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Neonatal oxygen deficiency in rats may disturb growth and long-term metabolic homeostasis. In order to facilitate metabolic evaluation, the subjects are usually housed individually. However, social isolation associated with individually housed conditions alters animal behavior, which may influence the experimental results. This study investigated the effects of social isolation on neonatal anoxia-induced changes in growth and energy metabolism. Male and female Wistar rats were exposed, on postnatal day 2 (P2), to either 25-min of anoxia or control treatment. From P27 onward, part of the subjects of each group was isolated in standard cages, and the remaining subjects were housed in groups. At P34 or P95, the subjects were fasted for 18 h, refeed for 1 h, and then perfused 30 min later. Glycemia, leptin, insulin, and morphology of the pancreas were evaluated at both ages. For subjects perfused at P95, body weight and food intake were recorded up to P90, and the brain was collected for Fos and NeuN immunohistochemistry. Results showed that male rats exposed to neonatal anoxia and social isolation exhibited increased body weight gain despite the lack of changes in food intake. In addition, social isolation (1) decreased post-fasting weight loss and post-fasting food intake and (2) increased glycemia, insulin, and leptin levels of male and female rats exposed to anoxia and control treatments, both at P35 and P95. Furthermore, although at P35, anoxia increased insulin levels of males, it decreased the area of the ß-positive cells in the pancreas of females. At P95, anoxia increased post-prandial weight loss of males, post-fasting food intake, insulin, and leptin, and decreased Fos expression in the arcuate nucleus (ARC) of males and females. Hyperphagia was associated with possible resistance to leptin and insulin, suspected by the high circulating levels of these hormones and poor neuronal activation of ARC. This study demonstrated that continuous social isolation from weaning modifies, in a differentiated way, the long-term energy metabolism and growth of male and female Wistar rats exposed to neonatal anoxia or even control treatments. Therefore, social isolation should be considered as a factor that negatively influences experimental results and the outcomes of the neonatal injury. These results should also be taken into account in clinical procedures, since the used model simulates the preterm babies' conditions and some therapeutic approaches require isolation.
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Animais Recém-Nascidos , Peso Corporal , Ingestão de Alimentos , Metabolismo Energético , Hipóxia , Ratos Wistar , Isolamento Social , Animais , Isolamento Social/psicologia , Masculino , Feminino , Ratos , Metabolismo Energético/fisiologia , Ingestão de Alimentos/fisiologia , Hipóxia/metabolismo , Peso Corporal/fisiologia , Leptina/sangue , Leptina/metabolismo , Glicemia/metabolismo , Insulina/sangue , Insulina/metabolismo , Desmame , Fatores EtáriosRESUMO
Little is known about the impact of hypoxia and anoxia during mycelial growth on tolerance to different stress conditions of developing fungal conidia. Conidia of the insect-pathogenic fungus Metarhizium robertsii were produced on potato dextrose agar (PDA) medium under normoxia (control = normal oxygen concentrations), continuous hypoxia, and transient anoxia, as well as minimal medium under normoxia. The tolerance of the conidia produced under these different conditions was evaluated in relation to wet heat (heat stress), menadione (oxidative stress), potassium chloride (osmotic stress), UV radiation, and 4-nitroquinoline-1-oxide (=4-NQO genotoxic stress). Growth under hypoxic condition induced higher conidial tolerance of M. robertsii to menadione, KCl, and UV radiation. Transient anoxic condition induced higher conidial tolerance to KCl and UV radiation. Nutritional stress (i.e., minimal medium) induced higher conidial tolerance to heat, menadione, KCl, and UV radiation. However, neither of these treatments induced higher tolerance to 4-NQO. The gene hsp30 and hsp101 encoding a heat shock protein was upregulated under anoxic condition. In conclusion, growth under hypoxia and anoxia produced conidia with higher stress tolerances than conidia produced in normoxic condition. The nutritive stress generated by minimal medium, however, induced much higher stress tolerances. This condition also caused the highest level of gene expression in the hsp30 and hsp101 genes. Thus, the conidia produced under nutritive stress, hypoxia, and anoxia had greater adaptation to stress.
