Metabolic Tissue Swelling and Local Microcirculation in Splanchnic Artery Occlusion Shock: Implications for Critical Illness

Trauma is a leading cause of death in the United States. Advancements in shock resuscitation have been disappointing because the correct upstream mechanisms of injury are not being targeted. Recently, significant advancements have been shown using new cell-impermeant molecules that work by transferring metabolic water from swollen ischemic cells to the capillary, which restores tissue perfusion by microcirculatory decompression. The rapid normalization of oxygen transfer improves resuscitation outcomes. Since poor resuscitation and perfusion of trauma patients also causes critical illness and sepsis and can be mimicked by ischemia-reperfusion of splanchnic tissues, we hypothesized that inadequate oxygenation of the gut during trauma drives development of later shock and critical illness. We further hypothesized that this is caused by ischemia-induced water shifts causing compression no-reflow. To test this, the superior mesenteric artery of juvenile anesthetized swine was occluded for 30 minutes followed by 8 hours of reperfusion to induce mild splanchnic artery occlusion (SAO) shock. One group received the impermeant polyethylene glycol 20,000 Da (PEG-20k) that prevents metabolic cell swelling, and the other received a lactated Ringer's vehicle. Survival doubled in PEG-20k-treated swine along with improved macrohemodynamics and intestinal mucosal perfusion. Villus morphometry and plasma inflammatory cytokines normalized with impermeants. Plasma endotoxin rose over time after reperfusion, and impermeants abolished the rise. Inert osmotically active cell impermeants like PEG-20k improve intestinal reperfusion injury, SAO shock, and early signs of sepsis, which may be due to early restoration of mucosal perfusion and preservation of the septic barrier by reversal of ischemic compression no-reflow. SIGNIFICANCE STATEMENT: Significant advancements in treating shock and ischemia have been disappointing because the correct upstream causes have not been targeted. This study supports that poor tissue perfusion after intestinal ischemia from shock is caused by capillary compression no-reflow secondary to metabolic cell and tissue swelling since selectively targeting this issue with novel polyethylene glycol 20,000 Da-based cell-impermeant intravenous solutions reduces splanchnic artery occlusion shock, doubles survival time, restores tissue microperfusion, and preserves gut barrier function.

Prenatal diagnosis of aortic atresia by colour Doppler flow mapping

A case of aortic atresia with insufficiency of mitral valve diagnosed prenatally at 33 weeks of gestation is presented. An accurate diagnosis of this fetal cardiovascular malformation was possible by application of Doppler colour flow mapping, which demonstrated (a) the absence of forward flow in the hypoplastic ascending aorta, (b) reverse flow of blood from the ductus arteriosus into the severely hypoplastic ascending aorta in the late systole, (c) pansystolic mitral valve regurgitation, and (d) absent flow across the foramen ovale as a result of premature closure of the foramen ovale.

An outpatient approach to female sterilization with methylcyanoacrylate

MCA is a tissue adhesive which can be delivered transcervically to the Fallopian tubes by means of the FEMCEPT device. In the patients treated with this system, both prior to hysterectomy and on an ambulatory basis, there have been no significant complications or side effects. In the most recent series of ambulatory patients treated with the REMCEPT-MCA system, the bilateral tubal closure rate was 78%.

Bordetella pertussis serotypes in the United States

To determine the Bordetella pertussis serotypes currently causing whooping cough in the United States, recently isolated cultures from different geographic areas were studied. Specific adsorbed antisera were prepared in our laboratory and used in both tube and slide agglutination tests. Among the 177 cultures isolated during 1966 and 1967 in seven states and one Canadian province, the predominant serotype was 1.3 (or 1.3.6), represented by 85% of the cultures. Fifteen cultures were serotype 1.2.3.4.6. The 376 cultures isolated in the Grand Rapids area during the last 30 years showed a changing pattern from serotype 1.2.3 during the early years to the currently prevailing 1.3 (or 1.3.6). During the 2-year study period, seven cultures of B. parapertussis were isolated in Michigan, and seven were received from other states. One culture of B. bronchiseptica, recovered from a child in Boston, was sent to us.

Mouse-protective properties of Bordetella pertussis serotypes in passive tests

In a passive protection procedure in which the ed(50) values of Bordetella pertussis antisera were determined, groups of mice were given graded intraperitoneal doses of serum, followed the next day by intracerebral challenge with 100,000 organisms. Antiserum produced with B. pertussis culture 5373, serotype 1.3, protected mice against challenge with culture 18-323, serotype 1.2.3, as effectively as did an antiserum produced with a serotype 1.2.3 culture. When two groups of mice similarly treated with pertussis immune serum were challenged with culture 353Z (serotype 1) and 18-323, respectively, much lower ed(50) values were obtained with the animals challenged with 353Z. Passive protection tests with adsorbed antiserum gave equivocal results, suggesting that some of the adsorbing antigen remained in the serum and interfered with the tests. There was no evidence that serotype is related to protection.

Bordetella pertussis culture having only species factor 1

Eldering, Grace (Michigan Department of Public Health, Grand Rapids), Jack Holwerda, and Julia Baker. Bordetella pertussis culture having only species factor 1. J. Bacteriol. 91:1759-1762. 1966.-Preston's description of Bordetella pertussis 353-Z as a culture possessing only factor 1 was confirmed by agglutination and agglutinin-adsorption tests. The ld(50) values of this culture for mice inoculated by the intracerebral route were approximately the same as that of B. pertussis 18-323, the challenge culture in mouse potency tests of pertussis vaccine. In mouse protection tests, vaccine prepared with the factor 1 culture protected as well against challenge with B. pertussis 18-323, which has a broad antigenic pattern, as did vaccines made with cultures possessing factors 2, 3, 4, and 5 in addition to factor 1. When two groups of similarly immunized mice were challenged with 353-Z and 18-323, respectively, much lower ed(50) values were obtained with the animals challenged with 353-Z. This was true whether a factor 1 vaccine or a vaccine with factors 1, 2, 3, 4, and 5 was tested.