Drain placement in retromuscular ventral hernia repair: a systematic review and meta-analysis.

PURPOSE: Drain placement in retromuscular ventral hernia repair is controversial. Although it may reduce seroma formation, there is a concern regarding an increase in infectious complications. We aimed to perform a meta-analysis on retromuscular drain placement in retromuscular ventral hernia repair. METHODS: We performed a literature search of Cochrane, Scopus and PubMed databases to identify studies comparing drain placement and the absence of drain in patients undergoing retromuscular ventral hernia repair. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics. RESULTS: 3808 studies were screened and 48 were thoroughly reviewed. Four studies comprising 1724 patients were included in the analysis. We found that drain placement was significantly associated with a decrease in seroma (OR 0.34; 95% CI 0.12-0.96; P = 0.04; I2 = 78%). Moreover, no differences were noted in surgical site infection, hematoma, surgical site occurrences or surgical site occurrences requiring procedural intervention. CONCLUSIONS: Based on the analysis of short-term outcomes, retromuscular drain placement after retromuscular ventral hernia repair significantly reduces seroma and does not increase infectious complications. Further prospective randomized studies are necessary to confirm our findings, evaluate the optimal duration of drain placement, and report longer-term outcomes.

Western diet in the perinatal period promotes dysautonomia in the offspring of adult rats.

The present study investigated the impact of a western diet during gestation and lactation on the anthropometry, serum biochemical, blood pressure and cardiovascular autonomic control on the offspring. Male Wistar rats were divided into two groups according to their mother's diet received: control group (C: 18% calories of lipids) and westernized group (W: 32% calories of lipids). After weaning both groups received standard diet. On the 60th day of life, blood samples were collected for the analysis of fasting glucose and lipidogram. Cardiovascular parameters were measured on the same period. Autonomic nervous system modulation was evaluated by spectrum analysis of heart rate (HR) and systolic arterial pressure (SAP). The W increased glycemia (123±2 v. 155±2 mg/dl), low-density lipoprotein (15±1 v. 31±2 mg/dl), triglycerides (49±1 v. 85±2 mg/dl), total cholesterol (75±2 v. 86±2 mg/dl), and decreased high-density lipoprotein (50±4 v. 38±3 mg/dl), as well as increased body mass (209±4 v. 229±6 g) than C. Furthermore, the W showed higher SAP (130±4 v. 157±2 mmHg), HR (357±10 v. 428±14 bpm), sympathetic modulation to vessels (2.3±0.56 v. 6±0.84 mmHg2) and LF/HF ratio (0.15±0.01 v. 0.7±0.2) than C. These findings suggest that a western diet during pregnancy and lactation leads to overweight associated with autonomic misbalance and hypertension in adulthood.

Quality of prescription of high-alert medication and patient safety in pediatric emergency / Calidad de las recetas de los medicamentos potencialmente peligrosos y la seguridad del paciente en urgencias pediátricas

Objective: Verify the importance of compliance by prescribed doses of high-alert medications in unit of pediatric emergency in patient safety. Method: This was a cross-sectional descriptive study conducted in a unit of pediatric emergency, for March to April of 2012. This study included all prescriptions that contained at least one high-alert medication, excluding all of others. The data were analyzed using Microsoft Office Excel® version 2007, and the study was approved by the Research Ethics Committee of the Hospital. Results: This study included prescriptions for 100 patients with a mean age of 5.2 ± 4.2 years. Were identified 983 (40.1%) high-alert medications (21 different), with predominance of injectable solutions (834, 84,8%), and of these 727(73.95%) were electrolytes. The analysis of the dose was possible for 641 electrolytes and 104 non-electrolytes, being thedose inadequacies observed for some medications. Was observed concentration absent to 189 (18.9%) prescribed medications, these with liquid pharmaceutical form or aerosol. Was observed also the absence of maximum dose for 8 (36.3%) prescribed drugs "if necessary". Conclusión: The inadequacies of doses of high-alert medications identified in this study may compromise patient safety, demonstrating the importance of knowledge of multidisciplinary health care team by this subject, in this context, it is noteworthy that the acting of a clinical pharmacist together with the health multidisciplined team can contributes with the review of drug prescriptions, reducing potential errors and collaborating with patient safety

