Guideline-based flexible cystoscopy safely improves capacity, avoiding unnecessary intervention with cost savings

Introduction:

Flexible cystoscopy (FC) is a common and useful diagnostic tool. Because of its broader applications, availability and simplicity, there has been criticism of its overuse with accompanying financial burden to the health system and unnecessary invasive intervention to the patient. Therefore, we reviewed our local practice against current guidelines to evaluate compliance, enhance patient safety and capacity utilisation.

Patients and methodology:

Data were collected retrospectively on all patients having FC over two months. The indications and findings of FC were gathered from the hospital electronic patient record system.

Results:

A total of 413 FCs were carried out over the study period. The most common indications were cancer surveillance 116 (28%) and visible haematuria 76 (18.4%). A total of 152 (37%) FCs were performed for non-recommended indications. The most common conditions that deviated from guidelines were lower urinary tract symptoms (LUTS) (72, 17.4%), urinary tract infection (UTI) (41, 9.9%) and asymptomatic non-visible haematuria (35, 8.5%). In all non-visible haematuria cases, 65 (90%) of LUTS and 39 (95%) of UTI patients, FC was non-contributory. Adherence to guidelines would have yielded 37% of FC slots. Based on current UK National Tariffs, cost savings would have been £352,032 annually in this trust.

Conclusions:

FC is a frequent investigation within urology departments for which referral guidelines exist. Protocol-driven practice enables appropriate use, ensures patient safety and leads to efficient utilisation of capacity with substantial cost savings.

Level of evidence:

Not applicable for this multicentre audit.

Effectiveness of Pressurized Normal Saline Irrigation of Subcutaneous Tissue Following Appendicectomy in Decreasing Wound Infection: A Quasi Experimental Study

Acute appendicitis is the commonest cause of acute abdomen necessitating surgical intervention and wound infection is the most frequently encountered complication following appendicectomy. To assess the effectiveness of pressurized normal saline irrigation of subcutaneous tissue following appendicectomy in decreasing wound infection this quasi experimental study was done in Surgery Unit III, Mymensingh Medical College Hospital from January 2018 to December 2018. In this study total 200 patients of acute appendicitis were enrolled according to inclusion and exclusion criteria and assigned equally into two groups by non-equivalent control group design. In control group all the standard protocol of wound closure following appendicectomy was followed and in experimental group along with the standard protocol the subcutaneous tissue was irrigated by pressure with normal saline and all the data were recorded in individual case record form. Among the sample most of the patients were between 10-19 years of ages and the male female ratio was 1.38:1. In control group 30% patients developed wound infection while 12% patients developed wound infection in experimental group with a P value of 0.027. Mean hospital stay of experimental group was less than the control group (P value less than 0.05). Overall postoperative outcome in context of wound infection and hospital stay is better following pressurized normal saline irrigation of subcutaneous tissue during closure.

Plant Part-Derived Carbon Dots for Biosensing

Carbon dots (CDs) are a new cluster of carbon atoms with particle size less than 10 nm. CDs also exhibit interesting fluorescence (FL) properties. CDs are attractive because of their fascinating characteristics including low toxicity, good water solubility, and tremendous biocompatibility. Recently, CDs have been investigated as biosensors for numerous target analytes. Meanwhile, the utilization of cheap and renewable natural resources not only fulfills the pressing requirement for the large-scale synthesis of CDs but also encourages the establishment of sustainable applications. The preparation of CDs using natural resources, i.e., plants, offers several advantages as it is inexpensive, eco-friendly, and highly available in the surroundings. Plant parts are readily available natural resources as the starting materials to produce CDs with different characteristics and attractive applications. Several review articles are now available covering the synthesis, properties, and applications of CDs. However, there is no specific and focused review literature discussing plant part-derived CDs for biosensing applications. To handle this gap, we provide a review of the progress of CDs derived from various plant parts with their synthesis methods, optical properties, and biosensing applications in the last five years. We highlight the synthesis methods and then give an overview of their optical properties and applications as biosensors for various biomolecules and molecules in biological samples. Finally, we discuss some future perspectives for plant part-derived CDs for better material development and applications.

