Adalimumab in recalcitrant severe psoriasis associated with atopic dermatitis

Tumor necrosis factor-α inhibitors may induce various cutaneous side effects including eczematous-like lesions. The management of such side effects can be challenging. Herein, we report a case of a 55-year-old man who had a flare-up and subsequent improvement of atopic dermatitis during treatment of severe psoriasis with adalimumab.

Sheep macrophages express at least two distinct receptors for IgG which have similar affinity for homologous IgG1 and IgG2.

Ovine bone marrow-derived macrophages (BMM) may express several IgG receptor (Fc gamma receptor; FcR) subsets. To study this, model particles (opsonized erythrocytes; EA), which are selectively handled by certain FcR subsets of human macrophages were used in cross-inhibition studies and found to react in a similar manner with FcR subsets of sheep macrophages. In experiments with monoclonal antibodies against subsets of human FcR, human erythrocytes (E) treated with human anti-D-IgG (anti-D-EAhu) and sheep E treated with bovine IgG1 (Bo1-EAs) were handled selectively by human macrophage FcRI and FcRII, respectively. Rabbit-IgG-coated sheep E (Rb-EAs) were recognized by FcRI, FcRII and possibly also by FcRIII of human macrophages. Anti-D-EAhu, Bo1-EAs and Rb-EAs were also ingested by sheep BMM. Competitive inhibition tests, using various homologous and heterologous IgG isotypes as fluid phase inhibitors and the particles used as FcR-specific tools in man (anti-D-EAhu and Bo1-EAs), revealed a heterogeneity of FcR also in sheep BMM. Thus, ingestion of anti-D-EAhu by ovine BMM was inhibited by low concentrations of competitor IgG from rabbit or man in the fluid phase, but not at all by bovine IgG1, whereas ingestion of Bo1-EAs was inhibited by bovine IgG1. This suggested that anti-D-EAhu were recognized by a FcR subset distinct from that recognizing bovine-IgG1. It was concluded that sheep BMM express functional analogs of human macrophage FcRI and FcRII and that Bo1-EAs and anti-D-EAhu are handled by distinct subsets of BMM FcR. All EAhu tested (EAhu treated with anti-D, sheep IgG1 or sheep IgG2) were ingested to a lower degree than EAs. This inefficient phagocytosis could be enhanced by treatment of EAhu with antiglobulin from the rabbit, suggesting that it is caused by a low degree of activity of opsonizing antibodies rather than special properties of the erythrocytes themselves. Several lines of evidence suggested that both FcR subsets of ovine BMM recognize both ovine IgG1 and IgG2. In contrast, bovine IgG1 reacts with one FcR subset and bovine IgG2 interacts inefficiently with all FcR of ovine BMM.

Current United States stem cell policy considerations and a recommendation for an alternative policy based on guidelines from existing international policies

Embryonic stem cell research is a widely debated topic in modern politics and religion. Differing views on the fetal rights conflict with the rights of an embryo. Those who believe an embryo has the same human qualities as a fetus accordingly believe embryonic stem cell research is unethical because it destroys a potential human life. However, scientists advocate the embryo does not have human qualities and should be used for valuable research in the stem cell field. Stem cell research may lead to vast developments in medical treatments, including cancer and brain conditions and injuries that are currently incurable. ^ The current stem cell policy introduced by President Bush in 2001 in an attempt to balance the moral issues with the need for scientific research has broad negative implications on the furthering of stem cell research. There is a limited diversity of available stem cell lines, there may be constitutional issues, there is an increasing disparity between the public and private research spheres, and the U.S. is struggling to maintain its scientific community. The U.S. must develop a new stem cell research policy that will balance the interest of science and public health with the moral issues that concern the public. ^ The United Kingdom allows researchers great liberty in conducting research, permitting the creation of embryos for the sole purpose of research, while Germany is equally conservative in their laws, as their policies support the philosophy that all embryos deserve the protection of full life. The United States should adopt a policy that takes the "middle ground" approach and permit research on excess embryos created for IVF purposes, rather than simply discarding those potentially valuable research tools. ^

Whence a healthy mind: Correlation of physical fitness and academic performance among schoolchildren

