[Warming up with endotrainer prior to laparoscopic cholecystectomy]. / Calentamiento en endotrainer previo a colecistectomía laparoscópica.

BACKGROUND: Laparoscopic cholecystectomy is a safe and effective treatment and remains the gold standard in patients with benign disease. However it presents difficulties such as: the limited movement range of the instruments, the loss of depth perception, haptic feedback and the fulcrum effect. Previous training can optimize surgical performance in patients to master basic skills. OBJECTIVE: Assess the effectiveness of surgeons warming up with an endotrainer before performing laparoscopic cholecystectomy. MATERIAL AND METHODS: Single-blind controlled clinical trial with 16 surgeons who performed 2 laparoscopic cholecystectomies, the first according to standard practice and the second with warm-up comprising 5 MISTELS system exercises. Patient and surgeon demographics were recorded, in addition to findings and complications during and after surgery for each procedured. RESULTS: We found a decrease in surgical time of 76.88 (±18.87) minutes in the group that did not warm up to prior to surgery compared with 72.81 (±35.5) minutes in the group with warm-up (p=0.0196). In addition, increased bleeding occurred in the procedures performed with warm-up 31.25 (±30.85) ml compared with the group that had no warm-up 23.94 (±15.9) (p=0.0146). CONCLUSION: Performing warm up on a MISTELS system endotrainer before performing laparoscopic cholecystectomy reduces the operating time of surgery for all surgeons. Surgery bleeding increases in operations performed by surgeons with less experience in laparoscopic surgery.

Class I-Restricted T Cell-Associated Molecule Is a Marker for IFN-γ-Producing iNKT Cells in Healthy Subjects and Patients with Type 1 Diabetes.

Class I-restricted T cell-associated molecule (CRTAM) is an activation marker expressed on the cell surface of activated invariant natural killer T (iNKT) cells, CD8+ T cells, and a small subset of CD4+ T cells. CRTAM has also been associated with a proinflammatory profile in murine CD4+ T cells. However, CRTAM has not been thoroughly explored in human cells. This work focused on evaluating CRTAM expression in human iNKT lymphocytes after activation with α-galactosylceramide, its widely used specific glycolipid antigen. We also analyzed the involvement of costimulatory molecules in CRTAM expression and whether CRTAM expression is associated with a specific effector cytokine profile. We found that the signal produced by invariant T cell receptor (iTCR) engagement with α-galactosylceramide is sufficient to trigger CRTAM expression on human iNKT cells after 18 h of stimulation. Moreover, we observed a clear association between CRTAM expression and IFN-γ production in iNKT cells from healthy subjects and patients with type 1 diabetes. However, blocking the engagement of costimulatory molecules, such as CD40, CD80, and CD86, did not modify CRTAM expression. These results indicate that CRTAM may also play a role in triggering the production of IFN-γ in human iNKT cells and that CRTAM could be used as a marker to identify these inflammatory cells.

Peripheral blood T cells and neutrophils from asthma patients express class-I MHC-restricted T cell-associated molecule.

BACKGROUND: Class-I MHC-restricted T cell-associated molecule (CRTAM) is a protein expressed by activated natural killer T (NKT) cells, natural killer (NK) cells, CD8 T cells, and certain CD4 T lymphocytes. It is also expressed in Purkinje neurons and epithelial cells. However, no studies have examined the expression of CRTAM in peripheral blood cells during homeostasis or disease. Therefore, we explored whether CRTAM expression is influenced by the presence of allergic asthma. METHODS: We collected whole peripheral blood cells from non-asthmatic control subjects (n = 17) and patients with asthma (n = 17). All patients with asthma tested positive in allergen skin prick tests. We analyzed CRTAM expression in CD4(+) and CD8(+) T lymphocyte populations. CRTAM expression was also analyzed in CD177(+) neutrophils and IL5Rα(+) eosinophils. FINDINGS: The percentage of CD4(+)CRTAM(+) and CD8(+)CRTAM(+)T lymphocytes in peripheral blood was higher in allergic asthma patients compared with healthy controls. Furthermore, the percentage of CD177(+)CRTAM(+) neutrophils in peripheral blood was also elevated in patients with allergic asthma. However, the percentage of IL5Rα(+)CRTAM(+) eosinophils in peripheral blood was not significantly different in patients with allergic asthma compared with healthy controls. CONCLUSIONS: CRTAM expression on T cells, eosinophils, and neutrophils may be involved in bronchial inflammation in allergic asthma. Determination of CRTAM expression in peripheral blood may be useful for the diagnosis of bronchial inflammation and/or to identify recently activated immune cells.

