676 research outputs found

    Chitotriosidase as a biomarker of cerebral adrenoleukodystrophy

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    <p>Abstract</p> <p>Background</p> <p>Adrenoleukodystrophy (ALD) is an X-linked peroxisomal disorder characterized by the abnormal beta-oxidation of very long chain fatty acids (VLCFA). In 35-40% of children with ALD, an acute inflammatory process occurs in the central nervous system (CNS) leading to demyelination that is rapidly progressive, debilitating and ultimately fatal. Allogeneic hematopoietic stem cell transplantation (HSCT) can halt disease progression in cerebral ALD (C-ALD) if performed early. In contrast, for advanced patients the risk of morbidity and mortality is increased with transplantation. To date there is no means of quantitating neuroinflammation in C-ALD, nor is there an accepted measure to determine prognosis for more advanced patients.</p> <p>Methods</p> <p>As cellular infiltration has been observed in C-ALD, including activation of monocytes and macrophages, we evaluated the activity of chitotriosidase in the plasma and spinal fluid of boys with active C-ALD. Due to genotypic variations in the chitotriosidase gene, these were also evaluated.</p> <p>Results</p> <p>We document elevations in chitotriosidase activity in the plasma of patients with C-ALD (n = 38; median activity 1,576 ng/mL/hr) vs. controls (n = 16, median 765 ng/mL/hr, p = 0.0004), and in the CSF of C-ALD patients (n = 38; median activity 4,330 ng/mL/hr) vs. controls (n = 16, median 0 ng/mL/hr, p < 0.0001). In addition, activity levels of plasma and CSF chitotriosidase prior to transplant correlated with progression as determined by the Moser/Raymond functional score 1 year following transplantation (p = 0.002 and < 0.0001, respectively).</p> <p>Conclusions</p> <p>These findings confirm elevation of chitotriosidase activity in patients with active C-ALD, and suggest that these levels predict prognosis of patients with C-ALD undergoing transplantation.</p

    A meta-analysis of point-of-care laboratory tests in the diagnosis of novel 2009 swine-lineage pandemic influenza A (H1N1)

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    Abstract This paper reviews 14 published studies describing performance characteristics, including sensitivity and specificity, of commercially available rapid, point-of-care (POC) influenza tests in patients affected by an outbreak of a novel swine-related influenza A (H1N1) that was declared a pandemic in 2009. Although these POC tests were not intended to be specific for this pandemic influenza strain, the nonspecialized skills required and the timeliness of results make these POC tests potentially valuable for clinical and public health use. Pooled sensitivity and specificity for the POC tests studied were 68% and 81%, respectively, but published values were not homogeneous with sensitivities and specificities ranging from 10% to 88% and 51% to 100%, respectively. Pooled positive and negative likelihood ratios were 5.94 and 0.42, respectively. These results support current recommendations for use of rapid POC tests when H1N1 is suspected, recognizing that positive results are more reliable than negative results in determining infection, especially when disease prevalence is high

    Temperatures achieved in human and canine neocortex during intraoperative passive or active focal cooling

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    Focal cortical cooling inhibits seizures and prevents acquired epileptogenesis in rodents. To investigate the potential clinical utility of this treatment modality, we examined the thermal characteristics of canine and human brain undergoing active and passive surface cooling in intraoperative settings. Four patients with intractable epilepsy were treated in a standard manner. Before the resection of a neocortical epileptogenic focus, multiple intraoperative studies of active (custom-made cooled irrigation-perfused grid) and passive (stainless steel probe) cooling were performed. We also actively cooled the neocortices of two dogs with perfused grids implanted for 2 hours. Focal surface cooling of the human brain causes predictable depth-dependent cooling of the underlying brain tissue. Cooling of 0.6–2°C was achieved both actively and passively to a depth of 10–15 mm from the cortical surface. The perfused grid permitted comparable and persistent cooling of canine neocortex when the craniotomy was closed. Thus, the human cortex can easily be cooled with the use of simple devices such as a cooling grid or a small passive probe. These techniques provide pilot data for the design of a permanently implantable device to control intractable epilepsy

    Color-Coding Improves Parental Understanding of Body Mass Index Charting

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    To assess parental understanding of body mass index (BMI) and BMI percentiles using standard versus color-coded charts and investigate how parental literacy and/or numeracy (quantitative skills) impacts that understanding

