Πέμπτη 29 Δεκεμβρίου 2022

SARS-CoV-2 infection history and antibody response to three COVID-19 mRNA vaccine doses

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ABSTRACT
Background
Three doses of coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccines produce robust antibody responses, but data are limited among individuals previously infected with SARS-CoV-2. From a cohort of health care personnel (75.5%), first responders (4.6%), and other frontline workers (19.8%) in 6 US states, we longitudinally assessed antibody waning after dose-2, and response to dose-3, according to SARS-CoV-2 infection history.
Methods
Participants submitted sera every three months, after SARS-CoV-2 infection, and after each COVID-19 vaccine dose. Sera were tested for antibodies and reported quantitatively as area under the serial dilution curve (AUC). Changes in the AUC values over time were compared as fold-changes using a linear mixed model.
Results
Analysis included 388 participants who received dose-3 by November 2021. Three comparison groups: (1) vaccine only with no known prior SARS-CoV-2 inf ection (n = 224); (2) infection prior to dose-1 (n = 123); and (3) infection after dose 2 and before dose-3 (n = 41). The interval from dose 2 and dose 3 was approximately 8-months. After dose-3, antibody levels rose 2.5-fold (95%CI = 2.2-3.0) in group 2, and 2.9-fold (95%CI = 2.6-3.3) in group 1. Those infected within 90 days before dose-3 (and median 233 days (IQR = 213-246) after dose-2) did not increase significantly after dose-3.
Conclusions
A third dose of mRNA vaccine typically elicited a robust humoral immune response among those with primary vaccination regardless of SARS-CoV-2 infection >3 months prior to boosting. Those with infection < 3 months prior to boosting did not have a significant increase in antibody concentrations in response to a booster.
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Do incentives work to motivate voluntary blood donation?

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Abstract

Based on previous research on blood donation incentives, we investigated the effectiveness of two incentives—eligibility for free blood transfusions and improving individual credit scores—and explored the psychological mechanisms underlying these effects. We conducted four studies to explore the relationship between incentives and blood donation intention. The results showed that eligibility for free blood transfusions was more effective than improving individual credit scores due to the mediating effect of perceived attractiveness. Meanwhile, improving individual credit scores failed to play an effective role and was significantly lower than eligibility for free blood transfusions due to the mediating effect of perceived threat to freedom. We further found that after adding the moderating variable of involvement, there was no difference between the two incentives due to the weakened mediating effects of perceived threat to freedom and perceived attractiveness in the high-invo lvement group. This study establishes two effect paths from incentives to perceived threat to freedom/perceived attractiveness to blood donation intention, explaining the effectiveness of incentives.
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Topical Adenosine Inhibits Inflammation and Mucus Production in Viral Acute Rhinosinusitis

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Topical Adenosine Inhibits Inflammation and Mucus Production in Viral Acute Rhinosinusitis

Topical adenosine treatment inhibits inflammation and mucus production in a mouse model of viral acute rhinosinusitis. It may be an effective treatment for viral ARS. Original work created with Biorender.com.


Objective

Viral acute rhinosinusitis (ARS) is the leading cause of work and school absence and antibiotic over-prescription. There are limited treatment options available to ameliorate the symptoms caused by viral ARS. We have previously demonstrated that topical adenosine treatment enhances mucociliary clearance in the sino-nasal tract. Here, we assessed the therapeutic potential of topical adenosine in a mouse model of viral ARS.

Methods

The effect of topical adenosine on inflammatory response and mucin gene expression was examined in a mouse model of viral ARS induced by respiratory syncytial virus (RSV) nasal-only infection. We also investigated the inflammatory effect of both endogenous and exogenous adenosine in the sino-nasal tract.

Results

Topical adenosine significantly inhibited the expression of pro-inflammatory cytokines, goblet hyperplasia, mucin expression, and cell damage in the nose of mice with viral ARS. This treatment did not prolong virus clearance. This inhibitory effect was primarily mediated by the A2A adenosine receptor (AR). Although previous studies have shown that adenosine induces a robust inflammatory response in the lungs, neither endogenous nor exogenous adenosine produced inflammation in the sino-nasal tract. Instead, exogenous adenosine inhibited the baseline expression of TNF and IL-1β in the nose. Additionally, baseline expression of ARs was lower in the nose than that in the trachea and lungs.

Conclusion

We demonstrated that intranasal adenosine administration effectively decreased inflammation and mucus production in a mouse model of viral ARS.

Level of Evidence

N/A Laryngoscope, 2022
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Diagnosis and Management of Vocal Complications after Chondrolaryngoplasty

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Diagnosis and Management of Vocal Complications after Chondrolaryngoplasty

Anterior commissure dislocation should be suspected with signs of vocal impairment after chondrolaryngoplasty. Following proper diagnosis, resuspension of the anterior commissure via feminization laryngoplasty approach can be an effective reparative technique.


