In the face of chronic aspiration, prolonged ischemic time exacerbates obliterative bronchiolitis in rat pulmonary allografts

Aspiration of gastric fluid into the lung mediates the development of obliterative bronchiolitis (OB) in orthotopic WKY-to-F344 rat pulmonary transplants that have been subjected to immunosuppression with cyclosporine. However, the contribution of ischemic time to this process remains unknown. In this study, the effect of long (n = 16) and short (n = 12) ischemic times (average of 6 h and of 73 min, respectively) on rat lung transplants receiving aspiration of gastric fluid was assessed. Long ischemic times (LIT) led to significantly (p < 0.05) greater development of OB (ratio of OB lesions/total airways = 0.45 ± 0.07, mean ± standard error) compared to short ischemic times (ratio = 0.19 ± 0.05). However, the development of OB was dependent on aspiration, as controls receiving aspiration with normal saline showed little development of OB, regardless of ischemic time (p < 0.05). These data suggest that LIT, while insufficient by itself to lead to OB, works synergistically with aspiration of gastric fluid to exacerbate the development of OB.

Quantitative analysis of rectal cancer by spectral domain optical coherence tomography

To quantify OCT images of rectal tissue for clinic diagnosis, the scattering coefficient of the tissue is extracted by curve fitting the OCT signals to a confocal single model. A total of 1000 measurements (half and half of normal and malignant tissues) were obtained from 16 recta. The normal rectal tissue has a larger scattering coefficient ranging from 1.09 to 5.41 mm⁻¹ with a mean value of 2.29 mm⁻¹ (std:±0.32), while the malignant group shows lower scattering property and the values ranging from 0.25 to 2.69 mm⁻¹ with a mean value of 1.41 mm⁻¹ (std:±0.18). The peri-cancer of recta has also been investigated to distinguish the difference between normal and malignant rectal tissue. The results demonstrate that the quantitative analysis of the rectal tissue can be used as a promising diagnostic criterion of early rectal cancer, which has great value for clinical medical applications.

Prospects for gene transfer for clinical heart failure

Congestive heart failure is an inexorable disease associated with unacceptably high morbidity and mortality. Preclinical results indicate that gene transfer using various proteins is a safe and effective approach for increasing function of the failing heart. In the current review, we provide a summary of cardiac gene transfer in general and summarize findings using adenylyl cyclase 6 as therapeutic gene in the failing heart. We also discuss the potential usefulness of a new treatment for congestive heart failure, paracrine-based gene transfer.

Deletion of estrogen receptor beta accelerates early stage of bone healing in a mouse osteotomy model

This study examined the role of estrogen receptor (ER) beta during mouse femoral fracture healing by employing ER knockout (KO) mice. The fracture healing in KO mice was enhanced in the early stage of neovascularization and the middle stage of endochondral ossification.

INTRODUCTION

This study was conducted to examine the role of ER beta during fracture healing.

METHODS

Female ERbeta knockout (KO) mice (18 weeks old) and age-matched female wild-type (WT) mice underwent open osteotomy on the right femur. They were sacrificed at 1, 2, 4 and 6 weeks post-fracture. The sera and callus samples were subjected to the following analyses: micro-computed tomography (CT)-based angiography, micro-CT evaluation, histological examination, histomorphometry examination, real-time polymerase chain reaction (PCR) analysis, biochemical marker, and mechanical testing.

RESULTS

Micro-CT-based angiography showed that the total vessel volume at the fracture site was larger in the KO group than the WT group at 1 and 2 weeks post-fracture. Micro-CT analysis revealed that the callus volume was significantly higher in the KO group from week 2 to week 4 post-fracture when compared with the WT group consistent with the histological data. Analysis of biochemical markers indicated that circulating P1NP levels in the KO mice were significantly higher than in the WT mice from week 2 to week 4 and that temporal expression of circulating C-terminal telopeptide of type I collagen (CTX) levels was also higher in the KO mice than in the WT mice. These results were consistent with quantitative real-time PCR analysis. The ultimate load, stiffness, and energy to failure were significantly higher in the KO mice than in the WT mice at week 4.

CONCLUSIONS

The fracture healing in KO mice was enhanced in the early stage of neovascularization and the middle stage of endochondral ossification, but not by the end of healing. Blockade of ERbeta can be considered as another therapeutic strategy for osteoporotic fracture and non-union fracture.

