Apoptosis after intestinal ischemia-reperfusion injury: a morphological study

BACKGROUND: Apoptosis has been identified after ischemia-reperfusion (IR) injury to the brain, heart, kidney, retina, and the adrenals. Intestinal IR injury causes villous and crypt damage, which has so far been attributed to cellular necrosis. This study was undertaken to investigate the possible role of apoptosis after reperfusion of cold-stored small bowel grafts in syngeneic rats. METHODS: Small intestinal grafts were stored at 4 degrees C for 24 hr in saline (n=6) or in modified University of Wisconsin solution (n=6), followed by reperfusion for 1 hr in syngeneic Lewis rats. Small bowel samples were obtained before storage, after preservation and after 1 hr of reperfusion. They were processed for light and electron microscopy and analyzed for cell death, with particular emphasis on apoptosis. RESULTS: Less than one apoptotic event was seen per 10 crypts in normal and stored bowels. An occasional normal and some denuded villous epithelial cells of stored bowels exhibited apoptosis. After isotransplantation and 1 hr of reperfusion, marked increase in apoptosis was seen in the crypts and denuded villous epithelial cells of both saline- and modified University of Wisconsin-stored bowels. Secondary necrosis was seen in apoptotic cells, as were dark cells. Only a few cells showed signs of primary ischemic necrosis. CONCLUSIONS: Apoptosis occurs after intestinal IR injury. Modulation of its genetic regulatory and biochemical effector machinery might alleviate or even prevent IR injury in small bowel transplanted after similar periods of storage.     

Methylene blue prevents pulmonary injury after intestinal ischemia-reperfusion

OBJECTIVE: To investigate the effect of methylene blue, an inhibitor of oxygen radicals, on lung injury caused by reperfusion of ischemic tissue. METHODS: Intestinal ischemia-reperfusion injury was induced in rats by clamping the superior mesenteric artery for 1 hour. Thereafter, the experimental group was administered 1% methylene blue intraperitoneally and the control group received saline. After 4 hours, pulmonary histopathologic features were assessed, and lung wet-weight to dry-weight ratios and tissue xanthine oxidase were determined. RESULTS: The control group suffered from severe pulmonary parenchymal damage, compared with slight damage in the experimental group. The number of sequestered neutrophils was significantly higher in the control group (319 +/- 60 polymorphonuclear cells per 10 high-power fields) than in the methylene blue-treated group (91 +/- 8 polymorphonuclear cells per 10 high-power fields; p < 0.001). The wet-weight to dry-weight ratio was significantly increased in the saline-treated rats compared with the methylene blue-treated group (6.19 +/- 0.28 vs. 5.07 +/- 0.21; p < 0.001). Xanthine oxidase activity was similar in both groups. CONCLUSION: Methylene blue attenuated lung injury after intestinal ischemia-reperfusion. Inhibition of oxygen free radicals may be the protective mechanism.     

Dissociation as a predictor of psychopathology following burns injury

Forty-six burned adults were seen, on average 7 days after admission to hospital. Eighty per cent suffered from one or more dissociative symptoms during trauma and three or more dissociative phenomena were experienced by 19.5 per cent. Blunting or absence of emotion was the symptom most frequently reported. The number of dissociative phenomena during trauma was statistically significant and associated with extreme anxiety. The intensity of the dissociation-anxiety reaction during trauma was a predictor for psychopathology measured at the moment of discharge.     

Cerebral blood flow as a predictor of outcome following traumatic brain injury

As part of a prospective study of the cerebrovascular effects of head injury, 54 moderate and severely injured patients underwent 184 133Xe-cerebral blood flow (CBF) studies to determine the relationship between the period of maximum blood flow and outcome. The lowest blood flows were observed on the day of injury (Day 0) and the highest CBFs were documented on postinjury Days 1 to 5. Patients were divided into three groups based on CBF values obtained during this period of maximum flow: Group 1 (seven patients), CBF less than 33 ml/100 g/minute on all determinations; Group 2 (13 patients), CBF both less than and greater than or equal to 33 ml/100 g/minute; and Group 3 (34 patients), CBF greater than or equal to 33 ml/100 g/minute on all measurements. For Groups 1, 2, and 3, mean CBF during Days 1 to 5 postinjury was 25.7 +/- 4, 36.5 +/- 4.2, and 49.4 +/- 9.3 ml/100 g/minute, respectively, and PaCO2 at the time of the CBF study was 31.4 +/- 6, 32.7 +/- 2.9, and 33.4 +/- 4.7 mm Hg, respectively. There were significant differences across Groups 1, 2, and 3 regarding mean age, percentage of individuals younger than 35 years of age (42.9%, 23.1%, and 76.5%, respectively), incidence of patients requiring evacuation of intradural hematomas (57.1%, 38.5%, and 17.6%, respectively) and incidence of abnormal pupils (57.1%, 61.5%, and 32.4%, respectively). Favorable neurological outcome at 6 months postinjury in Groups 1, 2, and 3 was 0%, 46.2%, and 58.8%, respectively (p < 0.05). Further analysis of patients in Group 3 revealed that of 14 with poor outcomes, six had one or more episodes of hyperemia-associated intracranial hypertension (simultaneous CBF > 55 ml/100 g/minute and ICP > 20 mm Hg). These six patients were unique in having the highest CBFs for postinjury Days 1 to 5 (mean 59.8 ml/100 g/minute) and the most severe degree of intracranial hypertension and reduced cerebral perfusion pressure (p < 0.0001). These results indicate that a phasic elevation in CBF acutely after head injury is a necessary condition for achieving functional recovery. It is postulated that for the majority of patients, this rise in blood flow results from an increase in metabolic demands in the setting of intact vasoreactivity. In a minority of individuals, however, the constellation of supranormal CBF, severe intracranial hypertension, and poor outcome indicates a state of grossly impaired vasoreactivity with uncoupling between blood flow and metabolism.     

