Impact of colloids or crystalloids in renal function assessed by NGAL and KIM-1 after hysterectomy: randomized controlled trial

Abstract Background Hydroxyethyl starches are colloids used in fluid therapy that may reduce volume infusion compared with crystalloids, but they can affect renal function in critical care patients. This study aims to assess renal effects of starches using renal biomarkers in the perioperative setting. Methods This prospective, controlled, randomized study compared Hydroxyethyl starch 6% (HES) with Ringer's lactate (RL) in hysterectomy. Each episode of mean arterial pressure (MAP) below 60 mmHg guided the fluid replacement protocol. The RL group received 300 mL bolus of RL solution while the HES group received 150 mL of HES solution. All patients received RL (2 mL.kg−1.h−1) intraoperatively to replace insensible losses. Blood and urine samples were collected at three time points (preoperatively, 24 hours, and 40 days postoperatively) to assess urinary NGAL and KIM-1, as primary outcome, and other markers of renal function. Results Seventy patients were randomized and 60 completed the study. The RL group received a higher crystalloid volume (1,277 ± 812.7 mL vs. 630.4 ± 310.2 mL; p= 0.0002) with a higher fluid balance (780 ± 720 mL vs. 430 ± 440 mL; p= 0.03) and fluid overload (11.7% ± 10.4% vs. 7.0% ± 6.3%; p= 0.04) compared to the HES group. NGAL and KIM-1 did not differ between groups at each time point, however both biomarkers increased 24 hours postoperatively and returned to preoperative levels after 40 days in both groups. Conclusion HES did not increase renal biomarkers following open hysterectomy compared to RL. Moreover, HES provided better hemodynamic parameters using less volume, and reduced postoperative fluid balance and fluid overload.

Resuscitation fluids as drugs: targeting the endothelial glycocalyx / 中华医学杂志(英文版)

Fluid resuscitation is an essential intervention in critically ill patients, and its ultimate goal is to restore tissue perfusion. Critical illnesses are often accompanied by glycocalyx degradation caused by inflammatory reactions, hypoperfusion, shock, and so forth, leading to disturbed microcirculatory perfusion and organ dysfunction. Therefore, maintaining or even restoring the glycocalyx integrity may be of high priority in the therapeutic strategy. Like drugs, however, different resuscitation fluids may have beneficial or harmful effects on the integrity of the glycocalyx. The purpose of this article is to review the effects of different resuscitation fluids on the glycocalyx. Many animal studies have shown that normal saline might be associated with glycocalyx degradation, but clinical studies have not confirmed this finding. Hydroxyethyl starch (HES), rather than other synthetic colloids, may restore the glycocalyx. However, the use of HES also leads to serious adverse events such as acute kidney injury and bleeding tendencies. Some studies have suggested that albumin may restore the glycocalyx, whereas others have suggested that balanced crystalloids might aggravate glycocalyx degradation. Notably, most studies did not correct the effects of the infusion rate or fluid volume; therefore, the results of using balanced crystalloids remain unclear. Moreover, mainly animal studies have suggested that plasma may protect and restore glycocalyx integrity, and this still requires confirmation by high-quality clinical studies.

Actividad antioxidante y quelante de sistemas hidrocoloides mixtos formados por hidrolizados proteicos de Phaseolus vulgaris endurecido y goma modificada de flamboyán (Delonix regia) / Antioxidant and metal-chelating activities of mixed hydrocolloid systems formed by hard-to-cook Phaseolus vulgaris protein hydrolysates and flamboyant (Delonix regia) modified gum

Las proteínas y polisacáridos con frecuencia son utilizados simultáneamente en la industria de alimentos. Las interacciones entre ambos biopolímeros juegan un papel importante en la estructura y estabilidad de muchos alimentos procesados ya que pueden resultar en un sistema con propiedades bioactivas diferentes como ocurre en el caso de las funcionales. Objetivo. Evaluar los cambios en la capacidad antioxidante de un sistema hidrocoloide mixto formado por un hidrolizado enzimático proteico de frijol endurecido (P. vulgaris) y goma modificada de flamboyán (Delonix regia) (SHM). Materiales y métodos. El estudio se hizo entre febrero-octubre, 2014, en Mérida, México. Se modificó enzimáticamente el concentrado proteico de P. vulgaris con Pepsina-Pancreatina® y la goma extraída del flamboyán mediante carboximetilación, preparando dispersiones al 1% de cada uno de los biopolímeros, determinado la fluorescencia intrínseca de Trp (FIT) como indicador de la interacción entre ambos biopolímeros y la actividad antioxidante y quelante del sistema resultante. Resultados. Se obtuvo un hidrolizado proteico extensivo con 28,8% de grado de hidrólisis y una goma de flamboyán con grado de sustitución de 0,91. La mayor interacción entre ambos biopolímeros, se obtuvo empleando una relación 5:1 del SHM a pH 4 de acuerdo con el valor de FIT. Conclusiones. Los sistemas hidrocoloides mixtos preparados con hidrolizado extensivo de las proteínas Phaseolus vulgaris y goma modificada de flamboyán presentaron un incremento en la actividad antioxidante, respecto del hidrolizado dependiendo del mecanismo de oxidación, así como de las condiciones de pH en que se encuentra el sistema y la interacción entre ambos componentes(AU)

