Rhabdomyolysis and fluctuating asymptomatic hyperCKemia associated with CACNA1S variant.

BACKGROUND AND PURPOSE: CACNA1S encodes Cav 1.1, a voltage sensor for muscle excitation-contraction coupling, which activates the ryanodine receptor 1 (RYR1) leading to calcium release from the sarcoplasmic reticulum. CACNA1S mutations cause hypokalemic periodic paralysis, malignant hyperthermia and congenital myopathy. RYR1 mutations result in congenital myopathy, malignant hyperthermia and rhabdomyolysis. METHODS: The aim was to describe a novel phenotype associated with a CACNA1S variant at a site previously linked to hypokalemic periodic paralysis. RESULTS: The patient presented with fluctuating asymptomatic creatine kinase elevation after an episode of rhabdomyolysis but has no history of periodic paralysis. His muscle biopsy showed core-like structures occurring mainly in type 2 fibers. He carries a novel Cav 1.1 variant (p.Arg528Leu) affecting a highly conserved amino acid. Different mutations at the same location cause hypokalemic periodic paralysis. CONCLUSION: This case underscores the similarity between the phenotypes caused by mutations in two functionally linked proteins, RYR1 and Cav 1.1.

Drug release characteristics of quercetin-loaded TiO2 nanotubes coated with chitosan.

TiO2 nanotubes formed by anodic oxidation of Ti-6Al-7Nb were loaded with quercetin (TNTQ) and chitosan was coated on the top of the quercetin (TNTQC) to various thicknesses. Field emission scanning electron microscopy (FESEM), 3D and 2D analyses were used to characterize the samples. The drug release studies of TNTQ and TNTQC were studied in Hanks' solution for 192h. The studies showed that the native oxide on the sample is substituted by self assembled nanotube arrays by anodisation. FESEM images of chitosan-loaded TNT samples showed that filling of chitosan takes place in inter-tubular space and pores. Drug release studies revealed that the release of drug into the local environment during that duration was constant. The local concentration of the drug can be controlled and tuned by controlling the thickness of the chitosan (0.6, 1 and 3µm) to fit into an optimal therapeutic window in order to treat postoperative infections, inflammation and for quick healing with better osseointegration of the titanium implants.

Electrochemical behavior and effect of heat treatment on morphology, crystalline structure of self-organized TiO2 nanotube arrays on Ti-6Al-7Nb for biomedical applications.

In the present work, we investigate the formation of self-organized titanium oxide nanotube layers by anodic oxidation on titanium alloy Ti-6Al-7Nb in electrolyte solution containing sulfuric acid and hydrofluoric acid. The anodized surface was characterized by micro-Raman, X-ray diffraction (XRD), field emission scanning electron microscopy (FESEM) and energy-dispersive X-ray spectroscopy (EDS). The corrosion behavior of the treated and untreated samples was investigated through electrochemical impedance spectroscopy (EIS) and potentiodynamic polarization studies in simulated body fluid (Hanks' solution). The investigations show that the native oxide on the sample is replaced by self-assembled nanoarray by anodization. FESEM of samples annealed at 450 to 800 °C show tubular morphology whereas those annealed at 850 °C show collapse of nanotubes. Electrochemical impedance data of the substrate and 10 V anodized samples were fitted with a two-time constant equivalent circuit and that of anodized samples (20, 30 V) with a three-time constant equivalent circuit.

Response surface modeling for optimization heterocatalytic Fenton oxidation of persistence organic pollution in high total dissolved solid containing wastewater.

The rice-husk-based mesoporous activated carbon (MAC) used in this study was precarbonized and activated using phosphoric acid. N2 adsorption/desorption isotherm, X-ray powder diffraction, electron spin resonance, X-ray photoelectron spectroscopy and scanning electron microscopy, transmission electron microscopy, (29)Si-NMR spectroscopy, and diffuse reflectance spectroscopy were used to characterize the MAC. The tannery wastewater carrying high total dissolved solids (TDS) discharged from leather industry lacks biodegradability despite the presence of dissolved protein. This paper demonstrates the application of free electron-rich MAC as heterogeneous catalyst along with Fenton reagent for the oxidation of persistence organic compounds in high TDS wastewater. The heterogeneous Fenton oxidation of the pretreated wastewater at optimum pH (3.5), H2O2 (4 mmol/L), FeSO4[Symbol: see text]7H2O (0.2 mmol/L), and time (4 h) removed chemical oxygen demand, biochemical oxygen demand, total organic carbon and dissolved protein by 86, 91, 83, and 90%, respectively.

Development and characterization of coaxially electrospun gelatin coated poly (3-hydroxybutyric acid) thin films as potential scaffolds for skin regeneration.

