Comparison of a modified Sugiura procedure with portal systemic shunt for prevention of recurrent variceal bleeding in cirrhosis

BACKGROUND: There is no agreement on the management of patients with cirrhosis and recurrent variceal bleeding after failure of medical or endoscopic treatments or both. Portal systemic shunts are highly effective in preventing rebleeding but are associated with a high incidence of chronic encephalopathy. This study compared the results of a slightly modified Sugiura procedure (esophageal transection plus esophagogastric devascularization plus splenectomy) with those of nonselective portal systemic shunts in patients with previous variceal bleeding. METHODS: Fifty-four patients were included in this randomized controlled study between January 1984 and April 1989. The major end point was chronic encephalopathy. Secondary end points were recurrent variceal bleeding, survival, ascites, and hepatocellular carcinoma. RESULTS: Twenty-seven patients were assigned to each group. The rate of chronic encephalopathy was significantly (p = 0.002) lower after modified Sugiura procedure than after portal systemic shunt. Recurrent variceal bleeding was more frequent after modified Sugiura procedure than after portal systemic shunt, but the difference is not significant. One-, two-, and three-year survival rates were 93%, 81%, and 67%, respectively, in the modified Sugiura group and 78%, 66%, and 39%, respectively, in the portal systemic shunt group (p = 0.044). CONCLUSIONS: These results suggest that the modified Sugiura procedure is better overall than the nonselective portal systemic shunt in the management of patients with cirrhosis and recurrent variceal bleeding. Although the rebleeding rate is higher after the modified Sugiura procedure, this does not seem to affect mortality in these patients.     

Leukemic pleural effusion in B-cell prolymphocytic leukemia

BACKGROUND: Proinflammatory mediators that include tumor necrosis factor-alpha (TNF-alpha) and macrophage inflammatory protein-2 (MIP-2) and anti-inflammatory mediators such as interleukin-10 (IL-10) modulate the immune response to endotoxemia. IL-10 downregulates the production of TNF-alpha and MIP-2. Acute lung injury may occur secondary to neutrophil chemotaxis mediated by chemokine MIP-2. We studied the temporal relationship of TNF-alpha, MIP-2, and IL-10 in rat endotoxemia and correlation of MIP-2 concentrations with acute lung injury. METHODS: Ten ventilated rats were randomized to receive an intravenous infusion of 2 mg/kg Escherichia coli lipopolysaccharide (n = 6) or saline placebo (n = 4). Blood pressure was continuously monitored and arterial blood was obtained for lactate, blood gas, TNF-alpha, IL-10, and MIP-2 measurements at baseline, 2, 4, and 5.5 hours after LPS or saline infusion. RESULTS: Endotoxemia resulted in hypotension, lactic acidemia, and increased alveolar-arterial oxygen gradient (A-a O2 gradient) compared with the placebo group. TNF-alpha, MIP-2, and IL-10 levels were increased 2 hours after endotoxemia. Subsequently, TNF-alpha levels declined while IL-10 and MIP-2 levels remained elevated. Control rats had no significant increase in cytokine production at any time point. MIP-2 concentrations correlated with A-a O2 gradient, an indicator of lung injury (r = 0.56, p < 0.001). CONCLUSIONS: MIP-2, possibly released by TNF-alpha stimulation of macrophages, is associated with acute lung injury possibly by inducing neutrophil chemotaxis. IL-10 may exert its counter-inflammatory response by inhibiting the release of TNF-alpha in endotoxemia.     

Path Flow and Trip Matrix Estimation Using Link Flow Density

A macroscopic model is presented that simultaneously estimates route flows and trip matrices for congested road networks using data on link densities instead of link flows. The advantage of this approach is that it avoids errors that may occur in the individual links’ flow-cost relationships when congestion is heavy. Under the proposed methodology, both the flows and the matrices are estimated by the model using an image of the network such as an aerial photograph in which the number of vehicles on each link can be identified. The model itself is formulated as a maximum entropy optimization problem subject to linear constraints given by vehicle densities on the links, and is validated using analytic examples and traffic microsimulations. The results demonstrate the superiority of the link-density approach over the traditional flow-based method.     

Characterization of a Cutibacterium acnes Camp Factor 1-Related Peptide as a New TLR-2 Modulator in In Vitro and Ex Vivo Models of Inflammation

