The Prototheca species are achlorophyllic algae and they are recognized pathogens in animals. They have been reported to cause infections in humans; the majority of the infected patients are ...immunocompromised. Organ transplant recipients are at risk of infection caused by such unusual organisms.
Here we present a highly atypical case report of Prototheca mimicking a cecum tumor in a kidney recipient 7 years after the transplantation. Three years before this Prototheca infection, after a native nephrectomy, the patient underwent a complicated duodeno-jejunal reconstruction with feeding catheter jejunostomy. Imaging studies indicated a tumor-like space occupying lesion in the cecum. The patient was treated successfully with colon resection. Detailed histology excluded malignancy and proved Prototheca wickerhamii.
The pathogenesis and many biological aspects of human protothecosis are unclear. Usually, treatment involves both medical and surgical approaches. The surgical treatment should be complete excision. The literature suggests an extremely high mortality rate, and therefore we advocate aggressive surgery in organ transplant recipients. This case is the first report of a successfully treated gastrointestinal manifestation of protothecosis in an organ transplant recipient.
Situs inversus totalis is a rare anatomical variation of both the thoracic and the abdominal organs. Common bile duct strictures can be caused by malignant and benign diseases as well. 7-18% of the ...latter ones are 'malignant masquerade' cases, as pre-operative differentiation is difficult.
We present the case of a 68y male patient with known situs inversus totalis and a recent onset of obstructive jaundice caused by a malignant behaving common bile duct stricture. Technically difficult endoscopic retrograde cholangiopancreatography, brush cytology, magnetic resonance cholangiopancreatography, endoscopic ultrasound, and percutaneous transhepatic drainage with stent implantation were performed for proper diagnosis. Cholecystectomy, common bile duct resection with hilar lymphadenectomy, and hepatico-jejunostomy have been performed following multidisciplinary consultation. The final histology report did not confirm any clear malignancy, the patient is doing well.
In situs inversus patients, both diagnostic and therapeutic procedures can lead to various difficulties. Benign biliary strictures are frequently misdiagnosed preoperatively as cholangiocellular carcinoma. Surgery is usually unavoidable, involving a significant risk of complications. The co-existence of these two difficult diagnostic and therapeutic features made our case challenging.
Summary
Chronic inflammation and protein energy wasting (PEW) syndrome are common in kidney transplant recipients (KTR). The presence of inflammation and PEW syndrome can directly affect bone ...resorption and bone formation, leading to bone loss and fractures. We showed PEW is independently associated with new clinically detected bone fractures in prevalent KTR.
Introduction
Kidney transplant recipients (KTR) have a 4-fold higher risk of fracture compared to the general population. Chronic inflammation and PEW syndrome are common in KTR and are associated with poor outcomes. We hypothesized that the Malnutrition–Inflammation Score (MIS), a validated measure of PEW, is associated with higher risk of bone fractures in KTR.
Methods
This prospective cohort study included 839 prevalent KTR from a Central European academic center. MIS, a semiquantitative instrument of PEW, was calculated at the study entry. Self-reported history of fractures was recorded during the 2-year follow-up period. The association between MIS and bone fractures was examined in logistic regression analyses with adjustment for age, gender, eGFR, smoking habits, history of pre-transplant bone fractures, and acute rejection.
Results
Mean age was 51 ± 13 years, and 56% of patients were males with median (interquartile range) transplant vintage 69 (38–112) months, estimated glomerular filtration rate 55 ± 21 ml/min/1.73 m
2
, and calculated MIS 3 (2–4) at enrollment. Fifty-five (7%) patients experienced self-reported bone fractures during the 2-year follow-up period. Higher MIS score showed linear association with increased risk of fracture. Each one-point higher MIS was associated with 23% higher risk of bone fractures (odds ratio (OR) and 95% CI 1.23, 1.12–1.34), which remained significant after multivariable adjustments (OR 1.17, 95% CI 1.06–1.29).
Conclusion
The MIS is independently associated with new clinically detected bone fractures in prevalent KTR.
