Rapid single-cell detection and identification of pathogens by using surface-enhanced Raman spectroscopy.

For the successful treatment of infections, real-time analysis and enhanced multiplex capacity, sensitivity and cost-effectiveness of the developed detection method are critical. In this work, surface-enhanced Raman scattering (SERS) was employed with the final aim of identification and discrimination of pathogenic bacteria, based on their detected SERS fingerprint at the single-cell level. Several genera of bacteria that are found in most of the isolated infections in bacteraemia were successfully identified in less than 5 minutes without the use of antibodies or other specific receptors. The key element of the SERS direct detection platform is the SERS substrate, which combines easy production at low costs with a high enhancement enabling single-cell detection. The innovative approach of detection required the in situ synthesis of silver nanoparticles (NPs), ensuring an intimate contact with the bacterial membrane. This protocol provided a good reproducibility of the single-cell SERS spectra and was successfully applied both on Gram-negative and Gram-positive microorganisms (E. coli, M. morganii, E. lactis, L. casei). Thus, a label-free SERS-based biosensor for pathogen detection was developed with low costs, minimal sample preparation, high-accuracy and a very short analysis time of less than 5 min, which is crucial for infection diagnosis.

Epicardial fat thickness significantly decreases after short-term growth hormone (GH) replacement therapy in adults with GH deficiency.

BACKGROUND AND AIM: Growth Hormone Deficiency (GHD) is characterized by increased visceral fat accumulation. Echocardiographic epicardial fat thickness is a new marker of visceral adiposity. Aim of the present study was to evaluate whether epicardial fat thickness can significantly change and therefore serve as a marker of visceral fat reduction after short-term rhGH replacement therapy in patients with adult-onset GHD. METHODS AND RESULTS: Echocardiographic epicardial fat thickness was measured in 18 patients (10 M, 8 F, age 48 ± 11.8 yrs, BMI 29 ± 5.9 kg/m(2)) with adult-onset GHD, at baseline and after 6 and 12 months of rhGH therapy and in 18 healthy matched controls, at baseline. Echocardiographic epicardial fat thickness, conventional anthropometric and metabolic parameters, body fat percentage and quality of life were also evaluated. Epicardial fat thickness in adult GHD patients was higher than in controls (9.8 ± 2.8 vs 8 ± 3 mm, p < 0.05). Epicardial fat thickness significantly decreased after 6-months of rhGH replacement therapy (from 9.8 ± 2.8 to 7.0 ± 2.3 mm, P < 0.01, i.e. -29% from baseline). After 12 months of rhGH replacement therapy, epicardial fat thickness showed a further significant decrease (from 7.0 ± 2.3 to 5.9 ± 3.1 mm, P < 0.01, i.e. -40% from baseline). No significant changes in BMI or waist circumference after 6 or 12 months of rhGH therapy were observed. CONCLUSIONS: Echocardiographic epicardial fat thickness may represent a valuable and easy marker of visceral fat and visceral fat changes during rhGH replacement treatment in patients with adult-onset growth hormone deficiency.

A new HLA-B*15 allele, B*15:220, found in three individuals sharing the HLA-A*66:01, HLA-C*12:03 and HLADRB1*07:01 alleles.

The new allele HLA-B*15:220 is associated with a conserved haplotype.

Immunohistochemical expression of non-collagenous extracellular matrix molecules involved in tertiary dentinogenesis following direct pulp capping: a systematic review.

BACKGROUND: Extracellular matrix molecules (ECMM) expression during tertiary dentinogenesis provides useful information for regenerative applications and efficacy of pulp capping materials. AIM: To identify and review the expression and roles of non-collagenous ECMM after successful direct pulp capping (DPC), following mechanical pulp exposures, via immunohistochemistry (IHC). The study addressed the question of where will successful DPC impact the IHC expression of these molecules. DATA SOURCES: In vivo animal and human original clinical studies reporting on ECMM in relation to different follow-up periods were screened and evaluated via descriptive analysis. The electronic literature search was carried out in three databases (MEDLINE/PubMed, Web of Science, Scopus), followed by manual screening of relevant journals and cross-referencing, up to December 2018. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: Randomized and non-randomized controlled trials, conducted in humans and animals, were selected. Histological evidence for tertiary dentine formation was a prerequisite for IHC evaluation. STUDY APPRAISAL AND SYNTHESIS METHODS: The methodological quality of the included articles was independently assessed using the Systematic Review Centre for Laboratory animal Experimentation (SYRCLE) and the Cochrane risk of bias tool (RoB 1), respectively. RESULTS: From a total of 1534 identified studies, 18 were included. Thirteen papers evaluated animal subjects and five studies were carried out on humans. In animals and humans, fibronectin and tenascin expressions were detected in pulp and odontoblast-like cells (OLC); dentine sialoprotein was expressed in both soft and newly-formed mineralized tissue. In animals, bone sialoprotein was early expressed, in association with OLC and predentin; the immunoreactivity for dentine sialophosphoprotein and dentine matrix protein-1 was associated with the OLC and dentine bridge; osteopontin was expressed in OLC, predentine and reparative dentine. A considerable heterogeneity was found in the methodologies of the included studies, as well as interspecies variability of results in terms of time. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Within the limited scientific evidence, all non-collagenous ECMM expressions during tertiary dentinogenesis are active and related to soft and hard tissues. There is a shortage of human studies, and future research directions should focus more on them. PROSPERO Protocol: CRD42019121304.

