The early prediction of mortality in acute cholecystitis: Temperature, Neutrophils and Multiple organ failure (TNM) score.

OBJECTIVE: Acute Cholecystitis (AC) accounts for a significant proportion of patients presenting to the Emergency Department with abdominal pain. We suggest grading the severity of AC with a simple system: TNM, an acronym borrowed by cancer staging where T indicated Temperature, N neutrophils and M Multiple organ failure. This retrospective-prospective observational study evaluates the predictive value of TNM score on mortality of patients with AC. PATIENTS AND METHODS: TNM was developed in a training cohort of 178 patients with AC who underwent cholecystectomy from February 2005 to December 2012 (retrospectives data). To verify the prognostic value of TNM score, we prospectively recruited 172 patients who were consecutively included and treated from January 2013 to July 2020 as the validation cohort. After defining the categories T, N and M, patients were grouped in stages. The variables analyzed were age, sex, American Society of Anesthesiologists (ASA) score, blood transfusion, temperature, neutrophils count, preoperative organ failure, immune-compromised status, stage. RESULTS: In the training cohort TNM staging was: none patient at stage 0; 6 patients at stage I; 71 patients at stage II; 71 patients at stage III; 30 patients at stage IV. Death occurred in 51 patients. ASA score, neutrophils count, preoperative organ failure, stage III-IV emerged as statistically significant different prognostic factors. ASA score (III-IV) and stage (III-IV) were significant independent predictors of post-operative mortality in multivariate analysis. Comparable results were observed in the validation cohort. CONCLUSIONS: TNM classification is very easy to use; it helps to define the mortality risk and it is useful to objectively compare patients with AC.

Network meta-analysis on the comparative effectiveness and safety of transcatheter aortic valve implantation with CoreValve or Sapien devices versus surgical replacement.

INTRODUCTION: Surgical replacement for aortic stenosis is fraught with complications in high-risk patients. Transcatheter techniques may offer a minimally invasive solution, but their comparative effectiveness and safety is uncertain. We performed a network meta-analysis on this topic. METHODS: Randomized trials on transcatheter aortic valve replacement vs surgery were searched. The primary outcome was all cause death. Risk estimates were obtained with Bayesian network meta-analytic methods. RESULTS: Four trials with 1,805 patients were included. After a median of 8 months, risk of death and myocardial infarction was not different when comparing surgery versus transcatheter procedures, irrespective of device or access. Conversely, surgery was associated with higher rates of major bleeding (odds ratio vs CoreValve=3.03 [95% credible interval: 2.23-4.17]; odds ratio vs transfemoral Sapien =1.82 [1.21-2.70]; odds ratio vs transapical Sapien =2.08 [1.20-3.70]), and acute kidney injury (odds ratio vs CoreValve =2.08 [1.33-3.32]; odds ratio vs transapical Sapien =2.78 [2.21-99.80]), but lower rates of pacemaker implantation (odds ratio vs CoreValve =0.41 [0.28-0.59]), and moderate or severe aortic regurgitation (odds ratio vs CoreValve =0.06 [0.02-0.27]; odds ratio vs Sapien=0.17 [0.02-0.76]). Strokes were less frequent with CoreValve than with transfemoral Sapien (odds ratio =0.32 [0.13-0.73]) or transapical Sapien (odds ratio =0.33 [0.10-0.93]), whereas pacemaker implantation was more common with CoreValve (odds ratio vs surgery =2.46 [1.69-3.61]; odds ratio vs transfemoral Sapien =2.22 [1.27-3.85]). CONCLUSIONS: Survival after transcatheter or surgical aortic valve replacement is similar, but there might be differences in the individual safety and effectiveness profile between the treatment strategies and the individual devices used in transcatheter aortic valve implantation.

In vivo effects on human skeletal muscle oxygen delivery and metabolism of cardiopulmonary bypass and perioperative hemodilution.

