The development of pediatric fluid resuscitation: an interview with Dr. Frederic A. ‘Fritz’ Berry

Dr. Frederic A. ‘Fritz’ Berry (1935), Professor Emeritus of Anesthesiology and Pediatrics at the University of Virginia, has played a pioneering role in the development of pediatric anesthesiology through training generations of anesthesiologists. He identifies his early advocacy of balanced electrolyte solution for perioperative fluid resuscitation as his defining contribution. Based on his clinical experiences, he pushed to extend the advances in adult fluid resuscitation into pediatric practice. He imparted these and other insights to his colleagues although textbooks, book chapters, original journal publications, and decades of Refresher Course Lectures at the American Society of Anesthesiologists' annual meetings. A model educator, clinician, and researcher, he shaped the careers of hundreds of physicians‐in‐training while advancing the field of pediatric anesthesiology.     

Genetic polymorphisms in NQO1 and SOD2: Interactions with smoking,schistosoma infection,and bladder cancer risk in Egypt

BackgroundBladder cancer is the most prevalent form of cancer in men among Egyptians, for whom tobacco smoke exposure and Schistosoma haematobium (SH) infection are the major risk factors. We hypothesized that functional polymorphisms in NAD(P)H:quinone oxidoreductase 1 (NQO1) and superoxide dismutase 2 (SOD2), modulators of the effects of reactive oxidative species, can influence an individual's susceptibility to these carcinogenic exposures and hence the risk of bladder cancer.MethodsWe assessed the effects of potential interactions between functional polymorphisms in the NQO1 and SOD2 genes and exposure to smoking and SH infection on bladder cancer risk among 902 cases and 804 population-based controls in Egypt. We used unconditional logistic regression to estimate the odds ratios (OR) and confidence intervals (CI) 95%.ResultsWater pipe and cigarette smoking were more strongly associated with cancer risk among individuals with the TT genotype for SOD2 (OR [CI 95%] = 4.41 [1.86–10.42]) as compared with those with the CC genotype (OR [CI 95%] = 2.26 [0.97–6.74]). Conversely, the risk associated with SH infection was higher among the latter (OR [CI 95%] = 3.59 [2.21–5.84]) than among the former (OR [CI 95%] = 1.86 [1.33–2.60]). Polymorphisms in NQO1 genotype showed a similar pattern, but to a much lesser extent. The highest odds for having bladder cancer following SH infection were observed among individuals with the CC genotypes for both NQO1 and SOD2 (OR [CI 95%] = 4.41 [2.32–8.38]).ConclusionOur findings suggest that genetic polymorphisms in NQO1 and SOD2 play important roles in the etiology of bladder cancer by modulating the effects of known contributing factors such as smoking and SH infection.     

NLR is predictive of upstaging at the time of radical cystectomy for patients with urothelial carcinoma of the bladder

ObjectiveTo evaluate the ability of preoperative neutrophil-lymphocyte ratio (NLR) to predict pathologic upstaging and nonorgan-confined (NOC) (≥pT3) disease.Methods and materialsAfter institutional review board approval, the records of consecutive patients undergoing radical cystectomy (RC) for urothelial carcinoma from 2002 to 2012 at the University of Wisconsin Hospital were reviewed. A total of 102 patients with NLR within 100 days of surgery were eligible for analysis. The primary outcome was difference in stage from preoperative assessment to time of RC. Differences in preoperative NLR between groups were evaluated with an unequal variance t test. A univariate analysis assessed whether NLR, preoperative stage, grade, associated lymphovascular invasion, preoperative hydronephrosis, gender, previous pelvic radiotherapy, previous intravesical bladder cancer treatments, or nodal stage were related to upstaging. Multivariate analyses were performed to evaluate the relationship of NLR to upstaging and relative organ-confined (≤pT2) and NOC disease.ResultsOf 390 consecutive patients undergoing RC, 102 patients met study criteria. Overall, 55 (53.9%) patients were upstaged, 25 (25.5%) were unchanged, and 21 (20.6%) were downstaged. Fifty-one patients (50%) were upstaged to more advanced disease (≥pT3). NLR and preoperative hydronephrosis were significantly related to pathologic tumor staging. NLR, preoperative hydronephrosis, and preoperative tumor stage were significantly related to upstaging to NOC disease. Patients who were upstaged to≥pT3 demonstrated statistically significant greater NLRs (4.33±0.87) compared with patients who remained at≤pT2 stage (2.66±0.29) (P<0.001).ConclusionsPreoperative NLR is a simple measurement that can be used to identify high-risk patients who may be upstaged at the time of RC and may benefit from neoadjuvant chemotherapy.     

