Infectious origins of, and molecular mimicry in, Guillain-Barré and Fisher syndromes

Guillain-Barré syndrome (GBS), characterised by limb weakness and areflexia, is the prototype of postinfectious autoimmune diseases, and Campylobacter jejuni is the most frequent antecedent pathogen. GBS subsequent to C jejuni enteritis is associated with a severe, pure motor axonal variant and IgG antibodies against GM1, GM1b, GD1a, or GalNAc-GDla, gangliosides expressed in human peripheral nerves. Lipopolysaccharides of C jejuni isolated from GBS patients have ganglioside-like epitopes. Cytomegalovirus is the most common viral antecedent infection. Patients with demyelinating GBS who have had a recent CMV infection have severe sensory deficits and anti-GM2 IgM antibody. CMV-infected fibroblasts express the GM2 epitope. Fisher syndrome (FS), characterised by ophthalmoplegia, ataxia, and areflexia, is a GBS variant associated with anti-GQ1b IgG antibody. GQ1b is enriched in the cranial nerves that innervate the extraocular muscles. Some patients develop FS after C jejuni infection, and the lipopolysaccharide present bears the GQ1b epitope. Molecular mimicry is a possible cause of GBS and FS.     

Seroepidemiology and occupational and environmental variables for leptospirosis, brucellosis and toxoplasmosis in slaughterhouse workers in the Paraná State, Brazil

Leptospirosis, brucellosis and toxoplasmosis are widely-distributed zoonosis, being the man an accidental participant of their epidemiological chains. The aim of this paper was to make a seroepidemiological report and identify occupational and environmental variables related to these illnesses in 150 workers in a slaughterhouse in the Northern region of Paraná. For the diagnosis of leptospirosis a microscopical seroagglutination test was applied; for brucellosis, the tamponated acidified antigen test and the 2-mercaptoetanol tests were used, and for toxoplasmosis the indirect immunofluorescence reaction test. For each employee an epidemiological survey was filled, which investigated occupational and environmental variables which could be associated with these infections. Positive results for leptospirosis were found in 4.00% of the samples, for brucellosis in 0.66% of samples and toxoplasmosis in 70.00%. From the three diseases researched, only the results for leptospirosis suggest occupational infection.     

Effects of resveratrol, a grape polyphenol, on uterine contraction and Ca²+ mobilization in rats in vivo and in vitro

Dysmenorrhea is directly related to elevate prostaglandin F (PGF)(?α) levels. In Western medicine, this condition is treated using nonsteroidal antiinflammatory drugs. Because nonsteroidal antiinflammatory drugs produce many side effects, Chinese medicinal therapy is considered as a feasible alternative for treating dysmenorrhea. Many special physiological components used in Chinese medicine, such as resveratrol, have been isolated and identified. Resveratrol has many physiological functions, such as antioxidation and anticarcinogenic effects. However, the relationship between uterine smooth muscle contraction and resveratrol remains unknown. Here, we studied the in vitro and in vivo effects of resveratrol on uterine smooth muscle contraction. The uterus was separated from a female Sprague Dawley rat, and uterine smooth muscle contraction activity was measured and recorded. The results demonstrated that 1) resveratrol treatment inhibited PGF(?α)-, oxytocin-, acetylcholine-, and carbachol-induced uterine contractions in rats; 2) resveratrol inhibited uterine contractions stimulated by the Ca2(+) channel activator (Bay K 8644) and depolarization in response to high K(+) (KCl); 3) resveratrol inhibited PGF(?α)-induced increases in the [Ca2(+)]i in human uterine smooth muscle cells; 4) resveratrol could mimic Ca2(+) channel blockers to block Ca2(+) influx through voltage-operated Ca2(+) channels in the plasma membrane; and 5) resveratrol inhibited PGF(?α)-induced uterine contractions in rats in vivo. Resveratrol inhibited uterine contractions induced by PGF(?α) and high K(+) in a concentration-dependent manner in vitro; furthermore, it inhibited Ca2(+)-dependent uterine contractions. Thus, resveratrol consistently suppressed the increases in intracellular Ca2(+) concentrations ([Ca2(+)]i) induced by PGF(?α) and high K(+) concentrations. It can be assumed that resveratrol probably inhibited uterine contraction by blocking external Ca2(+) influx, leading to decreased [Ca2(+)]i. Therefore, resveratrol can be considered as a feasible alternative therapeutic agent for dysmenorrhea.     

