Microbiome profile associated with malignant pleural effusion.

INTRODUCTION:There is ongoing research into the development of novel molecular markers that may complement fluid cytology malignant pleural effusion (MPE) diagnosis. In this exploratory pilot study, we hypothesized that there are distinct differences in the pleural fluid microbiome profile of malignant and non-malignant pleural diseases. METHOD:From a prospectively enrolled pleural fluid biorepository, samples of MPE were included. Non-MPE effusion were included as comparators. 16S rRNA gene V4 region amplicon sequencing was performed. Exact Sequence Variants (ESVs) were used for diversity analyses. The Shannon and Richness indices of alpha diversity and UniFrac beta diversity measures were tested for significance using permutational multivariate analysis of variance. Analyses of Composition of Microbiome was used to identify differentially abundant bacterial ESVs between the groups controlled for multiple hypothesis testing. RESULTS:38 patients with MPE and 9 with non-MPE were included. A subgroup of patients with metastatic adenocarcinoma histology were identified among MPE group (adenocarcinoma of lung origin (LA-MPE) = 11, breast origin (BA-MPE) = 11). MPE presented with significantly greater alpha diversity compared to non-MPE group. Within the MPE group, BA-MPE was more diverse compared to LA-MPE group. In multivariable analysis, ESVs belonging to family S24-7 and genera Allobaculum, Stenotrophomonas, and Epulopiscium were significantly enriched in the malignant group compared to the non-malignant group. CONCLUSION:Our results are the first to demonstrate a microbiome signature according to MPE and non-MPE. The role of microbiome in pleural effusion pathogenesis needs further exploration

Microfluidic platforms to study host-microbiome interactions

About three-quarters of human body surface is exposed to dense microbial population along the gastro-intestinal tract (GIT) that accommodates around 80% of immune cells. The GIT is one of the most critical sites for metabolic and immunologic homeostasis in the body. While large-scale genomic analysis and germ-free mice have been widely used, they are limited to capture the dynamic functional interaction between host-microbiome in a humanized setting. in-vitro recapitulation of GIT physiology can be a powerful alternative for hypothesis testing in diseases like IBD and cancer. As a first step, we developed a simple transwell assembly to closely emulate GIT anatomy and the barrier function in a quantitative and analytical manner. The system enables us to sequentially house bacterial cells, a mucus layer, human intestinal epithelial cells and human peripheral blood mononuclear cells (hPBMCs) in a single co-culture platform. Porcine intestine-derived mucin formed a biophysically relevant barrier and also provided in-vivo like biochemical milieu to bacterial cells. Addition of human epithelial cell monolayer on a collagen coated semi-permeable membrane added another level of cellular and biophysical complexity. Finally, by introducing human peripheral blood mononuclear cells (hPBMCs), we simulated host-microbiome interactions and successfully captured responses relevant to gut inflammation. Initial data indicate that bacterial products successfully stimulate hPBMCs. Whereas, mucus and epithelial barriers demonstrated strong immunomodulatory functions. Further investigations are being carried out in order to create models that will incorporate differentiated epithelial cells (villi), physiologically relevant flow and stress conditions along with co-culture of aerobic (mucosal) and anaerobic (luminal) components of the human GIT. Hopefully, these models will enable us to study mechanistic interactions of the microbiome with the host and reveal novel therapeutic targets for diseases associated with the dysregulation of host-microbiome homeostasis in human GIT

Parental Limit Setting, Acculturation, and Screen Time in Latino Children

Childhood obesity is a becoming growing epidemic in the United States, and screen time has been noted as a correlate. Obesity disproportionally affects Latino children, and Latino children may be more susceptible to engaging in greater screen time. Screen time behaviors established in youth are likely to carry over and have been shown to track into adulthood,1 predisposing them to life-long unhealthy lifestyle habits. Furthermore, sedentary behavior, which is primarily comprised of screen-based activities,2 has been linked to overweight and obesity, type 2 diabetes, cardiovascular disease, cancer, and all-cause mortality.3-5 With the growing Latino population in the United States, the overall purpose of this study is to identify the effect of acculturation proxies (generational status and language use) on screen time in 6-11 year old Latino children mediated by parental limit setting of screen time. Data was extracted from the 2011-2012 National Survey of Children’s Health (NSCH), providing a final sample of 3127 children. The relationships between generational status and language use with screen time mediated by parental limit setting were investigated using a mediation analysis as proposed by Baron and Kenny’s steps for mediation. We did not find support that parental limit setting mediated the relationship between generational status and screen time. However, parental limit setting was responsible for an average of 1.6 minutes/day less screen time accounting for 11% of the relationship between language use and screen time. Although the mediation effect of parental limit setting contributed minimally to this association, parental limit setting had a significant effect on reducing child screen time by approximately an hour. Future research should further explore the protective role of parent limit setting in reducing excessive screen time in Latino children, and how this relationship may vary by generational status or language use

