Goal-directed therapy with dopexamine, dobutamine, and volume expansion: effects of systemic oxygen transport on hepatic ultrastructure in porcine sepsis

OBJECTIVES

Can the hepatic structural deterioration that occurs during peritonitis be attenuated by increasing cardiac output and oxygen consumption (VO2)? Do the agents used to achieve these increases have any characteristic affects on these hepatic structural changes?

DESIGN

Randomized, prospective, observational animal study.

SETTING

Research laboratory of a university medical school.

SUBJECTS

Twenty-five Middle White adolescent pigs, weighing 25 to 30 kg, divided into five groups.

INTERVENTIONS

A thermodilution flotation catheter was advanced into the pulmonary artery. Additional catheters were inserted into the jugular, portal, and hepatic veins, and into the femoral artery. Ultrasound flow probes were placed around the portal vein and the hepatic artery. A metabolic cart was attached to the ventilator. Baseline measurements were made and cardiac output was increased by > 25% by administering either dobutamine (10 micrograms/min), dopexamine (10 micrograms/kg/min), or colloid. A control group had its cardiac output maintained at its baseline value. Peritonitis was induced in the four groups by contamination with cecal content and maintained for 6 hrs. Hepatic tissue was then removed for ultrastructural analysis and the animals were killed.

MEASUREMENTS AND MAIN RESULTS

Before infection, cardiac output, VO2, and hepatic blood flow were increased in the three treatment groups. In the dobutamine and dopexamine groups, oxygen delivery increased, but decreased in the volume group. Mean arterial pressure increased in the dobutamine and dopexamine groups, but in the volume group, mean arterial pressure was maintained. Six hours after infection, cardiac output and VO2 had further increased in the dobutamine and volume groups, but both variables had decreased in the dopexamine group. After infection in the control group, cardiac output had decreased, although oxygen delivery and VO2 increased. There were no significant differences between hepatic hemodynamic or oxygen transport variables in any of the groups during the infection period. Hepatic ultrastructure was well maintained in the dopexamine group, while considerable deterioration was seen in the volume and control groups. In the dobutamine group, hepatic deterioration was greater than in the other three groups.

CONCLUSIONS

Increasing cardiac output and VO2 before and during infection was only protective when dopexamine was administered. Dobutamine infusion was associated with greater hepatic deterioration than that effect seen in either the control or volume groups.

An epidemiological study of Candida species infection in cancer patients using genetic fingerprinting and morphotyping

During a six-week period a cluster of four cases of Candida fungaemia occurred in a mixed haematology/oncology unit of a large Dublin teaching hospital. A study was conducted to determine whether the cluster of cases was caused by a particular strain. Nine patients were studied; five who were colonized with Candida spp. and four who developed Candida fungaemia. Twenty-two clinical isolates of Candida spp. were collected and identified. Three of the patients with fungaemia yielded Candida albicans from blood cultures and C. tropicalis was isolated from the fourth patient. C. albicans isolates were serotyped, morphotyped and analysed by DNA fingerprinting of total cellular DNA using the cloned C. albicans-specific, mid-repeat sequence element 27A as a molecular probe. All C. albicans isolates were of serotype A. Eight distinguishable types were identified by both morphotyping and DNA typing from 19 C. albicans isolates recovered from seven individual patients, although there were several discrepancies. Of three patients from whom two or more isolates of C. albicans were recovered on separate occasions, two yielded recurrent isolates with different morphotype codes. However, in both cases, the recurrent isolates from individual patients yielded indistinguishable, or closely related, DNA fingerprint profiles. Both morphotyping and DNA fingerprint analysis readily distinguished the three blood culture isolates of C. albicans. We conclude that the Candida spp. infections in the unit were not due to cross-infection and were probably related to the patients' indigenous flora.

