Percutaneous cholecystostomy:Single centre experience in 111 patients with an acute cholecystitis

'Purpose: 'To evaluate the safety and long-term outcome of percutaneous cholecystostomy (PC) under radiologic guidance for acute calculous cholecystitis (ACC) and acute acalculous cholecystitis (AAC) in all patients undergoing that procedure at our institution. 'Materials and methods: 'We performed a retrospective analysis of 111 patients who underwent PC from 2004 to 2012. Patients were divided into two groups: AAC and ACC. For all patients, comorbidity and American Society of Anesthesiologists (ASA) classification were determined. The indications, complications, recurrence rate and long-term outcome for both groups were analysed. The mean follow-up was 55 months. 'Results: 'Twenty-four patients with AAC and 87 patients with ACC underwent PC. The most common sonographic findings of ACC and AAC were gallbladder wall thickening (90,9%) and hydrops (72,9%). Twelve of 24 patients with AAC (50%) were hospitalized at the Intensive Care Unit (ICU). Overall, the procedure failed in 2 (1,8%) patients. There were 4 (3,6%) abscesses and 2 (1,8%) fistulas post PC. Drain dislodgment was found without sequelae in 8 (7,2%) patients. Elective cholecystectomy was performed in 35/111 (31,5%). Fifty-one of 87 (58,6%) patients with gallstones underwent cholecystectomy; 36/87 (41,3%) did not undergo surgery due to a too short follow-up or death of nonbiliary disease. In the AAC group, there was no recurrent cholecystitis in 17/24 (70,8%) patients; 3/24 (12,5%) underwent surgery and 4/24 (16,6%) patients died in the ICU. 'Conclusion: 'PC is a minimally invasive treatment with low complication rate for patients with acute cholecystitis whom considered being at high-risk for urgent cholecystectomy. Good selection (ASA III and IV) and indication is needed in patients with ACC before PC because the majority will be operated later on. AAC can be managed nonoperatively and further treatment might not be needed

Discovery of a single faint AGN in a large sample of z>5 Lyman break galaxies

As part of a large spectroscopic survey of z>5 Lyman break galaxies (LBGs), we have identified a single source which is clearly hosting an AGN. Out of a sample of more than fifty spectroscopically-confirmed R-band dropout galaxies at z~5 and above, only J104048.6-115550.2 at z=5.44 shows evidence for a high ionisation-potential emission-line indicating the presence of a hard ionising continuum from an AGN. Like most objects in our sample the rest-frame-UV spectrum shows the UV continuum breaking across a Ly_alpha line. Uniquely within this sample of LBGs, emission from NV is also detected, a clear signature of AGN photo-ionisation. The object is spatially resolved in HST imaging. This, and the comparatively high Ly_alpha/NV flux ratio indicates that the majority of the Ly_alpha (and the UV continuum longward of it) originates from stellar photo-ionisation, a product of the ongoing starburst in the Lyman break galaxy. Even without the AGN emission, this object would have been photometrically-selected and spectroscopically-confirmed as a Lyman break in our survey. The measured optical flux (I(AB)=26.1) is therefore an upper limit to that from the AGN and is of order 100 times fainter than the majority of known quasars at these redshifts. The detection of a single object in our survey volume is consistent with the best current models of high redshift AGN luminosity function, providing a substantial fraction of such AGN are found within luminous starbursting galaxies. We discuss the cosmological implications of this discovery.Comment: 7 pages, 3 figures, MNRAS in pres

National mapping of schistosomiasis, soil-transmitted helminthiasis and anaemia in Yemen: Towards better national control and elimination