Proteins and polysaccharides are frequently used simultaneously in the food industry. The interactions between both biopolymers play an important role in the structure and stability of many processed foods since they can result in a system with different bioactive properties as in the case of functional ones. Objective. Evaluate the changes in the antioxidant capacity of mixed hydrocolloid system formed by a hard to cook bean (P. vulgaris) protein enzymatic hydrolyzate and modified flamboyant gum (Delonix regia) (SHM). Materials and methods. The study was conducted from February to October 2014 in Merida, Mexico. For this, the protein concentrate of P. vulgaris was treated with Pepsin-Pancreatin® and the gum extracted from the flamboyant were modified enzymatically by carboxymethylation, preparing 1% dispersions of each of the biopolymers, determining the intrinsic Trp fluorescence (FIT) as an indicator of the interaction between both biopolymers and the antioxidant and chelating activity of the resulting system. Results. The main results indicated that an extensive protein hydrolyzate with 28.8% degree of hydrolysis and a flamboyant gum with a substitution degree of 0.91 were obtained. The greatest interaction between both biopolymers was obtained using a 5:1 ratio of SHM to pH 4 according to the FIT value. Conclusions. The mixed hydrocolloid systems prepared with extensive hydrolyzate of the hard to cook P. vulgaris and modified flamboyant gum proteins showed an increase in antioxidant activity, compared to the hydrolyzate depending on the oxidation mechanism, as well as the pH conditions used and interaction between both component(AU)

Per-operative fluid therapy, vasopressor and transfusion rate in DIEP-flap breast reconstruction. A series of cases / Fluidoterapia, uso de vasopresores y tasa transfusional peroperatoria en la reconstrucción mamaria con colgajo DIEP. Una serie de casos

OBJECTIVE: Anesthetic management in DIEP-flap breast reconstruction surgery may influence the appearance of postoperative complications. Fluid therapy, vasopressor use, and blood management are controversial. The aim was to audit hemodynamic management and to assess its impact on perioperative outcomes. MATERIAL AND METHODS: Sixty-seven cases of DIEP-flap breast reconstruction were reviewed. Data collected: anthropometric data; ASA score; comorbidities; timing of reconstruction (immediate/delayed), type of reconstruction (unilateral/bilateral); length of surgery; per-operative complications; per-operative fluid therapy, use of vasopressors, transfusion rate; re-intervention requirements; surgical success rate; hospital stay, and readmission rate. RESULTS: Median crystalloid infusion rate was 3.18 (2.63-3.76) ml/kg/h in the first 24 hours. Intraoperatively, colloids were administered in 35 (52%) patients at a median infusion rate of 1.40 (1.08-1.86) ml/Kg/h; 21 (60%) of them presented some postoperative complication. Hypotensive events were registered in 13 (19%) patients; 9 (69%) suffered some postoperative complication. The only vasopressor used was Ephedrine in 14 (21%) patients, at a median dose of 0 (0-6) mg. Red blood cell (RBC) transfusion was required in 18 (27%) patients. All of the patients who were transfused, 11 (61%) presented some postoperative complication. Hospital stay was 7 (7-9) days. Surgery was successful in 46 (69%) patients and readmission was necessary in 11 (16%) patients. CONCLUSIONS: Colloids administration, intraoperative hypotensive events, RBC transfusion, and delayed surgery are variables that could increase the risk of postoperative complications in our series.