Background. Public schools are a key forum in the fight for child health because of the opportunities they present for physical activity and fitness surveillance. However, because schools are evaluated and funded on the basis of standardized academic performance rather than physical activity, empirical research evaluating the connections between fitness and academic performance is needed to justify curriculum allocations to physical activity. ^ Methods. Analyses were based on a convenience sample of 315,092 individually-matched standardized academic (TAKS™) and fitness (FITNESSGRAM®) test records collected by 13 Texas school districts under state mandates. We categorized each fitness result in quintiles by age and gender and used a mixed effects regression model to compare the academic performance of the top and bottom fitness groups for each fitness test and grade level combination. ^ Results. All fitness variables except BMI showed significant, positive associations with academic performance after sociodemographic covariate adjustments, with effect sizes ranging from 0.07 (95% CI: 0.05,0.08) in girls trunklift-TAKS reading to 0.34 (0.32,0.35) in boys cardiovascular-TAKS math. Cardiovascular fitness showed the largest inter-quintile difference in TAKS score (32-75 points), followed by curl-ups. After an additional adjustment for BMI and curl-ups, cardiovascular associations peaked in 8th-9 th grades (maximum inter-quintile difference 142 TAKS points; effect size 0.75 (0.69,0.82) for 8th grade girls math) and showed dose-response characteristics across quintiles (p<0.001 for both genders and outcomes). BMI analysis demonstrated limited, non-linear association with academic performance after adjustment for sociodemographic, cardiovascular fitness and curl-up variables. Low-BMI Hispanic high school boys showed significantly lower TAKS scores than the moderate (but not high) BMI group. High-BMI non-Hispanic white high school girls showed significantly lower scores than the moderate (but not low) BMI group. ^ Conclusions. In this study, fitness was strongly and significantly related to academic performance. Cardiovascular fitness showed a distinct dose-response association with academic performance independent of other sociodemographic and fitness variables. The association peaked in late middle to early high school. The independent association of BMI to academic performance was only found in two sub-groups and was non-linear, with both low and high BMI posing risk relative to moderate BMI but not to each other. In light of our findings, we recommend that policymakers consider PE mandates in middle-high school and require linkage of academic and fitness records to facilitate longitudinal surveillance. School administrators should consider increasing PE time in pursuit of higher academic test scores, and PE practitioners should emphasize cardiovascular fitness over BMI reduction.^

Indeterminate QunatiFERON-TB Gold In-Tube assay results in association with procedural specimen collection in children

BACKGROUND. The development of interferon-gamma release assays (IGRA) has introduced powerful tools in diagnosing latent tuberculosis infection (LTBI) and may play a critical role in the future of tuberculosis diagnosis. However, there have been reports of high indeterminate results in young patient populations (0-18 years). This study investigated results of the QunatiFERON-TB Gold In-Tube (QFT-GIT) IGRA in a population of children (0-18 years) at Texas Children's Hospital in association with specimen collection procedures using surrogate variables. ^ METHODS. A retrospective case-control study design was used for this investigation. Cases were defined as having QFT-GIT indeterminate results. Controls were defined as having either positive or negative results (determinates). Patients' admission status, staff performing specimen collection, and specific nurse performing specimen collection were used as surrogates to measure specimen collection procedures. ^ To minimize potential confounding, abstraction of patients' electronic medical records was performed. Abstracted data included patients' medications and evaluation at the time of QFT-GIT specimen collection in addition to their medical history. QFT-GIT related data was also abstracted. Cases and controls were characterized using chi-squared tests or Fisher's exact tests across categorical variables. Continuous variables were analyzed using one-way ANOVA and t-tests for continuous variables. A multivariate model was constructed by backward stepwise removal of statistically significant variables from univariate analysis. ^ RESULTS. Patient data was abstracted from 182 individuals aged 0-18 years from July 2010 to August 2011 at Texas Children's Hospital. 56 cases (indeterminates) and 126 controls (determinates) were enrolled. Cancer was found to be an effect modifier with subsequent stratification resulting in a cancer patient population too small to analyze (n=13). Subsequent analyses excluded these patients. ^ The exclusion of cancer patients resulted in a population of 169 patients with 49 indeterminates (28.99%) and 120 determinates (71.01%), with mean ages of 9.73 (95% CI: 8.03, 11.43) years and 11.66 (95% CI: 10.75, 12.56) years (p = 0.033), respectively. Median age of patients who were indeterminates and determinates were 12.37 and 12.87 years, respectively. Lack of data for our specific nurse surrogate (QFTNurse) resulted in its exclusion from analysis. The final model included only our remaining surrogate variables (QFTStaff and QFTInpatientOutpatient). The staff collecting surrogate (QFTStaff) was found to be modestly associated with indeterminates when nurses collected the specimen (OR = 1.54, 95% CI: 0.51, 4.64, p = 0.439) in the final model. Inpatients were found to have a strong and statistically significant association with indeterminates (OR = 11.65, 95% CI: 3.89, 34.9, p < 0.001) in the final model. ^ CONCLUSION. Inpatient status was used as a surrogate for indication of nurse drawn blood specimens. Nurses have had little to no training regarding shaking of tubes versus phlebotomists regarding QFT-GIT testing procedures. This was also measured by two other surrogates; specifically a medical note stating whether a nurse or phlebotomist collected the specimen (QFTStaff) and the name and title of the specific nurse if collection was performed by a nurse (QFTNurse). Results indicated that inpatient status was a strong and statistically significant factor for indeterminates, however, nurse collected specimens and indeterminate results had no statistically significant association in non-cancer patients. The lack of data denoting the specific nurse performing specimen collection excluded the QFTNurse surrogate in our analysis. ^ Findings suggests training of staff personnel in specimen procedures may have little effect on the number of indeterminates while inpatient status and thus possibly illness severity may be the most important factor for indeterminate results in this population. The lack of congruence between our surrogate measures may imply that our inpatient surrogate gauged illness severity rather than collection procedures as intended. ^ Despite the lack of clear findings, our analysis indicated that more than half of indeterminates were found in specimens drawn by nurses and as such staff training may be explored. Future studies may explore methods in measuring modifiable variables during pre-analytical QFT-GIT procedures that can be discerned and controlled. Identification of such measures may provide insight into ways to lowering indeterminate QFT-GIT rates in children.^

