Fire in the Operating Room During Hypospadias Repair

Fire in the operating room (OR) is a very distressful and shocking occurrence with potential dramatic consequences. Despite safety rules and rigorous recommendations, such unintentional events do occur every so often. Notably, the vast majority of cases have been reported in the adult population, with very few pediatric cases described to date. Herein, we report on a 16-month-old boy undergoing reconstructive surgery for penoscrotal hypospadias, who experienced an OR fire most likely related to the use of alcohol-based solution ignited by monopolar electrocautery

Feasibility, safety and outcome of inguinal hernia repair under spinal versus general anesthesia in preterm and term infants

Background: Inguinal hernia repair (IHR) is a common operation in preterm and term infants. Recently, spinal anesthesia (SA) has been proposed as an alternative to avoid exposure to general anesthesia (GA) during early life. The aim of this study was to compare surgical outcomes of open IHR performed under SA versus GA in neonates and infants, and to detect criteria to predict the success or failure of SA. Materials and methods: This is a 6-year, single center, nonrandomized interventional study (2013–2019). SA was performed with 0.5% bupivacaine. GA was given using propofol, fentanyl, sevoflurane, and laryngeal mask. Patient demographics, operative time, intraoperative events related to surgery or anesthesia, and complications were analyzed at short and long-term follow-up. Results: 68 infants (78 IHR) and 37 infants (44 IHR) received SA and GA at the discretion of the anesthesiologist, respectively. SA failure rate was 9%, and positively correlated with weight at surgery (p = 0.001; rp = 0.38). Conversion from SA to GA occurred in 4 (6%) patients owing to prolonged operative time (43.75 ± 4.8 vs 23.02 ± 11.3 min; p = 0.0006). There were no differences regarding operative time and intra- and postoperative complications among the two groups at mean follow-up of 18.53 ± 21.9 months. Conclusions: This pilot study confirms that SA is safe, effective and not detrimental to surgical outcome of neonates and infants undergoing IHR. Additionally, it may help further define what patients may have a successful SA. Our experience suggests that SA is especially suitable in infants weighing < 4000 g, and conversion to GA correlates with prolonged operative time. Level of evidence: Level II

Role of HO/CO in the Control of Peripheral Circulation in Humans

Experimental studies show that the heme oxygenase/carbon monoxide system (HO/CO) plays an important role in the homeostasis of circulation and in the pathophysiology of hypertension. No data are available on its role in the control of peripheral circulation in humans. We evaluated the effects of inhibition of HO with stannous mesoporphyrin IX (SnMP) (200 μM) locally administered by iontophoresis, on human skin blood flow, evaluated by laser-Doppler flowmetry, in the presence and absence of nitric oxide synthase (NOS) inhibition with L-NG-Nitroarginine methyl ester (L-NAME) (100 μM). We also evaluated the effect of HO inhibition on vasodilatation induced by acetylcholine (ACh) and vasoconstriction caused by noradrenaline (NA). SnMP and L-NAME caused a similar 20–25% decrease in skin flow. After nitric oxide (NO) inhibition with L-NAME, HO inhibition with SnMP caused a further 20% decrease in skin perfusion. SnMP decreased vasodilatation induced by ACh by about 70%, while it did not affect vasoconstriction to NA. In conclusion, HO/CO participates in the control of peripheral circulation, independently from NO, and is involved in vasodilatation to ACh

Obesidad y deuda de sueño: epidemias de la actualidad

VIII Congreso Iberoamericano de Nutrición. ¿Nutrición basada en la videncia o en la evidencia

OMEGA 3 OS ÁCIDOS GORDOS: RESPOSTA IMUNE E SEU EFEITO SOBRE CERTAS DOENÇAS.

