Objective To investigate molecular characterization of streptococcus pyogenes isolates involved in an outbreak of scarlet fever in China in 2011. Methods Seventy-four 5treptococcol pyogenes involved in an outbreak of ...Objective To investigate molecular characterization of streptococcus pyogenes isolates involved in an outbreak of scarlet fever in China in 2011. Methods Seventy-four 5treptococcol pyogenes involved in an outbreak of scarlet fever were isolated from pediatric patients in the areas with high incidence in China from May to August of 2011. Emm genotyping, pulsed-field gel electrophoresis （PFGE）, superantigen （SAg） genes and antimicrobial susceptibility profiling were analyzed for these isolates. Results A total of 4 different emm types were identified. Emm12 was the most prevalent type which contained four predominating PFGE patterns corresponding to four different virulence and superantigen profiles. Emm12（79.7%） and emml （14.9%） accounted for approximately 94% of all the isolates. The speA gene was all negative in emm12 isolates and positive in emml isolates. All strains were resistant to erythromycin, and 89.4% of them were resistant to erythromycin, tracycline, and clindamycin simultaneously. Conclusion Several highly diversified clones with a high macrolide resistance rate comprise a predominant proportion of circulating strains, though no new emm type was found in this outbreak. The data provide a baseline for further surveillance of scarlet fever, which may contribute to the explanation of the outbreak and development of a GAS vaccine in China.展开更多
Objective:To assess the in vitro antibacterial activity of honey from different geographical location on Gram negative organismes.Methods:Different concentrations(Undiluted honey,10%, 30%,50%and 70%wt/vol) of honey we...Objective:To assess the in vitro antibacterial activity of honey from different geographical location on Gram negative organismes.Methods:Different concentrations(Undiluted honey,10%, 30%,50%and 70%wt/vol) of honey were studied in vitro using Staphylococcus aureus(S.aureus) and Streptococcus pyogenes(S.pyogenes),briefly,two-fold dilutions of honey solutions were tested to determine the minimum inhibitory concentration(MIC) against each type of microorganism,followed by more assays within a narrower dilution range to obtain more precise MIC values.MICs were determined by both visual inspection and spectrophotometric assay at 620 nm.These honey samples were compared with standard antibiotics like ampicillin,penicillin G,amoxicillin,gentamycin,tobramycin,erythromycin and chloramphenicol was determined by the disc diffusion method.Results:The diameter of zone of the inhibition(ZDI) of honey has various concentrations tested for the isolates ranged 0-46 mm for S.aureus,0-44 mm for S.pyogenes.While the MIC(%) ranged 12%-95%,25%-73%respectively.Conclusions:Algeria honey,in-vitro,possess antibacterial activity.展开更多
Streptococcus pyogenes (S. pyogenes) is popular pathogen caused various infectious disease. This study was conducted to find out the recent clinical characteristics of S. pyogenes isolates from vaginal discharge at Ja...Streptococcus pyogenes (S. pyogenes) is popular pathogen caused various infectious disease. This study was conducted to find out the recent clinical characteristics of S. pyogenes isolates from vaginal discharge at Japanese hospital. S. pyogenes was identified by standard laboratory procedure. Antimicrobial susceptibility testing was performed by microdilution assay according to CLSI recommendation. Total 61 S. pyogenes were isolated from vaginal discharge. The major age incidence among 0 - 10 years age group was 14 (23%), among 21 - 30 years age group, 7 (11.5%), among 31 - 40 years age group, 13 (21.3%), among 51 - 60 years age group, 8 (13.1%), and among 61 - 70 years age group, 11 (18%). The numbers of ciprofloxacin and clarithromycin no-susceptible S. pyogenes from 0 - 10, 31 - 40, and 61-70 years age group were higher than those from other groups. The numbers of clindamycin and minocycline no susceptible S. pyogenes from 0 - 10, and 21 - 40 years age group were higher than those from other group. Furthermore, our study revealed that clarithromycin was completely ineffective in 21 - 30 years age group (p S. pyogenes because the trend of infectious disease epidemiology is always changing drastically.展开更多
Streptococcus pyogenesis most popularpathogen caused respiratory tract infection disease. This study was conducted to find out the recent clinical characteristics of Streptococcus pyogenes isolates from respiratory tr...Streptococcus pyogenesis most popularpathogen caused respiratory tract infection disease. This study was conducted to find out the recent clinical characteristics of Streptococcus pyogenes isolates from respiratory tract at Japanese hospital in 2014. Streptococcus pyogenes was identified by standard laboratory procedure. Antimicrobial susceptibility testing was performed by micro dilution assay according to CLSI recommendation. Respiratory tract isolates were defined as isolation from pharynx, nasal discharge, tonsillar, and sputum. Total one hundred sixty-one Streptococcus pyogenes were isolated among which 136 were from respiratory tract and 25 were from non- respiratory tract. Respiratory tract-associated Streptococcus pyogenes was isolated among which 102 were from male and 59 were from female. The age incidence among 0 - 1 years age group was 8, among 1 - 18 years age group, 131 (p < 0.01), among 19 - 64 years age group, 17 (p < 0.01), and in 65-years it was 5. Although we investigated the relationship between season and bacterial isolation, we did not find any significant differences between respiratory tract and no respiratory tract isolation. However, our study revealed that clarithromycin was less antimicrobial effective in respiratory tract disease than in no respiratory tract disease significantly (p < 0.01). Although several antibiotics such as penicillin are still effective against Streptococcus pyogenes, incidence of Streptococcus pyogenes infection is not decreasing worldwide. Our study suggests the need for continuous epidemiological surveillance of Streptococcus pyogenes.展开更多
In Streptococcus pyogenes, we have described the two-component signal transduction sensor and regulatory systems, CovR/S affect the antimicrobial susceptibility including penicillin G before. But the mechanism how two...In Streptococcus pyogenes, we have described the two-component signal transduction sensor and regulatory systems, CovR/S affect the antimicrobial susceptibility including penicillin G before. But the mechanism how two-component sensor protein CovS modulates penicillin G susceptibility has not been elucidated till date. This study aimed to determine how the CovS affected penicillin G susceptibility in Streptococcus pyogenes by northern blot analysis. At first, we investigated the covS mRNA expression under penicillin G induction. We found that the decrease of covS mRNA expression under Penicillin G stimulation. Next we investigated the expression of cell wall synthesis gene, pbp2a and glmM with use of covS knockout mutants from emm1 Streptococcus pyogenes strain 1529. We found that the cell-wall synthesis gene expression of the ?covS mutant strain were lower than that of the wild-type strain. Furthermore the expression of glmM mRNA gene was lower than the expression of pbp2a mRNA gene in the ?covS mutant strain. The covS-complemented strain almost restored the mRNA expression compared to covS mutant strain. The two-component sensor protein CovS affects the susceptibility to penicillin G in Streptococcus pyogenes by modulation of cell-wall synthesis.展开更多
