Cardioprotective Effects of S-Nitrosothiols in Ischemia- Reperfusion: Role for Mitochondria and Calcium Channels

The most important clinical consequence of coronary disease is acute myocardial infarction caused by an occlusion that limits the irrigation to the heart. Although the gold standard treatment is to restore blood flow, this reperfusion causes inherent damage by increasing the size of the infarcted area primarily through the opening of the mitochondrial permeability transition pore (MPTP). The cardioprotective effect of nitric oxide (NO) has been described to operate through S-nitrosylation of several important proteins in the cardiomyocytes such as the calcium channels RyR2 and the L-type Ca2+ channel and mitochondrial proteins, including the MPTP. In this sense, an attractive strategy to prevent the ischemia-reperfusion damage is to increase the bioavailability of endogenous S-nitrosothiols. S-nitrosoglutathione reductase (GSNOR) is an enzyme involved in the metabolism of NO through denitrosylation, which would limit the cardioprotective effect of NO. Although inhibition of GSNOR has been studied in different organs, its effects on myocardial reperfusion have not yet been fully elucidated. In this chapter, we review the pathophysiology underlying myocardial reperfusion injury and the opening of the MPTP along with the cardioprotective role of S-nitrosothiols and the potential role for GSNOR

Pulmonary-renal crosstalk in the critically ill patient

Indexación: Web of Science; Scielo.A pesar de los avances en el desarrollo de las terapias de reemplazo renal, la mortalidad de la falla renal aguda permanece elevada, especialmente, cuando se manifiesta simultáneamente con fallas orgánicas distantes, como es en el caso del síndrome de distrés respiratorio agudo. Se revisa la relación bidireccional deletérea entre pulmón y riñón, en el escenario de disfunción orgánica, la cual presenta aspectos clínicos relevantes de conocer. Se discuten los efectos renales del síndrome de distrés respiratorio agudo y del uso de la ventilación mecánica a presión positiva, siendo el daño inducido por este (ventilator induced lung injury) uno de los modelos utilizado frecuentemente para el estudio de la interacción pulmón-riñón. Se enfatiza el rol de la falla renal inducida por la ventilación mecánica (ventilator-induced kidney injury) en la patogenia de la falla renal aguda. Asimismo se analizan las repercusiones pulmonares de la falla renal aguda, reconociéndose que esta condición patológica induce un incremento en la permeabilidad vascular pulmonar, inflamación y alteración de los canales de sodio y agua del epitelio alveolar, entre otros efectos. Este modelo conceptual puede ser la base para el desarrollo de nuevas estrategias terapéuticas a utilizar en el paciente con síndrome de disfunción orgánica múltiple.Despite advances in the development of renal replacement therapy, mortality of acute renal failure remains high, especially when occurring simultaneously with distant organic failure as it is in the case of the acute respiratory distress syndrome. In this update, birideccional deleterious relationship between lung and kidney on the setting of organ dysfunction is reviewed, which presents important clinical aspects of knowing. Specifically, the renal effects of acute respiratory distress syndrome and the use of positive-pressure mechanical ventilation are discussed, being ventilator induced lung injury one of the most common models for studying the lung-kidney crosstalk. The role of renal failure induced by mechanical ventilation (ventilator-induced kidney injury) in the pathogenesis of acute renal failure is emphasized. We also analyze the impact of the acute renal failure in the lung, recognizing an increase in pulmonary vascular permeability, inflammation, and alteration of sodium and water channels in the alveolar epithelial. This conceptual model can be the basis for the development of new therapeutic strategies to use in patients with multiple organ dysfunction syndrome.http://ref.scielo.org/nxgzw

