Blocking effects of polyunsaturated fatty acids on Na+ channels of neonatal rat ventricular myocytes.

Recent evidence indicates that polyunsaturated long-chain fatty acids (PUFAs) prevent lethal ischemia-induced cardiac arrhythmias in animals and probably in humans. To increase understanding of the mechanism(s) of this phenomenon, the effects of PUFAs on Na+ currents were assessed by the whole-cell patch-clamp technique in cultured neonatal rat ventricular myocytes. Extracellular application of the free 5,8,11,14,17-eicosapentaenoic acid (EPA) produced a concentration-dependent suppression of ventricular, voltage-activated Na+ currents (INa). After cardiac myocytes were treated with 5 or 10 microM EPA, the peak INa (elicited by a single-step voltage change with pulses from -80 to -30 mV) was decreased by 51% +/- 8% (P < 0.01; n = 10) and 64% +/- 5% (P < 0.001; n = 21), respectively, within 2 min. Likewise, the same concentrations of 4,7,10,16,19-docosahexaenoic acid produced the same inhibition of INa. By contrast, 5 and 10 microM arachidonic acid (AA) caused less inhibition of INa, but both n - 6 and n - 3 PUFAs inhibited INa significantly. A monounsaturated fatty acid and a saturated fatty acid did not. After washing out EPA, INa returned to the control level. Raising the concentration of EPA to 40 microM completely blocked INa. The IC50 of EPA was 4.8 microM. The inhibition of this Na+ channel was found to be dose and time, but not use dependent. Also, the EPA-induced inhibition of INa was voltage dependent, since 10 microM EPA produced 83% +/- 7% and 29% +/- 5% inhibition of INa elicited by pulses from -80 to -30 mV and from -150 to -30 mV, respectively, in single-step voltage changes. A concentration of 10 microM EPA shifted the steady-state inactivation curve of INa by -19 +/- 3 mV (n = 7; P < 0.01). These effects of PUFAs on INa may be important for their antiarrhythmic effect in vivo.

Genetic variation in vulnerability to the behavioral effects of neonatal hippocampal damage in rats.

We explored how two independent variables, one genetic (i.e., specific rat strains) and another environmental (i.e., a developmental excitotoxic hippocampal lesion), contribute to phenotypic variation. Sprague-Dawley (SD), Fischer 344 (F344), and Lewis rats underwent two grades of neonatal excitotoxic damage: small and large ventral hippocampal (SVH and LVH) lesions. Locomotion was tested before puberty [postnatal day 35 (P35)] and after puberty (P56) following exposure to a novel environment or administration of amphetamine. The behavioral effects were strain- and lesion-specific. As shown previously, SD rats with LVH lesions displayed enhanced spontaneous and amphetamine-induced locomotion as compared with controls at P56, but not at P35. SVH lesions in SD rats had no effect at any age. In F344 rats with LVH lesions, enhanced spontaneous and amphetamine-induced locomotion appeared early (P35) and was exaggerated at P56. SVH lesions in F344 rats resulted in a pattern of effects analogous to LVH lesions in SD rats--i.e., postpubertal onset of hyperlocomotion (P56). In Lewis rats, LVH lesions had no significant effect on novelty- or amphetamine-induced locomotion at any age. These data show that the degree of genetic predisposition and the extent of early induced hippocampal defect contribute to the particular pattern of behavioral outcome. These results may have implications for modeling interactions of genetic and environmental factors involved in schizophrenia, a disorder characterized by phenotypic heterogeneity, genetic predisposition, a developmental hippocampal abnormality, and vulnerability to environmental stress.

Aod1, the immunoregulatory locus controlling abrogation of tolerance in neonatal thymectomy-induced autoimmune ovarian dysgenesis, maps to mouse chromosome 16.

Mice thymectomized at three days of age (D3Tx) develop during adulthood a variety of organ-specific autoimmune diseases, including autoimmune ovarian dysgenesis (AOD). The phenotypic spectrum of AOD is characterized by the development of anti-ovarian autoantibodies, oophoritis, and atrophy. The D3Tx model of AOD is unique in that disease induction depends exclusively on perturbation of the normal developing immune system, is T-cell-mediated, and is strain specific. For example, D3Tx A/J mice are highly susceptible to AOD, whereas C57BL/6J mice are resistant. After D3Tx, self ovarian antigens, expressed at physiological levels, trigger an autoimmune response capable of eliciting disease. The D3Tx model provides, therefore, the opportunity to focus on the mechanisms of self-tolerance that are relevant to disease pathogenesis. Previous studies indicate that the principal mechanisms involved in AOD susceptibility are genetically controlled and govern developmental processes associated with the induction and maintenance of peripheral tolerance. We report here the mapping of the Aod1 locus to mouse chromosome 16 within a region encoding several loci of immunologic relevance, including scid, Igl1, VpreB, Igll, Igl1r, Mtv6 (Mls-3), Ly-7, Ifnar, and Ifgt.