Background: Streptococcus pyogenes (group A streptococcus, GAS) is an important human bacterial pathogen. This organism possesses many virulence factors, Streptococcal pyrogenic exotoxinone of these. Aim: Detection of...Background: Streptococcus pyogenes (group A streptococcus, GAS) is an important human bacterial pathogen. This organism possesses many virulence factors, Streptococcal pyrogenic exotoxinone of these. Aim: Detection of Streptococcal pyrogenic exotoxin SpeA and SpeB in isolated Streptococcus pyogenes. Methods: Tow hundred throat swab samples were collected from children with pharyngitis referred to Pediatric Teaching hospital and ENT hospital Wad medani, Sudan, from January to November 2021. The questionnaire was filled out to collect clinical and demographic data. Throat swabs were collected and processed with the standard microbiological procedure to isolate Streptococcus pyogenes. Antimicrobial susceptibility testing was done on all GAS isolates using the Kirby Bauer disk diffusion method according to clinical laboratory standard institute (CLSI) guidelines. Detection of Spy 1258 gene and Streptococcal pyrogenic exotoxins SpeA and SpeB were done by using Multiplex PCR. Results: Amongst the Tow hundred collected samples fifty-one isolates (25.5%) were identified as S. pyogenes. Antibiotic susceptibility testing showed that all the GAS isolates were sensitive to Azithromycin and Penicillin. Sensitivity to Erythromycin, Gentamicin, Clarithromycin, Amoxicillin and Cephalexin were 88.2%, 86.3%, 45.1%, 41.2%, 13.7%, respectively. SpeA was detected in 17 (33.3%) and SpeB in 48 (94.1%). Conclusion: Streptococcal pyrogenic exotoxin genes SpeA and SpeB were detected in 17 (33.3%) and 48 (94.1%) respectively of Streptococcus pyogenes isolates.展开更多
Streptococcus pyogenes frequently causes purulent infections in humans. Biofilm formation is an important virulence property of S. pyogenes because of decreased susceptibility of bacteria to antibiotic treatment. Biof...Streptococcus pyogenes frequently causes purulent infections in humans. Biofilm formation is an important virulence property of S. pyogenes because of decreased susceptibility of bacteria to antibiotic treatment. Biofilm is composed of various types of matrix including glycocalyx which is an important exocellular matrix material related to bacterial sugar metabolism. A putative antiterminator protein, LicT (Spy0571), is one of the components of the glucose-independent β-gluco-side-specific phosphotransferase system (PTS). Although the PTS, a carbohydrate metabolic system, may play a role in biofilm formation, the relationship between LicT and biofilm formation has not yet been elucidated. Here, we evaluated whether LicT affected biofilm formation in modified chemically defined medium (CDMM) supplemented with glucose or β-glucoside:salicin. We created licT- and licT-complemented mutant strains from S. pyogenes 1529. Although the licT mutant strain tended to have higher growth rate than wild-typestrain in CDMM with glucose, it had a significant lower growth rate than the wild-type strain in CDMM with salicin. In addition, the licT mutant exhibited lower biofilm formation in CDMM containing salicin than the wild-type strain by 96 well plate analysis and confocal laser scanning microscopic analysis. Our results suggest that LicT plays an important role in biofilm formation of S. pyogenes.展开更多
Background: Streptococcus pyogenes secretes NAD+ glycohydrolase (NADase, also known as SPN or Nga). All S. pyogenes strains examined to date possess the gene that encodes SPN (spn), but some strains produce SPN that l...Background: Streptococcus pyogenes secretes NAD+ glycohydrolase (NADase, also known as SPN or Nga). All S. pyogenes strains examined to date possess the gene that encodes SPN (spn), but some strains produce SPN that lacks detectable NADase activity. Although there is much evidence to support that SPN’s NADase activity contributes to virulence, there is very little evidence that NADase-inactive SPN has detectable functions. Results: In order to characterize the NADase-inactive SPN, we firstly attempted to clone the NADase-inactive spn allele in Escherichia coli. Although we obtained recombinants which were shown to have the correct size insert, all had some mutations in the spn allele. Therefore, we attempted to change the mutated nucleotides back to the original nucleotides. While a nucleotide mutagenesis (inverse PCR method) easily changed a target nucleotide of control genes back to the original nucleotides, the mutations of NADase-inactive spn allele were never successfully converted back to the original nucleotides. Finally the mutant spn alleles were sub-cloned into another vector (pLZ12-Km2), which is maintained in both E. coli and S. pyogenes. The resultant plasmids were subjected to nucleotide mutagenesis using inverse PCR;the resultant mutagenized plasmid DNAs were used to transform both E. coli and S. pyogenes strains. We observed successful nucleotide substitutions back to the original spn nucleotide sequence in S. pyogenes transformants, but not in E. coli transformants. Thus, the NADase-inactive spn allele was successfully cloned in S. pyogenes, but not in E. coli. However, we could not find an association with NADase-inactive spn allele and virulence in a mouse infection model. Conclusions: These results suggest that NADase-inactive spn allele has some toxic effect to E. coli, but not S. pyogenes. This effect may due to an as of yet unknown function attributable to NADase-inactive SPN.展开更多
Objective: The objective is to study the antibacterial activity of six medicinal plants against two naso-pharyngeal pathogens and determination of total phenol contents in ethanol extracts of those plants. Methods: Di...Objective: The objective is to study the antibacterial activity of six medicinal plants against two naso-pharyngeal pathogens and determination of total phenol contents in ethanol extracts of those plants. Methods: Different serial concentrations (0.05 g/mL, 0.1 g/mL, 0.2 g/mL, 0.4 g/mL) of ethanolic and acetone extracts of Piper nigrum L. (Piperaceae), Ocimum sanctum Linn., Plectranthus amboinicus L. (Lamiaceae), Ayapana triplinervis M.Vahl. (Asteraceae), Cinnamomum zeylanicum L. (Lauraceae), Allium schoenoprasum Linn. (Liliaceace) were evaluated for the antibacterial activity using disc diffusion method against gram positive Streptococcus pyogenes and gram negative Pseudomonas aeruginosa. The extracts were prepared from different parts of the plants. The total phenol content was estimated using folin-ciocaltau reagent in catechol equivalents. Results: Majority of the extracts had inhibitory effect against the tested bacteria at different concentrations. In ethanol extracts, Plectranthus amboinicus exhibited the maximum zone of inhibition (14 mm) at 0.05 g/mL concentration against Streptococcus pyogenes, and Ocimum sanctum showed highest zone of bacterial inhibition (19 mm) at 0.05 g concentration against Pseudomonas aeruginosa. In acetone extracts, Piper nigrum had the maximum zone of bacterial inhibition (17 mm) in 0.4 g/mL concentration against Streptococcus pyogenes and Cinnamomum zeylanicum and Allium schoenoprasum exhibited the highest zone of bacterial inhibition (0.4 g/mL) against Pseudomonas aeruginosa. The ethanol extract of Plectranthus amboinicus contained the highest amount of phenol (0.8 mg/mL) and Allium schoenoprasum contained the lowest amount (0.62 mg/mL). In acetone, Cinnamomum zeylanicum contained highest phenol content (0.78 mg/mL). Conclusion: All these investigations pave way to the molecular modeling of the lead phyto compounds present in the studied plants, and also in finding out their biochemical action in various metabolic pathways and reactions of infection.展开更多
BACKGROUND Psoriasis is one of the most common chronic systemic diseases,mainly appearing as lesions on the skin and joints,and is associated with a high mortality due to a lack of standard treatment.The exact mechani...BACKGROUND Psoriasis is one of the most common chronic systemic diseases,mainly appearing as lesions on the skin and joints,and is associated with a high mortality due to a lack of standard treatment.The exact mechanism of this disease is not fully understood,but the inflammatory response and dysregulation of the immune system are the most important molecular processes that trigger this disease.The skin microflora is one of the main factors involved in inducing,maturing,and dysregulating the immune system,which may underly the development of psoriasis.AIM To determine the impact of Streptococcus pyogenes(S.pyogenes)infection and susceptibility to psoriasis using available case-control studies.METHODS In this study,we conducted a comprehensive literature search using PubMed,Scopus,Web of science,and Google scholar databases to obtain all available relevant studies on the association between S.pyogenes and psoriasis.We pooled the data using Comprehensive Meta-analysis software to investigate the role of S.pyogenes infection in the development of psoriasis.The probable connection between S.pyogenes and susceptibility to psoriasis was assessed using the odds ratio(OR)with corresponding 95%confidence intervals(CIs).RESULTS Data from 781 cases were evaluated in this study.Our results showed that the rate of infection with S.pyogenes in psoriatic patients and healthy individuals was 33.4%(95%CI:27.8-39.6)and 16.2%(95%CI:9.7-25.9),respectively.S.pyogenes infection significantly increased the risk of psoriasis(OR:6.58;95%CI:3.64-11.87;P=0.001).CONCLUSION S.pyogenes infection can significantly increase the risk of psoriasis.Thus,infection with S.pyogenes is a risk factor for the initiation and development of psoriatic events.展开更多
