Hemodilution and intravenous perflubron emulsion as an alternative to blood transfusion: effects on tissue oxygenation during profound hemodilution in anesthetized dogs

BACKGROUND: Intravenously administered perfluorocarbon (PFC) emulsions increase oxygen solubility in plasma. PFC might therefore temporarily replace red cells (RBCs) lost during intraoperative hemorrhage. In patients who have undergone hemodilution, the return of autologous blood may be delayed by the administration of PFC, and autologous RBCs may be saved for transfusion after surgical bleeding is stopped and PFC is cleared by the reticuloendothelial system. STUDY DESIGN AND METHODS: In 22 anesthetized, hemodiluted dogs (hemoglobin [Hb] 7 g/dL) breathing 100-percent O2, an intraoperative volume-compensated blood loss was simulated. The efficacy of three therapeutic regimens in maintaining tissue oxygenation was compared: 1) RBC group (n = 7): maintenance of a Hb > 7 g per dL by transfusion of autologous RBCs; 2) PFC group (n = 7): bolus application of a second-generation PFC emulsion (60% wt/vol perflubron) and further acute normovolemic hemodilution (ANH) to a Hb of 3 g per dL; and 3) control group (n = 7): further ANH alone to a Hb of 3 g per dL. Systemic and myocardial oxygenation status and tissue oxygenation were assessed. RESULTS: Autologous RBCs transfused to maintain a Hb of 7 g per dL preserved hemodynamics and tissue oxygenation during blood loss. In the PFC and control groups, heart rate and cardiac index increased significantly in response to further ANH. Tissue oxygenation was not different in the PFC and the RBC groups. Direct comparison of the PFC and control groups revealed better tissue oxygenation in the PFC group, as reflected by significantly higher mixed venous, coronary venous, and local tissue pO2 on liver and skeletal muscle. CONCLUSION: Bolus intravenous administration of 60- percent (wt/vol) perflubron emulsion and further hemodilution from a Hb of 7 g per dL to one of 3 g per dL were as effective as autologous RBC transfusion in maintaining tissue oxygenation during volume-compensated blood loss designed to mimic surgical bleeding.     

Molecular analysis of cutaneous B- and T-cell lymphomas

Among extranodal non-Hodgkin's lymphomas, primary cutaneous lymphomas (CLs) represent a consistent group of B- and T-cell malignancies. We investigated the arrangement of Ig and T-cell receptor (TCR) genes, together with the involvement of several oncogenes and the tumor- suppressor gene p53, in a panel of primary cutaneous B- and T-cell lymphomas (CBCLs and CTCLs). Southern blot analysis was performed to detect rearrangements of the Ig, c-myc, bcl-1, bcl-2, bcl-3, bcl-6, and the NFKB2/lyt-10 genes in 52 cases of CBCLs and of the TCR, bcl-3, and NFKB2/lyt-10 genes in 38 cases of CTCLs. tal-1 gene deletions were analyzed in CTCLs by means of polymerase chain reaction (PCR). p53 gene mutations were assayed using PCR, single-strand conformation polymorphism analysis, and direct DNA sequencing in CBCL and CTCL cases. Clonal rearrangements of Ig genes or oncogenes were found in 25 of the 52 CBCLs. In particular, we detected rearrangements of the bcl-1 locus (2 cases), the bcl-2 gene (2 cases), the NFKB2/lyt-10 gene (2 cases), and the bcl-6 gene (1 case); interestingly, 4 of these cases showed a germline arrangement of the Ig genes. Clonal rearrangements of TCR genes were detected in 37 of the 38 CTCLs. Rearrangements of the NFKB2/lyt-10 gene were present in 2 cases and tal-1 gene deletions in 3 CTCL cases; p53 gene mutations were detected in 1 CTCL case. Overall, our data indicate that (1) clonal rearrangement of Ig genes is frequently undetectable by means of Southern blot in CBCLs (60%); (2) genetic lesions are involved in a limited but significant fraction of primary CLs showing a molecular marker of clonality (13/62; 20%); and (3) rearrangements of the bcl-1, bcl-2, or bcl-6 loci, associated with specific subsets of nodal lymphoid neoplasias, are rarely observed in CBCLs. Moreover, our results suggest that tal-1 gene deletions may play a pathogenetic role in non-acute T-cell malignancies and that, in the context of lymphoid malignancies, CLs may represent a favorable target for the possible oncogenic potential of the NFKB2/lyt-10 gene.     

SUBGLOTTIC STENOSIS SECONDARY TO TUBERCULOSIS

Although the incidence of laryngeal tuberculosis has been declining over the past 30 years, it should still be considered in the differential diagnosis of patients with laryngeal pathology. In contrast to the pre-chemotherapy era, few, if any, signs of pulmonary tuberculosis are seen in such cases, and presentation is similar to either chronic non-specific laryngitis or carcinoma. The subglottis is a site rarely involved in laryngeal tuberculosis. Tissue biopsy and culture are diagnostic and a full course of antituberculous chemotherapy usually resolves the condition. Airway insufficiency due to fibrosis, however, often necessitates surgical Intervention. We present a case where the only laryngeal manifestation of tuberculosis was subglottic stenosis.     

