Korea is an intermediate-burden country with high rates of tuberculosis (TB) drug resistance.To evaluate the performance of the GenoType® MTBDRplus (MTBDR) assay in diagnosing drug-resistant TB in routine practice in Korea.The MTBDR assay was performed on 428 samples, and the results were retrospectively compared with the results of conventional drug susceptibility testing (DST). The interval between treatment and diagnosis of drug resistance was also compared.The sensitivity, specificity and positive and negative predictive values of the MTBDR assay were respectively 96.6%, 98.9%, 93.4% and 99.5% for the detection of rifampicin (RMP) resistance; 93.8%, 98.3%, 92.7% and 98.6% for isoniazid (INH) resistance; and 91.1%, 99.2%, 99.4% and 98.7% for multidrug-resistant TB (MDR-TB). The median interval between the start of anti-tuberculosis chemotherapy and the reporting of results was 88.9 days for conventional DST and 19.8 days for MTBDR using clinical specimens.The specificity of the MTBDR assay in detecting MDR-TB was very high, although the sensitivity in detecting INH resistance and MDR-TB was not optimal (<95%). Although the turnaround time in detecting drug resistance was dramatically reduced with MTBDR compared to conventional DST, more effort is needed to shorten the turnaround time.
Introduction: Prior studies examined the risk of food insecurity on nonalcoholic fatty liver disease (NAFLD) and fibrosis, but population data using novel non-invasive methods remains under characterized. In this study, we described the characteristics of NAFLD and fibrosis in food secure and insecure participants, using vibration-controlled transient elastography (VCTE). Methods: Cross-sectional analysis of adults in the United States who participated in the 2017–March 2020 pre-pandemic National Health and Nutrition Examination Survey was performed. Participants with excessive alcohol use (≥2 or 1 drinks/day for males and females, respectively) or viral hepatitis were excluded. Food insecurity was defined using the Household Food Security Survey. NAFLD was defined as controlled attenuation parameter (CAP) scores ≥ 263 dB/m. Advanced fibrosis and cirrhosis was defined as liver stiffness measurement (LSM) ≥ 9.6 kPa and ≥ 11.0 kPa, respectively. Results: Among 6,474 participants, 1,463 (22.6%) were food insecure. Prevalence of NALFD was 53.8% and 44.6% for food insecure and secure respectively (P < 0.001). Compared to food secure participants with NAFLD, food insecure participants with NAFLD had significantly higher age, lower male gender, higher percentage of Hispanic and Black ethnicity, body mass index (BMI), and percentage of current smokers (P < 0.05). Furthermore, food insecure participants with NAFLD had significantly higher platelet count and alanine aminotransferase, compared to food secure participants with NAFLD (P < 0.05). Food insecure and secure participants with NAFLD had similar prevalence of advanced fibrosis. Conclusion: Participants with food insecurity had significantly higher prevalence of NAFLD, but advanced fibrosis was not significantly different between food insecure and secure participants with NAFLD. However, large inequalities exist between food insecure and secure participants with NAFLD, in terms of younger age, female gender, Hispanic or Black ethnicity, and higher BMI. This study highlights important risk factors for NAFLD and fibrosis in food insecure and secure participants (Table 1). Table 1. - Baseline characteristics Variables Food insecure NAFLD (unweighted n=662, 22.1%) Food secure NAFLD (unweighted n=2,193, 77.9%) P value Demographic variables Age, years 44.2 (1.7) 52.9 (1.0) < 0.001 Male gender 47.8% 57.6% 0.009 Race Hispanic 34.4% 13.3% 0.001 White 40.9% 68.4% Black 13.9% 8.2% Other 10.9% 10.1% BMI 34.2 (0.7) 32.4 (0.3) 0.017 Current smoking 48.4% 18.8% 0.007 Laboratory variables Platelet count, 109/L 240.2 (9.1) 228.6 (8.3) 0.002 Aspartate aminotransferase, IU/L 22.8 (2.5) 21.2 (0.6) 0.104 Alanine aminotrasferase, IU/L 25.5 (3.0) 23.6 (1.3) 0.043 Serum albumin, g/dL 3.9 (< 0.1) 4.1 (< 0.1) 0.985 Total bilirubin, mg/dL 0.5 (< 0.1) 0.5 (< 0.1) 0.167 LDL-cholesterol, mg/dL 99.9 (3.4) 107.3 (1.2) 0.514 HbA1c, % 6.0 (0.1) 5.9 (0.1) 0.301 Liver fibrosis Liver stiffness, kPa 10.6 (1.8) 6.7 (0.4) 0.522 Advanced fibrosis 10.2% 10.0% 0.847 Liver steatosis Controlled attenuation parameter, dB/m 330.0 (5.0) 327.1 (5.3) 0.056 Variables are expressed as mean (standard error), or %. NAFLD, nonalcoholic fatty liver disease; BMI, body mass index; LDL, low-density lipoprotein; HbA1c, hemoglobin A1c; kPa, kilopascal.
