Detect and suppress future zoonotic‐derived outbreaks: A lesson from last two decades

alexandrossfakianakis shared this article with you from Inoreader Detect and suppress future zoonotic‐derived outbreaks: A lesson from last two decades via Journal of Medical Virology Abstract COVID-19 pandemic has revealed how vulnerable and inexperienced we are when dealing with an unprecedented global infectious threat. Looking back on the last few decades, there has been a surge in zoonotic-derived viruses globally. Notably, these outbreaks emerged as harmless zoonotic diseases within a favorable environment, then spilled over to humans and widely spread to become outbreaks. Most of these are respiratory viruses (particularly Orthomyxoviridae Orthomyxoviridae or Coronaviridae Coronaviridae family), with high transmissibility and can be easily spread. Low- and middle-income countries, particularly those with tropical climates, provide ideal environments for the growth and evolution of these zoonotic viruses. Nevertheless, a lot of our advanced centers for infectious diseases are located in high-income countries (HIC) and focus on human pathogens only (e.g., influenza, RSV, adenovirus). We should critically think about reallocating health resources in th e near-term. It is an urge for a few surveillance centers aim to detect surges in cases of respiratory pathogens or any spikes in cases, and suppress the transmission chain from an early stage. In this article, we digest lessons learned from the previous spillover pandemics and suggest actionable tactics to deal with future pandemics properly. This article is protected by copyright. All rights reserved. View on Web

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Genetic characteristics and treatment outcome in infants with KMT2A germline B‐cell precursor acute lymphoblastic leukemia: Results of MLL‐Baby protocol

alexandrossfakianakis shared this article with you from Inoreader Genetic characteristics and treatment outcome in infants with KMT2A germline B‐cell precursor acute lymphoblastic leukemia: Results of MLL‐Baby protocol via Pediatric Blood & Cancer Abstract The aim of this study was to present the diagnostic and outcome characteristics of infants with germline status of KMT2A gene (KMT2A-g) B-cell precursor acute lymphoblastic leukemia (BCP-ALL) treated consistently according to the MLL-Baby protocol, a moderate-intensity protocol. Of the 139 patients enrolled in the MLL-Baby study, 100 (71.9%) carried different types of rearranged KMT2A (KMT2A-r), while the remaining 39 infants (28.1%) had KMT2A-g. KMT2A-g patients were generally older (77% older than 6 months), less likely to have a very high white blood cell count (greater than 100 × 109/L), less likely to be central nervous system (CNS)-positive, and more likely to be CD10-positive. The 6-year event-free survival and overall survival rates for all 39 patients were 0.74 (standard error [SE] 0.07) and 0.80 (SE 0.07), respectively. Relapse was the most common adverse event (n = 5), with a cumulativ e incidence of relapse (CIR) of 0.13 (SE 0.06), while the incidence of a second malignancy (n = 1) and death in remission (n = 3) was 0.03 (SE 0.04) and 0.08 (SE 0.04), respectively. None of the initial parameters, including genetics and the presence of recently described fusions of NUTM1 and PAX5 genes, was able to distinguish patients with different outcomes. Only rapidity of response, measured as minimal residual disease (MRD) by flow cytometry, showed a statistically significant impact. Moderate-intensity therapy, as used in the MLL-Baby protocol in infants with KMT2A-g BCP-ALL, yields results comparable to other infant studies. Patients with a slow multicolor flow cytometry (MFC)-MRD response should be subjected to advanced therapies, such as targeted or immunotherapies. View on Web

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The incidence and characterization of weight gain associated with MEK inhibitors in pediatric patients

alexandrossfakianakis shared this article with you from Inoreader The incidence and characterization of weight gain associated with MEK inhibitors in pediatric patients via Pediatric Blood & Cancer Abstract Background Mitogen-activated protein kinase enzyme (MEK) inhibitors are used in the treatment of pediatric patients with neurofibromatosis, low grade glioma, and astrocytoma, and may demonstrate a unique side effect profile in this population. Inhibition of MEK has been shown to decrease interleukin (IL)-6 production, a proinflammatory cytokine. The inhibition of IL-6 and other proinflammatory cytokines is thought to decrease muscle wasting and may contribute to weight gain. However, there is limited information on the association of MEK inhibition and weight gain in children and adolescents. This study aimed to characterize and define the incidence of significant weight gain associated with MEK inhibitors in pediatric patients. Methods This was a retrospective chart review conducted at a tertiary pediatric hospital. Children 1–18.99 years old were included if they started a MEK inhibitor from July 1, 2013–October 31, 2021, and continued therapy for at least 6 months. Significant weight gain was defined as ≥5% increase in patient's weight-for-age percentile. Results Sixty-seven patients were included in the analysis. Sixty-two received trametinib and 5 received selumetinib. An increase in weight-for-age percentile ≥5% was seen in 60% of patients receiving selumetinib and 56% on trametinib. The Dunnett's multiple comparisons test revealed a difference in weight-for-age percentile from baseline to end of data collection (p = .0173). Patients who were obese at baseline were more likely to lose weight during treatment, while underweight patients increased in weight-for-age percentiles. Conclusions Weight gain may be a notable side effect associated with the use of MEK inhibitors in pediatric patients. View on Web

