Abdominal compartment syndrome (ACS) and intra abdominal hypertension(IAH) are common clinical findings in patients with severe acute pancreatitis(SAP). It is thought that an increased intra ...abdominal pressure(IAP) is associated with poor prognosis in SAP patients. But the detailed effect of IAH/ACS on different organ system is not clear. The aim of this study was to assess the effect of SAP combined with IAH on hemodynamics, systemic oxygenation, and organ damage in a 12 h lasting porcine model.
Following baseline registrations, a total of 30 animals were divided into 5 groups (6 animals in each group): SAP+IAP30 group, SAP+IAP20 group, SAP group, IAP30 group(sham-operated but without SAP) and sham-operated group. We used a N(2) pneumoperitoneum to induce different levels of IAH and retrograde intra-ductal infusion of sodium taurocholate to induce SAP. The investigation period was 12 h. Hemodynamic parameters (CO, HR, MAP, CVP), urine output, oxygenation parameters(e.g., S(v)O(2), PO(2), PaCO(2)), peak inspiratory pressure, as well as serum parameters (e.g., ALT, amylase, lactate, creatinine) were recorded. Histological examination of liver, intestine, pancreas, and lung was performed.
Cardiac output significantly decreased in the SAP+IAH animals compared with other groups. Furthermore, AST, creatinine, SUN and lactate showed similar increasing tendency paralleled with profoundly decrease in S(v)O(2). The histopathological analyses also revealed higher grade injury of liver, intestine, pancreas and lung in the SAP+IAH groups. However, few differences were found between the two SAP+IAH groups with different levels of IAP.
Our newly developed porcine SAP+IAH model demonstrated that there were remarkable effects on global hemodynamics, oxygenation and organ function in response to sustained IAH of 12 h combined with SAP. Moreover, our model should be helpful to study the mechanisms of IAH/ACS-induced exacerbation and to optimize the treatment strategies for counteracting the development of organ dysfunction.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Intrinsic error field on EAST is measured using the 'compass scan' technique with different n = 1 magnetic perturbation coil configurations in ohmically heated discharges. The intrinsic error field ...measured using a non-resonant dominated spectrum with even connection of the upper and lower resonant magnetic perturbation coils is of the order br2,1/BT≃10−5 and the toroidal phase of intrinsic error field is around 60°. A clear difference between the results using the two coil configurations, resonant and non-resonant dominated spectra, is observed. The 'resonant' and 'non-resonant' terminology is based on vacuum modeling. The penetration thresholds of the non-resonant dominated cases are much smaller than that of the resonant cases. The difference of penetration thresholds between the resonant and non-resonant cases is reduced by plasma response modeling using the MARS-F code.
Background
Intra-abdominal hypertension (IAH) is common in patients with severe acute pancreatitis (SAP). The aim of the present study was to investigate the risk factors of IAH in SAP patients and ...assess the prognosis of SAP combined with IAH.
Methods
To analyze the data from patients with SAP, both univariate and multivariate logistic regression analyses were applied, using 16 indices, including age, gender, Acute Physiology and Chronic Health Evaluation II scores (APACHE II), 24 h fluid balance, hematocrit, serum calcium level, and so on. Clinical prognosis such as mortality, hospital duration, of SAP patients with or without IAH was also compared.
Results
First 24 h fluid balance (Odds Ratio OR, 1.003; 95% Confidence Interval CI, 1.001–1.006), number of fluid collections (OR, 1.652; 95% CI, 1.023–2.956), and serum calcium level (OR, 0.132; 95% CI, 0.012–0.775) were found to be independent risk factors for IAH in patients with SAP. Moreover, patients with SAP and IAH had significantly longer average length of stay, both in the hospital and in the intensive care unit, higher rates of systemic and local complications, and more invasive treatments.
Conclusions
The significant risk factors for IAH in patients with SAP include 24 h fluid balance (first day), number of fluid collections, and serum calcium level. Additionally, IAH is associated with extremely poor prognosis, evidenced by high rates of mortality, morbidity, and the need for invasive interventions.
