Alteración de la mineralización de tejidos dentarios y paradentarios inducida por bifosfonatos en ratas Wistar / Alteration of mineralization of dental and paradental tissues induced by biphosphonates in Wistar rats

Desórdenes sistémicos de la homeostasis mineral o fallas en la mineralización de la matriz extracelular pueden afectar tanto a las piezas dentarias como a su aparato de sostén, conduciendo al fracaso de los tratamientos odontológicos. Existe poca evidencia científica sobre modelos animales que permitan es-tudiar la respuesta de tejidos dentarios/paradenta-rios frente a este tipo de desórdenes. El objetivo del presente trabajo fue estudiar experimentalmente al-teraciones de la biomineralización inducidas por bis-fosfonatos en ratas Wistar. Para ello, 20 ratas Wistar hembras y machos (35±10 g) fueron tratados con 20 mg/kg de etidronato bisódico (EHBP) o solución fi-siológica (control) vía intraperitoneal 5 veces por se-mana durante 3 semanas. Luego de la eutanasia, se extrajeron las mandíbulas para su procesamiento y análisis histológico (H&E). Mediante microfotografías digitales se evaluó: área ósea/área total, espesor de ligamento periodontal, áreas de dentina y de cemen-to. Los resultados se analizaron estadísticamente mediante el test T de Student para comparaciones entre grupos y el test ANOVA de 2 vías para las com-paraciones intersexo. Los grupos EHBP presentaron mayor proporción de osteoide, dentina y cemento no mineralizados respecto a los controles, siendo más marcadas las diferencias en las hembras. Las hem-bras del grupo EHBP mostraron una disminución significativa en el espesor del ligamento periodontal respecto de los controles, aunque esta tendencia no se observó en machos. Los resultados del presente estudio demuestran que el EHBP, en la dosis y tiempo estudiados, altera los procesos de biomineralización tanto del tejido óseo como de los tejidos dentarios (AU)

Systemic disorders of mineral homeostasis or alterations in the mineralization of the extracellular matrix can affect both dental and supportive tissues, leading to the failure of dental treatments. There is a lack of scientific information about animal models that allow to study the response of dental/paradental tissues in this type of disorders. The aim of the present work was to study the biomineralization alterations induced by bisphosphonates in Wistar rats and to study the response of dental and paradental tissues. Twenty Wistar rats (35±10 g) were divided in control (females, males) and EHBP (females, males) groups. The EHBP group received 20 mg/kg of ethidronate bisodium intraperitoneally 5 times a week for 3 weeks, while the control group received saline solution. After euthanasia, mandibles were resected and processed histologically to obtained oriented sections for H&E staining. Photomicrographs were used to evaluate: Bone area/total area, periodontal ligament thickness, dentin and cement area. Results were statistically analyzed using the Student's T test for comparisons between groups and the 2-way ANOVA test for male and female comparisons. The EHBP groups showed a higher amount of non-mineralized osteoid, dentin and cement compared to control groups, being more evident in females. Females in the EHBP group showed a significant decrease in periodontal ligament thickness compared to controls, although this profile was not observed in males. The results of the present study demonstrate that EHBP, at the dose and time studied, alters the biomineralization processes of both bone and dental tissues (AU)

Short-term effects of stored homologous red blood cell transfusion on cardiorespiratory function and inflammation: an experimental study in a hypovolemia model