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Paralysis Versus Non‐Paralysis Anesthesia for Operative Laryngoscopy: A Randomized Controlled Trial

alexandrossfakianakis shared this article with you from Inoreader Paralysis Versus Non‐Paralysis Anesthesia for Operative Laryngoscopy: A Randomized Controlled Trial via The Laryngoscope We conducted a prospective, single-blinded randomized controlled trial at an ambulatory surgery center comparing two standard-of-care anesthesia regimens for laryngeal surgeries using a direct laryngoscopy approach: anesthesia with paralysis using rocuronium and anesthesia without paralysis using a continuous remifentanil/propofol infusion. Intraoperative impressions, anesthesia data, and post-operative patient surveys were collected. Anesthesia with paralysis during direct laryngoscopy was associated with more favorable surgical conditions and post-op pain compared to anesthesia with propofol and remifentanil. Objective To compare outcomes between two standard-of-care anesthesia regimens for operative laryngoscopy: general anesthesia with a neuromuscular blocking agent (NMBA) versus remifentanil and propofol (non-NMBA). Methods This was a prospective, single-blinded, randomized controlled trial at a tertiary care center. Patients were randomized to either anesthesia using rocuronium (NMBA) or with remifentanil/propofol infusion alone (non-NMBA). Intraoperative impressions, anesthesia data, and post-operative patient surveys were collected. Results Sixty-one patients who underwent suspension laryngoscopy from 2020 to 2022 were included (25 female, 36 male, ranging 20–81 years). Thirty patients were enrolled in the NMBA arm and 31 patients in the non-NMBA arm. Heart rate and mean arterial pressure were higher in the NMBA (p < 0.01). Patients in the non-NMBA group were more likely to require vasopressors (p = 0.04, RR = 3.08 [0.86–11.05]). Surgeons were more frequently satisfied with conditions in the NMBA group (86.7%) compared to the non-NMBA group (58.1%, p < 0.01). Procedures were more likely to be paused due to movement in the non-NMBA group (45.1%) compared to the NMBA group (16.6%, p < 0.03, RR = 2.26 [1.02–4.99]). Patients in the non-NMBA group were more likely to endorse myalgia the week after surgery (44%) compared to the NMBA group (8.3%, p < 0.01) and reported higher average pain levels on a 0–10 pain scale (3.7) compared to the paralysis group (2.0). Conclusions Anesthesia with rocuronium was associated with better intraoperative conditions and postoperative pain compared to anesthesia with remifentanil/propofol. Remifentanil/propofol were associated with lower blood pressure and suppression of laryngoscopy-associated tachycardia. Level of Evidence Level 2 Laryngoscope, 2023 View on Web

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Automated Creak Differentiates Adductor Laryngeal Dystonia and Muscle Tension Dysphonia

alexandrossfakianakis shared this article with you from Inoreader Automated Creak Differentiates Adductor Laryngeal Dystonia and Muscle Tension Dysphonia via The Laryngoscope Objective The purpose of this study was to determine whether automated estimates of vocal creak would differentiate speakers with adductor laryngeal dystonia (AdLD) from speakers with muscle tension dysphonia (MTD) and speakers without voice disorders. Methods Sixteen speakers with AdLD, sixteen speakers with MTD, and sixteen speakers without voice disorders were recorded in a quiet environment reading aloud a standard paragraph. An open-source creak detector was used to calculate the percentage of creak (% creak) in each of the speaker's six recorded sentences. Results A Kruskal-Wallis one-way analysis of variance revealed a statistically significant effect of group on the % creak with a large effect size. Pairwise Wilcoxon tests revealed a statistically significant difference in % creak between speakers with AdLD and controls as well as between speakers with AdLD and MTD. Receiver operating characteristic curve analyses indicated that % creak differentiated AdLD from both controls and speakers with MTD with high sensitivity and specificity (area under the curve statistics of 0.94 and 0.86, respectively). Conclusion Percentage of creak as calculated by an automated creak detector may be useful as a quantitative indicator of AdLD, demonstrating the potential for use as a screening tool or to aid in a differential diagnosis. Level of Evidence 3 Laryngoscope, 2023 View on Web

