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Chen JW, Hsu CC, Su CC, Hsu RB, Chiu YL, Chia JS, Jung CJ. Transient bacteremia promotes catheter-related central venous thrombosis through neutrophil extracellular traps. Thromb Haemost 2021; 122:1198-1208. [PMID: 34768303 DOI: 10.1055/a-1695-8612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Formation of intravenous catheter-related thrombosis leads to central venous stenosis in patients requiring renal replacement therapy or chemotherapy infusion, yet the triggering or mechanisms remain unclear, especially in patients without symptoms of infection. In this study, we found that neutrophil extracellular traps (NETs) could be detected in the fibrin sheaths from dialysis patients without clinical manifestations of infection. Confocal microscopy revealed bacteria imbedded in NETs in the fibrin sheaths. Thirty-nine of 50 (78%) fibrin sheath specimens contained bacteria detectable by 16S ribosomal RNA genome typing with a predominance of Staphylococcus aureus (69%). In rat models, transient bacteremia of S. aureus induced NETs in enlarged fibrin sheaths, and treatment with DNase I alone significantly reduced both NET and fibrin sheath formation surrounding the catheter. Therefore, transient bacteremia could be a silent trigger that induces NET-related immunothrombosis enhancing catheter-related central venous stenosis.
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Affiliation(s)
- Jeng-Wei Chen
- National Taiwan University Hospital, Department of Surgery, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate institute of clinical medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chih-Chieh Hsu
- School of Dentistry, Graduate Institute of Oral Biology, National Taiwan University, Taipei, Taiwan
| | - Chien-Chia Su
- National Taiwan University Hospital, Department of ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate institute of clinical medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ron-Bin Hsu
- National Taiwan University Hospital, Department of Surgery, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Ling Chiu
- Graduate institute of clinical medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Medicine, Division of Nephrology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,College of Informatics, Department of Computer Science and Engineering, Graduate Program in Biomedical Informatics, Yuan Ze University, Chung-Li, Taiwan
| | - Jean-San Chia
- Graduate institute of clinical medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan.,School of Dentistry, Graduate Institute of Clinical Dentistry, National Taiwan University, Taipei, Taiwan
| | - Chiau-Jing Jung
- College of Medicine, School of Medicine, Department of Microbiology and Immunology, Taipei Medical University, Taipei, Taiwan
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Cellini M, Bergadano A, Crocoli A, Badino C, Carraro F, Sidro L, Botta D, Pancaldi A, Rossetti F, Pitta F, Cesaro S. Guidelines of the Italian Association of Pediatric Hematology and Oncology for the management of the central venous access devices in pediatric patients with onco-hematological disease. J Vasc Access 2020; 23:3-17. [PMID: 33169648 DOI: 10.1177/1129729820969309] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Central venous accesses devices (CVADs) have a fundamental importance for diagnostic and therapeutic purposes in pediatric onco-hematological patients. The treatment of pediatric onco-hematological diseases is complex and requires the use of integrated multimodal therapies. Long-lasting and safe central venous access is therefore a cornerstone for any successful treatment. METHODS The aim of this work is to define pediatric guidelines about the management of CVADs in onco-hematology. A panel of experts belonging to the working groups on Infections and Supportive Therapy, Surgery and Nursing of the Italian Pediatric Hematology Oncology Association (AIEOP) revised the scientific literature systematically, scored the level of evidence and prepared these guidelines. The content of the following guidelines was approved by the Scientific Board of AIEOP. RESULTS AND CONCLUSIONS Important innovations have been developed recently in the field of CVADs, leading to new insertion methods, new materials and new strategy in the overall management of the device, especially in the adult population. These guidelines recommend how to apply these innovations in the pediatric population, and are directed to all physicians, nurses and health personnel active in the daily management of CVADs. Their aim is to update the knowledge on CVAD and improve the standard of care in pediatric patients with malignancies.
