Safety and efficacy of a mesenchymal stem cell intramammary therapy in dairy cows with experimentally induced Staphylococcus aureus clinical mastitis.

Although, antibiotics are effective in the treatment of bovine mastitis, they do not address the regeneration of mammary glandular tissue and have been associated to the increment in antimicrobial resistance worldwide. Considering the necessity of alternative therapies for this disease of high economic impact and the reported regenerative and antibacterial effects of mesenchymal stem cell (MSCs), we evaluated the safety and efficacy of an allogenic MSC-based intramammary therapy in dairy cows with experimentally induced Staphylococcus aureus clinical mastitis. In a safety trial, heifers were inoculated intramammarily with a 2.5 × 107-suspension of bovine fetal AT-MSCs on experimental days 1 and 10. Animals were evaluated clinically on a daily basis during a 20-day experimental period and blood samples were collected for hemogram determination and peripheral blood leukocytes (PBLs) isolation. In an efficacy trial, Holstein Friesian cows were inoculated with S. aureus and treated intramammarily with vehicle (NEG; days 4 and 10), antibiotics (ATB; days 4 and 5) or a suspension of 2.5 × 107 AT-MSCs (MSC; days 4 and 5). Cows were clinically evaluated daily and milk samples were collected for somatic cell count (SCC) and colony forming units (CFU). Blood samples were collected for serum haptoglobin and amyloid A determination. Intramammary administration of two doses of bovine fetal AT-MSCs in healthy cows did not induce changes in clinical or hematological variables, and gene expression profiles in PBLs associated to activation (CD4, CD8, CD25, CD62L and CD69) and proinflammatory cytokines (CCL2, CCL5, IL2, CXCL3, IFNγ, and TNFα). Quarters of MSC group of cows had similar SCC log/mL in milk compared to infected quarters of ATB or NEG cows. However, quarters of MSC cows had lower CFU log/mL in milk compared to quarters of NEG cows. Intramammarily inoculation of repeated doses of 2.5 × 107 allogenic AT-MSCs did not induce clinical or immunological response in healthy cows. Moreover, MSC-intramammary treatment reduced bacterial count in milk of cows with S. aureus clinical mastitis compared to untreated cows. This work provides initial evidence for the safety and efficacy of an allogenic MSC-based intramammary therapy for the treatment of bovine mastitis.

Objetivos de la rotación de los médicos residentes de cirugía en la unidad clínica de cirugía mayor ambulatoria / No disponible

El objetivo del estudio es establecer criterios objetivos en la evaluación de los médicos residentes de cirugía general y digestiva durante su estancia en la UCMA, que tienen establecida en el segundo año de la especialidad y durante 6 meses. La actividad asistencial semanal consta de 9 consultas externas y 9 quirófanos en sesiones de mañana y tarde. Dos residentes como máximo rotan en cada periodo de 6 meses. Como criterios de valoración se estableció un sumatorio de 3dimensiones: conocimientos (30%) + actitudes (20%) + habilidades(50%) + conocimientos: 30%. Grado de formación adquirida(discente 5% + docente 25%). Actitudes: 20%, asistencia, disponibilidad y relaciones. Habilidades: 50%, hábitos científicos y técnicos adquiridos. Consultas externas (5%): asistencia a 10 consultas externas. Actividad quirúrgica (45%): participación en 282 Intervenciones registradas en el Libro del Residente. Entre 2001-2006 15 residentes han rotado por la UCMA, alcanzándolos niveles medios siguientes: conocimientos (5% + 23,6% =28,6%), actitudes (4% asistencia + 5% disponibilidad + 10% relaciones= 19%), habilidades (5% asistencia a consultas + 45% intervenciones quirúrgicas, 327 intervenciones de media = 50%).Grado de cumplimentación: conocimientos: 28,6/30%(98,3%), actitudes: 19/20% (95%), habilidades: 50/50% (100%).Se concluye que la rotación en la UCMA debe ser obligatoria en los programas de formación de la especialidad. Es necesario establecer medidas objetivas para valorar la actividad realizada. Para ello se deben incluir aspectos en relación a la adquisición de conocimientos, actitudes y habilidades. El programa presentado establece criterios objetivos de la evaluación (AU)

