Coccidioidomycosis mimicking testicular cancer: A case report.

We present the case of a 48 year-old man with a history of pulmonary tuberculosis who was brought to our centre with a progressively increasing left testicular mass. Radiological findings were not conclusive on whether the mass was neoplastic or infectious in nature. Therefore, an orchiectomy was performed. Pathology examination revealed coccidioidomycosis of the left testicle, highlighting an exceedingly rare presentation of disseminated genitourinary coccidioidomycosis.

Calcium and mitochondrial metabolism in ceramide-induced cardiomyocyte death.

Ceramides are important intermediates in the biosynthesis and degradation of sphingolipids that regulate numerous cellular processes, including cell cycle progression, cell growth, differentiation and death. In cardiomyocytes, ceramides induce apoptosis by decreasing mitochondrial membrane potential and promoting cytochrome-c release. Ca(2+) overload is a common feature of all types of cell death. The aim of this study was to determine the effect of ceramides on cytoplasmic Ca(2+) levels, mitochondrial function and cardiomyocyte death. Our data show that C2-ceramide induces apoptosis and necrosis in cultured cardiomyocytes by a mechanism involving increased Ca(2+) influx, mitochondrial network fragmentation and loss of the mitochondrial Ca(2+) buffer capacity. These biochemical events increase cytosolic Ca(2+) levels and trigger cardiomyocyte death via the activation of calpains.

Intravenous lidocaine decreases tumor necrosis factor alpha expression both locally and systemically in pigs undergoing lung resection surgery.

BACKGROUND: Lung resection surgery is associated with an inflammatory reaction. The use of 1-lung ventilation (OLV) seems to increase the likelihood of this reaction. Different prophylactic and therapeutic measures have been investigated to prevent lung injury secondary to OLV. Lidocaine, a commonly used local anesthetic drug, has antiinflammatory activity. Our main goal in this study was to investigate the effect of IV lidocaine on tumor necrosis factor α (TNF-α) lung expression during lung resection surgery with OLV. METHODS: Eighteen pigs underwent left caudal lobectomy. The animals were divided into 3 groups: control, lidocaine, and sham. All animals received general anesthesia. In addition, animals in the lidocaine group received a continuous IV infusion of lidocaine during surgery (1.5 mg/kg/h). Animals in the sham group only underwent thoracotomy. Samples of bronchoalveolar lavage (BAL) fluid and plasma were collected before initiation of OLV, at the end of OLV, at the end of surgery, and 24 hours after surgery. Lung biopsy specimens were collected from the left caudal lobe (baseline) before surgery and from the mediastinal lobe and the left cranial lobe 24 hours after surgery. Samples were flash-frozen and stored to measure levels of the following inflammatory markers: interleukin (IL) 1ß, IL-2, IL-10, TNF-α, nuclear factor κB, monocyte chemoattractant protein-1, inducible nitric oxide synthase, and endothelial nitric oxide synthase. Markers of apoptosis (caspase 3, caspase 9, Bad, Bax, and Bcl-2) were also measured. In addition, levels of metalloproteinases and nitric oxide metabolites were determined in BAL fluid and in plasma samples. A nonparametric test was used to examine statistical significance. RESULTS: OLV caused lung damage with increased TNF-α expression in BAL, plasma, and lung samples. Other inflammatory (IL-1ß, nuclear factor κB, monocyte chemoattractant protein-1) and apoptosis (caspase 3, caspase 9, and BAX) markers were also increased. With the use of IV lidocaine there was a significant decrease in the levels of TNF-α in the same samples compared with the control group. Lidocaine administration also reduced the inflammatory and apoptotic changes observed in the control group. Hemodynamic values, blood gas values, and airway pressure were similar in all groups. CONCLUSIONS: Our results suggest that lidocaine can prevent OLV-induced lung injury through reduced expression of proinflammatory cytokines and lung apoptosis. Administration of lidocaine may help to prevent lung injury during lung surgery with OLV.

Mandibular Myxoid Liposarcoma: a Case Study.

Liposarcomas are described as soft tissue sarcomas derived from adipose tissue. The finding of this tumor in the mandibular region is exceedingly rare. As of now, it has been described mainly in case reports and small series. A multidisciplinary approach is required to offer optimal treatment and may involve surgery, radiation and systemic therapies. Surgical repair of these defects represents a major challenge in oral and maxillofacial reconstructive surgery. We present the case of a 54-year-old man referred to our center with a progressively increasing mass in the anterior portion of the mandible. Biopsy revealed a well-differentiated myxoid liposarcoma. Resection of the tumor was performed with an additional primary reconstruction.