New classes of organic pollutants in the remote continental environment - Chlorinated and brominated polycyclic aromatic hydrocarbons on the Tibetan Plateau

Halogenated polycyclic aromatic hydrocarbons are carcinogenic and ubiquitous environmental organic pollutants. The abundance and sources of these compounds have not been studied in remote environments. We collected and analyzed air, soil, lichen, and moss samples from the Tibetan Plateau. Concentrations of chlorinated polycyclic aromatic hydrocarbons were 0.78-4.16 pg/m³ in air, 3.11-297 pg/g in soil, 260-741 pg/g in lichens, and 338-934 pg/g in mosses. Concentrations of brominated polycyclic aromatic hydrocarbons were 0.15-0.59 pg/m³ in air, 0.61-72.3 pg/g in soil, 33.5-64.9 pg/g in lichens, and 20.5-72.5 pg/g in mosses. The dominant congeners were 9- and 2-chlorophenanthrene, 1-chloropyrene, 3-chlorofluoranthene, and 1-bromopyrene. We found correlations between congener concentrations in lichens and in air, and lichens effectively predicted near-ground atmospheric concentrations of the pollutants. The enrichment of photochemically stable compounds in high-altitude environments is influenced by their physicochemical properties. Principal component analysis with multivariate linear regression of chlorinated polycyclic aromatic hydrocarbons measured in lichens provided an assessment of the relative source contributions, and suggested that in Medog County of Tibetan Plateau, 48% was likely from long-range combustion sources, 26% was from local burning sources, and 26% was from photochemical formation.

Efficacy of Intra-peritoneal Tramadol Instillation for Postoperative Pain Management after Laparoscopic Cholecystectomy

Gall stone disease is one of the most common conditions encountered in general surgical practices in adult population. The gold standard treatment for symptomatic gall stone disease is laparoscopic cholecystectomy. It results in less post-operative pain as compared to open cholecystectomy but post-operative pain may be mild, moderate or even severe in some patients. This Randomized control trail was conducted to In-patient department of Surgery, Mymensingh Medical College & Hospital (MMCH), Mymensingh, Bangladesh from April 2018 to September 2018. It was undertaken to evaluate the analgesic effect of intra-peritoneal tramadol instillation in patients undergoing laparoscopic cholecystectomy. Total 70 patients with symptomatic gallstone disease undergoing laparoscopic cholecystectomy were randomized equally in two groups. Then patients were selected in according to the inclusion and exclusion criteria. In first group (Group A), patients were received intra-peritoneal tramadol 100mg (diluted in 20.0ml distilled water). Sprayed 10.0ml diluted tramadol into the sub diaphragmatic area, 5.0ml into the area of gall bladder bed and 5.0ml into the space between the liver and kidney under direct vision just before removal of trocars. In second group (Group B) the conventional operative procedure was followed. Postoperatively, patient was extubated and shifted to recovery room. Data recorded and analyzed, such as post-operative pain score at 1, 4, 8, and 24 hour; cumulative 1, 8 and 24 hour analgesic consumption. In addition that postoperative hospital period monitoring of heart rate, blood pressure, respiratory rate, temperature at 0, 4, 8, 24 hours was also analyzed. Intensity of pain was assessed by Visual Analogue Scale (VAS) scoring system. Patients showed a VAS ≥3 or patients who requested for analgesia was administrated a supplemental dose of analgesic. In the present study the mean pain scores in Group A were found to be low at1hourpost-operative was 0.60±0.56 and there was a gradual increase in score in respect of time interval with peak of 2.07±0.91 at 24 hours. Whereas, in Group B the mean pain scores immediate post-operative period were at its peak was, 2.50±0.82 which decreased to 1.30±0.84 at 1 hour and further there was rise at 4 hours (2.10±0.71) and 24 hours (2.33±0.0.71). But at any point of time the mean VAS remained significantly low (p<0.050) in patients with Group A compared to Group B except at 1st 24 hours (p=0.210). Intra-peritoneal instillation of tramadol for postoperative pain control in laparoscopic cholecystectomy has beneficial effect in terms of postoperative pain relief following laparoscopic cholecystectomy.

