Survival prediction algorithms for COVID-19 patients admitted to a UK district general hospital.

OBJECTIVE: To collect and review data from consecutive patients admitted to Queen's Hospital, Burton on Trent for treatment of Covid-19 infection, with the aim of developing a predictive algorithm that can help identify those patients likely to survive. DESIGN: Consecutive patient data were collected from all admissions to hospital for treatment of Covid-19. Data were manually extracted from the electronic patient record for statistical analysis. RESULTS: Data, including outcome data (discharged alive/died), were extracted for 487 consecutive patients, admitted for treatment. Overall, patients who died were older, had very significantly lower Oxygen saturation (SpO2) on admission, required a higher inspired Oxygen concentration (IpO2) and higher CRP as evidenced by a Bonferroni-corrected (P < 0.0056). Evaluated individually, platelets and lymphocyte count were not statistically significant but when used in a logistic regression to develop a predictive score, platelet count did add predictive value. The 5-parameter prediction algorithm we developed was: [Formula: see text] CONCLUSION: Age, IpO2 on admission, CRP, platelets and number of lungs consolidated were effective marker combinations that helped identify patients who would be likely to survive. The AUC under the ROC Plot was 0.8129 (95% confidence interval 0.0.773 - 0.853; P < .001).

HOS15 and HDA9 negatively regulate immunity through histone deacetylation of intracellular immune receptor NLR genes in Arabidopsis.

Plant immune responses need to be tightly controlled for growth-defense balance. The mechanism underlying this tight control is not fully understood. Here we identify epigenetic regulation of nucleotide-binding leucine rich repeat or Nod-Like Receptor (NLR) genes as an important mechanism for immune responses. Through a sensitized genetic screen and molecular studies, we identified and characterized HOS15 and its associated protein HDA9 as negative regulators of immunity and NLR gene expression. The loss-of-function of HOS15 or HDA9 confers enhanced resistance to pathogen infection accompanied with increased expression of one-third of the 207 NLR genes in Arabidopsis thaliana. HOS15 and HDA9 are physically associated with some of these NLR genes and repress their expression likely through reducing the acetylation of H3K9 at these loci. In addition, these NLR genes are repressed by HOS15 under both pathogenic and nonpathogenic conditions but by HDA9 only under infection condition. Together, this study uncovers a previously uncharacterized histone deacetylase complex in plant immunity and highlights the importance of epigenetic regulation of NLR genes in modulating growth-defense balance.

Fecal indicator bacteria, fecal source tracking markers, and pathogens detected in two Hudson River tributaries.

Volunteer monitoring in the Hudson River watershed since 2012 has identified that the Wallkill River and Rondout Creek tributary complex have elevated concentrations of the fecal indicator bacteria, enterococci. Concentrations of enterococci do not provide insight into the sources of pollution and are imperfect indicators of health risks. In 2017, the regular monthly volunteer monitoring campaign for culturable enterococci at 24 sites on the Wallkill and Rondout expanded to include: (1) culturable measurements of E. coli and quantification of E. coli and Enterococcus specific markers vis nanoscale qPCR, (2) microbial source tracking (MST) assays (avian, human, bovine, and equine) via real time PCR and nanoscale qPCR, and 3) quantification of 12 gastrointestinal pathogens including viruses, bacteria, and protozoa via nanoscale qPCR. Three human associated MST markers (HumM2, HF183, and B. theta) corroborated that human pollution was present in Rondout Creek and widespread in the Wallkill River. The presence of B. theta was associated with increased concentrations of culturable E. coli. Genes for adenovirus 40 and 41 conserved region, rotavirus A NSP3, E. coli eae and stx1, and Giardia lamblia 18S rRNA were detected in >45% of samples. Abundance of rotavirus A NSP3 genes was significantly correlated to the bovine marker gene, CowM3, though wild bird sources cannot be ruled out. This is the first study to investigate potential fecal pollution sources and pathogen concentrations in Hudson tributaries during the months of peak recreational use.

Three-year analysis of tapered screw vent implants placed into maxillary sinuses grafted with mineralized bone allograft.

With an increase in the number of patients presenting for dental implant treatment, it is becoming more common for clinicians to encounter inadequate bone volume. Several surgical techniques have been advocated for placing dental implants in the posterior maxilla, including the lateral window sinus elevation technique. This article reports the results of implants placed into maxillary sinuses grafted with particulate mineralized cancellous bone allograft alone or in combination with resorbable hydroxyapatite over a 3-year period. A total of 56 sinuses were grafted, and 136 dental implants were placed into the grafted sites after a 4- to 8-month healing period. All reentries revealed a bony hard structure acceptable for osteotomy preparation. Of these implants, 124 have been restored with fixed prosthesis and 12 with removable overdentures for a total of 136 loaded implants. A total of 3 implants required removal (failure) resulting in a 97.7% implant success rate (2.3% failure rate). A conclusion was made that mineralized human allograft, placed into lateral window sinus elevations, is a clinically predicable method acceptable for implant placement and restoration.

Retrospective Study of Tapered One-Piece Implants Placed Over a Ten-Year Period in a Single Private Practice.

Today, clinicians have a variety of treatment modalities available to address the increasing number of implant procedures performed each year. Single-stage implant surgery is now commonly used in implant dentistry. With patients' demands for immediate restoration, the utilization of 1-piece implants is gaining acceptance. This article reports the results of tapered 1-piece implants (Zimmer Biomet) placed in a single practice over a 10-year period. A total of 33 1-piece dental implants were placed in 24 patients and provisionally restored out of occlusion at the time of surgery. All 33 implants were definitively restored with ceramometal crowns after 3 months of provisionalization. Implant survival and success rates were 100% after 2.6-10 years of follow-up. Only 1 minor complication of crestal bone remodeling occurred among the 33 implants placed. Adequately stabilized tapered 1-piece implants can be successfully restored out of occlusion at the time of implant placement and definitively loaded in occlusion 3 months without adversely affecting function or esthetics. Additional long-term controlled studies are recommended to further understand these findings.

