RESUMO
BACKGROUND AND AIMS: The insulin resistance (IR) is a major metabolic impairment in severe obesity, a multifactorial disease in which the importance of the effect of single nucleotide polymorphisms (SNP) associations in different rather than individual genes was established. The aim of this study was to test the predictive value of presence/absence of polymorphisms/ variants in ß3-adrenergic receptor (ADRB3), uncoupling protein 1 (UCP1), peroxisome proliferator-activated receptor γ (PPARγ), and adiponectin (ADIPOQ) genes in diagnosing the IR in obesity. SUBJECTS AND METHODS: We studied 112 (40 males, 72 females) severely obese (body mass index: 48.5±7.5 kg/m2) subjects recruited from the outpatient obesity clinic of Federico II University Hospital in Naples. Genomic DNA was extracted from peripheral leukocytes with a commercial kit. The gene polymorphisms Trp64Arg in ADRB3, -3826 A>G in UCP1, Pro12Ala in PPARγ, and c.268G>A, c.331T>C, and c.334C>T in ADIPOQ were characterized by TaqMan assay or by direct sequencing (ADIPOQ). RESULTS AND CONCLUSION: Our results demonstrate that -3826A>G UCP1 polymorphism is associated with IR in morbid obesity. Further, the lack of any polymorphisms, Trp64Arg in ADRB3 and/or -3826 A>G in UCP1 and/or Pro12Ala in PPARγ and/or c.268G>A, c.331T>C and c.334C>T in ADIPOQ, appears a useful prognostic factor (NPV=100%) toward the IR onset in these obese patients representing a further parameter for an earlier and appropriate therapy.
Assuntos
Adiponectina/genética , Resistência à Insulina/genética , Canais Iônicos/genética , Proteínas Mitocondriais/genética , Obesidade Mórbida/genética , PPAR gama/genética , Polimorfismo de Nucleotídeo Único/genética , Receptores Adrenérgicos beta 3/genética , Adulto , Glicemia , Índice de Massa Corporal , DNA/genética , Feminino , Humanos , Insulina , Masculino , Reação em Cadeia da Polimerase , Proteína Desacopladora 1RESUMO
OBJECTIVE: Blood loss following joint replacement surgery represents a relevant issue for orthopedic surgeons. The use of tranexamic acid (TXA) to reduce transfusion requirements has become mainstream. However, consensus about the starting time, methods, or volume of usage of TXA in joint replacement surgery has yet to be found. A retrospective study was conducted comparing pre- and post-operative infusion of TXA 15 mg/kg to a single pre-operative infusion. PATIENTS AND METHODS: 291 patients undergoing TKA were retrospectively reviewed. 109 received a single pre-operative dose of 15 mg/ kg TXA (single dose, SD group), 182 received a single pre- operative dose of 15 mg/ kg TXA followed by a second post-operative dose of 15 mg/kg TXA (double dose, DD group). The primary outcome was blood loss calculated from haematological values and perioperative transfusions. Secondary outcomes included the occurrence of major complications within the first postoperative year. RESULTS: None of the patients reported adverse events. Blood transfusions were administered to 63 patients (13.5%) in the SD and 36 in the DD group (5.7%). Significant difference between the groups was observed (p < 0.005). No significant difference between the two groups was found concerning mean blood loss in drainage after the 24th hour and postoperative hemoglobin values (p = n.s.). CONCLUSIONS: The study demonstrated that TXA possesses a good safety profile. In addition, pre- and post-operative infusion of TXA 15 mg/kg is more effective compared to single pre-operative infusion in reducing need for transfusion requirements.