Polychlorinated Naphthalene Congener Profiles in Common Vegetation on the Tibetan Plateau as Biomonitors of Their Sources and Transportation

Polychlorinated naphthalenes (PCNs) are globally transported, carcinogenic, persistent organic pollutants (POPs) that were recently added to the Stockholm Convention with 184 parties. The Tibetan Plateau plays an important role in the global transportation and distribution of POPs. Knowledge of PCN sources and transportation on the Tibetan Plateau is important for their control globally. In this study, we quantified the congener-specific concentrations of PCNs in lichen, moss, soil, and air samples collected on the Tibetan plateau and found that common lichens were effective biomonitors for predicting atmospheric PCNs in this area. The physiochemical properties of the PCNs, the temperatures, and the lichen lipid contents were identified as important factors influencing PCN partitioning between lichens and air. Lichen-air partitioning equations were established and used to predict PCN concentrations in air in Southeast Tibet. The lichens could be used as PCN biomonitors to clarify their spatial variations, sources, and transportation in the southeast of the plateau. PCN concentrations in lichens increased with altitude, suggesting that high-mountain cold-trapping influenced the PCN transportation behavior. Principal component analysis and linear discriminant analysis showed that the major source of PCNs in this region was long-range atmospheric transportation via the Indian monsoon in summer and wind from Southwest Asia in winter. This study provides a novel method using PCN congener profiles as fingerprints and statistical models for studying the geochemical effects of conditions in high-mountain regions on the contamination behaviors of 75 congeners of the notorious PCNs.

Flag leaf size and posture of bread wheat: genetic dissection, QTL validation and their relationships with yield-related traits

Major and environmentally stable QTL for flag leaf-related traits in wheat were identified and validated across ten environments using six populations with different genetic backgrounds. Flag leaf size and posture are two important factors of "ideotype" in wheat. Despite numerous studies on genetic analysis of flag leaf size including flag leaf length (FLL), width (FLW), area (FLA) and the ratio of length/width (FLR), few have focused on flag leaf posture including flag leaf angle (FLANG), opening angle (FLOA) and bend angle (FLBA). Further, the numbers of major, environmentally stable and verified genetic loci for flag leaf-related traits are limited. In this study, QTL for FLL, FLW, FLA, FLR, FLANG, FLOA and FLBA were identified based on a recombinant inbred line population together with values from up to ten different environments. Totally, eight major and stably expressed QTL were identified. Three co-located chromosomal intervals for seven major QTL were identified. The five major QTL QFll.sicau-5B.3 and QFll.sicau-2D.3 for FLL, QFlr.sicau-5B for FLR, QFlw.sicau-2D for FLW and QFla.sicau-2D for FLA were successfully validated by the tightly linked Kompetitive Allele Specific PCR (KASP) markers in the other five populations with different genetic backgrounds. A few genes related to leaf growth and development in intervals for these major QTL were predicated. Significant relationships between flag leaf- and yield-related traits were evidenced by analyses of Pearson correlations, conditional QTL and genetic mapping. Taken together, these results provide valuable information for understanding flag leaf size and posture of "ideotype" as well as fine mapping and breeding utilization of promising loci in bread wheat.

Correction to: Identification and validation of a major and stably expressed QTL for spikelet number per spike in bread wheat

Unfortunately, the author contribution statement was missed out in the original publication. The complete statement is given below.

Identification and validation of a major and stably expressed QTL for spikelet number per spike in bread wheat

A major and stably expressed QTL for spikelet number per spike identified in a 2-cM interval on chromosome arm 2DS was validated using two populations with different genetic backgrounds. Spikelet number per spike (SNS) plays a key role in wheat yield improvement. Numerous genetic and environmental factors influencing SNS have been documented, but the number of major, stably expressed and validated loci underlying SNS is still limited. In this study, a recombinant inbred line (RIL) population derived from a normal spikelet cultivar and a multiple-spikelet wheat line (with a longer spike with more canonically oriented apical spikelets) was genotyped using a Wheat55K single-nucleotide polymorphism (SNP) array and simple sequence repeat (SSR) markers. SNS was measured for this RIL population in eight environments. Five QTL were each identified in two or more environments. One of them, QSns.sau-2D (LOD = 3.47-38.24, PVE = 10.16-45.68%), was detected in all the eight environments. The QTL was located in a 2-cM interval on chromosome arm 2DS flanked by the markers AX-109836946 and AX-111956072. This QTL, QSns.sau-2D, significantly increased SNS by up to 14.72%. Several genes associated with plant growth and development were identified in the physical interval of QSns.sau-2D. This QTL was further validated by the tightly linked Kompetitive Allele Specific PCR (KASP) marker, KASP-AX-94721936, in two other populations with different genetic backgrounds. The significant correlation between SNS and anthesis date, plant height, spike length, grain number per spike and thousand-grain weight were detected and discussed. These results lay the foundation for fine mapping and cloning gene(s) underlying QSns.sau-2D.

