Impact of myocardial ischemia on myocardial revascularization in stable ischemic heart disease. Lessons from the COURAGE and FAME 2 trials.

In patients with stable ischemic heart disease (SIHD), myocardial revascularization should be performed to either improve survival or improve symptoms and functional status among patients who are not well controlled with optimal medical therapy (OMT). A general consensus exists on the core elements of OMT, which include both lifestyle intervention and intensive secondary prevention with proven pharmacotherapies. By contrast, however, there is less general agreement as to what constitutes the optimal approach to revascularization in SIHD patients. The COURAGE and FAME 2 randomized trials form the foundation of the current clinical evidence base and raise the important question: "What is the impact of myocardial ischemia on myocardial revascularization in stable ischemic heart disease?"

Effects of anterior maxillary distraction compared to LeFort-1 osteotomy and total maxillary distraction osteogenesis for treating hypoplastic maxilla in patients with cleft lip and palate- A systematic review and meta-analysis.

OBJECTIVE: To compare the treatment outcomes and effectiveness of Anterior Maxillary Distraction (AMD) with the LeFort I Osteotomy and Total Maxillary Distraction Osteogenesis (TMDO) to treat cleft maxillary hypoplasia. METHODS: (PROSPERO CRD42020223345) Thorough electronic search of seven databases, unpublished gray literature, and a hand search of the relevant studies reference lists was done. Studies assessing mid-facial skeletal, dentoalveolar, and soft-tissue outcomes of AMD in patients >8 years of age, hypoplastic cleft maxilla, and with either TMDO/LeFort 1/ both as control groups were included. Seven included articles were assessed for the study characteristics and qualitative synthesis. Three studies were analyzed quantitatively using the RevMan 5.4 software. The quality of studies was assessed using Cochrane ROB2 and the overall certainty of evidence using GRADE. RESULTS: AMD was performed in 241 subjects, LeFort 1 in 145 subjects, and TMDO in 42 subjects. Maxillary advancement for AMD and LeFort 1 groups showed no statistically significant difference (Mean Difference, MD -0.64°) while TMDO showed statistically significant advancement than AMD (MD -1.44°). Statistically significant upward rotation of anterior maxilla was noted with AMD (MD -6.15 degrees) than Lefort 1. Upper incisor inclination improved in both AMD and TMDO groups (MD 1.5°). Improvement in the maxilla-mandibular relationship, convexity of face, lip and nose, and marked dentoalveolar changes in overjet and upper incisor position were noted in all the three groups. Discernible airway alterations were noted in LeFort 1 and TMDOs. Total relapse was the least with AMD. CONCLUSION: Distraction osteogenesis exhibited better dento-skeletal outcomes and minor skeletal relapse than LeFort 1. TMDO is a preferred modality in treating severe maxillary hypoplasia associated with CLP than AMD. Further long-term prospective comparative studies are required, possibly involving the patient-centric merits.

Evaluation of fluoride varnish and its comparison with pumice prophylaxis using self-etching primer in orthodontic bonding--an in vivo study.

The aim of this study was to evaluate the use of fluoride varnish as a prophylaxis method with self etching primer (SEP) and its comparison with pumice before orthodontic bonding. Thirty seven orthodontic patients participated in a prospective clinical trial. A split mouth technique was used in each patient, one quadrant was assigned to fluoride varnish and the contralateral quadrant to pumice prophylaxis. A total of 684 teeth were bonded with SEP (Transbond plus; 3M Unitek) and monitored for 6 months for bond failures. A total of 42 (6.1%) failures were recorded, 9 (2.6%) in the pumice group and 33 (9.6%) in the fluoride varnish group. Chi-square analysis was used to compare the number of bracket failures between the pumice and fluoride varnish groups and the number of patients in each group experiencing at least one bond failure. Statistically significant differences were found both in total number of bond failures (P < 0.001) and in the number of patients with bond failures (P < 0.05) between both groups. A significantly lower and clinically acceptable bond failure rate was observed with Transbond Plus self etching primer after pumice prophylaxis.

