Proceedings of resources for optimal care of acute care and emergency surgery consensus summit Donegal Ireland.

BACKGROUND: Opportunities to improve emergency surgery outcomes exist through guided better practice and reduced variability. Few attempts have been made to define optimal care in emergency surgery, and few clinically derived key performance indicators (KPIs) have been published. A summit was therefore convened to look at resources for optimal care of emergency surgery. The aim of the Donegal Summit was to set a platform in place to develop guidelines and KPIs in emergency surgery. METHODS: The project had multidisciplinary global involvement in producing consensus statements regarding emergency surgery care in key areas, and to assess feasibility of producing KPIs that could be used to monitor process and outcome of care in the future. RESULTS: Forty-four key opinion leaders in emergency surgery, across 7 disciplines from 17 countries, composed evidence-based position papers on 14 key areas of emergency surgery and 112 KPIs in 20 acute conditions or emergency systems. CONCLUSIONS: The summit was successful in achieving position papers and KPIs in emergency surgery. While position papers were limited by non-graded evidence and non-validated KPIs, the process set a foundation for the future advancement of emergency surgery.

Management of severe thoracic impalement trauma against two-wheeled horse carriage: a case report and literature review.

Thoracic injuries in general are of great importance due to their high incidence and high mortality. Thoracic impalement injuries are rare but severe due to the combination of cause, effect and result. This study's primary objective is to report the case of a young man who was impaled by a two-wheeled horse carriage shaft while crashing his motorcycle in a rural zone. An EMT-B ferry was called at the crash scene and a conscious patient was found, sustaining a severe impalement injury to the left hemithorax, suspended over the floor by the axial skeleton with the carriage shaft coming across his left chest. As a secondary objective, a literature review of thoracic impalement injuries is performed. Cases of thoracic impalement injury require unique and individualized care based on injury severity and affected organs. Reported protocols for managing impalement injuries are entirely anecdotal, with no uniformity on impaled patient's approach and management. In penetrating trauma, it is essential not to remove the impaled object, so that possible vascular lesions remain buffered by the object, avoiding major bleeding and exsanguination haemorrhage. Severed impaled thoracic patients should be transferred to a specialist centre for trauma care, as these lesions typically require complex multidisciplinary treatment. High-energy thoracic impalement injuries are rare and hold a high mortality rate, due to the complexity of trauma and associated injuries such as thoracic wall and lung lesions. Modern medicine still seems limited in cases of such seriousness, not always with satisfactory results.

Penetrating bladder trauma: a high risk factor for associated rectal injury.

Demographics and mechanisms were analyzed in prospectively maintained level one trauma center database 1990-2012. Among 2,693 trauma laparotomies, 113 (4.1%) presented bladder lesions; 51.3% with penetrating injuries (n = 58); 41.3% (n = 24) with rectal injuries, males corresponding to 95.8%, mean age 29.8 years; 79.1% with gunshot wounds and 20.9% with impalement; 91.6% arriving the emergence room awake (Glasgow 14-15), hemodynamically stable (average systolic blood pressure 119.5 mmHg); 95.8% with macroscopic hematuria; and 100% with penetrating stigmata. Physical exam was not sensitive for rectal injuries, showing only 25% positivity in patients. While 60% of intraperitoneal bladder injuries were surgically repaired, extraperitoneal ones were mainly repaired using Foley catheter alone (87.6%). Rectal injuries, intraperitoneal in 66.6% of the cases and AAST-OIS grade II in 45.8%, were treated with primary suture plus protective colostomy; 8.3% were sigmoid injuries, and 70.8% of all injuries had a minimum stool spillage. Mean injury severity score was 19; mean length of stay 10 days; 20% of complications with no death. Concomitant rectal injuries were not a determinant prognosis factor. Penetrating bladder injuries are highly associated with rectal injuries (41.3%). Heme-negative rectal examination should not preclude proctoscopy and eventually rectal surgical exploration (only 25% sensitivity).

Trypanosoma cruzi: altered parasites after in vitro treatment with gangliosides, a therapeutic agent in experimental Chagas' disease.

