Sepsis and hemorrhage can result in injury to multiple organs and is associated with an extremely high rate of mortality. We hypothesized that peritoneal negative pressure therapy (NPT) would reduce ...systemic inflammation and organ damage. Pigs (n = 12) were anesthetized and surgically instrumented for hemodynamic monitoring. Through a laparotomy, the superior mesenteric artery was clamped for 30 min. Feces was mixed with blood to form a fecal clot that was placed into the peritoneum, and the abdomen was closed. All subjects were treated with standard isotonic fluid resuscitation, wide spectrum antibiotics, and mechanical ventilation, and were monitored for 48 h. Animals were separated into two groups 12 h (T12) after injury: for NPT (n = 6), an abdominal wound vacuum dressing was placed in the laparotomy, and negative pressure (-125 mmHg) was applied (T12 - T48), whereas passive drainage (n = 6) was identical to the NPT group except the abdomen was allowed to passively drain. Negative pressure therapy removed a significantly greater volume of ascites (860 ± 134 mL) than did passive drainage (88 ± 56 mL). Systemic inflammation (e.g. TNF-α, IL-1β, IL-6) was significantly reduced in the NPT group and was associated with significant improvement in intestine, lung, kidney, and liver histopathology. Our data suggest NPT efficacy is partially due to an attenuation of peritoneal inflammation by the removal of ascites. However, the exact mechanism needs further elucidation. The clinical implication of this study is that sepsis/trauma can result in an inflammatory ascites that may perpetuate organ injury; removal of the ascites can break the cycle and reduce organ damage.
Inappropriate mechanical ventilation in patients with acute respiratory distress syndrome can lead to ventilator-induced lung injury (VILI) and increase the morbidity and mortality. Reopening ...collapsed lung units may significantly reduce VILI, but the mechanisms governing lung recruitment are unclear. We thus investigated the dynamics of lung recruitment at the alveolar level. Rats (n = 6) were anesthetized and mechanically ventilated. The lungs were then lavaged with saline to simulate acute respiratory distress syndrome (ARDS). A left thoracotomy was performed, and an in vivo microscope was placed on the lung surface. The lung was recruited to three recruitment pressures (RP) of 20, 30, or 40 cmH(2)O for 40 s while subpleural alveoli were continuously filmed. Following measurement of microscopic alveolar recruitment, the lungs were excised, and macroscopic gross lung recruitment was digitally filmed. Recruitment was quantified by computer image analysis, and data were interpreted using a mathematical model. The majority of alveolar recruitment (78.3 +/- 7.4 and 84.6 +/- 5.1%) occurred in the first 2 s (T2) following application of RP 30 and 40, respectively. Only 51.9 +/- 5.4% of the microscopic field was recruited by T2 with RP 20. There was limited recruitment from T2 to T40 at all RPs. The majority of gross lung recruitment also occurred by T2 with gradual recruitment to T40. The data were accurately predicted by a mathematical model incorporating the effects of both pressure and time. Alveolar recruitment is determined by the magnitude of recruiting pressure and length of time pressure is applied, a concept supported by our mathematical model. Such a temporal dependence of alveolar recruitment needs to be considered when recruitment maneuvers for clinical application are designed.
This study evaluated the effect of vacuum and modified atmosphere (40% CO
+60% N
, MA) packaging on the chemical composition, physicochemical properties and sensory attributes of chill-stored meat ...from 10 fallow deer (
) bucks at 17 to 18 months of age. The animals were hunter-harvested in the forests of north-eastern Poland. During carcass dressing (48 to 54 h post mortem), both
muscles were cut out. Each muscle was divided into seven sections which were allocated to three groups: 0, A, and B. Samples 0 were immediately subjected to laboratory analyses. Samples A were vacuum-packaged, and samples B were packaged in MA. Packaged samples were stored for 7, 14, and 21 days at 2°C. The results of the present study showed that the evaluated packaging systems had no significant effect on the quality of fallow deer meat during chilled storage. However, vacuum-packaged meat samples were characterised by greater drip loss. Vacuum and MA packaging contributed to preserving the desired physicochemical properties and sensory attributes of meat during 21 days of storage. Regardless of the packaging method used, undesirable changes in the colour, water-holding capacity and juiciness of meat, accompanied by tenderness improvement, were observed during chilled storage.
