Healthcare-associated infections (HAIs) occurring in patients treated in an intensive care unit (ICU) are serious complications in the treatment process. Aetiological factors of these infections can have an impact on treatment effects, treatment duration and mortality. The aim of the study was to determine the prevalence and microbiological profile of HAIs in patients hospitalized in an ICU over a span of 10 years. The active surveillance method was used to detect HAIs in adult patients who spent over 48 h in a general ICU ward located in southern Poland between 2007 and 2016. The study was conducted in compliance with the methodology recommended by the Healthcare-associated Infections Surveillance Network (HAI-Net) of the European Centre for Disease Prevention and Control (ECDC). During the 10 years of the study, 1849 patients hospitalized in an ICU for a total of 17,599 days acquired 510 with overall HAIs rates of 27.6% and 29.0% infections per 1000 ICU days. Intubation-associated pneumonia (IAP) posed the greatest risk (15.2 per 1000 ventilator days), followed by CLA-BSI (8.0 per 1000 catheter days) and CA-UTI (3.0 per 1000 catheter days). The most common isolated microorganism was Acinetobacter baumannii (25%) followed by Coagulaase-negativ staphylococci (15%), Escherichia coli (9%), Pseudomonas aeruginosa (8%), Klebsiella pneumoniae (7%), Candida albicans (6%). Acinetobacter baumannii in 87% and were classified as extensive-drug resistant (XDR). In summary, in ICU patients pneumonia and bloodstream infections were the most frequently found. Acinetobacter baumannii strains were most often isolated from clinical materials taken from HAI patients and showed resistance to many groups of antibiotics. A trend of increasing resistance of Acinetobacter baumannii to carbapenems was observed.
We examined retrospectively whether the quantitative morphometric analysis of nuclear shapes in patients with advanced cancer of the larynx could be used as a prognostic factor. In all, specimens were taken from 90 patients treated by surgery in the Department of Otolaryngology, Jagiellonian University, Cracow, Poland, between 1987 and 1988. The follow-up period was no shorter than 5 years. In the group examined there were 59 patients with T3 tumors and 31 with T4 tumors. A neck dissection was performed on one or both sides in each case. Metastases in regional lymph nodes were found in 26 patients. Histologic grading was assessed in all cases. Fourteen parameters of nuclear shape were studied using a computer-assisted system of image analysis. Morphometric data were compared with patients' survival rates. The worse survival rates were found to be linked with a nuclear area (NA) > or = 64.82 micron 2 and its standard deviation (SDNA) > or = 20.10 micron 2, a nuclear perimeter (NP) > or = 32.45 microns and its variation (SDNP) > or = 4.77 microns, nuclear density (ND) > or = 22,215.63 and its variation (SDND) > or = 6930.85 and nuclear roundness (NR) > or = 0.76. By using multivariate Cox regression analysis the SDND, presence of metastases in lymph nodes and low tumor differentiation were found to be independent prognostic factors. No statistically significant correlation was found between the parameters examined, lymph node status and tumor differentiation.
The changes in cell nuclei reflect their activity. Quantitative morphometric analyses of tumor nuclei could be instrumental in providing prognostic information. We studied whether, and if so, which specific nuclear parameters and histoclinical factors in patients with cancer of the larynx could be related to the lymph node metastases. Specimens were taken from 61 patients surgically treated in the Department of Otolaryngology, Jagiellonian University, Cracow, Poland, between 1987 and 1988. The period between the onset of the first symptoms and the actual commencement of the treatment spanned no more than 9 months. The follow-up period was no shorter than 5 years. Histologically confirmed metastases in the regional lymph nodes were found in 16 patients. The histologic grading and tumor front grading was pursued in all cases. Fourteen parameters of the nuclei were studied with the aid of a computer-assisted system of image analysis. The morphometric parameters and the histoclinical factors were analyzed by the chi(2) test and the stepwise logistic regression. It was established that nuclear area > or =66 microm (P = 0.042), perimeter > or =32 microm (P = 0.087), optical density > or =22,500 (P = 0.027), long axis > or =10.15 microm (P = 0.025), short axis > or =7.3 microm (P = 0.003), TFG assessed (> or =15 points) and tumor advancement (T3, T4) were related to more frequent metastases to the lymph nodes. The morphometric parameters of the greatest significance were short axis and optical density. The quantitative morphometric analysis could prove a useful tool in predicting metastases to the lymph nodes.
The mechanism driving accumulation of large numbers of apoptotic and necrotic neutrophils in inflamed lateral neck cysts (LNC), in the absence of infection, remains obscure. The cellular content of cysts obtained from 17 patients was co-cultured with human macrophages. Phagocytosis levels of cyst-derived neutrophils were determined and compared to the uptake of spontaneously apoptotic neutrophils. Simultaneously, the expression of cytokines in macrophages exposed to cyst contents was measured. In comparison to spontaneously apoptotic neutrophils, the phagocytosis of LNC-derived neutrophils by macrophages was inefficient. An inverse correlation between neutrophil content in LNC and their uptake was observed. Macrophages co-cultured with cyst contents responded with variable expression of IL-6, TNF-α and IL-10. The hindered clearance of apoptotic neutrophils in LNC may lead to secondary necrosis of these cells and stimulation of the inflammatory reaction. Together with local production of anti-inflammatory cytokines, this may fuel chronic inflammation in the cysts.
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