Uso prolongado de cánula nasal de alto flujo en niños con problemas respiratorios / Prolonged use of high flow nasal cannula in children with respiratory problems

La cánula nasal de alto flujo (CNAF) es una modalidad ventilatoria no invasiva segura y efectiva, usada ampliamente en patología respiratoria aguda en adultos y niños. Objetivo: presentar casos clínicos pediátricos que utilizaron CNAF por tiempo prolongado por problemas respiratorios crónicos. Descripción de casos clínicos, revisión de fichas clínicas de 5 pacientes que utilizaron CNAF por más de 1 mes, entre los años 2017-2020 en el Complejo Asistencial Dr. Sótero del Río. Aprobado por Comité de Ética. Resultados: 5 pacientes varones de mediana 61 (44 a 212) días de edad al inicio del uso de CNAF. Diagnóstico de base: displasia broncopulmonar (2/5), síndrome de Treacher Collins (1/5), síndrome de cimitarra con hipoplasia pulmonar derecha (1/5) y traqueobroncomalacia severa (1/5). Todos requirieron previamente uso de ventilación invasiva o no invasiva con mediana de 59 (4 a 78) días. A todos se les realizó broncoscopia, saturometría contínua o poligrafía para diagnóstico y titulación de CNAF y oxígeno. Todos mejoraron clínicamente, la SpO2 y el número de apneas. Dos pacientes se enviaron a domicilio con uso de Airvo2 nocturno. La mediana de uso de CNAF fue 165 (34 a 445) días. Conclusiones: el uso prolongado de CNAF es útil en pacientes pediátricos seleccionados, bien tolerado y factible de utilizar en domicilio.

The high-flow nasal cannula (HFNC) is a safe and effective non-invasive ventilation support widely used in acute respiratory pathology in adults and children. Objective: To present pediatric clinical cases that used HFNC for an extended period due to chronic respiratory disease. Description of clinical cases, review of medical records of 5 patients who used HFNC for more than 1 month, between the years 2017-2020 at Complejo Asistencial Dr. Sótero del Río. Approved by the Ethics Committee. Results: 5 male patients with a median age of 61 (44 to 212) days at the start of HFNC use. Underlying diagnoses: bronchopulmonary dysplasia (2/5), Treacher Collins syndrome (1/5), Scimitar syndrome with right pulmonary hypoplasia (1/5), and severe tracheobronchomalacia (1/5). All of them previously required invasive or non-invasive ventilation for a median of 59 (4 to 78) days. All patients underwent bronchoscopy, continuous pulse oximetry or polygraphy for diagnosis and titration of HFNC and oxygen. All showed clinical improvement, including SpO2 levels and the number of apneas. Two patients were discharged with nocturnal use of Airvo 2 at home. The median duration of HFNC use was 165 (34 to 445) days. Conclusions: Prolonged use of HFNC is useful in selected pediatric patients, well tolerated, and feasible for home use.

Terapia con cánula nasal de alto flujo en pacientes pediátricos en domicilio / High flow nasal cannula therapy in pediatric patients at home

Se realiza comentario de estudio de Israel en el cual analizan 75 pacientes pediátricos que utilizaron cánula nasal de alto flujo (CNAF) en domicilio, evaluando la seguridad, las indicaciones, los parámetros de utilización, la duración del tratamiento, los resultados clínicos y la satisfacción de los padres. Se acompaña de una revisión de la literatura del tema.

A comment is made on a study conducted in Israel analyzing 75 pediatric patients who used high-flow nasal cannula at home, evaluating safety, indications, utilization parameters, treatment duration, clinical outcomes, and parental satisfaction. It is accompanied by a literature review on the topic.

Stenocereus huastecorum-fruit juice concentrate protects against cisplatin-induced nephrotoxicity by nitric oxide pathway activity and antioxidant and antiapoptotic effects.

