Background: Previous studies have demonstrated a relationship between biomass of fungi exposure in the home and the risk of sarcoidosis. β-glucan was present in the bronchial alveolar lavage fluid (BALF) of patients with sarcoidosis. The Kveim-Siltzbach test reagent (KSTR) induces a sarcoidosis specific, granulomatous, cutaneous response and was used to establish the diagnosis. To date, the granuloma-inducing component of KSTR is still unknown. The present study was undertaken to investigate the presence of β-glucan in the lymph nodes of patients with sarcoidosis and to determine the relationship between the amounts of this agent with disease severity and to investigate the presence of β-glucan in KSTR. Materials and methods: Lymph node aspirations were collected by transbronchial needle aspiration (TBNA) in region R4 or 7 from patients with newly diagnosed sarcoidosis. The samples were treated to isolate β-glucan and analyzed using a Limulus-based assay. Cultures of Propionibacterium ac. and Mycobacterium gordonae as well as samples of Kveim-Siltzbach test reagent were analyzed to determine β-glucan content. Results: A significant relationship was observed between the amount of the β-glucan in the lymph nodes and the extent of granuloma formation in the lung parenchyma, and the size of the lymph nodes in the mediastinum (r=0.787, p=0.0001 and r=0.664, p<0.001 respectively, Spearman's test). The samples of Kveim-Siltzbach test reagent contained high levels of β-glucan. Cultures of Propionibacterium ac. and Mycobacterium gordonae contained β-glucan, the levels of which were lower in the Mycobacterium cultures. Comments: The results support the hypothesis that β-glucan, and thus fungal exposure, are involved in the pathogenesis of sarcoidosis. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 130-135).

Although the relevance of magnesium in obstetrics has been known for a long time and its effect in many diseases is well documented, oral magnesium supplementation during pregnancy is a subject of discussion. The evaluation of the variety of studies regarding magnesium supplementation in pregnancy clearly shows positive effects of oral substitution, in contrast to the Cochrane analysis. In addition to the needs of the growth of the fetus and the maternal tissue, elevated renal magnesium excretion is a reason for an increased magnesium requirement during pregnancy. This enhanced renal loss leads to a decreased serum magnesium concentration, which can also be recognized in the myometrium.

Background: Previous studies have demonstrated a relation between fungal exposure at home and the risk of sarcoidosis. Other studies have shown that β-glucan, a cell wall agent in fungi, was present in BALF of patients with sarcoidosis. At higher levels there was a suppression of iNKT-cells and IL-10 and a relation to the severity of granuloma infiltration. The present study was undertaken prospectively to investigate the presence of β-glucan in lymph nodes of patients with sarcoidosis. The amount was also measured in Kveim9s agent and in Propionibacterium acnes and Mycobacterium gordoniicultures. Material and methods: TBNA lymph nodeaspiration by flexible fiberoptic bronchoscopy in regions R4 or R7 was performed in 33 patients with newly diagnosed sarcoidosis, stages II and I. The samples were treated to retrieve the non-soluble part of β-glucan and analysed using a Limulus based assay. Different CFUs/mL of P.acnes and M.gordoniiin one ml of saline solution, as well as samples of Kveim9s agent were also analysed. Results: There was a significant relationship between the amount of non-soluble β-glucan in lymph nodes and the extent of granuloma formation in lung parenchyma (r= 0.849; p<0.0001) and the size of lymph nodes in mediastinum (r=0.689; p<0.0001). The samples of Kveim9s agent contained high levels of non-soluble β-glucan. Different CFUs/mL of P. acnes also contained different levels of β-glucan as did those of M. gordonii although at lower levels. Comments: The results support a conclusion that non-soluble β-glucan and thus a higher level of fungal exposure is involved in the pathogenesis of sarcoidosis through a depression of the normal immune defence system in susceptible patients.

