On the Move-Sensitive Fluorescent Aptassay on Board Catalytic Micromotors for the Determination of Interleukin-6 in Ultra-Low Serum Volumes for Neonatal Sepsis Diagnostics.

A graphene oxide/nickel/platinum nanoparticle micromotor (MM)-based fluorescent aptassay is proposed to determine interleukin-6 (IL-6) in serum samples from low-birth-weight infants (gestational age of less than 32 weeks and birthweight below 1000 g) with sepsis suspicion. In this kind of patients, IL-6 has demonstrated good sensitivity and specificity for the diagnosis of sepsis, both for early and late onset sepsis. The approach was based on the adsorption of the aptamer for IL-6 tagged with 6-FAM as a fluorescent label (AptIL-6, λem = 520 nm) on the graphene oxide external layer (MMGO-AptIL-6) inducing fluorescence quenching (OFF state) and a subsequent on-the-move affinity recognition of IL-6 from AptIL-6 (IL-6-AptIL-6 complex) recovering the fluorescence (ON state). An aptamer against IL-6 was selected and developed by the systematic evolution of ligands by exponential enrichment technology. This approach displayed a suitable linear range of 0.07-1000 pg mL-1 (r = 0.995) covering the cut-off and clinical practice levels, allowing direct determination without any dilution and simplifying the analysis as well as exhibiting an excellent sensitivity (LOD = 0.02 pg mL-1) in ultralow volumes of diagnostic clinical samples (2 µL). A high agreement between IL-6 levels obtained from our MM-based approach and the method used by the Hospital was obtained (relative error < 3%). The MM-based aptassay is competitive in comparison with that of the Hospital, in terms of a significant reduction of the sample volume (15 times less) and enhanced sensitivity, employing similar analysis times. These results position MM technology with enough potential to achieve high sensitivities in low sample volumes, opening new avenues in diagnosis based on low sample volumes.

Association of miR-21 and miR-335 to microsatellite instability and prognosis in stage III colorectal cancer.

BACKGROUND: MicroRNAs (miRs) are frequently altered in colorectal cancer (CRC) and can be used as prognostic factors. OBJECTIVE: To confirm in stage III CRC patients a reported miR signature that was associated to the presence of metastatic disease. To correlate miR expression with microsatellite instability (MSI) and mutations in RAS and BRAF. METHODS: miR-21, miR-135a, miR-206, miR-335 and miR-Let-7a expression was analyzed by RT-qPCR in 150 patients out of the 329 patients used to analyze MSI and RAS and BRAF mutations. Association with disease free survival (DFS) and overall survival (OS) was analyzed. Data was confirmed by a multivariate analysis. RESULTS: MiR-21 high expression (p= 0.034) and miR-335 low expression (p= 0.0061) were significantly associated with MSI-H. A positive trend (p= 0.0624) between miR-135a high expression and RAS mutations was found. Lower miR-21 expression levels are associated with DFS (HR = 2.654, 95% CI: 1.066-6.605, p= 0.036) and a trend with OS (HR = 2.419, 95% CI: 0.749-7.815, p= 0.140). MiR-21 high expression significantly improves DFS of the poor prognosis group (T4 or N2) (p= 0.03). CONCLUSIONS: Association of increased expression of miR-21 and better prognosis in the poor prognostic group may be of interest and could be explored in future prospective clinical trials.

Healthy Zerumbone: From Natural Sources to Strategies to Improve Its Bioavailability and Oral Administration.

Zerumbone is a multifunctional compound with antimicrobial, antitumor, hyperalgesic, antioxidant and anti-inflammatory applications, and constitutes a point molecule for the future synthesis of derivatives with improved efficiency. This monocyclic sesquiterpenoid is found in high content in wild ginger (Zingiber zerumbet Smith), a perennial herb with economic importance as an ornamental as well as a medicinal plant. The presence of zerumbone is a distinctive feature that allows identification and differentiation from other species, not only in Zingiber, but also in Curcuma, Alpinia, Boesenbergia, Ethlingera and Ammomum spp., as well as related families (Costaceaee). To successfully use zerumbone in areas such as medicine, food and agriculture, further research on improving its low solubility and bioavailability, as well as its preservation, is a major current priority. In addition, despite its promising pharmacological activities, preclinical and clinical studies are required to demonstrate and evaluate the in vivo efficacy of zerumbone.

