Surgical exploration for stable patients with penetrating cardiac box injuries: When and how? A cohort of 155 patients from Marseille area

alexandrossfakianakis shared this article with you from Inoreader Surgical exploration for stable patients with penetrating cardiac box injuries: When and how? A cohort of 155 patients from Marseille area via Journal of Trauma and Acute Care Surgery - Current Issue BACKGROUND The management of penetrating thoracic injuries in moribund or unstable patients is clearly described in contrast to that of stable patients, particularly for those with a cardiac box injury. This anatomic location suggests a potentially lethal cardiac injury and requires urgent therapeutic decision making. The present study aims at determining when surgical exploration is beneficial for stable patients presenting with penetrating cardiac box injuries (PCBIs). METHODS This was a retrospective study of stable civilian patients with PCBI referred to level I trauma centers in the Marseille area between January 2009 and December 2019. Using post hoc analysis of the management outcomes, patients whose surgery was considered therapeutic (group A) were compared with those whose surgery was considered nontherapeutic and with nonoperated patients (group B). RESULTS A total of 155 patients with PCBI were included, with 88% (n = 137) of stab wound injuries. Overall, surgical exploration was performed in 54% (n = 83), considered therapeutic in 71% (n = 59), and performed by video-assisted thoracoscopy surgery in 42% (n = 35) with a conversion rates of 14% (n = 5). Initial extended fast assessment with sonography for trauma revealed the presence of hemopericardium in 29% (n = 29) in group A versus 9.5% (n = 7) in group B, p = 0.010, and was associated with a negative predictive value of 93% regarding the presence of a cardiac injury. Chest tube flow was significantly higher in patients who required surgery, with a median (interquartile range) of 600.00 (350.00–1200.00) mL versus 300.0 (150.00–400.00) mL (p = 0.001). CONCLUSION Extended fast assessment with sonography for trauma and chest tube flow are the cornerstones of the management of stable PCBI. Video-assisted thoracoscopy represents an interesting approach to check intrathoracic wounds while minimizing surgical morbidity. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV. View on Web

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The relationship between sarcopenia, dysphagia, malnutrition, and frailty: making the case for proactive swallowing exercises to promote healthy aging

alexandrossfakianakis shared this article with you from Inoreader The relationship between sarcopenia, dysphagia, malnutrition, and frailty: making the case for proactive swallowing exercises to promote healthy aging via Current Opinion in Otolaryngology & Head and Neck Surgery - Published Ahead-of-Print Purpose of review The purpose of this review is to summarize current evidence regarding the relationship between sarcopenia of the swallowing muscles, dysphagia, malnutrition, and frailty in the context of aging. Further, this review will provide preliminary support for proactive swallowing exercises to reverse and/or prevent sarcopenia of the swallowing muscles. Recent findings Recent studies lend support to a cyclic relationship between sarcopenia of the swallowing muscles, dysphagia, malnutrition, and frailty. Unfortunately, all studies are limited by their study design and lack instrumental imaging of swallowing function. Research (in the limbs) supports the use of proactive exercises and protein supplementation to reverse sarcopenia, especially in prefrail individuals. This provides a foundation to design and test similar preventive exercises for the swallowing muscles. Summary As the population is rapidly aging, it is vital to understand how the natural loss of muscle in aging impacts swallowing function and the downstream impact on nutritional and physical function. Prospective, longitudinal research with sophisticated outcome measures are required to fully understand this cycle and provide an opportunity to test methods for interrupting the cycle. View on Web

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Asthma inflammatory phenotypes on four continents: most asthma is non-eosinophilic

