Kawasaki Disease and Peripheral Gangrene in Infancy

Introduction: Early diagnosis and treatment of Kawasaki disease as the most common cause of acquired heart disease in childhood, may significantly improve the prognosis. Diagnosing infantile Kawasaki (younger than a year) is difficult because of obscure symptoms; at the same time they are at the higher risk of coronary abnormalities. Case Presentation: We report three infants with prolonged (more than 5 days) fever and peripheral gangrene without any other clinical manifestations of Kawasaki disease. Kawasaki was diagnosed due to dilation of coronary artery and other aortic branches, thrombocytosis, and rising of ESR and CRP. All patients were treated with high dose aspirin, IVIG and pulse therapy with methylprednisolone. Additionally, cytotoxic drugs or infliximab were used for two of them because of severe aneurysms in the aortic branches. All 3 patients received aspirin with anti-platelet aggregation dose and 2 patients heparin as an anti-coagulant agent for longtime. After adequate treatment, peripheral gangrene, arterial dilations and aneurysms improved, but during 12 months follow-up coronary aneurysms did not improve completely. Conclusions: Peripheral gangrene must be regarded as an important sign of infantile Kawasaki disease early treatment of which can prevent severe permanent coronary involvements and sequels.

Neuromuscular deficits after peripheral joint injury: a neurophysiological hypothesis

In addition to biomechanical disturbances, peripheral joint injuries (PJIs) can also result in chronic neuromuscular alterations due in part to loss of mechanoreceptor-mediated afferent feedback. An emerging perspective is that PJI should be viewed as a neurophysiological dysfunction, not simply a local injury. Neurophysiological and neuroimaging studies have provided some evidence for central nervous system (CNS) reorganization at both the cortical and spinal levels after PJI. The novel hypothesis proposed is that CNS reorganization is the underlying mechanism for persisting neuromuscular deficits after injury, particularly muscle weakness. There is a lack of direct evidence to support this hypothesis, but future studies utilizing force-matching tasks with superimposed transcranial magnetic stimulation may be help clarify this notion.

Bias in peripheral depression biomarkers

BACKGROUND: To aid in the differentiation of individuals with major depressive disorder (MDD) from healthy controls, numerous peripheral biomarkers have been proposed. To date, no comprehensive evaluation of the existence of bias favoring the publication of significant results or inflating effect sizes has been conducted. METHODS: Here, we performed a comprehensive review of meta-analyses of peripheral nongenetic biomarkers that could discriminate individuals with MDD from nondepressed controls. PubMed/MEDLINE, EMBASE, and PsycINFO databases were searched through April 10, 2015. RESULTS: From 15 references, we obtained 31 eligible meta-analyses evaluating biomarkers in MDD (21,201 cases and 78,363 controls). Twenty meta-analyses reported statistically significant effect size estimates. Heterogeneity was high (I2 ≥ 50%) in 29 meta-analyses. We plausibly assumed that the true effect size for a meta-analysis would equal the one of its largest study. A significant summary effect size estimate was observed for 20 biomarkers. We observed an excess of statistically significant studies in 21 meta-analyses. The summary effect size of the meta-analysis was higher than the effect of its largest study in 25 meta-analyses, while 11 meta-analyses had evidence of small-study effects. CONCLUSIONS: Our findings suggest that there is an excess of studies with statistically significant results in the literature of peripheral biomarkers for MDD. The selective publication of 'positive studies' and the selective reporting of outcomes are possible mechanisms. Effect size estimates of meta-analyses may be inflated in this literature.

Retinal tissue thickness is reduced in diabetic peripheral neuropathy

AIM: To investigate the relationship between diabetic peripheral neuropathy (DPN) and retinal tissue thickness.

METHODS: Full retinal thickness in the central retinal, parafoveal, and perifoveal zones and thickness of the ganglion cell complex and retinal nerve fiber layer (RNFL) were assessed in 193 individuals (84 with type 1 diabetes, 67 with type 2 diabetes, and 42 healthy controls) using spectral domain optical coherence tomography. Among those with diabetes, 44 had neuropathy defined using a modified neuropathy disability score recorded on a 0-10 scale. Multiple regression analysis was performed to investigate the relationship between diabetic neuropathy and retinal tissue thickness, adjusted for the presence of diabetic retinopathy (DR), age, sex, duration of diabetes, and HbA1c levels.

