The multiple forms of pulmonary aspergillosis caused by Aspergillus species are the most common respiratory mycoses. Although invasive, the analysis of diagnostic biomarkers in bronchoalveolar lavage ...fluid (BALF) is a clinical standard for diagnosing these conditions. The BALF samples from 22 patients with proven or probable aspergillosis were assayed for human pentraxin 3 (Ptx3), fungal ferricrocin (Fc), and triacetylfusarinine C (TafC) in a retrospective study. The infected group included patients with invasive pulmonary aspergillosis (IPA) and chronic aspergillosis (CPA). The BALF data were compared to a control cohort of 67 patients with invasive pulmonary mucormycosis (IPM), non-Aspergillus colonization, or bacterial infections. The median Ptx3 concentrations in patients with and without aspergillosis were 4545.5 and 242.0 pg/mL, respectively (95% CI, p < 0.05). The optimum Ptx3 cutoff for IPA was 2545 pg/mL, giving a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100, 98, 95, and 100%, respectively. The median Ptx3 concentration for IPM was high at 4326 pg/mL. Pentraxin 3 assay alone can distinguish IPA from CPA and invasive fungal disease from colonization. Combining Ptx3 and TafC assays enabled the diagnostic discrimination of IPM and IPA, giving a specificity and PPV of 100%.
Current treatment options for esophageal diseases Martínek, Jan; Akiyama, Jun-ichi; Vacková, Zuzana ...
Annals of the New York Academy of Sciences,
October 2016, Letnik:
1381, Številka:
1
Journal Article
Recenzirano
Exciting new developments—pharmacologic, endoscopic, and surgical—have arisen for the treatment of many esophageal diseases. Refractory gastroesophageal reflux disease presents a therapeutic ...challenge, and several new options have been proposed to overcome an insufficient effectiveness of proton pump inhibitors. In patients with distal esophageal spasm, drugs and endoscopic treatments are the current mainstays of the therapeutic approach. Treatment with proton pump inhibitors (or antireflux surgery) should be considered in patients with Barrett's esophagus, since a recent meta‐analysis demonstrated a 71% reduction in risk of neoplastic progression. Endoscopic resection combined with radiofrequency ablation is the standard of care in patients with early esophageal adenocarcinoma. Mucosal squamous cancer may also be treated endoscopically, preferably with endoscopic submucosal dissection. Patients with upper esophageal cancer often refrain from surgery. Robot‐assisted, thoracolaparoscopic, minimally invasive esophagectomy may be an appropriate option for these patients, as the robot facilitates a good overview of the upper mediastinum. Induction chemoradiotherapy is currently considered as standard treatment for patients with advanced squamous cell carcinoma, while the role of neoadjuvant therapy for adenocarcinoma remains controversial. A system for defining and recording perioperative complications associated with esophagectomy has been recently developed and may help to find predictors of mortality and morbidity.
The COVID-19 pandemic continues to be a health crisis with major unmet medical needs. The early responses from airway epithelial cells, the first target of the virus regulating the progression toward ...severe disease, are not fully understood. Primary human air-liquid interface cultures representing the broncho-alveolar epithelia were used to study the kinetics and dynamics of SARS-CoV-2 variants infection. The infection measured by nucleoprotein expression, was a late event appearing between day 4–6 post infection for Wuhan-like virus. Other variants demonstrated increasingly accelerated timelines of infection. All variants triggered similar transcriptional signatures, an “early” inflammatory/immune signature preceding a “late” type I/III IFN, but differences in the quality and kinetics were found, consistent with the timing of nucleoprotein expression. Response to virus was spatially organized: CSF3 expression in basal cells and CCL20 in apical cells. Thus, SARS-CoV-2 virus triggers specific responses modulated over time to engage different arms of immune response.
