ESTUDO DA MUCOSA ENTERALDE RESERVATÓRIOS EM J EM CÃES

Total proctocolectomy with enteral reservoir is, at present, the best technique used for the surgical treatment of some large intestine diseases involving the whole colon. In order to study the characteristics of the J reservoir enteral mucosa, thirty-six dogs underwent surgery. After resection of 5cm of the jejunum caudalis the animals were divided into two equal groups (GI and GII) for study-control. In GI, an entero-enteral end-to-end anastomosis was performed; in GII, a J reservoir was performed in the cranialis segment of the jejunum and this pouch was anastomosed end-to-end to the jejunun caudalis (similar to GI). On the 21st, 42nd and 63rd postoperative days, six animals of each group were sacrificed for macro and microscopic studies, including cellular counting and the measuring of the enteral mucosa lamina propria. On the 21st day, both groups showed oedema and erythema on macroscopic examination, and necrosis under microscopy in similar numbers. On the 42nd and 63rd days, these alterations decreased or disappeared in GI and persisted in GII. Only in the latter group, on macroscopy, ulcers were observed on the 21st day (2 dogs) and on the 42nd day (1 dog). In both groups there was no significant difference as to the incidence of abscess under microscopy. On the 21st day there was an increase of the volumetric density of neutrophils polymorph, macrophages, eosinophils, plasma cells and lymphocites in both groups. All the cells, except the eosinophils, showed a significant enlargement of the volumetric density in GII on the 63rd day. The transversal diameter of lamina propria, except for the villi height, was significantly larger in GII on the 63rd postoperative day. It was concluded that the enteral mucosa of the J reservoir in dogs shows alterations of the normal pattern of macroscopy and microscopy, including the volumetric density enlargement of the inflammatory cells.A proctocolectomia total com reservatório enteral é a principal técnica utilizada para o tratamento operatório de algumas doenças do intestino grosso. Com o objetivo de estudar as características da mucosa enteral de reservatórios em J, foram operados 36 cães. Após a ressecção de 5 cm do jejunum caudalis, para estudo-controle, os cães foram separados em dois grupos (GI e GII). No GI, foi realizada anastomose êntero-enteral término-terminal; no GII, foi feito um reservatório na forma de J no segmento cranialis, que foi anastomosado ao segmento caudalis da mesma forma que no GI. Aos 21, 42 e 63 dias de pós-operatório, foi realizada eutanásia de 6 cães de cada grupo para estudos macroscópico e microscópico, incluindo-se contagens celulares e medidas da lâmina própria da mucosa enteral. Os resultados revelaram, aos 21 dias, edema e enantema, à macroscopia, e necrose à microscopia, em freqüências semelhantes nos dois grupos. Aos 42 e 63 dias, essas alterações diminuiram ou desapareceram no GI e persistiram no GII. Somente neste último foram observadas úlceras à macroscopia aos 21 dias (2 cães) e 42 dias (1 cão). Não houve diferença significante à presença de abscesso, à microscopia, nos dois grupos. Na contagem celular, já aos 21 dias houve aumento da densidade volumétrica de neutrófilos, macrófagos, eosinófilos, plasmócitos e linfócitos nos dois grupos. Todas as células, exceto eosinófilos, apresentavam-se com densidade volumétrica significantemente maior no GII, aos 63 dias. O diâmetro transversal da lâmina própria, excluindo a altura dos vilos, apresentou-se significantemente maior no GII aos 63 dias de pós-operatório. Concluiu-se que a mucosa enteral de reservatórios em J, em cães, apresenta modificações do padrão de normalidade macroscópica e microscópica, entre as quais o aumento da densidade volumétrica de células inflamatórias.PUCCAMPUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Sufentanilo intratecal para revascularización del miocardio

ResumenContextopacientes de cirugía cardíaca sometidos a revascularización miocárdica con circulación extracorpórea.Objetivoevaluar el efecto hemodinámico de la adición de sufentanilo intratecal para anestesia general.Proyectoestudio prospectivo, aleatorizado y abierto, con posterior aprobación del Comité de Ética en Investigación.Escenarioestudio monocéntrico realizado en el Instituto Dante Pazzanese de Cardiología, São Paulo, Brasil.Pacientescuarenta pacientes de ambos sexos que firmaron el consentimiento informado fueron sometidos a revascularización electiva.Criterios de exclusiónenfermedad renal crónica, procedimientos de urgencia, reintervenciones, contraindicación para la raquianestesia, fracción de eyección del ventrículo izquierdo inferior al 40%, índice de masa corporal por encima de 32kg/m2 y uso de nitroglicerina.Intervencioneslos pacientes fueron aleatorizados para recibir (o no), 1μg/kg de sufentanilo intratecal. La anestesia se indujo y se mantuvo con infusión continua de sevoflurano y remifentanilo.Principales medidas de resultadosvariables hemodinámicas, niveles sanguíneos de troponina i cardíaca, péptido natriurético del tipo B, interleucina 6 y factor de necrosis tumoral alfa durante y después de la cirugía.Resultadoslos pacientes del grupo sufentanilo necesitaron menos soporte inotrópico con dopamina, comparado con el grupo control (9,5 vs. 58%, p=0,001) y menos aumentos de dosis de remifentanilo (62 vs. 100%, p=0,004). Los datos hemodinámicos en 8 intervalos de tiempo diferentes y los datos bioquímicos no presentaron diferencias entre los grupos.Conclusioneslos pacientes que recibieron sufentanilo intratecal tuvieron una estabilidad hemodinámica mayor, evidenciada por el soporte inotrópico reducido y menos ajustes en las dosis intravenosas de opiáceos

European Association of Cardiothoracic Anesthesiology and Intensive Care (EACTAIC) Fellowship Curriculum: Second Edition.

