Should patients with NAFLD/NASH be surveyed for HCC?

Background Patients with nonalcoholic fatty liver disease (NAFLD) are at risk of developing hepatocellular carcinoma (HCC), but the magnitude of the association still needs to be determined in order to define the need for a specific surveillance strategy. Methods We based our assessment on a previously published review by White et al (1992-2011) and on a systematic review (2012-2017). Results The new search identified 328 abstracts. Combining both eras (1992-2011 and 2012-2017), 25 studies were included in the analysis. Four were prospective, 2 described a retrospective analysis of a prospective database, and the others were retrospective. All studies were published after 2004, but the inclusion period of half of them ended before the year 2000. Studies showed variation in the definition of NAFLD, in the incidence of fibrosis/cirrhosis, in the presence of comorbidities (potentially affecting HCC incidence), and in the type and duration of screening. Considering only studies strictly including patients with or without cirrhosis, the reported incidence of HCC in NAFLD patients with cirrhosis was between 6.7 and 15% at 5-10 years, while the incidence in NAFLD patients without cirrhosis was 2.7% at 10 years and 23 per 100 000 person-years. Conclusions HCC screening in NAFLD patients with cirrhosis is mandatory. However, the currently observed low (and insufficiently documented) incidence of HCC in NAFLD-patients without cirrhosis does not justify a systematic surveillance. Research efforts should focus on developing a score, which could aid the clinician in identifying NAFLD patients without cirrhosis who are at higher risk of developing HCC. Corresponding authors: María Reig, BCLC group. Liver Unit. IMDiM. CIBEREHD. IDIBAPS. Hospital Clínic. c/ Villarroel, 170. Escala 11, 4ª planta. 08036. Barcelona. Spain. Phone: +34 932279803; Fax: +34 932275792. Email: mreig1@clinic.ub.es; Christian Toso, Geneva University Hospitals, Department of Surgery, Rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland, Phone: +41 223723311, Fax : +41 223727755. E-mail : christian.toso@hcuge.ch Authorship: María Reig and Christian Toso, participated in the research design, and all authors participated in the writing of the paper, performance of the research, and/or participated in data analysis. Disclosure: The authors declare no conflict of interest. Funding: CT was supported by the Swiss National Science Foundation (PP00P3_165837). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2AKDeYH

The use of smartphone for liver graft biopsy assessment at the time of procurement

No abstract available

https://ift.tt/2ON2LU8

Comparison of the different retention appliances produced using CAD/CAM and conventional methods and different surface roughening methods

Abstract

The purposes of this study are to conduct an in vitro comparison of the shear bond strength, breakage mode, and wire deformation of three different types of retainers and to compare the subsequent enamel surface changes. Two hundred seventy intact lower incisor teeth were embedded in acrylic blocks in pairs. Dead wire and CAD/CAM-fabricated and fiber-reinforced wires were applied to the teeth roughened with acid and Er:YAG or Er,Cr:YSGG laser. The surface roughness was observed by scanning electron and atomic force microscopy. The samples were analyzed for shear bonds. The dead wire and acid group were found to have the highest bonding strength and the strengths for all groups in which acid was used as an agent were found to be higher than others. Deformation of retainers was most noted in the dead wire-acid group. Among all the groups, the CAD/CAM-fabricated wire group showed the least deformation, with no deformation observed. In this study, it was determined that there is a significant correlation between ARI scores and agents. Consequently, acid etching was found to create more enamel surface roughness than laser groups. It was also seen that the combined use of the acid method and dead soft wire had the highest bond strength, even though it was not statistically significant. It was concluded that CAD/CAM-fabricated wire provides the opportunity for reuse in clinical applications due to its lack of deformation, being more conservative for the patient, and being more advantageous for the clinician in terms of session time, considering the residual adhesive amount left on the enamel surface.

https://ift.tt/2OLIuyc

In situ phytoremediation characterization of heavy metals promoted by Hydrocotyle ranunculoides at Santa Bárbara stream, an anthropogenic polluted site in southern of Brazil

