Eficacia y seguridad del cloruro mórfico epidural en cirugía abdominal laparoscópica. Estudio observacional.

The use of epidural neuraxial morphine for abdominal surgery is widely described in the medical literature. Its use has sometimes been limited by the possible appearance of adverse effects, emphasizing among them, respiratory depression. In abdominal laparoscopic surgery and specifically in enhanced recovery programs (P.R.I.) its use is limited by the possible appearance of side effects that can basically lengthen the length of stay (L.O.S.), from the acronym in English . Its use is limited to the results obtained and the consensus reached with the different members of the P.R.I. internally, of the institution. That is why, in order to know and evaluate the results obtained, we carried out an internal audit (self audit), retrospectively collecting the different variables of interest in the use of epidural morphine in laparoscopic major abdominal surgery, in the periods between 14-1-2016 and 11-10-2020 and in transperitoneal laparoscopic nephrectomy surgeries between 11-9-2015 and 06-30-2017. We want to share and publicize the results of this study, focused on analgesic efficacy and clinical safetyEl uso de cloruro mórfico vía neuroaxial  vía epidural para cirugía abdominal está ampliamente descrito en la literatura médica. Su uso a veces ha estado limitado por la posible aparición de efectos adversos , destacando entre ellos ,  la depresión respiratoria. En cirugía laparoscópica abdominal y en concreto en los programas de recuperación intensificada ,  ( P.R.I. ) su uso queda limitado por la posible aparición de efectos secundarios que básicamente ,puedan alargar el tiempo de estancia hospitalaria , length of stay ( L.O.S. ) , del acrónimo en inglés. Su uso queda limitado a los resultados obtenidos y al  consenso llegado con los diferentes integrantes  de los P.R.I. a nivel interno , de la institución. Es por  ello , que con el fin de conocer y evaluar los resultados obtenidos ,realizamos  una   auditoría interna  , ( self audit ) ,  recojimos de forma retrospectiva, las diferentes variables de interés del uso de morfina peridural en cirugía abdominal mayor laparoscópica , en los periodos comprendidos  entre el 14-1-2016 y el 10-11-2020 y en  las cirugías de nefrectomías laparoscópicas transperitoneales  comprendidas entre el 9-11-2015 y el 30-06-2017. Queremos compartir y dar a conocer los resultados del presente estudio , centrados en la eficacia analgésica y seguridad clínica

PPARs and Adipose Cell Plasticity

Due to the importance of fat tissues in both energy balance and in the associated disorders arising when such balance is not maintained, adipocyte differentiation has been extensively investigated in order to control and inhibit the enlargement of white adipose tissue. The ability of a cell to undergo adipocyte differentiation is one particular feature of all mesenchymal cells. Up until now, the peroxysome proliferator-activated receptor (PPAR) subtypes appear to be the keys and essential players capable of inducing and controlling adipocyte differentiation. In addition, it is now accepted that adipose cells present a broad plasticity that allows them to differentiate towards various mesodermal phenotypes. The role of PPARs in such plasticity is reviewed here, although no definite conclusion can yet be drawn. Many questions thus remain open concerning the definition of preadipocytes and the relative importance of PPARs in comparison to other master factors involved in the other mesodermal phenotypes

Human multipotent adipose-derived stem cells differentiate into functional brown adipocytes

International audienceIn contrast to the earlier contention, adult humans have been recently shown to possess active brown adipose tissue (BAT) with a potential of being of metabolic significance. Up to now, brown fat precursor cells have not been available for human studies. We have shown previously that human multipotent adipose-derived stem (hMADS) cells exhibit a normal karyotype and high self-renewal ability; they are known to differentiate into cells which exhibit the key properties of human white adipocytes, i.e. UCP2 expression, insulin-stimulated glucose uptake, lipolysis in response to beta-agonists and atrial natriuretic peptide, and release of adiponectin and leptin. Herein we show that, upon chronic exposure to a specific PPARgamma but not to a PPARbeta/delta or a PPARalpha agonist, hMADS cell-derived white adipocytes are able to switch to a brown phenotype by expressing both UCP1 and CIDEA mRNA. This switch is accompanied by an increase in oxygen consumption and uncoupling. The expression of UCP1 protein is associated to stimulation of respiration by beta-AR agonists, including beta3-AR agonist. Thus hMADS cells represent an invaluable cell model to screen for drugs stimulating the formation and/or the uncoupling capacity of human brown adipocytes that could help to dissipate excess caloric intake of individuals