Detecting abnormalities of corpus callosum connectivity in autism using magnetic resonance imaging and diffusion tensor tractography

The corpus callosum (CC) has emerged as one of the primary targets of autism research. To detect aberrant CC interhemispheric connectivity in autism, we performed T1-weighted magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI)-based tractography in 18 children with high functioning autism (HFA) and 16 well-matched typically developing (TD) children. We compared global and regional T1 measures (CC volume, and CC density), and the DTI measures [fractional anisotropy (FA), apparent diffusion coefficient (ADC), average fiber length (AFL), and fiber number (FN)] of transcallosal fibers, between the two groups. We also evaluated the relationships between scores on the Childhood Autism Rating Scale (CARS) and CC T1 or DTI measurements. Significantly less white matter density in the anterior third of the CC, and higher ADC and lower FN values of the anterior third transcallosal fiber tracts were found in HFA patients compared to TD children. These results suggested that the anterior third CC density and transcallosal fiber connectivity were affected in HFA children.

Effects of a single dose of methylprednisolone versus three doses of rosiglitazone on nerve growth factor levels after spinal cord injury

Acute spinal cord lesions result in dramatic changes in neuronal function. Studies have shown that the peroxisome proliferator-activated receptor-γ agonist, rosiglitazone, has neuroprotective properties. The effect of rosiglitazone after acute spinal cord injury was examined in the present study. Rats were subjected to laminectomy only; laminectomy with spinal cord contusion injury; laminectomy with contusion injury plus 30 mg/kg body weight methylprednisolone administered 5 min after surgery; or laminectomy with contusion injury plus 2 mg/kg body weight rosiglitazone administered intraperitoneally 5 min, 6 h and 24 h after surgery. Both drugs increased neurotrophin gene and protein expression 24 h after injury compared with injured rats without drug treatment. Rosiglitazone increased neurotrophin expression at 7 days to a greater extent than methylprednisolone. Early functional recovery was observed in rats treated with rosiglitazone. The greater increase in rosiglitazone-induced nerve growth factor expression soon after injury could explain, at least in part, the improved recovery of motor function compared with methylprednisolone or saline.

Identification and characterization of the cysteine protease inhibitor gene MdCPI from Musca domestica

Cysteine proteinase inhibitors (CPIs) are involved in many vital cellular processes such as signalling pathways, apoptosis, immune response and development; however, no CPIs have yet been reported from the housefly Musca domestica. Here we report the isolation and characterization of a housefly CPI gene designated MdCPI. The gene contains an open reading frame of 357 bp encoding a protein of 118 amino acid residues with a putative signal peptide of 17 amino acid residues. Protein alignment demonstrated a high homology to that of Sarcophaga crassipalpis (identity = 51%). Phylogenetic analysis suggested that all CPIs from dipterans, including the housefly, belong to the I25A family and may be descended from a single common ancestor. The gene was expressed in and purified from Escherichia coli. Biochemical studies showed that MdCPI exerts an inhibiting function on papain, which is a classical assay to confirm CPIs. Real-time quantitative PCR and immunolocalization analysis revealed that MdCPI is specifically expressed in haemocytes and fat bodies. It is highly down-regulated in larvae and markedly up-regulated in the pupal stage, suggesting that it may be related to development.

Humanized theta-defensins (retrocyclins) enhance macrophage performance and protect mice from experimental anthrax infections

Retrocyclins are humanized versions of the -defensin peptides expressed by the leukocytes of several nonhuman primates. Previous studies, performed in serum-free media, determined that retrocyclins 1 (RC1) and RC2 could prevent successful germination of Bacillus anthracis spores, kill vegetative B. anthracis cells, and inactivate anthrax lethal factor. We now report that retrocyclins are extensively bound by components of native mouse, human, and fetal calf sera, that heat-inactivated sera show greatly enhanced retrocyclin binding, and that native and (especially) heat-inactivated sera greatly reduce the direct activities of retrocyclins against spores and vegetative cells of B. anthracis. Nevertheless, we also found that retrocyclins protected mice challenged in vivo by subcutaneous, intraperitoneal, or intranasal instillation of B. anthracis spores. Retrocyclin 1 bound extensively to B. anthracis spores and enhanced their phagocytosis and killing by murine RAW264.7 cells. Based on the assumption that spore-bound RC1 enters phagosomes by "piggyback phagocytosis," model calculations showed that the intraphagosomal concentration of RC1 would greatly exceed its extracellular concentration. Murine alveolar macrophages took up fluorescently labeled retrocyclin, suggesting that macrophages may also acquire extracellular RC1 directly. Overall, these data demonstrate that retrocyclins are effective in vivo against experimental murine anthrax infections and suggest that enhanced macrophage function contributes to this property.

