Neutralization of extracellular histones by sodium-Β-O-methyl cellobioside sulfate in septic shock.

BACKGROUND: Extracellular histones have been associated with severity and outcome in sepsis. The aim of the present study was to assess the effects of sodium-ß-O-Methyl cellobioside sulfate (mCBS), a histone-neutralizing polyanion, on the severity and outcome of sepsis in an experimental model. METHODS: This randomized placebo-controlled experimental study was performed in 24 mechanically ventilated female sheep. Sepsis was induced by fecal peritonitis. Animals were randomized to three groups: control, early treatment, and late treatment (n = 8 each). mCBS was given as a bolus (1 mg/kg) followed by a continuous infusion (1 mg/kg/h) just after sepsis induction in the early treatment group, and 4 h later in the late treatment group. Fluid administration and antimicrobial therapy were initiated 4 h T4 after feces injection, peritoneal lavage performed, and a norepinephrine infusion titrated to maintain mean arterial pressure (MAP) between 65-75 mmHg. The experiment was blinded and lasted maximum 24 h. RESULTS: During the first 4 h, MAP remained > 65 mmHg in the early treatment group but decreased significantly in the others (p < 0.01 for interaction, median value at T4: (79 [70-90] mmHg for early treatment, 57 [70-90] mmHg for late treatment, and 55 [49-60] mmHg for the control group). mCBS-treated animals required significantly less norepinephrine to maintain MAP than controls (p < 0.01 for interaction) and had lower creatinine (p < 0.01), lactate (p < 0.01), and interleukin-6 (p < 0.01) levels, associated with reduced changes in H3.1 nucleosome levels (p = 0.02). Early treatment was associated with lower norepinephrine requirements than later treatment. Two control animals died; all the mCBS-treated animals survived. CONCLUSIONS: Neutralization of extracellular histones with mCBS was associated with reduced norepinephrine requirements, improved tissue perfusion, less renal dysfunction, and lower circulating IL-6 in experimental septic shock and may represent a new therapeutic approach to be tested in clinical trials.

Bariatric surgery on social media: A cross-sectional study.

INTRODUCTION: Bariatric Surgery (BS) represents a viable option for the treatment of obesity and its risks. Nevertheless, it is still being underused by the eligible patient population because of the general lack of information, false beliefs, and the stigmatization of obesity. Social media seems to be a solution for overcoming this problem. MATERIALS AND METHODS: The search terms "Bariatric surgery", "Metabolic surgery", "Obesity surgery" and "Weight loss surgery" were employed to analyze the Twitter accounts and Facebook pages dedicated to Bariatric Surgery. The most relevant metadata from each account was collected and analyzed with descriptive statistics. RESULTS: 293 Facebook pages and 122 Twitter accounts were analyzed, being most of them created in the US (42%). No significant differences were found between the mean of followers of both platforms. Medical centers were the biggest creator category with 69.24% of the total number of followers. Although the promotion of medical services accounted for 68.65% of the total number of followers, the promotion of medical products had a significant higher mean of followers. (p = 0.002). CONCLUSION: Doctors and businesses acknowledge the importance of social media for informing patients about BS and promoting their services. Accounts with commercial purposes presented the highest number of followers. The high number of supporters this commercial content has, along with the relative lack of followers in educational and support groups, could lead to undeliberate decisions in detriment of the patients and their well-being.

Fetoscopic laser ablation in twin-to-twin transfusion syndrome: tips for counselling.

Twin-to-twin transfusion syndrome (TTTS) is a serious complication that affects approximately 10-15% of monochorionic twin pregnancies. The most important role for the development of this condition is the presence of an unbalanced flow through the inter-twin vascular anastomoses. Depending on the number, type and direction of the connecting vessels, blood can be transfused disproportionately from one twin (the donor) to the other twin (the recipient). The diagnosis is defined prenatally by ultrasound and involves of two main criteria: the presence of a monochorionic diamniotic (MCDA) pregnancy; and the presence of oligohydramnios in the donor's sac- deep vertical pocket (DVP) 2 cm - and polyhydramnios in the recipient's sac- DVP>8 cm. Once diagnosed, TTTS is usually graded by using the Quintero staging system, that is composed by five stages, from oligohydramnios in the donor and polyhydramnios in the recipient twin to fetal demise in one or both twins. Photocoagulation of the anastomotic vessels, usually followed by equatorial dichorionization, it has currently become the most common fetoscopic operation today and is considered as the gold standard for stage II-IV TTTS. pPROM, chorioamniotic separation and iatrogenic preterm birth are among the most common complications of fetoscopic laser ablation, and the mean gestational age at delivery after laser procedure is about 31 weeks.