Bacterial contamination of bone allografts in the tissue banks: a systematic review and meta-analysis.

Bone allografts are harvested and transplanted under sterile conditions. However, the risk of bacterial contamination of grafts during these processes is a health concern. Bioburden testing and bacterial contamination detection are conducted to ensure allograft sterility. The present study aimed to determine the incidence of bacterial contamination in bone allografts based on different classifications. A PROSPERO registration number was received for the study. Systematic searches were conducted in PubMed and EMBASE databases with relevant keywords from January 2000 to March 2021. After choosing related studies according to the PRISMA flow diagram, Stata software was used for data analysis. We considered I2˃50% as heterogeneity between studies. The overall incidence of bacterial contamination was 12.6% (95% confidence interval 0.100, 0.152) among 19,805 bone allografts of 17 studies. The bacterial contamination rate among bone allografts was 10.8% before 2010 and 14.7% from January 2010 to March 2021. The contamination frequency in Asia, Europe, and Australia was 11.5%, 14.3% and 5.2%, respectively. Bone contamination rates were higher in cadaver donors (19.9%), retrieval time sampling (13.5%), and swab samples (13.2%) compared with those in living donors (7.5%), implantation time sampling (6.9%), and bone fragments cultures (6.3%). Bacterial contamination was recovered 24.4%, 19.7%, 13.2%, and 21% from tibia, fibula, femoral, and other bones, respectively. Staphylococcus spp. was the predominant isolated bacteria from bones (63.2% of all isolated genera), followed by Propionibacterium spp. (10.6%). In conclusion, the high contamination of bone allografts is a health concern, indicating the need for more health monitoring and improvement of standards.

Hemodynamic Changes and Early Recovery of Liver Graft Function after Liver Transplantation.

BACKGROUND: Patients with liver cirrhosis experience a hyperdynamic circulation. OBJECTIVE: To investigate the association between early hemodynamic changes and graft function after liver transplant. METHODS: Those patients who underwent liver transplantation in 2016 were enrolled in the study. Liver function indices measured in postoperative days (POD) 1, 3, 5, 7, 9, and 11 along with hemodynamic indices including pulse rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and central venous pressure (CVP) measured q6h in the first 3 days after transplantation were recorded. RESULTS: 57 deceased-donor liver recipients with a mean±SD age of 41.4±11.8 years including 33 (58%) males were enrolled in the study. The mean±SD aspartate and alanine aminotransferases, alkaline phosphatase, and lactate dehydrogenase were significantly decreased from 1879±670.5, 369.2±40.5, 174.9±18.8, and 1907.6±323.1 U/L in POD 1 to 37.2±10.7, 243.4±37.3, 207.5±19.5, and 382.4±59.8 U/L in POD 3, respectively (p=0.028, <0.001, 0.002, and 0.001, respectively). During this period, the pulse rate of the patients was significantly (p<0.001) decreased by a median (IQR) of 28.7 (8.5-39.7) beats/min; it was significantly correlated with a decrease in serum hepatic enzymes activities during this period. SBP, DBP, and CVP were significantly increased (p<0.001 for all) during this period. Liver graft function improved significantly earlier in those patients with a mean pulse rate of 87 beats/min compared with others (p=0.03). CONCLUSIONS: There may be an association between changes of hemodynamic indices, especially reduction of pulse rate, and improved graft function early after liver transplantation.

Safety and Efficacy of Early Oral Feeding after Liver Transplantation with Roux-en-Y Choledochojejunostomy: A Single-Center Experience.

