Tuesday, November 1, 2022

Tracking down the recent surge of polio virus in endemic and outbreak countries.

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Abstract

Continuous and progressive efforts are being made globally to eradicate the incidence of polio virus. The detrimental nature of polio calls for action of global vaccination. Owing to large scale vaccination efforts, many countries have been declared polio-free and the people are fully vaccinated against polio virus. However, concern still remains as new cases are being identified in countries declared polio free. This scenario is particularly noticed due to the comprised healthcare system in the past three years of the Corona pandemic. Conditions for lower middle income countries are more problematic, where there are meager healthcare resources and the burden on the healthcare system is higher. Studies indicate some cases of non-paralytic species of polio including cVDPV1, cVDPV2, and cVDPV3 in the group of outbreak countries. However, the major problem is associated with wild type polio virus i.e. WPV1 that leads to paralytic disease and is still present in endemic countries, such as Afghanistan and Pakistan. The incidence rate of wild polio cases has significantly decreased in comparison to the past years but the problem needs to be dealt with at the grass-roots level. In this article, the most recent data has been collected pertaining to the incidence of multi-variant species of polio virus, with a special focus on endemic and outbreak countries. A short overview of challenges to vaccination and a recommendatory overview has also been included for dealing with polio surges.

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An Endoscopic Cap Electrode for Posterior Cricoarythenoid Muscle Stimulation in a Porcine Model

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An Endoscopic Cap Electrode for Posterior Cricoarythenoid Muscle Stimulation in a Porcine Model

The article describes the development of a diagnostic procedure with a novel endoscopic cap to identify patients with vocal fold immobility who are eligible for implantation of future laryngeal pacing systems. The concept aims at transferring the examination to a gastroscopy setting.


Objective

Laryngeal pacing (LP) is a highly anticipated therapeutic option for patients suffering from bilateral vocal fold paralysis with synkinesis. Identification of candidate patients requires confirmation of a stimulable posterior cricoidarythenoid muscle (PCA) by neuromuscular electrical stimulation (NMES). A silicone endoscopic cap electrode (ECE50) was designed to be operated as an endoscopic extension tip for selective PCA stimulation and confirmation of a glottic opening movement in a setting comparable to a gastroscopy procedure.

Methods

A porcine animal model (n = 6) was applied to develop and test endoscopic cap prototypes in general anesthesia and sedation at a biomedical research center. Two ENT endoscopy experts evaluated and refined the cap design and performance in regard to procedure safety, endoscope handling, accessibility of the PCA by the transoral approach and selective muscle stimulation.

Results

Vocal fold opening movements could be evoked by the investigators in 9 of 12 PCA muscles to stimulate with similar electric parameters. The endoscopic approach using the ECE50 proved to be atraumatic and sufficiently controlled under sedation to locate the required hotspot for NMES of the PCA.

Conclusion

The functionality of the novel endoscopic cap concept has been proven in a porcine model. It can be expected to be transferable to human application and to be of diagnostic importance in the screening and identification of LP candidate patients in future.

Level of Evidence

NA Laryngoscope, 2022

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“Alexa, lock my front door”: An empirical study on factors affecting consumer's satisfaction with VCA‐controlled security devices

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Abstract

Voice conversation agents (VCAs) have moved beyond simple tasks such as information gathering. The integration of VCAs in smart technologies for security has grown in the consumer market. This paper investigates consumers' motivation to use smart technologies controlled by voice conversational agents and how that impacts their perceived hedonic and utilitarian value, which eventually leads to their satisfaction with smart technologies usage. Two cross-sectional studies and a netnography were conducted. The findings showed that the variables measuring technology acceptance mediate the relationship between consumers' motivation and the perceived value of the VCA-controlled smart technologies. Study 1 results show that ease of use and usefulness of the VCA-controlled smart technologies have a more substantial mediating effect between motivation and hedonic value than utilitarian value. For study 2, results show that the mediators had a stronger influence on hedonic and utilitarian va lues for outdoor voice conversational agent-controlled smart technologies than indoor smart technologies. Study 3 showed that smart technologies have both risks and benefits and depend on whether they are being used for themselves or others. The results suggest that marketers need to consider consumer's emphasis on the products' features including its ease of use and usefulness, and strategically complement it with consumers' prevention and promotion focus for each product.

