Safety of Platelet-Rich Plasma Subepithelial Infusion for Vocal Fold Scar, Sulcus, and Atrophy

OBJECTIVE

To demonstrate the safety profile of platelet-rich plasma (PRP) as an injectable therapeutic for the treatment of vocal fold scarring and atrophy.

METHODS

Preliminary report on a prospective clinical trial of patients with vocal fold scar or atrophy undergoing unilateral vocal fold subepithelial infusion with autologous PRP. Enrolled patients underwent four subepithelial injections spaced 1 month apart. Adverse events were assessed peri and post-injection at each session. Patient-reported outcomes were collected at every visit using the Voice Handicap Index-10 (VHI-10) and Vocal Fatigue Index (VFI) questionnaires.

RESULTS

Twelve patients underwent unilateral vocal fold injection with autologous PRP prepared according to Eclipse PRP® system protocol. Forty-three injections were performed using a peroral or percutaneous approach. An average of 1.57 ± 0.4 cc (range 0.6-2.0 cc) injectate was used. All patients tolerated the procedure without difficulty or peri-procedural complications. The average duration of follow-up was 3.6 ± 1.8 months. No significant inflammatory reactions or adverse events were seen to date. There was statistically significant improvement in patient-reported outcomes at the 3 month follow up (n = 9) follow-up (mean ΔVHI-10 = 10.8, p < 0.001, mean ΔVFI = 18.9, p = 0.01, t test, paired two sample for means, two-tail). All nine patients who completed the series of four injections subjectively (yes/no) reported they were satisfied with the results.

CONCLUSION

This prospective study cohort demonstrated a favorable safety profile, with no adverse events or peri-procedural complications. Subjective improvements in vocal quality and reduction in vocal fatigue need to be clinically correlated with further study.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:647-653, 2023.

2449. Early Detection of Candida auris is Essential to Control Spread: Four Effective Active Surveillance Strategies

Background

C. auris has been identified from > 1600 US patients. Risk factors include high-acuity post-acute care admissions (e.g., long-term acute care hospitals (LTACHs)), hospitalization abroad, and carbapenemase-producing organism (CPO) colonization. Early detection of C. auris is key to controlling spread. We describe four active surveillance strategies that led to early C. auris identification.

Methods

Based on known risk factors, state health departments used active C. auris surveillance strategies: (1) species identification of yeast from urine cultures from LTACHs, (2) screening patients with a CPO and hospitalization abroad, (3) LTACH C. auris point prevalence surveys (PPS), or (4) admission screening in acute and long-term care settings.

Results

(1)A laboratory in Southern California serving 12 LTACHs began species identification for all Candida from urine cultures, which would have otherwise been discarded because they are assumed to be not clinically significant. Within 5 months, testing of 271 Candida urine isolates identified the region’s first C. auris case, prompting contact tracing and identification of additional cases and facilities. (2) When CPOs were identified in patients with recent hospitalizations outside of the United States, the Maryland Department of Health screened patients for C.auris colonization. Of four screened, one, who received care in Kenya, was C. auris colonized. (3) The Indiana State Department of Health implemented monthly PPS at an LTACH that frequently admits patients transferred from a high prevalence area. Of 38 patients screened, two were colonized. (4) The Connecticut Department of Public Health offers C. auris admission screening for patients who received inpatient care in high prevalence areas; of 12 screened, one C. auris colonized patient was found. Infection control assessments and implementation of infection control measures followed each detection.

Conclusion

Early detection of C. auris is important but is impacted by infrequent yeast species identification and a reservoir of asymptomatic colonized patients. Healthcare facilities and public health jurisdictions can consider adopting one or more of these strategies based on epidemiology and resource availability.

Disclosures

All authors: No reported disclosures.

The ability of an attaching and effacing pathogen to trigger localized actin assembly contributes to virulence by promoting mucosal attachment

Enterohaemorrhagic Escherichia coli (EHEC) colonizes the intestine and causes bloody diarrhoea and kidney failure by producing Shiga toxin. Upon binding intestinal cells, EHEC triggers a change in host cell shape, generating actin 'pedestals' beneath bound bacteria. To investigate the importance of pedestal formation to disease, we infected genetically engineered mice incapable of supporting pedestal formation by an EHEC-like mouse pathogen, or wild type mice with a mutant of that pathogen incapable of generating pedestals. We found that pedestal formation promotes attachment of bacteria to the intestinal mucosa and vastly increases the severity of Shiga toxin-mediated disease.

Circulating human mononuclear cells exhibit augmented lysis of pig endothelium after activation with interleukin 2

In immunohistochemical studies investigating the cellular infiltrates in pig xenografts undergoing delayed rejection by newborn and adult primate recipients, we observed extensive infiltration with primate macrophages and natural killer (NK) cells. To extend these studies in vitro, we investigated the functional properties of human NK cell precursors with respect to their potential interactions with pig aortic endothelial cells (PAEC). Using a short-term 51Cr release assay, human peripheral blood mononuclear cells (PBMC) demonstrated spontaneous and interleukin (IL) 2 augmented lytic activity against PAEC which increased with increasing effector to target cell ratio. Treatment of human PBMC with anti-CD2 significantly reduced this NK lytic activity by IL-2-activated PBMC. Finally, we investigated the effects of PAEC treatment with certain macrophage-derived human cytokines on adhesion of IL-2-activated human PBMC. Treatment of PAEC with IL-1 and tumor necrosis factor-alpha, in a dose-dependent manner, increased adherence of IL-2-activated human PBMC. These results demonstrate that humans contain circulating NK cells capable of lysing PAEC after activation with IL-2, that the mechanism involves interactions between CD2 and its ligand on porcine endothelium, and that these interactions may be influenced by macrophage-derived cytokines produced at the site of xenograft rejection.