Improved outcomes for index cholecystectomy for acute cholecystitis following a dedicated emergency surgery and trauma service (ESAT).
Journal: European journal of trauma and emergency surgery : official publication of the European Trauma Society
Februar/5/2020
Early laparoscopic cholecystectomy (ELC) has shown to reduce length of stay and improve patients’ satisfaction as compared to delayed laparoscopic cholecystectomy (DLC). However, logistics and manpower limitations often preclude ELC.A retrospective study was conducted in a single institute to compare outcomes of AC before (August 2013-2014) and after (August 2017-2018) establishment of emergency surgery and trauma (ESAT).There were 82 patients in pre-ESAT period and 172 patients in ESAT period. Mean age was 52.3 ± 11.6 and 55.7 ± 13.8 years, respectively, p = 0.369. There were more patients with moderate-severe grading of cholecystitis based on Tokyo Guidelines (TG 18) in ESAT 143/172 (83.1%) as compared to pre-ESAT 65/82 (79.3%), p = 0.042. Index cholecystectomy was performed in 145/172 (84.3%) of patients in the ESAT vs 34/82 (41.5%) of patients in the pre-ESAT period (p = 0.001). Time interval between booking to surgery was 180 ± 56 min in ESAT vs 197 ± 98 min in pre-ESAT, p = 0.014. Operative duration was shorter in ESAT 121 ± 38.5 min vs 139 ± 53.4, in pre-ESAT period, p = 0.030. Conversion rates were lower in ESAT (4/172, 2.3%) vs (9/72, 11%) in pre-ESAT, p = 0.003. Length of stay was shorter in ESAT (DLC 1.89 ± 1.6 and ELC ± 2.9 days) as compared to pre-ESAT (DLC 4.55 ± 2.2 and ELC 5.03 ± 2.6 days), p = 0.001. 30-day readmissions were lower in ESAT (3/172, 1.7%) vs pre-ESAT (8/72, 9.8%).The ESAT model provided more early laparoscopic cholecystectomies with improved efficiency and clinical outcomes.
Si Goh; Clement Chia; Jing Ong; John Quek; Woan Lim; Kok Tan; Jerry Goo
EspM Is a Conserved Transcription Factor That Regulates Gene Expression in Response to the ESX-1 System.
Journal: mBio
Februar/5/2020
Pathogenic mycobacteria encounter multiple environments during macrophage infection. Temporally, the bacteria are engulfed into the phagosome, lyse the phagosomal membrane, and interact with the cytosol before spreading to another cell. Virulence factors secreted by the mycobacterial ESX-1 (ESAT-6-system-1) secretion system mediate the essential transition from the phagosome to the cytosol. It was recently discovered that the ESX-1 system also regulates mycobacterial gene expression in Mycobacterium marinum (R. E. Bosserman, T. T. Nguyen, K. G. Sanchez, A. E. Chirakos, et al., Proc Natl Acad Sci U S A 114:E10772-E10781, 2017, https://doi.org/10.1073/pnas.1710167114), a nontuberculous mycobacterial pathogen, and in the human-pathogenic species M. tuberculosis (A. M. Abdallah, E. M. Weerdenburg, Q. Guan, R. Ummels, et al., PLoS One 14:e0211003, 2019, https://doi.org/10.1371/journal.pone.0211003). It is not known how the ESX-1 system regulates gene expression. Here, we identify the first transcription factor required for the ESX-1-dependent transcriptional response in pathogenic mycobacteria. We demonstrate that the gene divergently transcribed from the whiB6 gene and adjacent to the ESX-1 locus in mycobacterial pathogens encodes a conserved transcription factor (MMAR_5438, Rv3863, now espM). We prove that EspM from both M. marinum and M. tuberculosis directly and specifically binds the whiB6-espM intergenic region. We show that EspM is required for ESX-1-dependent repression of whiB6 expression and for the regulation of ESX-1-associated gene expression. Finally, we demonstrate that EspM functions to fine-tune ESX-1 activity in M. marinum Taking the data together, this report extends the esx-1 locus, defines a conserved regulator of the ESX-1 virulence pathway, and begins to elucidate how the ESX-1 system regulates gene expression.IMPORTANCE Mycobacterial pathogens use the ESX-1 system to transport protein substrates that mediate essential interactions with the host during infection. We previously demonstrated that in addition to transporting proteins, the ESX-1 secretion system regulates gene expression. Here, we identify a conserved transcription factor that regulates gene expression in response to the ESX-1 system. We demonstrate that this transcription factor is functionally conserved in M. marinum, a pathogen of ectothermic animals; M. tuberculosis, the human-pathogenic species that causes tuberculosis; and M. smegmatis, a nonpathogenic mycobacterial species. These findings provide the first mechanistic insight into how the ESX-1 system elicits a transcriptional response, a function of this protein transport system that was previously unknown.
Kevin Sanchez; Micah Ferrell; Alexandra Chirakos; Kathleen Nicholson; Robert Abramovitch; Matthew Champion; Patricia Champion
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ORF019042 | 1.0 ug DNA: Ask for price | |
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Description: Recombinant |
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ESAT-6-like protein EsxB Antibodyfrom Abbexa |
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20-abx110662 | [ 100 ug: Ask for price ] [ 1 mg: Ask for price ] [ 200 ug: Ask for price ] [ 20 ug: Ask for price ] [ 50 ug: Ask for price ] | |
ESAT-6-like protein EsxB Antibody (HRP)from Abbexa |
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20-abx109228 | [ 100 ug: Ask for price ] [ 1 mg: Ask for price ] [ 200 ug: Ask for price ] [ 20 ug: Ask for price ] [ 50 ug: Ask for price ] | |
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20-abx107810 | [ 100 ug: Ask for price ] [ 1 mg: Ask for price ] [ 200 ug: Ask for price ] [ 20 ug: Ask for price ] [ 50 ug: Ask for price ] | |
ESAT-6-Like Protein EsxB (esxB) Antibodyfrom Abbexa |
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abx110662-100l | 100 µl: 162.50 EUR | |
ESAT-6-Like Protein EsxH (esxH) Antibodyfrom Abbexa |
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abx140580-100g | 100 µg: 350.00 EUR | |
ESAT-6-like protein EsxB Antibody (Biotin)from Abbexa |
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20-abx106398 | [ 100 ug: Ask for price ] [ 1 mg: Ask for price ] [ 200 ug: Ask for price ] [ 20 ug: Ask for price ] [ 50 ug: Ask for price ] | |
ESAT 3'UTR GFP Stable Cell Linefrom ABM |
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TU057053 | 1.0 ml: 2799.60 EUR | |
ESAT sgRNA CRISPR Lentivector set (Human)from ABM |
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abx107810-50g | 50 µg: 250.00 EUR | |
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TU007053 | 1.0 ml: 2799.60 EUR | |
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Description: Recombinant Mycobacterium tuberculosis ESAT-6-like protein esxB(esxB) expressed in Yeast |
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Mycobacterium tuberculosis ESAT-6-like protein EsxB (esxB)from Cusabio |
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Description: Recombinant Mycobacterium tuberculosis ESAT-6-like protein EsxB(esxB) expressed in E.coli |
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Mycobacterium tuberculosis ESAT-6-like protein EsxH (esxH)from Cusabio |
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Description: Recombinant Mycobacterium tuberculosis ESAT-6-like protein EsxH(esxH),partial expressed in E.coli |
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Recombinant Mycobacteroides abscessus ESAT-6-like protein (esxT)from Cusabio |
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CSB-EP4811GTR | 11119 mg: Ask for price | |
ESAT-6 Secretion System Extracellular Protein A (ESXA) Antibodyfrom Abbexa |
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20-abx300131 | [ 100 ug: Ask for price ] [ 1 mg: Ask for price ] [ 200 ug: Ask for price ] [ 20 ug: Ask for price ] [ 50 ug: Ask for price ] | |
ESAT-6 Secretion System Extracellular Protein A (esxA) Antibodyfrom Abbexa |
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abx300131-100g | 100 µg: 362.50 EUR | |
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ESAT-6, with the modified C-terminus (His6-Tag) Proteinfrom Abbexa |
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ESAT Lentiviral Vector (Human) (CMV) (pLenti-GIII-CMV)from ABM |
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LV724667 | 1.0 ug DNA: Ask for price | |
ESAT Lentiviral Vector (Human) (UbC) (pLenti-GIII-UbC)from ABM |
