Chemical constituents, viable micro-organism and malignant cell content in ultrasonic scalpel plume: A literature review.

PURPOSE: To identify all published data on the chemical, micro-organism and malignant cell contents of ultrasonic scalpel plume, if any, and on any clinical implications of the contents on patients and operating staff. METHODS: Searches were conducted aiming to identify all published evidence on the chemical constituents, presence/absence of viable micro-organisms and malignant cells in ultrasonic scalpel plume. Attempts were made to source unpublished industry data. RESULTS: There is evidence from human and in vitro studies of the presence of a range of harmful, and some human carcinogenic, chemicals within ultrasonic plume, mostly at very low concentrations. Any clinical relevance of this has not been studied. There is evidence from experimental studies of the presence of hepatitis virus, human coronavirus and human papillomavirus material within ultrasonic plume. Any clinical effect of this has not been studied. There is conflicting evidence from combined in vitro and mouse model studies of the presence of viable malignant cells within ultrasonic plume. Any clinical relevance of this has also not been studied. CONCLUSION: Overall, relatively little research into the plume has been published, and further study is required to more clearly delineate any potential risk to patients, surgeons and other theatre staff. Current safety recommendations are discussed.

Preventing bacterial disease in poultry in the post-antibiotic era: a case for innate immunity modulation as an alternative to antibiotic use.

The widespread use of antibiotics in the poultry industry has led to the emergence of antibiotic-resistant bacteria, which pose a significant health risk to humans and animals. These public health concerns, which have led to legislation limiting antibiotic use in animals, drive the need to find alternative strategies for controlling and treating bacterial infections. Modulation of the avian innate immune system using immunostimulatory compounds provides a promising solution to enhance poultry immune responses to a broad range of bacterial infections without the risk of generating antibiotic resistance. An array of immunomodulatory compounds have been investigated for their impact on poultry performance and immune responses. However, further research is required to identify compounds capable of controlling bacterial infections without detrimentally affecting bird performance. It is also crucial to determine the safety and effectiveness of these compounds in conjunction with poultry vaccines. This review provides an overview of the various immune modulators known to enhance innate immunity against avian bacterial pathogens in chickens, and describes the mechanisms involved.

Non-Antibiotic Compounds Synergistically Kill Chronic Wound-Associated Bacteria and Disrupt Their Biofilms.

Chronic wounds and their treatment present a significant burden to patients and healthcare systems alike, with their management further complicated by bacterial infection. Historically, antibiotics have been deployed to prevent and treat infections, but the emergence of bacterial antimicrobial resistance and the frequent development of biofilms within the wound area necessitates the identification of novel treatment strategies for use within infected chronic wounds. Here, several non-antibiotic compounds, polyhexamethylene biguanide (PHMB), curcumin, retinol, polysorbate 40, ethanol, and D-α-tocopheryl polyethylene glycol succinate 1000 (TPGS) were screened for their antibacterial and antibiofilm capabilities. The minimum inhibitory concentration (MIC) and crystal violet (CV) biofilm clearance against two bacteria frequently associated with infected chronic wounds, Staphylococcus aureus and Pseudomonas aeruginosa, were determined. PHMB was observed to have highly effective antibacterial activity against both bacteria, but its ability to disperse biofilms at MIC levels was variable. Meanwhile, TPGS had limited inhibitory activity but demonstrated potent antibiofilm properties. The subsequent combination of these two compounds in a formulation resulted in a synergistic enhancement of their capability to kill both S. aureus and P. aeruginosa and disperse their biofilms. Collectively, this work highlights the utility of combinatory approaches to the treatment of infected chronic wounds where bacterial colonization and biofilm formation remains significant issues.

Real-time analysis of dynamic compartmentalized GSH redox shifts and H2O2 availability in undifferentiated and differentiated cells.

