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Introduction The majority of radiocontrast media (RCM) reactions are from direct mast cell degeneration,[1] but there are some patients with recurrent reactions despite standard premedication who may have immediate hypersensitivity reactions[1] (IHR). Although some have found skin testing a helpful tool,[2] consensus on the best method of diagnosis and treatment is lacking. Case Description The patient is a 73-year-old Caucasian female with history of angioedema and urticaria after RCM administration on three separate occasions, despite premedication[3] with the last two exposures, history of asthma, and bicuspid aortic valve status post replacement in 2016. She presented with dyspnea and chest discomfort, diagnosed with severe prosthetic stenosis, and TAVR was recommended. Due to need for cardiac intervention with RCM, the patient underwent skin prick testing followed by intradermal testing with Iodixanol, resulting positive. Therefore, an IgE-mediated IHR to contrast dye was deduced and the patient received a desensitization protocol[4] in addition to a stronger premedication regimen[4] prior to her cardiac intervention. This was successful in preventing angioedema or urticaria, with only mild pruritus and erythema on her extremities, which resolved within 24 hours. Discussion With at least seventy million patients exposed to RCM yearly,[5] Allergist face a growing need for an efficient IHR evaluation protocol. Risk factors for recurrent reaction currently include prior severe allergic reaction to any substance, drug allergies, chronic oral glucocorticoid use, and allergy to four or more allergens.[6] Without all variables for IHR in RCM known, there remains much ambiguity in evaluation strategy, with further research required.

OBJECTIVES: To evaluate the impact of a dietary supplement within an elderly population who reside in a Community Living Center (CLC; VA Nursing Home), on the number of respiratory tract infections (RTIs) during a 90-day study period. METHODS: This is a randomized, double-blind, placebo-controlled study to evaluate the impact of bovine Lactoferrin (bLf) on RTIs in an elderly nursing home population in the US. Subjects will be residents of the CLC and screened within 21 days prior to starting study supplementation. Eligible participants were at least 55 years of age, able to eat and drink and expected to reside at the CLC for the duration of the study. Consent was obtained from the study participant or their legally recognized representative decision maker. Participants will be excluded if: receiving tube feeds or specialized diets for eating disorders; immunocompromised; have a life expectancy of less than six months; or allergic to study products. RESULTS: Subjects will be randomized in a ratio of 1:1 to either investigational (600 mg of bLf) or (placebo arms. All participants will take study supplement by mouth daily for 90 days. Subjects will be assessed daily for RTI symptoms. Blood and saliva will be collected at 45 and 90 days. Ad hoc assessments and a nasal sample will take place if a subject develops a protocol-defined RTI. CONCLUSIONS: The primary outcome will be number of RTIs over the 90-day study period. Secondary outcomes include severity and duration of RTI symptoms, symptoms associated with RTIs, number of RTI complications, and nasopharyngeal swab at onset of RTI, Other secondary outcomes include the following, all measured at baseline, day 45 and day 90: quality of life by questionnaire, weight, saliva markers, laboratory testing and immunological markers. An exploratory endpoint is vaccine specific inflammatory panel (influenza and Sars-Cov2) measured upon vaccination during supplement period. RTI number, severity, duration and complications and medically confirmed adverse events will be compared between the placebo and investigational groups. FUNDING SOURCES: RB/Mead Johnson & Company.

Objective: The older adult population is increasing worldwide, and a significant percentage has asthma. This review will discuss the challenges to diagnosis and management of asthma in older adults. Data Sources: PubMed was searched for multiple terms in various combinations, including asthma, older adult, elderly, comorbid conditions, asthma diagnosis, asthma treatment, biologics and medication side effects, and adverse events. From the search, the data sources that were utilized included peer reviewed scholarly review articles, peer reviewed scientific research articles, and peer reviewed book chapters. Study Selections: Study selections that were utilized included peer reviewed scholarly review articles, peer reviewed scientific research articles, and peer reviewed book chapters. Results: Asthma in older adults is frequently underdiagnosed and has higher morbidity and mortality rates compared to their younger counterparts. A detailed history and physical examination as well as judicious testing are essential to establish the asthma diagnosis and exclude alternative ones. Medical comorbidities, such as cardiovascular disease, cognitive impairment, depression, arthritis, gastroesophageal reflux disease (GERD), rhinitis, and sinusitis are common in this population and should also be assessed and treated. Non-pharmacologic management, including asthma education on inhaler technique and self-monitoring, is vital. Pharmacologic management includes standard asthma therapies such as inhaled corticosteroids (ICS), inhaled corticosteroid-long acting β-agonist combinations (ICS-LABA), leukotriene antagonists, long acting muscarinic antagonists (LAMA), and short acting bronchodilators (SABA). Newly approved biologic agents may also be utilized. Older adults are more vulnerable to polypharmacy and medication adverse events, and this should be taken into account when selecting the appropriate asthma treatment. Conclusions: The diagnosis and management of asthma in older adults has certain challenges, but if the clinician is aware of them, the morbidity and mortality of this condition can be improved in this growing population.

