Liver retransplantation as a therapeutic method in graft dysfunctions in the immediate postoperative period

Departament Chirurgie Generală, I.C. Fundeni, București, România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaCu toate că în ultimii ani au apărut progrese importante în domeniul hepatic, problema prevenirii apariției disfuncției și eșecului post-transplant nu a prezentat progrese semnificative. Intrucât disfuncția hepatică primară influențează dramatic evoluția grefei și a pacientului transplantat hepatic, prevenirea acestui fenomen devine obligatoriu. Creșterea penuriei de organe și a numărului persoanelor aflate pe lista de așteptare a dus la folosirea unor grefe ce depășesc criteriile normale de selecție pentru recoltare precum și transplantarea unor donatori considerați marginali. Aceste circumstanțe au adus în prim plan importanța diagnosticării și tratamentului disfuncției hepatice primare. Conceptul de disfuncție hepatică primară nu este clar definit. Există un spectru de evenimente ce definesc disfuncția hepatică postoperatorie precoce: non funcția primară (PNF), nonfuncția întârziată, funcția slabă/săracă inițială (initial poor function – IPF), non funcția inițială, insuficiența hepatică primară și disfuncția primară. Distincția între aceste entități ia în considerare gradul disfuncției hepatice, necesitatea retransplantării urgente, precum și apariția și durata acestor evenimente după transplantul hepatic.Although important progress has been made over the last few years, the problem of preventing dysfunction and post-transplant liver failure has not shown significant progress. Since primary liver dysfunction dramatically influences the progress of the graft and the liver transplant patient, prevention of this phenomenon becomes obligatory. The increase in organ shortage and the number of people on the waiting list led to the use of grafts that exceeded the normal selection criteria for harvesting as well as the transplantation of marginal donors. These circumstances have highlighted the importance of diagnosis and treatment of primary hepatic dysfunction. The concept of primary liver dysfunction is not clearly defined. There is a spectrum of events that defines early postoperative liver dysfunction: primary non-function (PNF), delayed dysfunction, initial poor function (IPF), primary hepatic failure, and primary dysfunction. The distinction between these entities takes into account the degree of hepatic dysfunction, the need for urgent retransplantation, and the occurrence and duration of these events after liver transplantation

Most neutralizing human monoclonal antibodies target novel epitopes requiring both Lassa virus glycoprotein subunits

Lassa fever is a severe multisystem disease that often has haemorrhagic manifestations. The epitopes of the Lassa virus (LASV) surface glycoproteins recognized by naturally infected human hosts have not been identified or characterized. Here we have cloned 113 human monoclonal antibodies (mAbs) specific for LASV glycoproteins from memory B cells of Lassa fever survivors from West Africa. One-half bind the GP2 fusion subunit, one-fourth recognize the GP1 receptor-binding subunit and the remaining fourth are specific for the assembled glycoprotein complex, requiring both GP1 and GP2 subunits for recognition. Notably, of the 16 mAbs that neutralize LASV, 13 require the assembled glycoprotein complex for binding, while the remaining 3 require GP1 only. Compared with non-neutralizing mAbs, neutralizing mAbs have higher binding affinities and greater divergence from germline progenitors. Some mAbs potently neutralize all four LASV lineages. These insights from LASV human mAb characterization will guide strategies for immunotherapeutic development and vaccine design

Tuberculosis in migrants from 106 countries to Italy, 2008-2014

In migrants coming to Italy from 106 countries, MDR-TB was high from the former Soviet Union and low from Africa http://ow.ly/WZDb

Extensively drug-resistant tuberculosis is worse than multidrug-resistant tuberculosis: different methodology and settings, same results.

11siThe article by Kim et al. about the impact of extensively drug-resistant (XDR) tuberculosis (TB) on treatment outcomes of non–HIV-infected patients affected by multidrug-resistant (MDR) TB. Kim et al. found, with univariate analysis, that patients with XDR TB had a borderlinesignificant higher probability of treatment failure and death than did patients with MDR TB. Multivariate analysis confirmed that XDR TB is a poor independent prognostic factor for treatment failure. Two studies from our group had previously reached similar conclusions. Our first study found that patients with XDR TB in Italy and Germany, compared with patients with MDR TB, had a 5-fold increase in the risk of death (relative risk, 5.45; 95% CI, 1.95–15.27; P ! .01), required longer hospitalization, had longer treatment duration, and, for the few patients whose sputum and smear converted from positive to negative, a longer time to smear or culture conversion. The second study found that patients with XDR TB had a relative risk of 1.58 to die or have treatment failure, compared with patients with MDR TB resistant to all first-line drugs , and a relative risk of 2.61, compared with patients with MDR TB for whom susceptibility to _1 first-line drug still existed. Interestingly, the results of the studies from the 2 groups are consistent, although the definitions used were slightly different: Migliori et al. used theWorld Health Organization definitions of treatment success and failure, and Kim et al. applied the definitions proposed by Laserson et al.nonemixedMIGLIORI GB; LANGE C; GIRARDI E; CENTIS R; BESOZZI G; KLIIMAN K; ORTMANN J; MATTEELLI A; SPANEVELLO A; CIRILLO DM; SMIRATBNET STUDY GROUPMigliori, Gb; Lange, C; Girardi, E; Centis, R; Besozzi, G; Kliiman, K; Ortmann, J; Matteelli, A; Spanevello, Antonio; Cirillo, Dm; SMIRATBNET STUDY, Grou