A systematic review of the use of lasers for the treatment of hidradenitis suppurativa.

AIM: To conduct a systematic review of the effectiveness of various types of lasers (and light based therapies) for the treatment of hidradenitis suppurativa (HS) and to establish recommendations based on our findings. DATA SOURCES: MEDLINE, Cochrane and PubMed databases. STUDY SELECTION: English language studies describing the use of laser for the treatment of HS. DATA EXTRACTION: Multiple reviewers performed independent extraction and identified 22 studies that met the inclusion and exclusion criteria. DATA SYNTHESIS: Studies were categorised according to grading recommendations based on evidence quality guidelines for systematic reviews. Only 2 studies met criteria to be assigned the highest grade. CONCLUSION: Nd:YAG laser has been shown to be effective for the treatment of HS, as is intense pulsed light therapy (IPL) using the same principles of laser hair removal. There is weak evidence to recommend the use of carbon dioxide, diode or alexandrite lasers. The need for larger randomized controlled trials is highlighted.

Male-biased hermaphrodites in a gynodioecious shrub, Daphne jezoensis.

Gynodioecy, a state where female and hermaphrodite plants coexist in populations, has been widely proposed an intermediate stage in the evolutionary pathway from hermaphroditism to dioecy. In the gynodioecy-dioecy pathway, hermaphrodites may gain most of their fitness through male function once females invade populations. To test this prediction, comprehensive studies on sex ratio variation across populations and reproductive characteristics of hermaphrodite and female phenotypes are necessary. This study examined the variation in sex ratio, sex expression, flower and fruit production and sexual dimorphism of morphological traits in a gynodioecious shrub, Daphne jezoensis, over multiple populations and years. Population sex ratio (hermaphrodite:female) was close to 1:1 or slightly hermaphrodite-biased. Sex type of individual plants was largely fixed, but 15% of plants changed their sex during a 6-year census. Hermaphrodite plants produced larger flowers and invested 2.5 times more resources in flower production than female plants, but they exhibited remarkably low fruit set (proportion of flowers setting fruits). Female plants produced six times more fruits than hermaphrodite plants. Low fruiting ability of hermaphrodite plants was retained even when hand-pollination was performed. Fruit production of female plants was restricted by pollen limitation under natural conditions, irrespective of high potential fecundity, and this minimised the difference in resources allocated to reproduction between the sexes. Negative effects of previous flower and fruit production on current reproduction were not apparent in both sexes. This study suggests that gynodioecy in this species is functionally close to a dioecious mating system: smaller flower production with larger fruiting ability in female plants, and larger flower production with little fruiting ability in hermaphrodite plants.

Vitamin D supplementation during pregnancy and infancy reduces aeroallergen sensitization: a randomized controlled trial.

BACKGROUND: Vitamin D has immune-modulating effects. We determined whether vitamin D supplementation during pregnancy and infancy prevents aeroallergen sensitization and primary care respiratory illness presentations. METHODS: A randomized, double-blind, placebo-controlled parallel-group trial. We assigned pregnant women, from 27-week gestation to birth, and then their infants, from birth to 6 months, to placebo or one of two dosages of daily oral vitamin D. Woman/infant pairs were randomized to: placebo/placebo, 1000 IU/400 IU or 2000 IU/800 IU. When the children were 18 months old, we measured serum-specific IgE antibodies and identified acute primary care visits described by the doctor to be due to a cold, otitis media, an upper respiratory infection, croup, asthma, bronchitis, bronchiolitis, a wheezy lower respiratory infection or fever and cough. RESULTS: Specific IgE was measured on 185 of 260 (71%) enrolled children. The proportion of children sensitized differed by study group for four mite antigens: Dermatophagoides farinae (Der-f1, Der-f2) and Dermatophagoides pteronyssinus (Der-p1, Der-p2). With results presented for placebo, lower dose, and higher dose vitamin D, respectively (all P < 0.05): Der-f1 (18%, 10%, 2%), Der-f2 (14%, 3%, 2%), Der-p1 (19%, 14%, 3%) and Der-p2 (12%, 2%, 3%). There were study group differences in the proportion of children with primary care visits described by the doctor as being for asthma (11%, 0%, 4%, P = 0.002), but not for the other respiratory diagnoses. CONCLUSIONS: Vitamin D supplementation during pregnancy and infancy reduces the proportion of children sensitized to mites at age 18 months. Preliminary data indicate a possible effect on primary care visits where asthma is diagnosed.

Advanced age, but not anergy, is associated with altered serum polyunsaturated fatty acid levels.

