Accumulation of eosinophils in intestine-draining mesenteric lymph nodes occurs after Trichuris muris infection

Eosinophils have recently been demonstrated capable of localizing to lymph nodes that drain mucosal surfaces, in particular during T helper 2 (Th2) responses. Resistance of mice to infection with the gastrointestinal nematode Trichuris muris depends critically on mounting of a Th2 response and represents a useful model system to investigate Th2 responses. Following infection of resistant BALB/c mice with T. muris, we observed accumulation of eosinophils in intestine-draining mesenteric lymph nodes (MLNs). The accumulation of MLN eosinophils was initiated during the second week of infection and peaked during worm expulsion. In contrast, we detected a comparably late and modest increase in eosinophil numbers in the MLNs of infected susceptible AKR mice. MLN eosinophils localized preferentially to the medullary region of the lymph node, displayed an activated phenotype and contributed to the interleukin-4 (IL-4) response in the MLN. Despite this, mice genetically deficient in eosinophils efficiently generated IL-4-expressing CD4⁺ T cells, produced Th2 cytokines and mediated worm expulsion during primary T. muris infection. Thus, IL-4-expressing eosinophils accumulate in MLNs of T. muris-infected BALB/c mice but are dispensable for worm expulsion and generation of Th2 responses, suggesting a distinct or subtle role of MLN eosinophils in the immune response to T. muris infection.

Multicentre prospective study of fascial closure rate after open abdomen with vacuum and mesh-mediated fascial traction

BACKGROUND

Damage control surgery and temporary open abdomen (OA) have been adopted widely, in both trauma and non-trauma situations. Several techniques for temporary abdominal closure have been developed. The main objective of this study was to evaluate the fascial closure rate in patients after vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) for long-term OA treatment, and to describe complications.

METHODS

This prospective study included all patients who received VAWCM treatment between 2006 and 2009 at four hospitals. Patients with anticipated OA treatment for fewer than 5 days and those with non-midline incisions were excluded.

RESULTS

Among 151 patients treated with an OA, 111 received VAWCM treatment. Median age was 68 years. Median OA treatment time was 14 days. Main disease aetiologies were vascular (45 patients), visceral surgical disease (57) and trauma (9). The fascial closure rate was 76·6 per cent in intention-to-treat analysis and 89 per cent in per-protocol analysis. Eight patients developed an intestinal fistula, of whom seven had intestinal ischaemia. Intestinal fistula was an independent factor associated with failure of fascial closure (odds ratio (OR) 8·55, 95 per cent confidence interval 1·47 to 49·72; P = 0·017). The in-hospital mortality rate was 29·7 per cent. Age (OR 1·21, 1·02 to 1·43; P = 0·027) and failure of fascial closure (OR 44·50, 1·13 to 1748·52; P = 0·043) were independently associated with in-hospital mortality.

CONCLUSION

The VAWCM method provided a high fascial closure rate after long-term treatment of OA. Technique-related complications were few. No patient was left with a large planned ventral hernia.

Alloreactivity but failure to reject human islet transplants by humanized Balb/c/Rag2gc mice

A human islet transplant can cure patients with type 1 diabetes. A drawback of islet transplantation is the life-long immunosuppressive medication, often associated with severe side effects. Moreover, in spite of the immunosuppressive therapy, islets are lost in the majority of transplanted patients over time. An improved small animal model for studies on human islet allograft rejection mechanisms and the development of new measures for its prevention is clearly warranted. Here, we evaluated the potential of Balb/cRag2(-/-)gammac(-/-) mice carrying a human-like immune system (so-called humanized mice) as a tool for studies on the rejection of transplanted human islets. Human T cells from Balb/cRag2(-/-)gammac(-/-) mice, which as neonates had been transplanted with CD34(+) human cord blood haematopoietic stem cells (HIS mice), proliferated in response to allogeneic human dendritic cells, but failed to reject a human islet allograft transplanted to the renal subcapsular space as assessed by immunohistochemistry and analysis of human serum C-peptide levels. Histological analysis revealed that few if any T cells had migrated to the grafted tissue. These observations question the usefulness of the HIS mouse model for studies on human islet allograft rejection mechanisms and highlight the need for further improvements.