Background: Streptococcus pyogenes (Group A streptococcus) is an important Gram-positive human pathogen affected the upper respiratory tract, such as the tonsils and pharynx, and is also induces post-infection disease...Background: Streptococcus pyogenes (Group A streptococcus) is an important Gram-positive human pathogen affected the upper respiratory tract, such as the tonsils and pharynx, and is also induces post-infection diseases such as rheumatic fever and glomerulonephritis. This study aim to isolate Streptococcus pyogenes from children with pharyngitis and to evaluate the molecular identification of S. pyogenes compared with conventional methods. Methods: A cross sectional study was conducted on total of 200 throat swab samples which were collected from children with pharyngitis referred to Wad medani Pediatric Teaching Hospital and Wad medani ENT hospital from January to November 2021. Demographic and clinical data were collected by questionnaire. Throat swabs were tested with the standard microbiological techniques to isolated Group A streptococcus (GAS). Antimicrobial susceptibility testing was performed to all GAS isolates using the Kirby Bauer disk diffusion method according to clinical laboratory standard institute (CLSI) guidelines. Additionally, PCR was used to identify Spy 1258 gene of isolated bacteria. Results: From all throat swab samples screened, 51 isolates (25.5%) were identified as GAS. Antibiotic susceptibility testing revealed that all the GAS isolates were sensitive to Penicillin and Azithromycin. Sensitivity to Erythromycin, Gentamicin, Clarithromycin, Amoxicillin and Cephalexin were 88.2%, 86.3%, 45.1%, 41.2%, 13.7%, respectively. Based on PCR identification of Spy 1258 gene the percentage of isolated bacteria was 21%. Conclusion: The rate of isolated Streptococcus pyogenes was 25.5% by conventional methods and 21% by PCR. The bacteria were sensitive to Penicillin and Azithromycin. The Spy 1258 gene was specific for detection of Streptococcus pyogenes.展开更多
Invasive infection caused by Streptococcus pyogenes emm89 strains has been increasing in several countries linked to a recently emergent clade of emm89 strains,designated clade 3.In Japan,the features of emm89 S.pyoge...Invasive infection caused by Streptococcus pyogenes emm89 strains has been increasing in several countries linked to a recently emergent clade of emm89 strains,designated clade 3.In Japan,the features of emm89 S.pyogenes strains,such as clade classification,remains unknown.In this study,we collected emm89 strains isolated from both streptococcal toxic shock syndrome(STSS)(89 STSS isolates)and noninvasive infections(72 non-STSS isolates)in Japan from 2011 to 2019,and conducted wholegenome sequencing and comparative analysis,which resulted in classification of a large majority into clade 3 regardless of disease severity.In addition,invasive disease-associated factors were found among emm89 strains,including mutations of control of virulence sensor,and absence of the hylP1 gene encoding hyaluronidase.These findings provide new insights into genetic features of emm89 strains.展开更多
A21-year-old male farmer was admitted to our hospital n December 28, 2011 with intermittent fever and chills of three months duration. Two weeks previously he had developed chest congestion and shortness of breath. Hi...A21-year-old male farmer was admitted to our hospital n December 28, 2011 with intermittent fever and chills of three months duration. Two weeks previously he had developed chest congestion and shortness of breath. His medical history was unremarkable. On physical examination, his temperature was 37.5℃, pulse 115/ min, and respiratory rate 20/min. His blood pressure was 118/49 mmHg. Cardiac auscultation revealed the presence of a systolic ejection murmur at the left sternal border and diastolic murmur at the right sternal border. A transthoracic echocardiogram performed on December 28 revealed left ventricular hypertrophy, an 8 mm ventricular septum, mild aortic valve stenosis, moderate to severe aortic insufficiency, moderate mitral valve insufficiency, vegetation on the aortic valve （measuring 5 mm×5 mm）, and trace pericardial effusion. The remaining physical examination was unremarkable. The laboratory test results for this patient are shown in the Table 1.展开更多
Background:Pyogenic granuloma(PG)is a benign vascular skin lesion that occurs in children.Although,sclerotherapy is a common treatment for patients with PG,all the previous studies have been case reports or series.At ...Background:Pyogenic granuloma(PG)is a benign vascular skin lesion that occurs in children.Although,sclerotherapy is a common treatment for patients with PG,all the previous studies have been case reports or series.At present,no reports have compared the efficacy of the two different sclerosing agents,polidocanol and bleomycin,in the treatment of PG.Therefore,we aimed to compare the cure rates and adverse reactions associated with these two agents in sclerotherapy for PG in children.Methods:This retrospective analysis included children<18 years of age with PG undergoing cutaneous treatment at our hospital between January 2016 and January 2022.Two sclerosing agents,polidocanol and bleomycin,were topically injected.The efficacy and incidence of adverse reactions were compared between the two groups.Results:A total of 117 children with PG were divided into the polidocanol(n=52)and bleomycin(n=65)groups.Lesions disappeared after one injection in 38 children,two in 11 children,and three in 3 children in the polidocanol group.A similar phenomenon was observed after one injection in 53 children,two injections in 8 children,and three injections in children in the bleomycin group.The single-injection cure rate was not significantly different between the two groups(P>0.05).The rate of adverse reactions was significantly different between the two groups(P<0.05).No severe complications occurred,and no recurrences were detected during the 6-12 months of postoperative follow-up period.Conclusion:This study showed that both polidocanol and bleomycin are safe and effective sclerosing agents for treatment of PG in children.The incidence of adverse reactions to polidocanol was lower than that to bleomycin.We recommend sclerotherapy with polidocanol as a first-line treatment for PG,as it is suitable for application in hospitals at various levels.展开更多
BACKGROUND Effective management of liver abscess depends on timely drainage,which is influenced by the liquefaction degree.Identifying predictive factors is crucial for guiding clinical decisions.AIM To investigate th...BACKGROUND Effective management of liver abscess depends on timely drainage,which is influenced by the liquefaction degree.Identifying predictive factors is crucial for guiding clinical decisions.AIM To investigate the predictive factors of liver abscess liquefaction and develop a predictive model to guide optimal timing of percutaneous drainage.METHODS This retrospective study included 110 patients with pyogenic liver abscesses who underwent percutaneous catheter drainage.Patients were divided into a poor liquefaction group(n=28)and a well liquefaction group(n=82)based on the ratio of postoperative 24-hour drainage volume to abscess volume,using a cutoff value of 0.3.Clinical characteristics,laboratory indicators,and computed tomography imaging features were compared.A predictive model was constructed using logistic regression and evaluated using receiver operating characteristic curves and five-fold cross-validation.RESULTS Independent predictive factors for good liquefaction included the absence of diabetes[odds ratio(OR)=0.339,P=0.044],absence of pneumonia(OR=0.218,P=0.013),left-lobe abscess location(OR=4.293,P=0.041),cystic features(OR=5.104,P=0.025),and elevated preoperative serum alanine aminotransferase(ALT)levels(OR=1.013,P=0.041).The logistic regression model based on these factors demonstrated an area under the curve of 0.814,with a sensitivity of 90.24%and specificity of 67.86%.Five-fold cross-validation yielded an average accuracy of 83.61%and a kappa coefficient of 0.5209.CONCLUSION Pneumonia,diabetes,abscess location,abscess composition,and preoperative serum ALT levels are significant predictors of liver abscess liquefaction.The model can guide clinical decision-making.展开更多
