Expression of TREM-1 in maternal leukocytes in preterm, prelabour rupture of the membranes.

Studies have shown that triggering receptor expressed on myeloid cells-1 (TREM-1) is the mediator and activator of neutrophils and monocytes after stimulation with lipopolysaccharide (LPS), heat-inactivated Gram (-) bacteria, Gram (+) bacteria or fungi. Different studies have measured the expression of TREM-1 in patients with bacterial infections and critical states. The purpose of this study was to evaluate the expression of TREM-1 in circulating maternal leukocytes in premature rupture of the membranes (PRM). Two groups of patients were included in this case control study: pregnant women with PRM and healthy controls. All patients were free of any infection, including cervix and urinary tract. Although all patients expressed TREM-1 to some extent, there was no statistically significant difference in the expression of different cellularities in both groups; except for the mononuclear leukocytes (p < 0.05). In this study, TREM-1 was not altered in PRM.

Tubular vs. mini-open lumbar discoidectomy: surgical-clinical outcome.

OBJECTIVE: To evaluate the clinical-surgical results of the tubular vs. mini-open approach in lumbar discoidectomy. The tubular approach promises to reduce the number of rest days and an earlier return to daily activities and work. METHOD: A case-control study of patients operated on for disc herniation using tubular surgery (case) and mini-open (control) was carried out. The variables investigated were as follow: radicular and lumbar pain, sex, age, failure in conservative treatment, single-level lumbar hernia, surgical time, bleeding, length of hospital stay, persistence of symptoms, complications, occupational activity, and reintegration into everyday activities. RESULTS: Through 100 surgeries performed, two groups were created, tubular and mini-open, with 50 patients each, with L4-L5 or L5-S1 disc herniation, respectively. The most affected level was L4-L5 (69%). Of the total cases, a significant improvement was found (p < 0.05) at 15 postoperative days in the VAS and ODI scale in the tubular group with respect to mini-open. Complications such as surgical wound infection, durotomy, and persistent pain occurred. CONCLUSIONS: The tubular approach is a safe and effective option for herniated discs of the lumbar segment, and reduces surgical times, bleeding, and the time of reinsertion to daily activities of the patient.

OBJETIVO: Evaluar los resultados clínico-quirúrgicos del abordaje tipo tubular en comparación con el mini-open en la discoidectomía lumbar. El abordaje tubular promete reducir el número de días de reposo y una reincorporación más temprana a las actividades diarias y laborales. MÉTODO: Se realizó un estudio de casos y controles de pacientes operados por hernia discal mediante cirugía tubular (casos) o mini-open (controles). Las variables investigadas fueron: dolor radicular y lumbar, sexo, edad, falla en el tratamiento conservador, hernia lumbar de un solo nivel, tiempo quirúrgico, sangrado, tiempo de estancia hospitalaria, persistencia de síntomas, complicaciones, tipo de actividad ocupacional y reinserción a las actividades cotidianas. RESULTADOS: Se realizaron 100 cirugías y se crearon dos grupos, tubular y mini-open, con 50 pacientes cada uno, con hernia discal de L4-L5 o L5-S1, respectivamente. El nivel más afectado fue L4-L5 (69%). Del total de los casos, se encontró mejoría significativa (p < 0.05) a los 15 días posquirúrgicos en la escala EVA y ODI en el grupo tubular con respecto al mini-open. Ocurrieron complicaciones como infección de herida quirúrgica, durotomía y dolor persistente. CONCLUSIONES: El abordaje tubular es una opción segura y efectiva para hernias discales del segmento lumbar, y reduce los tiempos quirúrgicos, el sangrado y el tiempo de reinserción a las actividades cotidianas del paciente.

Raloxifene modifies the insulin sensitivity and lipid profile of postmenopausal insulin resistant women.

