Differential Effects of Obesity,Hyperlipidaemia, Dietary Intake and Physical Inactivity on Type I versus Type IV Allergies

Background: Alongside metabolic diseases (esp. obesity), allergic disorders are becoming increasingly prevalent. Since both obesity and allergies are highly impacted by environmental determinants, with this study we assessed the potential link between metabolic implications and two distinct types of allergies. Methods: Using cross-sectional data from the German FoCus cohort, n = 385 allergy cases, either hay fever (=type I allergy, n = 183) or contact allergy (=type IV allergy, n = 202) were compared to age- and sex-matched healthy control subjects (1:1 ratio, in total n = 770) regarding their metabolic phenotype, diet, physical activity, sleep, gut microbial composition, and serum metabolite profile using suitable BMI-adjusted models. Results: Obesity and metabolic alterations were found significantly more prevalent in subjects with allergies. In fact, this relation was more pronounced in contact allergy than hay fever. Subsequent BMI-adjusted analysis reveals particular importance of co-occurring hyperlipidaemia for both allergy types. For contact allergy, we revealed a strong association to the dietary intake of poly-unsaturated fatty acids, particularly α-linolenic acid, as well as the enrichment of the corresponding metabolic pathway. For hay fever, there were no major associations to the diet but to a lower physical activity level, shorter duration of sleep, and an altered gut microbial composition. Finally, genetic predisposition for hyperlipidaemia was associated to both contact allergy and hay fever. Conclusions: Reflected by higher allergy prevalence, our findings indicate an impaired immune response in obesity and hyperlipidaemia, which is differentially regulated in type I and type IV allergies by an unfavourable lifestyle constellation and subsequent microbial and metabolic dysfunctions.     

Does my high blood pressure improve your survival? Overall and subgroup learning curves in health

Learning curves in health are of interest for a wide range of medical disciplines, healthcare providers, and policy makers. In this paper, we distinguish between three types of learning when identifying overall learning curves: economies of scale, learning from cumulative experience, and human capital depreciation. In addition, we approach the question of how treating more patients with specific characteristics predicts provider performance. To soften collinearity problems, we explore the use of least absolute shrinkage and selection operator regression as a variable selection method and Theil–Goldberger mixed estimation to augment the available information. We use data from the Belgian Transcatheter Aorta Valve Implantation (TAVI) registry, containing information on the first 860 TAVI procedures in Belgium. We find that treating an additional TAVI patient is associated with an increase in the probability of 2‐year survival by about 0.16%‐points. For adverse events like renal failure and stroke, we find that an extra day between procedures is associated with an increase in the probability for these events by 0.12%‐points and 0.07%‐points, respectively. Furthermore, we find evidence for positive learning effects from physicians' experience with defibrillation, treating patients with hypertension, and the use of certain types of replacement valves during the TAVI procedure.     

Hodgkin Lymphoma after Disseminated Mycobacterium genavense Infection,Germany

Mycobacterium genavense infection, a rare nontuberculous mycobacteria infection, occurs in heavily immunocompromised patients (i.e., those with advanced HIV disease, genetic disorders, or acquired immunologic disorders and those undergoing immunosuppressive therapy). We report a case of disseminated M. genavense infection preceding Hodgkin lymphoma in a patient without obvious risk factors for this infection.     

Concentration gradients in evaporating binary droplets probed by spatially resolved Raman and NMR spectroscopy

Understanding the evaporation process of binary sessile droplets is essential for optimizing various technical processes, such as inkjet printing or heat transfer. Liquid mixtures whose evaporation and wetting properties may differ significantly from those of pure liquids are particularly interesting. Concentration gradients may occur in these binary droplets. The challenge is to measure concentration gradients without affecting the evaporation process. Here, spectroscopic methods with spatial resolution can discriminate between the components of a liquid mixture. We show that confocal Raman microscopy and spatially resolved NMR spectroscopy can be used as complementary methods to measure concentration gradients in evaporating 1-butanol/1-hexanol droplets on a hydrophobic surface. Deuterating one of the liquids allows analysis of the local composition through the comparison of the intensities of the C–H and C–D stretching bands in Raman spectra. Thus, a concentration gradient in the evaporating droplet was established. Spatially resolved NMR spectroscopy revealed the composition at different positions of a droplet evaporating in the NMR tube, an environment in which air exchange is less pronounced. While not being perfectly comparable, both methods—confocal Raman and spatially resolved NMR experiments—show the presence of a vertical concentration gradient as 1-butanol/1-hexanol droplets evaporate.