Continuous and Daily Oral Immunotherapy for Peanut Allergy: Results from a 2-Year Open-Label Follow-On Study.

BACKGROUND: The randomized, controlled PALISADE trial demonstrated the benefit of daily oral immunotherapy with Peanut (Arachis Hypogaea) allergen powder-dnfp (PTAH, formerly AR101) in peanut-allergic children and adolescents. OBJECTIVE: ARC004, the open-label follow-on study to PALISADE, used 5 dosing cohorts to explore PTAH treatment beyond 1 year and alternative dosing regimens in peanut-allergic individuals. METHODS: Active arm (PTAH-continuing) PALISADE participants who tolerated 300-mg peanut protein at the exit double-blind placebo-controlled food challenge and placebo arm (PTAH-naive) participants could enter ARC004. PTAH-continuing participants were assigned to receive daily (cohorts 1 and 3A) or non-daily (cohorts 2, 3B, and 3C) dosing regimens; PTAH-naive participants were built up to 300 mg/d PTAH, followed by maintenance dosing. At study completion, participants underwent an exit double-blind placebo-controlled food challenge with doses up to 2000 mg peanut protein. Data were assessed using descriptive statistics. RESULTS: Overall, 358 (87.5%) eligible participants (4-17 years) entered ARC004 (PTAH-continuing, n = 256; PTAH-naive, n = 102). Among PTAH-continuing participants, exposure-adjusted adverse event rates were 12.94 to 17.54/participant-year and 25.95 to 42.49/participant-year in daily and non-daily dosing cohorts, respectively; most participants (83%) experienced mild or moderate adverse events. Daily dosing cohorts appeared to have higher desensitization rates than non-daily dosing cohorts. Of all PTAH-continuing cohorts, cohort 3A had the longest daily dosing duration and the highest desensitization rates. Changes in immune markers with PTAH continuation demonstrated ongoing immunomodulation. Outcomes in PTAH-naive participants mirrored those of the PALISADE active arm. CONCLUSIONS: Continued daily PTAH treatment beyond 1 year showed sustained safety and efficacy. Ongoing immunomodulation was observed during the second year of treatment.

Curcuma longa L. Rhizome Essential Oil from Extraction to Its Agri-Food Applications. A Review.

Curcuma longa L. rhizome essential oil is a valuable product in pharmaceutical industry due to its wide beneficial health effects. Novel applications in the agri-food industry where more sustainable extraction processes are required currently and safer substances are claimed for the consumer are being investigated. This review provides information regarding the conventional and recent extraction methods of C. longa rhizome oil, their characteristics and suitability to be applied at the industrial scale. In addition, variations in the chemical composition of C. longa rhizome and leaf essential oils regarding intrinsic and extrinsic factors and extraction methods are also analysed in order to select the most proper to obtain the most efficient activity. Finally, the potential applications of C. longa rhizome oil in the agri-food industry, such as antimicrobial, weedicide and a food preservative agent, are included. Regarding the data, C. longa rhizome essential oil may play a special role in the agri-food industry; however, further research to determine the application threshold so as not to damage crops or affect the organoleptic properties of food products, as well as efficient encapsulation techniques, are necessary for its implementation in global agriculture.

Encapsulated Limonene: A Pleasant Lemon-Like Aroma with Promising Application in the Agri-Food Industry. A Review.

Limonene, mainly found as a major component in Citrus spp., has been proven to possess a valuable potential as sustainable replacement to synthetic pesticides and food preservatives. This review intends to give a clear overview of the principal emerging applications of limonene in the agri-food industry as antimicrobial, herbicidal and antioxidant agent. To successfully use limonene in a greener agri-food industry, its preservation had become a top concern for manufacturers. In order to elucidate the most efficient and sustainable manner to encapsulate limonene, the different techniques and materials tested up to the present are also reviewed. In general, encapsulation conserves and protects limonene from outside aggressions, but also allows its controlled release as well as enhances its low water solubility, which can be critical for the discussed applications. Other parameters such as scalability, low cost and availability of equipment will need to be taken into account. Further efforts would likely be oriented to the elucidation of encapsulating sustainable systems obtained by cost-efficient elaboration processes, which can deliver effective concentrations of limonene without affecting crops and food products.