The aim of the study is to establish objective criteria in the evaluation of surgical residents in the day surgery unit. Surgical residents stay 6 months in the day surgery unit. Weekly clinical activity consists of 9 consultations and 9 surgical programs. At any given time, 2 surgical residents stay for a period of 6 months. The criteria used for evaluation was a summary of 3 variables: Knowledge(30%), attitude (20%) and surgical skills (50%). Knowledge(30%) included: degree of formation acquired (learning 5% +teaching 25%). Attitude (20%) included: daily assistance + availability+ relationship with team. Surgical skills (50%) included: scientific and surgical abilities acquired: Ten clinical consultations(5%) and a minimum of 282 surgical operations confirmed in the Resident’s Log Book (45%) were obligatory. From 2001 to 2006 a total of 15 residents have passed through the day surgery unit for a period of 6 months each, with the following mean results: knowledge (5% + 23.6% = 28.6%),attitude: (4% daily assistance + 5% availability + 10% relations =19%), surgical skills (5% consultations + 45% surgical operations,327 mean = 50%).Degree of complementation: knowledge: 28.6/30% (98.3%),attitude: 19/20% (95%), surgical skills: 50/50% (100%).In conclusion the permanency in a day surgery unit should be obligatory in postgraduate general surgery programs. Objective criteria are necessary to evaluate the activity of surgical residents. In this way the evaluation must considerer the knowledge, attitude and surgical skills acquired. The present surgical program develops objective criteria for this evaluation (AU)

Correlation between the radiologic and histologic size of hepatocellular carcinoma in patients eligible for liver transplantation.

Hepatocellular carcinoma is the most prevalent primary hepatic tumor. Early diagnosis and staging is of paramount importance to obtain favorable survivals. So far, there is no general agreement on the most appropriate imaging technique to detect the tumor for correlation between pretransplant radiologic and pathologic size of the tumor, which remains inadequate. With greater clinical experience and increasing accuracy of imaging methods, magnetic resonance (MR) appears to be the most accurate method, yielding a correlation in 67% of cases.

Mycotic pseudoaneurysms after liver transplantation.

The most frequent etiology of visceral artery aneurysms is arteriosclerosis, but vascular manipulation during hepatic transplantation may also cause a mycotic pseudoaneurysm. Treatment with embolization, stents or percutaneous thrombin injection have been recommended but surgical revascularization is indicated when interventional techniques fail. A 43-year-old man with hepatitis C virus cirrhosis who underwent orthotopic liver transplantation from a cadaveric donor was treated with cyclosporine, mycophenolate, and steroids and was discharged from hospital at 35 days. Two months later he was readmitted with a febrile syndrome. Abdominal computed tomography showed necrosis of hepatic segments IV, V, and VI. Magnetic resonance imaging and angiography revealed partial thrombosis of the hepatic artery and stenosis of the portal anastomosis secondary to an aneurysm of the hepatic artery. A few hours after the radiological diagnosis, the patient suffered a bout of upper gastrointestinal bleeding and shock. Emergency surgery revealed a mycotic pseudoaneurysm of the common hepatic artery, which had ruptured into the bile tract with hemobilia. The liver graft was removed because of severe necrosis of the right liver. The patient died awaiting a new liver transplantation.

Results of an upper endoscopy protocol in liver transplant candidates.

OBJECTIVE: our aims is to understand endoscopic findings from a preoperative systematic study of patients with hepatic cirrhosis who were candidates for transplantation and their impact on a protocol for primary and secondary prophylaxis of variceal haemorrhage. PATIENTS AND METHODS: this study involves a retrospective evaluation of upper digestive tract lesions detected before inclusion and a prospective evaluation of new episodes of variceal haemorrhage, associated mortality rates, and factors that are likely to be involved in the development of this condition. Primary prophylaxis with beta-blockers was considered indicated in cases of varices of grande II or greater or with signs associated with increased risk. Secondary prophylaxis was essentially always associated with medical and endoscopic treatment. RESULTS: of 134 patients, there were 9 deaths, with a median time on the waiting list of 3 months. Of all patients, 33.6% presented with high risk oesophageal varices, 11.2 % with gastric varices, 42.6% with portal hypertensive gastropathy, and 26.9% with peptic lesions. Primary prophylaxis was indicated in 33 of 90 patients, and was initiated in almost half of the cases as a results of the study. Optimum fulfiment of the pre-established objectives was 75.3%. The incidence of new haemorrhagic events due to varices was 10.4% and accounted for almost half of the deaths during the monitoring period. The only statistically significant predictive factors were the presence of gastrict varices and previous history. CONCLUSION: upper endoscopy should play a role in the preoperative examination of liver transplant candidates due to the significant impact it has on subsequent management.