Wound ballistic evaluation of the TASER® XREP ammunition

The Taser® eXtended Range Electronic Projectile (XREP®) is a wireless conducted electrical weapon (CEW) designed to incapacitate a person from a larger distance. The aim of this study was to analyze the ballistic injury potential of the XREP. Twenty rounds were fired from the Taser®X12 TM shotgun into ballistic soap covered with artificial skin and clothing at different shooting distances (1–25 m). One shot was fired at pig skin at a shooting distance of 10 m. The average projectile velocity was 67.0 m/s. The kinetic energy levels on impact varied from 28–52 J. Depending on the intermediate target, the projectiles penetrated up to 4.2 cm into the ballistic soap. On impact the nose assembly did not separate from the chassis, and no electrical activation was registered. Upon impact, a skin penetration of the XREP cannot be excluded. However, it is very unlikely at shooting distances of 10 m or more. Clothing and a high elasticity limit of the target body area can significantly reduce the penetration risk on impact.     

Stand der Nierentransplantation im Jahr 2012

Triple immunosuppression including a calcineurin inhibitor, mycophenolic acid and steroids remains the standard of care after (renal) transplantation, while steroid-free immunosuppression and calcineurin inhibitor-free (mTOR inhibitor or belatacept-based) therapies are increasingly being used. In several transplant centers induction therapy with basiliximab or antilymphocyte globulin/antithymocyte globulin (ATG/ALG) is routinely used. Impairment of renal graft function necessitates a thorough investigation, often including a renal core biopsy and imaging studies for the assessment of vascular perfusion to allow adequate treatment for, e.?g. humoral, antibody-mediated rejection or polyomavirus type BK (BKV) nephropathy. Long-term survival of patients with functioning graft is largely determined by cardiovascular mortality. Therefore, aggressive preventive and therapeutic strategies are required in cardiovascular high-risk transplant patients. This comprises blood pressure control <140/90?mmHg, with calcium channel blocker, diuretic, angiotensin-converting enzyme (ACE) inhibitor, beta blocker as agents of first choice, statin treatment (fluvastatin, pravastatin most intensely studied), diabetes treatment (target HbA1c at 7%), avoidance of inadequate post-transplantation weight gain and nicotine abstinence. Tumor risk is increased 4-fold, especially skin tumors, post-transplant lymphoproliferative disorders (PTLD) and renal/bladder cancer. Besides standard tumor prevention protocols as suggested for the general population, regular dermatological and ultrasound studies (liver when viral hepatitis is present, native kidneys) are recommended. High-dose immunosuppression increases the risk of infection especially within the first 6 months. Transplantation-associated infections (catheter, wound, pneumonia, urinary tract infections with urinary bladder catheterization), de novo infections or endogeneous reactivation of viral infections, i.e. with herpes viruses (HSV, VZV, CMV) are most frequent. Due to the medical complexity of transplantation patients, an interdisciplinary approach and a close collaboration between transplant center and the primary care nephrologist is needed.     

Hiding Lipid Presentation: Viral Interference with CD1d-Restricted Invariant Natural Killer T (iNKT) Cell Activation

The immune system plays a major role in protecting the host against viral infection. Rapid initial protection is conveyed by innate immune cells, while adaptive immunity (including T lymphocytes) requires several days to develop, yet provides high specificity and long-lasting memory. Invariant natural killer T (iNKT) cells are an unusual subset of T lymphocytes, expressing a semi-invariant T cell receptor together with markers of the innate NK cell lineage. Activated iNKT cells can exert direct cytolysis and can rapidly release a variety of immune-polarizing cytokines, thereby regulating the ensuing adaptive immune response. iNKT cells recognize lipids in the context of the antigen-presenting molecule CD1d. Intriguingly, CD1d-restricted iNKT cells appear to play a critical role in anti-viral defense: increased susceptibility to disseminated viral infections is observed both in patients with iNKT cell deficiency as well as in CD1d- and iNKT cell-deficient mice. Moreover, viruses have recently been found to use sophisticated strategies to withstand iNKT cell-mediated elimination. This review focuses on CD1d-restricted lipid presentation and the strategies viruses deploy to subvert this pathway.     

Glioblastoma invasion and cooption depend on IRE1α endoribonuclease activity

IRE1α is an endoplasmic reticulum (ER)-resident transmembrane signaling protein and a cellular stress sensor. The protein harbors a cytosolic dual kinase/endoribonuclease activity required for adaptive responses to micro-environmental changes. In an orthotopic xenograft model of human glioma, invalidation of IRE1α RNase or/and kinase activities generated tumors with remarkably distinct phenotypes. Contrasting with the extensive angiogenesis observed in tumors derived from control cells, the double kinase/RNase invalidation reprogrammed mesenchymal differentiation of cancer cells and produced avascular and infiltrative glioblastomas with blood vessel co-option. In comparison, selective invalidation of IRE1α RNase did not compromise tumor angiogenesis but still elicited invasive features and vessel co-option. In vitro, IRE1α RNase deficient cells were also endowed with a higher ability to migrate. Constitutive activation of both enzymes led to wild-type-like lesions. The presence of IRE1α, but not its RNase activity, is therefore required for glioblastoma neovascularization, whereas invasion results only from RNase inhibition. In this model, two key mechanisms of tumor progression and cancer cell survival are functionally linked to IRE1α.     

Rheumatoid arthritis in Senegal: a comparison between patients coming from rural and urban areas, in an urban tertiary health care center in Senegal

Several studies have suggested that rheumatoid arthritis (RA) is uncommon in rural sub-Saharan Africa. The aim of this study is to determine the potential differences between patients with RA living in rural areas and those living in urban areas. We performed a cross-sectional study from June 2006 to May 2009. We included all patients with RA (1987 ACR criteria) seen at the Rheumatology Unit of the Le Dantec Teaching Hospital, Dakar, Senegal. We compared the main socio-demographic and clinical characteristics of patients living in rural areas to those living in urban areas. We included 180 patients in our study, of whom, 143 (79.4?%) lived in urban areas and 37 (20.6?%) in rural areas. The median age was 44?years [range 34–55] in patients from rural areas vs. 41?years [range 30–53] in patients from urban areas, without any statistical significance (p?=?0.24). Patients under the age of 60 mostly lived in urban areas (p?=?0.03). The extra-articular manifestations were significantly more frequent in patients living in rural areas (p?=?0.02). There was no statistical significance when comparing the delay in diagnosis, number of swollen joints, disease activity, hand deformities, and concentration of autoantibodies (RF and ACPA) in both populations. The percentage of patients seen from the rural areas of Senegal is low (20.6?%) compared to those seen from the urban areas. The number of extra-articular manifestations is the main difference between patients living in rural and urban areas. The role played by environmental factors seems important. Further incidence studies are needed.