The global burden of chronic urticaria for the patient and society.

Chronic urticaria (CU) affects about 1% of the world population of all ages, mostly young and middle-aged women. It usually lasts for several years (> 1 year in 25-75% of patients) and often takes > 1 year before effective management is implemented. It presents as chronic spontaneous urticaria (CSU), chronic inducible urticaria (CIndU) or both in the same person. More than 25% of cases are resistant to H1 -antihistamines, even at higher doses, and third- and fourth-line therapies (omalizumab and ciclosporin) control the disease only in two-thirds of H1 -antihistamine-resistant patients. Here we review the impact of CU on different aspects of patients' quality of life and the burden of this chronic disease for the patient and society. CU may have a strong impact on health-related quality of life (HRQoL), particularly when CSU is associated with angio-oedema and/or CIndU (Dermatology Life Quality Index > 10 in 30% of patients). Comorbidities, such as anxiety and depression, which are present in more than 30% of patients with CSU, compound HRQoL impairment. Severe pruritus and the unpredictable occurrence of weals and angio-oedema are responsible for sleep disorders; sexual dysfunction; limitations on daily life, work and sports activities; interfering with life within the family and in society; and patients' performance at school and work (6% absenteeism and 25% presenteeism). Apart from treatment costs, with annual values between 900 and 2400 purchasing power parity dollars (PPP$) in Europe and the USA, CU is associated with a high consumption of medical resources and other indirect costs, which may reach a total annual cost of PPP$ 15 550.

Influence of Acromial Morphologic Characteristics and Acromioclavicular Arthrosis on the Effect of Platelet-Rich Plasma on Partial Tears of the Supraspinatus Tendon.

OBJECTIVE. The purposes of this study were to determine the medium-term effect of ultrasound-guided infiltration of platelet-rich plasma (PRP) on partial tears of the supraspinatus tendon (SST) and to identify prognostic indicators of an unfavorable outcome. SUBJECTS AND METHODS. Over a period of 4 years, patients with a partial SST tear smaller than 1.5 cm referred for ultrasound-guided PRP infiltration (1 mL) for shoulder pain lasting more than 3 months were recruited consecutively. MRI was used to analyze the type of acromion and presence of acromioclavicular (AC) arthrosis. Primary (size of the tear and associated bursitis) and secondary (mobility and pain) results were collected at 3 months. RESULTS. The study included 128 patients (66 men, 62 women; mean age, 48.3 years; range, 20-59 years). At 3 months, favorable evolution of the tear repair was recorded in 71.1% (91/128) of patients and resolution of bursitis in 66.7% (42/63). Changes in tear size had large effect sizes (Cohen d ≥ 1.16), as did pain and shoulder mobility (Cohen d ≥ 0.95). The strongest predictors of unfavorable evolution of tear and bursitis were type 3 acromion and types 1 and 2 acromion with AC arthrosis (p < 0.001; ß = 20.412). CONCLUSION. Ultrasound-guided PRP infiltration of partial tears of the SST relieves pain and improves shoulder mobility, but its effect on the size of the tear is influenced by the morphologic characteristics of the acromion and the presence of AC arthrosis. The effect of PRP is insufficient in patients with a type 3 acromion or severe AC arthrosis.

Neisseria gonorrhoeae Sequence Typing for Antimicrobial Resistance, a Novel Antimicrobial Resistance Multilocus Typing Scheme for Tracking Global Dissemination of N. gonorrhoeae Strains.