N-3 fatty acids and cardiac autonomic function in humans

Studies suggest that marine n-3 polyunsaturated fatty acids (PUFA) offer some protection against sudden cardiac death (SCD). The autonomic nervous system is involved in the pathogenesis of SCD and due to the fact that n-3 PUFA is abundant in the brain and other nervous tissue it is likely that n-3 PUFA might modulate autonomic control of the heart. Heart rate variability (HRV) is a non-invasive marker of cardiac autonomic function and an attenuated HRV is a predictor for SCD and arrhythmic events. Studies on HRV and n-3 PUFA have been performed in several populations such as patients with ischaemic heart disease, patients with diabetes mellitus, patients with chronic renal failure, and in healthy subjects. Many studies have demonstrated a positive association between cellular content of n-3 PUFA and HRV as well as supplementation with n-3 PUFA seems to increase HRV and thereby decreasing the risk of arrhythmic events and SCD.

Hydraulic conductivity of fly ash-sewage sludge mixes for use in landfill cover liners

Secondary materials could help meeting the increasing demand of landfill cover liner materials. In this study, the effect of compaction energy, water content, ash ratio, freezing, drying and biological activity on the hydraulic conductivity of two fly ash-sewage sludge mixes was investigated using a 2(7-1) fractional factorial design. The aim was to identify the factors that influence hydraulic conductivity, to quantify their effects and to assess how a sufficiently low hydraulic conductivity can be achieved. The factors compaction energy and drying, as well as the factor interactions material x ash ratio and ash ratio x compaction energy affected hydraulic conductivity significantly (alpha=0.05). Freezing on five freeze-thaw cycles did not affect hydraulic conductivity. Water content affected hydraulic conductivity only initially. The hydraulic conductivity data were modelled using multiple linear regression. The derived models were reliable as indicated by R(adjusted)(2) values between 0.75 and 0.86. Independent on the ash ratio and the material, hydraulic conductivity was predicted to be between 1.7 x 10(-11)m s(-1) and 8.9 x 10(-10)m s(-1) if the compaction energy was 2.4 J cm(-3), the ash ratio between 20% and 75% and drying did not occur. Thus, the investigated materials met the limit value for non-hazardous waste landfills of 10(-9)m s(-1).

Treatment with a barrier-strengthening moisturizing cream delays relapse of atopic dermatitis: a prospective and randomized controlled clinical trial

BACKGROUND

Standard treatment of atopic dermatitis (AD) is based on topical glucocorticosteroids or calcineurin inhibitors to treat flares combined with moisturizer treatment to alleviate dry skin symptoms. Patients with AD have an abnormal skin barrier function, and strategies for reducing the risks for eczema would be to repair the barrier or prevent barrier dysfunction.

OBJECTIVES

The objective of this study was to explore the time to relapse of eczema during a 26-week maintenance treatment with a urea containing moisturizer compared to no treatment (neither medical nor non-medicated preparations) after successful clearing of atopic lesions. The moisturizer has previously been shown to improve skin barrier function.

METHODS

Patients applied betamethasone valerate (0.1%) on eczematous lesions during a 3-week period. Those with cleared eczema entered a 26-week maintenance phase, applying the moisturizer or left the previously affected area untreated. Upon eczema relapse, patients were instructed to contact the clinic and to have the relapse confirmed by the investigator.

RESULTS

Fifty-five patients entered the study and 44 patients were included in the maintenance phase (22 using moisturizer twice daily and 22 using no treatment). Median time to relapse for patients treated with moisturizer was > 180 days (duration of the study) compared with 30 days for the no-treatment group. Sixty-eight per cent of the patients treated with the moisturizer and 32% of the untreated patients remained free from eczema during the observation period.

CONCLUSIONS

Maintenance treatment with a barrier-improving urea moisturizer on previous eczematous areas reduced the risk of relapse to approximately one third of that of no treatment.

