摘要:

Burn injury and endotoxin lead to the development of a systemic inflammatory response. Because tumor necrosis factor-alpha (TNF-alpha) is a component of the proinflammatory response, we have determined the effect of burn injury and endotoxin in a murine model of thermal on tissue specific TNF-alpha levels in the liver and lung. Male mice were divided into four groups and injected with endotoxin (ETX) (2.5 mg/kg intraperitoneally) or saline (CNTL) or subjected to a 16% full-thickness scald burn (B), or ETX administration 72 hours after burn injury (B+ETX). Animals were killed at 0 to 24 hours after ETX or CNTL, 0 to 72 hours after B, and 72 to 96 hours after B+ETX (ETX administration 72 hours after B). TNF-alpha mRNA by Northern blot and protein analysis by enzyme-linked immunosorbent assay were determined and protein expressed as nanogram per gram of tissue. Statistical analysis was performed using analysis of variance with significance at p < 0.05. Burn injury did not result in detectable levels of liver or lung TNF protein or mRNA. Endotoxin administration resulted in a near six-fold rise in liver TNF protein compared with controls at 1, 2, and 6 hours after ETX (p < 0.05 to p < 0.001). Liver mRNA remained elevated from 20 minutes to 24 hours after ETX versus CNTL (p < 0.05). Endotoxin injection produced a persistent lung TNF protein elevation reaching significance at 1 and 2 hours (p < 0.001) and a rise in mRNA at 40 minutes to 6 hours (p < 0.05) versus CNTL. The liver showed a trend of reduced mRNA after B+ETX versus ETX (p = NS), whereas protein levels were reduced by 50 to 60% at 1 and 2 hours (p < 0.01). Lung mRNA values after B+ETX were only 40% compared with ETX at nearly all time points (p < 0.001) but were 15 times above CNTL values at 2 hours (p < 0.05). Based on these results, we conclude that burn injury did not cause an increase in liver or lung tissue specific TNF-alpha. However, the presence of a preexisting burn injury dramatically altered the response to endotoxin and the primary point of regulation appears to be at the posttranscriptional level.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

To answer the question whether a xenograft dermal substitute could enhance skin grafting, we used porcine dermis as a template for a widely expanded mesh autologous split-thickness skin (ASTS) graft in a rat model. Four groups of rats had received widely expanded meshed skin autografts to cover an excised back wound. Group 1 had a bed of autologous dermis, group 2 had porcine xenograft dermis, group 3 had widely expanded meshed autograft alone, and group 4 had no graft with the wound healing by contraction alone. Wounds were studied by clinical inspection for texture and contraction, and by histologic and immunofluorescent techniques. At 2 weeks, there was acceptable ASTS graft take, and most of the wound healed completely by 3 weeks. The integrity of this complex skin graft was maintained for 4 months but wound contraction gradually decreased overall wound size. Size was maintained better in the ASTS-autodermis and ASTS-xenodermis groups at postgraft 4, 5, and 6 weeks when compared with the ASTS graft, and there was no difference between the ASTS-autodermis and ASTS-xenodermis groups. Thus both allodermis and xenodermis provided a similar template to enhance widely expanded mesh skin growth and delay wound contraction. The pathologic studies indicate that the xenodermis collagen was replaced either by fibrosis or by biodegradation to rat collagen. The immunofluorescent study also reflected that anti-porcine antibody activity was hugely diminished in the ASTS-xenodermis graft wound after long-term follow-up. In conclusion, either autodermis or xenodermis enhances widely expanded mesh ASTS survival in a rat model, and could significantly maintain the original wound size better than ASTS graft without a template. In a long-term follow-up study, the porcine dermis was replaced either by fibrosis or biodegradation to rat dermis.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Branched chain amino acids (BCAAs) and glutamine are both recommended in catabolic states. The object of this study was to compare the efficacies of alanylglutamine (Ala-Gln)-enriched and BCAA-enriched total parenteral nutrition (TPN) on the protein kinetics in peritonitis. Rats were divided into Ala-Gln and BCAA groups after intraperitoneal implantation of an osmotic pump, delivering a continuous infusion of Escherichia coli. Glutamine composed 30.0% (w/v) of the total amino acids in the Ala-Gln group, and BCAA composed 30.5% (w/v) of the total amino acids in the BCAA group. The two solutions were isocaloric and isonitrogenous. Whole body protein turnover and organ fractional protein synthetic rates (FSR) were measured on days 3 and 5. Serum amino acid levels and mucosal morphology were determined. Ala-Gln group had higher rates of whole body protein turnover, and hepatic FSR on both days. Serum glutamine levels correlated with hepatic and muscle FSR. Ala-Gln TPN group had greater mucosal thickness, numbers of mitoses per crypt, and FSR in distal intestine. Ala-Gln-enriched TPN may be a useful nutritional treatment modality in sepsis.