Background
Drug‐induced maculopapular exanthemas (MPEs) are mediated by Th1 CD4+ T cells. One of the mechanisms of control of Th1 cells in homeostasis is the interaction between the checkpoint ...inhibitor Tim3 and its physiological ligand galectin‐9 (Gal9). Disorders affecting this axis may be responsible for various autoimmune and immunological diseases. The aim of this study was to determinate the influence of the Tim3‐Gal9 axis on the development of MPE induced by drugs.
Methods
Frequencies of different cell subsets and the expression of Tim3 and Gal9 were measured in peripheral blood by flow cytometry and in skin biopsies by immunohistochemistry. Gal9 expression was assessed by RT‐qPCR; its release was measured by multiplex assay. The effects of blocking or enhancing the Tim3‐Gal9 axis on monocyte‐derived dendritic cell (moDC) maturation and T‐cell proliferation were determined by flow cytometry.
Results
The expression of Tim3 was significantly reduced in peripheral blood Th1 cells and in the skin of MPE patients vs controls. Gal9 expression and release were significantly reduced in patient peripheral blood and moDCs, respectively. The addition of exogenous Gal9 significantly reduced Tim3+ Th1 proliferation, although Treg proliferation increased.
Conclusion
This study showed the involvement of the Tim3‐Gal9 axis in MPE. The reduced expression of Tim3 in Th1 cells together with the impaired expression of Gal9 in PBMCs and DCs appears to have a role in the development of the disease. The potential of Gal9 to suppress Th1 and enhance Treg proliferation makes it a promising tool for treating these reactions.
The reduced level of the checkpoint molecule Tim3 in Th1 cells together with the impaired expression of Gal9 in PBMCs and dendritic cells hampers the control of Th1 cell numbers in patients with drug‐induced maculopapular exanthema (MPE). The reduced expression of Gal9 in patients with drug‐induced MPE could be responsible for the low frequencies of Treg cells in these patients. Exogenous administration of Gal9 could be a potential therapeutic tool able to suppress Th1 and enhance Treg differentiation in patients with drug‐induced MPE.
Background
Over 30% of local allergic rhinitis (LAR) patients self‐report bronchial symptoms suggestive of asthma, but the relationship between the allergen exposure and the bronchial symptoms has ...not been studied.
Objective
To investigate whether a bronchial counterpart of LAR exists.
Methods
Patients were classified by clinical history, skin prick test/serum specific IgE (sIgE), and nasal allergen provocation test (NAPT) into the LAR, allergic rhinitis (AR), and nonallergic rhinitis (NAR) phenotypes. Twenty‐eight LAR, 18 AR, and 19 NAR patients self‐reporting bronchial symptoms suggestive of asthma and 8 healthy controls (HC) were subjected to a methacholine test (MT) before (Visit 1) and 24 hours after (Visit 3) a bronchial provocation test with Dermatophagoides pteronyssinus (BPT‐DP) (Visit 2). Induced sputum and peripheral blood obtained after each MT were analyzed for immune cell populations, tryptase, ECP, and sIgE.
Results
A positive MT was found in 50% of LAR, 83.3% of AR, 57.89% of NAR, and 0% of HC individuals (P = 0.022 AR vs LAR) at V1. BPT‐DP was positive in 8 LAR and 15 AR patients (28% vs 83.3%, P < 0.001), with no positive responses in NAR and HC. All BPT‐DP+ patients experienced a significant decrease of PC20 at V3 vs V1 (P = 0.016 LAR, P ≤ 0.001 AR). BPT‐DP+ patients also showed a significant increase of eosinophils, monocytes, and ECP in induced sputum at V3 compared with V1.
Conclusion
The results suggest the existence of a new asthma phenotype (local allergic asthma) defined by absence of systemic atopy and positivity to BPT with allergen.
Twenty‐eight percent of patients with house dust mite (HDM)–triggered local allergic rhinitis (LAR) and asthma‐like symptoms display positive bronchial allergen provocation test (BAPT) responses. In LAR patients, BAPT induces a significant increase in the airway hyperresponsiveness together with a recruitment and activation of eosinophils and monocytes. Collectively, these findings suggest the existence of differentiated asthma phenotype defined by the absence of atopy and positive response to BAPT. NAPT: Nasal allergen provocation test
This study explores consumers’ desire for purchase of luxury fashion motivated by envy. Strong benign and malicious envies are psychological forces leading to action in various human endeavors ...including the purchase of products. Luxury fashion purchase and use in social settings motivated by envy is an attempt by some consumers to demonstrate social status and to claim success by targeting, matching, or exceeding the envied others. The conceptual models developed to guide this study enable comparing the influences of benign and malicious envies through the processes of admiration, affiliation and moral disengagement leading to the desire to purchase luxury fashion. Data collected from 202 shoppers in a mall intercept in Lisbon indicate that benign envy, as compared to malicious envy, is a stronger predictor of desire to purchase luxury fashion items and is a motivation to improve social image, project success and allow positive comparison with the desired social status. Theoretical and managerial implications are discussed.