Electro-plasmonic nanoantenna: A nonfluorescent optical probe for ultrasensitive label-free detection of electrophysiological signals

Harnessing the unprecedented spatiotemporal resolution capability of light to detect electrophysiological signals has been the goal of scientists for nearly 50 years. Yet, progress toward that goal remains elusive due to lack of electro-optic translators that can efficiently convert electrical activity to high photon count optical signals. Here, we introduce an ultrasensitive and extremely bright nanoscale electric-field probe overcoming the low photon count limitations of existing optical field reporters. Our electro-plasmonic nanoantennas with drastically enhanced cross sections (~10⁴ nm² compared to typical values of ~10^-2 nm² for voltage-sensitive fluorescence dyes and ~1 nm² for quantum dots) offer reliable detection of local electric-field dynamics with remarkably high sensitivities and signal-to-shot noise ratios (~60 to 220) from diffraction-limited spots. In our electro-optics experiments, we demonstrate high-temporal resolution electric-field measurements at kilohertz frequencies and achieved label-free optical recording of network-level electrogenic activity of cardiomyocyte cells with low-intensity light (11 mW/mm²).

Novel apoE receptor mimetics reduce LPS-induced microglial inflammation

Apolipoprotein E (apoE) and apoE-mimetic peptides exert prominent anti-inflammatory effects. We determined the anti-inflammatory effects of novel apoE receptor mimetics, composed of the LDL receptor-binding domain of apoE (aa 133-152, ApoEp) or ApoEp with 6 lysines (6KApoEp) or 6 aspartates added at the N-terminus (6DApoEp). BV2 microglia and human THP-1 monocytes were treated with lipopolysaccharide (LPS) in the absence or presence of ApoEp, 6KApoEp or 6DApoEp, followed by determination of pro-inflammatory tumor necrosis factor α (TNFα) and interleukin-6 (IL-6) release by ELISA. As signaling intermediates of inflammation, Signal Transducer and Activator of Transcription 3 (STAT3), Janus-Activated Kinase2 (JAK2) and p38 and p44/42 MAPK phosphorylation levels were determined by Western blot analysis. In addition, we isolated splenocytes from female htau mice treated with 6KApoEp or 6K for 28 weeks, followed by determination of concanavalinA (conA)-mediated interferon gamma (IFNγ) release. 6KApoEp starting at 2.5 µM significantly reduced LPS-mediated TNFα and IL-6 secretion in BV2 and THP-1 cells in a dose-dependent manner. In BV2 cells, 6KApoEp reduced TNFα secretion more effectively than 6DApoEp and ApoEp, which was blocked by PCSK9 treatment, suggesting a role for LDL receptors. 6KApoEp also inhibited LPS-induced p44/42 MAPK, JAK2 and STAT3 phosphorylation, while enhancing p38 MAPK phosphorylation. In addition, conA induced significantly less IFNγ release in splenocytes derived from htau mice treated with 6KApoEp compared with those treated with 6K. Thus, 6KApoEp most effectively reduces LPS-mediated neuroinflammation by interacting with LDL receptors, thus representing a novel anti-inflammatory agent for treatment of neurodegenerative disease.

Validation and delineation of a locus conferring Fusarium crown rot resistance on 1HL in barley by analysing transcriptomes from multiple pairs of near isogenic lines

BACKGROUND

Fusarium crown rot (FCR) is a chronic and severe disease in cereal production in semi-arid regions worldwide. A putative quantitative trait locus conferring FCR resistance, Qcrs.cpi-1H, had previously been mapped on the long arm of chromosome 1H in barley.

RESULTS

In this study, five pairs of near-isogenic lines (NILs) targeting the 1HL locus were developed. Analysing the NILs found that the resistant allele at Qcrs.cpi-1H significantly reduced FCR severity. Transcriptomic analysis was then conducted against three of the NIL pairs, which placed the Qcrs.cpi-1H locus in an interval spanning about 11 Mbp. A total of 56 expressed genes bearing single nucleotide polymorphisms (SNPs) were detected in this interval. Five of them contain non-synonymous SNPs. These results would facilitate detailed mapping as well as cloning gene(s) underlying the resistance locus.