Objetivo: Investigar la importancia de la conformidad de las dosis prescritas delos medicamentos potencialmente peligrosos en un hospital pediátrico de urgencia en la garantía de la seguridad del paciente. Método: Estudio descriptivo transversal realizado en una unidad de atención de urgencia pediátrica, referente a los meses de marzo y abril de 2012. Se incluyeron todas las prescripciones que contienen al menos un medicamento potencialmente peligroso, excluyendo todas las otras. Los datos fueron analizados utilizando Microsoft Office Excel® versión 2007, y el estudio fue aprobado por el Comité Ético de Investigación Institucional. Resultados: Se incluyeron prescripciones de 100 pacientes con 5,2 ± 4,2 años de edad. Se identificaron 983 (40,1%) medicamentos potencialmente peligrosos (21diferentes), con mayoría de la soluciones inyectables (834, 84,8%), siendo 727(73,95%) electrolitos. El análisis de las dosis fue posible para 641 medicamentos electrolitos y 104 no electrolitos, observándose non conformidad de dosis para para algunos medicamentos. Fue posible constatar que la concentración de los fármacos estuvo ausente para 189 (18,9%) medicamentos prescritos con forma farmacéutica líquida y/o aerosoles. También se observó la ausencia de las dosis máximas de 8 (36,3%) medicamentos prescritos "si es necesario". Conclusión: Las non conformidad en las dosis de medicamentos potencialmente peligrosos identificados en el presente estudio pueden comprometer la seguridad del paciente, lo que demuestra la importancia del equipo multidisciplinario de atención a la salud tener conocimiento de este tema. En este contexto, cabe destacar que la actuación de un farmacéutico clínico insertado en este equipo puede contribuir para la revisión de las prescripciones de medicamentos, lo que reducelos posibles errores y colabora con la seguridad del paciente

A time-compressed simulated geomagnetic storm influences the nest-exiting flight angles of the stingless bee Tetragonisca angustula.

Insects have been used as models for understanding animal orientation. It is well accepted that social insects such as honeybees and ants use different natural cues in their orientation mechanism. A magnetic sensitivity was suggested for the stingless bee Schwarziana quadripunctata, based on the observation of a surprising effect of a geomagnetic storm on the nest-exiting flight angles. Stimulated by this result, in this paper, the effects of a time-compressed simulated geomagnetic storm (TC-SGS) on the nest-exiting flight angles of another stingless bee, Tetragonisca angustula, are presented. Under an applied SGS, either on the horizontal or vertical component of the geomagnetic field, both nest-exiting flight angles, dip and azimuth, are statistically different from those under geomagnetic conditions. The angular dependence of ferromagnetic resonance (FMR) spectra of whole stingless bees shows the presence of organized magnetic nanoparticles in their bodies, which indicates this material as a possible magnetic detector.

Preparation and cytotoxicity of cisplatin-containing liposomes

We encapsulated cisplatin into stealth pH-sensitive liposomes and studied their stability, cytotoxicity and accumulation in a human small-cell lung carcinoma cell line (GLC4) and its resistant subline (GLC4/CDDP). Since reduced cellular drug accumulation has been shown to be the main mechanism responsible for resistance in the GLC4/CDDP subline, we evaluated the ability of this new delivery system to improve cellular uptake. The liposomes were composed of dioleoylphosphatidylethanolamine (DOPE), cholesteryl hemisuccinate (CHEMS), and distearoylphosphatidylethanolamine-polyethyleneglycol 2000 (DSPE-PEG2000) and were characterized by determining the encapsulation percentage as a function of lipid concentration. Among the different formulations, DOPE/CHEMS/DSPE-PEG liposomes (lipid concentration equal to 40 mM) encapsulated cisplatin more efficiently than other concentrations of liposomes (about 20.0 percent, mean diameter of 174 nm). These liposomes presented good stability in mouse plasma which was obtained using a 0.24-M EDTA solution (70 percent cisplatin was retained inside the liposomes after 30 min of incubation). Concerning cytotoxic effects, they are more effective (1.34-fold) than free cisplatin for growth inhibition of the human lung cancer cell line A549. The study of cytotoxicity to GLC4 and GLC4/CDDP cell lines showed similar IC50 values (approximately 1.4 æM), i.e., cisplatin-resistant cells were sensitive to this cisplatin formulation. Platinum accumulation in both sensitive and resistant cell lines followed the same pattern, i.e., approximately the same intracellular platinum concentration (4.0 x 10-17 mol/cell) yielded the same cytotoxic effect. These results indicate that long-circulating pH-sensitive liposomes, also termed as stealth pH-sensitive liposomes, may present a promising delivery system for cisplatin-based cancer treatment. This liposome system proved to be able to circumvent the cisplatin resistance, whereas...

