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Journal of Clinical Microbiology Jun 2024This study compared the performance of two commercial molecular assays, the STANDARD M10 assay (M10) and the Xpert assay (Xpert), for detecting toxigenic in stool...
This study compared the performance of two commercial molecular assays, the STANDARD M10 assay (M10) and the Xpert assay (Xpert), for detecting toxigenic in stool specimens. A total of 487 consecutive stool specimens submitted for routine testing between June and November 2023 were included. Following routine testing using C. DIFF QUIK CHEK COMPLETE (QCC), M10 and Xpert were tested in parallel, alongside toxigenic culture (reference standard). Additionally, two-step algorithms, using QCC on the first step and either M10 or Xpert on the second step, were assessed. Both M10 and Xpert demonstrated a sensitivity and negative predictive value (NPV) of 100%. M10 exhibited significantly higher specificity and positive predictive value (PPV; 91.9% and 64.2%, respectively) than Xpert (90.3% and 59.8%, respectively). Both two-step algorithms showed a sensitivity and NPV of 98.4% and 99.8%, respectively. The specificity and PPV of the two-step algorithm using M10 (95.2% and 75.0%, respectively) were slightly higher than those of the one using Xpert (94.8% and 73.2%, respectively), without statistical significance. Receiver operating characteristic curve analysis, assessing the predictive ability of cycle threshold (Ct) values for the detection of free toxin, exhibited an area under the curve of 0.825 for M10 and 0.843 for Xpert. This indicates the utility of Ct values as predictors for the detection of free toxin in both assays. In conclusion, M10 proves to be an effective diagnostic tool with performance comparable to Xpert, whether utilized independently or as part of a two-step algorithm.
PubMed: 38934589
DOI: 10.1128/jcm.00524-24 -
Vaccine: X Aug 2024Comirnaty, Pfizer-BioNTech's polyethylene-glycol (PEG)-containing Covid-19 vaccine, can cause hypersensitivity reactions (HSRs), or rarely, life-threatening anaphylaxis...
BACKGROUND
Comirnaty, Pfizer-BioNTech's polyethylene-glycol (PEG)-containing Covid-19 vaccine, can cause hypersensitivity reactions (HSRs), or rarely, life-threatening anaphylaxis in a small fraction of immunized people. A causal role of anti-PEG antibodies (Abs) has been proposed, but causality has not yet proven in an animal model. The aim of this study was to provide such evidence using pigs immunized against PEG, which displayed very high levels of anti-PEG antibodies (Abs). We also aimed to find evidence for a role of complement activation and thromboxane A2 release in blood to explore the mechanism of anaphylaxis.
METHODS
Pigs (n = 6) were immunized with 0.1 mg/kg PEGylated liposome (Doxebo) i.v., and the rise of anti-PEG IgG and IgM were measured in serial blood samples with ELISA. After ∼2-3 weeks the animals were injected i.v. with 1/3 human dose of the PEGylated mRNA vaccine, Comirnaty, and the hemodynamic (PAP, SAP) cardiopulmonary (HR, EtCO2,), hematological (WBC, granulocyte, lymphocyte and platelet counts) parameters and blood immune mediators (anti-PEG IgM and IgG antibodies, thromboxane B2, C3a) were measured as endpoints of HSRs (anaphylaxis).
RESULTS
The level of anti-PEG IgM and IgG rose 5-10-thousand-fold in all of 6 pigs immunized with Doxebo by day 6, after which time all animals developed anaphylactic shock to i.v. injection of 1/3 human dose of Comirnaty. The reaction, starting within 1 min involved maximal pulmonary hypertension and decreased systemic pulse pressure amplitude, tachycardia, granulo- and thrombocytopenia, and skin reactions (flushing or rash). These physiological changes or their absence were paralleled by C3a and TXB2 rises in blood.
CONCLUSIONS
Consistent with previous studies, these data show a causal role of anti-PEG Abs in the anaphylaxis to Comirnaty, which involves complement activation, and, hence, it represents C activation-related pseudo-anaphylaxis. The setup provides the first large-animal model for mRNA-vaccine-induced anaphylaxis in humans.
