Modelo experimental de lesión cerebral tipo masa en rata: expresión del daño cerebral mediante enolasa neuroespecífica y proteína S100B / An experimental model of mass-type brain damage in the rat: Expression of brain damage based on neurospecific enolase and protein S100B

OBJETIVO: Evaluar si un modelo experimental de lesiones tipo masa (LM) transitoria en rata produce la liberación precoz a sangre periférica de enolasa neuroespecífica (NSE) y proteínaS100B como expresión del daño cerebral inducido. DISEÑO: Estudio experimental con grupo control. Ámbito: Quirófano experimental del Instituto de Biomedicina (IBiS) del Hospital Universitario Virgen del Rocío. PARTICIPANTES: Catorce ratas adultas Wistar. INTERVENCIONES: Se extrajo muestra sanguínea basal y posteriormente se realizó: grupo LM, através de un trépano, se infló el globo de una sonda con 500 _L/20 s; posteriormente, se realizaron4 extracciones sanguíneas cada 20 min. Grupo control, se repitieron de forma sistemática todos los pasos salvo que no se realizo trépano. Variables de interés principal: Peso, mortalidad precoz, concentración en suero de NSE yS100B.RESULTADOS: Encontramos diferencias entre las concentraciones de NSE y S100B a lo largo del tiempo dentro del propio grupo LM (p < 0,001), no sucediendo este hecho en el grupo control. Excepto en la determinación basal, encontramos diferencias en los valores medios de NSE yS100B entre ambos grupos. Tras el daño cerebral, la NSE y la S100B presentaron un incremento progresivo en el tiempo en todas las determinaciones realizadas con una r = 0,765; p = 0,001,y r = 0,628; p = 0,001, respectivamente. Por contra, en el grupo control no encontramos dicha correlación para ninguno de los dos biomarcadores. CONCLUSIONES: Las concentraciones en suero de NSE y S100B reflejan de forma precoz el daño cerebral que acontece sobre la sustancia gris y blanca en un modelo experimental de LM en rata

OBJECTIVE: To determine whether a model of transient mass-type brain damage (MTBD) in the rat produces early release of neurospecific enolase (NSE) and protein S100B in peripheral blood, as an expression of the induced brain injury. DESIGN: An experimental study with a control group. SETTING: Experimental operating room of the Institute of Biomedicine (IBiS) of Virgen del Rocío University Hospital (Seville, Spain).PARTICIPANTS: Fourteen adult Wistar rats. INTERVENTIONS: Blood was sampled at baseline, followed by: MTBD group, a trephine perforation was used to insert and inflate the balloon of a catheter at a rate of 500 _l/20 sec, followed by 4blood extractions every 20 min. Control group, the same procedure as before was carried out, though without trephine perforation. Primary study variables: Weight, early mortality, serum NSE and S100B concentration. RESULTS: Differences in NSE and S100B concentration were observed over time within the MTB Dgroup (P < .001), though not so in the control group. With the exception of the baseline determination, differences were observed between the two groups in terms of the mean NSE andS100B values. Following MTBD, NSE and S100B progressively increased at all measurement timepoints, with r = 0.765; P = .001 and r = 0.628; P = .001, respectively. In contrast, the control group showed no such correlation for either biomarker. CONCLUSIONS: Serum NSE and S100B concentrations offer an early indication of brain injury affecting the gray and white matter in an experimental model of mass-type MTBD in the rat

Effect of bariatric surgery on microvascular dysfunction associated to metabolic syndrome: a 12-month prospective study.

OBJECTIVE: To prospectively evaluate the effect of weight loss after bariatric surgery on microvascular function in morbidly obese patients with and without metabolic syndrome (MetS). METHODS: A cohort of morbidly obese patients with and without MetS was studied before surgery and after 12 months of surgery. Healthy lean controls were also examined. Microvascular function was assessed by postocclusive reactive hyperemia (PORH) at forearm skin evaluated by laser Doppler flowmetry (LDF). Cutaneous vascular conductance (CVC) was calculated from laser-Doppler skin blood flow and blood pressure. Regression analysis was performed to assess the contribution of different clinical, metabolic and biochemical parameters to microvascular function. RESULTS: Before surgery, 62 obese patients, 39 with MetS and 23 without MetS, and 30 lean control subjects were analyzed. The absolute area under the hyperemic curve (AUC(H)) CVC of PORH was significantly decreased in obese patients compared with lean control subjects. One year after surgery, AUC(H) CVC significantly increased in patients free of MetS, including patients that had MetS before surgery. In contrast, AUC(H) CVC did not significantly change in patients in whom MetS persisted after surgery. Stepwise multivariate regression analysis showed that only changes in HDL cholesterol (HDL-C) and oxidized LDL (oxLDL) independently predicted improvement of AUC(H) after surgery. These two variables together accounted for 40.9% of the variability of change in AUC(H) CVC after surgery. CONCLUSIONS: Bariatric surgery could significantly improve microvascular dysfunction in obese patients, but only in patients free of MetS after surgery. Improvement of microvascular dysfunction is strictly associated to postoperative increase in HDL-C levels and decrease in oxLDL levels.