BACKGROUND Pyogenic liver abscess(PLA)is a prevalent liver infection with gradual onset and severe symptoms,including fever,abdominal pain,jaundice,and vomiting.Complications like sepsis or toxic shock can also occur....BACKGROUND Pyogenic liver abscess(PLA)is a prevalent liver infection with gradual onset and severe symptoms,including fever,abdominal pain,jaundice,and vomiting.Complications like sepsis or toxic shock can also occur.AIM To investigate the clinical value of early ultrasound-guided percutaneous drainage(PCD)in PLA patients,specifically those with non-liquefied abscesses,and evaluate the feasibility of early intervention.METHODS This retrospective analysis included 143 patients with PLA who were admitted to the Department of General Surgery between January 2018 and March 2023.All patients underwent ultrasound-guided PCD.Based on the liquefaction status of the abscess,patients were divided into two groups:Liquefied group and nonliquefied group.Clinical outcomes,including puncture success rate,puncture duration,length of hospital stay,time to fever resolution,abscess shrinkage rate,and complication rates,were compared between the two groups.RESULTS The puncture success rate for all patients was 99.3%,with a postoperative complication rate of 5.59%,and no intraoperative deaths occurred.Compared to the liquefied group,the non-liquefied group had significantly shorter hospital stays(3.9±1.8 days vs 5.1±2.7 days),faster fever resolution(2.4±1.1 days vs 4.9±2.2 days),and quicker abscess shrinkage(>50%)(4.7±1.5 days vs 8.6±3.3 days)(P<0.05).There were no significant differences in puncture success rates or complication rates between the two groups.CONCLUSION Early ultrasound-guided PCD can be safely and effectively performed in PLA,even when the abscess is not fully liquefied or is non-liquefied,supporting the clinical feasibility of early intervention.展开更多
BACKGROUND In recent years,there has been a significant increase in pyogenic liver abscesses(PLAs)caused by multidrug-resistant(MDR)Gram-negative bacteria(GNB),pre-dominantly Klebsiella pneumoniae and Escherichia coli...BACKGROUND In recent years,there has been a significant increase in pyogenic liver abscesses(PLAs)caused by multidrug-resistant(MDR)Gram-negative bacteria(GNB),pre-dominantly Klebsiella pneumoniae and Escherichia coli.AIM To clarify the clinical characteristics and risk factors associated with MDR-GNB-related PLAs,develop a predictive nomogram for personalized risk assessment,and enhance the timeliness of empirical antibiotic selection.METHODS Based on the antibiotic susceptibility profiles,enrolled patients were divided into two groups:A MDR group com-prising 105 individuals and a non-resistant group comprising 163 individuals.A systematic collection of demo-graphic characteristics,laboratory findings,and prognostic indicators was performed.A predictive nomogram was established using multivariate stepwise regression modeling.Model effectiveness was evaluated by examining its discriminative capability,calibration accuracy,and clinical utility through receiver operating characteristic curves with corresponding area under the curve values,calibration graphs,and decision curve analysis.Continuous data were analyzed using the independent-sample t-test if they met normality criteria;otherwise,the Wilcoxon rank-sum test was adopted.For categorical data,Fisher’s exact test was chosen when the expected count in any cell was below five;in all other instances,theχ2 test was applied.RESULTS This retrospective study analyzed clinical and laboratory data from 268 patients diagnosed with Gram-negative PLA at a major healthcare facility from January 2019 to February 2025.Among these,105 cases(39%)were asso-ciated with MDR-GNB,primarily Klebsiella pneumoniae(43%)and Escherichia coli(42%).Mixed infections were rare,accounting for only 3%of cases.Multivariate regression revealed five independent predictors of MDR-GNB liver abscesses:Age≥60 years,diabetes,presence of a malignant tumor,lower C-reactive protein levels,and prolonged prothrombin time.These variables were integrated into a nomogram to facilitate individualized risk assessment.CONCLUSION The results imply that being aged over 60,diabetes,malignant tumor,lower C-reactive protein levels,and higher prothrombin time levels can accurately forecast MDR-GNB infections in PLAs,highlighting the importance of early screening to enable more targeted antibiotic treatments.However,as this was a single-center study without external validation,the generalizability of our model remains limited.Future multicenter,multi-ethnic prospective studies are needed to validate and extend these findings.展开更多
The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic ducts.The disease is more prevalent in Asia,mainly owing to socioeconomic ...The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic ducts.The disease is more prevalent in Asia,mainly owing to socioeconomic and dietary factors,as well as the prevalence of biliary parasites.In the last century,owing to migration,its global incidence has increased.The main pathophysiological mechanisms involve cholangitis,bile infection and biliary strictures,creating a self-sustaining cycle that perpetuates the disease,frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of“recurrent pyogenic cholangitis”.Furthermore,long-standing hepatolithiasis is a known risk factor for development of intrahepatic cholangiocarcinoma.Various classifications have aimed at providing useful insight of clinically relevant aspects and guidance for treatment.The management of symptomatic patients and those with complications can be complex,and relies upon a multidisciplinary team of hepatologists,endoscopists,interventional radiologists and hepatobiliary surgeons,with the main goal being to offer relief from the clinical presentations and prevent the development of more serious complications.This comprehensive review provides insight on various aspects of hepatolithiasis,with a focus on epidemiology,new evidence on pathophysiology,most important clinical aspects,different classification systems and contemporary management.展开更多
BACKGROUND:Xuebijing(XBJ)can alleviate the inflammatory response,improve organ function,and shorten the intensive care unit(ICU)stay in patients with pyogenic liver abscess(PLA)complicated with sepsis,but the molecula...BACKGROUND:Xuebijing(XBJ)can alleviate the inflammatory response,improve organ function,and shorten the intensive care unit(ICU)stay in patients with pyogenic liver abscess(PLA)complicated with sepsis,but the molecular mechanisms have not been elucidated.This study aimed to explore the molecular mechanism of XBJ in treating PLA complicated with sepsis using a network pharmacology approach.METHODS:The active ingredients and targets of XBJ were retrieved from the ETCM database.Potential targets related to PLA and sepsis were retrieved from the GeneCards,PharmGKB,DisGeNet,Online Mendelian Inheritance in Man(OMIM),Therapeutic Targets Database(TTD),and DrugBank databases.The targets of PLA complicated with sepsis were mapped to the targets of XBJ to identify potential treatment targets.Protein-protein interaction networks were analyzed using the STRING database.Potential treatment targets were imported into the Metascape platform for Gene Ontology(GO)functional enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses.Molecular docking was performed to validate the interactions between active ingredients and core targets.RESULTS:XBJ was found to have 54 potential treatment targets for PLA complicated with sepsis.Interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor(TNF)were identifi ed as core targets.KEGG enrichment analysis revealed important pathways,including the interleukin-17(IL-17)signaling pathway,the TNF signaling pathway,the nuclear factor-kappa B(NF-κB)signaling pathway,and the Toll-like receptor(TLR)signaling pathway.Molecular docking experiments indicated stable binding between XBJ active ingredients and core targets.CONCLUSION:XBJ may exert therapeutic eff ects on PLA complicated with sepsis by modulating signaling pathways,such as the IL-17,TNF,NF-κB,and TLR pathways,and targeting IL-1β,IL-6,and TNF.展开更多