Assuntos
Metarhizium , Vitamina K 3 , Esporos Fúngicos , Vitamina K 3/metabolismo , Raios Ultravioleta , Hipóxia/metabolismoRESUMO
Hypoxic-ischemic encephalopathy is a severe clinical condition, among others, affecting the brain after offspring exposure to neonatal anoxia, which causes persistent sensorimotor and cognitive deficits. During peripartum, maternal behaviors are crucial for the healthy development of the offspring. In rats, the vocalization of newborns, around 40 kHz, corresponds to separation calls that encourage their mothers to retrieve them. Alterations in this pattern affect the maternal behavior addressed to the offspring. This study aimed to evaluate the maternal behavior of primiparous rats whose offspring were exposed to neonatal anoxia in P2 (postpartum day) during the lactation period, to assess mother-pup interactions through the pups' vocalization from P3 to P18. It also intends to quantify eventual neuronal alterations in the mothers' medial preoptic area after the last weaning (P21) through FOS protein expression. Anoxia offspring were found to reduce maternal behaviors toward them, increased frequency of separation calls in the male anoxia group, and reduced vocalization rate in the female anoxia group compared to their respective controls. Body weight gain reduction of males' and females' anoxia was observed. We concluded that anoxia exerts deleterious effects on the vocalization patterns of the pups, with sex differences that alter maternal behavior toward them. Impaired USV makes an additional negative impact on the already noxious effects of neonatal anoxia. Understanding those phenomena applies/contributes to guiding procedures and strategies to mitigate the deleterious outcomes and orient research concerning the complexity of neonatal anoxia events and the influence of maternal care quality concerning the pups, which should also be considered sex differences.
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Comportamento Materno , Vocalização Animal , Humanos , Ratos , Animais , Feminino , Masculino , Vocalização Animal/fisiologia , Mães , Lactação , Hipóxia , Animais Recém-NascidosRESUMO
Aerobic respiration and oxygen consumption are indicators of routine metabolic rate, and dissolved oxygen in plant tissues is one of the most important environmental factors affecting their survival. The reduction of available O2 leads to hypoxia which causes a limitation of the oxidative phosphorylation; when O2 is absent, tissues generate ATP by activating the fermentative glycolysis to sustain glycolysis in the absence of mitochondrial respiration, which results in the production of lactate. Overall, hypoxia was reported to often decrease the respiration rate (O2 uptake) and delay the climacteric rise of ethylene in climacteric fruits by inhibiting action, thus delaying their ripening. Much research has been done on the application of postharvest hypoxia and anoxia treatment to temperate fresh crops (controlled or modified atmosphere), however, very few reported on tropical commodities. Indeed, the physiological mode of action of low or absence of oxygen in fresh crops is not well understood; and the physiological and biochemical bases of the effects low or absence of O2 are also yet to be clarified. Recent investigations using omics technologies, however, have provided useful information on the response of fresh fruits and vegetables to this abiotic stress. The aims of this review are to (i) report on the oxygen exchange in the crops tissue, (ii) discuss the metabolic responses to hypoxia and anoxia, and (iii) report the physiological and biochemical responses of crops tissues to these abiotic stresses and the potential benefits of these environmental conditions.
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Neonatal anoxia is a well-known world health problem that results in neurodevelopmental deficits, such as sensory alterations that are observed in patients with cerebral palsy and autism disorder, for which oxygen deprivation is a risk factor. Nociceptive response, as part of the sensory system, has been reported as altered in these patients. To determine whether neonatal oxygen deprivation alters nociceptive sensitivity and promotes medium- and long-term inflammatory feedback in the central nervous system, Wistar rats of around 30 h old were submitted to anoxia (100% nitrogen flux for 25 min) and evaluated on PND23 (postpartum day) and PND90. The nociceptive response was assessed by mechanical, thermal, and tactile tests in the early postnatal and adulthood periods. The lumbar spinal cord (SC, L4-L6) motor neurons (MNs) and the posterior insular cortex neurons were counted and compared with their respective controls after anoxia. In addition, we evaluated the possible effect of anoxia on the expression of astrocytes in the SC at adulthood. The results showed increased nociceptive responses in both males and females submitted to anoxia, although these responses were different according to the nociceptive stimulus. A decrease in MNs in adult anoxiated females and an upregulation of GFAP expression in the SC were observed. In the insular cortex, a decrease in the number of cells of anoxiated males was observed in the neonatal period. Our findings suggest that oxygen-deprived nervous systems in rats may affect their response at the sensorimotor pathways and respective controlling centers with sex differences, which were related to the used stimulus.
