Periodontitis associated bacteria in supragingival plaque of dental hygienists, stability of carrier state and clinic development

The purpose of this study was the clinical and microbiological re-examination of dental hygienists, who, 30 months before, had shown remarkably high supragingival levels of periodontitis-associated micro-organisms. Interdental plaque was collected from the same molar sites and investigated by the same immunofluorescence assay with taxa-specific monoclonal antibodies as at the initial examination. On average, the 15 re-examined subjects showed slightly increased plaque levels but unchanged bleeding on probing scores (0.3-1.4). Pocket formation was restricted to a single subject. Prevotella intermedia/P. nigrescens and Peptostreptococcus micros were present in every plaque sample. Prevalences of Actinobacillus actinomycetemcomitans, Bacteroides forsythus and Campylobacter rectus were again between 20-40%, but some fluctuation within subjects was noted. The data confirm supragingival plaque as a natural habitat for periodontitis-associated bacteria in periodontially healthy persons, and indicate that colonization with A. actinomycetemcomitans, B. forsythus or C. rectus is mostly stable in spite of better than average personal plaque control.     

Coronary collateral flow reversal

Summary Coronary collaterals demonstrated angiographically are expected to be usable both ways and to remain on standby even if they are no longer used after flow improvement through the physiological pathway. Evidence of these hypotheses is provided by two case reports, one showing spontaneous reversal of collaterals and one showing recruitable reversed collaterals.     

Clinical validation of a novel enzyme‐linked immunosorbent spot assay‐based in vitro diagnostic assay to monitor cytomegalovirus‐specific cell‐mediated immunity in kidney transplant recipients: a multicenter,longitudinal, prospective,observational study

Impaired cytomegalovirus (CMV)‐specific cell‐mediated immunity (CMV‐CMI) is a major cause of CMV reactivation and associated complications in solid‐organ transplantation. Reliably assessing CMV‐CMI is desirable to individually adjust antiviral and immunosuppressive therapy. This study aimed to evaluate the suitability of T‐Track^® CMV, a novel IFN‐γ ELISpot assay based on the stimulation of peripheral blood mononuclear cells with pp65 and IE‐I CMV proteins, to monitor CMV‐CMI following kidney transplantation. A prospective longitudinal multicenter study was conducted in 86 intermediate‐risk renal transplant recipients. CMV‐CMI, CMV viral load, and clinical complications were monitored over 6 months post‐transplantation. Ninety‐five percent and 88–92% ELISpot assays were positive pre‐ and post‐transplantation, respectively. CMV‐specific response was reduced following immunosuppressive treatment and increased in patients with graft rejection, indicating the ability of the ELISpot assay to monitor patients' immunosuppressive state. Interestingly, median pp65‐specific response was ninefold higher in patients with self‐clearing viral load compared to antivirally treated patients prior to first viral load detection (P < 0.001), suggesting that reactivity to pp65 represents a potential immunocompetence marker. Altogether, T‐Track^® CMV is a highly sensitive IFN‐γ ELISpot assay, suitable for the immunomonitoring of CMV‐seropositive renal transplant recipients, and with a potential use for the risk assessment of CMV‐related clinical complications (ClinicalTrials.gov Identifier: NCT02083042).     

