Blood or skin: what is best in predicting cow's milk allergy diagnosis?

Summary

Cut-off values for both skin prick tests (SPT) and specific IgE (sIgE) levels for predicting cow´s milk allergy (CMA) diagnosis are not universally defined. This study is a retrospective analysis of consecutive children (0-18 years-old) with suspected CMA tested with SPT and sIgE for cow's milk (CM) and its fractions between 2016-2017. CMA diagnosis was defined by a positive oral food challenge or a highly suggestive clinical history of CMA and SPT and/or sIgE positive to CM and/or its fractions. One hundred and five patients were included, 58% males with a median age of 2.5 (P25-P75:1-6) years and the diagnosis was confirmed in 83 patients (79%). The variables associated with CMA diagnosis were SPT with CM (p minor 0,05) and casein (p minor 0,05) and all sIgE to CM and its fractions (alfa Lactalbumin, beta Lactoglobulin and casein; p minor 0,05 for all). Optimal cut39 off points (Youden's index) for CMA diagnosis were, for the mean wheal diameter, to CM milk of 4.5mm and to casein of 3mm. For sIgE levels the optimal cut-off points were: for CM of 4.36 kUA/L, alfa-lactalbumin of 1.6 kUA/L, beta-lactoglobulin of 1.7 kUA/L and for casein of 2.6 kUA/L. The role of SPT and sIgE levels to cow´s mlik and its fractions is unequivocal in CMA follow-up. Moreover, sIgE levels seem to be more discriminatory than SPT.

APPLICATION OF DROPLET DETECTORS TO ALPHA RADIATION DETECTION

Superheated droplet detectors (SDDs) are traditionally employed in the detection of neutrons. In this work the focus is on the detection of alpha particles using C2ClF5 as the target liquid. The alpha-droplet interaction is examined via computational studies, and a geometric model developed to describe the expected detector response. Experiments with alpha-emitting uranium- and samarium-doped SDDs at temperatures of 5-12°C confirm that the event rate is related to the size of the droplets, and are in model agreement for temperatures below 8°C; above this temperature, the acoustic sensitivity is reduced by signal attenuation as a result of the increasing bubble population, for which the addition of an attenuation coefficient restores the agreement with experiment. The results suggest the viability of a SDD-based alpha spectrometer using mono-sized droplets.

Characterisation of the epithermal neutron irradiation facility at the Portuguese research reactor using MCNP

The radiation field at the epithermal beamline and irradiation chamber installed at the Portuguese Research Reactor (RPI) at the Campus Tecnológico e Nuclear of Instituto Superior Técnico was characterised in the context of Prompt Gamma Neutron Activation Analysis (PGNAA) applications. Radiographic films, activation foils and thermoluminescence dosimeters were used to measure the neutron fluence and photon dose rates in the irradiation chamber. A fixed-source MCNPX model of the beamline and chamber was developed and compared to measurements in the first step towards planning a new irradiation chamber. The high photon background from the reactor results in the saturation of the detector and the current facility configuration yields an intrinsic insensitivity to various elements of interest for PGNAA. These will be addressed in future developments.

[Chronic recurrent multifocal osteomyelitis: case series of four patients treated with biphosphonates]

AIM

To report and describe a series of four cases of chronic recurrent multifocal osteomyelitis (CRMO) and to discuss therapeutic options, particularly bisphosphonate therapy.

METHODS

Retrospective review of four CRMO cases in two Pediatric Units in Lisbon, between 2005 and 2010.

RESULTS

Median age of first CRMO symptoms was 11.3 years (range 9-13). The more affected sites were the metaphysis of the long bones, pelvis and coxofemoral joints. Median number of initial bony lesions for each patient was 2.3 (range 1-3) at onset and 3.8 (range 2-6) during the disease course. All patients failed to respond to NSAIDs therapy. Two patients received corticosteroids, with clinical disease remission in only one of them. All patients received bisphosphonates (alendronate in two and pamidronate in two), all with good clinical response and induction of clinical remission in two of them. After a median follow-up period of 4.3 years (range 4-5), three patients are clinically asymptomatic and one patient remains with chronic residual pain.

