Determination of Optimal Phage Load and Administration Time for Antibacterial Treatment.

Using phages as antibacterials is becoming a customary practice in Western countries. Nonetheless, successful treatments must consider the growth rate of the bacterial host and the degradation of the virions. Therefore, successful treatments require administering the right amount of phage (viral load, Vφ) at the right moment (administration time, Tφ). The present protocols implement a machine learning approach to determine the best combination of Vφ and Tφ to obtain the elimination of the target bacterium from a system. © 2024 The Authors. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: One bacterium, one phage Alternate Protocol 1: One bacterium, one phage (wrapping function) Alternate Protocol 2: One bacterium, one phage (wrapping function, alternative growing model) Basic Protocol 2: Two bacteria, one phage Alternate Protocol 3: Two bacteria, one phage (launch from terminal).

Modulation of the replication of positive-sense RNA viruses by the natural plant metabolite xanthohumol and its derivatives.

The COVID-19 pandemic has highlighted the importance of identifying new potent antiviral agents. Nutrients as well as plant-derived substances are promising candidates because they are usually well tolerated by the human body and readily available in nature, and consequently mostly cheap to produce. A variety of antiviral effects have recently been described for the hop chalcone xanthohumol (XN), and to a lesser extent for its derivatives, making these hop compounds particularly attractive for further investigation. Noteworthy, mounting evidence indicated that XN can suppress a wide range of viruses belonging to several virus families, all of which share a common reproductive cycle. As a result, the purpose of this review is to summarize the most recent research on the antiviral properties of XN and its derivatives, with a particular emphasis on the positive-sense RNA viruses human hepatitis C virus (HCV), porcine reproductive and respiratory syndrome virus (PRRSV), and severe acute respiratory syndrome corona virus (SARS-CoV-2).

Surgeon Henry Tonks and the blur of artistry.

The professional career of 20th Century British surgeon and artist Henry Tonks provides a unique perspective into the complex balance of technique, creativity, and empathy necessary to heal both body and soul. For Tonks, the skills of surgery did not suffice to address his intense emotional attachment to his suffering patients. For that reason, he turned to painting as an expression of deeper efforts to demonstrate human suffering to which he was so sensitive and which engulfed him at times in the tragedies of mankind. Nevertheless, his appreciation of the fine details of surgery and surgical manipulations of the body never diminished. His anatomic sketches proved invaluable in reconstructive surgery. Yet, his preference remained to display the entire dimensions of his world through brush and colors. In the process, concern for the personal imperfections of both of his chosen professions enabled Tonks to continually analyze his artistry and to instill that same discipline in his students. This, too, made him a revered teacher and effective interpreter of humanism.

Korea and the Bloodstained Path to Pusan: A Medical Calamity of Retreat and the Redemptive Genesis of MASH.

June of 1950 found the US forces poorly prepared to stop North Korean forces rolling into South Korea. First encounters scattered American soldiers and presented unique challenges for care of the casualties; battalion doctors and medics hustled the wounded along, sometimes themselves trapped, captured, or killed. Finally, within the Pusan perimeter American and South Korean resistance stiffened. It was in this defensive position the first Mobile Army Surgical Hospitals (MASH) were deployed far forward-heretofore simply a paper concept. MASH units performed magnificently, resuscitating and evacuating gravely wounded American and South Korean casualties, ushering in a new dimension to combat casualty care.

Alexis Carrel and His Voyage of Discovery: Miracles and the Spirituality of Healing.

In the era of positivism and anticlericalism of France's Belle Époque, scientist Alexis Carrel stood in stark contrast as one preoccupied with his faith and its relation to scientific scrutiny. Despite his early adult agnosticism, he sought proof of the divine and chose verification of the miraculous cures reported from the shrine at Lourdes, France. It so happened that on his first visit there, he encountered a truly remarkable "cure" of a young woman in the terminal stages of tubercular peritonitis. On a return visit, for the second time, he witnessed the restoration of sight to a blind child. Throughout the rest of his life, Carrel was struck by the proximity of the supernatural to corporeal interactions. He ultimately found a place for his faith as a parallel pathway and not in juxtaposition to the scientific. This paper chronicles Carrel's evolution of belief and reconciliation of faith and science.

