Ultrastructural observations on the vincristine-induced neuronal crystalloid inclusion in young rats

Summary Vincristine-induced crystalloid inclusions were examined in the neurons and neuronal processes of young rats by the electron microscope (EM) equipped with a tilting stage. Using a computer system that reproduces three-dimensional organization, an optical transformation method was applied to the microtubules and neurofilaments in an attempt to clarify the morphological appearance and internal pattern of crystalloid inclusions. The dimensional models obtained were compared with actual EM photographs, and the characteristic ultrastructural component and morphology were drawn out.Basically, a crystalloid inclusion is composed of four strands of intermediate 10 nm neurofilaments connected to one another by four side-arms producing a circular profile on a transverse section. These four side-arms seemed to arise from nodules within the filaments at regular intervals simulating a bead-like appearance. These data did not significantly differ from those obtained from EM images. Characteristically, these crystalloid inclusions began to appear 6 h after the administration of 10^–3 M vincristine sulfate and persisted up to a period of 6 days. Beyond that, however, these inclusions were no longer demonstrable suggesting a transient state. This was in contrast to neurofibrillary tangles which appeared to be permanent changes.     

Initial assessment on the impact of crystalloids versus colloids during damage control resuscitation

Background

High ratios of fresh frozen plasma:packed red blood cells in damage control resuscitation (DCR) are associated with increased survival. The impact of volume and type of resuscitative fluid used during high ratio transfusion has not been analyzed. We hypothesize a difference in outcomes based on the type and quantity of resuscitative fluid used in patients that received high ratio DCR.

Methods

A matched case control study of patients who received transfusions of ≥ four units of PRBC during damage control surgery over 4 1/2 y, was conducted at a Level I Trauma Center. All patients received a high ratio DCR, >1:2 of fresh frozen plasma:packed red blood cells. Demographics and outcomes of the type and quantity of resuscitative fluids used in combination with high ratio DCR were compared and analyzed. A Kaplan-Meier survival analysis was computed among four groups: colloid (median quantity = 1.0 L), <3 L crystalloid, 3–6 L crystalloid, and >6 L crystalloid.

Results

There were 56 patients included in the analysis (28 in the crystalloid group and 28 in the colloid group). Demographics were statistically similar. Intraoperative median units of PRBC: crystalloid versus colloid groups was 13 (IQR 8-21) versus 16 (IQR 12–19), P = 0.135; median units of FFP: 12 (IQR 7–18) versus 12 (IQR 10–18), P = 0.440. OR for 10-d mortality in the crystalloid group was 8.41 [95% CI 1.65–42.76 (P = 0.01)]. Kaplan-Meier survival analysis demonstrated lowest mortality in the colloid group and higher mortality with increasing amounts of crystalloid (P = 0.029).

Conclusions

During high ratio DCR, resuscitation with higher volumes of crystalloids was associated with an overall decreased survival, whereas low volumes of colloid use were associated with increased survival. In order to improve outcomes without diluting the survival benefit of hemostatic resuscitation, guidelines should focus on effective low volume resuscitation when high ratio DCR is used. A multi-institutional analysis is needed in order to validate these results.     

晶体停搏液中Ca^2＋浓度对未成熟心肌细胞超微结构的影响

目的采用离体心脏灌注模型探讨了不同Ｃａ２＋浓度的Ｓｔ．Ｔｈｏｍａｓ停搏液对未成熟心肌细胞超微结构的影响。方法采用日本长耳幼兔，根据停搏液中Ｃａ２＋浓度的不同，实验分为４组：无Ｃａ２＋组，［Ｃａ２＋］０ｍｍｏｌ／Ｌ；低Ｃａ２＋组，［Ｃａ２＋］０．６ｍｍｏｌ／Ｌ；中Ｃａ２＋组，［Ｃａ２＋］１．２ｍｍｏｌ／Ｌ；高Ｃａ２＋组，［Ｃａ２＋］２．４ｍｍｏｌ／Ｌ．；另设对照组。离体灌注心脏经２０℃、９０ｍｉｎ缺血后，３７℃再灌注３０ｍｉｎ。结果各实验组心肌细胞超微结构呈现为轻度可逆性损伤。高Ｃａ２＋组细胞内糖元颗粒极少见，肌原纤维张力较高，线粒体损伤较其他组显著。结论高Ｃａ２＋浓度的Ｓｔ．Ｔｈｏｍａｓ停搏液对未成熟心肌不能提供满意的心肌保护作用。     

Intravenous Fluid Selection for Unruptured Intracranial Aneurysm Clipping : Balanced Crystalloid versus Normal Saline

