Stress amplifies lung tissue mechanics, inflammation and oxidative stress induced by chronic inflammation

ABSTRACT Background: Mechanisms linking behavioral stress and inflammation are poorly understood, mainly in distal lung tissue. Objective: We have investigated whether the forced swim stress (FS) could modulate lung tissue mechanics, iNOS, cytokines, oxidative stress activation, eosinophilic recruitment, and remodeling in guinea pigs (GP) with chronic pulmonary inflammation. Methods: The GP were exposed to ovalbumin or saline aerosols (2×/wk/4wks, OVA, and SAL). Twenty-four hours after the 4th inhalation, the GP were submitted to the FS protocol (5×/wk/2wks, SAL-S, and OVA-S). Seventy-two hours after the 7th inhalation, lung strips were cut and tissue resistance (Rt) and elastance (Et) were obtained (at baseline and after OVA and Ach challenge). Strips were submitted to histopathological evaluation. Results: The adrenals' weight, the serum cortisol, and the catecholamines were measured. There was an increase in IL-2, IL-5, IL-13, IFN-γ, iNOS, 8-iso-PGF2α, and in %Rt and %Et after Ach challenge in the SAL-S group compared to the SAL one. The OVA-S group has had an increase in %Rt and %Et after the OVA challenge, in %Et after the Ach and in IL-4, 8-iso-PGF2α, and actin compared to the OVA. Adrenal weight and cortisol serum were increased in stressed animals compared to nonstressed ones, and the catecholamines were unaltered. Conclusion & clinical relevance: Repeated stress has increased distal lung constriction, which was associated with an increase of actin, IL-4, and 8-iso-PGF2α levels. Stress has also induced an activation of iNOS, cytokines, and oxidative stress pathways.     

Laparoscopic ileocytoplasty and continent ileovesicostomy in a porcine model

BACKGROUND AND PURPOSE: Bladder augmentation with autologous bowel is commonly accompanied by a continent ileovesicostomy (the Monti procedure). Herein, we describe our initial experience with laparoscopy-assisted ileocystoplasty and continent ileovesicostomy in a porcine model. MATERIALS AND METHODS: Thirteen Yucatan minipigs with an average weight 49 lb underwent a laparoscopy-assisted ileocystoplasty and ileovesicostomy (Monti procedure) using a four-port technique. After catheter removal at 3 weeks, the animals underwent twice-daily catheterization of the ileovesicostomy until complete occlusion of the ileovesicostomy occurred. RESULTS: All animals survived the initial surgery, with 10 animals being available for catheterization at 3 weeks. The average Monti anastomotic time, average ileal patch-bladder anastomotic time, and average total surgery times were 47 minutes, 89 minutes, and 307 minutes, respectively. Eight of ten animals developed stomal stenosis after catheter removal (average time to complete occlusion of 6 days; range 1-13 days), with two animals also demonstrating partial obstruction at the Monti-bladder anastomosis and four partial obstruction at the fascial level of the Monti tube. Pathologic review of select bladder augmentation and Monti tube specimens revealed moderate to severe acute and chronic inflammation with severe scarring at the Monti-skin stoma site in the majority of specimens. CONCLUSIONS: We have demonstrated the feasibility of laparoscopic ileocystoplasty and continent ileovesicostomy in a porcine model. The development of stomal stenosis may be related to the intrinsic properties of the pig skin, but additional investigation is required prior to human studies of this novel surgical technique.     

Laparoscopic partial kidney ablation with high intensity focused ultrasound

PURPOSE: High intensity focused ultrasound has been performed for transrectal and extracorporeal thermal ablation of tissues. We developed and tested a laparoscopic probe that allows real-time ultrasound imaging during partial renal ablation using high intensity focused ultrasound. METHODS: A Sonablate 200 (Focus Surgery, Indianapolis, Indiana) high intensity focused ultrasound system with a modified 18 mm. laparoscopic probe was used in all experiments. In 13 Yucatan mini-pigs a 5Fr ureteral catheter was inserted into the renal pelvis and 10 cc air were instilled into the collecting system. The kidney was laparoscopically dissected, the high intensity focused ultrasound probe was inserted through a 33 mm. laparoscopic port and the targeted renal pole was treated. RESULTS: Renal lesions were created in 12 of 13 treated kidneys under real-time ultrasound visualization. Median operative time was 180 minutes, average high intensity focused ultrasound activation time was 18.3 minutes and lesion size was 23 x 17 x 11 mm. At 4 and 14 days 4 (acute group) and 6 (subacute group) animals were available for renal functional and anatomical evaluation, respectively. No difference in renal function was seen in treated and untreated kidneys. Pathological examination at 14 days revealed homogenous and complete tissue necrosis throughout the whole volume of the lesion with sharp demarcation from adjacent normal tissue. CONCLUSIONS: We were able to refine a probe for laparoscopic high intensity focused ultrasound delivery capable of simultaneous ultrasound imaging. Partial renal ablation using this probe is feasible and safe, and resulted in homogenous, complete and reproducible lesions.     