Association between Non-Competitive Physical Exercise and Menstrual Disorders.

Menstrual disorders are highly prevalent and generate discomfort, anxiety, and more gynecological visits. There has been an increase in the practice of physical exercise among the general population. This study determined the association between physical exercise and menstrual disorders. An observational analytical study was conducted during 2016 in women of reproductive age from southeast Spain. Information was collected on sociodemographic, gynecological, and nutritional status variables, and the International Physical Activity Questionnaire (IPAQ) was used to gather data on physical exercise. Quantitative/qualitative variables were compared using the non- parametric Mann-Whitney U test and categorical variables with the chi-square (χ2) or Fisher's exact test, followed by multivariate logistic regression analysis. The study included 122 women; physical exercise was practiced by 50%; menstrual disorders were reported by 53.28 %. The practice of physical exercise, h/week of physical exercise, body type, level of physical exercise, and marital status were associated with the presence of menstrual cycle disorders (p˂0.05). This association persisted (p=0.042) after adjustment of the analysis for impaired nutritional status, medication consumption, the presence of disease, age, marital status, age at menarche, and number of children. A high physical activity not related to the practice of sport is associated with menstrual disorders.

Phytotoxic Effects of Commercial Eucalyptus citriodora, Lavandula angustifolia, and Pinus sylvestris Essential Oils on Weeds, Crops, and Invasive Species.

BACKGROUND: essential oils are well known for their pharmacological effectiveness as well as their repellent, insecticide, and herbicide activities. The emergence of resistant weeds, due to the overuse of synthetic herbicides, makes it necessary to find natural alternatives for weed control. The aim of this study was to evaluate the phytotoxic effects of Eucalyptus citriodora, Lavandula angustifolia, and Pinus sylvestris, three common commercial essential oils, on weeds (Portulaca oleracea, Lolium multiflorum, and Echinochloa crus-galli), food crops (tomato and cucumber), and the invasive species Nicotiana glauca. Methods: to determine herbicidal effects, essential oils were tested at different concentrations (0.125-1µL/mL). The index of germination and seedling length data were recorded over 14 days. RESULTS: the in vitro assays showed that L. angustifolia with linalool (38.7 ± 0.1%), 1,8-cineole (26.5 ± 0.1%), and camphor (14.2 ± 0.1%) as the main compounds showed the most phytotoxic effects affecting seed germination in weeds and tomato, and the aforementioned invasive species. L. multiflorum was the most sensitive weed, particularly to lavender essential oil, which decreased the growth of its hypocotyl and radicle by 87.8% and 76.7%, respectively, at a dose of 1 µL/mL. Cucumber was the most resistant food crop, with no significant reduction observed in seed germination and hypocotyl growth with E. citriodora and L. angustifolia essential oils. CONCLUSIONS: lavender essential oil represents a promising candidate for the development of effective and safe herbicides in the management of L. multiflorum affecting cucumber crops.

GRAZAX®: a sublingual immunotherapy vaccine for Hay fever treatment: from concept to commercialization.

Allergen immunotherapy has been used for more than 100 y, but only recently underlying immunological mechanisms have started to be understood. New Allergy vaccines are now considered to be full pharmaceutical products, that should comply with general as well as specific pharmaceutical legal framework. GRAZAX® is the first global allergy vaccine developed in compliance with the new legal environment and is thus a reference for developing new allergy vaccines. Here, we provide a rationale description of GRAZAX®, providing a sequential description of its pharmaceutical and clinical development. With more than 25 clinical trials, involving more than 8000 patients, including as well three 5-y prospective clinical trials, GRAZAX® is a key product to understand the unique position of allergen-specific immunotherapy as a disease-modifying intervention.

Ginger and Turmeric Essential Oils for Weed Control and Food Crop Protection.

