Serum melatonin levels during the first seven days of severe sepsis diagnosis are associated with sepsis severity and mortality

Objective

Higher serum melatonin levels have previously been found in patients with severe sepsis who died within 30 days of diagnosis than in survivors. The objective of our study were to determine whether serum melatonin levels during the first seven days of severe sepsis diagnosis could be associated with sepsis severity and mortality.

Role of the fibroblast growth factor receptor axis in cholangiocarcinoma

Advanced cholangiocarcinoma (CCA) is a highly lethal disease with limited therapeutic options beyond cytotoxic chemotherapy. Molecular profiling of CCA has provided insights into the pathogenesis of this disease and identified potential therapeutic targets. The fibroblast growth factor receptor (FGFR) axis is important for maintaining tissue homeostasis. Aberrations in FGFR activity have been implicated in the development and progression of CCA and other malignancies, which has generated significant interest in exploring FGFR's therapeutic potential. FGFR2 fusion events are present in up to 17% of intrahepatic CCAs and appear to predict sensitivity to FGFR inhibitors even after progression on chemotherapy. These observations have led to a clinical trial evaluating FGFR inhibition in patients with CCA enriched for FGFR alterations. This review summarizes current knowledge about the role of the FGFR pathway in cholangiocarcinogenesis and ongoing work in developing FGFR‐directed therapies as an antineoplastic strategy for CCA.     

Estimated incidence of influenza-virus-associated severe pneumonia in children in El Salvador, 2008�C2010

Objective

To estimate the incidence of influenza-virus-associated severe pneumonia among Salvadorian children aged < 5 years.

Methods

Data on children aged < 5 years admitted with severe pneumonia to a sentinel hospital in the western region were collected weekly. Nasal and oropharyngeal swab specimens were collected from a convenience sample of case patients for respiratory virus testing. A health-care utilization survey was conducted in the hospital catchment area to determine the proportion of residents who sought care at the hospital. The incidence of influenza-virus-associated severe pneumonia among all Salvadorian children aged < 5 years was estimated from surveillance and census data, with adjustment for health-care utilization. Influenza virus strains were characterized by the United States Centers for Disease Control and Prevention to determine their correspondence with northern and southern hemisphere influenza vaccine formulations.

Findings

Physicians identified 2554 cases of severe pneumonia. Samples from 608 cases were tested for respiratory viruses and 37 (6%) were positive for influenza virus. The estimated incidence of influenza-virus-associated severe pneumonia was 3.2 cases per 1000 person–years (95% confidence interval, CI: 2.8–3.7) overall, 1.5 cases per 1000 person–years (95% CI: 1.0–2.0) during 2008, 7.6 cases per 1000 person–years (95% CI: 6.5–8.9) during 2009 and 0.6 cases per 1000 person–years (95% CI: 0.3–1.0) during 2010. Northern and southern hemisphere vaccine formulations matched influenza virus strains isolated during 2008 and 2010.

Conclusion

Influenza-virus-associated severe pneumonia occurred frequently among young Salvadorian children during 2008–2010. Antigens in northern and southern hemisphere influenza vaccine formulations corresponded to circulating strains.     

Reliability of a digital electroneurometer for the determination of motor latency of the median nerve

Measurement of distal motor latencies of the median nerve are often part of electrodiagnostic studies used to verify a diagnosis of peripheral neuropathy. Since electrodiagnostic studies are time consuming, expensive, and impractical for large-scale screening of at-risk individuals, a portable digital electroneurometer was developed for measuring motor latencies as a screening tool for early detection of nerve compression syndromes, including carpal tunnel syndrome. The purpose of this study was to determine the intertester and intratester reliability of a digital electroneurometer in subjects with (n=12) and without (n=20) clinical signs of carpal tunnel syndrome. This study addressed only the reliability and not the validity of this device. Using a repeated measures design, three evaluators performed two distal motor latency tests on the median nerve of each of the subjects. Pearson product-moment correlations for intratester reliability ranged from 0.94 to 0.99, and the intraclass correlation coefficient for intertester reliability was 0.96. Two examiners obtained statistically larger latency values on the second test, although these differences are judged to be clinically insignificant. Use of an electroneurometer may expand motor latency testing to a wider variety of settings.     

