Investigating the role of Candida albicans as a universal substrate for oral bacteria using a transcriptomic approach: implications for interkingdom biofilm control?

Candida albicans is frequently identified as a colonizer of the oral cavity in health and has recently been termed a "keystone" commensal due to its role on the bacterial communities. However, the role that C. albicans plays in such interactions is not fully understood. Therefore, this study aimed to identify the relationship between C. albicans and bacteria associated with oral symbiosis and dysbiosis. To do this, we evaluated the ability of C. albicans to support the growth of the aerobic commensal Streptococcus gordonii and the anaerobic pathogens Fusobacterium nucleatum and Porphyromonas gingivalis in the biofilm environment. RNA-Sequencing with the Illumina platform was then utilized to identify C. albicans gene expression and functional pathways involved during such interactions in dual-species and a 4-species biofilm model. Results indicated that C. albicans was capable of supporting growth of all three bacteria, with a significant increase in colony counts of each bacteria in the dual-species biofilm (p < 0.05). We identified specific functional enrichment of pathways in our 4-species community as well as transcriptional profiles unique to the F. nucleatum and S. gordonii dual-species biofilms, indicating a species-specific effect on C. albicans. Candida-related hemin acquisition and heat shock protein mediated processes were unique to the organism following co-culture with anaerobic and aerobic bacteria, respectively, suggestive that such pathways may be feasible options for therapeutic targeting to interfere with these fungal-bacterial interactions. Targeted antifungal therapy may be considered as an option for biofilm destabilization and treatment of complex communities. Moving forward, we propose that further studies must continue to investigate the role of this fungal organism in the context of the interkingdom nature of oral diseases.

Radiology Technologists Performing Peritoneal Drainage, Local Experience

Purpose We conducted this study to review our experience of peritoneal drainages (paracentesis) performed by interventional radiology technologists.

Materials and Methods This is a retrospective study of peritoneal drainages performed by interventional radiology technologists.

Results We reviewed all peritoneal drainages performed in interventional radiology between November 2018 and November 2021. The review process included success rate, volume drained, catheter duration, and complications.

Conclusion Interventional radiology technologists can safely perform ultrasound-guided peritoneal drainages. Extending Interventional radiology technologists' role to perform ultrasound-guided peritoneal drainages allows interventional radiologists to do more complex procedures, enhances the workflow, and increases the efficiency of the interventional radiology team.

Experience of Radiology Technologists Performing Peripherally Inserted Central Catheters (PICC)

Purpose We conducted this study to review our local experience of performing peripherally inserted central catheters by interventional radiology technologists.

Materials and Methods This is a retrospective study of peripherally inserted central catheters performed by interventional radiology technologists. These procedures were performed using ultrasound guidance for venous puncture and fluoroscopy or electrocardiography guidance followed by chest X-ray to confirm tip location.

Results We reviewed all peripherally inserted central catheters performed in interventional radiology between May 2017 and July 2020. The review process included the success rate, number of venous puncture attempts, method of guidance, procedure time, fluoroscopy time, catheter duration to removal, and complications.

Conclusion Interventional radiology technologists can perform peripherally inserted central catheters safely with high success rate. Extending interventional radiology technologists' role to perform peripherally inserted central catheters allow interventional radiologists to do more complex procedures. This enhances the workflow, increases the interventional radiology team efficiency, and improves the waiting time.

1059 Sleep Parameters In People With Type 2 Diabetes With And Without Insomnia Symptoms

Introduction

There is an increasing awareness of the high prevalence of insomnia symptoms in people with type 2 diabetes (T2D). Past studies have demonstrated the importance of measuring sleep parameters in both averages and variabilities using subjective and objective methods. Thus, we aimed to compare the averages and variability of sleep parameters in people with T2D with and without insomnia symptoms.

