Cystic fibrosis exacerbations treated with medical therapy with and without concurrent sinus surgery.

OBJECTIVE: This analysis investigates any potential differences in pulmonary function test (PFT) outcomes among pediatric patients with cystic fibrosis (CF) receiving both medical management (MM) and functional endoscopic sinus surgery (FESS) versus MM alone for CF exacerbation. STUDY DESIGN: Prospective cohort. SETTING: Pediatric tertiary care facility. METHODS: The data was prospectively collected from July 2011 to March 2020. Diagnosis of CF and age ≤ to 18 were required. All patients were hospitalized and treated for CF exacerbations with both FESS with MM and MM alone at variable time intervals, although the order of initial treatment received differed. Two-way ANOVA with repeated measures were used to determine the effect of receiving FESS with MM versus MM alone on PFT outcomes over time (during admission, at discharge, at 3 months, at 6 months, and at 12 months). RESULTS: 13 pediatric patients, 7 of which had FESS with MM initially and 6 who had MM alone initially, and 20 events of both FESS and MM were included for analysis. For PFT outcomes, there was no statistically significant two-way interaction between treatment type and time following treatment, p = 0.492. The main effect of treatment did not show a statistically significant difference in FEV1 between treatment types, p = 0.737. There was no statistically significant association between treatment type and time between hospital readmission in months, p = 0.111. CONCLUSION: There was no significant difference between PFT outcomes in pediatric patients hospitalized for CF exacerbation treated with MM with or without FESS at any time interval.

Efficacy of melatonin for auditory brainstem response testing in children: A systematic review.

OBJECTIVE: To examine the literature on pre-treatment with melatonin for successful completion of Auditory Brainstem Response (ABR) testing in pediatric patients and evaluate melatonin dosing protocols. DATA SOURCES: The Cochrane Library, PubMed, Ovid MEDLINE, and Web of Science from inception through May 20th, 2019. In addition, a retrospective case series of pediatric patients (<18yr) who underwent melatonin assisted ABR testing between 2015 and 2018 was performed at our institution. REVIEW METHODS: Prospective and retrospective studies involving melatonin use in pediatric patients (<18yrs) for auditory brainstem response testing were evaluated. Studies meeting inclusion/exclusion criteria reported success rate of ABR testing using melatonin pre-treatment, dosage of melatonin used, duration of sleep, and whether adverse events occurred. RESULTS: 43 studies were identified, 8 studies were selected, and finally 5 studies were included in the review. A total of 480 pediatric patients underwent ABR testing with pre-treatment of melatonin with success rates ranging from 65% to 86.7%. Age across studies ranged from 1 month to 14 years, 6 months. Dosage of melatonin varied from 0.25 mg for patients <3 months of age to 20 mg for patients >6 years of age, with one study using a weight-based approach. No significant adverse events were reported by any of the included studies. CONCLUSION: Pre-medication with melatonin may be a useful option for obtaining successful results of non-sedated ABR testing in pediatric patients and may provide a useful alternative to sedation. Dosing patterns are highly variable. No adverse events were reported with any dosing strategy.

Pyrosequencing for classification of human FcγRIIIA allotypes: a comparison with PCR-based techniques.

BACKGROUND: Surface-specific antigens expressed by hematopoietic cells are attractive targets for antibody-mediated immunotherapy. Monoclonal antibodies (mAbs) involve various mechanisms to eliminate target cells, including antibody-dependent cellular cytotoxicity (ADCC)- and phagocytosis (ADCP)-mediated killing through natural killer (NK) and macrophage effector cells bearing FcγRIIIA (CD16). The clinical efficacy of ADCC is particularly impacted by a single nucleotide polymorphism (SNP) found in the gene encoding FcγRIIIA (FCGR3A), which generates a variable distribution of the 158 V/V, F/V or F/F CD16 allotypes (F = phenylalanine, V = valine) in the normal human population. Currently, most patients are not screened for CD16 allotypes, creating the potential to include in their treatment a mAb-based therapy that may have limited benefit. Therefore, it is important to identify CD16 allotypes when considering mAb therapies that require ADCC/ADCP. OBJECTIVE: The objective of this study was to develop a reliable PCR-based assay for classification of human FcγRIIIA allotypes. METHODS: We studied 42 normal human subjects for the incidence of FcγRIIIA-158 polymorphisms using comparative molecular approaches. RESULTS: The results of our study showed 100% accuracy in genotyping by pyrosequencing. In contrast, nested PCR-based allele-specific restriction assay and quantitative PCR techniques proved to be relatively less sensitive and less specific in distinguishing variant genotypes. CONCLUSION: Since the efficacy of the mAb-based targeted immunotherapy may be highly dependent upon the CD16 polymorphism in a given individual, we recommend pyrosequencing for CD16 allotype testing.

Nitrogen concentration in mountain pine beetle larvae reflects nitrogen status of the tree host and two fungal associates.

Individual lodgepole pines (Pinus contorta) were fertilized with urea at nitrogen (N) inputs equivalent to 0, 315, or 630 kg/ha. Four months after application of the fertilizer, inner bark tissue N concentrations were significantly higher in the trees that had received the low dose (315 kg/ha) fertilization treatment than in the control trees; trees that had received the high-dose treatment (630 kg/ha) were intermediate and not significantly different from either of the other treatments. There was a significant positive correlation between N concentration in inner bark tissue and larval mountain pine beetle, Dendroctonus ponderosae (Coleoptera: Curculionidae, Scolytinae). In vitro studies on synthetic growth media examined effects of temperature and N concentration on N concentration of two common fungal associates of the mountain pine beetle (Ophiostoma clavigerum and Ophiostoma montium). Increasing N concentration in growth media significantly increased fungal N concentrations in both O. clavigerum and O. montium. Furthermore, N concentration was consistently higher in O. clavigerum than in O. montium. Neither species had sufficient growth at 30 degrees C, nor did O. clavigerum at 15 degrees C, to test N concentration. However, for O. montium, increasing temperatures decreased fungal N concentrations. There was no correlation between N concentration of O. clavigerum and growth temperature. Potential impacts of ingestion of the fungal species by developing mountain pine beetle larvae-infesting trees under various environmental conditions such as increasing temperatures are discussed.