Objective

Transfeminine patients (transwomen/feminine nonbinary folks assigned male at birth) can undergo chondrolaryngoplasty ("tracheal shave") to feminize their neck appearance. While isolated cases of vocal complications have been reported following the procedure, aggregated outcomes have not been quantitatively studied. We present acoustic and stroboscopic data to describe a patient cohort with vocal complications after chondrolaryngoplasty and discuss reparative surgical technique.

Methods

Subjective and objective data, including videostroboscopy, were collected from patients with voice complaints after chondrolaryngoplasty. Dislocated anterior commissures were reconstructed with feminization laryngoplasty. Postoperative voice data were recorded and statistically compared to preoperative data using paired t-tests.

Results

On consecutive chart review, of the 94 transfeminine women with prior outside history of chondrolaryngoplasty, 27 (29%) reported chronic postoperative hoarseness, deepened pitch, or loss of upper register. On endoscopy, short, lax vocal folds with persistent anterior glottic gap and phase asymmetry were commonly noted; anterior commissure dislocation was confirmed in-office by using needle localization through absent thyroid cartilage. After open resuspension of the anterior commissure with feminization laryngoplasty, post-repair modal-speaking, minimum, and maximum fundamental frequencies (F0) increased on average by 7, 8, and 5 semitones, respectively (p < 0.01), when compared to pre-repair values. On average, perioperative maximum phonation time did not change significantly (p = 0.15). Average self-assessment of vocal femininity increased by 48% (p < 0.01).

Conclusion

Anterior commissure dislocation should be suspected with signs of vocal impairment after chondrolaryngoplasty. Following proper diagnosis, resuspension of the anterior commissure via feminization laryngoplasty approach can be an effective reparative technique.

Level of Evidence

This work represents a 2011 OCEBM Level 4 evidence as a case series Laryngoscope, 2022
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Reassessing Endotracheal Tube Size in Critically Ill Patients

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To the Editor We read with great interest the article by Esianor and colleagues on endotracheal tube (ETT) size in critically ill patients. Laryngotracheal injuries after invasive mechanical ventilation range from reversible pressure injuries to permanent damage, scarring, fistulas, and transmural lesions. Endotracheal tubes larger than 7.0 mm pose greater risk of laryngeal injury, and ETTs larger than 7.5 mm are often selected for critically ill patients in efforts to improve airflow resistance, avoid blockage, and facilitate procedural int erventions. Little is known as to whether larger ETTs improve recovery. Esianor and colleagues found no difference in 30-day all-cause in-hospital survival between patients with small, appropriate, or large-for-height endotracheal tubes. If larger tubes do not improve survival, is survivorship a better focus? Even with optimally sized tubes, translaryngeal intubation carries risks for impaired speech, swallowing, and airway protection. The investigation presented new questions around selection of ETT size, and has several implications for current practice and future investigation.
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Künstliche Intelligenz auf dem Vormarsch – Hohe Vorhersage-Genauigkeit bei der Früherkennung pigmentierter Melanome

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Laryngorhinootologie
DOI: 10.1055/a-1949-3639