OBJECTIVE: To investigate the effects of raloxifene on the insulin sensitivity and lipid profile in insulin-sensitive and insulin-resistant postmenopausal women. STUDY DESIGN: This placebo-controlled, double-blind, randomized study involved 64 postmenopausal women aged between 45 and 55 years. All subjects were screened with the insulin resistance homeostasis model assessment (IR-HOMA) and those patients in the lowest quartile (n = 16) were assigned as insulin sensitive and those in the highest quartile as insulin resistant (n = 16). Patients in both groups received either raloxifene hydrochloride (60 mg/day) or a placebo for a period of 12 weeks. Insulin sensitivity, the serum lipid profile and anthropometric measurements were established before and after therapy. RESULTS: Women with the highest IR-HOMA scores were associated with a significantly higher weight, body mass index, waist and waist-to-hip ratio (p < 0.05). Raloxifene significantly reduced the IR-HOMA scores from 5.76 ± 2.91 to 1.93 ± 0.96 (p = 0.02) and modified the lipid profile in insulin-resistant patients when compared with the placebo group and those patients receiving raloxifene in the insulin-sensitive group. CONCLUSION: Raloxifene reduced insulin resistance and modified the lipid profile in insulin-resistant postmenopausal women.

Effect of an educative intervention on the clinical ability of physicians in the management of metabolic syndrome.

PURPOSE: To measure the effect of an educative intervention on the clinical ability of Family Physicians of two Family Units of the Mexican Institute of Social Security (IMSS) in the diagnosis and treatment of patients with metabolic syndrome. MATERIAL AND METHODS: A quasi-experimental study was conducted with a control group using basal and final measurements. The educative intervention of the experiment group included one in-the-classroom work and another at the doctors' office. The instrument was validated by a panel of experts and included 140 items and five case-oriented problems, reaching a reliability index of 0.87. RESULTS: . There was no significant difference at base measurement among the different levels of clinical ability between the two groups (p = 0.82), both the experimental and the control groups showed a higher frequency of medium level abilities (33.3 vs. 36.8% respectively). At the end of the follow-up, a significant increase in the experimental group (98 with 49-106 over 69 with 26-94) was observed. CONCLUSIONS: The educative intervention utilized in this study improved the ability of Family Physicians to diagnose, treat an apply preventive measures in patients with metabolic syndrome.

Assisted dorso-lumbar instrumentation with O-arm neuronavegation and minimally invasive surgery: clinical-surgical outcome.

OBJECTIVE: To evaluate the clinical-surgical outcomes after dorso-lumbar instrumentation using O-arm assisted neuronavigation and minimally invasive surgery. METHOD: In this retrospective cohort, 104 patients who underwent dorso-lumbar instrumentation with the use of O-arm from September 2013 to May 2020 were studied. Variables investigated included: symptoms, number of screws, levels approached, bleeding, surgical time, hospital stay, complications and clinical improvement after the surgical procedure. RESULTS: The most frequent symptoms were: unilateral or bilateral radiculopathy of the pelvic extremities, paresthesia, mechanical low back pain and progressive decrease in strength. A total of 542 screws were placed, with the lumbar spine being the site with the highest prevalence. The average bleeding, surgical time, and hospital stay was: 50 ml, 160 minutes, and 24 hours, respectively. The most frequent complications were: Residual neuropathy, dura mater tear and surgical site infection. Clinical improvement at 24 hours, 4 weeks and 6 months was achieved in: 77.3%, 86.5% y 94.8% of the patients, respectively. CONCLUSIONS: Neuronavigation with the use of O-arm along with mini-open surgery approach results in good clinical-surgical outcomes in the correction of complex disorders of the dorso-lumbar spine.

OBJETIVO: Evaluar los resultados clínico-quirúrgicos de la instrumentación dorso-lumbar mediante neuronavegación asistida con O-arm y cirugía mínimamente invasiva. MÉTODO: En esta cohorte retrospectiva se estudiaron 104 pacientes sometidos a instrumentación dorso-lumbar con uso de O-arm, operados entre septiembre de 2013 y mayo de 2020. Las variables investigadas fueron sintomatología, cantidad de tornillos, niveles abordados, sangrado, tiempo quirúrgico, estancia hospitalaria, complicaciones y mejoría clínica posterior al procedimiento quirúrgico. RESULTADOS: La sintomatología más frecuente fue radiculopatía unilateral o bilateral de extremidades pélvicas, parestesias, lumbalgia mecánica y disminución progresiva de la fuerza. Se utilizaron en total 542 tornillos, siendo la columna lumbar el sitio de mayor prevalencia. Los promedios de sangrado, tiempo quirúrgico y estancia hospitalaria fueron de 50 ml, 160 minutos y 24 horas, respectivamente. Las complicaciones más frecuentes fueron neuropatía residual, rasgadura de la duramadre e infección del sitio quirúrgico. La mejoría clínica a las 24 horas, 4 semanas y 6 meses se logró en el 77.3%, el 86.5% y el 94.8% de los pacientes, respectivamente. CONCLUSIONES: La neuronavegación con O-arm junto con el abordaje quirúrgico de tipo mini-open permite buenos resultados clínico-quirúrgicos en la corrección de los trastornos complejos de la columna dorso-lumbar.