The morphology of fibers synthesized through electrospinning has been found to mimic extracellular matrix. Coaxially electrospun fibers of gelatin (sheath) coated poly (3-hydroxybutyric acid) (PHB) (core) was developed using 2,2,2 trifluoroethanol(TFE) and 1,1,1,3,3,3 hexafluoro-2-propanol(HFIP) as solvents respectively. The coaxial structure and coating of gelatin with PHB fibers was confirmed through transmission electron microscopy (TEM), scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS). Thermal stability of the coaxially electrospun fibers was analyzed using thermogravimetric analysis(TGA), differential scanning calorimetry(DSC) and differential thermogravimetric analysis(DTA). Complete evaporation of solvent and gelatin grafting over PHB fibers was confirmed through attenuated total reflection-Fourier transformed infrared spectroscopy (ATR-FTIR). The coaxially electrospun fibers exhibited competent tensile properties for skin regeneration with high surface area and porosity. In vitro degradation studies proved the stability of fibers and its potential applications in tissue engineering. The fibers supported the growth of human dermal fibroblasts and keratinocytes with normal morphology indicating its potential as a scaffold for skin regeneration.

Investigation of electrochemical behavior of nitrogen implanted Ti-15Mo-3Nb-3Al alloy in Hank's solution.

Titanium alloy Ti-15-3-3 (Beta-21S) was implanted with nitrogen ions by plasma immersion ion implantation at 700, 750 and 800 °C. Micro Raman and XPS results confirm the formation of nitrides after implantation. Corrosion current density (icorr) of the treated samples in simulated body fluid (Hank's solution) is higher than that of the substrate. Treated samples also exhibit lower charge transfer resistance and higher double layer capacitance as compared to that of substrate in electrochemical impedance spectroscopic studies. However, no corrosion related effects are observed after 28 days of immersion in SBF. EDS results show the presence of oxygen after corrosion studies. XPS spectra from the implanted samples show the presence of nitride and oxynitride on the surface and formation of oxide due to corrosion process.

Is the prevalence of asthma declining? Systematic review of epidemiological studies.

Asthma prevalence has increased very considerably in recent decades such that it is now one of the commonest chronic disorders in the world. Recent evidence from epidemiological studies, however, suggests that the prevalence of asthma may now be declining in many parts of the world, which, if true is important for health service planning and also because this offers the possibility of generating and testing new aetiological hypotheses. Our objective was to determine whether the prevalence of asthma is declining worldwide. We undertook a systematic search of EMBASE, Medline, Web of Science and Google Scholar, for high quality reports of cohort studies, repeat cross-sectional studies and analyses of routine healthcare datasets to examine international trends in asthma prevalence in children and adults for the period 1990-2008. There were 48 full reports of studies that satisfied our inclusion criteria. The large volume of data identified clearly indicate that there are, at present, no overall signs of a declining trend in asthma prevalence; on the contrary, asthma prevalence is in many parts of the world still increasing. The reductions in emergency healthcare utilization being reported in some economically developed countries most probably reflect improvements in quality of care. There remain major gaps in the literature on asthma trends in relation to Africa and parts of Asia. There is no overall global downward trend in the prevalence of asthma. Healthcare planners will for the foreseeable future, therefore, need to continue with high levels of anticipated expenditure in relation to provision of asthma care.

Epidemiology and disease burden from allergic disease in Scotland: analyses of national databases.

BACKGROUND: There are ongoing concerns about the quality of care provided to patients with allergic disorders in Scotland, but there are relatively few reliable data on the overall disease burden. We sought to: (1) describe the incidence, prevalence and outcome of allergic disorders; (2) estimate healthcare burden and costs; and (3) investigate ethnic variations in the epidemiology and outcomes from allergic disorders in Scotland. DATA SOURCES: national surveys; primary care data; prescribing and medication data; hospital admissions data and mortality data. RESULTS: Allergic disorders are extremely common in Scotland, affecting about one in three of the population at some time in their lives. Incidence was highest for eczema (10.2 per 1000 registered patients). Over 4% of all GP consultations and 1.5% of hospital admissions were for allergic disorders. There were 100 asthma deaths in 2005 (20 per million people). Direct healthcare costs for allergic disorders were an estimated pound130 million per year, the majority of these being incurred in primary care and related to asthma. CONCLUSIONS: Allergic disorders are common in Scotland and given the very high proportion of children now affected, the high disease burden associated with these conditions is likely to persist for many decades.

Omega 3 and 6 oils for primary prevention of allergic disease: systematic review and meta-analysis.