PubMed: 38933697
DOI: 10.1016/j.jvacx.2024.100497 -
World Journal of Nuclear Medicine Jun 2024The purpose of a parallel-hole collimator in a scintillation camera system is to transmit only those photons that have an emission angle close to the direction of...
The purpose of a parallel-hole collimator in a scintillation camera system is to transmit only those photons that have an emission angle close to the direction of the hole. This makes it possible to receive spatial information about the origin of the emission, that is, radioactivity decay. The dimension, shape, and intrahole thickness determine the spatial resolution and, by a tradeoff, sensitivity. The composition of the collimator material also plays an important role in determining a proper collimator. In this study, we compared tungsten alloys as a potential collimator material replacement for the conventional lead antimony material used in most of the current camera systems. Monte Carlo simulations of a commercial scintillation camera system with low energy high resolution (LEHR), medium-energy (ME), and high-energy (HE) collimators of lead, tungsten, and tungsten-based alloy were simulated for different I-131, Lu-177, I-123, and Tc-99m sources, and a Deluxe rod phantom using the SIMIND Monte Carlo code. Planar images were analyzed regarding spatial resolution, image contrast in a cold source case, and system sensitivity for each collimator configuration. The hole dimensions for the three collimators were those specified in the vendor's datasheet. Using Pb, W, and tungsten alloy (Wolfmet) as collimator materials, the full width at half maximum (FWHM) measures for total counts (T) for LEHR with Tc-99m source (6.9, 6.8, and 6.8 mm), for ME with Lu-177 source (11.7, 11.5, and 11.6 mm), and for HE with I-131 (6.2, 13.1, and 13.1 mm) were obtained, and the system sensitivities were calculated as 89.9, 86.1, and 89.8 cps /MBq with Tc-99m source; 42.7, 17.4, and 20.9 cps /MBq with Lu-177 source; and 40.1, 69.7, and 77.4 cps /MBq with I-131 source. The collimators of tungsten and tungsten alloy (97.0% W, 1.5% Fe, 1.5% Ni) provided better spatial resolution and improved image contrast when compared with conventional lead-based collimators. This was due to lower septal penetration. The results suggest that development of a new set of ME and HE tungsten and tungsten alloy collimators could improve imaging of I-131, Lu-177, and I-123.
PubMed: 38933066
DOI: 10.1055/s-0044-1786165 -
Journal of Diabetes and Metabolic... Jun 2024Advanced hybrid closed loop (AHCL) systems have the potential to improve glycemia and reduce burden for people with type 1 diabetes (T1D). Children and youth, who are at...
Protocol for a prospective, multicenter, parallel-group, open-label randomized controlled trial comparing standard care with Closed lOoP In chiLdren and yOuth with Type 1 diabetes and high-risk glycemic control: the CO-PILOT trial.
PURPOSE
Advanced hybrid closed loop (AHCL) systems have the potential to improve glycemia and reduce burden for people with type 1 diabetes (T1D). Children and youth, who are at particular risk for out-of-target glycemia, may have the most to gain from AHCL. However, no randomized controlled trial (RCT) specifically targeting this age group with very high HbA has previously been attempted. Therefore, the CO-PILOT trial (Closed lOoP In chiLdren and yOuth with Type 1 diabetes and high-risk glycemic control) aims to evaluate the efficacy and safety of AHCL in this group.
METHODS
A prospective, multicenter, parallel-group, open-label RCT, comparing MiniMed™ 780G AHCL to standard care (multiple daily injections or continuous subcutaneous insulin infusion). Eighty participants aged 7-25 years with T1D, a current HbA ≥ 8.5% (69 mmol/mol), and naïve to automated insulin delivery will be randomly allocated to AHCL or control (standard care) for 13 weeks. The primary outcome is change in HbA between baseline and 13 weeks. Secondary outcomes include standard continuous glucose monitor glycemic metrics, psychosocial factors, sleep, platform performance, safety, and user experience. This RCT will be followed by a continuation phase where the control arm crosses over to AHCL and all participants use AHCL for a further 39 weeks to assess longer term outcomes.
