Investigation of the effect of intracolonic melatonin gel formulation on acetic acid-induced colitis.

The aims of the present study were to develop a colon-specific gel formulation of melatonin with sodium alginate and to evaluate its in vitro characteristics and intracolonic performance on oxidative stress parameters, such as nitric oxide (NOx), malondialdehyde (MDA) and glutathione (GSH) levels in rats with acetic acid-induced colitis. The melatonin-alginate gel formulations were prepared and their physico-pharmaceutical properties were determined. Formulation M5, which contained 3% of sodium alginate and 20% polyethylene glycol, was used for in vivo studies. The in vivo studies were conducted in rats with acetic acid-induced colitis. NOx, MDA and GSH levels were determined and histological investigations were performed. It was found that formulation M5 was the most suitable formulation for the colon-specific melatonin gel, in terms of pH, viscosity, drug release and mucoadhesion properties. The MDA levels in the tissues of Group 2 (treated with an intracolonic gel formulation without melatonin) were found to be significantly higher than in Group 1 (the untreated group). NOx levels decreased with the intracolonic and systemic melatonin treatment in the colitis-induced rats. Neither intracolonic nor intra-peritoneal (IP) melatonin treatment affected GSH levels. The epitelization of the colon tissues in groups administered with intracolonic melatonin, IP melatonin, and the intracolonic gel formulation without melatonin was much better than that found in the untreated group. It was concluded that melatonin participated in various defense mechanisms against the colonic inflammatory process, and that the dose, route and formulation type were the most important parameters in the effectiveness of melatonin.

Investigation of the effects of local glutathione and chitosan administration on incisional oral mucosal wound healing in rabbits.

The aim of the present study was to investigate the effects of local glutathione (GSH) and chitosan applications on the oxidant events and histological changes that occur, during healing processes in rabbits with incisional intraoral mucosal wounds. For this purpose, discs containing glutathione and chitosan (1:1) were prepared and their physicochemical characteristics were evaluated. New Zealand white rabbits were used in in vivo studies. A standard incision was applied to the oral mucosa of rabbits. The rabbits were divided into four groups, being: an untreated incisional group (n=6), a group treated with discs containing GSH+chitosan (n=6), a group treated with discs containing solely chitosan (n=5) and a group treated with discs containing solely GSH (n=5). The levels of malondialdehyde (MDA), glutathione and nitric oxide (NOx) in the oral wound tissues were measured on the fifth day after the injury. Histological changes in the wound tissues were also investigated. The tissue MDA levels in the group treated with the disc containing GSH+chitosan were found to be lower than those in the other groups. There were no statistically significant differences in terms of tissue GSH and NOx levels between the group treated with the disc comprising GSH+chitosan and the control group that had untreated incision wounds. According to the histological findings, wound healing in the group treated with the disc containing solely chitosan was found to be better than in the other groups. The results of the experiments showed that the local application to the intraoral incision wounds of chitosan+GSH, and chitosan alone, can be effective in the wound healing processes of soft tissues and dental implants.

Ultrastructural changes in blood vessels in epidermal growth factor treated experimental cutaneous wound model.

This study investigates the impact of epidermal growth factor (EGF) on blood vessels, specifically on the development of intussusceptive angiogenesis in cutaneous wound healing. Excisional wounds were formed on both sides of the medulla spinalis in dorsal location of the rats. The control and EGF-treated groups were divided into two groups with respect to sacrifice day: 5 d and 7 d. EGF was topically applied to the EGF-treated group once a day. The wound tissue was removed from rats, embedded in araldite and paraffin, and then examined under transmission electron and light microscopes. The ultrastructural signs of intussusceptive angiogenesis, such as intraluminal protrusion of endothelial cells and formation of the contact zone of opposite endothelial cells, were observed in the wound. Our statistical analyses, based on light microscopy observations, also confirm that EGF treatment induces intussusceptive angiogenesis. Moreover, we found that induction of EGF impact on intussusceptive angiogenesis is higher on the 7th day of treatment than on the 5th day. This implies that the duration of EGF treatment is important. This research clarifies the effects of EGF on the vessels and proves that EGF induces intussusceptive angiogenesis, being a newer model with respect to sprouting type.

