Τετάρτη 7 Σεπτεμβρίου 2022

Alterations in Vaginal Microbiota among Pregnant Women with COVID‐19

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Abstract

The maintenance of vaginal microbiota is an important factor to achieve optimum pregnancy outcomes. The study aims to describe the alterations in the composition of vaginal microbiota in pregnant women with COVID-19. This was a prospective case-control study. Vaginal swabs were collected from uninfected pregnant women (n=28) and pregnant women with COVID-19 (n=19) during the active phase of infection and within a month after recovering from infection. The vaginal microbiota on the swabs was examined by 16S rRNA gene sequencing. Shannon index indicates that alpha diversity is significantly higher in women with COVID-19 (P=0.012). There was a significant decrease in Firmicutes (P=0.014) with an increase in Bacteroidota (P=0.018) phyla and a decrease in Lactobacillus (P=0.007) genus in women with COVID-19 than those of uninfected pregnant women. The relative abundance of L.crispatus, L.iners, L.gasseri, and L.jenseni i were lower in the COVID-19 group than in uninfected pregnant women. In subgroup analysis, the amount of Ureaplasma spp. was higher in women with moderate/severe than those of asymptomatic/mild disease (P=0.036). The study revealed that vaginal dysbiosis with low abundance of Lactobacillus species occurred in pregnant women infected with SARS-CoV-2. These findings may lead to new studies to elucidate the risk of pregnancy adverse outcomes related to COVID-19.

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Decreased frequency of a novel T‐lymphocyte subset, CD3+CD4‐CD7+CD57‐ T cells, in hepatitis B virus‐related end‐stage liver disease might contribute to disease progression

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Abstract

CD7 and CD57 are related to the differentiation and functional stages of CD8+ T cells. However, the role of their combined presence in CD8+ T cells in patients with chronic hepatitis B virus (HBV) infection, especially those with end-stage liver disease, remains unclear. Blood samples from healthy volunteers and patients with chronic hepatitis B were analyzed via Luminex assay and ELISA to measure plasma cytokine levels. Further, recombinant IL-22 was used to stimulate peripheral blood mononuclear cells from healthy volunteers, and the frequency of CD3+CD4−CD7+CD57− T cells and apoptosis rates were investigated via flow cytometry. Patients with end-stage liver disease, particularly those with acute to chronic liver failure, showed decreased CD3+CD4−CD7+CD57− T cell frequency. Furthermore, the prevalence of CD3+CD4−CD7< sup>+CD57− T cells was negatively correlated with disease severity, prognosis, and complications (ascites). We also observed that IL-22 promoted apoptosis and brought about a decrease in the number of CD3+CD4−CD7+CD57− T cells in a dose-dependent manner. CD3+CD4−CD7+CD57− T cells displayed a BTLAhighCD25highCD127high immunosuppressive phenotype and showed low IFN-γ, TNF-α, granzyme A, and perforin expression levels. The present findings will elucidate the pathogenesis of HBV-related end-stage liver disease and aid the identification of novel drug targets.

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Three‐dimensional exoscope‐assisted single‐stage tracheal resection

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Abstract

The three-dimensional (3D) 4K exoscope is a surgical tool recently introduced in numerous fields of otolaryngology, such as microvascular surgery, otology, and laryngology. However, other surgical fields may also benefit from this technology. In this case, a single-stage tracheal resection was planned with the aid of the 3D 4K exoscope, in a 75-year-old female with post-tracheostomy tracheal stenosis. High-quality magnification of the surgical field was obtained, with facilitated skeletonization of the laryngotracheal axis. The exoscope provided greater involvement in surgery and allowed more interactions among all operating room personnel and learners, as they could access the same field of view of the first surgeon, as well as perceiving depth of the surgical field with 3D technology. The exoscope represents a valid application in open surgery performed for laryngotracheal stenosis, with advantages of enhancing training and education, allowing precise surgical dissection, and re ducing risks of iatrogenic damage to surrounding structures.
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Buccal fat pad as a sealant in palatal mucosa tearing: technical note

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For patients with a dentofacial deformity undergoing a planned segmentation of the maxilla for the management of a transverse maxillary arch discrepancy, palatal mucosa tearing may occur during sawing or palatal expansion traction, giving rise to an oronasal communication. This technical note describes the covering of a tear in the palatal mucosa using a buccal fat pad (BFP) flap, in the context of maxillary segmentation during Le Fort I osteotomy. Through the limited buccal incision used for the Le Fort I osteotomy, a small incision is made in the right periosteum posteriorly, and a supraperiosteal dissection is performed to access the BFP. (Source: International Journal of Oral and Maxillofacial Surgery)
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Locoregional failure after postoperative flank irradiation for nephroblastoma: Results from the French cohort of the SIOP‐2001 trial

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Abstract

Objective

To describe locoregional failure (LRF) after postoperative flank radiotherapy (RT) among French patients with nephroblastoma included in the Société Internationale d'Oncologie Pédiatrique (SIOP)-2001 protocol.

