Early appearance of functional plasma cells (CD138+CD98+) in non-immunized neonate mice.

Plasma cells (PCs) are terminally differentiated antibody-secreting cells, derived from activated B-lymphocytes in response to either T-independent or T-dependent antigens. The plasma cell population is scarce in circulation in non-immunized individuals. It is established that neonates are incapable of mounting an efficient immune response due to the immaturity of the immune system. However, this disadvantage is well overcome through the antibodies neonates receive from breastmilk. This implies that neonates will be only protected against antigens the mother had previously encountered. Thus, the child might be potentially susceptible to new antigens. This issue prompted us to seek for the presence of PCs in non-immunized neonate mice. We found a PC population identified as CD138+/CD98+ cells since day one after birth. These PCs were positive for Ki67 and expressed Blimp-1, B220, and CD19, which suggests the populations are plasmablasts and PCs with heterogeneous phenotype. These PCs were also determined to secrete antibodies, although mainly isotype IgM. Altogether, the results indicated that neonate PCs can produce antibodies against antigens they encounter in the first weeks of life, most likely coming from food, colonizing microbiota, or the environment.

Chronic intake of moderate fat-enriched diet induces fatty liver and low-grade inflammation without obesity in rabbits.

Non-Alcoholic Fatty Liver Disease (NAFLD) is the cause of chronic liver disease. Even though NAFLD is strongly associated with obesity and metabolic syndrome, there is a proportion of patients who develop this condition in the absence of obesity and the underlying mechanisms are poorly understood. We investigated early events in the pathogenesis of non-obese NAFLD, analyzing the impact of the chronic intake of a moderate fat-enriched diet on hepatic lipid accumulation and their relationship with inflammation. Rabbits fed with a moderate Fatty-Acid- Enriched Diet 3% palmitic acid (FAED), were evaluated for body weight, biochemical parameters, and liver function. Liver samples were analyzed by histology and RT-qPCR to measure lipid accumulation, the expression of inflammation-related genes IL-1ß, IL-6, IL-10, IL-13, IL-18, COX-2, TNF-α, and TLR-4. Chronic consumption by 6-months of FAED did not generate metabolic changes, but it induced fatty liver. We also observed the development of low-grade inflammation characterized by the up regulation of TNF-α, IL-13 and IL-18. The consumption by 12-months of FAED caused the overexpression of IL-6, IL-10, IL-13, COX-2, and TLR-4. We show that hepatic steatosis is an early consequence of fat-enriched diets, and that it is accompanied by an immune response that exerts protective effects that prevent the development of metabolic disorders, such as overweight/obesity and metabolic syndrome. However, the excessive intake of fatty acids renders these mechanisms less efficient for delaying the start of metabolic alterations. Rabbits fed with FAED can be used as a model of NAFLD in non-obese and obese groups, especially at early stages of the disease.

Artificial phrenoesophageal ligament. An experimental study in dogs.

This report deals with the preparation of a 'true' artificial phrenoesophageal ligament aimed at restoring effective anchoring of the esophagus to the diaphragm, keeping the esophagogastric sphincter in the abdomen. A total of 24 mongrel dogs were assigned to four groups: (i) Group I (n = 4): the esophageal diaphragm hiatus left wide open; (ii) Group II (n = 8): the anterolateral esophagus walls were attached to the diaphragm by the artificial ligament and the esophageal hiatus was left wide opened; (iii) Group III (n = 5): in addition to the use of the artificial ligament, the esophageal hiatus was narrowed with two retroesophageal stitches; (iv) Group IV (n = 7): the only procedure was the esophageal hiatus narrowing with two retroesophageal stitches. The phrenoesophagogastric connections were released, sparing the vagus nerves. Five animals of groups III and IV, which did not develop hiatal hernia, were submitted to esophageal manometry immediately before and 15 days after surgery. In group I, all animals developed huge sliding hiatal hernias. In group II, two dogs (25%) had a paraesophageal hernia between the two parts of the artificial ligament. In group III, neither sliding hiatal hernia nor paraesophageal hernia occurred. In group IV, two animals (28.6%) developed sliding esophageal hiatus hernia. Regarding esophageal manometry, postoperative significant difference between groups III and IV (P = 0.008) was observed. Thus, the artificial phrenoesophageal ligament maintained the esophagus firmly attached to the diaphragm in all animals and the esophagogastric sphincter pressure was significantly higher in this group.

