PROTOCOL FOR HUMAN EXPOSURE TO OPIOIDS AND CONCENTRATED MEDETOMIDINE USED IN FIELD APPLICATIONS.

Wildlife professionals routinely use potent sedatives and anesthetics when chemically immobilizing wildlife and zoo species in remote environments. Accidental exposure to these prescription veterinary drugs is rare but could be rapidly fatal. Commonly used agents include opioids and α2 adrenoreceptor agonists. These drugs can be reversed with specific antagonists; however, they are often not approved for human use. The protocol created here can be used by wildlife health professionals in a field setting with basic human emergency medical response training in coordination with local Emergency Medical Services (EMS). Key components include, building local relationships between EMS and wildlife professionals, focused EMS training, administering opioid and α2 adrenergic antagonists off label, and local evacuation procedures. This framework could allow wildlife management agencies or zoos to mitigate the risk of human exposures to these commonly used drugs, significantly improving occupational safety in an otherwise high-risk environment.

Tafasitamab and lenalidomide for relapsed/refractory diffuse large B-cell lymphoma in a patient on chronic intermittent hemodialysis.

INTRODUCTION: Tafasitamab is an anti-CD19 monoclonal antibody indicated for the treatment of relapsed/refractory diffuse large B-cell lymphoma to be given in combination with lenalidomide. Experiences with tafasitamab in the setting of hemodialysis are limited and the efficacy and safety of this agent in this setting are unknown. CASE REPORT: We describe a patient with relapsed/refractory diffuse large B-cell lymphoma with hemodialysis-dependent end-stage renal disease who successfully received tafasitamab/lenalidomide. MANAGEMENT AND OUTCOME: Tafasitamab and reduced dose lenalidomide were initiated for relapsed diffuse large B-cell lymphoma. Tafasitamab was administered on non-dialysis days. Follow-up imaging for disease response assessment demonstrated a complete response. Therapy was well tolerated; the only major toxicity experienced was grade 4 neutropenia that resolved with dose adjustment to lenalidomide. Over a year from initiating therapy, the patient remains in a complete response. DISCUSSION/CONCLUSION: The combination of tafasitamab and dose-reduced lenalidomide produced a complete response in the treatment of relapsed/refractory diffuse large B-cell lymphoma in the setting of chronic intermittent hemodialysis.

An osteopontin-derived peptide inhibits human hair growth at least in part by decreasing fibroblast growth factor-7 production in outer root sheath keratinocytes.

BACKGROUND: Given that unwanted hair growth (hirsutism, hypertrichosis) can cause major psychological distress, new pharmacological treatment strategies with safe and effective hair growth inhibitors that do not destroy the hair follicle (HF) and its stem cells need to be developed. OBJECTIVES: To establish if osteopontin-derived fragments may modulate human hair growth given that human HFs express the multifunctional, immunomodulatory glycoprotein, osteopontin. METHODS: Our hypothesis was tested ex vivo and in vivo by using a newly generated, toxicologically well-characterized, modified osteopontin-derived peptide (FOL-005), which binds to the HF. RESULTS: In organ-cultured human HFs and scalp skin, and in human scalp skin xenotransplants onto SCID mice, FOL-005 treatment (60 nmol L-1 to 3 µmol L-1 ) significantly promoted premature catagen development without reducing the number of keratin 15-positive HF stem cells or showing signs of drug toxicity. Genome-wide DNA microarray, quantitative reverse-transcriptase polymerase chain reaction and immunohistochemistry revealed decreased expression of the hair growth promoter, fibroblast growth factor-7 (FGF7) by FOL-005, while cotreatment of HFs with recombinant FGF7 partially abrogated FOL-005-induced catagen promotion. CONCLUSIONS: With caveats in mind, our study identifies this osteopontin-derived peptide as an effective, novel inhibitory principle for human hair growth ex vivo and in vivo, which deserves systematic clinical testing in hirsutism and hypertrichosis. What's already known about this topic? The treatment of unwanted hair growth (hypertrichosis, hirsutism) lacks pharmacological intervention, with only few and often unsatisfactory treatments available. Osteopontin is prominently expressed in human HFs and has been reported to be elevated during catagen in the murine hair cycle. What does this study add? We tested the effects on hair growth of a novel, osteopontin-derived fragment (FOL-005) ex vivo and in vivo. In human hair follicles, high-dose FOL-005 significantly reduces hair growth both ex vivo and in vivo. What is the translational message? High-dose FOL-005 may provide a new therapeutic opportunity as a treatment for unwanted hair growth.

