Surgical Mask to Prevent Influenza Transmission in Households: A Cluster Randomized Trial

Facemasks and respirators have been stockpiled during pandemic preparedness. However, data on their effectiveness for limiting transmission are scarce. We evaluated the effectiveness of facemask use by index cases for limiting influenza transmission by large droplets produced during coughing in households.A cluster randomized intervention trial was conducted in France during the 2008-2009 influenza season. Households were recruited during a medical visit of a household member with a positive rapid influenza A test and symptoms lasting less than 48 hours. Households were randomized either to the mask or control group for 7 days. In the intervention arm, the index case had to wear a surgical mask from the medical visit and for a period of 5 days. The trial was initially intended to include 372 households but was prematurely interrupted after the inclusion of 105 households (306 contacts) following the advice of an independent steering committee. We used generalized estimating equations to test the association between the intervention and the proportion of household contacts who developed an influenza-like illness during the 7 days following the inclusion. Influenza-like illness was reported in 24/148 (16.2%) of the contacts in the intervention arm and in 25/158 (15.8%) of the contacts in the control arm and the difference between arms was 0.40% (95%CI: -10% to 11%, P = 1.00). We observed a good adherence to the intervention. In various sensitivity analyses, we did not identify any trend in the results suggesting effectiveness of facemasks.This study should be interpreted with caution since the lack of statistical power prevents us to draw formal conclusion regarding effectiveness of facemasks in the context of a seasonal epidemic.clinicaltrials.gov NCT00774774

Glucocorticosteroids Differentially Regulate MMP-9 and Neutrophil Elastase in COPD

Background: Chronic Obstructive Pulmonary Disease (COPD) is currently the fifth leading cause of death worldwide. Neutrophilic inflammation is prominent, worsened during infective exacerbations and is refractory to glucocorticosteroids (GCs). Deregulated neutrophilic inflammation can cause excessive matrix degradation through proteinase release. Gelatinase and azurophilic granules within neutrophils are a major source of matrix metalloproteinase (MMP)-9 and neutrophil elastase (NE), respectively, which are elevated in COPD. Methods: Secreted MMP-9 and NE activity in BALF were stratified according to GOLD severity stages. The regulation of secreted NE and MMP-9 in isolated blood neutrophils was investigated using a pharmacological approach. In vivo release of MMP-9 and NE in mice exposed to cigarette smoke (CS) and/or the TLR agonist lipopolysaccharide (LPS) in the presence of dexamethasone (Dex) was investigated. Results: Neutrophil activation as assessed by NE release was increased in severe COPD (36-fold, GOLD II vs. IV). MMP-9 levels (8-fold) and activity (21-fold) were also elevated in severe COPD, and this activity was strongly associated with BALF neutrophils (r = 0.92, p < 0.001), but not macrophages (r = 0.48, p = 0.13). In vitro, release of NE and MMP-9 from fMLP stimulated blood neutrophils was insensitive to Dex and attenuated by the PI3K inhibitor, wortmannin. In vivo, GC resistant neutrophil activation (NE release) was only seen in mice exposed to CS and LPS. In addition, GC refractory MMP-9 expression was only associated with neutrophil activation. Conclusions: As neutrophils become activated with increasing COPD severity, they become an important source of NE and MMP-9 activity, which secrete proteinases independently of TIMPs. Furthermore, as NE and MMP-9 release was resistant to GC, targeting of the PI3K pathway may offer an alternative pathway to combating this proteinase imbalance in severe COPD

Optimizing the diagnostic work-up of acute uncomplicated urinary tract infections

