[Advances on pathogenesis of acquired peritoneal ultrafiltration failure in peritoneal dialysis].

Peritoneal ultrafiltration failure is a common reason for peritoneal dialysis (PD) withdrawal as well as mortality in PD patients. Based on the three-pore system, inter-cellular small pores and trans-cellular ultra-small pores (aquaporin-1) are mainly responsible for water transfer across the peritoneum. Both small and ultra-small pores-dependent water (free water) transport decline accompanied with time on PD, with more significant decrease in free water, resulting in peritoneal ultrafiltration failure. The reduction of free water transport is associated with fast peritoneal solute transfer, reduced crystalloid osmotic gradient due to increased interstitial glucose absorption, and declined osmotic conductance to glucose resulted from impaired aquaporin-1 function and peritoneal interstitial fibrosis. The decline of small pore-based water is mainly because of fast loss of crystalloid osmotic gradient, decrease of hydrostatic pressure mediated by peritoneal vasculopathy, as well as reduced absolute number of small pores. The current review discusses the advance on pathogenesis of acquired peritoneal ultrafiltration failure in long-term PD.

Patient experience from a doctor's perspective: A case report concerning treatment, fracture healing and rehabilitation of multiple complex injuries due to a high energy motor vehicle collision.

A 35-year old healthy male trauma surgery chief resident, suffered a high-speed motor vehicle collision. The patient sustained the following injuries: a Gustilo-Anderson grade 2 open comminuted intra-articular fracture of the left distal femur (AO 33C3.3), a Hawkins 1A neck fracture of the right talus (AO 81.2A), an undisplaced Lisfranc injury of the right foot comprising avulsion fractures at the base of the 1st, 2nd and 5th metatarsal as well as the cuboid bone suggesting ligament injury and 2nd to 5th carpometacarpal dislocations of the right (non-dominant) hand with comminuted fractures of the capitate, hamate, trapezoid and the base of the fifth metacarpal bone. A staged-treatment approach ensued. An external fixator (ex-fix) was placed over the left knee, followed by definitive fixation of the distal femoral fracture using a Qwix screw, Non-Contact Bridging (NCB) plate and Locking Compression Plate (LCP). An ex-fix was placed over the right wrist, followed by open reduction and k-wire fixation. The talar fracture of the right foot was treated with a single lag screw and the Lisfranc injury was treated non-operatively with four weeks of non-weight bearing cast immobilization. An intensive clinical rehabilitation program was started, including early use of Continuous Passive Motion (CPM), daily non-weightbearing swimming pool exercises, hand, physical and recreational therapy. One year after the injury the patient was rehabilitated and resumed his surgical residency. Two years after the injury, limited flexion and pain in the left leg remains, possibly related to partial union of the femoral fracture. Range of motion (ROM) of the right ankle and wrist remains limited, not causing significant functional impairment. Lessons learned from a patient experience combined with detailed descriptions of injuries, rehabilitation and long term outcomes can be used as a reference for treating patients with comparable injuries.

Reduced serum exosomal miR-874 expression predicts poor prognosis in colorectal cancer.

OBJECTIVE: Emerging evidence has indicated that serum exosomal microRNAs (miRNAs) have promising diagnostic and prognostic value for colorectal cancer (CRC). This study aimed to detect serum exosomal miR-874 expression in CRC patients and assess its potential clinical significance. PATIENTS AND METHODS: Blood samples were collected from 125 CRC patients, 45 cases with benign adenomas (AD) and 70 healthy individuals. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was performed to examine serum exosomal miR-874 levels. RESULTS: The results showed that serum exosomal miR-874 levels were significantly downregulated in CRC patients compared to AD cases and healthy controls. Receiver operating characteristic (ROC) curve analysis revealed that serum exosomal miR-874 expression could discriminate CRC patients from healthy controls, as well as patients with AD. In addition, low serum exosomal miR-874 expression was associated with positive distant metastasis, positive lymph node metastasis, poor differentiation, and advanced TNM stage. Moreover, serum exosomal miR-874 expression was identified as a statistically significant independent prognostic factor for overall survival of CRC patients. CONCLUSIONS: Collectively, serum exosomal miR-874 expression might serve as a reliable marker for CRC diagnosis and prognosis prediction.

Improving diet recipe and cooking methods attenuates hyperphosphatemia in patients undergoing peritoneal dialysis.

