Blockade of sympathetic ganglia improves vascular dysfunction in septic shock.

Sepsis/septic shock activates the sympathetic nervous system (SNS) to deal with the infection stress. However, an imbalanced or maladaptive response due to excessive or uncontrolled activation characterizes autonomic dysfunction. Our hypothesis was that reducing this excessive activation of the autonomic nervous system would impact positively in sepsis. Using ganglionic blockers as a pharmacological approach, the main aim of the present report was to assess the role of ganglionic transmission in the vascular dysfunction associated with sepsis.Sepsis was induced in rats by cecal ligation and puncture (CLP). One hour after CLP surgery, rats were treated subcutaneously with hexamethonium (15 mg/kg; ganglionic blocker), pentolinium (5 mg/kg; a blocker with a higher selectivity for sympathetic ganglia compared to hexamethonium), or vehicle (PBS). Basal blood pressure and the response to adrenergic agonists were evaluated at 6 and 24 h after CLP surgery. Reactivity to vasoconstrictors, nitric oxide (NO) synthase 2 (NOS-2) expression, IL-1 and TNF plasma levels, and density of α1 adrenergic receptors were evaluated in the aorta 24 h after CLP.Septic shock resulted in hypotension and hyporesponsiveness to norepinephrine and phenylephrine, increased plasma cytokine levels and NOS-2 expression in the aorta, and decreased α1 receptor density in the same vessel. Pentolinium but not hexamethonium recovered responsiveness and α1 adrenergic receptor density in the aorta. Both blockers normalized the in vivo response to vasoconstrictors, and reduced plasma IL-1 and NOx levels and NOS-2 expression in the aorta.Blockade of ganglionic sympathetic transmission reduced the vascular dysfunction in experimental sepsis. This beneficial effect seems to be, at least in part, due to the preservation of α1 adrenergic receptor density and to reduced NOS-2 expression and may lead to adjuvant ways to treat human sepsis.

EARLY BLOOD LACTATE AS A BIOMARKER FOR CARDIOVASCULAR COLLAPSE IN EXPERIMENTAL SEPSIS.

ABSTRACT: Cecal ligation and puncture (CLP) is the gold standard model for studying septic shock, which is characterized by hypotension and hyporeactivity to vasoconstrictors. However, approximately 30% of CLP animals do not exhibit cardiovascular changes, requiring more replicates because of the high variability of the model. Therefore, biomarkers enabling the early prediction of cardiovascular collapse in sepsis would greatly benefit sepsis nonclinical studies, refining experimental models and improving clinical translation. Thus, this study aimed to test whether the early increase in lactate levels could predict hypotension and hyporesponsiveness to vasoconstrictors in a rat model of sepsis. Male and female Wistar rats were subjected to CLP or sham procedure. Tail blood lactate was measured 6, 12, and 24 h after surgery. Then, inflammatory, biochemical, and hemodynamic parameters were evaluated. Rats subjected to CLP developed hypotension, hyporesponsiveness to vasoconstrictors, an intense inflammatory process, and increased plasma markers of organ dysfunction. By using receiver operating characteristics curve analysis, we have established that a lactate value of 2.45 mmol/L can accurately discriminate between a rat exhibiting a normal vasoconstrictive response and a vasoplegic rat with 84% accuracy (area under the curve: 0.84; confidence interval [CI]: 0.67-1.00). The sensitivity, which is the ability to identify a diseased rat (true positive), was 75% (CI: 41-95), and the true negative rate was 81% (CI: 57-93). Therefore, early measurement of lactate levels in sepsis could serve as a valuable biomarker for distinguishing vasoplegic rats from those exhibiting normal vasoconstrictive responses.

Cannabinoid CB2 receptor agonist reduces local and systemic inflammation associated with pneumonia-induced sepsis in mice.