Correction of renal hypertension after kidney transplantation from a donor with Gitelman syndrome.

The relationship between the kidney and blood pressure control is complex. Monogenetic forms of hypertension have recently been identified that implicate specific mutations responsible for blood pressure control. The thiazide sensitive Na-Cl cotransporter (NCC) has been implicated in the control of blood pressure, however a direct link between the kidney NCC and blood pressure regulation is lacking. Here, we report a case of chimerism in which a kidney from a patient with Gitelman syndrome was transplanted into a non-Gitelman hypertensive recipient. After transplantation, postural hypotension resulted, necessitating discontinuation of all antihypertensive medications used for treatment of calcineurin-induced hypertension. This is the first reported case of acquired Gitelman syndrome after transplantation. Transplantation of a Gitelman "kidney" into a hypertensive recipient provides additional support for the role of the kidney NCC in blood pressure regulation. Furthermore, this case suggests the potential use of thiazide diuretics in the treatment of calcineurin-induced hypertension.

Three-year analysis of Tapered Screw-Vent implants placed into extraction sockets grafted with mineralized bone allograft.

With clinicians placing more dental implants, it is becoming increasingly important to maintain bone volume after tooth extraction. This article reports the results of implants placed into extraction sites grafted with particulate mineralized bone allograft (Puros). A total of 313 extraction sites were grafted with mineralized bone graft during a 36-month period. A total of 252 Tapered Screw-Vent dental implants were placed into the grafted extraction sites after a 4- to 7-month healing period. All reentries revealed a bony hard structure acceptable for osteotomy preparation. A total of 244 of these implants have been restored with fixed prosthesis and 6 with removable overdentures for a total of 250 loaded implants. A total of 6 implants failed, which required their removal (2 implants before load and 4 after loading), resulting in a 97.6% implant success rate. We conclude that mineralized human allograft placed into extraction sites is clinically useful to maintain bone volume. This material provided a bony hard structure acceptable for implant placement with good success rates.

Human histologic analysis of mineralized bone allograft (Puros) placement before implant surgery.

Because clinicians are placing more dental implants, it is becoming more important to maintain bone volume after tooth extraction. This article discusses the various bone-augmentation materials available to the clinician and illustrates a case report of particulate mineralized bone allograft (Puros) placement after extraction. Exposure of the grafted site after 5 months revealed a hard bony structure. Human histologic analysis at the light microscopic level revealed nonvital spicules of mature calcified bone having a highly organized matrix surrounded by viable noncalcified immature bone matrix, or osteoid. It was concluded that mineralized human allograft demonstrated the formation or remodeling of bone histologically and was clinically useful to maintain bone volume for implant placement after extraction. To the authors' knowledge, this is the first publication to demonstrate human histology of particulate mineralized bone allograft (Puros) after placement into an extraction site.

Air bubble-associated endothelial trauma in descemet stripping automated endothelial keratoplasty.

PURPOSE: To evaluate endothelial cell trauma by anterior chamber (AC) air bubbles in Descemet stripping automated endothelial keratoplasty (DSAEK). DESIGN: Laboratory investigation. METHODS: Twelve human donor corneas (6 pairs) were sectioned using an automated microkeratome system (Moria ALTK System, Antony, France). One cornea of each pair was mounted on a Moria artificial AC, and an air bubble was injected to fill 40% of the AC. The apparatus was rotated 180 degrees for a total of 50 times to simulate air bubble trauma. The fellow corneas were used as controls. Each endothelial graft was stained with 0.25% Trypan blue for 90 seconds followed by 0.2% alizarin red for 2 minutes, and digital photomicrographs were obtained. Abnormally staining areas indicative of graft injury were removed digitally from the total graft area. The proportion of uninjured corneal endothelium was calculated, and differences were analyzed. RESULTS: In this ex vivo model of air bubble trauma, the proportion of viable graft endothelium after air bubble injury was 79.8 +/- 0.04% (n = 6). The proportion of viable endothelium in the control group was 89.9 +/- 0.02% (n = 6). The statistically significant mean difference of 10.1% (P = .03) is indicative of greater endothelial injury after air bubble trauma. CONCLUSIONS: Using this model, a moderate but significant amount of endothelial cell damage was associated with air bubble trauma compared with the control group. Air bubble trauma may account partially for the loss of endothelial cell density after DSAEK surgery and may impact graft survival.

Induction of IL-6 expression by mechanical stress in the trabecular meshwork.

The trabecular meshwork (TM)/Schlemm's canal (SC) outflow pathway is the tissue responsible for maintaining normal levels of intraocular pressure. In the present study, we investigate the effects of mechanical stress on the expression of IL-6 in the TM meshwork, as well as the effects of this cytokine on outflow pathway function. Application of cyclic mechanical stress to human TM primary cultures resulted in a statistically significant increase in both secretion and transcription of IL-6, compared to nonstressed controls. Addition of TGF-beta1, which has been reported to be upregulated in TM cells under mechanical stress, also induced a significant activation of both the transcription and secretion of IL-6. Moreover, anti-TGF-b1 antibodies partially blocked the stretch-induced IL-6 production. Injection of IL-6 into perfused porcine anterior segments resulted in a 30% increase in outflow facility, as well as increased permeability through SC cell monolayers. These results suggest a role for IL-6 in the homeostatic modulation of aqueous humor outflow resistance.