Development and Evaluation of Modified Criteria for Infant and Toddler Anaphylaxis.

BACKGROUND: Current clinical criteria for identifying anaphylaxis do not account for unique aspects of infant anaphylaxis presentation and have not been validated in patients younger than 2 years of age. This may contribute to under recognition and is thus an unmet need. OBJECTIVE: To demonstrate age-specific signs and symptoms that more accurately identify anaphylaxis in young children and to develop and compare modified criteria for "likely anaphylaxis" against the widely used 2006 National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN) criteria. METHODS: Retrospective chart review of 337 clinical encounters presenting with suspected allergic or anaphylactic reactions to a pediatric emergency department. Modified criteria for likely anaphylaxis were developed and evaluated against the NIAID/FAAN criteria. RESULTS: The study population included 33% infants (age < 12 mo), 39% toddlers (age 12 mo to < 36 mo), and 29% children (age ≥ 36 mo). The NIAID/FAAN criteria captured 85% of all patient encounters in the study and the modified criteria captured 98% (P < .001). Compared with NIAID/FAAN criteria, modified criteria had 22.8% improved performance among infants (p < .001) and 10.3% improved performance among toddlers (P = .04). CONCLUSIONS: We developed modified anaphylaxis clinical criteria that incorporated symptoms specific to infants and young children. The modified criteria increased identification of anaphylaxis in infants and potentially toddlers. Future research is needed to validate our findings on a larger cohort.

Temporalis fascia for lip augmentation.

BACKGROUND: The pervasiveness of the desire for beautiful lips persists today, with women in the United States spending almost 2.9 billion dollars annually on cosmetics and lip products. The lips occupy the central feature of the lower third of the face and are of paramount importance to facial beauty. Various surgical approaches and methods are used in lip augmentation. METHODS: We reviewed the charts of 7 patients who underwent temporalis fascia lip augmentation to evaluate the temporalis fascia as a safe and effective means for lip augmentation. RESULTS: The average follow-up was 5 years (range, 4-6 years). All patients who underwent lip augmentation were female. The average age of the patients was 47 years old with a range of 36 to 67 years. All patients were very satisfied with the results of their surgical lip augmentation postoperatively and no patients required any revision operations. CONCLUSION: Temporalis fascia is a safe method of lip augmentation and is durable and long lasting. Lip augmentation with temporalis fascia can easily be performed in conjunction with other procedures.

Polysorbate Degradation and Particle Formation in a High Concentration mAb: Formulation Strategies to Minimize Effect of Enzymatic Polysorbate Degradation.

Polysorbate (PS) 20 and 80 are the most common surfactants in monoclonal antibody (mAb) drug product (DP) formulations. Residual host cell proteins (HCP) present at extremely low concentrations in DP formulations can maintain enough enzymatic activity to degrade PS surfactants. Over time, the hydrolysis of surfactant causes the accumulation of minimally soluble free fatty acids resulting in precipitation and formation of subvisible and visible particulates. This manuscript summarizes the investigation of a batch of high concentration (>100 mg/mL) mAb DP where subvisible particles formed abruptly after prolonged storage at 5C°. The work also summarizes the effectiveness of different strategies for managing host cell proteins and fatty acid particles. The concentration and fatty acid composition of polysorbates were found to be significant factors in particle development. Solubilizers and alternative surfactants were all shown to be effective means of preventing particle formation. Lipase inhibitors proved to be a simple means to identify the problem but are more difficult to utilize as a solution.

Solution structure and assembly of ß-amylase 2 from Arabidopsis thaliana.

