Traditional Uses, Phytochemistry, and Pharmacological Activities of Coleus amboinicus: A Comprehensive Review

Coleus amboinicus Benth., also known as Plectranthus amboinicus (Lour.) Spreng., is a perennial plant from the Lamiaceae family commonly found in tropical and warm regions of Africa, Asia, and Australia. Folk medicine commonly employs this remedy to address various ailments, including but not limited to asthma, headaches, skin disorders, coughs, constipation, colds, and fevers. Several phytoconstituents from various phytochemical classes, such as phenolics, terpenoids, phenolic acids, flavonoids, flavones, and tannins, have been identified in Coleus amboinicus up to the present time. Numerous pharmacological properties of Coleus amboinicus crude extracts have been documented through both in vitro and in vivo studies, including but not limited to antitumor, antibacterial, antifungal, antiprotozoal, anti-inflammatory, antioxidant, antidiabetic, wound healing, analgesic, antirheumatic, and various other therapeutic effects. Due to its extensive history of traditional usage, the diverse array of bioactive phytochemicals, and numerous established pharmacological activities, Coleus amboinicus is widely regarded as having significant potential for clinical applications and warrants further exploration, development, and exploitation through research. With this context, the present study gathers information on the occurrence, biological description, cultivation, and nutritional values of Coleus amboinicus. Furthermore, it thoroughly discusses various phytoconstituents, along with their classes, present in Coleus amboinicus, followed by detailed descriptions of their pharmacological activities based on recent literature.

Advancements in gelatin-based hydrogel systems for biomedical applications: A state-of-the-art review

A gelatin-based hydrogel system is a stimulus-responsive, biocompatible, and biodegradable polymeric system with solid-like rheology that entangles moisture in its porous network that gradually protrudes to assemble a hierarchical crosslinked arrangement. The hydrolysis of collagen directs gelatin construction, which retains arginyl glycyl aspartic acid and matrix metalloproteinase-sensitive degeneration sites, further confining access to chemicals entangled within the gel (e.g., cell encapsulation), modulating the release of encapsulated payloads and providing mechanical signals to the adjoining cells. The utilization of various types of functional tunable biopolymers as scaffold materials in hydrogels has become highly attractive due to their higher porosity and mechanical ability; thus, higher loading of proteins, peptides, therapeutic molecules, etc., can be further modulated. Furthermore, a stimulus-mediated gelatin-based hydrogel with an impaired concentration of gellan demonstrated great shear thinning and self-recovering characteristics in biomedical and tissue engineering applications. Therefore, this contemporary review presents a concise version of the gelatin-based hydrogel as a conceivable biomaterial for various biomedical applications. In addition, the article has recapped the multiple sources of gelatin and their structural characteristics concerning stimulating hydrogel development and delivery approaches of therapeutic molecules (e.g., proteins, peptides, genes, drugs, etc.), existing challenges, and overcoming designs, particularly from drug delivery perspectives.

Nanoparticle-Based Approaches for Treatment of Hematological Malignancies: a Comprehensive Review

Blood cancer, also known as hematological malignancy, is one of the devastating types of cancer that has significantly paved its mortality mark globally. It persists as an extremely deadly cancer type and needs utmost attention owing to its negligible overall survival rate. Major challenges in the treatment of blood cancer include difficulties in early diagnosis, as well as severe side effects resulting from chemotherapy. In addition, immunotherapies and targeted therapies can be prohibitively expensive. Over the past two decades, scientists have devised a few nanoparticle-based drug delivery systems aimed at overcoming this challenge. These therapeutic strategies are engineered to augment the cellular uptake, pharmacokinetics, and effectiveness of anticancer drugs. However, there are still numerous types of nanoparticles that could potentially improve the efficacy of blood cancer treatment, while also reducing treatment costs and mitigating drug-related side effects. To the best of our knowledge, there has been limited reviews published on the use of nano-based drug delivery systems for the treatment of hematological malignancies. Therefore, we have made a concerted effort to provide a comprehensive review that draws upon recent literature and patents, with a focus on the most promising results regarding the use of nanoparticle-based approaches for the treatment of hematological malignancies. All these crucial points covered under a common title would significantly help researchers and scientists working in the area.

Tools for assessing health research partnership outcomes and impacts: a systematic review

OBJECTIVE

To identify and assess the globally available valid, reliable and acceptable tools for assessing health research partnership outcomes and impacts.

METHODS

We searched Ovid MEDLINE, Embase, CINAHL Plus and PsycINFO from origin to 2 June 2021, without limits, using an a priori strategy and registered protocol. We screened citations independently and in duplicate, resolving discrepancies by consensus and retaining studies involving health research partnerships, the development, use and/or assessment of tools to evaluate partnership outcomes and impacts, and reporting empirical psychometric evidence. Study, tool, psychometric and pragmatic characteristics were abstracted using a hybrid approach, then synthesized using descriptive statistics and thematic analysis. Study quality was assessed using the quality of survey studies in psychology (Q-SSP) checklist.

