Immunosuppression for acquired hemophilia A: results from the European Acquired Haemophilia Registry (EACH2)

Acquired hemophilia A (AHA) is an autoimmune disease caused by an autoantibody to factor VIII. Patients are at risk of severe and fatal hemorrhage until the inhibitor is eradicated, and guidelines recommend immunosuppression as soon as the diagnosis has been made. The optimal immunosuppressive regimen is unclear; therefore, data from 331 patients entered into the prospective EACH2 registry were analyzed. Steroids combined with cyclophosphamide resulted in more stable complete remission (70%), defined as inhibitor undetectable, factor VIII more than 70 IU/dL and immunosuppression stopped, than steroids alone (48%) or rituximab-based regimens (59%). Propensity score-matched analysis controlling for age, sex, factor VIII level, inhibitor titer, and underlying etiology confirmed that stable remission was more likely with steroids and cyclophosphamide than steroids alone (odds ratio = 3.25; 95% CI, 1.51-6.96; P < .003). The median time to complete remission was approximately 5 weeks for steroids with or without cyclophosphamide; rituximab-based regimens required approximately twice as long. Immunoglobulin administration did not improve outcome. Second-line therapy was successful in approximately 60% of cases that failed first-line therapy. Outcome was not affected by the choice of first-line therapy. The likelihood of achieving stable remission was not affected by underlying etiology but was influenced by the presenting inhibitor titer and FVIII level.     

In vitro antimicrobial activity of auxiliary chemical substances and natural extracts on Candida albicans and Enterococcus faecalis in root canals

Objective:

The aim of this study was to evaluate the antimicrobial activity of auxiliary chemical substances and natural extracts on Candida albicans and Enterococcus faecalis inoculated in root canals.

Material and Methods:

Seventy-two human tooth roots were contaminated with C. albicans and E. faecalis for 21 days. The groups were divided according to the auxiliary chemical substance into: G1) 2.5% sodium hypochlorite (NaOCl), G2) 2% chlorhexidine gel (CHX), G3) castor oil, G4) glycolic Aloe vera extract, G5) glycolic ginger extract, and G6) sterile saline (control). The samples of the root canal were collected at different intervals: confirmation collection, at 21 days after contamination; 1^st collection, after instrumentation; and 2^nd collection, seven days after instrumentation. Microbiological samples were grown in culture medium and incubated at 37º C for 48 hours.

Results:

The results were submitted to the Kruskal-Wallis and Dunn (5%) statistical tests. NaOCl and CHX completely eliminated the microorganisms of the root canals. Castor oil and ginger significantly reduced the number of CFU of the tested bacteria. Reduction of CFU/mL at the 1^st and 2^nd collections for groups G1, G2, G3 and G4 was greater in comparison to groups G5 and G6.

Conclusion:

It was concluded that 2.5% sodium hypochlorite and 2% chlorhexidine gel were more effective in eliminating C. albicans and E. faecalis, followed by the castor oil and glycolic ginger extract. The Aloe vera extract showed no antimicrobial activity.     

Photodynamic therapy for the treatment of induced mammary tumor in rats

The objective of this work was to evaluate photodynamic therapy (PDT) by using a hematoporphyrin derivative as a photosensitizer and light-emitting diodes (LEDs) as light source in induced mammary tumors of Sprague–Dawley (SD) rats. Twenty SD rats with mammary tumors induced by DMBA were used. Animals were divided into four groups: control (G1), PDT only (G2), surgical removal of tumor (G3), and submitted to PDT immediately after surgical removal of tumor (G4). Tumors were measured over 6 weeks. Lesions and surgical were LEDs lighted up (200 J/cm² dose). The light distribution in vivo study used two additional animals without mammary tumors. In the control group, the average growth of tumor diameter was approximately 0.40 cm/week. While for PDT group, a growth of less than 0.15 cm/week was observed, suggesting significant delay in tumor growth. Therefore, only partial irradiation of the tumors occurred with a reduction in development, but without elimination. Animals in G4 had no tumor recurrence during the 12 weeks, after chemical induction, when compared with G3 animals that showed 60 % recurrence rate after 12 weeks of chemical induction. PDT used in the experimental model of mammary tumor as a single therapy was effective in reducing tumor development, so the surgery associated with PDT is a safe and efficient destruction of residual tumor, preventing recurrence of the tumor.     

Stimulation of the intra-cardiac vagal nerves innervating the AV-node to control ventricular rate during AF: specificity, parameter optimization and chronic use up to 3?months

Background  

Stimulation of the intra-cardiac vagal nerves innervating the AV-node (AVNS) is a promising approach to slow down ventricular rate (VR) during atrial fibrillation (AF). Our purpose was to demonstrate that effects on R-R-interval during stable AF can be maintained for several months once optimized and that AVNS affects specifically the nerves innervating the AV-node.     

Ionic self-assembled organogel polyelectrolytes for energy storage applications

High performance organogel polyelectrolytes were synthesized by super acid catalyst step-growth polycondensation of isatin and the non-activated multiring aromatic p-terphenyl. Subsequently, a chemical modification reaction was carried out to obtained quaternary ammonium functionalized polyelectrolytes through a nucleophilic substitution reaction with (3-bromopropyl)trimethylammonium bromide and potassium carbonate at room temperature. Different functionalization degrees were obtained by controlling the molar ratio of the polymer and the modification agent. The organogel polyelectrolytes were formed due to the high phase segregation and self-assembling observed owing to the amphiphilic character of the material (hydrophobic backbone and hydrophilic fragment grafted). The organogel polyelectrolytes were used to fabricate supercapacitors using two commercial graphite electrodes. These polyelectrolytes displayed good ionic conductivity without the use of another doping agent such as salts, acids or ionic liquids. In this work, a strong correlation of functionalization degree and ionic conductivity of the polyelectrolytes and capacitance of the supercapacitors was observed. The ionic conductivity of the polyelectrolytes reached 0.46 mS cm⁻¹ for the 100% functionalization degree, meanwhile the polyelectrolyte with the 10% functionalization degree shows 0.036 mS cm⁻¹. Li-doped polyelectrolytes showed higher ionic conductivity due the presence of extra ionic charges (2.26 and 0.2 mS cm⁻¹ for the polyelectrolytes with the 100% and 10% of functionalization degree, respectively). The principal novelty of this work lies in the possibility of modulating the ionic conductivity of organogels and the capacitance of supercapacitors by chemical modifications. The capacitance of the supercapacitors was 1.17 mF cm⁻² for the 100% functionalized polyelectrolyte and is higher in comparison with the polyelectrolyte with 10% functionalization degree (0.68 mF cm⁻²) measured at a discharge current of 52 μA cm⁻² by galvanostatic charge discharge technique. Additionally, when lithium salt (lithium triflate) was added, the polyelectrolytes retained a gel consistency, increasing the ionic conductivity and capacitance. For the doped polyelectrolytes, the areal capacitance reaches 1.37 mF cm⁻² for the 100% functionalization degree polyelectrolyte with lithium triflate. These organogel polyelectrolytes open the possibility to design flexible and all solid-state supercapacitors without the risk of leakage.

High performance organogel polyelectrolytes were synthesized by super acid catalyst step-growth polycondensation of isatin and the non-activated multiring aromatic p-terphenyl.