REC Group Research Articles

Gastrointestinal colonization by KPC-producing Klebsiella pneumoniae following hospital discharge: duration of carriage and risk factors for persistent carriage

The natural history of KPC-producing Klebsiella pneumoniae (KPC KP) carriage is unknown. We aimed to examine the duration of KPC KP carriage following hospital discharge and to study the risk factors for persistent carriage. A cohort of 125 KPC KP carriers was followed monthly for between 3 and 6 months after discharge from an acute-care hospital. Rectal swabs and data were collected at baseline and at each visit. KPC KP was detected by culture and direct blaKPC PCR. Acquisition time was regarded as the earliest date of KPC KP isolation. Resolution of carriage was defined as a negative KPC KP test in at least two consecutive samples. Analyses were separated for recent (<4 months) (REC, 75 patients) and remote (≥4 months) (REM, 50 patients) acquisition groups. Risk factors for persistent carriage were examined by survival analyses for the REC group and by prevalence methods for the REM group. The mean age of patients was 67.5 years and 49.6% were male. Forty-six (61%) patients in the REC group and 14 (28%) in the REM group were persistent carriers (p < 0.001). A significant risk factor for persistent carriage identified in both the REC and REM groups was the presence of any catheter (p < 0.05). Unique risk factor groups included long-term care facility (LTCF) residence (p < 0.01) and a low functional status as measured by the Barthel’s index (p < 0.05) in the REC group and high Charlson’s score in the REM group (p < 0.05). Out of the entire 100 patients who had at least one negative sample, only 65 remained negative on subsequent cultures. In conclusion, persistent carriage of KPC KP is associated with catheter use and a low functional status; it is more common in patients with recent acquisition and is related to LTCF stay. A single negative KPC KP test is insufficient to exclude persistent carriage.

The partly epithelialized free gingival graft (pe‐fgg) at lower incisors. A pilot study with implications for alignment of the mucogingival junction

A partly epithelialized free gingival graft (PE-FGG) is described for the treatment of isolated and multiple gingival recessions in lower incisors to improve root coverage potential and mucogingival junction (MGJ) alignment. Twelve single gingival recessions in 12 patients and 16 multiple recessions in 7 patients at lower incisors were included. A FGG partly deprived of epithelium was harvested from the palate. The epithelialized coronal part of the graft extended from the CEJ to the "ideal" position of the MGJ of the recession site/s. The apical part of the PE-FGG deprived of the epithelium was inserted between the alveolar mucosal flap and the recipient bed periostium. An aesthetic evaluation was performed. Treatment resulted in 94±11% and 96±11% root coverage and 75% and 87.5% of the treated teeth completely covered in the single recession and in the multiple recession groups respectively. The 1-year KT was associated with the baseline extent of the epithelialized part of the graft in both groups. As a consequence, the MGJ resulted in properly aligned teeth in 14 of 19 patients. Three independent clinicians assigned an aesthetic score ranging from 6.36±2.5 to 7.91±1.7 in the single REC group and from 6.62±2.2 to 7.87±1.8 in the multiple REC group. The application of the M-FGG resulted in high percentage of recessions completely covered with excellent alignment of the MGJ and appreciable aesthetic outcomes.

Influence of nutrient intake on antioxidant capacity, muscle damage and white blood cell count in female soccer players

