En Bloc Simultaneous Liver-Kidney Transplantation Compared to the Traditional Technique: Results From a Single Center.

BACKGROUND: Simultaneous liver-kidney transplantation is indicated for patients with concomitant end-stage liver disease and end-stage renal disease. The traditional technique involves separate implantations of the liver and the kidney. In the en bloc approach, the liver is recovered en bloc with the right kidney and the donor renal artery is anastomosed to the donor splenic artery. We aimed to compare the outcomes of the traditional and en bloc techniques for simultaneous liver-kidney transplantation in a single center. METHODS: This single-center retrospective study involved all adult patients who underwent simultaneous liver-kidney transplantation from brain-dead donors from January 2017 to December 2022. RESULTS: A total of 15 patients were included: 10 transplanted with the traditional technique and 5 with the en bloc approach. Patients in the en bloc group presented higher body mass index, shorter kidney cold and total ischemia times, shorter overall surgical time and longer kidney warm ischemia time (29.07 kg/m2vs 23.20 kg/m2 [P = .048]; 560 minutes vs 880 minutes [P = .026]; 615 minutes vs 908 minutes [P = 0.025]; 405 minutes vs 485 minutes [P = .046]; 46 minutes vs 33.5 minutes [P = 0.027], respectively). Ureteroneocystostomy was performed in 2 patients of the en bloc group and ureteroureterostomy in the remaining 3 patients. One patient in the en bloc group presented stenosis of renal artery anastomosis and underwent percutaneous angioplasty. This same patient eventually developed late urinary fistula. In the traditional technique group, there were 2 cases of renal vein thrombosis and 1 of ureteral stenosis. CONCLUSIONS: Compared with the traditional technique, the en bloc approach is feasible and safe, reducing kidney total ischemia time and overall surgical time.

Liver Transplantation for Adenomatosis: A Single-Center Experience.

BACKGROUND: Liver adenomatosis is characterized by multiple adenomas diffusely distributed throughout the liver parenchyma. Studies addressing liver transplantation for those cases are scarce, and the criteria used to indicate transplantation are still debatable. OBJECTIVE: To report a single-center experience of liver transplantation for diffuse adenomatosis. METHODS: Single-center retrospective study involving all adult patients who underwent liver transplantation due to adenomatosis from January/2010 to June/2023. RESULTS: A total of 13 patients were identified, corresponding to 0.89% of liver transplants performed during the study period. The mean age was 33 ± 6.55 years, and most of them were female (n = 9, 69.23%). There were 12 transplants with deceased donors and 1 with a right lobe from a living donor. The most frequent reason to preclude liver resection was multiple and large unresectable adenomas in patients without previous liver disease (n = 8, 61.58%), followed by underlying liver disease (Abernethy Malformation, n = 3, 23.07%) and recurrence after liver resection (n = 2, 15.38%). The indications for liver transplantation were high risk of malignant transformation (n = 7, 53.84%), increasing size and number of nodules (n = 3, 23.07%), confirmed malignant transformation (n = 2, 15.38%), and hemorrhage (n = 2, 15.38%). There was 1 perioperative death due to primary non-function. Another patient died during follow-up because of COVID-19. CONCLUSION: Liver adenomatosis is a rare indication for liver transplantation, with acceptable post-transplant outcomes. Unresectable adenomas with high-risk or confirmed malignant transformation are the main indications for transplant. Reasons for unresectability involve underlying liver disease, multiple and large high-risk nodules, and recurrence after previous resection.

Uso del modelador nasolabial (NAM) como tratamiento ortopédico prequirúrgico de paciente con labio y paladar hendido / Use of nasoalveolar molding (NAM) as a pre-surgical orthopedic treatment for patients with cleft lip and palate