RESULTS

From 56 123 total citations, we screened 36 027 citations, assessed 2784 full-text papers, abstracted data from 48 studies and one companion report, and identified 58 tools. Most tools comprised surveys, questionnaires and scales. Studies used cross-sectional or mixed-method/embedded survey designs and employed quantitative and mixed methods. Both studies and tools were conceptually well grounded, focusing mainly on outcomes, then process, and less frequently on impact measurement. Multiple forms of empirical validity and reliability evidence was present for most tools; however, psychometric characteristics were inconsistently assessed and reported. We identified a subset of studies (22) and accompanying tools distinguished by their empirical psychometric, pragmatic and study quality characteristics. While our review demonstrated psychometric and pragmatic improvements over previous reviews, challenges related to health research partnership assessment and the nascency of partnership science persist.

CONCLUSION

This systematic review identified multiple tools demonstrating empirical psychometric evidence, pragmatic strength and moderate study quality. Increased attention to psychometric and pragmatic requirements in tool development, testing and reporting is key to advancing health research partnership assessment and partnership science. PROSPERO CRD42021137932.

Health promotion among unemployed people – meta-analytic evidence

Background

It is well known that unemployment impairs health. However, less is known about health promotion among unemployed people and healthy coping strategies to deal with unemployment.

Methods

A random-effect meta-analysis was applied to statistically integrate quantitative controlled intervention studies among unemployed people.

Results

The meta-analysis included 34 eligible primary studies with 36 independent intervention samples. For mental health, the average meta-analytic effect sizes for the comparison of intervention group and comparison group was significant and of small size after the intervention d = 0.25; 95% CI [0.10, 0.39], and at follow-up, d = 0.13; 95% CI [0.04, 0.22]. For health behavior (measured as physical activity), the effects were also significant after the intervention, d = 0.30; 95% CI [0.12, 0.47] (no data available at follow-up). Effects on self-assessed physical health status were very small and not significant. However, when health improvement was the only goal of the respective intervention (in contrast to studies with multiple goals, e.g., health improvement plus re-employment), the effect on physical health was significant, too, d = 0.15; 95% CI [0.04, 0.25]. Moderator tests showed that intervention effects on mental health were significantly stronger when cognitive-behavioral methods were used (p < .05), while the use other kinds of stress-management techniques (p < .05), of methods to increase social support (p < .05), or of relaxation techniques (p < .07) did not improve the effectiveness of the intervention.

Conclusions

The present meta-analyses provided evidence that, on average, interventions aiming at improving unemployed people’s health do indeed improve participants’ health.

Key messages

• The present meta-analysis confirms that it is possible to promote unemployed people’ health. The moderator effects for type of intervention that were found here might be helpful for health promotion.

• The inclusion of cognitive-behavioral methods, appears to be a successful approach for health-oriented interventions with unemployed people.

Discrimination impairs cognitive function in ageing men and women

Background

We sought to assess changes in episodic memory and executive functioning among men and women in the Midlife in the United States (MIDUS) cohort study; and to delineate variations in episodic memory and executive functioning by gender; and to determine the impact of discrimination on longitudinal changes in episodic memory and executive functioning.

Methods

We used data from the MIDUS study - a national probability sample of non-institutionalized, English speaking respondents aged 25-74 living in the 48 contiguous states of the United States. The initial wave in our study (1995) included 4963 non-institutionalized adults aged 32 to 84 (M = 55, SD = 12.4). Dependent variables are episodic memory and executive functioning, assessed with the Brief Test for Cognition. The independent variables were discrimination (lifetime and daily discrimination) variables. Furthermore, we investigated baseline cognition score, race/ethnicity (White, Hispanic, other), education (some college or more vs high school of less), whether or not living with partner, income (per 100% above Federal Poverty Level), unemployed (vs employed), retired (vs employed), physical health (self-reported), vigorous physical activity, depression (continuous scale), anxiety (continuous scale). To assess cognition changes we estimated adjusted linear regression models.

Results

Cross-sectional, work discrimination was associated with cognition in men and women. Longitudinally, adjusting for baseline cognition score, race/ethnicity, education, living situation, income, (un)employed, (not)retired, physical health, vigorous physical activity, depression, and anxiety, we found an association of family strain with cognition changes in high-income men, and an association of daily discrimination with cognition changes in men (Beta 0.01, P-value: 0.001).

Conclusions

Reducing discrimination might be an important measure to support cognitive function in ageing populations.

0426 Time Restricted Feeding Consolidates Sleep in the BACHD Mouse Model of Huntington’s Disease

Introduction

Disturbances in the daily sleep-wake cycle are common in individuals with neurodegenerative disorders. Huntington’s disease (HD) is a genetic neurodegenerative disorder in which patients exhibit a variety of impairments that include, poor motor function, disrupted circadian rhythms, and sleep abnormalities such as difficulty initiating sleep at bedtime and more frequent nighttime arousals. In the BACHD mouse model time restricted feeding (TRF) has been successful at improving motor functions and circadian rhythms. The BACHD mouse model has a bacterial artificial chromosome that expresses the full-length human mutant huntingtin gene.

Methods

In order to determine the effects of TRF on sleep-wake architecture, EEG/EMG polysomnographic records were examined in mice between 3-4 months old bearing the BAC knock-in of a human genetic mutation of HD and WT litter mates, first during ad libitum (ad lib) feeding then during an 18 hour fasting protocol. TRF protocol consisted of 6 hours of food access limited between ZT15-ZT21 and 18 hours of fasting.