Evaporating droplets occur in various contexts such as inkjet printing (1, 2), heat transfer, or daily phenomena such as drying coffee stains (3, 4). In many applications, such as painting (5), cleaning, gluing, or printing (6), where liquid mixtures are used, the evaporation of a droplet is a complex process because the concentration profile within the droplet varies over time. To improve the controllability and predictability of the technical processes, it is essential to characterize the transport phenomena during the drying process. The measurement of the droplet composition is a crucial element and has to be carried out with sufficient spatial and temporal resolution. In particular, spectroscopic methods are promising tools for contactless concentration measurements of liquid mixtures.The evaporation of a droplet is governed by physical properties such as surface tension (7), density (8–10), vapor pressure (11), and boiling temperature. Additionally, concentration gradients can evolve in liquid mixtures (12). These gradients are driven by thermal gradients due to the enthalpy of evaporation (droplet cooling) or on heated surfaces, by surface tension gradients induced by preferential evaporation of one component or by density gradients for droplets composed of liquids with different densities like water and glycerol (13). The evaporation rates of the components can vary over the droplet surface. For sessile droplets with contact angles smaller than 90°, for example, the evaporation rates are higher at the three-phase contact line (14). These thermal or surface tension gradients can induce flow inside the droplet called Marangoni flow. This flow leads to concentration gradients across the droplet (7–10). The direction of the gradient depends on the density and surface tension. A direct application of this principle is, for instance, Marangoni cleaning in semiconductor technology (15).The investigation of the composition of sessile drops on the microliter scale, as they occur in inkjet printing or other technical processes, poses a challenge because the typical length scales of interest are smaller than the capillary length. In bulk samples, the composition can be examined in a straightforward manner with chromatographic methods such as gas chromatography and high-performance liquid chromatography or spectroscopic methods such as NMR spectroscopy, infrared spectroscopy, and Raman spectroscopy. However, for the investigation of sessile droplets, a high spatial and temporal resolution is required. For this purpose, confocal Raman spectroscopy and spatially resolved NMR spectroscopy are powerful tools. For both techniques, concentration determination is straightforward if at least two signals of the components of interest are baseline-separated. NMR is intrinsically calibration-free, whereas Raman spectroscopy requires calibration through reference experiments (16–18). Both approaches allow the quantification of concentration gradients in sessile droplets, as is shown here.In Raman microscopy, good spatial resolution can be achieved in a confocal setup. The components of mixtures can be distinguished via specific vibrations for different functional groups or through a careful analysis of the Raman signals in the fingerprint region (<1,500 cm⁻¹). For example, binary mixtures of ethanol and water can be characterized in a straightforward manner (17). If, however, both liquids have a similar chemical structure, the discrimination of the components might be hampered by signal overlap in the C–H stretching region (2,800 to 3,000 cm⁻¹); e.g., in such cases, Raman signals in the fingerprint region (<1,500 cm⁻¹) might be used for the identification of the species. However, these signals often provide a poor signal-to-noise ratio, which makes large integration times necessary. Thus, the image rate or resolution is so low that even slow diffusion processes are hardly resolved. Here, Raman stable isotope probing (SIP), which has been developed to monitor metabolic processes in microbiology, offers a solution (19). The basic idea of Raman SIP is to replace the proton in the C–H with deuterium in one of the mixture components such that the C–D stretching region occurs at roughly 1/2 times the C–H stretching and falls into a region with very weak or even without signals from the protonated liquid component. Thus, the concentration in a binary mixture can be calculated in a straightforward manner from the ratio of the integrated Raman intensities ICD/ICH of the respective stretching vibrations.Compared to Raman microscopy, where localization is achieved by scanning the focal point across the region of interest, in NMR experiments localization is achieved by using magnetic field gradients. Usually, one avoids phase boundaries (especially liquid–gas interfaces) in NMR experiments because they disturb the magnetic field homogeneity and reduce the spectral quality in terms of line shape and baseline separation of the resonances. Nevertheless, it has been shown that MRI can be used to characterize freezing water droplets (20), the infiltration of water into asphalts (21), and the evaporation of sessile droplets from porous surfaces (22–24). Additionally, NMR can be used to quantify the composition of binary droplets during evaporation (25).Thus, the use of both complementary approaches to characterize evaporating binary droplets may be beneficial. In this article, we discuss the capabilities of Raman SIP and NMR techniques to analyze the evolution of the composition of an evaporating sessile binary droplet. As a model system, a binary mixture of 1-butanol and 1-hexanol was used. This mixture shows a low volatility such that the evaporation process can be captured with both Raman and NMR spectroscopies. With Raman spectroscopy, it was possible to observe concentration gradients of 1-butan-d₉-ol over the height of the droplet during evaporation. NMR techniques were examined in terms of the capability to observe the evaporation of 1-butanol and yield time-dependent droplet composition with spatially resolved ¹H-NMR spectra. Furthermore, the contours of the evaporating droplets were tracked by optical measurements to characterize the time-dependent changes in the droplet dimensions. Flows induced by the concentration gradients were confirmed by astigmatic particle tracking velocimetry.     

