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Objectives. Aneurysmal bone cyst (ABC) is a benign but locally aggressive tumor. It has several challenging features. The aim of this study is to identify challenges in the diagnosis and treatment of ABC especially in patients with unusual features. Methods. This retrospective study involved medical record review of primary ABC patients with one or more of the following features: unusual clinical presentation with a mass or a pathological fracture especially at an unusual age, rare locations, radiological findings suggesting other diagnoses especially sarcoma, and a nondiagnostic histopathology of biopsy samples. Results. 25 patients (17 males and 8 females) were included. Most patients were either younger than 10 or older than 20 years. 10 patients presented with a mass or a pathological fracture. Unusual locations include the scapula, the olecranon, the hamate, the calcaneus, and the first metatarsal bone. Extension into the epiphysis occurred in 2 patients with proximal fibula and olecranon ABCs. Two separate synchronous cysts existed in the proximal epiphysis and middiaphysis of one humerus. Radiological imaging suggested other primary diagnoses in 8 patients. Core needle biopsy was diagnostic in only 2 of 7 patients. The main treatment was intralesional resection/curettage with bone grafting. Wide resection was performed in 4 patients. Recurrence rate was 28%. Recurrence risk factors included the following: age less than 10 years, male gender, and proximal femur location. Late recurrence occurred in 3/7 patients. One patient with asymptomatic radiological recurrence showed subsequent spontaneous resolution one year later. Conclusions. This study presented multiple unusual features of ABC including: unusual age, rare locations, and nondiagnostic radiological and histopathological findings. These features can complicate the diagnosis and management. Given these features, especially with pathological fractures, a well-planned incision, the use of frozen section examination, and the application of either external fixation or plate osteosynthesis for fracture fixation can be recommended.

OBJECTIVELumbar central stenosis can theoretically be decompressed with minimal bone removal via an endoscopic approach. Although multiple studies have demonstrated an adequate radiographic decompression, none has quantified the volume of bone removal after endoscopic decompression. The objective of this study was to quantify the 3D volume of bone removed from the lamina and facet joints during endoscopic decompression for lumbar central and lateral recess stenosis.METHODSThis retrospective study included adults with lumbar spinal stenosis who underwent endoscopic decompression of a single level or 2 noncontiguous lumbar levels. Central stenosis on MRI was graded preoperatively and postoperatively using the Schizas scale. A computer program was developed in MATLAB to semiautomatically perform a 3D volumetric analysis of preoperative and postoperative lumbar CT scans. The volumetric percentage of bone removed from the lamina and facet joints ipsilateral and contralateral to the side of approach was quantified.RESULTSNineteen patients with 21 treated lumbar levels were included in the study. Preoperatively, the number of levels with Schizas stenosis grades B, C, and D were 5, 12, and 4, respectively. Stenosis grades improved postoperatively to grades A, B, C, and D for 17, 3, 1, and 0 levels, respectively. All levels improved by at least 1 stenosis grade. The volumetric percentage of laminar bone removed was 15.5% (95% CI 11.2%–19.8%, p < 0.001) from the ipsilateral lamina and 8.8% (95% CI 5.7%–11.8%, p < 0.001) from the contralateral lamina. The percentage of facet joint resection was 5.3% (95% CI 4.2%–6.4%, p < 0.001) and 4.3% (95% CI 2.2%–6.4%, p < 0.001) for the ipsilateral and contralateral facet joints, respectively. Average pain scores, as measured by the visual analog scale, improved from 7.9 preoperatively to 2.2 by 3–10 months postoperatively (p < 0.001).CONCLUSIONSEndoscopic lumbar decompression achieves improvement in the radiographic grade of lumbar central stenosis with minimal bone removal from the lamina and facet joints. Future prospective studies are needed to validate the findings of this study with more comprehensive clinical outcomes.

The conventional surgical approach to far lateral lumbar disk herniations is a paraspinal Wiltse approach. During the Wiltse approach, it is sometimes necessary to resect some of the facet or pars interarticularis to achieve an adequate exposure. The endoscopic transforaminal route can be of benefit in far lateral disk herniations due to direct access to the epidural space through Kambin's triangle, without the need for any bony removal or nerve retraction. In this video, we describe a percutaneous endoscopic transforaminal approach for far lateral discectomy in a patient presenting with a left L4 radiculopathy due to a far lateral L4-5 disk herniation. We describe Kambin's triangle anatomy and its relevance to the transforaminal route. The steps of the procedure are then described: dissection of soft tissue and removal of free disk fragments on the inferior aspect of the foramen far from the compressed exiting nerve route above to decrease the risk of retraction injury, gentle maneuvering of endoscope superiorly with removal of further compressive disk fragments, exposure of the exiting nerve root superiorly after adequate decompression is achieved and removal of any remaining fragments in close proximity to the nerve, and finally evaluation of traversing nerve root for any compressive lesions. The presentation ends with postoperative imaging confirming decompression of the far lateral disk herniation.