Small molecule selectin inhibitor in global cerebral ischemia and controlled hemorrhagic shock.

BACKGROUND: The clinical and experimental management of stroke has not reached the therapeutic success seen in other medical conditions associated with ischemia/reperfusion. In this work, we investigated the effect of a small molecule selectin inhibitor TBC-1269, in animals subjected to global cerebral ischemia (GCI) and controlled hemorrhagic shock (CHS). METHODS: Forty-eight male Sprague-Dawley rats weighting between 275 g and 300 g were subjected to a model of GCI and CHS. Three groups of animals were included in this study (n = 16 per group): sham/saline (group 1); GCI/CHS/Saline (group 2); GCI/CHS/TBC-1269 (group 3). Experimental design consisted of bilateral carotid artery occlusion for 20 minutes, and the development of CHS until a mean arterial pressure of 50 mm Hg was reached. At 20 minutes, clamps were released, and resuscitation was achieved with normal saline, and the end point was to attain a mean arterial pressure of 80 mm Hg. Treatment at the beginning of resuscitation included either normal saline (groups 1 and 2) or TBC-1269 (25 mg/kg, group 3). The following indices were evaluated: brain tissue myeloperoxidase, average numbers of ischemic neurons, and 7-day survival. RESULTS: Brain myeloperoxidase was decreased in animals treated with TBC-1269, although this difference was not statistically significant. Treated animals demonstrated a significant smaller amount of ischemic neurons than the controls. Survival was also improved from 40% in controls to 80% with TBC-1269 treatment. This difference was statistically significant. CONCLUSION: The use of a small molecule selectin inhibitor, TBC-1269, had a protective effect in this model of GCI and CHS, as evidenced by decreased numbers of ischemic neurons and improved survival rates.

Scientific basis of organ preservation.

PURPOSE OF REVIEW: To review the basic mechanisms involved during hypothermia and reperfusion, with special attention paid to efforts being made in refining solutions and the molecular characterization of cells during preservation. RECENT FINDINGS: Several graft-related molecules have been identified as correlating with early graft dysfunction and/or poor outcome in the immediate posttransplant period. Also, different inhibitors have been utilized to ameliorate the preservation-induced injury, alone or in combination with different preservation solutions. SUMMARY: Preservation-induced injury is a major contributing factor to early graft dysfunction in organ recipients. The success of organ transplantation is critically dependent on the quality of the donor organ. Donor-organ quality, in turn, is determined by a variety of factors, including donor age, donor management prior to organ procurement, the duration of hypothermic storage, and perfusion techniques utilized to protect organs from ischemia/reperfusion injury, which in turn cause a dramatic reprogramming of cell metabolism during organ transplantation. The expression of a number of inflammatory genes has been associated with early graft dysfunction and/or poor outcome in the immediate postoperative period. Some therapeutic manipulations have been demonstrated to be of significance in attaining near-normal organ function after transplantation.

Intestinal pseudo-obstruction caused by herpes zoster: Case report and pathophysiology.

Herpes zoster (HZ) infection occurs in approximately 10% to 30% of individuals. Visceral neuropathies secondary to HZ can cause cystitis and urinary retention. But colonic pseudo-obstruction can also occur. Peripheral neuropathy may reveal segmental motor paresis of either upper or lower limbs, the abdominal muscles or the diaphragm. We report the case of a 62-year-old male patient who presented with abdominal distention and cutaneous vesicular eruption on the left side of the abdominal wall. Plain X-rays and computed tomography scan showed distended small bowel. A diagnosis of intestinal pseudo-obstruction was made secondary to segmental paresis of the small intestine and visceral neuropathy. Conservative management was successful and the patient was discharged uneventfully. Intestinal pseudo-obstruction ought to be considered when dealing with non-obstructive (adynamic) conditions of the digestive tract associated with HZ infection; since early recognition may help to avoid unnecessary surgery.

