Effects of en bloc esophagectomy on nutritional and immune status in patients with esophageal carcinoma

BACKGROUND AND OBJECTIVES

En bloc esophagectomy has been established as the treatment of choice for patients with resectable esophageal carcinoma. However, an extensive surgical procedure may result in further impairment of the patient's nutritional status and immune system. Thus a prospective study was undertaken to evaluate the perioperative sequential changes in patients' nutritional and immune status and the timing to institute postoperative adjuvant therapy.

METHODS

Thirty-seven patients (34 male, 3 female) who had undergone en bloc esophagectomy with gastric institution for epidermoid carcinoma of the esophagus were studied. The mean age was 62.3 years. The nutritional and immune assessments were performed preoperatively, on the third postoperative day, in the first week, second week, third week, and at the end of the first and third month. The biochemical studies for nutritional evaluation included serum albumin, cholesterol, iron, transferrin, magnesium, zinc, total iron binding capacity (TIBC), and nitrogen balance. Evaluation of the immune status consisted of: (1) total lymphocyte count, (2) lymphocyte subpopulation, (3) immunoglobulins, (4) complements (C3 and C4), (5) lymphocyte blastogenic responses, (6) tumor necrosis factor-alpha and interleukin-2 secretion activity from mononuclear cells, and (7) C-reactive protein (CRP) level.

RESULTS

All the parameters in nutritional assessment declined profoundly by the third postoperative day (P < 0.05). The most severe deterioration was in serum iron, followed by transferrin, TIBC, cholesterol, and zinc. Most of them returned to the preoperative levels within 2-3 weeks after surgery. However, the serum levels of iron, transferrin, and TIBC required a longer period of time (> 1 month) to return to normal. A remarkable increase of serum CRP was detected in the first postoperative week (P < 0.05), but immunoglobulins and complements decreased significantly yet variably (P < 0.05) in the second or third postoperative week before gradually returning to preoperative levels. Moreover, during the first week after surgery, CD3 and CD8 diminished following esophageal surgery, whereas CD20, CD4/CD8 ratio, and lymphocyte blastogenic responses increased significantly (P < 0.05).

CONCLUSIONS

Except for iron-related parameters, all the other nutritional parameters returned to the preoperative level by the third postoperative week. An adequate supplementation of iron and protein for 1-3 months after surgery is needed. En bloc esophagectomy might have only a mild and temporarily adverse effect on the host immune defense. Regarding the postoperative recovery of a patient's nutritional and immune status, postoperative chemo-radiotherapy is optimally instituted after the third postoperative week, instead of within 2 weeks of surgery.

Closed humeral shaft fractures: a prospective evaluation of surgical treatment

OBJECTIVE

We tried to define the roles of the rigid dynamic compression plate (DCP) and the semi-rigid Ender nail (EN) in the treatment of closed humeral shaft fractures.

DESIGN

A prospective, randomized clinical study was performed with detailed comparison parameters.

MATERIALS AND METHODS

Ninety-one closed humeral shaft fractures were treated. Randomly, 30 humeri were treated with open reduction and internal fixation with DCP and no bone grafting (BG), 29 were treated with the same procedure but with BG, and 32 were treated with closed reduction and internal fixation with Ender nails. The average follow-up period was 32 months (range, 13-54 months).

MEASUREMENTS AND MAIN RESULTS

In the group with DCP without BG, the average blood loss was 270 mL, operation time was 92 minutes, hospital length of stay was 6.5 days, and union time was 12.5 weeks. In the group with DCP with BG, the average blood loss was 325 mL, operation time was 108 minutes, hospital length of stay was 6.9 days, and union time was 9.4 weeks. In the EN group, the average blood loss was 114 mL, operation time was 54 minutes, hospital length of stay was 5.6 days, and union time was 9.9 weeks. Analysis of variance and Fisher's exact test were used to evaluate the statistical significance.

CONCLUSION

In our experience, for humeral shaft fractures fixed surgically, EN is better than DCP without BG. When DCP is chosen for the means of fixation, prophylactic BG is recommended, especially in cases with more comminution.