Assuntos
Antifibrinolíticos/administração & dosagem , Artroplastia do Joelho/efeitos adversos , Transfusão de Sangue/estatística & dados numéricos , Ácido Tranexâmico/administração & dosagem , Administração Intravenosa , Antifibrinolíticos/uso terapêutico , Artroplastia do Joelho/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Humanos , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Ácido Tranexâmico/uso terapêuticoRESUMO
BACKGROUND: Severe obesity is a major worldwide public health concern affecting 0.5-5% of the adult population. Adiponectin (Acpr30), an adipokine secreted from adipocytes, shows pleiotropic beneficial effects on obesity and related disorders. In this study, sequence analysis of Acpr30 gene (ACDC) was performed in a highly selected population of severely obese young adult patients from Southern Italy to investigate the associations between polymorphisms in the ACDC gene and the development of severe obesity concomitantly with other features of the metabolic syndrome. METHODS: The ACDC gene was analyzed by direct sequencing in the severely obese patients (n=220) and compared to healthy controls (n=116). The associations between the ACDC gene single-nucleotide polymorphisms (SNPs) and the levels of serum Acpr30 as well as the correlation with the presence of severe obesity jointly associated with other features of the metabolic syndrome were also investigated. Total serum Acpr30 concentrations were measured by the ELISA method. RESULTS: ACDC gene molecular screening revealed the presence of previously described SNPs and a new nucleotide alteration, c.355T>G, leading to a protein variant, p.L119V. Measurement of serum concentration of Acpr30 demonstrated lower levels of Acpr30 in the obese population compared to controls (30.5+/-28.3 vs. 43.9+/-35.7 microg/ml, p<0.01); in particular, significantly lower Acpr30 concentrations were observed in obese patients bearing c.-11377C>G SNP CG+GG genotypes than in those with CC genotype (22.9+/-20.5 vs. 33.1+/-29.4 microg/ml, p<0.05). CONCLUSIONS: Our results confirmed that low serum levels of Acpr30 are related to severe obesity and a difference in protein expression is associated with variants in ACDC gene promoter region.
Assuntos
Obesidade Mórbida/sangue , Obesidade Mórbida/genética , Polimorfismo de Nucleotídeo Único , Adiponectina/sangue , Adiponectina/genética , Adulto , Índice de Massa Corporal , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Feminino , Genótipo , Humanos , Itália/epidemiologia , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/genética , Mutação , Polimorfismo de Nucleotídeo Único/genética , Regiões Promotoras GenéticasRESUMO
The study aimed to evaluate, with regard to the human nutrition, the lipid profile of meat and backfat from gilts and barrows of the Italian autochthonous genotype Casertana and its crossbreed (Casertana×Large White) slaughtered at two different live weights. Meat from the Casertana cross was nutritionally comparable to that from the purebreed and both would be considered healthy, irrespective of sex and weight, due to the relatively low levels of intramuscular lipids and cholesterol. Muscle cholesterol was considerably lower in the heavy pigs than in the light ones and, as weight increased, cholesterol decreased but only in gilts. Females supply meat with higher polyunsaturated fatty acids (PUFA) and slightly lower saturated fatty acids (SFA) respect to barrows and, thus, higher PUFA/SFA ratio. Casertana crossbreds can represent a good alternative to pure Casertana, mainly in the production of Colonnata lard, due to the better fatty acid profile of the subcutaneous adipose tissue. From the nutritional point of view, the optimal slaughtering weight was about 150kg for both genotypes. Heavy pigs, compared to the light ones, produced loin with lower atherogenic and thrombogenic indexes, lower SFA/unsaturated fatty acids ratio, and higher PUFA/SFA ratio.
RESUMO
OBJECTIVE: To evaluate the prevalence of beta(3)-adrenergic receptor (ADRB3) Trp64Arg polymorphism and its relationship with the metabolic syndrome in severe obesity. DESIGN: Cross-sectional outpatients study. PATIENTS AND METHODS: In 265 (100 men) severely obese non-diabetic subjects and 78 (25 men) healthy volunteers, genomic DNA was isolated from peripheral leukocytes. In obese patients, plasma concentrations of leptin, lipids, glucose and insulin, the homeostasis model assessment index and blood pressure have been measured. The Trp64Arg mutation was identified with the real-time TaqMan method. RESULTS: Neither genotype distribution nor allele frequency differed between the two groups. The metabolic syndrome prevalence was 59% in obese subjects, and was higher in men than in women (65 vs 55%: P=0.03). The body mass index (BMI) was related to age tertiles (beta=0.08; P<0.001; multiple linear regression) in Trp64Arg-positive obese subjects. CONCLUSION: We confirm the high prevalence of the metabolic syndrome among severely obese subjects. ADRB3 polymorphism was significantly related to insulin resistance only in obese male subjects. Moreover, increased BMI was related to age in obese subjects with the ADRB3 polymorphism.
