Liver regeneration after liver resection: Clinical aspects and correlation with infective complications

AIM:To investigate whether early liver regeneration after resection in patients with hepatic tumors might be influenced by post-operative infective complications.METHODS:A retrospective analysis of 27 liver resections for tumors performed in a single referral center from November 2004 to January 2010.Regeneration was evaluated by multidetector computed tomographyat a mean follow-up of 43.85 d.The Clavien-Dindo classification was used to evaluate postoperative events in the first 6 mo after transplantation,and Centers for Disease Control and Prevention definitions were used for healthcare associated infections data.Generalized linear regression models with Gaussian family distribution and log link function were used to reveal the principal promoters of early liver regeneration.RESULTS:Ten of the 27 patients(37%)underwent chemotherapy prior to surgery,with a statistically significant prevalence of patients with metastasis(P=0.007).Eight patients(30%)underwent embolization,3 with primary tumors,and 5 with secondary tumors.Twenty patients(74%)experienced complications,with 12(60%)experiencing Clavien-Dindo Grade 3a to 5 complications.Regeneration≥100%occurred in 10(37%)patients.The predictors were smaller future remnant liver volume(-0.002;P<0.001),and a greater spleen volume/future remnant liver volume ratio(0.499;P=0.01).Patients with a resection of≥5 Couinaud segments experienced greater early regeneration(P=0.04).Nine patients experienced surgical site infections,and in 7 cases Clavien-Dindo Grade 3a to 4 complications were detected(P=0.016).There were no significant differences between patients with primary or secondary tumors,and either onset or infections or severity of surgical complications.CONCLUSION:Regardless of the onset of infective complications,future remnant liver and spleen volumes may be reliable predictors of early liver regeneration after hepatic resection on an otherwise healthy liver.

套式PCR扩增SSU rDNA特定片段检测云南金平县疟原虫感染的研究

目的 采用套式 PCR系统诊断、鉴别人体疟原虫感染。 方法 采用已建立的套式 PCR系统扩增 SSU r DNA特定片段检测云南金平县恶性疟镜检阳性患者的 6份血样 ,并设阳性与阴性对照。 结果 间日疟原虫、恶性疟原虫和三日疟原虫感染血样中分别扩增出 10 4 bp、10 2 bp和 115 bp预期大小的特定扩增带。正常人血、人源弓形虫、杜氏利什曼原虫 DNA及灭菌双蒸水均未产生特异扩增带。 6份血样中检出 4份 P.v.、P.f.和 P.m.的混合感染 ,1份 P.v.和 P.f .及 1份 P.f .和 P.m.的混合感染。 结论 该系统特异、灵敏、稳定 ,在诊断疟疾的同时可准确地判定混合感染 ,对疟疾的诊断、大规模流行病学研究及疫情监控等具有实际应用价值。

套式PCR扩增特定SSU rRNA基因片段检测四川疟原虫感染的研究

目的用套式 PCR系统诊断、鉴别人体疟原虫感染。方法以疟原虫小亚单位核糖体核糖核酸 (SSUr RNA)基因为靶基因 ,选用 1对疟原虫属特异性引物和 4对种特异性引物 ,建立套式 PCR扩增系统并用于四川省疟疾病人血样的检测。结果从间日疟原虫、恶性疟原虫和三日疟原虫感染血样中分别扩增出 1 0 4 bp、1 0 2 bp和 1 1 5bp预期大小的特定扩增带。61份血样检测结果与镜检的间日疟阳性符合率为 1 0 0 %。并查出镜检漏诊的 2例 P.v.和 P.m.的混合感染及 1例 P.v.、P.f.和 P.m.的混合感染病例。结论本系统特异、灵敏、稳定、简便 ,可在诊断疟疾的同时判定混合感染 ,故对疟疾的诊断、大规模流行病学研究及疫情监控有实际应用价值。

A comparative evaluation of methicillin-resistant staphylococci isolated from harness racing-horses,breeding mares and riding-horses in Italy

