Determinants of death from malformations of the circulatory system

Background

Congenital malformations (CMs) were the second cause of death in infants under the age of 1 year in North America and Europe in 2017, behind perinatal causes.Of the CMs, those of the circulatory system (MCSs) were the most lethal. Studies in Brazil, North America and England have reported higher mortality from MCS in the presence of prematurity, non-white skin color of the newborn, asphyxia, low birthweigth, advanced maternal age, and low maternal education level. The magnitudes of those associations vary. Those studies have investigated neither the risk of death from MCS, with control of the mediation provoked by those and other variables, nor the construction of a model to explain the relationship between variables and deaths.

Objective

To assess the associations of maternal geographic and socioeconomic factors, as well as gestational and birth factors, with deaths from MCSs in the first year of life in Brazil from 2006 to 2016, and to build an explanatory model of the relationship between variables and death.

Methods

Study of the Brazilian databases Information System on Live Births and Mortality Information System, which were linked by deterministic relationship and submitted to the cohort strategy. Crude and controlled relative risks were estimated. Acyclic graphs directed the creation of explanatory models of the relationship between maternal and fetal variables and the risks of death from MCSs and all causes.

Results

The deterministic linkage of 32,011,727 live birth certificates and 266,215 deaths yielded 248,027 linked pairs. Low birth weight (RR=14.38), asphyxia in the first (RR=5.95) and fifth minute (RR=11.86), maternal age ≥35 years (RR=1.66), male sex (RR=1.13), residing in the West-Central Brazil (RR=1.22) and small number of prenatal visits (RR=2.24) increased the risk of death from MCSs. Prematurity and multiple-gestation pregnancy had effects on death mediated by low birth weight and asphyxia regardless of the cause of death. Maternal education level and skin color did not increase the risk of death from MCS but influenced deaths from other causes.

Conclusion

The explanatory model of the relation of maternal geographic and socioeconomic, gestational and birth factors with deaths in the first year of life in Brazil from 2006 to 2016 showed that the small number of prenatal visits, male sex, low birthweigth, and presence of asphyxia in the first and fifth minutes are variables with a direct effect on the risk of death regardless of the cause of death. Deaths from MCSs in the West-Central regions and maternal age ≥35 years pose a higher risk of death, but this effect was not evidenced for other causes of death. Better gestational care with an adequate number of prenatal visits would enable the early diagnosis of MCSs with proper life support and treatment.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Federal University of Rio de Janeiro

Using MVDA with stoichiometric balances to optimize amino acid concentrations in chemically defined CHO cell culture medium for improved culture performance

Chemically defined (CD) media are routinely used in the production of biologics in Chinese hamster ovary (CHO) cell culture and provide enhanced raw material control. Nutrient optimized CD media is an important path to increase cell growth and monoclonal antibody (mAb) productivity in recombinant CHO cell lines. However, nutrient optimization efforts for CD media typically rely on multifactorial and experimental design of experiment approaches or complex mathematical models of cellular metabolism or gene expression systems. Moreover, the majority of these efforts are aimed at amino acids since they constitute essential nutrients in CD media as they directly contribute to biomass and protein production. In this study, we demonstrate the utilization of multivariate data analytics (MVDA) coupled with amino acid stoichiometric balances (SBs) to increased cell growth and mAb productivity in efforts to support CD media development efforts. SBs measure the difference between theoretical demand of amino acids and the empirically measured fluxes to identify various catabolic or anabolic states of the cell. When coupled with MVDA, the statistical models were not only able to highlight key amino acids toward cell growth or productivity, but also provided direction on metabolic favorability of the amino acid. Experimental validation of our approach resulted in a 55% increase in total cell growth and about an 80% increase in total mAb productivity. Increased specific consumption of stoichiometrically balanced amino acids and decreased specific consumption of glucose was also observed in optimized CD media suggesting favorable consumption of desired nutrients and a potential for energy redistribution toward increased cellular growth and mAb productivity.

