Cardiac arrest following sugammadex administration.

A 68-year-old man underwent elective surgical repair of an abdominal wall hernia under general anaesthesia. The operation required muscle relaxation, for which we used rocuronium. Following completion of surgery, 180 mg sugammadex was administered intravenously. Shortly afterwards, the patient became severely bradycardic with hypotension, refractory to treatment with ephedrine. This progressed to a pulseless electrical activity cardiac arrest. After 4 min of cardiopulmonary resuscitation, there was return of spontaneous circulation and, following a period of haemodynamic stability in which general anaesthesia was maintained, the patient emerged from anaesthesia without incident. He remained haemodynamically stable until discharge. Post-resuscitation investigations including the serum tryptase level were unremarkable except for a mild respiratory acidosis and slightly elevated D-dimers. Sugammadex-induced bradycardia has previously been described, but its mechanism remains unknown. We believe that sugammadex was the cause of cardiac arrest in this case because of the timing and sequence of events, the evolution to pulseless electric activity and the relatively uneventful post-arrest clinical course. We hope that our report will help to promote awareness about this potential complication of a now commonly-used drug.

Performance of rapid prescreening and 100% rapid review as internal quality control methods for cervical cytopathology.

BACKGROUND: An objective of quality control for cervical cytopathology is reducing high rates of false-negative results of laboratory tests. Therefore, methods to review smears such as rapid prescreening and 100% rapid review, which have shown better performance detecting false-negative results, have been widely used. The performance of rapid prescreening and the performance of 100% rapid review as internal quality control methods for cervical cytology examinations were evaluated. METHODS: For 24 months, 9318 conventional cervical cytology smears underwent rapid prescreening and routine screening. The 100% rapid review method was performed for 8244 smears classified as negative during routine screening. Any discordant results underwent detailed review to define the final diagnosis. This was considered the gold standard for evaluating the performance of rapid prescreening and 100% rapid review. RESULTS: Routine screening showed increases of 13.3% and 11.5% in the detection of abnormal smears with rapid prescreening and 100% rapid review, respectively. The relative percentage variation showed a 38.1% increase in the diagnosis of atypical squamous cells of undetermined significance with routine screening and rapid prescreening and a 12.5% increase in the diagnosis of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion with both rapid prescreening and 100% rapid review. Sensitivity rates of rapid prescreening and routine screening were 48.2% and 83.2%, respectively. Sensitivity rates of rapid prescreening and 100% rapid review were 65.7% and 57.8%, respectively, for detecting false-negative results. CONCLUSIONS: Inclusion of rapid prescreening and/or 100% rapid review improved the diagnostic sensitivity of the cervical cytology examination and reduced false-negative results of routine screening and can provide good quality control.

Cytokine expression in response to root repair agents.

AIM: To evaluate the expression of TNF-α, IL-6, IFN-γ, TGF-ß, IL-4, IL-10, RANKL, RANK and OPG on mouse calvarial bone treated with MTA, Geristore® and Emdogain® . METHODOLOGY: Bone wounds were made on the heads of C57BL/6 mice, breaking the periosteum and the cortical surface of the calvaria. Each repair agent was inserted into sectioned Eppendorf microtubes and placed on the bone wound, and soft tissues were sutured. At 14 and 21 days, animals were sacrificed and the treated region was dissected. The calvaria bone was removed, and RNA was extracted. mRNA expression of the aforementioned cytokines was assessed using real-time PCR. Data were analysed by nonparametric methods, including the Mann-Whitney and Kruskal-Wallis tests (P < 0.05). RESULTS: Following treatment with Emdogain® and MTA, mRNA expression of RANKL, RANK and OPG increased significantly (P < 0.05) between days 14 to 21. Geristore® did not alter the basal expression of these mediators during the same period of evaluation. Whilst treatment with Emdogain® did cause a significant increase in TNF-α mRNA expression between days 14 and 21 (P < 0.05), treatment with MTA did not alter the basal expression of this cytokine at either experimental time point. However, TNF-α mRNA expression was down-regulated significantly at day 21 (P < 0.05) when Geristore® was applied. A significant increase in the mRNA expression of IL-6, TGF-ß, IL-10, IL-4 and IFN-γ was observed with Emdogain® and MTA treatment between days 14 to 21, whereas Geristore® reduced significantly the expression of IL-6, TGF-ß and IL-4 (P < 0.05). CONCLUSION: The clinical indication of these repair agents depends on the root resorption diagnosis. Whilst MTA and Emdogain® induce a pro- and anti-inflammatory response early and late, respectively, Geristore® was not associated with an inflammatory reaction when compared with both repair agents.