Patients and methods

In selected SIOP-2001 patients, planning with simulation computed tomography (CT) scan and posttreatment CT scan demonstrating LRF were registered and analyzed. LRF was contoured and classified as in-field, marginal or out-of-field according to dose distribution.

Results

Total 316 French SIOP-2001 patients were treated with postoperative RT. Three patients with nephroblastoma developed LRF after flank RT. All failures were located within the retroperitoneum. In two patients, the relapse was within the RT field and in one it was classified as marginal.

Conclusion

LRF after postoperative flank RT for nephroblastoma was rare and exclusively situated in the retroperitoneum. These results point out this region as the most at risk of local relapse. A prospective evaluation of a target volume restricted to the retroperitoneum allowing the use of modern and highly conformal radiation techniques in order to decrease dose to normal tissues shall be encouraged.
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Management of childhood cancer survivors at risk for thyroid function abnormalities: A Delphi study

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Abstract

Background

Thyroid function abnormalities can occur after treatment for childhood cancer. Evidence for the management of thyroid dysfunction among asymptomatic childhood cancer survivors (CCS) is lacking. We used a Delphi consensus methodology to expand guidelines for screening asymptomatic CCS at risk for thyroid dysfunction and explore recommendations for the clinical management of abnormal results.

Procedure

A Delphi panel of 40 expert physicians representing oncology, endocrinology, and primary care participated in three rounds of anonymous, iterative questionnaires formatted as clinical scenarios. Consensus is defined as ≥ 90% of panelists agree with recommendation and disagreement as < 70% agree.

Results

Panelists reached consensus that CCS treated with radiation including neck, total body, whole brain, brain including the hypothalamic-pituitary axis (HPA), and therapeutic meta-iodobenzylguanidine (MIBG) should have annual, lifelong screening using serum thyroid-stimulating hormone (TSH) and free T4 starting within one year off-treatment (98%). Panelists disagreed on continuing to screen CCS for thyroid dysfunction after immunotherapy associated with acute thyroid injury (31%-50%). There was also disagreement on indications for brain (17%-43%) or thyroid (50%-65%) imaging, laboratory tests to assess the HPA (29%-75%), and TSH threshold to initiate treatment of subclinical hypothyroidism. Lack of evidence was the most frequent rationale panelists offered for not recommending additional testing or medications. Panelists' recommendations did not vary by geography, specialty, or survivorship clinical experience.

Conclusions

Consensus was reached on most recommendations for screening and management of cancer treatment-related thyroid dysfunction. Screening after completion of thyroid-toxic immunotherapy, indications for imaging, and treatment of subclinical hypothyroidism are areas of disagreement for further investigation.
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Myeloperoxidase‐positive bilineal mixed phenotype acute leukemia (B/T) with chromosome copy neutral loss of heterozygosity exhibits simultaneous diffuse leukemic infiltrations in the lung, bone, and endorachis

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Beyond Laryngeal Clefts: Interarytenoid Injection Augmentation to Predict Success of Suture Augmentation in Children

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Beyond Laryngeal Clefts: Interarytenoid Injection Augmentation to Predict Success of Suture Augmentation in Children

We present our work to children with persistent pharyngeal dysphagia and use the interarytenoid injection augmentation (IAIA) procedure as a diagnostic and therapeutic tool to help determine which patients will be the most likely to respond to interarytenoid suture augmentation (IASA) or laryngeal cleft repair. This work represents the largest series in the literature on IAIA procedures, including one of the oldest patient populations, which serves to isolate the impact of this intervention and improve the ability of this data to best predict which patient will respond to IASA. This data has been incredibly useful to better inform peri-operative conversations with the families of patients undergoing these procedures.


Objective

To assess the efficacy of interarytenoid injection augmentation (IAIA) and the ability of IAIA to predict response to interarytenoid suture augmentation (IASA) based on diet advancement on video fluoroscopic swallow studies (VFSS).

Methods

Retrospective cohort analysis of patients with persistent pharyngeal dysphagia at a tertiary children's hospital with VFSS pre- and post-IAIA were included between March 2011 and June 2019.