INTRODUCTION: CT is commonly used to examine patients who present to with abdominal pain. Moreover, bowel wall thickening (BWT) is a common finding on abdominal CT. Inflammation, malignant processes, or non-significant abnormalities can lead to BWT. BWT on CT is a common reason for gastroenterology consultation and subsequently endoscopic evaluation. The aim of our study was to establish the value of colonoscopy in incidental CT findings of BWT in patients with negative history of gastrointestinal disorders. METHODS: This was a retrospective study of involving patients seen between October 2014 and March 2019 at the Banner University Medical Center in Arizona. All patients with BWT on CT who underwent colonoscopy were included. Subjects were excluded if they were under 18 years of age, history of bowel cancer, history of inflammatory bowel disease or chronic liver disease, or if there was a specific CT finding such as a mass. Flexible sigmoidoscopy or colonoscopy with biopsy was performed by gastroenterologists. RESULTS: A total of 117 out of 332 patients (72 females and 45 males) had an abdominopelvic CT with a report of BWT as well as a follow-up colonoscopy. The mean age was 52 years. There were 67 Caucasian patients (57.4%), 41 Hispanic (35%), 4 Native-American (3.4%), 2 Asian (1.7%) and 3 patients (2.5%) were African-American (Table 1). 69 patients (59%) showed significant pathology results. The most common site was the sigmoid in 43 patients (68.2%). We found 3 patients (2.4%) had malignant lesions including 1 (0.8%) patient with adenocarcinoma, 1 (0.8%) carcinoid tumor and 1 (0.8%) with an adenoma with high grade dysplasia. In our study, 48 (41%) of our patients who underwent colonoscopy had normal or no significant pathology findings. We observed that males have a greater proportion of abnormal pathology compared to females (OR 0.31, 95% CI 0.12–0.76; P = 0.006). Additionally, rectal bleeding is associated with a greater proportion of abnormal endoscopy (OR 0.19, 95% CI 0.04–0.6; P = 0.002). CONCLUSION: With respect to etiology, we found that a significant number of patients with BWT on CT did have underlying pathology on direct visualization. The association is especially strong where there is BWT of the sigmoid colon, male gender and if there is a history of rectal bleeding. Asymptomatic malignancy may be detected; therefore, endoscopic confirmation is practical when a finding of BWT is found on CT examinations particularly with history of gastrointestinal bleeding.Table 1.: Patient characteristics, including laboratory value and outcome variablesFigure 1
To compare the optical effects of an immediately placed anodized pink-neck implant and abutment vs a conventional gray implant and abutment in relation to soft tissue thickness 6 months after the restoration was completed.Forty patients with a hopeless maxillary anterior tooth received an immediate implant and an immediate provisional or custom healing abutment after flapless extraction. Participants were randomized to receive either a conventional titanium implant (control) or a pink-neck implant (test). All patients then received two identical CAD/CAM titanium abutments (one conventional gray, delivered first, and one anodized to appear pink, delivered 3 weeks after) and a zirconia crown. A spectrophotometer was used to record the color of the peri-implant mucosa and gingiva 3 weeks after delivery of each abutment and 6 months after the final restoration was delivered. The color difference between the two sites was calculated (ΔL*, Δa*, Δb*), and correlations with soft tissue thickness, change in ridge dimension, and implant position were assessed.Irrespective of the randomization group, changing the abutments from gray to pink showed a change in color between the peri-implant mucosa and the natural gingiva. Patients with a thin gingival biotype showed a statistically significant color change (P = .00089) in the a* axis, meaning that the gingiva appeared more pink (Δa*). No significant correlation between the soft tissue color and buccolingual collapse, vertical recession, or implant position was observed in either group.The difference in color observed between the peri-implant mucosa and the gingiva was considerable in all groups. Anodized pink implants and abutments could reduce the difference in the red aspect (Δa*) of the peri-implant mucosa compared to the adjacent gingiva in patients with a thin biotype.