William and Charles Mayo: their influence on American medicine.

In a little-known Midwest town named Rochester, Minnesota, a talented physician grew in fame and respect: Dr. William Worrall Mayo, who was influential in the evolution of medicine. He was a steadfast learner and raised two sons, William and Charles, to follow in his footsteps and further medical knowledge. They were leaders in surgery and in the creation of advanced and sophisticated medical facilities. Their talents, the issues surrounding medical practice, and unexpected opportunity all came into play for the Mayos. Two hospitals, St. Mary's Hospital and later the Methodist Hospital, witnessed and influenced the advancement of medicine through the Mayo Clinic heritage and dynasty in Minnesota and the rest of the world. In this article, we focus on the role of the Mayo brothers and their influence over the increasing acceptance of hospital care in America and abroad.

[Early neonatal sepsis and associated factors]. / Sepsis neonatal temprana y factores asociados.

BACKGROUND: Early-onset neonatal sepsis (EONS) is an infectious disease of low incidence but high morbidity and mortality with severe consequences to the newborn prognosis. Identifying the associated factors related to EONS allows to start a timely treatment and to take preventive measures. METHODS: In this case and controls study we identified all the newborns (NB) with and without EONS (cases and controls), diagnosed through blood culture in a period of three years. We studied risk factors such as: low gestational age, gender, weight, maternal infections, and premature rupture of membranes. RESULTS: Our study consisted of 27 cases and 36 controls, with a mean age of 32.43 and 33.19 weeks of gestation (WOG), respectively (p > 0.05). Of these, 22 and 29 of the cases and controls had a gestational age < 37 WOG, (p > 0.05). However, maternal infection (odds ratio [OR] 1.76), respiratory distress syndrome (OR 4.72), the need of resuscitation (OR 2.9), intubation (OR 5.1) and ventilation support (OR 2.6) were statistically different between both groups (p < 0.05). The most isolated microorganism was Staphylococcus coagulase negative (42.3%). CONCLUSIONS: Risk factors associated with EONS were maternal infection, the need of resuscitation, and intubation to ventilation support.

Introducción: la sepsis neonatal es un problema de baja incidencia, pero de elevada morbimortalidad y consecuencias severas para el pronóstico del recién nacido (RN). Conocer los factores asociados a sepsis neonatal temprana (SNT) permite iniciar un tratamiento oportuno y tomar medidas preventivas. Métodos: en este estudio de casos y controles identificamos a todos los RN con y sin SNT (casos y controles), diagnosticada con hemocultivo, en un periodo de tres años. Estudiamos los factores de riesgo para SNT: baja edad gestacional, peso, sexo, patologías maternas y ruptura prematura de membranas. Resultados: pudimos captar un total de 27 casos y 36 controles, con una edad promedio de 32.43 y 33.19 semanas de gestación (SDG), respectivamente (p > 0.05). Respectivamente 22 y 29 de los casos y controles tuvieron una edad < 37 SDG (p > 0.05). Sin embargo, la presencia de enfermedad materna, la necesidad de reanimación, intubación y apoyo ventilatorio fueron estadísticamente diferentes entre ambos grupos (p < 0.05). El microorganismo más frecuentemente aislado fue el Staphylococcus coagulasa negativo (42.3%). Conclusión: los factores asociados a SNT fueron la presencia de enfermedad materna, la necesidad de reanimación y la intubación para apoyo ventilatorio.

Urine TREM-1 as a marker of urinary tract infection in children.

