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Background: Tobacco smoking is the most common preventable cause of morbidity and mortality in the world. In an effort to counteract the harmful consequences of smoking, various tobacco control measures have been implemented, including the use of smoking cessation programmes to reduce the number of new smokers as well as helping current smokers to quit smoking. In Thailand, the SMART Quit Clinic Program (FAH-SAI Clinics) was launched in 2010 to provide smoking cessation services by a multidisciplinary team. There are currently 552 FAH-SAI Clinics established across all 77 provinces of Thailand. Aim: This protocol describes a study aiming to evaluate the SMART Quit Clinic Program (FAH-SAI Clinics) in terms of programme performance and clinical outcomes. We hope that the results of the study could be used to improve the current service model and the programme’s success. Method: A multicentre prospective observational study will be conducted. The study will focus on 24 FAH-SAI Clinics across 21 provinces of Thailand. The primary outcomes are seven-day point prevalence abstinence rate and continuous abstinence rate at three and six months. The outcomes will be measured using a self-reported questionnaire and biochemical validated by exhaled carbon monoxide. Discussion: This study will be the first real-world study that reports the effectiveness of the well-established smoking cessation programme in Thailand. Findings from this study can help improve the quality of smoking cessation services provided by multidisciplinary teams and other smoking cessation services, especially those implemented in low- and middle-income countries.

Containment measures have been implemented in Thailand after the country was hit by the Covid-19 pandemic. The top priority is to save people’s lives. Unavoidably, serious consequences that affected the people’s income, privacy, needs, equality, and equity emerged, presenting new challenges. In order to begin to investigate these complex ethical questions, the Office of Research Integrity of National Science and Technology Development Agency organized a meeting in order to bring together key experts in various fields related to the Covid-19 pandemic to discuss what was going on in Thailand and how to manage it properly. Three key ethical settings, each of which caused significant effects, were discussed in the meeting, namely public health, medical services, and research and clinical trial settings. Many key ethical issues were revealed during the meeting, as well as how best to address and manage them properly.

"Virtual Work” has been a growing trend that defined as people work at different locations and times. The concept of virtual work is transforming a physical place into a virtual environment, and change people interacts via online communication technologies. How people work as a team and integrated progression in this virtual environment is a key issue to work effectively. Therefore, communication is a key process in the virtual work method to improve work performance. This paper aims at how to manage the communication process in a framework of virtual work, providing communication strategies for a startup entrepreneur to improve the effectiveness of work and reduce impact factors that affect to work performance of employees’ work-life in the virtual work method. This impact factor is about work-life balance, social relation, communication, and knowledge sharing. These communication strategies are combined both online communication technologies and face-to-face communication to reduce impact factors and providing objective of face-to-face communication to make productive meetings. This framework was approved that able to resolve various factors that are caused by digital transform as well.

Nowadays, Industry 4.0 is widely known in the industry. Many large companies have pushed and adapted to Industry 4.0 to increase their business competitiveness, so small and medium-sized companies must adjust to improve their production capabilities to keep up with the technological development of Industry 4.0. Industry 4.0 development can be done in many ways as outsourcing or self-developing systems, but outsourcing and purchasing systems Installation have a high cost. This paper proposes a digital twin focuses on self-development. By using digital twins combined with existing production systems to develop data following the concept of Industry 4.0, digital twins are used to creating digital data from physical forms to inspect, record production data and create digital communication channels to other systems. In summary, this paper uses a digital twin to show another way to develop into Industry 4.0, which starts with the development of data. This way is using the cost of starting a very lower without automation structure and get the data to analyze for adapting with automatic layer systems in maximum efficiency.