Experiencia de atención al paciente politraumatizado en Urgencias del Hospital General de Granollers / No disponible

Objetivos: 1) Presentar y describir el perfil y los procedimientos llevados a cabo en los pacientes que acuden al Servicio de Urgencias con criterio de activación del protocolo de paciente politraumatizado; 2) unificar los criterios de actuación de todos los profesionales que intervienen en la asistencia para acelerar la atención inicial, diagnóstico y tratamiento de los mismos; 3) conocer qué técnicas, pruebas y actuaciones que se realizan con mayor frecuencia en un paciente politraumatizado; y 4) actualizar el protocolo de actuación al paciente politraumatizado existente en el centro desde 1996. Material y método: Se ha realizado un estudio observacional prospectivo en el que se incluyeron a 26 pacientes visitados en el Servicio de Urgencias con criterio de activación del protocolo de politrauma durante los meses de enero a abril de 2007. Se analizaron las siguientes variables: filiación, edad, sexo, atención prehospitalaria, tiempos de actuación, maniobras extra- e intrahospitalarias, constantes vitales, mecanismos lesionales, derivaciones y destinos, pruebas complementarias, tipos de traumatismos y medicación. Resultado: Se visitaron un total de 19 hombres y 7 mujeres, con una media de edad de 23 años y una permanencia en Urgencias de 3,9 horas. El 75% de los pacientes fue asistido por el equipo de Extrahospitalaria. El 32% de los accidentes sucedió en vehículos de 2 ruedas. El 50% presentaba TCE (traumatismo craneoencefálico). El 40% fue derivado al Hospital Vall d’Hebron como centro de referencia. Un 0,3% fueron éxitus en el Servicio de Urgencias. Conclusiones: El perfil del paciente politraumatizado asistido en Urgencias es un varón de entre 19 y 25 años, con traumatismo craneoencefálico y traumatismo en extremidades y tórax, producido por accidente de motocicleta. Su primera asistencia es realizada por el servicio de asistencia extrahospitalario y su destino una vez visitado y estabilizado será traslado al Hospital Vall d’Hebron para la realización de pruebas o ingreso. Es necesario unificar los criterios de actuación de diferentes profesionales frente a una misma situación(AU)

Background: The polytraumatic patient is, beyond all doubt, an important problem in public health. Every year people have thousands of accidents from which many people get permanently injured or may even die. The emergency care of this kind of patient should be effective and conducted by a team trained in emergency situations. Objectives: 1) To show and to describe the polytraumatic patient's profile; 2) to unify the professionals' viewpoint in the polytraumatic patient's care; and 3) to update de polytraumatic patient's protocol. Materials and methods: Observational prospective analysis from January to April 2007 from 26 polytraumatic patients performed shortly after the trauma. Results: The participants were 19 male and 7 female (median 23 years). The average time in Emergency Department was 3,9 hours. Approximately 75% of them were assisted by the Prehospital Emergency Care. The traffic accident by two-wheeled vehicles were 32%. The presence of a traumatic head injury was 50%. The interhospitalary transfer was 40% and the Hospital Vall d'Hebron was our reference center. About 0,3% of the patients died in the Fundación Hospital Asil de Granollers. Conclusions: The profile of the patient treated in the Fundación Hospital Asil de Granollers was a young male (19-25 years) with a traumatic head, thoracic and extremities injury. The most common accident mechanism was a motorcycle accident and all of them received treatment at the accident site. The length of primary hospital stay was 3,9 hours and after that, the patients were transferred and followed up in the Hospital Vall d'Hebron in Barcelona. It's important to put in place an interdisciplinary protocol for the activation and care of the polytraumatic patient, and reviewing the 1996 protocol is a good way to start(AU)

A role for tachykinins in the regulation of human sperm motility.

