Mechanical biofilm disruption causes microbial and immunological shifts in periodontitis patients.

Periodontitis is characterized by subgingival biofilm dysbiosis, inflammation and tissue destruction. Current treatment involves mechanical biofilm disruption known as non-surgical periodontal therapy (NSPT). This study sought to characterise the impact of treatment on microbial diversity and overall community, and the parallel impact on host inflammation in the oral cavity. Fourty-two periodontitis patients were included in this study, with periodontal clinical parameters, subgingival plaque and saliva samples collected at baseline and 90 days after treatment. Salivary cytokines were quantified, and subgingival plaque was analysed using 16S rRNA sequencing. After treatment, there were marked health-associated alterations in microbial composition and diversity, including differential abundance of 42 genera and 61 species. These changes were accompanied by substantial clinical improvement (pockets ≥ 5 mm, 27.50% to 9.00%, p < 0.001) and a decrease in salivary IL-1ß (p < 0.001)-a putative marker of periodontal inflammation. Despite significant reductions in disease associated anaerobes, several genera (Fusobacterium, Prevotella, Tanenerella, Treponema) remained present and formed a distinct subnetwork associated with residual disease. Collectively, this study shows that current periodontal treatment results in partial restoration of a healthy microbial ecosystem, but features of biofilm dysbiosis and host inflammation remain in some patients, which were surprisingly independent of clinical response.

Nitrate as a potential prebiotic for the oral microbiome.

The salivary glands actively concentrate plasma nitrate, leading to high salivary nitrate concentrations (5-8 mM) after a nitrate-rich vegetable meal. Nitrate is an ecological factor that can induce rapid changes in structure and function of polymicrobial communities, but the effects on the oral microbiota have not been clarified. To test this, saliva of 12 healthy donors was collected to grow in vitro biofilms with and without 6.5 mM nitrate. Samples were taken at 5 h (most nitrate reduced) and 9 h (all nitrate reduced) of biofilm formation for ammonium, lactate and pH measurements, as well as 16S rRNA gene Illumina sequencing. Nitrate did not affect biofilm growth significantly, but reduced lactate production, while increasing the observed ammonium production and pH (all p < 0.01). Significantly higher levels of the oral health-associated nitrate-reducing genera Neisseria (3.1 ×) and Rothia (2.9 ×) were detected in the nitrate condition already after 5 h (both p < 0.01), while several caries-associated genera (Streptococcus, Veillonella and Oribacterium) and halitosis- and periodontitis-associated genera (Porphyromonas, Fusobacterium, Leptotrichia, Prevotella, and Alloprevotella) were significantly reduced (p < 0.05 at 5 h and/or 9 h). In conclusion, the addition of nitrate to oral communities led to rapid modulation of microbiome composition and activity that could be beneficial for the host (i.e., increasing eubiosis or decreasing dysbiosis). Nitrate should thus be investigated as a potential prebiotic for oral health.

Oral microbiota maturation during the first 7 years of life in relation to allergy development.

BACKGROUND: Allergic diseases have become a major public health problem in affluent societies. Microbial colonization early in life seems to be critical for instructing regulation on immune system maturation and allergy development in children. Even though the oral cavity is the first site of encounter between a majority of foreign antigens and the immune system, the influence of oral bacteria on allergy development has not yet been reported. OBJECTIVE: We sought to determine the bacterial composition in longitudinally collected saliva samples during childhood in relation to allergy development. METHODS: Illumina sequencing of the 16S rDNA gene was used to characterize the oral bacterial composition in saliva samples collected at 3, 6, 12, 24 months, and 7 years of age from children developing allergic symptoms and sensitization (n = 47) and children staying healthy (n = 33) up to 7 years of age. RESULTS: Children developing allergic disease, particularly asthma, had lower diversity of salivary bacteria together with highly divergent bacterial composition at 7 years of age, showing a clearly altered oral microbiota in these individuals, likely as a consequence of an impaired immune system during infancy. Moreover, the relative amounts of several bacterial species, including increased abundance of Gemella haemolysans in children developing allergies and Lactobacillus gasseri and L. crispatus in healthy children, were distinctive during early infancy, likely influencing early immune maturation. CONCLUSION: Early changes in oral microbial composition seem to influence immune maturation and allergy development. Future experiments should test the probiotic potential of L. gasseri and L. crispatus isolates.

Effects of warm-up on hamstring muscles stiffness: Cycling vs foam rolling.

