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Παρασκευή 18 Νοεμβρίου 2022

Emergence of recombinant norovirus GII.12[P16] and predominance of GII.3[P12] strains in pediatric patients with acute gastroenteritis in Thailand, 2019‐2020

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ABSTRACT

Norovirus (NoV) and sapovirus (SaV) are important pathogens that cause acute gastroenteritis (AGE) in all age groups, commonly in children worldwide. Recently, a number of studies have reported a wide variety of NoV recombinant strains. This study aimed to investigate the distribution of NoV and SaV recombinant strains circulating in Chiang Mai, Thailand during 2019-2020. One hundred and twenty-four NoV and seven SaV strains detected in children admitted to the hospital with AGE were included in this study. The partial RdRp/VP1 regions of these NoV and SaV strains were analyzed by phylogenetic analysis, Simplot and RDP softwares. Overall, eight recombination patterns of NoV were detected. NoV GII.4[P16] was the most common strain detected (39.1%), followed by GII.3[P12] (25.0%), GII.4[P31] (17.2%), and other recombinant strains were detected at lower rate. NoV GII.12[P16] strains were detected for the first time in Thailand. For SaV, none of the recombinant strains was detected. All SaV strains, GI.1/GI.1, GI.2/GI.2, and GII.5/GII.5, exhibited VP1 genotype corresponded to RdRp genotype. In conclusion, this study demonstrates the distribution and diversity of NoV and SaV recombinant strains circulating in pediatric patients with AGE in Chiang Mai, Thailand during 2019-2020 with the emergence of NoV GII.3[P12] and GII.12[P16].

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Busulfan, fludarabine, and melphalan are effective conditioning for pediatric and young adult patients with myeloid malignancies underdoing matched sibling or alternative donor transplantation

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Abstract

Background

Allogeneic hematopoietic cell transplantation (allo-HCT) remains a curative option for patients with high-risk myeloid malignancies.

Procedure

We present our 10-year experience (October 2012 to October 2021) of consecutive allo-HCT in patients with myeloid malignancies treated on the pediatric HCT service and conditioned with myeloablative targeted dose—busulfan (BU), fludarabine (FLU), and melphalan (MEL). Twenty-three children, adolescents, and young adult patients (CAYA) (median age 15.4 years) with acute myeloid leukemia (AML, n = 17), myelodysplastic syndrome (MDS, n = 4), or chronic myeloid leukemia (CML, n = 2) underwent allo-HCT post-BU-FLU-MEL. Four patients had treatment-related AML/MDS. Donor/stem cell source was matched sibling donor (MSD) PBSC (n = 7), matched unrelated donor (MUD) PBSC (n = 2), umbilical cord blood (UCB) (n = 3), or haploidentical-BMT (n = 11). Risk stratification was low (n = 2), intermediate (n = 15), high (n = 3), and very high risk (n = 1). The two patients with CML had failed tyrosine kinase inhibitor t herapies.

Results

With a median follow-up of 41.6 months, the relapse rate is only 4.5% with an overall survival (OS) 100%, progression-free survival (PFS) 95.5%, and graft-versus-host-free-relapse-free survival (GRFS) 67.8%. The donor source and the acute graft-versus-host disease (GvHD) prophylaxis regimen significantly impacted grade II–IV aGvHD 66.7% versus 19.2% (p = .039) and chronic graft-versus-host-disease (cGvHD) 66.7% versus 0% (p = .002) in the patients receiving MSD or MUD PBSC compared to haplo-BMT, respectively, resulting in improved GRFS in haplo-BMT, 83.3% compared to 40% matched donor peripheral blood stem cell transplant (PBSCT) (p = .025).

Conclusions

Our results demonstrate that BU-FLU-MEL is efficacious conditioning for disease control in young patients with myeloid malignancies undergoing MSD or alternative donor allo-HCT, but in the setting of PBSC grafts with cyclosporine A-methotrexate (CSA-MTX) GvHD prophylaxis, it results in an unacceptably high incidence of GvHD.
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Dental implant failure rates with low insertion torque with a nonsubmerged surgical approach: A retrospective clinical study

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Abstract

Background

It is currently unclear if a low insertion torque (IT) should prompt a clinician to submerge the dental implant at time of placement.

