A Novel Family of Cyst Proteins with Epidermal Growth Factor Repeats in Giardia lamblia

The biological goal of Giardia lamblia life cycle is differentiation into a cyst form (encystation) that can survive in the environment and infect a new host. Since cystic stages are key to transmission of parasites, this differentiation may be a target for interruption of the life cycle. Synthesis and assembly of the extracellular cyst wall are the major hallmarks of this important differentiation. During encystation, cyst wall structural proteins are coordinately synthesized and are mainly targeted to the cyst wall. However, only a few such proteins have been identified to date. In this study, we used a combination of bioinformatics and molecular approaches to identify new cyst structural proteins from G. lamblia and found a group of Epidermal Growth Factor (EGF)-like Repeats containing Cyst Proteins (EGFCPs). Interestingly, the levels of EGFCPs proteins increased significantly during encystation, which matches the characteristics of the Giardia cyst wall protein. Further characterization and localization studies suggest that EGFCPs may function like cyst wall proteins, involved in differentiation of G. lamblia trophozoites into cysts. Our results provide valuable information regarding the function of a new group of cyst proteins in parasite differentiation into cysts and help develop ways to interrupt the parasite life cycle

Comparison between the use of percutaneous nephrostomy and internal ureteral stenting in the management of long-term ureteral obstructions

AbstractObjectivesIn this study, we compared between the efficacy and complications of percutaneous nephrostomy (PCN) tubes and those of internal ureteral stents (e.g., double-J stents) used for relieving ureteral obstructions.Materials and methodsA retrospective chart review was performed. Between 2003 and 2009, 110 patients (63 females and 47 males, with a mean age of 63.6 years, range 19–89 years) who had an extrinsic ureteral obstruction, and subsequently underwent either PCN tube placement (n = 44) or internal ureteral stent placement (n = 66), were enrolled. Clinical data on patients with duration of diversion/drainage for more than 6 months were collected. Statistical analyses were performed with respect to a patient's age, etiology of the obstruction, outcome of residual hydronephrosis, and renal function tests.ResultsPatient ages and procedure-related complications were comparable between these two groups. The mean duration of diversion was 16.8 ± 8.6 months in the stent group versus 14.1 ± 6.7 months in the PCN group (p = 0.067). A smaller elevation in serum creatinine was noted in the PCN group (0.21 vs. 0.78 mg/dL, p = 0.03). Nine of 86 (10.4%) double-J stents were converted to PCN tubes during the study period. Residual hydronephrosis after decompression was more common in the stent group than in the PCN group (65.2% vs. 27.2%, p = 0.01). These findings suggest better preservation of renal function by a PCN tube.ConclusionsResults of this study suggest that, to better preserve renal function, PCN is the choice of treatment, irrespective of the etiology. While patients who have a PCN tube may have to carry an additional external drainage device, the complications did not seem to differ significantly from those who used internal drainage with a ureteral stent. Because young cancer patients may especially need aggressive chemotherapy to prolong their survival, PCN urinary drainage may become a better choice from the standpoint of cancer control

Chinese Herbal Medicine as an Adjunctive Therapy Ameliorated the Incidence of Chronic Hepatitis in Patients with Breast Cancer: A Nationwide Population-Based Cohort Study

We conducted a National Health Insurance Research Database-based Taiwanese nationwide population-based cohort study to evaluate whether Chinese herbal medicine (CHM) treatment decreased the incidence of chronic hepatitis in breast cancer patients receiving chemotherapy and/or radiotherapy. A total of 81171 patients were diagnosed with breast cancer within the defined study period. After randomly equal matching, data from 13856 patients were analyzed. Hazard ratios of incidence rate of chronic hepatitis were used to determine the influence and therapeutic potential of CHM in patients with breast cancer. The patients with breast cancer receiving CHM treatment exhibited a significantly decreased incidence rate of chronic hepatitis even across the stratification of age, CCI score, and treatments. The cumulative incidence of chronic hepatitis for a period of seven years after initial breast cancer diagnosis was also reduced in the patients receiving CHM treatment. The ten most commonly used single herbs and formulas were effective in protecting liver function in patients with breast cancer, where Hedyotis diffusa and Jia-Wei-Xiao-Yao-San were the most commonly used herbal agents. In conclusion, our study provided information that western medicine therapy combined with CHM as an adjuvant modality may have a significant impact on liver protection in patients with breast cancer

