Bacterial infection is a frequent trigger of acute-on-chronic liver failure (ACLF), syndrome that could also increase the risk of infection. This investigation evaluated prevalence and ...characteristics of bacterial and fungal infections causing and complicating ACLF, predictors of follow-up bacterial infections and impact of bacterial infections on survival.
407 patients with ACLF and 235 patients with acute decompensation (AD).
152 patients (37%) presented bacterial infections at ACLF diagnosis; 46%(n=117) of the remaining 255 patients with ACLF developed bacterial infections during follow-up (4 weeks). The corresponding figures in patients with AD were 25% and 18% (p<0.001). Severe infections (spontaneous bacterial peritonitis, pneumonia, severe sepsis/shock, nosocomial infections and infections caused by multiresistant organisms) were more prevalent in patients with ACLF. Patients with ACLF and bacterial infections (either at diagnosis or during follow-up) showed higher grade of systemic inflammation at diagnosis of the syndrome, worse clinical course (ACLF 2-3 at final assessment: 47% vs 26%; p<0.001) and lower 90-day probability of survival (49% vs 72.5%;p<0.001) than patients with ACLF without infection. Bacterial infections were independently associated with mortality in patients with ACLF-1 and ACLF-2. Fungal infections developed in 9 patients with ACLF (2%) and in none with AD, occurred mainly after ACLF diagnosis (78%) and had high 90-day mortality (71%).
Bacterial infections are extremely frequent in ACLF. They are severe and associated with intense systemic inflammation, poor clinical course and high mortality. Patients with ACLF are highly predisposed to develop bacterial infections within a short follow-up period and could benefit from prophylactic strategies.
Despite the evidence on the antioxidant capability of estrogens, little is known about their reaction mechanism involved. According to the above, this work was carried out on the hydroperoxyl radical ...scavenging activity of three estrogens—estriol (EST), estradiol (ESD), and estrone (ESO)—in lipid and aqueous media by theoretical methodologies employing the DFT. In lipid and aqueous media, hydrogen transfer was the main reaction mechanism on the hydroperoxyl radical scavenging of EST, ESD, and ESO. The reaction rate constants calculated in lipid media were 1.08 × 106, 8.39 × 104, and 6.43 × 104 M−1 s−1 for the EST, ESD, and ESO, respectively. The reaction rate constants calculated in aqueous media were 3.00 × 106, 3.58 × 106, and 1.05 × 108 M−1 s−1 on the hydroperoxyl radical scavenging activity of EST, ESD, and ESO, respectively. The results also showed that the EST, ESD, and ESO estrogens could scavenge high reactivity radicals through the SET mechanism in aqueous media. In lipid media, estrogens are moderate antioxidants, whereas in aqueous media, these are good antioxidants. These theoretical results support the intrinsic antioxidant activity of EST, ESD, and ESO estrogens in lipid and aqueous media.
The estrogens have hydroperoxyl radical scavenging activity mainly through the hydrogen transfer mechanism in lipid and aqueous media. The hydroperoxy radical scavenging reactivity of estrogens is discussed, considering the radical, mechanism, and solvent media considered.
Objective
The purpose of this study was to compare physical activity (PA) in a group of patients with psoriatic arthritis (PsA) versus healthy controls and to determine whether the mobility of these ...patients is affected by disease activity.
Methods
A group of 52 patients with PsA and 53 controls were included in this case–control study. PA was assessed by accelerometry in both groups and additionally with the International Physical Activity Questionnaire (IPAQ) in patients with PsA. Multiple regression analysis was used to compare PA between groups and to determine the relationship between PA and PsA features, including disease activity, as assessed by the 28‐joint Disease Activity Score (DAS28) and the Disease Activity Index for Psoriatic Arthritis (DAPSA) score. In a group of 36 patients, a test–retest study was carried out after 6 months.
Results
The time engaged in moderate‐to‐vigorous physical activity (MVPA) per day, as evaluated by accelerometry, and adjusted by confounders, proved similar in patients with PsA and controls. In patients with PsA, disease activity was inversely related to PA as assessed either by IPAQ or accelerometry. When PA was compared in patients with PsA between the 2 visits, a significant difference in the amount of time doing MVPA was found (42 ± 33 versus 30 ± 22 minutes/day; P = 0.004). Interestingly, in the test–retest study, variations in disease activity over time based on DAPSA scores (r = –0.49, P = 0.002) and DAS28 using the C‐reactive protein level (r = –0.4, P = 0.017) were inversely correlated with changes in PA, as determined by accelerometry.
