Classic and modern in the therapy of hepatic hidatid cysts – experience of a general surgery center

Clinica II Chirurgie, Spitalul Județean de Urgențe ”Sf. Spiridon”, Iași UMF ”Gr.T. Popa” Iași, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011INTRODUCERE. În ultimii 20 de ani, asistăm la o tendință de afirmare a terapiilor mai puțin invazive pentru pacienții cu chist hidatic hepatic (radiologie intervențională, endoscopie intervențională, puncții eco sau CT-ghidate, tehnici chirurgicale laparoscopice precum şi asocieri ale acestora). SCOP. Ne-am propus o comparație între rezultatele după abordul clasic şi cel minim-invaziv pentru tratamentul echinococozei hepatice. MATERIAL ŞI METODĂ. Au fost analizate retrospectiv 180 cazuri de chist hidatic hepatic operate în Clinica I Chirurgie Iaşi, România în perioada 2004-2010. Au fost selectate pentru analiză următoarele variabile: localizarea chistului, tipul acestuia (conform clasificării propuse de Informal Working Group on Echinococcosis), calea de abord, tehnica chirurgicală, durata evoluției postoperatorii, complicațiile survenite, recidivele şi asocierea chimioterapiei antiparazitare. Pentru analiza statistică s-au folosit testele neparametrice Mann-Whitney U şi Spearman cu pragul de semnificație p<0.05. REZULTATE. Leziunile s-au tratat prin puncție echoghidată (n=6;3.3%); pe cale laparoscopică (n= 48;26.6%) şi abord clasic (n=126;70.1%). Pe cale laparoscopică s-au efectuat: inactivare-aspirație-drenaj şi inactivare-aspirație-perichistectomie parțială. Pe cale clasică s-au practicat: inactivare-aspirație-drenaj, inactivare-aspirație-perichistectomie parțială, perichistectomie ideală, hepatectomie reglată, hepatectomie atipică. Abordul minim-invaziv se corelează semnificativ cu tipul I-II al chisturilor (p=0.016) şi cu localizarea acestora în segmentele II, III şi VI (p=0.001). Durata evoluției postoperatorii a fost semnificativ mai redusă după abordul laparoscopic (p=0.003) comparativ cu cea după intervențiile clasice „minimale” (inactivare-aspirație-drenaj şi inactivare-aspirație-perichistectomie parțială) practicate pentru leziunile tip I-III, dar diferența dintre numărul de zile de îngrijiri după abordul laproscopic vs. chirurgie radicală (perichistectomie ideală, hepatectomie) este nesemnificativă. Nu am întâlnit corelații semnificative între apariția recidivelor/complicațiilor şi tipul de abord. Chimioterapia antiparazitară, instituită în 118 de cazuri (65.5%), se corelează semnificativ cu o rată redusă a recidivelor survenite în 9 cazuri (5%). CONCLUZII. Boala hidatică beneficiază astăzi de o terapie multimodală în care chimioterapia, PAIR-ul, videochirurgia şi chirurgia clasică trebuie să se completeze cât mai fericit şi nu să se excludă. Chiar dacă „pierde din indicații”, chirurgia clasică rămâne „rezerva strategică” în terapia chistului hidatic.INTRODUCTION. In the last 20 years, we noticed an outstanding of less invasive therapy for the patients with hidatid disease (interventional radiology, interventional endoscopy, eco- or CT punctions, laparoscopy and association between these). AIM. We intend to compare the results after classic and laparoscopic approach as treatment for hepatic echinococcosis. METHODS. We analysed 180 cases operated in 1st Surgical Clinic, Iasi, Romania, between 2004-200. We recorded the fallowing parameters: location, type (classification approved by Informal Working Group on Echinococcosis), approaching type, surgical technique, postoperative evolution, complications, recurrences and chemotherapy. We used Mann-Whitney U and Spearman tests (p<0.05).RESULTS. The cases were solved by eco guidance punction (n=6; 3.3%); laparoscopic (n= 48; 26.6%) and classic approach (n=126; 70.1%). Minim invasive approach we did inactivation-suction-drainage and partial perichistectomy. Using open approach we did inactivation-suction-drainage, partial perichistectomy, total perichistectomy and hepatectomy. Laparoscopic treatment has significant correlation with type I-II (p=0.016) located in segments II, III and IV (p=0.001). Postoperative evolution is significant lower for laparoscopic methods (p=0.003) comparing with the „minimal” open techniques used for lesions type I-III. There is no significant differentiation between laparoscopic procedures and open radical surgery (total perichistectomy and hepatectomy). We did not register significant correlations about recurrences and complications. Chemotherapy used in 8 cases is correlated with a low rate of recurrence 9 cases (5%).CONCLUSIONS. Hidatid disease has the benefits of a multimodal therapy. Chemotherapy, PAIR, video surgery and open approach are completing themselves and not excluding each other. Even if classic methods are less frequent used, it remains as a „back up solution” in the therapy of hidatid cyst disease

