Tracheobronchial injuries in blunt thoracic trauma

Catedra Chirurgie nr.1 ,,Nicolae Anestiadi’’, Catedra Chirurgie nr.4, USMF ,,Nicolae Testemiţanu’’, Secția Chirurgie Toracică, Departament Clinic Chirurgie IMU, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Majoritatea traumatismelor toracice severe (80%) sunt rezultatul politraumatismelor. Acestea reprezintă o entitate asociată unui risc sporit de morbiditate şi mortalitate de până la 15-30%. Leziunea traheobronşică, deşi rară ca incidenţă (1,5-3%), reprezintă un traumatism potenţial letal prin dezvoltarea complicațiilor precoce (insuficiență cardiorespiratorie acută) și tardive (sepsisul pulmonar), care sunt dependente direct de momentul diagnosticării. Scop. Aprecierea factorilor preoperatorii determinanți necesari stabilirii precoce a diagnosticului şi tacticii chirurgicale adecvate în timpi oportuni. Material şi metode. Trei politraumatizaţi (Cr,To,Lo) cu leziune predominantă toracică, vârsta medie – 23,67±2,73ani, raportul B:F/2:1, perioada de referință 2011-2015, cu ISS=38p(3), RTS=6,171(1) și 7,841(2), și TRISS – 20,3%(1), 6,2%(2). În 100% cazuri s-a efectuat hemoleucograma, radiografia toracelui, USG-FAST și FBS, TC doar într-un caz. Durata accident-intervenţie: până la 12h(2), 5zile(1) – transfer AVIASAN. Rezultate. Rx-toracic a evidenţiat: fracturi costale multiple bilaterale(2), unilaterale(1), hemopneumotorace bilateral(2), pneumotorace bilateral(1) și pneumomediastinum(2) cu suspecție de leziune bronşică într-un caz. S-a efectuat toracocenteză bilaterală (100%) și drenarea mediastinului anterior (1). TC a evidențiat fracturile costale, contuzia pulmonară și pneumotoracele persistent. Fluxul aerian continuu prin drenajele montate a impus necesitatea bronhoscopiei diagnostice (100%), care a confirmat leziunea bronșică (BPD – 2, BPS – 1). S-a efectuat toracotomie cu plastia bronhiei lezate(3) și lobectomie superioară dreaptă(1). Evoluția postoperatorie favorabilă, durata de spitalizare – 17,67±2,72zile. Toți au dezvoltat pneumonie, confirmată prin examenele imagistice și paraclinice. Concluzii. Instabilitatea hemodinamică și respiratorie acută, prezența fluxului de aer continuu posttoracocenteză și examenele imagistice impun suspecția leziunii traheobronșice și necesită confirmare prin fibrobronhoscopie. Ultima asigură diagnosticul cert şi determină tactica chirurgicală oportună în timpi efectivi.Introduction. The majority of severe thoracic trauma (80%) result from polytrauma. It is associated with a high risk of morbidity and mortality (15-30%). Despite the rare incidence of tracheobronchial injury (1,5- 3%), the lethality is high due to development of early complications (acute cardiorespiratory failure) and late complications (lung sepsis) that depend directly on the time of diagnosis. Purpose. Appreciation of determinant preoperative factors, necessary to establish on time an accurate diagnosis and surgical treatment. Material and methods. Three polytraumatized patients (Cr,Th,Loco) with predominant thoracic injury, mean age – 23,67±2,73 years, M:F ratio 2:1, hospitalized between 2011-2015. ISS=38p(3), RTS= 6,171(1) and 7,841(2), TRISS – 20,3%(1), 6,2%(2). In 100% of cases investigations include: chest x-ray, FAST and FBS, TC – one case. The time period injury-intervention: up to 12h(2), 5 days(1) – AVIASAN transfer. Results. Chest x-ray revealed: multiple bilateral rib fractures(2), unilateral(1), bilateral hemopneumothorax(2), bilateral pneumothorax(1) and pneumomediastinum(2) with suspicion of bronchial lesion in one case. Bilateral thoracocentesis was performed in all patients, anterior mediastinal drainage – in one. TC revealed rib fractures, lung contusion and persistent pneumothorax. The continuous airflow through drainages required diagnostic bronchoscopy(100%) that confirmed the bronchial lesion (RMB – 2, LMB – 1). Thoracotomy with the plasty of injured bronchus was performed in all patients, right upper lobectomy in 1. Postoperative evolution – favorable, hospitalization period – 17,67±2,72 days. All patients developed pneumonia, confirmed by imagistic examinations. Conclusions. Acute hemodynamic and respiratory instability, the presence of the continuous airflow through drainages and imagistic examinations lead to suspicion of tracheobronchial injury, which required a confirmation by fibrobronchoscopy, that guarantees the right diagnosis and surgical treatment on time