OBJECTIVE:To elucidate the molecular mechanisms governing the effect of Tounongsan decoction(透脓散方,TNS)on the pyogenic liver abscess.METHODS:Based on oral bioavailability and druglikeness,the main active components...OBJECTIVE:To elucidate the molecular mechanisms governing the effect of Tounongsan decoction(透脓散方,TNS)on the pyogenic liver abscess.METHODS:Based on oral bioavailability and druglikeness,the main active components of TNS were screened using the Traditional Chinese Medicine Systems Pharmacology platform.The Gene Card and Uni Prot databases were used to establish a database of pyogenic liver abscess targets.The interactive network map of drug-ingredients-target-disease was constructed using Cytoscape software(Version 3.7.2).A proteinprotein interaction network was constructed using the STRING database,and the related protein interaction relationships were analyzed.biological process of gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses were performed for the core targets.Finally,a clinical trial was performed to verify the reliability of the network pharmacology.RESULTS:Forty active components of TNS decoction were obtained,and 61 potential targets and 11 proteins were identified.Pathways involved in the treatment of pyogenic liver abscess include the phosphatidylinositide 3-kinases-protein kinase B(PI3K-AKT),advanced glycation end products-receptor for advanced glycation end products(AGE-RAGE),and tumor necrosis factor(TNF)signaling pathways.The results of network pharmacology analysis combined with clinical trials validated that TNS decoction could alleviate the inflammatory response of pyogenic liver abscesses by decreasing interleukin 6(IL-6)levels.CONCLUSIONS:TNS decoction has the characteristics of being multi-system,multi-component,and multi-target.Active ingredients in TNS,such as quercetin,kaempferol,fisetin,andβ-sitosterol,have strong potential to be candidate drugs for treating pyogenic liver abscesses.The possible mechanism of TSN decoction includes regulating immune and inflammatory responses and reducing IL-6 production to control inflammatory development.展开更多
基金supported by a fund for China Mega-Project for Infectious Disease(2011ZX10004-001)
文摘Objective To investigate molecular characterization of streptococcus pyogenes isolates involved in an outbreak of scarlet fever in China in 2011. Methods Seventy-four 5treptococcol pyogenes involved in an outbreak of scarlet fever were isolated from pediatric patients in the areas with high incidence in China from May to August of 2011. Emm genotyping, pulsed-field gel electrophoresis （PFGE）, superantigen （SAg） genes and antimicrobial susceptibility profiling were analyzed for these isolates. Results A total of 4 different emm types were identified. Emm12 was the most prevalent type which contained four predominating PFGE patterns corresponding to four different virulence and superantigen profiles. Emm12（79.7%） and emml （14.9%） accounted for approximately 94% of all the isolates. The speA gene was all negative in emm12 isolates and positive in emml isolates. All strains were resistant to erythromycin, and 89.4% of them were resistant to erythromycin, tracycline, and clindamycin simultaneously. Conclusion Several highly diversified clones with a high macrolide resistance rate comprise a predominant proportion of circulating strains, though no new emm type was found in this outbreak. The data provide a baseline for further surveillance of scarlet fever, which may contribute to the explanation of the outbreak and development of a GAS vaccine in China.
文摘Objective:To assess the in vitro antibacterial activity of honey from different geographical location on Gram negative organismes.Methods:Different concentrations(Undiluted honey,10%, 30%,50%and 70%wt/vol) of honey were studied in vitro using Staphylococcus aureus(S.aureus) and Streptococcus pyogenes(S.pyogenes),briefly,two-fold dilutions of honey solutions were tested to determine the minimum inhibitory concentration(MIC) against each type of microorganism,followed by more assays within a narrower dilution range to obtain more precise MIC values.MICs were determined by both visual inspection and spectrophotometric assay at 620 nm.These honey samples were compared with standard antibiotics like ampicillin,penicillin G,amoxicillin,gentamycin,tobramycin,erythromycin and chloramphenicol was determined by the disc diffusion method.Results:The diameter of zone of the inhibition(ZDI) of honey has various concentrations tested for the isolates ranged 0-46 mm for S.aureus,0-44 mm for S.pyogenes.While the MIC(%) ranged 12%-95%,25%-73%respectively.Conclusions:Algeria honey,in-vitro,possess antibacterial activity.
文摘Streptococcus pyogenes (S. pyogenes) is popular pathogen caused various infectious disease. This study was conducted to find out the recent clinical characteristics of S. pyogenes isolates from vaginal discharge at Japanese hospital. S. pyogenes was identified by standard laboratory procedure. Antimicrobial susceptibility testing was performed by microdilution assay according to CLSI recommendation. Total 61 S. pyogenes were isolated from vaginal discharge. The major age incidence among 0 - 10 years age group was 14 (23%), among 21 - 30 years age group, 7 (11.5%), among 31 - 40 years age group, 13 (21.3%), among 51 - 60 years age group, 8 (13.1%), and among 61 - 70 years age group, 11 (18%). The numbers of ciprofloxacin and clarithromycin no-susceptible S. pyogenes from 0 - 10, 31 - 40, and 61-70 years age group were higher than those from other groups. The numbers of clindamycin and minocycline no susceptible S. pyogenes from 0 - 10, and 21 - 40 years age group were higher than those from other group. Furthermore, our study revealed that clarithromycin was completely ineffective in 21 - 30 years age group (p S. pyogenes because the trend of infectious disease epidemiology is always changing drastically.
文摘Streptococcus pyogenesis most popularpathogen caused respiratory tract infection disease. This study was conducted to find out the recent clinical characteristics of Streptococcus pyogenes isolates from respiratory tract at Japanese hospital in 2014. Streptococcus pyogenes was identified by standard laboratory procedure. Antimicrobial susceptibility testing was performed by micro dilution assay according to CLSI recommendation. Respiratory tract isolates were defined as isolation from pharynx, nasal discharge, tonsillar, and sputum. Total one hundred sixty-one Streptococcus pyogenes were isolated among which 136 were from respiratory tract and 25 were from non- respiratory tract. Respiratory tract-associated Streptococcus pyogenes was isolated among which 102 were from male and 59 were from female. The age incidence among 0 - 1 years age group was 8, among 1 - 18 years age group, 131 (p < 0.01), among 19 - 64 years age group, 17 (p < 0.01), and in 65-years it was 5. Although we investigated the relationship between season and bacterial isolation, we did not find any significant differences between respiratory tract and no respiratory tract isolation. However, our study revealed that clarithromycin was less antimicrobial effective in respiratory tract disease than in no respiratory tract disease significantly (p < 0.01). Although several antibiotics such as penicillin are still effective against Streptococcus pyogenes, incidence of Streptococcus pyogenes infection is not decreasing worldwide. Our study suggests the need for continuous epidemiological surveillance of Streptococcus pyogenes.
文摘In Streptococcus pyogenes, we have described the two-component signal transduction sensor and regulatory systems, CovR/S affect the antimicrobial susceptibility including penicillin G before. But the mechanism how two-component sensor protein CovS modulates penicillin G susceptibility has not been elucidated till date. This study aimed to determine how the CovS affected penicillin G susceptibility in Streptococcus pyogenes by northern blot analysis. At first, we investigated the covS mRNA expression under penicillin G induction. We found that the decrease of covS mRNA expression under Penicillin G stimulation. Next we investigated the expression of cell wall synthesis gene, pbp2a and glmM with use of covS knockout mutants from emm1 Streptococcus pyogenes strain 1529. We found that the cell-wall synthesis gene expression of the ?covS mutant strain were lower than that of the wild-type strain. Furthermore the expression of glmM mRNA gene was lower than the expression of pbp2a mRNA gene in the ?covS mutant strain. The covS-complemented strain almost restored the mRNA expression compared to covS mutant strain. The two-component sensor protein CovS affects the susceptibility to penicillin G in Streptococcus pyogenes by modulation of cell-wall synthesis.
