Victorino GP, Ramirez RM, Chong TJ, Curran B, Sadjadi J. Ischemia-reperfusion injury in rats affects hydraulic conductivity in two phases that are temporally and mechanistically separate. Am J Physiol Heart Circ Physiol 295: H2164 -H2171, 2008. First published September 12, 2008 doi:10.1152/ajpheart.00419.2008 injury is a major insult to postcapillary venules. We hypothesized that IR increases postcapillary venular hydraulic conductivity and that IR-mediated changes in hydraulic conductivity result from temporally and mechanistically separate processes. A microcannulation technique was used to determine hydraulic conductivity (Lp) in rat mesenteric postcapillary venules serially throughout ischemia (45 min) and reperfusion (5 h) induced by superior mesenteric artery occlusion and release. Mesenteric IR resulted in a biphasic increase in Lp. White blood cell (WBC) adhesion slowly increased with maximal adhesion corresponding to the second peak (P Ͻ 0.005). After IR, tissue was harvested for RT-PCR analysis of ICAM-1, E-selectin, and P-selectin mRNA. Intercellular adhesion molecule-1 (ICAM-1) mRNA in the gut showed the most significant upregulation. Quantitative real-time PCR revealed that ICAM-1 mRNA was upregulated 60-fold in the gut. An ICAM-1 antibody was therefore used to determine the effect of WBC adhesion on Lp during IR. ICAM-1 inhibition attenuated Lp during the first peak and completely blocked the second peak (P Ͻ 0.005). When rats were fed a tungsten diet to inhibit xanthine oxidase and then underwent IR, Lp was dramatically attenuated during the first peak and mildly decreased the second peak (P Ͻ 0.005). Inhibition of xanthine oxidase by oxypurinol decreased Lp during IR by over 60% (P Ͻ 0.002). Tempol, a superoxide dismutase mimetic, decreased Lp during IR by over 30% (P Ͻ 0.01). We conclude that IR induces a biphasic increase in postcapillary hydraulic conductivity. Reactive oxygen species impact both the first transient peak and the sustained second peak. However, the second peak is also dependent on WBC-endothelial cell adhesion. These serial measurements of postcapillary hydraulic conductivity may lead the way for optimal timing of pharmaceutical therapies in IR injury. microvascular permeability; reactive oxygen species; intercellular adhesion molecule-1

SCCT is safe and effective for triaging hemodynamically stable patients with penetrating torso trauma. It successfully determined the need for operative intervention with appropriate clinical accuracy without the additional costs, morbidity, and delay of oral and rectal contrast. Trauma surgeons can reproducibly interpret SCCT with high-predictive accuracy as to whether patients with penetrating torso trauma require operative exploration.

Objectives In expert hands, the intra-thoracic esophago-gastric anastamosis usually provides a low rate of strictures and leaks. However, anastomoses can be technically challenging and time consuming when minimally invasive techniques are used. We present our preliminary results of a standardized 25mm/4.8mm circular stapled anastomosis using a trans-orally placed anvil. Materials and Methods We evaluated a prospective cohort of 37 consecutive patients offered minimally invasive Ivor Lewis Esophagectomy at a tertiary referral center. The esophagogastric anastomosis was created using a 25mm anvil (Orvil, Autosuture, Norwalk, CT) passed trans-orally, in a tilted position, and connected to a 90cm long PVC delivery tube through an opening in the esophageal stump. The anastomosis was completed by joining the anvil to a circular stapler (EEA XL 25mm with 4.8mm Staples, Autosuture, Norwalk, CT) inserted into the gastric conduit. Primary outcomes were leak and stricture rates. Results Thirty-seven patients (mean age 65 yrs) with distal esophageal adenocarcinoma (n=29), squamous cell cancer (n=5), or high-grade dysplasia in Barrett's Esophagus (n=3) underwent an Ivor Lewis Esophagectomy between October 2007 and August 2009. The abdominal portion of the operation was completed laparoscopically in 30 patients (81.1%). The thoracic portion was done using a muscle sparing mini-thoracotomy in 23 patients (62.2%) and thoracoscopic techniques in 14 patients (37.8%). There were no intra-operative technical failures of the anastomosis or deaths. Five patients had strictures (13.5%) and all were successfully treated with endoscopic dilations. One patient had an anastomotic leak (2.7%) that was successfully treated by re-operation and endoscopic stenting of the anastomosis. Discussion The circular stapled anastomosis with the transoral anvil allows for an efficient, safe and reproducible anastomosis. This straightforward technique is particularly suited to the completely minimally invasive Ivor Lewis Esophagectomy.

•* These findings suggest that lipoproteins may play a role in the altered binding of monocytes to the endothelial cell surface. In previous studies, we demonstrated that treatment of endothelial cells with /3-migrating very low density lipoprotein (/3-VLDL) and malondialdehydealtered low density lipoprotein (MDA-LDL), but not LDL, increased the production of a monocyte chemotactic factor that may modulate monocyte migration into the vessel wall.3 The present study was undertaken to evaluate the effect of /3-VLDL and LDL on the ability of endothelial cells to bind monocytes. The characteristics of binding were examined, and the effect of antibodies to monocyte surface antigens on the adhesion was determined. Methods UpoprotelnsLDL was prepared from normal human plasma (d=1.019 to 1.063), and 0-VLDL was prepared from d<1.006fractions of cholesterol-fed rabbit plasma as previously described. 45 Endothelial CellsHuman umbilical vein endothelial (HUV) cells from passages 2 to 4 were cultured in Medium 199 containing 15% calf serum (CS). Rabbit aorta endothelial cells (RAEC) from Received November 7,1988; revision accepted June 14,1989. passages 9 to 14 were cultured in Medium 199 containing 15% CS as previously described. 6 -8 Human aortic endothelial cells isolated as described previously were obtained from Mamad Navab. 10 The cells were cultured to confluence in 24-or 48-well tissue culture plates. The cells were then transferred to the control media (Dulbecco's modified Eagle's medium, DME, or Media 199+5% CS) or to media (DME or Media 199+5% CS) containing /3-VLDL (50 to 100 jig/ml), or LDL (100 MQ/ml) for 48 hours or for other designated time periods before the adhesion assays were performed. These conditions were nontoxic to the cells. Exposure of the cells to /3-VLDL effectively induced cholesterol loading with a 60% to 80% increase in cellular cholesterol content. There was no statistically significant increment in the cholesterol content of the LDL-treated cells. To expose the monolayers to endotoxin (LPS), 5 ng/ml of LPS was added to the wells, which were then incubated for 4 hours before the adhesion assays. LeukocytesHuman peripheral blood monocytes (MO) were obtained from heparinized blood by elutriation 11 or by the method described by Fogelman et al. 12 The human monocyte cell line, THP-1 (ATCC TIB-202), was also used as a source of monocytes in some studies. Human neutrophils (PMN) were isolated on Ficoll-Hypaque followed by dextran sedimentation. 13Leukocytes were washed and resuspended at a concentration of 6x10* cells/ml in RPMI media containing 1 % fetal catf serum (FCS) before performing the adhesion assays. AdhesionThe treated endothelial cell monolayers were rinsed twice with RPMI, removing the lipoprotein or LPS from the subsequent assay.