Subclinical ketosis risk prediction in dairy cows based on prepartum metabolic indices / [Previsão do risco de cetose subclínica em vacas de leite, baseado nos índices metabólicos pré-parto]

Ketosis can seriously impair cow performance. This study detected changes in prepartum blood metabolic parameters for predicting postpartum ketosis occurrence in dairy cows. Body condition score (BCS) was assessed before and after delivery. Blood samples of 63 cows were collected from 10 days before calving to 10 days after calving to measure metabolic parameters including ß-hydroxybutyric acid (BHBA), non-esterified fatty acid (NEFA), glucose (GLU), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), total protein (TP), albumin (ALB), globulin (GLO), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). There was a postpartum subclinical ketosis incidence of 42.25%. Compared with prepartum, plasma, levels of BHBA, AST, and NEFA significantly increased postpartum, and prepartum AST (R=0.57) and NEFA (R=0.45) showed a significant positive correlation with ketosis postpartum. Plasma GLU level significantly decreased postpartum and was significantly negatively correlated with ketosis (R=-0.21). Receiver operating characteristic curve analysis revealed prepartum BSC < 2.88, and prepartum plasma AST > 68.0 U/L, GLU < 3.97mmol/L, NEFA > 0.27mmol/L, and BHBA > 0.43mmol/L, indicating a high risk of subclinical ketosis postpartum. These levels can be used as risk indicators to predict the occurrence of subclinical ketosis in postpartum cows.(AU)

A cetose pode trazer sérios prejuízos ao desempenho da vaca. Este estudo detectou alterações nos parâmetros metabólicos do sangue pré-parto para prever a cetose pós-parto que ocorre em vacas leiteiras. O escore de condição corporal (ECC) foi avaliado antes e após o parto. Foram coletadas amostras de sangue de 63 vacas entre 10 dias antes e 10 dias após o parto para medir os parâmetros metabólicos, incluindo ácido ß-hidroxibutírico (BHBA), ácido graxo não esterificado (NEFA), glicose (GLU), bilirrubina total (TBIL), bilirrubina direta (DBIL), bilirrubina indireta (IBIL), proteína total (TP), albumina (ALB), globulina (GLO), alanina aminotransferase (ALT) e aspartato aminotransferase (AST). Houve uma incidência de cetose subclínica pós-parto de 42,25%. Em comparação com o pré-parto, o plasma, os níveis de BHBA, AST e NEFA aumentaram significativamente no pós-parto, e AST no pré-parto (R = 0,57) e NEFA (R = 0,45) mostraram uma correlação significativa positiva com cetose pós-parto. O nível plasmático de GLU diminuiu significativamente no pós-parto e foi negativamente correlacionado com a cetose de forma significativa (R = -0,21). A análise da curva característica de operação do receptor revelou BSC pré-parto <2,88 e AST plasmático pré-parto> 68,0 U / L, GLU <3,97mmol / L, NEFA> 0,27mmol / L e BHBA> 0,43mmol / L, indicando um alto risco de cetose subclínica pós-parto. Esses níveis podem ser usados ​​como indicadores de risco para prever a ocorrência de cetose subclínica em vacas no pós-parto.(AU)

Sodium-Glucose Cotransporter 2 Inhibitors: Mechanisms of Action and Various Effects / 임상당뇨병

The basic action mechanism of sodium-glucose cotransporter 2 (SGLT2) inhibitor is to lower the glucose burden by excreting the glucose filtered by the kidney into the urine. Although SGLT2 inhibitors are primarily indicated as glucose-lowering agents, they have a broad range of effects on renal function and plasma volume homeostasis, as well as on adiposity and energy metabolism across the entire body. That might be why SGLT2 inhibition causes spill-over of sodium and glucose beyond the proximal tubule, triggering dynamic and reversible realignment of energy metabolism, renal filtration, and plasma volume. A better understanding of SGLT2 inhibition in the kidney and the entire body will lead to more benefits in people with and without diabetes.