PURPOSE: To investigate the in vivo effects of cardiopulmonary bypass (CPB) and perioperative hemodilution on human skeletal muscle oxygen delivery and metabolism and to determine the dilution state at which these effects arise. METHODS: We conducted this observational study in adult patients undergoing CPB surgery. Microcirculatory data were obtained by near-infrared spectroscopy from the brachioradial muscle in 20 consecutive patients undergoing hemodilution for CPB. Outcome variables included tissue oxy- and deoxyhemoglobin concentration ([HbO(2)], [HHb]), oxygen content, blood flow, oxygen delivery, and oxygen consumption. RESULTS: Although CPB left tissue blood flow and oxygen delivery unchanged, both microcirculatory variables correlated significantly and inversely with hematocrit (Hct) (r = -0.39, p < 0.001; r = -0.50, p < 0.001). CPB also left muscle oxygen consumption (mVO(2)) unchanged and this variable correlated with the tissue hemoglobin concentration and tissue oxygen delivery (r = 0.40, p = 0.001; r = 0.35, p = 0.005). During CPB most of the systemic cardiovascular variables remained unchanged. Conversely at Hct lower than 30%, mean arterial pressure and pH decreased and lactate values increased twofold, whereas microvascular blood volume and oxygen delivery increased. At Hct lower than 20% blood flow and oxygen delivery increased, whereas hemoglobin and oxygen content variables decreased. CONCLUSIONS: CPB leaves skeletal muscle oxygen delivery and metabolism as measured by near-infrared spectroscopy unchanged. The only factor that correlates directly with the oxygen content variables and inversely with blood flow, and induces significant changes in tissue hemoglobin content and oxygen delivery, is hemodilution.

[Exanthemic diseases (measles, chickenpox, rubella and parotitis). Focus on screening and health surveillance of health workers: results and perspectives of a multicenter working group]. / Le malattie esantematiche (Morbillo, Varicella, Rosolia e Parotite). Focus su screening e sorveglianza sanitaria dei lavoratori della sanità: risultati e prospettive di un gruppo di lavoro multicentrico.

BACKGROUND: Nosocomial transmission of varicella-zoster virus, certain paramixovirus and rubivirus might pose a risk of morbidity for varicella (V), rubella (R), mumps (Mu) and measles (Me) in health care workers (HCW), patients and coworkers. International literature and European legislation recommend preventive interventions to minimize the risk. METHODS: A literature review and a seroprevalence study were carried out in 9 hospitals located in north and central Italy, in order to evaluate risk assessment, health surveillance and fitness for work of HCW exposed to V, R, Mu and Me. Antibodies (Ab) against V, R, Mu and Me were determined. For a subgroup of 4 hospitals; sociodemographic, occupational data and sera were collected and analyzed. RESULTS: About 36000 tests on about 9000 HCW were analyzed. Differences in seroprevalence ratios (V 85.7-95.1%, R 47-96.8%, Me 71.4-97.8%, Mu 52.5-87.6%) were detected. In a subgroup, a relevant number of non immune HCW was also found among women infertile age and areas at higher risk. Statistically significant differences were detected only for selected variables and viruses. DISCUSSION AND CONCLUSIONS: Data of multicenter study confirm literature evidences and allow to define good medical practices for manage and minimize the risk of nosocomial transmission of V, R, Me and Mu. Recommendation are issued about serologic screening on HCW exposed to all 4 viruses thorough the modern analytical techniques, in order to assess risk on individual a group basis and to select priorities for intervention. Vaccination should be prescribed for those HCW non immune, selecting areas and HCW according to priorities.

Transmisión sexual del virus de Hepatitis C / Sexual transmision of Hepatitis C virus

Fifty heterosexual partners out of 50 patients (index cases) without confirmed or probable risk factors of parenteral transmission by HCV were studied from 1/1997 to 1/2001. The index cases were HCV Ab (+) (EIA 3rd Abbott and PCR + by RT-nested PCR). The couples with probable or confirmed risk factors of parenteral transmission were strictly excluded. No case of HCV infection was found, suggesting that sexual via wouldn't be a direct transmission of HCV

Transmisión sexual del virus de Hepatitis C / Sexual transmision of Hepatitis C virus

Fifty heterosexual partners out of 50 patients (index cases) without confirmed or probable risk factors of parenteral transmission by HCV were studied from 1/1997 to 1/2001. The index cases were HCV Ab (+) (EIA 3rd Abbott and PCR + by RT-nested PCR). The couples with probable or confirmed risk factors of parenteral transmission were strictly excluded. No case of HCV infection was found, suggesting that sexual via wouldnt be a direct transmission of HCV (AU)

[The prevalence of antibodies against hepatitis B abs c virus in odontology students]. / Prevalencia de anticuerpos contra los virus de hepatitis B y C en estudiantes de odontología.

