Targeted Antimicrobial Therapy in the Microbiome Era

Abstract

Even though the oral microbiome is one of the most complex sites on the body it is an excellent model for narrow-spectrum antimicrobial therapy. Current research indicates disruption of the microbiome leads to a dysbiotic environment allowing for the overgrowth of pathogenic species and the onset of oral diseases. The gram-negative colonizer, Porphyromonas gingivalis has long been considered a key player in the initiation of periodontitis and Streptococcus mutans has been linked to dental caries. With antibiotic research still on the decline, new strategies are greatly needed to combat infectious diseases. By targeting key pathogens, it may be possible to treat oral infections while allowing for the recolonization of the beneficial, healthy flora. In this review, we examine unique strategies to specifically target periodontal pathogens and address what is needed for the success of these approaches in the microbiome era.

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Validation of International consensus equation for acute serum total tryptase in mast cell activation: A perioperative perspective

Abstract

Introduction

There is no standardised method for assessing serum total mast cell tryptase (MCT) in anaphylaxis. The consensus equation (peak MCT should be>1.2x baseline tryptase+2mg/L) has been proposed to interpret acute MCT in mast cell activation syndrome (MCAS).

Aim

To validate consensus equation in a setting of perioperative anaphylaxis.

Methods

Analyses of suspected perioperative anaphylaxis during general anaesthesia (GA). Anaphylaxis was defined as per World Allergy Organisation (WAO) criteria. Timed serial MCT measurements were mapped against the consensus equation and receiver operating characteristic (ROC) curves produced.

Results

82 patients (60 females, mean age 56.5 years ± SD17.2) underwent investigation. 60 (73%) patients fulfilled WAO criteria for anaphylaxis and 22 patients did not (controls). Aetiology: 59% IgE-mediated anaphylaxis, 2% non-IgE mediated anaphylaxis, 12% anaphylaxis of unknown cause, and 27% deemed non-anaphylaxis. IgE-mediated anaphylaxis included - NMBA (35%), antibiotics (46%), chlorhexidine (8%), patent blue dye (8%) and others (8%). An acute MCT with a comparable baseline was available in 71/82 (87%) patients (60-anaphylaxis and 11-controls).The median (IQR) time from reaction to peak MCT was 1.34 (0.82-2.51) hours. Analyses confirmed that a rise in acute MCT greater than that defined by the equation had a sensitivity, specificity, positive predictive value (PPV) and negative (N) PV of 78%, 91%, 98%, and 44% respectively. The magnitude of increase in acute MCT above the threshold predicted by consensus equation was higher in the anaphylaxis group compared to controls (P=0.0001).

Conclusion

This equation has a high specificity, PPV with a moderate NPV and sensitivity in perioperative anaphylaxis.

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Association between polymorphisms in pre-miRNA genes and risk of oral squamous cell cancer in a Chinese population

by Enjiao Zhang, Zhongfei Xu, Weiyi Duan, Shaohui Huang, Li Lu

Background

MicroRNAs play important roles in the development of human cancers. This case-control study is to evaluate the roles of the polymorphisms in pre-miRNAs on risk of oral cancer in a Chinese population.

Methods

The genotypes of three polymorphisms were determined in 340 patients with oral squamous cell cancer and 340 healthy controls who were frequency matched for age and sex. Odds ratios (ORs) and 95% confidence intervals (95%CIs) were calculated to assess the association. All analyses were performed using the SPSS software. 3.154() 0.001.

Results

For miR-499 rs3746444, individuals carrying homozygous CC genotype had increased risks of oral cancer compared with the homozygous wild TT genotype (adjusted OR was 3.154, 95%CI was 1.555–6.397, P value was 0.001). The C allele of miR-499 rs3746444 was associated with a higher risk of oral cancer with significant odds ratio of 1.453. In the stratified analyses by sex, the associations between miR-499 rs3746444 and miR-146a rs2910164 polymorphisms with the susceptibility of oral squamous cell cancer were significant in males. However, with 1/4 as many subjects there were no significant associations between the three polymorphisms and oral cancer risks in females. The joint effects of miRNA polymorphisms and smoking on the risk of OSCC were analyzed and the results suggested that the association between microRNA genetic variants and OSCC risk was modified by smoking.

Conclusions

These findings suggest that miR-499 rs3746444 and miR-146a rs2910164 polymorphisms may contribute to genetic susceptibility to oral squamous cell cancer.

