Characteristics of atopic dermatitis patients using complementary and alternative medicine: A literature review

BACKGROUND

Atopic dermatitis (AD) is a chronic inflammatory skin disease. Due to the burden of the disease, some patients try complementary and alternative medicine (CAM).

OBJECTIVE

To identify characteristics associated with CAM use in children and adults with AD.

METHODS

We conducted a literature review in accordance with the PRISMA international guidelines for literature reviews and meta-analyses. A systematic search was performed in the PubMed database. Qualitative and quantitative analyses using a χ2 test were performed to compare characteristics between CAM users and non-users. A p-value of <0.05 was considered statistically significant.

RESULTS

Out of 514 articles retrieved, 12 studies were included, giving a total of 2240 patients. Our statistical analysis identified an association between CAM use and rhino-conjunctivitis (p = 0.015 in children, p = 0.041 in adults), topical corticosteroid use (p = 0.042 in children, p = 0.008 in adults), and daily application of moisturizing cream (p = 0.002 in children, p < 0.001 in adults). Gender did not affect the decision to use CAM (p > 0.05). In studies, a higher number of affected eczema sites (p < 0.001), prior use of more than two conventional treatments (p = 0.047), and food avoidance diets (p = 0.016) were predictive of CAM use in children. In adults, a younger age (p < 0.05), higher education level (p = 0.043), and lower age at AD onset (p = 0.004) were related to CAM use.

DISCUSSION

To our knowledge, this is the first literature review focusing on socio-demographic and disease determinants related to CAM use among AD patients. The lack of homogeneity in measuring tools makes it difficult to compare and synthesize the studies.

High incidence of skin reactions secondary to the use of adhesives in glucose sensors or insulin pumps for the treatment of children with type 1 diabetes

AIMS

To evaluate the incidence of the skin reactions secondary to continuous subcutaneous insulin infusion (CSII) or continuous glucose monitoring (CGM), sensors and the characteristics of affected children with type 1 diabetes.

METHODS

An observational, retrospective, single-centre study included 198 children with type 1 diabetes, (46% girls, mean age 11.75 years). A standardised questionnaire was completed with the patient during current care to evaluate the skin reactions (mean and percentage), the type of reaction, their impact and the treatment) and the characteristics of affected children with univariate and multivariate analysis.

RESULTS

Sixty-seven children (33.8%) reported active skin reactions: 45 children with CSII (30.4%) and 46 with CGM (23.5%). Children with skin reactions were younger (mean age 10.6 yo versus 12.34 yo, p < 0.05), with a younger age at the diagnosis of diabetes (5.59 yo versus 7.08 yo, p < 0.05). Atopy was more frequent in the group with skin reactions (76.1% versus 54.1% p < 0.05). On multivariate analysis, only the personal history of atopy was associated with skin reactions: OR 2.56 [1.16-5.97] (p < 0.05).

CONCLUSION

This study confirms the high incidence of skin reactions to adhesive devices used in the treatment of type 1 diabetes in children.

Complementary feeding practices are related to the risk of food allergy in the ELFE cohort

BACKGROUND

Conflicting results have been obtained when analyzing the relationship between complementary feeding (CF) practices and allergic diseases in childhood. This study aims to further explore the association between allergic diseases in early childhood (10.1016/j.jaci.2012.02.036) and the age at CF introduction (10.1016/S0140-6736(15)00149-X), food diversity in the first year of life (10.1016/j.ijporl.2019.109759) and the delayed introduction of major allergenic foods.

METHODS

This analysis focused on 6662 children from the French nationwide ELFE cohort. Data on feeding practices were collected monthly from 3 to 10 months old. Their age at CF introduction was calculated alongside a diversity score, and the number of major allergenic foods (out of eggs, fish, wheat, and dairy products) not introduced at 8 and 10 months. Their associations with parent-reported allergy-related health events between 1 and 5.5 years were assessed using logistic regressions adjusted for confounding factors. A sensitivity analysis excluding early allergic cases (occurring between 2 months and 1 or 2 years) was conducted.

RESULTS

Late CF (>6 months) was related to a higher risk of food allergy (OR [95% CI] = 1.35 [1.02; 1.78]), a low diversity score at 8 months to a higher risk of asthma (OR [95% CI] = 1.22 [1.01; 1.48]), and two allergenic foods or more not being introduced at 10 months to a higher risk of rhinoconjunctivitis (OR [95% CI] = 1.20 [1.00; 1.44]) and food allergy (OR [95% CI] = 2.46 [1.77; 3.42]). Only this last association remained significant after the exclusion of early cases.

CONCLUSION

The delayed introduction of major allergenic foods is related to a higher risk of food allergy, which supports the updated guidelines for allergy prevention.

