Clinical features of radiologically confirmed pneumonia due to adenovirus in children

BackgroundClinical features of radiologically confirmed pneumonia due to adenovirus in children have not been comprehensively evaluated.ObjectiveTo describe the detailed clinical features of radiologically confirmed adenovirus-associated pneumonia in children.Study designOf 3298 children with a throat virus culture positive for adenovirus treated at a university-affiliated hospital, from January 2000 to June 2008, in northern Taiwan, 80 hospitalized children (2.4%) with radiologically confirmed pneumonia were identified. From four children with incomplete medical records, only demographics were included for analysis.ResultsThe median age was 2.97 years, ranging from 25 days to 14 years. Seventy-three patients (96%) had fever, with a median duration of 7 days. The three most common respiratory symptoms were cough (99%), rhinorrhea (82%) and dyspnea (42%). Gastrointestinal symptoms were recorded in 80% of the patients, and neurologic symptoms in four children. Leukocytosis (WBC ≥ 15,000/μL) was noted in 19 (25%) patients. Only six patients (8%) had a normal serum C-reactive protein (CRP) value (<5 mg/L), while 48 patients (63%) had a CRP level >40 mg/L. Seventeen (21%) children required intensive care. Seventy-three patients (96%) recovered uneventfully. Sequelae were seen in two patients and death in 1. Of the 69 isolates with serotyping determination, seven serotypes were identified, with a predominant serotype (type 3 for 73%).ConclusionLess than 5% of the children with adenoviral infection had radiologically confirmed patch pneumonia. The manifestation of pneumonia caused by adenovirus was similar to that of bacterial pneumonia.     

EFFECT OF LOCALLY DELIVERED BISPHOSPHONATES ON ALVEOLAR BONE: A SYSTEMATIC REVIEW AND META-ANALYSIS

ObjectiveTo assess the effect of locally applied bisphosphonate drugs on alveolar bone defects caused by periodontitis and marginal bone level after placement of dental implants.Materials and MethodsThree electronic databases (PubMed/MEDLINE, Web of Science, and Scopus) were searched from January 2010 until May 2020 for randomized controlled clinical trials reporting the effect of locally delivered bisphosphonates on alveolar bone. The risk of bias was assessed and quantitative synthesis was conducted with both fixed and random-effects meta-analyses by using RevMan version 5.3. Subgroup and sensitivity analyses were performed whenever required.ResultsAmong the included studies, the effect of locally delivered bisphosphonates on alveolar bone regeneration in periodontitis was measured by 15 studies and on marginal bone level after installation of dental implants by three studies. Bisphosphonates showed significantly higher intrabony defect depth reduction than placebo/control in vertical bone defects treated with non-surgical approach (MD = 1.69mm; 95% CI, 1.32-2.05; P < 0.00001; I²=93%) or surgical approach (MD = 0.70mm; 95% CI, 0.23-1.16; P = 0.003; I² = 78%) and in class II furcation defects treated with non-surgical approach (MD = 1.61mm; 95% CI, 1.15-2.07; P < 0.00001; I² = 99%) or surgical approach (MD = 0.24mm; 95% CI, 0.05-0.42; P = 0.01; I² = 62%). Clinical attachment loss increased by 1.39mm (95% CI, 0.92-1.85; P < 0.01; I²=93%) and 1mm (95% CI, 0.75-1.26; P < 0.001; I² = 0%) in vertical bone defects after non-surgical and surgical treatments, respectively, and by 1.95mm (95% CI, 1.37-2.53; P < 0.00001; I² = 96%) and 0.84mm (95% CI, 0.58-1.10; P < 0.01, I² = 47%) after non-surgical and surgical treatment in class II furcation defects, respectively. Lesser marginal bone loss during pre-loading (MD = -0.18 mm; 95% CI, -0.24- -0.12; P<0.00001; I²=0%) and 1-year post-loading (MD = -0.33 mm; 95% CI, -0.59–0.07; P = 0.01; I² = 0%) periods was observed when bisphosphonate coated dental implants were used.ConclusionLocally delivered bisphosphonates induce bone regeneration in periodontal defects and decrease the rate of marginal bone loss after dental implant therapy.     

Sleep and suicide: an analysis of a cohort of 394,000 Taiwanese adults

Background

Sleep problems may lead to, or be symptomatic of, depression and other mental illnesses yet few studies have investigated their association with suicide risk.

Design

Prospective cohort study.

Setting

Taiwan.

Participants

393,983 men and women aged 20 or above participating in the MJ health check-up programme.

