Pneumonia is relatively common in ADHF and a predictor for in-hospital mortality. However, inflammation in general seems to be more important than pneumonia itself for long-term prognosis. Compared to community-acquired pneumonia studies, C-reactive protein levels were rather low and therefore pneumonia might be over-diagnosed in ADHF patients.

<b><i>Background:</i></b> The use of stereoscopic laparoscopic systems in minimally invasive surgery (MIS) allows a three-dimensional (3D) view of the surgical field, which improves hand-eye coordination. Depending on the stereo base used in the construction of the endoscopes, 3D systems may differ regarding the 3D effect. Our aim was to investigate the influence of different stereo bases on the 3D effect. <b><i>Methods:</i></b> This was a prospective randomized study involving 42 MIS-inexperienced study participants. We evaluated two laparoscopic 3D systems with stereo bases of 2.5 mm (system A) and 3.8 mm (system B) for differences in learning MIS skills using the Lübeck Toolbox (LTB) video box trainer. We evaluated participants’ performance regarding the times and repetitions required to reach each exercise’s goal. After completing the final exercise (“suturing”), participants performed the exercise again using a two-dimensional (2D) representation. Additionally, we retrospectively compared our study results with a preliminary study from participants completing the LTB curriculum with a 2D system. <b><i>Results:</i></b> The median number of repetitions until reaching the goals for LTB exercises 1, 2, 3, and 6 for system A were: 18 (range 7–53), 24 (range 8–46), 24 (range 13–51), and 21 (range 10–46), respectively, and for system B were: 12 (range 2–30), 16 (range 6–43), 17 (range 4–47), and 15 (range 6–29), respectively (<i>p</i> = not significant). Changing from a 3D to a 2D representation after completing the learning curve led to a longer average time required, from 95.22 to 119.3 s (<i>p</i> &#x3c; 0.0001), for the last exercise (exercise 6; “suturing”). When comparing the results retrospectively with the learning curves acquired with the 2D system, there was a significant reduction in the number of repetitions required to reach the LTB exercise goals for exercises 1, 3, and 6 using the 3D system. <b><i>Conclusion:</i></b> Stereo bases of 2.5 and 3.8 mm provide acceptable bases for designing 3D systems. Additionally, our results indicated that MIS basic skills can be learned quicker using a 3D system versus a 2D system, and that when the 3D effect is eliminated, the corresponding compensatory mechanisms must be relearned.

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RATIONALE:We previously demonstrated that the Chinese herbal formula ASHMI reduced inflammation associated hyperreactivity in a murine model of allergic asthma. In this study we investigated possible direct modulation of airway reactivity by ASHMI using tracheal ring preparations. METHODS: Reactivity of tracheal rings isolated from allergic or naïve BALB/C mice to acetylcholine (Ach) or prostaglandin E2 (PGE2) challenge was measured by myography. Contractility to Ach was monitored in the presence or absence of ASHMI (100ug/ml) with or without beta-adrenergic antagonist ICI118, 551 (10uM) or the cyclooxygenase inhibitor indomethacin (5uM). PGE2 release and tissue cyclic AMP levels following Ach and PGE2 stimulation were evaluated by ELISA. RESULTS: ASHMI-pretreated rings showed significantly reduced Achinduced contractility (26.3±11.5 vs 236.9±19.6, % contraction, P<.001). Suppression of responses to Ach was unaffected by ICI118, 551(43.5±12.0 vs 45±11.5, % contraction), but markedly reversed in the presence of indomethacin (78.5±3.8 vs 20.68±7.2, % contraction, P<.001). Increased levels of PGE2 release were observed in ASHMI-pretreated Ach-stimulated ring preparations (6905±769 vs 3314±160, pg/ml P<.001). Furthermore, ASHMI-pretreated rings showed an increased relaxation response to PGE2 (25.03±6.9 vs 58.4±4.0, % contraction, P<0.01). Elevated levels of tissue cAMP were observed in ASHMI-pretreated rings exposed to Ach (287±88.8 vs 98±20.2 uM/mg tissue, P<.001) or PGE2 (988±18.3 vs 852±33.7 uM/mg tissue, P<0.05) implying possible phosphodiesterase inhibition. CONCLUSIONS: Pretreatment of tracheal rings with ASHMI reduced contractile responses to Ach in a beta-adrenergic independent manner and potentiated relaxation to PGE2, making it an attractive option for asthma therapy. Funding: NCCAM