Results

A two-way ANOVA revealed that TRF significantly decreased the amount of total sleep (p=0.04) and NREM sleep (p=0.04) in the dark phase in both WT and BACHD mice. TRF did not significantly affect sleep in the light phase, however trends suggest that BACHD mice have more sleep in the light phase under TRF than ad lib.

Conclusion

This data suggests that TRF improves sleep by consolidating sleep to the light phase and wake to the dark phase. In conclusion, TRF may be a promising tool that can improve the negative effects of neurodegenerative diseases on sleep-wake processes.

Support

These experiments were supported by R01-NS078410 and UCLA start-up funds.

0309 Stress Induced Nitric Oxide Synthase Activation in the Basal Forebrain is a Result of Sleep Loss

Introduction

The mechanisms underlying the reciprocal relationship between stress and sleep are unclear. Nitric oxide, a diffusible signaling molecule, plays an important role in physiological stress responses and sleep. The medial septum (MS) and vertical diagonal band (VDB) are sleep regulatory regions of the basal forebrain whose cells express nitric oxide synthase (NOS). In this study, we examined the effects of sleep loss and restraint stress on NOS activation in the MS and VDB.

Methods

Adult male and female C57BL/J6 mice were randomly assigned to a control, total sleep deprivation (TSD), or restraint stress group. TSD was performed for 6h using gentle handling, and restraint was performed for 6h by immobilizing the mice in a plastic restraint device. Both procedures began at light onset in a 12:12 light:dark cycle. Immediately following the procedures, mice were sacrificed, and NADPH-diaphorase (NADPH-d) was measured in the MS and VDB to determine NOS activity.

Results

A multivariate ANOVA revealed main effects of TSD and restraint stress on NADPH-d in the MS (F(2,13) = 7.0921, p = 0.011) and VDB (F(2,13)=6.416, p = 0.014) in females. A post hoc analysis showed a significant difference between control and TSD (p = 0.011 (MS), p = 0.014 (VDB)), and between control and restraint (p = 0.032 (MS), p = 0.048 (VDB)), but no significant difference between TSD and restraint. There is a sex difference in NADPH-d in these regions (p < 0.005) that reverses direction following TSD and restraint stress.

Conclusion

Our findings provide evidence that NOS activity in the basal forebrain may underlie sex differences in stress responses. Since there is no significant difference between the TSD and restraint stress, this suggests that the effect of restraint stress on NOS activation is a result of sleep loss, and not due to induction of a stress mechanism.

Support

This study was partly funded by R01-NS078410 and UCLA start-up funds.

Rehabilitation Enablement in Chronic Heart Failure-a facilitated self-care rehabilitation intervention in patients with heart failure with preserved ejection fraction (REACH-HFpEF) and their caregivers: rationale and protocol for a single-centre pilot randomised controlled trial

INTRODUCTION

The Rehabilitation EnAblement in CHronic Heart Failure in patients with Heart Failure (HF) with preserved ejection fraction (REACH-HFpEF) pilot trial is part of a research programme designed to develop and evaluate a facilitated, home-based, self-help rehabilitation intervention to improve self-care and quality of life (QoL) in heart failure patients and their caregivers. We will assess the feasibility of a definitive trial of the REACH-HF intervention in patients with HFpEF and their caregivers. The impact of the REACH-HF intervention on echocardiographic outcomes and bloodborne biomarkers will also be assessed.

METHODS AND ANALYSIS

A single-centre parallel two-group randomised controlled trial (RCT) with 1:1 individual allocation to the REACH-HF intervention plus usual care (intervention) or usual care alone (control) in 50 HFpEF patients and their caregivers. The REACH-HF intervention comprises a REACH-HF manual with supplementary tools, delivered by trained facilitators over 12 weeks. A mixed methods approach will be used to assess estimation of recruitment and retention rates; fidelity of REACH-HF manual delivery; identification of barriers to participation and adherence to the intervention and study protocol; feasibility of data collection and outcome burden. We will assess the variance in study outcomes to inform a definitive study sample size and assess methods for the collection of resource use and intervention delivery cost data to develop the cost-effectiveness analyses framework for any future trial. Patient outcomes collected at baseline, 4 and 6 months include QoL, psychological well-being, exercise capacity, physical activity and HF-related hospitalisation. Caregiver outcomes will also be assessed, and a substudy will evaluate impact of the REACH-HF manual on resting global cardiovascular function and bloodborne biomarkers in HFpEF patients.

ETHICS AND DISSEMINATION

The study is approved by the East of Scotland Research Ethics Service (Ref: 15/ES/0036). Findings will be disseminated via journals and presentations to clinicians, commissioners and service users.

TRIAL REGISTRATION NUMBER

ISRCTN78539530; Pre-results .