CONCLUSIONS

The treatment of CRMO is not standardized. Bisphosphonate therapy can be of benefit to patients with relapsing symptoms. Randomized controlled multicentric trials are needed to provide better evidence for universal recommendation and definition of bisphosphonate therapy protocol.

Biofunctionalized nanoparticles with pH-responsive and cell penetrating blocks for gene delivery

Bridging the gap between nanoparticulate delivery systems and translational gene therapy is a long sought after requirement in nanomedicine-based applications. However, recent developments regarding nanoparticle functionalization have brought forward the ability to synthesize materials with biofunctional moieties that mimic the evolved features of viral particles. Herein we report the versatile conjugation of both cell penetrating arginine and pH-responsive histidine moieties into the chitosan polymeric backbone, to improve the physicochemical characteristics of the native material. Amino acid coupling was confirmed by 2D TOCSY NMR and Fourier transform infrared spectroscopy. The synthesized chitosan-histidine-arginine (CH-H-R) polymer complexed plasmid DNA biopharmaceuticals, and spontaneously assembled into stable 105 nm nanoparticles with spherical morphology and positive surface charge. The functionalized delivery systems were efficiently internalized into the intracellular compartment, and exhibited remarkably higher transfection efficiency than unmodified chitosan without causing any cytotoxic effect. Additional findings regarding intracellular trafficking events reveal their preferential escape from degradative lysosomal pathways and nuclear localization. Overall, this assembly of nanocarriers with bioinspired moieties provides the foundations for the design of efficient and customizable materials for cancer gene therapy.

Final analysis and results of the Phase II SIMPLE dark matter search

We report the final results of the Phase II SIMPLE measurements, comprising two run stages of 15 superheated droplet detectors each, with the second stage including an improved neutron shielding. The analyses include a refined signal analysis, and revised nucleation efficiency based on a reanalysis of previously reported monochromatic neutron irradiations. The combined results yield a contour minimum of σp=5.7×10(-3)  pb at 35  GeV/c2 in the spin-dependent sector of weakly interacting massive particle (WIMP) proton interactions, the most restrictive to date for MW}≤60  GeV/c2 from a direct search experiment and overlapping, for the first time, with results previously obtained only indirectly. In the spin-independent sector, a minimum of 4.7×10(-6)  pb at 35  GeV/c2 is achieved, with the exclusion contour challenging a significant part of the light mass WIMP region of current interest.

First results of the Phase II SIMPLE dark matter search

We report results of a 14.1   kg d measurement with 15 superheated droplet detectors of total active mass 0.208 kg, comprising the first stage of a 30 kg d Phase II experiment. In combination with the results of the neutron-spin sensitive XENON10 experiment, these results yield a limit of |a(p)|<0.32 for M(W)=50 GeV/c² on the spin-dependent sector of weakly interacting massive particle-nucleus interactions with a 50% reduction in the previously allowed region of the phase space, formerly defined by XENON, KIMS, and PICASSO. In the spin-independent sector, a limit of 2.3×10⁻⁵ pb at M(W)=45 GeV/c² is obtained.

Dosimetry at the Portuguese research reactor using thermoluminescence measurements and Monte Carlo calculations

This work presents an extensive study on Monte Carlo radiation transport simulation and thermoluminescent (TL) dosimetry for characterising mixed radiation fields (neutrons and photons) occurring in nuclear reactors. The feasibility of these methods is investigated for radiation fields at various locations of the Portuguese Research Reactor (RPI). The performance of the approaches developed in this work is compared with dosimetric techniques already existing at RPI. The Monte Carlo MCNP-4C code was used for a detailed modelling of the reactor core, the fast neutron beam and the thermal column of RPI. Simulations using these models allow to reproduce the energy and spatial distributions of the neutron field very well (agreement better than 80%). In the case of the photon field, the agreement improves with decreasing intensity of the component related to fission and activation products. (7)LiF:Mg,Ti, (7)LiF:Mg,Cu,P and Al(2)O(3):Mg,Y TL detectors (TLDs) with low neutron sensitivity are able to determine photon dose and dose profiles with high spatial resolution. On the other hand, (nat)LiF:Mg,Ti TLDs with increased neutron sensitivity show a remarkable loss of sensitivity and a high supralinearity in high-intensity fields hampering their application at nuclear reactors.