BACKGROUND AND AIMS: Hyperphosphatemia is an independent predictor for cardiovascular and all-cause mortality in patients undergoing peritoneal dialysis (PD). The study aimed to investigate the effect of dietary intervention on reducing serum phosphate concentration in hyperphosphatemic PD patients. METHODS AND RESULTS: In this single-center clinical trial, 97 prevalent PD patients with serum phosphate concentration ≥ 1.6 mmol/l were allocated to the intervention (n = 48) or control (n = 49) group and followed up for 1 year. In addition to phosphate binder (calcium carbonate) therapy, patients in the intervention group were intensively educated to reduce phosphate-rich food intake and improve cooking methods. While stable in the control group (1.97 ± 0.20 to 1.94 ± 0.35 mmol/l, p > 0.05), the serum phosphate concentration decreased significantly in the intervention group (1.98 ± 0.28 to 1.65 ± 0.33 mmol/l, p = 0.015) concurrently with the drop in dietary phosphate intake (13.03 ± 3.39 to 10.82 ± 3.00 mg/kg ideal body weight/day, p = 0.001). Moreover, after 6 months of intervention, fewer patients needed to use calcium carbonate (from 64.6% to 41.5%, p = 0.029) and the medicine dose reduced significantly (from 2.25 (0, 3.94) to 0 (0, 1.50) g/day, p < 0.001). CONCLUSIONS: Our data indicated that intensive dietary intervention of reducing phosphate-rich food intake and improving cooking methods attenuated hyperphosphatemia in PD patients. It suggests that regular assessment of dietary phosphate intake and modification of diet recipe and cooking methods are essential for hyperphosphatemia treatment in PD patients in addition to phosphate binder therapy.

Efficacy of cyantraniliprole fly bait against housefly (Musca domestica L.) under laboratory conditions.

Novel and effective baits are needed to manage pest housefly populations and avoid the development of insecticide resistance. In this study, we bioassayed the efficacy of Zyrox®, a novel fly bait containing a novel 0.5 % cyantraniliprole insecticide, to kill adult houseflies under laboratory conditions. We found that Zyrox® killed a significantly greater proportion of flies than the current competing fly bait, QuickBayt®, after a 24-h exposure. The cumulative mortalities of houseflies were up to 96.36 % and 92.57 % for Zyrox® and 78.88 % and 68.76 % for QuickBayt® in no-choice and choice tests, respectively. Our results suggested that there was negligible behavioral resistance to both fly baits but revealed that Zyrox® appeared to work slower than QuickBayt® (at a 3-h exposure, proportionally fewer flies were killed by Zyrox® than by QuickBayt®). Importantly, we found that the efficacy of Zyrox® did not diminish with the age of the bait (up to 90 days old). In actual knockdown time (KDT) feeding bioassay, the results showed that Zyrox® knocked down flies significantly slower (11.97 min for females; 12.30 min for males) than QuickBayt® (1.89 min for females; 2.24 min for males). These results reveal the high efficacy of Zyrox® bait to kill adult flies and suggest that it is a promising slow-action bait for management of houseflies.

Effect of chlorfenapyr on cypermethrin-resistant Culex pipiens pallens Coq mosquitoes.

Chlorfenapyr is a promising pyrrole insecticide with a unique mechanism of action that does not confer cross-resistance to neurotoxic insecticides. The effect of chlorfenapyr on pyrethorid-resistant Culex pipiens pallens Coq (Diptera: Culicidae) has not been fully investigated under laboratory conditions. In this study, cypermethrin-resistant C. p. pallens exhibited 376.79-fold and 395.40-fold increase in resistance to cypermethrin compared with susceptible strains after exposure for 24 and 48h, respectively. Larvae and adults were tested for susceptibility using dipping, topical, and impregnated paper methods as recommended by the WHO. No cross-resistance to chlorfenapyr was found. Increased mortality was apparent between 48 and 72h, indicating a slow rate of toxic activity. Synergism experiments with piperonyl butoxide (PBO) showed an antagonistic effect on chlorfenapyr toxicity. Mixtures of chlorfenapyr and cypermethrin could therefore provide additional benefits over either insecticide used alone. Mixtures of 5ng/ml chlorfenapyr and 500ng/ml cypermethrin exhibited a slight synergistic effect on cypermethrin-resistant mosquitoes (3.33, 6.84 and 2.34% after 24, 48 and 72h exposure, respectively. This activity was lost when the chlorfenapyr concentration was increased to 10 or 20ng/ml. Chlorfenapyr showed quite good results for pyrethroid-resistant C. p. pallens, and could improve public health by reducing the occurrence of mosquito bites and subsequently protecting against transmission of lymphatic filariasis and Japanese encephalitis.