Pacific abalone, Haliotis discus hannai, is a high commercial seafood in South-East Asia. The aim of the present study was to determine effects of cryopreservation on gene expression and post thaw sperm quality of Pacific abalone. Two ions, Na+ (459.1 ± 3.1 mM) and Cl– (515.9 ± 1.1 mM), were predominant in the seminal plasma (pH: 6.8 ± 0.1; osmolarity: 1,126 ± 3 mOsmL–1). Cryopreservation reduced mRNA expression levels of protein kinase A (PKA-C) and heat shock proteins (HSP70 and HSP90) genes in sperm. Fluorescent technique was used to compare morphological defects, acrosome integrity (AI), plasma membrane integrity (PMI), mitochondrial membrane potential (MMP), and DNA integrity of sperm cryopreserved with five different cryopreservation solutions (8% Me2SO, 8% EG, 6% PG, 2% GLY, and 2% MeOH). Droplet in tail and coiled tail defects was not observed for sperm cryopreserved with 8% Me2SO or 2% GLY. Sperm cryopreserved with 8% Me2SO showed improved DNA integrity and lower cryodamage than sperm cryopreserved with other cryoprotectants. Sperm to egg ratio of 10,000:1 was found to be the most suitable ratio for in vitro fertilization among different ratios tested. The fertilization rate of sperm cryopreserved with 8% Me2SO was not significantly (p > 0.05) different from that of sperm cryopreserved with 2% GLY. DNA fragmentation showed strongly negative relationships with sperm quality parameters. Sperm cryopreserved with 8% Me2SO showed higher post thaw quality and mRNA expression of sperm motility associated gene than those cryopreserved with other cryoprotectants. The present research suggests to use 8% Me2SO for cryopreservation of Pacific abalone sperm as well as for hatchery production.

Patients exposed to pollutants are more likely to suffer from allergic rhinitis and may benefit from antioxidant treatment. Our study determined if patients diagnosed with grass-induced allergic rhinitis could benefit from broccoli sprout extract (BSE) supplementation. In total, 47 patients were confirmed with grass-induced allergic rhinitis and randomized to one of four groups: group 1 (nasal steroid spray + BSE), group 2 (nasal steroid spray + placebo tablet), group 3 (saline nasal spray + BSE) and group 4 (saline nasal spray + placebo tablet). Peak Nasal Inspiratory Flow (PNIF), Total Nasal Symptoms Scores (TNSS) and nasal mucus cytokine levels were analyzed in samples collected before and after the 3-week intervention. Comparing before and after the intervention, PNIF improved significantly when comparing Groups 1 and 2, vs. placebo, at various time points (p ≤ 0.05 at 5, 15, 60 and 240 min) following nasal challenge, while TNSS was only statistically significant at 5 (p = 0.03), 15 (p = 0.057) and 30 (p = 0.05) minutes. There were no statistically significant differences in various cytokine markers before and after the intervention. Combining nasal corticosteroid with BSE led to the most significant improvement in objective measures.

Wilms tumor (WT) is one of the most common renal malignancies in children, comprising about 5% of all childhood cancers. If diagnosed early, WT responds well to appropriate interventions such as surgical resection, chemotherapy and radiotherapy, with a 5 year survival higher than 85%. In this review, we will describe the first-line treatment options for WT, discuss controversies related to particular modes of therapy, and highlight promising advances in molecular biology that may serve as effective therapeutics in the near future. Current treatment protocols for WT include nephrectomy followed by postoperative chemotherapy with or without preoperative chemotherapy. Though both are acceptable forms of treatment, preoperative chemotherapy prior to tumor resection has been shown to reduce tumor size and decrease the risk of intraoperative tumor rupture. Preoperative transcatheter arterial chemoembolization has also been shown to improve tumor resections and relapse-free survival rates, potentially providing an additive method to improve WT outcomes. Radical nephrectomy is the mainstay surgical treatment for WT, however evidence suggests that partial nephrectomies may be an equally viable option. Radiotherapy traditionally utilizes the anteroposterior-posteroanterior field technique, but recent advances have allowed for tumor-specific targeting and sparing of non-neoplastic tissues using intensity-modulated radiation therapy and volumetric-modulated arc therapy. Lastly, potential targets for future therapy include the β-catenin pathway, which has been found to be important in the development of WT, in addition to advances in applying microRNA, M6620, and stem cell therapy.