The role of renal proximal tubule transport in the regulation of blood pressure

The electrogenic sodium/bicarbonate cotransporter 1 (NBCe1) on the basolateral side of the renal proximal tubule plays a pivotal role in systemic acid-base homeostasis. Mutations in the gene encoding NBCe1 cause severe proximal renal tubular acidosis accompanied by other extrarenal symptoms. The proximal tubule reabsorbs most of the sodium filtered in the glomerulus, contributing to the regulation of plasma volume and blood pressure. NBCe1 and other sodium transporters in the proximal tubule are regulated by hormones, such as angiotensin II and insulin. Angiotensin II is probably the most important stimulator of sodium reabsorption. Proximal tubule AT(1A) receptor is crucial for the systemic pressor effect of angiotensin II. In rodents and rabbits, the effect on proximal tubule NBCe1 is biphasic; at low concentration, angiotensin II stimulates NBCe1 via PKC/cAMP/ERK, whereas at high concentration, it inhibits NBCe1 via NO/cGMP/cGKII. In contrast, in human proximal tubule, angiotensin II has a dose-dependent monophasic stimulatory effect via NO/cGMP/ERK. Insulin stimulates the proximal tubule sodium transport, which is IRS2-dependent. We found that in insulin resistance and overt diabetic nephropathy, stimulatory effect of insulin on proximal tubule transport was preserved. Our results suggest that the preserved stimulation of the proximal tubule enhances sodium reabsorption, contributing to the pathogenesis of hypertension with metabolic syndrome. We describe recent findings regarding the role of proximal tubule transport in the regulation of blood pressure, focusing on the effects of angiotensin II and insulin.

Efecto de la maca (Lepidium meyenii) sobre los niveles plasmáticos de los aminoácidos en personas que viven a nivel del mar / Effect of maca (Lepidium meyenii) on plasma levels of amino acids in people living at sea level

La maca (Lepidium meyenii) es una planta andina con diferentes propiedades terapéuticas que varían según su fenotipo. Hasta el momento no se conoce el principio activo responsable de su efecto terapéutico. Por ello, en base a los datos obtenidos del proyecto "Metabolómica, aceptabilidad y seguridad alimentaria al consumo de maca (Lepiidum Meyenii) en varones y mujeres adultas de Cerro de Pasco (4340 m) y de Lima (150m)" (SIDISI 61697) en el cual se realizó un estudio clínico, doble ciego, controlado por placebo donde se administró tres tratamientos (placebo, maca roja y maca negra) en treinta personas que vivían a nivel del mar durante tres meses; se realizó un análisis secundario de datos para evaluar si el consumo de maca aumenta o disminuye metabolitos de la ruta de los aminoácidos en seres humanos. El consumo de maca negra por tres meses disminuyó significativamente los niveles de aminoácidos esenciales (leucina e histidina); mientras que la maca roja disminuyó los niveles de aminoácidos esenciales (arginina, triptófano e isoleucina), no esenciales (glutamato y aspartato) e intermediarios (n-acetiltaurina) y aumentó aminoácidos no esenciales como cisteína y glutamina. Al comparar los deltas de cada grupo se observó que la maca negra aumentaba n-acetiltaurina y glutamato a diferencia del placebo, mientras que la maca roja aumentaba de ß-hidroxiisovalerato a diferencia del placebo. También se evidenció el efecto del sexo en los distintos tratamientos, las mujeres presentaron cambios más significativos en aminoácidos esenciales (leucina, lisina, metionina), no esenciales (cisteína, alanina, glutamina, glutamato) e intermediarios (ß-hidroxiisovalerato) en comparación con los hombres. Este estudio demuestra que el consumo por tres meses de maca de dos fenotipos distintos (roja y negra) altera los niveles de metabolitos de la ruta de los aminoácidos en personas que viven a nivel del mar y representa una novedosa forma de estudiar la medicina tradicional/complementaria mediante un enfoque (metabolómico) que permite integrar datos previos sobre sus propiedades.

