The role of glycosylation in clinical allergy and immunology

While glycans are among the most abundant macromolecules on the cell with widespread functions, their role in immunity has historically been challenging to study. This is in part due to difficulties assimilating glycan analysis into routine approaches used to interrogate immune cell function. Despite this, recent developments have illuminated fundamental roles for glycans in host immunity. The growing field of glycoimmunology continues to leverage new tools and approaches to uncover the function of glycans and glycan-binding proteins in immunity. Here we utilize clinical vignettes to examine key roles of glycosylation in allergy, inborn errors of immunity, and autoimmunity. We will discuss the diverse functions of glycans as epitopes, as modulators of antibody function, and as regulators of immune cell function. Finally, we will highlight immune modulatory therapies that harness the critical role of glycans in the immune system.

Antibody-mediated antigen loss switches augmented immunity to antibody-mediated immunosuppression

Antibodies against fetal red blood cell (RBC) antigens can cause hemolytic disease of the fetus and newborn (HDFN). Reductions in HDFN due to anti-RhD antibodies have been achieved through use of Rh immune globulin (RhIg), a polyclonal antibody preparation that causes antibody-mediated immunosuppression (AMIS), thereby preventing maternal immune responses against fetal RBCs. Despite the success of RhIg, it is only effective against 1 alloantigen. The lack of similar interventions that mitigate immune responses toward other RBC alloantigens reflects an incomplete understanding of AMIS mechanisms. AMIS has been previously attributed to rapid antibody-mediated RBC removal, resulting in B-cell ignorance of the RBC alloantigen. However, our data demonstrate that antibody-mediated RBC removal can enhance de novo alloimmunization. In contrast, inclusion of antibodies that possess the ability to rapidly remove the target antigen in the absence of detectable RBC clearance can convert an augmented antibody response to AMIS. These results suggest that the ability of antibodies to remove target antigens from the RBC surface can trigger AMIS in situations in which enhanced immunity may otherwise occur. In doing so, these results hold promise in identifying key antibody characteristics that can drive AMIS, thereby facilitating the design of AMIS approaches toward other RBC antigens to eliminate all forms of HDFN.

The superposed electric field effect on the charge transport and polaron formation in molecular crystals

We study the polaron formation and its mobility in a one-dimensional molecular crystal subjected to superposed static and harmonic electric fields. Such molecular chain exhibits intermolecular vibrational degrees of freedom, which makes the carrier-lattice interaction an important parameter of the system. By exploring field settings in which the preferential transport occurs, we show the existence of different small polaron formations, including those that travel close to the sound velocity or that are stationary by self-trapping. Electric fields magnitudes and carrier-lattice coupling have also been analyzed, which allowed to show a phase diagram that describes the existing regimes. In addition to thresholds between the mobile and stationary polaron regimes, this phase diagram unveils an unusual aspect: a metastable polaron formation.

The spirit of Vienna: health strategies in managing the world drug problem

Health sciences have always had a lot of influence in the formulation of drug policies. However, the international system for the control of illicit drugs is distant from the World Health Organization, for example. It was in the name of health and well-being protection that the Single Narcotics Convention (1961) established a ban on drugs as a rule, with the exception of medical and scientific uses. But it was also in the name of a health category, Harm Reduction, that the so-called Vienna consensus began to break in 2009: it is about the global bipolarization around drug policy, locating member states in two groups.

Taking strategy as a means designed to achieve a purpose, which updates the position of agents in the International Drug Control System and which operates the renunciation of the other (FOUCAULT, 2001), we ask: what, in the last decade, was their strategy groups of countries in managing the global drug problem? To answer this question, an ethnography of events and documents was carried out, in addition to semi-structured interviews and participant observation. The field research was the 62nd Ministerial Segment of the UN Commission on Narcotic Drugs (Vienna, 2019), when the last 10 years of drug policy were evaluated and the next decade was planned.