CONCLUSION
This study will evaluate the efficacy and safety of AHCL in this population and has the potential to demonstrate that AHCL is the gold standard for children and youth with T1D experiencing out-of-target glucose control and considerable diabetes burden.
TRIAL REGISTRATION
This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry on 14 November 2022 (ACTRN12622001454763) and the World Health Organization International Clinical Trials Registry Platform (Universal Trial Number U1111-1284-8452).
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s40200-024-01397-4.
PubMed: 38932805
DOI: 10.1007/s40200-024-01397-4 -
Pain Reports Apr 2024Neuropathic pain is a challenging chronic pain condition. Limited knowledge exists regarding the relative effectiveness of pharmacological treatments, and differences in... (Review)
Review
Neuropathic pain is a challenging chronic pain condition. Limited knowledge exists regarding the relative effectiveness of pharmacological treatments, and differences in trial design and impact of the placebo response preclude indirect comparisons of efficacy between drug classes. The purpose of this systematic review and meta-analysis of head-to-head trials was to compare the efficacy and tolerability of drugs recommended for neuropathic pain. We conducted a systematic review and meta-analysis of direct-comparison double-blind randomized trials. Primary outcomes were mean change in pain intensity and number of responders with a 50% reduction in pain intensity. Secondary outcomes encompassed quality of life, sleep, emotional functioning, and number of dropouts because of adverse events. We included 30 trials (4087 patients), comprising 16 crossover and 14 parallel-group design studies. All studies were conducted in adults, and the majority were investigator-initiated trials. We found moderate-quality evidence for equivalence (no clinically relevant difference) between tricyclic antidepressants (TCA) and gabapentin/pregabalin with a combined mean difference in pain score of 0.10 (95% CI -0.13 to 0.32). We could not document differences between TCA and serotonin-noradrenaline reuptake inhibitors (SNRI), between SNRI and gabapentin/pregabalin, or between opioids and TCA (low quality of evidence). We found more dropouts because of adverse events with SNRI and opioids compared with TCA (low quality of evidence). We did not identify any studies that included topical treatments. This systematic review of direct-comparison studies found evidence for equivalence between TCA and gabapentin/pregabalin and fewer dropouts with TCA than SNRI and opioids.
PubMed: 38932764
DOI: 10.1097/PR9.0000000000001138 -
Viruses Jun 2024The HIV envelope glycoprotein (Env) is a trimeric protein that facilitates viral binding and fusion with target cells. As the sole viral protein on the HIV surface, Env...
The HIV envelope glycoprotein (Env) is a trimeric protein that facilitates viral binding and fusion with target cells. As the sole viral protein on the HIV surface, Env is important both for immune responses to HIV and in vaccine designs. Targeting Env in clinical applications is challenging due to its heavy glycosylation, high genetic variability, conformational camouflage, and its low abundance on virions. Thus, there is a critical need to better understand this protein. Flow virometry (FV) is a useful methodology for phenotyping the virion surface in a high-throughput, single virion manner. To demonstrate the utility of FV to characterize Env, we stained HIV virions with a panel of 85 monoclonal antibodies targeting different regions of Env. A broad range of antibodies yielded robust staining of Env, with V3 antibodies showing the highest quantitative staining. A subset of antibodies tested in parallel on viruses produced in CD4 T cell lines, HEK293T cells, and primary cells showed that the cellular model of virus production can impact Env detection. Finally, in addition to being able to highlight Env heterogeneity on virions, we show FV can sensitively detect differences in Env conformation when soluble CD4 is added to virions before staining.
Topics: Humans; env Gene Products, Human Immunodeficiency Virus; HIV-1; Virion; HEK293 Cells; HIV Antibodies; Antibodies, Monoclonal; CD4-Positive T-Lymphocytes; HIV Infections
PubMed: 38932227
DOI: 10.3390/v16060935 -
Viruses May 2024The COVID-19 pandemic, which emerged in early 2020, has had a profound and lasting impact on global health, resulting in over 7.0 million deaths and persistent...