BACKGROUND: There is conflicting evidence on the use of omega 3 and omega 6 supplementation for the prevention of allergic diseases. We conducted a systematic review evaluating the effectiveness of omega 3 and 6 oils for the primary prevention of sensitization and development of allergic disorders. METHODS: We searched The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, LILACS, PsycInfo, AMED, ISI Web of Science and Google Scholar for double-blind randomized controlled trials. Two authors independently assessed articles for inclusion. Meta-analyses were undertaken using fixed effects modelling, or random effects modelling in the event of detecting significant heterogeneity. RESULTS: Of the 3129 articles identified, 10 reports (representing six unique studies) satisfied the inclusion criteria. Four studies compared omega 3 supplements with placebo and two studies compared omega 6 supplements with placebo. There was no clear evidence of benefit in relation to reduced risk of allergic sensitization or a favourable immunological profile. Meta-analyses failed to identify any consistent or clear benefits associated with use of omega 3 [atopic eczema: RR = 1.10 (95% CI 0.78-1.54); asthma: RR = 0.81 (95% CI 0.53-1.25); allergic rhinitis: RR = 0.80 (95% CI 0.34-1.89) or food allergy RR = 0.51 (95% CI 0.10-2.55)] or omega 6 oils [atopic eczema: RR = 0.80 (95% CI 0.56-1.16)] for the prevention of clinical disease. CONCLUSIONS: Contrary to the evidence from basic science and epidemiological studies, our systematic review and meta-analysis suggests that supplementation with omega 3 and omega 6 oils is probably unlikely to play an important role as a strategy for the primary prevention of sensitization or allergic disease.

Nasopharyngeal cancer incidence and survival in Scotland, 1975-2001.

OBJECTIVES: To investigate trends in the incidence of, and survival from, nasopharyngeal cancer in Scotland during the period 1975-2001. DESIGN: Descriptive epidemiological study. SETTING: Scotland. PARTICIPANTS: The anonymised records of 556 patients diagnosed with nasopharyngeal cancer (ICD-9 147; ICD-10 C11) in Scotland between 1975 and 2001, and held on the Scottish Cancer Registry. MAIN OUTCOME MEASURES: Incidence rates, and relative survival at 1, 3 and 5 years for defined age groups and time periods. RESULTS: There was no clear trend in age-standardised incidence rates of nasopharyngeal cancer throughout the study period, although age-specific incidence rates do suggest a downward trend among older age groups, especially in men. The trend in incidence with deprivation was significant for both males (P = 0.011) and females (P = 0.004). Survival from nasopharyngeal cancer has improved for all age groups over time, although survival still decreases with age. In the 15-44 age group, 5 year relative survival was 84% in patients diagnosed during 1995-2001 compared to 46% in those diagnosed during 1975-1979. Survival was higher among patients from the most affluent quintile (P = 0.004). CONCLUSIONS: In Scotland, age-standardised incidence rates of nasopharyngeal cancer have remained relatively stable over the last 25 years. Survival has improved across all age groups in recent years, but is higher in younger patients, and in residents of the most affluent socio-economic areas.

Will Systematized Nomenclature of Medicine-Clinical Terms improve our understanding of the disease burden posed by allergic disorders?

Analysis of data collected through the use of high-quality computerized systems is vital if we are to understand the health burden from allergic disease. Coding systems currently used, such as the World Health Organization's International Classification of Diseases and the Read system, have however been criticized as being unduly restrictive and hence inadequate for the detailed coding of allergic problems. Greater granularity of coding can be achieved by using the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) system, which will be adopted by several countries including the United States and United Kingdom. Before the introduction of SNOMED-CT, it is important that several issues are resolved, including ensuring that adequate mapping occurs from existing systems, that the SNOMED-CT is trialled before general implementation, and that training is provided for users new to coding as part of their clinical practice. Of particular importance is that the allergy fraternity bring to light any gaps in allergy coding through the creation of a working group to advise the newly formed International Healthcare Terminology Standards Development Organisation. There is also a role for allergy experts, working in conjunction with government agencies and professional bodies, to determine a recommended set of codes, which will obviate some of the inevitable challenges raised by a very fluid coding structure for those wishing to undertake secondary analysis of health care datasets.

Exploiting the potential of routine data to better understand the disease burden posed by allergic disorders.

The Department of Health and Scottish Executive are currently undertaking independent reviews of allergy services in England (and Wales) and Scotland. Each review will assess the disease burden posed by allergic problems, involving secondary analyses of routine National Health Service (NHS) datasets. Major suggestions for re-structuring and/or re-focusing the NHS efforts to better deal with allergic disease are anticipated. The UK has some of the best datasets of routine health data in the world, but despite their strengths, they have important limitations. These include gaps in data collection, particularly in relation to monitoring of Accident & Emergency and out-patient consultations, and in-patient prescribing, thereby resulting in considerable under-estimates of hospital workload. The current gaps in service monitoring are likely to under-estimate the burden and workload associated with allergic problems, particularly in secondary care. One major limitation of existing data sources is the general inability to link individual patient level data between different datasets. By unlocking this potential there are very considerable potential gains to be made. Data linkage techniques currently being developed in the UK offer exciting new possibilities of looking across the primary-, secondary- and tertiary-care interfaces and also assessing short-and long-term social and educational outcomes in relation to allergic disorders. The current reviews of allergy services being undertaken need to be cognisant of these inherent limitations of existing data sources and would do well to recommend strategic initiatives that could enhance the availability, accessibility and quality of these datasets. Ideally, this should include investment in central data repositories staffed by teams with the necessary technical and statistical expertise, which would also take responsibility for progressing data linkage capabilities.