Efficacy of dupilumab in chronic prurigo and chronic idiopathic pruritus: A systematic review of current evidence and analysis of response predictors

Dupilumab has demonstrated a great reduction on chronic pruritus that is the hallmark of atopic dermatitis (AD). Underscoring relevant pathogenesis similarities emerging from AD, chronic idiopathic pruritus (CIP) and chronic prurigo (CP), several authors suggested the beneficial role of dupilumab in these conditions. The evidence on this subject is limited with no precise data available. In this study, we carried out a systematic literature review in order to evaluate the efficacy of dupilumab on both pruritus and skin manifestations in the two largest retrospective cohorts of patients with CP and CIP and tried to identify potential response predictors. Electronic searches were conducted on 4 databases. Our primary outcome was the improvement in pruritus measured by a reduction in patient's reported numerical rating scale of itch (NRSI) by > 4. Secondary outcomes included: proportion of patients with complete response at the end of treatment, reduction in the number of lesions by the Investigator Global Assessment (IGA), improvement in numerical rating scale of sleep (NRSS), improvement in quality of life measured by the Dermatology Life Quality Index (DLQI), time until patient perceived any improvement (Time-First) and time until patient reported absence of pruritus (Time-Final). Descriptive statistics were calculated for each demographic and clinical variable. Univariate logistic regression analyses were conducted to explore association between response to dupilumab and potential predictive factors. We included 25 articles in the analysis, counting a total of 153 patients. Based on CP patients' cohort (n=132), the mean NRSI at baseline was 8.79 ±0.86 and the NRSI final was 2.32 ±1.27. The mean time to first improvement was 5.18 ±3.13 weeks, while the time to complete improvement of pruritus (Time-final) was 13.6 ±12.0 weeks. Ninety patients out of 109 (83%) noticed improvement in pruritus before 4 weeks of dupilumab therapy. At the end of treatment, 18 patients out of 126 (14%) had a complete remission of pruritus and 110 patients out of 123 (89%) had a reduction of NRSI > 4. The reduction in NRSI was significantly greater in patients improving before 4 weeks of treatment (6.57 ±1.71) compared to patients improving in more than 4 weeks (5.49 ±1.39, p<0.001). Patients with history of AD and those who have been previously treated with cyclosporine or methotrexate had a significantly lower reduction in NRSI (e.g. 6.05 ±1.34 vs 7.08 ±1.90 p<0.01 for non-associated AD patients). Based on CIP patient's cohort (n=21), the mean NRSI at baseline was 8.33 ±0.80 and the NRSI final was 0.95 ±0.59. The mean time to first improvement was 2 ±0 weeks, while the time to complete improvement (Time-final) was 14.6 ±10 weeks. At the end of treatment, 3 patients out of 21 (14%) had a complete remission of pruritus and 100% of patients had a reduction of NRSI > 4. No serious treatment-emergent adverse events were reported. The most common adverse event was mild conjunctivitis (13 cases). We highlight the importance of one early sign of improvement as predictor of the future response to dupilumab: the improvement before 4 weeks of treatment that leads significantly to a greater final reduction in NRSI. Furthermore, patients with the presence or history of atopy appear to be less responsive to dupilumab than non-atopic patients and develop more side effects, in particular conjunctivitis.

Bilateral nevus comedonicus of the eyelids: An unusual cause of ptosis and ectropion

Purpose

Nevus comedonicus is a rare developmental abnormality of the infundibulum of the hair follicle.

Observation

We report here an unusual case of bilateral extensive nevus comedonicus of the eyelids complicated by bilateral ptosis and ectropion of the lower eyelids. Blepharoplasty was performed on both upper eyelids. Histopathological findings on skin biopsy typically show large, grouped, dilated follicular ostia filled with keratin.

Conclusions and importance

This case is unusual as regards the late-onset (lesions first appeared at age 35) and location of the nevus comedonicus on both eyelids.

4034Distance from hospital as an early marker of outcomes in out of hospital cardiac arrest acute myocardial infarction survivors treated with endovascular mild therapeutic hypothermia

Background

The prediction of outcome in comatose patients after out of hospital cardiac arrest (OHCA) has major ethical and socioeconomic implications. At present, there is a lack of data comparing the predictive value from cardiac arrest localization to hospital distance in OHCA survivors treated with endovascular therapeutic hypothermia.

Methods

86 patients (64±14 years, 69 men) were evaluated after OHCA due to ventricular fibrillation (VF) during an acute myocardial infarction (MI). All patients (NSTEMI 28%, STEMI 72%) were indicated for urgent coronary angiography, echocardiography for left ventricular ejection fraction (LVEF) estimation using Simpson biplane formula and treated with mild therapeutic hypothermia (MTH) using intravascular temperature management to maintain target temperature (33 °C) for 24 hours. The Cerebral Performance Categories scale (CPC) was used as the outcome measure and was assessed 3 months post admission; a CPC of 3–5 was regarded as a poor outcome (n=45), and a CPC of 1–2 (n=41) as a good outcome.

Results

Distance to hospital was significantly higher (p=0.0473) in patients with poor outcomes (CPC 3–5) after OHCA (37.5±4.5 km) compared with CPC 1–2 patients (27.1±4.4 km). No significant differences in return of spontaneous circulation time (21; 10.5–47.5 95th percentile vs. 23; 10.0–50.0, p=0.738), lactate (7.8; 4.5–12.4 vs. 8.4; 5.4–13.5, p=0.54), LVEF (40; 22–50 vs. 40; 21–62%, p=0.208), peak cardiac troponin T (1.5; 0.08–10.00 vs. 0.64; 0.04–5.28 μg/L, p=0.078), NSE (29.2; 15.7–54.9 vs. 25.8; 13.6–52.3 μg/L, p=0.26) and S100-B (0.17; 0.09–1.69 vs. 0.19; 0.04–1.14 μg/L, p=0.734) were found in CPC 3–5 and CPC 1–2 groups comparison. Using an optimal cut-off value ≥33 km calculated from the receiver operating characteristic curve (area under curve = 0.62; p=0.004), the sensitivity of predicting survival with poor neurological outcome was 61% and the specificity was 62%.

Conclusions

In patients after OHCA for VF during MI, distance from cardiac arrest localization to hospital gives reliable and on return of spontaneous circulation time independent prognostic information concerning outcome after cardiopulmonary resuscitation.