Assessment of the effect of Punica granatum (pomegranata) on the bioavailability of the radiopharmaceutical sodium pertechnetate (99mTc) in Wistar rats.

The many desirable characteristics of technetium-99m (99mTc) have stimulated the development of labeling techniques for different molecular and cellular structures. It is generally accepted that a variety of factors other than disease can alter the bioavailability of radiopharmaceuticals and one such factor is the drug therapy. The use of medicinal plants has increased in the last decades all over the world. Punica granatum (pomegranata) is used as food or as medication in folk medicine for antiviral, anthelmintic, antifungal, antibacterial and antimicrobial activity. We have studied in rats, the effect of the medicinal plant Punica granatum on the bioavailability of the radiopharmaceutical 99mTc-sodium pertechnetate (Na(99m)TcO4). The infusion of pomegranata was administered by intragastric via into Wistar rats during seven days. After that, the animals received by ocular plexus via, 0.1 ml of the Na(99m)TcO4 (3.7MBq) and the animals were rapidly sacrificed after 5, 20 and 40 min. The organs were isolated (brain, heart, thyroid, liver, lungs, kidneys, stomach, testis, intestines, pancreas, spleen, bladder, muscle and bone), the radioactivity determined in a well counter, the percentages of radioactivity (%ATI) in the organs were calculated and statistical analyses were performed by Wilcoxon test (p < 0.05). The results have shown a significant (p < 0.05) increase of the activity of the Na(99m)TcO4 in spleen, heart, stomach, liver, stout bowel, pancreas, lungs and testis at 5 min. Twenty minutes after the administration of the radiopharmaceutical, the analysis of the results reveals a significant (p < 0.05) increase of the %ATI in heart, stomach, femur, pancreas, lungs and kidneys. Forty minutes after the administration of the Na(99m)TcO4, the results show a significant (p < 0.05) increase in spleen, brain, heart, stomach, liver, stout bowel, muscle, femur, lungs, pancreas, kidneys and testis. These results can be justified by therapeutic effect of this extract and/or by generation of active metabolites capable to interfere with the biodistribution of the studied radiopharmaceutical.

Efeitos do extrato aquoso da hyptis pectinata sobre a regeneração hepática após hepatectomia parcial de 70%: resultados preliminares

The use of medicinal plants has strongly increased by the world population. The objetive of this study is to assess the effects of the aqueous extract of Hyptis pectinata leaves, popularly known as "sambacaitá" or "canudinho", on liver regeneration after 70% partial hepatectomy. Twenty four rats were divided into 4 groups: group OS, submitted to sham operation and oral administration of distilled water during 4 days; group OSD200, also submitted to sham operation and ingestion of 200 mg of extract/Kg of animal for the same period of time; group HP, which underwent 70% hepatectomy after 4 days of distilled water administration; and group HPD200, which underwent 70% hepatectomy after 4 days of oral administration of 200 mg of extract/Kg of animal. Alkaline phosphatase, total bilirubin and the serum level of aminotransferases were measured and state III of mitochondrial respiratory activity was assessed. Group OSD200, when compared to OS, presented significant decrease of alcaline fosfatase. Group HPD200, when compared to HP, showed statistically significant decrease of AST level and state III respiratory process.