Quantification of intraventricular hemorrhage with electrical impedance tomography using a spherical model

We have developed a robust EEG-based current pattern which shows promise for the detection of intraventricular hemorrhage (IVH) in neonates. Our reconstructions to date are based on a layered spherical head model. In this study, the current pattern was used to gather data from three realistic-shaped neonatal head models and a physical phantom based on one of these models. We found that a sensitivity matrix calculated from a spherical model gave us satisfactory reconstructions in terms of both image quality and quantification. Incorporating correct geometry information into the forward model improved image quality. However, it did not improve quantification accuracy. The results indicate that using a spherical matrix may be a more practical choice for monitoring IVH volumes in neonates for whom patient-specific models are not available.

Effect of water-soluble P-chitosan and S-chitosan on human primary osteoblasts and giant cell tumor of bone stromal cells

Water-soluble phosphorylated chitosan (P-chitosan) and disodium (1 → 4)-2-deoxy-2-sulfoamino-β-D-glucopyranuronan (S-chitosan) are two chemically modified chitosans. In this study, we found that P-chitosan significantly promotes cell proliferation of both human primary osteoblasts (OBs) and the OB like stromal cell component of the giant cell tumor of bone (GCTB) cells at the concentration from 125 to 1000 µg ml⁻¹ at all time points of 1, 3, 5 and 7 days after treatment. Further investigation of the osteogenic effect of the P-chitosan suggested that it regulates the levels of osteoclastogenic factors, receptor activator of nuclear factor kappa B ligand and osteoprotegerin expression. An interesting finding is that S-chitosan at lower concentration (100 µg ml⁻¹) stimulates cell proliferation while a higher dose (1000 µg ml⁻¹) of S-chitosan inhibits it. The inhibitory effect of S-chitosan on human primary GCT stromal cells was greater than that of OBs (p < 0.05). Taken together, our findings elucidated the osteogenic effect of P-chitosan and the varying effects of S-chitosan on the proliferation of human primary OBs and GCT stromal cells and provided us the rationale for the construction of novel bone repair biomaterials with the dual properties of bone induction and bone tumor inhibition.

Neuraxial anesthesia for cardiac surgery: thoracic epidural and high spinal anesthesia - why is it different?

Anesthesiologists can offer much more then stable blood pressure and heart rate in the intraoperative period. By choosing appropriate anesthetic techniques they can tremendously influence perioperative stress. This may positively impact on the overall surgical outcome. One of the most intriguing aspects of neuraxial anesthesia is its ability to attenuate the stress response to surgery. At present there is no agreement on the clinical importance of such a response but there is substantial indirect evidence that it may play an important role in a patient's outcome. Neuraxial anesthesia supplemented by general anesthesia is justified and can be safely used in cardiac surgery. The authors of this expert opinion prefer spinal anesthesia to thoracic epidural anesthesia and have been using it routinely for the last 20 years without any neurological complications. The risk of spinal hematoma from a 27G spinal needle prior to full heparinization is unknown but in our opinion is remote. Both epidural and spinal techniques can and should have a place in modern cardiac anesthesia practice and should be further investigated.

Randomised clinical trial: herbal extract HMPL-004 in active ulcerative colitis - a double-blind comparison with sustained release mesalazine

BACKGROUND

Andrographis paniculata is an herbal mixture used to treat inflammatory diseases. An extract of the herb, HMPL-004, inhibits TNF-α and IL-1β, and prevents colitis in animal models.

AIM

To determine the efficacy and safety of HMPL-004 in patients with mild-to-moderate ulcerative colitis.

METHODS

A randomised, double-blind, multicentre, 8-week parallel group study was conducted using HMPL-004 1200 mg/day compared with 4500 mg/day of slow release mesalazine (mesalamine) granules in patients with mild-to-moderately active ulcerative colitis. Disease activity was assessed at baseline and every 2 weeks for clinical response, and at baseline and 8 weeks by colonoscopy.

RESULTS

One hundred and twenty patients at five centres in China were randomised and dosed. Clinical remission and response were seen in 21% and 76% of HMPL-004-treated patients, and 16% and 82% of mesalazine-treated patients. By colonoscopy, remission and response were seen in 28% and 74% of HMPL-004-treated patients and 24% and 71% of mesalazine-treated patients, respectively. There was no significant difference between the two treatment groups.

