Dialysis complications in acute kidney injury patients treated with prolonged intermittent renal replacement therapy sessions lasting 10 versus 6 hours: results of a randomized clinical trial

Prolonged intermittent renal replacement therapy (PIRRT) has emerged as an alternative to continuous renal replacement therapy in the management of acute kidney injury (AKI) patients. This trial aimed to compare the dialysis complications occurring during different durations of PIRRT sessions in critically ill AKI patients. We included patients older than 18 years with AKI associated with sepsis admitted to the intensive care unit and using noradrenaline doses ranging from 0.3 to 0.7 mu g/kg/min. Patients were divided into two groups randomly: in G1, 6-h sessions were performed, and in G2, 10-h sessions were performed. Seventy-five patients were treated with 195 PIRRT sessions for 18 consecutive months. The prevalence of hypotension, filter clotting, hypokalemia, and hypophosphatemia was 82.6, 25.3, 20, and 10.6%, respectively. G1 was composed of 38 patients treated with 100 sessions, whereas G2 consisted of 37 patients treated with 95 sessions. G1 and G2 were similar in male predominance (65.7 vs. 75.6%, P=0.34), age (63.6 +/- 14 vs. 59.9 +/- 15.5 years, P=0.28) and Sequential Organ Failure Assessment score (SOFA; 13.1 +/- 2.4 vs. 14.2 +/- 3.0, P=0.2). There was no significant difference between the two groups in hypotension (81.5 vs. 83.7%, P=0.8), filter clotting (23.6 vs. 27%, P=0.73), hypokalemia (13.1 vs. 8.1%, P=0.71), and hypophosphatemia (18.4 vs. 21.6%, P=0.72). However, the group treated with sessions of 10h were refractory to clinical measures for hypotension, and dialysis sessions were interrupted more often (9.5 vs. 30.1%, P=0.03). Metabolic control and fluid balance were similar between G1 and G2 (blood urea nitrogen [BUN]: 81 +/- 30 vs. 73 +/- 33mg/dL, P=1.0; delivered Kt/V: 1.09 +/- 0.24 vs. 1.26 +/- 0.26, P=0.09; actual ultrafiltration: 1731 +/- 818 vs. 2332 +/- 947mL, P=0.13) and fluid balance (-731 +/- 125 vs. -652 +/- 141mL, respectively) . In conclusion, intradialysis hypotension was common in AKI patients treated with PIRRT. There was no difference in the prevalence of dialysis complications in patients undergoing different durations of PIRRT.

Effect of mesenchymal stem cells on movement and urination of rats with spinal cord injury

Cell therapy has frequently been reported as a possible treatment for spinal trauma in humans and animals; however, without pharmacologically curative action on damage from the primary lesion. In this study, we evaluated the effect of administering human adipose-derived stem cells (hADSC) in rats after spinal cord injury. The hADSC were used between the third and fifth passages and a proportion of cells were transduced for screening in vivo after transplantation. Spinal cord injury was induced with a Fogarty catheter no. 3 inserted into the epidural space with a cuff located at T8 and filled with 80 mu L saline for 5 min. The control group A (n = 12) received culture medium (50 mu L) and group B (n = 12) received hADSC (1.2 x 10(6)) at 7 and 14 days post-injury, in the tail vein. Emptying of the bladder by massage was performed daily for 3 months. Evaluation of functional motor activity was performed daily until 3 months post-injury using the Basso-Beattie-Bresnahan scale. Subsequently, the animals were euthanized and histological analysis of the urinary bladder and spinal cord was performed. Bioluminescence analysis revealed hADSC at the application site and lungs. There was improvement of urinary bladder function in 83.3% animals in group B and 16.66% animals in group A. The analysis of functional motor activity and histology of the spinal cord and urinary bladder demonstrated no significant difference between groups A and B. The results indicate that transplanted hADSC improved urinary function via a telecrine mechanism, namely action at a distance.