Background
To investigate the effects of early enteral nutrition (EEN) on intra-abdominal pressure (IAP) and disease severity in patients with severe acute pancreatitis (SAP).
Methods
Enteral ...nutrition (EN) was started within 48 h after admission in the EEN group and from the 8th day in the delayed enteral nutrition (DEN) group. The IAP and intra-abdominal hypertension (IAH) incidence were recorded for 2 weeks. The caloric intake and feeding intolerance (FI) incidence were recorded daily after EN was started. The severity markers and clinical outcome variables were also recorded.
Results
Sixty patients were enrolled to this study. No difference about IAP was found. The IAH incidence of the EEN group was significantly lower than that of the DEN group from the 9th day (8/30 versus 18/30;
P
= 0.009) after admission. The FI incidence of the EEN group was higher than that of the DEN group during the initial 3 days of feeding (25/30 versus 12/30;
P
= 0.001; 22/30 versus 9/30;
P
= 0.001; 15/30 versus 4/30;
P
= 0.002). Patients with an IAP <15 mmHg had lower FI incidence than those with an IAP ≥15 mmHg on the 1st day (20/22 versus 17/38;
P
< 0.001), the 3rd day (11/13 versus 8/47;
P
< 0.001), and the 7th day (3/5 versus 3/55;
P
= 0.005) of feeding. The severity markers and clinical outcome variables of the EEN group were significantly improved.
Conclusions
Early enteral nutrition did not increase IAP. In contrast, it might prevent the development of IAH. In addition, EEN might be not appropriate during the initial 3–4 days of SAP onset. Moreover, EN might be of benefit to patients with an IAP <15 mmHg. Early enteral nutrition could improve disease severity and clinical outcome, but did not decrease mortality of SAP.
CYP3A4-mediated Phase I biotransformation is the rate-limiting step of elimination for many commonly used clinically agents. The modulatory effects of herbal medicines on CYP3A4 activity are one of ...the risk factors affecting the safe use of drug and herbal medicine. In the present study, the inhibitory effects of nearly hundred kinds of herbal medicines against CYP3A4 were evaluated based on a visual high-throughput screening method. Furthermore, biflavone components including bilobetin (7-demethylginkgetin, DGK), ginkgetin (GK), isoginkgetin (IGK), and amentoflavone (AMF) were identified as the main inhibitory components of
L. (GB) and
(P. Beauv.) Spring (ST), which displayed very strong inhibitory effects toward CYP3A4. The inhibitory effects of these biflavones on clinical drugs that mainly undergo CYP3A4-dependent metabolism were evaluated. The
of GK toward tamoxifen, gefitinib and ticagrelor were found to be of 0.478 ± 0.003, 0.869 ± 0.001, and 1.61 ± 0.039 μM, respectively. These results suggest the potential pharmacokinetic interactions between the identified biflavones and clinical drugs undergoing CYP3A4-mediated biotransformation. The obtained information is important for guiding the rational use of herbal medicine in combination with synthetic pharmaceuticals.
Panax Notoginseng Saponins (PNS) have been well known to have anti-tumor activity and enhance cytotoxicity of some cancer chemotherapy agents, but the mechanisms underlying these effects are still ...unknown. This study investigates the effect of PNS on cytotoxicity of cisplatin and the relationship between this effect and the modulation of gap junctions (GJ) function by PNS in a transfected cell line. The cytotoxicity of cisplatin (0.25-1 µg/mL) was increased in the presence of GJ. Inhibition of gap junction by either GJ blocker or interception of Connexin (Cx) expression decreased the cytotoxicity of cisplatin. Increasing GJ function enhanced cytotoxicity of cisplatin, only in the cells with functional GJ. PNS (50-200 µg/mL) significantly enhanced cisplatin cytotoxicity, but this effect required functional gap junctions between the cells. Exposure of the cells to PNS (50-200 µg/mL) for 4 h leads to a significant enhance in dye coupling of GJ in a dose-dependent manner. These results suggest that PNS increases the cytotoxicity of cisplatin through enhancement of GJ activity.
