Influência da dexmedetomidina/atropina sobre as alterações da variação de pulso induzidas pela hemorragia seguida por reposição volêmica em cães anestesiados com isoflurano

Pós-graduação em Anestesiologia - FMB

Developmental aspects of early pregnancy in mares

In mares, the embryo migrates to the uterus between days 5 and 6 postovulation beginning its mobility through all uterine segments, which is essential for the maternal recognition of pregnancy. During the mobility phase, the embryonic vesicle shows a linear growth rate until its fixation between days 15 and 17, when the orientation phenomenon occurs. From fixation to day 28 of pregnancy, the embryonic growth is less evident (plateau) by cross-section ultrasound examination. After this period the linear growth rate is reestablished until day 46. This plateau is attributed to the increased uterine tone that compresses the vesicle and to volume expansion, making it difficult to detect the conceptus growth only by the cross-section diameter. Around day 20, the embryo proper is visualized as an echogenic spot in the ventral aspect of the vesicle. Additionally, development of allantoic sac, embryonic heartbeat, yolk sac regression and posterior umbilical cord formation also can be visualized from days 20 to 40. An intimate interaction between uterus and conceptus is essential for the normal pregnancy development. Color-and spectral-Doppler ultrasonography can be useful for the evaluation of this interface. A gradual increase on uterine vascularity during the early pregnancy and transient changes in endometrial vascularity accompanying the vesicle location during the mobility phase have been described. Around day 38 of gestation, the formation of the endometrial cups begins and, consequently, the synthesis of the equine chorionic gonadotropin (eCG) induces the formation and development of supplementary corpora lutea, which are important to secrete progesterone and to maintain pregnancy until around day 120.

Role of alpha1 and alpha2-adrenoceptors of the lateral hypothalamic area on urinary excretion caused by centrally administered angiotensin II

To determine whether central α1 and α2-adrenergic mechanisms are involved in urinary sodium and potassium excretion and urine volume induced by angiotensin II (ANGII), these renal parameters were measured in volume-expanded Holtzman rats with cannulas implanted into lateral ventricle (LV) and lateral hypothalamus (LH). The injection of ANGII into LV in rats with volume expansion reduced the sodium, potassium and urine excretion in comparison to the control injections of isotonic saline, whereas prazosin (α1 antagonist) potentiated these effects. Clonidine (α2 agonist) and yohimbine (α2 antagonist) injected into LH previous to injection of ANGII into LV also abolished the inhibitory effect of ANGII. These results suggest that the discharge of central alpha-adrenergic receptors has dual inhibitory and excitatory effect on antinatriuretic, antikaliuretic and antidiuretic effect induced by central ANGII in volume-expanded rats. © 1995.

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.

Perioperative fluid therapy: a statement from the international fluid optimization group

Perioperative fluid therapy remains a highly debated topic. Its purpose is to maintain or restore effective circulating blood volume during the immediate perioperative period. Maintaining effective circulating blood volume and pressure are key components of assuring adequate organ perfusion while avoiding the risks associated with either organ hypo- or hyperperfusion. Relative to perioperative fluid therapy, three inescapable conclusions exist: overhydration is bad, underhydration is bad, and what we assume about the fluid status of our patients may be incorrect. There is wide variability of practice, both between individuals and institutions. The aims of this paper are to clearly define the risks and benefits of fluid choices within the perioperative space, to describe current evidence-based methodologies for their administration, and ultimately to reduce the variability with which perioperative fluids are administered. Based on the abovementioned acknowledgements, a group of 72 researchers, well known within the field of fluid resuscitation, were invited, via email, to attend a meeting that was held in Chicago in 2011 to discuss perioperative fluid therapy. From the 72 invitees, 14 researchers representing 7 countries attended, and thus, the international Fluid Optimization Group (FOG) came into existence. These researches, working collaboratively, have reviewed the data from 162 different fluid resuscitation papers including both operative and intensive care unit populations. This manuscript is the result of 3 years of evidence-based, discussions, analysis, and synthesis of the currently known risks and benefits of individual fluids and the best methods for administering them. The results of this review paper provide an overview of the components of an effective perioperative fluid administration plan and address both the physiologic principles and outcomes of fluid administration. We recommend that both perioperative fluid choice and therapy be individualized. Patients should receive fluid therapy guided by predefined physiologic targets. Specifically, fluids should be administered when patients require augmentation of their perfusion and are also volume responsive. This paper provides a general approach to fluid therapy and practical recommendations.

