Comparative Analysis of Subtyping Methods against a Whole-Genome-Sequencing Standard for Salmonella enterica Serotype Enteritidis

A retrospective investigation was performed to evaluate whole-genome sequencing as a benchmark for comparing molecular subtyping methods for Salmonella enterica serotype Enteritidis and survey the population structure of commonly encountered S. enterica serotype Enteritidis outbreak isolates in the United States. A total of 52 S. enterica serotype Enteritidis isolates representing 16 major outbreaks and three sporadic cases collected between 2001 and 2012 were sequenced and subjected to subtyping by four different methods: (i) whole-genome single-nucleotide-polymorphism typing (WGST), (ii) multiple-locus variable-number tandem-repeat (VNTR) analysis (MLVA), (iii) clustered regularly interspaced short palindromic repeats combined with multi-virulence-locus sequence typing (CRISPR-MVLST), and (iv) pulsed-field gel electrophoresis (PFGE). WGST resolved all outbreak clusters and provided useful robust phylogenetic inference results with high epidemiological correlation. While both MLVA and CRISPR-MVLST yielded higher discriminatory power than PFGE, MLVA outperformed the other methods in delineating outbreak clusters whereas CRISPR-MVLST showed the potential to trace major lineages and ecological origins of S. enterica serotype Enteritidis. Our results suggested that whole-genome sequencing makes a viable platform for the evaluation and benchmarking of molecular subtyping methods.     

Cumulative use of salivary markers with an adaptive design improves detection of periodontal disease over fixed biomarker thresholds

Objective: Aim was to analyze the diagnostic ability of cumulative risk score (CRS), which uses salivary levels of Porphyromonas gingivalis, interleukin (IL)-1β, and matrix metalloproteinase (MMP)-8 in an adaptive design, compared to previously reported thresholds of each marker alone.

Materials and Methods: Oral and general health information of 463 participants were included in the analysis. Having the percentage of bleeding on probing (BOP)?>?25%, having at least two sites with probing pocket depth (PPD) of 4–5?mm or having at least one tooth with alveolar bone loss (ABL) of at least 1/3 of the root length were accepted as outcome variables. Being above the salivary threshold concentrations of P. gingivalis, IL-1β, and MMP-8 and CRS values were used as explanatory variables. Receiver operating characteristics (ROC) producing an area under the curve (AUC) and multinomial regression analysis were used in statistical analysis.

Results: CRS provided AUCs larger than any other tested biomarker threshold. Sensitivity and specificity of CRS for detecting clinical markers of periodontitis were acceptable, and a strong association was observed between the highest CRS score and having at least two sites with PPD of 4–5?mm.

Conclusion: CRS brings additional power over fixed thresholds of single biomarkers in detecting periodontitis.     

Analyses of Gingival Adhesion Molecules in Periodontitis: Theoretical In Silico,Comparative In Vivo,and Explanatory In Vitro Models

Background: A deeper understanding of periodontitis pathophysiology is central to future development of novel biomarkers and therapeutics. The following is reported here: 1) an in silico network model of interactions among cell adhesion molecules and a network‐focused microarray analysis of the corresponding genes in periodontitis; 2) analysis of secretions of adhesion molecules in gingival tissue samples from patients with periodontitis and healthy controls; and 3) effect of the human neutrophilic peptide‐1 (HNP‐1) on epithelial adhesion molecules. Methods: The network model identified 85 nodes in relation to the interactions of adhesion molecules. Subsequently, the relative gene expression was overlaid on the network model. Differential gene expression was analyzed, and false discovery rate control was performed for statistical assessment of the microarray data. Both tissue and cell culture samples were immunostained for desmocollin (DSC)2, occludin (OCLN), desmoglein (DSG)1, tight junction protein 2, and gap junction protein α. Results: The differential gene expression analysis revealed that the epithelial adhesion molecules were significantly lower in abundance in individuals with periodontitis than controls. In contrast, the genes for leukocyte adhesion molecules showed a significant upregulation. Immunostainings revealed elevated secretions of both DSG1 and OCLN in periodontitis. An in vitro model suggested reduced DSC2 and OCLN secretions in the presence of HNP‐1. Conclusions: Gene expression of gingival adhesion molecules in periodontitis is regulated by leukocyte transmigration, whereas the neutrophilic antimicrobial peptide HNP‐1 is noted as a putative regulator of epithelial adhesion molecules. These observations contribute to the key mechanisms by which future biomarkers might be developed for periodontitis.     