Cisplatin (CP) is an antineoplastic agent used to treat solid tumors, that has high nephrotoxicity caused by physiologic, hemodynamic, and biochemical alterations. Some studies have shown that naturally derived bioactive compounds in CP-induced nephrotoxicity reduce the side effects of this antineoplastic drug. Pitaya is an endemic fruit from Mexico with a high bioactive compound content, including betalains and phenolic compounds, with reports of antioxidant and anti-inflammatory properties. In this study, the aim was to establish the effect of a pitaya juice concentrate (PJC) on CP-induced nephrotoxicity in Wistar male rats through the identification of metabolites, determination of its chemical composition and antioxidant activity, and evaluation of the protective effect of a PJC on CP-induced nephrotoxicity in rats. The PJC showed a high content of betanins with antioxidant activity by an oxygen radical absorbance capacity assay (1299.6 ± 2.80 Trolox equivalents/g). PJC was administered daily (400 mg day-1, p. o.) for 3 days before CP administration until the end of the experiment. On day four, rats were administered a single injection of CP (6 mg kg, i.p.-1) and sacrificed 72 h later. We observed that CP provoked renal dysfunction (1.0 ± 0.1 vs. 0.4 ± 0.07 serum creatinine levels), oxidative stress, a decrease in nitrate and nitrite (NO2¯/NO3¯) levels (0.1 ± 0.08 vs. 0.4 ± 0.3) and activation of apoptosis and immune responses in kidney tissue. In addition, CP treatment induced tubular damage threefold. PJC administration prevented renal dysfunction (0.5 ± 0.06 vs. 1.0 ± 0.1), normalized degenerative structural damage prevented the increase in lipoperoxidation levels (0.04 ± 0.01 vs. 0.2 ± 0.1) and reduced the apoptosis index by 2.5 in kidney tissue. However, it did not modify the immune response caused by CP. Furthermore, PJC treatment increased nuclear factor erythroid two related factors two protein levels two times and NO2¯/NO3¯ levels 22 times in kidney tissue, which may play a role in the renoprotective effect. In conclusion, the renoprotective effect of PJC on CP-induced nephrotoxicity was associated with the attenuation of dysfunction, structural damage, apoptosis activation, and oxidative stress and was related to changes in the tumor necrosis factor-alpha and renal nitric oxide (NO) pathways. The changes in the NO pathway may be involved in renal hemodynamics. Pitaya could be used as a functional food and therapeutic coadjuvant during CP treatments due to its high bioactive levels and renoprotective compounds.

Global metabolome analysis of Dunaliella tertiolecta, Phaeobacter italicus R11 Co-cultures using thermal desorption - Comprehensive two-dimensional gas chromatography - Time-of-flight mass spectrometry (TD-GC×GC-TOFMS).

Dunaliella tertiolecta is a marine microalgae that has been studied extensively as a potential carbon-neutral biofuel source (Tang et al., 2011). Microalgae oil contains high quantities of energy-rich fatty acids and lipids, but is not yet commercially viable as an alternative fuel. Carefully optimised growth conditions, and more recently, algal-bacterial co-cultures have been explored as a way of improving the yield of D. tertiolecta microalgae oils. The relationship between the host microalgae and bacterial co-cultures is currently poorly understood. Here, a complete workflow is proposed to analyse the global metabolomic profile of co-cultured D. tertiolectra and Phaeobacter italicus R11, which will enable researchers to explore the chemical nature of this relationship in more detail. To the best of the authors' knowledge this study is one of the first of its kind, in which a pipeline for an entirely untargeted analysis of the algal metabolome is proposed using a practical sample preparation, introduction, and data analysis routine.

Administración de radioyodo en cáncer diferenciado de tiroides bajo régimen hospitalario: a propósito de la implementación del aislamiento de radioyodoterapia en un hospital regional / Administration of radioiodine in differentiated thyroid cancer under a hospital regime: about the implementation of radioiodotherapy isolation in a regional hospital

Resumen Introducción El cáncer diferenciado de tiroides (CDT) presenta un aumento a nivel mundial. El uso selectivo de terapia con radioyodo (RAI) es un pilar de su tratamiento. Su efecto terapéutico se debe a la radiación beta, mientras que la gamma hace que sea necesaria la hospitalización para limitar la exposición de terceros. Objetivo Describir la seguridad de la administración de altas dosis de RAI en pacientes con CDT. Materiales y Método Estudio retrospectivo descriptivo. Se incluyó a todos los pacientes con diagnóstico de CDT que requirieron hospitalización para administración de RAI ≥ 30 mCi en el Hospital Regional de Talca (HRT) entre agosto-diciembre de 2018. Resultados Durante el período descrito 10 pacientes recibieron RAI bajo régimen hospitalario. La mediana de dosis de RAI administrada fue de 100 mCi (rango: 50-150 mCi). Todos los pacientes fueron manejados con asilamiento estricto. El promedio de hospitalización fue 28 horas, siendo dados de alta al reportar una tasa de dosis absorbida < 70 µSv/h a 1 metro. Se entregaron instrucciones al alta para minimizar el riesgo de irradiación o contaminación a terceras personas. Conclusiones Nuestro protocolo de administración de RAI permite tratar de manera segura a pacientes con CDT disminuyendo la exposición a radiación de terceros. Las salas de asilamiento de radioyodoterapia, podrían dar cobertura al 100% de la demanda de terapia con RAI en CDT a nivel local.