Assuntos
Síndrome Metabólica/genética , Obesidade Mórbida/complicações , Polimorfismo Genético , Receptores Adrenérgicos beta 3/genética , Adulto , Fatores Etários , Glicemia/análise , Índice de Massa Corporal , Estudos Transversais , Feminino , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Humanos , Insulina/sangue , Itália/epidemiologia , Leptina/sangue , Leucócitos/metabolismo , Modelos Lineares , Lipídeos/sangue , Masculino , Síndrome Metabólica/epidemiologia , Mutação , Obesidade Mórbida/sangue , Obesidade Mórbida/genética , Fatores SexuaisRESUMO
The present study was undertaken to evaluate the effect of age on lipid content and composition of lamb meat. Thirty suckling ram lambs of the Italian Merino breed, reared according to a traditional semi-extensive management, were slaughtered at 30, 50 and 70 days of age to evaluate total lipids and fatty acid profile in three different muscles: longissimus dorsi (LD), semimembranosus (SM) and quadriceps femoris (QF). Age did not dramatically modify lipid content and composition, even if effects of nutritional interest were observed. Meat from lambs slaughtered at 70 days of age presented the best fatty acid profile, because they had the highest PUFA content and ratio to SFA, as well as the lowest thrombogenic index. The SM muscle had better nutritional quality than the LD and the QF, as a result of a higher PUFA percentage and PUFA/SFA ratio, together with a lower thrombogenic index. These characteristics were also associated with slightly lower amounts of intramuscular lipids and SFA.
RESUMO
We treated a group of 18 hospitalized adult diabetic patients (all with retinopathy, 17 with symptomatic neuropathy, and 6 with macroangiopathy) presenting with gangrenous lesions of the foot by a combined regime consisting of strict metabolic control, daily debridement of necrotic tissues, and daily hyperbaric oxygen (HBO) treatments given in a multiplace oxygen chamber. Another group of 10 adult subjects with comparable foot lesions (all with retinopathy, 9 with symptomatic neuropathy, and 4 with macroangiopathy) was treated in exactly the same way except for HBO. In the test treatment group, 16 patients were healed, and the remaining 2 showed no improvement and later underwent amputation. The number of HBO treatments required for healing was significantly related to the size of gangrenous lesions. In the non-HBO-treated group, only 1 patient improved, 5 of 10 showed no change, and 4 of 10 worsened until leg amputation was unavoidable. Comparison of the two groups by chi 2-test revealed a highly significant difference (P = .001). In practical terms, HBO treatment drastically reduced leg amputations in patients so treated in the last 3 yr compared with earlier and current figures for patients not receiving HBO treatment.
Assuntos
Complicações do Diabetes , Doenças do Pé/terapia , Gangrena/terapia , Oxigenoterapia Hiperbárica , Adulto , Idoso , Angiopatias Diabéticas/complicações , Neuropatias Diabéticas/complicações , Retinopatia Diabética/complicações , Feminino , Doenças do Pé/etiologia , Gangrena/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Cutânea/terapiaRESUMO
OBJECTIVE: To evaluate the effectiveness of systemic hyperbaric oxygen therapy (s HBOT) in addition to a comprehensive protocol in decreasing major amputation rate in diabetic patients hospitalized for severe foot ulcer. RESEARCH DESIGN AND METHODS: From August 1993 to August 1995, 70 diabetic subjects were consecutively admitted into our diabetologic unit for foot ulcers. All the subjects underwent our diagnostic-therapeutic protocol and were randomized to undergo s-HBOT. Two subjects, one in the arm of the treated group and one in the arm of nontreated group, did not complete the protocol and were therefore excluded from the analysis of the results. Finally, 35 subjects received s-HBOT and another 33 did not. RESULTS: Of the treated group (mean session = 38.8 +/- 8), three subjects (8.6%) underwent major amputation: two below the knee and one above the knee. In the nontreated group, 11 subjects (33.3%) underwent major amputation: 7 below the knee and 4 above the knee. The difference is statistically significant (P = 0.016). The relative risk for the treated group was 0.26 (95% CI 0.08-0.84). The transcutaneous oxygen tension measured on the dorsum of the foot significantly increased in subjects treated with hyperbaric oxygen therapy: 14.0 +/- 11.8 mmHg in treated group, 5.0 +/- 5.4 mmHg in nontreated group (P = 0.0002). Multivariate analysis of major amputation on all the considered variables confirmed the protective role of s-HBOT (odds ratio 0.084, P = 0.033, 95% CI 0.008-0.821) and indicated as negative prognostic determinants low ankle-brachial index values (odds ratio 1.715, P = 0.013, 95% CI 1.121-2.626) and high Wagner grade (odds ratio 11.199, P = 0.022, 95% CI 1.406-89.146). CONCLUSIONS: s-HBOT, in conjunction with an aggressive multidisciplinary therapeutic protocol, is effective in decreasing major amputations in diabetic patients with severe prevalently ischemic foot ulcers.