A curated Web-based user-friendly sequence typing tool based on antimicrobial resistance determinants in Neisseria gonorrhoeae was developed and is publicly accessible (https://ngstar.canada.ca). The N. gonorrhoeae Sequence Typing for Antimicrobial Resistance (NG-STAR) molecular typing scheme uses the DNA sequences of 7 genes (penA, mtrR, porB, ponA, gyrA, parC, and 23S rRNA) associated with resistance to ß-lactam antimicrobials, macrolides, or fluoroquinolones. NG-STAR uses the entire penA sequence, combining the historical nomenclature for penA types I to XXXVIII with novel nucleotide sequence designations; the full mtrR sequence and a portion of its promoter region; portions of ponA, porB, gyrA, and parC; and 23S rRNA sequences. NG-STAR grouped 768 isolates into 139 sequence types (STs) (n = 660) consisting of 29 clonal complexes (CCs) having a maximum of a single-locus variation, and 76 NG-STAR STs (n = 109) were identified as unrelated singletons. NG-STAR had a high Simpson's diversity index value of 96.5% (95% confidence interval [CI] = 0.959 to 0.969). The most common STs were NG-STAR ST-90 (n = 100; 13.0%), ST-42 and ST-91 (n = 45; 5.9%), ST-64 (n = 44; 5.72%), and ST-139 (n = 42; 5.5%). Decreased susceptibility to azithromycin was associated with NG-STAR ST-58, ST-61, ST-64, ST-79, ST-91, and ST-139 (n = 156; 92.3%); decreased susceptibility to cephalosporins was associated with NG-STAR ST-90, ST-91, and ST-97 (n = 162; 94.2%); and ciprofloxacin resistance was associated with NG-STAR ST-26, ST-90, ST-91, ST-97, ST-150, and ST-158 (n = 196; 98.0%). All isolates of NG-STAR ST-42, ST-43, ST-63, ST-81, and ST-160 (n = 106) were susceptible to all four antimicrobials. The standardization of nomenclature associated with antimicrobial resistance determinants through an internationally available database will facilitate the monitoring of the global dissemination of antimicrobial-resistant N. gonorrhoeae strains.

Egg shape mimicry in parasitic cuckoos.

Parasitic cuckoos lay their eggs in nests of host species. Rejection of cuckoo eggs by hosts has led to the evolution of egg mimicry by cuckoos, whereby their eggs mimic the colour and pattern of their host eggs to avoid egg recognition and rejection. There is also evidence of mimicry in egg size in some cuckoo-host systems, but currently it is unknown whether cuckoos can also mimic the egg shape of their hosts. In this study, we test whether there is evidence of mimicry in egg form (shape and size) in three species of Australian cuckoos: the fan-tailed cuckoo Cacomantis flabelliformis, which exploits dome nesting hosts, the brush cuckoo Cacomantis variolosus, which exploits both dome and cup nesting hosts, and the pallid cuckoo Cuculus pallidus, which exploits cup nesting hosts. We found evidence of size mimicry and, for the first time, evidence of egg shape mimicry in two Australian cuckoo species (pallid cuckoo and brush cuckoo). Moreover, cuckoo-host egg similarity was higher for hosts with open nests than for hosts with closed nests. This finding fits well with theory, as it has been suggested that hosts with closed nests have more difficulty recognizing parasitic eggs than open nests, have lower rejection rates and thus exert lower selection for mimicry in cuckoos. This is the first evidence of mimicry in egg shape in a cuckoo-host system, suggesting that mimicry at different levels (size, shape, colour pattern) is evolving in concert. We also confirm the existence of egg size mimicry in cuckoo-host systems.

Genetic identification of Theobroma cacao L. trees with high Criollo ancestry in Soconusco, Chiapas, Mexico.

Criollo-type cacao trees are an important pool of genes with potential to be used in cacao breeding and selection programs. For that reason, we assessed the diversity and population structure of Criollo-type trees (108 cultivars with Criollo phenotypic characteristics and 10 Criollo references) using 12 simple sequence repeat (SSR) markers. Cultivars were selected from 7 demes in the Soconusco region of southern Mexico. SSRs amplified 74 alleles with an average of 3.6 alleles per population. The overall populations showed an average observed heterozygosity of 0.28, indicating heterozygote deficiency (average fixation index F = 0.50). However, moderate allelic diversity was found within populations (Shannon index for all populations I = 0.97). Bayesian method analysis determined 2 genetic clusters (K = 2) within individuals. In concordance, an assignment test grouped 37 multilocus genotypes (including 10 references) into a first cluster (Criollo), 54 into a second (presumably Amelonado), and 27 admixed individuals unassigned at the 90% threshold likely corresponding to the Trinitario genotype. This classification was supported by the principal coordinate analysis and analysis of molecular variance, which showed 12% of variation among populations (FST = 0.123, P < 0.0001). Sampled demes sites (1- 7) in the Soconusco region did not show any evidence of clustering by geographic location, and this was supported by the Mantel test (Rxy = 0.54, P = 0.120). Individuals with high Criollo lineage planted in Soconusco farms could be an important reservoir of genes for future breeding programs searching for fine, taste, flavor, and aroma cocoa.