Abstract

Aquatic environments are widely affected by anthropogenic activities and efficient remediation of these areas requires detailed studies for each natural ecosystem. This research aimed to evaluate the natural phytoremediation potential of Hydrocotyle ranunculoides L., a floating aquatic macrophyte located in a polluted aquatic environment in South of the Rio Grande do Sul, Brazil. Nutrients such as P, K, Ca, Mg, and S and heavy metals such as Cu, Zn, Fe, Mn, Na, Cd, Cr, Ni, Pb, Al, As, Co, and V content in the roots and shoots of the plants were evaluated through nitric perchloric acid digestion (HNO₃-HClO₄) methods and quantified by ICP-OES. Bioconcentration factor (BCF), translocation factor (TF), plant effective number (PEN), and potential phytoremoval (mg m⁻²) were carried out. H. ranunculoides showed a substantial ability for phytoextracting P, Na, and As, since showed ability of uptake these elements from the water and translocate them to the shoots of the plants. H. ranunculoides also showed potential for application in rhizofiltration of Mg, S, Cu, Zn, Fe, Mn, Cd, Cr, Ni, Pb, Al, and V, since exhibited high potential to uptake higher levels in the roots. The highest potential for bioremoval (mg m⁻²) of the H. ranunculoides was detected for K, Ca, P (recommending thus the use for phytoextraction), Fe, and Al (highly recommended for rhizofiltration). Therefore, this species under study showed high potential for in situ phytoremediation at Santa Bárbara stream, and as a widespread species, it might be tested for phytoremediation in other sites.

https://ift.tt/2OLCRA4

The way forward confronting eco-environmental challenges during land-use practices: a bibliometric analysis

Abstract

With rapid urbanisation and industrialisation, land-use practice, while satisfying the ever-increasing desires of our material civilisation in the short term, may undermine natural ecosystems on a local, regional and global scale in the long run. Innovative and sustainable land-use practices should be developed in response, so that eco-environmental problems can assessed and dealt with during the whole process of land-use planning, construction, operation, maintenance and management. Using a bibliometric analysis, this study has traced global trends in land-use research from 1992 to 2016, as indexed in the Science Citation Index EXPANDED (SCI-EXPANDED) and the Social Sciences Citation Index (SSCI). A novel method called 'word cluster analysis' has revealed that hotspot analysis is one of the emerging techniques, tools and strategies used to respond to, improve, and protect deteriorating ecosystems during land use. Based on involving various elements, the emerging analytical techniques and tools, including geographical information systems (GIS) and remote sensing, have attracted attention for their ability to assess and solve increasingly serious eco-environmental problems, such as climate change, deforestation, soil erosion, greenhouse gas (GHG) emissions and eutrophication. Ecosystem services, biodiversity conservation, protected areas, and sustainable development are also potential resilience strategies used to confront eco-environmental destruction. The maximum benefits that can be derived from natural ecosystems should be pursued to achieve environmentally sustainable land-use development, strengthening the socio-economy and eco-environment, as well as enhancing the well-being of people and nature.

https://ift.tt/2AKvFkL

Cell Type and Species-specific Patterns in Neuronal and Non-neuronal Methylomes of Human and Chimpanzee Cortices

Abstract

Epigenetic changes have likely contributed to the large size and enhanced cognitive abilities of the human brain which evolved within the last 2 million years after the human–chimpanzee split. Using reduced representation bisulfite sequencing, we have compared the methylomes of neuronal and non-neuronal cells from 3 human and 3 chimpanzee cortices. Differentially methylated regions (DMRs) with genome-wide significance were enriched in specific genomic regions. Intraspecific methylation differences between neuronal and non-neuronal cells were approximately 3 times more abundant than interspecific methylation differences between human and chimpanzee cell types. The vast majority (>90%) of human intraspecific DMRs (including DMRs in retrotransposons) were hypomethylated in neurons, compared with glia. Intraspecific DMRs were enriched in genes associated with different neuropsychiatric disorders. Interspecific DMRs were enriched in genes showing human-specific brain histone modifications. Human–chimpanzee methylation differences were much more frequent in non-neuronal cells (n. DMRs = 666) than in neurons (n. DMRs = 96). More than 95% of interspecific DMRs in glia were hypermethylated in humans. Although without an outgroup we cannot assign whether a change in methylation occurred in the human or chimpanzee lineage, our results are consistent with a wave of methylation affecting several hundred non-neuronal genes during human brain evolution.

https://ift.tt/2LTbq9A

Penoscrotal swelling—an unusual occurrence in a patient with an anastomotic leak following ileostomy closure