BackgroundSoccer is a form of exercise that induces inflammatory response, as well as an increase in free radicals potentially leading to muscle injury. Balanced nutritional intake provides important antioxidant vitamins, including vitamins A, C and E, which may assist in preventing exercise-related muscle damage. The purpose of the present study was to determine the effect of macro/micronutrient intake on markers of oxidative stress, muscle damage, inflammatory and immune response in female soccer players.MethodsTwenty-eight female players belonging to two soccer teams of the same professional soccer club participated in this study after being informed about the aims and procedures and after delivering written consent. Each team completed an 8-day dietary record and played one competition match the same week. Participants were divided into two groups: the REC group (who complied with recommended intakes) and the NO-REC group (who were not compliant). Laboratory blood tests were carried out to determine hematological, electrolytic and hormonal variables, as well as to monitor markers of cell damage and oxidative stress. Blood samples were obtained 24 h before, immediately after and 18 h after official soccer matches. Student t-test or Mann–Whitney U-test was used to compare both groups throughout the match.ResultsAt rest, we observed that the REC group had higher levels of total antioxidant status (TAS), glutathione peroxidase (GPx), and lower levels of creatine kinase (CK) and lactate dehydrogenase (LDH) in comparison to the NO-REC group. Immediately after the match, levels of TAS, GPx, superoxide dismutase (SOD), LDH and % lymphocytes were higher and the % of neutrophils were lower in the REC group compared to the NO-REC group. These differences were also maintained 18 h post-match, only for TAS and GPx.ConclusionsOur data reveal an association between nutritional intake and muscle damage, oxidative stress, immunity and inflammation markers. The benefit of the intake of specific nutrients may contribute to preventing the undesirable physiological effects provoked by soccer matches.

Recurrent hepatocellular carcinoma successfully treated with laparoscopic thermal ablation

Aggressive treatment of intrahepatic recurrence of hepatocellular carcinoma (HCC) increases patients' survival. This study aimed to evaluate laparoscopic thermal ablation (TA) in the treatment of intrahepatic HCC recurrences. A retrospective analysis was performed on 88 patients (REC group) who underwent laparoscopic TA after prior TA (66 patients.) or partial hepatic resection (HR) (22 patients) as initial local treatment. Another 170 patients with primary HCC tumors (PRIM group) were regarded as the control group. The postoperative morbidity rates were similar for the patients with prior TA (18%) and those with prior HR (21%) (nonsignificant difference [NS]). The overall survival rates were not significantly different between the two groups (3-year survival rates of 59 and 78%, respectively; P = 0.1662). Moreover, the disease-free survival (DFS) rates did not differ significantly between the patients with prior TA and those with prior HR (3-year DFS of 21 and 8%, respectively; P = 0.1911). The incidences of morbidity in the whole REC (21%) and PRIM (20%) groups were similar (P = NS), and no mortality occurred in either group (0%). The cumulative 3-year survival rate was 63% in the REC group and 59% in the PRIM group (P = 0.5739), whereas the 3-year DFS rate was 17% in the REC group and 22% in the PRIM group (P = 0.5266). Laparoscopic TA can be performed safely and may be effective for intrahepatic HCC recurrence after prior TA or HR. It leads to survival and DFS rates similar to those obtained using laparoscopic TA for primary HCC without increasing morbidity. Laparoscopic TA could be proposed as first-line treatment of intrahepatic HCC recurrence for selected patients.

The clinical study on efficacy of clarithromycin, levofloxacin, and streptomycin for pulmonary Mycobacterium avium-intracellulare complex infection

The purpose of this study was to elucidate retrospectively the clinical effects of using RFP, EB, CAM, LVFX, and SM for pulmonary Mycobacterium avium-intracellulare complex infection. During 9-year (1995-2003) period, 72 patients diagnosed according to the criteria of the Japanese Society for Tuberculosis Guidelines and treated for at least 6 months were available for this study. The age averaged 68 (range, 32-92) years. The male to female ratio was approximately 2 : 3. The follow-up period averaged 344 (190-365) days. 59 of 72 patients were treated for the first time. 58 of 72 patients were diagnosed as primary infection type. Among them, 20, 38, and 14 patients were treated by RFP, EB, and CAM (REC group), RFP, EB, CAM and LVFX (LVFX group), and RFP, EB, CAM, and SM (SM group), respectively. Comparing the baseline patient characteristics among three groups, we found significant difference (measured by ANOVA) in gender (male/female, REC group: 8/12, LVFX group: 20/18, and SM group: 2/12, p < 0.05), age (REC group: 75.2 +/- 9.1, LVFX group : 66.5 +/- 12.5, and SM group: 63.9 +/- 11.9, p < 0.01) and body mass index (REC group: 17.2 +/- 2.9, LVFX group: 18.9 +/- 2.8, and SM group: 19.7 +/- 2.4, p < 0.05). However, we did not find any significant difference in the clinical outcomes (improving rate of the symptoms, change of the erythrocyte sedimentation rate, improving rate of the chest X-ray, and the results of follow-up on bacteriological effect). In the 60 of 72 patients treated for 1 year, the results were superior to those of some previous reports (1-year improving rate of the symptoms, 1-year improving rate of the chest X-ray, 1-year improving rate of the sputum conversion, and 1-year rate of the relapse were 54.3%, 65.0%, 60.0%, and 15.3%, respectively). Further study was warranted that no advantage was shown by an additional use of LVFX or SM on REC from the point of view of the clinical effects for pulmonary Mycobacterium avium-intracellulare complex infection, in spite of the higher age and deteriorated nutritional status of REC group.

Clinical outcomes of renal transplant recipients treated with enteric‐coated mycophenolic acid vs. mycophenolate mofetil as a switch agent using a primary steroid‐free rapamune and microemulsion cyclosporine protocol

Since 2002 our transplant program has utilized a steroid free, cyclosporine (CSA)- and rapamycin (RAPA)-based maintenance immunosuppression regimen. In cases where it has been desirable to avoid the potential nephrotoxicity with this regimen we have used mycophenolic acid (MPA) as our "switch" drug of choice. Both mycophenolate mofetil (MMF) (Roche Inc., Nutley, NJ, USA) and enteric-coated MPA (ECM) (Novartis, East Hanover, NJ, USA) have been used. In this study, we retrospectively compared the tolerability of the two formulations of MPA. Thus we compared 103 recipients switched to RAPA/MMF (RMM group) to 114 switched to RAPA/ECM (REC group). There was a significantly higher incidence of patients requiring dose changes and drug discontinuation in the RMM group, as well as an increased frequency of dose changes. There were significantly more acute rejection episodes and kidney losses in the dose adjustment vs. no dose adjustment patients. However, when comparing the incidence of acute rejection and kidney loss between the RMM and REC groups, there was no significant difference. We conclude that in this cohort of recipients, the ECM formulation of MPA was better tolerated than the MMF formulation, resulting in fewer patients requiring dose adjustments or drug discontinuation.

Salvage radiotherapy for postoperative loco-regional recurrence of esophageal cancer

The aim of this paper is to evaluate the treatment outcome of radiation therapy (RT) for 16 loco-regionally recurrent esophageal cancer patients. Between 1995 and 2004, patients with loco-regional recurrence of esophageal cancer after curative surgery received RT with or without chemotherapy (CTx) at an average total dose of 56.6 Gy (n = 16, REC group). The site of recurrence was the supraclavicular region in three patients, the mediastinal region in nine patients, and both the supraclavicular and mediastinal regions in four patients. We compared the data with those of patients receiving palliative RT with or without CTx for mediastinal relapse, distant metastasis or malignant pleural effusion (n = 39, META group) and with those of patients receiving postoperative RT with or without CTx in a planned fashion 4-6 weeks after esophagectomy (n = 27, PORT group). The median survival period was 13.8 months in the REC group, 3.5 months in the META group, and 19.1 months in the PORT group. The survival rates at 1 and 2 years were 56% and 19% in the REC group, 6% and 3% in the META group (P = 0.0003), and 70% and 43% in the PORT group (P = 0.1917), respectively. According to univariate analysis, the factor of worse prognosis was not found in the REC group. Complete or partial responses were observed in four (25%) and nine (56%) of the REC group patients, respectively. In the REC group, changes in clinical symptoms, such as dysphagia and recurrent nerve paralysis, could be evaluated in eight patients, and improvement in symptoms was obtained in five (63%) patients. The prognosis of patients who received RT for postoperative loco-regional recurrence of esophageal cancer was significantly better than that of the META group patients and compatible with that of the PORT group patients. Additionally, there is symptomatic relief in a substantial proportion of such patients, and long-term survival is possible in some patients.

