Ulinastatin shortens the length of ICU stay in critical patients with organ failure: A 7-year real-world study.

BACKGROUND: Ulinastatin has been applied in a series of diseases associated with inflammation but its clinical effects remain somewhat elusive. OBJECTIVE: We aimed to investigate the potential effects of ulinastatin on organ failure patients admitted to the intensive care unit (ICU). METHODS: This is a single-center retrospective study on organ failure patients from 2013 to 2019. Patients were divided into two groups according to using ulinastatin or not during hospitalization. Propensity score matching was applied to reduce bias. The outcomes of interest were 28-day all-cause mortality, length of ICU stay, and mechanical ventilation duration. RESULTS: Of the 841 patients who fulfilled the entry criteria, 247 received ulinastatin. A propensity-matched cohort of 608 patients was created. No significant differences in 28-day mortality between the two groups. Sequential organ failure assessment (SOFA) was identified as the independent risk factor associated with mortality. In the subgroup with SOFA ≤ 10, patients received ulinastatin experienced significantly shorter time in ICU (10.0 d [interquartile range, IQR: 7.0∼20.0] vs 15.0 d [IQR: 7.0∼25.0]; p = .004) and on mechanical ventilation (222 h [IQR:114∼349] vs 251 h [IQR: 123∼499]; P = .01), but the 28-day mortality revealed no obvious difference (10.5% vs 9.4%; p = .74). CONCLUSION: Ulinastatin was beneficial in treating patients in ICU with organ failure, mainly by reducing the length of ICU stay and duration of mechanical ventilation.

A comparative analysis of sivelestat sodium hydrate and ulinastatin combination therapy in the treatment of sepsis with acute respiratory distress syndrome.

OBJECTIVE: This comparative analysis aimed to investigate the efficacy of Sivelestat Sodium Hydrate (SSH) combined with Ulinastatin (UTI) in the treatment of sepsis with acute respiratory distress syndrome (ARDS). METHODS: A control group and an observation group were formed with eighty-four cases of patients with sepsis with ARDS, with 42 cases in each group. The control group was intravenously injected with UTI based on conventional treatment, and the observation group was injected with SSH based on the control group. Both groups were treated continuously for 7 days, and the treatment outcomes and efficacy of both groups were observed. The Murray Lung Injury Score (MLIS), Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II) were compared. Changes in respiratory function, inflammatory factors, and oxidative stress indicators were assessed. The occurrence of adverse drug reactions was recorded. RESULTS: The total effective rate in the observation group (95.24%) was higher than that in the control group (80.95%) (P < 0.05). The mechanical ventilation time, intensive care unit (ICU) hospitalization time, and duration of antimicrobial medication in the observation group were shorter and multiple organ dysfunction syndrome incidence was lower than those in the control group (P < 0.05). The mortality rate of patients in the observation group (35.71%) was lower than that in the control group (52.38%), but there was no statistically significant difference between the two groups (P > 0.05). MLIS, SOFA, and APACHE II scores in the observation group were lower than the control group (P < 0.05). After treatment, respiratory function, inflammation, and oxidative stress were improved in the observation group (P < 0.05). Adverse reactions were not significantly different between the two groups (P > 0.05). CONCLUSION: The combination of SSH plus UTI improves lung injury and pulmonary ventilation function, and reduces inflammation and oxidative stress in patients with sepsis and ARDS.

Effect of degalactosylated bovine glycoprotein formulations MAF and M сapsules on lymphopenia and clinical outcomes in hospitalized COVID-19 patients: a randomized clinical trial.

BACKGROUND: Targeting mucosal immunity of the gut, which is known to provide antigen processing, while avoiding excessive or unnecessary inflammation, was tested as a way to modulate COVID-19 severity. METHODS: Randomized open-label trial in 204 adults hospitalized with non-critical COVID-19 who received for 14 days in addition to standard of care (SOC) degalactosylated bovine glycoproteins formulations of either MAF capsules (MAF group) or M capsules (M group) or SOC only (control group). RESULTS: Median recovery time when patients did not require supplemental oxygen was 6 days in both study groups compared to 9 days in the control (MAF vs. control; P = 0.020 and M vs. control; P = 0.004). A greater reduction in mortality was seen in the MAF group compared to the control by day 14 (8.3% vs. 1.6%; P = 0.121) and by day 29 (15.3% vs. 3.2%; P = 0.020), and similarly in the M group by day 14 (8.3% vs. 2.9%; P = 0.276) and by day 29 (15.3% vs. 2.9%; P = 0.017). The proportion of those who had baseline absolute lymphocyte count (ALC) lower than 0.8 × 109/L was 13/63 (20.6%), 17/69 (24.6%), and 18/72 (25.0%) of patients in MAF, M, and control group respectively. Day 29 mortality among these lymphopenic patients was three times higher than for the intent-to-treat population (21% vs. 7%) and consisted in above subgroups: 2/13 (15%), 2/17 (12%), and 6/18 (33%) of patients. The decreased mortality in both study subgroups correlated with greater ALC restoration above 0.8 × 109/L level seen on day 14 in 91% (11/12) and 87.5% (14/16) of survivors in MAF and M subgroups respectively compared to 53.3% (8/15) of survivors in control subgroup. Incidences of any ALC decrease below the baseline level on day 14 occurred in 25.4% of patients in the MAF group and 29.0% of patients in the M group compared to 45.8% in control and ALC depletion by ≥ 50% from the baseline level consisted of 7.9%, 5.8%, and 15.3% of cases in these groups respectively. CONCLUSION: This study showed that both study agents prevented ALC depletion and accelerated its restoration, which is believed to be one of the mechanisms of improved crucial clinical outcomes in hospitalized COVID-19 patients. TRIAL REGISTRATION: The trial was registered after the trial start in ClinicalTrials.gov NCT04762628, registered 21/02/2021, https://www. CLINICALTRIALS: gov/ct2/show/NCT04762628 .

