Surgical tracheostomy (ST) and Percutaneous dilatational tracheostomy (PDT) are classified as high-risk aerosol-generating procedures and might lead to healthcare workers (HCW) infection. Albeit the ...COVID-19 strain slightly released since the vaccination era, preventing HCW from infection remains a major economical and medical concern. To date, there is no study monitoring particle emissions during ST and PDT in a clinical setting. The aim of this study was to monitor particle emissions during ST and PDT in a swine model.
A randomized animal study on swine model with induced acute respiratory distress syndrome (ARDS) was conducted. A dedicated room with controlled airflow was used to standardize the measurements obtained using an airborne optical particle counter. 6 ST and 6 PDT were performed in 12 pigs. Airborne particles (diameter of 0.5 to 3 μm) were continuously measured; video and audio data were recorded. The emission of particles was considered as significant if the number of particles increased beyond the normal variations of baseline particle contamination determinations in the room. These significant emissions were interpreted in the light of video and audio recordings. Duration of procedures, number of expiratory pauses, technical errors and adverse events were also analyzed.
10 procedures (5 ST and 5 PDT) were fully analyzable. There was no systematic aerosolization during procedures. However, in 1/5 ST and 4/5 PDT, minor leaks and some adverse events (cuff perforation in 1 ST and 1 PDT) occurred. Human factors were responsible for 1 aerosolization during 1 PDT procedure. ST duration was significantly shorter than PDT (8.6 ± 1.3 vs 15.6 ± 1.9 minutes) and required less expiratory pauses (1 vs 6.8 ± 1.2).
COVID-19 adaptations allow preventing for major aerosol leaks for both ST and PDT, contributing to preserving healthcare workers during COVID-19 outbreak, but failed to achieve a perfectly airtight procedure. However, with COVID-19 adaptations, PDT required more expiratory pauses and more time than ST. Human factors and adverse events may lead to aerosolization and might be more frequent in PDT.
The microbiological contamination of the environment in independent healthcare facilities such as dental and general practitioner offices was poorly studied. The aims of this study were to describe ...qualitatively and quantitatively the bacterial and fungal contamination in these healthcare facilities and to analyze the antibiotic resistance of bacterial pathogens identified. Microbiological samples were taken from the surfaces of waiting, consulting, and sterilization rooms and from the air of waiting room of ten dental and general practitioner offices. Six surface samples were collected in each sampled room using agar contact plates and swabs. Indoor air samples were collected in waiting rooms using a single-stage impactor. Bacteria and fungi were cultured, then counted and identified. Antibiograms were performed to test the antibiotic susceptibility of bacterial pathogens. On the surfaces, median concentrations of bacteria and fungi were 126 (range: 0–1280) and 26 (range: 0–188) CFU/100 cm2, respectively. In indoor air, those concentrations were 403 (range: 118–732) and 327 (range: 32–806) CFU/m3, respectively. The main micro-organisms identified were Gram-positive cocci and filamentous fungi, including six ubiquitous genera: Micrococcus, Staphylococcus, Cladosporium, Penicillium, Aspergillus, and Alternaria. Some antibiotic-resistant bacteria were identified in general practitioner offices (penicillin- and erythromycin-resistant Staphylococcus aureus), but none in dental offices. The dental and general practitioner offices present a poor microbiological contamination with rare pathogenic micro-organisms.
Introduction Surgical tracheostomy (ST) and Percutaneous dilatational tracheostomy (PDT) are classified as high-risk aerosol-generating procedures and might lead to healthcare workers (HCW) ...infection. Albeit the COVID-19 strain slightly released since the vaccination era, preventing HCW from infection remains a major economical and medical concern. To date, there is no study monitoring particle emissions during ST and PDT in a clinical setting. The aim of this study was to monitor particle emissions during ST and PDT in a swine model. Methods A randomized animal study on swine model with induced acute respiratory distress syndrome (ARDS) was conducted. A dedicated room with controlled airflow was used to standardize the measurements obtained using an airborne optical particle counter. 6 ST and 6 PDT were performed in 12 pigs. Airborne particles (diameter of 0.5 to 3 μm) were continuously measured; video and audio data were recorded. The emission of particles was considered as significant if the number of particles increased beyond the normal variations of baseline particle contamination determinations in the room. These significant emissions were interpreted in the light of video and audio recordings. Duration of procedures, number of expiratory pauses, technical errors and adverse events were also analyzed. Results 10 procedures (5 ST and 5 PDT) were fully analyzable. There was no systematic aerosolization during procedures. However, in 1/5 ST and 4/5 PDT, minor leaks and some adverse events (cuff perforation in 1 ST and 1 PDT) occurred. Human factors were responsible for 1 aerosolization during 1 PDT procedure. ST duration was significantly shorter than PDT (8.6 ± 1.3 vs 15.6 ± 1.9 minutes) and required less expiratory pauses (1 vs 6.8 ± 1.2). Conclusions COVID-19 adaptations allow preventing for major aerosol leaks for both ST and PDT, contributing to preserving healthcare workers during COVID-19 outbreak, but failed to achieve a perfectly airtight procedure. However, with COVID-19 adaptations, PDT required more expiratory pauses and more time than ST. Human factors and adverse events may lead to aerosolization and might be more frequent in PDT.
β-amyloid (Aβ) and tau aggregation as well as neuronal injury and atrophy (ATN) are the major hallmarks of Alzheimer's disease (AD), and biomarkers for these hallmarks have been linked to ...neuroinflammation. However, the detailed regional associations of these biomarkers with microglial activation in individual patients remain to be elucidated. We investigated a cohort of 55 patients with AD and primary tauopathies and 10 healthy controls that underwent TSPO-, Aβ-, tau-, and perfusion-surrogate-PET, as well as structural MRI. Z-score deviations for 246 brain regions were calculated and biomarker contributions of Aβ (A), tau (T), perfusion (N1), and gray matter atrophy (N2) to microglial activation (TSPO, I) were calculated for each individual subject. Individual ATN-related microglial activation was correlated with clinical performance and CSF soluble TREM2 (sTREM2) concentrations. In typical and atypical AD, regional tau was stronger and more frequently associated with microglial activation when compared to regional Aβ (AD: β
= 0.412 ± 0.196 vs. β
= 0.142 ± 0.123, p < 0.001; AD-CBS: β
= 0.385 ± 0.176 vs. β
= 0.131 ± 0.186, p = 0.031). The strong association between regional tau and microglia reproduced well in primary tauopathies (β
= 0.418 ± 0.154). Stronger individual associations between tau and microglial activation were associated with poorer clinical performance. In patients with 4RT, sTREM2 levels showed a positive association with tau-related microglial activation. Tau pathology has strong regional associations with microglial activation in primary and secondary tauopathies. Tau and Aβ related microglial response indices may serve as a two-dimensional in vivo assessment of neuroinflammation in neurodegenerative diseases.
Background
18‐kDa translocator protein position‐emission‐tomography (TSPO‐PET) imaging emerged for in vivo assessment of neuroinflammation in preclinical and clinical research of Alzheimer’s disease ...(AD). Higher TSPO‐PET binding as a surrogate of microglial activation in females has been reported for cognitively normal humans (HC), but sex effects have not yet been systematically evaluated in patients with AD. Thus, we aimed to investigate the impact of sex and the body mass index (BMI) on the relationship between β‐amyloid‐accumulation and microglial activation in AD.
Method
Fifty‐six patients with AD (34 female; BMI 24.9±4.0; age 71.1±7.7 years; 100% Aβ‐positive; MMSE 20.9±5.5) and 13 Aβ‐negative HC (7 female; BMI 24.2±3.3; age 70.6±7.5 years; MMSE 29.0±1.0) underwent TSPO‐PET (18F‐GE‐180) and β‐amyloid‐PET imaging (Aβ‐PET; 18F‐flutemetamol). The brain was parcellated into 218 cortical regions and standardized‐uptake‐value‐ratios (SUVr, cerebellar reference) were calculated for TSPO‐ and Aβ‐PET. Per AD patient, the averaged regional increase of TSPO‐ and Aβ‐PET SUVr (z‐score) was calculated versus HC. We used the function between regional Aβ‐PET and TSPO‐PET SUVr to determine the Aβ‐plaque dependent microglial response (slope) and the Aβ‐plaque independent microglial response (intercept) at the single patient level (Figure 1). All PET read‐outs were compared between sexes and we tested for a moderation effect of sex on the association between BMI and microglial activation, controlled for age.
Result
In AD the mean cortical TSPO‐PET z‐score of females (+0.69±0.72) was higher when compared to males (+0.30±0.73; p=0.048; Figure 2), whereas Aβ‐PET z‐scores were similar (female: +4.56±1.76; male: +4.44±2.08). The Aβ‐plaque independent microglial response was stronger in females with AD (intercept: +0.35±0.63) when compared to males (‐0.23±0.71; p=0.0024) whereas the Aβ‐plaque dependent microglial response was indifferent between sexes (Figure 2). BMI and the Aβ‐plaque independent microglial response were significantly associated in females (β=0.35, p=0.043) but not in males (β=‐0.02, p=0.940; BMI*sex interaction: F(3,52)=4.77, p=0.0052; Figure 3).
Conclusion
Females with AD comprise a higher Aβ‐plaque independent microglia response, whereas the microglial response to fibrillar Aβ is indifferent between sexes. BMI is positively associated with the Aβ‐plaque independent microglia response in females with AD but not in males, indicating that sex and BMI need to be considered when studying neuroinflammation in AD.
Recent advances in HRD in Australia Holland, Peter; Sheehan, Cathy; Cieri, Helen De ...
Human resource development international,
09/2007, Volume:
10, Issue:
3
Journal Article
PDF