Abstract

Diverting loop ileostomy is a frequently done procedure accompanying colorectal surgeries. Dreaded complication is anastomotic leak. Early identification of anastomotic leak and apt management is required for better outcomes. Most often leak presents with fever, abdominal pain, rigidity, fever and hemodynamic instability. We report a rare occurrence of penoscrotal oedema in a patient with anastomotic leak and spontaneously subsiding with drainage of leaked contents.

https://ift.tt/2neENV3

‘No visible lesions?’—an unusual case of Intestinal metaplasia of the bladder

Abstract

Intestinal metaplasia (IM) of the bladder is an extremely rare benign condition. The clinical features are similar to other bladder tumours. Its pathogenesis is unclear and its role as a precursor of adenocarcinoma has long been debated. Transurethral resection is the main form of treatment for IM. We report the case of a 49-year-old gentleman who presented with visible haematuria. He was submitted to multiple cystoscopies which showed no macroscopic irregularities. Radiological (CT urogram and multiparametric MRI) imaging revealed abnormalities within the bladder neck, suspicious of a neoplastic lesion. Following transurethral resection of his trigonal area, pathology demonstrated IM occurring on a background of cystitis glandularis. This case highlights the unusual difficulty in macroscopically diagnosing IM of the bladder compared to other neoplasms of the bladder. Therefore, in patients with persistent visible haematuria there should be a low threshold to perform biopsies.

https://ift.tt/2vHDYb0

A case of extensive hepatic adenomatosis in a renal transplant patient

Abstract

Hepatic adenomatosis (HA) is a rare condition that is traditionally associated with oral contraceptive use, glycogen storage diseases or metabolic syndrome. Here we present a renal transplant recipient that was diagnosed with HA and has none of the traditional risk factors. We review the literature on diagnosing and managing HA.

https://ift.tt/2LVFfXf

Pneumoperitoneum caused by tubo-ovarian abscess in an elderly patient

Abstract

Perforation of the gastrointestinal tract may present with abdominal pain and imaging demonstrating pneumoperitoneum. These findings usually require exploratory laparotomy for diagnosis and treatment. Tubo-ovarian abscess (TOA) is a complication of pelvic inflammatory disease presenting as an encapsulated inflammatory mass, but it can occasionally involve other pelvic organs. TOA is most commonly seen in females of reproductive age. Here we report a case of a 63-year-old female presenting with abdominal pain, fever and vomiting. Chest x rays and computed tomography scan revealed pneumoperitoneum. Emergent exploratory laparotomy was performed, and the findings were consistent with TOA and intact bowel. The patient recovered well after surgery with antibiotic therapy. In conclusion, while pneumoperitoneum is mostly caused by perforation of the gastrointestinal tract, other possibilities such as gynecological complications should be considered.

https://ift.tt/2vECvT6

Primary dural lymphoma mimicking meningioma: a clinical and surgical case report

Abstract

Introduction: Primary central nervous system lymphoma and its subtype, primary dural lymphoma, are types of non-Hodgkin's lymphoma that only occur in the central nervous system without any dissemination. They are extremely rare cases of extra nodal lymphomas accounting for 1--5% of intracranial tumors. Case report: We present a patient diagnosed with primary dural lymphoma in right frontal brain region who underwent surgical resection. Histopathological analysis revealed diffuse B-type large cell non-Hodgkin lymphoma. Patient underwent four cycles of R-CHOP and intrathecal methotrexate protocol. Six months postoperative, no signs of newly onset infiltration were present. Discussion: Primary dural lymphoma most likely presents with unusual radiological signs, which can easily be mistaken for meningioma, the main differential diagnosis. A thorough immunological, histopathological and clinical patients profile should be conducted in order to establish the certainty of diagnosis. Although there are few treatment options: surgery, radiotherapy or chemotherapy, there is no established treatment protocol.

https://ift.tt/2LTHKJm

Adjuvant radiation for T1-2N1 oral cavity cancer survival outcomes and utilization treatment trends: Analysis of the SEER database

Publication date: October 2018

Source: Oral Oncology, Volume 85

Author(s): Vanessa Torrecillas, Hailey M. Shepherd, Sam Francis, Luke O. Buchmann, Marcus M. Monroe, Shane Lloyd, Donald Cannon, Ying J. Hitchcock, John R. Weis, Jason P. Hunt, Jeffrey J. Houlton, Richard B. Cannon

Abstract

Objective

Evaluate current practice patterns in the use of adjuvant radiation for T1-2N1 OCSCC patients and investigate its efficacy in the population-based setting.

