[Analysis of different protein expression levels in peripheral blood circulating tumor cells from patients with diffuse large B-cell lymphoma and their predictive efficiency for recurrence]

Objective: To analyze the expression levels of differentiation cluster 47 (CD47), signal regulatory protein α (SIRP-α), proto-oncogene (MYC) and proliferating cell associated antigen (Ki67) proteins in peripheral blood circulating tumor cells (CTC) from patients with diffuse large B-cell lymphoma and their predictive efficiency for tumor recurrence. Methods: The data of 82 patients with diffuse large B-cell lymphoma who were confirmed by histopathology and were in remission after chemotherapy in the Hematology Department of Linyi People's Hospital from January 2018 to January 2021 were retrospectively analyzed. There were 44 males and 38 females, and aged from 50 to 75 (63.8±4.6) years. The patients were divided into recurrent group (n=36) and non-recurrent group (n=46) according to their recurrence within 1 year after remission. The fasting peripheral venous blood samples (4 ml) from patients in the morning were collected, and the CTC were isolated. The expression levels of CD47, SIRP-α, MYC and Ki67 proteins in CTC were detected by Western blotting. The correlations between CD47 expression level and SIRP-α, MYC and Ki67 expression levels were analyzed by Pearson correlation analysis. The predictive efficiency of CD47, SIRP-α, MYC and Ki67 expression levels on tumor recurrence was evaluated by receiver operating characteristic (ROC) curves, and the areas under the curve (AUC) were calculated. Results: The expression levels of CD47, SIRP-α, MYC and Ki67 in recurrent group were 2.24±0.23, 1.17±0.12, 1.98±0.20 and 2.63±0.27, while those in non-recurrent group were 2.04±0.21, 1.31±0.13, 1.53±0.16 and 2.24±0.25. The expression levels of CD47, MYC and Ki67 in the recurrent group were higher than those in the non-recurrent group, while the expression levels of SIRP-α were lower than those in the non-recurrent group (all P<0.001). In 82 patients, the expression levels of CD47, SIRP-α, MYC and Ki67 were 2.13±0.22, 1.25±0.13, 1.73±0.18 and 2.41±0.26, respectively. The expression level of CD47 was negatively correlated with the expression level of SIRP-α (r=-0.308, P=0.005), but positively correlated with the expression level of MYC and Ki67 (r=0.484 and 0.332, P=0.012 and 0.003). The sensitivity of CD47, SIRP-α, MYC and Ki67 expression levels in predicting recurrence of diffuse large B-cell lymphoma was 66.7%, 72.2%, 72.2% and 66.7%, with the specificity of 67.4%, 71.7%, 67.4% and 71.7%, and AUC (95%CI) of 0.694 (0.582-0.791), 0.693 (0582-0.790), 0.714 (0.603-0.808) and 0.709 (0.598-0.804), respectively. The sensitivity of the combined detection of the above four indicators was 83.3%, with the specificity of 78.3% and the AUC (95%CI) of 0.864 (0.771-0.930), which was higher than those of the individual detection of each indicator (all P<0.05). Conclusions: The expression level of CD47 was negatively correlated with the expression level of SIRP-α, but positively correlated with the expression level of MYC and Ki67. The expression levels of CD47, SIRP-α, MYC and Ki67 have certain predictive value for tumor recurrence in patients with diffuse large B-cell lymphoma, and the predictive efficiency of combined detection is higher than single indicator detection.