Eocene/Oligocene paleoceanography from ODP Hole 113-689B and Hole 113-690B

Middle Eocene to Late Oligocene sediments from near the crest (Site 689B, water depth 2080 m) and flank (water depth 2914 m) of the Maud Rise (62°S) have been investigated by coarse fraction analysis and have revealed the following: (1) The middle Eocene (50-40 Ma) was a period of pure carbonate sedimentation, with good preservation of carbonate microfossils. No opal > 40 µm is present. (2) In the late Eocene (40-36.5 Ma) opal fossils (mainly radiolaria, and some diatoms > 40 µm) appeared for the first time. Three maxima in opal sedimentation (Eocene/Oligocene boundary, middle early Oligocene and early/late Oligocene boundary) are separated by increases in carbonate sedimentation. The dissolution of carbonate fossils is strong in the opal-rich layers. Opal sedimentation is attributed to cooling and probably more vigorous atmospheric circulation and increased upwelling. (3) Carbonate dissolution increased with water depth in the Oligocene, whereas in the middle Eocene excellent carbonate preservation in the deeper Site 690B and stronger dissolution in the shallower Site 689B is attributed to different bottom-water characteristics. The middle Eocene bottom water probably was formed by strong evaporation at low latitudes, whereas by the earliest Oligocene formation of Antarctic Bottom Water (AABW) had set in. (4) Current influence, not on top but on the flank of the Maud Rise, could be recorded by means of larger grain sizes of benthonic and planktonic microfossils. (5) Ice-rafted debris was not found. Quartz and other minerals are very rare and not larger than 125 µm and may have been supplied by ice as well as by wind or by deep currents. Mica contents were up to 10 times higher in the middle Eocene on the flank compared to on the crest of the Maud Rise, indicating deep current supply.

Reflectance and composition of dispersed organic matter at DSDP Leg 67 Hole

Dispersed organic matter of plant origin from three sites of the Middle America Trench transect was investigated by coal petrographic methods. Samples from the slope region are rich in lipoid and inert substances. Humic matter is predominant in the trench sediments. Reflectance measurements show that the rank of the organic matter is peat, independent of the tectonic position and age of the samples in question. A slow increase of coalification with depth is observed.

Lexicografia bilingue e tratamento digital na elaboração de um glossário eletrônico de verbos médios do grego antigo em Apolodoro

Presentación de la metodología empleada en el montaje del glosario electrónico de los verbos griegos medios presentes en la obra Biblioteca de Apolodoro. Después de algunas reflexiones sobre el concepto de la voz media en griego y el reconocimiento de las apariciones en el corpus mencionado, presentamos una pequeña lista de palabras, con algunos lemas previamente seleccionados, con la clasificación de los verbos medios según la función semántica señalada por el sujeto oracional

Lexicografia bilingue e tratamento digital na elaboração de um glossário eletrônico de verbos médios do grego antigo em Apolodoro

Presentación de la metodología empleada en el montaje del glosario electrónico de los verbos griegos medios presentes en la obra Biblioteca de Apolodoro. Después de algunas reflexiones sobre el concepto de la voz media en griego y el reconocimiento de las apariciones en el corpus mencionado, presentamos una pequeña lista de palabras, con algunos lemas previamente seleccionados, con la clasificación de los verbos medios según la función semántica señalada por el sujeto oracional

Lexicografia bilingue e tratamento digital na elaboração de um glossário eletrônico de verbos médios do grego antigo em Apolodoro

Presentación de la metodología empleada en el montaje del glosario electrónico de los verbos griegos medios presentes en la obra Biblioteca de Apolodoro. Después de algunas reflexiones sobre el concepto de la voz media en griego y el reconocimiento de las apariciones en el corpus mencionado, presentamos una pequeña lista de palabras, con algunos lemas previamente seleccionados, con la clasificación de los verbos medios según la función semántica señalada por el sujeto oracional