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Validation of a modified bedside Pediatric Early Warning System score for detection of clinical deterioration in hospitalized pediatric oncology patients: A prospective cohort study

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Abstract

Background

Hospitalized pediatric oncology patients are at risk of severe clinical deterioration. Yet Pediatric Early Warning System (PEWS) scores have not been prospectively validated in these patients. We aimed to determine the predictive performance of the modified BedsidePEWS score for unplanned pediatric intensive care unit (PICU) admission and cardiopulmonary resuscitation (CPR) in this patient population.

Methods

We performed a prospective cohort study in an 80-bed pediatric oncology hospital in the Netherlands, where care has been nationally centralized. All hospitalized pediatric oncology patients aged 0–18 years were eligible for inclusion. A Cox proportional hazard model was estimated to study the association between BedsidePEWS score and unplanned PICU admissions or CPR. The predictive performance of the model was internally validated by bootstrapping.

Results

A total of 1137 patients were included. During the study, 103 patients experienced 127 unplanned PICU admissions and three CPRs. The hazard ratio for unplanned PICU admission or CPR was 1.65 (95% confidence interval [CI]: 1.59–1.72) for each point increase in the modified BedsidePEWS score. The discriminative ability was moderate (D-index close to 0 and a C-index of 0.83 [95% CI: 0.79–0.90]). Positive and negative predictive values of modified BedsidePEWS score at the widely used cutoff of 8, at which escalation of care is required, were 1.4% and 99.9%, respectively.

Conclusion

The modified BedsidePEWS score is significantly associated with requirement of PICU transfer or CPR. In pediatric oncology patients, this PEWS score may aid in clinical decision-making for timing of PICU transfer.

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Selenium ameliorates inflammation by decreasing autophagic flux and mitogen‐activated protein kinase signalling on experimentally induced rat periapical lesions

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Abstract

AIM

To reveal the molecular mechanisms that targets mitogen-activated protein kinase (MAPK) signalling and the autophagic flux and to investigate the possible effects of the systemic administration of selenium (Se) on experimentally induced rat periapical lesions.

METHODOLOGY

Thirty adult Sprague Dawley rats were divided equally into negative control, positive control and Se groups. In the positive control and Se groups, the pulp chambers of their mandibular first molars were exposed to the oral environment to induce periapical lesions The Se group received daily intraperitoneal injections of Se at a dose of 0.1 mg kg−1. After 28 days, the amount of bone destruction; severity of inflammation; penetration of microorganisms along the root canal; collagen degradation in periodontal ligament; interleukin (IL)-6, hypoxia-inducible factor-1 (HIF-1), cyclooxygenase-2 (COX-2) and caspase-3 expression; autophagic flux; and p38 MAPK signalling were evaluated using radiographic, histopathological, Gram staining, picrosirius red stain, immunohistochemical, quantitative real-time polymerase chain (qRT–PCR) and western blot methods, respectively. The data was analysed through the Kruskal–Wallis and Dunnett's tests (p<0.05).

RESULTS

The area of radiographic periapical bone loss, histopathological scores, the area of periapical bone loss and the scores for the bacteria localisation, the intensity of immunohistochemical staining for IL-6, HIF-1, COX-2 and caspase-3 in the Se group was significantly less than those of the positive control group (p<0.01). The mRNA expression levels of Beclin-1, Atg3, Atg5, Atg7, and Atg16L1 were lower in the Se group than in the positive control group (p<0.01). The protein expressions of Beclin-1, Atg5 and LC3-II, the phosphorylation ratio of the p38 MAPK and the ratios of LC3II/LC3I were significantly higher (p<0.05) in the positive control and Se groups. On the other hand, the expression of the p62/SQSTM1 protein was significantly lower (p < 0.05) in the positive control and Se groups than in the negative control group.