Nuclear genome transfer in human oocytes eliminates mitochondrial DNA variants.

Mitochondrial DNA mutations transmitted maternally within the oocyte cytoplasm often cause life-threatening disorders. Here we explore the use of nuclear genome transfer between unfertilized oocytes of two donors to prevent the transmission of mitochondrial mutations. Nuclear genome transfer did not reduce developmental efficiency to the blastocyst stage, and genome integrity was maintained provided that spontaneous oocyte activation was avoided through the transfer of incompletely assembled spindle-chromosome complexes. Mitochondrial DNA transferred with the nuclear genome was initially detected at levels below 1%, decreasing in blastocysts and stem-cell lines to undetectable levels, and remained undetectable after passaging for more than one year, clonal expansion, differentiation into neurons, cardiomyocytes or ß-cells, and after cellular reprogramming. Stem cells and differentiated cells had mitochondrial respiratory chain enzyme activities and oxygen consumption rates indistinguishable from controls. These results demonstrate the potential of nuclear genome transfer to prevent the transmission of mitochondrial disorders in humans.

Applying Nanoparticle Tracking Analysis to Characterize the Polydispersity of Aggregates Resulting from Tannin-Polysaccharide Interactions in Wine-Like Media.

Interactions between grape seed tannin and either a mannoprotein or an arabinogalactan in model wine solutions of different ethanol concentrations were characterized with nanoparticle tracking analysis (NTA), UV-visible spectroscopy and dynamic light scattering (DLS). NTA results reflected a shift in particle size distribution due to aggregation. Furthermore, the light scattering intensity of each tracked particle measured by NTA demonstrated the presence of aggregates, even when a shift in particle size was not apparent. Mannoprotein and arabinogalactan behaved differently when combined with seed tannin. Mannoprotein formed large, highly light-scattering aggregates, while arabinogalactan exhibited only weak interactions with seed tannin. A 3% difference in alcohol concentration of the model solution (12 vs. 15% v/v) was sufficient to affect the interactions between mannoprotein and tannin when the tannin concentration was high. In summary, this study showed that NTA is a promising tool for measuring polydisperse samples of grape and wine macromolecules, and their aggregates under wine-like conditions. The implications for wine colloidal properties are discussed based on these results.

Potato Protein Fining of Phenolic Compounds in Red Wine: A Study of the Kinetics and the Impact of Wine Matrix Components and Physical Factors.

Producing wines within an acceptable range of astringency is important for quality and consumer acceptance. Astringency can be modified by fining during the winemaking process and the use of vegetable proteins (especially potato proteins) as fining agents has gained increasing interest due to consumers' requirements. The research presented was the first to investigate the effect of a potato protein dose on the kinetics of tannin and phenolic removal compared to gelatin for two unfined Cabernet Sauvignon wines. To further understand the results, the influence of the wine matrix and fining parameters (including pH, ethanol concentration, sugar concentration, temperature, and agitation) were tested according to a fractional 25-1 factorial design on one of the Cabernet Sauvignon wines using potato proteins. The results from the factorial design indicate that potato protein fining was significantly influenced by wine pH, ethanol concentration, fining temperature as well as an interaction (pH × ethanol) but not by sugar content or agitation. Insights into the steps required for the optimisation of fining were gained from the study, revealing that potato protein fining efficiency could be increased by treating wines at higher temperatures (20 °C, rather than the conventional 10-15 °C), and at both a lower pH and/or alcohol concentration.

