Correction: Thrombotic and bleeding events,mortality, and anticoagulant use among 546,656 hospitalized patients with COVID‑19 in the United States: a retrospective cohort study

Journal of Thrombosis and Thrombolysis -     

Use of Georges Lopez Institute Preservation Solution IGL-1 in Pancreas Transplantation: A Series of 47 Cases

Background

Graft preservation continues to be one of the main pillars of pancreas transplantation (PT). Surgical complications, possibly caused or facilitated by organ damage during preservation, continue to occur more frequently after PT than for any other abdominal organ. During the past few years, the Georges Lopez Institute preservation solution IGL-1 has been introduced with satisfactory results for the perfusion and cold storage of abdominal grafts such as kidney and liver.

Electromyographic evaluation of the gastrointestinal tract in dogs with short bowel syndrome

Seven dogs were subjected to resection of 80% of the total length of the small bowel. Seven pairs of electrodes were implanted in the seromuscular layer of the antrum and remaining small bowel. Electromyographic recordings were obtained during fasting and after milk ingestion. Slow waves were identified in all sites studied and their frequencies were 4.7±0.4/min in the antrum; 17.5±0.58/min in D1; 17.5±0.61/min in D2; 17.43±0.65/min in J1; 17.40±0.62/min in J2; 10.28±0.77/min in I1; and 9.81±0.53/min in I2. The phase III of the migrating motor complex was identified in only one recording. Ingestion of milk caused the appearance of the fed pattern in all recording sites, except the antrum. It is concluded that extensive resection of the small bowel causes reduction of the slow wave frequency in the gut distal to the resection and disappearance of phase III of the migrating motor complex.     

Two-dimensional gel electrophoresis, isoelectric focusing and agarose gel electrophoresis in the diagnosis of multiple sclerosis

Two dimensional gel electrophoresis (2-DE), isoelectric focusing (IEF) and agarose gel electrophoresis (AGE) were used to examine cerebrospinal fluid (CSF) and sera from 22 patients with confirmed multiple sclerosis, 11 patients with probable multiple sclerosis and 20 control patients with non-inflammatory neurological diseases of the central nervous system (CNS). All of the 22 patients with confirmed multiple sclerosis showed abnormal patterns of oligoclonal IgG in all three methods. In the CSF from patients with probable multiple sclerosis, oligoclonal IgG was detectable in 18 percent with AGE, in 72 percent with IEF and 90 percent with 2-DE. No oligoclonal IgG was observed in subjects with non-inflammatory neurological diseases. Many artefacts in IEF, which lead to misinterpretation, are eliminated in the 2-DE system. Based on our observations and this study in particular, it is evident that some patients have IgG changes which can be detected only by 2-DE. The application of research-oriented 2-DE for routine clinical purposes is still limited by its cost and technical complexity.     

Two-dimensional gel electrophoresis of cerebrospinal fluid proteins from patients with various neurological diseases

We subjected cerebrospinal fluid (CSF) samples from over 200 patients with various neurological diseases to two-dimensional electrophoresis. The series included non-inflammatory diseases such as epilepsy, amyotrophic lateral sclerosis, and polyneuropathy; and inflammatory diseases such as multiple sclerosis and neurolues. In the resulting electrophoretograms we considered mainly the region of CSF-specific proteins and the area corresponding to the immunoglobulin light chains. The former, at Mr 35 000-38 000, shows some interesting variations from one CSF to another. Samples from patients with various brain tumors show a specific change. A zone of oligoclonal immunoglobulin light chains appeared in all CSF samples with above-normal gamma-globulin content. These oligoclonal patterns remained constant and characteristic during the course of different diseases for several patients so examined. As expected, differences appeared in the patterns of immunoglobulin light chains from one individual to another, even among a group of patients with the same disease. The extent of the correlation of certain basic patterns with certain diseases cannot yet be determined.     

Prevalence of Posttransplantation Lymphoproliferative Disease in Pediatric Liver Transplant Recipients

Objective

The objective of this study was to identify the incidence of posttransplantation lymphoproliferative disease (PTLD) among children within 1 year after liver transplantation.

Methods

This retrospective review analyzed information in medical charts of pediatric (younger than 18 years of age) recipients of liver transplants between September 2000 and December 2007.

Results

Seventy-one patients underwent a liver transplantation and 7 (9.85%) developed PTLD. Among this group, 6 children were girls and 1 was a boy. The median age at transplantation was 35.14 months. Indications that led the children to have their transplantation were 1 case of hemangioendothelioma, 1 case of autoimmune hepatic cirrhosis, 1 case of alpha-1-antitrypsin deficiency, and 4 cases of biliary atresia. The most frequent symptoms were splenomegaly, diarrhea, and fever. The median time from the first symptoms to the initial treatment was 9.7 days. The standard treatment was withdrawal of immunosuppression and close observation of tacrolimus levels and liver function tests associated with antiviral drugs and chemotherapy. Four among 7 children died; 3 children recovered. All 3 children who recovered has presented at the transplantation center within 5 days of initiation of symptoms (P = .033896).

Conclusion

Despite its rarity, when it occurs, PTLD shows a high mortality rate. Therefore, it is necessary to have interdisciplinary work between the medical team that performs the transplantation and those promoting the primary care to diagnose the disease early and treat it effectively.     

