Quantitative analysis of microcirculatory disorders after prolonged ischemia in skeletal muscle

Reperfusion injury following prolonged ischemia is thought to be caused primarily by microvascular failure. The aim of the present study was to investigate whether prophylactic isovolemic hemodilution with Dextran 60 (hct 30%) could improve microvascular perfusion after 4 h of pressure-induced ischemia in skeletal muscle. In 28 Syrian golden hamsters (6-8 weeks/60-80 g b. wt.) a dorsal skinfold chamber and permanent arterial and venous catheters were implanted under Nembutal anesthesia (50 mg/kg b. wt.). Following a recovery period of 48 h pressure-induced ischemia was applied to the skeletal muscle within the skinfold chamber by means of a transparent stamp. Quantitative analyses of microhemodynamics were performed in the awake animal prior to and 15 min, 1, 2, 4 and 24 h after ischemia using vital fluorescence microscopy. In non-treated animals, functional capillary density decreased after 4 h of ischemia to 30% of the initial values (P less than 0.001); after 24-h reperfusion only 50% of the initially perfused capillaries were reperfused (P less than 0.001). The heterogeneity of functional capillary density increased after ischemia to a maximum of 2.19 +/- 0.94 as compared to 0.48 +/- 0.11 prior to ischemia. Capillary RBC-velocity suffered a marked reduction in the early reperfusion phase and did not recover up to the 24-h observation time. In contrast, prophylactic isovolemic hemodilution was associated with only a small and reversible reduction of functional capillary density after 4-h ischemia. At 24-h reperfusion 90% of the initially perfused capillaries were reperfused. Capillary RBC-velocity was reduced in the early reperfusion phase, but returned to normal values within 24 h. Thus, prophylactic isovolemic hemodilution resulted in a marked reduction of microvascular reperfusion failure in skeletal muscle. A hematocrit lower than normal prior to ischemia provides better conditions for capillary reperfusion after prolonged ischemia.     

Increased knowledgeability of the population and physicians on questions of prophylaxis--the basis for programs to prevent the main noninfectious diseases

One of the main ways of improving health of the population and increasing the duration of life, especially active life, is the upbringing of habits of a healthy way of life among the population. Interviewing by mail of a representative sample of the population 3670 persons of both sexes aged 20 to 60 in Frunze showed that over one third knew nothing of a possibility of the prevention of cardiovascular and bronchopulmonary diseases and two thirds knew nothing of a possibility of cancer prevention. Physicians were also poorly oriented in the problems of prophylaxis of the main noncommunicable diseases. Enhancing measures to form hygienic habits of a healthy way of life in the population and reorientation of medical workers to enhancing prophylactic measures, particularly primary prevention, was found appropriate.     

Registry versus publication: discrepancy of primary outcomes and possible outcome reporting bias in child and adolescent mental health

Outcome reporting bias is one of the fundamental forms of publication bias. It implies publishing only outcomes that have positive results. The aim of this observational study was to explore primary outcome discrepancies between registry of clinical trials and their corresponding publications, since these can indicate outcome reporting bias in child mental health. Data were extracted from completed interventional clinical trials from ClinicalTrial.gov registry and its Archive site. Trials were registered under “Behaviours and Mental Disorders” category, and conducted on underage participants (0–17 years). Their primary outcomes were compared to those published in publication which had a corresponding NCT number stated in the text. Sixteen percent of trials did not have the minimum information on primary outcome stated in the registry—neither the measure used nor the measurement time points; 38.9% of trials had the minimum information stated to describe primary outcome, while only 3.3% of trials had all the necessary elements stated in the registry. Most of the publication in our sample had positive results (66.4%). Half of the trials registered before completion had non-matching primary outcomes in the registry and publication; 85.4% of trials with non-matching outcomes indicated possible outcome reporting bias for some of the primary outcome. Middle-sized trials and industry-funded trials were related with higher quality of primary outcome registration. Industry funding was related with positive findings in publication. Non-industry funding proved to be the only significant predictor of discrepancy between registered and published primary outcomes, and possible outcome reporting bias. Journal impact factor was not related with any of the outcome measures. The main limitation of the study is that it primarily offers an insight into discrepancy of registered and published outcomes. The methodology does not imply an access to results of unpublished outcomes — therefore, it was not possible to determine the presence of the bias with sufficient certainty in large number of trials. Further research should be done with improved methodology and additional data.

     

Innervation extrakranialer Gewebe durch Kollateralen von Hirnhautafferenzen

Headaches are believed to arise from the cranial dura mater and large cerebral arteries because stimuli applied to these structures cause exclusively headache-like sensations. The contribution of extracranial structures like head and neck muscles with their trigger points has also been discussed. The convergence of afferent input to the trigemino-cervical brainstem complex is mainly regarded as an explanation for the influence of extracranial nociceptive events on the headache generation. New structural and functional examinations, particularly tracing experiments in rodent and human tissues, show clearly that collaterals of meningeal nerve fibres penetrate the skull through sutures and along blood vessels to innervate parts of the outer periosteum and deep layers of pericranial muscles. Upon noxious stimulation of these extracranial structures the excitation spreads along these afferent branches into the meninges causing neuropeptide release and increased meningeal blood flow. The concept of an extracranial innervation by meningeal afferent collaterals offers a new explanation for the role of pericranial tissues in headache generation and the beneficial effects of therapeutic manipulations on these structures.     

Breast and Scrotal Sparganosis

Objective. Sparganosis is caused by the tapeworm larva of the geneus Spirometra. Because sparganosis usually manifests as a migrating subcutaneous mass, sonography can play an important role in its diagnosis. Methods. In this series, we investigated 4 cases of subcutaneous sparganosis and focused on the sonographic findings. Three of the cases involved the breast, and the other involved the scrotum, as confirmed by surgery. Results. The characteristics of subcutaneous sparganosis included a poorly defined hyperechoic lesion with internal serpiginous tubular structures, anechoic serpiginous tubular structures with a surrounding hyperechoic lesion, and an elongated hyperechoic mass with a hypoechoic nodular lesion in the central portion. Conclusions. We suggest that a mass combined with a hypoechoic tubular structure should raise the suspicion of subcutaneous sparganosis.