UNLABELLED: It is accepted that the practice of odontology implies a risk of BBV and HCV transmission but the study of does not. This work tries to determine the prevalence of HBv Ac and HCV Ac (by ELISA) in odontology students and whether there is any relation to the year of study and/or the presence of other risk factors. 188 students in their last three years of studies were investigated, all the participants filled out a clinical epidemiological form. 89 women (47.3%) and 99 men (52.7%), x age was 24.8. 50 (26.7%) had other risk factors. 160 (85.1%) fulfilled biosecurity norms and 40 (21.2%) had a labour accident. RESULTS: None of the analyzed sera were positive for HCV Ac (0%) and 1 was positive for HbcAc. CONCLUSION: The prevalence of HBv Ac and HCV Ac is extremely low with no relation to the year of study or any other risk factors.

Factors influencing immediate and long-term results after button's technique.

BACKGROUND: Aim of this study was to evaluate the factors influencing immediate and long-term results in patients undergoing aortic root replacement with a composite graft. METHODS: Between January 1989 and February 1999, 105 patients (83 males, 22 females) who underwent Bentall technique were studied. Preoperative diagnosis was annulo-aortic ectasia in 54, aortic dissection in 27, atherosclerotic aneurysm in 21, and aortitis in 3 cases. Seventeen patients were affected by Marfan's syndrome. All cases, elective, urgent, and emergency were included. Button technique was performed and the associated surgical procedures were coronary artery bypass grafting in 21, total aortic arch replacement in 15, proximal hemi arch in 5, and mitral valve replacement in 5 cases. RESULTS: The overall hospital mortality rate was 7.6% (n=8). Univariate analysis using chi(2) and/or two-sample "t"-test showed that dissection, aortitis, aneurysm rupture into-pleura or pericardium, emergency status, redo, prolonged pump times and circulatory arrest, were predictors influencing in-hospital mortality. Coagulopathy, low cardiac output, stroke, perioperative myocardial infarction, surgical bleeding leading to reoperation, were significantly related to in-hospital mortality (by correlation analysis). A multivariate analysis showed that, emergency status (p=0.027), aortic dissection (p=0.029), perioperative myocardial infarction (p=0.0021), reoperation for bleeding (p=0.0023), and pump time >180 min (p=0.011), were significant. The actuarial survival rate at 10 years follow-up was 84.7%. There were 8 late deaths. The Kaplan-Meier showed significant differences when considering dissection vs non-dissection (p=0.018), but did not reach significance in Marfan vs non-Marfan groups (p=0.83). NYHA class IV (p=0.052), previous cardiac surgery procedure (p=0.041), concomitant CABG (p=0.021), total aortic arch reconstruction (p=0.001), and mitral valve replacement (p=0.016), were identified as significant by Log Rank test. CONCLUSIONS: The Bentall procedure for aortic root replacement is safe and durable; in hospital mortality in elective status it was 1.28%; early and long-term mortality higher in patients with acute dissection. Six late deaths were procedures related. Sixty-six patients (76.4%) were in NYHA I class at follow-up. The incidence of late outcomes, thromboembolism (1.03%), graft infection (2.06%), pseudoaneurysm (0%), reoperation in ascending aorta or aortic valve (3.1%), operations on the remaining aorta (6.7%), and hemorrhage due to anticoagulant therapy (1.03%), are very low.