Biochemical and structural modifications were investigated in axenic cultured Trypanosoma cruzi after treatment with gangliosides. Fluorescence anisotropy showed dose dependent increments in parasite membranes of ganglioside treated epimastigotes. NADP-GDH activity increased in parasites treated at day 4 (13%), 7 (137.2%), and 14 (28.50%) while NAD-MDH but decreased from day 7 to 21 (-5.74%, -32.22%, -27.92%). Treated parasites presented electron-lucent vacuoles opposite to the cytostoma, multilamellar bodies and dilated mitochondrion cristae, disorganized kinetoplast and altered heterochromatin structure. Gangliosides inhibited fusogenic ability (80%) and PLA2 activity (>75%) from the parasite. The same occurred with anti-PLA2 antibodies. Trypomastigotes suffered loss of cytoplasmic material and organelles when GM1 was present in culture medium. We propose that exogenous gangliosides produced: altered lipid order, inhibited membrane enzymes, the parasite energy source shifted from glucose to amino acids, ending on a structural transformation which signals parasite cell death.

Androgenic action of Tinospora cordifolia ethanolic extract in prostate cancer cell line LNCaP.

AIM OF THE STUDY: Recently, Tinospora cordifolia (TC) was shown to affect prostate growth in rats. It is not known whether this is a direct effect of TC or whether it is induced by altered hormone release. To investigate the actions of TC on the prostate, human LNCaP cells were exposed to an ethanolic extract of TC. MATERIALS AND METHODS: LNCaP cells were incubated with the test substances for 48 h. Proliferation was measured by MTT test and prostate-specific antigen (PSA) secretion was determined with ELISA. RESULTS: TC showed a dose-dependent stimulation of proliferation of LNCaP cells. Co-incubation with the anti-androgen flutamide (FLU) reversed the TC-induced stimulation of PSA secretion. CONCLUSIONS: The reference compound dihydrotestosterone (DHT) caused a significant increase of growth of LNCaP cells. Similarly, TC stimulated proliferation of these prostate cells. The anti-androgen FLU reversed the increase of PSA release caused by either DHT or TC. Thus, we suggest that TC may contain androgenic compounds, which appear to act via androgen receptor (AR).

Spearmint induced hypothalamic oxidative stress and testicular anti-androgenicity in male rats - altered levels of gene expression, enzymes and hormones.

Mentha spicata Labiatae, commonly known as spearmint, can be used for various kinds of illnesses in herbal medicines and food industries. One of the prominent functions of this plant extract is its anti-androgenic activity. The present study investigated the probable correlation between oxidative stress in hypothalamic region and anti-androgenic action of this plant's aqueous extract on rats. Decreased activities of enzymes like superoxide dismutase, catalase, glutathione peroxidase and glutathione reductase in hypothalamus of treated rats indicated spearmint induced oxidative stress. Further RT-PCR and immunoblot analysis demonstrated the decreased expression of some of the steroidogenic enzymes, cytochrome P450scc, cytochrome P450C17, 3beta-Hydroxysteroid dehydrogenase (3beta-HSD), 17beta-Hydroxysteroid dehydrogenase (17beta-HSD) and other related proteins like, steroidogenic acute regulatory protein, androgen receptor and scavenger receptor class B-1. Further, in vitro enzyme assays demonstrated depressed activities of testicular 3beta-HSD and 17beta-HSD enzymes. Histopathology indicated a decreased sperm density in cauda epididymis and degeneration of ductus deference. Our study suggested that spearmint probably induced oxidative stress in hypothalamus resulting in decreased synthesis of LH and FSH which in turn down-regulated the production of testicular testosterone through the disruption of a number of intermediate cascades.

Evaluation of the antiosteoporotic potential of Tinospora cordifolia in female rats.