Neonatal lethality associated with respiratory distress in mice lacking cytochrome P450 1A2.

Cytochrome P450 1A2 (CYP1A2) is a constitutively expressed hepatic enzyme that is highly conserved among mammals. This protein is primarily involved in oxidative metabolism of xenobiotics and is capable of metabolically activating numerous procarcinogens including aflatoxin B1, arylamines, heterocyclic amine food mutagens, and polycylic aromatic hydrocarbons. Expression of CYP1A2 is induced after exposure to certain aromatic hydrocarbons (i.e., 2,3,7,8-tetrachlorodibenzo-p-dioxin). Direct evidence for a role of CYP1A2 in any physiological or developmental pathway has not been documented. We now demonstrate that mice homozygous for a targeted mutation in the Cyp1a-2 gene are nonviable. Lethality occurs shortly after birth with symptoms of severe respiratory distress. Mutant neonates display impaired respiratory function associated with histological signs of lung immaturity, lack of air in alveoli at birth, and changes in expression of surfactant apoprotein in alveolar type II cells. The penetrance of the phenotype is not complete (19 mutants survived to adulthood out of 599 mice). Surviving animals, although lacking expression of CYP1A2, appear to be normal and are able to reproduce. These findings establish that CYP1A2 is critical for neonatal survival by influencing the physiology of respiration in neonates, thus offering etiological insights for neonatal respiratory distress syndrome.

Invariance and restriction toward a limited set of self-antigens characterize neonatal IgM antibody repertoires and prevail in autoreactive repertoires of healthy adults.

Analysis of the reactivity of IgM with self-antigens in tissues by a quantitative immunoblotting technique showed striking invariance among newborns in the human and in the mouse. The self-reactive repertoire of IgM of adults was also markedly conserved; it comprised most anti-self reactivities that prevailed among neonates. Multivariate analysis confirmed the homogeneity of IgM repertoires of neonates toward self- and non-self-antigens. Multivariate analysis discriminated between newborn and adult repertoires for reactivity with two of five sources of self-proteins and with non-self-antigens. Our observations support the concept that naturally activated B lymphocytes are selected early in development and throughout life for reactivity with a restricted set of self-antigens.

Free, long-chain, polyunsaturated fatty acids reduce membrane electrical excitability in neonatal rat cardiac myocytes.

Because previous studies showed that polyunsaturated fatty acids can reduce the contraction rate of spontaneously beating heart cells and have antiarrhythmic effects, we examined the effects of the fatty acids on the electrophysiology of the cardiac cycle in isolated neonatal rat cardiac myocytes. Exposure of cardiomyocytes to 10 microM eicosapentaenoic acid for 2-5 min markedly increased the strength of the depolarizing current required to elicit an action potential (from 18.0 +/- 2.4 pA to 26.8 +/- 2.7 pA, P < 0.01) and the cycle length of excitability (from 525 ms to 1225 ms, delta = 700 +/- 212, P < 0.05). These changes were due to an increase in the threshold for action potential (from -52 mV to -43 mV, delta = 9 +/- 3, P < 0.05) and a more negative resting membrane potential (from -52 mV to -57 mV, delta = 5 +/- 1, P < 0.05). There was a progressive prolongation of intervals between spontaneous action potentials and a slowed rate of phase 4 depolarization. Other polyunsaturated fatty acids--including docosahexaenoic acid, linolenic acid, linoleic acid, arachidonic acid, and its nonmetabolizable analog eicosatetraynoic acid, but neither the monounsaturated oleic acid nor the saturated stearic acid--had similar effects. The effects of the fatty acids could be reversed by washing with fatty acid-free bovine serum albumin. These results show that free polyunsaturated fatty acids can reduce membrane electrical excitability of heart cells and provide an electrophysiological basis for the antiarrhythmic effects of these fatty acids.