<p>Abstract</p> <p>Background</p> <p>Most diagnostic tests for acute uncomplicated urinary tract infections (UTIs) have been previously studied in so-called single-test evaluations. In practice, however, clinicians use more than one test in the diagnostic work-up. Since test results carry overlapping information, results from single-test studies may be confounded. The primary objective of the Amsterdam Cystitis/Urinary Tract Infection Study (ACUTIS) is to determine the (additional) diagnostic value of relevant tests from patient history and laboratory investigations, taking into account their mutual dependencies. Consequently, after suitable validation, an easy to use, multivariable diagnostic rule (clinical index) will be derived.</p> <p>Methods</p> <p>Women who contact their GP with painful and/or frequent micturition undergo a series of possibly relevant tests, consisting of patient history questions and laboratory investigations. Using urine culture as the reference standard, two multivariable models (diagnostic indices) will be generated: a model which assumes that patients attend the GP surgery and a model based on telephone contact only. Models will be made more robust using the bootstrap. Discrimination will be visualized in high resolution histograms of the posterior UTI probabilities and summarized as 5^th, 10^th, 25^th50^th, 75^th, 90^th, and 95^thcentiles of these, Brier score and the area under the receiver operating characteristics curve (ROC) with 95% confidence intervals. Using the regression coefficients of the independent diagnostic indicators, a diagnostic rule will be derived, consisting of an efficient set of tests and their diagnostic values.</p> <p>The course of the presenting complaints is studied using 7-day patient diaries. To learn more about the natural history of UTIs, patients will be offered the opportunity to postpone the use of antibiotics.</p> <p>Discussion</p> <p>We expect that our diagnostic rule will allow efficient diagnosis of UTIs, necessitating the collection of diagnostic indicators with proven added value. GPs may use the rule (preferably after suitable validation) to estimate UTI probabilities for women with different combinations of test results. Finally, in a subcohort, an attempt is made to identify which indicators (including antibiotic treatment) are useful to prognosticate recovery from painful and/or frequent micturition.</p

Carpal tunnel syndrome and the "double crush" hypothesis: a review and implications for chiropractic

Upton and McComas claimed that most patients with carpal tunnel syndrome not only have compressive lesions at the wrist, but also show evidence of damage to cervical nerve roots. This "double crush" hypothesis has gained some popularity among chiropractors because it seems to provide a rationale for adjusting the cervical spine in treating carpal tunnel syndrome. Here I examine use of the concept by chiropractors, summarize findings from the literature, and critique several studies aimed at supporting or refuting the hypothesis. Although the hypothesis also has been applied to nerve compressions other than those leading to carpal tunnel syndrome, this discussion mainly examines the original application – "double crush" involving both cervical spinal nerve roots and the carpal tunnel. I consider several categories: experiments to create double crush syndrome in animals, case reports, literature reviews, and alternatives to the original hypothesis. A significant percentage of patients with carpal tunnel syndrome also have neck pain or cervical nerve root compression, but the relationship has not been definitively explained. The original hypothesis remains controversial and is probably not valid, at least for sensory disturbances, in carpal tunnel syndrome. However, even if the original hypothesis is importantly flawed, evaluation of multiple sites still may be valuable. The chiropractic profession should develop theoretical models to relate cervical dysfunction to carpal tunnel syndrome, and might incorporate some alternatives to the original hypothesis. I intend this review as a starting point for practitioners, educators, and students wishing to advance chiropractic concepts in this area

Does clinical examination aid in the diagnosis of urinary tract infections in women? A systematic review and meta-analysis