OBJECTIVE We sought to determine whether treatment with lisofylline (LSF) preserves intestinal barrier function in rats subjected to hemorrhagic shock and resuscitation (HS/R). SETTING Research laboratory at a major university teaching hospital. DESIGN Rats were bled to a mean arterial pressure of 30 mm Hg and maintained at that pressure for 90 mins. One group (n = 8) was treated with LSF (bolus doses of 15 mg/kg at 45 and 89 min plus infusion at 10 mg x kg(-1) x hr(-1)), whereas another group (n = 8) received only the lactated Ringer's solution (LRS) vehicle. At 90 mins, the animals were resuscitated with shed blood and LRS (55 mL x kg(-1) x hr(-1)). Intestinal mucosal permeability was determined by measuring the mucosal-to-serosal clearance of fluorescein isothiocyanate dextran (molecular weight = 4 kDa) into everted gut sacs. MEASUREMENTS AND MAIN RESULTS Intestinal and hepatic blood flow (assessed by laser Doppler flowmetry) was greater in LSF-treated rats. Treatment with LSF ameliorated the development of histologic evidence of mucosal damage and hyperpermeability. Rats treated with LSF had lower plasma concentrations of the intracellular hepatic enzyme, aspartate aminotransferase. After 90 mins of resuscitation, concentrations of adenosine triphosphate in intestinal and hepatic tissue were greater in LSF-treated as compared with LRS-treated rats, but concentrations of the endogenous antioxidant, glutathione, in intestinal and hepatic tissue, although lower than in rats not subjected to HS/R, were similar in the two treatment groups. CONCLUSION Treatment with LSF ameliorated HS/R-induced derangements in intestinal structure and function and hepatic injury, possibly by preserving microvascular perfusion and tissue adenosine triphosphate concentrations.

In a reductionist in vitro system, intestinal epithelial permeability appears to be dependent on cellular ATP content. In order to extend these prior observations, we used rat models of mesenteric ischemia/reperfusion (I/R) and pressure-controlled hemorrhagic shock to test the hypothesis that intestinal barrier function is directly proportional to tissue ATP content. I/R was induced by clamping the mesenteric vessels for 60 min followed by 60 min of reperfusion. Normal, ischemic, and reperfused ileal segments were prepared from each rat (n = 12). Hemorrhagic shock was induced by bleeding rats (n = 9) to a mean arterial pressure of 30 mmHg and maintaining this pressure for 4 h by infusing Ringer's lactate solution as necessary. Ileal segments were harvested before induction of hemorrhage and at 1 h intervals thereafter. Everted gut sacs were prepared to measure the mucosal-to-serosal passage of fluorescein-conjugated dextran (FD4; M.W. = 4 kDa). Tissue ATP levels were determined using a luciferase assay. FD4 clearance rates were plotted as a function of tissue ATP content. Linear regression analyses showed a strong inverse relationship between intestinal permeability and tissue ATP level in rats subjected to I/R (r2 = 0.78; P < 0.001) or hemorrhage (r2 = 0.82; P < 0.001). These data support the idea that ATP content is a determinant of intestinal epithelial barrier function in vivo.

In order to detoxify ammonia, mammalian livers use carbamoyl phosphate synthetase (CPS) and glutamine synthetase (GS) for conversion into respective non-toxic urea and glutamine. CPS is expressed in the periportal hepatocytes whereas GS is contained in the pericentral hepatocytes.To examine the expressional changes of CPS and GS in the liver being induced to become cirrhotic by hepatotoxin thioacetamide (TAA).Twenty-five male Wistar rats were divided into 5 groups of 5 animals each. Group 1 was for control. Groups 2 to 5 were treated with 200 mg/kg TAA intraperitoneally three times weekly for 1, 2, 3 and 4 months respectively. The immunohistochemical technique was employed in order to elucidate the expression of CPS and GS in each animal group.As centro-central fibrous bridging developed in the course of TAA treatment, expression of CPS declined dramatically and that of GS was no longer restricted to the pericentral hepatocytes. In month 4, CPS-positive hepatocytes were only found in some regenerative nodules, whereas GS expression became confined to the nodular periphery. Proper CPS staining required tissue fixation in a mixture of methanol, acetone and water (2:2:1 v/v) as opposed to 4% paraformaldehyde.In response to the hepatotoxin TAA, the liver attempts to regenerate by means of conserving persistent CPS-positive hepatocytes and rearranging GS-positive hepatocytes in response to vascular obstruction.