OBJETIVO: El manejo anestésico en la cirugía de reconstrucción mamaria con colgajo DIEP podría influir en la aparición de complicaciones posoperatorias. La fluidoterapia, el uso de vasopresores y la tasa transfusional son motivo de controversia. Nuestro objetivo fue auditar el manejo hemodinámico y valorar su impacto en los resultados perioperatorios. MATERIAL Y MÉTODOS: Analizamos 67 pacientes programadas para reconstrucción mamaria con colgajo DIEP. Datos registrados: antropométricos; ASA; comorbilidades; momento de la reconstrucción (inmediata/diferida); tipo de reconstrucción (unilateral/bilateral); duración quirúrgica; complicaciones perioperatorias; fluidoterapia, vasopresores y tasa transfusional peroperatorios; tasa de reintervención, reingresos y éxito de la cirugía; estancia hospitalaria. RESULTADOS: La velocidad promedio de infusión de cristaloides fue de 3,18 (2,63-3,76) ml/kg/h en las primeras 24 h. Intraoperatoriamente se administraron coloides en 35 (52%) pacientes a una velocidad promedio de infusión de 1,40 (1,08-1,86) ml/kg/h, presentando complicaciones posoperatorias en 21 (60%) casos. Trece (19%) pacientes presentaron eventos hipotensivos intraoperatorios, registrándose complicaciones en 9 (69%). El único vasopresor utilizado fue la efedrina en 14 (21%) pacientes, a una dosis mediana de 0 (0-6) mg. Requirieron transfusión sanguínea 18 (27%) pacientes. Del total de pacientes transfundidos, 11 (61%) habían presentado alguna complicación posoperatoria. La cirugía fue un éxito en 46 (69%) casos. La estancia hospitalaria fue de 7 (7-9) días y el reingreso fue necesario en 11 (16%) casos. CONCLUSIONES: La administración de coloides, los eventos hipotensivos intraoperatorios, la transfusión de hemoderivados y la cirugía con reconstrucción tardía son variables que podrían incrementar el riesgo de complicaciones posoperatorias.

Effects of colloid preload on the incidence of hypotension in spinal anesthesia for cesarean section: a systematic review and meta-analysis / 中华医学杂志(英文版)

BACKGROUND@#Hypotension is a common complication caused by spinal anesthesia (SA), which may have adverse impacts on the condition of the parturient and fetus. Liquid infusion was found to be relatively effective for reducing the incidence of hypotension. However, the question of whether colloid preload can optimize hemodynamic variables in the cesarean section remains controversial. This study aims to determine the effects of colloid preload on the incidence of hypotension induced by SA in elective cesarean section.@*METHODS@#Related keywords were searched on PubMed, EMBASE, and Cochrane Library from inception dates to May 2020. Studies included were evaluated for eligibility and quality. The primary outcome was the intra-operative incidence of hypotension and severe hypotension. The secondary outcomes included the lowest intra-operative systolic blood pressure, the maximal intra-operative heart rate, the intra-operative needs of ephedrine and phenylephrine, the incidence of maternal nausea and/or vomiting, and neonatal outcomes (umbilical artery pH and Apgar scores). Apart from the above, RevMan 5.3 was used for the data analysis.@*RESULTS@#Altogether nine randomized controlled trials were included in the meta-analysis. There were no significant differences in the incidence of intra-operative hypotension, severe hypotension, or neonatal outcomes between the colloid preload group and control group, except for the umbilical artery pH.@*CONCLUSION@#This meta-analysis suggests that colloid preload does not significantly reduce the incidence of hypotension associated with SA in elective cesarean section.

Rotational thromboelastometry assessment of ballanced crystalloid, hydroxyethyl starch and gelatin effects on coagulation: a randomized trial / Tromboelastometria rotacional na avaliação dos efeitos de cristaloides balanceados, hidroxietilamido e gelatina na coagulação: estudo randômico

Abstract Background and objectives Modern crystalloid and colloid solutions are balanced solutions which are increasingly used in perioperative period. However, studies investigating their negative effect on whole blood coagulation are missing, and vivid debate is going on about which solution has the minimal coagulopathy effect. The aim of our study was to assess the effect of modern fluid solutions on whole blood coagulation using rotational thromboelastometry. Methods Blood samples were obtained from 30 patients during knee arthroscopy before and after administration of 500 mL of crystalloid, Hydroxyethyl Starch and gelatin according to the randomization. Rotational thromboelastometry (Extem, Intem and Fibtem tests) was used to assess negative effect of fluid solutions on whole blood coagulation. Results In Extem test, the initiation phase of fibrin clot formation represented by CT parameter was not influenced by any fluid solution (p > 0.05). The speed of clot formation represented by CFT and α angle was impaired by Hydroxyethyl Starch and gelatin but not by crystalloids (p < 0.05). The strength of formatted coagulum represented by MCF parameter was impaired both in Extem and Fibtem test by HES and in Fibtem also by crystalloids (p < 0.05). Intem test was not negatively influenced by any crystalloid or colloid solution in any parameter (p > 0.05). Conclusion Extem test appears to be sensitive to coagulopathy effect of modern colloids and crystalloids. Hydroxyethyl starch has the most obvious negative effect on clot formation followed by gelatin and finally by crystalloids. Intem test seems to be insensitive to adverse effect of modern colloids and crystalloids.