The pathophysiological mechanisms associated with the effects of red blood cell (RBC) transfusion on cardiopulmonary function and inflammation are unclear. We developed an experimental model of homologous 14-days stored RBC transfusion in hypovolemic swine to evaluate the short-term effects of transfusion on cardiopulmonary system and inflammation. Sixteen healthy male anesthetized swine (68±3.3 kg) were submitted to controlled hemorrhage (25% of blood volume). Two units of non-filtered RBC from each animal were stored under blood bank conditions for 14 days. After 30 min of hypovolemia, the control group (n=8) received an infusion of lactated Ringer's solution (three times the removed volume). The transfusion group (n=8) received two units of homologous 14-days stored RBC and lactated Ringer's solution in a volume that was three times the difference between blood removed and blood transfusion infused. Both groups were followed up for 6 h after resuscitation with collection of hemodynamic and respiratory data. Cytokines and RNA expression were measured in plasma and lung tissue. Stored RBC transfusion significantly increased mixed oxygen venous saturation and arterial oxygen content. Transfusion was not associated with alterations on pulmonary function. Pulmonary concentrations of cytokines were not different between groups. Gene expression for lung cytokines demonstrated a 2-fold increase in mRNA level for inducible nitric oxide synthase and a 0.5-fold decrease in mRNA content for IL-21 in the transfused group. Thus, stored homologous RBC transfusion in a hypovolemia model improved cardiovascular parameters but did not induce significant effects on microcirculation, pulmonary inflammation and respiratory function up to 6 h after transfusion.

Short-term effects of stored homologous red blood cell transfusion on cardiorespiratory function and inflammation: an experimental study in a hypovolemia model.

The pathophysiological mechanisms associated with the effects of red blood cell (RBC) transfusion on cardiopulmonary function and inflammation are unclear. We developed an experimental model of homologous 14-days stored RBC transfusion in hypovolemic swine to evaluate the short-term effects of transfusion on cardiopulmonary system and inflammation. Sixteen healthy male anesthetized swine (68±3.3 kg) were submitted to controlled hemorrhage (25% of blood volume). Two units of non-filtered RBC from each animal were stored under blood bank conditions for 14 days. After 30 min of hypovolemia, the control group (n=8) received an infusion of lactated Ringer's solution (three times the removed volume). The transfusion group (n=8) received two units of homologous 14-days stored RBC and lactated Ringer's solution in a volume that was three times the difference between blood removed and blood transfusion infused. Both groups were followed up for 6 h after resuscitation with collection of hemodynamic and respiratory data. Cytokines and RNA expression were measured in plasma and lung tissue. Stored RBC transfusion significantly increased mixed oxygen venous saturation and arterial oxygen content. Transfusion was not associated with alterations on pulmonary function. Pulmonary concentrations of cytokines were not different between groups. Gene expression for lung cytokines demonstrated a 2-fold increase in mRNA level for inducible nitric oxide synthase and a 0.5-fold decrease in mRNA content for IL-21 in the transfused group. Thus, stored homologous RBC transfusion in a hypovolemia model improved cardiovascular parameters but did not induce significant effects on microcirculation, pulmonary inflammation and respiratory function up to 6 h after transfusion.

Prior use of antithrombotic agents and neurological functional outcome at discharge in patients with ischemic stroke.

BACKGROUND: Studies in experimental animals have suggested that antithrombotic agents may have a neuroprotective effect after an ischemic injury. The aim of this study was to analyze the effect of prior use of antithrombotic agents (antiplatelets or anticoagulants) on neurological functional outcome in patients with acute ischemic stroke. SUBJECTS AND METHODS: Consecutive patients included in the Perugia Stroke Registry were considered for this analysis. Neurological functional outcome was evaluated at discharge using the modified Rankin Scale (mRS >or= 3 disabling stroke). RESULTS: Of the 1921 patients included in the analysis (mean age 76.3 +/- 12.5 years; 53% males), 662 (34.5%) were on antithrombotic treatment (581 antiplatelets, 71 anticoagulants and 10 antiplatelets associated with anticoagulants). One hundred and twenty-two patients (6.4%) died in hospital; at discharge 712 patients (37.1%) were disabled and 1,087 patients (56.6%) were non-disabled. Fifty-four (44.3%) of the deceased patients and 270 (37.9%) of disabled patients were on antithrombotic treatment, while 338 (31.1%) non-disabled patients were taking antithrombotic agents. From multivariate analysis, age and stroke severity were associated with an adverse outcome. Male gender, dyslipidemia, stroke due to small vessel disease and no history of previous stroke were associated with an improved outcome, while no correlation was found between prior use of antithrombotic agents and outcome (mortality odds ratio; OR = 1.32, 95% confidence interval; CI 0.85-2.04; P = 0.20, mortality or disability OR = 0.95, 95% CI 0.72-1.25; P = 0.80). CONCLUSION: Prior use of antithrombotic agents does not improve the functional outcome in patients with acute ischemic stroke.