Phylogenetic and Phylogeographic Analyses of Porcine Circovirus Type 2 Among Pig Farms in Vietnam

This study demonstrated the prevalence of Porcine circovirus type 2 (PCV2) among pig farms in Vietnam. Analyses of the genome, capsid protein and phylogeny classified all 30 Vietnamese PCV2 strains as the PCV2b genotype, belonging to the clusters of 1A, 1B, 1C and recombinant forms. Each viral genome was 1767 nucleotides long and shared 96.0–100% nucleotide sequence identity. The amino acid substitutions in the capsid protein of the Vietnamese PCV2 strains were in immunodominant regions, and the majority of strains (24/30) contained a lysine extension at the C‐terminus. Bayesian phylogeographic analysis revealed epidemic links of the PCV2 recombinant cluster within and among countries, which supports a circulating recombinant form of PCV2. Further analysis by the Jameson–Wolf antigenic index indicated antigenic alterations at important sites in the capsid protein (sites 131–133) among the recombinant cluster and the other clusters of PCV2b.     

CD146在聚乙二醇诱导的小鼠脉络膜新生血管模型中的表达及意义

目的：探讨在聚乙二醇（polyethylene glycol,PEG）诱导的小鼠脉络膜新生血管（choroidal neovascularization,CNV）模型中CD146的表达及意义。方法：将60只8周龄雄性C57BL/6J小鼠采用随机数字表法,将小鼠随机分为第5、10和15天组,每组各20只。设定每组小鼠左眼为正常对照眼,右眼为实验眼,采用在视网膜下注射PEG诱导形成脉络膜新生血管模型。造模后摘取各组小鼠眼球,制作视网膜组织切片及HE染色,鉴定CNV模型。通过比较各组视网膜HE染色切片外核层（outer nuclear layer,ONL）厚度,观察PEG的视网膜毒性作用。采用实时荧光定量PCR法检测小鼠神经视网膜和RPE/脉络膜复合体中CD146、血管内皮生长因子（vascular endothelial growth factor,VEGF）、血管内皮生长因子受体2（vascular endothelial growth factor receptor 2,VEGFR2）的mRNA水平变化。免疫组化染色法检测小鼠眼内CD146、VEGF和VEGFR2的表达。结果：HE染色和ONL层厚度比较均证实,视网膜下注射PEG造模成功且模型可靠,视网膜下注射后第5和10天均有CNV形成。实验组小鼠神经视网膜和脉络膜中CD146、VEGF、VEGFR2的mRNA表达水平与对照组相比明显升高,差异有统计学意义（F=30.412,P=0.000;F=84.974,P=0.000;F=117.423,P=0.000;F=918.786,P=0.000;F=319.110,P=0.000;F=113.896,P=0.000）。Person相关性分析提示在视网膜下注射PEG后,小鼠RPE/脉络膜复合体中CD146与VEGF和VEGFR2的表达量呈正相关（r=0.940,P=0.000;r=0.940,P=0.000;r=0.769,P=0.045;r=0.910,P=0.003;r=0.910,P=0.003;r=0.777,P=0.042）。免疫组化染色的结果显示,在造模第10天后,造模组与正常对照组相比较CD146、VEGFR2在神经节细胞层、内核层、外从状层、外核层的阳性表达均有不同程度增强（P=0.000,P=0.000,P=0.000）。结论：CD146伴随着CNV的形成表达上调,且与VEGF的表达量和VEGFR2的表达量呈正相关性,由此推断CD146可能在CNV形成的病理过程中起到至关重要的作用。     

