Timber-colonizing gram-negative bacteria as potential causative agents of respiratory diseases in woodworkers

Occurrence Gram-negative bacteria occur commonly in the inner tissues of stored coniferous and deciduous timber, showing a marked variation in numbers. The greatest maximal numbers are found in the sapwood of coniferous timber. The common constituents of the Gram-negative biota are potentially pathogenic species of Enterobacteriaceae family of the genera Rahnella, Pantoea, Enterobacter, and Klebsiella. The air of wood-processing facilities is polluted with the wood-borne Gram-negative bacteria and produced by them endotoxin, as demonstrated worldwide by numerous studies. Effects There are three potential pathways of the pathogenic impact of wood-borne Gram-negative bacteria on exposed woodworkers: allergic, immunotoxic, and infectious. Allergic impact has been underestimated for a long time with relation to Gram-negative bacteria. Hopefully, the recent demonstration of the first documented case of hypersensitivity pneumonitis (HP) in woodworkers caused by Pantoea agglomerans which developed in extremely large quantities in birch sapwood, would speed up finding of new wood-related cases of HP caused by Gram-negative bacteria. The second pathway is associated with endotoxin, exerting strong immunotoxic (excessively immunostimulative) action. It has been demonstrated that endotoxin is released into wood dust in the form of nano-sized microvesicles, by peeling off the outer membrane of bacteria. Endotoxin microvesicles are easily inhaled by humans together with dust because of small dimensions and aerodynamic shape. Afterwards, they cause a nonspecific activation of lung macrophages, which release numerous inflammatory mediators causing an inflammatory lung reaction, chest tightness, fever, gas exchange disorders, and bronchospasm, without radiographic changes. The resulting disease is known as “Organic Dust Toxic Syndrome” or “toxic pneumonitis.” The potential third pathway of pathogenic impact is infection. The suspected species is Klebsiella pneumoniae that may occur commonly in wood dust; however, until now this pathway has not been confirmed. Conclusion Summarizing, Gram-negative bacteria-inhabiting timber should be considered, besides filamentous fungi and actinobacteria, as important risk factors of occupational disease in woodworkers that could be either HP with allergenic background or toxic pneumonitis elicited by endotoxin.

Combination Therapy with Rituximab, Tofacitinib and Pirfenidone in a Patient with Rapid Progressive Interstitial Lung Disease (RP-ILD) Due to MDA5 Antibody-Associated Dermatomyositis: A Case Report

Anti-melanoma differentiation-associated protein 5 (MDA5)-positive rapidly progressive interstitial lung disease (RP-ILD) is associated with poor prognosis, and the most effective therapeutic intervention has not been established. Herein we report a case of a 45-year-old female patient who presented with myalgia, Gottron’s papules with ulceration, and dyspnea on exertion which became aggravated within weeks. Laboratory examination and electromyography confirmed myopathy changes, and a survey of myositis-specific antibodies was strongly positive for anti-MDA5 antibody. High-resolution chest tomography suggested organizing pneumonia with rapidly progressive changes within the first month after diagnosis of the disease. Anti-MDA5-associated dermatomyositis with RP-ILD was diagnosed. Following combination therapy with rituximab, tofacitinib and pirfenidone, clinical symptoms, including cutaneous manifestation, respiratory conditions and radiographic changes, showed significant and sustainable improvement. To our knowledge, this is the first reported case of anti-MDA5-associated dermatomyositis with RP-ILD successfully treated with the combination of rituximab, tofacitinib, and pirfenidone.

Comparison of radiographic changes in the alveolar crest after extraction of fully and partially erupted premolars during orthodontic treatment: A retrospective analytical study

Background. The alveolar process plays an essential role in providing dental support and gradually disappears with tooth loss. Space deficiency can cause one premolar to remain semi-erupted adjacent to a fully-erupted premolar. During orthodontic treatment, each of these premolars can be extracted. This retrospective study aimed to compare radiographic changes of the alveolar crest due to orthodontic movements of fully-erupted and semi-erupted premolars into the extraction sites before and after treatment. Methods. The patients were divided into the fully-erupted premolar extraction (first) group and the semi-erupted premolar extraction (second) group. The distance between the cementoenamel junction (CEJ) and the alveolar crest, from the distal aspect of the canine to the mesial aspect of the first molar, was measured on panoramic radiographs of 78 patients (39 from each group) before and after treatment with a digital caliper. Changes in the alveolar crest were compared between the two groups. Finally, the height differences of the alveolar crest in mesial and distal aspects of the remaining premolars in both groups were calculated at the end of treatment. Descriptive statistical analyses and paired and independent t tests were used in the study. Results. The distance from the CEJ to the alveolar crest at mesial and distal aspects in the first group and the distal aspect of the extraction site in the second group increased significantly. However, changes at the mesial aspect were not significant in the second group. Comparing the alveolar crest height between the two groups and between the mesial and distal aspects of the remaining premolar tooth indicated no significant differences. Conclusion. No significant difference was observed between the extraction of a fully-erupted or semi-erupted premolar to obtain greater alveolar height.

