Technique for Rapid Hand Transplant Donor Procurement Through the Elbow

Background: Hand and distal forearm allotransplantation has advanced over the last 20 years from experimental to a viable treatment option for bilateral upper extremity amputation. Despite widespread growth of this field, there are few technical reports that elaborate the details of donor arm procurement. This article details a technique for rapid donor procurement through the elbow for mid to distal forearm-level hand allograft procurement. Methods: Nine arm procurements were performed on deceased tissue-only donors provided by the local organ procurement organization, including two bilateral and five unilateral cases. Technique highlights include using a fishmouth incision through the lateral and medical epicondyles, identification of the neurovascular structures, and disarticulating the elbow joint. Results: Procuring through the elbow provides straightforward anatomy, bypasses the need to cut through bone, and allows tissue allotransplantation teams to achieve procurement, flushing, and packaging within 20 minutes. Conclusions: Procurement through the elbow is a simple procedure that streamlines the process for multi-organ donors by minimizing the time needed for hand allograft procurement. Team coordination and surgical rehearsals are essential for successful hand and upper extremity procurement and allotransplantation.     

Malnourished Children in Refugee Camps and Lack of Connection with Services After US Resettlement

Identifying and addressing malnutrition among US-bound refugee children is an important human rights issue. Failure to address childhood malnutrition can impair cognitive development and productivity. The target population was children aged 6–59 months, originating from eight countries representing 51 % of US-resettled refugees for 2005–2011, living in 22 camps prior to potential US-resettlement. The corresponding camp-level nutritional survey data were evaluated. State Refugee Health Coordinators were surveyed on nutritional assessment, reporting and referrals for their US-refugee medical screenings. From 2004 to 2010, half of the camps (63 total surveys) had global acute malnutrition prevalence over 15 % at least once (surveys not done annually) and anemia prevalence greater than 40 %. The majority of US-refugee medical screenings included height and weight measurements but few used national or WHO standards to evaluate presence or level of malnutrition. Improve overseas camp monitoring and link these nutritional data to US-resettling refugee children to inform potential nutritional interventions. Domestically, use WHO or US growth standards for anthropometrics to determine presence of malnutrition and need for corrective action.     

The role of pituitary adenylyl cyclase activating polypeptide in affective signs of nicotine withdrawal

Recent evidence implicates endogenous pituitary adenylyl cyclase activating polypeptide (PACAP) in the aversive effect of nicotine. In the present study, we assessed if nicotine-induced conditioned place preference (CPP) or affective signs of nicotine withdrawal would be altered in the absence of PACAP and if there were any sex-related differences in these responses. Male and female mice lacking PACAP and their wild-type controls were tested for baseline place preference on day 1, received conditioning with saline or nicotine (1 mg/kg) on alternate days for 6 days and were then tested for CPP the next day. Mice were then exposed to four additional conditioning and were tested again for nicotine-induced CPP 24 hr later. Controls were conditioned with saline in both chambers and tested similarly. All mice were then, 96 hr later, challenged with mecamylamine (3 mg/kg), and tested for anxiety-like behaviors 30 min later. Mice were then, 2 hr later, forced to swim for 15 min and then tested for depression-like behaviors 24 hr later. Our results showed that male but not female mice lacking PACAP expressed a significant CPP that was comparable to their wild-type controls. In contrast, male but not female mice lacking PACAP exhibited reduced anxiety- and depression-like behaviors compared to their wild-type controls following the mecamylamine challenge. These results suggest that endogenous PACAP is involved in affective signs of nicotine withdrawal, but there is a sex-related difference in this response.     