Objective:To investigate the prevalence of methicillin-resistant staphylococci(MRS)which is a potencial risk factor of transmission between animals and humans in different types of horses(harness racing-horses,breeding mares and riding-horses)and to compare the antimicrobial resistance of the isolates.Methods:A total of 191 healthy horses,housed at different locations of the Campania Region(Italy),were included in the study.Nasal swab samples were collected from each nostril of the horses.The mecA gene was detected by a nested PCR technique.Antibiotic susceptibility was tested for each isolate.Results:MRS was isolated from nasal samples of 68/191(35.6%;95%CI:28.9%-42.9%)healthy horses.All isolates were coagulase-negative with the exception of two coagulase-positive MRS strains,identified as Staphylococcus aureus and Staphylococcus pseudintermedius.2/83(2.4%;95%,CI:0.4%-9.2%).Interestingly,both coagulase-positive MRS isolates were from harness racing-horses.These horses also presented a significantly higher positivity for MRS(53.3%;95%CI:40.1%-66.1%)than the breeding mares and riding-horses groups.Antibiotic susceptibility testing showed difference between isolates due to different origins except for an almost common high resistance to aminopenicillins,such as ampicillin and amoxicillin.Conclusions:It can be concluded that harness racing-horses may act as a significant reservoir of MRS as compared to breeding mares and riding-horses.

Transient elastography: A non-invasive tool for assessing liver fibrosis in HIV/HCV patients

AIM: To assess the prevalence of advanced liver fibrosis (ALF) in human immunodeficiency virus (HIV), hepatitis C virus (HCV) and HIV/HCV patients using transient elastography, and to identify factors associated with ALF. METHODS: Between September 2008 and October 2009, 71 HIV mono-infected, 57 HIV/HCV co-infected and 53 HCV mono-infected patients on regular follow-up at our Center were enrolled in this study. Alcohol intake, the main parameters of liver function, presence of HCV-RNA, HIV-RNA, duration of highly active anti-retroviraltherapy (HAART) and CD4 cell count were recorded. ALF was defined as liver stiffness (LS) ≥ 9.5 kPa. To estimate liver fibrosis (LF) a further 2 reliable biochemical scores, aspartate aminotransferase platelet ratio index (APRI) and FIB-4, were also used. RESULTS: LS values of co-infected patients were higher than in either HIV or HCV mono-infected patients (χ 2M H = 4, P < 0.04). In fact, LS ≥ 9.5 was significantly higher in co-infected than in HIV and HCV mono-infected pa-tients (χ 2 = 5, P < 0.03). Also APRI and the FIB-4 index showed more LF in co-infected than in HIV mono-infect-ed patients (P < 0.0001), but not in HCV mono-infected patients. In HIV?HCV co-infected patients, the extent of LS was significantly associated with alcohol intake (P < 0.04) and lower CD4+ cell count (P < 0.02). In HCV pa-tients, LS was correlated with alcohol intake (P < 0.001) and cholesterol levels (P < 0.03). Body mass index, dia-betes, HCV-and HIV-viremia were not significantly cor-related with LS. In addition, 20% of co-infected patients had virologically unsuccessful HAART; in 50% compliance was low, CD4+ levels were < 400 cells/mm 3 and LS was > 9.5 kPa. There was no significant correlation between extent of LF and HAART exposure or duration of HAART exposure, in particular with specific dideoxynucleoside analogues. CONCLUSION: ALF was more frequent in co-infected than mono-infected patients. This result correlated with lower CD4 levels. Protective immunological effects of HAART on LF progression outweigh its hepatotoxic effects.

