Evaluación del rendimiento diagnóstico de un nomograma de predicción de preeclampsia / Evaluation of the diagnostic performance of a preeclampsia prediction nomogram

OBJETIVO: Determinar el rendimiento diagnóstico de un nomograma de predicción de preeclampsia en gestantes atendidas en el Hospital Nacional Dos de Mayo en Lima, Perú de enero de 2016 a julio de 2019. MÉTODO: Estudio de tipo pruebas diagnósticas. Se contó con una muestra de 513 pacientes; de ellas, 225 con diagnóstico de preeclampsia y 288 sin dicho diagnóstico. El análisis de los datos obtenidos se realizó en STATA v.14 y se determinaron la sensibilidad, la especificidad, el valor predictivo positivo y el valor predictivo negativo. RESULTADOS: Se analizó la curva ROC y se encontró un área bajo la curva de 0,91 (intervalo de confianza del 95%: 0,89-0,93), obteniendo 187 puntos como valor de corte de mejor rendimiento diagnóstico, con una sensibilidad del 81,33% y una especificidad del 85,76%. CONCLUSIONES: El nomograma de predicción de preeclampsia tiene un buen rendimiento diagnóstico para las gestantes atendidas en el servicio de ginecología y obstetricia del Hospital Nacional Dos de Mayo.

OBJECTIVE: Determine the diagnostic performance of a preeclampsia prediction nomogram in pregnant women attended at the Dos de Mayo National Hospital during the period from January 2016 to July 2019. METHOD: Study of diagnostic tests. There was a sample of 513 patients, 225 patients with a diagnosis of pre-eclampsia and 288 patients without such diagnosis were selected. The analysis of the data obtained was carried out in STATA v.14, obtaining the values of sensitivity, specificity, PPV and NPV. RESULTS: The ROC curve was analyzed obtaining an AUC of 0.91 (95% CI: 0.89 - 0.93), obtaining 187 points as the cut-off point for the best diagnostic performance, with a sensitivity of 81.33% and a specificity of 85.76%. CONCLUSIONS: The preeclampsia prediction nomogram has a good diagnostic performance for pregnant women attended at the Gynecology and Obstetrics service of the Dos de Mayo National Hospital.

Histomorphological analysis of placental changes of pre-eclampsia patients in a tertiary care hospital of Puducherry, India

Background: Placenta is a dynamic tissue synthesized physiologically to serve as a nutrient source for developing fetus it is exposed to several changes in reaction to many toxemic conditions associated with pregnancies. Studies had proved that placental changes observed on histomorphology is directly proportional to reaction to hemodynamic compensatory mechanisms, thereby aiding the obstetricians to manage the sequelae of complications. Objective of this study was to study the placental histomorphology in pregnancies associated with pre-eclampsia and to quantitate the observed placental changes.Methods: The study comprised on 101 placental specimens obtained from department of obstetrics and gynecology, Mahatma Gandhi Medical College and Research Institute, Pondicherry. Toxemia of pregnancies were divided into mild, severe preeclampsia and eclampsia based on blood pressure. The 101 cases were divided as 4 groups: Group 1 (control group); Group 2 (mild preeclampsia); Group 3 (severe preeclampsia); Group 4 (eclampsia).Results: Among the 101 cases, 38 placentas were from uncomplicated full-term deliveries which constitutes the control group. The rest 63 placenta were from toxemia of pregnancies which constitutes the study group.Conclusions: The incidence of toxemic pregnancies and pre-eclamptic cases are on higher margin than assumed. Histomorphology examination of placenta plays a vital role in assessing etiopathogenesis and mechanism of toxemic pregnancies. This aids the obstetrician to further manage subsequent sequelae and fix the complication to significant proportion.

Successful Medical Management of Pregnancy Toxemia in Goats

Pregnancy toxaemia is a metabolic disorder that occurs in does and ewes during the late stage of pregnancy. Pregnant does that have low energy levels and having multiple numbers of fetuses are more susceptible to toxaemia. The present study was carried out in twenty five goats in advanced stage of pregnancy with the history of anorexia, torticolis, grinding of teeth, salivation and rigors. On clinical examination of animals, they were dull, depressed with tachycardia, tachypenia, opisthotonus and pale conjunctival mucous membrane. The biochemical parameters revealed hypoglycemia and hypocalcemia. Urine samples were collected and urine analysis revealed positive for ketone bodies. The goats were successfully treated with 25% dextrose i/v as a bolus, multiple electrolytes solution containing 5% dextrose i/v, glycerin orally and Vitamin B-complex injection intramuscularly and all the twenty five animals survived. Out of 25 animals medical termination of pregnancy was done in 21 cases and four animals delivered a live kid.

Ancho de distribución plaquetaria como predictor de preeclampsia severa / Platelet distribution width as a marker for the development of severe preeclampsia

Resumen Introducción: La fisiopatología de la preeclampsia no está dilucidada por completo, diferentes índices plaquetarios dentro de los que se incluye el ancho de distribución plaquetaria (ADP) podrían ser utilizado para predecir la severidad en esta condición. Objetivo: Analizar el comportamiento del ADP en el desarrollo de severidad en preeclampsia en mujeres atendidas en la unidad de medicina materno-fetal del Hospital Simón Bolívar de Bogotá, Colombia. Materiales y métodos: Estudio de corte trasversal analítico en 105 pacientes con trastorno hipertensivo asociado al embarazo, preeclampsia y preeclampsia severa. Se analizó el comportamiento del ADP en una población de mujeres hipertensas con preeclampsia mediante una curva de análisis ''Receiver Operating Characteristic'' (ROC) para estimar la sensibilidad, tasa de falsos positivos, razón de probabilidad positiva y negativa de la prueba como marcador de desarrollo de severidad Resultados: El ADP tuvo un ascenso significativo mayor en pacientes donde su progresión de enfermedad desarrollaron características de severidad. En la curva ROC el área bajo la curva para del ADP como predictor de severidad en la preeclampsia fué de 0.68 Conclusión: El ADP es un índice plaquetario que aumentó significativamente en las mujeres con preeclampsia con características de severidad. El ADP podría ser un marcador para la predicción de severidad de la preeclampsia.

