The Effect of <Emphasis Type="SmallCaps">l</Emphasis>-arginine and Aprotinin on Intestinal Ischemia–reperfusion Injury

Background Intestinal ischemia/reperfusion (I/R) results in local mucosal injury, systemic injuries, and organ dysfunction. These injuries are characterized by altered microvascular and epithelial permeability and villous damage. Activation of neutrophils, platelets, and endothelial factors are known to be involved in this process. Cytokines such as TNF-α, IL-1, IL-6, and oxygen-derived free radicals are believed to be important pathogenic mediators. Capillary no-reflow is also known to play a role in I/R. The aim of our study was to examine the role of l-arginine, a known nitric oxide (NO) donor, and aprotinin, a protease inhibitor with multiple effects, on intestinal I/R. Methods Pigs weighing 20–25 kg were used. Ischemia was established by clamping the superior mesenteric artery (SMA) at its origin and was sustained for 2 hours. Duration of reperfusion was 2 hours. The animals were divided into four groups: group A, the control group, which was submitted to I/R injury only; group B, in which l-arginine was administered at a rate of 5 mg/kg/min during ischemia and continuing throughout reperfusion; group C, in which aprotinin was administered with an initial bolus dose of 20,000 U/kg during ischemia followed by a continuous dose at 50 U/hour throughout reperfusion; and group D in which both substances were administered. In all groups TNF-α, IL-1, and IL-6 levels were measured using ELISA at baseline, 2 hours of ischemia, and 1 hour and 2 hours of reperfusion. SMA blood flow was measured with a Doppler probe at baseline, 10 min, 1 hour, and 2 hours of reperfusion. Histological changes of the intestinal mucosa were examined and graded on a five-point scale in all groups. Results In the control group, levels of TNF-α, IL-1, and IL-6 were significantly increased during reperfusion (p < 0.05) compared to baseline. Administration of l-arginine and aprotinin led to suppression of the release of TNF-α, IL-1, and IL-6 during reperfusion in a statistically significant manner (all p < 0.05). A synergistic or additive effect of l-arginine and aprotinin was not observed. SMA blood flow in the control group was decreased (p > 0.05) during reperfusion compared to baseline. In animals treated with l-arginine and aprotinin, SMA blood flow during reperfusion was significantly increased (p < 0.05) compared to the control group. Histologic examination of the intestinal mucosa was characterized by flattening of the villi and necrosis in the control group. In the treated animals, less severe histological changes were noted. Conclusions Administration of l-arginine and aprotinin may lead to amelioration of intestinal I/R injury. We did not note a synergistic or additive effect of these two substances. These findings warrant further studies in clinical settings for future treatment efforts. This paper was presented as a poster at the 47th Annual Meeting of the Society for Surgery of the Alimentary Tract, Los Angeles, California, May 20–24, 2006.     