Post-intubation double tracheal stenosis.

Post-intubation tracheal stenosis is a condition that can occur as a consequence of tracheostomy or prolonged intubation. The development of two levels of airway narrowing is rare. We present the case of a 43-year-old male with a history of prolonged mechanical ventilation, who presented to our center with progressive respiratory impairment. Computed tomography with three-dimensional reconstruction demonstrated complex tracheal anatomy with double-level stenosis. The patient underwent successful endoscopic procedure. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-022-01426-y.

Massive hemoptysis as a complication of pulmonary actinomycosis: a case report.

Massive hemoptysis is a rare life-threatening complication of pulmonary actinomycosis that should be treated promptly due to the risk of asphyxiation and hemodynamic instability. We present the case of a 57-year-old female who was presented to our center with massive hemoptysis. Thoracic computed tomography scan revealed a cavitated lesion with perilesional ground-glass opacity. Right lower lobectomy was then performed using uniportal video-assisted thoracic surgery, excising a 13 × 12 × 8 cm cavitated lung fragment. The pathology service reported the presence of microscopical evidence of filamentous gram positive bacterial colonies, showing compatible features of pulmonary actinomycosis. The patient was discharged with oral penicillin with an uneventful post-operative course.

La hemoptisis masiva es una complicación poco frecuente de la actinomicosis pulmonar que pone en peligro la vida del paciente y que debe ser tratada con prontitud debido al riesgo de asfixia e inestabilidad hemodinámica. Presentamos una mujer de 57 años que acudió a nuestro centro con hemoptisis masiva. La tomografía reveló una cavitación con opacidad perilesional en vidrio deslustrado. Realizamos lobectomía mediante cirugía uniportal, extirpando un fragmento de lesión. Patología informó de la presencia de colonias bacterianas filamentosas grampositivas, mostrando características compatibles con actinomicosis pulmonar. El paciente fue dado de alta con penicilina oral, con un curso postoperatorio sin incidentes.

Surgical activation protocol COVID-19 (SAP COVID).

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak have major implications in conventional surgical practice. As the number of patients with this diagnosis is rising, the infection risk for the surgical staff will be higher. Few publications have addressed the surgical management of patients diagnosed with COVID-19. OBJECTIVE: To assess recommendations for care of patients and surgical team during the COVID-19 pandemic. METHOD: MEDLINE, Embase and the Cochrane Database of Systematic Reviews (April 2020) were searched the key words "COVID-19", "PROTOCOL" and "SURGERY". Relevant recommendations, guidelines and cases series were checked for the most accurate information for apply to our center. RESULTS: We found 379 papers that included the key words. A total of 25 papers were included in the manuscript based in the pertinence of the recommendations. Three major topics were selected: perioperative, intraoperative and postoperative. CONCLUSION: As an attempt to regulate the surgical team approach, we present recommendations to preserve patients and surgical staff safety with high quality standards of care through reproducible strategies applicable in most hospital centers.

ANTECEDENTES: La pandemia de COVID-19 ha tenido un gran impacto en la práctica quirúrgica convencional. Conforme el número de pacientes diagnosticados con esta enfermedad vaya en aumento, el riesgo de contagio para el equipo quirúrgico será mayor. Pocas publicaciones han abordado el manejo del paciente diagnosticado con COVID-19 dentro del quirófano. OBJETIVO: Evaluar las recomendaciones para el cuidado de pacientes y del equipo quirúrgico durante la pandemia de COVID-19. MÉTODO: La búsqueda bibliográfica principal utilizó las bases de datos MEDLINE, Embase y Cochrane, utilizando las palabras clave "COVID-19", "PROTOCOL" y "SURGERY". Se verificaron recomendaciones, guías y series de casos relevantes para obtener la información más precisa y aplicable. RESULTADOS: Se hizo la revisión de 379 artículos que contenían las palabras clave. Se incluyeron 25 artículos basándose en la pertinencia de las recomendaciones. Los tres temas principales seleccionados fueron las fases preoperatoria, transoperatoria y posoperatoria. CONCLUSIÓN: En un esfuerzo por tratar de normar el manejo quirúrgico, presentamos recomendaciones para preservar la seguridad del paciente y del equipo quirúrgico con estándares de alta calidad, mediante estrategias reproducibles en la mayoría de los centros hospitalarios.

The effect of acoustically-induced cavitation on the permeance of a bullfrog urinary bladder.