Mensuração de área de cicatrização por planimetria após aplicação do ultra-som de baixa intensidade em pele de rato / Measurement of healing area using planimetry after applying low-intensity ultrasound to the skin of rats

CONTEXTUALIZAÇÃO: A planimetria é um método utilizado para avaliar a evolução da cicatrização de feridas. A planimetria computacional é um método ainda em experimentação, mas cujas vantagens têm sido demonstradas em várias investigações. OBJETIVOS: Avaliar os efeitos do ultra-som pulsado de baixa intensidade sobre a cicatrização de lesão cutânea produzida na região dorsal de ratos, por meio da planimetria computacional. MATERIAIS E MÉTODOS: Utilizou-se 60 ratos machos Wistar (peso médio de 300g) divididos em dois grupos com 30 animais cada, de acordo com o tratamento: 1) irradiação simulada (controle); 2) irradiação efetiva (Freqüência fundamental de 1,5MHz, freqüência de repetição de pulsos de 1KHz, largura de pulso de 200µs, intensidade de 30mW/cm² SATA, dez minutos de aplicação em dias alternados). Cada grupo foi subdividido em três grupos, de acordo com o período de irradiação ultra-sônica, de três, sete e 14 dias, respectivamente, e a cicatrização foi avaliada por meio da planimetria, um decalque da lesão sendo obtido em papel especial, digitalizado e medido ao computador por meio de um programa gráfico. Análise estatística pelo método não-paramétrico de Mann-Whitney. RESULTADOS: Houve aumento significante (p<0,05) da área cicatrizada no grupo 2 (141,88±18,50mm²) em relação ao grupo 1 (117,38±15,14mm²), no 14º dia. Não houve diferenças significantes entre os grupos nos demais períodos. CONCLUSÕES: O ultra-som pulsado de baixa intensidade estimula a cicatrização cutânea por segunda intenção em condições experimentais. A planimetria computacional mostrou-se um recurso de baixo custo, fácil manuseio e de aplicabilidade clínica.

BACKGROUND: Planimetry is a method used to evaluate the progression of skin wound healing. Computerized planimetry is still an experimental method, but its advantages have been demonstrated in several investigations. OBJECTIVE: To evaluate the effects of low-intensity pulsed ultrasound on the healing of a skin lesion produced on the dorsal region of rats, by means of computerized planimetry. METHODS: Sixty male Wistar rats of mean weight 300g were used. They were divided into two groups according to the treatment applied: 1) simulated irradiation (control); 2) effective irradiation (fundamental frequency 1.5MHz, pulse repetition frequency 1KHz, pulse width 200µs, SATA intensity 30mW/cm² and application for ten minutes on alternate days). Each group was divided into three subgroups according to the length of time for which ultrasound irradiation was applied of three, seven and 14 days, respectively, and healing was evaluated by means of planimetry; a tracing of the wound was obtained on special paper and this was digitized and measured by means of a graphing software. Statistical analysis was performed using the Mann-Whitney non-parametric method. RESULTS: The healed area was significantly greater (p<0.05) in group 2 (141.88±18.50mm²) than in group 1 (117.38±15.14mm²) on the 14th day. There were no significant differences between the subgroups for the other experimental periods. CONCLUSIONS: Low-intensity pulsed ultrasound irradiation stimulated secondary skin healing under these experimental conditions. Computerized planimetry was shown to be a low cost method that was easy to use and present clinical applicability.

