Intradialytic periodized exercise improves cardiopulmonary fitness and respiratory function: A randomized controlled trial.

BACKGROUND: Chronic kidney disease (CKD) is a factor that predisposes to gradual physical deconditioning from its early stages leading to cardiorespiratory fitness and musculoskeletal system impairment. We evaluated the effects of combined and periodized intradialytic exercise training on cardiopulmonary fitness and respiratory function in HD subjects. METHODS: A randomized controlled trial with HD subjects was allocated into two groups: exercise group (EXG) and usual care group (UCG). EXG performed a 12-week combined and periodized intradialytic training. UCG maintained the HD routine. RESULTS: Thirty-nine HD subjects were analyzed (EXG = 20; UCG = 19). The EXG in comparison with the UCG showed improvements in peak oxygen consumption (Δ3.1[0.4-5.5] vs. -0.2[-2.0-1.5] ml/kg/min; p = 0.003), forced expiratory volume in the first second (Δ0.1[-0.0-0.1] vs. -0.0[-0.1-0.0] L; p = 0.022), forced vital capacity (Δ0.1[0.0-0.2] vs. -0.1[-0.2-0.0] L; p = 0.005), peak expiratory flow (Δ0.4[-0.7-1.2] vs. -0.1[-0.5-0.2] L; p = 0.046), and maximal inspiratory pressure (Δ7.35[-8.5-17.5] vs. -4.0[-18.0-12.0] cmH2 O; p = 0.028). The EXG, different from the UCG, did not worsen the maximal expiratory pressure (Δ0.1[-8.8-7.5] vs. -2.5[-15.0-9.0] cmH2 O; p = 0.036). Besides, EXG showed a significant improvement in quadriceps strength (32.05 ± 10.61 vs. 33.35 ± 11.62 kg; p = 0.042). CONCLUSIONS: The combined and periodized intradialytic exercise training improved cardiopulmonary fitness, respiratory function, inspiratory muscle strength, and quadriceps strength, beyond maintaining the expiratory muscle strength in HD subjects.

Whole or coarsely broken açai seed as a source of roughage in the diet of feedlot cattle: intake, digestibility, and ruminal parameters.

This study was conducted to evaluate the effects of two methods of provision of açai seed (AS) as a fiber source (coarsely broken or whole) for feedlot beef cattle on the intake, digestibility, and ruminal parameters. Four bulls (male, non-castrated, and rumen fistulated), with an average body weight of 340 ± 31 kg, distributed in two simultaneous 2 × 2 Latin squares, were used. The treatments were two methods of processing of the açai seed, as follows: whole açai seed (WAS), and coarsely broken açai seed (CBAS). The dry matter (DM), crude protein (CP), and neutral detergent fiber (NDF) intake were higher (P < 0.10) with the use of CBAS. The digestibility of DM and nutrients was not affected (P > 0.10) by AS processing. Acetate and total volatile fatty acids concentrations, and acetate:propionate ratio were higher with the CBAS diet, whereas the pH was higher with the WAS diet. The concentrations of propionate, butyrate, and ruminal ammonia nitrogen (NH3) did not change with AS processing. Thus, coarsely broken açai seed increases the intake of DM and nutrients without altering the digestibility. Furthermore, it increases the concentrations of total fatty acids and acetate.

High occurrence of Calodium hepaticum (syn. Capillaria hepatica) spurious infection in a village in the Atlantic Forest of southern Brazil.

Calodium hepaticum (syn. Capillaria hepatica) is a nematode of the Capillariidae family that infects rodents and other mammals. In Brazil, human spurious infections of C. hepaticum have been detected in indigenous or rural communities from the Amazon Basin, but not in the southern states of the country. Here, we report the highest occurrence (13.5% of 37 residents) of C. hepaticum human spurious infection detected in Brazil and the first record in a southern region, Guaraqueçaba. The finding is explained by the area being located in the Atlantic Forest of the state of Paraná, surrounded by preserved forests and because the inhabitants consume the meat of wild mammals.

Parasitic Granulomatous Dermatitis Caused by Pelodera spp. in Buffalo on Marajó Island, Pará.

