COVID-19 and IL-6: Why vitamin D (probably) helps but tocilizumab might not.

Interleukin 6 (IL-6), which is involved in the cytokine storm phenomenon, is a therapeutic target in COVID-19, but monoclonal receptor antibody therapeutic agents such as tocilizumab have demonstrated mixed results. Could Vitamin D, which modulates IL-6, be more effective than currently deployed IL-6 antagonists, including tocilizumab, thereby presenting a useful therapeutic option in COVID-19? A narrative review of published trials examining the effect of Vitamin D administration in COVID-19 patients was conducted, and the theoretical basis for the use of tocilizumab as an IL-6 antagonist was compared with the immunomodulatory effect of Vitamin D on IL-6 production. Four of the six included studies reported a positive effect of Vitamin D on outcomes.

Correlation between premorbid IL-6 levels and COVID-19 mortality: Potential role for Vitamin D.

There is recent evidence that interleukin-6 (IL-6) levels are elevated in cases of complicated COVID-19, but it is also possible that this cytokine may have a far more important role in the pathogenesis of viral infection. IL-6 is known to be modulated by Vitamin D, and there is preliminary evidence that deficiency of this vitamin is linked to poorer outcomes. To identify whether IL-6 levels prior to infection might predict outcome, early data on COVID-19 mortality from Italy and the UK were compared with previously published results of mean IL-6 levels from these countries as well as from the USA.

Vitamin D: A simpler alternative to tocilizumab for trial in COVID-19?

There is anecdotal evidence that tocilizumab, an immunosuppressant drug, may be a potential therapeutic option for patients with severe manifestations of coronavirus disease 2019 (COVID-19). Like tocilizumab, Vitamin D appears to modulate the activity of an interleukin (IL-6), which may explain the seasonal variation in prevalence of influenza. While most cases of COVID-19 have, thus far, occurred in the Northern Hemisphere winter, limiting the ability to assess seasonal variation, there remains substantial variation in the severity of this condition that has yet to be explained.

A Human Sensory Pathway Connecting the Foot to Ipsilateral Face That Partially Bypasses the Spinal Cord.

Human sensory transmission from limbs to brain crosses and ascends through the spinal cord. Yet, descriptions exist of ipsilateral sensory transmission as well as transmission after spinal cord transection. To elucidate a novel ipsilateral cutaneous pathway, we measured facial perfusion following painfully-cold water foot immersion in 10 complete spinal cord-injured patients, 10 healthy humans before and after lower thigh capsaicin C-fiber cutaneous conduction blockade, and 10 warm-immersed healthy participants.

Is acupuncture "stimulation" a misnomer? A case for using the term "blockade".

Background: The term used most frequently in the literature to describe acupuncture's effects is "stimulation" which may be used to describe either (or both) the direct stimulus applied to a needle as well as putative stimulation of the nervous system, despite little published evidence describing what is actually being stimulated. In contrast, recent published work has suggested that acupuncture may, in fact be inhibitory at a peripheral level, acting by blocking neural transmission.

Discussion: The suggestion that acupuncture exerts its effects through peripheral neural blockade is supported by recent evidence explaining related techniques including low level laser and capsaicin at acupoints.

Do acupuncture meridians exist? Correlation with referred itch (mitempfindung) stimulus and referral points.

Objective: To describe the relationship between referred itch (mitempfindung) stimulus and referral points and acupuncture meridians, noting that the neuroanatomical mechanism of mitempfindung has never previously been satisfactorily explained.

Methods: Analysis of clinical findings in the author as well as subjects in four previously described studies, comparing proportions in each of five groups.

Results: Ninety-two per cent (range 85-94%) of mitempfindung point pairs (stimulus and referral) aligned to a recognised acupuncture meridian with no statistical difference (p<0.

Synthesis, structural, and photophysical investigation of diimine triscarbonyl Re(I) tetrazolato complexes.

The synthesis, structural, and photophysical properties of a novel family of neutral fac-[Re(N(∧)N)(CO)(3)(L)] complexes, where N(∧)N is either 2,2'-bipyridine or 1,10-phenanthroline and L is a para functionalized 5-aryltetrazolate [namely, 5-phenyltetrazolate (Tph(-)), 4-(tetrazolate-5-yl)benzaldehyde (Tbdz(-)), 5-(4-acetylphenyl)tetrazolate (Tacy(-)), and methyl 4-(tetrazolate-5-yl)benzoate (Tmeb(-))] are reported. The complexes were prepared by direct addition of the corresponding tetrazolate anion to the acetonitrile solvated fac-[Re(N(∧)N)(CO)(3)](+) precursor. NMR data demonstrate that the coordination of the metal fragment is regiospecific at the N2 atom of the tetrazolate ring.

The cutaneous intrinsic visceral afferent nervous system: a new model for acupuncture analgesia.

The mechanism of acupuncture, whilst not known with certainty, has previously been considered to be stimulatory. A novel hypothesis is presented here in which C fiber tactile afferent axons bifurcate at acupuncture points and then diverge, running along acupuncture meridians, to subsequently communicate with Merkel cells. It is proposed that acupuncture disrupts the bifurcation of these axons, preventing neural transmission between Merkel cells as well as central communication with the spinal cord.

Synthetic and structural comparisons of bismuth(III) carboxylates synthesised under solvent-free and reflux conditions.

Two synthetic approaches to the formation of bismuth(III) carboxylates have been explored and compared. Ph(3)Bi was reacted with a series of carboxylic acids (RCO(2)H) of varying pK(a) and functionality (R = PhCH[double bond, length as m-dash]CH, o-MeOC(6)H(4), m-MeOC(6)H(4), o-H(2)NC(6)H, o-O(2)NC(6)H(4), p-O(2)NC(6)H(4), 2-(C(5)H(4)N)) under reflux conditions in toluene and solvent-free. The thermochemical profiles of the solvent-free reactions were also studied by DSC-TGA.

Gelation of La(III) cations promoted by 5-(2-pyridyl)tetrazolate and water.

Addition of water to the product formed when LaCl3 and 1H-5-(2-pyridyl)tetrazole (LH) were treated with an excess of triethylamine in ethanol, resulted in the reversible formation of a hydrogel, which when further treated with EtOH-iPrOH produced crystals of [LaL3(H2O)3].(H2O)4, as determined by X-ray crystallography.

Sonographic and MRI evaluation of the plantar plate: A prospective study.

The purpose of this study was to establish the accuracy of ultrasound in the examination of the plantar plate by comparing it with MRI, or if available, surgical findings. The lesser metatarsophalangeal joint plantar plates of 40 symptomatic and 40 asymptomatic feet (160 asymptomatic and 160 symptomatic plantar plates) were examined with ultrasound and MRI. Patients treated with surgery were chosen on a clinical basis and provided surgical correlation for the imaging techniques.

Sonography of plantar plates in cadavers: correlation with MRI and histology.

Objective: The purpose of our study was to describe the sonographic appearance of the lesser metatarsal plantar plates in cadavers and to correlate these findings with MRI and histology.

Materials And Methods: Six soft-embalmed cadaveric feet (74-92 years old; two male, one female) were imaged with sonography and MRI. Tear dimensions of the plantar plate were recorded in the long and short axes.

Identification of a by-product of nitric oxide synthase activity in human acute brain injury with in vivo proton magnetic resonance spectroscopy.

Background And Purpose: Laboratory studies have been used to identify nitric oxide as a notable mediator in neuronal death after acute brain injury. To our knowledge, this has not previously been confirmed with in vivo study in humans. Our purpose was to seek in vivo evidence for the induction of nitric oxide synthase (NOS) in human acute brain injury by using proton MR spectroscopy.