UNLABELLED: The available courses of therapy to osteoporosis in menopausal women are limited by several side effects generated. A need therefore arises to explore herbal alternatives that are effective and safe. OBJECTIVE: Present animal studies were conducted to investigate the potential of Tinospora cordifolia (TC) ethanolic stem extract as an antiosteoporotic agent. METHODS: Three-month-old female Sprague-Dawley rats were either ovariectomized (ovx) or sham operated and treated with vehicle (benzyl benzoate:castor oil; 1:4), E(2) (1 microg/day) or TC (10, 50, 100 mg/kg b.wt) subcutaneously for 4 weeks. At the end of experiment bone mineral density of tibiae was measured by quantitative computer tomography. Serum was analyzed for the activity of alkaline phosphatase and levels of osteocalcin, cross-laps and lipids. Uterus and mammary gland were processed for histological studies. RESULTS: Ovx rats treated with TC (10 mg/kg b.wt) showed an osteoprotective effect as the bone loss in tibiae was slower than ovx controls. Serum osteocalcin and cross-laps levels were significantly reduced. All the above effects of TC were much milder than those produced by E(2). Alkaline phosphatase activity was higher in TC treatment groups. Total cholesterol and LDL levels remained unaltered but HDL levels were significantly lowered with TC (50 mg/kg b.wt) treatment. Uterus and mammary gland showed no signs of proliferation after treatment with TC extract. CONCLUSION: TC extract showed estrogen like effects in bone but not in reproductive organs like uterus and mammary gland. Thus, this study demonstrates that extract of T. cordifolia has the potential for being used as antiosteoporotic agent.

Phospholipase-C sensitive GPI-anchored proteins of goat sperm: possible role in sperm protection.

The role of glycosylphosphatidylinositol (GPI)-anchored sperm proteins in reproduction has been investigated. SDS-polyacrylamide gels (PAGE) analysis of goat sperm (Capra indica) indicated that several GPI-anchored proteins were released by phosphatidylinositol-specific phospholipase-C (PI-PLC) treatment. The distribution of this category of PI-PLC-sensitive GPI-anchored proteins on the surface of sperm was examined by indirect immunofluorescence. The fluorescence microscopic study clearly demonstrated that the PI-PLC-sensitive GPI-anchored proteins are confined predominantly to the head region of goat sperm. Further experiments were conducted on intact and PI-PLC treated sperm in order to decipher the function of GPI proteins. Co-incubation of sperm with peritoneal macrophages led to the enhanced phagocytosis of PI-PLC treated sperm by macrophages compared with the untreated intact sperm. Transmission electron micrographs of the macrophages acquired from the phagocytosis assay are provided to corroborate the same. From the results obtained it is inferred that one or more of the PI-PLC-sensitive GPI-anchored proteins on the sperm surface could act as protection factor(s) that shield the sperm from macrophages.

A comprehensive evaluation of the reproductive toxicity of Quassia amara in male rats.

Chloroform extracts of the bark of Quassia amara in different dilutions was used to assess its impact on the male reproductive system of albino rats. Single daily intramuscular injections of the extract for 15 days resulted in a significant reduction in the weight of testis and epididymis but not that of the seminal vesicles and prostate (all lobes). A marked decrease in the sperm count, motility, viability was also observed in sperm collected from the cauda epididymis of treated animals. A number of abnormalities like double heads, double tails, detached heads and fragile tails were frequently seen. Epididymal alpha-glucosidase activity was drastically reduced. However, prostatic acid phosphatase activity and citric acid levels and seminal vesicle fructose concentrations remained unchanged following treatment. Thus, it appears that the prime site of action is at the level of both the testis and the epididymis. Examination of the blood showed that cell counts and hemoglobin levels were in the normal range. Bilirubin, SGPT, SGOT, protein and urea were also not altered by the herbal extract. From the selective action on the male reproductive tract we suggest that the chloroform extract of the bark of Quassia amara has potential for use as an antifertility agent.

Characterization of biofilm formed on intrauterine devices.

