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1.
Rev. Hosp. Ital. B. Aires (2004) ; 40(2): 53-55, jun. 2020. ilus
Article in Spanish | LILACS (Americas) | ID: biblio-1102484

ABSTRACT

Una de las características de la afección pulmonar por enfermedad por coronavirus (COVID-19) es la disociación entre la gravedad de la hipoxemia y el mantenimiento de una mecánica respiratoria relativamente conservada. En este contexto se ha establecido una teoría en relación con dos fenotipos de pacientes con síndrome de distrés respiratorio del adulto (SDRA): un fenotipo Low, caracterizado por baja elastancia y baja reclutabilidad, y un fenotipo High, con características de alta elastancia y alta reclutabilidad. Presentamos el caso de un paciente que cursó internación en la Unidad de Terapia Intensiva de Adultos de nuestro hospital, con clínica, mecánica ventilatoria y patrón tomográfico compatible con el fenotipo Low de SDRA por COVID-19. (AU)


Dissociation between severity of hypoxemia and relative preserved respiratory mechanics is a characteristic observed in lung impairment due to coronavirus disease (COVID-19). Patients with COVID-19 that present adult respiratory distress syndrome (ARDS) are identified for one of two phenotypes according to a theory recently established. The Low phenotype is distinguished by low elastance and low recruitability; and the High phenotype, by high elastance and high recruitability. The case describes a patient admitted in the adult Intensive Care Unit of Hospital Italiano de Buenos Aires with observed symptoms, ventilatory mechanics and tomographic pattern that are compatible with Low phenotype of ARDS due to COVID-19. (AU)


Subject(s)
Humans , Male , Middle Aged , Respiratory Distress Syndrome, Adult/microbiology , Coronavirus Infections/therapy , Phenotype , Respiratory Distress Syndrome, Adult/genetics , Respiratory Mechanics , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Cough/etiology , Dyspnea/etiology , Fever/etiology , Hypertension/complications , Intensive Care Units , Hypoxia/physiopathology , Obesity/complications
2.
Brasília; Brasil. Ministério da Saúde; abr. 2020. ilus, tab.
Non-conventional in Portuguese | LILACS (Americas), ColecionaSUS, BRISA | ID: biblio-1096170

ABSTRACT

ANÁLISE: O coronavírus da Síndrome Respiratória Aguda Grave 2 (abreviado para SARS-CoV-2, do inglês Severe Acute Respiratory Syndrome Coronavirus 2), anteriormente conhecida como novo coronavírus (2019-nCoV), é um agente zoonótico recém-emergente que surgiu em dezembro de 2019, em Wuhan, China, causando manifestações respiratórias, digestivas e sistêmicas, que se articulam no quadro clínico da doença denominada de COVID-19 (do inglês Coronavirus Disease 2019. Ainda não há informações robustas sobre a história natural da doença, nem medidas de efetividade para manejo clínico dos casos de infecção pelo COVID-19, restando ainda muitos detalhes a serem esclarecidos. No entanto, sabe-se que o vírus tem alta transmissibilidade e provoca uma síndrome respiratória aguda que varia de casos leves (cerca de 80%) a casos muito graves com insuficiência respiratória (5% e 10% dos casos), que podem requerer tratamento especializado em unidades de terapia intensiva (UTI). Sua letalidade varia, principalmente conforme a faixa etária. A TECNOLOGIA: O suporte de vida extracorpóreo ou oxigenação por membrana extracorpórea (ECMO) é uma modalidade terapêutica que possibilita suporte temporário à falência pulmonar e/ou cardíaca refratária ao tratamento clínico convencional. Fazem parte essencial de um circuito de ECMO duas cânulas de drenagem e retorno do sangue (inflow/outflow), uma bomba de propulsão de sangue, um oxigenador, sensores de fluxo e pressão, sistema de controle de temperatura para resfriamento ou aquecimento do sangue e pontos de acesso arterial e venoso para coleta de sangue no circuito. A função da bomba de propulsão é impulsionar o sangue do paciente para a membrana oxigenadora, gerando fluxo para o sistema. O oxigenador é um dispositivo de troca de gases que usa uma membrana semipermeável (membrana de oxigenação) para separar compartimento sanguíneo e um gasoso. O sangue desoxigenado é drenado pela força da bomba externa, atravessa o oxigenador (onde se processa a troca de dióxido de carbono por oxigênio) e é devolvido ao paciente. ANÁLISE DA EVIDÊNCIA: O objetivo deste relatório é analisar as evidências científicas sobre eficácia e segurança da oxigenação por membrana extracorpórea (ECMO) para tratamento de pacientes graves com COVID-19. Com o objetivo de nortear a busca da literatura, foi formulada a pergunta estruturada, de acordo com o acrônimo PICO (População, Intervenção, Comparador e Outcomes [desfechos]. CONSIDERAÇÕES ÉTICAS Usar critérios de consenso predeterminados para o racionamento da ECMO, se indicado; reavaliar todos os aspectos do plano de tratamento de um paciente regularmente, incluindo a necessidade de continuar ou encerrar a ECMO; invocar justiça distributiva somente em circunstâncias em que o racionamento exclua a capacidade de cuidar de cada indivíduo de maneira ideal; buscar opiniões de comitês de ética hospitalar e médico-legais em cenários eticamente desafiadores. GARANTIA DE QUALIDADE E PESQUISA COLABORATIVA: Manter estruturas de garantia de qualidade e governança clínica com análises frequentes da qualidade da ECMO; garantir a coleta e o compartilhamento de dados para informar a preparação e o atendimento ao paciente; objetivar a aprovação da ética em vigor ou desenvolver mecanismos para processos de revisão e aprovação da ética. CONCLUSÕES Ao todo, foram analisados 11 estudos que incluíram pacientes com COVID-19 em uso de ECMO. Uma taxa maior de mortalidade foi atribuída à ECMO, no entanto, análises agrupadas não mostraram diferença estatisticamente significativa na mortalidade entre pacientes tratados com ECMO e com terapia padrão. Não há evidências claras do benefício do uso do ECMO em pacientes com COVID-19 até o momento. As diretrizes provisórias da OMS recomendam oferecer oxigenação por membrana extracorpórea (ECMO) a pacientes elegíveis com síndrome do desconforto respiratório agudo relacionada à COVID-19. A utilização do equipamento é recomendada pela OMS em casos de hipoxemia refratária e apenas em centros especializados que conte uma equipe capacitada para a utilização do equipamento (24,25). A Organização Extracorpórea de Suporte à Vida (ELSO - The Extracorporeal Life Support Organization) orienta que uso de ECMO em pacientes com COVID19 irá depender do caso e deve ser reavaliada regularmente com base na carga geral do paciente, na capacitação da equipe e na disponibilidade de outros recursos. A AARC também recomenda o uso de ECMO apenas em pacientes adultos com COVID19 e SRAG grave, cuidadosamente selecionados, ventilados mecanicamente e com hipoxemia refratária. A complexidade da ECMO exige uma equipe de UTI bem qualificada para prestar atendimento a pacientes graves, sendo limitado seu uso a centros especializados. As evidências disponíveis de populações semelhantes de pacientes sugerem que pacientes cuidadosamente selecionados com SRAG grave que não se beneficiam do tratamento convencional podem obter bons resultados com a ECMO venovenosa.


