It happened to an ICU nurse : an experience on the receiving end of intensive care.

After working in intensive care for thirteen years, I believed I understood some of the experiences of our patients and their families. However, my own experience on the receiving end of intensive care has demonstrated how little I knew and has changed not only my own views and perceptions, but has stimulated changes to practice in one icu.     

Mao's heritage: Medicinal plant knowledge among the Bai in Shaxi,China, at a crossroads between distinct local and common widespread practice

Ethnopharmacological relevance

The study focuses on medicinal plant knowledge among the Bai in the Shaxi Valley, Northwest Yunnan, where no ethnobotanical study has been conducted so far. In an area of high biodiversity, distinct medicinal plant knowledge is documented and the influence of herbals on local knowledge is revealed.

Aim of the study

To analyse current medicinal plant knowledge among the Bai in the context of the influence of the Han culture and mainstream Chinese herbal medicine.

Materials and methods

During fieldwork in summer 2005, semistructured interviews were conducted with 68 stakeholders, and voucher specimens of all plants mentioned were prepared.

Results

A total of 176 medicinal plant species were documented and 1133 use-reports have been collected. Overall, 91.5% of the documented plants are already established as known drugs, and are mentioned in books on medicinal plants in Yunnan and China. Furthermore, the way in which they are used largely coincides. Fourteen plant species represent novel recordings, 9 of which were independently mentioned by three or more informants.

Conclusions

The medicinal plant knowledge of the Bai is strongly influenced by mainstream Chinese herbal medicine and especially by medicinal plant books from the 1970s, which were distributed under Mao Zedong's directive to improve rural health care. We conclude that these herbals have exerted, and continue to exert, a strong influence on the standardisation of plant knowledge among rural populations in China. However, distinct local use of plants also exists, indicating that plant knowledge specific to the Bai people is alive and practiced.     

Retrograde flush following topical cooling is superior to preserve the non-heart-beating donor lung

Objective: The use of non-heart-beating donors (NHBD) has been propagated as an alternative to overcome the scarcity of pulmonary grafts. Formation of microthrombi after circulatory arrest, however, is a major concern for the development of reperfusion injury. We looked at the effect and the best route of pulmonary flush following topical cooling in NHBD. Methods: Non-heparinized pigs were sacrificed by ventricular fibrillation and divided into three groups (n = 6 per group). After 1 h of in situ warm ischaemia and 2.5 h of topical cooling, lungs in group I were retrieved unflushed (NF). In group II, lungs were explanted following an anterograde flush (AF) through the pulmonary artery with 50 ml/kg Perfadex^® (6 °C). Finally, in group III, lungs were retrieved after an identical but retrograde flush (RF) via the left atrium. Flush effluent was sampled at intervals to measure haemoglobin concentration. Performance of the left lung was assessed during 60 min in our ex vivo reperfusion model. Wet-to-dry weight ratio (W/D) of both lungs was calculated as an index of pulmonary oedema. IL-1ß and TNF- protein levels in bronchial lavage fluid from both lungs were compared between groups. Results: Haemoglobin concentration (g/dl) was higher in the first effluent in RF versus AF (3.4 ± 1.1 vs 0.6 ± 0.1; p < 0.05). Pulmonary vascular resistance (dynes × s × cm⁻⁵) was 975 ± 85 RF versus 1567 ± 98 AF and 1576 ± 88 NF at 60 min of reperfusion (p < 0.001). Oxygenation (mmHg) and compliance (ml/cmH₂O) were higher (491 ± 44 vs 472 ± 61 and 430 ± 33 NS, 22 ± 3 vs 19 ± 3 and 14 ± 1 NS, respectively) and plateau airway pressure (cmH₂O) was lower (11 ± 1 vs 13 ± 1 and 13 ± 1 NS) after RF versus AF and NF, respectively. No differences in cytokine levels or in W/D ratios were observed between groups after reperfusion. Histology demonstrated microthrombi more often present after AF and NF compared to RF. Conclusion: Retrograde flush of the lung following topical cooling in the NHBD results in a better washout of residual blood and microthrombi and subsequent reduced pulmonary vascular resistance upon reperfusion.     

Prostatitis versus pelvic pain syndrome: Immunologic studies

The pathogenesis of chronic pelvic pain syndrome continues to be an enigma. The observation of inflammatory cells in urine, ejaculate, prostate fluid, and prostate tissue combined with changed local expressions of cytokines, immunoglobulins, complement, and other inflammatory markers led to the hypothesis of an involvement of the immune system in this clinical entity. This review presents a survey of the immunology-related data available for chronic pelvic pain syndrome and attempts to explain them in the context of causes and consequences.