T-CELL RESPONSE OF ADVANCED AIDS PATIENTS AFTER HIGHLY ACTIVE ANTIRETROVIRAL THERAPY

Objective To investigate the response on late stage Chinese AIDS patients after highly active antiretroviral therapy (HAART). Methods From October 2002 to March 2004, 20 cases of late stage Chinese AIDS patients were selected to particip-ate in this opened and randomised study, we purposely chose those with CD4+ T cell counts < 100/mm3. All of them had one or two opportunistic infections and none had been treated with anti-HIV drugs. All patients were tested with CD4+ (naive CD4+ T cell defined by CD45RA+ and CD62L+, memory CD4+ T cell defined by CD45RA-), CD8+ T cell, plasma HIV viral load, and clinical manifestations on before, during, and after HAART (5 different regimes) on 1, 3, 6, 9, and 12 months. Results Before HAART mean CD4+ T cell counts were 32 ± 31(range 2-91)/mm3, and plasma HIV viral load were 5.07 ± 0.85(range 2.04-5.70) log copies/mL. In 1 month’s time patients treated with HAART had mean CD4+ and CD8+ T cell counts increasing rapidly. After 1 month the increasing speed turned to slow down, but HIV viral load decreased predominantly within the first 3 months. The major part of increasing CD4+ T cells were memory CD4+ T cells, as for naive CD4+ T cells increasing low and slow. Clinical symptoms and signs improved, and opportunistic infections reduced. The quality of life will be far much better than before. Each patient was followed for 12 months, and had finished 12 months’ HAART. Conclusion This is the first report in China that late stage Chinese AIDS patients after HAART could have their immune reconstitution. The regular pattern is similar to what had been reported in Western countries and also in China. So it is worth to treat late stage Chinese AIDS patients with HAART.

ANTIBIOTIC USE AND NOSOCOMIAL INFECTIONS IN THE USA

Gram-negative bacteriacontinue to be the most common cause ofnosocomial infection, often resulting inextended hospitalization and mortality.Ascompared with penicillins and aminogly-cosides, potent beta-lactam antibioticshave been recently introduced with fewertoxic side efTects and a broader spectrum ofantibacterial activity. The cephalosporinsare the most widely used antibiotics in theUnited States and account for almost$ 1. 6 billion in U. S. health-care dollarsin 1987, cephalosporins commanded 55%of the inpatient/parenteral market and40% of the outpatient/oral market.However, gram-negative organisms suchaspseudomonas aeruginosa and Serratiaspp. may be resistant to the older cepha-losporins, and Enterococcus, methicillin-resistant Staphylococcus spp.and Candidaalbicans are resistant to all cephalosporins.These troublesome pathogens now causean increasing numbers of nosocomialinfections and superinfections in patientswho have received prolonged antibiotictreatment Unfortunately, nosocomial infe-ctions often affect the growing number ofimmunocompromised patients. In the future,nosocomial infections will be more frequentlyassociated with the emergnce of more resistantbacterial strains. Oral monotherapy alternativesto parenteral cephalosporin therapy arebeing tested, and if proven useful mayhelp reduce the upward trend in antibioticcosts.

What is the purpose of launching World Journal of Neurology?

The first issue of World Journal of Neurology,a bimonthly peer-reviewed,online,open-access journal will be published on December 28,2011.The preparatory work for this journal was initiated on December 5,2010.The WJN Editorial Board has now been established and consists of 100 members who are distinguished,world-renowned experts in neurology and related specialties(psychiatry,geriatric medicine,and internal medicine)from 30 countries.Our purpose in launching WJN is to publish peer-reviewed,high-quality articles via an open-access online publishing model.In this context,a multidisciplinary journal such as WJN may serve as a unique and useful platform for updated”review”,“mini-review”and”experimental”articles in neurological and psychiatric age-related research that would eventually help promote healthy lives in both adult and older individuals.

Penicillin-Resistant <i>Aerococcus viridans</i>Bacteremia Associated with Bovine Severe Respiratory Syndrome

Aerococcus viridans, a less frequently isolated bacteria, is a gram-positive, catalase-negative coccus, found singly or in tetrads, with biochemical and growth characteristics of streptococci and enterococci. This microorganism, usually susceptible to penicillin, is often found in the environment and is infrequently associated with human/veterinary infections. We described a case of Holstein Friesian female calf, 150-day-old, affected by respiratory emergencies. Following the clinical signs, radiographic analysis and bacteriological/molecular examinations carried out on blood culture, a diagnosis of severe broncho-pulmonary disease associate with a multidrug-resistant A. viridans bacteremia was done. The present case highlights the invasive nature of a saprophytic bacterium showing a broad profile of antibiotic-resistance including β-lactams. Furthermore, this report confirms that the effectiveness of an antibiotic therapy is based primarily on a sure diagnosis including susceptibility testing.

