The ultimate technique for posterior rib fractures: The parascapular sub-iliocostalis plane block – A series of cases / Una técnica fundamental para las fracturas costales posteriores: el bloqueo paraescapular del plano subiliocostal. Una serie de casos

We report retrospectively a series of four cases involving the successful use of the recently described parascapular sub-iliocostalis plane block (PSIP), for lateral-posterior rib fractures. The efficacy of the PSIP block may potentially depend on different mechanisms of action: (1) direct action in the fracture site by craniocaudal myofascial spread underneath the erector spinae muscle (ESM); (2) spread to deep layers through tissue disruption caused by trauma, to reach the proximal intercostal nerves; (3) medial spread below the ESM, to reach the posterior spinal nerves; and (4) lateral spread in the sub-serratus (SS) plane to reach the lateral cutaneous branches of the intercostal nerves; while avoiding significant negative hemodynamic effects and other possible complications associated to other techniques leading that the PSIP may be considered an alternative in some clinical scenarios to the erector spinae plane block or the paravertebral block. (AU)

Presentamos retrospectivamente una serie de 4 casos en los que se utilizó con éxito el bloqueo paraescapular del plano subiliocostal (PSIP), descrito recientemente, para fracturas costales laterales-posteriores. La eficacia del bloqueo PSIP puede depender potencialmente de diferentes mecanismos de acción: (1) acción directa en las fractura por la extensión miofascial craneocaudal por debajo del músculo erector de la columna, (2) diseminación a capas profundas a través de la disrupción tisular causada por el traumatismo, para alcanzar los nervios intercostales proximales, (3) extensión medial por debajo del músculo erector de la columna, para alcanzar los nervios espinales posteriores y (4) extensión lateral en el plano subserrato para alcanzar las ramas cutáneas laterales de los nervios intercostales, evitando al mismo tiempo efectos hemodinámicos negativos y otras posibles complicaciones asociados a otras técnicas, lo que hace que el bloqueo PSIP pueda considerarse en algunos escenarios clínicos una alternativa al bloqueo del plano erector de la columna vertebral o al bloqueo paravertebral. (AU)

The ultimate technique for posterior rib fractures: the parascapular sub-iliocostalis plane block - A series of cases.

We report retrospectively a series of four cases involving the successful use of the recently described parascapular sub-iliocostalis plane block (PSIP), for lateral-posterior rib fractures. The efficacy of the PSIP block may potentially depend on different mechanisms of action: (1) direct action in the fracture site by craniocaudal myofascial spread underneath the erector spinae muscle (ESM); (2) spread to deep layers through tissue disruption caused by trauma, to reach the proximal intercostal nerves; (3) medial spread below the ESM, to reach the posterior spinal nerves; and (4) lateral spread in the sub-serratus (SS) plane to reach the lateral cutaneous branches of the intercostal nerves; while avoiding significant negative hemodynamic effects and other possible complications associated to other techniques leading that the PSIP may be considered an alternative in some clinical scenarios to the Erector Spinae Plane block or the Paravertebral block.

Human Bone Marrow Mesenchymal Stem/Stromal Cells Preserve Their Immunomodulatory and Chemotactic Properties When Expanded in a Human Plasma Derived Xeno-Free Medium.

Due to their immunomodulatory and chemotactic properties, hMSC are being explored to treat immune-related diseases. For their use in human therapies, it is necessary to culture hMSC in xeno-free conditions. In this study, the impact that a xeno-free medium based on a human plasma derivate has on these properties was analysed. Bone marrow-derived hMSC preserved their immunosuppressive and immunostimulatory properties, as observed with in vitro assays with hMSC cocultured with mixed leukocyte reactions or with mitogen-stimulated leukocytes. Moreover, hMSC expanded in xeno-free medium were recruited by macrophages in both migration and invasion assays, which indicates that the cells maintained their chemotactic properties. These data suggest that xeno-free expanded hMSC preserved their immunomodulatory and chemotactic properties, indicating that the described xeno-free medium composition is a potential candidate to culture and expand hMSC for human cell therapies.

Adsorbed fibrinogen leads to improved bone regeneration and correlates with differences in the systemic immune response.

