Four-Duct Ligation for the Treatment of Sialorrhea in Children.

IMPORTANCE: The 4-duct ligation procedure has appeal for its surgical simplicity and limited invasiveness in the management of pediatric sialorrhea. However, more information is required to understand the benefits, risks, success rates, and long-term effects of this intervention. OBJECTIVES: To report the clinical outcomes of the 4-duct ligation procedure in pediatric patients diagnosed as having sialorrhea and the associated complication rates and to characterize patient and caregiver satisfaction in a consecutive series. DESIGN, SETTING, AND PARTICIPANTS: This investigation was a retrospective cohort study at an academic tertiary pediatric center and pediatric rehabilitation hospital. Patients included 38 children with neurological impairment who underwent a 4-duct salivary gland ligation (parotid and submandibular glands) between January 1, 2004, and July 31, 2012. The dates of the analysis were August 2013 through February 2015. MAIN OUTCOMES AND MEASURES: Posttreatment assessments included duration of effect, severity and frequency of drooling before and after the procedure, patient complications, caregiver satisfaction, caregiver recommendation of the procedure, and caregiver overall assessment of the child's quality of life. Clinical and outcome measures were collected before the procedure, 1 month after the procedure, 1 year after the procedure, and at the most recent follow-up (range, 3-8 years). RESULTS: The study cohort comprised 38 participants. Their median age was 11 years (age range, 5-17 years), and 37% (14 of 38) were female. The mean (SD) duration of effect was 52.6 (20.4) months. Patients with previous sialorrhea management were more likely to demonstrate an improvement in their drooling frequency score at 1 year. Thirteen complications were documented in 12 patients. The most common complications were persistent facial swelling and aspiration pneumonia. Eighty percent (28 of 35) of caregivers reported an improvement in their child's drooling at 1 month, while 69% (25 of 36) and 71% (24 of 34) stated that there was an improvement at the 1-year follow-up and the most recent follow-up, respectively. CONCLUSIONS AND RELEVANCE: The 4-duct ligation procedure offers a simple, effective, and minimally invasive approach to the management of sialorrhea in children.

Insulitis and ß-Cell Mass in the Natural History of Type 1 Diabetes.

Descriptions of insulitis in human islets throughout the natural history of type 1 diabetes are limited. We determined insulitis frequency (the percent of islets displaying insulitis to total islets), infiltrating leukocyte subtypes, and ß-cell and α-cell mass in pancreata recovered from organ donors with type 1 diabetes (n = 80), as well as from donors without diabetes, both with islet autoantibodies (AAb(+), n = 18) and without islet autoantibodies (AAb(-), n = 61). Insulitis was observed in four of four donors (100%) with type 1 diabetes duration of ≤1 year and two AAb(+) donors (2 of 18 donors, 11%). Insulitis frequency showed a significant but limited inverse correlation with diabetes duration (r = -0.58, P = 0.01) but not with age at disease onset. Residual ß-cells were observed in all type 1 diabetes donors with insulitis, while ß-cell area and mass were significantly higher in type 1 diabetes donors with insulitis compared with those without insulitis. Insulitis affected 33% of insulin(+) islets compared with 2% of insulin(-) islets in donors with type 1 diabetes. A significant correlation was observed between insulitis frequency and CD45(+), CD3(+), CD4(+), CD8(+), and CD20(+) cell numbers within the insulitis (r = 0.53-0.73, P = 0.004-0.04), but not CD68(+) or CD11c(+) cells. The presence of ß-cells as well as insulitis several years after diagnosis in children and young adults suggests that the chronicity of islet autoimmunity extends well into the postdiagnosis period. This information should aid considerations of therapeutic strategies seeking type 1 diabetes prevention and reversal.

Health-related quality of life in long-term survivors of paediatric liver transplantation.

