Journal Article The syndrome of nutritional deficiency after gastrectomy in the rat. A study of its nature and pathogenesis with particular reference to the role of iron Get access I D A Johnston, I D A Johnston Senior Tutor in Surgery Queen's University of Belfast Search for other works by this author on: Oxford Academic Google Scholar H O Nevin, H O Nevin Chief Technician Department of Surgery, Queen's University of Belfast Search for other works by this author on: Oxford Academic Google Scholar R B Welbourn R B Welbourn Professor of Surgical Science Queen's University, Surgeon, Royal Victoria Hospital, Belfast Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 48, Issue 207, July 1960, Pages 81–86, https://doi.org/10.1002/bjs.18004820715 Published: 06 December 2005
Abstract Two patients with phaeochromocytomas developed crises in which severe hypertension alternated with profound hypotension. One patient died during an emergency operation. The other was controlled with a long-acting alpha-cholinergic blocking agent and had his tumour removed uneventfully.
Acid aspiration-induced systemic organ, injury is mediated by the sequestration of activated neutrophils (PMN). In other settings cytokines have been shown to increase neutrophil-endothelial adhesion, a requisite for injury. This study tests whether the systemic leukosequestration and permeability following localized aspiration is mediated by tumor necrosis factor (TNF)-α-induced synthesis of an adhesion protein. Anesthetized rats underwent tracheostomy and insertion of a fine-bore cannula into the anterior segment of the left lung. This was followed by the instillation of either 0.1 mL 0.1 N HCI (n = 18) or 0.1 mL saline in control rats (n = 18). Localized aspiration induced generalized pulmonary leukosequestration with 95 PMN/10 high-power fields (HPF) in the aspirated lung and 46 PMN/10 HPF in the nonaspirated lung, higher than control values of 7 PMN/10 HPF and 5 PMN/10 HPF in saline- and nonsaline-aspirated sides, respectively (p < 0.05). The leukosequestration was associated with permeability edema shown by increased protein concentrations in bronchoalveolar lavage (BAL) of 3900 μg/mL in the aspirated and 2680 μg/mL in the nonaspirated side, higher than saline with 482 μg/mL and 411 μg/mL, respectively (p < 0.05). There was generalized pulmonary edema following aspiration measured by increase in wet-to-dry weight ratios (w/d) of 6.6 in the aspirated and 5.1 in the nonaspirated lung, higher than control values of 3.5 and 3.4, respectively (p < 0.05). Localized aspiration led to systemic leukosequestration documented by increases in myeloperoxidase activity (units/g tissue) of 2.2 and 1.7 in heart and kidney, higher than control values of 0.3 and 0.4, respectively (p < 0.05). This event was associated with edema of these organs with w/d ratios of 4.6 and 4.3, relative to control values of 3.0 and 3.4 (p < 0.05). Treatment of animals (n = 18) 20 minutes after aspiration with anti-TNF-α antiserum (rabbit anti-murine) but not normal rabbit serum (n = 18) reduced lung leukosequestration in the aspirated and nonaspirated segments (61 and 32 PMN/10HPF), BAL protein concentration (1490 and 840 μg/mL), and w/d ratio (4.3 and 3.7) (all p < 0.05). In the heart and kidney there were reductions in myeloperoxidase activity (0.7 and 0.6) and w/d ratio (3.5 and 3.6) (both p < 0.05). Treatment of rabbits (n = 18) with the protein synthesis inhibitor cycloheximide, 0.2 mg/kg/hr was as effective as TNF-α antiserum in modifying aspiration injury. The data indicate that TNF-α mediates acid aspiration-induced local and multisystem organ injury, in part by a mechanism involving an inducible endothelial adhesion protein.
ObjectiveTo evaluate the impact of the QuinteT Recruitment Intervention (QRI) on recruitment in challenging randomized controlled trials (RCTs) that have applied the intervention. The QRI aims to understand recruitment difficulties and then implements "QRI actions" to address these as recruitment proceeds.Study Design and SettingA mixed-methods study, comprising (1) before-and-after comparisons of recruitment rates and the numbers of patients approached and (2) qualitative case studies, including documentary analysis and interviews with RCT investigators.ResultsFive UK-based publicly funded RCTs were included in the evaluation. All recruited to target. Randomized controlled trial 2 and RCT 5 both received up-front prerecruitment training before the intervention was applied. Randomized controlled trial 2 did not encounter recruitment issues and recruited above target from its outset. Recruitment difficulties, particularly communication issues, were identified and addressed through QRI actions in RCTs 1, 3, 4, and 5. Randomization rates significantly improved after QRI action in RCTs 1, 3, and 4. Quintet Recruitment Intervention actions addressed issues with approaching eligible patients in RCTs 3 and 5, which both saw significant increases in the number of patients approached. Trial investigators reported that the QRI had unearthed issues they had been unaware of and reportedly changed their practices after QRI action.ConclusionThere is promising evidence to suggest that the QRI can support recruitment to difficult RCTs. This needs to be substantiated with future controlled evaluations.
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