Coevolution with hosts underpins speciation in brood-parasitic cuckoos.

Coevolution between interacting species is thought to increase biodiversity, but evidence linking microevolutionary processes to macroevolutionary patterns is scarce. We leveraged two decades of behavioral research coupled with historical DNA analysis to reveal that coevolution with hosts underpins speciation in brood-parasitic bronze-cuckoos. At a macroevolutionary scale, we show that highly virulent brood-parasitic taxa have higher speciation rates and are more likely to speciate in sympatry than less-virulent and nonparasitic relatives. We reveal the microevolutionary process underlying speciation: Hosts reject cuckoo nestlings, which selects for mimetic cuckoo nestling morphology. Where cuckoos exploit multiple hosts, selection for mimicry drives genetic and phenotypic divergence corresponding to host preference, even in sympatry. Our work elucidates perhaps the most common, but poorly characterized, evolutionary process driving biological diversification.

How Diet and Lifestyle Can Fine-Tune Gut Microbiomes for Healthy Aging.

Many physical, social, and psychological changes occur during aging that raise the risk of developing chronic diseases, frailty, and dependency. These changes adversely affect the gut microbiota, a phenomenon known as microbe-aging. Those microbiota alterations are, in turn, associated with the development of age-related diseases. The gut microbiota is highly responsive to lifestyle and dietary changes, displaying a flexibility that also provides anactionable tool by which healthy aging can be promoted. This review covers, firstly, the main lifestyle and socioeconomic factors that modify the gut microbiota composition and function during healthy or unhealthy aging and, secondly, the advances being made in defining and promoting healthy aging, including microbiome-informed artificial intelligence tools, personalized dietary patterns, and food probiotic systems.

Comparison of the efficacy and safety of bilastine 20 mg vs levocetirizine 5 mg for the treatment of chronic idiopathic urticaria: a multi-centre, double-blind, randomized, placebo-controlled study.

BACKGROUND: Bilastine is a novel nonsedative H(1)-receptor antagonist, which may be used for the symptomatic treatment of chronic idiopathic urticaria (CU). The aim of this study was to compare the clinical efficacy and safety of bilastine 20 mg vs levocetirizine 5 mg and placebo in CU patients with moderate-to-severe symptoms. METHODS: Overall 525 male and female subjects aged 18-70 years were randomized to receive bilastine 20 mg, levocetirizine 5 mg or placebo, once daily for 28 days, in double-blind manner, in 46 centres across Europe and Argentina. Patients rated symptoms of pruritus, number of wheals, and maximum size of wheals (on predefined scales) as reflective (over past 12 h) symptoms twice daily, for assessment of change from baseline in the total symptoms scores (TSS) over 28 days as the primary efficacy measure. Changes in reflective and instantaneous symptoms scores, Dermatology Life Quality Index (DLQI), and CU-associated discomfort and sleep disturbance were assessed as secondary outcomes. Safety was assessed according to adverse events, laboratory tests and electrocardiograms. RESULTS: Bilastine reduced patients' mean reflective and instantaneous TSS from baseline to a significantly greater degree than placebo (P < 0.001); from day 2 onwards of treatment. The DLQI, general discomfort, and sleep disruption were also improved significantly in bilastine-treated patients as compared with placebo-treated patients (P < 0.001 for all parameters). Comparison with levocetirizine indicated both treatments to be equally efficacious as well as equally safe and well tolerated as compared with placebo. CONCLUSIONS: Bilastine 20 mg is a novel effective and safe treatment option for the management of CU.

