Intracellular adhesion molecule-1 in patients developing pulmonary insufficiency after cardiopulmonary bypass

OBJECTIVES

Cardiopulmonary bypass activates adhesion molecules, which are associated with systemic inflammation and organ dysfunction. The intracellular adhesion molecule-1 (ICAM-1) has been evaluated in patients presenting pulmonary dysfunction after cardiac surgery.

MATERIALS AND METHODS

Postoperative serum levels of the ICAM-1 were measured in 40 patients who underwent isolated coronary artery bypass grafting, in 28 with uneventful postoperative recovery (70 %) (Group 1), and in 12 (30 %) with postoperative respiratory insufficiency (Group 2), defined by the need for prolonged (> 24 hours) mechanical ventilation using a fractional oxygen concentration of > 40 %.

RESULTS

Patients in group 1 were ventilated for 12.21 +/- 4.86 hours and those in group 2 for 92.91 +/- 48.14 hours (p < 0.001). ICAM-1 decreased from 145.98 +/- 73.40 ng/ml to 81.15 +/- 114.82 ng/ml in group 1, while in group 2 ICAM-1 showed a significant higher level and increased to 435.01 +/- 130.02 ng/ml (p < 0.001). The leukocyte count increased in both groups as well as the C-reactive protein (CRP) during the postoperative course. The CRP behaves similar in both groups (p = 0.636) in contrast to the leukocyte count which was significantly higher in group 2 (p < 0.01). While none of the patients in group 1 died the mortality in group 2 was 50 % (p < 0.001).

CONCLUSION

Respiratory insufficiency after cardiopulmonary bypass is associated with a distinct increase in the ICAM-1. The reason for the increase of the ICAM-1 in this small subset of patients has not been clarified.

Left-lateralized fMRI activation in the temporal lobe of high repressive women during the identification of sad prosodies

We investigated with fMRI whether different lateralization types of cortical activation in prosodic tasks are caused by individually different stress-related coping strategies. After healthy women had been classified as high or low repressive they performed four different identification tasks with acoustically presented speech material while being in the MR scanner. The two materials presented in blocks were emotionally irrelevant CV syllables and adjectives with a mix of different prosodic intonations. Sad and happy intonations had to be targeted by two affective identification tasks in the same adjective mixtures. For testing stimulus-material effects the phoneme /a/ had to be identified both in the syllables and the adjectives. This design allowed us to test influences of coping strategies and affective tasks on cortical activation in both hemispheres. Results showed no differences in global cortical lateralization as a function of high or low repressiveness and no global support for either the valence hypothesis or the right-hemisphere hypothesis of emotional processing. However, we observed differences in auditory and speech cortex. In accordance to the construct of repression/sensitization, high repressive women showed larger left, low repressive women larger right hemisphere activation during the identification of sad intonations. Thus, differences in stress-related coping strategies may not lead to general differences in cortical lateralization, but may depend on specific elicitors and task-relevant brain areas. In contrast, the identification of happy intonations led to strong and right-lateralized global cortical activation independent of coping strategies which complies with the right-hemisphere hypothesis of emotional processing. In addition, this may reflect general cognitive and arousal effects of task difficulty as well as auditory cue-specific attentional effects.

Strategies for surgical management of cerebral aneurysms of special location, size and form--approach, technique and monitoring

Special strategies are mandatory for optimal surgical management of aneurysms of special location, size and form. Approaches of extradural selective anterior clinoidectomy, partial occipital condylectomy, transpetrosal approach by anterior petrosectomy and supracerebellar transtentorial approach are discussed among them. Furthermore various types of temporary and permanent clipping procedures are discussed along with mention of intraoperative monitoring.

New methods for monitoring cerebral oxygenation and hemodynamics in patients with subarachnoid hemorrhage

Radiographic cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) do not reflect cerebral hemodynamics and oxygenation and may occur in the absence of clinical deficit and vice-versa. This report is to describe preliminary findings in further development of a non invasive method to estimate regional cerebral oxygenation and perfusion. Measurements were performed with a technique combining near infrared spectroscopy (NIRS) and indocyaningreen (ICG) dye dilution. Successful data analysis has been performed based on the decomposition in pulsatile and non-pulsatile components of NIRS absorption data collected before and during the passage of ICG through the vascular bed under the NIRS-detector. First measurements in patients with CVS suggest that the technique could become a powerful tool in the detection and treatment of CVS. This non invasive technique can be done at the bedside, it seems to be safe, easy to perform and less time-consuming compared to conventional techniques. The influence of extracerebral bone and surface tissue on cerebral NIRS signal has not been clarified yet. Therefore a new subdural NIRS probe has been developed, which gives the opportunity to measure directly the concentration of the chromophores in the brain without the influence of extracerebral contamination. In future comparative measurements with conventional NIRS probes on the scalp will allow to quantify and eliminate extracerebral contamination from the NIRS signal.