Determinação do caseinomacropeptídeo em leite UAT por espectroscopia no infravermelho próximo e regressão por mínimos quadrados parciais / Determination of caseinomacropeptide in uht milk using near infrared spectroscopy and pls regression

O presente trabalho foi realizado com o objetivo de desenvolver um método para a determinação de CMP em leite UAT por meio da aplicação da espectroscopia de infravermelho próximo. Leites UAT de oito marcas diferentes foram utilizados para a construção dos modelos de calibração. Os resultados demonstram que, para o desenvolvimento de um modelo de calibração adequado para a determinação de CMP em leite UAT, deve-se utilizar, juntamente com o método de regressão PLS, o método de seleção de espectros máxima distância e os pré-tratamentos 2ª derivada e variável normal padronizada. Além disso, pôde-se determinar que as regiões do infravermelho próximo mais correlacionadas com os movimentos vibracionais dos aminoácidos presentes no CMP foram: 1100-1310; 1400-1430; 1490-1550; 1640-1680; 1780-1970; 2020-2100 e 2310-2350nm. Conclui-se que a espectroscopia de infravermelho próximo pode ser uma alternativa para a determinação de CMP em leite UAT, desde que haja um conjunto de calibração com amostras representativas da população a ser predita no futuro.(AU)

his work´s objective was to develop an UHT milk caseinomacropeptide determination method trough NIR spectroscopy application. Eight UHT milk trademarks are used to produce a mathematical calibration model. The results of NIR analysis suggested that to produce a suitable calibration model, partial least-square regression (PLSR) must be used, with maximum distance in wavelenght space to select spectra, pre - treatment with 2nd derivative and standard normal variant (SNV). Also, suitable near-infrared regions more correlated with CPM aminoacids vibrational movements: 1100-1310; 1400-1430; 1490-1550; 1640-1680; 1780-1970; 2020-2100; and 2310-2350nm. Therefore, NIR spectroscopy can be an alternative to caseinomacropeptide determination of UHT milk, since there was a representative calibration set with a large enough and representative sample of entire population to be predicted in the future.(AU)

Analysis of trace metal concentrations in raw cow's milk from three dairy farms in North Gondar, Ethiopia: chemometric approach.

Concentrations of essential (Cu, Mn, and Zn) and toxic (Cr, Cd, and Pb) trace metals in 30 raw cow's milk samples were quantified using flame atomic absorption spectrometry. The samples were collected from the Nara-Awudarda, Tana-Abo, and Kosoye Amba-Rass sites in North Gondar, Ethiopia, preserved in a deep freezer (-20 °C), and then digested by Kjeldahl apparatus with HNO3/H2O2 (5:2; v/v) at 300 °C for 2.5 h. The data were subject to principal component analysis (PCA) and partial least square-discriminant analysis (PLS-DA). Overall hazard quotient (HQ) and carcinogenic risk (CR) values were also estimated to assess metal-related health risks. The mean concentrations of Cr, Mn, Cu, Zn, Cd, and Pb in the milk samples ranged 0.468-0.828, 1.614-2.806, 0.840-1.532, 1.208-5.267, ND-0.330, and ND-0.186 mg/kg, respectively. The lowest values were obtained for Kosoye Amba-Rass milk samples, while the highest were found for those collected from Nara-Awudarda milk samples, probably due to high mineral enrichment and metal leaching (especially Cd and Pb) from coal deposits. PCA revealed clustering of samples with respect to their geographic origin. Validation of PLS-DA model showed 100% classification efficiency using external validation samples and detected Cd and Cu as trace metal markers. The HQ and CR values were within the safe level; however, the former is close to the alert threshold level for Nara-Awudarda milk samples. Thus, further studies on common foodstuffs, constituting a higher proportion in the local diet, are required in this area to provide a complete risk assessment.

