Vascular endothelial growth factor mRNA expression can be a marker for response to antiviral treatment of HCV

Angiogenesis has a significant pathogenic role in liver damage-associated hepatitis C virus infection. We evaluated whether chronic hepatitis C (CHC) is associated with elevated levels of angiogenesis marker (vascular endothelial growth factor) and whether it is modulated by therapy. Vascular endothelial growth factor (VEGF) mRNA was determined in the 36 CHC patients included in this study before therapy and 12 weeks after receiving antiviral combination therapy, pegylated interferon alpha-2b plus ribavirin, compared to 20 healthy controls. CHC patients showed elevated baseline VEGF level before and during treatment, but it was decreased in responder group, indicating a shift toward an “anti-angiogenic” process in CHC patients. In conclusion, this suggests that VEGF mRNA level could be useful as non-invasive, base markers of response to therapy.     

Prevalence of oral anticoagulation in atrial fibrillation

OBJECTIVES:

Atrial fibrillation is the most common sustained arrhythmia and is associated with poor outcomes, including stroke. The ability of anticoagulation therapy to reduce the risk of stroke has been well established; however, the prevalence of anticoagulation therapy use in the Public Health System is unknown. The aim of this study is to evaluate both the prevalence of anticoagulation therapy among patients with atrial fibrillation and the indications for the treatment.

METHODS:

In this cross-sectional study, we included consecutive patients who had atrial fibrillation documented by an electrocardiogram performed between September 2011 and March 2012 at a university hospital of the Public Health System. The variables analyzed included the risk of a thromboembolic event and/or bleeding, the use of antiplatelet or anticoagulation therapy, the location where the electrocardiogram report was initially reviewed and the specialty of the physician who initially reviewed it.

RESULTS:

We included 162 patients (mean age 68.9 years, 56% men). Hypertension (90.1%), heart failure (53.4%) and stroke (38.9%) were the most prevalent diseases found. Only 50.6% of the patients knew that they had atrial fibrillation. Regarding the use of therapy, only 37.6% of patients classified as high risk according to the CHADS2 scores and 35.5% according to the CHA2DS2VASc used oral anticoagulation. A presumptive diagnosis of heart failure and the fact that the electrocardiogram was evaluated by a cardiologist were the only independent predictors of the use of anticoagulants.

CONCLUSIONS:

Our study found a low prevalence of oral anticoagulation therapy among patients with atrial fibrillation and an indication for stroke prophylaxis for the use of this therapy, including among those with high CHADS2 and CHA2DS2VASc scores.     

Isolated congenital tuberculosis otitis in a preterm infant

We report an unusual case of localized congenital tuberculosis otitis in a preterm infant. Unlike disseminated congenital cases, the manifestations of localized otitis are associated with a triad of signs: (i) regional lymphadenopathy in the absence of typical systemic features of tuberculosis; (ii) delayed onset of presentation; and (iii) refractory otitis unresponsive to conventional antimicrobial agents. The need for greater diligence in looking for neonatal tuberculosis is emphasized, especially in an ethnic or socioeconomic environment where the disease is prevalent. Congenital tuberculosis, otitis, preterm
PC Ng, Department of Paediatrics, Level 6, Clinical Sciences Building, Prince of Wales Hospital, Shatin, NT, Hong Kong     

Circulating autoantibodies recognize and bind dying neurons following injury to the brain

While it is known that autoimmune cells can protect against cell damage following traumatic injury of the brain, the role of autoantibodies in brain injury is less clear. Here we present evidence in adult rats that following a cortical lesion of the brain, circulating IgG autoantibodies bind to dying neurons in the vicinity of the lesion. At intervals that ranged from 4 h to 7 days after making a unilateral lesion of visual cortex, we observed neurons near the lesion that were immunopositive for rat IgG. Many of these IgG-positive neurons were in advanced stages of degeneration. The magnitude of the immunostaining observed was directly proportional to the percent reactivity to rat IgG of the antibodies that were used. Preadsorption of the antibodies with rat serum eliminated the immunostaining. In addition, immunostaining for serum albumin in sections through the cortical lesion was negative, supporting the conclusion that the positive staining for IgG does not result from the passive diffusion of serum proteins into injured cells. Instead, the evidence presented here strongly suggests that naturally occurring IgG autoantibodies bind specifically to dying neurons in the injured brain. We propose that this autoantibody binding may participate in the phagocytosis and removal of injured neurons.     