Methods

Actigraph measurements and sleep diaries were used in 59 participants to assess sleep parameters, including sleep efficiency (SE), sleep latency, total sleep time, and wake after sleep onset over seven nights. Validated instruments were used to assess the symptoms of depression, anxiety, and pain. Circular data were used to describe the distribution of bed distribution with SE as a magnitude for both groups. Mann Whitney U test was utilized to compare averages and variability of sleep parameters between the two groups. Multivariable general linear model to control for demographic and clinical variables. For the secondary aim, multiple linear regression tests were utilized to assess the association between averages and variability values for both groups.

Results

SE was found to be lower in average and higher in variability for participants with T2D and insomnia symptoms, than those with T2D only subjectively and objectively. SE variability was also the only sleep parameter higher in people with T2D and insomnia symptoms, with psychological symptoms potentially playing a role in this difference. We observed that people in T2D+Insomnia tend to go to bed earlier compared to the T2D only group based on objective measures, but no difference was observed between groups in subjective measures. The only significant relationship in both objective and subjective measures was between the averages and variability of SE.

Conclusion

Our findings suggest a discrepancy between subjective and objective measures in only average of total sleep time, as well as agreement in measures of variability in sleep parameters. Also, the relationship between averages and variabilities suggested the importance of improving SE to minimize its variability. Further research is warranted to investigate the complex relationship between sleep parameters and psychological factors in people with T2D and insomnia symptoms.

Support

None

Periodontal status and serum creatine kinase levels among young soccer players: A preliminary report

OBJECTIVES

It is hypothesized that soccer players with periodontal disease exhibit raised serum creatine kinase (CK) levels as compared to those without periodontal disease. We assessed the clinical gingival status and serum CK levels among young soccer players.

MATERIALS AND METHODS

Demographic data were collected through a structured questionnaire. Full mouth bleeding on probing (BOP) and probing pocket depth (PPD) were assessed. Blood samples (4 mL) were collected for measurement of serum CK levels. All blood samples were collected from a vein in the antecubital region. Total CK activities in serum were determined with an optimized spectrophotometric method. Statistical analysis was performed using one-way analysis of variance, and P< 0.05 was considered statistically significant.

RESULTS

Twenty-seven male soccer players volunteered to participate in the present study. The mean age of the participants in Groups 1 (n = 14) and 2 (n = 13) were 18.2 ± 2.3 years and 19.1 ± 0.6 years, respectively. Mean scores of BOP were significantly higher among individuals in Group 2 (56.8%) compared with individuals in Group 1 (19.4%) (P < 0.001). Mean scores of PPD ≥4 mm were significantly higher among subjects in Group 2 (12.1%) as compared to individuals in Group 1 (0.8%) (P < 0.001). Levels of CK were significantly higher among individuals in Group 2 (292.7 U/L) as compared to those in Group 1 (52.3 U/L) (P < 0.01).

CONCLUSION

Increased BOP and PPD are associated with increased serum CK levels in young soccer players.

Glioma invasion mediated by the p75 neurotrophin receptor (p75(NTR)/CD271) requires regulated interaction with PDLIM1

The invasive nature of glioblastoma renders them incurable by current therapeutic interventions. Using a novel invasive human glioma model, we previously identified the neurotrophin receptor p75^NTR (aka CD271) as a mediator of glioma invasion. Herein, we provide evidence that preventing phosphorylation of p75^NTR on S303 by pharmacological inhibition of PKA, or by a mutational strategy (S303G), cripples p75^NTR-mediated glioma invasion resulting in serine phosphorylation within the C-terminal PDZ-binding motif (SPV) of p75^NTR. Consistent with this, deletion (ΔSPV) or mutation (SPM) of the PDZ motif results in abrogation of p75^NTR-mediated invasion. Using a peptide-based strategy, we identified PDLIM1 as a novel signaling adaptor for p75^NTR and provide the first evidence for a regulated interaction via S425 phosphorylation. Importantly, PDLIM1 was shown to interact with p75^NTR in highly invasive patient-derived glioma stem cells/tumor-initiating cells and shRNA knockdown of PDLIM1 in vitro and in vivo results in complete ablation of p75^NTR-mediated invasion. Collectively, these data demonstrate a requirement for a regulated interaction of p75^NTR with PDLIM1 and suggest that targeting either the PDZ domain interactions and/or the phosphorylation of p75^NTR by PKA could provide therapeutic strategies for patients with glioblastoma.