Introducción: el labio y paladar hendido es la malformación craneofacial congénita más frecuente y es producida por una falla en la fusión de procesos faciales durante periodos iniciales en el desarrollo embrionario. Objetivo: el objetivo de la ortopedia prequirúrgica es facilitar la primera intervención para la corrección de esta condición de manera que disminuya el trauma quirúrgico, al obtener una menor formación de cicatrices y menor riesgo de complicaciones postquirúrgicas, además de ayudar a obtener una óptima deglución en el paciente para mejorar el aspecto nutricional en el bebé. Material y métodos: el paciente fue llevado a la clínica a las dos semanas de nacido para la toma de impresión y colocación de un aparato ortopédico; se le colocó el NAM (nasoalveolar molding), la cinta transport, además se realizaban citas una vez al mes para evaluar el stent nasal, activarlo y revisar que la colocación de la cinta estuviese correcta, así como para comprobar que la alimentación del bebé estuviera mejorando. Resultados: se observa una mejoría anatómica y fisiológica, también una disminución de la fisura labial de 6 mm y una remodelación nasal. Se notó una mejora en deglución y alimentación con ganancia de peso. Conclusiones: la ortopedia prequirúrgica con el NAM es una terapia aceptable y recomendable para los pacientes con labio y paladar hendido, ya que nos ayudan a generar mejores resultados quirúrgicos, además de colaborar con el aspecto nutricional del bebe (AU)

Introduction: cleft lip and palate is a craniofacial malformation most frequent congenital and is produced by a failure to fuse facial processes during early periods in embryonic development. Objective: the objective of pre-surgical orthopedics is to facilitate the first intervention for the correction of this condition, reducing surgical trauma, obtaining less scar formation and less risk of post-surgical complications, in addition to helping the patient obtain better swallowing to improve the nutritional aspect in the baby. Material and methods: the patient came to the clinic at two weeks of age for impression taking and placement of the orthopedic device. The NAM (nasoalveolar molding) and the transport tape were placed and appointments were made once a month to evaluate the nasal stent, activate it and check that the placement of the tape was correct, as well as to check that the baby's feeding was improving. Results: an anatomical and physiological improvement is observed, as well as a 6mm decrease in the cleft lip and nasal remodeling. An improvement in swallowing and feeding with weight gain was observed. Conclusions: pre-surgical orthopedics with NAM is an acceptable and recommended therapy for patients with cleft lip and palate since it helps us to generate better surgical results in addition to collaborating with the nutritional aspect of the baby (AU)

Cryptococcus neoformans- and Cryptococcus gattii-specific IgG, IgA and IgM differ among children and adults with and without cryptococcosis from Colombia.

Cryptococcus neoformans (Cn) and Cryptococcus gattii (Cg) cause cryptococcosis, a life-threatening systemic mycosis of global distribution affecting mainly immunocompromised adults. Although a humoral response occurs during cryptococcosis, the role of antibody production against this mycosis is not fully understood. We aimed to determine total and specific antibodies against cryptococcal protein antigens in sera from people with and without a diagnosis of cryptococcosis from Colombia. Using ELISA, total and specific levels of immunoglobulin (Ig)G, IgA and IgM were determined in sera from children and adults with (n = 109) and without (n = 119) cryptococcosis. Specific antibodies were those binding Cn- and Cg-protein antigens. In general, the mean of the total IgG production was higher in cryptococcosis patients than in controls (13 942.32 vs. 6459.91 µg/ml), while levels of IgA (488.13 vs. 1564.53 µg/ml) and IgM (775.69 vs. 1014.72 µg/ml) were higher in controls than in cryptococcosis patients (P ≤ .05). In patients with cryptococcosis, total IgG, IgA and IgM levels were higher in HIV + compared with HIV- (P ≤ .05). Specific antibodies tended to be higher in cryptococcosis patients than in controls and in adults than in children, with a positive correlation between antibody reactivity and age. All immunoglobulins were more reactive against Cn-proteins than Cg-proteins. Overall, a positive weak correlation between total and specific antibodies was found, although not always statistically significant. In patients with cryptococcosis from Colombia, the levels of immunoglobulins, total and specific, differ with respect to people without cryptococcosis. Variations in antibody production among adults and children with cryptococcosis and between Cn- and Cg-protein antigens were as well established. Our findings encourage further studies to determine the role of humoral immunity for host defense against cryptococcosis.

Differential IgG, IgA, and IgM production and their reactivity with cryptococcal proteins, both among children and adults with and without a diagnosis of cryptococcosis from Colombia, lead to reappraise the study of the potential role of antibody production as host defense against this fungal infection.

Septuagenarian Donors and Recipients in Deceased Donor Liver Transplantation: A Brazilian Single Center Experience and Literature Review.