Vitamin A supplementation in Tanzania: the impact of a change in programmatic delivery strategy on coverage

Background  

Efficient delivery strategies for health interventions are essential for high and sustainable coverage. We report impact of a change in programmatic delivery strategy from routine delivery through the Expanded Programme on Immunization (EPI+) approach to twice-yearly mass distribution campaigns on coverage of vitamin A supplementation in Tanzania     

A new amino acid mixture permits new approaches to the treatment of phenylketonuria

A new amino acid mixture for incorporation into medical foods for the treatment of hyperphenylalaninemia has been tested in a regular clinic. The mix is designed to be as unobtrusive as possible, consistent with good nutrition. After more than 1 year of trial as a beverage, we have shown that it is safe and well tolerated but that plasma phenylalanine is no better controlled than with some other products. The mix can be incorporated into a large number of different foods without affecting the taste. Occult monitoring of the quantity of medical foods purchased compared with the amounts reported to be consumed in diet histories provides an excellent way to monitor dietary compliance.     

Expression of two developmentally regulated brain-specific proteins is correlated with late outgrowth of the pyramidal tract

The regulation of axon outgrowth is not well understood. In previous studies, however, axon elongation has been well correlated with expression of a small number of growth-associated proteins (GAPs). To identify other proteins whose expression could be correlated with axon outgrowth during development of CNS pathways, monoclonal antibodies were raised against growth cone particles isolated from neonatal hamster brains. Two of these antibodies recognized a brain-specific 33 kDa protein associated with intracellular membranes of axons and growth cones. Immunoblotting demonstrated a sharp developmental decline in levels of the protein in hamster brain during the first postnatal week and a more gradual decline thereafter. Immunocytochemical studies with the antibodies revealed ubiquitous staining of the neuropil during the first several days, which by the end of the first week became restricted to a few later-maturing pathways. Staining was most intense in the pyramidal tract and was well correlated with axon outgrowth, which continues until 14 d in this pathway. These results suggest that the 33 kDa protein may, like previously identified GAPs, play a role in axon elongation. Late outgrowth of the hamster pyramidal tract is also correlated with expression of another developmentally regulated protein, the high-molecular-weight neurofilament subunit (NF-H). Immunostaining with a monoclonal antibody that recognized phosphorylated NF-H demonstrated that this subunit does not begin to appear in the late-maturing pyramidal tract fibers until several weeks after birth, in striking contrast to intense immunoreactivity of other spinal cord pathways from postnatal day 1. This finding suggests that specific pathways may have a highly idiosyncratic time course for expression of neurofilament subunits.     

Dark rearing in the cat: effects on visuomotor behavior and cell growth in the dorsal lateral geniculate nucleus

The morphological and behavioral effects of complete binocular deprivation were studied by rearing cats from birth in total darkness. Nineteen animals were sacrificed immediately upon removal from the dark at intervals that ranged from 3 to 16 weeks. Measurements of cell sizes in the dorsal lateral geniculate nucleus revealed that dark rearing affects cell growth in two stages. During the first three months of dark rearing the growth rate of geniculate cells is reduced, and a maximum size difference between cells from light reared control animals and dark reared cats is seen at 12 weeks. However, during the fourth month of deprivation, geniculate cells recover from the effects of dark rearing, and grow to essentially normal size by 16 weeks. In a separate set of experiments, cats were removed from the dark at 8, 12 and 16 weeks, and given normal visual experience for as long as one and one-half years. Lateral geniculate neurons in these animals were also normal in size. These results indicate that the effects of dark rearing on cell growth in the lateral geniculate nucleus are significant, but transitory, since they can be reversed either by long term deprivation, alone, or by exposure to normal levels of illumination. Behavioral experiments were performed to study the influence of dark rearing upon visually guided avoidance, jumping, placing, and following. After 8, 12 and 16 weeks of dark rearing, cats appear blind when first examined, and fail each of the behavioral tests. Within four weeks, however, visuomotor behavior recovers almost completely. Visual field perimetry testing was also carried out, and the results indicate that orientation is not reliably affected by periods of dark rearing less than 12 weeks in duration. However, 16 week dark reared animals show visual field defects, which persist for several months, and suggest that only the nasal hemiretina is used for orientation. Since the dark reared cats which showed deficits in orientation also demonstrated a pronounced convergent strabismus, it is proposed that misalignment of the visual axes may be directly responsible for the behavioral impairment.