Using surveillance data to direct infection control efforts to reduce surgical-site infections following clean abdominal operations in Japan.

We initiated surveillance for surgical-site infections (SSIs) in a Japanese hospital using Centers for Disease Control and Prevention definitions and the approach of the National Nosocomial Infections Surveillance (NNIS) System. Patients were observed following clean and clean-contaminated abdominal operations. SSI rates were higher than those of the NNIS System, but there was a trend toward decreased SSI rates in the latter half of the study period.     

Inactivation of inducible nitric oxide synthase protects intestinal pacemaker cells from postoperative damage

Abdominal surgery causes postoperative gastrointestinal dysmotility which can progress to paralytic ileus. Surgery causes inflammatory responses leading to loss of interstitial cells of Cajal (ICC), which generate intestinal pacemaker activity. Here, we demonstrate that a deficiency in or pharmacological inhibition of inducible nitric oxide synthase (iNOS) before surgery protects ICC from postoperative damage. Ileal segments from wild-type, iNOS and cyclooxygenase-2 (COX-2) knockout mice were resected and reconstructions were performed by end-to-end anastomoses. Wild-type animals were exposed to iNOS inhibitors before surgery, and electrical activity and ICC were examined 5 h after surgery. Intestinal surgery on wild-type mice caused a significant reduction in ICC and pacemaking at distances up to 5 cm from the anastomosis site. ICC networks and pacemaking were protected in iNOS^−/− mice. In animals treated preoperatively with iNOS inhibitors, pacemaker activity was depressed only at the anastomosis site. COX-2 deficiency also muted postoperative disruption in pacemaker activity. Postoperative surgical damage consists of a local response and a more widespread response in which ICC and pacemaker activity are disrupted. Damage to ICC and pacemaking was greatly attenuated in the absence of NO derived from iNOS. Thus, management of iNOS expression or activity prior to intestinal surgery protects against postsurgical dysmotility and reduces the severity of postoperative ileus.     

Fibrinolysis and fibrinogenolysis in liver disease

Patients with liver disease frequently have hemostatic abnormalities which include accelerated fibrinolysis. In order to assess the fibrinolytic state in liver disease, plasma levels of fibrinogenolysis products (FgDP), fibrinolysis products (FbDP), and fibrinogenolysis plus fibrinolysis products (TDP) were measured with newly developed enzyme-linked immunosorbent assays based on monoclonal antibodies in 36 patients with liver disease (six patients with acute hepatitis, seven with chronic hepatitis, ten with liver cirrhosis, 11 with hepatocellular carcinoma, and two with intrahepatic cholestasis). As compared with healthy subjects, mean plasma levels of FbDP (1,083 +/- SD 1,254 vs. 236 +/- 100 ng/ml, P = 0.005) and TDP (1,773 +/- 1,814 vs. 669 +/- 212 ng/ml, P = 0.001) were significantly elevated in patients with liver disease, whereas FgDP was normal (389 +/- 202 vs. 396 +/- 132 ng/ml, P = 0.87). Plasma FbDP correlated very well with TDP (r = 0.986, P less than 0.00001) in liver disease. In addition, FbDP and TDP but not FgDP correlated with plasma concentrations of thrombin-antithrombin III complex. When plotted by the disease categories, the magnitude of elevations of FbDP and TDP was the most prominent in acute hepatitis followed by hepatocellular carcinoma. These findings indicate that activation of fibrinolysis occurs following thrombin generation, but increased primary fibrinogenolysis is rare in liver disease.     

Atherosclerosis is accelerated in patients with long-term well-controlled systemic lupus erythematosus (SLE)

BACKGROUND: It is uncertain whether atherosclerosis is accelerated in premenopausal and postmenopausal patients with long-term well-controlled systemic lupus erythematosus (SLE). METHODS: We measured the intima-media thickness (IMT) of the carotid arteries and the cardio-ankle vascular index (CAVI) in 39 women with SLE and in age- and sex-matched controls. RESULTS: In the premenopausal state, carotid plaque was detected only in SLE patients (36%). In the postmenopausal state, the maximum IMT was about 2-fold greater in SLE patients than in control subjects (1.3+/-0.7 vs. 0.7+/-0.2 mm, p<0.001). CAVI was higher in both the premenopausal and postmenopausal SLE patients. The serum amyloid A protein (SAA) was higher in SLE patients in the premenopausal state (p=0.025), while remnant like particle-cholesterol (RLP-C), the homeostasis model assessment of insulin resistance (HOMA-IR), and SAA were significantly increased in postmenopausal SLE patients (p=0.001, p<0.001 and p<0.05, respectively). Multiple regression analysis revealed that the maximum IMT was associated with cumulative PSL dosage (p=0.027) and SAA (p=0.074) in the premenopausal SLE patients, and with HOMA-IR (p<0.001) in the postmenopausal SLE patients. CONCLUSION: Atherosclerosis is accelerated in long-term well-controlled SLE. More attention should be given to subclinical inflammation and insulin resistance in the management of SLE patients.     