整形外科研究的循证医学证据水平

目的 近年来,医学、外科类文献有向循证医学方向发展的趋势.本研究旨在检测已发表的整形外科类文章的证据水平.方法 回顾性分析<整形再造外科杂志(Plastic and Reconstructive Surgery,PRS)><整形外科年鉴(Annals of Plastic Surgery,Annals)><整形再造与美容外科杂志(Journal of Plastic,Reconstructive,and Aesthetic Surgery,JPRAS)><美国美容外科杂志(American Journal of Aesthetic Surgery,Aesthetic)>4本主要的整形外科类杂志2009年1～12月刊载论文利用证据的水平.结果 在1759篇文献中,共有726篇(41%)纳入本研究标准(排除动物实验、尸体研究、基础医学、文献复习、继续教育和信函等方面文献).将选中的文献根据其证据水平进行分级(Ⅰ～Ⅳ级;Ⅰ级,证据水平最高,如随机对照研究;Ⅳ级,证据水平最低,如病例报告).4本杂志的平均证据水平分别为:PRS=3.05,Aesthetic=3.11,JPRAS=3.35,Annals=3.31.4本杂志的平均证据水平,除了JPRAS与Aesthetic的差异无统计学意义外,余者差异均有统计学意义(P<0.05).本研究纳入标准的文献,只有2.2%的证据水平为Ⅰ级.结论 4本杂志的平均证据水平为3.2(Ⅲ级水平).为了使整形外科专业加入到高水平循证医学行列,我们应当在今后的工作中着重强调随机对照研究的应用.     

Sensitization to cocaine after a single intra-cerebral injection of orphanin FQ/nociceptin

Orphanin FQ/nociceptin (OFQ/N) has been shown to modulate mesolimbic dopaminergic neurotransmission. Repeated administration of OFQ/N into the ventral tegmental area results in a sensitized locomotor response to subsequent peripheral cocaine administration. The aim of the present study was to examine the potential for OFQ/N to produce a sensitized locomotor response to cocaine after a single intra-VTA administration and to determine if this effect of OFQ/N extrapolates to other points along the mesolimbic or nigrostriatal dopaminergic axes. Bilateral administration of OFQ/N (30 microg/side) into the VTA on day 1 to male Sprague--Dawley rats resulted in an enhanced locomotor response to cocaine (10 mg/kg i.p) administered on day 2. However, OFQ/N (3, 10 and 30 microg per side) administered on day 2, 5 mins prior to the administration of cocaine (10 mg/kg i.p), in animals treated with aCSF or OFQ/N on day 1, similarly blocked the action of cocaine, suggesting that the sensitized response was not due to tolerance to the effect of endogenously released OFQ/N. The administration of OFQ/N into the substantia nigra or nucleus accumbens failed to produce a significant sensitized response to a cocaine challenge 24 h later. A significant increase in cocaine stimulated locomotor response on day 2 was observed after injection of OFQ/N into the striatum on day 1. These results demonstrate the ability of a single intra-VTA or intra-striatal administration of OFQ/N to produce increases in the sensitivity to cocaine and may indicate a role for endogenous OFQ/N systems in regulating responses to psychostimulant drugs.     

Enhanced P53 and BAX gene expression and apoptosis in A549 cells by cis-Pt(II) complex of 3-aminoflavone in comparison with cis-DDP

Lung cancer remains one of the most common causes of cancer-related death worldwide. Approximately 80% is histologically non-small cell lung carcinoma (NSCLC) and in about 70% of patients it is an unresectable type. Clinical studies indicated that application of platinum derivatives caused good results and combinations of platinum with other agents could improve median survivals. In view of the central problem of sufficient efficiency of drugs in chemotherapy, efforts have focused on the development of alternative platinum-based analogues that can be more effective in cancer treatment. cis-bis(3-aminoflavone)dichloroplatinum(II) (cis-Pt(II) complex of 3-aminoflavone) represents a novel class of platinum-based potential antitumour agents. In order to evaluate the degree of apoptosis, acridine orange/ethidium bromide and Hoechst 33258/propidum iodide double staining as well as RT-PCR (P53 and BAX expression evaluation) were used in lung cancer cell line A549 after treatment with this compound in comparison with cis-diamminedichloroplatinum(II) (cis-DDP). Apoptotic cells at early and late stages and also necrotic ones were observed after usage of cis-Pt(II) complex of 3-aminoflavone and the percentage of these cells outnumbered the values obtained after cis-DDP application. The former compound induced a higher percentage of P53 and BAX expression in A549 cells in comparison with the latter one. Results indicate the beneficial properties of cis-Pt(II) complex of 3-aminoflavone as a potential antitumor drug.     