Materials and methods

This study extracted patients who were treated surgically for T1N1 and T2N1 OCSCC without adverse nodal features from the SEER database from 2004 to 2013. Patients with distant metastatic disease, unknown surgery or radiation status, or prior malignancies were excluded. Patients were divided into those who underwent surgical resection with and without adjuvant radiation. Disease-specific survival (DSS) and overall survival (OS) were the primary outcomes measured.

Results

746 patients met inclusion criteria and 70% received adjuvant radiation therapy. Treatment with adjuvant radiation therapy was significantly associated with improved 5-year DSS (65% versus 51%; p < 0.001) and OS (54% versus 44%; p = 0.007) for T1N1 tumors. Likewise, improved 5-year DSS (58% versus 38%; p = 0.009) and OS (48% versus 28%; p = 0.004) was shown in T2N1 tumors. Patients with T2N1 tumors wer significantly more likely to receive adjuvant radiation (75% versus 63%; p < 0.001). Those with insurance and high risk primary subsites: buccal, retromolar trigone, and hard palate were more likely to receive adjuvant radiation. The percent utilization of adjuvant radiation remained constant through the study period for T2N1 tumors (72–74%) but significantly decreased for T1N1 (71–55%) (p = 0.047).

Conclusion

Adjuvant radiation therapy is independently associated with a significant survival benefit for patients with both T1N1 and T2N1 OCSCC. However, this study demonstrates that patients with T1N1 cancer are less likely to receive adjuvant radiation and utilization is decreasing.

https://ift.tt/2ndop7b

Correction to: High PD-L1 expression indicates poor prognosis of HIV-infected patients with non-small cell lung cancer

The graphs are incorrectly identified in Fig. 3i, s and should be replaced with the following.

https://ift.tt/2LUTThi

Indocyanine Green Lymphangiography as an Adjunct for the Optimal Identification and Management of Lymphatic Leaks in the Groin

J reconstr Microsurg
DOI: 10.1055/s-0038-1667131

Background The treatment of lymphatic leaks and lymphoceles in the groin can be challenging with no optimal management determined to date. We postulate that indocyanine green (ICG) lymphangiography improves visualization of the site of a lymphatic leak and can optimize their management. Methods A retrospective review was conducted of all cases in which ICG lymphangiography was used in the management of lymphatic leaks in the groin over an 18-month span. The inciting surgical procedure resulting in the leak was determined. Following thorough debridement, ICG was injected intradermally in the distal extremity and the site of the lymphatic leak was documented (superficial or deep) and oversewn. Outcomes were reported with regard to healing, infection, time to drain removal, and adjunctive procedures. Results Fifteen patients underwent ICG lymphangiography during the surgical treatment of a lymphatic leak in the groin during the study period. In all cases, the site of the lymphatic leak was accurately identified and oversewn. In eight cases, the site of the lymphatic leak was in the subcutaneous tissue superficial to the femoral vessels rather than medial to the femoral vessels in the area of the lymph node basin. A local muscle flap was used in 10 cases simultaneously. All wounds healed primarily without an associated wound or infection. Conclusion ICG lymphangiography facilitated the identification of lymphatic leaks in the groin and optimized their management in these challenging cases, many of which may have been missed if the area around the inguinal lymph node basin was treated exclusively.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

https://ift.tt/2OMMJt9

Genital Sensibility in the Neophallus: Getting a Sense of the Current Literature and Techniques

