Prospective, randomized and controlled study of mesh displacement after laparoscopic inguinal repair: fixation versus no fixation of mesh.

INTRODUCTION: Repair of inguinal hernia is one of the most common elective operations performed in general surgery practice. Mesh hernia repair became the gold standard because of its low recurrence rate in comparison with non-tension-free repair. Laparoscopic approach seems to have potential advantages over open techniques, including faster recovery and reduced acute and chronic pain rate. Laparoscopic mesh fixation is usually performed using staples, which is associated with higher cost and risk for chronic pain. Recently, the role of mesh fixation has been questioned by several surgeons. AIM: To evaluate mesh displacement in patients undergoing laparoscopic inguinal hernia repair comparing mesh fixation with no fixation. METHODS: From January 2012 to May 2014, 60 consecutive patients with unilateral inguinal hernia were randomized into two groups: control group--10 patients underwent totally extraperitoneal (TEP) repair with mesh fixation; NO FIX group-50 patients underwent TEP repair with no mesh fixation. Mesh was marked with three 3-mm surgical clips at its medial inferior, medial superior and lateral inferior corners. Mesh displacement was measured by comparing an initial X-ray, performed in the immediate postoperative period, with a second X-ray obtained 30 days later. RESULTS: The mean displacement of all three clips in control group was 0.1-0.35 cm (range 0-1.2 cm), while in NO FIX group was 0.1-0.3 cm (range 0-1.3 cm). The overall displacement of control and NO FIX group did not show any difference (p = 0.50). CONCLUSION: Fixation of the mesh for TEP repair is unnecessary. TEP repair with no mesh fixation is safe and is not associated with increased risk of mesh displacement.

Congenital diaphragmatic hernia - the neonatal period (part I).

AIM: The aim of the study was to review our experience in the management of newborns with congenital diaphragmatic hernia (CDH). METHODS: A retrospective study including all infants with CDH at the Hospital de São João, a center that does not provide ECMO support, for the period from 1997 to 2006. Since 2003, a new treatment protocol has been used. RESULTS: There were 61 newborns (30 male/31 female) with a birth weight of 2800 g (880 - 3770), and a gestational age of 38 weeks (28 - 41); 46 (75 %) were inborn and 42 (69 %) had a prenatal diagnosis of CDH. There were 2 (3 %) chromosomal anomalies, 3 (5 %) with other congenital anomalies and 1 (2 %) with nonimmune hydrops fetalis. The diaphragmatic defect was left sided in 55 (90 %) cases. Corrective surgery was performed in 43 (70 %) patients. New therapies were used: HFOV 13 % (n = 8); inhaled nitric oxide 13 % (n = 8); and sildenafil 7 % (n = 4). We found that systemic arterial hypotension (p = 0.001), the severity of pulmonary hypertension (p = 0.001), prenatal diagnosis (p = 0.006), birth weight (p = 0.022), female gender (p = 0.029), inborn birth (p = 0.030), arterial pH < 7.35 at admission (p = 0.030), right-sided defect (p = 0.033) and pneumothorax (p = 0.033) to be predictive of mortality. The overall survival rate was 43 % (n = 26), and since 2003 this rate has improved to 61 % for term neonates without other congenital or chromosomal anomalies. CONCLUSIONS: Our survival rate for infants with CDH has improved over the last ten years, and this improvement is associated with the use of new therapies such as HFOV, inhaled nitric oxide and sildenafil.

Congenital Diaphragmatic Hernia. The Post-neonatal period. Part II.

AIM: The aim of the study was to review our experience in the management of newborns with congenital diaphragmatic hernia (CDH). METHODS: A retrospective study including all infants with CDH at the Hospital de São João, a center that does not provide ECMO support, for the period from 1997 to 2006. Since 2003, a new treatment protocol has been used. RESULTS: There were 61 newborns (30 male/31 female) with a birth weight of 2800 g (880 - 3770), and a gestational age of 38 weeks (28 - 41); 46 (75 %) were inborn and 42 (69 %) had a prenatal diagnosis of CDH. There were 2 (3 %) chromosomal anomalies, 3 (5 %) with other congenital anomalies and 1 (2 %) with nonimmune hydrops fetalis. The diaphragmatic defect was left sided in 55 (90 %) cases. Corrective surgery was performed in 43 (70 %) patients. New therapies were used: HFOV 13 % (n = 8); inhaled nitric oxide 13 % (n = 8); and sildenafil 7 % (n = 4). We found that systemic arterial hypotension (p = 0.001), the severity of pulmonary hypertension (p = 0.001), prenatal diagnosis (p = 0.006), birth weight (p = 0.022), female gender (p = 0.029), inborn birth (p = 0.030), arterial pH < 7.35 at admission (p = 0.030), right-sided defect (p = 0.033) and pneumothorax (p = 0.033) to be predictive of mortality. The overall survival rate was 43 % (n = 26), and since 2003 this rate has improved to 61 % for term neonates without other congenital or chromosomal anomalies. CONCLUSIONS: Our survival rate for infants with CDH has improved over the last ten years, and this improvement is associated with the use of new therapies such as HFOV, inhaled nitric oxide and sildenafil.