Spinal Radiographic Progression and Predictors of Progression in Patients With Radiographic Axial Spondyloarthritis Receiving Ixekizumab Over 2 Years

Objective To evaluate the long-term effect of ixekizumab on radiographic changes in the spine in patients with radiographic axial spondyloarthritis (r-axSpA) by measuring change from baseline through 2 years in modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) and to identify potential predictors of progression. Methods This study evaluates patients from COAST-V (NCT02696785, bDMARD-naive) and COAST-W (NCT02696798, TNFi-experienced) who had mSASSS data at baseline in the originating studies and 108 weeks after baseline in the extension study COAST-Y (NCT03129100). We examined the proportion of patients who did not have spinal radiographic progression through 2 years (108 weeks) of treatment with ixekizumab (80 mg every 2 or 4 weeks) and the change from baseline to year 2 in mSASSS. Potential predictors of spinal radiographic progression were also evaluated. Results Among patients with evaluable radiographs who were originally assigned to ixekizumab (N=230), mean (SD) change in mSASSS from baseline at year 2 was 0.3 (1.8). The proportion of non-progressors over 2 years was 89.6% if defined as mSASSS change from baseline <2 and 75.7% if defined as mSASSS change from baseline ≤0. Predictors of structural progression at year 2 (mSASSS change >0) were age ≥40, baseline syndesmophytes, HLA-B27 positivity and male gender. Week 52 inflammation in SPARCC spine was also a predictor of radiographic progression at year 2 in patients with MRI-data in COAST-V (N=109). Conclusion The majority of patients with r-axSpA receiving ixekizumab had no radiographic progression in the spine through 2 years of treatment. Predictors were generally consistent with previous studies.

Radiographic Changes vis-à-vis Tracheo-bronchial Aspirate Cytology Profile in Pneumonic Cattle

Background: The study was conducted to establish the utility of radiography in the diagnosis of lung diseases in cattle and its correlation with different pneumonia diagnosed on the basis of TBA cytology. Methods: Lateral chest radiography and tracheo-bronchial wash was performed in control (n=21) and diseased group (n=55). Diseased group included cattle presented with respiratory signs and diagnosed with pulmonary diseases on the basis of history, physical and clinical examination and tracheo-bronchial wash cytology. Cytologic diagnosis was established as chronic pneumonia (n=24), acute pneumonia (n=18), tuberculosis (n=5) and aspiration pneumonia (n=8). Survivability was also correlated with lung patterns in diseased cattle. Result: Nodular interstitial pattern (27.3%), unstructured interstitial pattern (25.4%), bronchial pattern (20.0%), pleural effusions (12.7%), mixed lung patterns (10.9%) and miliary interstitial pattern (4.54%) was observed in diseased group. Unstructured interstitial pattern and pleural effusions were most evident in acute pneumonia. The radiographic findings in aspiration pneumonia did not correlate well with cytologic findings. Highest survivability was recorded in cows with bronchial pattern (81.8%) and lowest in miliary interstitial pattern (zero per cent).

Effect of Different Treatment Regimen and Types of Endodontic Sealers on Pain and Periapical Radiographic Changes

INTRODUCTION: The study aims as a pilot study to evaluate the effect of different treatment regimen and different types of endodontic sealers on pain and periapical radiographic changes was studied. MATERIALS AND METHODS: Forty patients in need of an endodontic root canal treatment on anterior teeth were selected and divided into two groups (20 patients each), according to the endodontic treatment protocol (single or multiple visits). Then, each group was subdivided into two subgroups according to sealer used 10 each (AH Plus Jet resin sealer, Total Fill Bioceramic Sealer). To record pain intensity of the patients at different intervals: 1, 2, 3, 7 days, a visual analog scale was used. Furthermore, patients were recalled after 1, 3, 6, 9 months to evaluate periapical radiographic changes. RESULTS: Showed that as regard pain assessment both tested endodontic sealers, as well as single or multiple visits have no statistically significant difference between pain values of patients during all the observation period from immediately post-operative, after 4, 12, 24, 48, 72 h as well as after 7 days (p > 0.05). As regard lamina dura thickness, results showed that with both tested endodontic sealers as well as single or multiple visits, there was no statistically significant difference between lamina dura thickness of patients after 1 month, 3, 6 as well as after 9 months. CONCLUSIONS: Neither number of visits of endodontic treatment nor type of sealer used for obturation affects post-operative pain and thickness of lamina dura.