It is well known that ultrasound enhances drug delivery to tissues, although there is not a general consensus about the responsible mechanisms. However, it is known that the most important factor associated with ultrasonically-enhanced drug permeance through tissues is cavitation. Here we report results from research conducted using a experimental approach adapted from single bubble sonoluminescence experiments which generates very well defined acoustic fields and allows controlled activation and location of cavitation. The experimental design requires that a biological tissue be immersed inside a highly degassed liquid media to avoid random bubble nucleation. Therefore, live frog bladders were used as the living tissue due to their high resistance to hypoxia. Tissue membrane permeance was measured using radiolabeled urea. The results show that an increase in tissue permeance only occurs when cavitation is present near the tissue membrane. Moreover, confocal microscopy shows a direct correlation between permeance increases and physical damage to the tissue.

Changes in mitochondrial dynamics during ceramide-induced cardiomyocyte early apoptosis.

AIMS: In cells, mitochondria are organized as a network of interconnected organelles that fluctuate between fission and fusion events (mitochondrial dynamics). This process is associated with cell death. We investigated whether activation of apoptosis with ceramides affects mitochondrial dynamics and promotes mitochondrial fission in cardiomyocytes. METHODS AND RESULTS: Neonatal rat cardiomyocytes were incubated with C(2)-ceramide or the inactive analog dihydro-C(2)-ceramide for up to 6 h. Three-dimensional images of cells loaded with mitotracker green were obtained by confocal microscopy. Dynamin-related protein-1 (Drp-1) and mitochondrial fission protein 1 (Fis1) distribution and levels were studied by immunofluorescence and western blot. Mitochondrial membrane potential (DeltaPsi(m)) and cytochrome c (cyt c) distribution were used as indexes of early activation of apoptosis. Cell viability and DNA fragmentation were determined by propidium iodide staining/flow cytometry, whereas cytotoxicity was evaluated by lactic dehydrogenase activity. To decrease the levels of the mitochondrial fusion protein mitofusin 2, we used an antisense adenovirus (AsMfn2). C(2)-ceramide, but not dihydro-C(2)-ceramide, promoted rapid fragmentation of the mitochondrial network in a concentration- and time-dependent manner. C(2)-ceramide also increased mitochondrial Drp-1 and Fis1 content, Drp-1 colocalization with Fis1, and caused early activation of apoptosis. AsMfn2 accentuated the decrease in DeltaPsi(m) and cyt c redistribution induced by C(2)-ceramide. Doxorubicin, which induces cardiomyopathy and apoptosis through ceramide generation, also stimulated mitochondrial fragmentation. CONCLUSION: Ceramides stimulate mitochondrial fission and this event is associated with early activation of cardiomyocyte apoptosis.

Effect of carbon nanohorns in the radical polymerization of methacrylate monolithic capillary columns and their application as extractant phases.

A successful copolymerization of the single-walled carbon nanohorns (SWNHs) with methacrylate monomers was achieved via thermal initiated free-radical polymerization because of the high reactivity of the SWNHs in comparison with other carbon nanostructures. The hybrid solids were deeply characterized in terms of morphology, by scanning electron microscopy (SEM). The effect of the incorporation of the bare or oxidized (o-SWNHs) carbon nanoparticles at different percentages (0-0.5 wt%) in polymerization mixtures to obtain hybrid monolithic capillary columns has been evaluated. In addition, their impact both in the polymerization step and in the extraction capacity was deeply studied. Final hybrid monoliths were applied for the extraction of polycyclic aromatic hydrocarbons and nonsteroidal anti-inflammatory drugs in water and biological samples, respectively. The precision was calculated both intra- and inter-capillaries obtaining satisfactory RSD values of less than 19.1%, which indicated the high robust reproducibility of the extraction procedure and the synthesis method. The accuracy of the method was also evaluated through a recovery study giving good recovery values, which varied between 78% and 112% for PAHs in waters, and 90-114% for NSAIDs in human urine samples.

[The effect of anesthetic preconditioning with sevoflurane on intracellular signal-transduction pathways and apoptosis, in a lung autotransplant experimental model]. / O efeito do pré­condicionamento anestésico com sevoflurano sobre as vias de transdução de sinal intracelular e a apoptose, em modelo experimental de autotransplante pulmonar.