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Use of incorrect and correct methods to account for age in studies on epigenetic accelerated aging: implications and recommendations for best practices

alexandrossfakianakis shared this article with you from Inoreader Use of incorrect and correct methods to account for age in studies on epigenetic accelerated aging: implications and recommendations for best practices via American Journal of Epidemiology - Advance Access Abstract Motivated by our conduct of a literature review on social exposures and accelerated aging as measured by a growing number of epigenetic "clocks" (which estimate age via DNA methylation patterns (DNAm)), we report on three different approaches – 1 incorrect and 2 correct – in the epidemiologic literature on treatment of age in these and other studies using other common exposures (i.e., body mass index and alcohol consumption). Among the 50 empirical articles reviewed, the majority (n = 29; 58%) used the incorrect method of analyzing accelerated aging detrended for age as the outcome and did not control for age as a covariate. By contrast, only 42% used the correct methods, which are either to analyze accelerated aging detrended for age as the outcome and control for age as a covariate (n = 16; 32%), or to analyze raw DNAm age as the outcome and control for age as a covariate (n = 5; 10%). In accord with prior demonstrations of bias introdu ced by the incorrect approach, we provide simulation analyses and additional empirical analyses to illustrate how the incorrect method can lead to bias to the null, and we discuss implications for extant research and recommendations for best practices. View on Web

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Risk prediction in early childhood SHH medulloblastoma treated with radiation-avoiding chemotherapy: Evidence for more than two subgroups

alexandrossfakianakis shared this article with you from Inoreader Risk prediction in early childhood SHH medulloblastoma treated with radiation-avoiding chemotherapy: Evidence for more than two subgroups via Neuro-Oncology Advance Access Abstract Background The prognostic impact of clinical risk factors and DNA methylation patterns in sonic hedgehog (SHH)-activated early childhood desmoplastic/nodular medulloblastoma (DMB) or medulloblastoma with extensive nodularity (MBEN) were evaluated to better identify patients at risk for relapse. Methods Hundred-forty-four patients with DMB (n=99) or MBEN (n=45) aged <5 years and treated with radiation-sparing approaches, including intraventricular methotrexate in 132 patients, were evaluated. Results Patients with DMB had less favorable 5-year progression-free survival than MBEN (5y-PFS, 71% [DMB] vs 93% [MBEN]). Patients' age >3 years was associated with more unfavorable 5y-PFS (47% [>3 years] vs 85% [<1 year] vs 84% [1-3 years]). DNA methylation profiles available (n=78) were reclassified according to the 2021 WHO classification into SHH-1 (n=39), SHH-2 (n=38), and SHH-3 (n=1). Hierarchical clustering de lineated two subgroups among SHH-2: SHH-2a (n=19) and SHH-2b (n=19). Patients with SHH-2b medulloblastoma were older, predominantly displayed DMB histology, and were more often located in the cerebellar hemispheres. Chromosome 9q losses were more frequent in SHH-2b, while few chromosomal alterations were observed in SHH-2a. SHH-2b medulloblastoma carried a significantly increased relapse risk (5y-PFS: 58% [SHH-2b] vs 83% [SHH-1] vs 95% [SHH-2a]). Subclassification of SHH-2 with key clinical and cytogenetic characteristics was confirmed using two independent cohorts (total n=188). Gene mutation analysis revealed a correlation of SHH-2a with SMO mutations. Conclusion These data suggest further heterogeneity within early childhood SHH-DMB/MBEN: SHH-2 splits into a very low-risk group SHH-2a enriched for MBEN histology and SMO mutations, and SHH-2b comprising older DMB patients with higher risk of r elapse. View on Web

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Photo‐/ mechanical and physical implant surface decontamination approaches in conjunction with surgical peri‐implantitis treatment: A systematic review

alexandrossfakianakis shared this article with you from Inoreader Photo‐/ mechanical and physical implant surface decontamination approaches in conjunction with surgical peri‐implantitis treatment: A systematic review via Journal of Clinical Periodontology Abstract Aim To evaluate the efficacy of adjunctive/alternative photo-/mechanical and physical implant-surface decontamination approaches compared to a standard instrumentation in conjunction with surgical peri-implantitis treatment. Materials and Methods Randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) investigating the efficacy of adjunctive or alternative photo-/mechanical/physical measures for implant surface decontamination in conjunction with surgical peri-implantitis treatment without (PICOS 1) or with (PICOS 2) additional decontamination methods performed in test and control groups with changing inflammation parameters. Changes in bleeding scores (i.e., bleeding index (BI), or bleeding on probing (BOP)), suppuration (SUP) and PD values were considered as primary outcomes. Results Six articles describing five original RCTs were eligible for analysis. Based on two RCTs, the adjunctive/alternative use of an air polishing with glycine or erythritol powders did not improve BOP reduction compared to a standard instrumentation (PICOS 1). Based on one RCT, alternative use of titanium brushes resulted in significantly higher BOP reduction compared to either air polishing or a standard instrumentation (PICOS 1). During reconstructive therapy and as an adjunct to implantoplasty, use of a titanium brush did not have a benefit on the BOP and mean PD reductions compared to the control group (i.e., implantoplasty + mechanical and chemical implant surface decontamination; 1 RCT; PICOS 2). An Er:YAG laser resulted in significantly higher PD reduction after 6 months (1 RCT), whereas no difference between the test and respective controls could be detected after 1 and 2 years (1 RCT). Additionally, the use of the Er:YAG laser was not associated with improved BOP reductions over respective controls (2 RCTs; PICOS 2). Conclusions Due to the limited available data, clinical efficacy of photo-/mechanical and physical implant surface decontamination in conjunction with surgical peri-implantitis therapy is inconclusive. However, titanium brushes may be beneficial in reducing signs of inflammation. View on Web