Resumo Justificativa e objetivos Os cristaloides e coloides modernos são soluções balanceadas e cada vez mais utilizadas no período perioperatório. No entanto, não há estudos que avaliem seu efeito negativo na coagulação do sangue total e o intenso debate sobre a solução que cause um efeito mínimo na coagulopatia permanece. O objetivo de nosso estudo foi avaliar o efeito das soluções líquidas modernas na coagulação do sangue total com o uso da tromboelastometria rotacional. Métodos De acordo com a randomização, amostras de sangue foram colhidas de 30 pacientes durante a artroscopia de joelho, antes e após a administração de 500 mL de cristaloides, hidroxietilamido e gelatina. A tromboelastometria rotacional (testes Extem, Intem e Fibtem) foi utilizada para avaliar o efeito negativo das soluções líquidas na coagulação do sangue total. Resultados No teste Extem, a fase de iniciação da formação de coágulos de fibrina representada pelo parâmetro CT não foi influenciada por qualquer solução líquida (p > 0,05). A velocidade da formação de coágulos representada pelo CFT e pelo ângulo α foi prejudicada pelo hidroxietilamido e pela gelatina, mas não pelos cristaloides (p < 0,05). A força do coágulo formatado representado pelo parâmetro MCF foi prejudicada tanto no teste Extem quanto no teste Fibtem pelo HES e no teste Fibtem também pelos cristaloides (p < 0,05). O teste Intem não foi influenciado negativamente por nenhuma solução cristaloide ou coloide em nenhum parâmetro (p > 0,05). Conclusão O teste Extem parece ser sensível ao efeito de coagulopatia dos coloides e cristaloides modernos. O hidroxietilamido apresentou o efeito negativo mais óbvio na formação do coágulo, seguido pela gelatina e finalmente pelos cristaloides. O teste Intem parece ser insensível ao efeito adverso dos coloides e cristaloides modernos.

Multimodal Composite Iron Oxide Nanoparticles for Biomedical Applications

BACKGROUND: Iron oxide nanoparticles (IONPs) are excellent candidates for biomedical imaging because of unique characteristics like enhanced colloidal stability and excellent in vivo biocompatibility. Over the last decade, material scientists have developed IONPs with better imaging and enhanced optical absorbance properties by tuning their sizes, shape, phases, and surface characterizations. Since IONPs could be detected with magnetic resonance imaging, various attempts have been made to combine other imaging modalities, thereby creating a high-resolution imaging platform. Composite IONPs (CIONPs) comprising IONP cores with polymeric or inorganic coatings have recently been documented as a promising modality for therapeutic applications. METHODS: In this review, we provide an overview of the recent advances in CIONPs for multimodal imaging and focus on the therapeutic applications of CIONPs. RESULTS: CIONPs with phototherapeutics, IONP-based nanoparticles are used for theranostic application via imaging guided photothermal therapy. CONCLUSION: CIONP-based nanoparticles are known for theranostic application, longstanding effects of composite NPs in in vivo systems should also be studied. Once such issues are fixed, multifunctional CIONP-based applications can be extended for theranostics of diverse medical diseases in the future.

Anaphylactic reaction with hydroxyethyl starch during anesthesia: A case report

BACKGROUND: Hydroxyethyl starch (HES), a class of synthetic colloid solutions, has been widely used to treat perioperative hypovolemia. The use of HES, however, is associated with the risk of allergic reactions.CASE: An 83-year-old man was scheduled to undergo an open reduction and internal fixation of a pertrochanteric fracture under spinal anesthesia. He had no history of allergy. Five minutes after HES administration, hypotension, agitation, and skin rash were developed. HES infusion was terminated due to a suspected anaphylactic reaction. The vital signs recovered following administration of phenylephrine, dexamethasone, and hydrocortisone. Serum tryptase and total immunoglobulin E levels were elevated in plasma samples collected following the commencement of the allergic reaction during surgery.CONCLUSIONS: In the present report, the risk of anaphylactic reaction with HES and the laboratory tests needed to support the diagnosis are highlighted.