Inflammation, vitamin D and dendritic cell precursors in chronic kidney disease

Decreased blood dendritic cell precursors (DCP) count is linked with atherosclerotic disease, while reduction of circulating DCP is also seen in patients with chronic kidney disease (CKD). As poor vitamin D status could be linked to a compromised innate immune response, we hypothesized that vitamin D status might be involved in the decrease in circulating DCP in CKD. Moreover, the potential role of inflammation was considered. Circulating myeloid (mDCP), plasmacytoid (pDCP) and total DCP (tDCP) were analysed using flow cytometry in 287 patients with CKD stage 3. Serum 25(OH)D and 1,25(OH)2D levels were measured using enzyme-linked immunosorbent assays (ELISA), interleukin (IL)-6, IL-10 and tumour necrosis factor (TNF)-α using cytometric bead array, C-reactive protein (CRP) using a high-sensitivity (hs) ELISA. Contrary to our hypothesis, there was no association between vitamin D levels and DCP, although their number was decreased significantly in CKD (P < 0·001). Instead, mDCP (r = -0·211) and tDCP (r = -0·188,) were associated slightly negatively with hsCRP but positively with the estimated glomerular filtration rate (eGFR, r = 0·314 for tDCP). According to multivariate linear regression, only higher hsCRP concentration and the presence of diabetes mellitus had a significant negative influence on DCP count (P < 0·03, respectively) but not vitamin D, age and eGFR. A significant impact of vitamin D on the reduction of circulating DCP in CKD 3 patients can be neglected. Instead, inflammation as a common phenomenon in CKD and diabetes mellitus had the main influence on the decrease in DCP. Thus, a potential role for DCP as a sensitive marker of inflammation and cardiovascular risk should be elucidated in future studies.

Using Art as a Medium for First Nations Youth to Express Their Pain: A Two-Eyed Seeing Qualitative Study

BACKGROUND: First Nations (FN) youth in Canada have the highest rates of pain-related conditions (ear, dental, headaches) yet may be least likely to be treated for them. Untreated pain has an arresting impact on growth and development and is detrimental to the achievement of life goals. In recent research conducted by the Aboriginal Children’s Hurt & Healing Initiative (ACHH), community participants reported that First Nation children are stoic and are reluctant to talk about their pain (Latimer & Rudderham, 2013). Clinicians are trained to assess pain based on overt signs of expression (cry, facial grimace, ability to describe) however if you do not present your pain this way it may reduce the chance of proper assessment and treatment.

OBJECTIVES: Using a Two-Eyed Seeing qualitative perspective (best of Indigenous and Western knowledge) the purpose of this research was to provide FN youth with the method of art making to determine how they express their pain.

DESIGN/METHODS: Youth from four FN communities, in three Maritime Provinces were invited to participate in art workshops facilitated by internationally renowned Mi’kmaq artist Alan Syliboy. The workshop began with a conversation circle about pain experiences and then proceeded to the art making. A FN documentary cinematographer captured the workshops and the results are documented in art and film. Three team members independently themed the data using thematic analysis and the inter-rater reliability was &gt;85%.

RESULTS: 39 youth aged 10-18 years participated in 4 community-based conversation and art sessions. The themes for the sessions were themed using the four dimensions of the Medicine Wheel. While the overwhelming theme discussed in the conversation sessions was physical pain, when provided the nonverbal, art mode of expression, the youth painted emotional pain more frequently than physical, spiritual and mental pain. There was overlap between the four themes but 70% of the artwork prominently illustrated emotional pain with 54% overlapping with physical, 30% mental and 31% spiritual.

CONCLUSION: These results present a more complicated issue regarding the integration of the different types of pain, intertwined together. The finding that when asked-youth primarily discussed physical pain but given the opportunity, more frequently painted emotional pain may shed new light on the degree to which emotional pain is a factor for these youth. The artwork and accompanying narratives are powerful and have implications for understanding the complexity of assessing the different dimensions of pain in a culturally meaningful manner and for clinician education purposes. A sample of the artwork is attached.

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D1 receptor-mediated inhibition of medial prefrontal cortex neurons is disrupted in adult rats exposed to amphetamine in adolescence

Amphetamine (AMPH) exposure leads to changes in behavior and dopamine receptor function in the prefrontal cortex (PFC). Since dopamine plays an important role in regulating GABAergic transmission in the PFC, we investigated if AMPH exposure induces long-lasting changes in dopamine's ability to modulate inhibitory transmission in the PFC as well as whether the effects of AMPH differed depending on the age of exposure. Male Sprague-Dawley rats were given saline or 3 mg/kg AMPH (i.p.) repeatedly during adolescence or adulthood and following a withdrawal period of up to 5 weeks (Experiment 1) or up to 14 weeks (Experiment 2), they were sacrificed for in vitro whole-cell recordings in layer V/VI of the medial PFC. We found that in brain slices from either adolescent- or adult-exposed rats, there was an attenuation of dopamine-induced increases in inhibitory synaptic currents in pyramidal cells. These effects did not depend on age of exposure, were mediated at least partially by a reduced sensitivity of D1 receptors in AMPH-treated rats, and were associated with an enhanced behavioral response to the drug in a separate group of rats given an AMPH challenge following the longest withdrawal period. Together, these data reveal a prolonged effect of AMPH exposure on medial PFC function that persisted for up to 14 weeks in adolescent-exposed animals. These long-lasting neurophysiological changes may be a contributing mechanism to the behavioral consequences that have been observed in those with a history of amphetamine abuse.

Clinical effectiveness and cost-effectiveness of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) facilitated self-care rehabilitation intervention in heart failure patients and caregivers: rationale and protocol for a multicentre randomised controlled trial

INTRODUCTION

The Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) trial is part of a research programme designed to develop and evaluate a health professional facilitated, home-based, self-help rehabilitation intervention to improve self-care and health-related quality of life in people with heart failure and their caregivers. The trial will assess the clinical effectiveness and cost-effectiveness of the REACH-HF intervention in patients with systolic heart failure and impact on the outcomes of their caregivers.