Purpose

This study aimed to analyze implant failure rates and marginal bone loss (MBL) as a function of IT and surgical approach.

Materials and Methods

A total of 197 patients who had received 295 Mozo Grau (MG) implants were included in this study. The healing of submerged or nonsubmerged implants was evaluated in regular IT (≥20–25 Ncm) or low IT (<20–25 Ncm) cases. Implant failure and MBL were evaluated before prosthesis placement and at 6 and 12 months after functional loading with generalized estimating equations.

Results

The overall 12-month implant failure rate was 4.8% (95% confidence interval [CI]: 2.7%–8.2%). When successful at 12 months, dental implants placed with low IT and nonsubmerging had the same MBL as implants dental implants placed with other approaches (mean difference = −0.02 mm; 95% CI −0.05 to 0.02). Low IT combined with nonsubmerging of the dental implant was associated with a 30-fold increased odds for dental implant failure (95% CI: 3.8–236.6).

Conclusion

low IT and nonsubmerged healing was associated with a high failure rate.
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Naphazoline and oxymetazoline are superior to epinephrine in enhancing the cutaneous analgesia of lidocaine in rats

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Abstract

This study observed the cutaneous analgesic effect of adrenergic agonists when combined with lidocaine. We aimed at the usefulness of 4 adrenergic agonists and epinephrine as analgesics or as tools to prolong the effect of local anesthetics using a model of cutaneous trunci muscle reflex (pinprick pain) in rats. We showed that subcutaneous 4 adrenergic agonists and epinephrine, as well as the local anesthetic bupivacaine and lidocaine, developed a concentration-dependent cutaneous analgesia. The rank order of the efficacy of different compounds (ED50; median effective dose) was epinephrine [0.013 (0.012 – 0.014) μmol] > oxymetazoline [0.25 (0.22 – 0.28) μmol] > naphazoline [0.42 (0.34 – 0.53) μmol] = bupivacaine [0.43 (0.37 – 0.50) μmol] > xylometazoline [1.34 (1.25 – 1.45) μmol] > lidocaine [5.86 (5.11 – 6.72) μmol] > tetrahydrozoline [6.76 (6.21 – 7.36) μmol]. The duration of full reco very caused by tetrahydrozoline, oxymetazoline, or xylometazoline was greater (P<0.01) than that induced via epinephrine, bupivacaine, lidocaine, or naphazoline at equianesthetic doses (ED25, ED50 , and ED75). Co-administration of lidocaine (ED50) with 4 adrenergic agonists or epinephrine enhanced the cutaneous analgesic effect. We observed that 4 adrenergic agonists and epinephrine induce analgesia by themselves, and such an effect has a longer duration than local anesthetics. Co-administration of lidocaine with the adrenergic agonist enhances the analgesic effect, and the cutaneous analgesic effect of lidocaine plus naphazoline (or oxymetazoline) is greater than that of lidocaine plus epinephrine.
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Association of upper respiratory Streptococcus pneumoniae colonization with SARS-CoV-2 infection among adults

