An ANMS-NASPGHAN consensus document on anorectal and colonic manometry in children

BACKGROUND

Over the last few years, the study of the colon and anorectal function has experienced great technical advances that have facilitated the performance of the tests and have allowed a more detailed characterization of reflexes and motor patterns. As a result, we have achieved a much better understanding of the pathophysiology of children with defecation problems. Anorectal and colonic manometry are now commonly used in all major pediatric referral centers as diagnostic tools and to guide the management of children with intractable constipation and fecal incontinence, particularly when a surgical intervention is being considered.

PURPOSE

This review highlights some of the recent advances in pediatric colon and anorectal motility testing including indications and preparation for the studies, and how to perform and interpret the tests. This update has been endorsed by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN).

Inadequate Glycaemic Control and Therapeutic Management of Adults over 65 Years Old with Type 2 Diabetes Mellitus in Spain

OBJECTIVES

The glycaemic goals for older patients with type 2 diabetes mellitus (DM) are recommended to avoid an HbA1c levels <7%. The purpose of this study was to analyse the glycaemic control and therapeutic management of older adults (≥65 years) with type 2 DM.

DESIGN

Pooled analysis of patients enrolled in three Spanish cross-sectional epidemiological studies.

SETTING

The study was conducted between 2009 and 2011 by primary care or specialist physicians.

PARTICIPANTS

A total of 7,269 patients aged ≥65 years with type 2 DM.

MEASUREMENTS

Sociodemographic, medical history, lifestyle habits, biochemical laboratory parameters, comorbidities, type 2 DM complications, and pharmacological treatment data collected from medical records.

RESULTS

In total, data from 7,269 patients were analysed (mean age 73.4 years old; 48.4% male). A total of 10.9% of patients had HbA1c levels ≥8.5% and 43.2% <7%. The most common comorbidities were hypertension (82.0%) and dyslipidaemia (76.6%). The microvascular complications were mainly diabetic nephropathy (23.6%) and retinopathy (19.3%). Oral antidiabetic drugs (OADs) were taken by 70.5% of patients (sulphonylureas 65.3%), 4.1% were taking insulin alone and 25.4% took both insulin and an OAD. Half of the patients (51.0%) were taking a combination of OADs.

CONCLUSION

In conclusion, more than half of older patients with type 2 DM had unsatisfactory management: approximately one in ten had inadequate glycaemic control (HbA1c ≥8.5%) despite hypoglycaemic drugs and four in ten were potentially overtreated (HbA1c <7%).

Intrathecal baclofen therapy improves functional intelligibility of speech in cerebral palsy

Objective: To assess the effect of intrathecal baclofen on spastic dysarthia in cerebral palsy.

Design: Single case study.

Methods: Functional outcome measures, including the Assessment of Intelligibility of Dysarthric Speech, were performed before and after a trial of intrathecal baclofen in an adult patient with spastic dysarthria due to cerebral palsy. The patient proceeded to intrathecal baclofen pump implantation and was reassessed after six months of continuous intrathecal baclofen therapy.

Results: Improvement in function including speech intelligibility was seen following the intrathecal baclofen trial. The improvement was sustained at six months post pump implantation.

Conclusions: Intrathecal baclofen improved functional intelligibility of speech in a carefully selected subject. The Assessment of Intelligibility of Dysarthric Speech was found to be a useful quantitative tool to assess the effect of intrathecal baclofen on spastic dysarthria.

An Integrative Analysis of Foot-and-Mouth Disease Virus Carriers in Vietnam Achieved Through Targeted Surveillance and Molecular Epidemiology