[Effect of digital virtual simulation system for preclinical teaching of access and coronal cavity preparation]

Objective: To investigate the effectiveness of a digital virtual simulation training system applied in the preclinical teaching of access and coronal cavity preparation. Methods: Twenty dental undergraduate students from Peking University School and Hospital of Stomatology were recruited and divided randomly and equally into two groups according to the random number method after being unified with theory training, including access and coronal cavity preparation skills assessment form and Simodont system operation manual. Tests for access and coronal cavity preparation skills by using standard simulation plastic teeth were performed and the scores were recorded as baseline for each student. Students in group of virtual simulation priority were trained using Simodont virtual simulation system, while those in group of phantom-simulator priority were trained using conventional phantom-simulator system. Access and coronal cavity preparation skills of standard simulation plastic teeth were assessed once again and recorded as the second scores for the two groups. Furthermore, the two groups of students exchanged training systems and were assessed and graded once more as the third scores. Finally, all students were asked to fill up a Teaching Questionnaire after the training. The data were then collected and analyzed. Results: For the group of virtual simulation priority, after the training by using Simodont virtual simulation system and conventional phantom-simulator system, the mean score of access and coronal cavity preparation (16.00±1.49) was significantly higher than the baseline score (13.30±1.41) (P<0.05). For the group of phantom-simulator priority, after the training by using conventional phantom-simulator system and Simodont virtual simulation system, the mean score of access and coronal cavity preparation (15.60±1.26) was also significantly higher than the baseline score (13.00±1.89) (P<0.05). Furthermore, in the group of virtual simulation priority, of which the students were trained by using Simodont virtual simulation system first and then conventional phantom-simulator system, the score of access and coronal cavity preparation was significantly higher than the score of training by using conventional phantom-simulator system only (14.30±1.77) (P<0.05). In the group of phantom-simulator priority, of which the students were trained by using conventional phantom-simulator system first and then Simodont virtual simulation system, the score of access and coronal cavity preparation was significantly higher than the score of training by using Simodont virtual simulation system only (14.10±1.45) (P<0.05). Moreover, in the group of virtual simulation priority, the score of training by using conventional phantom-simulator system after using Simodont virtual simulation system was significantly higher than that of training by using Simodont virtual simulation system only (P<0.05). The results of the questionnaire showed that the students fully agreed that "the Simodont virtual simulation system has the characteristics of repeatability, multi-dimension and multiple practice, and provides me with more attention to details" [80% (16/20)], however "it needs to be improved and upgraded to be close to the conventiaonl phantom-simulator system" [90% (18/20)]. Conclusions: Compared with using the conventional phantom-simulator system only, the preclinical teaching effectiveness of access and coronal cavity preparation could be effectively improved by using Simodont virtual simulation system combined with the phantom-simulator training system and might influenced by the training sequence.

QTL analysis of durable stripe rust resistance in the North American winter wheat cultivar Skiles

This study determined the effects of growth stage and temperature on expression of high-temperature adult-plant resistance to stripe rust, mapped six QTL for durable resistance in winter wheat Skiles using a doubled haploid population, and selected breeding lines with different combinations of the QTL using marker-assisted selection. The winter wheat cultivar Skiles has a high level of high-temperature adult-plant (HTAP) resistance to stripe rust caused by Puccinia striiformis f. sp. tritici (Pst). The Skiles HTAP resistance was highly effective at the adult-plant stage even under low temperatures, but high temperatures induced earlier expression and increased levels of resistance. To map resistance genes, Skiles was crossed with the susceptible cultivar Avocet S and a doubled haploid (DH) population was developed. The DH population was tested in fields at Pullman, WA, in 2016, 2017 and 2018, Mount Vernon, WA, in 2017 and 2018 under natural infection, and an environmentally controlled greenhouse at the adult-plant stage with the currently predominant race PSTv-37. The population was genotyped using the 90 K Illumina iSelect wheat SNP chip and selected SSR markers on specific chromosomes. In total, 2526 polymorphic markers were used for QTL mapping and six QTL were detected. Two of the six QTL had major effects across all environments, with one mapped on chromosome 3BS, explaining up to 28.2% of the phenotypic variation and the other on chromosome 4BL, explaining up to 41.8%. Minor QTL were mapped on chromosomes 1BL, 5AL, 6B and 7DL. Genotyping 140 wheat cultivars from the US Pacific Northwest revealed high polymorphism of markers for five of the QTL, and five highly resistant lines with the five QTL were selected from Skiles-derived breeding lines using the markers. This study demonstrated that multiple QTL with mostly additive effects contributed to the high-level HTAP resistance in Skiles.