The simple SDD

We describe the fabrication and characterisation of the SIMPLE superheated droplet detector, a 10 g active mass device of C(2)ClF(5) in 1-3% weight concentrations currently employed in a direct search for spin-dependent astroparticle dark matter candidates.

Photon and fast neutron dosimetry using aluminium oxide thermoluminescence dosemeters

Al(2)O(3):Mg,Y thermoluminescence (TL) dosemeters were used to measure photon and fast neutron doses in a fast neutron beam recently implemented at the Portuguese Research Reactor, Nuclear and Technological Institute, Portugal. The activation of Al(2)O(3):Mg,Y by fast neutrons provides information about the fast neutron component by measuring the activity of the reaction products and the self-induced TL signal. Additionally, the first TL reading after irradiation determines the photon dose. The elemental composition of the dosemeters was determined by instrumental neutron activation analysis and by particle induced X-ray emission. Results demonstrate that Al(2)O(3):Mg,Y is an adequate material to discriminate photon and fast neutron fields for reactor dosimetry purposes.

Neutron spectrometry with large volume, heavy-loaded superheated droplet detectors: a simple spin-off

SIMPLE is a superheated droplet detector (SDD) experiment designed to search for the evidence of spin-dependent weakly interacting neutralino dark matter (WIMPs). SDDs, a type of emulsion detector, consist of a uniform suspension of superheated liquid droplets in a compliant material such as a polymeric or aqueous gel. We report on the first neutron spectrometry experiments with SIMPLE SDDs, a spin-off of the neutron detector calibrations performed at the Portuguese Research Reactor. SIMPLE SDDs differ from most SDDs available commercially as they have a 10 times higher loading factor, containing 10(3) times more freon than their commercial counterparts and a 100 times larger volume. We have analysed the response of SIMPLE SDDs to two quasi-monochromatic neutron beams of energies 54 and 144 keV obtained with passive filters. Results show that the characteristic peaks in the fluence distribution of both filters could be determined and their energy position obtained using a simple thermodynamic relation.

Thermoluminescence dosimetry of a thermal neutron field and comparison with Monte Carlo calculations

The characteristics of thermoluminescence dosemeters (TLDs) regarding the determination of photon and neutron absorbed doses were investigated in a thermal neutron beam. Harshaw TLD-100 (LiF:Mg,Ti) and TLD-700 (7LiF:Mg,Ti) were compared with similar materials from Solid Dosimetric Detector and Method Laboratory (People's Republic of China). Harshaw TLD-700H (7LiF:Mg,Cu,P) and aluminium oxide (Al2O3:Mg,Y) from Hungary were also considered for photon dose measurement. The neutron sensitivity of the investigated materials was measured and found to be consistent with values reported by other authors. A comparison was made between the TL dose measurements and results obtained via conventional methods. An agreement within 20% was obtained, which demonstrates the ability of TLD for measuring neutron and photon doses in a mixed field, using careful calibration procedures and determining the neutron sensitivity for the usage conditions.

[Transient neutropenia in previously healthy children]

Transient neutropenia in otherwise healthy children is not unusual, the main causes being infections and drugs. The risk of developing an infectious complication in previously healthy children with transient neutropenia is low. These infections are usually superficial and caused by common bacteria. We present two cases of previously healthy children with Pseudomonas sepsis who presented with severe neutropenia, not submitted to recent hospitalization or invasive therapeutic or monitoring proceedings. We discuss the etiology of transitory neutropenia and the reasons for this severe community-acquired infection, caused by an unusual agent. The authors also mention their therapeutic attitudes for previously healthy children with transient neutropenia. They should be guided by clinical presentation and neutropenia severity.