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1.
Braz J Microbiol ; 55(1): 529-536, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38280093

ABSTRACT

The accumulation of nitrogen compounds in shrimp farming water and effluent presents a major challenge. Ammonia is a form of nitrogen that limits shrimp growth due to its potential toxicity and effects on shrimp health and water quality. This study is aimed at identifying promising bioremediators from shrimp pond sludge to mitigate ammonia levels in both culture water and wastewater and at determining major bacterial communities in sludge using metagenomic analysis. A sludge sample was collected from a shrimp pond in Selangor, Malaysia, to isolate potential ammonia-removing bacteria. Out of 64 isolated strains, Bacillus flexus SS2 showed the highest growth in synthetic basal media (SBM) containing ammonium sulfate at a concentration of 70 mg/L as the sole nitrogen source. The strain was then incubated in SBM with varying pH levels and showed optimal growth at pH 6.5-7. After 24 h of incubation, B. flexus SS2 reduced the ammonia concentration from an initial concentration of 5 to 0.01 mg/L, indicating a 99.61% reduction rate, which was highest in SBM at pH 7. Moreover, the strain showed ammonia removal ability at concentrations ranging from 5 to 70 mg/L. Metagenomic analysis revealed that Proteobacteria was the most abundant phylum in the sludge, followed by Cyanobacteria, Actinobacteria, Chloraflexi, Firmicutes, and Campilobacterota. Bacillus flexus SS2 belongs to the Bacillota phylum and has the potential to serve as a bioremediator for removing ammonia from shrimp culture water and wastewater.


Subject(s)
Bacillus , Microbiota , Wastewater , Sewage/microbiology , Ammonia , Ponds , Bacteria/genetics , Nitrogen
2.
Med J Malaysia ; 78(2): 131-138, 2023 03.
Article in English | MEDLINE | ID: mdl-36988520

ABSTRACT

INTRODUCTION: COVID-19 patients frequently demonstrate radiological organising pneumonia (OP) pattern. The longterm outcome and treatment options for this group of patients remain uncertain. We aim to describe the clinical and radiological outcomes of patients with COVID-19-related OP and identify possible clinical factors associated with inferior radiological outcome. MATERIALS AND METHODS: Post-COVID-19 clinic attendees, consisting of post-COVID-19 patients discharged from major hospitals in the state of Selangor during the third pandemic wave of COVID-19 in Malaysia, were enrolled in this retrospective study for 6 months. Physician-scored Modified Medical Research Council (mMRC), patient self-reported quality of life (EQ-VAS) score and follow-up CT scan were evaluated. RESULTS: Our cohort comprised 131 patients, with a median age of 52 (IQR 39-60) years and median BMI of 29.40 (IQR 25.59-34.72). Majority (72.5%) had co-morbidities, and 97.7% had severe disease requiring supplementary oxygen support during the acute COVID-19 episode. 56.5% required intensive care; among which one-third were invasively ventilated. Median equivalent dose of methylprednisolone prescribed was 2.60 (IQR 1.29-5.18) mg/kg during admission, while the median prednisolone dose upon discharge was 0.64 (IQR 0.51-0.78) mg/kg. It was tapered over a median of 8.0 (IQR 5.8-9.0) weeks. Upon follow-up at 11 (IQR 8-15) weeks, one-third of patients remained symptomatic, with cough, fatigue and dyspnoea being the most reported symptoms. mMRC and EQ-VAS scores improved significantly (p<0.001) during follow-up. Repeat CT scans were done in 59.5% of patients, with 94.8% of them demonstrating improvement. In fact, 51.7% had complete radiological resolution. Intensive care admission and mechanical ventilation are among the factors which were associated with poorer radiological outcomes, p<0.05. CONCLUSION: Approximately one-third of patients with SARSCoV- 2-related OP remained symptomatic at 3 months of follow-up. Majority demonstrated favourable radiological outcomes at 5-month reassessment, except those who required intensive care unit admission and mechanical ventilation.