Stunning method in broiler chickens meat processing

Quality is a variable concept, which involves many factors, depending on the consumer market. In meat production, the concern with environmental aspects, animal welfare and the health and safety of workers is increasing. This work studied the effect of controlled atmosphere stunning of broilers on meat features and biochemical parameters for stress. Cobb broilers were stunned by electrical stunning and by controlled atmosphere with 70% CO2 and 70% CO2 + 30% Argon. After stunning, serum levels of glucose, lactate and corticosterone were compared with those of broilers at rest, immediately before transportation and slaughter and after 12 h of feed withdrawal (control group). At slaughter, blood volume drained during bleeding was not different for the stunning methods tested, ranging from 3.3 to 3.4% birds weight. This finding was important to demonstrate that gas stunning was not responsible for the animals′ death. Final pH in breast (6.1 to 6.2) and thigh (6.3 to 6.5) also did not vary among the different stunning methods (P > 0.05). Lightness (L = 60.55) and redness (a = +8.94) values found for breasts from electrical stunning showed that they were darker and redder (P < 0.05), probably due to changes in blood pressure. Glucose and corticosterone levels were not different between gas stunned birds (302.45 to 315.7 mg/dl and 55.71 to 72.49 ng/ml respectively) and birds at rest (305.95 mg/dl and 50.65 ng/ml) (P > 0.05). These stress indicators were higher (337.65 mg/dl for glucose and 104.13 ng/ml for costicosterone) when electrical stunning was used (P < 0.05). Lactate concentrations were lower (5.4 mmol/l) for birds at rest (P < 0.05) but not different for all stunning methods tested (7.3 to 8.1 mmol/l; P > 0.05). These results show that serum glucose may be used as a stress indicator in birds, with the advantage of being a quick and cheap biochemical test. Gas stunning favored birds′ management during slaughter and so reduced workers′ effort and injury hazard and the amount of feces and dust in the room. To make this method available for a large scale process, adjustments in equipments will be necessary to avoid delays in the processing line.

Role of alfa2-adrenoceptors in the lateral parabrachial nucleus in the control of body fluid homeostasis

Central α2-adrenoceptors and the pontine lateral parabrachial nucleus (LPBN) are involved in the control of sodium and water intake. Bilateral injections of moxonidine (α2-adrenergic/imidazoline receptor agonist) or noradrenaline into the LPBN strongly increases 0.3 M NaCl intake induced by a combined treatment of furosemide plus captopril. Injection of moxonidine into the LPBN also increases hypertonic NaCl and water intake and reduces oxytocin secretion, urinary sodium, and water excreted by cell-dehydrated rats, causing a positive sodium and water balance, which suggests that moxonidine injected into the LPBN deactivates mechanisms that restrain body fluid volume expansion. Pretreatment with specific α2-adrenoceptor antagonists injected into the LPBN abolishes the behavioral and renal effects of moxonidine or noradrenaline injected into the same area, suggesting that these effects depend on activation of LPBN α2-adrenoceptors. In fluid-depleted rats, the palatability of sodium is reduced by ingestion of hypertonic NaCl, limiting intake. However, in rats treated with moxonidine injected into the LPBN, the NaCl palatability remains high, even after ingestion of significant amounts of 0.3 M NaCl. The changes in behavioral and renal responses produced by activation of α2-adrenoceptors in the LPBN are probably a consequence of reduction of oxytocin secretion and blockade of inhibitory signals that affect sodium palatability. In this review, a model is proposed to show how activation of α2-adrenoceptors in the LPBN may affect palatability and, consequently, ingestion of sodium as well as renal sodium excretion.

Comparação entre índices dinâmicos e volumétricos de pré-carga em cães submetidos à hemorragia moderada seguida de reposição volêmica

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

Moxonidine into the lateral parabrachial nucleus reduces renal and hormonal responses to cell dehydration