Acknowledgement/Funding

Grant support FNOL RIV 87-85

Failure of systemic oral doxycycline in preventing ocular toxoplasmic retinochoroiditis in French military personnel

This paper describes two cases of toxoplasmic chorioretinitis presenting in two French soldiers who had been receiving oral doxycycline for malaria prophylaxis. This is despite the proven effectiveness of oral doxycycline in treating Toxoplasma gondii, the most common cause of this infection. The lack of effectiveness of oral doxycycline in these two cases most likely reflected that the ocular concentration of 100 mg daily doxycycline is too low to treat or prevent Toxoplasmic retinochoroiditis (TC). Clinicians should therefore be aware that soldiers taking prophylactic oral doxycycline are still at risk of developing ocular TC with potentially sight-threatening consequences if not treated adequately.

Red or white wine consumption effect on atherosclerosis in healthy individuals (In Vino Veritas study)

AIMS

Consumption of wine has a protective effect on cardiovascular diseases. Data from prospective, long-term, head-to-head comparisons of effects of different drinks on markers of atherosclerosis have been insufficient.

METHODS AND RESULTS

In Vino Veritas (IVV) study is long-term, prospective, multi-centre, randomized trial comparing effects of red and white wine on atherosclerosis. 157 healthy subjects were randomized to white or red wine consumption for one year. We did not find increase in HDL-cholesterol in the whole group (1.66±0.58 vs 1.62±0.49, p=0.180) or difference between both groups (1.60±0.53 vs 1.64±0.46, p=0.634). At 12 months there was reduction of LDL-cholesterol in both groups, but with no difference between the groups (3.37±0.75 vs 3.60±1.10, p=0.134); there was no difference between the groups in total cholesterol, CRP, fasting blood glucose and liver function tests. Both groups had comparable differences from baseline in levels of parameters of oxidative stress.

CONCLUSION

We did not find any clinically relevant differences in the lipid profile, CRP, fasting blood glucose and other markers of atherosclerosis, between long-term consumption of red and white wine. Moreover, we were unable to confirm the hypothesis that wine drinking is associated with an elevation of HDL (Tab. 7, Fig. 1, Ref. 30).

Risk factors involved in spread of HCV in patients from sub urban Rawalpindi and their association with existing genotypes

The current epidemiological study was designed to trace the involved risk factors in Hepatitis C Virus (HCV) spread and to identify any association between HCV genotypes and risk factors. Blood samples were taken from 400 participants and viral genotyping was performed in order to find any possible relationship between the risk factors and genotypes. Major genotypes included 3, 1, 4 and several untypeable ones with prevalence rates 65%, 22.5%, 2.75% and 9.75% respectively. Surgery and dental procedure were strongly related to the spread of genotype 3b, while genotype 1b was strongly related to blood transfusion and dental procedures as a single combination risk factor. On the other hand genotypes 1a, 3a, 4 and the untypeable genotypes, were equally affected by all reported risk factors. The probability of occurrence of genotype 3a with reference to dental procedures was 11%. Dental procedures, unsafe injection and surgical procedures are the main risk factors while the blood transfusion in combination with dental procedures has emerged as a potent risk factor in the transmission of HCV.

Equine atypical myopathy: A metabolic study

Atypical myopathy (AM) is a potentially fatal disease of grazing horses. It is reportedly caused by the ingestion of sycamore seeds containing toxic hypoglycin A. In order to study metabolic changes, serum and urine samples from nine horses with atypical myopathy and 12 control samples from clinically healthy horses were collected and then analysed using a high-performance liquid chromatography coupled with tandem mass spectrometry; serum metabolic profiles as the disease progressed were also studied. Metabolic data were evaluated using unsupervised and supervised multivariate analyses. Significant differences were demonstrated in the concentrations of various glycine conjugates and acylcarnitines (C2-C26). Moreover, the concentrations of purine and pyrimidine metabolites, vitamins and their degradation products (riboflavin, trigonelline, pyridoxate, pantothenate), and selected organic and amino acids (aspartate, leucine, 2-oxoglutarate, etc.) were altered in horses with AM. These results represent a global view of altered metabolism in horses with atypical myopathy.

Systemic Inflammatory Response After Open, Laparoscopic and Robotic Surgery in Endometrial Cancer Patients

AIM

To study inflammatory response and nutritional biomarkers in operated endometrial cancer (EC) patients.

MATERIALS AND METHODS

A total 109 consecutive EC patients undergoing open laparotomy (LT), laparoscopic (LS) or robot-assisted surgery (RS) were studied. Twenty four patients served as controls. Pre- and postoperative levels of inflammatory and nutritional biomarkers were analyzed prospectively.

RESULTS

The estimated blood loss was significantly lower in RS compared to all other groups. C-reactive protein (CRP) and interleukin-6 (IL-6) correlated with each other and exhibited positive correlation with age, body-mass index (BMI), leukocyte count, platelet count, kynurenine, kynurenine/tryptophan ratio and urinary neopterin and a negative correlation with vitamin D and retinol. Hemoglobin, retinol, alpha-tocopherol, vitamin D and citrulline concentrations decreased and inflammatory biomarkers increased after surgery to a different extent in LT, LS, RS and control groups.

CONCLUSION

The present data demonstrate a differential response to surgical trauma in patients with endometrial carcinoma.