Following the Brazilian resolution, created in partnership with Norway, entitled “Promoting measures to prevent transmission of HIV for women who use drugs, including by improving access to post-exposure prophylaxis”, it was possible to observe the effort to maintain that space as a place where health has no voice. Categories such as 'women who use drugs' and 'emergency contraceptives' have been the subject of controversy among diplomats, who have backed down to maintain the already weakened consensus.

It is concluded that health is historically used as a strategy for the prohibition of substances, but it can be a tool for changing the paradigm if observed as an instrument in dispute and based on Harm Reduction

Key messages

Health is the strategy to legitimize drug prohibition, but it can also be the protagonist of the paradigm shift in drug policy if it is anchored in harm reduction. There is an effort to keep the UN's international illicit drug control system out of the health field.

Boron in soil: The impacts on the biomass, composition and activity of the soil microbial community

The high boron (B) content in desalinated seawater is a concern for crop development. However, in spite of the importance of the soil microbial community in soil fertility, the below-ground impacts of B are still unknown. Here, in a soil-ryegrass model system, the activity, biomass and diversity of the soil microbial community were evaluated in response to irrigation with: i) 0.3 mg B L^-1; ii) 1 mg B L^-1; and iii) 50 mg B L^-1. We assessed two different compounds of boron: boric acid (H₃BO₃) and disodium tetraborate decahydrate (Na₂B₄O₇·10H₂O). Overall, the 1 mg B L^-1 dose was identified as the threshold limit that did not irreversibly harm soil sustainability. In contrast, the highest B dose had a noticeable impact on the nitrogen (N) cycle of the soil, as demonstrated by an increase in the water-soluble N content and a decrease in urease activity. Analysis of the phospholipid fatty acids (PLFAs) revealed that the effect of B on the soil microbial biomass was dependent on the chemical form used. High B doses reduced soil microbial respiration and influenced the composition of the bacterial and fungal communities, with fungal diversity being diminished, as revealed by sequencing approaches.

Dot1 promotes H2B ubiquitination by a methyltransferase-independent mechanism

The histone methyltransferase Dot1 is conserved from yeast to human and methylates lysine 79 of histone H3 (H3K79) on the core of the nucleosome. H3K79 methylation by Dot1 affects gene expression and the response to DNA damage, and is enhanced by monoubiquitination of the C-terminus of histone H2B (H2Bub1). To gain more insight into the functions of Dot1, we generated genetic interaction maps of increased-dosage alleles of DOT1. We identified a functional relationship between increased Dot1 dosage and loss of the DUB module of the SAGA co-activator complex, which deubiquitinates H2Bub1 and thereby negatively regulates H3K79 methylation. Increased Dot1 dosage was found to promote H2Bub1 in a dose-dependent manner and this was exacerbated by the loss of SAGA-DUB activity, which also caused a negative genetic interaction. The stimulatory effect on H2B ubiquitination was mediated by the N-terminus of Dot1, independent of methyltransferase activity. Our findings show that Dot1 and H2Bub1 are subject to bi-directional crosstalk and that Dot1 possesses chromatin regulatory functions that are independent of its methyltransferase activity.

Evaluation of Cognitive Functions through the Systemic Lisbon Battery: Normative Data

INTRODUCTION

This article is part of the Focus Theme of Methods of Information in Medicine on "Methodologies, Models and Algorithms for Patients Rehabilitation".

BACKGROUND

ICT is an emerging alternative to paper-and-pencil tests for the assessment of cognitive functions, allowing for the monitoring of participants' behavior while they perform simulations of instrumental activities of daily life (IADLs) in a virtual reality (VR) scenario. This requires normative values for each VR task, so that deviations to normality can be identified as indicators of cognitive impairment.

OBJECTIVES

To identify normative data for several IADL tasks that are available on the Systemic Lisbon Battery (SLB).

METHODS

Fifty-nine participants performed a series of VR tasks that require the use of the memory and executive function dimensions of cognitive functionality.

RESULTS

Normative data for the different subsets and total score of the SLB, based on proportion of correct hits per execution time, were identified. Age and experience with video games affect (respectively, negatively and positively) performance on the SLB and should be taken into account in assessment; on the other hand, gender and education do not.