Objective Triggering receptor expressed on myeloid cells (TREM)-1 is a receptor that is thought to improve recognition of patients with true infection. In this study, we investigated whether Triggering receptor expressed on myeloid cells (TREM-1) is present in urine samples from children with urinary tract infection (UTI) and in samples from healthy children. Methods A total of 128 samples met the inclusion criteria for the study. Urine samples were processed for culture and urinalysis as a regular protocol for patients with UTI. Samples were classified according to culture and urinalysis results. TREM-1 protein expression was detected with flow cytometry and sTREM-1 was assessed by ELISA. Results Flow cytometry showed detectable expression of TREM-1 in 100% of samples, UTI and non-UTI groups ( p < 0.001). Mean fluorescence intensity of TREM-1 was different between the groups ( p < 0.001). Levels of sTREM-1 were detected in patients with UTI, but not in non-UTI patients. Conclusions All of our patients (healthy and diseased) showed TREM-1 expression. However, TREM-1 levels in patients with UTI tend to be higher and are associated with increased neutrophils and cytokine activity induced by bacteria.

The surgeon as a scientific writer.

The skills of a surgeon as a scientific writer are many and sophisticated. Recognizing the essential elements of research, learning how to plan and execute the idea, and finally assembling and reporting the data in a coherent and intelligent manner are all critical elements in successfully writing a publication. But writing a research paper is a demanding process that young surgeons are often ill-equiped to address. It consists of many complex tasks and inevitable difficulties that confront every researcher. From undergraduate programs through residency, more attention must be given to cultivate writing skills, especially within the scientific realm. In this article we specifically address these shortcomings while identifying solutions for and attributes of sound scientific writing. When we can manage the parts, we can manage the whole, and look forward to more research with greater confidence. Those who want to join communities that depend on research, such as surgical and medical communities, have to demonstrate not only that they can give good answers to hard questions, but also that they can report their results in ways that are useful to their community, and that means in ways that are apparent, accessible, and recognizable. Being a scientific writer allows him or her to clearly express and effectively convey the importance of worthwhile research. Only when someone has experienced the process of doing his or her own research can one intelligently evaluate the research of others.

Selectin inhibition modulates NF-kappa B and AP-1 signaling after liver ischemia/reperfusion.

The infiltration of neutrophils after ischemia and reperfusion (I/R) is facilitated by the expression of adhesion molecules on the surface of both leukocytes and endothelial cells. Adhesion molecules of the selectin family are of particular importance at the onset of neutrophil mediated injury, as demonstrated by the occurrence of many cellular interactions with the final extravasation of inflammatory leukocytes at the site of I/R damage. Previous studies demonstrated a prevention of neutrophil extravasation and protection of ischemic damage when a small anti-selectin molecule was used. In this study, we tested a new small anti-selectin compound (OC-229) in a murine model of partial hepatic I/R. The aim of this study was to determine the effect of OC-229 on liver function and histology after I/R and to evaluate its role in the modulation of the inflammatory molecular signaling pathways of NF-kappa B and AP-1 under the same experimental condition. Mice subjected to 90 min of partial (70-80%) hepatic ischemia and 3 h of reperfusion were divided into three groups (n = 9/group): sham, ischemic control, and treated group, which received 25 mg/kg of the anti-selectin small molecule OC-229. These groups were studied when the treatment was given at the time of reperfusion (no pretreatment was given). The parameters measured at 3 h of reperfusion included liver function tests (ALT and AST), liver histology, and liver tissue electrophoretic mobility shift assay (EMSA) for NF-kappa B and AP-1. It was demonstrated that the multiselectin inhibitor OC-229 offered significant protection for the ischemic liver when given at 25 mg/kg at the time of reperfusion. ALT and AST serum levels significantly decreased when the ischemic control and the group receiving OC-229 were compared (p = .01). Treated animals demonstrated better histological findings as well. The EMSA showed dissociation of NF-kappa B and AP-1 activity in the liver nuclear extracts after selectin inhibition treatment. A reduction in the activity of AP-1 and an increment in NF-kappa B activation was seen. In this work, we obtained evidence that the small-molecule selectin inhibitor OC-229 offered functional and histological protection of the ischemic liver when given at 25 mg/kg at the time for reperfusion. There was dissociation in the activation signals of NF-kappa B and AP-1. Increase in NF-kappa B and reduction of the activation of AP-1 were noted at 3 h of reperfusion.