Ginger and turmeric are two food ingredients that are in high demand due to their flavor and positive effects on health. The biological properties of these spices are closely related to the aromatic compounds they contain. The chemical compositions of their essential oils and their in vitro phytotoxic activity against weeds (Portulaca oleracea, Lolium multiflorum, Echinochloa crus-galli, Cortaderia selloana, and Nicotiana glauca) and food crops (tomato, cucumber, and rice) were studied. Forty-one compounds, accounting for a relative peak area of 87.7% and 94.6% of turmeric and ginger essential oils, respectively, were identified by Gas Chromatography⁻Mass Spectrometry analysis. Ginger essential oil with α-zingiberene (24.9 ± 0.8%), ß-sesquiphelladrene (11.7 ± 0.3%), ar-curcumene (10.7 ± 0.2%), and ß-bisabolene (10.5 ± 0.3%) as the main compounds significantly inhibited the seed germination of P. oleracea, L. multiflorum, and C. selloana at the highest dose (1 µL/mL) assayed, as well as the hypocotyl and radicle growth of the weeds. Turmeric essential oil with ar-turmerone (38.7 ± 0.8%), ß-turmerone (18.6 ± 0.6%), and α-turmerone (14.2 ± 0.9%) as principal components significantly inhibited the seed germination of C. selloana and hypocotyl and radicle growth of weeds (the latter in particular) at the highest dose, whereas it did not affect either the seed germination or seedling growth of the food crops. Turmeric essential oil can be an effective post-emergent bioherbicide against the tested weeds without phytotoxicity to crops.

Evaluating primary end points in peanut immunotherapy clinical trials.

Food immunotherapy has been the focus of several allergy research initiatives over the last decade. Although many questions remain unanswered, the evidence suggests that this treatment might be available in the near future outside clinical trials. Additionally, pharmaceutical companies, in light of promising early-stage results, have shown interest in developing commercially available products, thus increasing the likelihood that new immunotherapy treatments will be introduced, especially for peanut allergy. Given this optimistic scenario and given the prospect of rigorously developed products for peanut allergy treatment, each allergist will need to understand the specificities of these treatments and their expected efficacy and adverse event profiles. Thus it is imperative that allergists understand the differences in efficacy between the different management options, as well as how the end points are measured in the relevant literature. However, given the significant heterogeneity detected among food immunotherapy trials, this task might not be as straightforward as desired. This article aims to dissect how primary efficacy end points are defined and assessed to facilitate understanding of the design of these trials and the potential effect that this variation might have on the reported outcomes.

Phytotoxicity of Essential Oils on Selected Weeds: Potential Hazard on Food Crops.

The chemical composition of winter savory, peppermint, and anise essential oils, and in vitro and in vivo phytotoxic activity against weeds (Portulaca oleracea, Lolium multiflorum, and Echinochloa crus-galli) and food crops (maize, rice, and tomato), have been studied. Sixty-four compounds accounting for between 97.67⁻99.66% of the total essential oils were identified by Gas Chromatography-Mass Spectrometry analysis. Winter savory with carvacrol (43.34%) and thymol (23.20%) as the main compounds produced a total inhibitory effect against the seed germination of tested weed. Menthol (48.23%), menthone (23.33%), and iso-menthone (16.33%) from peppermint only showed total seed germination inhibition on L. multiflorum, whereas no significant effects were observed with trans-anethole (99.46%) from anise at all concentrations (0.125⁻1 µL/mL). Low doses of peppermint essential oil could be used as a sustainable alternative to synthetic agrochemicals to control L. multiflorum. The results corroborate that in vivo assays with a commercial emulsifiable concentrate need higher doses of the essential oils to reproduce previous in vitro trials. The higher in vivo phytotoxicity of winter savory essential oil constitutes an eco-friendly and less pernicious alternative to weed control. It is possible to achieve a greater in vivo phytotoxicity if less active essential oil like peppermint is included with other active excipients.

Efficacy and effectiveness of omalizumab in the treatment of childhood asthma.