Untargeted metabolomic analysis of urine samples in the diagnosis of some inherited metabolic disorders

BACKGROUND

Metabolomics is becoming an important tool in clinical research and the diagnosis of human diseases. It has been used in the diagnosis of inherited metabolic disorders with pronounced biochemical abnormalities. The aim of this study was to determine if it could be applied in the diagnosis of inherited metabolic disorders (IMDs) with less clear biochemical profiles from urine samples using an untargeted metabolomic approach.

METHODS

A total of 14 control urine samples and 21 samples from infants with cystinuria, maple syrup urine disease, adenylosuccinate lyase deficiency and galactosemia were tested. Samples were analyzed by liquid chromatography on aminopropyl column in aqueous normal phase separation system using gradient elution of acetonitrile/ammonium acetate. Detection was performed by time-of-flight mass spectrometer fitted with electrospray ionisation in positive mode. The data were statistically processed using principal component analysis (PCA), principal component discriminant function analysis (PCA-DFA) and partial least squares (PLS) regression.

RESULTS

All patient samples were first distinguished from controls using unsupervised PCA. Discrimination of the patient samples was then unambiguously verified using supervised PCA-DFA. Known markers of the diseases in question were successfully confirmed and a potential new marker emerged from the PLS regression.

CONCLUSION

This study showed that untargeted metabolomics can be applied in the diagnosis of mild IMDs with less clear biochemical profiles.

Optimization of decision support tool using medication regimens to assess rehospitalization risks

BACKGROUND

Unnecessary hospital readmissions are costly for the U.S. health care system. An automated algorithm was developed to target this problem and proven to predict elderly patients at greater risk of rehospitalization based on their medication regimens.

OBJECTIVE

Improve the algorithm for predicting elderly patients' risks for readmission by optimizing the sensitivity of its medication criteria.

METHODS

Outcome and Assessment Information Set (OASIS) and medication data were reused from a study that defined and tested an algorithm for assessing rehospitalization risks of 911 patients from 15 Medicare-certified home health care agencies. Odds Ratio analyses, literature reviews and clinical judgments were used to adjust the scoring of patients' High Risk Medication Regimens (HRMRs). Receiver Operating Characteristic (ROC) analysis evaluated whether these adjustments improved the predictive strength of the algorithm's components.

RESULTS

HRMR scores are composed of polypharmacy (number of drugs), potentially inappropriate medications (PIM) (drugs risky to the elderly), and Medication Regimen Complexity Index (MRCI) (complex dose forms, dose frequency, instructions or administration). Strongest ROC results for the HRMR components were Areas Under the Curve (AUC) of .68 for polypharmacy when excluding supplements; and .60 for PIM and .69 for MRCI using the original HRMR criteria. The "cut point" identifying MRCI scores as indicative of medication-related readmission risk was increased from 20 to 33.

CONCLUSION

The automated algorithm can predict elderly patients at risk of hospital readmissions and its underlying criteria is improved by a modification to its polypharmacy definition and MRCI cut point.

Darstellung und Struktur von [Ti(acac)3]ClO4 / Preparation and Structure of [Ti(acac)3]ClO4

The title compound has been obtained from acetylacetone, AgClCO4 and either π-C5H5TiCl3 or TiCl4. An X-ray structure analysis (R = 0.068) shows the cation to be octahedrally coordinated. The average values of the Ti-O distances and of the endocyclic O-Ti-O angles are 1.94 Å and 84.3°, respectively

Analysis of thymidine kinase serum levels by novel method DiviTum in multiple myeloma and monoclonal gammopathy of undetermined significance - comparison with imaging methods 99mTc-MIBI scintigraphy and 18F-FDG PET/CT

AIMS

The study aimed at comparing two methods for evaluating thymidinekinase TK in serum - an older RIA method and novel DiviTum - in patients with MM and MGUS, and also comparing them with biochemical markers and degree of activity evaluated by imaging methods 99mTc-MIBI scintigraphy and 18F-FDG PET/CT.

METHODS

Serum thymidinekinase TK levels were evaluated by DiviTum and an RIA method (TK REA kit by Immunotech);The study analyzed correlation of TK activity in serum with biochemical markers reflecting activity of MM: β2-m, LDH, the ratio of kappa to lambda (κ/λ) free light chains and percentage of bone marrow plasma cells (BMPC). 99mTc-MIBI scintigraphy and 18F-FDG PET/CT were performed at the time of diagnosis. The degree of activity was expressed semiquantitatively. Scans were classified as 0 (normal activity), 1 (diffuse positivity) or 2 (focal positivity).

RESULTS

We found a strong positive correlation between TK in serum evaluated by DiviTum and by TK REA.. The DiviTum analytic method extended the detection range and was able to detect higher levels of TK than the RIA method. DiviTum technique found positive correlation with β2-m (r = 0.497) and LDH (r = 0.502) and moderate positive correlation with BMPC (r = 0.368). Significantly higher TK values measured by TK REA and DiviTum in the group of patients with MM (stages I, II or III) than in those with MGUS. Increased TK levels were observed in MIBI- or PET/CT-positive patients. Analysis of repeated measurements of TK in serum during treatment of MM patients found a correlation between change in TK measured by DiviTum and LDH during treatment.

CONCLUSIONS

Analysis revealed a significant correlation between TK in serum and LDH, β2-m and BMPC. Increased levels of TK in serum were observed in MIBI- or PET/CT-positive patients. Combination of positivity of imaging methods which can localize active tumor lesions and increased levels of TK in serum can have an impact on decision-making and optimization of the therapeutic approach.