Assuntos
Pé Diabético/terapia , Pé/irrigação sanguínea , Oxigenoterapia Hiperbárica , Isquemia/terapia , Idoso , Amputação Cirúrgica , Angiopatias Diabéticas/epidemiologia , Angiopatias Diabéticas/fisiopatologia , Neuropatias Diabéticas/epidemiologia , Neuropatias Diabéticas/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Oxigênio/sangue , Pressão Parcial , PrognósticoRESUMO
This study investigates the microvascular permeability changes in tracheal tissue of rats exposed to hyperbaric oxygen (HBO). Rats, following exposure to HBO or ambient air (control animals) for 1.5, 3 and 6 h, were prepared for recording of nitric oxide exhaled (FENO) in air using a chemiluminescence analyser. The level of FENO was not statistically different in the two groups. Plasma exudation, evaluated by measuring the leakage of Evans blue (EB) dye into the tracheal tissue, was significantly elevated (48, 86 and 105% at 1.5, 3 and 6 h, respectively) in HBO-treated rats. Plasma exudation in the trachea of control rats was significantly increased (42%, P<0.05) by NG-nitro-L-arginine methyl ester (L-NAME), whereas it was significantly reduced (31%, P<0.05) in rats exposed to HBO for 3 h. N-acetylcysteine (NAC) and flunisolide significantly prevented the increase in plasma leakage in HBO-treated rats. In contrast, indomethacin was devoid of anti-exudative activity in these experiments. Western immunoblot showed a significant increase in the level of inducible nitric oxide synthase (iNOS) protein in the tracheal homogenates of HBO-treated rats, as compared to basal levels. These results indicate that nitric oxide (NO) is involved in the maintenance of microvascular permeability in tracheal tissue of rats. The protective effect observed with the steroid seems to support this hypothesis. Furthermore, the beneficial action of NAC underlines that reactive oxygen species participate in the microvascular permeability changes observed in tracheal tissue of rats exposed to HBO.
Assuntos
Permeabilidade Capilar/fisiologia , Oxigenoterapia Hiperbárica , Traqueia/fisiopatologia , Acetilcisteína/farmacologia , Animais , Antiasmáticos/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Western Blotting , Permeabilidade Capilar/efeitos dos fármacos , Inibidores Enzimáticos/farmacologia , Fluocinolona Acetonida/análogos & derivados , Fluocinolona Acetonida/farmacologia , Sequestradores de Radicais Livres/farmacologia , Frequência Cardíaca/efeitos dos fármacos , Frequência Cardíaca/fisiologia , Hemodinâmica/efeitos dos fármacos , Hemodinâmica/fisiologia , Indometacina/farmacologia , Masculino , NG-Nitroarginina Metil Éster/química , NG-Nitroarginina Metil Éster/farmacologia , Óxido Nítrico/metabolismo , Óxido Nítrico Sintase/metabolismo , Óxido Nítrico Sintase Tipo II , Ratos , Ratos Sprague-Dawley , Estereoisomerismo , Traqueia/efeitos dos fármacos , Traqueia/enzimologiaRESUMO
In these experiments rats were exposed to hyperbaric oxygen (100% oxygen; 2.5 atmospheres absolute pressure) for 1, 3 or 6 h. At the end of these periods the hearts were removed and subjected to low flow ischemia (perfusion rate from 12 ml/min to 2 ml/min for 40 min) and reperfusion. Hearts excised from control rats were subjected to the same procedure of ischemia and reperfusion. The data obtained from these experiments clearly indicate that the ischemic picture observed in control hearts is worsened in hearts obtained from hyperbaric oxygen-exposed animals. In fact, after ventricular standstill of the ischemic phase, the left ventricular end-diastolic pressure increased significantly and proportionally according to the time of hyperbaric oxygen exposure. The vasopressor activity of angiotensin II on coronary perfusion pressure was significantly changed, as compared to that in the control preparation: these alterations, well correlated to the time of hyperbaric oxygen exposure, seem to suggest impairment of the vascular endothelium-dependent relaxant function. Furthermore N-acetylcysteine and defibrotide, given orally to the rats before hyperbaric oxygen exposure, prevented the aggravation of the ischemic damage induced in ex vivo hearts.
