Dilataciones quísticas congénitas de las vías biliares (primera parte). Vías biliares intrahepáticas / Congenital bile duct cystic dilatation (part 1). Intrahepatic bile ducts

RESUMEN La enfermedad de Caroli es una enfermedad infrecuente que requiere un alto índice de sospecha para su diagnóstico. Puede afectar un segmento hepático, un lóbulo o todo el hígado; suele generar episodios repetidos de colangitis. Existe una amplia gama de propuestas terapéuticas que oscilan desde el tratamiento médico hasta el trasplante de hígado. En este trabajo presentamos 3 casos, realizamos una revisión de la literatura y proponemos una ampliación de la clasificación de Alonso-Lej modificada por Todani que, a nuestra manera de ver, tiene implicaciones a la hora de seleccionar un tratamiento.

ABSTRACT Caroli's disease is a rare condition, and its diagnosis requires high level of suspicion. The disease may affect one segment, one lobe or the entire liver, and may result in repeated episodes of cholangitis. The disease can be managed using different therapeutic approaches ranging from medical treatment to liver transplantation. In this paper we report 3 cases with review of the literature and propose a modification of the classification by Alonso-Lej modified by Todani which we believe may be useful to guide treatment.

Etiología y perfil de resistencia antimicrobiana en pacientes con infección urinaria / Etiology and antimicrobial resistance profile in patients with urinary infection

Introducción: La infección de vías urinarias (IVU) es una de las enfermedades más prevalentes en la práctica clínica Objetivo: Identificar los principales agentes etiológicos y la frecuencia de resistencia a antibióticos por parte de microorganismos aislados por urocultivos en pa cientes con IVU en un hospital de primer nivel de atención. Materiales y Métodos: Estudio descriptivo de corte transversal, a partir de una muestra aleatoria de pacientes con IVU en La Virginia, Risaralda, entre el 1 de abril de 2014 a 31 de marzo de 2015. Se evaluaron las bacterias aisladas en la totalidad de urocultivos procesados y los resultados de los antibiogramas. Se establecieron frecuencias y proporciones. Para el análisis de datos, se utilizó SPSS Statistics 22. Se hizo análisis multivariado. Resultados: Se realizaron 1563 urocultivos en el periodo de estudio, de los cuales 329 (21,0%) mostraron crecimiento mayor a 100.000 UFC. Las frecuencias más altas de resistencia para E. coli se observaron para cefalotina (75,8%), ampicilina (72,6%) y trimetoprim/sulfametoxazol (55,3%). De 296 pacientes seleccionados aleatoriamente se halló que la cistitis era la IVU más frecuente (70,3%) y al 50,7% no se les prescribió ningún antimicrobiano. El uso de antiulcerosos se asoció con mayor probabilidad de uso inadecuado del antibiótico (OR:4,28; IC95%:1,070-17,153; p=0,04). Conclusiones: Existe una elevada resistencia bacteriana a los antibióticos de primera línea para el tratamiento de las IVUs, lo que sugiere la importancia de identi ficar los microorganismos y sus perfiles de sensibilidad a antimicrobianos para seleccionar con mejor criterio cual emplear.

Introduction: Urinary tract infection (UTI) is one of the most prevalent diseases in clinical practice. Objective: To identify the main etiologic agents and the frequency of antibiotic resistance by microorganisms isolated from urine culture and sensitivity in patients with IVU in a hospital primary care. Materials and Methods. Descriptive cross-sectional study, from a random sample of patients with UTI in La Virginia, Risaralda, from April 1, 2014 to March 31, 2015. Bacteria isolated from all processed urine cultures and the results of susceptibility were evaluated. Frequencies and proportions were established. For data analysis was used SPSS Statistics 22. Results: A total of 1563 urine cultures were performed in the study period, of which 329 (21.0%) showed further growth to 100,000 UFC. Higher frequencies of resis tance were observed for E. coli to cephalothin (75.8%), ampicillin (72.6%) and trimethoprim/sulfamethoxazole (55.3%). In the 296 randomized patients it was found that the most common UTI was cystitis (70.3%) and 50.7% were not prescribed any antimicrobial. The use of anti-ulcer is associated with increased probability of inappropriate use of antibiotics (OR:4.28; 95% CI:1.070-17.153; p=0.04). Conclusions: There is a high bacterial resistance to first-line antibiotics for treatment of UTIs, suggesting the importance of identifying microorganisms and their antimicrobial susceptibility profiles to select which use better approach.

