Emerging Cerebrospinal Fluid Biomarkers of Disease Activity and Progression in Multiple Sclerosis.

Importance: Biomarkers distinguishing nonrelapsing progressive disease biology from relapsing biology in multiple sclerosis (MS) are lacking. Cerebrospinal fluid (CSF) is an accessible fluid that most closely reflects central nervous system biology.

Objective: To identify CSF biological measures associated with progressive MS pathobiology.

Immersive virtual reality and psychological well-being in adult chronic physical illness: systematic review.

Introduction: Individuals with chronic physical illness are at increased risk of negative psychological sequelae. Immersive virtual reality (VR) is an emerging treatment that might reduce these negative effects and increase quality of life in individuals with chronic physical illness.

Objective: To systematically review literature examining the use of immersive VR in adult populations with chronic physical illness to understand: (1) how immersive VR is used to improve psychological well-being of adults with chronic physical illness (2) what effect this immersive VR has on the psychological well-being of adults with chronic physical illness.

Differential effects of anti-CD20 therapy on CD4 and CD8 T cells and implication of CD20-expressing CD8 T cells in MS disease activity.

A small proportion of multiple sclerosis (MS) patients develop new disease activity soon after starting anti-CD20 therapy. This activity does not recur with further dosing, possibly reflecting deeper depletion of CD20-expressing cells with repeat infusions. We assessed cellular immune profiles and their association with transient disease activity following anti-CD20 initiation as a window into relapsing disease biology.

Nothing about me without me: a scoping review of how illness experiences inform simulated participants' encounters in health profession education.

Background: Person-centred simulation in health professions education requires involvement of the person with illness experience.

Objective: To investigated how real illness experiences inform simulated participants' (SP) portrayals in simulation education using a scoping review to map literature.

Study Selection: Arksey and O'Malley's framework was used to search, select, chart and analyse data with the assistance of personal and public involvement.

A systematic review of the use of virtual reality or dental smartphone applications as interventions for management of paediatric dental anxiety.

Background: Virtual reality (VR) has been used successfully in medicine both as a distraction tool during procedures, and as an acclimatisation tool to prepare for a procedure or experience. It has not yet become widely used in dentistry, but could theoretically have a role in exposure-based acclimatisation for dental experiences.

Methods: To examine the use of VR or bespoke dental smartphone applications pre- or perioperatively in dentistry, to decrease anxiety in a paediatric population attending for dental examination or treatment, compared with children/adolescents who receive no intervention, or more conventional behavioural management techniques.

Interventions for oropharyngeal dysphagia in acute and critical care: a systematic review and meta-analysis.

Purpose: To determine the effectiveness of dysphagia interventions compared to standard care in improving oral intake and reducing aspiration for adults in acute and critical care.

Methods: We searched electronic literature for randomised and quasi-randomised trials and bibliography lists of included studies to March 2020. Study screening, data extraction, risk of bias and quality assessments were conducted independently by two reviewers.

Interventions for oropharyngeal dysphagia in acute and critical care: a protocol for a systematic review and meta-analysis.

Background: Oropharyngeal dysphagia or swallowing difficulties are common in acute care and critical care, affecting 47% of hospitalised frail elderly, 50% of acute stroke patients and approximately 62% of critically ill patients who have been intubated and mechanically ventilated for prolonged periods. Complications of dysphagia include aspiration leading to chest infection and pneumonia, malnutrition, increased length of hospital stay and re-admission to hospital. To date, most dysphagia interventions in acute care have been tested with acute stroke populations.

Infectious complications of bronchial stenosis in lung transplant recipients.

Background: Bronchial stenosis is a known complication of lung transplantation, but there are limited data regarding whether transplant recipients with bronchial stenosis develop more infectious complications than those without bronchial stenosis.

Methods: We conducted a retrospective single-center observational cohort study between January 1, 2011 and September 29, 2016 of 35 lung transplant recipients diagnosed with bronchial stenosis and a random sample of 35 lung transplant recipients without bronchial stenosis. Data collected included donor/recipient demographic and anatomic information, respiratory cultures, episodes of respiratory infections diagnosed using CDC-NNIS criteria, hospitalizations, and 1-year all-cause mortality.