Starch is a key energy-storage molecule in plants that requires controlled synthesis and breakdown for effective plant growth. ß-Amylases (BAMs) hydrolyze starch into maltose to help to meet the metabolic needs of the plant. In the model plant Arabidopsis thaliana there are nine BAMs, which have apparently distinct functional and domain structures, although the functions of only a few of the BAMs are known and there are no 3D structures of BAMs from this organism. Recently, AtBAM2 was proposed to form a tetramer based on chromatography and activity assays of mutants; however, there was no direct observation of this tetramer. Here, small-angle X-ray scattering data were collected from AtBAM2 and its N-terminal truncations to describe the structure and assembly of the tetramer. Comparison of the scattering of the AtBAM2 tetramer with data collected from sweet potato (Ipomoea batatas) BAM5, which is also reported to form a tetramer, showed there were differences in the overall assembly. Analysis of the N-terminal truncations of AtBAM2 identified a loop sequence found only in BAM2 orthologs that appears to be critical for AtBAM2 tetramer assembly as well as for activity.

Resilience of BST-2/Tetherin structure to single amino acid substitutions.

Human tetherin, also known as BST-2 or CD317, is a dimeric, extracellular membrane-bound protein that consists of N and C terminal membrane anchors connected by an extracellular domain. BST-2 is involved in binding enveloped viruses, such as HIV, and inhibiting viral release in addition to a role in NF-kB signaling. Viral tethering by tetherin can be disrupted by the interaction with Vpu in HIV-1 in addition to other viral proteins. The structural mechanism of tetherin function is not clear and the effects of human tetherin mutations identified by sequencing consortiums are not known. To address this gap in the knowledge, we used data from the Ensembl database to construct and model known human missense mutations within the ectodomain to investigate how the structure of the ectodomain influences function. From the data, we identified an island of sequence stability within the ectodomain, which corresponds to a functionally and structurally important region identified in previous biochemical and biophysical studies. Most of the modeled mutations had little effect on the structure of the dimer and the coiled-coil, suggesting that the coiled-coil compensates for changes in primary structure. Thus, many of the functional defects observed in previous studies may not be due to changes in tetherin structure, but rather, due to in changes in protein-protein interactions or in aspects of tetherin not currently understood. The lack of structural effects by mutations known to decrease function further illustrates the need for more study of the structure-function connection for this system. Finally, apparent flexibility in tetherin sequence may allow for greater anti-viral activities with a larger number of viruses by reducing specific interactions with anti-tetherin proteins, while maintaining virus restriction.

3D Printing of Biomolecular Models for Research and Pedagogy.

The construction of physical three-dimensional (3D) models of biomolecules can uniquely contribute to the study of the structure-function relationship. 3D structures are most often perceived using the two-dimensional and exclusively visual medium of the computer screen. Converting digital 3D molecular data into real objects enables information to be perceived through an expanded range of human senses, including direct stereoscopic vision, touch, and interaction. Such tangible models facilitate new insights, enable hypothesis testing, and serve as psychological or sensory anchors for conceptual information about the functions of biomolecules. Recent advances in consumer 3D printing technology enable, for the first time, the cost-effective fabrication of high-quality and scientifically accurate models of biomolecules in a variety of molecular representations. However, the optimization of the virtual model and its printing parameters is difficult and time consuming without detailed guidance. Here, we provide a guide on the digital design and physical fabrication of biomolecule models for research and pedagogy using open source or low-cost software and low-cost 3D printers that use fused filament fabrication technology.

Influence of anisotropy on the dynamic wetting and permeation of paper coatings.

A void network model, named Pore-Cor, has been used to study the permeation of an ink solvent into paper coating formulations coated onto a synthetic substrate. The network model generated anisotropic void networks of rectangular cross-sectional pores connected by elliptical cross-sectional throats. These structures had porosities and mercury intrusion properties which closely matched those of the experimental samples. The permeation of hexadecane, used as an analogue for the experimental test oil, was then simulated through these void structures. The simulations were compared to measurements of the permeation of mineral oil into four types of paper coating formulation. The simulations showed that the inertia of the fluid as it enters void features causes a considerable change in wetting over a few milliseconds, a timescale relevant to printing in a modern press. They also showed that in the more anisotropic samples, fast advance wetting occurred through narrow void features. It was found that the match between experimental and simulated wetting could be improved by correcting the simulation for the number of surface throats. The simulations showed a more realistic experimental trend, and much greater preferential flow, than the traditional Lucas-Washburn and effective hydraulic radius approaches.