Environmental exposures to Florida red tides: Effects on emergency room respiratory diagnoses admissions

Human exposure to Florida red tides formed by Karenia brevis, occurs from eating contaminated shellfish and inhaling aerosolized brevetoxins. Recent studies have documented acute symptom changes and pulmonary function responses after inhalation of the toxic aerosols, particularly among asthmatics. These findings suggest that there are increases in medical care facility visits for respiratory complaints and for exacerbations of underlying respiratory diseases associated with the occurrence of Florida red tides.This study examined whether the presence of a Florida red tide affected the rates of admission with a respiratory diagnosis to a hospital emergency room in Sarasota, FL. The rate of respiratory diagnoses admissions were compared for a 3-month time period when there was an onshore red tide in 2001 (red tide period) and during the same 3-month period in 2002 when no red tide bloom occurred (non-red tide period). There was no significant increase in the total number of respiratory admissions between the two time periods. However, there was a 19% increase in the rate of pneumonia cases diagnosed during the red tide period compared with the non-red tide period. We categorized home residence zip codes as coastal (within 1.6 km from the shore) or inland (>1.6 km from shore). Compared with the non-red tide period, the coastal residents had a significantly higher (54%) rate of respiratory diagnoses admissions than during the red tide period. We then divided the diagnoses into subcategories (i.e. pneumonia, bronchitis, asthma, and upper airway disease). When compared with the non-red tide period, the coastal zip codes had increases in the rates of admission of each of the subcategories during the red tide period (i.e. 31, 56, 44, and 64%, respectively). This increase was not observed seen in the inland zip codes.These results suggest that the healthcare community has a significant burden from patients, particularly those who live along the coast, needing emergency medical care for both acute and potentially chronic respiratory illnesses during red tide blooms.     

急性失血患者中早期输注冷沉淀治疗对凝血功能的影响

摘要 目的：探讨急性失血患者中早期输注冷沉淀治疗对凝血功能的影响。方法：收集江苏省中医院（南京中医药大学附属医院）2015年9月-2019年8月收治的80例急性失血患者的临床资料,将患者按照住院号排序后取随机数字后分为研究组（40例）和对照组（40例）,其中对照组给予常规输注血小板治疗,研究组给予早期输注冷沉淀凝血因子治疗,观察两组凝血功能变化及临床指标。结果：两组患者均顺利完成相应的输注治疗,无终端、退出、输注中死亡等异常情况。研究组治疗的总有效率显著高于对照组（P＜0.05）。两组患者输血前的凝血酶原时间（Prothrombin time,PT）、部分活化凝血酶时间（Activated partial thromboplastin time,APTT）、纤维蛋白原（Fibrinogen,Fbg)、血小板（blood platelet,PLT）、凝血酶时间（thrombin time,TT）水平组间差异无统计学意义（P>0.05）;输血24 h后两组患者的TT、PT、APTT均降低,Fbg、PLT水平升高,并且研究组的变化幅度大于对照组变化幅度（P＜0.05）。研究组患者的有效止血率、平均止血时间、24 h悬浮红细胞续用量与对照组相比,有显著差异（P＜0.05）。结论：急性失血患者中早期输注冷沉淀治疗可改善患者的凝血功能,起到较好止血效果,值得临床推广应用。     

Immunoregulatory T cell abnormalities in mucocutaneous lymph node syndrome

We recently demonstrated that during the acute phase of mucocutaneous lymph node syndrome (MCLS)3 there was a significant reduction in circulating T8+ suppressor/cytotoxic T cells and an increased number of Ia/Dr-bearing T4+ T cells, which suggests the presence of circulating activated helper T cells (1). Furthermore, the vast majority of patients with acute MCLS had a significantly elevated number of circulating B cells spontaneously secreting IgG and IgM. In the present study, the possible role of the immunoregulatory T cell abnormalities in the polyclonal B cell activation was investigated by assaying the ability of T cells and T cell factors from patients with acute MCLS to induce immunoglobulin production by normal B lymphocytes. We also examined the capacity of normal T cells to suppress immunoglobulin production by activated B cells from patients with acute MCLS.     