文摘Background: Streptococcus pyogenes (group A streptococcus, GAS) is an important human bacterial pathogen. This organism possesses many virulence factors, Streptococcal pyrogenic exotoxinone of these. Aim: Detection of Streptococcal pyrogenic exotoxin SpeA and SpeB in isolated Streptococcus pyogenes. Methods: Tow hundred throat swab samples were collected from children with pharyngitis referred to Pediatric Teaching hospital and ENT hospital Wad medani, Sudan, from January to November 2021. The questionnaire was filled out to collect clinical and demographic data. Throat swabs were collected and processed with the standard microbiological procedure to isolate Streptococcus pyogenes. Antimicrobial susceptibility testing was done on all GAS isolates using the Kirby Bauer disk diffusion method according to clinical laboratory standard institute (CLSI) guidelines. Detection of Spy 1258 gene and Streptococcal pyrogenic exotoxins SpeA and SpeB were done by using Multiplex PCR. Results: Amongst the Tow hundred collected samples fifty-one isolates (25.5%) were identified as S. pyogenes. Antibiotic susceptibility testing showed that all the GAS isolates were sensitive to Azithromycin and Penicillin. Sensitivity to Erythromycin, Gentamicin, Clarithromycin, Amoxicillin and Cephalexin were 88.2%, 86.3%, 45.1%, 41.2%, 13.7%, respectively. SpeA was detected in 17 (33.3%) and SpeB in 48 (94.1%). Conclusion: Streptococcal pyrogenic exotoxin genes SpeA and SpeB were detected in 17 (33.3%) and 48 (94.1%) respectively of Streptococcus pyogenes isolates.
文摘Streptococcus pyogenes frequently causes purulent infections in humans. Biofilm formation is an important virulence property of S. pyogenes because of decreased susceptibility of bacteria to antibiotic treatment. Biofilm is composed of various types of matrix including glycocalyx which is an important exocellular matrix material related to bacterial sugar metabolism. A putative antiterminator protein, LicT (Spy0571), is one of the components of the glucose-independent β-gluco-side-specific phosphotransferase system (PTS). Although the PTS, a carbohydrate metabolic system, may play a role in biofilm formation, the relationship between LicT and biofilm formation has not yet been elucidated. Here, we evaluated whether LicT affected biofilm formation in modified chemically defined medium (CDMM) supplemented with glucose or β-glucoside:salicin. We created licT- and licT-complemented mutant strains from S. pyogenes 1529. Although the licT mutant strain tended to have higher growth rate than wild-typestrain in CDMM with glucose, it had a significant lower growth rate than the wild-type strain in CDMM with salicin. In addition, the licT mutant exhibited lower biofilm formation in CDMM containing salicin than the wild-type strain by 96 well plate analysis and confocal laser scanning microscopic analysis. Our results suggest that LicT plays an important role in biofilm formation of S. pyogenes.
文摘Background: Streptococcus pyogenes secretes NAD+ glycohydrolase (NADase, also known as SPN or Nga). All S. pyogenes strains examined to date possess the gene that encodes SPN (spn), but some strains produce SPN that lacks detectable NADase activity. Although there is much evidence to support that SPN’s NADase activity contributes to virulence, there is very little evidence that NADase-inactive SPN has detectable functions. Results: In order to characterize the NADase-inactive SPN, we firstly attempted to clone the NADase-inactive spn allele in Escherichia coli. Although we obtained recombinants which were shown to have the correct size insert, all had some mutations in the spn allele. Therefore, we attempted to change the mutated nucleotides back to the original nucleotides. While a nucleotide mutagenesis (inverse PCR method) easily changed a target nucleotide of control genes back to the original nucleotides, the mutations of NADase-inactive spn allele were never successfully converted back to the original nucleotides. Finally the mutant spn alleles were sub-cloned into another vector (pLZ12-Km2), which is maintained in both E. coli and S. pyogenes. The resultant plasmids were subjected to nucleotide mutagenesis using inverse PCR;the resultant mutagenized plasmid DNAs were used to transform both E. coli and S. pyogenes strains. We observed successful nucleotide substitutions back to the original spn nucleotide sequence in S. pyogenes transformants, but not in E. coli transformants. Thus, the NADase-inactive spn allele was successfully cloned in S. pyogenes, but not in E. coli. However, we could not find an association with NADase-inactive spn allele and virulence in a mouse infection model. Conclusions: These results suggest that NADase-inactive spn allele has some toxic effect to E. coli, but not S. pyogenes. This effect may due to an as of yet unknown function attributable to NADase-inactive SPN.
文摘Objective: The objective is to study the antibacterial activity of six medicinal plants against two naso-pharyngeal pathogens and determination of total phenol contents in ethanol extracts of those plants. Methods: Different serial concentrations (0.05 g/mL, 0.1 g/mL, 0.2 g/mL, 0.4 g/mL) of ethanolic and acetone extracts of Piper nigrum L. (Piperaceae), Ocimum sanctum Linn., Plectranthus amboinicus L. (Lamiaceae), Ayapana triplinervis M.Vahl. (Asteraceae), Cinnamomum zeylanicum L. (Lauraceae), Allium schoenoprasum Linn. (Liliaceace) were evaluated for the antibacterial activity using disc diffusion method against gram positive Streptococcus pyogenes and gram negative Pseudomonas aeruginosa. The extracts were prepared from different parts of the plants. The total phenol content was estimated using folin-ciocaltau reagent in catechol equivalents. Results: Majority of the extracts had inhibitory effect against the tested bacteria at different concentrations. In ethanol extracts, Plectranthus amboinicus exhibited the maximum zone of inhibition (14 mm) at 0.05 g/mL concentration against Streptococcus pyogenes, and Ocimum sanctum showed highest zone of bacterial inhibition (19 mm) at 0.05 g concentration against Pseudomonas aeruginosa. In acetone extracts, Piper nigrum had the maximum zone of bacterial inhibition (17 mm) in 0.4 g/mL concentration against Streptococcus pyogenes and Cinnamomum zeylanicum and Allium schoenoprasum exhibited the highest zone of bacterial inhibition (0.4 g/mL) against Pseudomonas aeruginosa. The ethanol extract of Plectranthus amboinicus contained the highest amount of phenol (0.8 mg/mL) and Allium schoenoprasum contained the lowest amount (0.62 mg/mL). In acetone, Cinnamomum zeylanicum contained highest phenol content (0.78 mg/mL). Conclusion: All these investigations pave way to the molecular modeling of the lead phyto compounds present in the studied plants, and also in finding out their biochemical action in various metabolic pathways and reactions of infection.
文摘BACKGROUND Psoriasis is one of the most common chronic systemic diseases,mainly appearing as lesions on the skin and joints,and is associated with a high mortality due to a lack of standard treatment.The exact mechanism of this disease is not fully understood,but the inflammatory response and dysregulation of the immune system are the most important molecular processes that trigger this disease.The skin microflora is one of the main factors involved in inducing,maturing,and dysregulating the immune system,which may underly the development of psoriasis.AIM To determine the impact of Streptococcus pyogenes(S.pyogenes)infection and susceptibility to psoriasis using available case-control studies.METHODS In this study,we conducted a comprehensive literature search using PubMed,Scopus,Web of science,and Google scholar databases to obtain all available relevant studies on the association between S.pyogenes and psoriasis.We pooled the data using Comprehensive Meta-analysis software to investigate the role of S.pyogenes infection in the development of psoriasis.The probable connection between S.pyogenes and susceptibility to psoriasis was assessed using the odds ratio(OR)with corresponding 95%confidence intervals(CIs).RESULTS Data from 781 cases were evaluated in this study.Our results showed that the rate of infection with S.pyogenes in psoriatic patients and healthy individuals was 33.4%(95%CI:27.8-39.6)and 16.2%(95%CI:9.7-25.9),respectively.S.pyogenes infection significantly increased the risk of psoriasis(OR:6.58;95%CI:3.64-11.87;P=0.001).CONCLUSION S.pyogenes infection can significantly increase the risk of psoriasis.Thus,infection with S.pyogenes is a risk factor for the initiation and development of psoriatic events.