Time-resolved analysis of the emission of sidestream smoke (SSS) from cigarettes during smoking by photo ionisation/time-of-flight mass spectrometry (PI-TOFMS): towards a better description of environmental tobacco smoke

In this study, the chemical composition of sidestream smoke (SSS) emissions of cigarettes are characterised using a laser-based single-photon ionisation time-of-flight mass spectrometer. SSS is generated from various cigarette types (2R4F research cigarette; Burley, Oriental and Virginia single-tobacco-type cigarettes) smoked on a single-port smoking machine and collected using a so-called fishtail chimney device. Using this setup, a puff-resolved quantification of several SSS components was performed. Investigations of the dynamics of SSS emissions show that concentration profiles of various substances can be categorised into several groups, either depending on the occurrence of a puff or uninfluenced by the changes in the burning zone during puffing. The SSS emissions occurring directly after a puff strongly resemble the composition of mainstream smoke (MSS). In the smouldering phase, clear differences between MSS and SSS are observed. The changed chemical profiles of SSS and MSS might be also of importance on environmental tobacco smoke which is largely determined by SSS. Additionally, the chemical composition of the SSS is strongly affected by the tobacco type. Hence, the higher nitrogen content of Burley tobacco leads to the detection of increased amounts of nitrogen-containing substances in SSS.

The concomitant occurrence of JAK2V617F mutation and BCR/ABL transcript with phenotypic expression - an overlapping myeloproliferative disorder or two distinct diseases? - case report

The concomitant occurrence of JAK2617F mutation and BCR/ABL translocation is a rare event. It is unclear if this is a result of the clonal evolution or a separately emergence of two clones and if it could lead to the progression to a more aggressive phase of the disease. We present the case of a 61-year-old man diagnosed and treated for polycythaemia vera for 7 years, which evolved into chronic myeloid leukemia BCR/ABL positive and with JAK2617F mutated clone, that became dominant after an effective treatment with Imatinib.

Constitutive expression of clathrin hub hinders elicitor-induced clathrin-mediated endocytosis and defense gene expression in plant cells

Endocytosis has been recently implicated in the signaling network associated with the recognition of microbes by plants. In a previous study, we showed that the elicitor cryptogein was able to induce clathrin-mediated endocytosis (CME) in tobacco suspension cells. Herein, we investigate further the induced CME by means of a GFP-tagged clathrin light chain and a CME inhibitor, the hub domain of clathrin heavy chain. Hub constitutive expression does affect neither cell growth nor constitutive endocytosis but abolishes cryptogein-induced CME. Such an inhibition has no impact on early events in the cryptogein signaling pathway but reduces the expression of defense-associated genes.

Highly sensitive GC/MS/MS method for quantitation of amino and nonamino organic acids

Metabolite profiling methods are important tools for measurement of metabolite pools in biological systems. While most metabolite profiling methods report relative intensities or depend on a few internal standards representing all metabolites, the ultimate requirement for a quantitative description of the metabolite pool in biological cells and fluids is absolute concentration determination. We report here a high-throughput and sensitive gas chromatography/tandem mass spectrometry (GC/MS/MS) targeted metabolite profiling method enabling absolute quantification of all detected metabolites. The method is based on methyl chloroformate derivatization and quantification by spiking samples with metabolite standards separately derivatized with deuterated derivatization reagents. The traditional electron impact ionization is replaced with positive chemical ionization since the latter to a much larger extent preserve the molecular ion and other high molecular weight fragments. This made it easier to select unique MS/MS transitions among the many coeluting metabolites. Currently, the novel GC/MS/MS method comprises 67 common primary metabolites of which most belong to the groups of amino and nonamino organic acids. We show the applicability of the method on urine and serum samples. The method is a significant improvement of present methodology for quantitative GC/MS metabolite profiling of amino acids and nonamino organic acids.

Two patients with clinically distinct manifestation of pyruvate dehydrogenase deficiency due to mutations in PDHA1 gene

The most common cause of pyruvate dehydrogenase complex (PDHc) deficiency is the deficit of the E1α-subunit. The aim of this study was to describe distinct course of the disease in two boys with mutations in PDHA1 gene and illustrate the possible obstacles in measurement of PDHc activity. Clinical data and metabolic profiles were collected and evaluated. PDHc and E1α-subunit activities were measured using radiometric assay. Subunits of PDHc were detected by Western blot. PDHA1 gene was analysed by direct sequencing. In patient 1, the initial hypotonia with psychomotor retardation was observed since early infancy. The child gradually showed symptoms of spasticity and arrest of psychomotor development. In patient 2, the disease manifested by seizures and hyporeflexia in the toddler age. The diagnosis was confirmed at the age of seven years after attacks of dystonia and clinical manifestation of myopathy with normal mental development. Brain MRI of both patients revealed lesions typical of Leigh syndrome. Enzymatic analyses revealed PDHc deficiency in isolated lymphocytes in the first but not in the second patient. The direct measurement of PDH E1-subunit revealed deficiency in this individual. In patient 1, a novel hemizigous mutation c.857C>T (Pro250Leu) was detected in the X-linked PDHA1 gene. Mutation c.367C>T (Arg88Cys) was found in patient 2. We present first two patients with PDHc deficit due to mutations in PDHA1 gene in the Czech Republic. We document the broad variability of clinical symptoms of this disease. We proved that normal PDHc activity may not exclude the disease.

Oligodendroglia from ADSL-deficient patient produce SAICAribotide and SAMP

Succinylpurines accumulate in the body fluids of patients with adenylosuccinate lyase (ADSL) deficiency but their source in the cerebrospinal fluid remains obscure. Study based on the incorporation of 13C-stable isotope-labeled glycine into cultured oligodendroglia from ADSL-deficient patient and the measurement of labeled products by LC/MS/MS showed total intracellular concentrations of succinylpurines from 45 to 99μmol/l and so these results suggest that these cells can be the source of the compounds in vivo.

