Effects of parenteral fish-oil emulsion (Omegaven) on cutaneous wound healing in rats treated with dexamethasone

BACKGROUND: The aim was to assess wound healing when parenteral fish-oil emulsion is given to rats receiving dexamethasone. METHODS: For 5 days after skin wounding, group S (control; n = 7) received saline 1 mL/kg intraperitoneal (IP); group D (n = 7), dexamethasone 0.2 mg/kg IP; and group DO (n = 9), dexamethasone 0.2 mg/kg IP plus 1 mL/kg Omegaven (Fresenius Kabi, Austria). Wound specimens were assessed for hydroxyproline level, wound depth, histology (epidermal/dermal regeneration, granulation tissue thickness, and angiogenesis), and expression of transforming growth factor-beta (TGF-beta) and platelet-derived growth factor-AA (PDGF-AA). RESULTS: Compared with D and DO specimens, controls had higher hydroxyproline (p < .01), deeper wounds (p < .05), and better histologic scores (p < .01 angiogenesis; others p < .05). There were no significant differences between the group D and DO means for hydroxyproline level, wound depth, or histologic scores (p > .05 for all). Controls had higher TGF-beta expression scores than the other groups (p < .01 for both) and a higher PDGF-AA expression score than group DO (p < .01). Groups D and DO had statistically similar TGF-beta scores, but group D had a higher PDGF-AA score (2.71 +/- 0.75 vs 1.55 +/- 0.72, respectively; p < .05). CONCLUSIONS: According to the parameters we studied, adding parenteral omega-3 and omega-6 fatty acids to the nutrition regimen of rats treated with dexamethasone does not seem to have adverse effects on wound healing, and effects on wound healing may not need to be considered when determining if these agents should be supplemented in nutrition support regimens.     

Complex conotruncal cardiac anomalies consecutively in three siblings from a consanguineous family possibly associated with maternal hyperhomocysteinemia

Introduction Conotruncal defects represent an anatomically heterogeneous group of cardiac malformations affecting the outflow tract of the ventricles and the arterial pole of the heart. The exact etiology of congenital heart diseases is unknown. Case report A 31–year-old woman who had three offspring with complex conotruncal cardiac anomalies after consanguineous marriage was reported. The first child is still alive. However, the second affected child died at the age of 3 years. Fluorescence in situ hybridization studies of the siblings excluded CATCH₂₂ chromosomal abnormality. The maternal laboratory work-up was unremarkable except for low serum folic acid and cobalamin levels and high homocysteine levels. The woman received high dose pyridoxine, cobalamin and folate treatment preconceptionally, and she became pregnant. She delivered a healthy male infant without any abnormalities. Six months later, she became pregnant again without any preconceptional medications. When she was examined during the fourth pregnancy, unfortunately the fetus was found to have a restrictive ventricular septal defect, a right ventricle with two outflows and a right aortic arch. Her last pregnancy was terminated at 22 weeks. The 22-week-old female fetus was examined postmortem and the diagnosis of congenital heart disease was confirmed. Conclusion Cobalamin and folate administration may help to reduce the development of cardiac malformations.     

Double-Outlet Left Ventricle with a Superiorly Positioned and Hypoplastic Left Ventricle

Double outlet left ventricle (DOLV) is a rare congenital cardiac malformation in which both the pulmonary artery and the aorta arise exclusively or predominantly from the morphologic left ventricle. We describe a case of DOLV with situs inversus, L-loop ventricles, d-malposition of the great arteries (I, L, D), superior-inferior ventricles, unbalanced complete atrioventricular septal defect, pulmonary stenosis, and total anomalous pulmonary venous return in which the left ventricle was also severely hypoplastic and superiorly positioned. Many morphologic variations of this malformation have been described, but to the best of our knowledge DOLV with superiorly positioned and hypoplastic left ventricle has not been reported before.     

