Prevalence of beta lactamase producing species of pseudomonas and acinetobacter in pediatric burn patients Prevalence de pseudomonas et acinetobacter secreteurs de blse et metallo-beta lactamases chez les brules pediatriques

Burn wound infection is a major cause of morbidity and mortality in burn victims. Pseudomonas and Acinetobacter species are among the most common organisms complicating burn wounds. Presence of extended spectrum β-lactamase (ESBL) and metallo-β-lactamase (MBL) genes plays an important role in spreading β-lactam resistant strains of these organisms and is a serious condition in the treatment of the affected patients. As a result, we aimed to determine the prevalence of SHV, TEM, PER and VIM β-lactamases in Pseudomonas and Acinetobacter species isolates from burn wound swabs of children with burn injury. In this descriptive observational study, 107 Pseudomonas and Acinetobacter isolates collected from burn patients were subjected to PCR assay. Using PCR method and DNA sequencing, the existence of SHV-, TEM-, PER- and VIM-type β-lactamase encoding genes were determined. Out of the 107 Pseudomonas and Acinetobacter isolates, 66 (77.6) were ESBL positive, 26.2 were positive for SHV gene, 37.4 were positive for TEM gene, 14 were positive for PER gene and 15.9 of them harbored VIM gene. More than half of the Pseudomonas and Acinetobacter strains in our pediatric burn unit harbor β-lactamase encoding genes that make them resistant to a wide range of β-lactam antibiotics. Consequently, it is suggested to choose an appropriate antibiotic regimen based on the antibiogram pattern of the strains. © 2015, Mediterranean Club for Burns and Fire Disasters. All rights reserved

Educational case: Pseudomonas and acinetobacter sepsis due to thermal injury

Background: Multi drug resistant (MDR) Pseudomonas and Acinetobacter species are defined as resistant to at least three classes of antibiotics. Most studies have demonstrated that MDR gram negative infections convey increased mortality and morbidity. Case: An 11-year âold girl was admitted to pediatric burns unit with burn injury of approximately 68 total body surface area (TBSA). Discussion: Role of systemic antibiotics is adjunctive and never replaces surgical debridement, use of topical agents, nutritional support, increasing in immune system function and grafting. Evidence in the published literature suggests that combination therapy with Meropenem and Colistin are effective for burned patients with MDR gram negative sepsis. © 2013, Kowsar Corp

Longitudinal Image Registration with Temporal-Order and Subject-Specificity Discrimination

Morphological analysis of longitudinal MR images plays a key role in monitoring disease progression for prostate cancer patients, who are placed under an active surveillance program. In this paper, we describe a learning-based image registration algorithm to quantify changes on regions of interest between a pair of images from the same patient, acquired at two different time points. Combining intensity-based similarity and gland segmentation as weak supervision, the population-data-trained registration networks significantly lowered the target registration errors (TREs) on holdout patient data, compared with those before registration and those from an iterative registration algorithm. Furthermore, this work provides a quantitative analysis on several longitudinal-data-sampling strategies and, in turn, we propose a novel regularisation method based on maximum mean discrepancy, between differently-sampled training image pairs. Based on 216 3D MR images from 86 patients, we report a mean TRE of 5.6 mm and show statistically significant differences between the different training data sampling strategies

Automatic segmentation of prostate MRI using convolutional neural networks: Investigating the impact of network architecture on the accuracy of volume measurement and MRI-ultrasound registration

Convolutional neural networks (CNNs) have recently led to significant advances in automatic segmentations of anatomical structures in medical images, and a wide variety of network architectures are now available to the research community. For applications such as segmentation of the prostate in magnetic resonance images (MRI), the results of the PROMISE12 online algorithm evaluation platform have demonstrated differences between the best-performing segmentation algorithms in terms of numerical accuracy using standard metrics such as the Dice score and boundary distance. These small differences in the segmented regions/boundaries outputted by different algorithms may potentially have an unsubstantial impact on the results of downstream image analysis tasks, such as estimating organ volume and multimodal image registration, which inform clinical decisions. This impact has not been previously investigated. In this work, we quantified the accuracy of six different CNNs in segmenting the prostate in 3D patient T2-weighted MRI scans and compared the accuracy of organ volume estimation and MRI-ultrasound (US) registration errors using the prostate segmentations produced by different networks. Networks were trained and tested using a set of 232 patient MRIs with labels provided by experienced clinicians. A statistically significant difference was found among the Dice scores and boundary distances produced by these networks in a non-parametric analysis of variance (p < 0.001 and p < 0.001, respectively), where the following multiple comparison tests revealed that the statistically significant difference in segmentation errors were caused by at least one tested network. Gland volume errors (GVEs) and target registration errors (TREs) were then estimated using the CNN-generated segmentations. Interestingly, there was no statistical difference found in either GVEs or TREs among different networks, (p = 0.34 and p = 0.26, respectively). This result provides a real-world example that these networks with different segmentation performances may potentially provide indistinguishably adequate registration accuracies to assist prostate cancer imaging applications. We conclude by recommending that the differences in the accuracy of downstream image analysis tasks that make use of data output by automatic segmentation methods, such as CNNs, within a clinical pipeline should be taken into account when selecting between different network architectures, in addition to reporting the segmentation accuracy

