Escherichia coli in chronic inflammatory bowel diseases: An update on adherent invasive Escherichia coli pathogenicity

Escherichia coli(E. coli), and particularly the adherent invasive E. coli(AIEC) pathotype, has been increasingly implicated in the ethiopathogenesis of Crohn's disease(CD). E. coli strains with similar pathogenic features to AIEC have been associated with other intestinal disorders such as ulcerative colitis, colorectal cancer, and coeliac disease, but AIEC prevalence in these diseases remains largely unexplored. Since AIEC was described one decade ago, substantial progress has been made in deciphering its mechanisms of pathogenicity. However, the molecular bases that characterize the phenotypic properties of this pathotype are still not well resolved. A review of studies focused on E. coli populations in inflammatory bowel disease(IBD) is presented here and we discuss about the putative role of this species on each IBD subtype. Given the relevance of AIEC in CD pathogenesis, we present the latest research findings concerning AIEC host-microbe interactions and pathogenicity. We also review the existing data regarding the prevalence and abundance of AIEC in CD and its association with other intestinal diseases from humans and animals, in order to discuss the AIEC disease- and hostspecificity. Finally, we highlight the fact that dietarycomponents frequently found in industrialized countries may enhance AIEC colonization in the gut, which merits further investigation and the implementation of preventative measures.

Minimally manipulated autologous adherent bone marrow cells (ABMCs):a promising cell therapy of spinal cord injury

Spinal cord injury（SCI）is a devastating ailment that results in drastic life style alterations for the patients and their family members（Mc Donald and Sadowsky,2002）.Damage post injury causes necrosis,edema,hemorrhage and vasospasm.Post injury,secondary damage is caused by ischemia,

Expression of Adherent Molecule and Cyclin by Ligustrazine in Bone Marrow of Mice with Immune-Induced Aplastic Anemia

Summary: Mice with immune induced aplastic anemia (AA) were given 5 mg ligustrazine intraperitoneally twice a day. On the 14th day, the expression of CD 49d , CD 49e , cyclinD 2 in bone marrow mononuclear cells (MNC) was examined by flow cytometry, and VCAM 1 on stromal cells was immunohistochemically measured by Strept Avidin Biotin Complex (SABC). The expression of CD 49d , CD 49e , VCAM 1 and cyclinD 2 in ligustrazine treated group was significantly higher than that in AA group ( P <0 01), but the ratio of G 0+G 1 phase cells was significantly lower than that in AA group ( P <0.01).The results showed that ligustrazine could improve the expression of adherent molecule and cyclin D 2 in the bone marrow of mice with immune induced aplastic anemia, thereby promoting the growth of hematopoietic cells.

Detecting Accuracy of Three Dimensional Power Doppler (3DPD) Vascular Indices for Prenatal Diagnosis of Morbidly Adherent Placenta in Patients with Placenta Previa

Objective:?The study’s objective was to assess the accuracy of using prenatal 3-dimensional power Doppler analysis of vascular placental indices to accurately diagnose morbidly adherent placenta objectively. Background:?Traditionally, 2D ultrasound was used for the diagnosis of a suspected morbidly adherent placenta (MAP) previa. More objective techniques like 3D power Doppler haven’t been well studied. Study Design:?A prospective cohort study?is?designed for women with gestational age between 28 and?32 weeks with suspected placenta previa. Patients were examined by 2D ultrasound which was used in management decisions.?3D Power Doppler’s VI, FI and VFI were measured during the same examination after manual tracing of placenta;data were blinded to obstetricians. Histopathology was performed to confirm MAP. Results: Our results showed that the 3D power Doppler VI ≥ 16 predicted the diagnosis of MAP with 100% sensitivity, 100% specificity which is better than those of 2D ultrasound. While VI > 33.1 measured by 3D Doppler predicted severe MAP with a sensitivity of 73.9% and specificity of 86.4%, which was superior to 2D ultrasound. Conclusion:?In patients with placenta previa, the 3D Doppler’s vascular index accurately predicts MAP. Furthermore, vascular and vascular flow indices of 3D Doppler were more predictive of severe cases of MAP compared to 2D ultrasound.

