Left ventricular assist device-related infections: a multicentric study.

OBJECTIVES: The implantable left ventricular assist device (LVAD) is a major therapeutic development for end-stage heart failure in selected patients. As their use is expanding, infectious complications are emerging, with limited data available to guide their management. We aimed to better characterize LVAD-related infections. METHODS: We enrolled all consecutive patients diagnosed with LVAD-related infections in three referral centres in France, using a standardized definition of infections in patients with LVAD. Data were collected from medical charts using a standardized questionnaire. RESULTS: Between 2007 and 2012, 159 patients received LVAD for end-stage heart failure. Among them, 36 (22.6%; 5 women, 31 men) presented at least one infectious complication, after a median time of 2.9 months from LVAD implantation (interquartile range, 1.8-7.5), with a median follow up of 12 months (interquartile range 8-17). Main co-morbidities were alcoholism (33%), diabetes (11%) and immunosuppression (11%). Mean age at implantation was 51 (±11) years. LVAD were implanted as bridge-to-transplantation (n=22), bridge-to-recovery (n=8), destination therapy (n=4), or unspecified (n=2). LVAD-related infections were restricted to the driveline exit site (n=17), had loco-regional extension (n=13), or reached the internal pump (n=3). The main bacteria isolated were Staphylococcus aureus (n=20), coagulase-negative staphylococci (n=7), Enterobacteriaceae (n=14), Pseudomonas aeruginosa (n=10) and Corynebacterium sp. (n=7), with polymicrobial infections in 19 cases. LVAD could be retained in all patients, with the use of prolonged antibacterial treatment in 34 (94%), and debridement in 17 (47%). One patient died due to LVAD-associated infection. CONCLUSIONS: LVAD-related infections are common after LVAD implantation, and may be controlled by prolonged antibiotic treatment.

The anxiolitic effects of BTG1640 and BTG1675A on ultrasonic isolation calls and locomotor activity of rat pups.

OBJECTIVE: The aim of the present study was to evaluate the anxiolytic properties of the new isoxazoline compounds BTG1640 and BTG1675A in comparison with diazepam. MATERIALS AND METHODS: We evaluated the ultrasonic distress emission in both sexes of neonatal rat pups (which seems to be a sensitive indicator of the rat emotional reactivity and represents a valuable tool to screen compounds with expected anxiolytic properties) and the locomotor activity in 30-day old rat pups. RESULTS: We found a significant reduction in the number of emitted ultrasonic calls only after i.p. administration of diazepam 1 mg/kg, while no significant reduction have been detected after i.p. administration of BTG 1640 and BTG 1675A. Furthermore, we found a significant reduction of locomotor activity in the first 10' of the test, only in the group treated with diazepam 0.1 mg. CONCLUSIONS: The tests validating the supposed anxiolytic properties of the new isoxazoline compounds BTG1640 and BTG1675A, in comparison with diazepam, gave negative results.

Glass-ceramic coated Mg-Ca alloys for biomedical implant applications.

Biodegradable metals and alloys are promising candidates for biomedical bone implant applications. However, due to the high rate of their biodegradation in human body environment, they should be coated with less reactive materials, such, for example, as bioactive glasses or glass-ceramics. Fort this scope, RKKP composition glass-ceramic coatings have been deposited on Mg-Ca(1.4wt%) alloy substrates by Pulsed Laser Deposition method, and their properties have been characterized by a number of techniques. The prepared coatings consist of hydroxyapatite and wollastonite phases, having composition close to that of the bulk target material used for depositions. The 100µm thick films are characterized by dense, compact and rough morphology. They are composed of a glassy matrix with various size (from micro- to nano-) granular inclusions. The average surface roughness is about 295±30nm due to the contribution of micrometric aggregates, while the roughness of the fine-texture particulates is approximately 47±4nm. The results of the electrochemical corrosion evaluation tests evidence that the RKKP coating improves the corrosion resistance of the Mg-Ca (1.4wt%) alloy in Simulated Body Fluid.

A Comparative Study on Antibiotic Resistance of Klebsiella Strains from Surgical and Intensive Care Wards.

