Respiratory muscle involvement in Bethlem myopathy

BACKGROUND: There is a great need to learn more about porcine islet physiology because porcine islets represent a promising source of xenogeneic tissue for beta-cell replacement therapy in humans. METHODS: We evaluated the effects of two important physiological regulators of insulin secretion, glucagon-like peptide-1 (GLP-1) and pituitary adenylate cyclase-activating peptide (PACAP), on insulin release and intracellular calcium ([Ca++]i) by adult porcine islet cells. RESULTS: Exposure to GLP-1 and PACAP significantly potentiated glucose-induced insulin release and improved the sensitivity to glucose as a secretagogue. About 70% of cells stimulated with 20 mmol/L glucose alone showed an increase in [Ca++]i, whereas the addition of GLP-1 and PACAP induced [Ca++]i increases in 86% and 93% of cells, respectively. CONCLUSIONS: The good insulin and [Ca++]i responsiveness of porcine islet cells to both GLP-1 and PACAP provides an additional proof of their suitability for transplantation.     

辊面裂纹引起的冷轧辊大面积剥落失效分析

针对某产线冷轧工作辊多次出现大面积剥落事故,为了研究其失效原因,从剥落面断口观察、化学成分、工作层组织、淬硬层深度、裂纹扩展等角度对其进行了较为深入的分析研究。结果表明,该轧辊大面积剥落失效为疲劳裂纹扩展所致,裂纹源是轧钢过程中异常压痕产生的辊面裂纹。最后,针对如何预防辊面剥落恶性事故的问题,从轧辊使用、维护和设计制造三个角度提出了相应的建议,确保了近期未再发生类似的事件。     

Respiratory failure in ANCA-associated vasculitis

OBJECTIVE: To assess the prevalence, clinical manifestations, and course of respiratory failure in all patients who tested positive for antineutrophil cytoplasmic autoantibodies (ANCA) in our clinics in the period between January 1985 and January 1993. DESIGN: Case-series analysis. SETTING: Three teaching hospitals in the Netherlands. PATIENTS: Two hundred twenty consecutive patients suspected of having vasculitis and/or glomerulonephritis who tested positive for ANCA by indirect immunofluorescence and enzyme-linked immunosorbent assay. RESULTS: Sixty-two patients had pulmonary involvement. Acute respiratory failure developed in nine. Respiratory failure was related to infections in two of them and to ANCA-associated vasculitis in seven. These seven patients uniformly presented with pulmonary hemorrhage and diffuse pulmonary infiltrates. The diagnosis of systemic vasculitis was supported by the presence of a pulmonary-renal syndrome in all patients, and by detection of antibodies to the proteinase 3 or myeloperoxidase antigen in all but one patient. Antiglomerular basement membrane antibodies were absent. The mortality was high due to hypoxic respiratory failure, pulmonary superinfections, and concomitant renal failure. CONCLUSIONS: Acute respiratory failure due to vasculitis developed in one of every nine patients with ANCA-associated pulmonary disease. Patients usually present with pulmonary infiltrates and hemoptysis. A diagnosis of vasculitis may be further supported by analysis of the urinary sediment and determination of the ANCA target antigen. It remains to be proved that early detection of ANCA favorably affects the outcome.     

Procalcitonin--a sepsis parameter in severe burn injuries

Procalcitonin (PCT) levels increase in patients with systemic infections; the highest levels have been found in sepsis. This study tested whether plasma procalcitonin level was related to sepsis, CRP, burn size, inhalation injury or mortality in severely burned patients over the entire clinical course. In 27 patients with 51 (20-91)% TBSA, PCT was measured three times weekly from admission over the entire course of stay in a single ICU. Daily scoring by the "Baltimore Sepsis Scale" was performed. The patients were assigned to three groups depending on the clinical course and outcome: A = no septic complications, B = septic complications-survivors, C = septic complications non-survivors. PCT levels were elevated slightly at admission (mean 2.1 ng/ml) except in three patients who suffered electrical burns (mean 15.7 ng/ml). PCT peak levels correlated well with the Scoring values (r = 0.84) while CRP did not (r = 0.64). Peak PCT levels were significantly higher (p < 0.005) in septic patients (B and C) who averaged 49.8+/-76.9 ng/ml, than in non-septic patients (A) who averaged peak levels of 2.3+/-3.7 ng/ml. The highest PCT levels were found immediately before death (86.8+/-97 ng/ml). Seven patients had an inhalation injury 3rd degree. In these patients at 24 h postburn, there was no relationship between PCT levels and inhalation injury but during the later days postburn there were significant differences in PCT levels in patients with versus without inhalation injury. All patients with inhalation injury 3rd degree developed septic complications. There was no positive correlation between the PCT-admission-levels and the TBSA, but there was a positive correlation between the TBSA and the mean peak PCT levels during the later days postburn (r = 0.73; p < 0.05). The cut-off value of 3 ng/ ml we found reliable to indicate severe bacterial or fungal infection. PCT values over 10 ng/ml increasing over the following days were found only in life-threatening situations due to systemic infections. The individual course of PCT in one patient is more important than absolute values. PCT presented in this study as a useful diagnostic parameter in severely burned patients.     