Theracurmin Ameliorates Cognitive Dysfunctions in 5XFAD Mice by Improving Synaptic Function and Mitigating Oxidative Stress

As the elderly population is increasing, Alzheimer's disease (AD) has become a global issue and many clinical trials have been conducted to evaluate treatments for AD. As these clinical trials have been conducted and have failed, the development of new theraphies for AD with fewer adverse effects remains a challenge. In this study, we examined the effects of Theracurmin on cognitive decline using 5XFAD mice, an AD mouse model. Theracurmin is more bioavailable form of curcumin, generated with submicron colloidal dispersion. Mice were treated with Theracurmin (100, 300 and 1,000 mg/kg) for 12 weeks and were subjected to the novel object recognition test and the Barnes maze test. Theracurmin-treated mice showed significant amelioration in recognition and spatial memories compared those of the vehicle-treated controls. In addition, the antioxidant activities of Theracurmin were investigated by measuring the superoxide dismutase (SOD) activity, malondialdehyde (MDA) and glutathione (GSH) levels. The increased MDA level and decreased SOD and GSH levels in the vehicle-treated 5XFAD mice were significantly reversed by the administration of Theracurmin. Moreover, we observed that Theracurmin administration elevated the expression levels of synaptic components, including synaptophysin and post synaptic density protein 95, and decreased the expression levels of ionized calcium-binding adapter molecule 1 (Iba-1), a marker of activated microglia. These results suggest that Theracurmin ameliorates cognitive function by increasing the expression of synaptic components and by preventing neuronal cell damage from oxidative stress or from the activation of microglia. Thus, Theracurmin would be useful for treating the cognitive dysfunctions observed in AD.

In vitro wear behavior between enamel cusp and three aesthetic restorative materials: Zirconia, porcelain, and composite resin

PURPOSE: The aim of this study was to identify the effects of three aesthetic restorative materials on the wear between tooth and restoration by a pin-on-disk manner. MATERIALS AND METHODS: Six aesthetic restorative materials were used to prepare disk specimens for wear test, which were Lava Zirconia as zirconia group, Vintage MP and Cerabien ZR as veneering porcelain group, Gradia Direct microhybrid composite containing prepolymerized fillers, Filtek Z250 microhybrid composite containing zirconia glass and colloidal silica particles, and Filtek Z350 nanocomposite as composite resin group. Vertical loss of the worn cusp, change of the surface roughness of the restoration materials, and the surface topography were investigated after wear test under 9.8-N contact load. RESULTS: The porcelain groups (Vintage MP and Cerabien ZR) caused the largest vertical loss of teeth when compared with those of the composite resin and zirconia groups, and Filtek Z250 microhybrid composite results in the second-largest vertical loss of teeth. The surface of Filtek Z350 nanocomposite was deeply worn out, but visible wear on the surface of the zirconia and Gradia Direct microhybrid composite was not observed. When the zirconia surface was roughened by sand-blasting, vertical loss of teeth considerably increased when compared with that in the case of fine polished zirconia. CONCLUSION: It was identified that microhybrid composite resin containing a prepolymerized filler and zirconia with reduced surface roughness by polishing were the most desirable restorative materials among the tested materials to prevent the two-body wear between aesthetic restorative material and tooth.

Patterns in the amount of discharge at split-thickness skin graft donor sites

BACKGROUND: Split-thickness skin grafts (STSGs) are commonly used in the reconstruction of skin defects induced by trauma or burns. Although STSGs are used to successfully treat various wound types, donor site wounds can be challenging, and complications often develop. Therefore, optimal donor site dressings are required. In this study, we introduce an evidence base for patterns in how the discharge amount decreases over time, with the goal of providing insights into the selection of dressing materials. METHODS: Twenty patients with burns who received STSGs harvested from the thigh between January 2016 to April 2017 were prospectively reviewed. A donor site dressing with foam was changed daily. The weight of the foam dressing was measured before and after placement on the donor site. The wound area was calculated using Visi-Trak. The mean weight of the discharge amount per unit area (g/10 cm2) was calculated. RESULTS: The mean weight of the discharge amount per unit area (g/10 cm2) decreased from 3.84 to 2.02 (P < 0.05) and 1.09 (P < 0.05) on postoperative days 5 and 10, respectively. It further decreased to 0.61 by postoperative day 14. CONCLUSIONS: To prevent infections induced by donor site leakage, the use of highly-absorptive foam materials until 5 days after the operation is beneficial. Moreover, hydrocolloid or highly-absorptive foam materials can be used to promote re-epithelialization of the donor site after 5 days postoperatively. For re-epithelialization and wound protection, it is effective to use hydrocolloid materials starting on postoperative day 10.