Evaluation of the Effectiveness and Cost-Effectiveness of Personalized Surveillance After Colorectal Adenomatous Polypectomy.

Lifetime risk of developing colorectal cancer is 5%, and 5-year survival at early stage is 92%. Individuals with precancerous lesions removed at primary screening are typically recommended surveillance colonoscopy. Because greater benefits are anticipated for those with higher risk of colorectal cancer, scope for risk-specific surveillance recommendations exists.

Resolving variable maternal D typing using serology and genotyping in selected prenatal patients.

Background: RhIG prophylaxis for D- pregnant women prevents hemolytic disease of the newborn and typically depends on results of serologic D typing. Interpretation and follow-up of weak D serology is variable. Recent recommendations promote genotyping for RHD status determination in those with weak D serology.

The Effect of Statins on Intraocular Pressure and on the Incidence and Progression of Glaucoma: A Systematic Review and Meta-Analysis.

Purpose: We conducted a systematic review and meta-analysis of observational studies to evaluate the effect of oral statins on intraocular pressure (IOP) and the incidence and progression of glaucoma.

Methods: This was a systematic review of the literature and meta-analysis. Searches of PubMed/Medline and Embase were conducted to include all types of studies.

Design characteristic of randomised controlled trials for geographic atrophy in age-related macular degeneration: selection of outcomes and sample size calculation.

Purpose: The selection of suitable outcomes and sample size calculation are critical factors in the design of a randomised controlled trial (RCT). The goal of this study was to identify the range of outcomes and information on sample size calculation in RCTs on geographic atrophy (GA).

Methods: We carried out a systematic review of age-related macular degeneration (AMD) RCTs.

The prevalence of anti-K in Canadian prenatal patients.

Background: Anti-KEL1(K) is a major cause of hemolytic disease of the fetus and newborn. We utilized data from prenatal testing of patients in Western Canada to determine the frequency of anti-K. In Manitoba, we evaluated the frequency of transfusion as the likely cause for alloimmunization.

Changes in Fatigue and Cognition in Patients with Relapsing Forms of Multiple Sclerosis Treated with Natalizumab: The ENER-G Study.

Fatigue and cognitive impairment are debilitating features of multiple sclerosis (MS). ENER-G was a 12-month, open-label, multicenter, single-arm observational study designed to evaluate changes in fatigue and cognition in MS patients treated with natalizumab. Adults with relapsing MS and initiating natalizumab were enrolled.

Alterations in T cell antigen specificity and class II restriction during the course of chronic relapsing experimental allergic encephalomyelitis.

In order to assess T cell antigen specificities and class II restriction requirements during the course of chronic relapsing experimental allergic encephalomyelitis (CREAE), (SJL x PL)F1 mice were used as a model. EAE can be passively transferred in these mice by F1 T cells incubated with Ia-positive antigen-presenting cells (APC) from either parent SJL (H-2s) or PL (H-2u) and MBP fragments 89-169 or 1-37, respectively. T cells purified from F1 mice immunized with MBP fragment 1-37 were positively selected for I-Au-supported proliferation by culture in the presence of irradiated Iau-positive PL spleen cells as APC.

Chronic relapsing experimental allergic encephalomyelitis. Cytotoxicity effected by a class II restricted T cell line specific for an encephalitogenic epitope.

We have examined the possibility that Ag-specific CTL responses may play a role in the pathogenesis of CREAE by using an effector T cell line (LN400) specifically reactive to the SJL encephalitogenic epitope defined by myelin basic protein MBP residues(90-101). The LN400 cell line was capable of adoptively transferring CREAE to naive SJL mice and proliferated specifically to synthetic peptides corresponding to MBP residues(90-101) and an N-acetylated analogue of this epitope, as well as MBP. Moreover, the cell line generated Ag-specific CTL responses only against syngeneic targets that had been pulsed with these Ag.

Chronic relapsing experimental allergic encephalomyelitis in SJL mice following the adoptive transfer of an epitope-specific T cell line.

