Variety of Expiratory Resistance Between Different Continuous Positive Airway Pressure Devices for Preterm Infants

Continuous positive airway pressure (CPAP) systems for preterm infants work with conventional ventilators or use a jet ventilation system. It is assumed that the most important advantage of jet‐CPAP systems is a lower expiratory resistance (R_E). We investigated the R_E of seven different CPAP systems. We studied two primary‐care CPAP systems, three jet‐CPAP generators, and two conventional CPAP devices. All devices were adjusted at 6 mbar and connected with a test lung simulating a standardized expiration volume. Maximum pressure increase during expiration was measured and maximum R_E was calculated. In primary‐care CPAP devices, the maximum R_E of the Benveniste valve was 9.7 mbar/L/s (SD 1.2) while that of the Neopuff was 102.8 mbar/L/s (SD 7.9) (P < 0.01). In jet‐CPAP devices, the R_E of the Infant Flow was 6.8 mbar/L/s (SD 1.7), the one of the Medijet REF 1000 was 43.5 mbar/L/s (SD 1.5), and that of the Medijet REF 1010 was 36.7 mbar/L/s (SD 0.3) (P < 0.01). In conventional CPAP systems, the R_E of the Baby Flow was 29.7 mbar/L/s (SD 1.1) and that of the Bubble CPAP was 37.1 mbar/L/s (SD 4.3) (P < 0.01). All CPAP devices created an R_E. Jet‐CPAP devices did not produce lower R_E than conventional CPAP devices.     

Hydroxychloroquine use associated with improvement in lipid profiles in rheumatoid arthritis patients

Objective

Cardiovascular disease (CVD) is the leading cause of death in patients with rheumatoid arthritis (RA). Disease‐modifying therapies that improve risk factors for CVD, such as dyslipidemia, are desired. This study used an electronic health record to determine if hydroxychloroquine (HCQ) use was associated with an improvement in lipid levels in an inception RA cohort.

Methods

All adult individuals with the initial diagnosis of RA between January 1, 2001, and March 31, 2008, were identified (n = 1,539). Only patients with at least one lipid level post–RA diagnosis were included (n = 706). Information on demographics, medical history, body mass index (BMI), laboratory measures, and medications were collected at office visits. Potential risk and protective factors for dyslipidemia were controlled for in linear mixed‐effects regression models for low‐density lipoprotein (LDL), high‐density lipoprotein (HDL), total cholesterol, triglycerides, LDL/HDL, and total cholesterol/HDL.

Results

Patients were 69% women and 98% white, with a median age of 65 years and a median BMI of 29.8 kg/m². In the adjusted regression models, HCQ use was associated with the following average differences in lipids: LDL decrease of 7.55 mg/dl (P < 0.001), HDL increase of 1.02 mg/dl (P = 0.20), total cholesterol decrease of 7.70 mg/dl (P = 0.002), triglycerides decrease of 10.91 mg/dl (P = 0.06), LDL/HDL decrease of 0.136 (P = 0.008), and total cholesterol/HDL decrease of 0.191 (P = 0.006), which were stable over time.

Conclusion

Use of HCQ in this RA cohort was independently associated with a significant decrease in LDL, total cholesterol, LDL/HDL, and total cholesterol/HDL. Considering these results, its safety profile, and low cost, HCQ remains a valuable initial or adjunct therapy in this patient population at high risk for CVD.     

Hippocampal metabolic proteins are modulated in voluntary and treadmill exercise rats

Systematic protein expression studies in the brain of exercising and sedentary animals have not been carried out so far and it was therefore decided to determine differences in metabolic protein levels in rat hippocampus of sedentary, voluntary and involuntary exercising rats by a proteomic approach.Aged, male Sprague-Dawley rats, 23 months old, were used for the study: the first group consisted of sedentary rats, the second of rats with voluntary exercise from five to 23 months and the third group was performing involuntary exercise on a treadmill from five to 23 months. Two-dimensional gel electrophoresis with subsequent mass spectrometrical identification of spots followed by quantification of spots was carried out. Identification of significantly differential proteins was validated by the determination of the corresponding enzyme activity.Five individual metabolic proteins showed differential protein levels in the three groups: mitochondrial precursors of ornithine aminotransferase, isocitrate dehydrogenase [NAD] subunit alpha, malate dehydrogenase, ubiquinol-cytochrome-c reductase complex core protein 1, and ubiquitin carboxyl-terminal hydrolase isozyme L1.The unambiguously identified metabolic proteins were mainly of mitochondrial localization and fit the expectations of altered mitochondrial activity in exercise. Reduced ubiquitin carboxyl-terminal hydrolase isoenzyme L1 levels in treadmill (forced) exercise show the involvement of the proteasomal pathway as a novel finding. These results not only form the basis for functional studies elucidating mechanisms and differences between voluntary and forced exercise in hippocampal metabolism but also highlight the most intriguing aspect that exercise is affecting the brain at the protein level.     