O uso de plantas medicinais tem aumentado bastante na população mundial. O objetivo desta pesquisa é avaliar os efeitos do extrato aquoso das folhas da Hyptis pectinata, popularmente conhecida como "sambacaitá" ou "canudinho", sobre a regeneração hepática após hepatectomia parcial de 70%. Foram utilizados 24 ratos, divididos em 4 grupos: grupo OS, em que se realizou operação simulada e aplicação oral de água destilada por 4 dias; grupo OSD200, também submetido à laparotomia com manipulação do fígado e aplicação de 200 mg de extrato/Kg de animal durante o mesmo período; grupo HP, hepatectomizado a 70% após 4 dias de aplicação por via oral de água destilada; e grupo HPD200, hepatectomizado a 70% após 4 dias de administração de 200 mg extrato/Kg de animal. Foram dosadas fosfatase alcalina, bilirrubina total e as aminotransferases e estudou-se o estado III da função mitocondrial. O grupo OSD200, quando comparado ao OS, apresentou redução significativa da fosfatase alcalina. O grupo HPD200, em comparação ao HP, teve redução estatisticamente significativa no nível da AST e do estado III da função mitocondrial.

[Stabilization of 99m Tc-HMPAO with methylene blue: its use in leukocyte labelling)]. / Estabilización del 99mTc-HMPAO con azul de metileno: su utilización en el marcaje de leucocitos.

A method to stabilize the 99mTc-HMPAO obtained from Ceretec(R) saline fractions using methylene blue is described. The mean radiochemical purity two hours after the stabilized 99mTc-HMPAO preparation was 92.5% (SD 1.8%), the pH ranged from 7.0 to 7.6 and the osmolality ranged from 305 to 309 mOsm/kg. These features made the stabilized 99mTc-HMPAO suitable for leukocyte labelling. In order to evaluate this method, we performed the labelling of two identical leukocyte samples withdrawn from 10 blood donors. The first sample was labeled using 99mTc-HMPAO non-stabilized and the second one was labelled using 99mTc-HMPAO stabilized 2 hours before with methylene blue. The mean labelling efficiencies we obtained were 70.9% (SD 6.9%) and 66.1% (SD 4.2%) respectively. With the conditions described using the 99mTc-HMPAO stabilized with methylene blue, we had no drawbacks from the stabilizing blue colour and we did not found changes in the cellular viability.

[The absence of invasive amebiasis in male homosexual AIDS patients in Recife]. / Ausência de amebíase invasiva em aidéticos homossexuais masculinos, no Recife.

The purpose of this paper was to determine if among male homosexual AIDS [correction of SIDA] patients, the Entamoeba histolytica was able to product invasive illness. From the 77 investigated patients only one (1.3%) has cysts of E. histolytica in his stools. The electrophoresis of the only isolated strain has shown it was from zimodeme I, non pathogenic. The research of antiamebic antibodies was negative in the serum of the totality of patients. Those results showed that even in immunocompromised patients with AIDS [correction of SIDA], E. histolytica strain found in Recife was not able to produce disease. The utilization of metronidazol is not indicated in amoebic cysts carriers.

[Splenic cyst. Review of the literature and report of 2 cases]. / Cisto esplênico. Revisão da literatura e relato de dois casos.

Splenic cysts are rare lesions. By 1978, only 651 cases had been reported. Over the years, the management of splenic cysts has changed with advances in surgical techniques. The traditional treatment of these lesions has been splenectomy. The recognition of the post splenectomy complications has led to emphasis on conservation of splenic tissue. Nowadays, the tendency is to use splenic salvage techniques: partial splenectomy, partial splenic decapsulation and laparoscopic assistance. The purpose of this paper is to review the literature, and to report two cases of splenic cysts that were treated by the conservative method.

Endocytic apparatus and transcytosis in epithelial cells of the vas deferens in the rat.

