Angiogenic output in viral hepatitis, C and B, and HCV-associated hepatocellular carcinoma

Introduction: Angiogenesis is known to play a pivotal role in most of malignancy, including HCC, and in chronic inflammation.Aim: To investigate the angiogenic output in HCV and HBV infection and its implication in the development of HCV associated HCC.Materials and methods: Blood samples were collected and grouped as; HS healthy subjects control group; HCC–HCV; chronic HCV infected patient group (HCV+ve) who are positive for serum anti-HCV antibodies and HCV–RNA; anti-HCV antibody positive and HCV–RNA negative patient group (HCVve); patients with positive HBsAg and HBV-DNA group (HBV+ve); and HBsAg positive and HBV-DNA negative patient group (HBVve). Serum levels of vascular endothelial growth factor, angiopoietin-2, endostatin and angiostatin were assessed in different studied groups.Results: The level of sVEGF was insignificantly elevated in both HCV+ve and HCVve groups when compared with controls, while Ang-2, sES and sAS were significantly elevated in both groups as compared with healthy controls. The studied parameters were significantly elevated in HBV-+ve patients when compared with the control. However, HBVve patients showed significantly elevated levels in sAng-2, sES and sAS when compared with the control while the level of sVEGF was equal to that of controls. In patients with HCC, the studied parameters showed a significant elevation when compared with healthy controls and patients either with HBV or HCV infection except for sAS in the case of HCV-+ve patients and VEGF for HBV-+ve patients who were also higher but not significant.Conclusion: The increased hepatic angiogenesis in chronic HCV and HBV could provide the molecular basis for liver carcinogenesis and contribute to the increased risk of HCC in patients with cirrhosis due to HCV and/or HBV.KEYWORDS Angiogenesis; HCC; HCV; HB

Portal Vein Thrombosis after Restorative Proctocolectomy for Familial Adenomatous Polyposis and Sigmoid Cancer

Postoperative portal vein thrombosis (PVT) is rare, but has been described after various open as well as minimal access abdominal operations, especially splenectomy and colorectal surgical procedures. We report the case of a 39-year-old female who underwent restorative proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis with sigmoid cancer. She presented 14 days later with vague upper abdominal pain, nausea, vomiting and high output stoma. Doppler ultrasonography confirmed PVT and therefore anticoagulant therapy was started. Her condition improved dramatically and she underwent closure of ileostomy after finishing adjuvant chemotherapy. She remained well at 3-year follow-up with good pouch function and no local or distant recurrence. A high index of suspicion is essential for early diagnosis and prompt treatment of postoperative PVT after restorative proctocolectomy. Early anticoagulation is essential to avoid subsequent complications

Identification of a human neonatal immune-metabolic network associated with bacterial infection

Understanding how human neonates respond to infection remains incomplete. Here, a system-level investigation of neonatal systemic responses to infection shows a surprisingly strong but unbalanced homeostatic immune response; developing an elevated set-point of myeloid regulatory signalling and sugar-lipid metabolism with concomitant inhibition of lymphoid responses. Innate immune-negative feedback opposes innate immune activation while suppression of T-cell co-stimulation is coincident with selective upregulation of CD85 co-inhibitory pathways. By deriving modules of co-expressed RNAs, we identify a limited set of networks associated with bacterial infection that exhibit high levels of inter-patient variability. Whereas, by integrating immune and metabolic pathways, we infer a patient-invariant 52-gene-classifier that predicts bacterial infection with high accuracy using a new independent patient population. This is further shown to have predictive value in identifying infection in suspected cases with blood culture-negative tests. Our results lay the foundation for future translation of host pathways in advancing diagnostic, prognostic and therapeutic strategies for neonatal sepsis

Sequencing of high-complexity DNA pools for identification of nucleotide and structural variants in regions associated with complex traits

We have used targeted genomic sequencing of high-complexity DNA pools based on long-range PCR and deep DNA sequencing by the SOLiD technology. The method was used for sequencing of 286 kb from four chromosomal regions with quantitative trait loci (QTL) influencing blood plasma lipid and uric acid levels in DNA pools of 500 individuals from each of five European populations. The method shows very good precision in estimating allele frequencies as compared with individual genotyping of SNPs (r(2) = 0.95, P < 10(-16)). Validation shows that the method is able to identify novel SNPs and estimate their frequency in high-complexity DNA pools. In our five populations, 17% of all SNPs and 61% of structural variants are not available in the public databases. A large fraction of the novel variants show a limited geographic distribution, with 62% of the novel SNPs and 59% of novel structural variants being detected in only one of the populations. The large number of population-specific novel SNPs underscores the need for comprehensive sequencing of local populations in order to identify the causal variants of human traits

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Effect of Influenza-A Virus Infection On Inflammatory gene Expression Profiles Of Leukocyte Concentrate Buffy Coats and Exacerbation of Azthma (Inflammatory Response to Influenzaa Virus Infection)

Objectives: Influenza A virus is a major cause of respiratory infections with high rates of morbidity and mortality worldwide. An understanding of how InfluenzaA virus (IAV) modulates host cellular responses is critically important to explore the molecular mechanisms of viral-host interaction. The aims of this study are; to detect changes in the mRNA expression in a panel of inflammatory genes in the leukocyte concentrate Buffy coat of IAV infected patients after 48 hrs of infection. Also to determine the relation between the inflammatory gene expression and asthma in IAV patients. Methods: Blood from 90 hospital admitted patients suffering from flu within the first 48 hrs of infection was tested for IgM- influenzaA virus. Only eight patients were positive. Leukocytes from the IAV positive patients were tested for a panel of 84 inflammatory genes using real time-PCR array technology. Results: Only 14 inflammatory genes (IL1B, IL8, IL10, IL13, CCL2, CCL5, CCL7, CXCL1, CXCL10/IP-10, CX3CR1, C5, TNF, ABCF1, and BCL6) shown a significant upregulation fold ranging between between 1.01 and 121.35 fold in all the eight patients with a 100% frequency. The upregulation of IL8, IL 10, IL13, C5, CCL7, CCL5/RANTES, CXCL1 and CCL18mRNA transcription with high significance might suggest that the asthma complication during IAV infection is due to the stimulation of immune response. Six inflammatory genes (CEBPB, CCR1, IL1R1, MIF, CXCL11 and IL9R) shown a decrease in the mRNAexpression with fold ranged between -250.99 and -1.11 compared to control cells after recovery but with variable frequencies indicating a time dependent response. Conclusion: Our results revealed several alterations of many Leukocyte`s inflammatory gene expressions induced by influenza A virus. Eight of the over expressed genes are involved in asthma complication. All samples are mostly infected with related subtypes of influenza A viruses. These results may help for further analysis of influenza A virus role on host– pathogen interaction