Effects of single low dose of dexamethasone before noncardiac and nonneurologic surgery and general anesthesia on postoperative cognitive dysfunction : a phase III double blind, randomized clinical trial

Postoperative cognitive dysfunction (POCD) is a multifactorial adverse event most frequently in elderly patients. This study evaluated the effect of dexamethasone on POCD incidence after noncardiac and nonneurologic surgery. METHODS: One hundred and forty patients (ASA I-II; age 60–87 years) took part in a prospective phase III, double blind, randomized study involving the administration or not of 8 mg of IV dexamethasone before general anesthesia under bispectral index (BIS) between 35–45 or 46–55. Neuropsychological tests were applied preoperatively and on the 3rd, 7th, 21st, 90th and 180th days after surgery and compared with normative data. S100β was evaluated before and 12 hours after induction of anesthesia. The generalized estimating equations (GEE) method was applied, followed by the posthoc Bonferroni test considering P<0.05 as significant. RESULTS: On the 3rd postoperative day, POCD was diagnosed in 25.2% and 15.3% of patients receiving dexamethasone, BIS 35–45, and BIS 46–55 groups, respectively. Meanwhile, POCD was present in 68.2% and 27.2% of patients without dexamethasone, BIS 35–45 and BIS 46–55 groups (p<0.0001). Neuropsychological tests showed that dexamethasone associated to BIS 46–55 decreased the incidence of POCD, especially memory and executive function. The administration of dexamethasone might have prevented the postoperative increase in S100β serum levels. CONCLUSION: Dexamethasone can reduce the incidence of POCD in elderly patients undergoing surgery, especially when associated with BIS 46–55. The effect of dexamethasone on S100β might be related with some degree of neuroprotection

Evaluation of the cardioprotective effect of fentanyl in pigs exposed to highdose epinephrine

INTRODUÇÃO E HIPÓTESE: A epinefrina é um potente vasoconstritor com efeitos inotrópico e arritmogênico, é utilizada em protocolos de reanimação cardiopulmonar e como fármaco de primeira escolha em alguns casos de choque. Contudo, o seu uso pode ser seguido por lesões do miocárdio e disfunção cardíaca. Modelos experimentais têm mostrado efeitos cardioprotetores do fentanil por meio de mecanismos antiarrítmicos e anti-isquêmicos. O objetivo deste estudo foi avaliar o efeito cardioprotetor do fentanil em suínos expostos a altas doses de epinefrina. MÉTODOS: Após aprovação do comitê de ética institucional, 26 porcos Large White e Landrace foram alocados aleatoriamente em três grupos: grupo fentanil (n = 10), no qual os porcos receberam 20 ug/kg de fentanil 5 minutos antes de 5 doses de 20 ug/kg de epinefrina, as quais foram intercaladas por intervalos de 5 minutos entre cada dose; grupo salina (n = 10), no qual os porcos receberam solução salina volume-equivalente ao fentanil 5 minutos antes das 5 doses de epinefrina e grupo Sham (n = 6), que não recebeu fentanil ou epinefrina. Foram coletadas variáveis hemodinâmicas, ecocardiográficas, gasométricas e marcadores cardíacos durante as 6 horas de experimento. Ao final do estudo, o coração e os pulmões dos porcos foram removidos para análise por microscopia óptica, microscopia eletrônica e imuno-histoquímica (caspase-3). Os dados foram analisados usando equações de estimação generalizadas (GEE) e a significância estatística foi estabelecida em p < 0,05. RESULTADOS: Os níveis de troponina-I entre os grupos foram inicialmente equivalentes. Ao final do experimento, foi observado menor nível de troponina-I no grupo fentanil, em comparação com o grupo salina (1,91 ± 1,47 versus 5,44 ± 5,35 ng.ml-1, p = 0,019). Adicionalmente, a microscopia eletrônica e a imunohistoquímica demonstraram menor lesão miocárdica no grupo fentanil. Não houve diferença significativa entre o grupo fentanil e o salina para as variáveis hemodinâmicas, ecocardiográficas e gasométricas. CONCLUSÃO: O fentanil promove cardioproteção aos efeitos de altas doses de epinefrina sem prejudicar o efeito hemodinâmico da mesmaINTRODUCTION AND HYPOTHESIS: Epinephrine is a powerful vasopressor with inotropic and arrhythmogenic effects that is used in cardiopulmonary resuscitation protocols and as first choice drug in some cases of shock. However, its use could be followed by myocardial injury and dysfunction. Experimental models have shown cardioprotective effects of fentanyl through antiarrhythmic and anti-ischaemic mechanisms. The objective of this study was to evaluate the cardioprotective effect of fentanyl on myocardial function in swine exposed to high doses of epinephrine. METHODS: After institutional ethics committee approval, twenty-six Large White and Landrace pigs were allocated randomly into three groups: Fentanyl group (n=10), which received 20ug/kg of fentanyl five minutes before five doses of 20ug/kg of epinephrine interspersed with 5 minute intervals between each dose; Saline group (n=10), which received saline in a volume-equivalent manner of fentanyl five minutes before 20ug/kg of epinephrine doses; and Sham group (n=6), which did not receive fentanyl nor epinephrine. We assessed hemodynamics, transesophageal echocardiography, cardiac markers, and gasometry for 6 h. At the end of the experiment, the heart and lungs were removed for analysis by optical and electron microscopy and immunohistochemical (Caspase-3) assay. Data was analyzed using generalized estimating equations (GEE) and statistical significance was assumed at p < 0.05. RESULTS: Troponin levels among the groups were initially equivalent. Fentanyl group showed lower levels of troponin at the end of the sixth hour compared to the saline group (1.91 ± 1.47 vs. 5.44 ± 5.35 ng.mL-1, p=0.019). There were no significantly difference between fentanyl and saline group for hemodynamic, echocardiographic and gasometrical data. Transmission electron microscopy and immunohistochemistry also showed less myocardial injury in the fentanyl group. CONCLUSION: We concluded that fentanyl promotes effective cardioprotection to high-dose epinephrine without blunting the hemodynamic effect of epinephrin