A CD18 antibody prevents lung injury but not hypotension after intestinal ischemia-reperfusion

Antibodies to the neutrophil CD18 integrin have been shown to ameliorate the local effects of intestinal ischemia and reperfusion (I/R). In addition to local mucosal injury, intestinal I/R results in systemic hypotension and injury to the lungs with lung leukosequestration. This study tests the effect of a CD18 monoclonal antibody on the hypotension and lung injury after intestinal I/R. In anesthetized rabbits, the superior mesenteric artery was clamped for 60 min followed by 3 h of reperfusion. Animals were treated with saline, an anti-CD18 monoclonal antibody (R15.7 MAb), or nonspecific immunoglobulin G. Another non-ischemic group were sham controls. Neutrophil sequestration was assessed by measure of lung myeloperoxidase (MPO) and permeability by lung-to-blood concentration ratio of 125I-labeled bovine serum albumin and wet-to-dry weight ratio. Immediately after reperfusion, mean arterial pressure fell to 49 +/- 2.1 mmHg and remained at this level. The hypotension was unaffected by treatment with R15.7 MAb. Thirty minutes after reperfusion, the circulating white blood cell count fell to 2.91 +/- 0.53 x 10(3)/mm3 vs. sham 6.40 +/- 0.66 x 10(3)/mm3 (P < 0.05). Treatment with R15.7 MAb prevented this fall in white blood cell count (5.75 +/- 1.59 x 10(3)/mm3). At 3 h of reperfusion in saline-treated animals there was increased MPO, 74.8 +/- 4.9 U/g vs. 42.0 +/- 4.8 U/g in sham animals (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Serum neuron-specific enolase as early predictor of outcome after cardiac arrest

OBJECTIVE: To examine the prognostic value of serum neuron-specific enolase for early prediction of outcome in patients at risk for anoxic encephalopathy after cardiac arrest. DESIGN: Prospective study. SETTING: Coronary intensive care unit of the University of Heidelberg. PATIENTS: Forty-three patients (66.8 +/- 12.7 [SD] yrs, range 33 to 85) who had had either primary or secondary cardiac arrest, followed by cardiopulmonary resuscitation (CPR). INTERVENTIONS: Serial blood samples and clinical examinations. MEASUREMENTS AND MAIN RESULTS: Serum neuron-specific enolase concentrations were determined after CPR on 7 consecutive days. Twenty-five patients remained comatose and subsequently died; 18 patients survived the first 3 months and had no relevant functional deficit at 3-month follow-up. Neuron-specific enolase concentrations were correlated with neurologic outcome. Concentrations of >33 ng/mL predicted persistent coma with a high specificity (100%) and a positive predictive value of 100%. Overall sensitivity was 80%, with a negative predictive value of 78%. Serum concentrations of neuron-specific enolase exceeded this cutoff value no more than 3 days after cardiac arrest in 95% of patients in whom these concentrations had exceeded 33 ng/mL. CONCLUSIONS: In patients who have been resuscitated after cardiac arrest, serum neuron-specific enolase concentrations of >33 ng/mL predict persistent coma with a high specificity. Values below this cutoff level do not necessarily indicate complete recovery, because this method has a sensitivity of 80%.     