J reconstr Microsurg
DOI: 10.1055/s-0038-1667360

Introduction Phalloplasty attempts to achieve a functional and aesthetic phallus. Sensation is a key component for sexual pleasure. Sensation is also important for protection in the setting of penile implant insertion. Little data are available on genital sensibility outcomes after phalloplasty, and there are no standardized approaches for assessment of either sensibility or erogenous perception. Methods A literature search of PubMed, Google Scholar, and MEDLINE databases was conducted with terms related to genital sensibility after phalloplasty. Data on patient demographics, nerves used for coaptation, and measurements of genital sensibility were collected. Pooled event rates were determined for recovered glans sensibility and recovered erogenous sensation using a Freeman–Tukey arcsine transformation. Results A total of 341 articles were identified of which 26 met the inclusion criteria for final analysis. The dorsal cutaneous branch of the pudendal nerve and ilioinguinal were the most common donor nerves. The lateral and medial antebrachial cutaneous and lateral femoral cutaneous were the most common recipient nerves. Pooled event rates suggest that some recovered glans sensibility occurs in more than 70% of cismale patients and in more than 90% of transmale patients. Recovered "erogenous" sensation occurs in more than 75% of cismale patients and more than 95% of transmale patients. In cismale patients, outcomes of recovered glans sensibility and erogenous sensation may be better for upper extremity recipient nerves than lower extremity recipient nerves. Conclusions Based on the limited data in current literature on genital sensibility after phalloplasty, it is difficult to draw evidence-based conclusions. Yet data support improved outcomes with innervation. A validated outcome measure of "erogenous sensation" and a standardized approach to measuring cutaneous sensibility are required.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

https://ift.tt/2AR0VPc

Remarkable geographical variations between India and Europe in carriage of the staphylococcal surface protein encoding sasX/sesI and in the population structure of methicillin-resistant Staphylococcus aureus belonging to clonal complex 8.

Remarkable geographical variations between India and Europe in carriage of the staphylococcal surface protein encoding sasX/sesI and in the population structure of methicillin-resistant Staphylococcus aureus belonging to clonal complex 8.

Clin Microbiol Infect. 2018 Aug 01;:

Authors: De Backer S, Xavier BB, Vanjari L, Coppens J, Lammens C, Vemu L, Carevic B, Hryniewicz W, Jorens P, Kumar-Singh S, Lee A, Harbarth S, Schrenzel J, Tacconelli E, Goossens H, Malhotra-Kumar S

Abstract
OBJECTIVES: SasX is a colonization-virulence factor that potentially underlies the success of MRSA-ST239 in Asia. We aimed to study the spread of sasX and the population structure of MRSA in two geographically distinct regions, Europe and India.
METHODS: MRSA (n=128) from screening and clinical samples from tertiary care patients in 12 European countries (n=119), and from India (n=9) were multilocus-sequence-typed and screened for sasX and its carrier φSPβ-like prophage by PCR. Whole genome sequencing was performed on sasX-harbouring strains from India (n=5) and Europe (n=2) and on a selection non-harbouring sasX (n=36) (2X150bp, Miseq, Illumina). Reads were mapped to the ST239 reference strain, TW20.
RESULTS: SasX and sesI, a sasX homologue native to S. epidermidis, were detected in 5/9 Indian MRSA belonging to ST239 and to other ST types of CC8. In contrast, sasX was restricted to 2 ST239 strains in Europe. The intact sasX and sesI carrier φSPβ-like prophages were ∼80 kb and ∼118 kb, and integrated in the yeeE gene. We identified 'novel' ST239 clades in India and Serbia that showed significant differences in base substitution frequencies (0.130 and 0.007, respectively, Tamura-Nei model) (P<0.05).
CONCLUSIONS: Our data highlight dissemination of sasX to non-ST239 STs of CC8. Detection of the S. epidermidis-associated sesI in MRSA provided unquestionable evidence of transfer between the two species. Stark differences in evolutionary rates between the novel Indian and Serbian ST239 clades identified here might be due to inherent clade characteristics or influenced by other environmental differences such as antibiotic use.

PMID: 30076977 [PubMed - as supplied by publisher]

https://ift.tt/2ncgyqw

Effect of Hochuekkito (Buzhongyiqitang) on Nasal Cavity Colonization of Methicillin-Resistant Staphylococcus aureus in Murine Model.

Related Articles

Effect of Hochuekkito (Buzhongyiqitang) on Nasal Cavity Colonization of Methicillin-Resistant Staphylococcus aureus in Murine Model.