Introduction Differentiated thyroid cancer (CDT) presents an increase in global levels. The selective use of radioiodine therapy (RAI) is a pillar of its treatment. Its therapeutic effect is due to beta radiation, while gamma makes hospitalization necessary to limit exposure. Aim To describe the safety treated with RAI inpatients and the functioning of the radioactive isolation rooms of our center. Materials and Method Retrospective descriptive study. All patients diagnosed with CDT who required RAI therapy under a hospital regimen at the Regional Hospital of Talca (HRT) between August-December 2018 were included. Results During the period described, 10 patients were treated. The median dose of RAI administered was 100 mCi (range: 50-150 mCi). The average of hospitalization was 28 hours, being discharged when reporting an absorbed dose rate < 70 μSv/h at 1 meter, giving the patient instructions, so that they follow to minimize the risk of irradiation or contamination of people in their environment. Conclusions Our RAI administration protocol allows patients with CDT to be treated safely. The radioactive isolation rooms could cover 100% of the demand for RAI therapy in CDT at the local level.

Enfrentamiento de la osteoporosis post menopáusica en la consulta ginecológica / Coping with postmenopausal osteoporosis in the gynecological consultation

La osteoporosis es un desorden esquelético que afecta aproximadamente al 21% de las mujeres entre 50 y 84 años. Su importancia radica en que se asocia a un aumento en el riesgo de fractura, y por lo tanto, a un incremento en la morbimortalidad. El diagnóstico puede ser realizado mediante historia clínica o densitometría mineral ósea. Teniendo en cuenta que el sobrediagnóstico y sobretratamiento de osteoporosis en la práctica ginecológica es frecuente, es esencial conocer tanto las indicaciones para realizar densitometría como los criterios diagnósticos de la patología. El primer pilar para la prevención y tratamiento de osteoporosis es el ejercicio y el aporte adecuado de calcio y vitamina D. Los bifosfonatos son la terapia médica de primera línea, sin embargo, existen otras alternativas que han ha demostrado disminuir el riesgo de fractura osteoporótica como la terapia hormonal de la menopausia y el denosumab.

Osteoporosis is a skeletal disorder that affects approximately 21% of women between 50 and 84 years. It's an important public health issue because low bone mass leads to an increased risk of fracture, having negative consequences in morbidity and mortality in this population. Diagnosis is based in clinical history and bone densitometry. Over diagnosis and over treatment of osteoporosis is common in gynecologic practice. The knowledge of diagnostic criteria and indications to perform bone densitometry is relevant. Treatment of osteoporosis consists in lifestyle measures like exercise and adequate consumption of calcium and vitamin D. Bisphosphonates are first-line medical therapy, but alternative treatments including hormone replacement therapy and denosumab have also shown to decrease risk of fracture.

Role of sphingomyelinase in mitochondrial ceramide accumulation during reperfusion.

Ceramide accumulation in mitochondria has been associated with reperfusion damage, but the underlying mechanisms are not clearly elucidated. In this work we investigate the role of sphingomyelinases in mitochondrial ceramide accumulation, its effect on reactive oxygen species production, as well as on mitochondrial function by using the sphingomyelinase inhibitor, tricyclodecan-9-yl-xanthogenate (D609). Correlation between neutral sphingomyelinase (nSMase) activity and changes in ceramide content were performed in whole tissue and in isolated mitochondria from reperfused hearts. Overall results demonstrated that D609 treatment attenuates cardiac dysfuncion, mitochondrial injury and oxidative stress. Ceramide was accumulated in mitochondria, but not in the microsomal fraction of the ischemic-reperfused (I/R) group. In close association, the activity of nSMase increased, whereas glutathione (GSH) levels diminished in mitochondria after reperfusion. On the other hand, reduction of ceramide levels in mitochondria from I/R+D609 hearts correlated with diminished nSMase activity, coupling of oxidative phosphorylation and with mitochondrial integrity maintenance. These results suggest that mitochondrial nSMase activity contributes to compartmentation and further accumulation of ceramide in mitochondria, deregulating their function during reperfusion.

