Bacteriophages as Beneficial Regulators of the Mammalian Microbiome

Much of the research on viruses has concentrated on their disease causing ability. The creation model biomatrix theory predicts that viruses play a beneficial role in cells and organisms. In this report we present a new theory which proposes that mammalian phages (bacteriophages), the most abundant organism associated with mammals, guard and regulate growth of the mammalian microbiome. We base this theory on nearly a century of published evidence that demonstrates that phage can insert into the bacterial genome and cover the surface of bacteria. We propose that this “cloaking” of the bacterial cell surface is an elegant mechanism whereby the normal flora bacteria are protected from immune detection and pathogenic bacteria can be directly lysed by the same phage. Additionally, both phage genome integration and cloaking can be used to prevent normal flora bacteria from conversion to a pathogenic state. Further support for the phage cloaking aspect of our theory has been demonstrated in recent studies which show that phage proteins bind specifically to microbial-associated molecular patterns (MAMPs), which are known to be the major ligands that activate the mammalian immune system. Although these phenomena have been documented separately over decades, we postulate for the first time that these functions work together to promote the integrity of the mammalian microbiome

Using Light to Treat Mucositis and Help Wounds Heal

A continuing program of research and development is focusing on the use of controlled illumination by light-emitting diodes (LEDs) to treat mucositis and to accelerate healing of wounds. The basic idea is to illuminate the affected area of a patient with light of an intensity, duration, and wavelength (or combination of wavelengths) chosen to produce a therapeutic effect while generating only a minimal amount of heat. This method of treatment was originally intended for treating the mucositis that is a common complication of chemotherapy and radiation therapy for cancer. It is now also under consideration as a means to accelerate the healing of wounds and possibly also to treat exposure to chemical and radioactive warfare agents. Radiation therapy and many chemotherapeutic drugs often damage the mucosal linings of the mouth and gastrointestinal tract, leading to mouth ulcers (oral mucositis), nausea, and diarrhea. Hyperbaric-oxygen therapy is currently the standard of care for ischemic, hypoxic, infected, and otherwise slowlyhealing problem wounds, including those of oral mucositis. Hyperbaric-oxygen therapy increases such cellular activities as collagen production and angiogenesis, leading to an increased rate of healing. Biostimulation by use of laser light has also been found to be effective in treating mucositis. For hyperbaricoxygen treatment, a patient must remain inside a hyperbaric chamber for an extended time. Laser treatment is limited by laser-wavelength capabilities and by narrowness of laser beams, and usually entails the generation of significant amounts of heat

Outpatient management of cholesteatoma with canal wall reconstruction tympanomastoidectomy

Objectives The postoperative wound infection rate for canal wall reconstruction (CWR) tympanomastoidectomy with mastoid obliteration in the treatment of chronic otitis media with cholesteatoma has been reported to be 3.6%. Postoperative administration of 24–48 hours of intravenous antibiotics has been recommended. We aim to determine the infection rate of CWR with postoperative outpatient oral antibiotics. Study Design Institutional review board—approved retrospective case review. Setting Tertiary referral center. Patients: Retrospective review of consecutive patients who underwent CWR tympanomastoidectomy with mastoid obliteration at a single institution from 2014 to 2016. Main Outcome Measure: Patient characteristics (age, sex) were calculated. Rate of postoperative complications and infections within 1 month of surgery were calculated. Comparison to previous published infection rates with postoperative intravenous antibiotics. Results 51 patients underwent CWR followed by outpatient oral antibiotics with a mean age of 25.9 years (16 patients were less than 10 years old). There were no postoperative wound infections. Outpatient antibiotics showed non-inferiority to IV antibiotic historic controls (0% vs. 3.6%; 95% confidence interval [CI], 0–6.09%; p = 0.03). One patient had small postoperative wound dehiscence with CSF leak that was managed conservatively. One patient developed Clostridium difficile colitis on postoperative day 2. Conclusions The infection rate after CWR tympanomastoidectomy with use of outpatient antibiotics is low and is non-inferior to a historic cohort treated with inpatient intravenous antibiotics. A larger randomized controlled trial is warranted. Level of Evidence 4