Invasive Infections for Endemic Fungi in Pediatrics in Guatemala

Background: Invasive fungal infections are common opportunistic diseases in patients with AIDS, other conditions related to immunodeficiency and healthy infants. Most publications on this subject are related to industrialized countries, and in adult population, with limited data in Latin America (except for Brazil, Colombia, and Argentina), and especially in pediatric population. These patients present a variety of clinical manifestations representing a diagnostic and therapeutic challenge for the health system. Objective: The objective of the study is to describe the epidemiological and laboratory characteristics of children with invasive fungal infections in Guatemala. Methods: A review of the microbiology service database was carried out at Roosevelt Hospital in Guatemala. Positive cultures were taken from children under 15 years of age, in a period of seven years, from 2007 to 2014, with its corresponding medical history. Results: Finally, 23 isolates were documented but only 15 patients were included in the study with complete information;10 Histoplasma capsulatum cases, 4 Cryptococcus neoformans cases and 1 Coccidioidessp case. The average age was 7 years old for Histoplasma and 9 years old for Criptococo, with an age range from 6 months to 14 years. Around 60% of the patients were older than 5 years, of which, more than two-thirds were HIV positive children without antiretroviral therapy, who presented an invasive fungal infection at the time of HIV diagnosis. These infections are endemic in Guatemala, so the distribution was mostly uniform. Around 80% of the patients had some disease related to immunodeficiency and 70% were infected with human immunodeficiency virus (HIV). The microbiological isolation was from blood, bone marrow, lymph nodes, cerebrospinal fluid and urine. The predominant laboratory findings were decrease in hematological series. The most frequent clinical syndromes were fever, adenomegaly, hepatosplenomegaly, respiratory, gastrointestinal, neurological and weight loss. Mortality rate was 53% (from them, 62% were HIV positive). From these patients, an87% did not receive antifungal treatment in time due to late diagnosis of the infection. Conclusions: These infections should be considered when treating pediatric patients from tropical regions, with nonspecific systemic symptoms and signs, lymph node involvement and hematological alterations related to the mononuclear phagocytic system, mainly if they are patients infected by HIV in an advanced stage, infants, or children with a disease that weakens the immune system. When there is a high suspicion of a fungal infection, screening for HIV is mandatory;cultures should be taken early and together with rapid diagnostic tests. An antifungal treatment should be started immediately and then modified accordingly to laboratory results.

Necrotizing Fasciitis: A Surgical and Medical Emergency

Necrotizing fasciitis (NF) is still remained a dreaded disease with high morbidity and mortality due to rapidly progressive necrotizing infection. Objective: Review recent available literature on necrotizing fasciitis (NF) and compare it with our publications. Data and Source: Local and international published literature on NF from early nineties to 2012;Midline and pub Med literature search using the term “necrotizing fasciitis”. Data Synthesis: NF is more common in male patient, it is frequently polymicrobial. Common site of NF is the extremities. NF is classified according to the microbes. Common co-morbid condition associated with NF is diabetes mellitus. Minor trauma and surgery are the major etiological risk factors for NF. There seems to be significant correlation between the use of non steroidal anti-inflammatory medication (NSAID) and NF. Severe pain disproportionate to injury is the presenting symptom. Laboratory risk indicators for necrotizing fasciitis (LRINEC) score will diagnose NF early in emergency clinics. Tissue biopsy is the gold standard for the diagnosis of NF. Pathophysiology of NF is rapid horizontal spread of infection with fascial necrosis and secondary vertical involvement of skin. More than 90% of NF patients need intensive care therapy. Early and bold debridement in combination with brave organ supportive intensive care will have better outcome of NF patients. Conclusion: High index of suspicion and knowledge is essential for early diagnosis of NF. Finger test and LRINEC score may help in early diagnosis. Early debridement, proper antibiotics and organ supportive intensive care will improve morbidity and mortality of NF patients.