Pathway-oriented action of dietary essential oils to prevent muscle protein oxidation and texture deterioration of farmed rainbow trout.

Recently, great attention has been directed towards the use of essential oils from aromatic plants as antimicrobials and antioxidant in food matrix. Fish is well known to be a high perishable food. Indeed, fish muscle is susceptible to suffer protein and lipid oxidation during frozen storage, which can lead to the development of softening and undesirable volatile molecules. However, the possible inclusion of essential oils in fish feed for preserving fish flesh quality during storage is still unclear. For this reason, the potential protective effects of the incorporation of a dietary essential oil constituted by eucalyptol, carvacrol and thymol, to rainbow trout's (Oncorhynchus mykiss) feed were here investigated. Frozen fish fillets resulting from trout fed the essential oil showed a significant protection of specific muscle proteins against the oxidation produced during frozen storage at -10ºC for 6 months. Essential oil-enriched feed decreased carbonylation of specific myofibrillar (α-actinins-1 and -3, myosin heavy chain, myomesin-1, pyruvate kinase, tropomyosin, troponin-T and actin) and sarcoplasmic proteins (glycogen phosphorylase, creatine kinase, fructose-bisphosphate aldolase A and phosphoglycerate mutase 2). Essential oils also increased actin stability and preserved muscle protein solubility and water holding capacity. In addition, essential oils inhibited the onset of lipid oxidation and rancidity, resulting in frozen fish with superior textural quality and sensory scores. As a final conclusion, the inclusion of essential oils in farmed rainbow trout feed is largely efficient for increasing fish quality and shelf life during frozen storage, mainly through a selective-antioxidant effect on muscle proteins.

Competencies on environmental health and pedagogical approaches in the nursing curriculum: A systematic review of the literature.

It has been suggested that climate change is the biggest threat to public health for the 21st Century; increased demand on health services will impact on already overstretched resources and systems will need to be able to respond. However limited attention is given to climate change and sustainability in nursing education; there is no clear guidance on curricula content for nurses or recommendations regarding the skills and competencies that will be required. Literature published in Dutch, English, German, and Spanish was searched and 32 papers met the inclusion criteria for the review. Results suggests that holistic/systems thinking is relevant to healthcare so bringing a 'sustainability lens' to nursing curricula could be seen as being consistent with wider determinants of health. The literature review has identified the educational approaches necessary to provide a broad based curriculum and a cross-disciplinary approach. The findings suggest that topics such as the use of resources, food, health promotion, globalism, disease management, and the environmental impact of delivering healthcare, if embedded in nursing education could support the nursing profession's response for this new and important aspect of healthcare.

Ca2+ oscillations mediated by the synergistic excitatory actions of GABA(A) and NMDA receptors in the neonatal hippocampus.

We asked whether GABA(A) and NMDA receptors may act in synergy in neonatal hippocampal slices, at a time when GABA exerts a depolarizing action. The GABA(A) receptor agonist isoguvacine reduced the voltage-dependent Mg2+ block of single NMDA channels recorded in cell-attached configuration from P(2-5) CA3 pyramidal neurons and potentiated the Ca2+ influx through NMDA channels. The synaptic response evoked by electrical stimulation of stratum radiatum was mediated by a synergistic interaction between GABA(A) and NMDA receptors. Network-driven Giant Depolarizing Potentials, which are a typical feature of the neonatal hippocampal network, provided coactivation of GABA(A) and NMDA receptors and were associated with spontaneous and synchronous Ca2+ increases in CA3 pyramidal neurons. Thus, at the early stages of development, GABA is a major excitatory transmitter that acts in synergy with NMDA receptors. This provides in neonatal neurons a hebbian stimulation that may be involved in neuronal plasticity and network formation in the developing hippocampus.

A novel inward rectifier K+ channel with unique pore properties.