Assuntos
Coração/fisiopatologia , Oxigenoterapia Hiperbárica/efeitos adversos , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Acetilcisteína/farmacologia , Angiotensina II/farmacologia , Animais , Circulação Coronária/efeitos dos fármacos , Circulação Coronária/fisiologia , Sequestradores de Radicais Livres/farmacologia , Coração/efeitos dos fármacos , Técnicas In Vitro , Masculino , Polidesoxirribonucleotídeos/farmacologia , Ratos , Ratos Sprague-Dawley , Fatores de Tempo , Vasoconstritores/farmacologia , Pressão Ventricular/efeitos dos fármacos , Pressão Ventricular/fisiologiaRESUMO
From 1990 to 1993, 115 diabetic patients were consecutively hospitalized in our diabetologic unit for foot ulcer and 27 (23.5%) major amputations were carried out. The major amputation rate of this series of cases was compared with that occurring in diabetic subjects taken into our hospital for foot ulcer in two previous periods: 1979-1981 (17 major amputations in 42 inpatients or 40.5%) and 1986-1989 (26 major amputations in 78 inpatients or 33.3%). The comparison shows a progressive reduction in major amputation rate [Odds ratio 0.66, 95% confidence interval (CI) 0.46-0.96]. Univariate and multivariate analysis, carried out in the population of the 1990-1993 period, in order to detect the independent factors associated with major amputation show the following prognostic determinants of major amputation: Wagner grade (odds ratio 7.69, CI 1.58-37.53), prior stroke (odds ratio 35.05, CI 3.14-390.53), prior major amputation (odds ratio 3.49, CI 1.26-9.38), transcutaneous oxygen level (odds ratio 1.06, CI 1.01-1.12), and ankle-brachial blood pressure index (odds ratio 4.35, CI 1.58-12.05), while an independent protective role was attributed to hyperbaric oxygen treatment (odds ratio 0.15, CI 0.03-0.64). In accordance with other studies, we, therefore, conclude that a comprehensive protocol as well as a multidisciplinary approach in a dedicated center can assure a decrease in major amputation rate. The parameters of limb perfusion were the modifiable prognostic determinants most strongly predictive for amputation.
Assuntos
Amputação Cirúrgica/estatística & dados numéricos , Pé Diabético/terapia , Análise de Variância , Pressão Sanguínea , Intervalos de Confiança , Pé Diabético/fisiopatologia , Pé Diabético/cirurgia , Feminino , Úlcera do Pé/cirurgia , Úlcera do Pé/terapia , Humanos , Oxigenoterapia Hiperbárica , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Prognóstico , Estudos RetrospectivosRESUMO
BACKGROUND: Diabetes, gallstones and dyslipidaemia are widespread, metabolically related, disorders that can affect the liver, often in a clinically silent fashion. AIM: To investigate whether the presence of these disorders may worsen chronic viral disease by inducing additional liver damage, revealed by variations in serum increases of aminotransferase, alkaline phosphatase and gamma-glutamyl-transpeptidase activities. PATIENTS AND METHODS: This retrospective, cross-sectional study involved 1,195 patients with chronic hepatitis C virus infection: 47.2% chronic hepatitis, 45.2% cirrhosis, and 7.6% hepatocellular carcinoma. 14.9% of patients had enzymatic cholestasis, defined as combined increase of alkaline phosphatase and gamma-glutamyl-transpeptidase. A Log-linear statistical model was applied to the following variables: stages of liver disease, diabetes, cholelithiasis, hypertriglyceridaemia, hypercholesterolaemia, and enzymatic cholestasis. RESULTS: Log-linear analysis, applied to categorical variables, revealed, for the first time, a three-way interaction between the stages of chronic liver disease, diabetes, and enzymatic cholestasis. Two-way interactions demonstrated that liver disease stages correlated directly to the prevalence of cholelithiasis and inversely to hypercholesterolaemia. Irrespective of the liver disease stage, hypertriglyceridaemia correlated to hypercholesterolaemia. CONCLUSIONS: This study discloses a synergistic liver damaging effect of diabetes and hepatitis C virus. The three-way interaction obtained by our analysis suggests that diabetes is a risk factor for the progression of viral liver disease and that it contributes to disease evolution, at least in part, by induction of cholestasis.
