t tests and Wilcoxon signed-rank tests were performed between prebypass and postbypass samples. Correlations were examined among α2-macroglobulin, soluble α2-macroglobulin receptor, cytokine ratios, and the clinical variables of cardiopulmonary bypass, aortic crossclamp, and circulatory arrest times.Resultsα2-Macroglobulin increased by 50% (mean densitometry increase 82,683 ± 184,594, P = .012), and soluble α2-macroglobulin receptor increased by 17% (mean densitometry increase 506,148 ± 687,037, P = .0001) after cardiopulmonary bypass. The ratio of interleukin-8/interleukin-4 increased by 136% (P = .0001), and interleukin-8/interleukin-10 increased by 102% (P = .001). The increase in soluble α2-macroglobulin receptor was positively correlated with the ratios of interleukin-8/interleukin-4 and interleukin-8/interleukin-10. There were no statistically significant positive correlations between the increase in α2-macroglobulin or soluble α2-macroglobulin receptor and measured clinical variables.ConclusionsWe report for the first time the upregulation of α2-macroglobulin and soluble α2-macroglobulin receptor in tracheal aspirates after cardiopulmonary bypass in infants and children. Soluble α2-macroglobulin receptor correlates with increased α2-macroglobulin and a disproportionate increase in pro-inflammatory to anti-inflammatory cytokine ratios

miR-181a/b downregulation exerts a protective action on mitochondrial disease models.

Mitochondrial diseases (MDs) are a heterogeneous group of devastating and often fatal disorders due to defective oxidative phosphorylation. Despite the recent advances in mitochondrial medicine, effective therapies are still not available for these conditions. Here, we demonstrate that the microRNAs miR-181a and miR-181b (miR-181a/b) regulate key genes involved in mitochondrial biogenesis and function and that downregulation of these miRNAs enhances mitochondrial turnover in the retina through the coordinated activation of mitochondrial biogenesis and mitophagy. We thus tested the effect of miR-181a/b inactivation in different animal models of MDs, such as microphthalmia with linear skin lesions and Leber\u27s hereditary optic neuropathy. We found that miR-181a/b downregulation strongly protects retinal neurons from cell death and significantly ameliorates the disease phenotype in all tested models. Altogether, our results demonstrate that miR-181a/b regulate mitochondrial homeostasis and that these miRNAs may be effective gene-independent therapeutic targets for MDs characterized by neuronal degeneration

miR-181a/b downregulation exerts a protective action on mitochondrial disease models.

Mitochondrial diseases (MDs) are a heterogeneous group of devastating and often fatal disorders due to defective oxidative phosphorylation. Despite the recent advances in mitochondrial medicine, effective therapies are still not available for these conditions. Here, we demonstrate that the microRNAs miR-181a and miR-181b (miR-181a/b) regulate key genes involved in mitochondrial biogenesis and function and that downregulation of these miRNAs enhances mitochondrial turnover in the retina through the coordinated activation of mitochondrial biogenesis and mitophagy. We thus tested the effect of miR-181a/b inactivation in different animal models of MDs, such as microphthalmia with linear skin lesions and Leber's hereditary optic neuropathy. We found that miR-181a/b downregulation strongly protects retinal neurons from cell death and significantly ameliorates the disease phenotype in all tested models. Altogether, our results demonstrate that miR-181a/b regulate mitochondrial homeostasis and that these miRNAs may be effective gene-independent therapeutic targets for MDs characterized by neuronal degeneration.Italian Fondazione Telethon (grant no. TGM16YGM02 to S. Ban, the Fondazione Roma (grant no. RP‐201300000009 to S. Ban)) and the AFM‐Telethon (grant no. 20685 to B.F.). A.I. received an Umberto Veronesi Fellowship. This research was carried out in the frame of Programme STAR, financially supported by UniNA and Compagnia di San Paolo (Bando STAR, 16‐CSP‐UNINA‐048, to A.I)

Unusual anatomic variant of the axillary nerve challenging the deltopectoral approach to the shoulder: a case report

Abstract Background The deltopectoral approach is a well-described surgical approach to the proximal humerus and glenohumeral joint. One of the structures at risk during this approach is the axillary nerve. Typically, the axillary nerve arises off the posterior cord of the brachial plexus and courses lateral to the proximal humerus and inferior to the glenohumeral joint, exiting the axilla through the quadrangular space. We describe a case of an aberrant axillary nerve, coursing anteriorly across the glenohumeral joint within the deltopectoral groove encountered during a reverse total shoulder arthroplasty. Case presentation A 73-year-old female presented complaining of atraumatic progressive right shoulder pain of several months duration. Clinical and radiographic findings were consistent with advanced rotator cuff arthropathy. After failing appropriate non-operative treatment, the patient elected to undergo reverse total shoulder arthroplasty. During the deltopectoral approach to the glenohumeral joint, the axillary nerve was found to be coursing deep to the cephalic vein within the deltopectoral interval. The nerve was isolated and protected, and the glenohumeral joint was accessed via a small window in the anterior deltoid muscle. The remainder of the procedure was performed without complication. The patient was found to be healing well and with normal axillary nerve function at 4-month follow-up. Conclusions Neurologic lesions are well-documented complications of reverse total shoulder arthroplasty. The integrity of the axillary nerve is of particular importance to reverse total shoulder arthroplasty as it innervates the deltoid and post-operative function of the extremity is dependent upon a functioning deltoid muscle. Extreme care must be taken to avoid insult to the axillary nerve and any aberrant paths it may course around the glenohumeral joint