PURPOSE: Intrauterine device (IUD) is one of the most convenient contraceptive procedures used by women of Asian and African countries. Previous surveys have revealed that 75% of the IUDs recovered from patients suffering from reproductive tract infections (RTIs) were covered with a consortium of microbes. This study was designed to characterize these microbes and recommend remedial measures. METHODS: Quantitative measurement of biofilm formation was assessed by a microtitre plate assay on 86 samples of microorganisms dislodged from IUDs of patients with RTIs. Susceptibility of biofilm to various antimicrobial agents was also quantified. Scanning electron microscopy (SEM) was used to scrutinize the microorganisms adherent to IUDs. RESULTS: The organisms associated with IUDs were predominantly composed of Staphylococcus aureus (16%), Staphylococcus epidermidis (18%), Pseudomonas aeruginosa (5%), Escherichia coli (27%), Neisseria gonorrhoeae (2%), Candida albicans (20%) and Candida dubliniesis (12%). SEM studies indicated that these organisms were organized into biofilms. Studies on the in vitro adherence pattern by crystal violet staining on 96 well microtitre plates revealed that the biofilms were stably established after 60 hours. These biofilms are resistant to an array of antibiotics tested. CONCLUSION: Biofilm formation may be one of the major causes for persistent infection and antibiotic resistance in IUD users.

N-acetyl beta-D-glucosaminidase is not attached to human sperm membranes through the glycosylphosphatidyl inositol (GPI)-anchor.

AIM: The mode of anchorage of N-acetyl beta-D-glucosaminidase (NAGA) on human ejaculated sperm was investigated. METHODS: Sperm plasma membrane was prepared by discontinuous sucrose gradient centrifugation from human sperm. NAGA was solubilized from these membranes by two detergents: octyl-glycoside and triton X-100. In separate studies, the release of the enzyme from the sperm membrane preparation by phosphatidylinositol specific phospholipase C (PI-PLC) was also examined. RESULTS: NAGA activity was detected on sperm membranes isolated from human ejaculates. The pattern of the enzyme solubilization by detergents indicated that the enzyme was an integral protein of sperm membrane. NAGA was not released from the sperm membranes by PI-PLC treatment. CONCLUSION: The evidence presented strongly suggests that human sperm membrane bound NAGA is not attached via the GPI anchor.

Plant natural products active against snake bite--the molecular approach.

The article surveys the substances identified in plants reputed to neutralize the effects of snake venoms. Protective activity of many of them against the lethal action of the venom of the jararaca (Bothrops jararaca) snake was confirmed by biological assays. It was shown that all belong to chemical classes capable of interacting with macromolecular targets--receptors and enzymes. In a few cases it has been shown that exogenous natural micromolecules can mimic the biological activity of endogenous macromolecules. From the evidence presented, it can be inferred that micromolecules which neutralize the action of snake venoms mechanistically replace endogenous antitoxic serum proteins with venom neutralizing capacity such as produced by some animals.

Anti-inflammatory and immunologically active polysaccharides of Periandra mediterranea.

Three polysaccharides, glucans with mean M(r)'s of 1.5 x 10(5), 3.6 x 10(4) and 2.1 x 10(4), were isolated from dried roots of Periandra mediterranea by fractionation on Sephacryl S-300 HR and Sephadex G-25. Chemical and spectroscopic studies indicated that they have a highly branched glucan type structure composed of alpha-(1-->4) linked D-glucopyranose residues with both (3-->4) and (4-->6) branching points. The polysaccharides enhance phagocytosis in vivo, and exhibit anti-inflammatory activity.

Ganoderma lucidum: partial characterization of spore and whole body antigenic extracts.

This study focused on the characterization of antigenic/ allergenic profiles of Ganoderma lucidum spore and whole body preparations. Whole body G. lucidum contained higher protein to carbohydrate ratio whereas it was less than one for spore extract. Isoelectric focusing showed 12 and 11 bands in acidic pH range (pI 3.5-6.5) for G. lucidum spore and whole body, respectively, while SDS-PAGE showed 8 and 23 fractions, respectively, in molecular weight range of 12.8-75.0 kD. The prominent protein fractions of G. lucidum spores were 19.4, 22.8 and 23.8 kD, whereas for G. lucidum whole body, 13.2, 14.7, 18. 7, 21.5 and 23.5 constituted major fractions. Immunoblotting with 41 individual serum samples revealed 21.8, 23.8, 19.4 and 20.0 kD to be major allergenic protein fractions of G. lucidum spores. The same using G. lucidum whole body and 26 individual serum samples identified several fractions of 17.0, 17.5, 18.5, 22.0, 23.8, 42.0, 44.0, 56.0 and 69.0 kD as major allergens. The compiled data suggest that there are common as well as specific allergenic components in two G. lucidum extracts studied.

