COMPARISON OF SCAPULAR MORPHOLOGY IN DEGENERATIVE AND TRAUMATIC ROTATOR CUFF TEARS

Background: Degenerative cuff tears have impingement pathophysiology due to altered scapular morphology as measured by increased critical shoulder angle (CSA), decreased lateral acromial angle (LAA) and increased acromion index (AI). But scapular morphology in traumatic tears has neither been studied nor compared with degenerative tears. Aim: To compare scapular morphology with CSA, LAA, AI between traumatic and degenerative tears and determine their reliability. Methods: This observational study includes 100 patients (50 with traumatic and degenerative tears). We analyzed MRI and standardized AP shoulder radiograph of these patients. Parameters, such as CSA, LAA, AI, were measured on AP radiographs by two separate observers in a blinded manner. The 1st observer repeated measurements after four weeks. We compared age, gender, degree of cuff tear, and CSA values, LAA, and AI between the two groups. Results: On comparison using chi-square test, degenerative group had significantly higher age, higher CSA (mean 37.55, SD 0.88 versus traumatic group mean 36.6, SD 0.95, [Formula: see text]-[Formula: see text], highly significant), higher AI (mean 0.73, SD 0.02 versus traumatic mean 0.69, SD 0.04 [Formula: see text]-[Formula: see text], highly significant), and lower LAA (77.14, SD 2.03 versus traumatic mean 78.36, SD 2.73, [Formula: see text]-value 0.013, significant). Interobserver and intraobserver reliability of parameters using the intraclass correlation coefficient (ICC) revealed excellent (CSA, LAA) and good (AI) agreement. ROC curve analysis calculated sensitivity (0.7) and specificity (0.66) to diagnose degenerative tear for CSA above 37.05[Formula: see text]. Conclusion: Scapular morphology in traumatic tears differs from degenerative. CSA, LAA, AI can be reliably measured on standardized shoulder AP radiographs.

Mouth breathing – A predictor for patient satisfaction after nasal septoplasty?

Background: No reliable marker exists to predict septoplasty outcome. Most patients suffering from nasal airway obstruction (NAO) caused by a deviation of the nasal septum report a bothersome mouth breathing and dryness. In this study our aim was to assess, whether mouth breathing could be objectified in these patients and whether mouth breathing could predict septoplasty outcome. Methods: A monocentric, prospective case-control study of 21 patients was conducted. The proportion of mouth breathing was measured in a blinded manner. As a measurement of patient satisfaction, subjective symptoms pre- and postoperatively, were assessed by using VAS, NOSE and SNOT-20 score. In the patient group an additional acoustic rhinometry and a clinical examination of the nose were performed. Results: With a mean of 25% (SD = 20%) the proportion of mouth breathing in patients with NAO did not differ significantly from the proportion in controls without NAO, with a mean of 27% (SD = 23%). Analysis of subjective scores revealed a significant reduction of subjective symptoms after septoplasty. A higher preoperative proportion of mouth breathing correlated with more remaining postoperative NAO. Conclusions: The percentage of mouth breathing is no different in patients with symptomatic septal deviation than in control patients. Mouth breathing in patients with NAO, evaluated for septoplasty, could be a negative predictive factor for patient satisfaction after nasal septoplasty. Mouth breathing in these patients should be observed carefully because more preoperative mouth breathing should make one more hesitant to consider septoplasty.

Association of childhood tracheomalacia with bronchiectasis: a case–control study

ObjectiveChildren with tracheomalacia can develop chronic lower airway infection and neutrophilic inflammation. It is plausible children with tracheomalacia are at increased risk of developing bronchiectasis. We hypothesised that compared with controls, tracheomalacia in children is associated with bronchiectasis.DesignSingle-centre, case–control study.Setting and patients45 children with chest high-resolution CT (c-HRCT) confirmed bronchiectasis (cases) and enrolled in the Australian Bronchiectasis Registry were selected randomly from Queensland, and 90 unmatched children without chronic respiratory symptoms or radiographic evidence of bronchiectasis (disease controls). Cases and controls had flexible bronchoscopy performed for clinical reasons within 4 weeks of their c-HRCT.InterventionsThe bronchoscopy videos were reviewed in a blinded manner for: (a) any tracheomalacia (any shape deformity of the trachea at end-expiration) and (b) tracheomalacia defined by the European Respiratory Society (ERS) statement (>50% expiratory reduction in the cross-sectional luminal area).Main outcome measures and resultsCases were younger (median age=2.6 years, IQR 1.5–4.1) than controls (7.8 years, IQR 3.4–12.8), but well-balanced for sex (56% and 52% male, respectively). Using multivariable analysis (adjusted for age), the presence of any tracheomalacia was significantly associated with bronchiectasis (adjusted OR (ORadj)=13.2, 95% CI 3.2 to 55), while that for ERS-defined tracheomalacia further increased this risk (ORadj=24.4, 95% CI 3.4 to infinity).ConclusionBronchoscopic-defined tracheomalacia is associated with childhood bronchiectasis. While causality cannot be inferred, children with tracheomalacia should be monitored for chronic (>4 weeks) wet cough, the most common symptom of bronchiectasis, which if present should be treated and then investigated if the cough persists or is recurrent.