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Hipóxia/fisiopatologia , Córtex Insular/fisiopatologia , Nociceptividade/fisiologia , Medula Espinal/fisiopatologia , Animais , Feminino , Masculino , Neurônios/fisiologia , Ratos , Ratos Wistar , Fatores SexuaisRESUMO
The aim of this study was to experimentally test for adult cross-resistance to hypoxia or anoxia in a desiccation-resistant population of Anastrepha ludens Loew. We compared desiccation resistant flies with unselected (control) flies by measuring the effect of pre-emergence hypoxia on some fitness parameters (emergence, flight ability, copulation success, latency to copulation, copulation duration, ovary size). Anoxia effects were determined using eye color changes during pupa development and fly emergence after re-oxygenation. Both strains were negatively affected in all measured parameters when exposed to hypoxia for more than 48 h. However, after hypoxia, control flies showed, in general, shorter latency to mate and longer copula duration than desiccation-resistant flies. Anoxia-induced arrest of pupa development, whereas returning to normoxia conditions induced resumption of development. Anoxia period length (longer than 72 h) increased mortality to 100% in the control line, whereas the desiccation-resistant line survived even at 120 h of anoxia. Thus, pre-release hypoxia must not exceed 24 h in order to maintain insect quality independently of fly type.
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Dessecação , Hipóxia , Pupa/fisiologia , Tephritidae/fisiologia , Animais , Cor de Olho , Feminino , Voo Animal , Masculino , Tamanho do Órgão , Ovário , Comportamento Sexual AnimalRESUMO
Knowledge of skeletal muscle adaptations is important to understand the functional deficits in cerebral palsy (CP). This study aimed to investigate the morphofunctional characteristics of skeletal muscle in a CP animal model. Initially, pregnant Wistar rats were injected intraperitoneally with saline or lipopolysaccharide over the last five days of pregnancy. The control group (n = 8) consisted of male pups born to females injected with saline. The CP group (n = 8) consisted of male pups born to females injected with lipopolysaccharide, which were submitted to perinatal anoxia [day of birth, postnatal day 0 (P0)] and sensorimotor restriction (P1-P30). The open-field test was undertaken on P29 and P45. On P48, the animals were weighed, and the plantaris muscle was collected and its weight and length were measured. Transverse sections were stained with haematoxylin-eosin, NADH-TR, Masson's trichrome and non-specific esterase reaction for analysis. and transmission electron microscopy was performed. In the CP group, reductions were observed in mobility time, number of crossings and rearing frequency, body weight, muscle weight and length, and nucleus-to-fibre and capillary-to-fibre ratios. There was a statistically significant increase in the percentage area of the muscle section occupied by collagen; reduction in the area and increase in the number of type I muscle fibres; increase in myofibrillar disorganization and Z-line disorganization and dissolution; and reduction in the area and largest and smallest diameters of neuromuscular junctions. Thus this animal model of CP produced morphofunctional alterations in skeletal muscle, that were associated with evidence of motor deficits as demonstrated by the open-field test.
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Paralisia Cerebral/patologia , Paralisia Cerebral/fisiopatologia , Locomoção , Atividade Motora , Músculo Esquelético/fisiopatologia , Músculo Esquelético/ultraestrutura , Animais , Paralisia Cerebral/induzido quimicamente , Paralisia Cerebral/metabolismo , Colágeno/metabolismo , Modelos Animais de Doenças , Feminino , Hipóxia/complicações , Lipopolissacarídeos , Masculino , Músculo Esquelético/metabolismo , Junção Neuromuscular/patologia , Junção Neuromuscular/fisiopatologia , Gravidez , Ratos WistarRESUMO
Little is known about the phenotypic effects of hypoxia and transient anoxia on the virulence of an entomopathogenic fungus. Conidia of Metarhizium robertsii were produced on: (1) potato dextrose agar medium (PDA) under normoxia; (2) PDA medium under continuous hypoxia; (3) PDA medium under transient anoxia; and (4) minimal medium with lactose (MML) under normoxia. Conidia produced under transient anoxia and produced on MML were the most virulent to Tenebrio molitor. Conidia produced under normoxia and hypoxia were the least virulent. Conidial production and germination speed of conidia produced under normoxia, hypoxia, and transient anoxia were similar; however, MML produced less conidia, but germinated faster than any other treatments.