Subject(s)
Humans , Respiration, Artificial/instrumentation , Extracorporeal Membrane Oxygenation/instrumentation , Coronavirus Infections/therapy , Hypoxia/etiology , Technology Assessment, Biomedical
3.
Pan African Medical Journal; 35(2): 61, Journal article, 2020
in English | AIM (Africa) | ID: afr-201839
4.
Int. j. morphol ; 37(4): 1572-1577, Dec. 2019. tab
Article in English | LILACS (Americas) | ID: biblio-1040171

ABSTRACT

Hypoxia hypobaric (HH) can cause alterations at testicular level, with temperature increase, intrascrotal alteration and deterioration of spermatogenesis. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketoprofen have anti-angiogenic properties, and can decrease testicular abnormalities. The objective of the study was to evaluate the effect of ketoprofen on spermatogenesis of mice exposed to continuous hypobaric hypoxia. 78 Mus musculus CF-1 male mice 3 to 4 months old were used and subjected to HH in chamber at 4200 m. They were divided into 13 groups (G) of 6 animals: 10 with HH cycles (1, 2, 3, 4 and 8, lasting 8.3 days each cycle, two groups each) and 3 in normoxia (Nx). Intraperitoneal ketoprofen 25 mg/kg was administered every 4 days. Euthanasia of these animals was performed at the end of each cycle and in the case the Nx groups at the end of cycles 1, 4 and 8. Percentage of microhematocrit and reticulocytes were measured in blood smears and a morphometric and histopathological analysis of the height of the epithelium, the tubular diameter and the diameter of the tubular lumen was made. It was shown that hematocrit increases continuously up to 8 cycles, while reticulocytes increase up to 3 cycles. Continuous HH decreases the tubular diameter in a sustained manner and proportional to HH cycles, and the height increased only in the groups subjected to 8 cycles. The groups treated with ketoprofen saw a decrease in angiogenesis, presenting some degree of protection at the testicular level.