Role of adherent invasive Escherichia coli in pathogenesis of inflammatory bowel disease

Gut microbiota imbalances play an important role in inflammatory bowel disease(IBD),but no single pathogenic microorganism critical to IBD that is specific to the IBD terminal ileum mucosa or can invade intestinal epithelial cells has been found.Invasive Escherichia coli(E.coli)adhesion to macrophages is considered to be closely related to the pathogenesis of inflammatory bowel disease.Further study of the specific biological characteristics of adherent invasive E.coli(AIEC)may contribute to a further understanding of IBD pathogenesis.This review explores the relationship between AIEC and the intestinal immune system,discusses the prevalence and relevance of AIEC in Crohn's disease and ulcerative colitis patients,and describes the relationship between AIEC and the disease site,activity,and postoperative recurrence.Finally,we highlight potential therapeutic strategies to attenuate AIEC colonization in the intestinal mucosa,including the use of phage therapy,antibiotics,and anti-adhesion molecules.These strategies may open up new avenues for the prevention and treatment of IBD in the future.

Maternal Outcome of Cases of Placenta Previa with and without Morbidly Adherent Placenta at King Abdul-Aziz University Hospital, Saudi Arabia

Introduction:?Worldwide increasing cesarean section rates are expected to have a parallel increase in the number of cases of Placenta Previa with all the expected complications, including pathologically adherent placenta. This morbidly adherent placenta constitutes a serious and possibly a life threatening complication. An efficient team capable for managing possible complicated situations will be able to reduce mortality and morbidity. Objectives: The aim of our study was to evaluate maternal outcome in cases of Placenta Previa with and without morbidly adherent placenta. Methods: Analysis of all pregnancies complicated by antepartum hemorrhage during the period from January 2013 to September 2017 at King Abdul-Aziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia (KSA) was done. Cases of Placenta Previa with gestational age > 28 weeks were included. They were classified into 2 groups;Group (A) included Placenta Previa cases without morbidly adherent placenta and Group (B) included cases with morbidly adherent placenta. Maternal outcomes were recorded. Results: Placenta Previa was the leading cause of antepartum hemorrhage constituting 76.8%, out of them 52% were unbooked. Morbidly adherent placenta constituted 13.5% of total Placenta Previa cases and was diagnosed prenatally in only 1 case. Morbidity rate in placenta previa patients with adherent placenta (Group B) was higher than in placenta previa without adherent placenta (Group A). We considered the occurrence of intrapartum hypovolemic shock, Intensive care unit admission, surgical complications and peripartum hysterectomy as parameters for morbidity. P value for hypovolemic shock was insignificant (P = 0.580), significant for Intensive care unit admission (P = 0.008), significant for surgical complications (P = 0.009) and significant for peripartum

Morbidly Adherent Placenta (MAP): Lessons learnt

Context: Once a rare occurrence, MAP is becoming an increasing threat to maternal lives. Aims: To summarize our experience in the management of patients with morbidly adherent placenta. Introduction: MAP is a potentially life threatening hemorrhagic condition responsible for 7% - 10% maternal mortality. Settings and Design: Tertiary care center. Methods and Material: Retrospective study in which data of twelve patients with clinical diagnosis of morbidly adherent placenta was reviewed from Jan 2009 till Sept 2012. Results: The incidence of placenta accreta was found to be increasing every year. Out of twelve cases with clinical diagnosis of MAP, placenta previa was present in 10/12 patients with MAP. All patients had history of previous section. Two patients with preoperative diagnosis of MAP on USG/MRI were found to be normal intra-operative and in one patient focal accreta was diagnosed intraoperatively. Nine patients of MAP underwent caesarean hysterectomy due to excessive bleeding during placental separation and were confirmed histo-pathologically (3 accreta vera, 3 increta and 3 percreta). Internal iliac artery ligation was done in 2 patients. Two patients with placenta percreta had bladder rupture which was repaired and these two patients subsequently expired. Conclusions: The incidence of placenta accreta is increasing due to higher cesarean section (C/S) rate. Key to successful outcome is awareness, anticipation, preoperative counseling, planning and multidisciplinary approach.