Conclusion
Patients with PsA show levels of PA like healthy controls. In patients with PsA, disease activity and PA are inversely correlated and the evaluation of PA by accelerometry is sensitive to changes in disease activity.
For many European rural areas, the rural development programmes based on the LEADER approach constitute the main policy for promoting tourism. Going a step further than a rural development programme, ...LEADER represents an ideal method for overcoming some of the challenges involved in rural tourism development, such as the integration of tourism supply through public-private organizations or the coordination of multi-level policies. Despite its potential, there are difficulties involved in putting this approach into practice. This article aims to provide in-depth understanding of the challenges faced by some managers responsible for developing tourism strategies through the LEADER approach. To do this, semi-structured in-depth interviews have been held with Local Action Groups managers from Castilla-La Mancha (Spain). The main findings reveal that the actions of regional governments lead to the limitation and strangulation of the principle of subsidiarity according with the LAG managerś opinion.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Balanced hemostasis with hypocoagulable and hypercoagulable features may occur in acute‐on‐chronic liver failure (ACLF). The characteristics and prognostic impact of the coagulation profile in ACLF ...are unknown. Consecutive patients with ACLF (n = 36) and acute decompensation (AD; n = 24) were included. Blood samples for thromboelastometry (TE) were obtained at admission and 72 hours thereafter. The coagulation profile was evaluated in patients with and without ACLF and in those with and without systemic inflammatory response syndrome. The impact of the coagulation profile on transfusion requirements, bleeding events, and short‐term survival was assessed. At admission, patients with ACLF showed more hypocoagulable characteristics compared to AD subjects, with prolonged time to initial fibrin formation and clot formation time and decreased maximum clot firmness and alpha‐angle values. TE parameters worsened at 72 hours in ACLF but improved in patients with AD. Prevalence of a hypocoagulable profile (three or more TE parameters outside range) was significantly higher in patients with ACLF either at admission (61% versus 29% in AD; P = 0.03) or during follow‐up. Hypocoagulability correlated with systemic inflammation and was associated with higher 28‐day (45% versus 16%; P = 0.02) and 90‐day (52% versus 19%; P = 0.01) mortality rates but not with transfusion requirements or bleeding. Prolonged time to initial fibrin formation (extrinsic TE assay >80 seconds) and Model for End‐Stage Liver Disease score at baseline were independent predictors of 28‐day mortality. Conclusion: Patients with ACLF frequently show hypocoagulable features with prolonged time to initial fibrin formation and clot formation time and reduced clot firmness; these alterations worsen after admission, correlate with systemic inflammation, and translate into higher short‐term mortality; hypofibrinolysis could contribute to organ failure in ACLF.
To report the 24-month efficacy and safety of the interleukin-6 receptor antagonist tocilizumab (TCZ) for refractory uveitis-related macular edema (ME).
Data were obtained by standardized chart ...review. Patients with quiescent uveitis seen at a single tertiary referral center, for whom ME was the principal cause of reduced visual acuity.
Central foveal thickness measured by optical coherence tomography; degree of anterior and posterior chamber; inflammation (Standardization of Uveitis Nomenclature Working Group criteria); and visual acuity (Snellen and logarithm of the minimum angle of resolution) were recorded in all patients during TCZ therapy at months 1, 3, 6, 12, 18, and 24.
Sixteen eyes from 12 patients (10 women) were included. Mean age was 34.6 years. Mean duration of ME was 13.2 years. All patients achieved 24 months of follow-up and that is the census date for data collection. Before TCZ was commenced, ME was present, and all patients had been previously treated with immunosuppressive therapy and biologic agents. Uveitis diagnoses were juvenile idiopathic arthritis associated, uveitis (n = 6), birdshot chorioretinopathy (n = 2), idiopathic panuveitis (n = 2), sympathetic ophthalmia (n = 1), and ankylosing spondylitis (n = 1). Mean central foveal thickness (95%; confidence interval) was 516 ± 55 μm at baseline, improving to 274 ± 13 at Month 12 (P = 0.0004), and sustained at 274 ± 14 at Month 24 of follow-up (P = 0.00039). Mean logarithm of the minimum angle of resolution best-corrected visual acuity improved from 0.78 ± 0.18 (Snellen 20/120 ± 20/30) at baseline to 0.42 ± 0.17 (20/52 ± 20/30) at Month 12 (P = 0.0001) and 0.40 ± 0.17 (20/50 ± 20/30) at Month 24 of follow-up (P = 0.0002). Tocilizumab therapy was withdrawn in 5 patients with sustained remission at Month 12 but in all, ME relapsed between 1 and 3 months after TCZ discontinuation. Rechallenge of TCZ infusions led to recovery of uveitis control and ME resolution. Two adverse events were reported during two 4-month follow-ups: one Grade 1 neutropenia and one community-acquired pneumonia.
