Fungi as emergent etiologic agents in ventilator-associated pneumonia after cardiac surgery

Evaluation of the fungal involvement in the etiology of ventilator-associated pneumonia (VAP) after cardiac surgery. The study had as target the patients diagnosed with VAP after cardiac surgery at the Institute of Cardiovascular Diseases in Ia?i, between April 2nd 2002 and December 31st 2009. MATERIAL AND METHOD: Our study included only cases with fungal etiology of VAP. We examined quantitatively the tracheal aspirates with cytology quality score Q = 2+: microscopy and cultivation. The isolates with clinical significance (= 10(6)UFC/mL significantly associated to inflammatory cells) were identified by standard methods or based on the API system (bioMérieux) and tested by the breakpoints method for susceptibility to antifungal agents. RESULTS: Among the 2167 operated patients, 35 of them were diagnosed with VAP through the clinical pulmonary infection score = 6. Fungi caused 15 of 44 VAP episodes. With a frequency of 30.19%, fungi are on 2nd place within the etiologic agents of VAP after non-fermenting Gram-negative bacilli (45.28%). The fungi involved in VAP were: Candida albicans (16.97%), Pneumocystis jirovecii (3.77%), while Candida glabrata, Candida sake, Candida krusei, Geotrichum capitatum and Cryptococcus humicola, amounted 1.89% each. The widespread use of broad spectrum antibiotics led to the emergence of fungi as a common cause of ventilator-associated pneumonia. The involvement in the VAP etiology of P. jirovecii, an un-cultivable fungus with special sensitivity to antibiotics, requires a careful microscopy of specimens.     

VEGF-A/HGF induce Prox-1 expression in the chick embryo chorioallantoic membrane lymphatic vasculature

Vascular endothelial growth factor-A (VEGF-A) and hepatocyte growth factor (HGF) are well known angiogenesis inductors and promoters in normal and pathologic conditions. Recent data showed that VEGF-A and HGF could also influence lymphangiogenesis but this matter has not been completely elucidated. Administration of VEGF-A and HGF in combination has been used to improve the angiogenic response in different experimental models, but their effects on lymphangiogenesis have not been investigated. The aim of this study was to characterize blood and lymphatic vascular response to VEGF-A/HGF administration. To this purpose, we built a pBlast VEGF-A/HGF combination suitable for in vivo research. By using as an experimental in vivo model the chick embryo chorioallantoic membrane (CAM) assay, we applied pBlast VEGF-A/HGF combination for 7 days. Results showed that VEGF-A/HGF combination was able to induce a strong angiogenic response and the expression of Prox-1 in the lymphatic endothelial cells of the CAM. The possible mechanisms involved have been speculated.     

Effort and costs of tooth preservation in supportive periodontal treatment in a German population

Objectives: Assessment of effort (number of visits) and costs of tooth preservation 10 years after initiation of anti-infective therapy.
Material and Methods: Data of 98 patients who had received active periodontal treatment 10 years ago by the same examiner were analysed to gather information on effort and costs of supportive periodontal therapy (SPT). Clinical examination, interleukin-1 (IL-1) polymorphism test, smoking, search of patients' files (i.e. initial diagnosis), as well as a questionnaire on medical history and socioeconomic data were performed.
Statistical analysis was performed using multivariate linear regression analysis.
Results: During 10 years of SPT patients had 14.8±7.4 visits. Number of visits was statistically significantly higher for individuals with a mean plaque control record24%. The number of subgingival scalings per tooth ranged from 0 to 14 (mean: 1.17). On tooth level several confounders could be identified: tooth type, initial bone loss, furcation involvement, abutment status, and previous regenerative surgery ( p 0.003).
Costs for therapy per tooth during SPT ranged from €1.21 to €404.72 with mean costs between €60.52 and €91.99. On tooth level the tooth type, initial bone loss, abutment status, furcation involvement, and previous regenerative surgery showed statistical significance ( p 0.002).
Conclusion: Costs for tooth retention via SPT are relatively low compared with alternatives (e.g. implants or bridgework) even in periodontally impaired teeth.     