Abstract Introduction: The pathophysiology of preeclampsia is not completely elucidated. Different platelet indices, including the platelet distribution width (PDW), could be used to predict the severity of this condition. Objective: To analyze the behavior of PDW in the severity development of preeclampsia in women treated in the maternal-fetal medicine unit of Hospital Simón Bolívar in Bogotá, Colombia. Materials and methods: This is an analytical cross-sectional study in 105 patients with hypertensive disorder associated with pregnancy, preeclampsia and severe preeclampsia. We analyzed the behavior of PDW in a population of hypertensive women with preeclampsia using a curve of analysis '' Receiver Operating Characteristic '' (ROC) to estimate the sensitivity, false positive rate, positive and negative likelihood ratio of the test as a marker of development of severity Results: PDW had a higher significant increase in patients where their disease progression developed severity characteristics. In the ROC curve, the area under the curve for PDW as a predictor of severity in preeclampsia was 0.68. Conclusion: PDW is a platelet index that increased significantly in women with preeclampsia with severity characteristics. PDW could be a marker for the prediction of severity of preeclampsia.

Biochemical, endocrine, and histopathological profile of liver and kidneys of sheep with pregnancy toxemia / Perfil bioquímico, endócrino e histopatológico do fígado e rins de ovelhas com toxemia na prenhez

The objective of the present study was to characterize the biochemical, hormonal, and mineral profile, and histopathology of the liver and kidneys, related to the severity of natural cases of pregnancy toxemia (PT) in sheep. A total of 45 sheep with PT were analyzed at the "Clínica de Bovinos", Campus Garanhuns-UFRPE. The animals were submitted to clinical examination, followed by the collection of blood and urine. A necropsy was performed on thirteen animals that died and a histopathological examination was performed on samples of liver and kidneys. Increased creatinine, urea, glucose, fructosamine, non-esterified fatty acids, β-hydroxybutyrate, cortisol, chlorine, amylase, aspartate aminotransferase, gamma-glutamyltransferase, and folic acid were found, whereas insulin, potassium, and total and ionizable calcium presented low values for the species. Total protein, albumin, globulin, sodium, magnesium, and vitamin B12 remained within the normal range. In the macroscopic analysis of the liver, it was possible to observe an increase in organ and border size, yellowish coloration and parenchyma that varied from firm to friable. Vacuolation of the hepatocytes and renal tubular cells was observed. Metabolic disorders in sheep associated with hepatic and renal lesions are more apparent in overweight animals. With the greater impairment in hepatic and renal function, the clinical prognosis of animals with a high body score should be considered reserved.(AU)

Objetivou-se caracterizar o perfil bioquímico, hormonal, mineral e a histopatologia hepática e renal, relacionando com a severidade de casos naturais de toxemia da prenhez (TP) em ovelhas. Analisou-se 45 ovelhas na Clínica de Bovinos, Campus Garanhuns-UFRPE, com TP. Foram submetidas ao exame clínico, seguido de coleta de sangue e urina. Treze animais que vieram a óbito foram necropsiados, nas amostras de fígado e rins realizou-se exame histopatológico. Revelou-se elevação de creatinina, ureia, glicose, frutosamina, ácidos graxos não esterificados, β-hidroxibutirato, cortisol, cloro, amilase, aspartato aminotransferase, gama glutamiltransferase e ácido fólico, enquanto insulina, potássio, cálcio total e ionizável apresentaram valores abaixo para os da espécie. A proteína total, albumina, globulina, sódio, magnésio e vitamina B12 mantiveram-se dentro da normalidade. Na análise macroscópica do fígado, pôde-se observar aumento de tamanho do órgão e dos bordos, coloração amarelada e parênquima que variava de firme a friável. Observou-se vacuolização dos hepatócitos e das células tubulares renais. Os transtornos metabólicos nas ovelhas associados às lesões hepáticas e renais são mais aparentes nos animais com sobrepeso. Com o maior comprometimento da função hepática e renal, o prognóstico clínico dos animais com escore corporal elevado há de ser considerado reservado.(AU)

Comparação dos parâmetros bioquímicos entre gestação única e gemelar de ovelhas da raça Dorper durante gestação, parto e pós-parto / Comparison of biochemical parameters between single and twin pregnancies of Dorper breed ewes during gestation, lambing and postpartum

Nas ovelhas, a demanda de nutrientes aumenta durante a gestação, especialmente nas últimas seis semanas, quando ocorre maior desenvolvimento do feto. Os objetivos deste trabalho foram estudar o perfil bioquímico de ovelhas durante a gestação e no periparto imediato, comparando-se gestação única com gemelar. Foram utilizadas 60 ovelhas, Dorper, divididas em dois grupos experimentais com base no diagnóstico de gestação ultrassonográfico: grupo 1: 30 ovelhas com feto único; grupo 2: 30 ovelhas com gestação gemelar. Em nove momentos de coleta, foram mensurados no soro sanguíneo: ureia, creatinina, proteína total (PT), albumina, globulina, aspartato aminotransferase (AST), gamaglutamiltransferase, fosfatase alcalina, colesterol e triglicérides. O peso vivo das ovelhas do G2 foi maior que do G1 em todos os momentos, inclusive quando estavam vazias. Houve diferença entre as ovelhas do G1 e do G2 nos valores de PT, albumina, AST e triglicérides. A partir de 120 dias de gestação, o perfil proteico se modificou, com menores níveis de ureia, PT, albumina e globulina, mostrando que a demanda metabólica se intensificou no último mês da gestação. Os níveis de colesterol e triglicérides diminuíram de 140 dias de gestação para o parto. Este trabalho mostrou que a gestação proporcionou mudanças significativas no metabolismo da ovelha, principalmente no terço final da gestação, quando há maior necessidade de acompanhamento para evitar a incidência de doenças metabólicas.(AU)

In sheep, nutrient demand increases during gestation, particularly in the last six weeks, when the fetuses develop. The objectives of this study were to evaluate the biochemical profile of ewes during pregnancy and in the immediate peripartum comparing single with twin pregnancies. Sixty ewes of Dorper breed were divided into two groups by pregnancy ultrasonographic diagnosis: 1 - 30 ewes with single fetus gestation; 2 - 30 ewes with twin pregnancy. In nine collection moments the following parameters were measured: urea, creatinine, total protein (TP), albumin, globulin, aspartate aminotransferase, gamma glutamyltransferase, alkaline phosphatase, cholesterol and triglycerides. The weight of G2 sheep was higher than G1 since they were empty. There were differences in G1 and G2 sheep metabolism in TP, Albumin, AST and Triglycerides. From 120 days of pregnancy, the protein profile changed, with lower levels of urea, TP, albumin and globulin, showing that the metabolic demand intensified in the last month of pregnancy. The levels of cholesterol and triglycerides decreased from 140 days of pregnancy to lambing day. This study showed that gestation provided significant changes in the ewe's metabolism, especially in the final third of gestation, when there is a greater need to follow the animals to avoid the incidence of metabolic diseases.(AU)