Background Schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) are known to be endemic in Yemen. However, the distribution of both diseases had not previously been assessed by a well-structured national mapping study covering all governorates. The main aim of this study was, therefore, to map the prevalence of SCH and STH in Yemen in order to better inform implementation of effective national control and elimination interventions. The assessment of the distribution of anaemia was also included as a well-known consequence of infection with both SCH and STH. Secondarily, the study aimed to provide a broad indication of the impact of large-scale treatment on the distribution of infection. Methodology and principal findings To achive these aims, 80,432 children (10–14 years old) from 2,664 schools in 332 of Yemen’s 333 districts were included, in 2014, into this national cross-sectional survey. Countrywide, 63.3% (210/332) and 75.6% (251/332) of districts were found to be endemic for SCH and STH respectively. More districts were affected by intestinal than urogenital SCH (54.2% and 31.6% respectively). SCH infection was mostly mild and moderate, with no districts reporting high infection. One quarter (24.4%) of Yemeni districts had high or moderate levels of Ascaris lumbricoides infection. Infection with Trichuris trichiura was the second most common STH (44.9% of districts infected) after A. lumbricoides (68.1%). Hookworm was the least prevalent STH (9.0%). Anaemia was prevalent in 96.4% of districts; it represented a severe public health problem (prevalence ≥ 40%) in 26.5% of districts, and a mild to moderate problem in two thirds of the districts (33.7% and 36.1% respectively). Conclusion This study provided the first comprehensive mapping of SCH, STH, and anaemia across the country. This formed the basis for evaluating and continuing the national control and elimination programme for these neglected tropical diseases in Yemen

Altered Antioxidant-Oxidant Status in the Aqueous Humor and Peripheral Blood of Patients with Retinitis Pigmentosa

Retinitis Pigmentosa is a common form of hereditary retinal degeneration constituting the largest Mendelian genetic cause of blindness in the developed world. It has been widely suggested that oxidative stress possibly contributes to its pathogenesis. We measured the levels of total antioxidant capacity, free nitrotyrosine, thiobarbituric acid reactive substances (TBARS) formation, extracellular superoxide dismutase (SOD3) activity, protein, metabolites of the nitric oxide/cyclic GMP pathway, heme oxygenase-I and inducible nitric oxide synthase expression in aqueous humor or/and peripheral blood from fifty-six patients with retinitis pigmentosa and sixty subjects without systemic or ocular oxidative stress-related disease. Multivariate analysis of covariance revealed that retinitis pigmentosa alters ocular antioxidant defence machinery and the redox status in blood. Patients with retinitis pigmentosa present low total antioxidant capacity including reduced SOD3 activity and protein concentration in aqueous humor. Patients also show reduced SOD3 activity, increased TBARS formation and upregulation of the nitric oxide/cyclic GMP pathway in peripheral blood. Together these findings confirmed the hypothesis that patients with retinitis pigmentosa present reduced ocular antioxidant status. Moreover, these patients show changes in some oxidative-nitrosative markers in the peripheral blood. Further studies are needed to clarify the relationship between these peripheral markers and retinitis pigmentosa

IL-22 Production Is Regulated by IL-23 During Listeria monocytogenes Infection but Is Not Required for Bacterial Clearance or Tissue Protection

Listeria monocytogenes (LM) is a gram-positive bacterium that is a common contaminant of processed meats and dairy products. In humans, ingestion of LM can result in intracellular infection of the spleen and liver, which can ultimately lead to septicemia, meningitis, and spontaneous abortion. Interleukin (IL)-23 is a cytokine that regulates innate and adaptive immune responses by inducing the production of IL-17A, IL-17F, and IL-22. We have recently demonstrated that the IL-23/IL-17 axis is required for optimal recruitment of neutrophils to the liver, but not the spleen, during LM infection. Furthermore, these cytokines are required for the clearance of LM during systemic infection. In other infectious models, IL-22 induces the secretion of anti-microbial peptides and protects tissues from damage by preventing apoptosis. However, the role of IL-22 has not been thoroughly investigated during LM infection. In the present study, we show that LM induces the production of IL-22 in vivo. Interestingly, IL-23 is required for the production of IL-22 during primary, but not secondary, LM infection. Our findings suggest that IL-22 is not required for clearance of LM during primary or secondary infection, using both systemic and mucosal models of infection. IL-22 is also not required for the protection of LM infected spleens and livers from organ damage. Collectively, these data indicate that IL-22 produced during LM infection must play a role other than clearance of LM or protection of tissues from pathogen- or immune-mediated damage