RESULTS: In individuals with diabetes, perifoveal thickness was inversely related to the severity of neuropathy (p < 0.05), when adjusted for age, sex, duration of diabetes, and HbA1c levels. DR was associated with reduced thickness in parafovea (p < 0.01). The RNFL was thinner in individuals with greater degrees of neuropathy (p < 0.04).

CONCLUSIONS: DPN is associated with structural compromise involving several retinal layers. This compromise may represent a threat to visual integrity and therefore warrants examination of functional correlates.

The role of thermomechanical routes on the distribution of grain boundary and interface plane orientations in transformed microstructures

In the current study, a series of thermomechanical routes were used to produce different microstructures (i.e., ferrite and martensite) in low-carbon low alloy steels. The five-parameter grain boundary character distribution was measured for all microstructures. The thermomechanical processing route altered the texture of the fully ferritic microstructure and significantly influenced the anisotropy of the grain boundary character distribution. Generally, the population of (111) planes increased with an increase in the γ-fiber texture for the ferritic microstructure, but it did not change the shape of the grain boundary plane distribution at specific misorientations. The most commonly observed boundaries in the fully ferritic structures produced through different routes were {112} symmetric tilt boundaries with the Σ3 = 60 deg/[111] misorientation; this boundary also had a low energy. However, the grain boundary plane distribution was significantly changed by the phase transformation path (i.e., ferrite vs martensite) for a given misorientation. In the martensitic steel, the most populous Σ3 boundary was the {110} symmetric tilt boundary. This results from the crystallographic constraints associated with the shear transformation (i.e., martensite) rather than the low-energy interface that dominates in the diffusional phase transformation (i.e., ferrite).

Risk of African swine fever introduction into the European Union through transport-associated routes: returning trucks and waste from international ships and planes

BACKGROUND The uncontrolled presence of African swine fever (ASF) in Russian Federation (RF) poses a serious risk to the whole European Union (EU) pig industry. Although trade of pigs and their products is banned since the official notification in June 2007, the potential introduction of ASF virus (ASFV) may occur by other routes, which are very frequent in ASF, and more difficult to control, such as contaminated waste or infected vehicles. This study was intended to estimate the risk of ASFV introduction into the EU through three types of transport routes: returning trucks, waste from international ships and waste from international planes, which will be referred here as transport-associated routes (TAR). Since no detailed and official information was available for these routes, a semi-quantitative model based on the weighted combination of risk factors was developed to estimate the risk of ASFV introduction by TAR. Relative weights for combination of different risk factors as well as validation of the model results were obtained by an expert opinion elicitation. RESULTS Model results indicate that the relative risk for ASFV introduction through TAR in most of the EU countries (16) is low, although some countries, specifically Poland and Lithuania, concentrate high levels of risk, the returning trucks route being the analyzed TAR that currently poses the highest risk for ASFV introduction into the EU. The spatial distribution of the risk of ASFV introduction varies importantly between the analyzed introduction routes. Results also highlight the need to increase the awareness and precautions for ASF prevention, particularly ensuring truck disinfection, to minimize the potential risk of entrance into the EU. CONCLUSIONS This study presents the first assessment of ASF introduction into the EU through TAR. The innovative model developed here could be used in data scarce situations for estimating the relative risk associated to each EU country. This simple methodology provides a rapid and easy to interpret results on risk that may be used for a target and cost-effective allocation of resources to prevent disease introduction.

Peripheral brain-derived neurotrophic factor levels in alzheimer's disease and mild cognitive impairment: A comprehensive systematic review and meta-analysis

Alzheimer's disease (AD) is becoming a growing global problem, and there is an urgent need to identify reliable blood biomarkers of the risk and progression of this condition. A potential candidate is the brain-derived neurotrophic factor (BDNF), which modulates major trophic effects in the brain. However, findings are apparently inconsistent regarding peripheral blood BDNF levels in AD patients vs. healthy people. We thus performed a systematic review and meta-analysis of the studies that have examined peripheral BDNF levels in patients with AD or mild cognitive impairment (MCI) and healthy controls. We searched articles through PubMed, EMBASE, and hand searching. Over a total pool of 2061 potential articles, 26 met all inclusion criteria (including a total of 1584 AD patients, 556 MCI patients, and 1294 controls). A meta-analysis of BDNF levels between early AD and controls showed statistically significantly higher levels (SMD [95 % CI]: 0.72 [0.31, 1.13]) with no heterogeneity. AD patients with a low (<20) mini-mental state examination (MMSE) score had lower peripheral BDNF levels compared with controls (SMD [95 % CI]: -0.33 [-0.60, -0.05]). However, we found no statistically significant difference in blood (serum/plasma) BDNF levels between all AD patients and controls (standard mean difference, SMD [95 % CI]: -0.16 [-0.4, 0.07]), and there was heterogeneity among studies (P < 0.0001, I 2 = 85.8 %). There were no differences in blood BDNF levels among AD or MCI patients vs. controls by subgroup analyses according to age, sex, and drug use. In conclusion, this meta-analysis shows that peripheral blood BDNF levels seem to be increased in early AD and decreased in AD patients with low MMSE scores respectively compared with their age- and sex-matched healthy referents. At present, however, this could not be concluded from individual studies.

