Intra-abdominal pressure in patients with abdominal trauma

Objetivos: Pacientes com trauma abdominal tratados cirurgicamente são muito suscetíveis ao desenvolvimento de hipertensão intra-abdominal e síndrome do compartimento abdominal, cujo diagnóstico é baseado na medição da pressão intraabdominal associada a parâmetros clínicos. Este estudo teve por objetivos avaliar prospectivamente o comportamento da pressão intra-abdominal de pacientes com trauma abdominal cirurgicamente tratados e identificar se há relação entre tal comportamento e parâmetros clínicos destes pacientes. Método: A técnica de Kron foi utilizada para medir a pressão intra-abdominal. A casuística foi composta por 17 homens e três mulheres com média de idade de 36,9 anos (D.P. 12,943). O mecanismo de trauma mais freqüente foi contusão abdominal 12 (60%) contra oito (40%) pacientes com ferimentos penetrantes. Os dados foram coletados em 6 e 18 horas de pós-operatório. Resultados: As médias de pressão intra-abdominal foram 10,4 cmH2O (D.P. 3,939) em 6 horas e 10,263 cmH2O (D.P. 3,445) em 18 horas de pós operatório. A análise dos resultados mostrou correlação estatisticamente significante entre o volume de colóides infundidos e a pressão intra-abdominal em 6 e 18 horas pós-operatórias (p = 0,0380 e p = 0,0033 respectivamente). É provável que tal correlação se deva ao edema visceral causado pelo extravasamento capilar de soluções, aumentando a pressão intra-abdominal. Conclusões: Os achados deste estudo ratificam a idéia de relação entre grandes volumes de infusão venosa, sobretudo colóides, e o aumento da pressão intra-abdominal e destacam a importância da avaliação da pressão intra-abdominal em pacientes com trauma abdominal submetidos a grandes reposições volêmicas, sobretudo as soluções coloidais. _________________________________________________________________________________________ ABSTRACT: Bacjground: Patients with significant abdominal traumatism submitted to surgical treatment are susceptible to develop intra-abdominal hypertension and abdominal compartment syndrome. Those diagnosis are based on intra-abdominal pressure measurement associated with clinical parameters. The aims of this study were: to study prospectively the behavior of intra-abdominal pressure in patients with abdominal trauma submitted to surgical treatment; to identify if there is association between that behavior and clinical parameters. Methods: There were 17 males and three females with an average age of 36.9 years (S.D. 12.9). The data was collected in two times, six and 18 hours in the immediate postoperative period. The averages of intra-abdominal pressures found were 10.4 cmH2O (S.D. 3.9) in the first six hours and 10.3 cmH2O (S.D. 3.5) in 18 hours of postoperative period. Results: There was significant statistical correlation between the volume of infused colloids and intra-abdominal pressure at six and 18 hours of postoperative period (p = 0.0380 and p = 0.0033, respectively). These correlations are probably explained by visceral edema caused by the capillary leak of solutions, increasing intra-abdominal pressure. Conclusions: Our findings confirm the relationship between large volumes of fluid infusion, mainly colloid solutions, and the increase of intra-abdominal pressure and detach the importance of intraabdominal pressure monitorization in patients with abdominal trauma submitted to massive replacement of liquids, mainly when this replacement was done with colloids solutions

A hypothetico-deductive approach to assessing the social function of chemical signalling in a non-territorial solitary carnivore

The function of chemical signalling in non-territorial solitary carnivores is still relatively unclear. Studies on territorial solitary and social carnivores have highlighted odour capability and utility, however the social function of chemical signalling in wild carnivore populations operating dominance hierarchy social systems has received little attention. We monitored scent marking and investigatory behaviour of wild brown bears Ursus arctos, to test multiple hypotheses relating to the social function of chemical signalling. Camera traps were stationed facing bear ‘marking trees’ to document behaviour by different age sex classes in different seasons. We found evidence to support the hypothesis that adult males utilise chemical signalling to communicate dominance to other males throughout the non-denning period. Adult females did not appear to utilise marking trees to advertise oestrous state during the breeding season. The function of marking by subadult bears is somewhat unclear, but may be related to the behaviour of adult males. Subadults investigated trees more often than they scent marked during the breeding season, which could be a result of an increased risk from adult males. Females with young showed an increase in marking and investigation of trees outside of the breeding season. We propose the hypothesis that females engage their dependent young with marking trees from a young age, at a relatively ‘safe’ time of year. Memory, experience, and learning at a young age, may all contribute towards odour capabilities in adult bears

Evaluation of the efficacy and tolerability of miglitol in Chinese patients with type 2 diabetes mellitus inadequately controlled by diet and sulfonylureas