About eighteen percent of cirrhotic patients come along with decreased systemic arterial oxygenation and expansion of pulmonary venous plexus which triggered by nitric oxide. The level of nitrate and iNOS significantly increase in the cirrhotic patients. However the localization of nNOS and iNOS in the lung tissue has not yet been clarified.The present study, therefore, aimed to demonstrate the sites of expansion of pulmonary blood vessels and to localize nNOS and iNOS in the lung tissue of cirrhotic rat models induced by thioacetamide (TAA).The rats were divided into 5 groups. The first group was the control. The other four groups were treated with 200 mg/kg body weight of TAA 3 times per week for 1, 2, 3, or 4 month(s), respectively. At the end of each month rats in each treated group were sacrificed. Lung histology and pulmonary NOS expression was studied by light microscope and immunohistochemical technique, respectively.It was found that diameter of blood vessels were highest increased in the right lower lobe of the 4-months TAA-treated group. In addition, iNOS and nNOS expression was localized at epithelium of respiratory tract, endothelium of pulmonary vessel and macrophage at this age.The present study demonstrated that the pulmonary blood vessels at the right lower lobe with cirrhotic background got enormous dilatation. iNOS and nNOS were immunostained at epithelium of respiratory tract, pulmonary endothelium and macrophages. Our observations suggested that enhanced NOS expression is important in the development of systemic hyperdynamic circulatory abnormalities in cirrhosis. As appearance of vasodilatation at right lower lobe of lung, it could, therefore, be evidence confirming that there was a real connection between inferior pulmonary vein and azygos vein at the embryonic period but obliterated later.

Although biliary bypass technique which used jejunum as a conduit is a common procedure in open technique of hepatobiliary tract surgery, its complicated technique made it is not feasible for laparoscopic surgery. Before 1960, stomach was used vastly for biliary drainage but late stricture which resulted from too much tension along suture line made it not much acceptable. The authors report surgical technique of laparoscopic gastric tube flap for biliary bypass in order to made it practicable for laparoscopic surgery.

This survey was aimed at obtaining a screening survey on mental health status of Thai physicians. We systematically sampled to obtain 440 Thai physicians from the directory of Thai Center for Continuing Medical Education (CCME). Then, we obtained their mental health status by mailing a questionnaire containing Thai GHQ-28 and asking them to reply, later we obtained through telephone interview. The response rate was 86.3 percent, and 60.3 percent of them were male. The result revealed that 15 male and 13 female physicians had abnormal mental health status. The overall prevalence rate of abnormal mental health status was 7.4 percent. We also found a significant negative association between mental health status and career satisfaction and the use of sedatives in the past 6 months. This study pointed out that mental health of some Thai physicians was to be concerned. These problems, along with their physical health problems, should be tackled systematically and preventatively in order to have the majority of Thai physicians in good health and able to serve the population more effectively.

The objectives of this study were to explore characteristics of the long-lived Thai physicians. We sent 983 posted questionnaires to 840 male and 143 female physicians. We obtained 327 of them back after 2 rounds of mailing, yielding a response rate of 33.3 percents. The response rate of male physicians was 32.4 percents and that of female physicians was 38.5 percents. Their ages were between 68-93 years (75.1 +/- 4.86 years on average). The majority were married, implying that their spouses were also long-lived. Around half of them still did some clinical work, one-fourth did some charity work, one-fourth did various voluntary works, one-fifth did some business, one-fifth did some academic work, and some did more than one type of work. Most long-lived physicians were not obese, with BMI of 16.53-34.16 (average 23.97 +/- 2.80). Only 8 had BMI higher than 30. BMIs were not different between male and female physicians. However, four-fifths of them had diseases that required treatment, and some of them had more than one disease. The five most frequent diseases were hypertension, diabetes, ischemic heart disease, dyslipidemia, and benign prostate hypertrophy, respectively. Most long-lived physicians did exercise (87.8%), and some did more than one method. The most frequent one was walking (52.3%). Most did not drink alcohol or drank occasionally, only 9.0% drank regularly. Most of them slept 3-9 hours per night (average 6.75 +/- 1.06). Most (78.3%) took some medication regularly; of most were medicine for their diseases. Most did not eat macrobiotic food, vegetarian food, or fast food regularly. Most long-lived physicians practiced some religious activities by praying, paying respect to Buddha, giving food to monks, practicing meditation, and listening to monks' teaching. They also used Buddhist practice and guidelines for their daily living and work, and also recommended these to their younger colleagues. Their recreational activities were playing musical instruments (15%), singing (27%), doing hobbies (64.0%), and others (51.8%). Most did not reply on question whether they achieved their self-actualization target of their lives, this might result from the fact that this was rather an abstract question. Our first part study revealed some characteristics of long-lived Thai physicians that seem to be in agreement with other studies indicating that physicians compared favorably with the general population in mortality from physical illness. This may result from several factors: the medical student selective process leading to "healthy worker effect", knowledge in medicine, access to care, and their healthy behaviors (such as nutrition, exercise, religious activities which help improve their spiritual well-being).