    A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity

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    BACKGROUND: Chronic non-cancer pain is a common problem that is often accompanied by psychiatric comorbidity and disability. The effectiveness of a multi-disciplinary pain management program was tested in a 3 month before and after trial. METHODS: Providers in an academic general medicine clinic referred patients with chronic non-cancer pain for participation in a program that combined the skills of internists, clinical pharmacists, and a psychiatrist. Patients were either receiving opioids or being considered for opioid therapy. The intervention consisted of structured clinical assessments, monthly follow-up, pain contracts, medication titration, and psychiatric consultation. Pain, mood, and function were assessed at baseline and 3 months using the Brief Pain Inventory (BPI), the Center for Epidemiological Studies-Depression Scale scale (CESD) and the Pain Disability Index (PDI). Patients were monitored for substance misuse. RESULTS: Eighty-five patients were enrolled. Mean age was 51 years, 60% were male, 78% were Caucasian, and 93% were receiving opioids. Baseline average pain was 6.5 on an 11 point scale. The average CESD score was 24.0, and the mean PDI score was 47.0. Sixty-three patients (73%) completed 3 month follow-up. Fifteen withdrew from the program after identification of substance misuse. Among those completing 3 month follow-up, the average pain score improved to 5.5 (p = 0.003). The mean PDI score improved to 39.3 (p < 0.001). Mean CESD score was reduced to 18.0 (p < 0.001), and the proportion of depressed patients fell from 79% to 54% (p = 0.003). Substance misuse was identified in 27 patients (32%). CONCLUSIONS: A primary care disease management program improved pain, depression, and disability scores over three months in a cohort of opioid-treated patients with chronic non-cancer pain. Substance misuse and depression were common, and many patients who had substance misuse identified left the program when they were no longer prescribed opioids. Effective care of patients with chronic pain should include rigorous assessment and treatment of these comorbid disorders and intensive efforts to insure follow up

    Dispersive transport and symmetry of the dispersion tensor in porous media

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    The macroscopic laws controlling the advection and diffusion of solute at the scale of the porous continuum are derived in a general manner that does not place limitations on the geometry and time evolution of the pore space. Special focus is given to the definition and symmetry of the dispersion tensor that is controlling how a solute plume spreads out. We show that the dispersion tensor is not symmetric and that the asymmetry derives from the advective derivative in the pore-scale advection-diffusion equation. When flow is spatially variable across a voxel, such as in the presence of a permeability gradient, the amount of asymmetry can be large. As first shown by Auriault [J.-L. Auriault et al. Transp. Porous Med. 85, 771 (2010)TPMEEI0169-391310.1007/s11242-010-9591-y] in the limit of low Péclet number, we show that at any Péclet number, the dispersion tensor D_{ij} satisfies the flow-reversal symmetry D_{ij}(+q)=D_{ji}(-q) where q is the mean flow in the voxel under analysis; however, Reynold's number must be sufficiently small that the flow is reversible when the force driving the flow changes sign. We also demonstrate these symmetries using lattice-Boltzmann simulations and discuss some subtle aspects of how to measure the dispersion tensor numerically. In particular, the numerical experiments demonstrate that the off-diagonal components of the dispersion tensor are antisymmetric which is consistent with the analytical dependence on the average flow gradients that we propose for these off-diagonal components

    NFIL3-Deficient Mice Develop Microbiota-Dependent, IL-12/23-Driven Spontaneous Colitis

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    NFIL3 (nuclear factor, IL-3 regulated) is a transcription factor that regulates multiple immunologic functions. In myeloid cells, NFIL3 is IL-10 inducible, and has a key role as a repressor of IL-12p40 transcription. NFIL3 is a susceptibility gene for the human inflammatory bowel diseases. Here we describe spontaneous colitis in Nfil3−/− mice. Mice lacking both Nfil3 and Il10 (NIDKO) had severe early-onset colitis, suggesting NFIL3 and IL-10 independently regulate mucosal homeostasis. Lymphocytes were necessary for colitis, as Nfil3/Rag1 double knockout (NRDKO) mice were protected from disease. However, NRDKO mice adoptively transferred with wild type CD4+ T cells developed severe colitis compared to Rag1−/− recipients, suggesting that colitis was linked to defects in innate immune cells. Colitis was abrogated in Nfil3/Il12b double-deficient mice, identifying Il12b dysregulation as a central pathogenic event. Finally, germ-free Nfil3−/− mice do not have colonic inflammation. Thus, NFIL3 is a microbiota-dependent, IL-10-independent regulator of mucosal homeostasis via IL-12p40
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