THE EFFECT OF PHENYLACETATE ON THE EXPANSION AND CYTOTOXIC ACTIVITY OF ADHERENT LAK CELLS FROM PATIENTS WITH HEPATOCELLULAR CARCINOMA

Objective: To improve the preparation of adherent lymphokine-activated killer (A-LAK) cells and study the synergistic anti-tumor effect of phenylacetate (PA) and A-LAK cells. Methods: A-LAK cells were obtained from peripheral blood mononuclear cells (PBMC) of patients with hepatocellular carcinoma (HCC) by using L-phenylalanine methyl ester (PME) to deplete immunosuppressive monocytes. The proliferation of SMMC7721 cell line treated with PA was studied. A-LAK cells were treated with the supernatant of SMMC7721 cells which had been pretreated with PA and the changes of the proliferation and anti-tumor activity of A-LAK cells were investigated. Results: The expansion of A-LAK cells was significantly higher than that of non-adherent LAK (NA-LAK) cells as well as regular LAK cells. The growth of SMMC7721 cells was significantly suppressed by PA. The supernatant of cultured tumor cells intensively suppressed the proliferation and cytotoxicity of A-LAK cells, but the suppressive effect of supernatant treated with PA previously was decreased. Conclusion: A-LAK cells could be simply prepared by using PME, and showed a synergistic anti-tumor effect with the combination of PA.

Engineered Interfaces for Adherent Coatings

Two methods used to grow adherent coatings, roughening of the surface for mechanical interlocking and the use of chemically compatible interlayers having intermediate thermal expansion coefficients are analyzed numerically with the aid of phase diagram. Calculations indicate that more roughness and smaller periodicity of the substrate surface will increase the interfacial area and thus enhance the adherence strength of the coating. The phase diagram shows that an intermediate layer with a proper composition gradient from the substrate to the film will relax the thermal stress at the interface effectively.

Effect of Ligustrazine on Expression of Adherent Molecule CD_(49)d and Cyclin D_2 in Hematopoietic Cells in Acute Radiation Injured Mice

After irradiation by 8.0 Gy γ ray, each mouse was stomach fed by 4 mg ligustrazine injection twice a day. On the 7th day after irradiation, CD 49 d expression in ligustrazine treated group was significantly higher than that in control group ( P <0.01), and showed no difference from that in normal group ( P > 0.05). On the 14th day after irradiation, CD 49 d expression was increased in control group, but decreased significantly in ligustrazine treated group ( P <0.01). The expression of Cyclin D 2 in spleen mononuclear cells (MNC) in ligustrazine treated group was significantly higher than that in control group, but the ratio of G 0+G 1 phase cells was significantly lower in ligustrazine treated group ( P <0.01). This finding indicated that ligustrazine could increase the expression of adherent molecule on bone marrow hematopoietic cells and Cyclin D 2 in spleen MNC, thereby promoting the growth of hematopoietic cells.

Psychological Repercussions of Morbid Adherent Placenta (MAP) Patients

Morbidly adherent placenta (MAP) is a major cause of maternal morbidity and cause of severe fear and stress to the patient, family and the treating staff. Proper counseling and sympathetic case handling and management is of great relief. Detailed explanation for the pathology and the treatment plan will support the psychology of the patient and surrounding.

Association between etiopathogenesis of morbidly adherent placenta and adenomyosis

The association between etio-pathogenesis of morbidly adherent placenta (MAP) or placenta cretas and adenomyosis has never been described in medical literature. Contrary to the believe that MAP is due to direct invasion of trophoblastic tissues into the adjacent normal myometrium due to prior uterine surgeries, this article describes how pre-existence of adenomyosis acts as a precursor for the development of placenta cretas. It elucidates how prior uterine traumas such as surgeries, repeated childbirths and endometritis cause endometrial tissues to invade the myometrium as a result of disruption of decidua basalis. The invaded endometrial tissues cause hyper-plasia and hypertrophy of surrounding myometrium to form the clinical entity called adenomyosis. The over-expression of bcl-2 oncogene in the endometrium causes inhibition of apoptosis of endometrial cells removing the barrier of trophoblastic tissues to invade the myometrium to form MAP. This hypothesis is based on the similarity of their clinical perspectives, similar pathological description of the two disease entities and their common molecular components. Both diseases increase with age;more in women older than 35 years and also in those with history of previous endometrial traumas such as surgeries, childbirth and endometritis. Both diseases also share common pathological factors and molecular components due to absence of deciduas basalis and over-expression of bcl-2 oncoprotein gene, inhibition of cell apoptosis and failure to find genetic abnormalities such as mutations of K-ras, P53 or LOH. An ongoing study looking at uterine specimens from cesarean hysterectomies and pelvic MRI evaluation of patients with retained placentas to prove that pre-existing adenomyosis may be a precursor to the development of morbidly adherent placenta is near to conclusion.