Consenso sobre el manejo de eventos de aparente amenaza a la vida del lactante (ALTE): comisión de sueño, sociedad chilena de neumología pediátrica 2013 / Consensus on evaluation and management of apparent life-threatening events in infancy (ALTE)

Un Evento de Aparente Amenaza de la Vida o ALTE (del inglés: Apparent Life Threatening Event) corresponde a un episodio agudo que ante los ojos del observador pone en riesgo la vida de un lactante menor de 1 año. Debe presentar la combinación de 2 o más de los criterios siguientes: apnea / cambio de color / alteración del tono / atoro e implicar la necesidad de algún tipo de maniobras para reanimar. En el presente consenso sobre el manejo de un ALTE se revisaron la evidencia internacional y nacional respecto al enfoque diagnóstico, estudio etiológico, criterios y duración de hospitalización y las indicaciones de monitorización domiciliaria.

Apparent life threatening events are defined as an acute episode in which the observer fears an infant < 1 year may die. ALTE is characterized by some combination of apnea, color or muscle tone change, chocking and has to be followed by cardiorespiratory reanimation. The present consensus paper reviews international and national evidence concerning diagnosis, etiologies, hospitalization criteria and indications for home monitoring.

Oxidative stress and lung injury induced by short-term exposure to wood smoke in guinea pigs.

Oxidative stress and lung injury induced by short-term exposure to wood smoke were evaluated in guinea pigs through cell profile, bronchoalveolar lavage (BAL), conventional histology and immunohistochemistry (4-hydroxynonenal, 3-nitrotyrosine, Mn-superoxide dismutase, heme oxygenase-1); malondialdehyde and 4-hydroxynonenal concentration, Mn-superoxide dismutase, glutathione reductase, glutathione peroxidase, and catalase activities in plasma, lung and BAL. Total cells increased in BAL, and the percentage of macrophages, neutrophils and lymphocytes augmented (72-96 h). Histopathological examination of lung tissues showed mild thickening of membranous bronchiole walls, infiltration of foamy macrophages and polymorphonuclear leukocytes in bronchial, bronchiolar and intraalveolar spaces. Goblet cell hyperplasia was also observed in bronchial and bronchiolar epithelia. Plasma malondialdehyde concentration was increased at all times, while 4-hydroxynonenal was increased only in plasma and BAL after 24 h. Plasma glutathione reductase activity increased at 24 and 72 h, BAL glutathione peroxidase activity decreased at 72 and 96 h, whereas catalase activity increased in plasma at 72 h, and decreased in BAL at 24 h. Immunostaining intensity to 4-hydroxynonenal, 3-nitrotyrosine, Mn-superoxide dismutase and heme oxygenase-1 was enhanced mainly in macrophages, bronchial/bronchiolar epithelial cells and type II pneumocytes after 72-96 h of wood smoke exposure. Overall, short-term exposure to wood smoke induces alterations in oxidative/antioxidant state in lung and airway injury, similar to those observed in humans with domestic exposure.

Effect of sunflower oil supplementation and milking frequency reduction on sheep milk production and composition.