Subject(s)
COVID-19 , Organizing Pneumonia , Humans , Adult , Middle Aged , SARS-CoV-2 , Retrospective Studies , Quality of Life
4.
Med J Malaysia ; 75(5): 472-478, 2020 09.
Article in English | MEDLINE | ID: mdl-32918412

ABSTRACT

INTRODUCTION: Stent thrombosis (ST) is an uncommon, but significant complication following angioplasty. We aimed to examine the predictors, clinical outcomes and mechanism of definite ST cases among patients who underwent percutaneous coronary intervention (PCI). METHODS: This was a retrospective observational registry of 14,935 patients from the year 2011 till 2015. Clinical characteristics, clinical outcome and intracoronary imaging data were recorded in all the patients. The SPSS Statistic version 24 was used for statistical analysis. The Cox regression hazard model was used to report calculate the hazard ratio (HR) with a 95% confidence interval (95%CI). Independent predictors of ST were identified by univariate logistic regression analysis. Variables that showed a statistically significant effect in univariate analyses were entered in a multivariate Cox proportional hazards model. A p-value<0.05 was regarded as significant. RESULTS: The incidence of definite ST was 0.25% (37 out of 14935 patients). 75% of ST group patients presented with ST elevation myocardial infarction (75% vs. 19.8%, p<0.01). There was higher mortality among patients with ST when compared to the group without ST (Hazard Ratio, HR=10.69, 95%CI: 1.13, 100). Two independent predictors of ST were 1) previous history of acute myocardial infarction (HR=2.36, 95%CI: 1.19, 4.70) and 2) PCI in the context of acute coronary syndrome when compared to elective PCI (HR=37, 95%CI: 15.7, 91.5). Examination of 19 ST cases with intracoronary imaging identified nine cases (47%) of underexpanded stents and five cases (26%) of malopposition of stents. CONCLUSIONS: ST is associated with high mortality. PCI in acute coronary syndrome setting and a previous history of acute myocardial infarction were significant predictors for ST. Intracoronary imaging identified stent underexpansion and malopposition as common reasons for ST. In cases where the risk of ST is high, the use of intracoronary imaging guided PCI is recommended.


Subject(s)
Coronary Angiography/adverse effects , Stents/adverse effects , Thrombosis/diagnostic imaging , Aged , Female , Humans , Male , Middle Aged , Myocardial Infarction , Outcome Assessment, Health Care , Proportional Hazards Models , Registries , Retrospective Studies , Thrombosis/etiology
5.
PLoS Pathog ; 16(7): e1008623, 2020 07.
Article in English | MEDLINE | ID: mdl-32639986

ABSTRACT

Antibiotic treatment has emerged as a promising strategy to sterilize and kill filarial nematodes due to their dependence on their endosymbiotic bacteria, Wolbachia. Several studies have shown that novel and FDA-approved antibiotics are efficacious at depleting the filarial nematodes of their endosymbiont, thus reducing female fecundity. However, it remains unclear if antibiotics can permanently deplete Wolbachia and cause sterility for the lifespan of the adult worms. Concerns about resistance arising from mass drug administration necessitate a careful exploration of potential Wolbachia recrudescence. In the present study, we investigated the long-term effects of the FDA-approved antibiotic, rifampicin, in the Brugia pahangi jird model of infection. Initially, rifampicin treatment depleted Wolbachia in adult worms and simultaneously impaired female worm fecundity. However, during an 8-month washout period, Wolbachia titers rebounded and embryogenesis returned to normal. Genome sequence analyses of Wolbachia revealed that despite the population bottleneck and recovery, no genetic changes occurred that could account for the rebound. Clusters of densely packed Wolbachia within the worm's ovarian tissues were observed by confocal microscopy and remained in worms treated with rifampicin, suggesting that they may serve as privileged sites that allow Wolbachia to persist in worms while treated with antibiotic. To our knowledge, these clusters have not been previously described and may be the source of the Wolbachia rebound.


Subject(s)
Brugia pahangi/microbiology , Filariasis/microbiology , Filaricides/pharmacology , Rifampin/pharmacology , Wolbachia/drug effects , Animals , Female , Gerbillinae
6.
Adv Neurobiol ; 25: 219-235, 2020.
Article in English | MEDLINE | ID: mdl-32578149