Crawford Williamson Long: The True Pioneer of Surgical Anesthesia.

Anesthesia and analgesia are as old as mankind itself. However, we now know that the true pioneer of surgical anesthesia through inhalation of ether was Doctor Crawford Williamson Long (1815-1878), who endeavored to help his profession and mankind without pursuing any reward or honor. Crawford Williamson Long was a great and beloved American surgeon. He was a well-educated and elegant man with an outstanding personality. Crawford was born in Danielsville, Georgia, in the United States and was the son of James Long and Elizabeth Ware Long. He married Mary Caroline Swain Long and gave birth to 12 children. Long proved the effectiveness of ether after painlessly removing a tumor from the neck. In 1847, a rivalry broke out among Horace Wells, Charles Thomas Jackson, and William Thomas Green Morton for the primacy as regards the discovery of anesthesia. The US Congress offered itself to arbitrate the case of the so called "ether controversy." Finally, a few years after the end of the North American Civil War, while taking care of a patient, Crawford passed away, presumably after suffering a stroke.

[Expression of TREM-1 in patients with invasive cervical cancer and precursor lesions]. / Expresión de TREM-1 en pacientes con cáncer cervical invasor y lesiones precursoras.

BACKGROUND: It has been shown that the TREM-1 glycoprotein belongs to the immunoglobulin superfamily that induces secretion of various proinflammatory cytokines. The aim of this study was to measure the expression of TREM-1 in patients with cervical cancer. METHODS: In this cross-sectional study we included four groups of patients: GI: women with low-grade squamous intraepithelial lesion (IL) (n = 15 p / g); GII: patients with high-grade squamous IL (n = 9 w / g); GIII: patients with invasive cervical cancer (n = 9 p / g) and GIV: healthy patients (n = 15 p / g). In all patients the expression of TREM-1 and the Average Fluorescence Index (AFI) in neutrophils and monocytes were measured, as well as levels of leukocytes, neutrophils and monocytes. We used Student's t test for independent samples. For these variables, we applied Mann-Whitney rank-sum, ANOVA, and Tukey tests. Chi square test was used for qualitative variables. RESULTS: The percentages of TREM-1 expression in neutrophils and monocytes, plus the AFI in neutrophils in the 4 groups was not significantly different. The AFI of TREM-1 in monocytes was significantly different when comparing group II and group III versus group IV (p < 0.02). There was also no significant difference when comparing the mean values of leukocytes, neutrophils and monocytes in the different groups. CONCLUSION: This study shows increased expression of TREM-1 in monocytes from patients with advanced cancer.

Introducción: se ha demostrado que la glicoproteína TREM-1 pertenece a la superfamilia de las inmunoglobulinas que induce la secreción de varias citocinas proinflamatorias. El objetivo de este trabajo fue medir la expresión de TREM-1 en pacientes con cáncer cervical. Métodos: en este estudio transversal analítico incluimos 4 grupos de pacientes: GI: mujeres con lesión intraepitelial (LI) escamosa de bajo grado (n = 15 p/g); GII: pacientes con LI escamosa de alto grado (n = 9 p/g); GIII: pacientes con cáncer cervical invasor (n = 9 p/g), y GIV: pacientes sanas (n = 15 p/g). En todas las pacientes se midió la expresión de TREM-1 y el Índice Medio de Fluorescencia (IMF) en neutrófilos y monocitos, así como los niveles de leucocitos, neutrófilos y monocitos. Usamos t de Student para muestras independientes. Para estas mismas variables, aplicamos prueba de suma de rangos de Mann-Whitney, ANOVA y Turkey. Para las variables cualitativas se utilizó la prueba de Chi cuadrada. Resultados: los porcentaje de expresión de TREM-1 en neutrófilos y monocitos, además del IMF en neutrófilos en los 4 grupos, no fue significativamente diferente. El IMF de TREM-1 en monocitos fue significativamente diferente al comparar el grupo II y grupo III frente al grupo IV (p < 0.02). Tampoco hubo diferencia significativa al comparar los valores promedio de leucocitos, neutrófilos y monocitos en los diferentes grupos. Conclusión: este estudio documenta una mayor expresión de TREM-1 en monocitos de pacientes con cáncer avanzado.