Mutiröes de colecistectomia por videolaparoscopia em regime de cirurgia ambulatorial / Intensive program of videolaparoscopy cholecystectomy on an ambulatory surgery basis

Introduçäo: As listas de espera para colecistectomia, associadas à elevada demanda dos leitos e salas cirúrgicas dos Hospitais Universitários, säo incentivos para adoçäo de novos programas de assistência. Objetivo: Avaliar o processo de organizaçäo e os resultados clínicos dos Mutiröes de Colecistectomia por Videolaparoscopia, em regime de Cirurgia Ambulatorial. Pacientes e Métodos: Dentre os 314 pacientes portadores de colelitíase sintomática que aguardavam cirurgia no HCFMRP-USP, 160 foram selecionados para tratamento em regime ambulatorial. Uma equipe multiprofissional, formada por cirurgiöes, anestesistas, enfermeiros e assistentes sociais, programou 4 mutiröes para serem realizados em fins de semana, em funçäo da disponibilidade do bloco cirúrgico e da sala de recuperaçäo pós-anestésica. Mediante avaliaçäo retrospectiva, foram analisados 79 prontuários dos pacientes operados nos Mutiröes I e II (Grupo A) e 79 dos 80 operados nos Mutiröes III e IV (Grupo B). Análise estatística: teste de Wilcoxon e exato de Fisher (p<0,05). Resultados: As co-morbidades foram registradas em 48 pacientes do Grupo A - (60,8 por cento) e em 31 do Grupo B (39,8 por cento) (p=0,007). A inflamaçäo aguda e a escleroatrofia da vesícula foram observadas em 10 pacientes do Grupo A (12,7 por cento) e em 2 do Grupo B (2,6 por cento). A duraçäo média das operaçöes, em minutos, foi de 90 (25-240) no Grupo A e de 68,2 (20-180) no Grupo B (p=0,002). Houve uma conversäo em cada Grupo (1,3 por cento). A profilaxia da dor e dos vômitos foi realizada, respectivamente, em 13 (16,4 por cento) e em 2 (2,5 por cento) pacientes do Grupo A. No Grupo B, 63 pacientes (79,7 por cento) receberam analgésicos e 73 (92,5 por cento) antieméticos de forma profilática. A dor abdominal, os vômitos e os sintomas cardiorespiratórios, na recuperaçäo pós-anestésica, acometeram, respectivamente, 34 (43 por cento), 18 (22,6 por cento) e 10 (12,6 por cento) dos pacientes do Grupo A e 18 (22,8 por cento), 14 (17,7 por cento) e 3 (3,8 por cento) do Grupo B. A necessidade de pernoite foi maior no Grupo A: 45 pacientes (50,7 por cento) com permanência hospitalar média de 18,3 horas (8,2-26), enquanto no Grupo B houve 5 pernoites e a média de permanência foi de 7,5 horas (4-24) (p=0,000). Ocorreram 5 internaçöes no Grupo A (6,3 por cento) e 2 no Grupo B (2,5 por cento)...

Mutirões de colecistectomia por videolaparoscopia em regime de cirurgia ambulatorial

Introduction: The growing list of patients awaiting cholecystectomy, together with the great demand for beds and operating rooms at University Hospitals have encouraged the adoption of different solutions. Objective: To evaluate the process of organization and the clinical results of intensive programs of cholecystectomy by videolaparoscopy on an ambulatory surgery basis. Methods: Among the 314 patients with symptomatic cholelithiasis who were waiting for surgery at HCFMRP-USP, 160 were selected for treatment on an ambulatory basis. A multiprofessional team consisting of surgeons, anesthesiologists, nurses and social workers scheduled 4 intensive programs to be performed on weekends according to the availability of the surgical block and of the post-anesthesia recovery room. In a retrospective evaluation, the authors analyzed 79 medical records of patients operated upon in the intensive programs I and II (Group A) and 79 records of the 80 patients operated upon in the intensive programs III and IV (Group B). Statistical analysis was concluded using the Wilcoxon and Fisher's exact tests, with the level of significance of p=0.05. Results: Co-morbidities were recorded for 48 patients of Group A (60.8%) and for 31 of Group B (39.8%), p=0.007. Acute inflammation and scleroatrophy of the gallbladder were observed in 10 patients of group A (12.7%) and in 2 patients of group B (2.6%). The mean duration of surgery was 90 minutes (25-240) for group A and 68.2 minutes (20-180) for group B, p=0.002. There was one conversion in each group (1.3%). Prophylaxis for pain and vomiting was performed in 13 (16.4%) and 2 (2.5%) patients of group A, respectively. In group B, 63 patients (79.7%) received prophylaxis with analgesics and 73 (92.5%) with anti-emetics. Abdominal pain, vomiting and cardiorespiratory symptoms during post-anesthetic recovery involved 34 (43%), 18 (22.6%) and 10 (12.6%) of the patients in group A and 18 (22.8%), 14 (17.7%) and 3 (3.8%) of the patients in group B. The need for an overnight stay was greater in group A: 45 patients (50.7%) with a mean hospital stay of 18.3 hours (2.2-26), while in group B 5 patients stayed overnight and the mean permanence time was 7.8 hours (4-24), p=0.000. Five hospital admissions occurred in group A (6.3%) and 2 in group B (2.5%). Medical re-evaluation during the first week was necessary for 8 patients of group A (10.2%) and resulted in 3 readmissions (3.8%). In group B, 2 patients (2.6%) sought health services but did not require readmission. In group A, 2 patients presented coliperitoneum and 1 was re-operated upon. No death occurred in either group. Conclusion: As experience was gained in these programs, the process of patient selection and the offer of preoperative care were improved, demonstrating that intensive programs of videolaparoscopic cholecystectomy are a possible strategy for the reduction of waiting lists.