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Accuracy of implant placement using CAD‐CAM tooth‐supported surgical guides for an auricular prosthesis in vitro

alexandrossfakianakis shared this article with you from Inoreader Accuracy of implant placement using CAD‐CAM tooth‐supported surgical guides for an auricular prosthesis in vitro via Journal of Prosthodontics Abstract Purpose To evaluate the accuracy of tooth-supported surgical guides used to place implants in auricular prostheses. The accuracy (trueness and precision) of the implant positions was evaluated, and the difference between the surgical guide with and without retention of the external auditory canal was compared. Materials and methods This study simulated implant placement in vitro for the treatment of right auricle malformation. Surgical guides and other casts were fabricated using additive manufacturing technology. The casts were divided into two groups according to the surgical guide, with 10 bone blocks in each group (with or without the external auditory canal plug (Guide 1 and Guide 2)). Three implant positions (Implants 1, 2, and 3) were prepared for each bone block using surgical guides. Implant positions were registered using light-body silicone impressions combined with optical surface scans to measure the coronal, apical, depth, and angular deviations. Four deviations of trueness and precision were reported as the mean ± standard deviation which was analyzed by Student's t-test. Results Each group of 10 bone blocks with 30 implant positions were successfully prepared and digitally reproduced as implants. The accuracy of implant position with surgical guides were acceptable when compared with the preoperatively planned implant positions. Compared with the Guide 2 group, there was a significant difference in the apical, depth, and angular deviations of Guide 1 group in terms of precision (p<0.001). There was a significant difference in the depth deviation of Implant 1 (p = 0.028) and apical deviation of Implant 2 (p<0.001) compared two groups in terms of trueness. In terms of precision, there was a significant difference in the coronal (p = 0.002), apical (p<0.001), and depth (p<0.001) deviation of Implant 1; apical (p = 0.036) and angular (p<0.001) deviation of Implant 2 also existed significant difference; the coronal deviation of Implant 3 (p = 0.018) also existed significant difference. Moreover, the group with the external auditory canal plug showed lower deviation in precision and a smaller volume in the 95% confidence ellipsoid. Conclusion Both types of tooth-supported surgical guides can provide acceptable accuracy. A surgical guide with an external auditory canal plug was considered to be more precise. This article is protected by copyright. All rights reserved View on Web

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A Novel Sampling Device for the Quantification of Primary Aromatic Amines on Surfaces

alexandrossfakianakis shared this article with you from Inoreader A Novel Sampling Device for the Quantification of Primary Aromatic Amines on Surfaces via Annals of Work Exposures and Health Advance Access Abstract Primary aromatic amines (PAAs) are a class of hazardous substances where many compounds are classified as carcinogen, mutagen, and reproduction toxin (CMR). PAAs can be taken up by dermal exposure. In the polyurethane industry, a valid and trustworthy method for the quantification of PAAs in the presence of isocyanates that could interfere is of great interest, especially on workplaces where a regular contact to PAAs cannot be excluded. The aim of this work is the development, validation, and verification of a novel sampling device to quantify selectively the PAA load on work surfaces. We describe the synthesis of Cell-ßALA-PEMSA analytical papers and their characterization by infrared spectroscopy and thermogravimetric analysis. The recovery of TDA and MDA spiked on these filters is satisfactory. An excellent selectivity of Cell-ßALA-PEMSA papers towards PAAs in the presence of isocyanates of almost 100% was found by wipe tests of amine/isocya nate contaminated surfaces. First positive field tests were achieved at certain areas in a Polyurethane Technical Application Department where surface contamination with PAAs was expected, and the Cell-ßALA-PEMSA analytical papers were superior to an established method of surface sampling. However, recovery of these amines from surfaces shows a large variability, and more work is required to address influencing surface properties. View on Web

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