Acute hepatitis associated with Q fever in a man in Greece: a case report

Coxiella burnetii is the causative agent of Q fever. Q fever is a worldwide zoonosis that is responsible for various clinical manifestations. However, in Greece hepatitis due to Coxiella is rarely encountered. A case of Q fever associated with hepatitis is reported here. Diagnosis was made by specific serological investigation (enzyme-linked immunosorbent and indirect immunofluorescene assays) for Coxiella burnetii

Gene therapy target investigation in diabetic macroangiopathy: AGEs-RAGE system and PPARγ in monocytes

[…] Aim: In the study we examined the importance of AGEs-RAGE system, the nuclear receptor PPARγ and monocytes surface antigen CD36 in diabetic macroangiopathy and we explored the possibility of RAGE gene therapy. Therefore we investigated: a) SRAGE levels in diabetics with CAD and in non-diabetics without CAD, b) the relationship between serum fluorescent AGEs and SRAGE and atheromatic plaque in diabetics with CAD, c) the effect of siRNA induced RAGE inhibition in monocytes from diabetics and controls in regard to production of ROS and CD36 after AGEs administration and d) the prevalence of PPARγ Pro12Ala polymorphism in diabetics with CAD, without CAD and in controls. […][…] Σκοπός: Στη μελέτη μας εξετάσθηκε η σημασία του συστήματος AGEs-RAGE, του πυρηνικού υποδοχέα PPARγ και του αντιγόνου επιφανείας των μονοπυρήνων CD36 στην αθηρωμάτωση της διαβητικής μακροαγγειοπάθειας και η δυνατότητα παρέμβασης με γονιδιακή θεραπεία. Για το σκοπό αυτό διερευνήθηκαν: α) τα επίπεδα S-RAGE σε διαβητικούς με ΣΝ και σε μάρτυρες μη διαβητικούς χωρίς ΣΝ, β) η σχέση των επιπέδων των φθοριζόντων AGEs και του S-RAGE ορού με την έκταση και βαρύτητα της αθηρωματικής πλάκας στους διαβητικούς με ΣΝ, γ) η επίδραση του siRNA του RAGE σε μονοπύρηνα διαβητικών και υγιών αναφορικά με την παραγωγή ROS και την έκφραση του CD36 σε αυτά μετά την χορήγηση AGEs και δ) η συχνότητα του πολυμορφισμού pro12ala του PPARγ σε διαβητικούς και υγιείς και η σχέση του με την παρουσία ΣΝ σε αυτούς. […

Simulation-based quantification of native T1 and T2 of the myocardium using a modified MOLLI scheme and the importance of Magnetization Transfer

Quantitative cardiovascular Magnetic Resonance Imaging techniques are gaining wide acceptance within the MR community due to their potential to diagnose non-localized disease, guide therapy and improve patient outcome. During the last decade, there has been an increasing interest for developing new techniques that allow for simultaneous quantification of both T1 and T2 maps of myocardium. Newer studies demonstrated that the incorporation of MRI simulations could yield similar results to conventional mapping techniques in the myocardium. However, these simulation-based quantitative MR techniques usually compare the in-vivo T1 estimates against less accurate T1 techniques, whereas they present inconsistencies between simulation studies, phantom and in-vivo measurements. Moreover, these studies do not investigate the effect of Magnetization Transfer on the myocardial T1 and T2 estimates but are usually validated on phantoms where the MT effect is small. The main aim of this study was to perform simultaneous mapping of the native T1 and T2 of the myocardium through the utilization of a modified MOLLI pulse sequence and the incorporation of advanced MR simulations through the SQUAREMR framework. A second aim of this study was to investigate the effect of MT on simulation-based quantitative MR techniques. A conventional MOLLI pulse sequence was modified so as to present combined high T2 sensitivity and low MT effect. The new technique was applied in healthy volunteers and demonstrated an improved T1 accuracy compared to the conventional MOLLI and a T2 accuracy similar to the one provided by the T2prep-bSSFP method. The effect of MT on T1 and T2 estimates was also investigated in the current study. Phantoms with an increasing MT effect as well as phantoms without an MT effect were included in this work whereas several variants of the modified-MOLLI that introduce different amounts of T2 modulation on the MR signal and induce different MT effects were applied on the phantoms. The proposed simulation-based quantitative MR technique for simultaneous T1 and T2 mapping of the myocardium does not require the incorporation of a complicated custom designed pulse sequence and does not require a complicated reconstruction workflow. Moreover, the current study demonstrates for the first time that MT plays an important role in the simulation-based quantitative MR studies and points out the necessity of incorporating the study of MT in future techniques

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)