A hot water supply as the source of Legionella pneumophila in incubators of a neonatology unit.

The humidification trays of five of seven incubators in a neonatology unit of a hospital were found to be colonized with Legionella pneumophila, serogroup 1. Bacteriological analysis of the water in the humidification trays showed very large numbers of heterotrophic bacteria, one of which also contained Pseudomonas aeruginosa. Two hot water systems supply the neonatology unit, either of which is used to add water to the humidification trays; one system (A) is maintained at about 60 degrees C, while the other system (B) is maintained at 45 degrees C. The latter was also found to be colonized with L. pneumophila, Sg1. Monoclonal antibody (Mab) subgrouping of the isolates, indicated that system B was the source of colonization of the humidification trays of the incubators.

The role of cachectin/TNF in the pathogenesis of tuberculosis.

The presence of cachectin or tumor necrosis factor (TNF) associated with hypertriglyceridemia was demonstrated in the serum of patients with pulmonary tuberculosis. The hyperlipidemia that accompanies this infection may be mediated by the TNF inhibition of lipoprotein lipase activity. This sequence of events may be sufficient to explain, in part, the complex metabolic changes and emaciation observed in tuberculosis patients.

Recurrent meningitis in a case of congenital anterior sacral meningocele and agenesis of sacral and coccygeal vertebrae.

A rare case of recurrent meningitis due to congenital anterior sacral meningocele and agenesis of the sacral and coccygeal vertebrae is described. An autosomal dominant inheritance is demonstrated for lower cord malformation, and environmental factors (chromic acid or fumes) are discussed.

[Preventive practices of the residents over 25 years of age in Monterrey and its metropolitan area (Mexico)]. / Prácticas preventivas de los habitantes mayores de 25 años en Monterrey y su zona metropolitana (México).

BACKGROUND: Chronic and degenerative disorders are the leading causes of morbidity-mortality in Mexico, as a result of which the Health Sector has implemented preventive and suitable detection measures. The use of the health services is a dynamic behavior on the part of the population. In order for people to use these preventive measures, the barriers to accessing these services must be lessened. Hence, the objective of this study was that of ascertaining the use of the services for the detection of diabetes mellitus, high blood pressure, cervical-uterine and breast cancer and tetanus and diphtheria toxoide vaccinations. METHODS: The sample size was that of 254 individuals age 25 and over living in Monterrey or in the greater Monterrey metropolitan area. Those having employed preventive measures during the year immediately prior to the study were taken into account with regard to the use of preventive measures. The analysis consisted of descriptive statistics and bivariate analysis. RESULTS: Over 60% of the population was female, the average age being 42.3 + 14 years of age, three fourths of the population being on the social security rolls. A total 37% mentioned having undergone the diabetes test, and 44.5 the test for high blood pressure, while 31.1% had been vaccinated with the tetanus and diphtheria toxoide. Regarding specifically female checkups, 34.3% of all females had undergone the corresponding cervical-uterine cancer test, 29.5% having been screened for breast cancer. No relationship was found to exist between the use of measures and family histories and the perception of the importance of the checks. CONCLUSIONS: The use of preventive measures fall below some international standards. Individuals exposed to the risk must be sought in order to fittingly detect any chronic disorder.

Estimação de valores genéticos para codornas europeias em função dos níveis da relação treonina: lisina da dieta: do nascimento aos 21 dias de idade / Estimation of breeding values for European quails in function of threonine: lysine ratios of diet: from birth to 21 days of age

O presente trabalho foi realizado com o objetivo de avaliar a sensibilidade dos valores genéticos dos pesos corporais e as características de carcaças de codornas europeias às mudanças do gradiente ambiental (níveis da relação treonina com a lisina das dietas), do nascimento aos 21 dias de idade, por meio de modelos de regressão aleatória com diferentes classes de variância residual. Os dados utilizados neste estudo são provenientes de 915 codornas de corte da linhagem LF1 e 839 da linhagem LF2, pertencentes ao Programa de Melhoramento Genético da Universidade Federal dos Vales do Jequitinhonha e Mucuri. Foram avaliados os pesos corporais e os rendimentos da carcaça das aves. As sensibilidades dos valores genéticos às mudanças nos níveis da relação treonina:lisina (interação genótipo x ambiente) foram obtidas por modelos de regressão aleatória (utilizando normas de reação) por meio do programa Wombat, que utiliza o princípio da máxima verossimilhança restrita (REML). O modelo de regressão aleatória que considerou duas classes de variância residual foi o mais indicado para a maioria das análises realizadas. Verificaram-se alterações na classificação dos valores genéticos para as duas linhagens de codornas de corte estudadas. Esse comportamento indica sensibilidade de valores genéticos aditivos às mudanças nutricionais, o que caracteriza a existência de interação genótipo x ambiente. A predição dos valores genéticos deve ser feita com o mesmo nível da relação treonina:lisina da dieta com a qual as codornas serão alimentadas no sistema de produção.(AU)

