Fos expression in the sleep-active cell group of the ventrolateral preoptic area in the diurnal murid rodent, Arvicanthis niloticus

The ventrolateral preoptic area (VLPO) of the nocturnal laboratory rat receives direct input from the retina and is active during sleep; however, nothing is known about VLPO function in day-active (diurnal) species. In the first study, we used 24-h videotaping of Arvicanthis niloticus, a diurnal murid rodent, to estimate the distribution of sleep and wakefulness across a 12:12 light-dark cycle. Based on behavioral data, A. niloticus were perfused at a time when the animals are inactive (zeitgeber time (ZT) 20) or at a time when they are awake and active (ZT 23). The brains were processed for immunocytochemistry for Fos, an immediate early gene product used as an index of neural activity. Animals had more Fos-immunoreactive (Fos+) cells in the VLPO at ZT 20 than at ZT 23. The pattern of change in Fos expression seen in this area suggest that the VLPO serves the same function in A. niloticus as in rats. Eye injections of cholera toxin (beta subunit) were used to identify the retinal inputs to the VLPO of A. niloticus. In these animals, the VLPO had only very sparse retinal inputs compared to the rat. Together, these results raise the possibility that inputs from the suprachiasmatic nucleus (SCN) or the retina affect neuronal activity in the VLPO differently in rats and A. niloticus, thereby, contributing to differences in their sleep/wake patterns.     

Enteral nutrition in intensive care patients: a practical approach.

Severe protein-calorie malnutrition is a major problem in many intensive care (ICU) patients, due to the increased catabolic state often associated with acute severe illness and the frequent presence of prior chronic wasting conditions. Nutritional support is thus an important part of these patient's management. Over the years, enteral nutrition (EN) has gained considerable popularity, due to its favorable effects on the digestive tract and its lower cost and rate of complications compared to parenteral nutrition. However, clinicians caring for ICU patients are often faced with contradictory data and difficult decision-making when having to determine the optimal timing and modalities of EN administration, estimation of patient requirements and choice of formulas. The purpose of this paper is to provide practical guidelines on these various aspects of enteral nutritional support, based on presently available evidence.     

去甲硫氨酸全肠外营养对大鼠血清氨基酸谱的影响

目的观察去甲硫氨酸全肠外营养对大鼠血清氨基酸谱等的影响.方法 Wistar大鼠24只,随机分为含甲硫氨酸(+MetTPN,n=12)和去甲硫氨酸全肠外营养2组(-MetTPN,n=12),分别给予相应的TPN支持.治疗7d后,每组随机抽取6只大鼠处死,检测血清FAA(HPLC法)、肝肾功能和全血常规,同时作心、肺、肝、肾组织病理学检查.两组其余大鼠继续原TPN治疗,观察生存期.结果 -MetTPN组大鼠血清游离Met、Cys明显降低,Asp、Glu、Ser等显著增高;大鼠体重下降;血清总蛋白和白蛋白水平下降;血常规和肾功能未见明显异常;组织学检查见肝细胞轻度肿胀,细胞核仁增粗,心肺肾未见明显异常;平均生存18d.对照组上述检查未见异常,除一只大鼠因导管并发症于TPN第16d死亡,其余大鼠全部存活.结论 -MetTPN一周可致大鼠血清游离Met、Cys明显降低和Asp、Glu、Ser等显著增高,及轻度肝功能改变;随着-MetTPN时间延长,出现严重的代谢紊乱和器官功能障碍导致死亡.     

Long-term results after surgical basal cell carcinoma excision in the eyelid region

AIMS: To evaluate the data for patients with basal cell carcinoma (BCC) in the eyelid region, to demonstrate histologically controlled tumour excision, and to prove the efficacy of the treatment on the basis of long term observations. METHODS: Retrospective analysis of 382 microscopically controlled BCC excisions in the eyelid apparatus (350 patients) in a follow up study over 5.7 (SD 1.1) years. Tumour location, tumour size, and histological results were recorded. The same procedure was followed for recurrences. Follow up examinations were carried out 1, 3, 6, and 12 months after the operation, and then annually for a further 4 years or longer. RESULTS: A recurrence rate of 5.36% was observed after the primary operation. 60.3% of first recurrences occurred in the medial canthus, 41.2% showed in depth extension, and sclerosing types were overly represented at 35.3%. After the second operation the recurrence rate increased to 14.7% and reached 50% after a third and fourth operation. CONCLUSIONS: The greatest risk of recurrence exists for BCCs of the medial canthus with in depth extension, and for sclerosing types. The recurrence rate increases after every operation. For high risk cases, consideration should be given to adjuvant treatment such as radiotherapy.     