Performance of MRSA ID chromogenic medium for detection of methicillin-resistant Staphylococcus aureus directly from blood cultures and clinical specimens

MRSA ID was evaluated to see its performance in identifying methicillin-resistant Staphylococcus aureus (MRSA) directly from blood culture bottles (n = 837), wound swabs (n = 112), and abscesses (n = 18). Each positive blood culture and clinical specimen was directly inoculated on MRSA ID and the culture media routinely used. The sensitivity of MRSA ID was 97.8% after 24 h and 100% after 48 h for blood cultures, and 88.9% after 24 h and 100% after 48 h for wound samples. The specificity was 99.7% after 24 h and 99.6% after 48 h for blood cultures, and 100% after 24 and 48 h for wound samples. Four strains with green colonies indicating MRSA on MRSA ID were identified as methicillin-susceptible S. aureus (MSSA) by conventional methods. Three of these MSSA strains showed negative results with the mecA polymerase chain reaction, and 1 strain harbored the mecA gene. Using MRSA ID with primary culture media should decrease the time (18-24 h) to report a positive result compared with conventional methods.     

B cell–derived IL‐1β and IL‐6 drive T cell reconstitution following lymphoablation

Understanding the mechanisms of T cell homeostatic expansion is crucial for clinical applications of lymphoablative therapies. We previously established that T cell recovery in mouse heart allograft recipients treated with anti‐thymocyte globulin (mATG) critically depends on B cells and is mediated by B cell–derived soluble factors. B cell production of interleukin (IL)‐1β and IL‐6 is markedly upregulated after heart allotransplantation and lymphoablation. Neutralizing IL‐1β or IL‐6 with mAb or the use of recipients lacking mature IL‐1β, IL‐6, IL‐1R, MyD88, or IL‐6R impair CD4⁺ and CD8⁺ T cell recovery and significantly enhance the graft‐prolonging efficacy of lymphoablation. Adoptive co‐transfer experiments demonstrate a direct effect of IL‐6 but not IL‐1β on T lymphocytes. Furthermore, B cells incapable of IL‐1β or IL‐6 production have diminished capacity to mediate T cell reconstitution and initiate heart allograft rejection upon adoptive transfer into mATG treated B cell deficient recipients. These findings reveal the essential role of B cell–derived IL‐1β and IL‐6 during homeostatic T cell expansion in a clinically relevant model of lymphoablation.     

Lessons learned from the Marmara disaster: Time period under the rubble

OBJECTIVE: To investigate the effect of the time period under the rubble on morbidity and mortality of the crush-syndrome patients after the catastrophic Marmara earthquake that struck northwestern Turkey in August 1999. DESIGN: Observational study. SETTING: Consecutive admissions to emergency and intensive care units of 35 reference hospitals that treated the renal victims. METHODS: Analysis of questionnaires obtained from these hospitals. PATIENTS: A total of 539 of 639 crush-syndrome patients whose time under the rubble was identified in the questionnaires. RESULTS: Mean time under the rubble was 11.7 +/- 14.3 hrs (median, 8 hrs; interquartile range, 6 hrs; range, 0.5-135 hrs). The highest number of patients was entrapped within the 5-8 hrs time stratum, and by the end of 48 hrs, 97% of the victims had been rescued. Nondialyzed victims spent a longer duration under the rubble than dialyzed ones (15.9 +/- 23.1 hrs [median, 7 hrs; interquartile range, 8.5 hrs] vs. 10.3 +/- 9.5 hrs [median, 8 hrs; interquartile range, 6 hrs), p <.001)]. Likewise, in the strata of longer time under the rubble, the percentage of survivors was higher (p =.07). Time under the rubble correlated positively with the number of amputated extremities (p <.001) and admission platelet count (p <.001), and it correlated negatively with admission serum albumin (p <.001). The victims entrapped for >50 hrs (n = 6) were characterized by lower figures of admission blood urea nitrogen (p =.04), serum creatinine (p =.003), hemodialysis sessions, and duration of hemodialysis support (p =.005, for both analyses) compared with victims whose time under the rubble was shorter. CONCLUSION: Rescue efforts should continue at least for 5 days after the disaster. Time under the rubble is not an adverse prognostic indicator of survival or renal dysfunction for the patients of crush syndrome, probably because only the victims with mild or moderate injuries can survive under the rubble for longer durations.     

Are high initial CEA and CA 19–9 levels associated with the presence of K-ras mutation in patients with metastatic colorectal cancer?