Augmentation Stability of Guided Bone Regeneration for Peri-Implant Dehiscence Defects with L-shaped Porcine-Derived Block Bone Substitute

Block bone substitutes have better augmentation stability for guided bone regeneration (GBR) than particulate bone substitutes. This study sought to determine whether GBR with an L-shaped porcine block bone (DPBM-C) differs from GBR with an L-shaped bovine block bone (DBBM-C) based on clinical, radiographic, and volumetric outcomes for peri-implant dehiscence defects. A total of 42 peri-implant defects were grafted with 20 L-shaped DPBM-C and 22 DBBM-C groups. The horizontal and vertical thicknesses of the augmented hard tissue were measured using sagittal cone-beam computed tomography, and the volumetric tissue change was evaluated by stereolithography image superimposition. Postoperative discomfort, early wound healing outcomes, and implant stability were also assessed. Among the clinical (subjective pain and swelling, wound dehiscence, membrane exposure, and periotest values), radiographic (changes in horizontal and vertical hard tissue thickness), and volumetric parameters of the L-shaped DPBM-C and DBBM-C groups during the healing period, only the periotest values showed a statistically significant difference (0.67 ± 1.19, p = 0.042). Within the limitations of this study, an L-shaped DPBM-C is not inferior to an L-shaped DBBM-C based on their clinical, radiographic, and volumetric outcomes for GBR of peri-implant dehiscence defects.

Radiological changes, infections and neurological complications after reverse shoulder arthroplasty related to different design types and their rates: Part II

Early reported complication rates with the Grammont-type reverse shoulder arthroplasty (RSA) were very high, up to 24%. A ‘problem’ is defined as an intraoperative or postoperative event that is not likely to affect the patient’s final outcome, such as intraoperative cement extravasation and radiographic changes. A ‘complication’ is defined as an intraoperative or postoperative event that is likely to affect the patient’s final outcome, including infection, neurologic injury and intrathoracic central glenoid screw placement. Radiographic changes around the glenoid or humeral components of the RSA are very frequently observed and described in the literature. High complication rates related to the Grammont RSA design led to development of non-Grammont designs which led to a dramatic fall in the majority of complications. The percentage of radiological changes after RSA is not negligible and remains unsolved, despite a decrease in its occurrence in the last decade. However, such changes should be now considered as simple problems because they rarely have a negative influence on the patient’s final outcome, and their prevalence has dramatically decreased. With further changes in indications and designs for RSA, it is crucial to accurately track the rates and types of complications to justify its new designs and increased indications. Cite this article: EFORT Open Rev 2021;6:1109-1121. DOI: 10.1302/2058-5241.6.210040

Poor Patient-Reported Outcomes following Surgical Treatment of Eaton Grade 1 Osteoarthritis of the Thumb Carpometacarpal Joint

Background Osteoarthritis of the thumb carpometacarpal joint (CMC-1 OA) is increasingly common with age. Conservative treatment with anti-inflammatory medication, thumb spica splinting, and steroid injection is recommended for early-stage OA, but some patients will continue to have refractory symptoms and surgery may be considered. We found it interesting to study outcomes of surgical treatment of cases with mild radiographic changes and yet symptoms severe enough to indicate surgery. The specific research question is, if there is a limit of radiographic changes, below which a poor patient-reported outcome (PRO) can be expected. Purpose In a retrospective cohort of patients with prospectively collected PROs, we intend to study the effect of the radiographic CMC-1 OA severity on the PRO improvement and satisfaction after interposition arthroplasty. Patients and Methods Radiographs of 347 patients, who had CMC-1 surgery, were retrospectively analyzed. Each rater independently assessed all radiographs classifying each according to the Eaton classification. All patients had surgery with CMC-1 interposition arthroplasty using three well-known techniques that all include a complete trapeziectomy. Comparison between stage 1 and stage 2–4 was done using Chi-square test and t-test. Results Patients with Eaton stage 1 had a mean improvement in Quick-DASH (Quick-Disability of the Arm, Shoulder, and Hand questionnaire) scores of 14.6 points. Patients with Eaton stage 2 to 4 had a mean improvement of 25.3 points. The difference between these two groups was 10.6 points (p = 0.009). Only 52% of patients with Eaton stage 1 OA were satisfied. However, 76% of patients with Eaton stage 2 to 4 were satisfied (p = 0.008, chi-square between stage 1 and stage 2–4). Conclusion Patients with Eaton stage 1 CMC-1 OA had poorer PROs, as compared with more advanced stages of OA, 6 months following surgical treatment with interposition arthroplasty. Based on our results, we advise against surgical treatment with interposition arthroplasty of the very mildest CMC-1 OA, regardless of the preoperative PROs.