Hong Kong dentists' preparedness for medical emergency in dental clinics

Aim: The aim of this study was to investigate the Hong Kong dentists’ and dental clinics’ preparedness for medical emergency in the dental clinic. Methods: Two custom designed questionnaires were developed, one for dentists and another for dental clinics, to collect the required information. The sampling frame for participants was the list of registered dentists published by the Hong Kong Dental Council on its website in January 2016. A total of 434 dentists and 143 dental clinics were selected from the list by systematic random sampling. The latter sample was supplemented by 10 randomly selected government dental clinics. The questionnaires were mailed the selected dentists together with a cover letter and a stamped return envelope. A reminder letter and another copy of the questionnaire were sent out two weeks after the first mailing. Results: 167 (38%) completed dentist questionnaires and 53 (35%) clinic questionnaires were collected. Most of the respondent dentists had some deficient knowledge on basic life support (BLS), their mean score was 3.5 out of a maximum of 5. Most (>60%) of the respondents thought they were competent in performing medical emergency procedures except giving intravenous injection. Moreover, most (>60%) of them held positive attitude towards having immediate availability of essential medical emergency equipment and drugs in their clinic. Dentists who were more recent graduates, those with postgraduate qualifications, and those who work with accompaniment generally had higher mean BLS knowledge scores. In the dental clinics, the most commonly kept medical emergency equipment/drug was instant glucose (70%) and followed by antihistamine (62%). Only a quarter of the clinics were equipped with AED, and 45% were equipped with oxygen cylinder. For 8 out of the 11 items, a higher proportion of the bigger clinics (>2 dental chairs) than the smaller clinics had the medical emergency equipment/drug available (Chi-square test, p<0.05). Conclusion: Hong Kong dentists have a moderate level of knowledge on BLS which should be enhanced through regular attendance at CE courses. Their knowledge level is affected by a number of their background and professional activities factors. Most dental clinics in Hong Kong have only few of the essential medical emergency equipment and drugs while the larger clinics are better equipped than the smaller clinics.published_or_final_versio

Multi-Modal Proteomic Analysis of Retinal Protein Expression Alterations in a Rat Model of Diabetic Retinopathy

As a leading cause of adult blindness, diabetic retinopathy is a prevalent and profound complication of diabetes. We have previously reported duration-dependent changes in retinal vascular permeability, apoptosis, and mRNA expression with diabetes in a rat model system. The aim of this study was to identify retinal proteomic alterations associated with functional dysregulation of the diabetic retina to better understand diabetic retinopathy pathogenesis and that could be used as surrogate endpoints in preclinical drug testing studies.A multi-modal proteomic approach of antibody (Luminex)-, electrophoresis (DIGE)-, and LC-MS (iTRAQ)-based quantitation methods was used to maximize coverage of the retinal proteome. Transcriptomic profiling through microarray analysis was included to identify additional targets and assess potential regulation of protein expression changes at the mRNA level. The proteomic approaches proved complementary, with limited overlap in proteomic coverage. Alterations in pro-inflammatory, signaling and crystallin family proteins were confirmed by orthogonal methods in multiple independent animal cohorts. In an independent experiment, insulin replacement therapy normalized the expression of some proteins (Dbi, Anxa5) while other proteins (Cp, Cryba3, Lgals3, Stat3) were only partially normalized and Fgf2 and Crybb2 expression remained elevated.These results expand the understanding of the changes in retinal protein expression occurring with diabetes and their responsiveness to normalization of blood glucose through insulin therapy. These proteins, especially those not normalized by insulin therapy, may also be useful in preclinical drug development studies

Purifying selection decreases the potential for Bangui orthobunyavirus outbreaks in humans