Accuracy and cross-sensitivity of 10 different anesthetic gas monitors

Objective. The objective of this study was to test the accuracy and cross-sensitivity of commercially available anesthetic gas monitors.Methods. Using gas chromatography (GC) as a reference method, the accuracy, cross-sensitivity, and ability to recognize an erroneously selected agent were determined in the following 10 monitors for volatile anesthetics: Datex Capnomac Ultima-S, Datex Capnomac, Ohmeda 5330 agent monitor, Iris Dräger, Andros Dräger PM 8020 (all monochromatic, infrared analyzers), Nellcor N-2500E, Criticare POET II, Irina Dräger (all polychromatic, infrared analyzers), Siemens Servo Gas Monitor 120 (a piezoelectric analyzer), and Brüel & Kjaer Type 1304 (a photoacoustic analyzer). Accuracy was determined at 0.5, 1, 2, and 4 times the minimal alveolar concentration (MAC) of either halothane or isoflurane in oxygen (O₂). The cross-sensitivity tests were performed with 70 vol% nitrous oxide in O₂, 5 vol% carbon dioxide in O₂, 0.032 vol% alcohol in O₂, and 70% water vapor in O₂. The photoacoustic analyzer showed a higher accuracy for isoflurane than the polychromatic infrared monitors. The greatest inaccuracy with isoflurane was found in the Iris Dräger monitor, which had a maximal bias percentage by volume (vol%) of 0.09 at 0.5 MAC. (This bias was within the manufacturer's specified tolerance of ±0.1 vol% or 10% relative difference of reading, whichever is greater.) Irina Dräger was the most accurate analyzer with halothane (mean % bias [relative %] ± SD, 0.9 ± 2.0%). The greatest bias with halothane was found in the monochromatic infrared analyzers, with a maximal % bias at 0.5 MAC of 50.3% of the GC reading (12.4% with a new inner Nafion tube) found in the Datex Ultima monitor. The Siemens gas monitor showed a cross-sensitivity for water vapor (–0.248 vol%). The monochromatic infrared analyzers showed a small sensitivity to alcohol (additional deviation of 0.011 to 0.147 vol% at 2 MAC isoflurane) but no sensitivity to nitrous oxide. No cross-sensitivity was found in the polychromatic infrared and photoacoustic analyzers. An incorrect selection of anesthetic agent when using a monochromatic infrared analyzer can be fatal; for example, when using halothane and selecting isoflurane the values measured by the Datex Capnomac monitor were nearly 6 times below the actual value (i.e., 1 vol% isoflurane on the display = 6 vol% halothane in reality).Conclusions. The photoacoustic measurement principle is more accurate than the other methods, although the polychromatic infrared analyzers are safer because they detect erroneously selected agents.

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Abstrakt Zielsetzung. Ziel der Untersuchung war es, die Genauigkeit und Kreuzempfindlichkeit kommerziell erhältlicher Narkosegasmonitore zu überprüfen. Ein Gaschromatograph (GC) wurde als Referenz verwendet, um die Genauigkeit, Kreuzempfindlichkeit und die Fähigkeit fälschlich gewhlter Narkosegase zu erkennen, an 10 verschiedenen Monitoren überprüft: Datex Capnomac® Ultima -S, Datex Capnomac®, Ohmreda 5330® Nakosegasmonitor, Iris® Dräger, Andros® Dräger PM8020 (alle monochromatische Infrarotanalysesysteme), Nellcor® N-2500E, Criticare® POET II, Irina® Dräger (alle polychromatische Infrarotanalysesysteme), Siemens Servo® Gasmonitor 1320 (ein piezoelektrisches System) und das Brüel & Kjaer® Typ 1304 ein photakustische Analysesystem. Die Genauigkeit wurde bei der 0.5–1–2 und 4fachen minimalen alveolären Konzenztration (MAC) in entweder Halothan oder Isofluran in Sauerstoff bestimmt. Eine Kreuzempfindlichkeit wurde mit 70 Vol% Lachgas in Sauerstoff, 5 Vol% Kohlendioxyd in Sauerstoff, 0.032 Vol% Alkohol in Sauerstoff und 70 Vol% Wasserdampf in Sauerstoff untersucht.Ergebnisse. Das photoakustische System wies grssere Genauigkeit für Isofluran auf als alle polychromatischen Infrarotgasmonitore Die grösste ungenauigheit wurde beim Dräger Iris® Monitor für Isofluran gefunden, der eine prozentuale Abweichung von 0.09 Vol% bei 0.5 MAC aufwies. Diese Abweichung lag innerhalb der vom Hersteller angegebenen Toleranzgrenze von ± 0.1 Vol% bzw. relative10%. Der Irina® Drägermonitor war der genauste für Halothan (mittlere % Abweichung [relative %] ± Stabdardabweichung, 0.9 Vol% ± 2.0%). Die größte Abweichung für Halothan wurde bei den monochromatischen Systemen gefunden; bei 0.5 MAC wurde eine maximale % Abweichung für den Datex Ultima® Monitor von 50.3% (12.4% mit dem neuen Nafionschlauch) von dem am Gaschromatographen gemessenen Wert gefunden. Der Siemens Gasmonitor wies eine Kreuzempfindlichkeit für Wasserdampf auf (–0.248 Vol%). Die monochromatischen Infrarotsysteme wiesen alle eine geringe Kreuzempfindlichkeit für Alkohol (zusätzliche Abweichung von 0.011 bis 0.147 Vol% bei 2 MAC Isofluran) jedoch keine Kreuzempfindlichkeit für Lachgas auf. Keine Kreuzempfindlichkeit wurde bei den polychromatischen Infrarot- und photoakustischen Systemen nachgewiesen. Eine fehlerhafte Auswahl zum verwendeten Narkosegas kann bei einem monochromatischen Infrarot-Narkosegasmonitor fatale Folgen haben, wenn z.B. beim Gebrauch von Halothan und der Wahleinstellung Isofluran, die mit dem Datex Capnomat® gemessenen Werte bis zum 6fachen unterhalb der eigentlichen Konzentration liegen (i.e. 1 Vol% Isofluran in der Anzeige bei eigentlichen 6 Vol% Halothan).Schlußfolgerung. Das photoakustische Messprinzip ist genauer als alle anderen Methoden, obgleich das polychromatischen System sicherer ist, da hiermit fälschlicherweise Narkosegase gewählte entdeckt werden können.