Perioperative red blood cell transfusion in orofacial surgery

In the field of orofacial surgery, a red blood cell transfusion (RBCT) is occasionally required during double jaw and oral cancer surgery. However, the question remains whether the effect of RBCT during the perioperative period is beneficial or harmful. The answer to this question remains challenging. In the field of orofacial surgery, transfusion is performed for the purpose of oxygen transfer to hypoxic tissues and plasma volume expansion when there is bleeding. However, there are various risks, such as infectious complications (viral and bacterial), transfusion-related acute lung injury, ABO and non-ABO associated hemolytic transfusion reactions, febrile non-hemolytic transfusion reactions, transfusion associated graft-versus-host disease, transfusion associated circulatory overload, and hypersensitivity transfusion reaction including anaphylaxis and transfusion-related immune-modulation. Many studies and guidelines have suggested RBCT is considered when hemoglobin levels recorded are 7 g/dL for general patients and 8-9 g/dL for patients with cardiovascular disease or hemodynamically unstable patients. However, RBCT is occasionally an essential treatment during surgeries and it is often required in emergency cases. We need to comprehensively consider postoperative bleeding, different clinical situations, the level of intra- and postoperative patient monitoring, and various problems that may arise from a transfusion, in the perspective of patient safety. Since orofacial surgery has an especially high risk of bleeding due to the complex structures involved and the extensive vascular distribution, measures to prevent bleeding should be taken and the conditions for a transfusion should be optimized and appropriate in order to promote patient safety.

Severe Hyponatremia with Mental Change after Ingestion of Picosulfate Sodium/Magnesium Citrate for Bowel Preparation / 대한내과학회지

Picosulfate sodium/Magnesium citrate (PS/MC) is a common bowel cleansing agent for colonoscopy. It is equally effective and better tolerated by patients with regard to taste and volume than polyethylene glycol. However, because of its osmotically active characteristics, PS/MC can cause plasma volume depletion and electrolyte disturbances, such as hyponatremia. Here, we report a case of severe hyponatremia combined with loss of consciousness in a 59-year-old woman following ingestion of PS/MC as bowel preparation for a screening colonoscopy. Upon arrival, serum sodium level was 109 mEq/L and urine osmolality and sodium levels were 393 mOms/Kg and 99 mmol/L, respectively. She was euvolemic and showed normal kidney, thyroid, and adrenal function. Based on these findings, inappropriate anti-diuretic hormone syndrome (SIADH) was diagnosed. She was treated with 3% hypertonic saline and completely recovered without any neurologic sequelae. This case shows that SIADH can be caused by PS/MC (not accompanied by dehydration), even in patients without any underlying renal, heart, or liver diseases.

Influência da massa muscular e da atividade física nos níveis plasmáticos de creatinina / Influence of muscle mass and physical activity on creatinine plasma levels

Avaliar a creatinina e ureia plasmáticas de indivíduos saudáveis, sem suspeita clínica de disfunção renal, com massa muscular proeminente e que exerciam atividade física extenuante. Métodos: Foram selecionados 49 trabalhadores rurais, cuja coleta de sangue foi realizada à noite (GI/ n=27) ou pela manhã (GII/ n=22). Resultados: No GI, 96,2% dos indivíduos apresentaram níveis elevados de creatinina e, no GII, foram 50%. Conclusão: Considerando que os indivíduos não apresentavam evidências de disfunção renal, mostrando-se clinicamente saudáveis, e que tinham uma atividade laboral pesada de 6-8 horas diárias, é possível inferir, reliminarmente, que, no GI, o somatório da massa muscular e do esforço físico teriam contribuído para esse resultado e, no GII, apenas a massa muscular justificaria o aumento da creatinina. Este estudo demonstrou a possível interferência da atividade física na creatinina plasmática, sinalizando para a necessidade de maior divulgação e controle das orientações aos clientes pelos laboratórios, bem como a onferência da adesão dos indivíduos às mesmas, antes da coleta de sangue,para minimizar a variabilidade pré-analítica nesse exame laboratorial...

Therapeutic Plasma Exchange Using the Spectra Optia Cell Separator Compared With the COBE Spectra