Medicines (Basel). 2018 Aug 01;5(3):

Authors: Minami M, Konishi T, Makino T

Abstract
Background: Methicillin-resistant Staphylococcus aureus (MRSA) infections are largely preceded by colonization with MRSA. Hochuekkito is the formula composing 10 herbal medicines in traditional Kampo medicine to treat infirmity and to stimulate immune functions. We evaluated the efficacy of hochuekkito extract (HET) against MRSA colonization using a nasal infection murine model. Methods: We evaluated the effects of HET as follows: (1) the growth inhibition by measuring turbidity of bacterial culture in vitro, (2) the nasal colonization of MRSA by measuring bacterial counts, and (3) the splenocyte proliferation in mice orally treated with HET by the ³H-thymidine uptake assay. Results: HET significant inhibited the growth of MRSA. The colony forming unit (CFU) in the nasal fluid of HET-treated mice was significantly lower than that of HET-untreated mice. When each single crude drug-Astragali radix, Bupleuri radix, Zingiberis rhizoma, and Cimicifugae rhizome-was removed from hochuekkito formula, the effect of the formula significantly weakened. The uptake of ³H-thymidine into murine splenocytes treated with HET was significantly higher than that from untreated mice. The effects of the modified formula described above were also significantly weaker than those of the original formula. Conclusions: Hochuekkito is effective for the treatment of MRSA nasal colonization in the murine model. We suggest HET as the therapeutic candidate for effective therapy on nasal cavity colonization of MRSA in humans.

PMID: 30071688 [PubMed]

https://ift.tt/2vDmaOu

Unveiling the fate of adhering bacteria to antimicrobial surfaces: expression of resistance-associated genes and macrophage-mediated phagocytosis.

Related Articles

Unveiling the fate of adhering bacteria to antimicrobial surfaces: expression of resistance-associated genes and macrophage-mediated phagocytosis.

Acta Biomater. 2018 Jul 30;:

Authors: Alves DF, Magalhães AP, Neubauer D, Bauer M, Kamysz W, Pereira MO

Abstract
Since most antibacterial coatings reported to fight biomaterial-associated infections (BAI) fail in completely preventing bacterial colonization, it is crucial to know the impact of that small fraction of adhered bacteria in BAI recrudescence. This study aims to understand the fate of Staphylococcus aureus able to adhere to an antimicrobial coating previously developed, in terms of potential development of bacterial resistance and their macrophage-mediated phagocytosis. Antimicrobial coating comprised the co-immobilization of Palm peptide and DNase I onto polydimethylsiloxane. Expression of genes associated to resistance and virulence mechanisms showed that cells in contact with antimicrobial surfaces for a long period of 30 days, exhibit genes equally or less expressed, as compared to cells recovered from control surfaces. Recovered cells also exhibit the same susceptibility patterns, which strengthens the evidence of no resistance development. Remarkably, cells adhered to modified surfaces shows a reduced metabolic activity upon vancomycin treatment unlike the cells found on control surfaces, which can be identified as a clinical opportunity for prophylactically administration after implant surgery. Furthermore, results highlight that functionalization of PDMS with Palm and DNase I should not compromise the action of host immune cells. The overall results reinforce the potential of this antimicrobial strategy to fight BAI.

PMID: 30071350 [PubMed - as supplied by publisher]

https://ift.tt/2nbG5QL

Temporal Variation of Staphylococcus aureus clonal complexes in Atopic Dermatitis - a follow up study.

Related Articles

Temporal Variation of Staphylococcus aureus clonal complexes in Atopic Dermatitis - a follow up study.

Br J Dermatol. 2018 Aug 02;:

Authors: Clausen ML, Edslev SM, Nørreslet LB, Sørensen JA, Andersen PS, Agner T

Abstract
BACKGROUND: A strong link between disease severity and S. aureus colonization of the skin has been reported in patients with atopic dermatitis (AD). In the present study, temporal variations in S. aureus colonization and S. aureus CC-type in AD patients are examined, and linked to disease severity, skin barrier properties and filaggrin (FLG) gene mutations.
METHODS: A follow-up study of a cohort of 101 adult AD patients recruited from an outpatient clinic. Bacterial swabs were taken at baseline and at follow-up from lesional skin, non-lesional skin and nose. Swabs positive for S. aureus were characterized by spa and the respective clonal complex (CC) type assigned. Patients were characterized with respect to disease severity (SCORAD), skin barrier properties (TEWL, pH) and FLG gene mutations.
RESULTS: A total of 63 patients participated in a follow-up visit. Twenty-seven patients (42.9%) were colonized at both visits, 27 were colonized only at one visit and 9 patients (14.3%) were not colonized at either visit. Of patients colonized at both visits a total of 51.9% remained colonized with the same CC-type at follow-up. Change in CC-type was related to an increase in SCORAD of 10.7 points compared to patients who carried the same CC-type who had a reduction in SCORAD of 4.4 points. Significantly higher skin pH was found in patients colonized at both visits, while change in CC-type was not related to TEWL, pH or FLG gene mutations.
CONCLUSION: Data indicates that temporal variation in S. aureus CC-type is linked to flares of the disease. This article is protected by copyright. All rights reserved.