This research was carried out to evaluate the sensitivity of breeding values of body weight and carcass traits in two lines of European quails (LF1 and LF2) to changes in the environment gradient (levels of threonine: lysine ratio of diets) from hatch to 21 days of age in two lines LF1 and LF2 using Random Regression Models with different classes of residual variance. Records are from 915 quails of line LF1 and 839 of line LF2 belonging to the Breeding Improvement Program of Universidade Federal dos Vales do Jequitinhonha e Mucuri. Live body weight and weights and yields of carcass, breast, and thigh and drumstick were measured. The sensitivities of breeding values to changes in threonine: lysine ratios (genotype x environment interaction) of diets were obtained by random regression models (reaction model) using the WOMBAT program using the Restricted Maximum Likelihood principle. Model considering two classes of residual variance showed the best goodness of fit. The Reaction Norms analyses indicated changes in the ranking of breeding values for both lines suggesting quails selected in one level of threonine: lysine ratio will not express all their genetic potential if fed different threonine: lysine ratio diets. This behavior indicates sensitivity of breeding values to changes in the nutrition characterizing the genotype by environment interaction. The prediction of breeding values must be performed using the same level of threonine: lysine ratio in diet the quails will be fed in the production system.(AU)

Lisina digestível na ração de frangos de corte tipo caipira na fase de crescimento / Dietary digestible lysine in free-range broiler chickens during the growth phase

O presente experimento foi conduzido para determinar as exigências de lisina digestível para frangos de corte (linhagem Redbro), machos e fêmeas, durante o período de crescimento. Foram utilizados 630 frangos, alojados em 30 boxes com acesso à área de pastejo. O delineamento experimental utilizado foi o inteiramente ao acaso, em esquema fatorial 5x2 (lisina e sexo), e três repetições com 21 aves cada. Os níveis de lisina digestível avaliados foram: 7,07; 8,07; 9,07; 10,07 e 11,07g/kg. Avaliou-se o consumo de lisina, o consumo de ração, o ganho de peso e a conversão alimentar. Observou-se efeito de interação (P<0,05) entre os níveis de lisina e sexo para o ganho de peso. Houve efeito (P<0,01) dos níveis de lisina sobre o consumo de lisina, o ganho de peso e a conversão alimentar. Verificou-se que todas as variáveis foram influenciadas (P<0,05) pelo sexo dos frangos. Recomendam-se 10,08 e 9,49g de lisina digestível/kg de ração, correspondendo ao consumo estimado de 21 e 20g de lisina, para machos e fêmeas, respectivamente, para melhor ganho de peso das aves. Para melhor conversão alimentar, recomendam-se 9,61g de lisina digestível/kg, para frangos de ambos os sexos, correspondendo ao consumo estimado de 20g de lisina.(AU)

This experiment was conducted to determine the requirements of digestible lysine in male and female free-range broiler chickens (Redbro lineage) during the growth phase. Six hundred and thirty broiler chickens were allocated in 30 pens with access to the pasture area. The experimental design was completely randomized in a 5x2 (lysine and gender) factorial arrangement with 3 repetitions with 21 chickens each. The levels of digestible lysine evaluated were: 7.07, 8.07, 9.07, 10.07 and 11.07g/kg. The performance traits evaluated were lysine intake, feed intake, weight gain and feed conversion ratio. An interaction effect (P<0.05) was observed between dietary lysine level and gender for body weight gain. There was an effect (P<0.01) of the levels of lysine on lysine intake, body weight gain and feed conversion ratio. It was found that all the variables were affected (P<0.05) for the gender of chickens. We recommended 10.08 and 9.49 g of digestible lysine/kg diet, corresponding to the estimated intake of 21 and 20g of lysine, for males and females, respectively, for better body weight gain of chickens. For better feed conversion ratio, the recommendation is of 9.61 g of lysine/kg of diets, for chickens of both genders, corresponding to the estimated intake of 20g of lysine.(AU)

Enantioselective analysis of praziquantel in plasma samples.