Weltweit steigt die Inzidenz des malignen Melanoms an. Bei frühzeitiger Erkennung ist das Melanom gut behandelbar, eine Früherkennung ist also lebenswichtig.Die Hautkrebs-Früherkennung hat sich in den letzten Jahrzehnten bspw. durch die Einführung des Screenings im Jahr 2008 und die Dermatoskopie deutlich verbessert. Dennoch bleibt die visuelle Erkennung insbesondere von frühen Melanomen eine Herausforderung, weil diese viele morphologische Überlappungen mit Nävi zeigen. Daher ist der medizinische Bedarf weiterhin hoch, die Methoden zur Hautkrebsfrüherkennung gezielt weiterzuentwickeln, um Melanome bereits in einem sehr frühen Stadium sicher diagnostizieren zu können.Die Routinediagnostik zur Hautkrebs-Früherkennung umfasst die visuelle Ganzkörperinspektion, oft ergänzt durch die Dermatoskopie, durch die sich die diagnostische Treffsicherheit erfahrener Hautärzte deutlich erhöhen lässt. E in Verfahren, was in einigen Praxen und Kliniken zusätzlich angeboten wird, ist die kombinierte Ganzkörperfotografie mit der digitalen Dermatoskopie für die Früherkennung maligner Melanome, insbesondere für das Monitoring von Hochrisiko-Patienten.In den letzten Jahrzenten wurden zahlreiche nicht invasive zusatzdiagnostische Verfahren zur Beurteilung verdächtiger Pigmentmale entwickelt, die das Potenzial haben könnten, eine verbesserte und z. T. automatisierte Bewertung dieser Läsionen zu ermöglichen. In erster Linie ist hier die konfokale Lasermikroskopie zu nennen, ebenso die elektrische Impedanzspektroskopie, die Multiphotonen-Lasertomografie, die Multispektralanalyse, die Raman-Spektroskopie oder die optische Kohärenztomografie. Diese diagnostischen Verfahren fokussieren i. d. R. auf hohe Sensitivität, um zu vermeiden, ein malignes Melanom zu übersehen. Dies bedingt allerdings üblicherweise eine geringere Spezifität, was im Screening zu unnötigen Exzisionen vieler gutartiger Läsionen führen kann. Auch sind einige der Verfahren zeitaufwendig und kostenintensiv,was die Anwendbarkeit im Screening ebenfalls einschränkt.In naher Zukunft wird insbesondere die Nutzung von künstlicher Intelligenz die Diagnosefindung in vielfältiger Weise verändern. Vielversprechend ist v. a. die Analyse der makroskopischen und dermatoskopischen Routine-Bilder durch künstliche Intelligenz. Für die Klassifizierung von pigmentierten Hautläsionen anhand makroskopischer und dermatoskopischer Bilder erzielte die künstliche Intelligenz v. a. in Form neuronaler Netze unter experimentellen Bedingungen in zahlreichen Studien bereits eine vergleichbare diagnostische Genauigkeit wie Dermatologen. Insbesondere bei der binären Klassifikationsaufgabe Melanom/Nävus erreichte sie hohe Genauigkeiten, doch auch in der Multiklassen-Differenzierung von verschiedenen Hauterkrankungen zeigt sie sich vergleichbar gut wie Dermatologen. Der Nachweis der grundsätzlichen Anwendbark eit und des Nutzens solcher Systeme in der klinischen Praxis steht jedoch noch aus. Noch zu schaffende Grundvoraussetzungen für die Translation solcher Diagnosesysteme in die dermatologischen Routine sind Möglichkeiten für die Nutzer, die Entscheidungen des Systems nachzuvollziehen, sowie eine gleichbleibend gute Leistung der Algorithmen auf Bilddaten aus fremden Kliniken und Praxen.Derzeit zeichnet sich ab, dass computergestützte Diagnosesysteme als Assistenzsysteme den größten Nutzen bringen könnten, denn Studien deuten darauf hin, dass eine Kombination von Mensch und Maschine die besten Ergebnisse erzielt. Diagnosesysteme basierend auf künstlicher Intelligenz sind in der Lage, Merkmale schnell, quantitativ, objektiv und reproduzierbar zu erfassen, und könnten somit die Medizin auf eine mathematische Grundlage stellen – zusätzlich zur ärztlichen Erfahrung.
[...]

Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
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Dysphagie bei tracheotomierten Patienten nach Langzeitbeatmung

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Laryngorhinootologie 2023; 102: 27-31
DOI: 10.1055/a-1076-9686

Unabhängig von der Art der kritischen Erkrankung haben tracheotomierte Patienten ein hohes Risiko für die Entwicklung einer Schluckstörung. Diese ist potenziell lebensbedrohlich, da sie zu Aspiration und Pneumonie führen kann. Vor einer oralen Nahrungsgabe sollte daher unbedingt eine Schluckdiagnostik mittels Bolusfärbetest und/oder FEES durchgeführt werden. Da ein physiologischer Luftstrom durch den Larynx und ein adäquater subglottischer Druck Schlüsselkomponenten eines effektiven Schluckaktes sind, sollte eine Oralisierung bei geblockter Trachealkanüle möglichst vermieden werden.
[...]

Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text
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Τετάρτη 28 Δεκεμβρίου 2022

Clinical reproducibility of different centric relation recording techniques in edentulous individuals: an observational cross sectional study

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Abstract

Purpose

To assess the reproducibility of four different centric relation (CR) recording techniques, and time spent performing each technique in edentulous individuals.

Materials and Methods

Four techniques were assessed: extraoral gothic arch tracing (EOGA), intraoral gothic arch tracing (IOGA), deglutition (D), and frontal manipulation with tongue elevation (FMTE). Twelve subjects participated in the study; four technique records were performed on each volunteer by the same operator. Each record was repeated three times, in the same period of the day, with a 30 min interval between each technique. The reproducibility of each technique was assessed by the tri-dimensional displacement of the position of the condylar housing (mandible condyle) to the wall of the condylar guide (glenoid cavity) in the semi-adjustable articulator (anteroposterior, mediolateral, and superior-inferior). The time spent on each technique was timed in seconds (from the beginning of each technique until the wax occlusion fixation). The analysis of variance and the Tukey test were performed for anteroposterior displacement (two-way) and for time spent on CT recording techniques (one-way) (α &l t; 0.05). Regarding mediolateral and superior-inferior displacements, the non-parametric Kruskal-Wallis was performed for the comparison between recording methods, while the Mann-Whitney test was performed for the comparison between sides (α < 0.05).