Rapid alteration of thalamocortical axon morphology follows peripheral damage in the neonatal rat.

The effect of day of birth (postnatal day 0; P0) infraorbital nerve section on the morphology of individual thalamocortical axons in rat somatosensory cortex was examined on P3. Thalamic fibers were labeled in fixed brains with the carbocyanine dye 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate, and individual photo-converted thalamocortical fibers were reconstructed. In normal animals on P3, axon arbor terminal formation within layer IV has commenced and terminal arbor width is comparable to that of a cortical "barrel." After infraorbital nerve section, the average width of thalamocortical terminal arbors is significantly greater than is the average arbor width of normal rats of the same age; however, neither the number of branches per terminal arbor nor total arbor length differs between groups. These observations suggest that the role of the periphery in guiding terminal arbor formation is exerted both very rapidly and at the level of the single thalamic axon. Further, these results indicate a close association between individual axon terminal arbor morphology and pattern formation in the rat somatosensory cortex.

Otimização dos valores de referência da 17OH-progesterona neonatal de acordo com o peso ao nascimento no programa de triagem neonatal da APAE DE SÃO PAULO

Introdução: A Hiperplasia Adrenal Congênita por deficiência da 21-hidroxilase (HAC) é uma doença com mortalidade neonatal elevada sendo elegível para programas públicos de Triagem Neonatal (TN). A HAC é causada por mutações no gene CYP21A2, as quais acarretam diferentes comprometimentos da atividade enzimática e resultam em espectro amplo de manifestações clínicas. Apesar da eficiência da TN para diagnosticar os casos graves, a taxa elevada de resultados falso-positivos (RFP), principalmente relacionados à prematuridade, é um dos maiores problemas. Porém, resultados falso-negativos também podem ocorrer em coletas antes de 24 horas de vida. No Brasil, a coleta da amostra neonatal difere entre os municípios, podendo ser no terceiro dia de vida como após. Objetivo: Avaliar se os valores da 17OH-progesterona neonatal (N17OHP) das coletas no terceiro dia de vida diferem significativamente das coletas a partir do quarto dia. Determinar qual percentil (99,5 ou 99,8) pode ser utilizado como valor de corte para a N17OHP, de acordo com o peso ao nascimento e tempo de vida na coleta, a fim de que proporcione taxa menor de RFP. Métodos: Foi avaliada, retrospectivamente, a N17OHP de 271.810 recém-nascidos (Rns) de acordo com o tempo de vida na coleta (G1: 48 - = 72h) e peso ao nascimento (P1: <= 1.500g, P2: 1.501-2.000g, P3: 2.001-2.500g e P4: >= 2.500g), pelo método imunofluorimétrico. Testes com resultados alterados foram confirmados no soro por Espectrometria de Massas em Tandem - LC-MS/MS. Rns afetados e/ou assintomáticos e com valores persistentemente elevados de 17OHP sérica foram submetidos ao estudo molécular, sequenciamento do gene CYP21A2. Resultados: os valores da N17OHP no grupo G1 foram significativamente menores do que em G2 em todos os grupos de peso (p < 0.001). A taxa de RFP em G1 e G2 foi de 0,2% para o percentil 99,8 e de 0,5% para o percentil 99,5 em ambos os grupos. O percentil 99,8 da N17OHP foi o melhor valor de corte para distinguir os Rns não afetados dos afetados, cujos valores são: G1 (P1: 120; P2: 71; P3: 39 e P4: 20 ng /mL) e em G2 (P1: 173; P2: 90; P3: 66 e P4: 25 ng/mL). Vinte e seis Rns do grupo G1 apresentaram a forma perdedora de sal (PS) (13H e 13M), nestes a N17OHP variou de 31 a 524 ng/mL e vinte Rns no grupo G2 (8H e 12M), nestes a N17OHP variou de 53 a 736 ng/mL. Para ambos os grupos foram encontrados três Rns com a forma virilizante simples (1H e 2M) e os valores da N17OHP variaram de 36 a 51 ng/mL. Resultados falso-negativos não foram relatados. O valor preditivo positivo (VPP) no teste do papel filtro foi de 5,6% e 14,1% nos grupos G1 e G2, respectivamente, ao se utilizar o percentil 99,8, e de 2,3% e 7% nos grupos G1 e G2 ao se utilizar o percentil 99,5. Dentre os casos com TN alterada (RFP), 29 deles também apresentaram 17OHP sérica elevada quando dosada por LC-MS/MS. Os casos assintomáticos foram acompanhados até normalização da 17OHP sérica e/ou submetidos ao estudo molecular, que identificou dois Rns com genótipo que prediz a forma não clássica. Conclusão: a melhor estratégia para otimização do diagnóstico da HAC na triagem neonatal é se padronizar valores de corte da N17OHP em dois grupos de acordo com o tempo de vida na coleta (antes e depois de 72 horas), subdivididos em quatro grupos de peso. A utilização dos valores de corte do percentil 99,8 se mantém eficaz no diagnóstico da HAC-21OH na triagem neonatal, reduzindo de forma significativa a taxa de RFP, sem perda do diagnóstico da forma PS