Colloid osmotic pressure during and after surgical interventions in adult and geriatric dogs / Pressão coloidosmótica durante e depois de intervenção cirúrgica em cães adultos e geriátricos

The objective this study is to evaluate colloid osmotic pressure (COP) fluctuations in adult and senile dogs during surgical interventions. Thirty-six healthy dogs to surgical interventions, distributed in two groups, A and B, according to their age, and were all subjected to the same anesthetic protocol. Values of albumin, total plasmatic protein and COP were evaluated from samples collected before pre-anesthetic medication, fifteen minutes after pre-anesthetic medication, and shortly after the end of the intervention. Results were tested using t-test to compare among groups and ANOVA for repeated measures followed by Tukey's test to compare different moments within the same group. Statistical significance was set at p<0.05. In both groups, significant decreases were observed in colloid osmotic pressure, as well as albumin and total proteins (p<0.001). Despite slightly lower COP values for the group of adult animals, this difference was not significant as there was a high individual variation within groups. The results therefore indicate no difference in colloid osmotic pressure values or fluctuation patterns among adult and senile dogs (p=0.124). The observed results indicate that colloid osmotic pressure decreases significantly during surgical procedures, due to hypotension caused by the anesthetic drugs and to hemodilution caused by the fluid administration but there is no difference between groups. However, in both adult and senile dogs, these variables recover gradually after the animals awaken, through increased urine production and recovery of vascular tonus, indicating the successful reestablishment of homeostasis.(AU)

O objetivo deste estudo é avaliar as flutuações da pressão coloidosmótica (PCO) em cães adultos e idosos durante a intervenção cirúrgica. Foram utilizados 36 cães hígidos submetidos à intervenção cirúrgica, distribuídos em dois grupos de acordo com a idade e submetidos ao mesmo protocolo anestésico. Os valores de albumina, proteína plasmática total e PCO foram avaliados de amostras coletadas antes da medicação pré-anestésica, 15 minutos após e ao final do procedimento cirúrgico. Os dados obtidos foram analisados através do teste-t para comparação entre os grupos e ANOVA para medidas repetidas seguido do teste de Tukey para comparar diferentes momentos dentro do mesmo grupo. Foram considerados estastisticamente diferentes com p<0.05. Em ambos os grupos foram observados decréscimo dos valores da pressão coloidosmótica, como os valores de albumina e proteína total (p<0.001). Apesar de ligeiramente inferior, os valores de PCO para o grupo adulto não apresentaram diferença significativa. Os resultados indicam que não houve diferença nos valores da pressão oncótica ou padrão de flutuação entre adultos e idosos (p=0,124). Os resultados observados indicam significativo decréscimo da pressão coloidosmótica durante os procedimentos cirúrgicos devido à hipotensão causada pelos fármacos anestésicos e pela hemodiluição causada pela administração de fluídos, mas não houve diferença entre os grupos. Entretanto, tanto em cães adultos como idosos, essas variações retornaram gradualmente após a recuperação dos animals, através do aumento da produção de urina e da recuperação do tônus vascular, indicando restabelecimento da homeostase.(AU)

A Case of Nodular Colloid Degeneration in a 40-year-old Woman / 대한피부과학회지

Colloid degeneration of the skin is a rare, distinct clinicopathological entity characterized by the deposition of colloid material in the dermis. Nodular colloid degeneration (NCD) is a clinical variant of colloid degeneration of the skin. Herein, we report the case of a 40-year-old woman who presented with a 3-year history of multiple asymptomatic yellowish-brown, indurated papules and plaques on her forehead. Histopathologic examination of the lesion revealed deposition of amorphous pale pink homogenous colloid material with irregular clefts, fissures, and scattered pyknotic nuclei in the upper dermis. The material was negative for Congo red staining, and periodic acid-Schiff and Masson's trichrome staining revealed positive reactivity. Scattered fragmented elastic fibers were present in the colloid material on Verhoeff—Van Gieson staining. The patient was diagnosed with NCD. We propose that NCD should be considered in the differential diagnosis of long-standing facial nodules and plaques.