BACKGROUND: Glutathione (GSH) is the most abundant, small biothiol antioxidant. GSH redox state (Eh) supports developmental processes, yet with disrupted GSH Eh, poor developmental outcomes may occur. The role of subcellular, compartmentalized redox environments in the context of redox regulation of differentiation is not well understood. Here, using the P19 neurogenesis model of cellular differentiation, kinetics of subcellular H2O2 availability and GSH Eh were evaluated following oxidant exposure. METHODS: Stably transfected P19 cell lines expressing H2O2 availability or GSH Eh sensors, Orp1-roGFP or Grx1-roGFP, respectively, targeted to the cytosol, mitochondria, or nucleus were used. Dynamic, compartmentalized changes in H2O2 availability and GSH Eh were measured via spectrophotometric and confocal microscopy over 120 min following treatment with H2O2 (100 µM) in both differentiated and undifferentiated cells. RESULTS: Generally, treated undifferentiated cells showed a greater degree and duration of both H2O2 availability and GSH Eh disruption than differentiated neurons. In treated undifferentiated cells, H2O2 availability was similar in all compartments. Interestingly, in treated undifferentiated cells, mitochondrial GSH Eh was most affected in both the initial oxidation and the rebound kinetics compared to other compartments. Pretreatment with an Nrf2 inducer prevented H2O2-induced effects in all compartments of undifferentiated cells. CONCLUSIONS: Disruption of redox-sensitive developmental pathways is likely stage specific, where cells that are less differentiated and/or are actively differentiating are most affected. GENERAL SIGNIFICANCE: Undifferentiated cells are more susceptible to oxidant-induced redox dysregulation but are protected by chemicals that induce Nrf2. This may preserve developmental programs and diminish the potential for poor developmental outcomes.

Converting Hybrid Potato Breeding Science into Practice.

Research on diploid hybrid potato has made fast advances in recent years. In this review we give an overview of the most recent and relevant research outcomes. We define different components needed for a complete hybrid program: inbred line development, hybrid evaluation, cropping systems and variety registration. For each of these components the important research results are discussed and the outcomes and issues that merit further study are identified. We connect fundamental and applied research to application in a breeding program, based on the experiences at the breeding company Solynta. In the concluding remarks, we set hybrid breeding in a societal perspective, and we identify bottlenecks that need to be overcome to allow successful adoption of hybrid potato.

Functional outcomes following mandibulectomy and fibular free-flap reconstruction.

There remains a paucity of evidence with regards to functional outcomes following the reconstruction of segmental defects in the mandible. It is, however, well recognised that oral rehabilitation following head and neck surgery is a driver of improved quality of life outcomes. We present a prospective service review of functional outcomes of a consecutive cohort of patients following segmental mandibulectomy and virtual surgical planning (VSP) composite fibular free-flap reconstruction. Twenty-five patients, who were identified as having a complete dataset with a minimum of 12 months' follow up, ultimately met the inclusion criteria. Validated functional outcome measures were used primarily to assess speech, diet, and swallowing outcomes. The results demonstrate a decline in both speech and swallowing outcomes at three months postoperatively, with a decline of 37% in the Speech Handicap Index from the preoperative baseline, and a decline of 35% in the MD Anderson Dysphagia Inventory score over the same period. The MD Anderson Dysphagia Inventory score improved at 12 months, whereas the Speech Handicap Index did not. Fundamentally a collaborative approach is required between members of the multidisciplinary team (MDT) to enable optimal patient outcomes.

Environmentally Acquired Bacillus and Their Role in C. difficile Colonization Resistance.

Clostridioides difficile is an environmentally acquired, anaerobic, spore-forming bacterium which ordinarily causes disease following antibiotic-mediated dysbiosis of the intestinal microbiota. Although much is understood regarding the life cycle of C. difficile, the fate of C. difficile spores upon ingestion remains unclear, and the underlying factors that predispose an individual to colonization and subsequent development of C. difficile infection (CDI) are not fully understood. Here, we show that Bacillus, a ubiquitous and environmentally acquired, spore-forming bacterium is associated with colonization resistance to C. difficile. Using animal models, we first provide evidence that animals housed under conditions that mimic reduced environmental exposure have an increased susceptibility to CDI, correlating with a loss in Bacillus. Lipopeptide micelles (~10 nm) produced by some Bacilli isolated from the gastro-intestinal (GI)-tract and shown to have potent inhibitory activity to C. difficile have recently been reported. We show here that these micelles, that we refer to as heterogenous lipopeptide lytic micelles (HELMs), act synergistically with components present in the small intestine to augment inhibitory activity against C. difficile. Finally, we show that provision of HELM-producing Bacillus to microbiota-depleted animals suppresses C. difficile colonization thereby demonstrating the significant role played by Bacillus in colonization resistance. In the wider context, our study further demonstrates the importance of environmental microbes on susceptibility to pathogen colonization.

Little heterosis found in diploid hybrid potato: The genetic underpinnings of a new hybrid crop.