Evaluation of MCT1, MCT4 and CD147 Genes in Peripheral Blood Cells of Breast Cancer Patients and Their Potential Use as Diagnostic and Prognostic Markers

Background: Patients with breast cancer-the deadliest cancer among women-are at constant risk of developing metastasis. Oxidative stress and hypoxia are common feature of tumor cells that can proliferate even in a resultant metabolic acidosis. Despite the low extracellular pH, intracellular pH of tumor cells remains relatively normal, or even more alkaline due to the action of a membrane protein family known as monocarboxylate transporters (MCTs). The objective of this study was to verify the diagnostic and prognostic value of MCT1, MCT4 and CD147 in tumor and peripheral blood samples of patients with breast cancer undergoing chemotherapic treatment. Methods: Differential expression of MCT1, MCT4 and CD147 obtained by qPCR was determined by 2(-Delta Delta Cq) method between biological samples (tumor and serial samples of peripheral) of patients (n = 125) and healthy women (n = 25). Results: tumor samples with higher histological grades have shown higher expression of these markersthis higher expression was also observed in blood samples obtained at diagnosis of patients when compared to healthy women and in patients with positive progression of the disease (metastasis development). Conclusion: markers studied here could be a promising strategy in routine laboratory evaluations as breast cancer diagnosis and prognosis.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo - FAPESPFMABC, Clin Lab, Ave Principe Gales,821, BR-09060650 Santo Andre, SP, BrazilUNIFESP, Biol Sci Dept, Rua Prof Artur Riedel,275, BR-09972270 Diadema, SP, BrazilFMABC, Epidemiol Lab & Data Anal, Ave Principe Gales,821, BR-09060650 Santo Andre, SP, BrazilUNIFESP, Biol Sci Dept, Rua Prof Artur Riedel,275, BR-09972270 Diadema, SP, BraziFAPESP: 2014/17693-1Web of Scienc

Peixes da bacia do rio Taquari-Antas (sistema da Laguna dos Patos), sul do Brasil

The aquatic habitats of the Taquari-Antas river basin (in the Patos Lagoon basin, southern Brazil) are under marked environmental transformation because of river damming for hydropower production. In order to provide an information baseline on the fish fauna of the Taquari-Antas basin, we provide a comprehensive survey of fish species based on primary and secondary data. We found 5,299 valid records of fish species in the basin, representing 119 species and 519 sampling sites. There are 13 non-native species, six of which are native to other Neotropical river basins. About 24% of the total native species are still lacking a taxonomic description at the species level. Three native long-distance migratory species were recorded (Leporinus obtusidens, Prochilodus lineatus, Salminus brasiliensis), as well as two potential mid-distance migrators (Parapimelodus nigribarbis and Pimelodus pintado). Although there is only one officially endangered species in the basin (S. brasiliensis), restricted range species (21.7% of total species) should be considered in conservation efforts.Os ambientes aquáticos da Bacia do rio Taquari-Antas (Bacia da Laguna dos Patos, sul do Brasil) vêm sofrendo considerável transformação, principalmente em razão da implantação de barragens para geração de energia elétrica. Com o objetivo de estabelecer um diagnóstico amplo da ictiofauna da Bacia do Taquari-Antas, realizou-se um inventário das espécies dessa bacia a partir de dados primários e secundários. Foram obtidos 5.299 registros válidos de espécies de peixe na bacia, representando 119 espécies e 519 localidades amostradas. Ocorrem, na bacia, 13 espécies não nativas, seis das quais são oriundas de outras bacias neotropicais. Cerca de 24% de todas as espécies carecem de descrição taxonômica no nível específico. Foram registradas três espécies nativas migradoras de longa distância (Leporinus obtusidens, Prochilodus lineatus e Salminus brasiliensis) e duas potenciais migradoras de média distância (Parapimelodus nigribarbis e Pimelodus pintado). O fato de uma espécie ser oficialmente reconhecida como ameaçada na bacia (S. brasiliensis) e a grande proporção de espécies de distribuição restrita (21,7% do total) devem ser levados em consideração nos esforços de conservação