Atrial fibrillation in patients with first-ever stroke: frequency, antithrombotic treatment before the event and effect on clinical outcome.

BACKGROUND AND PURPOSES: Atrial fibrillation (AF) is an independent risk factor for stroke. The aims of this study were to assess: (i) the frequency of known or unknown AF in patients admitted to the hospital for a first-ever ischemic stroke and whether AF is associated with an adverse outcome at discharge (death or disability); (ii) the rates and determinants for the use of antithrombotic agents before stroke in patients with known AF and the adherence to the current treatment guidelines; and (iii) whether the lack of adherence to the current guidelines is associated with adverse outcome at discharge. METHODS: Consecutive patients with acute first-ever stroke admitted to an individual Stroke Unit between January 2000 to December 2003, were included in the study. Twelve-lead electrocardiogram (ECG) was performed in all patients on admission. Functional outcome was measured at discharge according to modified Rankin Score. RESULTS: A total of 1549 patients were included in the study: 238 patients (15.4%) were known to have AF and 76 (4.9%) were diagnosed with AF (unknown) on ECG performed on admission. At discharge 91 patients (5.9%) had died and 605 patients (39.0%) had died or were functionally dependent. Multivariate analysis showed that AF on admission was correlated with mortality or disability (OR = 1.58, 95% CI 1.09-2.30, P = 0.015). Before stroke, 124 out of 238 patients with known AF (52.1%) were not on antithrombotic therapy, 83 (34.9%) were receiving antiplatelet and 31 (13.0%) anticoagulant treatment. Previous transient ischemic attack, history of ischemic heart disease and hyperlipidemia were associated with the use of antithrombotic therapy. Only 24 out of 114 patients on antithrombotic treatment on admission were adequately treated according to the current guidelines. Of the adequately treated patients, 41.7% died or were disabled at discharge respect to 52.3% of the patients non-adequately treated (RR = 0.80, 95% CI 0.48-1.30). CONCLUSIONS: AF (on history or new diagnosis) was present in 20.3% of the patients with first-ever stroke admitted to a Stroke Unit and it was associated with increased mortality or disability. Only 10% of patients with known AF were previously receiving an adequate antithrombotic treatment according to current guidelines.

[Estimating the grade of patient satisfaction at the bone marrow transplantation department in Florence hospitals]. / Misurazione del grado di soddisfazione dei pazienti nel reparto di trapianto di midollo osseo di Firenze.

The satisfaction of the patients admitted to the bone marrow transplant unit of Careggi Hospital was evaluated by the nursing team. The aim of the evaluation was to measure the level of satisfaction for the nursing care and services and the areas of improvement. The questionnaire, with 23 questions referring to 5 areas (hotel care, Nurses' reliability, Ability to reassure, to answer to patients' needs and Empathy) derived from the conceptual model of Servqual. Ninety patients were given (or mailed) the questionnaire during a follow-up visit. Patients were asked to answer the questions evaluating each aspect on a scale from 1 (falls short of expectation) to 10 (exceeds all expectations). The answers show a very high satisfaction (> 8) for all the areas except for the food that reported a medium score of 5.2. Further analysis will allow a better understanding of the causes of dissatisfaction.