[Tricophyton rubrum in a case of tinea unguium phenotypic mycological diagnostic algorithm and its limits]. / Tricophyton rubrum într-un caz de tinea unguium--algoritmul de diagnostic micologic fenotipic si limitele acestuia.

Trichophyton rubrum is the most common dermatophyte isolated from human dermatophytosis. We present the mycological diagnosis algorithm and results in an onychomycosis case--tinea unguium. Biological samples have been inoculated on both usual and special culture media and incubated at both 30 degrees C and 37 degrees C for a period of fourteen days. Based on the macroscopic and microscopic characters and on the physiological and biochemical tests results, we identified a Trichophyton rubrum granular type dermatophyte. We are discussing phenotypic mycological diagnosis limits and molecular diagnostic benefits for rapid setting up of fungal therapy in order to avoid chronic mycosis and their complications.

Echocardiographic alterations in patients with non-functioning adrenal incidentaloma.

OBJECTIVE: While left ventricular (LV) dysfunction has been described in patients with Cushing's syndrome (CS), data concerning morphologic and functional cardiac alterations in patients with incidentally discovered adrenal masses [adrenal "incidentaloma" (AI)], without overt hypercortisolism, are lacking. In this study the echocardiographic characteristics of patients with AI were evaluated and then compared with those of lean and obese normotensive subjects. SUBJECTS AND METHODS: Twenty-one patients with AI, without clinical or subclinical hypercortisolism, 18 normotensive obese subjects matched for gender and body mass index (BMI) and 20 normotensive lean subjects were studied. Echocardiography was performed in all subjects. In all patients plasma ACTH, serum cortisol, and DHEA-S levels were measured. RESULTS: Patients with AI showed greater impairment of several echocardiographic indices of LV hypertrophy and diastolic dysfunction compared to normotensive lean subjects (p<0.05), but did not differ from those in obese subjects. Hypertensive AI patients showed a greater alteration of echocardiographic parameters (p<0.05) and higher BMI (p<0.01) and cortisol values (p<0.05) than normotensive ones. Plasma ACTH and serum cortisol were similar in AI patients and in obese controls, while DHEA-S levels were lower in AI (p<0.05). No correlations between cortisol secretion and echocardiographic parameters were found. CONCLUSION: In patients with non-functioning AI there is an impairment of cardiac morphology and function. These data suggest that patients with AI should be carefully screened also by means of echocardiographic studies.

Transplantation of composite tissue allograft: scientific bases and clinical applications.

Plastic surgery is by excellence a surgery in permanent search for new reconstructive options. In the last 50 years researches in the field of allotransplantation led to obtaining promising results for solving difficult cases when autologous tissues are not available for reconstruction, despite all the bioethical issues of this subject. This field of composite tissue transplantation evolved constantly, the top of it being total face transplantation, successfully accomplished while being based on the knowledge accumulated. There are many clinical applications of CTA, hand transplantation or only flexor tendon apparatus, lower limb, partial or complete face transplantations represent the most important part for us, plastic surgeons for obtaining the best reconstruction possible.

[Corrective surgery of congenital chest malformations of the type Pectus excavatum and Pectus carinatum (author's transl)]. / Procédé chirurgical de correction des déformations congénitales de la paroi thoracique types Pectus excavatum et Pectus carinatum.