Hybrid potato breeding has become a novel alternative to conventional potato breeding allowing breeders to overcome intractable barriers (e.g. tetrasomic inheritance, masked deleterious alleles, obligate clonal propagation) with the benefit of seed-based propagule, flexible population design, and the potential of hybrid vigor. Until now, however, no formal inquiry has adequately examined the relevant genetic components for complex traits in hybrid potato populations. In this present study, we use a 2-step multivariate modeling approach to estimate the variance components to assess the magnitude of the general and specific combining abilities in diploid hybrid potato. Specific combining ability effects were identified for all yield components studied here warranting evidence of nonadditive genetic effects in hybrid potato yield. However, the estimated general combining ability effects were on average 2 times larger than their respective specific combining ability quantile across all yield phenotypes. Tuber number general combining abilities and specific combining abilities were found to be highly correlated with total yield's genetic components. Tuber volume was shown to have the largest proportion of additive and nonadditive genetic variation suggesting under-selection of this phenotype in this population. The prominence of additive effects found for all traits presents evidence that the mid-parent value alone is useful for hybrid potato evaluation. Heterotic vigor stands to be useful in bolstering simpler traits but this will be dependent on target phenotypes and market requirements. This study represents the first diallel analysis of its kind in diploid potato using material derived from a commercial hybrid breeding program.

Micellar Antibiotics of Bacillus.

Members of the Bacillus genus, particularly the "Bacillus subtilis group", are known to produce amphipathic lipopeptides with biosurfactant activity. This includes the surfactins, fengycins and iturins that have been associated with antibacterial, antifungal, and anti-viral properties. We have screened a large collection of Bacillus, isolated from human, animal, estuarine water and soil samples and found that the most potent lipopeptide producers are members of the species Bacillus velezensis. B. velezensis lipopeptides exhibited anti-bacterial activity which was localised on the surface of both vegetative cells and spores. Interestingly, lipopeptide micelles (6-10 nm diameter) were detectable in strains exhibiting the highest levels of activity. Micelles were stable (heat and gastric stable) and shown to entrap other antimicrobials produced by the host bacterium (exampled here was the dipeptide antibiotic chlorotetaine). Commercially acquired lipopeptides did not exhibit similar levels of inhibitory activity and we suspect that micelle formation may relate to the particular isomeric forms produced by individual bacteria. Using naturally produced micelle formulations we demonstrated that they could entrap antimicrobial compounds (e.g., clindamycin, vancomycin and resveratrol). Micellar incorporation of antibiotics increased activity. Bacillus is a prolific producer of antimicrobials, and this phenomenon could be exploited naturally to augment antimicrobial activity. From an applied perspective, the ability to readily produce Bacillus micelles and formulate with drugs enables a possible strategy for enhanced drug delivery.

Dosimetry-guided virtual surgical planning in the reconstruction of mandibular osteoradionecrosis.

Patients with osteoradionecrosis (ORN) of the mandible pose additional challenges to the attending clinician when it comes to major reconstructive head and neck surgery. We present a novel technique to assist in the virtual surgical planning of mandibular ORN, which involves deforming previously delivered radiation dosimetry data on to the virtual mandible to aid in the assessment of surgical resection margins. This is a retrospective case series of patients whose treatment involved a traditional virtual surgical planning approach or dosimetry-guided virtual surgical planning. All the patients whose treatment involved dosimetry-guided virtual surgical planning had evidence of bony consolidation between the native mandible and fibular free flap. In comparison, only three of the nine patients in the traditional virtual surgical planning group demonstrated bony healing on subsequent imaging. In this known cohort of difficult-to-manage patients, any technique that helps to improve outcomes is a welcome addition to the armamentarium of the surgeon.

Relationship between proxies for Type II fiber type and resting blood pressure in Division I American Football Athletes.

OBJECTIVE: The risk for cardiovascular disease is well-documented. Perhaps surprisingly, specific athletic populations, including American football players, exhibit increased risk for cardiovascular disease as presented by elevated blood pressure. There is evidence suggesting a link between muscle fiber type distribution and resting blood pressure. Acknowledging this association, it becomes important to clarify an individual's risk for developing cardiovascular disease later in adulthood. The purpose of this study was to assess football performance measures-in particular proxies for muscular power-and their effect on resting blood pressure in football athletes. METHODS: A total of 80 collegiate-level football players participated in this study. Each participant's body fat %, body mass index, waist circumference, and mean arterial pressure (MAP) were measured. Participants performed one-repetition maximums of bench press, back squat, 40-yard dash, and vertical leap, and a power index (PI) defined as the product of vertical leap and mass. Linear regressions were run between body composition variables and performance measures for all players and a subset of skill players only. RESULTS: The PI was found to be positively, significantly correlated with MAP in all players (r = 0.269; P = 0.035) and the skill players subset (r = 0.425; P = 0.004). CONCLUSION: The results of the present study indicate an association between muscle fiber type distribution, as indicated by muscular power capacity, and resting blood pressure.