Inguinal hernia repair: the choice of prosthesis outweighs that of technique

Background The use of prostheses in inguinal hernia repair reduces the incidence of recurrence. Quality of life and pain after hernia repair are largely correlated with the technique and type of prosthesis. Aims of study To evaluate the 2-year incidence of recurrence and pain for two types of hernioplasty, Lichtenstein repair and laparoscopy (totally extraperitoneal approach or TEP), and two types of mesh, polypropylene mesh and beta-d-glucan-coated mesh (Glucamesh). Patients A total of 410 consecutive patients of mean age 54 years (18–84) underwent repair of inguinal hernias, 96 (23%) of which were bilateral and 56 (13%) recurrent. A total of 273 (66.5%) patients underwent Lichtenstein repair: 215 (78.7%) with polypropylene mesh, 58 (21.3%) with Glucamesh; 137 patients underwent laparoscopy: 80 (58.4%) with polypropylene mesh, 57 (41.6%) with Glucamesh. In each group, the populations were comparable and the techniques utilized were identical. Methods The patients were followed-up for at least 2 years, after which the incidence of recurrence was determined, and chronic pain was assessed by means of a visual analog scale and a validated questionnaire. Results A total of 349 patients (85.1%) were reassessed, 117 of whom had undergone laparoscopy and 232 Lichtenstein repair. There were ten recurrences (2.8%), and incidence which was independent of the technique (laparoscopy 1.7% vs. Lichtenstein 3.4%) (ns) and the type of prosthesis (Glucamesh 1.9% vs. polypropylene 2.4%) (ns). Chronic pain was noted in 69 patients (19.7%) and severe pain in 11 (3.1%). The incidence of chronic pain was the same for the two techniques: laparoscopy 17.9% vs. Lichtenstein 20.7% (ns). The same was true for severe pain: laparoscopy 3.4% vs Lichtenstein 3% (ns). The incidence of chronic pain was closely correlated with the type of prosthesis utilized: Glucamesh 4.8% vs. polypropylene 26.5% (P = 0.02), irrespective of the technique. The same was true for severe pain (0.9 vs. 4%) (P = 0.02). Conclusion The utilization of beta-d-glucan-coated mesh did not involve more recurrence and was accompanied by a significant decrease in chronic pain at 2 years, independent of the technique. After 2 years, the results of hernia repair show that the choice of prosthesis was more determinant than choice of technique.     

Late foreign-body reaction to PLLA screws used for fixation of acetabular osteotomy

A 31-year-old woman underwent rotational acetabular osteotomy for acetabular dysplasia. At surgery, the acetabular fragment and the grafted bone were fixed with PLLA screws. One year 7 months after surgery, the patient returned to our clinic with acute swelling and pain with sinus formation. Based on the diagnosis of an infection, local debridement was performed. Histological examination of the debrided tissue revealed inflammatory cells; however no organism was found growing on the bacterial culture. During subsequent attempts to drain the lesion, we found small PLLA particles. Thus, we diagnosed the condition as a continued inflammatory process due to foreign-body reaction to the fragmented screw material. After a repeat debridement, the inflammation subsided. At the final follow-up two years after the last procedure, there was no recurrence and the patient had returned to regular activities. This report represents the first case of a severe local reaction to PLLA implants at and around the major joints.     

Testing a Social-Cognitive Model of Intimate Abusiveness Among Substance-Dependent Males

Throughout history, the human race has been characterized by the use of physical and emotional aggression by individuals, particularly males, in their intimate relationships. Intimate abusiveness is particularly common among substance-dependent males. As a result of male intimate abusiveness, victims suffer a variety of problems, ranging from emotional trauma to death due to physical injury. Despite increased attention to this problem, our understanding of the process leading to intimate abusiveness is far from comprehensive. The primary purpose of the present study was to expand our understanding of intimate abusiveness through the application of a social-cognitive model of intimate abusiveness among substance-dependent males. Participants were 57 males from an inpatient substance abuse treatment program. Subjects completed questionnaires indicating their level of intimate abusiveness. In addition, they completed partner-related attribution measures, as well as coping response measures indicating how they would interpret and handle five ambiguous vignettes involving their partner. It was hypothesized that violent men would attribute greater negative intent and responsibility to their partner, and that they would choose to handle the ambiguous vignettes in less competent ways compared with nonviolent men. Further, it was predicted that the association between intimate abusiveness and competency of coping responses would be mediated by attributions made about the partner. Results of the study generally supported predictions. The implications of the results are discussed, and suggestions are made for future research.     