BACKGROUND: The Spectra Optia (SPO) is a novel continuous-flow centrifugal apheresis system based on the COBE Spectra (CSP) platform. There have been few attempts to validate the advantages of the SPO. We performed a retrospective study comparing the two cell separators for therapeutic plasma exchange (TPE) procedures in kidney transplant (KT) patients and seeing efficacy and safety. METHODS: We analyzed 720 TPE procedures performed between August 2012 and July 2014. Procedures included desensitization TPE before KT and TPE for the management of acute and chronic antibody-mediated graft rejection. Demographic characteristics, operational TPE variables, and laboratory data were analyzed. RESULTS: Demographic characteristics for the SPO (n=389) and CSP (n=331) groups did not differ significantly. The procedure time to exchange one plasma volume was 94.2+/-10.3 min in the SPO group and 100.4+/-11.2 min in the CSP group (P<0.001). The plasma removal efficiency (PRE) was 92.5+/-4.9% in the SPO group and 83.2+/-3.7% in the CSP group (P<0.001). There were no significant differences across the two apheresis systems for changes in hematologic parameters. CONCLUSIONS: Compared with the CSP, the SPO was associated with an improved PRE and a shorter procedure time to exchange one plasma volume. Our results in KT patients show that the SPO is superior to the CSP in TPE procedures.

Transfusion-related acute lung injury; clinical perspectives / 대한마취과학회지

Transfusion-related acute lung injury (TRALI) was introduced in 1983 to describe a clinical syndrome seen within 6 h of a plasma-containing blood products transfusion. TRALI is a rare transfusion complication; however, the FDA has suggested that TRALI is the leading cause of transfusion-related mortality. Understanding the pathogenesis of TRALI will facilitate adopting preventive strategies, such as deferring high plasma volume female product donors. This review outlines the clinical features, pathogenesis, treatment, and prevention of TRALI.

Niveles de colinesterasa plasmática en mujeres embarazadas y no embarazadas expuestas a plaguicidas en la zona del Páramo: Mérida-Venezuela / Plasma cholinesterase levels pregnant and non-pregnant women exposed to pesticides Páramo area: Mérida-Venezuela

Se realizó un estudio comparativo y experimental para determinar el nivel plasmático de colinesterasa (con la técnica de Ensayo del reactivo de Ellman) en 51 mujeres embarazadas y 52 no embarazadas, expuestas en forma crónica a insecticidas organofosforados y carbamatos en la zona del páramo merideño y que acudieron a control y/o consulta en el Hospital tipo I de Mucuchíes (Mérida) con la finalidad de establecer la prevalencia de sus efectos en la zona mencionada y la ulterior consecuencia en el producto de la gestación. Los datos se analizaron mediante el software estadístico SPSS versión 15 para Windows. Los resultados mostraron que las pacientes embarazadas con o sin antecedentes patológicos, sus niveles de colinesterasa tienden a disminuir en cierta magnitud, se encontró diferencia estadísticamente significativa entre los niveles de colinesterasa promedio de mujeres embarazadas con antecedentes con respecto a las que no tenían antecedentes, en las mujeres no embarazadas y sin antecedentes que vivían cerca de zonas de cultivo con exposición a plaguicidas el nivel promedio de colinesterasa fue menor al nivel promedio de las mujeres en edad reproductiva no expuestas y una disminución de los valores de colinesterasa promedio en las gestantes menores de 39 años de edad. Se concluyo que las mujeres embarazadas con antecedentes patológicos presentan inhibición de niveles de colinesterasa plasmática con respeto a las no embarazadas y sin antecedentes.

A study was conducted to determine comparative and experimental plasma cholinesterase level (with the assay technique of Ellman's reagent) in 51 pregnant women and 52 non-pregnant, chronically exposed to organophosphate and carbamate wilderness area in Merida and who came to control and / or reference in the type I Mucuchíes Hospital Merida state in order to establish the prevalence of its effects on the area mentioned and further result in the product of gestation. The data were analyzed using SPSS statistical software version 15 for Windows. The results showed that pregnant patients with or without pathological history cholinesterase levels tend to decrease to some extent, statistically significant difference was found between the average cholinesterase levels of pregnant women with a history over which they had no background in nonpregnant women with no history of living near farming areas with pesticide exposure cholinesterase level was lower average to average level of reproductive age women unexposed and decreased average cholinesterase values in pregnant women under 39 years of age. It was concluded that pregnant women with medical history presented inhibition of plasma cholinesterase levels with respect to the non-pregnant and no history.