Evaluation of Different Ultrasonographic Modalities in the Diagnosis of Morbidly Adherent Placenta: A Cross-Sectional Study

Objective: To compare the accuracy of different ultrasonographic modalities;two-dimensional ultrasound (2D-US), color Doppler and three-dimensional power Doppler (3D-PD) in the antenatal diagnosis of the morbidly adherent placenta. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt. Study Design: A cross-sectional study. Methods: All patients fulfill the inclusions criteria: gestational age > 28 weeks, previous one or more cesarean delivery, previous uterine surgery, placenta previa, vitally stable patient and women accepted to participate in the study were included. All patients were evaluated using 2D-US, color Doppler and 3D-PD before delivery. The final diagnosis was established by laparotomy and by histopathology of hysterectomy sample if hysterectomy would be done. Results: One-hundred fifty patients were enrolled in the study. 2D-US has higher sensitivity (86.96%) than 2D color Doppler (84.06%) and 3D-PD (79.71%) in the diagnosis of placenta accreta. On the other hand, 3D-PD has slightly higher specificity (83.95%) than color Doppler (82.72%) and 2D-US (77.78%) in the diagnosis of placenta accreta. The most sensitive parameter in 2D-Us was the loss of retroplacental sonolucent zone (86.96%). As regards color Doppler, the most sensitive parameter was the hypervascularity of the uterine-bladder interface (84.06%). Tortuous vascularity with chaotic branching was the most sensitive parameter in 3D-PD with a sensitivity of 82.61%. Conclusions: The use of 3D power Doppler with both 2D-US and color Doppler as complementary techniques could improve the antenatal diagnosis or exclusion of morbidly adherent placenta.

Fazari’s Sign in Ultrasound Scan of Morbid Adherent Placenta/Placenta Accreta Spectrum (MAP/PAS) and Fazari’s Triad during (MAP/PAS) Surgery

Morbid Adherent Placenta (MAP)/Placenta Accreta Spectrum (PAS) is a serious diagnosis which has a risk of complications. Ultrasound scan helps in early diagnosis and has great value in further confirmation and follow up. Observed new clinical sign and associated clinical triad are discussed here.

Discovery of the Exquisite Meaning of the Word “chudu” in Chinese Poetry of the Adherents of a Former Dynasty

The word “chudu” comes from Qu Yuan’s Li Sao “huang lan kui yu chu du xi, zhao ci yu yi jia ming”. The original meaning was the day of birth. After the Song Dynasty, the literati began to use it to refer to birthdays. By the end of the Ming Dynasty, they had been calling their birthdays “chudu” once they celebrated it and they were so keen on birthday celebrations. Gu Yanwu pointed out that the word “chudu” only fits “the old ministers （or the exiled ministers） who lamented the crash of the Yingcapital of the country of “Chu” such as Qu Yuan. At the same time, its use in Huang Zongxi’s and Wang Fuzhi’s birthday poems is also consistent with this context. The unique situation and mood of the adherents led them to be close to Qu Yuan and Wen Tianxiang, which bestowed “chudu” the special meaning. It is very suitable for the ministers who suffered the crash of their Dynasties or those who were exiled distantly to express their feelings about the old dynasties and old friends. After these people, Chen Yinke consciously acknowledged this layer of interpreting “chudu” and used it, which has not only enriched the connotation of “chudu”, but also extended its cultural life. From Qu Yuan to Wen Tianxiang, until Gu Yanwu, Huang Zongxi, Wang Fuzhi, and then to Chen Yinke, we can take a glimpse of the spiritual world of the Chinese adherents of Dynasties.

Can Necrosis and Ovarian Vein Thrombus Be a Serious Complication in Morbidly Adherent Placenta?

