Does cranberry have a role in catheter-associated urinary tract infections?

INTRODUCTION: Catheter-associated urinary tract infections (CA-UTIs) are a prevalent and costly condition, with very few therapeutic options. We sought to evaluate the efficacy of an oral cranberry supplement on CA-UTIs over a six-month period. METHODS: Subjects with long-term indwelling catheters and recurrent symptomatic CA-UTIs were enrolled to take a once-daily oral cranberry supplement with 36 mg of the active ingredient proanthocyanidin (PACs). Primary outcome was reducing the number of symptomatic CA-UTIs. This was defined by ≥103 (cfu)/mL of ≥1 bacterial species in a single catheter urine specimen and signs and symptoms compatible with CA-UTI. Secondary outcomes included bacterial counts and resistance patterns to antibiotics. RESULTS: Thirty-four patients were enrolled in the trial; 22 patients (mean age 77.22 years, 77.27% were men) completed the study. Cranberry was effective in reducing the number of symptomatic CA-UTIs in all patients (n=22). Resistance to antibiotics was reduced by 28%. Furthermore, colony counts were reduced by 58.65%. No subjects had adverse events while taking cranberry. CONCLUSIONS: The cranberry supplement reduced the number of symptomatic CA-UTIs, antibiotic resistances, and major causative organisms in this cohort. Larger, placebo-controlled studies are needed to further define the role of cranberry in CA-UTIs.

Robotic-assisted cystogastrostomy for a patient with a pancreatic pseudocyst.

Pancreatic pseudocysts are generally treated by endoscopic cystogastrostomy. However, difficult cases involving abscess, necrosis, or risk of hemorrhage often require surgical intervention. Here, we report a case of a robotically assisted cystogastrostomy. The patient presented with an infected pseudocyst with adjacent varices. Use of the da Vinci Surgical System allowed us to create a widely patent anastomosis between the pseudocyst and the stomach. The patient tolerated the procedure well without any complications. This report demonstrates the feasibility of robotic cystogastrostomy.

Single-incision sleeve gastrectomy for successful treatment of a gastrointestinal stromal tumor.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors that are located specifically in the gastrointestinal tract, with up to 60% of occurrences in the stomach, 30% in the small intestine, and 10% in the esophagus, colon, and rectum. The annual incidence of GISTs is about 15 cases per million, which in the United States equals 5000 cases per year. In most cases, these tumors are asymptomatic and are found incidentally on computed tomography scan or by endoscopy. Preoperative evaluation is based on location, size, and anatomic features and helps to confirm the diagnosis of the GIST and assess outcomes. Surgical intervention is the gold standard for treatment of nonmetastatic GISTs. CASE PRESENTATION: We report the case of an 80-year-old man with a gastric mass on the posterior surface of the greater curvature of the stomach at the junction of the gastric antrum and the pylorus, found incidentally on a computed tomography scan. The patient underwent a diagnostic laparoscopy and a single-incision laparoscopic sleeve gastrectomy. After histologic evaluation, the resected lesion was determined to be a gastrointestinal stromal tumor. CONCLUSION: A single-incision laparoscopic sleeve gastrectomy for the resection of GISTs is a feasible and appropriate method if the lesion is a safe distance from the pylorus and the gastroesophageal junction for gross negative margins to be obtained. Its advantages include decreased pain and a shorter hospital stay compared with other methods.

Structural and functional insights into DNA-end processing by the archaeal HerA helicase-NurA nuclease complex.

Helicase-nuclease systems dedicated to DNA end resection in preparation for homologous recombination (HR) are present in all kingdoms of life. In thermophilic archaea, the HerA helicase and NurA nuclease cooperate with the highly conserved Mre11 and Rad50 proteins during HR-dependent DNA repair. Here we show that HerA and NurA must interact in a complex with specific subunit stoichiometry to process DNA ends efficiently. We determine crystallographically that NurA folds in a toroidal dimer of intertwined RNaseH-like domains. The central channel of the NurA dimer is too narrow for double-stranded DNA but appears well suited to accommodate one or two strands of an unwound duplex. We map a critical interface of the complex to an exposed hydrophobic epitope of NurA abutting the active site. Based upon the presented evidence, we propose alternative mechanisms of DNA end processing by the HerA-NurA complex.

Development and morphology of class II Kenyon cells in the mushroom bodies of the honey bee, Apis mellifera.

Class II Kenyon cells, defined by their early birthdate and unique dendritic arborizations, have been observed in the mushroom bodies of evolutionarily divergent insects. In the fruit fly Drosophila melanogaster, Class II (also called clawed) Kenyon cells are well known for their extensive reorganization that occurs during metamorphosis. The present account reports for the first time the occurrence of mushroom body reorganization during metamorphosis in holometabolous insect species outside of the Diptera. In the honey bee, Apis mellifera, Class II Kenyon cells show signs of degeneration and undergo a subtle reshaping of their axons during metamorphosis. Unlike in Drosophila, reorganization of Class II Kenyon cells in the honey bee does not involve the loss of axon branches. In contrast, the mushroom bodies of closely related hymenopteran species, the polistine wasps, undergo a much more dramatic restructuring near the end of metamorphosis. Immunohistochemistry, dextran fills, and Golgi impregnations illuminate the heterogeneous nature of Class II Kenyon cells in the developing and adult honey bee brain, with subpopulations differing in the location of dendritic arbors within the calyx, and branching pattern in the lobes. Furthermore, polyclonal antibodies against the catalytic subunit of Drosophila protein kinase A (anti-DC0) label an unusual and previously undescribed trajectory for these neurons. The observed variations in morphology indicate that subpopulations of Class II Kenyon cells in the honey bee can likely be further defined by significant differences in their specific connections and functions within the mushroom bodies.