Automated, high-throughput derivation, characterization and differentiation of induced pluripotent stem cells.

Induced pluripotent stem cells (iPSCs) are an essential tool for modeling how causal genetic variants impact cellular function in disease, as well as an emerging source of tissue for regenerative medicine. The preparation of somatic cells, their reprogramming and the subsequent verification of iPSC pluripotency are laborious, manual processes limiting the scale and reproducibility of this technology. Here we describe a modular, robotic platform for iPSC reprogramming enabling automated, high-throughput conversion of skin biopsies into iPSCs and differentiated cells with minimal manual intervention. We demonstrate that automated reprogramming and the pooled selection of polyclonal pluripotent cells results in high-quality, stable iPSCs. These lines display less line-to-line variation than either manually produced lines or lines produced through automation followed by single-colony subcloning. The robotic platform we describe will enable the application of iPSCs to population-scale biomedical problems including the study of complex genetic diseases and the development of personalized medicines.

Oncogenic role of microRNA-155 in mycosis fungoides: an in vitro and xenograft mouse model study.

BACKGROUND: MicroRNA (miR)-155 contributes to the proliferation of mycosis fungoides (MF) in vitro and is upregulated in tumours of MF compared with early MF lesions. OBJECTIVES: To investigate the contribution of miR-155 to the cancerous phenotype and drug resistance of MF/Sézary cell lines. METHODS: miR-155 was inhibited in MF cell lines (MyLa and MJ) by transduction of miRZip anti-miR-155, and overexpressed in Hut78 cells by transduction of miRVec-miR-155; empty plasmids served as controls. Cells were analysed for response to inducers of apoptosis and cell-cycle arrest, using fluorescence-activated cell sorting. Transduced MyLa cells were subcutaneously injected into severe combined immunodeficient mice, and tumours were analysed immunohistochemically and for final size. RESULT: MyLa and MJ cells expressed a high level of miR-155; Hut78 cells expressed a low level. MF cell lines stably expressing miR-155 inhibitor showed increased G2/M arrest in response to N-p-tolyl-2-(3,4,5-trimethoxyphenyl quinazolin-4-amine) (SL111), an inducer of cell-cycle arrest, followed by increased apoptosis. Additionally, they showed increased apoptosis in response to suberoylanilide hydroxamic acid (SAHA). Tumours formed in mice from injected anti-miR-155-expressing MyLa cells had a significantly lower volume and higher occurrence of apoptosis than controls. Stable overexpression of miR-155 in Hut78 cells had no effect. CONCLUSIONS: Oncogenic miR-155 appears to contribute to the cancerous phenotype of MyLa and MJ cells, but not of Hut78 cells, by interrupting activation of the G2/M checkpoint in response to SL111, and decreasing apoptosis in response to SL111 and SAHA, thereby facilitating tumour growth. These findings have implications for the potential development of novel therapeutic modalities for MF incorporating miR-155 inhibitors.

Evolution from a nodeless gap to d(x(2)-y(2))-wave in underdoped La(2-x)Sr(x)CuO4.

Using angle-resolved photoemission spectroscopy (ARPES), it is revealed that the low-energy electronic excitation spectra of highly underdoped superconducting and nonsuperconducting La(2-x)Sr(x)CuO(4) cuprates are gapped along the entire underlying Fermi surface at low temperatures. We show how the gap function evolves to a d(x(2)-y(2)) form with increasing temperature or doping, consistent with the vast majority of ARPES studies of cuprates. Our results provide essential information for uncovering the symmetry of the order parameter(s) in strongly underdoped cuprates, which is a prerequisite for understanding the pairing mechanism and how superconductivity emerges from a Mott insulator.

What causes alopecia areata?

