Eosinophilic Esophagitis due to Aeroallergens: A Systematic Review and Update.

Eosinophilic esophagitis is a chronic antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by TH2 inflammation (at least 15 eosinophils/high power field) when other secondary systemic and local causes of esophageal eosinophilia are excluded. Although this disease was initially ascribed to a delayed reaction to food allergens, emerging evidence suggests that aeroallergens may also play a role in pathogenesis and disease course. Some studies support seasonal variations in the diagnosis of eosinophilic esophagitis and disease exacerbations owing to the increase in aeroallergens to which patients are sensitized. It is also known that this disease can be caused by extensive, identifiable exposure to aeroallergens and after treatment with specific immunotherapy based on food or aeroallergens. It was recently postulated that treatment of allergic rhinoconjunctivitis can improve the symptoms of eosinophilic esophagitis, although data are limited to case reports and small series. Currently, biomarkers and biologic therapies are not helpful for diagnosis or inducing clinical and histological remission of the disease. Nevertheless, there are high hopes for dupilumab. This review aims to give visibility to the involvement of aeroallergens in the triggering and exacerbation of eosinophilic esophagitis, since many of them, in addition to being airborne and inhalant, can also be ingested as food. Clearly, we must try to identify the cause of the disease to ensure remission.

Eosinophilic Esophagitis due to Aeroallergens: A Systematic Review and Update

Eosinophilic esophagitis is a chronic antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by TH2 inflammation (at least 15 eosinophils/high power field) when other secondary systemic and local causes of esophageal eosinophilia are excluded. Although this disease was initially ascribed to a delayed reaction to food allergens, emerging evidence suggests that aeroallergens may also play a role in pathogenesis and disease course. Some studies support seasonal variations in the diagnosis of eosinophilic esophagitis and disease exacerbations owing to the increase in aeroallergens to which patients are sensitized. It is also known that this disease can be caused by extensive, identifiable exposure to aeroallergens and after treatment with specific immunotherapy based on food or aeroallergens. It was recently postulated that treatment of allergic rhinoconjunctivitis can improve the symptoms of eosinophilic esophagitis, although data are limited to case reports and small series. Currently, biomarkers and biologic therapies are not helpful for diagnosis or inducing clinical and histological remission of the disease. Nevertheless, there are high hopes for dupilumab. This review aims to give visibility to the involvement of aeroallergens in the triggering and exacerbation of eosinophilic esophagitis, since many of them, in addition to being airborne and inhalant, can also be ingested as food. Clearly, we must try to identify the cause of the disease to ensure remission. (AU)

Influence of releases of (129)I and (137)Cs from European reprocessing facilities in Fucus vesiculosus and seawater from the Kattegat and Skagerrak areas.

(129)I is a very long-lived radionuclide (T1/2=15.7×10(6) years) that is present in the environment because of natural and anthropogenic sources. Compared to the pre-nuclear era, large amounts of (129)I have been released to the marine environment, especially as liquid and gaseous discharges from two European reprocessing facilities located at Sellafield (England) and La Hague (France). The marine environment, i.e., the oceans, is the major source of iodine. Brown seaweed accumulates iodine at high levels up to 1.0% of dry weigh, and therefore they are ideal bioindicators for studying levels of (129)I. In this work, (129)I concentrations have been determined in seaweed Fucus vesiculosus and seawater collected in the Kattegat and Skagerrak areas in July 2007. The resulting data were evaluated in terms of (129)I concentrations and (129)I/(137)Cs ratios. (129)I concentrations were found to be in the order of (44-575)×10(9) atoms g(-1) in seaweed and (5.4-51)×10(9) atoms g(-1) in seawater, with an enhancement in the Skagerrak area in comparison to the Kattegat area. Iodine-129 concentrations in both seaweed and seawater were used to determine the concentration factor of iodine in brown seaweed F. vesiculosus. The high levels of (129)I and (129)I/(137)Cs ratios in the Skagerrak area and their gradually decreasing trend to the Kattegat indicates that the most important contribution to the (129)I inventory in those areas comes from Sellafield and La Hague reprocessing plants.

Pre- and post-Chernobyl accident levels of 129I and 137Cs in the Southern Baltic Sea by brown seaweed Fucus vesiculosus.