Foot-and-mouth disease (FMD) is a major constraint to transboundary trade in animal products, yet much of its natural ecology and epidemiology in endemic regions is still poorly understood. To address this gap, a multidisciplinary, molecular and conventional epidemiological approach was applied to an investigation of endemic FMD in Vietnam. Within the study space, it was found that 22.3% of sampled ruminants had previously been infected with FMD virus (FMDV), of which 10.8% were persistent, asymptomatic carriers (2.4% of the total population). Descriptive data collected from targeted surveillance and a farm questionnaire showed a significantly lower prevalence of FMDV infection for dairy farms. In contrast, farms of intermediate size and/or history of infection in 2010 were at increased risk of FMD exposure. At the individual animal level, buffalo had the highest exposure risk (over cattle), and there was spatial heterogeneity in exposure risk at the commune level. Conversely, carrier prevalence was higher for beef cattle, suggesting lower susceptibility of buffalo to persistent FMDV infection. To characterize virus strains currently circulating in Vietnam, partial FMDV genomic (VP1) sequences from carrier animals collected between 2012 and 2013 (N = 27) and from FMDV outbreaks between 2009 and 2013 (N = 79) were compared by phylogenetic analysis. Sequence analysis suggested that within the study period, there were two apparent novel introductions of serotype A viruses and that the dominant lineage of serotype O in Vietnam shifted from SEA/Mya-98 to ME-SA/PanAsia. FMDV strains shared close ancestors with FMDV from other South-East Asian countries indicating substantial transboundary movement of the predominant circulating strains. Close genetic relationships were observed between carrier and outbreak viruses, which may suggest that asymptomatic carriers of FMDV contribute to regional disease persistence. Multiple viral sequences obtained from carrier cattle over a 1-year period had considerable within-animal genetic variation, indicating within-host virus evolution.

Aminolevulinic acid dendrimers in photodynamic treatment of cancer and atheromatous disease

ALA dendrimers are taken up by caveolae-mediated endocytosis in macrophages. Intracellular ALA release gives rise to PpIX synthesis and subsequent photosensitization of key cells in atheromas and tumour diseases.

Virus-host interactions in persistently FMDV-infected cells derived from bovine pharynx

Foot-and-mouth disease virus (FMDV) produces a disease in cattle characterized by vesicular lesions and a persistent infection with asymptomatic low-level production of virus in pharyngeal tissues. Here we describe the establishment of a persistently infected primary cell culture derived from bovine pharynx tissue (PBPT) infected with FMDV serotype O1 Manisa, where surviving cells were serially passed until a persistently infected culture was generated. Characterization of the persistent virus demonstrated changes in its plaque size, ability to grow in different cell lines, and change in the use of integrins as receptors, when compared with the parental virus. These results demonstrate the establishment of persistently infected PBPT cell cultures where co-adaptation has taken place between the virus and host cells. This in vitro model for FMDV persistence may help further understanding of the molecular mechanisms of the cattle carrier state.

Prevalence and risk factors of vitamin D deficiency in inherited ichthyosis: a French prospective observational study performed in a reference center

BACKGROUND

To date, few studies have investigated serum vitamin D status in patients with inherited ichthyosis. The aim of this study was to determine the prevalence of vitamin D deficiency (defined as serum level <10 ng/mL) in a French cohort of patients and to identify associated risk factors.

METHODS

This was a prospective observational study performed in a hospital reference center with expertise for rare skin diseases. Patients' clinical characteristics were recorded. Serum concentration of 25-hydroxyvitamin D and parathyroid hormone were determined. For patients with vitamin D deficiency, serum calcium, serum phosphorus and bone mineral density were also investigated. Comparisons between groups (25-hydroxyvitamin D <10 ng/mL versus ≥10 ng/mL) were conducted by univariate and multivariate logistic regression.

RESULTS

Of the 53 included patients, 47 (88.7%) had serum 25-hydroxyvitamin D below the optimal level of 30 ng/mL: 18 (34%) had vitamin D sufficiency, 14 (26.4%) had vitamin D insufficiency, and 15 (28.3%) had vitamin D deficiency. A negative linear correlation was found between 25-hydroxyvitamin D and parathyroid hormone levels for the whole study population. Serum calcium and phosphorus levels were normal for the 15 patients with vitamin D deficiency. Bone mineral density was investigated for 11 of these latter 15 patients, and six of them had osteopenia. Winter/spring seasons of vitamin D measurement, severity of ichthyosis, and phototypes IV-VI were identified as independent risk factors for vitamin D deficiency.

CONCLUSIONS

Clinicians should be aware of the risk of vitamin D deficiency in the management of patients with inherited ichthyosis, especially in winter and spring, and in case of dark skin or severe disease.