Pancreatitis in pregnancy：etiology,diagnosis, treatment,and outcomes

BACKGROUND: Acute pancreatitis in pregnancy is a rare and dangerous disease. This study aimed to examine the etiology, treatment, and outcomes of pancreatitis in pregnancy.
METHOD: A total of 25 pregnant patients diagnosed with pancreatitis during the period of 1994 and 2014 was analyzed retrospectively.
RESULTS: The pregnant patients were diagnosed with pancre-atitis during a period of 21 years. Most (60%) of the patients were diagnosed with pancreatitis in the third trimester. The mean age of the patients at presentation was 25.7 years, with a mean gestational age of 24.4 weeks. Abdominal pain occurred in most patients and vomiting in one patient was associated hyperemesis gravidarum. The common cause of the disease was gallstone-related (56%), followed by alcohol-related (16%), post-ERCP (4%), hereditary (4%) and undetermined condi-tions (20%). The level of triglycerides was minimally high in three patients. ERCP and wire-guided sphincterotomy were performed in 6 (43%) of 14 patients with gallstone-related pancreatitis and elevated liver enzymes with no complications. Most (84%) of the patients underwent a full-term, vaginal delivery. There was no difference in either maternal or fetal outcomes after ERCP.
CONCLUSIONS: Acute pancreatitis is rare in pregnancy, oc-curring most commonly in the third trimester, and gallstones are the most common cause. When laparoscopic cholecystec-tomy is not feasible and a common bile duct stone is highly suspected on imaging, endoscopic sphincterotomy or stenting may help to prevent recurrence and postpone cholecystectomy until after delivery.     

Why and how to implement sodium, potassium, calcium, and magnesium changes in food items and diets?

The present average sodium intakes, approximately 3000-4500 mg/day in various industrialised populations, are very high, that is, 2-3-fold in comparison with the current Dietary Reference Intake (DRI) of 1500 mg. The sodium intakes markedly exceed even the level of 2500 mg, which has been recently given as the maximum level of daily intake that is likely to pose no risk of adverse effects on blood pressure or otherwise. By contrast, the present average potassium, calcium, and magnesium intakes are remarkably lower than the recommended intake levels (DRI). In USA, for example, the average intake of these mineral nutrients is only 35-50% of the recommended intakes. There is convincing evidence, which indicates that this imbalance, that is, the high intake of sodium on one hand and the low intakes of potassium, calcium, and magnesium on the other hand, produce and maintain elevated blood pressure in a big proportion of the population. Decreased intakes of sodium alone, and increased intakes of potassium, calcium, and magnesium each alone decrease elevated blood pressure. A combination of all these factors, that is, decrease of sodium, and increase of potassium, calcium, and magnesium intakes, which are characteristic of the so-called Dietary Approaches to Stop Hypertension diets, has an excellent blood pressure lowering effect. For the prevention and basic treatment of elevated blood pressure, various methods to decrease the intake of sodium and to increase the intakes of potassium, calcium, and magnesium should be comprehensively applied in the communities. The so-called 'functional food/nutraceutical/food-ceutical' approach, which corrects the mineral nutrient composition of extensively used processed foods, is likely to be particularly effective in producing immediate beneficial effects. The European Union and various governments should promote the availability and use of such healthier food compositions by tax reductions and other policies, which make the healthier choices cheaper than the conventional ones. They should also introduce and promote the use of tempting nutrition and health claims on the packages of healthier food choices, which have an increased content of potassium, calcium, and/or magnesium and a lowered content of sodium. Such pricing and claim methods would help the consumers to choose healthier food alternatives, and make composition improvements tempting also for the food industry.     

Iron overload in MDS—pathophysiology,diagnosis, and complications

Many patients with myelodysplastic syndromes (MDS) become dependent on blood transfusions and develop transfusional iron overload, which is exacerbated by increased absorption of dietary iron in response to ineffective erythropoiesis. However, it is uncertain whether there is an association among iron accumulation, clinical complications, and decreased likelihood of survival in MDS patients. Here, we discuss our current understanding of the effects of transfusion dependency and iron overload in MDS, indicate our knowledge gaps, and suggest that particular emphasis should be placed on further characterizing the role of redox-active forms of labile iron, which may be as important as the total iron burden.     

Oxidized LDL and anti-oxidized LDL antibodies in atherosclerosis – Novel insights and future directions in diagnosis and therapy,

We provide an up-to-date overview of current topics surrounding oxidized low-density lipoprotein (oxLDL) and its related antibodies in the quest to better identify the individuals at risk of cardiovascular disease and atherosclerotic plaques with unfavorable characteristics. We discuss the potential of oxLDL and anti-oxLDL antibodies as serum biomarkers of cardiovascular disease and emerging studies examining the targeting of arterial oxLDL for imaging and therapeutic delivery.     