The impact of ulinastatin on wound infection and healing in patients with burn wounds: A meta-analysis.

Burn injuries result in localised tissue damage and precipitate systemic responses; routine clinical treatments, which typically include metabolic nutritional support and anti-infection therapies, do not yield optimal outcomes. Therefore, we aimed to systematically evaluate the effects of ulinastatin on wound infection and healing in patients with burns to provide reliable evidence-based recommendations for burn treatment. An electronic search of the Web of Science, PubMed, Cochrane Library, Embase, Wanfang, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure databases, supplemented by manual searches, was conducted from database inception to October 2023 to collect randomised controlled trials (RCTs) assessing the efficacy of ulinastatin for the treatment of burns. Two researchers screened all retrieved articles according to the inclusion and exclusion criteria; the included studies were evaluated for quality, and the relevant data were extracted. Stata 17.0 software was employed for data analysis. Overall, 8 RCTs with 803 patients were included, with 404 and 399 in the ulinastatin and conventional treatment groups, respectively. The analysis revealed that wound infections (odds ratio [OR] = 0.08, 95% CI: 0.02-0.35, p = 0.001) and complications (OR = 0.21, 95% CI: 0.10-0.42, p < 0.001) were significantly lower, and wound healing time (standardised mean differences [SMD] = -1.31, 95% CI: -2.05 to -0.57, p = 0.001) was significantly shorter, in the ulinastatin groups than in the control group. This meta-analysis revealed that ulinastatin can effectively reduce the incidence of wound infections and complications and significantly shorten the duration of wound healing in patients with burns, thereby promoting early recovery in these patients.

Ulinastatin protects against myocardial ischemia/reperfusion injury in rats via Rho/ROCK signaling pathway.

We aimed to study the influences of ulinastatin on diseased myocardial tissues, cardiomyocyte apoptosis and inflammatory reaction in rats with myocardial ischemia/reperfusion injury (IRI) via the Ras homolog (Rho)/Rho-associated kinase (ROCK) signaling pathway and its mechanism. The rats were randomly divided into three groups: control group (C group), IR model group (IR group) and IR model + ulinastatin treatment group (UR group). The pathological changes in myocardial tissues were detected via HE staining, the markers of myocardial injury were examined using kits, and apoptosis was determined through TUNEL assay. Moreover, ELISA was applied to measure the expressions of TNF-α, interleukin-6 (IL-6) and IL-8 in cardiac tissues, and Western blotting was performed to detect the protein expression levels of RhoA, ROCK2 and MLCP. The myocardial infarction area in the IR group was markedly larger than that in the C group (P<0.01) but was significantly reduced after ulinastatin treatment (P<0.05), and the IR group had higher levels of AST, cTnI, CK-MB and LDH than C group, but the levels of those indexes were significantly reduced after ulinastatin treatment.The cardiomyocyte apoptosis was increased in the IR group compared with that in the C group, while it was decreased in the UR group in comparison with that in the IR group. Besides, the UR group exhibited lowered expression levels of the Rho/ROCK signaling pathway-related proteins compared with the IR group. Ulinastatin may ameliorate the prognosis of rats with myocardial IRI via the Rho/ROCK signaling pathway.