Improvement of the microcirculation in the acute ischemic rat limb during intravenous infusion of drag-reducing polymers

Drag-reducing polymers (DRPs) are blood-soluble macromolecules that can increase blood flow and reduce vascular resistance. The purpose of the present study is to examine the effects of DRPs on microcirculation in rat hind limb during acute femoral artery occlusion. Two groups of 20 male Wistar rats were subjected to either hemodynamic measurement or contrast enhanced ultrasound (CEU) imaging during peripheral ischemia. Both groups were further subdivided into a DRP-treated group or a saline-treated group. Polyethylene oxide (PEO) was chosen as the test DRP, and rats were injected with either 10 ppm PEO solution or saline through the caudal vein at a constant rate of 5 ml/h for 20 min. Abdominal aortic flow, iliac artery pressure, iliac vein pressure, heart rate, carotid artery pressure and central venous pressure (CVP) were monitored, and vascular resistance was calculated by (iliac artery pressure-iliac vein pressure)/abdominal aortic blood flow. Flow perfusion and capillary volume of skeletal muscle were measured by CEU. During PEO infusion, abdominal aortic blood flow increased (p<0.001) and vascular resistance decreased (p<0.001) compared to rats that received saline during peripheral ischemia. There was no significant change in ischemic skeletal capillary volume (A) with DRP treatment (p>0.05), but red blood cell velocity (β) and capillary blood flow (A×β) increased significantly (p<0.05) during PEO infusion. In addition, A, β and A×β all increased (p<0.05) in the contralateral hind limb muscle. In contrast, PEO had no significant influence on heart rate, mean carotid artery blood pressure or CVP. Intravenous infusion of drag reducing polymers may offer a novel hydrodynamic approach for improving microcirculation during acute peripheral ischemia.     

Diameter changes in skeletal muscle venules during arterial pressure reduction

Previous studies in skeletal muscle have shown a substantial (>100%) increase in venous vascular resistance with arterial pressure reduction to 40 mmHg, but a microcirculatory study showed no significant venular diameter changes in the horizontal direction during this procedure. To examine the possibility of venular collapse in the vertical direction, a microscope was placed horizontally to view a vertically mounted rat spinotrapezius muscle preparation. We monitored the diameters of venules (mean diameter 73. 8 +/- 37.0 microm, range 13-185 microm) oriented horizontally and vertically with a video system during acute arterial pressure reduction by hemorrhage. Our analysis showed small but significant (P < 0.0001) diameter reductions of 1.0 +/- 2.5 microm and 1.8 +/- 3. 1 microm in horizontally and vertically oriented venules, respectively, upon reduction of arterial pressure from 115.0 +/- 26. 3 to 39.8 +/- 12.3 mmHg. The venular responses were not different after red blood cell aggregation was induced by Dextran 500 infusion. We conclude that diameter changes in venules over this range of arterial pressure reduction are isotropic and would likely increase venous resistance by <10%.     

Physiological Responses and Evaluation of Effects of BMI,Smoking and Drinking in High Altitude Acclimatization: A Cohort Study in Chinese Han Young Males

High altitude acclimatization is a series of physiological responses taking places when subjects go to altitude. Many factors could influence these processes, such as altitude, ascending speed and individual characteristics. In this study, based on a repeated measurement design of three sequential measurements at baseline, acute phase and chronic phase, we evaluated the effect of BMI, smoking and drinking on a number of physiological responses in high altitude acclimatization by using mixed model and partial least square path model on a sample of 755 Han Chinese young males. We found that subjects with higher BMI responses were reluctant to hypoxia. The effect of smoking was not significant at acute phase. But at chronic phase, red blood cell volume increased less while respiratory function increased more for smoking subjects compared with nonsmokers. For drinking subjects, red blood cell volume increased less than nondrinkers at both acute and chronic phases, while blood pressures increased more than nondrinkers at acute phase and respiratory function, red blood cell volume and oxygen saturation increased more than nondrinkers at chronic phase. The heavy and long-term effect of smoking, drinking and other factors in high altitude acclimatization needed to be further studied.     