INTRODUCTION: Klebsiella infections are common in Intensive Care Unit (ICU) and surgical wards. In order to establish the prophylaxis protocols, we must know the prevalence of infections and the antibiotic resistance profiles. MATERIAL AND METHODS: This cross-sectional study included isolates from patients in County Clinical Emergency County Hospital, Craiova, Romania: 1254 isolates from the ICU and 1040 isolates from surgical wards. We used an automated method (Phoenix analyzer, Becton-Dickinson, USA) with antimicrobial testing according to CLSI 2014. We tested by disc diffusion the ESBL and carbapenemases production, using kits ESBL Confirm ID and KPC/Metallo-beta-lactamase/OXA-48 Confirm (ROSCO Diagnostica, Denmark). The patients in ICU were also screened at admission for carbapenemase producting strains by PCR (GeneXpert® II, Cepheid, Sunnyvale, CA, USA) for the carbapenemases: KPC, IMP-1, VIM-1, NDM, OXA-48. RESULTS: Klebsiella strains were more prevalent in ICU (20.81%) vs. surgical wards (16.34%) and they were resistant in high percentages at: cefuroxime (95.81% vs. 87.21%),ceftazidime (91.70% vs. 84.71%), cefepime (84.2% vs. 69.82%). The highest differences in resistance were observed for Tygecycline (Risk Ratio (RR) = 7.69), Imipenem/Cilastatine (RR=3.36), Cefoperazone with sulbactam (RR=2.58), Ciprofloxacine (RR=2.11), Gentamycin (RR=2.05) and Ertapenem (RR=1.93). The ICU strains showed MDR in 48.57% of cases vs. 23.57% in surgery strains. The prevalence of ESBL production was 82.4% in ICU vs. 32.3% in surgical wards. The prevalence of carbapenemase producing strains was 43.68% in ICU vs. 23.53% in surgical wards. CONCLUSIONS: The infections with Klebsiella spp. are more frequent in ICU compared with surgical wards and their antibiotic resistance is greater.

Immunohistochemical profile of the estrogen and progesterone receptors in mammary benign lesions.

UNLABELLED: The immunohistochemical diagnosis for estrogen and progesterone receptors must be carried out in the tracking of every primary tumor, benign or malign, especially in the case of in situ carcinoma. MATERIAL AND METHOD: We have studied the expression of estrogen and progesterone receptors in benign lesions, identifying phenotypes depending on the presence of estrogen and progesterone receptors. RESULTS: The result "positive" or "negative" in the report sent to the doctor is not sufficient, the inclusion of the total score in the case of a positive result, the clone used, the usage / non-usage of antigenic exposure and also the quality control being necessary. The benign mammary lesions occur in the context of a hormonal imbalance, which, in the long run runs the risk of developing a mammary carcinoma. CONCLUSION: The further study of the hormonal spectrum of those lesions, considered as pre-malignant, may lead to the identification of some groups of hyperplastic lesions, presenting a high risk for developing a mammary cancer.

Human epidermal growth factor receptor 2 (HER2/neu) supraexpression in the mammary tumors.

A series of morphological and molecular factors can be used in order to appreciate the prognostic of mammary cancer. A multitude of molecular factors has been investigated in order to identify a prognostic factor, one of the most studied factors being HER2 (human epidermal receptor growth factor). For this purpose, we have carried out an immunohistochemical research, in order to determine the correlation between the presence of morphological factors in tumor formation, different stages of evolution, and the response to therapy. We have correlated HER2 expression with the histological type of carcinomas, the histological differential degree, ER, PR immunohistochemical expression, as well as the available clinical data. Within the studied carcinomas, we have identified a number of 98/156 (62.8%) carcinomas HER2/neu negative, out of which 74/156 (47.4%) did not reveal the presence of HER2/neu and 24/156 (15.4%) have been quantified as being 1+. The HER2/neu supraexpression was encountered in 58/156 (37.17%) cases: in 34/156 (21.8%) cases the immunostaining was interpreted as being 2+ and in 24/156 (15.4%) cases it was interpreted as being 3+. HER2/neu supraexpression should be routinely determined through immunohistochemical methods in all primary mammary tumors, especially in those poorly differentiated.

Altered anatomy in a case with a buccally impacted maxillary canine tooth.