Clinical trial: B vitamins improve health in patients with coeliac disease living on a gluten-free diet

BACKGROUND

Patients with coeliac disease living on a gluten-free diet show vitamin deficiency and reduced subjective health status.

AIM

To study the biochemical and clinical effects of B vitamin supplementation in adults with longstanding coeliac disease.

METHODS

In a double blind placebo controlled multicentre trial, 65 coeliac patients (61% women) aged 45-64 years on a strict gluten-free diet for several years were randomized to a daily dose of 0.8 mg folic acid,0.5 mg cyanocobalamin and 3 mg pyridoxine or placebo for 6 months. The outcome measures were psychological general well-being (PGWB) and the plasma total homocysteine (tHcy) level, marker of B vitamin status.

RESULTS

Fifty-seven patients (88%) completed the trial. The tHcy level was baseline median 11.7 micromol/L (7.4-23.0), significantly higher than in matched population controls [10.2 micromol/L (6.7-22.6) (P < 0.01)]. Following vitamin supplementation, tHcy dropped a median of 34% (P < 0.001), accompanied by significant improvement in well-being (P < 0.01), notably Anxiety (P < 0.05) and Depressed Mood (P < 0.05) for patients with poor well-being.

CONCLUSIONS

Adults with longstanding coeliac disease taking extra B vitamins for 6 months showed normalized tHcy and significant improvement in general well-being, suggesting that B vitamins should be considered in people advised to follow a gluten-free diet.

Neuronal Survival and Glial Reactions after Recurrent Laryngeal Nerve Resection in the Rat

OBJECTIVES/HYPOTHESIS

Complete axonal injury to the recurrent laryngeal nerve (RLN) leads to permanent loss of coordinated function of the intrinsic muscles of the larynx. The aim of the present study was to investigate retrograde reactions, neuronal survival, and glial reactions in the nucleus ambiguus after a distal resection of the RLN to evaluate the potential need for neuroprotective substances.

STUDY DESIGN AND METHODS

A segment of the left RLN was resected in 31 adult rats. Before sacrifice of the animals at 2 to 28 days postlesion, the motor neurons in the nucleus ambiguus were retrogradely traced by the use of Fluorogold. Brainstems were isolated and processed for neuron quantification and immunohistochemical analysis. Neuron counts were performed in the nucleus ambiguus on serial sections. Glial reactions were investigated in the nucleus ambiguus using immunohistochemistry.

RESULTS

No decrease in the number of motor neurons in the nucleus ambiguus could be demonstrated up to 1 month postlesion. Astroglia and microglia showed increased immunoreactivity at 7 to 14 days postinjury, followed by a slight decline in glial reaction. Microglia revealed no signs of transformation into macrophages during the study period, further indicating the absence of neuronal loss.

CONCLUSIONS

Neuronal death does not occur within 1 month postlesion as a result of resection of the RLN in the adult rat, and neuroprotective substances should therefore be of minor value after RLN injury. Glial reactions appear in a similar fashion as after other peripheral nerve lesions not causing neuronal loss.

Daytime sleepiness relates to snoring independent of the apnea-hypopnea index in women from the general population

OBJECTIVES

The aim was to investigate the significance of snoring and sleep apnea on daytime symptoms in a population-based sample of women.

METHOD

From the general population, 400 women aged 20 to 70 years were randomly selected, with oversampling of habitually snoring women. The women were investigated using full-night polysomnography and a questionnaire. The apnea-hypopnea index (AHI) was calculated, and women who acknowledged snoring loudly and disturbingly often or very often were considered habitual snorers.

RESULTS

Habitual snoring was independently related to excessive daytime sleepiness (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.31 to 3.99), to falling asleep involuntarily during the day (OR, 2.11; 95% CI, 1.06 to 4.21), to waking up unrefreshed (OR, 2.14; 95% CI, 1.30 to 3.52), to daytime fatigue (OR, 2.77; 95% CI, 1.54 to 4.99), and to a dry mouth on awakening (OR, 2.00; 95% CI, 1.22 to 3.27) after adjustment for AHI, age, body mass index (BMI), smoking, total sleep time, percentage of slow-wave sleep, and percentage of rapid eye movement (REM) sleep. An AHI > or = 15/h was only related to a dry mouth on awakening after adjustment for snoring, age, BMI, smoking, total sleep time, percentage of slow-wave sleep, and percentage of REM sleep (OR, 2.24; 95% CI, 1.14 to 4.40). An AHI of 5 to 15/h was not related to any daytime symptom.

