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1.
Ann Nutr Metab ; 73(2): 131-137, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30056446

RESUMO

BACKGROUND AND AIM: Oral administration of cystine and theanine (CT) may modulate antioxidant glutathione (GSH) metabolism, thereby improving outcomes after gut ischemia reperfusion. METHODS: Experiment 1: Institute of Cancer Research mice (n = 35) were assigned to a Vehicle (n = 11), a CT140 (n = 14), or a CT280 (n = 10) group. The CT140 and 280 groups were given CT at respective dosages of 140 and 280 mg/kg (cystine: theanine = 5: 2) once daily via gavage for 5 days. All mice underwent 75-min occlusion of the superior mesenteric artery (SMA). Survival after reperfusion was observed. Experiment 2: Mice (n = 67) were pretreated for 5 days (Vehicle: n = 24, CT280: n = 20, vehicle/sham: n = 23). The Vehicle and CT280 groups underwent 60-min SMA occlusion. Levels of GSH, the oxidized form of GSH, Glutathione-S-S-Glutathione (GSSG), and GSH-related amino acids (cysteine and glutamic acid) in the small intestine, and plasma cytokine (IL-6, IL-1ß, TNFα) levels, were evaluated before (0 h), 3, 6, or 9 h after reperfusion. RESULTS: Experiment 1: The CT280 group showed significantly better survival than the Vehicle group. Experiment 2: Gut GSSG, cysteine, and glutamic acid levels were higher in the CT280 than in the Vehicle group after reperfusion. Plasma IL-6 and TNFα levels rose more rapidly in the CT280 than in the Vehicle group. CONCLUSION: Oral administration of CT improves survival after gut I/R, possibly through the modulation of the GSH-redox cycle and cytokine responses.


Assuntos
Cistina/administração & dosagem , Glutamatos/administração & dosagem , Traumatismo por Reperfusão/terapia , Animais , Citocinas/sangue , Glutamatos/análise , Glutationa/análise , Masculino , Camundongos Endogâmicos ICR , Distribuição Aleatória
2.
J Org Chem ; 82(13): 6846-6856, 2017 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-28561589

RESUMO

We developed an acylative desymmetrization of meso-1,2-diols using a binaphthyl-based N,N-4-dimethylaminopyridine (DMAP) derivative 1h with tert-alcohol substituents. The reaction proceeds with a wide range of acyclic meso-1,2-diols and six-membered-ring meso-1,2-diols to provide a monoacylate selectively with a high enantiomeric ratio (er). Only 0.1 mol % of the catalyst facilitated the reaction within a short reaction time (3 h) to afford enantio-enriched monoacylated products in moderate to good yield. Several control experiments revealed that the tert-alcohol units of catalyst 1h play a significant role in achieving high catalytic activity, chemoselectivity of monoacylation, and enantioselectivity.

3.
Microbiol Immunol ; 58(2): 142-6, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24268024

RESUMO

Carbapenem-resistant Acinetobacter baumannii has rapidly spread worldwide. This study investigated antibiotic susceptibility and genotypic resistance of 123 consecutive blood culture isolates of Acinetobacter species collected between 2003 and 2011 in two Japanese hospitals. The isolates were assigned to 13 species. Carbapenem resistance was detected in four isolates. Only one A. baumannii isolate had blaOXA-23 together with ISAba1; the remaining three isolates had IMP-1 metallo-ß-lactamase. Quinolone resistance was detected in five isolates that had point mutations in the quinolone resistance-determining region. The predominance of various non-A. baumannii species and low prevalence of carbapenem resistance among blood culture isolates of Acinetobacter species in two Japanese hospitals were confirmed.


