scholarly journals Nutritional and Pharmacological Enhancement of the Gut-Associated Lymphoid Tissue

2000 ◽  
Vol 14 (suppl d) ◽  
pp. 145D-151D ◽  
Author(s):  
M Keith Hanna ◽  
Kenneth A Kudsk
Keyword(s):  
Enteral Nutrition ◽  
Mucosal Immunity ◽  
Lymphoid Tissue ◽  
Severely Injured Patients ◽  
Quarter Century ◽  
The Past ◽  
Improved Outcomes ◽  
Injured Patients ◽  
Lower Morbidity

There has been an explosion of research in the field of nutrition over the past quarter century. Clinical studies have demonstrated the effectiveness of providing nutrition by the enteral route in reducing septic morbidity in critically ill patients. These improved outcomes have been substantiated by animal models that show that enteral nutrition decreases gut permeability while maintaining the gut-associated lymphoid tissue (GALT) in mucosal immunity. Evidence points to the important immunological role of the gut in the maintenance of mucosal immunity at both intestinal and extraintestinal sites. The preservation of this mucosal immunity by enteral nutrition is consistent with the lower morbidity seen in severely injured patients who receive nutrition via the gastrointestinal tract. For patients who are unable to be fed by the enteral route and who require parenteral nutrition, several supplements show promise in enhancing the mucosal immune system defenses. The nutritional and pharmacological tactics that may enhance the GALT and thereby maintain mucosal immunity are examined.

scholarly journals The evolution of trauma care in the Netherlands over 20 years

2019 ◽  
Vol 46 (2) ◽  
pp. 329-335 ◽  
Author(s):  
Falco Hietbrink ◽  
Roderick M. Houwert ◽  
Karlijn J. P. van Wessem ◽  
Rogier K. J. Simmermacher ◽  
Geertje A. M. Govaert ◽  
...  
Keyword(s):  
The Netherlands ◽  
Trauma Care ◽  
Trauma System ◽  
Trauma Surgeon ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
The Past ◽  
Level 1 ◽  
Trauma Surgeons ◽  
Injured Patients

Abstract Introduction In 1999 an inclusive trauma system was initiated in the Netherlands and a nationwide trauma registry, including all admitted trauma patients to every hospital, was started. The Dutch trauma system is run by trauma surgeons who treat both the truncal (visceral) and extremity injuries (fractures). Materials and Methods In this comprehensive review based on previous published studies, data over the past 20 years from the central region of the Netherlands (Utrecht) was evaluated. Results It is demonstrated that the initiation of the trauma systems and the governance by the trauma surgeons led to a region-wide mortality reduction of 50% and a mortality reduction for the most severely injured of 75% in the level 1 trauma centre. Furthermore, major improvements were found in terms of efficiency, demonstrating the quality of the current system and its constructs such as the type of surgeon. Due to the major reduction in mortality over the past few years, the emphasis of trauma care evaluation shifts towards functional outcome of severely injured patients. For the upcoming years, centralisation of severely injured patients should also aim at the balance between skills in primary resuscitation and surgical stabilization versus longitudinal surgical involvement. Conclusion Further centralisation to a limited number of level 1 trauma centres in the Netherlands is necessary to consolidate experience and knowledge for the trauma surgeon. The future trauma surgeon, as specialist for injured patients, should be able to provide the vast majority of trauma care in this system. For the remaining part, intramural, regional and national collaboration is essential

Secular Evolution in Ireland

2017 ◽  
pp. 62-83
Author(s):  
David T. Buckley
Keyword(s):  
Public Opinion ◽  
Education Policy ◽  
Institutional Change ◽  
Rapid Decline ◽  
Quarter Century ◽  
Secular Evolution ◽  
The Past ◽  
Muslim Minority

How has Irish benevolent secularism withstood challenges brought on by rapid decline in Catholic influence over the past quarter century? This chapter documents the role of religious-secular and interfaith partnerships in steering institutional change in Ireland during this period. Benevolent secularism has evolved without changing into a more assertive form of secularism. The chapter traces secular evolution in areas like education policy and accommodating the growing Muslim minority. It traces elite alliances through field interviews, and then documents similar consensus in public opinion data.