BACKGROUND: The number of elderly patients who have end-stage liver disease and require liver transplantation has dramatically increased. On the other hand, liver grafts from elderly donors have been offered more frequently for transplantation. The present study aims to analyze the results of liver transplants performed with donors and recipients aged ≥70 years. METHODS: We performed a single-center retrospective study of deceased donors liver transplants that involved recipients aged ≥7070 years or recipients who received grafts from donors aged ≥70 years from 2011 to 2021. A literature review on the results of liver transplantation in elderly recipients was also performed. RESULTS: Thirty septuagenarian recipients were included; their overall 1- and 5-years survival was 80% and 76.6%, respectively. The prevalence of recipients aged ≥70 years in our department was 2.65%. Twenty recipients received grafts form septuagenarian donors; their overall 1- and 5-years survival was 75%. The prevalence of donors aged ≥70 years in our department was 1%. In the literature review, 17 articles were analyzed. The 5-years survival of recipients aged ≥70 years ranged from 47.1% to 78.5%. CONCLUSIONS: Septuagenarian recipients and patients who received grafts from elderly brain-dead donors present adequate overall survival after liver transplantation. Optimized donor-recipient matching is paramount for achieving good outcomes. The combination of high-risk donors with septuagenarian recipients should be avoided as well as using grafts of elderly donors that present others risk factors. Thus, the age of the donor or recipient alone cannot be considered an absolute contraindication for liver transplantation.

Small-for-Size Syndrome: Systemic Review in a Porcine Experimental Model.

BACKGROUND: The small-for-size syndrome (SFSS) is characterized by prolonged hyperbilirubinemia, coagulopathy, and/or encephalopathy caused by a small liver graft that cannot sustain the metabolic demands of the recipient after a partial liver transplant (PLT). Models of PLT in pigs are excellent for studying this syndrome. This review aimed to identify the different porcine models of SFSS in the literature and compare their technical aspects and therapeutics methods focused on portal inflow modulation (PIM). METHODS: We performed a systematic review of the porcine experimental model and SFSS. The MEDLINE-PubMed, EMBASE, Cochrane Library, LILACS, and SciELO databases were electronically searched and updated until June 20, 2021. The MeSH terms used were ''ORGAN SIZE'' AND ''LIVER TRANSPLANTATION". RESULTS: Thirteen SFSS porcine models were reported. Four were performed with portocaval shunt to PIM and 3 with mesocaval shunt to PIM. A few studies focused on clinical therapeutics to PIM; a study described somatostatin infusion to avoid SFSS. Initially, studies on PIM showed its potentially beneficial effects without mentioning the minimum portal flow that permits liver regeneration. However, an excessive portal diversion could be detrimental to this process. CONCLUSIONS: The use of porcine models on SFSS resulted in a better understanding of its pathophysiology and led to the establishment of various types of portal modulation, surgical techniques with different complexities, and pharmaceutical strategies such as somatostatin, making clear that without reducing the portal vein pressure the outcomes are poor. With the improvement of these techniques, SFSS can be avoided.

Incidence of Donor Hepatic Artery Thrombosis in Liver Grafts Recognized During Organ Procurement and Backtable: A Rare but Treacherous Pitfall In Liver Transplantation.

INTRODUCTION: Donor hepatic artery thrombosis (dHAT) identified during liver procurement and backtable is a rare and little-reported event that can make liver transplants unfeasible. METHODS: This is a retrospective study of dHAT identified during liver grafts procurements or backtable procedures. All grafts were recovered from brain-dead donors. The demographic characteristics of the donors and the incidence of dHAT were analyzed. The data were also compared to a cohort of donors without dHAT. RESULTS: There was a total of 486 donors during the study period. The incidence of dHAT was 1.85% (n = 9). The diagnosis of dHAT was made during procurement in 5 cases (55.5%) and during the backtable in 4 (44.4%). Most donors were female (n = 5), with an average BMI of 28.14 ± 6.9 kg/m2, hypertensive (n = 5), and with stroke as cause of brain death (n = 8). The most prevalent site of dHAT was a left hepatic artery originating from the left gastric artery (n = 4). Of the 9 cases reported, 2 livers were used for transplantation, and 7 were discarded. Comparing those cases to a cohort of 260 donors without dHAT, we found a higher incidence of anatomic variations in the hepatic artery (P = .01) and of stroke as cause of brain death (P = .05). CONCLUSION: The occurrence of dHAT before liver procurement is a rare event, however it may become a treacherous pitfall if the diagnosis is late. Grafts with anatomic variations recovered from women with brain death due to stroke and with past history of hypertension seem to be at a higher risk of presenting dHAT.