Plasma volume expanders: classification and characteristics of colloids

Fluid therapy remains an important therapeutic maneuver in managing surgical, medical, and the critically ill intensive care patient. However, the ideal volume replacement strategy remains under debate. The debate on whether patients should be managed with crystalloids, colloids, or both has for many years been mainly a debate about effectiveness. The dispute over crystalloids versus colloids has been enlarged to a colloid versus colloid debate because of the varying properties of different colloids. The natural colloid albumin and artificial colloids such as gelatin, dextran, and hydroxyethyl starch continue to enjoy widespread usage for clinical fluid management. Colloid is an effective plasma volume expander and is able to restore the hemodynamic profile with less total volume than crystalloid. However, colloid is associated with coagulation abnormalities, renal impairment, and allergic reactions. Albumin is considered to be one of the safe colloids. However, due to its cost, albumin cannot be recommended for hypovolemia. Gelatin and dextran can also cause coagulation abnormalities and renal impairment. Dextran is not used anymore due to its high anaphylactic potency. Each hydroxyethyl starch has different properties by concentration, mean molecular weight, molar substitution, and its C2/C6 ratio. New hydroxyethyl starches with a lower mean molecular weight and molar substitution than the old hydroxyethyl starch may be promising by improving volume management therapy with lower risks of coagulation abnormalities and renal impairment. The selection of colloid for plasma volume expansion should be based on the patients' clinical conditions and the characteristics of each colloid.

Coagulation and renal effects of voluven versus haes-steril in major orthopedic surgery

Hydroxyelhyl starch [HES] solutions are effective plasma volume expanders. Impairment of coagulation and renal junction occur with large HES volumes infused perioperatively. Therefore, a lower substituted novel HES [Voluven] was developed to minimize hemostatic interactions. The aim of the study is to evaluate the benefit of voluven to reduce hemostatic interactions and preserve renal junction while preserving its efficacy in restoring plasma volume in comparison to HAES-steril [pentastarch]. After approval of our local institutional university ethical committee, and a written consent was obtained from each one. Fifty consecutive adult patients, ASA I and II, scheduled for elective major orthopedic surgery at Assiut University Hospital were included in the study. The patients were allocated into two equal groups [each of 25 patients] according to the type of the study solution used as plasma volume replacement. Group-A: received [Voluven]. Group-B: received HAES-steril. Hemodynamic parameters: central venous pressure [CVP], mean arterial blood pressure [MABP], and heart rate [HR] were recorded before anesthesia induction [baseline], one hour after induction of anesthesia, at the end of surgery, 5 h after surgery and 24 h after surgery. Coagulation profile: Screening tests: prothrombin time [PT], prothrombin concentration [PC], International Normalized Ratio [INR]], partial thromboplastin time [aPTT] and serum fibrinogen level. Specific tests of haemostasis: factor VIII concentration and von Willebrand factor [vWF], Renal function tests: blood urea nitrogen and serum creatinine. Measurements time: sample were collected one day before surgery ['baseline], at 5 h and 24h after surgery. Amount of given colloids [ml], blood loss [ml] and packed RBCs [ml,] were recorded in all patients in two groups. All patients in the two groups were subjected to the some anesthetic management. Data was statistically analyzed using SPSS program version 16, a p value < 0.05 was considered statistically significant. There were significant differences with time as regard PT, PC, and INR in both groups and there was significant difference between the two groups, more increase in PT, INR and more decrease in PC in Haesteril group than in Voluven group. Voluven produced less inhibitory effect on coagulation factor VIII and Von Willibrand factor concentration and consequently, aPTT in comparison with HA ES-steril. Blood loss and transfusion requirements were less with Voluven group than with HAES-steril group. BUN and serum creatinine significantly changed over time in both groups but still within normal range in Voluven groups, but in Haesteril group there were significantly changed over time, mildly elevated above normal range and there was significant difference between the two groups with more increase in Haestril group. Compared with HAES-steril, Voluven are more likely to produce less coagulation abnormalities and less renal impairment in patients undergoing major orthopedic surgery manifested by less blood loss and less erythrocytes transfusion

Effects of rehydration fluid temperature and composition on body weight retention upon voluntary drinking following exercise-induced dehydration