Sepsis is a severe condition secondary to dysregulated host response to infection leading to tissue damage and organ dysfunction. Cannabinoid CB2 receptor has modulatory effects on the immune response. Therefore, this study investigated the effects of a cannabinoid CB2 receptor agonist on the local and systemic inflammatory process associated with pneumonia-induced sepsis. Pneumonia-induced sepsis was induced in mice by intratracheal inoculation of Klebsiella pneumoniae. Tissue and bronchoalveolar lavage (BAL) were collected 6, 24, or 48 h after surgery. Mice were treated with CB2 agonist (AM1241, 0.3 and 3 mg/kg, i.p.) and several parameters of inflammation were evaluated 24 h after sepsis induction. Polymorphonuclear cell migration to the infectious focus peaked 24 h after pneumonia-induced sepsis induction in male and female animals. Septic male mice presented a significant reduction of cannabinoid CB2 receptor density in the lung tissue after 24 h, which was not observed in females. CB2 expression in BAL macrophages was also reduced in septic animals. Treatment of septic mice with AM1241 reduced cell migration, local infection, myeloperoxidase activity, protein extravasation, and NOS-2 expression in the lungs. In addition, the treatment reduced plasma IL-1ß, increased IL-10 and reduced the severity and mortality of septic animals. These results suggest that AM1241 promotes an interesting balance in the inflammatory response, maintaining lung function and preventing organ injury. Therefore, cannabinoid CB2 receptors are potential targets to control the excessive inflammatory process that occurs in severe conditions, and agonists of these receptors can be considered promising adjuvants in pneumonia-induced sepsis treatment.

Inhibition of Bruton's Tyrosine Kinase Activity Attenuates Hemorrhagic Shock-Induced Multiple Organ Dysfunction in Rats.

OBJECTIVE: The aim of this study was to investigate (a) the potential of the Bruton's tyrosine kinase (BTK) inhibitors acalabrutinib and fenebrutinib to reduce multiple organ dysfunction syndrome (MODS) in acute (short-term and long-term follow-up) hemorrhagic shock (HS) rat models and (b) whether treatment with either acalabrutinib or fenebrutinib attenuates BTK, NF-κB and NLRP3 activation in HS. BACKGROUND: The MODS caused by an excessive systemic inflammatory response following trauma is associated with a high morbidity and mortality. The protein BTK is known to play a role in the activation of the NLRP3 inflammasome, which is a key component of the innate inflammatory response. However, its role in trauma-hemorrhage is unknown. METHODS: Acute HS rat models were performed to determine the influence of acalabrutinib or fenebrutinib on MODS. The activation of BTK, NF-κB and NLRP3 pathways were analyzed by western blot in the kidney. RESULTS: We demonstrated that (a) HS caused organ injury and/or dysfunction and hypotension (post-resuscitation) in rats, while (b) treatment of HS-rats with either acalabrutinib or fenebrutinib attenuated the organ injury and dysfunction in acute HS models and (c) reduced the activation of BTK, NF- kB and NLRP3 pathways in the kidney. CONCLUSION: Our results point to a role of BTK in the pathophysiology of organ injury and dysfunction caused by trauma/hemorrhage and indicate that BTK inhibitors may be repurposed as a potential therapeutic approach for MODS after trauma and/or hemorrhage.

Pharmacological Inhibition of FAK-Pyk2 Pathway Protects Against Organ Damage and Prolongs the Survival of Septic Mice.

Sepsis and septic shock are associated with high mortality and are considered one of the major public health concerns. The onset of sepsis is known as a hyper-inflammatory state that contributes to organ failure and mortality. Recent findings suggest a potential role of two non-receptor protein tyrosine kinases, namely Focal adhesion kinase (FAK) and Proline-rich tyrosine kinase 2 (Pyk2), in the inflammation associated with endometriosis, cancer, atherosclerosis and asthma. Here we investigate the role of FAK-Pyk2 in the pathogenesis of sepsis and the potential beneficial effects of the pharmacological modulation of this pathway by administering the potent reversible dual inhibitor of FAK and Pyk2, PF562271 (PF271) in a murine model of cecal ligation and puncture (CLP)-induced sepsis. Five-month-old male C57BL/6 mice underwent CLP or Sham surgery and one hour after the surgical procedure, mice were randomly assigned to receive PF271 (25 mg/kg, s.c.) or vehicle. Twenty-four hours after surgery, organs and plasma were collected for analyses. In another group of mice, survival rate was assessed every 12 h over the subsequent 5 days. Experimental sepsis led to a systemic cytokine storm resulting in the formation of excessive amounts of both pro-inflammatory cytokines (TNF-α, IL-1ß, IL-17 and IL-6) and the anti-inflammatory cytokine IL-10. The systemic inflammatory response was accompanied by high plasma levels of ALT, AST (liver injury), creatinine, (renal dysfunction) and lactate, as well as a high, clinical severity score. All parameters were attenuated following PF271 administration. Experimental sepsis induced an overactivation of FAK and Pyk2 in liver and kidney, which was associated to p38 MAPK activation, leading to increased expression/activation of several pro-inflammatory markers, including the NLRP3 inflammasome complex, the adhesion molecules ICAM-1, VCAM-1 and E-selectin and the enzyme NOS-2 and myeloperoxidase. Treatment with PF271 inhibited FAK-Pyk2 activation, thus blunting the inflammatory abnormalities orchestrated by sepsis. Finally, PF271 significantly prolonged the survival of mice subjected to CLP-sepsis. Taken together, our data show for the first time that the FAK-Pyk2 pathway contributes to sepsis-induced inflammation and organ injury/dysfunction and that the pharmacological modulation of this pathway may represents a new strategy for the treatment of sepsis.