BACKGROUND: Early oral feeding, as one of the most important components of multimodal strategies referred to as Enhanced Recovery After Surgery (ERAS), is now widely adopted for optimization of post-operative recovery of surgical patients. OBJECTIVE: To assess ERAS outcome in patients who underwent liver transplantation in our center. METHODS: In a prospective study, patients who underwent liver transplantation from April 2015 to June 2018 at Imam Khomeini Hospital Complex, affiliated to Tehran University of Medical Sciences, Tehran, Iran, were enrolled in this study. Serum albumin, total iron-binding capacity (TIBC), and course of hospital stay were assessed. RESULTS: 39 (23 male) patients who underwent choledochojejunostomy with Roux-en-Y anastomosis for liver transplantation were enrolled. The mean±SD pre-operative serum albumin and TIBC levels of patients were 3.0±0.6 (range: 1.9-4.1) g/dL and 304±75 (range: 154.0-437.0) µg/dL, respectively. The mean±SD time between the end of operation and starting oral feeding was 11.6±1.8 (range: 9.0-15.0) hours. All patients tolerated early oral feeding with liquids followed by solid foods; no vomiting reported in patients. Overall, patient survival rates at one month and three months were 89.7% and 89.7%, respectively. In our study, no leak of anastomosis was reported. CONCLUSION: There was no major harm for ERAS after liver transplantation and it might be even helpful as in colorectal surgeries. As seen in our study, oral feeding was started as soon as possible after the end of operation in almost all patients and all of them tolerated early oral feeding. No one had vomiting or nausea.

Diabetes and foot burns.

The incidence of diabetes and diabetic foot burns is increasing worldwide. In the present study, we surveyed frequency, morbidity and mortality of diabetic foot burn patients in our centre. The study was a cross-sectional survey with one-year follow up of our adult diabetic patients with lower extremity burns. Data on demographics, cause of burn, time from injury to hospital, TBSA, presence of neuropathy and diabetic foot, treatment plan for controlling blood sugar, smoking, infection, morbidity, co-morbid diseases, amputation and mortality were gathered from patient files. Statistical analysis was done with SPSS 21 software. A p value less than 0.05 was considered significant. Of the 34,300 burn patients seen in a year, 2096 were admitted according to ABA criteria. 47 patients had diabetic foot burn. Half of them had diabetic neuropathy. 48.9% had type I diabetes and 51.1% had type II. 70.2% were male, 29.8% were female. Mean +/- SD age was 58 +/- 14 years; 14 patients were smokers and 40 had co-morbid diseases. Hypertension frequency was 44%, ischemic heart disease 25%, CVA 8.5% and renal failure 6.4%. Half of the patients had uncontrolled blood sugar. Mean +/- SD delay in admission was 2.5±1.5 (days). Mean +/- SD TBSA was 2.4 +/- 1.4%. Mean +/- SD length of stay was 11.4±6.1 (days). 8.5% underwent amputation and there were no deaths. Diabetic foot burn patients delay seeking medical attention, have a longer length of stay, more complications and more amputations than other burn patients (compared with our previous study on burn patients). Prevention and training programs are highly needed to prevent foot burns.

L'incidence du diabète et, concomitamment, des brûlures du pied chez ces patient, est en augmentation dans le monde. Nous rapportons la fréquence, la morbidité et la mortalité des brûlures du pied chez les diabétiques vues dans notre centre. Il s'agit d'une étude en cross-over avec suivi sur 1 an des adultes diabétiques avec une brûlure de l'extrémité distale des membres inférieurs. Nous avons relevé les données démographiques, les comorbidités, la cause et l'étendue de la brûlure, le délai entre brûlure et hospitalisation, le tabagisme, la présence de neuropathie et de pied diabétique, la stratégie d'équilibration glycémique, les infections, la nécessité d'amputation, la mortalité. Les analyses ont été réalisées avec SSPS 21, un p<0,05 étant considéré significatif. Deux mille quatre vingt seize des 34 300 patients vus ont été hospitalisés (en utilisant les critères de l'ABA). Quarante sept diabétiques (48,9% type 1 ; 51,1% type 2) avaient une brûlure de pied. Ils étaient âgés de 58 +/- 14 ans ; 70,2% étaient des hommes (29,8% des femmes). Quatorze étaient fumeurs, 40 avaient une pathologie associée (HTA 44%, coronaropathie 25%, insuffisance rénale 6,4%). La moitié d'entre eux avaient un diabète mal équilibré. Ils étaient admis après 2,5 +/- 1,5 jours et restaient 11,4 +/- 6,1 jours. La surface brûlée était évaluée à 2,4 +/- 1,4%. Une amputation a été nécessaire dans 8,5% des cas, aucun patient n'est mort. Les diabétiques avec un pied brûlé consultent plus tardivement, restent plus longtemps, ont plus de complications et sont amputés plus fréquemment que les autres brûlés (données d'une étude précédente). Des programmes d'éducation et de prévention sont réellement nécessaires vis-à-vis de ces patients.