[Association of hyperglycemia with the length of stay in hospitalized patients]. / Prevalencia de hiperglicemia y su relación con el tiempo de estadía en un hospital terciario.

BACKGROUND: Hyperglycemia during hospital stay is associated with adverse outcomes. AIM: To characterize the frequency of hyperglycemia in a tertiary hospital and to correlate it with length of hospital stay (LOS). MATERIAL AND METHODS: Review of medical records of hospitalized patients. Demographic data and laboratory data, previous diabetes mellitus (DM) history, current main diagnosis, unit of hospitalization and the two highest capillary blood glucose values from the analyzed period were recorded for each patient. LOS was obtained from electronic clinical records. RESULTS: 210 subjects, aged 60 ± 19 years (104 women) were included. 113 patients (54%) developed hyperglycemia ≥ 140 mg/L. Thirty one percent of these had a previous history of diabetes and 29% had stress hyperglycemia (SHG). Patients with a history of DM had a higher average blood glucose than those with SHG (238.9 and 178.2 mg/dL, respectively, p < 0.01) and a greater percentage of cases with a blood glucose above 180 mg/dL (72 and 40.0%, respectively, p < 0.01). Hospital LOS was significantly longer in patients with hyperglycemia ≥ 140 mg/dL as compared with those with normoglycemia (29.3 and 12.8 days, respectively, p < 0.01). This association remained significant when introduced in a linear regression analysis including diagnosis, decreased glomerular filtration rate (GFR) and hospitalization unit (p < 0.01). CONCLUSIONS: Hyperglycemia during hospitalization affects more than half of hospitalized patients and is associated with a longer length of stay.

Effect of respiratory inhibitors and quinone analogues on the aerobic electron transport system of Eikenella corrodens.

The effects of respiratory inhibitors, quinone analogues and artificial substrates on the membrane-bound electron transport system of the fastidious ß-proteobacterium Eikenella corrodens grown under O2-limited conditions were studied. NADH respiration in isolated membrane particles were partially inhibited by rotenone, dicoumarol, quinacrine, flavone, and capsaicin. A similar response was obtained when succinate oxidation was performed in the presence of thenoyltrifluoroacetone and N,N'-dicyclohexylcarbodiimide. NADH respiration was resistant to site II inhibitors and cyanide, indicating that a percentage of the electrons transported can reach O2 without the bc1 complex. Succinate respiration was sensitive to myxothiazol, antimycin A and 2-heptyl-4-hydroxyquinoline-N-oxide (HQNO). Juglone, plumbagin and menadione had higher reactivity with NADH dehydrogenase. The membrane particles showed the highest oxidase activities with ascorbate-TCHQ (tetrachlorohydroquinone), TCHQ alone, and NADH-TMPD (N,N,N',N'-tetramethyl-p-phenylenediamine), and minor activity levels with ascorbate-DCPIP (2,6-dichloro-phenolindophenol) and NADH-DCPIP. The substrates NADH-DCPIP, NADH-TMPD and TCHQ were electron donors to cyanide-sensitive cbb' cytochrome c oxidase. The presence of dissimilatory nitrate reductase in the aerobic respiratory system of E. corrodens ATCC 23834 was demonstrated by first time. Our results indicate that complexes I and II have resistance to their classic inhibitors, that the oxidation of NADH is stimulated by juglone, plumbagin and menadione, and that sensitivity to KCN is stimulated by the substrates TCHQ, NADH-DCPIP and NADH-TMPD.