Developing self-guided scuba dive routes in the Algarve (Portugal) and analysing visitors' perceptions

Scuba diving allows for underwater visitation of cultural and natural resources. Underwater routes can be used as a tool for guided and supervised underwater visits. Two scuba diving routes were implemented in the Algarve (South of Portugal), the "B24" and "Poco" diving sites. The perceptions of scuba divers regarding several aspects of the routes and the existing support infrastructures were studied following a survey carried out through face-to-face interviews from 2008 to 2012. Divers profile and their perceptions were analysed using 246 valid questionnaires. Divers were mainly Portuguese, over 30 years old and with more than 12 years of formal education. Some of the support infrastructures did not achieve a "good" or "acceptable" grade. This should be carefully considered by diving operators and managers, because perceptions tend to circulate throughout the diving tourists. All features of interpretative slates were graded as highly satisfactory. Overall, diver satisfaction increased slightly after route implementation, with an average ranking of "good". These findings support the implementation of underwater routes as a way to promote diving activity, and to increase divers' environmental education and awareness. (C) 2013 Elsevier Ltd. All rights reserved.

Ecotourism snorkelling routes at Marinha Beach (Algarve)

Coastal ecotourism is one of the fastest growing leisure industries in the world and snorkelling is emerging as an important beach-based activity. Snorkelling has the potential to enhance biodiversity conservation when developed within environmental education framework. The aim of this study was to implement and evaluate snorkelling routes, in the Algarve (South Portugal), as a sustainable ecotourism offer. To achieve these objectives, three snorkelling routes were established at the pristine Marinha beach. After the diving experience, a face-to-face questionnaire survey was conducted to collect information about individuals' opinions regarding the underwater routes, their social demographic characteristics, ecological appreciation, opinions about beach facilities and trip expenditures. The survey was undertaken during the summer months of 2008 and 2009, and 202 people were interviewed. Data was analysed using univariate and multivariate statistic methods. Most respondents perceived the existence of routes to be good for the preservation of the local biodiversity and reported this experience as "good" or "excellent". The only difference in perceptions was observed by visitor snorkelling in groups of more than two people. Interviewers consider that emergency support and sanitary facilities are the most important beach support infrastructures. Overall, these routes seem to be an effective tool for developing ecological awareness in tourists, as they enhance the preservation and the understanding of the marine coastal environment.

Eco-touristic snorkelling routes at Marinha beach (Algarve): Environmental education and human impacts

The use of natural areas for underwater coastal marine activities such as snorkelling is growing, but the amount of ecological and socioeconomic data on these activities is scarce and relates mainly to coral reef areas. Three underwater self-guided routes were designed at Marinha Beach (Algarve, Portugal), based on scientific information, with in situ interpretation and guidance, as a way to enhance biodiversity awareness and, hence, reduce the probability of human impacts. The routes were implemented in two consecutive summer seasons and after each season, visual census techniques were used to describe flora composition and cover area (seaweeds and seagrasses) in order to understand patterns and evaluate human impacts. Snorkelers' opinions and perceptions about several issues related to the routes' environmental education role (e.g. role in enhancing biocliversity awareness) were investigated by questionnaire after the snorkelling activity. An inter-annual difference inflora assemblages was found, probably associated to natural variability, rather than snorkelers' impacts. Results indicate that, in fact, in situ education and interpretation can raise environmental awareness if properly addressed, resulting in a satisfactory way of engaging snorkelers in the protection and in the conservation of the visited environments, thereby preventing negative ecological impacts. (C) 2015 Elsevier Ltd. All rights reserved.