Laronidase como terapia de reposição enzimática na mucopolissacaridose tipo I / Laronidase as enzyme replacement therapy in mucopolysaccharidosis type I

CONTEXTO: A mucopolissacaridose tipo I (MPS I) é uma doença lisossômica (DL) crônica, progressiva, causada pela atividade deficiente da alfa-L-iduronidase (IDUA). A IDUA é responsável pela clivagem dos resíduos de ácido idurônico dos glicosaminoglicanos (GAGs) heparan e dermatan sulfato. Na MPS I, ocorre o acúmulo desses GAGs parcialmente degradados no interior dos lisossomos e o aumento da sua excreção na urina. Em consequência, os pacientes apresentam comprometimento dos sistemas respiratório, nervoso, musculoesquelético, gastrointestinal (fígado e baço), cardiovascular, dentre outros. A MPS I é herdada de forma autossômica recessiva, sendo uma doença rara. A sua incidência mundial é bastante variável, sendo estimada entre 0,69 e 1,66 por 100.000 pessoas. Está associada a três formas clássicas, que diferem entre si com base na presença de comprometimento neurológico, na velocidade de progressão da doença e na gravidade do acometimento dos órgãos-alvo. Não existe tratamento curativo para a MPS I. O manejo clínico dos pacientes envolve equipe multidisciplinar e inclui intervenções realizadas no nível do fenótipo clínico (como cirurgias para correção de hérnias) e no nível da proteína mutante (transplante de células hematopoiéticas (TCTH) e terapia de reposição enzimática (TRE), conduzida com laronidase, enzima produzida por tecnologia de DNA recombinante). TECNOLOGIA: Laronidase. INDICAÇÃO: Reposição enzimática na mucopolissacaridose tipo I. PERGUNTA: O uso da laronidase como TRE em pacientes com MPS tipo I é eficaz e seguro na melhora clínica e da qualidade de vida dos pacientes? EVIDÊNCIAS CIENTÍFICAS: Foram realizadas buscas nas seguintes bases de dados: PubMed, Embase, Lilacs, Cochrane e ClinicalTrials.gov. Treze estudos foram incluídos nesse relatório, sendo nove ensaios clínicos controlados e randomizados, 4 revisões sistemáticas, os quais foram avaliados pelos desfechos, classificados, por sua vez, como de maior ou menor relevância clínica no tratamento da doença. Dentre os quatro desfechos considerados de maior relevância avaliados, o tratamento com laronidase trouxe benefício clinicamente significativo na capacidade de flexão do ombro que reflete um efeito positivo nas doenças osteoarticulares. Para os outros desfechos avaliados, qualidade de vida, manifestações cardiológicas e doença ocular não foi possível determinar com precisão a existência de benefício. Entre os desfechos de menor relevância, o uso de laronidase demonstrou ter impacto benéfico na diminuição da excreção de GAGs urinários e diminuição do crescimento hepático, mas com efeito incerto na capacidade respiratória, e no crescimento e estado nutricional. O uso de laronidase foi considerado seguro, não se relatando efeitos adversos importantes que pudessem comprometer o tratamento. Em estudos não controlados ou randomizados observaram-se maior probabilidade de sobrevida e menor impacto em órgãosalvo em participantes que fizeram o tratamento de reposição enzimática, principalmente quando se iniciava o tratamento de forma mais precoce. Recomendam-se que sejam implementadas políticas de saúde e educacionais no Brasil, que permitam o diagnóstico precoce dos pacientes, a fim de possibilitar a realização de TCTH, quando indicado, o início precoce da TRE e o aconselhamento genético. Da mesma forma, Protocolo Clínico e Diretrizes Terapêuticas deve estabelecer os critérios para início e interrupção do tratamento. ANÁLISE DE IMPACTO ORÇAMENTÁRIO: A estimativa de impacto orçamentário decorrente da incorporação de laronidase estaria entre R$ 29 milhões a R$ 44 milhões no primeiro ano de incorporação. RECOMENDAÇÃO INICIAL: A CONITEC recomendou preliminarmente a incorporação no SUS da laronidase para reposição enzimática em pacientes com mucopolissacaridose tipo I. CONSULTA PÚBLICA: Foram recebidas 348 contribuições, sendo 340 pelo formulário de experiência ou opinião e 8 pelo formulário técnico-científico. No que diz respeito às características das 340 contribuições pelo formulário de experiência ou opinião analisadas, 337 contribuições foram de pessoa física e 3 de pessoa jurídica. O percentual de concordância com a recomendação da CONITEC foi de 100%. Dos 08 formulários técnico-cientifico enviados e analisados, 7 foram de pessoa física (4 de profissionais de saúde, 2 interessados e 1 familiar) e 1 de pessoa jurídica. Todas as 8 contribuiçoes recebidas pelo formulário técnico-científico se declaravam favoráveis à recomendação da CONITEC e apenas 1 apresentou argumentos ciêntíficos. DELIBERAÇÃO FINAL: Os membros presentes na 57ª reunião do Plenário da CONITEC, nos dias 5 e 6 de julho, deliberaram por unanimidade recomendar a incorporação da laronidase para reposição enzimática em pacientes com mucopolissacaridose tipo I. Foi assinado o Registro de Deliberação nº 275/2017.(AU)