Multi-omics profiling of a CHO cell culture system unravels the effect of culture pH on cell growth, antibody titer, and product quality

A robust monoclonal antibody (mAb) bioprocess requires physiological parameters such as temperature, pH, or dissolved oxygen to be well-controlled as even small variations in them could potentially impact the final product quality. For instance, pH substantially affects N-glycosylation, protein aggregation, and charge variant profiles, as well as mAb productivity. However, relatively less is known about how pH jointly influences product quality and titer. In this study, we investigated the effect of pH on culture performance, product titer, and quality profiles by applying longitudinal multi-omics profiling, including transcriptomics, proteomics, metabolomics, and glycomics, at three different culture pH set points. The subsequent systematic analysis of multi-omics data showed that pH set points differentially regulated various intracellular pathways including intracellular vesicular trafficking, cell cycle, and apoptosis, thereby resulting in differences in specific productivity, product titer, and quality profiles. In addition, a time-dependent variation in mAb N-glycosylation profiles, independent of pH, was identified to be mainly due to the accumulation of mAb proteins in the endoplasmic reticulum disrupting cellular homeostasis over culture time. Overall, this multi-omics-based study provides an in-depth understanding of the intracellular processes in mAb-producing CHO cell line under varied pH conditions, and could serve as a baseline for enabling the quality optimization and control of mAb production.

Medical Management of Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group

Melasma is one of the most common hyperpigmentary disorders found mainly in women and dark-skinned patients. Sunlight, hormones, pregnancy, and genetics remain the most implicated in the causation of melasma. Although rather recalcitrant to treatment, topical agents such as hydroquinone, modified Kligman's Regime, azelaic acid, kojic acid, Vitamin C, and arbutin still remain the mainstay of therapy with sun protection being a cornerstone of therapy. There are several new botanical and non botanical agents and upcoming oral therapies for the future. There is a lack of therapeutic guidelines, more so in the Indian setup. The article discusses available evidence and brings forward a suggested treatment algorithm by experts from Pigmentary Disorders Society (PDS) in a collaborative discussion called South Asian Pigmentary Forum (SPF).

Chemical Peels in Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group

Melasma is a notorious dermatosis, often resistant to treatment. Chemical peeling constitutes an acceptable option of management of melasma (of any type and duration). In this article, as a group of experts from Pigmentary Disorders Society (PDS) in collaboration with South Asian Pigmentary Forum (SPF), we have tried to elaborate the various chemical peeling agents for the treatment of melasma. Besides, we have reviewed the indications, mechanism of action, rationality and the detailed procedure of peeling. The evidence in favor of various peeling agents have been summarized as well.

Dissatisfaction and persistent post-operative pain following total knee replacement – A 5 year follow-up of all patients from a whole region

Introduction

Total knee replacement (TKR) is the treatment of choice for the millions of individuals whose osteoarthritis related pain can no longer be managed through non-invasive methods. Although most patients report improvement in pain and functioning following TKR, up to 30% report after 1–2 years persistent pain that interferes with their daily function. Further knowledge on long term results are highly demanded. The present study is the first 5 year follow-up of all patients from a whole region.

Methods

Patients were interviewed by letter concerning pain, overall satisfaction and forgotten joint score (FJS). In 2011, 607 patients in the region of North Denmark had a primary TKR, of which 20 was bilateral. Still alive are 546 patients. A total of 498 answered by letter (91%) of which 13 were not able to answer detailed due to psychological reasons.

Results

A total of 290 (59%) patients were very satisfied with their TKR, 140 (30%) were satisfied and 58 (12%) dissatisfied. Pain free were 269 (55%). 163 patients (33%) experienced moderate pain and 55 (11%) had strong pain. Dissatisfaction and pain were highly correlated, especially pain at walking: Among patients reporting strong pain, 35 (64%) scored higher than 6 on the VAS-average pain last 24 h versus 46 (84%) that scored higher than 6 on the VAS-pain after 30 min’s walk.

Conclusions

Among an unselected series of patients having TKR, 12% were dissatisfied and 11% still had strong pain 5 years later. Dissatisfaction was especially correlated with pain when walking. Thus, the association between dissatisfaction, pain at activity and the individual expectations should be further focused.

Lasers in Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group

Lasers have come up as the newest therapeutic modality in dermatological conditions including melasma. In this article, as a group of experts from Pigmentary Disorders Society in collaboration with South Asian Pigmentary Disorders Forum (SPF), we have tried to discuss the lasers which have been used in melasma and formulate simple consensus guidelines. Following thorough literature search, we have summarised the rationale of using the lasers and the supporting evidences have also been provided. It is clear that laser cannot be the first line treatment for melasma. However, it can be used as an adjuvant therapy in resistant cases, provided the selection of patient and counselling has been done properly.

