Infections and neutrophils in the pathogenesis of bronchiolitis obliterans syndrome in children after allogeneic stem cell transplantation

It is plausible that infections post‐hematopoietic SCT play a role in the pathogenesis of BOS. A prospective study for children with history, questionnaire, examination, PFTs, and blood counts at one, three, six, nine, 12, 18, and 24 months post‐SCT was conducted. Between September 2009 and September 2011 (n = 39), six developed BOS at 200 days (range 94–282), three patients had probable clinical respiratory infection, and all six had higher neutrophil count compared to non‐BOS patients (4.7 vs. 2.4 at three months and 6.3 vs. 2.9 at six months ×10⁹/L, p = 0.03). Contribution of clinical and subclinical infection needs to be considered in the pathogenesis of BOS.     

A novel approach to the development of benchmarking parameters for characterizing cartilage health

This article outlines the motivation and preliminary investigations into a novel method of characterizing cartilage health for potential in vivo application. Current in vivo indentation techniques, which primarily rely on stiffness measurements based on axial data, are unable to adequately distinguish between healthy and degraded tissue. The present in vitro study investigates the effects of controlled artificial degradation on the effective surface stretch, comparing the results with those obtained from the peripheral cartilage surrounding focal osteoarthritis. Results suggest that this technique is highly sensitive, showing a maximum range of 14% effective surface stretch in a normal joint compared with 42% for axial strain measurements. We further demonstrated that the technique can discriminate between degenerative changes and the intrinsic variations in cartilage properties across the normal joint. From these investigations we propose that the relationship between indentation and the in-plane strain field under the indenter can better distinguish degraded tissue than the currently used stiffness techniques.     

Ethnoracial differences in cannabis use among native-born and foreign-born high school students in Ontario

The objective of this study was to examine the association of ethnoracial background and immigrant status to cannabis use among students in Ontario, Canada. Data were derived from the Ontario Student Drug Use and Health Survey, a school-based, province-wide survey of students in Grades 7–12. The survey utilized a stratified two-stage cluster design. Analyses were based on a pooled subsample of 12,527 students in Grades 9–12 during the 2011 and 2013 survey cycles and included adjustments for the complex sample design. Results indicate that youth who were of South Asian or East/Southeast Asian background were at lower odds of cannabis use than those who were White, Black, or mixed-race backgrounds. Youth who were of mixed-race background (i.e., White and another group) were at higher odds of cannabis use than youth who were of White background. The association between ethnoracial background and cannabis use also varied for some foreign-born and native-born youth. These findings suggest that ethnoracial background should be an important consideration in investigations of cannabis use among foreign- relative to native-born youth.     

Online scan of FASD prevention and health promotion resources for Aboriginal and Torres Strait Islander communities

Issue addressed

Foetal Alcohol Spectrum Disorder (FASD) includes a range of life‐long impairments caused by alcohol exposure in utero. Health professionals are vital to preventing FASD but many are hesitant to discuss FASD with clients due to their need for additional resources to aid the conversation. This scan sought to identify the scope and gaps in publicly available FASD prevention and health promotion resources, and assess their cultural appropriateness for use among five key groups of Indigenous Australian people including: (i) pregnant women, (ii) women of childbearing age, (iii) grandmothers and aunties, (iv) men, and (v) health professionals.

Methods

Relevant resources published 1995‐2017 were identified through the Australian Indigenous HealthInfoNet, FASD organisation websites, grey literature, Google searches, and field experts. Results were screened by inclusion and cultural appropriateness criteria developed and piloted by the research team, and further screened by health professionals attending FASD training workshops.

Results

115 of the 2146 identified resources were eligible. Relevant resources were found for all five key groups; however, no resources were specifically designed for men, grandmothers or aunties.

Conclusions

A range of high‐quality, culturally appropriate resources were identified, however, health professionals attending the training workshops were not aware of their availability. Further resource development is suggested for men, grandmothers and aunties.

So what?

Prioritisation of active dissemination and implementation strategies is suggested to increase awareness and use of future resource developments. The inclusion of a resource trial among health professionals is a recommended strategy to increase awareness and use of newly developed resources.

     

Is bolus or continuous enteral feeding better in critically ill children: An evidence-based review

Inadequate nutrition can lead to increased morbidity and mortality for mechanically ventilated children in the paediatric intensive care unit (PICU). Enteral feeding can either be delivered by gravity bolus (intermittent) feeding or continuously via a pump and in UK PICUs variable practice exists. This evidence-based review therefore aimed to examine the evidence surrounding the two feeding methods for ventilated children, to determine whether one provides better enteral nutrition. Four papers were included, three randomized controlled trials and a systematic review, which provide conflicting evidence. There is some suggestion that bolus feeding may be superior in medical children on PICU to achieve their energy and protein goals faster, however, the clinical significance of the results is questionable and further research is needed to identify whether one method of feeding can impact on patient outcomes.     

Osteopontin, a key component of the hematopoietic stem cell niche and regulator of primitive hematopoietic progenitor cells

Although recent data suggests that osteoblasts play a key role within the hematopoietic stem cell (HSC) niche, the mechanisms underpinning this remain to be fully defined. The studies described herein examine the role in hematopoiesis of Osteopontin (Opn), a multidomain, phosphorylated glycoprotein, synthesized by osteoblasts, with well-described roles in cell adhesion, inflammatory responses, angiogenesis, and tumor metastasis. We demonstrate a previously unrecognized critical role for Opn in regulation of the physical location and proliferation of HSCs. Within marrow, Opn expression is restricted to the endosteal bone surface and contributes to HSC transmarrow migration toward the endosteal region, as demonstrated by the markedly aberrant distribution of HSCs in Opn-/- mice after transplantation. Primitive hematopoietic cells demonstrate specific adhesion to Opn in vitro via beta1 integrin. Furthermore, exogenous Opn potently suppresses the proliferation of primitive HPCs in vitro, the physiologic relevance of which is demonstrated by the markedly enhanced cycling of HSC in Opn-/- mice. These data therefore provide strong evidence that Opn is an important component of the HSC niche which participates in HSC location and as a physiologic-negative regulator of HSC proliferation.