Results

Median age of the 229 patients was 2.2 years (5.8 months–19 years). Interarytenoid mucosal height (IAMH) was found to be above the false vocal folds in 112 patients (53.4%) and at true vocal folds in 10 (4.9%) patients. On VFSS post-IAIA, 95 (41.5%) patients were successfully advanced in recommended diet consistency, 115 (50.2%) were stable, and 19 (8.3%) needed thicker consistency. Paired t-tests on pre- and post-operative consistency scores showed significant improvement, p-value of <0.0001, 95% confidence interval (CI; 0.50–0.85). Poisson regression found no covariates with significant association with improvement on IAIA. For IASA patients, 35/60 (58.3%) improved on post-op VFSS. Paired t-tests on pre- and post-operative consistency scores showed significant improvement, p-value of <0.0001, 95% CI (0.63–1.33). Positive predictive value for IAIA predicting response to IASA was 77% with positive likelihood ratio of 2.3. The response to IAIA versus no response to IAIA likelihood ratios were found to have a statistically significant difference (p < 0.05).

Conclusions

Our study suggests IAIA yields objective improvement in swallow function on VFSS in nearly half of our patients and may be a reliable diagnostic tool to predict response to IASA in patients with persistent pharyngeal dysphagia with or without a laryngeal cleft.

Level of Evidence

Level 3 Laryngoscope, 2022
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Polyetheretherketone CAD‐CAM framework for all‐on‐4 mandibular full arch prosthesis: Three years' retrospective study of periimplant soft tissue changes and ridge base relationship

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ABSTRACT

Purpose

: This study was conducted to evaluate the clinical peri-implant soft tissue changes during first year after occlusal loading and the ridge base relation after three years for mandibular CAD-CAM manufactured screw-retained implant-supported hybrid prosthesis of polyetheretherketone (PEEK) framework utilized with All-on-Four treatment concept.

Material and methods

: Sixteen completely edentulous patients were rehabilitated by 4 implants following the All-On-Four protocol. After 3 months, the definitive prosthesis was constructed to be a screw retained CAD-CAM milled framework from the modified PEEK (BioHPP), bonded to polymethylmethacrylate (PMMA) teeth and a pink shaded indirect light-polymerized nanofilled composite resin imitating the soft tissues. Peri-implant soft tissue changes regarding plaque, bleeding, gingival scores, and probing depth were evaluated at prosthesis insertion (T0), six months (T1) and 12 months (T2) after insertion. Also, monitoring of the ridge base relation was performed using cone beam computed tomography after one year (T0), two years (T1), and three years (T2) after mandibular fixed detachable All-on-Four framework insertion. Using Shapiro Wilk tests using SPSS® software version 22 (SPSS Inc.), all clinical data were non- parametric while the ridge base relation data was parametric.

Results

: There were statistically significant differences regarding plaque, gingival, and bleeding scores for all implants with advancement of time. However, there was a statistically insignificant difference regarding probing depth in the posterior implants (p = .581). Regarding ridge base relation, there was a significant difference between observation times only in the anterior ridge area in between the two anterior implants (p = .011).

Conclusion

: Within limitations of the study, the full arch PEEK framework of fixed-detachable, hybrid prosthesis used with All-on-Four concept for rehabilitation of mandibular edentulous arches is an acceptable treatment approach. Based on the stable ridge base relation posteriorly found in this study, less stress is distributed to the underlining bone due to the shock absorbing ability of PEEK. Special considerations for frequent soft tissue follow up and regular maintenance of oral hygiene measures are recommended.

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Implants in the pterygoid region: An updated systematic review of modern roughened surface implants

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ABSTRACT

Purpose

To determine the survival rates of modern roughened surface dental implants in the pterygoid region.

Material and Methods

This systematic review was an update from a previously published systematic review in 2011, which largely reported data on older machined surface dental implants. An electronic search for articles in the English language literature published from January 1, 2010 to December 8, 2021 was performed using PubMed, Scopus, and CENTRAL search engines. After applying a systematic search process in 3 stages, the final list of selected articles on roughened surface pterygoid implants was obtained. Data from the selected articles were collated with data from pertinent articles on roughened implant surface from the previous systematic review. The combined data was then used for calculating the interval survival rate (ISR) and cumulative survival rate (CSR) of pterygoid implants.

Results

The initial electronic search resulted in 1263 titles. The systematic search process eventually resulted in 10 clinical studies reporting on modern roughened surface pterygoid implants. These 10 studies reported on a total of 911 pterygoid implants with 39 reported failures over a 6-year period. The majority of failures (37) were reported during the first year time interval and a majority of them (30) occurred before loading of the pterygoid implants. Only 2 late failures were reported after loading, during the 6th year time interval. The majority of implants were used for rehabilitation of full arch fixed implant supported prosthesis. At the maximum follow-up interval of 6 years, the cumulative survival rate of pterygoid implants with roughened surfaces was 95.5%, which was 5% higher than reported in the previous systematic review which combined machined and roughed surface pterygoid implants.

Conclusions

The survival rate of modern roughened surface dental implants in the pterygoid region is favorable at 95.5% over a 6 year period, and comparable to the existing evidence on survival of implants in other regions of the maxilla and mandible.

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