文摘Background: Streptococcus pyogenes (Group A streptococcus) is an important Gram-positive human pathogen affected the upper respiratory tract, such as the tonsils and pharynx, and is also induces post-infection diseases such as rheumatic fever and glomerulonephritis. This study aim to isolate Streptococcus pyogenes from children with pharyngitis and to evaluate the molecular identification of S. pyogenes compared with conventional methods. Methods: A cross sectional study was conducted on total of 200 throat swab samples which were collected from children with pharyngitis referred to Wad medani Pediatric Teaching Hospital and Wad medani ENT hospital from January to November 2021. Demographic and clinical data were collected by questionnaire. Throat swabs were tested with the standard microbiological techniques to isolated Group A streptococcus (GAS). Antimicrobial susceptibility testing was performed to all GAS isolates using the Kirby Bauer disk diffusion method according to clinical laboratory standard institute (CLSI) guidelines. Additionally, PCR was used to identify Spy 1258 gene of isolated bacteria. Results: From all throat swab samples screened, 51 isolates (25.5%) were identified as GAS. Antibiotic susceptibility testing revealed that all the GAS isolates were sensitive to Penicillin and Azithromycin. Sensitivity to Erythromycin, Gentamicin, Clarithromycin, Amoxicillin and Cephalexin were 88.2%, 86.3%, 45.1%, 41.2%, 13.7%, respectively. Based on PCR identification of Spy 1258 gene the percentage of isolated bacteria was 21%. Conclusion: The rate of isolated Streptococcus pyogenes was 25.5% by conventional methods and 21% by PCR. The bacteria were sensitive to Penicillin and Azithromycin. The Spy 1258 gene was specific for detection of Streptococcus pyogenes.
基金AMED(Grant numbers:JP19fk0108044,JP19fm0208007)Japanese Society for the Promotion of Science(JSPS)KAKENHI(Grant numbers:19H03825,20K18474)。
文摘Invasive infection caused by Streptococcus pyogenes emm89 strains has been increasing in several countries linked to a recently emergent clade of emm89 strains,designated clade 3.In Japan,the features of emm89 S.pyogenes strains,such as clade classification,remains unknown.In this study,we collected emm89 strains isolated from both streptococcal toxic shock syndrome(STSS)(89 STSS isolates)and noninvasive infections(72 non-STSS isolates)in Japan from 2011 to 2019,and conducted wholegenome sequencing and comparative analysis,which resulted in classification of a large majority into clade 3 regardless of disease severity.In addition,invasive disease-associated factors were found among emm89 strains,including mutations of control of virulence sensor,and absence of the hylP1 gene encoding hyaluronidase.These findings provide new insights into genetic features of emm89 strains.
文摘A21-year-old male farmer was admitted to our hospital n December 28, 2011 with intermittent fever and chills of three months duration. Two weeks previously he had developed chest congestion and shortness of breath. His medical history was unremarkable. On physical examination, his temperature was 37.5℃, pulse 115/ min, and respiratory rate 20/min. His blood pressure was 118/49 mmHg. Cardiac auscultation revealed the presence of a systolic ejection murmur at the left sternal border and diastolic murmur at the right sternal border. A transthoracic echocardiogram performed on December 28 revealed left ventricular hypertrophy, an 8 mm ventricular septum, mild aortic valve stenosis, moderate to severe aortic insufficiency, moderate mitral valve insufficiency, vegetation on the aortic valve （measuring 5 mm×5 mm）, and trace pericardial effusion. The remaining physical examination was unremarkable. The laboratory test results for this patient are shown in the Table 1.
文摘Background:Pyogenic granuloma(PG)is a benign vascular skin lesion that occurs in children.Although,sclerotherapy is a common treatment for patients with PG,all the previous studies have been case reports or series.At present,no reports have compared the efficacy of the two different sclerosing agents,polidocanol and bleomycin,in the treatment of PG.Therefore,we aimed to compare the cure rates and adverse reactions associated with these two agents in sclerotherapy for PG in children.Methods:This retrospective analysis included children<18 years of age with PG undergoing cutaneous treatment at our hospital between January 2016 and January 2022.Two sclerosing agents,polidocanol and bleomycin,were topically injected.The efficacy and incidence of adverse reactions were compared between the two groups.Results:A total of 117 children with PG were divided into the polidocanol(n=52)and bleomycin(n=65)groups.Lesions disappeared after one injection in 38 children,two in 11 children,and three in 3 children in the polidocanol group.A similar phenomenon was observed after one injection in 53 children,two injections in 8 children,and three injections in children in the bleomycin group.The single-injection cure rate was not significantly different between the two groups(P>0.05).The rate of adverse reactions was significantly different between the two groups(P<0.05).No severe complications occurred,and no recurrences were detected during the 6-12 months of postoperative follow-up period.Conclusion:This study showed that both polidocanol and bleomycin are safe and effective sclerosing agents for treatment of PG in children.The incidence of adverse reactions to polidocanol was lower than that to bleomycin.We recommend sclerotherapy with polidocanol as a first-line treatment for PG,as it is suitable for application in hospitals at various levels.
文摘BACKGROUND Effective management of liver abscess depends on timely drainage,which is influenced by the liquefaction degree.Identifying predictive factors is crucial for guiding clinical decisions.AIM To investigate the predictive factors of liver abscess liquefaction and develop a predictive model to guide optimal timing of percutaneous drainage.METHODS This retrospective study included 110 patients with pyogenic liver abscesses who underwent percutaneous catheter drainage.Patients were divided into a poor liquefaction group(n=28)and a well liquefaction group(n=82)based on the ratio of postoperative 24-hour drainage volume to abscess volume,using a cutoff value of 0.3.Clinical characteristics,laboratory indicators,and computed tomography imaging features were compared.A predictive model was constructed using logistic regression and evaluated using receiver operating characteristic curves and five-fold cross-validation.RESULTS Independent predictive factors for good liquefaction included the absence of diabetes[odds ratio(OR)=0.339,P=0.044],absence of pneumonia(OR=0.218,P=0.013),left-lobe abscess location(OR=4.293,P=0.041),cystic features(OR=5.104,P=0.025),and elevated preoperative serum alanine aminotransferase(ALT)levels(OR=1.013,P=0.041).The logistic regression model based on these factors demonstrated an area under the curve of 0.814,with a sensitivity of 90.24%and specificity of 67.86%.Five-fold cross-validation yielded an average accuracy of 83.61%and a kappa coefficient of 0.5209.CONCLUSION Pneumonia,diabetes,abscess location,abscess composition,and preoperative serum ALT levels are significant predictors of liver abscess liquefaction.The model can guide clinical decision-making.
文摘BACKGROUND Pyogenic liver abscess(PLA)is a prevalent liver infection with gradual onset and severe symptoms,including fever,abdominal pain,jaundice,and vomiting.Complications like sepsis or toxic shock can also occur.AIM To investigate the clinical value of early ultrasound-guided percutaneous drainage(PCD)in PLA patients,specifically those with non-liquefied abscesses,and evaluate the feasibility of early intervention.METHODS This retrospective analysis included 143 patients with PLA who were admitted to the Department of General Surgery between January 2018 and March 2023.All patients underwent ultrasound-guided PCD.Based on the liquefaction status of the abscess,patients were divided into two groups:Liquefied group and nonliquefied group.Clinical outcomes,including puncture success rate,puncture duration,length of hospital stay,time to fever resolution,abscess shrinkage rate,and complication rates,were compared between the two groups.RESULTS The puncture success rate for all patients was 99.3%,with a postoperative complication rate of 5.59%,and no intraoperative deaths occurred.Compared to the liquefied group,the non-liquefied group had significantly shorter hospital stays(3.9±1.8 days vs 5.1±2.7 days),faster fever resolution(2.4±1.1 days vs 4.9±2.2 days),and quicker abscess shrinkage(>50%)(4.7±1.5 days vs 8.6±3.3 days)(P<0.05).There were no significant differences in puncture success rates or complication rates between the two groups.CONCLUSION Early ultrasound-guided PCD can be safely and effectively performed in PLA,even when the abscess is not fully liquefied or is non-liquefied,supporting the clinical feasibility of early intervention.