This is the first report of parasitic granulomatous dermatitis caused by Pelodera spp. in a buffalo. The affected buffalo was about seven years old, was a female of the Murrah breed and belonged to a property located on Marajó Island in the State of Pará. During the clinical examination, the animal was in a standing position and presented several multifocal nodular and placoid masses throughout the body, mostly on the forelimbs, hindlimbs, abdomen, mammary glands, perineum, vulva and tail. These masses were also observed on the nasal mucosa, head, neck, back and chest. On macroscopic examination, the skin had several multifocal-to-coalescent sessile nodular and placoid lesions. Histopathology of the skin showed a marked reduction in the number of hair follicles. In the superficial dermis, there was significant multifocal-to-coalescent inflammatory infiltration, consisting of macrophages, epithelioid macrophages, lymphocytes, plasma cells and multinucleated giant cells. In the remaining hair follicles, there were numerous cross and longitudinal sections of small rhabditoid nematodes characterized by a thin cuticle, platymyarian musculature, an intestinal tract, a rhabditiform esophagus and lateral alae (morphologically compatible with Pelodera spp.). The diagnosis of parasitic dermatitis was confirmed by histopathological skin lesions associated with the presence of intralesional rhabditiform larvae morphologically compatible with Pelodera spp.

Description of the Dunning-Kruger effect in general surgery residents during laparoscopic cholecystectomy: a blinded prospective study.

PURPOSE: The purpose of this study is to assess whether the Dunning-Kruger effect occurs in surgical residents when performing laparoscopic cholecystectomy in a porcine model. METHODS: Prospective blinded study, which counted with forty PGY-1 general surgery residents who agreed to participate in the study were blindly recruited to perform a laparoscopic cholecystectomy in a porcine model. At the end of the procedure, the participants assigned a score of 0-10 for their own performance and the video of the operation was independently assessed by 2 experienced laparoscopic surgeons using a validated tool. RESULTS: Participants were divided into groups of 10 individuals according to objective performance and compared. The group with the worst objective result was inferior to the group with the best objective result (3.77 ± 0.44 vs. 8.1 ± 0.44, p < 0.001), but they were similar in self-perception of performance (5.11 ± 1.69 vs. 6.1 ± 1.79, p = 0.999). CONCLUSIONS: In the studied sample, it was possible to demonstrate the presence of the Dunning-Kruger effect.

The Risk Factors of Dewclaw Dermatitis in Beef Cattle in the Amazon Biome.

Bovine Dewclaw Dermatitis (BDCD) is a hoof disease characterized by inflammation of the second and fifth accessory digits and the skin in this region. This pathology is poorly described in the literature; however, it has recently been observed in beef cattle in the Amazon Biome, Brazil. The objective of this study was to perform a clinical diagnosis and identify the risk factors associated with BDCD onset in cattle in the studied biome. Samples were collected from eight farms with extensive breeding systems located in Xinguara, Rondon do Pará, Curionópolis, and Ipixuna do Pará in the state of Pará, Brazil. A total of 706 Nellore and Nellore crossbred with taurine bovine of both sexes were evaluated, with males aged between 2 and 4 years and a mean weight of 650 kg, and females aged between 2 and 11 years and a mean weight of 400 kg. Distal extremities were inspected during cattle management, and in cases of dewclaw lesions, a specific examination was carried out after proper restraint. Cattle were diagnosed with BDCD on all farms analyzed. Of the 706 cattle inspected, 49 (6.94%) showed BDCD, of which 19 (38.77%) were Nellore and 30 (61.22%) were crossbred. This was the first study to determine BDCD's occurrence in extensive farming systems in the Amazon region, also showing that pastures with large amounts of stumps and stones, the physical structure of pens, and trauma and injury incidence during animal management are the most important predisposing factors for the onset of BDCD.

Allergic Dermatitis in Pêga Breed Donkeys (Equus asinus) Caused by Culicoides Bites in the Amazon Biome, Pará, Brazil.

An allergy to bites from Culicoides (Diptera: Ceratopogonidae) occurs because of a hypersensitivity reaction caused by the inoculation of insect salivary antigens during the bite, resulting in immune-mediated dermatitis. To the best of our knowledge, no previous studies have focused on allergic dermatitis in donkeys in Brazil. Therefore, this study aimed to describe the epidemiological, clinicopathological, and therapeutic aspects of allergic dermatitis in donkeys and to identify the insects involved in its epidemiology. This study reported the occurrence of dermatitis in 17 animals. The clinical signs were restlessness and severe itching. Skin lesions were found on the head, depigmented areas of the muzzle and cheeks, flanks, pelvic and thoracic limbs, and the scrotal sac. The lesions were characterized by areas of alopecia with crusts accompanied by serosanguineous exudates. Histologically, the lesions were characterized as moderate superficial dermatitis with irregular epidermal acanthosis and pronounced diffuse orthokeratotic hyperkeratosis. In total, 378 Culicoides specimens were collected, with Culicoides ocumarensis Ortiz being the most abundant species. The combined application of copaiba oil and a multivitamin emulsion exhibited potential for topical treatment of allergic dermatitis caused by insect bites in donkeys. Our study revealed an association between allergic dermatitis in donkeys and Culicoides.