Assuntos
Infecções por Acinetobacter/microbiologia , Acinetobacter/classificação , Acinetobacter/efeitos dos fármacos , Anti-Infecciosos/farmacologia , Hospitais Universitários , Acinetobacter/genética , Acinetobacter/isolamento & purificação , Infecções por Acinetobacter/diagnóstico , Farmacorresistência Bacteriana/genética , Genes Bacterianos , Humanos , Japão , Testes de Sensibilidade Microbiana
4.
World J Surg ; 38(11): 3015-22, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24952076

RESUMO

BACKGROUND: The influence of broken sophisticated surgical instruments on the safety of surgery has yet to be determined, in spite of an assumption that breakage of surgical instruments is not associated with critical incidents. The purpose of the present study was to delineate the risk from breakage of surgical instruments used in surgery assisted by endoscopy. METHODS: A retrospective analysis was conducted to determine the frequency of breakage of instruments used in 39,817 operations from 2007 to 2011. Data of breakage were collected using incident/near-incident reports and the request forms for repair of broken instruments. RESULTS: During the study period, 441 instruments were reported to be broken intraoperatively, and 7,541 were found to be broken on inspection. The incidence of breakage adjusted by the number of operations and the number of uses suggested that instruments for endoscopy-assisted surgery are broken more frequently intraoperatively than are any other type of instruments (visceral surgery: 0.039 versus 0.017, P = 0.0002, RR = 2.318; obstetrics/gynecology: 0.023 versus 0.0067, P < 0.0001, RR = 3.461; thoracic surgery: 0.019 versus 0.004, P = 0.0772, RR = 5.212). Inappropriate use and wearing out were two major possible causes of breakage of instruments. The predominant adverse events were suggested to be attributable to parts falling off broken instruments because of inappropriate use. CONCLUSIONS: Our results demonstrated that surgery assisted by endoscopy has its own occult risk, which has not been previously highlighted. Minimally invasive surgery is not necessarily safe with respect to breakage of surgical instruments. Our data provide substantial evidence for higher risk of instrument breakage in endoscopy-assisted surgery, as well as its possible detrimental effect on patient safety.


Assuntos
Endoscopia/instrumentação , Falha de Equipamento/estatística & dados numéricos , Complicações Intraoperatórias/epidemiologia , Instrumentos Cirúrgicos/efeitos adversos , Endoscopia/estatística & dados numéricos , Humanos , Incidência , Segurança do Paciente , Estudos Retrospectivos , Medição de Risco , Instrumentos Cirúrgicos/classificação , Tóquio/epidemiologia
5.
Surg Today ; 44(6): 1123-7, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24026197

RESUMO

PURPOSE: The vagus nerve exerts immunomodulatory functions by inhibiting pro-inflammatory cytokine overproduction. Because vagotomy is a standard procedure during the radical operation for esophageal or gastric cancer, the postoperative clinical course might be related to vagotomy-associated changes in the cytokine milieu. We herein examined the gut cytokine kinetics after vagotomy in mice. METHODS: Thirty-eight male Institute of Cancer Research mice underwent sham or sub-diaphragmatic truncal vagotomy. The whole small intestine was harvested on postoperative day (POD) 14 (sham: vagotomy, n = 9:10) or 20 (n = 9:10). The pro- and anti-inflammatory cytokine levels in the plasma, jejunum, ileum and whole small intestine were evaluated. RESULTS: The plasma cytokine levels were similar in the vagotomy and sham groups on POD 14 and 20. However, both the pro- and anti-inflammatory cytokine levels tended to be lower on POD 14 and higher on POD 20 in the vagotomy group than in the sham group. With regard to the cytokine kinetics, the jejunal IL-12p70, TNF-α, MCP-1 and IL-10, ileal IL-12p70, TNF-α, IL-6, MCP-1 and IL-10, and whole small intestinal IL-12p70, TNF-α, IFN-γ, MCP-1 and IL-10 of the vagotomy group all significantly increased on POD 20 as compared to POD 14. CONCLUSION: Vagotomy has a major impact on the gut cytokine milieu. Vagotomy may initially inhibit both pro- and anti-inflammatory cytokine production, while both later increase.


Assuntos
Citocinas/metabolismo , Mediadores da Inflamação/metabolismo , Intestino Delgado/metabolismo , Vagotomia , Nervo Vago/imunologia , Animais , Masculino , Camundongos , Período Pós-Operatório , Tempo , Vagotomia/efeitos adversos
6.
J Surg Res ; 174(2): 334-8, 2012 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-21276985