Physicians often conduct research on other occupations' health or general populations' health, but their health has hardly been studied systematically. The authors conducted a cross-sectional descriptive survey on 440 physicians systematically selected from their medical license numbers. The response rate was 86.4% (380 out of 440). Two-hundred and twenty-nine were male, and 151 were female. Their average age was 40.8 years (range: 22-74). Most of them were Buddhists (93.9%), specialists (64.2%), married only once and still lived with their spouses (59.5%), and concurrently practiced medicine (95.5%). Their overall satisfaction as physicians was 60.2% high, and 37.2% moderate. Their average sleep time was 6-8 hours per night for 58.9%. Most had eye problems (74.9%) and most were refractive errors such as myopia. Most (63.8%) of them did not have any prevalent diseases. Whereas those who had diseases had (in order) allergy, hypertension, asthma, diabetes, and cancer. Their current illnesses included respiratory tract infection. Most physicians did not smoke (94.2%) nor drink alcohol (70.5%). Most of them were not vegetarians (60.4%), did not eat fast food (99.2%). Interestingly, 41.4% of them were accounted for spending less than twice per week for exercise. As expected, 23.7% of them were exposed to blood, 14.5% to respiratory tract secretion, and 13.7% to pus/secretion from wounds. This study serves as a basis for health promotion approach to medical community and does create awareness of health among Thai physicians.

To investigate the risk factors for suicide in Thai physicians.The study focused on 18 doctors who had committed suicide before January 2002, identified by death certificates and the reported data from Thai Medical Council. Consensus case reports were assembled by using the psychological autopsy method. Study methods included semi-structured and in-depth interviews of next of kin and interviews of classmates, colleagues and medical or mental health services workers who had treated the suicide victims.The sample consisted of 18 subjects (17 males, one female). The age range was 30-49 years old. Most victims were specialists (11 out of 18; 3 gynecologists, 2 psychiatrists, 2 pediatricians, 2 surgeons and 1 internist, 1 radiologist). The methods of suicide were 6 hanging, 5 gun shots, 5 intravenous injections, 1 jumping and 1 drug over-dose. Psychiatric disorders were found in 11 out of 18 cases, and depressive disorder was the most common disorder. Interpersonal conflict and/or loss were the most common factors leading to suicide (6 out of 18), the second factor was psychiatric illness and the third factor was work problems.In assessing suicidal risk, a history of interpersonal conflicts and loss and the presence of co-morbid psychiatric disorders are particularly important. The important strategies for suicide prevention in Thai physicians are early detection and proper management of psychiatric illness especially depressive disorder and recognition the significance of family support.

The purposes of this cross-sectional study were to collect data regarding satisfaction and influencing factors related to satisfaction of Thai Physicians. The survey was conducted during October 2002 to March 2003. Study subjects were 440 physicians obtained by systematic random sampling. They were asked to reply posted questionnaire and telephone interviewed later if they did not reply the mailed questionnaire. The authors could obtain data from 380 out of 440 cases (86.3%), 60.3% were male and 39.7% were female. Their average age was 43.9 and 37.7 years, respectively, with an overall average of 40.9 years. The level of career satisfaction of Thai Physicians was high (60.2%), moderate (37.2%) and low (2.6%). Conclusively the factors which influenced or predicted satisfaction of Thai physicians were age, exercise and accident. The author make some recommendations for improving Thai physicians' satisfaction.

