Nocardiosis of the lung: chest radiographic findings in 21 cases

Pulmonary manifestations of nocardial infection were present in 21 patients, with microbiologic proof in all and pathologic proof in 12. An analysis of the findings in these patients, combined with a review of previous reports of nocardiosis, suggests several important conclusions for radiologists. First, nocardiosis may occur in otherwise healthy persons but is most common in compromised patients, especially those being treated with anti-inflammatory agents, particularly corticosteroids, for chronic obstructive pulmonary disease and other systemic diseases. As pathologic manifestations are both suppurative and granulomatous, the chest radiographic manifestations are pleomorphic and not specific. Consolidations and large irregular nodules, often cavitary, are most common; nodules, masses, and interstitial patterns also occur. Pleural effusions are quite common, and lymph nodes may be enlarged. Difficulty and slowness of culture growth, along with the lack of a serologic test for nocardiosis, necessitate its inclusion in the differential diagnosis for both compromised and noncompromised patients in whom an apparent pulmonary infection cannot be rapidly diagnosed.     

The relationship between right duct lymph flow and extravascular lung water in dogs given alpha-naphthylthiourea.

The relationship between right duct lymph flow and extravascular lung water was studied in 3 normal dogs and 15 dogs with pulmonary edema induced by alpha-naphthylthiourea (ANTU). Right duct lymph was collected in a pouch created by ligating jugular, subclavian, and brachiocephalic veins. Extravascular lung water was measured in vivo by double indicator dilution and post-mortem by weighting lungs before and after drying. Cardiac output, pulmonary artery and pulmonary artery wedge pressures, and the concentration of protein and electrolytes in plasma and right duct lymph were determined. Eight lungs were examined by light and electron microscopy. There was a direct relationship between right duct lymph flow (RDLF in milliters per hour per gram dry lung) and extravascular lung water (Qwl in milliliters per gram dry lung) which was best described by the equation RDLF=0.75-0.26 Qwl+0.03 (Qwl).2 Dogs with severe ANTU-induced edema had extensive lung capillary endothelial destruction but only mild interstitial swelling and no visible damage to type I alveolar epithelial cells. Cardiac output, pulmonary artery and wedge pressures, and protein and electrolyte concentrations did not correlate with either extravascular water or right duct flow. Thus, in ANTU-induced pulmonary edema right duct lymph flow was directly related to extravascular lung water with the highest flows occurring with severe edema. The absence of a rapid increase in lymph flow with small increases in extravascular water may be due to early sequestration of fluid in the alveolar space. Hemodynamic changes did not account for changes in lung water or lymph flow. The pulmonary interstitial factors relating increased extravascular water to lymph drainage remain to be determined.     

长期运动对十二指肠黏膜一氧化氮合成和铁贮存的调控效应

目的:观察长期运动对十二指肠黏膜一氧化氮合成和铁贮存的影响及一氧化氮对铁贮存的调节作用。方法:实验于2004-04/09在江苏大学医学院铁代谢研究室完成。①健康雌性SD大鼠40只,随机分为静息组、静息并应用一氧化氮抑制剂组、运动组、运动并应用一氧化氮抑制剂组,每组10只。②静息并应用一氧化氮抑制剂组和运动并应用一氧化氮抑制剂组饮用水中含有一氧化氮抑制剂(1g/L),运动组和运动并应用一氧化氮抑制剂组的大鼠游泳3个月。③3个月后分析各组大鼠血浆铁饱和度,一氧化氮浓度以及十二指肠黏膜一氧化氮含量和非血红素铁含量。结果:实验过程中死亡11只,进入结果分析29只(静息组8只、静息并应用一氧化氮抑制剂组5只、运动组8只、运动并应用一氧化氮抑制剂组8只)。①运动及一氧化氮抑制剂对大鼠血浆铁饱和度和一氧化氮浓度的影响:运动组的血浆铁饱和度低于静息组(P<0.01);运动并应用一氧化氮抑制剂组的血浆铁饱和度低于静息并应用一氧化氮抑制剂组(P<0.05),并且高于运动组(P<0.05)。运动组血浆一氧化氮浓度显著高于静息组(P<0.01);运动并应用一氧化氮抑制剂组的血浆一氧化氮浓度低于运动组(P<0.01),与静息并应用一氧化氮抑制剂组差别不显著(P>0.05)。②运动及一氧化氮抑制剂对大鼠十二指肠黏膜一氧化氮和非血红素铁含量的影响:运动组的十二指肠一氧化氮含量高于静息组(P<0.01);静息并应用一氧化氮抑制剂组的一氧化氮含量低于静息组(P<0.01);运动并应用一氧化氮抑制剂组的一氧化氮含量低于运动组(P<0.01),但高于静息并应用一氧化氮抑制剂组(P<0.01),与静息组差别不显著。与静息组比较,运动组和静息并应用一氧化氮抑制剂组的十二指肠黏膜非血红素铁含量均降低(P<0.05)。结论:静息状态下十二指肠黏膜细胞一氧化氮合成具有较高的紧张性,可能参与维持非血红素铁含量。长期运动可刺激十二指肠黏膜一氧化氮合成,降低铁贮存。但其机制是否涉及运动诱导的一氧化氮的直接作用以及是否参与铁吸收的调节有待于进一步研究。     

DIGITAL ISCHAEMIA: AN UNUSUAL PRESENTATION OF DYSBARISM

SUMMARY Dysbaric symptoms following ascent from a scuba dive are due to symptomatic nitrogen or air emboli with clear patterns of associated injury. This case report highlights an unusual presentation of dysbaric injury treated successfully with a prostacyclin analogue.     

Renal transplantation following donation after cardiac death: impact of duration from withdrawal to asystole

Donation after cardiac death (DCD) allows for expansion of the donor pool, however, the process for DCD donation can lead to a donor's physiological instability before asystole. This may have a detrimental effect on graft and patient outcomes. We analyzed all 201 DCD donations at our unit from 2002 to 2009 and compared short versus long durations to asystole around the median time (20 min). Delayed graft function was comparable between the groups (P = .13), primary nonfunction was increased in the long duration to asystole group (P < .0001), and acute rejection was increased in the short duration group (P < .001). Five year patient survival was comparable (P = .6). In conclusion, long duration asystole may have an immediate effect on graft survival, but it has no overall detrimental effect on longer-term outcomes. Further studies are required to investigate the acceptable time to wait from withdrawal to asystole.     

The determination of stem cell fate by 3D scaffold structures through the control of cell shape

Stem cell response to a library of scaffolds with varied 3D structures was investigated. Microarray screening revealed that each type of scaffold structure induced a unique gene expression signature in primary human bone marrow stromal cells (hBMSCs). Hierarchical cluster analysis showed that treatments sorted by scaffold structure and not by polymer chemistry suggesting that scaffold structure was more influential than scaffold composition. Further, the effects of scaffold structure on hBMSC function were mediated by cell shape. Of all the scaffolds tested, only scaffolds with a nanofibrous morphology were able to drive the hBMSCs down an osteogenic lineage in the absence of osteogenic supplements. Nanofiber scaffolds forced the hBMSCs to assume an elongated, highly branched morphology. This same morphology was seen in osteogenic controls where hBMSCs were cultured on flat polymer films in the presence of osteogenic supplements (OS). In contrast, hBMSCs cultured on flat polymer films in the absence of OS assumed a more rounded and less-branched morphology. These results indicate that cells are more sensitive to scaffold structure than previously appreciated and suggest that scaffold efficacy can be optimized by tailoring the scaffold structure to force cells into morphologies that direct them to differentiate down the desired lineage.