Chronic relapsing experimental allergic encephalomyelitis (CREAE) was induced in SJL mice following the adoptive transfer of a T cell line derived from mice immunized with a synthetic peptide corresponding to residues 89-100 of the guinea pig myelin basic protein (MBP) molecule. This cell line proliferated to both the peptide and MBP and induced CREAE characterized by a series of relapses with eventual stabilization. Central nervous system (CNS) inflammation and demyelination were prominent neuropathologic features of both the acute and relapsing phase of the disease.

Immunoregulatory abnormalities induced by experimental reovirus infection: functional alterations in T-cell subpopulations.

A primary anti-sheep red blood cell (SRBC) plaque assay system was used to analyze the effect of reovirus infection on immunoregulatory T-cells. A decrease in the plaque-forming cell (PFC) response of splenic lymphocytes was observed within 24 hr of infection with 10(9) or 10(11) particles of reovirus type 1 or reovirus type 3 and persisted for more than 7 days. In coculture experiments, T-cells from infected mice were found to produce less help to control B-cells and to suppress helper function mediated by control T-cells.

Serial analysis of peripheral blood T-cell phenotypes and myelin basic protein reactivity in experimental allergic encephalomyelitis.

We have serially analyzed peripheral blood T-cell phenotypes and reactivity to myelin basic protein (MBP) during the course of acute experimental allergic encephalomyelitis (EAE) in the Lewis rat and have correlated changes with the onset of clinical disease. A reduction in total T cells (W3/13+), due primarily to a reduced helper/inducer (W3/25+) subpopulation, preceded the onset of EAE. Circulating MBP-reactive lymphocytes were only transiently present in the blood at the time EAE was clinically evident.

Adoptive transfer of murine chronic-relapsing autoimmune encephalomyelitis. Analysis of basic protein-reactive cells in lymphoid organs and nervous system of donor and recipient animals.

Frequency analysis of myelin basic protein (MBP)-reactive lymphocytes was performed in the chronic relapsing murine experimental allergic encephalomyelitis (EAE) model induced by the adoptive transfer of myelin basic protein (MBP)-primed lymphocytes to naive recipients. During the first attack, MBP-reactive cell frequencies were: 1/41,700 in spleen, 1/328,000 in lymph nodes, 1/64,500 in the peripheral blood. After recovery from a second attack, the frequencies were: 1/11,000 in spleen, 1/46,000 in lymph node, and 1/195,000 in the blood.

Cell-mediated immunity to myelin-associated glycoprotein, proteolipid protein, and myelin basic protein in multiple sclerosis.

Peripheral blood lymphocytes (PBL) from active and stable multiple sclerosis (MS) patients, patients with other neurologic diseases (OND), and control subjects were tested for sensitization to two myelin antigens not previously examined in multiple sclerosis, using a [3H]thymidine incorporation assay. The antigens investigated were myelin-associated glycoprotein (MAG) and proteolipid protein (PLP). In addition, sensitization to myelin basic protein (MBP) was also tested.

Immunologic responses of progressive multiple sclerosis patients treated with an anti-T-cell monoclonal antibody, anti-T12.

Twelve patients with progressive MS were treated with a murine IgM pan-T-cell monoclonal antibody reactive against T12, a determinant present on most post-thymic T-cells. Circulating T12+ cells could not be detected from days 1 to 7, although T3+T11+T12- cells appeared by day 3. Human anti-mouse antibodies were detected in 78% of patients by day 7 and correlated with a decrease in anti-T12 MAb blood levels and the reappearance of T12+ cells in the blood.

Cerebral vasculitis and hemorrhage associated with phenylpropanolamine.

A 20-year-old woman using an oral diet aid preparation containing phenylpropanolamine presented with an intracerebral hemorrhage and angiographic evidence of cerebral vasculitis. Gas chromatography demonstrated phenylpropanolamine in the urine. Even when used within recommended guidelines, phenylpropanolamine usage should be included in the differential diagnosis of patients presenting with intracranial hemorrhage.