BACKGROUND: Tachykinins and tachykinin receptors are widely distributed in the male reproductive tract and appear to be involved in reproduction. However, the function and expression of tachykinins and their receptors in human spermatozoa remain poorly studied. We analysed the effects of tachykinins on sperm motility and characterized the population of tachykinin receptors in human spermatozoa. METHODS AND RESULTS: Motility analysis was performed following World Health Organization guidelines and we found that substance P (SP), human hemokinin-1 (hHK-1), neurokinin A (NKA) and neurokinin B (NKB) produced concentration-dependent increases in sperm progressive motility. The effects of tachykinins were antagonized by the NK(1) receptor-selective antagonist SR 140333, the NK(2) receptor-selective antagonist, SR 48968 and, to a lesser extent, also by the NK(3) receptor-selective antagonist SR 142801. Immunocytochemistry studies showed expression of the NK(1), NK(2) and NK(3) tachykinin receptor proteins in spermatozoa with different major sites of localization for each receptor. Western blot analysis confirmed the presence of tachykinin receptors in sperm cell homogenates. RT-PCR demonstrated expression of the genes that encode SP/NKA (TAC1), NKB (TAC3) and hHK-1 (TAC4) but not the genes TACR1, TACR2 and TACR3 encoding NK(1), NK(2) and NK(3) receptors, respectively. CONCLUSIONS: These results show for the first time that the NK(1), NK(2) and NK(3) tachykinin receptor proteins are present in human spermatozoa. Our findings suggest that tachykinins, probably acting through these three tachykinin receptors, play a role in the regulation of human sperm motility.

A microscopic study of kidney tissue in Familial Mediterranean Fever patients.

Familial Mediterranean Fever (FMF) is an autosomal recessive hereditary disease leading mostly to renal failure and nephrotic syndrome. The ultrastructure of kidney has not been fully investigated in FMF associated renal disease. The aim of this study is to provide further evidence on the ultrastructure of kidney in patients with FMF who suffer from renal disease. Renal biopsies obtained from two patients who were diagnosed with FMF renal disease complications were examined. Examination of renal tissue by light and electron microscopy identified degenerations both in tubules and the filtration barrier. Foot processes were partly effaced. Amorphous material was found in thickened glomerular basement membranes. Fibrous material deposits in thick Bowman's capsule wall were also seen. Finally, degeneration in the form of folding of plasma membrane and vacuolization as well as fusion in mitochondria cristae, was observed. Accumulation of tissue remnants in the lumen was also found in tubules.

[Mechanical ventilation on paediatric intensive care units in Czech Republic]. / Kontrollierte Beatmung auf pädiatrischen Intensivstationen in der Tschechischen Republik.

OBJECTIVE: The aims of this study were to evaluate the incidence of mechanically ventilated children in participating units, to find out the demographic data of the patients, to evaluate ventilator settings and to assess the mortality of ventilated children. DESIGN: Prospective observational multicenter study between 1. 2. 2002 and 30. 4. 2002. SETTING: Seven paediatric intensive care units in tertiary hospitals in the Czech Republic. PATIENTS: All children between 1 month and 18 years admitted to the participating paediatric intensive care units who required intubation and mechanical ventilation were enrolled. METHOD: Following parameters were recorded in all patients: demographic data (age, weight, gender), the origin of the admitting diagnosis, severity of illness (Pediatric Risk of Mortality Score - PRISM, Multiorgan System Failure - MOSF, Lung Injury Score - LIS), the origin of respiratory failure, presence of chronic disease and immunosuppression, length of ventilation, length of stay, ventilator setting, the use of unconventional ventilation, outcome (mortality), blood gas analyses and indices (alveoloarterial oxygen difference - AaDO (2), oxygenation index - OI, hypoxemia score - PaO (2)/FiO (2) and ventilation index - VI), deadspace to tidal volume ratio-Vd/Vt and dynamic respiratory system compliance (Cdyn). RESULTS: One hundred and forty four children (42 % girls) were enrolled in total which represent 23 % of all admitted children. The mean age of the patients was 70 months and mean weight was 23 kg. PRISM score and the length of stay were twofold against mean values (11.7 vs. 5.7 and 10.4 vs. 4.8 days respectively). The mean length of ventilation was 117 hours, 66 % of the patients had an extrapulmonary origin of respiratory failure, 19 % of the patients were chronically ill, and 0,7 % had the evidence of immunosuppression. Pressure regulated volume controlled and Biphasic positive airway pressure were the most frequently used ventilator settings. Unconventional ventilation in all was used in 13 % of the patients. Mortality was 3.5 %. CONCLUSION: Children on mechanical ventilation create 23 % of all patients admitted to paediatric intensive care units. The severity of illness and length of stay were twofold against mean values. Mortality rate was 3.5 % and hypoxia was not a cause of death in any patient.