Fibulina-5, una nueva potencial diana terapeútica en AAA / Fibulin-5, a new potential therapeutic target in AAA

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XVI Congreso SEINAP. Cómo prescribir actividad física / XVI Congreso SEINAP. How prescribe physical activity

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Eficácia e segurança dos trombolíticos estreptoquinase, alteplase e tenecteplase no tratamento de infarto agudo do miocárdio / Efficacy and safety of thrombolytic agents streptokinase, alteplase and tenecteplase in the treatment of acute myocardial infarction / La eficacia y la seguridad de los agentes trombolíticos estreptoquinasa, alteplasa y tenecteplasa en el tratamiento del infarto agudo de miocardio

TECNOLOGIAS: Alteplase (administração acelerada e convencional), estreptoquinase e tenecteplase. INDICAÇÃO: Tratamento de Síndromes Coronarianas Agudas (SCA), as quais incluem Infarto Agudo do Miocárdio (IAM). CARACTERIZAÇÃO DAS TECNOLOGIAS: Os trombolíticos são responsáveis pela transformação do plasminogênio em plasmina, que tem capacidade de degradar a fibrina, o maior componente do trombo, componente-chave na fisiopatologia de SCA. Os trombolíticos avaliados são divididos em fibrino­específicos (alteplase; tenecteplase) e não fibrino­específicos (estreptoquinase). Pergunta: Alteplase, estreptoquinase e tenecteplase são eficazes, efetivos e seguros no tratamento hospitalar e pré-hospitalar de pacientes diagnosticados com IAM ou outras SCA? BUSCA E ANÁLISE DE EVIDÊNCIAS CIENTÍFICAS: Foram pesquisadas as bases The Cochrane Library (via Bireme), Medline (via Pubmed) e Lilacs. Buscaram-se revisões sistemáticas (RS) de ensaios clínicos que comparassem os medicamentos entre si ou com outras opções terapêuticas no tratamento IAM e SCA. Também se buscou por avaliações de tecnologias em saúde (ATS) e guias terapêuticos em websites de agências internacionais e da Rede Brasileira de Avaliação de Tecnologia em Saúde. Foram selecionados estudos publicados em inglês, português ou espanhol. RESUMO DOS RESULTADOS DOS ESTUDOS SELECIONADOS: Foram incluídas três revisões sistemáticas com metanálise, duas avaliações de tecnologia em saúde e dois guias terapêuticos versando acerca da trombólise em SCA. Os trombolíticos somente estão indicados e são efetivos para IAM com supradesnível do segmento ST (IAMCSST), sendo que seu uso não apresenta benefícios em outras SCA como o IAM sem supradesnível do segmento ST e na angina instável. Em IAMCSST a terapia trombolítica é considerada como segunda linha de tratamento, preterida por angioplastia primária. Com relação aos principais desfechos, o uso pré-hospitalar de trombolíticos não apresentou diferenças significativas em relação ao uso intra-hospitalar, entretanto estas conclusões foram obtidas em um contexto de países desenvolvidos, portadores de uma rede de transporte em saúde efetiva. Dentre as tecnologias avaliadas não se pode afirmar a superioridade de nenhuma em relação à outra com nível de evidência alto, sendo que o prognóstico do paciente, história pregressa e contraindicações dos medicamentos são fatores preponderantes na escolha da terapia. Estudos de custo-efetividade indicaram que estreptoquinase é o medicamento mais custo efetivo entre os três, dado o fato que tem menor preço e efetividade semelhante. RECOMENDAÇÕES: Para pacientes sem indicação para angioplastia e que não apresentem contraindicações para o uso de trombolíticos recomenda-se o uso de estreptoquinase, devido à sua relação custoefetividadesuperior em relação a alteplase e tenecteplase. Para pacientes que já utilizaram estreptoquinase ou tem prognóstico muito ruim recomenda-se a utilização de alteplase com administração acelerada.(AU)

