Donor-derived Transmission of Hepatitis A Virus Following Kidney Transplantation: Clinical Course of Two Cases From One Donor.

Donor-derived transmission of infections is a rare complication of kidney transplant. Hepatitis A virus (HAV) is a common cause of acute viral hepatitis worldwide, but donor-derived transmission to organ recipients has been reported in the literature only twice previously. The timeline for HAV incubation and clearance in transplant recipients is not well understood. Methods: In 2018, 2 kidneys and a liver were procured from a deceased donor resident of Kentucky, one of many states that was experiencing an HAV outbreak associated with person-to-person transmission through close contact, primarily among people who reported drug use. Both kidney recipients, residents of Virginia, subsequently developed acute HAV infections. We report the results of an investigation to determine the source of transmission and describe the clinical course of HAV infection in the infected kidney recipients. Results: The liver recipient had evidence of immunity to HAV and did not become infected. The donor and both kidney recipients were found to have a genetically identical strain of HAV using a next-generation sequencing-based cyber molecular assay (Global Hepatitis Outbreak Surveillance Technology), confirming donor-derived HAV infections in kidney recipients. At least 1 kidney recipient experienced delayed development of detectable hepatitis A anti-IgM antibodies. By 383 and 198 d posttransplant, HAV RNA was no longer detectable in stool specimens from the left and right kidney recipients, respectively. Conclusions: Adherence to current guidance for hepatitis A vaccination may prevent future morbidity due to HAV among organ recipients. http://links.lww.com/TXD/A548.

A Novel Approach to Sternal Fracture Repair With the Implementation of a Compression/Distraction Device.

Sternal fractures are common following blunt traumatic injury. Most sternal fractures can be managed successfully nonoperatively; however, surgical fixation should be considered in certain scenarios. Specifically, surgery may be indicated in cases of severe pain, respiratory failure or dependency on mechanical ventilation, cosmetic deformity, malunion, disunion, and compression of the heart. A variety of surgical approaches to sternal fracture fixation have been documented (steel wire, suture materials, a seven-hole aluminum plate, an eight-holed Sternolock X plate, sternum-osteosynthesis plate, t-shaped plate); however, few techniques have been discussed for the initial reduction of the sternal fracture prior to fixation. In this paper, we describe a novel surgical technique used to reduce sternal fractures and approximate the edges of the sternum using a compression/distraction device.

Iodide Functionalized Paper-Based SERS Sensors for Improved Detection of Narcotics.

An inkjet-printed paper-based Surface-enhanced Raman scattering (SERS) sensor is a robust and versatile device that provides trace sensing capabilities for the detection and analysis of narcotics and drugs. Such sensors generally work well for analytes with good binding affinity towards the Au or Ag plasmonic nanoparticles (NPs) resident in the sensors. In this report, we show that iodide functionalization of the printed sensors helps to remove adsorbed contaminants from AuNP surfaces enabling superior performance with improved detection of narcotics such as fentanyl, heroin and cocaine by SERS. SERS signals are easily doubled with the iodide-functionalized sensors which also showed orders of magnitude improvement in detection limit. In this report, we show that a short (90 s) iodide treatment of the sensors significantly improved the detection of heroin. We propose that iodide functionalization be integrated into field detection kits through the solvent that wets paper-based sensor prior to swabbing for narcotics. Alternatively, we have also demonstrated that iodide functionalized sensors can be stored in ambient for up to 1 week and retain the improved performance towards heroin detection. This report will help to significantly improve the performance of paper-based sensors for field detection of narcotic drugs.

Transplant of a Kidney from a Hepatitis C Viremic Donor to a Naïve Recipient without Viral Transmission: A Case Report.

BACKGROUND Kidneys from deceased donors who were positive for hepatitis C virus (HCV) on a nucleic acid amplification test (NAT) are not given to anti-HCV antibody-negative recipients. This is because of the high risk of HCV transmission, combined with the lack of effective antiviral treatment. Several studies have demonstrated rates of transmission of HCV from anti-HCV-positive/HCV NAT-positive donors to anti-HCV-negative recipients of 100%. Ours is the first report of transplantation of a kidney from an anti-HCV antibody-positive/HCV NAT-positive donor into an anti-HCV antibody-negative recipient who remains anti-HCV antibody-negative at 3 months after transplant with no treatment. CASE REPORT A 49-year-old man had a history of end-stage renal disease that was presumed to be secondary to type ll diabetes. He received a kidney from a deceased donor who was HCV antibody-positive/NAT-negative. The patient's HCV antibody status was checked prior to transplant and he was found to be negative and nonreactive. Since the transplant, his HCV viral load has been checked 5 times, on postoperative days 15, 23, 44, 62, and 64; each time, it has been undetectable. Furthermore, the patient's HCV antibody status was rechecked 1 month after transplant and it remained negative and nonreactive. CONCLUSIONS Further research is required on the accuracy of polymerase chain reaction as an indicator of donor HCV infection when the quantity of the viral load is not reported.

Toxicity and cosmetic outcomes after treatment with a novel form of breast IORT.

