No abstract

Surgical procedures are associated with significant muscular fatigue that can be measured simply and which has a direct effect on comfort and surgical accuracy. More important, this effect is completely or almost completely prevented by MPs.

The present study stems from our recent demonstration (Moreau-Bussiere F, Samson N, St-Hilaire M, Reix P, Lafond JR, Nsegbe E, Praud JP. J Appl Physiol 102: 2149-2157, 2007) that a progressive increase in nasal intermittent positive pressure ventilation (nIPPV) leads to active glottal closure in nonsedated, newborn lambs. The aim of the study was to determine whether the mechanisms involved in this glottal narrowing during nIPPV originate from upper airway receptors and/or from bronchopulmonary receptors. Two groups of newborn lambs were chronically instrumented for polysomnographic recording: the first group of five lambs underwent a two-step bilateral thoracic vagotomy using video-assisted thoracoscopic surgery (bilateral vagotomy group), while the second group, composed of six lambs, underwent chronic laryngotracheal separation (isolated upper airway group). A few days later, polysomnographic recordings were performed to assess glottal muscle electromyography during step increases in nIPPV (volume control mode). Results show that active glottal narrowing does not develop when nIPPV is applied on the upper airways only, and that this narrowing is prevented by bilateral vagotomy when nIPPV is applied on intact airways. In conclusion, active glottal narrowing in response to increasing nIPPV originates from bronchopulmonary receptors.

from 9.8% to 5.5% (P ¼ .004), and 1-year major amputation decreased from 25.4% to 18.2% (P < .001), with a corresponding odds ratio of 0.65 (95% CI, 0.517-0.838; P < .0001) as the volume increased. An increase in the chance of a revision surgery (10.6% vs 8.2%, P < .001) was seen with higher volume, with an increased odds ratio of 1.031 (95% CI, 1.005-1.057; P ¼ .018). Comment: Although the 30-day mortality for leg bypass is quite high in this series, this is another bit of evidence that outcomes for open vascular surgical procedures are better in hospitals with higher volumes of such procedures. The data have some limitations because it is unclear whether every procedure analyzed was an additional bypass, followed a failed endovascular procedure, or was a vein or prosthetic bypass. There are some additional oddities in the data, in that 54% of the patients treated with femoral distal bypass were supposedly treated for claudication. Nevertheless, the relationship between increasing volume and favorable outcomes for LEAB seems statistically solid. The data also suggest that benefits for limb salvage may be partly due to increased reintervention rates in higher-volume hospitals with perhaps better resources and willingness to attempt revisions rather than move to amputation.

We investigated whether xanthine oxidase (XO) is a major source of oxygen-derived free radicals (oxy-radicals) in the pig and human skeletal muscles. It was observed that xanthine dehydrogenase and XO activities in nonischemic pig latissimus dorsi (LD) and gracilis muscles and human LD and rectus abdominis (RA) muscles were < 0.5 mU/g wet wt. The pig LD muscle hypoxanthine content increased significantly from 0.33 +/- 0.02 to 2.33 +/- 0.44 mumol/g dry wt after 5 h of warm ischemia, but the muscle uric acid content remained unchanged up to 2 h of reperfusion. Similarly, the hypoxanthine content in the human LD and RA muscles increased from 0.33 +/- 0.03 to 0.84 +/- 0.23 mumol/g dry wt after 2.0-3.5 h of warm ischemia, and the muscle uric acid content remained unchanged at the end of 15-90 min of reperfusion. Furthermore, 5 days of allopurinol treatment (25 mg/kg iv twice daily) starting 2 days before ischemia or 3 days of oxypurinol treatment (25 mg/kg iv twice daily) starting 15 min before reperfusion did not attenuate the extent of skeletal muscle necrosis in pig LD muscles subjected to 5 h of ischemia and 48 h of reperfusion. However, deferoxamine treatment (250 mg/kg iv twice daily) starting before or after ischemia, as described above, significantly reduced the extent of pig LD muscle necrosis. Finally, at 2 and 48 h of reperfusion significantly higher muscle neutrophil contents were seen in ischemic than in nonischemic control pig LD muscles. Neutrophil depletion with mechlorethamine (0.75 mg/kg iv) significantly reduced the extent of necrosis in pig LD muscles. These observations indicate that XO is not a major source of oxy-radicals in ischemia/reperfusion injury in the pig gracilis and LD muscles and human RA and LD muscles.