The pathobiology of alopecia areata (AA), one of the most frequent autoimmune diseases and a major unsolved clinical problem, has intrigued dermatologists, hair biologists and immunologists for decades. Simultaneously, both affected patients and the physicians who take care of them are increasingly frustrated that there is still no fully satisfactory treatment. Much of this frustration results from the fact that the pathobiology of AA remains unclear, and no single AA pathogenesis concept can claim to be universally accepted. In fact, some investigators still harbour doubts whether this even is an autoimmune disease, and the relative importance of CD8(+) T cells, CD4(+) T cells and NKGD2(+) NK or NKT cells and the exact role of genetic factors in AA pathogenesis remain bones of contention. Also, is AA one disease, a spectrum of distinct disease entities or only a response pattern of normal hair follicles to immunologically mediated damage? During the past decade, substantial progress has been made in basic AA-related research, in the development of new models for translationally relevant AA research and in the identification of new therapeutic agents and targets for future AA management. This calls for a re-evaluation and public debate of currently prevalent AA pathobiology concepts. The present Controversies feature takes on this challenge, hoping to attract more skin biologists, immunologists and professional autoimmunity experts to this biologically fascinating and clinically important model disease.

Chronic exposure to mercury increases arrhythmia and mortality post-acute myocardial infarction in rats.

Introduction: Mercury (Hg) is a heavy metal that causes a variety of toxic effects in eukaryotic cells. Previous studies have reported detrimental effects of mercury toxicity in the cardiovascular system. Given the importance of understanding the relationship between Hg and cardiovascular disease, we sought to investigate if the Hg could worsen the myocardial repercussions following ischemic injury. We demonstrated that once mercury toxicity is established, it can influence the outcome of myocardial infarction (MI). Methods: Male Wistar rats received intramuscular injections of either saline (NaCl 0.9%) or mercuric chloride (HgCl2, first dose of 4.6 µg/kg, and subsequent doses of 0.07 µg/kg/day) for 4 weeks. Three weeks post-exposure, we induced transmural infarction in the left ventricle free wall through coronary artery occlusion surgery. Results: ECG recordings obtained from MI groups demonstrated alterations in the rhythm of the heartbeat/heart electrical activity, as expected, including ventricular extrasystoles and ventricular tachycardia. However, the MI group exposed to Hg (MI-Hg) exhibited augmented ventricular extrasystoles and ventricular tachycardia compared to the MI group. Also, Basckó coefficient revealed that the arrhythmic events-after MI-were aggravated by Hg exposure. Discussion: Our results indicate that the significantly increased mortality in MI-Hg groups when compared to MI (21%, MI vs 32%, MI-Hg) is correlated with greater occurrence of arrhythmias. In conclusion, this study further supports the idea that exposure to mercury (Hg) should be recognized as a significant risk factor that exacerbates the impact of cardiac ischemic injury, potentially leading to an increased mortality rate among patients experiencing acute MI.

Advances in the differentiation of constrictive pericarditis and restrictive cardiomyopathy.

The diagnosis of constrictive pericarditis should be considered in any patient with unexplained right heart failure. The differentiation between constrictive pericarditis and restrictive cardiomyopathy is based on a combination of clinical presentation, history and imaging, and on occasion, on the basis of invasive hemodynamic studies or biopsy. Pertinent anatomic and physiologic findings on cardiac imaging modalities including echocardiography, computed tomography and cardiac magnetic resonance imaging are reviewed, and in many cases the diagnosis can be determined on the basis of imaging. Hemodynamic studies may clarify the diagnosis, and biopsy may find treatable causes of disease.

Quantification of protein by acid hydrolysis reveals higher than expected concentrations in red wines: Implications for wine tannin concentration and colloidal stability.