It is known that n-3 and n-6 PUFAs (polyunsaturated fatty acids) have effect on the immune response. The aim of this review focuses on research on the importance of the derivatives of n-3 PUFAs (eicosanoids), its effect on immunity and its effect on autoimmune and inflammatory diseases. These two types of fatty acids are different from the structural point of view and also from the functional point of view. So, they result in products with different biological activity. Through enzymatic reactions, the linoleic acid is a precursor of potent proinflammatories: 2-prostaglandins and 4-leukotrienes. In contrast, the alpha-linolenic acid is a precursor of 3-prostaglandins and 5-leukotrienes (both of them: anti-inflammatories). It is also being studied the action of other eicosanoids such as lipoxins, resolvins and protectins. The proportion in which the eicosanoids are produced depends on the amount of substrate available.This influences if the response is proinflammatory or antiinflammatory.The specific dose recommendations of consumption of n-3 PUFAs for inflammatory and autoimmune diseases is not yet known with precision, so that itbecomes evident the need for more work on this topic. The unit of analysis of this paper is to review the latest scientific evidence related to the topic.Es reconocido el efecto sobre la respuesta inmune que tienen los ácidos grasos poliinsaturados de la serie n-6 y n-3. El objetivo de esta revisión es investigar la importancia de los derivados de los ácidos grasos omega 3 (eicosanoides),su efecto sobre la inmunidad y su acción sobre algunas enfermedades inmunes e inflamatorias. Las series n-6 y n-3 son distintas desde el punto de vistaestructural y funcional dando origen a productos con diferente actividad biológica. A través de reacciones enzimáticas el ácido linoleico es precursor de prostaglandinas de la serie 2 y leucotrienos de la serie 4, ambos potentes proinflamatorios. En cambio, el ácido alfa- linolénico forma prostaglandinas de la serie 3 y leucotrienos de la serie 5, compuestos con acción antiinflamatoria.Se está investigando además la acción de otros eicosanoides como lipoxinas, resolvinas y protectinas, entre otros. La proporción en que los eicosanoides se producen depende de la cantidad de sustrato disponible, lo que influye en que la respuesta sea proinflamatoria o antiinflamatoria. Las recomendaciones específicas de dosis de consumo de n-3 para las patologías inflamatorias y autoinmunes aun no se conocen con precisión. Se requiere una mayorcantidad de trabajos investigativos al respecto. La unidad de análisis del presente trabajo es la revisión de las últimas evidencias científicas relacionadas con el tema.Reconhece-se o efeito sobre a resposta imune com os ácidos graxos poliinsaturados da série n - 6 e n- 3. O objetivo desta revisão é investigar a importância dos derivados de ômega-3 ácidos graxos ( eicosanóides ), o seu efeito sobre a imunidade e seu efeito sobre algumas doenças imunes e inflamatórias. O n- 6 e n - 3 são diferentes do ponto de vista estrutural e funcional, dando origem a produtos com atividade biológica variada.Através de reações enzimáticas o ácido linoléico é um precursor das prostaglandinas e leucotrienos Série 2 Série 4, dois potentes pró-inflamatórios . Em contraste, a forma do ácido alfa-linolênico prostaglandinas da série 3 e série 5 leucotrienos, compostos com ação antiinflamatória. Também estão pesquisando a forma como outros eicosanóides como lipoxinas, resolvins e protectins, entre outros. A proporção em que os eicosanóides são produzidosdepende da quantidade de sustrato disponível, o que influência que a resposta seja pró – inflamatória ou antiinflamatória. As recomendações de doses específicas para o consumo de n - 3 para doenças inflamatórias e auto-imunes,não são conhecidas ainda com exactitude, o qual evidência a necessidade de uma maior quantidade de trabalho nesta área. A unidade de análise deste trabalho é revisar as últimas provas científicas relacionadas com o tema

PD/1-PD-Ls Checkpoint: Insight on the Potential Role of NK Cells

The identification of inhibitory NK cell receptors specific for HLA-I molecules (KIRs and NKG2A) provided the molecular basis for clarifying the mechanism by which NK cells kill transformed cells while sparing normal cells. The direct interactions between inhibitory NK cell receptors and their HLA-I ligands enable NK cells to distinguish healthy from transformed cells, which frequently show an altered expression of HLA-I molecules. Indeed, NK cells can kill cancer cells that have lost, or under express, HLA-I molecules, but not cells maintaining their expression. In this last case, it is possible to use anti-KIR or anti-NKG2A monoclonal antibodies to block the inhibitory signals generated by these receptors and to restore the anti-tumor NK cell activity. These treatments fall within the context of the new immunotherapeutic strategies known as "immune checkpoint blockade." These antibodies are currently used in clinical trials in the treatment of both hematological and solid tumors. However, a more complex scenario has recently emerged. For example, NK cells can also express additional immune checkpoints, including PD-1, that was originally described on T lymphocytes, and whose ligands (PD-Ls) are usually overexpressed on tumor cells. Thus, it appears that the activation of NK cells and their potentially harmful effector functions are under the control of different immune checkpoints and their simultaneous expression could provide additional levels of suppression to anti-tumor NK cell responses. This review is focused on PD-1 immune checkpoint in NK cells, its potential role in immunosuppression, and the therapeutic strategies to recover NK cell cytotoxicity and anti-tumor effect

Single-cell imaging of α and β cell metabolic response to glucose in living human Langerhans islets

Here we use a combination of two-photon Fluorescence Lifetime Imaging Microscopy (FLIM) of NAD(P)H free/bound ratio in living HIs with post-fixation, immunofluorescence-based, cell-type identification. FLIM allowed to measure variations in the NAD(P)H free/bound ratio induced by glucose; immunofluorescence data allowed to identify single α and β cells; finally, matching of the two datasets allowed to assign metabolic shifts to cell identity. 312 α and 654 β cells from a cohort of 4 healthy donors, 15 total islets, were measured. Both α and β cells display a wide spectrum of responses, towards either an increase or a decrease in NAD(P)H free/bound ratio. Yet, if single-cell data are averaged according to the respective donor and correlated to donor insulin secretion power, a non-random distribution of metabolic shifts emerges: robust average responses of both α and β cells towards an increase of enzyme-bound NAD(P)H belong to the donor with the lowest insulin-secretion power; by contrast, discordant responses, with α cells shifting towards an increase of free NAD(P)H and β cells towards an increase of enzyme-bound NAD(P)H, correspond to the donor with the highest insulin-secretion power. Overall, data reveal neat anti-correlation of tissue metabolic responses with respect to tissue insulin secretion power