Bench-to-bedside review: Delirium in ICU patients - importance of sleep deprivation

Delirium occurs frequently in critically ill patients and has been associated with both short-term and long-term consequences. Efforts to decrease delirium prevalence have been directed at identifying and modifying its risk factors. One potentially modifiable risk factor is sleep deprivation. Critically ill patients are known to experience poor sleep quality with severe sleep fragmentation and disruption of sleep architecture. Poor sleep while in the intensive care unit is one of the most common complaints of patients who survive critical illness. The relationship between delirium and sleep deprivation remains controversial. However, studies have demonstrated many similarities between the clinical and physiologic profiles of patients with delirium and sleep deprivation. This article aims to review the literature, the clinical and neurobiologic consequences of sleep deprivation, and the potential relationship between sleep deprivation and delirium in intensive care unit patients. Sleep deprivation may prove to be a modifiable risk factor for the development of delirium with important implications for the acute and long-term outcome of critically ill patients.     

中老年尿毒症患者肾移植术前后左室结构和功能的对比分析

目的 分析20例中老年尿毒症患者肾移植前、后左室结构和功能的改变.方法 二维、M型及多普勒超声心动图测量20例正常人、20例中老年尿毒症患者肾移植前、肾成功移植后1个月及三个月以后的左室结构及功能.结果 病例组肾移植后一个月扩张的左房内径、左室舒末径均较术前减小,增厚的左室壁厚度开始变薄,三个月后增厚的左室壁厚度、收缩功能及舒张功能较移植术前明显改善(P<0.01),左房内径及左室壁厚度仍高于对照组(P<0.05),左室舒末径与正常无差异.结论 中老年尿毒症患者在成功进行肾移植术后,左室的结构及功能逐渐得以改善,术后3个月变化明显.     

Effects of Subchronic Exposure via Drinking Water to a Mixture of Eight Water-Contaminating Metals: A Biochemical and Histopathological Study in Male Rats

In the current study, we examined whether subchronic exposure via drinking water to low doses of a mixture of metals (arsenic, cadmium, lead, mercury, chromium, manganese, iron, and nickel), found as contaminants in various water sources of India, and to concentrations equivalent to WHO maximum permissible limits (MPL) in drinking water for individual metals, can alter systemic physiology of male rats. Data on water contamination with metals in India were collected from the literature and metals were selected on the basis of their frequency of occurrence and contamination level above MPL. Male Wistar rats were exposed to the mixture at 0, 1, 10, and 100 times the mode concentrations (the most frequently occurring concentration) of the individual metals via drinking water for 90 days. One more group of rats was exposed to the mixture at a concentration equivalent to the MPL (WHO) in drinking water for individual metals. Toxic potential of the mixture was evaluated by assessing general toxicological end points, serum chemistry and histopathology of vital organs. The mixture decreased body weight and water consumption and increased weights of brain, liver, and kidneys with 10× and 100× doses. After 30 days of exposure, no appreciable changes were found in any blood clinical markers. After 60 days, only the 100× dose, while after 90 days both 10× and 100× doses increased activities of aspartate aminotransferase and alkaline phosphatase and levels of urea nitrogen and creatinine and decreased total protein and albumin levels, but alanine aminotransferase activity and glucose level were not affected. At 10× and 100× exposure levels, qualitatively similar, but dose-dependent vascular, degenerative, and necrotic changes were observed in brain, liver, and kidney. The results indicate that subchronic exposure to the metal mixture affected general health of male rats by altering the functional and structural integrity of kidney, liver, and brain at 10 and 100 times the mode concentrations of the individual metals in Indian water sources, but exposure at mode concentrations of contemporary water contamination levels or at concentrations equivalent to the MPL for individual metals in drinking water may not cause any health hazards in male rats.     

A multi-institutional analysis of 263 hilar tumors during robot-assisted partial nephrectomy

Journal of Robotic Surgery - Hilar tumors pose unique challenges during partial nephrectomy. We present the characteristics and outcomes of 263 patients with hilar tumors undergoing robot-assisted...     

Carcinogenic effects in the syrian golden hamster of N-methyl-N-formylhydrazine of the false morel mushroom gyromitra esculenta

Summary N-Methyl-N-formylhydrazine (MFH) was administered in drinking water as a 0.0078% solution oto randomly bred Syrian golden hamsters for life beginning at 6 weeks of age. The treatment gave rise to benign and malignant liver cell tumors, malignant histiocytomas and tumors of tha gall bladder and bile ducts. The tumor incidence in these four treated tissues was 43, 34, 11,8%, while in untreated controls it was 0, 0, 0, 0%, respectively. Histopathologically, tumors were classified as benign hepatomas, liver cell carcinomas, malignant histiocytomas, adenomas and adenocarcinomas of the gall bladder, cholangiomas, and cholangiocarcinomas.The edible false morel mushroom contains a substantial amount of N-methyl-N-formylhydrazine. In view of its earlier reported carcinogenicity in mice and now in hamsters, the human population should obviously abandon the consumption of this fungus.Supported by USPHS Contract NO1 CP33278 from the National Cancer Institute, NIH, USA