Unknown factors present in the serum of older adults impair lymphocyte function and may be responsible for anergy (absence of delayed-type hypersensitivity (DTH)) present in many older adults. Polyunsaturated fatty acids (PUFAs) and their metabolites are immunomodulatory and may play a role in clinical conditions of advanced age, including immune dysfunction. We hypothesized that PUFAs could be the factor(s) present in serum that contribute to impaired immune responses in older adults. Prior studies of serum PUFAs in older adults neither adequately control dietary PUFA intake, nor investigated the relationship of PUFAs and DTH responses. We determined serum PUFA concentrations in young adults with normal immune responses, and older adults with impaired (anergic elderly) or normal immunity (nonanergic elderly) before and after administering a standardized diet. After controlling for dietary intake, advancing age was associated with markedly higher serum concentrations of arachidonic acid (AA), dihomo-gamma-linoleic acid (DGLA), and eicosapentaenoic acid (EPA) and a lower AA:EPA ratio. Other serum PUFAs and the AA:DGLA ratio were unaffected by age. However, there was no difference between older adults with or without anergy. These data suggest advanced age is associated with marked alterations of serum PUFAs that are only apparent after strictly controlling dietary intake. However, there was no association of serum PUFA concentrations with DTH status among older adults.

Relationship between seizure-induced transcription of the DNA damage-inducible gene GADD45, DNA fragmentation, and neuronal death in focally evoked limbic epilepsy.

We investigated the temporal and spatial profile of mRNA transcription for the growth arrest and DNA damage-inducible gene GADD45, DNA fragmentation, and neuronal death in rat brain following focally evoked limbic seizures. GADD45 mRNA was detected by in situ hybridization, whereas fragmented DNA was detected using in situ nick end-labeling by the large (Klenow) fragment of DNA polymerase I. Kainic acid (0.1 microg) was injected into the right amygdala of rats to induce seizures for 45 min, after which diazepam (30 mg/kg) was administered. GADD45 mRNA, DNA fragmentation, and cell death were quantified bilaterally within six limbic brain regions 0-96 h following seizure cessation. All animals underwent seizures of equivalent severity and duration as determined electrographically. In situ hybridization detected bilateral up-regulation of GADD45 mRNA throughout the CA1, CA3, and dentate gyrus of the hippocampus, the piriform and retrosplenial cortices, and the thalamus within 1 h of seizure termination. GADD45 mRNA levels remained elevated for up to 6 h, declining to baseline within all structures by 16 h. Klenow-positive cells were only found within the CA3 pyramidal layer of the ipsilateral hippocampus and appeared 16-72 h following seizure cessation. Morphologic cell death was also restricted to the CA3 subfield. These data demonstrate that focally evoked limbic seizures trigger early bihemispheric GADD45 mRNA transcription within connected limbic structures, whereas subsequent DNA fragmentation and cell death are restricted to selectively vulnerable brain regions.

Dose-related effect of alcohol on mismatch negativity and reaction time performance.

In a recent study, the mismatch negativity (MMN) component of auditory event-related potential, elicited by occasional frequency changes in a repetitive tone, was strongly attenuated by a low dosage of alcohol. We investigated the phenomenon in nine subjects with two different dosages of ethanol (0.35 and 0.55 g/kg), and with two magnitudes of frequency changes (5% and 10%), in a single-blind, placebo-controlled paradigm. Ethanol had no observable effect on the N1 and P2 deflections, nor on the reaction time to frequency changes measured in a separate session. However, the MMN was attenuated after administration of the larger dosage of alcohol, suggesting impaired preconscious processing of stimulus features outside the scope of attention. The results support the view according to which the automatic functions of human information processing are more sensitive than the controlled functions to the detrimental effects of alcohol. The fact that the MMN suppression was stronger when stimulus deviation was smaller indicates that at relatively low blood alcohol concentrations the detection of small deviations is especially hampered.

The transcription factor YY1 binds to negative regulatory elements in the human cytomegalovirus major immediate early enhancer/promoter and mediates repression in non-permissive cells.

We have previously shown that repression of human cytomegalovirus (HCMV) major immediate early (IE) gene expression in non-permissive human teratocarcinoma (T2) cells is associated with a number of nuclear factors which bind to the imperfect dyad symmetry located in the modulator region upstream of the major IE enhancer as well as to the 21 bp repeat elements within the enhancer. Differentiation of T2 cells with retinoic acid (RA) results in a decrease in binding of some of these nuclear factors to these sites and deletion of these specific binding sites from major IE promoter/reporter constructs results in increased IE promoter activity in normally non-permissive cells. In this study, we demonstrate that the transcription factor YY1, which can negatively regulate the adeno-associated virus P5 promoter, directly binds to both the imperfect dyad symmetry and the 21 bp repeat elements in the HCMV major IE promoter/regulatory region and mediates repression of HCMV IE gene expression. This strongly suggests that YY1 plays an important role in regulating HCMV expression in non-permissive cells.

