High number of circulating CD34+ cells in patients with myelophthisis.

Hematopoietic Stem Cells High number of circulating CD34+ cells in patients with myelophthisis Six patients with bone marrow micrometastases from solid cancers presented with increased numbers of circulating CD34+ cells; the CD34+ cell counts were very high in some cases. By contrast, no patient with metastatic cancer without bone marrow involvement showed raised numbers of circulating hemopoietic progenitors. haematologica 2005; 90:976-977 (http:/

Mutation in a conserved motif next to the insulin receptor key autophosphorylation sites de-regulates kinase activity and impairs insulin action.

We have recently reported two non-insulin-dependent diabetic patients exhibiting a heterozygous point mutation (R1152-Q) next to the key tyrosine autophosphorylation sites (Y1146, Y1150, Y1151) of the insulin receptor. In the present study, we demonstrate that the Q1152 mutation alters a previously unrecognized consensus sequence in the insulin receptor family of tyrosine kinases. To define the effect of this alteration on insulin receptor function, the mutant insulin receptor (Q1152) was constructed and overexpressed in NIH-3T3 cells. In spite of normal insulin binding, "in vivo" and "in vitro" autophosphorylation as well as transphosphorylation by the wild-type receptor (WT) were deficient in Q1152 as compared with the transfected WT receptors. Insulin-stimulated kinase activity toward poly(Glu, Tyr) 4:1 and the endogenous substrates p120 and p175 were also impaired in Q1152. However, insulin-independent kinase activity of Q1152 was 2-5-fold higher than that of WT. While insulin stimulated 2-deoxyglucose uptake and glycogen synthase activity in WT-transfected cells with a sensitivity proportional to receptor number, no insulin stimulation was observed in Q1152 cells. Similar to the kinase, insulin-independent glycogen synthase activity and 2-deoxyglucose uptake were 2-fold higher in Q1152 than in either WT or parental cells. We conclude that the Q1152 mutation deregulates insulin receptor kinase and generates insulin insensitivity in cells. Alterations in this highly conserved region of the insulin receptor may contribute to non-insulin dependent diabetes mellitin pathogenesis in humans

Force-frequency relationship during dobutamine stress echocardiography predicts exercise tolerance and BNP levels in patients with chronic congestive heart failure

Purpose: D obutamine stress echocardiography (DSE) is widely used to evaluate myocardial contractile reserve; it provides prognostic information in patients with chronic congestive heart failure (CHF). The force?frequency relationship (FFR) is a method for evaluate LV contractility during DSE . The aim of our study is to assess the relationship among FFR, BNP levels, and aerobic exercise capacity in CHF patients. Methods and materials: 37 CHF patients (age 67?8 years, 54% with an ischemic etiology), underwent high dose DSE (up to 40 m g/kg/min). FFR was determined as a ratio between systolic cuff pressure and end-systolic volume (biplane using a Simposon rule) assessed at baseline and peak DSE . BNP levels were determined on blood samples withdrawn at baseline. After a few hours, CHF patients underwent cardiopulmonary exercise test with expired gas measurement. Results: Mean ejection fraction was 32?7% and NHYA class 2.5?0.6. FFR was directly related to peak oxygen consumption (Figure Left), LV ejection fraction (r=0.398, p=0.015) and mitral annulus peak systolic velocity (r=0.428, p=0.013). FFR was inversely related to NYHA class (r=-0.43, p=0.013), LV end-diastolic diameter (r=-0.377, p=0.022), LV intraventricular dyssynchrony (r=-0.394, p=0.016), and BNP levels (Figure Right). At multiple regression analysis, FFR (B=0.502, p= 0.004) and E/Ea ratio (B=-0.336, p=0.044) were the best predictors of exercise tolerance. Conclusions: In patients with stable CHF, impaired myocardial contractility during DSE is related to higher BNP levels and poorer exercise tolerance

Super selective arterial embolization to treat radiation-induced hemorrhagic gastritis: a case report and review of the literature

Radiation-induced hemorrhagic gastritis (RIHG) is a rare but potentially fatal event following radiotherapy for locally advanced gastric cancer; the treatment of this condition is not standardized. Only few cases of RIHG have been reported, treated with different therapeutic approaches. Here we report the case of a 79-year-old patient who underwent subtotal gastrectomy for gastric cancer, followed by adjuvant chemo-radiotherapy. Approximately 3 months after the end of the treatment, she developed recurrent diffuse bleeding originating from the entire mucosa of the gastric pouch and from a marginal ulcer. As the bleeding was refractory to several endoscopic treatments and surgery was not indicated, the patient underwent two sessions of transcatheter selective arterial embolization, with resolution of bleeding. Arterial embolization has already been reported for the treatment of hemorrhagic cystitis, developing after irradiation of the pelvis for prostate, bladder, rectum, and cervix cancer. However, to our knowledge, it has never been reported as a treatment for hemorrhagic gastritis. Based on this case, we suggest arterial embolization as an option in the management of RIHG, when standard endoscopic treatment fails

