Advanced Glycation End Products as a Potential Target for Restructuring the Ovarian Cancer Microenvironment: A Pilot Study.

Ovarian cancer is the sixth leading cause of cancer-related death in women, and both occurrence and mortality are increased in women over the age of 60. There are documented age-related changes in the ovarian cancer microenvironment that have been shown to create a permissive metastatic niche, including the formation of advanced glycation end products, or AGEs, that form crosslinks between collagen molecules. Small molecules that disrupt AGEs, known as AGE breakers, have been examined in other diseases, but their efficacy in ovarian cancer has not been evaluated. The goal of this pilot study is to target age-related changes in the tumor microenvironment with the long-term aim of improving response to therapy in older patients. Here, we show that AGE breakers have the potential to change the omental collagen structure and modulate the peritoneal immune landscape, suggesting a potential use for AGE breakers in the treatment of ovarian cancer.

Delayed Severe Gingivitis After Placement of Orthodontic Braces in an Atopic Teenager: A Case Report and Literature Review.

We report a case of a 15-year-old atopic patient presenting with delayed, severe ulcerative hypertrophic gingivitis after placement of orthodontic braces, which required removal of braces and restorative laser surgical procedures. Patch testing to multiple metals and chemicals showed weak positive reactions to steel bands and formaldehyde. The patient experienced urticarial, gingivitis, and other intraoral symptoms after patch testing and re-exposure to nickel-containing products. In contrast, nickel, cobalt, and cobalt-chromium (Co-Cr) bracket patch testing sites were negative. Nickel-caused contact dermatitis is Type IV delayed hypersensitivity reaction occurring at least 24 h after exposure. This reaction can result in intraoral blisters, ulcerations, eczematous and urticarial reactions of the face and more distant skin areas. This case illustrates the intraoral delayed response, symptom resolution after removing the braces, and brackets and local reactions upon subsequent nickel exposure, despite negative patch testing and lymphocyte stimulation test to nickel. This case further illustrates the difficulty associated with diagnosing nickel allergy.

Revisiting the Definition of Anaphylaxis.

PURPOSE OF REVIEW: Anaphylaxis is a common phenomenon that has been studied for many decades. Despite this, there is still disagreement among organizations regarding the precise definition for anaphylaxis. This article discusses the difference between the proposed definitions of anaphylaxis. Furthermore, the most up-to-date literature on specific subtypes of anaphylaxis is reviewed, and implications for clinical practice are discussed. RECENT FINDINGS: Recent literature on various subtypes of anaphylaxis has been conducted. This has helped clarify guidelines for conditions such as allergy to radiocontrast media, idiopathic anaphylaxis, and food-dependent exercise-induced anaphylaxis. Recent literature has also studied available biomarkers for anaphylaxis and the cost-effectiveness of current standard-of-care prescription of epinephrine autoinjectors. Anaphylaxis is an increasingly more frequent phenomenon and remains a hot topic in current research. Much progress has been made in clarifying the definition of anaphylaxis and differentiating between subtypes, but more research is needed to identify a readily available biomarker for anaphylaxis and identify the standard of care for various subtypes of anaphylaxis.

Questioning Cause and Effect: Children with Severe Asthma Exhibit High Levels of Inflammatory Biomarkers Including Beta-Hexosaminidase, but Low Levels of Vitamin A and Immunoglobulins.

Asthma affects over 8% of the pediatric population in the United States, and Memphis, Tennessee has been labeled an asthma capital. Plasma samples were analyzed for biomarker profiles from 95 children with severe asthma and 47 age-matched, hospitalized nonasthmatic controls at Le Bonheur Children's Hospital in Memphis, where over 4000 asthmatics are cared for annually. Asthmatics exhibited significantly higher levels of periostin, surfactant protein D, receptor for advanced glycation end products and ß-hexosaminidase compared to controls. Children with severe asthma had lower levels of IgG1, IgG2 and IgA, and higher levels of IgE compared to controls, and approximately half of asthmatics exhibited IgG1 levels that were below age-specific norms. Vitamin A levels, measured by the surrogate retinol-binding protein, were insufficient or deficient in most asthmatic children, and correlated positively with IgG1. Which came first, asthma status or low levels of vitamin A and immunoglobulins? It is likely that inflammatory disease and immunosuppressive drugs contributed to a reduction in vitamin A and immunoglobulin levels. However, a nonmutually exclusive hypothesis is that low dietary vitamin A caused reductions in immune function and rendered children vulnerable to respiratory disease and consequent asthma pathogenesis. Continued attention to nutrition in combination with the biomarker profile is recommended to prevent and treat asthma in vulnerable children.

Unproven Diagnostic Tests for Food Allergy.