Comparação de métodos para avaliação de beta-hidroxibutirato em ovelhas / Comparison of methods for evaluation of beta-hydroxybutyrate in ewes

Atualmente o uso de sensores portáteis para mensuração de corpos cetônicos está padronizado e difundido na rotina clínica, contudo estudos em ovinos são escassos. Assim, a presente pesquisa objetivou avaliar a acurácia dos sensores portáteis de uso humano e de uso veterinário para a determinação de beta-hidroxibutirato (BHB) em ovelhas no final da gestação e no pós-parto recente. Foram utilizadas 37 amostras de sangue provenientes de nove ovelhas mestiças Corriedale. A determinação bioquímica de BHB no soro, considerada como o padrão-ouro, foi realizada utilizando-se metodologia enzimática colorimétrica. A média obtida na bioquímica sérica foi de 0,497mmol/L; no sensor de uso humano, a média foi igual a 0,537mmol/L, enquanto no sensor de uso veterinário foi de 0,751mmol/L. Foi verificada alta correlação entre o dosímetro de uso humano e o padrão-ouro (r=0,93, P<0,001). A média do aparelho de uso veterinário diferiu das demais (51%; P<0,05), superestimando os resultados em ovelhas. As medições obtidas no aparelho veterinário também apresentaram menor precisão e veracidade. Concluiu-se que o sensor portátil de uso humano é mais acurado e mais preciso no diagnóstico precoce de toxemia da gestação em ovelhas.

Currently the use of portable sensors for measuring ketone bodies is standardized and diffused in the clinical routine, however, studies in sheep are scarce. Therefore, the present study aimed to evaluate the accuracy of the human portable sensor and the veterinary portable sensor for the determination of beta-hydroxybutyrate (BHB) in sheep at the end of gestation and postpartum. We used 37 samples of blood from nine crossbred Corriedale sheep. Biochemical determination of serum BHB, considered gold standard, was performed using colorimetric enzymatic methodology. The mean serum biochemistry was 0.497mmol/L, in the human sensor the mean was 0.537mmol/L, while in the veterinary sensor it was 0.751mmol/L. A high correlation was verified between the dosimeter for human use and the gold standard (r= 0.93, P< 0.001). The mean of the veterinary apparatus differed from the others, being 51% (P< 0,05), higher than the standard, that is, it was less accurate and had lower veracity, overestimating the results in sheep. It was concluded that the portable sensor for human use is more accurate and accurate in the early diagnosis of toxemia of pregnancy in sheep.

Using the Reduced Uterine Perfusion Pressure model of preeclampsia to study the blood brain barrier permeability / Uso do modelo de Redução da Pressão de Perfusão Uterina de pré-eclâmpsia para estudar a permeabilidade da barreira hematoencefálica

AIMS: To use the Reduced Uterine Perfusion Pressure (RUPP) model for preeclampsia to describe and evaluate the blood brain barrier permeability in pregnant rats. METHODS: Forty-one pregnant Wistar rats were divided into different intervention groups between 13 to 15 days of gestation: PregnantControl (PC; n=12), Reduced Uterine Perfusion Pressure (RUPP; n=15), Invasive Blood Pressure-Control (IBP; n=7) and Reduced Uterine Perfusion Pressure and Invasive Blood Pressure (RUPP-IBP; n=7). The 14 rats of groups IBP and RUPP-IBP had their mean arterial pressure measured at day 21. All animals were then sacrificed, administered Evans Blue dye through the tail vein and perfused with paraformaldehyde 4%. Brains were removed and evaluated by a blinded pathologist. Results are presented as means and standard errors. Comparisons between the groups were performed using Student's t-test for continuous variables and Fisher's exact test for categorical variables. Statistical significance was set as a p value less than 0.05. RESULTS: Mean arterial pressure averaged 85.4±2.2 mmHg in the IPB group and 102.5±8.3 mmHg in the RUPP-IPB group (p=0.002). Among all the RUPP rats (RUPP and RUPP-IBP groups), 82% had a positive staining with Evans Blue dye for at least one of the brain hemispheres, while none of the pregnant control rats (PC and IBP groups) had brain staining (p<0.001). CONCLUSIONS: In this study, altered permeability of the blood brain barrier was successfully reproduced in pregnant rats exposed to the RUPP protocol. Therefore, we concluded that the RUPP model is a valid surrogate to study blood brain barrier abnormalities.

OBJETIVOS: Usar o modelo de Redução da Pressão de Perfusão Uterina / Reduced Uterine Perfusion Pressure (RUPP) de pré-eclâmpsia para descrever e avaliar a permeabilidade da barreira hematoencefálica. MÉTODOS: Quarenta e uma ratas Wistar prenhes foram estratificadas em diferentes grupos de intervenção entre 13 a 15 dias de gestação: grupo controle (PC; n=12), grupo modelo de redução da pressão de perfusão uterina (RUPP; n=15), grupo monitorização invasiva da pressão arterial (IBP; n=7) e grupo redução da pressão de perfusão uterina e monitorização invasiva da pressão arterial (RUPP-IBP; n=7). As 14 ratas dos grupos IBP e RUPP-IBP tiveram sua pressão arterial média aferida no dia 21. Logo após todos os animais foram sacrificados e foi administrado o corante Azul de Evans pela veia da cauda, seguido de formaldeído 4%. Os cérebros foram removidos e avaliados por um patologista cegado para os grupos. Os resultados são apresentados em médias e erros padrão. As comparações entre os grupos foram realizadas utilizando o teste t de Student para variáveis contínuas e o teste exato de Fisher para variáveis categóricas. A significância estatística foi definida como um valor de p inferior a 0,05. RESULTADOS: As médias e desvios padrões da pressão arterial média foram 85,4±2,2 mmHg no grupo IPB e 102,5±8,3 mmHg no grupo RUPP-IPB (p=0,002). Entre todas as ratas RUPP (grupos RUPP e RUPP-IBP), 82% tiveram marcação positiva pelo corante em pelo menos um dos hemisférios cerebrais, enquanto nenhuma das ratas controle (grupos PC e IBP) teve marcação cerebral positiva (p<0,001). CONCLUSÕES: Neste estudo, a permeabilidade alterada da barreira hematoencefálica foi reproduzida com sucesso em ratas prenhes expostas ao protocolo RUPP. Portanto, concluímos que o modelo RUPP é um substituto válido para estudar anormalidades da barreira hematoencefálica.