Primary myogenic cells see the light: improved survival of transplanted myogenic cells following low energy laser irradiation

BACKGROUND AND OBJECTIVES: There is a substantial need for finding new avenues to promote muscle recovery when acute skeletal muscle loss extends beyond the natural capacity of the muscle to recover. Maintenance and regeneration of skeletal muscles depend mainly on resident stem cells known as satellite cells. Nevertheless, there are situations in which a significant loss of muscle tissue exhausts the satellite cell pool. For such cases, cell therapy and tissue engineering are becoming promising alternatives. Thus far, attempts to supplement damaged host muscles with donor satellite cells by means of myoblast transplantation therapy were mostly unsuccessful due to massive and rapid loss of donor cells within few hours after transplantation. This study aims at following the effects of low-energy-laser irradiation on the fate of implanted myoblasts. STUDY DESIGN: Primary myogenic cells, harvested from male rat skeletal muscles, were irradiated with low energy laser, seeded on a biodegradable scaffold and expanded in vitro. The scaffold containing cells was transplanted into partially excised muscles of host female rats. Donor cells were identified in the host muscle tissue, using Y-chromosome in situ hybridization. RESULTS: In this study, we show that laser irradiated donor primary myogenic cells not only survive, but also fuse with host myoblasts to form a host-donor syncytium. CONCLUSIONS: Our data show that the use of low energy laser irradiation (LELI), a non-surgical tool, is a promising means to enhance both the survival and functionality of transplanted primary myogenic cells.     

Heterotopic ossification of the vocal cords after spinal cord injury

BACKGROUND/OBJECTIVE: To report a rare complication of heterotopic ossification of the vocal cords after spinal cord and multiple organ injuries. STUDY DESIGN: Case report. SETTING: Acute rehabilitation in the Department of Neurologic Rehabilitation. RESULTS: A 55-year-old patient sustained spinal cord injury and multitrauma after falling from a height. Approximately 3 months later, after weaning from mechanical ventilation, plugging of the cannula resulted in severe stridor indicating upper airway obstruction. A computed tomography scan showed bilateral vocal cord fixation in a para-median position, with hyperossification of the vocal processes of the arytenoids. Direct laryngoscopy revealed interarytenoid ossification, and sawing through the ossification resulted in remobilization of the vocal cords enabling decannulation. CONCLUSIONS: Heterotopic ossification of the vocal cords was found to be an early complication of acute spinal cord injury and multiple trauma. This rare complication should be considered in the differential diagnosis of patients showing signs of upper airway obstruction.     

The “floating forearm” injury in a child: a case report

Abstract: The case of a eleven-year-old girl who had a fracture dislocation of the left elbow with entrapment of the ulnar nerve into the dislocated ulnar epicondyle anlage and unstable forearm fracture of the ipslateral upper extremity is described. This severe injury to the elbow and the ipsilateral forearm is termed “floating forearm” injury. The forearm was stabilized percutaneously and the elbow fracture dislocation, remaining unstable after internal fixation was treated with a pediatric elbow fixator with motion capacity. Electronic supplementary material The online version of this articlecontains supplementary material, which is available on SpringerLink     

Novel approaches to treatment of autoimmune neuroinflammation and lessons for drug development

Drug development, and especially that intended for central nervous system (CNS) disorders, still poses a challenge. We investigated both the use of bifunctional compounds designed for multiple targeting and enhanced CNS permeability, and of recombinant alpha-fetoprotein (AFP), a natural pregnancy-associated immunomodulating protein for the treatment of CNS inflammation. Bifunctional compounds showed a novel pharmacokinetic profile due to the conjugation, yet retained, and even improved pharmacodynamics. AFP was well tolerated and decreased various aspects of neuroinflammation, including disease severity, axonal loss and damage, T-cell reactivity, and antigen presentation. Our results show that both strategies may serve as future drug modalities.