TECHNOLOGIES: Alteplase (accelerated and conventional administration), streptokinase and tenecteplase. INDICATION: Treatment of Acute Coronary Syndromes (ACS), which include acute myocardial infarction (AMI). CHARACTERIZATION OF TECHNOLOGIES: The thrombolytic agents are responsible for the transformation of plasminogen into plasmin, which has the ability to degrade fibrin, the major component of thrombus, leading cause of ACS. The evaluated thrombolytics are divided into fibrin-specific (alteplase; tenecteplase) and not fibrin-specific (streptokinase). QUESTION: Alteplase, streptokinase and tenecteplase are efficient, effective and safe treatment in hospital and pre-hospital patients diagnosed with AMI or other SCA? SEARCH AND ANALYSIS OF SCIENTIFIC EVIDENCE: We searched the databases The Cochrane Library (via Bireme), Medline (via Pubmed) and Lilacs. We sought to systematic reviews (SR) of clinical trials that compared the drugs with each other or with other therapeutic options in treating AMI and ACS. We also searched for health technology assessments (HTA) and therapeutic guides on websites of international agencies and the Brazilian Network for Technology Assessment in Health. We selected studies published in English, Portuguese or Spanish. SUMMARY OF THE RESULTS OF THE SELECTED STUDIES: Three systematic reviews were included in meta-analysis, two health technology assessments and two therapeutic guidelines about thrombolysis in SCA. The thrombolytics are only indicated and effective for AMI with ST segment elevation (STEMI), and its use does not present benefits in other SCA as AMI without ST segment elevation and unstable angina. In STEMI thrombolytic therapy is considered as a second line treatment, angioplasty is the first. Regarding the main outcomes, prehospital use of thrombolytics showed no significant differences in relation to in-hospital use, however these findings were obtained in a context of developed countries, with an effective emergency transport system. Among the evaluated technologies we cannot affirm the superiority of any over the other with a high level of evidence. The prognosis of the patient, medical history and contraindications of drugs are important factors in the choice of therapy. Costeffectiveness studies indicated that streptokinase is the most cost-effective medicine, given the fact that has lower price and similar effectiveness. RECOMMENDATION: For patients with no indication for angioplasty and who have no contraindications to the use of thrombolytic therapy is recommended the use of streptokinase due to its higher relative cost-effectiveness compared to alteplase and tenecteplase. For patients who have used streptokinase before or have poor prognostic is recommended the use of alteplase with accelerated administration.(AU)

TECNOLOGÍAS: alteplasa (acelerado y administración convencional), la estreptoquinasa y tenecteplasa. INDICACIÓN: El tratamiento de los síndromes coronarios agudos (SCA), que incluyen infarto agudo de miocardio (IAM). CARACTERIZACIÓN DE LAS TECNOLOGÍAS: Los agentes trombolíticos son responsables de la transformación del plasminógeno en plasmina, que tiene la capacidad de degradar la fibrina, el principal componente de trombo, causa principal de ACS. Los trombolíticos evaluados se dividen en específico de fibrina (alteplasa; tenecteplasa) y no fibrina específico (estreptoquinasa). PREGUNTA: Alteplasa, estreptoquinasa y tenecteplasa son eficazes y seguros en el tratamiento prehospitalar de pacientes con diagnóstico de IAM o de otro SCA? BÚSQUEDA Y ANÁLISIS DE LA EVIDENCIA CIENTÍFICA: Se realizaron búsquedas en las bases de la Cochrane Library (a través de BIREME), MEDLINE (vía PubMed) y lilas. Buscaron reseñas (SR) ensayos clínicos sistemáticos que compararon los fármacos entre sí o con otras opciones terapéuticas en el tratamiento del IAM y ACS. También se interesaron por evaluaciones de tecnologías sanitarias (HTA) y las guías terapéuticas en los sitios web de los organismos internacionales y la Red Brasileña de Evaluación de Tecnologías en Salud. Se seleccionaron los estudios publicados en Inglés, portugués o español. RESUMEN DE LOS RESULTADOS DE LOS ESTUDIOS SELECCIONADOS: Tres revisiones sistemáticas se incluyeron en el metanálisis, dos evaluaciones de tecnologías sanitarias y dos pautas terapéuticas que tratan acerca de la trombolisis en SCA. Los trombolíticos sólo están indicados y son eficaces para el IAM con elevación del segmento ST, y su uso no beneficios presentes en otra SCA como IAM sin elevación del segmento ST y angina inestable. En STEMI terapia trombolítica es considerado como un tratamiento de segunda línea, la angioplastia en desuso. En cuanto a los principales resultados, el uso pre hospitalario de trombolíticos no mostraron diferencias significativas en relación con el uso en el hospital, sin embargo, estos resultados se obtuvieron en un contexto de los países desarrollados, las personas con un sistema de transmisión en salud eficaz. Entre las tecnologías evaluadas no puede afirmar la superioridad de cualquiera sobre la otra con un alto nivel de evidencia, y el pronóstico del paciente, historia clínica y las contraindicaciones de los fármacos son factores importantes en la elección del tratamiento. Los estudios de costoefectividad indicaron que la estreptoquinasa es la medicina más rentable de los tres, dado el hecho de que tiene un menor precio y una efectividad similar. RECOMENDACIÓN: Para pacientes sin indicación de angioplastia y que no tienen contraindicaciones para el uso de trombolíticos recomienda el uso de estreptoquinasa debido a su mayor rentabilidad relativa en comparación con alteplasa y tenecteplasa. Para los pacientes que han utilizado la estreptoquinasa o tienen mal pronóstico recomienda el uso de alteplasa con la administración acelerada.(AU)

Ulinastatin attenuates oxidation, inflammation and neural apoptosis in the cerebral cortex of adult rats with ventricular fibrillation after cardiopulmonary resuscitation