In certain cell culture studies, significant CEA expression was observed in K-ras mutant cells. However, the relationship between high CEA levels and K-ras status has not been sufficiently investigated. In the present study, we aimed to determine the prognostic role of initial CEA and CA 19–9 values in metastatic colorectal cancer patients according to the status of K-ras. Between 2000 and 2010, a total of 215 patients with metastatic colorectal cancer who were treated and followed up in our oncology center were analyzed. Smokers were excluded from the study. The clinicopathological findings and initial CEA and CA19-9 values were determined. K-ras mutation analysis was performed using quantitative PCR evaluation of the DNA from the tumor tissues. Eighty-two patients (38.1 %) were female and 133 (61.9 %) were male, with a median age of 59 years (range 27–83). Based on tumor localization, 127 patients (59 %) were classified as colon cancer patients and 88 patients (41 %) were classified as rectal cancer patients. The majority of patients (83.3 %) had pure adenocarcinoma histology, while 36 cases (16.7 %) had mucinous adenocarcinoma. The initial CEA levels were detected to be high (>5 ng/mL) in 108 of the patients (50.2 %), while high levels of initial CA 19–9 (>37 ng/mL) were found in 90 patients (41.8 %). K-ras mutations were detected in 99 of the patients (46 %). K-ras was found to be wild type in 116 patients (54 %). Significant differences were detected between the K-ras wild-type and mutant groups with respect to age and the initial serum CEA levels. Patients with K-ras mutations were younger (p?=?0.04) and had higher initial CEA levels (p?=?0.02) compared to patients with K-ras wild type. The median overall survival (OS) time and 3-year OS rate for patients with a high initial CEA level (>5 ng/mL) were significantly shorter than those of patients with a low initial CEA level (<5 ng/mL) (50.5 months and 61.8 % vs. 78.6 months and 79.1 %, p?=?0.014). Furthermore, the patients with low initial CA 19–9 levels (<37 ng/mL) had a significant better median OS interval and 3-year OS rate (76.1 months and 80.1 %) compared to patients with high initial CA 19–9 levels (>37 ng/mL) (37.6 months and 55.7 %, p?=?0.04). Multivariate analysis indicated that stage at the time of diagnosis (p?<?0.001) and low initial serum CEA level (p?=?0.037) were independent prognostic factors of OS. For K-ras mutant patients, the stage at diagnosis (p?=?0.017), low initial serum CEA level (p?=?0.001), and low initial serum CA 19–9 level were found to be independent prognostic indicators of OS. Our findings demonstrate for the first time that the presence of a K-ras mutation correlated with high initial CEA and CA 19–9 levels in patients with metastatic colorectal cancer. Patients with high initial CEA and CA 19–9 levels may potentially predict the presence of a K-ras mutation, and this prediction may guide targeted therapies in these patients.     

Histopathological effects of ethyl 2-cyanoacrylate tissue adhesive following surgical application: an experimental study.

OBJECTIVES: To investigate experimentally the possible histopathological effects of ethyl 2-cyanoacrylate glue when used as a tissue adhesive in cardiovascular and thoracic surgery. METHODS: Sprague-Dawley rats were used for this study. For histopathological investigation, a study group of 144 rats in which intentionally produced lesions in myocardium (n=36), ascending aorta (n=36), lung (n=36) and abdominal aorta (n=36) were closed by using ethyl 2-cyanoacrylate was compared with the control group (n=144) in which the same lesions were closed by using sutures. On each of days 1, 7, 15, 30, 45 and 60, six rats from the study group and six rats from the control group were sacrificed and analyzed for each relevant organ in terms of bonding of ethyl 2-cyanoacrylate polymers to tissue, foreign body reaction, inflammatory reactions, and necrosis. Endothelial cell damage, intimal hyperplasia, and thrombus formation were also evaluated in arteriotomy sections. RESULTS: In histopathological analysis of vascular, myocardial and pulmonary tissue sections, there was no significant histopathological difference between conventionally sutured tissues and ethyl 2-cyanoacrylate-applied tissues. CONCLUSIONS: As no significant difference between conventional suture and ethyl 2-cyanoacrylate application was detected in terms of histopathological reactions, ethyl 2-cyanoacrylate may be considered as an alternative or adjunct to conventional techniques in controlling hemorrhage that cannot be controlled by conventional methods, in tissue repair and in the control of pulmonary air leakage, and may be used in vascular, myocardial and pulmonary surgery.