Atomic layer oxidation on graphene sheets for tuning their oxidation levels, electrical conductivities, and band gaps

Graphene sheets that can exhibit electrical conducting and semiconducting properties are highly desirable and have potential applications in fiber communications, photodetectors, solar cells, semiconductors, and broadband modulators. However, there is currently no efficient method that is able to tune the band gap of graphene sheets. This work adopts an efficient atomic layer oxidation (ALO) technique to cyclically increase the oxidation level of graphene sheets, thus, tuning their electrical conductance, band-gap structure, and photoluminescence (PL) response. The O/C atomic ratio as an increasing function of the ALO cycle number reflects two linear regions: 0.23% per cm2 per cycle (0-15 cycles) and 0.054% per cm2 per cycle (15-100 cycles). The excellent correlation coefficients reveal that the ALO process follows a self-limiting route to step-by-step oxidize graphene layers. The interlayer distance of ALO-graphene sheets shows an obvious increase after the ALO treatment, proved by X-ray diffraction. As analyzed by X-ray photon spectroscopy, the hydroxyl or epoxy group acts as a major contributor to the interlayer spacing distance and oxidation extent in the initial ALO stage, as compared to carbonyl and carboxyl groups. The ALO mechanism, based on Langmuir-Hinshelwood and Eley-Rideal models, is proposed to clarify the formation of oxygen functionalities and structural transformation from pristine graphene sheets to oxidized ones during the ALO cycle. With a tunable oxidation level, the electrical resistivity, semiconductor character, and PL response of ALO-graphene samples can be systematically controlled for desired applications. The ALO approach is capable of offering a straightforward route to tune the oxidation level of graphene sheets or other carbons.

[Effect of thermal conductivity on apical sealing ability of 4 dental gutta-percha cones]

OBJECTIVE

To investigate the effect of thermal conductivity on the apical sealing ability of different dental gutta-percha cones during the warm vertical condensation obturation.

METHODS

Four kinds of dental gutta-percha cones were used in this study: Bio-GP points (BP, B&L, Korea), large-tapered gutta-percha (DP, DENTSPLY, America), PROTAPER Universal gutta-percha points (DPP, DENTSPLY, America) and mtwo gutta-percha points (VP, VDW, Germany). Volume differences method was used to determine the main components and the thermal conductivity determinator was used to measure the thermal conductivity of these dental gutta-percha cones. Furthermore, 20 cones randomly selected from each kind of dental gutta-percha cones. And 10 cones of each dental gutta-percha cones, which were cut out the part of 4 mm in length from the apical end, were heated (200 °C) from the upper end without compression, and the temperature of the gutta perchacones surface was monitored in time by the infrared thermal imager during the whole heating process. In addition, the rest of the 10 cones of each dental gutta-percha cones were used to obturate the root canal in the transparent root canal resin model using warm vertical condensation technique. The cross-sectional surface was observed by stereomicroscope (× 40) at 1 mm and 3 mm from the working length and the gutta-percha obturation area proportion was measured and analyzed. The data were analyzed by one-way ANOVA.

RESULTS

The proportion of inorganic fillers (80.90%±1.14 %) (P<0.05) and the thermal conductivity (2.247±0.002) of DP was significantly higher than BP (79.28%±3.88%, 1.179±0.003), DPP (68.46%±5.09%, 0.604±0.001), VP (78.86%±1.87%, 1.150±0.001) (P<0.05). During the thermal obturation without compression at the setting temperature (200 °C), DP could achieve 65 °C beyond 1 mm from the heating point, and BP, DPP and VP only reached 65 °C within 1 mm. After warm vertical condensation obturation, all the groups showed increased gutta-percha obturation area proportion. At the position of WL-3, DP (96.89%±0.03%) showed significantly higher proportion of gutta-percha obturation area than BP (95.47%±0.06%), DPP (95.21%±0.03%) and VP (95.15%±0.03%) (P<0.05).