Prevalencia de hiperglicemia y su relación con el tiempo de estadía en un hospital terciario / Association of hyperglycemia with the length of stay in hospitalized patients

Background: Hyperglycemia during hospital stay is associated with adverse outcomes. Aim: To characterize the frequency of hyperglycemia in a tertiary hospital and to correlate it with length of hospital stay (LOS). Material and Methods: Review of medical records of hospitalized patients. Demographic data and laboratory data, previous diabetes mellitus (DM) history, current main diagnosis, unit of hospitalization and the two highest capillary blood glucose values from the analyzed period were recorded for each patient. LOS was obtained from electronic clinical records. Results: 210 subjects, aged 60 ± 19 years (104 women) were included. 113 patients (54%) developed hyperglycemia ≥ 140 mg/L. Thirty one percent of these had a previous history of diabetes and 29% had stress hyperglycemia (SHG). Patients with a history of DM had a higher average blood glucose than those with SHG (238.9 and 178.2 mg/dL, respectively, p < 0.01) and a greater percentage of cases with a blood glucose above 180 mg/dL (72 and 40.0%, respectively, p < 0.01). Hospital LOS was significantly longer in patients with hyperglycemia ≥ 140 mg/dL as compared with those with normoglycemia (29.3 and 12.8 days, respectively, p < 0.01). This association remained significant when introduced in a linear regression analysis including diagnosis, decreased glomerular filtration rate (GFR) and hospitalization unit (p < 0.01). Conclusions: Hyperglycemia during hospitalization affects more than half of hospitalized patients and is associated with a longer length of stay.

Compromiso pulmonar por cryptoccus laurentii en paciente inmunocomprometido / Pulmonary Involvement with Cryptococcus Laurentii in an Immunocompromised Patient

La criptococosis afecta predominantemente a pacientes con compromiso de la inmunidad celular. Se presenta el caso de un paciente masculino de 45 años, con antecedentes de VIH y linfoma de Hodgkin, internado por fiebre persistente sin neutropenia. El PET-TC evidenció imágenes hipermetabólicas pulmonares y ganglionares se sospechó recaída de su enfermedad y/o proceso infeccioso. Se realizó BAL, se aisló en cultivo Crytococcus laurentii. Recibió tratamiento con anfotericina B y fluconazol, cultivos de control negativos. Se repitió TC de control sin infiltrados pulmonares y persistencia de adenopatías. Realizó tratamiento con ESHAP evolucionando con buena respuesta.

Cryptococcosis mostly affects patients with cell-mediated immunity involvement. We present the case of a male patient, 45 years old, with history of HIV and Hodgkin's lymphoma, who was admitted to the hospital due to persistent fever without neutropenia. The PET-TC (Positron Emission Tomography - Computed Tomography) showed hypermetabolic pulmonary and lymph node images. We suspected disease relapse and/or the presence of an infectious process. We performed a BAL (Bronchoalveolar Lavage) and Cryptococcus laurentii was isolated in culture. The patient received treatment with amphotericin B and fluconazole, with negative control cultures. The CT control was repeated without pulmonary infiltrates and persistence of adenopathies. The patient received treatment with ESHAP and evolved with good response.

Portación de Candida spp. en cavidad oral en diabéticos y no diabéticos / Carrying of Candida spp. in the oral cavity in diabetic and non-diabetic patients

Introducción: Candida spp. es un habitante normal de la microbiota humana, que puede originar infecciones superficiales y sistémicas de carácter oportunista. En pacientes diabéticos se incrementa el riesgo de infecciones por esta levadura, lo cual estaría determinado por la portación de Candida spp. Esta portación es variable, así se observa en cavidad oral desde 13,7 al 64 por ciento. Objetivo: establecer los porcentajes de colonización y posibles factores asociados en este grupo de alto riesgo. Método: se realizó un estudio descriptivo en un total de 172 pacientes diabéticos y no diabéticos. Las muestras de enjuague bucal se sembraron en agar Sabouraud y CHROMagar Candida. Los aislamientos se sometieron a pruebas fenotípicas y a reacción en cadena de la polimerasa múltiple para su identificación. Las variables demográficas, los hábitos de higiene oral, el uso de prótesis dental, así como los niveles de hemoglobina glucosilada se evaluaron para determinación de frecuencias y asociación por chi2 y análisis multivariado, mediante el programa SPSS versión 19.0. Resultados: el porcentaje de colonización en el total de la población diabética y no diabética (n= 172) fue de 33,7 por ciento. La distribución por especies fue de Candida albicans (63,8 por ciento), Candida glabrata (10,3 por ciento), Candida tropicalis (6,9 por ciento), Candida krusei (5,2 por ciento), Candida dubliniensis (3,4 por ciento), Candida parapsilosis (3,4 por ciento), Candida lusitaniae (1,7 por ciento), Candida guilliermondii (1,7 por ciento) y Candida spp. (no identificada, 3,4 por ciento). En sujetos no diabéticos el porcentaje de colonización fue de 27,9 por ciento y en diabéticos de 36,9 por ciento. En los sujetos del estudio se encontró que 14,9 por ciento tenía control glúcemico por los niveles de hemoglobina glucosilada, el 57,6 por ciento utilizaba prótesis dentales y el 63,9 por ciento practicaba higiene oral regular. Conclusión: Candida albicans es la especie predominante en ambos grupos, con un porcentaje significativo de las especies no albicans en estos pacientes. El uso de prótesis dental es un factor coadyuvante para la colonización por especies del género Candida(AU)