The objective of this study is to examine the efficacy and tolerability of miglitol with respect to improving glycemic control in Chinese patients with type 2 diabetes mellitus inadequately controlled by diet and sulfonylurea treatment. This was a randomized, double-blinded, placebo-controlled, multicenter study. A total of 105 patients were randomized to receive 24 weeks of treatment with miglitol (n = 52; titrated from 50 mg to 100 mg 3 times daily) or placebo (n = 53). Concomitant sulfonylurea treatment and diet remained unchanged. The primary endpoint was change in glycated hemoglobin (HbA1c) from baseline at 24 weeks. Secondary endpoints were changes in fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and postprandial serum insulin (PSI). The miglitol treatment group showed significantly greater reductions in HbA1c and PPG levels compared with the placebo group. With respect to adverse events, abdominal discomfort, diarrhea, and hypoglycemia occurred with similar frequency in both groups. Results of this study indicate that miglitol significantly improves metabolic control in Chinese patients with type 2 diabetes mellitus. Miglitol is safe and well tolerated, with the exception of abdominal discomfort. Therefore, miglitol may be a useful adjuvant therapy for Chinese patients with type 2 diabetes mellitus inadequately controlled by diet and sulfonylurea treatment

Semi-automatic algorithm for construction of the left ventricular area variation curve over a complete cardiac cycle

<p>Abstract</p> <p>Background</p> <p>Two-dimensional echocardiography (2D-echo) allows the evaluation of cardiac structures and their movements. A wide range of clinical diagnoses are based on the performance of the left ventricle. The evaluation of myocardial function is typically performed by manual segmentation of the ventricular cavity in a series of dynamic images. This process is laborious and operator dependent. The automatic segmentation of the left ventricle in 4-chamber long-axis images during diastole is troublesome, because of the opening of the mitral valve.</p> <p>Methods</p> <p>This work presents a method for segmentation of the left ventricle in dynamic 2D-echo 4-chamber long-axis images over the complete cardiac cycle. The proposed algorithm is based on classic image processing techniques, including time-averaging and wavelet-based denoising, edge enhancement filtering, morphological operations, homotopy modification, and watershed segmentation. The proposed method is semi-automatic, requiring a single user intervention for identification of the position of the mitral valve in the first temporal frame of the video sequence. Image segmentation is performed on a set of dynamic 2D-echo images collected from an examination covering two consecutive cardiac cycles.</p> <p>Results</p> <p>The proposed method is demonstrated and evaluated on twelve healthy volunteers. The results are quantitatively evaluated using four different metrics, in a comparison with contours manually segmented by a specialist, and with four alternative methods from the literature. The method's intra- and inter-operator variabilities are also evaluated.</p> <p>Conclusions</p> <p>The proposed method allows the automatic construction of the area variation curve of the left ventricle corresponding to a complete cardiac cycle. This may potentially be used for the identification of several clinical parameters, including the area variation fraction. This parameter could potentially be used for evaluating the global systolic function of the left ventricle.</p

Functional alpha-1B adrenergic receptors on human epicardial coronary artery endothelial cells

Alpha-1-adrenergic receptors (α1-ARs) regulate coronary arterial blood flow by binding catecholamines, norepinephrine (NE), and epinephrine (EPI), causing vasoconstriction when the endothelium is disrupted. Among the three α1-AR subtypes (α1A, α1B, and α1D), the α1D subtype predominates in human epicardial coronary arteries and is functional in human coronary smooth muscle cells (SMCs). However, the presence or function of α1-ARs on human coronary endothelial cells (ECs) is unknown. Here we tested the hypothesis that human epicardial coronary ECs express functional α1-ARs. Cultured human epicardial coronary artery ECs were studied using quantitative real-time reverse transcription polymerase chain reaction, radioligand binding, immunoblot, and 3H-thymidine incorporation. The α1B-subtype messenger ribonucleic acid (mRNA) was predominant in cultured human epicardial coronary ECs (90–95% of total α1-AR mRNA), and total α1-AR binding density in ECs was twice that in coronary SMCs. Functionally, NE and EPI through the α1B subtype activated extracellular signal-regulated kinase (ERK) in ECs, stimulated phosphorylation of EC endothelial nitric oxide synthase (eNOS), and increased deoxyribonucleic acid (DNA) synthesis. These results are the first to demonstrate α1-ARs on human coronary ECs and indicate that the α1B subtype is predominant. Our findings provide another potential mechanism for adverse cardiac effects of drug antagonists that nonselectively inhibit all three α1-AR subtypes