Interactions of New bis-Ammonium Thiacalix[4]arene Derivatives in 1,3-Alternate Stereoisomeric Form with Bovine Serum Albumin

© 2016, Springer Science+Business Media New York.New bis-ammonium thiacalix[4]arene derivatives with different lipophilicity were synthesized using copper(I)-catalyzed azide-alkyne cycloaddition in good yields. Binding of a new thiacalix[4]arene derivatives with bovine serum albumin (BSA) was investigated in detail using fluorescence spectroscopy method. Quenching mechanism, the binding constants, and number of binding sites were determined

Detection of sulfate surface-active substances via fluorescent response using new amphiphilic thiacalix[4]arenes bearing cationic headgroups with Eosin Y dye

© 2016 Elsevier B.V.New ammonium-containing derivatives of p-tert-butylthiacalix[4]arene in 1,3-alternate stereoisomeric form were synthesized via copper-catalyzed azide-alkyne cycloaddition (CuAAC) reaction of corresponding azides with N-propargyl-N,N,N-triethylammonium bromide. Critical aggregation concentration (CAC) of new amphiphilic thiacalixarenes 1-3 (with butyl, octyl and tetradecyl substituents) determined by pyrene micellization method are 91, 59 and 33 μM, respectively. According to DLS data the diameter of these aggregates is around 130 nm. Anionic dye Eosin Y (EY) forms the associates with positive charged thiacalixarenes 1-3, shifts CAC to the low concentration region (2 μM) and decreases nanoaggregates size up to 90 nm. Thiacalixarene/EY associates were investigated as fluorescent probe for the determination of different surface active substances (SAS) in the solution. It was found that only sodium dodecyl sulfate (SDS) and sodium laureth sulfate (SLES) causes EY release, while other anionic, cationic and zwitterionic SAS form only mixed aggregates. Fluorescent response of thiacalixarene/EY associates is considerable from 3.5 μM concentration of SDS

Thiacalix[4]arene-functionalized vesicles as phosphorescent indicators for pyridoxine detection in aqueous solution

© The Royal Society of Chemistry 2015. Amphiphilic tetracarboxylate derivatives of p-tert-butylthiacalix[4]arene were obtained by click reactions of the corresponding azido derivatives with acetylene dicarboxylic acid. Embedding of the amphiphilic tetraacids in DPPC vesicles was studied by DLS, AFM, turbidity techniques and by probing with merocyanine 540. The obtained DPPC-calixarene vesicles are effective antennae for Tb(iii) ion luminescence. It allows the use of DPPC-calixarene-Tb(iii) vesicles for the selective detection of analytes with a higher affinity for Tb(iii) due to cation removal from the calixarenes in the DPPC bilayer. It was found that pyridoxine hydrochloride can be selectively detected at the 7 μM concentration in the presence of a 100 fold excess of different biologically important molecules, like amino acids, adenosine phosphates, sugars, amines and ammonium salts

