Portal Vein Embolization with PVA and Coils before Major Hepatectomy: Single-Center Retrospective Analysis in Sixty-Four Patients.

OBJECTIVES: Portal vein embolization (PVE) stimulates hypertrophy of the future liver remnant (FLR) and improves the safety of extended hepatectomy. This study evaluated the efficacy of PVE, performed with PVA and coils, in relation to its effect on FLR volume and ratio. Secondary endpoints were the assessment of PVE complications, accomplishment of liver surgery, and patient outcome after hepatectomy. MATERIALS AND METHODS: All patients who underwent PVE before planned major hepatectomy between 2013 and 2017 were retrospectively analyzed, comprising a total of 64 patients. Baseline patient clinical characteristics, imaging records, liver volumetric changes, complications, and outcomes were analyzed. RESULTS: There were 45 men and 19 women with a mean age of 64 years. Colorectal liver metastasis was the most frequent liver tumor. The majority of patients (n = 53) had a right PVE. FLR increased from a mean value of 484 ml ± 242 to 654 ml ± 287 (p < 0.001) after PVE. Two major complications were experienced after PVE: 1 case of left hepatic artery branch laceration and 1 case of hemoperitoneum and hemothorax. A total of 44 (69%) patients underwent liver surgery. Twenty-one patients were not taken to surgery due to disease progression (n = 18), liver insufficiency (n = 1), and insufficient FLR volume (n = 1), and one patient declined surgery (n = 1). CONCLUSIONS: PVE with PVA and coils was accomplished safely and promoted a high FLR hypertrophy yield, enabling most of our patients to be submitted to the potentially curative treatment of liver tumor resection.

The Endocannabinoid System and Anxiety.

The medical properties of Cannabis sativa is known for centuries. Since the discovery and characterization of the endogenous cannabinoid system, several studies have evaluated how cannabinoid compounds and, particularly, how the modulation of the endocannabinoid (eCB) system influences a wide range of functions, from metabolic to mental disorders. Cannabinoids and eCB system often exert opposite effects on several functions, such as anxiety. Although the mechanisms are not completely understood, evidence points to different factors influencing those effects. In this chapter, the recent advances in research about the relationship between eCB system and anxiety disorders in humans, as well as in animal models, will be discussed. The recent data addressing modulation of the eCBs in specific brain areas, such as the medial prefrontal cortex, amygdaloid complex, bed nucleus of stria terminalis, hippocampus, and dorsal periaqueductal gray, will be summarized. Finally, data from animal models addressing the mechanisms through which the eCB system modulates anxiety-related behavior dependent on stressful situations, such as the involvement of different receptors, distinct eCBs, modulation of neurotransmitters release, HPA axis and immune system activation, and plastic mechanisms, will also be discussed.

Cannabidiol effects in the prepulse inhibition disruption induced by amphetamine.

RATIONALE: The information processing appears to be deficient in schizophrenia. Prepulse inhibition (PPI), which measures the inhibition of a motor response by a weak sensory event, is considered particularly useful to understand the biology of information processing in schizophrenia patients. Drugs that facilitate dopaminergic neurotransmission such as amphetamine induce PPI disruption in human and rodents. Clinical and neurobiological findings suggest that the endocannabinoid system and cannabinoids may be implicated in the pathophysiology and treatment of schizophrenia. Cannabidiol (CBD), a non-psychotomimetic constituent of the Cannabis sativa plant, has also been reported to have potential as an antipsychotic. OBJECTIVE: Our aim was to investigate if CBD pretreatment was able to prevent PPI disruption induced by amphetamine. Since one possible mechanism of CBD action is the facilitation of endocannabinoid-mediated neurotransmission through anandamide, we tested the effects of an anandamide hydrolysis inhibitor (URB597) in the amphetamine-induced PPI disruption. METHODS: Male Swiss mice were treated with CBD systemic or intra-accumbens, or URB597 (systemic) prior to amphetamine and were exposed to PPI test. RESULTS: Amphetamine (10 mg/kg) disrupted PPI while CBD (15-60 mg/kg) or URB597 (0.1-1 mg/kg) administered alone had no effect. Pretreatment with CBD attenuated the amphetamine-disruptive effects on PPI test after systemic or intra-accumbens administration. Similar effects were also found with the inhibitor of anandamide hydrolysis. CONCLUSION: These results corroborate findings indicating that CBD induces antipsychotic-like effects. In addition, they pointed to the nucleus accumbens as a possible site of these effects. The increase of anandamide availability may be enrolled in the CBD effects.