Prosthetic fungal infections: poor prognosis with bacterial co-infection.

AIMS: The aims of this study were to report the efficacy of revision surgery for patients with co-infective bacterial and fungal prosthetic joint infections (PJIs) presenting to a single institution, and to identify prognostic factors that would guide management. PATIENTS AND METHODS: A total of 1189 patients with a PJI were managed in our bone infection service between 2006 and 2015; 22 (1.85%) with co-infective bacterial and fungal PJI were included in the study. There were nine women and 13 men, with a mean age at the time of diagnosis of 64.5 years (47 to 83). Their mean BMI was 30.9 kg/m2 (24 to 42). We retrospectively reviewed the outcomes of these PJIs, after eight total hip arthroplasties and 14 total knee arthroplasties. The mean clinical follow-up was 4.1 years (1.4 to 8.8). RESULTS: The median number of risk factors for PJI was 5.5 (interquartile range (IQR) 3.25 to 7.25). All seven patients who initially underwent debridement and implant retention (DAIR) had a recurrent infection that led to a staged revision. All 22 patients underwent the first of a two-stage revision. None of the nine patients with negative tissue cultures at the second stage had a recurrent infection. The rate of recurrent infection was significantly higher in the presence of multidrug-resistant bacteria (p = 0.007), a higher C-reactive protein (CRP) at the time of presentation (p = 0.032), and a higher number of co-infective bacterial organisms (p = 0.041). The overall rate of eradication of infection after two and five years was 50% (95% confidence interval (CI) 32.9 to 75.9) and 38.9% (95% CI 22.6 to 67), respectively. CONCLUSION: The risk of failure to eradicate infection with the requirement of amputation associated with this diagnosis is much higher than in patients with PJI without bacterial and fungal co-infection, and this risk is heightened when the fungal organism is joined by polymicrobial and multidrug-resistant bacterial organisms. Cite this article: Bone Joint J 2019;101-B:582-588.

Systematic review of the effectiveness of community-based self-management interventions among primary care COPD patients.

COPD self-management reduces hospital admissions and improves health-related quality of life (HRQoL). However, whilst most patients are managed in primary care, the majority of self-management trials have recruited participants with more severe disease from secondary care. We report the findings of a systematic review of the effectiveness of community-based self-management interventions in primary care patients with COPD. We systematically searched eleven electronic databases and identified 12 eligible randomised controlled trials with seven included in meta-analyses for HRQoL, anxiety and depression. We report no difference in HRQoL at final follow-up (St George's Respiratory Questionnaire total score -0.29; 95%CI -2.09, 1.51; I2 0%), nor any difference in anxiety or depression. In conclusion, supported self-management interventions delivered in the community to patients from primary care do not appear to be effective. Further research is recommended to identify effective self-management interventions suitable for primary care populations, particularly those with milder disease.

Polyclonal antibodies in renal transplantation--a relook.

Polyclonal antibodies have been used in renal transplantation for the past four decades. Increasing knowledge regarding their varied mechanisms of action have confirmed their versatility in clinical practice. They can be used for induction, reversing acute rejections (especially those resistant to steroids), and possibly conferring an element of allotolerance, thereby reducing chronic allograft nephropathy. Their recent usage as IV bolus, single-dose, preoperative infusion as induction therapy in renal transplantation is an attractive and extremely cost-effective strategy, especially in a developing country such as India.

Disinfectant and antibiotic resistance of lactic acid bacteria isolated from the food industry.