A direct enantioselective high-performance liquid chromatography method is described for the quantitative determination of praziquantel enantiomers in plasma samples. The method involves two-step extraction of plasma with toluene, evaporation of the solvent and chromatography on a Chiralcel OD-H column using hexane-ethanol (85:15, v/v) as the mobile phase and detection at 220 nm. The assay satisfies all of the criteria required for use in clinical pharmacokinetic studies.

Cell cycle delay and apoptosis in response to osmotic stress.

As part of the urinary concentrating mechanism, renal inner medulla cells may be exposed to extremely variable NaCl and urea concentrations that can reach very high levels. A number of studies, reviewed herein, aim to understand how such osmotic stress affects the cells and what protective mechanisms might exist. The majority of these studies are done on inner medullary epithelial cells that grow continuously in tissue culture (mIMCD3). Cells grown at 300 mosmol/kg survive increase to 500 mosmol/kg by adding NaCl or urea, but only after a growth arrest of approximately 24 h. At a higher osmolality (650-700 mosmol/kg) most cells die within hours by apoptosis. The cells both in vitro and in vivo adapt to high osmolality by a number of mechanisms, including accumulation of variety of organic osmolytes and induction of heat shock proteins. The cell cycle delay results from blocks at the G1 and G2/M checkpoints and slowing during S. After adding NaCl, but not urea, the amount and transcriptional activity of p53 (the tumor suppressor protein) increases. The p53 is phosphorylated on ser-15 and is transcriptionally active at 500 mosmol/kg (associated with cell survival), but not at 700 mosmol/kg (associated with apoptosis). Reduction of p53 expression by p53 antisense oligonucleotide increases sensitivity of renal cells in culture to hyperosmotic stress caused by NaCl. The possible mechanisms of the protection action of p53 against hypertonic stress are discussed.

IL-5 drives eosinophils from bone marrow to blood and tissues in a guinea-pig model of visceral larva migrans syndrome.

This study was undertaken to evaluate the role of IL-5 in eosinophil migration and in the maintenance of eosinophilia in a guinea-pig model of visceral larva migrans syndrome. The results show that the infection of animals with Toxocara canis induced an early increase in serum IL-5 levels that might be essential for eosinophil differentiation and proliferation and for the development of eosinophilia. When infected guinea-pigs were treated with mAb anti-IL-5 (TRFK-5) given at the same time or 1 or 3 days after infection, there was a high percentage of reduction of eosinophil counts 18 days after infection. However, when the mAb was administered during the peak of eosinophilia, there was high inhibition in blood, no inhibition in bronchoalveolar lavage fluid (BALF) or peritoneum and an increase in eosinophil numbers in bone marrow. Thus, a basic level of IL-5 may be essential to drive eosinophils from bone marrow to blood and tissues, and for the maintenance of eosinophilia in infected animals. We may also conclude that when eosinophils have already migrated to the lungs, TRFK-5 has no power to inhibit eosinophilia, which is also under control of local lung cells producing IL-5. In this way, only one later TRFK-5 treatment may not be sufficient to modify the lung parenchyma microenvironment, since T. canis antigens had already stimulated some cell populations to produce IL-5.

Direct toxicity of nonsteroidal antiinflammatory drugs for renal medullary cells.

Antipyretic analgesics, taken in large doses over a prolonged period, cause a specific form of kidney disease, characterized by papillary necrosis and interstitial scarring. Epidemiological evidence incriminated mixtures of drugs including aspirin (ASA), phenacetin, and caffeine. The mechanism of toxicity is unclear. We tested the effects of ASA, acetaminophen (APAF, the active metabolite of phenacetin), caffeine, and other related drugs individually and in combination on mouse inner medullary collecting duct cells (mIMCD3). The number of rapidly proliferating cells was reduced by approximately 50% by 0.5 mM ASA, salicylic acid, or APAF. The drugs had less effect on confluent cells, which proliferate slowly. Thus, the slow in vivo turnover of IMCD cells could explain why clinical toxicity requires very high doses of these drugs over a very long period. Caffeine greatly potentiated the effect of acetaminophen, pointing to a potential danger of the mixture. Cyclooxygenase (COX) inhibitors, indomethacin and NS-398, did not reduce cell number except at concentrations greatly in excess of those that inhibit COX. Therefore, COX inhibition alone is not toxic. APAF arrests most cells in late G(1) and S and produces a mixed form of cell death with both oncosis (swollen cells and nuclei) and apoptosis. APAF is known to inhibit the synthesis of DNA and cause chromosomal aberrations due to inhibition of ribonucleotide reductase. Such effects of APAF might account for renal medullary cell death in vivo and development of uroepithelial tumors from surviving cells that have chromosomal aberrations.