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Metarhizium/patogenicidade , Esporos Fúngicos/patogenicidade , Tenebrio/parasitologia , Virulência/fisiologia , Animais , Esporos Fúngicos/crescimento & desenvolvimentoRESUMO
Morphological analysis of all developmental stages (except female), mitochondrial DNA sequences from cytochrome c oxidase subunit I (cox1) and cytological analysis of the polytene chromosomes were used to describe a new species of Chironomus found in the littoral and profundal zones of an endorheic, warm-monomictic lake in Mexico. Male imago is distinguished by the shape of superior volsella and by an antennal and bristle ratio lower than two. The pupa is characterized by the spur morphology of abdominal segment VIII. There is also a continuous row of hooklets on abdominal segment II. The larva is distinguished by a combination of antenna, mentum, mandible, and pecten epipharyngis characteristics, and abdominal ventral tubules. Molecular and cytological analysis supported the morphological differences found. The maximum likelihood tree obtained shows that Chironomus alchichica sp. n. clusters together with Chironomus decorus-group sp. 2 Butler et al. (1995) (bootstrap support = 92%), but genetic p-distances within C. alchichica sp. n. (0.004) were lower than the p-distances between other species of the decorus-group (C. decorus-group sp. 2, Chironomus bifurcatus Wülker et al., 2009 and Chironomus maturus Johannsen, 1908) confirming that it is a different species. The new species belongs to thummi cytocomplex, (decorus-group), with chromosome set- 2n = 8 and chromosome arm combinations: AB CD EF G. Karyologically, the species is closest to Chironomus riihimaekiensis Wülker (1973). This species has very compact salivary gland chromosomes with well heterochromatinized centromere regions in chromosomes AB CD G. Several fixed homozygous inversions distinguish arm A of the species from that of C. riihimaekiensis. Arm E differs from that of C. riihimaekiensis by simple fixed homozygous inversion. Some similarities in band sequences of this arm were found with species from the decorus-group as Chironomus blaylocki Wülker et al., 2009 and C. bifurcatus (decorus-group). The position of the key constrictions in chromosome G: Nucleolar organizer (NOR) and Balbiani rings (BRs) is similar to the species of decorus-group. C. alchichica sp. n. has been found in soft sediments rich in organic matter in well mineralized waters (where conductivity >10 mS cm-1) and with a high pH (≥9). The profundal zone is inhabited only during the mixing period, when dissolved oxygen is present.
Assuntos
Chironomidae , Animais , Dípteros , Feminino , Lagos , Larva , Masculino , México , Cromossomos PolitênicosRESUMO
Resumen Desde hace algunos años se ha sugerido que los pacientes con síndrome de apnea-hipopnea obstructiva del sueño sin tratamiento tienen una mayor probabilidad de cáncer sólido y de mortalidad por cáncer, sin embargo hay dudas frente al tema. Por esta razón, en este artículo se describen, por un lado, los estudios más importantes al respecto y, por el otro, la fisiopatología propuesta por los investigadores que plantean esta asociación donde la hipoxia, el daño oxidativo del DNA, la disfunción endotelial y la disrupción de la arquitectura del sueño juegan un papel fundamental, además de otras consideraciones interesantes.
Abstract For some years, it has been suggested that patients with untreated obstructive sleep apnea-hypopnea syndrome are more likely to have solid cancer and increased cancer mortality, although some doubt on the issue has arisen. In consequence, this article describes, on the one hand, the most important studies on the topic and, on the other, the pathophysiology proposed by researchers, who formulate an association in which hypoxia, DNA oxidative damage, endothelial dysfunction and the disruption of the dream architecture play a fundamental role, in addition to other interesting considerations.