Prevalencia de anticuerpos contra los virus de hepatitis B y C en estudiantes de ondontología / The prevalence of antibodies against hepatitis B abs c virus in odontology

It is accepted that the practice of odontology implies a risk of BBV and HCV transmission but the study of does not. This work tries to determine the prevalence of HBv Ac and HCV Ac (by ELISA) in odontology students and whether there is any relation to the year of study and/or the presence of other risk factors. 188 students in their last three years of studies were investigated, all the participants filled out a clinical epidemiological form. 89 women (47.3%) and 99 men (52.7%), x age was 24.8. 50 (26.7%) had other risk factors. 160 (85.1%) fulfilled biosecurity norms and 40 (21.2%) had a labour accident. RESULTS: None of the analyzed sera were positive for HCV Ac (0%) and 1 was positive for HbcAc. CONCLUSION: The prevalence of HBv Ac and HCV Ac is extremely low with no relation to the year of study or any other risk factors

Prevalencia de anticuerpos contra los virus de hepatitis B y C en estudiantes de ondontología / The prevalence of antibodies against hepatitis B abs c virus in odontology

It is accepted that the practice of odontology implies a risk of BBV and HCV transmission but the study of does not. This work tries to determine the prevalence of HBv Ac and HCV Ac (by ELISA) in odontology students and whether there is any relation to the year of study and/or the presence of other risk factors. 188 students in their last three years of studies were investigated, all the participants filled out a clinical epidemiological form. 89 women (47.3%) and 99 men (52.7%), x age was 24.8. 50 (26.7%) had other risk factors. 160 (85.1%) fulfilled biosecurity norms and 40 (21.2%) had a labour accident. RESULTS: None of the analyzed sera were positive for HCV Ac (0%) and 1 was positive for HbcAc. CONCLUSION: The prevalence of HBv Ac and HCV Ac is extremely low with no relation to the year of study or any other risk factors (AU)

Prospective surveillance applying the national nosocomial infection surveillance methods in a Brazilian pediatric public hospital.

BACKGROUND: A hospital-wide, traditional prospective surveillance for nosocomial infections was commenced in 1992 in Centro Geral de Pediatria in Minas Gerais, Brazil, to describe the epidemiology of nosocomial infection in this pediatric hospital and to implement cross-infection prevention and control policies. METHODS: We performed a prospective cohort nosocomial infection surveillance of all patients receiving acute care according to the hospital-wide and intensive care unit components of the National Nosocomial Infections Surveillance System from January 1993 to December 1997 (14,892 discharges; 131,764 patient-days). The Centers for Disease Control and Prevention (Atlanta) 1988-definitions and the Brazilian Ministry of Health-Legislation 930 (1992) were used. RESULTS: The average overall nosocomial infection rate per 1000 patient-days was 8.9 in units 2 and 3 and 16.4 in the pediatric intensive care unit. Over time, the overall hospital infection rate decreased from 16.6 nosocomial infections per 1000 patient-days in 1993 to 7.0 in 1997 (P <.05). We believe this can be attributed to interventions and data reporting during the period. The five most frequent sites of infections were eye-ear-nose-throat (38%), skin (22%), pneumonia (12%), soft tissue (5%) and laboratory-confirmed bloodstream infection (4%). In the pediatric intensive care unit, the most frequent nosocomial infection sites were pneumonia related to mechanical ventilators (22%), with rates ranging from 0 to 42 per 1000 ventilator-days; and sepsis related to central lines (11%), with rates ranging from 0 to 32 per 1000 central line-days. CONCLUSIONS: Describing the epidemiology of nosocomial infections in this hospital enabled us to establish infection occurrence, distribution, and expected incidence, as well as to recognize trends and keep track of possible outbreaks. The knowledge acquired through this surveillance allowed us to target more specific and continuous quality improvement projects, to upgrade health care quality in pediatric public hospitals in Brazil, and to implement preventive strategies. Methods from the National Nosocomial Infections Surveillance System can be successfully applied in pediatric public hospitals in Brazil.

[Sexual transmission of Hepatitis C virus]. / Transmisiòn sexual del virus de Hepatitis C.

Fifty heterosexual partners out of 50 patients (index cases) without confirmed or probable risk factors of parenteral transmission by HCV were studied from 1/1997 to 1/2001. The index cases were HCV Ab (+) (EIA 3rd Abbott and PCR + by RT-nested PCR). The couples with probable or confirmed risk factors of parenteral transmission were strictly excluded. No case of HCV infection was found, suggesting that sexual via wouldn't be a direct transmission of HCV.