The purpose of this study was to determine the effects of beverage temperature and composition on weight retention and fluid balance upon voluntary drinking following exercise induced-dehydration. Eight men who were not acclimated to heat participated in four randomly ordered testing sessions. In each session, the subjects ran on a treadmill in a chamber maintained at 37degrees C without being supplied fluids until 2% body weight reduction was reached. After termination of exercise, they recovered for 90 min under ambient air conditions and received one of the following four test beverages: 10degrees C water (10W), 10degrees C sports drink (10S), 26degrees C water (26W), and 26degrees C sports drink (26S). They consumed the beverages ad libitum. The volume of beverage consumed and body weight were measured at 30, 60, and 90 min post-recovery. Blood samples were taken before and immediately after exercise as well as at the end of recovery in order to measure plasma parameters and electrolyte concentrations. We found that mean body weight decreased by 1.8-2.0% following exercise. No differences in mean arterial pressure, plasma volume, plasma osmolality, and blood electrolytes were observed among the conditions. Total beverage volumes consumed were 1,164 +/- 388, 1,505 +/- 614, 948 +/- 297, and 1,239 +/- 401 ml for 10W, 10S, 26W, and 26S respectively (P > 0.05). Weight retention at the end of recovery from dehydration was highest in 10S (1.3 +/- 0.7 kg) compared to 10W (0.4 +/- 0.5 kg), 26W (0.4 +/- 0.4 kg), and (0.6 +/- 0.4 kg) (P < 0.005). Based on these results, carbohydrate/electrolyte-containing beverages at cool temperature were the most favorable for consumption and weight retention compared to plain water and moderate temperature beverages.

Influência dos níveis plasmáticos de lipoproteína de alta densidade na contagem de leucócitos e plaquetas em camundongos dislipidêmicos / Influence of plasma high density lipoprotein levels on leukocyte and platelet count in dyslipidemic mice

Neste estudo experimental investigou-se a influência da dislipidemia nos parâmetros do hemograma. Coletaram-se amostras de sangue de camundongos wild type, alimentados com dieta padrão, e de camundongos knockout para o gene do receptor de lipoproteína de baixa densidade, alimentados com dietas padrão e hiperlipídica. Determinaram-se os parâmetros do hemograma associando-os com os níveis plasmáticos de lipídeos. Os resultados mostraram uma associação negativa entre os níveis plasmáticos de lipoproteína de alta densidade e as contagens total e diferencial de leucócitos e plaquetas nos camundongos knockout para o gene do receptor de lipoproteína de baixa densidade. Essa relação demonstrou importante influência da lipoproteína de alta densidade na modulação da resposta imunológica e inflamatória na dislipidemia. Portanto, a avaliação dos resultados do hemograma correlacionada com os níveis plasmáticos de lipídeos, rotineiramente, pode ser promissora na prevenção e no prognóstico da severidade de quadros patológicos que envolvam respostas imunológicas nas dislipidemias.

The aim of this study was to investigate the influence of dyslipidemia on the hemogram. Blood samples were collected from wild type mice fed a standard diet and from knockout mice for the low density lipoprotein (LDL) receptor gene fed on high-fat and standard diets. The blood cell counts were analyzed for their association with plasma lipid levels. The results showed a negative association between high density lipoprotein (HDL) plasma levels and complete and differential leukocyte and platelet counts in knockout mice for the LDL receptor gene. This relation revealed the important influence of the HDL on the modulation of the immune and inflammatory response in dyslipidemia. Therefore, routine analysis of the hemogram, correlated with the plasma lipid levels, may be valuable in the prevention and prognosis of the severity of pathological processes involving immune responses in dyslipidemia.

Treatment of Recurrent Nephrotic Syndrome after Transplantation / 대한이식학회지

Focal segmental glomerulosclerosis (FSGS) is the most common glomerulopathy that progresses to end-stage renal disease in children. It is also notorious for frequent recurrence after transplantation. The recurrence of FSGS after transplant leads to the loss of the grafts in nearly half of the recurrent cases, especially in those who did not respond to treatment. Remission can be achieved in majority of the recurrent patients as long as the treatment is initiated early enough (<48 hours after onset). Since recurrence typically manifests as massive proteinuria, usually within a few days after the engraftment, close monitoring of proteinuria and prompt treatment on recurrence is advisable. Plasmapheresis to remove the 'circulating factor' been used as a mainstay of treatment of the recurrence; on each session, one to two times of plasma volume is exchanged, and the treatment is continued for 8~12 sessions or until remission is achieved. High dose cyclosporine is another arm of commonly practiced treatment with good result. Recently, depletion of B cells by rituximab has been tried as another option of treatment of recurrence, with excellent response by some and no response by others. Again, prompt administration of the treatment seems critical to achieve remission. The efficacy of pre-emptive, prophylactic plasmapheresis before transplantation is controversial. In summary, the recurrence of primary FSGS is observed in more than half of the children after transplantation. Prompt initiation of treatment would improve the survival. To improve the prognosis of recurrent primary nephrotic syndrome/FSGS, close monitoring and multidisciplinary approach is required.