The apex of the principal epithelial cells lining the vas deferens of the rat contains coated pits in continuity with the apical plasma membrane and large subsurface-coated vesicles (100-125 nm). In the apical cytoplasm, large, pale, uncoated vesicles (150-300 nm), small coated and uncoated vesicles (50-60 nm), uncoated vesicles about 75-90 nm, and membranous apical tubules are present, in addition to large, vacuolar, pale, multivesicular bodies, dense multivesicular bodies, and secondary lysosomes seen deeper in the cytoplasm amongst numerous ER cisternae, saccules of the Golgi apparatus, and mitochondria. The endocytic activity of these cells was investigated by using cationic ferritin (CF) as a marker of adsorptive endocytosis and native ferritin (NF) for demonstrating fluid-phase endocytosis. These tracers were injected separately into the lumen of the vas deferens, and the animals were killed at various time intervals thereafter from 2 to 90 minutes. At 2 minutes CF was seen bound predominantly to microvilli and to areas of the apical plasma membrane delimiting coated pits as well as in large, coated vesicles. At 5 and 15 minutes the tracers were seen in apical tubules and pale multivesicular bodies; at 30 minutes moderately dense multivesicular bodies were labeled. At 1 hour and longer time intervals dense multivesicular bodies and secondary lysosomes were labeled. NF followed the same pathway as CF; however, no binding to microvilli or areas delimiting coated pits was observed. The numerous other vesicular structures, i.e., the large uncoated vesicles (150-300 nm) and the small coated and uncoated vesicles (50-60 nm), never became labeled with the tracers and therefore were not involved in the endocytic process. There was, however, an exception in the case of several small (75-90 nm) uncoated vesicles seen deeper in the apical cytoplasm of these cells which were labeled exclusively with CF. With time such vesicles appeared along the lateral and basal surfaces of these cells and discharged their content of CF into the lateral intercellular space or the connective tissue space at the base of these cells. Thus the principal epithelial cells in addition to sequestering the endocytosed tracers within secondary lysosomes where they are presumably degraded also appear to be involved in the transcytosis of material from the lumen of the vas deferens to the underlying lamina propria.

The fine structure of the swine sweat gland. II. The coiled ducts.

The duct of the swine sweat gland crosses the dermis and epidermis in sequence. The cells of the dermic segment seem to be related with cellular secretion and absorption. In the epidermic segment of the duct the whole morphology of the cells resembles the cellular morphology of the epidermic cells.

The fine structure of the swine sweat gland. I. The acini.

The structure of the acini in the swine sweat gland is described here at the TEM level. The acini of the sweat gland in the pig is formed by 2 secretory cell types: dark seromucous cells and clear cells. The dark seromucous cells are actively secretory and their secretion is apocrine. The clear cells seem to be involved in an active transport of water and electrolytes through their cytoplasms.

Fine structure of the interstitium of the epididymis of the South American Opossum (Didelphis azarae, Marsupialia).

The interstitial space of the ductus epididymidis of the opossum (D. azarae), contains fibers and cell elements of the connective tissue, smooth muscle cells and amyelinic nerve fibers. This structure, studied through TEM, is similar to the fine structure of the interstitium of the epididymis in rodents. However, the normal occurrence of mast cells in the interstitial space of the ductus epididymidis in opossum, seems to be a peculiar morphological characteristic of this species.

Fine structure of principal and basal cells of the cauda epididymidis of the South American opossum (Didelphis azarae).

The aim of the study was to investigate cytological characteristics of principal and basal cells, at the ultrastructural level, in the cauda epididymidis of the opossum. Adult sexually mature opossums were used. Signs of pinocytosis and absorption and secretion were seen in both cells. These functions and the fine structure of the principal and basal cells of this marsupial are discussed comparatively with the fine structure of these cells in the epididymidis of eutherian mammals.

Subcellular structure of the luminal content of the cauda epididymidis of the opossum (Didelphis azarae).

The luminal content of the cauda epididymidis of the opossum has been studied by transmission electron microscopy. The content is represented by single and paired spermatozoa. Subcellular features of both spermatozoa and their cytological components have been described on the basis of the morphology of spermatozoa in the epididymis of other metatherian forms.