Immediate-Type Hypersensitivity to Succinylated Corticosteroids

Background: Despite their frequent use, systemic corticosteroids have rarely elicited immediate-type reactions. Objective: We report two male patients, aged 26 and 70 years, respectively, with severe immediate-type hypersensitivity secondary to the administration of corticosteroids esterified with succinate. Methods: Skin tests, basophil activation tests and challenge tests were performed for diagnostic evaluation. Results: In both patients, immediate-type skin test reactions were found to methylprednisolone sodium hemisuccinate (MSH) and prednisolone sodium hemisuccinate (PSH). In contrast, nonsuccinylated corticosteroids (including methylprednisolone and prednisolone in one patient) yielded no test reactions. Basophils from one patient exhibited a stimulated expression of the activation marker CD63 upon in vitro incubation with PSH or hydrocortisone sodium succinate, but not with hydrocortisone. Skin tests and basophil activation tests were negative in controls. One patient was challenged with the incriminated drugs. He developed flush, conjunctivitis, tachycardia and dyspnea 2 min after injection of MSH, and dyspnea shortly after intravenous administration of PSH. Oral and intravenous challenge tests with nonsuccinylated corticosteroids were tolerated well by both patients. Conclusions: These case reports should alert clinicians to rare, but severe immediate-type reactions to corticosteroids, related to the succinate moiety in our patients. In case of allergic reactions to corticosteroids, it is mandatory to identify the causative agent and find safe alternatives. Copyright (C) 2010 S. Karger AG, Base

Indications and outcomes of patients receiving therapeutic plasma exchange under critical care conditions: a retrospective eleven-year ingle-center study at a tertiary care center

Abstract: Background: Therapeutic plasma exchange (TPE) is frequently performed in critical care settings for heterogenous indications. However, specific intensive care unit (ICU) data regarding TPE indications, patient characteristics and technical details are sparse. Methods: We performed a retrospective, single-center study using data from January 2010 until August 2021 for patients treated with TPE in an ICU setting at the University Hospital Zurich. Data collected included patient characteristics and outcomes, ICU-specific parameters, as well as apheresis-specific technical parameters and complications. Results: We identified n = 105 patients receiving n = 408 TPEs for n = 24 indications during the study period. The most common was thrombotic microangiopathies (TMA) (38%), transplant-associated complications (16.3%) and vasculitis (14%). One-third of indications (35.2%) could not be classified according to ASFA. Anaphylaxis was the most common TPE-related complication (6.7%), while bleeding complications were rare (1%). The median duration of ICU stay was 8 ± 14 days. Ventilator support, renal replacement therapy or vasopressors were required in 59 (56.2%), 26 (24.8%), and 35 (33.3%) patients, respectively, and 6 (5.7%) patients required extracorporeal membrane oxygenation. The overall hospital survival rate was 88.6%. Conclusion: Our study provides valuable real-world data on heterogenous TPE indications for patients in the ICU setting, potentially supporting decision-making

Allergy skin prick tests with COVID-19 vaccines and their contribution to improve vaccination readiness and reduce anxiety

Background When coronavirus disease 2019 (COVID-19) vaccines were introduced, they were suspected of triggering severe allergic reactions disproportionately often. This contributed to the fear of vaccination, particularly among allergy patients. Methods In an allergy center in eastern Bavaria, we used a skin prick test to investigate how often sensitization to COVID-19 vaccines can be detected and whether appropriate testing could significantly reduce the fear of vaccination. Results Comirnaty® (n = 245 tested/6.93% clearly positive reaction; Biontec/Pfizer, Mainz, Germany/New York City, NY, USA), Spikevax® (56/14.28%; Moderna, Cambridge, MA, USA), Vaxzevria® (208/4.32%; Astra Zeneca, Cambridge, England) and Jcovden® (48/4.16%; Johnson & Johnson, New Brunswick, NJ, USA) were tested by skin prick test. Most participants tested were female (83.6%) and had a history of allergies (94.8%). Depending on the result of the skin prick test, the test subjects were advised on vaccination. In a questionnaire survey approximately 1 year after testing, 75.7% of the N = 70 respondents stated that their fear of vaccination had been greatly or very greatly reduced as a result of the testing and counseling. In the follow-up survey, 88.5% of all respondents had been vaccinated at least once. No notable allergic problems occurred during the COVID-19 vaccination in study participants. Conclusion The study shows that simple skin prick testing could reduce fears and concerns about allergic reactions to COVID-19 vaccines, and thus significantly increase the willingness to vaccinate in the population, especially among allergy patients

Bioinspired Molecular Factories with Architecture and In Vivo Functionalities as Cell Mimics

Despite huge need in the medical domain and significant development efforts, artificial cells to date have limited composition and functionality. Whereas some artificial cells have proven successful for producing therapeutics or performing in vitro specific reactions, they have not been investigated in vivo to determine whether they preserve their architecture and functionality while avoiding toxicity. Here we overcome these limitations and achieve customizable cell mimic - molecular factories (MFs) - by supplementing giant plasma membrane vesicles derived from donor cells with nanometer-sized artificial organelles (AOs). MFs inherit the donor cell's natural cytoplasm and membrane, while the AOs house reactive components and provide cell-like architecture and functionality. We demonstrate that reactions inside AOs take place in a close-to-nature environment due to the unprecedented level of complexity in the composition of the MFs. We further demonstrate that in a zebrafish vertebrate animal model these cell mimics showed no apparent toxicity and retained their integrity and function. The unique advantages of highly varied composition, multi-compartmentalized architecture, and preserved functionality in vivo open new biological avenues ranging from the study of bio-relevant processes in robust cell-like environments to the production of specific bioactive compounds

