The Effects of Acute and Chronic Inflammation on the Dynamics of Fluid Shift of Ringer's Solution and Hemodynamics during Surgery.

The aim of this study was to investigate the influences of acute and chronic inflammation on the dynamics of fluid shift of Ringer's solution and hemodynamics in patients during surgery. Thirty-seven patients with the American Society of Anesthesiologists (ASA) grades I-II were enrolled and allocated to two study groups according to the type of disease and operation and inflammation, including patients undergoing emergency appendectomy (Acute group, n = 19) and patients undergoing elective cholecystectomy (Chronic group, n = 18). All of the patients were administered 15 mL/kg of Ringer's lactated (LR) solution at a constant rate over 35 min before the induction of anesthesia. Plasma dilution (PD), volume expansion (VE), volume expansion efficiency (VEE), and extravascular volume (EVV) were calculated based on the concentration of hemoglobin within 2 h post-infusion. Heart rate (HR), arterial blood pressure and urine output were also recorded. PD and VE peaked at the end of infusion, while VEE peaked at the beginning of infusion in all of the patients. After infusion, PD, VE and VEE in the Acute group were all higher than those in the Chronic group (p < 0.05). PD and VE were higher during anesthesia or surgery than during awake or non-surgery (p < 0.001). The mean arterial pressure (MAP) and diastolic pressure (DBP) in the Acute group were significantly lower (p < 0.001) and HR was significantly higher (p < 0.001) than in the Chronic group during the study periods. It was suggested that patients with acute inflammation be treated with individualized fluid therapy during surgery.

Combined inhibition of complement C5 and CD14 markedly attenuates inflammation, thrombogenicity, and hemodynamic changes in porcine sepsis.

Complement and the TLR family constitute two important branches of innate immunity. We previously showed attenuating effects on inflammation and thromogenicity by inhibiting the TLR coreceptor CD14 in porcine sepsis. In the present study, we explored the effect of the C5 and leukotriene B4 inhibitor Ornithodoros moubata complement inhibitor (OmCI; also known as coversin) alone and combined with anti-CD14 on the early inflammatory, hemostatic, and hemodynamic responses in porcine Escherichia coli-induced sepsis. Pigs were randomly allocated to negative controls (n = 6), positive controls (n = 8), intervention with OmCI (n = 8), or with OmCI and anti-CD14 (n = 8). OmCI ablated C5 activation and formation of the terminal complement complex and significantly decreased leukotriene B4 levels in septic pigs. Granulocyte tissue factor expression, formation of thrombin-antithrombin complexes (p < 0.001), and formation of TNF-α and IL-6 (p < 0.05) were efficiently inhibited by OmCI alone and abolished or strongly attenuated by the combination of OmCI and anti-CD14 (p < 0.001 for all). Additionally, the combined therapy attenuated the formation of plasminogen activator inhibitor-1 (p < 0.05), IL-1ß, and IL-8, increased the formation of IL-10, and abolished the expression of wCD11R3 (CD11b) and the fall in neutrophil cell count (p < 0.001 for all). Finally, OmCI combined with anti-CD14 delayed increases in heart rate by 60 min (p < 0.05) and mean pulmonary artery pressure by 30 min (p < 0.01). Ex vivo studies confirmed the additional effect of combining anti-CD14 with OmCI. In conclusion, upstream inhibition of the key innate immunity molecules, C5 and CD14, is a potential broad-acting treatment regimen in sepsis as it efficiently attenuated inflammation and thrombogenicity and delayed hemodynamic changes.

Yanomamos: ingestión de sal e hipertensión arterial / Yanomamos: salt intake and arterial hypertension

La nación yanomama es un grupo indigena aislado y autosuficiente que reside en la selva lluviosa al sur de Venezuela y norte de Brasil que ha logrado vivir en armonia con su ambiente y que ha mostrado ancestral respecto a la naturaleza sin producir basura ni contaminación. Deparam la sal que necesitan de un àrbol de la misma región llamado Tavarí. El Estudio Intersalt es una investigación observacional que ha demostrado una asociación entre la presión arterial y el consumo de sal de la dieta a través de la medición de su excreción urinaria. Los hallazgos encontrados en este grupo poblacional fueron extraordinarios: Niveles de presión arterial muy bajos que no se incrementaron con la edad, niveles de colesterol muy reducidos, ausencia de alcoholismo u obesidad. Constituyen un experimento de la naturaleza digno de seguir; desafortunadamente el mundo occidental ha tenido un impacto negativo en sus vidas y cultura

