The Journal of surgical research
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The systemic and local tissue repair responses of radiation in combination with surgery are still unclear. We have studied the effect of fractionated pre-operative radiotherapy with or without subsequent laparotomy on collagen accumulation using a rodent model. ⋯ A clinically relevant fractionated radiation scheme reduced subcutaneous collagen accumulation pre-operatively and profoundly within the radiation field post-operatively after laparotomy, possibly because of lowered TGF-beta1 levels.
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Injury is one of the leading causes of death for infants younger than 1 year of age. We investigated potential contributing factors for injury among children born to high-risk families. ⋯ Among this higher-risk group, injury in the first year of life is more than twice the national incidence. Predisposing factors to injury often are complex and interrelated, but with focused education and prevention efforts, including discussions of maternal alcohol use and attitudes toward physical discipline, we may decrease the burden of infant injury in this vulnerable population.
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Neutrophils play a major role as the first line in host defense after exposure to bacterial products. However, an exaggerated inflammatory response characterized by overwhelming neutrophil activation can be injurious to the host. Pentoxifylline (PTX), a nonspecific phosphodiesterase inhibitor, has been shown to attenuate neutrophil oxidative burst and decrease proinflammatory mediator synthesis. We hypothesized that PTX down-regulates neutrophil activation by decreasing the surface expression of both CD35 and CD66b, two markers of neutrophil degranulation. ⋯ In addition to the known effects of PTX on neutrophil oxidative burst, PTX also affects neutrophil degranulation, an essential step in enzyme release and subsequent tissue injury. These findings may have clinical relevance in the treatment of disease processes due to inflammation in which primed neutrophils play a role.
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Impedance cardiography (ICG) technology has improved dramatically, and at least one device now can give a measurement of fluid status by using thoracic fluid content (TFC), along with cardiac output (CO) and cardiac index (CI). With a built-in sphygmomanometer cuff, it can also provide blood pressure (BP) and systemic vascular resistance index (SVRI). A currently available small portable ICG that provides reliable measures of fluid status could be an ideal noninvasive monitor for hemodialysis (HD), with the potential of helping avoid significant hemodynamic instability during HD. ⋯ TFC, measured easily and noninvasively using ICG, correlates with the amount of fluid removed during HD. In comparison with the other hemodynamic parameters measured, TFC changed most consistently with fluid removal. Whether or not serial TFC measurements in a given patient at different HD sessions can guide the extent of FR will require additional study. This compact, easily operated, and nonobtrusive ICG device with the capability for continuously providing the standard hemodynamic parameters plus CO, TFC, and standard limb lead electrocardiography could replace current monitoring systems.
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Randomized Controlled Trial
Pulse low dose steroids attenuate post-cardiopulmonary bypass SIRS; SIRS I.
Cardiopulmonary bypass (CPB) initiates inflammation that contributes to multiorgan dysfunction (SIRS). Steroids have been demonstrated to attenuate this response; however, resistance to use steroids remains because of potential adverse effects of the high doses used. This study examines a lower dose steroid protocol for safety and attenuation of SIRS. ⋯ Patients undergoing cardiopulmonary bypass receiving low pulse dose steroids had better hemodynamics, shorter mechanical ventilation times, less blood loss, and required less time in the ICU compared to those receiving placebo. Therefore, this study demonstrates that prophylactic low dose steroids attenuate the SIRS response to CPB without resulting in any untoward side-effects.