Quaternary ammonium compounds (QACs) are widely used as disinfectant in medical and food environments. There is a growing concern about the increasing incidence of disinfectant-resistant microorganisms from food. Disinfectant-resistant lactic acid bacteria (LAB) may survive disinfection and cause spoilage problems. Moreover, resistant LAB may potentially act as a reservoir for resistance genes. A total number of 320 LAB from food industry and meat were screened for resistance to the QAC benzalkonium chloride (BC). Out of 320 strains, five strains (1.5%) were considered to be resistant and 56 (17.5%) were tolerant to BC. The resistant strains were isolated from food processing equipment after disinfection. The resistant, tolerant, and some sensitive control bacteria were examined for susceptibility to 18 different antibiotics, disinfectants, and dyes using disc agar diffusion test and microdilution method. Little systematic cross-resistance between BC and any of the antimicrobial agents tested were detected except for gentamycin and chlorhexidine. A BC-tolerant strain was much easier to adapt to higher levels of BC as compared to a BC-sensitive strain. No known gram-positive QAC resistance genes (qacA/B, qacC, qacG, and qacH) were detected in the BC-resistant strains. Identification to species level of the BC-resistant isolates was carried out by comparative analysis of 16S-rDNA sequencing. In conclusion, resistance to BC is not frequent in LAB isolated from food and food environments. Resistance may occur after exposure to BC. The BC resistant isolates showed no cross-resistance with other antimicrobial compounds, except for gentamycin and chlorhexidine. Nevertheless, BC-resistant LAB may be isolated after disinfection and may contribute to the dissemination of resistance.

Genetic linkage between resistance to quaternary ammonium compounds and beta-lactam antibiotics in food-related Staphylococcus spp.

Little is known about the occurrence of antimicrobial resistance determinants in staphylococci isolated from food and food processing industries. Quaternary ammonium compound (QAC)-resistant coagulase-negative staphylococci (CNS) isolated from food and food-processing industries were investigated for the presence of genetic determinants (qacA/B and qacC/smr) encoding resistance to the QAC benzalkonium chloride (BC), several antibiotic resistance genes, and staphylococcal insertion sequences IS257 and IS256. Six qacA/B-harboring strains were resistant to penicillin and hybridized to a blaZ probe. The qacA/B and blaZ probes hybridized to plasmids of similar size in three isolates. Molecular and genetic characterization of the 23-kb plasmid (pST6) of Staphylococcus epidermidis St.6 revealed the presence of qacB adjacent to an incomplete beta-lactamase transposon Tn552 encoding the gene cluster blaZ, blaR, and blaI. Sequence analysis of flanking regions and the intergenic region between blaZ and qacB revealed the presence of IS257 downstream of blaZ as well as sin and binR between blaZ and qacB. In the three other BC and penicillin-resistant strains, the qacA/B and blaZ genes were located on separate plasmids. A qacC harboring S. epidermidis strain (St.17) also hybridized to tetK (tetracycline resistance) and ermB (erythromycin resistance) genes. The individual genes were located on separate plasmids, suggesting no linkage between QAC and antibiotic resistance determinants. Plasmid-free Staphylococcus aureus RN4220 allowed uptake of the pST6 plasmid DNA, indicating that the resistance genes could potentially be transferred to pathogens under selective stress. In conclusion, presence of both resistance determinants could lead to co-selection during antimicrobial therapy or disinfection in hospitals or in food industries.

Effects of prostaglandin E2 analogue suppository on blood loss in suction abortion.

The purpose of the present clinical investigation was to determine the effect of preoperative treatment with a long-acting prostaglandin suppository containing 9-deoxo-16,16-dimethyl-9-methylene prostaglandin E2 on uterine blood loss in patients undergoing preoperative cervical dilatation before transcervical abortion. Ninety-five young women in the ninth to 14th week of gestation were randomly assigned to one of two groups. Patients in group 1 were treated with a long-acting prostaglandin suppository and group 2 patients acted as control subjects. At the end of three hours, patients in both groups underwent abortion with careful intraoperative measurement of blood loss in both groups. The blood loss in the prostaglandin-treated group was significantly lower than that in the control group (69.0 +/- 14.1 mL versus 151.1 +/- 26.6 mL). The difference in intraoperative blood loss was observed at all gestations between nine and 14 weeks. There was significantly greater dilation of the cervix after prostaglandin treatment (mean difference, 4.58 mm; P less than .005).