Laparoscopically assisted transhiatal resection for malignancies of the distal esophagus.

BACKGROUND: Resection of the esophagus remains the only curative therapy for esophageal cancer. Conventional resections are right-side thoracotomy in combination with laparotomy, gastric tube creation, and the transhiatal approach according to Orringer. This study evaluated laparoscopically assisted transhiatal esophagus resection, which offers perfect visualization of the esophagus during mediastinal dissection without the necessity of a thoracotomy. METHODS: In this study, 25 laparoscopically assisted transhiatal esophagus resections were compared with a historical control group consisting of 20 open transhiatal esophagus resections. RESULTS: Nine laparoscopically assisted resections (36%) were converted to open procedures. The operating time was longer in the laparoscopically assisted group (300 vs 257 min; p < 0.05), but laparoscopically assisted esophagus resection was associated with less blood loss (600 vs 900 ml; p < 0.05) and shorter intensive care unit stay (1 vs 2 days; p < 0.05). There were no differences in morbidity, mortality, and hospital stay. During a shorter follow-up time for the laparoscopic group (17 vs 54 months), 11 patients (44%) in the laparoscopically assisted group and 10 (50%) patients in the open group had recurrence of the disease. CONCLUSIONS: Laparoscopically assisted transhiatal esophagus resection is a safe procedure with important advantages, as compared with the open procedure, such as less blood loss and shorter intensive care unit stay. At this point, the oncologic consequences are not clear.

Anesthesiological hazards during laparoscopic transhiatal esophageal resection: a case control study of the laparoscopic-assisted vs the conventional approach.

BACKGROUND: Interest for minimal invasive approach of esophagus resection is increasing. Today, a minimally invasive transhiatal esophagectomy is possible and is accepted widespread. Since cardiopulmonary changes during laparoscopic dissection of the mediastinum has not been studied yet we assessed the anesthesiological consequences of pneumothorax during laparoscopic mediastinal dissection. METHODS: In this case control study, 25 laparoscopically assisted transhiatal espohagus resections were compared with a control group consisting of 20 open transhiatal esophagus resections. Patient characteristics and intraoperative haemodynamic, respiratory, and ventilatory parameters were assessed. RESULTS: The laparoscopic assisted procedure was performed successfully in 12 of the 20 patients. The duration of the laparoscopic assisted procedure, compared to the open group was significantly longer (p<0.05). Intraoperative blood loss was significantly less in the laparoscopic group (p<0.05). Mediastinal dissection resulted in entry of the pleura in 84% of the open and 93% of the laparoscopic assisted procedure. Carbonedioxide pneumothorax resulted in increased end-tidal CO2)and airway pressure levels and decreased lung compliance. Airway pressure showed a significant difference between the groups (p<0.05). Hemodynamic parameters did not differ between groups significantly. There were no differences in postoperative cardiopulmonary complications. CONCLUSIONS: Laparoscopic assisted transhiatal esophagectomy is a safe procedure and has no increased risk of postoperative cardiopulmonary complications compared to thr conventional approach. The anesthesiologist and the surgeon must be aware of the potential risk of pleural injury to manage cardiopulmonary compromises and minimize complications.

Toxicity of cinnamomin--a new type II ribosome-inactivating protein to bollworm and mosquito.

The toxicity of cinnamomin, a new type II ribosome-inactivating protein purified from the seeds of camphor tree (Cinnamomum camphora), to bollworm (Helicoverpa armigera) and mosquito (Culex pipines pallens) during larval stage was tested. The LC50 of cinnamomin to bollworm larvae fed on diet containing cinnamomin was 1839 ppm and the LC50 to larvae of mosquito was 168 ppm. The gut extract of bollworm larvae could apparently hydrolyze cinnamomin. The inhibition of protein synthesis by cinnamomin was tested in in vitro translation system of bollworm larvae, and its LC50 was determined to be approx. 14 nM. Bollworm larvae ribosome treated with cinnamomin produced a specific RNA fragment (R-fragment) characterized on urea-denatured polyacrylamide gel. Evidence was provided that hidden breaks exist in the largest ribosomal RNA of bollworm larvae.