Canine bone marrow cell cultures infected with canine distemper virus: an in vitro model of Paget's disease

We have previously shown that the canine paramyxovirus, canine distemper virus (CDV), is a possible aetiologic agent in Paget's disease of bone and in the canine bone disorder, metaphyseal osteopathy. More recently, we have examined the effects of CDV on the formation of multinucleated, tartrate resistant acid phosphatase positive, calcitonin receptor positive, osteoclast-like cells in cultures of canine bone marrow mononuclear cells, and shown that both in vitro and in vivo infection with CDV produced a dose dependent increase in the number and size of osteoclast-like cells. We have now extended these results to show that CDV infection induces interleukin-6 and c-Fos mRNA in these cells, similar to our recent findings in pagetic bone cells. These results further support the hypothesis that CDV might be involved in the aetiopathogenesis of Paget's disease and metaphyseal osteopathy and suggest that canine marrow culture systems will prove useful as an in vitro model to examine the disease processes in more detail.

Accuracy of in-line venous saturation and hematocrit monitors in pediatric perfusion

Cardiopulmonary bypass (CPB) in neonates and infants routinely employs lower blood flow rates (BFR), temperatures, and hematocrits (Hct) than those typically observed in adult CPB. The purpose of this study was to evaluate the accuracy of three devices available for continuous in-line measurement of venous oxygen saturation (SvO2) and Hct during pediatric CPB. Venous blood samples were obtained over a range of BFR, temperatures, and Hct and analyzed on a Corning 2500 Co-Oximeter and HematoStat C-70 centrifuge. These values were then compared to those measured by the Bentley OxySat SM-0200, the Gish StatSat, and the 3M CDI 100 in-line monitors. Seventy samples were obtained and analyzed using linear regression, paired t-test and residual analysis to establish the reliability and accuracy of each device. The results demonstrate the CDI to be more statistically accurate (p > 0.05) than the Gish and Bentley devices for measuring SvO2 in nearly all circumstances, though all correlated well with the control (r > 0.70). When comparing spun Hct to the CDI and Gish values, the CDI in-line monitor demonstrated a greater reliability to predict actual patient Hct (r > 0.90) than the Gish StatSat (r > 0.60). Residual analysis revealed that even though the Gish StatSat had higher calculated p values (p > 0.05) than the CDI 100 for interpreting Hct, it was shown to display more inconsistent and sporadic values over the ranges of BFR and temperature studied. It is concluded that the CDI 100 proved to be more accurate, reliable, and consistent than the Gish StatSat and the Bentley Oxysat devices in determining SvO2 and Hct over all evaluated parameters in this study.

Generation of multinucleated osteoclast-like cells from canine bone marrow: effects of canine distemper virus

Recent evidence has implicated canine distemper virus (CDV) as a possible aetiologic agent in Paget's disease of bone and the canine bone disorder, metaphyseal osteopathy. We have therefore examined the effects of CDV on the formation of multinucleated osteoclast-like cells in cultures of canine bone marrow mononuclear cells. Marrow cells from a distemper-infected dog and from five uninfected dogs were cultured in the presence of 1 alpha, 25-(OH)2 vitamin D3 and the number of tartrate resistant acid phosphatase positive multinucleated cells (MNCs) was determined. The presence of calcitonin (CT) receptors was confirmed by autoradiography with 125I-labeled human CT. Cultures from the distemper-infected dog contained a higher level of MNCs than those from the normal dogs. The in vitro addition of CDV to the cultures from all the dogs produced a dose-dependent increase in the number of MNCs, and an increase in size of these cells in the cultures from the infected dog. Cells infected with CDV were hyperresponsive to 1 alpha,25-(OH)2 vitamin D3. The presence of the virus in the relevant samples was confirmed using molecular techniques. In situ hybridization studies also revealed a significant increase in the level of infection following in vitro addition of the virus to the culture from the distemper-infected dog, suggesting that further infection had taken place. Resorption pits were formed on bone slices, although the number of pits was not significantly altered by viral infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Rheumatoid factor, anti-heat shock protein (65 kDa) antibodies and anti-nuclear antibodies in equine joint diseases