CONCLUSION

DP contains more inorganic fillers, possesses higher thermal conductivity, and leads a better apical sealing ability than BP,DPP and VP at the position of WL-3 during warm vertical condensation obturation.

[Durability of protective effect of resin-based coating material on root surface]

OBJECTIVE

To compare the durability of resin-based root-surface coating material and all-in-one self-etching adhesive on root surface in vitro.

METHODS

Human extracted premolars or molars with intact roots were selected. The cementum was removed using a periodontal scaler to expose root dentin. The root surface was coated with an acid-resistant nail varnish, leaving a window of 3 mm×3 mm on the exposed dentin.The window was covered with either PRG Barrier Coat (PRG) or Clearfil S3 Bond (CS3). After water aging for 14 d, specimens were immersed in acid buffer at pH 4.5 for 4 d and the demineralization buffer was changed every 24 h. Then the specimen was split longitudinally through the center of the 'window' and the cross-sectional surface was observed with scanning electron microscope (SEM). After fixed and dehydrated, the prepared samples were coated with platinum. The coating material, root dentin and the interface was observed by scanning electron microscope (SEM). The thickness of the coating material was measured on the SEM images. Regarding toothbrush wear test, coronal dentindisks were prepared and covered with PRG and CS3, respectively. After storage in water for 24 h, the specimen was subjected to the toothbrush wear tester for 100, 200, 300, 500, 700, 1 500 brushing cycles. A slurry of fluoride toothpaste (1:2 ratio of toothpaste and deionized water by weight) was used and the brushing load was 300 N. The surface microstructure of remaining coating material was analyzed using SEM. The wear depths were determined by a profilometer. Statistical analysis was performed with SPSS 20.0 by one-way ANOVA. The level of significance was at 0.05.

RESULTS

Application of PRG Barrier Coat produced a coating layer of (47.1±27.3) μm, while CS3 presented a thin film of (5.7±2.1) μm in thickness. The exposed dentin was hermetically sealed and no obvious gap was observed at the interface in both PRG and CS3 groups. There was no dentin demineralization observed in both groups after water aging. The wear depths of PRG and CS3 increased along with the numbers of brushing cycles. PRG wore at a significant lower pace than CS3 did (P<0.05).

CONCLUSION

PRG coating resin had similar performances as CS3 on protecting root dentin from demineralization after water aging. What's more, PRG demonstrated a higher toothbrush wear resistance than CS3. We concluded that PRG Barrier Coat contained S-PRG filler may be an effective coating material for protecting exposed root from both chemical and mechanical challenges. Further studies should be carried out to evaluate the long-term reliability of the rootsurface coating materials under the clinical setting.

One-step electrophoretic fabrication of a graphene and carbon nanotube-based scaffold for manganese-based pseudocapacitors

A reduced graphene oxide (rGO)/carbon nanotube (CNT)/MnO_x based supercapacitor electrode has been fabricated successfully by a facile one-step electrophoretic deposition (EPD) method.

First Report of Alternaria alternata Causing a Leaf Spot on Philodendron 'con-go' in China