(129)I is a very long-lived radionuclide (T(1/2) = 15.7 × 10(6) years) that is present in the environment both because of natural and anthropogenic sources. In this work (129)I concentration and (129)I/(127)I ratio have been determined in seaweed Fucus vesiculosus collected in the Southern Baltic Sea during 1982 and 1986 (post-Chernobyl accident). The resulting data were evaluated in terms of (129)I concentrations, (129)I/(127)I and (129)I/(137)Cs ratios. (129)I concentrations were found to be in the order of (0.82-5.89) × 10(9) atoms g(-1) in 1982 and (1.33-38.83) × 10(9) atoms g(-1) in 1986. The (129)I/(127)I ratios ranged from (22.7-87.8) × 10(-10) for seaweed collected in 1982 and from (26.1-305.5) × 10(-10) for seaweed collected in 1986. Also a linear relationship was established for (127)I concentrations in seawater and salinity in this area, enabling the estimation of concentration factors for (127)I in F. vesiculosus. The high levels of (129)I and (129)I/(127)I in the Kattegat and their gradually decreasing trend to the Baltic Sea indicates that the most important contribution to the (129)I inventory in the Baltic Sea area comes from Sellafield and La Hague reprocessing plants. With respect to Chernobyl accident, (129)I concentrations in samples collected in 1986 were not much higher than those expected in less contaminated samples from 1982. This supports the view that the contribution of the Chernobyl accident to (129)I in the Baltic region was not significant.

Testis-specific protein Y-encoded copy number is correlated to its expression and the field fertility of Canadian Holstein bulls.

Testis-specific protein Y-encoded (TSPY) is present in varying copy number in both human (20-76 copies) and cattle (37-200 copies), and some studies have linked this variation to semen quality in men. The purpose of this study was to determine if TSPY copy number is associated with fertility in bulls by using adjusted non-return rates, a commonly used measure of field fertility in Canada. In addition, we investigated the associations between TSPY copy number and its expression as well as specific semen parameters, such as average sperm concentration, sperm count, ejaculate volume, and motility. In 2 independent trials, TSPY copy number was shown to be positively correlated to adjusted non-return rates (trial #1: Spearman r = 0.34, p < 0.05; trial #2: Spearman r = 0.77, p < 0.01). Furthermore, TSPY copy number was inversely correlated to TSPY mRNA expression in the testis (Pearson r = -0.71, p < 0.0001). There were no correlations of TSPY copy number or expression with the semen parameters measured. Therefore, TSPY copy number might represent a potential marker of bull fertility, but its mechanism does not appear to be directly related to the semen characteristics analyzed as part of this study.

Patients with relapsing polychondritis and previous cartilage trauma present more autoimmunity phenomena.

Relapsing polychondritis (RP) is an autoimmune disease characterized by inflammation and destruction of all type of body cartilage, and the cartilage trauma may be a trigger of the disease in a susceptible person. We describe the clinical and laboratory findings in a group of 18 patients with RP with (7 cases) or without (11 cases) anteceding cartilage trauma. The mean age was 41 years in the group with cartilage trauma and 55 years in the group without cartilage trauma. For both groups, female gender was predominant. All patients presented with auricular chondritis. Systemic manifestations and autoimmunity were more common in patients with anteceding trauma.

129I measurements on the 1MV AMS facility at the Centro Nacional de Aceleradores (CNA, Spain).

The AMS system at CNA has been the first 1MV compact AMS system designed and manufactured by HVE. In this paper we present the experimental set-up for (129)I measurements in this facility. Charge state +3 has been selected at high-energy side and an optimum stripper pressure of 6×10(-3)mbar of argon (mass thickness of about 0.15µgcm(-2)) has been reached to obtain lowest blank values ((129)I/(127)I≅3×10(-13)). The measurements of the reference materials provided by the IAEA have demonstrated the viability of this facility to make routine measurements of (129)I at environmental levels. This blank value obtained is enough for the measurement of most environmental samples and comparable with other reported backgrounds obtained in facilities working at higher energies and higher charge states.

Level and origin of 129I and 137Cs in lichen samples (Cladonia alpestris) in central Sweden.

