Mass Oral Azithromycin for Childhood Mortality: Timing of Death After Distribution in the MORDOR Trial.

In a large community-randomized trial, biannual azithromycin distributions significantly reduced postneonatal childhood mortality in sub-Saharan African sites. Here, we present a prespecified secondary analysis showing that much of the protective effect was in the first 3 months postdistribution. Distributing more frequently than biannually could be considered if logistically feasible. Clinical Trials Registration. NCT02047981

The sagittal geometry of the trochlear groove could be described as a circle: an intraoperative assessment with navigation

Purpose: The aim of this study was to describe the sagittal geometry of the trochlear groove in patients who underwent primary TKA, based on intraoperative data acquired with a navigation system. Methods: Intraoperative navigation data were collected from 110 patients. All operations were guided by a non-image-based navigation system (BLU-IGS, Orthokey Italia Srl). The trochlear groove has been described on the three anatomical planes; in particular, on the sagittal plane the hypothesis has been verified that the acquired points are referable to a circle. Using the data collected during intraoperative navigation, possible correlation between the radius of the trochlear groove and other femur dimension (length, AP dimension) was analyzed; the orientation of the trochlear sulcus with respect to the mechanical axis and the posterior condyle axis was analyzed too, searching for possible correlation between groove alignment (frontal and axial) or groove radius and the hip–knee–ankle (HKA). Results: The average radius of curvature of the femoral trochlea was 25.5 ± 5.6 mm; the difference was not statistically significant between the men and women (n.s. p value). No correlation was found between the trochlear groove radius and the femur length (r = − 0.02) or the HKA-phenotypes (r = 0.03) and between the groove alignment and HKA-phenotypes. On axial plane, the trochlear groove was 3.2° ± 4.3° externally rotated, with respect to the posterior condylar axis; on frontal plane, the trochlear groove was 3.9° ± 5.3° externally rotated, with respect to the mechanical axis. In both cases, no statistically significant differences were found between male and female and between left and right limb (p > 0.05). Conclusion: The present study shows that the sagittal plane geometry of the femoral trochlea in patients affected by osteoarthritis could be described accurately as a circle. The acquisition of the trochlear morphology intraoperatively can lead to more anatomically shape definition, to investigate deeper its radius of curvature and geometry. Trochlear shape could be used as landmarks for femoral component positioning, thus customizing the implant design, optimize the outcomes and improving anterior knee pain after TKA. Level of evidence: IV

Isolation of follicular dendritic cells from human tonsils and adenoids. VI. Analysis of prostaglandin secretion.

Follicular dendritic cells (FDC) are able to fix high amounts of immune complexes by C3b or Fc receptors without endocytosis and for long periods of time. In order to determine the function of this retention, we analysed the secretion of prostaglandin E2 (PGE2) by FDC in vitro; indeed, it is well-known that immune complex fixation on cells may induce PGE2 production. FDC were isolated by enzymic digestion of lymph follicles dissected under the biomicroscope from human tonsils or adenoids. Isolated FDC appeared as spherical clusters where they enveloped lymphoid cells with their cytoplasmic extensions. Tests were performed in synthetic culture media or in media supplemented with foetal calf serum. PGE2 production in FDC suspensions was compared to that of lymphocyte or macrophage-enriched populations prepared from the same human tonsils. In all experimental conditions, FDC and macrophage-enriched cell populations produced high levels of PGE2, inversely to lymphoid cell populations. This secretion was inhibited by indomethacin. At the ultrastructural level, we also showed that 3H-arachidonic acid was metabolized in cell membranes of all three cell types. The PGE2 produced in the culture media, according to our experimental conditions, do not influence cell proliferation, as assessed by 3H-thymidine incorporation tests on phytohaemagglutinin-stimulated lymphocytes.In VitroJournal ArticleResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

Gut Microbial Diversity in Antibiotic-Naive Children After Systemic Antibiotic Exposure: A Randomized Controlled Trial.

BackgroundAntibiotic exposure can alter the gut microbiome. We evaluate the effects of azithromycin on the gut microbiome diversity of children from an antibiotic-naive community in Niger.MethodsA population-based sample of 80 children aged 1-60 months in the Dosso region of Niger was randomized to receive a single dose of either oral azithromycin or placebo. Fecal samples were collected immediately before treatment and 5 days after treatment for 16S rRNA gene sequencing. The prespecified outcome was α-diversity (inverse Simpson's α-diversity index), with secondary outcomes of β and γ Simpson's and Shannon's diversities.ResultsAt 5 days after treatment, 40 children aged 1-60 months were analyzed in the azithromycin-treated group and 40 children in the placebo-treated group. Diversity of the gut microbiome was significantly lower in the treated group (inverse Simpson's α-diversity, 5.03; 95% confidence interval [CI], 4.08-6.14) than in the placebo group (6.91; 95% CI, 5.82-8.21; P = .03). Similarly, the Shannon's α-diversity was lower in the treated group (10.60; 95% CI, 8.82-12.36) than the placebo group (15.42; 95% CI, 13.24-17.80; P = .004). Simpson's community-level (γ) diversity decreased with azithromycin exposure from 17.72 (95% CI, 13.80-20.21) to 10.10 (95% CI, 7.80-11.40; P = .00008), although β-diversity was not significantly reduced (2.56, 95% CI, 1.88-3.12; to 2.01, 95% CI, 1.46-2.51; P = .26).ConclusionsOral administration of azithromycin definitively decreases the diversity of the gut microbiome of children in an antibiotic-naive community.Clinical trials registrationNCT02048007