Establishing Arizona's Statewide Cardiac Arrest Reporting andEducational Network

Background. Only a few large cities have published their out-of-hospital cardiac arrest (OHCA) survival statistics using the Utstein style reporting method. To date, to the best of our knowledge there has been no published OHCA survival data for a state. Objective. To describe the process, benefits, andchallenges of establishing a statewide OHCA database andeducational network. Methods. Arizona's Bureau of Emergency Medical Services andTrauma System initiated a statewide, prospective, observational cohort review of all OHCA victims on whom resuscitation was attempted in the field. Emergency medical services (EMS) first care reports, voluntarily submitted by 35 departments in Arizona, were analyzed. We chronicled the development of our data-collection process along with how we obtained patient outcomes anddelivered feedback to field providers. Entry data included time intervals andnodal events conforming to the Utstein style template. Results. In data collected between January 1, 2005, andApril 1, 2006, there were 1,484 OHCAs reported, of which 1,104 were of presumed cardiac etiology occurring prior to EMS arrival. The OHCA incidence was approximately 0.44 per 1,000 population per year. In our database, bystander CPR provided an odds ratio of 3.0 for survival (95% confidence interval 1.3, 6.7). Outcomes for 1,076 patients were obtained. Thirty-seven (3.4%) of the 1,076 cardiac arrest victims survived to hospital discharge. Twenty-seven (8.6%) of the 331 ventricular fibrillation cardiac arrest victims survived to hospital discharge. Conclusion. It is feasible for a public health agency to implement a voluntary, statewide data-collection system andeducational network to determine andimprove survival from OHCA.     

Locus of control,attributional style and discipline problems in secondary schools

This article presents the findings of a study hypothesizing that school discipline problems are a maladaptive response to the demand of the school environment as a result of deficits in the area of locus of control and attributional style. The findings indicate that an external orientation of locus of control and a passive pattern of attribution remain significant predictors of discipline problems when other factors are held constant. The findings lend support to the idea of establishing programmes that “induce appropriate attributions” in children and train teachers to become aware of the attributional process in order to effectively deal with discipline problems in school. Cognitive re‐structuring is suggested as an effective means of intervention aimed at disputing the irrational beliefs, which leads to positive effects and consequences. This study was conducted on a sample of three hundred and eighty‐four students recruited from the junior forms of four secondary schools in Hong Kong.     

教育管理对哮喘患者疾病知识及应对策略的影响

目的研究教育管理对哮喘患者的疾病知识及应对策略的影响。方法对228例成年哮喘患者除进行常规的药物治疗外，还实施了系统的教育管理。使用哮喘疾病知识问卷及医学应对问卷对患者在入院时及出院前的哮喘知识及应对策略进行了2次测量，同时，出院3个月后对患者的哮喘知识进行了第3次测量。结果经过系统的教育管理，哮喘患者出院时屈服的应对策略得分较入院时相对较低，差异具有统计学意义（P〈0．001）。在哮喘知识的掌握上，出院前的得分高于入院时．出院3个月后的得分高于出院前，差异均具有统计学意义（P〈0．001）。回归分析的结果显示，哮喘知识在出院前与入院时的差值能够显著地预测面对差值（t=2．377，P〈0．05）及屈服差值（t=-3．126，P〈O．01）的变化。结论系统化的教育管理方案能够提高患者对哮喘相关知识的掌握，减少消极应对方式的使用；哮喘知识的提高是患者应对策略改变的重要影响因素。     

Modulation of interpersonal trust in borderline personality disorder by intranasal oxytocin and childhood trauma

Borderline personality disorder (BPD) is characterized by interpersonal difficulties, whereby patients are negatively biased concerning the evaluation of others' trustworthiness. Here, we examined the effect of oxytocin on interpersonal behavior of BPD patients in a trust game, emphasizing the assessment of facial attractiveness of the patients' counterparts in the game, and patients' history of childhood trauma. Thirteen BPD patients and thirteen healthy controls played a trust game after receiving oxytocin or placebo in a randomized, double-blind crossover design. Childhood trauma was evaluated using the Childhood Trauma Questionnaire (CTQ). Patients transferred less money in the oxytocin condition compared to placebo. While healthy controls transferred more money units (MUs) to attractive counterparts than to unattractive ones only after the administration of oxytocin, BPD patients showed this pattern in both conditions. Emotional neglect during childhood negatively correlated with the amount of MUs transferred by patients under oxytocin, but not placebo. Oxytocin had a trust-lowering effect in BPD, which was correlated with patients' history of childhood trauma. Patients' evaluation of interpersonal trust seems to depend more on attractiveness features of their counterparts than in controls, a finding that may have important implications for further research on the usefulness of “prosocial” peptides as an adjunct to psychotherapeutic interventions.