CONCLUSIONS

Overall results suggest that the SLB may be useful to assess cognitive functioning during the execution of activities of daily living, but larger studies and with clinical samples are needed.

Virtual Kitchen Test. Assessing frontal lobe functions in patients with alcohol dependence syndrome

INTRODUCTION

This article is part of the Focus Theme of Methods of Information in Medicine on "New Methodologies for Patients Rehabilitation".

BACKGROUND

The ecological validity of paper-and-pencil neuropsychological tests is currently a matter of debate. Arguments in favor of alternatives indicate that paper-and-pencil forms are unable to account for both mental and functional aspects of cognitive functioning.

OBJECTIVES

In this study we developed a new neuropsychological evaluation test - the Virtual Kitchen Test (VKT) - devised to evaluate frontal brain functioning in cognitively impaired individuals. We designed this test according to the rationale of the Trail Making Test (TMT), in order to capture frontal lobe abilities during a more ecologically valid task.

METHODS

Forty-nine participants, 25 from a clinical sample of patients diagnosed with Alcohol Dependence Syndrome, plus 24 healthy participants.

RESULTS

Execution errors and task completion time were significantly higher in the clinical sample. Also, scores on the new VKT showed moderate to high positive correlations with scores on the TMT. Furthermore, the overall discriminant performance of the VKT was high for both of its indicators.

CONCLUSIONS

Overall results support the ability of the VKT to evaluate frontal lobe functions. The best cut-off scores based on this sample are discussed.

Comparison of two-step transient evoked otoacoustic emissions (TEOAE) and automated auditory brainstem response (AABR) for universal newborn hearing screening programs

OBJECTIVE

Both transitory auditory otoemissions (TEOAE) and automated auditory brainstem responses (AABR) are considered adequate methods for universal hearing screening. The goal of this study was to compare the results obtained with each device, applying the same screening procedure.

MATERIALS AND METHODS

From 2001 to 2003, all the newborns in our health area (2454 infants) were evaluated with TEOAE (ILO92, otodynamics) and all those born from 2004 to 2006 (3117) were evaluated with AABR (AccuScreen, Fischer-Zoth). The population studied included all well newborns and those admitted to neonatal intensive care units (NICU). The first screening was normally undertaken with well babies during the first 48h of life, before hospital discharge. Infants referred from this first step underwent a second screening after hospital discharge, before they were a month old.

RESULTS

The results from each study group were compared and analyzed for significant differences. TEOAE screening yielded 10.2% fail results from the first screening step; AABR gave 2.6%. In the second screening step, 2% of the newborns screened with TEOAE were referred, whereas 0.32% of those screened with AABR were referred. These differences are statistically significant.

CONCLUSIONS

Although AABR screening tests involve a slightly higher cost in time and money than TEOAE, the results obtained compensate this difference. AABR gives fewer false positives and a lower referral rate; the percent of infants lost during follow-up is consequently smaller. Therefore, in our environment, universal newborn auditory screening with AABR is more effective than that with TEOAE.

[Asymptomatic bilateral pharyngocele]

The diverticula of the lateral wall of the pharynx are called pharyngoceles. We present a case of a 71-year old male in whom we discovered, by chance, a bilateral pharyngocele. Given their scarcity, we review the characteristics of the process, highlighting the relevance of the oesophagopharingeal barium swallow. Finally, we describe two possible anatomical locations of the herniated sac.

[Stenon's or Stensen's duct carcinoma]

Carcinomas arising from the Stensen's duct are extremely rare, and only 28 cases have been reported since 1927. Only two cases of the whole were adenoid cystic carcinoma like our case. A 83-year-old man with painless tumour of the left cheek is reported. The tumour was removed without facial nerve injury via extended parotidectomy incision and after superficial lobectomy.