Assuntos
Carcinoma Hepatocelular/epidemiologia , Hepatite C Crônica/epidemiologia , Neoplasias Hepáticas/epidemiologia , Doenças Metabólicas/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/diagnóstico , Colelitíase/diagnóstico , Colelitíase/epidemiologia , Comorbidade , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Progressão da Doença , Feminino , Seguimentos , Inquéritos Epidemiológicos , Hepatite C Crônica/diagnóstico , Humanos , Hiperlipidemias/diagnóstico , Hiperlipidemias/epidemiologia , Incidência , Itália/epidemiologia , Modelos Lineares , Neoplasias Hepáticas/diagnóstico , Masculino , Doenças Metabólicas/diagnóstico , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Distribuição por SexoRESUMO
The aim of the study was to determine the influence of adiposity on the relationship between bioelectrical impedance (BIA) measurements of body segments and estimation of body composition by dual-energy X-ray absorptiometry (DXA). Multiple frequencies of whole body and segmental impedances were measured in 68 normal-weight and obese subjects (46 women and 22 men), mean age 37.2+/-14.8 years (range, 18-69). Total and appendicular lean body mass (LBM) assessed by DXA correlated significantly with total and segmental impedance values adjusted for stature in both obese and normal-weight subjects. Best fitting equations for the prediction of appendicular LBM from segmental impedance measurements were derived for the arm and leg with and without the inclusion of adiposity (the percentage of body fat measured by DXA) in the regression models. Best prediction was obtained at low frequency for the arm and high frequency for the leg. Adiposity appears to significantly influence the prediction of leg LBM by BIA. These preliminary observations need further validation to provide an accurate assessment of appendicular LBM assessment by BIA.
Assuntos
Tecido Adiposo , Composição Corporal , Impedância Elétrica , Absorciometria de Fóton , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Caracteres SexuaisRESUMO
The objectives of this study were to obtain values for resting metabolic rate in Italians in relation to parameters of body composition, and to compare them to predicted values using the FAO/WHO/UNU equation. We performed a cross-sectional observational study of 131 healthy subjects (46 males and 85 females) at the Human Nutrition Unit, University Tor Vergata, Rome. Body composition was determined by dual energy X-ray absorptiometry (DXA) and resting metabolic rate was calculated using the Weir formula. Resting metabolic rate was 1,865 +/- 234 kcal/day in males and 1,354 +/- 154 kcal/day in females. These values decreased slightly with age. The relationships with weight and age were stronger than that with lean mass from DXA as independent variables in multiple regression analysis. Mean resting metabolic rates predicted with FAO/WHO/UNU and Harris-Benedict formula were not significantly different from measured values except for the Harris-Benedict value for females (p < 0.01). Individual differences between measured and predicted values were notably high. The measured values were higher than those reported in the literature. The prediction of resting metabolic rate is more accurate with simple anthropometric parameters than with fat-free mass obtained by DXA. The individual error in the predicted values can be so high that for individual use a measured value is preferred over an estimated value.
Assuntos
Antropometria , Composição Corporal , Metabolismo , Absorciometria de Fóton , Adulto , Envelhecimento/fisiologia , Peso Corporal , Estudos Transversais , Feminino , Previsões , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Análise de RegressãoRESUMO
The aim of this study, starting from some concepts of physiology, was to deal with the ever growing question of intentional anemia. Physiology suitably expresses the linear relationship between hematocrit and blood fluidity, and at the same time explains how viscosity and aggregability are important co-factors in the circulation, in disease and in thromboembolic complications. The need to understand how a low hematocrit level, compared to the volemia, is a fundamental requirement in surgery, and even more so in surgery with a high risk of embolism, like orthopedic traumatology surgery. Normovolemic hemodilution was analyzed both for the risks it involves and for how much it sticks to the changes induced by a similar situation on the various organs and apparatus. The authors, based on their experience in the field of anesthesiology, propose an operating schedule to safely perform intentional normovolemic hemodilution, describing the preoperative, intraoperative and finally the postoperative period. In conclusion, the authors advocate a wider use of this technique, confirming its safety in relation to volemia.