A Single-Port, Multiple-Access, Custom-Made Device Used in Laparoscopically Assisted Cryptorchidectomy in Standing Horses-A Preliminary Study.

This study evaluates a new multiport device with single access to the abdominal cavity produced with routine hospital supplies that could be applied to laparoscopically assisted cryptorchidectomy in standing horses. Initially, the new device was evaluated on five cadavers of bovine fetuses (n = 5), placed assisted in a minilaparotomy performed in the flank region. Subsequently, the device was evaluated in four cryptorchid horses treated during the hospital routine. During the evaluation of the new device, the possibilities of exploring the abdominal cavity, inspection, and intra-abdominal manipulation with two Babcock forceps were verified. The possibilities were described, and surgical time data were recorded and analyzed using descriptive statistics. In the cadavers, a wide exploration of the abdominal cavity was possible, with a laparoscopic inspection through the right paralumbar fossa and manipulation of intra-abdominal structures with Babcock forceps inserted by the new device. In cryptorchid horses, laparoscopically assisted cryptorchidectomy with a new device was feasible in two patients, and in the others, it allowed the diagnosis of adhesions and ectopic locations in the inguinal region of testicles retained in the cavity. Therefore, the new device was efficient in exploring the inguinal region of cryptorchid horses in the standing position. The present study is preliminary and can support future studies that aim to improve the developed prototype.

Estimation of pulmonary artery systolic pressure in hemodialysis patients and its association with cardiorespiratory fitness and pulmonary function.

PURPOSE: To evaluate the estimated pulmonary arterial systolic pressure (PASP) through transthoracic echocardiography in hemodialysis (HD) patients and associate it with cardiorespiratory fitness and pulmonary function. METHODS: This study was a cross-sectional analysis of HD patients that performed evaluations of cardiac function, cardiorespiratory fitness, and pulmonary function, through transthoracic echocardiography, cardiopulmonary exercise test, spirometry, and manovacuometry, respectively. All patients underwent the evaluations on a non-dialysis day. RESULTS: Thirty-five HD patients were evaluated and separated according to the presence of probable pulmonary hypertension (PH) (estimated PASP ≥ 35 mmHg) or not (estimated PASP < 35 mmHg). Those HD patients with probable PH had the worst cardiorespiratory fitness, evaluated by the peak oxygen consumption (VO2peak) (17.11 ± 4.40 versus 12.90 ± 2.73 mL/kg/min; p = 0.011), and pulmonary function, evaluated by absolute and predicted of forced vital capacity (FVC) (85.52 ± 12.29 versus 71.38 ± 11.63%; p = 0.005) and absolute and predicted of forced expiratory volume in the first second (FEV1) (83.37 ± 14.98 versus 69.21 ± 13.48%; p = 0.017). The secondary analysis showed that estimated PASP was correlated with VO2peak (r = - 0.508; p = 0.002), FVC (r = - 0.450; p = 0.007), and FEV1 (r = - 0.361; p = 0.033). Moreover, the adjusted odds ratio by HD vintage, dry weight and gender showed that increments in VO2peak (OR 1.62; CI 95% 1.04-2.54; p = 0.034), FVC (OR 39.67; CI 95% 1.74-902.80; p = 0.021), and FEV1 (OR 39.54; CI 95% 1.89-826.99; p = 0.018) were associated with 1-fold and 39-fold higher chance, respectively, for not having PH. However, all these associations were lost when age was included in the analysis. CONCLUSIONS: The HD patients with probable PH had the worst cardiorespiratory fitness and pulmonary function. Exploratory analyses showed that greater cardiopulmonary fitness was associated with better cardiac function. Moreover, increments in cardiorespiratory fitness and pulmonary function may increase the chance of not having PH.

Proximal and Distal Vagal Indigestion in Buffaloes (Bubalus bubalis) in the Amazon Biome.