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OBJECTIVES: Trauma is an important public health issue and associated with substantial socioeconomic impacts and major adverse clinical outcomes. No single study has previously investigated the predictors of mortality across all stages of care (pre-hospital, emergency room, surgical center and intensive care unit) in a general trauma population. This study was designed to identify early predictors of mortality in severely injured polytrauma patients across all stages of care to provide a better understanding of the physiologic changes and mechanisms by which to improve care in this population. METHODS: A longitudinal, prospective, observational study was conducted between 2010 and 2013 in São Paulo, Brazil. Patients submitted to high-energy trauma were included. Exclusion criteria were as follows: injury severity score <16, <18 years old or insufficient data. Clinical and laboratory data were collected at four time points: pre-hospital, emergency room, and 3 and 24 hours after hospital admission. The primary outcome assessed was mortality within 30 days. Data were analyzed using tests of association as appropriate, nonparametric analysis of variance and generalized estimating equation analysis (p<0.05). ClinicalTrials.gov: NCT01669577. RESULTS: Two hundred patients were included. Independent early predictors of mortality were as follows: arterial hemoglobin oxygen saturation (p<0.001), diastolic blood pressure (p<0.001), lactate level (p<0.001), Glasgow Coma Scale score (p<0.001), infused crystalloid volume (p<0.015) and presence of traumatic brain injury (p<0.001). CONCLUSION: Our results suggest that arterial hemoglobin oxygen saturation, diastolic blood pressure, lactate level, Glasgow Coma Scale, infused crystalloid volume and presence of traumatic brain injury are independent early mortality predictors.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Traumatismo Múltiplo/fisiopatologia , Traumatismo Múltiplo/mortalidade , Valores de Referência , Fatores de Tempo , Traumatismo Múltiplo/etiologia , Traumatismo Múltiplo/terapia , Escala de Coma de Glasgow , Análise de Sobrevida , Índices de Gravidade do Trauma , Estudos Prospectivos , Fatores de Risco , Causas de Morte , Medição de Risco , Lesões Encefálicas Traumáticas/fisiopatologia , Lesões Encefálicas Traumáticas/mortalidade , Hospitalização/estatística & dados numéricos , Unidades de Terapia IntensivaRESUMO
ABSTRACT Objective: To infer the prevalence and variables predictive of isolated nocturnal hypoxemia and obstructive sleep apnea (OSA) in patients with COPD and mild hypoxemia. Methods: This was a cross-sectional study involving clinically stable COPD outpatients with mild hypoxemia (oxygen saturation = 90-94%) at a clinical center specializing in respiratory diseases, located in the city of Goiânia, Brazil. The patients underwent clinical evaluation, spirometry, polysomnography, echocardiography, arterial blood gas analysis, six-minute walk test assessment, and chest X-ray. Results: The sample included 64 patients with COPD and mild hypoxemia; 39 (61%) were diagnosed with sleep-disordered breathing (OSA, in 14; and isolated nocturnal hypoxemia, in 25). Correlation analysis showed that PaO2 correlated moderately with mean sleep oxygen saturation (r = 0.45; p = 0.0002), mean rapid eye movement (REM) sleep oxygen saturation (r = 0.43; p = 0.001), and mean non-REM sleep oxygen saturation (r = 0.42; p = 0.001). A cut-off point of PaO2 ≤ 70 mmHg in the arterial blood gas analysis was significantly associated with sleep-disordered breathing (OR = 4.59; 95% CI: 1.54-13.67; p = 0.01). The model showed that, for identifying sleep-disordered breathing, the cut-off point had a specificity of 73.9% (95% CI: 51.6-89.8%), a sensitivity of 63.4% (95% CI: 46.9-77.9%), a positive predictive value of 81.3% (95% CI: 67.7-90.0%), and a negative predictive value of 53.1% (95% CI: 41.4-64.4%), with an area under the ROC curve of 0.69 (95% CI: 0.57-0.80), correctly classifying the observations in 67.2% of the cases. Conclusions: In our sample of patients with COPD and mild hypoxemia, the prevalence of sleep-disordered breathing was high (61%), suggesting that such patients would benefit from sleep studies.