[Results of the application of the protocol for the early detection of hearing loss in high-risk neonates]

In coordination with the Paediatrics Department, we drew up a protocol for the "Early Detection of Hearing Loss in High-Risk Neonates" based fundamentally on the sequential application of impedanciometry and the Auditory Brain Stem Response (ABR). These are the results obtained from October 1994 to March 2001. Of the 240 children examined, we found 36 cases (15%) of severe-to-profound bilateral sensorineural hearing loss (> 60 dBs HL). 55% was associated with risk factors. However, we diagnosed only 2 of these cases of hearing loss (5.5%) using the protocol (sent by the neonatology department due to the fact that they showed hearing loss risk factors), since the rest (94.5%) came as a result of suspected hearing loss, which resulted in an average age for diagnosis of 3 years. Although the procedure used is highly sensitive and is diagnostically specific, in the light of these results, we consider it necessary to extend hearing screening to all newborn infants in order to evaluate its effectiveness in the early detection of infant deafness.

[Results of one year's application of a universal protocol for the early detection of hearing loss in neonates]

These are the results of the first year of the application of a universal programme for the early detection of neonatal deafness. Our objective is making a diagnosis of all the unilateral or bilateral cases of hearing loss above 35 dB HL, before the age of 6 months. The detection strategy has 2 screening phases with transient evoked otoacoustic emissions (TEOAE) and one diagnostic phase with auditory brain stem response (ABR). The ABR were carried out both on those patients that failed the TEOAE screening and on the neonates with hearing loss risk factors. Of the 1,277 living newborn babies (NB), we evaluated 94%. 3.3% of the NB showed hearing loss risk factors. 90% of the NB passed the first TEOAE in both ears and, after the second TEOAE, only 2.5% of the NB reached the diagnostic phase. We provided early detection and treatment of 0.58% of cases of bilateral severe-deep hearing loss. Finally, the results obtained are examined together with the importance of planning universal hearing screening.

[Mastoid osteoma]

The osteomas of the mastoids are slow growing benign tumors, made predominantly of mature bone. Clinically these tumors are asymptomatic, except for cosmetic deformities, and they are usually casual radiological findings. Surgical treatment is indicated for symptomatic osteomas. In Spain only sixteen cases of extracanalicular osteoma have been described in the literature. Two new cases are reported and a review of the literature is presented.

[Local sclerosing treatment with etoxiesclerol in ORL disease: Rendu-Osler disease, granuloma, angioma...]

In a previous report, we showed the efficacy of the submucous sclerosant therapy with Etoxiesclerol (Polidocanol) in two patients with Rendu-Osler-Weber disease. We confirm, in this present study, the advantages of Etoxiesclerol in the treatment of the epistaxis in the Rendu-Osler disease, in six patients, 3 males and 3 females and likewise in two patients with non-specific granuloma of nasal septum and another patient with cavernous hemangioma of soft palate.

Arteriovenous malformation of the mandible: review of literature and case history

Vascular malformations of the jaws can lead to disastrous complications, but there seems to be no consensus as to their treatment. The literature presents the pathophysiology and clinical aspects of these lesions, as well as the divergent views of the authors. Treatment by catheterization and embolization, with direct transosseous injection of cyanoacrylate, appears to be the least harmful and most permanent treatment in certain conditions, as evidenced by the case of this 9-year-old patient having a high-flow mandibular vascular malformation

[Internal jugular phlebectasia]

The jugular phlebectasia is an infrequent anomaly in which a jugular dilatations of the jugular vein during the Valsalva manoeuvre is the main characteristic. We report a case of a 7 years old male with an internal jugular phlebectasia manifestating as a latero-cervical right mass expanding with Valsalva manoeuvre. After the first initial echographic study, we recommend angio-TAC helicoidal as an useful test to confirm the diagnosis, it is also useful to get a tridimensional reconstruction of the jugular anomaly as well as establish the extension and possible complication. Jugular phlebectasia is a benign entity, usually it doesn't progress and causes a minimal estatic defect, therefore it is recommended to avoid any surgical resection or drapping. Periodical follow up is the best choice.

[Pilomatrixoma and differential diagnosis of parotid area tumors]

A case report of pilomatrixoma, benign neoplasy, originated of the skin annexes, which localisation force us to rule out a parotid tumor. Our intention is to include the pilomatrixoma among the possible differential diagnosis of calcified masses inside the growths of the parotid gland.