Cardiac arrest during anesthesia in a teaching hospital. A 4 years survey

METHODS

During the past 4 years, 48 cases of cardiac arrest occurred during anesthesia among a total of 104,600 cases of anesthesia at Mackay Memorial Hospital in Taipei.

RESULTS

The incidence of cardiac arrest was thus about 0.046% (48/104,600), with the causative factors being anesthetic related in 21% (10/48) of cases, surgical factors in 19% (9/48) of cases and patient's pathological factors in 60% (29/48) of cases. Of these 48 patients, 34 died and 14 survived after cardiopulmonary resuscitation (CPR). Anesthesia contributed to death in 3 cases of a total of 104,600 cases of anesthesia giving an approximate incidence of 3/100,000. Two of these 3 cases were avoidable.

Selective precipitation separation and inductively coupled plasma mass spectrometric determination of trace metal impurities in high purity silver

A simple and rapid method for the determination of some trace element impurities in high purity silver, combining the isolation of analytes from the silver matrix with selective precipitation followed by ICP-MS determination was developed. On the basis of an extreme difference in the solubilities of the chlorides of silver and the other accompanying trace elements, silver can be separated completely through the addition of hydrochloric acid. The sample of silver was at first dissolved in 7 M nitric acid followed by addition of hydrochloric acid to remove the silver matrix by formation of a silver chloride precipitate, while leaving the trace element impurities in the solution, which was subsequently analysed by ICP-MS. Eleven elements (Al, Au, Cd, Co, Cu, Fe, Mg, Mn, Ni, Pb and Sn) were determined with good accuracy and precision. The limits of detection (based on the 3 sigma criterion) of these elements were 10(-1)-10(-3) ng g-1. The proposed method was successfully applied to the determination of metal impurities in high-purity silver samples (EM9465 and EM 9343) and validated by the analysis of NIST SRM 8171 (Fine Silver FS 14).

Molecular characterization of a plasmid-borne (pTC82) chloramphenicol resistance determinant (cat-TC) from Lactobacillus reuteri G4

Lactobacillus reuteri G4 contains a 7.0-kb plasmid (pTC82) encoding resistance to chloramphenicol (Cm). Determination of the nucleotide sequence of the genetic determinant (cat-TC) encoding resistance to Cm on pTC82 revealed an open reading frame for a 238-amino-acid Cm acetyltransferase (CAT) monomer. This structural cat gene, 714 bp in length, was highly related (ca. 95% nucleotide and ca. 81% amino acid identity) to the 648-bp cat gene from Staphylococcus aureus plasmid pC194. A total of 6 bp transversions and 4 bp deletions was observed along the whole DNA sequence of cat-TC compared to that of cat-pC194. To determine the activity of the putative cat-TC gene, recombinant plasmid pUC8217 containing the cat determinant from pTC82 was subjected to a maxicell analysis. The observed molecular mass of the synthesized protein, based on electrophoretic mobility, was in reasonable agreement with the 27.3 kDa predicted from the DNA sequence. This is the first reported nucleotide sequence of a Cm-resistance determinant from L. reuteri and also the first evidence of adding Lactobacillus to the list of versatile bacterial genera which naturally acquire the cat-pC194 gene in the microbial ecological system.

Effectiveness of a manually controlled infusion scheme of propofol and alfentanil mixture for endotracheal intubation in hypertensive patients: in comparison with thiamylal and nifedipine plus thiamylal

BACKGROUND

Bolus administration of propofol for induction causes hypotension, especially in elderly hypertensive patient. Carefully titrated infusion of propofol minimizes adverse effects, such as hypotension, and permits a rapid recovery of its central effects. The objective of this study was to investigate the effect of a manually controlled infusion scheme of propofol and alfentanil mixture on hemodynamic stability during induction and endotracheal intubation for hypertensive patient. At the same time, the effectiveness of this scheme was compared with two other induction regimens (thiamylal or nifedipine plus thiamylal).