Prevalencia de anticuerpos contra los virus de hepatitis B y C en estudiantes de odontología. / [The prevalence of antibodies against hepatitis B abs c virus in odontology students]

It is accepted that the practice of odontology implies a risk of BBV and HCV transmission but the study of does not. This work tries to determine the prevalence of HBv Ac and HCV Ac (by ELISA) in odontology students and whether there is any relation to the year of study and/or the presence of other risk factors. 188 students in their last three years of studies were investigated, all the participants filled out a clinical epidemiological form. 89 women (47.3

) and 99 men (52.7

), x age was 24.8. 50 (26.7

) had other risk factors. 160 (85.1

) fulfilled biosecurity norms and 40 (21.2

) had a labour accident. RESULTS: None of the analyzed sera were positive for HCV Ac (0

) and 1 was positive for HbcAc. CONCLUSION: The prevalence of HBv Ac and HCV Ac is extremely low with no relation to the year of study or any other risk factors.

Transmisiòn sexual del virus de Hepatitis C. / [Sexual transmission of Hepatitis C virus]

Fifty heterosexual partners out of 50 patients (index cases) without confirmed or probable risk factors of parenteral transmission by HCV were studied from 1/1997 to 1/2001. The index cases were HCV Ab (+) (EIA 3rd Abbott and PCR + by RT-nested PCR). The couples with probable or confirmed risk factors of parenteral transmission were strictly excluded. No case of HCV infection was found, suggesting that sexual via wouldnt be a direct transmission of HCV.

Left ventricular thrombosis after blunt chest trauma.

A 22-year-old man was admitted to our observation with left ventricular thrombus arising after blunt chest trauma occurring during a ski accident one year before. None was obtained from a review of instrumental and laboratory data at trauma time. Transesophageal echocardiography showed an intraventricular thrombus and severe hypokinesia at the apex. Standard cardiac surgery procedure was performed and postoperative period was uneventful. Echocardiography controls at 6/12 months showed a normal apex kinesia. This case shows the importance of hospitalization, hemodynamics monitorization and late serial echocardiographic controls for timely diagnosis and management of myocardial contusion and consecutive ventricular thrombus formation to prevent life-threatening complications.

[Laparoscopic or open appendectomy. Critical review of the literature and personal experience]. / Appendicectomia laparoscopica o a cielo aperto. Revisione critica della letteratura ed esperienza personale.

UNLABELLED: In the era of video-laparoscopic surgery there are a lot of surgeons that still continue to perform open appendectomy. This choice is the consequence of the good results of open appendectomy (clinical, cosmetic, hospital stays and hospital costs). Published trials on laparoscopic appendectomy don't show that it is superior to the open approach. The aim of this study is to critically review the literature on laparoscopic and traditional appendectomies and to report a clinical experience on 86 consecutive patients that underwent open appendectomy. PATIENTS AND METHODS: From September 2000 to March 2001, in the Department of Emergency Surgery of Villa Scassi Hospital in Genoa, 86 patients underwent open appendectomy (32 men; mean age 29.8 years; range 15-54 years/54 women; mean age 22.4 years; range 13-80 years). All the patients underwent blood examinations, abdomino-pelvic ultrasonographys and the women gynecological evaluation. The Authors used, almost always, the Stropeni way of access (cutaneous Mac Burney and right para-rectal incision of the muscles). Discharge has been done as soon as possible. Removed appendices were submitted to histological examination and were classified as normal or pathologic according to the severity of the lesion. Review of articles has been done on Medline. RESULTS: Suspected appendicitis have been confirmed by histological examination that documented 1 normal appendix, 7 chronic appendicitis, 45 acute catharralis, 22 acute suppurative and 11 gangrenous or perforated appendicitis. The specificity of open appendectomy has been 97.6% (100% for men). Post-operative complications were: 2 wound infections and 1 recurrence of an abscess (2.58%). Open appendectomy did carry an hospital bill of 2,500,000 IT liras (1,200 USA dollars) for non complicated appendicitis and 2,000 USA dollars for perforated appendicitis. The early discharge allowed us to spend 119 millions IT liras less in 7 months (99,600 USA dollars in a year). DISCUSSION: The role of laparoscopic appendectomy isn't still established. After a critical review of the literature we can suggest that: 1) laparoscopic appendectomy increase operative time (63 vs 43 minutes: p < 0.0001); 2) laparoscopic approach can reduce the length of post-operative stay in hospital; 3) hospital bill is strongly reduced by open appendectomy (4,274 vs 7,923 USA dollars). On our experience the cost of the hospital for uncomplicated appendicitis is 2,500,000 IT liras (1,200 USA dollars). Otherwise it has been suggested that laparoscopic appendectomy has a better diagnostic accuracy respect to open appendectomy. Some Authors report a percentage of "negative" appendices of 16-50%. In Authors experience the percentage of "negative" appendices is 1.3% and so the diagnostic accuracy is 96% in women and 100% in men, probably because we systematically performed a preoperative abdomino-pelvic ultrasonography and, for the women, a gynecological evaluation. In conclusion, laparoscopic appendectomy should be done in case of suspected appendicitis in women. In the other cases, when there is a strong clinical suspect of appendicitis and, in particular, in case of suppurative appendicitis, the Authors recommend to perform an open appendectomy using the Stropeni approach. In case of perforated appendicitis with abdominal abscess they recommend to perform an open appendectomy using the right para-rectal approach or the median umbilical-pubis approach.