[An experimental model of mass-type brain damage in the rat: expression of brain damage based on neurospecific enolase and protein S100B]. / Modelo experimental de lesión cerebral tipo masa en rata: expresión del daño cerebral mediante enolasa neuroespecífica y proteína S100B.

OBJECTIVE: To determine whether a model of transient mass-type brain damage (MTBD) in the rat produces early release of neurospecific enolase (NSE) and protein S100B in peripheral blood, as an expression of the induced brain injury. DESIGN: An experimental study with a control group. SETTING: Experimental operating room of the Institute of Biomedicine (IBiS) of Virgen del Rocío University Hospital (Seville, Spain). PARTICIPANTS: Fourteen adult Wistar rats. INTERVENTIONS: Blood was sampled at baseline, followed by: MTBD group, a trephine perforation was used to insert and inflate the balloon of a catheter at a rate of 500 µl/20 sec, followed by 4 blood extractions every 20 min. Control group, the same procedure as before was carried out, though without trephine perforation. PRIMARY STUDY VARIABLES: Weight, early mortality, serum NSE and S100B concentration. RESULTS: Differences in NSE and S100B concentration were observed over time within the MTBD group (P<.001), though not so in the control group. With the exception of the baseline determination, differences were observed between the two groups in terms of the mean NSE and S100B values. Following MTBD, NSE and S100B progressively increased at all measurement timepoints, with r=0.765; P=.001 and r=0.628; P=.001, respectively. In contrast, the control group showed no such correlation for either biomarker. CONCLUSIONS: Serum NSE and S100B concentrations offer an early indication of brain injury affecting the gray and white matter in an experimental model of mass-type MTBD in the rat.

Serologic behavior of S100B protein in patients who are brain dead: preliminary results.

OBJECTIVE: The objective of this study is to assess the S100B protein serum concentrations from brain dead (BD) donors to understand whether its level could provide clinical information during BD diagnosis as a potential confirmatory test. METHODS: During 12 months, 26 patients declared BD were prospectively included in this study. Once the diagnosis of BD was achieved, serum S100B protein levels were measured using an electrochemiluminescence assay. For analytical purposes, we selected the maximum S100B serum value reached during the first 5 days of evolution from a historical cohort of 124 survived patients after a severe brain injury (SBI), as well as from 18 healthy donors (HD) and a subgroup of patients who had severe traumatic brain injuries (TBIs) without extracranial injuries. RESULTS: Mean age was 53.48 years (SD, 18.91 years). The BD group had significantly higher S100B serum levels (1.44 µg/L; interquartile ratio [IR], 0.63-3.68) than the SBI (0.34 µg/L; IR, 0.21-0.60) and HD groups (0.06 µg/L; IR, 0.03-0.07; P < .001). Analysis of S100B levels depending on the main cause responsible for BD development showed significant differences between subgroups (P = .012). S100B serum levels were higher in the isolated TBI BD group (P = .004). The S100B value showed an odds ratio for BD diagnosis of 8.38 (95% confidence interval [CI], 1.16-60.45; P = .035). Reciever operating characteristic analysis revealed an area under the curve of 0.92 (95% CI, 0.79-1.00; P = .007). We set a cut-off value of 2 µg/L in S100B serum concentrations. At this level, the diagnostic properties of S100B would reach 100% of specificity and positive predictive value (PPV), and sensitivity and negative predictive value (NPV) of 60% and 86.7%, respectively. CONCLUSION: This preliminary analysis shows for the very first time that BD is associated with higher S100B serum levels, compared with other neurocritical care patients. We also found that the cause of BD development must be considered. Specifically, S100B serum levels in severe isolated TBI patients-with clinical exploration compatible with BD-could be used in a future as confirmatory test.

Changes of lactate levels during cardiopulmonary bypass in patients undergoing cardiac transplantation: possible early marker of morbidity and mortality.