Estimation of serum β-2-microglobulin in children with malabsorption disorders syndrome

The aim of this study was to examine serum levels of β-2-microglobulin (b-2-m) in 132 children at various stages for the evaluation of celiac disease (CD). Serum b-2-m was analyzed by a radio immunossay (RIA) method, using a β-2-micro RIA kit (Pharmacia, Uppsala, Sweden). The mean concentration of b-2-m in children with an established diagnosis of CD was 4.38±1.86 mg/l. In children receiving a gluten-free diet, the mean b-2-m concentration was 1.95±1.09mg/l, and in children who received a gluten-containing diet, the concentration was 3.19±0.71mg/l. In children with CD who were on a gluten-free diet and who presented no antibodies against EmA in class IgA serum, b-2-m concentration was within the normal range (1.86±0.55mg/l). The concentration of b-2-m in children with secondary malabsorption syndrome was within the physiological range (1.77±0.64mg/l). In children with IgA-EmA antibodies present in serum, the b-2-m concentration was significantly higher (3.5±1.23mg/l;P<0.001) than that in children with IgA-EmA in serum. We showed a linear dependence between the degree of villous atrophy in CD and concentrations of b-2-m in serum (r ²=0.94). Determination of b-2-m concentration in sera of children with CD may be used to monitor treatment with a gluten-free diet and to differentiate secondary malabsorption syndrome from CD.     

Novel gastric sleeve magnetic implant: safety and efficacy in rats

BackgroundThe prevalence of obesity is growing worldwide and has reached epidemic proportions. Vertical sleeve gastrectomy, which requires irreversible removal of gastric tissue, is considered an effective weight loss treatment of severe obesity. The aim of the present study was to evaluate the feasibility of a reversible gastric sleeve magnetic implant that mimics the vertical sleeve gastrectomy without the gastrectomy for weight loss in a group of normal and obese rats.MethodsA group of Zucker fatty rats either underwent surgical implantation or a sham operation and were followed up for 6 weeks. Also, a group of Wistar rats underwent surgical implantation for 6 weeks, followed by surgical implant removal at 6 weeks, and recovery for an additional 4 weeks. Food intake and body weight were monitored after surgery to determine the efficacy of the device. A histologic examination for all rats was made to evaluate the change in the gastric wall in response to gastric sleeve magnetic implantation.ResultsThe implanted Zucker fatty and Wistar rats showed a statistically significant decrease in food intake and weight gain rate compared with the sham-operated rats (approximately 3%/wk of body weight loss in the treated group). Moreover, the decrease in the weight gain rate was sustained for 4 weeks after removal of the magnetic implant. The histologic evidence revealed an inflammatory mononuclear cell infiltration and mild fibrosis and hyperplasia of blood vessels, as expected for any implant. No significant structural damage, tissue ischemia, hemorrhage, or necrosis was found in the gastric wall.ConclusionOur results have shown that the device is feasible in rats, results in effective weight loss, and can be easily removed. These findings, along with the lack of the need for resection of the native stomach, provide a compelling basis for additional development of the device in large animal models.     

Pesticides exposure in Culturama, Brazil--knowledge, attitudes, and practices

In this study, the knowledge, attitudes, and practices associated with pesticide use and exposure were evaluated in the agricultural community of Culturama, in the state of Mato Grosso do Sul, Brazil. A standardized questionnaire was completed by 250 farm workers aged > or =18 years old. The average age of the studied population was 43.6 years and 17.6% had never been to school. Their farms were small (approximately 30ha) and family operated and did not utilize advanced farming technology. About 92% of the interviewees had worked directly with pesticides and 59.6% reported typical intoxication symptoms. Only 44.3%, however, believe that they had been intoxicated. A significant correlation was found between hand washing after pesticide application and reporting symptoms (P=0.014). Over 90% of the farmers reported using the organophosphorus insecticide methamidophos. A great majority (>90%) considered pesticides to be harmful to human health, but less than 20% used masks, impermeable clothes, or gloves during pesticide application. These results indicate that special educational programs, legislation promoting the use of safer pesticides, and implementation of personal protective measures are necessary to decrease the pesticide exposure of farmers in Culturama.