Prognostic factors for survival with nab-paclitaxel plus gemcitabine in metastatic pancreatic cancer in real-life practice: the ANICE-PaC study

Abstract Background Treatment with nab-paclitaxel plus gemcitabine increases survival in patients with metastatic pancreatic cancer. However, the assessment of treatment efficacy and safety in non-selected patients in a real-life setting may provide useful information to support decision-making processes in routine practice. Methods Retrospective, multicenter study including patients with metastatic pancreatic cancer, who started first-line treatment with nab-paclitaxel plus gemcitabine between December 2013 and June 2015 according to routine clinical practice. In addition to describing the treatment pattern, overall survival (OS) and progression-free survival (PFS) were assessed for the total sample and the exploratory subgroups based on the treatment and patients’ clinical characteristics. Results All 210 eligible patients had a median age of 65.0 years (range 37–81). Metastatic pancreatic adenocarcinoma was recurrent in 46 (21.9%) patients and de novo in 164 (78.1%); 38 (18%) patients had a biliary stent. At baseline, 33 (18.1%) patients had an ECOG performance status ≥2. Patients received a median of four cycles of treatment (range 1–21), with a median duration of 3.5 months; 137 (65.2%) patients had a dose reduction of nab-paclitaxel and/or gemcitabine during treatment, and 33 (17.2%) discontinued treatment due to toxicity. Relative dose intensity (RDI) for nab-paclitaxel, gemcitabine, and the combined treatment was 66.7%. Median OS was 7.2 months (95% CI 6.0–8.5), and median PFS was 5.0 months (95% CI 4.3–5.9); 50 patients achieved either a partial or complete response (ORR 24.6%). OS was influenced by baseline ECOG PS, NLR and CA 19.9, but not by age ≥ 70 years and/or the presence of hepatobiliary stent or RDI  3 vs. ≤ 3 (p = 0.043), and baseline CA 19.9 > 37 U/mL vs. ≤37 U/mL (p = 0.004). Conclusions Nab-Paclitaxel plus gemcitabine remain effective in a real-life setting, despite the high burden of dose reductions and poorer performance of these patients. A nomogram to predict survival using baseline ECOG performance status, NLR and CA 19.9 is proposed

A reservoir of brown adipocyte progenitors in human skeletal muscle

Brown adipose tissue uncoupling protein-1 (UCP1) plays a major role in the control of energy balance in rodents. It has long been thought, however, that there is no physiologically relevant UCP1 expression in adult humans. In this study we show, using an original approach consisting of sorting cells from various tissues and differentiating them in an adipogenic medium, that a stationary population of skeletal muscle cells expressing the CD34 surface protein can differentiate in vitro into genuine brown adipocytes with a high level of UCP1 expression and uncoupled respiration. These cells can be expanded in culture, and their UCP1 mRNA expression is strongly increased by cell-permeating cAMP derivatives and a peroxisome-proliferator-activated receptor-{gamma} (PPAR{gamma}) agonist. Furthermore, UCP1 mRNA was detected in the skeletal muscle of adult humans, and its expression was increased in vivo by PPAR{gamma} agonist treatment. All the studies concerning UCP1 expression in adult humans have until now been focused on the white adipose tissue. Here we show for the first time the existence in human skeletal muscle and the prospective isolation of progenitor cells with a high potential for UCP1 expression. The discovery of this reservoir generates a new hope of treating obesity by acting on energy dissipation. <br /