腹直肌外侧入路与髂腹股沟入路切开复位内固定治疗幼儿Torode-Zieg Ⅳ型骨盆骨折的疗效比较

目的:比较腹直肌外侧入路与髂腹股沟入路切开复位内固定治疗幼儿Torode-Zieg Ⅳ型骨盆骨折的临床疗效。方法:采用回顾性队列研究分析2012年6月至2019年6月右江民族医学院附属医院和南方医科大学第三附属医院收治的12例幼儿Torode-Zieg Ⅳ型骨盆骨折患者临床资料,其中男6例,女6例;年龄13~36个月［...     

Receptor activator of NF-κB ligand-dependent expression of caveolin-1 in osteoclast precursors, and high dependency of osteoclastogenesis on exogenous lipoprotein

Although extensive studies have done much to clarify the molecular mechanisms of osteoclastogenesis during the last ten years, there may still be unknown molecules associated with osteoclast differentiation. Thus, we used fluorescent differential display to screen for genes whose expression is induced by receptor activator of NF-κB ligand (RANKL), a crucial molecule for osteoclast formation. We identified caveolin-1 (Cav-1) as a RANKL-induced gene. Cav-1 is a major structural protein of caveolae and lipid rafts, cholesterol-enriched microdomains in the plasma membrane (PM). The RANKL-induced Cav-1 was immediately conveyed to lipid rafts. Conversely, expression of flotillin-1 (Flot-1), another scaffolding protein of lipid rafts, was reduced during osteoclastogenesis, indicating conversion of Flot-1-predominant rafts into Cav-1-enriched rafts. However, in vitro osteoclastogenesis of precursor cells from Cav-1-null mice was comparable to that of wild-type mice, while Cav-2 expression in the knockout osteoclasts was maintained. Conversely, Cav-2 gene silencing in Cav-1-null osteoclast precursors using siRNA for Cav-2 increased osteoclast formation, suggesting that the Cav-1/Cav-2 complex may act as a negative regulator for osteoclastogenesis. On the other hand, destruction of lipid rafts by removal of cholesterol from the PM by methyl-ß-cyclodextrin (MCD) treatment caused disordered signal transductions for osteoclastogenesis, such as hyperactivation of Erk1/2 and insensitivity of Akt to RANKL stimulus. The abnormal signaling was reproduced by deleting exogenous lipoproteins from the culture medium, which also resulted in reduced osteoclast formation. In addition, the deletion caused delayed expression of nuclear factor of activated T cells c1 (NFATc1), and depressed its activation in the cytosol and inhibited its translocation into nuclei. Simultaneously, the deletion reduced the level of FcRγ, a trigger protein for initiating the calcium signaling needed to activate NFATc1, and decreased Cav-1 in lipid rafts. These findings indicate that the molecular mechanisms of osteoclastogenesis are highly dependent on extracellular lipoprotein and the integrity of lipid rafts, and suggest possible involvement of cholesterol.     

护理风险层级安全干预机制的建立与实施

目的建立护理风险层级安全干预机制并评价应用效果。方法以心内科为试点,建立护理部主任、护理部质控人员(三级),片区总护士长(二级),科室护士长和安全员(一级)组成的护理风险层级安全管理网络,实行由一级到三级逐级报告制度。结果实施护理风险层级安全干预前发生护理差错、纠纷19例,实施后发生护理差错、纠纷4例。实施前后护理差错、纠纷发生率比较,差异有统计学意义(P<0.01)。结论护理风险层级安全干预机制的建立,充分发挥了各部门的职能作用,提高了护理人员对风险的识别与应对能力,降低和避免了护理风险,确保了护理安全。