The gold standard for diagnosis of immunoglobulin E (IgE)-mediated food allergy remains the oral food challenge, with serum IgE testing and skin prick testing serving as acceptable alternatives. However, the increase in prevalence of food allergy (both physician diagnosed and patient suspected) has led patients to pursue a variety of other alternative diagnostic procedures for suspected food allergy, which are reviewed in this article. These procedures (IgG testing, electrodermal testing, cytotoxic testing, provocation/neutralization, and applied kinesiology) have largely been unproven and may lead to unnecessary elimination diets.

Rhinovirus and asthma: a storied history of incompatibility.

The human rhinovirus (HRV) is commonly associated with loss of asthma symptom control requiring escalation of care and emergency room visits in many patients. While the association is clear, the mechanisms behind HRV-induced asthma exacerbations remain uncertain. Immune dysregulation via aberrant immune responses, both deficient and exaggerated, have been proposed as mechanisms for HRV-induced exacerbations of asthma. Epithelium-derived innate immune cytokines that bias Th2 responses, including interleukin (IL)-25, IL-33, and thymic stromal lymphopoietin (TSLP), have also been implicated as a means to bridge allergic conditions with asthma exacerbations. In this review, we discuss the literature supporting these positions. We also discuss new and emerging biotherapeutics that may target virus-induced exacerbations of asthma.

Keratin-based Wound Care Products for Treatment of Resistant Vascular Wounds.

Use of new keratin-based wound dressings represent a novel approach to wound management. The authors present three patients with recalcitrant, venous and mixed venous, and arterial leg ulcers treated with these dressings. Improvement in each case was observed.

The reliability of a handheld wound measurement and documentation device in clinical practice.

PURPOSE: The aim of this study was to evaluate the precision (intra- and interrater variability) and usability of a new handheld wound measurement device designed to measure wound surface area and depth across a range of typical wound types. SUBJECTS AND SETTING: Raters included a doctor, a nurse, and a novice who was unfamiliar with wound care and the study equipment. Patients of nurse maude, a community-based home health organization in christchurch, new zealand, were assessed at either the wound clinic or the patient's home. METHOD: Five repeated area and depth measurements were made on 5 different wounds by the 3 raters, resulting in up to 75 area and depth measurements. The time taken to make each measurement was also recorded. INSTRUMENT: This study evaluated a handheld wound imaging, measurement, and documentation device (SilhouetteMobile, ARANZ Medical Limited, Christchurch, New Zealand). RESULTS: Variances and coefficients of variation (CV) between raters (interrater) and within raters (intrarater) over the 5 wounds were calculated, as was the intraclass correlation coefficient. Inter- and intrarater precision for surface area was 3.2% and 2.6%, respectively, and depth 13.5% and 5.5%, respectively; intraclass correlation coefficients for area and depth were 99.76% and 98.95%, respectively. Approximately 2 minutes were required to capture photographic documentation and perform area and depth measurements. Use of the device provided practitioners and patients with immediate feedback on wound healing progress. CONCLUSION: The device was found to have low intra- and interrater variation. The photographic record and measurements can be collected in approximately 2 minutes and in a noncontact fashion. A novice user was able to use the device proficiently with 1 hour of training.

Leading wound care technology: The ARANZ medical silhouette.

Despite major advances in medical technology and wound care, wound assessment and documentation still rely mainly on rudimentary measures. Many practitioners continue to estimate wound size using maximal length, width, and depth measurements with rulers and probes. Others use acetate tracings or equivalent measures to outline the wound onto a grid to estimate surface area and document wound border changes. Even fewer practitioners seem to routinely photograph wounds with an included scale for more visual records. This article presents a recently developed device that is changing clinical documentation, assessment, auditing, and interservice communication-the ARANZ Medical Silhouette (ARANZ Medical Limited, Christchurch, New Zealand).

Clinical evaluation of a wound measurement and documentation system.

Wound measurement is essential in assessing the progress of wound healing. The most commonly used tools include wound tracings, width and length measurements, and digital photography. These methods have been useful in clinical practice but have some limitations, such as lack of accuracy, difficulty of use, and often entail wound contact. More advanced equipment tends to be bulky, heavy, and expensive. The following reviews the authors' experience with a new wound measurement and documentation system, the ARANZ Medical Silhouette Mobile™ (ARANZ Medical, Christchurch, New Zealand). This innovative device combines a digital camera and structured lighting in the form of 2 laser beams to automatically correct for image scale and skin curvature, allowing rapid and accurate measurements of the wound surface area and depth. The scanner unit plugs into a standard personal digital assistant to form a portable device that can be easily held and operated using 1 hand. The scanner has been used in clinical practice trials in patients with venous leg ulcers, diabetic foot ulcers, and in the community setting. The scanner was found to be accurate and reliable, easy to learn and use, portable, and compact. The results presented suggest that this device may be a viable choice in the management of different types of chronic wounds.