CONCLUSION

NILs developed in this study and the transcriptomic sequences obtained from them did not only allow the validation of the resistance locus Qcrs.cpi-1H and the identification of candidate genes underlying its resistance, they also allowed the delineation of the resistance locus and the development of SNPs markers which formed a solid base for detailed mapping as well as cloning gene(s) underlying the locus.

Comparing the effect of the novel ionic cocrystal of lithium salicylate proline (LISPRO) with lithium carbonate and lithium salicylate on memory and behavior in female APPswe/PS1dE9 Alzheimer's mice

Alzheimer's disease (AD) is characterized by progressive decline of cognition and associated neuropsychiatric signs including weight loss, anxiety, depression, agitation, and aggression, which is particularly pronounced in the female gender. Previously, we have shown that a novel ionic co-crystal of lithium salicylate proline (LISPRO) is an improved lithium formulation compared to the carbonate or salicylate form of lithium in terms of safety and efficacy in reducing AD pathology in Alzheimer's mice. The current study is designed to compare the prophylactic effects of LISPRO, lithium carbonate (LC), and lithium salicylate (LS) on cognitive and noncognitive impairments in female transgenic APPswe/PS1dE9 AD mice. Female APPswe/PS1dE9 mice at 4 months of age were orally treated with low-dose LISPRO, LS, or LC for 9 months at 2.25 mmol lithium/kg/day followed by determination of body weight, growth of internal organs, and cognitive and noncognitive behavior. No significant differences in body or internal organ weight, anxiety or locomotor activity were found between lithium treated and untreated APPswe/PS1dE9 cohorts. LISPRO, LC, and LS prevented spatial cognitive decline, as determined by Morris water maze and depression as determined by tail suspension test. In addition, LISPRO treatment was superior in preventing associative memory decline determined by contextual fear conditioning and reducing irritability determined by touch escape test in comparison with LC and LS. In conclusion, low-dose LISPRO, LC, and LS treatment prevent spatial cognitive decline and depression-like behavior, while LISPRO prevented hippocampal-dependent associative memory decline and irritability in APPswe/PS1dE9 mice.

Development of tightly linked markers and identification of candidate genes for Fusarium crown rot resistance in barley by exploiting a near-isogenic line-derived population

This study demonstrates the feasibility of developing co-segregating markers and identifying candidate genes for Fusarium crown rot resistance in barley based on the generation and exploitation of a near-isogenic line-derived large population. Fusarium crown rot (FCR) is a chronic and severe disease in cereals in semi-arid regions worldwide. Previous studies showed that FCR assessment could be affected by many factors including plant height, growth rate as well as drought stress. Thus, accurate assessment, which is essential for detailed mapping of any locus conferring FCR resistance, is difficult. Targeting one of the resistance loci reported earlier, we developed a near-isogenic line-derived population consisting of 1820 F9 lines. By analysing this population, the Qcrs.cpi-4H locus was mapped to an interval of 0.09 cM covering a physical distance of about 637 kb and 13 markers co-segregating with the targeted locus were developed. Candidate genes underlying the resistance locus were identified by analysing the expression and sequence variation of genes in the targeted interval. The accurate localization and the development of co-segregating markers should facilitate the incorporation of this large-effect QTL into breeding programmes as well as the cloning of gene(s) underlying the locus.

[Hookworm-related folliculitis in a woman performing skin bleaching in Benin]

Hookworm-related cutaneous larva migrans is caused by the subcutaneous migration of hookworm larvae. The characteristic sign is a serpiginous cutaneous track. Folliculitis is an uncommon clinical manifestation. We report a case of hookworm-related folliculitis in a woman performing skin bleaching. A 33-year-old woman presented with a widespread cutaneous eruption made of erythematous and itchy follicular papulo-nodules, with erythematous serpiginous tracks, about 5-10cm long and numerous streaks of scratching, located on the limbs, buttocks and trunk. The cutaneous lesions occurred two days after contact with the floor of a warehouse contamined by faeces of cats. The lesions have been evolving for a week and have been treated with antibiotics without success. Clinical examination found cutaneous atrophy, purple stretch marks and hyperpigmentation of dorsal parts of fingers joints. The patient reported having been using bleaching cosmetics containing topical steroids and hydroquinone for twelve years. She was cured within 4 weeks with oral albendazole 400mg per day during 7 consecutive days.