OBJECTIVE: The role of Ulinastatin in neuronal injury after cardiopulmonary resuscitation has not been elucidated. We aim to evaluate the effects of Ulinastatin on inflammation, oxidation, and neuronal injury in the cerebral cortex after cardiopulmonary resuscitation. METHODS: Ventricular fibrillation was induced in 76 adult male Wistar rats for 6 min, after which cardiopulmonary resuscitation was initiated. After spontaneous circulation returned, the rats were split into two groups: the Ulinastatin 100,000 unit/kg group or the PBS-treated control group. Blood and cerebral cortex samples were obtained and compared at 2, 4, and 8 h after return of spontaneous circulation. The protein levels of tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) were assayed using an enzyme-linked immunosorbent assay, and mRNA levels were quantified via real-time polymerase chain reaction. Myeloperoxidase and Malondialdehyde were measured by spectrophotometry. The translocation of nuclear factor-κB p65 was assayed by Western blot. The viable and apoptotic neurons were detected by Nissl and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL). RESULTS: Ulinastatin treatment decreased plasma levels of TNF-α and IL-6, expression of mRNA, and Myeloperoxidase and Malondialdehyde in the cerebral cortex. In addition, Ulinastatin attenuated the translocation of nuclear factor-κB p65 at 2, 4, and 8 hours after the return of spontaneous circulation. Ulinastatin increased the number of living neurons and decreased TUNEL-positive neuron numbers in the cortex at 72 h after the return of spontaneous circulation. CONCLUSIONS: Ulinastatin preserved neuronal survival and inhibited neuron apoptosis after the return of spontaneous circulation in Wistar rats via attenuation of the oxidative stress response and translocation of nuclear factor-κB p65 in the cortex. In addition, Ulinastatin decreased the production of TNF-α, ...

Marcador tumoral antígeno carbohidrato 125 e insuficiencia cardiaca / No disponible

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The Anti-Inflammatory Effects of Ulinastatin in Trauma Patients with Hemorrhagic Shock

We investigated the use of ulinastatin in association with the suppression of polymorphonuclear leukocyte elastase (PMNE), tumor necrosis factor alpha (TNF-alpha) and interleukin 6 (IL-6), and its effects on the prognosis of patients with traumatic hemorrhagic shock. Nineteen patients who visited the emergency department for traumatic hemorrhagic shock were enrolled. Eleven patients were randomly selected to receive a total of 300,000 IU of ulinastatin. Measurements of serum PMNE, TNF-alpha and IL-6 were taken before ulinastatin treatment at 24 hr, two days, three days, and seven days after admission. We compared the Systemic Inflammatory Response Syndrome scores, Multiple Organ Dysfunction Syndrome scores and Acute Physiology, age, Chronic Health Evaluation III scores of the control and ulinastatin groups. There were no significant differences in baseline values, laboratory data, treatment or mortality between the two groups. The serum PMNE levels in the ulinastatin group were lower than in the control group on the second hospitalized day. Serum TNF-alpha and IL-6 levels in the ulinastatin group decreased 24 hr after admission but had no significance. It is suggested that ulinastatin treatment could decrease the serum PMNE levels in trauma patients with hemorrhagic shock at 48 hr after treatment.

Optimización de la función intestinal en pacientes con fibrosis quística mediante la administración de probióticos / Improvement of intestinal function in cystic fibrosis patients using probiotics

Introducción: La fibrosis quística puede cursar con inflamación de la mucosa intestinal y síndrome de hipercrecimiento bacteriano (SHB). Se ha argumentado que los probióticos actúan como inmunomoduladores, antiinflamatorios y reguladores de la microbiota. El objetivo del presente estudio es conocer la prevalencia de SHB en pacientes con fibrosis quística y tratar de optimizar la función intestinal mediante la administración de probióticos. Pacientes y método: Fueron valorados 20 pacientes afectados de fibrosis quística, con una edad media de 10,33 años (rango, 5-17 años). El estudio del SHB se efectuó en 10 pacientes mediante el test de hidrógeno espirado tras una sobrecarga de dextrosa al 20 %, a dosis de 2 g/kg. Tras la prueba se administró Lactobacillus rhamnosus LGG a dosis de1011 ufc dos veces al día durante 4 semanas. La determinación de grasa, nitrógeno, agua y azúcares en las heces se efectuó antes y después del tratamiento mediante análisis de reflexión de infrarrojos (FENIR). Resultados: Cinco pacientes (50%) presentaron SHB. En los valores de H2 se detectó una correlación positiva con respecto a las cifras de esteatorrea (R = 0,57) y de azúcares (R = 0,52). Los valores del FENIR pretratamiento frente a postratamiento, expresados en gramos, fueron: grasa 6,2 +/- 3,3 frente a 4,9 +/- 2,1 (p < 0,5), azúcares 6,7 +/- 3,6 frente a 5 +/- 2,6(p < 0,05) y nitrógeno 0,87 +/- 0,27 frente a 0,91 +/- 0,14 (NS). En 13 pacientes (81,25 %) se evidenció una mejoría de la comodidad intestinal y del aspecto de las deposiciones, yen 9 pacientes (56,25 %) disminuyó el número de deposiciones. Conclusiones: El tratamiento con probióticos mejora la función intestinal en los pacientes afectados de fibrosis quística desde el punto de vista clínico y bioquímico. Su administración podría ser pautada de una manera regular sobre todo en casos de SHB (AU)

