Mycobacterium abscessus Complex – a Particular Challenge in the Setting of Lung Transplantation

Mycobacterium abscessus complex is an emerging pathogen in lung transplant candidates and recipients. M. abscessus complex is widespread in the environment and can cause pulmonary, skin and soft tissue, and disseminated infection, particularly in lung transplant recipients. It is innately resistant to many antibiotics making it difficult to treat. Herein we describe the epidemiology, clinical manifestations, diagnosis and treatment of M. abscessus with an emphasis on lung transplant candidates and recipients. We also outline the areas where data are lacking and the areas where further research is urgently needed.     

Dynesys非融合动态系统在腰椎间盘突出症疗效观察

目的:观察后路Dynesys非融合动态系统在腰椎间盘突出症近期疗效及安全性。方法:2010年4月至2012年4月,对我科经症状及动力位X片、CT、MRI等资料确诊的30例腰椎间盘突出症患者行了Dynesys动态非融合螺钉固定结合全椎板切除减压手术,术后随访(6-12)个月,分别对术前1天、术后1周、术后3个月、术后6个月患者VAS评分及ODI评分进行配对t检验。结果:术前1天VAS(6.8—8.5分),平均7.9分,术后1周(1.7—3.1),t=49.395,P0.001,术后3月(1.1-2.6),t=88.304,P0.001,术后6个月(0.5—1.8),t=93.721,P0.001,术前1天ODI:68%--79%,平均74%,术后1周:17.6%--21%,t=82.006,P0.001,术后3月:14.5%--19%,t=88.344,P0.001,术后6月:11.5%--18.5%,t=90.113,P0.001。术后1周、3月、6月均给予X线复查,未发现螺钉松动及断钉。结论:Dynesys后路非融合动态稳定系统与减压结合在腰椎间盘突出症近期疗效安全确切,Dynesys保留了病变腰椎的活动度,保证了后柱稳定性,纠正腰椎失稳。     

Recognition and management of drug-induced blood cytopenias: the example of drug-induced acute neutropenia and agranulocytosis

Background: More than several hundred drugs, toxins, and herbs have been reported to cause blood abnormalities, and drugs account for 20 – 40% of all instances of cytopenias. Objective: In the present paper, we report and discuss the recognition and the management of drug-induced acute neutropenia or agranulocytosis (neutrophil count of < 0.5 × 10⁹/l). Methods: A bibliographic search was performed on the PubMed database of the US National Library of Medicine for articles published from January 1990 to January 2008. Additional not published data of our cohort of drug-induced agranulocytosis in the University Hospital of Strasbourg, France were incorporated in this review. Results/conclusions: Idiosyncratic drug-induced acute neutropenia or agranulocytosis is a serious adverse event due to the frequency of severe infections (such as deep infections, septicemia and septic shock) but modern management with broad spectrum antibiotics and hematopoietic growth factors is likely to improve the prognosis. Given the increased life expectancy, increasing use of medications as a therapeutic modality and subsequent longer exposure to drugs, as well as the development of new agents, healthcare professionals should be aware of this adverse event and its management.     

Global thinking,local action

This article examines the risk of proliferation of nuclear weapons to several Third World countries, exemplified by recent events in Iraq, and the possibility of rapid acquisition of a nuclear weapons capability in developed countries. It considers the role of the International Atomic Energy Agency and the United Nations in preventing proliferation and calls for wider powers for the latter. The role of the civil nuclear power industry and of reprocessing of nuclear fuel to produce plutonium is stressed, with emphasis on the part played by nuclear power in Japan and the THORP reprocessing plant at Sellafield.     

Epstein–Barr virus patterns in US Burkitt lymphoma tumors from the SEER residual tissue repository during 1979–2009

Burkitt lymphoma (BL) occurs at all ages, but the patterns of Epstein–Barr virus (EBV) positivity in relation to human immunodeficiency virus (HIV), immunoprofiles and age have not been fully explored. BL tissues from residual tissue repositories, and two academic centers in the United States were examined by expert hematopathologists for morphology, immunohistochemistry, MYC rearrangement, EBV‐encoded RNA (EBER), and diagnosed according to the 2008 WHO lymphoma classification. Analysis was done using frequency tables, Chi‐squared statistics, and Student's t‐test. Of 117 cases examined, 91 were confirmed as BL. The age distribution was 26%, 15%, 19%, and 29% for 0–19, 20–34, 35–59, 60+ years, and missing in 11%. MYC rearrangement was found in 89% and EBER positivity in 29% of 82 cases with results. EBER positivity varied with age (from 13% in age group 0–19 to 55% in age group 20–34, and fell to 25% in age group 60+ years, p = 0.08); with race (56% in Blacks/Hispanics vs 21% in Whites/Asians/Pacific Islanders, p = 0.006); and by HIV status (64% in HIV positive vs 22% in HIV negative cases, p = 0.03). EBER positivity was demonstrated in about one‐third of tumors and it was strongly associated with race and HIV status, and marginally with age‐group.