ABSTRACT

Bipolar I Disorder (BP) is a serious, recurrent mood disorder that is characterized by alternating episodes of mania and depression. To begin to identify novel approaches and pathways involved in BP, we have obtained skin samples from BP patients and undiagnosed control (C) individuals, reprogrammed them to form induced pluripotent stem cells (iPSC), and then differentiated the stem cells into astrocytes. RNAs from BP and C astrocytes were extracted and RNAseq analysis carried out. 501 differentially expressed genes were identified, including genes for cytoskeletal elements, extracellular matrix, signaling pathways, neurodegeneration, and notably transcripts that identify exosomes. When we compared highly expressed genes using hierarchial cluster analysis, "Exosome" was the first and most highly significant cluster identified, p < 5 × 10-13, Benjamini correction. Exosomes are membrane-bound vesicles that package and remove toxic proteins from cells and also enable cell to cell communication. They carry genetic material, including DNA, mRNA and microRNAs, proteins, and lipids to target cells throughout the body. Exosomes are released by cortical neurons and astrocytes in culture and are present in BP vs C postmortem brain tissue. Little is known about what transcripts and proteins are targeted to neurons, how they regulate biological functions of the acceptor cell, or how that may be altered in mood disorders. Since astrocyte-derived exosomes have been suggested to promote neuronal plasticity, as well as to remove toxic proteins in the brain, alterations in their function or content may be involved in neurodevelopmental, neuropathological, and neuropsychiatric conditions. To examine exosome cargos and interactions with neural precursor cells, astrocytes were differentiated from four bipolar disorder (BP) and four control (C) iPSC lines. Culture supernatants from these astrocytes were collected, and exosomes isolated by ultra-centrifugation. Western blot analysis demonstrated the presence of the exosome markers CD9, CD81, and Hsp70. Nanosight technology was used to characterize exosomes from each astrocyte cell line, suggesting that exosomes were slightly more concentrated in culture supernatants derived from BP compared with C astrocytes but there was no difference in the mean sizes of the exosomes. Analysis of their function in neuronal differentiation is being carried out by labeling exosomes derived from bipolar patient and control astrocytes and adding them to control neural progenitor cells. Given the current interest in clearing toxic proteins from brains of patients with neurodegenerative disorders, exosomes may present similar opportunities in BP.


Subject(s)
Bipolar Disorder , Exosomes , Induced Pluripotent Stem Cells , Neural Stem Cells , Astrocytes , Humans
7.
QJM ; 113(11): 821-822, 2020 Nov 01.
Article in English | MEDLINE | ID: mdl-32077956
8.
Article in English | MEDLINE | ID: mdl-31869759

ABSTRACT

The quinazolines CBR417 and CBR490 were previously shown to be potent anti-wolbachials that deplete Wolbachia endosymbionts of filarial nematodes and present promising pre-clinical candidates for human filarial diseases such as onchocerciasis. In the present study we tested both candidates in two models of chronic filarial infection, namely the Litomosoides sigmodontis and Brugia pahangi jird model and assessed their long-term effect on Wolbachia depletion, microfilariae counts and filarial embryogenesis 16-18 weeks after treatment initiation (wpt). Once per day (QD) oral treatment with CBR417 (50 mg/kg) for 4 days or twice per day (BID) with CBR490 (25 mg/kg) for 7 days during patent L. sigmodontis infection reduced the Wolbachia load by >99% and completely cleared peripheral microfilaremia from 10-14 wpt. Similarly, 7 days of QD treatments (40 mg/kg) with CBR417 or CBR490 cleared >99% of Wolbachia from B. pahangi and reduced peritoneal microfilariae counts by 93% in the case of CBR417 treatment. Transmission electron microscopy analysis indicated intensive damage to the B. pahangi ovaries following CBR417 treatment and in accordance filarial embryogenesis was inhibited in both models after CBR417 or CBR490 treatment. Suboptimal treatment regimens of CBR417 or CBR490 did not lead to a maintained reduction of the microfilariae and Wolbachia load. In conclusion, CBR417 or CBR490 are pre-clinical candidates for filarial diseases, which achieve long-term clearance of Wolbachia endosymbionts of filarial nematodes, inhibit filarial embryogenesis and clear microfilaremia with treatments as short as 7 days.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Filariasis/drug therapy , Onchocerciasis/drug therapy , Quinazolines/therapeutic use , Wolbachia/drug effects , Animals , Anti-Bacterial Agents/administration & dosage , Brugia pahangi/drug effects , Female , Filariasis/microbiology , Filarioidea/drug effects , Gerbillinae/microbiology , Gerbillinae/parasitology , Microfilariae/drug effects , Quinazolines/administration & dosage , Symbiosis/drug effects
9.
Clin Radiol ; 74(9): 663-675, 2019 Sep.
Article in English | MEDLINE | ID: mdl-31109715