alexandrossfakianakis shared this article with you from Inoreader

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ABSTRACT
Background
Streptococcus pneumoniae interacts with numerous viral respiratory pathogens in the upper airway. It is unclear whether similar interactions occur with SARS-CoV-2.
Methods
We collected saliva specimens from working-age adults receiving SARS-CoV-2 molecular testing at outpatient clinics and via mobile community-outreach testing between July and November 2020 in Monterey County, California. Following bact erial culture enrichment, we tested for pneumococci by quantitative polymerase chain reaction (qPCR) targeting the lytA and piaB genes, and measured associations with SARS-CoV-2 infection via conditional logistic regression.
Results
Analyses included 1,278 participants, with 564 enrolled in clinics and 714 enrolled through outreach-based testing. Prevalence of pneumococcal carriage was 9.2% (117/1,278) among all participants (11.2% [63/564] clinic-based testing; 7.6% [54/714] outreach testing). Prevalence of SARS-CoV-2 infection was 27.4% (32/117) among pneumococcal carriers and 9.6% (112/1,161) among non-carriers (adjusted odds ratio [aOR]: 2.73; 95% confidence interval: 1.58-4.69). Associations between SARS-CoV-2 infection and pneumococcal carriage were enhanced in the clinic-based sample (aOR = 4.01 [2.08-7.75]) and among symptomatic participants (aOR = 3.38 [1.35-8.40]), when compared to fin dings within the outreach-based sample and among asymptomatic participants. Adjusted odds of SARS-CoV-2 co-infection increased 1.24 (1.00-1.55)-fold for each 1-unit decrease in piaB qPCR CT value among pneumococcal carriers. Last, pneumococcal carriage modified the association of SARS-CoV-2 infection with recent exposure to a suspected COVID-19 case (aOR = 7.64 [1.91-30.7] and 3.29 [1.94-5.59]) among pneumococcal carriers and non-carriers, respectively).
Conclusions
Associations of pneumococcal carriage detection and density with SARS-CoV-2 suggest a synergistic relationship in the upper airway. Longitudinal studies are needed to determine interaction mechanisms between pneumococci and SARS-CoV-2.
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Πέμπτη 17 Νοεμβρίου 2022

Mediterranean Diet component oleic acid increases protective lipid‐mediators and improves trabecular bone in a Porphyromonas‐gingivalis‐inoculation‐model

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Background

Therapeutic modulation of bacterial-induced inflammatory host response is being investigated in gingival inflammation and periodontal disease pathology. Therefore, dietary intake of monounsaturated fatty acid (FA) oleic acid (OA (C18:1)), main-component of Mediterranean-style diets, and Western-style diet component saturated FA palmitic acid (PA (C16:0)) were investigated for their modifying potential in a P.gingivalis-oral-inoculation-model.

Methods

Normal-weight C57BL/6-mice received OA-or PA-enriched diets (PA-ED, OA-ED, PA/OA-ED) or normal-standard-diet for 16 weeks and were inoculated with P.gingivalis/placebo (n=12/group). Gingival inflammation, alveolar bone structure, circulating lipid mediators and in vitro cellular response were determined.

Results

FA-treatment of P.gingivalis-LPS-incubated gingival fibroblasts (GFb) modified inflammatory activation, which only PA exacerbated with concomitant TNF-α-stimulation. Mice exhibited no signs of acute inflammation in gingiva or serum and no inoculation-and nutrition-associated changes of crestal alveolar bone. However, following P.gingivalis-inoculation, OA-ED improved oral trabecular bone-micro-architecture and enhanced circulating pro-resolving mediators Resolvin D4 (RvD4) and 4-hydroxydocosahexaenoic acid (4-HDHA), whereas PA-ED did not. In vitro-experiments demonstrated significantly improved differentiation in RvD4-and 4-HDHA-treated primary osteoblast-cultures and reduced expression of osteoclastogenic factors in GF. Further, P.gingivalis-infection of OA-ED animals led to a serum composition that suppressed osteoclastic differentiation in vitro.

Conclusions

Results underline preventive impact of Mediterranean-style-OA-EDs by indicating their pro-resolving nature beyond anti-inflammatory properties.
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The Arterial Pattern of the Upper Nasal Septum (S‐Point) and Potential Role in Severe Epistaxis

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The Arterial Pattern of the Upper Nasal Septum (S-Point) and Potential Role in Severe Epistaxis

The previously described S-point, corresponds to the medial projection of the middle turbinate axilla in the superior nasal septum and has been identified as a common source of severe epistaxis. The rich anatomical patterns of vascularization of the S-point area could explain why this area is a common site of severe epistaxis and guide its surgical cauterization when an obvious vascular ectasia is not visualized.


Objectives

The previously described S-point, corresponds to the medial projection of the middle turbinate axilla in the superior nasal septum and has been identified as a common source of severe epistaxis. The objective is to define the anatomical patterns of vascularization of the S-point area that could explain its clinical relevance.