PURPOSE: Intraoperative radiation therapy (IORT), a form of accelerated partial breast irradiation (APBI), is an appealing alternative to postoperative whole breast irradiation for early-stage breast cancer. The purpose of this study was to examine the toxicity and cosmetic outcomes of patients treated with a novel form of breast IORT (precision breast IORT; PB-IORT), that delivers a targeted, higher dose of radiation than conventional IORT. METHODS AND MATERIALS: The first 204 patients treated with PB-IORT in a Phase II clinical trial (NCT02400658) with 12 months of followup were included. Trial inclusion criteria were age ≥45 years, invasive or in situ breast cancer, tumor size ≤3 cm, and node negative. Toxicity and cosmetic scoring were performed at 6 and 12 months. RESULTS: 98 patients (48%; 95% CI, 41-55%) experienced toxicity. Seven Grade 3 toxicities occurred (3.4%; 95% CI, 1.4-6.9%). Most patients (95%) had excellent or good cosmetic outcomes (95% CI, 91-98%) at 12 months. Most patients (94%) had little or no pigmentation change (95% CI, 90-97%), 88% little to no size change (95% CI, 82-92%), and 87% experienced minimal shape change (95% CI, 82-92%). CONCLUSIONS: Overall, Grade 3+ toxicity was rare and cosmetic outcomes were excellent. Severe toxicity with PB-IORT is similar to that reported in the TARGIT trial (3.3% rate of major toxicity) but lower than APBI (NSABP-39, 10.1% Grade 3/4 toxicities). We propose that the toxicity of PB-IORT compared with TARGIT and NSABP-39 is related to the radiation dose and delivery schedule. PB-IORT offers low-toxicity and good cosmetic outcomes when compared with other forms of APBI.

Self-assembled vertically aligned Au nanorod arrays for surface-enhanced Raman scattering (SERS) detection of Cannabinol.

Self-assembled multi-layered vertically aligned gold nanorod (AuNR) arrays have been fabricated by a simple preparation process that requires a balance between the particle concentration and the ionic strength of the solvent. An experimentally determined critical AuNR concentration of 2.0nM and 50mM NaCl produces well-ordered vertically aligned hexagonally close-packed AuNR arrays. We demonstrate surface treatment via UV Ozone cleaning of such samples to allow introduction of analyte molecules (benzenethiol and cannabinol) for effective surface enhanced Raman scattering detection. This is the first demonstration of the SERS analysis of cannabinol. This approach demonstrates a cost-effective, high-yield and simple fabrication route to SERS sensors with application in the screening for the cannabinoids.

Multifunctional nanoprobes for pathogen-selective capture and detection.

The synthesis of magnetic and fluorescent particles is described. The particles are biofunctionalized by binding pathogen-specific proteins to the particles via interactions between His-tags of proteins and zinc of the quantum dots. Detection of Salmonella and Staphylococcus aureus (S. aureus) by these particles is demonstrated.

Silica encapsulated SERS nanoprobe conjugated to the bacteriophage tailspike protein for targeted detection of Salmonella.

Silica-encapsulated Raman-reporter embedded SERS nanoprobes, named nanoaggregate embedded beads (NAEBs), were conjugated to the Salmonella specific tailspike protein (TSP) isolated from the P22 bacteriophage to enable a highly specific and ultrasensitive optical transduction platform. We demonstrate three successful surface conjugation strategies and highlight the detection of a single bacterium using SERS.

Detection of acute brain injury by Raman spectral signature.

Brain injury can lead to irreversible tissue loss and functional deficit along with significant health care costs. Raman spectroscopy can be used as a non-invasive technique to provide detailed information on the molecular composition of diseased and damaged tissues. This technique was used to examine acute mouse brain injury, focusing on the motor cortex, a region directly involved in controlling execution of movement. The spectral profile obtained from the injured brain tissue revealed a markedly different signature, particularly in the amide I and amide III vibrational region when compared to that of healthy brain tissue. Most noticeably, there was a significant reduction of the amide I vibration at the acute injury site and the appearance of two distinct features at 1586 and 1618 cm(-1). Complementary immunohistochemical analysis of the injured brain tissue showed an abundant expression of Caspase 3 (a cysteine protease marker used for apoptosis), suggesting that the injury-induced specific Raman shifts may be correlated with cell death. Taken together, this study demonstrates that Raman spectroscopy can play an important role in detecting the changes that occur in the injured brain and provide a possible technology for monitoring the recovery process.

Nanoscale aggregation of cellular beta2-adrenergic receptors measured by plasmonic interactions of functionalized nanoparticles.

Adrenergic signaling that controls the contraction of cardiac myocyte cells and the beating of the mammalian heart is initiated by ligand binding to adrenergic receptors contained in nanoscale multiprotein complexes at the cellular membrane. Here we demonstrate that the surface-enhanced Raman scattering (SERS) of functionalized silver nanoparticles can be used to report on the receptor aggregation state of specifically label beta(2)-adrenergic receptors on mouse cardiac myocyte cells. Furthermore, multimodal imaging including Raman, Rayleigh scattering, scanning electron microscopy, and luminescence imaging was combined to fully characterize the beta(2)-adrenergic receptor-mediated aggregation of silver nanoparticles on the membrane of cardiac myocytes. Scanning electron microscopy analysis reveals distinct SERS active clusters of between 10 and 70 nanoparticles per signaling domain from ultra-high-resolution images of beta(2)-adrenergic receptor clusters on the cellular membrane. These techniques can be generally applied to study the aggregation of other cell surface receptors and explore their distribution on cell surfaces.