RESUMO

BACKGROUND: Absence of enteral delivery of nutrients causes gut associated lymphoid tissue (GALT) atrophy and an imbalance between immunoglobulin A (IgA)-inhibiting Th1 and IgA-stimulating Th2 cytokine levels in the gut, leading to impaired mucosal immunity. We previously demonstrated exogenous IL-7 to reverse parenteral nutrition (PN)-induced GALT cell loss but not to normalize the gut cytokine imbalance or reduce secretory IgA levels, in uninjured mice. Herein, we examined effects of exogenous IL-7 during PN on survival and IgA levels after intra-tracheal bacterial challenge. METHODS: Sixty-five male Institute of Cancer Research (ICR) mice were randomized to chow, PN or PN+IL-7 (1 µg/kg, administered i.v. twice a day), and jugular vein catheters were inserted. The chow and PN mice received normal saline i.v. infusions instead of IL-7. After 5 d of feeding (chow or PN) and treatment, 8 × 10(7)Pseudomonas aeruginosa were instilled intra-tracheally. Survival was observed in 41 mice, while 24 were killed at 6 h after challenge and small intestinal, nasal and bronchoalveolar washings were obtained for IgA measurement. RESULTS: PN significantly reduced survival time and IgA levels in small intestine and bronchoalveolar washings compared with chow feeding. IL-7 treatment restored these parameters. Therefore, no significant differences in survival or secretory IgA levels were found between the chow and PN+IL-7 groups. CONCLUSIONS: Exogenous IL-7 reverses PN-induced impairment of resistance to respiratory tract infections associated with increased secretory IgA levels.


Assuntos
Imunoglobulina A Secretora/metabolismo , Interleucina-7/uso terapêutico , Nutrição Parenteral/efeitos adversos , Pneumonia Bacteriana/prevenção & controle , Animais , Masculino , Camundongos , Camundongos Endogâmicos ICR , Pneumonia Bacteriana/imunologia
7.
JPEN J Parenter Enteral Nutr ; 45(6): 1293-1301, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-32829500

RESUMO

BACKGROUND: Low-carbohydrate high-fat diets (LCHFDs) are thought to be beneficial for metabolic support in patients with advanced cancer. However, whether LCHFDs affect the progression of carcinomatous peritonitis (CP) remains unclear. Our study examined the influence of a lard-based LCHFD on host immunity and survival in a murine CP model. METHODS: Mice were fed either a normal diet (ND) or an LCHFD ad libitum. On day 7, Panc02 cancer cells were inoculated intraperitoneally. Mice were killed on days 7, 21, and 35, and cytokine levels in the peritoneal fluid, as well as the number and phenotypes of peritoneal, splenic, and tumor-infiltrating lymphocytes were measured. Survival studies were performed with both ad libitum and isocaloric feeding in other sets of mice. RESULTS: The levels of all cytokines significantly increased in the LCHFD group compared with those in the ND group on day 21. The tumor necrosis factor α and interleukin-10 levels were higher in the LCHFD group than in the ND group on day 35. In the LCHFD group, the regulatory T-cell (Treg) number was significantly higher in the peritoneal cavity and tumor. The survival times were worse in the LCHFD group than in the ND group. CONCLUSION: The ad libitum, lard-based LCHFD feeding of CP mice increases the peritoneal cytokine levels, which may reduce splenic, anticancer lymphocytes and increase the number of Tregs in the peritoneal cavity and tumor. The detrimental effects of LCHFD are linked to dietary composition rather than overfeeding.


Assuntos
Neoplasias , Peritonite , Animais , Carboidratos , Dieta Hiperlipídica/efeitos adversos , Modelos Animais de Doenças , Humanos , Inflamação , Linfócitos , Camundongos
8.
J Chem Phys ; 133(16): 164113, 2010 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-21033781