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveNutritive immunomodulation of patients after major surgery.DesignProspective, randomized controlled double-blind study.PatientsForty patients undergoing major intestinal surgery. Patients were divided into two groups: one received a total parenteral nutrition enriched with omega-3 fatty acids for 5 days postoperatively, the other an isocaloric, control nutrition.Material and MethodsWe analyzed the leukocyte ability to release leukotrienes from whole blood leukocytes stimulated with the calcium ionophore A23187 (5 micromol/L) by reverse phase high-performance liquid chromatography and circulating cytokines by enzyme-linked immunosorbent assay.ResultsLeukocytes from patients of the omega-3 fatty acids group generated significantly higher amounts of less biologically active leukotriene B5as compared to the control group (p < or = to 0.001). This was accompanied by a significant decrease in the generation of proinflammatory leukotriene B4(p < or = to 0.006) in the study group. In contrast to interleukin-1beta, interleukin-6, and interleukin-10 systemic levels of tumor necrosis factor-alpha (p < or = to 0.05) were postoperatively decreased in the study group.ConclusionOur data provide evidence that a total parenteral nutrition enriched with omega-3 fatty acids modulates the lipid mediator pattern and systemic tumor necrosis factor-alpha levels.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare recombinant hemoglobin solution (rHb1.1) with colloid/blood (CB) resuscitation in a hemorrhagic shock (HS) model based on oxygen debt (O2D).MethodsTwenty-two anesthetized canines (weight 23.3 +/- 0.2 kg) were bled to an O2D of 99.9 +/- 2.1 mL/kg over 60 minutes (estimated lethal dose 31%), blood loss 65.9 +/- 2.3% of estimated blood volume, -199 g hemoglobin (Hgb). Prospectively randomized resuscitation done in 20 minutes with 120% of shed blood volume, either colloid 60% blood 60% shed blood volume (CB), 118 g Hgb, or 120% shed blood volume as 5% rHb1.1, 85 g Hgb, and fall in O2D was quantified over 80 minutes. Six animals died during HS, one after CB resuscitation (32% actual mortality). Blood lactate (L) and base deficit (BEA) were related to O2D.ResultsBoth lactate (L) and BEA quantified O2D during hemorrhage: L = 0.0671 (O2D) + 1.209; r2= 0.90, p < 0.0001; BEA = 0.1313 (O2D) + 1.764; r2= 0.90, p < 0.0001, but L was a better indicator than BEA of fall in O2D during resuscitation (L = 0.069 (O2D) + 1.083; r2= 0.80). Both groups were followed for 7 days after HS and had normal renal and hepatic function by day 7. However, at equal resuscitation volume, rHb1.1 resuscitation with 41% of Hgb loss produced a more rapid initial fall in O2D than CB at 60% of Hgb loss (p < 0.002). rHb1.1 resuscitation also caused a more complete washout of metabolic acids than CB.ConclusionsLactate and BEA accurately quantify O2D in HS and resuscitation. rHb1.1 replacement is as good as CB with regard to survival, but leads to a more uniform reperfusion and produces a more complete resolution of ischemic acidosis.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo test the hypothesis that protective-preservative moderate hypothermia during uncontrolled hemorrhagic shock (UHS) in rats increases survival.DesignRandomized outcome study in rats.Materials and MethodsUHS phase I of 90 minutes, with initial withdrawal of 3 mL/100 g of blood plus tail amputation, was followed by hemostasis and all-out resuscitation phase II from 90 to 150 minutes, and observation phase III to 72 hours. Forty male rats under light anesthesia and spontaneous breathing were randomized into four groups: Group 1 received no fluid resuscitation during UHS and normothermia (37.5degreesC) throughout. Group 2 received no fluid resuscitation and hypothermia (30degreesC) from 15 to 120 minutes. Group 3 received lactated Ringer's solution to maintain mean arterial pressure at 40 mm Hg during UHS and normothermia. Group 4 received lactated Ringer's solution to a mean arterial pressure of 40 mm Hg during UHS and hypothermia from 15 to 120 minutes.ResultsUHS phase I was survived by 0 of 10 rats in group 1, 7 of 10 in group 2, 5 of 10 in group 3, and 10 of 10 in group 4 (p < 0.01 for group 1 vs. 2, 3, or 4; p < 0.05 for group 4 vs. 3). Survival to 72 hours was achieved by 0 of 10 rats in group 1, 3 of 10 in group 2 (p < 0.001 vs. group 1), 1 of 10 in group 3, and 7 of 10 in group 4 (p < 0.001 vs. group 1, and p < 0.01 vs. group 3). All 72-hour survivors were neurologically normal. Necropsies in rats that died early during phase III showed edema and gastrointestinal hemorrhages.ConclusionsModerate hypothermia or limited (hypotensive) fluid resuscitation -best both combined -increases survival during and after UHS in rats.