ABSTRACT

A subdural haematoma (SDH) is a frequently encountered pathology seen on an emergency room computed tomography (CT) head scan. An extra-axial crescentic density along the convexity of the brain or within the interhemispheric fissure is generally thought to represent a SDH; however, SDH mimics are known to occur in nature, and can be broadly classified under the subcategories of normal anatomy, artefacts, tumour, inflammation, infection, ischaemia, trauma, and iatrogenic. Understanding the typical characteristics of a SDH, knowledge of normal anatomy, close inspection of the morphology of the subdural process, changes to the adjacent structures, and rigorous attention to clinical details may reveal subtle clues that distinguish a true SDH from a mimic. This is crucial in appropriately directing clinical management. This review amalgamates most of the rare subdural processes that have been reported to mimic SDH, and discusses the imaging and clinical features that help to differentiate between them. This topic is highly valuable for radiology trainees, general radiologists, and emergency room physicians, and may serve as a refresher for the practising neuroradiologist.


Subject(s)
Hematoma, Subdural/diagnostic imaging , Tomography, X-Ray Computed/methods , Diagnosis, Differential , Humans
10.
PLoS Negl Trop Dis ; 13(1): e0006787, 2019 01.
Article in English | MEDLINE | ID: mdl-30650084

ABSTRACT

River blindness and lymphatic filariasis are two filarial diseases that globally affect millions of people mostly in impoverished countries. Current mass drug administration programs rely on drugs that primarily target the microfilariae, which are released from adult female worms. The female worms can live for several years, releasing millions of microfilariae throughout the course of infection. Thus, to stop transmission of infection and shorten the time to elimination of these diseases, a safe and effective drug that kills the adult stage is needed. The benzimidazole anthelmintic flubendazole (FBZ) is 100% efficacious as a macrofilaricide in experimental filarial rodent models but it must be administered subcutaneously (SC) due to its low oral bioavailability. Studies were undertaken to assess the efficacy of a new oral amorphous solid dispersion (ASD) formulation of FBZ on Brugia pahangi infected jirds (Meriones unguiculatus) and compare it to a single or multiple doses of FBZ given subcutaneously. Results showed that worm burden was not significantly decreased in animals given oral doses of ASD FBZ (0.2-15 mg/kg). Regardless, doses as low as 1.5 mg/kg caused extensive ultrastructural damage to developing embryos and microfilariae (mf). SC injections of FBZ in suspension (10 mg/kg) given for 5 days however, eliminated all worms in all animals, and a single SC injection reduced worm burden by 63% compared to the control group. In summary, oral doses of ASD formulated FBZ did not significantly reduce total worm burden but longer treatments, extended takedown times or a second dosing regimen, may decrease female fecundity and the number of mf shed by female worms.


Subject(s)
Brugia pahangi/drug effects , Filariasis , Filaricides/therapeutic use , Mebendazole/analogs & derivatives , Microfilariae/drug effects , Administration, Oral , Animals , Disease Models, Animal , Female , Filariasis/drug therapy , Filariasis/prevention & control , Filariasis/transmission , Filaricides/administration & dosage , Gerbillinae/parasitology , Injections, Subcutaneous , Male , Mebendazole/administration & dosage , Mebendazole/therapeutic use , Parasite Load
11.
Int Endod J ; 52(2): 201-210, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30099741

ABSTRACT

AIM: To determine if bacteria associated with persistent apical periodontitis induce species-specific pro-inflammatory cytokine responses in macrophages, and the effects of this species-specific microenvironment on osteogenic differentiation. METHODOLOGY: Macrophages were exposed to Enterococcus faecalis, Streptococcus oralis, Streptococcus mitis, Fusobacterium nucleatum, Treponema denticola or Tannerella forsythia, and levels of TNF-α and IL-1ß elicited were determined by immunoassay. Following treatment of MG-63 pre-osteoblasts with conditioned media from bacteria-exposed macrophages, osteogenic differentiation and viability of osteoblasts were analyzed by Alizarin Red Staining and MTS assay, respectively. Statistical analysis was carried out by one-way anova with the Tukey post-hoc test. Differences were considered to be significant if P < 0.05. RESULTS: Macrophages exposed to Gram-positive bacteria did not produce significant amounts of cytokines. F. nucleatum-challenged macrophages produced up to four-fold more TNF-α and IL-1ß compared to T. denticola or T. forsythia. Only conditioned media from macrophages treated with Gram-negative bacteria decreased mineralization and viability of osteoblasts. CONCLUSIONS: Gram-positive bacteria did not impact osteogenic differentiation and appeared innocuous. Gram-negative bacteria, in particular F. nucleatum elicited an enhanced pro-inflammatory response in macrophages, inhibited osteogenic differentiation and reduced cell viability. The findings suggest that the presence of this organism could potentially increase the severity of persistent apical periodontitis.