Designing new biomaterials that can modulate the inflammatory response instead of attempting just to reduce it constitutes a paradigm change in regenerative medicine. This work aimed to investigate the capacity of an immunomodulatory biomaterial to enhance bone regeneration. For that purpose we incorporated a molecule with well-established pro-inflammatory and pro-healing roles, fibrinogen, in chitosan scaffolds. Two different incorporation strategies were tested, leading to concentrations of 0.54±0.10mg fibrinogen g(-1) scaffold immediately upon adsorption (Fg-Sol), and 0.34±0.04mg fibrinogen g(-1) scaffold after washing (Fg-Ads). These materials were implanted in a critical size bone defect in rats. At two months post-implantation the extent of bone regeneration was examined by histology and the systemic immune response triggered was evaluated by determining the percentages of myeloid cells, T and B lymphocytes in the draining lymph nodes. The results obtained indicate that the fibrinogen incorporation strategy conditioned the osteogenic capacity of biomaterials. Fg-Ads scaffolds led to more bone formation, and the presence of Fg stimulated angiogenesis. Furthermore, animals implanted with Fg-Ads scaffolds showed significant increases in the percentages of B lymphocytes and myeloid cells in the draining lymph nodes, while levels of T lymphocytes were not significantly different. Finally, a significant increase in TGF-ß1 was detected in the plasma of animals implanted with Fg-Ads. Taken together the results presented suggest a potential correlation between the elicited immune response and biomaterial osteogenic performance.

Absence of antihyperglycemic effect of jambolan in experimental and clinical models.

The use of alternative therapies to treat diabetes, including teas prepared with different vegetables, is widespread in Brazil. In Porto Alegre, a southern city of Brazil, the tea prepared from leaves of Syzygium cumini (L.) Skeels or S. jambos (L.) Alst has been report to be used frequently by diabetic patients. We investigated the postulated antihyperglycemic effect of the S. cumini (L.) Skeels in three experiments. In the first, a randomized, parallel, placebo controlled trial, tea prepared from leaves of S. cumini did not present any antihyperglycernic effect in 30 non-diabetic young volunteers submitted to a glucose blood tolerance test. In the animal experiments, we tested the effect of increasing doses of the crude extract prepared from leaves of S. cumini administrated for 2 weeks, on the post-prandial blood glucose level of normal rats and rats with streptozotocin-induced diabetes mellitus. The treatment did not produce any antihyperglycernic effect in both models. These results do not rule out hypoglycemic effects in patients with type 2 diabetes mellitus, but strongly suggest that, for a while, the jambolan can not be recommended as an antihyperglycemic treatment.

Plague surveillance in Brazil: 1983-1992.

Plague caused by Yersinia pestis, has persisted in Brazil in several natural foci spread throughout rural areas in the States of Ceara, Paraiba, Pernambuco, Piaui, Rio Grande do Norte, Alagoas, Bahia, Minas Gerais and Rio de Janeiro. Nationwide surveillance of plague in Brazil based on serological testing started in 1983. We now present an update report of the examinations carried out in our laboratory from 1983 to 1992. The passive hemagglutination test for antibodies against fraction 1A antigen of Y. pestis and the passive hemagglutination inhibition control were employed for testing a total of 220,769 sera. Samples analyzed included 2,856 sera from clinically diagnosed plague cases or suspects, 49,848 sera from rodents of 24 species and 2 species of small wild carnivores (marsupials), 122,890 sera from dogs, and 45,175 sera from cats. Specific antibodies were found in 92 (3.22%) human sera; 143 (0.29%) sera from rodents of 8 species and from the two species of marsupials, 1,105 (0.90%) sera from dogs and 290 (0.64%) sera from cats. The presence of significant levels of specific anti-F1A antibodies among rodents and wild or domestic carnivores (dogs and cats) indicates that all the Brazilian plague foci remain active in spite of the absence of human cases in some of them.

Street food vending in Latin America.