•Benign envy is strongly related to admiration and affiliation with the object of envy.•Benign envy can predict the desire to buy luxury brands.•Promoting through benign envy is advantageous.•Malicious envy is a destructive emotion and triggers moral disengagement.•Moral disengagement mediates malicious envy and buying desire.
Pollen grains are among the main causes of respiratory allergies worldwide and hence they are routinely monitored in urban environments. However, their sources can be located farther, outside cities' ...borders. So, the fundamental question remains as to how frequent longer-range pollen transport incidents are and if they may actually comprise high-risk allergy cases. The aim was to study the pollen exposure on a high-altitude location where only scarce vegetation exists, by biomonitoring airborne pollen and symptoms of grass pollen allergic individuals, locally.
The research was carried out in 2016 in the alpine research station UFS, located at 2650 m height, on the Zugspitze Mountain in Bavaria, Germany. Airborne pollen was monitored by use of portable Hirst-type volumetric traps. As a case study, grass pollen-allergic human volunteers were registering their symptoms daily during the peak of the grass pollen season in 2016, during a 2-week stay on Zugspitze, 13–24 June. The possible origin of some pollen types was identified using back trajectory model HYSPLIT for 27 air mass backward trajectories up to 24 h.
We found that episodes of high aeroallergen concentrations may occur even at such a high-altitude location. More than 1000 pollen grains m−3 of air were measured on the UFS within only 4 days. It was confirmed that the locally detected bioaerosols originated from at least Switzerland, and up to northwest France, even eastern American Continent, because of frequent long-distance transport. Such far-transported pollen may explain the observed allergic symptoms in sensitized individuals at a remarkable rate of 87 % during the study period.
Long-distance transport of aeroallergens can cause allergic symptoms in sensitized individuals, as evidenced in a sparse-vegetation, low-exposure, ‘low-risk’ alpine environment. We strongly suggest that we need cross-border pollen monitoring to investigate long-distance pollen transport, as its occurrence seems both frequent and clinically relevant.
Display omitted
•Pollen exposure and allergic symptoms were monitored on low-vegetation German Alps.•The possible origin of airborne pollen types was identified using back trajectory modelling.•We found >1000 pollen grains m−3 of air on the Alps within only 4 days.•Pollen originated most frequently from at least Switzerland, up to France and Canada.•Far-transported pollen may explain allergic symptoms at a rate of 87 %.
Online peer-to-peer communities provide environments in which people with similar health concerns can interact and exchange information that can support self-care of long-term conditions. However, ...current theories have not adequately accounted for how self-care support is enacted in online communities. We conducted an observational netnography to identify and analyze posts in a publicly accessible online community (discussion forum boards) designed for older people. A Straussian grounded theory approach was used to examine 659 posts in health-related message boards. Self-care support involved the construction of three interrelated identities: (1) the support seeking self, in which members described problems and requested information; (2) the empathizing self, in which they described similar experiences and offered support; and (3) the influencing self, in which they provided information or advice. Online communities appear to be an important source of peer support and information and may be a cost-effective approach to supplement standard care.
Exposure to environmental pollutants is linked to increased risk of cardiovascular disease. Beyond the extensive evidence for particulate air pollution, accumulating evidence supports that exposure ...to nonessential metals such as lead, cadmium, and arsenic is a significant contributor to cardiovascular disease worldwide. Humans are exposed to metals through air, water, soil, and food and extensive industrial and public use. Contaminant metals interfere with critical intracellular reactions and functions leading to oxidative stress and chronic inflammation that result in endothelial dysfunction, hypertension, epigenetic dysregulation, dyslipidemia, and changes in myocardial excitation and contractile function. Lead, cadmium, and arsenic have been linked to subclinical atherosclerosis, coronary artery stenosis, and calcification as well as to increased risk of ischemic heart disease and stroke, left ventricular hypertrophy and heart failure, and peripheral artery disease. Epidemiological studies show that exposure to lead, cadmium, or arsenic is associated with cardiovascular death mostly attributable to ischemic heart disease. Public health measures reducing metal exposure are associated with reductions in cardiovascular disease death. Populations of color and low socioeconomic means are more commonly exposed to metals and therefore at greater risk of metal-induced cardiovascular disease. Together with strengthening public health measures to prevent metal exposures, development of more sensitive and selective measurement modalities, clinical monitoring of metal exposures, and the development of metal chelation therapies could further diminish the burden of cardiovascular disease attributable to metal exposure.