Introduction: Candida spp. is a normal inhabitant of the human microbiota, which can cause superficial and systemic infections of an opportunistic nature. In diabetic patients the risk of infections by this yeast increases, which would be determined by the carrying of Candida spp. This carrying is variable, as observed in the oral cavity from 13.7 to 64 percent. Objective: to establish the percentages of colonization and possible associated factors in this high-risk group. Method: a descriptive study was carried out in a total of 172 diabetic and non-diabetic patients. Mouthwash samples were seeded on Sabouraud agar and CHROMagar Candida. The isolates were subjected to phenotypic tests and to a multiple polymerase´s chain reaction for identification. Demographic variables, oral hygiene habits, the use of dental prostheses, as well as glycosylated hemoglobin levels were evaluated for frequency and association determination by chi2 and multivariate analysis, using the SPSS program version 19.0. Results: the percentage of colonization in the total of the diabetic and non-diabetic population (n= 172) was 33.7 percent. The distribution by species was Candida albicans (63.8 percent), Candida glabrata (10.3 percent), Candida tropicalis (6.9 percent), Candida krusei (5.2 percent), Candida dubliniensis (3.4 percent), Candida parapsilosis (3.4 percent), Candida lusitaniae (1.7 percent), Candida guilliermondii (1.7 percent), and Candida spp. (unidentified, 3.4 percent). In non-diabetic patients the percentage of colonization was 27.9 percent and in diabetics 36.9 percent. In the study´s patients, it was found that 14.9 percent had glycemic control by glycosylated hemoglobin levels, 57.6 percent used dental prostheses, and 63.9 percent practiced regular oral hygiene. Conclusion: Candida albicans was the predominant specie in both groups, with a significant percentage of the non-albicans species in these patients. The use of dental prostheses was a contributory factor for colonization by species of the genus Candida(AU)

Recessive dystrophic epidermolysis bullosa results in painful small fibre neuropathy.

Small fibres in the skin are vulnerable to damage in metabolic or toxic conditions such as diabetes mellitus or chemotherapy resulting in small fibre neuropathy and associated neuropathic pain. Whether injury to the most distal portion of sensory small fibres due to a primary dermatological disorder can cause neuropathic pain is still unclear. Recessive dystrophic epidermolysis bullosa (RDEB) is a rare condition in which mutations of proteins of the dermo-epidermal junction lead to cycles of blistering followed by regeneration of the skin. Damage is exclusive to the skin and mucous membranes, with no known direct compromise of the nervous system. It is increasingly recognized that most RDEB patients experience daily pain, the aetiology of which is unclear but may include inflammation (in the wounds), musculoskeletal (due to atrophy and retraction scars limiting movement) or neuropathic pain. In this study we investigated the incidence of neuropathic pain and examined the presence of nerve dysfunction in RDEB patients. Around three quarters of patients presented with pain of neuropathic characteristics, which had a length-dependent distribution. Quantitative sensory testing of the foot revealed striking impairments in thermal detection thresholds combined with an increased mechanical pain sensitivity and wind up ratio (temporal summation of noxious mechanical stimuli). Nerve conduction studies showed normal large fibre sensory and motor nerve conduction; however, skin biopsy showed a significant decrease in intraepidermal nerve fibre density. Autonomic nervous system testing revealed no abnormalities in heart rate and blood pressure variability however the sympathetic skin response of the foot was impaired and sweat gland innervation was reduced. We conclude that chronic cutaneous injury can lead to injury and dysfunction of the most distal part of small sensory fibres in a length-dependent distribution resulting in disabling neuropathic pain. These findings also support the use of neuropathic pain screening tools in these patients and treatment algorithms designed to target neuropathic pain.

