Prophylactic Activity of Orally Administered FliD-Reactive Monoclonal SIgA Against Campylobacter Infection

This work is licensed under a Creative Commons Attribution 4.0 International License.Campylobacter infection is one of the most common causes of bacterial gastroenteritis worldwide and a major global health threat due to the rapid development of antibiotic resistance. Currently, there are no vaccines approved to prevent campylobacteriosis, and rehydration is the main form of therapy. Secretory immunoglobulin A (SIgA) is the main antibody class found in mucous secretions, including human milk, and serves as the first line of defense for the gastrointestinal epithelium against enteric pathogens. In this study, we describe the prophylactic activity of orally delivered recombinant SIgA generated from two human monoclonal antibodies (CAA1 and CCG4) isolated for their reactivity against the flagellar-capping protein FliD, which is essential for bacteria motility and highly conserved across Campylobacter species associated with severe enteritis. In an immunocompetent weaned mouse model, a single oral administration of FliD-reactive SIgA CAA1 or CCG4 at 2 h before infection significantly enhances Campylobacter clearance at early stages post-infection, reducing the levels of inflammation markers associated with epithelial damage and polymorphonuclear (PMN) cells infiltration in the cecum lamina propria. Our data indicate that the prophylactic activity of CAA1 and CCG4 is not only dependent on the specificity to FliD but also on the use of the SIgA format, as the immunoglobulin G (IgG) versions of the same antibodies did not confer a comparable protective effect. Our work emphasizes the potential of FliD as a target for the development of vaccines and supports the concept that orally administered FliD-reactive SIgA can be developed to prevent or mitigate the severity of Campylobacter infections as well as the development of post-infection syndromes.Bill & Melinda Gates foundation (grant: OPP1170883

Implant loss and sinusitis after sinus lift ‐ an underestimated complication

Background: Sinus lift is designed to enable the placement of maxillary implants in situations with vertically reduced alveolar bone. It has become a more frequently performed procedure. Possible complications comprise sinusitis, failing grafts and failing of the dental implant. More severe problems and chronic sinusitis have been reported. Aim/Hypothesis: To report on 76 patients with implant loss after sinuslift. To report the reasons, the possibilities for repair in routine cases and in more severe situations of sinusitis with multiple implant loss and damage to surrounding structures. To report the long‐term outcome. Materials and Methods: Between 2000 and 2020 76 patients with failing implants after sinuslift were referred to four Oral Surgery and ENT services in Switzerland. Of 169 implants originally placed 71 implants were already lost before the first consultation. 14 patients had no complaints other than implant loss. The other 62 patients complained about varying degrees of pain, swollen midface, pussy exudates, paresthesia etc. In 3 patients implants had been failing repeatedly. CBCT showed in 58 patients maxillary sinusitis, in 4 patients half‐sided pan‐sinusitis. In 11 patients, nasal fiberoptic endoscopy was carried out. Further investigations consisted of bacteriology, mycology and histology. Reasons for sinusitis were attributable to postoperative blowing of the nose, infection of the graft, antiresorptive drugs, peri‐implantitis reaching the floor of the sinus and allergic reaction to sinus grafting material mixed with collagen. Another reason for implant loss was a failing graft without signs of sinusitis. Results: 53 implants had to be removed under Local Anaesthesia (LA), 9 implants could be left in situ. 8 patients did not need surgical intervention for sinusitis but only antibiotic treatment. 41 patients needed surgical intervention under LA for cleaning the sinus of infected graft material and closing of fistula. 27 patients needed surgical intervention under General Anaesthesia (GA) because of more extensive disease, removal of debris, fungi, dislocated dental implants and nasal endoscopy. 51 patients became pain free. In 11 patients some chronic pain remained. In 18 patients the sinus did not heal to a degree that re‐sinuslift was deemed appropriate. Whilst 29 patients were subsequently treated with dentures, 47 patients underwent a second surgery for new grafting procedures with autologous bone, followed by implant insertion. This was possible in 28 patients under LA, whilst 19 patients needed GA for reconstruction of lost maxillary structures with large mandibular or with hip bone graft. Conclusions and Clinical Implications: Whilst many complications after sinus lift are not severe and can be treated locally, some patients exhibit more severe problems with e.g. pan‐sinusitis and chronic sinusitis. Multidisciplinary cooperation between dentists, oral surgeons, and ear, nose and throat specialists can be very helpful in diagnosing and treating these cases. To estimate the chance for success of redo of sinus lift is rather difficult, especially when bone substitutes were used beforehand which may not have integrated