The aim of this study was to investigate the effects of milking frequency reduction and dietary lipid supplementation on intake, BW, and milk yield and composition in high yielding dairy ewes. Ten lactating Assaf ewes were allocated into 2 experimental groups (n=5). Ewes were fed alfalfa hay ad libitum and 34 g·kg(-1) of BW of a concentrate feed with either 0 (Control group) or 43 g of sunflower oil·kg(-1) of DM (SO group). The experiment lasted 63 d and consisted of 3 periods. During Period 1 (from d 1 to 21), ewes were milked twice a day. During Period 2 (from d 22 to 49), ewes were unilaterally milked, so that each gland of each ewe was milked either once or twice daily. During Period 3 (from d 50 to the end of the experiment), both udder halves were again milked twice daily. Intake, BW, and milk composition were controlled weekly and milk production from each half udder was recorded twice a week. Total DM intake, BW, and milk yield in Period 1 were not significantly (P>0.10) affected by dietary treatments. Milk yield tended to be increased in the ewes fed the SO diet in periods 2 (P=0.093) and 3 (P=0.067). Oil supplementation (SO diet) significantly (P<0.05) decreased milk protein and total solids concentrations in the 3 experimental periods and fat content in Period 3, and tended (P=0.077) to decline fat content in Period 2. Lactose content and somatic cell count (SCC) were unaffected (P>0.10) by dietary lipid supplementation in any of the experimental periods. There were no significant (P>0.10) differences between half udders in milk yield and composition in Period 1, and in SCC in any of the experimental periods. Fat and total solids contents were unaffected (P>0.10) by reducing milking frequency. Nevertheless, milk protein content was increased (P<0.001) when glands were milked only once daily whereas milk yield and lactose content were decreased (P=0.001). The interaction between gland and diet was significant for lactose in Period 2, suggesting a greater effect of milking frequency reduction on tight junctions in Control ewes. In fact, the ratio between glands for milk yield was significantly (P<0.05) greater in SO (0.82) than in Control (0.72) ewes. In Period 3, this ratio increased but it was still lower in Control ewes (0.92 vs. 0.78, P<0.05). Thus, milking frequency reduction and SO supplementation seem to have counteracting effects on milk production and composition. Our results suggest that SO-supplemented ewes have a better capacity of adaptation to changes in milking frequency, probably due to processes induced in the mammary gland.

The liver antioxidant status of fattening lambs is improved by naringin dietary supplementation at 0.15% rates but not meat quality.

Twenty Assaf lambs fed barley straw plus a concentrate alone (CONTROL group) or enriched with naringin (1.5 g/kg DM, NARINGIN group) were used to assess the effect of this polyphenolic compound on meat quality attributes. Serum samples were collected for 7 weeks, then the animals were slaughtered and the livers and longissimus thoracis et lumborum muscles extracted for analysis. Triacylglycerol levels in the serum samples tended to show (P = 0.087) lower average values for the NARINGIN group when compared with the CONTROL, but no differences were observed when the meat was analysed for the intramuscular fat content. Lower thiobarbituric acid-reactive substances procedure (TBARS) values (P < 0.001) in the liver of the NARINGIN group were detected, probably as a consequence of naringenin accumulation in this organ. No significant differences were observed in the meat samples concerning TBARS or colour evolution during refrigerated storage, as not enough naringenin would have reached the muscle. Independent of naringin administration, the low levels of the most atherogenic oxysterols must be highlighted as the most important quality score in the lamb meat samples studied.

Naringin and vitamin E influence the oxidative stability and lipid profile of plasma in lambs fed fish oil.

Thirty two Merino lambs (15 weeks old) fed barley straw and fish oil enriched concentrate were used to assess the effect of vitamin E (6 g kg(-1) DM) and naringin (1.5-3 g kg(-1) DM) on plasma lipid peroxidation (TBARS), total antioxidant status (TAS), immune response, plasma cholesterol, and triglycerides. After 21 days feeding the experimental diets, lambs were subjected to a 4 h transportation stress period and then held 4 more hours without feed. TBARS values before stress were lower for animals consuming vitamine E and naringin when compared to control lambs (P<0.05). However, after stress all groups presented similar levels of TBARS. TAS decreased (P<0.05) in all groups in response to stress with values recovering (P<0.05) to pre-stress values following 4 h of rest. A rise (P<0.05) in serum concentrations of triacylglycerol following 21 d of fish oil supplementation was dampened in lambs consuming vitamin E or naringin. Both pre-stress TBARS and triacylglycerol-reducing effects of naringin added to fish oil enriched concentrate for fattening lambs are reported.

Fatores que afetam a germinação de sementes e emergência de plântulas de arruda (Ruta graveolens L. ) / Factors affecting seed germination and seedling emergence in rue (Ruta graveolens L. )

Ruta graveolens L., também conhecida com arruda, é planta originária do sul da Europa, cultivada no Brasil e em outros países como planta medicinal, muito utilizada em rituais religiosos. Tendo em vista que a germinação constitui um fator primordial para que a semente possa gerar uma planta vigorosa e com alto potencial produtivo, o presente trabalho teve como objetivo avaliar a resposta germinativa de sementes para arruda sob condições de temperatura, luminosidade, estresse hídrico e salino e emergência de plântulas em diferentes profundidades de semeadura. Sementes de Ruta graveolens são indiferentes à luz, germinando melhor em temperatura constante de 25ºC ou alterna (20-30ºC). Os potenciais osmóticos induzidos por manitol a partir de -0,4MPa e por NaCl a partir de -0,8MPa influenciam negativamente o processo germinativo. Maiores percentuais de plântulas são obtidas quando a espécie é semeada na superfície do substrato.