Changes in Trypanosoma cruzi phospholipid turnover induced by parasite contact with cell membranes.

To investigate the possibility that cell contact could initiate a series of signals in both the host cell and the flagellate protozoan Trypanosoma cruzi, we studied [32P]-phospholipid turnover during parasite interaction with cellular membranes in vitro. Lipid alterations were produced in the parasite during the initial period of contact with the plasma membranes of human erythrocytes. In the presence of calcium an increment in phosphatidylethanolamine was observed with a concomitant decrease in phosphatidic acid fractions, whereas these modifications were not observed in the absence of calcium. There was an evident decrease in phosphatidylcholine and a shift in the phosphatidylinositol/lysophosphatidylethanolamine fraction among the phospholipids of major turnover in the absence or presence of calcium. Among the minor labeled species, lysophosphatidylcholine reached levels that duplicated control values, whereas the amounts of lysophosphatidylinositol, phosphatidylinositol 4-phosphate, and phosphatidylinositol 4,5-bisphosphate diminished by over 50%. All of these variations indicate that the parasite's contact with plasma membranes induces changes involving T. cruzi phospholipids and suggest the participation of these compounds in the activation of intracellular mechanisms that might be important during the life cycle of this parasite.

Inductively coupled plasma emission spectroscopic and flame photometric analysis of goat epididymal fluid.

AIM: The elemental composition of the epididymal luminal fluid (ELF) in adult goat (Capra indica) was investigated. METHODS: ELF was collected by micropuncture from twelve sites along the epididymal duct. The elemental contents was analyzed with inductively coupled plasma (ICP) emission spectroscopy, a microanalytical technique that can simultaneously measure many elements in minute volumes of sample. The Na and K concentrations were determined by flame photometry. RESULTS: ICP spectroscopy showed the presence of copper, calcium, nickel, iron, magnesium, chromium, titanium and zinc in ELF, with fluctuating levels at different sites along the length of the epididymis. Cadmium, cobalt, lead and manganese were not found. The Na+/K+ ratio was seen to be higher at the initial segments of the epididymis and lower at the distal. CONCLUSION: It is proposed that the observed characteristic distribution of elements in ELF may have far reaching implications in sperm maturation and storage known to occur in the epididymis.

Fomes pectinatis: an aeroallergen in India.

This work is focused on the aerobiology and allergenicity of Fomes pectinatis in India. The atmospheric concentration of Fomes basidiospores was recorded and the antigens were prepared from spore (FSE) and whole body (FWBE) materials. The intradermal (ID) and prick (PT) skin tests were conducted on 172 patients having respiratory allergy. The period from July to October has been recorded as having a higher concentration of Fomes spores. The maximum counts (67 spores/m3) were observed from the North Delhi site in the month of July, 1989, compared with 550 spores/m3 in the South Delhi site. Marked skin positivity (2+ and above) varied from 9.8% to FSE to 22% to FWBE. Nine out of twelve ID positive patients (2+ to 3+) to FSE also gave PT positive response. For FWBE, similar ID and PT response was obtained in 80% of cases. The soluble protein content of FSE was 0.37 mg/ml, whereas, for FWBE it was 0.70 mg/ml. It was observed through ELISA that almost all patients had significantly raised FP specific IgE levels in their sera. The current study, therefore, indicates that Fomes pectinatis may be a prevalent aeroallergen in India.

Ganglioside treatment of acute Trypanosoma cruzi infection in mice promotes long-term survival and parasitological cure.

Ganglioside treatment of mice during their acute infection with Trypanosoma cruzi promoted long-term survival and clearance of parasites from the bloodstream and organs. Additionally, such treatment completely prevented the clinical manifestations of the infection, and progression into the chronic stages of the disease, for at least 18 months post-infection. Trypanosoma cruzi must invade nucleated cells to survive and reproduce within the mammalian host, and it has been suggested that ganglioside treatment inhibits the parasite's phospholipase A2 enzymes (PLA2), which are involved in membrane destabilization. However, since total brain gangliosides were not toxic to the parasite, either in xenic or axenic cultures, it seems unlikely that their action in vivo relates to their inhibition of PLA2. Other possible mechanisms of action are discussed.