Bilateral dissections of maxilla were performed in a human adult cadaver head, male, aged 53 years. After the en block removal of the soft tissues in the oral and infraorbital regions, the antero-lateral surface of maxilla was exposed and also the vestibular aspect of the upper alveolar process. An oblique labially impacted right upper canine was evidenced, completely submucosal: its apex was tangent to the maxillary sinus floor, while the superior side of the apical part of the root was in close relation with the floor of the laterally expanded inferior nasal meatus. Superior and adjacent to the neck of that impacted canine a follicular cyst was evidenced and the antral wall presented distally to the apex of the impacted canine a dehiscent area, where the antral mucosa was only covered by an incomplete thin bony lamella. The incisors on that side were present but no resorption was identified at their level. Within the anterior border of the wall separating the maxillary sinus, small, and the inferior nasal meatus, the nerve for that impacted canine was coursing; the nerves for the upper incisors were initially located within the antero-lateral wall of the inferior nasal meatus. Although small, the maxillary sinus presented a supero-medial recess above the enlarged inferior nasal meatus and lateral to the normally-sized middle nasal meatus.

Alteration of PTGS2 promoter methylation in chronic periodontitis.

Levels of prostaglandin E(2) and the prostaglandin-endoperoxide synthase-2 (PTGS2, or COX-2) increase in actively progressing periodontal lesions, but decrease in chronic disease. We hypothesized that chronic inflammation is associated with altered DNA methylation levels within the PTGS2 promoter, with effects on COX-2 mRNA expression. PTGS2 promoter methylation levels from periodontally inflamed gingival biopsies showed a 5.06-fold increase as compared with non-inflamed samples (p = 0.03), and the odds of methylation in a CpG site in the inflamed gingival group is 4.46 times higher than in the same site in the non-inflamed group (p = 0.016). The level of methylation at -458 bp was inversely associated with transcriptional levels of PTGS2 (RT-PCR) (p = 0.01). Analysis of the data suggests that, in chronically inflamed tissues, there is a hypermethylation pattern of the PTGS2 promoter in association with a lower level of PTGS2 transcription, consistent with a dampening of COX-2 expression in chronic periodontitis. These findings suggest that the chronic persistence of the biofilm and inflammation may be associated with epigenetic changes in local tissues at the biofilm-gingival interface.

The adult coeliac ganglion: a morphologic study.

The coeliac plexus is located on the sides of the coeliac trunk and nearby the origins of the superior mesenteric and renal arteries. Afferent branches get to this plexus from the vagus nerve, splanchnic nerves and the right phrenic nerve; efferents leave for viscera through periarterial plexuses and the retroportal nerves. The coeliac plexus ganglia - coeliac, superior mesenteric, aorticorenal - are prevertebral ganglia that receive the preganglionic sympathetic fibers brought by the splanchnic nerves from the thoracic spinal cord. For studying the adult coeliac ganglia dissections were performed then pieces were drawn for silver staining by the method of Bielschowsky on blocks and HE stains. The adult coeliac ganglia consist of well-defined ganglionic subunits, of a varying number of neurons with somata ranging from 14 to 48 microns and characteristically involved in extensive dendritic fields. Individual degrees of coalescence may justify the macroscopic appearance of the coeliac ganglion but its structure keeps distinctive subunits.

Bilateral struma ovarii: a case mimicking an ovarian neoplasm.

We present a case of bilateral struma ovarii which developed postoperatively and was histopathologically diagnosed after the patient was hospitalized for investigation and treatment of tumoral anexal bilateral formations. There was no evidence of clinical malignancy or metastases. Data from the literature, together with histopathologic, diagnostic and therapeutic aspects of the disease were checked again taking into account the scarcity of this lesion, especially bilaterally.

Details of the intralingual topography and morphology of the lingual nerve.

The lingual nerve supplies the tongue with trigeminal sensory fibers and sensory fibers that originate from the chorda tympani. The aim of this study was to investigate, by dissection, the anatomical features of the lingual nerve at the level of the tongue and to correlate the findings with existing data. Six human adult cadavers dissected bilaterally and 6 specimens of tongue-pharynx-larynx from autopsied adult cadavers were studied. The lingual nerve gives off its terminal branches at the anterior border of the hyoglossus muscle where the anastomotic loops between the lingual and hypoglossal nerves are found. Two morphological types of terminal division of the lingual nerve were seen: a single primary trunk or two primary trunks, a medial one distributed in the middle third of the tongue and a lateral one for the anterior third of the tongue. The primary terminal branches of the lingual nerve were located on the outer surface of the genioglossus muscle, forming a nervous layer over the deep artery of the tongue. The following emerged from the primary trunk(s): thin branches for the ipsilateral mucosa of the ventral surface of the tongue and 4-9 thick secondary trunks, with palisade disposition and translingual courses that followed the outer surface of the genioglossus muscle towards the dorsal mucosa of the ipsilateral part of the tongue, anterior to the circumvallate papillae.