Suicidal ideation among Canadian youth: a multivariate analysis

A multivariate model was developed incorporating various socio-demographic, social-environmental, and social-psychological factors in an attempt to predict suicidal ideation among Canadian youth. The main research objective sought to determine what socially based factors elevate or reduce suicidal ideation within this population. Using data from the National Longitudinal Study of Children and Youth-Cycle 5 (2003), a cross-sectional sample of 1,032 was used to empirically identify various social determinants of suicidal ideation among youth between the ages of 12 and 15. Results reveal statistically significant correlations between suicide ideation and some lesser examined socially based measures. In particular, ability to communicate feelings, negative attachment to parents/guardians, taunting/bullying or abuse, and presence of deviant peers were significant predictors of suicidal ideation. As expected, depression/anxiety, gender, and age were also correlated with thoughts of suicide. Research findings should help foster a better understanding toward the social elements of suicide and provide insight into how suicide prevention strategies may be improved through an increased emphasis on substance use education, direct targeting of dysfunctional families and deviant peer groups, and exploring more avenues of self-expression for youth.     

Anterior resection of the rectum for rectal cancer--options, limits, immediate complications

A number of factors have recently led to a more conservative approach for middle or low rectal cancers, making possible sphincter preservation and reducing the number of abdomino perineal excisions of the rectum. We have performed a retrospective analysis on 510 patients operated on in our unit between 1994 and 2003 for rectal cancer. There were a number of 118 anterior resection of rectum; in 20 cases the TME has been performed and in 6 cases a very low anterior resection of rectum was done. The overall operative morbidity rate was 16.10% in direct relation with the distal limit of resection. We note urinary dysfunctions, anastomotic leakage, recto-vaginal fistulas as immediate postoperative complications. With the practice of total mesorectal excision, the use of abdomino perineal excision of the rectum is decreasing. The use of preoperative radiotherapy can increase the rate of operative morbidity but despite of these, its long-term benefit, is important.     

Environmental enrichment improves response strength, threshold, selectivity, and latency of auditory cortex neurons

Over the last 50 yr, environmental enrichment has been shown to generate more than a dozen changes in brain anatomy. The consequences of these physical changes on information processing have not been well studied. In this study, rats were housed in enriched or standard conditions either prior to or after reaching sexual maturity. Evoked potentials from awake rats and extracellular recordings from anesthetized rats were used to document responses of auditory cortex neurons. This report details several significant, new findings about the influence of housing conditions on the responses of rat auditory cortex neurons. First, enrichment dramatically increases the strength of auditory cortex responses. Tone-evoked potentials of enriched rats, for example, were more than twice the amplitude of rats raised in standard laboratory conditions. Second, cortical responses of both young and adult animals benefit from exposure to an enriched environment and are degraded by exposure to an impoverished environment. Third, housing condition resulted in rapid remodeling of cortical responses in <2 wk. Fourth, recordings made under anesthesia indicate that enrichment increases the number of neurons activated by any sound. This finding shows that the evoked potential plasticity documented in awake rats was not due to differences in behavioral state. Finally, enrichment made primary auditory cortex (A1) neurons more sensitive to quiet sounds, more selective for tone frequency, and altered their response latencies. These experiments provide the first evidence of physiologic changes in auditory cortex processing resulting from generalized environmental enrichment.     

The effects of GSTM1 and GSTT1 polymorphisms on micronucleus frequencies in human lymphocytes in vivo.