Previous report suggested early age at death of Thai physicians; the estimate however was not a comparable measurement with general Thai population. This information created a concern on the health status of Thai population. This study was therefore aimed to calculate life expectancy of Thai physicians and to compare with Thai population. Information on year of birth of all registered physicians and year of death of physicians who died during 1998-2002 was retrieved from the database of the Thai Medical Council and the Centre for Continuing Medical Education of Thailand. Age-specific mortality rates were computed for ages of 23-24, 25-29, and then 5-year intervals until 70 years or more. These age-specific mortality rates were used for calculation of life expectancy by using the method of abridged life table. During the year 1998-2002, there were 655 deaths among 25,501 Thai physicians. According to life table calculation, life expectancy at age 23 for Thai physicians was 63.5 years or they could live until age of 86.5 years when they started their career and those figures for Thai general population were 53.2 and 76.2 respectively. The differences between these two populations were declined in older age groups. Increased life expectancy among physicians compared to general population was also reported in other countries. A longer life span of physicians might be a result of higher socioeconomic status and low prevalence of health risk behavior.

Introduction The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, named statins, are well-established cholesterol-lowering drugs able to reduce cardiovascular risk in hypercholesterolemic patients. The possible effect of statin on bone tissue, so-called pleiotropic effects has received particular attention. Studies reported a positive effect of statin on bone tissue in both of animal and human study by enhancing the expression of the bone morphogenetic proteins (BMPs), in particular of BMP2, which in turn leads to osteoblast differentiation and bone formation including interfering with osteoclastic activity. In a systematic review, the lipophilic statin as simvastatin had positive effect to bone mineral density (BMD) better than the more hydrophilic statin such as atorvastatin and fluvastatin. This study was aimed to compare efficacy of medical therapy between HMG-CoA reductase inhibitor and non-HMG-CoA reductase inhibitor group to changing of bone mineral density and bone markers in the patients with hyperlipidemia. Materials and methods A prospective randomized control trial study enrolled the 212 hyperlipidemia with osteopenia patients to study in year 2006–2008. All subjects were randomized to 2 groups between statin and non-statin group; the patients were screened by inclusion criteria and measured in bone mineral density (BMD), bone marker and blood chemistry. All data were analyzed by difference of changing in bone marker and BMD between statin and non-statin groups using paired t test. Results The present study showed 212 hyperlipidemia with osteopenia patients of which 106 patients in statin group had mean age (63.17 ± 9.51 years) and the same number of patients in non-statin group had mean age (60.96 ± 8.9 years). All subjects were 63 patients in male and 149 patients in female. Difference of bone formation marker and BMD between after and before was significantly higher than in statin group and the difference of bone resorption marker was also significantly lower than in statin group. Conclusion The lipophilic statin as moderate to high dose of simvastatin had beneficial positive effect to increasing BMD and could be additive use for prevention of bone loss in hyperlipidemia patients.

This study examined the effect of temperature and ischemia on permeation of fluorescently-labeled dextran (M.W. = 4 kDa; FD4) across rat intestinal mucosa. Permeability was evaluated ex vivo using an everted gut sac technique in both the mucosal-to-serosal (M--S) and serosal-to-mucosal (S--M) directions. At baseline (B), 30-min of ischemia (I-30) and 60-min of ischemia (I-60), intestinal segments were prepared and incubated at 37 degrees C, 15 degrees C and 4 degrees C for 30 min. Clearance (nl/min/cm2) was calculated based on the accumulated amount of FD4 at 30 min. Both M--S and S--M fluxes increased with increasing temperature at B, I-30 and I-60. Ischemic gut (I-30 and I-60) had about a three-fold higher (M--S)/(S--M) flux ratio than that of normal gut (p0.001). At 4 degrees C, neither M--S nor S--M flux was different between B and I-30, but both M--S and S--M fluxes significantly increased at I-60, suggesting an increase in permeation via a passive mechanism. Increased bidirectional fluxes at 37 degrees C were obtained in the I-30 and I-60 gut sacs when compared to B. We conclude that FD4 is actively transported across the intestinal mucosa in the S--M direction and that ischemic injury increases passive diffusion of the probe across the gut wall.