Hepatic follicular lymphoma in an old patient with Crohn’s disease: a rare case and review of the literature

OBJECTIVE: Crohn’s Disease (CD) has been associated with non-Hodgkin lymphoma. Follicular Lymphoma (FL) limited to the liver is extremely rare, accounting for 1% to 4.4% of all Primary Hepatic Lymphoma (PHL). CASE PRESENTATION: In 2018, an 85-years old male patient with post-operative recurrence of ileal CD referred rare episodes of fever and mild diffuse abdominal pain. Since cholecystectomy in 2001, clinical history was characterized by recurrent episodes of cholangitis and common bile duct stones. In 2018, ultrasonography and MRI showed a solid focal hepatic lesion (FHL)(4.5 cm x 2.5 cm) in the IV hepatic segment. The radiographic aspect of the lesion was unusual. Initially, focal nodular hyperplasia was suspected. Clinical history of cholangitis and radiological findings subsequently suggested a diagnosis of Hepatic Abscess (HA). A progressive enlargement of the FHL (7.3 cm x 5.8 cm) despite antibiotic treatments, led to perform a liver biopsy. Histological and immunophenotypi-cal analysis of the FHL (7.5 cm x 5.4 cm) enabled a final diagnosis of FL. The “in situ” hybridization for Epstein-Barr virus (EBER) was negative. No additional lesions related to FL were initially detected, thus suggesting a very rare case of PHL in an old patient with CD never treated with thiopurines. CONCLUSIONS: This case report highlights the need to consider a rare diagnosis of FL of the liver in patients showing a challenging focal hepatic lesion of unknown origin

Przygotowanie jelita do kolonoskopii: Zalecenia Europejskiego Towarzystwa Endoskopii Przewodu Pokarmowego

 CEL: Niniejsze zalecania są oficjalnym stanowiskiem Europejskiego Towarzystwa Endoskopii Przewodu Pokarmowego (ESGE, European Society of Gastrointestinal Endoscopy) na temat wyboru sposobu przygotowania jelita do kolonoskopii.METODY: Zalecania opracowano na podstawie przeglądu literatury ukierunkowanego na dowody dotyczące przygotowania jelita do kolonoskopii. Siła zaleceń i jakość dowodów, na których je oparto zostały określone przy użyciu systemu GRADE (Grading of Recommendations Assessment, Development and Evaluation).WYNIKI: Najważniejsze zalecenia są następujące:1. ESGE zaleca w dniu poprzedzającym kolonoskopię dietę ubogoresztkową (słabe zalecenie, dowody umiarkowanej jakości);2. ESGE zaleca w rutynowym przygotowaniu do kolonoskopii 4 litry roztworu glikolu polietylenowego (PEG) w dwóch dawkach podzielonych lub, w przypadku kolonoskopii wykonywanej po południu, w jednorazowej dawce porannej. Alternatywą, szczególnie w przygotowaniu do kolonoskopii w warunkach ambulatoryjnych, może być podanie 2 l PEG z kwasem askorbinowym lub pikosiarczanu sodu z cytrynianem magnezu w dwóch dawkach podzielonych lub, w przypadku kolonoskopii wykonywanej po południu, w jednorazowej dawce porannej (silne zalecenie, dowody wysokiej jakości). Odstęp pomiędzy ostatnią dawką preparatu do przygotowania a kolonoskopią nie powinien przekraczać 4 godzin;3. ESGE radzi ze względów bezpieczeństwa nie używać rutynowo do przygotowania do kolonoskopii preparatów fosforanu sodu (silne zalecenie, dowody niskiej jakości).

An Enriched European Eel Transcriptome Sheds Light upon Host-Pathogen Interactions with Vibrio vulnificus

Infectious diseases are one of the principal bottlenecks for the European eel recovery. The aim of this study was to develop a new molecular tool to be used in host-pathogen interaction experiments in the eel. To this end, we first stimulated adult eels with different pathogen-associated molecular patterns (PAMPs), extracted RNA from the immune-related tissues and sequenced the transcriptome. We obtained more than 2 x 10(6) reads that were assembled and annotated into 45,067 new descriptions with a notable representation of novel transcripts related with pathogen recognition, signal transduction and the immune response. Then, we designed a DNA-microarray that was used to analyze the early immune response against Vibrio vulnificus, a septicemic pathogen that uses the gills as the portal of entry into the blood, as well as the role of the main toxin of this species (RtxA13) on this early interaction. The gill transcriptomic profiles obtained after bath infecting eels with the wild type strain or with a mutant deficient in rtxA13 were analyzed and compared. Results demonstrate that eels react rapidly and locally against the pathogen and that this immune-response is rtxA13-dependent as transcripts related with cell destruction were highly up-regulated only in the gills from eels infected with the wild-type strain. Furthermore, significant differences in the immune response against the wild type and the mutant strain also suggest that host survival after V. vulnificus infection could depend on an efficient local phagocytic activity. Finally, we also found evidence of the presence of an interbranchial lymphoid tissue in European eel gills although further experiments will be necessary to identify such tissue

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic