Tratamiento de heridas complejas mediante fibrina rica en plaquetas y leucocitos (L-PRF), experiencia inicial de un centro / Treatment of complex wounds using platelet rich fibrin and leukocytes (L-PRF), initial experience of a center

Resumen Introducción El uso de concentrados plaquetarios para el tratamiento de heridas complejas y regeneración tisular está siendo ampliamente utilizado a nivel mundial. Durante el último tiempo, la segunda generación de concentrados plaquetarios, particularmente el L-PRF, ha permitido tratar de manera efectiva a pacientes con esta patología. Debido a su bajo costo y versatilidad, ha sido posible aplicar esta técnica en variadas situaciones clínicas con buenos resultados. El objetivo de este trabajo es presentar nuestra experiencia utilizando L-PRF para la curación de heridas complejas (CHC) como una alternativa al uso de injertos de distinto grado de complejidad. Materiales y Método: Se realizó un análisis prospectivo de una serie de casos de pacientes que fueron sometidos a tratamiento quirúrgico de heridas complejas mediante el uso de L-PRF en el Hospital Santiago Oriente - Luis Tisné Brousse, entre los meses de enero de 2017 y diciembre de 2018. Mediante examen clínico y parámetros de inclusión, de éxito y de fracaso definidos previamente, se evaluó un total de 11 pacientes con heridas complejas a los cuales se les realizó un tratamiento local con injerto de L-PRF. Resultados: _La etiología de las heridas fue variada. 8 (72%) de los casos lograron una epitelización del 100% y 3 (28%) fracasaron. Se identificaron factores predisponentes para el fracaso de la técnica, y también fue posible establecer una relación de predicción de éxito en donde se relaciona una probabilidad alta de epitelización cuando la granulación de la herida ocurre durante los primeros 10 días sobre el injerto de L-PRF. Conclusión: El tratamiento de heridas complejas mediante L-PRF es una alternativa factible, de bajo costo y requerimientos (comparada con el uso de injertos, colgajos y sustitutos dérmicos), es segura en la resolución de heridas complejas, permitiendo disminuir la morbilidad, los costos asociados al tratamiento y estadía hospitalaria.

Introduction: The use of platelet concentrates for the treatment of complex wounds and tissue regenera-tion is being widely used worldwide. During the last time, the second generation of platelet concentrates, particularly L-PRF, has made it possible to effectively treat patients with this pathology. Due to its low cost and versatility, it has been possible to apply this technique in various clinical situations with good results. The objective of this work is to present our experience using L-PRF for the healing of complex wounds (HCC) as an alternative to the use of grafts of different degrees of complexity. Materials and Method: A prospective analysis was carried out with a series of cases who underwent surgical treatment of complex wounds using L-PRF at Santiago Oriente - Luis Tisné Brousse Hospital, between the months of January 2017 and December 2018. Through clinical examination and previously defined inclusion, success, and failure parameters, a total of 11 patients with complex wounds were evaluated who underwent local treatment with an L-PRF graft. Results: The etiology of the wounds was varied. 8 (72%) of the cases achieved 100% epithelialization and 3 (28%) failed. Predisposing factors for the failure of the technique were identified, and it was also possible to establish a predictive relationship of success where a high probability of epithelialization is related when the granulation of the wound occurs during the first 10 days on the L-PRF graft. Conclusion: The treatment of complex wounds using L-PRF is a feasible alternative, with low cost and requirements (compared to the use of grafts, flaps and dermal substitutes) and safe in the resolution of complex wounds, allowing to reduce morbidity, the costs associated with treatment and hospital stay.

MicroRNA-135a in ABCA1-labeled Exosome is a Serum Biomarker Candidate for Alzheimer's Disease / 生物医学与环境科学（英文）

Objective@#In the present study, the ABCA1 was used as a label to capture specific exosomes, the level of ABCA1-labeled exosomal microRNA-135a (miR-135a) was evaluated for the diagnosis of Alzheimer's disease (AD), especially in patients with early stages of AD.@*Methods@#This is a preliminary research focused on the levels of ABCA1 in WBCs, RBCs, HT-22 cells, and neuron cells. The diagnostic value of ABCA1-labeled exosomal miR-135a was examined using the CSF and serum of APP/PS1 double transgenic mice, and 152 patients with SCD, 131 patients with MCI, 198 patients with DAT, and 30 control subjects.@*Results@#The level of ABCA1 exosomes harvested from HT-22 cells and neuron culture medium was significantly higher compared to that of RBCs and WBCs ( @*Conclusion@#This study outlines a method to capture specific exosomes and detect them using immunological methods, which is more efficient for early diagnosis of AD.

A Case of Schnitzler's Syndrome without Monoclonal Gammopathy-Associated Chronic Urticaria Treated with Anakinra

Chronic urticaria may often be associated with interleukin (IL)-1-mediated autoinflammatory disease, which should be suspected if systemic inflammation signs are present. Here, we report a case of Schnitzler's syndrome without monoclonal gammopathy treated successfully with the IL-1 receptor antagonist anakinra. A 69-year-old man suffered from a pruritic urticarial rash for 12 years. It became aggravated episodically and was accompanied by high fever, arthralgia, leukocytosis, and an elevated C-reactive protein and erythrocyte sedimentation rate. The episodes each lasted for over one week. Neutrophilic and eosinophilic inflammation was found on skin biopsy. However, serum and urine electrophoresis showed no evidence of monoclonal gammopathy. The cutaneous lesions were unresponsive to various kinds of anti-histamines, systemic glucocorticoids, colchicine, cyclosporine, dapsone, and methotrexate, which were administered over a span of 3 years immediately preceding successful treatment. A dramatic response, however, was observed after a daily administration of anakinra. This observation suggests that the correct diagnosis of this case is Schnitzler's syndrome without monoclonal gammopathy. For an adult patient with refractory chronic urticaria and systemic inflammation, Schnitzler's syndrome could be considered as a possible differential diagnosis. Although the typical form of Schnitzler's syndrome exhibits the presence of monoclonal gammopathy as a diagnostic criterion, monoclonal gammopathy may be absent in an atypical form. In such a situation, an IL-1 antagonist should be effective for the management of chronic urticaria.

Comparison of biochemical and immunological profile of pediatric patients with acute myeloid leukemia in relation to healthy individuals / Comparação do perfil bioquímico e imunológico de pacientes pediátricos com leucemia mieloide aguda e de indivíduos saudáveis

ABSTRACT OBJECTIVE: To compare the biochemical and immunological profiles of pediatric patients with acute myeloid leukemia (AML) with healthy children and adolescents. METHODS: This was a cross-sectional study in which 21 therapy-naïve patients with AML were compared with a group of 24 healthy individuals. The following data were analyzed: serum proteins, leucocytes and subgroups, erythrocytes, hematocrit, hemoglobin, platelets, cytokines in peripheral blood mononuclear cells cultures under spontaneous and BCG- or PHA-stimulated conditions, immunoglobulin A, and erythrocytic glutathione. Statistical analysis was performed using SPSS software, considering as significant p-values < 0.05. RESULTS: Serum albumin levels were higher (p < 0.0001) in the control group, as well as all the parameters related to red blood cells (p < 0.0001). For leucocytes and subgroups, no statistical difference was found between the AML and the control groups. For cytokines, the concentrations were significantly higher under spontaneous and BCG-stimulated conditions for TNF-a, IL-6, IL-10, and IFN-? in the control group. Under PHA-stimulated conditions, the concentration was higher (p = 0.002) only for IL-6. No difference was found between the two groups for the other cytokines and for IgA in the saliva. Erythrocytic glutathione was higher (p < 0.0001) in AML patients. CONCLUSIONS: It was possible to characterize the biochemical and immunological profile of pediatric patients with AML, as well as highlight some significant differences in these parameters when comparing with healthy children and adolescents.

RESUMO OBJETIVO: Comparar o perfil bioquímico e imunológico de pacientes pediátricos portadores de leucemia mieloide aguda (LMA) em relação a um grupo de crianças e adolescentes saudáveis. MÉTODOS Estudo transversal, em que foram avaliados 21 pacientes com LMA virgens de terapia e 24 indivíduos saudáveis. Foram analisados: proteínas séricas, leucócitos e subgrupos, eritrócitos, hematócrito, hemoglobina e plaquetas, citocinas em cultura de células mononucleares do sangue periférico sob condição espontânea e estimulada por BCG ou PHA, imunoglobulina A e glutationa eritrocitária. Análise estatística foi feita com o software SPSS considerando p < 0,05. RESULTADOS: Albumina sérica foi superior (p < 0,0001) no grupo de controle, bem como todos os parâmetros relacionados com os glóbulos vermelhos (p < 0,0001). Para os leucócitos e subgrupos não houve diferença estatística entre os pacientes com LMA e o grupo controle. As concentrações foram significativamente mais elevadas sob condições espontânea e estimulada por BCG para as citocinas TNF-a, IL-6, IL-10 e IFN-? no grupo controle. Sob condição estimulada com PHA a concentração foi superior (p = 0,002) apenas para a IL-6. Não houve diferença estatística para as demais citocinas e para IgA salivar entre os dois grupos. Glutationa eritrocitária foi superior (p < 0,0001) nos pacientes LMA. CONCLUSÕES: Diante do exposto, foi possível caracterizar o perfil bioquímico e imunológico de pacientes pediátricos com LMA, bem como evidenciar diferenças significativas em alguns desses parâmetros ao se compararem os indivíduos doentes e o grupo de crianças e adolescentes saudáveis.

Effect on hemostasis of an absorbable hemostatic gelatin sponge after transrectal prostate needle biopsy

Objectives To examine the usefulness of an absorbable hemostatic gelatin sponge for hemostasis after transrectal prostate needle biopsy. Subjects and Methods The subjects comprised 278 participants who underwent transrectal prostate needle biopsy. They were randomly allocated to the gelatin sponge insertion group (group A: 148 participants) and to the non-insertion group (group B: 130 participants). In group A, the gelatin sponge was inserted into the rectum immediately after biopsy. A biopsy-induced hemorrhage was defined as a case in which a subject complained of bleeding from the rectum, and excretion of blood clots was confirmed. A blood test was performed before and after biopsy, and a questionnaire survey was given after the biopsy. Results Significantly fewer participants in group A required hemostasis after biopsy compared to group B (3 (2.0%) vs. 11 (8.5%), P=0.029). The results of the blood tests and the responses from the questionnaire did not differ significantly between the two groups. In multivariate analysis, only “insertion of a gelatin sponge into the rectum” emerged as a significant predictor of hemostasis. Conclusion Insertion of a gelatin sponge into the rectum after transrectal prostate needle biopsy significantly increases hemostasis without increasing patient symptoms, such as pain and a sense of discomfort. .

Tetraspanin CD9 modulates ADAM17-mediated shedding of LR11 in leukocytes

LR11, also known as SorLA or SORL1, is a type-I membrane protein from which a large extracellular part, soluble LR11 (sLR11), is released by proteolytic shedding on cleavage with a disintegrin and metalloproteinase 17 (ADAM17). A shedding mechanism is presumed to have a key role in the functions of LR11, but the evidence for this has not yet been demonstrated. Tetraspanin CD9 has been recently shown to regulate the ADAM17-mediated shedding of tumor necrosis factor-alpha and intercellular adhesion molecule-1 on the cell surface. Here, we investigated the role of CD9 on the shedding of LR11 in leukocytes. LR11 was not expressed in THP-1 monocytes, but it was expressed and released in phorbol 12-myristate 13-acetate (PMA)-induced THP-1 macrophages (PMA/THP-1). Confocal microscopy showed colocalization of LR11 and CD9 proteins on the cell surface of PMA/THP-1. Ectopic neo-expression of CD9 in CCRF-SB cells, which are LR11-positive and CD9-negative, reduced the amount of sLR11 released from the cells. In contrast, incubation of LR11-transfected THP-1 cells with neutralizing anti-CD9 monoclonal antibodies increased the amount of sLR11 released from the cells. Likewise, the PMA-stimulated release of sLR11 increased in THP-1 cells transfected with CD9-targeted shRNAs, which was negated by treatment with the metalloproteinase inhibitor GM6001. These results suggest that the tetraspanin CD9 modulates the ADAM17-mediated shedding of LR11 in various leukemia cell lines and that the association between LR11 and CD9 on the cell surface has an important role in the ADAM17-mediated shedding mechanism.

A Case of Isolated Lymphoblastic Relapse of the Central Nervous System in a Patient with Chronic Myelogenous Leukemia Treated with Imatinib

No abstract available.

A Novel Mutation (c.200T>C) in the NAGLU Gene of a Korean Patient with Mucopolysaccharidosis IIIB

Mucopolysaccharidosis (MPS) IIIB is a lysosomal storage disorder (LSD) caused by abnormalities of the enzyme alpha-N-acetylglucosaminidase (NAGLU) that is required for degradation of heparan sulfate. The patient in this study was a 4-yr-old boy. He presented with normal height and weight, pectus carinatum, and multiple persistent Mongolian spots on his back. He had mild dysmorphic features with prominent speech developmental delays and, to a lesser extent, motor developmental delays. The cetylpyridinium chloride precipitation test revealed excessive mucopolysacchariduria (657.2 mg glycosaminoglycan/g creatinine; reference range, C (p.L67P) and c.1444C>T (p.R482W). The c.200T>C mutation was a novel finding. This is the first report of a Korean patient with MPS IIIB who was confirmed by molecular genetic analyses and biochemical investigation.

Fas and FasL expression in leukocytes from Chronic Granulomatous Disease patients / Expresión de Fas y FasL en leucocitos de pacientes con Enfermedad Granulomatosa Crónica

Chronic Granulomatous Disease (CGD) is a primary immunodeficiency characterized by defects in superoxide (O2-) production, which result from mutations in one of the four NADPH oxidase components, predisposing to bacterial and fungal infections. Besides the O2-defect, it has been described that neutrophils from CGD patients are resistant to cell death, a phenomenon that has been connected to chronic inflammation and predisposition to autoimmune diseases. A diminished expression of Fas and its counterpart FasL, molecules known to play a major role in cell death, has been described in lymphocytes depleted of O2-reactive oxygen species (ROS), suggesting an involvement of ROS in Fas/FasL expression. In this work, Fas and FasL expressions were analyzed in T cells and neutrophils from two CGD families, previously known to harbor two different molecular defects: absence of either p47-phox or p67-phox. We found that T lymphocytes from CGD patients express low levels of Fas and FasL, while a diminished FasL expression was observed on neutrophils from a CGD A470 patient. These defects may contribute to understand altered cell death in CGD patients.

La Enfermedad Granulomatosa Crónica (EGC) es una inmunodeficiencia primaria caracterizada por un defecto en la producción de superóxido (O2-), que se genera como consecuencia de mutaciones en uno de los cuatro componentes del complejo NADPH oxidasa y predispone a infecciones por bacterias y hongos. Además de los defectos en la producción de O2-, se ha descrito que los neutrófilos de los pacientes con EGC exhiben una resistencia a la muerte celular, evento que se asocia con la inflamación crónica y predisposición a enfermedades autoinmunes. Se ha descrito que linfocitos en medios desprovistos de O2-especies reactivas del oxigeno (ROS), muestran reducida expresión de Fas y FasL, moléculas que juegan un papel relevante en el control de la muerte celular, sugiriendo la participación de los ROS su regulación. En este trabajo analizamos la expresión de Fas y FasL en linfocitos T y neutrófilos en dos familias portadores de dos defectos genéticos diferentes asociados con EGC: ausencia de p47-phox o de p67-phox. Evidenciamos una baja expresión de Fas y FasL en los linfocitos T de los pacientes con EGC, pero solo los neutrófilos de los pacientes con defecto de p47-phox, fueron incapaces de expresar FasL. Estos defectos pudieran contribuir a entender la alteración de la muerte celular observada en los pacientes con EGC.

Comparison of oxidative stress & leukocyte activation in patients with severe sepsis & burn injury.

Background & objectives: We evaluated pro- and anti-oxidant disturbances in sepsis and non-sepsis burn patients with systemic inflammatory response syndrome (SIRS). Adhesion molecules and inflammation markers on leukocytes were also analyzed. We hypothesized that oxidative stress and leukocyte activation markers can lead to the severity of sepsis. Methods: In 28 severe sepsis and 27 acute burn injury patients blood samples were collected at admission and 4 days consecutively. Oxidative stress markers: production of reactive oxygen species (ROS), myeloperoxidase, malondialdehyde and endogenous antioxidants: plasma protein sulphydryl groups, reduced glutathione, superoxide dismutase and catalase were measured. Flow cytometry was used to determine CD11a, CD14, CD18, CD49d and CD97 adhesion molecules on leukocytes. Procalcitonin, C-reactive protein, fibrinogen, platelet count and lactate were also analyzed. Results: Pro-oxidant parameters were significantly elevated in sepsis patients at admission, ROS intensity increased in burn patients until the 5th day. Endogenous antioxidant levels except catalase showed increased levels after burn trauma compared to sepsis. Elevated granulocyte activation and suppressed lymphocyte function were found at admission and early activation of granulocytes caused by increasing activation/migration markers in sepsis. Leukocyte adhesion molecule expression confirmed the suppressed lymphocyte and monocyte function in sepsis. Interpretation & conclusions: Severe sepsis is accompanied by oxidative stress and pathological leukocyte endothelial cell interactions. The laboratory parameters used for the evaluation of sepsis and several markers of pro- and antioxidant status were different between sepsis and non-sepsis burn patients. The tendency of changes in these parameters may refer to major oxidative stress in sepsis and developing SIRS in burns.

Inflamação, hemólise e ativação celular: importância nos eventos vasculares da anemia falciforme / Inflammation, cellular activation and hemolysis: importance in vascular events of sickle cell anemia

A anemia falciforme (AF) é uma desordem genética caracterizada por hemólise, estresse oxidativo, infecções recorrentes, estado inflamatório crônico e eventos de oclusão vascular, com ocorrência de crises de dor, danos teciduais e possibilidade de óbito precoce. Os eventos vasculares na AF envolvem a participação de hemácias, leucócitos, células endoteliais, plaquetas, fatores da coagulação e proteínas plasmáticas. Neste estudo, avaliou-se o papel de marcadores hematológicos, de hemólise, inflamação e de ativação celular na fisiopatologia da ativação endotelial na AF. Foi realizado um estudo de corte transversal, seguido por caso controle. Quarenta e cinco (45) indivíduos com AF em estado estável, com idade média 20,5 anos participaram do estudo. O perfil de hemoglobinas foi confirmado por HPLC. Os marcadores bioquímicos foram investigados por kits específicos; a expressão de moléculas na superfície dos leucócitos por citometria de fluxo e a quantificação de citocinas e moléculas de adesão solúveis por ELISA. Níveis elevados de lactato desidrogenase (LDH) e bilirrubinas foram associados a eventos de Síndrome Torácica Aguda e úlcera de perna, respectivamente. A leucocitose foi observada em pacientes com histórico de hepatomegalia e úlcera de perna. Os pacientes com histórico de terapia transfusional apresentaram concentrações aumentadas da aspartato aminotransferase (AST) e contagem de reticulócitos. Os níveis diminuídos de HDL estiveram associados a eventos de sequestro esplênico e esplenomegalia. A expressão do CD11b em neutrófilos, linfócitos e monócitos foi maior nos pacientes que nos controles; entretanto, a expressão do CD62L nos neutrófilos foi menor nos pacientes do que nos controles antes e após o desafio com o lipopolissacarídeo bacteriano (LPS). A expressão do CD11b e CD32 em neutrófilos teve correlação positiva com plaquetas e com o LDL, respectivamente. A expressão do CD62L em neutrófilos apresentou correlação negativa com plaquetas. A expressão do CD11b e CD18 em linfócitos teve correlação positiva com o ácido úrico e com a molécula de adesão vascular solúvel 1 (VCAM-1s), respectivamente. A expressão do CD62L em linfócitos foi negativamente correlacionada com o número de plaquetas, molécula de adesão intercelular solúvel 1 (ICAM-1s) e TNF-alfa. A expressão do CD32 em monócitos foi menor nos pacientes que nos controles e apresentou correlação negativa com a AST e hemoglobina S. A expressão reduzida do CD32 em monócitos de pacientes foi associada ao aumento da LDH, enquanto que a expressão do CD62L nessas células apresentou correlação positiva com o HDL e com as concentrações de hemoglobina. Os níveis de IL-18 e do ácido úrico foram associados a marcadores de hemólise, de disfunção endotelial e citocinas e podem representar a participação do complexo inflammasome. Os resultados apresentados sugerem o papel importante de biomarcadores na avaliação do perfil clínico de pacientes com AF, além de sugerir a provável influência de moléculas expressas na superfície de leucócitos, da IL-18 e do ácido úrico no processo inflamatório crônico e na gravidade clínica da AF. Acreditamos que a interação desses biomarcadores envolve processos complexos relacionados à hemólise, inflamação e ativação celular com importância na avaliação da gravidade dos eventos vasculares presentes na AF. Em conjunto, todos esses marcadores podem ser considerados como alvos terapêuticos promissores em intervenções clínicas futuras na doença.

Expression of IL-17 and COX2 gene in peripheral blood leukocytes of vitiligo patients

Vitiligo is a pigmentation disorder in which inflammatory mediators such as cytokines have a pivotal role in disease's pathogenesis. Interleukin 17 [IL-17A] is a proinflammatory cytokine which is involved in the induction of several proinflamatory mediators such as cyclooxygenase 2 [COX2]. The aim of this study was to investigate the gene expression of IL-17 and COX2 in peripheral blood leukocytes of vitiligo's patients. Peripheral blood leukocytes from 15 patients with vitiligo and 15 healthy controls were separated using a gradient density centrifugation method. After total RNA isolation and cDNA synthesis, IL-17 and COX2 gene expression were quantified by real-time polymerase chain reaction [PCR]. There were no significant differences in IL-17 and COX2 gene expression in lymphocytes of patients with vitiligo compared with control group [p<0.05]. However there was an increased IL-17 and COX2 gene expression in neutrophils of patients compared to controls, but it did not reach statistical significance [p=0.05]. We could not find any differences in IL-17 and Cox2 gene expression between clinical diseases subtypes, sex and age. There was a significant correlation between IL-17 and COX2 genes expression in the neutrophils of patients [p=0.00, r=0.80]. Our results showed an increased expression in IL-17 and Cox-2 genes in neurophils of patients with vitiligo. This suggested that these two factors are involved in the inflammatory process. Further studies with a larger sample size might help to establish the role of these factors in the pathogenesis of diseases

Ultrastructural evidences for endothelial cell - leukocytes interactions: margination and migration / Evidencias ultraestructurales de las interacciones células endoteliales - leucocitos: marginación y migración

Leukocyte-endothelial cell interactions have a pivotal role in immune responses. In our study Ten adult Wistar albino rats weighing 180-200 g were used to obtain tissue samples. The animals were sacrificed by decapitation under ether anesthesia. The lymph nodes of the animals were then quickly removed. Specimens were immersed in the zinc iodide-osmium tetroxide (ZIO) solutation by Niebauer et al. (1969) and kept in the dark for 2 hours in this solution from temperature for fixation/staining. Samples were processed according to routine plastic embedding tecnique. Semi thin sections of 1µm thick were cut and stained with methilene blue-azure II for light microscopic examination. We used zinc iodide-osmium tetroxide staining technique to distinguish endothelial cell from leukocytes. Present data supports the understanding of this unique relationship as documented by figures.

Las interacciones entre células endoteliales y leucocitos tienen un papel fundamental en la respuesta inmune. Se utilizaron 10 ratas albinas Wistar, adultas, con peso entre 180-200 g, para obtener muestras de tejido. Los animales fueron sacrificados por decapitación bajo anestesia con éter. Inmediatamente, los nodos linfáticos de los animales fueron removidos. Las muestras se sumergieron en tetraóxido de osmio-yoduro de zinc (ZIO), solución de Niebauer et al. (1969), manteniéndose en oscuridad durante 2 horas, a temperatura de fijación/tinción. Las muestras fueron tratadas de cuerdo a la rutina de la técnica de inserción en plástico. Para el examen microscópico de luz, se tiñeron con Azur-II - Azul de metileno secciones de corte semifinos de 1µm de grosor. Se utilizó la técnica tinción tetraóxido de osmio-yoduro de zinc para distinguir las células endoteliales de los leucocitos. Los datos presentados apoyan la comprensión de esta relación única.

Effects of different peep levels on mesenteric leukocyte-endothelial interactions in rats during mechanical ventilation

INTRODUCTION: Mechanical ventilation with positive end expiratory pressure (PEEP) improves oxygenation and treats acute pulmonary failure. However, increased intrathoracic pressure may cause regional blood flow alterations that may contribute to mesenteric ischemia and gastrointestinal failure. We investigated the effects of different PEEP levels on mesenteric leukocyte-endothelial interactions. METHODS: Forty-four male Wistar rats were initially anesthetized (Pentobarbital I.P. 50mg/kg) and randomly assigned to one of the following groups: 1) NAIVE (only anesthesia; n=9), 2) PEEP 0 (PEEP of 0 cmH2O, n=13), 3) PEEP 5 (PEEP of 5 cmH2O, n=12), and 4) PEEP 10 (PEEP of 10 cmH2O, n=13). Positive end expiratory pressure groups were tracheostomized and mechanically ventilated with a tidal volume of 10 mL/kg, respiratory rate of 70 rpm, and inspired oxygen fraction of 1. Animals were maintained under isoflurane anesthesia. After two hours, laparotomy was performed, and leukocyte-endothelial interactions were evaluated by intravital microscopy. RESULTS: No significant changes were observed in mean arterial blood pressure among groups during the study. Tracheal peak pressure was smaller in PEEP 5 compared with PEEP 0 and PEEP 10 groups (11, 15, and 16 cmH2O, respectively; p<0.05). After two hours of MV, there were no differences among NAIVE, PEEP 0 and PEEP 5 groups in the number of rollers (118±9,127±14 and 147±26 cells/10minutes, respectively), adherent leukocytes (3±1,3±1 and 4±2 cells/100µm venule length, respectively), and migrated leukocytes (2±1,2±1 and 2±1 cells/5,000µm², respectively) at the mesentery. However, the PEEP 10 group exhibited an increase in the number of rolling, adherent and migrated leukocytes (188±15 cells / 10 min, 8±1 cells / 100 µm and 12±1 cells / 5,000 µm², respectively; p<0.05). CONCLUSIONS: High intrathoracic pressure was harmful to mesenteric microcirculation in the experimental model of rats with normal lungs and ...

Inibição in vivo das óxido nítrico sintases: efeitos sobre a expressão de moléculas de adesão e secreção de mediadores inflamatórios / In vivo inhibition of nitric oxide synthases: effects on expressions of adhesion molecules and secretion of inflammatory mediators

Resultados preliminares do nosso grupo de pesquisa demonstraram que a inibição da síntese de NO por período de tempo prolongado reduz o recrutamento de leucócitos para focos inflamatórios, dependente, pelo menos em parte, da inibição da interação leucócito-endotélio e da expressão de L-selectina. 0 presente trabalho visou complementar os estudos sobre os mecanismos envolvidos nesta ação antiinflamatória. Para tanto, ratos Wistar machos (180 a 220g) receberam L-NAME (20mg/Kg; v.o.; 14 dias) ou água pela mesma via e período de tempo. Foi avaliada a atividade das enzimas óxido nítrico sintases (NOS) no tecido cerebral por radioimunoensaio; o recrutamento leucocitário para cavidade peritoneal induzido pelo LPS (5mg/kg, 4 horas); as expressões de moléculas de adesão em leucócitos do sangue circulante, no músculo cremaster e nos sinusóides hepáticos por ensaios de citometria de fluxo ou imunohistoquímica; as expressões gênicas de moleculas de adesão, quantificadas por PCR e a secreção/produção de mediadores inflamatórios em leucócitos por ensaios imunoenzimáticos, reacao de Griess ou quimiluminescência. Os resultados obtidos mostraram que: 1) o tratamento com L-NAME reduziu em torno de 90% a atividade das NOS dependentes de Ca+2 em condições basais ou após estimulação in vivo com LPS; 2) as concentrações de NO no plasma e no peritônio inflamado estavam reduzidos em animais tratados com L-NAME (30% vs. controles); 3) a migração de leucócitos polimorfonucleares (PMN) para o peritônio inflamado estava reduzida em animais tratados com L-NAME (40% vs. controles); 4) as expressões de L-selectina e PECAM-1 em leucócitos circulantes; de PECAM-1 no endotélio do músculo cremaster e de VAP-1 no endotélio dos sinusóides hepáticos e músculo cremaster de animais tratados com L-NAME estavam reduzidas; 5) a redução na expressão de L-selectina foi dependente de inibição de sua síntese; 6) a concentração de IL-10 estava major no soro de animais tratados com L-NAME em relação aos controles; 7) a maior concentração de IL-10 circulante pode refletir a produção desta citocina por leucócitos na circulação, uma vez que a concentração de IL-10 também estava maior no sobrenadante de leucócitos circulantes de animais tratados com L-NAME; 8) concentrações reduzidas de IL-1ß e LTB4 foram detectadas nos sobrenadantes de neutrófilos obtidos de animais tratados com L-NAME; 9) macrófagos obtidos de animais tratados com L-NAME produziram maiores concentrações de IL-1ß, TNF-α e IL-6, e menores concentrações de IL-10 na ausência de estimulação; na vigência estimulação in vitro com LPS os macrófagos de animais tratados com L-NAME produziram menores concentrações de NO. Em conjunto, os resultados obtidos neste trabalho mostram que o tratamento com L-NAME por período prolongado de tempo inibe a atividade das NOS dependentes de Ca+2 e nesta condição reduz as concentrações de NO circulante e no foco da inflamação, além de inibir a migração de leucócitos para o foco inflamatório, confirmando propriedades pro-inflamatórias do NO. Os mecanismos envolvidos na inibição da migração celular parecem compreender a modulação da expressão e/ou síntese das moléculas de adesão constitutivas expressas em leucócitos e no endotélio, além da modulação da secreção de mediadores pró ou antiinflamatórios em leucócitos circulantes e neutrófilos. Por outro lado, os efeitos do tratamento com L-NAME sobre a secreção de mediadores químicos por macrófagos induzem a secreção destes e corroboram a dualidade dos efeitos do NO no processo de recrutamento celular

Our previous results have demonstrated that in vivo chronic inhibition of nitric oxide synthesis reduces leukocyte recruitment into inflammatory focus, dependent, at least in part, on impaired leukocyte-endothelial interactions and expression of L-selectin. This study aimed to clarify the mechanisms involved in the reduced leukocyte migration observed in L-NAME-treated rats. For this purpose, male Wistar rats (180-220g) were treated with L-NAME (20 mg/kg, oral route, 14 days, dissolved in drinking water); controls animals received water by the same route and period of time. The effectiveness of L-NAME treatment was investigated by examining the activity of nitric oxide synthases (NOS) in the brain tissue using radioimmunoassay. In addition, effects of L-NAME treatment were evaluated in LPS-induced leukocyte recruitment into peritoneal cavity (5mg/kg, 4 hours); expression of adhesion molecules was determined in circulating leukocytes, cremaster muscle and liver sinusoids by flow cytometry and immunohistochemistry assay; gene expressions of adhesion molecules were quantified by PCR and leukocyte secretion of inflammatory mediators was measured by immunoenzimatics assays, Griess reaction or chemiluminescence. Our results show that: 1) L-NAME treatment reduced, around 90%, Ca+2 - dependent NOS activity in the presence or not of in vivo inflammation; 2) concentrations of NO in the plasma and into inflamed peritoneum were reduced in L-NAME-treated animals (30% vs. control animals); 3) migration of PMN leukocytes into inflammed peritoneum was impaired in L-NAME-treated rats (40% vs. control animals); 4) expressions of L-selectin and PECAM-1 in circulating leukocytes, PECAM-1 in endothelium from cremaster muscle and VAP-1 in endothelium from liver sinusoids and cremaster muscle were reduced in L-NAME-treated rats; 5) decrease in L-selectin expression was dependent on inhibition of its synthesis; 6) concentrations of IL-10 was higher in serum from L-NAME-treated rats in comparison to control rats; 7) these higher concentrations of circulating IL-10 can reflect the production of this cytokine by leukocytes from circulation, as IL-10 levels was greater in the supernatant of circulating leukocytes obtained from L-NAME-treated animals; 8) L-NAME treatment disturbed neutrophils ability to secrete IL-1ß e LTB4, since these concentrations were lower in the supernatants of neutrophils from L-NAME-treated animals; 9) in absence of stimulation, macrophages obtained from L-NAME-treated rats produced higher concentrations of IL-1ß, TNF-α e IL-6, and lower concentrations of IL-10, whereas in presence of in vitro LPS these cells produced lower concentrations of NO. Taken together, our results show that L-NAME treatment administrated for a prolonged period of time inhibits Ca+2 -dependent NOS activity, and in this condition, reduces concentrations of NO in plasma and into inflammatory focus and decreases leukocyte migration to the inflammatory focus thus confirming pro-inflammatory properties of NO. The mechanisms involved in impaired cellular migration seem to involve the modulation of expression and/or synthesis of constitutive adhesion molecules in leukocytes and endothelium, and to interfere in the secretion of pro or anti inflammatory mediators. On the other hand, actions of NO in secreation of chemical mediators by macrophages induces the production of inflammatory mediators and support the duality of NO in the cellular recruitment process

Efecto de los leucocitos sobre la lesión por almacenamiento en plaquetas de aferesis / Effect of leukocytes on the storage lesion in apheresis platelet

En el Banco de Sangre , las plaquetas sufren una serie de cambios físicos, metabólicos y fisiológicos que se denominan "lesión por almacenamiento" (LA), que depende de varios factores: métodos de preparación del concentrado, tipo de bolsa utilizada, concentración de plaquetas, número de leucocitos presentes en la unidad y acumulación de citoquinas. Todos ellos podrían producir activación plaquetaria y así afectar la calidad del producto, lo cual se reflejaría en una menor sobrevida de las plaquetas transfundidas. Basándose en lo anterior, se plantea que la remoción precoz de leucocitos aminoraría la LA en los concentrados plaquetarios (CPs) obtenidos por aféresis. Se estudiaron veinte CPs obtenidos mediante dos métodos de aféresis que difieren en el número de leucocitos residuales que permanecen en el producto final; un CP leucoreducido (Cobe Spectra) y otro estándar (Baxter CS 3000 plus). Las determinaciones se realizaron el día cero (prealmacenamiento) y al quinto día de almacenamiento. La evaluación de la LA incluyó marcadores de menbrana plaquetaria: p-selectina (CD62-P), glicoproteína Ib (CD42b), fosfatidilserina (Ax V.), factor tisular (CD142), formación de micropartículas (MPs), los cuales se analizaron por citometría de flujo, y citoquinas liberadas por los leucocitos y/o plaquetas activadas (IL-1. IL-6,FNT y RANTES), las cuales se analizaron por ELISA. El principal marcador de activación de las plaquetas (p-selectina) se encontró significativamente aumentado en los CP leucorreducidos (P: 0.001) y en los obtenidos en forma estándar (p: 0.02). La expresión de GPIb disminuyó significativamente solo en las plaquetas no leucorreducidas (p: 0.01). En relación a la actividad procoagulante de las plaquetas, se observó un aumento significativo en la expresión de fosfatidilserina sobre la cara externa de la membrana (p: 0.019) y de MPs plasmáticas (p: 0.025) solo en las plaquetas leucorreducidas y un muy leve aumento de la expresión de factor tisular...

Under Blood Bank storage conditions, platelet undergo a series of physical, metabolic and physiological changes that are denominated "platelet storage lesion" (PSL). This condition depends on several factors: the platelets number and the methodology used for the preparations of platelet concentrates (PC), type of storage bag, the number of leukocytes present in the cell unit, cytokines release, among others. All these factors may produce platelet activation and thus affect the quality of the product, which would be reflected in a shorter survival of the transfused platelets. Based on the previous knowledge, we hypothesized that early removal of leukocytes from the apheresis concentrate will diminish platelets "activation/lesion" during storage. We studied twenty PC obtained by two methods of apheresis that differed in the number of residual leukoreduced PC (Cobe Spectra) and a standard PC (3000 Baxter CS extra). The determinations were made at day zero (pre-storage) and at the fifth day of storage. The evaluation included markers present in platelets membrane, such as, p-selectin (CD62-P), glycoprotein Ib (CD42b), phosphatydilserine expression (PS). Tissue Factor (CD142) and microparticles (MPs) generation, that were analyzed by flow cytometry. Cytokines released by leucocytes or activated platelet (IL-1). IL-6, TNF and RANTES), were analysed by the ELISA technique. The most important marker of platelets activation, CD62-P, was significantly more increased in leukoreduced CP (P: 0.001) than in the standard method (p: 0.02). The expression of GPIb diminished significantly only in non-leukoreduced platelets (p: 0.01). With regard to the procoagulant activity of platelets, a significant increase in the PS expression was observed on the external face of the platelet membranes (p: 0.019) and on MPs (p: 0.025) only in leukoreduced preparations, changes that were accompanied by a very slight increase of tissue factor expression (p: 0.055). The determinations...

Influence of laparoscopy and laparotomy on gasometry, leukocytes and cytokines in a rat abdominal sepsis model

OBJETIVO: A cirurgia laparoscópica está associada com trauma reduzido e baixa resposta na fase aguda do trauma, quando comparada com a cirurgia aberta. As citocinas e o balanço ácido-base são fatores importantes da resposta biológica ao trauma cirúrgico-anestésico. O objetivo deste estudo foi determinar se o pneumoperitôneo com CO2 altera a expressão das citocinas, a gasometria e a contagem diferencial de leucócitos em ratos com sepse abdominal. MÉTODOS: Ratos Wistar foram aleatoriamente distribuídos em 5 grupos: controle (somente anestesia), laparotomia, pneumoperitôneo com CO2, ligadura e punção do ceco por laparotomia, ligadura e punção do ceco por laparoscopia. Após 30 minutos dos procedimentos, sangue arterial foi colhido para leucometria diferencial em hemocitômetro. TNFa, IL-1b e IL-6 foram dosadas no líquido intraperitoneal (por ELISA). Os parâmetros gasosos foram medidos no sangue arterial e nos exsudatos intraperitoneal e subperitoneal. RESULTADOS: Os valores de TNFa, IL-1b e IL-6 foram significantemente menores nos ratos submetidos ao pneumoperitôneo do que em todos os outros grupos (p<0.05). Expressão de TNFa, IL-1b e IL-6 foi menor no grupo sepse induzida por laparoscopia do que por laparotomia (p<0.05). Os ratos submetidos a ligadura e punção do ceco via laparoscópica desenvolveram acidose hipercárbica no sangue arterial e exsudato subperitoneal, mais intensa do que no grupo sepse laparotômica. Leucopenia e linfopenia foram mais acentuadas no grupo sepse laparoscópica (p<0.01). Entretanto, os animais submetidos a sepse laparotômica desenvolveram significante aumento de neutrófilos e eosinófilos quando comparados com os controles (p<0.05). CONCLUSÕES: Este estudo demonstrou que o pneumoperitôneo com CO2 contribuiu para reduzir a resposta inflamatória em ratos submetidos a modelo de sepse abdominal, no que diz respeito à expressão de citocinas intraperitoneais e leucometria diferencial. O pneumoperitôneo também contribuiu para instalação de acidose hipercárbica nos ratos sépticos.

O papel das quimiocinas na neuroinflamação / The role of chemokines in neuroinflammation

Inflamação é parte do processo fisiológico que visa reparar o dano tecidual causado por infecção, trauma, isquemia, autoimunidade. Entretanto, quando o processo inflamatório não é controlado, pode contribuir para o aumento da lesão tecidual. A regulação da resposta inflamatória no sistema nervoso central (SNC) envolve diferentes tipos celulares, como neutrófilos, macrófagos e linfócitos, células da glia, moléculas de adesão, citocinas e quimiocinas. As quimiocinas são uma família de citocinas de baixo peso molecular responsáveis pelo recrutamento seletivo de leucócitos, e subdividem-se em quatro subfamílias de acordo com a posição do resíduo cisteína N-terminal dessas moléculas: C, CC, CXC, CX3C. O objetivo desta revisão é apresentar o papel das quimiocinas na regulação da inflamação em doenças do SNC.

Inflammation is part of the physiological process that aims at repairing the tissue damage produced by infection, trauma, ischemia, autoimmune diseases. However, when this process is not controlled, it can increase the tissue lesion. The regulation of the inflammatory response in the central nervous system (CNS) involves different cell types such as neutrophils, macrophages, lymphocytes, glia cells, adhesion molecules, cytokines and chemokines. Chemokines are a large family of low-molecular weight cytokines associated with the selective trafficking of leukocytes, and are classified into four subfamilies on the basis of the arrangement of cysteine residues located in the N-terminal region of these molecules: C, CC, CXC and CX3C. This review will attempt to describe the role of chemokines in the regulation of inflammation in CNS diseases.

Bases para estimar las necesidades de vitamina C en la gestación / Bases to determine the dose of vitamin C in pregnancy

Objetivo: Establecer la dosis de vitamina C para mantener una concentración leucocitaria >18 µg/10(8) células en mujeres embarazadas entre las semanas 28 y 32 de la gestación, con la finalidad de establecerla como base para la estimación de la ingestión diaria recomendada (IDR). Metodología: Etapa 1: estudio agudo de suplementación. Se suplementó a 10 gestantes al inicio del segundo trimestre con dosis que fueron de 0 a 200 mg/día de vitamina C (sin contar con el aporte dietético), cada dosis se administró durante una semana. Etapa 2: estudio doble ciego aleatorizado (100 mg/día de vitamina C vs. Placebo) entre la semana 20 y el término de la gestación con 52 mujeres. Resultados: Etapa 1. Con 100 mg/día de vitamina C se alcanzó la saturación leucocitaria sin incrementar significativamente la excreción urinaria. Etapa 2. Las mujeres que recibieron placebo disminuyeron significativamente su concentración leucocitaria de vitamina C a lo largo de la gestación mientras que las gestantes que recibieron el suplemento la incrementaron en forma significativa manteniéndola por arriba de >18 µg/10(8) células. Conclusión: Una dosis diaria de 100 mg de vitamina C durante la segunda mitad del embarazo ocasiona una reserva leucocitaria adecuada y puede ser considerada como referencia para establecer la IDR.

Objective: Determine the dose of Vitamin C able to maintain a leukocyte Vitamin C concentration of >18 µg/10(8)cells, in pregnant women with 28 to 32 weeks of gestation, in order to compile a database to estimate the daily recommended intake (DRI) during pregnancy. Methodology: Stage 1: acute supplementation study. A group of 10 healthy women in late first and early second trimester pregnancy were supplemented with 0 to 200 mg vitamin C/day during one week each. Stage 2: a randomized double blind study (placebo vs. vitamin C [100 mg/d]) was carried out with 52 women studied from week 20 to week 32 of pregnancy. Their plasma and leukocyte vitamin C concentrations were measured every 4 weeks to evaluate the previously established supplementation dose. Results: Stage 1: with the 100 mg/day dose, leukocyte vitamin C saturation was reached without increasing urinary excretion. Stage 2: leukocyte concentration of vitamin C decreased throughout pregnancy in women receiving placebo, while supplemented women maintained their concentrations >18 µg/10(8) cells. Conclusion: A 100 mg/day dose of vitamin C during the second half of pregnancy keeps leucocyte storage and could be useful to establish the DRI of Vitamin C during pregnancy.