Prenatal omega-3 LCPUFA and symptoms of allergic disease and sensitization throughout early childhood - a longitudinal analysis of long-term follow-up of a randomized controlled trial

Background

Randomized controlled trials of prenatal omega (ω-3) long chain polyunsaturated fatty acid (LCPUFA) supplementation are suggestive of some protective effects on allergic sensitization and symptoms of allergic disease in childhood. Due to the nature of the atopic march, investigation of any effects of this prenatal intervention may be most informative when consistently assessed longitudinally during childhood.

Methods

Follow-up of children (n = 706) with familial risk of allergy from the Docosahexaenoic Acid to Optimize Mother Infant Outcome (DOMInO) trial. The intervention group received fish oil capsules (900 mg of ω-3 LCPUFA) daily from <21 weeks' gestation until birth; the control group received vegetable oil capsules without ω-3 LCPUFA. This new longitudinal analysis reports previously unpublished data collected at 1 and 3 years of age. The allergic disease symptom data at 1, 3 and 6 years of age were consistently reported by parents using the "International Study of Asthma and Allergies in Childhood" (ISAAC) questionnaire. Sensitization was determined by skin prick test to age specific, common allergen extracts.

Results

Changes over time in symptoms of allergic disease with sensitization (IgE-mediated) and sensitization did not differ between the groups; interaction p = 0.49, p = 0.10, respectively. Averaged across the 1, 3 and 6-year assessments, there were no significant effects of prenatal ω-3 LCPUFA supplementation on IgE-mediated allergic disease symptoms (adjusted relative risk 0.88 (95% CI 0.69, 1.12), p = 0.29) or sensitization (adjusted relative risk 0.97 (95% CI 0.82, 1.15), p = 0.76). Sensitization patterns to common allergens were consistent with the atopic march, with egg sensitization at 1 year strongly associated with house dust mite sensitization at 6 years, (p < 0.0001).

Discussion

Although there is some evidence to suggest that maternal supplementation with 900mg ω-3 LCPUFA has a protective effect on early symptoms of allergic disease and sensitization in the offspring, we did not observe any differences in the progression of disease over time in this longitudinal analysis. Further investigation into the dose and timing of ω-3 LCPUFA supplementation, including long-term follow up of children using consistent outcome reporting, is essential to determine whether this intervention may be of benefit as a primary prevention strategy for allergic disease.

Conclusion

Maternal supplementation with 900 mg of ω-3 LCPUFA did not change the progression of IgE-mediated allergic disease symptoms or sensitization throughout childhood from 1 to 6 years.

Trial registration

Australian New Zealand Clinical Trials Registry (ACTRN); DOMInO trial ACTRN12605000569606, early childhood allergy follow up ACTRN12610000735055 and 6-year allergy follow up ACTRN12615000498594.

Perinatal and long-term effects of maternal uterine artery adenoviral VEGF-A165 gene therapy in the growth-restricted guinea pig fetus

Uterine artery application of adenoviral vascular endothelial growth factor A₁₆₅ (Ad.VEGF-A₁₆₅) gene therapy increases uterine blood flow and fetal growth in experimental animals with fetal growth restriction (FGR). Whether Ad.VEGF-A₁₆₅ reduces lifelong cardiovascular disease risk imposed by FGR remains unknown. Here, pregnant guinea pigs fed 70% normal food intake to induce FGR received Ad.VEGF-A₁₆₅ (1×10¹⁰ viral particles, n = 15) or vehicle ( n = 10), delivered to the external surface of the uterine arteries, in midpregnancy. Ad libitum-fed controls received vehicle only ( n = 14). Litter size, gestation length, and perinatal mortality were similar in control, untreated FGR, and FGR+Ad.VEGF-A₁₆₅ animals. When compared with controls, birth weight was lower in male but higher in female pups following maternal nutrient restriction, whereas both male and female FGR+Ad.VEGF-A₁₆₅ pups were heavier than untreated FGR pups ( P < 0.05, ANOVA). Postnatal weight gain was 10-20% greater in female FGR+Ad.VEGF-A₁₆₅ than in untreated FGR pups, depending on age, although neither group differed from controls. Maternal nutrient restriction reduced heart weight in adult female offspring irrespective of Ad.VEGF-A₁₆₅ treatment but did not alter ventricular wall thickness. In males, postnatal weight gain and heart morphology were not affected by maternal treatment. Neither systolic, diastolic, mean arterial pressure, adrenal weight, nor basal or challenged plasma cortisol were affected by maternal undernutrition or Ad.VEGF-A₁₆₅ in either sex. Therefore, increased fetal growth conferred by maternal uterine artery Ad.VEGF-A₁₆₅ is sustained postnatally in FGR female guinea pigs. In this study, we did not find evidence for an effect of maternal nutrient restriction or Ad.VEGF-A₁₆₅ therapy on adult offspring blood pressure.