Subject(s)
Bacteria/classification , Cell Differentiation , Cytokines/metabolism , Osteogenesis , Periapical Periodontitis/immunology , Periapical Periodontitis/microbiology , Calcification, Physiologic , Cell Survival , Enterococcus faecalis/pathogenicity , Fusobacterium nucleatum/pathogenicity , Gene Expression , Humans , Inflammation/microbiology , Interleukin-1beta/metabolism , Macrophages/immunology , Macrophages/microbiology , Osteoblasts , Periapical Periodontitis/pathology , Species Specificity , Streptococcus mitis/pathogenicity , Streptococcus oralis/pathogenicity , Tannerella forsythia/pathogenicity , Treponema denticola/pathogenicity , Tumor Necrosis Factor-alpha/metabolism
12.
Int J Parasitol Drugs Drug Resist ; 8(3): 571-586, 2018 12.
Article in English | MEDLINE | ID: mdl-30503203

ABSTRACT

Treatment of schistosomiasis relies precariously on just one drug, praziquantel (PZQ). In the search for alternatives, 15 S-[2-(alkylamino)alkane] thiosulfuric acids were obtained from a previous research program and profiled in mice for efficacy against both mature (>42-day-old) and juvenile (21-day-old) Schistosoma mansoni using a screening dose of 100 mg/kg PO QDx4. One compound, S-[2-(tert-butylamino)-1-phenylethane] thiosulfuric acid (TPT sulfonate), was the most effective by decreasing female and male worm burdens by ≥ 90% and ≥46% (mature), and ≥89% and ≥79% (juvenile), respectively. In contrast, PZQ decreased mature female and male worm burdens by 95% and 94%, respectively, but was ineffective against juvenile stages. Against 7-day-old lung-stage worms, TPT sulfonate was only effective at twice the dose decreasing female and male burdens by 95 and 80%, respectively. Single oral doses at 400 and/or 600 mg/kg across various developmental time-points (1-, 7-, 15-, 21- and/or 42 day-old) were consistent with the QD x4 data; efficacy was strongest once the parasites had completed lung migration, and female and male burdens were decreased by at least 90% and 80%, respectively. In vitro, TPT sulfonate is inactive against the parasite suggesting a pro-drug mechanism of action. In mice, TPT sulfonate is fully absorbed and subject to rapid, non-CYP-mediated, first-pass metabolism that is initiated by desulfation and yields a series of metabolites. The initially-formed free thiol-containing metabolite, termed TP thiol, was chemically synthesized; it dose-dependently decreased S. mansoni and Schistosoma haematobium motility in vitro. Also, when administered as a single 50 mg/kg IP dose, TP thiol decreased 33-day-old S. mansoni female and male burdens by 35% and 44%, with less severe organomegaly. Overall, TPT sulfonate's efficacy profile is competitive with that of PZQ. Also, the characterization of a parasiticidal metabolite facilitates an understanding and improvement of the chemistry, and identification of the mechanism of action and/or target.


Subject(s)
Arylsulfonates/administration & dosage , Prodrugs/administration & dosage , Schistosoma mansoni/drug effects , Schistosomicides/administration & dosage , Schistosomicides/metabolism , Administration, Oral , Animals , Arylsulfonates/chemistry , Arylsulfonates/therapeutic use , Disease Models, Animal , Drug Discovery , Female , Liver/parasitology , Male , Metabolomics/methods , Mice , Praziquantel/adverse effects , Praziquantel/therapeutic use , Schistosoma haematobium/drug effects , Schistosomiasis mansoni/drug therapy
14.
PLoS Negl Trop Dis ; 9(2): e0003534, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25700363