Pre-transplant shedding of BK virus in urine is unrelated to post-transplant viruria and viremia in kidney transplant recipients.

BK virus-(BKV) associated nephropathy (BKVN) is a major cause of allograft injury in kidney transplant recipients. In such patients, subclinical reactivation of latent BKV infection can occur in the pre-transplant period. The purpose of this study was to determine whether urinary BKV shedding in the immediate pre-transplant period is associated with a higher incidence of viruria and viremia during the first year after kidney transplantation. We examined urine samples from 34 kidney transplant recipients, using real-time quantitative polymerase chain reaction to detect BKV. Urine samples were obtained in the immediate pre-transplant period and during the first year after transplant on a monthly basis. If BKV viruria was detected, blood samples were collected and screened for BKV viremia. In the immediate pre-transplant period, we detected BKV viruria in 11 (32.3%) of the 34 recipients. During the first year after transplantation, we detected BKV viruria in all 34 patients and viremia in eight (23.5%). We found no correlation between pre-transplant viruria and post-transplant viruria or viremia (p = 0.2). Although reactivation of latent BKV infection in the pre-transplant period is fairly common among kidney transplant recipients, it is not a risk factor for post-transplant BKV viruria or viremia.

The effects of a mineral trioxide aggregate-based sealer on the production of reactive oxygen species, nitrogen species and cytokines by two macrophage subtypes.

AIM: To test the effects of a mineral trioxide aggregate-based sealer (MTA Fillapex(®)) and MTA (MTA-Ângelus(®)) on viability and on the production of cytokines, reactive oxygen species (ROS) and nitrogen species (NO) by M1 and M2 inflammatory macrophages. METHODOLOGY: M1 (from C57BL/6 mice) and M2 (from BALB/c mice) peritoneal inflammatory macrophages were obtained and cultured in vitro in the presence of original and diluted extracts of MTA and MTA Fillapex (FLPX). The cell viability, ROS release and the release of tumour necrosis factor-a, interleukin (IL)-12, IL-10 and NO in response to stimulation with interferon-γ and Fusobacterium nucleatum or Peptostreptococcus anaerobius were evaluated. The data were analysed using the Mann-Whitney test and Student's t-test. RESULTS: Fillapex was cytotoxic at the highest concentrations (1:1;1:2) and decreased the viability (P < 0.05) of both macrophage types (<20%). MTA did not interfere with cellular viability. FLPX inhibited the release of ROS and decreased NO release in F. nucleatum and P. anaerobius -stimulated M1 and M2 macrophages (≤25 µ mol L(-1)). F. nucleatum-stimulated M2 macrophage cultures released lower levels of TNF-α when FLPX was added (≤1 ng mL(-1)). M2 macrophages released higher (>5 ng mL(-1)) levels of IL-10 than M1 macrophages. Only M1 macrophage cultures produced IL-12p70. CONCLUSIONS: Fillapex impaired effector immune responses during inflammation (M1 macrophages), as well as during healing (M2 macrophages) responses.

Septin localization in the dimorphic fungus Paracoccidioides brasiliensis.

Septins are evolutionarily conserved proteins that contain a GTPase domain and are capable of forming filaments at the cell periphery. Septins are involved in many essential cellular processes, such as cytokinesis and cell polarization, and are used as markers of morphogenesis in several fungi. Dimorphism in fungi enables cells to switch between morphologies (yeast or filament forms), due to changes in the temperature of the environment. We analysed the localization of septin proteins in yeast and filamentous cells of the dimorphic fungus Paracoccidioides brasiliensis, a common cause of granulomatous mycosis. In order to determine septin localization, we first cloned Cdc12p, a septin homolog from P. brasiliensis, and expressed it in Escherichia coli. Following PbCdc12p purification, specific serum against PbCdc12p were raised for use in immunofluorescence assays. We observed the hourglass and ring forms of septin filaments during cell division in yeast. Septin filaments were also simultaneously localized in the necks of multiple budding cells. A distinctive pattern of punctuate and/or diffuse localization was also seen in the periphery of multinucleate yeast cells and at the tips and septa of filamentous cells. A more diffuse and punctuate pattern of localization observed in P. brasiliensis cells seems to be unique to filamentous and dimorphic fungi and may be related to their specialization in cell wall deposition, morphogenesis and cell cycle control.