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•SARS-CoV-2 Wuhan-like virus and variants displayed different kinetics of infection•Virus triggers a biphasic & polarized transcriptional response in airway epithelia•Virally induced spatial protein response with CSF3 on epithelial basal side•Virally induced spatial protein response with CCL20 on epithelial apical side
Biological sciences; Molecular biology; Immunology; Microbiology
Abstract
Objective. Evidence does not support an association between systemic corticosteroid use and the development of peptic ulcer disease (PUD) and prophylactic anti-ulcer therapy is not routinely ...indicated. The aim was to find out the opinion of physicians in the Czech Republic on corticosteroid-induced ulcers. Materials and methods. A questionnaire-based study targeting 360 physicians of different specialties (100 from Gastroenterology, 100 from General Practice, 80 from Pneumology/Immunology, and 80 from Neurology/Neurosurgery). Results. Eighty-two percent of the physicians considered corticosteroids ulcerogenic, 7.5% of the responders considered them ulcerogenic only in patients with a family history of PUD, and 10.3% of the physicians considered corticosteroids non-ulcerogenic. Seventy-five percent of the responders would administer concomitant antisecretory treatment. Sixty-seven percent of the physicians thought that PUD was a frequent complication of corticosteroid therapy. If the ulcerogenic potential of ibuprophene, diclofenac, and prednisone was a subject of the physicians' judgment, a majority (40.5%) considered prednisone to be the most ulcerogenic substance. Thirty percent of gastroenterologists (vs. 1.9% of others; p < 0.001) did not consider corticosteroids to be ulcerogenic; 27.4% (vs. 4.3%; p < 0.01) would not administer an antisecretory prophylaxis routinely. Conclusions. Although there is no evidence showing an association between PUD and the use of corticosteroids, a majority of physicians consider corticosteroids gastrotoxic. This applies, to a lesser extent, to gastroenterologists. Action should be taken to explode the myth about the gastrotoxicity of corticosteroids and to minimize useless expenses on concomitant prophylaxis.
We develop the theory of the electron transport through quantum dot weakly coupled to ferromagnetic leads with noncollinear magnetization directions, that has been studied in recent experiments. One ...can observe much richer transport behavior of the canted quantum dot spin valves, as compared to single magnetic tunnel junctions, that relies on the possibility to generate a nonequilibrium accumulated spin on the quantum dot and the presence of the exchange interaction between dot and electrodes, depending on system parameters such as gate and bias voltages, the charging energy, an asymmetry of the tunnel couplings, and the external magnetic field. We demonstrate that one can extract information about spin dynamics on quantum dot from the dc current–voltage characteristic even at the linear response, and detect the exchange field similarly to the FMR (ferromagnetic resonance) experiment. This exchange field can be widely used in nano-spinelectronics, as a local field controlled by the gate or bias voltages also at high temperatures.
•The analytical relations between the accumulated spin and the current flowing in the canted quantum dot spin valve are obtained.•The effective Bloch equation describing spin dynamics in the quantum dot is formulated.•The experimental scheme for determination of the local electrically tunable exchange field is demonstrated.
Endoscopic submucosal dissection or widespread endoscopic resection allow the radical removal of circumferential or near-circumferential neoplastic esophageal lesions. The advantage of these ...endoscopic methods is mini-invasivity and low risk of major adverse events compared to traditional esophagectomy. The major drawback of these extensive resections is the development of stricture - the risk is 70-80% if more than 75% of the circumference is removed and almost 100% if the whole circumference is removed. Thus, an effective method to prevent post-ER/ESD esophageal stricture would be of major benefit, because treatment of strictures requires multiple sessions of endoscopic dilatation and may carry a risk of perforation. Moreover, not all strictures are easy to treat and some patients may develop refractory strictures. There are several techniques and methods, which have been tested in both experimental and/or clinical studies but no one has received general acceptance based on results of high-quality evidence. The studies are usually small with a limited number of patients, there is a lack of randomized controlled trials and some techniques have been described only in experimental studies. Thus, prevention of post-ESD strictures remains an unresolved issue. On the other hand, because of the high risk of stricture and partially proven effectiveness of some preventive techniques, a preventive strategy should be considered in patients undergoing extensive ER/ESD in the esophagus. There is, however, no evidence about the superiority or inferiority of a particular preventive strategy compared to other techniques, moreover, there is paucity of data assessing the effectiveness of the combination of different preventive methods. The best preventive strategies known so far include 1) oral or local administration of corticosteroids; and 2) preventive stenting. Other strategies (preventive sessions of endoscopic dilatation or tissue engineering methods) have unproven efficacy or are too demanding for practical use. Nevertheless, the use of (any) preventive strategy after extensive ER/ESD of the esophagus probably reduces the risk of stricture and the number of endoscopic dilatations, therefore, it should be considered in these patients. However, there is a need for high quality evidence as well as for new ideas and approaches to resolve this important clinical problem.
We present a theoretical description of the spin accumulation effect in metallic Fermi leads on the Kondo effect in the quantum dot attached to those. It has been shown that the spin accumulation by ...breaking the spin symmetry leads to the suppression of the Kondo effect in some cases. In order to better understand the observed effects, we analyze the spin currents in the system, depending on the spin accumulation of the electrodes, for both symmetrical and anti-symmetrical configuration of spin accumulation. We demonstrate that in the absence of the Kondo resonance splitting the suppression of the Kondo effect is related to the presence of the non-equilibrium spin current in the system.
