Cellular mechanisms of ischemia-reperfusion injury

As of yet, only a few strategies to prevent myocardial reperfusion injury have been tested clinically. In the first minutes of reperfusion, the myocardium can be damaged by contracture development, causing mechanical stiffness, tissue necrosis, and the "stone heart" phenomenon. Reperfusion-induced contracture can have two different causes, namely, Ca2+overload-induced contracture or rigor-type contracture. Ca2+ contracture results from rapid re-energization of contractile cells with a persistent Ca2+ overload. Strategies to prevent this type of injury are directed at cytosolic Ca2+ control or myofibrillar Ca2+ sensitivity. Rigor-contracture occurs when re-energization proceeds very slowly. It does not depend on Ca2+ overload. It may be prevented by strategies improving early mitochondrial reactivation     

Species of Propionibacterium and Propionibacterium acnes phylotypes associated with orthopedic implants

Propionibacterium sp. is commonly isolated in association with orthopedic implants, either as a pathogen or a colonizer. Microbial characteristics that indicate whether the isolated species is a likely cause of orthopedic implant infection versus a colonizing agent would be clinically useful. We performed a prospective trial to determine the species of Propionibacterium and the phylotype (IA, IB, II, III) of Propionibacterium acnes isolated from the surface of removed orthopedic implants, and we correlated these findings with the presence or absence of infection. P. acnes represented 61 of 62 isolates. P. acnes type I was more commonly isolated than was type II (62% versus 38%, respectively), whether associated with infection or not. P. acnes type III was not detected. There was no clear association between types I and II P. acnes and infection or colonization of failed orthopedic implants (P = 0.75), however type IB strains were more frequently isolated than type IA from infected prosthese.     

关注健康,没有借口——高寿糖尿病明星Louis Zorich的健康态度

<正>"不管存在多少借口,预防和控制糖尿病比出现并发症后再去补救要容易得多。"2008年11月的一次常规体检后,84岁高龄的美国著名演员Louis Zorich得知自己患上了糖尿病。     

In vitro comparison of the circulaire and AeroTee to a traditional nebulizer T-piece with corrugated tubing

BACKGROUND: Nebulizers are a popular means of delivering aerosolized medication, primarily albuterol, to the bronchial airways of patients, and there has been extensive research done on numerous nebulizers used with nebulizer T-pieces and corrugated tubing. Very little research has been performed on other types of nebulizer delivery systems and there is no substantial information on how effective various nebulizer delivery systems are in terms of the quantity and particle size of aerosolized medication delivered to the patient. In this study the Circulaire and the AeroTee, two devices that rely on bags to store aerosol during patient exhalation, are evaluated and compared to the conventional nebulizer T-piece with corrugated tubing. METHODS: Three each of the nebulizer T-piece with corrugated tubing, the Circulaire, and the AeroTee were sampled using 3 Vixone nebulizers. Each one of the 3 nebulizer delivery systems used the same 3 Vixone nebulizers. Each nebulizer delivery system was evaluated by connecting a constant-flow vacuum and compressed gas source cycled to simulate patient breathing at a respiratory rate of 14 breaths/min and an inspiration-expiration ratio of 1:2. Medication delivered was determined by sampling a portion of the simulated patient's flow onto a membrane filter and calculating the total medication received by the patient. Particle size was determined by sampling with a cascade impactor under ambient conditions. RESULTS: The Circulaire delivered significantly less medication than the nebulizer T-piece with corrugated tubing (p < 0.001), whereas the AeroTee delivered substantially more medication than the nebulizer T-piece with corrugated tubing (p < 0.001). The particle size delivered by the Circulaire was significantly smaller than that of the nebulizer T-piece with corrugated tubing (p < 0.001), whereas the AeroTee delivered particle size equivalent to a nebulizer T-piece with corrugated tubing (p = 0.82). CONCLUSION: There are clinically important differences between nebulizer delivery systems. When evaluating the optimum means for delivering aerosolized medication, equal consideration should be given to both the brand of nebulizer and the nebulizer delivery system.     

Safety and efficacy of percutaneous coronary interventions performed immediately after diagnostic catheterization in northern new england and comparison with similar procedures performed later

"Ad hoc" percutaneous coronary interventions (PCIs)-those performed immediately after diagnostic catheterization-have been reported in earlier studies to be safe with a suggestion of higher risk in certain subgroups. Despite increasing use of this strategy, no data are available in recent years with new device technology. We studied use of an ad hoc strategy in a large regional population to determine its use and outcomes compared with staged procedures. A database from the 6 centers performing PCIs in northern New England and 1 center in Massachusetts was analyzed. During 1997, excluding only patients requiring emergency procedures or those with a prior PCI, 4,136 PCIs were performed, 1,748 (42.3%) of these being ad hoc procedures. Patients having ad hoc procedures were less likely to have peripheral vascular disease, renal failure, prior myocardial infarction, or coronary artery bypass surgery, congestive heart failure, or poor left ventricular function, and more likely to have received preprocedural intravenous heparin or nitroglycerin or to have required an urgent procedure. Narrowings treated during ad hoc procedures were less frequently types B and C or in saphenous vein grafts. Adjusted rates of clinical success were not different between ad hoc and non-ad hoc procedures (93.7% vs 93.6%); there was no difference in the incidence of death (0.6% vs 0.5%), emergency (0. 9% vs 0.8%) or any (1.4% vs 0.8%) coronary artery bypass surgery, or myocardial infarction (2.6% vs 2.0%). As currently practiced in our region, ad hoc intervention is used selectively with outcomes similar for ad hoc and non-ad hoc procedures.     

Low-dose versus high-dose oxytocin augmentation of labor — A randomized trial

OBJECTIVE: Our purpose was to compare the efficacy and safety of low-dose versus high-dose oxytocin regimens in the augmentation of labor.STUDY DESIGN: Three hundred ten term pregnancies requiring augmentation of labor underwent randomization to receive either a low-dose or high-dose oxytocin augmentation regimen. Maternal demographics, labor-delivery data, and neonatal outcome were compared.RESULTS: The hgih-dose oxytocin group had a significant lower cesarean section rate, regarless of parity (10.4% vs 25.7%. p < 0.001), with no differences in maternal complications and neonatal outcomes. The time needed to correct the labor abnormality as also significantly decreased (1.24 ± 1.4 hours vs 3.12 ± 1.6 hours, p < 0.001) in the high-dose group.CONCLUSIONS: The use of a high-dose oxytocin regimen benefits both nulliparous and multiparous women requiring labor augmentation by significantly lowering both the time necessary to correct the labor normality and the need for cesarean section.