Alterations of tendons in patients with diabetes mellitus: a systematic review.

AIMS: To perform a systematic review of observational studies which analyse tendon alterations in patients with diabetes mellitus compared with healthy individuals. METHODS: Data collection was performed, with no language restriction, using the databases of PubMed/Medline, BIREME, CINAHL, LILACS and Cochrane, as well as the references found in these studies. Three reviewers performed independent extractions of articles. Subsequently, these reviewers analysed the articles, focusing on their methodological quality, using the appropriate scale to evaluate observational studies from the Agency for Healthcare Research and Quality. RESULTS: Six articles were included in the analysis. Of these, four had used ultrasonographic diagnostics, one computed tomography and one magnetic resonance imaging. The patient pool comprised 396 individuals. All the articles evaluated tendon thickness and presented heterogeneous results. Two articles stated thickening or increased volume of the tendons in diabetic people, one article did not report any alteration, the fourth failed to determine any alterations and the fifth showed thinning of the tendons. The arrangement of collagen fibrils and the presence of calcification were analysed in only one article (n = 80), showing that 88.10% (n = 68) of individuals with diabetes presented disorientation of collagen fibril arrangement, while only 10% (n = 1) of healthy individuals presented this condition. Regarding tendon calcification, the article showed diabetic individuals with higher values than healthy individuals. CONCLUSIONS: All the articles indicated some relation between diabetes mellitus and tendon alterations in human beings, but due to methodological drawbacks, this association could not be sustained.

Hypoxic environments as refuge against predatory fish in the Amazonian floodplains

Several groups of Amazonian fishes exhibit behavioral, morphological and physiological characteristics that allow occupying hypoxic environments, despite the energetic costs of living in such harsh conditions. One of the supposed advantages of occupying hypoxic habitats would be a lower predation pressure resulting from a lower number of piscivorous fishes in those environments. We tested this hypothesis in an area of the Amazon River floodplain through gill net fishing in normoxic and hypoxic habitats. From the 103 species caught, 38 were classified as piscivores. We found no difference in the number of piscivorous species captured in hypoxic and normoxic habitats (chi2 = 0.23; p = 0.63; df = 1) but piscivorous individuals were more numerous in normoxic than in hypoxic sampling stations (chi2 = 104.4; p < 0.001; df = 1). This indicates that environments submitted to low oxygen conditions may in fact function as refuges against piscivorous fishes in the Amazonian floodplains.

Diversos grupos de peixes amazônicos apresentam mecanismos para suportar condições de hipóxia, incluindo especializações comportamentais, morfológicas e fisiológicas, apesar do custo energético envolvido. Uma das supostas vantagens em ocupar ambientes hipóxicos seria a redução da pressão de predação, devido à presença de um menor número de peixes piscívoros. Testamos esta hipótese em um ambiente de várzea do rio Amazonas, por meio de coleta de peixes com malhadeiras em ambientes hipóxicos e normóxicos. Das 103 espécies capturadas, 38 foram classificadas como piscívoras. Não houve diferença no número de espécies piscívoras e não piscívoras nos dois tipos de ambientes amostrados (chi2 = 0,23; p = 0,63; gl = 1), mas a proporção de peixes piscívoros foi maior sob condições de normóxia (chi2 = 104,40; p < 0,001; gl = 1). Isto indica que ambientes com baixa concentração de oxigênio dissolvido podem de fato funcionar como locais de refúgio contra peixes piscívoros nas várzeas amazônicas.