RESUMO

A unified interpretation of Hund's first and second rules for 2p (C, N, O) and 3p (Si, P, S) atoms is given by Hartree-Fock (HF) and multiconfiguration Hartree-Fock (MCHF) methods. Both methods exactly satisfy the virial theorem, in principle, which enables one to analyze individual components of the total energy E(=T+V(en)+V(ee)), where T, V(en), and V(ee) are the kinetic, the electron-nucleus attraction, and the electron-electron repulsion energies, respectively. The correct interpretation for each of the two rules can only be achieved under the condition of the virial theorem 2T+V=0 by investigating how V(en) and V(ee) interplay to attain the lower total potential energy V(=V(en)+V(ee)). The stabilization of the more stable states for all the 2p and 3p atoms is ascribed to a greater V(en) that is caused by contraction of the valence orbitals accompanied with slight expansion of the core orbitals. The contraction of the valence orbitals for the two rules is a consequence of reducing the Hartree screening of the nucleus at short interelectronic distances. The reduced screening in the first rule is due to a greater amount of Fermi hole contributions in the state with the highest total spin-angular momentum S. The reduced screening in the second rule is due to the fact that two valence electrons are more likely to be on opposite sides of the nucleus in the state with the highest total orbital-angular momentum L. For each of the two rules, the inclusion of correlation does not qualitatively change the HF interpretation, but HF overestimates the energy difference ∣ΔE∣ between two levels being compared. The magnitude of the correlation energy is significantly larger for the lower L states than for the higher L states since two valence electrons in the lower L states are less likely to be on opposite sides of the nucleus. The MCHF evaluation of ∣ΔE∣ is in excellent agreement with experiment. The present HF and MCHF calculations demonstrate the above statements that were originally given by Katriel [Theor. Chem. Acta 23, 309 (1972); 26, 163 (1972)]. We have, for the first time, analyzed the correlation-induced changes in the radial density distribution for the excited LS terms of the 2p and 3p atoms as well as for the ground LS term.

10.
JPEN J Parenter Enteral Nutr ; 43(4): 516-524, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30260489

RESUMO

BACKGROUND: Preoperative carbohydrate (CHO) supplementation has been recommended in enhanced recovery after surgery protocols. However, the effects of CHO supplementation on gut and systemic immunity are not well understood. METHODS: Mice (n = 60) were randomized to 1 of the following 5 groups: control (ad lib feeding), 12-hour fasting without CHO administration (fasting), and 12 hours of fasting with CHO administration at 2, 4, and 8 hours before sacrifice. Then, lymphocytes were isolated from gut-associated lymphoid tissue, that is, Peyer's patches, the intraepithelial space, and the lamina propria of the small intestine. These lymphocyte numbers and phenotypes were evaluated. IgA levels in respiratory and small-intestinal washings were determined by ELISA. Morphology, proliferation, and apoptosis of the intestinal epithelium were also evaluated histologically. RESULTS: Although there were no significant differences in IgA levels among the 5 groups, fasting decreased intraepithelial and lamina propria, but not Peyer's patches lymphocyte numbers. CHO at 2 hours prevented lymphocyte loss in intraepithelial, whereas CHO at 4 hours reversed lamina propria lymphocytes numbers. Percentages of lymphocyte phenotypes were similar in each site among the 5 groups. Fasting caused villous atrophy; however, CHO at 2 hours restored villous structure along with maintenance of epithelial cell proliferation rate. CONCLUSIONS: Only 12 hours of fasting causes marked gut-associated lymphoid tissue cell loss along with gut atrophy. However, CHO at 2 hours preserves gut immunity and morphology not completely but moderately.


Assuntos
Carboidratos da Dieta/administração & dosagem , Jejum/fisiologia , Imunidade nas Mucosas/fisiologia , Mucosa Intestinal/imunologia , Animais , Atrofia , Líquido da Lavagem Broncoalveolar/imunologia , Contagem de Células , Células Epiteliais/fisiologia , Imunoglobulina A/análise , Mucosa Intestinal/ultraestrutura , Intestino Delgado/imunologia , Intestino Delgado/ultraestrutura , Linfócitos/imunologia , Masculino , Camundongos , Camundongos Endogâmicos ICR , Microvilosidades/ultraestrutura , Mucosa/imunologia , Nódulos Linfáticos Agregados/imunologia
11.
PDA J Pharm Sci Technol ; 72(4): 420-437, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29545322