Padronização da rotina operacional em banco de ossos realizada por um serviço hemoterápico: propostas de elaboração de normas / Guidelines to standardize an operation routine manual of a bone bank at Sírio-Libanês Hospital

Desde 1970 vem ocorrendo crescimento na utilização de ossos alogênicos em vários procedimentos ortopédicos, resultando na criação de bancos de ossos no mundo todo. Com o propósito de minimizar a morbidade nos receptores de ossos e padronizar procedimento operacionais para banco de ossos, os autores consideram necessário e fundamental estabelecer normas e critérios para regulamentar a doação de ossos. Seu objetivo é propor uma padronização para procedimentos operacionais em banco de ossos no Brasil. Com a finalidade de padronizar um manual operacional, vários manuais de padronização provenientes de instituições internacionais foram consultados, juntamente com a Portaria 1.376 do Ministério da Saúde (1993), por ser esta a referência concernente à doação de sangue no Brasil. Dessa maneira, parece ser plausível a adaptação de regulamentos internacionais para banco de ossos à legislação brasileira. Um manual de procedimentos operacionais em banco de ossos foi desenvolvido com o objetivo de padronizar os critérios para a retirada, identificação, processamento, estoque e liberação do material doado. Nesse manual também estão contidos os testes sorológicos mínimos para a investigação de doenças infecciosas e testes microbiológicos para o descarte de material contaminado. O banco de ossos necessita de um programa de controle de qualidade similar ao do banco de sangue. É recomendado que o banco de ossos seja gerenciado pelo banco de sangue, por sua experiência gerencial e sua estrutura operacional adequada para o manuseio do material doado.

Absence of serological surrogate markers for Trypanosoma-cruzi-infected blood donors.

Specific serological screening tests for Trypanosoma-cruzi-infected donors are not yet available and thus not routinely performed in North America. With the recent increase of Latin-American immigration to North America and Europe, there is a risk of transmission by blood products. In this study, we evaluated the possibility whether any of the serological screening tests currently recommended by the AABB could be used as a surrogate marker for this protozoarium. A group of 26,365 blood donors (male = 21,053 and female = 5,312) was analysed for the correlation of T. cruzi antibodies (TcAb) with other serological markers (HIV, HBsAg, ALT, HTLV-I/II, HCV, Anti-HBc, syphilis and unexpected hemoglobins other than A1, A2 and F). Association could be demonstrated only between syphilis and TcAb in the female group (p = 0.005), but the low number of donors found with this association (n = 4) renders the effect of this correlation very small. A higher prevalence of TcAb was found in older age groups, with even gender distribution (p < 0.05), however, donors aged more than 54 years also represent a minority of the donor pool (4.83%) and the detection of positive donors in this age group also has a minor preventive effect on transfusion-transmitted Chagas disease. We conclude that when infected blood donors must be detected, specific serological screening for TcAb is essential and that currently no surrogate marker can be considered for detecting T. cruzi-infected blood donors.

Electrophysiological and neuropsychological functions in patients treated with interferon-beta.

The neurotoxicity of interferon-beta (IFN-beta) was assessed by performing electrophysiological examinations and neuropsychological tests on 22 patients with malignant hematological diseases before, during, and after IFN-beta treatment. IFN-beta (6 x 10(6) IU/m2) was infused i.v. for 6 h daily for 7 days on alternate weeks for a total of three cycles (induction therapy) and was then continued at the same dose, twice a week, for an additional 24 weeks (maintenance therapy). Twenty-one of the 22 patients were evaluable. There were no significant changes in EEGs, visual evoked potentials, sensory conduction central time or motor nerve conduction velocity of two long nerves in the 15-19 patients studied before and after induction therapy, nor in the 6-8 patients investigated at the end of maintenance therapy. Neuropsychological monitoring failed to disclose any IFN-induced deterioration in 21 patients tested before and at the end of induction therapy or in the 10 patients who were also studied at the end of maintenance therapy. Despite certain limitations in the patient follow-up, the results underline the good general tolerance of IFN-beta.