The effect of mesenchymal stem cell use on intra-abdominal adhesions in a rat model

PURPOSE: Intra-abdominal adhesions (IAA) are among the most frequently seen pathologies in general surgery practice with an increased morbidity and mortality. In the present study, we investigated the effect of locally applied mesenchymal stem cells (MSCs) on IAA. METHODS: Twenty-four Wistar Albino rats were used in the study. The rats were divided into three groups including: Sham, control, and MSCs group. On day 0, cecum was reached under anesthesia in all groups, except the Sham group. Scraping with a sponge was performed until petechial bleeding occurred. The control group received no treatment. In the stem cell group, MSCs were applied topically immediately after surgery on adhesions. The rats were sacrificed on day 10 and colon tissues and blood samples were collected for macroscopic, histopathological, and biochemical analysis. RESULTS: In our study, E-selectin, P-selectin, TNF-α and IL-1 levels were statistically significantly lower in the MSC group than the control group, while the sham group has the lowest levels. In both the macroscopic and histopathological analyses (Zühlke's scale), the least amount of adhesion was observed in the Sham group. In addition, although there was less adhesion in the MSC group than the control group, the difference did not reach statistical significance. CONCLUSION: Topical MSC application immediately after surgery suppresses the inflammatory process. However it was found to be ineffective in histopathological and macroscopic examinations performed on the 10th day.

Platelet receptors: an instrumental of platelet physiology

Platelets play an important role in hemostasis, inflammation, host defense, tumor growth and metastasis. Platelets receptors are instrumental in platelet-platelet aggregation and interaction of platelets with leukocytes, endothelial cells and coagulation factors. These receptors are also the targets for antiplatelet drugs. This review focuses on the role of platelet receptors in human physiology. Data were extracted from peer-reviewed journals using MEDLINE and EMBASE databases, and the following terms [platelets, platelet receptors, CD markers, integrins, tetraspanins, transmembrane receptors, prostaglandin receptors, immunoglobulin superfamily receptors] were used

Mecanismos que controlan la migración del linfocito T a la piel / Mechanisms that control T lymphocyte migration into the skin

La piel es un órgano complejo que cumple funciones de barrera física e inmunológica. La presencia de numerosos tipos celulares explica su participación en la inmunidad innata y adaptativa y su capacidad de iniciar una cascada de eventos con repercusión sistémica, a la vez que la hace órgano blanco de procesos patológicos sistémicos. Uno de los principales componentes del sistema inmunitario cutáneo son las células de Langerhans, especializadas en la captura y presentación de antígenos; ante estímulos como la captura de antígenos extraños o propios alterados, migran al ganglio linfático para presentar los antígenos a los linfocitos T. Una vez activados, los linfocitos T pueden migrar a la piel gracias a la expresión de CLA (Cutaneous Lymphocyte-associated Antigen), cuyo ligando, la E-Selectina, se expresa en los endotelios dérmicos. Este proceso de migración y alojamiento en la piel está controlado por quimiocinas, citocinas y moléculas de adhesión que se presentan en el texto.

Câncer de mama e disfunção endotelial: [revisão] / Breast cancer and endothelial dysfunction: [review]

Entre as mulheres brasileiras a principal causa de mortalidade são as doenças cardiovasculares, seguida em freqüência pelo câncer, sendo o de mama o mais comum. É bastante conhecida a associação de câncer com eventos tromboembólicos, mas pouco estabelecida sua relação com os demais eventos cardiovasculares. Para estudar estes eventos desde suas alterações primordiais, como a lesão e disfunção endotelial e a formação da placa aterosclerótica, vários métodos têm sido utilizados. Dentre eles, a dosagem sérica de P e E-selectina e do fator de von Willebrand são relevantes devido à associação tanto com o risco cardiovascular quanto com o processo de progressão e formação de metástase do câncer de mama. Outro método de avaliação da função endotelial é a medida da dilatação da artéria braquial mediada por fluxo, que cada vez mais ganha popularidade devido à sua natureza não-invasiva e a comprovação de sua associação com a disfunção endotelial e risco de eventos cardiovasculares. Buscamos, através desta revisão, condensar o que houve de mais relevante nestes últimos anos sobre a associação de câncer, em especial o de mama, com lesão endotelial e risco cardiovascular.