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveThis study used a Wiggers shock model to investigate the effect of the removal of the intestines on the outcome of hemorrhagic shock.Methods0.05).ResultsThis protocol resulted in a 42% mortality (11 of 26) in the control group and 0% mortality (0 of 25) in the experimental group (p < 0.005, chi20.05). Measurement of hepatic adenosine triphosphate (ATP) by the luminometric method showed that hepatic ATP contents were significantly reduced in both groups after shock (p's < 0.05). However, a higher magnitude of hepatic ATP depletion occurred in the control group; significantly lower amounts of ATP in the liver tissues of the sham-enterectomized group (367 +/- 95 nmol/g, n = 7) than in that of the enterectomized group (870 +/- 100 nmol/g, n = 13) were observed at 5 hours after shock (p < 0.05).ConclusionsThese experimental findings show that, in the absence of the intestines, hemorrhagic shock is associated with both an improved outcome and higher hepatic ATP levels in rats, suggesting the importance of intestinal participation in the process leading to hepatic ATP depletion as well as irreversibility in shock.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

We investigated the effect of intermittent cigarette smoke inhalation on the bone healing of tibial lengthening in rabbits. Thirty-eight male rabbits were divided into two groups of 19 animals each. The first group went through intermittent cigarette smoke inhalation, and the second group did not go through intermittent cigarette smoke inhalation. Each animal's right tibia was lengthened 5 mm using an uniplanar lengthening device. Five animals of each group were killed at 4, 6, and 8 weeks postoperatively for biomechanical testing, and one animal of each group was killed at 2, 4, 6, and 8 weeks postoperatively for histologic study. Using the contralateral nonoperated tibia as an internal control, we found that torsional strength of the lengthened tibia of the smoke inhalation group was decreased significantly compared with the non-smoke inhalation group. The mean percent of maximal torque at 4, 6, and 8 weeks were 22.0, 66.3, and 78.6%, respectively, in the smoke inhalation group, whereas the mean percent of maximal torque were 48.0, 84.1, and 90.8%%, respectively, in non-smoke inhalation group (one-tailed t test, p < 0.01, p < 0.01, and p < 0.05 at 4, 6, and 8 weeks, respectively). Our histologic observations revealed that the granulation tissue resorption, bone formation, and remodeling were delayed in smoke inhalation group. The results of this study suggest that intermittent inhalation of cigarette smoke delays, but does not prevent, the bone healing in tibial lengthening.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

A review is made of 16 cases of ipsilateral fractures of the scapula and clavicle treated conservatively. After a mean follow-up of 7.5 years, the functional results were good or excellent in 92% of the cases.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Thirty cases of humeral shaft fracture sustained during arm wrestling were analyzed. Twenty eight were men and two were women. Eighteen were fractures of the right arm and 12 were of the left. The patients ranged in age from 15 to 60 years old, averaging 30 years. Although there was no prominent tendency for the injuries to occur at a certain phase of the match, they happened in all cases while full force was being exerted in an effort to win or to change the tide of the contest. All cases were spiral fractures, of which 23% presented with a medial butterfly fragment, and also 23% of which had radial nerve palsy. We infer that, through a shift in body weight and subsequent counterattack from the opponent, the shoulder internal rotator muscles suddenly changed from their maximum concentric contraction to eccentric contraction, resulting in development of an intense rotational force leading to the subsequent fracture. Therefore, this type of fracture may occur in anyone of any age engaging in this type of sport.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID