Matrix Metalloproteinases 2 and 9 Polymorphism in Patients With Myeloproliferative Diseases: A STROBE-Compliant Observational Study

Chronic myeloproliferative disorders such as polycythemia vera (PV), essential thrombocytosis (ET), and idiopathic myelofibrosis arise from clonal proliferation of neoplastic stem cells in the bone marrow. Matrix metalloproteinases (MMPs) are a family of zinc-dependent endopeptidases that have potential to degrade all types of extracellular matrix (ECM) and also play a role in remodeling of the ECM. It is known that MMPs play a role in bone marrow remodeling.The primary goal of our study is to explore the relationship between chronic myeloproliferative diseases and some of MMP gene polymorphisms. The demonstration of a relationship will help to understand whether these polymorphisms may be a potential early diagnosis marker of the diseases.Patients were selected from outpatient clinics of Turgut Ozal University Hospital, Ankara, Turkey, between December 2010 and May 2011. Twenty-eight patients that previously diagnosed and followed-up with PV, 17 with secondary polycythemia (SP), and 12 with ET were enrolled in the study, along with a control group of 22 healthy people.DNA was isolated from peripheral blood. Using polymerase chain reaction–restriction fragment length polymorphism method, MMP2 and MMP9 gene polymorphisms were analyzed with agarose gel electrophoresis. There was a statistically significant difference between the study groups and the control group in terms of Gln279Arg polymorphisms rates of MMP9. The highest MMP9 Gln279Arg polymorphism rate was observed in the ET group. But nobody from the control group had polymorphic MMP9. There was no statistically significant difference between the groups in terms of MMP2-735 C > T polymorphism rates.In conclusion, MMP9 gene Gln279Arg polymorphism was associated with ET, SP, and PV diseases. Hence, we believe that these gene polymorphisms may play a role in the mechanism of bone marrow fibrosis and may be a factor that increases the risk of thrombosis. Illumination of the molecular basis of the relationship between MMP-thrombosis and MMP-fibrosis provides a better understanding of the pathophysiology of PV and ET diseases and will allow new approaches to diagnosis and treatment.     

Silicone-based simulation models for peripheral nerve microsurgery

Background

There is a need for a peripheral nerve model on which surgeons-in-training can simulate the repair of nerve injuries at their own pace. Although practicing on animal models/cadavers is considered the “gold standard” of microsurgical training, the proposed model aims to provide a platform for improving the technical skills of surgical trainees prior to their practice on cadaver/animal models. In addition, this model has the potential to serve as a standardized test medium for assessing the skill sets of surgeons.

Aortic prosthetic ring annuloplasty: a useful adjunct to a standardized aortic valve-sparing procedure?

OBJECTIVE: Dilation of aortic annulus, sinuses of Valsalva, and sinotubular junction (STJ) diameters are the characteristic lesions of aortic root aneurysm. The remodeling technique reduces STJ diameter and creates three neosinuses of Valsalva. Alternatively, the reimplantation technique reduces both annulus and STJ diameters to the detriment of aortic root dynamics. Although the remodeling technique is recognized as the most physiological valve-sparing procedure, aortic annulus dilation may jeopardize its results. A standardized approach that combines an external subvalvular aortic prosthetic ring annuloplasty with the remodeling technique is suggested. METHODS: Eighty-three patients underwent an elective aortic root remodeling procedure, either isolated (group 1, n=34) or combined with an external subvalvular aortic prosthetic ring annuloplasty (group 2, n=49). Preoperative aortic regurgitation was 1.59+/-1.1 (group 1) and 1.97+/-1.3 (group 2) (NS). The aortic annulus was more dilated in group 2 than in group 1 (27+/-2.77 mm vs 26.4+/-2.3 mm, p<0.01). Residual aortic regurgitation > or =grade II was the conversion criteria for aortic valve replacement. RESULTS: Operative mortality was 3.6% (n=3). Intraoperative conversion for valve replacement was 32.7% in group 1 (n=11) versus 4.2% in group 2 (n=2) (p<0.001). In group 1, preoperative annulus diameter was larger for converted than for valve-spared patients (27.6+/-1.7 mm vs 25.2+/-1.5 mm, p<0.02). In group 2, implanted aortic ring significantly reduced annulus diameter (20.6+/-1.8 mm) without significant aortic valve gradient (8.3+/-3 mmHg). Follow-up was 17.2+/-13.4 months (group 1) and 10.41+/-7.95 months (group 2). Reoperation for recurrent aortic regurgitation was 13% in group 1 (n=3) versus 4.2% in group 2 (n=2). Echocardiographic follow-up found residual aortic regurgitation < or =grade I in 17 patients in group 1 (90%) versus 43 patients in group 2 (95.5%) and of grade II in two patients in group 1 (10%) and two patients in group 2 (4.5%). CONCLUSION: The addition of external aortic prosthetic ring annuloplasty improves the remodeling technique's operative reproducibility and short-term results. Therefore, its use as a systematical adjunct to the remodeling procedure is suggested. However, further long-term evaluation comparing this valve-sparing procedure to composite graft replacement should define the best surgical strategy for aortic root aneurysm.     

Nosocomial infections and risk factors in intensive care unit of a university hospital in Turkey

The aim of this study was to determine the types nosocomial infections (NIs) and the risk factors for NIs in the central intensive care unit (ICU) of Trakya University Hospital. The patients admitted to the ICU were observed prospectively by the unit-directed active surveillance method based on patient and the laboratory over a 9-month-period. The samples of urine, blood, sputum or tracheal aspirate were taken from the patients on the first and the third days of their hospitalization in ICU; the patients were cultured routinely. Other samples were taken and cultured if there was suspicion of an infection. Infections were considered as ICU-associated if they developed after 48 hours of hospitalization in the unit and 5 days after discharge from the unit if the patients had been sent to a different ward in the hospital. The rate of NIs in 135 patients assigned was found to be 68%. The most common infection sites were lower respiratory tract, urinary tract, bloodstream, catheter site and surgical wound. Hospitalization in ICU for more than 6 days and colonization was found to be the main risk factor for NIs. Prolonged mechanical ventilation and tracheostomy, as well as frequently changed nasogastric catheterization, were found to be risk factors for lower respiratory tract infections. For bloodstream infections, both prolonged insertion of and frequent change of arterial catheters, and for urinary tract infections, female gender, period and repeating of urinary catheterization were risk factors. A high prevalence rate of nosocomial infections was found in this study. Invasive device use and duration of use continue to greatly influence the development of nosocomial infection in ICU. Important factors to prevent nosocomial infections are to avoid long hospitalization and unnecessary device application. Control and prevention strategies based on continuing education of healthcare workers will decrease the nosocomial infections in the intensive care unit.     

Evaluation of the MS-2 automated antimicrobial susceptibility testing system: Report of a European collaborative study

The MS-2 is an instrument for rapid automated testing of antimicrobial susceptibility. Its performance was evaluated by comparison with disc diffusion and MIC tests in a collaborative study in four European laboratories. Tests on independently isolated organisms showed the MS-2 to be in essential agreement with conventional methods in 94.8% of tests. A further series of 170 welldefined pathogens for which a reference antibiogram was available were tested by MS-2 and the manual methods in all of the participating laboratories. MS-2 results were in full accord in 90 % of tests and in essential agreement in 94 %. MS-2 results compared at least as well with the reference values as did either of the manual methods. Initial problems of false susceptibility results with erythromycin and penicillin were resolved by (1) the addition of small amounts of erythromycin which acted as an inducer and (2) by the use of a low content penicillin disc. MS-2 was found to be reliable and needed no attention following loading of the test cuvette cartridges. A print-out of the results was available 2–5 h after inception of the test.     

Typhoid fever due to a Salmonella typhi strain of reduced susceptibility to fluoroquinolones

Objective: To report a case of typhoid fever contracted in Portugal in 1994 due to a Salmonella typhi isolate which had reduced susceptibility to fluoroquinolone (MIC 1 mg/L of ciprofloxacin) and high level resistance to nalidixic acid (MIC ≥56 mg/L).
Methods: Molecular studies of reduced susceptibility to fluoroquinolones comprised complementation tests with a wild-type allele and sequencing directly from PCR products of the gyrA gene.
Results: Complementation tests and DNA sequencing showed that a mutation occurred in the gyrA gene of this clinical isolate, resulting in a substitution of phenylalanine for serine at position 83 of GyrA.
Conclusions: Because quinolones may be regarded as a treatment of choice in typhoid fever, it seems important now to recommend cautious use of these drugs as first-line therapy and possibly use of nalidixic acid resistance as a marker for detection of 'first-step' resistance to fluoroquinolones in S. typhi.     

Comparative activity of teicoplanin and vancomycin against 400 penicillin susceptible and resistantStreptococcus pneumoniae

The MICs of teicoplanin and vancomycin were determined for 400 penicillin-susceptible and -resistant strains ofStreptococcus pneumoniae isolated during a multicenter study in 1992. Teicoplanin displayed a four-fold better activity than vancomycin, with modal MICs of these agents being 0.06 and 0.25 µg/ml, respectively. These data warrant further studies with teicoplanin in the treatment of pneumococcal infections.J. Akli, Centre Hospitalier Général, 41016 Blois Cédex; P. Allouch, Hôpital André Mignot, 78157 Le Chesnay Cédex; C. Bébéar, Centre Hospitalier Pellegrin-Tripode, 33076 Bordeaux Cédex; P. Blondel, Centre Hospitalier Général, 93205 Saint-Denis Cédex 1; A. Boisivon, Centre Hospitalier Général, 78104 Saint-Germain en Laye; J.C. Burdin, Hôpital Central, 54035 Nancy Cédex; H. Chardon, Centre Hospitalier Général, 13616 Aix en Provence Cédex; A. Coupry, Nouvel Hôpital de Fleyrat, 01012 Bourg-en-Bresse Cédex; J.C. Croix, Centre Hospitalier Général, 10003 Troyes Cédex; G. Dorche, Hôpital Bellevue, 42043 Saint-Etienne Cédex; P. Fiévet, Centre Hospitalier, 59507 Douai Cédex; F. Geffroy, Centre Hospitalier René Laënnec, 29107 Quimper Cédex; P. Geslin, Centre Hospitalier Intercommunal, 94010 Créteil; M.L. Grillot, Hôpital Général, 76083 Le Havre Cédex; B. Hautefort, Centre Hospitalier Général, 13697 Arles Cédex; M. Larrouy, Centre Hospitalier Intercommunal de la Côte Basque, 64109 Bayonne; H. Lefrand, Hôpital Henri Duffaut, 84902 Avignon Cédex 9; J.F. Lemeland, Hôtel-Dieu, 76000 Rouen; J.M. Libert, Centre Hospitalier Mane-Lannelongue, 92350 Le Plesssis-Robinson; A. Marmonier, Centre Hospitalier, 72037 Le Mans Cédex; M. Melon, Centre Hospitalier Général, 64011 Pau Cédex; M.H. Nicolas, Hôpital Ambroise Paré, 92104 Boulogne; J.C. Reveil, Hôpital Manchester, 08011 Charleville-Mézières Cédex; Y. Rio, Hôpital Notre Dame de Bon Secours, 57038 Metz Cédex; R. Sanchez, Hôpital Général, 24019 Périgueux Cédex; A. Sédaillan, Centre Hospitalier, 74011 Annecy Cédex, France.