Changes in Perimicrovascular Protein Spatial Distribution due to Superfusate

Objective: To determine superfusate-induced changes in the distribution of plasma proteins in the perimicrovascular interstitial matrix. Methods: Rats were anesthetized with sodium pentobarbital and a mesenteric loop was exteriorized. Intravital video microspectrophotometry was performed using wavelengths of 280, 320, and 700 nm. The images were analyzed to give protein and collagen spatial distributions in vascular regions of rat mesenteric tissue. Perimicrovascular protein concentrations were fitted to an exponential decay model c_i + c_v exp (-x/k), where c_i is distal protein concentration, c_i + c_v is the protein concentration proximal to the vessel, x is the distance from the vessel wall, and k is the decay constant indicating protein gradient slope. Results: Before superfusion with 0.5-ml normal saline, c_i = 1.45 ± 0.13 g/dl, c_i + c_v = 4.56 ± 0.23 g/dl. After the first superfusion, c_i decreased (p < 0.01) to 0.53 ± 0.06 g/dl; following a second superfusion, c_i decreased to 0.4 ± 0.03 g/dl; an additional final superfusion caused a further decrease to 0.33 ± 0.02 g/dl. c_i + c_v also decreased significantly during repeated superfusions to 2.92 ± 0.15, 2.35 ± 0.25, and 2.1 ± 0.12 g/dl, respectively. Conclusions: Superfusion produced changes in perivascular and distal interstitial matrix protein distribution. Protein concentration proximal to the microvessel remained higher than distal concentrations. This could be due to increased gel concentrations inhibiting protein mobility.     

Knowledge, attitude and beliefs about measles and vaccination coverage in a rural area

In the present study an attempt was made to collect data on the attitude, belief and customs of mothers regarding occurrence of measles among children in a rural area in Jammu region. Their views on the various aspects of the disease have been highlighted in this article. Simultaneously an effort was also made to evaluate the vaccination coverage of measles vaccine in the study area 2 1/2 years after its introduction into the Universal Immunization Programme (UIP). This study brings out the scope of health education in the eventual goal of eradicating measles in the country.     

Associations of Posthemodialysis Weights above and below Target Weight with All-Cause and Cardiovascular Mortality

Background and objectives

Fluid removal via ultrafiltration is a primary function of hemodialysis, and inadequate volume control is associated with significant morbidity and mortality among chronic dialysis patients. Treatment-to-treatment fluid removal goals are typically calculated on the basis of interdialytic weight gain and prescribed target weight. The clinical effect of frequent missed target weights is unclear. This study was designed to evaluate the associations of postdialysis weights above and below the prescribed target weight (separately) and outcomes.

Design, setting, participants, & measurements

Data were taken from a national cohort of 10,785 prevalent, thrice-weekly, in-center hemodialysis patients dialyzing from 2005 to 2008 (median time at risk, 2.1 [25th percentile, 75th percentile] years) at a single dialysis organization. Patients were characterized as having an above target weight miss if their postdialysis weight was >2 kg above target weight in at least 30% of baseline treatments (14.6% of cohort), or they were characterized as control otherwise. Below target weight miss characterization was analogous for patients with postdialysis weight >2 kg below target weight (6.6% of cohort). Coprimary endpoints were all-cause and cardiovascular mortality.

Results

Above target weight miss in at least 30% of treatments (versus not) was associated with greater all-cause mortality (adjusted hazard ratio, 1.28; 95% confidence interval, 1.15 to 1.43); and below target weight miss in at least 30% of treatments (versus not) was associated with greater all-cause mortality (adjusted hazard ratio, 1.22; 95% confidence interval, 1.05 to 1.40). Both above and below target weight misses were also significantly associated with greater cardiovascular mortality. Secondary analyses demonstrated dose-response relationships between target weight misses and mortality. Results from sensitivity analyses considering the difference in postdialysis and target weights as a proportion of body weight were analogous to the primary results.

Conclusions

Postdialysis weights >2 kg above and below target weight are associated with higher all-cause and cardiovascular mortality. Consistent target weight achievement is a viable target for improving fluid management.     

Alcoholic pancreatitis: patients at high risk of acute zinc deficiency.

The important role of zinc as an essential nutrient and therapeutic agent has been increasingly recognized in the last two decades. Abnormalities in physical growth and sexual maturation are caused by zinc deficiency. More recently, several clinical observations have suggested an association between zinc deficiency and poor healing of wounds, anorexia, hypogeusia and behavioral disorders. Furthermore, zinc-responsive vesiculobullous dermatitis has been well described.Within a seven-month period, we have seen two patients with alcoholic pancreatitis in whom acute zinc deficiency developed in the course of their treatment with parenteral hyperalimentation. Clinically, the zinc deficiency was manifested by the appearance of an erythematous, desquamative rash on the face. Serum zinc levels were remarkably low in each patient at the time the skin rash appeared: 18 and 11 μg/dl. Upon treatment with one or two tablets of zinc sulfate per day (220 mg each), the skin rashes rapidly and completely resolved within one to two weeks. Serum zinc levels were 49 and 50 μg/dl at the time the rash disappeared.Alcoholics, when subjected to stress, appear to be a high-risk group for the development of severe zinc deficiency while undergoing parenteral nutrition. Several factors which contribute to the development of zinc deficiency in alcoholics include diminished dietary intake, enhanced urinary excretion of zinc and, probably, marked diminution in zinc absorption. It is recommended that zinc supplementation be included as a standard part of total parenteral nutrition in this patient group.     