Short-term topical therapy of experimental tinea pedis in guinea pigs with lanoconazole, a new imidazole antimycotic agent.

The therapeutic efficacy of short-term treatment with a 1% cream of lanoconazole, a new imidazole antimycotic agent, in comparison with that of a 1% cream of terbinafine was evaluated in the guinea pig model of tinea pedis. Each agent was topically applied once a day for 3 or 7 consecutive days, starting on day 10 postinfection, and a culture study was conducted on day 5 after the last treatment with each agent. The 1% cream of lanoconazole was as highly effective as the 1% cream of terbinafine in terms of eradicating the fungi from the infected feet.     

Effect of procainamide on the postrepolarization refractoriness in cardiac muscle: evaluation using the block coupling interval in the artificial isthmus model in the canine right atrium

The post-repolarization refractoriness (PRR) is an important factor to determine the conduction block in cardiac muscle. Recently, we proposed the block coupling interval (BCI) as an useful electrophysiological index for evaluating the PRR. In the present study, the effect of procainamide on PRR was evaluated using the BCI and the effective refractory period (ERP). In five beagle dogs, radiofrequency linear ablation was performed on the right atrial surface parallel to the AV groove, forming an artificial isthmus (8-10 mm width and 15-20 mm length). Bipolar recordings were performed in the isthmus at a resolution of 1.2 mm and single extrastimuli with eight basic drive trains were delivered to cause conduction blocks in the isthmus. When a conduction block occurred, the recorded coupling interval at the recording site just proximal to the site of block was defined as BCI. At the site of the block, the ERP and duration of the monophasic action potential (MAP) at each drive cycle length was measured. The PRR was calculated using two different formulas: (1) [ERP-MAP] and (2) [BCI-MAP]. Procainamide was administrated intravenously at a dose of 15 mg/kg after the control study and the whole study protocol was repeated. The site of the block in an individual dog was always the same. BCI, ERP, and MAP were all shortened in accordance with the shortening of the basic drive cycle length, and the BCI was always the longest, ERP the middle, and the MAP was the shortest. The administration of procainamide prolonged each parameter, but the order of BCI > ERP > MAP remained unchanged. The PRR calculated as [BCI-MAP] was prolonged from 15 +/- 10 ms to 29 +/- 8 ms by the administration of procainamide (P = 0.048), but [ERP-MAP] was unchanged (8 +/- 10 ms vs 8 +/- 4 ms). In the conduction block model in the canine right atrium, procainamide prolonged the [BCI-MAP], but did not change the [ERP-MAP]. The procainamide effect of prolonging the PRR might be expressed better by the change in the BCI than the ERP.     

Edaravone reduces mitochondrial damage due to reperfusion injury following leg ischemia in rats

PURPOSE:

Free radicals have been implicated in reperfusion injury. It was shown that the free radical scavenger edaravone might suppress reperfusion injury in rat extremities. The present study aimed to elucidate how edaravone suppresses reperfusion injury, focusing on its effect on the mitochondrial structure and glycogen storage in the lower extremity muscles.

METHODS:

Sixteen male Lewis rats (mean [± SD] weight 497±32 g) were divided into two groups and injected with either 3.0 mg/kg of edaravone (edaravone group, n=8 rats) or the same dose of saline (control group, n=8 rats) into the peritoneal cavity. The rat reperfusion injury models were created by clamping the bilateral common femoral arteries for 5 h, then declamping. The muscles were harvested more than 5 h after the start of reperfusion. The mitochondrial damage, defined as mitochondrial swelling, was examined using a transmission electron microscope at ×30,000 original magnification (n=3 for each rat). Glycogen storage, defined as a positive periodic acid-Schiff stain area, was examined using computerized densitometry (n=5 sections for each rat).

RESULTS:

The mitochondria in the control group demonstrated marked swelling (mean mitochondrial size = 0.169±0.059 μm²). However, the mitochondria in the edaravone group had significantly less swelling (mean mitochondrial size = 0.102±0.036 μm²; P<0.01). The mean percentage of positive periodic acid-Schiff stain was also significantly higher in the edaravone group than in the control group (51.7±6.8% versus 7.3±2.1%; P<0.01).

CONCLUSION:

The results suggested that edaravone reduces mitochondrial damage due to reperfusion injury, resulting in a high level of glycogen storage.