Cutibacterium acnes (C. acnes) has been implicated in inflammatory acne where highly mutated Christie–Atkins–Munch–Petersen factor (CAMP)1 displays strong toll like receptor (TLR)-2 binding activity. Using specific antibodies, we showed that CAMP1 production was independent of C. acnes phylotype and involved in the induction of inflammation. We confirmed that TLR-2 bound both mutated and non-mutated recombinant CAMP1, and peptide array analysis showed that seven peptides (A14, A15, B1, B2, B3, C1 and C3) were involved in TLR-2 binding, located on the same side of the three-dimensional structure of CAMP1. Both mutated and non-mutated recombinant CAMP1 proteins induced the production of C-X-C motif chemokine ligand interleukin (CXCL)8/(IL)-8 in vitro in keratinocytes and that of granulocyte macrophage-colony stimulating factor (GM-CSF), tumor necrosis factor (TNF)-α, IL-1β and IL-10 in ex vivo human skin explants. Only A14, B1 and B2 inhibited the production of CXCL8/IL-8 by keratinocytes and that of (GM-CSF), TNF-α, IL-1β and IL-10 in human skin explants stimulated with rCAMP1 and C. acnes. Following pretreatment with B2, RNA sequencing on skin explants identified the 10 genes displaying the strongest differential expression as IL6, TNF, CXCL1, CXCL2, CXCL3, CXCL8, IL-1β, chemokine ligand (CCL)2, CCL4 and colony stimulating factor (CSF)2. We, thus, identified a new CAMP1-derived peptide as a TLR-2 modulator likely to be a good candidate for clinical evaluation.     

Basic sites on mixed nitrided galloaluminophosphates “AlGaPON”: infrared studies of SO2 and CDCl3 adsorption

The basic properties of nitrided galloaluminophosphate “AlGaPON” are documented by FTIR of sulphur dioxide and deuterated chloroform. To evidence the increase in the number of basic sites with nitrogen enrichment, we compared the spectra recorded after adsorption of CDCl₃ on the phosphate precursor “AlGaPO” and on four oxynitrides with increasing nitrogen contents. On the oxide, adsorption arises from CDCl₃ interacting with surface hydroxyl groups, on the oxynitrides basic sites are shown to be M–NH₂ groups. This interpretation is confirmed by FTIR of adsorbed SO₂. This revised version was published online in July 2006 with corrections to the Cover Date.     

Catalytic removal of NO

The aim of this paper is to review the catalytic reactions for the removal of NO and, more particularly, to discuss the reduction of NO in the presence of NH₃, CO, H₂ or hydrocarbons as well as the decomposition of NO. The nature of the different active species, their formation due to dispersion and their interaction with different supports as well as the corresponding correlations with catalytic performance are also discussed. Another goal of this review is to explain the mechanism and kinetics of these reactions on different surfaces as well as the catalyst stability.     

Effect of trial-by-trial variation in center frequency on detection of interaural temporal and intensitive differences in bands of noise

Sensitivity to interaural temporal disparities (ITDs) and interaural intensitive disparities (IIDs) was measured as a function of duration in conditions where the center frequency (CF) of the stimuli was constant and, separately, in conditions where the CF of the stimuli was varied on a trial-by-trial basis. Stimuli were bands of noise centered at either 300, 1200, 2400, or 4800 Hz with the bandwidth of the noise being 40% of their CF. The largest effects of shortening duration and varying center CF of the stimuli were degradations of sensitivity to ITDs for stimuli centered at 2400 or 4800 Hz. Overall, the data confirm and extend previous findings which indicate that ITDs and IIDs are processed separately within the central nervous system.     

Study of microstructure and solute partitioning in a cast Ti-48Al-2Cr-2Nb alloy by quenching during directional solidification technique

One major hindrance to effective implementation of cast gamma TiAl-based intermetallic alloys in aircraft engines lies in the variability of their mechanical properties resulting from chemical and microstructural heterogeneities. In the present work, the buildup of microsegregation in a cast Ti-48Al-2Cr-2Nb alloy is investigated through experiments of quenching during directional solidification (QDS). The solidification process, as well as the partitioning of alloying elements, between the solid and liquid phases, is investigated. Considering experimental conditions, the α-hcp phase is found to be the primary solidifying phase. A low dendrite tip temperature of 1475 °C was estimated from thermal recordings. These observations could be explained considering the value of the thermal gradient (around 4 °C/mm). Quantitative values of partition coefficients are proposed for Al, Cr, and Nb. In addition to Al, Cr is found to segregate in interdendritic regions, whereas Nb tends to be retained in the Ti-rich inner dendrites. Considering experimental cumulative solute distributions, the buildup of microsegregation can be satisfactorily represented on the basis of Gulliver-Scheil assumptions. Due to high-temperature quenching, the QDS experiments are also found to be appropriate to the study of high-temperature phase transformations and microstructural development of TiAl-based alloys. The results of QDS experiments are discussed with regard to the range of microstructural and chemical heterogeneities determined within Ti-48Al-2Cr-2Nb investment castings. Finally, regarding solid-state phase transformations subsequent to solidification, the study attempts to explain the formation of B2 phase particles stabilized by the ternary additions. This article is based on a presentation made in the symposium entitled “Fundamentals of Structural Intermetallics,” presented at the 2002 TMS Annual Meeting, February 17–21, 2002, in Seattle, Washington, under the auspices of the ASM and TMS Joint Committee on Mechanical Behavior of Materials.