Rheumatoid arthritis (RA) is a common inflammatory disease with several implications on health, disability and economy. Conventional treatment for RA centers on anti-inflammatory drugs and specific targeting of tumor necrosis factor  (TNF-) and interleukin 6 (IL-6). Baricitinib is a novel, Food and Drug Administration (FDA) approved, once daily oral drug that is effective in combination with current treatment and results in significantly reduced symptoms with good safety profile. Further studies are required to find rare side effects and evaluate the long term efficacy in disease modulation and patient symptom reduction. This is a comprehensive review of the literature on baricitinib for the treatment of RA. This review provides an update on the pathophysiology, diagnosis and conventional treatment of RA, then proceeds to introduce baricitinib and the data that exists to support or refute its use in RA. The presented study also indicated clinical trials confirming the effectiveness of baricitinib in this indication.

Composite materials (CMs) based on activated carbon fiber material (ACFM) modified with oxygen-containing transition metal compounds (MnO2, Ni(OH)2, and Co(OH)2) by using colloid electrophoresis are studied. All prepared CMs have higher capacitance than the individual parental materials, with the CM ACFM–Ni(OH)2 exhibiting the maximum capacitance (~380 F g–1). Changes in the capacitances of ACFM and prepared ACFM-based CMs induced by potential cycling, the time of exposure to electrolyte solution, and potential scan rate are investigated. The capacitances of all CMs are found to increase with the number of cycles, but tend to decrease at higher potential scan rates.

High-performance deep ultraviolet (DUV) photodetectors operating at ambient conditions with

Anaphylaxis is a severe, acute, life-threatening multisystem allergic reaction resulting from the release of a plethora of mediators from mast cells culminating in serious respiratory, cardiovascular and mucocutaneous manifestations that can be fatal. Medications, foods, latex, exercise, hormones (progesterone), and clonal mast cell disorders may be responsible. More recently, novel syndromes such as delayed reactions to red meat and hereditary alpha tryptasemia have been described. Anaphylaxis manifests as sudden onset urticaria, pruritus, flushing, erythema, angioedema (lips, tongue, airways, periphery), myocardial dysfunction (hypovolemia, distributive or mixed shock and arrhythmias), rhinitis, wheezing and stridor. Vomiting, diarrhea, scrotal edema, uterine cramps, vaginal bleeding, urinary incontinence, dizziness, seizures, confusion, and syncope may occur. The traditional (or classical) pathway is mediated via T cells, Th2 cytokines (such as IL-4 and 5), B cell production of IgE and subsequent crosslinking of the high affinity IgE receptor (FcεRI) on mast cells and basophils by IgE-antigen complexes, culminating in mast cell and basophil degranulation. Degranulation results in the release of preformed mediators (histamine, heparin, tryptase, chymase, carboxypeptidase, cathepsin G and tumor necrosis factor alpha (TNF-α), and of de novo synthesized ones such as lipid mediators (cysteinyl leukotrienes), platelet activating factor (PAF), cytokines and growth factors such as vascular endothelial growth factor (VEGF). Of these, histamine, tryptase, cathepsin G, TNF-α, LTC4, PAF and VEGF can increase vascular permeability. Recent data suggest that mast cell-derived histamine and PAF can activate nitric oxide production from endothelium and set into motion a signaling cascade that leads to dilatation of blood vessels and dysfunction of the endothelial barrier. The latter, characterized by the opening of adherens junctions, leads to increased capillary permeability and fluid extravasation. These changes contribute to airway edema, hypovolemia, and distributive shock, with potentially fatal consequences. In this review, besides mechanisms (endotypes) underlying IgE-mediated anaphylaxis, we also provide a brief overview of IgG-, complement-, contact system-, cytokine- and mast cell-mediated reactions that can result in phenotypes resembling IgE-mediated anaphylaxis. Such classifications can lead the way to precision medicine approaches to the management of this complex disease.

Variation of the specific capacitance of electrodes made of activated carbon-fiber material depending on the number of voltammetric cycles is studied. The specific capacitances of electrodes fabricated by different methods are measured in relation to the number of voltammetric cycles. The dependence curves of the material capacitance with reference to the time of residence in electrolyte and to the potential sweep rate are obtained. A viable explanation of the observed patterns is proposed.