CONCLUSION

The induction of periapical lesions in rats increased autophagic flux and activated p38 MAPK signal transduction processes. Se suppressed the inflammatory process, reduced bone destruction and both the autophagic flux and p38 MAPK activation.

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Biocompatibility and bioactive potential of an experimental tricalcium silicate‐based cement in comparison with Bio‐C Repair and MTA HP Repair materials

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Abstract

Aim

To evaluate the tissue reaction of a tricalcium silicate-based repair material associated with 30% calcium tungstate (TCS + CaWO4) in comparison to Bio-C Repair (Bio-C; Angelus, Brazil) and to MTA Repair HP (MTA HP; Angelus, Brazil).

Methodology

Polyethylene tubes filled with one of the materials or left empty (control group, CG) were implanted into the subcutaneous tissues of rats for 7, 15, 30 and 60 days (n = 32/group). The capsule thickness, number of inflammatory cells, collagen content, interleukin-6 (IL-6), osteocalcin (OCN), von Kossa reaction and analysis under polarised light were evaluated. The data which were subjected to generalised linear models for repeated measures, except the OCN. OCN data were submitted to Kruskal-Wallis and Dunn's post hoc test, and Friedman followed by Nemenyi's test at significance level of 5%.

Results

At all time points, significant differences in the number of inflammatory cells were not observed between TCS + CaWO4 and Bio-C whereas, at 15, 30 and 60 days, no significant difference was detected between TCS + CaWO4 and MTA HP. At all periods, significant differences were not detected in the number of fibroblasts in TCS + CaWO4 versus MTA HP and, at 60 days, no significant difference was demonstrated between these groups and CG. Significant differences in the immunoexpression of IL-6 were not detected among bioceramic materials at all periods. From 7 to 60 days, significant reduction in the number of inflammatory cells, number of IL-6-immunopositive cells and in the capsule thickness was accompanied by significant increase in the collagen in all groups. OCN-immunolabelled cells, von Kossa-positive structures and amorphous calcite deposits were observed around all materials whereas, in the CG, these structures were not seen.

Conclusions

These findings indicate that the experimental material (TCS + CaWO4) is biocompatible and has a bioactive potential, similarly to the MTA HP and Bio-C Repair, and suggest its use as a root repair material.

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Survey the effect of drug treatment on modulation of cytokines gene expression in Allergic Rhinitis

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Allergic rhinitis as common airway disease has high prevalence in all peoples worldwide. In allergic diseases, Th2 cells release type 2 cytokines which support the inflammation in airways. All the drugs used for allergic rhinitis, do not cure completely, and the choice of drugs according to cost and efficacy is very important in all groups of atopic patients. Therefore, in this study, the effect of commercial drugs on cytokine gene expression has been studied. Male Balb/c mice were divided into six groups. Allergic rhinitis was induced in five of the six groups with ovalbumin, and four of these five groups were treated with salbutamol, budesonide, theophylline and montelukast. The 5th group was used as positive control group and the 6th group as negative control group. For the survey, RNA was extracted, cDNA was synthesized, and quantitative real time PCR was done for 21 genes. The four drugs had different effect on mRNA expression of cytokines (IL-1b, 2, 4, 5, 7, 8, 9, 11, 12, 13 , 17, 18, 22, 25, 31, 33, 37, IFN-γ, TNF-α, TGF-β1 and Eotaxin) in the allergic rhinitis groups. Salbutamol can be used during pregnancy and breastfeeding, but it has some side effects. Budesonide in the inhaled form is generally safe in pregnancy. Theophylline cannot control allergic attack in the long run. Montelukast is not useful in the treatment of acute. Immunomodulatory and anti-inflammatory effects of drugs in control of allergic rhinitis via Th2 cytokines can be new approaches in molecular medicine.