[Lingual abscess]

The unilateral abscess of the anterior portion of the tongue is an extremely rare occurrence. We report a case in which we have used the ultrasonography in the diagnosis, and discuss, as etiologic hypothesis the participation of Blandin-Nühn glands in the genesis of these abscess.

[Early diagnosis of childhood deafness: detection protocol in high-risk neonates]

The protocol developed at our hospital for auditory assessment of children with risk factors for deafness is presented. The results obtained with tympanometry and auditory brainstem response (ABR) audiometry from October 1994 to March 1998 were analyzed. In 122 children, 17 cases (14%) of severe-to-profound bilateral deafness were found. Only 50% of these cases were associated with risk factors present at birth. The average age at time of diagnosis of deafness was over 3 years. In view of these results, we recommend auditory screening for all newborns as the only effective procedure for early detection of childhood deafness.

[A new sclerosant for the treatment of Rendu-Osler-Weber disease]

We report the cases of two women with Rendu-Osler-Weber disease and severe epistaxis. After several procedures failed (electrocoagulation, vascular clamping, dermoplasty, embolization), submucosal infiltration of a sclerosant was performed using the new product etoxysclerol. Epistaxis remained under control after two years of monitoring.

[Cemented fibroma of the maxillary sinus]

Cementifying fibroma is a benign fibro-osseous lesion with dental origin. We describe a case of cementifying fibroma of the maxillary sinus, an unusual location for this tumor.

Superficial femoral artery as a substitute for common carotid artery affected by malignant cervical tumors

Tumoral disease of the arteries is uncommon. It is possible that, in tumoral reoperations affecting cervical structures, periarterial fibrosis due to radiotherapy and previous surgery and metastatic adherences to the arterial wall makes radical surgery difficult. We present a case where the surgical treatment of a regional relapse from laryngeal neoplasm needed the removal of the common carotid artery and its reconstruction with autologous patent superficial femoral artery. Surgical technique included a PTFE graft interposition in the leg.

[Fibrous diaphragm of the nasopharynx]

A case of nasopharyngeal fibrous diaphragm of unknown origin is reported. In view of the scarcity of publications about this disorder, this new case is interesting. A differential diagnosis is made with choanal atresia and nasopharyngeal stenosis. Aspects of the etiology, clinical manifestations, and treatment are discussed.

[Surgery of the elongated styloid syndrome]

The symptomatology sometimes due to a giant styloid process can be very troublesome and at the same time unspecific, raising differential diagnosis problems with a large group of pathologies. We report a clinical case of elongated styloid syndrome, stylalgia or Eagle's syndrome, that forced our team to the exeresis of the anomalous process. We emphasizes the relative simplicity of the diagnosis and its treatment as well, especially when the intrabucal approach is followed.

[Cholesterol granuloma of the temporal lobe]

Cholesterol granuloma is a histological term used to describe a non-specific inflammatory reaction produced by the presence of cholesterol crystals, which may originate a foreign-body reaction. Cholesterol granuloma of the temporal bone is silent for years and not preceded by a history of otitis media. The diagnosis is made by CT and MRI, which reveal an expansive, isodense lesion brain tissue and increased signal intensity on both T1 and T2-weighted images respectively. A case of cholesterol granuloma of the petrous apex is presented. The granuloma was excised completely using an infra-retrolabyrinthine approach.

Tonsillar metastasis from adenocarcinoma of the stomach

Metastatic carcinoma of the tonsil is rare with only some 100 cases having been reported in the literature, of which nine have resulted from stomach carcinoma. Tonsillar metastases rarely become apparent before the diagnosis of the primary neoplasm. We describe here the clinical and histopathological findings of a case of unilateral palatine tonsil metastasis as the first sign of a signet-ring cell carcinoma of the stomach. This has not been reported previously.