Introduction: In some cases, cystic fibrosis may include intestinal inflammation and bacterial overgrowth. Probiotics are considered as immunomodulatory, anti-inflammatory and microbiotic regulator substances. The aim of our study is to determine the prevalence of bacterial overgrowth in cystic fibrosis patients and try to improve the intestinal function with the administration of probiotics. Patients and method: We examined 20 patients with cystic fibrosis (mean age10.33, range 5 to 17 years). The expired hydrogen test with a 2 g/kg of 20 % dextrose overload was performed on 10 patients. After the test, Lactobacillus rhamnosus LGG1011 CFU was administered twice daily for four weeks. Faecal near infrared spectroscopy (FENIR) of water, fat, nitrogen and sugar content in faeces was performed before and after probiotics administration. Results: Five patients (50 %) showed bacterial overgrowth. Weobtained a positive correlation between the hydrogen test and steator rhea (R = 0.57) and sugar in faeces (R = 0.52).The FENIR results pre-treatment vs post-treatment were: fat 6.2 g +/- 3.3 g vs. 4.9 g +/- 2.1 g (p < 0.05), sugar6.7 g +/- 3.6 g vs. 5 g +/- 2.6 g (p < 0.05) and nitrogen 0.87 g +/- 0.27 g vs. 0.91 g +/- 0.14 g (NS) respectively. Thirteen patients (81.25 %) had improved stool appearance and intestinal comfort and nine (56.25 %) decreased the number of daily stools. Conclusions: Probiotics improved not only clinical but also biochemical intestinal function in cystic fibrosis patients. These could be given as a regular treatment in this type of patients and in those with bacterial overgrowth (AU)

Utilidad de los antagonistas de los receptores de la glucoproteína IIb/IIIa en pacientes ingresados por cardiopatía isquémica en la UCI de un hospital sin disponibilidad de cateterismo cardíaco / Use of glucoprotein IIb/IIIa in patients admitted in the intensive care unit of one hospital due to ischemic cardiopathy without disponibility of cardiac catterization

Fundamento. Se describe la utilización de antagonistas de la glucoproteína IIb/IIIa (AGIIb/IIIa) en una serie de casos, recogidos a partir de los pacientes con síndrome coronario agudo ingresados en la UCI de un hospital sin disponibilidad de cateterismo cardíaco, entre febrero de 1999 y diciembre de 2000.Método. Estudio descriptivo y retrospectivo sobre pacientes con síndrome coronario agudo tratados con AGIIb/IIIa. Se valoró la evolución inicial, a los 6 meses y los efectos secundarios.Resultados. Se estudió a 22 pacientes (20 varones) entre febrero de 1999 y diciembre de 2000. Once pacientes recibieron abciximab (cinco antes del cateterismo cardíaco por síndrome coronario agudo de alto riesgo y seis por isquemia refractaria) y 11 enfermos tirofibán (por isquemia refractaria). Inicialmente, 12 (70,6 por ciento) de los 17 pacientes con ángor refractario quedaron asintomáticos. Se realizó cateterismo cardíaco en otro hospital en todos los pacientes menos uno. En 18 enfermos se instauró tratamiento invasivo percutáneo, 2 pacientes requirieron cirugía cardíaca, un enfermo no presentó lesiones coronarias significativas y en otro enfermo éstas no fueron susceptibles de revascularización. A los 6 meses, 18 pacientes (81,8 por ciento) permanecían asintomáticos aunque cuatro (18,2 por ciento) habían precisado nueva revascularización percutánea. En ningún caso se constató muerte por cualquier causa o infarto de miocardio de nueva aparición.Respecto a efectos secundarios, un enfermo presentó hemorragia gastrointestinal y en otro paciente se evidenció trombocitopenia grave.Conclusión. Los AGIIb/IIIa son una opción terapéutica en los pacientes ingresados por angina inestable refractaria en hospitales sin disponibilidad de cateterismo cardíaco, ya que pueden estabilizar inicialmente el síndrome coronario agudo; no obstante, son fármacos que no están exentos de importantes efectos secundarios (AU)