Effect of early intervention of high-frequency oscillatory ventilation on the outcome in pediatric acute respiratory distress syndrome.

BACKGROUND: Acute respiratory failure in both pediatric and adult patient populations has been extensively studied with recent emphasis on ventilation strategies that can effect mortality outcome. This research in adults has focused on definitive trials of lung protective strategies that have been proposed following preliminary reports of their potential benefits. High frequency oscillatory ventilation has also been described as a lung protective strategy. For many institutions HFOV is today considered a routine therapy as a "rescue" method in acute pediatric respiratory failure. Because HFOV is considered to be a "rescue" therapy, intervention with HFOV is usually in the later stages of acute respiratory failure and consideration of the time to intervention has not been previously examined. OBJECTIVE: To evaluate the effect of time to intervention with high-frequency oscillatory ventilation (HFOV) on the survival of children with severe acute hypoxemic respiratory failure who were managed with lung protective strategies on conventional mechanical ventilation (CMV). METHODS: Twenty-six consecutive patients older 1 month of age with severe hypoxemic respiratory failure and ARDS who at some point in their management were treated with HFOV were evaluated. The mean age was 3.7 years and included three patients treated in the Pediatric Intensive Care Unit (17, 19 and 24 years). Mean weight was 13.8 kg and there were 17 males and 9 females. Nine patients met Extracorporeal Membrane Oxygenation (ECMO) criteria, although only two patients were cannulated. Upon admission to the PICU, patients were initially managed with lung protective strategies using Pressure Controlled Ventilation (PCV) or Pressure Regulated Volume Control (PRVC) modes with limited peak inspiratory pressure, high positive end-expiratory pressure, and permissive hypercapnia. If a Pa-CO2 reached > 75 torr (10.0 kPa) and/or pH < 7.20, tracheal gas insufflation (TGI) was instituted. If FiO2 remained above 0.6 and mean airway pressure (Paw) exceeded 15 cmH2O in order to maintain arterial saturation above 89% or if hypercapnia and/or acidosis on CMV with TGI persisted, the patients were switched to HFOV. An "Optimal Volume Strategy" with HFOV was utilized to recruit alveoli and optimize lung volume. Patients were returned to CMV when their mean airway pressure were between 15 and 20 cmH2O, FiO2 < 0.6, had no evidence of air-leak and/or improved chest X-rays, and did not desaturated during airway suctioning. Patients were offered ECMO if the hypoxemia persisted on HFOV and there were no contraindications to its use. The patients were stratified for analysis by the time to intervention with HFOV. Early intervention was defined as within the first 24 hours of mechanical ventilation (17 patients) and late intervention defined patients beyond 24 hours (9 patients). Demographic data (gender, age, weight, admission PRISM score), time of each mode of ventilation, oxygenation indices and outcomes were recorded for both groups of patients. MAIN RESULTS: The severity of respiratory failure at the time of HFOV intervention was comparable in both early and late groups (PaCO2/FiO2 83 vs. 79 torr, oxygenation index 27 vs. 33, AaDO2 421 torr (56 kPa) vs. 413 torr (55 kPa)). There were no differences in mean age, weight, admission PRISM score length of HFOV, length of CMV after HFOV (CMV post-HFOV) and the total duration of mechanical ventilation between the groups. We found a statistically significant difference in mortality with 58.8% of the early intervention patients surviving while only 12.5% of the late intervention patients survived. The overall survival rate was 42% (11/26 patients). CONCLUSION: Early use of HFOV within the first 24 hours of acute hypoxic respiratory failure in pediatric patients is associated with better survival. Use of this therapy should be considered early in the course of treatment of any pediatric patient meeting this definition. (Tab. 2, Fig. 1, Ref. 28.)

Relationship between endoscopic esophagitis and patterns of gastroesophageal reflux in ambulatory pHmetry.

AIM: to evaluate the possible relationship between the various grades of endoscopic esophagitis and the different patterns of reflux determined by 24-hour ambulatory pH-metry. PATIENTS AND METHODS: we selected 80 patients with symptoms of gastroesophageal reflux disease in whom upper digestive tract endoscopy revealed some degree of mucosal lesion. These patients subsequently underwent 24-hour ambulatory pH-metry. The lesions of the mucosa were classified into 4 grades according to the criteria of Savary and Miller. The patterns of reflux were determined by 24-hour pH-metry and classified according to the severity of reflux (slight, moderate or severe, using DeMeester's table) and the type of reflux (in bipedestation, supine or mixed) according to the percentage of time at pH < 4 in bipedestation, in decubitus or in both positions. RESULTS: patients with grades I and II esophagitis showed variable patterns of reflux, although the most frequent seemed to be slight in bipedestation, which we observed in 34% of the patients. Most (76. 2%) of the patients with grades III or IV (p < 0.05) showed a clearly defined pattern of severe type in the supine position or in both positions. CONCLUSIONS: the presence of a reflux pattern of predominantly supine or mixed type in 24-hour pH-metry may help to identify patients at higher risk for developing severe esophagitis or other complications.

Partial liquid ventilation in the therapy of pediatric acute respiratory distress syndrome.

BACKGROUND: Acute respiratory failure represents life-threatening disease with persistently marked mortality and late morbidity in pre-term newborns (RDS--respiratory distress syndrome), children as well as, adults (ARDS--acute respiratory distress syndrome). We are probably in the period when better understanding of pulmonary pathophysiology enables the development of new technologies that can help in decreasing the morbidity and mortality of patients with respiratory failure. One of these unconventional methods is partial liquid ventilation (PLV). MAIN PURPOSE: The main aim of the study was to verify the possibility of treating potentially reversible respiratory failure in patients where extracorporeal life support (ECLS) was contraindicated and extracorporeal membrane oxygenation (ECMO) could not be used, or the patient had not met the criteria for ECMO. METHODS: PLV was used in 6 children totally, in 7 applications with severe hypoxemic respiratory failure. Preoxygenated perfluorocarbon Rimar 101 (Miteni, Milan, Italy) warmed to 37 degrees C was applied intratracheally in the doses which corresponds with the functional residual capacity of lungs, the dose of perfluorocarbon was repeated every hour. Following parameters were recorded before, during and after PLV: pH, blood gases, ventilator setting, alveoloarterial difference for oxygen, dynamic compliance, and indices--oxygenation index and hypoxemia score (PaO2/FiO2). The values obtained 1 hour before PLV were compared with the values during PLV; the data before PLV and in the 3rd hour of PLV were evaluated statistically. RESULTS: Statistically significant increase of pH (7.22 vs 7.34, p < 0.05) and PaO2/FiO2 (72 vs 100 Torr, p < 0.01) and decrease of FiO2 (82% vs 64%, p < 0.05) and oxygenation index (23 vs 17, p < 0.05) occurred during 3 hours of PLV. CONCLUSION: Partial liquid ventilation is an effective method for controlling ARDS in certain groups of patients with severe lung disease. (Tab. 4, Ref. 15.)

Inhibition of prolactin secretion in rats with the ergoline derivative deprenon.

In three experimental models, (1) reserpine-premedicated male rats, (2) estrogen-premedicated female rats, (3) intact female rats, the prolactin secretion inhibiting activity was studied of the ergoline derivative D-6-methyl-8-ergolin(I)ylacetamide (deprenon). In all experiments deprenon was administered orally (by gavage), in single doses of 0.5 mg/kg to reserpine-premedicated male rats and to intact female rats, and of 0.025 mg/kg or 0.25 mg/kg, to estrogen-premedicated female rats. The animals were killed by decapitation at h 1 to 9 after administration of deprenon. The serum prolactin levels were determined by the double antibody radioimmunoassay procedure. After single oral administrations of deprenon in any of the specified doses the serum prolactin levels were depressed statistically highly significantly, both in the animals with intentionally raised serum prolactin levels and in the intact animals with physiological serum levels of the hormone. The inhibitory effect of deprenon on prolactin secretion became apparent already within 1 h, and still persisted at h 9 after administration.