Efeitos da desidratação sobre desempenho de força de atletas de jiu-jitsu / Effects of dehydration on strength performance of Brazilian Jiu-jitsu fighters

Estratégias destinadas a rápida e drástica redução de peso são comumente adotadas por atletas que competem em eventos de combate esportivo. Portanto, o objetivo do estudo foi determinar o efeito agudo da desidratação induzida por sauna sobre a força e a resistência muscular de atletas de Jiu-jitsu. Onze atletas foram submetidos a um teste de força dinâmica máxima (1RM) no Leg Press nas condições de euhidratação (EH) e desidratação (DES – ~2% do peso) induzida por sauna seca. Em um protocolo adicional, seis voluntários dos onze iniciais também foram submetidos a um teste de resistência muscular localizada (número máximo de repetições com 60% de 1RM no exercício supino reto) e a análise de amostragem sanguínea em ambas as condições (EH e DES). A redução na massa corporal de aproximadamente 2,1% não induziu efeito deletério significativo sobre a força dinâmica máxima (EH 307,72 ± 87,7 kg vs. DES 306,27 ± 88,3 kg; P = 0,148) e a resistência muscular localizada (EH = 29 ± 4 repetições; DES = 28 ± 4 repetições; P= 0,180). Embora a desidratação tenha causado uma redução de 7,6 ± 1,5% no volume plasmático, a concentração de bicarbonato sanguíneo não mudou significativamente (27,2 ± 7,5 vs. 27,5 ± 7,2 mEq/L, condições EH e DES, respectivamente). Concluindo, a desidratação moderada induzida por sauna não afetou significativamente a força e a resistência muscular, além de não induzir alterações nas variáveis bioquímicas associadas ao desempenho de endurance.

Athletes who compete in combat sports events commonly adopt strategies aimed to a fast and drastic weight loss. Therefore, the purpose of this study was to determine the acute effect of sauna- induced dehydration on strength and endurance performance of Brazilian Jiu-jitsu athletes. Eleven athletes performed a one-repetition maximum test (1RM) on a Leg Press exercise in two different hydration states, euhydration (EH) and dry sauna-induced dehydration (DES - 2% of body mass). Additionally, six of the eleven athletes were also submitted to a muscle endurance test (the maximum number of repetitions at 60% of 1RM on a bench press exercise). Blood samples were withdrawn from the same subsample in both hydration conditions. An approximate body mass reduction of 2.1% did not induce a significant deleterious effect on either muscular strength (EH 307.72 ± 87.7 kg vs. DES 306.27 ± 88.3 kg; P = 0.148) or endurance (EH = 29 ± 4 repetitions; DES = 28 ± 4 repetition; P = 0.180). Although dehydration has induced a plasma volume reduction of 7.6 + 1%, plasmatic bicarbonate concentration did not change (EH = 27.2 ± 7.5 vs. DES = 27.5 ± 7.2 mEq/L for EH and DES, respectively). In conclusion, sauna-induced moderate dehydration did not significantly affect either muscular strength or endurance. In addition, no changes were induced on biochemical variables related to the endurance performance.

effect of Ramadan fasting and weight-lifting training on plasma volume, glucose and lipids profile of male weight-lifters