Desempenho de vacas leiteiras alimentadas com cana de açúcar associada à ureia e tratada com cal virgem na região do Alto Pantanal Sul-Mato-Grossense

This study evaluated the effect of diets containing fresh sugar cane associated with urea and/or calcium oxide on the productive performance, milk composition and feed digestibility in Girolando dairy cows. The experiment lasted 84 days. Animals were feedlot using a tie stall system and assigned to the following treatments: Fresh sugarcane (Ca); Fresh sugarcane with Urea (CaUr); Sugarcane hydrolyzed with Calcium oxide (CaCal) and Sugarcane hydrolyzed with Calcium oxide plus Urea (CaUrCal). Four multiparous cows, with 21 days postpartum, were distributed in a 4x4 Latin Square. The experimental period was 21 days; the first 14 days for adaptation of animals to diets, and seven days for data collection. Data were subjected to analysis of variance and the means were compared by Tukey’s test (P<0.05). The intake was not influenced by the diets and the best feed efficiency was foundin animals fed the diet CaUrCal (1.25 kg milk / kg DM). Differences were detected between the treatments for the non-fiber carbohydrate digestibility, in which the diet based on CaCal exceeded CaUr. Serum glucose and urea were similar between treatments, but the excretion of urea and urinary nitrogen was higher in animals fed CaCal than CaUr and Ca. The use of diets containing sugarcane associated with urea and calcium oxide had no influence on milk composition and production.Avaliou-se o efeito do uso de dietas contendo cana de açúcar in natura e associada com ureia e/ou cal virgem, sobre o desempenho produtivo, composição do leite e digestibilidade dos alimentos em vacas leiteiras da raça Girolando. O experimento teve duração de 84 dias. Os animais foram mantidos confinados em sistema tie stall e receberam os seguintes tratamentos: Cana in natura (Ca); Cana in natura com Ureia (CaUr); Cana hidrolisada com Cal Virgem (CaCal) e Cana hidrolisada com Cal Virgem mais Ureia (CaUrCal). Foram utilizadas quatro vacas multíparas com 21 dias após o parto, distribuídas num delineamento em quadrado latino 4x4. O período experimental teve duração de 21 dias, sendo os 14 dias iniciais para adaptação dos animais à respectiva dieta, e sete dias para coleta dos dados. Os dados foram submetidos à análise de variância e as médias comparadas pelo teste de Tukey (P<0,05). O consumo apresentado pelos animais não foi influenciado pelas dietas e a melhor eficiência alimentar foi observada nos animais que consumiram CaUrCal (1,25 kg leite/kg MS). Houve diferença entre os tratamentos para a digestibilidade de carboidratos não fibrosos, em que a dieta a base de CaCal foi superior à CaUr. Os níveis séricos de glicose e ureia foram semelhantes entre os tratamentos; porém a excreção de ureia e nitrogênio urinário foram superiores nos animais que receberam a dieta CaCal em relação aos alimentados com Ca e CaUr. O uso de dietas a base de cana com os aditivos ureia e cal virgem não influenciam a composição e a produção de leite

Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil

ABSTRACT BACKGROUND: Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country. OBJECTIVES: The aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest. CONTENTS: There were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia-related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes. CONCLUSIONS: There was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care

Parada cardíaca perioperatória: uma análise evolutiva da incidência de parada cardíaca intraoperatória em centros terciários no Brasil