Mechanism of imipenem resistance acquired by threePseudomonas aeruginosa strains during imipenem therapy

Imipenem sensitive pretherapy isolates (MICs 1–2 mg/l) and the corresponding resistant posttherapy isolates (MICs 16 mg/l) ofPseudomonas aeruginosa from three patients undergoing imipenem treatment were analyzed to establish the resistance mechanism. The identity of pyocin types, serotypes, DNA restriction endonuclease profiles and plasmid profiles strongly suggested isogenicity of pre- and posttherapy isolates. The imipenem resistant posttherapy isolates showed cross-resistance only to another carbapenem, meropenem. There were neither qualitative nor quantitative differences between pre- and posttherapy isolates in -lactamase production. Affinity of the penicillin-binding proteins 1A, 1B, 2, 3, 4, 4 and 5 for [¹⁴C]imipenem was the same in pre- and posttherapy isolates. One-dimensional and two-dimensional gel electrophoresis of outer membrane protein preparations showed diminished expression of an outer membrane protein of about 46.5 and 47.5 kilodaltons, respectively, in the posttherapy isolates. This protein had an apparent isoelectric point of about pH 5.2 in two-dimensional gel electrophoresis. Growth in proteose peptone no. 2 broth did not reduce expression of this outer membrane protein, which spoke against its identity with the outer membrane protein D1. The permeability of the outer membrane for imipenem was reduced in the posttherapy isolates, since addition of 0.5 or 0.25 of the MIC of the permeabilizing agent ethylenediaminetetraacetate reduced the MICs of imipenem for all isolates from each patient to the same (susceptible) level. The diminished expression of one of the outer membrane proteins might be the reason for this reduced permeability.     

Gastrointestinal motility of patients with Roux-en-Y reconstruction

The electromyographic activity of the gastrointestinal tract was studied in 28 patients undergoing gastric, biliary, and pancreatic operations with reconstruction of the gastrointestinal tract with a Roux-en-Y limb. The Roux-en-Y limb was constructed 1 to 5 years before the study in 8 patients (chronic Roux-en-Y) and at the operation in which the electrodes were implanted in 20 patients (recent Roux-en-Y). All four phases of the migrating motor complex (MMC) were identified in the gastrointestinal tract, including in the Roux-en-Y limb. The duration of the MMC was 82.4 ± 22.3 min in the patients with chronic Roux-en-Y and 89.0 ± 25.1 min in the patients with recent Roux-en-Y. Food ingestion converted the MMC to the fed pattern in the entire gastrointestinal tract, including the Roux-en-Y limb in 16 (76.2%) of 21 recordings of the patients with chronic Roux-en-Y and in 27 (84.4%) of 32 recordings of the patients with recent Roux-en-Y. The duration of the fed pattern was 170 ± 34 min in the patients with chronic Roux-en-Y and 154 ± 26 min in the patients with recent Roux-en-Y. The findings of this study indicate that the electromyographic activity of the Roux-en-Y limb is normal during both fasting and fed states, even many years after the construction of the Roux-en-Y.

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Resumen Se estudió la motilidad electromiográphica del tracto gastrointestinal de 28 pacientes sometidos a operaciones gástricas, biliares y pancreáticas con reconstrucción de tipo Roux-en-Y. El asa de Roux-en-Y fue construida 1–5 años antes del estudio en un grupo de ocho pacientes (Roux-en-Y crónica) y en otro grupo de 20 lose electrodos fueron implantados durante la operación (Roux-en-Y reciente). Se identificaron las cuatro fases del complejo motormigratorio en el tracto gastrointestinal, incluso en el asa de Roux-en-Y. La duración del CMM fue 82.4 ± 22.3 min en los pacientes con Roux-en-Y crónica y 89.0 ± 25.1 min en los pacientes con Roux-en-Y reciente. Con la ingesta de alimento se substituyó el CMM por el patrón postalimentación en la totalidad del tracto gastrointestinal incluso en el asa de Roux-en-Y, en 16 de los 21 registros (76.2%) de los pacientes con Roux-en-Y crónica y en 27 de los 32 registros (84.4%) de los pacientes con Roux-en-Y reciente. La duración del patrón postalimentacón fue 170 ± 34 min en los pacientes con Roux-en-Y crónica y 154 ± 26 min en los pacientes con Roux-en-Y reciente. Los hallazgos en este estudio indican que la actividad electromiográphica del asa de Roux-en-Y es normal durante las fases de ayuno o de alimentación, aún transcurridos muchos años de la confección del Roux-en-Y.

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Résumé L'activité électromyographique de l'intestin grêle a été étudiée chez 28 patients ayant eu des interventions portant sur le l'estomac, les voies biliaires ou le pancréas et comportant une reconstruction avec une anse en Y. Chez huit de ces patients, l'intervention initiale pendant laquelle cette anse en Y avait été mopntée, datait de 1 à 5 ans (anse en Y dite chronique). Chez les 20 autres patients, les électrodes pour mesurer l'activité électrique ont été placées pendant l'intervention initiale (anse en Y dite récente). Les quatre phases du complexe moteur migrateur (CMM) ont été identifiées sur l'intestin et sur l'anse en Y. La durée du CMM a été de 82.4 ± 22.3 min chez les patients ayant une anse en Y chronique, et de 89.0 ± 25.1 min chez les patients ayant une anse en Y récente. Pendant l'alimentation, la courbe d'activité dite d'alimentation a remplacé les CMM dans le tube intestinal en entier, y compris l'anse en Y chez 16 des 21 enregistrements (76.2%) des patients ayant une anse en Y chronique et chez 27 des 32 (84.4%) enregistrements des patients ayant une anse en Y récente. La durée des courbes dites d'alimentation a été de 170 ± 34 min chez les patients avec une anse en Y chronique et de 154 ± 26 min chez les patients avec une anse en Y récente. Les résultats de cette étude indiquent que l'activité électromyographique des anses en Y est normale pendant le jeûne et pendant l'alimentation, et ce même plusieurs années après la confection d'une anse en Y.