RESUMO

Recently, the use of filters has come into light for sanitizing water plants. This study investigated the role of heat-tolerant ultrafilters (UFs) for the remediation of reverse osmosis (RO) plants using periodic thermal disinfection. Two completely identical RO plants (RO plants A and B) were installed in 2006 for surgical hand antisepsis in the operating theater. RO water was stored in the 300 L storage tank and recirculated in the 190 meter-long loop delivering water to 12 faucets in each RO plant. Periodic thermal disinfection came into practice periodically when a UF module was retrofitted to the recirculation loop of each RO plant in 2010. Endotoxin was monitored closely before and after thermal disinfection. Before UF modules were retrofitted, endotoxin increased to a maximum of 0.301 EU/mL in RO plant A and 1.446 EU/mL in RO plant B after thermal disinfection, respectively. Since a UF module was retrofitted to each RO plant in 2010, endotoxin has been continuously below 0.025 EU/mL in RO plant A and exceeded this level five times in RO plant B. On one occasion, endotoxin increased in all samples collected simultaneously after solenoid valves were replaced in the recirculation loop near the air conditioner outlet. At this time, the inside of the pipework was exposed to the ventilation airflow. After the valves were replaced again, this time with the workplace isolated using a curing sheet, endotoxin decreased. On the other occasions, endotoxin increased only in one sample and decreased after thermal disinfection. Annually replaced UF modules were examined twice for estimating the amounts of immobilized endotoxin. The estimated amounts decreased in 2013 by the order of 10-3 in comparison with those in 2011 in both RO plants. The present study suggested that UFs acted synergistically with periodic thermal disinfection for the remediation of RO plants.


Assuntos
Antissepsia/métodos , Desinfecção/métodos , Desinfecção das Mãos/métodos , Purificação da Água/métodos , Endotoxinas/isolamento & purificação , Filtração/métodos , Temperatura Alta , Humanos , Estudos Longitudinais , Salas Cirúrgicas/normas , Osmose , Água/normas
12.
Infect Control Hosp Epidemiol ; 38(2): 143-146, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27795211

RESUMO

BACKGROUND Recently, robotic surgery has been introduced in many hospitals. The structure of robotic instruments is so complex that updating their cleaning methods is a challenge for healthcare professionals. However, there is limited information on the effectiveness of cleaning for instruments for robotic surgery. OBJECTIVE To determine the level of residual contamination of instruments for robotic surgery and to develop a method to evaluate the cleaning efficacy for complex surgical devices. METHODS Surgical instruments were collected immediately after operations and/or after in-house cleaning, and the level of residual protein was measured. Three serial measurements were performed on instruments after cleaning to determine the changes in the level of contamination and the total amount of residual protein. The study took place from September 1, 2013, through June 30, 2015, in Japan. RESULTS The amount of protein released from robotic instruments declined exponentially. The amount after in-house cleaning was 650, 550, and 530 µg/instrument in the 3 serial measurements. The overall level of residual protein in each measurement was much higher for robotic instruments than for ordinary instruments (P<.0001). CONCLUSIONS Our data demonstrated that complete removal of residual protein from surgical instruments is virtually impossible. The pattern of decline differed depending on the instrument type, which reflected the complex structure of the instruments. It might be necessary to establish a new standard for cleaning using a novel classification according to the structural complexity of instruments, especially for those for robotic surgery. Infect Control Hosp Epidemiol 2017;38:143-146.


Assuntos
Descontaminação/métodos , Contaminação de Equipamentos/prevenção & controle , Proteínas/análise , Procedimentos Cirúrgicos Robóticos , Instrumentos Cirúrgicos , Humanos , Japão
13.
Shock ; 47(5): 646-652, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27798536

RESUMO

BACKGROUND: How vagotomy affects host responses to gut ischemia-reperfusion (I/R) is unclear. MATERIALS AND METHODS: Experiment 1: male Institute of Cancer Research mice (n = 22) were assigned to the I/R or the vago-I/R group. The I/R mice underwent 45-min superior mesenteric artery (SMA) occlusion. The vago-I/R mice received vagotomy before SMA occlusion. Survival was observed for 48 h.Experiment 2: mice (n = 55) were divided into four groups (Sham, vago, I/R, vago-I/R). Sham and vago groups did not undergo gut I/R. Mice were killed at 3 or 6 h after reperfusion, and cytokine levels in the plasma, jejunum, and ileum were evaluated. In addition, gut histology at 6 h was examined.Experiment 3: mice (n = 24) were divided into four groups as in Experiment 2. The small intestine was harvested at 3 h after reperfusion and the tissue was cultured ex vivo for 3 h. Cytokine levels of the culture supernatant were then measured. RESULTS: Experiment 1: survival was significantly worse with vago-I/R than I/R.Experiment 2: along with severe gut injury, vago-I/R increased IL-6 and monocyte chemoattractant protein-1 (MCP-1) in plasma, IFN-γ in the jejunum and MCP-1 in the ileum, as compared with I/R. Significant positive correlations were noted between plasma and intestinal levels of pro-inflammatory cytokines (IL-6, MCP-1, and TNF-α).Experiment 3: MCP-1 in the jejunal culture medium was higher in the vago-I/R than in the I/R group. CONCLUSIONS: Vagotomy worsens survival after gut I/R, together with increases in pro-inflammatory cytokines in both plasma and the gut in association with severe intestinal tissue damage.