Chronic opioid antagonist treatment: assessment of receptor upregulation

Changes in specific brain opioid binding and opioid pharmacodynamics were determined in mice treated with the opioid antagonist naltrexone (subcutaneously implanted pellets) for 8 days. Chronic opioid antagonist treatment increased the number of binding sites (upregulation) for [³H]naloxone (+55%) and [³H][D-Ala²,D-Leu⁵]enkephalin (+41%) but did not alter the affinity of the ligands, as determined in saturation studies. Displacement studies of [³H]naloxone by morphine also indicated that there was no change in morphine's affinity. In vivo estimation of naloxone affinity (pA₂), agreed with the in vitro results indicating that chronic naltrexone treatment did not alter naloxone affinity. Chronic naltrexone treatment (0.5, 1.0, 15.0 mg pellets) increased the analgesic potency of morphine (supersensitivity) in a dose-dependent manner, up to a maximal increase in relative potency of 1.8. However, in mice tested with the naltrexone pellets still implanted, the 15 mg naltrexone pellet was able to shift the dose-response function for morphine analgesia more than 300-fold. The lowest dose naltrexone pellet (0.5 mg), produced significant antagonism of morphine analgesia, but did not produce significant supersensitivity. Thus, supersensitivity and upregulation are not proportional to the degree of antagonism of opioid effects; and supersensitivity in the mouse is related to increased binding sites and not to changes in receptor affinity as determined by in vivo and in vitro methods.     

Reporting disclosures to the reader in plastic surgery journal publications

BACKGROUND:

With the associations between investigators and funding sources becoming increasingly complicated, conflicts of interest may arise that could potentially cause biases in the reporting of results.

OBJECTIVE:

To determine the number of published plastic surgery articles that lack reporting of disclosures.

METHODS:

An online review of four major North American plastic surgery journal publications from January 1, 2007 to December 31, 2007, was performed. For identification and to provide anonymity, journals were assigned a letter from A to D.

RESULTS:

Of the 1759 articles reviewed, 726 (41%) were included. Disclosure was not reported in 368 (51%) articles: Journal A (n=10, 3%), Journal B (n=153, 85%), Journal C (n=193, 93%) and Journal D (n=12, 32%). Journals differed significantly in their reporting of disclosure (P<0.01).

CONCLUSION:

In the plastic surgery journals reviewed, the lack of documentation of disclosures was frequent. To ensure identification of bias in plastic surgery publications, a section dedicated to disclosure statements is recommended for each published article.     

Species differences in mu- and delta-opioid receptors.

The mu opioid receptor ligand [D-Ala2, NMePhe4, Gly-ol5]enkephalin (DAGO) and delta opioid receptor ligand [D-Pen2,D-Pen5]enkephalin (DPDPE) show similar specificity in competition binding studies in whole brain homogenate in rat and mouse. However, in saturation studies, the density and affinity of DPDPE binding sites were substantially greater in the mouse. There was no difference between the mouse and rat in the density and affinity of DAGO sites. Results from dose-response studies for analgesia using the same ligands administered i.c.v. in both species paralleled the binding studies. DAGO was approximately 2 times more potent in the mouse compared to the rat; while DPDPE was more than 15 times more potent in the mouse. Thus, binding capacity and affinity differences appear to be related to the functional potency of the mu and delta ligands in the two species. These results suggest that the difference in potency of DPDPE between rat and mouse is related to the differences in brain delta opioid receptors.