Respiratory complications in patients with severe burns

The rising emphasis on conservative surgical treatment of the fallopian tube has generated a greater demand for methods of reparative surgery. Thus far, the use of surrogate tubes and allotransplantation of the fallopian tube hae not fulfilled the requirements for success. A case of homotransplantation of the human fallopian tube is presented. At surgery, a midsegment anastomosis was performed by grafting the good portion of the left tube to a viable segment of the right tube. The arteries and veins were then anastomosed with 9-0 silk and a single-layer closure; an operating microscope was used. Patency was documented with chromotubation, and bleeding was controlled with microcautery. Decadron and Phenergan were placed in the patient's abdomen along with 150 ml of saline. She was given systemic Decadron, Phenergan, and antibiotics pre- and postoperatively. Three months after surgery hysterography revealed a viable-appearing fallopian tube. The patient subsequently aborted an 8-week intrauterine gestation. Fallopian tube homotransplantation has a role in the treatment of infertility, but the patient population for which this procedure is applicable is limited.     

Erythema multiforme caused by saquinavir]

A multidisciplinary audit to monitor the introduction of a ward-based urine screening test using Multistix 10 SG was associated with a 40% reduction in the number of culture-negative samples being sent for laboratory testing. Ongoing education and support was provided for nursing staff throughout the process of change.     

Infection and sepsis in resuscitation]

Perhaps no area of medicine has advanced as dramatically and rapidly as the one dedicated to the knowledge of infections and sepsis. In the last decade, there has been a virtual explosion of new information in the area, including, among others, the discovering of new antibiotics of broad spectre and important sighting into the mechanisms of cardiovascular dysfunction, several sepsis-induced new cytokines and inflammatory mediators, as well as the role of the L-arginine-nitric oxide pathway in the pathophysiology of sepsis. These advances have provided further expectations in reduction of morbidity and mortality from sepsis, that have not still been confirmed on different phase III clinical trials with immunologic therapies. That have seen undertaken and reported the aim of this issue is reviewing the current concepts and definitions, pathophysiology, prophylaxis, and therapeutic approaches in infection and sepsis.     

Effect of interleukin-10 on gut-derived sepsis caused by Pseudomonas aeruginosa in mice

We evaluated the protective effect of interleukin-10 (IL-10) against murine gut-derived sepsis caused by Pseudomonas aeruginosa. Gut-derived sepsis was induced by administering cyclophosphamide and ampicillin while feeding P. aeruginosa to specific-pathogen-free mice. Treating mice with recombinant human IL-10 (rhIL-10) at 1.0 or 5.0 microg/mouse twice a day following the second cyclophosphamide administration significantly increased the survival rate compared to that of control mice treated with saline; however, treatment with rhIL-10 at 0.1 microg/mouse did not result in significant protection. Bacterial counts in the liver, spleen, and blood were all significantly lower in mice treated with rhIL-10 than in saline-treated control mice. Treatment with rhIL-10 significantly suppressed tumor necrosis factor alpha, interleukin-1beta, interleukin-6, and gamma interferon levels in the serum of mice following induction of gut-derived sepsis. We also studied the effect of IL-10 on leukocyte recovery after cyclophosphamide treatment of mice. Administration of rhIL-10 intraperitoneally at 1. 0 microg/mouse significantly accelerated the recovery of leukocytes in comparison with that of the group of saline-treated controls. These results indicate that IL-10 shows a protective effect against gut-derived P. aeruginosa sepsis. We suspect that the mechanism of this effect is that IL-10 regulates in vivo production of inflammatory cytokines. Furthermore, acceleration of leukocyte recovery by IL-10 after cyclophosphamide-induced depression may also play an important role in this protection.