<p>Abstract</p> <p>Background</p> <p>Clinicians should be aware of the diagnostic values of various symptoms, signs and antecedents. This information is particularly important in primary care settings, where sophisticated diagnostic approaches are not always feasible. The aim of the study is to determine the probability that various symptoms, signs, antecedents and tests predict urinary tract infection (UTI) in women.</p> <p>Methods</p> <p>We conducted a systematic search of the MEDLINE and EMBASE databases to identify articles published in all languages through until December 2008. We particularly focused on studies that examined the diagnostic accuracy of at least one symptom, sign or patient antecedent related to the urinary tract. We included studies where urine culture, a gold standard, was preformed by primary care providers on female subjects aged at least 14 years. A meta-analysis of the likelihood ratio was performed to assess variables related to the urinary tract symptoms.</p> <p>Results</p> <p>Of the 1, 212 articles identified, 11 met the selection criteria. Dysuria, urgency, nocturia, sexual activity and urgency with dysuria were weak predictors of urinary tract infection, whereas increases in vaginal discharge and suprapubic pain were weak predictors of the absence of infection. Nitrites or leukocytes in the dipstick test are the only findings that clearly favored a diagnosis of UTI.</p> <p>Conclusions</p> <p>Clinical findings do not aid in the diagnosis of UTI among women who present with urinary symptoms. Vaginal discharge is a weak indicator of the absence of infection. The urine dipstick test was the most reliable tool for detecting UTI.</p

Busulphan-Cyclophosphamide Cause Endothelial Injury, Remodeling of Resistance Arteries and Enhanced Expression of Endothelial Nitric Oxide Synthase

Stem cell transplantation (SCT) is a curative treatment for malignant and non malignant diseases. However, transplantation-related complications including cardiovascular disease deteriorate the clinical outcome and quality of life. We have investigated the acute effects of conditioning regimen on the pharmacology, physiology and structure of large elastic arteries and small resistance-sized arteries in a SCT mouse model. Mesenteric resistance arteries and aorta were dissected from Balb/c mice conditioned with busulphan (Bu) and cyclophosphamide (Cy). In vitro isometric force development and pharmacology, in combination with RT-PCR, Western blotting and electron microscopy were used to study vascular properties. Compared with controls, mesenteric resistance arteries from the Bu-Cy group had larger internal circumference, showed enhanced endothelium mediated relaxation and increased expression of endothelial nitric oxide synthase (eNOS). Bu-Cy treated animals had lower mean blood pressure and signs of endothelial injury. Aortas of treated animals had a higher reactivity to noradrenaline. We conclude that short-term consequences of Bu-Cy treatment divergently affect large and small arteries of the cardiovascular system. The increased noradrenaline reactivity of large elastic arteries was not associated with increased blood pressure at rest. Instead, Bu-Cy treatment lowered blood pressure via augmented microvascular endothelial dependent relaxation, increased expression of vascular eNOS and remodeling toward a larger lumen. The changes in the properties of resistance arteries can be associated with direct effects of the compounds on vascular wall or possibly indirectly induced via altered translational activity associated with the reduced hematocrit and shear stress. This study contributes to understanding the mechanisms that underlie the early effects of conditioning regimen on resistance arteries and may help in designing further investigations to understand the late effects on vascular system

Proteomic analysis reveals distinct cerebrospinal fluid signatures across genetic frontotemporal dementia subtypes