Exercise and heart disease in women: why, how, and how much?

Despite a traditional view that cardiovascular disease primarily affects men, a growing body of information now recognizes that it is a disease that equally affects women and is the leading cause of morbidity and mortality in women in the United States. Both physical activity and physical fitness have been shown to have an inverse association with coronary heart disease and cardiovascular risk factors. Furthermore, physical inactivity is now recognized by the American Heart Association as an independent risk factor for coronary heart disease. However, national surveillance programs have reported that 1/4 of adults are currently sedentary, and 1/3 of women do not engage in any leisure-time physical activity. Regular exercise may significantly impact coronary heart disease in women, as some coronary risk factors have a stronger predictive value for coronary heart disease in women as compared with men. Recent studies have shown that women who exercise regularly are less likely to develop diabetes mellitus; exercise may reduce blood pressure and produce improvements in lipid profiles. Conflicting data exist regarding the dose and intensity of exercise necessary to achieve significant health benefits; however, many reports demonstrate a reduced risk of mortality from cardiovascular diseases and from all causes with only moderate intensity physical activity. The Centers for Disease Control, American Heart Association, and American College of Sports Medicine recommend a regular pattern of physical activity of moderate intensity, which can be accumulated throughout the day and should be performed at least 3 to 5 days per week. In addition, the benefit of weight-bearing exercise should be underscored in women, because it plays an important role in the prevention and treatment of osteoporosis. Continued efforts are necessary to encourage the many American women who are currently inactive to make even modest increases in levels of physical activity to achieve substantial cardiovascular, as well as other, health benefits.     