Evaluation of the particle measurement programme (PMP) protocol to remove the vehicles' exhaust aerosol volatile phase

European regulation for Euro 5/6 light duty emissions introduced the measurement of non-volatile particles with diameter >23 nm. The volatile phase is removed by using a heated dilution stage (150 degrees C) and a heated tube (at 300-400 degrees C). We investigated experimentally the removal efficiency for volatile species of the specific protocol by conducting measurements with two Euro 3 diesel light duty vehicles, a Euro 2 moped, and a Euro III heavy duty vehicle with the system's heaters on and off. The particle number distributions were measured with a Scanning Mobility Particle Sizer (SMPS) and a Fast Mobility Particle Sizer (FMPS). An Aerosol Mass Spectrometer (AMS) was used to identify the non-refractory chemical composition of the particles. A Multi-Angle Absorption Photometer (MAAP) was used to measure the black carbon concentration. The results showed that the condensed material in the accumulation mode (defined here as particles in the diameter range of approximately 50-500 nm) was removed with an efficiency of 50-90%. The (volatile) nucleation mode was also completely evaporated or was decreased to sizes <23 nm; thus these particles wouldn't be counted from the particle counter, indicating the robustness of the protocol.

Chemical characterization of emissions from modern two-stroke mopeds complying with legislative regulation in Europe (EURO-2)

In view of a new amendment to the European legislative regulation on emissions from two-stroke mopeds a study was carried out to comprehensively characterize exhaust gases of mopeds complying current EURO-2 emission standards. Three mopeds with different engine types (carburetor, direct injection, and electronic carburetion system ECS) where investigated by applying two different driving cycles, the legislative cycle ECE47 and the worldwide motorcycle test cycle WMTC. Thereby, particulate matter (PM), regulated compounds, carbonyls, volatile hydrocarbons (VOC), and particle-associated polyaromatic hydrocarbons (PAH) were analyzed and ozone formation potentials (OFP) as well as toxicity equivalents (TEQ) determined. The ECE47 emission factors for almost all species and moped types were much higher in the nonregulated, prior cold phase than in the hot phase, which is considered for legislation. Great differences for the mopeds could be observed for NO(x), VOC, and PM, whereas discrepancies between the driving cycles ECE47 and WMTC were smaller. In addition, a positive influence on exhaust composition caused by technical modifications of the ECS engine was determined. Results indicate that regulation of total hydrocarbons (THC) alone might not be sufficient to regulate PM, especially for direct injection engines. Moreover, recommendations for a revised future test protocol are demonstrated and discussed, whereby the cold phase and the hot phase are taken into account.

Identification of the predominant antigenic epitopes in intestinal flora in IBD

The normal intestinal flora is required for the development of intestinal inflammation in animal models of inflammatory bowel disease (IBD). In humans, several studies indicated a potential association of Escherichia coli (E. coli) with IBD. In addition, we have shown that T-cell clones of IBD patients cross react toward different enteric bacterial species and thus likely respond to conserved bacterial antigens. Therefore, we hypothesized that highly conserved E. coli proteins might be a reasonable candidate to screen for abnormal T-cell responses in IBD. We used high-throughput techniques for cloning, expression, and purification under native conditions of a set of 271 conserved proteins of E. coli, of which 196 were used for whole blood stimulations to assess peripheral T helper (T(H))-cell responses. In addition, because of the association of an adherent-invasive E. coli with Crohn's disease (CD), we included 13 pathogenicity factors of E. coli in the study. We observed that pools of these conserved E. coli proteins less frequently induced interferon-gamma (IFNgamma) production in peripheral T(H) cells in patients with CD and ankylosing spondylitis (AS) compared with healthy controls. In addition, lower percentage of patients with CD and AS responded toward single proteins. The reason for the decreased frequency of an in vitro T(H)-cell IFNgamma response toward E. coli proteins in peripheral blood of CD and AS patients, e.g., increased suppression needs to be clarified.

ITPase activity in dry blood spots is comparable with that in fresh erythrocytes

Inosine triphosphate pyrophosphohydrolase (ITPase) catalyzing the pyrophosphohydrolysis of inosine triphosphate, deoxyinosine triphosphate and xanthosine triphosphate is involved in the metabolism and tolerance of thiopurine drugs. ITPase activity plays an important role in the prediction of toxicity to thiopurine therapy. Activities in dry blood spots were compared with fresh erythrocytes. Samples were incubated with inosine triphosphate, then inosine monophosphate was determined by a capillary electrophoresis method. Calculated enzyme activities obtained from dry blood spots were in good accordance with activity in fresh erythrocytes.

[Inherited metabolic disorders and pregnancy]

OBJECTIVE

Review of contemporary knowledge about inherited metabolic disorders in pregnant women and fetuses.

DESIGN

A review of literature.

SETTING

Laboratory for inherited metabolic disorders, Departament of Clinical Biochemistry and Childern's Clinic, University Hospital and Palacky University, Olomouc.

METHOD

Review of literature and publications using medical databases.

CONCLUSION

Metabolic examination of mother or child is recommended if any clinical problems during or immediately after pregnancy occur. Nowadays most of inherited errors of metabolism can be diagnosed prenataly in first or second trimester of pregnancy.