To assess the effects of consumer engagement in health care policy, research and services. We updated a review published in 2006 and 2009 and revised the previous search strategies for key databases ...(The Cochrane Central Register of Controlled Trials; MEDLINE; EMBASE; PsycINFO; CINAHL; Web of Science) up to February 2020. Selection criteria included randomised controlled trials assessing consumer engagement in developing health care policy, research, or health services. The International Association for Public Participation, Spectrum of Public Participation was used to identify, describe, compare and analyse consumer engagement. Outcome measures were effects on people; effects on the policy/research/health care services; or process outcomes. We included 23 randomised controlled trials with a moderate or high risk of bias, involving 136,265 participants. Most consumer engagement strategies adopted a consultative approach during the development phase of interventions, targeted to health services. Based on four large cluster-randomised controlled trials, there is evidence that consumer engagement in the development and delivery of health services to enhance the care of pregnant women results in a reduction in neonatal, but not maternal, mortality. From other trials, there is evidence that involving consumers in developing patient information material results in material that is more relevant, readable and understandable for patients, and can improve knowledge. Mixed effects are reported of consumer-engagement on the development and/or implementation of health professional training. There is some evidence that using consumer interviewers instead of staff in satisfaction surveys can have a small influence on the results. There is some evidence that consumers may have a role in identifying a broader range of health care priorities that are complementary to those from professionals. There is some evidence that consumer engagement in monitoring and evaluating health services may impact perceptions of patient safety or quality of life. There is growing evidence from randomised controlled trials of the effects of consumer engagement on the relevance and positive outcomes of health policy, research and services. Health care consumers, providers, researchers and funders should continue to employ evidence-informed consumer engagement in their jurisdictions, with embedded evaluation. Systematic review registration: PROSPERO CRD42018102595.
Objective
To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion.
Design
We used the mixed-methods design with concurrent ...triangulation of a retrospective cohort and a qualitative study.
Setting
Economically disadvantaged areas in rural Australia.
Participants
Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status.
Main measures
A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28).
Results
Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57–0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00–1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02–2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14–2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18–0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion.
Conclusions
Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes.
Hyperspectral imaging (HSI) is a non-ionizing and non-contact imaging technique capable of obtaining more information than conventional RGB (red green blue) imaging. In the medical field, HSI has ...commonly been investigated due to its great potential for diagnostic and surgical guidance purposes. However, the large amount of information provided by HSI normally contains redundant or non-relevant information, and it is extremely important to identify the most relevant wavelengths for a certain application in order to improve the accuracy of the predictions and reduce the execution time of the classification algorithm. Additionally, some wavelengths can contain noise and removing such bands can improve the classification stage. The work presented in this paper aims to identify such relevant spectral ranges in the visual-and-near-infrared (VNIR) region for an accurate detection of brain cancer using in vivo hyperspectral images. A methodology based on optimization algorithms has been proposed for this task, identifying the relevant wavelengths to achieve the best accuracy in the classification results obtained by a supervised classifier (support vector machines), and employing the lowest possible number of spectral bands. The results demonstrate that the proposed methodology based on the genetic algorithm optimization slightly improves the accuracy of the tumor identification in ~5%, using only 48 bands, with respect to the reference results obtained with 128 bands, offering the possibility of developing customized acquisition sensors that could provide real-time HS imaging. The most relevant spectral ranges found comprise between 440.5-465.96 nm, 498.71-509.62 nm, 556.91-575.1 nm, 593.29-615.12 nm, 636.94-666.05 nm, 698.79-731.53 nm and 884.32-902.51 nm.
Background
PGF2α is commonly given at the end of embryo flushing (EF) to shorten the interval to the next oestrus and ovulation.
Objectives
To determine the effect of repeated EF on plasma ...progesterone concentration, percentage of mares with endometritis, unwanted pregnancy and subsequent fertility in mares flushed without the use of PGF2α.
Study design
Controlled experiments.
Methods
Nine mares were inseminated in seven consecutive cycles (n = 63), to either perform an EF (n = 54) 7–9 days after ovulation or left pregnant (n = 9). PGF2α was not used to induce oestrus. Ultrasound examination and blood sampling were performed just before the EF and 72 h later to determine changes in progesterone concentration and signs of endometritis.
Results
The overall percentage of positive EF/pregnancy was 55.5% (30/54) and 66.7% (6/9), respectively. The likelihood of pregnancy/positive EF in the first three cycles was 55.5% (15/29). This was not different (p > 0.1) from the fertility of the last four cycles (69.4%, 25/36). In five EF cycles (9.3%), mares had signs of endometritis and early luteolysis (progesterone <2 ng/mL) 72 h after EF. The reduction in progesterone concentration by 72 h after EF was greater (p < 0.05) for Day 9 (−2.3 ± 0.7 ng/mL) than Day 7 (−1.0 ± 0.8 ng/mL) or Day 8 (−1.3 ± 1.1 ng/mL) cycles. The progesterone concentration in non‐flushed mares did not vary significantly during the sampled period (Day 7–12). There were 5 cycles in which the donor mare remained pregnant after the EF, although four were from a single mare.
Main limitations
The mare population was limited to barren and maiden mares. The cycle order and operator allocation to each EF were not randomised.
Conclusions
EF induces a subtle, but significant reduction in progesterone concentrations compared with non‐EF cycles. However, the percentage of mares with EF‐induced full luteolysis is low (9.3%). The fertility of mares after repeated EF without administration of PGF2α was unaffected; however, there is a considerable risk of unwanted pregnancy (5/27 = 18.5%) in donors from which an embryo was not recovered.
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