The deactivation of the inhibitory mechanisms with injections of moxonidine (alpha(2)-adrenoceptor/imidazoline receptor agonist) into the lateral parabrachial nucleus (LPBN) increases hypertonic NaCl intake by intra- or extracellular dehydrated rats. In the present study, we investigated the changes in the urinary sodium and volume, sodium balance, and plasma vasopressin and oxytocin in rats treated with intragastric (i.g.) 2 M NaCl load (2 ml/rat) combined with injections of moxonidine into the LPBN. Male Holtzman rats (n=5-12/group) with stainless steel cannulas implanted bilaterally into LPBN were used. Bilateral injections of moxonidine (0.5 nmol/0.2 mu l) into the LPBN decreased i.g. 2 M NaCIinduced diuresis (4.6 +/- 0.7 vs. vehicle: 7.4 +/- 0.6 ml/120 min) and natriuresis (1.65 +/- 0.29 vs. vehicle: 2.53 +/- 0.17 mEq/120 min), whereas the previous injection of the alpha(2)-adrenoceptor antagonist RX 821002 (10 nmol/0.2 mu l) into the LPBN abolished the effects of moxonidline. Moxonidine injected into the LPBN reduced i.g. 2 M NaCl-induced increase in plasma oxytocin and vasopressin (14.6 +/- 2.8 and 2.2 +/- 0.3 vs. vehicle: 25.7 +/- 7 and 4.3 +/- 0.7 pg/ml, respectively). Moxonidine injected into the LPBN combined with i.g. 2 M NaCl also increased 0.3 M NaCl intake (7.5 +/- 1.7 vs. vehicle: 0.5 +/- 0.2 mEq/2 h) and produced positive sodium balance (2.3 +/- 1.4 vs. vehicle: -1.2 +/- 0.4 mEq/2 h) in rats that had access to water and NaCl. The present results show that LPBN alpha(2)-adrenoceptor activation reduces renal and hormonal responses to intracellular dehydration and increases sodium and water intake, which facilitates sodium retention and body fluid volume expansion. (C) 2012 IBRO. Published by Elsevier Ltd. All rights reserved.

Use of pulse pressure variation to estimate changes in preload during experimental acute normovolemic hemodilution

Background. Acute normovolemic hemodilution (ANH) is an alternative to blood transfusion in surgeries involving blood loss. This experimental study was designed to evaluate whether pulse pressure variation (PPV) would be an adequate tool for monitoring changes in preload during ANH, as assessed by transesophageal echocardiography. Methods. Twenty-one anesthetized and mechanically ventilated pigs were randomized into three groups: CTL (control), HES (hemodilution with 6% hydroxyethyl starch at a 1:1 ratio) or NS (hemodilution with saline 0.9% at a 3:1 ratio). Hemodilution was performed in animals of groups NS and HES in two stages, with target hematocrits 22% and 15%, achieved at 30-minute intervals. After two hours, 50% of the blood volume withdrawn was transfused and animals were monitored for another hour. Statistical analysis was based on ANOVA for repeated measures followed by multiple comparison test (P<0.05). Pearson's correlations were performed between changes in left ventricular end-diastolic volume (LVEDV) and PPV, central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP). Results. Group NS received a significantly greater amount of fluids during ANH (NS, 900 +/- 168 mL vs. HES, 200 +/- 50 mL, P<0.05) and presented greater urine output (NS, 2643 +/- 1097mL vs. HES, 641 +/- 338mL, P<0.001). Significant decreases in LVEDV were observed in group NS from completion of ANH until transfusion. In group HES, only increases in LVEDV were observed, at the end of ANH and at transfusion. Such changes in LVEDV (Delta LVEDV) were better reflected by changes in PPV (Delta PPV, R=-0.62) than changes in CVP (Delta CVP R=0.32) or in PAOP (Delta PAOP, R=0.42, respectively). Conclusion. Changes in preload during ANH were detected by changes in PPV. Delta PPV was superior to Delta PAOP and Delta CVP to this end. (Minerva Anestesiol 2012;78:426-33)

Increased NHE3 abundance and transport activity in renal proximal tubule of rats with heart failure

Inoue BH, dos Santos L, Pessoa TD, Antonio EL, Pacheco BPM, Savignano FA, Carraro-Lacroix LR, Tucci PJF, Malnic G, Girardi ACC. Increased NHE3 abundance and transport activity in renal proximal tubule of rats with heart failure. Am J Physiol Regul Integr Comp Physiol 302: R166-R174, 2012. First published October 26, 2011; doi:10.1152/ajpregu.00127.2011.-Heart failure (HF) is associated with a reduced effective circulating volume that drives sodium and water retention and extracellular volume expansion. We therefore hypothesized that Na(+)/H(+) exchanger isoform 3 (NHE3), the major apical transcellular pathway for sodium reabsorption in the proximal tubule, is upregulated in an experimental model of HF. HF was induced in male rats by left ventricle radiofrequency ablation. Sham-operated rats (sham) were used as controls. At 6 wk after surgery, HF rats exhibited cardiac dysfunction with a dramatic increase in left ventricular end-diastolic pressure. By means of stationary in vivo microperfusion and pH-dependent sodium uptake, we demonstrated that NHE3 transport activity was significantly higher in the proximal tubule of HF compared with sham rats. Increased NHE3 activity was paralleled by increased renal cortical NHE3 expression at both protein and mRNA levels. In addition, the baseline PKA-dependent NHE3 phosphorylation at serine 552 was reduced in renal cortical membranes of rats with HF. Collectively, these results suggest that NHE3 is upregulated in the proximal tubule of HF rats by transcriptional, translational, and posttranslational mechanisms. Enhanced NHE3-mediated sodium reabsorption in the proximal tubule may contribute to extracellular volume expansion and edema, the hallmark feature of HF. Moreover, our study emphasizes the importance of undertaking a cardiorenal approach to contain progression of cardiac disease.