METHODS

Sixty hypertensive patients undergoing orthopedic surgery were randomized into 3 groups (n = 20 per each group), None of the patients received premedication. Anesthesia was induced in group 1 (G1) with alfentanil 10 micrograms/kg. 30 s later, manual infusion of a mixture of propofol (10-12 mg/kg/h) and alfentanil (25 micrograms/kg/h) was performed for 2 min, followed by atracurium (5 mg) and propofol (1-1.5 mg/kg) as a bolus induction dose over 20 s, and then Suxamethonium (1.5 mg/kg) at 30-40 s later. Intubation was done while giving a continuous infusion of propofol and alfentanil. After intubation, the infusion rate was adjusted according to the blood pressure (BP) variation. Group 2 patients (G2) were induced with fentanyl (2 micrograms/kg), thiamylal (4-5 mg/kg), atracurium (5 mg) and succinylcholine (1.5 mg/kg). Induction of anesthesia in group 3 patients (G3) was the same as for G2, with additional sublingual nifedipine (1/2 capsule) 10 min prior to induction. Extra bolus dose of propofol (20 mg) or thiamylal (20 mg) was given at every 15 s if the systolic BP was still higher than 160 mmHg after induction by the above 3 regimens. The radial arterial pressure and electrocardiogram were continuously recorded for evaluation of hemodynamic changes.

RESULTS

Post-intubation peak mean arterial pressure (MAP) in G1 and G3 were below to awake baseline values, while MAP of G2 was significantly higher than over awake baseline level (p < 0.001). The lowest MAP of G3 at post-intubation period before surgical stimulation were significantly lower than those of G1 and G2 (p < 0.001). Peak tachycardiac response to intubation in G2 was significantly higher than G1 (p < 0.05). After intubation, the peak rate pressure product were significantly higher in G2 compared with that in G1 (p < 0.05) and G3 (p < 0.001).

CONCLUSIONS

The proposed manual infusion scheme of propofol and alfentanil mixture performed during induction and intubation attenuated the subsequent peak pressor response to incubation and reduced the hypotensive effect, in comparison to thiamylal or thiamylal plus nifedipine treatment, during post-intubation period. The same infusion scheme also attenuated the tachycardiac response to intubation.

Effects of a program on symmetrical posture in patients with hemiplegia: A single-subject design

OBJECTIVES

Asymmetrical posture during static stance has been identified as a common problem in persons with hemiplegia. This study examined the effect of an activity-based therapy regimen on symmetric weight bearing and midline position of center of gravity (COG) in three adult subjects with hemiplegia.

METHOD

An ABAB single-subject design was used. The intervention program, including sanding in front of a standing table and play a bean bag game, was introduced for 30 min each day during each intervention phase. Quantitative measurements of the weight distribution and the midline position of COG were taken with the Balance Master System (version 2.20).

RESULTS

Visual inspection and statistical analysis of the data revealed a significant improvement in symmetric weight distribution and midline position of COG. The study suggests that this program may be a promising alternative to a variety of postural rehabilitation programs for persons with hemiplegia.

CONCLUSION

Insecurity caused by poor stabilization and abnormal reactions to body weight bearing in an antigravity position might contribute to asymmetric postures. Results of this study suggest that an activity-oriented program can be effective in helping the persons with hemiplegia achieve symmetric stances.

Mechanical strain induces monocyte chemotactic protein-1 gene expression in endothelial cells. Effects of mechanical strain on monocyte adhesion to endothelial cells