The Mechanical Design Of The Bpm Inter-Tank Section For P-Linac At FAIR

At the planned Proton LINAC at the FAIR facility,four-fold button Beam Position Monitor (BPM) will beinstalled at 14 locations along the 30 m long FAIR p-LINAC. The LINAC comprises of crossbar H-mode (CH)cavity to accelerate a 70 mA proton beam up to 70 MeVat frequency of 325 MHz. At four locations, the BPMswill be an integral part of the inter-tank section betweenthe CCH and CH cavities within an evacuated housing.As the BPM centre is only 48 mm apart from the upstreamcavity boundary, the rf-background at the BPMposition, generated by the cavity must be evaluated. Inthis paper the mechanical design of the BPM for the intertanksection is presented and the rf-noise at the BPMlocation is discussed

The Favorable Effects of a High-Intensity Resistance Training on Sarcopenia in Older Community-Dwelling Men with Osteosarcopenia: The Randomized Controlled FrOST Study

Purpose: Sarcopenia, the loss of muscle mass combined with the loss of muscle function, has become a public health issue. There is an urgent need for interventions. The study aimed to determine the effect of high-intensity resistance training (HI-RT), a time- and cost-efficient training modality, on sarcopenia in osteosarcopenic (OS) older men. Methods: Forty-three community-dwelling men aged ≥72 years from Northern Bavaria, Germany, with OS were randomly assigned to either an active HI-RT group (HI-RT) or an inactive control group (CG). Both received dietary protein (up to 1.5 g/kg/day in HI-RT and 1.2 g/kg/day in CG) and Vitamin-D (up to 800 IE/d) supplements. The HI-RT was applied as a consistently supervised single-set training on resistance exercise machines using intensifying strategies, with two training sessions/week, structured into three phases (ranging from 8 to 12 weeks) totaling 28 weeks. The primary study endpoint was the Sarcopenia Z-score; secondary endpoints were changes in the underlying physiological parameters, skeletal muscle mass index (SMI), handgrip-strength and gait velocity. Results: The results show a significant effect of the exercise intervention on the sarcopenia Z-score in the HI-RT (p<0.001) and a significant worsening of it in the CG (p=0.012) in the intention-to-treat analysis, as well as a significant intergroup change (p<0.001). Analysis upon the underlying parameters showed a significant increase of skeletal muscle mass index (SMI) in the HI-RT group (p<0.001) and a significant intergroup difference of SMI (p<0.001) and handgrip strength (p<0.001). There were no adverse effects related to dietary supplementation or training. Conclusion: The results clearly confirm the favorable effects of HI-RT on sarcopenia. We conclude that HI-RT is a feasible, highly efficient and safe training modality for combating sarcopenia, also in the elderly

The SARC-F Questionnaire: Diagnostic Overlap with Established Sarcopenia Definitions in Older German Men with Sarcopenia

Background: The high relevance of sarcopenia for the aging societies of most developed nations is emphasized by its recent inclusion in the ICD-10-CM (M62.84). However, diagnosing sarcopenia is a daunting task. Apart from varying definitions, the proper assessment of recognized sarcopenia criteria is time and cost consuming. A short and inexpensive screening tool may thus be welcome for clinicians and others working in the area of gerontology. Recently, a simple questionnaire was provided (SARC-F) that may adequately realize this aim. Objective: The purpose of this study is to compare established sarcopenia definitions (European Working Group on Sarcopenia in Older People [EWGSOP], Foundation National Institute of Health [FNIH], International Working Group on Sarcopenia [IWGS]) with the SARC-F. Our hypothesis was that the diagnostic overlap between the SARC-F and sarcopenia as determined by these recognized definitions was too low to reliably diagnose sarcopenia. Methods: Seventy-four community-dwelling German men aged 70 years and older with established sarcopenia according to EWGSOP and/or FNIH and/or IWGS were screened with the SARC-F questionnaire. Results: Applying the definitions of EWGSOP, IWGS, and FNIH, 66.2, 43.2, and 50% of the cohort were classified sarcopenic, respectively. The SARC-F identified 33.5% of the cohort as sarcopenic. The predictive power of the SARC-F increased when men were classified as sarcopenic according to 2 (57.1%) or all (78.8%) sarcopenia definitions. The diagnostic overlap with the 3 sarcopenia definitions varied between 38.8% (SARC-F-FNIH) and 54.1% (SARC-F-IWGS). In comparison, the overlap of diagnosed sarcopenia ranged from 27.0% (FNIH-IWGS) to 49.0% (IWGS-EWGSOP) among the definitions themselves. Only 12.2% of the men met all 3 sarcopenia definitions. Conclusion: The diagnostic overlap with respect to sensitivity of the SARC-F and present sarcopenia definitions was at least as high as the range of the diagnostic overlap of these approaches themselves. Thus, although the sensitivity of the SARC-F may be debatable, for want of a better option it seems reasonable to consider the SARC-F as a first simple step within a hierarchical screening procedure. Independently of this procedure, a universally accepted mandatory sarcopenia definition along with comprehensive criteria and fixed cutoff points should be provided promptly

Electronic excitations induced by the impact of coinage metal ions and clusters on a rare gas matrix: neutralization and luminescence

Low energy collisions of atomic ions and cluster ions with rare gas covered metal substrates can lead to strong light emission which is element and size specific. Instead of a direct energy transfer into the electronic system of the cluster the observed emission originates from excitons trapped in the rare gas layer which carries the excitation energy. The nature of the processes involved in the neutralization and excitation of the neutral clusters electronic system are discussed. Strong analogies to thermoluminescence are found