The wound dressing synthesized from carboxymethylchitosan hydrogel (CM) and chitin-(polyacrylic acid) hydrogel (PAA) were examined for their dermal irritation potential response using the Draize test.Eighteen male Sprague-Dawley rats were divided into three groups (6 rats/each). Rats in group 1 were designed as control, group 2 were treated with CM, and group 3 were treated with PAA. The test materials diameter 1 x 1 cm were topically applied on the skin in group 2 and 3. Two skin sites (1 x 1 cm in size) were located at the back. One site was intact and the other was abraded in such a way the stratum corneum had no bleeding.After 24 and 72 hours of wrappings, the materials were removed and the test sites were evaluated in terms of erythema and edema using adopted Draize scoring system. At the end of the experiment, all rats were anesthesized with intravenous thiopental sodium. Blood samples from descending aorta were collected for liver and kidney function test and all organs were weighed. The results of this experiment showed 1) no irritation of both materials in this animal model; 2) no material-related induced liver and kidney dysfunction and 3) organ weights had no significant difference between the groups.Both CM and PAA should be considered safe to use in the purpose of wound dressing in further clinical trials.

This is Phase 2 of the authors study on long-lived Thai physicians. After obtaining quantitative data from Phase 1, the authors approached 11 male and 5 female physicians whose ages were older than general population's life expectancy. The authors conducted an in-depth interview using semi-structured questions asking about their life, work, lifestyle, and relevant factors. Then the authors synthesized the factors influencing longevity. The authors found that they are genetic, financial stability/security, trying to be disease-free by increasing positive lifestyle (such as exercise) and decrease negative lifestyle (such as drug addict, alcohol consumption), mind-set to be non-attachment (either doing nothing or busy doing everything), and being mentally ready to die. The authors also proposed policy implications for Thai physicians and people accordingly.

We hypothesized that ischemic preconditioning (IPC) would ameliorate ischemia (I) and reperfusion (R)-induced intestinal mucosal hyperpermeability and that this effect would be diminished by lowering local adenosine concentrations using adenosine deaminase (ADA). The small intestine of anesthetized rats (group 1; n = 6) was divided into six 10-cm segments (A 1 -F 1 ) each perfused by a different set of mesenteric branches. Segments D 1 -F 1 were subjected to 3 cycles of IPC (2 min 1/5 min R). Segments A 1 , B 1 , and C 1 were excised at baseline, after 60 min of 1 (160), and after 60 min of I followed by 60 min of R (160/R60), respectively. Segment D 1 was excised immediately after the last cycle of IPC, E 1 was excised at 160 after IPC, and F 1 was excised at 160/R60 after IPC. In group 2 (n = 6), the intestine was divided into five 10-cm vascularly isolated segments (A 2 -E 2 ). Segment A 2 was resected at baseline. The lumen of the remaining segments was filled with ADA (32 U/50 cm). Segment B 2 was removed at the end of the experiment having been exposed to ADA for 150 min (ADA 150 ). Segments C 2 , D 2 , and E 2 were subjected to IPC. Segment C 2 was excised immediately thereafter. Segments D 2 and E 2 were excised at 160 and 160/R60, respectively. Intestinal permeability to fluorescein isothiocyanate-labeled dextran (molecular weight 4000 D) was assessed ex vivo by using an everted gut sac method. IPC ameliorated intestinal hyperpermeability induced by 60 (43.0 ± 7.6 vs. 70.4 ± 8.3 nL/min/cm 2 ; P = 0.024) and 160/R60 (20.2 ± 3.7 vs. 69.5 ± 10.8 nL/min/cm 2 P = 0.003). IPC prevented ischemia-induced reduction in villus height. Treatment with ADA partially reversed the protective effect of IPC on the changes in permeability and villus height induced by I/R. We conclude that IPC partially protects against mucosal barrier dysfunction in rats subjected to mesenteric I/R. Adenosine is a mediator of IPC in the gut mucosa, but other factors also may be important.