Fracture process characterization of fiber-reinforced dental composites evaluated by optical coherence tomography, SEM and optical microscopy

This study used optical coherence tomography (OCT) compared to scanning electron microscopy (SEM) and optical microscopy (OM) to evaluate qualitatively crack propagation and final fracture in restorative composite materials - Filtek Z250 and Filtek Z350 (3M ESPE) - with fiber reinforcement after cyclic loading. Samples were made using a split mold. Initially, 3-point bending tests were performed to determine the maximum force and tension at the fracture moment using samples without fiber reinforcement. Then, mechanical cycling tests were performed using samples with glass fiber embedded internally. The failures were analyzed using the 3 methods described before. OCT permitted good characterization of internal crack propagation of the dental composites, which, however, could not be visualized by either SEM or OM. OCT was proven to be laboratory research tool that is easy to use, does not require any specific preparation of the samples, and is less expensive than SEM.     

Influence of social factors on weight-related behaviors according to gender in the French adult population

Although the prevalence of obesity is higher in low socioeconomic position (SEP), the relationship between SEP and body mass index (BMI) differs according to gender. The purpose of this study is to investigate the relationships between BMI and SEP according to gender and explore the weight-related behaviors. In a cross-sectional survey, 1646 French adults were weighed and answered a questionnaire about eating behavior (DEBQ), SEP markers, ideal weight perception, physical activity and smoking. Our study showed that BMI was inversely correlated with SEP score in women only, independently of other BMI-associated factors (age, restrained eating, smoking status, TV viewing and physical activity). The SEP gradient was the same in both genders for some weight-related behaviors, such as restrained eating, physical activity and TV viewing, but differs for others, such as smoking and weight consciousness. There was an interaction between the SEP score and the actual BMI on the ideal BMI in women only, thus the difference in ideal body weight according to SEP is mainly due to difference in obese women. Our study concluded that gender differences in the relationship between BMI and SEP could be mainly due to the subjects' perception of weight appropriateness and their weight-related behaviors.     

Caudal bupivacaine supplemented with morphine or clonidine,or supplemented with morphine plus clonidine in children undergoing infra-umbilical urological and genital procedures: a prospective,randomized and double-blind study

Purpose  

We aimed to evaluate postoperative analgesia of morphine, or clonidine, or morphine plus clonidine, added to caudal bupivacaine in children undergoing infra-umbilical urological and genital procedures.     

Enteral Antibiotics are Non-inferior to Intravenous Antibiotics After Complicated Appendicitis in Adults: A Retrospective Multicentre Non-inferiority Study

Background

Prolonging post-operative antibiotic treatment beyond 3 days does not seem to reduce the incidence of post-operative abscess formation or wound infection after surgery for complicated appendicitis. The route of administration seems to be based on an empirical basis. Using enteral antibiotics could reduce length of stay and reduce overall costs. We aimed to examine whether treatment with enteral antibiotics during the first three post-operative days is non-inferior to intravenous antibiotics regarding intra-abdominal abscess formation or wound infection after surgery for complicated appendicitis.

Methods

A retrospective study of adult patients having surgery for complicated appendicitis within a period of 32 months in the Capital Region of Denmark. Primary outcome was the incidence of post-operative abscess formation, and secondary outcome was wound infections, both within 30 days of surgery. Route of antibiotic administration for the first three post-operative days was registered for all patients.

Results

A total of 1141 patients were included in the study. The overall risk of developing an intra-abdominal abscess was 6.7% (95% CI 5.2%; 8.1%), and the risk of wound infection was 1.2% (95% CI 0.6%; 1.8%). In a multivariate intention-to-treat analysis, patients treated post-operatively with enteral antibiotics had an odds ratio of 0.78 (95% CI 0.41; 1.45, p = 0.429) for developing an intra-abdominal abscess and an odds ratio of 0.86 (95% CI 0.17; 4.29, p = 0.851) for developing a wound infection compared to patients treated post-operatively with intravenous antibiotics.

Conclusion

Treatment with enteral antibiotics was non-inferior compared to treatment with intravenous antibiotics during the first 3 days after surgery for complicated appendicitis.

     

The Use of Blunt-tipped 12-mm Trocars Without Fascial Closure in Laparoscopic Live Donor Nephrectomy

Objectives:

Blunt-tipped trocar placement may eliminate the need for fascial closure in transperitoneal laparoscopic live donor nephrectomies (LDN). The process of 12-mm blunt-tipped trocar insertion through the abdominal wall involves fascial and muscle spreading, not incision. Coaptation of the tissue layers occurs during withdrawal of the trocar, preventing volume gaps that can be prone to herniation.

Methods:

We retrospectively assessed the safety and efficacy of fascial nonclosure after 12-mm blunt-tipped port insertion in 70 transperitoneal LDNs performed between October 1998 and March 2001. Five ports (two 12-mm blunt-tipped and three 5-mm blunt-tipped) were used in all cases. The 12-mm trocars were inserted at the lateral border of the rectus muscle, approximately 8 cm below the costal margin and also along the anterior axillary line approximately 8 cm below the costal margin. Fascial non-closure was performed in all 70 patients. Postoperative data were analyzed regarding complications and long-term outcomes.

Results:

Three major and 7 minor complications occurred in this series. No patient developed clinically detectable trocar-site hernias or other complications related to blunt-trocar placement.

Conclusions:

Our data shows that fascial nonclosure after transperitoneal 12-mm blunt-tipped trocar insertion is safe. Visualization of the tissue layers during port placement facilitated the insertion process. Further application of this method in a larger number of patients is needed to confirm its clinical applicability.