ABSTRACT

Two major human diseases caused by filariid nematodes are onchocerciasis, or river blindness, and lymphatic filariasis, which can lead to elephantiasis. The drugs ivermectin, diethylcarbamazine (DEC), and albendazole are used in control programs for these diseases, but are mainly effective against the microfilarial stage and have minimal or no effect on adult worms. Adult Onchocerca volvulus and Brugia malayi worms (macrofilariae) can live for up to 15 years, reproducing and allowing the infection to persist in a population. Therefore, to support control or elimination of these two diseases, effective macrofilaricidal drugs are necessary, in addition to current drugs. In an effort to identify macrofilaricidal drugs, we screened an FDA-approved library with adult worms of Brugia spp. and Onchocerca ochengi, third-stage larvae (L3s) of Onchocerca volvulus, and the microfilariae of both O. ochengi and Loa loa. We found that auranofin, a gold-containing drug used for rheumatoid arthritis, was effective in vitro in killing both Brugia spp. and O. ochengi adult worms and in inhibiting the molting of L3s of O. volvulus with IC50 values in the low micromolar to nanomolar range. Auranofin had an approximately 43-fold higher IC50 against the microfilariae of L. loa compared with the IC50 for adult female O. ochengi, which may be beneficial if used in areas where Onchocerca and Brugia are co-endemic with L. loa, to prevent severe adverse reactions to the drug-induced death of L. loa microfilariae. Further testing indicated that auranofin is also effective in reducing Brugia adult worm burden in infected gerbils and that auranofin may be targeting the thioredoxin reductase in this nematode.


Subject(s)
Auranofin/therapeutic use , Elephantiasis, Filarial/drug therapy , Loiasis/drug therapy , Microfilariae/drug effects , Onchocerciasis/drug therapy , Adult , Albendazole/therapeutic use , Animals , Anthelmintics/therapeutic use , Brugia malayi/drug effects , Cattle , Cell Line , Diethylcarbamazine/therapeutic use , Drug Repositioning , Elephantiasis, Filarial/parasitology , Female , Filaricides/therapeutic use , Gerbillinae , Haplorhini , Humans , Ivermectin/therapeutic use , Loa/drug effects , Loiasis/parasitology , Onchocerca volvulus/drug effects , Onchocerciasis/parasitology
15.
Neuroscience ; 252: 262-76, 2013 Nov 12.
Article in English | MEDLINE | ID: mdl-23892008

ABSTRACT

Focal malformations of cortical development (FMCD) are highly associated with several neurological disorders including intractable epilepsy and neurocognitive disabilities. Over the past decade, several FMCD subtypes have been linked to hyperactivation of the mammalian target of rapamycin (mTOR) signaling cascade. In view of the roles that mTOR plays in cell proliferation, size, motility, and stem cell phenotype, many of the features of FMCD such as cytomegaly, disorganized lamination, and expression of stem cell markers can be explained by enhanced mTOR signaling. FMCD result from several distinct and fascinating molecular mechanisms including biallelic gene inactivation, somatic mutation, and potentially, viral infection. These mechanisms have been directly linked to mTOR activation. Perhaps most compelling, pharmacological inhibition of mTOR has been implemented successfully in clinical trials for select FMCD and provides a new vista for treatment.


Subject(s)
Malformations of Cortical Development/genetics , Malformations of Cortical Development/metabolism , Signal Transduction/physiology , TOR Serine-Threonine Kinases/genetics , TOR Serine-Threonine Kinases/metabolism , Animals , Humans
16.
Br J Surg ; 99(12): 1622-9, 2012 Dec.
Article in English | MEDLINE | ID: mdl-23023956

ABSTRACT

BACKGROUND: Long-term overall survival after liver resection in patients with hepatocellular carcinoma (HCC) within the Milan criteria has been reported to improve in recent years. This study systematically reviewed the outcomes of surgical resection for HCC in patients with good liver function and meeting the Milan criteria for early HCC, published in the past 10 years. METHODS: A literature search was conducted in PubMed for papers on outcomes of surgical resection for HCC published between January 2000 and December 2010. Cochrane systematic review methodology was used for this review. The primary outcome was overall survival. Secondary outcomes included operative mortality and disease-free survival. Studies that focused on geriatric populations, paediatric populations, a subset of the Milan criteria (such solitary tumours) or included patients with incidental tumours were excluded, as were case reports, conference abstracts, and studies with a large proportion of Child-Pugh grade C liver cirrhosis or unknown Child-Pugh status. RESULTS: Of 152 studies reviewed, two randomized clinical trials and 27 retrospective case series were eligible for inclusion. The 5-year overall survival rate after resection of HCC ranged from 27 to 81 (median 67) per cent, and the median disease-free survival rate from 21 to 57 (median 37) per cent. There was a trend towards improved overall survival in recent years. The operative mortality rate ranged from 0 to 5 (median 0·7) per cent. CONCLUSION: Surgical resection offers good overall survival for patients with HCC within the Milan criteria and with good liver function, although recurrence rates remain high. Outcomes have tended to improve in more recent years.