Various designs of dental implants representing different geometries and surface technologies are commercially available for patient treatment. However, data with regard to the biologic events that occur immediately after implant placement, regardless of the surface characteristic, are scarce. It has become a common procedure to perform immediate/early prosthetic loading rather than delayed loading. The goal of this study was to observe the early biologic events of peri-implant healing to understand the role of surface modifications in relation to the early phases of bone integration. The secondary goal was to observe the possible differences in the healing pattern at two oral implant surfaces differing in morphology and roughness (Ra, with Ra values ranging from 0.5 μm (machined surface; MS) to 1.5 μm (oxidized surface; OS). A total of 36 implants were placed in six foxhound dogs, equally divided between machined and oxidized surfaces. Three implants were positioned per hemimandible following a randomization scheme. Each animal was euthanized at a specific time point for histologic observation and histomorphometry: immediately after implant insertion and after 24 hours, 7 days, 15 days, 30 days, and 90 days. The study demonstrated an extremely low bone-implant contact (BIC) for both OS and MS implant surfaces during the first 15 days after implant placement (ranging from 12.9% to 26.9% independent of the implant surface). Increased BIC values were observed only in the 30- and 90-day specimens. The presence and the degradation of residual bone particles acted as centers for new bone formation, with osteoblasts lining osteoid tissue and subsequently woven bone independent of the implant surface characteristics. The bone-forming activity appeared strongly reduced after 30 days of healing and seemed to be complete only in the 90-day specimens, where abundant lamellar bone was evident. There is a continuing effort to develop improved titanium surfaces to achieve more rapid osseointegration and improve BIC, with the ultimate goal of applying occlusal load as early as possible. Since immediate or early implant loading is applied during and not after the first 15 days, the findings in the present study of an extremely low BIC and limited mineralized bone formation for both implant surfaces during the first 15 days after implant placement suggest that the surface roughness may not be a key factor for successful osseointegration of immediately or early loaded implants. Within the limits of this study, it can be stated that osseointegration follows a similar healing pattern with machined and oxidized implant surfaces.
Self-supported backpacking treks are popular among a subset of the active population, yet the grueling duration in unpredictable conditions furnishes a low success rate. However, the physiological consequences of multi-month backpacking treks in the wilderness remain unclear. PURPOSE: Observe the effects of a multi-month, self-supported backpacking trek in the wilderness on body composition and resting metabolism. METHODS: An experienced backpacker (30.1 yrs; 78.3 kg; 179.1 cm; 20.5% BF; 35.2 kg SMM) completed a wilderness-based backpacking trek known as the Appalachian National Scenic Trail northbound thru-hike. The participant hiked 3,531 km with an accumulated elevation gain of 99,643 m over 139 days. Body composition and resting metabolism data were collected at 6 time points (PRE-, MID-, POST-, 1-WK, 2-WK, and 4-WK-POST). Body composition was assessed via multi-frequency BIA with urine specific gravity hydration confirmation. Indirect calorimetry via metabolic cart was used to determine resting metabolism under fasted and standardized conditions. Data are reported as percent changes from pre-trek baseline (PRE). RESULTS: The participant lost 2.68 kg (-3.42%) body weight (BW) over the 139-d trek defined by a 4.5 kg (-27.98%) fat mass (FM) loss and a 0.9 kg (2.6%) skeletal muscle mass (SMM) gain. Specifically, visceral adipose tissue area (VAT, PRE 66.0cm2, POST 47.1cm2, -28.6%) and body fat percentage (BF%, PRE 20.5%, POST 15.4%, -24.9%) decreased in response to trek demands. 1-WK-POST trek, BW (1.4%), FM (1.7%), SMM (1.2%), VAT (-2.4%), and BF% (1.0%) returned to near-baseline levels (PRE) and were maintained through 4-WK-POST. Trek demands increased resting energy expenditure and reliance on carbohydrate metabolism at rest, peaking 1-WK-POST (REE: PRE 2035 kcal/d, 1-WK 2291 kcal/d, 12.6%; RQ: PRE 0.80, 1-WK 1.03, 28.7%) before returning to near-baseline levels 4-WK-POST (REE: 2054 kcal/d, 0.9%; RQ: 0.84, 5.0%). CONCLUSION: Completing a 139-d self-supported backpacking event in the wilderness positively alters body composition in response to greater stress, activity exposure, and overall metabolic demand. Upon relief of significant daily activity, stress demands, and caloric modification, the physiological system quickly reverts to the previously established metabolic baseline.
A preclinical trial was conducted to treat 54 mandibular critical-sized alveolar ridge defects in 27 canines. Each hemimandible was randomized to be treated with two different anorganic bovine bone grafts (group A = InterOss [SigmaGraft]; group B = Bio-Oss [Geistlich]) or negative control (group C = empty defect) followed by a 4-, 8-, or 12-week observation period. Microcomputed tomography, histology, histopathology, and histomorphometric analyses were performed to evaluate the safety and efficacy of these treatments. By all the parameters assessed in this study, the biocompatibility and healing of group A treated defects were indistinguishable from those in group B. Radiographic comparison of graft resorption and bony integration demonstrated similar mean scores for both treatment groups. Likewise, no statistical differences were observed between the two groups with respect to percent mineralized volume and density. When compared to the critical-sized empty controls, both treatment groups showed statistically greater amounts of bone present in the defect sites and appeared to help preserve the mesial and distal alveolar walls of the defect. Histomorphometry also supported the similarity in performance of both tested groups as no statistically significant differences were observed with regard to percent bone, percent residual implant, and percent bone marrow values. While not statistically different, on average group A had more than twice the mean amount of bone present at 8 and 12 weeks compared to group B. Overall, group A had a good biocompatibility response, similar to group B. Clinical studies are recommended to confirm these findings.
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