INTRODUCTION: Omalizumab is a monoclonal antibody that binds and inhibits free serum immunoglobulin E, a mediator involved in the clinical manifestations of allergic asthma. Evidence for its efficacy and safety in the treatment of moderate-to-severe allergic asthma is based primarily on studies in adolescents and adults. However, there is increasing evidence of its utility in children with allergic asthma aged 6-12 years. Areas covered: This article reviews efficacy, safety, and effectiveness of omalizumab in the treatment of moderate-to-severe allergic asthma in children aged 6-12 years in clinical trials and in studies in clinical practice. Pharmacoeconomic aspects of its use among this population and the positioning of omalizumab in pediatric asthma management guidelines are also discussed. Additionally, an algorithm for the management of poorly controlled severe pediatric asthma in children older than 6 years is proposed. Electronic databases, such as PubMed, were searched for terms Asthma and Omalizumab and for asthma management guidelines. Expert commentary: Add-on omalizumab is an effective maintenance therapy in children aged 6-12 years with poorly controlled moderate-to-severe allergic asthma treated with medium-high inhaled corticosteroids doses and inhaled long-acting ß2-agonists. Omalizumab appears safe in children in both clinical trials and real-life setting and may be cost-effective.

Prospective assessment of diagnostic tests for pediatric penicillin allergy: From clinical history to challenge tests.

BACKGROUND: Diagnostic guidelines for penicillin allergy in children recommend cumbersome protocols based partially on data from adults, which may be suboptimal for pediatric use. OBJECTIVE: To assess the accuracy of tools for diagnosis of penicillin allergy in children. METHODS: A prospective, multicenter study was conducted in children with reported adverse events related to penicillin, excluding severe reactions. All patients underwent a uniform diagnostic protocol that consisted of clinical history, skin tests, serum specific IgE (sIgE), and, regardless of these results, drug provocation tests (DPTs). RESULTS: A total of 732 children (mean age, 5.5 years; 51.2% males) completed the allergy workup, including DPTs. Amoxicillin triggered 96.9% of all reactions. None of the patients with an immediate index reaction (IR) developed a reaction on DPT. Penicillin allergy was confirmed in 35 children (4.8%): 6 immediate reactions (17%) and 29 nonimmediate reactions (83%) on the DPT. No severe reactions were recorded. The allergist diagnosis based on the clinical history was not associated with the DPT final outcome. In 30 of 33 allergic patients (91%), the results of all skin tests and sIgE tests were negative. A logistic regression model identified the following to be associated with penicillin allergy: a family history of drug allergy (odds ratio [OR], 3.03; 95% confidence interval [CI], 1.33-6.89; P = .008), an IR lasting more than 3 days vs 24 hours or less (OR, 8.96; 95% CI, 2.01-39.86; P = .004), and an IR treated with corticosteroids (OR, 2.68; 95% CI, 1.30-5.54; P = .007). CONCLUSION: Conventional predictors of allergy to penicillin performed weakly. The authors propose straightforward penicillin provocation testing in controlled, experienced centers for the diagnosis of nonsevere penicillin allergy in children.

Comparison of 2 intravenous insulin protocols: Glycemia variability in critically ill patients. / Comparación de 2 protocolos de insulina intravenosa: variabilidad de la glucemia en pacientes críticos.

OBJECTIVE: Glycemic variability is an independent predictor of mortality in critically ill patients. The objective of this study was to compare two intravenous insulin protocols in critically ill patients regarding the glycemic variability. MATERIAL AND METHODS: This was a retrospective observational study performed by reviewing clinical records of patients from a Critical Care Unit for 4 consecutive months. First, a simpler Scale-Based Intravenous Insulin Protocol (SBIIP) was reviewed and later it was compared for the same months of the following year with a Sliding Scale-Based Intravenous Insulin Protocol (SSBIIP). All adult patients admitted to the unit during the referred months were included. Patients in whom the protocol was not adequately followed were excluded. A total of 557 patients were reviewed, of whom they had needed intravenous insulin 73 in the first group and 52 in the second group. Four and two patients were excluded in each group respectively. RESULTS: Glycemic variability for both day 1 (DS1) and total stay (DST) was lower in SSBIIP patients compared to SBIIP patients: SD1 34.88 vs 18.16 and SDT 36.45 vs 23.65 (P<.001). CONCLUSION: A glycemic management protocol in critically ill patients based on sliding scales decreases glycemic variability.