RESUMO Objetivo: Inferir a prevalência e as variáveis preditivas de hipoxemia noturna e apneia obstrutiva do sono (AOS) em pacientes portadores de DPOC com hipoxemia leve. Métodos: Estudo transversal realizado em pacientes ambulatoriais, clinicamente estáveis, portadores de DPOC e hipoxemia leve (saturação de oxigênio = 90-94%) em um centro clínico especializado no atendimento de doenças respiratórias em Goiânia (GO). Os pacientes foram submetidos à avaliação clínica, espirometria, polissonografia, ecocardiografia, gasometria arterial, teste de caminhada de seis minutos e radiografia de tórax. Resultados: Foram avaliados 64 pacientes com DPOC e hipoxemia leve, e 39 (61%) apresentaram distúrbios respiratórios do sono (14 com AOS e 25 com hipoxemia noturna isolada). A análise de correlação mostrou moderada correlação da PaO2 com saturação média do sono (r = 0,45; p = 0,0002), saturação média do sono rapid eye movement (REM; r = 0,43; p = 0,001) e saturação média do sono não-REM (r = 0,42; p = 0,001). Um ponto de corte de PaO2 ≤ 70 mmHg (OR = 4,59; IC95%: 1,54-13,67; p = 0,01) na gasometria arterial foi significativamente associada com distúrbios respiratórios do sono. O modelo mostrou que, para identificar distúrbios respiratórios do sono, o ponto de corte teve uma especificidade de 73,9% (IC95%: 51,6-89,8%), uma sensibilidade de 63,4% (IC95%: 46,9-77,9%) e valores preditivos positivo e negativo de 81,3% (IC95%: 67,7-90,0%) e 53,1% (IC95%: 41,4-64,4%), respectivamente. A área sob a curva ROC foi de 0,69 (IC95%: 0,57-0,80), e a proporção de observações corretamente classificadas foi de 67,2% dos casos. Conclusões: A elevada prevalência de distúrbios respiratórios do sono em portadores de DPOC e hipoxemia leve nesta amostra (61%) sugere que esses pacientes podem se beneficiar da realização de estudos do sono.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Hipóxia/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Análise de Variância , Brasil/epidemiologia , Estudos Transversais , Hipóxia/etiologia , Hipóxia/fisiopatologia , Oximetria , Oxigênio/metabolismo , Polissonografia , Valor Preditivo dos Testes , Prevalência , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Valores de Referência , Testes de Função Respiratória , Fatores de Risco , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/fisiopatologia , Sono REM/fisiologia , Estatísticas não Paramétricas , Fatores de TempoRESUMO
ABSTRACT In patients with severe respiratory failure, either hypoxemic or hypercapnic, life support with mechanical ventilation alone can be insufficient to meet their needs, especially if one tries to avoid ventilator settings that can cause injury to the lungs. In those patients, extracorporeal membrane oxygenation (ECMO), which is also very effective in removing carbon dioxide from the blood, can provide life support, allowing the application of protective lung ventilation. In this review article, we aim to explore some of the most relevant aspects of using ECMO for respiratory support. We discuss the history of respiratory support using ECMO in adults, as well as the clinical evidence; costs; indications; installation of the equipment; ventilator settings; daily care of the patient and the system; common troubleshooting; weaning; and discontinuation.
RESUMO Em pacientes com insuficiência respiratória grave (hipoxêmica ou hipercápnica), o suporte somente com ventilação mecânica pode ser insuficiente para suas necessidades, especialmente quando se tenta evitar o uso de parâmetros ventilatórios que possam causar danos aos pulmões. Nesses pacientes, extracorporeal membrane oxygenation (ECMO, oxigenação extracorpórea por membrana), que também é muito eficaz na remoção de dióxido de carbono do sangue, pode manter a vida, permitindo o uso de ventilação pulmonar protetora. No presente artigo de revisão, objetivamos explorar alguns dos aspectos mais relevantes do suporte respiratório por ECMO. Discutimos a história do suporte respiratório por ECMO em adultos; evidências clínicas; custos; indicações; instalação do equipamento; parâmetros ventilatórios; cuidado diário do paciente e do sistema; solução de problemas comuns; desmame e descontinuação.
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Humanos , Adulto , Oxigenação por Membrana Extracorpórea , Síndrome do Desconforto Respiratório/terapia , Insuficiência Respiratória/terapia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Hipercapnia , Hipóxia , Síndrome do Desconforto Respiratório/diagnóstico por imagem , Síndrome do Desconforto Respiratório/fisiopatologia , Insuficiência Respiratória/diagnóstico por imagem , Insuficiência Respiratória/fisiopatologia , Infecções Respiratórias/fisiopatologia , Infecções Respiratórias/terapiaRESUMO
Introduction: Refractory hypoxaemia is a critical, life-threatening condition if not resolved promptly. The flow phenomenon is implicated in its development. Objectives: Clinical case presentation and non-systematic review of the literature on refractory hypoxaemia and flow phenomenon. Incidence, aetiology and pathophysiology are described. Materials and methods: Clinical case presentation authorised by the Ethics Committee of our institution of a young patient who presented with progressive dyspnoea, reaching functional class IV/IV. A search of the literature was conducted in Pub Med, Scielo and Bireme. Results: There is a growing interest in the physiological flow phenomenon leading to the development of refractory hypoxaemia in the absence of increased pressure in the cardiac cavities. Few reports are found. Conclusions: Flow phenomenon-related refractory hypoxaemia must be suspected as an exclusion diagnosis in patients with a mediastinal mass. Prone ventilation is proposed as a bridging therapy in order to revert a life-threatening condition.