The Comparison of Biodistribution, Efficacy and Toxicity of Two PEGylated Liposomal Doxorubicin Formulations in Mice Bearing C-26 Colon Carcinoma: a Preclinical Study.

BACKGROUND: Over the past several years, the considerable attention has been progressively given to liposomal formulations of anthracyclines. SinaDoxosome(®) (Exir Nano Sina Company, Iran) is a pegylated liposomal doxorubicin (DOX) which approved by Food and Drug Administration of IRAN for treatment of some types of cancer. The aim of this study was to compare the biodistribution, efficacy, cardiotoxicity and hepatotoxicity of SinaDoxosome(®) with Caelyx(®) in mice bearing C-26 colon carcinoma. METHODS AND RESULTS: Mice tumor size evaluation during the experimental period (28 days) showed comparable therapeutic efficacy of nano-formulations. The biodistribution studies showed no significant difference in DOX tissue concentration between Caelyx(®) and SinaDoxosome(®). DOX induced-ECG changes were not detected in nano-formulations. No significant alteration was found in biochemical indexes of myocardial injury in mice exposed to nano-formulations in comparison with control mice. The tissue oxidative parameters such as lipid peroxidation, glutathione, catalase and superoxide dismutase was significantly changed as the results of free DOX treatment. However, the oxidative status of Caelyx(®) and SinaDoxosome(®) treated animals did not showed any changes. The experiment also revealed that apoptotic pathway was not activated in the heart of mice exposed to nano-formulations. CONCLUSIONS: Although this investigation showed that Caelyx(®) and SinaDoxosome(®) are similar in terms of biodistribution, efficacy and toxicity, appropriate clinical evaluations in patients should be considered.

The role of COX-2 and Ki-67 over-expression in the prediction of pathologic response of rectal cancer to neoadjuvant chemoradiation therapy.

BACKGROUND: The response to neoadjuvant chemoradiotherapy (CRT) is not the same among all cases with advanced rectal cancer. AIMS: This study investigated the association between over-expression of the two molecular markers (Cyclooxygenase-2 [COX-2] and Ki-67) and tumor response to neoadjuvant therapy. MATERIALS AND METHODS: In a retrospective cohort study, 55 patients with stage II-III rectal carcinoma were enrolled. All patients were treated with neoadjuvant therapy (45-50.4 Gy plus Capecitabine) between 2002 and 2009 in our institute. The pretreatment specimens were immunohistochemistry (IHC) stained for COX-2 and Ki-67 markers. The tumor response to neoadjuvant treatment was evaluated using a 5-point tumor regression grade (TRG) system. The induced inflammation and necrosis after CRT were also investigated. Statistical analysis was performed using SPSS version 11.5 and statistical significance was determined at P < 0.05. RESULTS: The pathologic response to neoadjuvant treatment from complete response as (TRG = 1) through no response as (TRG = 5) was found in 10 (22.2%), 8 (17%), 6 (13.3%), 16 (35.6%), and 5 (11.1%) cases. In comparison with poor responders (TRG: 4, 5), patients with good response to neoadjuvant treatment (TRG: 1, 2) were associated with lower pretreatment mean COX-2 staining extent (72.9% vs. 22.8%, P < 0.001) as well as lower mean Ki-67 staining extent (70.7% vs. 28.5%, P < 0.001). High COX-2 staining and high Ki-67 index were significantly associated with more inflammation. CONCLUSIONS: Over-expression of COX-2 and high Ki-67 index were associated with a poorer response to neoadjuvant CRT. These markers might be helpful to define those patients with rectal carcinoma who benefit more from neoadjuvant treatments.

Hydatid cyst of fallopian tube.

Echinococcosis is a common disease in the Middle East region and is in the differential diagnosis of cystic lesions in patients of this area. Liver and lung are commonly involved. Infection of unusual sites can cause difficulties in diagnosis. Here, we present a patient with echinococcal cyst of the fallopian tube. She had abdominal pain and a cystic lesion in adnexa was found by imaging. She underwent surgery and diagnosis of echinococcosis was established.