Calcareous nannofossils and planktonic foraminifera of ODP Hole 132-810C

The 136 m of calcareous oozes recovered in Hole 810C span the interval from upper Maastrichtian to middle Pleistocene. Three major hiatuses interrupt the sequence, with the topmost part of the Maastrichtian through the entire lower Paleocene, most of the lower Eocene, and the entire middle Eocene through most of the middle Miocene missing. Severe reworking and displacement affected the lower part of the succession from the Maastrichtian through the middle Miocene. Reworking and displacement gradually decreased in the upper portion. Calcareous nannofossil biostratigraphy enabled us to calibrate precisely the nearly complete magnetic reversal sequence of the Pliocene to the late Pleistocene. Two minor hiatuses detected by calcareous nannofossils across the Pliocene/Pleistocene boundary and in the upper lower Pleistocene, respectively, resulted in shortening of the Olduvai and Jaramillo Events within the Matuyama Chron of the magnetic reversal sequence.

Middle Eocene to Pleistocene calcareous nannofossils of ODP Leg 113 holes

Long sequences of Upper Cretaceous through Quaternary sediments rich in calcareous and siliceous microfossils were recovered at Ocean Drilling Program Sites 689 and 690 on Maud Rise off East Antarctica. These sites have become the southernmost anchor in the Atlantic Basin for bio-, magneto-, chemostratigraphic, and paleobiogeographic studies. ODP Sites 692 and 693 on the Weddell Sea margin of East Antarctica and Site 696 on the South Orkney microcontinent of West Antarctica yielded calcareous nannofossils within some stratigraphic intervals. Sites 691, 692, 694, 695, and 697 did not recover Cenozoic calcareous nannofossils. Calcareous nannofossil biostratigraphy suggests a major hiatus across the Paleogene/Neogene boundary at Sites 689 and 690, and two additional hiatuses in the middle Eocene-lower Oligocene section at Site 690. Correlation with magnetostratigraphy reveals: the last occurrence (LO) of Reticulofenestra umbilica at Maud Rise is over 1 m.y. younger than that at the middle-latitude sites; the LO of Isthmolithus recurvus is synchronous in the middle-latitude and high-latitude areas (about 34.8 Ma); Reticulofenestra oamaruensis ranges from 38.0 to 36.0 Ma at Maud Rise; Reticulofenestra reticulata has a shorter range at Maud Rise (42.1 to 38.9 Ma) than at the middle-latitude DSDP Site 516; the range of Chiasmolithus oamaruensis is diachronous over different latitudes; and the LO of Chiasmolithus solitus is a good datum at 41.3 Ma from 30°S to 65°S in the South Atlantic Ocean. Comparison of calcareous nannofossil abundances in a latitudinal transect shows: Reticulofenestra bisecta is a temperate-water species and its LO, which crosses below that of Chiasmolithus altus at Maud Rise, is not applicable for the Paleogene/Neogene boundary in high southern latitude areas; Clausicoccus fenestratus is rare or absent at Maud Rise and can not be used as a marker; Coccolithus formosus is a warm-water species which disappeared earlier toward higher latitudes. Calcareous nannofossil assemblages indicate that by at least the middle Eocene, surface water temperatures became considerably lower in the high southern latitudes than in the middle-latitude areas and that there have been more extreme cold events in the high latitudes during the Neogene. Bicolumnus ovatus n. gen., n. sp. is proposed in this paper.

Characteristic magnetization of upper Cretaceous and lower Tertiary sediments

Lower Campanian to middle Eocene chalks and oozes were recovered at Sites 761 and 762 of Ocean Drilling Program Leg 122 on the Exmouth Plateau, northwest Australia. Paleomagnetic analyses were made on 125 samples from Hole 761B and 367 samples from Hole 762C. Thermal cleaning, alternating field demagnetization, or mixed treatment reveals a stable remanent component of normal or reversed polarity. Correlation of the magnetic polarity sequences established for these holes with the standard magnetic polarity time scale was aided by nannofossil zonation. At Hole 761B, the sequence extends from Subchron C32-N (upper Campanian) through Subchron C17-R (middle Eocene), but given the low sedimentation rate, not all the subchrons of the standard magnetic polarity sequence were recognized. The sequence at Hole 762C extends from Subchron C13-R (middle Eocene) to the boundary between Chrons C33 and C34 (lower Campanian). The sedimentation rate is higher at Hole 762C, and all the magnetic polarity subchrons of the Campanian and Maestrichtian stages were identified. Thus, this hole could be a reference section to refine the Upper Cretaceous time scale.