Comparison of microbial load in immersion chilling water and poultry carcasses after 8, 16 and 24 working hours

As atividades dos estabelecimentos de abate de frangos são conhecidas por utilizarem grandes volumes de água durante seus processos, principalmente no processo de resfriamento das carcaças de frangos. Parte desse volume utilizado se faz necessário, em cumprimento à legislação que determina que cada tanque do sistema de pré-resfriadores contínuos por imersão deve ser completamente esvaziado, limpo e desinfetado no final de cada período de trabalho (oito horas). O objetivo deste estudo foi comparar a carga microbiana das águas do sistema de resfriamento e das carcaças de frango ao final de oito, dezesseis e vinte e quatro horas de trabalho do abatedouro, para possível redução do número de vezes do completo esvaziamento dos tanques do sistema de resfriamento. Foram avaliadas, por meio de métodos convencionais microbiológicos e físico-químicos, amostras da água de abastecimento (n=69), visando a evitar possível interferência nas contagens das águas do sistema de resfriamento, amostras de carcaças de frango antes (n=345) e após (n=345) sua passagem pelo sistema de resfriamento e amostras de águas do último estágio do sistema de resfriamento de carcaças (n=69). Os resultados obtidos demonstraram que não houve diferença significativa na carga microbiana das amostras entre as três jornadas de trabalho do estabelecimento, sugerindo que a redução é segura, diminuindo assim o volume de águas residuais e seu impacto no meio ambiente, bem como melhorando o uso racional do tempo de processamento.

The Lanz® endotracheal tube decreases tracheal injury in dogs

Purpose: To determine, in dogs anesthetized with nitrous oxide (N2O), whether the endotracheal tube (ETT) cuffed with a Lanz® pressure regulating valve decreases the tracheal consequences of tracheal intubation. Methods: Sixteen mixed-breed dogs were allocated to two groups according to the ETT used: Control group (n = 8) - Rüsch ETT, and Lanz group (n = 8) - ETT with Lanz® pressure regulating valve. The ETT cuffs in both groups were inflated with air to an intracuff pressure of 30 cm H2O. Anesthesia was induced and maintained with pentobarbitone and N2O (1.5 L·min-1) and O2 (1 L·min-1). ETT cuff pressures were measured before (control) and 60, 120, and 180 min during N2O administration. The dogs were sacrificed, and biopsy specimens from four predetermined areas of the tracheal mucosa in contact with the ETT were collected for light and scanning electron microscopy (SM) examination. Results: Cuff pressures in the Control group were higher than in the Lanz group at all time points studied (P < 0.001), with an increase over time only in the Control group (P < 0.001). Median neutrophilic inflammatory infiltration values of the epithelial surface, and in the subepithelial layer in contact with the cuff, were higher in the Control group as compared to the Lanz group (3.0 vs 1.0 and 3.0 vs 1.5 respectively) (P < 0.05). On SM examination, median histological grades were higher in the Control group compared to Lanz group (2.9 vs 1.9 respectively), (P < 0.05). Conclusions: The Lanz® ETT decreases tracheal mucosal injury in dogs.

Effect of root canal status on periodontal healing after surgical injury in dogs.

This study was carried out to observe if the status of the root canal might influence the healing process of surgically prepared experimental periodontal lesions. Forty tooth roots from four dogs were divided into four different groups: a) root canals with vital pulps, b) root canals open to the oral environment, c) root canals infected and filled with zinc oxide eugenol cement, and d) root canals infected and filled with calcium hydroxide. By means of a surgical intervention, a cavity was prepared in the medium portion of the roots. Six months later, the specimens were removed and prepared for histological analysis. The results, which were submitted to statistical analysis, showed that the status of the root canals influenced the healing process of the experimental periodontal lesions. In the groups where the root canals were filled, calcium hydroxide gave the best results. In the group with root canals left open to the oral environment, resorption of the dentin of the experimental cavities, was the most obvious observation. However, it did not prevent the repair process, only slowed it down.

Acute kidney injury after massive attack of Africanised bees

Acute kidney injury (AKI) is a well-documented complication of massive attack by Africanised bees and can be observed 48-72 h after the accident. We report a case of Africanised bees attack followed by severe and lethal AKI. A 56-year-old man was admitted to emergency department after a massive attack of Africanised bees (>1000 bee stings). He was unconscious, presenting with hypotension and tachycardia. Mechanical ventilation, volume expansion and care for anaphylaxis were instituted. The patient was transferred to the intensive care unit (ICU) and after 48 h he developed rhabdomyolysis, oliguria, increased creatinine levels, hyperkalaemia and refractory acidosis. A diagnosis of AKI secondary to rhabdomyolysis and shock was made. The patient was treated with a prolonged course of haemodialysis. However, he progressed to refractory shock and died 5 days after admission.