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Affiliation(s)
- Monica Cellini
- Pediatric Hematology Oncology Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena, Emilia-Romagna, Italy
| | - Anna Bergadano
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Piemonte, Italy
| | - Alessandro Crocoli
- Surgical Oncology Unit, Department of Surgery, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Clara Badino
- Pediatric Hematology and Oncology Unit, Giannina Gaslini's Children Hospital, Genova, Liguria, Italy
| | - Francesca Carraro
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Piemonte, Italy
| | - Luca Sidro
- Anesthesiology and Intensive Care Unit, AORN Santobono Pausillipon, Napoli, Campania, Italy
| | - Debora Botta
- Pediatric Unit Ospedale Santissima Annunziata di Savigliano, Savigliano, Piemonte, Italy
| | - Alessia Pancaldi
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Rossetti
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria Meyer, Firenze, Italy
| | - Federica Pitta
- Pediatric Hematology and Oncology Unit AORN Santobono Pausillipon, Napoli, Campania, Italy
| | - Simone Cesaro
- Pediatric Hematology and Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Veneto, Italy
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Kim D, Moon SB. Letter to the Editor. J Pediatr Surg 2019; 54:210. [PMID: 30449606 DOI: 10.1016/j.jpedsurg.2018.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 09/03/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Duhyeong Kim
- Department of Health Management and Policy, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Suk Bae Moon
- Department of Surgery, Kangwon National University School of Medicine, Chuncheon, South Korea.
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Han SB, Kim D, Moon SB. Letter to the Editor. J Pediatr Surg 2018; 53:1080. [PMID: 29499846 DOI: 10.1016/j.jpedsurg.2018.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/07/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Sang Beom Han
- Department of Ophthalmology, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Duhyeong Kim
- Department of Health Management and Policy, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Suk Bae Moon
- Department of Surgery, Kangwon National University School of Medicine, Chuncheon, 24341, South Korea.
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Li Z, Wang W, Wang X, Jiang L, Wang F, Liu Q. Sustained-released mixture of vascular endothelial growth factor 165 and fibrin glue strengthens healing of ileal anastomoses in a rabbit model with intraperitoneal infection. Ann Surg Treat Res 2017; 93:159-165. [PMID: 28932732 PMCID: PMC5597540 DOI: 10.4174/astr.2017.93.3.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/02/2017] [Accepted: 03/13/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose To investigate the effects of a sustained-released mixture of vascular endothelial growth factor 165 (VEGF165) and fibrin glue (FG) local administration on postoperative rabbit ileal anastomoses. Methods One hundred twenty-eight male and female New Zealand white rabbits underwent intraperitoneal infection subsequent ileal anastomosis surgery were divided randomly into 4 groups, including 32 animals in each, applied with saline solution, FG, rhVEGF165 and a mixture of rhVEGF165 with FG (VEGF + FG) on the anastomoses, respectively. The incidences of anastomotic leakage were observed. Histopathological examination for inflammatory infiltration, fibroblast proliferation, and capillary vascular proliferation were performed. Then, bursting pressure and hydroxyproline concentrations were assessed in anastomoses sits on postoperative days 3, 5, 7, and 14. Results Rabbits in VEGF + FG group had the lowest incidence of leakage (P < 0.05). Histological evaluations revealed that granulation tissue was formed on days 5 after anastomosis; fibroblast proliferation and capillary vascular proliferation were significantly increased on days 7 and 14 in VEGF + FG group. Furthermore, there was a statistically significant difference in the mean bursting pressures between VEGF + FG group and other groups on days 7 and 14 (P < 0.05), and rabbits in VEGF + FG group exhibited a higher concentration than VEGF group (P < 0.05) and FG group (P < 0.05) on day 14. Conclusion Administration of VEGF165 mixed with FG to ileal anastomosis accelerates wound healing and enhances the anastomosis by increased angiogenesis.
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Affiliation(s)
- Zhanwu Li
- Department of Emergency Surgery, Affiliated Zhongshan Hospital of Dalian University, Liaoning, China
| | - Wenjun Wang
- Department of Emergency Surgery, Affiliated Zhongshan Hospital of Dalian University, Liaoning, China
| | - Xiaozhou Wang
- Department of Emergency Surgery, Affiliated Zhongshan Hospital of Dalian University, Liaoning, China
| | - Lei Jiang
- Department of Emergency Surgery, Affiliated Zhongshan Hospital of Dalian University, Liaoning, China
| | - Fengyi Wang
- Department of Emergency Surgery, Affiliated Zhongshan Hospital of Dalian University, Liaoning, China
| | - Qiang Liu
- Department of Emergency Surgery, Affiliated Zhongshan Hospital of Dalian University, Liaoning, China
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