Effects of tannic acid on growth performance, carcass characteristics, digestibility, nitrogen volatilization, and meat lipid oxidation of steers fed steam-flaked corn-based finishing diets

Effects of a tannic acid blend (ByPro; Silvateam USA, Ontario, CA) added to steam-flaked corn-based fishing diets on beef cattle growth performance, carcass characteristics, nutrient digestibility, fecal N volatilization, and meat lipid oxidation were evaluated. Steers ( = 144; 349 ± 25 kg initial BW) were blocked by initial BW and assigned randomly to 1 of 3 treatments with 12 pens/treatment and 4 steers/pen and fed ad libitum. Treatments included a control (CON; no ByPro) and ByPro fed at 30 or 60 g DM/steer daily (30-ByPro and 60-ByPro, respectively). Pen fecal samples were collected 7 d after cattle were shipped to slaughter for estimation of N volatilization. Strip loins were aged for 21 d for evaluation of color and antioxidant activity. Intake quadratically increased ( = 0.05) from d 0 to 35, whereas linear trends were observed for increased DMI from d 0 to 105 and d 0 to slaughter ( = 0.07 and = 0.06, respectively), resulting in a 3.7% greater overall DMI for 60-ByPro than for CON. No differences were detected for carcass-adjusted ADG ( = 0.65) or G:F ( = 0.17). Carcass characteristics including HCW ( = 0.52), fat thickness ( = 0.32), LM area ( = 0.57), quality grade ( = 0.44), yield grade ( = 0.29), and percentage of condemned livers ( = 0.13) were not affected by treatments. Apparent total tract digestibility of starch linearly decreased tendency ( = 0.03) with increasing ByPro dose, whereas tends for a linear decrease ( = 0.09) in CP and a quadratic increase ( = 0.09) in OM digestibility were observed. No effects of treatment ( ≥ 0.39) were noted for fecal N volatilization. An increase ( < 0.01) in metmyoglobin in strip loin steaks was observed with ByPro inclusion. Oxymyoglobin decreased ( < 0.01) as display day progressed, except on d 5, at which time CON and 30-ByPro steaks had lower proportions than 60-ByPro steaks. Only subtle changes in discoloration ratio and deoxymyoglobin were observed, whereas no effects ( ≥ 0.43) for pH or thiobarbituric acid reactive substances were noted. Feeding ByPro increased DMI during the first half of the feeding period without negatively affecting gain efficiency; however, fecal N retention was not altered by ByPro. ByPro did not negatively affect meat quality or carcass characteristics, and it did not seem to affect retail meat antioxidant activity.

Peripheral Neuropathy in Hypothyroidism - an Association with Spurious Polycythemia (Gaisbock's Syndrome)1

The neurological complications of hypothyroidism, including dementia, cerebellar ataxia, myopathy and entrapment neuropathy, are well recorded, but peripheral neuropathy has rarely been documented (Swanson et al. 1981). In this paper two patients are described who developed myxoedema and peripheral neuropathy. The first patient had a very rapid onset of myxoedema, and during observation he developed spurious polycythemia (Gaisbock's syndrome) over a period of nine days.

Interleukin-17A and vascular remodelling in severe asthma; lack of evidence for a direct role

BACKGROUND

Bronchial vascular remodelling may contribute to the severity of airway narrowing through mucosal congestion. Interleukin (IL)-17A is associated with the most severe asthmatic phenotype but whether it might contribute to vascular remodelling is uncertain.

OBJECTIVE

To assess vascular remodelling in severe asthma and whether IL-17A directly or indirectly may cause endothelial cell activation and angiogenesis.