METHODS AND ANALYSIS

A parallel two group randomised controlled trial with 1:1 individual allocation to the REACH-HF intervention plus usual care (intervention group) or usual care alone (control group) in 216 patients with systolic heart failure (ejection fraction <45%) and their caregivers. The intervention comprises a self-help manual delivered by specially trained facilitators over a 12-week period. The primary outcome measure is patients' disease-specific health-related quality of life measured using the Minnesota Living with Heart Failure questionnaire at 12 months' follow-up. Secondary outcomes include survival and heart failure related hospitalisation, blood biomarkers, psychological well-being, exercise capacity, physical activity, other measures of quality of life, patient safety and the quality of life, psychological well-being and perceived burden of caregivers at 4, 6 and 12 months' follow-up. A process evaluation will assess fidelity of intervention delivery and explore potential mediators and moderators of changes in health-related quality of life in intervention and control group patients. Qualitative studies will describe patient and caregiver experiences of the intervention. An economic evaluation will estimate the cost-effectiveness of the REACH-HF intervention plus usual care versus usual care alone in patients with systolic heart failure.

ETHICS AND DISSEMINATION

The study is approved by the North West-Lancaster Research Ethics Committee (ref 14/NW/1351). Findings will be disseminated via journals and presentations to publicise the research to clinicians, commissioners and service users.

TRIAL REGISTRATION NUMBER

ISRCTN86234930; Pre-results.

[Diffusion Weighted Magnetic Resonance Imaging and its Application in Ophthalmology]

The value of diffusion-weighted magnet resonance imaging (DWI-MRI) has been demonstrated for an ever growing range of clinical indications. DWI is sensitive to the diffusion of water molecules and probes their random displacement within tissue. DWI provides both qualitative and quantitative information on tissue characteristics, e.g. tissue cellularity. This review provides an overview of diffusion-weighted imaging and its emerging applications in ophthalmology. The basic physics and technical foundations of DWI are introduced. The emerging applications of DWI are surveyed, particularly in diseases of the eye, orbit and optical nerve.

Effect of nutrition education on exclusive breastfeeding for nutritional outcome of low birth weight babies

BACKGROUND/OBJECTIVES

Low birth weight (LBW), defined as the body weight at birth of less than 2500 g, is a major public health problem in Bangladesh, where 37% of the babies are born with LBW. The objective of this study is to see the impact of nutrition education on growth of LBW babies with early initiation and exclusive breastfeeding compared to control group.

SUBJECTS/METHODS

A total of 184 LBW babies and their mothers who attended the Maternal Care and Health Training Institute and Dhaka Medical College Hospital were randomly allocated to either intervention or control group. Enrollment of the study population started in May 2008 and was completed in October 2008. Nutrition education was given to mothers twice weekly for 2 months, on initiation of breastfeeding within 1 h, exclusive breastfeeding and increasing their dietary intake. Nutritional status of LBW babies was assessed for length and weight every 2 weeks. Data were analyzed using SPSS/Window's version 12. Comparison of mean of data was done using standard Student's t-test.

RESULTS

Mean initial body weight and length of LBW babies were similar in both groups (2261±198 g vs 2241±244 g, P=0.535 and 43.0±1.3 cm vs 43.0±1.7 cm, P=0.77). Body weight and length of the LBW babies after 2 months increased significantly (3620±229 g vs 3315±301 g, P<0.001 and 50.2±1.3 cm vs 48.7±1.6 cm, P<0.001). It was found that the intervention group suffered less from respiratory illness compared with the control group (39% vs 66%, P<0.001). The rate of early initiation of breastfeeding was also significantly higher with nutrition intervention (59.8% vs 37.2%, P<0.001). Exclusive breastfeeding rate was significantly higher in intervention group (59.8% vs 37%, P=0.003).

CONCLUSIONS

The present study showed that weight and length gain of LBW babies significantly increased by breastfeeding and nutrition education. Therefore, nutrition education on breastfeeding proves to be a strong tool to reduce the high risk of malnutrition and mortality of the LBW babies.

Gender, age and ethnic aspects of analgesia in acute abdominal pain: is analgesia even across the groups?

BACKGROUND

Numerous studies have shown differences in pain perception between men and women, which may affect pain management strategies.

AIM

Our primary aim was to investigate whether there are gender-based differences in pain management in patients admitted to our emergency department with acute, non-specific abdominal pain (NSAP). Our secondary aim was to evaluate if other factors influence administration of analgesia for patients admitted with NSAP.

METHODS

From June 2007 to June 2008, we carried out a retrospective, gender-based, frequency-matched control study with 150 patients (75 consecutive men and 75 women) who presented with NSAP at our emergency department. Pain was documented using a numerical rating scale ('0' no pain, '10' most severe pain). A multinomial regression model was used to assess factors that might influence pain management.

RESULTS

No statistically significant difference was seen between men and women with respect to pain management (P= 0.085). Younger patients were, however, more likely to receive weaker (P= 0.011) and fewer analgesics (P < 0.001). Patients with previous abdominal surgery (P= 0.012), known chronic pain conditions (P= 0.029) or relevant comorbidities (P= 0.048) received stronger analgesia. Nationality (P= 0.244), employment status (P= 0.988), time of admission (P= 0.487) and known psychiatric illness (P= 0.579) did not influence pain management.