•Meat quality parameters of the wild and farm-raised fallow deer were analyzed.•Our findings may suggest that meat from wild fallow deer has more desirable properties.•Further research is needed to ...validate this hypothesis.
The objective of the present study was to determine the chemical composition as well as the physicochemical and sensory properties of meat (Longissimus lumborum muscle) from wild fallow deer (Dama dama L.) bucks shot during a hunt in forests of north-eastern Poland (n=11) and farm-raised fallow deer bucks (n=14) slaughtered on a farm in north-eastern Poland. It was found that the number of samples with pHu higher than 6.0 accounted for 57% of all samples collected in the group of farmed-raised fallow deer. Meat samples with pH>6.0 were not taken into consideration while evaluating meat quality. Meat from wild fallow deer, compared with farmed animals, was characterized by a higher (P≤0.01) content of fat, a higher (P≤0.01) calorific value, a more desirable fatty acid profile, including higher (P≤0.05) concentrations of unsaturated fatty acids, lower (P≤0.01) average pHu values, lower (P≤0.05) lightness (L*) and higher (P≤0.01) color saturation resulting from a higher contribution of redness (P≤0.01) and yellowness (P>0.05). Meat from wild fallow deer received also higher scores for aroma desirability (P≤0.01), taste desirability (P≤0.05), juiciness (P≤0.05) and lower (P≤0.01) scores for tenderness.
The objective of the present study was to determine the chemical composition as well as the physicochemical and sensory properties of meat (M. longissimus dorsi) from roe deer (Capreolus capreolus ...L.) does (n=26) and bucks (n=16) hunter-harvested in the forests of north-eastern Poland. It was found that meat from female roe deer, in comparison with meat from male roe deer, had higher (P≤0.01) content of dry matter, total protein and fat. The water extracts of meat from does also contained more (P≤0.01) total nitrogen and non-protein nitrogen. An analysis of the fatty acid profile revealed that the muscles of male roe deer had higher (P≤0.01) concentrations of the following fatty acids: C14:0, C15:0, C18:0, C20:0, C18:2 and C18:3, and higher (P≤0.01) total content of polyunsaturated fatty acids, while the muscles of female roe deer had higher (P≤0.01) levels of C17:1 and C18:1 and higher (P≤0.01) total content of monounsaturated and unsaturated fatty acids. Meat from does was also characterized by higher (P≤0.01) drip loss and, as shown by a sensory evaluation, higher (P≤0.01) juiciness. No significant differences were found between males and females with respect to the average scores for meat tenderness, but meat from bucks was characterized by a higher (P≤0.05) value of shear force.
Abstract
Chronic granulomatous disease (CGD) is a primary immunodeficiency syndrome that results in increased risk for bacterial and fungal infections, as well as inflammatory/autoimmune ...complications. While CGD historically has been associated with early death in childhood, the life expectancy and morbidity of patients with CGD have greatly improved. Many patients with CGD now survive well into adulthood, and data on adult cohorts of patients with CGD have been published. However, reports of pregnancy management, complications, and outcomes for patients with CGD are sparse. In addition, management of invasive fungal infections, including use of newer triazole antifungals, during pregnancy has not been well described. We report a case of fungal lung infection in a pregnant woman with CGD, diagnosed during her second trimester, which was treated with multiple antifungal agents, including more than 12 weeks of isavuconazole therapy, resulting in resolution of infection and delivery of a healthy newborn at term.
Humans have evolved alongside infectious diseases for millennia. Despite the efforts to reduce their incidence, infectious diseases still pose a tremendous threat to the world population. Fast ...development of molecular techniques and increasing risk of new epidemics have resulted in several studies that look to the past in order to investigate the origin and evolution of infectious diseases. Tuberculosis and leprosy have become frequent targets of such studies, owing to the persistence of their molecular biomarkers in ancient material and the characteristic skeletal lesions each disease may cause. This review examines the molecular methods used to screen for the presence of
M. tuberculosis
and
M. leprae
ancient DNA (aDNA) and their differentiation in ancient human remains. Examples of recent studies, mainly from Europe, that employ the newest techniques of molecular analysis are also described. Moreover, we present a specific approach based on assessing the likely immunological profile of historic populations, in order to further elucidate the influence of
M. tuberculosis
and
M. leprae
on historical human populations.
Hospital level of care, complications, treatments, and outcomes were collected as were financial charges including inpatient and outpatient visits up to 2 months post-hematopoietic stem cell ...transplant (HSCT).
Background Although many sepsis treatments have shown efficacy in acute animal models, at present only activated protein C is effective in humans. The likely reason for this discrepancy is that most ...of the animal models used for preclinical testing do not accurately replicate the complex pathogenesis of human sepsis. Our objective in this study was to develop a clinically applicable model of severe sepsis and gut ischemia/reperfusion (I/R) that would cause multiple organ injury over a period of 48 h. Materials and Methods Anesthetized, instrumented, and ventilated pigs were subjected to a “two-hit” injury by placement of a fecal clot through a laparotomy and by clamping the superior mesenteric artery (SMA) for 30 min. The animals were monitored for 48 h. Wide spectrum antibiotics and intravenous fluids were given to maintain hemodynamic status. FiO2 was increased in response to oxygen desaturation. Twelve hours following injury, a drain was placed in the laparotomy wound. Extensive hemodynamic, lung, kidney, liver, and renal function measurements and serial measurements of arterial and mixed venous blood gases were made. Bladder pressure was measured as a surrogate for intra-peritoneal pressure to identify the development of the abdominal compartment syndrome (ACS). Plasma and peritoneal ascites cytokine concentration were measured at regular intervals. Tissues were harvested and fixed at necropsy for detailed morphometric analysis. Results Polymicrobial sepsis developed in all animals. There was a progressive deterioration of organ function over the 48 h. The lung, kidney, liver, and intestine all demonstrated clinical and histopathologic injury. Acute lung injury (ALI) and ACS developed by consensus definitions. Increases in multiple cytokines in serum and peritoneal fluid paralleled the dysfunction found in major organs. Conclusion This animal model of Sepsis+I/R replicates the systemic inflammation and dysfunction of the major organ systems that is typically seen in human sepsis and trauma patients. The model should be useful in deciphering the complex pathophysiology of septic shock as it transitions to end-organ injury thus allowing sophisticated preclinical studies on potential treatments.
Background ARDSnet standards limit plateau pressure (Pplat) to reduce ventilator induced lung injury (VILI). Transpulmonary pressure (Ptp) Pplat –pleural pressure (Ppl), not Pplat, is the distending ...pressure of the lung. Lung distention can be affected by increased intra-abdominal pressure (IAP) and atelectasis. We hypothesized that the changes in distention caused by increases in IAP and atelectasis would be reflected by Ptp but independent of Pplat. Methods In Yorkshire pigs, esophageal pressure (Pes) was measured with a balloon catheter as a surrogate for Ppl under two experimental conditions: (1) high IAP group ( n = 5), where IAP was elevated by CO2 insufflation in 5mm Hg steps from 0 to 30mm Hg; and (2) Atelectasis group ( n = 5), where a double lumen endotracheal tube allowed clamping and degassing of either lung by O2 absorption. Lung collapse was estimated by increases in pulmonary shunt fraction. Results High IAP: Sequential increments in IAP caused a linear increase in Pplat (r2 = 0.754, P < 0.0001). Ptp did not increase (r2 = 0.014, P = 0.404) with IAP due to the concomitant increase in Pes (r2 = 0.726, P < 0.0001). Partial Lung Collapse: There was no significant difference in Pplat between the atelectatic (21.83 ± 0.63cm H2 O) and inflated lung (22.06 ± 0.61 cmH2 O, P < 0.05). Partial lung collapse caused a significant decrease in Pes (11.32 ± 1.11mm Hg) compared with inflation (15.89 ± 0.72mm Hg, P < 0.05) resulting in a significant increase in Ptp (inflated = 5.97 ± 0.72mm Hg; collapsed = 10.55 ± 1.53mm Hg, P < 0.05). Conclusions Use of Pplat to set ventilation may under-ventilate patients with intra-abdominal hypertension and over-distend the lungs of patients with atelectasis. Thus, Ptp must be used to accurately set mechanical ventilation in the critically ill.
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