To consider the hypothesis that autoimmune mechanisms may contribute to the pathology of equine joint diseases, 3 autoimmune responses were assayed in sera and synovial fluids. IgM-rheumatoid factor and antibodies to heat shock protein 65 kDa were determined by ELISA; anti-nuclear antibodies were assayed by indirect immunofluorescence to whole cell nuclear components. All parameters showed only modest increases, if any and not in a pattern related to disease, although some statistically significant increases were detected. Group analysis showed significantly elevated synovial fluid IgM-rheumatoid factor (IgM-RF) in horses with OA (P < 0.01), traumatised joints (P < 0.01) and articular fractured bones (P < 0.001). There was no significantly increased IgM-RF in the sera of horses with joint disorders compared to control horses. Significantly raised anti-heat shock protein molecular weight 65 kDa (HSP65) antibodies were only found in the synovial fluids of the horses with traumatised joints (P < 0.001). No correlations were found between the synovial fluid and sera levels of IgM-RF or anti-HSP65 antibodies. Synovial fluid anti-HSP65 antibody and IgM-RF levels positively correlated in the OCD (P < 0.001), fracture (P < 0.01) and synovitis (P < 0.05) groups. As antibodies to HSP65 correlated with IgG concentrations in synovial fluids, it is not possible to draw conclusions on HSP roles in joint disease pathogenesis. No serum anti-nuclear antibodies (ANA) were detected by immunofluorescence using rat liver and a human epithelial cell line (HEp-2) as substrates.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies to heat shock proteins in dogs with rheumatoid arthritis and systemic lupus erythematosus

Antibodies to heat shock proteins of the 65 kDa group were demonstrated in canine sera and synovial fluid. This paper reports these antibody measurements in three groups of dogs with joint disease and compares them with those of a control population. Dogs with rheumatoid arthritis (RA) showed higher anti-heat shock proteins (HSP) antibody levels, in both their sera and synovial fluids, compared to the control dogs and these antibodies were predominantly of the IgG and IgM class; there was a significant correlation between IgM anti-HSP65 and IgM-rheumatoid factors. There was also a significant correlation between anti-HSP65 and antibodies to canine distemper virus, but only of the IgM class and the relevance of these antibodies to the overall pathogenesis of canine RA and, in particular, to the presence of canine distemper virus within the joint, are discussed.

Age-associated alterations in thirst and arginine vasopressin in response to a water or sodium load

We have examined simultaneous changes in thirst, plasma osmolality and arginine vasopressin, after oral water loading or hypertonic saline infusion. The studies were carried out in the same subjects, comprising young controls aged 26.8 years (SD 4.8, n = 10) and health status-defined elderly people aged 72.1 years (SD 3.1, n = 10). Water loading caused significant falls in plasma osmolality (p < 0.001) and thirst (p < 0.001), but there was no variation with age. Infusion with 462 mmol/l of sodium chloride increased plasma osmolality significantly (p < 0.001), but there was no variation with age (p = 0.12). The perception of thirst during the osmotic loading experiment was recorded differently by the two age groups (p < 0.0001). However, linear regression analysis showed no age difference in the relationship between thirst and plasma osmolality during osmotic loading. During osmotic loading the relationship between the plasma concentration of arginine vasopressin in response to increasing plasma osmolality varied significantly (slope: p = 0.02; intercept: p = 0.02). Plasma arginine vasopressin rose more rapidly with increasing plasma osmolality in old subjects.

Anti-collagen antibodies and immune complexes in equine joint diseases

An investigation was made into the possible contribution of autoimmune mechanisms to equine arthropathies. Serum and synovial fluid (SF) immune complexes and anti-collagen Type II antibodies were measured, by ELISA, in groups of horses with naturally occurring osteoarthritis (OA), osteochondritis dissecans (OCD), bone fracture, traumatised joints, synovitis, infected joints and non-diseased (control) joints. Significantly raised anti-collagen Type II antibodies were found in osteoarthritic (P < 0.02) and traumatised joint synovial fluids (P < 0.01) compared with the control, where ten of 38 (26%) OA and five of eight (63%) traumatised joint synovial fluid samples had raised anti-collagen Type II antibodies (above mean and 2 SD of control group; P < 0.05). Significantly raised levels of C1q-binding immune complexes were found in the synovial fluids of horses with OA (P < 0.001), OCD (P < 0.02), fractured articular bone (P < 0.001), infected (P < 0.01) and traumatised joints (P < 0.001) as compared with the control horses. Raised C1q-binding activity (above mean and 2 SD of control group; P < 0.05) was shown in synovial fluids in 18 of 38 (47%) OA, four of 16 (25%) OCD, four of nine (44%) fractured bone, one of eight (14%) synovitis, two of four (50%) infected joints and seven of eight (88%) traumatised joints. No raised anti-collagen Type II antibodies or C1q-binding activity were detected in sera from any clinical group. Correlations were found, in synovial fluids, between anti-collagen Type II antibodies and C1q-binding activity in OA (P < 0.02), synovitis (P < 0.01) and infected joint (P < 0.05) groups. Within individual horses, there were no correlations between the SF and sera measurements of either anti-collagen II or C1q-binding activity. The relationship between cause and effect of these immunological findings cannot be determined; as they are common to many types of equine joint disorder it is probable that they are not an initiating factor in pathology.