Elucidating determinants of the plateau in oxygen consumption at o2max

Background: A plateau in oxygen consumption (o2) is the primary means of confirming that maximal oxygen uptake (o2max) is attained during incremental exercise to fatigue. However, it is still unresolved...

Effect of post-hypoxic MgSO 4 administration in utero on Ca 2+-influx and Ca 2+/calmodulin kinase IV activity in cortical neuronal nuclei

Previously we have demonstrated that in utero hypoxia results in increased nuclear Ca 2+-influx and increased CaM kinase IV activity in neuronal nuclei of the guinea pig fetus. The present study tests the hypothesis that maternal treatment with magnesium sulfate (MgSO 4) following in utero hypoxia will attenuate the hypoxia-induced increase in Ca 2+-influx and CaM kinase IV activity in neuronal nuclei of the fetal guinea pig brain during recovery. Pregnant guinea pigs at 60 days of gestation were divided into four groups: normoxic (Nx = 5), hypoxic (Hx, n = 4), untreated post-hypoxic 24 h recovery (Rec, n = 8) and Mg 2+-treated post-hypoxic 24 h recovery (Mg 2+-Rec, n = 8). Maternal hypoxia was induced by decreasing FiO 2 to 8% for 1 h. Recovery groups received either saline or 300 mg/kg MgSO 4 (i.p.) followed by 100 mg/kg/h i.p. for 4 h. Fetal cerebral tissue hypoxia was documented by ATP and phosphcreatine (PCr) levels. Neuronal nuclei were isolated and nuclear Ca 2+-influx as well as CaM kinase activity was determined. Nuclear Ca 2+ influx (pmol/mg protein) was 4.84 ± 0.83 in Nx, 12.50 ± 2.97 ( p < 0.05) in Hx, 7.83 ± 1.78 in Rec group ( p < 0.05 versus Nx and Hx) and 5.02 ± 1.77 in Mg 2+-Rec group ( p < 0.05 versus Rec group, p < 0.05 versus Hx, p = NS versus Nx). CaM kinase IV activity (pmol/mg protein/min) was 1197 ± 62 in Nx, 2524 ± 132 ( p < 0.05 versus Nx) in Hx, 1830 ± 141 ( p < 0.05 versus Nx and Hx) in Rec and 1938 ± 118 in Mg 2+-Rec group ( p < 0.05 versus Hx and Nx, p = n.s. versus Rec). The data show that MgSO 4 administration following in utero hypoxia prevents hypoxia-induced increase in neuronal nuclear Ca 2+-influx but has no effect on CaM kinase activity in the guinea pig fetus during recovery. We conclude that post-hypoxic administration of Mg 2+ prevents hypoxia-induced modification of neuronal nuclear membrane function.

Characterizing immune reconstitution after long-term highly active antiretroviral therapy in pediatric AIDS.

In this study, we sought to characterize the T lymphocyte recovery in vertically HIV-1-infected children who respond to long-term highly active antiretroviral therapy (HAART). A 3-year longitudinal retrospective study was used to perform a cross-sectional study of 32 children rated according to the time course of CD4(+) T cell percentages in response to antiretroviral therapy and CDC clinical classification: (1) long-term asymptomatic (LTA group): 8 children in A1 during the whole follow-up period; (2) responsive to HAART (Rec group): 13 children in C3 before HAART who achieved CD4(+) T cell counts of > 500 cells/mm(3) after 3 years of HAART; and (3) nonresponsive to HAART (Non-Rec group): 11 children in C3 during the whole follow-up period despite 3 years of HAART. We also studied 17 healthy age-matched uninfected children as controls. Lymphoproliferative responses (LPRs) were evaluated by incorporation of [(3)H]thymidine, identification of T cell subsets by three-color flow cytometry, and determination of thymic production of T cells by quantification of T cell receptor rearrangement excision circles (TRECs). Interestingly, the Rec group showed an increase in percentage of CD4(+) T cells and a decrease in viral load, and recovered LPRs to mitogens and recall antigens, with values similar to those of the LTA group. Moreover, the Rec group produced similar percentages and absolute counts of naive (CD45RA(+)CD62L(+)) CD4(+) and CD8(+) T cells, and TRECs similar to those of the LTA group. In particular, the Rec group produced similar percentages of CD8(+)CD28(-)CD57(+) and CD8(+)CD28(-)CD57(-) T cell subsets compared with controls. Our data indicate that among children who have already progressed to AIDS and severe immunodeficiency but who respond to HAART, the immune system can recover and resemble those of nonprogressors or even uninfected children, in quantitative as well as in functional terms.