Philodendron 'con-go' is widely cultivated indoors in China as an evergreen potted plant. In October 2013, a leaf spot on Philodendron 'con-go' was observed in the residential district of Luoyang (112.46° E, 34.62° N), Henan Province, China. The disease was characterized by oval-shaped, 10 to 20 × 25 to 55 mm, yellow to brown lesions with darker brown borders. Fifty potted plants were surveyed, and less than 2% of the leaves were infected. Lesions appeared mostly in old leaves. The symptomatic leaves affected on the plants' ornamental value, but had little impact on their health. Some lesions merged to form a large irregular lesion that could cover a whole leaf. Two infected leaves from one plant were selected randomly for the isolation of the pathogen. Lesions were cut into 1 cm² pieces, soaked in 70% ethanol for 30 s, sterilized with 1% sodium hypochlorite for 5 min, then washed three times in sterilized distilled water. The pieces were incubated at 25°C on potato dextrose agar (PDA) for 4 to 5 days. A fungus was consistently isolated. Colonies of the fungus were deep green with white mycelium borders. Conidiophores were light brown with 2 to 4 septa. Conidia were obclavate, 14.6 to 49.1 × 8.3 to 16.4 μm, with a short beak, and with 1 to 5 transverse septa and 0 to 3 longitudinal septa, light brown to olive-brown. Based on morphology, the pathogen was identified as Alternaria alternata. Three isolates were selected randomly for further identification. To confirm pathogenicity, eight leaves of potted Philodendron 'con-go' plants were wounded with a sterile pin after wiping each leaf surface with 70% ethanol and washing each leaf with sterilized distilled water three times. The isolates were grown on PDA for 7 days and suspended in sterile distilled water to produce a final concentration of 2 × 10⁵ spores/ml. A 5-μl drop of spore suspension was placed on each pin-wounded leaf. Each of three fungal isolates was inoculated on two leaves, and the control treatment (water inoculated) was done similarly on two leaves. The plants were placed in a growth chamber at 28°C with 80% relative humidity, 50 to 60 klx/m² light intensity, and a 10-h photoperiod. After 7 days, lesions appeared on inoculated leaves, but the control leaves remained symptomless. Pathogenicity tests were repeated three times. Similar disease symptoms and re-isolation of A. alternata fulfilled Koch's postulates. To confirm the fungal identification, the rDNA of the internal transcribed spacer region in three isolates were amplified using primers ITS1 and ITS4 (1) and sequenced. The nucleotide sequence of the ITS region was submitted to GenBank under accession KJ829535 and showed 100% sequence identity with the strain A. alternata LPSC 1187 (KF753947.1). To our knowledge, this is the first report of a leaf spot of Philodendron 'con-go' by A. alternate in China. Reference: (1) T. J. White et al. PCR Protocols: A Guide to Methods and Applications. M. A. Innis et al., eds. Academic Press, San Diego, CA, 1990.

Genetic diversity analysis of okra (Abelmoschus esculentus L.) by inter-simple sequence repeat (ISSR) markers

Okra (Abelmoschus esculentus L.) is not only a nutrient-rich vegetable but also an important medicinal herb. Inter-simple sequence repeat (ISSR) markers were employed to investigate the genetic diversity and differentiation of 24 okra genotypes. In this study, the PCR products were separated by electrophoresis on 8% nondenaturing polyacrylamide gel and visualized by silver staining. The 22 ISSR primers produced 289 amplified DNA fragments, and 145 (50%) fragments were polymorphic. The 289 markers were used to construct the dendrogram based on the unweighted pair-group method with arithmetic average (UPGMA) cluster analysis. The dendrogram indicated that 24 okras were clustered into 4 geographically distinct groups. The average polymorphism information content (PIC) was 0.531929, which showed that the majority of primers were informative. The high values of allele frequency, genetic diversity, and heterozygosity showed that primer-sample combinations produced measurable fragments. The mean distances ranged from 0.045455 to 0.454545. The dendrogram indicated that the ISSR markers succeeded in distinguishing most of the 24 varieties in relation to their genetic backgrounds and geographical origins.

Fracture resistance of root filled premolar teeth restored with direct composite resin with or without cusp coverage

AIM

To evaluate the fracture resistance and fracture patterns of root filled maxillary first premolar teeth (with mesio-occlusal cavity preparation) restored with several composite restoration designs.

