Myocardial Edema Attenuation and Sphingosine- 1-Phosphate.

Introduction: Myocardial edema contributed to cardiac dysfunction in different clinical circumstances. The precise pathophysiology of myocardial edema and therapeutic interventions that target it have remained largely unexplored. The lysophospholipid, Sphingosine-1-Phosphate (S1P) has been shown to decrease edema in the lung through modulation of pulmonary endothelial barrier function. We apply this agent to an isolated rat heart model of ischemia-reperfusion injury and examine its effects on subsequent myocardial edema formation. Methods: 18 isolated male Sprague-Dawley rat hearts were used in this experiment. 3 served as nonischemic controls, 7 served as ischemic controls and 8 served as the intervention group. A 20 minute ischemic period was applied to all groups except the non-ischemic controls. In the intervention group, the rat hearts were given a 30mL bolus of 10nM S1P prior to ischemia. After completion, heart were histologically analyzed to evaluate the extent of myocardial edema. Results: In the non-ischemic controls there was 13.65% (+/- 0.73%) extracellular area and 84.56% (+/- 0.89%) intracellular area. In the ischemic controls there was 24.50% (+/- 3.92%) extracellular area and 74.11% (+/- 3.90%) intracellular area. In the S1P treatment group, there was 21.55% (+/- 2.6%) extracellular area and 76.77% (+/- 2.70%) intracellular area. These differences did not reach statistical significance (p>0.05). Conclusion: In this experimental design we observed a non-significant trend in histologic myocardial edema in the S1P treatment group. We also observed a correlated trend in improved myocardial function in the S1P treatment group.

Selective therapeutic hypothermia: A review of invasive and noninvasive techniques / Hipotermia terapêutica seletiva: uma revisão de técnicas invasivas e não invasivas

OBJECTIVE: Therapeutic hypothermia is a promising treatment to prevent secondary neurologic injury. Clinical utility is limited by systemic complications of global hypothermia. Selective brain cooling remains a largely uninvestigated application. We review techniques of inducing selective brain cooling. METHOD: Literature review. RESULTS: Strategies of inducing selective brain cooling were divided between non-invasive and invasive techniques. Non-invasive techniques were surface cooling and cooling via the upper airway. Invasive cooling methods include transvascular and compartmental (epidural, subdural, subarachnoid and intraventricular) cooling methods to remove heat from the brain. CONCLUSION: Selective brain cooling may offer the best strategy for achieving hypothermic neuroprotection. Non-invasive strategies have proven disappointing in human trials. There is a paucity of human experiments using invasive methods of selective brain cooling. Further application of invasive cooling strategies is needed.

OBJETIVO: A hipotermia terapêutica é uma estratégia promissora para prevenção do dano neurológico secundário. Sua utilidade clínica é limitada por complicações sistêmicas da hipotermia global. Resfriamento cerebral seletivo (RCS), entretanto, permanece uma técnica pouco estudada. Revisamos aqui as diferentes técnicas de indução de RCS. MÉTODO: Revisão de literatura. RESULTADOS: As estratégias de indução de RCS foram divididas em invasivas e não-invasivas. Métodos de remoção de calor do cérebro não-invasivos incluem o resfriamento de superfície e o de vias aéreas superiores; as técnicas invasivas incluem resfriamento transvascular e compartimental (epidural, subdural, subaracnóideo e intraventricular). CONCLUSÃO: RCS pode oferecer a melhor estratégia para alcançar neuroproteção hipotérmica. Estratégias não-invasivas têm se mostrado ineficazes em estudos clínicos. Técnicas invasivas foram raramente estudadas em humanos e necessitam ser mais investigadas para tornarem-se úteis.

Screening mexicans for psychosocial and behavioral problems during pediatric consultation / Detección de problemas psicosociales y de comportamiento en población pediátrica originaria de México

Background. Psychosocial and behavioral problems should be detected early during the pediatric consultation to prevent more severe psychosocial impairment as children move into adolescence. The pediatric visit offers an excellent opportunity to assess possible problems using screening tools. The aim of this study is to assess whether an adaptation of a screening tool (Pediatric Symptom Checklist) using visual aids is valid and suitable for the early detection of psychosocial problems among a sample of Mexican children and adolescents. Methods. We included 411 of 468 (87.8%) Mexican mothers or female caretakers of children and adolescents aged 4-16 undergoing routine health assessments in two Preventive Child Health Clinical Services in El Paso, Texas, USA. Mothers or female caretakers completed the Pictorial Pediatric Symptom Checklist and a psychological comprehensive test known as the Child Behavior Checklist (CBCL). Sensitivity and specificity was established using the CBCL as criteria for the validity of the PPSC. Results. The PPSC screening tool performed well as demonstrated by its detection rates of psychosocial and behavioral problems among the sample of Mexican children. Sensitivity and specificity at the standard cut-off scores was 69.6% and 95.2% for children 4-5 years old and 61.8% and 91.8% for children 6-16 years old respectively. The results were slightly lower than those found using the PSC among other ethnic groups in the United States, with a sensitivity and specificity of 71.7% and 93.0%, respectively. Conclusions. The PPSC is a simple, effective tool that can detect on average more than 65% of the children and adolescents with possible psychosocial problems during pediatric consultations. This free screening tool detected psychosocial problems in pediatric populations of Mexican origin living on the border and may be also effective for Mexican children living in Mexico.

Antecedentes. Los problemas psicosociales y de comportamiento deben ser detectados durante la consulta pediátrica para prevenir problemas irreparables y severos cuando el niño pasa a la adolescencia. La visita pediátrica ofrece una excelente oportunidad para detectar posibles problemas utilizando "pruebas rápidas" de diagnóstico. El objetivo de este estudio es determinar la validez diagnóstica de una adaptación de una prueba rápida conocida como "Pediatric Symptom Checklist" utilizando apoyos visuales para la detección de problemas psicosociales en una muestra de niños y adolescentes mexicanos. Métodos. Se trabajó con una muestra de 411 (87.8%) madres mexicanas de niños y adolescentes de 4 a 16 años, asistiendo a servicios preventivos en dos clínicas en El Paso, Texas, Estados Unidos. Las madres completaron la adaptación de la prueba rápida "PPSC" y una prueba psicológica comprensiva conocida como el "Child Behavior Checklist". Se utilizó el método de sensibilidad y especificidad para establecer la validez diagnóstica del PPSC. Resultados. La prueba rápida del PPSC se comportó favorablemente como se muestra en los resultados de detección de problemas psicosociales y de comportamiento en la muestra de niños y adolescentes. Los puntos de corte convencionales para el PPSC dieron una sensibilidad de 69.6% y especificidad de 95.2% para los niños en edades 4 a 5 años y de 61.8% y 91.8% para las edades de 6 a 16 años, respectivamente. Los resultados cuando se comparan con los reportados en otros grupos étnicos en los Estados Unidos (sensibilidad 71.7% y especificidad 93.0%) son ligeramente menores. Conclusiones. La prueba rápida del PPSC es una herramienta sencilla y efectiva que detectó en promedio más de 65% de los niños y adolescentes con posibles problemas psicosociales durante la consulta pediátrica. Esta "prueba rápida" que es gratuita detectó problemas psicosociales en poblaciones pediátricas de origen mexicano viviendo en la frontera y puede ser efectiva para niños y adolescentes que viven en México.