Critical examination of therapeutic efficacy of a ph-sensitive enteric-coated pancreatic enzyme preparation in treatment of exocrine pancreatic insufficiency secondary to cystic fibrosis

In an attempt to critically examine the therapeutic efficacy of pH-sensitive entericcoated pancreatic enzyme preparations in patients with pancreatic insufficiency due to cystic fibrosis, postprandial duodenal concentration and recovery of orally administered pancreatic enzymes, duodenal pH, and coefficient of fat absorption were determined in eight cases after ingestion of equivalent dosage of enteric-coated as well as conventional enzyme preparations. Ingestion of a pH-sensitive enteric-coated pancreatic enzyme preparation was accompanied with a significant (P<0.05) reduction in steatorrhea, as well as a lower mean concentration and recovery of lipase and trypsin activity in the postprandial duodenal samples. Furthermore, the intraluminal duodenal pH was noted to be below 4.0 during the postprandial period in all patients. These data suggest that in cystic fibrosis, the greater therapeutic efficacy of pH-sensitive enteric-coated preparations over conventional preparations may be related to the protection of pancreatic enzymes from the highly acidic milieu in the duodenum, allowing for possible bioavailability in the distal small intestine.Supported by the Veterans Administration.     

P-selectin blockade fails to improve acute lung injury in sheep

Accumulation of neutrophils in the lung contributes to the endothelial damage in the tissue associated with acute respiratory distress syndrome. This initial recruitment of neutrophils within the pulmonary microvasculature may involve P-selectin. Thus we hypothesized that an antibody against P-selectin would reduce pulmonary damage. Sheep were chronically instrumented and prepared. The first group received 40% body surface area third-degree burns with 48 breaths of cotton smoke and 1 mg/kg of anti-(P-selectin) antibody (termed 3D4) 1 h post injury (n = 5). The second group (non-treated) received the same injury but no antibody treatment (n = 6). The third group comprised of sham animals without any injury or antibody treatment (n = 6). Sheep were studied for 48 h during which they were uniformly resuscitated with Ringer's lactate solution by following the Parkland formula. All the animals were mechanically ventilated. In the non-treated injured group, the arterial partial pressure of O(2) ('PaO(2)')/inspired fraction of O(2) ('F(i)O(2)') ratio dropped to 168+/-30 at 48 h, whereas the lung lymph flow increased to an average of 46+/-9 ml/h (10-fold of baseline). These changes were not prevented by an anti-(P-selectin) antibody. The plasma and lymph nitrate/nitrite levels were lower in the antibody-treated group than in the non-treated group. The lymph conjugated dienes were significantly lower in the treated animals. However, lung myeloperoxidase activity and lung tissue conjugated dienes were significantly increased in the treated animals compared with the non-treated injured controls. In conclusion, although the anti-(P-selectin) antibody did not protect against lung injury during the initial 48 h of burn and smoke, it decreased some aspects of injury in the peripheral microcirculation.     

Engineering of cotton fabrics for maximizing in vitro ultraviolet radiation protection

Introduction: Cotton fabrics used in summer do not often provide good protection against solar ultraviolet (UV) radiation. Heavy cotton fabrics can provide good protection against UV radiation. However, heavy fabrics are not good from a comfort point of view as the air permeability and moisture vapour transmission rate is very low. Objectives: To engineer cotton fabrics which will provide maximum UV protection without sacrificing the minimum requirement of air permeability and thermal resistance for a particular climatic condition. Methods: Sixteen plain and sixteen twill woven fabrics were manufactured using different cotton yarn count and picks per cm. Nonlinear regression models were developed to relate the fabric parameters with the ultraviolet protection factor (UPF), air permeability and thermal resistance. Optimization problems were formulated for UPF maximization keeping air permeability and thermal resistance as constraints. Optimization problems were solved to find out the values of yarn count and picks per cm. New fabrics were then woven using optimized combinations of yarn count and picks per cm, and error assessment between the target and the achieved fabric properties was performed. Results: The target, optimized and achieved fabric properties are showing good association. When air permeability requirement is high, the engineered cotton fabric can provide good UV protection (UPF>15). When the air permeability requirement is low, the engineered cotton fabric can provide excellent UV protection (UPF>40). Conclusions: It is possible to engineer cotton fabrics to maximize the UV protection without compromising with the comfort properties.     

Diagnosis and treatment of cystic disease of the thyroid by aspiration

One hundred forty-one cases of euthyroid solitary "cold" and "uniform" nodules, each of which contained at least 3 ml of fluid obtained on aspiration, are presented. Sixty-three patients had complete disappearance of swelling after one aspiration. Seventy-eight patients were selected for surgery on the basis of cytologic findings of malignancy in the aspirated fluid (one patient), on the basis of recurrent cyst formation after one aspiration (17 patients; in these cases the incidence of malignancy was similar to that in solid, cold nodules), and on the basis of palpable tissue after aspiration that indicated a partially cystic lesion (60 patients). Surgicopathologic findings revealed six malignant lesions; all of these nodules were more than 3 cm in diameter. In percentage, 6.6% of the partially cystic and 2.5% of the purely cystic nodules were malignant. The color of the aspirated fluid did not add to the discriminant value of the aspirate. The identification of malignant conditions in thyroid cysts was handicapped by the yield of acellular material in three of five cases of malignant disease and in more than 50% of benign lesions. However, the study suggests that aspiration biopsy of cystic thyroid nodules when used in association with the above clinical criteria is a useful technique of selecting patients for operation and, by itself, is a safe and reliable means of treating the disorder.