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Resumen Objetivo. El objetivo de este estudio fue determinar la precisión y sensibilidad cruzada de monitores de gases anestésicos disponibles en el comercio.Metodos. Usando cromatografía de gases (GC) como método de referencia, se determinó la precisión, sensibilidad cruzada, y capacidad de reconocer un agente seleccionado en forma errónea, de los siguientes diez monitores de agentes anestésicos volátiles: Datex Capnomac Ultima S, Datex Capnomac, Ohmeda 5330, Iris Drager, Andros Drager PM 8020 (todos analizadores infrarrojos monocromáticos), Nellcor N 2500E, Criticare POET II, Irina Drager (todos analizadores infrarrojos policromáticos), Siemens Servo Gas Monitor 120 (analizador piezoeléctrico), y el Bruel & Kjaer Tipo 1304 (analizador fotoacústico). La precisión fue determinada a 0.5, 1, 2, y 4 veces la concentración alveolar mínima (MAC) de halothane o isoflurane en oxígeno (O2). Las pruebas de sensibilidad cruzada fueron realizadas con 70 vol% de óxido nitroso en O2, 5 vol% de CO2 en O2, 0.032 vol% alcohol in O2 y 70% vapor de agua en O2. El analizador fotoacústico mostró mayor precisión para el isofluorano que los monitores infrarrojos policromáticos. La mayor falta de precisión para el isoflurane se observó en el monitor Iris Drager, cuyo sesgo máximo en porcentaje por volumen (vol%) fue 0.09 at 0.5 MAC. (Este sesgo estaba dentro de la tolerancia especificada por el fabricante, de ±0.1 vol% o 10% diferencia relativa de lectura, lo que resultare mayor). El analizador Irina Drager fue el más preciso con halothane (sesgo % medio [% relativo] ± SD, 0.9 ± 2.0%). El mayor sesgo con halothane se observó en los analizadores infrarrojos monocromáticos, con un sesgo máximo a 0.5 MAC de 50.3% de la lectura del GC (12.4% con un tubo interior de Nafion nuevo) en el monitor Datex Ultima. El monitor de gases Siemens demostró sensibilidad cruzada para el vapor de agua (0.248 vol%). Los analizadores infrarrojos monocromáticos mostraron escasa sensibilidad al alcohol (desviación adicional de 0.011 a 0.147 vol% a 2 MAC isoflurane), pero no sensibilidad al óxido nitroso. No se detectó sensibilidad cruzada a los analizadores infrarrojos policromáticos ni fotoacústico. Una selección incorrecta de agente anestésico, usando un analizador infrarrojo monocromático, puede ser fatal: Por ejemplo, al usar halothano y seleccionar isofluorano los valores medidos por el monitor Datex Capnomac eran casi 6 veces por debajo del valor real (i.e., 1 vol% isoflurane en el display = 6 vol% halothane en la realidad).Conclusiones. El principio fotoacústico de medición es más preciso que los otros métodos, si bien los analizadores infrarrojos policromáticos son más seguros porque detectan selección errónea de agente anestésico.