SESSION TITLE: Sarcoidosis SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, October 26, 2016 at 07:30 AM - 08:30 AM PURPOSE: Previous studies have demonstrated a relation between fungal exposure at home and the risk of sarcoidosis. Β-glucan, a cell wall agent in fungi, was present in BALF of patients with sarcoidosis and at higher levels, there was a suppression of iNKT-cells and IL-10 and a relation to the severity of granuloma infiltration. The present study was undertaken prospectively to investigate the presence of β-glucan in lymph nodes of patients with sarcoidosis. The amount was also measured in Kveim’s agent. METHODS: TBNA lymph node aspiration by flexible fiberoptic bronchoscopy in regions R4 or R7 was performed in 40 patients with newly diagnosed sarcoidosis, stages II and I. The samples were treated to retrieve the non-soluble part of β-glucan and analysed using a Limulus based assay. Different CFUs/mL of Propionibacterium acnes and Mycobacterium gordonii in 1 ml of saline solution, as well as samples of Kveim’s agent were also analysed. RESULTS: The levels of ß-glucan in the lymph node samples ranged from 90 to 8350 pg/mL with a mean of 763 and SEM of 196. There was a significant relationship between the amount of non-soluble β-glucan in lymph nodes and the extent of granuloma formation in lung parenchyma (r = 0.8456 p<0.0001) and the size of lymph nodes in mediastinum (r=0.742; p<0.0001). The samples of Kveim’s agent contained high levels of non-soluble β-glucan, mean 3900 pg/mL, range 2500 to 5400 pg/mL. Different CFUs/mL of Propionibacterium acnes also contained different levels of β-glucan as did those of Mycobacterium gordonii although at lower levels. CONCLUSIONS: The results support a conclusion that non-soluble β-glucan and thus a higher level of fungal exposure is involved in the pathogenesis of sarcoidosis in susceptible patients. CLINICAL IMPLICATIONS: β-glucan should thus be recognized as a causative agent for sarcoidosis. It is likely that other microbial agents, not yet defined, have the same effect. DISCLOSURE: The following authors have nothing to disclose: Marjeta Tercelj-Zorman, Barbara Salobir, Ragnar Rylander No Product/Research Disclosure Information

Citation: Ragnar Rylander. Treatment with Magnesium in Pregnancy[J]. AIMS Public Health, 2015, 2(4): 804-809. doi: 10.3934/publichealth.2015.4.804

Indoor AirVolume 25, Issue 3 p. 353-353 Letter to the Editor Pre-eclampsia, solid-fuel cooking, and magnesium R. Rylander, R. Rylander [email protected] BioFact Environmental Health Research Centre, Lerum, SwedenSearch for more papers by this author R. Rylander, R. Rylander [email protected] BioFact Environmental Health Research Centre, Lerum, SwedenSearch for more papers by this author First published: 24 April 2015 https://doi.org/10.1111/ina.12157Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume25, Issue3June 2015Pages 353-353 RelatedInformation

Previous laboratory and field studies have demonstrated that the enzyme β-N-acetylhexosaminidase (NAHA) is a marker of fungal biomass. The purpose of the study was to evaluate the influence of storage of filters, air movements during sampling, and the relation to β-glucan. Air samples were taken on a filter. An enzyme activator was added, followed by a developer. The fluorescence of the fluid was read and expressed as the NAHA activity in units. The analysis of β-glucan was made using a Limulus-based test. Storage of filters up to 360 days did not influence the content of NAHA. There was a relation between NAHA and β-glucan but only for the non-soluble fraction. Movements in the room increased the NAHA values but agitation in terms of fan blowing did not increase the potential to detect differences between rooms with or without fungal growth. Enzyme measurements of fungal biomass are rapid and easy to perform. The sensitivity and specificity of the method is high which makes it suitable for field use. Incorporation of the fractions in assessment of fungi is important as they have a higher penetration rate into the deep parts of the lung.

INTRODUCTION:Women with pre-eclampsia (PE) have an increased risk of cardiovascular disease (CVD) later in life. This association might reflect an effect of pre-eclampsia on mechanisms inducing a higher risk of CVD or the presence of a group at risk.MATERIALS AND METHODS:The possibility that women with a magnesium deficiency might constitute a risk group was examined using published evidence form investigations on PE and CVD.RESULTS:Available data strongly suggest that a magnesium deficiency is a major risk factor for both PE and for CVD disease later in life.CONCLUSIONS:Magnesium homeostasis studies in women with PE should be undertaken for validation purposes. The results suggest that women with PE should be given dietary counselling to decrease future risks of CVD.

There is an abundance of data regarding the importance of magnesium (Mg) in a variety of human functions such as regulation of muscular tonus, insulin sensitivity, and cardio-vascular function [1-4]. In spite of this the results from intervention studies with the aim to ameliorate or prevent pathological processes in relation to these mechanisms remain less convincing. A meta-analysis of the effect of Mg on blood pressure concluded that there was no robust evidence that oral Mg supplementation reduces [...]