Introdução: As listas de espera para colecistectomia, associadas à elevada demanda dos leitos e salas cirúrgicas dos Hospitais Universitários, são incentivos para adoção de novos programas de assistência. Objetivo: Avaliar o processo de organização e os resultados clínicos dos Mutirões de Colecistectomia por Videolaparoscopia, em regime de Cirurgia Ambulatorial. Pacientes e Métodos: Dentre os 314 pacientes portadores de colelitíase sintomática que aguardavam cirurgia no HCFMRP-USP, 160 foram selecionados para tratamento em regime ambulatorial. Uma equipe multiprofissional, formada por cirurgiões, anestesistas, enfermeiros e assistentes sociais, programou 4 mutirões para serem realizados em fins de semana, em função da disponibilidade do bloco cirúrgico e da sala de recuperação pós-anestésica. Mediante avaliação retrospectiva, foram analisados 79 prontuários dos pacientes operados nos Mutirões I e II (Grupo A) e 79 dos 80 operados nos Mutirões III e IV (Grupo B). Análise estatística: teste de Wilcoxon e exato de Fisher (p 0,05). Resultados: As co-morbidades foram registradas em 48 pacientes do Grupo A - (60,8%) e em 31 do Grupo B (39,8%) (p=0,007). A inflamação aguda e a escleroatrofia da vesícula foram observadas em 10 pacientes do Grupo A (12,7%) e em 2 do Grupo B (2,6%). A duração média das operações, em minutos, foi de 90 (25-240) no Grupo A e de 68,2 (20-180) no Grupo B (p=0,002). Houve uma conversão em cada Grupo (1,3%). A profilaxia da dor e dos vômitos foi realizada, respectivamente, em 13 (16,4%) e em 2 (2,5%) pacientes do Grupo A. No Grupo B, 63 pacientes (79,7%) receberam analgésicos e 73 (92,5%) antieméticos de forma profilática. A dor abdominal, os vômitos e os sintomas cardiorespiratórios, na recuperação pós-anestésica, acometeram, respectivamente, 34 (43%), 18 (22,6%) e 10 (12,6%) dos pacientes do Grupo A e 18 (22,8%), 14 (17,7%) e 3 (3,8%) do Grupo B. A necessidade de pernoite foi maior no Grupo A: 45 pacientes (50,7%) com permanência hospitalar média de 18,3 horas (8,2-26), enquanto no Grupo B houve 5 pernoites e a média de permanência foi de 7,5 horas (4-24) (p=0,000). Ocorreram 5 internações no Grupo A (6,3%) e 2 no Grupo B (2,5%). A reavaliação médica, na primeira semana, foi necessária em 8 pacientes do Grupo A (10,2%) e redundou em 3 readmissões (3,8%). No Grupo B, 2 pacientes (2,6%) procuraram o serviço de saúde e a readmissão não foi necessária. No Grupo A, 2 pacientes apresentaram coleperitônio e 1 foi reoperado; não houve óbitos em nenhum Grupo. Conclusão: O aprimoramento no processo de seleção e nos cuidados perioperatórios para colecistectomia videolaparoscópica, em regime ambulatorial, assegura o tratamento, na forma de mutirões, como estratégia eventual de redução das listas de espera.