CONCLUSION

HMPL-004 may be an efficacious alternative to mesalazine in ulcerative colitis.

Expansion of CD14+CD16+ peripheral monocytes among patients with aseptic loosening

OBJECTIVE AND DESIGN

In this study, we have investigated the relevance of peripheral blood inflammatory CD14(+)CD16(+) monocytes phenotype to patients with aseptic loosening (AL).

MATERIAL AND TREATMENT

Immunophenotypes of monocytes were examined among patients with AL (n = 43), patients with mechanical loosening (ML, n = 30), patients with stable implant (SI, n = 16), and patients with osteoarthritis (OA, n = 17) using flow cytometry.

METHODS

Immunological assay was used to measure TNF-alpha and IL-1 beta levels in both sera and culture media of implant wear stimulated CD14(+)CD16(+) and CD14(++)CD16(-) monocytes. Periprosthetic tissues were collected during surgery for histological assessment.

RESULTS

The frequency of CD14(+)CD16(+) monocytes showed significant increase in AL patients than in ML, SI, and OA patients. A positive association was found between the subpopulation of CD14(+)CD16(+) monocytes and plasma TNF-alpha and IL-1 beta level in AL patients. Furthermore, a positive correlation existed between the subpopulation of CD14(+)CD16(+) monocytes and the total histopathology score.

CONCLUSION

The results indicate that CD14(+)CD16(+) monocytes represent a sensitive marker for the disease activity of AL, and may serve as an effective prognostic index to identify total joint replacement recipients who are at increased risk for osteolysis and progression of AL.

Inhibition of the development of collagen-induced arthritis in Wistar rats through vagus nerve suspension: a 3-month observation

OBJECTIVE AND DESIGN

In this study, we have investigated the effects of vagus nerve suspension in a rat model of collagen-induced arthritis (CIA) .

MATERIALS AND TREATMENT

CIA was induced in male Wistar rats and vagus nerve suspension or sham operation was performed on day 10 after the second immunization. All rats were monitored for macroscopic signs of clinical arthritis and cytokine titres within 2 months after the second immunization. Radiological and histological examination were performed 3 months after the second immunization.

RESULTS

Rats subjected to vagus nerve suspension (the test group) showed nerve activities that resemble electrical stimulation of the vagus nerve in the control group. Compared to control, the test group had reduced soft-tissue swelling, arthritic scores, TNF-alpha level and Collagen-II antibody titre, throughout the course of the experiment. Sham operation produced similar suppression on the CIA symptoms as the test group but most of the effects produced by sham operation subsided after 27 or 35 days.

CONCLUSION

Vagus nerve suspension is a novel approach to achieve sustained long-term stimulation of the vague nerve. This procedure can suppress the development of CIA in rats.

Doppler-guided intra-operative fluid management during major abdominal surgery: systematic review and meta-analysis

BACKGROUND

Peri-operative fluid therapy is a controversial area with few randomised trials to guide practice. Recently, a number of trials have suggested that intra-operative therapy guided by oesophageal Doppler acquired haemodynamic variables may improve postoperative outcome.

METHODS

Abstract databases and conference proceedings were searched to identify randomised controlled trials comparing Doppler-guided intra-operative fluid management to standard practice in patients undergoing major abdominal surgery. Pooled odds ratios (POR) and weighted mean differences (WMD) were calculated for categorical and continuous outcomes respectively.

RESULTS

Four trials, comprising 393 patients, were identified. Use of an oesophageal Doppler-guided fluid management algorithm resulted in fewer postoperative complications (POR 0.32; 95% CI: 0.19-0.52; p < 0.0001) and shorter hospital stays (WMD 1.68 days; 95% CI: 2.39-0.98; p < 0.0001). There were no significant differences in the quantities of intra-operative fluids administered although there was some evidence of heterogeneity with respect to this outcome.

CONCLUSION

Oesophageal Doppler-guided fluid management may improve outcome following major intra-abdominal surgery. However, comparison with fluid restriction strategies, including a cost-effectiveness analysis are required.

Perioperative fluid management: prospective audit

BACKGROUND

Postoperative fluid management is a core surgical skill but there are few data regarding current fluid management practice and the incidence of potential fluid-related complications in general surgical units. We conducted a prospective audit of postoperative fluid management and fluid-related complications in a consecutive cohort of patients undergoing midline laparotomy.