This study aims to describe the clinical signs and ultrasonographic and necropsy findings of the first cases of proximal (Buffalo 1) and distal (Buffalo 2) vagal indigestion in two Bubalus bubalis in the Brazilian Amazon biome. The clinical histories of the buffaloes were characterized by progressive weight loss, recurrent tympany, abdominal distention (apple and pear shapes), anorexia, and scant feces. Buffalo 1 was submitted to orogastric intubation, and due to the recurrent tympany, an exploratory laparotomy. Buffalo 2 was submitted to ultrasound examination, and a segment of the pylorus was shown to be adhered to the eventration by ultrasonography. Both animals produced positive results for the atropine test. In the necropsy evaluation, Buffalo 1 was shown to have dilation of the esophagus, rumen, and reticulum; the ruminal contents of animal 1 were olive green and foamy with bubbles within the ingesta. On the other hand, Buffalo 2 was shown to have distention of the forestomach and abomasum; the complex rumen-reticulum and omasum contents were semi-liquid and had a yellowish color. In animal 2, in the eventration region, there was adherence to the pyloric region. The diagnosis of vagal indigestion was based on the history, clinical signs, and ultrasound and necropsy findings, in addition to the results of the atropine test.

Extracutaneous Melanotic Melanoma with Nervous System Involvement in a Buffalo (Bubalus bubalis).

Melanomas are tumors arising from externally uncontrolled melanocytes that produce varying amounts of melanin. In this study, we report a case of melanoma with neurological impairment without evidence of cutaneous neoplastic lesions in an adult buffalo in the state of Pará, Brazil. Clinically, the buffalo exhibited apathy, decreased mandibular tone, and occasionally an open mouth with motor incoordination, and eventually succumbed to the condition. Necropsy revealed multifocal tumor masses in the brain, pituitary gland, trigeminal ganglion, and spinal cord. The neoplastic cells showed strong positive signals for vimentin, Melan-A, PNL-2, and SOX10. The diagnosis was made via necropsy, histopathology, and positive immunostaining for Melan-A and PNL-2, which are specific markers for melanocyte identification.

The design of new adjuvants for mucosal immunity to Neisseria meningitidis B in nasally primed neonatal mice for adult immune response.

The aim of this study was to determine the value of detoxified Shiga toxins Stx1 and Stx2 (toxoids of Escherichia coli) as mucosal adjuvants in neonatal mice for immunogenicity against the outer membrane proteins (OMPs) of Neisseria meningitidis B. Mucosal immunization has been shown to be effective for the induction of antigen-specific immune responses in both the systemic and mucosal compartments. Systemic antibody levels (IgG, IgG1, IgG2a, IgG2b, IgM, and IgA) and mucosal IgM and IgA were measured by ELISA using an N. meningitidis as an antigen. In addition, IFN-γ and IL-6 production were measured after stimulated proliferation of immune cells. Intranasal administration elicited a higher anti-OMP IgA response in both saliva and vaginal fluids. Our results suggest that both Stx1 and Stx2 toxoids are effective mucosal adjuvants for the induction of Ag-specific IgG, IgM, and IgA antibodies. The toxoids significantly enhanced the IgG and IgM response against OMPs with a potency equivalent to CT, with the response being characterized by both IgG1 and IgG2a isotypes, and increased IFN-gamma production. Additionally, bactericidal activity was induced with IgG and IgM antibodies of high avidity. These results support the use of the new toxoids as potent inducing adjuvants that are particularly suitable for mucosal immunization.

Low prevalence of Post-thrombotic syndrome in patients treated with rivaroxaban.