Autoimmune hepatitis in human immunodeficiency virus infection: Case report and literature review

The infection due to human immunodeficiency virus(HIV) is characterized by the progressive reduction of CD4+ T lymphocytes and the compromise of other cell lines of the immune system, resulting in immunosuppression. In this context, autoimmune diseases could be considered contradictory, however, cases of autoimmune diseases during this infection have been described, including autoimmune hepatitis(AIH), which is uncommon and has few case reports within medical literature, none of them from Latin America. In this case report where a patient with an HIV infection on combined antiretroviral treatment developed acute elevation of transaminases, hyperbilirubinemia, and deterioration in hepatic synthetic function. Although initially an antiretroviral drug-induced liver injury was suspected, during the study a diagnosis of autoimmune hepatitis was proven, which required treatment with corticosteroid and azathioprine, obtaining a satisfactory response and managing to continue the antiretroviral therapy. Autoimmune diseases in HIV infection must be taken into account. In the case of hepatitis in patients with HIV on antiretroviral treatment, the differentiation between viral hepatitis caused by autoimmune diseases or medications is essential to establish an adequate treatment, and avoid the suspension of the antiretroviral therapy.

Microbiologic and Clinical Comparison of Patients Harboring <i>Escherichia coli</i>Blood Isolates with and without Extended-Spectrum <i>β</i>-Lactamases

The clinical and microbiologic characteristics of 34 patients with extended-spectrum β-lactamase (ESBL) positive E. coli isolated from blood were compared to 66 bacteremic patients with ESBL negative E. coli, from January 2007 through December 2009. Of the 21 ESBL positive isolates available for PCR analysis, 13 were positive for CTX-M, 8 for TEM, 4 for SHV β-lactamases, with 6 possessing multiple enzymes. Twenty of 34 (59%) ESBL-positive and 41 of 66 (62%) ESBL-negative blood isolates were considered community-associated. All but one isolate in both groups had MICs of ≤1.0 μg/ml to meropenem. However, when compared to ESBL-negative isolates, ESBL-positive isolates were more frequently resistant to levofloxacin, trimethoprim/sulfamethoxazole and had higher MICs to gentamicin, tobramycin and piperacillin/tazobactam. The use of intravenous and urinary catheters was strongly associated with the isolation of E. coli bloodstream isolates in both groups of patients. Although hospital stay was similar in both groups, appropriate therapy was given in 87% of patients with ESBL positive vs. 98% of patients with ESBL negative isolates and mortality was greater for patients with ESBL positive isolates (26% vs. 17%). Since a large proportion of E. coli blood isolates were ESBL-positive and community-associated, carbapenems should be considered as initial empiric therapy for such infections in our locale.

Decreased incidence of febrile neutropenia in Michigan following masking and social distancing orders for the COVID-19 pandemic: A population based cohort study

BACKGROUND It has been theorized that 75%-80%of febrile neutropenia(FN)is caused by endogenous pathogens,while up to 20%of cases are thought to be caused by a viral infection.It is unknown if precautions such as masking and social distancing reduce the risk of FN in susceptible populations.AIM To determine whether coronavirus disease 2019(COVID-19)infection mitigation efforts,namely masking and social distancing,were associated with a reduction in the incidence of FN.METHODS This was a retrospective population based cohort study comparing the incidence of FN in the 13 mo prior to(Year 0)and 13 mo following(Year 1)the public health executive orders(PHEO)in Michigan.Data was queried for all emergency department(ED)visits from April 1,2019 to March 31,2021 from the National Syndromic Surveillance Program,a program which collects data that is voluntarily submitted by approximately 89%of Michigan EDs.The primary study outcome was the incidence of FN as a proportion of ED visits in the 13-mo before and 13-mo after COVID-19 mitigations efforts,namely masking and social distancing.We hypothesized that there would be a significant decrease in the incidence of FN in the period following the PHEO aimed at reducing the spread of the severe acute respiratory syndrome coronavirus 2 virus.RESULTS There was a total of 8979221 total ED visits captured during the study period.In Year 0 there were 5073081 recorded ED visits and 3906140 in Year 1.There was a significant reduction in the proportion of total ED visits with a diagnosis of FN,decreasing 13.3%across periods(0.15%vs 0.13%,P=0.036).In patients with a hematologic malignancy a more impressive reduction in the incidence of FN was evident following PHEO(22%vs 17%,P=0.02).CONCLUSION We found a significant association between social distancing and mask guidelines implemented on a large public scale with decreased rates of FN,particularly in those with a hematologic malignancy.These findings may be useful in the design of future research and recommendations regarding the prevention of FN.