Septic shock in pediatrics I. Current approach in diagnosis and therapeutics

Indexación: Web of Science; Scielo.El shock séptico es una de las principales causas de mortalidad infantil a nivel mundial y representa una compleja y progresiva vía inflamatoria secundaria a una enfermedad infecciosa, la cual origina disfunción cardiovascular aguda, no necesariamente hipotensión arterial, condicionando disoxia tisular y eventualmente falla celular y orgánica. Los paquetes de medidas de resucitación propuestos enfatizan el reconocimiento clínico y un tratamiento precoz. Estas intervenciones se basan en la pronta y agresiva resucitación con fluidos intravenosos para una adecuada perfusión tisular, administración de antibióticos, remoción del foco infeccioso y el uso de drogas vasoactivas en caso de ser necesario. La terapia debe evaluarse permanentemente según la normalización de metas clínicas y de laboratorio. En la presente publicación se actualiza el conocimiento de las características epidemiológicas y fisiopatológicas de la sepsis, una puesta al día en definiciones operacionales, campañas internacionales y referentes a las iniciativas propuestas para disminuir su morbimortalidad. Se aborda el enfoque terapéutico inicial en el servicio de urgencia. El objetivo de este artículo es dar a conocer el estado actual del conocimiento en el diagnóstico y tratamiento del paciente con shock séptico especialmente en su fase inicial previo al ingreso a UCI.Septic shock is a major cause of infant mortality worldwide and represents the progressive underlying inflammatory pathway secondary to an infectious disease, which causes acute cardiovascular dysfunction, not necessarily hypotension, tissue dysoxia and eventually cellular and organ failure. Standard resuscitative measures emphasize clinical recognition and early treatment. These interventions are based on early and aggressive resuscitation with intravenous fluids to optimize tissue perfusion, antibiotics, removal of the source of infection and the use of vasoactive drugs if necessary. Therapy should be permanently evaluated according to the standardized laboratory and clinical targets. This publication is an update on the epidemiology and pathophysiology of sepsis, operational definitions, current international campaigns and initiatives concerning proposals to decrease the morbidity and mortality of this condition. It also addresses initial therapeutic approaches in the emergency room. The aim of this study is to present the current state of knowledge in the diagnosis and treatment of patients with septic shock especially in the initial phase before admissions to intensive care units.http://ref.scielo.org/sbjrb

The VVV Survey RR Lyrae Population in the Galactic Center Region

Indexación: Scopus.We gratefully acknowledge the use of data from the ESO Public Survey program ID 179.B-2002 taken with the VISTA telescope, and data products from the Cambridge Astronomical Survey Unit (CASU). Support for the authors is provided by the BASAL Center for Astrophysics and Associated Technologies (CATA) through grant PFB-06, and the Ministry for the Economy, Development, and Tourism, Programa Iniciativa Cientifica Milenio through grant IC120009, awarded to the Millennium Institute of Astrophysics (MAS). D.M. and M.Z. acknowledge support from FONDECYT Regular grants No. 1170121, and 1150345, respectively. P.H. acknowledges financial support from FONDECYT regular grant 1170305. F.G. acknowledge support from CONICYT-PCHA Doctorado Nacional 2017-21171485 and Proyecto Fondecyt Regular 1150345. J.A.-G. acknowledges support by FONDECYT Iniciacion 11150916. D.M. is also grateful for the hospitality of the Vatican Observatory. This research made use of Astropy, a community-developed core Python package for astronomy; Scikit-learn, NumPy, and matplotlib, a Python library for publication-quality graphics; and Aladin Sky Atlas, developed at CDS, Strasbourg Observatory, France, and TOPCAT.Deep near-IR images from the VISTA Variables in the V a L ctea (VVV) Survey were used to search for RR Lyrae stars within 100 arcmin from the Galactic Center. A large sample of 960 RR Lyrae of type ab (RRab) stars were discovered. A catalog is presented featuring the positions, magnitudes, colors, periods, and amplitudes for the sample, in addition to estimated reddenings, distances, and metallicities, and measured individual relative proper motions. We use the reddening-corrected Wesenheit magnitudes, defined as WKs Ks 0.428 J Ks = - ( - ), in order to isolate bona fide RRL belonging to the Galaxy Center, finding that 30 RRab are foreground/background objects. We measure a range of extinctions from AKs 0.19 = to 1.75 mag for the RRab in this region, finding that large extinction is the main cause of the sample incompleteness. The mean period is P =0.5446±0.0025 days, yielding a mean metallicity of [Fe/H] =-1.30±0.01 (ς = 0.33) dex for the RRab sample in the Galactic Center region. The median distance for the sample is D =8.05±0.02 kpc. We measure the RRab surface density using the less reddened region sampled here, finding a density of 1000 RRab/sq deg at a projected Galactocentric distance RG =1.6 deg. Under simple assumptions, this implies a large total mass (M>109Me) for the old and metal-poor population contained inside RG. We also measure accurate relative proper motions, from which we derive tangential velocity dispersions of ςVl =125.0 and ςVb =124.1 km s-1 along the Galactic longitude and latitude coordinates, respectively. The fact that these quantities are similar indicate that the bulk rotation of the RRab population is negligible, and implies that this population is supported by velocity dispersion. In summary, there are two main conclusions of this study. First, the population as a whole is no different from the outer bulge RRab, predominantly a metal-poor component that is shifted with respect to the Oosterhoff type I population defined by the globular clusters in the halo. Second, the RRab sample, as representative of the old and metal-poor stellar population in the region, has high velocity dispersions and zero rotation, suggesting a formation via dissipational collapse. ©2018. The American Astronomical Society. All rights reserved.https://iopscience.iop.org/article/10.3847/1538-4357/aacf9