METHODS

Bronchial vascularization was quantified in asthmatic subjects, COPD and healthy subjects together with the number of IL-17A⁺ cells as well as the concentration of angiogenic factors in the sputum. The effect of IL-17A on in vitro angiogenesis, cell migration and endothelial permeability was assessed directly on primary human lung microvascular endothelial cells (HMVEC-L) or indirectly with conditioned medium derived from normal bronchial epithelial cells (NHBEC), fibroblasts (NHBF) and airway smooth muscle cells (ASMC) after IL-17A stimulation.

RESULTS

Severe asthmatics have increased vascularity compared to the other groups, which correlates positively with the concentrations of angiogenic factors in sputum. Interestingly, we demonstrated that increased bronchial vascularity correlates positively with the number of subepithelial IL-17A⁺ cells. However IL-17A had no direct effect on HMVEC-L function but it enhanced endothelial tube formation and cell migration through the production of angiogenic factors by NHBE and ASMC.

CONCLUSIONS & CLINICAL RELEVANCE

Our results shed light on the role of IL-17A in vascular remodelling, most likely through stimulating the synthesis of other angiogenic factors. Knowledge of these pathways may aid in the identification of new therapeutic targets.

The Notion of Time in Medical Records — Structure of Chronology, Validation and Calculation of a Time Interval

The reasons for and requirements of collecting chronological information in a chronic progressive disease are considered. The authors discuss the rules for writing the chronology together with the algorithms permitting full validation. They show from examples the kinds of studies made possible by the chronology. Taking the progressive nature of the disease into consideration, its chronicity and numerous degenerations necessitate the structuration of different occurrences of the same notion. Hence, there results the development of chronological axes relative to each notion. Our procedures used operationally for several years are only limited in their efficacy by the time the doctor can spare to use them.

Structural, Syntactical and Semantic Data Validation in the Computer Processing of a Medical File

Validation of all data in the medical file is indispensable before storage in the computer in order to eliminate errors which may have occurred during data collection and transmission. Formal internal validation checks the observance of spelling and syntax rules governing conversion of medical observations into a form usable by the computer. Internal semantic validation checks the credibility of data by reference to standards. External validation cheeks conformity of the file, printed in clear language, with medical reality.

Long Range Medical Follow-up and Updating of Computerized Records

In order to follow the clinical course of patients with chronic diseases, it is necessary to have a system for updating their computerized record.

To achieve this objective, it is necessary to minimize the length of time devoted to information collecting and to feed the data into the computer in a manner which satisfies two essential criteria:

— easy filing process,

— easy access to the data for searches.

In this article we will consider five aspects of the updating process of a computerized record : a file of records, any record, any elementary item, the lexicon of notions, the results of questioning before and after updating.

With such a tool in hand, one can perform longitudinal studies using the data contained in the records. The approach of the authors is not only a formal one. They set up some basic formal principles from an existing experience of processing the data of several thousands of patients with diabetes and give a condensed description of the existing system.

Magnetically Coated Bioabsorbable Stents for Renormalization of Arterial Vessel Walls after Stent Implantation

The insertion of a stent in diseased arteries is a common endovascular procedure that can be compromised by the development of short- and long-term inflammatory responses leading to restenosis and thrombosis, respectively. While treatment with drugs, either systemic or localized, has decreased the incidence of restenosis and thrombosis these complications persist and are associated with a high mortality in those that present with stent thrombosis. We reasoned that if stents could be made to undergo accelerated endothelialization in the deployed region, then such an approach would further decrease the occurrence of stent thrombosis and restenosis thereby improving clinical outcomes. Toward that objective, the first step necessitated efficient capture of progenitor stem cells, which eventually would become the new endothelium. To achieve this objective, we engineered intrinsic ferromagnetism within nonmagnetizable, biodegradable magnesium (Mg) bare metal stents. Mg stents were coated with biodegradable polylactide (PLA) polymer embedding magnetizable iron-platinum (FePt) alloy nanoparticles, nanomagnetic particles, ⁿMags, which increased the surface area and hence magnetization of the stent. ⁿMags uniformly distributed on stents enabled capture, under flow, up to 50 mL/min, of systemically injected iron-oxide-labeled (IO-labeled) progenitor stem cells. Critical parameters enhancing capture efficiency were optimized, and we demonstrated the generality of the approach by showing that ⁿMag-coated stents can capture different cell types. Our work is a potential paradigm shift in engineering stents because implants are rendered as tissue in the body, and this "natural stealthiness" reduces or eliminates issues associated with pro-inflammatory immune responses postimplantation.