In this long-term study, TCZ was effective and had a comparable safety profile to published data for TCZ use in other indications, when used for the treatment of refractory uveitis-related ME.
SARS-CoV-2 Antibodies in Breast Milk After Vaccination Romero Ramírez, Dolores Sabina; Lara Pérez, María Magdalena; Carretero Pérez, Mercedes ...
Pediatrics (Evanston),
11/2021, Letnik:
148, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Passive and active immunity transfer through human milk (HM) constitutes a key element in the infant's developing immunity. Certain infectious diseases and vaccines have been described to induce ...changes in the immune components of HM.
We conducted a prospective cohort single-institution study from February 2 to April 4, 2021. Women who reported to be breastfeeding at the time of their coronavirus disease 2019 (COVID-19) vaccination were invited to participate. Blood and milk samples were collected on day 14 after their second dose of the vaccine. Immunoglobulin G (IgG) antibodies against nucleocapsid protein as well as IgG, immunoglobulin M and immunoglobulin A (IgA) antibodies against the spike 1 protein receptor-binding domain against severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2 RBD-S1) were analyzed in both serum and HM samples.
Most of the participants (ie, 94%) received the BNT162b2 messenger RNA COVID-19 vaccine. The mean serum concentration of anti-SARS-CoV-2 RBD-S-IgG antibodies in vaccinated individuals was 3379.6 ± 1639.5 binding antibody units per mL. All vaccinated study participants had anti-SARS-CoV-2 RBD-S1-IgG, and 89% of them had anti-SARS-CoV-2 RBD-S-IgA in their milk. The antibody concentrations in the milk of mothers who were breastfeeding 24 months were significantly higher than in mothers with breastfeeding periods <24 months (
< .001).
We found a clear association between COVID-19 vaccination and specific immunoglobulin concentrations in HM. This effect was more pronounced when lactation periods exceeded 23 months. The influence of the lactation period on immunoglobulins was specific and independent of other variables.
SF3B1
is a highly mutated gene in myelodysplastic syndrome (MDS) patients, related to a specific subtype and parameters of good prognosis in MDS without excess blasts. More than 40% of MDS patients ...carry at least two myeloid-related gene mutations but little is known about the impact of concurrent mutations on the outcome of MDS patients. In applying next-generation sequencing (NGS) with a 117 myeloid gene custom panel, we analyzed the co-occurrence of
SF3B1
with other mutations to reveal their clinical, biological, and prognostic implications in very low/low- and intermediate-risk MDS patients. Mutations in addition to those of
SF3B1
were present in 80.4% of patients (median of 2 additional mutations/patient, range 0–5). The most frequently mutated genes were as follows:
TET2
(39.2%),
DNMT3A
(25.5%),
SRSF2
(10.8%),
CDH23
(5.9%), and
ASXL1
,
CUX1
, and
KMT2D
(4.9% each). The presence of at least two mutations concomitant with that of
SF3B1
had an adverse impact on survival compared with those with the
SF3B1
mutation and fewer than two additional mutations (median of 54 vs. 87 months, respectively:
p
= 0.007). The co-occurrence of
SF3B1
mutations with specific genes is also linked to a dismal prognosis:
SRSF2
mutations were associated with shorter overall survival (OS) than
SRSF2
wt (median, 27 vs. 75 months, respectively;
p
= 0.001), concomitant
IDH2
mutations (median OS, 11 mut vs. 75 wt months;
p
= 0.001),
BCOR
mutations (median OS, 11 mut vs. 71 wt months;
p
= 0.036), and
NUP98
and
STAG2
mutations (median OS, 27 and 11 vs. 71 months, respectively;
p
= 0.008 and
p
= 0.002). Mutations in CHIP genes (
TET2
,
DNMT3A
) did not significantly affect the clinical features or outcome. Our results suggest that a more comprehensive NGS study in low-risk MDS
SF3B1
mut
patients is essential for a better prognostic evaluation.
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