CONCLUSIONS

No statistically significant gender-dependent differences in pain management were observed. However, younger patients received less potent analgesic treatment. There is no reason for certain groups to receive suboptimal treatment, and greater efforts should be made to offer consistent treatment to all patients.

Phenotype determining alleles in GM1 gangliosidosis patients bearing novel GLB1 mutations

GM1 gangliosidosis manifests with progressive psychomotor deterioration and dysostosis of infantile, juvenile, or adult onset, caused by alterations in the structural gene coding for lysosomal acid beta-galactosidase (GLB1). In addition, allelic variants of this gene can result in Morquio B disease (MBD), a phenotype with dysostosis multiplex and entire lack of neurologic involvement. More than 100 sequence alterations in the GLB1 gene have been identified so far, but only few could be proven to be predictive for one of the GM1 gangliosidosis subtypes or MBD. We performed genotype analyses in 16 GM1 gangliosidosis patients of all phenotypes and detected 28 different genetic lesions. Among these, p.I55FfsX16, p.W65X, p.F107L, p.H112P, p.C127Y, p.W161X, p.I181K, p.C230R, p.W273X, p.R299VfsX5, p.A301V, p.F357L, p.K359KfsX23, p.L389P, p.D448V, p.D448GfsX8, and the intronic mutation IVS6-8A>G have not been published so far. Due to their occurrence in homozygous patients, four mutations could be correlated to a distinct GM1 gangliosidosis phenotype. Furthermore, the missense mutations from heteroallelic patients and three artificial nonsense mutations were characterized by overexpression in COS-1 cells, and the subcellular localization of the mutant proteins in fibroblasts was assessed. The phenotype specificity of 10 alleles can be proposed on the basis of our results and previous data.

Multivariate analysis of full-term neonatal polysomnographic data

INTRODUCTION

Polysomnography (PSG) is one of the most important noninvasive methods for studying maturation of the child brain. Sleep in infants is significantly different from sleep in adults. This paper addresses the problem of computer analysis of neonatal polygraphic signals.

METHODS

We applied methods designed for differentiating three important neonatal behavioral states: quiet sleep, active sleep, and wakefulness. The proportion of these states is a significant indicator of the maturity of the newborn brain in clinical practice. In this study, we used data provided by the Institute for Care of Mother and Child, Prague (12 newborn infants of similar postconceptional age). The data were scored by an experienced physician to four states (wake, quiet sleep, active sleep, movement artifact). For accurate classification, it was necessary to determine the most informative features. We used a method based on power spectral density (PSD) applied to each EEG channel. We also used features derived from electrooculogram (EOG), electromyogram (EMG), ECG, and respiration [pneumogram (PNG)] signals. The most informative feature was the measure of regularity of respiration from the PNG signal. We designed an algorithm for interpreting these characteristics. This algorithm was based on Markov models.

RESULTS

The results of automatic detection of sleep states were compared to the "sleep profiles" determined visually. We evaluated both the success rate and the true positive rate of the classification, and statistically significant agreement of the two scorings was found. Two variants, for learning and for testing, were applied, namely learning from the data of all 12 newborns and tenfold cross-validation, and learning from the data of 11 newborns and testing on the data from the 12th newborn. We utilized information obtained from several biological signals (EEG, ECG, PNG, EMG, EOG) for our final classification. We reached the final success rate of 82.5%. The true positive rate was 81.8% and the false positive rate was 6.1%.

DISCUSSION

The most important step in the whole process is feature extraction and feature selection. In this process, we used visualization as an additional tool that helped us to decide which features to select. Proper selection of features may significantly influence the success rate of the classification. We made a visual comparison of the computed features with the manual scoring provided by the expert. A hidden Markov model was used for classification. The advantage of this model is that it determines the future behavior of the process by its present state. In this way, it preserves information about temporal development.

Pyridoxine-dependent epilepsy: normal outcome in a patient with late diagnosis after prolonged status epilepticus causing cortical blindness

We report on a male proband with pyridoxine-dependent epilepsy (PDE) and neonatal seizure onset. At the age of 31 months, a prolonged status epilepticus led to severe neurological regression with cortical blindness, loss of speech and muscular hypotonia with slow recovery over the following 3 months. At 33 months of age pyridoxine therapy was initiated with excellent response and the boy remained seizure-free on pyridoxine monotherapy, except for two occasions with seizure recurrence 10 days after accidental pyridoxine withdrawal. alpha-aminoadipic semialdehyde dehydrogenase (antiquitin) deficiency was indicated by elevated pipecolic acid concentrations in plasma and alpha-aminoadipic semialdehyde excretion in urine. Molecular analysis of the antiquitin gene revealed a novel missense mutation c.57insA, while the mutation of the other allele remained unidentified so far. Despite the delay in diagnosis and prolonged status epilepticus, neuropsychological evaluations at the ages of 11 and 18 years demonstrated full-scale IQ of 93 and 92, respectively, with better verbal IQ (103 and 101) than performance IQ (85 and 82).