Assuntos
Mucosa Intestinal/metabolismo , Isquemia/imunologia , Traumatismo por Reperfusão/imunologia , Vagotomia/efeitos adversos , Animais , Quimiocina CCL2/sangue , Quimiocina CCL2/metabolismo , Citocinas/sangue , Citocinas/metabolismo , Íleo/metabolismo , Interleucina-6/sangue , Interleucina-6/metabolismo , Intestino Delgado/metabolismo , Intestinos/lesões , Isquemia/mortalidade , Masculino , Camundongos , Traumatismo por Reperfusão/mortalidade , Fator de Necrose Tumoral alfa/sangue , Fator de Necrose Tumoral alfa/metabolismo , Nervo Vago/metabolismo , Nervo Vago/cirurgia
14.
Nat Commun ; 7: 11297, 2016 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-27079273

RESUMO

Catalysts that can promote acyl transfer processes are important to enantioselective synthesis and their development has received significant attention in recent years. Despite noteworthy advances, discovery of small-molecule catalysts that are robust, efficient, recyclable and promote reactions with high enantioselectivity can be easily and cost-effectively prepared in significant quantities (that is, >10 g) has remained elusive. Here, we demonstrate that by attaching a binaphthyl moiety, appropriately modified to establish H-bonding interactions within the key intermediates in the catalytic cycle, and a 4-aminopyridyl unit, exceptionally efficient organic molecules can be prepared that facilitate enantioselective acyl transfer reactions. As little as 0.5 mol% of a member of the new catalyst class is sufficient to generate acyl-substituted all-carbon quaternary stereogenic centres in quantitative yield and in up to 98:2 enantiomeric ratio (er) in 5 h. Kinetic resolution or desymmetrization of 1,2-diol can be performed with high efficiency and enantioselectivity as well.

15.
Mol Clin Oncol ; 5(6): 773-776, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28101355

RESUMO

Undifferentiated carcinoma of the gallbladder is a rare cancer type with a poor prognosis. The present study described a case of undifferentiated gallbladder carcinoma of the spindle- and giant-cell type, according to the 2010 World Health Organization classification. Hematoxylin and eosin staining revealed that the tumor consisted of dense interlacing bundles of spindle-shaped cells. No evidence of cartilaginous, osseous or rhabdomyosarcomatous differentiation was observed. Immunohistochemical staining revealed that spindle- and polygonal-shaped cells of the undifferentiated carcinoma were positive for cytokeratin AE1/3, vimentin and vascular endothelial growth factor. Furthermore, numerous spindle-shaped cells were positive for cluster of differentiation (CD)34 and CD31, and certain spindle-shaped cells were positive for Factor VIII. These results suggested classification of the present case as 'undifferentiated gallbladder carcinoma with endothelial differentiation'.

16.
Hepatogastroenterology ; 52(65): 1474-8, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16201100

RESUMO

BACKGROUND/AIMS: In patients with acute mesenteric ischemia, early diagnosis is considered to improve the prognosis by preventing the occurrence of systemic inflammatory response syndrome (SIRS). However, it remains unclear which factors affect the mortality once advanced ischemia and SIRS develop in cases of delayed diagnosis. The aim of this study was to investigate the predictors of in-hospital mortality in the late stage of acute mesenteric ischemia. METHODOLOGY: We retrospectively studied 66 consecutive patients who had acute intestinal infarction associated with SIRS between 1986 and 2002. They included 19 of acute mesenteric thromboembolism and 47 cases of postoperative adhesions or an incarcerated hernia. A multivariate logistic model was used to identify important factors for in-hospital death among the background data. Two models were constructed with/without the cause of intestinal obstruction as a variable, since it might affect the prognosis. RESULTS: The results suggested that concomitant cardiac morbidity, high serum amylase level, and thrombocythemia are important factors for in-hospital mortality of acute intestinal infarction, regardless of the cause of intestinal infarction. CONCLUSIONS: Our results indicated that the prognosis is strongly influenced by associated cardiac morbidity and abnormal coagulopathy in the advanced stage of mesenteric ischemia.