Withdrawal syndrome follows abrupt cessation of intracerebroventricular infusion of epinephrine in spontaneously hypertensive rats

Aortic blood pressure and heart rate were measured directly during chronic (5-day) intracerebroventricular infusion of epinephrine in conscious, unrestrained spontaneously hypertensive rats (SHR), and following abrupt cessation of drug infusion. During the infusion period, no statistically significant differences in mean aortic pressures were observed between SHR that received vehicle and those which received epinephrine at 1.25, 2.5, or 5.0 micrograms (base) per hour for 5 days via osmotic minipumps. A significant reduction in heart rate was noted during some, but not all, days of the epinephrine infusion period; the onset of bradycardia appeared to be dose-related. Immediately following abrupt cessation of epinephrine (but not vehicle) infusion, a complex withdrawal syndrome was observed to include: a significant and sustained elevation of aortic blood pressure, tachycardia, increased water consumption, and several distinct behavioral effects. The reaction appeared maximal at about 2 hours, and lasted less than 24 hours.     

Acute hyperglycaemia and mast-cell-dependent mitogenesis in rat

Hyperglycaemia is considered to be of possible aetiological significance for proliferative lesions in diabetes. We recently found that mast-cell-mediated proliferation in mesentery and skin is augmented in hyperglycaemic rats with longstanding diabetes. We now report a study to examine whether acute hyperglycaemia affects the proliferative response of fibroblasts and mesothelial cells that follows local mast-cell secretion in healthy rats. Hyperglycaemia was achieved by continuous intravenous infusion of glucose over a period of 2.5 h preceding and 9.5 h following administration of the mast-cell secretagogue compound 48/80. The 48/80 was given intraperitoneally which causes rapid mast-cell secretion and prompt subsequent mesenteric mitogenic stimulation. Hyperglycaemia thus persisted throughout the prereplicative period, during which stimulated cells are recruited into the cell cycle from a quiescent state. Because the ensuing mesenteric mitogenic response, estimated by specific DNA activity and mitosis counting, was unaffected by glucose infusion, acute hyperglycaemia itself appears to be of no aetiological significance for the accelerated mast-cell-dependent mesenteric mitogenesis in the diabetic rat.     

缺氧对右心室最大心肌血流量的影响

为了探讨缺氧对冠状血管贮备力的影响,我们观察了缺氧时大鼠血流动力学及右心室最大心肌血流量的变化。结果表明,急性缺氧引起ＰａＯ２、心输出量及氧运送量降低,但右心室心肌血流量增加,右心室最大与安静血流量比值降低。慢性缺氧时ＰａＯ２降低,血球比积和右心室重量指数增加,氧运送量和右心室血流量正常,但最大血流量降低,小动脉增厚、外膜胶元增加。以上结果提示,慢性缺氧对冠状血管贮备减少可能是小动脉壁增厚、外膜胶元增加和血液粘滞性增加及右心室肥大的结果。     

缺氧对右心室最大心肌心血流量的影响

为了探讨氧对冠状血管贮备方法的影响,我们观察了缺氧对血流动力学及右心室最大心肌血汉量的变化。结果表明,急性缺氧引起的ＰａＯ２、心输出量及氧运送量降低,但右心室心肌血流量增加,右心室最大与安静血流量比值降低,生缺氧时ＰａＯ２降低,血球比积和右心室生理指数增加,氧运送量和右心室血流量正常,但最大血流量降低,小动脉增厚、外胶元增加,以上结果提示,慢性缺氧对冠状血管贮备减少可能是小动脉壁增厚、外胶元增加和     