Regeneration of spermatogenesis in a mouse model of azoospermia by follicle-stimulating hormone and oestradiol.

Busulfan is a chemotherapeutic drug that induces sterility, azoospermia and testicular atrophy. To induce degeneration of spermatogenesis, we used different amounts of busulfan. Adult male C57Bl/6 mice were treated with 15, 30 and 45 mg kg(-1) of busulfan. After 5 weeks, animals had daily injections of 7.5 IU human follicle-stimulating hormone (hFSH) and 12.5 µg kg(-1) oestradiol benzoate (EB), separately or simultaneously. After this time, the animals were killed and blood samples were taken through cardiac puncture. Testes were used for histopathology experiments, DNA flow cytometry and RNA extraction for expression of c-kit and cyclin B1 genes. EB unlike FSH has induced stimulatory effects on spermatogenesis, increased the level of serum testosterone 2-fold and caused a 2-fold increase in the number of haploid cells. The result showed that hFSH with EB multiplied EB stimulatory effects on spermatogenesis up to four times. Expression of c-kit and cyclin B1 genes increased in EB and hFSH+EB groups. These findings suggest that EB regulates spermatogonial stem cells via hFSH. hFSH with EB had synergistic effect on regeneration of spermatogenesis.

Cytotoxic effects of chloroform and hydroalcoholic extracts of aerial parts of Cuscuta chinensis and Cuscuta epithymum on Hela, HT29 and MDA-MB-468 tumor cells.

Previous studies have indicated that some species of Cuscuta possess anticancer activity on various cell lines. Due to the lack of detailed researches on the cytotoxic effects of Cuscuta chinensis and Cuscuta epithymum, the aim of the present study was to evaluate cytotoxic effects of chloroform and hydroalcoholic extracts of these plants on the human breast carcinoma cell line (MDA-MB-468), human colorectal adenocarcinoma cell line (HT29) and human uterine cervical carcinoma (Hela). Using maceration method, different extracts of aerial parts of C. chinensis and C. epithymum were prepared. Extraction was performed using chloroform and ethanol/water (70/30). Total phenolic contents of the extracts were determined according to the Folin-Ciocalteu method. Using MTT assay, the cytotoxic activity of the extracts against HT29, Hela and MDA-MB-468 tumor cells was evaluated. Extracts were considered cytotoxic when more than 50% reduction on cell survival was observed. The poly-phenolic content of the hydroalcoholic and chloroform extracts of C. chinensis and C. epithymum were 56.08 ± 4.11, 21.49 ± 2.00, 10.64 ± 0.86 and 4.81 ± 0.38, respectively. Our findings showed that the chloroform extracts of C. chinensis and C. epithyum significantly reduced the viability of Hela, HT-29 and MDA-MB-468 cells. Also, hydroalcoholic extracts of C. chinensis significantly decreased the viability of HT29, Hela and MDA-MB-468 cells. However, in the case of hydroalcoholic extracts of C. epithymum only significant decrease in the viability of MDA-MB-468 cells was observed (IC50 = 340 µg/ml). From these findings it can be concluded that C. chinensis and C. epithymum are good candidates for further study to find new possible cytotoxic agents.

Biodistribution of amikacin solid lipid nanoparticles after pulmonary delivery.

The main purpose of the present work was studying the biodistribution of amikacin solid lipid nanoparticles (SLNs) after pulmonary delivery to increase its concentration in the lungs for treatment of cystic fibrosis lung infections and also providing a new method for clinical application of amikacin. To achieve this aim, (99m)Tc labelled amikacin was loaded in cholesterol SLNs and after in vitro optimization, the desired SLNs and free drug were administered through pulmonary and i.v. routes to male rats and qualitative and biodistribution studies were done. Results showed that pulmonary delivery of SLNs of amikacin by microsprayer caused higher drug concentration in lungs than kidneys while i.v. administration of free drug caused reverse conditions. It seems that pulmonary delivery of SLNs may improve patients' compliance due to reduction of drug side effects in kidneys and elongation of drug dosing intervals due to the sustained drug release from SLNs.

QuantiFERON-TB Gold In-Tube test for diagnosis of latent tuberculosis (TB) infection in solid organ transplant candidates: a single-center study in an area endemic for TB.