•Spin accumulation leads to the suppression of the Kondo effect.•The suppression of the Kondo effect is related to the presence of the spin current.•This effect can be compensated by a properly tuned external magnetic field.
Background Animal models are used for training of different endoscopic procedures. Whether this really improves endoscopic skills remains controversial. Objective To assess the effectiveness of ...training by using an ex vivo animal gastric model on the performance of two therapeutic procedures—hemostasis and treatment of perforation. Design A randomized, single-blind study. Setting An experimental endoscopy center in a university hospital. Participants Thirty-one gastroenterology fellows with comparable endoscopic experience. Methods Participants were randomized into two groups: with (T, n = 16) and without (S, n = 15) training. All fellows continued with standard endoscopic practice. Baseline skills were assessed at enrollment. All physicians in group T underwent 2 full days of a hands-on course over a 3-month period, in addition to their standard endoscopic practice. Both groups then underwent a blinded, final evaluation. Endoscopic skills were scored from 1 (best) to 5 (poorest) by two expert, blinded tutors. Outcomes of clinical hemostatic procedures also were analyzed. Main Outcome Measurements Successful hemostasis and successful perforation closure. Results Thirty physicians completed the study. Hemostasis results (n = 15): The number of physicians who carried out a successful hemostasis procedure increased significantly in the group with training (27% vs 73%; P = .009) but did not change in the group without training (20% vs 20%). The mean scores of injection and clipping technique improved significantly only after training. The number of clips used decreased significantly only in the group with training; the time of clipping did not change significantly in either group. Perforation results (n = 15): The number of physicians with a successful and complete perforation closure increased nearly significantly in the group with training (40% vs 73%, P = .06) as opposed to the group without training (27% vs 47%; P = .27). The procedure time decreased significantly in the group with training only. In clinical practice, fellows in group T had a significantly higher success rate with respect to hemostatic procedures (83.2%, range 67-100 vs 63.6%, range 25-100; P = .0447). The majority of participants (93%) agreed that such courses should be compulsory in gastroenterological credentials. Limitations A retrospective analysis of clinical outcomes. Clinical outcome data were based on self-reporting of the participants. Conclusion Hands-on training by using an animal ex vivo model improves endoscopic skills in both hemostasis and perforation closure. In clinical practice, the training improves the outcome of hemostatic procedures.
AIM： To compare natural orifice transluminal endoscopic surgery （NOTES） vs standard laparoscopic ovari- ectomy in mini pigs with respect to technical aspects, complications and parameters of systemic ...inflammatory response. METHODS： This was a randomized, experimental,survival study. Ten female mini pigs underwent NOTES transgastric ovariectomy （NOTES group） and ten fe- male mini pigs underwent laparoscopic ovariectomy （LAP group）. A ＂percutaneous endoscopic gastrostomy＂ approach with guidewire and sphincterotome was used for gastrotomy creation. The ovary was resected us- ing standard biopsy forceps and a snare. The access site was closed using a ＂KING＂ closure with a single endoloop and several clips. In the laparoscopic group, a three-port laparoscopy and an ovariectomy were performed with the use of standard laparoscopic de- vices. C-reactive protein （CRP）, white blood count and interleukin （IL）-6 plasma levels were used as indicators of systemic inflammatory response. All animals were euthanized 28 d after surgery. RESULTS： All animals survived without complications. The mean procedure time was 41.3 min ＋ 17.6 min （NOTES group） and 25.7 min ＋ 5.25 min （LAP group, P 〈 0.02）. Postmortem examinations demonstrated that 50% and 70% of animals were free of any complica- tions in the NOTES and LAP groups, respectively. The remaining animals developed minor complications （ad- hesions） in a comparable frequency between the two groups. In the NOTES group, one animal developed a small intramural gastric abscess close to the gastrotomy site. A minor serous exudate that was present in 50% and 40% of the animals in the NOTES and laparoscopy groups, respectively, was not considered a complica- tion. In both groups CRP levels increased significantly on the 2nd and 7th postoperative days （POD） and re- turned to normal after 28 d. On POD 2, an increase of CRP level was significantly higher in the NOTES group compared to the LAP group. Values of IL-6 did not dif- fer from baseline values in either of the groups post- operatively. Interestingly, the platelet count decreased significantly on POD 2, but returned close to baseline values on POD 7 and PODs 28-30.CONCLUSION： Both NOTES and laparoscopic ovariec-tomies had a similar frequency of minor complications. However, the NOTES technique produced an increased systemic inflammatory response on POD 2.
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