Influence of cell-free Hb on local tissue perfusion and oxygenation in acute anemia after isovolemic hemodilution

BACKGROUND: Oxygen-carrying solutions are intended to eliminate the blood transfusion trigger. Their ability to maintain microvascular perfusion and to deliver oxygen to tissue when they replace the RBCs as oxygen carriers has not been directly measured. STUDY DESIGN AND METHODS: Microvascular response to exchange transfusion with a polymerized bovine cell-free Hb (PBH) solution after acute isovolemic hemodilution with a plasma expander was investigated by using the hamster window model. In vivo functional capillary density (FCD), blood flow, and high-resolution oxygen distribution in microvascular networks were measured by noninvasive methods. RESULTS: Exchange transfusion of PBH solution after a 60-percent isovolemic hemodilution with dextran 70 (MW, 70 kDa) resulted in a Hct of 11 percent and a Hb content of 6.7 g per dL. FCD was 0.37 of baseline. Interstitial pO2 was reduced from 21.0 mm Hg to 0.3 mmHg. Arteriolar and venular blood flows were ratios of 0.75 and 0.76 relative to baseline. In a previous study, tissue pO2 after hemodilution to 5.6 g of Hb per dL with dextran 70 was 23.0 mmHg. Hypervolemic injection of PBH solution increased blood pressure and caused vasoconstriction. CONCLUSION: Using PBH solution to replace RBC oxygen-carrying capacity during low Hb content conditions (<50%) causes abnormally low tissue oxygenation and FCD, while the same level of hemodilution with dextran maintains normal microvascular conditions.     

Evaluation of storing hepatitis B vaccine outside the cold chain in the Solomon Islands: Identifying opportunities and barriers to implementation

Monovalent Hepatitis B vaccine (HepB) is heat stable, making it suitable for storage outside cold chain (OCC) at 37 °C for 1 month. We conducted an OCC project in the Solomon Islands to determine the feasibility of and barriers to national implementation and to evaluate impact on coverage. Healthcare workers at 13 facilities maintained monovalent HepB birth dose (HepB-BD) OCC for up to 28 days over 7 months. Vaccination data were recorded for children born during the project and those born during 7 months before the project. Timely HepB-BD coverage among facility and home births increased from 30% to 68% and from 4% to 24%, respectively. Temperature excursions above 37 °C were rare, but vaccine wastage was high and shortages common. Storing HepB OCC can increase HepB-BD coverage in countries with insufficient cold chain capacity or numerous home births. High vaccine wastage and unreliable vaccine supply must be addressed for successful implementation.     

8—氯腺苷抗肿瘤作用研究

（Sp)-8-氯腺苷3‘,5‘-环磷酸辛酯（OCC）是8－氯腺苷3‘,5‘－环磷酸的新衍生物，对人白血病细胞HL－60有很强的抑制作用和诱导分化作用，用细胞流式光度术发现OCC阻断HL－60细胞周期于G1期，OCC对HL－60－细胞DNA合成有显著抑制作用。但不影响RNA和蛋白质合成。OCC能激活HL－60细胞浆中蛋白激酶A，8－氯腺苷是OCC的活性代谢产物，能在体外和体内实验中明显抑制肿瘤的生长。8－氯腺苷也能诱导人胃癌MGc80-3细胞分化和人T淋巴母细胞MOTL－4的凋亡，本文讨论了8－氯腺苷抗肿瘤作用的机理。     

Obesity as a determinant of perioperative and postoperative outcome in patients following colorectal cancer surgery: A population-based study (2009–2016)

Background

Obesity is an increasing problem worldwide that can influence perioperative and postoperative outcomes. However, the relationship between obesity and treatment-related perioperative and short-term postoperative morbidity after colorectal resections is still subject to debate.

Self- or parent report of (co-occurring) internalizing and externalizing problems,and basal or reactivity measures of HPA-axis functioning: A systematic evaluation of the internalizing-hyperresponsivity versus externalizing-hyporesponsivity HPA-axis hypothesis

Background

Previous research findings on the link between adolescents’ psychopathology and hypothalamic–pituitary–adrenal (HPA) axis activity have been heterogeneous.

Method

Adolescents (n = 211) with a preadolescent DSM-IV diagnosis participated in a lab-based social stress task. Saliva cortisol was assessed at awakening and during social stress. It was investigated if continuous measures of internalizing and externalizing problems and their interaction, using both self- and parent report, were associated with basal or reactivity measures of HPA-axis functioning

Results

During social stress, an enhanced total release of cortisol was associated with self-reported internalizing problems and a blunted total release of cortisol with self-reported externalizing problems. Post hoc analyses revealed that the association between enhanced cortisol output and internalizing problems held for boys but not for girls. Associations with morning cortisol measures were overall weak

Conclusions

Only in the context of stress, and particularly when based on self-report, blunted cortisol output was associated with externalizing and enhanced cortisol output with internalizing problems. Our broad approach demonstrates the importance of who reports on psychopathology, the use of dimensional measures of psychopathology, simultaneous analysis of internalizing and externalizing problems, and the use of awakening and social stress related measures of cortisol.     

Studies on the Antitumour Activities of 8-Chloroadenosine

（Ｓｐ）－８－氯腺苷３′，５′环磷酸辛酯（ＯＣＣ）是８－氯腺苷３′，５′环磷酸的新衍生物，对人白血病细胞ＨＬ－６０有很强的抑制作用和诱导分化作用。用细胞流式光度术发现ＯＣＣ阻断ＨＬ－６０细胞周期于Ｇ１期。ＯＣＣ对ＨＬ－６０细胞ＤＮＡ合成有显著抑制作用，但不影响ＲＮＡ和蛋白质合成。ＯＣＣ能激活ＨＬ－６０细胞浆中蛋白激酶Ａ。８－氯腺苷是ＯＣＣ的活性代谢产物，能在体外和体内实验中明显抑制肿瘤的生长。８－氯腺苷也能诱导人胃癌ＭＧｃ８０－３细胞分化和人Ｔ淋巴母细胞ＭＯＴＬ－４的凋亡。本文讨论了８－氯腺苷抗肿瘤作用的机理。     

A novel mortality prediction model for the current population in an adult intensive care unit

Background

The accurate and reliable mortality prediction is very useful, in critical care medicine. There are various new variables proposed in the literature that could potentially increase the predictive ability for death in ICU of the new predictive scoring model.

Orbitocranial Complications of Acute Sinusitis in Children

Background

Orbitocranial complications (OCCs) of sinusitis are uncommon but potentially life threatening. OCCs carry high morbidity, mortality, and significant long-term sequelae. Late recognition leads to even worse outcomes.

Objective

To present four case reports showing that aggressive management of complications of sinusitis-like OCC decreases long-term sequelae and mortality in pediatric patients.

Case Reports

Four pediatric patients diagnosed with OCC were treated at our institution from April 2012 to March 2013. Three were boys and one was a girl; ages ranged from 4–14 years. Magnetic resonance imaging and computed tomography were the most useful imaging modalities. All patients received broad-spectrum antibiotics. Additional interventions consisted of endoscopic sinus surgery, subdural empyema drainage, and orbital decompression.

Conclusion

The difficult complications of acute sinusitis in the pediatric age group should be anticipated, recognized early, and aggressively managed to prevent morbidity and a fatal outcome.