Photothermal lesions in soft tissue induced by optical fiber microheaters.

Photothermal therapy has shown to be a promising technique for local treatment of tumors. However, the main challenge for this technique is the availability of localized heat sources to minimize thermal damage in the surrounding healthy tissue. In this work, we demonstrate the use of optical fiber microheaters for inducing thermal lesions in soft tissue. The proposed devices incorporate carbon nanotubes or gold nanolayers on the tips of optical fibers for enhanced photothermal effects and heating of ex vivo biological tissues. We report preliminary results of small size photothermal lesions induced on mice liver tissues. The morphology of the resulting lesions shows that optical fiber microheaters may render useful for delivering highly localized heat for photothermal therapy.

Colonización por Candida spp. en sujetos diabéticos y no diabéticos / Colonization by Candida spp. in diabetic and non-diabetic individuals in the north of Colombia

Introducción: el género Candida puede encontrarse colonizando el cuerpo humano, pero también puede provocar infecciones de carácter oportunista. La diabetes es considerada comúnmente un factor de riesgo para la infecciones candidósicas, dadas sus características asociadas a inmunosupresión, hiperglucemia, problemas de microvascularización, entre otros. Usualmente, para que se inicie un proceso infeccioso, es necesaria la colonización; por tanto, es importante conocer su frecuencia de portación en grupos con factores de riesgo asociados. Objetivo: determinar los porcentajes de colonización por Candida spp. en la cavidad oral y la zona interdigital del pie en pacientes diabéticos y no diabéticos. Métodos: el estudio, de carácter descriptivo, se realizó en un grupo de 85 pacientes del norte de Colombia: 46 diabéticos y 39 no diabéticos. La identificación de los aislamientos se realizó por pruebas fenotípicas, que incluyeron CHROMagar, microscopía, prueba de tubo germinal, prueba de clamidosporas y zimograma. Resultados: en los pacientes diabéticos se encontró una frecuencia de colonización por Candida spp. en la cavidad oral de 23,9 por ciento, y en el pie, de 56,52 por ciento; mientras que, para los sujetos no diabéticos, la frecuencia de colonización en la cavidad oral fue del 33,3 por ciento y en el pie del 43,58 por ciento. Adicionalmente, en el grupo de diabéticos se encontró que la frecuencia de colonización por la especie Candida albicans en la cavidad oral fue de 45,5 por ciento, mientras que en el pie fue del 11,5 por ciento. Conclusiones: los resultados obtenidos sugieren que las condiciones locales del ambiente de donde se aísla Candida spp. pueden influir en los niveles de portación y la variedad de especies, lo que podría ser más determinante que la condición de base(AU)

Introduction: Candida genus may colonize the human body but also may cause opportunistic infections. Diabetes is frequently considered a risk factor for Candida infections, given its characteristics associated to immunosuppresion, hyperglycemia, microvascularization problems and others. Generally, colonization is necessary for the starting of an infectious process; therefore, it is important to know its frequency of carriage in groups with associated risk factors. Objective: to determine the percentages of Candida spp. colonization in the oral cavity and the inter-toe area in diabetic and nondiabetic patients. Methods: the descriptive study was carried out in a group of 85 patients from the north of Colombia, that is, 46 diabetics and 39 non diabetics. The isolates were identified through phenotypical tests including CHROMagar, microscopy, germ tube test, Chlamydospore test and zymogram. Results: it was found in diabetic patients that the frequency of colonization by Candida spp. in the oral cavity was 23.9 percent and in the foot was 56.52 percent whereas in non-diabetic patients, the frequency of colonization in the oral cavity was 33.3 percent and in the foot was 43.58 percent. Additionally, it was found in the group of diabetic subjects that the frequency of colonization by Candida albicans was 45.5 percent in the oral cavity whereas that of the foot was 11.5 percent. Conclusions: the achieved results indicate that the local environmental conditions where the Candida spp. is isolated may have an impact on the levels of carriage and the variety of species, which could be more determining than the underlying condition(AU)

Angiotensin II increases mRNA levels of all TGF-beta isoforms in quiescent and activated rat hepatic stellate cells.