Peripheral T-cell lymphomas - cytokine profile and characteristic interleukin-4 and tumor-necrosis-factor alpha-deficiency

Because of the recent evidence of involvement of cytokines in the inflammatory processes, cellular proliferation and host defence mechanism, we have measured the in vitro production of interferon-gamma (IFN-gamma), interleukin (IL)-4, IL-6 and tumor necrosis factor-alpha (TNFalpha) from the phenotypically and histologically characterized ten peripheral T cell lymphoma (PTCL) cases. The immunophenotypic study had identified three gammadelta PTCL cases (CD3-CD4+CD8+, one case and CD3+CD4-CD8, two cases). Mononuclear cells obtained from the lymph node cells of PTCL cases, irrespective of histologic type, were found to produce highly elevated levels of IFN-gamma and IL-6 both spontaneously and in response to concanavalin A stimulations. However, IL-4 and TNFalpha production was characteristically decreased from cells obtained from both blood and lymph nodes. IL-4 and TNFalpha have a number of pleiotropic activities in particular stimulation of various immune effector functions. Their deficient production is an important indication of severe immune dysfunction in this disease. However, the meaning of their deficient production is currently unclear. It may be a loss of physiologic regulation within the cytokine network. On the contrary, elevated IFN-gamma and IL-6 production may be important in etiology, inflammatory response or disease pathogenesis.

Efficacy of nebulized furosemide in children with moderate attack of asthma

BACKGROUND

Bronchodilators are the most commonly used drugs for asthma. However, alternative treatment is necessary for those patients who experience adverse effects from bronchodilators.

OBJECTIVE

To investigate the efficacy of nebulized furosemide in children with moderate asthma exacerbations.

METHOD AND MATERIALS

A double-blind randomized, controlled trial involving three groups of children with moderate attack of asthma. Twenty children were enrolled in group A and received nebulized albuterol, 20 children in group B received nebulized furosemide and 19 children in group C received both albuterol and furosemide. Pulmonary function parameters, peak flow rates, respiratory rate, oxygen saturation and clinical scores were obtained before and after treatment.

RESULTS

The maximum increases in FEV1 achieved were 21.1 +/- 4.6 %, 20.8 +/- 3.2 and 21.7 +/- 4.9 in groups A, B and C respectively. The differences between the groups were not significant. Maximum increase in FVC was 20.3 +/- 1.6, 22.5 +/- 5.8 % and 24.5 +/- 4.9 % in groups B and C respectively. The difference between the three groups was not statistically significant. With regards to peak expiratory flow rate (PEFR), the mean increase after treatment was 23.5 +/- 8.6% and 21.8 +/- 6.3% in groups A and B respectively. There was significant increase in PEFR in group C children (26.0 +/- 9.1%; p = 0.01). There was no statistical significant difference among the three groups regarding the improvement in respiratory rate, SaO2 and clinical scores.

CONCLUSION

Combination of both furosemide and albuterol led to significant increase in peak flow rate but it did not significantly affect FEV1, FVC, FEF 25-75, respiratory rate, SaO2 or clinical scores as compared to other groups. There were no significant adverse effects from the three drugs used.

A comparison of inhaled fluticasone and oral prednisone for children with severe acute asthma

BACKGROUND

Inhaled corticosteroids are effective in the treatment of children with asthma. It is uncertain how inhaled corticosteroids compare with oral corticosteroids in the management of severe acute disease.