Characteristics and significance of interferon-induced protein with tetratricopetide repeats 1 expressed in radia-tion injury and infection stress / 局解手术学杂志

Objective To explore characteristics and significance of interferon-induced protein with tetratricopetide repeats 1 expressed in radiation injury and infection stress.Methods RNA was extracted from Raw264.7 cell,3T3 cell and 10T1 /2 cell after 5 hours stimulated with 5 μg/mL LPS.At the same time,to set up normal control group (untreated by LPS),and RNA of IFIT1 was detected by RT-PCR.Total-ly 20 C57 /BL6 mice were randomly divided into 4 groups,namely 0 h group,1 h group,4 h group and 12 h group.The mice were given 12 Gray60Co full-body exposure once,then liver IFIT1 was detected by western blot.Results Stimulated with LPS for 5 hours,IFIT1 was in-duced expression in Raw264.7 cell,3T3 cell and 10T1 /2 cell.The expression of normal control group was negative.The level of IFIT1 /Actin increased significantly 1 hour after radiation injury,and it reached the peak 12 hours after radiation injury (P <0.01).Conclusion LPS can stimulated a variety of cell lines expressed IFIT1,prompting that IFIT1 may participate in the occurrence and development of post-traumatic toxemia.IFIT1 of liver tissue increased significantly during the early stage in radiation mice.

Inclusão de cloreto de amônia na dieta pré-parto de ovelhas leiteiras e sua influência nos metabolismos do cálcio e energético / Inclusion of ammonium chloride in the pre-partum diet in dairy sheep and its influence on calcium and energetic metabolism

Esta pesquisa foi realizada com o objetivo de avaliar o efeito da inclusão de cloreto de amônia na dieta pré-parto de ovelhas leiteiras sobre o pH urinário, cálcio sérico e metabolismo energético dos animais. Foram utilizadas vinte fêmeas ovinas da raça Lacaune, separadas em dois grupos: o Grupo Controle (GC, n=10) que recebeu a dieta pré-parto sem adição de cloreto de amônia e o Grupo Tratado (GT, n=10) que recebeu a dieta pré-parto com a inclusão de 0,4% de cloreto de amônia do total de matéria seca (MS) consumida por animal/dia. As coletas de urina e sangue ocorreram aos 120 (M0), 127 (M1) e 135 (M2) dias de gestação. Foram avaliados o pH urinário e os níveis séricos de cálcio, cetonas, glicose e colesterol. Houve redução no pH urinário no GT nos dias 127 e 135 de gestação. Os valores de cetonas séricas foram inferiores no GT no dia 135 de gestação enquanto que os níveis de cálcio e colesterol foram superiores neste grupo no mesmo momento tempo avaliado. Não houve diferença nos valores de glicose entre os grupos. Desta forma, conclui-se que a inclusão de 0,4% de cloreto de amônia do total de matéria seca consumida por animal/dia na dieta pré-parto de ovelhas leiteiras foi eficiente na manutenção da calcemia neste período e que esta pode estar associada à não redução do status energético em ovelhas gestantes.

This research was done to evaluate the effect of inclusion of ammonium chloride in the pre-partum diet in dairy sheep over the urinary pH and in calcium and energetic metabolism of these animals. Twenty ewe of Lacaune breed were separated into two groups, the Control Group (CG, n = 10) that received pre-partum diet without ammonium chloride and Treated Group (TG, n = 10) that received the diet pre-partum with 0.4% of ammonium chloride in total dry matter (DM) consumed per animal/day. The samples of urine and blood were collected in 120 (M0), 127 (M1) and 135 (M2) days of gestation. The parameters assessed were the urine pH and serum levels of calcium, ketones, glucose and cholesterol. In the urinary pH assay occurred a reduction in the GT on 127 and 135 days of gestation. The values were lower in the serum ketones in GT on 135 of gestation on the day whereas calcium levels and cholesterol levels were higher in this group at the same experimental time. There was no difference in glucose values between groups. Thus, it is concluded that inclusion of 0.4% of ammonium chloride to the total dry matter intake per animal/day in the pre-partum diet of milk sheep was effective in maintaining calcium levels over this period. And yet, this maintenance of calcium levels may be associated with no reduction in energy status in pregnant ewes.

Prepartum administration of recombinant bovine somatotropin (rBST) on adaptation to subclinical ketosis of the ewes and performance of the lambs / Administração pré-parto de somatotropina bovina recombinante (rBST) na adaptação da cetose subclínica de ovelhas e no desempenho dos cordeiros

The aim of this study was to determine the effect of prepartum rbST injection on the metabolic profile of pregnant ewes induced to subclinical ketosis, as well as the metabolism until seven days of life and weight gain until seven weeks of life of the lambs. Twenty seven pregnant ewes of the pantaneiro genetic group were used, divided into two groups: rbST group (n = 14) and control group (n = 13). The rbST group received two applications of 1 mg/kg of rbST, at 97 and 111 days gestation, while the control group received placebo injections. There were significant differences between groups in levels of GGT in the ketosis post induction period and BHB concentrations in the postpartum period. Concentrations of glucose, urea, phosphorus, albumin, cholesterol, AST, NEFA and insulin were not different between dams from the two groups in different periods of the study (P>0.05). There was an effect of rbST on body weight observed already at fourteen days of life (P<0.0001), there was an increase in serum phosphorus levels at birth of lambs (P=0.0014), and albumin at seven days of life (P = 0.0014) of the lambs, with no difference between groups for the other metabolites. Therefore, the use of rbST was effective in increasing the weight of the lambs until the seventh week of life. In addition, rbST treatment had positive effects on the dam metabolism with reduction of liver overload, as indicated by decreased GGT after ketosis induction and decreased BHB at the postpartum period.