Solution-processed deep ultraviolet (DUV) photodetectors based on wide band gap oxide semiconductors (WBGS) working in the

Gonadotropin-releasing hormone (GnRH) is a key hypothalamic neuropeptide regulating the reproductive function of vertebrates and invertebrates. In the present study, we report the role of GnRH in gamete cell proliferation of Pacific abalone, Haliotis discus hannai using BrDU incorporation, and analyzed the expression of reproductive responsive genes. In vivo injection of buserelin and H. discus hannai GnRH peptides (GnRH-I and GnRH-II) at doses of 250 and 500 ng/g BW resulted in a significant increases in the number of testicular and ovarian proliferating cells. Administration of GnRH peptide at higher doses was less effective in stimulating gonadal cell proliferation. A qPCR analysis revealed that the mRNA expression of GnRH, GnRH-R, and serotonin-R was elevated in the male gonad compared with female gonad in all treatment groups. Compared with control and other treatment groups, the expression profile of GnRH, GnRH-R, and serotonin-R was significantly higher after treatment with buserelin and synthetic GnRH peptides at doses of 250 ng/g BW in both male and female gonad. However, the gonadal tissues expressed lower levels of mRNA following the treatment with GnRH peptide at the higher dose (1000 ng/g BW). Furthermore, the results of comet assay demonstrated that gonadal cells did not show significant differences in the average level of fragmented DNA and tail length between control and treated groups. Taken together, these findings suggest that administration of GnRH peptide at a concentration of 250 ng/g BW effectively accelerated the gametogenesis of abalone. This strategy will enhance the benefits of breeding technology in this species, or may useful for increasing the aquaculture production.

The effect of conditions of electrochemical deposition of manganese oxide (overall current density, solution concentration) on physico-chemical properties of the obtained carbon-oxide composite materials (mass of deposited manganese (IV) oxide, specific capacity of the composite) is studied. Electrophoresis is used to obtain composite materials with different composition: up to 19 wt % of the MnO2 additive with respect to the mass of the initial activated carbon fiber. The specific capacity of the obtained composite materials is 16 to 131 F/g.

A high-performance vertically injected broadband UV-to-IR photodetector based on Gd-doped ZnO nanorods (NRs)/CH3NH3PbI3 perovskite heterojunction was fabricated on metal substrates. Our perovskite-based photodetector is sensitive to a broad spectral range, from ultraviolet to infrared light region (λ = 250–1357 nm). Such structure leads to a high photoresponsivity of 28 and 0.22 A/W, for white light and IR illumination, respectively, with high detectivity values of 1.1 × 1012 and 9.3 × 109 Jones. Optical characterizations demonstrate that the IR detection is due to intraband transition in the perovskite material. Metal substrate boosts carrier injection, resulting in higher responsivity compared to the conventional devices grown on glass, whereas the presence of Gd increases the ZnO NRs performance. For the first time, the perovskite-based photodetector is demonstrated to extend its detection capability to IR (>1000 nm) with high room temperature responsivity across the detected spectrum, leading to a hig...

In this study, we presented a pilot study of metronomic photodynamic therapy (mPDT) by the use of organic light emitting diode (OLED) in treating treatment of brain tumor. The low cost, lightweight, and low fluence rate OLED has significant potential in the clinical mPDT applications. In this study, we treated nude mice with glioblastma by 5-aminolevulinic acid (ALA) mediated OLED, mPDT. Afterwards, we investigated the tumor severity though bioluminescenct imaging and recorded survival days. Compared to control group (ALA treatment without illumination), PDT group mice showed increased survival days. This pilot study suggests that OLED is a useful light source for mPDT.

Introduction Mast cell activation syndrome (MCAS) has been increasingly used to define patients with episodic systemic symptoms secondary to mast cell activation that do not fit the criteria for systemic mastocytosis or monoclonal mast cell activation syndrome. Here we present a patient with MCAS with laboratory features of carcinoid syndrome. Case Description A 54-year old Caucasian female with allergic rhinitis, urticaria, flushing with and without eating, fogginess, polycythemia, and Graves disease s/p total thyroidectomy presented to establish care. Labs revealed elevated tryptase of 18 ng/mL, and an elevated 24-hour urine prostaglandin D2 of 388 ng. Bone marrow biopsy findings were normal. Serum 5-HIAA and chromogranin A were normal. However, her 24-hour urine 5-HIAA was persistently elevated. Further work up failed to reveal findings consistent with carcinoid syndrome, including negative chest and abdominal scans. Given a convincing history of venom hypersensitivity, skin tests were performed revealing positives to honeybee, wasp and mixed venom. Patient was started on oral cromolyn with improvement in her flushing symptoms. She initially experienced diarrhea and abdominal cramping which has now resolved. She has been doing well with immunotherapy for allergic rhinitis, and is currently waiting to start venom immunotherapy. Discussion Although our patient's work up revealed persistently elevated urine 5-HIAA consistent with carcinoid syndrome, further work up revealed a picture more consistent with mast cell disorder. This case emphasizes the importance of considering MCAS even in patients with laboratory markers seen in carcinoid syndrome.