Effect of acute intestinal obstruction on erythrocyte membrane function

The amino acid composition of red blood cell membrane proteins had been studied in different stages of acute intestinal obstruction. Hydrophobic amino acids were revealed to increase and glutamate was found to decrease during the early period of acute intestinal obstruction. Later neutral amino acids and some of the main amino acids were stated to decrease. Shifts in the ratio of protein fractions seen in red blood cell membrane of rats with acute intestinal obstruction could be explained by changes followed in the amino acid composition. The data accumulated had demonstrated that such a significant modification of protein component of the red blood cell membrane could be one of the reasons of the erythrocyte membrane penetrability violation and could play the pathogenetic role in the occurrence of irreversibility changes in cases of the intestinal obstruction. All that was mentioned above had shown the necessity to use membrane protectors and antienzyme drugs in the postoperative period.     

Feeding, body weight, and sensitivity to non-ingestive reward stimuli during and after 12-day continuous central infusions of melanocortin receptor ligands

The brain melanocortin system mediates downstream effects of hypothalamic leptin and insulin signaling. Yet, there have been few studies of chronic intracerebroventricular (i.c.v.) melanocortin receptor (MCR) agonist or antagonist infusion. Although there is evidence of interaction between melanocortin and dopamine (DA) systems, effects of chronic MCR ligand infusion on behavioral sensitivity to non-ingestive reward stimuli have not been investigated. The objective of this study was to investigate effects of chronic i.c.v. infusion of the MCR agonist, MTII, and the MCR antagonist, SHU9119, on food intake, body weight, and sensitivity to rewarding lateral hypothalamic electrical stimulation (LHSS) and the reward-potentiating (i.e., threshold-lowering) effect of D-amphetamine. The MCR antagonist, SHU9119 (0.02 microg/h) produced sustained hyperphagia and weight gain during the 12-day infusion period, followed by compensatory hypophagia and an arrest of body weight gain during the 24-day post-infusion period. At no point during the experiment was sensitivity to LHSS or D-amphetamine (0.25mg/kg, i.p.) altered. The MCR agonist, MTII (0.02 microg/h) produced a brief hypophagia (3 days) followed by a return to control levels of daily intake, but with body weight remaining at a reduced level throughout the 12-day infusion period. This was followed by compensatory hyperphagia and weight gain during the 24-day post-infusion period. There was no change in sensitivity to non-ingestive reward stimuli during the infusion of MTII. However, sensitivity to D-amphetamine was increased during the 24-day post-infusion period. It therefore seems that changes in ingestive behavior that occur during chronic MCR ligand infusion may not affect the response to non-ingestive reward stimuli. However, it is possible that the drive to re-feed and restore body weight following MCR agonist treatment includes neuroadaptations that enhance the incentive effects of drug stimuli.     

Arginine vasopressin infusion increases plasma levels of atrial natriuretic factor in humans.

Seven normal subjects underwent sequential 20-min infusion of arginine vasopressin (AVP) at 0.5 and 2 ng/(kg.min) and a complete right-side heart hemodynamic evaluation during the study to analyze the effect of this hormone on atrial natriuretic factor (ANF) secretion in humans and to elucidate whether this effect was primary or secondary to the hemodynamic or hormonal changes induced by AVP. Plasma ANF levels increased at the end of the first (P less than 0.05) and second (P less than 0.01) infusion periods. No significant changes in mean arterial, pulmonary artery, right and left atrial pressures were recorded during the study. Cardiac output (P less than 0.05) and heart rate (P less than 0.05) decreased, while total vascular resistances (P less than 0.05) increased with respect to basal values in both infusion periods. Plasma renin activity decreased (P less than 0.01) at the end of the infusion, while plasma aldosterone, epinephrine and norepinephrine showed no significant changes. We conclude that arginine vasopressin increases plasma ANF levels in humans and that this effect cannot be ascribed to hemodynamic or hormonal changes induced by this hormone, suggesting a direct effect of vasopressin on the atrial myocyte.     