O objetivo deste estudo foi determinar o efeito da administração pré-parto de rbST sobre o perfil metabólico de ovelhas induzidas à cetose subclínica, assim como sobre o metabolismo até sete dias de vida e ganho de peso até sete semanas de vida dos cordeiros. Vinte e sete ovelhas prenhas do grupo genético pantaneiro foram divididas em dois grupos: grupo rbST (n = 14) e grupo controle (n = 13). O grupo rbST recebeu duas aplicações de 1mg/kg de rbST, aos 97 e 111 dias de gestação, ao passo que o grupo controle recebeu injeções de placebo. Houve diferenças significativas entre os grupos nos níveis de GGT no período de pós-indução de cetose e concentrações de BHB no período pós-parto. As concentrações de glicose, ureia, fósforo, albumina, colesterol, AST, NEFA e insulina não foram diferentes entre os grupos nos diferentes períodos do estudo (P>0,05). Houve um efeito de rbST no peso corporal dos cordeiros já observado nos 14 dias de vida (P<0,0001), verificou-se um aumento dos níveis séricos de fósforo ao nascimento de cordeiros (P=0,0014) e albumina de sete dias de vida (P=0,0014 ), e não houve diferença entre os grupos para os outros metabólitos. Portanto, a utilização de rbST foi eficaz em aumentar o peso dos cordeiros até a sétima semana de vida. Além disso, a aplicação de rbST teve efeitos positivos no metabolismo com a redução da sobrecarga do fígado, como indicado pela diminuição da GGT após a indução da cetose e diminuição de BHB no período pós-parto.

Different anticoagulant techniques in severe sepsis application of CRRT treatment in patients with thrombocytopenia / 重庆医学

Objective To analyze and compare of regional citrate anticoagulation (RCA),low molecular weight heparin and hep-arin-free in severe sepsis patients with thrombocytopenia CRRT treatment effect and complication of the situation.Methods Retro-spective analysis of 3 6 patients admitted to ICU CRRT therapy of severe sepsis in patients with thrombocytopenia was made.Nine patients were given RCA,1 4 patients were given low-molecular-weight heparin calcium and 1 3 patients were given no heparin anti-coagulation programme.And then observation of three groups of CRRT treatment of coagulation function in patients with platelet depletion,blood,bleeding conditions,filter effects,filter usage time,and 15-day,30-day mortality were made.Results In RCA group and heparin-free group,coagulation blood features was significantly superior to low-molecular liver pigment calcium group (P0.05)between RCA group and heparin-free group coagulation in blood features. Bleeding rate and platelet consumption in RCA group were significantly lower than that in heparin-free group and low molecular liv-er pigment group(P0.05).Conclusion Severe sepsis in patients with thrombocytopenia in CRRT applications of regional citrate anticoagu-lation could reduce the risk of hemorrhage,reduced platelet consumption and longer filter usage time.

Achados bioquímicos, eletrolíticos e hormonais de cabras acometidas com toxemia da prenhez / Biochemical, electrolytic and hormonal findings in goats affected with pregnancy toxemia

A abrangência dos estudos sobre a toxemia da prenhez (TP) tem sido constante e inovadora em alguns conceitos, porém o estudo dos casos clínicos naturais em cabras é inexistente no Brasil. Diante disso, realizou-se análise das alterações clínicas, do perfil bioquímico, eletrolítico e hormonal com o objetivo de compreender a fisiopatogenia da enfermidade. Foram avaliadas 22 cabras atendidas na Clínica de Bovinos, Campus Garanhuns/UFRPE, diagnosticadas com TP, no período de 2007 a 2012. Realizou-se exame clínico e coleta de sangue e urina, para análise do perfil bioquímico e hormonal. Acentuadas alterações clínicas foram observadas, como decúbito, apatia, dispneia, aumento da temperatura corpórea, mucosas congestas, vasos episclerais injetados, desidratação, anorexia, hipomotilidade ou atonia ruminal, edema nos membros. Os resultados laboratoriais revelaram valores elevados para ureia, creatinina, ácidos graxos não esterificados (AGNE), β-hidroxibutirato, amilase e cortisol, enquanto as variáveis: proteína total, albumina, cálcio total, cálcio ionizado, fósforo, a relação cálcio e fósforo, sódio e insulina encontraram-se diminuídos. Outros parâmetros bioquímicos e eletrolíticos, como frutosamina, globulina, cloro, potássio e magnésio mantiveram-se dentro da faixa de normalidade. Quanto a glicemia, foram constatados três condições nas cabras com TP, normoglicêmicas (50%), hiperglicêmicas (27,28%) e hipoglicêmicas (22,72%). Dos 17 (77,27%) animais que obtiveram alta 10 (58,82%) eram normoglicêmicos. Vieram a óbito 22,8 % (5/22), no qual 60% (3/5) delas estavam hiperglicêmicas. A média de nascimento por cabra foi superior a duas crias. Verificou-se existir associação fortemente positiva dos AGNE's com a albumina (r=0,60), fraca com o β-hidroxibutirato (r=0,10) e glicose (r=0,03). Porém, existiu relação fortemente negativa dos AGNE's com a insulina (r= -0,70), moderada com o cortisol (r= -0,52) e amilase (r= -0,30). Marcadas alterações clínicas e metabólicas ...

Studies on pregnancy toxemia (PT) have been constant and innovative with regard to some concepts. However, no studies have been carried out on natural clinical cases in Brazil. Thus, the aim of the present study was to perform an analysis of clinical, biochemical, electrolytic and hormonal findings in goats with PT to gain an understanding of the physiopathology of this metabolic disease. Twenty-two goats with a diagnosis of PT were analyzed at the Bovine Clinic of the Federal Rural University of Pernambuco (Garanhuns Campus, Brazil) between 2007 and 2012. Clinical exams were performed and both blood and urine were collected for the biochemical and hormonal analyses. Accentuated clinical changes were found, such as decubitus, apathy, dyspnea, increased body temperature, congested mucous membranes, dilated episcleral vessels, dehydration, anorexia, ruminal stasis and edema in the limbs. The laboratory findings revealed high concentrations of urea, creatinine, non-esterified fatty acids, β-hydroxybutyrate, amylase and cortisol as well as reductions in total proteins, albumin, total calcium, ionized calcium, phosphorus the calcium to phosphorus ratio, sodium and insulin. Fructosamine, globulin, chlorine, potassium and magnesium were within the range of normality. Regarding blood sugar, 50% of the goats were within the normal range, 27.28% were hyperglycemic and 22.72% were hypoglycemic; among the 17 animals (77.27%) discharged with life, ten (58.82%) had normal blood sugar levels. Five goats (22.8%) died, 60% (3/5) of which were hyperglycemic. The mean birth rate per goat was more than two offspring. Non-esterified fatty acids were strongly associated with albumin (r = 0.60) and weakly associated with both β-hydroxybutyrate (r=0.10) and glucose (r=0.03). Moreover, non-esterified fatty acids were negatively associated with insulin (r= -0.70; strong association), cortisol (r= -0.52; moderate association) and amylase (r= -0.30; moderate association)...