La hipoxia hipobárica (HH) puede provocar alteraciones a nivel testicular, con aumento de la temperatura, alteración intraescrotal y deterioro de la espermatogénesis. Los antiinflamatorios no esteroidales (AINEs) como el ketoprofeno tienen propiedades antiangiogénicas, pudiendo disminuir las alteraciones testiculares. El objetivo de estudio fue evaluar el efecto del ketoprofeno en la espermatogénesis de ratones expuestos a hipoxia hipobárica continua. Se utilizaron 78 ratones macho Mus musculus CF-1 de 3 a 4 meses de edad y se sometieron a HH en cámara a 4200 m. Se dividieron en 13 grupos (G) de 6 animales: 10 con ciclos de HH (1, 2, 3, 4 y 8, con duración de 8,3 días cada ciclo, dos grupos cada uno) y 3 en normoxia (Nx). Se administró ketoprofeno intraperitoneal 25 mg/kg cada 4 días. La eutanasia de estos animales se realizó al final de cada ciclo y en el caso los grupos Nx al final de los ciclos 1, 4 y 8. Se midió porcentaje de microhematocrito y reticulocitos en frotis de sangre y se hizo un análisis morfométrico e histopatológico de la altura del epitelio, el diámetro tubular y el diámetro de la luz tubular. Se evidenció que el hematocrito aumenta de manera continua hasta los 8 ciclos, en cambio los reticulocitos aumentan hasta los 3 ciclos. La HH continua disminuye el diámetro tubular de forma sostenida y proporcional a los ciclos de HH, y la altura aumentó sólo en los grupos sometidos a 8 ciclos. Los grupos tratados con ketoprofeno se vio una disminución de la angiogénesis, presentando algún grado de protección a nivel testicular.


Subject(s)
Animals , Male , Mice , Spermatogenesis/drug effects , Testis/drug effects , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Ketoprofen/pharmacology , Hypoxia/physiopathology , Reticulocytes/drug effects , Seminiferous Tubules/drug effects , Testis/injuries , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Ketoprofen/administration & dosage , Hematocrit , Neovascularization, Pathologic
5.
Bol. latinoam. Caribe plantas med. aromát ; 18(5): 504-517, sept. 2019. ilus, tab, graf
Article in English | LILACS (Americas) | ID: biblio-1008288

ABSTRACT

Nowdays it is established that ischemic brain damage like ischemic stroke is one of the leading cause of death and disability in the population that assumes relevance development of anti-ischemic drugs. The work studied the anti-hypoxic and anti-ischemic effect of 7 plant extracts. Antihypoxic activity was assessed on models of hypobaric, hypercapnic, histotoxic, hematotoxic hypoxia. Anti-ischemic activity of test-extracts was studied on the focal cerebral ischemia model. Administration of Tagetes patula, Gaillardia pulchella, Sorbaria sorbifolia, Grossularia reclinata, Ribes nigrum, Rubus caesius and Lysimachia punctata extracts contributed to the necrosis zone reduction by 56.6% (p<0.05); 37.3% (p<0.05); 73.2% (p<0.05); 49.4% (p<0.05); 42.5% (p<0.05); 85.5% (p<0.05); 44.2% (p<0.05) and also restored aerobic metabolism in brain tissue. Test - objects increased of the animal lifespan under hypoxia conditions. Based on the data obtained, it is assumed that further studies of North Caucasus flora plant extracts as cerebro-protective agents are promising.


Hoy en día, se ha establecido que el daño cerebral isquémico, como el accidente cerebrovascular isquémico, es una de las principales causas de muerte y discapacidad en la población lo cual hace relevante el desarrollo fármacos antiisquémicos. En este trabajo se estudió el efecto antihipóxico y antiisquémico de siete extractos de plantas. La actividad antihipóxica se evaluó en modelos de hipoxia hipocrática, hipercápnica, histotóxica y hematotóxica. La actividad antiisquémica de los extractos de prueba se estudió en el modelo de isquemia cerebral focal. La administración de los extractos de Tagetes patula; Gaillardia pulchella; Sorbaria sorbifolia; Grossularia reclinata; Ribes nigrum; Rubus caesius y Lysimachia punctata contribuyeron a la reducción de la zona de necrosis en un 56,6% (p<0,05); 37,3% (p<0,05); 73,2% (p<0,05); 49,4% (p<0,05); 42,5% (p<0,05); 85,5% (p<0,05); 44.2% (p<0.05), respectivamente, además, de restaurar el metabolismo aeróbico en el tejido cerebral. Comparado con el control, se observó un aumento en el tiempo de sobrevida del animal en condiciones de hipoxia. Sobre la base de los interesantes datos obtenidos, se sugiere estudios adicionales de extractos de plantas de la flora del Cáucaso Norte como agentes protectores del cerebro.


Subject(s)
Animals , Male , Mice , Rats , Plant Extracts/therapeutic use , Brain Ischemia/drug therapy , Hypoxia/drug therapy , Enzyme-Linked Immunosorbent Assay , Adenosine Triphosphate/analysis , Rats, Wistar , Lactic Acid/analysis , Pyruvic Acid/analysis , Mice, Inbred BALB C
6.
Rev. bras. ter. intensiva ; 31(1): 106-110, jan.-mar. 2019. tab, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-1003625

ABSTRACT

RESUMO Relatamos o caso de um paciente que evoluiu com suspeita de morte encefálica associada à atelectasia e à hipoxemia moderada a grave, apesar de instituídos ventilação protetora, sistema de aspiração traqueal fechado, pressão positiva ao final da expiração moderada e manobra de recrutamento. Diante da não obtenção de pressão parcial de oxigênio adequada para o teste de apneia, optamos por pronar o paciente, utilizar pressão positiva expiratória final mais elevada, realizar nova manobra de recrutamento e ventilar com volume corrente mais elevado (8mL/kg), sem ultrapassar pressão de platô de 30cmH2O. O teste de apneia foi realizado em posição prona, com válvula de pressão positiva contínua nas vias aéreas acoplada em tubo T. O atraso no diagnóstico foi de 10 horas; a doação de órgãos não foi possível devido à parada circulatória. Este relato demonstra as dificuldades para obtenção de níveis de pressão parcial de oxigênio mais altos para a realização do teste de apneia. Os atrasos que isso pode acarretar ao diagnóstico de morte encefálica e ao processo de doação de órgãos são discutidos, além de potenciais estratégias de otimização da pressão parcial de oxigênio para realização do teste, conforme as recomendações atuais.


ABSTRACT We report the case of a patient in whom brain death was suspected and associated with atelectasis and moderate to severe hypoxemia even though the patient was subjected to protective ventilation, a closed tracheal suction system, positive end-expiratory pressure, and recruitment maneuvers. Faced with the failure to obtain an adequate partial pressure of oxygen for the apnea test, we elected to place the patient in a prone position, use higher positive end-expiratory pressure, perform a new recruitment maneuver, and ventilate with a higher tidal volume (8mL/kg) without exceeding the plateau pressure of 30cmH2O. The apnea test was performed with the patient in a prone position, with continuous positive airway pressure coupled with a T-piece. The delay in diagnosis was 10 hours, and organ donation was not possible due to circulatory arrest. This report demonstrates the difficulties in obtaining higher levels of the partial pressure of oxygen for the apnea test. The delays in the diagnosis of brain death and in the organ donation process are discussed, as well as potential strategies to optimize the partial pressure of oxygen to perform the apnea test according to the current recommendations.


Subject(s)
Humans , Male , Apnea/diagnosis , Pulmonary Atelectasis/complications , Brain Death/diagnosis , Hypoxia/complications , Oxygen/blood , Partial Pressure , Tidal Volume , Prone Position , Continuous Positive Airway Pressure , Delayed Diagnosis , Middle Aged
7.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-759923

ABSTRACT

Hypoxia inducible factor (HIF)-stabilizers are being developed for the renal anemia treatment. This small molecules inhibit prolyl hydroxylase domain (PHD)-containing enzymes, causing HIF activation instead of degradation under the state of normoxia, finally increase production of intrinsic erythropoiesis. Current treatment guidelines suggest that renal anemia should be treated mainly with iron and erythropoiesis stimulating agents (ESAs). But there are several complications and concerns such as hypertension, ESA refractory anemia and increased cardiovascular mortality in using ESAs. Advantages of HIF stabilizers over ESAs are orally available, no dose-up requirement for inflammation. So far new HIF stabilizers showed efficacy and safety in renal anemia treatment. This new therapeutic agent may emerge as a standard treatment option for renal anmia treatment.


Subject(s)
Anemia , Anemia, Refractory , Hypoxia , Erythropoiesis , Hematinics , Hepcidins , Humans , Hypertension , Inflammation , Iron , Mortality , Prolyl Hydroxylases , Renal Insufficiency, Chronic
8.
Article in English | WPRIM (Western Pacific) | ID: wprim-759874

ABSTRACT

We present the case of a 48-year-old woman who complained of sustained dyspnea and newly developed dyspnea, who then suddenly and unexpectedly expired during bronchoscopy. On postmortem examination, the deceased had advanced gastric cancer as a primary tumor. Frequent lymphatic tumor emboli were observed with some pulmonary lymphangitic carcinomatosis (PLC), and pulmonary tumor thrombotic microangiopathy (PTMA). PLC and PTMA are lethal forms of pulmonary metastasis, and PTMA can lead to sudden death. The characteristic findings of PLC and PTMA in the deceased were not predominant, however, and the clinical manifestation was not acutely deteriorating. These findings are, therefore, insufficient to explain the deceased's sudden death. Clinically, the deceased manifested hypoxemia, bradycardia and cardiac arrest during bronchoscopy and then soon expired, suggesting the possibility of cardiovascular complication related to bronchoscopy. Despite several limitations, we assumed that the sudden unexpected death might have been induced by cardiovascular complications related to bronchoscopy and due to the underlying pathologic condition by PLC and PTMA.


Subject(s)
Hypoxia , Autopsy , Bradycardia , Bronchoscopy , Carcinoma , Death, Sudden , Dyspnea , Female , Forensic Pathology , Heart Arrest , Humans , Middle Aged , Neoplasm Metastasis , Stomach Neoplasms , Thrombotic Microangiopathies
9.
Article in English | WPRIM (Western Pacific) | ID: wprim-759570

ABSTRACT

Whole body ultrasound can be used to improve the speed and accuracy of evaluation of an increasing number of organ systems in the critically ill. Cardiac and abdominal ultrasound can be used to identify the mechanisms and etiology of hemodynamic instability. In hypoxemia or hypercarbia, lung ultrasound can rapidly identify the etiology of the condition with an accuracy that is equivalent to that of computed tomography. For encephalopathy, ocular ultrasound and transcranial Doppler can identify elevated intracranial pressure and midline shift. Renal and bladder ultrasound can identify the mechanisms and etiology of renal failure. Ultrasound can also improve the accuracy and safety of percutaneous procedures and should be currently used routinely for central vein catheterization and percutaneous tracheostomy.


Subject(s)
Hypoxia , Brain Diseases , Catheterization , Catheters , Critical Care , Critical Illness , Hemodynamics , Intensive Care Units , Intracranial Hypertension , Lung , Operating Rooms , Renal Insufficiency , Tracheostomy , Ultrasonography , Urinary Bladder , Veins
10.
Article in English | WPRIM (Western Pacific) | ID: wprim-759546

ABSTRACT

BACKGROUND: Congenital central hypoventilation syndrome (CCHS) is a rare disorder characterized by alveolar hypoventilation and autonomic dysregulation. Patients with CCHS have adequate ventilation while awake but exhibit hypoventilation while asleep. More severely affected patients exhibit hypoventilation both when awake and when asleep. CASE: Here, we report a case of successful spinal anesthesia and postoperative epidural analgesia in a patient with CCHS who underwent orthostatic surgery. CONCLUSIONS: In patients with CCHS, anesthesia is used with the goal of minimizing respiratory depression to avoid prolonged mechanical ventilation. Regional anesthesia should be considered where appropriate. Continuous oxygen saturation and end-tidal carbon dioxide monitoring must be available.


Subject(s)
Analgesia, Epidural , Anesthesia , Anesthesia, Conduction , Anesthesia, Spinal , Hypoxia , Carbon Dioxide , Humans , Hypoventilation , Oxygen , Respiration, Artificial , Respiratory Insufficiency , Ventilation
11.
Article in English | WPRIM (Western Pacific) | ID: wprim-763680

ABSTRACT

BACKGROUND: The relationship between obstructive sleep apnoea (OSA) and metabolic disorders is complex and highly associated. The impairment of adipogenic capacity in pre-adipocytes may promote adipocyte hypertrophy and increase the risk of further metabolic dysfunction. We hypothesize that intermittent hypoxia (IH), as a pathophysiologic feature of OSA, may regulate adipogenesis by promoting macrophage polarization. METHODS: Male C57BL/6N mice were exposed to either IH (240 seconds of 10% O₂ followed by 120 seconds of 21% O₂, i.e., 10 cycles/hour) or intermittent normoxia (IN) for 6 weeks. Stromal-vascular fractions derived from subcutaneous (SUB-SVF) and visceral (VIS-SVF) adipose tissues were cultured and differentiated. Conditioned media from cultured RAW 264.7 macrophages after air (Raw) or IH exposure (Raw-IH) were incubated with SUB-SVF during adipogenic differentiation. RESULTS: Adipogenic differentiation of SUB-SVF but not VIS-SVF from IH-exposed mice was significantly downregulated in comparison with that derived from IN-exposed mice. IH-exposed mice compared to IN-exposed mice showed induction of hypertrophic adipocytes and increased preferential infiltration of M1 macrophages in subcutaneous adipose tissue (SAT) compared to visceral adipose tissue. Complementary in vitro analysis demonstrated that Raw-IH media significantly enhanced inhibition of adipogenesis of SUB-SVF compared to Raw media, in agreement with corresponding gene expression levels of differentiation-associated markers and adipogenic transcription factors. CONCLUSION: Low frequency IH exposure impaired adipogenesis of SAT in lean mice, and macrophage polarization may be a potential mechanism for the impaired adipogenesis.


Subject(s)
Adipocytes , Adipogenesis , Animals , Hypoxia , Culture Media, Conditioned , Gene Expression , Humans , Hypertrophy , In Vitro Techniques , Inflammation , Intra-Abdominal Fat , Macrophages , Male , Mice , Subcutaneous Fat , Transcription Factors
12.
Article in English | WPRIM (Western Pacific) | ID: wprim-763654

ABSTRACT

Adipose tissue inflammation is considered a major contributing factor in the development of obesity-associated insulin resistance and cardiovascular diseases. However, the cause of adipose tissue inflammation is presently unclear. The role of mitochondria in white adipocytes has long been neglected because of their low abundance. However, recent evidence suggests that mitochondria are essential for maintaining metabolic homeostasis in white adipocytes. In a series of recent studies, we found that mitochondrial function in white adipocytes is essential to the synthesis of adiponectin, which is the most abundant adipokine synthesized from adipocytes, with many favorable effects on metabolism, including improvement of insulin sensitivity and reduction of atherosclerotic processes and systemic inflammation. From these results, we propose a new hypothesis that mitochondrial dysfunction in adipocytes is a primary cause of adipose tissue inflammation and compared this hypothesis with a prevailing concept that “adipose tissue hypoxia” may underlie adipose tissue dysfunction in obesity. Recent studies have emphasized the role of the mitochondrial quality control mechanism in maintaining mitochondrial function. Future studies are warranted to test whether an inadequate mitochondrial quality control mechanism is responsible for mitochondrial dysfunction in adipocytes and adipose tissue inflammation.


Subject(s)
11-beta-Hydroxysteroid Dehydrogenases , Adipocytes , Adipocytes, White , Adipokines , Adiponectin , Adipose Tissue , Hypoxia , Cardiovascular Diseases , Homeostasis , Inflammation , Insulin Resistance , Metabolism , Mitochondria , Nitric Oxide , Obesity , Quality Control
13.
Article | WPRIM (Western Pacific) | ID: wprim-763554

ABSTRACT

OBJECTIVE: Hypoxic-ischemic (HI) brain injury in the human perinatal period often leads to significant long-term neurobehavioral dysfunction in the cognitive and sensory-motor domains. Using a neonatal HI injury model (unilateral carotid ligation followed by hypoxia) in postnatal day seven rats, the present study investigated the long-term effects of HI and potential behavioral protective effect of pentoxifylline. METHODS: Seven-day-old rats underwent right carotid ligation, followed by hypoxia (FiO2 = 0.08). Rats received pentoxifylline immediately after and again 2 hours after hypoxia (two doses, 60–100 mg/kg/dose), or serum physiologic. Another set of seven-day-old rats was included to sham group exposed to surgical stress but not ligated. These rats were tested for spatial learning and memory on the simple place task in the Morris water maze from postnatal days 77 to 85. RESULTS: HI rats displayed significant tissue loss in the right hippocampus, as well as severe spatial memory deficits. Low-dose treatment with pentoxifylline resulted in significant protection against both HI-induced hippocampus tissue losses and spatial memory impairments. Beneficial effects are, however, negated if pentoxifylline is administered at high dose. CONCLUSION: These findings indicate that unilateral HI brain injury in a neonatal rodent model is associated with cognitive deficits, and that low dose pentoxifylline treatment is protective against spatial memory impairment.


Subject(s)
Animals , Hypoxia , Brain Injuries , Brain , Cognition Disorders , Hippocampus , Humans , Hypoxia-Ischemia, Brain , Learning , Ligation , Memory , Pentoxifylline , Rats , Rodentia , Spatial Learning , Spatial Memory , Water
14.
Article in English | WPRIM (Western Pacific) | ID: wprim-762868

ABSTRACT

BACKGROUND: Face transplantation has naturally evolved from reconstructive procedures. However, few institutions perform face transplantations, because it is time-consuming and it is necessary to justify non-vital organ transplantation. We investigated the process of organ donation from brain-dead patients and the possibility of incorporating face transplantation into the donation process. METHODS: A retrospective review was performed of 1,074 brain-dead patients from January 2015 to December 2016 in Korea. We analyzed the time intervals from admission to brain death decisions (first, second, and final), the causes of brain death, and the state of the transplanted organs. RESULTS: The patient base (n=1,074) was composed of 747 males and 327 females. The average period between admission to the first brain death decision was 8.5 days (±15.3). The average time intervals between the first brain death decision and medical confirmation using electroencephalography and between the first brain death decision and the final determination of brain death were 16 hours 58 minutes (±14 hours 50 minutes) and 22 hours 57 minutes (±16 hours 16 minutes), respectively. The most common cause of brain death was cerebral hemorrhage/stroke (42.3%), followed by hypoxia (30.1%), and head trauma (25.2%). CONCLUSIONS: When face transplantation is performed, the transplantation team has 22 hours 57 minutes on average to prepare after the first brain death decision. The cause of brain death was head trauma in approximately one-fourth of cases. Although head trauma does not always imply facial trauma, surgeons should be aware that the facial tissue may be compromised in such cases.


Subject(s)
Hypoxia , Brain Death , Brain , Craniocerebral Trauma , Electroencephalography , Facial Transplantation , Female , Humans , Korea , Male , Organ Transplantation , Retrospective Studies , Surgeons , Tissue and Organ Procurement , Tissue Donors , Transplantation , Transplants
15.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-740980

ABSTRACT

BACKGROUND: The cerebral blood flow velocity (CBFV) has been known to increase in response to acute hypoxia. However, how CBFV might respond to exercise in hypoxic conditions and be associated with electroencephalogram (EEG) remains unclear. The purpose of this study was to evaluate the effect of exercise in hypoxic conditions corresponding to altitudes of 4,000 m on CBFV and EEG. METHODS: In a randomized, double-blind, balanced crossover study, ten healthy volunteers (19.8±0.4 years) were asked to perform the incremental bicycle ergometer exercise twice in hypoxic and control (sea level) conditions with a 1-week interval, respectively. Exercise intensity was set initially at 50 W and increased by 25 W every 2 minutes to 125 W. Acute normobaric hypoxic condition was maintained for 45 minutes using low oxygen gas mixture. CBFV in the middle cerebral artery (MCA) and EEG were measured at rest 5 minutes, rest 15 minutes, immediately after exercise, and 15 minutes recovery using transcranial-Doppler sonography and EEG signal was recorded from 6 scalp sites leading to analysis of alpha and beta wave relative activities. All data were analyzed using two-way repeated-measures analysis of variance and Pearson's correlation. RESULTS: CBFV in the MCA in the hypoxic condition was significantly higher than that in the control condition at rest 5 minutes (83±9 vs. 69±9 cm/s, P<0.01), rest 15 minutes (87±8 vs. 67±7 cm/s, P<0.001), immediately after exercise (112±9 vs. 97±9 cm/s, P<0.01), and 15 minutes recovery (91±11 vs. 74±7 cm/s, P<0.01). However, no significant correlation was found between the changes of CBFV and EEG wave activities. CONCLUSIONS: These results suggest that the drastic change of CBFV observed during exercise with hypoxia might appear independently with EEG wave activities.


Subject(s)
Altitude , Hypoxia , Cerebrovascular Circulation , Cross-Over Studies , Electroencephalography , Healthy Volunteers , Middle Cerebral Artery , Oxygen , Scalp
16.
Article in English | WPRIM (Western Pacific) | ID: wprim-786676

ABSTRACT

BACKGROUND: Low temperature plasma (LTP) was recently shown to be potentially useful for biomedical applications such as bleeding cessation, cancer treatment, and wound healing, among others. Keratinocytes are a major cell type that migrates directionally into the wound bed, and their proliferation leads to complete wound closure during the cutaneous repair/regeneration process. However, the beneficial effects of LTP on human keratinocytes have not been well studied. Therefore, we investigated migration, growth factor production, and cytokine secretion in primary human keratinocytes after LTP treatment.METHODS: Primary cultured keratinocytes were obtained from human skin biopsies. Cell viability was measured with the EZ-Cytox cell viability assay, cell migration was evaluated by an in vitro wound healing assay, gene expression was analyzed by quantitative real-time polymerase chain reaction, and protein expression was measured by enzyme-linked immunosorbent assays and western blotting after LTP treatment.RESULTS: Cell migration, the secretion of several cytokines, and gene and protein levels of angiogenic growth factors increased in LTP-treated human keratinocytes without associated cell toxicity. LTP treatment also significantly induced the expression of hypoxia inducible factor-1α (HIF-1α), an upstream regulator of angiogenesis. Further, the inhibition of HIF-1α expression blocked the production of angiogenic growth factors induced by LTP in human keratinocytes.CONCLUSION: Our results suggest that LTP treatment is an effective approach to modulate wound healing-related molecules in epidermal keratinocytes and might promote angiogenesis, leading to improved wound healing.


Subject(s)
Hypoxia , Biopsy , Blotting, Western , Cell Migration Assays , Cell Movement , Cell Survival , Cytokines , Enzyme-Linked Immunosorbent Assay , Gene Expression , Hemorrhage , Humans , In Vitro Techniques , Intercellular Signaling Peptides and Proteins , Keratinocytes , Plasma , Real-Time Polymerase Chain Reaction , Skin , Wound Healing , Wounds and Injuries
17.
Kosin Medical Journal ; : 106-116, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-786391

ABSTRACT

OBJECTIVES: Hypoxia—a characteristic of almost all types of solid tumors—has been associated with poor outcomes in several human malignancies. Genipin—an active constituent of Gardenia fruit— has been reported to exert an anti-tumor effect in several cancers. In this study, we investigated inhibition of angiogenesis using Genipin-mediated hypoxia-induced hypoxia inducible factor (HIF-1) and VEGF expression in human cervical cancer cells.METHODS: Under normoxic and hypoxic conditions, the expression of HIF-1α and VEGF in cervical cancer HeLa cells was detected by quantitative reverse transcription polymerase chain reaction and western blotting. Luciferase reporter assays were used to investigate the molecular mechanisms underlying the hypoxia-induced survivin activation.RESULTS: Surprisingly, we found that Genipin suppressed the HIF-1α accumulation during hypoxia in human liver cancer cell line (HepG2), human prostate cancer cell line (LNCaP), colon cancer cell line (HCT116), and breast cancer cell line (MDA231). Genipin treatment also significantly reduced hypoxia-induced secretion of VEGF.CONCLUSIONS: Suppression of HIF-1α accumulation following treatment with Genipin under hypoxia was associated with PI3K and MAPK pathways. Taken together, these results suggested that Genipin inhibits HIF-1α expression through inhibition of PI3K and MAPK signaling pathways. These results provide new insights into a potential mechanism of the anticancer properties of Genipin.