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It All Depends on Who Does What: A Survey of Patient and Family Member Comfort With Surgical Trainees Operating

Publication date: Available online 12 June 2017
Source:Journal of Surgical Education
Author(s): Michael E. Petravick, Jonathan P. Edgington, Olumuyiwa A. Idowu, Lewis L. Shi, Michael J. Lee
ObjectiveTo measure patient and family member comfort with surgical trainees of varying levels performing different portions of surgery.Design, Setting, and ParticipantsAn electronic survey dividing surgery into 6 steps (prepping and positioning, initial incision, deep dissection, critical portions, deep suturing, and closing incision), differentiating surgical trainees by 4 levels of experience (medical student, intern, resident, and fellow), and specifying whether or not an attending surgeon is in the operating room (OR) was given to 200 patients and family members in the surgical waiting area of a single academic medical center. Responses were on a 7-point Likert scale from "Not Comfortable at All" to "Completely Comfortable".ResultsPatient and family member comfort significantly increased as trainee experience increased. It reached a nadir for all trainees performing "critical portions" of surgery. However, their average response was "Comfortable" for residents and fellows performing any surgical step when the attending surgeon is present in the OR. The percentage of "Comfortable" responses was significantly lower for all trainee levels performing any surgical step when the attending surgeon is absent from the OR.ConclusionsPatient and family member comfort with surgical trainees operating varies based on the trainee's level of experience, the step the trainee performs, and whether or not the attending surgeon is present in the OR. Patients and family members are on average "Comfortable" with surgical residents and fellows performing any surgical step when the attending surgeon is present.



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Thyrotropin levels and coronary artery calcification: cross-sectional results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Abstract

Background

There is little information about the association between thyrotropin (TSH) levels and coronary artery calcification (CAC).

Objective

Our aim was to analyze the association between TSH quintiles and subclinical atherosclerosis measured by CAC, using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Design

Cross-sectional study.

Patients and Measurements

We excluded individuals using medications that affect thyroid function and who self-reported cardiovascular disease. We included euthyroid subjects, and individuals with subclinical hypothyroidism (SCHypo) and subclinical hyperthyroidism (SCHyper). Logistic regression models evaluated CAC >100 Agatston units as the dependent variable, and increasing quintiles of TSH as the independent variable, adjusted for demographic and cardiovascular risk factors.

Results

Our sample included 3,836 subjects, mean age 49 years (interquartile range 44–56); 1,999 (52.1%) were female, 3,551 (92.6%) were euthyroid, 239 (6.2%) had SCHypo and 46 (1.2%) had SCHyper. The frequency of women, whites, and never smokers as well as body mass index and insulin resistance increased according to quintiles. The 1^st quintile for TSH (0–0.99mIU/l) was associated with CAC >100, using the 3^rd quintile (1.39–1.85mIU/l) as reference (adjusted OR=1.57, 95% CI 1.05–2.35, P=0.027), but no association was shown for the 5^th quintile (2.68–35.5mIU/l) compared to the 3^rd. Restricting the analysis to euthyroid subjects did not change the results. For women, but not for men, we observed a U-shaped curve with 1^st and 5^th TSH quintiles associated with CAC>100.

Conclusion

Low and low-normal (1^st quintile) TSH levels were associated with CAC >100 Agatston units in a sample with subclinical thyroid disorders and euthyroid subjects.

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Osteosarcoma of the lower limb metastasized to the septum and right side of the heart: a case report

Metastatic cardiac tumors are far more common than primary tumors. Although the hematogenous spread of osteosarcoma is well known, the imaging findings of cardiovascular involvement by osteosarcoma are seldom ...

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Association between polymorphisms in pre-miRNA genes and risk of oral squamous cell cancer in a Chinese population

by Enjiao Zhang, Zhongfei Xu, Weiyi Duan, Shaohui Huang, Li Lu

Background

MicroRNAs play important roles in the development of human cancers. This case-control study is to evaluate the roles of the polymorphisms in pre-miRNAs on risk of oral cancer in a Chinese population.

Methods

The genotypes of three polymorphisms were determined in 340 patients with oral squamous cell cancer and 340 healthy controls who were frequency matched for age and sex. Odds ratios (ORs) and 95% confidence intervals (95%CIs) were calculated to assess the association. All analyses were performed using the SPSS software. 3.154() 0.001.

Results

For miR-499 rs3746444, individuals carrying homozygous CC genotype had increased risks of oral cancer compared with the homozygous wild TT genotype (adjusted OR was 3.154, 95%CI was 1.555–6.397, P value was 0.001). The C allele of miR-499 rs3746444 was associated with a higher risk of oral cancer with significant odds ratio of 1.453. In the stratified analyses by sex, the associations between miR-499 rs3746444 and miR-146a rs2910164 polymorphisms with the susceptibility of oral squamous cell cancer were significant in males. However, with 1/4 as many subjects there were no significant associations between the three polymorphisms and oral cancer risks in females. The joint effects of miRNA polymorphisms and smoking on the risk of OSCC were analyzed and the results suggested that the association between microRNA genetic variants and OSCC risk was modified by smoking.

Conclusions

These findings suggest that miR-499 rs3746444 and miR-146a rs2910164 polymorphisms may contribute to genetic susceptibility to oral squamous cell cancer.

http://ift.tt/2rX75ql