Results

The factor recording technique interfered with the anteroposterior displacement (ANOVA: α < 0.001; F = 11.396). The technique D (right side: 3.78 ± 0.69 mm; left side: 3.45 ± 0.74 mm) showed a statistically significant difference compared to the other techniques (EOGA: right side: 3.00 ± 0.00 mm; left side: 3.00 ± 0.00 mm; FMTE: right side: 2.81 ± 0.52 mm; left side: 2.82 ± 0.79 mm; IOGA: right side: 2.90 ± 0.65 mm; left side: 3.12 ± 0.44 mm). The time spent on the recording technique influenced the results (ANOVA: α < 0.001; F = 21.118). The IOGA (340.40 ± 163.41 seconds) and EOGA (285.93 ± 133.84 seconds) required more time compared to the D (86.00 ± 34.33 seconds) and FMTE (101.33 ± 36.72 seconds) techniques.

Conclusion

Graphic recordings showed better reproducibility and accuracy of the position of the centric relation.

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Esthetic and clinical outcomes after immediate placement and restoration: Comparison of two implant systems in the anterior maxilla—A cross‐sectional study

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Abstract

Aim

To assess the esthetic and clinical performance of a novel self-tapping implant system for single-tooth restorations in the esthetic zone after immediate placement and provisionalization.

Materials and Methods

This cross-sectional study included 52 patients contributing a total of 52 immediately placed and restored implants with ≥12 months after functional loading, comparing two different implant systems: Straumann® BLX (Institut Straumann AG, Basel, Switzerland; 25 patients) and Ankylos® (Dentsply Sirona, Hanau, Germany; 27 patients). As the primary outcome measure, peri-implant tissue esthetics were assessed by means of pink esthetics score (PES) rated by three independent clinicians. Moreover, as secondary outcome measures, the peri-implant tissue health was assessed by means of bleeding on probing, probing depth, and suppuration. Apart from that, the modified plaque index, keratinized mucosa width, and the presence of mucosal recessions were also assessed. When clinical signs suggested the possibility of peri-implantitis, radiographs were indicated to assess progressive bone loss.

Results

The mean PES ratings were 12.10 ± 1.10 for Ankylos versus 11.2 ± 1.86 for BLX, both achieving good esthetic results without significant differences (p = 0.143). There were no differences among most clinical parameters (plaque, bleeding on probing, probing depth, peri-implant mucosal recession), although peri-implant mucositis was present in one-third of the cases. The inter-rater agreement on esthetics was not significant (p < 0.250).

Conclusion

Within the limitations of the present study, it was concluded that the use of either BLX or Ankylos implant systems was associated to comparable peri-implant health and good pink esthetic outcomes during immediate implantation and restoration protocols, for at least 12 months.
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Τρίτη 27 Δεκεμβρίου 2022

Risk of waning humoral responses after inactivated or subunit recombinant SARS‐CoV‐2 vaccination in patients with chronic diseases: Findings from a prospective observational study in China

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Abstract

Heterogeneity of antibody responses has been reported in SARS-CoV-2 vaccination recipients with underlying diseases. We investigated the impact of the presence of comorbidities on the humoral response to SARS-CoV-2 vaccination in patients with chronic disease (PWCD) and assessed the effect of the number of comorbidities on the humoral response to vaccination. In this study, neutralizing antibodies (NAbs) and IgG antibodies against the receptor-binding domain (RBD-IgG) were monitored following a full-course vaccination. In total, 1400 PWCD (82.7%, inactivated vaccines; 17.3%, subunit recombinant vaccine) and 245 healthy controls (65.7% inactivated vaccines, 34.3% subunit recombinant vaccine) vaccinated with inactivated or subunit recombinant SARS-CoV-2 vaccines, were included. The seroconversion and antibody levels of the NAbs and RBD-IgG were different in the PWCD group compared with those in the control group. Chronic hepatitis B (odds ratio [OR]: 0.65; 95% confidence interval [C I]: 0.46–0.93), cancer (OR: 0.65; 95% CI: 0.42–0.99), and diabetes (OR: 0.50; 95% CI: 0.28–0.89) were associated with lower seroconversion of NAbs. Chronic kidney disease (OR: 0.29; 95% CI: 0.11–0.76), cancer (OR: 0.38; 95% CI: 0.23–0.62), and diabetes (OR: 0.37; 95% CI: 0.20–0.69) were associated with lower seroconversion of RBD-IgG. Only the presence of autoimmune disease showed significantly lower NAbs and RBD-IgG titers. Patients with most types of chronic diseases showed similar responses to the controls, but humoral responses were still significantly associated with the presence of ≥2 coexisting diseases. Our study suggested that humoral responses following SARS-CoV-2 vaccination are impaired in patients with certain chronic diseases.

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