RESUMEN
In recent decades, the world has witnessed a remarkable resurgence of bedbugs (Hemiptera: Cimicidae). Although populations of the common bedbug, Cimex lectularius L., expanded in temperate regions of its original distribution, the tropical bedbug, C. hemipterus (F.), increased its abundance in warmer regions, where it also had been historically distributed. However, C. hemipterus has recently been observed to be expanding to other areas, e.g. North Australia, Middle East, the United States and Russia. In other parts of Europe, few sporadic and ephemeral introductions of C. hemipterus were recorded until recently. We conducted an extensive sampling of European bedbug populations starting in 2002 and found that C. hemipterus has recently become locally established. Among 566 examined infestations, nearly all of which involved C. lectularius, C. hemipterus occurred in six infestations collected since 2019. In at least three cases, the social background of inhabitants of the infested properties indicated that tropical bedbugs likely spread within local communities. Using cytochrome oxidase subunit I, we linked five of the infestations to the most common haplotype found globally, and one to an African haplotype. In all infestations, we observed two kdr-associated mutations in the sodium channel gene, which are also commonly found across the world.
Asunto(s)
Chinches , Infestaciones Ectoparasitarias , Animales , Infestaciones Ectoparasitarias/epidemiología , Infestaciones Ectoparasitarias/veterinaria , Europa (Continente) , Medio Oriente , MutaciónRESUMEN
INTRODUCTION: Acute calculous cholecystitis is a common disease treated mostly by surgical therapy - laparoscopic cholecystectomy (CHE), particularly upon the common failure of conservative therapy. Timing of the surgery is essential for the development of perioperative complications. METHODS: We carried out a retrospective study with patients hospitalised at our Department of Surgery, University Hospital Královské Vinohrady between January 2013 and December 2015 for the treatment of acute calculous cholecystitis. We had a set of 209 patients. We looked for the presence of perioperative complications in relation to the time of surgery - cholecystectomy. RESULTS: Having compared patients with primary surgical treatment of acute calculous cholecystitis we found that twice as many patients after acute cholecystectomy done within 24 hours from admission developed 26% perioperative complications compared to those who had the surgery later than within 24 hours from their admission to the hospital (43.9%). We also found that there was a higher number of conversions from laparoscopic to open cholecystectomy in the group of patient undergoing cholecystectomy within 24 hours from admission. CONCLUSION: Timing of the surgical treatment of acute calculous cholecystitis is essential for the development of postoperative complications. Acute laparoscopic cholecystectomy done by an experienced surgeon within 24 hours from admission of the patient to the hospital should be the golden standard, irrespective of the duration of the symptoms or severity of the acute cholecystitis. The sooner, the better.
Asunto(s)
Colecistectomía Laparoscópica , Colecistitis Aguda , Enfermedad Aguda , Colecistectomía , Colecistitis Aguda/cirugía , Hospitalización , Humanos , Tiempo de Internación , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Organisms with wide geographical or phenotypic diversity often constitute assemblages of genetically distinct species or lineages. Within parasites, an emergence of host-specific lineages is assumed to create such cryptic variability; however, empirical evaluation of these processes is scarce. Here, we analyse populations of a parasite with a complex life cycle, wide host spectrum and global distribution, with the aim to reveal factors underlying the evolution of host- or geography-dependent lineages. Using 15 microsatellite loci, deep genetic distances were observed between populations from distant geographical areas. On the local scale, host-mediated genetic structure was found among sympatric samples. Two lineages differing in the spectrum of infected hosts co-occurred in the Euro-Mediterranean area, and two distinct lineages were recovered from Lake Tana in Ethiopia. Although sampled across several host taxa and multiple localities, a lack of marked genetic structure was seen in the populations belonging to one of the European lineages. Only weak genetic differentiation between sympatric samples from two host species was found. Complexity of the parasite life-cycle contributed to such a stratified pattern. Differences in the immune response between fish hosts were suggested as the factor diversifying the populations locally; conversely, high mobility of the parasite due to migration with its bird (definitive) host were assessed to homogenize populations across the area of distribution. However, despite the high mobility, large bodies of salt water prevent the parasite from long-distance migrations, as was demonstrated in an example of the Mediterranean Sea which represented an effective barrier to gene flow.
Asunto(s)
Cestodos/genética , Genética de Población , Interacciones Huésped-Parásitos , Animales , Aves/parasitología , Etiopía , Peces/parasitología , Flujo Génico , Geografía , Mar Mediterráneo , Repeticiones de Microsatélite , Análisis de Secuencia de ADN , Especificidad de la EspecieRESUMEN
706 appendectomic procedures using laparoscopy were performed in the Surgical Clinic of the FTN hospital during 2003-2005. The group's mortality rate was nil, the morbidity rated 3.54%. The following complications were recorded: nine patients (1.27%) experienced infiltration in the right hypogastric region, which was confirmed on CT or ultrasound examinations, nine subjects (1.27%) suffered wound infections, two subjects (0.28%) developed subileus, in two subjects (0.28%) intraabdominal abscesses, and in one subject (0.14%) diffuse suppurative peritonitis were diagnosed, one subject (0.14%) developed intraabdominal hemorrhaging, in one subject (0.14%) intraabdominal hematoma was detected. Rates of complications in our group are similar to those presented in literature [1, 2, 3]. Based on their study group analysis, the authors found the laparoscopic appendectomy more beneficial for a patient than the open appendectomy.