The influence of genetic polymorphisms in GSTM1 and GSTT1 genes on micronucleus frequencies in human peripheral blood lymphocytes was assessed through a pooled analysis of data from seven laboratories that did biomonitoring studies using the in vivo cytokinesis-block micronucleus assay. A total of 301 nonoccupationally exposed individuals (207 males and 94 females) and 343 workers (237 males and 106 females) occupationally exposed to known or suspected genotoxic substances were analyzed by Poisson regression. The results of the pooled analysis indicate that the GSTT1 null subjects had lower micronucleus frequencies than their positive counterparts in the total population (frequency ratio, 0.55; 95% confidence interval, 0.33-0.89). The protective effect of this genotype is reversed with increasing age, with a frequency ratio of 1.33 (95% confidence interval, 1.06-1.68) in subjects aged 60 years. A significant overall increase in micronucleus frequency with age and gender (P < 0.001 and P = 0.024, respectively) was observed, females having higher micronucleus frequencies than males, when occupationally exposed (P = 0.002). Nonoccupationally exposed smokers had lower micronucleus frequencies than nonsmokers (P = 0.001), whereas no significant difference in micronucleus level was observed between smokers and nonsmokers in the occupationally exposed group (P = 0.79). This study confirms that pooled analyses, by increasing the statistical power, are adequate for assessing the involvement of genetic variants on genome stability and for resolving discrepancies among individual studies.     

Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature

BACKGROUNDSuperior mesenteric artery syndrome is a disease with a complex diagnosis, and it is associated with complications that make it even harder to identify. Currently, a frequent association with psychiatric disorders has been noted. Despite numerous case reports and case series, the variability of the disease has not allowed the development of protocols regarding diagnosis and management.CASE SUMMARYA 33-year-old woman presented with abdominal pain, nausea, and bile vomiting over the last 15 mo, associated with a 15-kg weight loss over the last three months. After the onset of the symptoms, the patient was diagnosed with anxiety-depressive disorder and treated appropriately. Standard examinations excluded an organic cause, and the cause of the symptoms was considered psychogenic. The persistence of symptoms, even under treatment, prompted a computer tomography angiography examination of the abdomen and pelvis. The examination identified emergence at a sharp angle of 13.7° of the superior mesenteric artery, with a reduced distance between the artery and the anterior wall of the aorta up to a maximum of 8 mm. A diagnosis of aortomesenteric clamp was established. Surgical treatment by laparoscopic duodenojejunostomy was performed. Postoperative evolution was marked by a patent anastomosis at 1 mo, with a 10-kg weight gain and improvement of the associated anxiety.CONCLUSIONThis case report underlines two major aspects. One aspect refers to the predisposition of patients with superior mesenteric artery syndrome to develop psychiatric disorders, with an excellent outcome when proper treatment is administered. The second aspect underlines the key role of a multidisciplinary approach and follow-up.     

Toxicological Assessment of an Acrylic Removable Orthodontic Appliance Using 2D and 3D In Vitro Methods

Malocclusion is a global health problem, mainly affecting children and adolescents. For this reason, orthodontic treatment must be, on the one hand, safe, non-toxic, and effective and, on the other hand, it must have the best possible esthetic profile. Thus, the use of orthodontic appliances is addressed to all age groups, including young children, for a long period of time, which is why their safety profile is a matter of real interest. For this reason, the purpose of the present study was to evaluate the safety and biocompatibility of an acrylic removable orthodontic appliance made of polymethylmethacrylate and stainless steel alloy made by our team of researchers. To verify the biocompatibility of the medical device, it was immersed in artificial saliva with three different pHs (3, 7, and 10) for a period of ten days. Subsequently, the three types of saliva were tested on human keratinocytes (HaCaT cell line) in terms of viability and modification of cell morphology. Finally, the use of 3D reconstructed human epidermis verified the cytotoxic and irritating potential of the medical device, thus providing relevant information regarding its biocompatibility. The results revealed that by maintaining the orthodontic device in the saliva there is no release of substances with a toxic effect on the human keratinocytes and on the 3D reconstructed human epidermis. There were also no significant changes in cell morphology. In conclusion, it is suggested that the acrylic removable appliance has a safety profile recommended for in vivo use.