Mouse silver mutation is caused by a single base insertion in the putative cytoplasmic domain of Pmel 17

This laboratory has established in previous studies that Pmel 17, a gene expressed specifically in melanocytes, maps near the silver coat color locus (si/si) on mouse chromosome 10. In the current study, we have focused on determining whether or not the si allele carries a mutation in Pmel 17. Pmel 17 cDNA clones, isolated from wild-type and si/si murine melanocyte cDNA libraries, were sequenced and compared. A single nucleotide (A) insertion was found in the putative cytoplasmic tail of the si/si Pmel 17 cDNA clone. This insertion is predicted to alter the last 24 amino acids at the C-terminus. Also predicted is the extension of the Pmel 17 protein by 12 residues because a new termination signal created downstream from the wild-type reading frame. The mutation was confirmed by the sequence of the PCR-amplified genomic region flanking and including the mutation site. The fact that si/si Pmel 17 was not recognized by antibodies directed toward the C-terminal 15 amino acids of wild-type Pmel 17, indicated a defect in this region. We conclude from these results that silver pmel 17 protein has a major defect at the carboxyl terminus. The chromosomal location and the identification of a potentially pathologic mutation in si-Pmel 17 support our conclusion that Pmel 17 is encoded at the silver locus.

Survey of HIV/AIDS-Related Curricula in Programs of Occupational Therapy

AIDS has affected or will affect virtually every provider of health care. The purpose of this study was to determine the quantity of HIV/AIDS-related curricula in programs of occupational therapy across the United States. A survey was distributed to the program directors of all accredited technical, undergraduate, and graduate programs in the United States. Of the 137 surveys mailed, 95 were returned, yielding a 69%% response rate. Results of the survey indicated that graduate and undergraduate professional programs devoted an average of six classroom hours to this topic while technical programs averaged three classroom hours, with the majority of program directors indicating there is no need for further HIV/AIDS related curricula in their respective programs.

Kinetic characterization of the interaction of biotinylated human interleukin 5 with an Fc chimera of its receptor alpha subunit and development of an ELISA screening assay using real-time interaction biosensor analysis

The interaction of biotinylated human interleukin 5 ([BT]hIL5) with immobilized receptor was measured with a real-time biosensor, and these results were used as a basis for configuring an ELISA for screening antagonists of hIL5-receptor binding. The recombinant proteins used, hIL5 and shIL5R alpha-Fc (chimeric fusion receptor constructed by linking the soluble component of the hIL5 receptor alpha subunit to the constant domain (Fc) of immunoglobulin G), were produced by the expression of cloned vectors in Drosophila schneider (S2) cells. Initial attempts to develop a screening assay by direct immobilization of soluble IL5 receptor to microtiter plates proved unsatisfactory and led to use of the Fc chimera attached by oriented immobilization via protein A. Hence, shIL5R alpha-Fc was bound to protein A covalently immobilized on a carboxymethyl dextran (CM-5) biosensor chip. Specific binding was demonstrated of [BT]hIL5 to protein A/shIL5R alpha-Fc receptor complex. The binding was high affinity (Kdapp = 6 nM), reversible and saturable. The affinity of [BT]hIL5 was similar to that determined with the biosensor assay for unmodified hIL5. The observed kinetics of the interactions of Fc chimera with protein A (slow dissociation) and of [BT]hIL5 with immobilized Fc chimera (faster dissociation) were favorable for subsequently establishing a microtiter plate based ELISA assay. In the latter, Fc chimera was immobilized to the plate via protein A as in the biosensor experiment. Binding of [BT]hIL5 to immobilized Fc chimera in the ELISA was concentration dependent and was competed by both hIL5 and shIL5R alpha.(ABSTRACT TRUNCATED AT 250 WORDS)