METHODS

We performed a double-blind, randomized trial involving 100 children five years of age or older who had severe acute asthma (indicated by a forced expiratory volume in one second [FEV1] that was less than 60 percent of the predicted value) and in whom the results could be evaluated. All were treated with an aggressive bronchodilator regimen and received one dose of either 2 mg of inhaled fluticasone through a metered-dose inhaler with a spacer or 2 mg of oral prednisone per kilogram of body weight. They were assessed hourly for up to four hours.

RESULTS

The mean (+/-SD) base-line FEV1 as a percentage of the predicted value was 46.3+/-12.5 in the fluticasone group (51 subjects) and 43.9+/-9.9 in the prednisone group (49 subjects). The FEV1 increased by a mean of 9.4+/-12.5 percentage points in the fluticasone group and by 18.9+/-9.8 percentage points in the prednisone group four hours after therapy (P< 0.001). None of the children in the prednisone group had a reduction in FEV1 as a percentage of the predicted value from base line to four hours, as compared with 25 percent of those in the fluticasone group (P<0.001). Sixteen (31 percent) of the children treated with fluticasone were hospitalized, as compared with five (10 percent) of those treated with prednisone (P=0.01).

CONCLUSIONS

Children with severe acute asthma should be treated with oral prednisone and not with inhaled fluticasone or a similar inhaled corticosteroid.

Anaphylaxis and epinephrine auto-injector training: who will teach the teachers?

BACKGROUND

Anaphylaxis is the most urgent clinical immunologic event. Effective treatment is best achieved by administration of epinephrine. Accidental exposure to the responsible allergen is the most common cause of anaphylaxis, and because it could be fatal within minutes, epinephrine in preloaded syringes and auto-injectors has been introduced. In our experience patients and medical personnel are not familiar with the use of this device.

OBJECTIVE

We sought to assess community-based professionals' knowledge of epinephrine auto-injector use and their ability to educate patients.

METHODS

Study participants consisted of a medical convention's delegates and emergency department personnel in metropolitan Toronto, as well as pharmacists of the target hospitals and retail pharmacists. Research assistants approached eligible professionals to fill out a questionnaire and demonstrate their ability to use a standard placebo auto-injector trainer.

RESULTS

A total of 122 professionals (composed of emergency physicians, family practitioners, and pediatricians) consented to participate in this study. The majority of participants (81%) did not have a placebo trainer to educate their patients; 76% did not know the 2 available dose strengths. To provide instructions and reinforcement, physicians clearly must have the necessary skills and knowledge, yet only 25% of the study participants were able to demonstrate the 3 steps of injection correctly.

CONCLUSION

Our study highlights a specific and important deficiency in medical professionals' care of patients at risk for anaphylaxis. The results challenge the current methods of educating professionals, as well as patients, when prescribing or using epinephrine auto-injectors. Clearly a new approach to educating and maintaining such skills is required.

Hyperplasia of pulmonary neuroendocrine cells in a case of childhood pulmonary emphysema

Pulmonary emphysema is very uncommon in children in the first decade of life. The few cases documented in the literature were all due to alpha1-antitrypsin deficiency. We present the case of a 6-year-old white boy with chronic cough and dyspnea on exertion. Lung biopsy showed panacinar type emphysema with patent airways and diffuse hyperplasia of pulmonary neuroendocrine cells revealed after immunostaining for bombesin, a peptide produced by these cells. We speculate that idiopathic diffuse hyperplasia of bombesin-producing pulmonary neuroendocrine cells may contribute to the pathogenesis of unusual COPD in childhood.

Transcatheter management of pulmonary venous pathway obstruction with atrial baffle leak following Mustard and Senning repair

Two patients presenting with pulmonary venous baffle obstruction following Mustard or Senning repair of transposition of the great arteries were successfully treated with percutaneous balloon dilatation. At the time of baffle dilatation, a significant systemic to pulmonary venous Mustard baffle leak was successfully closed with a Rashkind ductal occluder device. Specific features pertaining to the morphology of the baffle defect that allowed successful catheter occlusion are discussed and compared to that found in a Senning patient. The important adjunctive role of transoesophageal echocardiography within the catheterization laboratory is emphasized.