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Résumé Objectifs. Le but de cette étude était deverifier l'exactitude et la sensibilité croisée des moniteurs de gaz anesthésiques disponibles sur le marché.Méthodes. En choisissant la chromatographie gazeuse (CG) comme méthode de référence, nous avons déterminé l'exactitude, la sensibilité croisée, et la capacité de reconnaissance d'un agent sélectionné par erreur, chez les 10 moniteurs d'anesthésiques volatils suivants: Datex Capnomac Ultima-S, Datex Capnomac, Ohmeda 5330, Iris Drager, Andros Drager PM 8020 (analyseurs infra-rouges monochromatiques); Nelicor N-2500E, Criticare POET II, Irina Drager (analyseurs infra-rouges polychromatiques), Siemens Servo Gas Monitor 120 (analyseur piezoélectrique), et Bruel & Kjaer Type 1304 (analyseur photoacoustique). L'exactitude a été déterminée à respectivement 0,5; 1; 2; 4 fois la concentration alvéolaire minimale (MAC) soit d'halothane, soit d'isoflurane sous oxygène. Les tests de sensibilité croisée ont été réalisés avec un mélange gazeux contenant de l'oxygène et, respectivement, 70% de protoxyde d'azote, 5% de dioxyde de carbone, 0,032% d'alcool, et 70% de vapeur d'eau. L'analyseur photoacoustique s'est révèlé d'une plus grande exactitude pour l'isoflurane que les moniteurs infra-rouges polychromatiques. La plus grande inexactitude avec l'isoflurane était obtenue avec le moniteur Iris Drager, qui présentait l'erreur maximale en pourcentage de volume (vol %) de 0,09 à 0,5 MAC. Cette erreur était située dans l'intervalle de tolérance spécifié par le constructeur de 0,1 vol% en valeur absolue ou de 10% d'erreur relative. Irina Drager était l'analyseur le plus précis avec l'halothane (erreur moyenne ± écart-type de 0,9 ± 2,0 %). L'erreur la plus importante avec l'halothane était obtenue avec les analyseurs infra-rouges monochromatiques, avec une erreur relative maximale 0,5 MAC de 50.3% des résultats de la CG (12,4% avec le nouveau tube Nafion) obtenue avec le moniteur Ultima de Datex. Le moniteur Siemens a montré une sensibilité croisée pour la vapeur d'eau (–0,248 vol%). Les analyseurs infra-rouges monochromatiques ont montré une petite sensibilité à l'alcool (déviation de 0,011 à 0,147 vol% à 2 MAC d'isoflurane) mais aucune sensibilité au protoxyde d'azote. Aucune sensibilité croisée n'était obtenue chez les analyseurs polychromatiques infrarouges et photo-acoustiques. Une sélection incorrecte d'agent anesthésique d'un agent anesthésique lors de l'utilisation d'un analyseur monochromatique infra-rouge peut être fatal; par exemple, en cas d'utilisation d'halothane et de sélection de l'isoflurane, les valeurs mesurées par le moniteur Capnomac de Datex étaient près de 6 fois inférieures aux valeurs réelles (c'est-à-dire: 1 vol% d' isoflurane affiché = 6 vol% d'halothane en réalité).Conclusions. Le principe de mesure photoacoustique est plus exacte que les autres méthodes, bien que les analyseurs infra-rouges polychromatiques sont plus srs puisqu'ils détectent les agents sélectionnés par erreur.

     

Parameters of thick and thin nerve-fiber functions as predictors of pain in carpal tunnel syndrome

Pain intensity in carpal tunnel syndrome (CTS) was correlated with neuro- and psychophysiological parameters related to the function of different nerve fiber classes within the median nerve in 23 patients. Control data were obtained from 16 normal subjects.