Minerals and Cancer: Overview of the Possible Diagnostic Value.

Cancer is the second leading cause of death worldwide and is expected to increase by one-third over the next two decades, in parallel with the growing proportion of the elderly population. Treatment and control of cancer incidence is a global issue. Since there is no clear way to prevent or cure this deadly malignancy, diagnostic, predictive, and prognostic markers for oncological diseases are of great therapeutic value. Minerals and trace elements are important micronutrients for normal physiological function of the body. They are abundant in natural food sources and are regularly included in dietary supplements whereas highly processed industrial food often contains reduced or altered amounts of them. In modern society, the daily intake, storage pools, and homeostasis of these micronutrients are dependent on certain dietary habits and can be thrown out of balance by malignancies. The current work summarizes the data on minerals and trace elements associated with abnormal accumulation or depletion states in tumor patients and discusses their value as potential tumor-associated biomarkers that could be introduced into cancer therapy.

Vitamins as Possible Cancer Biomarkers: Significance and Limitations.

The Western-style diet, which is common in developed countries and spreading into developing countries, is unbalanced in many respects. For instance, micronutrients (vitamins A, B complex, C, D, E, and K plus iron, zinc, selenium, and iodine) are generally depleted in Western food (causing what is known as 'hidden hunger'), whereas some others (such as phosphorus) are added beyond the daily allowance. This imbalance in micronutrients can induce cellular damage that can increase the risk of cancer. Interestingly, there is a large body of evidence suggesting a strong correlation between vitamin intake as well as vitamin blood concentrations with the occurrence of certain types of cancer. The direction of association between the concentration of a given vitamin and cancer risk is tumor specific. The present review summarized the literature regarding vitamins and cancer risk to assess whether these could be used as diagnostic or prognostic markers, thus confirming their potential as biomarkers. Despite many studies that highlight the importance of monitoring vitamin blood or tissue concentrations in cancer patients and demonstrate the link between vitamin intake and cancer risk, there is still an urgent need for more data to assess the effectiveness of vitamins as biomarkers in the context of cancer. Therefore, this review aims to provide a solid basis to support further studies on this promising topic.

Operative versus non-operative management in the care of patients with complicated appendicitis.

BACKGROUND: The approach to complicated appendicitis is unclear. We have sought to determine factors which may persuade surgeons to non-operative management and whether such treatment affects outcome. METHODS: All adult patients admitted over a five-year period 2009-2014 with a diagnosis of appendicitis were reviewed. Patients were grouped into uncomplicated and complicated presentations and stratified by age, gender, ethnicity, socio-economic status, and time to presentation. Mortality, morbidity, length of hospital stay (LOS), readmission, and hospital charges were used as outcome measures. RESULTS: 611 adult patients were admitted with the diagnosis of appendicitis. Of those 306 patients presented in an uncomplicated manner, and 305 patients were complicated presentations. Selection for non-operative management was significantly correlated with older age and a longer time to presentation. For outcome patients who underwent early surgery experienced a longer LOS (5.8 ± 4.4 days versus 3.4 ± 4.5 days, p < 0.0001), and more readmissions. CONCLUSION: Surgical treatment of patients presenting with complicated appendicitis is preferable to non-operative, antibiotic oriented treatment in reduction of LOS and need for readmissions.

Failure events in transition of care for surgical patients.