The effect of mineral trioxide aggregate on phagocytic activity and production of reactive oxygen, nitrogen species and arginase activity by M1 and M2 macrophages.

AIM: To assess the influence of co-culture with mineral trioxide aggregate (MTA) on phagocytosis and the production of reactive oxygen intermediates (ROI) and nitrogen (NO) species and the arginase activity by M1 and M2 peritoneal macrophages. METHODOLOGY: Cellular viability, adherence and phagocytosis of Saccharomyces boulardii were assayed in the presence of MTA. Macrophages were stimulated with zymosan for ROI assays and with Fusobacterium nucleatum and Peptostreptococcus anaerobius and IFN-gamma for NO production and arginase activity, when in contact with capillaries containing MTA. Data were analysed by T, anova, Kruskall-Wallis and Mann-Whitney tests. RESULTS: M2 macrophages displayed greater cellular viability in polypropylene tubes, greater ability to ingest yeast and smaller production of ROI and higher arginase activity when compared with M1 macrophages. Both macrophages, M1 and M2, presented similar cell adherence and NO production. The addition of bacterial preparations to macrophages interfered with NO and arginase productions. MTA did not interfere with any of the parameters measured. CONCLUSIONS: Phagocytosis and the ability of the two macrophage subtypes to eliminate microbes were not affected by MTA.

[Is there a place for randomized biopsies in the follow up of superficial transitional cell carcinoma of the urinary bladder?]. / Cuál es el valor de la biopsia aleatoria en el seguimiento del carcinoma uroterial superficial de vejiga?

INTRODUCTION: Transitional cell carcinoma of the bladder represents a disease of entire urothelial tract. The follow up is very important to detect any lesion that might represent a progression or a local recurrence. Some authors recommend randomized biopsies as a routine workup, others recommend cystoscopies and urinary cytology as the main part of superficial bladder cancer follow up. PATIENTS AND METHODS: Forty nine patients with superficial bladder cancer were followed up during a ten-year period. Randomized biopsies and urinary cytology were harvested according to the international cancer protocol on bladder cancer. RESULTS: 15 (1%) out of 1.489 randomized biopsies found to be positive to transitional cell carcinoma. Four out (10.5%) of 35 biopsies targeted to suspicious areas were positive to transitional cell carcinoma. 50 (17.4%) out of 288 cystoscopies with urinary cytology found to be positive to transitional cell carcinoma. Sensitivity and Specificity of biopsies (including randomized and targeted) were 31% and 85.2% respectively. Sensitivity and specificity of cystoscopies with urinary cytology were 48% and 86.5% respectively. CONCLUSION: Randomized biopsies did not show to detect more local recurrence or progression when compared to the urinary cytology. Cystoscopies with urinary cytology have good sensitivity and specificity for detection of tumor recurrence during follow up of transitional cell carcinoma.

Effectiveness of liposomes to transfect livestock fibroblasts

The development of an efficient transfection system in livestock cells is an important step towards investigating gene transfer and the functioning and production of transgenic animals. Important factors involved in cationic liposome mediated gene transfer were evaluated through in vitro transfection of bovine, caprine and ovine fibroblast cells. Transfection of plasmid DNA complexes of different commercially available liposomes (Lipofectamine, Lipofectin, Cellfectin and DMRIE-C; Gibco-BRL, USA) was evaluated utilizing the following parameters: DNA/liposome ratio, cell density, DNA conformation, and the effect of transfection time on the efficiency of bovine fibroblasts to express a reporter gene. The effects and concentrations of liposomes were also evaluated in caprine and ovine fibroblasts. Lipofectamine alone and Lipofectamine with Plus reagent induced high-frequency expression of beta-galactosidase and neo genes in all cells evaluated (47 and 88.3%, respectively). Regarding phenotype, chromosomal stability was similar in transfected and non-transfected cells. The parameters set in this study will establish a foundation for utilizing transfected fibroblast cells to generate transgenic animals through nuclear transfer technology and gene function studies.

[Surgical treatment of blepharospasm. Report of 2 patients]. / Tratamento cirúrgico do blefaroespasmo essencial. Relato de dois pacientes.

