Shock after blast wave injury is caused by a vagally mediated reflex.

OBJECTIVE: Bomb blast survivors occasionally suffer from profound shock and hypoxemia without signs of external injury. We hypothesize that a vagally mediated reflex such as the pulmonary defensive reflex is the cause of shock from blast wave injury. This study was a prospectively randomized, controlled animal study. METHODS: By using a previously described model of blast wave injury, we randomized rats to one of four groups: control, blast-only, bilateral cervical vagotomy plus atropine 200 microg/kg i.p. only, and bilateral cervical vagotomy plus atropine 200 microg/kg i.p. before blast injury. Cardiopulmonary parameters were recorded for 90 minutes after the blast or until death. RESULTS: Bradycardia, hypotension, and absence of compensatory peripheral vasoconstriction, typically seen in animals subjected to a blast pressure injury, were prevented by bilateral cervical vagotomy and intraperitoneal injection of atropine methyl-bromide. Hypoxia and lung injury were not statistically significant between the blasted groups, suggesting equivalent injury. CONCLUSION: Our data implicate a vagally mediated reflex such as the pulmonary defensive reflex as the cause of shock seen immediately after a blast pressure wave injury.     

A convenient one-pot synthesis of N-substituted amidoximes and their application toward 1,2,4-oxadiazol-5-ones

The first direct one-pot approach for the synthesis of N-substituted amidoximes from secondary amides or the intermediate amides has been developed. Through the Ph₃P–I₂-mediated dehydrative condensation, a variety of N-aryl and N-alkyl amidoximes (R¹(C NOH)NHR², where R¹ or R² = aryl, alkyl, or benzyl) were readily afforded under mild conditions and short reaction times. The synthetic application of the obtained amidoximes has also been demonstrated through the formation of 1,2,4-oxadiazolones via base-mediated carbonylative cyclization with 1,1′-carbonyldiimidazole.

Ph₃P–I₂ mediated one-pot synthesis of N-substituted amidoximes via imidoyl iodide was developed. The synthesis of 1,2,4-oxadiazol-5-ones was also demonstrated.     

Surgeon-directed ultrasound for trauma is a predictor of intra-abdominal injury in children

This study investigated the efficacy of surgeon-directed focused assessment with sonography for trauma (FAST) in conjunction with physical exam (PEx) as a predictor of intra-abdominal injury in children. Injured children (ages < or = 17) presenting to a level I trauma center with abdominal trauma were evaluated in the emergency department (ED) by the trauma team of surgical attendings and residents. PEx and FAST were performed immediately upon arrival to the ED and results compared to CT, the standard exam for presence of intra-abdominal injury. Data was collected prospectively from July 1, 2000, until April 30, 2002. One hundred and twenty injured children underwent evaluation of abdominal trauma with PEx, FAST, and abdominal CT. Two patients had false-negative CT scans. Bayesian analysis was applied to the results of the remaining 118 patients. FAST compared with CT findings revealed sensitivity 70 per cent, specificity 100 per cent, positive predictive value 100 per cent, and negative predictive value 92 per cent. FAST results were combined with PEx findings such that either suggestive of intra-abdominal injury was regarded as a "positive exam." Sensitivity was 100 per cent, specificity 74 per cent, positive predictive value 53 per cent, and negative predictive value 100 per cent. Surgeon-directed FAST with consideration of PEx is a predictor of intra-abdominal injury in children.     

Expression of oestrogen receptor α in the endometrium of porcine reproductive and respiratory syndrome virus-infected gilts

Porcine reproductive and respiratory syndrome (PRRS) virus infection often lead to infertility in gilts and sows. Nevertheless, the impact of PRRS virus on the endometrial function has not been fully elucidated. The present study aimed to determine the effect of PRRS virus infection on the expression of oestrogen receptor (ER) α in the endometrium of gilts. Uterine tissues from 54 gilts were classified into two groups according to PRRS virus detection using immunohistochemistry (26 positive and 28 negative samples). The reproductive status was classified as prepubertal, luteal and follicular phases. The expression of ERα in the epithelium, subepithelium and glandular tissue layers of the endometrium was determined by immunohistochemistry. ERα immunostaining was detected in 22.2, 13.5 and 33.6 % of the cells in the epithelial, subepithelial and glandular tissue layers, respectively. The ERα immunostaining in the glandular layer of the endometrium in follicular-phase gilts was higher than that in prepubertal gilts (46.1 and 15.2 %, respectively, P?=?0.011). The ERα immunostaining in the glandular layer of the endometrium was positively correlated with body weight (r?=?0.138, P?=?0.020) and average daily gain (r?=?0.169, P?=?0.005) of the gilts. The ERα immunostaining in all tissue layers of the endometrium with PRRS virus detection did not differ significantly compared to that without PRRS virus (P?>?0.05). However, in prepubertal gilts, the ERα immunostaining cells in the epithelial layer of PRRS virus negative (9.5 %) tended to be lower than PRRS virus positive (26.3 %, P?=?0.196) uterine tissues. This tendency indicates some impact of PRRS virus infection on the ERα expression in prepubertal gilts.     