Use of antibiotic-cement coated locking plates in the setting of periprosthetic infection and infected nonunion

INTRODUCTION: In the setting of periprosthetic total hip and knee arthroplasty (THA/TKA) infection, plating of the femur may be necessary for fracture fixation, prophylactic fixation of the femur, poor bone quality, or infected femoral shaft nonunion. The purpose of this study was to investigate infection control rates and fracture healing in patients receiving antibiotic cement coated plates in the setting of infected nonunion and periprosthetic infections. METHODS: We retrospectively reviewed a series of ten patients who had an antibiotic coated plate placed in the setting of periprosthetic infection or infected nonunion with a minimum follow-up of six months. 80 g of Simplex bone cement (Stryker, Mahwah, NJ) were mixed with 4 g of powdered vancomycin and 4.8 g of powdered tobramycin and applied to a dynamic compression plate with locking screw guides in every hole. The antibiotic loaded cement was allowed to harden before implantation. Outcome measures were designed to assess for fracture healing defined as three out of four cortices united on radiographs along with bearing full weight without pain and evidence of infection control defined as normalized erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in the absence of antibiotic treatment with no clinical signs of infection. RESULTS: Ten patients were treated with an antibiotic cement coated plate in the settings of infectious nonunion and periprosthetic infection and followed for an average of three years (mean 21.4 months, seven months to 61 months). Eight patients (80%) went on to successful control of infection after initial procedure. Two patients developed chronic drainage and had a second antibiotic spacer with antibiotic cement coated plate placed before the infection was controlled. All patients obtained successful control of infection at latest follow-up showing no clinical signs of infection, normalized laboratory markers, and negative culture results. There were no reported mechanical failures of the implant, fractures of the femur, or soft tissue complications. CONCLUSION: An antibiotic cement coated plating technique is a viable option for periprosthetic THA and TKA infections requiring plating of the femur or in patients with an infected nonunion

MENINGKATKAN KEMAMPUAN MEMBACA DINI PADA ANAK USIA TAMAN KANAK-KANAK DENGAN METODE SHARED READING

Membaca dini adalah kegiatan fisik dan mental untuk menemukan makna dari tulisan, walaupun dalam tulisan itu terjadi proses pengenalan huruf-huruf. kemampuan membaca dini pada anak usia taman kanak-kanak merupakan salah satu pondasi awal agar anak mampu berinteraksi dengan lingkungan sekitar serta memasuki jenjang pendidikan yang lebih tinggi. tujuan dari penelitian ini antara lain 1) untuk mengetahui kemampuan membaca dini pada anak usia taman kanak-kanak di paud gamus sebelum menggunakan metode shared reading, 2) untuk mengetahui kemampuan membaca dini pada anak usia taman kanak-kanak di paud gamus setelah menggunakan metode shared reading, 3) untuk mengetahui perbedaan kemampuan membaca dini pada anak usia taman kanak-kanak di paud gamus sebelum dan setelah menggunakan metode shared reading. penelitian ini dilaksanakan di paud gamus kelurahan gegerkalong pada kelompok b yang berjumlah 21 anak. temuan penelitian menunjukkan bahwa melalui penerapan metode shared reading, kemampuan anak dalam membaca dini mengalami peningkatan yang lebih baik, hal tersebut ditunjukkan oleh uji hipotesis yang menunjukkan data pretes-postes yang signifikan karena memiliki nilai p<0,05 yaitu nilai rata-rata setelah diterapkan metode shared reading meningkat yang pada awalnya 18,1905 menjadi 27.7143. melalui analisis yang telah dilakukan, ditemukan bahwa metode shared reading memiliki pengaruh positif pada aktivitas guru dalam mempersiapkan pengalaman belajar baru bagi anak untuk meningkatkan kemampuan membaca dini. Abstract Early reading is a physical and mental activities to discover the meaning of the text, although in the writing was a process of recognition of letters. early reading skills in children ages kindergarten is one of the early foundation for children to interact with the environment and entering higher education. the aim of this study include 1) for early reading skills in children of kindergarten age in early childhood gamus before using the shared reading, 2) to assess early reading skills in children of kindergarten age in early childhood gamus after using the shared reading, 3) to determine differences in early reading skills in children of kindergarten age in early childhood gamus before and after using the shared reading. the research was carried out in early childhood gamus village gegerkalong in group b, which has 21 children. the findings showed that by applying the method shared reading, children's ability to read early has increased better, it was shown by testing the hypothesis that the data showed a significant pretest-posttest because it has value p <0.05 is the average value after application shared reading improved method that initially 18.1905 to 27.7143. through the analysis conducted, it was found that the method of shared reading has a positive effect on the activity of teachers in preparing a new learning experience for children to enhance early literacy