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Association of preoperative low skeletal muscle mass with postoperative complications after selective neck dissection

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Skeletal muscle mass (SMM) is an emerging predictive and prognostic factor in head and neck cancer patients. The aim of this study was to investigate the predictive value of low SMM for postoperative complications in clinically T1 –2 oral cavity cancer patients undergoing selective neck dissection. A retrospective study in clinically T1–2 oral cavity cancer patients who underwent selective neck dissection between 2011 and 2017 was performed. The predictive value of low SMM for the occurrence of postoperative complications and prolonged hospital stay was evaluated. (Source: International Journal of Oral and Maxillofacial Surgery)
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COVID-19 Vaccination and the Timing of Surgery Following COVID-19 Infection

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imageObjective: To evaluate whether COVID-19 vaccination status or mode of anesthesia modified the temporal harms associated with surgery following coronavirus disease-2019 (COVID-19) infection. Background: Surgery shortly after COVID-19 infection is associated with higher rates of complications, leading to recommendations to delay surgery following COVID-19 infection when possible. However, prior studies were based on populations with low or no prevalence of vaccination. Methods: A retrospective cohort study of patients who underwent scheduled surgery in a health system from January 1, 2018 to February 28, 2022 (N=228,913) was performed. Patients were grouped by time of surgery relative to COVID-19 test positivity: 0 to 4 weeks after COVID-19 ("early post-COVID-19"), 4 to 8 weeks after COVID-19 ("mid post-COVID-19"), >8 weeks after COVID-19 ("late post-COVID-19"), surgery at least 30 days before subsequent COVID-19 ("pre-COVID-19"), and surgery with no prior or subsequent test positivity for COVID-19. Results: Among patients who were not fully vaccinated at the time of COVID-19 infection, the adjusted rate of perioperative complications for the early post-COVID-19 group was significantly higher than for the pre-COVID-19 group (relative risk: 1.55; P=0.05). No significantly higher risk was identified between these groups for patients who were fully vaccinated (0.66; P=1.00), or for patients who were not fully vaccinated and underwent surgery without general anesthesia (0.52; P=0.83). Conclusions: Surgery shortly following COVID-19 infection was not associated with higher risks among fully vaccinated patients or among patients who underwent surgery without general anesthesia. Further research will be valuable to understand additional factors that modify perioperative risks associated with prior COVID-19 infection.
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A Gene Expression Signature to Select Hepatocellular Carcinoma Patients for Liver Transplantation

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imageObjective: To propose a new decision algorithm combining biomarkers measured in a tumor biopsy with clinical variables, to predict recurrence after liver transplantation (LT). Background: Liver cancer is one of the most frequent causes of cancer-related mortality. LT is the best treatment for hepatocellular carcinoma (HCC) patients but the scarcity of organs makes patient selection a critical step. In addition, clinical criteria widely applied in patient eligibility decisions miss potentially curable patients while selecting patients that relapse after transplantation. Methods: A literature systematic review singled out candidate biomarkers whose RNA levels were assessed by quantitative PCR in tumor tissue from 138 HCC patients submitted to LT (>5 years follow up, 32% beyond Milan criteria). The resulting 4 gene signature was combined with clinical variables to develop a decision algorithm using machine learning approaches. The method was named HepatoPredict. Results: HepatoPredict identifies 99% disease-free patients (>5 year) from a retrospective cohort, including many outside clinical criteria (16%–24%), thus reducing the false negative rate. This increased sensitivity is accompanied by an increased positive predictive value (88.5%–94.4%) without any loss of long-term overall survival or recurrence rates for patients deemed eligible by HepatoPredict; those deemed ineligible display marked reduction of survival and increased recurrence in the short and long term. Conclusions: HepatoPredict outperforms conventional clinical-pathologic selection criteria (Milan, UCSF), providing superior prognostic information. Accurately identifying which patients most likely benefit from LT enables an objective stratification of waiting lists and information-based allocation of optimal versus suboptimal organs.
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