Asunto(s)
Apendicectomía/efectos adversos , Laparoscopía/efectos adversos , HumanosRESUMEN
Phylogenetic analysis of sequences of the ITS-2 rRNA genes of 20 samples of pseudophyllidean cestodes of the family Diphyllobothriidae (Ligula, Digramma, Diphyllobothrium, and Schistocephalus) from different hosts and geographical regions revealed that: (1) the inclusion of ligulids (previously family Ligulidae) to the Diphyllobothriidae is correct; (2) Schistocephalus appears as the most basal taxon of the Diphyllobothriidae, well separated from Ligula and Digramma, thus supporting the validity of Schistocephalinae Dubinina, 1962; (3) Digramma belonged with samples of Ligula, thus suggesting its invalidity as a genus; and (4) isolates of Ligula, presumably belonging to Ligula intestinalis, are paraphyletic, indicating that this species may represent a complex of separate taxa. Our results indicate the necessity for a taxonomic revision of the family Diphyllobothriidae.
Asunto(s)
Cestodos/clasificación , Infecciones por Cestodos/veterinaria , ADN Espaciador Ribosómico/genética , Enfermedades de los Peces/parasitología , Filogenia , Análisis de Secuencia de ADN , Animales , Cestodos/genética , Infecciones por Cestodos/parasitología , ADN Espaciador Ribosómico/análisis , Diphyllobothrium/clasificación , Diphyllobothrium/genética , Peces/parasitología , Datos de Secuencia MolecularRESUMEN
BACKGROUND: Patients with systemic lupus erythematosus (SLE) who experience persistent multiorgan dysfunction, despite standard doses of intravenous cyclophosphamide, represent a subset of patients at high risk of early death. We investigated the safety and efficacy of immune suppression and autologous haemopoietic stem-cell infusion to treat such patients. METHODS: From 1996, we selected patients with persistent SLE despite use of cyclophosphamide. Patients underwent dose-intense immune suppression and autologous haemopoietic stem-cell (CD34) infusion. Peripheral blood lymphocytes were analysed by flow cytometry, ELISA, and T-cell-receptor spectratyping before and after transplantation. We mobilised autologous haemopoietic stem cells with 2.0 g/m2 cyclophosphamide and 10 microg/kg granulocyte colony stimulating factor daily, enriched with CD34-positive selection, and reinfused after immunosuppression with 200 mg/kg cyclophosphamide, 1 g methylprednisolone, and 90 mg/kg equine antithymocyte globulin. RESULTS: Nine patients underwent stem-cell mobilisation but two were excluded before transplantation because of infection. The remaining seven received high-dose chemotherapy and stem-cell infusion. Median time to an absolute neutrophil count higher than 0.5x10(9)/L and nontransfused platelet count higher than 20x10(9)/L was 9 days (range 8-11) and 11 days (10-13), respectively. At a median follow-up of 25 months (12-40), all patients were free from signs of active lupus. Renal, cardiac, pulmonary, and serological markers, and T cell phenotype and repertoire had normalised. INTERPRETATION: Patients remained free from active lupus and improved continuously after transplantation, with no immunosuppressive medication or small residual doses of prednisone. T-cell repertoire diversity and responsiveness was restored. Durability of remission remains to be established.