BACKGROUND: Long-term survival after paediatric liver transplantation is now the rule rather than the exception. Improving long-term outcomes after transplantation must consider not only the quantity but also the quality of life years restored. OBJECTIVES: To characterize health-related quality of life (HRQOL) of LT recipients ≥15 years after paediatric LT. METHODS: Recipients of a paediatric LT performed before December 1996 in a single institution with continuous follow-up at either the paediatric or adult partner centre were identified. Patients with severe developmental or neurological impairment were excluded. HRQOL was assessed using the Pediatric Quality of Life Inventory 4.0, the Medical Outcomes Study Short Form-36 version 2 and the Pediatric Liver Transplant Quality of Life Tool. RESULTS: A total of 27 (67% male) subjects (mean age 24.3±6.7 years [median 23.2 years; range 16.6 to 40.3 years]) participated. The median age at transplant was 1.7 years (range 0.5 to 17.0 years). Seven (26%) participants underwent retransplantation. Seventeen (63%) participants were engaged in full-time work/study. Mean Short Form-36 version 2 scores included physical (49.6±11.1) and mental (45.3±12.5) subscale scores. The mean score for the disease-specific quality of life tool for paediatric liver transplant recipients (the Pediatric Liver Transplant Quality of Life Tool) was 64.70±15.2. The physical health of the young adults strongly correlated with level of involvement in work/study (r=0.803; P<0.05). CONCLUSIONS: The self-reported HRQOL of participants <18 years of age was comparable with a standardized healthy population. In contrast, participants between 18 and 25 years of age had HRQOL scores that were more similar to a group with chronic illness. Participants engaged in full-time work/study experienced enhanced physical health.

HISTORIQUE: La survie à long terme après une transplantation du foie (TF) en pédiatrie est maintenant la règle plutôt que l'exception. Il faut tenir compte à la fois de la quantité et de la qualité des années de vie récupérées dans l'amélioration des résultats après la TF. OBJECTIFS: Caractériser la qualité de vie liée à la santé (QdVLS) des greffés du foie de 15 ans et plus après une TF en pédiatrie. MÉTHODOLOGIE: Les chercheurs ont dépisté des greffés du foie opérés avant décembre 1996 dans un seul établissement et recevant un suivi continu au centre pédiatrique ou au centre partenaire pour adultes. Les patients ayant une grave atteinte développementale et neurologique étaient exclus. La QdVLS était évaluée au moyen de l'inventaire de la qualité de vie en pédiatrie 4.0, de la version 2 du formulaire court sur les résultats médicaux en 36 questions et de l'outil sur la qualité de vie des greffés du foie en pédiatrie. RÉSULTATS: Au total, 27 sujets (67 % d'hommes, âge moyen de 24,3±6,7 ans [médiane de 23,2 ans; plage de 16,6 à 40,3 ans]) ont participé. Ils avaient un âge médian de 1,7 an au moment de la transplantation (plage de 0,5 à 17,0 ans). Sept participants (26 %) ont dû subir une autre transplantation. Dix-sept participants (63 %) travaillaient ou étudiaient à temps plein. La version 2 du formulaire court en 36 questions incluait des scores de sous-échelle physique (49,6±11,1) et mentale (45,3±12,5). Le score moyen pour l'outil de qualité de vie propre à la maladie (outil de qualité de vie des greffés du foie en pédiatrie) était de 64,70±15,2. La santé physique des jeunes adultes était fortement corrélée avec le taux d'investissement dans le travail ou l'étude (r=0,803, P<0,05). CONCLUSIONS: La QdVLS autodéclarée des participants de moins de 18 ans était comparable à celle d'une population en santé standardisée. En revanche, les participants de 18 à 25 ans avaient un score de QdVLS qui ressemblait davantage à celui d'un groupe ayant une maladie chronique. Les participants qui s'investissaient dans un emploi ou des études à temps plein présentaient une meilleure santé physique.

High strain-rate response of injectable PAA hydrogel.

Hydrogel materials have been widely considered as potential soft tissue replacements because of their high permeability, hydrophilicity, and biocompatibility, as well as their low coefficient of friction. Injectable (thermo-responsive) hydrogels can provide support and cushioning at irregularly shaped disease sites, and are thus suitable for use in treating osteoarthritis or degenerative disc disease. However, while some injectable hydrogels have been proven to sustain human body weight during daily activities, their mechanical properties under harsh dynamic conditions have not been well documented. A specified injectable polyacrylic acid (PAA) hydrogel was prepared for this study. To simulate sudden impacts or unexpected shocks to the PAA hydrogel, the split Hopkinson pressure bar technique was utilized. The dynamic responses of various hydrogels at confined high strain rates (100-2590 s(-1)) were presented. Hydrogel specimens with 3.37, 6.75, and 13.5% acrylic acid (AAc) concentrations were tested in the following three different material conditions: raw, phosphate-buffered saline (PBS) swollen, and PBS swollen with elevated temperature (37 °C). The dynamic bulk moduli of the hydrogels varied from 1.55 to 47.8 MPa depending on the given hydrogel's AAc concentration and swollen condition.