Adaptación cultural y validación de la escala de valoración de riesgo de desarrollar úlceras por presión en neonatos hospitalizados (Neonatal Skin Risk Assessment Scale)

Los estudios epidemiológicos realizados hasta la fecha en neonatos hospitalizados son escasos. En España en las unidades neonatales las cifras de prevalencia se mueven entre un 50% en unidades de cuidados intensivos (UCIN) y un 12,5% en unidades de hospitalización. Desde todas las organizaciones de salud, nacionales (GNEAUPP) e internacionales (EPUAP, EWMA, NPUAP) relacionadas con las heridas, se promociona y potencia la seguridad del paciente mediante la prevención de los efectos adversos hospitalarios. Para conseguirlo es necesario dotar a los profesionales sanitarios de herramientas validadas y adaptadas a la edad neonatal que permitan valorar el riesgo de la población hospitalizada. De esta forma los profesionales sanitarios podrán gestionar de forma eficiente los recursos preventivos y trazar planes de cuidados centrados en el neonato. En la actualidad, en España no existe ninguna escala validada específicamente para neonatos. Por tanto, el objetivo principal de nuestro equipo de investigación fue adaptar transculturalmente al contexto español la escala NSRAS original y evaluar la validez y la fiabilidad de la versión en español. En esta ponencia se presentarán los resultados preliminares de la tesis. Método. El estudio se subdividió en tres fases. En la primera fase se realizó la adaptación transcultural de la escala NSRAS original mediante el método de traducción con retrotraducción. Posteriormente entre un grupo de expertos se calculó la validez de contenido mediante el IVC. La versión de la escala adaptada fue evaluada mediante dos fases de estudio multicéntrico observacional analítico en las unidades neonatales de 10 hospitales públicos del Sistema Nacional de Salud. Se evaluó la fiabilidad interobservadores e intraobservadores, la validez de constructo en la segunda fase y en una tercera fase se evaluó la capacidad predictiva y el punto de corte de la versión en español de la escala NSRAS. Resultados. En la primera fase la validez de contenido evaluada obtuvo un IVC de 0,926 [IC95%0,777-0,978]. En la segunda fase, la muestra evaluada fue de 336 neonatos. La consistencia interna mostró un Alfa de Cronbach de 0,794. Y la fiabilidad intraobservadores fue de 0,932 y la fiabilidad interobservadores fue de 0,969. En la tercera fase la muestra evaluada fue de 268 neonatos. El análisis multivariante de la relación entre los factores de riesgo, las medidas preventivas y la presencia de UPP mostró que 3 variables eran significativas: la puntuación NSRAS, la duración del ingreso y el uso de VMNI. Siendo de esta forma la puntuación NSRAS (debido a que activa las medidas preventivas) un factor protector frente a UPP. Es decir, a mayor puntuación de NSRAS, menor riesgo de UPP. La valoración clinicométrica de la puntuación 17 mostró una sensibilidad del 91,18%, una especificidad de 76,5%, un VPN de 36,05% y un VPP de 98,35%. El área bajo la curva ROC fue de 0,8384 en la puntuación 17. Conclusiones. La versión en español de la escala NSRAS es una herramienta válida y fiable para medir el riesgo de UPP en la población neonatal hospitalizada en el contexto español. Los neonatos hospitalizados con una puntuación igual o menor a 17 están en riesgo desarrollar UPP.

Sépsis neonatal com meningite a streptococcus do grupo B na era do rastreio e da quimioprofilaxia : a propósito de um caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Parotidite supurativa neonatal : caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Lúpus eritematoso neonatal

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Hemangiomatose neonatal difusa : caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Kernicterus e icterícia neonatal : revisão teórica a propósito de um caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014