[Undifferentiated carcinoma, or lymphoepithelioma, of the base of the tongue]

The histologic features of undifferentiated carcinoma of the base of the tongue and lymphoepithelioma, or lymphoepithelial carcinoma, of the nasopharynx are identical and can be considered synonymous. The frequency of undifferentiated nasopharyngeal carcinoma (lymphoepithelioma) located on the base of the tongue is discussed because undifferentiated carcinoma of the base of the tongue is considered to be the same tumor.

[The descriptive study of primary care in otorhinolaryngology]

A descriptive study was made of medical and surgical activity over a six-month period in an outpatient ENT clinic of Valladolid, Spain, serving a health district of 142,779 persons. Age, sex, type of consultation, symptoms, complementary studies, diagnosis, check-up, and surgical treatment were analyzed and correlated in 1170 patients.

[Spontaneous cervical and mediastinal emphysema]

Cervical emphysema may have its origin in multiple causes. The continuity of the fascial planes connecting the soft tissues of the neck to the mediatinum and retroperitoneum enables the "aberrant air" localized in one of these three areas to spread to the other ones. The otolaryngologist must know the differential diagnosis of the presence of air in the neck, since the ultimate treatment to be given will depend on the etiology involved. We present two clinical cases of cervical emphysema secondary to spontaneous pneumomediastinum. One of the cases is idiopathic while the other one is associated with diabetic ketoacidosis. We analyze this and other causes that can give rise to cervical emphysema.

[Hypoglossal nerve paralysis after intubation and direct laryngoscopy]

We described an extremely uncommon case of hypoglossal nerve paralysis occurred after a direct laryngoscopy under general anesthesia with McIntosh's laryngoscope intubation. We reviewed the literature on similar cases and studied the etiology and pathogenesis of these paralyses.

[Lateral pharyngeal phlegmon following nasotracheal intubation]

We present a case of lateropharyngeal abscess, which was caused by the undermucous dissection of the lateral wall of the nasopharynx in the moment to make a nasotracheal intubation in a patient with long-term intubation. In the International Literature none other case of this complication have previously been reported and we things that is suitable his publication and the revision of this anesthetic method and their repercussions in the field ORL.

Anatomic placement of fixation devices in genioplasty

The form of the anterior mandible in 45 patients was assessed before, immediately after, and 1 year after genioplasty. A specific, consistent pattern of bone apposition and resorption was observed after advancement genioplasty. A consistent but inverse apposition-resorption pattern was observed after reduction genioplasty. In view of the observed pattern of bony change, it is recommended that fixation devices for genioplasty be placed in areas of future bone deposition.

[Sjögren's syndrome and differential diagnosis of parotid gland hypertrophy]

Some auto-immune systemic pathologies can first be detected through a very characteristic symptomatology which must be known for an early diagnosis. This is particularly the case with primary Sjögren syndrome (sicca syndrome). Based on a well documented case, this article is a review of the etiopathogenesis, symptomatology and investigation of the Sjögren syndrome. The differential diagnosis of the parotid gland hypertrophies is also discussed, based on a systematic approach.

[Granular myringitis]

We present two cases of granular myringitis. A clinical study, diagnosis and therapy of this rare condition are undertaken.

Long-term ototoxic effects of neomycin applied topically in the middle ear: a morphological study in the guinea pig

Neomycin was instilled daily, uni- or bilaterally, into the middle ear of guinea pigs for three months. The cochleae were examined, by light and electron microscopy, six months after the end of treatment. The organs of Corti of the treated ears were completely destroyed, and in the most advanced lesions, were substituted by a single layer of very thin flat cells. In the spiral ganglion only some glial cells and a few neurons could be observed. All surviving neurons were myelinated, and their ultrastructure was greatly altered, with disorganization of the rough endoplasmic reticulum and ribosomes. The basilar membrane almost disappeared, losing it amorphous and filamentous components. The spiral limbus and the stria vascularis were atrophic and were also covered, in the final stages, by flat elongated cells. In view of its morphological characteristics, this epithelium may arise from the displacement of the interdental cells and perhaps from the cochlear surface of Reissner's membrane.