Estimating physical splenic filtration of Plasmodium falciparum‐infected red blood cells in malaria patients

Splenic filtration of Plasmodium falciparum‐infected red blood cells has been hypothesized to influence malaria pathogenesis. We have developed a minimum cylindrical diameter (MCD) filtration model which estimates physical splenic filtration during malaria infection. The key parameter in the model is the MCD, the smallest tube or cylinder that a red blood cell (RBC) can traverse without lysing. The MCD is defined by a relationship between the RBC surface area and volume. In the MCD filtration model, the MCD filtration function represents the probability of a cell becoming physically removed from circulation. This modelling approach was implemented at a field site in Blantyre, Malawi. We analysed peripheral blood samples from 120 study participants in four clinically defined groups (30 subjects each): cerebral malaria, uncomplicated malaria, aparasitaemic coma and healthy controls. We found statistically significant differences in the surface area and volumes of uninfected RBCs when healthy controls were compared with malaria patients. The estimated filtration rates generated by the MCD model corresponded to previous observations in ex vivo spleen experiments and models of red blood cell loss during acute malaria anaemia.There were no differences in the estimated splenic filtration rates between cerebral malaria and uncomplicated malaria patients. The MCD filtration model estimates that at time of admission, one ring‐stage infected RBC is physically filtered by the spleen for each parasite that remains in peripheral circulation. This field study is the first to use microfluidic devices to identify rheological diversity in RBC populations associated with malaria infection and illness in well‐characterized groups of children living in a malaria endemic area.     

Therapy of paretic arm in hemiplegic subjects augmented with a neural prosthesis: a cross-over study

There are indications that both intensive exercise and electrical stimulation have a beneficial effect on arm function in post-stroke hemiplegic patients. We recommend the use of Functional Electrical Therapy (FET), which combines electrical stimulation of the paretic arm and intensive voluntary movement of the arm to exercise daily functions. FET was applied 30 min daily for 3 weeks. Forty-one acute hemiplegics volunteered in the 18-months single blinded cross-over study (CoS). Nineteen patients (Group A) participated in FET during their acute hemiplegia, and 22 patients (Group B) participated in FET during their chronic phase of hemiplegia. Group B patients were controls during FET in acute hemiplegia, and Group A patients were controls during the FET in chronic hemiplegia. Thirty-two patients completed the study. The outcomes of the Upper Extremity Function Test (UEFT) were used to assess the ability of patients to functionally use objects, as were the Drawing Test (DT) (used to assess the coordination of the arm), the Modified Ashworth Scale, the range of movement, and the questionnaire estimating the patients' satisfaction with the usage of the paretic arm. Patients who participated in the FET during the acute phase of hemiplegia (Group A) reached functionality of the paretic arm, on average, in less than 6 weeks, and maintained this near-normal use of the arm and hand throughout the follow-up. The gains in all outcome scores were significantly larger in Group A after FET and at all follow-ups compared with the scores before the treatment. The gains in patients who participated in the FET in the chronic phase of hemiplegia (Group B) were measurable, yet not significant. The speed of recovery was larger during the period of the FET compared with the follow-up period. The gains in Group A were significantly larger compared with the gains in Group B. The FET greatly promotes the recovery of the paretic arm if applied during the acute phase of post-stroke hemiplegia.     

Immunologic effects of interferon-alpha in man: treatment with human recombinant interferon-alpha suppresses in vitro immunoglobulin production in patients with chronic type B hepatitis

The effect of human recombinant interferon-alpha on lymphocyte proliferation and differentiation was studied in 18 patients with chronic type B hepatitis who were participating in a randomized controlled trial of interferon-alpha therapy. Peripheral blood mononuclear cells (PBMC) were obtained by lymphopheresis before and during a 4 mo course of interferon. Pokeweed mitogen-induced immunoglobulin synthesis by PBMC obtained from patients before therapy was similar to that of PBMC from normal individuals. However, after 2 wk treatment with human recombinant interferon-alpha mitogen-induced immunoglobulin production was decreased by an average of 50%. Staining for cytoplasmic immunoglobulin revealed decreases that paralleled secreted immunoglobulin, indicating that interferon-alpha treatment inhibited immunoglobulin synthesis. Mixing autologous T and B cell enriched populations from before and during interferon treatment revealed that the decrease in immunoglobulin synthesis involved a defect in the B cell-enriched population. In contrast to immunoglobulin synthesis, pokeweed mitogen-induced lymphocyte proliferation was not significantly affected by in vivo administration of interferon-alpha. Thus a major effect of in vivo interferon-alpha on immunoregulation in patients with chronic type B hepatitis appears to be an inhibition of the late stages of B cell differentiation into immunoglobulin producing and secreting plasma cells.     