Uso de los antagonistas de la glucoproteína IIb/IIIa en el síndrome coronario agudo sin elevación del segmento ST. Importancia del riesgo individual y de las preferencias del paciente / Use of glycoprotein IIB/IIIA antagonists in acute coronary syndrome without ST segment elevation. Importance of individual risk and patient preferences

Fundamento. Con frecuencia, las guías de práctica clínica se apoyan exclusivamente en la efectividad del tratamiento, e ignoran el papel de la predisposición individual a los efectos del tratamiento (tanto beneficiosos como perjudiciales) y las preferencias del paciente. Actualmente se dispone de herramientas sencillas que permiten cuantificar estos aspectos a la cabecera del paciente. El objetivo de este estudio es explorar las posibilidades de algunas de estas herramientas para decidir sobre el uso de los antagonistas de la glucoproteína IIb/IIIa (AGIIb/IIIa) en pacientes con síndrome coronario sin elevación del segmento ST tratados médicamente. Métodos. La efectividad de los AGIIb/IIIa (efecto sobre el riesgo de muerte o infarto a los 30 días) y su seguridad (efecto sobre el riesgo de hemorragias moderadas o graves) se obtuvieron de una revisión sistemática de la bibliografía. A partir de estos datos se calculó el cociente ayuda/año (likehood of being helped or harmed, LHH) en distintos escenarios hipotéticos con diferente grado de riesgo cardiovascular, riesgo hemorrágico y preferencias individuales. Resultados y conclusiones. La administración de AGIIb/IIIa mejora las expectativas del paciente cuando coexisten un alto riesgo de muerte/infarto, un bajo riesgo hemorrágico, y unas preferencias estándares. Cuando el riesgo hemorrágico es alto (mayor que en el paciente promedio incluido en los ensayos clínicos) o el paciente presenta una aversión anormal a la hemorragia, la adición de anti-IIb/IIIa puede hacer más daño que beneficio(AU)

Nuevos fibrinolíticos para el tratamiento del infarto agudo de miocardio / Novel fibrinolytics for treatment of acute myocardial infarction

El tratamiento fibrinolítico ha mejorado significativamente el pronóstico de los pacientes con infarto agudo de miocardio. Pero esta estrategia terapéutica tiene limitaciones importantes como son: la escasa utilización, no conseguir óptima reperfusión en todos los pacientes y las complicaciones sobre todo hemorrágicas que en ocasiones pueden ser graves.Se están investigando fármacos que eviten o disminuyan estos problemas, que actúen más rápidamente, sean más fáciles de administrar, lo que facilitaría el uso prehospitalario, y que tengan más capacidad lítica y menores complicaciones hemorrágicas. (AU)

Estudio de la actividad biológica del coralán II: actividad antitumoral indirecta / Study of the biologic activity of coralan II: indirect antitumoral activity

La actividad antitumoral de los polisacáridos se manifiesta cuando se administran antes del trasplante de las células tumorales. El coralán manifiesta también esta características de inducir el rechazo del tumor ascitico de Ehrlich en animales que reciben este producto en dosis únicas o fraccionadas. Este efecto se manifiesta a partir de dosis bajas de este producto inferiores a 1 mg/mL

Estudio de la actividad biolígica del coralán I: actividad antitumoral directa / Study of the biologic activity of coralan I: direct antitumoral activity

El coralán es una glicoproteina obtenida de un coral blando del sublitoral cubano. Su actividad antitumoral es evaluada en tumores trasplantables de ratón (leucemia P-338. adenocarcinoma 155. carcinoma pulmonar de Lewis. carcinoma pulmonar RL-67 y sarcoma (180). Su actividad antitumoral es baja en comparación con la que exhiben los citostáticos en estos modelos experimentales y es más manifiesta en tumores de mediana sensibilidad a la quimioterapia

Estudio de la actividad biolígica del coralán I: actividad antitumoral directa / Study of the biologic activity of coralan I: direct antitumoral activity

El coralán es una glicoproteina obtenida de un coral blando del sublitoral cubano. Su actividad antitumoral es evaluada en tumores trasplantables de ratón (leucemia P-338. adenocarcinoma 155. carcinoma pulmonar de Lewis. carcinoma pulmonar RL-67 y sarcoma (180). Su actividad antitumoral es baja en comparación con la que exhiben los citostáticos en estos modelos experimentales y es más manifiesta en tumores de mediana sensibilidad a la quimioterapia

Estudio de la actividad biológica del coralán II: actividad antitumoral indirecta / Study of the biologic activity of coralan II: indirect antitumoral activity

La actividad antitumoral de los polisacáridos se manifiesta cuando se administran antes del trasplante de las células tumorales. El coralán manifiesta también esta características de inducir el rechazo del tumor ascitico de Ehrlich en animales que reciben este producto en dosis únicas o fraccionadas. Este efecto se manifiesta a partir de dosis bajas de este producto inferiores a 1 mg/mL