BACKGROUND: Unexpected clinical deterioration (failure events) in surgical patients on standard nursing units (WARDs) could have a significant impact on eventual survival. We sought to investigate failure events requiring intensive care (surgical ICU [SICU]) transfer of surgical patients on WARDs in a single-center academic setting. STUDY DESIGN: Surgical patients admitted to WARDs over a 12-month period, who developed failure events, were retrospectively reviewed. Time to deterioration since WARD arrival, clinical factors, notification chain, and outcomes were identified. A physician review panel determined the preventability of failure events. RESULTS: Ninety-eight patients experienced 111 failure events requiring SICU transfer. Most patients (85%) were emergency admissions. Of 111 events, 90% had been previously discharged from an SICU or a postanesthesia care unit (PACU). Recognition of failure was by nursing (54%) and on routine physician rounds (34%). Rapid response or code blue alone was less common (12%). A second physician notification was needed in 29%, with delays due to failure to identify severity of illness. Most commonly, respiratory events prompted notification (77 of 111, 69%). Overall mortality was 26 of 98 (27%). Median time to failure was 2 days and was associated with early transfer from the SICU or PACU. Rapid response or code blue activation was associated with higher mortality than physician notification. CONCLUSIONS: Patients most at risk for WARD failures were those with acute surgical emergencies or recently discharged from the SICU or PACU. Respiratory complications were the most common cause of WARD failure events. Many early failures may have been due to premature transfer from the SICU or PACU. Failure events on WARDs can have lethal consequences. Awareness, monitoring, and communication are important components of preventative measures.

Ton That Tung's livers.

Born in the early 20th century, the Vietnamese surgeon Ton That Tung received his medical education in French colonial Indochina at the fledgling l'Ecole de Médecine de Hanoi, the first indigenous medical school in Southeast Asia. The benefactor of a postgraduate position at the medical school, Ton That Tung subsequently obtained his surgical training at the Phù Doãn Hospital in Hanoi and concurrently developed a passion for the study of liver anatomy, pathology, and surgery. His contributions to an understanding of liver anatomy based on meticulous dissection of autopsy specimens antedated and rivaled later work by the famous Western anatomists Couinaud, Healey, Schroy, and others. Ton That Tung's contributions, however, were overshadowed by the intense national struggles of the Vietnamese to establish independent rule and self-governance from the French and by eventual alignment with eastern bloc Communist countries, thus isolating much of his work behind the "Iron Curtain" until well after the end of the Cold War. Nevertheless, Ton That Tung remains a pioneer in liver anatomy and liver surgery. His commitment to surgical science and, more importantly, to the Vietnamese people stands as a tribute to the tireless pursuit of his ideals.

Cause of death from liver metastases in colorectal cancer.

BACKGROUND: Surgically directed therapy for liver metastases from colorectal cancer (CRC) has received substantial attention in the literature as a major focus of treatment for metastatic CRC. It is presumed, but not proven, that liver metastases are a major threat to life. This study examined the course of a cohort of consecutive patients who died with CRC to determine the role played by the presence of liver metastases. METHODS: This is single-institution retrospective observational study involved all patients who died of CRC. Records were examined and imaging studies reviewed to determine the extent of liver and extrahepatic metastases in these patients. Overall survival in patients with and without liver metastases and those in whom liver metastases were thought to contribute to death was determined. RESULTS: After patient exclusions, the study population totaled 121 patients. There were 75 patients (62%) with liver metastases at death. In 40 of 75 (53%) patients, the liver metastases contributed to the patients' death. In 46 of 121 patients (38%), metastatic disease did not include liver metastases. Overall survival in patients with and without liver metastases (median survival 12 vs. 8.5 months, p = 0.089) and in those whose liver metastases did or did not contribute to death (median survival 11.5 vs. 14 months, p = 0.361) was not significant. CONCLUSIONS: The presence of liver metastases seemed to contribute to death in approximately half of the study patients, although there did not appear to be a survival disadvantage in these patients.

Evaluation and treatment of gastric stimulator failure in patients with gastroparesis.

