Adenovirus type D and type E infection in broiler chickens: the effect on CD4 and CD8 T cell response, cytokines expression and their immunopathology.

1. A total of 150-day-old chicks were divided into three groups of 50 birds (G1-G3); G1 and G2 were orally inoculated at 1-day old with 0.5 ml of 107 TCID50/ml FAdV-D serotype 2 (MT386509.1) and FAdV-E serotype 8a (MW847902), respectively, and G3 was blank control group.2. Cell-mediated immune response was evaluated by detection of CD4, CD8 T lymphocytes and the mRNA expression of IL6 and IL8 in the chicken spleen using q-PCR. Additionally, immunopathology was performed at 3, 5 and 7 day post infection (dpi) and weekly until the end of the experiment.3. Results revealed that transcription of inflammatory cytokines (IL6, IL8) was up regulated in the spleen of FAdV type D and type E infected chickens at various time points relative to the control group. A marked decrease in the number of CD4 and CD8 T lymphocytes at 5 and 7 dpi in G1 of chickens infected with FAdV type D. Whereas, in chickens infected with FAdV type E, the CD4 and CD8 T lymphocytes were markedly decreased at 7 dpi.4. In contrast, there were no significant differences in humoral immune responses against NDV vaccine in (G1 and G2) at different intervals post-vaccination compared to the control group. The histopathology of the bursa, thymus, and spleen in the infected groups showed lymphocytolysis with severe reticular cells hyperplasia and lymphoid depletion.5. In conclusion, fowl adenovirus types D and E have an immunosuppressive effect in broilers which may be considered one of the main causes of the continuous co-infections with other viruses reported in the field during the last 10 years.

Outcomes of Noninvasive Positive Pressure Ventilation in Acute Respiratory Distress Syndrome and Their Predictors: A National Cohort.

RATIONALE: Although noninvasive positive pressure ventilation (NIPPV) is increasingly used in acute respiratory distress syndrome (ARDS) to avoid invasive mechanical ventilation (IMV), the data supporting its benefit for this indication are lacking. OBJECTIVES: To analyze the all-cause in-hospital mortality rate and length of stay (LOS) for ARDS patients who received NIPPV in the United States (US) compared to those who were initially intubated. Our secondary outcome of interest was to determine the predicting factors for NIPPV failure. METHODS: We used the 2016 National Inpatient Sample database to identify 4,277 adult records with ARDS who required positive pressure ventilation. We divided the cohort into initial treatment with IMV or NIPPV. Then, the NIPPV group was further subdivided into NIPPV failure or success. We defined NIPPV failure as same-patient use of NIPPV and IMV either on the same day or using IMV at a later date. We analyzed the in-hospital mortality, LOS, and NIPPV failure rate. Linear regression of log-transformed LOS and logistic regression of binary outcomes were used to test for associations. RESULTS: The NIPPV success group had the lowest mortality rate (4.9% [3.8, 6.4]) and the shortest LOS (7 days [6.6, 7.5]). The NIPPV failure rate was 21%. Sepsis, pneumonia, and chronic liver disease were associated with higher odds of NIPPV failure (adjusted OR: 4.47, 2.65, and 2.23, respectively). There was no significant difference between NIPPV failure and IMV groups in-hospital mortality (26.9% [21.8, 32.8] vs. 25.1% [23.5, 26.9], p=0.885) or LOS (16 [14, 18] vs. 15.6 [15, 16.3], p=0.926). CONCLUSIONS: NIPPV success in ARDS exhibits significantly lower hospital mortality rates and shorter LOS compared with IMV, and NIPPV failure exhibits no significant difference in hospital mortality or LOS compared with patients who were initially intubated. Therefore, an initial trial of NIPPV may be considered in ARDS. Sepsis, pneumonia, and chronic liver disease were associated with higher odds of NIPPV failure; these factors should be used to stratify patients to the most suitable ventilation modality.

Comparison of four cordless gingival displacement systems: A clinical study.