LDHA and CPT2 association with therapy resistance in prostate cancer

Background The aerobic glycolysis as energy source in cancer confers a selective advantage for its proliferation and survival. Previous in vitro studies demonstrated that treatment with [C16Pyr][Amp], a potential anti-cancer drug in prostate, decreased the transcript levels of LDHA and CPT2, both involved in metabolic plasticity. In fact, LDHA and CPT2 were reported to be overexpressed in cancer, with association with poor prognosis and resistance to chemo- and radiotherapy. Since LDHA and CPT2 can be potential therapy resistance biomarkers, the aim of this work was to assess LDHA and CPT2 expression using PCa tissues. Methods LDHA and CPT2 expression was evaluated by immunohistochemistry in 57 PCa tissues, 24 from patients that developed resistance to hormonal therapy and 33 without therapy resistance. For both proteins, percentage of positive tumor cells, intensity of immunostaining, and immunoexpression pattern was determined by a blinded manner. Comparisons between therapy variables and protein expression were assessed using the Chi square test. P < 0.05 indicated a statistically significant difference. Results LDHA expression is significantly associated with therapy resistance (P < 0.001). Moreover, CPT2 pattern’s immunoexpression is also associated with therapy resistant (P < 0.001), being cytoplasmatic expression most frequent in patients that respond to therapy (41%), whereas both nuclear and cytoplasmatic expression is more prevalent in therapy-resistant cases (48%). Conclusions LDHA overexpression is significantly associated with therapy resistance in PCa cases, while CPT2 cell expression distribution might be a predictive marker.

Analgesic Efficacy of Cordia Verbenacea-based Gel in the Reduction of Pain Associated with Use of Separator Elastics/ Eficácia Analgésica do Gel à base de Cordia Verbenacea na Redução de Tinta Associada ao Uso de Elásticos Separadores

Introduction: In Orthodontics separator elastics are used to create space for inserting the bands. This causes pain. Phytotherapy has been promising as a therapy. Objective. This double blind randomized clinical trial evaluated the level of pain due to the use of elastic separator (SE) after intraoral topical administration of Cordia verbenacea gel (CV). Methods. 50 volunteers received the SE on the mesial and distal surfaces of the maxillary first molars. In a blinded manner, 0.5 g of the gel was used in one hemi-arch, and placebo in the other hemi-arch on the free gingival margin of the first molar, every 8 hours, for 3 days. Pain was measured on a visual analog scale (VAS), before insertion of the SE (t0), immediately after (t1) and every hour after the following applications. Sensory analysis of the was performed for effects of taste and burning. Wilcoxon (comparison between sides) and Friedman and Nemenyi tests were performed for comparisons between times (α=0.05). Results. The pain was lower on the side that received the phytotherapeutic gel, from the first application until before the removal of the elastic (p 0.05). As regards the burning sensation, the experimental side had higher scores and 20% of the subjects considered the CV gel had an unpleasant taste. It was concluded that the use of the intrabucal topic of CV has an analgesic potential for pain resulting from the insertion of SE.