Monocyte chemotactic protein-1 (MCP-1), a potent monocyte chemoattractant secreted by endothelial cells (ECs), is believed to play a key role in the early events of atherogenesis. Since vascular ECs are constantly subjected to mechanical stresses, we examined how cyclic strain affects the expression of the MCP-1 gene in human ECs grown on a flexible membrane base deformed by sinusoidal negative pressure (peak level, -16 kPa at 60 cycles per minute). Northern blot analysis demonstrated that the MCP-1 mRNA levels in ECs subjected to strain for 1, 5, or 24 hours were double those in control ECs (P < .05). This strain-induced increase was mainly serum independent, and MCP-1 mRNA level returned to its control basal level 3 hours after release of strain. Culture media from strained ECs contained approximately twice the MCP-1 concentration and more than twice the monocyte chemotactic activity of media from control ECs (P < .05). Pretreatment of collected media with anti-MCP-1 antibody suppressed such activity. Monocyte adhesion to ECs subjected to strain for 12 hours was 1.8-fold greater than adhesion to unstrained control ECs (P < .05). A protein kinase C inhibitor, calphostin C, abolished the strain-induced MCP-1 gene expression. In addition, cAMP- or cGMP-dependent protein kinase inhibitors (KT5720 and KT5823, respectively) partially inhibited such expression. Pretreatment with EGTA or the intracellular Ca2+ chelator BAPTA/AM strongly suppressed the strain-induced MCP-1 mRNA. Verapamil, a Ca2+ channel blocker, greatly reduced MCP-1 mRNA levels in both strained and unstrained ECs.(ABSTRACT TRUNCATED AT 250 WORDS)

Purification and properties of alpha-amylase from Aspergillus oryzae ATCC 76080

An alpha-amylase was purified from the solid cultural extract of Aspergillus oryzae ATCC 76080 by sequential steps of amylopectin affinity adsorption, DEAE-Sepharose ion-exchange chromatography and Sephacryl S-200 HR gel filtration. By these steps, the purity of the enzyme increased by 16 fold and recovery of the enzyme activity was 45%. The purified enzyme had an optimal pH between 4 to 5, optimal temperature at 50 degrees C and a Km value of 0.22% for hydrolysis of starch. About 80% of the enzyme activity was lost after incubation at 50 degrees C for 30 min. The heat denaturation constant at 50 degrees C was 0.024 min-1. The molecular weight was 52 kDa as determined by gel filtration. Mercuric ion (0.3 mM), DNFB# (6 mM), NBSI (6 mM) and NAI (6 mM) inhibited the activity of the enzyme. The main products for hydrolysis of maltoheptaose by the enzyme were maltotriose and maltotetraose.

Comparison of the number and type of dental functional units in geriatric populations with diverse medical backgrounds

Elderly subjects (N 430) from four convenience populations that represented different levels of medical health--independent living (Veterans Affairs and non-Veterans Affairs), nursing home, and hospitalized acute care--were given dental examinations. The independent living groups had significantly higher numbers of functional units (opposing natural or prosthetic tooth pairs) and of contiguous functional units compared with the nursing home and hospitalized groups. There was a shift from functional units that consisted of natural teeth to functional units that consisted of prosthetic teeth in the nursing home and hospitalized groups. Numbers of functional units were negatively correlated to plaque index, papillary bleeding scores, and minor salivary gland output. This study suggests a strong relationship between functional integrity of the dentition and general health.

Fractionation of fulvic acids: characteristics and complexation with copper

Two fulvic acid samples isolated from Suwannee river (International Humic Substance Society) and Feeitsuey reservoir were subjected to gel filtration chromatography (GFC) for molecular size fractionation. The GFC-eluted samples were separated into three groups corresponding to the molecular weight ranges: < 220, 220-1000, and 1000-4000. Fluorescence quenching techniques were employed for determining the conditional stability coefficient and kinetic parameters of copper complexation with the three fractions of fulvic acids. Experimental conditions were pH 6, 5 x 10(-5)m total copper and 5 mg C litre(-1) of fulvic acids. The conditional stability coefficients of the fulvic acid fractions were in the order of 0.9-3.3 x 10(5)m(-1), and the forward and reverse rate constants were in the order of 6.9-12.4 x 10(3)m(-1) s(-1) and 3.5-8.0 x 10(-2) s(-1). Information could be useful in modelling copper transport in the hydrosphere.