Subject(s)
Hypoxia , Blotting, Western , Breast Neoplasms , Cell Line , Colonic Neoplasms , Gardenia , HeLa Cells , Humans , Liver Neoplasms , Luciferases , Polymerase Chain Reaction , Prostatic Neoplasms , Reverse Transcription , Uterine Cervical Neoplasms , Vascular Endothelial Growth Factor A
18.
Article in English | WPRIM (Western Pacific) | ID: wprim-786245

ABSTRACT

High-flow nasal oxygenation (HFNO) is a promising new technique for anesthesiologists. The use of HFNO during the induction of anesthesia and during upper airway surgeries has been initiated, and its applications have been rapidly growing ever since. The advantages of this technique include its easy set-up, high tolerability, and its abilities to produce positive airway pressure and a high fraction of inspired oxygen and to influence the clearance of carbon dioxide to some extent. HFNO, via a nasal cannula, can provide oxygen both to patients who can breathe spontaneously and to those who are apneic; further, this technique does not interfere with bag-mask ventilation, attempts at laryngoscopy for tracheal intubation, and surgical procedures conducted in the airway. In this review, we describe the techniques associated with HFNO and the advantages and disadvantages of HFNO based on the current state of knowledge.


Subject(s)
Airway Management , Anesthesia , Hypoxia , Carbon Dioxide , Catheters , Humans , Intubation , Intubation, Intratracheal , Laryngoscopy , Oxygen , Ventilation
19.
Article in English | WPRIM (Western Pacific) | ID: wprim-786204

ABSTRACT

Oxygen is required to sustain aerobic organisms. Reactive oxygen species (ROS) are constantly released during mitochondrial oxygen consumption for energy production. Any imbalance between ROS production and its scavenger system induces oxidative stress. Oxidative stress, a critical contributor to tissue damage, is well-known to be associated with various diseases. The kidney is susceptible to hypoxia, and renal hypoxia is a common final pathway to end stage kidney disease, regardless of the underlying cause. Renal hypoxia aggravates oxidative stress, and elevated oxidative stress, in turn, exacerbates renal hypoxia. Oxidative stress is also enhanced in chronic kidney disease, especially diabetic kidney disease, through various mechanisms. Thus, the vicious cycle between oxidative stress and renal hypoxia critically contributes to the progression of renal injury. This review examines recent evidence connecting chronic hypoxia and oxidative stress in renal disease and subsequently describes several promising therapeutic approaches against oxidative stress.


Subject(s)
Hypoxia , Diabetic Nephropathies , Kidney , Kidney Failure, Chronic , Oxidative Stress , Oxygen , Oxygen Consumption , Reactive Oxygen Species , Renal Insufficiency, Chronic
20.
Article in English | WPRIM (Western Pacific) | ID: wprim-785603

ABSTRACT

OBJECTIVE: Assessing the severity of injury and predicting outcomes are essential in traumatic brain injury (TBI). However, the respiratory rate and Glasgow Coma Scale (GCS) of the Revised Trauma Score (RTS) are difficult to use in the prehospital setting. This investigation aimed to develop a new prehospital trauma score for TBI (NTS-TBI) to predict mortality and disability.METHODS: We used a nationwide trauma database on severe trauma cases transported by fire departments across Korea in 2013 and 2015. NTS-TBI model 1 used systolic blood pressure < 90 mmHg, peripheral capillary oxygen saturation < 90% measured via pulse oximeter, and motor component of GCS. Model 2 comprised variables of model 1 and age >65 years. We assessed discriminative power via area under the curve (AUC) value for in-hospital mortality and disability defined according to the Glasgow Outcome Scale with scores of 2 or 3. We then compared AUC values of NTS-TBI with those of RTS.RESULTS: In total, 3,642 patients were enrolled. AUC values of NTS-TBI models 1 and 2 for mortality were 0.833 (95% confidence interval [CI], 0.815 to 0.852) and 0.852 (95% CI, 0.835 to 0.869), respectively, while AUC values for disability were 0.772 (95% CI, 0.749 to 0.796) and 0.784 (95% CI, 0.761 to 0.807), respectively. AUC values of NTS-TBI model 2 for mortality and disability were higher than those of RTS (0.819 and 0.761, respectively) (P < 0.01).CONCLUSION: Our NTS-TBI model using systolic blood pressure, motor component of GCS, oxygen saturation, and age was feasible for prehospital care and showed outstanding discriminative power for mortality.


Subject(s)
Hypoxia , Area Under Curve , Blood Pressure , Brain Injuries , Capillaries , Fires , Glasgow Coma Scale , Glasgow Outcome Scale , Hospital Mortality , Humans , Hypotension , Korea , Mortality , Observational Study , Oxygen , Quality Improvement , Respiratory Rate
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