The Use of Standardized Brazilian Green Propolis Extract (EPP-AF) as an Adjunct Treatment for Hospitalized COVID-19 Patients (BeeCovid2): A Structured Summary of a Study Protocol for a Randomized Controlled Trial

Background The 2019 coronavirus disease (COVID-19) pandemic continues to spread and affects large numbers of people with unprecedented impacts. To date, there is no consensus on a specific treatment. Experimental evidence has already been obtained for use of the standardized extract of Brazilian green propolis (EPP-AF) against viral targets, and clinical rationality has been demonstrated for testing this extract as an adjunct to treatment in patients affected by COVID-19. The BeeCovid2 study is once again assessing EPP-AF in hospitalized patients with coronavirus infection. Methods BeeCovid2 is a randomized, double-blinded, placebo-controlled clinical study being conducted in Brazil to provide further evidence on the effectiveness of standardized green propolis extract as an adjunctive treatment for adults hospitalized with COVID-19. Adults hospitalized with COVID-19 with respiratory symptoms for less than 14 days who are not on invasive oxygen therapy are eligible. Enrolled patients are randomized at a 1:1 ratio to receive placebo or standardized propolis extract (900 mg/day) for 10 days. The study treatments are administered in a double-blinded manner, and patients are followed for 28 days. The primary outcome is the length of hospital stay. Secondary outcomes include the need for mechanical ventilation, the rate of acute kidney injury, the need for renal replacement therapy, the requirement for vasoactive drugs, the use of an intra-aortic balloon pump (IABP), and the use of extracorporeal membrane oxygenation (ECMO). Discussion This trial is very useful and will provide more data on the effectiveness of using the standardized Brazilian green propolis extract as an adjunctive treatment in association with standard care in adults hospitalized with moderate to severe acute COVID-19. Trial registration: ClinicalTrials.gov NCT04800224. Registered on March 16, 2021.

The suitability of panoramic radiographs for clinical decision making regarding root angulation compared to cone-beam computed tomography

Background The study compared clinical decisions regarding root angulation correction and root proximity based on the interpretation of Panoramic (PAN) versus Cone-Beam Computed Tomography (CBCT) images. Methods A total of 864 teeth from 36 existing, radiographic patient records at a university dental clinic with concurrent PAN and CBCT images were assessed using PANs, then using CBCTs in a blinded manner by two orthodontists. Teeth were rated regarding the need for root repositioning, the direction of repositioning and existence of root proximity. Frequencies, rating time and intra- and inter-examiner Cohen’s Kappa were calculated. Results There was 73.7–84.5% agreement between PAN-based and CBCT-based orthodontists’ decisions regarding the need to reposition roots. Root proximity was more frequently reported on PANs than CBCTs by one examiner (p = 0.001 and p = 0.168). Both PANs and CBCTs had moderate to substantial intra-examiner, within-radiograph-type reliability with Kappa values of 0.686–0.79 for PANs, and 0.661 for CBCTs (p < 0.001). Inter-examiner and inter-radiograph-type Kappa values ranged from 0.414 to 0.51 (p < 0.001). Using CBCT decisions as a reference, 78.9% of PAN decisions were coincident, 9.3% would have been repositioned on CBCT but not on PAN, 11.3% would not have been repositioned on CBCT but were on PAN, and 0.3% would have been repositioned in the opposite direction on CBCT versus PAN. Additionally, CBCT images required more time per tooth to assess than PANs (p < 0.001). Conclusions PAN-based clinical decisions regarding root angulation had comparable statistical reliability and substantial agreement with CBCT-based clinical decisions.

P294 AMT-101, a gut selective oral IL-10 fusion: results from a Phase 1b study in patients with active Ulcerative Colitis

Background IL-10 is a pleiotropic anti-inflammatory cytokine that restores mucosal homeostasis. Genetic deficiencies in IL-10 cause intestinal inflammation in mice and are associated with early onset IBD in humans. In mice, this can be reversed by addition of exogenous IL-10. Subcutaneous use of recombinant human IL-10 treatment in patients with Crohn’s Disease led to symptomatic and endoscopic improvement, but dose limiting systemic toxicity including anemia and thrombocytopenia was observed and appeared to be mediated by induction of gamma-interferon. AMT-101 is an oral, gut selective, fusion protein of IL-10 and a carrier protein that mediates transcytosis through intestinal enterocytes into the lamina propria (LP). Pre-clinical studies demonstrated that AMT-101 efficiently transits the epithelial cell barrier, targets mucosal immune cells in the LP, and results in improved colitis disease severity without systemic exposure. Methods A multiple ascending dose Ph1b POC trial was conducted in 16 patients with active UC where patients were randomized 3:1 to receive AMT-101 at doses of 1, 3, 10, or 30 mg or PBO, orally, once daily for 14 days. Primary and secondary outcome measures included safety and PK. Exploratory endpoints included changes in fecal calprotectin, histology, and stool microbiome. Results AMT-101 was safe and well tolerated; all AEs were mild to moderate and self limiting. No systemic toxicities associated with prior administration of IL-10 (e.g.anemia or thrombocytopenia) were observed. Systemic levels of AMT-101 were below limit of quantitation, given the GI restricted design. 1 mg and 3 mg AMT-101 led to placebo-adjusted mean reductions of FCP of 44% and 27%, respectively, in patients with baseline FCP&gt;150 μg/g. Paired biopsy samples were centrally read in a blinded manner using the Geboes scoring system. Improvements were observed in 60% (6/10) of patients on AMT-101, compared with 0% (0/2) patients treated with placebo. Microbiome analyses revealed changes in phyla abundance in the 1mg and 3mg treatment cohorts (Bacteroidetes: 28.3% ± 31.4 to 51.3% ± 21.6; Firmicutes: 21.8% ± 12.7 to 30% ± 7.3), including Roseburia hominis and Faecalibacterium prausnitzii species. Conclusion The results of this Phase 1b study confirm that once daily, oral AMT-101 was safe and well tolerated without SAEs previously observed with systemic IL-10 and without systemic exposure, by design. Doses at 10 mg or less suggest potential clinical efficacy paired with an enhancement of favorable enteric commensal bacteria after only 14 days of treatment. These findings support AMT-101 as actively exerting an immunomodulatory effect in the intestinal lamina propria and support ongoing Ph2 trials of AMT-101.