Asunto(s)
Antineoplásicos Alquilantes/uso terapéutico , Ciclofosfamida/uso terapéutico , Trasplante de Células Madre Hematopoyéticas , Lupus Eritematoso Sistémico/terapia , Adolescente , Adulto , Antígenos CD/sangre , Antígenos de Diferenciación de Linfocitos T/sangre , Antineoplásicos Alquilantes/administración & dosificación , Antineoplásicos Alquilantes/inmunología , Recuento de Células Sanguíneas , Creatinina/sangre , Ciclofosfamida/administración & dosificación , Ciclofosfamida/inmunología , Ensayo de Inmunoadsorción Enzimática , Citometría de Flujo , Humanos , Interferón gamma/sangre , Interleucina-4/sangre , Lectinas Tipo C , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
OBJECTIVE: To investigate the safety and efficacy of immune ablation with subsequent autologous hematopoietic stem cell transplantation (HSCT) in severe rheumatoid arthritis (RA). METHODS: Four patients with refractory RA and poor prognostic indicators were treated. Stem cells were collected and lymphocytes were depleted by 2.3-4.0 logs. The conditioning regimen included cyclophosphamide (200 mg/kg), antithymocyte globulin (90 mg/kg), and, for 1 patient, total body irradiation (TBI) with 400 cGy. Improvement was evaluated according to the American College of Rheumatology (ACR) preliminary definition of improvement in RA (ACR 20), and also according to the ACR 50 and ACR 70 criteria. RESULTS: HSCT was well tolerated. Three patients fulfilled the ACR 70 criteria at 1 month and 3 months post-HSCT. One patient did not fulfill the ACR 20 criteria because of persistent joint tenderness, despite improvement of the joint swelling. At 6 months post-HSCT, 1 patient fulfilled the ACR 70 criteria and 1 fulfilled the ACR 50 criteria, and these 2 patients fulfilled the ACR 70 criteria at 9 months post-HSCT. The other 2 patients (including the patient who received TBI) did not meet the ACR 20 criteria at 6 months and 9 months post-HSCT. The only patient with followup of >9 months fulfilled the ACR 70 criteria at 20 months post-HSCT. CONCLUSION: In this series, autologous HSCT was safe and effective in inducing major clinical response and maintained significant benefit for 2 patients at 9 months and 20 months posttreatment, respectively. Sustained response did not occur for 2 of 4 patients. A regimen dose-response effect may exist, but the addition of TBI did not prevent disease relapse for 1 of the patients. More aggressive T cell depletion of the autograft, use of a myeloablative regimen, or use of an allograft may be necessary to decrease relapse rates.
Asunto(s)
Artritis Reumatoide/terapia , Trasplante de Células Madre Hematopoyéticas , Adulto , Femenino , Estudios de Seguimiento , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Trasplante Autólogo/efectos adversosRESUMEN
BACKGROUND: With the advancement of genetics and hematopoiesis resulting in therapeutic applications, a growing focus has developed on the quality assessment of biological products generated for various cellular therapies. Endotoxin is a critical measure for the presence of Gram-negative bacteria, known to cause endotoxemia. Cellular products are currently regulated as medical devices. Each location engaged in clinical protocols is responsible for establishing a quality assurance program. METHODS: In this study, endotoxin levels were assayed using both the gel-clot and kinetic chromogenic Limulus amebocyte lysate (LAL) assays on 33 patients' cellular products, produced in clinical laboratory settings as part of a clinical trial or approved protocol. These patient samples include tumor infiltrating lymphocytes (HSVtk). We sought to identify the more reliable and informative method for the determination of endotoxin levels in a variety of cellular products, to meet the growing demand for standardization of product quality assessment. Comparison of the most sensitive gel-clot LAL test (0.03 EU/mL), with the kinetic chromogenic LAL test, with a lysate sensitivity of 0.005 EU/mL, found many advantages of the more sensitive method. RESULTS: The kinetic chromogenic LAL test, which has the greatest sensitivity, increased the percentage of samples with valid spike recoveries compared with the gel-clot LAL test from 65% to 70% at a 1:10 sample dilution; and from 81% to 88% at a 1:100 sample dilution. Ata sample dilution of 1:50 the kinetic chromogenic LAL test provided valid spike recoveries on 81% of all samples tested. DISCUSSION: In the interest of providing the highest quality and safety in the finished cellular product, the determination of endotoxin by the kinetic chromogenic LAL test is a rapid, effective, easy-to-use method to detect the presence of Gram-negative bacterial contamination.
Asunto(s)
Tratamiento Basado en Trasplante de Células y Tejidos/métodos , Endotoxinas/metabolismo , Linfocitos/microbiología , Sepsis/inmunología , Linfocitos T/inmunología , Bacterias Gramnegativas/metabolismo , Hematopoyesis , Humanos , Cinética , Prueba de Limulus , Linfocitos/metabolismo , Control de Calidad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Sepsis/diagnóstico , Sepsis/microbiologíaRESUMEN
This study will evaluate the safety and efficacy of allogenic donor lymphocyte infusions in patients who have relapsed hematologic malignancies after allogeneic bone marrow transplantation (BMT). Donor lymphocyte transfusions have resulted in the cure of some patients with relapsed leukemia or lymphoproliferative disorder after allogeneic BMT, but has been complicated by the development of graft versus host disease (GvHD). We hypothesize that a retroviral vector containing the Herpes simplex thymidine kinase (HStk) gene will allow for retention of the anti-leukemia response of transfused donor lymphocytes while allowing for the adverse effects of GVHD to be mitigated. Patients with relapsed hematologic malignancies after allogeneic BMT will be infused with ex vivo gene modified donor lymphocytes. The Herpes Simplex thymidine kinase (HStk) gene will be transduced into the cells ex vivo using LTKOSN. 1 vector supernate. Insertion of the HStk gene into lymphocytes confers a sensitivity to the anti-herpes drug ganciclovir (GCV). This selective destruction of donor lymphocytes in situ will be used to abrogate the effect of graft versus host disease, if it develops.