Stem cell transplantation offers a potentially transformative approach to treating neurodegenerative disorders. The safety of cellular therapies is established in multiple clinical trials, including our own in amyotrophic lateral sclerosis. To initiate similar trials in Alzheimer’s disease, efficacious cell lines must be identified. Here, we completed a preclinical proof-of-concept study in the APP/PS1 murine model of Alzheimer’s disease. Human neural stem cell transplantation targeted to the fimbria fornix significantly improved cognition in two hippocampal-dependent memory tasks at 4 and 16 weeks post-transplantation. While levels of synapse-related proteins and cholinergic neurons were unaffected, amyloid plaque load was significantly reduced in stem cell transplanted mice and associated with increased recruitment of activated microglia. In vitro, these same neural stem cells induced microglial activation and amyloid phagocytosis, suggesting an immunomodulatory capacity. Although long-term transplantation resulted in significant functional and pathological improvements in APP/PS1 mice, stem cells were not identified by immunohistochemistry or PCR at the study endpoint. These data suggest integration into native tissue or the idea that transient engraftment may be adequate for therapeutic efficacy, reducing the need for continued immunosuppression. Overall, our results support further preclinical development of human neural stem cells as a safe and effective therapy for Alzheimer’s disease.

Nerve root compression by foraminal pathology is challenging for a surgeon to decompress without violating the facet joint, which may necessitate a fusion procedure. One nonfusion approach to foraminal pathology is a combination intracanal approach for a laminotomy/foraminotomy followed by a paraspinal Wiltse approach for far lateral decompression. Unfortunately, even with the combination approach, it continues to be difficult to achieve adequate decompression without violating much of the facet joint overlying the nerve root. Spine endoscopy offers the ability to decompress the foraminal portion of the nerve without significant violation of the facet joint. We present a surgical video describing the technique for performing a percutaneous endoscopic contralateral L5-S1 foraminal decompression via an interlaminar approach, for a patient presenting with a left L5 radiculopathy due to L5-S1 foraminal stenosis. We explain the differences in the endoscopic channel docking point between ipsilateral and contralateral interlaminar approaches. The steps of an endoscopic foraminotomy are then described: dissect soft tissue and ligamentum flavum off the medial left S1 lamina and superior articulating process (SAP), undercut the superior articulating process of S1 and the inferior articulating process (IAP) of L5 with a drill, resect lateral ligamentum flavum off SAP and IAP exposing epidural fat, and finally dissect the left L5 nerve root and remove compressive lesions throughout its course in the lateral recess, foramen, and laterally. The presentation ends with an intraoperative photograph showing a decompressed L5 nerve root and postoperative imaging confirming this decompression. Appropriate patient consent was obtained.