Low-level laser therapy improves peri-implant bone formation: resonance frequency, electron microscopy, and stereology findings in a rabbit model.

Previous studies have reported positive effects of low-level laser therapy (LLLT) on bone healing. This study evaluated the effects of LLLT on peri-implant healing in vivo. Thirty-two rabbits had their mandibular left incisors removed, followed by immediate insertion of a dental implant into the fresh socket. Animals were assigned randomly to four groups: control (non-irradiated) or LLLT at three different doses per session: 5J/cm(2), 10J/cm(2), and 20J/cm(2). A GaAlAs laser (830nm, 50mW) was applied every 48h for 13 days, starting immediately after surgery. The implant stability quotient (ISQ) was measured using resonance frequency analysis upon implant insertion and immediately after death, 30 days after the last application. Tissues were prepared for scanning electron microscopy (SEM) and stereology. Variables measured were bone-implant contact (BIC) and bone neoformation within implant threads at three different sites. The results showed better ISQ for the 20J/cm(2) group (P=0.003). BIC values were significantly higher (P<0.05) in the 20J/cm(2) group, on both SEM and stereology. Bone area values were better in the 10J/cm(2) (P=0.036) and 20J/cm(2) (P=0.016) groups compared to the control group. Under these conditions, LLLT enhanced peri-implant bone repair, improving stability, BIC, and bone neoformation. The findings support and suggest parameters for the design of clinical trials using LLLT after implant placement.

Fine-tuning of defensive behaviors in the dorsal periaqueductal gray by atypical neurotransmitters

This paper presents an up-to-date review of the evidence indicating that atypical neurotransmitters such as nitric oxide (NO) and endocannabinoids (eCBs) play an important role in the regulation of aversive responses in the periaqueductal gray (PAG). Among the results supporting this role, several studies have shown that inhibitors of neuronal NO synthase or cannabinoid receptor type 1 (CB1) receptor agonists cause clear anxiolytic responses when injected into this region. The nitrergic and eCB systems can regulate the activity of classical neurotransmitters such as glutamate and γ-aminobutyric acid (GABA) that control PAG activity. We propose that they exert a ‘fine-tuning’ regulatory control of defensive responses in this area. This control, however, is probably complex, which may explain the usually bell-shaped dose-response curves observed with drugs that act on NO- or CB1-mediated neurotransmission. Even if the mechanisms responsible for this complex interaction are still poorly understood, they are beginning to be recognized. For example, activation of transient receptor potential vanilloid type-1 channel (TRPV1) receptors by anandamide seems to counteract the anxiolytic effects induced by CB1 receptor activation caused by this compound. Further studies, however, are needed to identify other mechanisms responsible for this fine-tuning effect.

Fine-tuning of defensive behaviors in the dorsal periaqueductal gray by atypical neurotransmitters.

This paper presents an up-to-date review of the evidence indicating that atypical neurotransmitters such as nitric oxide (NO) and endocannabinoids (eCBs) play an important role in the regulation of aversive responses in the periaqueductal gray (PAG). Among the results supporting this role, several studies have shown that inhibitors of neuronal NO synthase or cannabinoid receptor type 1 (CB1) receptor agonists cause clear anxiolytic responses when injected into this region. The nitrergic and eCB systems can regulate the activity of classical neurotransmitters such as glutamate and γ-aminobutyric acid (GABA) that control PAG activity. We propose that they exert a 'fine-tuning' regulatory control of defensive responses in this area. This control, however, is probably complex, which may explain the usually bell-shaped dose-response curves observed with drugs that act on NO- or CB1-mediated neurotransmission. Even if the mechanisms responsible for this complex interaction are still poorly understood, they are beginning to be recognized. For example, activation of transient receptor potential vanilloid type-1 channel (TRPV1) receptors by anandamide seems to counteract the anxiolytic effects induced by CB1 receptor activation caused by this compound. Further studies, however, are needed to identify other mechanisms responsible for this fine-tuning effect.

Neuroanatomical substrates involved in cannabinoid modulation of defensive responses.