Management of patients with dental disease and mitochondrial disorders.

UNLABELLED: This case report describes dental disease associated with mitochondrial disease (Leigh's disease) in a young adult. Normal preventive dentistry is difficult in these groups of patients and often leads to management required in secondary care. An awareness of the background pathology is needed when managing these groups of patients. Management of dental pathology in this particular patient often required input from other specialties to ensure a successful outcome. CLINICAL RELEVANCE: To raise awareness of the dental pathologies patients with mitochondrial disease may experience as they present to the general dental practitioner, and what treatments may be appropriate.

Cranial osteomyelitis: a late complication of a dental infection.

Dental infections are associated with a range of serious complications. The orofacial region provides potential spaces in the tissue that infections of dental origin can occupy. We describe the subtemporal extension of a dental infection, the late development of cranial osteomyelitis, and its surgical management.

Oral mucosal response to exposure to diquat: a rare occupational injury.

Diquat is a quaternary ammonium herbicide closely related to paraquat, and is used commonly by commercial and domestic gardeners. The systemic toxicity of this group of compounds is well-known, but isolated human oral mucosal responses to topical exposure are not well-reported. We present details of an accidental mucosal exposure to diquat during manufacture and the resultant injury, and give guidance for appropriate management of such an exposure.

Extensive ablation during pulmonary vein antrum isolation has no adverse impact on left atrial function: an echocardiography and cine computed tomography analysis.

BACKGROUND: Although pulmonary vein antrum isolation (PVAI) may cure atrial fibrillation (AF) and improve left atrial (LA) function, the effect of extensive LA ablation on LA function is not well known. OBJECTIVE: To assess the impact of PVAI on LA function remotely postablation. METHODS: Consecutive patients undergoing PVAI had either transthoracic (TTE) and transesophageal (TEE) echocardiography (n = 41) or cine EBCT (n = 26) performed preablation and 6 months postablation. Only patients with paroxysmal and persistent, but not permanent, AF were included. Imaging was done in sinus rhythm for all patients. LA diameter (LAD), LA systolic and diastolic areas, and left atrial fractional area change (LFAC) were assessed by TTE. Transmitral (TMF), left atrial appendage (LAA), and pulmonary venous (PVF) Doppler flows were measured by TEE. Peak A on TMF, LAA peak emptying velocity (LAAF), and peak A reversal (AR) on PVF were used as surrogates of LA contractile function. Peak S on PV flow was used as a surrogate of reservoir function. LA areas, volumes, and LA ejection fraction (LAEF) were measured from cine EBCT. RESULTS: Mean radiofrequency ablation time was 45 +/- 21 minutes. All four PVs were isolated for all patients; there were no cases of PV stenosis. Echocardiography revealed a significant reduction in LAD and LA areas post-PVAI. Both peak A and peak AR were also higher post, while other variables showed strong trends toward improvement. In the subset of patients with persistent AF, post-PVAI improvements were seen in LA size, peak A, and even peak S (P = 0.04). Cine EBCT showed a significant decrease in both LA areas and volumes post-PVAI. There was also a significant improvement in LAEF post-PVAI from 17 +/- 6% to 22 +/- 5% (P = 0.01). CONCLUSION: Extensive ablation during PVAI does not cause deterioration in LA function, and may cause long-term improvement, especially in patients with higher AF burden.

Life care plans: an emerging area for occupational therapists.

BACKGROUND: Life care plans, or cost of future care reports as they are often called in Canada, are medico-legal documents that predict probable future medical and rehabilitation needs and costs. They are used when someone has sustained a serious personal injury in an accident, as the result of medical malpractice, or due to some other unnatural cause. Life care plans are generally commissioned by third-party payers in order to set aside adequate reserves for future costs or to negotiate a settlement. SCOPE: Life care plans need to be grounded in knowledge of how personal injury law has been applied and interpreted. Therefore, Canadian law pertaining to the costs of future care in personal injury will be briefly reviewed. The balance of the article discusses the process used to develop a life care plan, the necessary content, and accepted formats for reports. The article concludes with a case example that demonstrates the application of life care planning skills. PRACTICE IMPLICATIONS: Occupational therapists are well suited to developing these plans by virtue of their training, knowledge base, and theoretical approaches. This is an emerging consultative role for experienced therapists.