Juvenile idiopathic arthritis-associated uveitis Sen, Ethan S.; Ramanan, A.V.
Baillière's best practice and research in clinical rheumatology/Baillière's best practice & research. Clinical rheumatology,
August 2017, 2017-Aug, 2017-08-00, 20170801, Volume:
31, Issue:
4
Journal Article
Peer reviewed
Open access
Juvenile idiopathic arthritis (JIA) is the commonest rheumatic disease in children and JIA-associated uveitis its most frequent extra-articular manifestation. The uveitis is potentially ...sight-threatening and thus carries a considerable risk of morbidity with associated reduction in quality of life. The commonest form of uveitis seen in association with JIA is chronic anterior uveitis, which is almost always asymptomatic in the initial stages. Therefore, screening for JIA-associated uveitis in at-risk patients is essential. The aim of early detection and treatment is to minimise intraocular inflammation and to avoid complications that lead to visual loss, which can result from both disease activity and medications. The sight-threatening complications of JIA-associated uveitis include cataracts, glaucoma, band keratopathy, and macular oedema. There is increasing evidence for the early introduction of systemic immunosuppressive therapies to reduce topical and systemic use of glucocorticoids. A recently published randomised controlled trial of adalimumab in JIA-associated uveitis now provides convincing evidence for the use of this biologic in patients who fail to respond adequately to methotrexate. Tocilizumab and abatacept are being investigated as alternatives in children inadequately treated with anti–tumour necrosis factor drugs.
Ovarian cancer is the leading cause of death among all gynecological malignancies due to the development of acquired chemoresistance and disease relapse. Although the role of cancer stem cells ...(CSCs), a subset of tumor cells with the self-renewal and differentiation capabilities, in therapeutic resistance is beginning to be better understood, the significance of epigenetic regulatory mechanisms responsible for integrating the stemness with drug resistance remain poorly understood. Here we identified that lysine demethylase KDM3A as a critical regulator of ovarian cancer stemness and cisplatin resistance by inducing the expressions of pluripotent molecules Sox2 and Nanog and anti-apoptotic B-cell lymphoma 2 (Bcl-2), respectively. In addition, KDM3A induces ovarian cancer growth while antagonizing cellular senescence by repressing the expression of cyclin-dependent kinase inhibitor, p21
. The underlying mechanism of the noted biological processes include KDM3A-mediated stimulation of Sox2 expression, and demethylating p53 protein and consequently, modulating its target genes such as Bcl-2 and p21
expression. Consistently, KDM3A depletion inhibited the growth of subcutaneously implanted cisplatin-resistant human ovarian cancer cells in athymic nude mice. Moreover, KDM3A is abundantly expressed and positively correlated with Sox2 expression in human ovarian cancer tissues. In brief, our findings reveal a novel mechanism by which KDM3A promotes ovarian CSCs, proliferation and chemoresistance and thus, highlights the significance of KDM3A as a novel therapeutic target for resistant ovarian cancer.
•A study of reducing distress in small acute paediatric burns, presenting to outpatient clinic, with distraction therapy.•Two cohorts of patients were recruited: with and without distraction ...therapy.•The Wong Baker TM visual analogue scale (VAS) was used to obtained pain scores at three stages of the consultation.•Distraction therapy by a qualified play specialist reduces pain experienced by 23% or 2 points on the Wong Baker TM VAS.
The majority of patients who sustained small (low % total body surface area TBSA) burns are assessed in an outpatient setting. This can be a traumatic experience, particularly, for paediatric patients. During the initial assessment pharmacological and non-pharmacological adjuncts, such as distraction therapy, can be employed to provide an environment that may reduce and minimise distress.
In this study, we investigated whether distraction therapy reduces objective pain scores during the outpatient assessment of small acute burns in children.
Two cohorts of patients were formed. In the first group (group A), the children received analgesia and routine nursing care. In the second group (group B), the children received specialist distraction therapy in addition to the same analgesia and nursing care.
We recorded patient demographics, TBSA, anatomical sites and mechanism of burn. The Wong Baker™ visual analogue scale (VAS) was used to convert perceived pain, as reported by the patient or parent, into a numerical value at three set intervals during the consultation.
50 patients were recruited with 32 patients in group A and 18 in group B. A larger TBSA positively correlated with higher pain scores (p < 0.05).
At the start of the consultation the mean pain score without distraction therapy was 1.55 and with specialist distraction therapy was 0.33 (p < 0.05). The mean peak pain score during dressing change without distraction therapy was 6.80 and with specialist distraction was 4.47 (p < 0.05). At the end of the procedure, the mean pain score was 2.12 without distraction therapy and with specialist distraction 1.75.
This study of pain scores in small acute paediatric burns has shown that distraction therapy provided by a qualified play specialist can reduce maximal pain by over 2 points on the Wong-Baker™ VAS. Consideration should be given to ensure that distraction therapy is available at all times during initial consultations for children who have sustained small burns.
This study explores the entropy generation analysis on unsteady nonlinear radiative ethylene glycol‐based Casson nanofluid flow near stagnation point towards a stretching sheet through a porous ...medium. Analysis has been accomplished in the presence of an inclined magnetic field, heat generation, homogeneous–heterogeneous reactions, and viscous dissipation with velocity slip and convective boundary conditions. The nondimensional governing equations are solved by the shooting technique with the help of the RK45 method. We have experimented with copper and silver nanoparticles and a comparative analysis has been highlighted for both copper and silver nanofluids. Numerical outcomes are executed by the MATLAB built‐in bvp4c function. The consequences of the experiment for various pertinent flow parameters are portrayed by graphs and tables for both the Ag‐ and Cu‐Casson nanofluids. Results reveal that the enhancement of nanoparticles volume fraction accelerates temperature but it slows down concentration and velocity distributions. Higher values of the Eckert number boost velocity and temperature but reduce skin friction coefficient and Nusselt number. Enhancement of the Brinkman number boosts up entropy generation but it slows down Bejan's number. The results of the model can be applied in the movement of biological fluids, separation of biomolecules, glass manufacturing, paper production, food processing, crude oil purification, polymer drag reduction, and cooling atomic reactors.
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