Anti-Echis carinatus venom antibodies from chicken egg yolk: Isolation, purification and neutralization efficacy

High titer antibodies (IgY) were raised in egg yolk of white leghorn chicken (Gallus gallus domesticus) by immunizing with the venom of Echis carinatus (Saw scaled viper or carpet viper), an Indian venomous snake belonging to the family Viperidae. The anti-snake venom antibodies (antivenom) were isolated from egg yolk by the water dilution method, enriched by 19% sodium sulfate precipitation and purified by immunoaffinity chromatography. A single, electrophoretically pure IgY band of 180-200 kDa was obtained on SDS-PAGE. Immunoblot analysis revealed not only the specific binding of the antivenom but also dose-dependent blocking of antivenom by venom proteins. In neutralization studies, a preincubated mixture of both affinity-purified (50 mg/kg body weight) as well as partially purified (210 mg/kg body weight) anti-E. carinatus IgY with 2 LD(50) dose of E. carinatus venom (2 x 6.65 mg/kg body weight) gave 100% protection in mice when administered subcutaneously.

Hospital at home for chronic obstructive pulmonary disease: an integrated hospital and community based generic intermediate care service for prevention and early discharge

Recent randomized controlled studies have reported success for hospital at home for prevention and early discharge of chronic obstructive pulmonary disease (COPD) patients using hospital based respiratory nurse specialists. This observational study reports results using an integrated hospital and community based generic intermediate care service. The length of care, readmission within 60 days and death within 60 days in the early discharge (9.37 days, 21.1%, 7%) and the prevention of admission (five to six days, 34.1%, 3.8%) are similar to previous studies. We suggest that this generic community model of service may allow hospital at home services for COPD to be introduced in more areas.

Anti-inflammatory cytokines in cystic fibrosis lung disease

Lung inflammation plays a pivotal role in the pathogenesis of airway disease in cystic fibrosis (CF). An imbalance between pro- and anti-inflammatory mediators has been observed and a deficiency in the anti-inflammatory response has been proposed, but this concept remains controversial. In the present study, the concentrations of two anti-inflammatory mediators, lipoxin A (LxA4) and Clara cell protein 10 (CC-10), were assessed in bronchoalveolar lavage fluid (BALF) of CF patients with a wide range of endobronchial inflammation and disease controls with neutrophilic inflammation unrelated to CF. No differences were observed in LxA4 BALF concentrations between CF patients and controls with a similar degree of neutrophilic airway inflammation. Concentrations were also similar in CF patients with mild versus more severe airway inflammation. In contrast, CC-10 concentrations were lower in CF patients, but this decrease was limited to patients with more intense airway inflammation. The present data do not support the concept of a primary defect in anti-inflammatory mediators in cystic fibrosis lung disease. Although Clara cell protein concentrations were found to be reduced, these alterations appear to be secondary to neutrophilic airway inflammation rather than due to a primary deficiency.

Thrombin generation time is a novel parameter for monitoring enoxaparin therapy in patients with end-stage renal disease

BACKGROUND

Patients with end-stage renal disease (ESRD) who receive enoxaparin are at increased risk for adverse bleeding episodes. This phenomenon appears to occur despite judicious monitoring of antifactor Xa (aFXa) activity. Better monitoring parameters are needed to quantify the anticoagulant effects of enoxaparin in the ESRD population.

OBJECTIVES

The objective of this study was to determine the utility of using thrombin generation time (TGT), platelet contractile force (PCF) and clot elastic modulus (CEM) to monitor the degree of anticoagulation in ESRD subjects, and to compare these results to aFXa activity, the current gold-standard monitoring parameter.

METHODS

Eight healthy volunteers without renal dysfunction and eight ESRD subjects were enrolled into this study. Subjects received a single dose of enoxaparin 1 mg kg(-1) subcutaneously, and blood samples were obtained for the determination of aFXa activity, TGT, PCF and CEM at baseline, 4, 8, and 12 h postdose.

RESULTS

Baseline, 4, 8, and 12-h aFXa activity concentrations were not different between groups. However, the corresponding TGT at 8 and 12 h was significantly prolonged in the ESRD group (P = 0.04, and P = 0.008, respectively). The 4-h peak TGT trended toward significance (P = 0.06). There were no differences in PCF or CEM across time.

CONCLUSIONS

These data suggest that the parameter aFXa activity is a poor predictor of the anticoagulant effect of enoxaparin in patients with ESRD. Thrombin generation time appears to be more sensitive to the antithrombotic effects of enoxaparin in this population. Further large-scale trials are needed to corroborate these data.

DNA concentrations in BAL fluid of cystic fibrosis patients with early lung disease: influence of treatment with dornase alpha

Recombinant DNase (dornase alpha) was shown to improve lung function and reduce pulmonary exacerbations in cystic fibrosis (CF) patients, but its effects on DNA concentrations in the lower airways remain unclear at the present time. As part of the Bronchoalveolar Lavage in the Evaluation of Anti-Inflammatory Treatment (BEAT) Study, a multicenter open study to evaluate the evolution of inflammation in CF patients with early lung disease and its modulation by dornase alpha treatment, we studied DNA concentrations in the bronchoalveolar lavage (BAL) fluid of 48 CF patients with mild lung disease. After the initial BAL, 29 patients received daily treatment with 2.5 mg of dornase alpha; 19 patients served as controls. BAL was repeated after 18 months in all patients. Mean BAL fluid DNA concentrations were not different between groups at baseline (mean +/- SD, 14.1 +/- 6.9 microg/ml for controls, and 17.6 +/- 11.2 microg/ml for the dornase alpha group), but higher than previously reported for infants with CF. A weak but positive correlation (P <0.01) was observed between the percentage of neutrophils in BAL fluid and DNA levels. On reassessment after 18 months, the percentage of neutrophils was not different between the two groups, but DNA had increased in controls, whereas decreased levels were observed in treated patients (P <0.03, t-test). DNA concentrations increased by more than 10 microg/ml in 7 of 19 controls compared to 2 of 29 CF patients treated with rhDNase (P=0.01, Fisher's test). Therefore, treatment with dornase alpha over 18 months reduces DNA load in BAL fluid, which may have a positive effect on the clearance of lower airway secretions.

