Mechanisms of subcutaneous adipose tissue formation in experimental lymphedema model

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Mechanisms of subcutaneous adipose tissue formation in experimental lymphedema model

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COMPARAÇÃO MICROBIOLÓGICA ENTRE MEMBRANAS AMNIÓTICAS HUMANAS COLETADAS EM PARTOS VAGINAIS E CESARIANAS – PROJETO PILOTO

Objective: The amniotic membrane, a thin membrane, may be used as a temporary cover on deep burns. The objective of this study is to identify the differences regarding bacterial contamination between membranes of vaginal and cesarean deliveries, as well as to assess the possibility of the clinical use of stored membranes.Methods: Twelve membranes were obtained from women submitted to vaginal and cesarean deliveries at the Obstetric Center of Hospital de Clínicas de Porto Alegre. Each amniotic membrane was stored in five different flasks containing a physiological solution. Samples were obtained from these flasks for analysis on days 1, 7, 14, 21 and 28. These samples were tested for bacterial contamination, analyzing its relation to time of storage and type of delivery. This is a pilot study with a transversal design.Results: The comparison between types of delivery yielded a relative risk of contamination in vaginal delivery (RR) of 2.67 (95% CI: 1.09-6.52) and no significance (P = 0.08). No contamination was found on day 1 flasks.Conclusion: All membranes derived from vaginal deliveries ended up showing bacterial contamination during the storage period, which lead to a theoretical unavailability for its use on Amniotic Membrane Banks.Objetivo: A membrana amniótica, uma membrana fina, pode ser utilizada como cobertura temporária em queimaduras profundas. O objetivo deste estudo é o de verificar as possíveis diferenças quanto à contaminação bacteriana entre as membranas de partos cesáreo e vaginal, assim como avaliar a viabilidade ou não do uso clínico-cirúrgico da membrana armazenada.Métodos: Foram coletadas 12 membranas amnióticas de mulheres submetidas a parto cesáreo e vaginal no Centro Obstétrico do HCPA. Cada membrana amniótica foi armazenada em cinco frascos diferentes contendo soro fisiológico, dos quais foram obtidas amostras para análise no momento da coleta e nos dias 7, 14, 21 e 28. Essas amostras foram testadas quanto à contaminação bacteriana, analisando sua relação com o tempo de armazenamento e com o tipo de parto realizado. O estudo é um piloto e tem um delineamento transversal. Resultados: A comparação entre os tipos de parto mostrou um risco relativo (RR) de 2,67 de contaminação no parto vaginal em relação à cesariana (IC de 95%: 1,09 a 6,52), P = 0,08. Não foi verificada contaminação em nenhum dos frascos no momento da coleta. Conclusão: Todas as membranas coletadas de parto vaginal apresentaram crescimento bacteriano no processo de estocagem, levando à sua inviabilidade teórica para uso em Bancos de Membrana Amniótica

Neutrophil Paralysis in Plasmodium vivax Malaria

Plasmodium vivax is responsible for approximately 60–80% of the malaria cases in the world, and contributes to significant social and economic instability in the developing countries of Latin America and Asia. The pathogenesis of P. vivax malaria is a consequence of host derived inflammatory mediators. Hence, a better understanding of the mechanisms involved in induction of systemic inflammation during P. vivax malaria is critical for the clinical management and prevention of severe disease. The innate immune receptors recognize Plasmodium sp. and initiate a broad spectrum of host defense mechanisms that mediate resistance to infection. However, the innate immune response is the classic “two-edged sword”, and clinical malaria is associated with high levels of circulating pro-inflammatory cytokines. Our findings show that both monocytes and neutrophils are highly activated during malaria. Monocytes produced high levels of IL-1β, IL-6 and TNF-α during acute malaria. On the other hand, neutrophils were a poor source of cytokines, but displayed an enhanced phagocytic activity and superoxide production. Unexpectedly, we noticed an impaired chemotaxis of neutrophils towards an IL-8 (CXCL8) gradient. We proposed that neutrophil paralysis is in part responsible for the enhanced susceptibility to bacterial infection observed in malaria patients

Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry

Background and purpose: Prospectively collected data comparing the safety and effectiveness of individual non-vitamin K antagonists (NOACs) are lacking. Our objective was to directly compare the effectiveness and safety of NOACs in patients with newly diagnosed atrial fibrillation (AF). Methods: In GLORIA-AF, a large, prospective, global registry program, consecutive patients with newly diagnosed AF were followed for 3 years. The comparative analyses for (1) dabigatran vs rivaroxaban or apixaban and (2) rivaroxaban vs apixaban were performed on propensity score (PS)-matched patient sets. Proportional hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest. Results: The GLORIA-AF Phase III registry enrolled 21,300 patients between January 2014 and December 2016. Of these, 3839 were prescribed dabigatran, 4015 rivaroxaban and 4505 apixaban, with median ages of 71.0, 71.0, and 73.0 years, respectively. In the PS-matched set, the adjusted HRs and 95% confidence intervals (CIs) for dabigatran vs rivaroxaban were, for stroke: 1.27 (0.79–2.03), major bleeding 0.59 (0.40–0.88), myocardial infarction 0.68 (0.40–1.16), and all-cause death 0.86 (0.67–1.10). For the comparison of dabigatran vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 1.16 (0.76–1.78), myocardial infarction 0.84 (0.48–1.46), major bleeding 0.98 (0.63–1.52) and all-cause death 1.01 (0.79–1.29). For the comparison of rivaroxaban vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 0.78 (0.52–1.19), myocardial infarction 0.96 (0.63–1.45), major bleeding 1.54 (1.14–2.08), and all-cause death 0.97 (0.80–1.19). Conclusions: Patients treated with dabigatran had a 41% lower risk of major bleeding compared with rivaroxaban, but similar risks of stroke, MI, and death. Relative to apixaban, patients treated with dabigatran had similar risks of stroke, major bleeding, MI, and death. Rivaroxaban relative to apixaban had increased risk for major bleeding, but similar risks for stroke, MI, and death. Registration: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01468701, NCT01671007. Date of registration: September 2013

Anticoagulant selection in relation to the SAMe-TT2R2 score in patients with atrial fibrillation. the GLORIA-AF registry

Aim: The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores >2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score >2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores >2 and 27.5% in those with scores ≤2. Conclusions: The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial. Clinical trial registration: URL: https://www.clinicaltrials.gov//Unique identifier: NCT01937377, NCT01468701, and NCT01671007