IL-17-producing peripheral blood CD177+ neutrophils increase in allergic asthmatic subjects.

BACKGROUND: A T helper cell (TH) 17-biased response has been observed in patients with allergic asthma, particularly in those with neutrophil accumulation in the lung. Therefore, we sought to test the hypothesis that neutrophils might be an important source of interleukin (IL)-17 in allergic asthma. METHODS: Whole peripheral blood cells from non-asthmatic control subjects (n = 17) and patients with mild asthma (n = 7), moderate but persistent asthma (n = 4), or acute asthma (n = 6) were analyzed for IL-17A expression in CD177+ neutrophils. IL-17A expression was also analyzed in CD3+CD4+ and CD3+CD8+ lymphocyte populations. Asthmatic patients were classified as allergic to fungi, indoor allergens, or other allergens (e.g., pollen) based on a positive intradermal allergy test reaction. RESULTS: The percentage of CD177+ neutrophils in whole blood of asthmatic patients was higher than in healthy controls and highest in the moderate asthma group. Furthermore, the percentage of CD177+IL-17+ neutrophils was elevated in patients with mild asthma, whereas the CD4+ IL-17+ lymphocyte population was higher in asthmatic patients and highest in those with moderate but persistent asthma. We also found that the four patients that were allergic to fungi had the highest percentage of CD177+IL17+ neutrophils and CD8+IL17+ lymphocytes. CONCLUSION: IL17+CD177+ Neutrophils increase in allergic asthma patients especially when allergic to fungi. This cell population, through release of IL-17, might be contributing during the initial phase asthmatic disease and/or during disease progression but its role has not yet been established.

[High-affinity C-reactive protein as inflammatory marker]. / Proteína C reactiva de alta afinidad como marcador inflamatorio.

ANTECEDENTS: Non-immunological and immunological diseases have been reported to present a level of serum C-reactive protein (CRP) higher than the base level. For both, this level can guide the diagnosis and prognosis. OBJECTIVE: To test the value of serum CRP, by a high-sensitivity CRP assay, during a non-immunological disease, in order to understand if this level is significant during the non-immunological diseases. PATIENTS AND METHODS: In this study, 50 patients were divided in two groups according to different specific illness: 25 patients with unstable angina (UA) and 25 with acute myocardial infarction (AMI) with and without metabolic syndrome associated. Plasmatic CRP measurement was made for every patient, following an immunoturbidimetric high affinity technique performed in a RX Daytona clinical chemistry analyzer by Randox. Statistical comparison of the serum CRP level between groups was done using a Student's t-test. An ANOVA test was used to value cardiovascular risk factors associated with the serum CRP level. A p < 0.05 was considered to be significant. RESULTS: To each illness, patients were classified into five subgroups, based on their plasmatic CRP level: 0.014 to 3.9 mg/L, 4 to 7.9 mg/L, 8.0 to 11.9 mg/L, 12 to 14.9 mg/L, and higher than 15 mg/L. Patients with UA were 16 (64%), 2 (8%), 0 (0%), 5 (20%), and 2 (8%), respectively. And patients with AMI were 15 (60%), 3 (12%), 4 (16%), 3 (12%), and 0 (0%), respectively. Statistical tests performed did not have significant difference. CONCLUSIONS: We have proved that the serum CRP level, determined by a high-sensitivity CRP assay, can be useful in early detection of inflammatory processes in immunological and non-immunological diseases.