Immunohistochemical detection of a unique protein within cells of snakes having inclusion body disease, a world-wide disease seen in members of the families Boidae and Pythonidae.

Inclusion body disease (IBD) is a worldwide disease in captive boa constrictors (boa constrictor) and occasionally in other snakes of the families Boidae and Pythonidae. The exact causative agent(s) and pathogenesis are not yet fully understood. Currently, diagnosis of IBD is based on the light microscopic identification of eosinophilic intracytoplasmic inclusion bodies in hematoxylin and eosin stained tissues or blood smears. An antigenically unique 68 KDa protein was identified within the IBD inclusion bodies, called IBD protein. A validated immuno-based ante-mortem diagnostic test is needed for screening snakes that are at risk of having IBD. In this study, despite difficulties in solubilizing semi-purified inclusion bodies, utilizing hybridoma technology a mouse anti-IBD protein monoclonal antibody (MAB) was produced. The antigenic specificity of the antibody was confirmed and validated by western blots, enzyme-linked immunosorbent assay, immuno-transmission electron microscopy, and immunohistochemical staining. Paraffin embedded tissues of IBD positive and negative boa constrictors (n=94) collected from 1990 to 2011 were tested with immunohistochemical staining. In boa constrictors, the anti-IBDP MAB had a sensitivity of 83% and specificity of 100% in detecting IBD. The antibody also cross-reacted with IBD inclusion bodies in carpet pythons (Morelia spilota) and a ball python (python regius). This validated antibody can serve as a tool for the development of ante-mortem immunodiagnostic tests for IBD.

Human Treg responses allow sustained recombinant adeno-associated virus-mediated transgene expression.

Recombinant adeno-associated virus (rAAV) vectors have shown promise for the treatment of several diseases; however, immune-mediated elimination of transduced cells has been suggested to limit and account for a loss of efficacy. To determine whether rAAV vector expression can persist long term, we administered rAAV vectors expressing normal, M-type α-1 antitrypsin (M-AAT) to AAT-deficient subjects at various doses by multiple i.m. injections. M-specific AAT expression was observed in all subjects in a dose-dependent manner and was sustained for more than 1 year in the absence of immune suppression. Muscle biopsies at 1 year had sustained AAT expression and a reduction of inflammatory cells compared with 3 month biopsies. Deep sequencing of the TCR Vß region from muscle biopsies demonstrated a limited number of T cell clones that emerged at 3 months after vector administration and persisted for 1 year. In situ immunophenotyping revealed a substantial Treg population in muscle biopsy samples containing AAT-expressing myofibers. Approximately 10% of all T cells in muscle were natural Tregs, which were activated in response to AAV capsid. These results suggest that i.m. delivery of rAAV type 1-AAT (rAAV1-AAT) induces a T regulatory response that allows ongoing transgene expression and indicates that immunomodulatory treatments may not be necessary for rAAV-mediated gene therapy.

Vascular endothelial growth factor receptor-3 promotes breast cancer cell proliferation, motility and survival in vitro and tumor formation in vivo.

Vascular endothelial growth factor receptor-3 is a receptor tyrosine kinase that is overexpressed in some human carcinomas, but its role in tumorigenesis has not been fully elucidated. We examined VEGFR-3 expression in normal, nonneoplastic and early stage malignant breast tissues and have shown that VEGFR-3 upregulation in breast cancer preceded tumor cell invasion, suggesting that VEGFR-3 may function as a survival signal. We characterized the biological effects of VEGFR-3 over-expression in human breast cancer cells based on two approaches: gain of function by overexpressing VEGFR-3 in MCF-7 breast cancer cells and loss of function by RNAi-mediated silencing of VEGFR-3 in MCF-7-VEGFR-3 and BT474 cells. VEGFR-3 overexpression increased cellular proliferation by 40% when MCF7-VEGFR-3 cells were compared to parental MCF7 cells, and proliferation was reduced by more than 40% when endogenous VEGFR-3 was downregulated in BT474 cells. VEGFR-3 overexpression promoted a three-fold increase in motility and invasion and both motility and invasion were inhibited by downregulation of VEGFR-3. Furthermore, VEGFR-3 overexpression promoted cellular survival under stress conditions induced by staurosporine treatment and led to anchorage-independent growth. VEGFR-3 overexpression dramatically increased tumor formation in both hormone-dependent and independent xenograft models. With estrogen stimulation, MCF7-VEGFR-3 xenografts were ten times larger than control xenografts. Finally, downregulation of VEGFR-3 expression in both xenograft model cell lines led to a significant reduction of tumor growth. For the first time, we have demonstrated that VEGFR-3 overexpression promotes breast cancer cell proliferation, motility, survival, anchorage-independent growth and tumorogenicity in the absence of ligand expression.