Results

There were 335 suicides over a mean of 7.4 years follow-up. There was a reverse J-shaped association between sleep duration and suicide risk. When compared with those sleeping 6–8 h per night the adjusted hazard ratios (95 % confidence intervals) for suicide associated with 0–4, 4–6 and >8 h sleep were 3.5 (2.0–6.1), 1.5 (1.1–1.9) and 1.5 (1.1–2.0), respectively. People requiring sleeping pills to get to sleep (1.2 % participants) were at over 11-fold increased risk; difficulty falling asleep (11.5 % participants), frequent dreaming (16.7 %) and being easily awoken (30.6 %) were associated with a 2.0-, 1.6- and 1.3-fold increased risk of suicide, respectively.

Conclusions

Less than 6 h sleep duration, sleep disturbances and reported use of sleep medicines are markers of suicide risk. Sleep problems should be assessed when evaluating suicide risk.     

Callosal Neglect in Hydrocephalus

A functional disconnection of the corpus callosum (CC) can induce a form of spatial neglect where each hand (e.g., left) when attempting to bisect lines in the opposite (e.g., right) hemispace deviates toward its own (e.g., left) hemispace. Patients with hydrocephalus often show thinning of the CC but callosal neglect has not been reported in this condition. Two right-handed patients with hydrocephalus and thinning of the CC, as well as six matched controls, were assessed for neglect by performing the line bisection task in left, right and center space with their right and left hands. When compared to controls neither patient, using either their right or left hands, demonstrated a bias in the center or left space conditions, but with lines in right space both subjects' left hand deviated significantly to the left. Thus, patients with hydrocephalic interhemispheric functional disconnection might show a form of callosal neglect. This hemispatial-hand asymmetry of deviation, however, also might be related to the disinhibition of the attentionally dominant right hemisphere.     

Differentiation of lung stem/progenitor cells into alveolar pneumocytes and induction of angiogenesis within a 3D gelatin – Microbubble scaffold

The inability to adequately vascularize tissues in vitro or in vivo is a major challenge in lung tissue engineering. A method that integrates stem cell research with 3D-scaffold engineering may provide a solution. We have successfully isolated mouse pulmonary stem/progenitor cells (mPSCs) by a two-step procedure and fabricated mPSC-compatible gelatin/microbubble-scaffolds using a 2-channel fluid jacket microfluidic device. We then integrated the cells and the scaffold to construct alveoli-like structures. The mPSCs expressed pro-angiogenic factors (e.g., b-FGF and VEGF) and induced angiogenesis in vitro in an endothelial cell tube formation assay. In addition, the mPSCs were able to proliferate along the inside of the scaffolds and differentiate into type-II and type-I pneumocytes The mPSC-seeded microbubble-scaffolds showed the potential for blood vessel formation in both a chick chorioallantoic membrane (CAM) assay and in experiments for subcutaneous implantation in severe combined immunodeficient (SCID) mice. Our results demonstrate that lung stem/progenitor cells together with gelatin microbubble-scaffolds promote angiogenesis as well as the differentiation of alveolar pneumocytes, resulting in an alveoli-like structure. These findings may help advance lung tissue engineering.     

Cytoreductive nephrectomy for metastatic renal cell carcinoma in the era of targeted therapy in the United States: a SEER analysis

Purpose

Two randomized trials published in 2001 provided level 1 evidence for the use of cytoreductive nephrectomy (CyNx) for the treatment of metastatic renal cell carcinoma (mRCC). However, the regulatory approval of vascular endothelial growth factor tyrosine kinase inhibitors (VEGFR-TKI) in 2005 has left an “evidence void” regarding the use of CyNx. We evaluated the patterns in the use of CyNx in the cytokine and VEGFR-TKI eras, and the patient characteristics associated with the use of CyNx.

Methods

The Surveillance, Epidemiology, and End Results registry was used to identify patients with histologically or cytologically confirmed stage IV RCC between 2001 and 2008. Patients were classified as treated during the cytokine (2001–2005) or VEGFR-TKI (2006–2008) eras. A multivariate logistic regression analysis was performed to calculate the odds of undergoing CyNx according to treatment era and socioeconomic characteristics.

Results

Overall, 1,112 of 2,448 patients (45 %) underwent CyNx. CyNx use remained stable between 2001 and 2005 (50 %), but decreased to 38 % in 2008. Logistic regression analysis revealed that older age (OR 0.82, 95 % CI: 0.68, 0.99), black race (OR 0.64, 95 % CI: 0.46, 0.91), Hispanic ethnicity (OR 0.71, 95 % CI: 0.54, 0.93), and treatment in the VEGFR-TKI era (OR 0.82, 95 % CI: 0.68, 0.99) were independently associated with decreased use of CyNx.