Under-five mortality in the Democratic Republic of the Congo: secondary analyses of survey and conflict data by province

ObjectiveTo compare coverage of key child health policy indicators across provinces and to explore their association with under-five mortality and level of conflict in the Democratic Republic of the Congo.MethodsWe made a secondary analysis of nationally representative data from 1380 health facilities and 20 792 households in 2017–2018. We analysed provincial-level data on coverage of 23 different indicators for improving common causes of childhood mortality, combined into mean scores for: newborn health, pneumonia, diarrhoea, malaria and safe environment. Using negative binomial regression we compared the scores with provincial-level under-five mortality. With binary logistic regression at the individual level we compared indicators (outcome) with living in a conflict-affected province (exposure).FindingsAll grouped coverage scores demonstrated large ranges across the 26 provinces: newborn health: 20% to 61%; pneumonia: 26% to 86%; diarrhoea: 25% to 63%; malaria: 22% to 53%; and safe environment: 4% to 53%. The diarrhoea score demonstrated the strongest association with under-five mortality (adjusted coefficient: −0.026; 95% confidence interval: −0.045 to −0.007). Conflict-affected provinces had both the highest as well as the lowest mortality rates and indicator coverages. The odds of coverage were higher in conflict-affected provinces for 13 out of 23 indicators, whereas in provinces unaffected by conflict only one indicator had higher odds of coverage.ConclusionConflict alone is a poor predictor for child health. Ensuring that children in unaffected provinces are not neglected while addressing the needs of the most vulnerable in conflict settings is important. Prevent, protect and treat strategies for diarrhoeal disease could help improve equity in child survival.     

Fulminant Adenoviral-Induced Hepatitis in Immunosuppressed Patients

Human adenovirus (HAdV) can often lead to fulminant hepatitis in immunocompromised patients, mostly after reactivation of HAdV. Different risk factors, e.g., transplantation and chemotherapy, increase the risk of developing a HAdV hepatitis. We retrospectively analyzed three patients who showed the characteristics of a HAdV hepatitis observed in disseminated disease. In addition to PCR, diagnosis could be proven by pathology, CT scan, and markedly elevated transaminases. All patients had a hemato-oncologic underlying disease. Two had received a stem-cell transplant, and one was under chemotherapy including rituximab. Despite therapy with cidofovir, all patients died. As the incidence of HAdV hepatitis is low, diagnosis may be easily overlooked. No treatment approaches have yet been established. HAdV hepatitis should be considered as a differential diagnosis, especially when risk factors are present. To avoid dissemination, treatment should be initiated as soon as possible.     