L-alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis.

BACKGROUND & AIMS: A growing number of randomized clinical trials suggest that glutamine (Gln) supplementation may be beneficial in a selected group of patients and conditions. However, the effects of Gln-enriched total parenteral nutrition (TPN) on recovery from acute intra-abdominal infection have not been thoroughly investigated. Therefore, the aim of this study was to investigate whether the provision of Gln-enriched TPN after surgical and medical treatment of secondary peritonitis improves infectious morbidity. METHODS: Thirty-three patients with secondary peritonitis were randomly assigned to receive either standard (n=16) TPN or L-alanyl-L-glutamine-supplemented (n=17) TPN, after medical and surgical treatment of the infectious focus. The two TPN formulae were isonitrogenous and isocaloric, which commenced the morning after surgery and ran continuously for 10 consecutive days. The control group received standard TPN, while the treatment group was given L-alanyl-L-glutamine, 0.40 g/kg/d (Dipeptiven, Fresenius Kabi, Bad Homburg, Germany). Infectious morbidity, nitrogen balance, leukocytes, lymphocytes, subpopulations CD(4) and CD(8), Immunoglobulin A (IgA), total proteins, albumin, hospital and intensive care unit (ICU) stays, and mortality were evaluated. Statistical analysis included one-way ANOVA, the unpaired Student's t-test, the Mann-Whitney U-test, chi(2) test, or Fisher's exact test. RESULTS: Patients in both groups were comparable prior to the operation. Nitrogen balance and the levels of albumin and IgA were significantly better than those in the control group. Also, a significant reduction in the infectious morbidity was found in the Gln-treated group. Lymphocyte counts as well as subpopulations CD(4) and CD(8), and proteins showed a propensity to improvement and a tendency to reduced rates of mortality were observed when comparing the groups. Hospital and ICU stays were similar. CONCLUSION: L-alanyl-L-glutamine-supplemented TPN improved the infectious morbidity of patients with secondary peritonitis. Gln supplementation to parenteral nutrition may be an alternative for enhancing host defenses and improving infectious morbidity.

Multiple selectin blockade with a small-molecule selectin inhibitor does not affect survival after a second inflammatory challenge with nonlethal LPS.

The effects of anti-adhesion molecule antibodies on the blockade of leukocyte-endothelial interactions have the potential of decreasing survival through possibly increased infection vulnerability. The aim of this study was to determine the effect of a small-molecule selectin inhibitor (TBC-1269) on both liver response and survival to a nonlethal lipopolysaccharide (LPS) challenge after hemorrhagic shock. Ninety-six Sprague-Dawley rats were subjected to a model of uncontrolled hemorrhagic shock. Six groups of animals were included in this study (n = 16 per group): sham/saline, sham/LPS, shock/saline, shock/LPS, shock/TBC1269, and shock/TBC-1269/LPS. Experimental design consisted of the development of hemorrhagick shock (3 mL/100 g) in a 15-min period, tail amputation and drug administration at 30 min, and subsequent resuscitation to maintain mean arterial pressure at 70mm Hg. A septic challenge was produced with 0.1 mg/kg of LPS (Escherichia coli type 78H4086; Sigma Chemical, St. Louis, MO) given intravenously via penile vein at 20 h. Liver injury tests (alanine aminotransferase, ALT), liver myeloperoxidase, liver histology, and 21-day survival were evaluated. Statistical analysis included the Bartlett test for equality of variance, a two-way analysis of variance (ANOVA), and overall followed by pairwise log-rank test for survival. Significant improvements in liver function and histology were observed in animals treated with TBC-1269 with or without a nonlethal septic challenge. Neutrophil infiltration, as evidenced by liver myeloperoxidase (MPO) was significantly decreased in animals treated with TBC-1269 alone and those having LPS administration after TBC-1269 treatment. We conclude that TBC-1269, multisectin blocker, was effective in reducing liver damage even with the addition of a second inflammatory insult as the nonlethal LPS challenge used in this study.

The attenuation of hemorrhage-induced liver injury by exogenous nitric oxide, L-arginine, and inhibition of inducible nitric oxide synthase.