‡ GENFI investigators are listed at the end of the paper (ORCiD https://orcid.org/0000-0002-9477-1812 ): GENFI authors: In addition to members of GENFI who are co-authors, the following members are collaborators who have contributed to the study design, the recruitment of participants, and the processing of samples at their sites, sending the samples and providing corresponding demographic data of their participants, data analysis, and interpretation: David L. Thomas, Thomas Cope, Timothy Rittman, Alberto Benussi, Enrico Premi, Roberto Gasparotti, Silvana Archetti, Stefano Gazzina, Valentina Cantoni, Andrea Arighi, Chiara Fenoglio, Elio Scarpini, Giorgio Fumagalli, Vittoria Borracci, Giacomina Rossi, Giorgio Giaccone, Giuseppe Di Fede, Paola Caroppo, Pietro Tiraboschi, Sara Prioni, Veronica Radaaelli, David Tang-Wai, Ekaterina Rogaeva, Michel Castelo-Branco, Morris Freedman, Ron Keren, Sandra Black, Sara Mitchell, Christen Shoesmith, Robart Bartha, Rosa Rademakers, Jackie Poos, Janne M. Papma, Lucia Giannini, Rick van Minkelen, Yolande Pijnenburg, Benedetta Nacmias, Camilla Ferrari, Cristina Polito, Gemma Lombardi, Valentina Bessi, Michele Veldsman, Christin Andersson, Hakan Thonberg, Linn Öijerstedt, Vesna Jelic, Paul Thompson, Tobias Langheinrich, Albert Lladó, Anna Antonell, Jaume Olives, Mircea Balasa, Nuria Bargalló, Sergi Borrego-Écija, Ana Verdelho, Carolina Maruta, Catarina B. Ferreira, Gabriel Miltenberger, Frederico Simões do Couto, Alazne Gabilondo, Jorge Villanua, Marta Cañada, Mikel Tainta, Miren Zulaica, Myriam Barandiaran, Patricia Alves, Benjamin Bender, Carlo Wilke, Lisa Graf, Annick Vogels, Mathieu Vandenbulcke, Philip van Damme, Rose Buffaerts, Koen Poesen, Pedro Rosa-Neto, Serge Gauthier, Agnès Camuzat, Alexis Brice, Anne Bertrand, Aurélie Funkiewiez, Daisy Rinaldi, Dario Saracino, Olivier Colliot, Sabrina Sayah, Catharina Prix, Elisabeth Wlasich, Olivia Wagemann, Sandra Loosli, Sonja Schönecker, Tobias Hoegen, Jolina Lombardi, Sarah Anderl-Straub, Adeline Rollin, Gregory Kuchcinski, Maxime Bertoux, Thibaud Lebouvier, Vincent Deramecourt, Beatriz Santiago, Diana Duro, Maria João Leitão, Maria Rosario Almeida, Miguel Tábuas-Pereira, Sónia Afonso.Editor’s summary: Familial frontotemporal dementia (FTD) is caused by mutations in risk genes, most commonly C9orf72, MAPT, or GRN. Here, Sogorb-Esteve et al. used untargeted mass spectrometry of cerebrospinal fluid samples from presymptomatic and symptomatic carriers of these three risk genes to characterize distinct and shared proteomic alterations. Weighted gene coexpression network analysis allowed grouping FTD-dysregulated proteins into modules with high coexpression patterns, highlighting potentially dysregulated biological pathways, such as “core markers,” “synapse,” and “actin binding.” The expression of a subset of these modules was correlated with clinical scores. These results provide a useful resource for FTD research and disease marker development. —Daniela NeuhoferSupplementary Materials are available online at: https://www.science.org/doi/10.1126/scitranslmed.adm9654#supplementary-materials .We used an untargeted mass spectrometric approach, tandem mass tag proteomics, for the identification of proteomic signatures in genetic frontotemporal dementia (FTD). A total of 238 cerebrospinal fluid (CSF) samples from the Genetic FTD Initiative were analyzed, including samples from 107 presymptomatic (44 C9orf72, 38 GRN, and 25 MAPT) and 55 symptomatic (27 C9orf72, 17 GRN, and 11 MAPT) mutation carriers as well as 76 mutation-negative controls (“noncarriers”). We found shared and distinct proteomic alterations in each genetic form of FTD. Among the proteins significantly altered in symptomatic mutation carriers compared with noncarriers, we found that a set of proteins including neuronal pentraxin 2 and fatty acid binding protein 3 changed across all three genetic forms of FTD and patients with Alzheimer’s disease from previously published datasets. We observed differential changes in lysosomal proteins among symptomatic mutation carriers with marked abundance decreases in MAPT carriers but not other carriers. Further, we identified mutation-associated proteomic changes already evident in presymptomatic mutation carriers. Weighted gene coexpression network analysis combined with gene ontology annotation revealed clusters of proteins enriched in neurodegeneration and glial responses as well as synapse- or lysosome-related proteins indicating that these are the central biological processes affected in genetic FTD. These clusters correlated with measures of disease severity and were associated with cognitive decline. This study revealed distinct proteomic changes in the CSF of patients with genetic FTD, providing insights into the pathological processes involved in the disease. In addition, we identified proteins that warrant further exploration as diagnostic and prognostic biomarker candidates.Alzheimer's Association: ADSF-24-1284328-C; Göteborgs Läkaresällskap: GLS-988641; the Bluefield Project; Race Against Dementia: ARUK-RADF2021A-003; Swedish Research Council: 2023-00356; European Union’s Horizon Europe research and innovation programme: 22HLT07; Alzheimerfonden: AF-980746; Stiftelsen för Gamla Tjänarinnor: 2022-01324. This work was supported by a Race Against Dementia fellowship, supported by Alzheimer’s Research UK (ARUK-RADF2021A-003 to A.S.