Ruta graveolens L., also known as rue, is from the south of Europe, cultivated in Brazil and other countries as a medicinal plant greatly used in religious rituals. Since germination is essential for the seed to generate a vigorous plant of high productive potential, this work aimed to evaluate the germinative response of rue seeds under different temperatures, luminosity conditions, and water and salt stress, besides seedling emergence at different sowing depths. Ruta graveolens L. seeds are indifferent to light, better germinating at constant temperature of 25ºC or alternated temperature (20-30ºC). The osmotic potentials induced by mannitol from -0.4MPa and by NaCl from -0.8MPa negatively influenced the germination process. Higher seedling percentages are obtained when the species is sown on the substratum surface.

Asistencia ventilatoria no invasiva en pediatría / Non-invasive ventilatory assistance: pediatrics considerations

Non-invasive ventilation (NIV) has extended its use in pediatric setting. Besides acute respiratory conditions, it is also used in chronic diseases associated to ventilatory failure. In the acute setting, PICU constitutes the natural scenery. In chronic conditions, therapy is transferred home as a multidisciplinary program already available in our country. The objective of this review is an update applying respiratory physiology, technical and clinical issues necessary for choosing and using accurately NIV in both acute and chronic settings.

La asistencia ventilatoria no invasiva (AVNI) es cada vez más utilizada en pacientes pediátricos; tanto en patologías respiratorias agudas, como en enfermedades crónicas que comprometen la bomba respiratoria en forma primaria o secundaria. En el escenario agudo, el paciente requiere de manejo intrahospitalario en Unidades de Paciente Critico (UPC), sin embargo en el paciente crónico su rol se extiende al hogar a través de programas multidisciplinarios integrales disponibles en nuestro país. El presente artículo de actualización pediátrica entrega las bases fisiológicas de la AVNI, sus diferentes modalidades, alternativas de interfases, sistemas de humedificación, aspectos de oxigenación y terapia broncodilatadora. Se entregan aspectos prácticos para la selección y empleo de la AVNI en el escenario agudo y crónico.

Rats with high left ventricular end-diastolic pressure can be identified by Doppler echocardiography one week after myocardial infarction

The severity of left ventricular (LV) dysfunction in rats with myocardial infarction (MI) varies widely. Because homogeneity in baseline parameters is essential for experimental investigations, a study was conducted to establish whether Doppler echocardiography (DE) could accurately identify animals with high LV end-diastolic pressure as a marker of LV dysfunction soon after MI. Direct measurements of LV end-diastolic pressure were made and DE was performed simultaneously 1 week after surgically induced MI (N = 16) or sham-operation (N = 17) in female Wistar rats (200 to 250 g). The ratio of peak early (E) to late (A) diastolic LV filling velocities and the ratio of E velocity to peak early (Em) diastolic myocardial velocity were the best predictors of high LV end-diastolic pressure (>12 mmHg) soon after MI. Cut-off values of 1.77 for the E/A ratio (P = 0.001) identified rats with elevated LV end-diastolic pressure with 90 percent sensitivity and 80 percent specificity. Cut-off values of 20.4 for the E/Em ratio (P = 0.0001) identified rats with elevated LV end-diastolic pressure with 81.8 percent sensitivity and 80 percent specificity. Moreover, E/A and E/Em ratios were the only echocardiographic parameters independently associated with LV end-diastolic pressure in multiple linear regression analysis. Therefore, DE identifies rats with high LV end-diastolic pressure soon after MI. These findings have implications for using serial DE in animal selection and in the assessment of their response to experimental therapies.

Primary chemotherapy with sequential docetaxel followed by docetaxel and epirubicin in large operable breast cancer.