This study investigated the effects of active and/or passive warm-up tasks on the hamstring muscles stiffness through elastography and passive torque measurements. On separate occasions, fourteen males randomly completed four warm-up protocols comprising Control, Cycling, Foam rolling, or Cycling plus Foam rolling (Mixed). The stiffness of the hamstring muscles was assessed through shear wave elastography, along with the passive torque-angle relationship and maximal range of motion (ROM) before, 5, and 30 minutes after each experimental condition. At 5 minutes, Cycling and Mixed decreased shear modulus (-10.3% ± 5.9% and -7.7% ± 8.4%, respectively; P≤.0003, effect size [ES]≥0.24) and passive torque (-7.17% ± 8.6% and -6.2% ± 7.5%, respectively; P≤.051, ES≥0.28), and increased ROM (+2.9% ± 2.9% and +3.2% ± 3.5%, respectively; P≤.001, ES≥0.30); 30 minutes following Mixed, shear modulus (P=.001, ES=0.21) and passive torque (P≤.068, ES≥0.2) were still slightly decreased, while ROM increased (P=.046, ES=0.24). Foam rolling induced "small" immediate short-term decreases in shear modulus (-5.4% ± 5.7% at 5 minutes; P=.05, ES=0.21), without meaningful changes in passive torque or ROM at any time point (P≥.12, ES≤0.23). These results suggest that the combined warm-up elicited no acute superior effects on muscle stiffness compared with cycling, providing evidence for the key role of active warm-up to reduce muscle stiffness. The time between warm-up and competition should be considered when optimizing the effects on muscle stiffness.

Effect of antibiotics on biofilm inhibition and induction measured by real-time cell analysis.

AIMS: The purpose of the current work was to study the pattern and dynamics of biofilm formation in clinical isolates of Staphylococcus aureus and Staphylococcus epidermidis in the presence of 10 antibiotics with different action mechanisms. METHODS AND RESULTS: By using impedance measurements in microtitre plates with gold electrodes we have assessed the antibiotic effect on bacterial biofilm growth in real time. The impedance measurements appear to combine both cellular growth and matrix production, representing a measurement of total biofilm mass. Several clinical and reference strains were tested, showing different slopes and cell index values which correlated with their capacity to form biofilms as assessed by attachment to standard microtitre well plates and safranin staining. Biofilms were heavily reduced in biofilm mutants or by protease treatment in protein-based biofilm matrixes. Antibiotic resistance patterns of biofilms, which were very different to those obtained by traditional methods like epsilon-tests on solid media, revealed features that would pass unnoticed by end-point methods. CONCLUSIONS: Once the biofilm is formed, antibiotic efficacy dramatically reduced and sub-inhibitory concentrations of some antibiotics, such as linezolid and clarithromycin, stimulated biofilm growth, stressing the importance of studying antibiotic resistance under biofilm growth conditions in real time. SIGNIFICANCE AND IMPACT OF THE STUDY: Real-time biofilm analysis provides a promising tool to evaluate antibiotic therapy in clinical biofilm-mediated infections.

Altered metabolism of gut microbiota contributes to chronic immune activation in HIV-infected individuals.

Altered interplay between gut mucosa and microbiota during treated HIV infection may possibly contribute to increased bacterial translocation and chronic immune activation, both of which are predictors of morbidity and mortality. Although a dysbiotic gut microbiota has recently been reported in HIV+ individuals, the metagenome gene pool associated with HIV infection remains unknown. The aim of this study is to characterize the functional gene content of gut microbiota in HIV+ patients and to define the metabolic pathways of this bacterial community, which is potentially associated with immune dysfunction. We determined systemic markers of innate and adaptive immunity in a cohort of HIV-infected individuals on successful antiretroviral therapy without comorbidities and in healthy non-HIV-infected subjects. Metagenome sequencing revealed an altered functional profile, with enrichment of the genes involved in various pathogenic processes, lipopolysaccharide biosynthesis, bacterial translocation, and other inflammatory pathways. In contrast, we observed depletion of genes involved in amino acid metabolism and energy processes. Bayesian networks showed significant interactions between the bacterial community, their altered metabolic pathways, and systemic markers of immune dysfunction. This study reveals altered metabolic activity of microbiota and provides novel insight into the potential host-microbiota interactions driving the sustained inflammatory state in successfully treated HIV-infected patients.

