Pathophysiological role of respiratory dysbiosis in hospital-acquired pneumonia

Hospital-acquired pneumonia is a major cause of morbidity and mortality. The incidence of hospital-acquired pneumonia remains high globally and treatment can often be ineffective. Here, we review the available data and unanswered questions surrounding hospital-acquired pneumonia, discuss alterations of the respiratory microbiome and of the mucosal immunity in patients admitted to hospital, and explore potential approaches to stratify patients for tailored treatments. The lungs have been considered a sterile organ for decades because microbiological culture techniques had shown negative results. Culture-independent techniques have shown that healthy lungs harbour a diverse and dynamic ecosystem of bacteria, changing our comprehension of respiratory physiopathology. Understanding dysbiosis of the respiratory microbiome and altered mucosal immunity in patients with critical illness holds great promise to develop targeted host-directed immunotherapy to reduce ineffective treatment, to improve patient outcomes, and to tackle the global threat of resistant bacteria that cause these infections.

Predictive capacity of prodromal symptoms in first-episode psychosis of recent onset

BACKGROUND

Both the nature and number of a wide range of prodromal symptoms have been related to the severity and type of psychopathology in the psychotic phase. However, at present there is an incomplete picture focused mainly on the positive pre-psychotic dimension.

AIM

To characterize the prodromal phase retrospectively, examining the number and nature of prodromal symptoms as well as their relationship with psychopathology at the onset of first-episode psychosis.

METHODS

Retrospective study of 79 patients experiencing a first-episode psychosis of less than 1 year from the onset of full-blown psychosis. All patients were evaluated with a comprehensive battery of instruments including socio-demographic and clinical questionnaire, IRAOS interview, PANSS, stressful life events scale (PERI) and WAIS/WISC (vocabulary subtest). Bivariate associations and multiple regression analysis were performed.

RESULTS

Regression models revealed that several prodromal dimensions of IRAOS (delusions, affect, language, behaviour and non-hallucinatory disturbances of perception) predicted the onset of psychosis, with positive (22.4% of the variance) and disorganized (25.6% of the variance) dimensions being the most widely explained.

CONCLUSION

In addition to attenuated positive symptoms, other symptoms such as affective, behavioural and language disturbances should also be considered in the definitions criteria of at-high-risk people.

In-vitro analysis of a novel 'add-on' silicone cuff to improve sealing properties of tracheal tubes

Leakage of colonised oropharyngeal secretions across the tracheal tube cuff may cause iatrogenic pulmonary infection. We studied a novel 'add-on' cuff, which can be inserted over an existing tracheal tube and advanced into the subglottic region. The physical properties of the novel silicone cuff (BronchoGuard, Ciel Medical, USA) were evaluated in comparison with the Hi-Lo^® tracheal tube. In a bench study, we identified saline inflation volumes required to transmit pressures between 15 and 30 cmH₂ O against artificial tracheas of 18, 20 and 22 mm internal diameter. We computed cuff compliance, and minimal inflation volume to achieve air sealing during mechanical ventilation. Finally, we compared the leakage flow rate of artificial saliva across the novel cuff. On average, the mean (SD) inflation volumes necessary to transmit tracheal pressures of 15, 20, 25 and 30 cmH₂ O were 4.1 (2.2), 4.4 (2.3), 4.6 (2.4) and 4.8 (2.4) ml for the novel cuff and 7.7 (2.5), 8.0 (2.6), 8.4 (2.6) and 8.7 (2.7) ml for the Hi-Lo tube, respectively (p < 0.001). The minimal inflation volumes to achieve air sealing were 3.8 (0.9) and 10.5 (2.1) ml (p < 0.001), which resulted in transmitted tracheal pressures of 8.3 (9.8) and 27.6 (34.8) cmH₂ O (p < 0.001). Compliance was 0.026 (0.004) and 0.616 (0.324) ml.cmH₂ 0^-1 , respectively (p < 0.001). Although massive leak was found when the novel cuff transmitted pressures ≤ 20 cmH₂ O against the trachea, leakage was avoided with pressures ≥ 25 cmH₂ O, owing to optimal contact between the cuff and the tracheal wall. In contrast, the standard cuff consistently leaked irrespective of the pressure. We conclude that the novel cuff has advantageous properties that warrant clinical corroboration.

Performance of butanol separation from ABE mixtures by pervaporation using silicone-coated ionic liquid gel membranes

This work aims at the separation of n-butanol from aqueous solutions by means of pervaporation using membranes based on gelled ionic liquids (IL).