PMID: 30070683 [PubMed - as supplied by publisher]

https://ift.tt/2vCiIDD

Increasing tolerance of hospital Enterococcus faecium to handwash alcohols.

Related Articles

Increasing tolerance of hospital Enterococcus faecium to handwash alcohols.

Sci Transl Med. 2018 Aug 01;10(452):

Authors: Pidot SJ, Gao W, Buultjens AH, Monk IR, Guerillot R, Carter GP, Lee JYH, Lam MMC, Grayson ML, Ballard SA, Mahony AA, Grabsch EA, Kotsanas D, Korman TM, Coombs GW, Robinson JO, Gonçalves da Silva A, Seemann T, Howden BP, Johnson PDR, Stinear TP

Abstract
Alcohol-based disinfectants and particularly hand rubs are a key way to control hospital infections worldwide. Such disinfectants restrict transmission of pathogens, such as multidrug-resistant Staphylococcus aureus and Enterococcus faecium Despite this success, health care infections caused by E. faecium are increasing. We tested alcohol tolerance of 139 hospital isolates of E. faecium obtained between 1997 and 2015 and found that E. faecium isolates after 2010 were 10-fold more tolerant to killing by alcohol than were older isolates. Using a mouse gut colonization model of E. faecium transmission, we showed that alcohol-tolerant E. faecium resisted standard 70% isopropanol surface disinfection, resulting in greater mouse gut colonization compared to alcohol-sensitive E. faecium We next looked for bacterial genomic signatures of adaptation. Alcohol-tolerant E. faecium accumulated mutations in genes involved in carbohydrate uptake and metabolism. Mutagenesis confirmed the roles of these genes in the tolerance of E. faecium to isopropanol. These findings suggest that bacterial adaptation is complicating infection control recommendations, necessitating additional procedures to prevent E. faecium from spreading in hospital settings.

PMID: 30068573 [PubMed - in process]

https://ift.tt/2KpUJgp

Enhanced disinfection leads to reduction of microbial contamination and a decrease in patient colonization and infection.

Related Articles

Enhanced disinfection leads to reduction of microbial contamination and a decrease in patient colonization and infection.

Infect Control Hosp Epidemiol. 2018 Jul 31;:1-4

Authors: Rutala WA, Kanamori H, Gergen MF, Knelson LP, Sickbert-Bennett EE, Chen LF, Anderson DJ, Sexton DJ, Weber DJ, and the CDC Prevention Epicenters Program

Abstract
In this prospective study, we monitored 4 epidemiologically important pathogens (EIPs): methicillin-resistane Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Clostridium difficile, and multidrug-resistant (MDR) Acinetobacter to assess the effectiveness of 3 enhanced disinfection strategies for terminal room disinfection against standard practice. Our data demonstrated that a decrease in room contamination with EIPs of 94% was associated with a 35% decrease in subsequent patient colonization and/or infection.

PMID: 30060770 [PubMed - as supplied by publisher]

https://ift.tt/2vzaFaA

Staphylococcus aureus colonization and non-influenza respiratory viruses: interactions and synergism mechanisms.

Related Articles

Staphylococcus aureus colonization and non-influenza respiratory viruses: interactions and synergism mechanisms.

Virulence. 2018 Jul 30;:

Authors: Morgene MF, Botelho-Nevers E, Grattard F, Pillet S, Berthelot P, Pozzetto B, Verhoeven PO

Abstract
Viral infections of the respiratory tract can be complicated by bacterial superinfection, resulting in a significantly longer duration of illness and even a fatal outcome. In this review, we focused on interactions between S. aureus and non-influenza viruses. Clinical data evidenced that rhinovirus infection may increase the S. aureus carriage load in humans and its spread. In children, respiratory syncytial virus infection is associated with S. aureus carriage. The mechanisms by which some non-influenza respiratory viruses predispose host cells to S. aureus superinfection can be summarized in three categories: i) modifying expression levels of cellular patterns involved in S. aureus adhesion and/or internalization, ii) inducing S. aureus invasion of epithelial cells due to the disruption of tight junctions, and iii) decreasing S. aureus clearance by altering the immune response. The comprehension of pathways involved in S. aureus-respiratory virus interactions may help developing new strategies of preventive and curative therapy.