Subject(s)
Carcinoma, Hepatocellular/surgery , Hepatectomy/methods , Liver Neoplasms/surgery , Carcinoma, Hepatocellular/mortality , Disease-Free Survival , Hepatectomy/mortality , Humans , Liver Neoplasms/mortality , Randomized Controlled Trials as Topic , Retrospective Studies , Treatment Outcome
17.
PLoS Pathog ; 8(8): e1002883, 2012.
Article in English | MEDLINE | ID: mdl-22927819

ABSTRACT

Although the vitamin A metabolite retinoic acid (RA) plays a critical role in immune function, RA synthesis during infection is poorly understood. Here, we show that retinal dehydrogenases (Raldh), required for the synthesis of RA, are induced during a retinoid-dependent type-2 immune response elicited by Schistosoma mansoni infection, but not during a retinoid-independent anti-viral immune response. Vitamin A deficient mice have a selective defect in T(H)2 responses to S. mansoni, but retained normal LCMV specific T(H)1 responses. A combination of in situ imaging, intra-vital imaging, and sort purification revealed that alternatively activated macrophages (AAMφ) express high levels of Raldh2 during S. mansoni infection. IL-4 induces Raldh2 expression in bone marrow-derived macrophages in vitro and peritoneal macrophages in vivo. Finally, in vivo derived AAMφ have an enhanced capacity to induce Foxp3 expression in CD4+ cells through an RA dependent mechanism, especially in combination with TGF-ß. The regulation of Raldh enzymes during infection is pathogen specific and reflects differential requirements for RA during effector responses. Specifically, AAMφ are an inducible source of RA synthesis during helminth infections and T(H)2 responses that may be important in regulating immune responses.


Subject(s)
Gene Expression Regulation, Enzymologic/immunology , Macrophage Activation/immunology , Macrophages, Peritoneal/immunology , Retinal Dehydrogenase/immunology , Schistosoma mansoni/immunology , Schistosomiasis mansoni/immunology , Up-Regulation/immunology , Animals , Cells, Cultured , Forkhead Transcription Factors/biosynthesis , Forkhead Transcription Factors/genetics , Forkhead Transcription Factors/immunology , Gene Expression Regulation, Enzymologic/genetics , Macrophage Activation/genetics , Mice , Mice, Knockout , Retinal Dehydrogenase/biosynthesis , Retinal Dehydrogenase/genetics , Schistosoma mansoni/metabolism , Schistosomiasis mansoni/enzymology , Schistosomiasis mansoni/genetics , Th1 Cells/immunology , Th2 Cells/immunology , Up-Regulation/genetics
18.
PLoS Negl Trop Dis ; 6(4): e1589, 2012.
Article in English | MEDLINE | ID: mdl-22509414

ABSTRACT

BACKGROUND: Cercarial elastase is the major invasive larval protease in Schistosoma mansoni, a parasitic blood fluke, and is essential for host skin invasion. Genome sequence analysis reveals a greatly expanded family of cercarial elastase gene isoforms in Schistosoma mansoni. This expansion appears to be unique to S. mansoni, and it is unknown whether gene duplication has led to divergent protease function. METHODS: Profiling of transcript and protein expression patterns reveals that cercarial elastase isoforms are similarly expressed throughout the S. mansoni life cycle. Computational modeling predicts key differences in the substrate-binding pockets of various cercarial elastase isoforms, suggesting a diversification of substrate preferences compared with the ancestral gene of the family. In addition, active site labeling of SmCE reveals that it is activated prior to exit of the parasite from its intermediate snail host. CONCLUSIONS: The expansion of the cercarial gene family in S. mansoni is likely to be an example of gene dosage. In addition to its critical role in human skin penetration, data presented here suggests a novel role for the protease in egress from the intermediate snail host. This study demonstrates how enzyme activity-based analysis complements genomic and proteomic studies, and is key in elucidating proteolytic function.