To review the role of magnesium in pregnancy. Analysis of published reports with emphasis on recent work on cellular mechanisms and magnesium responsive genes (MgRGs), plus controlled trials of magnesium (Mg) supplementation to prevent gestational hypertension. In a study on women with normal pregnancies, MgRGs were up regulated as compared to non-pregnant women, suggesting a higher Mg demand. They also had lower plasma levels of Mg and an increased urinary excretion of Mg. Systolic and diastolic blood pressure increases during pregnancy were related to the urinary excretion of Mg. Among women with PE, the expression of the MgRG SLC41A1 – a Na/Mg exchanger – was overexpressed in 54.2% of the placentas as compared to 9.5% in normal placentas. Brain and muscle levels of Mg were lower among women with PE. In three supplementation studies, Mg reduced the occurrence of gestational hypertension, particularly the diastolic blood pressure. Data from genetic, cellular, and clinical studies support a conclusion that Mg plays an important role in pregnancy and that Mg deficiency could be a major factor for the pathogenesis in complicated pregnancies. It is unlikely that Mg is the sole agent involved and other nutritional factors are probably also of importance. Further studies are needed to assess the relationship with Mg and formulate requirements for intervention programs. R. Rylander: None.

Background: Previous studies have demonstrated a relationship between the disease severity in sarcoidosis and serum levels of cytokines and the level of β-glucan in bronchoalveolar lavage fluid (BALF). It has also been shown that the number of iNKT cells decreases in sarcoidosis. A study was undertaken to investigate the relationship between iNKT cells and the degree of sarcoidosis granuloma infiltration in the lung, inflammatory cytokines in blood, and β-glucan in BALF. Material and methods: Newly diagnosed cases of sarcoidosis (n=109) were recruited. X-ray scores for granuloma infiltration and diffusion capacity were recorded, serum levels of IL-10, IL-12, TNFα, IL-2R, chitotriosidase, ACE were analyzed. β-glucan levels and iNKT-cells were determined in the BALF. Results: A lower percentage of iNKT cells in the BALF was present in cases of more severe sarcoidosis, defined on the basis of either the degree of granuloma infiltration in the lung (x-ray score) (p=0.001), or the decrease in DLco (p< 0.0001), chitotriosidase (p=0.001) as well as the levels of several pro-inflammatory cytokines IL-2R (p=0.001), IL-12 (p=0.019), in serum but not IL-10. A higher level of β-glucan was related to low percentages of iNKT cells in BALF (p<0.0001). Conclusion: The major finding of the present study is that a lower percentage of iNKT cells in the BALF is associated with more severe clinical features of sarcoidosis, expressed as the degree of granuloma infiltration of the lung parenchyma, lower level of lung diffusion capacity, and an increase in pro-inflammatory cytokines. A lower percentage of iNKT was also associated with a higher concentration of β-glucan in the BALF.

Early definition of individuals at risk of pre-eclampsia is desirable for surveillance and treatment. Several studies report criteria for this but there is no general agreement on the various outcomes tested. Hospital records of nulliparous, singleton normal pregnancies (n = 100) and those diagnosed with pre-eclampsia (n = 109) were obtained from a register at an antenatal health care unit. Data on blood pressure at the regular visits to the unit were collected and analyzed. The systolic and diastolic blood pressures were significantly higher at pregnancy week 12 among those who developed pre-eclampsia (p = 0.046 and 0.001 resp). An increase in diastolic blood pressure of ⩾15 mmHg occurred more frequently among women with pre-eclampsia. In 93% of the cases this increase was present before and on the same time as the clinical diagnosis of pre-eclampsia was established. The results suggest that an increase in diastolic blood pressure of ⩾15 mmHg could be used to identify women at risk of pre-eclampsia and as a selection criterion in magnesium prevention assays. R. Rylander: None. M. Bullarbo: None.

Magnesium (Mg) is the generally accepted treatment in pre-eclampsia and has been shown to reduce medical complications in the mother and fetus in around 50% of the cases. In view of this, attempts have been made to prevent gestational hypertension, pre-eclampsia, and other pregnancy complications by supplementation with magnesium during pregnancy. A review of previous studies showed an effect of Mg on blood pressure in three studies and no effect in one. The latter was, however, an intervention with two doses of Mg with a narrow therapeutic range. In our study we selected 60 primapara women who were given Mg-citrate from week 25 in a double-blind, placebo controlled design. Blood pressure was measured at regular visits to the maternity clinic and the expression of Mg responsive genes (MgRG) was determined. At pregnancy weeks 35 and 37, the systolic and diastolic blood pressures were lower in the Mg supplemented group. The number of women who had an increase in diastolic pressure ⩾15 mmHg was significantly lower in the supplemented group. At week 37 the MgRG TRPM7 was related to the systolic and diastolic blood pressure and the expression was higher among those with a diastolic blood pressure increase of ⩾15 mmHg. The results support the hypothesis that supplementation with Mg during pregnancy decreases the risk of gestational hypertension. Further studies in other population groups are required before general recommendations can be made. R. Rylander: None. M. Bullarbo: None.