Diaphragmatic lesions - clinic experience

Departament Chirurgie, Institutul de Medicină Urgentă, Catedra de Chirurgie nr.1 ,,Nicolae Anestiadi”, Universitatea de Stat de Medicină și Farmacie ,,Nicolae Testemițanu’’, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Leziunea diafragmei(LD) reprezintă o problemă de management diagnostico-curativ atât în traumatismele penetrante cât și închise. Material și metode: Studiul retrospectiv-prospectiv, 2012 ‒ mai 2019, pe 48 pacienți cu LD. Vârsta medie 35±12,65ani, raportul B:F//2:1. Plăgi penetrante ‒ 38(79,2%) cazuri, contuzii abdominale – 10(20,8%). S-a efectuat: radiografia toracelui – 39(81,2%) cazuri, ecografia abdominală(Focused abdominal Sonography for Trauma) ‒ 33(68,8%), pasaj gastro-duodenal ‒ 2(4,2%), Tomografia Computerizată – 13(27,1%), laparoscopie ‒ 13(27,1%) și toracoscopie – 3(6,3%). Rezultate: Instabilitate hemodinamică constatându-se în 13(27,1%) cazuri, durere toraco-abdominală ‒ 39(81,3%), insuficiență respiratorie – 34(70,8%). LD s-a diagnosticat: până la 12h ‒ 37(77%), 12-72h – 7(14,6%), 3-10 zile ‒ 3(6,3%) și un pacient la a 49-a zi. LD s-a constatat în 25(52,1%) cazuri intraoperator, preoperator fiind diagnosticată: imagistic – 9(18,8%), laparoscopic ‒ 11(23%) și toracoscopic – 3(6,3%), LD izolată apreciindu-se în 14(29,2%), cu lezarea organelor parenchimatoase – 14(29,2%) [splina(7), ficat(11), rinichi(2)], cavitare – 13(27,1%) [stomac(4), jejun(4), colon(6)] și combinate – 3(6,3%), în 5(10,4%) cazuri asociindu-se leziune pulmonară. LD pe stânga s-a determinat în 33(68,8%) cazuri, pe dreapta – 15(31,2%), diametrul variind de la 0,5cm la 20cm, în 2(4,2%) cazuri constatându-se plăgi multiple. În 40(83,3%) situații LD s-a rezolvat prin laparotomie, prin toracotomie ‒ 2(4,2%), toraco-laparotomie – 3(6,3%), prin toracoscopie ‒ 3(6,3%). LD s-a rezolvat prin sutură simplă – 44(91,6%) și duplicatură ‒ 4(8,4%), în 30(62,5%) cazuri asociindu-se cu alte intervenții. Mortalitate postoperatorie ‒ 2(4,2%). Concluzii: La politraumatizații cu leziuni severe ruptura diafragmei este cel mai frecvent constatată intraoperator, laparotomia fiind dictată de hemoperitoneu. În plagile toracice inferioare cu hemodinamică stabilă laparoscopia și toracoscopia pot stabili cu certitudine diagnosticul, ultima, în lipsa leziunilor intraabdominale, poate rezolva definitiv defectul.Introduction: Diaphragmic lesion (DL) is a diagnostic and curative management problem in both penetrating and closed traumas. Methods and materials: Retrospective-prospective study, 2012−May 2019 on 48 patients with DL. Average age 35±12.65years, M:F ratio 2:1. Penetrating wounds−38(79.2%) cases, abdominal contusion−10(20.8%). There were performed: chest radiography−39(81.2%), Focused Abdominal Sonography for Trauma− 33(68.8%), barium passage−2(4.2%), Computed Tomography−13(27.1%), laparoscopy−13(27.1%) and thoracoscopy−3(6.3%). Results: Hemodynamic instability−13(27.1%) cases, thoraco-abdominal pain−39 (81.3%), respiratory insufficiency−34(70.8%). DL was diagnosed: <12h−37(77%), 12-72h − 7(14.6%), 3-10 days − 3(6.3%), and in one patient on the 49th day after the trauma. DL was found intraoperatively in 25(52,1%) cases, preoperative were diagnosed: imaging−9(18,8%), laparoscopic−11(23%) and thoracoscopic−3(6.3%). Isolated DL was established in 14(29.2%) cases, accompanied injury of a parenchymatous organ−14(29.2%) [spleen(7), liver(11), kidney(2)], hollow organ–13(27,1%) [(stomach(4), jejun(4), colon(6)] and combined−3(6,3%), in 5(10,4%) cases pulmonary lesions were detected too. DL on the left side was determined in 33(68.8%) cases, on the right side−15(31.2%), the diameter ranging from 0.5cm to 20cm, in 2(4.2%) cases multiple lesions were determined. In 40(83.3%) cases DL were treated by laparotomy, thoracotomy−2(4.2%), thoracolaparotomy−3(6.3%), thoracoscopy−3(6.3%). DL was sutured by simple suture−44(91.6%) and duplication−4(8.4%), in 30(62.5%) cases associated with other interventions. Postoperative mortality−2(4.2%). Conclusion: In severe polytrauma the diaphragm rupture is most commonly observed intraoperatively lesion, the laparotomy being established by hemoperitoneum. In patients with inferior thoracic wounds and hemodynamic stability, laparoscopy and thoracoscopy can definitely establish the diagnosis, and in the absence of intraabdominal lesions, can definitively resolve the defect

Evaluation of the long-term memory T cell in mice after immunization with a live tularemia vaccine