The main cause of death among Brazilian women is cardiovascular disease followed by cancer with breast cancer as the most incident. The relationship between cancer and thrombosis is well known, although its association with other cardiovascular events is poorly understood. In order to study these events from the earliest findings such as endothelial injury and dysfunction and the evolving atherosclerotic plaque, many methods are currently being used. Among these methods, E- and P-selectin and the von Willebrand factor have been associated, either with cardiovascular risk or with breast cancer growth and metastasis. Brachial artery flow-mediated dilatation is a tool available that emerged in the last decade due to its noninvasive nature and its clear association with endothelial dysfunction and cardiovascular risk. The aim of this revision is to bring the newest and most relevant updates about the association of breast cancer, endothelial injury and cardiovascular risk.

Fucoidan: advances in the study of its anti-inflammatory and anti-oxidative effects / 药学学报

Fucoidan is a natural polysaccharide extracted from brown seaweeds, with a wide variety of biological features, especially the anti-inflammatory and anti-oxidative effects. Studies indicated that the anti-inflammatory effect of fucoidan related to its capacity to interact with the selectin or scavenger receptor on the cell membrane. Fucoidan can also inhibit the synthesis and release of reactive oxygen species (ROS), as well as promote its clearance, showing the anti-oxidative activity.

Evaluación de disfunción endotelial en pacientes con diabetes tipo 2 / Dysfunction endothelial evaluation in type 2 diabetes patients

El objetivo de este trabajo fue estudiar moléculas involucradas en la activación endotelial, tales como la molécula de adhesión sE-Selectina (sE-S) y el péptido vasoconstrictor Endotelina-1 (ET-1) en individuos diabéticos tipo 2 y su asociación con otros factores de riesgo cardiovascular. Se estudiaron 62 pacientes diabéticos que se compararon con un grupo control. Las concentraciones de sE-S y ET-1 fueron significativamente mayores en los diabéticos que en los controles (sE-S: 90,6±26,2 ng/mL vs. 49,5±9,2 ng/mL, p<0,00001; ET-1: 11,3±3,7 vs. 7,7±0,5 pg/mL, p<0,001, respectivamente). Estas moléculas, en pacientes con índice de masa corporal (IMC) normal y aumentado, mostraron diferencias significativas (sE-S: 75,5±22,4 vs. 97,1±32,9 ng/mL, p<0,05; ET-1: 8,4±2,4 vs. 14,1±4,9 pg/mL, p=0,001, respectivamente). No se encontraron diferencias entre individuos diabéticos normo e hipertensos, no fumadores y fumadores, ni normo e hipercolesterolémicos. El 81% de la población estudiada presentó un pobre control glucémico (HA1c>7%), siendo significativamente mayores los niveles de ET-1 en este grupo (p<0,01) no así para sE-S (p=0,74). Los resultados obtenidos muestran que los pacientes diabéticos presentan activación endotelial reflejada en los niveles elevados de sE-S y ET-1. El IMC aumentado y el pobre control glucémico incrementan la disfunción endotelial en estos pacientes.