BACKGROUND: The prevalence of Mycobacterium tuberculosis in transplant recipients is estimated to be 50 times higher than in the general population, with a mortality rate of around 40%. Diagnosis and treatment of latent tuberculosis (TB) infection (LTBI) is an essential strategy for TB control. In this study we compared the QuantiFERON-TB Gold In-Tube test (QFT) with the tuberculin skin test (TST) for detection of LTBI in solid organ transplant (SOT) candidates. PATIENTS AND METHODS: Between March 2008 and September 2011, 187 transplant candidates, who were referred to the transplant clinic of Imam-Khomeini Hospital, were enrolled in the study. Patients were screened for LTBI with both QFT and TST. Twenty-three patients (12.3%) were excluded for failure to follow up. Concordance between the 2 tests, and variables associated with test discordance were assessed. RESULTS: The mean age of patients was 40 years (range: 11-65) and male-to-female ratio was 1.2 (88/76). TST and QFT were positive in 26 (15.9%) and 33 (20.1%) patients, respectively. Five cases (3.1%) had indeterminate QFT. Overall agreement between QFT and TST was about 80% (k = 0.32, P-value = 0.0001). CONCLUSION: Considering the fair overall agreement between the 2 tests, and greater ease of the QFT from the patient's point of view, QFT is recommended for detection of LTBI in SOT candidates.

The effects of methanolic, chloroform, and ethylacetate extracts of the Cucurbita pepo L. on the delay type hypersensitivity and antibody production.

Pumpkin, as a dietary plant, has been used in traditional medicine around the world. In addition, during the last decade, antidiabetic, antihypertensive, antitumor, intestinal antiparasitic, antibacterial, anti hypercholesterolemia, anti-inflammatory, immunomodulatory and analgic effects of pumpkin has been reported. The aim of the present study was to determine the effects of different extracts of Cucurbita pepo L. on the immune responses. Methanolic, chloroform and ethylacetate extracts of C. pepo fruits was obtained using percolation method. Mice were used to study the effects of C. pepo extracts on the acquired immunity. Sheep red blood cell (SRBC) was injected (S.C., 1×10(8) cells/ml, 20 µl) and 5 days later, methanolic, chloroform and ethylacetate extracts of C. pepo at diiferent doses (10, 100 and 500 mg/kg), betamethasone and levamisol at equal doses (4 mg/kg) as positive controls and normal saline as a negative control were given i.p. After 1 h SRBC was injected to the footpad (S.C., 1×10(8) cells/ml, 20 ml) and the footpad swelling was measured up to 72 h. To investigate the effects of C. pepo on the innate immunity the same procedure was used, but animals received only one injection of SRBC 1 h after i.p. injection of test compounds. Our findings showed that SRBC induced an increase in the paw swelling with maximum response at 6-8 h. Betamethasone inhibited the paw swelling in both models. In both innate and acquired immunity models, methanolic, chloroform and ethylacetate extracts of C. pepo fruits significantly reduced the paw swelling dose dependently. The data suggest that the pumpkin extracts may have immunomodulatory effects.

Diagnostic Accuracy of Sixty Four Multi-Slice CT Angiography in Assessment of Arterial Cut-Off and Run-Off in Comparison with Surgical Findings.

BACKGROUND/OBJECTIVE: The accurate anatomic mapping and determination of the severity of arterial disease, an important health problem of the elderly, is of great significance. We aimed to determine the diagnostic value of 64-multislice CT angiography (MSCTA) in run-off and cut-off sites of arterial disease. PATIENTS AND METHODS: Throughout the study, MSCTA followed by an operative intervention was carried out on a total of 38 patients with clinical signs and symptoms suggestive of arterial disease (AD) all of whom had the indication for vascular surgery. The mean age of patients was 34±15.86 (range, 23 to 93) years. MSCTA was executed using a 64-slice CT scanner, during the arterial phase of injecting the nonionic, contrast medium with a power injector at the rate of 5 ml/sec into the antecubital vein and exploration and revascularization of peripheral arterial disease was performed intraoperatively. RESULTS: Atherosclerosis and arterial disease, the most common causes of vascular occlusion, were more common in the lower extremities. According to MSCTA findings, the most frequent site of stenosis was the superficial femoral artery. Spearman's correlation coefficient showed a high degree of agreement amongst the raters. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the accuracy of MSCTA compared to surgery were 83.8%, 96%, 96.8%, 81.3% and 89%, respectively. MSCTA findings were compared with surgery as a standard of reference, which showed concordance in the majority of cases (81.6%). Cut-off sites were correctly identified by MSCTA in 97.3% of the patients and the most common sites of discordance were the run-off sites (18.2%). CONCLUSION: MSCTA angiography as a novel diagnostic modality may be a suitable alternative and a viable choice for routine clinical diagnosis.