The authors presents an original process for surgical treatment of deformations of chest anterolateral wall, insisting on the procedures and techniques of the recommended process. The compulsory operative steps are: wide chondrectomy, retrosternal loosening, transversal osteotomy of the sternum and contention with retrosternal metallic plates. The author considers surgery to be necessary for all these anterolateral chest deformations and the best age for their correction to be after 10 to 12 years. The original technique for loosening and preserving the perichondrium in its wholeness is described together with the complete resection of deformed cartilages.

[A new technical procedure for middle and lower lobe lobectomy]. / Un nouveau procédé technique dans la bilobectomie médio-inférieure.

Among combined pulmonary resections, one of the most difficult operations is right middle and lower lobe lobectomy because of the very intricate anatomical relations between the three pulmonary lobes. Technical difficulties during the first-stage approach to the pulmonary artery in the fissure are compounded by the presence of pathological processes (neoplasm, suppuration, etc.) which provoke adhesions between the pulmonary artery and the bronchus, with inevitable major risks. A new technique for middle and lower lobe lobectomy which avoids the frequent accidents during this operation is described. The first stage involves ligature and section of the inferior root of the superior pulmonary vein and liberation of the horizontal fissure. Opening of the horizontal fissure exposes the superior fissural vein, which is then displaced towards the upper lobe. This allows access to the pulmonary artery in the fissure, together with its branches to the lower and middle lobes, and the fissural arteries to the upper lobe. This procedure enables simple dissection and ligature of the pulmonary artery, as at this level it is not adherent to the intermediary part of the bronchus. The triangular ligament, inferior pulmonary vein, and intermediary bronchus are then ligatured and sectioned. The advantages of this method consist in the simplification of the dissection, ligature, and section of the pulmonary artery in the fissure, and the need to apply only one ligature if there are no anatomical variations (common dorsal fissural and inferior apical artery, or common ventral fissural and middle lobe artery).

[Surgical treatment of congenital deformities of the thoracic wall]. / Contributii la tratamentul chirurgical al deformatiilor congenitale ale peretelui toracic.

The author describes an original procedure for the correction of deformities of the antero-lateral thoracic wall, stressing the tactical and technical principles. The mandatory operational steps are the following: wide chondrectomy, borad retrosternal separation of the periost, transversal osteotomy of the sternum and contention by metalic blades placed behind the sternum. The author stresses the surgical indications in all anterolateral deformities of the thorax and considers that the best age for performing the correction is after 10-12 years.

[Study of the indications for surgical treatment of pleuropulmonary tuberculosis at the present time]. / Contibutii la indicatiile tratamentului chirurgical al tuberculozei pleuropulmonare în etapa actuala.

On a large personal experience basis the authors discuss the present stage of surgical treatment of pleuropulmonary tuberculosis. Stress is laid on the fact that, owing to technical surgical progress and continuous improving of equipments in the thoracic surgery departments, practically there are no contraindications for surgical treatment of pleuropulmonary tuberculosis provided the functional lung and heart parameters are satisfactory. It is emphasized too the requirement of a timely indication for surgery in cases of chemotherapy failures, prior to lung and heart function impairment.

[Current problems in thoracic injuries]. / Contributii la problemele actuale ale traumatismelor toracice.

The authors stress the increased frequency in the recent years of single thoracic trauma and of thoracic trauma in the frame of polytraumatic lesions. The fact is stressed that the severity of thoracic trauma is usually determined by pathophysiological syndromes generated sometimes by minor anatomical lesions. An original classification is presented, of thoracic trauma, the present etiopathogenetic concept is discussed, as well as pathophysiologic syndromes consecutive to thoracic trauma. The major types of lesions are illustrated by clinical cases. The treatment of thoracic trauma should respect in the first place the principle of re-equilibration of vital functions that have been disturbed. Only after this has been achieved integrity of the anatomic structures of the organs involved should be attempted. Surgical indications are justified only if the anatomical lesions are the origin of a cardio-respiratory imbalance that cannot be eliminated but by surgical procedures. An original procedure is presented, that of Prof. C. Coman, which achieves immobilization of the flaps with the aid of blades, and the advantages of this system are stressed.

[Emergency pneumonectomy for severe hemoptysis in pulmonary tuberculosis]. / Pneumonectomii de urgenta pentru hemoptizii grave in tuberculoza pulmonara.

The authors present two cases of severe tuberculous hemopthysis cured by pneumectomy. The patients had repeatedly presented severe hemopthysis meanacing their life and necessitated intensive resbuscitation, with intubation and mechanical respiratory prostheses. The authors also discuss the mechanism of death in severe hemopthysis, demonstrating that death is especially due to bronchial obstruction by clots of blood.