A human cortex-derived neural stem cell (NSC) line modified to express insulin-like growth factor-I (IGF-I), HK532-IGF-I, is characterized in this report. The cell line is under study as a cellular therapy for Alzheimer’s disease (AD). HK532-IGF-I cells preferentially differentiated into gamma-aminobutyric acid-ergic neurons, a subtype dysregulated in AD; produced increased vascular endothelial growth factor levels; and displayed an increased neuroprotective capacity in vitro. HK532-IGF-I cells survived peri-hippocampal transplantation in a murine AD model and exhibited long-term persistence in targeted brain areas., Alzheimer’s disease (AD) is the most prevalent age-related neurodegenerative disorder and a leading cause of dementia. Current treatment fails to modify underlying disease pathologies and very little progress has been made to develop effective drug treatments. Cellular therapies impact disease by multiple mechanisms, providing increased efficacy compared with traditional single-target approaches. In amyotrophic lateral sclerosis, we have shown that transplanted spinal neural stem cells (NSCs) integrate into the spinal cord, form synapses with the host, improve inflammation, and reduce disease-associated pathologies. Our current goal is to develop a similar “best in class” cellular therapy for AD. Here, we characterize a novel human cortex-derived NSC line modified to express insulin-like growth factor-I (IGF-I), HK532-IGF-I. Because IGF-I promotes neurogenesis and synaptogenesis in vivo, this enhanced NSC line offers additional environmental enrichment, enhanced neuroprotection, and a multifaceted approach to treating complex AD pathologies. We show that autocrine IGF-I production does not impact the cell secretome or normal cellular functions, including proliferation, migration, or maintenance of progenitor status. However, HK532-IGF-I cells preferentially differentiate into gamma-aminobutyric acid-ergic neurons, a subtype dysregulated in AD; produce increased vascular endothelial growth factor levels; and display an increased neuroprotective capacity in vitro. We also demonstrate that HK532-IGF-I cells survive peri-hippocampal transplantation in a murine AD model and exhibit long-term persistence in targeted brain areas. In conclusion, we believe that harnessing the benefits of cellular and IGF-I therapies together will provide the optimal therapeutic benefit to patients, and our findings support further preclinical development of HK532-IGF-I cells into a disease-modifying intervention for AD. Significance There is no cure for Alzheimer’s disease (AD) and no means of prevention. Current drug treatments temporarily slow dementia symptoms but ultimately fail to alter disease course. Given the prevalence of AD and an increasingly aging population, alternative therapeutic strategies are necessary. Cellular therapies impact disease by multiple mechanisms, providing increased efficacy compared with traditional, single-target drug discovery approaches. This study describes a novel enhanced human stem cell line that produces increased amounts of growth factors beneficial to the disease environment. Findings support further development into a potentially safe and clinically translatable cellular therapy for patients with AD.

This work aims to investigate the effect of different bio-fertilizers (Arbascular mycorrhizae fungi, Azotobacter chroorcoccum, yeast strains and mixture of all inoculum) and irrigation intervals (3, 6 or 12 days) on the growth and chemical composition of Delonix regia seedlings grown in sandy soil. Pot experiments were conducted using a randomized complete blocks design with three replicates during two successive seasons of 2013 and 2014. The results indicated that dual bio-fertilizers led to significant increase in growth characters (plant height, root length, number of branches/plant, total fresh and dry weights/plant), microbial populations and AM fungi colonization (%), enzymatic activities, chemical composition (plant pigments, total carbohydrates, proline content, N, P, K) besides antioxidant enzymes such as catalase (CAT),and peroxidase (POD) compared to the un-inoculated seedlings (as control) at the recommended dose of NPK chemical fertilizers under the same conditions. Generally, these results undoubtedly confirm that dual bio-fertilizers could replace the use of chemical fertilizers and consequently improve the quality and quantity of D. regia. Key words: Delonix regia, Arbascular mycorrhizae fungi, Azotobacter chroorcoccum, yeast strains - growth characters, chemical composition.

Background: Almost all patients with amyotrophic lateral sclerosis (ALS) develop bulbar symptoms; therefore, it is important to have valid animal models that accurately reflect these features. While the SOD1-G93A rat is extensively used as an ALS model, bulbar symptoms in this model are not well characterized. Objective: In the present study, we aimed to better characterize bulbar dysfunction in terms of histology to determine whether the SOD1-G93A rat is a useful model for bulbar-onset ALS. Methods: Sixty-day-old SOD1-G93A rats on a Sprague-Dawley background and age-matched wild-type controls were assessed weekly for global motor function, facial nerve function, and vagal nerve function. The study endpoint was determined when an SOD1-G93A rat could not right itself within 30 s of being placed on its side. At that point, neuronal counts were assessed in different brainstem cranial nerve nuclei. In addition, the masseter muscle, posterior belly of the digastric muscle, and tongue muscle were evaluated for intact neuromuscular junctions. Results: Our data demonstrate decreases in the number of motor neurons in the trigeminal, facial, and hypoglossal nuclei, as well as compromised neuromuscular junction integrity in the muscles they innervate. Conclusion: These findings suggest that, from a histological standpoint, the SOD1-G93A rat is a valid model of ALS bulbar symptoms.