STATEMENT OF PROBLEM: Although the conventional chemicomechanical cord technique is widely used, packing the cord into the sulcus may cause pain and bleeding. Cordless displacement techniques have been introduced, but a comparison of these systems is lacking. PURPOSE: The purpose of this clinical study was to evaluate the efficiency and gingival response of 4 cordless gingival displacement systems. MATERIAL AND METHODS: One hundred twenty teeth in 30 participants were allocated to 4 groups according to the material used: Tr (Traxodent; Premier Dental Products Co), Es (Expasyl; Acteon UK), Ez (Expazen; Acteon UK), and Mr (3M Retraction; 3M ESPE). Baseline measurements of periodontal indices and a digital scan were acquired. The cordless displacement pastes were applied according to the manufacturer's instructions. After removal, a second scan was acquired. Participants were recalled on the 2nd and 14th day to measure periodontal indices and for scans. Screenshots were superimposed to measure changes in the gingiva. Statistical differences among the different materials in achieving lingual and buccal vertical gingival displacement were tested using the related-samples Friedman 2-way ANOVA test by ranks at 3 time points such as immediate, at 2 days, and at 14 days (α=.05). RESULTS: Immediate gingival displacement varied with the system used. For horizontal displacement, median values ranged between 150 µm (Tr) and 725 µm (Ez) for buccal displacement and between 93 µm (Tr) and 550 µm (Ez) for lingual displacement. Minimum and maximum displacements also varied and followed a similar trend, with Traxodent providing the lowest displacement. The plaque index and attachment level did not statistically differ before and after the treatment. The periodontal parameters were not statistically significant among the groups at all time intervals, except for the gingival index that increased for all the groups after 2 days. CONCLUSIONS: Significant differences were found among the 4 tested systems in both vertical and horizontal gingival displacement. Expasyl, Expazen, and 3M Retraction exceeded the 200-µm requirements for horizontal displacement. Traxodent provided the least displacement in both vertical and horizontal dimensions.

Hysteroscopic management of retained products of conception: A single center observational study.

BACKGROUND: Retained products of conception (RPOC) are defined as the presence of tissue inside the uterine cavity after delivery or termination of a pregnancy. Operative hysteroscopy is associated with increased surgical success and decreased postoperative formation of intrauterine adhesions. The aim of this study is to report our experience in hysteroscopic management of RPOC. METHODS: A retrospective chart review identified patients who underwent hysteroscopic removal of retained products of conception at a single center (n=45). Basic demographic data, surgical findings and applied technique were reviewed. Chi Square and independent samples t-tests were performed when appropriate. A significance level of p<0.05 was accounted. RESULTS: Of all cases included, 64% were the result of a spontaneous or elective abortion and 47% were from patients who had failed previous treatment. Previous medical or surgical treatment was observed in 37.9% of patients labeled as type 0-1 versus 62.5% of type 2-3 (p=0.1138). The timing between the end of the preceding pregnancy and hysteroscopic removal was in average 2.62 months in type 0-1 compared to 1.7 months in type 2-3 (p=0.1068). All patients who were classified as type 2-3 required the use of monopolar energy during the surgery, compared to zero patients who were classified as type 0-1 (p < 0.0001). CONCLUSION: Operative hysteroscopy remains a safe and highly effective option for the management of RPOC and should be the preferred method compared to traditional dilatation and suction curettage.

Conceptual and technical insights into the basis of neuromuscular monitoring.

Unrecognised postoperative residual neuromuscular block remains a frequent occurrence in recovery rooms. Evidence indicates that current practice continues to perpetuate the status quo, in which 10-40% of patients experience postoperative residual weakness. A departure from the current practice requires small efforts on the clinicians' part. This review addresses several selected core questions regarding neuromuscular blockade monitoring and provides a framework to rationally discuss and develop basic guidelines for the use of neuromuscular blocking agents in patient care.

The effect of hydrazine intercalation on the structure and capacitance of 2D titanium carbide (MXene).

Herein we show that hydrazine intercalation into 2D titanium carbide (Ti3C2-based MXene) results in changes in its surface chemistry by decreasing the amounts of fluorine, OH surface groups and intercalated water. It also creates a pillaring effect between Ti3C2Tx layers pre-opening the structure and improving the accessability to active sites. The hydrazine treated material has demonstrated a greatly improved capacitance of 250 F g(-1) in acidic electrolytes with an excellent cycling ability for electrodes as thick as 75 µm.

Effect of screw-access channels on the fracture resistance of 3 types of ceramic implant-supported crowns.