OBJECTIVES: High levels of lactate are associated with tissue hypoperfusion during cardiac surgery resulting in postoperative morbidity and mortality among patients undergoing cardiopulmonary bypass (CBP). Our goal was to evaluate the change in lactate levels during CBP for their possible predictive value for complications after heart transplant surgery. MATERIALS AND METHODS: From January to December 2010 we studied lactate levels in 16 heart transplant patients. Arterial blood samples were collected before, during, and after cardiopulmonary bypass on admission to the intensive care unit (ICU). Lactate levels were measured using the cobas B221 (Roche Diagnostic). The neurological, lung, and kidney complications were associated with mortality within 30 days. RESULTS: One patient displayed lactate levels > 2 mmol/L before bypass while 4 (25%) showed levels > 4 mmol/L during CPB. Lactate values higher than or equal to 4 mmol/L on ICU admission occurred in nine patients (56%). Postoperative mortality was higher among the group with levels above below 4 mmol/L on ICU admission (18.7% vs 6.2%). Neurological complications were observed in 22% of patients with elevated levels as opposed to none of the patients with levels below 4 mmol/L. Pulmonary complications were noted in 22% of patients with high lactate values versus 0% among the other group. CONCLUSION: Hyperlactemia above certain levels occurring during CPB serve as a biomarker to identify early postoperative morbidity and mortality.

CYFRA 21-1 as a tool for distant metastasis detection in lung cancer.

BACKGROUND: A study to analyse tumor markers (CEA, CA125, CA15.3, CA19.9, CYFRA 21-1, and NSE) for metastasis detection in lung cancer patients. METHODS: Serum tumor markers from 73 lung cancer patients were measured before they were diagnosed. After lung cancer diagnosis, tumor markers were analyzed for the detection of distant metastases. RESULTS: In NSCLC patients CYFRA 21-1 and NSE showed differences between stage IV and any of the other stages, p < 0.05. The accuracy for metastasis detection was AUC = 81.5 % for CYFRA 21-1 and AUC = 78.6 % for < 0.05) were independent predictors for metastasis presence. No tumor marker showed significant differences according to stages in SCLC patients. CONCLUSIONS: CYFRA 21-1 could be used as a screening tool for metastasis detection in lung cancer patients without symptoms of metastasis as well as CYFRA 21-1 and NSE in NSCLC patients.

Introduction of fibrinogen in the treatment of hemostatic disorders during orthotopic liver transplantation: implications in the use of allogenic blood.

BACKGROUND: Orthotopic liver transplantation (OLT) requires a large amount of blood-derived resources. The indications for their availability in the surgery area is based on empirical protocols. The implementation of point-of-care apparatuses gives rise to the detection of hemostatic alterations due to functional deficits of fibrinogen. METHODS: To monitor coagulation disorders and other biochemical parameters, we used thromboelastometry (ROTEM®) and a MovlLab® unit, respectively. We evaluated the stability and firmness of the clot based on fibrin (FibTem test). The measurements were performed during all of the liver transplant stages: baseline, anhepatic, and reperfusion. Fibrinogen (hemocompletan) was administered to achieve maximum clot firmness, based on patient weight and the existence of surgical bleeding. This pilot cohort of 20 transplant patients (group B) compared outcomes with the 59 patients from the previous year (group A). RESULTS: Haemocompletan was administered to 45% of the 20 patients. The ratio of red blood cell components per patient diminished from 8.4 to 3.9 (53% reduction) and, fresh frozen plasma from 5.6 to 1.9 (65% reduction). Transfusions of platelet concentrates decreased by 50% with a ratio of 1.5-0.7 per patient. Likewise, 20% of transplant patients received no transfusions of blood products compared with 3.5% in the previous period. CONCLUSION: The incorporation of fibrinogen into the treatment of hemostatic disorders in OLT leads to a reduced use of allogenic blood products. We observed reduced number of patients who received transfusions, while those who underwent transfusion did so to a lesser degree.

Determinación de mioglobina y troponina T en suero para el diagnóstico precoz del infarto agudo de miocardio / No disponible

No disponible

Estudio analítico cromatográfico de los metabolitos urinarios del cortisol / Analytical chromatography study of urinary cortisol metabolites

El objetivo de nuestro trabajo ha consistido en estudiar el cortisol y sus metabolitos urinarios. El conocimiento de estos compuestos, así como de la actividad enzimática 11Beta-hidroxiesteroide-deshidrogenasa tiene gran interés clínico porque nos proporciona información sobre el estado de la función adrenal. Se han descrito diferentes métodos, todos ellos relacionados con la cromatografía líquida de alta resolución (HPLC) usando el radioinmunoensayo o la espectometría de masas para la cuantificación final. Nosotros hemos analizado estos metabolitos urinarios en 25 sujetos clínicamente sanos realizando la valoración final en el propio sistema de HPLC mediante un detector ultravioleta-visible (UV-VIS). LA metodología empleada presenta la ventaja de su rapidez y economía, y los resultados obtenidos pueden ser utilizados en la práctica clínica (AU)