AII (angiotensin II) is a vasoactive peptide that plays an important role in the development of liver fibrosis mainly by regulating profibrotic cytokine expression such as TGF-beta (transforming growth factor-beta). Activated HSCs (hepatic stellate cells) are the major cell type responsible for ECM (extracellular matrix) deposition during liver fibrosis and are also a target for AII and TGF-beta actions. Here, we studied the effect of AII on the mRNA levels of TGF-beta isoforms in primary cultures of rat HSCs. Both quiescent and activated HSCs were stimulated with AII for different time periods, and mRNA levels of TGF-beta1, TGF-beta2 and TGF-beta3 isoforms were evaluated using RNaseI protection assay. The mRNA levels of all TGF-beta isoforms, particularly TGF-beta2and TGF-beta3, were increased after AII treatment in activated HSCs. In addition, activated HSCs were able to produce active TGF-beta protein after AII treatment. The mRNA expression of TGF-beta isoforms induced by AII required both ERK1/2 and Nox (NADPH oxidase) activation but not PKC (protein kinase C) participation. ERK1/2 activation induced by AII occurs via AT1 receptors, but independently of either PKC and Nox activation or EGFR (epidermal growth factor receptor) transactivation. Interestingly, AII has a similar effect on TGF-beta expression in quiescent HSCs, although it has a smaller but significant effect on ERK1/2 activation in these cells.

Aerosolized polymerized type I collagen reduces airway inflammation and remodelling in a guinea pig model of allergic asthma.

Collagen-polyvinylpyrrolidone (Collagen-PVP) has been demonstrated to elicit immunomodulatory properties in different chronic inflammatory diseases. Nevertheless, its effects on asthma are still unknown. We have evaluated whether collagen-PVP could modulate airway inflammation and remodelling in a guinea pig model of allergic asthma. Sensitized guinea pigs were challenged with the allergen (ovalbumin) six times (at 10-day intervals). From the third challenge on, animals were treated every 5 days with saline aerosols containing 0.16, 0.33, or 0.66 mg/ml of collagen-PVP (n = 5, respectively). Some guinea pigs, sensitized and challenged with saline as well as treated with 0 or 0.66 mg/ml collagen-PVP, were included in the study as control (n = 7) and sham groups (n = 5), respectively. From the first challenge on, ovalbumin induced a transient airway obstruction, measured by barometric plethysmography, which was not modified by collagen-PVP treatments. After the last allergen challenge, guinea pigs were anesthetized to obtain bronchoalveolar lavage (BAL) and the left lung caudal lobe. As expected, BAL cell count from allergen-challenged guinea pigs showed abundant neutrophils and eosinophils, as well as numerous tumor necrosis factor (TNF)-alpha-expressing granulocytes and macrophages in airway wall (determined by immunohistochemical assay). Neutrophilia and TNF-alpha-expressing leukocytes, from collagen-PVP treated animals, diminished from 0.16 mg/ml, and eosinophilia from 0.66 mg/ml of collagen-PVP doses. Histological changes induced by allergen challenges include thickening of connective tissue below airway epithelium and vascular wall widening of airway adjacent vessels; these changes were reduced by collagen-PVP treatment. Collagen-PVP seems to have anti-inflammatory and antifibrotic properties in this guinea pig asthma model.

SnoN co-repressor binds and represses smad7 gene promoter.

SnoN and Ski oncoproteins are co-repressors for Smad proteins and repress TGF-beta-responsive gene expression. The smad7 gene is a TGF-beta target induced by Smad signaling, and its promoter contains the Smad-binding element (SBE) required for a positive regulation by the TGF-beta/Smad pathway. SnoN and Ski co-repressors also bind SBE but regulate negatively smad7 gene. Ski along with Smad4 binds and represses the smad7 promoter, whereas the repression mechanism by SnoN is not clear. Ski and SnoN overexpression inhibits smad7 reporter expression induced through TGF-beta signaling. Using chromatin immunoprecipitation assays, we found that SnoN binds smad7 promoter at the basal condition, whereas after a short TGF-beta treatment for 15-30 min SnoN is downregulated and no longer bound smad7 promoter. Interestingly, after a prolonged TGF-beta treatment SnoN is upregulated and returns to its position on the smad7 promoter, functioning probably as a negative feedback control. Thus, SnoN also seems to regulate negatively the TGF-beta-responsive smad7 gene by binding and repressing its promoter in a similar way to Ski.