Assuntos
Infarto/mortalidade , Intestinos/irrigação sanguínea , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Doença Aguda , Amilases/sangue , Feminino , Mortalidade Hospitalar , Humanos , Infarto/sangue , Infarto/etiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trombocitose/epidemiologia , Tromboembolia/epidemiologia
17.
Am J Infect Control ; 43(9): 951-5, 2015 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-26050097

RESUMO

BACKGROUND: There is no established method to assess the contamination of environmental surfaces because the results change with time. We evaluated current methods for assessment of contamination of environmental surfaces in the operating room (OR). METHODS: Contamination of environmental surfaces in the OR was assessed using an adenosine triphosphate (ATP) test and bacterial culture. We collected 480 ATP test samples from 17 surfaces in 6 ORs to determine the influence of surface features, including frequency of touching and surface orientation on contamination, after completion of daily scheduled operations. Another 54 pairs of ATP and microbial samples were taken from 3 surfaces in each of the same OR except 1 to determine the time course of the results of ATP and microbial tests when ORs were not used. RESULTS: Multivariate analysis demonstrated that the ATP results were strongly influenced by frequency of touching and orientation of environmental surfaces. The microbial counts declined over time, whereas the ATP results remained at a high level. CONCLUSION: The ATP test result could be used as a relatively stable trace of contamination of environmental surfaces; however, it is not a surrogate indicator of the number of viable microbes which declines over time.


Assuntos
Bactérias/isolamento & purificação , Infecção Hospitalar/prevenção & controle , Salas Cirúrgicas/normas , Trifosfato de Adenosina/metabolismo , Poluição Ambiental , Contaminação de Equipamentos , Humanos , Modelos Logísticos , Medições Luminescentes , Análise Multivariada , Fatores de Tempo
18.
Am J Surg ; 187(3): 394-7, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15006569

RESUMO

BACKGROUND: Previous studies have investigated the mechanisms of gastric rupture based only on the findings in gastric rupture and excluding gastric lacerations. METHODS: We investigated 14 cases of gastric injury (five with rupture and nine with laceration) from blunt abdominal trauma with or without thoracic trauma. Gastric injuries were caused by a traffic accident in 12 and by a fall in two patients. All of the patients with gastric rupture had had a full stomach at the time of impact. RESULTS: The patients had associated injuries of adjacent solid organs, the thoracic cage, and extremities. The frequency of injury of the hepatoduodenal or gastrohepatic ligament was higher in patients with gastric laceration than in patients with gastric rupture. Eight of nine patients with a gastric laceration had hepatic or pancreatic injury, whereas none of the patients with gastric rupture had such injury. CONCLUSIONS: The results of our study showed that the distended stomach tends to rupture by absorbing the impact from blunt abdominal trauma (i.e., it works like an airbag to protecting adjacent organs such as the liver and pancreas).


Assuntos
Traumatismos Abdominais/diagnóstico , Traumatismo Múltiplo/diagnóstico , Ferimentos não Penetrantes/diagnóstico , Traumatismos Abdominais/epidemiologia , Traumatismos Abdominais/cirurgia , Acidentes de Trânsito , Adulto , Distribuição por Idade , Cuidados Críticos/métodos , Feminino , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/epidemiologia , Traumatismo Múltiplo/cirurgia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Estudos de Amostragem , Distribuição por Sexo , Ruptura Gástrica/diagnóstico , Ruptura Gástrica/epidemiologia , Ruptura Gástrica/cirurgia , Análise de Sobrevida , Resultado do Tratamento , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/cirurgia
19.
Am J Infect Control ; 42(1): 43-7, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24189327