Gantry-needle-target alignment technique for CT-guided needle approaches to the skull base and cranio-cervical junction.

PURPOSE CT-guided percutaneous procedures involving the skull base and atlanto-axial cervical spine pose particular challenges due to high density of vital vascular and nervous structures and because the ideal needle trajectory often has a cranio-caudal obliquity different from the axial scan plane. We describe how the variable CT gantry tilt, combined with gantry-needle-target alignment technique, is used to obtain precise and safe needle placement in conventional and non-conventional approaches to the skull base and the atlanto-axial spine. METHODS We retrospectively analyzed consecutive CT-guided needle accesses to the skull base and atlanto-axial spine performed for tissue sampling through fine-needle aspirates and core biopsies, cementoplasty of neoplastic lytic lesions of atlanto-axial spine, pain management injections, and dural puncture for cerebro-spinal fluid sampling. All the accesses were performed with the gantry-needle-target alignment technique. Procedural complications were recorded. RESULTS Thirty-nine CT-guided procedures were analyzed. Paramaxillary approach was used in 15 cases, postero-lateral in 11, subzygomatic in 3. Nine non-conventional approach were performed: submastoid in 3 cases, suprazygomatic in 2, trans-nasal in 2, trans-mastoid in 1, and trans-auricular in 1. Two peri-procedural complications occurred: one asymptomatic and one resolved within 24 h. All the procedures were successfully completed with successful needle access to the target. CONCLUSION The gantry tilt and gantry-needle-target alignment technique allows to obtain double-oblique needle accesses for CT-guided procedures involving the skull base and atlanto-axial cervical spine, minimizing uncertainty of needle trajectory and obtaining safe needle placement in conventional and non-conventional approaches

A survey of clinical features of allergic rhinitis in adults

Background: Allergic rhinitis (AR) has high prevalence and substantial socio-economic burden.Material/Methods: The study included 35 Italian Centers recruiting an overall number of 3383 adult patients with rhinitis (48% males, 52% females, mean age 29.1, range 18-45 years). For each patient, the attending physician had to fill in a standardized questionnaire, covering, in particular, some issues such as the ARIA classification of allergic rhinitis (AR), the results of skin prick test (SPT), the kind of treatment, the response to treatment, and the satisfaction with treatment.Results: Out of the 3383 patients with rhinitis, 2788 (82.4%) had AR: 311 (11.5%) had a mild intermittent, 229 (8.8%) a mild persistent, 636 (23.5%) a moderate-severe intermittent, and 1518 (56.1%) a moderate-severe persistent form. The most frequently used drugs were oral antihistamines (77.1%) and topical corticosteroids (60.8%). The response to treatment was judged as excellent in 12.2%, good in 41.3%, fair in 31.2%, poor in 14.5%, and very bad in 0.8% of subjects. The rate of treatment dissatisfaction was significantly higher in patients with moderate-to-severe AR than in patients with mild AR (p<0.0001). Indication to allergen immunotherapy (AIT) was significantly more frequent (p<0.01) in patients with severe AR than with mild AR.Conclusions: These findings confirm the appropriateness of ARIA guidelines in classifying the AR patients and the association of severe symptoms with unsuccessful drug treatment. The optimal targeting of patients to be treated with AIT needs to be reassessed