左西替利嗪治疗慢性特发性荨麻疹:一项随机、双盲、安慰剂对照研究

Background: Chronic urticaria is a common skin condition. It is frequently a disabling disease because of the persistence of clinical symptoms, the unpredictable course and its negative influence on the quality of life. Objectives: To determine whether levocetirizine is efficacious in the treatment of chronic idiopathic urticaria. Methods: A randomized, double-blind,placebo-controlled study was conducted in 106 patients with a diagnosis of chronic idiopathic urticaria. A 1-week singleblind placebo run-in period (baseline) was followed by a 6-week double blind active treatment period. The patients were randomized to receive one of the following treatments once daily: (a) oral levocetirizine 5 mg, or (b) oral placebo. The study ended after another 1-week single blind placebo washout period. Results: The evaluable population consisted of 100 patients. Levocetirizine administered once daily is effective and well tolerated in the treatment of the symptoms of chronic idiopathic urticaria and in improving the patient’s quality of life. Levocetirizine was superior to placebo in reducing the mean total symptoms score as well as individual symptoms, then umber of daily episodes and the number of weals, the overall severity of symptoms and the quality of life. The significant beneficial effects of levocetirizine lasted only during the active trial, while at follow-up there was a significant worsening of all the variables evaluated in this study, after the end of the active trial (week 7). Conclusions: A global assessment indicates that levocetirizine 5 mg once daily is an effective agent in patients with chronic idiopathic urticaria, as its action provides a rapid and satisfactory control of the symptoms and measures of subjective disease, although this is limited to the duration of treatment.

Understanding risk of thrombosis with thrombocytopenia syndrome after Ad26.COV2.S vaccination

On April 13,2021,the US Centers for Disease Control and Prevention(CDC)and the US Food and Drug Administration(FDA)recommended a pause in administration of the Ad26.COV2.S(Johnson&Johnson[Janssen])coronavirus disease 2019(COVID-19)vaccine for all persons[1].At that time,approximately 6.8 million doses of vaccine had been administered around the United States.The pause was prompted by 6 cases of cerebral venous sinus thrombosis(CVST)in combination with thrombocytopenia,a condition whose nomenclature is in flux but which we will refer to as thrombosis with thrombocytopenia syndrome(TTS),as used by CDC in describing the condition[2].All patients were women younger than 50 years.Of note,2 of 6 patients also had splanchnic and portal vein thrombosis.

Azithromycin Exerts Bactericidal Activity and Enhances Innate Immune Mediated Killing of MDR Achromobacter xylosoxidans

Azithromycin(AZM),the most commonly prescribed antibiotic in the United States,is thought to have no activity against multidrugresistant Gram-negative pathogens such as Achromobacter xylosoxidans(AX)per standard minimum inhibitory concentration testing in cation-adjusted Mueller Hinton Broth.Here we provide the first report of AZM bactericidal activity against carbapenemresistant isolates of AX,with a multifold decrease in minimum inhibitory concentration across 12 clinical isolates when examined under physiologic testing conditions that better recapitulate the in vivo human environment.This pharmaceutical activity,evident in eukaryotic tissue culture media,is associated with enhanced AZM intracellular penetration and synergistic killing with human whole blood,serum,and neutrophils.Additionally,AZM monotherapy inhibited preformed AX biofilm growth in a dose-dependent manner together with a reduction in viable bacteria.In an illustrative case,AZM in combination with piperacillin-tazobactam exerted clear therapeutic effects in a patient with carbapenem-resistant AX mediastinitis,sternal osteomyelitis,and aortic graft infection.Our study reinforces how current antimicrobial testing practices fail to recapitulate the host environment or host-pathogen interactions and may misleadingly declare complete resistance to useful agents,adversely affecting patient outcomes.We conclude that AZM merits further exploration in the treatment of drug-resistant AX infections.Novel approaches to antimicrobial susceptibility testing that better recapitulate the host environment should be considered,especially as infections caused by multidrug-resistant Gram-negative bacterial pathogens are expanding globally with high morbidity and mortality.