Resolvin D1 Attenuates the Organ Injury Associated With Experimental Hemorrhagic Shock.

OBJECTIVE: To evaluate the potential changes in the plasma levels of resolvin D1 (RvD1) in patients with trauma and hemorrhage. Having found that trauma results in a profound reduction in plasma RvD1 in patients, we have then investigated the effects of RvD1 on the organ injury and dysfunction associated with hemorrhagic shock (HS) in the rat. BACKGROUND: HS is a common cause of death in trauma due to excessive systemic inflammation and multiple organ failure. RvD1 is a member of the resolvin family of pro-resolution mediators. METHODS: Blood samples were drawn from critically injured patients (n = 27, ACITII-prospective observational cohort study) within 2 hours of injury for targeted liquid chromatography tandem mass spectrometry. HS rats (removal of blood to reduce arterial pressure to 30 ±â€Š2 mm Hg, 90 minutes, followed by resuscitation) were treated with RvD1 (0.3 or 1 µg/kg intravenous (i.v.)) or vehicle (n = 7). Parameters of organ injury and dysfunction were determined. RESULTS: Plasma levels of RvD1 (mg/dL) were reduced in patients with trauma+HS (0.17 ±â€Š0.08) when compared with healthy volunteers (0.76 ±â€Š0.25) and trauma patients (0.62 ±â€Š0.20). In rats with HS, RvD1 attenuated the kidney dysfunction, liver injury, and tissue ischemia. RvD1 also reduced activation of the nuclear factor (NF)-κB pathway and reduced the expression of pro-inflammatory proteins such as inducible nitric oxide synthase, tumor necrosis factor-α, interleukin-1ß, and interleukin-6. CONCLUSION: Plasma RvD1 is reduced in patients with trauma-HS. In rats with HS, administration of synthetic RvD1 on resuscitation attenuated the multiple organ failure associated with HS by a mechanism that involves inhibition of the activation of NF-κB.

The role of potassium channels in the endothelial dysfunction induced by periodontitis

Abstract Objective: Periodontitis is associated with endothelial dysfunction, which is clinically characterized by a reduction in endothelium-dependent relaxation. However, we have previously shown that impairment in endothelium-dependent relaxation is transient. Therefore, we evaluated which mediators are involved in endothelium-dependent relaxation recovery. Material and methods: Rats were subjected to ligature-induced experimental periodontitis. Twenty-one days after the procedure, the animals were prepared for blood pressure recording, and the responses to acetylcholine or sodium nitroprusside were obtained before and 30 minutes after injection of a nitric oxide synthase inhibitor (L-NAME), cyclooxygenase inhibitor (Indomethacin, SC-550 and NS- 398), or calcium-dependent potassium channel blockers (apamin plus TRAM- 34). The maxilla and mandible were removed for bone loss analysis. Blood and gingivae were obtained for C-reactive protein (CRP) and myeloperoxidase (MPO) measurement, respectively. Results: Experimental periodontitis induces bone loss and an increase in the gingival MPO and plasmatic CRP. Periodontitis also reduced endothelium-dependent vasodilation, a hallmark of endothelial dysfunction, 14 days after the procedure. However, the response was restored at day 21. We found that endothelium-dependent vasodilation at day 21 in ligature animals was mediated, at least in part, by the activation of endothelial calcium-activated potassium channels. Conclusions: Periodontitis induces impairment in endothelial-dependent relaxation; this impairment recovers, even in the presence of periodontitis. The recovery is mediated by the activation of endothelial calcium-activated potassium channels in ligature animals. Although important for maintenance of vascular homeostasis, this effect could mask the lack of NO, which has other beneficial properties.

Inhibition of IκB Kinase at 24 Hours After Acute Kidney Injury Improves Recovery of Renal Function and Attenuates Fibrosis.