RhD表型阴性分子机制的研究

我们对76名中国汉族RhD阴性个体的RHD基因全长编码区进行序列分析，初步探讨中国人D阴性的分子背景，报道如下。     

High-resolution computed tomography in patients with atypical ‘cardiac‘ chest pain: a study investigating patients at 10-year cardiovascular risks defined by the Framingham and PROCAM scores

Background and objective Atypical ‘cardiac‘ chest pain (ACCP) is not usually caused by myocardial ischaemia. Current noninvasive investigations for these symptoms are not yet as accurate as invasive coronary angiography. The latest 64-row multi-detector computed tomography (MDCT) technology is non-invasive, has high specificity and negative predictive values for the detection of significant coronary disease. Our aim was to investigate if this modality can provide more information in the assessment of outpatients with ACCP in addition to established cardiovascular risk scores. Methods Seventy consecutive patients presenting to the outpatient clinic with ACCP underwent 64-row MDCT scan of the coronary arteries. They were categorized into low, medium or high risk groups based upon the Framingham and PROCAM scores. We defined a clinically abnormal MDCT scan as coronary stenosis =50% or calcium score ＞400 Agatston. Results Fifty-three (75.7%) patients did not have clinically abnormal scans. Framingham score classified 43 patients as low-risk while PROCAM classified 59 patients as low-risk. MDCT scans were abnormal for 18.6% and 22.0% of the respective low-risk group of patients. For patients with medium-to-high risk, 33.3% and 36.4% of Framingham and PROCAM patient groups respectively had abnormal MDCT scans. Conclusion MDCT adds valuable information in the assessment of patients with ACCP by identifying a significant proportion of patients categorized as low-risk to have underlying significant coronary stenosis and coronary calcification by established cardiovascular risk scores.     

Feasibility and accuracy of coronary imaging in elderly patients using the 64-row multi-detector computed tomography: a correlation study with conventional coronary angiography

Background Elderly patients generally have higher occurrence of coronary calcification, increased heart rate and difficulty with prolonged breath-holding. The aim of our study was to investigate the feasibility and accuracy of using 64-row multi-detector computed tomography (MDCT) in the assessment of coronary artery stenoses in elderly patients. Methods One hundred and fifty two patients with suspected or known coronary artery disease were divided into 4 groups according to their age (Group A: 40-49 years, n=34; Group B: 50-59 years, n=57; Group C: 60-69 years, n=48; Group D: 70 years and above; n=13). Coronary CT angiography (CTA) using a 64-row MDCT was performed and the findings were compared with that of conventional coronary angiography (CCA). Using axial images, multi-planar reconstructions (MPR) and maximum intensity projections (MIP), coronary segments of lumen diameter = 1.5mm were analyzed for the presence of significant stenosis (= 50% ). Results Percentages of poor image quality from coronary CTA preventing reliable correlations with CCA were 21%, 14%, 19% and 62% in Groups A to D respectively. Patients in Group D had significantly higher calcium scores compared with the other groups (P<0.001). In patients where CTA images were of acceptable quality, percentages of accurate correlations with CCA were 89.8%, 93.4%, 86.6% and 78.0% for Groups A to D respectively. There were no significant difference in serum creatinine, heart rate and contrast volume between the 4 groups. Conclusions The 64-row MDCT coronary angiography was less accurate and feasible for patients aged 70 years or above due to heavy coronary calcification and inability to perform a satisfactory breath-hold. However, a high diagnostic accuracy with the MDCT is possible in patients aged less than 70 years.(J Geriatric Cardiol 2006;3(1):9-14)