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3420-2AST-P4-1 | 1 plate: 1380.75 EUR | |
Monoclonal Anti-Mycobacterium tuberculosis antigen (6kDa/ESAT-6) IgGfrom Alpha Diagnostics |
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MTB061-M | 100 ul: 578.40 EUR | |
ESAT Lentiviral Vector (Human) (EF1a) (pLenti-GIII-EF1a)from ABM |
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LV724672 | 1.0 ug DNA: Ask for price | |
Recombinant Mycobacterium tuberculosis ESAT-6-like protein esxB (esxB)from Cusabio |
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CSB-YP363658MVZ | 6400 mg: Ask for price | |
Recombinant Mycobacterium tuberculosis ESAT-6-like protein esxB(esxB)from SAB |
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AP72990 | each: Ask for price | |
Recombinant Mycobacterium tuberculosis ESAT-6-like protein EsxB(esxB)from SAB |
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AP76578 | 1mg: 2826.00 EUR | |
Recombinant Mycobacterium tuberculosis ESAT-6-like protein EsxB (esxB)from Cusabio |
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CSB-EP363658MVZ | 3423 mg: Ask for price | |
Recombinant Mycobacterium tuberculosis ESAT-6-like protein EsxB (esxB)from Cusabio |
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CSB-EP363658MVZb2 | 3424 mg: Ask for price | |
Recombinant Mycobacterium tuberculosis ESAT-6-like protein esxB (esxB)from Biomatik Corporation |
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RPC25281-100ug | 100ug: 817.30 EUR | |
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20-abx300380 | [ 100 ug: Ask for price ] [ 1 mg: Ask for price ] [ 200 ug: Ask for price ] [ 20 ug: Ask for price ] [ 50 ug: Ask for price ] | |
Recombinant Mycobacterium Tuberculosis ESAT-6 Protein (aa 1-99) [His]from Creative Biolabs |
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VAng-Lsx06137-100g | 100 µg: 717.60 EUR | |
Description: Mycobacterium Tuberculosis (H37Rv) ESAT-6, recombinant protein from E. coli. |
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Description: Mycobacterium Tuberculosis (H37Rv) ESAT-6, recombinant protein from E. coli. |
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abx300380-100g | 100 µg: 362.50 EUR | |
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ESAT-6 Secretion System Extracellular Protein A (esxA) Antibody (Biotin)from Abbexa |
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abx300382-50g | 50 µg: 250.00 EUR | |
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AB-23071-P | 100ug: 196.80 EUR | |
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Description: Recombinant Staphylococcus aureus ESAT-6 secretion system extracellular protein A(esxA) expressed in E.coli |
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Recombinant purified (E. coli) Mycobacterium tuberculosis antigen (6kDa/ESAT-6)from Alpha Diagnostics |
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MTB06-R | 100 ug: 927.60 EUR | |
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CSB-EP363659MVZ | 3425 mg: Ask for price | |
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3ES6-RSB14 | 1 mg: Ask for price | |
Mycobacterium tuberculosis (ESAT) mouse monoclonal antibody, clone RSB34from Origene Technologies GmbH |
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Recombinant Mycobacteroides abscessus subsp. abscessus ESAT-6-like protein (esxT)from Cusabio |
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FSP-0102-P4-1 | 1 plate: 1569.75 EUR | |
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K0696005 | 3 x 1.0 ug: 451.20 EUR | |
Recombinant purified M. tuberculosis antigen (6kDa/ESAT-6) control for Westernfrom Alpha Diagnostics |
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