Polytypism,polymorphism, and superconductivity in TaSe2?xTex

Polymorphism in materials often leads to significantly different physical properties—the rutile and anatase polymorphs of TiO₂ are a prime example. Polytypism is a special type of polymorphism, occurring in layered materials when the geometry of a repeating structural layer is maintained but the layer-stacking sequence of the overall crystal structure can be varied; SiC is an example of a material with many polytypes. Although polymorphs can have radically different physical properties, it is much rarer for polytypism to impact physical properties in a dramatic fashion. Here we study the effects of polytypism and polymorphism on the superconductivity of TaSe₂, one of the archetypal members of the large family of layered dichalcogenides. We show that it is possible to access two stable polytypes and two stable polymorphs in the TaSe_2−xTe_x solid solution and find that the 3R polytype shows a superconducting transition temperature that is between 6 and 17 times higher than that of the much more commonly found 2H polytype. The reason for this dramatic change is not apparent, but we propose that it arises either from a remarkable dependence of T_c on subtle differences in the characteristics of the single layers present or from a surprising effect of the layer-stacking sequence on electronic properties that are typically expected to be dominated by the properties of a single layer in materials of this kind.The MX₂ layered transition-metal dichalcogenides (TMDCs, M = Mo, W, V, Nb, Ta, Ti, Zr, Hf, or Re and X = Se, S, or Te), have long been of interest due to the rich electronic properties that emerge due to their low dimensionality (1–9). Structurally, these compounds can be regarded as having strongly bonded (2D) X–M–X layers, with M in either trigonal prismatic or octahedral coordination with X, and weak interlayer X–X bonding of the van der Waals type. Many of these materials manifest charge-density waves and competition between charge-density waves (CDWs) and superconductivity, e.g., refs. 5–9. Among the TMDCs, the 2H (H: hexagonal) polytype of tantalum diselenide (2H-TaSe₂) is considered one of the foundational materials (8–18), showing a transition from a metallic phase to an incommensurate charge-density wave (ICDW) phase at 123 K, followed by a “lock-in” transition to a commensurate charge-density wave (CCDW) phase at 90 K. It finally becomes a superconductor with a rather low transition temperature (T_c) of 0.15 K. Although detailed studies have been performed on the physics of CDWs and superconductivity in 2H-TaSe₂ (16–18), a comparative study of the superconductivity of the polytypes and polymorphs of TaSe₂ from the chemical perspective has not been done.TaSe₂ is highly polymorphic, possibly the most polymorphic of the TMDCs (19). In some of its forms, notably the 2H and 3R (R: rhombohedral) polytypes (Fig. 1A), Ta is found in trigonal prismatic coordination in Se-Ta-Se layers that are stacked along the c axis of the hexagonal (or rhombohedral) cell. The 2H and 3R polytypes differ only in their stacking periodicity—the structure repeats after two layers in the 2H form and three layers in the 3R form (20–22). The 3R form can be synthesized, but it is not the stable variant (the 2H form is) and so has been the subject of little study. In one of the other polymorphs, the 1T (T: trigonal) type, Ta is found in octahedral coordination in the Se-Ta-Se layers and the layer stacking along the c axis of the trigonal cell such that the structure repeats after only one layer (23) (Fig. 1A). Again, the 1T form has not been the subject of much study. Here we show that the 3R and 1T polymorphs are both quite stable in the TaSe_2−xTe_x system and that they are both superconducting. For pure TaTe₂, the monoclinic structure is 1T based (Fig. 1A), but is distorted such that there are two nonequivalent Ta and three nonequivalent Te positions in the unit cell (24); we find TaSe_2−xTe_x in this polymorph to be nonsuperconducting down to 0.4 K.Open in a separate windowFig. 1.Structural characterization and analysis of the polytypes and polymorphs of TaSe_2−xTe_x. (A) The crystal structures of 2H-TaSe₂, 3R-TaSe_1.65Te_0.35, 1T-TaSeTe, and monoclinic TaTe₂. (B) Powder X-ray diffraction pattern for 3R-TaSe_1.65Te_0.35. Inset shows the reduced lattice parameter ratio, (c/n)/a, where n = number of layers per cell, for 2H-TaSe₂ (38) and 3R-TaSe_2−xTe_x. (C) Powder X-ray diffraction pattern for 1T-TaTeSe. Inset shows the reduced lattice parameter ratio, (c/n)/a, for 1T-TaSe_2−xTe_x. (D) The variation of in-plane lattice parameter, a, with x for 2H-, 3R-, and 1T-TaSe_2−xTe_x. (E) The variation of reduced stacking-direction lattice parameter, c/n, with x for 2H-, 3R-, and 1T-TaSe_2−xTe_x. (F) The variation of the TaX₂ slab thickness, ((c·(∆z)), with x for 2H-, 3R-, and 1T-TaSe_2−xTe_x. (G) The variation of the van der Waals gap (vdWG) thickness with x for 2H-, 3R-, and 1T-TaSe_2−xTe_x.We report the structures and superconducting properties of TaSe_2−xTe_x for 0 ≤ x ≤ 2. The 2H, 3R, 1T, and monoclinic distorted 1T-structure forms were successfully synthesized. Only a small amount of Te doping (x = 0.02) changes 2H-TaSe₂ into the 3R polytype. Within the 3R polytype, TaSe_2−xTe_x shows the coexistence of a CDW and superconductivity above 0.4 K for 0.1 ≤ x ≤ 0.35. The Te-rich limit of the 3R-TaSe_1.65Te_0.35 polytype shows the highest T_c in the system, 2.4 K, which is 17 times higher than that of 2H-TaSe₂. For 0.8 ≤ x ≤ 1.3, 1T-type TaSe_2−xTe_x emerges and shows a lower T_c, of 0.5–0.7 K. At higher Te substitutions (1.8 ≤ x ≤ 2), TaSe_2−xTe_x changes again, into the monoclinic polymorph, and shows normal metallic behavior to 0.4 K. We argue that the isovalent Te/Se substitution acts to tune the anisotropy of the layers, inducing the 3R to 1T transition, consistent with what has been proposed previously (25). The driving force for the 2H to 3R transition currently remains obscure.     

Internet health-information seekers in Croatia--who, what, and why?

The aim of this study is to investigate the characteristics of the Internet users in Croatia related to seeking health information, which information they seek, the reasons, and the outcomes of that information on them. We surveyed the users of the Internet health portal 'Cybermed', in spring 2003 and autumn 2004. Responses were collected from a pop-up questionnaire, which appeared at every website visit. There were 369 respondents in 2003 and 580 respondents in 2004. Most respondents were women (82% in 2003 and 80% in 2004). While more than half of the respondents (55%) in 2003 had a college or university degree, this changed in 2004, when only 40% of respondents had a college or university degree (P < 0.001). Also, we recorded a significant age-related change, suggesting that the average age of the respondents increased in 2004 (P < 0.001). The leading motivation for seeking medical information was 'unanswered questions after visiting a physician'. Most respondents (90% in 2003, 87% in 2004) went online to seek information on a specific illness or condition. Women sought information for friends and colleagues more often than men (42% vs. 28%, P = 0.031) in 2003, while these differences were diluted in 2004. Approximately half of all respondents discussed the information they found online with their physicians. Patients who feel they were given insufficient information, or simply seek more information than the physician provided, turn to using online health information, which no longer seems to be reserved to those with the highest education degrees. Health-care providers should consider creating health-related Internet portals, supplementing the information they provide.     