The study on the effect of endoscopic nasobiliary drainage (ENBD) and endoscopic retrograde biliary drainage (ERBD) on obstructive jaundice / 中国医师杂志

Objective To compare the effect of endoscopic nasobiliary drainage (ENBD) and endoscopic retrograde biliary drainage (ERBD) on intestinal mucosal barrier function of patients with obstructive jaundice in clinical practice.Methods Forty patients with significant jaundice due to obstructive disorders of biliary tract and 20 health volunteers as controls were recruited.At the baseline,serum diamine oxidase (DAO) was measured with ultraviolet spectrophotometer,while endotoxin and tumor necrosis factorα (TNF-α) were determined with endotoxin detector and enzyme-linked immunosorbent assay (ELISA)kits,respectively.Forty patients were then divided randomly into ENBD and ERBD groups (n =20 patients per group).Dynamic changes in serum DAO,endotoxin and TNF-α were observed postoperatively.Results In the patients with obstruction of biliary tract,higher serum bilirubin,γ-glutamyl transpeptidas (γ-GT),alkaline phosphatase (ALP),DAO,endotoxin,and TNF-α were found preoperatively relative to those in health control (P ＜ 0.05).After operation,ERBD and ENBD had comparable effect on improving serum bilirubin,γ-GT and ALP,while serum DAO,endotoxin and TNF-α in each group were dramatically decreased.In day 1 after operation,there was no significant difference in serum DAO,endotoxin and TNF-α between two groups.However,in day 3 and 7 after operation,serum DAO,endotoxin and TNF-α in ENBD group were significantly higher than those in ERBD group (P ＜ 0.05).Conclusions It was suggested that ERBD and ENBD have comparable effects on removing obstruction of biliary tract and draining bile.However,ERBD might have greater benefits than ENBD in improving intestinal mucosal barrier function,and thus would be more beneficial in preventing systemic inflammatory response.

Clinical evaluation of nervous ketosis induced by isopropanol in sheep / Manifestações clínicas da cetose nervosa induzida por isopropanol em ovinos

Twelve healthy Santa Ines sheep, non-pregnant and non-lactating underwent a protocol of experimental induction of nervous ketosis for studying the symptoms in ketosis and Pregnancy Toxaemia (PT) disease. Eight animals were subjected to infusion of 150 mL of isopropanol (IPA) at 35% in the jugular vein and four sheep were treated identically with isotonic saline solution (NaCl 0.9%) during 40 minutes. The animals treated with IPA showed increased heart rate (HR) after 40 minutes of infusion and decreased ruminal movement from the 10 minutes infusion with IPA and remaining low up to 10 minutes from the end of the infusion. Ruminal atony appeared in three animals, which showed slight meteorism gas. Infusion of IPA caused the appearance of nervous symptoms as depression, staggering, adduction of hind limbs, head pressing, teeth grind and blindness almost always accompanied by a decreased pupillary reflex and nystagmus. All the animals exhaled ketosis breath with strong odor within few minutes of the start of induction that helped the elimination of the IPA from the organism. The present results strongly suggest that part of the nervous symptoms observed in PT may be derived from the action of IPA. These present findings open new perspectives for a better understanding of the pathogenesis of PT in sheep...

Doze ovelhas hígidas, não prenhes e não lactentes foram submetidas a um protocolo de indução experimental de cetose nervosa para a avaliação de sintomatologia nos quadros de cetose e Toxemia da Prenhez. Neste protocolo, oito animais foram submetidos a infusão de 150 mL de solução de isopropanol a 35% na veia jugular, constituindo o grupo Tratado (GT), e quatro ovinos foram tratados identicamente com solução salina isotônica (NaCl 0,9%), constituindo o grupo Controle (GC) no decorrer de 40 minutos. Os animais do GT apresentaram aumento da frequência cardíaca (FC) aos 40 minutos de infusão e redução no movimento ruminal a partir dos 10 minutos de infusão com isopropanol, o qual permaneceu diminuído ate 10 minutos do termino da infusão. A atonia ruminal ocorreu em três animais, que manifestaram em seguida leve meteorismo gasoso. A infusão de isopropanol provocou o surgimento de sintomas nervosos como, depressão e sonolência, cambaleios, adução de membros posteriores, pressão da cabeça em obstáculo, ranger de dentes e cegueira quase sempre acompanhada de diminuição do reflexo pupilar e nistagmo. Todos os animais exalaram forte odor cetótico com poucos minutos do inicio da indução, fato que ajudou a eliminação do isopropanol do organismo. Os presentes resultados sugerem que parte dos sintomas nervosos verificados na Toxemia da Prenhez possa ser oriunda da ação do isopropanol. Estes resultados abrem novas perspectivas para o melhor entendimento da patogenia da Toxemia da Prenhez em ovinos...

Effects of hydrogen gas on myocardial injury in rats with endotoxemia / 中华麻醉学杂志

Objective To investigate the effects of hydrogen gas on the myocardial injury in rats with endotoxemia.Methods Forty-eight healthy male Sprague-Dawley rats,weighing 200-220 g,were randomly divided into 4 groups (n =12 each ):control group (group C ),hydrogen gas control group (group HC ),endotoxemia group (group E) and hydrogen gas + endotoxemia group (group LH).Endotoxemia was induced by intraperitoneal lipopolysaccharide (LPS) 20 mg/kg in groups E and LH,while the equal volume of normal saline was given in groups C and HC.After LPS administration,the rats were exposed to the air containing 2％ hydrogen gas for 6 h in groups HC and LH,and the rats were exposed to the air for 6 h in groups C and E.Blood samples were taken from the abdominal aorta after 6 h inhalation of hydrogen gas to determine the serum level of cTnI.The hearts were then removed to determine the content of TNF-α and IL-6 and expression of phosphorylated nuclear factor κB ( NF-κB) inhibitory protein (p-IκB-α) and p38 mitogen-activated protein kinase (p-p38MAPK) in the myocardial tissues.Results Compared with group C,no significant change was found in the levels of cTnI,TNF-α and IL-6 and expression of p-IκB-α and p-p38MAPK in group HC ( P ＞ 0.05),and the levels of cTnI,TNF-α and IL-6 were significantly increased and the expression of p-IκB-α and p-p38MAPK was up-regulated in groups E and LH ( P ＜ 0.05).Compared with group E,the levels of cTnI,TNF-α and IL-6 were significantly decreased and the expression of p-IκB-α and p-p38MAPK was down-regulated in group LH ( P ＜ 0.05).Conclusion Hydrogen gas can reduce the myocardial injury in rats with endotoxemia,and inhibition of the p38MAPK and NF-κB pro-inflammatory pathway and reduction of the inflammatory response of myocardial tissues are involved in the mechanism.