PlantGDB: a resource for comparative plant genomics.

PlantGDB (http://www.plantgdb.org/) is a genomics database encompassing sequence data for green plants (Viridiplantae). PlantGDB provides annotated transcript assemblies for >100 plant species, with transcripts mapped to their cognate genomic context where available, integrated with a variety of sequence analysis tools and web services. For 14 plant species with emerging or complete genome sequence, PlantGDB's genome browsers (xGDB) serve as a graphical interface for viewing, evaluating and annotating transcript and protein alignments to chromosome or bacterial artificial chromosome (BAC)-based genome assemblies. Annotation is facilitated by the integrated yrGATE module for community curation of gene models. Novel web services at PlantGDB include Tracembler, an iterative alignment tool that generates contigs from GenBank trace file data and BioExtract Server, a web-based server for executing custom sequence analysis workflows. PlantGDB also hosts a plant genomics research outreach portal (PGROP) that facilitates access to a large number of resources for research and training.

Effects of ingested fruiting bodies, submerged culture biomass, and acidic polysaccharide glucuronoxylomannan of Tremella mesenterica Retz.:Fr. on glycemic responses in normal and diabetic rats.

Mushroom polysaccharides have been shown to regulate glucose metabolism. Using male Wistar rats injected with saline (normal rats), streptozotocin (STZ-NT rats), or streptozotocin plus nicotinamide (STZ+NT rats), we investigated the hypoglycemic activity of orally ingested fruiting bodies (FB), submerged culture biomass (CM), or the acidic polysaccharide glucuronoxylomannan (GXM) of Tremella mesenterica, an edible jelly mushroom. Our results demonstrated that FB ingestion significantly attenuated the elevated blood glucose levels in an oral glucose tolerance test (OGTT) in STZ-NT rats. However, in STZ+NT rats, FB, CM, and GXM ingestion significantly attenuated the increases in food and water intake, 2-h postprandial blood glucose concentrations, and blood glucose levels in OGTT. Moreover, FB and GXM ingestion significantly decreased serum concentration of fructosamine in STZ+NT rats. Our results indicated that T. mesenterica might be developed as a potential oral hypoglycemic agent or functional food for diabetic patients and for persons with high risk for diabetes mellitus.

Changes in serum insulin-like growth factors, not leptin, are associated with postnatal weight gain in preterm neonates.

BACKGROUND: Serum concentrations of conventional nutrition-related proteins, such as albumin, prealbumin, transferrin, and retinol-binding protein, are usually inconsistent with changes in anthropometric measurements in the postnatal period. The aim of this study was to evaluate how reliable growth hormone (GH), insulin-like growth factors (IGFs), IGF-binding proteins (IGFBPs), and leptin, the proteins known to be involved in the regulation of growth, are in reflecting postnatal growth and nutritional status in preterm neonates. METHODS: Blood samples and anthropometric measurements were collected from 55 preterm neonates (chronological age 30.4 +/- 2.8 weeks) for 4 continuous weeks (weeks 0 to 3). RESULTS: After adjusting for chronological age, body weights and serum IGF-II concentrations were significantly greater and serum transferrin concentrations were significantly lower in weeks 2 and 3 than in week 0 (repeated-measures analysis of variance (ANOVA) and Bonferroni test, p < .05). Forward stepwise multivariate regression analysis showed that change in total IGF-I (week 0 to week 3) was a positive predictor, and changes in insulin and prealbumin were negative predictors of postnatal weight gain. In addition, daily fat intake was a positive predictor of postnatal length increases, and changes in prealbumin, insulin, and GH were negative predictors of postnatal changes in the ponderal index (weight x length(-3)). Changes in GH and IGFBP-2 were negative predictors of changes in head circumference and triceps skinfold thickness, respectively. CONCLUSIONS: Serial measurements of serum IGF-I and IGF-II may be useful adjuncts to anthropometric measurements for monitoring postnatal growth and nutritional status in preterm neonates.