Object As medical costs continue to rise during a time of increasing medical resource utilization, both hospitals and physicians must attempt to limit superfluous health care expenses. Neurointerventional treatment has been shown to be costly, but it is often the best treatment available for certain neuropathologies. The authors studied the effects of 3 policy changes designed to limit the costs of performing neurointerventional procedures at the University of Michigan. Methods The authors retrospectively analyzed the costs of performing neurointerventional procedures during the 6-month periods before and after the implementation of 3 cost-saving policies: 1) the use of an alternative, more economical contrast agent, 2) standardization of coil prices through negotiation with industry representatives to receive economies of scale, and 3) institution of a feedback method to show practitioners the costs of unused products per patient procedure. The costs during the 6-month time intervals before and after implementation were also compared with costs during the most recent 6-month time period. Results The policy requiring use of a more economical contrast agent led to a decrease in the cost of contrast usage of $42.79 per procedure for the first 6 months after implementation, and $137.09 per procedure for the most current 6-month period, resulting in an estimated total savings of $62,924.31 for the most recent 6-month period. The standardized coil pricing system led to savings of $159.21 per coil after the policy change, and $188.07 per coil in the most recent 6-month period. This yielded total estimated savings of $76,732.56 during the most recent 6-month period. The feedback system for unused items decreased the cost of wasted products by approximately $44.36 per procedure in the 6 months directly after the policy change and by $48.20 per procedure in the most recent 6-month period, leading to total estimated savings of $22,123.80 during the most recent 6-month period. According to extrapolation over a 1-year period, the 3 policy changes decreased costs by an estimated $323,561.34. Conclusions Simple cost-saving policies can lead to substantial reductions in costs of neurointerventional procedures while maintaining high levels of quality and growth of services.

Febrile seizure is one of the most common neurological problems during childhood. The etiology and pathogenesis of febrile seizure remain unknown. However, several factors such as vitamin B6 deficiency, electrolyte disturbances, and reduction in serum zinc, selenium, magnesium levels, and low gamma - aminobutyric acid (GABA) levels are thought to play a role in the pathogenesis of febrile seizure. The present study included twenty children from 10 families, 11 were male and 9 were female. Each family has at least 2 members with a history of febrile convulsion. All cases were subjected to the following: Determination of serum levels of copper, zinc, magnesium, selenium level in serum, and plasma level of γ-aminobytaric acid (GABA). Serum levels of selenium and GABA were statistically significantly low in comparison with controls. Serum copper was statistically significantly higher in cases than controls, while serum zinc showed no significant changes in the cases of febrile convulsion compared with the control group. The mean Zn level in the serum of febrile convulsion was found to be at lower level than in the control group. The serum magnesium was significantly low in cases than controls. The logistic regression model in our study shows that Selenium and Magnesium have protective effects, while Copper has causative effect.

The enhancement of the solar cell efficiency field has been achieved in many methods due to the different factors and conditions that led to loss the solar energy. This work deals with the increasing of the efficiency of solar cell that made of single crystalline silicon. This increment achieved by the reduction of biggest type of losses of the conversion efficiency named reflection. by using two methods first; forming grooves on the surface using pulse Nd:YAG laser with max energy 1J and pulse width 10ns, using the fast and accurate movement of the 3D optical galvo mirror scanning system to form the grooves, the second method was by deposition nanomaterials as Silver (Ag) and Cadmium telluride (CdTe) to constitute an antireflection layer for the incident solar spectrum. The effect of antireflection layer material type and the effect of incident light angle on the reflection had been studied in this work. The reflectance had been measured by a system designed and built to give the reflection for angles ranged 0 – 180 degree controlled by Microcontroller. The result inducate that increase in conversion efficiency was 28.3% for Ag/Si, and 32.9% for CdTe/Si than the original efficiency of Si solar cell.

Background: Irritation of the sinuvertebral nerve by a posterior or posterolateral disk desiccation can cause somatic referred pain that can mimic a lumbar radiculopathy. We present a case of a patient presenting with this condition and the positive result in pain improvement after endoscopic radiofrequency ablation of the sinuvertebral nerve. Case Description: An 18-year-old Olympic runner presented to our clinic with back pain and left leg pain in a clear L5 distribution. He did not have a history of trauma. His imaging did not demonstrate any lesion causing compression of the left L5 nerve root as expected. He was found to have a left healing L5 pedicle fracture and ipsilateral chronic L5 pars interarticularis fracture. He was also found to have an ipsilateral minor left L5-S1 disk desiccation. His visual analog scale (VAS) score was 7. After a positive provocative diskogram, the patient underwent percutaneous transforaminal endoscopic radiofrequency ablation of the left L5 sinuvertebral nerve, which was irritated by the left L5-S1 disk desiccation. At his 6-month follow-up visit, the patient's VAS score was 1. Conclusions: It is important for clinicians to remember that back-associated leg pain can be caused by somatic referred pain because of irritation of the sinuvertebral nerve. Endoscopic radiofrequency of this nerve can be beneficial in pain control, but further randomized prospective trials are needed to study these techniques further. Key words: Back pain, Endoscopic spine surgery, Pars interarticularis fracture, Radiofrequency ablation, Sinuvertebral nerve