Studies on the mechanism of heat shock protein 70 that inhibits sepsis-induced myocardial cell apoptosis and-signaling transduction pathway / 中国医师杂志

Objective To investigate the mechanism of HSP70 that inhibits myocardial cell apoptosis in sepsis.Methods Myocardial cells in primary culture were randomly divided into control group,normal serum group,sepsis serum group,transported empty vector group and transported HSP70 group.The myocardial cells in transported HSP70 group have been transported by pcDNA3.1-HSP70 for 36 hours.The myocardial cells in every group have been cultured by respective serum for 2 hours and dyed by Hoechst 33258,and then calculate the rate of myocardial cells apoptosis.Using Western-blot to investigate the effect of overexpression of HSP70 on Caspase-3,8,9's activation and Bid's cracking.Results The rate of myocardial cells apoptosis after dealing in transported HSP70 group [ ( 12.48 ± 2.39 ) ％,( 23.96 ± 3.12 ) ％,( 25.40 ± 3.96) ％ ] is lower than in sepsis serum group [ ( 28.66 ± 2.24 ) ％,( 55.76 ± 5.69 ) ％,( 46.89±8.74)％,t =5.856,5.932,6.027,P ＜0.01,n =3] and lower than in transported empty vector group [(34.25±3.42)％,(50.71±6.38)％,(47.62+5.74)％,t =5.876,5.903,6.122,P ＜0.01,n =3],is higher than in control group,and in normal serum group(3.13％ ～ 6.75％ ,t =6.324,6.578,6.137,5.987,6.032,6.871,P ＜ 0.01,n =3 ).When Caspase-3,8,9 activating,the gray-scale of P11,P20 and P10 in transported HSP70 group( 12.5276 ± 2.1247,9.3481 ± 4.5423,16.1349 ± 6.0641 ) is lighter than that in sepsis serum group ( 27.1324 ± 2.1564,25.5643 ± 4.3018,36.5647 ± 6.7135,t =5.856,5.902,5.891,P ＜ 0.01,n =3 ) and lighter than in transported empty vector group (28.0314 ±2.0367,25.6413 ±4.1356,34.5648 ±5.9473,t =3.861,3.933,4.281,P ＜0.05,n =3),is deeper than in control group(8.0324 ± 1.5234,5.1246 ± 1.3274,2.0314 ±0.6423,t =3.286,3.867,4.031,P＜0.05,n =3) and in normal serum group(8.5649 ± 1.2136,6.0324 ± 1.0214,3.2146 ±0.1325,t =5.898,5.969,6.879,P ＜0.01,n =3).The gray-scale of tBid in transported HSP70 group( 12.0316 ±2.3641 ) is lighter than in sepsis serum group(27.0536 ± 5.3214),t =3.274 ( P ＜ 0.05,n =3 ) and lighter than in transported empty vector group(27.1034 ± 3.6741,t =3.301,P ＜ 0.05,n =3 ),is deeper than in control group ( 6.0347 ± 2.1304,t =5.924,P ＜ 0.01,n =3 ) and in normal serum group ( 7.3121± 1.3021,t =5.871,P ＜ 0.01,n =3 ).Conclusions HSP70 inhibit myocardial cells apoptosis in sepsis by intervened the death receptor pathway and mitochondrial pathway.

Preeclampsia severa: restricción del crecimiento intrauterino y desenlaces perinatales en gestaciones pretérmino / Severe pre-eclampsia: intrauterine growth restriction and perinatal outcome in preterm gestations

Describir la frecuencia de complicaciones perinatales en gestaciones pretérmino de madres con preeclampsia severa con y sin restricción del crecimiento intrauterino (RCIU). Materiales y métodos: estudio descriptivo en embarazo único, preeclampsia severa y parto entre 24 y 34 semanas, con y sin RCIU, entre enero 2007 y diciembre 2009. Se realizó monitoría fetal cada 48 horas, perfil biofísico fetal (PBF) dos veces por semana y Doppler fetoplacentario semanal. Resultados: se estudiaron 55 pacientes con edad promedio de 29.6 (DE 6.4) años, media de edad gestacional de 29.9 (DE 2.9) semanas, menor en el grupo con RCIU 28.8 (DE.3.1) vs 31.2 (DE 2.0). Hubo RCIU en 30 (54,5%) gestaciones, la mortalidad perinatal fue de 17 casos (31%), 15 en embarazos con RCIU. La mayoría ocurrió en gestaciones por debajo de 28.6 semanas. Conclusiones: la mortalidad perinatal en preeclampsia en edad gestacional temprana es alta en nuestro hospital, en especial en presencia de RCIU. Es probable que esta asociación actúe en forma sinérgica sobre las complicaciones por prematurez. Al mejorar la atención pre y neonatal esperamos superiores resultados perinatales...

To describe frequency of perinatal complications in preterm gestations associated to severe preeclampsia, with or without intrauterine growth restriction (IUGR). Materials and methods: this is a descriptive study of single pregnancies, severe preeclampsia and preterm birth between weeks 24 and 34, with and without IUGR, conducted between January 2007 and December 2009. Fetal monitoring was conducted every 48 hours, fetal biophysical profile testing (BPP) twice a week and fetal and placental Doppler every week. Results: 55 patients with mean age 29.6 (SD 6.4) years were assessed; mean gestational age was 29.9 (SD 2.9) weeks, lower in the group with IUGR [28.8 (SD.3.1) vs 31.2 (SD 2.0)]. IUGR was present in 30 (54.5%) pregnancies. Perinatal death occurred in 17 cases (31%) 15 with IUGR. Most perinatal deaths occurred in pregnancies of less than 28.6 weeks. Conclusions: perinatal mortality rate in preeclampsia in early gestational age is high in our hospital, especially associated with IUGR. This association may act in a synergic manner on complications caused by prematurity. We expect better perinatal results as we improve prenatal and neonatal care delivery...