CONCLUSIONS

Excessive daytime sleepiness and daytime fatigue are related to habitual snoring independent of the apnea-hypopnea frequency, age, obesity, smoking, and sleep parameters in a population-based sample of women, but not to the AHI. This indicates that snoring is an independent cause of excess daytime sleepiness and not merely a proxy for sleep apnea.

Psoriasis and stress: a prospective study

BACKGROUND

Psoriasis is generally thought to be worsened by stress. This presumption has been supported primarily by retrospective studies using questionnaires. No controlled prospective study on this issue has been performed.

METHODS

Nine women with moderate plaque psoriasis were enrolled in the study. They all believed that their psoriasis was worsened by stress. They filled in a daily diary with estimations of actual stress levels and grades of psoriasis. The study of each patient started when her skin disease was in a stable phase and was concluded when her psoriasis was worsened by at least 25% from the starting level. Psoriasis area severity index scores were recorded at the start, as soon as possible after exacerbation and 2 weeks later. Stress-related blood samples were taken at the same visits. The study was analysed as a nine-case study.

RESULTS

No clear pattern was found between stress levels and worsening of psoriasis in our nine patients. One patient had elevated stress levels 13 days before exacerbation of psoriasis, but for at least seven patients, there were no identifiable time relationships between stress and psoriasis appearance. For two patients, there were clear elevations of stress levels after psoriasis outbreak.

CONCLUSION

This limited study does not support the assumption that stress is a worsening factor in psoriasis.

Mobility of organic carbon from incineration residues

Dissolved organic carbon (DOC) may affect the transport of pollutants from incineration residues when landfilled or used in geotechnical construction. The leaching of dissolved organic carbon (DOC) from municipal solid waste incineration (MSWI) bottom ash and air pollution control residue (APC) from the incineration of waste wood was investigated. Factors affecting the mobility of DOC were studied in a reduced 2(6-1) experimental design. Controlled factors were treatment with ultrasonic radiation, full carbonation (addition of CO2 until the pH was stable for 2.5h), liquid-to-solid (L/S) ratio, pH, leaching temperature and time. Full carbonation, pH and the L/S ratio were the main factors controlling the mobility of DOC in the bottom ash. Approximately 60 weight-% of the total organic carbon (TOC) in the bottom ash was available for leaching in aqueous solutions. The L/S ratio and pH mainly controlled the mobilization of DOC from the APC residue. About 93 weight-% of TOC in the APC residue was, however, not mobilized at all, which might be due to a high content of elemental carbon. Using the European standard EN 13 137 for determination of total organic carbon (TOC) in MSWI residues is inappropriate. The results might be biased due to elemental carbon. It is recommended to develop a TOC method distinguishing between organic and elemental carbon.

The effect of isosaccharinic acid (ISA) on the mobilization of metals in municipal solid waste incineration (MSWI) dry scrubber residue