The potential of Dicyphus hesperus as a biological control agent of potato psyllid and sweetpotato whitefly in tomato

The potential of the mirid predator Dicyphus hesperus Knight (Heteroptera: Miridae) as a biological control agent of the sweetpotato whitefly, Bemisia tabaci Gennadius (Hemiptera: Aleyrodidae) and the potato psyllid, Bactericera cockerelli Sulcer (Hemiptera: Psyllidae) in tomato was investigated in two experiments. The first experiment focused on the study of the life history traits of D. hesperus when fed on nymphs of the potato psyllid compared with the factitious prey Ephestia kuehniella Zeller (Lepidoptera: Pyrallidae) eggs. Although reproductive and development rates were higher on E. kuehniella eggs, the predator exhibited a good intrinsic rate of natural increase (rm) when feeding on B. cockerelli nymphs (rm: B. cockerelli 0.069 ± 0.0001; E. kuehniella 0.078 ± 0.0001), thus reflecting good potential as a biocontrol agent of this pest. The second experiment focused on the efficacy of D. hesperus as a biocontrol agent of the potato psyllid and the sweetpotato whitefly in a tomato greenhouse. Prey species were offered individually or together in a series of five treatments in greenhouse cages. Results showed that the predator was able to establish and suppress populations of both pests inhabiting tomato plants when pests occurred alone or together. Thus, D. hesperus was demonstrated to be a suitable biocontrol agent of these two important pests that could be used in tomato greenhouses.

Six New Cases of a Caterpillar-Induced Bleeding Syndrome

We describe six new cases of a hemorrhagic diathesis induced by contact with Lonomia achelous caterpillars. Onset of clinical bleeding varied between a few hours and 10 days post-exposure. Laboratory coagulation tests showed prolonged PT, PTT and ThT; normal platelets and a marked decrease of fibrinogen, factor V, plasminogen and factor XIII (including its subunits A and S). Factors VII, II and alfa 2 anti-plasmin were variably affected. In addition, activation of the fibrinolytic system and the generation of a procoagulant effect could also be demonstrated. Two cases developed severe hemorrhagic diathesis and one of them died of a cerebral hemorrhage. Different aspects of this rare syndrome are discussed in relation to its complex physiopathology and the variability observed in all clinical and laboratory manifestations. Therapeutic recommendations and some possible hazards following replacement transfusions are also considered.

Attitude of Medical Students in Paraguay Towards Homosexuality

INTRODUCTION

The attitude of medical students towards homosexuality may affect the quality of care for homosexual patients. This study aimed to describe the attitude of medical students at the National University of Asuncion, Paraguay towards homosexuality.

METHODS

This observational, cross-sectional study was conducted in June 2016 in consecutive medical students from the National University of Asunción (Santa Rosa del Aguaray branch), Paraguay. The 10-item attitude towards homosexuality scale (EAH-10) was used to assess participants' acceptance/ rejection of homosexuals as individuals, homosexuality as a sexual orientation, and public manifestations of homosexuality.

RESULTS

A total of 48 female and 29 male participants (mean age, 21 ± 2 years) were included. Most were Catholic (71.4%), followed by non-Catholic Christian (10.4%), agnostic (9.1%), atheist (2.6%), and other (6.5%). 71.4% reported having at least one homosexual friend. The mean EAH-10 score was 27.23 ± 9.379. 42.9% of participants were indifferent or undecided in their attitude towards homosexuality and 28.6% were discriminatory. Having homosexual friends was associated with a lower EAH-10 score (t = -3.447 [75], p = 0.001).

CONCLUSION

Education about health issues of homosexuals is needed for medical students in Paraguay.

Changes in Plasma Levels of Protease and Fibrinolytic Inhibitors Induced by Treatment in Acute Myeloid Leukemia

We have studied the main protease inhibitors of leukocytes, alpha-1-protease (α1-PI), alpha- 1-antichymotrypsin (α1-Achy) and alpha-2-macroglobulin (α2-M), as well as different parameters of coagulation and fibrinolysis in 21 cases of acute nonlymphoblastic leukemia (ANLL) before, during and after therapy.

Nine of the patients presented signs of DIC, 8 of whom belonged to subtype M3 and to subtype 1 M1.

The initial α1-PI and α1-Achy levels, which were elevated, increased during the treatment period. There was no significant difference between patients with and without DIC. However, those leukemic patients with DIC showed a significant decrease in plasminogen (p <0.005) and fast antiplasmin (p <0.01) only during the treatment compared with DIC free patients. All DIC cases demonstrated circulating plasmin-antiplasmin complex (P-AP) both before and during treatment.

Independent of a possible proteolytic action of leukocyte enzymes on clotting factors in the clinical course of ANLL (mainly M3 subtype), our results suggest an activation of plasminmediated fibrinolysis related to the activation of plasminogen by leukocytes, reactive DIC or both.