Enteric nervous system development in cavitary viscera allocated to the celiac plexus.

Enteric nervous system (ENS) is a network made of neuronal cells and nervous fibers. There are two plexuses: myenteric of Auerbach and sub mucous of Meissner and Henle. Many substances are involved in neurotransmission at ENS level. ENS assures all gastrointestinal system functions: digestion, absorption, etc. Our study is made on 23 human fetal specimens at different ages of evolution with crown-rump lengths from 9 to 28 cm, and three new born human specimens. We used the Trichrome Masson stain technique and the argental impregnation Bielschowsky on block technique for microscopic evidence. Our study concerned the cavitary viscera allocated to the celiac plexus, involving all layers of each studied viscera.

Deep recurrent infection of the hip after tumoral resection in an 18-years old male--a case report.

An 18 years old male was referred to us 4 years after major tumoral surgery. In 2002 he was diagnosed with Ewing sarcoma of the proximal two-thirds of his left femur. Wide resection of the tumor was performed, with a makeshift implant one-stage reconstruction, followed by a combination of chemo and radiotherapy for another 6 months. Eight months after surgery a deep infection of the hip developed, and despite antibiotic treatment and two consecutive debridments and lavage the results were negative. When we first saw the patient in 2006, he still had an active infection in his left hip and a septic general appearance. A two-stage revision was performed and a modular tumoral reconstruction was implanted. At two years follow up the patient presents no signs of recurrence neither of the infection nor of the primary tumor.

Human gamma-aminobutyric acid A receptor alpha2 gene moderates the acute effects of alcohol and brain mRNA expression.

Gamma-aminobutyric acid A (GABA(A)) receptors moderate several of the behavioral effects of alcohol. In fact, recent studies have shown an association between the gene for the alpha2-subunit of the GABA(A) receptor (GABRA2) and alcoholism. In the present study, we examined the functional relevance of the GABRA2 gene in alcohol dependence by assessing brain GABRA2 mRNA and GABA(A)alpha2-subunit protein levels in post-mortem prefrontal cortical tissue collected from control and alcohol-dependent individuals. In addition, using an endophenotype approach, we tested whether the GABRA2 gene moderates sensitivity to the acute effects of alcohol in two independent samples from distinct human alcohol challenge studies. Results indicated that GABRA2 mRNA levels significantly differed by GABRA2 genotype. GABRA2 single nucleotide polymorphisms (rs573400, rs279871 and rs279858) were significantly associated with sensitivity to the acute effects of alcohol. Specifically, there was a significant main effect of GABRA2 x breath alcohol concentration on several measures of subjective responses to alcohol, including the hedonic value of alcohol. Importantly, reanalysis of a previous intravenous alcohol administration study confirmed the results of the oral alcohol challenge study. In summary, these results extend previous findings and provide new insights into the putative biobehavioral mechanisms that may moderate the association between the GABRA2 gene, sensitivity to the acute effects of alcohol and ultimately alcohol dependence.

Study of the celiac ganglia development.

The celiac ganglia and the visceral plexus are complexes structures, disposed in the proximity of the main collateral branches of the aorta. Pre visceral ganglia are sympathetic ganglia chains between the lateral vertebral sympathetic chain and viscera. Our study is made in the anatomy lab on 30 adult human bodies, one of new born and 10 human fetal specimens with crown-rump lengths from 9 to 28 cm. It was used the argental impregnation by Bielschowsky on block and Trichrome Masson methods for microscopic evidence. Prenatal, celiac ganglia are not a good defined morphological unit. They show a delay of neuroblastic maturation, comparing with the par vertebral ganglia. The nervous functional unit is represented by the neuron. The ontogenesis of the celiac ganglia follows several stages. Then, the neuronal specialization and the functional neuronal maturation are processes based on the numeric and morphological remodeling of the neuronal connecting figure, pre ganglia and post ganglia.