Acute kidney injury in septic patients admitted to emergency clinical room: risk factors and outcome

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Chilling of Steindachneridionparahybae (siluriformes: pimelodidae) embryos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Extrinsic factors affecting water absorption in chilling of broiler chicken carcasses

Brazil occupies an outstanding position as a producer and exporter of chicken meat, and the maintenance and expansion of this position require a constant evolution, especially in variables which determine quality. An important quality parameter of poultry meat is the amount of water absorbed by the carcass during processing. In Brazil, carcasses chilling is done by immersion in chilled water. In this process, the carcass is rehydrated and the water lost during transport and initial operations is replaced. At this stage, some care is needed to prevent the absorption of water upper than the level allowed by Brazilian law. This project aimed to evaluate extrinsic factors that can influence the absorption of water by the chicken meat. For this, 144 Cobb chickens divided into 24 groups of six birds were used. At 42 days of age, one chicken of each group, with weight ranging up to 10% more or less from the average of the group, was slaughtered in an experimental pilot scale abattoir where slaughter procedures were conducted under strictly controlled conditions. The chilling procedure was performed following a completely randomized design with factorial arrangement 3x2, where the factors were: three temperatures in the first section of the chilling system (4, 10 and 16ºC) and two degrees of water hardness (hard and soft water), with six treatments and four replications. Brazilian law provides that the water temperature in the first section of the chiller must not be higher than 16ºC, and the length of the carcasses in this section shall not exceed 30 minutes. All carcasses remained in the first section of the chiller for 30 minutes and then were transferred to another tank with water at 4ºC, remaining there until reaching 7ºC. The carcasses were weighed before and after chilling, to evaluate the percentage of water absorbed. The water absorption was influenced by the initial temperature of the water in the chiller and by the water hardness. When initially immersed in water at 4ºC, carcasses water absorption averaged 2.70%, a significantly lower absorption than the values found for the carcasses that were initially immersed in water at 16ºC, 3.83% (p<0.05). The carcasses immersed in water at 10ºC had mean water absorption of 3.66%, not differing from the means observed in the other two treatments (p>0.05). In hard water, the average water absorption was 2.46% and, in soft water, 4.33% (p<0.05). In all treatments, the water absorption did not exceed the limit established by Brazilian legislation, which is a maximum of 8%. This information is important to control the absorption of water by carcasses in chicken meat processing, preventing consumers from being harmed.

The role of oxidative stress in renal injury related to obesity

The mechanisms linking obesity to kidney damage are unknown. AGEs are responsible for renal damage in obese individuals. The receptor AGEs (RAGE) contributes to nuclear transcription factors that result in the production of proinflammatory cytokines and this seems to contribute to the development of renal disease. Thus, intervention with antioxidant can have an important effect in the prevention and treatment of pro-oxidant and pro-inflammatory state in the kidneys resulting from obesity.

Ventilator-induced lung injury and acute respiratory distress syndrome: a basic science review

Acute respiratory distress syndrome is the most severe manifestation of acute lung injury and it is associated with high mortality rate. Despite better understanding of ARDS pathophysiology, its mechanism is still unclear. Mechanical ventilation is the main ARDS supportive treatment. However, mechanical ventilation is a non-physiologic process and complications are associated with its application. Mechanical ventilation may induce lung injury, referred to as ventilator-induced lung injury. Frequently, VILI is related to macroscopic injuries associated with alveolar rupture. The present article is a review of the literature on ventilator-induced lung injury in acute respiratory distress syndrome. Animal and human studies were reviewed. We mainly selected publications in the past 5 years, but did not exclude commonly referenced and highly regarded older publications.

Prone positioning attenuates TNF-alpha production in rabbits with lung injury under protective conventional mechanical ventilation (CMV)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

HMGB1 in an experimental model of acute lung injury

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Fatores de risco nutricionais associados à mortalidade em pacientes com lesão renal aguda de acordo com os critérios do Acute Kidney Injury Network (AKIN)

Pós-graduação em Fisiopatologia em Clínica Médica - FMB