Arrhythmia prophylaxis after coronary artery bypass grafting: regimens of magnesium sulfate administration.

BACKGROUND: Arrhythmias are common after open heart surgery and may be related to hypomagnesaemia due to cardiopulmonary bypass. Although perioperative prophylactic Mg2+ administration may prevent arrhythmias after coronary artery bypass grafting (CABG), clear indications as well as the timing of Mg2+ substitution and dose regimen need to be clarified. Aim of this study was to evaluate the antiarrhythmic effects of Mg2+ infusion in patients who underwent elective CABG. METHOD: Ninety-seven patients who underwent elective CABG were divided in four Groups. In Group A 1 g of magnesium sulfate was added to the pump prime, Group B received 1 g in the pump prime plus 5 mmol/L in the cardioplegic solution, Group C received 5 mmol/L in the cardioplegic solution, and Group D was a placebo control Group. Groups A, B, and C also received 24 h continuous infusion of magnesium sulfate at 10 mmol/L. Three-channel electrocardiogram (II-V5-V6) continuous monitoring was performed 12 hours preoperatively and 48 hours postoperatively. Blood samples were taken for subsequent Serum magnesium measurements, at five different time points before, during and after CBP. RESULTS: In all Groups serum Mg2+ levels were reduced during CPB (Time 2) and statistically significant differences from pre-anaesthesia levels (Time 1) were noted (p <0.05). In Groups A, B, and C Serum Mg2+ levels increased progressively from Time 3 to Time 5; in Group D serum Mg2+ levels were still much lower at Time 5. Significant differences (p<0.05) were noted for Groups B and C vs Groups A and D in atrial ectopics, atrial fibrillation, and ventricular arrhythmic events. CONCLUSION: Our results demonstrate that Mg2+ sulfate administration regimens used in Group B and C reduce postoperative arrhythmic events in patients undergoing CABG.

Protection of human myocardium in vitro by K(ATP) activation with low concentrations of bimakalim.

We investigated whether the adenosine triphosphate (ATP)-sensitive K+ (K(ATP)) channel activation by bimakalim, at concentrations devoid of both negative inotropic and action-potential duration (APD) shortening effects, might exhibit myocardial protection after hypoxia and reoxygenation in human atrial myocardium by using 112 preparations. The recovery of contractility of human atrial trabeculae, subjected either to short-duration (5 min) or to long-duration (60 min) and severe (high pacing rate) hypoxia followed by reoxygenation, was assessed by challenging with dobutamine. Treated preparations were exposed to 10 or 100 nM bimakalim, 1 microM glibenclamide, or both before hypoxia. Variations of isometric developed tension (%DT) or APD90 were studied. At concentrations <100 nM, bimakalim showed no negative inotropic effects and did not modify significantly APD90 either in normoxia or in hypoxic conditions. In the short-duration hypoxia protocol, preparations treated with bimakalim showed a dobutamine-induced %DT increase significantly higher (p < 0.001) than in controls and similar to that observed in the absence of hypoxia. This bimakalim effect was blocked by glibenclamide. In the long-duration hypoxia protocol, %DT after dobutamine was 50% of that observed in normoxic preparations. Preparations treated with bimakalim showed after dobutamine %DT more than twofold above controls (p < 0.001), whereas in the glibenclamide group, recovery of DT with dobutamine remained 50% of what observed in normoxia (p < 0.001). In conclusion, exposure to hypoxia (either short- or long-lasting) and reoxygenation affects contractility of human atrial myocardium with pronounced reduction of the positive inotropic action of dobutamine. Pretreatment with bimakalim restores the response expected in the absence of hypoxia, and glibenclamide blocks the effect of bimakalim or further impairs the response to dobutamine when used alone before long-duration hypoxia. Evidence is provided for protective effects of the K(ATP) opener bimakalim on the human myocardial contractile function in conditions of hypoxia/reoxygenation, at concentrations at which negative inotropism and APD90 shortening are not contributory.