The interest in poor magnesium (Mg) status as risk factor for Alzheimer’s disease (AD) is increasing due to its antioxidant and neuroprotective properties. A systematic PubMed literature search of studies investigating Mg status was undertaken comparing AD to healthy controls (HCs) or patients with medical illness (medical controls [MCs]). Standardized mean differences (SMDs) ± 95% confidence intervals (CIs) were calculated for all outcomes. Of 192 potentially eligible studies, 13 were included (559 patients with AD, 381 HCs, and 126 MCs). Compared to HCs, patients with AD had significantly lower Mg in cerebrospinal fluid (2 studies; SMD = −0.35; P = .02) and in hair (2 studies; SMD = −0.75; P = .0001). No differences between AD and controls were evident for serum Mg. In conclusion, AD seems to be associated with a lower Mg status when compared to HCs, while the scarcity of studies limited the findings about MCs.

OBJECTIVES:A previous study demonstrated that the increase in diastolic blood pressure during pregnancy was reduced by supplementation with magnesium. The present study was undertaken to explore if increases in diastolic blood pressure could be useful for early identification of pre-eclampsia.STUDY DESIGN:Hospital records of nulliparous, singleton normal pregnancies (n = 100) and those diagnosed with pre-eclampsia (n = 109) were obtained from a register at an antenatal health care unit. Data on blood pressure at the regular visits to the unit were collected and analysed.RESULTS:The systolic and diastolic blood pressures were significantly higher at pregnancy week 12 among those who developed pre-eclampsia (p = 0.046 and 0.001, resp). An increase in diastolic blood pressure ≥15 mmHg occurred more frequently among women with pre-eclampsia. In 93 % of the cases, this increase was present before and at the same time as the clinical diagnosis of pre-eclampsia was established.CONCLUSION:The results suggest that a base-line diastolic blood pressure of ≥80 mmHg and an increase in diastolic blood pressure of ≥15 mmHg could be used to identify women at risk of pre-eclampsia (sensitivity 92 %, specificity 44 %) and as a selection criterion in treatment or prevention assays.

inhalation exposures to aerosols of b-glucan (grifolan) were investigated in mice. In addition, the effects on serum total immunoglobulin E (IgE) production and histopathological inflammation in the respiratory tract were studied. The b-glucan aerosols provoked slight sensory irritation in the airways, but the response was not concentration dependent at the levels studied. Slight pulmonary irritation was observed after repeated exposures. No effect was found on the serum total IgE levels, and no signs of inflammation were seen in the airways 6 h after the final exposure. The results suggest that, irrespective of previous fungal sensitization of the animals, inhaled b-glucan may cause symptoms of respiratory tract irritation but without apparent inflammation. Respiratory tract irritation reported after inhalation of fungi may not be entirely attributed to b-glucan.

Background and objectivePrevious studies have demonstrated increases of inflammatory mediators in sarcoidosis while epidemiological studies have also demonstrated an association with increased fungi exposure. This study measured the level of -glucan in the lungs and of inflammatory mediators in serum, and correlated both with the extent of pulmonary granuloma infiltration.MethodsThis is a cross-sectional study of 98 patients with sarcoidosis and 26 controls. -glucan, a cell wall constituent of fungi, was measured in bronchoalveolar lavage. Inflammatory mediator levels were determined in serum. The extent of granuloma infiltration was estimated on the chest X-ray. Exposure to fungi at home was determined by taking air samples in bedrooms and analysing for the presence of -N-acetylhexosaminidase.ResultsSignificantly, higher levels of -glucan were found in broncho-alveolar lavage in subjects with sarcoidosis as compared with controls. There were significant positive relationships between the extent of granuloma infiltration and the levels of the different inflammatory mediators, except for interleukin-10. Domestic fungal exposure was higher among subjects with sarcoidosis.ConclusionsThis is the first time that a specific agent, previously suspected to be related to the risk of sarcoidosis, has been detected in the lung of subjects with sarcoidosis and related to the levels of inflammatory mediators and the degree of home exposure to fungi. The results suggest that exposure to fungi should be explored when investigating patients with sarcoidosis.This study demonstrated -glucana fungal cell wall agentin the lungs of sarcoidosis patients. It also confirmed a positive relationship between -glucan and domestic fungi exposure. Lung granuloma infiltration correlated inflammatory cytokines except IL-10, an anti-granuloma cytokine.