-E.) and the UK Dementia Research Institute, which receives its funding from DRI Ltd, funded by the UK Medical Research Council, Alzheimer’s Society and Alzheimer’s Research UK (to A.S.-E.). The Dementia Research Centre is supported by Alzheimer’s Research UK, Alzheimer's Society, Brain Research UK, and the Wolfson Foundation. Coauthors of the manuscript were supported by the Gothenburg Medical Society (Göteborgs Läkaresällskap, #GLS-988641 to J.S.). H.Z. is a Wallenberg scholar and a distinguished professor at the Swedish Research Council supported by grants from the Swedish Research Council (#2023-00356, #2022-01018, and #2019-02397); the European Union’s Horizon Europe research and innovation programme under grant agreement no. 101053962; Swedish State Support for Clinical Research (#ALFGBG-71320); the Alzheimer Drug Discovery Foundation (ADDF), USA (#201809-2016862); the AD Strategic Fund and the Alzheimer’s Association (#ADSF-21-831376-C, #ADSF-21-831381-C, #ADSF-21-831377-C, and #ADSF-24-1284328-C); the European Partnership on Metrology, cofinanced from the European Union’s Horizon Europe Research and Innovation Programme and by the participating states (NEuroBioStand, #22HLT07); the Bluefield Project; Cure Alzheimer’s Fund; the Olav Thon Foundation; the Erling-Persson Family Foundation; Familjen Rönströms Stiftelse; Stiftelsen för Gamla Tjänarinnor, Hjärnfonden, Sweden (#FO2022-0270); the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement no. 860197 (MIRIADE); the European Union Joint Programme—Neurodegenerative Disease Research (JPND2021-00694); the National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre; and the UK Dementia Research Institute at UCL (UKDRI-1003). K.B. is supported by the Swedish Research Council (#2017-00915 and #2022-00732); the Swedish Alzheimer Foundation (#AF-930351, #AF-939721, and #AF-968270); Hjärnfonden, Sweden (#FO2017-0243 and #ALZ2022-0006); the Swedish state under the agreement between the Swedish government and the County Councils, the ALF-agreement (#ALFGBG-715986 and #ALFGBG-965240); the European Union Joint Program for Neurodegenerative Disorders (JPND2019-466-236); the Alzheimer’s Association 2021 Zenith Award (ZEN-21-848495); and the Alzheimer’s Association 2022-2025 grant (SG-23-1038904 QC). J.C.V.S. was supported by the Dioraphte Foundation grant 09-02-03-00, Association for Frontotemporal Dementias Research Grant 2009, Netherlands Organization for Scientific Research grant HCMI 056-13-018, ZonMw Memorabel (Deltaplan Dementie, project number 733 051 042), Alzheimer Nederland, and the Bluefield Project. F.M. received funding from the Tau Consortium and the Center for Networked Biomedical Research on Neurodegenerative Disease. R.S.-V. is supported by Alzheimer’s Research UK Clinical Research Training Fellowship (ARUK-CRF2017B-2) and has received funding from Fundació Marató de TV3, Spain (grant no. 20143810). D.G. received support from the EU Joint Programme–Neurodegenerative Disease Research and the Italian Ministry of Health (PreFrontALS) grant 733051042. C.G. received funding from EU Joint Programme–Neurodegenerative Disease Research-Prefrontals VR Dnr 529-2014-7504, VR 2015-02926, and 2018-02754; the Swedish FTD Inititative-Schörling Foundation; Alzheimer Foundation; Brain Foundation; and Stockholm County Council ALF. M.M. has received funding from a Canadian Institute of Health Research operating grant and the Weston Brain Institute and Ontario Brain Institute. J.B.R. has received funding from the Wellcome Trust (220258) and the Bluefield Project and is supported by the Cambridge University Centre for Frontotemporal Dementia, the Medical Research Council (MC_UU_00030/14; MR/T033371/1), and the National Institute for Health Research Cambridge Biomedical Research Centre (NIHR203312). E.F. has received funding from a Canadian Institute of Health Research grant #327387. RV has received funding from the Mady Browaeys Fund for Research into Frontotemporal Dementia. J.L. received funding for this work by the Deutsche Forschungsgemeinschaft German Research Foundation under Germany’s Excellence Strategy within the framework of the Munich Cluster for Systems Neurology (EXC 2145 SyNergy—ID 390857198). M.O. has received funding from Germany’s Federal Ministry of Education and Research (BMBF). J.D.R. is supported by the Bluefield Project and the National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre and has received funding from an MRC Clinician Scientist Fellowship (MR/M008525/1) and a Miriam Marks Brain Research UK Senior Fellowship. J.G. is supported by Alzheimerfonden (AF-980746) and Stiftelsen för Gamla tjänarinnor (2022-01324). Several authors of this publication are members of the European Reference Network for Rare Neurological Diseases (ERN-RND) - Project ID no. 739510 to J.C.V.S., M.S., R.S.V., A.d.M., M.O., R.V., and J.D.R. This work was also supported by the EU Joint Programme—Neurodegenerative Disease Research GENFI-PROX grant (2019-02248, to J.D.R., M.O., B.B., C.G., J.C.V.S., and M.S.) and by the Clinician Scientist programme “PRECISE.net” funded by the Else Kröner-Fresenius-Stiftung (to M.S.)