Clinical outcome of treatment cycles using preimplantation genetic diagnosis for structural chromosomal abnormalities.

To explore oocyte recovery, embryo quality, the number of transferable embryos and pregnancy rate after preimplantation genetic diagnosis (PGD) in patients with structural chromosomal aberrations. PGD was performed in seven couples with Robertsonian translocations (Rob), eight couples with reciprocal translocations (Rec), two couples with inversions and one couple with a deletion. A total of 43 treatment cycles were carried out. A total of 14.2 oocytes per cycle were retrieved. Fertilisation and cleavage rates were 63% and 58%, respectively. Of the biopsied embryos 20% were transferable. Comparison of the Rob and Rec group revealed no significant differences in number of oocytes, fertilisation or cleavage rates. The number of transferable embryos after biopsy was significantly higher in the Rob group than in the Rec group. When embryo transfer (ET) was performed the pregnancy rate did not differ between the Rob and the Rec groups. Twenty-eight embryo transfers (one or two embryos) were carried out leading to eight clinical pregnancies (29% per ET): two twins, four singletons, one miscarriage and one ectopic pregnancy. All the children are carriers of balanced chromosomal aberrations. An acceptable pregnancy rate can be achieved among couples with structural chromosomal abnormalities.

Hematological alterations after acute exposure to hyperbaric oxygen in rats.

1. Acute exposure to hyperbaric oxygen (HBO) is associated with a significant increase in haematocrit which returns to the control level after 24h of recovery in room air. In this study we report changes in blood viscosity in Sprague-Dawley rats after acute exposure to HBO. 2. The rats were divided into three groups: a control group included rats not exposed to HBO (CON), a group studied immediately after acute exposure to HBO at 283.7 kPa for 6h (HBO), and a group allowed to recover for 24h in room air after HBO exposure (REC). 3. The viscosity of the whole blood, plasma and red blood cells (RBC) suspension was measured in the three groups. A significant increase in whole blood viscosity was detected in HBO and REC groups compared with CON (P < 0.05), but no changes in the viscosity of the plasma or RBC suspension were noted. 4. A significant decrease in oxygen delivery index was found in the REC group compared with the CON and HBO groups (P < 0.05). 5. In a subgroup of rats, several blood parameters known to influence blood viscosity were evaluated. A significant increase in plasma colloid oncotic pressure was noted in HBO rats compared with CON (P < 0.01). A marked increase in platelet count and fibrinogen concentration was detected in HBO and REC rats compared with CON (P < 0.05). Furthermore, a significant increase in total leukocytic count was noticed in REC group compared with CON and HBO (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

A Comparison of Two Fitness Programs to Reduce the of Risk of Coronary Heart Disease in Public Safety Officers

The purpose of this investigation was to determine the effectiveness of a fitness program designed as an alternative to the standard weight-training and running program and using limited resources and facilities. Forty-three men from the North Carolina Justice Academy, randomly assigned into two groups, completed 12 weeks of physical training. The WT group used a standard weight training and running, whereas the REC group ran and completed a resistive exercise circuit. The REC circuit consisted of nine exercises designed to improve muscular strength and endurance separated by 30 seconds of aerobic exercise. The exercises used chairs, tables, sawhorses, and body weight to provide the resistance. The results indicated that the REC program improved muscular strength and aerobic capacity as well as the WT program. Furthermore, the REC group lost more weight, reduced body fat, and improved their lipid profiles significantly more than the WT group. Thus, the REC program is a viable alternative for the training of public safety officers when only limited resources are available.