The effect of employment on the relationship between gender-role preference and self-esteem in married women

The purpose of this study was to examine relationships among gender-role preference, self-esteem and employment category (full-time, part-time, homemaker) while controlling for the effects of income and religion. Data were collected from 79 White married women using the Rosenberg Self-Esteem Scale and a gender-role preference scale developed by the author. Findings indicated that: (a) there are significant differences in gender-role preference among categories of employment, with full-time workers having more modern views; (b) category of employment did not influence self-esteem; and (c) women with mixed gender-role preference had lower self-esteem than those with modern gender-role preference. The strength of the relationship between self-esteem and gender-role preference varied by category of employment. Gender-role preference made a significant contribution as a predictor of self-esteem (above and beyond the effects of income and religion) for full-time workers only.     

Normal instability of the hip in the neonate: US standards

In recent years, the use of real-time ultrasonography (US) has enabled dynamic evaluation of the infant hip through a range of motion and stress. Preliminary experience has suggested that a certain amount of instability in the hips of newborns is normal, but no standards have been established. In this study, a group of term neonates whose physical examinations were normal were examined with US on the 1st and 2d days of life. Each hip was imaged in the transverse plane in nonstressed and stressed positions, and movement of the femoral head under stress was quantitated. This displacement under stress was used to establish a normal range of hip instability in neonates. Patterns of hip laxity in boys and girls are identical, and in most infants hip instability diminishes between the 1st and 2d days of life. Our method of quantitating hip instability produces consistent results, with intraobserver 95% confidence intervals of +/- 1.2 mm for each measurement.     

Antimicrobials as a contributory factor in oral candidosis – a brief overview

The advent of the human immunodeficiency virus infection and the increasing prevalence of compromised individuals in the community due to modern therapeutic advances have resulted in a resurgence of opportunistic infections, including oral candidosis, which is by far the most common oral fungal infection in man. Broad-spectrum antibiotics used in the treatment of a wide range of disease conditions have also been attributed as a predisposing factor of oral candidosis. In this mini review we discuss the research findings on the relationship between antibiotics and oral candidosis and possible mechanisms of pathogenicity following such therapy.     

In vivo red cell destruction by anti-Lu6

An example is presented of an IgG1, anti-Lu6, that reacted by indirect antiglobulin test and was capable of destroying antigen-positive red cells in vivo. Two methods for the measurement of red cell survival, 51Cr labeling and flow cytometry, gave the same result: 20 percent of the test dose of Lu:6 red cells was destroyed in the first hour after injection and 80 percent in the first 24 hours. The clinical relevance of the antibody was correctly predicted by an in vitro monocyte monolayer assay. The finding that this example of anti-Lu6 was clinically significant should not be taken to mean that all antibodies directed against high-incidence Lutheran and Lutheran system-related antigens will behave similarly. When such antibodies are encountered, in vivo and/or in vitro studies to assess their clinical significance are necessary before rare blood is used for transfusion.     

流式细胞分选术和Rho123在分离MHCC97肿瘤干细胞中的应用

目的:肝癌组织中可能存在具有表型和功能特殊的肝癌细胞,分离和鉴定这群细胞是否具有干细胞特征对阐明肝癌发病机制、揭示肝癌复发和转移具有重要的意义。寻求分离MHCC97肿瘤干细胞的有效方法,探讨角蛋白(CK-19)在不同肝癌细胞亚群中的表达差异。方法:实验于2006-11/2007-05在解放军第四军医大学免疫实验室和肝胆外科实验室完成。细胞来源:MHCC97肝癌细胞(人高转移肝癌细胞系)由上海复旦大学中山医院肝癌研究所提供。实验方法:MHCC97细胞常规消化,HBSS洗涤,制备成单细胞悬液,细胞密度为1×109L-1。每份取1×106个细胞,参考Rho123对线粒体膜电位测定的0.1mg/L质量浓度,分别做0.1mg/L和0.05mg/L两个质量浓度细胞梯度染色,对照组加入维拉帕米(终浓度50mmol/L),以未加Rho123作为阴性对照。实验评估:采用免疫细胞化学方法观察细胞角蛋白19在0.05mg/LRho123细胞及0.1mg/LRho123两组中的表达和含量。结果:单纯加入Rho123组有一低荧光拖尾,而维拉帕米拮抗组无此区域,即0.05mg/LRho123细胞占总数的2.1%,其余为0.1mg/LRho123组细胞。两组细胞内均有细胞角蛋白19阳性表达,阳性反应为显示位于细胞质的棕黄色颗粒,两组比较有统计学差异(P<0.05)结论:细胞角蛋白19在肝癌细胞亚群中表达有差异,强阳性多数分布在0.05mg/LRho123组中,Rho123结合流式细胞分选术可以有效地分选出癌细胞中的肿瘤干细胞。