Purification and properties of beta-fructofuranosidase from Aspergillus oryzae ATCC 76080

A fructooligosaccharide-producing beta-fructofuranosidase was purified from the crude extract of Aspergillus oryzae ATCC 76080 through successive steps of ultrafiltration, DEAE-Sepharose CL-6B ion-exchange chromatography, preparative isoelectric focusing electrophoresis and Sephacryl S-200 gel filtration. The purified enzyme had an optimal pH of 5-6, an optimal temperature of 50 degrees C, a Km value of 0.53 M for catalyzing selftransfer reaction from sucrose. The molecular weight was 87 kDa by gel filtration. Mercuric ion (0.25 mM), p-hydroxymercuribenzoate (0.25 mM) and N-bromosuccinimide (0.5 mM), significantly inhibited the enzyme activity. The enzyme showed both transfructosylation and hydrolytic action in 0.5 to 50% sucrose. The transfructosylation ratio increased as the sucrose concentration increased and it was 88.5% at 50% sucrose. The main fructooligosaccharides produced from sucrose were 1-kestose and nystose.

[Intrathecal meperidine attenuates shivering induced by spinal anesthesia]

Shivering is a common and complex phenomenon that occurs in many patients during spinal anesthesia. Shivering can increase oxygen consumption up to 500 per cent which may be detrimental to patients with decreased myocardial reserve. The metabolic costs and cardiorespiratory consequences of shivering are important particularly for patients with anemia, coronary arterial disease, cardiopulmonary insufficient, debilitated status or are elderly. We studied whether intrathecal meperidine could prevent shivering after spinal anesthesia. 60 patients with ASA class I-II were divided into intrathecal meperidine group (Group I) (n = 30) and control group (Group II) (n = 30). Group I received spinal tetracaine 12-16 mg with meperidine 0.2 mg/kg and Group II received spinal tetracaine 12-16 mg without meperidine. During operation the highest level of spinal anesthesia, ambient and rectal temperatures, blood pressure (BP) and heart rate (HR), presence or absence of shivering, intensity of shivering in both groups were recorded. Close observation for side effects was given post-operatively. There was a significant reduction (p < .005) in incidence of shivering in group I patients (16.7%) when compared with group II (56.7%). There was no or less side effects observed with other neuraxial opioids except nausea. We concluded that intrathecal meperidine could suppress shivering induced by spinal anesthesia.

[Nifedipine in preeclampsia for cesarean section]

The patients with preeclampsia undergoing emergent cesarean section is always a challenge to an anesthesiologist, because severe hypertensive response after laryngoscopy and tracheal intubation may result in life-threatening complication such as cerebral hemorrhage. Most of these patients receive magnesium sulfate for the prevention of convulsion. An ideal anti-hypertensive drug for preeclampsia should be effective, limited fall in blood pressure, rapid onset, maintaining uteroplacental blood flow, and less maternal and fetal side effects. We studied the efficacy of 10 mg sublingual nifedipine in attenuating the pressor response to intubation. We were also concerned about whether this calcium antagonist may inhibit uterine contraction and increase intra and postpartum hemorrhage when it is used with magnesium sulfate and general anesthesia. There were thirty-three patients in our study (16 in nifedipine group and 17 in control group). This study revealed that nifedipine attenuate the hypertensive response effectively. Uterine contraction response to oxytocic drugs was quite well in both groups. There was no significant difference in blood loss between nifedipine and control group. And no severe maternal and fetal adverse effect.

Comparison of sublingual captopril, nifedipine and prazosin in hypertensive emergencies during hemodialysis

Hypertensive emergencies in hemodialysis require immediate therapy, usually by parenteral drug administration; however, sublingual medications may have potential in this special condition. Sublingual captopril (25 mg), nifedipine (10 mg) and prazosin (2 mg) were prescribed to determine the effectiveness and safety of each medication in the treatment of hypertensive emergencies during hemodialysis. Blood pressure and heart rate were measured continuously up to 120 min postdose. The response rates were 83% for captopril, 90% for nifedipine and 11% for prazosin. The significant hypotensive effects of both sublingual captopril and nifedipine occurred at 10 min and continued up to 120 min. The reduction of systolic blood pressure occurred earlier in nifedipine than captopril (10 vs. 15 min). No significant difference in heart rate between them was noted. There were no side effects in the captopril group but flushing, tachycardia and headache were observed in 4 patients of the nifedipine group. We concluded that sublingual captopril and nifedipine were effective but captopril seemed to have less side effects than nifedipine and may be an excellent alternative to sublingual nifedipine in the urgent treatment of hypertensive emergencies in hemodialysis. Prazosin was not recommended because of its low response rate.