ANH自体输血在完全性前置胎盘合并胎盘植入剖宫产术中的应用

目的:研究急性等容血液稀释(ANH)自体输血在完全性前置胎盘合并胎盘植入剖宫产术中的应用价值。方法:选择2012年1月~2015年12月在我院进行诊治的完全性前置胎盘合并胎盘植入患者80例,随机分为三组,对照组(n=26)进行常规处理,ANH组(n=27)进行急性等容血液稀释,AHH(急性高容血液稀释)组(n=27)进行急性高容血液稀释。比较三组产妇的体重、年龄、手术时间、术中出血量、输注异体血例数,ANH组和AHH组血液稀释前后和三组产妇术后的动脉血气分析值、术后2 h血常规,三组新生儿娩出后1min、5min Apgar评分及脐动脉血血气分析值。结果:血液稀释后,两组的血红蛋白、红细胞比容和碱剩余均较血液稀释前明显降低(P0.05),两组血气分析无明显差异(P0.05);ANH组输注异体血的比例明显低于AHH组和对照组(P0.05),剖宫产术后2h,ANH组的血红蛋白、红细胞比容和血小板均明显高于AHH组和对照组(P0.05);三组新生儿的血红蛋白、红细胞比容、碱剩余、血乳酸和Apgar评分均无明显差异(P0.05)。结论:ANH自体输血能减少异体血的输注和产妇剖宫术中红细胞的丢失,节约临床用血,对产妇和新生儿的影响较小。     

Rheological properties of erythrocyte suspensions in acute myocardial infarct in the physiological temperature range

A study was made over time of the relationships between the viscosity of red cell suspensions and temperature [eta (T)] in normal subjects and patients with acute myocardial infarction. In normal subjects, the curves eta (T) have a bend within the temperature range 37-40 degrees C, which apparently reflects the phasic transition. In patients with myocardial infarction, the bend on the curve eta (T) either disappears or is undemonstrable during the acute period within the temperature range indicated. During transition to the subacute period (after 7-10 days), the bend on the curves reappears and then only variation of its pattern follows. The changes seen in the viscosities of red cell suspensions or red cell "shades" in the phasic transition area might be used for defining the stages, the time course, and prognosis of myocardial infarction.     

Acute coronary syndrome frequency in western Herzegovina over the fifteen year period (1987-2001)

All patients who suffered from the acute coronary syndrome in western Herzegovina over the fifteen year period (1987-2001) are included in this retrospective epidemiological study. The population that was undertaken by the study is relative stabile and did not emigrate during the war period. The study compared the time before the war (1987-1991), during the war (1992-1996) and after the war (1997-2001). The data were acquired from the archives of the patients of the Mostar hospital and Clinical hospital Split during the war period. A total of 2022 acute coronary syndrome patients were found, 1305 men and 717 women. More patients were treated during the war compared to the time before the war for both male and female patients (p<0.0005). During the after-war period the number of treated patients was greater (p< 0.0005) compared to the war-time for both sexes. The comparison of the after-war period and the pre-war period reveals a statistically significant difference as the number of treated patients (male and female) is larger in the after-war period. The number of patient who are 65 years old and older than that is greater, and that is statistically significant (p= 0.0005.). We can conclude that the stress caused by the war and other factors have influenced a larger number of treated patients of acute coronary syndrome. Therefore, further epidemiological researches of acute coronary syndrome with the accent on prevention and treatment are needed.