Effects of bimakalim on human cardiac action potentials: comparison with guinea pig and nicorandil and use-dependent study.

Electrophysiologic effects of K(ATP) channel openers (KCOs) are rarely studied for tissue and species specificity, and use-dependent investigations in human tissues are lacking. We therefore investigated in vitro the concentration-dependent effects of the KCO bimakalim [from 10 nM to 10 microM, at 1,000 ms of cycle length (CL) and 37 degrees C] on human (atrium, n = 4, and ventricle, n = 6) and guinea pig (atrium, n = 7, and ventricle, n = 6) transmembrane action potential (AP). The frequency relation (from CL 1,600 to 300 ms, 31 degrees C) of human atrial AP duration 90% (APD90) shortening (10 microM vs. baseline, n = 7) also was determined. A parallel study was performed with the KCO nicorandil (from 10 nM to 1 mM, n = 3) in human atrial APs, at 31 degrees C. Resting membrane potential and maximal upstroke velocity of AP were not modified by bimakalim at maximal concentration, whereas AP amplitude was decreased in both guinea pig preparations (p < 0.05); APD90 was shortened in all tissues (p < 0.01). Median effective concentration (EC50) for APD90 shortening at 37 degrees C was 0.54 and 2.74 microM in atrial and ventricular human tissue, respectively, and 8.55 and 0.89 microM in atrial and ventricular guinea pig tissue, respectively. In human atrial tissue at 31 degrees C, EC50 with bimakalim was 0.39 microM; a much higher value was seen with nicorandil (210 microM). Bimakalim (10 microM)-induced APD90 shortening as a function of stimulation rate was greatest at longest CL. Evidence is provided for (a) species (human vs. guinea pig) and tissue (atrium vs. ventricle) differential AP sensitivity to bimakalim; (b) an approximately 500-fold higher efficacy of bimakalim versus nicorandil to shorten human atrial APD90; and (c) normal use-dependence of human atrial APD90 shortening with bimakalim at 10 microM.

[Immunological evaluation of 60 children with AIDS] / Avaliação imunológica em 60 crianças com AIDS.

OBJECTIVE: The immunologic defects that occur in children with HIV infection are important tests to both diagnosis and therapeutic response. The objective of this study was to verify the immunologic abnormalities in 60 children with AIDS, in Florianópolis, Santa Catarina State, Brazil. METHODS: Serum immunoglobulin levels were determined by nephelometry and compared to a normal pattern for Brazilian children. The lymphocyte T helper (CD4+) and the lymphocyte T suppressor (CD8+) count and percentage, and the ratio between them, determined by commercial flow cytometry, were compared to a pattern for healthy children of HIV-positive mothers. RESULTS: The mean serum IgG levels was higher in the children with AIDS (p<0.005). The mean serum IgM levels was higher in the children with AIDS in the age group between 13 and 108 months (p<0.005). The CD4+ lymphocytes count was below the inferior limit of the 95% confidence interval of the median reference values to each group of age in 50 (84.7%) of the 59 determinations. The CD4+ lymphocytes percentage was much lower than the percentages of reference. The graph curve of the medians of the ratio between lymphocytes CD4+ and CD8+ to each group of age was below the fifth percentile of the graph curve of the medians of reference. CONCLUSIONS: The hypergamaglobulinemia and the lymphocyte T CD4+ count and percentage are sensitive indicators of HIV infection, observed in the present study. Immunologic evaluation of the HIV-positive children is recommended, including those younger than 18 months of age.