Efeitos de corticosteróides em recém-nascidos de muito baixo peso, dependentes de ventilação mecânica

Corticosteroids have been used in bronchopulmonary dysplasia prevention because of their antiinflammatory effects. Among their effects is a decrease in the incidence of bronchopulmonary dysplasia. However, short- and long-term side effects have been detected in preterm newborns. PURPOSE: To analyze the effects of corticosteroids on bronchopulmonary dysplasia, length of stay, mortality, growth, as well as the adverse effects in very low birth weight newborns between 10 and 14 days of life and dependent on mechanical ventilation. METHODS: Cohort study. All newborns with a birth weight under 1500 g, mechanical ventilation-dependent between 10 and 14 days of life, during the period January 2000 and June 2001 were included (n = 38). They were divided into 2 groups: Group I with corticosteroids (n = 16) and Group II without corticosteroids (n = 22). Dexamethasone administration: from the 10th day of life, d1 - d3, 0.3 mg/kg/d; d4 - d6, 0.2 mg/kg/d; d7 - d9, 0.1 mg/kg/d. Respiratory evolution, bronchopulmonary dysplasia (oxygen dependence at 28 days of life), growth pattern and the presence of adverse effects were analyzed. RESULTS: The incidence of bronchopulmonary dysplasia was 6.5% (Group I) and 30% (Group II), P = .07. A decrease in growth was detected in Group I compared with Group II (change in weight: Group I - 47 g/week, Group II - 85.5 g/week, P = .06; change in head circumference: Group I - 0.75 cm/week, Group II - 1 cm/week, P = .05). CONCLUSION: Use of corticosteroids in very low birth weight infants dependent on mechanical ventilation during the first 10 to 14 days of life did not affect the respiratory evolution and occurrence of bronchopulmonary dysplasia, but the velocity of growth was reduced.Devido às suas ações anti-inflamatórias, os corticosteróides têm sido utilizados para prevenção de displasia broncopulmonar, sendo descrita, uma redução da incidência desta patologia. No entanto, efeitos adversos a curto e a longo prazo têm sido detectados, em recém-nascidos pré-termo. OBJETIVO: Analisar os efeitos sobre a incidência de displasia broncopulmonar, duração de ventilação mecânica e de internação, mortalidade, crescimento, além dos efeitos adversos dos corticosteróides, administrados entre 10-14 dias de vida, em recém-nascidos de muito baixo peso, dependentes de ventilação mecânica. MÉTODOS: Realizou-se estudo de coorte, incluindo-se todos os recém-nascidos com peso de nascimento < 1500 gramas dependentes de ventilação mecânica, entre 10-14 dias de vida. Foram divididos em: Grupo I - receberam dexametasona (16) e Grupo II - não receberam dexametasona (22). Administrou-se dexametasona, a partir do 10º dia de vida, dias 1 a 3 - 0,3 mg/kg/d, dias 4 a 6 - 0,2 mg/kg/d, dias 7 a 9 - 0,1 mg/kg/d. Analisou-se o desenvolvimento de displasia broncopulmonar (dependência de oxigênio aos 28 dias de vida), efeitos sobre a evolução respiratória e sobre o padrão de crescimento, além da ocorrência de efeitos adversos. RESULTADOS: A incidência de displasia broncopulmonar não diferiu entre os grupos (GI - 62,5%; GII - 22,7%;p = 0,07). Detectou-se desaceleração do crescimento no GI em relação ao GII(D P = 47g/semana, GI e 85,5g/semana, GII; p = 0,06; D PC - 0,75 cm/semana GI e 1cm/semana, no GII; p = 0,05). CONCLUSÃO: O uso de corticosteróides, em recém-nascidos pré-termo, entre 10 - 14 dias de vida não reduziu incidência de displasia broncopulmonar e causou uma desaceleração do crescimento

Uso de Corticosteróides e evolução de recém-nascidos com displasia broncopulmonar