The paper sheds light on the beamforming (BF) performance of large (potentially unconstrained in size) as well as dense (but physically constrained in size) antenna arrays when equipped with arbitrarily many elements. Two operational modes are investigated: Single-layer BF and multi-layer BF. In the first mode, a realistic BF criterion namely the average BF gain is revisited and employed to understand the far-field and the near-field effects on the BF performance of large-scale antennas above a clutter. The diminishing throughput returns in a single-layer BF mode versus the number of antennas necessitate multi-layering. In the multi-layer BF mode, the RF coverage is divided into a number of directive non-overlapping sector-beams in a deterministic manner within a multi-user multi-input multi-output (MIMO) system. The optimal number of layers that maximizes the user's sum-rate given a constrained antenna array is found as a compromise between the multiplexing gain (associated with the number of sector-beams) and the inter-beam interference, represented by the side lobe level (SLL).

Due to the considerable amount of motion at the L5–S1 segment, achieving bony fusion at that junction remains a challenge to spine surgeons. As such, pelvic fixation was developed and is used to help solve this problem. Prior to instrumentation, knowledge of the region’s anatomy, including the ligaments, is paramount. There are no absolute indications for when to instrument the pelvis or whether to stop at the sacrum when performing a long-segment construct, but relative indications do exist. The most widely used sacral instrumentation is the S1 pedicle screw. Because the S1 pedicles are wide with less cortical bone to allow for screw purchase, S1 screws at the end of long constructs can be prone to failure. Pelvic fixation helps protect S1 pedicle screws and, when coupled with S1 iliac screws, has been shown to enhance fusion rates at L5–S1. The two most common instrumentation methods for pelvic fixation use iliac screws and S2 alar-iliac (S2AI) screws. S2AI screws have the benefit over traditional iliac screws in that they minimize screw prominence, making it easier to attach these screws to the rest of the construct. The effect of S2AI screw trajectory on sacroiliac joint arthritis and sacroiliac pain continues to be debated.

Although antenna selection is a simple and efficient technique for enhancing the downlink performance of multiuser diversity systems, the large antenna interelement spacing required for achieving spatial diversity is prohibitive for user terminals due to size restrictions. In order to allay this problem, we propose miniaturized switched beam receiver designs assisted by low-cost passive reflectors. Unlike conventional spatial receive diversity systems, the proposed angular diversity architectures occupy a small volume whereas the antenna system properties are optimized by controlling the strong reactive fields present at small dimensions. The systems are designed for maximum antenna efficiency and low interbeam correlation, thus yieldingNpractically uncorrelated receive diversity branches. The simulation results show that the proposed enhanced diversity combining systems improve the average throughput of a multiuser network outperforming classical antenna selection especially for small user populations and compact user terminal size.

Space-time coded cooperative transmission has been proposed as a means to prolong the battery lifetime of conventional single-antenna energy-constrained wireless sensor nodes. However, newly proposed smart-antenna sensor prototypes enable the existence of more than one antenna within a single-radio transceiver architecture. Exploiting such capability, this paper proposes simple non-cooperative space-time techniques for single-RF switched-antenna systems that reduce significantly both the transmission and the circuit energy consumption. The energy savings of the suggested schemes are shown not only against conventional SISO systems, but also against cooperative diversity schemes in Rayleigh and log-normal shadowed Rayleigh fading channels with distance-based path loss.

A recent research program has identified the possibility of using the analysis of casing wall pressures in the direct measurement of gas turbine rotor blade vibration amplitudes. Currently the dominant method of non-contact measurement of gas turbine blade vibrations employs the use of a number of proximity probes located around the engine periphery measuring the blade tip (arrival) time. Despite the increasing ability of this method there still exist some limitations, ie. the requirement of a large number of sensors for each engine stage, sensitivity to sensor location, difficulties in dealing with multiple excitation frequencies and sensors being located in the gas path. Analytical modelling of the casing wall pressures and reconstruction of rotor blade vibration amplitudes from the analysis of these simulated pressure signals has shown significant improvement over current non-contact rotor blade vibration measurement limitations by requiring only a limited number of sensors and providing robust rotor blade vibration amplitude estimates in the presence of simulated measurement noise. However, this modelling was conducted with some fundamental assumptions about the casing wall pressures being made. One of these assumptions presumed that during blade motion the pressure profile around the rotor blades follows the blade's motion while it oscillates around its equilibrium position. This assumption is investigated in this paper through the numerical modelling of the fully coupled two-way rotor blade motion and fluid pressure interaction.

