Regulation of cytokine synthesis in cardiac surgery: Role of extracorporeal circuit and humoral mediators <Emphasis Type="Italic">in vivo</Emphasis> and <Emphasis Type="Italic">in vitro</Emphasis>

Objective and design: Cardiopulmonary bypass (CPB) impairs monocyte and neutrophil proliferation, cytokine synthesis, and antigen presentation. This study compares in vivo data with results from an extracorporeal circulation (ECC) model, distinguishing direct effects on cytokine synthesis from regulatory mechanisms. Patients and methods: Whole blood from 18 patients prior to, during and after CPB was stimulated with lipopolysaccharide (LPS). Tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-8 levels were measured. Additionally, blood from 4 volunteers was circulated in an ECC model. Cytokine levels were measured before and during mock ECC. Results: LPS-induced cytokine synthesis was reduced after CPB (TNF-α: 11 %; IL-6: 29 %; IL-8: 48 % of preoperative values, all p < 0.001). In mock ECC, cytokine production (except IL-8) was suppressed: TNF-α production was lowest 60 min after starting ECC, IL-6 synthesis was lowest at 90 min (33 % and 15 % vs. pre-ECC levels; both p < 0.001). Patient sera contained cytokine-inhibitory activity after CPB, an activity not found in mock ECC. Conclusions: (1) In patients, CPB induces early transient LPS hyporesponsiveness; (2) blood contact with foreign surfaces induces LPS hyporesponsiveness; (3) serum cytokineinhibitory activities are released after CPB, but not in mock ECC. Impaired leukocyte function may explain increased susceptibility to infections after CPB. Received 16 September 2006; accepted without revision by K. Visvanathan 18 October 2006     

自身免疫型习惯性流产的临床治疗

目的探讨三种不同方法治疗自身免疫型习惯性流产的临床效果。方法选取78例确诊为自身免疫异常引起的习惯性流产患者，分为4组，1为阿司匹林＋泼尼松组（22例），2为阿司匹林＋肝素组（18例），3为静丙组（20例），4为对照组（18例），不接受任何治疗，用卡方检验比较各组妊娠成功率。结果1、2、3组与对照组分别比较，差异均有统计学意义（P〈0．05），但3种治疗方法之间无显著差异（P〉0．05）；1组出现了胎膜早破、妊娠期高血压疾病等妊娠合并症，2组出现了早产和消化道出血，但各组发生率无统计学差异（P〉0．05）。结论传统的激素、抗凝剂和被动免疫疗法均有一定疗效，但三者之间疗效无差异。     

Sources of behavioral deviation modeled by early color preferences in quail. III. Developmental stability and normative canalization

Successful artificial selection of quail (C. coturnix japonica) for divergent early approach preferences for, and imprintabilities to, the wavelength characteristics of otherwise identical visual stimuli decreased the trait's developmental stability. The developmental error that resulted from selecting for extreme initial preferences was associated with enhanced imprintabilities. Conversely, the developmental error that resulted from selecting for extreme imprintabilities was associated with enhanced expression of directional gene effects in extreme initial preferences. The data are attributed to selectively relaxed normative canalization of trait development, and to related enhanced expression of genetic, environmental, and stochastic influences in trait deviations.     

The Graz learning and training model for arthroscopic surgery

Summary Up to 30% of all operative procedures in orthopaedic surgery are performed arthroscopically. Because of the steadily increasing number of residents, it seems to be difficult both to maintain high standards and to guarantee an adequate training in arthroscopic surgery. However, in contrast to many other surgical techniques it is possible to learn and practice arthroscopy using artificial models and cadaver joints, provided that experienced surgeons and anatomists act as supervisors and instructors. The aim of this paper is to assess practice models and training programs which should guarantee sufficient practical experience during the training period.