Protein is reportedly negligible in most red wines, due to its loss following co-precipitation with phenolic substances. A method for protein quantification in red wine was developed which overcame analytical interference from phenolic substances, based on ethanol precipitation, followed by acid-hydrolysis and amino acid quantification. Protein concentration was surveyed in a range of red wines produced from V. vinifera and interspecific (Vitis spp) hybrids, revealing higher than expected concentrations, ranging from 23 mg/L ± 2.57 to 380 mg/L ± 16. The results showed that tannin extracted from grapes remains soluble in wine in the presence of protein even at high protein (>100 mg/L) and tannin (>500 mg/L) concentrations. As a further consequence of this, the particle size and concentration of colloids within high- and low-protein wines were similar, independent of protein or tannin concentration. Higher wine tannin concentration was also correlated with increased heat stability of wine protein.

Precipitation of Tannin-Anthocyanin Derivatives in Wine is Influenced by Acetaldehyde Concentration and Tannin Molecular Mass with Implications for the Development of Nonbleachable Pigments.

This study aimed to assess the effect of tannin molecular mass on nonbleachable pigment formation and subsequent stability under wine-like conditions. Tannin fractions of a defined molecular mass range were prepared from grape skins and seeds and reacted with malvidin-3-glucoside for 120 days in three media types: chemically defined wine media with or without acetaldehyde addition or model wine without acetaldehyde. Precipitation was observed after the reaction period and increased in response to both higher tannin molecular mass and acetaldehyde concentration. To confirm whether acetaldehyde-mediated condensation of tannin and anthocyanin modified the solubility of the nonbleachable pigments formed, HPLC-MS was used for the semiquantitative identification of vinyl derivatives and ethyl-linked adducts in soluble and precipitated materials. It was found that the proportion of vinyl derivatives and ethyl-linked anthocyanin was elevated in tannin precipitates relative to soluble pigmented material. Despite substantial losses of tannin due to precipitation, the resulting nonbleachable pigment concentration and color intensity were higher in wine media containing elevated acetaldehyde, when each tannin size category was considered independently. The results of this study indicated that the development of nonbleachable pigments from larger tannins may be limited when acetaldehyde-mediated condensation with anthocyanin predominates in wine, concomitant with precipitation.

Nusinersen for spinal muscular atrophy type 1: Real-world respiratory experience.

BACKGROUND: The emergence of new treatments for spinal muscular atrophy (SMA) is revolutionary, especially for SMA type 1 (SMA1). Data on respiratory outcomes remain sparse and rely mostly on randomized clinical trials. We report our experience of Nusinersen-treated SMA1 patients in real-world settings. METHODS: Data from SMA1 patients treated with Nusinersen were prospectively collected between 1/2017 and 1/2020. Respiratory variables included the use of assisted ventilation, the use of mechanical insufflation-exsufflation (MIE), respiratory complications, and death or treatment cessation due to respiratory reasons. RESULTS: Twenty SMA1 patients were assessed before and after 2 years of Nusinersen treatment which was initiated at a median age of 13.5 months (range, 1-184). At baseline, 16 patients were using assisted ventilation, eight noninvasive and eight invasive. Twelve patients were using permanent ventilation and four partial ventilation. After 2 years of treatment, there was no change in respiratory support among ventilated patients. All four patients who were free from respiratory support at baseline required the initiation of assisted ventilation during the study period. All 20 patients used MIE after 2 years of treatment. Two patients died from acute respiratory failure and one sustained severe brain injury. Four patients had chronic and/or recurrent atelectasis. CONCLUSION: Most of our patients were stable in their need for assisted ventilation and did not worsen as expected in SMA1, nor did they improve as might be hoped. Future studies are needed to determine if earlier treatment with Nusinersen might result in respiratory outcomes superior to those reported in this real-life study.

Chemical and Sensory Impacts of Accentuated Cut Edges (ACE) Grape Must Polyphenol Extraction Technique on Shiraz Wines.