Despite occasional attempts to repress it, street food vending in Latin America appears to be on the rise--encouraged by growing marginal urban populations, the unemployed status of innumerable potential street vendors, lengthening commutes for workers, public demand for cheap and culturally appropriate food near workplaces, and a shortage or absence of regular establishments serving such food. Besides placing a hidden burden on public services, the generally unregulated and quasi-clandestine street food industry tends to observe poor hygienic practices and to pose significant public health problems. Within this context, Latin America's cholera epidemics have drawn increasing attention to street food's potential for disease transmission and have created growing support for attempts to resolve these troubles. What appears needed at this point, rather than futile attempts at abolition, is a new and more positive approach wherein countries change their regulations so as to permit peaceful and constructive adaptation of street food vending to a new style of Latin American social life. This implies legal reorganization directed at structurally developing street food vending and permitting application of measures--especially provision and use of safe water--that will foster good hygiene and safe foods. It also implies creating programs to provide appropriate training for inspectors as well as health education for both vendors and consumers of street food; and it implies promoting and adopting improved methods for preparing and selling such food. There is no reason to suppose these measures will provide an immediate panacea for the street food vending problem; but there is good reason to think they can immensely improve the situation that exists today.

[Natural infection by Yersinia pestis, in fleas from plague foci in the northeast of Brazil]. / Pesquisa da infecção natural por Yersinia pestis, em pulicídeos provenientes de focos pestosos do Nordeste do Brasil.

Three different containment transport processes of fleas were evaluated as an approach to the bacteriologic isolation of Yersinia pestis. The three methods employed were: live fleas in glass tubes containing pieces of wrapped filter paper; dead fleas in saline solution; and macerated fleas in Cary-Blair culture medium. The two latter methods were almost equal and superior to the first method. A total of 29512 flea pools, from plaque foci in Northeast Brazil collected during 1966 to 1982 were evaluated by the three methods. Among these samples, 236 (0.80%) flea pools were positive with regard to bacteriological cultivation and/or infection of susceptible animals.

[Bacteriologic and serologic studies of an outbreak of plague in the State of Paraíba, Brazil]. / Estudos bacteriológicos e sorológicos de um surto de peste no Estado da Paraíba, Brasil.

During a plaque outbreak in the Borborema Plateau focus (Paraiba), bacteriological and serological studies were carried out in material from 452 patients (48 positives), 1,938 rodents and other small mammals (75 positives), 4,756 dogs (141 positives) and 2,047 cats (57 positives) obtained from 41 counties (out of which, 21 produced positive samples). Twenty Yersinia pestis strains isolated from material from 3 patients and 17 rodents, displayed biochemical reactions, virulence factors, antibiotic susceptibility and animal experimental pathogenicity similar to those observed in strains previously isolated. According to our findings this recent plague outbreak did not exhibit different factors from those observed during prior outbreaks in other plague foci in the northeast of Brazil.

[The rodent. Akodon arviculoides, Wagner, 1842 (Cricetidae)--importance in plague foci in Brazil]. / Estudo do roedor Akodon arviculoides, Wagner, 1842 (Cricetidae)--importância nos focos pestosos do Brasil.

The occurrence of the rodent Akodon arviculoides Wagner, 1842 in the plague focus of the "Agreste" region of the State of Pernambuco and a report on its ability for survival, reproduction and development in captivity, its susceptibility to Yersinia pestis infection and the role of this rodent species in Brazilian plague foci are reported.

Informe sobre a peste bubonica (infeccao por Yersinia pestis) no Estado de Minas Gerais, Brasil. / Report on bubonic plague (Yersinia pestis infection) in Minas Gerais State, Brazil

Yersinia pestis foi isolada de roedores e detectados anticorpos antipestosos, em soros humanos e de roedor, do Estado de Minas Gerais, onde a infeccao pestosa nao era registrada, ha cerca de 10 anos

Plague in Brazil during two years of bacteriological and serological surveillance.

In north-east Brazil, where plague infection is endemic, bacteriological and serological methods were employed during a two-year period to determine accurately the occurrence of human infection and to define certain epidemiological features of both human and rodent infection. There were 67 confirmed cases of plague, predominantly among males and children. Most of these cases occurred in two inland rural plateaux of Ceara State. Clustering of cases in place and time was common, as was a history of contact with rats. Peak occurrence was in November 1978, during the warm, harvest time of year. Rodent surveillance resulted in isolation of Yersinia pestis from 33 animals, most of them from the field rodent, Zygodontomys pixuna, in the States of Pernambuco and Ceara. Our results indicate a decline in the number of human cases from previous years but show that several foci remain active and that serological testing, in addition to routine bacteriological testing, can assist workers in maintaining the surveillance of both human and rodent plague in Brazil.