Judicializing Religion

2020 ◽  
pp. 157-188
Author(s):  
Yvonne Tew
Keyword(s):  
Religious Freedom ◽  
Freedom Of Expression ◽  
Basic Structure ◽  
Constitutional Rights ◽  
Quarter Century ◽  
The Past ◽  
Malaysian Politics ◽  
Role Of Religion ◽  
Civil Courts

Religion has become one of the great fault lines of modern Malaysian politics and adjudication. This chapter focuses on the role of religion and religious freedom in the contemporary Malaysian state. It outlines the constitution-making process to locate the place of Islam and religious liberty within the Constitution’s generally secular original framework. Over the past quarter century, the politicization and judicialization of religion has led to an expansion of Islam’s role, fueling polarizing debate over the Malaysian state’s identity as secular or Islamic. Courts have contributed to elevating Islam’s position by deferring jurisdiction to the Sharia courts and expansively interpreting Islam’s constitutional position. The chapter then turns from the descriptive to the prescriptive. It discusses how courts can draw on the constitutional basic structure doctrine to entrench the judicial power of the civil courts to reclaim jurisdictional areas that engage constitutional rights which in the past they have ceded to the religious courts, such as apostasy. It also outlines how courts can use a purposive interpretive approach in line with the Constitution’s framework of protection for religious minorities and individual rights. Finally, it shows how the court can operationalize a proportionality analysis to closely scrutinize government regulations that restrict religious freedom or freedom of expression.

scholarly journals The mucosal immune system and IgA nephropathy

2021 ◽  
Author(s):  
Loreto Gesualdo ◽  
Vincenzo Di Leo ◽  
Rosanna Coppo
Keyword(s):  
Immune Response ◽  
Mucosal Immunity ◽  
Lymphoid Tissue ◽  
Genetic Factors ◽  
Immunoglobulin A ◽  
Mucosal Immune Response ◽  
Immunoglobulin A Nephropathy ◽  
Food Antigen ◽  
The Relationship

Abstract The precise pathogenesis of immunoglobulin A nephropathy (IgAN) is still not clearly established but emerging evidence confirms a pivotal role for mucosal immunity. This review focuses on the key role of mucosa-associated lymphoid tissue (MALT) in promoting the onset of the disease, underlying the relationship among microbiota, genetic factors, food antigen, infections, and mucosal immune response. Finally, we evaluate potential therapies targeting microbes and mucosa hyperresponsiveness in IgAN patients.

Probable impact of the 1994 elections on laboratory medicine

1995 ◽  
Vol 41 (8) ◽  
pp. 1223-1227
Author(s):  
H S Foster
Keyword(s):  
Clinical Laboratory ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
Policy Makers ◽  
Quarter Century ◽  
The Past ◽  
Probable Impact ◽  
Clinical Laboratory Improvement Amendments

Abstract During the past quarter century, federal health policy makers concerned themselves with: (a) improving the quality of healthcare delivered to the American public; (b) increasing access to needed healthcare services; and (c) curtailing the escalating cost of such services. These goals led Congress to expand the role of the federal government in regulating the delivery of healthcare. The enactment of the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) was a significant and widely discussed example of how Congress, when controlled by the Democrats, sought to correct healthcare problems and achieve federal objectives. In November 1994, the Republicans won majorities in both the Senate and the House, promising to reduce the federal government's power. Many now believe that CLIA '88, or significant parts of it, could be substantially modified as part of this effort. This paper addresses the developments that led the Democrats to seek enactment of CLIA '88 and the likely arguments that may be offered by the Republicans to lessen the rigor and scope of the law.

Imaging Evaluation in the Early Management of Severely Injured Patients.

