Synergistic effects of ischemic preconditioning and immediate post‐conditioning in the protection against ischemia/reperfusion injury in rabbit submandibular glands

Submandibular gland autotransplantation is an effective approach for treating severe keratoconjunctivitis sicca. However, ischemia/reperfusion (I/R) injury, which inevitably occurs during transplantation, is involved in the hypofunction and structural damage that occur early after transplantation. Therefore, it is critical to identify effective strategies to ameliorate I/R injury in submandibular glands. In this study, we investigated the ability of immediate post‐conditioning combined with ischemic preconditioning to attenuate I/R injury. We observed that after I/R injury, the level of reactive oxygen species was increased, inflammatory response was strengthened, and severe apoptosis had occurred. In addition, the salivary flow rate was greatly decreased. However, the pathogenesis of I/R injury was significantly ameliorated by ischemia post‐conditioning or ischemia preconditioning treatments. In addition, the combination of ischemia preconditioning and post‐conditioning achieved synergistic protective effects against I/R injury compared with ischemia preconditioning or ischemia post‐conditioning alone. The secretion function was restored in the combination group. Furthermore, the combination treatment involved the same mechanisms of ischemia preconditioning or ischemia post‐conditioning, including suppression of the inflammatory reaction and neutrophil accumulation, attenuation of oxidation stress, and inhibition of apoptosis. In conclusion, the combination of ischemia preconditioning and ischemia post‐conditioning treatment is a simple and effective approach for treating I/R injury in submandibular glands.     

FTT0831c/FTL_0325 Contributes to Francisella tularensis Cell Division,Maintenance of Cell Shape,and Structural Integrity

The Francisella FTT0831c/FTL_0325 gene encodes amino acid motifs to suggest it is a lipoprotein and that it may interact with the bacterial cell wall as a member of the OmpA-like protein family. Previous studies have suggested that FTT0831c is surface exposed and required for virulence of Francisella tularensis by subverting the host innate immune response (M. Mahawar et al., J. Biol. Chem. 287:25216–25229, 2012). We also found that FTT0831c is required for murine pathogenesis and intramacrophage growth of Schu S4, but we propose a different model to account for the proinflammatory nature of the resultant mutants. First, inactivation of FTL_0325 from live vaccine strain (LVS) or FTT0831c from Schu S4 resulted in temperature-dependent defects in cell viability and morphology. Loss of FTT0831c was also associated with an unusual defect in lipopolysaccharide O-antigen synthesis, but loss of FTL_0325 was not. Full restoration of these properties was observed in complemented strains expressing FTT0831c in trans, but not in strains lacking the OmpA motif, suggesting that cell wall contact is required. Finally, growth of the LVS FTL_0325 mutant in Mueller-Hinton broth at 37°C resulted in the appearance of membrane blebs at the poles and midpoint, prior to the formation of enlarged round cells that showed evidence of compromised cellular membranes. Taken together, these data are more consistent with the known structural role of OmpA-like proteins in linking the OM to the cell wall and, as such, maintenance of structural integrity preventing altered surface exposure or release of Toll-like receptor 2 agonists during rapid growth of Francisella in vitro and in vivo.     

Intravenous Lipid Emulsion Improves Recovery Time and Quality from Isoflurane Anaesthesia: A Double‐Blind Clinical Trial

Recovery time and quality after general anaesthesia is important for patient safety. This study aimed to determine whether intravenous lipid emulsion could improve recovery profiles from isoflurane anaesthesia in adult patients undergoing laparoscopic cholecystectomy. Sixty‐six patients were enrolled. After anaesthesia induction, inspired isoflurane concentration was adjusted to maintain stable vital signs and the suitable conditions for operation. At the end of the operation, the isoflurane was discontinued, and either 2 ml/kg 30% lipid emulsions or 0.9% saline solution was administered intravenously. The time to eye opening, extubation and exit from the operation room was recorded, and the quality of recovery from anaesthesia was assessed. Sixty patients completed the study. The median time to eye opening and exit from the operation room was significantly shorter in the lipid emulsion group than in the saline group [15.5 (interquartile range 9.0) versus 20.0 (10.0) min., p = 0.01; 19.5 (8.3) versus 23.6 (6.3) min., p = 0.04, respectively], whereas the median time to extubation did not show any noticeable difference. The quality of recovery was better in the lipid emulsion group than that of the saline solution group with respect to drowsiness visual analogue scale score (p < 0.01), Observer's Assessment of Alertness/Sedation score (p < 0.01), Mini‐Mental State Examination score (p = 0.04) and Modified Aldrete Post Anaesthesia Recovery score (p = 0.03). No serious adverse events were observed during the study period. In conclusion, intravenous lipid emulsion may effectively improve the recovery time and quality from isoflurane anaesthesia for laparoscopic cholecystectomy.     

The effects of cochlear implantation on quality of life in the elderly

The purpose of this study was to evaluate the benefits of unilateral cochlear implant (CI) in patients over 60 on speech perception and quality of life, comparing the results obtained with a control group of younger CI recipients. Twenty CI users (mean age 72 years), postlingually deafened, were included in this study. Audiological performance was evaluated using bisyllabic words and sentences recognition tests in a quiet and a noise environment. Moreover, we administered two questionnaires to evaluate the health status (SF-36), CI-related effects on daily activities and personal satisfaction (Questionnaire for self-evaluation of CI benefit with SADL scale modification). Performance measures of the geriatric population showed a significant benefit on speech recognition tests compared to pre-implantation condition, even if younger CI users scored significantly better in both bisyllabic words and sentences recognition test. All study patients reported being able to have a normal conversation with an acquaintance. No significant difference was found between the study and control group in physical and mental health status, conversation with an outsider, use of TV and phone. A significant difference (p < 0.05) was noticed, instead, between elderly and younger adult patients about the overall satisfaction derived from CI. Our findings confirm the indisputable utility of CI and provide evidence that elderly patients derive a substantial benefit from it on quality of life, as demonstrated by health status, success in the common activities of daily living and perceived satisfaction after this procedure.