Recognizing Guttate Psoriasis and Initiating Appropriate Treatment

Guttate psoriasis is a less common form of psoriasis. It manifests with numerous small, teardrop shaped, scaly plaques on the trunk and extremities. The etiology includes both environmental and genetic factors. It commonly arises 3-4 weeks following a beta hemolytic streptococcal infection. In some cases, it may be misdiagnosed as an allergy to the antibiotics being used to treat the streptococcal infection. The treatment of guttate psoriasis can vary by severity, but the mainstay treatment includes photo therapy and topical steroids. This case report presents the etiology, clinical findings and current treatment options of guttate psoriasis. It also discusses importance of differentiating guttate psoriasis from an antibiotic allergy. The confusion between the two can often delay and make treatment more difficult

Disinhibition Bursting of Dopaminergic Neurons

Substantia nigra pars compacta (SNpc) dopaminergic neurons receive strong tonic inputs from GABAergic neurons in the substantia nigra pars reticulata (SNpr) and globus pallidus (GP), and glutamatergic neurons in the subthalamic nucleus. The presence of these tonic inputs raises the possibility that phasic disinhibition may trigger phasic bursts in dopaminergic neurons. We first applied constant NMDA and GABAA conductances onto a two-compartment single cell model of the dopaminergic neuron (Kuznetsov et al., 2006). The model exhibited disinhibition bursting upon stepwise removal of inhibition. A further bifurcation analysis suggests that disinhibition may be more robust than excitation alone in that for most levels of NMDA conductance, the cell remains capable of bursting even after a complete removal of inhibition, whereas too much excitatory input will drive the cell into depolarization block. To investigate the network dynamics of disinhibition, we used a modified version of an integrate-and-fire based model of the basal ganglia (Humphries et al., 2006). Synaptic activity generated in the network was delivered to the two-compartment single cell dopaminergic neuron. Phasic activation of the D1-expressing medium spiny neurons in the striatum (D1STR) produced disinhibition bursts in dopaminergic neurons through the direct pathway (D1STR to SNpr to SNpc). Anatomical studies have shown that D1STR neurons have collaterals that terminate in GP. Adding these collaterals to the model, we found that striatal activation increased the intra-burst firing frequency of the disinhibition burst as the weight of this connection was increased. Our studies suggest that striatal activation is a robust means by which disinhibition bursts can be generated by SNpc dopaminergic neurons, and that recruitment of the indirect pathway via collaterals may enhance disinhibition bursting

STUDENT AND SCHOOL CORRELATES OF MATHEMATICS ACHIEVEMENT: MODELS OF SCHOOL PERFORMANCE BASED ON PAN‐ CANADIAN STUDENT ASSESSMENT

This study explored the relationships between student achievement and student, school and home variables from the pan‐Canadian assessment program administered by the Council of Ministers of Education Canada (CMEC): the School Achievement Indicators Program (SAIP) Mathematics 2001. The study also evaluated the datasets used in relationship to their utility for statistical modeling of school performance. Student beliefs about mathematics are positively related to mathematics achievement for both age groups and for both domains of mathematics. As students’ use of instructional supports (parental assistance with mathematics homework, computers in the mathematics classroom) increases, there is an associated decrease in mathematics scores. Key words: student achievement, school performance, multilevel modeling. Dans cet article, les auteurs explorent les relations entre le rendement scolaire et certaines caractéristiques des élèves, des écoles et de l’environnement familial à partir des données du programme d’évaluation pancanadien du Conseil des ministres de lʹÉducation (Canada) (CMEC), le Programme d’indicateurs du rendement scolaire (PIRS) 2001 en mathématiques. L’étude évalue également les bases de données au regard de leur pertinence pour la modélisation statistique de la performance scolaire. Les auteurs notent une corrélation directe entre les idées que se font les élèves au sujet des mathématiques et le rendement en mathématiques tant pour les groupes d’âge que pour les domaines des mathématiques. Plus les élèves font appel à du soutien pédagogique (aide des parents pour les devoirs de mathématiques, ordinateurs dans les classes de mathématiques), plus les notes en mathématiques diminuent. Mots clés : rendement des élèves, performance scolaire, modélisation à multiples niveaux.

Cardiomyopathy Secondary to Thyroid and Parathyroid Dysfunction: Case Report and Literature Review

Heart failure due to metabolic derangements is not common in clinical practice. However, outcome is usually positive given that the precipitating factor is recognized and treatment is initiated in a timely fashion. We report an unusual case of reduced left ventricular systolic function as a result of hypocalcemia and long standing untreated primary hypothyroidism in a patient without structural heart disease. Delay in seeking appropriate medical attention for both disorders has culminated in cardiac dysfunction that was favorably altered with correction of underlying etiologies. Therefore, early recognition and expedient management of hypocalcemia and hypothyroidism can result in an imminent improvement of cardiac function