The impact of intra-abdominal hypertension on gene expression in the kidney

BACKGROUND: Intra-abdominal hypertension (IAH) has been recognized as a source of morbidity and mortality in the injured patient. Research concerning this entity has focused predominantly on the pathophysiology. We developed a model of IAH to determine whether gene expression is altered in the presence of this condition. METHODS: Using general anesthesia, adult Sprague-Dawley rats were intubated and instrumented with a carotid and jugular catheter. Three pairs of rats (three control; three IAH 25 mm Hg) were used at each time interval. Continuous measurements of heart rate, blood pressure, cardiac output, and temperature were recorded. Arterial blood gases were measured every 30 minutes. A catheter was placed in the peritoneum and warm saline was infused up to a pressure of 25 mm Hg that was measured through this catheter continuously. At 30 and 60 minutes, the kidneys were harvested and standard protocols were used to extract nucleic acid and perform cDNA microarray analysis screening for 4,000 genes. Each experimental rat was paired with a control rat and each set underwent individual cDNA array analysis. RESULTS: Hemodynamic changes occurred that were consistent with IAH, including depression of cardiac output and acidosis. Although widespread changes in gene expression were identified, only genes that were up-regulated and down-regulated by a ratio of fivefold, a difference in magnitude of 150 molecular dynamic counts, and p < 0.05 were considered significant. When comparing IAH of 25 mm Hg at 30 and 60 minutes, there was a surprising decrease in up-regulated genes from 10 to 1. In addition, there was an increase in down-regulated genes from zero to five genes. CONCLUSION: IAH causes changes in gene up- and down-regulation in the kidney. The number and types of genes change in magnitude and type over time. Further investigation into renal gene expression may offer insight into the molecular pathophysiology of IAH.     

Congenital abdominal aortic aneurysm: a case report

Abdominal aortic aneurysm (AAA) is distinctly uncommon in infants and children, and usually results from infection, iatrogenic trauma, vasculitis, connective tissue disorder, or tuberous sclerosis. Congenital "primary" neonatal AAA is exceedingly rare. The few reported cases of repair of congenital AAA describe use of synthetic graft material or aneurysmorrhaphy. We report the first successful treatment of a known 6 cm congenital infrarenal AAA repaired with a 5 mm cryopreserved allograft in a 4-month-old infant girl. The graft was pretreated with an antigen reduction process (SynerGraft), which preliminary studies suggest may inhibit allograft degeneration. The postoperative course was unremarkable. Lower extremity pulses and results of duplex ultrasound flow studies remained excellent at 14-month follow-up. Panel reactive antibodies against class I alloantigens remain negative. The use of an antigen-reduced allograft provides an acceptable conduit, which potentially may decrease allograft degeneration and relative graft stenosis associated with growth of the child, but requires follow-up.     

Pediatric vacuum packing wound closure for damage-control laparotomy

Background/Purpose: Recent studies advocate the use of the open-abdomen technique for managing the abdominal compartment syndrome and uncontrolled intraperitoneal sepsis. The authors have used vacuum packing (Vac-Pac) in pediatric patients with excellent results and have developed a method for closing widely distracted fascial edges to avoid the need for skin grafting. Methods: Patients who had an intraabdominal catastrophe best managed by a temporary open-abdomen technique were included. After damage control laparotomy, the Vac-Pac temporary closure was used. In 2 patients a corsetlike lacing was used to bring the widely separated fascial edges together gradually. Results: Five patients with intraabdominal sepsis and one with the abdominal compartment syndrome were included. The length of time the Vac-Pac was used ranged from 3 to 21 days. In 2 patients, the corset closure allowed wound approximation within 5 to 7 days. One patient died of overwhelming sepsis, the remainder of the patients survived. Conclusions: The Vac-Pac technique for abdominal closure is a simple and inexpensive means by which to manage the open abdomen in the pediatric patient effectively. Use of a corset-type closure for wounds with widely distracted edges should eliminate the need for skin grafting over an open abdomen.     

Isolation of manumycin-type derivatives and genome characterization of a marine Streptomyces sp. C1-2

A marine actinomycete strain C1-2 was taxonomically characterized as the genus Streptomyces, based on whole-genome sequence analysis. The highest average nucleotide identity (ANI) value (98.96%) and digital DNA–DNA hybridization (DDH) value (90.4%) were observed between Streptomyces sp. C1-2 and Streptomyces griseoaurantiacus. Thus, Streptomyces sp. C1-2 could be identified as S. griseoaurantiacus. Genome analysis revealed that Streptomyces sp. C1-2 contained 22 biosynthetic gene clusters (BGCs) for secondary metabolites, where among them, 54% have low similarities with known BGCs. The chemical investigation led to the isolation of three new manumycin-type derivatives and two known analog antibiotics named SW-B and cornifronin B. All compounds showed antioxidant activity with the half-maximal inhibitory concentration (IC₅₀) values in a range of 50.82 ± 0.8–112.04 ± 1.0 μg/mL with no cytotoxicity against Vero cells. This is the first report of the antioxidant property of manumycin-type derivatives. Moreover, two known compounds exhibited antifungal activity against Phytophthora capsici, Fusarium oxysporum f. sp. cucumerinum, and Magnaporthe grisea, with the minimum inhibitory concentration (MIC) values in a range of 125–500 μg/mL.