METHODOLOGY

One hundred extracted sound human maxillary first premolars were randomly divided into five groups. Group 1 remained untreated (negative control). Conventional root canal treatment with additional mesial-occlusal cavity preparation was carried out on teeth in groups 2-5. In group 2, the teeth were restored intra-coronally with direct composite resin (positive control). In group 3, the palatal cusps of the teeth were reduced, and the cavities were restored with composite resin covering the palatal cusp (partial coverage). In group 4, the buccal and palatal cusps along with the distal marginal ridges were reduced; the cavities and cusps were restored with composite resin (conventional full coverage). In group 5, the buccal and palatal cusps were reduced but the distal marginal ridges were conserved. The cavities and the cusps were restored with composite resin (modified full coverage). All teeth were subjected to a progressive compressive loading parallel to their longitudinal axis until fracture. Fracture resistance was analysed using the one-way ANOVA and Fisher's LSD test. Fracture patterns were analyzed with chi-square test. The significance level was set at 0.05.

RESULTS

The fracture resistance (mean ± SD) of groups 1-5 was 1131 ± 207N, 904 ± 184N, 927 ± 224N, 1095 ± 289N and 1085 ± 243N, respectively (groups 1, 4, 5 > groups 2, 3; P = 0.004). Cusp fractures were recorded as the fracture pattern in 20 (100%), 19 (95%), 16 (80%), 8 (40%) and 12 (60%) premolars in groups 1-5, respectively (groups 1, 2 > groups 4, 5; group 3 > group 4; P < 0.001).

CONCLUSIONS

When direct composite resin was used to restore root filled maxillary first premolar teeth involving a proximal surface, those restored with full-coverage designs had greater fracture resistance.

Synthesis and characterization of organic–inorganic hybrid mesoporous silica materials with new templates

1-Hexadecane-3-methylimidazolium bromide and 1-hexadecane-2,3-dimethylimidazolium bromide were used as new templates for the syntheses of periodic mesoporous organosilica (PMO) materials; using these new templates, ethane-bridged PMO materials were successfully synthesized and characterized under basic conditions.

A case of spindle cell sarcomatous change of hepatic ducts manifesting as obstructive jaundice

Spindle cell carcinoma is a rare tumor commonly occurring in the upper aerodigestive tract. We report a 62-year-old male with spindle cell sarcomatous change located at the hepatic hilum, resulting in obstructive jaundice. The patient died after an extended resective operation. The rare disease and its histogenesis is discussed.

Fibrolamellar variant of hepatocellular carcinoma--report of a Chinese patient

Fibrolamellar hepatocellular carcinoma is rare. By chance, a Chinese woman detected a mass in the right upper quadrant of the abdomen. Ultrasonography, computed tomography and magnetic resonance imaging revealed a solid tumor with a central fibrous scar locating at the posterior inferior subsegment of the right hepatic lobe. The tumor was successfully resected and histopathological examination revealed a fibrolamellar hepatocellular carcinoma. Our case shows that fibrolamellar hepatocellular carcinoma may also occur in Chinese as well as in Japanese and Westerners.

Dead on arrival study in Kaohsiung area

Dead on arrival (DOA) is a distressful situation for most medical personnel and families. There are few papers about this topic in Taiwan though most DOAs are unexpected and sudden with or without underlying disease as predisposing factors. From January 1, 1993 to December 31, 1993, 487 DOA patients were sent to 4 large hospitals in the Kaohsiung area (including Kaohsiung City and Kaohsiung County). A retrospective study was carried out through questionnaires. The incidence was 0.22%, the male to female ratio was 2.25, and the largest age group was 61 to 75 years old. Most patients were sent to nearby hospitals and sent by non-medical personnel with non-ambulance motor vehicles. It is hard to define the exact time from arrest to arrival at the hospital, but the initial cardiac rhythm was mostly asystole. Only 1.44% of DOA patients survived and only 9.24% responded to resuscitation. About 31.42% of patients had no evident cause of death, 40.04% non-trauma deaths, and 28.54% trauma deaths. Most of the underlying diseases were treated regularly by medical specialists if past history could be traced. Though our emergency medical service system (EMSS) has been active since 1990, there are still several drawbacks. Public education of cardiopulmonary resuscitation, easy access to EMSS, and appropriate management in hospitals must be stressed. With the improvement of prehospital care, EMSS, and in-hospital care, there will be a decrease in DOA patients.