Assuntos
Volume de Eritrócitos/fisiologia , Hemodiluição/normas , Velocidade do Fluxo Sanguíneo , Viscosidade Sanguínea , Volume Sanguíneo , Encéfalo/fisiologia , Deformação Eritrocítica , Hematócrito , Hemodiluição/métodos , Humanos , Fígado/fisiologia , Consumo de Oxigênio/fisiologia , Respiração/fisiologia , Medição de RiscoRESUMO
To assess the causes of failure in a blood saving program and the consequent need for homologous transfusions during major orthopedic surgery, data were collected from six orthopedic centers where an autotransfusion program was carried out from 1992-1994. The 1,576 (1,016 female and 560 male) patients studied (average age 63.6 +/- 10 years) were treated either for total hip prosthesis (1,144 pts) total knee prosthesis (212 pts), plate and screw removal plus hip prosthesis (8 pts), hip revision (cup 48 pts, stem 10 pts, cup plus stem 146 pts) and total knee revision (8 pts). Ninety percent of patients did not undergo homologous transfusions, which was significantly connected to: male sex (8% versus 11.7% p = 0.02), younger age (63.2 vs 66.9 years, p = 0.0001), higher weight (male 76 vs 70.7 Kg. p = 0.003, female 65.6 vs 61.9 Kg. p = 0.0003); higher baseline Hb (13.9 vs 12.8 g/dl, p = 0.0041), shorter operation time (110 vs 128 minutes, p = 0.0001); use of indobufen for antithromboembolic prophylaxis (indobufen 4.6% vs heparin calcium 15.2% vs low molecular weight heparin 9% p = 0.0001). On the contrary, the factors favoring homologous transfusions were: peripheral anesthesia (spinal and epidural 15.3% vs general 9.3% vs integrated 9.8% p = 0.016), total hip or knee revision, fixation device removal before hip prosthesis, systemic hypertension and coronary heart disease.
Assuntos
Perda Sanguínea Cirúrgica , Transfusão de Sangue Autóloga/estatística & dados numéricos , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Idoso , Análise de Variância , Feminino , Fibrinogênio/análise , Fibrinogênio/metabolismo , Hemoglobinas/análise , Hemoglobinas/metabolismo , Prótese de Quadril/normas , Humanos , Itália , Prótese do Joelho/normas , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/administração & dosagem , Inibidores da Agregação Plaquetária/uso terapêutico , Contagem de Plaquetas , Complicações Pós-Operatórias/prevenção & controle , Fatores Sexuais , Tromboembolia/prevenção & controleRESUMO
We studied the influence of vitamin E on intramuscular collagen characteristics and on metacarpal growth plate evolution in suckling lambs. Twenty-four 5-d-old Ile de France suckling male lambs were divided into four equal weight groups, and weekly i.m. injections of DL-alpha-tocopheryl acetate (Control group, 0 IU; Group 1, 625 IU; Group 2, 1,000 IU; and Group 3, 1,500 IU) were given until the lambs were 33 d old. Blood samples were withdrawn for plasma alpha-tocopherol, cholesterol, and triglyceride analyses when the lambs were slaughtered at 40 d of age. Hot carcass weight, metacarpal and metatarsal bone characteristics, and metacarpal growth plate width were measured. After 24 h at 2 to 4 degrees C, semitendinosus muscles were removed for intramuscular collagen analyses. Weight was not influenced by treatment, but lambs in Group 1 had a higher (P < .01) intramuscular collagen content than the other groups. A positive quadratic correlation was found between total collagen and vitamin E doses (r = .511; P < .05). Amount and percentage of soluble collagen increased in muscles of all three vitamin E-treated groups compared with the control group. However, hydroxylysyl pyridinoline concentration decreased with vitamin E injection, but the difference compared to control lambs was only significant for the group injected with 1,000 IU. Amount of soluble collagen was strongly correlated to total collagen concentration (r = .879; P < .0001). It was also related to the alpha-tocopherol/(cholesterol + triglycerides) ratio in plasma (r = .431; P < .04). However, the correlation between soluble collagen percentage and alpha-tocopherol concentration in plasma was not significant (r = .369; P < .08). Bone length, weight, and diameter did not change, but the thickness of metacarpal growth plate increased as the DL-alpha-tocopheryl acetate dose increased; in Groups 2 and 3, the growth plate was significantly wider than in Group 1 and the controls. Growth plate width correlated with alpha-tocopherol/(cholesterol + triglycerides) ratio in plasma (r = .481; P < .02).
