Hearing impairment and hypoxia ischaemic encephalopathy: Incidence and associated factors

Objective

To establish the local incidence of hearing loss in newborns with Hypoxic Ischaemic Encephalopathy (HIE) and to identify associated risk factors.

Differences in the accommodation stimulus response curves of adult myopes and emmetropes

While the accommodation system has been implicated in myopia development, the nature of this relationship remains obscure. This study investigated the differences in accommodation stimulus response curves between adult myopes and emmetropes. Myopic subjects were classified according to age of onset and stability of their myopia. Accommodation stimulus response curves were measured using three different methods: (i) real targets presented at viewing distances of 4 m to 0.25 m, (ii) a target at 4 m viewed through negative lenses of increasing power, and (iii) a target at 0.25 m viewed through positive lenses of decreasing power. A Canon Autoref R-1 measured the accommodation responses at 5 levels of demand (increasing from 0 D to 4 D in 1 D steps). We found significant differences between the three methods used to stimulate an accommodation response in all subject groups, for example, accommodation lags at high accommodative demands were greatest for the negative lens series and least for the positive lens series. In addition, while differences between early-onset myopes, late-onset myopes and emmetropes were not observed, we did observe differences when myopic subjects were reclassified according to whether their myopia was progressing or stable. A reduced accommodation response to negative lens-induced accommodative demand was found in progressing myopes but not in stable myopes. These results provide further evidence for the link between myopia progression and inaccurate accommodation. The data also suggest that adult myopes with stable refractive errors show accommodation responses similar to that of emmetropes.     

Recombinant LH supplementation to recombinant FSH during induced ovarian stimulation in the GnRH-antagonist protocol: a meta-analysis

This study aims to compare the efficacy of recombinant LH (rLH) supplementation for ovarian stimulation in gonadotrophin-releasing hormone-antagonist protocol for IVF/intracytoplasmic sperm injection cycles. Search strategies included online surveys of databases. The fixed effects model was used for odds ratio (OR) and effect size (weighted mean difference, WMD). Five trials fulfilled the inclusion criteria. When the meta-analysis was carried out, advantages were observed for the LH supplementation protocol with respect to higher serum oestradiol concentrations on the day of human chorionic gonadotrophin administration P < 0.0001; WMD: 514, 95% CI 368, 660) and higher number of mature oocytes (P = 0.0098; WMD: 0.88, 95% CI 0.21, 1.54). However, these differences were not observed in the total amount of recombinant FSH (rFSH) administered, days of stimulation, number of oocyets retrieved, the clinical pregnancy rate per oocyte retrieval, the implantation rate and miscarriage rate. This result demonstrates that the association of rLH with rFSH may prevent any decrease in oestradiol after antagonist administration and that a significantly higher number of mature oocytes was available for laboratory work. Nevertheless, it failed to show any statistically significant difference in clinically significant end-points in IVF (implantation and pregnancy rates). Additional randomized controlled trials are needed to confirm these results further.     

Differential Effects of Dietary versus Exercise Intervention on Intrahepatic MAIT Cells and Histological Features of NAFLD

Background: Mucosal-associated invariant T (MAIT) cells promote inflammation in obesity and are implicated in the progression of non-alcoholic fatty liver disease (NAFLD). However, as the intrahepatic MAIT cell response to lifestyle intervention in NAFLD has not been investigated, this work aimed to examine circulating and intrahepatic MAIT cell populations in patients with NAFLD, after either 12 weeks of dietary intervention (DI) or aerobic exercise intervention (EI). Methods: Multicolour flow cytometry was used to immunophenotype circulating and intrahepatic MAIT cells and measure MAIT cell expression (median fluorescence intensity, MFI) of the activation marker CD69 and apoptotic marker CD95. Liver histology, clinical parameters, and MAIT cell populations were assessed at baseline (T0) and following completion (T1) of DI or EI. Results: Forty-five patients completed the study. DI participants showed decreased median (interquartile range) expression of the activation marker CD69 on circulating MAIT cells (T0: 104 (134) versus T1 27 (114) MFI; p = 0.0353) and improvements in histological steatosis grade post-intervention. EI participants showed increased expression of the apoptotic marker CD95, both in circulating (T0: 1549 (888) versus T1: 2563 (1371) MFI; p = 0.0043) and intrahepatic MAIT cells (T0: 2724 (862) versus T1: 3117 (1622) MFI; p = 0.0269). Moreover, the percentage of intrahepatic MAIT cells significantly decreased after EI (T0: 11.1 (14.4) versus T1: 5.3 (9.3)%; p = 0.0029), in conjunction with significant improvements in fibrosis stage and hepatocyte ballooning. Conclusions: These data demonstrate independent benefits from dietary and exercise intervention and suggest a role for intrahepatic MAIT cells in the observed histological improvements in NAFLD.     

Human anti-endoplasmic reticulum antibodies in sera of patients with halothane-induced hepatitis are directed against a trifluoroacetylated carboxylesterase.

Previous studies have demonstrated that patients with halothane-induced hepatitis have serum antibodies that are directed against novel liver microsomal neoantigens and have suggested that these neoantigens may play an immunopathological role in development of the patients' liver damage. These investigations have further revealed that the antibodies are directed against distinct polypeptide fractions (100 kDa, 76 kDa, 59 kDa, 57 kDa, 54 kDa) that have been covalently modified by the reactive trifluoroacetyl halide metabolite of halothane. In this paper, the trifluoroacetylated (TFA) 59-kDa neoantigen (59-kDa-TFA) recognized by the patients' antibodies was isolated from liver microsomes of halothane-treated rats by chromatography on an immunoaffinity column of anti-TFA IgG. Antibodies were raised against the 59-kDa-TFA protein and were used to purify the native protein from liver microsomes of untreated rats. Based upon its apparent monomeric molecular mass, NH2-terminal amino acid sequence, catalytic activity, and other physical properties, the protein has been identified as a previously characterized microsomal carboxylesterase (EC 3.1.1.1). A similar strategy may be used to purify and characterized neoantigens associated with other drug toxicities that are believed to have an immunopathological basis.     

A premature infant with skin injury successfully treated with bilayered cellular matrix

The immature skin of premature infants is functionally less effective than the skin of full-term infants and therefore more vulnerable to injury. This article discusses the use of a biologic wound healing agent--bilayered cellular matrix--to heal a denuded hip wound in a premature infant. The treatment involved a compassionate use, single application of an investigational biologic wound healing agent to a 2.0-cm x 1.5-cm hip wound in a 23-week gestational age premature infant. A sterile, nonadherent dressing containing 3% bismuth tribromophenate in a special petrolatum blend on a fine mesh gauze also was applied over the biologic dressing and changed as needed. Wound closure was evaluated by photographs taken before and after the application of the bilayered cellular matrix. Wound measurements were reduced to 1.0 cm x 0.5 cm by day 4 post application of the bilayered cellular matrix, and clean granulation tissue was present. The wound was healed 10 days later. No signs or symptoms of infection were evident during the follow-up period and no adverse events were recorded. Comparative studies are warranted to fully evaluate the utility of bilayered cellular matrix in this clinical setting.