A re-evaluation of the biokinetics of zirconium in humans

There is much interest in understanding the biokinetics of zirconium in humans due to the potential radiological risk represented by the radionuclide 95Zr and by its daughter 95Nb. Despite the significance of zirconium, few data are available on the actual biokinetics of zirconium in humans. Accordingly the biokinetic model currently recommended by ICRP for this element is based mainly on data from animal experiments. In this study, the use of the stable isotopes 90Zr and 96Zr as tracers has enabled the conduct of 6 biokinetic investigations in 3 healthy volunteers. These studies have provided new valuable information about intestinal absorption and kinetics in blood plasma of zirconium and have been used for the set-up of a more realistic compartmental model with possible applications for dosimetric purposes.

Influence of olive oil emulsions on dentin demineralization in vitro

The effect of two different concentrations of olive oil emulsions on development of artificial caries-like dentin lesions under severe demineralizing conditions was investigated. Bovine dentin samples (n = 180) were ground flat, polished, divided into four groups, and subjected to three demineralization cycles per day. Samples were stored in one of the following solutions for 5 min prior to demineralization in a buffer solution (pH 5): Group 1: 50% oil emulsion (olive oil and distilled water); group 2: 5% oil emulsion; group 3: distilled water; and group 4: 1,500 ppm sodium fluoride. Daily up to 9 days, lesion depth (ld) and mineral loss (deltaZ) were determined by means of microradiography and analyzed by ANOVA and Tukey's studentized range test (p < or = 0.05). Lesion depth increased with time for all groups. Mineral loss increased in groups 1-3. A small but significant decrease in mineral loss was observed following treatment with lipid emulsions as compared to treatment with distilled water, but fluoride treatment was considerably more effective. Mean mineral loss (means +/- SD in vol% x microm) averaged over the study period was 4,368 +/- 1,599, 4,536 +/- 1,823, 4,849 +/- 1,798, and 789 +/- 177 for group 1, 2, 3, and 4, respectively. Ratio (deltaZ/ld) remained constant around 30 vol% for groups 1-3, but decreased for group 4. In conclusion, externally provided lipids have the potential to reduce dentin demineralization in vitro.

Estimation of human exposure to natural radionuclides using in vivo skull measurements

In a preliminary study, in vivo skull measurements and in vitro urine measurements of 210Pb and nulU have been performed to find out the individual, chronic exposure to waterborne natural radionuclides of a small group of Finnish people. For their domestic water, the studied individuals use water from drilled wells containing elevated concentrations of natural uranium and its daughter nuclides ((234,235,238)U, 222Rn, (226,228)Ra, 210Po, 210Pb). Enhanced 210Pb and 235U activities were observed in several people. A positive correlation is observed between the U concentration in urine (microg d(-1)) and the number of counts (cpm) in the gamma ray energy peaks originating from the decay of 235U and 234Th respectively. Calibration of the detector set-up and the determination of background sources are in progress.

Stable tracer investigations in humans for assessing the biokinetics of ruthenium and zirconium radionuclides

The interest in the biokinetics of ruthenium and zirconium in humans is justified by the potential radiological risk represented by their radionuclides. Only a few data related to the biokinetics of ruthenium and zirconium in humans are available and, accordingly, the biokinetic models currently recommended by the ICRP for these elements are mainly based on data from animal experiments. The use of stable isotopes as tracers, coupled with a proper analytical technique (nuclear activation analysis with protons) for their determination in biological samples, represents an ethically acceptable methodology for biokinetic investigations, being free from any radiation risk for the volunteer subjects. In this work, the results obtained in eight biokinetic investigations for ruthenium, conducted on a total of three healthy volunteers, and six for zirconium, performed on a total of three subjects, are presented and compared to the predictions of the ICRP models.