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURO bservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry

Aims: Given the advances in atrial fibrillation (AF) management and the availability of new European Society of Cardiology (ESC) guidelines, there is a need for the systematic collection of contemporary data regarding the management and treatment of AF in ESC member countries. Methods and results: We conducted a registry of consecutive in- and outpatients with AF presenting to cardiologists in nine participating ESC countries. All patients with an ECG-documented diagnosis of AF confirmed in the year prior to enrolment were eligible. We enroled a total of 3119 patients from February 2012 to March 2013, with full data on clinical subtype available for 3049 patients (40.4% female; mean age 68.8 years). Common comorbidities were hypertension, coronary disease, and heart failure. Lone AF was present in only 3.9% (122 patients). Asymptomatic AF was common, particularly among those with permanent AF. Amiodarone was the most common antiarrhythmic agent used (~20%), while beta-blockers and digoxin were the most used rate control drugs. Oral anticoagulants (OACs) were used in 80% overall, most often vitamin K antagonists (71.6%), with novel OACs being used in 8.4%. Other antithrombotics (mostly antiplatelet therapy, especially aspirin) were still used in one-third of the patients, and no antithrombotic treatment in only 4.8%. Oral anticoagulants were used in 56.4% of CHA 2DS2-VASc = 0, with 26.3% having no antithrombotic therapy. A high HAS-BLED score was not used to exclude OAC use, but there was a trend towards more aspirin use in the presence of a high HAS-BLED score. Conclusion: The EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot Registry has provided systematic collection of contemporary data regarding the management and treatment of AF by cardiologists in ESC member countries. Oral anticoagulant use has increased, but novel OAC use was still low. Compliance with the treatment guidelines for patients with the lowest and higher stroke risk scores remains suboptimal. © The Author 2013

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Synergetic effects of the Cu/Pt{110} surface alloy: enhanced reactivity of water and carbon monoxide

We have used synchrotron-based high-resolution X-ray photoelectron spectroscopy in combination with ab initio density functional theory calculations to investigate the characteristics of water and CO adsorption on the bimetallic Cu/Pt{110}-(2 x 1) surface at a Cu coverage near 0.5 ML. Cu fills the troughs of the reconstructed clean surface forming nanowires, which are stable up to 830 K. Their presence dramatically influences the adsorption of water and CO. Water adsorption changes from intact to partially dissociated while the desorption temperature of CO on this surface increases by up to 27 K with respect to the clean Pt{110} surface. Ab initio calculations and experimental valence band spectra reveal that the Cu 3d-band is narrowed and shifted upward with respect to bulk Cu surfaces. This and electron donation to surface Pt atoms cause the increase in the bond strength between CO and the Pt surface atoms. The pathway for water dissociation occurs via Cu surface atoms. The heat of adsorption of water bonding to Cu surface atoms was calculated to be 0.82 eV, which is significantly higher than on the clean Pt{110} surface; the activation energy for partial dissociation is 0.53 eV (not corrected for zero point energy)