BACKGROUND: Acute kidney injury (AKI) is a major risk factor for the development of chronic kidney disease. Nuclear factor-κB is a nuclear transcription factor activated post-ischemia, responsible for the transcription of proinflammatory proteins. The role of nuclear factor-κB in the renal fibrosis post-AKI is unknown. METHODS AND RESULTS: We used a rat model of AKI caused by unilateral nephrectomy plus contralateral ischemia (30 minutes) and reperfusion injury (up to 28 days) to show impairment of renal function (peak: 24 hours), activation of nuclear factor-κB (peak: 48 hours), and fibrosis (28 days). In humans, AKI is diagnosed by a rise in serum creatinine. We have discovered that the IκB kinase inhibitor IKK16 (even when given at peak serum creatinine) still improved functional and structural recovery and reduced myofibroblast formation, macrophage infiltration, transforming growth factor-ß expression, and Smad2/3 phosphorylation. AKI resulted in fibrosis within 28 days (Sirius red staining, expression of fibronectin), which was abolished by IKK16. To confirm the efficacy of IKK16 in a more severe model of fibrosis, animals were subject to 14 days of unilateral ureteral obstruction, resulting in tubulointerstitial fibrosis, myofibroblast formation, and macrophage infiltration, all of which were attenuated by IKK16. CONCLUSIONS: Inhibition of IκB kinase at peak creatinine improves functional recovery, reduces further injury, and prevents fibrosis.

Artesunate Protects Against the Organ Injury and Dysfunction Induced by Severe Hemorrhage and Resuscitation.

OBJECTIVE: To evaluate the effects of artesunate on organ injury and dysfunction associated with hemorrhagic shock (HS) in the rat. BACKGROUND: HS is still a common cause of death in severely injured patients and is characterized by impairment of organ perfusion, systemic inflammatory response, and multiple organ failure. There is no specific therapy that reduces organ injury/dysfunction. Artesunate exhibits pharmacological actions beyond its antimalarial activity, such as anticancer, antiviral, and anti-inflammatory effects. METHODS: Rats were submitted to HS. Mean arterial pressure was reduced to 30 mm Hg for 90 minutes, followed by resuscitation. Rats were randomly treated with artesunate (2.4 or 4.8 mg/kg i.v.) or vehicle upon resuscitation. Four hours later, parameters of organ injury and dysfunction were assessed. RESULTS: Artesunate attenuated the multiple organ injury and dysfunction caused by HS. Pathway analysis of RNA sequencing provided good evidence to support an effect of artesunate on the Akt-survival pathway, leading to downregulation of interleukin-1 receptor-associated kinase 1. Using Western blot analysis, we confirmed that treatment of HS rats with artesunate enhanced the phosphorylation (activation) of Protein kinase B (Akt) and endothelial nitric oxide synthase and the phosphorylation (inhibition) of glycogen synthase kinase-3ß (GSK-3ß). Moreover, artesunate attenuated the HS-induced activation of nuclear factor kappa B and reduced the expression of proinflammatory proteins (inducible nitric oxide synthase, tumor necrosis factor-α, and interleukin 6). CONCLUSIONS: Artesunate attenuated the organ injury/dysfunction associated with HS by a mechanism that involves the activation of the Akt-endothelial nitric oxide synthase survival pathway, and the inhibition of glycogen synthase kinase-3ß and nuclear factor kappa B. A phase II clinical trial evaluating the effects of good manufacturing practice-artesunate in patients with trauma and severe hemorrhage is planned.

Neuronal Nitric Oxide Synthase is Involved in Vascular Hyporeactivity and Multiple Organ Dysfunction Associated with Hemorrhagic Shock.

Severe hemorrhage can lead to global ischemia and hemorrhagic shock (HS), resulting in multiple organ failure (MOF) and death. Restoration of blood flow and re-oxygenation is associated with an exacerbation of tissue injury and inflammatory response. The neuronal nitric oxide synthase (nNOS) has been implicated in vascular collapse and systemic inflammation of septic shock; however, the role of nNOS in HS is poorly understood. The aim of this study was to evaluate the role of nNOS in the MOF associated with HS.Rats were subjected to HS under anesthesia. Mean arterial pressure was reduced to 30  mmHg for 90  min, followed by resuscitation with shed blood. Rats were randomly treated with two chemically distinct nNOS inhibitors [ARL 17477 (1 mg/kg) and 7-nitroindazol (5 mg/kg)] or vehicle upon resuscitation. Four hours later, parameters of organ injury and dysfunction were assessed.HS was associated with MOF development. Inhibition of nNOS activity at resuscitation protected rats against the MOF and vascular dysfunction. In addition, treatment of HS rats with nNOS inhibitors attenuated neutrophil infiltration into target organs and decreased the activation of NF-κB, iNOS expression, NO production, and nitrosylation of proteins. Furthermore, nNOS inhibition also reduced the levels of pro-inflammatory cytokines TNF-α and IL-6 in HS rats.In conclusion, two distinct inhibitors of nNOS activity reduced the MOF, vascular dysfunction, and the systemic inflammation associated with HS. Thus, nNOS inhibitors may be useful as an adjunct therapy before fluids and blood administration in HS patients to avoid the MOF associated with reperfusion injury during resuscitation.