Morphological Change Forecasting for Prostate Glands using Feature-based Registration and Kernel Density Extrapolation

Organ morphology is a key indicator for prostate disease diagnosis and prognosis. For instance, In longitudinal study of prostate cancer patients under active surveillance, the volume, boundary smoothness and their changes are closely monitored on time-series MR image data. In this paper, we describe a new framework for forecasting prostate morphological changes, as the ability to detect such changes earlier than what is currently possible may enable timely treatment or avoiding unnecessary confirmatory biopsies. In this work, an efficient feature-based MR image registration is first developed to align delineated prostate gland capsules to quantify the morphological changes using the inferred dense displacement fields (DDFs). We then propose to use kernel density estimation (KDE) of the probability density of the DDFrepresented future morphology changes, between current and future time points, before the future data become available. The KDE utilises a novel distance function that takes into account morphology, stage-of-progression and duration-ofchange, which are considered factors in such subject-specific forecasting. We validate the proposed approach on image masks unseen to registration network training, without using any data acquired at the future target time points. The experiment results are presented on a longitudinal data set with 331 images from 73 patients, yielding an average Dice score of 0.865 on a holdout set, between the ground-truth and the image masks warped by the KDE-predicted-DDFs

Signal Detection Performance of Overlapped FFT Scheme with Additional Frames Consisting of Non-continuous Samples in Indoor Environment

Overlapped FFT has been proposed as a signal detection scheme in dynamic spectrum access to reduce the variance of the noise and improve the detection probability. However, the improvement of the detection probability in the conventional overlapped FFT is bounded with the upper limit of the overlap ratio. This paper proposes a new overlapped FFT scheme using additional frames. In the proposed scheme, in addition to the original FFT frames, new frames that consist of multiple subframes with non-continuous samples are constructed and included. It can realize the increase of the number of the FFT frames and the improvement of the detection probability compared with the conventional scheme. Numerical results through computer simulation show that the proposed scheme improves the detection probability by up to 0.07. On indoor channel models the proposed scheme also improves the detection probability. In addition, it is clarified that as the delay spread increases the detection probability reduces due to the correlation between the frames

Autologous cricoid cartilage as a graft for airway reconstruction in an emergent technique - A case report

Introduction: Laryngotracheal stenosis can be caused after traumatic injuries to the neck from the subglottic larynx to the trachea. Patients with laryngotracheal stenosis often need a tracheotomy and occasionally may become tracheotomy dependent. Different procedures have been described for the management of these lesions. Management options include techniques of endoscopic dilation, laser resection, laryngo-fissure, and an innovative array of plastic reconstructions with or without the use of stents. Case Report: This paper presents airway reconstruction in a young patient with severe subglottic stenosis due to a blunt trauma to the neck, who was treated using particles of an autologous fractured cricoid cartilage as the source for airway augmentation. An incision was made in the anterior midline of the cricoid lamina and deepened through the scar tissue to the posterior cricoid lamina. Then two lateral incisions (right&left) were made in the cricoid lamina and fractured cartilage particles and the scar tissue were removed via these two lateral incisions. The mucosal lining at the right and left of the midline incision, after debulking, were sutured to a lateral position. Thereafter three cartilage particles were used to reconstruct the anterior cricoid lamina and augment the lumen. Conclusion: It is worth to mention that an autologus cartilage graft can be used for certain cases with traumatic airway stenosis. Further follow up and more patients are needed to approve this method of reconstructive surgery in emergent situations