Morbilidad y mortalidad en neonatos hijos de madres toxémicas / Morbidity and mortality related to infants of toxemic mothers

La preeclampsia-eclampsia se caracteriza por edema, hipertensión arterial y proteinuria presente entre la vigésima semana de la gestación hasta 14 días después del parto. La presente investigación se realizó con el objetivo de analizar la morbilidad y mortalidad en neonatos hijos de madres toxémicas, en el Hospital Abel Santamaría, en Pinar del Río. MÉTODOS. Se realizó un estudio observacional, ambispectivo, longitudinal, descriptivo, en el período entre el 1 de enero de 2006 y el 31 de diciembre de 2007. Se estudiaron 129 neonatos cuyas madres presentaron hipertensión durante el embarazo. Se analizaron las variables: tipo de hipertensión, vía del nacimiento, prematuridad, Apgar, peso, crecimiento intrauterino, morbilidad y mortalidad. RESULTADOS. Predominó la hipertensión arterial (HTA) inducida por el embarazo y el nacimiento por cesàrea (74,4 por ciento). La HTA crónica y con toxemia sobreañadida se relacionó con mayores porcentajes de prematuridad, crecimiento intrauterino retardado y Apgar bajo. La morbilidad predominante fue la hipoxia al nacer (22,5 por ciento), seguida por la enterocolitis necrosante (12,4 por ciento) y el síndrome de dificultad respiratoria (10,8 por ciento). La tasa de mortalidad fue de 1,3 por 1000 nacidos vivos y la de letalidad ascendió a 31 por cada 100 casos. CONCLUSIONES. La hipertensión arterial en el embarazo influye negativamente en una serie de paràmetros perinatales, entre los cuales destacan en nuestro medio el incremento de las cesáreas, el bajo peso al nacer, el crecimiento intrauterino retardado y la hipoxia al nacer, entre otras patologías.

Pre-eclampsia-eclampsia is characterized by edema, high blood pressure and proteinuria present between the twentieth weeks of pregnancy up to 14 postpartum. Aim of present research was to analyze morbidity and mortality in infants of toxemic mothers at Abel Santamiría Cuadrado Hospital, Pinar del Río province. METHODS: A observational, ambispective, longitudinal and descriptive study was made from January 1, 2006 to December 31, 2007. A total of 129 neonates were studied whose mothers had hypertension during pregnancy. Following variants were analyzed: type of hypertension, birth route, prematurity, Apgar score, intrauterine development, morbidity and mortality. RESULTS: There was predominance of pregnancy-induced high blood pressure (HBP) and by cesarean section birth (74,4 percent). The chronic HBP and with presence of an added toxemia was related to higher percentages of prematurity, late intrauterine development, and low Apgar score. Predominant morbidity was the birth hypoxia (22,5 percent) followed by necrotizing enterocolitis (12,4 percent), and respiratory difficulty syndrome (10,8 percent). Rate mortality was of 1,3 by 1000 newborns, and lethality increased to 31 by 100 cases. CONCLUSIONS: High blood pressure during pregnancy influences negatively on a series of perinatal parameters among which, in our daily practice, is significant the cesarean section increase, the low birth weight, late intrauterine development, and birth hypoxia among other.

Histological changes of the liver and metabolic correlates in ewes with pregnancy toxemia / Alterações histológicas do fígado e correlações metabólicas em ovelhas com toxemia da prenhez

The histological changes of the liver in ewes with pregnancy toxemia were characterized. Ten ewes were fed on grass ad libitum, and another ten were starved from day 130 of pregnancy for up to four days. Liver puncture biopsies were performed at days 70, 100, 130, and 140 of pregnancy, and at day 45 in postpartum. Seric hydroxybutyrate (HB), non-esterified fatty acids (NEFA), aspartate aminotransferase, and alkaline phosphatase were dosed. Histological preparations revealed similar incidence and intensity of mild liver steatosis in both groups at day 130. Starved ewes become toxemic (as indicated by HB), and at day 140 exhibited more severe injury in a higher proportion (9/9 vs. 4/10; P<0.01). Almost all of them (7/9) had large amounts of small lipid droplets in almost every hepatocyte over the whole liver acinus, and higher NEFA values. At day 45 in postpartum, both groups had mild steatotic changes as initially. A positive correlation between severity of liver damage seric and only aspartate aminotransferase was observed at day 140 in starved animals (P<0.05). This enzyme could be used to assess liver damage, but not alkaline phosphatase. All samples with degeneration corresponded to the microvesicular type. A short starvation period during late pregnancy in ewes produced reversible liver degeneration.

Caraterizaram-se histologicamente as alterações do fígado de ovelhas com toxemia da prenhez. Dez ovelhas foram mantidas em pasto ad libitum, e outras 10 submetidas a jejum a partir do 130º dia de gestação, por até quatro dias. Biopsias hepáticas foram realizadas aos 70, 100, 130 e 140 dias de gestação e, aos 45 dias pós-parto. Níveis séricos de hydroxibutirato, ácidos graxos não esterificados (NEFA), aspartato aminotransferase e fosfatase alcalina foram determinados. O estudo histológico revelou extensão semelhantes de degeneração nos dois grupos no 130º dia de gestação. No 140º dia de gestação, alta proporção de animais submetidos ao jejum, apresentou intensa degeneração no fígado (9/9 vs. 4/10; P<0,01) e, desses, quase todos 7/9 tinham grande quantidade de pequenas gotas de lipídios em quase todos os hepatócitos, nas diferentes regiões do ácino, além de níveis séricos mais elevados de NEFA. Quarenta e cinco dias pós-parto, os animais dos dois grupos apresentaram degeneração discreta, como no início. No 140º dia de gestação, verificou-se correlação positiva entre a severidade das lesões histológicas e a enzima aspartato aminotransferase, nos animais submetidos a jejum (P<0.05). Todas as amostras com degeneração corresponderam ao tipo microvesicular. Um curto período de jejum, na fase final da gestação da ovelha produz degeneração hepática reversível.