The purpose of the present study was to evaluate the effect of Ramadan fasting and weight-lifting training on plasma volume, glucose, and lipids profile of male weight-lifter. Forty male weight-lifters were recruited and divided into 4 groups [n=10 each] and as the following groups: control [C], fasting [F], training [T] and fasting-training [F-T]. The T and F-T groups performed weight-lifting technique trainings and hypertrophy body building [3 sessions/week, 90 min/session]. All subjects were asked to complete a medical examination as well as a medical questionnaire to ensure that they were not taking any medication, were free of cardiac, respiratory, renal, and metabolic diseases, and were not using steroids. Blood samples were taken at 24 hr before and 24 hr after one month of fasting and weight-lifting exercise. The plasma volume, fasting blood sugar [FBS], lipid profiles, and lipoproteins were analyzed in blood samples. Body weight and plasma volume showed significant [P< 0.05] decrease and increase in the F group [P< 0.05] respectively. Also, a significant reduction was observed in F-T group body weight [P< 0.01]. A significant increase was found in FBS level of F group [P< 0.05]. The lipid profiles and lipoproteins didn't change significantly in C, F, T and the F-T groups. The effect of Ramadan fasting on body weight and plasma volumes may be closely related to the nutritional diet or biochemical response to fasting

The effect of administering colloid solution on the postoperative blood loss in patients who are undergoing total knee arthroplasty: Comparing Hextend with Voluven

BACKGROUND: Total knee arthroplasty (TKR) is associated with a significant loss of blood. Fluid substitution with crystalloid or colloid solutions to correct perioperative hypovolemia is essential. Colloid solutions, and especially hydroxyethyl starches (HES), are used to treat hypovolemia, but they may affect blood coagulation. The purpose of this study was to test the efficacy and the safety of colloid solutions in patients undergoing TKR. METHODS: The patients undergoing TKR were divided into a group that underwent fluid management with Voluven(R) (n = 22) and a group that was managed with Hextend(R) (n = 24). The blood loss, the autotransfused blood volume, the hemoglobin level, the allogenic blood requirement, the urine output and the complications were assessed. RESULTS: There were no significant differences in the amount of blood loss, the autotransfused blood volume, the allogenic requirement, the urine output and the complications between the two groups. CONCLUSIONS: Voluven(R) and Hextend(R) are equally efficacious plasma volume substitutes when performing TKR with an autotransfusion of drained blood.

Effects of anesthesia on fluid volume kinetics after infusion of colloid solution during blood donation / 대한마취과학회지

BACKGROUND: The fluid kinetics of intravenously infused colloid during inhalation anesthesia and hemorrhage have not been investigated. We therefore assessed fluid space changes during infusion of hydroxyethyl starch solution after hemorrhage in conscious and desflurane-anesthetized individuals. METHODS: Following the donation of 400 ml of blood, 500 ml of hydroxyethyl starch solution was infused over 20 minutes into wakeful and desflurane-anesthetized volunteers. Blood was repeatedly sampled to measure hemoglobin concentration, a marker of plasma dilution, and fluid kinetic analysis was performed to evaluate changes in fluid space. RESULTS: Using a fluid kinetic model, we found that the mean volume of fluid space was 7,724 +/- 1,788 ml in wakeful volunteers and 6,818 +/- 4,221 ml in anesthetized volunteers, and the elimination rate constants were 7.1 +/- 3.5 ml/min and 19.4 +/- 4.6 ml/min, respectively. CONCLUSIONS: Infusion of colloid after mild hemorrhage resulted in similar expansions of plasma volume in desflurane-anesthetized and conscious individuals. During anesthesia, however, the expansion of plasma volume by colloid was decreased and of shorter duration than observed in conscious patients.

Central actions of glucocorticoids in the control of body fluid homeostasis: review

The involvement of the hypothalamic-pituitary-adrenal axis in the control of body fluid homeostasis has been extensively investigated in the past few years. In the present study, we reviewed the recent results obtained using different approaches to investigate the effects of glucocorticoids on the mechanisms of oxytocin and vasopressin synthesis and secretion in response to acute and chronic plasma volume and osmolality changes. The data presented here suggest that glucocorticoids are not only involved in the mechanisms underlying the fast release but also in the transcriptional events that lead to decreased synthesis and secretion of these neuropeptides, particularly oxytocin, under diverse experimental conditions of altered fluid volume and tonicity. The endocannabinoid system, through its effects on glutamatergic neurotransmission within the hypothalamus and the nuclear factor κB-mediated transcriptional activity, seems to be also involved in the specific mechanisms by which glucocorticoids exert their central effects on neurohypophyseal hormone synthesis and secretion.