Analysis of intracellular nucleotides by capillary electrophoresis-mass spectrometry

A pilot study using capillary electrophoresis with mass spectrometry for the analysis of nucleotides in human erythrocytes is presented. Erythrocytes were incubated with 5-amino-4-imidazolecarboxamide riboside in order to mimic situation in defect of purine metabolism--AICA-ribosiduria. Characteristic AICA-ribotides together with normal nucleotides were separated by capillary electrophoresis in acetate buffer (20 mmol/L, pH 4.4) and identified on line by mass spectrometry.

Synthesis and mass spectrometric fragmentation characteristics of imidazole ribosides-analogs of intermediates of purine de novo synthetic pathway

Two inherited deficiencies have been described in purine de novo synthesis pathway. Both the defects are diagnosed by detecting ribosides--dephosphorylated substrates of the enzymes--in patient's urine. We describe here a synthesis and mass spectrometric fragmentation of ribosides potentially of diagnostic importance for defects in the second part of the pathway. All the species, except 5-amino-4-imidazolesuccinocarboxamideriboside can be synthesized from the commercially available 5-amino-4-imidazolecarboxamideriboside by chemical methods. Fragmentation spectra of the compounds were obtained by the ion trap mass spectrometry. During fragmentation an opening of the imidazole ring was not observed for any of the compounds but loss of its substituents in the form of small molecules (NH3, CO2, CO) is the major route of fragmentation. The ribose moiety cleaves off molecule(s) of water, undergoes a cross-ring cleavage or breaks away as a whole.

Evaluation of an antimicrobial and fluoride-releasing self-etching primer on the shear bond strength of orthodontic brackets

The enhanced risk of dental caries is one negative side-effect of fixed appliances. A new antimicrobial and fluoride-releasing self-etching bonding system (Clearfil Protect Bond) has been introduced in restorative dentistry and clinical studies have already shown the potential for this primer to be used clinically with effective antiplaque properties. Therefore, this in vitro study was conducted in order to evaluate the new primer in comparison with a conventional bonding preparation. One hundred and twenty extracted human teeth were randomly divided into three groups of 40 specimens each (20 incisors, 20 premolars). In group 1 a conventional bonding procedure was used (etching, Transbond XT), in group 2 the new primer was used according to the manufacturer's recommendations when bonding to intact enamel, while in group 3 the new primer was used without prior etching. Shear bond strength (SBS) was measured with a universal testing machine and the adhesive remaining after debonding was determined using an optical microscope at x10 magnification. The adhesive remnant index was used in order to assess the mode of failure. No enamel fractures were detected in any of the specimens. In all groups acceptable bond strengths were observed. The only statistically significant difference (P = 0.004) was found for the incisors in group 2, which showed the highest mean SBS (17.46 MPa). Considering the acceptable bond strength and the mode of failure, use of the new primer without prior etching is recommended in patients with fixed appliances. Further in vivo studies will be carried out in order to evaluate clinical performance.

Resonance-enhanced multiphoton ionization time-of-flight mass spectrometry for detection of nitrogen containing aliphatic and aromatic compounds: resonance-enhanced multiphoton ionization spectroscopic investigation and on-line analytical application

Resonance-enhanced multiphoton ionization (REMPI) combined with time-of-flight mass spectrometry (TOFMS) is an analytical method capable of on-line monitoring of trace compounds in complex matrices. A necessary prerequisite for substance selective detection is spectroscopic investigation of the target molecules. Several organic nitrogen compounds comprising aliphatic and aromatic amines, nitrogen heterocyclic compounds, and aromatic nitriles are spectroscopically investigated with a tunable narrow bandwidth optical parametric oscillator (OPO) laser system providing a scannable wavelength range between 220 and 340 nm. These species are known as possible precursors in fuel-NO formation from combustion of solid fuels such as biomass and waste. A newly conceived double inlet system was used in this study, which allows rapid change between effusive and supersonic molecular beams. The resulting REMPI spectra of the compounds are discussed with respect to electronic transitions that could be utilized for a selective ionization of these compounds in complex mixtures such as combustion and process gases. The practicability of this approach is demonstrated by wavelength selected on-line REMPI-TOFMS detection of aniline and cyanonaphthalene in the burning chamber of a waste incineration plant. REMPI mass spectra recorded at different excitation wavelengths as well as variations in time show the utilization of species-selective REMPI-TOFMS detection for on-line monitoring of crucial substances in pollutant formation.

Investigation of NO x precursor compounds and other combustion by-products in the primary combustion zone of a waste-incineration plant using on-line, real-time mass spectrometry and Fourier-transform infrared spectrometry (FTIR)

On-line analysis of trace and bulk gas compounds in the burning chamber of a waste-incineration plant has been performed, with high temporal resolution, by use of a variety of distinctly different measurement techniques. Time-of-flight mass spectrometry was performed with simultaneous use of three ionization techniques-resonance-enhanced multiphoton ionization (REMPI), single-photon ionization (SPI), and electron-impact ionization (EI). Chemical-ionization mass spectrometry (CIMS), Fourier-transform infrared spectrometry (FTIR), and electrochemical methods were also used. Sampling was conducted by means of a newly developed air-cooled stainless steel lance, to cope with the high temperatures and elevated particle concentrations at the sampling location. Nitrogen species were mainly nitrogen monoxide, ammonia, and hydrogen cyanide (HCN), with a small amount (approximately 0.3%) of aromatic nitrogen compounds. NO, NH(3), and HCN are the main contributors to the NO(x)-formation process in the postulated fuel-NO reaction scheme dominant at this location. The NO recycling process thereby plays a major role. Changes in plant operating conditions have a noticeable impact only when the air supply is varied. For example, reduction of oxygen leads to an increase in the HCN fraction of the total nitrogen content and a decrease in the NO fraction, and vice versa.