Involvement of the paraventricular nucleus (PVN) of hypothalamus in the cardiovascular alterations to head up tilt in conscious rats

We evaluated the involvement of paraventricular nucleus (PVN) in the changes in mean arterial pressure (MAP) and heart rate (HR) during an orthostatic challenge (head up tilt, HUT). Adult male Wistar rats, instrumented with guide cannulas to PVN and artery and vein catheters were submitted to MAP and HR recording in conscious state and induction of HUT. The HUT induced an increase in MAP and HR and the pretreatment with prazosin and atenolol blocked these effects. After inhibition of neurotransmission with cobalt chloride (1 mM/100 nl) into the PVN the HR parameters did not change, however we observed a decrease in MAP during HUT. Our data suggest the involvement of PVN in the brain circuitry involved in cardiovascular adjustment during orthostatic challenges. (C) 2011 Elsevier Ireland Ltd and the Japan Neuroscience Society. All rights reserved.

Amalgamersatz

Amalgamersatz:Neue Wege zur Herstellung von Dentalkompositen mit geringem Polymerisationsschrumpf auf (Meth-)Acrylat-Basis Aufgrund der ästhetischen und gesundheitlichen Bedenken wird seit Jahrzehnten nach einer Alternative für Amalgam als Zahnfüllmaterial gesucht. Der größte Nachteil von organischen Monomeren liegt in der Volumenkontraktion während der Aushärtung, welche sich negativ auf die Materialeigenschaften auswirkt. Aus diesem Grund war das Hauptziel dieser Arbeit, eine Minimierung des Schrumpfes bei der radikalischen Polymerisation zu erreichen. Dazu wurden verschiedene, zum Teil neue, (Meth-)Acrylate synthetisiert und auf ihre Einsetzbarkeit als Bestandteil von Dentalkompositen geprüft.Um die Volumenkontraktion während der Polymerisation zu minimieren, wurde die Beweglichkeit der polymerisierbaren Gruppe eingeschränkt. Im ersten Teil der Arbeit wurden dazu flüssigkristalline Substanzen eingesetzt. Durch Mischen von flüssigkristallinen Diacrylaten konnte eine Mesophase im gewünschten Temperaturintervall von 25 bis 35 °C erhalten werden. Der Einsatz dieser Flüssigkristalle zeigte einen positiven Einfluss auf den Polymerisationsschrumpf. Zudem wurden neue Monomere synthetisiert, deren Methacrylgruppe in direkter Nachbarschaft zum Mesogen angebunden wurde, um die Stabilität der erhaltenen Polymere zu erhöhen.Im zweiten Teil der Arbeit wurde die Beweglichkeit der polymerisierbaren Gruppe durch eine Fixierung an einem starren Kern reduziert. Als Grundkörper wurden Polyphenole, enzymatisch polymerisierte Phenole und ߖCyclodextrin verwendet. Bei den modifizierten Polyphenolen auf Basis von Gallussäure und 3,5-Dihydroxybenzoesäure konnte eine leichte Reduzierung des Polymerisationsschrumpfes erreicht werden. Mit HRP (Horseradish Peroxidase) katalysierten enzymatisch polymerisierten Phenole konnte dagegen nicht photochemisch vernetzt werden, da diese Oligomere in Lösung gefärbt vorlagen. Zudem zeigten die freien, phenolischen Hydroxygruppen eine sehr geringe Reaktivität. Die besten Ergebnisse wurden mit modifizierten ߖCyclodextrinen als Komponente einer Komposite erreicht. Dabei wurde in einem Fall sogar eine leichte Volumenexpansion während der Polymerisation erzielt.