Serum LDH value as a predictor of clinical outcome in acute myelogenous leukaemia of the elderly

PURPOSE: To determine whether the diagnostic quality of computed tomography (CT) during arterial portography (CTAP) performed via the splenic artery (SA) is better than that performed via the superior mesenteric artery (SMA). MATERIALS AND METHODS: The authors evaluated CTAP images obtained in 98 patients from 1991 to 1994; 47 examinations were performed via the SA and 51 were performed via the SMA. Images were reviewed, by consensus, by three radiologists blinded to catheter location. Hepatic enhancement was quantitatively assessed in 53 patients (31 in the SA group, 22 in the SMA group). RESULTS: The numbers of low-attenuation non-tumor-related perfusion defects (19 in the SA group, 17 in the SMA group), high-attenuation non-tumor-related perfusion defects (six in the SA group, six in the SMA group), diffuse mottled perfusion abnormalities (six in the SA group, five in the SMA group), and portal venous flow defects (20 in the SA group, 20 in the SMA group) were similar in both groups (P > .05). Peak hepatic enhancement was similar in both groups (SMA group = 111 HU; SA group = 112 HU) (P > .05). CONCLUSION: There is no difference in quality between CTAP performed via the SA versus CTAP performed via the SMA.     

Serum creatinine level during chemotherapy for testicular cancer as a possible predictor of bleomycin-induced pulmonary toxicity

BACKGROUND: Bleomycin is one of the key drugs used in induction chemotherapy for testicular cancer. Pulmonary toxicity is the major and potentially fatal adverse side-effect of this drug. METHODS: To evaluate the risk factors for bleomycin pulmonary toxicity, we retrospectively analyzed the cases of 20 men treated for metastatic testicular cancer at Tsukuba University Hospital between 1990 and 1996. All patients were treated with two to four cycles of a PVB regimen or BEP regimen. Recombinant human granulocyte colony-stimulating factor was used in all but one case. With a logistic procedure, we evaluated the age, total bleomycin dose, total cisplatin dose, renal injury, leukocytosis, smoking history, lung metastases and drug regimen as risk factors for a decrease in the diffusing capacity. RESULTS: Diffusing capacity was decreased to below 75% of the predicted values in nine patients. Elevation of the serum creatinine level was the most significant risk factor (P = 0.018) by the chi-squared test. A logistic regression analysis also indicated that the elevation of serum creatinine level was an independent risk factor for a decrease in the diffusing capacity (odds ratio 22.3, 95% Cl 1.02-487.3, P = 0.049). CONCLUSIONS: We recommend a pulmonary function assessment of patients receiving a relatively low dose of bleomycin, especially when an elevated serum creatinine level is seen during chemotherapy.     

The MMPI as a suicide predictor

MMPIs of 36 patient suicides (20 males and 16 females) were compared with 2 matching control groups (36 highly suicidal patients and 36 nonsuicidal patients; each group was matched with the suicide group by age and sex). Female suicides had higher Mf, Si, and Hy scores and lower K scores than the high-suicidal female controls, suggesting nondefensiveness, a more masculine interest pattern, social withdrawal, and denial and repression of inner needs and feelings. Male suicides were significantly differentiated from nonsuicidal males but not from the high-suicidal male controls. Nonsuicidal males had higher K and OH scores and lower Mf and D scores than the other 2 male groups, suggesting a more active, assertive, and self-protective stance. These differentiating patterns emerged from a population of voluntary psychiatric patients and are not necessarily generalizable to other populations. Results emphasize the necessity for knowing the population and the subgroups within; once these measures are taken, MMPI patterns appear to have usefulness in predicting suicide potential. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Serum cytokines as predictors of clinical outcome in AIDS-related intestinal cryptosporidiosis

BACKGROUND: This study examined the reliability of explicit guidelines developed using the RAND-UCLA appropriateness method. METHODS: The appropriateness of over 400 indications for colonoscopy was rated by two multispecialty expert panels (United States and Switzerland). A nine-point scale was used, which was consolidated into three categories of appropriateness: appropriate, uncertain, inappropriate. The distribution of appropriateness ratings between the two panels and the intrapanel and interpanel agreement for categories of appropriateness were calculated for all possible indications. Similar statistics were calculated for a series of 577 primary care patients referred for colonoscopy in Switzerland. RESULTS: Over 80% of all indications (348) could be directly compared. The proportions of indications classified as appropriate, uncertain, or inappropriate were 28.4%, 24.7%, 46.6% and 33.0%, 23.0%, 44.0% for the U.S. and the Swiss panels, respectively. Interpanel agreement was excellent for all the possible indications (kappa value: 0.75) and lower for actual cases (kappa value: 0.51) because of lower agreement for the most frequently encountered indications. CONCLUSIONS: Good agreement between the two sets of criteria was found, pointing to the reliability of the method. Partial disagreement occurred essentially for a few, albeit frequently encountered, indications for use of colonoscopy in cases of uncomplicated lower abdominal pain or constipation.     

Serum levels of erythropoietin as a novel marker reflecting the severity of diabetic nephropathy

Investigations were undertaken to observe the influence of technical grade carbofuran (CF) on the egg maturational processes of catfish, Heteropneustes fossilis (Bloch). Fish were exposed to sublethal doses (0.5, 1, and 2 mg/L) of CF for 30 days at 25 +/- 1 degrees C. Control fish were maintained in water. The gonado-somatic index (G.S. I. = ovarian weight x 100/body weight) of the fish, treated with 1 or 2 mg/L CF, was decreased significantly compared to that of the controls. The inhibition was almost at the same level in these doses. CF at the dose of 0.5 mg/L was found to be ineffective. From the histomorphological observations of the ovary, it was observed that CF altered both the area and the percentage occurrence of the various types of primary oocytes in the ovary compared to that of the control fish. The stage I primary oocytes were predominantly higher in CF-treated fish than stage II and stage III which was reversed in control animals. The degeneration of follicular walls, connective tissues and vacuolization in the ooplasm of the stage II and III oocytes were observed in CF-treated fish (0.5-2 mg/L). It appears that CF at sublethal concentrations inhibits oocyte maturational processes in catfish.     

Succinylcholine as a predictor in strabismus surgery

Succinylcholine was injected intraoperatively in 20 patients with congenital esotropia, before and after the surgical procedure. Regression analysis was performed to investigate the relationship between the awake pre- and postoperative alignment and the drug-induced ocular positions, under anesthesia. The postoperative succinylcholine-induced ocular position was found to be a highly significant predictor of the one week postoperative alignment (r = 0.98, p less than 0.0001). Further investigation may lead to an ability to predict the postoperative alignment intraoperatively.     

SVIB as a predictor of job satisfaction.

A study was made of 185 graduates of professional curricula to test the hypothesis that job satisfaction in a certain occupation is related to congruent or appropriate interests in that occupation. Occupations represented were medicine, law, dentistry, mechanical engineering, accounting, and journalism. Ss were contacted by mail and asked to fill out 3 job satisfaction blanks and the SVIB. 12th grade SVIB scores were also available for each S. Only 1 of 56 relationships between interests and job satisfaction scores was significantly different from 0. The lack of relationships was true for both earlier and current testing of interests and for all 3 job satisfaction blanks. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Student-college congruency as a predictor of satisfaction.

Tested hypotheses about person-environment congruency, consistency, and differentiation from J. L. Holland's (1973) theory of careers. Ss were 1,878 undergraduates from 1 college and 1 university who had been given the Self-Directed Search before their freshman year followed by a satisfaction questionnaire 1 or 3 yrs later. 2 analyses were conducted. The 1st was a 3-factor multiple analysis of variance with school, sex, and congruency level as the independent variables. The 2nd was a 4-factor multiple analysis of variance with school, sex, consistency, and differentiation as independent variables. 3 college satisfaction measures were the dependent variables. Statistically significant main effects (p     

Conservatism as a predictor of humor preferences.

Of a sample of 139 high school students, humor preference profiles were compared for 30 Ss scoring highest on the Conservatism Scale, and 30 Ss scoring lowest. As predicted, high-conservative Ss tended to prefer "safe," formal types of humor, e.g., puns, while low conservatives (liberals) expressed greater appreciation of transparently "libidinal" types of humor, e.g., sick and sexual. Results were interpreted as indicating the importance of individual differences in the extent to which it is necessary for appetitive content to be disguised by the structural aspects of the joke medium before humorous affect is evoked. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preconceptional natural-killer-cell activity as a predictor of miscarriage

There is no immunological test for the prospective identification of alloimmune causes of miscarriage. We investigated whether activity of natural killer cells was predictive of subsequent abortion in women who had had unexplained recurrent abortions and had received no treatment. 24 women with high preconceptional NK activity, defined as mean plus 1 SD of NK activity of 47 controls, had a significantly higher abortion rate in the next pregnancy than 44 women with normal levels of NK activity (71 vs 20%; relative risk 3.5; 95% CI 1.8-6.5). The preconceptional evaluation of NK activity in women with recurrent miscarriages may thus be predictive of the risk of pregnancy loss at the next conception.     

Exploring self-efficacy as a predictor of disease management

This research examined lay relationship and partner ideals in romantic relationships from both a social-cognitive and an evolutionary perspective. Studies 1 and 2 revealed that the qualities of an ideal partner were represented by 3 factors (partner warmth-trustworthiness, vitality-attractiveness, and status-resources), whereas the qualities of an ideal relationship were represented by 2 factors (relationship intimacy-loyalty and passion). A confirmatory factor analysis in Study 3 replicated these factor structures but found considerable overlap across the partner and relationship dimensions. Studies 4 and 5 produced convergent and discriminant validity evidence for all 5 factors. Study 6 indicated that the higher the consistency between the ideals and related assessments of the current partner and relationship, the more positively the current relationship was evaluated.