The Journal of surgical research
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Lung contusion (LC) from blunt thoracic trauma is a clinically-prevalent condition that can progress to acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Patients with LC are at risk for gastric aspiration at the time of trauma, but the combined insults have not been well-studied in animal models. This study tests the hypothesis that concurrent gastric aspiration (combined acid and small gastric particles, CASP) at the time of trauma significantly increases permeability injury and inflammation compared with LC alone, and also modifies the inflammatory response to include distinct features compared with the aspiration component of injury. ⋯ Concurrent gastric aspiration can exacerbate permeability lung injury and inflammation associated with LC, and also generates a modified inflammatory response compared with aspiration alone. Unwitnessed gastric aspiration has the potential to contribute to more severe forms of LC injury associated with progression to ALI/ARDS and pneumonia in patients with thoracic trauma.
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Liver ischemia-reperfusion (I/R) injury is one of the most serious complications of hepatic surgery. However, no effective treatment is yet clinically available. Although neutrophil elastase inhibitor (NEI) has been used clinically in acute lung injury, the effect of NEI on leukocyte dynamics in the liver microcirculation after hepatic I/R remained unclear. The purpose of this study was to use intravital microscopy (IVM) to evaluate the effect of NEI on leukocyte dynamics in the liver microcirculation after hepatic I/R. ⋯ Administration of sivelestat before ischemia effectively suppressed the activation of leukocytes and lipid peroxide, and it consequently prevented hepatic I/R injury.
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Few studies have analyzed the impact of mentoring on general surgical graduates' future career choices. We attempted to characterize the impact mentoring had on choices made by graduates from our residency program regarding surgical subspecialty training. ⋯ Mentored surgical residency graduates were likely to enter the same specialty and practice type as their mentor. Also, the timing of identifying a mentor was strongly correlated with future practice type. With increasing concerns about "the impending disappearance of the general surgeon" along with increasing growth in surgical sub-specialization, it is essential that all types of surgeons provide early and sustained mentorship to medical students and residents to help shape the future of surgery.
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The use of Dakin's solution on open wounds remains controversial in clinical practice. Here we investigated the effect of Dakin's solution on collagen degradation and fibroblast migration using a dermal equivalent. ⋯ Collagen degradation and fibroblast migration is affected by the concentration of Dakin's solution, the presence or absence of serum, time exposure and temperature. Use of Dakin's solution in clinical settings should take these findings into consideration in clinical practice.
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Comparative Study
Different tissue distribution of paclitaxel with intravenous and intraperitoneal administration.
Paclitaxel is considered to be suitable for disseminated cancer in the peritoneal cavity because of its high molecular weight and lipophilic characteristics. However, the difference in pharmacokinetics of paclitaxel after intraperitoneal (i.p.) and intravenous (i.v.) administration is not fully defined. Here, we investigated the tissue concentration of paclitaxel in various organs at various time points after i.p. or i.v. administration. ⋯ Compared with i.v. administration, paclitaxel concentration was maintained at a high level in the whole body by i.p. administration. Repeated i.p. paclitaxel can produce more marked clinical effects than i.v. administration for metastatic lymph nodes and primary lesions as well as peritoneal dissemination.