Doctors' views of attitudes towards peer medical error.

BACKGROUND: This study aims at evaluating doctors' attitudes towards handling medical errors made by their peers. MATERIALS: This cross-sectional questionnaire survey was conducted between April and July 2006 and targeted general practitioners attending continuing medical education programmes in Tehran. A total of 474 doctors were approached, 400 of whom completed the questionnaire. The questionnaire contained a clinical vignette with three hypothetical patient outcomes: near-miss, leading to harm, and leading to death. The participants were asked how they would deal with each case. They were also asked how they would prefer their peers to react when they themselves made a medical error. RESULTS: The most common attitude toward peers' medical errors was reporting it to the original doctor and asking them to disclose it to the patient (near-miss: 63.0%; 95% CI 58% to 68%; leading to harm: 70.0%; 95% CI 65.4% to 74.6%; and leading to death: 62.5%; 95% CI 57.5% to 67.5%). In most cases, doctors expected their peers to report their medical errors to them (92.7%; 95% CI 89.7% to 93.0). About 67% of the participating doctors had encountered a peer's medical error in the past 6 months, although 90% of them had received no or very little training in dealing with this issue. DISCUSSION: The most acceptable approach to dealing with a peer's medical error is to report it to the responsible doctor and encourage them to disclose it to the patient.

Mutation of the histidin residue of the DRH motif in vasopressin V2 receptor expression and function.

BACKGROUND AND THE PURPOSE OF THE STUDY: Vasopressin type 2 receptor (V2R), a G protein coupled receptor (GPCR), plays an important role in the regulation of renal antidiuretic function. The highly conserved DRH motif is essential for G protein signaling of V2R; however its role especially regarding the histidin residue is not fully understood.. METHODS: Site directed mutagenesis was performed with replacements of the histidin to isoleucine by using nested polymerase chain reaction. ELISA was performed for receptor expression assay and the adenylyl cyclase activity assay was performed for functional characterization of DRI mutation on V2R signaling. RESULTS AND MAJOR CONCLUSION: The adenylyl cyclase activity assay in COS-7 cells showed no difference in the amount of cAMP production between the wild type and the mutant V2 receptors. The V2 receptor expression was not changed in the presence of this mutation using ELISA assay. These results suggest that the role of histidin residue is not critical in the V2 receptor function, however further mutagenesis studies are required to define the role of this motif in V2R function.

Knowledge and attitude of donor cardholders toward organ and tissue donation and transplantation in an Iranian tissue bank: a case-control study.

BACKGROUND: Cadaveric organ shortage is the most important obstacle to more widespread provision of transplants. Many factors influence the donation rate: social factors, religion, familial relations, and especially knowledge and attitudes toward organ and tissue donation and transplantation. Increasing public awareness can reform the incorrect beliefs and myths about donation and transplantation. This study investigated knowledge and attitudes of donor cardholders toward organ and tissue donation as well as transplantation. METHODS: This case-control study was performed in 2006 among 178 donor cardholders and the same number of a control group who completed a questionnaire including 23 questions and demographic information. FINDINGS: Knowledge and attitude among the cardholder was significantly greater than the control group (P < .05). We observed a inverse correlation between age and a positive attitude toward donation and transplantation among cardholders. CONCLUSION: This study suggested that the main reasons for refusal to donate organ and tissue were insufficient knowledge and negative attitudes due to misinformation regarding donation and transplantation. We believe that educating and motivating the public via the mass media can increase the rate of consent for organ and tissue donation and transplantation.

Doctors' views of attitudes towards peer medical error.