The object of this work was to study molecules involved in endothelial activation, such as E-selectin (sE-S) and the vasoconstrictor peptide Endothelin-1 (ET-1) in Type 2 diabetes patients, and their relation with other cardiovascular risk factors. Sixty-two patients with diabetes were compared with matched controls. sE-S and ET-1 concentrations in diabetes patients were significantly elevated compared with controls (sE-S: 90.6±26.2 ng/mL vs 49.5±9.2 ng/mL, p<0.00001; ET-1: 11.3±3.7 vs 7.7±0.5 pg/mL, p<0.001, respectively). sE-S and ET-1 levels in diabetes patients with normal and increased body mass index showed significant differences (sE-S: 75.5±22.4 vs. 97.1±32.9 ng/mL, p<0.05; ET-1: 8.4±2.4 vs. 14.1±4.9 pg/mL, p=0.001 respectively). There were no significant differences in none of the molecules values between patients with or without hypertension, smokers or non-smokers, neither in diabetes patients with or without hypercholesterolemia. Eighty-one percent of the population with diabetes presented a poor glycemic control (HA1c>7%) and in these patients, ET-1 plasma levels were significantly increased (p<0.01), but not sE-S (p=0.74). These results show that obesity and a poor glycemic control increase the endothelial dysfunction in type 2 diabetes patients.

Moléculas de adesão e câncer oral: revisão de literatura / Adhesion molecules in oral cancer: review

O presente trabalho consiste em uma revisão de literatura onde se evidencia que as moléculas de adesão desempenham um importante papel nos processos fisiológicos celulares, através das interações célula-célula, célula-matriz extracelular. Sua expressão alterada pode estar associada aos diversos e complexos mecanismos envolvidos no comportamento biológico do câncer oral, podendo aumentar o potencial metastático de células tumorais.

This paper has reviewed the literature about adhesion molecules. It has showed the role of cell adhesion molecules on cellular physiology by cell-cell and cell-matrix interactions. Its altered expression can be related in many pathways involved in oral cancer biological behavior, being capable of improving the metastatic potential of neoplastic cells.

Sepsis: emerging role of nitric oxide and selectins

Sepse – um estado de infecção bacteriana sistêmica – frequentemente leva à falência múltipla de órgãos e associa-se a altos índices de mortalidade, apesar de progressos recentes no manejo de pacientes em unidades de terapia intensiva. Muitos dos efeitos maléficos associados à sepse são atribuídos a uma resposta inflamatória patologicamente ampliada que leva a recrutamento neutrofílico e ativação das moléculas de adesão do grupo das selectinas, durante as fases iniciais do processo . O óxido nítrico e sua diversas isoformas também foram implicados nas diversas manifestações vasculares da sepse como participantes diretos da toxicidade celular. Esta revisão descreve o papel das selectinas e do óxido nítrico em situações clínicas e experimentais de sepse, bem como os respectivos efeitos de processos terapêuticos de bloqueio.

Changes of ICAM-1 and P-selectin in rats with pulmonary thromboembolism and the effect of safflower injection / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe dynamically the expressions of intercellular adhesion molecule-1 (ICAM-1) and P-selectin (Ps) in the vascular endothelium in rats with pulmonary thromboembolism (PTE) and the effect of Safflower Injection (SI).</p><p><b>METHODS</b>Rats were randomly divided into the normal group, the model group and the treatment group. PTE model was induced by intravenous injection of auto-blood clots, and SI was injected intravenously immediately after modelling with 2 ml/(kg d) for 5 days to the rats in the treatment group. Animals were sacrificed in batches at the 1st, 3rd, 24th, 72nd and 120th h after embolization to observe the pathological changes and detect the protein and mRNA expressions of ICAM-1 and Ps in pulmonary vascular endothelium by immunohistochemistry and in situ hybridization respectively.</p><p><b>RESULTS</b>Pathological observation showed obvious embolism in pulmonary arteries and inflammatory reaction after modelling, which was abated after SI treatment. ICAM-1 and Ps expressions were elevated at the 3rd and the 1st h after embolization respectively (both P < 0.01), which also were abated in the treatment group.</p><p><b>CONCLUSION</b>SI may alleviate pulmonary injury in PTE rats by down-regulating the expressions of ICAM-1 and Ps.</p>

Interacción entre proteínas y glicanos en la regulación fisiológica de las células T / How do protein-glycan interactions regulate T-cell physiology?