Regional dependence of urinary uranium baseline levels in non-exposed subjects with particular reference to volunteers from Northern Italy

Knowledge of the level of natural uranium (U) in the human body is fundamental in order to estimate the potentially hazardous incorporation in accidentally exposed subjects. A constant monitoring of exposed workers needs reliable reference baseline values, which can be determined by measuring the U concentration in urine. ICPMS has proven to be a fast, reliable and highly sensitive technique for this purpose. Non-uniformity in the distribution of U levels in various regions and differences in dietary habits account for the significant regional variations of U concentration in urine in non-exposed subjects. In this paper, the determination of daily uranium urinary excretion levels in a group of 12 non-exposed subjects from Northern Italy is presented and compared to data present in the published literature and to values obtained in a larger group of German volunteers. The urinary U output values observed in the Italian subset are generally higher than the corresponding levels measured in other groups. This could be the result of a higher intake of U from liquids, as assessed by the determination of U concentration in drinking waters.

Developments in internal monitoring techniques

In an effort to increase accuracy and speed, improve detection limits and reduce uncertainties in internal dosimetry, laboratories have developed improved or new internal monitoring techniques in both in vivo measurements and bioassay analyses. Most of these techniques have not yet entered routine monitoring programmes. This paper intends to summarise these new techniques, show their potential improvements compared to the currently employed monitoring routines and discuss the main aspects of the EC-funded IDEA project, which aims at a comprehensive assessment of these techniques and the enhancements necessary to bring them to broader acceptance in the routine monitoring community.

[Should associated intraoperative and/or postoperative photocoagulation be systematic during or after vitrectomy for proliferative diabetic vitreoretinopathy?]

PURPOSE

To analyze the results of vitrectomy in proliferative diabetic vitreoretinopathy and to check whether systematic intra- and/or postoperative photocoagulation is necessary in most cases.

PATIENTS AND METHODS

We retrospectively reviewed 108 patient records (137 eyes) of vitrectomy performed for complications of proliferative diabetic vitreoretinopathy between 1982 and 2000. Fifty-eight percent of the patients were women. The average age was 44 years. Sixty percent of the patients presented with diabetes type 1. Only 39% of the eyes had complete preoperative panretinal photocoagulation. Preoperative visual acuity was lower than 2/200 in 81% of eyes, 27% presenting initially with traction retinal detachment involving the macula. The surgical technique used was segmentation-delamination. Endodiathermy was necessary in 45% of the eyes and intraoperative photocoagulation was not performed. Postoperative complementary photocoagulation was carried out in only 9% of the eyes.

RESULTS

Results were analyzed with an average follow-up of 66 months. Anatomical success was obtained in 69% of the eyes, with 55% visual improvement. These results were unchanging at long-term follow-up in 95% of the eyes studied. Iatrogenic retinal breaks were observed in 8% of the eyes. Postoperative complications were dominated by single (8%) or recurrent vitreous hemorrhage (8%). The rate of postoperative neovascular glaucoma was approximately 5%. These results are similar to the rates reported by other authors using intraoperative endophotocoagulation.

CONCLUSION

Intra- and/or postoperative photocoagulation should not be systematic but reserved for management of iatrogenic retinal breaks and also for extensive panretinal photocoagulation in recurrent vitreous hemorrhage.

Assessment of exposure to depleted uranium

In most circumstances, measurement of uranium excreted in urine at known times after exposure is potentially the most sensitive method for determining the amount of depleted uranium (DU) incorporated. The problems associated with this approach are that natural uranium is always present in urine because of the ingestion of natural uranium in food and drink, and that the uncertainties in the intakes as assessed from excretion measurements can be quite large, because many assumptions concerning the exposure characteristics (time pattern of exposure, route of intake, chemical form, solubility, biokinetics within the body) must be made. Applying currently available methods and instruments for the measurement of uranium in urine samples, DU incorporations of levels relevant with respect to potential health hazards can be detected reliably, even a long time after exposure.

[Partial CO(2) rebreathing technique versus thermodilution: measurement of cardiac output before and after operations with extracorporeal circulation]

BACKGROUND

The NICO(2) monitor determines "pulmonary capillary blood flow" (Qpc) and cardiac output (Qt) using the "partial CO(2) rebreathing technique". The agreement between NICO(2) and thermodilution (TD) cardiac output was compared before and after cardiac surgery with cardiopulmonary bypass (CBP). In addition, the possibility of calculating the intrapulmonary shunt fraction (Qs/Qt) by combining data from the NICO(2) monitor and the TD was investigated.