Effects of oxidised dietary oil and antioxidant supplementation on broiler growth and meat stability

1. Broilers were fed on diets containing oxidised sunflower oil, sunflower oil and sunflower oil supplemented with alpha-tocopherol, butylated hydroxyanisole (BHA) or butylated hydroxytoluene (BHT). 2. Oxidised oil caused a significant reduction in broiler body and carcase weights, whereas alpha-tocopherol and BHA/BHT supplementation improved growth. 3. Meat samples from these broilers were stored at 4 degrees C and -20 degrees C and their oxidative stability evaluated. Feeding oxidised oil to broilers resulted in meat that underwent rapid oxidative changes during refrigerated and frozen storage. 4. On the other hand, dietary alpha-tocopherol and BHA/BHT supplementation increased alpha-tocopherol and BHA/BHT concentrations in meat and significantly (P less than 0.05) improved the oxidative stability of meat during refrigerated and frozen storage.

Influence of oxidised dietary oil and antioxidant supplementation on membrane-bound lipid stability in broiler meat

1. The effects of oxidised oil, dietary alpha-tocopherol and BHA/BHT-supplementation on the fatty acid composition of mitochondrial, microsomal and soluble protein fractions of broiler muscles, and on their lability to metmyoglobin/hydrogen peroxide-catalysed peroxidation were investigated. 2. Oxidised oil in the broiler diets induced rapid oxidation of the membrane-bound lipids and decreased their stability towards metmyoglobin-hydrogen peroxide-catalysed peroxidation. 3. Supplementation of the broiler diets with alpha-tocopherol increased the alpha-tocopherol concentrations in the microsomal and soluble protein fractions of the dark meat as well as the soluble protein fraction of the white meat. This, in turn, stabilised the membrane-bound lipids against metmyoglobin/hydrogen peroxide-initiated peroxidative changes.

Production of Extracellular Pigment by a Mutant of Monascus kaoliang sp. nov

A hyperpigment-producing mutant, R-10847, was derived from Monascus kaoliang F-2 (ATCC 26264) through a series of mutagenesis steps. The mutant produced a large quantity of Monascus pigment when grown in mantou (steamed bread) by solid culture. The mutant produced pigments extracellularly by extruding the pigments outside the cell in a lump together with some viscous substances. The productivity of pigment was about 100-fold greater than that of the wild type. The mutant lost the capability of spore formation, the growth rate decreased, and both the size and quantity of conidia were reduced. The color of the pigment produced by the mutant changed from orange to deep red.

Characterization of a cellulase producing mold, Trichoderma sp. W-10 isolated from infected mushroom spawn

A potent cellulase producing mold, Tichoderma sp. W-10 suitable for enzyme production with solid state culture was isolated from infected mushroom spawn, its characteristics and taxonomic studies were carried out. As a result, this mold was identified as Trichoderma koningii (Oudemans) according to the keys of Gilman and Rifai's classification system and the morphological features described by Komatsu. Meanwhile, a detail survey of physiological, cultural and biochemical characteristics were also described.

Studies on the Monascus isolated from the startor of Kaoliang Brandy

Seven strains of Monascus spp. were isolated from the startors of Kaoliang Brandy in Taiwan and Kinmen. Their morphological, physiological, and biochemical characteristics were examined. Shape of colony, length of conidial chain, production of pigment and tolerance to NaCl were considered to be suitable keys to the classification of these isolates. It was found that there were at least 6 species of Monascus in the startors of Kaoliang Brandy, 2 from Kinmen and 4 from Taiwan.