We report a case of a 40-year-old woman, second pregnancy, previous cesarean section due to intrauterine growth restriction and placenta accreta spectrum disorders. She was 25 weeks gestational age, admitted to the hospital 25 weeks gestational age, diagnosed with fetal death. Initial conservative management attempt with uterine preservation progresses to complications requiring total hysterectomy followed by a rare outcome: pelvic thrombi with uterine necrosis, with its associated clinical complications.

Establishment and validation of an adherence prediction system for lifestyle interventions in non-alcoholic fatty liver disease

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the most common liver disease worldwide,affecting about 1/4th of the global population and causing a huge global economic burden.To date,no drugs have been approved for the treatment of NAFLD,making the correction of unhealthy lifestyles the principle method of treatment.Identifying patients with poor adherence to lifestyle correction and attempting to improve their adherence are therefore very important.AIM To develop and validate a scale that can rapidly assess the adherence of patients with NAFLD to lifestyle interventions.METHODS The Exercise and Diet Adherence Scale(EDAS)was designed based on com-pilation using the Delphi method,and its reliability was subsequently evaluated.Demographic and laboratory indicators were measured,and patients completed the EDAS questionnaire at baseline and after 6 months.The efficacy of the EDAS was evaluated in the initial cohort.Subsequently,the efficacy of the EDAS was internally verified in a validation cohort.RESULTS The EDAS consisted of 33 items in six dimensions,with a total of 165 points.Total EDAS score correlated significantly with daily number of exercise and daily reduction in calorie intake(P<0.05 each),but not with overall weight loss.A total score of 116 was excellent in predicting adherence to daily reduction in calorie intake(>500 kacl/d),(sensitivity/specificity was 100.0%/75.8%),while patients score below 97 could nearly rule out the possibility of daily exercise(sensitivity/specificity was 89.5%/44.4%).Total EDAS scores≥116,97-115,and<97 points were indicative of good,average,and poor adherence,respectively,to diet and exercise recommendations.CONCLUSION The EDAS can reliably assess the adherence of patients with NAFLD to lifestyle interventions and have clinical application in this population.

白蛋白-胆红素评分对急性失代偿心力衰竭患者短期死亡风险的预测价值

目的探讨白蛋白-胆红素(albumin-bilirubin,ALBI)评分对急性失代偿性心力衰竭(ADHF)患者短期全因死亡的预测价值,联合急性失代偿性心力衰竭国家注册研究(ADHERE)模型能否提高其预测能力。方法连续入选2018年1月至2021年3月在南京鼓楼医院心内科住院的ADHF患者共821例。根据入院ALBI评分,采用三分位法进行分组:低ALBI组(<-2.41,n=273),中ALBI组(-2.41~-2.10,n=274),高ALBI组(≥-2.10,n=274)。比较各组基线临床特征及实验室检查,主要终点为短期(院内或出院后30天内)全因死亡。采用logistics回归分析短期全因死亡的独立危险因素,绘制受试者工作特征(ROC)曲线,计算各模型ROC曲线下面积(AUC),根据约登指数确定最佳临界值,并计算不同模型间净重新分类指数(NRI),采用Z检验比较模型间AUC及NRI的差异。结果共有45例(5.48%)患者在院内及出院后30天内死亡。高ALBI组患者全因死亡率显著高于其他两组(P<0.001)。多因素logistics回归分析显示,ALBI评分(OR=4.012,95%CI 1.598~10.073,P=0.003)、ADHERE模型(OR=2.471,95%CI 1.317~4.434,P=0.004)、B型利钠肽水平(OR=1.000,95%CI 1.000~1.001,P=0.002)是ADHF患者短期全因死亡的独立危险因素。ALBI评分预测短期死亡的最佳临界值为-2.024。ALBI联合ADHERE评分对ADHF患者短期全因死亡的预测能力优于单独评分(ALBI+ADHERE比ADHERE:AUC P=0.008;NRI=0.37,95%CI 0.14~0.56,P<0.001;ALBI+ADHERE比ALBI:NRI=0.37,95%CI 0.14~0.56,P<0.001)。结论ALBI评分与ADHF患者短期全因死亡风险独立相关,且ALBI联合ADHERE模型的预测价值更高。