Behaviour of the Contact Phase of Blood Coagulation in the Adult Respiratory Distress Syndrome (ARDS)

In order to assess the role of the kallikrein-kinin (K-K) system in the pathogenesis of the adult respiratory distress syndrome (ARDS) we have prospectively determined coagulation contact phase, blood gas and hemodynamic parameters in patients with ARDS at 0, 36 and 72 h from diagnosis.

Compared to normal values, significantly lower mean levels of factor XII (71.4 ± 9.8%, p <0.0005), prekallikrein (PPK) (52 ± 5.7%, p <0.0005), high molecular weight kininogen (HMWK) (73 ± 2%, p <0.0005) and α2-macroglobulin (α2-M) (51 ± 7.1%, p <0.0005) were found in ARDS patients.

The functional kallikrein inhibitory activity (KKI) and Cr esterase inhibitor antigenic (CIINH) were significantly higher in these patients (113.2 ± 5, p <0.005 and 124.7 ± 7.6, p <0.0005 respectively) compared with normal values during the entire study period.

The KKI/CIINH ratio decreased significantly in our ARDS patients at 0, 36 and 72 h (p <0.025; p <0.05 and p <0.005 respectively).

We found a significant correlation between PPK levels and oxigenation index (r = 0.69, p <0.001), PPK and the static thoracic compliance values (r = 0.64, p <0.001). There was also a significant correlation between PPK levels and Qs/Qt (r = -0.89, p <0.001). ARDS patients that survived presented a stability in the PPK values in successive tests. Nevertheless non-survivors showed a progressive decrease in PPK levels during the follow-up period.

Our results suggest that the plasma kallikrein system becomes activated during ARDS and that this activation might increase the lung vessels’ permeability. In addition, PPK levels are in our opinion a useful prognostic parameter in predicting the outcome of ARDS patients.

Functional Activities and Concentrations of Plasmin Inhibitors in Normal Subjects and D. I. C. Patients

Alpha-2-macroglobulin and fast antiplasmin, the main inhibitors of the fibrinolytic system, and the presence of plasmin-antiplasmin complex (P-AP) were studied in 15 DIC patients and in 20 healthy individuals. There was a lack of correlation between immunological and chromogenic substrates alpha-2 antiplasmin levels when P-AP complex were found in DIC patients (in 6/15 cases). The levels of alpha-2-macroglobulin were within the normal range in most of these patients, confirm the secondary role of this inhibitor in fibrinolysis.

[Infrapectineal plate for repair with minimal invasion of quadrilateral blade acetabular fractures: description new implant and paramedial access]

INTRODUCTION

Quadrilateral plate fractures are the most difficult to reduce and fix. Different techniques have been developed for quadrilateral plate osteosynthesis. The objective of this work was to create an implant and a novel approach to simplify and improve acetabular fracture osteosynthesis.

MATERIAL AND METHODS

A total of 83 patients were studied. Pelvic CT scan images of both acetabula were measured at the proximal and distal posterior column. Implant length, diameters and morphological characteristics were determined. The anatomical features of a novel surgical approach are described. The paramedian approach was performed on a cadaveric specimen to determine its anatomical safety.

RESULTS

The screws measured 20 × 6 × 8 mm (length × core diameter x head diameter), with internal threads of 4.5 mm. The Kolmogorov-Smirnov (Lilliefors) test was used, where p had to be 0.05. Plates were previously determined to be 10 mm wide and 3 mm thick, of variable length. Instruments were developed to surmount difficulties.

DISCUSSION

This new procedure and implant could make the repair of acetabular fractures easier and offers several advantages. Clinical trials are needed to assess the benefits of this proposal. The newly described method can allow acetabular fracture osteosynthesis to be performed safely, avoid iatrogenic injury to anatomical structures and achieve better results.

Serum CEA, CA125, and SCC antigens and tumor recurrence in resectable non-small cell lung cancer

Carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC), and CA125 were determined pre- and postoperatively in non-small cell lung cancer patients (NSCLC) to assess the relationship between serum levels and postoperative recurrent disease. Ninety-five patients who underwent curative surgical resection were included (TNM stages I, II, IIIa). CEA and CA125 were determined by solid-phase enzyme-immunoassay, SCC by radio-immunoassay. Tumor relapse was detected in 41 patients (43%): 16 (39%) with locoregional disease and 25 (61%) with disseminated disease. The overall 36-month disease-free survival rate was 42%. The sensitivity for recurrence was 58% for CEA, 53.6% for CA125, and 51.2% for SCC; 87.8% of patients showed at least one elevated marker. The sensitivity of CEA and CA125 increased significantly in patients with preoperative serum concentrations above the cut-off: 86.6% versus 42.3% (p < 0.01), and 93% versus 18% (p < 0.01), respectively. Preoperative CA125 above 15 U/ml identified a high-risk group of patients: a lower 36-month disease-free survival rate (0%) versus 56%) (p < 0.001), a 3.02-fold higher risk of recurrence (p < 0.05), and a 6.22-fold higher risk of disseminated failure (p < 0.001). The identification of CEA and CA125 producer-tumors, based on preoperative serum values, enhances the clinical performance of a postoperative surveillance program in surgically treated NSCLC. Preoperative serum CA125 is a prognostic factor to identify patients at high risk of postoperative tumor recurrence.

Abstract P4-10-20: Breast cancer in Brazil: HER-2 testing and treatment patterns

BACKGROUND

Breast cancer is the most common cancer among Brazilian women. HER-2 targeted therapy improves overall survival in HER-2 overexpressing patients but immunohistochemistry testing for HER2 is not standardized in Brazil and is not available universally. In Brazil the health system includes a public and private sector. The aim of our study was to delineate the patterns of testing of HER-2 over time in Brazil in both of these settings and to determine if any disparities exist in testing and treatments received.

METHODS

Observational, retrospective study involving practice patterns of over 2000 cancer physicians in Brazil. We obtained de-identified data from a commercial database, which included 54,829 patients with breast cancer treated between 2012 and 2016. We analyzed the frequency of HER-2 testing, the percentage of positive results and the most common treatments used in the first line setting in both the private and public sector. The chi-squared test was used for proportions.

RESULTS

HER-2 testing was frequently performed in both the private and public sector (87% vs. 81%, p&lt;0.0001. Between 2012 and 2016 most patients had HER-2 testing (88%, 73%, 79%, 90% and 88%, respectively) but coverage was not universal. The percentage of HER-2 positivity was 25%. The most common first line regimens used were docetaxel/trastuzumab, paclitaxel/trastuzumab and trastuzumab monotherapy. In the private sector trastuzumab/pertuzumab/docetaxel was the most commonly used regimen. In the public sector taxanes were frequently used as monotherapy without HER-2 targeted therapy.

CONCLUSIONS

To our knowledge this is the largest dataset assessing HER-2 testing and treatment patterns in Brazil. The frequency of testing has remained stable over the last 5 years, but is higher in the private sector and this finding was highly statistically significant. There are also differences in the regimens used in the private vs. public sector. Pertuzumab was approved in 2013 in the US and its use has increased in Brazil over the last two years. This trend however was only seen in the private sector. In the public sector there is still significant use of chemotherapy without HER-2 directed therapy despite HER-2 overexpression, which is possibly related to the restricted access of anti-HER2 therapy in the public health system for metastatic patients. Taxanes are used widely in both the public and private sector, which is possibly related to the availability of generics.

HER 2 Testing in the Public Sector20122013201420152016Tested4,2853,7114,5924,6884,126%92%76%80%94%91%Non Tested36211441134322428%8%24%20%6%9%Total4,6474,8555,7265,0104,554

HER 2 Testing in the Public Sector20122013201420152016Tested5,3913,9964,9175,2084,945%85%71%78%87%85%Non Tested9491,6611,367761842%15%29%22%13%15%Total6,3405,6576,2845,9695,787

Citation Format: Palacio S, Torres A, Prado E, Lopes G. Breast cancer in Brazil: HER-2 testing and treatment patterns [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-20.

Social Capital in Transition(s) to Early Adulthood: A Longitudinal and Mixed-Methods Approach

Social capital captures the value of relationships. Although research has examined social capital among adults, comparatively little attention has been paid to social capital among young adults—particularly from a longitudinal and mixed-methods perspective. As social capital predicts educational achievement, employment, and psychosocial well-being, it is an important construct to study alongside youth transition(s). Following a Bourdieusian approach, we define social capital as the resources potentially available in our ties that can be mobilized when necessary. To examine social capital in transition to adulthood, we draw on survey ( n = 1,650, at ages 17 and 21) and interview ( n = 70, at age 24) data from a cohort of Portuguese youth. We study the two main dimensions of social capital: bonding and bridging. Survey data were analyzed with latent class modeling, logistic regressions, and Wilcoxon signed-rank tests, and interviews with thematic analysis. Findings show that respondents reported receiving more emotional support than financial support from their networks, but that both types of support increased over time. Perceived bonding and bridging also changed positively in transition to adulthood. In addition, gender and parental education predicted bonding and bridging. We contextualize these results with qualitative meanings and experiences of social capital.