Methods

Thirty-three nasal septums of latex-injected formalin-embalmed and fresh human cadaveric heads were dissected to analyze the arterial arrangement of the S-point area. Measurements and patterns of vascularization were described.

Results

The S-point area, was consistently surrounded by a single or multiple arterial anastomotic arches consistently formed superiorly by the anterior ethmoidal and posterior ethmoidal artery branches, and inferiorly by the posterior septal artery. The caliber of the arterial arches was typically larger than the caliber of the arterial branches supplying them. A single arch was present in 36.3% of septums, and multiple arches in 63.6%. The mean distance from the S-point to the anterior limit of the arch was 9 mm, to the posterior arch when the present was 3 mm, to the superior limit 6 mm, to the inferior limit 6 mm, and to the nasal roof was 10 mm.

Conclusion

This study demonstrates the dense arterial configuration of the S point area, which is characterized by a single or multiple vascular arches of greater caliber than the branches of origin. This finding could explain why the S-point area is a frequent source of epistaxis, and guide its surgical cauterization when an obvious vascular ectasia is not visualized.

Level of Evidence

N/A Laryngoscope, 2022
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Is drug‐induced sleep endoscopy associated with better outcomes after soft tissue surgery for sleep apnea? A systematic review and meta‐analysis

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Abstract

Objectives

The aim was to estimate the effect of drug-induced sleep endoscopy (DISE) on surgical outcomes after soft tissue surgery for obstructive sleep apnea (OSA).

Design and setting

Systematic review and meta-analysis.

Participants

Adult patients with OSA and candidates for soft tissue surgery, with and without preoperative DISE, were included.

Main outcomes measures

A systematic literature search of Medline, Web of Science, and Cochrane databases was performed from inception to December 31, 2021. Studies directly comparing patients with and without preoperative DISE were included. Success rate, change in apnea-hypopnea index (AHI), change in minimum SpO2 and change in Epworth Sleepiness Scale (ESS) score were extracted. Random-effect models were used to pool estimates.

Results

Seven out of 619 articles were included, representing 791 patients (389 in the DISE group and 402 in the no DISE group). DISE was neither associated with a higher success rate (pooled OR 1.34, 95% CI 0.69 – 2.59, p=0.39) after soft tissue surgery for OSA, nor a significant change in AHI (-4.69 events/hour, 95% CI -11.10 – 1.72, p=0.15), minimal SpO2 (mean increase of 2.02%, 95% CI -0.26 – 4.29, p=0.08) and ESS (mean difference of 1.29, 95% CI -0.48 – 3.05, p=0.15) when compared to patients without preoperative DISE.

Conclusions

Soft tissue surgery does not give better results after DISE compared to when DISE is not performed. However, given the overall low level of evidence of included studies, future well-conducted studies should confirm or overturn these results and clarify the added value of DISE.

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Post‐operative survival in head & neck cancer patients with elevated troponins

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Abstract

Objective

The strenuous demands of head and neck cancer surgery (HNS) place patients at increased risk of myocardial injury. Troponin positivity (TP) post-operatively is a predictor of increased complications and mortality. The present study is the first to investigate the effects of TP on potential delays in adjuvant treatment and disease-specific survival.

Methods

All patients undergoing HNS from 2014 to 2016 had troponins measured at a single academic center. Relevant patient data was extracted on retrospective chart review.

Results

Of 166 patients, 26 (15.6%) developed TP post-operatively. There was no significant difference between cohorts for baseline characteristics except for age. Overall and disease-specific survival for TP patients were respectively 45.9% and 57.4% at 3 years. There was no significant difference between cohorts for overall & disease-specific survival, and time to adjuvant therapy.

Conclusion

No significant association was found between TP and overall & disease-specific survival, and time to adjuvant therapy.
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Oncologic Outcomes After Clinically Node-Negative Salvage Laryngectomy

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This cohort study investigates the association of elective nec k dissection vs observation with oncologic outcomes among patients who received clinically node-negative salvage total laryngectomy.
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