Responding for oral ethanol after naloxone treatment by alcohol-preferring AA rats.

The present study examined the effect of a relatively nonselective opioid antagonist, naloxone, on lever pressing for oral ethanol by the alcohol-preferring AA rats. The AAs, housed continually in operant chambers with free access to food and water, learned to respond for 10% oral ethanol during daily 60-min alcohol access periods indicated by a stimulus light. The rats developed stable ethanol responding, resulting in mean ethanol intakes of 1.2 g/kg/60 min and measurable blood alcohol levels. In the first experiment, single systemic injections of naloxone (0.05-2.5 mg/kg) had no effect on the initial rate of responding; dose-dependent decreases were observed later during the alcohol access. The second experiment examined the effects of repeated injections of 0.5 and 2.5 mg/kg naloxone on 5 consecutive days. Naloxone suppressed responding dose-relatedly over the treatment days. In contrast to the effects of single injections, repeated injections with 2.5 mg/kg naloxone produced progressive decreases within the first minutes of access. The results suggest that naloxone may attenuate the reinforcing actions of ethanol.

Energy intake and the nature of growth in low birth weight infants.

Growth is accompanied by and depends on energy storage in growing tissue. The rate of energy storage in growing low birth weight infants depends on the rate of energy intake and on the rates of energy excretion and expenditure, both of which (on a body weight basis) are much higher than in adults, and both of which increase with increments of gross energy intake. Energy-balance studies of growing low birth weight infants on gross energy intakes approximating 500 kJ X kg-1 X d-1 of mothers' milk or of infant formula indicate that the composition of extrauterine weight gain of the low birth weight infant differs from that of the fetus of similar gestation, in that the energy storage cost of growth is much higher. Attempts to increase metabolizable energy intake beyond 500 kJ X kg-1 X d-1 by energy supplementation alone do not result in proportionately increased rates of weight gain; low birth weight formulae, in which energy, protein, and mineral contents are all increased can result in large weight gains with proportionate increases in rates of protein and fat accretion.

Insensible water loss in newborn infants.

In this review we have described, in some detail, the physical processes involved in water loss from both the skin and lungs. Although at first glance these physical processes may seem complex and confusing, once the basic concepts are grasped, the effect of the many variables in both the babies and their environment on IWL can be seen more clearly. Measurement of IWL, or its components, TEWL and RWL, is difficult in newborn infants. Some of the difficulties arise because of the nature of the subject being studied, and because of inaccuracy in the measuring apparatus. The difficulties in the subjects include lack of cooperation, and the presence of severe illness, both of which may limit the representativeness of any sample of babies that is eventually studied successfully. The size of the subjects studied means that small amounts of water are given off in any fixed period of time. Consequently, the accuracy of the measuring instruments has to be high. As we have discussed, each of the methods used to estimate IWL, TEWL, or RWL has limitations and potential inaccuracies. Despite the difficulties in obtaining estimates of IWL in newborn infants, there have been many studies over the years that have provided clinically useful data. More recently, improved survival of VLBW infants has lead to an awareness that IWL is substantially increased in these tiny babies. The best way to manage the problems of water and heat balance associated with increased IWL in VLBW infants remains to be determined.

Hydration of the low birth-weight infant.

Factors relating to water balance in the perinatal and neonatal periods are reviewed. The major areas considered are changes in body water compartments, insensible water loss, and renal function. A most striking feature in all these areas is the wide variation in 'normal' values, both within the same infant with advancing postnatal age and also between infants of the same postnatal age but of different gestational ages. A second feature is the fluctuation caused by changes in environmental conditions, e.g., temperature, humidity, type of warming device, use of phototherapy. Much of the literature on water balance relates to term infants and experimental animals; only for insensible water loss are there studies on infants as small as less than 1000 gm. Because of the developmental changes occurring in these infants, many areas require further study. The last 5 to 10 years have seen marked changes in our approach to the hydration and nutrition of the low birth-weight infant. Despite much experience with new routes and types of fluids and formulas, no method has been shown to be ideal for all situations. In replacing the neonate's ongoing water losses, the clinician strives to maintain normal volume and tonicity of the body fluids, and to prevent clinical and biochemical signs of dehydration or over-hydration. In planning therapy, the clinician is presented with a wide range of possible water requirements, and with a choice of route and type of fluid administration. Each low birth-weight infant must be viewed individually, and once fluid requirements have been estimated, frequent assessment of hydration status is necessary, with appropriately frequent readjustment of the rate of fluid administration.