International audienceThis document represents the first update of the Cardiothoracic and Vascular Anaesthesia Fellowship Curriculum of the European Association of Cardiothoracic Anaesthesiology and Intensive Care. After obtaining feedback from exit interviews with fellows in training, graduate fellows, and program directors, 2 modified online Delphi procedures with questionnaires were conducted. A consensus was reached when two-thirds of responding committee members gave green or yellow ratings on a traffic light system, and >70% indicated strong agreement or agreement on a 5-point Likert scale. The new regulations include the following: (1) more flexibility in the fellows` rotation, as long as the total number of days, rotations, and cases are completed during the training year; (2) recommendation for strict compliance with national working-time guidelines; (3) no extension of fellowship training to compensate for annual and/or sick leave, unless the required minimum number of cases and rotations are not reached; (4) interruption of fellowship training for >12 months is allowed for personal or medical reasons; (5) introduction of a checklist for quantitative assessment of standard clinical skills; (6) recommendations for a uniform structure of exit interviews; (7) possibility of a 1-month training rotation in a postanesthesia care unit instead of an intensive care unit; and (8) provided all other requirements have been met, the allowance of progression from the basic training year to the advanced fellowship training year without first passing the transesophageal echocardiography examination

European Association of Cardiothoracic Anesthesiology and Intensive Care Pediatric Cardiac Anesthesia Fellowship Curriculum:First Edition

International audiencePediatric cardiac anesthesia is a subspecialty of cardiac and pediatric anesthesiology dedicated to the perioperative care of patients with congenital heart disease. Members of the Congenital and Education Subcommittees of the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) agreed on the necessity to develop an EACTAIC pediatric cardiac anesthesia fellowship curriculum. This manuscript represents a consensus on the composition and the design of the EACTAIC Pediatric Cardiac Anesthesia Fellowship program. This curriculum provides a basis for the training of future pediatric cardiac anesthesiologists by clearly defining the theoretical and practical requirements for fellows and host centers

High levels of T lymphocyte activation in Leishmania-HIV-1 co-infected individuals despite low HIV viral load

<p>Abstract</p> <p>Background</p> <p>Concomitant infections may influence HIV progression by causing chronic activation leading to decline in T-cell function. In the Americas, visceral (AVL) and tegumentary leishmaniasis (ATL) have emerged as important opportunistic infections in HIV-AIDS patients and both of those diseases have been implicated as potentially important co-factors in disease progression. We investigated whether leishmaniasis increases lymphocyte activation in HIV-1 co-infected patients. This might contribute to impaired cellular immune function.</p> <p>Methods</p> <p>To address this issue we analyzed CD4⁺T absolute counts and the proportion of CD8⁺T cells expressing CD38 in <it>Leishmania</it>/HIV co-infected patients that recovered after anti-leishmanial therapy.</p> <p>Results</p> <p>We found that, despite clinical remission of leishmaniasis, AVL co-infected patients presented a more severe immunossupression as suggested by CD4⁺T cell counts under 200 cells/mm³, differing from ATL/HIV-AIDS cases that tends to show higher lymphocytes levels (over 350 cells/mm³). Furthermore, five out of nine, AVL/HIV-AIDS presented low CD4⁺T cell counts in spite of low or undetectable viral load. Expression of CD38 on CD8⁺T lymphocytes was significantly higher in AVL or ATL/HIV-AIDS cases compared to HIV/AIDS patients without leishmaniasis or healthy subjects.</p> <p>Conclusions</p> <p><it>Leishmania </it>infection can increase the degree of immune system activation in individuals concomitantly infected with HIV. In addition, AVL/HIV-AIDS patients can present low CD4⁺T cell counts and higher proportion of activated T lymphocytes even when HIV viral load is suppressed under HAART. This fact can cause a misinterpretation of these laboratorial markers in co-infected patients.</p

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Iron Behaving Badly: Inappropriate Iron Chelation as a Major Contributor to the Aetiology of Vascular and Other Progressive Inflammatory and Degenerative Diseases

The production of peroxide and superoxide is an inevitable consequence of aerobic metabolism, and while these particular "reactive oxygen species" (ROSs) can exhibit a number of biological effects, they are not of themselves excessively reactive and thus they are not especially damaging at physiological concentrations. However, their reactions with poorly liganded iron species can lead to the catalytic production of the very reactive and dangerous hydroxyl radical, which is exceptionally damaging, and a major cause of chronic inflammation. We review the considerable and wide-ranging evidence for the involvement of this combination of (su)peroxide and poorly liganded iron in a large number of physiological and indeed pathological processes and inflammatory disorders, especially those involving the progressive degradation of cellular and organismal performance. These diseases share a great many similarities and thus might be considered to have a common cause (i.e. iron-catalysed free radical and especially hydroxyl radical generation). The studies reviewed include those focused on a series of cardiovascular, metabolic and neurological diseases, where iron can be found at the sites of plaques and lesions, as well as studies showing the significance of iron to aging and longevity. The effective chelation of iron by natural or synthetic ligands is thus of major physiological (and potentially therapeutic) importance. As systems properties, we need to recognise that physiological observables have multiple molecular causes, and studying them in isolation leads to inconsistent patterns of apparent causality when it is the simultaneous combination of multiple factors that is responsible. This explains, for instance, the decidedly mixed effects of antioxidants that have been observed, etc...Comment: 159 pages, including 9 Figs and 2184 reference