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Objective: To identify a biomarker distinguishing patients who, despite a primary progressive multiple sclerosis (PPMS) clinical course, may nonetheless benefit from immune therapy. Methods: The presence or absence of both immunoglobulin (Ig) G and IgM oligoclonal bands (OCB) was blindly examined in paired cerebrospinal fluid (CSF) and serum samples from a large PPMS patient cohort, and related to clinical and imaging evidence of focal inflammatory disease activity. Results: Using both cross-sectional samples and serial sampling in a subgroup of patients followed prospectively as part of the placebo-controlled OLYMPUS study of rituximab in PPMS, we found that the presence of CSF-restricted IgM OCB (but not of IgG OCB) is associated with an active inflammatory disease phenotype in PPMS patients. This finding was confirmed in an independent, multicenter validation cohort. Interpretation: The presence of CSF IgM OCB may be a biomarker for a subset of PPMS patients with more active inflammatory disease, who may benefit from immune-directed treatments.

To determine if dietary texture altered the establishment, survival and reproduction of Heligmosomoides polygyrus during a primary infection, commercial mouse chow (Purina Chow®) was fed in either pelleted or powdered form to 2 groups of infected BALB/c mice, and a semipurified, biotin-fortified, egg-white-based diet was provided in powdered form to a third group of mice. Diet texture (powdered vs. pelleted) modified parasite establishment, as evidenced by higher worm recovery 6 days postinfection (PI) in both groups of mice fed powdered diets compared with the group fed the pelleted diet, but diet texture had no detectable effect on net or per capita egg production or on day 30 worm survival. However, almost twice as many worms were recovered from mice fed the semipurified, powdered diet than those fed either textural formulation of the commercial mouse chow on day 30 PI, indicating that a dietary component in the semipurified diet, such as the single fiber source cellulose, facilitated parasite survival, or that other ingredients in the commercial mouse chow, perhaps the more complex fiber components, reduced worm survival, or both. We conclude that dietary texture influences parasite establishment and that specific fibers that change texture can individually and independently modify H. polygyrus survival.

Enriched MCT (medium-chain triglycerides) formula has been used in the management of infants with congenital chylothorax (CC). Administration of total parenteral nutrition (TPN) has also been suggested. I evaluated the effect of these two regimens on the course of infants with CC described in the literature, in addition to two new cases reported herein. There were 29 infants who received non-MCT formulas. Twelve infants were given MCT formulas and/or parenteral nutrition. The total volume and duration of pleural effusion were decreased with these regimens, and there were no associated deaths. Data suggest that infants with CC must initially be given an enriched MCT formula. If pleural effusion persists, then total parenteral nutrition should be considered.

The data from the charts of 109 infants who were younger than 9 months of age and who had been hospitalized with acute diarrheal syndrome in 1978 were compared with data from the charts of 108 healthy infants of the same age range with the same sex and ethnic distributions who were attending well-child clinics serving the same geographic area during the same year. In a comparison of weight percentiles, 45.3% of the acute diarrheal syndrome patients and 11.3% of the well children were below the 10th percentile. When height percentiles were compared, 41.8% of the acute diarrheal syndrome patients and 15.3% of the well children were below the 10th percentile. The data indicate that malnutrition was a characteristic of infants with acute diarrheal syndrome who required hospitalization.

In a retrospective study, 9% of the admissions to Ben Taub General Hospital for diarrhea were found to have acquired monosaccharide intolerance (AMI). The course of AMI was compared with that of acute diarrheal syndrome (ADS). The patients with AMI were younger at the time of admission, and, although the mean birthweight and percent of prematurity were approximately the same in the two groups, the AMI patients were found to be malnourished (p less than 0.02). Data suggest that the nutritional insult had occurred between birth and admission, and that malnutrition was a contributing factor in the development of AMI.

Background: Tracheal stenosis, which has received more emphasis recently, is a common post intubation complication and may develop due to different reasons. One important reason is the endotracheal tube cuff pressure. Therefore, this study sought to examine the accuracy of diagnostic test for palpation and minimal occlusive volume techniques to measure the endotracheal tube cuff pressure. Materials and Methods: In this cross sectional study, the accuracy of diagnostic tests for palpation and minimal occlusive volume techniques to measure the endotracheal tube cuff pressure was assessed in 101 patients aged over 18 years who had undergone open heart surgery and post-surgical mechanical ventilation in the ICU. Results: In the palpation technique, the cuff pressure of 27 patients (26.7%) was reported to be out of the permissible range and for the rest of them (74 patients, 73.3%) it was within the permissible range. Then, the cuff pressure was checked by the standard method using a manometer and after comparing the results it was found that the cuff pressure of 92 patients (91.1%) was not in the permissible range and only nine patients (8.9%) had a cuff pressure within the permissible range (20–30 cm H2O). In minimal occlusive volume method compared with the standard method, 22 patients (21.7%) had cuff pressure within the permissible range of 20–30 cm H2O, and 79 of them (78.2%) had cuff pressure out of the permissible range and higher than the upper limit. Conclusion: This study recommends that the best way to measure the endotracheal tube cuff pressure is to use a cuff manometer, and when it is not available, the minimal occlusive volume would be a better alternative compared to the palpation technique to keep the cuff pressure within a proper range to avoid tracheotomy complications such as tracheal stenosis.