Post-thrombotic syndrome (PTS) is a complication of deep vein thrombosis (DVT). Residual vein thrombus (RVT) on Doppler Ultrasound can be associated with PTS. Limited data are available on the effect of direct oral anticoagulants (DOACs) on the long-term outcome of PTS. This study aimed to compare the prevalence of PTS and RVT, in patients with previous DVT treated with rivaroxaban or enoxaparin/warfarin. A total of 129 patients with previous proximal lower limb DVT and treated with rivaroxaban (n = 71) or enoxaparin/warfarin (n = 58) for at least 3 months were included. The Villalta scale for PTS was performed after treatment. The median duration of the DVT symptoms before anticoagulation was 7 days for both groups. The rate of PTS was 50.7% in the patients treated with rivaroxaban and 69% in the enoxaparin/warfarin group. Enoxaparin/warfarin showed an increased prevalence of PTS (P = .018). An analysis in 3 different models showed that the relative risk of PTS decreased by 76% with rivaroxaban use when compared with enoxaparin/warfarin treatment. In addition, 93 of the 129 patients were evaluated regarding the presence of RVT, of which, 11 (24.4%) and 31 (64.6%) presented with RVT for rivaroxaban and enoxaparin/warfarin, respectively (P < .0001). The RVT analysis excluded the possibility of RVT as a mediator of the association between type of treatment and PTS when comparing rivaroxaban with enoxaparin/warfarin (odds ratio (OR) = 0.14; 95% confidence interval (CI): 0.1-1.0, P = .051) with rivaroxaban compared with enoxaparin/warfarin. Rivaroxaban treatment was associated with a lower risk of PTS when compared to enoxaparin/warfarin; RVT however, was not a mediator in the association between PTS and type of treatment.

Mechanisms involved in the rat peritoneal leukocyte migration induced by a Kunitz-type inhibitor isolated from Dimorphandra mollis seeds.

DMTI-II is a Kunitz-type inhibitor isolated from Dimorphandra mollis seeds that causes rat inflammatory edema by mechanisms involving activation of mast cells and sensory C-fibers. The present study aimed to further explore the inflammatory mechanisms involved in DMTI-II-induced inflammation, focusing to the leukocyte migration in vivo. Male Wistar rats (250-280 g) were injected with DMTI-II (1-100microg/cavity), and at 4-24h thereafter the leukocyte counts in peritoneal lavage were evaluated. DMTI-II caused dose- and time-dependent accumulation of neutrophils and eosinophils. The peritoneal neutrophil influx initiated at 4h, achieving maximal responses at 16 h after DMTI-II injection (16- and 22-fold increase, respectively). The DMTI-II-induced eosinophil recruitment was observed as early as 4h achieving the maximal responses at 16 h (12- and 17-fold increase, respectively). The mononuclear cell number increased at 4h and 16 h (1.5-fold and 1.6-increase, respectively). Prior treatments with dexamethasone, the cyclooxygenase (COX) inhibitors indomethacin and celecoxib, as well as the PAF receptor antagonist PCA4248 largely reduced the neutrophil and eosinophil accumulation. The selective lypoxygenase inhibitor AA861, the tachykinin NK(1) antagonist SR-140333 and the nitric oxide inhibitor L-NAME reduced only the eosinophil number. The eotaxin levels were significantly higher in DMTI-II-injected rats compared with control animals. In conclusion, DMTI-II causes an early migration of eosinophils and neutrophils by mechanisms involving COX-2- and lipoxygenase-derived metabolites, PAF, substance P and NO. The capacity of DMTI-II to recruit eosinophils at early times is likely to reflect the allergen properties of proteinase inhibitors belonging to Kunitz family.

Inflammatory oedema induced by Lachesis muta muta (Surucucu) venom and LmTX-I in the rat paw and dorsal skin.

The ability of crude venom and a basic phospholipase A(2) (LmTX-I) from Lachesis muta muta venom to increase the microvascular permeability in rat paw and skin was investigated. Crude venom or LmTX-I were injected subplantarly or intradermally and rat paw oedema and dorsal skin plasma extravasation were measured. Histamine release from rat peritoneal mast cell was also assessed. Crude venom or LmTX-I induced dose-dependent rat paw oedema and dorsal skin plasma extravasation. Venom-induced plasma extravasation was inhibited by the histamine H(1) antagonist mepyramine (6mg/kg), histamine/5-hydroxytriptamine antagonist cyproheptadine (2mg/kg), cyclooxygenase inhibitor indomethacin (5mg/kg), nitric oxide synthesis inhibitor l-NAME (100nmol/site), tachykinin NK(1) antagonist SR140333 (1nmol/site) and bradykinin B(2) receptor antagonist Icatibant (0.6mg/kg). Platelet-activating factor (PAF) antagonist PCA4248 (5mg/kg) had no effect. LmTX-I-induced skin extravasation was inhibited by cyproheptadine, mepyramine, indomethacin and PCA4248, while l-NAME and SR140333 had no effect. Additionally, both Lachesis muta muta venom and LmTX-I concentration-dependently induced histamine release from rat mast cells. In conclusion, Lachesis muta muta venom and LmTX-I increase microvascular permeability by mechanisms involving in vivo mast cell activation and arachidonic acid metabolites. Additionally, crude venom-induced responses also involve substance P, nitric oxide and bradykinin release, whether LmTX-I-induced responses involve PAF.