Recent evidence indicates that protein-glycan interactions play a critical role in different events associated with the physiology of T-cell responses including thymocyte maturation, T-cell activation, lymphocyte migration and T-cell apoptosis. Glycans decorating T-cell surface glycoproteins can modulate T-cell physiology by specifically interacting with endogenous lectins including selectins and galectins. These endogenous lectins are capable of recognizing sugar structures localized on T-cell surface glycoproteins and trigger different signal transduction pathways leading to differentiation, proliferation, cell cycle regulation or apoptosis. Protein-carbohydrate interactions may be controlled at different levels, including regulated expression of lectins during T-cell maturation and differentiation and the spatio-temporal regulation of glycosyltransferases and glycosidases, which create and modify sugar structures present in T-cell surface glycoproteins. This article briefly reviews the mechanisms by which protein-carbohydrate interactions modulate immunological processes such as T-cell activation, migration and apoptosis.

Las interacciones entre proteínas y glicanos juegan un papel fundamental en numerosos eventos de la regulación de la fisiología del sistema inmune, como maduración tímica, activación, migración y apoptosis de células T. Los carbohidratos son capaces de modular la fisiología linfocitaria a través de la interacción específica con lectinas endógenas como selectinas y galectinas. Estas lectinas endógenas son capaces de reconocer estructuras sacarídicas localizadas en glicoproteínas de la superficie celular y regular procesos tan diversos como proliferación, diferenciación y ciclo celular. Existen diversos niveles de control de la interacción entre lectinas y azúcares; en primer lugar podemos mencionar la expresión regulada de estas lectinas durante el desarrollo de una respuesta inmune, y en segundo lugar la regulación espacio-temporal de la actividad de glicosiltranferasas y glicosidasas cuya función es crear y modificar los azúcares específicos para estas lectinas. Existen evidencias de que la expresión y actividad de estas enzimas se regulan en forma positiva o negativa durante diferentes eventos del desarrollo, ejecución y finalización de la respuesta inmune. En este artículo se analizarán los mecanismos a través de los cuales las interacciones entre lectinas con sus carbohidratos específicos modulan en forma específica diversos procesos fisiológicos, como maduración de timocitos, migración linfocitaria, activación y diferenciación de células T y apoptosis.

Glycobiology of Selectin / 한국유방암학회지

Selectins, carbohydrate-binding molecules, bind to fucosylated and sialylated glycoprotein ligands, and are found on endothelial cells, leukocytes and platelets. They can be classified into E-, L- and P-selectins, and are involved in trafficking of cells of the innate immune system, T lymphocytes and platelets via binding with specific ligands. An absence of selectins or selectin ligands has serious consequences in mice or humans, leading to recurrent bacterial infections and persistent disease. Selectins are involved in constitutive lymphocyte homing and chronic and acute inflammation processes, including post-ischemic inflammation in muscle, kidney, heart, skin inflammation, atherosclerosis, glomerulonephritis and lupus erythematosus. Selectin-neutralizing monoclonal antibodies, recombinant soluble P-selectin glycoprotein ligand 1 and small-molecule inhibitors of selectins have been tested in clinical trials on patients with multiple trauma, cardiac indications and pediatric asthma, respectively. Anti-selectin antibodies have also been successfully used in preclinical models to deliver imaging contrast agents and therapeutics to sites of inflammation. The contributions of selectins and selectin ligands to signalling deserve further study, which will allow a much more detailed analysis of the contributions of selectins in models of inflammation, haemostasis, haematopoiesis, wound healing, atherogenesis, and tumor metastasis.

Gliconutrientes: azúcares que curan. Revisión bibliográfica / Gliconutrients (Sugars that cures): Bibliographical revision

Se creía anteriormente que los carbohidratos solo servían para aportar energía. Investigaciones realizadas a partir de la década de los sesenta indican que además están implicados en una serie de funciones vitales, para la preservación de la función e integridad celular. Se han identificado 8 carbohidratos a los que se les ha denominado gliconutrientes, se cree que estos son esenciales para la vida por su participación en actividades como la vigilancia inmunológica y la trasmisión de información hereditaria. La glicobiología surge a partir del estudio de los carbohidratos y otras moléculas biológicas con las cuales interactúan. Es un campo de investigación relativamente incipiente pero que abre nuevos horizontes en la comprensión de los mecanismos fisiopatológicos que conducen a la enfermedad o al tratamiento efectivo de la misma. El objetivo de esta revisión es mostrar un panorama general acerca de este nuevo campo de la investigación.