Conclusions

Use of CyNx in the United States has declined in the VEGFR-TKI era. Older patients and minorities are less likely to receive CyNx. Results of ongoing phase III trials are needed to refine the role of this treatment modality.     

Comparison of Two Different Fixation Techniques for a Segmental Defect in a Rat Femur Model

Studies have attempted to identify the osteogenic effects of bone morphogenetic proteins using a rat femur model, which commonly involves the creation of a critical size defect followed by internal fixation of the femur. Among the most familiar fixation methods are either plating or intramedullary placement of a Kirschner wire (K-wire). There are advantages and disadvantages to each method; however, this study attempts to identify the best method by exploring the histological effects of each technique. The experiment involved two groups with no added treatment: Group P (plate fixation method) and Group K (K-wire fixation method). The animals were allowed a 4-week interval for the femurs to heal, and proximal, distal, and two midshaft cuts were examined under high-power microscopy after the fixation apparatus was removed. Group K exhibited a peculiar fibrotic healing pattern that followed the shaft of the then vacated K-wire and there was minimal new viable bone formation. Group P, however, exhibited a more natural ingrowth of newly formed bone that began at the proximal and distal cuts and proceeded centrally into the core of the defect. Due to the fibrotic tissue in Group K, this study shows that the model is insufficient due to the micromotion created and thus supports plating of critical defects as the fixation method of choice due to the creation of a stable healing environment.     

Human risk of infection with Borrelia burgdorferi, the Lyme disease agent, in eastern United States

The geographic pattern of human risk for infection with Borrelia burgdorferi sensu stricto, the tick-borne pathogen that causes Lyme disease, was mapped for the eastern United States. The map is based on standardized field sampling in 304 sites of the density of Ixodes scapularis host-seeking nymphs infected with B. burgdorferi, which is closely associated with human infection risk. Risk factors for the presence and density of infected nymphs were used to model a continuous 8 km×8 km resolution predictive surface of human risk, including confidence intervals for each pixel. Discontinuous Lyme disease risk foci were identified in the Northeast and upper Midwest, with a transitional zone including sites with uninfected I. scapularis populations. Given frequent under- and over-diagnoses of Lyme disease, this map could act as a tool to guide surveillance, control, and prevention efforts and act as a baseline for studies tracking the spread of infection.     

Variation in the ICAM1-ICAM4-ICAM5 locus is associated with systemic lupus erythematosus susceptibility in multiple ancestries

OBJECTIVE: Systemic lupus erythematosus (SLE; OMIM 152700) is a chronic autoimmune disease for which the aetiology includes genetic and environmental factors. ITGAM, integrin α(M) (complement component 3 receptor 3 subunit) encoding a ligand for intracellular adhesion molecule (ICAM) proteins, is an established SLE susceptibility locus. This study aimed to evaluate the independent and joint effects of genetic variations in the genes that encode ITGAM and ICAM. METHODS: The authors examined several markers in the ICAM1-ICAM4-ICAM5 locus on chromosome 19p13 and the single ITGAM polymorphism (rs1143679) using a large-scale case-control study of 17 481 unrelated participants from four ancestry populations. The single-marker association and gene-gene interaction were analysed for each ancestry, and a meta-analysis across the four ancestries was performed. RESULTS: The A-allele of ICAM1-ICAM4-ICAM5 rs3093030, associated with elevated plasma levels of soluble ICAM1, and the A-allele of ITGAM rs1143679 showed the strongest association with increased SLE susceptibility in each of the ancestry populations and the trans-ancestry meta-analysis (OR(meta)=1.16, 95% CI 1.11 to 1.22; p=4.88×10(-10) and OR(meta)=1.67, 95% CI 1.55 to 1.79; p=3.32×10(-46), respectively). The effect of the ICAM single-nucleotide polymorphisms (SNPs) was independent of the effect of the ITGAM SNP rs1143679, and carriers of both ICAM rs3093030-AA and ITGAM rs1143679-AA had an OR of 4.08 compared with those with no risk allele in either SNP (95% CI 2.09 to 7.98; p=3.91×10(-5)). CONCLUSION: These findings are the first to suggest that an ICAM-integrin-mediated pathway contributes to susceptibility to SLE.