We have cloned a novel K+-selective, inward rectifier channel that is widely expressed in brain but is especially abundant in the Purkinje cell layer of the cerebellum and pyramidal cells of the hippocampus. It is also present in a wide array of tissues, including kidney and intestine. The channel is only 38% identical to its closest relative, Kir1.3 (Kir1-ATP-regulated inward rectifier K+ [ROMK] family) and displays none of the functional properties unique to the ROMK class. Kir7.1 has several unique features, including a very low estimated single channel conductance (approximately 50 fS), low sensitivity to block by external Ba2+ and Cs+, and no dependence of its inward rectification properties on the internal blocking particle Mg2+. The unusual pore properties of Kir7.1 seem to be explained by amino acids in the pore sequence that differ from corresponding conserved residues in all other Kir channel proteins. Replacement of one of these amino acids (Met-125) with the Arg absolutely conserved in all other Kir channels dramatically increases its single channel conductance and Ba2+ sensitivity. This channel would provide a steady background K+ current to help set the membrane potential in cells in which it is expressed. We propose that the novel channel be assigned to a new Kir subfamily, Kir7.1.

A novel in vitro preparation: the intact hippocampal formation.

The intact hippocampal formation (IHF) of neonatal or young rats can be kept alive for an extended period in a fully submerged chamber with excellent morphological preservation. Field or patch-clamp recordings, intracellular Ca2+ measurements, and 3-D reconstruction of biocytin-filled neurons can be performed routinely. The generation and propagation of network-driven activities can be studied within the IHF or between connected intact structures such as the septum and the hippocampus or two hippocampi, and the use of a dual chamber enables the application of drugs separately to each structure. This preparation will be useful to study intact neuronal networks in the developing hippocampus in vitro.

Single-point acupuncture and physiotherapy for the treatment of painful shoulder: a multicentre randomized controlled trial.

OBJECTIVE: Evaluate the efficacy of acupuncture associated with physiotherapy for patients with painful shoulder. METHODS: In a multicentre controlled randomized study, participants were recruited with a clinical diagnosis of unilateral subacromial syndrome from six rehabilitation medicine departments belonging to the Public Health System in two Spanish regions. All participants received 15 sessions of physiotherapy during the 3 weeks that the treatment lasted and were randomized to additionally receive, once a week, acupuncture or mock TENS (transcutaneous electrical nerve stimulation). The primary outcome measure was the change in the Constant-Murley Score (CMS) for functional assessment of the shoulder, at 4 weeks after randomization. This study is registered as an International Standard Randomized Controlled Trial, number ISRCTN28687220. RESULTS: A total of 425 patients were recruited. The mean score (s.d.) on the CMS had increased by 16.6 (15.6) points among the acupuncture group, compared with 10.6 (13.5) points in the control group, and the mean difference between the two groups was statistically significant (6.0 points; 95% CI 3.2, 8.8 points; P < 0.001). By the end of the treatment, 53% of the patients in the acupuncture group had decreased their consumption of analgesics, compared with a corresponding 30% among the control group (P < 0.001). CONCLUSIONS: Single-point acupuncture in association with physiotherapy improves shoulder function and alleviates pain, compared with physiotherapy as the sole treatment. This improvement is accompanied by a reduction in the consumption of analgesic medicaments.

Secondary amyloidosis associated with histiocytosis X.

We report a 34-year-old man diagnosed with Langerhans cell histiocytosis (LCH) or histiocytosis X in 1980. He had multiple focal osseous lesions, difficult control of the disease activity and was treated many times with chemo- and radiotherapy for symptomatic control. His kidney disease started 20 years after the diagnosis with progressive renal failure and increasing non-nephrotic proteinuria, coinciding with two flares of LCH. A percutaneous renal biopsy demonstrated amyloidosis. There is only one case described in the amyloidosis literature associated with LCH.

Impact of black soldier fly larvae meal on the chemical and nutritional characteristics of rainbow trout fillets.