Advance of the studies on the adhesion molecules of blood cells / 中国实验血液学杂志

The interactions between blood cells and blood cells or blood cells and endothelium of blood vessel are mainly mediated by adhesion molecules. The role of adhesion molecules is diverse in vivo, which involved in adhesion, migration, differentiation and signal transduction of blood cells. The function of adhesion molecules is necessary to maintain the normal structure and fulfill many physiological processes of these cells. Therefore, the abnormal or deficiency of their expression and function will disrupts normal physiological processes and results in clinical disease. In this paper, several generic classes of adhesion molecules, including the integrins, the selectins, the immunoglobulin superfamily and others are introduced, and a lot of related physiopathological status, such as inflammation, hemostasis, arteriosclerosis, thrombosis and stem cell homing are discussed. The studies on the adhesion molecules of blood cells will contribute not only to understand the pathogenesis of some disorders, but also to search new targets in diagnosis and treatment of these diseases.

Expression of the ED3 Antigen and its Upregulation after Cyclophosphamide Treatment on Basal Epithelial Cells of Rat Stratified Squamous Epithelium / 대한해부학회지

Sialoadhesin (Sn) expression has been demonstrated on murine and rat macrophages in lymphatic organs and is recognized by the monoclonal antibody (mAb) ED3 in the rat. Sialoadhesin (Siglec-1), the ED3 antigen in the rat, is a subtype of sialic acid -binding Ig-like lectins (Siglecs) that bind specifically to sialic acid-containing structures such as selectins and was originally identified as the sheep erythrocyte receptor (SER) responsible for sialic acid-dependent binding of native sheep erythrocytes (SE) to resident murine bone marrow macrophages in rosetting assays. The aim of the present study was to investigate the expression and potential function of sialoadhesin in the stratified squamous epithelium of the rat tongue, esophagus and skin. The expression of sialoadhesin was demonstrated by immunohistochemical analysis with the mAb ED3. This study demonstrated not only the presence of sialoadhesin on the basal epithelial cells of the stratified epithelium in normal rat tongue, esophagus and skin but also its upregulated expression on these cells in CY-treated rats. The results of the present study shed some light on the potential function of sialoadhesin in the basal epithelial cells of the stratified epithelium. Further studies may provide more insight into the role of sialoadhesin in the epithelial stem cells.

Neutropenias / Neutropenias

La neutropenia severa se define como el conteo absoluto de neutrófilos abajo de 500/uL. El desorden puede ser congénito o adquirido pero todos se caracterizan por la ausencia de una respuesta adecuada a procesos inflamatorios, esto produce un alta susceptibilidad a las infecciones, particularmente de origen bacteriano piógeno y micótico. Los diferentes desórdenees asociados se revisan. Se sugiere que todo paciente neutropénico sea investigado aún con recursos limitados para poder determinar la causa del desorden. En todo paciente con infecciones bacterianas o micóticas debe sospecharse desórdenes cualitativos y cuantitativos de la función de los neutrófilos y en estos casos el primer paso debe ser un frote periférico con una evaluación adecuada por un hematólogo. La médula ósea indica en muchos casos una terapia de antibióticos agresiva y también se recomienda un drenaje de colecciones infecciosas

Galectinas: estructura, especificidad glicídica y ligandos específicos / Galectins: structure, sugar specificity and specific ligands

Las galectinas se definen por dos propiedades: secuencias de aminoácidos características compartidas y afinidad por azúcares ß-galactosídicos. Numerosas galactinas de mamíferos fueron secuenciadas y bien caracterizadas en diferentes especies, siendo clasificadas como galectina-1 a galectina-10, según sus homologías de secuencia. La identidad entre dominios que ligan carbohidratos de distintas galectinas de una especie de mamífero oscila entre 20-40 por ciento, mientras que la identidad de galectina-1, por ejemplo, entre distintas especies es de 80-90 por ciento. En la presente revisión, se describen las principales propiedades distintivas de las galectinas de mamífero en cuanto a estructura proteica, estructura cristalina, especificidad glicídica y ligandos específicos