Hypoxemia with air breathing periods in U.S. NAVY Treatment Table 6.

Air breathing is used to lessen hyperbaric oxygen (HBO2) toxicity. Hypoxemia could occur during hyperbaric air breathing in patients with lung dysfunction, although this has not been previously reported. We report two cases of hypoxemia during air breathing with two patients treated with the US Navy Table 6. Patient 1 was an 11-year-old male with cerebral gas embolism (during cardiac transplantation), patient 2 was a 66-year-old female with cerebral gas embolism from a central venous catheter accident. Both were mechanically ventilated. We monitored arterial blood gas (ABG) during therapy. In both patients, ABG measurements showed hypoxia during the first air breathing period at 1.9 atm abs (192.5 kPa). If patients require > or = 40% inspired oxygen before HBO2 therapy, oxygenation monitoring is advisable during air breathing periods, especially at lower chamber pressures (< or = 2.0 atm abs).     

Ureteral duplication, ectopy and ureteroceles

These entities pose some of the most challenging diagnostic and therapeutic objectives involving the urinary system. The clinical presentations are varied, and involve children from prenatal to adolescent age groups. The diagnostic and therapeutic alternatives are presented, along with a classification for the more complex clinical settings.     

Temperature and cellular regulation of spontaneous cytotoxicity in the shark

Spontaneous cytolytic activity of shark peripheral blood leukocytes is observed only during periods of decreased environmental temperature (< 23°C). The effector cell is adherent to glass and is phagocytic. Leukocytes tested during warmer periods (26–31°C) exhibit no spontaneous activity; however, glass-adherent cells isolated from those fish are cytotoxic in vitro, indicating that the effector cell is present at all temperatures. During warmer temperatures, nonadherent cells added to adherent cells were shown to inhibit spontaneous cytotoxicity. This inhibition requires viable cells in contact with the spontaneous cytotoxic population. Thus decreased environmental temperature correlated with spontaneous cytotoxicity, and appears to affect a regulatory cell that is glass nonadherent. In addition, the cytotoxic effector cell is more active at 23°C than 30°C in vitro. These data show that by the time of emergence of the nurse shark, a temperature-dependent mechanism had evolved for cellular regulation of at least one immune function, spontaneous cytotoxicity.     

Evaluation of Job Strain of Family Physicians in COVID-19 Pandemic Period- An Example from Turkey

Journal of Community Health - The purpose of this study was to evaluate family physicians’ job strain during the Covid-19 pandemic and determine the effective factors. The study was carried...     

Emergency treatment and long-term follow-up of posterior urethral valves

Posterior urethral valves have a broad spectrum of clinical severity determined by the degree and reversibility of the long stepwise sequence of secondary pathology. Neonatal azotemia and severe bilateral reflux are particularly important negative prognostic factors. In the mild cases, valve ablation with or without delayed reconstruction is good therapy. In the very severe cases, our interpretation of all the clinical and experimental information now available suggests that the time interval and the level of decompression are extremely important. Achievement of consistent low caliceal pressure without stasis and infections should be achieved as soon as possible. We do not agree with the philosophy of "valve ablation and wait and see" for secondary reconstruction as applied to the severe cases. An analogous philosophy would be treating all respiratory infections as upper respiratory infections and applying aggressive appropriate therapy for pneumonia only if the patient does not respond clinically. However, all controversy aside, the management of neonatal infants with posterior urethral valves remains a difficult and challenging problem for us all. The real challenge will be to improve published management results to the point that the family faced with decisions regarding an in utero diagnosis of posterior urethral valves will have enough hope to continue the pregnancy.     

An underlying mechanism for improved liver preservation with a combined histidine-lactobionate-raffinose flush solution

In previous experimental liver transplant studies, it was possible to extend cold ischaemic time (CIT) by using a flush/storage solution combining histidine, lactobionate and raffinose (HLR). In this study, energy metabolism, glycolytic substrate (glucose) and anaerobic end-product (lactate) were examined in rat liver over 24 h of cold storage to determine the mechanism of action of the HLR solution. In livers subjected to simple flush and storage with the HLR solution. levels of ATP and ADP were considerably higher than livers stored with modified UW throughout 24 h of storage; at 4 h of storage, ATP and ADP levels were 1.1 and 3.1 mol/g for HLR solution versus 0.18 and 0.81 mol/g for UW solution. Total adenylate contents (TA=ATP+ADP+AMP) also remained 1–2 mol/g higher in HLR-treated livers than those preserved in UW; TA values ranged from 3.8 to 5.7 mol/g. Glucose increased to 20–35 mol/g by 10–24 h of storage (similar to the UW group). Lactate rose to almost twice that in livers stored in UW; total lactate accumulation was approximately 10.0 mol/g. This study demonstrated that the combined HLR solution is able to prolong the maximum safe CIT by increasing anaerobic metabolism and consequently preserving liver energetics. The second part of the experiment examined the effect of continuous perfusion (with/without O₂) over the 1st h of cold ischaemia. Under current methods of liver flushing and excision, the 1st h of cold storage may be the critical time of metabolic adjustment since most of the pH and ATP changes occur during this period. Therefore, we tested the hypothesis that the combination of a simple flush with an additional brief 1-h perfusion period prior to storage would enhance the maintenance of hepatic energetics. There was no beneficial effect of 1 h of perfusion without O₂ compared to simple HLR flush and storage. However, perfusion with O₂ resulted in prolonged maintenance of high energy adenylates and total adenylates; at 10 h of storage ATP was 1.0, ADP 3.3, and TA 5.7 mol/g. However, any improvement in ultimate viability following long-term storage of the livers in these two groups needs to be tested in an animal transplant model.     

The RecBC enzyme loads RecA protein onto ssDNA asymmetrically and independently of chi, resulting in constitutive recombination activation

Double-strand DNA break repair and homologous recombination in Escherichia coli proceed by the RecBCD pathway, which is regulated by cis-acting elements known as chi sites. A crucial feature of this regulation is the RecBCD enzyme-directed loading of RecA protein specifically onto the 3'-terminal, chi-containing DNA strand. Here we show that RecBC enzyme (lacking the RecD subunit) loads RecA protein constitutively onto the 3'-terminal DNA strand, with no requirement for chi. This strand is preferentially utilized in homologous pairing reactions. We propose that RecA protein loading is a latent property of the RecBCD holoenzyme, which is normally blocked by the RecD subunit and is revealed following interaction with chi.