[Surgical treatment of endothoracic goiter]. / Tratamentul chirurgical al gusilor endotoracice.

The authors make an analysis of the experience accumulated in the Clinic for Thoracic Surgery of Bucharest as a result of the surgical treatment of 16 patients endothoracic goiters. The authors stress the fact that these goiters should be differentiated from the "plunging goiter" variety, by their symptomatology, and by the different way of approaching their treatment. The diagnostic difficulties are stressed, especially since the uptake of iodine (radioactive iodine) can be negative in the endothoracic goiter of the functional type. The authors prefer thoracotomy, while the sternotomy is reserved only for the endothoracic goiters in the median area. The immediate results have been good in 15 cases. One patient died as a result of toxi-infectious phenomena.

[Surgical treatment of mediastinal tumors]. / Tratamentul chirurgical al tumorilor mediastinale.

Based on a statistic which included 700 cases of mediastinal tumours (of which 460 underwent surgery), hospitalized in the Clinic for Thoracic Surgery of the Phtysiology Institute from Bucharest, the authors stress the particularities of the surgical interventions, which were due to particularities of the surgical interventions, which were due to particularities and extension of the tumours themselves. The mortality of 2,7 percent is explained by the careful indications for surgery, and this was due to a careful preoperative diagnosis.

[Mediastinal neurogenic tumors]. / Tumorile neurogene mediastinale.

An analysis is presented of clinical, radiological and evolutive aspects of 106 neurogenic mediastinal tumors operated in the Clinic for Tjhoracic surgery from Bucharest. The predominance is stressed of tumours originating in the nervous sheaths (62%), and the high incidence of tumours of the nervous cells (sympatomas, ganglio-neuroblastomas) in children. An analysis is made of the various surgical aspects. and the post-operative results, mostly favourable in over 90% of the subjects that underwent surgery.

[Congenital tracheoesophageal fistula: operation and cure]. / Fistula esotraheala congenitala, operata si vindecata.

On the basis of their personal experience, covering approximately 100 cases of oeso-thoracal fistulae of various origins and with different anatomo-pathological forms, the authors present a case of oeso-tracheal fistula of congenital origin, in a child aged 4 years, that recovered after surgery. The practical aspects of surgery are stressed, as well as the sequence of surgical stages, evaluating the fact that gastrostomy should be carried out simultaneously, at the end of the thoracal intervention.

[Technic, indications and value of pulmonary decortications (615 operated cases)]. / Contributii la tehnica, indicatiile si valoarea decorticcrilor pulmonare (615 cazuri operate).

On the basis of their experience in 615 cases of pleuropulmonary decortication, the authors discuss the indications, contraindications, approach and procedure in pleuropulmonary decortication. Surgery has the double purpose of suppressing the empyema cavity and recovering most of the functional pulmonary parenchyma. A personal procedure was applied consisting of thoracotomy through the sixth intercostal space, then along the cleavage lines outside the limits of the empyema pouch, from the periphery towards the center at the level of the pulsatile organs, zones called the key points of pleuropulmonary decortication. Very good results were obtained in 80--50% of the tuberculous empyema cases and in 90--95% of the non-tuberculous diseases. The authors consider that pleuropulmonary decortication is a widely applicable surgical method in pleural empyema, being one of the few surgical methods used for redressing the function of an organ.

[Surgical treatment of bronchial adenomas]. / Tratamentul chirurgical al adenoamelor bronsice.

The authors make an analysis of the experience acquired in the Clinic of Thoracic Surgery of Bucharest, based on interventions carried out in 42 cases of bronchial adenoma hospitalized between 1962 and 1976. The fact is stressed that in none of the 42 operated patients was the carcinoid syndrome encountered with any of its specific manifestations. Also on the basis of the experience obtained the bronchologic criteria for benignity of this type of tumour (absence of the infiltration in the mucosa, surrounding the tumour) is considered as non-significant because there are frequently areas of malignant transformation inside the tumour itself, or at its lower pole that cannot be explored by bronchoscopy. Surgical treatment of bronchial adenoma included a wide range of techniques, from simple lobectomies to bronchoanastomotic interventions, and resections of the trachea. The study of postoperative results showed a good prognosis and survivals of appreciable duration only when the intervention was carried out in the I-st and the II-nd stages of the disease. This also stresses the necessity for an early diagnosis and rapid surgery in these bronchial adenomatous tumours (most of which are of the carcinoid type).