Serum 25-hydroxyvitamin D levels in pediatric burn patients

Background: Previous studies have implicated the important and active role of vitamin D in the immune system. Objectives: The aim of this study was to evaluate serum levels of 25-hydroxyvitamin D in children with burn injuries. Materials and Methods: In this cross-sectional study, 118 patients with various degrees of burn injuries were enrolled. A checklist consisting of demographic data, total body surface area (TBSA) affected by burn, degree of burn, serum level of 25(OH)D, total protein, albumin, electrolytes, and parathyroid hormone was recorded for each patient. Results: Sixty-eight (57.6) males and 50 (42.4) females with a mean age of 4.04 years (SD = 3.04) were evaluated. The mean level of 25(OH)D was 14.58 ng/mL (SD = 6.94). Levels of 25(OH)D in four (3.39) cases were higher than 30 ng/mL, while 95 (81.35) cases had levels lower than 20 ng/mL, and 19 (16.10) cases had levels of 21 - 30 ng/mL. The level of 25(OH)D was below recommended levels in 96.61 of cases, while 81.34 had vitamin D deficiency and 16.1 had insufficiency. We found a significant correlation between vitamin 25(OH)D and total protein, albumin, and total and ionized calcium (P < 0.001). There was also a significant negative correlation between 25(OH)D and TBSA affected by burn (P = 0.001). Conclusions: The levels of 25(OH)D in children suffering from severe burns were low. Supplementation might be useful in patients with very low levels of serum vitamin D. Copyright © 2016, Trauma Monthly

Mevalonate Cascade Regulation of Airway Mesenchymal Cell Autophagy and Apoptosis: A Dual Role for p53

Statins inhibit the proximal steps of cholesterol biosynthesis, and are linked to health benefits in various conditions, including cancer and lung disease. We have previously investigated apoptotic pathways triggered by statins in airway mesenchymal cells, and identified reduced prenylation of small GTPases as a primary effector mechanism leading to p53-mediated cell death. Here, we extend our studies of statin-induced cell death by assessing endpoints of both apoptosis and autophagy, and investigating their interplay and coincident regulation. Using primary cultured human airway smooth muscle (HASM) and human airway fibroblasts (HAF), autophagy, and autophagosome formation and flux were assessed by transmission electron microscopy, cytochemistry (lysosome number and co-localization with LC3) and immunoblotting (LC3 lipidation and Atg12-5 complex formation). Chemical inhibition of autophagy increased simvastatin-induced caspase activation and cell death. Similarly, Atg5 silencing with shRNA, thus preventing Atg5-12 complex formation, increased pro-apoptotic effects of simvastatin. Simvastatin concomitantly increased p53-dependent expression of p53 up-regulated modulator of apoptosis (PUMA), NOXA, and damage-regulated autophagy modulator (DRAM). Notably both mevalonate cascade inhibition-induced autophagy and apoptosis were p53 dependent: simvastatin increased nuclear p53 accumulation, and both cyclic pifithrin-α and p53 shRNAi partially inhibited NOXA, PUMA expression and caspase-3/7 cleavage (apoptosis) and DRAM expression, Atg5-12 complex formation, LC3 lipidation, and autophagosome formation (autophagy). Furthermore, the autophagy response is induced rapidly, significantly delaying apoptosis, suggesting the existence of a temporally coordinated p53 regulation network. These findings are relevant for the development of statin-based therapeutic approaches in obstructive airway disease

HSP70/IL-2 treated NK cells effectively cross the blood brain barrier and target tumor cells in a rat model of induced glioblastoma multiforme (GBM)

Natural killer (NK) cell therapy is one of the most promising treatments for Glioblastoma Multiforme (GBM). However, this emerging technology is limited by the availability of sufficient numbers of fully functional cells. Here, we investigated the efficacy of NK cells that were expanded and treated by interleukin-2 (IL-2) and heat shock protein 70 (HSP70), both in vitro and in vivo. Proliferation and cytotoxicity assays were used to assess the functionality of NK cells in vitro, after which treated and naïve NK cells were administrated intracranially and systemically to compare the potential antitumor activities in our in vivo rat GBM models. In vitro assays provided strong evidence of NK cell efficacy against C6 tumor cells. In vivo tracking of NK cells showed efficient homing around and within the tumor site. Furthermore, significant amelioration of the tumor in rats treated with HSP70/Il-2-treated NK cells as compared to those subjected to nontreated NK cells, as confirmed by MRI, proved the efficacy of adoptive NK cell therapy. Moreover, results obtained with systemic injection confirmed migration of activated NK cells over the blood brain barrier and subsequent targeting of GBM tumor cells. Our data suggest that administration of HSP70/Il-2-treated NK cells may be a promising therapeutic approach to be considered in the treatment of GBM. © 2020 by the authors. Licensee MDPI, Basel, Switzerland