We investigated the role of nitric oxide (NO) in its ability to reduce liver injury in an animal model of hemorrhagic shock (HS). Ninety-six Sprague-Dawley rats weighing 250 to 300 g were divided in 6 groups (n = 16 per group) that included treatment at the beginning of resuscitation with normal saline (groups 1, 3) sodium nitroprusside (NP) (0.5 mg/kg) (groups 2, 4) L-arginine (300 mg/kg) (group 5), and L-N6-(1-iminoethyl) lysine (L-NIL, 40 mg/kg) (group 6). The experimental model of HS consisted of the withdrawal of 3 mL blood per 100 g in a 15-min period, tail amputation (75%), and drug administration at 30 min. This was followed by fluid resuscitation (FR) with lactated Ringer's (LR) solution to reach a mean arterial pressure (MAP) of 40 mm Hg, then a hospital phase of 60 min with hemostasis and FR with LR solution to reach a MAP of 70 mm Hg with a 3-day observation phase. NP, L-Arginine, and L-NIL significantly reduced fluid requirements for resuscitation (p =.0001) as well as significantly increased MAP after resuscitation from hemorrhage. We also observed an improved statistically significant difference (p =.001) in tests demonstrating less hepatic injury and histology damage. The mRNA expression of cytokines in the liver (interleukin [IL]-1alpha, IL-beta1, tumor necrosis factor [TNF]beta, IL-3, IL-4, IL-5, IL-6, IL-10, TNFalpha, IL-2, interferon [IFN]gamma) was reduced by NP treatment, L-arginine, and L-NIL. These data suggest that excess NO mediates hemorrhage-induced liver injury and that the suppression of inducible nitric oxide synthase (iNOS)-generated NO bioavailability with the NO donor sodium nitroprusside may reduce the pathophysiologic consequences of severe hemorrhage. This effect could be possibly related to the scavenging of to superoxide radicals (O2-) or the blockade of the deleterious effects of TNF and other inflammatory cytokines. The protective action noted with L-arginine cannot be fully explained within the context of this article, although it could be most likely associated with the supplementation of eNOS-generated NO.

[The HELPP syndrome--evidence of a possible systemic inflammatory response in pre-eclampsia?]. / Síndrome HELLP ?evidencias de una posible respuesta inflamatoria sistémica en la preeclampsia?

INTRODUCTION: The principal causes of morbidity and mortality during pregnancy in Mexico, are preeclampsia/eclampsia, obstetric hemorrhage and puerperium complications; this is, 62% of maternal deaths in last years. HELLP syndrome was observed between 5 to 25% of the mortality in pregnancies of 36 weeks or less. OBJECTIVE: To analyze patients with HELLP syndrome in ICU's (Intensive Care Unit) of a Gynecology and Obstetric Hospital, related to the abnormal hematological, hepatic and renal results with the obstetric case history and the clinical complications. MATERIALS AND METHODS: A transversal study in patients with HELLP syndrome during 1998 and 1999 were carry out. CASE DEFINITION: Peripheral blood with Microangiopathic hemolysis, elevated liver enzymes: AST, ALT over 40 UI/L, even when were LDH lower than 600 UI/L. It was evaluated the hepatic and renal function, platelets count, microangiopathic hemolysis, arterial pressure, seizures, icteric skin color, blindness, visual disturbances, nausea, vomiting and upper quadrant right abdominal pain. In newborn we analyzed gestational age, sex, weight and APGAR. We studied for an association between maternal and biochemical variables with Correlation Pearson Test, and dependence between variables with lineal regression model. RESULTS: 2878 patients with hypertensives disorders in pregnancy (11.64%). The 1.15% (n = 33) had HELLP syndrome with specific maternal mortality of 0.4 per 10,000 live birth, perinatal mortality of 1.62 per 10,000 live birth; and renal damage in 84.5%. Coefficient beta was higher between number of pregnancies to platelets count (-0.33) and creatinine clearance (-0.401). CONCLUSION: We found an important renal damage, low platelets, elevated liver enzymes in women with two or more pregnancies. Then we propose there are similarities between HELLP syndrome and Systemic Inflammatory Response Syndrome (SIRS) because they could have the same pathophysiology.