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

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

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

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

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

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

Factores de riesgo de mortalidad en el hijo de madre toxémica / Mortality Risk Factors in the Child of a Toxemic Mother

Objetivo. Determinar los factores de riesgo de mortalidad en el hijo de madre toxémica. Material y métodos. Estudio de casos y controles en hijos de toxémicas, de producto único, de 28 a 42 semanas de gestación; los casos fueron los fallecidos y los controles los sobrevivientes. Resultados. Fueron 57 casos y 114 controles. Los factores de riesgo significativos: eclampsia (RM= 4.25, IC95% 1.76-10.39, p= 0.0002), desprendimiento placentario (RM= 8.13, IC95% 2.29-31.4, p= 0.00007), anestesia general (RM= 5.32, IC95% 1.74-16.51 p= 0.0005), síndrome de dificultad respiratoria (RM= 23.68, IC95% 3.31-478 p= 0.00004), ventilación mecánica (RM= 334, IC95% 42.63-7084, p=0.000000001), hemorragia peri-intraventricular (RM= 64.57, IC95% 8.36-1361, p = 0.0000001), insuficiencia renal aguda (RM= 26.13, IC95% 5.21-177, p= 0.0000002 ) y hemorragia pulmonar (RM= 8.40, IC95% 2.71-27.11, p= 0.000006). Se detectaron como factores protectores: alta escolaridad materna (RM= 0.110, IC95% 0.01-0.66, p= 0.02), desnutrición in útero (RM= 0.39, IC95% 0.18-0.84, p= 0.008) y taquipnea transitoria del recién nacido (RM= 0.021, IC95% 0.00-0.15, p= 0.00000001 Conclusiones. Los factores de riesgo maternos fueron: eclampsia, desprendimiento placentario, anestesia general y muerte materna; en el producto: síndrome de dificultad respiratoria, ventilación mecánica y hemorragia peri-intraventricular. Es interesante el hallazgo de los factores de protección.

Objective. To determine risk factors of mortality in the infant of a toxemic mother. Material and Methods. A case-controls study, single products only, of 28-42 weeks of gestation; cases were either stillborn and neonatal deaths. Where controls were survivors. Results. There were 57 cases and 114 controls. Significant risk factors were: eclampsia (OR= 4.25, 95%CI 1.76-10.39, p =0.0002), placental detachment (OR = 8.13,95%CL 2.29-31.4, p= 0.00007), general anesthesia (OR= 5.32, 95%CI 1.74-16.51, p=0.0005), respiratory distress syndrome (OR= 23.68, 95%CI 3.31-478 p= 0.00004), mechanic ventilation (OR= 334, 95%CI 42.63-7084, p= 0.000000001), peri-intraventricular hemorrhage (OR = 64.57, 95%CI 8.36-1361, p= 0.0000001), acute renal failure (OR=2613, 95%CI 5.21-177, p=0.0000002) and pulmonary hemorrhage (OR= 8.40, 95%CL 2.71-27.11, p= 0.000006). We observed as protective factors: high maternal educational level (OR=0.110, 95%CI 0.01-0.66, p= 0.02), intrauterine malnutrition (OR= 0.39, 95%CL 0.18-0.84, p= 0.008) and transient tachypnea of the newborn (OR= 0.021, 95%CI0.00-0.15,p= 0.00000001). Conclusions. We found as maternal risk factors: eclampsia; premature placental detachment; general anesthesia, and maternal death, in the newborns they were respiratory distress syndrome, mechanical ventilation and peri-intraventricular hemorrhage. The finding of protection factorsis unteresting.

Angiographic Findings of Choroidal Lesions in Serous Retinal Detachment

PURPOSE: To study the relationship between the damage of retinal pigment epithelum and the lesion of choroidal vessels in various types of the serous retinal detachment(SRD) on fluorescein angiography(FAG) and indocyanine green angiography(ICGA). METHODS: FAG and ICGA were performed 81 eyes with various types of serous retinal detachment. The series comprised central serous chorioretinopathy(CSC, 63 eyes), toxemia of pregnancy(8 eyes), and Harada's disease(10 eyes). RESULTS: All the eyes showed dye leakage through the retinal pigment epithelium(RPE) by FAG. Of sixty-three eyes with CSC, sixty eyes showed choroidal tissue staining in late phase on ICGA. Delayed filling of ICG dye in early phase was present around the site of leakage on FAG in 48 eyes with CSC. In toxemia of pregnancy and Harada's disease, all the cases showed delayed choroidal circulation and leakage from choroidal vessels on ICGA. As a common feature, ICGA showed choroidal hypoperfusion or delayed choroidal circulation and choroidal vascular hyperpermeability in the three types of SRD. CONCLUSIONS: The authors presume that they might contribute to the damage of RPE. The pathogenesis of SRD may be related to the hypothesis fact that choroidal vascular hyperpermeability probably moves fluid into the subretinal space from the choroid.

The Effects of Treatment with Sairei-to on Toxemia of Pregnancy, as Evaluated by Measurement of Umbilical Arterial Blood Flow / 日本東洋医学雑誌

In order to evaluate the clinical usefulness of Sairei-to in the treatment of toxemia of pregnancy and to study its influence on the waveform of the umbilical arterial blood flow, a standard curve of the pulsatility index (PI) was constructed for 90 patients in their 19th through 41st weeks of normal pregnancy. A dose of 9.0g/day of Sairei-to was then given to 13 patients with edema (mild toxemia) and 3 patients with severe toxemia. These cases were observed for clinical improvement and changes in the PI. The results were as follows: 1) of the 13 patients with mild toxemia, edema improved in 12 cases (92%), along with a decrease in the PI of all of these cases as a result of administration of this Kampo formula, 2) Regarding the 3 patients with severe toxemia, the clinical usefulness of Sairei-to was not clear. In 2 of these cases, arrest of the endodiastolic velocity was observed 6 to 7 days after the start of administration, making it necessary to perform emergency cesarean sections. These findings suggest that in mild toxemia of pregnancy, due to the hydragogue effect of Sairei-to, alleviation of edema and improvement of the insufficiency of placental blood flow, demonstrated by a decrease in PI, could be expected. In severe toxemia, on the other hand, irreversible change had already occurred in the placenta, and consequently, no positive improvement in the insufficiency of placental blood flow could be expected with the administration of Sairei-to. Thus, administration served only to supplement other treatment methods in this group.