Indignação: entre o fim da ingenuidade e o prenúncio da tragédia / Indignation: between the end of naivety and the beginning of tragedy

O presente trabalho consiste num exercício psicanalítico inspirado na leitura do livro Indignação de Phillip Roth (2008). Seu principal objetivo é discutir, à luz da teoria do campo psicanalítico, a organização de um campo geracional crivado de conflitos que conduzem o herói do romance a um desfecho trágico. Inspirados na teoria do campo (Baranger & Baranger, 1961-62), os autores introduzem o tema proposto a partir de duas falas dos protagonistas da trama construída por Roth, como se estivessem se apresentando em uma sessão psicanalítica. No seguimento, apresentam algumas considerações sobre a obra e seu autor e sobre o campo criado entre o leitor e o processo de leitura. Por fim, buscam explorar, estimulados pela riqueza dramática da leitura do romance, alguns aspectos psicanalíticos sobre a trajetória do herói, cujo afastamento deliberado do convívio familiar é um disfarce inconsciente para a dificuldade de enfrentar o confronto geracional. As hipóteses psicanalíticas de filicídio e simbiose pai-filho são consideradas(AU)

This paper is a psychoanalytic exercise encouraged by the reading of the book Indignation by Philip Roth (2008). In light of the psychoanalytic field theory, the authors discuss the organization of a conflictual generational field that eventually leads the novel's hero to a tragic outcome. Inspired by field theory (Baranger & Baranger, 1961-62), they start by imagining how the two main characters of the book would talk about themselves to an analyst in a psychoanalytic session. Next, some thoughts about Phillip Roth and his work are presented, as well as the field that was created between the reader and the reading process. Finally, moved by the dramatic richness of the novel, the authors investigate some of the psychoanalytical aspects about the hero´s trajectory, whose deliberate departure from his family was an unconscious disguise for the difficulty in facing the generational confrontation. The hypotheses of filicide and father-son symbiosis are considered.(AU)

El presente trabajo consiste en un ejercicio psicoanalítico inspirado en la lectura del libro Indignación, de Phillip Roth (2008). Su principal objetivo es discutir, a la luz de la teoría del campo psicoanalítico, la organización de un campo generacional minado de conflictos que conducen al héroe de la novela a un desenlace trágico. Inspirados en la teoría del campo (Baranger & Baranger, 1961- 62), los autores introducen el tema propuesto a partir de dos intervenciones de los protagonistas del argumento construido por Roth como si estuvieran presentándose en una sesión psicoanalítica. Acto seguido, plantean algunas consideraciones sobre la obra y su autor y sobre el campo creado entre el lector y el proceso de lectura. Por último, buscan explorar, estimulados por la riqueza dramática de la lectura de la novela, algunos aspectos psicoanalíticos sobre la trayectoria del héroe, cuyo alejamiento deliberado de la convivencia familiar es un disfraz inconsciente de la dificultad de enfrentar el conflicto generacional. Las hipótesis de filicidio y simbiosis padre-hijo son manejadas

Rodas de conversa entre a educação e a psicanálise / Conversation circles involving education and psychoanalysis

Os autores apresentam a experiência de um trabalho em parceria de um grupo de psicanalistas da Sociedade Psicanalítica de Porto Alegre (SPPA) com a Secretaria Municipal de Educação de Porto Alegre (SMED) junto às instituições de educação infantil. Na atividade (Rodas de Conversa), participam os profissionais envolvidos na educação cotidiana das crianças em comunidades de alta vulnerabilidade social. Ressaltam que, a partir de uma atitude de acolhimento e continência das vivências compartilhadas, mais do que respostas/soluções às perguntas, os participantes conversam sobre as situações com vistas a encontrar alternativas possíveis e a tolerar não ter condições para resolver todos os problemas, a ouvir o que o outro tem a dizer e a aprender com a narrativa do outro. Observa-se que a autoestima dos educadores se fortalece percebendo que são capazes de avançar em sua trajetória pessoal e profissional. Finalizam trazendo questionamentos sobre o alcance do trabalho realizado, reconhecendo que segue sendo uma atividade em construção nestes nove anos.