The COVID-19 pandemic, which emerged in early 2020, has had a profound and lasting impact on global health, resulting in over 7.0 million deaths and persistent challenges. In addition to acute concerns, there is growing attention being given to the long COVID health consequences for survivors of COVID-19 with documented cases of cardiovascular abnormalities, liver disturbances, lung complications, kidney issues, and noticeable cognitive deficits. Recent studies have investigated the physiological changes in various organs following prolonged exposure to murine hepatitis virus-1 (MHV-1), a coronavirus, in mouse models. One significant finding relates to the effects on the gastrointestinal tract, an area previously understudied regarding the long-lasting effects of COVID-19. This research sheds light on important observations in the intestines during both the acute and the prolonged phases following MHV-1 infection, which parallel specific changes seen in humans after exposure to SARS-CoV-2. Our study investigates the histopathological alterations in the small intestine following MHV-1 infection in murine models, revealing significant changes reminiscent of inflammatory bowel disease (IBD), celiac disease. Notable findings include mucosal inflammation, lymphoid hyperplasia, goblet cell hyperplasia, and immune cell infiltration, mirroring pathological features observed in IBD. Additionally, MHV-1 infection induces villous atrophy, altered epithelial integrity, and inflammatory responses akin to celiac disease and IBD. SPIKENET (SPK) treatment effectively mitigates intestinal damage caused by MHV-1 infection, restoring tissue architecture and ameliorating inflammatory responses. Furthermore, investigation into long COVID reveals intricate inflammatory profiles, highlighting the potential of SPK to modulate intestinal responses and restore tissue homeostasis. Understanding these histopathological alterations provides valuable insights into the pathogenesis of COVID-induced gastrointestinal complications and informs the development of targeted therapeutic strategies.
Topics: Animals; Mice; COVID-19; Disease Models, Animal; Murine hepatitis virus; SARS-CoV-2; Intestinal Mucosa; Intestines; Intestine, Small; Female
PubMed: 38932125
DOI: 10.3390/v16060832 -
Pharmaceutics Jun 2024Progesterone (PROG) is a natural steroid hormone with low solubility and high permeability that belongs to biopharmaceutics classification system class II. In this...
Progesterone (PROG) is a natural steroid hormone with low solubility and high permeability that belongs to biopharmaceutics classification system class II. In this study, novel pharmaceutical cocrystals of PROG were successfully prepared by solvent evaporation or a liquid-assisted grinding process aimed at enhancing its solubility and bioavailability. The cocrystal formers selected based on crystal engineering principles were carboxylic acids, namely, 4-formylbenzeneboronic acid (BBA), isophthalic acid (IPA), and 3-nitrophthalic acid (NPA). The cocrystal structures were characterized using multiple techniques. Single-crystal X-ray diffraction results showed that the carbonyl group, acting as a hydrogen bond acceptor, was pivotal in the cocrystal network formation, with C-H···O interactions further stabilizing the crystals. The cocrystals exhibited improved solubility and dissolution profiles in vitro, with no significant changes in hygroscopicity. The parallel artificial membrane permeability assay (PAMPA) models indicated that the cocrystals retained PROG's high permeability. Pharmacokinetic studies in Sprague-Dawley rats revealed that all cocrystals increased PROG exposure, with AUC values for PROG-BBA, PROG-IPA, and PROG-NPA being 742.59, 1201.72 and 442.67 h·ng·mL, respectively. These values are substantially higher compared to free PROG, which had an AUC of 301.48 h·ng·mL. Notably, PROG-IPA provided the highest AUC improvement, indicating a significant enhancement in bioavailability. Collectively, the study concludes that the cocrystal approach is a valuable strategy for optimizing the physicochemical properties and oral bioavailability of PROG, with potential implications for the development of other poor water-soluble drugs.
PubMed: 38931937
DOI: 10.3390/pharmaceutics16060816 -
Sensors (Basel, Switzerland) Jun 2024Sensory information obtained from the visual, somatosensory, and vestibular systems is responsible for regulating postural control, and if damage occurs in one or more...
BACKGROUND
Sensory information obtained from the visual, somatosensory, and vestibular systems is responsible for regulating postural control, and if damage occurs in one or more of these sensory systems, postural control may be altered.