Administration of Cannabis sativa derivatives causes anxiolytic or anxiogenic effects in humans and laboratory animals, depending on the specific compound and dosage used. In agreement with these findings, several studies in the last decade have indicated that the endocannabinoid system modulates neuronal activity in areas involved in defensive responses. The mechanisms of these effects, however, are still not clear. The present review summarizes recent data suggesting that they involve modulation of glutamate and GABA-mediated neurotransmission in brain sites such as the medial prefrontal cortex, amygdaloid complex, bed nucleus of the stria terminalis, hippocampus and dorsal periaqueductal gray. Moreover, we also discuss results indicating that, in these regions, the endocannabinoid system could be particularly engaged by highly stressful situations.

[Chagasic infection prevalence in blood donors at the Regional Blood Donation Center of Iguatu]. / Prevalência de infecção chagásica em doadores de sangue do Hemocentro Regional de Iguatu, CE.

The objective of this study is to evaluate the frequency of Trypanosoma cruzi infection among blood donors at the Iguatu Regional Hemocenter, CE, 1996 - 1997, using the Enzyme-linked immunosorbent assay (ELISA) and hemagglutination passive reverse (HPR) tests. Of the 3,232 donors analyzed a total of 61 (1.9%) were seropositive for chagasic infection. The greatest number of infected donors was found in the 41-50 year age group, while the majority of donors were in the 18-30 year age group. Of the total number of donors analyzed 2,991 (92.5%) were men and 57 (1.9%) of these were seropositive. In all 1,825 (56.5 %) of the donors were from a rural area. The results showed that the ELISA test detected 49 cases of infection, but HPR only 38, thereby demonstrating that the use of two or more different tests by blood banks prevents transfusion associated Chagas' disease.

Prevalência de infecção chagásica em doadores de sangue do Hemocentro Regional de Iguatu, CE / Chagasic infection prevalence in blood donors at the Regional Blood Donation Center of Iguatu

The objective of this study is to evaluate the frequency of Trypanosoma cruzi infection among blood donors at the Iguatu Regional Hemocenter, CE, 1996 - 1997, using the Enzyme-linked immunosorbent assay (ELISA) and hemagglutination passive reverse (HPR) tests. Of the 3,232 donors analyzed a total of 61 (1.9%) were seropositive for chagasic infection. The greatest number of infected donors was found in the 41-50 year age group, while the majority of donors were in the 18-30 year age group. Of the total number of donors analyzed 2,991 (92.5%) were men and 57 (1.9%) of these were seropositive. In all 1,825 (56.5 %) of the donors were from a rural area. The results showed that the ELISA test detected 49 cases of infection, but HPR only 38, thereby demonstrating that the use of two or more different tests by blood banks prevents transfusion associated Chagas' disease.

Esse estudo tem como objetivo avaliar a prevalência de infecção pelo Trypanosoma cruzi em doadores de sangue do Hemocentro regional de Iguatu, CE, 1996-1997, usando os testes Ensaio Imunoenzimático (ELISA ) e Hemaglutinação Passiva Reversa (HPR). Dos 3.232 doadores analisados 61 (1,9%) foram soropositivos para a infecção chagásica, onde o maior número de soropositividade foi encontrado no grupo de 41-50 anos, no entanto, o maior número de doadores que procuram o branco de sangue encontra-se na faixa etária de 18-30 anos. Do total de doadores analisados 2.991 (92,5%) foram do sexo masculino e destes 57 (1,9%) foram soropositivos. Com relação a procedência dos doadores observamos que 1.825 (56,5%) foram procedentes da área rural. Os resultados mostram que o ELISA detectou 49 doadores com a infecção e por HPR apenas 38, mostrando portanto que a utilização de dois ou mais testes em bancos de sangue poderá prevenir a transmissão da doença de Chagas associada à transfusão.

Parametros hematologicos normais em Fortaleza, Ceara. 1. Serie vermelha. / Normal hematological parameters in Fortaleza, Ceara. 1. Red blood cells

Determina os parametros hematologicos: hemacias, hemoglobulina, hematocrito, indices hematimetricos, reticulocitos e hemossedimentacao, em 200 individuos adultos normais, residentes em Fortaleza, Ceara.Os valores encontrados foram submetidos a analise estatisca e os resultados comparados com os da literatura