Papulosis linfomatoide pustulosa / Pustular lymphomatoid papulosis

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Foliculitis pustulosa eosinofílica en el lactante / Eosinophilic pustular folliculitis in childhood

Antecedentes: La foliculitis pustulosa eosinofílica (FPE) es una anomalía inflamatoria de origen desconocido que se caracteriza en la infancia, por presentar brotes recurrentes de pústulas estériles que afectan principalmente o casi de forma exclusiva el cuero cabelludo, y de forma ocasional cara, tronco y extremidades. Existen pocas referencias de la FPE en la infancia. Objetivo: Nuestro propósito es describir las características clínico-evolutivas de 4 niños y comentar los principales diagnósticos diferenciales. Métodos: Se examinaron las biopsias, se cultivaron las pústulas y se analizaron los datos de laboratorio. Resultados: Cuatro pacientes (3 varones y 1 mujer) con edades comprendidas entre 3 y 11 meses, consultaron por lesiones papulopustulosas pruriginosas en el cuero cabelludo de curso recurrente y autolimitado. En uno de ellos se localizaban principalmente en extremidades. Los cultivos para bacterias, hongos y virus fueron negativos. No se encontró ninguna enfermedad sistémica asociada. El tratamiento con corticoides tópicos fue efectivo en 3 casos, aunque recurrían después de suspenderlo. No se instauró tratamiento sistémico, excepto la citericina e hidroxicina en 2 pacientes resistentes a los corticoides, con poca respuesta. Se detectó eosinofilia periférica en 3 pacientes. Conclusiones: La FEP de la infancia parece ser una enfermedad bien diferenciada y característica. A pesar de los pocos casos descritos en niños, es indudable que se trata de una dermatosis mucho más frecuente que lo que refleja la bibliografía. Pensamos que es muy importante su conocimiento por los pediatras (AU)

[Eosinophilic pustular folliculitis in childhood]. / Foliculitis pustulosa eosinofílica en el lactante.

BACKGROUND: Eosinophilic pustular folliculitis (EPF) is an inflammatory disorder of unknown etiology. In infants this disorder is characterized by recurrent episodes of sterile pustules primarily or exclusively involving the scalp with occasional involvement of the face, trunk and extremities. There are few reports of EPF in children. OBJECTIVE: To describe the clinical features and evolution of four pediatric patients and to discuss the main differential diagnoses. METHODS: Biopsy specimens were examined, pustules were cultured and laboratory tests were analyzed. RESULTS: Four patients (3 males and 1 female) aged 7-18 months presented with self limiting recurrent pruritic papules and pustules on the scalp. In one patient, the lesions were mainly localized on the extremities. Cultures for bacteria, fungi and viruses were negative. No systemic disease was found. Topical steroids were effective in three patients but pustules recurred after treatment was stopped. Cetirizine and Hydroxacen were administered in two corticoid-resistant patients with fair response. No other systemic therapy was administered. Peripheral eosinophilia was detected in three patients. CONCLUSIONS: EPF in infants seems to be a clearly defined entity. Although few cases have been described in children, this dermatosis is undoubtedly more frequent than suggested by the literature. Consequently, pediatricians should be aware of its existence.

[Transformation of glandular cystitis into bladder transitional carcinoma with adenocarcinoma areas]. / Conversión de cistitis glandular a carcinoma transicional vesical con áreas de adenocarcinoma.

OBJECTIVE: The association of cystitis glandularis with primary bladder tumors is well known. A case of cystitis glandularis progressing to transitional cell carcinoma is described and the literature briefly reviewed. METHODS/RESULTS: We report on a case of diffuse cystitis glandularis in whom progression to transitional cell carcinoma with areas of adenocarcinoma had been discovered. Treatment was by radical cystectomy with urinary diversion. CONCLUSION: Extensive and diffuse cystitis glandularis can be a potentially malignant lesion. Patients with diffuse cystitis glandularis should have a regular cystoscopic follow-up for early detection of progression to a bladder tumor.

[Increase in hospital productivity and zero base planning]. / El incremento en la productividad hospitalaria y la planificación base cero.

In this paper, ways of setting up the functions of personnel management is discussed. For this, the basic factors such as knowing exactly what the potential and needs of the personnel in question are used in order to undertake the objectives of the health care institution, as well as the different ways of employing incentives and motivation to strengthen the work capacity and maximize the results obtained from the hospital institution. In addition, the zero base planning and its role in this model are explained.