Lichen is a symbiosis between algae and fungi. They have for decades been used as bioindicators for atmospheric deposition of heavy metals, organic compounds and radioactive elements. Especially the species Cladonia alpestris and Cladonia rangiferina are important for the food chain lichen-reindeer-man. The concentration of (129)I was determined in lichen samples (Cladonia alpestris) contaminated by fallout from atmospheric nuclear tests explosions and the Chernobyl accident. The samples were collected at Lake Rogen District (62.3°N, 12.4°E) in central Sweden in the periods 1961-1975 and 1987-1998, and analysed with accelerator mass spectrometry (AMS) at CNA (Seville) to study its distribution in different layers. Data on the (137)Cs activity measured previously were also included in this study. The (129)I concentration ranged from (0.95 ± 0.13) × 10(8) at g(-1) in 1961 in the uppermost layer to (14.2 ± 0.5) × 10(8) at g(-1) in 1987 in deepest layer. The (129)I/(137)Cs atom ratio ranged between 0.12 and 0.27 for lichen samples collected in the period 1961-1975, indicating weapons tests fallout. For lichen samples collected between 1987 and 1998 the behaviour of (137)Cs concentrations reflected Chernobyl fallout. The concentrations of the two radionuclides followed each other quite well in the profile, reflecting the same origin for both. From the point of view of the spatial distribution in the lichen, it appears that (129)I was predominantly accumulated in the lowest layer, the opposite to (137)Cs for which the highest amounts were detected systematically in the topmost layer of lichen. This vertical distribution is important for radioecology because lichen is the initial link in the food chain lichen-reindeer-man, and reindeer only graze the upper parts of lichen carpets.

Predicting recovery of severe regional ventricular dysfunction. Comparison of resting scintigraphy with 201Tl and 99mTc-sestamibi.

BACKGROUND: Regional 201Tl activity after resting injection, imaged early and after redistribution, reflects viable myocardium and can predict improved isotope uptake as well as regional and global ventricular function after revascularization. 99mTc-sestamibi, a perfusion tracer with favorable imaging characteristics, has distinct kinetics compared with 201Tl, demonstrating minimal redistribution; this property may give 201Tl an advantage for detecting viable myocardium, particularly in segments with resting hypoperfusion. The purpose of this study was to compare regional activities of 201Tl and 99mTc-sestamibi after resting injections in patients with coronary artery disease and regional or global left ventricular dysfunction and to assess their comparative abilities for predicting recovery of severe regional ventricular dysfunction after revascularization. METHODS AND RESULTS: Qualitative and quantitative comparisons of rest and redistribution 201Tl activity and sestamibi activity 1 hour after rest injection were performed in 31 patients with coronary artery disease and left ventricular dysfunction. Quantitative analysis of three short-axis tomograms per patient was performed by use of circumferential profiles that allowed analysis of 12 segments per patient. Two-dimensional echocardiography was used to assess wall motion and thickening in segments corresponding to the single photon emission computed tomography data. Concordance between regional 201Tl activity at redistribution imaging and regional sestamibi activity by semiquantitative visual analysis demonstrated concordant regional activity in 87% of segments; among discordant segments, no significant skew was seen, indicating enhanced uptake of one agent over the other. Quantitative analysis for all segments showed significant correlation (r = .86, P < .001) between quantitative regional 201Tl redistribution activity and 1-hour post-rest injection sestamibi activity in individual segments. Eighteen of these patients were revascularized, and echocardiography was repeated 20 +/- 16 days later; segments exhibiting significant regional ventricular dysfunction before revascularization were classified as having reversible or irreversible dysfunction on the basis of the change in wall motion and thickening. 201Tl and sestamibi regional activities were similar in those segments with reversible (72 +/- 11% [percent of peak activity] versus 75 +/- 9%, respectively, P = NS) as well as irreversible ventricular dysfunction (51 +/- 11% versus 50 +/- 8%, P = NS). Positive (75% versus 80% for 201Tl and sestamibi, respectively) and negative (92% versus 96%, respectively) predictive values for recovery of regional ventricular dysfunction after revascularization were similar for the two agents. CONCLUSIONS: In patients with coronary artery disease and left ventricular dysfunction, quantified sestamibi activity 1 hour after rest injection parallels redistribution 201Tl activity after a resting injection, suggesting that uptake and subsequent handling of sestamibi are more complex than can be explained by a pure flow tracer with no redistribution. Quantitative analysis of regional activities of both 201Tl and sestamibi after resting injections can differentiate viable from nonviable myocardium, and the two agents comparably predict reversibility of significant regional wall motion abnormalities after revascularization in such patients to a similar degree.

Antepartum testing for vasa previa: current standard of care.

Vasa previa is a rare accident in obstetrics with high fetal mortality. There are simple tests available to distinguish fetal from maternal blood. Recently it has been called into medicolegal question whether patients with third-trimester bleeding need to be tested for fetal bleeding. We surveyed 100 community hospitals and all the medical schools in the United States in an attempt to answer the question. It appears that the standard of care in the United States does not require such testing.