Central giant cell granuloma of jaws--review of 19 cases.

19 cases of central giant cell granuloma (CGCG) were reviewed after screening the records of the past four years of the Dental out patient department of AIIMS Hospital, New Delhi. It was found that CGCG usually occurs in the 2nd and 3rd decades and is more common in females. The mandible is more frequently involved than the maxilla and lesions occur more commonly on the right than left side.

Effects of post-processing treatments on sensory quality and Shiga toxigenic Escherichia coli reductions in dry-fermented sausages.

The effects of post-processing treatments on sensory quality and reduction of Shiga toxigenic Escherichia coli (STEC) in three formulations of two types of dry-fermented sausage (DFS; salami and morr) were evaluated. Tested interventions provided only marginal changes in sensory preference and characteristics. Total STEC reductions in heat treated DFS (32°C, 6days or 43°C, 24h) were from 3.5 to >5.5 log from production start. Storing of sausages (20°C, 1month) gave >1 log additional STEC reduction. Freezing and thawing of sausages in combination with storage (4°C, 1month) gave an additional 0.7 to 3.0 log reduction in STEC. Overall >5.5 log STEC reductions were obtained after storage and freezing/thawing of DFS with increased levels of glucose and salt. This study suggests that combined formulation optimisation and post-process strategies should be applicable for implementation in DFS production to obtain DFS with enhanced microbial safety and high sensory acceptance and quality.

Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine (PCV13) when given as a toddler dose to children immunized with PCV7 as infants.

13-Valent pneumococcal conjugate vaccine (PCV13) administered as a 4-dose series in infants, and as a toddler dose in infants previously vaccinated with PCV7 elicited comparable vaccine serotypes IgG responses to the seven common serotypes. PCV13 elicited functional responses to the six additional serotypes in both schedules after the toddler dose. The toddler dose boosted immune responses. The two regimens had comparable safety profiles. A toddler dose of PCV13 given in children previously vaccinated with PCV7 should be effective in preventing pneumococcal disease caused by common serotypes, providing protection against the additional serotypes, and supporting the transition from PCV7 to PCV13.

Low-dose enflurane does not increase blood loss during therapeutic abortion.

PIP: A study was conducted to determine if uterine blood loss during therapeutic abortion could be kept to a minimum by utilizing relatively low concentrations of enflurane. The blood loss was compared to that observed when patients were anesthetized with a more routinely accepted nitrous oxide/narcotic technique. 34 healthy, unpremedicated, women undergoing elective suction abortion were studied. Patients ranged in age from 16-29 years and were at 8-13 weeks gestation. After informed consent was obtained, the patients were anesthetized with 1 of 2 anesthetic techniques. The 18 patients in Group 1 were given 50-100 mcg of fentanyl intravenously. Anesthesia was then induced with thiopental (4-5 mg/kg) and maintained with 70% nitrous oxide in oxygen. Additional thiopental was administered during the procedure in response to the patient moving, swallowing, breath holding, or exhibiting other signs of inadequate anesthesia. No additional fentanyl was required. The 16 patients in Group 2 had anesthesia induced with a small dose of thiopental (3-4 mg/kg) and maintained with 1% inspired enflurane and 66% nitrous oxide in oxygen. At no point was the concentration of inspired enflurane increased to more than 1%. Additional thiopental was administered in response to the same criteria as described for Group 1. There was no significant difference between the 2 groups in terms of the patient's gestational age or mean blood loss. Group 2 received approximately 1.7 mg/kg less thiopental than Group 1. No patient in Group 2 received fentanyl. The mean duration of anesthesia was 16.2 minutes for Group 1 and 17.4 minutes for Group 2. No patient in either group lost more than 180 ml of blood. There were no immediate postoperative complications, and all patients were discharged from the hospital approximately 2 hours after the procedure. Despite the fact that enflurane is known to relax uterine muscle, it has been shown that enflurane can be used safely for patients undergoing therapeutic abortion, in that it does not increase blood loss when compared to a nitrous oxide/narcotic technique. The use of enflurane in low concentrations as an anesthetic for outpatient abortion is advantageous because it obviates the need for narcotics or large doses of thiopental.^ieng

Production, localization and glucose repression of beta-glucosidase in Trichoderma longibrachiatum.