METHODS

Over a 6-month period, the peri-operative fluid management of 106 consecutive patients was prospectively audited. Serum electrolyte data, fluid balance data, co-morbidities, operative and anaesthetic variables and quantities of fluid and electrolytes prescribed were recorded. The development of fluid-related and other complications was noted.

RESULTS

There were no correlations between routinely available fluid balance parameters and the quantities of fluid and electrolytes prescribed, suggesting that doctors do not consult fluid balance data when prescribing. Fifty-seven patients (54%) developed at least one fluid-related complication. These patients received significantly greater volumes of fluid and sodium each day postoperatively. They had higher rates of other non-fluid-related complications and death. They had a longer hospital stay. In a multivariate model, mean daily fluid load predicted the development of fluid-related complications.

CONCLUSION

Fluid prescription practice in general surgical units is sub-optimal, resulting in avoidable iatrogenic complications. Involvement of senior staff, education and possibly the introduction of prescribing protocols may improve the situation.

Cardioprotection by remote ischaemic preconditioning †

Perioperative myocardial infarction is a leading cause of morbidity and mortality after major non-cardiac surgery. Pharmacological agents such as beta-blockers may reduce the risk but are associated with side-effects and may be contra-indicated in some patients. Basic scientific experiments and preliminary clinical trials in humans suggest that remote ischaemic preconditioning (RIPC), where brief ischaemia in one tissue confers resistance to subsequent sustained ischaemic insults in another tissue, may provide a simple, cost-effective means of reducing the risk of perioperative myocardial ischaemia. The Medline and Pubmed databases were searched for articles concerning RIPC. The mechanism may be humoral, neural, or a combination of both, and involves adenosine, opioids, bradykinins, protein kinase C, and K-ATP channels, although the precise end-effector remains unclear. Small randomized trials in humans undergoing major surgery suggest that RIPC induced by brief lower limb ischaemia significantly reduces myocardial injury. It may also reduce other ischaemic complications of surgery and anaesthesia. Small studies provide some evidence that RIPC could reduce myocardial injury and other ischaemic complications of surgery. However, large-scale clinical trials to assess the effect of RIPC on mortality and morbidity are required before RIPC can be recommended for routine clinical use.

Enterobacter sakazakii bacteraemia with multiple splenic abscesses in a 75-year-old woman: a case report

Enterobacter sakazakii is an uncommon bacterium that is known to cause severe neonatal infection and is rare among adults. We present a peculiar case of E. sakazakii bacteraemia with multiple splenic abscesses in a 75-year-old institutionalised woman, who was successfully treated with 6 weeks of imipenem and percutaneous drainage of the abscesses.

VBHOM, a data economic model for predicting the outcome after open abdominal aortic aneurysm surgery

Background

Vascular Biochemistry and Haematology Outcome Models (VBHOM) adopted the approach of using a minimum data set to model outcome. This study aimed to test such a model on a cohort of patients undergoing open elective and non-elective abdominal aortic aneurysm (AAA) repair.

Methods

A binary logistic regression model of risk of in-hospital mortality was built from the 2002–2004 submission to the UK National Vascular Database (NVD) (2718 patients). The subset of NVD data items used comprised serum levels of urea, sodium and potassium, haemoglobin, white cell count, sex, age and mode of admission. The model was applied prospectively using Hosmer–Lemeshow methodology to a test data set from the Cambridge Vascular Unit.

Results

The validation set contained 327 patients, of whom 208 had elective AAA repair and 119 had emergency repair of a ruptured AAA. Outcome following elective and non-elective AAA repair could be described accurately using the same model. The overall mean predicted risk of death was 14·13 per cent, and 48 deaths were predicted. The actual number of deaths was 53 (χ2 = 8·40, 10 d.f., P = 0·590; no evidence of lack of fit). The model also demonstrated good discrimination (c-index = 0·852).

Conclusion

The VBHOM approach has the advantage of using simple, objective clinical data that are easy to collect routinely. The VBHOM data items potentially allow prediction of risk in an individual patient before aneurysm surgery.

An audit of compliance with motor traffic regulations and use of green warning lights by consultants recalled to hospital to attend emergencies

OBJECTIVES

To determine consultants' compliance with motor traffic regulations on recall to hospital to attend emergencies, and ownership and use of green warning lights (GWLs). To determine the views of senior police officers on consultants complying with traffic regulations on emergency recall with and without GWLs.