Investigating the Role of TNF-α and IFN-γ Activation on the Dynamics of iNOS Gene Expression in LPS Stimulated Macrophages

Macrophage produced inducible nitric oxide synthase (iNOS) is known to play a critical role in the proinflammatory response against intracellular pathogens by promoting the generation of bactericidal reactive nitrogen species. Robust and timely production of nitric oxide (NO) by iNOS and analogous production of reactive oxygen species are critical components of an effective immune response. In addition to pathogen associated lipopolysaccharides (LPS), iNOS gene expression is dependent on numerous proinflammatory cytokines in the cellular microenvironment of the macrophage, two of which include interferon gamma (IFN-γ) and tumor necrosis factor alpha (TNF-α). To understand the synergistic effect of IFN-γ and TNF-α activation, and LPS stimulation on iNOS expression dynamics and NO production, we developed a systems biology based mathematical model. Using our model, we investigated the impact of pre-infection cytokine exposure, or priming, on the system. We explored the essentiality of IFN-γ priming to the robustness of initial proinflammatory response with respect to the ability of macrophages to produce reactive species needed for pathogen clearance. Results from our theoretical studies indicated that IFN-γ and subsequent activation of IRF1 are essential in consequential production of iNOS upon LPS stimulation. We showed that IFN-γ priming at low concentrations greatly increases the effector response of macrophages against intracellular pathogens. Ultimately the model demonstrated that although TNF-α contributed towards a more rapid response time, measured as time to reach maximum iNOS production, IFN-γ stimulation was significantly more significant in terms of the maximum expression of iNOS and the concentration of NO produced.

In silico Kinetic Model of iNOS expression in macrophages

Macrophages are a key component in the host innate response and are major contributors to the proinflammatory response against pathogens. One of the key players in the proinflammatory response is induced nitric oxide synthase (iNOS), an enzyme that provides the nitric oxide needed by phagocytic cells to create reactive nitrogen species, which are highly damaging to intracellular pathogens. To model the macrophage intracellular mechanism of iNOS gene expression, we use a systems biology approach to capture the dynamics of the iNOS gene expression system stimulated by bacterial lipopolysaccharide (LPS) and IFN-γ. Our simulation results agree with in vitro assays of iNOS gene expression and provide a platform for further investigating the potential impact of LPS and IFN-γ variations on macrophage effector function.

Cellular grafts in management of leucoderma

Cellular grafting methods constitute important advances in the surgical management of leucoderma. Different methods such as noncultured epidermal suspensions, melanocyte cultures, and melanocyte-keratinocyte cultures have all been shown to be effective. This article reviews these methods.

Lichen amyloidosus: A study of clinical, histopathologic and immunofluorescence findings in 30 cases

BACKGROUND

Lichen amyloidosus (LA) is a primary localized cutaneous amyloidosis characterized clinically by discrete hyperkeratotic hyperpigmented papules and histologically by deposition of amyloid material in previously normal skin without any evidence of visceral involvement.

AIMS AND OBJECTIVES

The aim of this work was to study the etiology, clinical features, histopathology and direct immunofluorescence findings in LA.

METHODS

A prospective study of 30 patients with clinical, histological and immunofluorescence findings suggestive of LA was undertaken. After a detailed history and clinical examination, two punch biopsies for histopathology and immunofluorescence were taken.

RESULTS

Of the 30 patients, 19 (63.3%) were males and 11 (36.7%) were females with duration of LA ranging from 6-20 months. Pruritus was the presenting symptom in 27 (90%) patients. Shin was involved in 26 (86.7%) followed by arms in three (10%) and back in one (3.3%). Seventeen patients (56%) had used scrubs for more than 2 years. Histopathology, direct immunofluorescence and Congo red staining detected amyloid in all cases.

CONCLUSIONS

LA commonly presents over the shins as pruritic discrete hyperpigmented papules. Familial predisposition and friction may have a pathogenic role. Histopathological examination is very useful in the detection of amyloid which may be supplemented with direct immunofluorescence and Congo red staining.