Subject(s)
Pancreatic Elastase/genetics , Pancreatic Elastase/metabolism , Schistosoma mansoni/enzymology , Amino Acid Sequence , Animals , Binding Sites , Cercaria/enzymology , Cercaria/genetics , Cricetinae , Gene Expression Profiling , Mesocricetus , Mice , Mice, Inbred BALB C , Molecular Dynamics Simulation , Molecular Sequence Data , Pancreatic Elastase/chemistry , Protein Binding , Proteolysis , Schistosoma mansoni/genetics , Sequence Homology, Amino Acid , Snails
19.
Transplant Proc ; 44(2): 363-5, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22410017

ABSTRACT

PURPOSE: In Korea, living donor transplantation is increasing steadily as a life-saving alternative. It is essential to provide living donors the mental and physical care they need throughout their lives including postoperative period. Therefore, this study explored postoperative pain among living liver donors. METHODS: We used a convenience sampling at a university-affiliated hospital from March 1 to August 30, 2009 including 102 subjects. Face-to-face interviews with questionnaires and medical records were used to assess postoperative pain levels, state and trait anxiety as well as satisfaction. Data were analyzed using SPSS 14.0 (SPSS Inc., Chicago, Ill, USA). RESULTS: Average age of donors was 28.9±7.7 years (ranged 16 to 53) with 70.6% male. Most donors (80.4%, n=82) were immediate family members. Ninety-one (89.2%) participants made the decision by themselves. To control postoperative pain, all participants had patient-controlled anesthesia with several types of analgesics as prescribed by physician's preference. The mean values of state anxiety, trait anxiety, and satisfaction in this study were 2.1±1.89, 36.7±7.25 and, 8.9±1.79, respectively. Multivariate analysis showed that trait anxiety and number of analgesics use were significantly associated with postoperative pain. Overall, approximately 29.7% of total variability in postoperative pain could be explained by the nine variables in this model (R2=0.297, F9,102=4.28, (P<.001). There was no multicollinearity checked by tolerance, variation inflation factor, or condition index. CONCLUSION: This study of postoperative pain among living liver donors may contribute to developing the safest, most effective strategy to relieve postoperative pain after living liver donation.


Subject(s)
Hepatectomy/adverse effects , Liver Transplantation/adverse effects , Living Donors , Pain, Postoperative/etiology , Adolescent , Adult , Analgesia, Patient-Controlled , Analgesics/therapeutic use , Anxiety/etiology , Drug Therapy, Combination , Female , Hospitals, University , Humans , Male , Middle Aged , Multivariate Analysis , Pain Measurement , Pain, Postoperative/diagnosis , Pain, Postoperative/drug therapy , Pain, Postoperative/psychology , Patient Satisfaction , Republic of Korea , Risk Assessment , Risk Factors , Surveys and Questionnaires , Time Factors , Treatment Outcome , Young Adult
20.
PLoS Negl Trop Dis ; 6(1): e1494, 2012 Jan.
Article in English | MEDLINE | ID: mdl-22303493

ABSTRACT

Lymphatic filariasis is caused by filarial nematode parasites, including Brugia malayi. Adult worms live in the lymphatic system and cause a strong immune reaction that leads to the obstruction of lymph vessels and swelling of the extremities. Chronic disease leads to the painful and disfiguring condition known as elephantiasis. Current drug therapy is effective against the microfilariae (larval stage) of the parasite, but no drugs are effective against the adult worms. One of the major stumbling blocks toward developing effective macrofilaricides to kill the adult worms is the lack of a high throughput screening method for candidate drugs. Current methods utilize systems that measure one well at a time and are time consuming and often expensive. We have developed a low-cost and simple visual imaging system to automate and quantify screening entire plates based on parasite movement. This system can be applied to the study of many macroparasites as well as other macroscopic organisms.


Subject(s)
High-Throughput Screening Assays/methods , Image Processing, Computer-Assisted/methods , Parasites/physiology , Parasitology/methods , Animals , Antiparasitic Agents/isolation & purification , Drug Evaluation, Preclinical/methods , Locomotion , Parasites/drug effects
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