RESUMO

BACKGROUND: The aim of this study was to determine the risk of contamination of surgical instruments according to the type of instrument and the surgical procedure. METHODS: Microbiologic examination was conducted on 140 pairs of forceps used in 24 elective laparotomies. These included 60 pairs of tissue forceps and 80 pairs of DeBakey forceps. Microbes on their surface were recovered using a membrane filter method. Adenosine triphosphate assay was also performed simultaneously in each pair of forceps. RESULTS: A total of 66 strains of microbes was recovered from 44 collected instruments (31%), with microbial counts ranging from 0 to 296 colony-forming units. Among the recovered microbes, gram-positive cocci were dominant [corrected]. The remaining microbes included 6 strains of gram-positive rods and 4 strains of gram-negative rods. The most common organism was Staphylococcus epidermidis, followed by S hominis and S warneri. Residual adenosine triphosphate was not correlated with the number of recovered microbes. CONCLUSION: Surgical instruments tend to be contaminated during operations by microbes that inhabit the skin and organs. Surgical instruments could act as fomites for the pathogens of surgical site infection even if the surgical field is not apparently contaminated, through application of appropriate practices adhering to surgical site infection guidelines.


Assuntos
Bactérias/isolamento & purificação , Fômites/microbiologia , Laparotomia , Instrumentos Cirúrgicos/microbiologia , Bactérias/classificação , Contagem de Colônia Microbiana , Humanos
20.
PDA J Pharm Sci Technol ; 67(4): 399-411, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23872448

RESUMO

This report deals with the construction and management of the reverse osmosis (RO) water system for final rinsing of surgical instruments in the washer-disinfector. Numerous operational challenges were encountered in our RO water system and these were analyzed utilizing the Ishikawa Fishbone diagram. The aim was to find potential problems and promote preventive system management for RO water. It was found that the measures that existed were inappropriate for preventing contamination in the heat-labile RO water system. The storage tank was found to be significantly contaminated and had to be replaced with a new one equipped with a sampling port and water drainage system. Additional filters and an UV treatment lamp were installed. The whole system disinfection started 1.5 years later using a peracetic acid-based compound after confirming the material compatibility. Operator errors were found when a new water engineer took over the duty from his predecessor. It was also found that there were some deficiencies in the standard operating procedures (SOPs), and that on-the-job training was not enough. The water engineer failed to disinfect the sampling port and water drainage system. The RO membrane had been used for 4 years, even though the SOP standard specified changing it as every 3 years. Various bacteria, such as Rothia mucilaginosa, were cultured from the RO water sampled from the equipment. Because Rothia mucilaginosa is a resident in the oral cavity and upper respiratory tract, it is believed that the bacteria were introduced into the system by the maintenance personnel or working environment. Therefore, the presence of R. mucilaginosa implied the failure of sanitary maintenance procedures. This study suggests that water systems should be designed based on the plans for profound system maintenance. It also suggests that SOP and on-the job training are essential to avoid any operator errors. These results must be carefully considered when either constructing new RO systems or performing maintenance and periodical examination of the equipment. LAY ABSTRACT: Reverse osmosis (RO) water is used for final rinsing in our washer-disinfector. The authors used the Ishikawa Fishbone diagram to clarify the critical points for optimizing RO water quality. There existed no measures to prevent contamination in the heat-labile RO water system. The storage tank was significantly contaminated and had to be replaced with a new one equipped with a sampling port and water drainage system. Additional filters and an UV treatment lamp were installed. The whole system disinfection started 1.5 years later using a peracetic acid-based compound after confirming the material compatibility. Operator errors occurred when a new water engineer took over the duty from his predecessor. There were neither standard operating procedures (SOPs) nor on-the-job training. The new water engineer had failed to disinfect the sampling port and water drainage system. Rothia mucilaginosa was cultured from the RO water. It is a resident in the oral cavity and upper respiratory tract. This implied the possible failure of sanitary procedures in the system maintenance. The Ishikawa Fishbone diagram was useful for this study. It suggests that water systems should be designed with plans for system maintenance taken into account. It also suggests that SOP and on-the job training are essential in order to avoid operator errors.


Assuntos
Desinfetantes , Qualidade da Água , Desinfecção/instrumentação , Estudos Longitudinais , Osmose , Instrumentos Cirúrgicos/microbiologia , Purificação da Água
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