PMID: 30058450 [PubMed - as supplied by publisher]

https://ift.tt/2Ke6DK2

Persistent and Transient Airborne MRSA Colonization of Piglets in a Newly Established Animal Model.

Related Articles

Persistent and Transient Airborne MRSA Colonization of Piglets in a Newly Established Animal Model.

Front Microbiol. 2018;9:1542

Authors: Rosen K, Roesler U, Merle R, Friese A

Abstract
Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) was first found in 2005 and is up to date widespread in animal husbandry reservoir - focusing on pig farming. The regular detectability of MRSA in the air of pigsties as well as in exhaust air of pig farms (mean count: 102 cfu/m3) poses the question whether an airborne spread and, therefore, a MRSA colonization of animals via the airborne route exists. To answer this question, we exposed three groups of nine MRSA-negative tested piglets each to a defined airborne MRSA concentration (102, 104, and 106 cfu/m3) in our aerosol chamber for 24 h. In the following observation period of 21 days, the MRSA status of the piglets was monitored by taking different swab samples (nasal, pharyngeal, skin, conjunctival, and rectal swab). At the end of the experiment, we euthanized the piglets and investigated different tissues and organs for the spread of MRSA. The data of our study imply the presence of an airborne MRSA colonization route: the animals exposed to 106 cfu/m3 MRSA in the air were persistent colonized. The piglets exposed to an airborne MRSA concentration of 104 cfu/m3 were transient, and the piglets exposed to an airborne MRSA concentration of 102 cfu/m3 were not colonized. Consequently, a colonization via the airborne route was proven.

PMID: 30057576 [PubMed]

https://ift.tt/2vBvaUn

The Protective Effect of Microbiota on S. aureus Skin Colonization Depends on the Integrity of the Epithelial Barrier.

Related Articles

The Protective Effect of Microbiota on S. aureus Skin Colonization Depends on the Integrity of the Epithelial Barrier.

J Invest Dermatol. 2017 04;137(4):976-979

Authors: Burian M, Bitschar K, Dylus B, Peschel A, Schittek B

PMID: 27923738 [PubMed - indexed for MEDLINE]

https://ift.tt/2nbGgvl

Flavored tobacco to E-cigarette’s: How the tobacco industry sustains its product flow

Publication date: Available online 5 August 2018

Source: Oral Oncology

Author(s): A. Thirumal Raj, Shankargouda Patil, Archana A. Gupta, G. Suveetha

https://ift.tt/2vknuXg

Short Stay Thyroid Surgery: Can We Replicate the Same in Low Resource Setting?

Introduction. The concept of short stay thyroidectomy has been tested and in practice in the developed world; the same has not been replicated in countries with limited resources due to lack of organized healthcare system. So, in this study, we tried to analyze if short stay thyroid surgery can be performed in a cost-effective way in developing countries and also if the endocrine surgical trainee can deliver these services safely. Methods. The study was conducted prospectively from January 2013 to July 2014, at Department of Endocrine Surgery, SGPGIMS, Lucknow, India. Study group included patients undergoing short stay hemithyroidectomy whereas matched patients who qualified for inclusion criteria but did not undergo short stay surgery due to various reasons constituted control group. Outcome in both the groups was compared in terms of complication rates, cost benefit, and patient satisfaction. Subgroup analysis was also done for trainee versus consultant performed short stay thyroid surgery. Results. A total of 439 patients with surgical thyroid disorders were evaluated at our institute during the study period and out of these 110 patients (58 cases and 52 controls) fulfilled the inclusion criteria. Younger patients with low socioeconomic status who were paying out of pocket were found to be more inclined to short stay thyroid surgery. There was no significant difference between the two groups in terms of postanesthetic discharge score (PADS), complication rates, and patients satisfaction; however there was significant reduction (p

https://ift.tt/2vE4Ngm