Essential blepharospasm can be approached by several types of treatment: clinical in which the most important is the botulinum toxin with advantages and limitations; and some options of surgical treatment. The surgical technique described by Gillum and Anderson offers an alternative to patients resistant to the clinical treatment or with secondary complications. Two cases are analysed. Myectomy of all accessible orbicularis oculi, procerus and corrugator superciliaris muscle associated with blepharoplastic surgery and frontal lifting was indicated due to poor answer to clinical treatment. The results were satisfactory and both patients returned to their normal activities.

Effects of prostaglandins and nitric oxide on rat macrophage lipid metabolism in culture: implications for arterial wall-leukocyte interplay in atherosclerosis.

Macrophages/foam cells have a pivotal role in atherogenesis although little is known about the way lipid imbalance, a hallmark of atherosclerosis, leads to lipid accumulation in these cells. Modified low-density lipoproteins are associated with macrophage lipid dysfunction in atherosclerosis, but a possible role for altered lipogenesis leading to lipid accumulation remains to be elucidated. Since endothelium-derived nitric oxide (NO) and prostaglandins (PGs) are physiological autacoids whose production may be impaired in atherosclerosis, the effects of these mediators on de novo lipid synthesis in 24-h cultured rat peritoneal macrophages is investigated. In resident (unstimulated) cells, 1 microM PGE2 and the stable analog of PGI2 carbaprostacyclin (cPGI2, 1 microM) deviated the overall [1-14C]acetate from incorporation into cholesterol, free fatty acids and triacylglycerols favoring the formation of phospholipids. In inflammatory (thioglycollate-elicited) macrophages, these eicosanoids likewise reduced 14C-incorporations into all the lipid fractions tested. Also, cPGI2 and PGE2 reduced [4-14C]cholesterol uptake from inflammatory cells but did not interfere in 14C-cholesterol export. The PGE2-derivative PGA2 (10-20 microM) reduced 14C-incorporations into all the lipids in resident cells while it enhanced phospholipid synthesis by up to 129% at the expense of reduced incorporations into the other test lipids. The NO donor S-nitroso-N-acetylpenicillamine (SNAP, 1-10 microM), when added to macrophages in the presence of superoxide dismutase (SOD, to avoid the reaction of superoxide with NO), significantly reduced lipogenesis especially in inflammatory cells. These findings suggest that endothelium-derived NO and PGs may be associated with macrophage lipid accumulation by modulating lipogenesis and cholesterol uptake within these cells.

Mioma uterino. Revisao de sete anos na Clinica do Hospital Barao de Lucena. / Uterine myoma. Review of 7 years at the Clinica do Hospital Barao de Lucena

No presente trabalho estudamos 638 pacientes portadoras de mioma uterino que foram admitidos na Clinica Ginecologica do Hospital Barao de Lucena, INAMPS, no periodo de julho de 1976 a julho de 1983. Foram analisados os aspectos clinicos, meios de diagnostico e terapeutica. Houve predominio da multiparidade (48,27%); da faixa etaria entre 40 a 49 anos (53,76%) e da cor parda (54,39%). Alteracoes do ciclo menstrual estiveram presentes na maioria dos casos (71,30%) e apenas em 35,42% foi realizada curetagem uterina previa. O tratamento foi cirurgico em todos os casos, havendo predominio da histerectomia abdominal com anexectomia bilateral (43,26%)

Leiomiossarcoma uterino. Relato de quatro casos. / Leiomyosarcoma of the uterus. Report of 4 cases

O presente trabalho consiste na apresentacao de quatro casos de leiomiossarcoma ocorridos na Clinica Ginecologica do Hospital Barao de Lucena/INAMPS - Recife, PE, entre junho de 1976 a maio de 1982, representando uma incidencia de 0,8% a todos os leiomiomas diagnosticados histopatologicamente neste periodo. Os autores relatam a raridade da patologia, a clinica e a terapeutica empregadas nestas pacientes, que julgam estar acordes com a literatura mundial consultada