METHODS

In 32 patients measurements were made following induction of anesthesia ("pre-CBP"), 30 min after weaning from CBP ("post-CBP"), and 6-8 h after surgery ("post-OP"). Qt was determined by the NICO(2) monitor and TD, Qpc by the NICO(2) monitor, and Qs/Qt(O(2)) from the standard formula. An intrapulmonary shunt was calculated using Qpc(NICO(2)) and Qt(TD) according to the equation Qs/Qt=1-Qpc/Qt. Bland-Altman and regression analysis techniques were used for statistical evaluation.

RESULTS

"Pre-CBP" there was a good agreement between Qt(NICO(2)) and Qt(TD) with both a bias and precision of -0.13+/-0.46 l/min and a correlation of r=0.88+/-0.47 ( p<0.001). In contrast, "post-CBP" and "post-OP" there was a lack of agreement for Qt (bias and precision: 0.97+/-1.05 l/min and -0.33+/-0.8 l/min, respectively). Regarding the shunt calculations no significant correlations between methods could be found.

CONCLUSION

Cardiac output measurement by the NICO(2) monitor agree well with TD under steady-state conditions but after CBP the agreement was too small. Combining Qpc(NICO(2)) and Qt(TD) does not offer a reliable possibility for calculating intrapulmonary shunt.

Assessment of intestinal absorption of trace metals in humans by means of stable isotopes

This study is aimed to demonstrate the feasibility of stable isotopes for the assessment of reliable data on fractional intestinal absorption of trace metals in healthy humans. Among the various methods available, the double isotope technique, i.e. one isotope given orally together with the test substance to be investigated and another isotope injected intravenously to correct for retention and endogenous excretion of the particular trace metal, provides quantitative figures of intestinal absorption at reasonable expenses with regard to costs for materials and number of samples to be evaluated. The trace metals exemplarily included in this study, i.e. iron, cobalt and molybdenum show diverging relations between absorbed fractions and amounts administered which are indicative for different regulatory mechanisms of their body content. Food ligands influence the fractional absorption significantly so that the uptake from a composite meal cannot be derived from results on uptake from particular foodstuffs. Therefore, validated data on the behaviour of intestinal absorption will significantly contribute to a better understanding of human trace metal metabolism.

Influence of continuous and discontinuous training protocols on subcutaneous adipose tissue and plasma substrates

It has been shown that bouts of high-intensity exercise may reduce subcutaneous adipose tissue more than low-intensity exercise. The aim of the present study was to examine if a discontinuous training protocol is more successful in reducing adipose tissue than a continuous endurance training protocol. Fourteen untrained male volunteers were divided into two groups and trained for 10 weeks performing 3 discontinuous or 3 continuous workouts weekly (discontinuous exercise: 25 times 80 s 35% VO2max and 40 s 80% VO2max; continuous exercise: 50 min 50% VO2max). The discontinuous and the continuous training resulted in a similar subcutaneous adipose tissue loss, determined by skinfold measurement, in the leg above the patella (-2.4+/-2.4 and -2.4+/-1.4mm, respectively). The normalised plasma concentrations of free fatty acid, glycerol, beta-hydroxybutyrate, and lactate were similar throughout the final exercise test at the end of the training period. Our data suggested that the discontinuous protocol, selected so that the average intensity was similar to that of the continuous protocol, was not better than the latter in reducing subcutaneous adipose tissue.

Mapping the landscape: levels of transference interpretation

The author argues that there are distinctly different kinds of transference interpretation, each of which might be valid in particular circumstances in analysis, but which contain and imply different understandings of what is meant by a 'transference interpretation'. She suggests that transference interpretations may be at any one of four different levels, and she describes these levels as ranging from interpretations that point to links between current events in the analysis and events from the patient's history, through interpretations that link events in the patient's external life to the patient's often unconscious phantasies about the analyst and the analysis, to interpretations that focus on the use of the analyst and the analytic situation to enact unconscious phantasy configurations, sometimes pulling the analyst into the enactment. Material from four consecutive sessions of an analysis is presented to illustrate how all levels of transference interpretation may be part of a lively and meaningful analysis, but how the level of interpretation may change as the level of understanding deepens within a session and from one session to the next.