The vaccine strain F. tularensis 15 NIIEG induces long-lived cell-mediated immunity but exhibits a certain reactogenicity and genetic instability. Progress in development of a vaccine against tularemia has been limited by a lack of information regarding the mechanisms required to protect against this disease. The BALB/c mouse is the most commonly used animal to study tularemia due to its relatively low cost, well-characterized genetics, available immunological tools and mouse infection with virulent F. tularensis recapitulates human disease.CD4+ and CD8+T cells are known to be critical for the formation of protective immunity but the relative roles of memory T cell subpopulations in long lived protection against virulent strains of F. tularensis are not well established. We hypothesized that this immunity depends on central (TCM) and effector memory (TEM) T cells and their functional activity. In this study we have dissected the T cell immune response in BALB/c mice 30, 60 and 90 days after subcutaneous vaccination with 15 NIIEG.Multiparametric flow cytometry were used to characterize in vitro recall responses of splenocytes to F. tularensis antigen. TEM cells were identified as CD3+CD4+CD44+CD62L- and CD3+CD8+CD44+CD62L-, TCM cells as CD3+CD4+CD44+CD62L+ and CD3+CD8+CD44+CD62L+, respectively. The functional activity of memory T cells was assessed by the following parameters: the level of expression of the activation marker CD69 and cytokine-producing activity by staining with the intracellular cytokines IFNg and TNFa.Thus, development of a long-lived vaccine directed against F. tularensis is dependent on identifying not only the correlates of immunity present early after vaccination, but also those that persist in the host after the effector phase has ended. The maintenance of long-term protective immunity initiated by vaccination with F. tularensis strain 15 NIIEG has been shown to require the presence of antigen-specific CD4+ and CD8+ memory T cells producing IFNg and TNFa and expressing the activation marker CD69. A decrease in count and functional activity of CD8+TCM and CD8+TEM was detected in the long term after vaccination. The detected parameters of functional activity of memory T cells can be used as criteria for evaluation of protective immunity against virulent strains of F. tularensis

Diagnostic Nutrient Media for Isolation and Identification of Anthrax Agent

Designed is a differential-diagnostic solid nutrient media for isolation and identification of anthrax agent. This media contains: nutrient base (enzymic hydrolysate of fishbone powder), agar-agar, D (+)-sorbite, pH indicator bromthymol blue, and broad-spectrum antibiotic (polymyxin). The media makes it possible to differentiate virulent (capsular) and avirulent (non-capsular) Bacillus anthracis strains, as well as closely related saprophyte microorganisms, depending upon the color and colony morphology

Polycationic derivatives of p-tert-butylthiacalix[4]arene in 1,3-alternate stereoisomeric form: New DNA condensing agents

© ISUCT Publishing.One of the important challenges in gene therapy is to search safe and efficient gene carries capable of compacting, protecting, transporting, and delivering nucleic acids into the cell. Most of condensing agents are functionalized on one side with appropriate cationic groups to act as DNA carriers, and, on the other side, with lipid-type chains that permit them to self-aggregate into well-defined aggregation patterns. Calixarenes and their thia-analogues are versatile macrocyclic compounds that can combine the properties of both macrocyclic hosts and self-organizing systems, such as micelles and liposomes. In addition, their relatively easy synthesis, variety of stereoisomeric forms and their low toxicity levels make them really promising vectors in gene delivery applications. It is noteworthy that amphiphilic gene vectors based on calixarenes are generally presented only in cone stereoisomeric form, while 1,3-alternate stereoisomeric form also allows to achieve a spatial separation between hydrophilic and hydrophobic moieties of macrocycle. Herein we report the synthesis of new water-soluble amphiphilic derivatives of p-tert-butylthiacalix[4]-arene in 1,3-alternate stereoisomeric form with different O-alkyl chain length (C4, C6, C14) containing polycationic diethylenetriammonium fragments. The synthesis of new macrocycles was done by stepwise functionalization of parent p-tert-butylthiacalix[4]arene using Mitsunoby reaction and the final introduction of diethylenetriammonium fragments using CuAAC protocol. The structure of new amphiphilic macrocycles was established by 1,2-D NMR and IR spectroscopy, MALDI-TOF spectrometry and elemental analysis. To evaluate their ability to form aggregates the values of critical concentrations of aggregation CCA were determined in aqueous solutions by a well-known fluorimetric method based on the pyrene emission spectra. The CCA values ​were equal to 24, 25 and 9 μmol for O,O-dibutyl, O,O-dioctyl and O,O-ditetradecyl derivatives, respectively. A significant decrease of CCA value for more lipophilic macrocycle indicates the importance of hydrophobic interactions gor aggregates formation. According to the dynamical and electroforetical light scattering data new macrocycles form stable aggregates with the diameter within 70–100 nm. Such size values indicate that all investigated macrocycles form vesicle-like structures. In the case of O,O-ditetradecyl derivative a significant size decrease up to 50–60 nm was found and can be associated with an increased packing density of the resulting vesicles by enhancing hydrophobic interactions between lipophilic molecule fragments. Also, zeta potential values were measured by electrophoretic light scattering method. Measured values are + 60 – +70 mV, what is in agreement with the polycationic nature of macrocycles, and correspond to the formation of colloidal systems with high stability. Binding of new polycationic macrocycles with nucleic acid was investigated using calf thymus DNA as model biopolymer and well-known DNA intercalator ethidium bromide. According to the dynamical, electroforetic light scattering data and fluorescent spectroscopy it was found that new polycationic macrocycles effectively interact with calf thymus DNA. Addition of all synthesized macrocycles in concentrations below the CAC does not lead to a significant change in the size of the calf thymus DNA, while at concentrations higher than that of CAC a significant compression of DNA in 2–5 times is observed. Increased lipophilicity of the macrocycles leads to the formation of more compact lipoplex. Furthermore it was found that ethidium bromide removal can be promoted by hydrophobic interactions between the planar aromatic ethidium ring and the surfactant tail groups. The proof of the ethidium bromide migration onto the surfactant tail groups is the non-linear Stern-Volmer curve having pronounced plateau accompanied by a bathochromic shift of the emission maximum at high concentration of o-tetradecyl substituted macrocycle that may be due to the location of the dye in the hydrophobic unit of aggregate