Conservative management of oesophageal soft food bolus impaction

Background: Impaction of a soft food bolus in the oesophagus causes dysphagia and regurgitation. If the bolus does not pass spontaneously, then the patient is at risk of aspiration, dehydration, perforation, and death. Definitive management is with endoscopic intervention, recommended within 24 hours. Prior to endoscopy, many patients undergo a period of observation, awaiting spontaneous disimpaction, or may undergo enteral or parenteral treatments to attempt to dislodge the bolus. There is little consensus as to which of these conservative strategies is safe and effective to be used in this initial period, before resorting to definitive endoscopic management for persistent impaction. Objectives: To evaluate the efficacy of non-endoscopic conservative treatments in the management of soft food boluses impacted within the oesophagus. Search methods: We searched the following databases, using relevant search terms: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and CINAHL. The date of the search was 18 August 2019. We screened the reference lists of relevant studies and reviews on the topic to identify any additional studies. Selection criteria: We included randomised controlled trials of the management of acute oesophageal soft food bolus impaction, in adults and children, reporting the incidence of disimpaction (confirmed radiologically or clinically by return to oral diet) without the need for endoscopic intervention. We did not include studies focusing on sharp or solid object impaction. Data collection and analysis: We used standard methodological procedures recommended by Cochrane. Main results: We identified 890 unique records through the electronic searches. We excluded 809 clearly irrelevant records and retrieved 81 records for further assessment. We subsequently included one randomised controlled trial that met the eligibility criteria, which was conducted in four Swedish centres and randomised 43 participants to receive either intravenous diazepam followed by glucagon, or intravenous placebos. The effect of the active substances compared with placebo on rates of disimpaction without intervention is uncertain, as the numbers from this single study were small, and the rates were similar (38% versus 32%; risk ratio 1.19, 95% confidence interval 0.51 to 2.75, P = 0.69). The certainty of the evidence using GRADE for this outcome is low. Data on adverse events were lacking. Authors' conclusions: There is currently inadequate data to recommend the use of any enteral or parenteral treatments in the management of acute oesophageal soft food bolus impaction. There is also inadequate data regarding potential adverse events from the use of these treatments, or from potential delays in definitive endoscopic management. Caution should be exercised when using any conservative management strategies in these patients.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.published versio

A Cross-Sectional Study to Assess Awareness and Practices Related to Prevention of COVID-19 Amongst Local Vendors around Medical and Dental Establishments

INTRODUCTION: Even as the world is returning to normalcy after COVID-19, there is still a need to be cautious and adopt proper hygiene practices and social distance norms. AIM: To assess the awareness and practices related to prevention of Covid-19 amongst local vendors around medical and dental establishments in Northern India. MATERIALS AND METHOD: This cross-sectional study was conducted over a period of  one month using a pre-tested and pre-validated questionnaire. Vendors near ten medical and dental establishments in north India were contacted by standardized volunteers to prevent bias. They were located within the range of 250 meters on both sides of these facilities through convenience sampling.  Data was coded, entered in MS excel, descriptive statistics were applied. Statistical tests included the student’s independent t-test and multiple logistic regression. P value was kept significant at <0.5 and software used was SPSS version 23.0. RESULTS: Most vendors were males (76.7%), were operating shops on rent (47.7%) and had passed middle school (40.2%). A Majority of them were aware of common symptoms (99.4%), while 90.1% were aware about the mode of transmission. All vendors knew about the availability of the vaccine (100%). and 78.2% of the vendors were fully vaccinated, while 04 (1.3%) were not vaccinated yet. However, only 60% (p=0.03) of the vendors practised hand washing, distancing from sick, no handshake, use a cloth while coughing/sneezing as preventive measures. CONCLUSION: There is still a need for continuous education of the food vendors regarding proper and hygienic practices as well as mask wearing to fight off this dreaded pandemic and return to normalcy as soon as possible

Lack of predictive tools for conventional and targeted cancer therapy:barriers to biomarker development and clinical translation

Predictive tools, utilising biomarkers, aim to objectively assess the potential response to a particular clinical intervention in order to direct treatment. Conventional cancer therapy remains poorly served by predictive biomarkers, despite being the mainstay of treatment for most patients. In contrast, targeted therapy benefits from a clearly defined protein target for potential biomarker assessment. We discuss potential data sources of predictive biomarkers for conventional and targeted therapy, including patient clinical data and multi-omic biomarkers (genomic, transcriptomic and protein expression). Key examples, either clinically adopted or demonstrating promise for clinical translation, are highlighted. Following this, we provide an outline of potential barriers to predictive biomarker development; broadly discussing themes of approaches to translational research and study/trial design, and the impact of cellular and molecular tumor heterogeneity. Future avenues of research are also highlighted