Formation and in situ sizing of gamma-Fe2O3 nanoparticles in a microwave flow reactor

Nanocrystalline gamma-Fe2O3 particles were produced in a microwave flow reactor. The reaction of iron pentacarbonyl [Fe(CO)5] with the plasma gases Ar/O2 to form nanosized particles was followed by in situ particle mass spectrometry. The particle mass spectrometer combines a nonintrusive sampling technique with a calibration-free mass determination. The influence of process parameters like microwave power, precursor concentration, and pressure on the particle size was studied. The results reveal a mean particle diameter in the range of 4-5 nm with a slight dependence on the process parameter. The geometric standard deviation of the measured size distribution was always between 1.1 and 1.2.

Remote dipole effects as a means to accelerate [Ru(amino alcohol)]-catalyzed transfer hydrogenation of ketones

A new generation of 2-aza-norbornyl amino alcohol ligands for the catalytic transfer hydrogenation reaction of aromatic ketones was synthesized. Extremely active catalysts were formed by introducing a ketal functionality at the rear end of the ligand. Acetophenone was reduced in 96% ee at low catalyst loading, substrate to catalyst ratio, S/C 5000, within 90 minutes with isopropyl alcohol as the hydrogen donor. It was found that the dioxolane substituent in the ligand increased the turnover frequency, TOF50, from 1050 h(-1) to 3000 h(-1) at an S/C ratio of 1000. Introduction of a methyl group at the carbinol carbon resulted in TOF50 as high as 8500 h(-1). Transfer hydrogenation of a range of aromatic ketones was evaluated and found to reach completion within 30 minutes at room temperature, and excellent enantioselectivity, up to 99 % ee, was obtained. A possible explanation for the enhanced activity was provided by density functional calculations, which showed that the presence of a remote dipole in the ligand lowered the transition state energy.

[An appreciation of maternal smoking with high-performance liquid chromatographic determination of maternal and neonatal urinary cotinine]

OBJECTIVE

To study the correlation of urinary cotinine levels in mothers and newborns with the number of cigarettes smoked at the end of pregnancy. Population and methods. We recorded the smoking habits of 123 mothers attending a university maternity clinic and measured urinary cotitine levels in mothers and their newborns. All mothers were Europeans and gave birth to a normal full-term (37 weeks gestation) infant. Cotinine levels were measured with high-performance liquid chromatography from urine samples taken during the 6-hour period prior to or after delivery for the mothers and 24-h after birth for the newborns.

RESULTS

The average cotinine level for non-smoking mothers, for those who smoked one to nine cigarettes a day and heavy smokers (ten or more cigarettes per day) were 0.21, 2.17 and 4.28 mol/l respectively (p<0.001). The average levels in their newborns were 0.04, 0.39 and 1.36 mol/l respectively (p<0.001). Thirteen percent of the mothers who claimed they did not smoke had cotinine levels higher than the significance cut-off (0.3 mol/l). There was a significant correlation 1) between the number of cigarettes the mothers stated they smoked at the end of pregnancy and their urinary cotinine concentrations (cotinine level=0.213 + 0.349 cigarettes, r=0.78, p<0.001); 2) between the number of cigarettes smoked and newborn's urinary cotinine concentration (cotinine level=0.002 + 0.104 cigarettes/day, r=0.81, p<0.001); and 3) between the mother's and the newborn's urinary cotinine concentrations (newborn cotinine=0.027 + 0.219 maternal cotinine, r=0.77, p<0.001).

CONCLUSION

The number of cigarettes smoked at the end of pregnancy accounts for roughly 50% of the variance in the mother's urinary cotinine level and that in her newborn at birth. The urinary cotinine concentration in newborns is 3 to 5 times lower than that of their mothers. A woman smoking 3 cigarettes per day has a urinary cotinine concentration of 1 mol/l. The urinary cotinine level in newborns is 1 mol/l for mothers smoking 10 cigarettes per day.

Kinetics of systemic ruthenium in human blood using a stable tracer

The biokinetics of ruthenium after oral and intravenous administration has been investigated in two human subjects using the stable isotope 101Ru as a tracer. Tracer concentrations in blood plasma have been determined using activation analysis with protons. The results presented here prove that the stable tracer technique is a valuable tool for obtaining relevant information about the biokinetics of ruthenium in humans. From these pilot studies, it may be argued that the clearance of systemic ruthenium from plasma is significantly slower than the predictions of the biokinetic model currently recommended by the International Commission on Radiological Protection (ICRP). The experimental data for the orally administered tracer, which reflect the gastrointestinal absorption process, differ from the curve derived from the ICRP model, suggesting that the uptake into the systemic circulation may be lower than predicted. On the basis of these preliminary data, investigations on a larger number of subjects with improvements in the experimental design are scheduled.