Discrimination of three tobacco types (Burley, Virginia and Oriental) by pyrolysis single-photon ionisation-time-of-flight mass spectrometry and advanced statistical methods

Pyrolysis single-photon ionisation (SPI)-time-of-flight mass spectrometry (TOFMS) and statistical analysis techniques have been applied to differentiate three major tobacco types, Burley, Virginia and Oriental, by means of the gas phase. SPI is known as a soft ionisation technique that allows fast and comprehensive on-line monitoring of a large variety of aliphatic and aromatic substances without fragmentation of the molecule ions. The tobacco samples were pyrolysed at 800 degrees C in a nitrogen atmosphere. The resulting pyrolysis gas contained signals from more than 70 masses between m/z 5 and 170. Mass spectra obtained were analysed by principal component analysis (PCA) and linear discriminant analysis (LDA) to distinguish between different tobacco types. Prior variable reduction of the data set was carried out by calculation of the Fisher ratios. Results achieved give information about chemical composition and characteristics of the smoke derived from each tobacco type and enable conclusions on plant cultivation to be drawn. Based on LDA, a model for tobacco type recognition of unknown samples was established, which was cross-checked by additional measurements of each tobacco type. Furthermore, first results on the recognition of tobacco mixtures based on principal component regression (PCR) are presented.

Resonance-Enhanced Multiphoton Ionization and VUV-Single Photon Ionization as Soft and Selective Laser Ionization Methods for On-Line Time-of-Flight Mass Spectrometry: Investigation of the Pyrolysis of Typical Organic Contaminants in the Steel Recycling Process

A newly conceived compact and mobile time-of flight mass spectrometer (TOFMS) for real-time monitoring of highly complex gas mixtures is presented. The device utilizes two selective and sensitive soft ionization techniques, viz., resonance-enhanced multiphoton ionization (REMPI) and single-photon ionization (SPI) in a (quasi)-simultaneous mode. Both methods allow a fragmentationless ionization. The REMPI method selectively addresses aromatic species, while with SPI applying vacuum ultaviolet light (118 nm) in principle all compounds with an ionization potential below 10.5 eV are accessible. This provides comprehensive information of the chemical composition of complex matrixes. The combustion and pyrolysis behavior of five organic materials typically used in steel processing in China was studied. The trace amounts of organic compounds in the gas phase during combustion and pyrolysis were monitored selectively and sensitively by real-time SPI/REMPI-TOFMS. The measurements were carried out at several constant temperatures in the range from 300 to 1190 degrees C in both synthetic air and nitrogen. Timely resolved mass spectra reveal the formation and subsequent growth of aromatic molecules. At lower temperatures, highly alkylated PAHs predominate, while at temperatures above 800 degrees C, the more stable benzene and PAHs without side chains prevail. Potential hyphenation of SPI/REMPI-TOFMS to methods of thermal analysis is discussed.

[Metabolic complications and neurologic manifestations of vitamin B12 deficiency in children of vegetarian mothers]

BACKGROUND

Serious hematological, metabolic and neurological complications owing to the nutritional deficiency of vitamin B12 may occur in infants of mothers on a strict vegetarian diet.

METHODS AND RESULTS

The mother of the first child was a strict vegetarian. She had an elevated urinary methylmalonic acid level and a low concentration of serum vitamin B12. Her 13-month-old daughter was exclusively breast-fed until the age of 9 month and then she was fed only vegetables. Physical examination revealed psychomotoric retardation, apathy, muscular hypotonia, abnormal movements and failure to thrive. Laboratory analysis showed a megaloblastic anaemia, a low level of vitamin B12 and methylmalonic aciduria. MRI of the brain revealed diffuse frontotemporoparietal atrophy and retardation of myelination. After treatment with vitamin B12 supplements, abnormal movements disappeared and development improved, but a mild generalised hypotonia continued. A cranial MRI 9 months after treatment still showed signs of retardation of myelination. The second patient, an 8 month-old male, son of a strict vegetarian mother too, was referred for investigation of psychomotoric retardation, hypotonia, dyskinesia, failure to thrive and microcephaly. He was breast-fed and from 6 month of age he had also received fruit juices. Laboratory analysis revealed megaloblastic anaemia, high methylmalonic aciduria and homocystinuria. The patient's and his mother's serum level of vitamin B12 were low. After treatment with vitamin B12 supplements, biochemical and metabolic markers of disease were normal but there continued a generalised hypotonia, microcephaly and language delay.

CONCLUSION

Our observations emphasize the health complications of nutritional cobalamine deficiency and a requirement of clinical, biochemical and metabolic monitoring in infants within strict vegetarian families.

Exploitation of host factors for efficient infection by Shigella

Shigellosis is a worldwide endemic ulcerating disease of the large intestine caused by enteroinvasive bacteria. Shigella takes the route via M-cells and macrophages to access the basolateral pole of enterocytes. After invasion of and cell-to-cell spread within the epithelial cell layer, the bacterium multiplies within the cytoplasm of enterocytes. Induced by a limited number of bacterial effector proteins, Shigella makes use of established signaling pathways of the host cell to achieve internalization, transcytosis, apoptosis or cell-to-cell spread. This review addresses the host factors required for efficient infection focusing on Shigella-induced cytoskeletal rearrangements and associated signaling.