ResumoJustificativaNos últimos 25 anos ocorreram grandes mudanças na medicina em todo o mundo. Essas mudanças de tecnologias, riscos do paciente, perfil do paciente e leis que regulam medicamentos tiveram impacto na incidência de parada cardíaca (PC). Postula‐se que a incidência de parada cardíaca intraoperatória (PCI) tem diminuído ao longo dos anos, especialmente em países desenvolvidos. A nossa hipótese foi que, como no resto do mundo, a incidência de PCI está diminuindo no Brasil, um país em desenvolvimento.ObjetivosO objetivo deste estudo foi pesquisar e avaliar na literatura as publicações que relacionam a incidência de PCI no Brasil e analisar a tendência na incidência de PCI.ConteúdoDescobrimos quatro artigos que atenderam aos critérios de inclusão, que resultaram em 204.072 pacientes submetidos à anestesia regional ou geral em dois hospitais terciários e acadêmicos e 627 casos de PCI. A média de incidência de PCI para o período de 25 anos foi de 30,72:10.000 anestesias. Houve uma diminuição de 39:10.000 anestesias para 13:10.000 anestesias no período analisado, com letalidade relacionada de 48,3% para 30,8%. Além disso, as principais causas de mortalidade relacionadas à anestesia mudaram de mau funcionamento de máquinas e overdose de medicamentos para hipovolemia e causas respiratórias.ConclusõesHouve uma clara redução na incidência de PCI nos últimos 25 anos no Brasil. Essa redução é observada em todo o mundo e pode ser o resultado de vários fatores, incluindo novas leis que regulam medicamentos no Brasil, incorporação de tecnologias, melhor nível de desenvolvimento humano do país e melhor assistência ao paciente.AbstractBackgroundGreat changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country.ObjectivesThe aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest.ContentsThere were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia‐related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes.ConclusionsThere was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care

Peixes da bacia do rio Taquari-Antas (sistema da Laguna dos Patos), sul do Brasil

The aquatic habitats of the Taquari-Antas river basin (in the Patos Lagoon basin, southern Brazil) are under marked environmental transformation because of river damming for hydropower production. In order to provide an information baseline on the fish fauna of the Taquari-Antas basin, we provide a comprehensive survey of fish species based on primary and secondary data. We found 5,299 valid records of fish species in the basin, representing 119 species and 519 sampling sites. There are 13 non-native species, six of which are native to other Neotropical river basins. About 24% of the total native species are still lacking a taxonomic description at the species level. Three native long-distance migratory species were recorded (Leporinus obtusidens, Prochilodus lineatus, Salminus brasiliensis), as well as two potential mid-distance migrators (Parapimelodus nigribarbis and Pimelodus pintado). Although there is only one officially endangered species in the basin (S. brasiliensis), restricted range species (21.7% of total species) should be considered in conservation efforts.Os ambientes aquáticos da Bacia do rio Taquari-Antas (Bacia da Laguna dos Patos, sul do Brasil) vêm sofrendo considerável transformação, principalmente em razão da implantação de barragens para geração de energia elétrica. Com o objetivo de estabelecer um diagnóstico amplo da ictiofauna da Bacia do Taquari-Antas, realizou-se um inventário das espécies dessa bacia a partir de dados primários e secundários. Foram obtidos 5.299 registros válidos de espécies de peixe na bacia, representando 119 espécies e 519 localidades amostradas. Ocorrem, na bacia, 13 espécies não nativas, seis das quais são oriundas de outras bacias neotropicais. Cerca de 24% de todas as espécies carecem de descrição taxonômica no nível específico. Foram registradas três espécies nativas migradoras de longa distância (Leporinus obtusidens, Prochilodus lineatus e Salminus brasiliensis) e duas potenciais migradoras de média distância (Parapimelodus nigribarbis e Pimelodus pintado). O fato de uma espécie ser oficialmente reconhecida como ameaçada na bacia (S. brasiliensis) e a grande proporção de espécies de distribuição restrita (21,7% do total) devem ser levados em consideração nos esforços de conservação

Role of innate immunity-triggered pathways in the pathogenesis of Sickle Cell Disease: a meta-analysis of gene expression studies

Despite the detailed characterization of the inflammatory and endothelial changes observed in Sickle Cell Disease (SCD), the hierarchical relationship between elements involved in the pathogenesis of this complex disease is yet to be described. Meta-analyses of gene expression studies from public repositories represent a novel strategy, capable to identify key mediators in complex diseases. We performed several meta-analyses of gene expression studies involving SCD, including studies with patient samples, as well as in-vitro models of the disease. Meta-analyses were performed with the Inmex bioinformatics tool, based on the RankProd package, using raw gene expression data. Functional gene set analysis was performed using more than 60 gene-set libraries. Our results demonstrate that the well-characterized association between innate immunity, hemostasis, angiogenesis and heme metabolism with SCD is also consistently observed at the transcriptomic level, across independent studies. The enrichment of genes and pathways associated with innate immunity and damage repair-associated pathways supports the model of erythroid danger-associated molecular patterns (DAMPs) as key mediators of the pathogenesis of SCD. Our study also generated a novel database of candidate genes, pathways and transcription factors not previously associated with the pathogenesis of SCD that warrant further investigation in models and patients of SCD5CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPES