Functional improvements associated with cranioplasty after stroke and traumatic brain injury: a cohort study.

OBJECTIVE: Decompressive craniectomy is part of the acute management of several neurosurgical illnesses, and is commonly followed by cranioplasty. Data are still scarce on the functional and cognitive outcomes following cranioplasty. We aim to evaluate these outcomes in patients who underwent cranioplasty following traumatic brain injury (TBI) or stroke. METHODS: In this prospective cohort, we assessed 1-month and 6-month neuropsychological and functional outcomes in TBI and stroke patients who underwent cranioplasty at a Brazilian tertiary center. The primary outcome was the change in the Digits Test at 1 and 6 months after cranioplasty. Repeated measures general linear models were employed to assess the patients' evolution and interactions with baseline characteristics. Effect size was estimated by the partial η2. RESULTS: A total of 20 TBI and 14 stroke patients were included (mean age 42 ± 14 years; 52.9% male; average schooling 9.5 ± 3.8 years; 91.2% right-handed). We found significant improvements in the Digits Tests up to 6 months after cranioplasty (p = 0.004, partial η2 = 0.183), as well as in attention, episodic memory, verbal fluency, working memory, inhibitory control, visuoconstructive and visuospatial abilities (partial η2 0.106-0.305). We found no interaction between the cranioplasty effect and age, sex or schooling. Patients submitted to cranioplasty earlier (<1 year) after injury had better outcomes. CONCLUSION: Cognitive and functional outcomes improved after cranioplasty following decompressive craniectomy for stroke or TBI. This effect was consistent regardless of age, sex, or education level and persisted after 6 months. Some degree of spontaneous improvement might have contributed to the results.

Aspectos clínicos e laboratoriais da mastite induzida por inoculação intramamária de Staphylococcus aureus em vacas e búfalas / Clinical and laboratory aspects of mastitis induced by intramammary inoculation of Staphylococcus aureus in cows and buffaloes

Vários aspectos relacionados à mastite bubalina precisam ser esclarecidos. Muitas condutas são adaptadas a essa espécie pelo conhecimento adquirido com a espécie bovina. Com este experimento, objetivou-se evidenciar particularidades da mastite em búfalas e vacas que tiveram uma glândula inoculada com 1,0 x 103 UFC de S. aureus. Os animais foram monitorados por cultura bacteriana do leite, California Mastitis Test (CMT), e escores para avaliação da severidade da mastite. Foram utilizados os seguintes critérios: temperatura retal, apetite, produção de leite (resposta sistêmica à inflamação), contagem de células somáticas (CCS), aparência/consistência da glândula e aparência da secreção láctea (resposta localizada à inflamação). Todos os animais desenvolveram mastite clínica superaguda. A bactéria foi recuperada de todas as glândulas desafiadas, sem diferença significativa no percentual de isolamento entre as espécies até o 11º dia pós-inoculação, porém com diferença (P<0,001) no 30º dia pós-inoculação. A CCS pelo método eletrônico e o CMT detectaram nas búfalas resposta mais intensa logo após a inoculação e diminuição mais rápida da contagem ao final do experimento, quando se comparou essa espécie com as vacas. Ambos os testes demonstraram correlação com a cultura bacteriana. Na avaliação da severidade da mastite, as médias do escore total, do escore da resposta local e do escore da resposta sistêmica foram mais elevadas na espécie bovina (P<0,05). Ao longo do período de observação, verificou-se uma capacidade superior das búfalas em recuperar o status sanitário adequado, chegando, ao final do experimento, com os parâmetros avaliados mais próximos dos fisiológicos...

Several aspects related to bubaline mastits need to be clarified. Many conducts are adapted to this species by the knowledge adquired with the bovine species. This experiment aimed to evidence particularities of mastits in buffaloes and cows submitted to one-gland inoculation with 1.0 x 103 CFU of S. aureus. The animals were monitored through bacterial culturing milk, California Mastitis Test (CMT) and scores to assess the severity of mastitis. The following criteria were used: rectal temperature, appetite, milk production (systemic response to inflammation), somatic cell count (SCC), appearance/consistency of the gland and appearance of the milk secretion (localized response to inflammation). All animals developed hyperacute clinical mastitis. The bacteria was recovered from all challenged glands, with no significant difference in the percentage of isolation between the species until day 11 after inoculation, but with a difference (p<0.001) on day 30 post inoculation. The SCC with the electronic method and CMT, detected in buffaloes a more intense response right after the inoculation and a faster decrease of counting by the end of the experiment, when compared to cows. In both tests correlation with the bacterial culture was detected. In assessing the severity of mastitis, the averages of total score, of the score of local response and the systemic response score were higher in the bovine species (P<0.05). Throughout the observation period, there was a higher capacity of buffaloes in reaching the appropriate sanitary status, coming to the end of the experiment with the parameters closer to the physiological...

Immunophenotyping and remodeling process in small airways of idiopathic interstitial pneumonias: functional and prognostic significance.

BACKGROUND AND AIMS: To test whether different degrees of immunologic and fibrotic airway remodeling processes occur in idiopathic interstitial pneumonias (IIPs), with impact on functional tests and survival, we studied the collagen/elastic system and immune cell density in the bronchiolar interstitium of lungs with the major types of IIPs. MATERIALS AND METHODS: Histochemistry, immunohistochemistry and morphometric analysis were used to evaluate collagen/elastic fibers and immune cells in the bronchiolar interstitium of open lung biopsies of patients with cryptogenic organizing pneumonia [COP/organizing pneumonia (OP) = 10], acute interstitial pneumonia [AIP/diffuse alveolar damage (DAD) = 20], nonspecific interstitial pneumonia (NSIP/NSIP = 20) and idiopathic pulmonary fibrosis/usual interstitial pneumonia (UIP) = 20. RESULTS: OP lungs presented a significant increase in collagenous/elastic fibers and in the total density of immune cells in the bronchiolar interstitium compared to controls, DAD, NSIP and UIP. We observed a significant increase in CD4, CD8 and CD20 lymphocytes, as well as in neutrophils, macrophages and plasma cells in OP. The increased amount of elastic fibers in the bronchiolar interstitium from OP lungs has a direct association with forced vital capacity (FVC) (r(s) = 0.99, P = 0.03). The most important survival predictor was CD20+ lymphocytes in the bronchiolar interstitium. In decreasing order, patients with UIP [Odds Ratio (OR) = 35.01], high forced expiratory volume in 1 s (FEV(1))/FVC FVC (OR = 7.01), increased CD20+ lymphocytes (OR = 4.44) and collagenous/elastic fiber densities (OR = 2.03 and OR = 1.49, respectively) in the bronchiolar interstitium were those who had the greatest risk of death, followed by those with AIP, NSIP and COP. CONCLUSION: Different degrees of immunologic and fibroelastotic airway remodeling processes occur in the major types of IIPs with impact on physiological tests and survival.

Effect of storage xyloglucans on peritoneal macrophages.

Xyloglucans from seeds of Copaifera langsdorffii (XGC), Hymenaea courbaril (XGJ) and Mucuna sloanei (XGM) were obtained from milled and defatted cotyledons by aqueous extraction at 25 degrees C. The resulting fractions contained Glc, Xyl and Gal in molar ratios of 2.5: 1.5: 1.0 (XGC), 3.8: 2.6: 1.0 (XGJ) and 2.5: 1.6: 1.0 (XGM). HPSEC-MALLS/RI analysis showed that each polysaccharide fraction was homogeneous; M(w) values were 1.6 x 10(5), 2.0 x 10(5) and 1.5 x 10(5)g/mol, respectively. The effect of the xyloglucans on the production of O(2)*(-) and NO* and on the recruitment of macrophages to the mouse peritoneum was evaluated. All polysaccharides promoted an increase in the number of peritoneal macrophages in a dose-dependent manner. The largest increase, of 576% in comparison to the control group, was elicited by XGJ at 200 mg/kg. The effect of XGC, XGJ and XGM on O(2)*(-) production, in the presence or absence of phorbol 12-myristate 13-acetate (PMA), was not statistically significant. For NO(.) production, the lowest concentration of XGC (10 microg/ml) gave rise to an increase of 262% when compared to the control group; the effect was dose-dependent, reaching 307% at 50 microg/ml. On the other hand, XGJ at a concentration of 50 microg/ml enhanced NO* production by 92%. XGM did not affect NO* production significantly. The results indicate that xyloglucans from C. langsdorffii, H. courbaril and M. sloanei have immunomodulatory activity.