Accentuated Cut Edges (ACE) is a recently developed grape must extraction technique, which mechanically breaks grape skins into small fragments but maintains seed integrity. This study was the first to elucidate the effect of ACE on Shiraz wine's basic chemical composition, colour, phenolic compounds, polysaccharides and sensory profiles. A further aim was to investigate any potential influence provided by ACE on the pre-fermentation water addition to must. ACE did not visually affect Shiraz wine colour, but significantly enhanced the concentration of tannin and total phenolics. Wine polysaccharide concentration was mainly increased in response to the maceration time rather than the ACE technique. ACE appeared to increase the earthy/dusty flavour, possibly due to the different precursors released by the greater skin breakage. The pre-fermentation addition of the water diluted the wine aromas, flavours and astringency profiles. However, combining the ACE technique with water addition enhanced the wine textural quality by increasing the intensities of the crucial astringent wine quality sub-qualities, adhesive and graininess. Furthermore, insights into the chemical factors influencing the astringency sensations were provided in this study. This research indicates that wine producers may use ACE with pre-fermentation water dilution to reduce the wine alcohol level but maintain important textural components.

Bioavailability of red wine and grape seed proanthocyanidins in rats.

This study explored plasma levels and urinary and fecal excretion of metabolites and microbial-derived catabolites over a 24 h period following the ingestion of red wine (RWP) or grape seed (GSP) proanthocyanidin-rich extracts by rats. In total, 35 structurally-related (epi)catechin metabolites (SREMs) and 5-carbon side chain ring fission metabolites (5C-RFMs) (phenyl-γ-valerolactones and phenylvaleric acids), and 50 phenolic acid and aromatic catabolites were detected after intakes of both extracts. The consumption of the RWP extract, but not the GSP extract, led to the appearance of a ∼200 nmol L-1 peak plasma concentration of SREMs formed from flavan-3-ol monomers. In contrast, ingestion of the GSPs, but not the RWPs, resulted in a substantial increase in microbiota-derived 5-carbon side chain ring fission metabolites (5C-RFMs) in plasma. 5C-RFMs, along with low molecular weight phenolic catabolites were detected in urine after ingestion of both extracts. The GSP and RWP extracts had respective mean degrees of polymerisation 5.9 and 6.5 subunits, and the RWP extract had an upper polymer size of 21 subunits compared to 44 subunits for the GSP extract. The differences in plasma metabolite profiles might, therefore, be a consequence of this polydispersity impacting on the microbiota-mediated rates of cleavage of the proanthocyanidin subunits and their subsequent metabolism and absorption. Urinary excretion of phenolic catabolites indicated that 11% of RWPs and 7% for GSPs were subjected to microbial degradation. In all probability these figures, rather than representing the percentage of proanthocyanidins that are completely degraded, indicate partial cleavage of monomer subunits producing a much higher percentage of shortened proanthocyanidin chains. Obtaining more detailed information on the in vivo fate of proanthocyanidins is challenging because of the difficulties in analysing unabsorbed parent proanthocyanidins and their partially degraded flavan-3-ol subunit chains in feces. Further progress awaits the development of improved purification and analytical techniques for proanthocyanidins and their use in feeding studies, and in vitro fecal and bacterial incubations, with radio and/or stable isotope-labelled substrates.

Magnetic properties of (Fe1-xMnx)2AlB2 and the impact of substitution on the magnetocaloric effect.

In this work, we investigate the magnetic structures of (Fe1-xMnx)2AlB2 solid-solution quaternaries in the x=0 to 1 range using x-ray and neutron diffraction, magnetization measurements, and mean-field theory calculations. While Fe2AlB2 and Mn2AlB2 are known to be ferromagnetic (FM) and antiferromagnetic (AFM), respectively, herein we focused on the magnetic structure of their solid solutions, which is not well understood. The FM ground state of Fe2AlB2 becomes a canted AFM at x≈0.2, with a monotonically diminishing FM component until x≈0.5. The FM transition temperature (TC) decreases linearly with increasing x. These changes in magnetic moments and structures are reflected in anomalous expansions of the lattice parameters, indicating a magnetoelastic coupling. Lastly, the magnetocaloric properties of the solid solutions were explored. For x=0.2 the isothermal entropy change is smaller by 30% than it is for Fe2AlB2, while the relative cooling power is larger by 6%, due to broadening of the temperature range of the transition.