The nation yanomami is an isolated and self-sufficient indigenous group who reside in the rainy forest to the south of Venezuela and north of Brazil that has managed to live in harmony with its atmosphere and that has shown ancestral respect to the nature without producing any sweepings or contamination. They obtain the salt that needs from a local tree of called Tavarí. The Intersalt Study is an observational investigation that has demostrated an association between the arterial pressure and the consumption of salt of the diet through the measurement of its urinary excretion. The findings found in this population group were extraordinary: very low levels of pressure arterial that are not increased with the age, cholesterol levels very reduced, absence of alcoholism or obesity, very low sodium excretion. They constitute an experiment of the nature worthy to follow; unfortunately western world had much of a negative impact on their lives or culture

Incapacidade temporária para atividades habituais: relação com a pressão arterial e o uso de terapia farmacológica anti-hipertensiva no Estudo Pró-Saúde / Temporary disability for daily activities: relationship with the blood pressure and use of anti-hypertensive drug therapy in the Pró-Saúde study

A hipertensão arterial (HA) desempenha papel determinante na ocorrência de eventos clínicos graves, havendo entretanto controvérsias quanto ao seu impacto no cotidiano do portador. A incapacidade temporária para a realização de atividades habituais definida como uma restrição temporária na capacidade funcional habitual do indivíduo, é um indicador de saúde recomendado pela Organização Mundial da Saúde para uso em estudos populacionais. A partir do objetivo geral de investigar a associação entre hipertensão arterial e incapacidade temporária para atividades habituais, delineamos os seguintes objetivos específicos: A) Investigar se a elevação dos níveis pressóricos determina a freqüência e o período acumulado de incapacidade temporária para atividades habituais; B) Investigar se o uso de medicações anti-hipertensivas associa-se a alterações na freqüência e no período acumulado de incapacidade temporária para atividades habituais. Estudo seccional com dados de 2953 participantes obtidos de questionário auto-administrado no Estudo Pró-Saúde, uma coorte de funcionários técnicos administrativos de universidade localizada no estado do Rio de Janeiro. A exposição foi avaliada a partir do valor aferido da PA e do uso de drogas anti-hipertensivas. Conduzimos a análise separando os participantes em 4 grupos, combinando as informações quanto à PA aferida...

Arterial hypertension (AH) plays a determinant role in the occurrence of severe clinical events; however, there are controversies about its impact on daily life. The temporary disability for daily activities, which is defined as a temporary restriction in an individual’s usual level of functioning, is a health indicator proposed by the World HealthOrganization for utilization in population studies. Objectives: To investigate the association between arterial hypertension and temporary disability for daily activities, we proposed thefollowing specific objectives: A) To investigate whether elevated blood pressure (BP) determine the frequency or accumulated period of temporary disability for daily activities; 2) To investigate whether the use of anti-hypertensive drugs are associated with changes in the frequency or accumulated period of temporary disability for daily activities. Methods: Across-sectional study with data obtained from 2953 participants who answered a selfadministered questionnaire in the Pro-Saude Study, a cohort of university emplyees in Rio de Janeiro state. The exposure was evaluated using the measured value of BP and the report ofthe use of anti-hypertensive drugs. We conducted the analysis classifying the participants in 4 groups, combining the information about measured BP (< or ³ 140/90 mmHg) and the report of the use of anti-hypertensive drugs or not. The outcome was evaluated with a composite variable with information about the report and period of disability. Multivariate analyses were conducted using multinomial logistic regression. Results: 690 (23.4 %) were classified as hypertensives, and 704 (23.8 %) reported temporary disability. The use of anti-hypertensive drugs, among the participants with BP < 140/90 mmHg, was directly associated with theprevalence of temporary disability for daily activities for a longer period (OR=2.25, CI 95 %: 1.31 - 3.87)...