Type 1 prophospholipase A2 propeptide in acute lung injury

Neutrophil sequestration and activation in the pulmonary vasculature and interstitium are important in acute lung injury. Phospholipase A2 plays an important part in the production of potent inflammatory mediators in this syndrome. We used our ELISA for type 1 prophospholipase A2 activation peptides, which have the aminoacid sequence Asp-Ser-Gly-Ile-Ser-Pro-Arg (DSGISPR), to show that DSGISPR concentrations in plasma and urine are a sensitive and specific marker of acute lung injury in patients admitted to intensive care. The detection of DSGISPR in the plasma of 11 of 50 unselected patients had a sensitivity of 100% and a specificity of 93% for the presence or future development of acute lung injury.

Effects of 3,4-dichloroaniline on the growth of two freshwater macroinvertebrates in a stream mesocosm

The growth of the freshwater macroinvertebrates Gammarus pulex (L.) and Chironomus riparius Meigen exposed to 3,4-dichloroaniline in chambers within stream mesocosms was determined. DCA significantly affected the growth of neonate G. pulex and third instar C. riparius over 25 and 12 days, respectively. The no-observed-effect concentrations (NOECs) obtained in the tests were 0.08 mg DCA liter-1 (G. pulex) and 0.76 mg DCA liter-1 (C. riparius) and these are compared to toxicity data from other investigations. Inclusion of single-species bioassays in mesocosm studies provides complementary information on toxicant effects and indicates the suitability of the results of such tests (which may be routinely performed under laboratory conditions) for protecting particular ecosystems.

Psychosocial factors and chronic fatigue syndrome

This study investigated the number and severity of life events, Type A behaviour, coping strategies and social support differences between chronic fatigue and irritable bowel syndrome patients prior to illness and between these groups and healthy controls. Although few differences were found between the groups for life events, a number of interesting results emerged with regard to different aspects of Type A behaviour, various coping strategies and social support. These findings are discussed with respect to existing research in the field.

Hyaluronan in canine arthropathies

Soluble hyaluronan (HA), which has been considered as a marker for joint disease in man, was measured in serum and synovial fluid (SF) from dogs with osteoarthritis (OA), rheumatoid arthritis (RA), and rupture of the cranial cruciate ligament (CCL) and from normal dogs (control). Dogs with OA and RA had significantly increased serum HA (P < 0.001) and decreased synovial fluid HA (P < 0.001), as did dogs with CCL rupture (serum, P < 0.05; synovial fluid, P < 0.005). In OA, HA was lower in the SF from the affected joint than in that from the clinically normal (inactive) contralateral joint; no such difference was seen in dogs with CCL rupture. Dogs with liver disease (portocaval shunts, viral infectious hepatitis, metastatic neoplasm and disease secondary to diabetes mellitus) had increased serum HA concentrations (P < 0.001). There was a significant overlap of HA values in the diseased and normal dogs. Therefore, it is unlikely that the measurement of this cartilage breakdown product would be of value for diagnosis or prognosis in canine arthropathies.

Recovery after oral surgery with halothane, enflurane, isoflurane or propofol anaesthesia

We have compared the recovery characteristics of four different techniques for maintenance of anaesthesia in 99 day-case patients admitted for oral surgery. All patients received propofol for induction of anaesthesia followed by halothane, enflurane, isoflurane or propofol infusion for maintenance of anaesthesia. Each patient was subjected to a battery of psychometric tests which included Spielberger state, trait, mood stress and mood arousal questionnaires, Maddox-Wing test and five-choice serial reaction time. All tests were performed before operation and at 0.5, 1, 2, 4, 24 and 48 h after operation. Performance in the reaction time test decreased significantly in the immediate postoperative period, returning almost to preoperative values by 4 h. However, only those patients who received enflurane or propofol had returned to their performance level before surgery by 4 h, although all four groups had achieved this target by 24 h. There was a further improvement in performance at 48 h. Anxiety and stress were high before surgery and decreased rapidly in the postoperative period. The Maddox-Wing test demonstrated a significant impairment in performance in the first 1 h after surgery, which returned to normal by discharge at 4 h. There were no significant differences between the four groups in these latter tests.