Propeller-shaped molecules diphenyldibenzofulvene (1) and (4-methoxyphenyl)phenyldibenzofulvene (2) were nonemissive when dissolved in good solvents but became luminescent when aggregated in poor ...solvents or in the solid state, showing a novel phenomenon of aggregation-induced emission (AIE). 8-Phenylbenzoeacephenanthrylene (3), a ring-closed form of 1 with one of its phenyl blades locked, was emissive in the solutions, suggesting that the AIE effects of 1 and 2 are caused by the restrictions of intramolecular rotations of their aromatic blades in the aggregation state. The crystals of 1 and 2 emitted stronger, bluer lights than their amorphous powders, possibly due to the structural rigidification and conformational twisting of the dye molecules in the crystalline phase. The light-emitting diodes with a device configuration of ITO/NPB/dye/BCP/Alq3/LiF/Al were fabricated, which emitted bluish-green and yellow lights with maximum luminance and current efficiency up to 5000 Cd/m2 and 1.90 Cd/A, respectively.
We report on the investigation of a high–efficiency, widely tunable femtosecond optical parametric oscillator (OPO) based on a multi–period MgO–doped periodically poled lithium niobite (MgO: PPLN) ...crystal, pumped by an all–solid–state femtosecond mode–locked Yb: KGW laser at 1030 nm providing 100 fs pulses. With 6 W pump power, the OPO generates 2.68 W of signal power at 1540 nm and 1.2 W of idler power at 3110 nm, which corresponds to the total conversion efficiency adding up to 67.4%. To the best of our knowledge, this is the highest conversion efficiency of a femtosecond OPO. Meanwhile, in order to obtain a broad optical spectrum range, both the grating period and working temperature are tuned, resulting in tunable signals of 1.43–1.78 µm and idlers of 2.44–3.68 µm. This source will be used to generate a femtosecond mid–infrared laser of wavelength range 3.7–6.5 µm and tens milliwatts average power through difference frequency generation (DFG).
The role of surgery in the treatment of Graves' disease (GD) needs to be revisited. The aims of the present retrospective study were to evaluate the outcomes of the current surgical strategy as a ...definitive treatment of GD at our center and to explore the clinical association between GD and thyroid cancer.
A patient cohort of 216 cases from 2013 to 2020 was involved in this retrospective study. The data of the clinical characteristics and follow-up results were collected and analyzed.
There were 182 female and 34 male patients. The mean age was 43.9 ± 15.0 years old. The mean duration of GD reached 72.2 ± 92.7 months. Of the 216 cases, 211 had been treated with antithyroid drugs (ATDs) and hyperthyroidism had been completely controlled in 198 cases. A total (75%) or near-total (23.6%) thyroidectomy was performed. Intraoperative neural monitoring (IONM) was applied to 37 patients. The failure of ATD therapy (52.3%) was the most common surgical indication, followed by suspicion of a malignant nodule (45.8%). A total of 24 (11.1%) patients had hoarseness after the operation and 15 (6.9%) patients had transient vocal cord paralysis; 3 (1.4%) had this problem permanently. No bilateral RLN paralysis occurred. A total of 45 patients had hypoparathyroidism and 42 of them recovered within 6 months. Sex showed a correlation with hypoparathyroidism through a univariate analysis. A total of 2 (0.9%) patients underwent a reoperation because of hematomas. A total of 104 (48.1%) cases were diagnosed as thyroid cancer. In most cases (72.1%), the malignant nodules were microcarcinomas. A total of 38 patients had a central compartment node metastasis. A lateral lymph node metastasis occurred in 10 patients. Thyroid carcinomas were incidentally discovered in the specimens of 7 cases. The patients with concomitant thyroid cancer had a significant difference in body mass index, duration of GD, gland size, thyrotropin receptor antibodies and nodule(s) detected.
Surgical treatments for GD were effective, with a relatively low incidence of complications at this high-volume center. Concomitant thyroid cancer is one of the most important surgical indications for GD patients. Careful ultrasonic screening is necessary to exclude the presence of malignancies and to determine the therapeutic plan.
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