The authors report on the experience of a series of meetings held by a group of psychoanalysts from the Psychoanalytical Society of Porto Alegre (SPPA) in collaboration with the Municipal Secretariat for Education of Porto Alegre (SMED) together with early childhood education institutions. Professionals involved on a daily basis in the education of children from communities with a high degree of social vulnerability took part in this activity (Conversation Circles). They highlight that, by embracing and containing shared experiences, rather than merely answering/solving questions, the participants discussed the situations with the aim of finding possible alternatives and accepting the inability to solve all problems, and also of listening to what the other has to say and of learning from the other's narrative. It was observed that the educators' self-esteem increased as they realized to be able to make steps forward in their personal and professional trajectory. The authors conclude by raising questions about the scope of the work carried out, while recognizing it remains as an activity in progress over the past nine years(AU)

Los autores presentan la experiencia de un trabajo conjunto de un grupo de psicoanalistas de la Sociedade Psicanalítica de Porto Alegre (SPPA) y de la Secretaría Municipal de Educación de Porto Alegre (SMED) en instituciones de educación inicial. En la actividad (Ruedas de Diálogo), participaron profesionales involucrados en la educación cotidiana de niños pertenecientes a comunidades de alta vulnerabilidad social. Resaltan los autores que, a partir de una actitud de acogida y contención de las vivencias compartidas, más que respuestas/soluciones para sus preguntas, los participantes conversaron sobre las situaciones con vistas a encontrar alternativas posibles y a tolerar no tener condiciones para solucionar todos los problemas, a escuchar lo que el otro tiene para decir y a aprender con el relato del otro. Se observó que la autoestima de los educadores se fortalece cuando perciben que son capaces de avanzar en su trayectoria personal y profesional. Esta presentación culmina con planteamientos sobre el alcance del trabajo realizado, reconociendo que sigue siendo una actividad en construcción en estos nueve años(AU)

Inhibition of IκB Kinase Attenuates the Organ Injury and Dysfunction Associated with Hemorrhagic Shock.

Nuclear factor-kappa B (NF-κB) activation is widely implicated in multiple organ failure (MOF); however, a direct inhibitor of IκB kinase (IKK), which plays a pivotal role in the activation of NF-κB, has not been investigated in shock. Thus, the aim of the present work was to investigate the effects of an IKK inhibitor on the MOF associated with hemorrhagic shock (HS). Therefore, rats were subjected to HS and were resuscitated with the shed blood. Rats were treated with the inhibitor of IKK or vehicle at resuscitation. Four hours later, blood and organs were assessed for organ injury and signaling events involved in the activation of NF-κB. Additionally, survival following serum deprivation was assessed in HK-2 cells treated with the inhibitor of IKK. HS resulted in renal dysfunction, lung, liver and muscular injury, and increases in serum inflammatory cytokines. Kidney and liver tissue from HS rats revealed increases in phosphorylation of IKKαß and IκBα, nuclear translocation of NF-κB and expression of inducible isoform of nitric oxide synthase (iNOS). IKK16 treatment upon resuscitation attenuated NF-κB activation and activated the Akt survival pathway, leading to a significant attenuation of all of the above parameters. Furthermore, IKK16 exhibited cytoprotective effects in human kidney cells. In conclusion, the inhibitor of IKK complex attenuated the MOF associated with HS. This effect may be due to the inhibition of the NF-κB pathway and activation of the survival kinase Akt. Thus, the inhibition of the IKK complex might be an effective strategy for the prevention of MOF associated with HS.

Tratamento grupal psicopedagógico e as cenas temidas na aprendizagem de crianças e adolescentes / Grupo de tratamiento psicopedagógico y escenas temía el aprendizaje de la niñez y la adolescencia / Therapeutic group approach and the fearful scenes of learning in children and adolescents

Esta pesquisa teve por objetivo o estudo das cenas temidas na aprendizagem no atendimento grupal psicopedagógico de crianças e adolescentes de 11 a 13 anos. A partir da identificação das "cenas temidas" no grupo, foi possível refletir sobre os obstáculos que os participantes encontraram. Coube à equipe estruturar atividades lúdicas que provocassem a confrontação do participante com ele mesmo e em relação ao outro, fazendo-o refletir sobre suas dificuldades, e provocando-os a assumirem suas capacidades criativas. Relatamos algumas cenas e de que forma foram pensadas pela equipe. Percebeu-se a importância da intervenção psicopedagógica grupal sobre as manifestações de ocultamento do sujeito criador/autor, que foram as que mais caracterizaram os modos como os participantes se relacionavam com o objeto de conhecimento.