This study used accepted asthma metrics and pharmaceutical claim data to develop a new asthma metric as a possible surrogate for spirometry and to better assess asthma control.To develop and validate a new asthma metric called the Rescue Index (RI) based on β(2)-agonist dispensings and to test the feasibility of a multivariate model to construct a global asthma metric called the Asthma Control Index (ACI).This prospective, observational, multicenter cohort study was conducted at the Naval Medical Center San Diego (NMCSD) and at the Phoenix VA Health Care System (PVAHCS). Pharmacy claim data were correlated with the ACT, Medication Adherence Report Scale for Asthma (MARS-A), and spirometry using univariate and multivariate analyses.A total of 263 individuals enrolled in the study, and 95 (PVAHCS) and 156 (NMCSD) individuals completed the study. In the PVAHCS, the ACT correlated with the asthma medication ratio (AMR) (ρ = 0.37, P.001) and inversely correlated with the RI (ρ = -0.33, P = .001), the RI inversely correlated with forced expiratory volume in 1 second (FEV(1)) (ρ = -0.22, P = .03) and the FEV(1) to forced vital capacity ratio (ρ = 0.22, P = .03). In the NMCSD population, the ACT correlated with the MARS-A (ρ = 0.23, P = .006), FEV(1) did not correlate with ACT (ρ = 0.09, P = .25) or MARS-A (ρ = 0.16, P = .047) but directly correlated with the RI (ρ = 0.19, P = .03). The AMR was strongly inversely correlated with RI in both populations (-0.74, P.001 in the PVAHCS group and -0.78, P.001 in the NMCSD group). When multivariate models were applied to the NMCSD and PVAHCS groups, the combination of RI and MARS-A was the best predictor of spirometry.The RI shows promise as a new asthma metric because it correlated with AMR in both cohorts. However, because RI correlated with adult spirometry and ACT only, further validation studies are needed before RI may be included in an ACI metric.

[Purpose] The purpose of this research was to investigate the effect of pulmonary rehabilitation using a mechanical in-exsufflator and feedback respiratory training on cervical cord injury (SCI) patients. [Subjects and Methods] Thirty-eight patients were selected through a random sampling method and divided into two groups: an experimental group (n=19) and a control group (n=19). The intervention was conducted five times per week over a four-week period. [Results] In the respiratory training group, there were significance improvements in the ratio (%VC) of the predicted value, forced expiratory volume at one second (FEV1), and unassisted peak cough flow (UPCF) after the intervention. [Conclusion] The results suggest that pulmonary rehabilitation using a mechanical in-exsufflator and feedback respiratory training is effective at increasing the lung function, as well as augmenting the strength of cough capacity. This may reduce the respiratory system?related complications of cervical cord injury patients.

The human herpes Virus, categorized into 8 types from HHV-1 to HHV-8 is in a DNA virus family, Herpesviridae. They are highly infectious and responsible for many human related diseases. Through this research, we applied data mining, which is the process of finding and analyzing the relationship among the raw data, for the first time to analyze the human herpes virus family. We discovered the patterns regarding the sequence data and analyzed them in associated with the clinical aspects and phylogenetic study results. In addition, we applied decision tree algorithm to support our data. As a result, we were able to stabilize the proof for the bioinformatical categorization. The rules we found were consists of 11 amino acids, Alanine, Leucine, Proline, Valine, Asparagine, Threonine, Phenylalanine, Arginine, Isoleucine, Serine and Lysine. Alanine and Leucine were the two major amino acids from the rules.

高齢化に伴い症例が増加している. Poorriskの症例が多いため,腸管が嵌頓し致死的になる場合もある.原則的に手術が選択されるが,比較的高侵襲な手術になることも多い.今回われわれはKugel法に準じた低侵襲な修復術を施行しえたので若干の文献的考察とともに報告する. 症例は75歳女性.吐き気を主訴に来院し,腹部レントゲン単純撮影,CTなどから,閉鎖孔ヘルニアの診断となった.腰椎麻酔下にKugel法に準じた修復術を施行した.術後特に問題なく第9病日に退院した. 閉鎖孔ヘルニアに対する修復術は,以前は全麻下に開腹で行われる傾向にあったが,昨今になりapproachや使用するメッシュの工夫により腰椎麻酔下でより低侵襲な手術が行われるケースが増えている. Kugel法による修復は低侵襲で有用であった.