U–Pb isotopic ages and Hf isotope composition of zircons in Variscan gabbros from central Spain: evidence of variable crustal contamination

Ion microprobe U–Pb analyses of zircons from three gabbroic intrusions from the Spanish Central System (SCS) (Talavera, La Solanilla and Navahermosa) yield Variscan ages (300 to 305 Ma) in agreement with recent studies. Only two zircon crystals from La Solanilla massif gave slightly discordant Paleoproterozoic ages (1,848 and 2,010 Ma). Hf isotope data show a relatively large variation with the juvenile end-members showing ɛHfi values as high as +3.6 to +6.9 and +1.5 to +2.9 in the Navahermosa and Talavera gabbros, respectively. These positive ɛHfi values up to +6.9 might represent the composition of the subcontinental mantle which generates these SCS gabbros. This ɛHfi range is clearly below depleted mantle values suggesting the involvement of enriched mantle components on the origin of these Variscan gabbros, and is consistent with previous whole-rock studies. The presence of zircons with negative ɛHfi values suggest variable, but significant, crustal contamination of the gabbros, mainly by mixing with coeval granite magmas. Inherited Paleoproterozoic zircons of La Solanilla gabbros have similar trace element composition (e.g. Th/U ratios), but more evolved Hf-isotope signatures than associated Variscan zircons. Similar inherited ages have been recorded in zircons from coeval Variscan granitoids from the Central Iberian Zone. Granitic rocks have Nd model ages (TDM) predominantly in the range of 1.4 to 1.6 Ga, suggesting a juvenile addition during the Proterozoic. However, Hf crustal model ages of xenocrystic Proterozoic zircons in La Solanilla gabbro indicate the presence of reworked Archean protoliths (TDM2 model ages of 3.0 to 3.2 Ga) incorporated into the hybridized mafic magma