Orthognathic surgery in COVID-19 times, is it safe?

COVID-19 has impacted the provision of orthognathic surgery globally. Uncertainty around its effects and transmission in aerosol generating procedures (AGP's) has led to disagreement within maxillofacial surgeons into the safety of orthognathic surgery during the pandemic. We present a local case series of orthognathic surgery undertaken during the COVID-19 pandemic. To our knowledge no such similar study has been reported worldwide. Data was collected from the 1st June to 30th November 2020 for all patients undergoing orthognathic surgery by a single consultant. All procedures and inpatient stays were performed 'off site' at the local Spire Healthcare Group plc© facility. A strict preoperative two-week self-isolation period and negative COVID-19 testing was mandatory. All procedures were classified as AGP's and personal protective equipment (PPE) was worn in line with local guidelines. The primary outcome was 30-day COVID-19 infection among patients, with day 0 the date of surgery. Secondary outcome measures included duration of stay, return to theatre and complications. A total of 59 patients were identified. 42/59 had bimaxillary procedures and 17/59 single jaw. 9/17 had maxillary and 8/17 had mandibular procedures. A total of 3/59 had simultaneous genioplasty. Median duration of stay was one night (range 1-3). Immediate and late complications were seen in 3% (2/59) and 3% (2/59) respectively. Only 1% (1/59) returned to theatre. Zero patients tested positive in the 30-day postoperative period. No staff members tested positive for the duration of the study. Adopting strict safety protocols, orthognathic surgery can be safely delivered during the pandemic without detriment to the patient or staff.

Community-curated and standardised metadata of published ancient metagenomic samples with AncientMetagenomeDir.

Ancient DNA and RNA are valuable data sources for a wide range of disciplines. Within the field of ancient metagenomics, the number of published genetic datasets has risen dramatically in recent years, and tracking this data for reuse is particularly important for large-scale ecological and evolutionary studies of individual taxa and communities of both microbes and eukaryotes. AncientMetagenomeDir (archived at https://doi.org/10.5281/zenodo.3980833 ) is a collection of annotated metagenomic sample lists derived from published studies that provide basic, standardised metadata and accession numbers to allow rapid data retrieval from online repositories. These tables are community-curated and span multiple sub-disciplines to ensure adequate breadth and consensus in metadata definitions, as well as longevity of the database. Internal guidelines and automated checks facilitate compatibility with established sequence-read archives and term-ontologies, and ensure consistency and interoperability for future meta-analyses. This collection will also assist in standardising metadata reporting for future ancient metagenomic studies.

The Northern Route for Human dispersal in Central and Northeast Asia: New evidence from the site of Tolbor-16, Mongolia.

The fossil record suggests that at least two major human dispersals occurred across the Eurasian steppe during the Late Pleistocene. Neanderthals and Modern Humans moved eastward into Central Asia, a region intermittently occupied by the enigmatic Denisovans. Genetic data indicates that the Denisovans interbred with Neanderthals near the Altai Mountains (South Siberia) but where and when they met H. sapiens is yet to be determined. Here we present archaeological evidence that document the timing and environmental context of a third long-distance population movement in Central Asia, during a temperate climatic event around 45,000 years ago. The early occurrence of the Initial Upper Palaeolithic, a techno-complex whose sudden appearance coincides with the first occurrence of H. sapiens in the Eurasian steppes, establishes an essential archaeological link between the Siberian Altai and Northwestern China . Such connection between regions provides empirical ground to discuss contacts between local and exogenous populations in Central and Northeast Asia during the Late Pleistocene.

Autologous bone-marrow mononuclear cell transplantation after acute myocardial infarction: comparison of two delivery techniques.

The objective of this study was to investigate safety and feasibility of autologous bone marrow mononuclear cells (BMMNC) transplantation in ST elevation myocardial infarction (STEMI), comparing anterograde intracoronary artery (ICA) delivery with retrograde intracoronary vein (ICV) approach. An open labeled, randomized controlled trial of 30 patients admitted with STEMI was used. Patients were enrolled if they 1) were successfully reperfused within 24 h from symptoms onset and 2) had infarct size larger than 10% of the left ventricle (LV). One hundred million BMMNC were injected in the infarct-related artery (intra-arterial group) or vein (intravenous group), 1% of which was labeled with Tc(99m)-hexamethylpropylenamineoxime. Cell distribution was evaluated 4 and 24 h after injection. Baseline MRI was performed in order to evaluate microbstruction pattern. Baseline radionuclide ventriculography was performed before cell transfer and after 3 and 6 months. All the treated patients were submitted to repeat coronary angiography after 3 months. Thirty patients (57 +/- 11 years, 70% males) were randomly assigned to ICA (n = 14), ICV (n = 10), or control (n = 6) groups. No serious adverse events related to the procedure were observed. Early and late retention of radiolabeled cells was higher in the ICA than in the ICV group, independently of microcirculation obstruction. An increase of EF was observed in the ICA group (p = 0.02) compared to baseline. Injection procedures through anterograde and retrograde approaches seem to be feasible and safe. BMMNC retention by damaged heart tissue was apparently higher when the anterograde approach was used. Further studies are required to confirm these initial data.

Adiponectin levels and its association with hyperglycaemia in adult Filipino participants in the 2003--04 National Nutrition and Health Survey.