OBJECTIVE: This study evaluates treatment of gastroparesis patients refractory to gastric electrical stimulation (GES) therapy with surgical replacement of the entire GES system. SUMMARY BACKGROUND DATA: Some patients who have symptomatic improvement with GES later develop recurrent symptoms. Some patients improve by simply altering pulse parameter settings. Others continue to have symptoms with maximized pulse parameters. For these patients, we have shown that surgical implantation of a new device and leads at a different gastric location will improve symptoms of gastroparesis. METHODS: This study evaluates 15 patients with recurrent symptoms after initial GES therapy who subsequently received a second GES system. Positive response to GES replacement therapy is evaluated by symptoms scores for vomiting, nausea, epigastric pain, early satiety, and bloating using a modified Likert score system, 0 to 4. RESULTS: Total symptom scores improved for 12 of 15 patients with GES replacement surgery. Total score for the replacement group decreased from 17.3 ± 1.6 to 13.6 ± 3.7 with a difference of 3.6 (P value = .017). This score is compared with that of the control group with a preoperative symptom score of 15.8 ± 3.6 and postoperative score of 12.3 ± 3.5 with a difference of 3.5 (P value = .011). The control group showed a 20.3% decrease in mean total symptoms score, whereas the study group showed a 22.5% decrease in mean with an absolute reduction of 2.2. CONCLUSION: Reimplantation of a GES at a new gastric location should be considered a viable option for patients who have initially failed GES therapy for gastroparesis.

Caution in interpretation of the tumor marker CA 19.9 in patients with obstructive jaundice: illustrative case reports.

BACKGROUND: Carbohydrate antigen (CA) 19.9 is a Lewis blood group oligosaccharide antigen which exists in fixed and soluble forms. The CA 19.9 antigen is synthesized by epithelial cells of the gastrointestinal tract, pancreatic duct, and biliary tree. The CA 19.9 antigen is commonly used as a tumor marker for malignancies of the pancreas and biliary tract. High levels (> 300 U/ml) of antigen have strongly suggested malignant processes. METHODS: Four patients are described with markedly elevated levels of CA 19.9 due to benign calculous disease. RESULTS: Three of four patients underwent endoscopic stone removal followed by cholecystectomy; the fourth patient spontaneously passed stones and had a subsequent cholecystectomy with benign inflammatory pathology. Removal or passage of the obstructing stones produced normalization of the CA 19.9 in each case even with long-term follow-up up to one year. All pathology specimens were interpreted as benign. CONCLUSIONS: Marked elevations of CA 19.9 may be found in benign obstructive disease and should be interpreted with caution until biliary obstruction is relieved.

Long-term effects of gastric stimulation on gastric electrical physiology.

INTRODUCTION: This study evaluates the modeling of gastric electrophysiology tracings during long-term gastric electrical stimulation for gastroparesis. We hypothesized that serosal electrogastrogram may change over time representing gastric remodeling from gastric stimulation. PATIENTS: Sixty-five patients with gastroparesis underwent placement of gastric stimulator for refractory symptoms. Mean age at initial stimulator placement was 44 years (range, 8-76), current mean age was 49, and the majority of the subjects were female (n = 51, 78 %). Only a minority had diabetes-induced gastroparesis (n = 16, 25 %); the remainder were either idiopathic or postsurgical. METHODS: At the time of stimulator placement, electrogastrogram was performed after the gastric leads were placed but before stimulation was begun. Patients underwent continuous stimulation until pacer batteries depleted. At the time of replacement, before the new pacemaker was attached, electrogastrogram was again performed. RESULTS: After a mean of 3.9 years of stimulation therapy, the mean of baseline frequency before stimulation therapy was 5.06 cycles/min and declined to 3.66 after replacement (p = 0.0000002). The mean amplitude was 0.33 mV before stimulation therapy and decreased to 0.31 mV (p = 0.73). The frequency/amplitude ratio was 38.4 before stimulation therapy and decreased to 21.9 (p = 0.001). CONCLUSION: Long-term gastric electrical stimulation causes improvement in basal unstimulated gastric frequency to near normal.

Ectopic liver masquerading as a floating intracaval mass.

Ectopic liver is defined as liver parenchyma situated outside the liver proper with no connection to native hepatic tissue. This rare developmental anomaly is most commonly described as an attachment to the gallbladder with an incidence <0.3%, but it has been reported in other locations within the abdomen and thorax.(2-4) Most cases are found incidentally in asymptomatic patients, but ectopic liver has been known to cause visceral or vascular obstruction.(4,5) Herein we present a unique case of ectopic liver attached by a thin stalk seemingly floating in the suprahepatic inferior vena cava.