Co-landfilling of incineration ash and cellulose might facilitate the alkaline degradation of cellulose. A major degradation product is isosaccharinic acid (ISA), a complexing agent for metals. The impact of ISA on the mobility of Pb, Zn, Cr, Cu and Cd from a municipal solid waste incineration dry scrubber residue was studied at laboratory using a reduced 2(5-1) factorial design. Factors investigated were the amount of calcium isosaccharinate (Ca(ISA)(2)), L/S ratio, temperature, contact time and type of atmosphere (N(2), air, O(2)). The effects of pH and Ca(ISA)(2) as well as other factors on the leaching of metals were quantified and modelled using multiple linear regression (alpha=0.05). Cd was excluded from the study since the concentrations were below the detection limit. The presence of Ca(ISA)(2) resulted in a higher leaching of Cu indicating complex formation. Ca(ISA)(2) alone had no effect on the leaching of Pb, Zn and Cr. A secondary effect on the mobilization was predicted to occur since Ca(ISA)(2) had a positive effect on the pH and the leaching of Pb, Zn and Cr increased with increasing pH. The leaching of Pb varied from 24 up to 66 wt.% of the total Pb amount (1.74+/-0.02 g(kgTS)(-1)) in the dry scrubber residue. The corresponding interval for Zn (7.29+/-0.07 g(kgTS)(-1)) and Cu (0.50+/-0.02 g(kgTS)(-1)) were 0.5-14 wt.% of Zn and 0.8-70wt.% of Cu. Maximum leaching of Cr (0.23+/-0.03 g(kgTS)(-1)) was 4.0 wt.%. At conditions similar to a compacted and covered landfill (4 degrees C, 7 days, 0 vol.% O(2)) the presence of ISA can increase the leaching of Cu from 2 to 46 wt.% if the amount of cellulose-based waste increases 20 times, from the ratio 1:100 to 1:5. As well, the leaching of Pb, Zn, and Cr can increase from 32 to 54 wt.% (Pb), 0.8-8.0 wt.% (Zn), and 0.5 to 4.0 wt.% (Cr) depending on the amount of cellulose and L/S ratio and pH value. Therefore, a risk (alpha=0.05) exists that higher amounts of metals are leached from landfills where cellulose-containing waste and ash are co-disposed. This corresponds to an additional 29 t of Pb and 17 t of Cu leached annually from a compacted and covered landfill in the north of Sweden.

Neuropeptidomics: expanding proteomics downwards

Biological function is mainly carried out by a dynamic population of proteins and peptides which may be used as markers for disease diagnosis, prognosis and as a guide for effective treatment. The study of proteins is called proteomics and it is generally performed by two-dimensional gel electrophoresis and mass spectrometric methods. However, gel-based proteomics is methodologically restricted from the low mass region, which includes important endogenous peptides. The study of endogenous peptides, peptidomics, is complicated by protein fragments produced post-mortem during conventional sample handling. Nanoflow liquid chromatography and MS, together with improved methods for sample preparation, have been used to semi-quantitatively monitor endogenous peptides in brain tissue. When rapidly heat-denatured brain tissue was analysed, these methods enabled simultaneous detection of hundreds of peptides and the identification of several endogenous peptides not previously described in the literature. In an application of the MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) model for Parkinson's disease, the expression of the small protein PEP-19 was compared with controls. The levels were found to be significantly decreased in the striatum of MPTP-treated animals.

Environmental influences on exopolysaccharide formation in Lactobacillus reuteri ATCC 55730

Lactobacillus reuteri is known to produce exopolysaccharides (EPS), which have the potential to be used as an alternative biothickener in the food industry. In this study, the effect of several environmental conditions on the growth and EPS production in the L. reuteri strain ATCC 55730 was determined. The expression of the corresponding reuteransucrase gene, gtfO, was investigated over time and the results indicated that the expression increased with growth during the exponential phase and subsequently decreased in the stationary phase. Fermentation with glucose and/or sucrose as carbon and energy source revealed that gtfO was constitutively expressed and that the activity profile was independent of the sugar source. In the applied ranges of parameter values, temperature and pH were the most important factors for EPS formation and only temperature for growth. The best EPS yield, 1.4 g g(-1) CDW, was obtained at the conditions 37 degrees C, pH 4.5 and 100 g l(-1) sucrose, which were close to the estimated optimal conditions: pH 4.56 and 100 g l(-1) sucrose. No EPS formation could be detected with glucose. In addition, no direct connection between the expression and the activity of reuteransucrase could be established. Finally, the strain ATCC 55730 was benchmarked against 14 other L. reuteri strains with respect to EPS production from sucrose and abilities to metabolise sucrose, glucose and fructose. Eight strains were able to produce glucan and a corresponding glucansucrase gene was confirmed for each of them.