Sleep disorders and endothelial dysfunction in children with sickle cell anemia.

OBJECTIVE: We sought to assess sleep characteristics in children with sickle cell anemia (SCA) to investigate the possible association between sleep-related disorders and parameters of endothelial function. METHODS: Sleep Disturbance Scale for Children (SDSC) and endothelial function variables (flow-mediated dilatation using brachial artery ultrasound, cytokines) were compared in children with SCA and healthy children aged 6-18 years. RESULTS: Flow-mediated dilation (FMD) median (IQR) values were 10.1 (6.4; 14) vs 16.9 (12; 26.4), in the SCA and comparison groups (p = 0.001), respectively. Associations were found between difficulty initiating and maintaining sleep as well as IL-12p70 (rs = 0.3, p = 0.03) and IL-1b (rs = 0.4, p = 0.01); disorders of excessive sleepiness and TNF-a (rs = 0.3, p = 0.02), IL-6 (rs = 0.3, p = 0.03), e IL-17A (rs = 0.3, p = 0.04), and disorders of arousal with IL-6 (rs = 0.3, p = 0.04). Regarding SDSC subscales, the score for sleep breathing disorders was higher in the SCA group than in the comparison group [6.7 (3.4) vs. 5.2 (2.7), p = 0.04]. Sleep breathing disorders, disorders of excessive sleepiness and sleep hyperhidrosis scores were also higher among those SCA patients who were using hydroxyurea than those with SCA who were not using hydroxyurea [7.4 (3.9) vs. 5.9 (2.9); p = 0.026; 7.5 (3.5) vs. 6.9 (3); p = 0.028; 4.3 (3.1) vs. 3.9 (2.6); p = 0.044, respectively]. CONCLUSION: The SCA group presented higher sleep-disordered breathing scores and lower FMD values. Patients with SCA using hydroxyurea exhibited a higher frequency of scores on SDSC subscales. A positive correlation was found between SDSC subscales and cytokines.

Effects of intradialytic exercise on cardiopulmonary capacity in chronic kidney disease: systematic review and meta-analysis of randomized clinical trials.

Patients with chronic kidney disease show poorer functional and cardiorespiratory capacity than healthy individuals, and these impairments result in sedentarism. The aim of this study was to conduct a systematic review and meta-analysis of randomized clinical trials on the effects of different intradialytic exercise protocols on cardiopulmonary capacity in chronic kidney disease patients. The primary outcome was peak oxygen consumption (VO2peak) and the secondary outcomes were exercise duration and ventilation in the cardiopulmonary test. The quality of the evidence was evaluated using the GRADE guidelines. Seven studies with a total of 124 participants met the inclusion criteria. Compared to the non-exercise group, the exercise group improved in mean VO2peak (MD 4.06 [IC 0.81; 7.31]). In a separate analysis according to exercise modality, aerobic exercise plus strength training performed better than aerobic exercise alone (MD 5.28 [IC 3.90; 6.66]). In the exercise group, both exercise tolerance values (MD 3.10 [IC 1.70; 4.51]) and ventilation values in the cardiopulmonary test were better than those of the control group (MD 13.10 [IC 7.12; 19.09]). Thus, intradialytic exercise protocols can improve cardiopulmonary function, exercise tolerance and ventilatory efficiency in chronic kidney disease patients.

Description of the Dunning-Kruger effect in general surgery residents during laparoscopic cholecystectomy: a blinded prospective study

ABSTRACT Purpose: The purpose of this study is to assess whether the Dunning-Kruger effect occurs in surgical residents when performing laparoscopic cholecystectomy in a porcine model. Methods: Prospective blinded study, which counted with forty PGY-1 general surgery residents who agreed to participate in the study were blindly recruited to perform a laparoscopic cholecystectomy in a porcine model. At the end of the procedure, the participants assigned a score of 0-10 for their own performance and the video of the operation was independently assessed by 2 experienced laparoscopic surgeons using a validated tool. Results: Participants were divided into groups of 10 individuals according to objective performance and compared. The group with the worst objective result was inferior to the group with the best objective result (3.77 ± 0.44 vs. 8.1 ± 0.44, p < 0.001), but they were similar in self-perception of performance (5.11 ± 1.69 vs. 6.1 ± 1.79, p = 0.999). Conclusions: In the studied sample, it was possible to demonstrate the presence of the Dunning-Kruger effect.