Transplantation in CML in the TKI era: who,when, and how?

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Evaluating patterns in retention,continuation, gaps,and re-engagement in HIV care in a Medicaid-insured population, 2006–2012, United States

We used the US-based MarketScan^® Medicaid Multi-state Databases to determine the un-weighted proportion of publically insured persons with HIV that were retained, continued, and re-engaged in care. Persons were followed for up to 84 months. Cox proportional hazards models were conducted to determine factors associated with gaps in care. Of the 6463 HIV cases identified in 2006, 61% were retained during the first 24 months, and 53% continued in care through 78 months. Between 8% and 30% experienced a gap in care, and 59% of persons who experienced a gap in care later re-engaged in care. Persons with one or more Charlson co-morbidities (HR 0.72, 95% CI 0.64–0.81), ages 40–59 (0.79, 0.71–0.88), mental illness diagnosis (0.79, 0.72–0.87), hepatitis C co-infection (0.83, 0.75–0.93), and female sex (0.86, 0.78–0.94) were less likely to experience a gap in care. Between 27% and 38% of those not retained in care continued to receive HIV-related laboratory services. This Medicaid claims database combines features of both clinic visits-based and surveillance lab-based surrogate measures to give a more complete picture of engagement in care than single-facility-based studies.     

Predicting the changes in depressive symptomatology in later life: how much do changes in health status, marital and caregiving status, work and volunteering, and health-related behaviors contribute?

This study examined the unique effects of four variable groups on changes in older adults' depressive symptoms for a 2-year period: (1) baseline health and disability status, (2) changes in health and disability since baseline, (3) stability and changes in marital and caregiving status and in work and volunteering, and (4) stability and changes in health-related behaviors. With data from the 1998 and 2000 interview waves of the Health and Retirement Study, the authors used gender-separate multistep (hierarchical) residualized regression analyses in which the Center for Epidemiological Studies Depression scale (CES-D) score at follow-up is modeled as a function of the effect of each group of independent variables. As hypothesized, changes in health, disability, marital, and caregiving status explained a larger amount of variance than the existing and stable conditions, although each group of variables explained a relatively small amount (0.3-3.4%) of variance in the follow-up CES-D score.     

Which personal,behavioural, environmental,and social factors are important in smoking cessation and relapse in male manual workers? A qualitative study in southeast England

Background

In most developed countries, the prevalence of smoking remains stubbornly high in lower socioeconomic groups. Male manual workers in England are more than twice as likely as those in managerial and professional occupations to smoke (26% vs 11%), find it more difficult to quit, and have the highest relapse rates. We sought to determine perceived factors in smoking cessation and relapse in this hard-to-reach group to inform the development of effective stop smoking services and public health efforts to reduce the health inequality caused by smoking.

Is Timed Up and Go Better Than Gait Speed in Predicting Health,Function, and Falls in Older Adults?

OBJECTIVES: To assess whether the Timed Up and Go (TUG) is superior to gait speed in predicting multiple geriatric outcomes. DESIGN: Prospective cohort study. SETTING: Medicare health maintenance organization and Veterans Affairs primary care clinics. PARTICIPANTS: Adults aged 65 and older (N=457). MEASUREMENTS: Baseline gait speed and TUG were used to predict health decline according to EuroQol and Medical Outcomes Study 36‐item Short Form Survey (SF‐36) global health; functional decline according to National Health Interview Survey (NHIS) activities of daily living (ADLs) score and SF‐36 physical function index; hospitalization; and any falls and multiple falls over 1 year. RESULTS: Mean age was 74, and 44% of participants were female. Odds ratios for all outcomes were equivalent for gait speed and TUG. Using area under the receiver operating characteristic curve of 0.7 or greater for acceptable predictive ability, gait speed and TUG each alone predicted decline in global health, new ADL difficulty, and falls, with no difference in predictive ability between performance measures. Neither performance measure predicted hospitalization, EuroQol decline, or physical function decline. As a continuous variable, TUG did not add predictive ability to gait speed for any outcome. CONCLUSION: Gait speed predicts most geriatric outcomes, including falls, as does TUG. The time taken to complete TUG may not add to information provided by gait speed, although its qualitative elements may have other utility.