Optimal production of beta-glucosidase was obtained by incubating the culture at 27 degrees C in a growth medium that had an initial pH of 5.0 and contained cellobiose. The bulk of the enzyme (70%) was present in a cell-associated state (cell debris and cytosol) while only a small portion (30%) appeared in the culture filtrate. When cellulosic substrates were used, the major portion of the enzyme (70%) appeared in the extracellular fraction. A repression of the enzyme occurred in the presence of glucose. A drop of the pH of the medium during the exponential growth phase coincided with a rapid inactivation of the enzyme. The glucose effect was most likely mediated by adverse effects of low pH on the integrity of the enzyme.

Fingerprinting human chromosomes by polymerase chain reaction-mediated DNA amplification.

We describe here a method for DNA fingerprinting of human chromosomes by Alu-polymerase chain reaction (PCR) amplification of DNA from monochromosomal hybrids, following digestion with restriction endonucleases. DNA digestion with restriction enzymes prior to PCR amplification reduces the total number of amplified fragments. The number and pattern of bands of PCR products observed in an electrophoretic medium are chromosome specific and provide a "fingerprint signature" for individual human chromosomes. Using this approach, we have produced fingerprints for human chromosomes 2, 5, 7, 9, and 12. The applicability of this approach to chromosome identification was assessed by comparing the fingerprints obtained for two different hybrids containing chromosome 7. DNA fragments specific for the long and the short arms of human chromosome 12 have also been identified. In addition, Alu-PCR-generated DNA fragments, specific for different chromosomes, were used to probe Southern blots of a hybrid cell panel to identify human chromosomes present in hybrid cell lines. The chromosomal specificity of these probes permits the identification of intact as well as rearranged chromosomes composed of segments arising from more than one chromosome.

An unusual complication of extradural catheterization in obstetric anaesthesia.

An extradural catheter was inserted at the third lumbar interspace for relief of pain during labour in a 21-year-old gravid patient. Attempts to withdraw the catheter met with resistance and produced severe pain in the distribution of the second left lumbar nerve. Radiography revealed an acutely angled loop of the catheter over the L2-3 nerve root.

[Can disinfectants contribute to antibiotic resistance?]. / Kan desinfeksjonsmidler bidra til bakteriell antibiotikaresistens?

BACKGROUND: Disinfectants are widely used in medicine, veterinary medicine, and the food processing industry. Increasingly, disinfectants are included in consumer products. Broad-scale use of antiseptics and disinfectants may have detrimental ecological consequences, for instance the development of antimicrobial resistance. MATERIAL AND METHODS: We give an overview of the correlation between the use of certain antiseptics and disinfectants, bacterial resistance to these agents, and antibiotic resistance. RESULTS: The mechanisms of antibiotic and biocide resistance share many common characteristics. There are links between disinfectant resistance and antibiotic resistance. Some biocides have the ability to select for antibiotic resistant mutants and vice versa. Resistance genes are often located on transferable genetic elements that facilitate horizontal gene transfer between microorganisms. Antibiotic resistance and disinfectant resistance may be stabilized and maintained even in the absence of a direct selective pressure. Higher incidence of bacteria resistant to certain disinfectants have been reported in environments where such agents are frequently used compared to environments where they are not in regular use. Increased domestic usage of non-antibiotic antimicrobial agents may select for antibiotic-resistant bacteria of clinical significance. INTERPRETATION: The use of antiseptics and disinfectants should be restricted to products and areas where they have an essential and documented effect.