The efficacy and safety of cuttlebone for lowering serum phosphate in patients with end-stage renal disease: a meta-analysis of randomized controlled trials

Background: The efficacy of cuttlebone for treating hyperphosphatemia in patients with end-stage renal disease and its safety remained unclear.Methods: Randomized controlled trials comparing the efficacy of cuttlebone with conventional interventions were retrieved from MEDLINE, EMBASE, Cochrane Library, Airiti Library, and other major Chinese databases until 1 February 2023. The primary outcome was circulating phosphate concentration, while secondary outcomes included circulating calcium and intact parathyroid hormone levels, calcium–phosphorus product, and treatment-related side-effects.Results: Analysis of nine studies published between 2000 and 2019 including 726 participants showed a lower circulating phosphate concentration in the cuttlebone group than in controls [mean difference (MD) = −0.23, 95% CI: −0.39 to −0.06, p = 0.006, I2 = 94%, 726 patients] and a dose-dependent effect of cuttlebone against hyperphosphatemia. Therapeutic benefits were noted after both short-term (1–2 months) and long-term (3–6 months) treatments. Besides, patients receiving hemodialysis showed a better response to cuttlebone than those receiving peritoneal dialysis. There was no difference in circulating calcium level (mean difference = 0.03, 95% CI: −0.01 to 0.07, p = 0.17, I2 = 34%, 654 patients), while patients receiving cuttlebone showed lower circulating iPTH level and calcium-phosphorus product (MD = −43.63, 95% CI: −74.1 to −13.16, p = 0.005, I2 = 76%, 654 patients), (MD = −0.38, 95% CI: −0.38 to −0.01, p = 0.04, I2 = 83%, 520 patients). No difference in the risks of constipation, gastrointestinal discomfort, and elevated blood calcium was noted between the two groups.Conclusion: Compared with conventional phosphate-binding agents, cuttlebone more efficiently suppressed hyperphosphatemia with a dose-dependent effect. The limited number of included studies warrants further clinical investigations to verify our findings.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42023396300

Necrotizing fasciitis in liver cirrhosis

SummaryBackgroundNecrotizing fasciitis (NF) is associated with a high mortality rate. Hepatitis is endemic in Taiwan, and liver cirrhosis is associated with the development of NF. The characteristics of these patients, however, have not been well documented or the predictors of mortality clearly identified. The purpose of this study is to identify predictors of mortality in patients with liver cirrhosis and necrotizing fasciitis.MethodsThis study was conducted at the Chi-Mei Medical Center in southern Taiwan. Demographic data, clinical characteristics, and the microorganisms responsible for NF in patients with liver cirrhosis were recorded. To identify independent predictors associated with mortality, univariate analysis followed by multivariate logistic regression modeling was performed.ResultsDuring the period 2003–2011, a total of 55 patients with liver cirrhosis and NF were treated at the Chi-Mei Medical Center. Most patients had infections by monomicrobial Gram-negative bacilli. Univariate analysis revealed that severity of liver cirrhosis, shock, band polymorphonuclear neutrophil (>10%), international normalized ratio (>1.5), serum creatinine (>2.0 mg/dL), serum albumin (<2.5 g/dL), and activated partial thromboplastin time (>60 seconds) were significantly associated with mortality. However, multivariate logistic regression analysis revealed that serum albumin of <2.5 g/dL was the only independent predictor of mortality in patients with liver cirrhosis and NF.ConclusionNF in the vast majority of cirrhotic patients was caused by Gram-negative bacilli. Hypoalbuminemia (serum albumin <2.5 g/dL) was associated with mortality in patients with liver cirrhosis and NF. Further studies are needed to assess whether resuscitation with albumin-containing solutions lowers the mortality rate in such patients

A lab-on-a-chip system with integrated sample preparation and loop-mediated isothermal amplification for rapid and quantitative detection of Salmonella spp. in food samples

A lab-on-a-chip system with integrated sample preparation and real-time loop-mediated isothermal amplification for rapid detection of Salmonella in food samples.</p