STATEMENT OF PROBLEM: Access channels for retrieving ceramic implant-supported screw-retained crowns may decrease their fracture resistance. PURPOSE: The purpose of this in vitro study was to evaluate the effect of screw-access channels on 3 types of ceramic implant-supported crowns. MATERIAL AND METHODS: Sixty computer-aided designed and computer-aided manufactured (CAD-CAM) ceramic implant-supported screw-retained maxillary premolar crowns were fabricated, 30 with an occlusal screw-access channel and 30 without access channels. Each group was further divided into the following 3 subgroups of 10 specimens each: monolithic zirconia, veneered zirconia, and lithium disilicate. Identical milled titanium implant abutments were fabricated. Crowns were fabricated with standardized thicknesses and subjected to cyclic loading until failure occurred. Data analysis was performed using 1-way analysis of variance test of significance followed by Tukey honest significant difference (HSD) test (α=.05). RESULTS: No significant differences in fracture resistance were found between access channel groups and corresponding groups without access channels (P>.05). Among the subgroups, monolithic zirconia recorded the highest fatigue failure mean load values (2047.8 ±83.2 N for crowns with access channels and 2028.7 ±104.5 N for crowns without access channels), which was significantly higher (P<.05) than values for the lithium disilicate group (605.4 ±37.9 N for crowns with access channels and 615.3 ±76.6 N for crowns without access channels) and the veneered zirconia group (411 ±34.4 N for crowns with access channels and 461.2 ±72.7 N for crowns without access channels), which recorded the lowest fatigue failure load mean values. CONCLUSIONS: Screw-access channels did not affect the fatigue failure load of monolithic zirconia, monolithic lithium disilicate, or veneered zirconia ceramic crowns. Monolithic zirconia crowns recorded significantly higher fatigue failure load among the 3 types of crowns tested.

Introduction and enzootic of A/H5N1 in Egypt: Virus evolution, pathogenicity and vaccine efficacy ten years on.

It is almost a decade since the highly pathogenic H5N1 avian influenza virus (A/H5N1) of clade 2.2.1 was introduced to Egypt in 2005, most likely, via wild birds; marking the longest endemic status of influenza viruses in poultry outside Asia. The endemic A/H5N1 in Egypt still compromises the poultry industry, poses serious hazards to public health and threatens to become potentially pandemic. The control strategies adopted for A/H5N1 in Egyptian poultry using diverse vaccines in commercialized poultry neither eliminated the virus nor did they decrease its evolutionary rate. Several virus clades have evolved, a few of them disappeared and others prevailed. Disparate evolutionary traits in both birds and humans were manifested by accumulation of clade-specific mutations across viral genomes driven by a variety of selection pressures. Viruses in vaccinated poultry populations displayed higher mutation rates at the immunogenic epitopes, promoting viral escape and reducing vaccine efficiency. On the other hand, viruses isolated from humans displayed changes in the receptor binding domain, which increased the viral affinity to bind to human-type glycan receptors. Moreover, viral pathogenicity exhibited several patterns in different hosts. This review aims to provide an overview of the viral evolution, pathogenicity and vaccine efficacy of A/H5N1 in Egypt during the last ten years.

Comparison of different scoring systems in predicting short-term mortality after liver transplantation.

BACKGROUND: Many scoring systems have been used in predicting the outcomes of liver transplantations. The aim of this study was to compare between 4 scoring systems-Sequential Organ Failure Assessment (SOFA), Model for End-Stage Liver Disease, Acute Physiology and Chronic Health Evaluation II, and Child Turcotte-Pugh -among patients who underwent living-donor liver transplantation (LDLT) seeking to evaluate the best system to correlate with post-operative outcomes. METHODS: This study retrospectively reviewed the medical records of 53 patients who had received LDLT in a tertiary care hospital from January 2005 to December 2010. Demographic, clinical, and laboratory data were recorded. Each patient was assessed by use of 4 scoring systems before transplantation and on post-operative days 1 to 7 and at 3 months. RESULTS: The overall 3-month survival rate was 64%. The pre-transplant SOFA score had the best discriminatory power; moreover, the SOFA score on post-operative day 7 had the best Youden index (.875). The survival rate at 3-month follow-up after liver transplantation differed significantly (P = .00023, highest area under the receiver operator characteristic curve = .952) between patients who had SOFA scores <8 and those had SOFA score >8 on post-liver transplant day 7. This study also demonstrated that respiratory rate (P = .017) and serum bilirubin level (P = .048) and duration of intensive care unit stay (P = .04) are significant risk factors related to early mortality after LDLT. CONCLUSIONS: The pre-transplant SOFA score was a statistically significant predictor of 3-month mortality; SOFA score on post-liver transplant day 7 had the best discriminative power for predicting 3-month mortality.