Surgical treatment of urethral stricture: Still a problem?

In the introduction the author stresses that the main facts which decide the choice and prognosis of therapy are localization, length and the so-called complexity of the stricture. His 15-year material from 388 operations on 290 patients is presented.Circular strictures of the anterior urethra (a total of 135 operations) are treated through endoscopic urethrotomy as the primary procedure and mostly by open resection as the secondary one. Longitudinal strictures of the anterior urethra (199 operations) are treated by marsupialization, pedicled cutaneous flap and Michalowski's sleeve technique as primary procedures. As the secondary procedure (after failure of the first operation) marsupialization only was performed. Complex strictures of the posterior urethra (total 54) were treated mostly by transpubic approach, which showed good results in 74% cases on 41 operations.     

Inhibition of bone repair in a rat model for chronic and excessive alcohol consumption.

Alcohol abuse is associated with increases in both the incidence of fractures and complications in fracture healing. The purpose of this study was to determine the dose-dependent effects of ethanol on bone repair in a rat model. Three-month-old male Wistar rats were continuously fed liquid diets containing ethanol as either 36% or 26% of total calories or control diets for 6 weeks. Then, a bone repair model was created in all rats. Bone healing and liver metabolism were evaluated 7 weeks after bone injury. For each dose, there were three ethanol-feeding groups receiving (1) ethanol for 13 weeks, (2) control diet for 13 weeks (pair-fed), and (3) ethanol before bone injury and control diet (pair-fed) after injury. Another group was fed ethanol (36%) before injury and given control diet ad libitum after injury. There were also two nutritional controls consuming control diet and standard rat chow ad libitum for 13 weeks. Abnormal liver metabolism was evident at the higher ethanol dose - increases in cytochrome P4502E1 specific activity (5-fold; P < .01), triglyceride content (4-fold; P < .02), and liver weight (25%; P = .05) - compared with pair-fed controls. The higher dose of ethanol resulted in deficient bone repair when compared with rats receiving ethanol-free control diet by pair-feeding: 26% less (P = .02) rigidity of the repaired bone, 41% less (P = .02) intrinsic stiffness, 24% less intrinsic strength (P = .05), and 14% less (P = .001) ash density of the repair tissue. The reduced food consumption of ethanol-fed rats compared with that in the nutritional controls did not contribute to this deficiency. Furthermore, removal of ethanol (as 36% of calories) from the diet after bone injury completely restored normal bone healing and nearly normalized the liver metabolism. The lower ethanol dose (26% of calories) had a minimal effect on liver metabolism and bone repair. We conclude that ethanol (as 36% of calories) in the rat diet, especially during the postinjury period, was solely responsible for the observed inhibition of bone repair.     

Preliminary assessment of an automated surveillance system for infection control.

BACKGROUND AND OBJECTIVE: Rapid identification and investigation of potential outbreaks is key to limiting transmission in the healthcare setting. Manual review of laboratory results remains a cumbersome, time-consuming task for infection control practitioners (ICPs). Computer-automated techniques have shown promise for improving the efficiency and accuracy of surveillance. We examined the use of automated control charts, provided by an automated surveillance system, for detection of potential outbreaks. SETTING: A 656-bed academic medical center. METHODS: We retrospectively reviewed 13 months (November 2001 through November 2002) of laboratory-patient data, comparing an automated surveillance application with standard infection control practices. We evaluated positive predictive value, sensitivity, and time required to investigate the alerts. An ICP created 75 control charts. A standardized case investigation form was developed to evaluate each alert for the likelihood of nosocomial transmission based on temporal and spatial overlap and culture results. RESULTS: The 75 control charts were created in 75 minutes and 18 alerts fired above the 3-sigma level. These were independently reviewed by an ICP and associate hospital epidemiologist. The review process required an average of 20 minutes per alert and the kappa score between the reviewers was 0.82. Eleven of the 18 alerts were determined to be potential outbreaks, yielding a positive predictive value of 0.61. Routine surveillance identified 5 of these 11 alerts during this time period. CONCLUSION: Automated surveillance with user-definable control charts for cluster identification was more sensitive than routine methods and is capable of operating with high specificity and positive predictive value in a time-efficient manner.