UNLABELLED: Primary chemotherapy is increasingly used in patients with large operable breast cancer. Docetaxel and epirubicin are the most active agents in breast cancer treatment. PURPOSE: To evaluate clinical response rate, breast conserving surgery and pathological response rate in patients with large operable breast cancer treated with docetaxel followed by docetaxel and epirubicin as primary chemotherapy. PATIENTS AND METHODS: Patients with operable breast cancer more than 3 cm in the longest diameter with T2N0, T2N1 and T3N0 disease were enrolled. Patients were treated with three cycles of docetaxel 100 mg/m2 followed by three cycles of docetaxel 75 mg/m2 and epirubicin 90 mg/m2 prior to surgery. RESULTS: Sixty-five patients were enrolled between 09/2002 and 12/2005. The median age was 48.9 years and 72.3% were premenopausal. Median tumour size was 4.26 cm, 10.8% were T3 tumours and 38.5% had clinical positive lymph nodes. Of the tumours 58.5% were grade 1/2, 33.9% ER positive and 21.5% c-erb negative. All six cycles were administered to 62 patients; six cycles were delayed and five had dose reductions. Complete clinical response occurred in 41.5% of patients and partial response in 49.2%. Breast conserving surgery was performed in 30% of patients however it was feasible in 57%. Complete pathological response occurred in both primary tumour and nodes in 28%, and in 34% just in the primary tumour. Nine percent of cases had neutropenia and 7.7% febrile neutropenia, and two cases had a hypersensitivity reaction to docetaxel. One associated treatment death occurred. CONCLUSION: Docetaxel followed by epirubicin and docetaxel as primary chemotherapy results in a high clinical and pathological response rate. The majority of adverse events were predictable and manageable.

Performance of two-dimensional Doppler echocardiography for the assessment of infarct size and left ventricular function in rats

Although echocardiography has been used in rats, few studies have determined its efficacy for estimating myocardial infarct size. Our objective was to estimate the myocardial infarct size, and to evaluate anatomic and functional variables of the left ventricle. Myocardial infarction was produced in 43 female Wistar rats by ligature of the left coronary artery. Echocardiography was performed 5 weeks later to measure left ventricular diameter and transverse area (mean of 3 transverse planes), infarct size (percentage of the arc with infarct on 3 transverse planes), systolic function by the change in fractional area, and diastolic function by mitral inflow parameters. The histologic measurement of myocardial infarction size was similar to the echocardiographic method. Myocardial infarct size ranged from 4.8 to 66.6 percent when determined by histology and from 5 to 69.8 percent when determined by echocardiography, with good correlation (r = 0.88; P < 0.05; Pearson correlation coefficient). Left ventricular diameter and mean diastolic transverse area correlated with myocardial infarct size by histology (r = 0.57 and r = 0.78; P < 0.0005). The fractional area change ranged from 28.5 ± 5.6 (large-size myocardial infarction) to 53.1 ± 1.5 percent (control) and correlated with myocardial infarct size by echocardiography (r = -0.87; P < 0.00001) and histology (r = -0.78; P < 00001). The E/A wave ratio of mitral inflow velocity for animals with large-size myocardial infarction (5.6 ± 2.7) was significantly higher than for all others (control: 1.9 ± 0.1; small-size myocardial infarction: 1.9 ± 0.4; moderate-size myocardial infarction: 2.8 ± 2.3). There was good agreement between echocardiographic and histologic estimates of myocardial infarct size in rats.

Excitotoxic brain damage involves early peroxynitrite formation in a model of Huntington's disease in rats: protective role of iron porphyrinate 5,10,15,20-tetrakis (4-sulfonatophenyl)porphyrinate iron (III).