Septic shock in pediatrics II. Current concepts in diagnosis and treatment

Indexación: Web of Science; Scielo.Aunque los principios básicos para el diagnóstico y los pilares terapéuticos del niño con shock séptico se mantienen en el tiempo, es innegable que en las últimas décadas se han incorporado nuevos y trascendentes conceptos, siendo importante que el médico tratante en el Servicio de Urgencia tenga conocimiento a cabalidad de ellos. En la segunda parte de esta actualización se discuten las similitudes y diferencias entre la población infantil y adulta, la utilidad de las metas de reanimación metabólicas, como también el enfoque terapéutico inicial en el paciente séptico. Los conceptos más importantes revisados se refieren a las diferencias entre el niño y adulto con shock séptico, especialmente en la fisiopatología, clínica y tratamiento. Se recalca la importancia de expansión de la volemia y el uso de drogas vasoactivas si no hay respuesta a fluidos de reanimación. El manejo terapéutico debe estar orientado a la búsqueda de la normalización de metas macrohemodinámicas y de perfusión sistémica. Se deben evitar los errores más frecuentes de observar en el tratamiento inicial del paciente séptico. Esta entidad presenta una elevada incidencia y mortalidad, por lo cual el manejo precoz y agresivo es de máxima importancia en pediatría.Although the basic concepts of diagnosis and therapy of the child with septic shock have remained similar over time, it is undeniable that in recent decades, new and important concepts have been added, and any treating physician either at the Emergency Department or Intensive Care Unit should be fully aware of them. This second part discusses the similarities and differences between pediatric and adult populations, the utility of metabolic resuscitation goals, as well as the initial therapeutic approach in septic patients. The most important concepts of this work make reference to the differences between children and adults with septic shock, specifically regarding to pathophysiology, clinical presentation and treatment. Volume expansion and vasoactive drugs are crucial if there is no response to fluid resuscitation. The therapeutic management should focus on finding the normalization of macrohemodynamic and systemic perfusion targets. Common observation mistakes in the initial treatment of septic patients should be avoided. This condition has a high incidence and mortality rate; therefore an early and aggressive treatment is essential.http://ref.scielo.org/cc6t3

Septic shock in ICU: Advanced therapeutics, immunoparalysis and genomics. State of the art

Indexación: Web of Science; Scielo.En las últimas décadas, se han incorporado nuevos y trascendentes conceptos para el tratamiento avanzado del paciente en shock séptico. Se debe considerar el uso de terapia inmune en grupos seleccionados de pacientes. Las terapias de sustitución renal de carácter continuo sonbien toleradas y su empleo precoz evita sobrecargas de fluidos. El uso de hemofiltración de alto volumen puede jugar un papel en el paciente séptico hiperdinámico. La plasmaféresis es útil en el paciente con disfunción multiorgánica. El empleo de soporte extracorpóreo se debe considerar en quienes presentan shock séptico refractario. La inmunoparálisis se ha asociado con infecciones nosocomiales y mortalidad tardía. La información obtenida de los marcadores genéticos puede permitir la búsqueda de una medicina basada en la genómica.New and important concepts have emerged for the advanced management of the child with septic shock in the recent decades. Attending physicians in the Pediatric intensive care unit must be fully aware of them to improve patient care in the critical care unit. It should be considered the use of immune therapy only in selected groups of patients. Continuous renal replacement therapies are well tolerated and their early use prevents deleterious fluid overload. Removal of inflammatory mediators by using high volume hemofiltration may play a role in hyperdynamic septic patients. The use of plasmapheresis is recommended in patients with thrombocytopenia-associated multiple organ failure. Extracorporeal support use should be considered in those with refractory septic shock despite goals directed therapy. The immunoparalysis has been associated with nosocomial infections and late mortality. The information from genetic markers may allow early intervention and preventive genomics-based medicine.http://ref.scielo.org/g8m9m