BACKGROUND: This study aims at evaluating doctors' attitudes towards handling medical errors made by their peers. MATERIALS: This cross-sectional questionnaire survey was conducted between April and July 2006 and targeted general practitioners attending continuing medical education programmes in Tehran. A total of 474 doctors were approached, 400 of whom completed the questionnaire. The questionnaire contained a clinical vignette with three hypothetical patient outcomes: near-miss, leading to harm, and leading to death. The participants were asked how they would deal with each case. They were also asked how they would prefer their peers to react when they themselves made a medical error. RESULTS: The most common attitude toward peers' medical errors was reporting it to the original doctor and asking them to disclose it to the patient (near-miss: 63.0%; 95% CI 58% to 68%; leading to harm: 70.0%; 95% CI 65.4% to 74.6%; and leading to death: 62.5%; 95% CI 57.5% to 67.5%). In most cases, doctors expected their peers to report their medical errors to them (92.7%; 95% CI 89.7% to 93.0). About 67% of the participating doctors had encountered a peer's medical error in the past 6 months, although 90% of them had received no or very little training in dealing with this issue. DISCUSSION: The most acceptable approach to dealing with a peer's medical error is to report it to the responsible doctor and encourage them to disclose it to the patient.

The role of strain variation in BAX and BCL-2 expression in murine bleomycin-induced pulmonary fibrosis.

This study hypothesized that the expression of apoptosis-regulatory genes, such as BCL-2 and BAX may be affected by genetic variation in bleomycin-induced pulmonary fibrosis in C57BL/6 and NMRI mice. Pulmonary fibrosis induced by single intratracheal dose of bleomycin (3 U kg(-1)). After 2 weeks, lung samples were analyzed for collagen deposition, pathological changes and expression of BCL-2 and BAX. The fibrotic lung changes were similar in both strains. The immunohistochemical assay using a biotin-streptavidin technique showed no significant difference in immunoreactivity for BCL-2 protein between the controls and bleomycin-treated C57BL/6 mice. However, in NMRI mice, the expression of BCL-2 was significantly (p<0.05) upregulated in myofibroblasts and neutrophils. The expression of BAX protein was significantly (p<0.05) upregulated in alveolar epithelial cells of both strains and downregulated in myofibroblasts and lymphocytes of the lung tissues of C57BL/6 mice and also in lymphocytes of NMRI mice at 2 weeks after bleomycin instillation. These results confirm the role of BCL-2 and BAX proteins in the pathogenesis of pulmonary fibrosis and suggest that the expression of apoptotic regulatory genes may be specific in different cell types in various strains.

Propofol-alfentanil vs propofol-remifentanil for posterior spinal fusion including wake-up test.

BACKGROUND: Wake-up test can be used during posterior spinal fusion (PSF) to ensure that spinal function remains intact. This study aims at assessing the characteristics of the wake-up test during propofol-alfentanil (PA) vs propofol-remifentanil (PR) infusions for PSF surgery. METHODS: Sixty patients with scoliosis and candidates for PSF surgery were randomly allocated in either alfentanil (PA) or remifentanil (PR) group. After an i.v. bolus of alfentanil 30 microg kg(-1) in the PA group or remifentanil 1 microg kg(-1) in the PR group, anaesthesia was induced with thiopental and atracurium. During maintenance, opioid infusion consisted of alfentanil 1 microg kg(-1) min(-1) or remifentanil 0.2 microg kg(-1) min(-1), in the PA group and the PR group, respectively. All patients received propofol 50 microg kg(-1) min(-1). Atracurium was given to maintain the required surgical relaxation. At the surgeon's request, all infusions were discontinued. Patients were asked to move their hands and feet. Time from anaesthetic discontinuation to spontaneous ventilation (T(1)), and from then until movement of the hands and feet (T(2)), and its quality were recorded. RESULTS: The average T(1) and T(2) were significantly shorter in the PR group [3.6 (2.5) and 4.1 (2) min] than the PA group [6.1 (4) and 7.5 (4.5) min]. Quality of wake-up test, however, did not show significant difference between the two groups studied. CONCLUSION: Wake-up test can be conducted faster with remifentanil compared with alfentanil infusion during PSF surgery.