Cephalometric analysis of changes produced by a modified Herbst appliance in the treatment of Class II division 1 malocclusion.

This study investigated treatment changes produced by the Herbst appliance in a sample of severe Class II division 1 cases, over a period of 8 months. The sample consisted of 16 girls, of whom eight were treated by the Herbst appliance, whilst eight served as controls. All cases were matched with respect to age, sex, skeletofacial morphology, and length of treatment/observation period. Twenty-two skeletal and 19 dental parameters were recorded on pre- and post-treatment cephalograms. The net treatment effect of Herbst therapy was evaluated, taking into account the growth that occurred in the control sample. The study revealed that during 8 months of Herbst therapy there was a significant increase in mandibular length, along with sagittal repositioning. The skeletal changes in the mandible were mainly responsible for overjet and molar relation correction. A slight, favourable forward rotation of the mandible was identified. Dentoalveolar features included flaring of lower incisors and distalization of upper molars. The appliance did not have any retrusive effect on the maxilla. The modified splint design differed from the original and was cemented rather than bonded.

Organization of the antiseptic resistance gene qacA and Tn552-related beta-lactamase genes in multidrug- resistant Staphylococcus haemolyticus strains of animal and human origins.

A part (12 kb) of a plasmid containing the beta-lactamase genes of Tn552, the disinfectant resistance gene qacA, and flanking DNA has been cloned from a Staphylococcus haemolyticus isolate and sequenced. This region was used to map the corresponding regions in six other multiresistant S. haemolyticus isolates of human and animal origin. The organizations of the genetic structures were almost identical in all isolates studied. The beta-lactamase and qacA genes from S. haemolyticus have >99.9% identities at the nucleotide level with the same genes from S. aureus, demonstrating that various staphylococcal species able to colonize animal and human hosts can exchange the genetic elements involved in resistance to antibiotics and disinfectants. The use of antibiotics and disinfectants in veterinary practice and animal husbandry may also contribute to the selection and maintenance of resistance factors among the staphylococcal species. Different parts of the 12-kb section analyzed had high degrees of nucleotide identity with regions from several other different Staphylococcus aureus plasmids. This suggests the contribution of interplasmid recombination in the evolutionary makeup of this 12-kb section involving plasmids that can intermingle between various staphylococcal species. The lateral spread of resistance genes between various staphylococcal species is probably facilitated by the generation of large multiresistance plasmids and the subsequent interspecies exchange of them.

Rescue of mumps virus from cDNA.

A complete DNA copy of the genome of a Jeryl Lynn strain of mumps virus (15,384 nucleotides) was assembled from cDNA fragments such that an exact antigenome RNA could be generated following transcription by T7 RNA polymerase and cleavage by hepatitis delta virus ribozyme. The plasmid containing the genome sequence, together with support plasmids which express mumps virus NP, P, and L proteins under control of the T7 RNA polymerase promoter, were transfected into A549 cells previously infected with recombinant vaccinia virus (MVA-T7) that expressed T7 RNA polymerase. Rescue of infectious virus from the genome cDNA was demonstrated by amplification of mumps virus from transfected-cell cultures and by subsequent consensus sequencing of reverse transcription-PCR products generated from infected-cell RNA to verify the presence of specific nucleotide tags introduced into the genome cDNA clone. The only coding change (position 8502, A to G) in the cDNA clone relative to the consensus sequence of the Jeryl Lynn plaque isolate from which it was derived, resulting in a lysine-to-arginine substitution at amino acid 22 of the L protein, did not prevent rescue of mumps virus, even though an amino acid alignment for the L proteins of paramyxoviruses indicates that lysine is highly conserved at that position. This system may provide the basis of a safe and effective virus vector for the in vivo expression of immunologically and biologically active proteins, peptides, and RNAs.