Acid/base alterations during major abdominal surgery: 6% hydroxyethyl starch infusion versus 5% albumin / 대한마취과학회지

BACKGROUND: To compare the effects of intraoperative infusions of balanced electrolyte solution (BES)-based hydroxyethyl starch (HES) and saline-based albumin on metabolic acidosis and acid/base changes during major abdominal surgery conducted using Stewart’s approach. METHODS: Forty patients, aged 20-65 years, undergoing major abdominal surgery, were randomly assigned to the HES group (n = 20; received 500 ml of BES-based 6% HES 130/0.4) or the albumin group (n = 20; received 500 ml of normal saline-based 5% albumin). Acid-base parameters were measured and calculated using results obtained from arterial blood samples taken after anesthesia induction (T1), 2 hours after surgery commencement (T2), immediately after surgery (T3), and 1 hour after arriving at a postanesthetic care unit (T4). RESULTS: Arterial pH in the HES group was significantly higher than that in the albumin group at T3 (7.40 ± 0.04 vs. 7.38 ± 0.04, P = 0.043), and pH values exhibited significant intergroup difference over time (P = 0.002). Arterial pH was significantly lower at T3 and T4 in the HES group and at T2, T3, and T4 in the albumin group than at T1. Apparent strong ion difference (SIDa) was significantly lower at T2, T3, and T4 than at T1 in both groups. Total plasma weak nonvolatile acid (ATOT) was significantly lower in the HES group than in the albumin group at T2, T3 and T4 and exhibited a significant intergroup difference over time (P < 0.001). CONCLUSIONS: BES-based 6% HES infusion was associated with lower arterial pH values at the end of surgery than saline-based 5% albumin infusion, but neither colloid caused clinically significant metabolic acidosis (defined as an arterial pH < 7.35).

Study on the Usage of Acne Patches in Patients with Acne / 대한피부과학회지

BACKGROUND: Patients with acne are at risk of using various over-the-counter drugs (OTCs). In addition, several OTCs are introduced in pharmacies in Korea. However, only few drugs are supported by well-established data. Among the treatments, acne patches are easy to purchase and use. Thus, they are widely used by patients. OBJECTIVE: This study aimed to investigate the patient's perception and usage of acne patches. METHODS: A questionnaire survey was conducted on 80 patients with acne who visited the outpatient department of the National Medical Center for 2 months. RESULTS: A total of 42 (52.5%) patients answered that they had used acne patches, and 38 (47.5%) patients stated that they had never used patches. Moreover, 27 (64.29%) patients responded that they used the patches on inflammatory lesions. Moreover, several patients were using acne patches after pricking themselves. There was only one response to confirm the ingredient when purchasing acne patch. Moreover, 14 (33.33%) participants responded that they noted side effects after using acne patches. Overall, the satisfaction score for the use of acne patches was 5.05. CONCLUSION: Patients often use acne patches because they can be easily purchased and used. However, they do not know how to properly choose and use the product that fits their skin. Therefore, doctors must educate patients on how to properly select and use the products.

An enhanced immunochromatographic strip test using colloidal gold nanoparticle-labeled dual-type N proteins for detection of antibodies to PRRS virus

Porcine reproductive and respiratory syndrome (PRRS) is recognized as one of the most important infectious diseases causing serious economic loss in the swine industry worldwide. Due to its increasing genetic diversity, a rapid and accurate diagnosis is critical for PRRS control. The immunochromatographic strip test (ICST) is a rapid and convenient type of immunoassay. In this study, an on-site immunochromatographic assay-based diagnostic method was developed for detection of PRRS virus (PRRSV)-specific antibodies. The method utilized colloidal gold nanoparticle-labeled dual-type nucleocapsid proteins encoded by open reading frame 7. We evaluated 991 field samples from pig farms and 66 serum samples from experimentally PRRSV-inoculated pigs. Based on true PRRSV-specific antibody-positive or

Colloid Carcinoma of the Uterine Cervix and Its Immunohistochemical Analysis: A Case Report

Colloid carcinoma, which is a very rare tumor of the uterine cervix, is composed of an excessive amount of mucus and a relative paucity of tumoral glandular cells within them. Herein, we report a rare case of colloid carcinoma of the cervix with adenocarcinoma in situ (AIS), intestinal and usual types, and endocervical adenocarcinoma (usual type) components. We also discuss the morphological and immunohistochemical characteristics of this tumor. A 51-year-old woman was referred to our outpatient clinic with the symptom of genital bleeding lasting for 5 months. She had a cervix surrounded by an irregular tumor with a diameter of 5 cm. The colloid carcinoma cells were positive for MUC2, MUC5AC, and cytokeratin (CK) 7, focal positive for CDX2, and negative for MUC6 and CK20. Also, the intestinal type AIS showed a similar staining pattern. Colloid carcinoma cells producing mucin showed an intestinal phenotype and AIS. The intestinal type can be considered as a precursor lesion of colloid carcinoma.