文摘BACKGROUND In recent years,there has been a significant increase in pyogenic liver abscesses(PLAs)caused by multidrug-resistant(MDR)Gram-negative bacteria(GNB),pre-dominantly Klebsiella pneumoniae and Escherichia coli.AIM To clarify the clinical characteristics and risk factors associated with MDR-GNB-related PLAs,develop a predictive nomogram for personalized risk assessment,and enhance the timeliness of empirical antibiotic selection.METHODS Based on the antibiotic susceptibility profiles,enrolled patients were divided into two groups:A MDR group com-prising 105 individuals and a non-resistant group comprising 163 individuals.A systematic collection of demo-graphic characteristics,laboratory findings,and prognostic indicators was performed.A predictive nomogram was established using multivariate stepwise regression modeling.Model effectiveness was evaluated by examining its discriminative capability,calibration accuracy,and clinical utility through receiver operating characteristic curves with corresponding area under the curve values,calibration graphs,and decision curve analysis.Continuous data were analyzed using the independent-sample t-test if they met normality criteria;otherwise,the Wilcoxon rank-sum test was adopted.For categorical data,Fisher’s exact test was chosen when the expected count in any cell was below five;in all other instances,theχ2 test was applied.RESULTS This retrospective study analyzed clinical and laboratory data from 268 patients diagnosed with Gram-negative PLA at a major healthcare facility from January 2019 to February 2025.Among these,105 cases(39%)were asso-ciated with MDR-GNB,primarily Klebsiella pneumoniae(43%)and Escherichia coli(42%).Mixed infections were rare,accounting for only 3%of cases.Multivariate regression revealed five independent predictors of MDR-GNB liver abscesses:Age≥60 years,diabetes,presence of a malignant tumor,lower C-reactive protein levels,and prolonged prothrombin time.These variables were integrated into a nomogram to facilitate individualized risk assessment.CONCLUSION The results imply that being aged over 60,diabetes,malignant tumor,lower C-reactive protein levels,and higher prothrombin time levels can accurately forecast MDR-GNB infections in PLAs,highlighting the importance of early screening to enable more targeted antibiotic treatments.However,as this was a single-center study without external validation,the generalizability of our model remains limited.Future multicenter,multi-ethnic prospective studies are needed to validate and extend these findings.
文摘The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic ducts.The disease is more prevalent in Asia,mainly owing to socioeconomic and dietary factors,as well as the prevalence of biliary parasites.In the last century,owing to migration,its global incidence has increased.The main pathophysiological mechanisms involve cholangitis,bile infection and biliary strictures,creating a self-sustaining cycle that perpetuates the disease,frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of“recurrent pyogenic cholangitis”.Furthermore,long-standing hepatolithiasis is a known risk factor for development of intrahepatic cholangiocarcinoma.Various classifications have aimed at providing useful insight of clinically relevant aspects and guidance for treatment.The management of symptomatic patients and those with complications can be complex,and relies upon a multidisciplinary team of hepatologists,endoscopists,interventional radiologists and hepatobiliary surgeons,with the main goal being to offer relief from the clinical presentations and prevent the development of more serious complications.This comprehensive review provides insight on various aspects of hepatolithiasis,with a focus on epidemiology,new evidence on pathophysiology,most important clinical aspects,different classification systems and contemporary management.
基金supported by Hunan Province Key Research and Development Program(2020SKC2004).
文摘BACKGROUND:Xuebijing(XBJ)can alleviate the inflammatory response,improve organ function,and shorten the intensive care unit(ICU)stay in patients with pyogenic liver abscess(PLA)complicated with sepsis,but the molecular mechanisms have not been elucidated.This study aimed to explore the molecular mechanism of XBJ in treating PLA complicated with sepsis using a network pharmacology approach.METHODS:The active ingredients and targets of XBJ were retrieved from the ETCM database.Potential targets related to PLA and sepsis were retrieved from the GeneCards,PharmGKB,DisGeNet,Online Mendelian Inheritance in Man(OMIM),Therapeutic Targets Database(TTD),and DrugBank databases.The targets of PLA complicated with sepsis were mapped to the targets of XBJ to identify potential treatment targets.Protein-protein interaction networks were analyzed using the STRING database.Potential treatment targets were imported into the Metascape platform for Gene Ontology(GO)functional enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses.Molecular docking was performed to validate the interactions between active ingredients and core targets.RESULTS:XBJ was found to have 54 potential treatment targets for PLA complicated with sepsis.Interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor(TNF)were identifi ed as core targets.KEGG enrichment analysis revealed important pathways,including the interleukin-17(IL-17)signaling pathway,the TNF signaling pathway,the nuclear factor-kappa B(NF-κB)signaling pathway,and the Toll-like receptor(TLR)signaling pathway.Molecular docking experiments indicated stable binding between XBJ active ingredients and core targets.CONCLUSION:XBJ may exert therapeutic eff ects on PLA complicated with sepsis by modulating signaling pathways,such as the IL-17,TNF,NF-κB,and TLR pathways,and targeting IL-1β,IL-6,and TNF.
基金Supported by Jiangsu Provincial Administration of Traditional Chinese Medicine:Clinical Study of TNS Combined with Puncture Catheter Drainage in the Treatment of PLA(YB201814)Natural Fund of Nanjing University of Chinese Medicine:Study on Promoting Glycolysis and Regulating Immune Microenvironment in Gastric Cancer MAIT Cells(ZR2021016)Natural Science Foudation of Jiangsu Province:the Dext Ran/Sore Spirit Complex Hydrogel was created in a Multicenter Study in the Treatment of Chronic Refractory Sores(BE2022819)。
文摘OBJECTIVE:To elucidate the molecular mechanisms governing the effect of Tounongsan decoction(透脓散方,TNS)on the pyogenic liver abscess.METHODS:Based on oral bioavailability and druglikeness,the main active components of TNS were screened using the Traditional Chinese Medicine Systems Pharmacology platform.The Gene Card and Uni Prot databases were used to establish a database of pyogenic liver abscess targets.The interactive network map of drug-ingredients-target-disease was constructed using Cytoscape software(Version 3.7.2).A proteinprotein interaction network was constructed using the STRING database,and the related protein interaction relationships were analyzed.biological process of gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses were performed for the core targets.Finally,a clinical trial was performed to verify the reliability of the network pharmacology.RESULTS:Forty active components of TNS decoction were obtained,and 61 potential targets and 11 proteins were identified.Pathways involved in the treatment of pyogenic liver abscess include the phosphatidylinositide 3-kinases-protein kinase B(PI3K-AKT),advanced glycation end products-receptor for advanced glycation end products(AGE-RAGE),and tumor necrosis factor(TNF)signaling pathways.The results of network pharmacology analysis combined with clinical trials validated that TNS decoction could alleviate the inflammatory response of pyogenic liver abscesses by decreasing interleukin 6(IL-6)levels.CONCLUSIONS:TNS decoction has the characteristics of being multi-system,multi-component,and multi-target.Active ingredients in TNS,such as quercetin,kaempferol,fisetin,andβ-sitosterol,have strong potential to be candidate drugs for treating pyogenic liver abscesses.The possible mechanism of TSN decoction includes regulating immune and inflammatory responses and reducing IL-6 production to control inflammatory development.