alexandrossfakianakis shared this article with you from Inoreader Asthma inflammatory phenotypes on four continents: most asthma is non-eosinophilic via International Journal of Epidemiology - Advance Access Abstract Background Most studies assessing pathophysiological heterogeneity in asthma have been conducted in high-income countries (HICs), with little known about the prevalence and characteristics of different asthma inflammatory phenotypes in low-and middle-income countries (LMICs). This study assessed sputum inflammatory phenotypes in five centres, in Brazil, Ecuador, Uganda, New Zealand (NZ) and the United Kingdom (UK). Methods We conducted a cross-sectional study of 998 asthmatics and 356 non-asthmatics in 2016–20. All centres studied children and adolescents (age range 8–20 years), except the UK centre which involved 26–27 year-olds. Information was collected using questionnaires, clinical characterization, blood and induced sputum. Results Of 623 asthmatics with sputum results, 39% (243) were classified as eosinophilic or mixed granulocytic, i.e. eosinophilic asthma (EA). Adjusted for age and sex, with NZ as ba seline, the UK showed similar odds of EA (odds ratio 1.04, 95% confidence interval 0.37–2.94) with lower odds in the LMICs: Brazil (0.73, 0.42–1.27), Ecuador (0.40, 0.24–0.66) and Uganda (0.62, 0.37–1.04). Despite the low prevalence of neutrophilic asthma in most centres, sputum neutrophilia was increased in asthmatics and non-asthmatics in Uganda. Conclusions This is the first time that sputum induction has been used to compare asthma inflammatory phenotypes in HICs and LMICs. Most cases were non-eosinophilic, including in settings where corticosteroid use was low. A lower prevalence of EA was observed in the LMICs than in the HICs. This has major implications for asthma prevention and management, and suggests that novel prevention strategies and therapies specifically targeting non-eosinophilic asthma are required globally. View on Web

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Transmission pattern of measles virus circulating

alexandrossfakianakis shared this article with you from Inoreader Transmission pattern of measles virus circulating in China during 1993–2021: genotyping evidence supports that China is approaching measles elimination via Clinical Infectious Diseases Advance Access Abstract Background To provide useful insights into the measles elimination progress in China, measles surveillance data was reviewed, and the transmission patterns of measles viruses circulating in China during 1993–2021 were analyzed. Methods Measles incidence data from the National Notifiable Disease Reporting System of the China Center for Disease Control and Prevention was analyzed. A total of 17,570 strains were obtained from 30 of 31 provinces in mainland China during 1993–2021. The recommended genotyping window was amplified. Genotyping analysis was conducted in comparison with the reference strains. Furthermore, phylogenetic analyses were performed to identify genetic relationships among different lineages within the genotypes. Results With high coverage of routine immunization and intensive supplementary immunization activities, measles incidence has shown a downward trend since 1993, despite two resurgences, reac hing a historic low level in 2020–2021 (average 0.5 per million). During 1993–2021, nine genotypes including domestic genotype H1, imported genotypes B3, D4, D8, D9, D11, G3, and H2, and vaccine-associated genotype A were identified. Among them, genotype H1 strain circulated endemically in China for over 25 years; the last strain was detected in Yunnan province in September 2019. Multiple imported genotypes were identified since 2009 showing different transmission patterns. Since April 2020, no imported strains have been detected, while vaccine-associated genotype A continues to be detected. Conclusions The evidence of low incidence during 2020–2021 and virological surveillance data in this study confirmed that China is currently approaching measles elimination. View on Web

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Rifapentine with and without moxifloxacin for pulmonary tuberculosis in people with HIV (S31/A5349)

alexandrossfakianakis shared this article with you from Inoreader Rifapentine with and without moxifloxacin for pulmonary tuberculosis in people with HIV (S31/A5349) via Clinical Infectious Diseases Advance Access Abstract Background Tuberculosis (TB) Trials Consortium Study 31/AIDS Clinical Trials Group A5349, an international randomized open-label phase 3 non-inferiority trial showed that a 4-month daily regimen substituting rifapentine for rifampin and moxifloxacin for ethambutol had non-inferior efficacy and was safe for the treatment of drug-susceptible pulmonary TB (DS-PTB) compared with the standard 6-month regimen. We explored results among the pre-specified subgroup of people with HIV (PWH). Methods PWH and CD4 + counts ≥100 cells/μL were eligible if they were receiving or about to initiate efavirenz-based antiretroviral therapy (ART). Primary endpoints of TB disease-free survival 12 months post-randomization (efficacy) and ≥ grade 3 adverse events (AEs) on treatment (safety) were compared, using a 6.6% non-inferiority margin for efficacy. Randomization was stratified by site, pulmonary cavitation, and HIV-status. PWH were e nrolled in a staged fashion, to support cautious evaluation of drug-drug interactions between rifapentine and efavirenz. Results 2,516 participants from 13 countries in sub-Saharan Africa, Asia, and the Americas were enrolled. Among 194 (8%) microbiologically eligible PWH, the median CD4 + count was 344 cells/μL (interquartile range: 223–455). The rifapentine-moxifloxacin regimen was non-inferior to control (absolute difference in unfavorable outcomes -7.4% [95% CI –20.8% to +6.0%]); the rifapentine regimen was not non-inferior to control (+7.5% [95% CI -7.3% to +22.4%]). Fewer AEs were reported in rifapentine-based regimens (15%) than the control regimen (21%). Conclusions In people with HIV-associated DS-PTB with CD4 + counts ≥100 cells/μL on efavirenz-based ART, the 4-month daily rifapentine-moxifloxacin regimen was non-inferior to the 6-month control regimen and was safe. View on Web