Complications of portal hypertension remain perplexing physiologic phenomena in the understanding of shunt hemodynamics with multiple theories. Hyperdynamic circulation was also found in sepsis, chronic anemia and arterio-venous (A-V) fistula which relate to an increase in nitric oxide. We hypothesize that portosystemic collaterals may mimic an A-V fistula in which the high-pressure portal blood connects with the lower pressure systemic venous circulation. Although these collaterals decompress the portal circulation, a number of secondary hemodynamic phenomena occur which increase portal blood flow and tend to counteract the portal hypotensive effect of the portosystemic shunt. The consequent increases in cardiac output and portal blood flow perfuse the compromised liver. As portal blood flow increases, collateral flow increases and is nearly totally shunted in the systemic circulation. This shunt may eventually introduce a vicious cycle of hyperdynamic circulation into a compromised host. Ultimately, high-output cardiac failure occurs, leading to cirrhotic cardiomyopathy.

In an effort to determine whether treatment with lisofylline (LSF) ameliorates intestinal barrier dysfunction in rats subjected to mesenteric ischemia and reperfusion (I/R), regional mesenteric vessels were occluded for 60 min and then unclamped for 60 min more. In Protocol 1, intravenous LSF (15 mg/kg bolus then 10 mg/kg/h) was administered 5 min before ischemia. In Protocol 2, LSF (same dose) was given 1 min before reperfusion. Controls received an equivalent volume of Ringer's lactate solution. Permeability was assessed by determining the mucosal-to-serosal clearance of fluorescein isothiocyanate-conjugated dextran (4 kDa) in everted ileal gut sacs incubated ex vivo. In Protocol 1, LSF treatment during ischemia ameliorated mucosal barrier dysfunction; mean +/- SEM clearances for the LSF and Ringer's lactate solution groups after 60 min of ischemia were 34.4+/-6.1 and 64+/-7.1 nL/min/cm2, respectively; p = .007. Clearances after reperfusion were the same in the two groups. In Protocol 2, LSF treatment just before reperfusion ameliorated barrier dysfunction measured 60 min after the restoration of blood flow; clearances for the LSF and Ringer's lactate solution groups were 23.1+/-3.8 and 40.2+/-4.5 nL/min/cm2, respectively; p = .012. Treatment with LSF did not affect intestinal levels of reduced glutathione or adenosine triphosphate or the extent of histological damage to the mucosa after I/R. Nevertheless, villus height was greater in animals treated with LSF than RLS prior to ischemia in Protocol 1 (250+/-37 and 160+/-15 microm, respectively; p = .04) and during reperfusion in Protocol 2 (170+/-21 and 82+/-7 microm, respectively; p = .002). We conclude that LSF is effective in reducing both ischemia- and I/R-induced gut barrier dysfunction, possibly due to a mechanism related to preservation of villus height.

Background: Lumbar sympathectomy retains a role in the treatment of patients with causalgia, Symptomatic vasospasm, and nonreconstructable arterial occlusive disease. Open surgical sympathectomy, with its attendant morbidities, remains the standard. Chemical sympathectomy has been introduced as a less invasive means of achieving sympatholysis. However, this has been associated with incomplete and transient denervation. Methods: We present a series of five lumbar sympathectomies performed laparoscopically. Results: All patients sustained symptomatic relief and no postoperative complications were noted. Postoperative skin thermometry and resistance measurements confirmed adequacy of sympatholysis. Conclusion: We conclude that lumbar sympathectomy can be performed laparoscopically. Our preferred technique is now the extraperitoneal approach. Such an approach combines the durability and reliability of standard open sympathectomy with the minimal invasiveness of laparoscopic surgery.

1, 4, Journal of Medicine and Health Sciences

A rare case of amoebic liver abscess that ruptured into the pericardial cavity is reported. This is the first case in the world in which CT scan and ultrasonography were performed in conjunction with each other in demonstrating the fistulous tract. CT scan, ultrasonographic and echocardiographic findings were described in detail. Pericardectomy with surgical drainage and supportive measures led to complete recovery after 37 days of hospitalization.