METHOD

Questionnaire survey of all consultants in obstetrics and gynaecology, paediatrics and emergency medicine in the Yorkshire Deanery, UK, and members of the Association of Chief Police Officers (ACPO).

RESULTS

220 consultant questionnaires were distributed and 166 replies were received; 21% of respondents owned a GWL. Almost 50% of consultants would consider exceeding speed limits when returning to an emergency. Between 43% and 80% consultants would cross red traffic lights; driving habits varied with usage and ownership of a GWL. 12.7% (21) of respondents had been stopped for traffic violations attending emergencies, 2.4% (4) had been prosecuted and 4.8% (8) had been involved in accidents. The ACPO advised that consultants should observe all traffic regulations at all times.

CONCLUSION

Consultants recalled to their hospitals for emergencies disregard speed restrictions and traffic light signals both with and without GWLs and risk both accident and prosecution for ignoring traffic legislation. They should consider using a GWL to ease their progress through traffic when attending an emergency and observe all traffic laws.

Giant colonic diverticulum: an unusual abdominal lump

Giant colonic diverticulum is a rare complication of diverticular disease of the colon and is thought to result, in most cases, from a "ball-valve" effect. The presentation and clinical course can be variable and confusing. The most common symptoms are abdominal pain and a palpable abdominal lump, with many patients presenting acutely with complications such as perforation and peritonitis. Preoperative diagnosis requires a high degree of suspicion and needs to be differentiated from sigmoid volvulus, caecal volvulus, intestinal duplication cyst, pneumatosis cystoidis intestinalis, and similar conditions. A plain x-ray and computed tomography (CT) scan of the abdomen shows a huge air-filled cyst termed "balloon sign" and confirms the diagnosis. The barium enema shows a communication with the bowel in most cases. In view of the high incidence of complications, treatment is advised even in asymptomatic cases and consists of excision of the cyst with resection of the adjacent colon with primary anastomosis. This treatment would, in most cases, be a sigmoid colectomy. Percutaneous drainage and Hartmann's procedure may be appropriate in some cases who present with a well-formed abscess or gross fecal peritonitis, respectively. A case is described, and the literature is reviewed.

Expression of the TAL1/SCL transcription factor in physiological and pathological vascular processes

The TAL1/SCL transcription factor is essential for haematopoietic commitment and vascular remodelling during embryonic development. To help clarify its role in postnatal vascular processes, we characterized the expression of mouse Tal1 protein by immunocytochemistry in several experimental models of blood vessel formation. In adult mice, Tal1 protein was expressed in rare microvascular endothelial cells and in extravascular cells provisionally identified as endothelial progenitors from their morphology, proximity to vessels and expression of vascular endothelial growth factor receptor-2. The number of Tal1-expressing endothelial cells increased significantly but transiently in all the models-hormone-induced ovulation, wound healing and tumour development. Finally, Tal1 protein was detected in the nuclei of newly formed lymphatic endothelial cells in tumour-bearing animals. These results show that TAL1 is expressed by vascular endothelial cells and endothelial progenitors at sites of physiological and pathological neovascularization and suggest a role for this transcription factor in adult vasculogenesis. This work also provides the first evidence for TAL1 expression in lymphangiogenesis.

Design of biomimetic fibrillar interfaces: 2. Mechanics of enhanced adhesion

This study addresses the strength and toughness of generic fibrillar structures. We show that the stress sigmac required to pull a fibril out of adhesive contact with a substrate has the form sigma(c) = sigma(0)Phi(chi). In this equation, sigma(0) is the interfacial strength, Phi(chi) is a dimensionless function satisfying 0 <or= Phi(chi) <or= 1 and chi is a dimensionless parameter that depends on the interfacial properties, as well as the fibril stiffness and radius. Pull-off is flaw sensitive for chi >> 1, but is flaw insensitive for chi < 1. The important parameter chi also controls the stability of a homogeneously deformed non-fibrillar (flat) interface. Using these results, we show that the work to fail a unit area of fibrillar surface can be much higher than the intrinsic work of adhesion for a flat interface of the same material. In addition, we show that cross-sectional fibril dimensions control the pull-off force, which increases with decreasing fibril radius. Finally, an increase in fibril length is shown to increase the work necessary to separate a fibrillar interface. Besides our calculations involving a single fibril, we study the concept of equal load sharing (ELS) for a perfect interface containing many fibrils. We obtain the practical work of adhesion for an idealized fibrillated interface under equal load sharing. We then analyse the peeling of a fibrillar surface from a rigid substrate and establish a criterion for ELS.