Efficacy and safety of high-dose rush oral immunotherapy in persistent egg allergic children: A randomized clinical trial.

BACKGROUND: Egg oral immunotherapy is effective but time consuming. OBJECTIVE: To assess the efficacy and safety of egg rush oral immunotherapy (ROIT) with a targeted dose equivalent to a raw egg white. METHODS: Thirty-three persistent egg allergic children confirmed by double-blind, placebo-controlled food challenge (DBPCFC) were randomized to receive egg ROIT immediately after randomization (ROIT1 group), or to continue an egg avoidance diet for 5 months after randomization (control group [CG]). A 5-day build-up phase starting with the highest single tolerated dose at baseline DBPCFC was scheduled and several doses administered daily until achieving a dose of approximately 2,808 mg of egg white protein. In the maintenance phase, patients ate an undercooked egg every 48 hours for 5 months. The CG participants who failed the DBPCFC at 5 months began active treatment. Children from the ROIT1 group plus children from the CG who failed a second DBPCFC at 5 months and then received egg ROIT were randomized to the ROIT2 group. Adverse events (AEs) and immune marker evolution were recorded. RESULTS: A total of 17 (89%) of 19 children in the ROIT1 group and no CG patients were desensitized at 5 months (P < .001). A total of 31 (97%) of the 32 children in the ROIT2 group completed the build-up phase in a median of 3 days (range, 1-14 days), and 30 (94%) of 32 maintained desensitization at 5 months. From baseline to 5 months of treatment, skin prick test, specific IgE, and specific IgE/IgG4 ratio to egg fractions significantly decreased, whereas specific IgG4 increased. During the build-up phase, AEs occurred in 69% of patients (50% had ≤2 AEs) and 31% of doses (2% severe, 55% gastrointestinal). Lower threshold dose in the DBPCFC and higher egg white and ovalbumin specific IgE levels at baseline revealed an association with a higher rate of AEs. CONCLUSION: The proposed 5-day egg ROIT desensitized 94% of the allergic patients, with most AEs being mild or moderate.

Molecular Diagnosis of Shrimp Allergy: Efficiency of Several Allergens to Predict Clinical Reactivity.

BACKGROUND: The diagnosis of shellfish allergy remains a challenge for clinicians. Several shellfish allergens have been characterized and their IgE epitopes identified. However, the clinical relevance of this sensitization is still not clear. OBJECTIVE: The objective of this study was to identify allergens and epitopes associated with clinical reactivity to shrimp. METHODS: Shrimp-sensitized subjects were recruited and grouped based on the history of shrimp-allergic reactions and challenge outcome. IgE reactivity to recombinant crustacean allergens, and IgE and IgG4 reactivity to peptides were determined. Subjects sensitized to dust mites and/or cockroach without shrimp sensitization or reported allergic reactions, as well as nonatopic individuals, were used as controls. RESULTS: A total of 86 subjects were recruited with a skin prick test to shrimp; 74 reported shrimp-allergic reactions, 58 were allergic (38 positive double-blind placebo-controlled food challenge and 20 recent anaphylaxis), and 16 were tolerant. All subjects without a history of reactions had negative challenges. The individuals with a positive challenge more frequently recognized tropomyosin and sarcoplasmic calcium-binding proteins than those found tolerant by the challenge. Especially a sarcoplasmic-calcium-binding-protein positive test is very likely to result in a positive challenge, though the frequency of recognition is low. Subjects with dust mite and/or cockroach allergy not sensitized to shrimp recognized arginine kinase and hemocyanin. Several epitopes of these allergens may be important in predicting clinical reactivity. CONCLUSION: Tropomyosin and sarcoplasmic-calcium-binding-protein sensitization is associated with clinical reactivity to shrimp. Myosin light chain testing may help in the diagnosis of clinical reactivity. Arginine kinase and hemocyanin appear to be cross-reacting allergens between shrimp and arthropods. Detection of IgE to these allergens and some of their epitopes may be better diagnostic tools in the routine workup of shrimp allergy.