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Modèle d'apprentissage et d'entraînement à la chirurgie sous arthroscopie

Résumé Jusqu'à 30% de toutes les techniques opératories en chirurgie orthopédique sont réalisées sous arthroscopie. En raison du nombre croissant de résidents, il semble difficile de maintenir à la fois le haut niveau de formation et de garantir un entraînement adéquat à la chirurgie sous arthroscopie. Toutefois, contrairement à de nombreuses autres techniques chirurgicales, il est possible d'apprendre à pratiquer l'arthroscopie en utilisant des modèles artificiels ou des articulations de cadavres, dans la mesure où des chirurgiens et des anatomistes expérimentés agissent comme enseignants et tuteurs. Le but de ce travail était d'évaluer les modèles pratiques et les programmes d'entraînement pouvant garantir une expérience pratique suffisante durant la période d'apprentissage.

     

Anatomosurgical study of the superficial and deep circumflex iliac arteries

Summary An anatomical study of the superficial and deep circumflex iliac arteries in 43 formalin-fixed cadavers is presented. The origin, calibre, course, branches, symmetry and variations of the vessels are pointed out as well as their special features related to surgical applications.

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Etude anatomochirurgicale des artères circonflexes iliaques superficielle et profonde: bases anatomiques de la confection du lambeau libre iliaque composé cutanéo-osseux

Résumé Une étude anatomique des artères circonflexes iliaque superficielle et profonde est effectuée sur 43 cadavres formulés. L'origine, le calibre, le trajet, les branches, la symétrie et les variations des vaisseaux sont mis en évidence ainsi que leurs caractères particuliers en vue d'une application chirurgicale.

     

An Animal Model for the Study of the Function of Pregnancy-Specific Beta1 Glycoprotein and Pregnancy Zone Protein: A Review*

ABSTRACT: Two pregnancy-associated murine proteins, PAMP-1 and PAMP-2, have been found to be immunologically cross-reacting analogues to the human proteins pregnancy zone protein (PZP) and pregnancy-specific beta₁-glycoprotien (SP-1), respectively. In this study, the physiochemical and biological properties of the proteins are compared and the effect on pregnancy of administration of monospecific antibodies against the proteins is reported.     

Anti-idiotypic IgM antibodies to anti-HLA class I antibodies in habitual abortion.

In order to investigate the role of the idiotypic network in miscarriages, sera from 28 habitually aborting women undergoing paternal leukocyte immunization were studied for the presence of HLA antibodies and related anti-idiotypes. Sixty-eight percent of sera from preimmunized patients which did not contain anti-lymphocyte antibodies inhibited the activity of antibodies to the HLA class I antigens expressed by the spouse. This inhibitory activity could be assigned to IgM antibodies, which cross-inhibit antibodies of similar specificity. This suggests that they are anti-idiotypes for the binding site of HLA antibodies. Immune sera of successfully treated patients exhibited both cytotoxic IgG anti-HLA antibodies and inhibitory IgM anti-idiotypic antibodies. A possible role for an intact idiotypic network in maintaining pregnancy is suggested.     

The soluble tumor necrosis factor receptor I is an early predictor of local infective complications after colorectal surgery

The clinical implications of increased cytokine levels after major surgery remain unclear. In this study, systemic concentration of a spectrum of cytokines, including interleukins IL-6, IL-8, IL-10, IL-1ra, and soluble tumor necrosis factor receptor-I (sTNF-RI) was examined in patients with and without postoperative septic complications following colorectal surgery. Although there were no significant changes in IL-1, TNF-, and IL-8 serum levels during the observation period, there was a significant rise in IL-6, IL-1ra, and sTNF-RI concentrations in the entire group of patients between postoperative day 1 and 14. There were no differences between the group without and with local complications when IL-6, IL-1ra, and IL-10 were examined. The serum levels of sTNF-RI, IL-1ra, and IL-6 were found to be sensitive indicators of the pro- and anti-inflammatory response to the surgical trauma, but only sTNF-RI turned out to be a sensitive early marker of local septic postoperative complications in patients with colorectal carcinoma.