Automatic Detection of Sleep Stages in Neonatal EEG Using the Structural Time Profiles

The new method for automatic sleep stages detection in neonatal EEG was developed. The procedure is based on processing of time profiles computed by adaptive segmentation and subsequent classification of signal graphoelements. The time profiles, functions of the class membership in the course of time, reflect the dynamic EEG structure and may be used for indication of changes in the neonatal sleep stages.

[Further development of neonates with severe pneumopathy]

OBJECTIVE

To assess the risk and the degree of possible unfavourable development in neonates with bronchopulmonal dysplasia and with congenital diaphragmatic hernia.

DESIGN

Longitudinal monitoring of the mental, motoric and neurological development until the age of 2 years. Comparison of the findings with the result of polygraphic examination carried out at the expected time of birth.

METHODS

The following children were monitored: a) 38 children with bronchopulmonal dysplasia born between the 24th and 33rd post-conception weeks; b) 18 children with congenital diaphragmatic hernia, of whom 3 children were born between the 34th and 36th post-conception weeks, while the remaining 15 children were born on the expected date. All children underwent polygraphic examinations (EEG - 8 channels, respiration, EKG, EOG and EMG) between the 38th and 42nd post-conception weeks. During the 1st and the 2nd years, their psychomotoric development and neurological status were repeatedly evaluated according to Bayley and Vlach, respectively.

RESULTS

Up until the 2nd year of life, approximately 2/3 of the children in both monitored groups were developing favourably or satisfactorily. However, the development of the remaining 1/3 was not favourable: The children were mentally or motorically retarded and/or cerebral palsy developed in them. The polygraphic examination in the neonatal period predicted the favourable or unfavourable development of the monitored children with high probability.

CONCLUSION

The study showed that in accordance with the data stated in the literature, the development of neural functions is seriously affected in a relatively high percentage of neonates with severe pneumopathy. Neonatal polygraphy can contribute to timely determination of the prognosis for these children. Children with serious neonatal pneumopathies need to be provided with dispensary care on a long-term basis, and professional consultancy and intervention programmes need to be ensured for them.

Fifteen years single center experience in the management of progressive familial intrahepatic cholestasis of infancy

Recent advances in genetics and in physiopathology of bile composition and excretion have clarified the understanding of progressive familial intrahepatic cholestasis (PFIC). The aim of the present study is to review the experience of our center in terms of diagnosis, management and outcome of 49 pediatric PFIC patients, belonging to the three classical subtypes described. We analyse the clinical, biological, and histological patterns and review the response to the medical and surgical treatment and the global outcome. The only clinical difference between the different subtypes of PFIC patients was the intensity of pruritus. Serum gamma-glutamyltransferase (GGT) and liver histology allowed to differentiate PFIC III from PFIC I and II patients. High levels of biliary bile acids in 2 low-GGT patients was associated with favourable outcome. Response to ursodeoxycholic acid (UDCA) varies from patient to patient and was not associated to a particular subtype of PFIC. In five patients of this cohort, external biliary diversion was performed without improvement. Transplantation is indicated whenever medical treatment fails to restore normal social life, growth and well being of the child and it is associated with excellent survival (> 90%).

Characterization of Two Novel BRCA1 Germ-Line Mutations Involving Splice Donor Sites

Deleterious BRCA1 mutations have significant clinical implications for the patients that carry them. Point mutations in critical functional domains and frameshift mutations that lead to early termination of protein translation are associated with a 60-80% risk of breast cancer and a 20-40% risk of ovarian cancer. In contrast, the significance of mutations located in intronic regions of BRCA1, even in the setting of a family history of breast and ovarian cancer, is not always clear. Some of these mutations occur in splice donor/acceptor consensus sites. These mutations can affect heteronuclear RNA (hnRNA) processing, leading to the loss of functional BRCA1 protein and thus may be disease-associated. However, it is important to verify the effect of these mutations, because splicing alterations cannot be predicted from genomic sequence alone. We report here the characterization of two novel BRCA1 mutations identified in families seen in our cancer risk evaluation clinic that alter splice donor sites of BRCA1. We show that both mutations alter transcript splicing and result in truncated BRCA1. IVS17 + 1G --> T leads to inclusion of part of intron 17 after the coding sequence of exon 17, resulting in early termination of BRCA1 protein following codon 1692. 252del5insT abolishes the splice donor site in exon 3, leading to the skipping of exon 5 and BRCA1 protein truncation following codon 45. Thus, both mutations result in loss of BRCA1 function, and carriers of these mutations should be counseled in the same manner as carriers of other truncating BRCA1 mutations.