ObjectiveWhile balanced crystalloid (BC) could be a relevant fluid regimen with buffer system compared with normal saline (NS), there have been no studies on the optimal fluid for surgery of an unruptured intracranial aneurysm (UIA). This study aimed to compare the effects of fluid regimens between NS and BC on the metabolic and clinical outcomes of patients who underwent surgery for UIA. MethodsThis study was designed as a propensity score matched retrospective comparative study and included adult patients who underwent UIA clipping. Patient groups were categorized as NS and BC groups based on the types of pre-operative fluid and the amount of fluid administered during surgery. The primary outcomes were defined as electrolyte imbalance and acidosis immediately after surgery. The secondary outcomes were the length of stay in the intensive care unit (ICU) and duration from the end of the operation to extubation. ResultsA total of 586 patients were enrolled in this study, with each of 293 patients assigned to the NS and BC groups, respectively. Immediately after surgery, serum chloride levels were significantly higher in the NS group. Compared to the NS group, the BC group had lower incidence rates of acidemia (6.5% vs. 11.6%, p=0.043) and metabolic acidosis (0.7% vs. 4.4%, p=0.007). As compared to NS group, BC group had significantly shorter duration from the end of the operation to extubation (250±824 vs. 122±372 minutes, p=0.016) and length of stay in ICU (1.37±1.11 vs. 1.12±0.61 days, p=0.001). Throughout multivariable analysis, use of BC was found to be significant factor for favorable post-operative results. ConclusionThis study showed that the patients who received BC during UIA clipping had lower incidence of metabolic acidosis, earlier extubation and shorter ICU stay compared to those who received NS. Therefore, using BC as a peri-operative fluid can be recommended for patients who undergo surgery for UIA.     

Krabbe's disease

Summary Ultrastructural studies of brain and sural nerve biopsy specimens from a patient with Krabbe's disease disclosed periodically constricted or twisted tubules in addition to the more abundant and characteristic crystalloid and prismatic structures within macrophages. It is suggested that the twisted tubules may result from the intracellular accumulation of lactosyl ceramide. Familiarity with these unusual tubular structures is of practical as well as theoretical importance since they may be encountered in brain and peripheral nerve biopsy specimens obtained for the morphological diagnosis of Krabbe's disease.     

胶体液和晶体液容量预负荷对硬膜外麻醉下剖宫产患者血流动力学及新生儿的影响

目的本研究拟观察胶体液及晶体液预负荷对剖宫产患者及新生儿的影响。方法征得病人同意并签字后,健康足月妊娠择期剖宫产妇80例随机分为A、B两组（n=40）。A、B组分别为硬膜外麻醉前20min内乳酸林格液或琥珀酰明胶500mL预负荷,记录产妇麻醉前和麻醉后收缩压、舒张压、心率、术中恶心呕吐情况,新生儿Apgars评分、新生儿脐静脉血pH、PvO2、SvO2、CvO2及脐动脉血pH、P（O2）、SaO2、CaO2。结果 A组患者麻醉后SBP和DBP明显较麻醉前下降（P〈0.01）,B组麻醉后SBP和DBP较麻醉前差异无显著意义（P〉0.05）,A、B两组患者在麻醉前及麻醉后心率及恶心呕吐频率差异无显著意义（P〉0.05）。B组新生儿脐静脉血pH、PvO2、SvO2、CvO2、脐动脉血P（O2）显著高于A组（P值分别为〈0.01、〈0.01、〈0.05、〈0.01、〈0.05）。A、B两组新生儿Ap-gar评分差异无显著意义（P〉0.05）。结论琥珀酰明胶预负荷不仅能够稳定硬膜外麻醉下剖宫产患者的血流动力学稳定性,还能有效地改善胎儿体内代谢状况,提高胎儿对麻醉及手术期缺氧的耐受。     

Variabilidad del uso intraoperatorio de cristaloides y asociación con los resultados postoperatorios: análisis post hoc de dos estudios prospectivos y multicéntricos de cohortes

BackgroundThe optimal regimen for intravenous administration of intraoperative fluids remains unclear. Our goal was to analyze intraoperative crystalloid volume administration practices and their association with postoperative outcomes.MethodsWe extracted clinical data from two multicenter observational studies including adult patients undergoing colorectal surgery and total hip (THA) and knee arthroplasty (TKA). We analyzed the distribution of intraoperative fluid administration. Regression was performed using a general linear model to determine factors predictive of fluid administration. Patient outcomes and intraoperative crystalloid utilization were summarized for each surgical cohort. Regression models were developed to evaluate associations of high or low intraoperative crystalloid with the likelihood of increased postoperative complications, mainly acute kidney injury (AKI) and hospital length of stay (LOS).Results7,580 patients were included. The average adjusted intraoperative crystalloid infusion rate across all surgeries was to 7.9 (SD 4) mL/kg/h. The regression model strongly favored the type of surgery over other patient predictors. We found that high fluid volume was associated with 40% greater odds ratio (OR 1.40; 95% confidence interval1.01-1.95, p = 0.044) of postoperative complications in patients undergoing THA, while we found no associations for the other types of surgeries, AKI and LOSConclusionsA wide variability was observed in intraoperative crystalloid volume administration; however, this did not affect postoperative outcomes.