Spatial insurance against a heatwave differs between trophic levels in experimental aquatic communities

Climate change-related heatwaves are major threats to biodiversity and ecosystem functioning. However, our current understanding of the mechanisms governing community resistance to and recovery from extreme temperature events is still rudimentary. The spatial insurance hypothesis postulates that diverse regional species pools can buffer ecosystem functioning against local disturbances through the immigration of better-adapted taxa. Yet, experimental evidence for such predictions from multi-trophic communities and pulse-type disturbances, like heatwaves, is largely missing. We performed an experimental mesocosm study to test whether species dispersal from natural lakes prior to a simulated heatwave could increase the resistance and recovery of plankton communities. As the buffering effect of dispersal may differ among trophic groups, we independently manipulated the dispersal of organisms from lower (phytoplankton) and higher (zooplankton) trophic levels. The experimental heatwave suppressed total community biomass by having a strong negative effect on zooplankton biomass, probably due to a heat-induced increase in metabolic costs, resulting in weaker top-down control on phytoplankton. While zooplankton dispersal did not alleviate the negative heatwave effects on zooplankton biomass, phytoplankton dispersal enhanced biomass recovery at the level of primary producers, providing partial evidence for spatial insurance. The differential responses to dispersal may be linked to the much larger regional species pool of phytoplankton than of zooplankton. Our results suggest high recovery capacity of community biomass independent of dispersal. However, community composition and trophic structure remained altered due to the heatwave, implying longer-lasting changes in ecosystem functioning

Synthesis of new p-tert-butylcalix[4]arene-based polyammonium triazolyl amphiphiles and their binding with nucleoside phosphates

© 2018 Burilov et al. The synthesis of new calix[4]arenes adopting a cone stereoisomeric form bearing two or four azide fragments on the upper rim and water-soluble triazolyl amphiphilic receptors with two or four polyammonium headgroups via copper-catalyzed azide–alkyne cycloaddition reaction has been performed for the first time. It was found that the synthesized macrocycles form stable aggregates with hydrodynamic diameters between 150–200 nm and electrokinetic potentials about +40 to +60 mV in water solutions. Critical aggregation concentration (CAC) values were measured using a micelle method with pyrene and eosin Y as dye probes. The CAC values of tetraalkyl-substituted macrocycles 12a,b (5 µM for both) are significantly lower than those for dialkyl-substituted macrocycles 10a,b (790 and 160 µM, respectively). Premicellar aggregates of macrocycles 10a,b and 12a,b with the dye eosin Y were used for nucleotides sensing through a dye replacement procedure. It is unusual that disubstituted macrocycles 10a,b bind more effectively a less charged adenosine 5'-diphosphate (ADP) than adenosine 5'-triphosphate (ATP). A simple colorimetric method based on polydiacetylene vesicles decorated with 10b was elaborated for the naked-eye detection of ADP with a detection limit of 0.5 mM