Hyperoxaluria, nephrolithiasis, nephrocalcinosis and renal failure after massive resection of the small intestine: report of a case

Hyperoxaluria is frequently seen in patients with inflammatory bowel disease, or after resection of the ileum. It is assumed to be responsible for the development of nephrolithiasis, nephrocalcinosis (oxalate nephrosis) and progressive renal impairment in these patients. Steatorrhea may aggravate the severity of hyperoxaluria. A 60-year-old male underwent massive resection of the jejunum and ileum 10 years prior to admission, due to strangulation of the small bowel, with occlusion of the superior mesenteric artery. He remained well except for steatorrhea which developed two-and-a-half years prior to admission, when microhematuria, proteinuria and oxaluria developed progressively. Since that time, the nephrolithiasis, nephrocalcinosis and renal failure have continued to worsen despite therapy with oxalate restriction and oxalate-binding agents. A renal biopsy, performed late in the clinical course, showed severe changes in the renal parenchyma. The decline in renal function proved irreversible. The unusual metabolic consequences of massive resection of the small intestine and their mechanisms are discussed.

Vibrio vulnificus infection in Taiwan: report of 28 cases and review of clinical manifestations and treatment

From May 1985 through July 1990, 28 episodes of Vibrio vulnificus infection in 27 patients were encountered in five major hospitals in Taiwan. The ages of patients ranged from 19 to 76 years; the ratio of male to female patients was 2:1. Eighteen episodes manifested as bacteremia and eight as wound infections alone. One patient each developed gastroenteritis and pneumonia after nearly drowning. Twenty-three patients exhibited skin manifestations. Twenty patients had underlying diseases. All patients were treated with antibiotics, and 14 also underwent some form of surgical treatment (incision and drainage, fasciotomy, debridement, or amputation). Thirteen of the 28 episodes were preceded by precipitating factors; most were due to ingestion of seafood or exposure of abraded skin to salt water. Ten of the 18 septicemic patients died--most within 48 hours of hospitalization. One patient without bacteremia who had a wound infection died. Results of in vitro susceptibility studies suggested that ampicillin or a third-generation cephalosporin would be effective. Susceptibility to aminoglycosides was observed for greater than 90% of isolates. We recommend combined therapy with a third-generation cephalosporin or ampicillin and an aminoglycoside along with appropriate surgical therapy for the treatment of V. vulnificus infection.

A reevaluation of 202 patients after surgical removal of intrahepatic stones: with special emphasis on intrahepatic biliary stricture

Intrahepatic stones are one of the most distressing problems of biliary diseases in the Orient. Surgical treatment, though greatly advanced over the last ten years, still poses a relatively high incidence of residual and recurrent stones. There were 258 patients treated by surgery for intrahepatic stones over a seven-year period at Yuan General Hospital in Taiwan. Among them, 202 patients (78.3%) were adequately followed up. The patients included 82 men and 120 women with a mean age of 40.5 years. There were 111 cases (55.0%) involving only the left side, 37 cases (18.3%) involving only the right side and 54 cases (26.7%) involving both hepatic biliary trees. Hepatic resection, either segmentectomy or lobectomy (37 cases, 18.3%) and extended choledocholithotomy with or without drainage procedures (165 cases, 81.7%) were the surgical procedures carried out in these patients. Treatment failure was defined by the existence of stones, residual or recurrent in the bile ducts. The failure rate of extended choledocholithotomy (32/165, 23.6%) was higher than that of hepatic resection (3/37, 8.1%) although the difference was not statistically significant (p = 0.06). The addition of various drainage procedures did not appear to affect the outcome of extended choledocholithotomy (p = 0.23). A significant number of patients had intrahepatic strictures in the biliary tracts. (62 cases, 30.7%). The overall treatment failure rate in patients with intrahepatic biliary stricture was significantly higher (28/62, 45.2%, p = 0.001) than those without stricture (14/100, 14%). However, hepatic resection was associated with a significantly lower failure rate than other treatment modalities (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)