Tension‐free vaginal tape procedure without preoperative urodynamic examination: Long‐term outcome

Objectives: To evaluate the long‐term outcome of the tension‐free vaginal tape procedure. Methods: A total of 191 patients were operated on with tension‐free vaginal tape between January 1998 and May 2000. Of these, 127 (66%) had stress urinary incontinence, 64 (34%) had mixed urinary incontinence and 39 (20%) had recurrent incontinence. A total of 34 (18%) patients had had concomitant surgery. The diagnosis of incontinence was based on a history of leakage during stress and physical examination with a supine stress test in all patients. Tension‐free vaginal tape was carried out under local (82%) or spinal (18%) anesthesia. After a mean of 10.5 years follow up, the assessment included a gynecological examination and a supine stress test. Subjective outcome was evaluated with Urinary Incontinence Severity Score, Detrusor Instability Score, visual analog scale, European quality of life‐five dimensions, European quality of life – visual analog scale and short versions of Incontinence Impact Questionnaire‐7 and Urogenital Distress Inventory‐6. Objective cure was defined as a negative stress test and an absence of reoperation for incontinence during the follow up. Results: A total of 138 (72%) of 191 patients were evaluated. Patients with minimally invasive surgery before operation had significantly higher scores in Urinary Incontinence Severity Score, Detrusor Instability Score, Incontinence Impact Questionnaire‐7 and Urogenital Distress Inventory‐6 at follow up than the patients with stress urinary incontinence (P < 0.01). Recurrent incontinence and concomitant surgery did not affect the long‐term outcome. Three patients (2.3%) had late‐onset adverse events. The objective and subjective cure rates were 90% and 78%, respectively. Conclusions: The tension‐free vaginal tape procedure is effective and safe even after 10 years. The objective cure rate is high, but the subjective outcome is significantly lower in mixed urinary incontinence patients compared with patients with pure stress urinary incontinence. Recurrent stress urinary incontinence does not affect the outcome, and tape‐related problems are rare.     

Strength and mobility of the neck-shoulder region in adolescent headache

The significance of the musculoskeletal function of the neck-shoulder region in different headache types in children and adolescents is not clear. The purpose of this study was to investigate the association between different types of headache and the strength and mobility of the neck-shoulder region in 13-year-old schoolchildren. A structured questionnaire on headache was sent to all 1,409 children in the sixth grade in the city of Turku. Of the 1,135 (81%) children who completed the questionnaire, a sample from different headache groups was randomly selected for clinical examination. The study consisted of 59 children with migraine, 65 with episodic tension-type headache (TTHA), and 59 headache-free controls. Dynamic muscle strength of the upper extremities (UE endurance), mobility of both shoulders (UE mobility), and the cervical range of motion (CROM) were measured. Girls with episodic TTHA had lower UE endurance of both dominant and nondominant sides than girls in the other study groups. Girls with migraine had lower UE endurance of nondominant side than girls in the control group. In boys, no significant differences were observed. An interesting association between the function of the neck-shoulder region and headache complaints in adolescents was ascertained.     

Recovery after severe cervical spine luxation

Permanent neurologic damage may be avoided after severe cervical spine injury if diagnosis is rapid and therapy is initiated immediately.     

Prevention of fat embolism by early internal fixation of fractures in patients with multiple injuries.

Symptoms of fat embolism occurred in 95 out of 1059 patients with multiple injuries treated in the intensive care unit between 1967 and 1974. The criteria for the diagnosis were: typical snowstorm infiltration on the chest X-ray films, disturbance of consciousness, petechial rash, hypoxaemia, pyrexia and tachypnoea. Long-bone fractures were usual and an important aetiological factor in the development of fat embolism. Early administration of oxygen was most important in treatment, together with regular measurement of blood gases. Tracheostomy was necessary for 28 patients. Fat embolism was not a centra-indication to operative treatment. Indeed, internal fixation of long-bone fractures seemed to reduce the incidence of fat embolism. The number of patients with clinical fat embolism decreased yearly between 1967 and 1974 from 21 to 0. From 1971, however, most of the longbone fractures in patients with multiple injuries were treated by operative fixation in the first days after injury, and this seemed to prevent many cases of clinical fat embolism.     

External fixation of unstable pelvic fractures

Summary The Hoffmann external fixator was used to stabilize unstable pelvic fractures in 56 patients with multiple injuries. It was applied under general anaesthesia and the dislocated pelvis reduced and secured with a single tie bar. In 16 cases residual dislocation of less than 1.5 cm was noted after the reduction and the reduced position was maintained in 48 out of 51 cases, a minor redislocation occurred in the remaining 3 patients. Few complications could be attributed to the method, infection was noted in one patient, the iliac crest was fractured in one case and an exostosis of the iliac crest occurred in one youth.Forty-three patients were symptom free with regard to the pelvis at the time of review whereas 5 patients had residual pain and 3 diffuse symptoms.The technique of application is simple but requires two surgeons at the time of reduction and fixation of the pelvis.

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Résumé Les auteurs ont utilisé le fixateur externe d'Hoffmann pour maintenir une fracture instable du bassin chez 56 blessés présentant des traumatismes multiples. Le fixateur a été mis en place sous anesthésie générale et le bassin fracturé réduit et maintenu par une barre simple. Dans 16 cas, il persistait après réduction une disjonction inférieure à 1,5 cm. La position de réduction s'est maintenue dans 48 des 51 cas, tandis qu'un redéplacement modéré s'est produit dans les 3 autres cas. Il n'y a eu qu'un petit nombre de complications dues à la méthode: une infection, une fracture de la crête iliaque et une exostose de la crête iliaque chez un sujet jeune.Quarante-trois blessés ne présentaient aucune séquelle en ce qui concerne le bassin lors de l'examen de contrôle, tandis que cinq signalaient des douleurs résiduelles et trois des troubles divers.Cette technique est de réalisation facile mais elle nécessite la présence de deux chirurgiens pour effectuer la réduction et la fixation du bassin.