Valutazione precoce della risposta a Sorafenib nel Carcinoma Epatocellulare mediante quantificazione dell'Ecografia con contrasto con software Sonotumor

Scopo dello studio: Stabilire se cambiamenti della perfusione di una lesione target di epatocarcinoma (HCC), valutati quantitativamente mediante ecografia con contrasto (CE-US) alla settimana 2 e 4 di terapia con sorafenib, possono predire la progressione di malattia alla settimana 8, valutata con la tomografia computerizzata o la risonanza magnetica con mezzo di contrasto (TC-RM) usando i criteri RECIST/RECIST modificati (response evaluation criteria in solid tumors). Pazienti e metodi: Il comitato etico ha approvato lo studio ed i pazienti hanno fornito un consenso informato scritto prima dell’arruolamento. Lo studio è stato effettuato su un campione di soggetti con epatocarcinoma avanzato o non suscettibile di trattamento curativo, in monoterapia con sorafenib. La valutazione della risposta tumorale è stata effettuata con TC o RM a 2 mesi usando i criteri RECIST/RECIST modificati. La CE-US è stata effettuata entro 1 settimana prima dell’inizio del trattamento con sorafenib e durante la terapia alla settimana 2, 4, 8, 16 e 32. I parametri quantitativi funzionali sono stati ottenuti impiegando un software dedicato. I cambiamenti dei valori dei parametri suddetti tra il tempo zero ed i punti temporali successivi sono stati confrontati con la risposta tumorale basata sui criteri RECIST/RECIST modificati. Risultati: La riduzione dei valori dei parametri relativi alla perfusione tumorale, in particolare di WiAUC e PE (parametri correlati con il volume ematico), al T2/T4 (settimana 2, 4), predice la risposta tumorale a 2 mesi, valutata secondo i criteri RECIST e RECIST modificati, risultata indicativa di malattia stabile (responders). Conclusione: L’ecografia con contrasto può essere impiegata per quantificare i cambiamenti della vascolarizzazione tumorale già alla settimana 2, 4 dopo la somministrazione di sorafenib nei pazienti con HCC. Questi precoci cambiamenti della perfusione tumorale possono essere predittivi della risposta tumorale a 2 mesi e possono avere un potenziale nella valutazione precoce dell'efficacia della terapia antiangiogenica nell’epatocarcinoma.

Controllable assembly of graphene hybrid materials and their application in energy storage and conversion

Hybrid Elektrodenmaterialien (HEM) sind der Schlüssel zu grundlegenden Fortschritten in der Energiespeicherung und Systemen zur Energieumwandlung, einschließlich Lithium-Ionen-Batterien (LiBs), Superkondensatoren (SCs) und Brennstoffzellen (FCs). Die faszinierenden Eigenschaften von Graphen machen es zu einem guten Ausgangsmaterial für die Darstellung von HEM. Jedoch scheitern traditionelle Verfahren zur Herstellung von Graphen-HEM (GHEM) scheitern häufig an der fehlenden Kontrolle über die Morphologie und deren Einheitlichkeit, was zu unzureichenden Grenzflächenwechselwirkungen und einer mangelhaften Leistung des Materials führt. Diese Arbeit konzentriert sich auf die Herstellung von GHEM über kontrollierte Darstellungsmethoden und befasst sich mit der Nutzung von definierten GHEM für die Energiespeicherung und -umwandlung. Die große Volumenausdehnung bildet den Hauptnachteil der künftigen Lithium-Speicher-Materialien. Als erstes wird ein dreidimensionaler Graphen Schaumhybrid zur Stärkung der Grundstruktur und zur Verbesserung der elektrochemischen Leistung des Fe3O4 Anodenmaterials dargestellt. Der Einsatz von Graphenschalen und Graphennetzen realisiert dabei einen doppelten Schutz gegen die Volumenschwankung des Fe3O4 bei dem elektrochemischen Prozess. Die Leistung der SCs und der FCs hängt von der Porenstruktur und der zugänglichen Oberfläche, beziehungsweise den katalytischen Stellen der Elektrodenmaterialien ab. Wir zeigen, dass die Steuerung der Porosität über Graphen-basierte Kohlenstoffnanoschichten (HPCN) die zugängliche Oberfläche und den Ionentransport/Ladungsspeicher für SCs-Anwendungen erhöht. Desweiteren wurden Stickstoff dotierte Kohlenstoffnanoschichten (NDCN) für die kathodische Sauerstoffreduktion (ORR) hergestellt. Eine maßgeschnittene Mesoporosität verbunden mit Heteroatom Doping (Stickstoff) fördert die Exposition der aktiven Zentren und die ORR-Leistung der metallfreien Katalysatoren. Hochwertiges elektrochemisch exfoliiertes Graphen (EEG) ist ein vielversprechender Kandidat für die Darstellung von GHEM. Allerdings ist die kontrollierte Darstellung von EEG-Hybriden weiterhin eine große Herausforderung. Zu guter Letzt wird eine Bottom-up-Strategie für die Darstellung von EEG Schichten mit einer Reihe von funktionellen Nanopartikeln (Si, Fe3O4 und Pt NPs) vorgestellt. Diese Arbeit zeigt einen vielversprechenden Weg für die wirtschaftliche Synthese von EEG und EEG-basierten Materialien.