SummaryMap is an enteropathogenic Escherichia coli (EPEC) protein that is translocated into eukaryotic cells by a type III secretion system. Although not required for the induction of attaching and effacing (A/E) lesion formation characteristic of EPEC infection, translocated Map is suggested to disrupt mitochondrial membrane potential, which may impact upon subsequent functions of the organelle such as control of cell death. Before secretion, many effector proteins are maintained in the bacterial cytosol by association with a specific chaperone. In EPEC, chaperones have been identified for the effector proteins translocated intimin receptor (Tir) and EspF, and for the translocator proteins EspB and EspD. In this study, we present evidence that the Tir-specific chaperone, CesT, also performs a chaperone function for Map. Using a combination of biochemical approaches, we demonstrate specific interaction between CesT and Map. Similar to other chaperone-effector pairings, binding is apparent at the amino-terminus of Map and is indicated to proceed by a similar mechanism to CesT:Tir interaction. Map secretion from a cesT mutant strain (SE884) is shown to be reduced and, importantly, its translocation from this strain after infection of HEp-2 cells is almost totally abrogated. Although other chaperones are reported to have a bivalent binding specificity, CesT is the first member of its family that chaperones more than one protein for translocation.
We aimed to demonstrate that surgery can be tailored to address a patient's unique medical and surgical issues. Our patient presented with severe symptomatic cholelithiasis and massive splenomegaly; she had additionally planned for pregnancy shortly after surgery. A combined laparoscopic cholecystectomy and splenectomy was proposed to avoid large abdominal incisions immediately prior to the planned pregnancy. No procedural complications were observed, and the patient successfully carried a healthy pregnancy to term within 1 year of surgery. We have provided supplemental data from the National Surgical Quality Improvement Program (NSQIP) database that compares the complication rates between laparoscopic splenectomy (LS) and open splenectomy (OS) for thrombocytopenia. These data support the safety and efficacy of LS.We discovered two related studies on splenectomy for thrombocytopenia from the literature. A NSQIP study published in 2013 compared patients who had undergone LS and OS and were cared for prior to 2010. A metaanalysis published in 2021 summarized the data from smaller reported series. 1,2 This case report and NSQIP study compared the expected complications and patient outcomes for LS and OS in this era, where LS is the standard approach. This study demonstrates the value of a tailored surgical approach. In addition, our supplemental NSQIP data reinforce the safety of LS. The patient's excellent clinical outcome demonstrates that combined laparoscopic cholecystectomy and splenectomy is safe, even in patients planning for pregnancy shortly after surgery. This case report has been reported in line with the SCARE Criteria. 3 | Case historyWe report the 5-year follow-up of a 28-year-old Caucasian woman who underwent combined laparoscopic cholecystectomy and splenectomy for severe symptomatic
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