Familial amyloid polyneuropathy (FAP): clinical features, pathophysiology and treatment

In the literature, concepts of “polyneuropathy”, “peripheral neuropathy” and “neuropathy” are often mistakenly used as synonyms. Polyneuropathy is a specific term that refers to a relatively homogenous process that affects multiple peripheral nerves. Most of these tend to present as symmetric polyneuropathies that first manifest in the distal portions of the affected nerves. Many of these distal symmetric polyneuropathies are due to toxic-metabolic causes such as alcohol abuse and diabetes mellitus. Other distal symmetric polyneuropathies may result from an overproduction of substances that result in nerve pathology such as is observed in anti-MAG neuropathy and monoclonal gammopathy of undetermined significance. Other “overproduction” disorders are hereditary such as noted in the Portuguese type of familial amyloid polyneuropathy (FAP). FAP is a manifestation of a group of hereditary amyloidoses; an autosomal dominant, multisystemic disorder wherein the mutant amyloid precursor, transthyretin, is produced in excess primarily by the liver. The liver accounts for approximately 98% of all transthyretin production. FAP is confirmed by detecting a transthyretin variant with a methionine for valine substitution at position 30 [TTR (Met30)]. Familial Amyloidotic Polyneuropathy (FAP) – Portuguese type was first described by a Portuguese neurologist, Corino de Andrade in 1939 and published in 1951. Most persons with this disorder are descended from Portuguese sailors who sired offspring in various locations, primarily in Sweden, Japan and Mallorca. Their descendants emigrated worldwide such that this disorder has been reported in other countries as well. More than 2000 symptomatic cases have been reported in Portugal. FAP progresses rapidly with an average time course from symptom onset to multi-organ involvement and death between ten and twenty years. Treatments directed at removing this aberrant protein such as plasmapheresis and immunoadsorption proved to be unsuccessful. Liver transplantation has been the only effective solution as evidenced by almost 2000 liver transplants performed worldwide. A therapy for FAP with a novel agent, “Tafamidis” has shown some promise in ongoing phase III clinical trials. It is well recognized that regular physical activity of moderate intensity has a positive effect on physical fitness as gauged by body composition, aerobic capacity, muscular strength and endurance and flexibility. Physical fitness has been reported to result in the reduction of symptoms and lesser impairment when performing activities of daily living. Exercise has been advocated as part of a comprehensive approach to the treatment of chronic diseases. Therefore, this chapter concludes with a discussion of the role of exercise training on FAP.

Pulsed electric field pre-treatment for apple juice extraction: Evaluation of monopolar and bipolar pulses effects

Additional apple juice extraction with pulsed electric field pretreated apple cubes towards control samples is evaluated. Monopolar and bipolar shaped pulses are compared and their effect is studied with variation of electric field, pulse width and number of pulses. Variation of electric field strength is ranged from 100 V/cm to 1300 V/cm, pulse width from 20 mu s to 300 mu s and number of pulses from 10 to 200, at frequency of 200Hz. Two pulse trains separated by 1 second are applied to all samples. Bipolar pulses showed higher apple juice yields with all studied parameters. Calculation of specific energies consumed was assessed and a threshold where higher energy inputs do not increase juice yield is found for a number of used parameters. Qualitative parameters of total soluble matter (Brix) and absorbance at 390 nm wavelength were determined for each sample and results show that no substantial differences are found for PEF pre-treated and control samples.

Feasibility of creosote treatment for glued-laminated pine-timber railway sleepers

This article studies the possibility of using market available glued-laminated timber (GLT) based on melamine-urea-formaldehyde (MUF) adhesives as an alternative to traditional solid timber sleepers. The study comprised an examination of the effect of creosote treatment on the short-term and durability after accelerated aging of the glue lines (delamination and shear strength) and the potential for full sapwood penetration by the creosote. Creosote treatment showed a negative effect on shear strength and delamination, more severe in the nonstructural than the structural GLT specimens tested. Full penetration of creosote into the sapwood was not achieved. GLT elements based on MUF adhesives can be considered an alternative to solid wood sleepers if specific grading of lamellas, proper treatment schedule, and highly controlled factory production are implemented.