2021 ◽  
Author(s):  
Christopher Spering ◽  
Soehren Dirk Brauns ◽  
Bertil Bouillon ◽  
Mark-Tilmann Seitz ◽  
Katharina Jaeckle ◽  
...  
Keyword(s):  
Vascular Injury ◽  
Thoracic Trauma ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Initial Management ◽  
Trauma Centres ◽  
Therapeutic Consequences ◽  
Time Period ◽  
Injured Patients

Abstract Introduction: The plain film chest x-ray in supine position (CXR) during the initial management of severely injured patients has almost lost its clinical relevance, since it has been challenged by extended focused assessment with sonography in trauma (eFAST) in early trauma management, due to its superiority in detecting a pneumo-/hematothorax. One of the last diagnostic fields in such setting of CXR is the mediastinal vascular injury. These injuries are rare yet life-threatening events. The most easily accessible diagnostic tool to identify these patients would be CXR as it is still one of the standard diagnostic tools in the early assessment of severely injured patients with significant thoracic trauma (Abbreviated Injury Scale, AIS ≥3). This study evaluates the role of early CXR in the Trauma Resuscitation Unit (TRU) in the last diagnostic field where eFAST cannot provide an answer: detecting mediastinal vascular injury in severely injured patients.Method: This retrospective, observational, single-centre study included all primary blunt trauma patients of a 24 months time period, that had been admitted to the TRU. Mediastinal/chest (M/C) ratio measurements were taken from CXRs at three defined levels of the mediastinum. The accuracy of the CXR findings were compared to whole-body computed tomography scans (WBCT) and therapeutic consequences were observed. Additionally a 15 years (2005–2019) time period out of the TraumaRegister DGU® was evaluated regarding usage of eFAST, CXR und WBCT in Level-1, -2, and − 3 Trauma Centres in Germany.Results: A total of 267 patients showed a significant blunt thoracic trauma (27 with mediastinal vascular injury (VThx)). The initial CXR in a supine position was unreliable for detecting mediastinal vascular injury. The sensitivity and specificity at different thresholds of maximum M/C ratio (2.0–3.0) were not clinically acceptable. The aortic contour and haemato- and pneumothorax were not reliably detected in the initial CXRs. No significant differences in the cardiac silhouette were observed between patients with or without mediastinal vascular injury (mean cardiac width, 136.5 mm, p = 0.44). No therapeutic consequences were drawn after CXR in the study period. The data from the TR-DGU (N = 251,095) showed a continuous reduction of CXR from 75% (2005) to 25% (2019), while WBCT raised from 35% to a steady level of about 80%. This development was seen in all trauma hospitals almost simultaneously.Conclusion: In present guidelines, CXR remains an integral diagnostic element during early TRU management, although several prior publications show the superior role of eFAST. Our data support that in most cases, CXR is time consuming and provides no benefit during initial management of severely injured patients and might delay the use of WBCT. The trauma centres in Germany have already significantly reduced the usage of CXR in the TRU. We therefore recommend to revise current guidelines and emphasise eFAST and rapid diagnostic through WBCT if rapidly available.

scholarly journals ROLE OF TOLL-LIKE RECEPTORS IN LICHEN PLANUS PATHOGENESIS

2019 ◽  
Vol 23 (5) ◽  
pp. 232-239
Author(s):  
Dmitry E. Mikhalev ◽  
V. A Stolyarova ◽  
N. A Cherevko ◽  
P. G Sysolyatin ◽  
O. D Baidik
Keyword(s):  
Lichen Planus ◽  
Mucosal Immunity ◽  
Toll Like Receptors ◽  
The Past ◽  
Number Of Patients ◽  
Shock Proteins ◽  
Scientific Facts ◽  
Relationship Of ◽  
The Relationship

Among diseases of the oral mucosa, lichen planus (LP) is up to 13%. Over the past decade, the number of patients with this dermatosis has doubled. Currently, the etiopathogenetic factor of LP development remains unclear, but there are many theories of the development of this disease. However, in the literature there is no description of a common pathogenetic link. In connection with th e above, the authors believe that these theories can be combined with new scientific facts and ideas about the barrier role of innate, and in particular, mucosal immunity. The review article describes the role of mucosal immunity of mucous membranes - toll-like receptors (TLR), describes the mechanism of activation of the immune system through TLR2 and TLR4, shows the relationship of immune inflammation triggers - the reaction of food intolerance, factors that contribute to the development of hypersensitivity in the pathogenesis of LP. The mechanism is presented for the presentation of autoantigens to immunocompetent cells with the participation of heat shock proteins. The prospects for further study of TLR with the aim of increasing the effectiveness of the treatment of LP are presented.

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