Anesthetic management of conjoined twins undergoing one-stage surgical separation: A single center experience.

OBJECTIVE: To summarize our experience in the anesthetic management of conjoined twins undergoing one-stage surgical separation. METHODOLOGY: Medical records of conjoined twins admitted to our hospital for treatment and considered for surgical separation from 1996 to present were retrospectively reviewed. Four cases of conjoined twins underwent one-stage surgical separation under general anesthesia. Preoperative evaluation was performed to determine the extent of anatomical conjunction and associated anomalies. Anesthesia was simultaneously induced in all conjoined twins. The intubation procedure was successfully performed with the head slightly rotated to each baby's side, followed by the administration of vecuronium. Anesthetic agents were administered according to the estimated weight of each baby. One case of conjoined twins underwent surgical separation with cardiopulmonary bypass due to shared hearts. Results : All conjoined twins were successfully separated. No significant respiratory or cardiac events occurred during surgery except for one twin, which died after separation because of complicated congenital heart disease. Conclusions : Accurate preoperative evaluation, respiratory and circulatory management, and close cooperation of the multidisciplinary team are important aspects of anesthetic management of conjoined twins surgery.

Low concentrations of corticosterone exert stimulatory effects on macrophage function in a manner dependent on glucocorticoid receptors.

Endogenous glucocorticoids (GCs) have both stimulatory and suppressive effects on immune cells depending on the concentration. However, the mechanisms underlying the stimulatory effects of GCs remain elusive. Rat peritoneal macrophages were treated with different concentrations of corticosterone (0, 30 nM, 150 nM, and 3 µ M). To inhibit the glucocorticoid receptor (GR) activity, macrophages were preincubated with the GR antagonist RU486 (mifepristone, 10 µ M) for 30 min before treatment with corticosterone (150 nM). In the absence of immune stimuli, the chemotactic and phagocytic activities of macrophages were markedly enhanced by low concentrations of corticosterone (30 and 150 nM) when compared with vehicle-treated controls. However, these effects were not observed at a high concentration of corticosterone (3 µ M). Furthermore, blocking GR activity inhibited 150 nM corticosterone-enhanced chemotaxis and phagocytosis of macrophages. Meanwhile, after treatment with corticosterone (150 nM) for 1 h and 3 h, GR protein expression increased to 1.4- and 2.2-fold, respectively, compared to untreated macrophages. These effects were inhibited by RU486. However, mineralocorticoid receptor (MR) protein expression was not influenced by 150 nM corticosterone. These results demonstrate that low concentrations of corticosterone exert stimulatory effects on macrophage function in the absence of immune stimuli, and GR is at least partially responsible for these effects.

Exogenous norepinephrine correlates with macrophage endoplasmic reticulum stress response in association with XBP-1.

BACKGROUND: The regulation of neuroendocrine hormones on the innate immune responses remains controversial. This report investigated the effects of exogenous norepinephrine with respect to macrophage function as well as to elucidate the underlying mechanism. MATERIALS AND METHODS: The adherence, chemotaxis, phagocytosis, and cytokine production of macrophages were observed in the presence of increasing concentrations of norepinephrine. The expression of macrophage glucose response protein 78 (GRP78), X-box binding protein 1 (XBP1), activating transcription factor 6 (ATF6), and C-EBP homologous protein (CHOP) in macrophages was determined. The lentiviral vector pGCL-GFP-siXBP1 was cloned by inserting the annealed oligonucleotides encoding shRNAs specific for XBP1. RESULTS: Norepinephrine exerted immunostimulatory effects on macrophage at low concentrations, while partial effects were observed at high concentrations. Low-dose norepinephrine induced an endoplasmic reticulum stress response, which was correlated with the immunostimulatory activities of norepinephrine. Levels of mRNA expression of XPB1, but not ATF6 or CHOP, was significantly increased only by low concentrations of norepinephrine. Inhibition of XBP1 expression with siRNA treatment significantly inhibited the immunostimulatory effects of low concentrations of norepinephrine. CONCLUSIONS: Our data convincingly indicated that norepinephrine exerted immunostimulatory actions on macrophages at low concentrations, suggesting that the underlying mechanisms are related to endoplasmic reticulum stress via XBP1.

The epidemiological analyses of trauma patients in Chongqing teaching hospitals following the Wenchuan earthquake.

BACKGROUND: Well-equipped comprehensive hospitals may provide better emergency and patient services for the recovery of injured patients from the earthquake zone. This study aimed to provide an overview of injuries among the patients admitted to the six teaching hospitals in Chongqing, China, after the 2008 Wenchuan earthquake. MATERIALS AND METHODS: The medical records of 533 earthquake victims who were treated and followed-up by the six hospitals were analysed retrospectively. Patients' demographic data, diagnosis, microbiological assessment and dispositions were reviewed. RESULTS: Of the 533 patients, 45.0% patients had an Injury Severity Score (ISS) below 8, 41.1% had an ISS between 9 and 14 and 13.9% had an ISS above 15. The patients were classified based on their fracture sites as follows: head and neck (7.9%), face (1.3%), chest (21.4%), abdomen and pelvis (15.2%), limb and pelvis (58.9%) and body surface (38.5%). Of the 533 patients, 41.6% had a single fracture site, 32.1% had two combined fracture sites and 26.3% had more than three combined fracture sites, while 32 (6.0%) patients suffered from amputation, 3.9% suffered from crush syndrome and 52.7% underwent surgical operations at the hospitals. Seventy-nine (14.8%) patients suffered from infections, including 87.3% of pre-hospital infections. The results from bacterial culture and antibiotic susceptibility assays showed that the infectious bacteria mainly involved Escherichia coli, Staphylococcus aureus, Staphylococcus haemolyticus, Baumanii, Aerobacter cloacae, Pseudomonas aeruginosa, C type chain coccus and Bacillus aerogenes capsulatus. The sensitivity of various bacterial strains to antibiotics did not exhibit obvious changes, except that the previously multi-drug-resistant hospital bacteria were sensitive to antibiotics. CONCLUSIONS: For emergency conditions after a catastrophe, comprehensive hospitals must be prepared to meet the massive numbers of severely injured patients. Trauma patients from delayed rescue and admission should be given broad-spectrum antibiotics, such as cephalosporin and macrolide antibiotics. The selection of antibiotics in the combination therapy, as described in this study, may greatly enhance the effectiveness of early specific treatments and prevent severe trauma complications in future natural disasters.