Septic shock in intensive care units. Current focus on treatment

Indexación: Web of Science; Scielo.Los pilares terapéuticos del niño con shock séptico se mantienen en el tiempo, sin embargo, se han incorporado nuevos conceptos, siendo importante que el pediatra y el intensivista tengan conocimiento a cabalidad de ellos. La reanimación con fluidos es una intervención fundamental, no obstante, aún no se ha establecido un tipo de fluido ideal, presentando cada uno limitaciones específicas, no existiendo evidencia sobre la superioridad de un tipo de fluido. Si a pesar de una adecuada resucitación con fluidos persiste el shock, el inicio de inótropos y/o vasopresores está indicado. En caso de refractariedad al uso de vasopresores, nuevos fármacos vasoactivos pueden ser empleados y el uso de hidrocortisona debe considerarse en niños con sospecha de insuficiencia suprarrenal. Existe controversia respecto a la transfusión de glóbulos rojos o el nivel óptimo de glucemia, no existiendo consenso en el valor umbral para el uso de estos hemocomponentes o el inicio de insulina, respectivamente. Asimismo, la utilización de la hemofiltración de alto volumen (HFAV)aún permanece controversial, requiriendo mayores estudios para su recomendación en forma rutinaria en el curso de un shock séptico refractario. El soporte nutricional es primordial, ya que la desnutrición es una grave complicación que debe ser prevenida y tratada adecuadamente. El objetivo de la presente revisión es entregar una actualización en los más recientes avances en tratamiento del shock séptico en la población pediátrica.Essential therapeutic principles in children with septic shock persist over time, although some new concepts have been recently incorporated, and fully awareness of pediatricians and intensivists is essential. Fluid resuscitation is a fundamental intervention, but the kind of ideal fluid has not been established yet, as each of these interventions has specific limitations and there is no evidence supportive of the superiority of one type of fluid. Should septic shock persists despite adequate fluid resuscitation, the use of inotropic medication and/or vasopressors is indicated. New vasoactive drugs can be used in refractory septic shock caused by vasopressors, and the use of hydrocortisone should be considered in children with suspected adrenal insufficiency, as it reduces the need for vasopressors. The indications for red blood cells transfusion or the optimal level of glycemia are still controversial, with no consensus on the threshold value for the use of these blood products or the initiation of insulin administration, respectively. Likewise, the use of high-volume hemofiltration is a controversial issue and further study is needed on the routine recommendation in the course of septic shock. Nutritional support is crucial, as malnutrition is a serious complication that should be properly prevented and treated. The aim of this paper is to provide update on the most recent advances as concerns the treatment of septic shock in the pediatric population.http://ref.scielo.org/79wr6

Proper motions in the VVV Survey: Results for more than 15 million stars across NGC 6544

Context: In the last six years, the VVV survey mapped 562 sq. deg. across the bulge and southern disk of the Galaxy. However, a detailed study of these regions, which includes $\sim 36$ globular clusters (GCs) and thousands of open clusters is by no means an easy challenge. High differential reddening and severe crowding along the line of sight makes highly hamper to reliably distinguish stars belonging to different populations and/or systems. Aims: The aim of this study is to separate stars that likely belong to the Galactic GC NGC 6544 from its surrounding field by means of proper motion (PM) techniques. Methods: This work was based upon a new astrometric reduction method optimized for images of the VVV survey. Results: Photometry over the six years baseline of the survey allowed us to obtain a mean precision of $\sim0.51$ mas/yr, in each PM coordinate, for stars with Ks < 15 mag. In the area studied here, cluster stars separate very well from field stars, down to the main sequence turnoff and below, allowing us to derive for the first time the absolute PM of NGC 6544. Isochrone fitting on the clean and differential reddening corrected cluster color magnitude diagram yields an age of $\sim$ 11-13 Gyr, and metallicity [Fe/H] = -1.5 dex, in agreement with previous studies restricted to the cluster core. We were able to derive the cluster orbit assuming an axisymmetric model of the Galaxy and conclude that NGC 6544 is likely a halo GC. We have not detected tidal tail signatures associated to the cluster, but a remarkable elongation in the galactic center direction has been found. The precision achieved in the PM determination also allows us to separate bulge stars from foreground disk stars, enabling the kinematical selection of bona fide bulge stars across the whole survey area. Our results show that VVV data is perfectly suitable for this kind of analysis.Comment: 13 pages, 12 figures, accepted in A&

Eficácia de Beauveria bassiana para o controle de Hedypathes betulinus em erva-mate, Ilex paraguariensis.

O controle das pragas da erva-mate, dentre as quais a broca-da-erva-mate, Hedypathes betulinus, é limitado principalmente a técnicas silviculturais e catação manual, pois não é permitida a aplicação de agroquímicos nessa cultura. A fim de contribuir com informações para o controle biológico de H. betulinus, o presente trabalho teve por objetivos determinar a eficácia e o número de aplicações anuais do micoinseticida à base do fungo entomopatogênico Beauveria bassiana para o controle dessa praga. Os experimentos foram conduzidos em uma área de erva-mate em monocultura, no município de Campo Alegre, SC, Brasil. O formulado foi pulverizado no tronco e na base das árvores, de acordo com um cronograma de duas ou três aplicações, em diferentes meses do ano. Constatou-se a eficácia com a utilização do formulado, sendo que os dados de captura das áreas tratadas diferiram estatisticamente da testemunha e do tratamento com catação manual. Contudo, não houve diferença estatística entre os tratamentos com duas e três aplicações, sendo capturados, respectivamente, 18,4% e 17,7% dos insetos marcados. Assim, apenas duas pulverizações com B. bassiana realizadas nos meses de novembro e fevereiro são eficientes para o controle de H. betulinus e manutenção do inóculo na área de erva-mate em monocultur