Our objective was to determine the association of serum adiponectin levels with the presence of IFG or DM in Filipinos. This case control study used sera of adult participants in the Philippines' NNHeS: 2003-04. Subjects were divided into: normoglycaemic control, impaired fasting glucose, and type 2 diabetes mellitus. Seventy-seven prediabetic and 83 diabetic subjects were included in the prediabetic and diabetic groups, respectively. There was no significant difference in adiponectin values between control and prediabetic subjects. Diabetic subjects had significantly lower mean serum adiponectin levels (10.7 versus 14.2 microg/ml, p=0.0198) compared with age- and BMI-matched control subjects. Diabetic subjects were found most frequently (43.53%) in the lowest tertile (1.6-7.2 microg/ml) and least frequently (20%) in the highest tertile (14-84 microg/ml) of adiponectin values. We conclude that Filipinos with diabetes mellitus had significantly lower adiponectin levels compared with normoglycaemic subjects.

Growth differentiation factor-15/macrophage inhibitory cytokine-1 induction after kidney and lung injury.

The immunoregulatory cytokine macrophage inhibitory cytokine-1 (MIC-1), a divergent TGF-beta family member, and its murine ortholog, growth/differentiation factor-15 (GDF-15) are induced in hepatocytes by surgical and chemical injury and heat shock. To better understand the in vivo role this factor plays in organ injury, we examined the regulation of GDF-15 in murine models of kidney and lung injury. We demonstrate herein induction of GDF-15/MIC-1 after surgical, toxic/genotoxic, ischemic, and hyperoxic kidney or lung injury. Gdf15 induction was independent of protein synthesis, a hallmark of immediate-early gene regulation. Although TNF induced GDF-15 expression, injury-elicited Gdf15 expression was not reduced in mice deficient for both TNF receptor subtype. Furthermore, although the stress sensor p53 is known to induce GDF-15/MIC-1 expression, injury-elicited Gdf15 expression was unchanged in p53-null mice. Our results demonstrate that GDF-15 induction after organ injury is a hallmark of many tissues. These data demonstrate that GDF-15/MIC-1 is an early mediator of the injury response in kidney and lung that might regulate inflammation, cell survival, proliferation, and apoptosis in a variety of injured tissues and disease processes.

Regulation of metanephric kidney development by growth/differentiation factor 11.

Growth/differentiation factor 11 (Gdf11) is a transforming growth factor beta family member previously shown to control anterior/posterior patterning of the axial skeleton. We now report that Gdf11 also regulates kidney organogenesis. Mice carrying a targeted deletion of Gdf11 possess a spectrum of renal abnormalities with the majority of mutant animals lacking both kidneys. Histological analysis revealed a failure in ureteric bud formation at the initial stage of metanephric development in most Gdf11 mutant embryos examined. The metanephric mesenchyme of mutant embryos lacking a ureteric bud was found to be defective in the expression of glial cell line-derived neurotrophic factor (Gdnf), a gene known to direct ureteric bud outgrowth. The addition of Gdnf protein to urogenital tracts taken from Gdf11 null embryos induced ectopic ureteric bud formation along the Wolffian duct. Our studies suggest that Gdf11 may be important in directing the initial outgrowth of the ureteric bud from the Wolffian duct by controlling the expression of Gdnf in the metanephric mesenchyme.

Induction of cachexia in mice by systemically administered myostatin.

Mice and cattle with genetic deficiencies in myostatin exhibit dramatic increases in skeletal muscle mass, suggesting that myostatin normally suppresses muscle growth. Whether this increased muscling results from prenatal or postnatal lack of myostatin activity is unknown. Here we show that myostatin circulates in the blood of adult mice in a latent form that can be activated by acid treatment. Systemic overexpression of myostatin in adult mice was found to induce profound muscle and fat loss analogous to that seen in human cachexia syndromes. These data indicate that myostatin acts systemically in adult animals and may be a useful pharmacologic target in clinical settings such as cachexia, where muscle growth is desired.

A sub-utilizaçäo da terapia trombolítica na cidade do Rio de Janeiro. Buscando as causas / The under utilization of the thrombolytic therapy in the City of Rio de Janeiro. In pursuit of the causes

OBJETIVOS: Este estudo teve como objetivo detectar em quais pontos do trajeto dor-trombolítico estäo ocorrendo entraves para a realizaçäo da terapia trombolítica (TT), no tratamento dos pacientes acometidos por um infarto agudo do miocárdio (IAM), na cidade do Rio de Janeiro. A detecçäo destas causas poderá ser o primeiro passo para se idealizar estratégias que visem reduzir a sub-utilizaçäo da TT em nosso meio. MÉTODOS: Foram entrevistados 68 pacientes consecutivos internados com diagnóstico de IAM na Unidade Coronária e na Unidade Intermediária do Hospital de Cardiologia de Laranjeiras (HCL), no período entre julho e dezembro de 1995, Foi usado o termo delta 1 para caracterizar o tempo decorrido entre o início dos sintomas e a chegada ao local do primeiro atendimento e delta 2, o tempo decorrido entre a chegada ao local do primeiro atendimento e o efetivo atendimento médico. Foram utilizados os teste do Chi-quadrado e a probabilidade exata de Fischer na análise estatística. RESULTADOS: O delta 1 foi menor do que 60 minutos em 24 casos (35,3 'por cento'). Em 56 casos (83, 4 'por cento', p<0,001), o delta 1 foi menor do que 6 horas. Em apenas 3 casos (4,4 'por cento") o delta 1 foi acima de 12 horas. O delta 2 foi menor do que 15 minutos, em 51 casos (75 'por cento' p<0,001). O serviço público foi o local do primeiro atendimento. CONCLUSÄO: O estudo sugere que, embora apenas uma minoria tenha chegado ao médico, dentro da janela de tempo ideal (60 minutos), a maioria chegou em tempo de se beneficiar da TT. Assim, as principais causas da sub-utilizaçäo da TT no tratamento do paciente com IAM, na cidade do Rio de Janeiro, näo parecem estar localizadas nas etapas iniciais, mas após o momento em que se inicial o atendimento médico.