Pathogens carried by insects, such as bunyaviruses, are frequently transmitted into human populations and cause diseases. Knowing which spillover events represent a public health threat remains a challenge. Metagenomic next-generation sequencing (mNGS) can support infectious disease diagnostics by enabling the detection of any pathogen from clinical specimens. mNGS was performed on blood samples to identify potential viral coinfections in human immunodeficiency virus (HIV)-positive individuals from Kinshasa, the Democratic Republic of the Congo (DRC), participating in an HIV diversity cohort study. Time-resolved phylogenetics and molecular assay development assisted in viral characterization. The nearly complete genome of a novel orthobunyavirus related to Nyangole virus, a virus previously identified in neighboring Uganda, was assembled from a hepatitis B virus-positive patient. A quantitative polymerase chain reaction assay was designed and used to screen &gt;2,500 plasma samples from Cameroon, the DRC, and Uganda, failing to identify any additional cases. The recent sequencing of a US Center for Disease Control Arbovirus Reference Collection revealed that this same virus, now named Bangui virus, was first isolated in 1970 from an individual in the Central African Republic. Time-scaled phylogenetic analyses of Bangui with the related Anopheles and Tanga serogroup complexes indicate that this virus emerged nearly 10,000 years ago. Pervasive and episodic models further suggest that this virus is under purifying selection and that only distant common ancestors were subject to positive selection events. This study represents only the second identification of a Bangui virus infection in over 50 years. The presumed rarity of Bangui virus infections in humans can be explained by its constraint to an avian host and insect vector, precluding efficient transmission into the human population. Our results demonstrate that molecular phylogenetic analyses can provide insights into the threat posed by novel or re-emergent viruses identified by mNGS

Full genome bootscanning reveals the true extent of recombination.

<p>Sequences 920–49 <b>(A)</b> and 789–10 <b>(B)</b> were evaluated in SIMPLOT against pure subtype reference sequences and both found to be subtype G throughout the genome (red line). Specimen 876–14 <b>(C)</b> and 1252–11 <b>(D)</b> were subjected to SIMPLOT bootscanning analysis; the vertical dashed lines indicate recombination breakpoints. The genomic structure is diagramed below each bootscan plot. Bootscan and SIMPLOT analysis was performed using a window of 400 base pairs and 20 base pair step.</p

Genetic organization of unique recombinant forms obtained by NGS.

<p>Nine unique recombinants are shown with the legend at the bottom indicating the classification of each sub-genomic fragment. Genomic coordinates for each recombination breakpoint are described in detail in the Supplemental information.</p

Breakpoint analysis for rare, complex recombinants endemic to Cameroon.

<p>Bootscan plots are shown for <b>(A)</b> CRF11_cpx, <b>(B)</b> CRF13_cpx, <b>(C)</b> CRF18_cpx and <b>(D)</b> CRF37_cpx isolates. In each panel the profile for a reference strain is shown on top and a representative new strain is on the bottom. Vertical dashed lines indicate recombination breakpoints determined by Find Site; genome structure is diagramed below each plot. Bootscan analysis was performed using a window of 400 base pairs and 20 base pair step.</p

HIV genome coverage is uniform and complete but varies in sequence depth.

<p>Three representative specimens sequenced by NGS with a wide range in percentage of HIV reads were selected and aligned to the A1-AF004885 reference genome to demonstrate the uniformity of genome coverage regardless of read depth. Coverage is expressed as number of reads at each nucleotide position along the length of the HIV genome. Strain/mean read number: 833-62/1085, green; 886-24/223, orange; B4043-15/7939, blue.</p

Phylogenetic trees of HPgV indicate Cameroon sequences group with genotype 1.

<p>Phylogenetic trees of 56 HPgV <b>(A)</b> complete genome sequences (8851 nt after degapping) and <b>(B)</b> 5’UTR sequences (366 nt) of 8 Cameroonian sequenced by NGS in this study, were constructed with bootstrap values indicated at each branch. GBV-C<i>tro</i> was used as the outgroup and the genetic distance scale is indicated. References are labeled individually with accession number and country of origin; Cameroonian sequences are in bold text.</p