OBJECTIVE
To evaluate and compare the postural sway velocity between children with normal hearing and with sensorineural hearing loss (SNHL), matched by sex and age group, and to compare the postural sway velocity between children with normal hearing and with SNHL, with and without vestibular dysfunction.
METHODS
Cross-sectional study that evaluated 130 children (65 with normal hearing and 65 with SNHL), of both sexes and aged between 7 and 11 years, from public schools of the city of Caruaru, Pernambuco state, Brazil. The postural sway velocity of the center of pressure (COP) was assessed by a force platform, in two directions, anteroposterior (AP) and mediolateral (ML)), in three positions, namely bipedal support with feet together and parallel (parallel feet (PF)), bipedal support with one foot in front of the other (tandem foot (TF)), and single-leg support (one foot (OF)), evaluated with the eyes open and closed.
RESULTS
Children with SNHL demonstrated greater postural sway velocity compared to children with normal hearing in all the positions evaluated, with significant differences in the AP direction, with the eyes open (PF: = 0.001; TF: = 0.000; OF: = 0.003) and closed (PF: = 0.050; TF: = 0.005). The same occurred in the ML direction, with the eyes open (PF: = 0.001; TF: = 0.000; OF: = 0.001) and closed (PF: = 0.002; TF: = 0.000). The same occurred in relation to vestibular function, where the children with SNHL with an associated vestibular dysfunction demonstrated greater postural sway velocity compared to children with normal hearing in all the positions evaluated, demonstrating significant differences in the AP direction, with the eyes open (TF: = 0.001; OF: = 0.029) and eyes closed (PF: = 0.036; TF: = 0.033). The same occurred in the ML direction, with the eyes open (TF: = 0.000) and with the eyes closed (PF: = 0.008; TF: = 0.009).
CONCLUSIONS
Children with SNHL demonstrated greater instability of postural control than children with normal hearing in all the directions assessed. Children with SNHL and an associated vestibular dysfunction demonstrated the greatest instability of postural control in this study.
Topics: Humans; Child; Postural Balance; Male; Female; Cross-Sectional Studies; Vestibular Diseases; Hearing Loss, Sensorineural; Deafness
PubMed: 38931672
DOI: 10.3390/s24123888 -
Sensors (Basel, Switzerland) Jun 2024Low-frequency distributed acoustic sensing (LF-DAS) is a diagnostic tool for hydraulic fracture propagation with far-field monitoring using fiber optic sensors. LF-DAS...
Low-frequency distributed acoustic sensing (LF-DAS) is a diagnostic tool for hydraulic fracture propagation with far-field monitoring using fiber optic sensors. LF-DAS senses strain rate variation caused by stress field change due to fracture propagation. Fiber optic sensors are installed in the monitoring wells in the vicinity of a fractured well. From the strain responses, fracture propagation can be evaluated. To understand subsurface conditions with multiple propagating fractures, a laboratory-scale hydraulic fracture experiment was performed simulating the LF-DAS response to fracture propagation with embedded distributed optical fiber strain sensors under these conditions. The experiment was performed using a transparent cube of epoxy with two parallel radial initial flaws centered in the cube. Fluid was injected into the sample to generate fractures along the initial flaws. The experiment used distributed high-definition fiber optic strain sensors with tight spatial resolutions. The sensors were embedded at two different locations on opposite sides of the initial flaws, serving as observation/monitoring locations. We also employed finite element modeling to numerically solve the linear elastic equations of equilibrium continuity and stress-strain relationships. The measured strains from the experiment were compared to simulation results from the finite element model. The experimentally derived strain and strain-rate waterfall plots from this study show the responses to both fractures propagating, while the fracture at the lower position took most of the fluid during the experiment. Interestingly, a fracture first began propagating from the upper flaw of the two flaws, but once the lower fracture was initiated, it grew much faster than the upper fracture. Both fibers were intercepted by the lower fracture, further verifying the strain signature as a fracture is approaching and intersecting an offset fiber.
PubMed: 38931664
DOI: 10.3390/s24123880