Oxidative/nitrosative stress is involved in NMDA receptor-mediated excitotoxic brain damage produced by the glutamate analog quinolinic acid. The purpose of this work was to study a possible role of peroxynitrite, a reactive oxygen/nitrogen species, in the course of excitotoxic events evoked by quinolinic acid in the brain. The effects of Fe(TPPS) (5,10,15,20-tetrakis (4-sulfonatophenyl)porphyrinate iron (III)), an iron porphyrinate and putative peroxynitrite decomposition catalyst, were tested on lipid peroxidation and mitochondrial function in brain synaptic vesicles exposed to quinolinic acid, as well as on peroxynitrite formation, nitric oxide synthase and superoxide dismutase activities, lipid peroxidation, caspase-3-like activation, DNA fragmentation, and GABA levels in striatal tissue from rats lesioned by quinolinic acid. Circling behavior was also evaluated. Increasing concentrations of Fe(TPPS) reduced lipid peroxidation and mitochondrial dysfunction induced by quinolinic acid (100 microM) in synaptic vesicles in a concentration-dependent manner (10-800 microM). In addition, Fe(TPPS) (10 mg/kg, i.p.) administered 2 h before the striatal lesions, prevented the formation of peroxynitrite, the increased nitric oxide synthase activity, the decreased superoxide dismutase activity and the increased lipid peroxidation induced by quinolinic acid (240 nmol/microl) 120 min after the toxin infusion. Enhanced caspase-3-like activity and DNA fragmentation were also reduced by the porphyrinate 24 h after the injection of the excitotoxin. Circling behavior from quinolinic acid-treated rats was abolished by Fe(TPPS) six days after quinolinic acid injection, while the striatal levels of GABA, measured one day later, were partially recovered. The protective effects that Fe(TPPS) exerted on quinolinic acid-induced lipid peroxidation and mitochondrial dysfunction in synaptic vesicles suggest a primary action of the porphyrinate as an antioxidant molecule. In vivo findings suggest that the early production of peroxynitrite, altogether with the enhanced risk of superoxide anion (O2*-) and nitric oxide formation (its precursors) induced by quinolinic acid in the striatum, are attenuated by Fe(TPPS) through a recovery in the basal activities of nitric oxide synthase and superoxide dismutase. The porphyrinate-mediated reduction in DNA fragmentation simultaneous to the decrease in caspase-3-like activation from quinolinic acid-lesioned rats suggests a prevention in the risk of peroxynitrite-mediated apoptotic events during the course of excitotoxic damage in the striatum. In summary, the protective effects that Fe(TPPS) exhibited both under in vitro and in vivo conditions support an active role of peroxynitrite and its precursors in the pattern of brain damage elicited by excitotoxic events in the experimental model of Huntington's disease. The neuroprotective mechanisms of Fe(TPPS) are discussed.

Avaliação econômica de bezerros alimentados com colostro fermentado, associado ao óleo de soja e zeranol / Economic evaluation of calves fed fermented colostrum, associated with soybean oil and zeranol

Utilizaram-se 40 bezerros Holandês x Zebu com objetivo de avaliar a viabilidade econômica da utilização do colostro fermentado, do óleo de soja e do zeranol em bezerros entre o 15º e o 60º dia de vida. Diariamente, foram fornecidos 1,5kg de concentrado contendo 23 por cento de proteína bruta, feno de tifton (Cynodon dactylon) à vontade e três litros de leite ou colostro fermentado. Considerando as despesas de criação e as receitas geradas, verificou-se menor custo dos animais tratados com colostro fermentado. Esse resultado, associado ao bom desempenho obtido, demonstrou que o colostro fermentado é eficiente como substituto do leite para bezerros em fase de aleitamento, gerando maior lucratividade.

Relación entre el síndrome de apnea obstructiva del sueño y el trastorno de déficit atencional con hiperactividad: estudio en una población de escolares chilenos / The relationship between obstructive sleep apnea syndrome and attention deficit hyperactivity disorder: a study in Chilean schoolchildren

Introducción: el síndrome de apnea obstructiva del sueño (SAOS) uqe afecta a 1-2 porciento de los niños, puede ser causa de importante morbilidad, como problemas conductuales y de rendimiento escolar. Objetivo: evaluar la asociación entre SAOS y trastorno de déficit atencional con hiperactividad (TDAH) en escolares en una comuna de Santiago. Métodos: se envió una encuesta a 50 padres de niños con diagnóstico de TDAH y a 100 niños controles, de edad y sexo similares, obtenidos de las mismas escuelas de los niños con TDAH. La encuesta incluyó información sobre datos generales, edad, sexo, peso, talla, promedio de notas; y un cuestionario de 12 preguntas para diagnóstico de SAOS, validado previamente en una población extranjera. Resultados: la respuesta de la encuesta fue de 84,6 porciento. No hubo diferencias significativas entre el grupo con TDAH y el grupo control de edad, peso, talla; si las hubo en sexo y promedio de notas (p < 0,01). El promedio del puntaje del cuestionario en niños con TDAH fue de 9 ñ 1,26, y en el grupo control de 6 ñ 0,66, (p < 0,05). Se encontraron preguntas del cuestionario que permitieron diferenciar, en forma significativa, niños con SAOS de otros sin esta patológia. Conclusiones: la presencia de SAOS es más frecuente en niños con TDAH que en controles, lo que podría tener una influencia en el déficit atencional de estos pacientes. Sugerimos buscar activamente problemas del sueño en niños con TDAH, con el objeto de proporcionar un tratamiento integral