Heparin-binding EGF-like growth factor (HB-EGF) protects the intestine from damage in animals. Future clinical trials of HB-EGF may involve administration of repeated doses of HB-EGF. Since HB-EGF activates EGF receptors which have been implicated in tumor development, we examined the effects of HB-EGF overexpression in the intestine.We generated transgenic (TG) mice in which the human HB-EGF gene is driven by the villin promoter to overexpress HB-EGF along the crypt-villous axis from the duodenum to the colon.HB-EGF TG mice have increased enterocyte proliferation balanced by increased enterocyte apoptosis. Despite prolonged overexpression of HB-EGF, no evidence of intestinal hyperplasia or tumor formation occurs. Although HB-EGF TG mice have no significant phenotypic alterations under basal conditions, they have increased resistance to intestinal injury.Prolonged intestinal HB-EGF overexpression results in no significant phenotypic alterations under basal conditions, but confers protection against intestinal injury.

Bacterial contamination of blood and its cellular components remains an unresolved problem in transfusion medicine, and is considered to be the most common microbiological cause of transfusion associated morbidity and mortality. This is because contaminated units may contain large numbers of virulent bacteria as well as, endotoxins that are considered to be fatal to the recipients. Endotoxins are high-molecular weight complexes of lipopolysaccharides that constitute the major cell wall component in all Gram-negative bacterial families. These molecules have been intensively investigated because of the increasing appreciation of their potentially pathogenic role in a wide variety of human disease states. The present study aimed to detect endotoxins and bacterial agents in collected blood bags and their transmission to the recipients of these blood bags. The study involved 100 randomly selected blood bags and their recipients. They were all examined by Limulus Amebocyte Lysate (LAL) assay using gel clot method for detection of endotoxins and by blood culture for the detection of bacterial agents. Endotoxins were detected in five blood bags (5%) using LAL assay (gel clot method), while bacterial contamination was found in only one blood bag . The bag that gave positive blood culture yielded Staphylococcus aureus, which was mostly a skin associated organism and was considered as a contaminant related to the procedure during donor venipuncture. None of the 100 studied recipients of these blood bags revealed positive blood culture. It was concluded from this study that LAL assay is a rapid, easy to perform, and a highly sensitive test that can detect as little as 0.03 endotoxin units per ml using the gel-clot method. In addition not all endotoxins or bacterial agents could be transmitted to the recipients of blood bags, this depends on their volume and whether the recipient is on antibiotic therapy or not.

The gut is highly susceptible to injury after hemorrhagic shock and resuscitation (HS/R) because of progressive mesenteric hypoperfusion. The aim of the current study was to evaluate the effect of heparin-binding EGF-like growth factor (HB-EGF) on mesenteric microcirculatory blood flow and intestinal injury in rats subjected to HS/R.HS/R was induced in adult rats, with some rats receiving HB-EGF (600 mug/kg) IV at the onset of resuscitation (HS/R+HB-EGF) and others receiving vehicle only (HS/R). FITC-dextran was administered intra-arterially to evaluate mesenteric microcirculation, and intestinal damage and restitution were evaluated histologically. Data were expressed as mean +/- SE, with P.05 considered statistically significant.Microcirculatory blood flow was significantly reduced 1 hour after HS/R. HS/R+HB-EGF rats had significantly increased microcirculatory flow compared with HS/R rats at 1 hour (4.5 +/- 0.43 vs 2.64 +/- 0.46, P.05) and 3 hours (8.04 +/- 1.58 vs 2.89 +/- 0.63, P.05) after HS/R. HS/R+HB-EGF rats had significantly less intestinal damage compared with HS/R rats 3 hours after resuscitation (2.04 +/- 0.5 vs 3.08 +/- 0.5, P.05), along with significantly fewer incompetent (nonresurfaced, nonhealed) villi, which is indicative of improved restitution.HB-EGF significantly improved postresuscitation microcirculatory blood flow in rats subjected to HS/R, associated with significantly decreased intestinal damage and increased restitution. These results suggest that HB-EGF may be a useful therapeutic agent that improves intestinal blood flow in patients with intestinal injury secondary to hemorrhagic shock.