Assuntos
Animais Lactentes , Osso e Ossos/metabolismo , Colágeno/metabolismo , Músculos/metabolismo , Vitamina E/farmacologia , Animais , Osso e Ossos/efeitos dos fármacos , Lâmina de Crescimento/efeitos dos fármacos , Lâmina de Crescimento/metabolismo , Injeções Intramusculares , Análise dos Mínimos Quadrados , Masculino , Metacarpo/efeitos dos fármacos , Metacarpo/metabolismo , Músculos/efeitos dos fármacos , Ovinos , Vitamina E/administração & dosagemRESUMO
Crossbred "heavy" pigs (average weight 120 kg, slaughter weight above 160 kg) were supplemented with all-rac-alpha-tocopheryl acetate during the last 60 d of late finishing at doses of 25 (control), 50, 100, 200, or 300 mg/kg of diet. At the end of this period, the pigs were slaughtered. Carcass characteristics and the meat quality of pork chops from longissimus muscle (LM) at the last lumbar vertebra were evaluated on eight barrows from each dosage group. Alpha-tocopherol levels were determined in plasma during supplementation and in LM muscle after slaughter. Thiobarbituric acid reactive substances (TBARS) and drip loss were also evaluated in meat. Plasma alpha-tocopherol levels increased (P < .005) during supplementation in treated animals compared to controls, with a peak at 40 d. Alpha-tocopherol levels were higher (P < .05) in LM from pigs treated with 300 mg/kg than in controls (8.4 vs 5.6 microg/g). Dressing percentages correlated (P < .05) with the ratio of plasma alpha-tocopherol levels to the sum of cholesterol and triglycerides. Inhibition of TBARS during storage was related (P < .005) to vitamin E supplementation level, but drip losses in chops were not related to supplementation levels. We concluded that dietary vitamin E supplementation to heavy pigs during the last 60 d of finishing improves dressing percentage, reduces lipid oxidation, and increases the alpha-tocopherol concentration of tissues.
Assuntos
Ração Animal , Suplementos Nutricionais , Carne/normas , Suínos/anatomia & histologia , Vitamina E/farmacologia , Criação de Animais Domésticos/métodos , Animais , Peso Corporal , Feminino , Masculino , Estado Nutricional , Controle de QualidadeRESUMO
In a 6-wk postweaning trial (Trial 1), 30 male New Zealand White rabbits were fed a starter diet with three different levels of all-rac-alpha-tocopheryl acetate (60, 160, or 260 mg/kg diet). Plasma concentrations of alpha-tocopherol and serum concentrations of total cholesterol, high density lipoprotein (HDL) cholesterol, and triglycerides were measured at 2, 4, and 6 wk. In a 20-wk postweaning trial (Trial 2), 48 male New Zealand White rabbits were divided into two groups; one group was fed a vitamin E-free diet, and the other was fed the same diet supplemented with 60 mg/kg of all-rac-alpha-tocopheryl acetate. Plasma concentrations of alpha-tocopherol and serum total cholesterol, HDL cholesterol, and triglycerides were measured at 2, 4, 6, and 20 wk. In Trial 1, split-plot ANOVA showed that dietary all-rac-alpha-tocopheryl acetate increased plasma alpha-tocopherol (P < .01); in addition, serum total cholesterol and triglycerides declined more rapidly (P < .01) and HDL cholesterol increased more rapidly (P < .005) in rabbits fed supplemental all-rac-alpha-tocopheryl acetate than in controls. The all-rac-alpha-tocopheryl acetate intake was significantly correlated with serum total cholesterol reduction and HDL cholesterol increase only when plasma alpha-tocopherol was relatively low (< 23.5 mumol/ L). In trial 2, the vitamin E-free diet caused an increase (P < .05) in total serum cholesterol and a reduction in HDL cholesterol (P < .05 at 6 wk and P < .01 at 20 wk). The overall results of this study suggest that vitamin E plays an important role in the regulation of serum concentrations of cholesterol and lipoproteins in weanling rabbits. Consequently, the maintenance of an adequate nutritional status of vitamin E in the postweaning period is important to avoid alterations of serum lipid pattern.