Influence of acute pancreatitis on the in vitro responsiveness of rat mesenteric and pulmonary arteries.

BACKGROUND: Acute pancreatitis is an inflammatory disease characterized by local tissue injury and systemic inflammatory response leading to massive nitric oxide (NO) production and haemodynamic disturbances. Therefore, the aim of this work was to evaluate the vascular reactivity of pulmonary and mesenteric artery rings from rats submitted to experimental pancreatitis. Male Wistar rats were divided into three groups: saline (SAL); tauracholate (TAU) and phospholipase A2 (PLA2). Pancreatitis was induced by administration of TAU or PLA2 from Naja mocambique mocambique into the common bile duct of rats, and after 4 h of duct injection the animals were sacrificed. Concentration-response curves to acetylcholine (ACh), sodium nitroprusside (SNP) and phenylephrine (PHE) in isolated mesenteric and pulmonary arteries were obtained. Potency (pEC50) and maximal responses (EMAX) were determined. Blood samples were collected for biochemical analysis. RESULTS: In mesenteric rings, the potency for ACh was significantly decreased from animals treated with TAU (about 4.2-fold) or PLA2 (about 6.9-fold) compared to saline group without changes in the maximal responses. Neither pEC50 nor EMAX values for Ach were altered in pulmonary rings in any group. Similarly, the pEC50 and the EMAX values for SNP were not changed in both preparations in any group. The potency for PHE was significantly decreased in rat mesenteric and pulmonary rings from TAU group compared to SAL group (about 2.2- and 2.69-fold, for mesenteric and pulmonary rings, respectively). No changes were seen in the EMAX for PHE. The nitrite/nitrate (NOx-) levels were markedly increased in animals submitted to acute pancreatitis as compared to SAL group, approximately 76 and 68% in TAU and PLA2 protocol, respectively. CONCLUSION: Acute pancreatitis provoked deleterious effects in endothelium-dependent relaxing response for ACh in mesenteric rings that were strongly associated with high plasma NOx- levels as consequence of intense inflammatory responses. Furthermore, the subsensitivity of contractile response to PHE in both mesenteric and pulmonary rings might be due to the complications of this pathological condition in the early stage of pancreatitis.

Storage and stability of IgG and IgM monoclonal antibodies dried on filter paper and utility in Neisseria meningitidis serotyping by Dot-blot ELISA.

BACKGROUND: A simple filter paper method was developed for, the transport and storage of monoclonal antibodies (Mabs) at room temperature or -20 degrees C after spotting on filter paper, for subsequent serotyping of outer membrane antigens of N.meningitidis by dot-blot ELISA. METHODS: Monoclonal antibodies (Mabs) were spotted within a 0.5-1 cm diameter area of Whatman grade 903 paper, which were stored individually at room temperature or at -20 degrees C. These MAbs were stored and analyzed after periods of one week, 4 weeks, 12 months, or 13 years in the case of frozen Mab aliquots, or after 4 weeks at -20 degrees C or at room temperature (RT) in the case of Mabs dried on filter paper strips. Assays were performed in parallel using dot-blot ELISA. In addition to the MAbs specific for serotyping class 1, 2 or 3, we used a larger number of Mabs for polysaccharides, lipooligosaccharides (LOS), class 5 and cross-reactive antigens for native outer membrane of N.meningitidis. The Mabs dried on filter paper were eluted with phosphate-buffered saline (PBS) containing 0.2% gelatin. RESULTS: Mabs of the isotypes IgG and IgM dried on filter papers were not affected by duration of storage. The detection by serotyping Mabs was generally consistent for dried filter paper MAb samples stored frozen for over 1 year at -20 degrees C, and although decreased reactive antibody titers were found after storage, this did not interfere with the specificity of the Mabs used after 13 years as dry spots on filter paper. CONCLUSION: The use of filter paper is an inexpensive and convenient method for collecting, storing, and transporting Mab samples for serotyping studies. In addition, the samples occupy little space and can be readily transported without freezing. The efficiency of using immunoglobulin G (IgG) or M (IgM) eluted was found to be consistent with measurement of IgG or IgM titers in most corresponding, ascites Mabs stored frozen for over 1 year. The application of meningococcal typing methods and designations depend on the question being asked.