BACKGROUND: Anesthetic pre-conditioning attenuates inflammatory response during ischemia-reperfusion lung injury. The molecular mechanisms to explain it are not fully understood. The aim of our investigation was to analyze the molecular mechanism that explain the anti-inflammatory effects of anesthetic pre-conditioning with sevoflurane focusing on its effects on MAPKs (mitogen-activated protein kinases), NF-κB (nuclear factor kappa beta) pathways, and apoptosis in an experimental lung autotransplant model. METHODS: Twenty large white pigs undergoing pneumonectomy plus lung autotransplant were divided into two 10-member groups on the basis of the anesthetic received (propofol or sevoflurane). Anesthetic pre-conditioning group received sevoflurane 3% after anesthesia induction and it stopped when one-lung ventilation get started. Control group did not receive sevoflurane in any moment during the whole study period. Intracellular signal-transduction pathways (MAPK family), transcription factor (NF-κB), and apoptosis (caspases 3 and 9) were analyzed during experiment. RESULTS: Pigs that received anesthetic pre-conditioning with sevoflurane have shown significant lower values of MAPK-p38, MAPK-P-p38, JNK (c-Jun N-terminal kinases), NF-κB p50 intranuclear, and caspases (p<0.05) than pigs anesthetized with intravenous propofol. CONCLUSIONS: Lung protection of anesthetic pre-conditioning with sevoflurane during experimental lung autotransplant is, at least, partially associated with MAPKs and NF κB pathways attenuation, and antiapoptotic effects.

Ceramide-induced formation of ROS and ATP depletion trigger necrosis in lymphoid cells.

In lymphocytes, Fas activation leads to both apoptosis and necrosis, whereby the latter form of cell death is linked to delayed production of endogenous ceramide and is mimicked by exogenous administration of long- and short-chain ceramides. Here molecular events associated with noncanonical necrotic cell death downstream of ceramide were investigated in A20 B lymphoma and Jurkat T cells. Cell-permeable, C6-ceramide (C6), but not dihydro-C6-ceramide (DH-C6), induced necrosis in a time- and dose-dependent fashion. Rapid formation of reactive oxygen species (ROS) within 30 min of C6 addition detected by a dihydrorhodamine fluorescence assay, as well as by electron spin resonance, was accompanied by loss of mitochondrial membrane potential. The presence of N-acetylcysteine or ROS scavengers like Tiron, but not Trolox, attenuated ceramide-induced necrosis. Alternatively, adenovirus-mediated expression of catalase in A20 cells also attenuated cell necrosis but not apoptosis. Necrotic cell death observed following C6 exposure was associated with a pronounced decrease in ATP levels and Tiron significantly delayed ATP depletion in both A20 and Jurkat cells. Thus, apoptotic and necrotic death induced by ceramide in lymphocytes occurs via distinct mechanisms. Furthermore, ceramide-induced necrotic cell death is linked here to loss of mitochondrial membrane potential, production of ROS, and intracellular ATP depletion.

Osmotically-induced genes are controlled by the transcription factor TonEBP in cultured cardiomyocytes.

Changes in cardiac osmolarity occur in myocardial infarction. Osmoregulatory mechanisms may, therefore, play a crucial role in cardiomyocyte survival. Tonicity-responsive enhancer binding protein (TonEBP) is a key transcription factor participating in the adaptation of cells to increases in tonicity. However, it is unknown whether cardiac TonEBP is activated by tonicity. Hypertonicity activated transcriptional activity of TonEBP, increased the amounts of both TonEBP mRNA and protein, and induced both the mRNA and protein of TonEBP target genes (aldose reductase and heat shock protein-70). Hypotonicity decreased the amount of TonEBP protein indicating bidirectional osmoregulation of this transcription factor. Adenoviral expression of a dominant negative TonEBP suppressed the hypertonicity-dependent increase of aldose reductase protein. These results indicated that TonEBP controls osmoregulatory mechanisms in cardiomyocytes.

Oxidative stress in pericardial fluid and plasma and its association with ventricular function.

UNLABELLED: There are no studies evaluating oxidative stress markers both in pericardial fluid and plasma and whether they correlate with cardiac function indexes. The purpose of the study was to investigate whether oxidative stress markers in pericardial fluid and plasma are associated with left ventricular function. METHODS AND RESULTS: Twenty-eight consecutive patients (class I or II NYHA) scheduled for myocardial revascularization, valve replacement, valve repair or closure of atrial septal defect. Plasma and pericardial fluid were collected and malondialdehyde, catalase, superoxide dismutase and glutathione peroxidase were determined. Left ventricular ejection fraction, left ventricular end diastolic diameter and left ventricular end systolic diameter were determined as echocardiographic indexes of ventricular function. We found that oxidative stress determined by a simple malondialdehyde (MDA) assay, correlated in plasma and pericardial fluid, and this parameter was associated with left ventricular end systolic diameter. CONCLUSION: Plasma and pericardial fluid malondialdehyde levels can be used as an early marker of ventricular dysfunction.