In order to ensure an optimal performance of the LHCb Distributed Computing, based on LHCbDIRAC, it is necessary to be able to inspect the behavior over time of many components: firstly the agents ...and services on which the infrastructure is built, but also all the computing tasks and data transfers that are managed by this infrastructure. This consists of recording and then analyzing time series of a large number of observables, for which the usage of SQL relational databases is far from optimal. Therefore within DIRAC we have been studying novel possibilities based on NoSQL databases (ElasticSearch, OpenTSDB and InfluxDB) as a result of this study we developed a new monitoring system based on ElasticSearch. It has been deployed on the LHCb Distributed Computing infrastructure for which it collects data from all the components (agents, services, jobs) and allows creating reports through Kibana and a web user interface, which is based on the DIRAC web framework. In this paper we describe this new implementation of the DIRAC monitoring system. We give details on the ElasticSearch implementation within the DIRAC general framework, as well as an overview of the advantages of the pipeline aggregation used for creating a dynamic bucketing of the time series. We present the advantages of using the ElasticSearch DSL high-level library for creating and running queries. Finally we shall present the performances of that system.
Bloodless liver transplantations (LT) have already been reported, but special characteristics of hemostatic changes remain less defined. The aim of this study was to evaluate the “inevitable” loss of ...coagulation factors (CF) in blood product–free LT.
Blood product and CF concentrate–free LT patient data were analyzed in terms of the first 2 days of perioperative hemostasis kinetics (N = 59). CF levels (FI, II, V, VII, X, and XIII), platelet (PLT) levels, and hemoglobin levels were measured before LT (T1), on arrival at the intensive care unit (T2), and 12, 24, and 48 hours after LT (T3, T4, and T5, respectively). Thromboelastographic (TEG) parameters were determined before and at the end of LT (T1-T2).
Fibrinogen levels decreased by 1.2 ± 0.6 g/L, prothrombin levels by 26% ± 14%, factor V levels by 40% ± 23%, VII levels by 29% ± 19%, and X levels by 39% ± 22% (P < .001). From T2 to T4 fibrinogen increased by 0.9 ± 0.6g/L for 24 hours (P < .001). Factor II, V, and VII levels increased by 20% ± 16%, 31% ± 32%, and 12% ± 27%, respectively, between T3 and T5 (P < .001). However, factor X reached only half of the T1 level (T3-T5, P < .001). Platelet count increased in 34 (58%) patients at T2 (P < .001). The TEG parameters remained in the normal range during LT (T1-T2).
The major findings of this study advocate that “inevitable” levels of CF decrease during LT by an average of 1.2 g/L in terms of fibrinogen and 23% to 40% regarding factors II, V, VII, and X. The authors suggest that knowing the “magic numbers” and comparing them against baseline laboratory results might predict the possibility of blood product–free transplant, providing confidence and safety to the surgeon and the anesthetist.
•In the “ideal” condition, the blood product and coagulation factor–free liver transplant reduces fibrinogen level by 1.2 g/L and FII, FV, FVII, and FX levels by 30% to 40%.•The transplanted liver restores the fibrinogen level by 1 g/L at the end of the first postoperative day and FII, FV, FVII, and FX levels by 20% to 30 % at the end of the second postoperative day.•The extent of “CF’s tick mark shape” complements Massicotte’s predictive nomograms for transfusion and blood loss in LT, and it might be advisable in LTs among Jehovah Witnesses as well.
Post-transplantation portal hypertension has severe complications, such as esophageal varix bleeding, therapy refractory ascites, extreme splenomegaly, and graft dysfunction. The aim of our study was ...to analyze the effectiveness of the therapeutic strategies and how to visualize the procedure.
A retrospective study involving liver transplantation patients from the Semmelweis University Department of Transplantation and Surgery was performed between 2005 and 2015. The prevalence, etiology, and leading complications of the condition were determined. The applied interventions' effects on the patients' ascites volume, splenic volume, and the occurrence of variceal bleeding were determined. Mean portal blood flow velocity and congestion index values were calculated using Doppler ultrasonography.
The prevalence of post-transplantation portal hypertension requiring intervention was 2.8%. The most common etiology of the disease was portal anastomotic stenosis. The most common complications were esophageal varix bleeding and therapy refractory ascites. The patients' ascites volume decreased significantly (2923.3 ± 1893.2 mL vs. 423.3 ± 634.3 mL; P < .05), their splenic volume decreased markedly. After the interventions, only one case of recurrent variceal bleeding was reported. The calculated Doppler parameters were altered in the opposite direction in cases of pre-hepatic versus intra- or post-hepatic portal hypertension. After the interventions, these parameters shifted towards the physiologic ranges.
The interventions performed in our clinic were effective in most cases. The patients' ascites volume, splenic volume, and the prevalence of variceal bleeding decreased after the treatment. Doppler ultrasonography has proved to be a valuable imaging modality in the diagnosis and the follow-up of post-transplantation portal hypertension.