Emergence of a novel cluster of influenza A(H5N1) virus clade 2.2.1.2 with putative human health impact in Egypt, 2014/15.

A distinct cluster of highly pathogenic avian influenzaviruses of subtype A(H5N1) has been found to emergewithin clade 2.2.1.2 in poultry in Egypt since summer2014 and appears to have quickly become predominant.Viruses of this cluster may be associated withincreased incidence of human influenza A(H5N1) infectionsin Egypt over the last months.

Kidney disease in the obese patient.

Obesity constitutes a strong risk factor for the development of chronic kidney disease. This review examines the epidemiology, clinicopathologic presentation, and proposed mechanisms for chronic kidney disease in the obese patient. Obesity-associated nephropathy displays a continuum that evolves from glomerulomegaly to glomerulosclerosis and from mild to severe proteinuria in the absence of significant edema and hypoalbuminemia. The disease may well progress into end-stage renal disease unless weight management strategies are used. The renal effects of different obesity treatments are reviewed. Interestingly, the reversibility of the disease throughout most of its stages highlights the benefit of weight loss strategies in this population. Nephrolithiasis as it relates to obesity also is examined in addition to other pertinent comorbidities in obesity such as incontinence, calciphylaxis, and the renal complications of bariatric procedures.

Synthesis and characterization of two-dimensional Nb4C3 (MXene).

We report on the synthesis of a phase-pure, 2-dimensional transition metal carbide Nb4C3, produced by immersing Nb4AlC3 powders in hydrofluoric acid. The structure of this, only second MXene with formula M4X3, was investigated with pair distribution function analysis. The resistivity of a cold-pressed disc was 0.0046 Ω m, rendering this MXene one of the most conductive to date.

Role of high resolution ultrasonography/endoscopic ultrasonography and elastography in predicting lymph node malignancy.

OBJECTIVE: To evaluate the role of high resolution ultrasonography (US) and endoscopic ultrasonography (EUS)-elastography in predicting malignant lymphadenopathy. METHODS: This prospective study included 88 patients who underwent EUS or US examination of different groups of lymph nodes (LNs). The classification as benign or malignant based on the real-time elastography pattern and the B-mode US/EUS images was compared to the final diagnosis obtained by EUS or US guided fine-needle aspiration cytology (FNAC), Tru-Cut biopsy or excisional biopsy and follow-up in benign lesions not indicated for biopsy for at least 12 months. RESULTS: Regarding the echogenicity, 98.3% of the benign LNs were hyperechoic, 1.7% were hypoechoic, while 89.7% of the malignant LNs were hypoechoic, 3.4% were heterogenous and 6.9% were hyperechoic. With cut-off value of 1.93, the sensitivity of longitudinal to transverse ratio was 73% and the specificity was 100%. Score 1 elastography had specificity of 100% in diagnosis of benign LNs, sensitivity was 76.3%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 84.7% while Score 2 had a sensitivity of 60%, specificity of 31.5%, PPV of 15.3%, NPV of 79.3%. Score 3 had a sensitivity of 70.2%, specificity of 100%, PPV of 13.8%, NPV of 100% in detecting malignancy while Score 4 had a sensitivity of 85.5%, specificity of 100%, PPV of 100%, NPV of 65.5%. CONCLUSION: Elastography is a promising diagnostic modality that may complement standard ultrasound and EUS and help guide FNAC during staging of LNs.

Gastric mucosa-associated lymphoid tissue lymphoma associated with pancreatic non-Hodgkin's lymphoma: A case report.

UNLABELLED: Mucosa-associated lymphoid tissue (MALT) lymphomas are extranodal lymphomas that arise from B lymphocytes located in the marginal zone of lymphoid follicles. Although, there is a substantial amount of lymphoid tissue in the gastrointestinal tract, MALT lymphomas usually arise in chronically inflamed sites that are normally devoid of lymphoid tissue. The best example is gastric MALT lymphoma that is almost always associated with Helicobacter pylori. Primary pancreatic lymphoma (PPL) is an extremely rare tumor (1% incidence) and is often confused with pancreatic adenocarcinoma. By suspecting PPL on clinical and imaging grounds, surgery and its associated complications can be avoided, since the mainstay of the treatment is non-surgical strategies including chemotherapy. We represent a case of a 45-year-old male presented with abdominal pain and vomiting. Upper endoscopy showed multiple gastric ulcers, biopsies revealed non-specific inflammatory ulcers. The patient was given 4-weeks course of proton pump inhibitor with no improvement. After few months, he complained of severe abdominal pain relieved by leaning forward and associated with repeated vomiting. Upper endoscopy revealed multiple umbilicated gastric masses, 10-20 mm in diameter. Biopsies were taken, histopathology and immunohistochemistry revealed MALT lymphoma. Endoscopic ultrasonography was done to the patient and it showed a pancreatic head mass, fine-needle aspiration was done, histopathology and immunohistochemistry revealed PPL. The patient received chemotherapy for MALT lymphoma with near total relief of symptoms and disappearance of gastric and pancreatic masses. CONCLUSION: This is a rare case having MALT lymphoma associated with PPL.

Spinal gene expression profiling and pathways analysis of a CB2 agonist (MDA7)-targeted prevention of paclitaxel-induced neuropathy.

AIMS: Patients receiving paclitaxel often develop peripheral neuropathies. We found that a novel selective cannabinoid CB2 receptor agonist (MDA7) prevents paclitaxel-induced mechanical allodynia in rats and mice. Here we investigated gene expression profiling in the lumbar spinal cord after 14-day treatment of MDA7 in paclitaxel animals and analyzed possible signaling pathways underlying the preventive effect of MDA7 on paclitaxel-induced neuropathy. METHODS: Peripheral mechanical allodynia was induced in rats or mice receiving intraperitoneal (i.p.) injection of paclitaxel at a dose of 1mg/kg daily for four consecutive days. MDA7 was administered at a dose of 15mg/kg 15min before paclitaxel and then continued daily for another 10days. Whole-genome gene expression profiling in the lumbar spinal cord of MDA7 and paclitaxel-treated rats was investigated using microarray analysis. The Ingenuity pathway analysis was performed to determine the potential relevant canonical pathways responsible for the effect of MDA7 on paclitaxel-induced peripheral neuropathy. RESULTS: We observed that the inflammatory molecular networks including tumor necrosis factor (TNF), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), transforming growth factor beta (TGFß), and mitogen-activated protein kinases (MAPK) signaling are most relevant to the preventive effect of MDA7 on paclitaxel-induced peripheral neuropathy. In addition, genes encoding molecules that are important in central sensitization such as glutamate transporters and N-methyl-d-aspartate receptor 2B (NMDAR2B), and neuro-immune-related genes such as neuronal nitric oxide synthase (nNOS1), chemokine CX3CL1 (a mediator for microglial activation), toll-like receptor 2 (TLR2), and leptin were differentially modulated by MDA7. CONCLUSION: The preventive effect of MDA7 on paclitaxel-induced peripheral allodynia in rats may be associated with genes involved in signal pathways in central sensitization, microglial activation, and neuroinflammation in the spinal cord.

Characterisation and objective monitoring of balance disorders following head trauma, using videonystagmography.

OBJECTIVE: To characterise balance disorders occurring after head trauma, using videonystagmography, and to test the efficiency of videonystagmography as a diagnostic and monitoring tool. METHOD: Prospective, cohort analysis of 126 head trauma patients managed with vestibular evaluation, monitoring and treatment, in a tertiary referral centre. Analytical parameters included: head injury severity; balance disorder type, severity and time of onset; and patient recovery and outcome. RESULTS: Head trauma was minor in 31.7 per cent, mild in 36.6 per cent, moderate in 19 per cent and severe in 12.7 per cent. Balance disorder symptoms included vertigo in 42.9 per cent, unsteadiness in 15.9 per cent, dizziness in 9.5 per cent and none in 31.7 per cent. Videonystagmographic balance disorder diagnosis type was peripheral vestibular in 23.8 per cent, central in 7.9 per cent, mixed in 12.7 per cent, benign paroxysmal positional vertigo in 4.8 per cent and no findings in 50.8 per cent. Balance disorder was immediate in 47.6 per cent (this included all moderate and severe trauma cases). Benign paroxysmal positional vertigo developed within the first week in two-thirds of cases. More severe trauma cases had longer recovery times. Peripheral, mixed and central balance disorders recovered within the first three months. Early rehabilitation of acute balance disorders led to early recovery regardless of diagnosis. CONCLUSION: Videonystagmography enables precise, simple, cost-effective monitoring of balance disorders after head trauma, and improves care and outcomes.