Tuberculosis of the thyroid

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To present a case of thyroid tuberculosis and to discuss its clinical presentation, differential diagnoses and management.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 55-year-old farmer presented with an 8-month progressively enlarging anterior neck mass, and fine needle aspiration biopsy yielded grossly turbid straw-colored aspirate admixed with blood with microscopy showing scattered inflammatory cells and macrophages set against a colloid background. After total thyroidectomy, hispathology revealed parenchymal infiltration by multiple aggregates of plump spindled to epitheloid cells forming granulomas with interspersed multinucleated giant cells, central caseation necrosis and surrounding fibrosis with chronic inflammatory infiltrates. The nodal masses also showed prominent germinal centers with interspersed epitheloid cells and foamy macrophages. Final diagnosis was chronic granulomatous inflammation consistent with tuberculosis.<br /><strong>CONCLUSION:</strong> Tuberculosis (TB) of the thyroid is a rare occurrence that can present as inflammation, infection or tumor formation of the thyroid gland. Diagnosis depends on identification of the tubercle from tissues and aspirates by acid fast staining and TB culture. Treatment consists of multiple drug therapy for tuberculosis but thyroidectomy may be an option if the thyroid gland is severely diseased.</p>

effects of balanced versus saline based colloid and crystalloid solutions on acid-base and electrolyte balance in gastrointestinal surgery

Background and Objectives: Large-volume administration of 0.9% saline are known to causes hyperchloremic metabolic acidosis [HMA] due to its high chloride load. Balanced or physiological fluids with inorganic ions are not associated with the same disturbance. The purpose of this study was to see whether balanced crystalloid and colloid solutions cause less disturbances in postoperative acid base status than sodium chloride based solutions in patients undergoing elective open gastrointestinal surgery

Methodology: Study subjects were patients aged between 30-60 years, ASA grades I and II, undergoing elective open gastrointestinal surgery, were selected as per proposed sampling design and were allotted into two groups, by the help of simple randomization process. Patients in the Group B received Hartmann's solution and 6% hetastarch in balanced electrolyte and glucose solution and patients in the Group N received 0.9% sodium chloride solution and 6% hetastarch in 0.9% sodium chloride solution. Arterial blood samples were taken from both the groups of patients just prior to and 30 min after surgery. Baseline and final acid base status, heart rate, mean blood pressure, peripheral temperature, as well as urine output before, during and after surgery were recorded up to 48 hours. Prevalence of development of HMA was determined by appropriate statistical technique

Results: The mean chloride level of normal saline group postoperatively was 118.66 +/- 5.75 mmol/L [Normal range: 98-106 mmol/L] whereas in balanced saline group it was 103.27 +/- 2.29 mmol/L, arterial pH was 7.31 +/- 0.29 and 7.4 +/- 0.02 respectively. Hence the changes in chloride level as well as arterial pH were significant in normal saline group versus balanced fluid group

Conclusion: Normal saline based fluids cause significant alteration in arterial chloride and pH levels against the use of balanced fluids in gastrointestinal surgery

Tuberculosis of the thyroid

OBJECTIVE: To present a case of thyroid tuberculosis and to discuss its clinical presentation, differential diagnoses and management.METHODS:Design: Case ReportSetting: Tertiary Government HospitalPatient: OneRESULTS: A 55-year-old farmer presented with an 8-month progressively enlarging anterior neck mass, and fine needle aspiration biopsy yielded grossly turbid straw-colored aspirate admixed with blood with microscopy showing scattered inflammatory cells and macrophages set against a colloid background. After total thyroidectomy, hispathology revealed parenchymal infiltration by multiple aggregates of plump spindled to epitheloid cells forming granulomas with interspersed multinucleated giant cells, central caseation necrosis and surrounding fibrosis with chronic inflammatory infiltrates. The nodal masses also showed prominent germinal centers with interspersed epitheloid cells and foamy macrophages. Final diagnosis was chronic granulomatous inflammation consistent with tuberculosis.CONCLUSION: Tuberculosis (TB) of the thyroid is a rare occurrence that can present as inflammation, infection or tumor formation of the thyroid gland. Diagnosis depends on identification of the tubercle from tissues and aspirates by acid fast staining and TB culture. Treatment consists of multiple drug therapy for tuberculosis but thyroidectomy may be an option if the thyroid gland is severely diseased.