The present research studied the effect of a dietary inclusion with Hermetia illucens larvae meal (Hi) on rainbow trout's fillets chemical composition. The effect of Hi inclusion in diets on rainbow trout chemical characteristics was evaluated. Trout were fed three different diets: control (C, no Hi inclusion), 25% and 50% of substitution of fish meal with Hi (Hi25 and Hi50, respectively). Fillets were analysed to quantify proximate composition, carbohydrates percentage, colour parameters, nucleotides concentration, fatty acids profile, volatile organic compounds (VOCs) and myofibrillar and sarcoplasmic concentrations. Diets did not affect proximate composition. Contrariwise, Hi50 diet decreased fillet yellowness and both substitution percentages affected negatively adenosine monophosphate concentration. Saturated fatty acids, mostly C12 : 0, increased their contents in relation with Hi inclusion at the expense of monounsaturated and polyunsaturated (both n-3 and n-6) fatty acids. Less modifications were reported in VOCs as only heptanal and octanal concentrations were affected, no new compounds appeared in relation with Hi inclusion. No modifications in proteins patterns were shown even if myofibrillar content decreased in trout fed Hi50. The results highlighted that chemical modifications occurred in fillets were related to the chemical composition of the H. illucens meal and to the percentage of inclusion in the diet. Substitution of fish meal with a precisely percentage of H. illucens meal could be a potential future solution in order to decrease the quantity of fish meal used in aquafeeds.

Tissue engineering strategies for the treatment of tendon injuries: a systematic review and meta-analysis of animal models.

OBJECTIVES: Recently, the field of tissue engineering has made numerous advances towards achieving artificial tendon substitutes with excellent mechanical and histological properties, and has had some promising experimental results. The purpose of this systematic review is to assess the efficacy of tissue engineering in the treatment of tendon injuries. METHODS: We searched MEDLINE, Embase, and the Cochrane Library for the time period 1999 to 2016 for trials investigating tissue engineering used to improve tendon healing in animal models. The studies were screened for inclusion based on randomization, controls, and reported measurable outcomes. The RevMan software package was used for the meta-analysis. RESULTS: A total of 388 references were retrieved and 35 studies were included in this systematic review. The different biomaterials developed were analyzed and we found that they improve the biomechanical and histological characteristics of the repaired tendon. At meta-analysis, despite a high heterogeneity, it revealed a statistically significant effect in favour of the maximum load, the maximum stress, and the Young's modulus between experimental and control groups. In the forest plot, the diamond was on the right side of the vertical line and did not intersect with the line, favouring experimental groups. CONCLUSIONS: This review of the literature demonstrates the heterogeneity in the tendon tissue engineering literature. Several biomaterials have been developed and have been shown to enhance tendon healing and regeneration with improved outcomes.Cite this article: D. González-Quevedo, I. Martínez-Medina, A. Campos, F. Campos, V. Carriel. Tissue engineering strategies for the treatment of tendon injuries: a systematic review and meta-analysis of animal models. Bone Joint Res 2018;7:318-324. DOI: 10.1302/2046-3758.74.BJR-2017-0326.

Effect of molecular structure of phenolic families as hydroxycinnamic acids and catechins on their antioxidant effectiveness in minced fish muscle.

The antioxidant effectiveness of two different families of phenolic compounds, hydroxycinnamic acids and catechins, added as a power (0.001% w/w) to chilled minced horse mackerel muscle was evaluated. Caffeic acid, chlorogenic acid, o-coumaric acid, and ferulic acid were selected as hydroxycinnamic acids with similar molecular structures. Commercial catechins with different numbers of hydroxylic groups, including catechin, gallocatechin, catechin gallate, and gallocatechin gallate, were also tested. The effectiveness found was individually discussed for each family as a function of the molecular structure. The capacity of hydroxycinnamic acids for donating electrons seems to play the most significant role for retarding the development of rancidity in fish muscle. Conversely, the properties related to the ability for chelating metals and the distribution between oily and aqueous phases were not correlated with the inhibitory activities. Among hydroxycinnamic acids, the results highlighted the potent antioxidant activity of 10 ppm caffeic acid in inhibiting lipid oxidation in fish muscle. Its antioxidant efficacy was similar to that of propyl gallate. Among catechins, catechin showed the highest antioxidant activity. There was an increment of efficacy in fish muscle using concentrations ranging between 10 and 100 ppm of both caffeic acid and catechin.