The histopathological synovitis score is influenced by biopsy location in patients with knee osteoarthritis

Introduction Osteoarthritis (OA) and rheumatoid arthritis (RA) represent the most common forms of arthritis, which are mainly caused by mechanical and inflammatory components, respectively. Determination of synovial inflammation in synovial biopsies via the histopathological Krenn score may be crucial for correct diagnosis and treatment. Specifically, it remains unclear whether synovitis scores differ among multiple biopsy locations within a single joint. Materials and methods Eighty synovial samples were taken from four standardized regions of the knee in 20 patients (ten primary OA, ten secondary OA) undergoing total knee arthroplasty (TKA) or total synovectomy. The Krenn synovitis score (grade 0–9) was determined in a blinded manner by two expert pathologists in all biopsies. Next to the inter-rater reliability, we evaluated the agreement of the determined scores among the four biopsy locations within each knee. Results The inter-rater reliability between the two pathologists was very high (Cohen’s kappa = 0.712; r = 0.946; ICC = 0.972). The mean synovitis score was significantly higher in knees with secondary than in primary OA (p = 0.026). Importantly, we found clear differences between the scores of the four different biopsy locations within the individual knee joints, with an average deviation of 10.6%. These deviations were comparable in knees with primary and secondary OA (p = 0.64). Conclusions While we confirmed the synovitis score as a reliable and reproducible parameter to assess the histopathological synovitis grade in the knee, the considerable variability within the joint indicates that multiple synovial biopsies from different regions should be obtained to enable reliable results of the synovitis score.

The extraperitoneal French AmbUlatory cesarean section technique leads to improved pain scores and a faster maternal autonomy compared with the intraperitoneal Misgav Ladach technique: A prospective randomized controlled trial

Objective To determine whether the French AmbUlatory Cesarean Section (FAUCS) technique reduces postoperative pain and promotes maternal autonomy compared with the Misgav Ladach cesarean section (MLCS) technique in elective conditions. Study design One hundred pregnant women were randomly, but in a non-blinded manner, assigned to undergo FAUCS or MLCS. The primary outcome was a postoperative mean pain score (PMPS), and secondary outcomes were a combined pain/medication score, time to regain autonomy, surgical duration, calculated blood loss, surgical complications, and neonatal outcome. Results Women in the FAUCS group experienced less pain than those in the MLCS group (PMPS = 1.87 [1.04–2.41] vs. 2.93 [2.46–3.75], respectively; p < 0.001). Six hours after surgery, the combined pain/medication score for FAUCS patients was 33% lower than that for MLCS patients (p < 0.001). FAUCS patients more rapidly regained autonomy, with 94% reaching autonomy within 12 h vs. 4% of MLCS patients (p < 0.001). There were no differences in maternal surgical or neonatal complications between groups. Conclusions Our results indicate that FAUCS can reduce postoperative pain and accelerate recovery, suggesting that this technique might be superior to MLCS and should be more widely used. One potentially key difference between FAUCS and MLCS is that MLCS includes 100 mcg spinal morphine anesthesia in addition to the same anesthesia used by FAUCS. Any interpretation of apparent differences must take the presence/absence of morphine into account.