Mean intensity of all pain attacks which occurred 14 days before surgical treatment was assessed on visual analogue scales (average CTS pain). Functions of thick myelinated nerve fibers were determined by motor and sensory nerve conduction studies. Functions of thin myelinated and unmyelinated nerve fibers were evaluated by measuring thresholds of warmth, cold and heat pain on the index and little finger. Pain intensity and neurogenic vasodilation following noxious mechano-stimulation on the interdigital web between index and middle finger provided additional information on the functioning of nociceptive nerve fibers. Sympathetic reflexes induced by these painful stimuli were assessed by means of infrared thermography and photoplethysmography.

Mean intensity of pain attacks (40 ± 19% VAS) correlated significantly with latency (r = 0.58, P < 0.01) and amplitude (r = −0.50, P < 0.01) of the compound action potential from abductor pollicis brevis muscle following distal median nerve stimulation. Thresholds of warmth, cold and heat pain on index finger were significantly increased during CTS when compared to the control subjects. The magnitude of neurogenic vasodilation and sympathetic vasoconstrictor reflexes were not significantly different. Average CTS pain correlated inversely to the threshold of heat pain on index (r = −0.46, P < 0.05), but also on the little finger (r = −0.41, P < 0.05), which is not innervated by the median nerve. Pain intensity due to noxious mechano-stimulation was significantly higher in patients than with control persons. In a multiple regression model, with distal motor latency of the median nerve and heat pain threshold on the index finger as independent variables, ongoing pain due to CTS was predicted with R = 0.72 (P < 0.001).

The conclusion is that intensity of pain due to CTS depends on alterations of peripheral and central nervous functions.     

Safe paediatric intensive care

In order to optimise safety within the paediatric intensive care unit (PICU), it is essential to optimise organisation, identify problem areas and implement standards and guidelines for safe practice (with appropriate monitoring). Organisational issues have a major impact on safety: the introduction and—recently—centralisation of paediatric intensive care, the appointment of dedicated paediatric intensivists, nursing staffing, handovers, rounds, the number of work hours and night shifts with the associated problems of disturbed circadian rhythms.The technique of voluntary, anonymous, non-punitive critical incident reporting has the potential to identify incidents and latent errors before they become self-evident through a major incident. This systems approach focuses on organisational and communication problems.Standards and guidelines may help in weighing up the benefits and risks of invasive procedures, and interventional studies have shown that implementation of standards and guidelines can improve outcome. Mortality prediction models enable us to monitor quality of care and, thus, to investigate the best ways of organising intensive care and monitoring the effects of changes in practice.     

Subcutaneous administration of a neutralizing IL‐1β antibody prolongs limb allograft survival

Cytokine‐expression profiles revealed IL‐1ß highly upregulated in rejecting skin of limb allografts. We investigate the effect of intragraft treatment with a neutralizing IL‐1β antibody in limb transplantation. Following allogenic hind‐limb transplantation, Lewis rats were either left untreated 1 or treated with anti‐lymphocyte serum + tacrolimus (baseline) 2 ; baseline immunosuppression + anti‐IL‐1β (1 mg/kg once/week, 6‐8 subcutaneous injections) into the transplanted 3 or contralateral 4 limb. Endpoint was rejection grade III or day 100. Graft rejection was assessed by histology, immunohistochemistry, flow cytometry phenotyping of immune cells, and monitoring cytokine expression. Anti‐IL‐1β injections into the allograft or contralateral limb resulted in a significant delay of rejection onset (controls: 58.60 ± 0.60; group 3: 75.80 ± 10.87, P = .044; group 4: 73.00 ± 6.49, P = .008) and prolongation of graft survival (controls: 64.60 ± 0.87; group 3: 86.60 ± 5.33, P = .002; group 4: 93.20 ± 3.82, P = .002), compared to controls. Although the phenotype of the graft infiltrating immune cells did not differ between groups, significantly decreased skin protein levels of IL‐1β, IL‐4, IL‐13, IP‐10, MCP‐1, and MCP‐3 in long‐term‐survivors indicate an overall decrease of chemoattraction and infiltration of immune cells as the immunosuppressive mechanism of anti‐IL‐1β. Inhibition of IL‐1β with short‐term systemic immunosuppression prolongs limb allograft survival and represents a promising target for immunosuppression in extremity transplantation.