The natural flavonoid silybin improves the response to Photodynamic Therapy of bladder cancer cells

Photodynamic Therapy (PDT) is an anticancer treatment based on photosensitisation of malignant cells. The precursor of the photosensitiser Protoporphyrin IX, 5-aminolevulinic acid (ALA), has been used for PDT of bladder cancer. Silybin is a flavonoid extracted from Silybum marianum, and it has been reported to increase the efficacy of several anticancer treatments. In the present work, we evaluated the cytotoxicity of the combination of ALA-PDT and silybin in the T24 and MB49 bladder cancer cell lines. MB49 cells were more sensitive to PDT damage, which was correlated with a higher Protoporphyrin IX production from ALA. Employing lethal light doses 50% (LD50) and 75% (LD75) and additional silybin treatment, there was a further increase of toxicity driven by PDT in both cell lines. Using the Chou-Talalay model for drug combination derived from the mass-action law principle, it was possible to identify the effect of the combination as synergic when using LD75, whilst the use of LD50 led to an additive effect on MB49 cells. On the other hand, the drug combination turned out to be nearly additive on T24 cells. Apoptotic cell death is involved both in silybin and PDT cytotoxicity in the MB49 line but there is no apparent correlation with the additive or synergic effect observed on cell viability. On the other hand, we found an enhancement of the PDT-driven impairment of cell migration on both cell lines as a consequence of silybin treatment. Overall, our results suggest that the combination of silybin and ALA-PDT would increase PDT outcome, leading to additive or synergistic effects and possibly impairing the occurrence of metastases.

Prevalence of inherited ichthyosis in France: a study using capture-recapture method

BACKGROUND

Inherited ichthyoses represent a group of rare skin disorders characterized by scaling, hyperkeratosis and inconstant erythema, involving most of the tegument. Epidemiology remains poorly described. This study aims to evaluate the prevalence of inherited ichthyosis (excluding very mild forms) and its different clinical forms in France.

METHODS

Capture - recapture method was used for this study. According to statistical requirements, 3 different lists (reference/competence centres, French association of patients with ichthyosis and internet network) were used to record such patients. The study was conducted in 5 areas during a closed period.

RESULTS

The prevalence was estimated at 13.3 per million people (/M) (CI95%, [10.9 - 17.6]). With regard to autosomal recessive congenital ichthyosis, the prevalence was estimated at 7/M (CI 95% [5.7 - 9.2]), with a prevalence of lamellar ichthyosis and congenital ichthyosiform erythroderma of 4.5/M (CI 95% [3.7 - 5.9]) and 1.9/M (CI 95% [1.6 - 2.6]), respectively. Prevalence of keratinopathic forms was estimated at 1.1/M (CI 95% [0.9 - 1.5]). Prevalence of syndromic forms (all clinical forms together) was estimated at 1.9/M (CI 95% [1.6 - 2.6]).

CONCLUSIONS

Our results constitute a crucial basis to properly size the necessary health measures that are required to improve patient care and design further clinical studies.

Novel approaches to foot-and-mouth disease vaccine development

The need for better foot-and-mouth disease (FMD) vaccines is not new, a report from the Research Commission on FMD, authored by F. Loeffler and P. Frosch in 1897, highlighted the need for developing a vaccine against FMD and qualified this as a devastating disease causing "severe economic damage to the country's agriculture" [1]. Inactivated antigen vaccines have been available since the early 1900s and have been instrumental in eradicating FMD from parts of the world and repressing clinical disease in others. However, these vaccines require using live virulent FMDV for manufacturing, fail to prevent infection resulting in the establishment of carrier animals, require multiple vaccination schedules (every six months) and have limited coverage to the specific serotype and in many cases subtype of FMDV. Therefore, FMD vaccinology continues to be a very active research field. Research-based novel vaccine approaches over the last decade have resulted in at least one novel molecular vaccine being licensed for emergency use in the US and multiple other vaccine approaches being actively pursued as alternatives to current vaccines. Here we will review and update the main research efforts on FMD vaccines, including subunit and peptide vaccines, DNA vaccines, empty capsid vaccines (directly delivered or vector delivered), novel inactivated antigen production platforms and live attenuated vaccines. Each of these approaches will be discussed in terms of their safety and efficacy characteristics, product transition feasibility as well as their applicability to global control and eradication efforts.