Effect of osmolality on mucociliary transportability and rheology of cystic fibrosis and bronchiectasis sputum

OBJECTIVE: Water is the main constituent of mucus, and its concentration is likely to be important in all aspects of mucus function, including ciliary clearance. The objective of this study was to investigate the effect of water content and osmolality of the mucus on mucociliary transportability. METHODOLOGY: Rheology and ciliary transportability of 10 sputum samples that had been subjected to various manipulations were measured using a mucus-depleted bovine trachea model. RESULTS: It was shown that addition of sodium chloride 0.2 Osmoles/kg (0.585% weight for weight) increased the transportability by 41% (P < 0.01). Evaporation of the sputum to 50% of its original weight caused a 118% increase in transportability (P < 0.0006), but iso-osmolal removal of 50% of the liquid with filter cards led to a non-significant, 25% increase in transportability. Parallel plate viscoelasticity was approximately doubled in both the evaporated and liquid-depleted samples, but was not changed by the addition of 0.2 Osmoles/kg of sodium chloride. The correlation between the osmolality of sputum and ciliary transportability (r = 0.54, P= 0.005) was better than the correlations between the viscosity (r = 0.21, P= 0.27) or elasticity (r = 0.23, P= 0.23) and ciliary transportability. CONCLUSIONS: These results suggest that the osmolality of sputum exerts a greater influence on mucociliary clearance than its viscoelastic properties.     

Mechanism of antithrombin III inhibition of factor VIIa/tissue factor activity on cell surfaces. Comparison with tissue factor pathway inhibitor/factor Xa-induced inhibition of factor VIIa/tissue factor activity

Recent studies have shown that antithrombin III (AT III)/heparin is capable of inhibiting the catalytic activity of factor VIIa bound either to relipidated tissue factor (TF) in suspension or to TF expressed on cell surfaces. We report studies of the mechanism of which by AT III inhibits factor VIIa bound to cell surface TF and compare this inhibitory mechanism with that of tissue factor pathway inhibitor (TFPI)-induced inhibition of factor VIIa/TF. AT III alone and AT III/heparin to a greater extent reduced factor VIIa bound to cell surface TF. Our data show that the decrease in the amount of factor VIIa associated with cell surface TF in the presence of AT III was the result of (1) accelerated dissociation of factor VIIa from cell surface TF after the binding of AT III to factor VIIa/TF complexes and (2) the inability of the resultant free factor VIIa-AT III complexes to bind effectively to a new cell surface TF site. Binding of TFPI/factor Xa to cell surface factor VIIa/TF complexes markedly decreased the dissociation of factor VIIa from the resultant quaternary complex of factor VIIa/TF/TFPI/factor Xa. Addition of high concentrations of factor VIIa could reverse the AT III-induced inhibition of cell surface factor VIIa/TF activity but not TFPI/factor Xa-induced inhibition of factor VIIa/TF activity.     

Laparoscopic transabdominal cervico-isthmic cerclage: a minimally invasive approach

BACKGROUND: While the traditional approach to management of cervical insufficiency has been the insertion of a transvaginal cerclage during pregnancy, a transabdominal cervico-isthmic suture is indicated in certain patients. This procedure is traditionally performed via laparotomy. Laparoscopic transabdominal cervico-isthmic cerclage (LTCC) placement, however, confers the benefit of the low morbidity associated with laparoscopy. AIMS: To describe the technique and outcomes of LTCC in three cases. METHODS: LTCC was performed using Mersilene tape at the level of the internal cervical os in the prepregnancy period in three patients: one with previous cervical amputation and two with previous failed cervical cerclage. Procedures were performed at a tertiary level endoscopic unit, Sydney, Australia. RESULTS: The laparoscopic approach enabled placement of a suture with no morbidity, and rapid patient recovery in these cases. CONCLUSIONS: Laparoscopic cervical cerclage proved technically feasible and safe for a surgeon trained in laparoscopic suturing methods.     

Fertility and pain outcomes following laparoscopic segmental bowel resection for colorectal endometriosis: a review

Intestinal involvement in endometriosis is thought to occur in up to 12% of all endometriosis cases. While colorectal resection is being increasingly advocated as a feasible management option in patients with severe disease, there still remains significant resistance towards this surgery. This article aims to review the current literature to determine the pain and fertility outcomes following segmental bowel resection for colorectal endometriosis.     

Long-Term Health and Psychosocial Status of Youth who Received Substance Abuse Treatment in Adolescence

Alcohol and substance abuse in the adolescent population is a major health concern with a number of harms known to be associated with high levels of use. Few studies report on long-term health status of youth who have received treatment for a substance abuse problem during adolescence. This study aimed to describe the long-term status of a cohort of adolescents who received treatment in an intensive day treatment program situated in a tertiary care paediatric hospital. Youth participated in an interview that collected data using both standardized screening tools (GAIN-SS, AUDIT, CUDIT, DUI) as well as closed and open ended questions about education, employment, and physical and mental health status. Young adults in this sample continue to use alcohol and cannabis, with a proportion reporting problematic use. Their academic achievement is close to expected for their age group. They report concurrent mental health disorders; and as a cohort, access the health care system for both acute and chronic health conditions more than their contemporaries. These findings support the inclusion of academic, mental health and medical components in programs for adolescents with substance abuse, in order to address a broad range of determinants of health outcomes.     

Response rates for providing a blood specimen for HIV testing in a population-based survey of young adults in Zimbabwe

Background  

To determine differences among persons who provided blood specimens for HIV testing compared with those who did not among those interviewed for the population-based Zimbabwe Young Adult Survey (YAS).     

Formula intake of 1- and 4-month-old infants

This study was designed to estimate energy intake in exclusively formula-fed infants. Formula intake of twenty-four 1- and 4-month-old infants was studied for 5 consecutive days; six boys and six girls were in each age group. Intake was estimated by laboratory-determined weights of formula consumed, spilled, and regurgitated. Two additional methods were used to estimate intake in the first nine infants during the 1st day of observation: test-weighing the infant at each feeding and mother's weighing of formula consumed, regurgitated, and spilled at each feeding. No consistent differences were detected among methods, but test-weighing appeared to have the greatest feed-to-feed variability. Intake was estimated to be 747 +/- 100 g or 125.5 +/- 17 kcal/kg, and 958 +/- 131 g or 94.0 +/- 13 kcal/kg for 1- and 4-month-old infants, respectively. The day-to-day variability (expressed as the coefficient of variation) was 13 and 15% (CV, g/kg) for 1- and 4-month-old infants, respectively. Between-infant variability of intake was approximately 8% (CV, g/kg) for both age groups. Energy intakes of 1-month-old formula-fed infants were similar to published values of breast-fed infants of similar age, but the energy intakes of 4-month-old formula-fed infants were significantly higher than values published for 4-month-old breast-fed infants.     

Effect of exogenous surfactant on total respiratory system compliance

We measured total respiratory system compliance (Crs) before and after instilling 25 mg artificial surfactant in 1 ml saline down the endotracheal tube of preterm babies requiring resuscitation at birth, and compared results with data from 6 similar babies receiving saline only. Surfactant did not produce a significant improvement in Crs.