The safety of laparoscopic appendectomy for the management of incidentally discovered appendiceal tumors has not yet been established.
Appendiceal tumor cases managed by laparoscopy or laparotomy ...over a 10-year period were reviewed.
The pathological diagnoses were 23 carcinoid and 20 cancerous lesions. The median patient ages were 36 and 69 years, respectively, for carcinoid and other tumors (p < 0.05). Acute appendicitis was present in 70% of carcinoid cases and 35% of other tumors (p < 0.05). Eight patients with carcinoid tumors were operated on by laparoscopy, whereas 15 underwent laparotomy. Laparoscopic and open procedures were performed in three and 17 patients with cancerous lesions, respectively. Invaded surgical margins were seen after laparoscopy in 20% of patients and open surgery in 6%. Synchronous colon carcinoma was detected in 14% of the patients with an appendix neoplasm. The 5-year survival rates were similar after both laparoscopic and open appendectomy for either carcinoid or other tumors.
Laparoscopic appendectomy for appendiceal tumors seems to have a slightly higher rate of inadequate resection. However, it is not associated with a significantly worse patient prognosis than open appendectomy.
The incidence of drug-induced acute liver failure (ALF) has been increasing in recent years. Despite the complex intensive treatment, liver transplant should be performed in progressive cases. A ...systemic inflammatory response syndrome and the burden of surgical intervention promote abdominal compartment syndrome (ACS); observed preoperatively, they are significant negative prognostic factors.
We demonstrate a young woman with liver transplant after ALF and a consecutive ACS. We presumed drug toxicity in the background of the rapidly progressive ALF, based on the preoperative hematologic examination and the histology of the removed liver. An ACS has occurred in the postoperative period that must have been resolved with mesh, and later, anatomic segment 2-3 resection had to be performed to further decrease the pressure. The patient left the hospital after 62 days with good graft function.
A complex intensive care is mandatory in the case of orthotopic liver transplant for ALF. Outcomes are good after orthotopic liver transplant. An ACS might occur after surgery. In these rare cases a delayed abdominal closure or even a liver resection can be the only solution and sometimes an urgent need to resolve the life-threatening problem.
Nowadays, many database systems are available but they may not be optimized for storing time series data. Monitoring DIRAC jobs would be better done using a database optimised for storing time series ...data. So far it was done using a MySQL database, which is not well suited for such an application. Therefore alternatives have been investigated. Choosing an appropriate database for storing huge amounts of time series data is not trivial as one must take into account different aspects such as manageability, scalability and extensibility. We compared the performance of Elasticsearch, OpenTSDB (based on HBase) and InfluxDB NoSQL databases, using the same set of machines and the same data. We also evaluated the effort required for maintaining them. Using the LHCb Workload Management System (WMS), based on DIRAC as a use case we set up a new monitoring system, in parallel with the current MySQL system, and we stored the same data into the databases under test. We evaluated Grafana (for OpenTSDB) and Kibana (for ElasticSearch) metrics and graph editors for creating dashboards, in order to have a clear picture on the usability of each candidate. In this paper we present the results of this study and the performance of the selected technology. We also give an outlook of other potential applications of NoSQL databases within the DIRAC project.
The DIRAC Web Portal 2.0 Mathe, Z; Ramo, A Casajus; Lazovsky, N. ...
Journal of physics. Conference series,
01/2015, Letnik:
664, Številka:
6
Journal Article
Recenzirano
Odprti dostop
For many years the DIRAC interware (Distributed Infrastructure with Remote Agent Control) has had a web interface, allowing the users to monitor DIRAC activities and also interact with the system. ...Since then many new web technologies have emerged, therefore a redesign and a new implementation of the DIRAC Web portal were necessary, taking into account the lessons learnt using the old portal. These new technologies allowed to build a more compact, robust and responsive web interface that enables users to have better control over the whole system while keeping a simple interface. The web framework provides a large set of "applications", each of which can be used for interacting with various parts of the system. Communities can also create their own set of personalised web applications, and can easily extend already existing ones with a minimal effort. Each user can configure and personalise the view for each application and save it using the DIRAC User Profile service as RESTful state provider, instead of using cookies. The owner of a view can share it with other users or within a user community. Compatibility between different browsers is assured, as well as with mobile versions. In this paper, we present the new DIRAC Web framework as well as the LHCb extension of the DIRAC Web portal.
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