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Elevated preradiotherapy serum lactate dehydrogenase predicts distant metastasis for lymphoepithelial carcinoma of major salivary gland following postoperative radiotherapy

alexandrossfakianakis shared this article with you from Inoreader Elevated preradiotherapy serum lactate dehydrogenase predicts distant metastasis for lymphoepithelial carcinoma of major salivary gland following postoperative radiotherapy via Head & Neck Abstract Background To evaluate the predicting factors associated with distant metastasis (DM) for lymphoepithelial carcinoma of salivary gland (LECSG) following postoperative radiotherapy (PORT). Methods We retrospectively collected 160 eligible patients from two cancer institutions. The DM rate was evaluated using competing risk method. Results The median follow-up time was 65.6 months. Elevated preradiotherapy serum LDH (ratio >0.5) (p = 0.006) and N classification (N2-3) (p = 0.001) were independently associated with DM for the LECSG. After the risk stratification, the high-risk subgroup was defined as the patients presented higher risk score (score >0), whereas 5-year cumulative incidence of DM in the high- and low-risk group was 30.9% and 6.0%, respectively (p < 0.001). Moreover, a significantly worse overall survival (OS) was observed in the high-risk patients compared with the low-risk subgroup (5-year OS: 83.9% vs. 97.8%, p = 0.006). Conclusion Elevated preradiotherapy serum LDH could serve as a predictive factor for DM in the LECSG following PORT. View on Web

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Curcumin reduces inflammation in rat apical periodontitis

alexandrossfakianakis shared this article with you from Inoreader Curcumin reduces inflammation in rat apical periodontitis via International Endodontic Journal Abstract Aim To evaluate the effect of systemic curcumin administration on the severity of apical periodontitis (AP). Methodology Forty male Wistar rats weighing 250-280g each, age 2.5 months, were distributed into four groups (n=10): control untreated rats (C), control rats treated with curcumin (CUR), rats with pulp exposure-induced apical periodontitis (AP), and rats with pulp exposure-induced apical periodontitis treated with curcumin (AP-CUR). Curcumin treatment was administered orally once daily for 15 days before pulp exposure and continued for 30 days after pulp exposure. The rats were sacrificed at 30 days, and the jaws were collected and reconstructed in a program specific for micro-CT. The jaws were processed for analysis of the inflammatory process using Haemotoxylin and Eosin staining and immunohistochemical assays for interleukin tumour necrosis factor alpha (TNF-α), interleukin (Il)-6, and Il-1β. Tartrate-resistant acid phosphatase (TRAP) and osteocalcin (OCN) staining were used to analyze the resorptive process on the bone surface of periapical area. Kruskal–Wallis with Dunn's test was performed for nonparametric data, and ANOVA with Tukey's test for parametric data, p < .05. Results Micro-CT revealed no statistically significant differences in bone resorption between the AP and AP-CUR groups (p > .05). The levels of inflammatory cell infiltration and immunoreactivity for the proinflammatory cytokines TNF-α, Il-6, and Il-1β were significantly higher in the periapical lesions of the AP group than in the AP-CUR group (p < .05). The number of TRAP-positive multinucleated cells was higher in the AP group than in the AP-CUR group (p < .05). In OCN-positive cells, no differences were observed between the AP and AP-CUR groups (p > .05). Conclusions Oral supplementation with curcumin had a significant effect on the AP severity in rats, suggesting an anti-inflammatory effect of curcumin on AP development. View on Web

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