Post-traumatic growth in (ex-) military personnel: review and qualitative synthesis

BACKGROUND

Military service can be a traumatic experience and cause mental health problems in a minority of personnel, such as post-traumatic stress disorder (PTSD), which is linked to negative long-term outcomes. As a result, PTSD has received significant research attention. However, post-traumatic growth (PTG) is a newer construct, with comparatively little known about its presentation and development.

AIMS

To qualitatively examine the experience of (PTG) in military and ex-military personnel.

METHODS

A qualitative systematic search of electronic databases was conducted, with studies assessed for methodological quality and data analysed using thematic analysis. Nine qualitative studies, carried out between 2011 and 2016, met the inclusion criteria with 195 participants in total, including both military and ex-military personnel.

RESULTS

Six themes were identified: appreciation for life, re-evaluating sense of purpose, improvement of personal human traits, bonding and connecting with others, integrating into society, and being proud of heritage and feeling valuable to society.

CONCLUSIONS

The results of this review illustrate that military personnel may experience PTG due to deployment-related trauma exposure, and the presentation of PTG in this population is not dissimilar to that of civilians. This study highlights the need for additional research to quantify the long-term psychological impact of PTG and whether a focus on PTG may be helpful in psychological treatment for (ex-) military personnel.

Prognosis of ischemic stroke patients with or without collateralization after carotid stenosis

The objective of this study was to see the  association of the prognosis of ischemic stroke patients with or without collateralization after carotid stenosis. This study was conducted on 36 patients presenting with acute ischemic stroke who were going through digital subtraction angiography from March 2017 to March 2018. Collateralization status after unilateral or bilateral stenosis was evaluated. Modified ranking scale (mRS) score was  measured on the first day of the stroke and after three months. The disability of ischemic stroke patients was compared between patients who developed collateralization and who had not. Among them, 61.6% developed collateralization. Among the patients who developed collateralization after three months, 90.9% patients had mRS scale of ≤2 and who not developed collateralization, 85.7% patients had mRS scale of ≤2. In both the groups, the p value was <0.05. It can be concluded that carotid stenosed patients who suffered from ischemic stroke, most of the patients disability improved to some extents whether collateralization developed or not among the major vessels.

Human Cord Blood Serum-Derived APP α-Secretase Cleavage Activity is Mediated by C1 Complement

Alzheimer's Disease (AD) is the leading cause of dementia in the elderly. In healthy individuals, amyloid precursor protein (APP) is cleaved by α-secretase, generating soluble α-amyloid precursor protein (sAPPα), which contributes neuroprotective functions in the neuronal environment. In contrast, in the neurodegenerative environment of AD patients, amyloid-β-peptide (Aβ) of either 40 or 42 residues are generated by increased activity of β- and γ-secretase. These proteins amalgamate in specific regions of the brain, which disrupts neuronal functions and leads to cognitive impairment. Human umbilical cord blood cells (HUCBC) have proven useful as potential immunomodulatory therapies in various models of neurodegenerative diseases, including AD. Our most recent work studied the impact of umbilical cord blood serum (CBS) on modulation of sAPPα production. Heat-sensitive CBS significantly promoted sAPPα production, indicating that heat-sensitive factor(s) play(s) a role in this process. Liquid chromatography with tandem mass spectrometry (LC-MS/MS) analysis was used to determine the molecular source of α-secretase in purified CBS and aged blood serum (AgBS) fraction. Of the proteins identified, the subunits of C1 complex (C1q, C1r, and C1s) and alpha-2-macroglobulin showed significantly greater levels in purified α-CBS fraction (α-CBSF) compared with the AgBS fraction (AgBSF). Specifically, C1 markedly increased sAPPα and alpha-carboxyl-terminal fragment (α-CTF) production in a dose-dependent fashion, whereas C1q alone only minimally increased and C3 did not increase sAPPα production in the absence of sera. Furthermore, C1q markedly increased sAPPα and α-CTF, while decreasing Aβ, in CHO/APPwt cells cultured in the presence of whole sera. These results confirm our initial assumption that APP α-secretase activity in human blood serum is mediated by complement C1, opening a potential therapeutic modality for the future of AD.