Study of the diameter and number of the pulmonary veins orifices.

The present study was made in the anatomy laboratory on 100 heart specimens. It was studied the morphological parameters about diameter and number of the atrial orifices of the pulmonary veins. The number of the orifices and their diameter depends on the lungs weight. Generally (70% of the cases) the orifices number is four and rarely three or five. An increased number of orifices are more frequently in the right side and a decreased number especially in the left side. The orifices diameter is much larger at the male's veins than the female's ones, and much larger in the right than the left side and also much larger at the superiors than the inferior veins.

Former and present aspects in upper level of viscero-skull architecture.

The classical reference material describes two resistance arcs, the maxillary arc and the mandibulary arc, from which the masticatory forces direct themselves towards the functional resistance structures of the viscero-skull. From the maxillary arc, three pairs of vertical pillars ascend (that is fronto-nasal, zygomatic and pterygoid). Certain authors add to these a median arc--the bony part of the nasal septum. From the mandibulary arc, the lines of force make for the cordyle and the coronoid process of the mandible. In terms of the new outlook, at the upper level of the viscero-skull, there are five vertical blades described: one median, two medial and two lateral, those last including the pillars from the classical descriptions. These vertical blades are joined by three horizontal laminae: the upper one, the middle one--interrupted by the median line and the lower one--included in the concavity of the maxillary arc. These structures of laminae induce the formation of some resistance cylinders and cones. Within the lower level of the viscero-skull there are three mandibulary arcs described: the upper one (the classic mandibulary arc), the middle one (with an oblique direction) and the lower one.

Former and present aspects in neuro-skull architecture.

The classical authors considered the functional resistance of the neuro-skull to consist of arcs at the arch level, rafters at the base and pillars at the joint of the arcs and rafters, those last also connecting the neuro-skull framework and that of the viscero-skull. The new outlooks replace the term pillar with that of resistance node and assemble the arcs and rafters within common structures, named resistance belts. The belts are: one in transversal, three sagittal, two in frontal plane and two oblique positions. At the intersection of the belts, the resistance nodes are placed.

Correlations between anomalies of jugular veins and areas of vascular drainage of head and neck.

The study conducted on 60 human cadavers preserved in formalin, in the Anatomy Laboratory of the "Victor Babes" University of Medicine and Pharmacy Timisoara, during 2000-2006, observed the internal and external jugular veins from the point of view of their origin, course and affluents. The morphological variability of the jugular veins (external jugular that receives as affluents the facial and lingual veins and drains into the internal jugular, draining the latter's territory--3.33%; internal jugular that receives the lingual, upper thyroid and facial veins, independent--13.33%, via the linguofacial trunk--50%, and via thyrolinguofacial trunk--33.33%) made possible the correlation of these anomalies with disorders in the ontogenetic development of the veins of the neck. Knowing the variants of origin, course and drainage area of jugular veins is important not only for the anatomist but also for the surgeon operating at this level.

Incidence of endometrial carcinoma in patients with endometrial hyperplasia.

OBJECTIVE: The purpose of this retrospective study was to establish the risk of developing endometrial adenocarcinoma in patients diagnosed with endometrial hyperplasia. MATERIAL AND METHODS: The incidence of endometrial hyperplasia and its relation with endometrial adenocarcinoma was evaluated in 1,139 patients who presented with abnormal bleeding between January 2000 and December 2004; D&C was performed in all cases. There were 591 (51.88%) cases of simple endometrial hyperplasia, out of which 110 (18.61% from 51.88%) cases had atypia, 60 (5.26%) cases of complex hyperplasia, out of which 19 (31.66% from 5.26%) had atypia, and the remaining 488 (42.84%) had different forms of mixed hyperplasia. RESULTS: The incidence of endometrial adenocarcinoma was 3.87% in atypical hyperplasia and 0.81% in other forms, and was related only to cases with atypia in which the incidence was 0.61%. CONCLUSIONS: The most indicated measure to prevent endometrial carcinoma in cases with complex endometria hyperplasia with atypia is hysterectomy, while for other forms of hyperplasia, hormonal treatment is used but only under strict control.