The research aims at studying the fearful scenes of learning in therapeutic groups of children and adolescents between 11 and 13 years old. During the process of the groups and by identifying the "fearful scenes" of learning it was possible to reflect the obstacles of each participant. The authors of the project created play activities to allow the reflection of each one's own difficulties and capacities in order to recognized one's own creative processes. In this article we show how the scenes were thought and performed. The authors point to the importance of the group intervention mainly when the manifestations and recognition of creativity are hidden for the participants of the group.

Esta investigación tubo como objetivo estudiar las escenas temidas en el apredizaje de niños y adolescentes, de 11 a 13 anõs, que estabam en tratamiento psicopedagógico en grupo. A partir de la identificación de las "escenas temidas" en el grupo fué posible pensar sobre los obstáculos encontrados por los participantes. El equipo de psicopedagogos estructuró actividades lúdicas para provocar la confrontación de cada articipante con él mismo y en relación al otro, con el objetivo de hacerlo pensar sobre sus dificultades y permitir que asumieran sus capacidades creativas. Relatamos algunas de las escenas y la forma como fueron pensadas por el equipo de psicopedagogos. Se percibió la importancia de la intervención psicopedagógica grupal sobre las manifestaciones de ocultación del sujeto creador/autor. Estas manifestaciones fueron las que más caracterizaron la forma como los participantes se relacionabam con el objeto del conocimiento.

Dual role of lipoxin A4 in pneumosepsis pathogenesis.

Lipoxin A4 (LXA4) is an endogenous lipid mediator with potent anti-inflammatory actions but its role in infectious processes is not well understood. We investigated the involvement of LXA4 and its receptor FPR2/ALX in the septic inflammatory dysregulation. Pneumosepsis was induced in mice by inoculation of Klebsiella pneumoniae. LXA4 levels and FPR2/ALX expression in the infectious focus as well as the effects of treatment with receptor agonists (LXA4 and BML-111) and antagonists (BOC-2 and WRW(4)) in early (1h) and late (24h) sepsis were studied. Sepsis induced an early increase in LXA4, FPR2/ALX lung expression, local and systemic infection and inflammation, and mortality. Treatment with BOC-2 in early sepsis increased leukocyte migration to the focus, and reduced bacterial load and dissemination. Inhibition of 5- and 15-lipoxygenase in early sepsis also increased leukocyte migration. Early treatment with WRW(4) and BOC-2 improved survival. Treatment with authentic LXA4 or BML-111 in early sepsis decreased cell migration and worsened the infection. In late sepsis, treatment with BOC-2 had no effect, but LXA4 improved the survival rate by reducing the excessive inflammatory response, this effect being abolished by pretreatment with BOC-2. Thus, the anti-inflammatory and pro-resolution mediator LXA4 and its receptor FPR2/ALX levels were increased in the early phase of sepsis, contributing to the septic inflammatory dysregulation. In addition, LXA4 has a dual role in sepsis and that its beneficial or harmful effects are critically dependent on the time. Therefore, a proper interference with LXA4 system may be a new therapeutic avenue to treat sepsis.

Experimental periodontitis promotes transient vascular inflammation and endothelial dysfunction.

OBJECTIVES: This study aimed to evaluate the systemic inflammatory response and cardiovascular changes induced by experimental periodontitis in rats. DESIGN: Experimental periodontitis was induced by placing a cotton ligature around the cervix of both sides of mandibular first molars and maxillary second molars in each male rat. Sham-operated rats had the ligature removed immediately after the procedure. Seven, 14 or 28 days after procedure, the effects of acetylcholine, sodium nitroprusside and phenylephrine were evaluated on blood pressure, aortic rings and isolated and perfused mesenteric bed. The blood was obtained for plasma Interleukin-6 (IL-6), C-reactive protein (CRP) and lipid evaluation. The mesenteric vessels were obtained to evaluate superoxide production and nitric oxide synthase 3 (NOS-3) expression. RESULTS: Ligature induced periodontitis reduced endothelium-dependent vasodilatation, a hallmark of endothelial dysfunction. This effect was associated with an increase in systemic inflammatory markers (IL-6 and CRP), worsens on lipid profile, increased vascular superoxide production and reduced NOS-3 expression. It is interesting to note that many of these effects were transitory. CONCLUSION: Periodontitis induced a transient systemic and vascular inflammation which leads to endothelial dysfunction, an initial step for cardiovascular diseases. Moreover, the animal model of periodontitis used here may represent a valuable tool for studying the relationship between periodontitis and endothelial dysfunction.

