Customized laboratory TLR4 and TLR2 detection method from peripheral human blood for early detection of doxorubicin-induced cardiotoxicity.

Cancer treatments can have significant cardiovascular adverse effects that can cause cardiomyopathy and heart failure with reduced survival benefit and considerable decrease in the use of antineoplastic therapy. The purpose of this study is to assess the role of TLR2 and TLR4 gene expression as an early marker for the risk of doxorubicin-induced cardiomyopathy in correlation with early diastolic dysfunction in patients treated with doxorubicin. Our study included 25 consecutive patients who received treatment with doxorubicin for hematological malignancies (leukemia, lymphomas or multiple myeloma), aged 18-65 years, with a survival probability>6 months and with left ventricular ejection fraction>50%. Exclusion criteria consisted of the following: previous anthracycline therapy, previous radiotherapy, history of heart failure or chronic renal failure, atrial fibrillation, and pregnancy. In all patients, in fasting state, a blood sample was drawn for the assessment of TLR2 and TLR4 gene expression. Gene expression was assessed by quantitative reverse transcription PCR (qRT-PCR) using blood collection, RNA isolation, cDNA reverse transcription, qRT-PCR and quantification of the relative expression. At enrollment, all patients were evaluated clinically; an ECG and an echocardiography were performed. The average amount of gene expression units was 0.113 for TLR4 (range 0.059-0.753) and 0.218 for TLR2 (range 0.046-0.269). The mean mRNA extracted quantity was 113 571 ng/µl. As for the diastolic function parameters, criteria for diastolic dysfunction were present after 6 months in 16 patients (64%). In these patients, the mean values for TLR4 were 0.1198625 and for TLR2 were 0.16454 gene expression units. As for the diastolic function parameters, criteria for diastolic dysfunction were present after 6 months in 16 patients (64%). In these patients, the mean value for TLR2 was 0.30±0.19 and for TLR4 was 0.15±0.04. The corresponding values for the patients who did not develop diastolic dysfunction were 0.16±0.07 for TLR2 (P=0.01) and 0.11±0.10 for TLR4 (P=0.2). Our study suggests that TLR4 and TLR2 expression is higher in patients under doxorubicin therapy who develop diastolic dysfunction. This may suggest a predisposition to myocardial involvement, a higher sensitivity to doxorubicin cardiac effects.

[Current methods for wound debridement]. / Metode curente de debridare a plagilor.

Wound management experienced significant changes in the last half century, while acknowledging the concept of "moist wound healing" and the strategy of "wound bed preparation". New solutions in this area have brought by developing new methods of debridement, exudates management and decrease of bacterial load. Debridement is the most widespread used method for conditioning wound and involves the application of interventions that accelerate the healing process. The main objective of this article is to identify current methods of debridement used worldwide in wounds treatment, their indications and recommended guidelines. For this purpose we analyzed reviews, randomized clinical trials, practical guides, meta-analysis, and clinical trials published in the Clinical Core Journals and Nursing Journals from 2006 to 2010. We identified six methods of wound debridement, each with its own advantages and limitations: surgical debridement, mechanical debridement, autolytic debridement, enzymatic debridement, chemical debridement and biological debridement. We found that in literature there is no consensus regarding the most effective debridement method or combination of debridement methods. According to various authors or expert groups' opinions, debridement methods are differentiated by specific properties, different costs and different levels of acceptance from medical staff.

Effects of the radiofrequency interference with modified titanium surgical clips on liver parenchyma--an in vivo experiment.

AIM: This study sets out to test the biocompatibility of titanium clips in liver, in the presence of radiofrequency. Biocompatibility is assessed at various distances from the RF electrode and different points in time. METHOD: It is an experimental study conducted on pigs and makes use of histological changes that occur at the liver-titanium interface in presence of RF to test hypotheses. The titanium clips were modified in high vacuum (10 -5 atm) by heating them at 1000 degrees C and 1150 degrees C. Titanium clips were placed in liver at 0.5, 1.5 and 2.5 cm from RF probe. At 7, 14 and 28 days the inflammation, necrosis and fibrosis were assessed. RESULTS: The histological alterations decrease with the distance of implantation of titanium clips. The inflammation and necrosis nearby the titanium clips decrease in time, but the fibrosis does not increased, as expected. The modified titanium at 1000 degrees C clips cause less necrosis than commercial titanium clips. The moderator role of clip type between distance and cell alteration is empirically supported only for fibrosis and necrosis. The moderator role between time and cell alteration is supported only for inflammation. CONCLUSIONS: Experimental data suggests there are no preferred surgical clips in all situations. The biocompatibility of the titanium clips depends on the distance from the RF probe. The commercial ones prove less damaging if they are placed close to the RF probe (less than 1 cm) and those that were treated at 1150 C have a better bio-compatibility if placed more than 1 cm from RF probe.

[Accessory renal allotransplantation with internal or external urinary drainage. An experimental model in pig]. / Allotransplantarea renala accesorie cu drenaj urinar intern sau extern. Model experimental la porc.

This study describes an experimental model of accessory renal allotransplantation in the big laboratory animal (pig). A total of 24 common-breed pigs were used. All allografts were transplanted in an accessory manner and revascularized at the level of the infrarenal abdominal aorta and inferior vena cava. The urinary drainage was performed either through a nexternal uretheroneostomy at the ipsilateral lumbar region (Group A--n=8) or by internal uretheroneocystostomy (Group B--n=8). All transplants were monitored for 8 days postoperatively using translumbar ultrasound-guided biopsies at 1, 4, 7 days. A total of 16 transplants were performed. 1 ectopic donor kidney was found and transplanted in the same fashion. Mean operative time was 125 minutes, immediate postoperative survival was 100% and at 72 hours, 87.5%. The onset of acute rejection was at day 4, by massive lymphocyte infiltration and was directly correlated with the abrupt decrease of the allograft diuresis in Group A, at day 3. At day 7, the rejection was complete. Both methods of urinary drainage are functional and can be employed. This experimental model is a useful tool for training of the transplant surgeons or for transplantation research. The surgical technique for accessory renal allotransplantation in pig is easy to learn and offers the possibility for allograft monitoring until complete rejection without influencing the receptor health condition.

Assessement by laser Doppler of the peripheral tumour perfusion after radiofrequency ablation for colorectal liver mestasis--experimental study.

Colorectal cancer became one of the most frequent malignant conditions of the past two decades. Non-resecable liver metastases might be destroyed in situ by radiofrequency although the local recurrence is still very important. Laser-Doppler flowmetry has proved to be a simple technique for monitoring the microcirculation, hereby the tissue perfusion at the edge of the post radiofrequency necrosis. The aim of the study was to evaluate microcirculation using lasser-Doppler for hepatic tissue and peripheral tumour perfusion after radiofrequency and the influence of local temperature increasing at 42 degrees C on tissular perfusion. Colorectal adenocarcinoma (CC531s) was used for liver tumour inoculationin on 15 Wag/Rij rats. Twenty-one days after inoculation, perfusion in hepatic tissue, on the tumour before and after radiofrequency treatment was mesured. When hepatic tissue was heated at 42 degrees C there was an increase in tissular perfusion, on the other part, heating the tumoural tissue do not increase perfusion. After radiofrequency in the periphery of necrosis the perfusion was still present, despite a clear drop towards initial level. Assessing the local microcirculation and tissue temperature during RF ablation by Laser-Doppler might be useful not only for RF efficiency evaluation but also as an indication for associating adjuvant local chemotherapy.