Ventilator-dependent premature infants are often treated with dexamethasone. Several trials showed that steroids while improve pulmonary compliance and facilitate extubation, some treated infants may have adverse effects, such as alterations of growth curves. We conducted this retrospective study to evaluate the effects of steroids on mechanical ventilation, oxygen therapy, hospital length stay and mortality, in ventilator-dependent infants with bronchopulmonary dysplasia (BPD) (defined as the need of oxygen supplementation at 28 days of life). Twenty-six newborns with BPD were evaluated during 9 -- 42 days postpartum (mean = 31 days) and were divided into two groups: Group I - 14 newborns that did not receive dexamethasone, and Group II - 12 newborns that received dexamethasone at 14 --21 days of life. Dexamethasone was given at a dose of 0.25 mg per kilogram of body weight twice daily intravenously for 3 days, after which the dose was tapered. RESULTS: There were no statistically significant differences in the mean length of mechanical ventilation (Group I - 37 days, Group II - 35 days); oxygen supplementation (Group I - 16 days, Group II - 29 days); hospital stay (Group I - 72 days, Group II - 113 days); mortality (Group I - 35.7%, Group II - 41.6%). At birth, Group II was lighter (BW: Group I - 1154 grams ± 302, Group II - 791 grams ± 165; p < 0.05) and smaller (height: Group I - 37.22 cm ± 3.3, Group II - 33.5 ± 2.4; p< 0.05) than Group I. At 40 weeks, there were no statistically significant differences between groups in relation to anthropometric measurements. CONCLUSIONS: The use of corticosteroids in bronchopulmonary dysplasic infants may influence the somatic growth during its use. However, after its suspension, a recovery seems to occur, suggesting that its influence could be transitory.Recém-nascidos (RN) pré-termo dependentes de ventilação mecânica são frequentemente, tratados com corticosteróides. Vários estudos demonstraram que o uso de corticosteróides melhora a complacência pulmonar e facilita a extubação. No entanto, o uso de corticosteróides é associado , também, a alguns efeitos colaterais, como alterações na curva de crescimento dos recém-nascidos. Nós realizamos um estudo retrospectivo, para avaliar os efeitos dos corticosteróides sobre a duração da ventilação mecânica, oxigenoterapia como também sobre o tempo de internação e mortalidade, em recém-nascidos com displasia broncopulmonar dependentes de ventilação mecânica (DBP) (definida como necessidade de suplementação de oxigênio até 28 dias de vida). Foram analisados 26 RN com DBP e divididos em 2 grupos: grupo I -- 14 RN, que não receberam dexametasona e grupo II -- 12 RN que receberam dexametasona a partir de 14 a 21 dias de vida, durante 9 a 42 dias ( média -- 31 dias). Administrou-se dexametasona, endovenosa, em uma dose inicial de 0,25 mg/kg dividida em duas tomadas durante 3 dias, e após diminuiu-se a dose até suspensão. RESULTADOS: Não se observou diferenças significantes em relação à duração da ventilação mecânica (grupo I- 37 dias e grupo II -- 35 dias), suplementação de oxigênio (grupo I -- 16 dias e grupo II -- 29 dias), tempo de permanência no hospital (grupo I -- 72 dias , grupo II -- 113 dias), e mortalidade (grupo I -- 35,7%, grupo II -- 41,6%). O grupo II tinha menor peso de nascimento ( PN- Grupo I -- 1154 gramas ± 302 e grupo II -- 791 gramas ± 165; p< 0,05) e menor comprimento ao nascimento (Comprimento- grupo I- 37,22 ± 3,3 e grupo II -- 33,5 ± 2,4; p < 0,05) em relação ao grupo I. Com 40 semanas, não se observou diferenças significantes entre os grupos com relação às medidas antropométricas. CONCLUSÃO: O uso de corticosteróides em RN com displasia broncopulmonar, pode influenciar o crescimento somático durante o seu uso. No entanto, após sua suspensão parece ocorrer uma recuperação do crescimento, sugerindo que sua influência pode ser transitória

Soft-tissue facial asymmetry before and after orthognathic surgery: application of a new 3D protocol

Introduction: Skeletal Class III patients often present a major facial asymmetry. In the current investigation, a quantitative method to assess 3D facial asymmetry was applied to an orthognathic surgery patient to quantify possible postsurgical modifications. Methodology: Soft-tissue facial scans of a 20-year-old man with skeletal Class III, candidate to orthognathic surgery, were collected in the pre-surgery stage and 6, 12, 24 months post-surgery with a stereophotogrammetric system. Soft tissue asymmetry was calculated in the facial thirds according to a published protocol (J Craniomaxillofac Surg 2017;45(1):76-81), and the relevant time-related modifications described. The results were also compared to normal values from a group of 23 control subjects (10 men, 13 women, mean age 26) by using z-scores. Results: The longitudinal analysis of the soft-tissue facial asymmetry showed a marked difference in the analysed time points: orthognathic surgery did reduce facial symmetry in the present patient. The comparison between the patient and the control subjects by using z-scores highlighted a clear difference in all-time points: the patient with facial dysmorphia had a higher degree of asymmetry than healthy subjects. Conclusion: The measurements of soft-tissue facial asymmetry using 3D optical digitisers can provide clinically useful information. The graphical representation of results can help in the patient’s understanding of the treatment phases, thus increasing compliance

In vitro hypoxia-conditioned colon cancer cell lines derived from HCT116 and HT29 exhibit altered apoptosis susceptibility and a more angiogenic profile in vivo

Hypoxia is an important selective force in the clonal evolution of tumours. Through HIF-1 and other transcription factors combined with tumour-specific genetic alterations, hypoxia is a dominant factor in the angiogenic phenotype. Cellular adaptation to hypoxia is an important requirement of tumour progression independent of angiogenesis. The adaptive changes, insofar as they alter hypoxia-induced apoptosis, are likely to determine responsiveness to antiangiogenic strategies. To investigate this adaptation of tumour cells to hypoxia, we recreated in vitro the in vivo situation of chronic intermittent exposure to low-oxygen levels. The colon carcinoma cell lines HT29 and HCT116 were subjected to 40 episodes of sublethal hypoxia (4 h) three times a week. The resulting two hypoxia-conditioned cell lines have been maintained in culture for more than 2 years. In both cell lines changes in doubling times occurred: in HT29 an increase, and in HCT116 a decrease. Cell survival in response to hypoxia and to DNA damage differed strikingly in the two cell lines. The HT29 hypoxia-conditioned cells were more resistant than the parental line to a 24 h hypoxic challenge, while those from HCT116 surprisingly were more sensitive. Sensitivity to cisplatin in vitro was also significantly different for the hypoxia-conditioned compared with the parental lines, suggesting a change in pathways leading to apoptosis following DNA damage signaling. The growth of both conditioned cell lines in vivo as xenografts in immunodeficient (SCID) mice was more rapid than their parental lines, and was accompanied in each by evidence of enhanced vascular proliferation as a consequence of the hypoxia-conditioning. Thus the changes in apoptotic susceptibility were independent of altered angiogenesis. The derivation of these lines provides a model for events within hypoxic regions of colon cancers, and for the acquisition of resistance and sensitivity characteristics that may have therapeutic implications for the use of antiangiogenesis drugs