Opioid analgesics in experimental sepsis: effects on physiological, biochemical, and haemodynamic parameters.

Cecal ligation and puncture (CLP) is the sepsis model that more closely resembles the human pathology, but it is likely to cause suffering to experimental animals. However, it is not clear whether the use of analgesia may affect some parameters evaluated in experimental sepsis research. Therefore, we investigated the effects of fentanyl and tramadol in experimental sepsis in the rat. The following parameters were evaluated: body temperature, body weight, water and food ingestion, mortality, analgesia, blood leukocytes, mean arterial blood pressure, vascular reactivity to phenylephrine, lung myeloperoxidase activity, and plasma levels of IL1-ß, glutamic-oxaloacetic, glutamic-pyruvic, lactate, creatinine and urea. While producing significant analgesia, the opioids modify minimally the parameters, with the exception of sepsis-induced hypotension and mortality. Although fentanyl and tramadol can minimize pain and the general suffering of animals submitted to CLP surgery, their effects on cardiovascular parameters as well as in the mortality indicate that their use in experimental sepsis must be done with caution and with all the proper control groups.

Inibição seletiva da ciclo-oxigenase-2: riscos e benefícios / Selective inhibition of cyclooxygenase-2: risks and benefits

Os anti-inflamatórios inibidores das ciclo-oxigenases (COX) representam a classe de fármacos mais comumente utilizada. A COX corresponde a uma classe de enzimas conservadas evolutivamente e tem duas isoformas principais: a COX-1 e a COX-2. Seus subprodutos têm papel fundamental na inflamação e na percepção da dor. Há uma grande discussão entre a inibição seletiva ou não da COX pelo fato de a mesma, além de participar dos eventos inflamatórios, ter papel fundamental na manutenção da homeostase do organismo. A inibição seletiva da COX-2 surgiu com o intuito de reduzir os efeitos deletérios gastrintestinais de uma inibição não seletiva; em contrapartida, a inibição exclusiva da COX-2 associou-se a sérios eventos cardiovasculares, por causar um desequilíbrio entre a produção de prostaciclina e tromboxano. O objetivo deste trabalho é revisar a literatura a esse respeito, apontando os prós e os contras da inibição seletiva ou não das enzimas ciclo-oxigenases.

The cyclooxygenase (COX) inhibitors are the most common drugs used worldwide. COX corresponds to an evolutionarily conserved class of enzymes and has two main isoforms: COX-1, which is largely associated with physiological functions, and COX-2, which is largely associated with pathological functions. Their subproducts have an important role in inflammation and pain perception. The COX-2 selective inhibition was designed to minimize gastrointestinal complications of non-selective inhibition. However, this exclusive COX-2 inhibition was associated with serious cardiovascular events, for causing an imbalance between prostacyclin and thromboxane production. The objective of this study is to discuss the mechanisms underlying the cardiovascular effects, pointing out the advantages and disadvantages of the selective or nonselective COX inhibitors.

The effect of losartan on angiotensin II-induced cell proliferation in a rat aorta smooth muscle cell line

The success of revascularization procedures is limited by recurrent stenosis, which is a narrowing of a blood vessels that results from neo-intimal hyperplasia. The renin-angiotensin-aldosterone system has been implicated in the pathogenesis of neo-intimal hyperplasia, and a role for angiotensin II in vascular smooth muscle cell proliferation has been proposed. There are at least two high-affinity subtypes of angiotensin II receptors, AT1 and AT2, both of which are seven-transmembrane G protein-coupled receptors. We investigated the effect of losartan, an AT1 receptor antagonist, on vascular smooth muscle cell proliferation using the A7r5 smooth cell line derived from rat aorta. Losartan was shown to prevent angiotensin II-induced cell proliferation, thereby suggesting that the effect of angiotensin II was mediated via AT1 receptors. These data strengthen the concept that inhibitors of the renin-angiotensin system can effectively prevent recurrent stenosis.