Resumen Introducción: La hipoxemia refractaria es una condición crítica potencialmente mortal si no se corrige rápidamente. El fenómeno de flujo está implicado en su desarrollo. Objetivos: Presentación de un caso clínico y revisión no sistemática de la literatura sobre hipoxemia refractaria y el fenómeno de flujo, describimos su incidencia, etiología y fisiopatología. Material y métodos: Con autorización del comité de Ética de nuestra institución, presentamos un caso clínico de un paciente joven quien consulto por disnea progresiva hasta clase funcional IV/IV. La búsqueda bibliográfica se realizó en Pub Med, Scielo y Bireme. Resultados: Se ha despertado un creciente interés en el fenómeno fisiológico de flujo que conlleva al desarrollo de hipoxemia refractaria en ausencia de aumento de presión en las cavidades cardiacas. Se encuentran escasos reportes. Conclusiones: La hipoxemia refractaria por el fenómeno de flujo debe ser sospechada como diagnóstico de exclusión en pacientes con masa mediastinal. Proponemos la ventilación en prono como terapia puente para revertir una condición potencialmente mortal.
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HumanosRESUMO
Contexto: Flebotomia terapêutica é um recurso antigo, porém ainda muito utilizado em determinadas circunstâncias clínicas. A flebotomia terapêutica é isovolêmica quando se repõe igual volume ao retirado. Descrição do caso: Paciente com poliglobulia secundária a hipóxia crônica por hipertensão pulmonar, admitida em pronto-socorro dispneica. Foram descartados trombose venosa profunda (TVP) e trombo-embolismo pulmonar (TEP), tratada a celulite de membro inferior, otimizadas as drogas para insuficiência cardíaca e indicada flebotomia terapêutica isovolêmica para tratamento adjuvante da poliglobulia. Considerando o insucesso nas tentativas com sistema de bolsa coletora, padronizado no Hospital das Clínicas da Universidade Estadual Paulista (HC-UNESP), obteve-se sucesso realizando método alternativo de flebotomia terapêutica, relatado neste artigo. Discussão: A indicação da flebotomia se deu por hemoconcentração em paciente policitêmica, com piora do quadro basal. Todavia, ainda não estava em uso de oxigenioterapia domiciliar, previamente indicado. Ainda que pouco disseminado, o método demonstrado consta no protocolo de algumas instituições. Neste caso, foi a forma possível de se operacionalizar a flebotomia. Conclusões: Com este relato, demonstra-se que, muitas vezes, as soluções para os desafios clínicos cotidianos podem ser encontradas nos recursos já existentes, reduzindo tempo de internação, custos e tornando o sistema público mais eficaz.
Assuntos
Humanos , Feminino , Adulto , Policitemia , Sangria , Flebotomia , Dispneia , HipóxiaRESUMO
FUNDAMENTO: A paralisia cerebral (PC) é caracterizada por distúrbios do movimento e da postura, que podem estar associados a déficits cognitivos. Tais comprometimentos são atribuídos a lesões não progressivas ao encéfalo em desenvolvimento. No âmbito experimental, modelos animais dessa condição clínica capazes de reproduzir o fenótipo e as alterações estruturais vistas em humanos são escassos. OBJETICO: Investigar as repercussões da indução de um modelo de PC sobre a função cognitiva e estrutura do hipocampo e amígdala em ratos Wistar. MÉTODOS: Dois grupos experimentais foram utilizados: 1) Controle - filhotes de ratas injetadas com solução salina durante a gestação (n=8) e 2) Paralisia cerebral - filhotes de ratas injetadas com Lipopolissacarídeo (LPS) durante a gestação (n=8), submetidos à anóxia perinatal e restrição sensório-motora durante 30 dias. A memória espacial dos animais foi avaliada pela tarefa de reconhecimento da localização de objetos, enquanto o comportamento do tipo ansioso foi verificado pelo teste de labirinto em cruz elevado. Após a avaliação comportamental, os animais foram eutanasiados e os encéfalos dissecados para posterior processamento histológico. RESULTADOS: O grupo PC apresentou déficits de memória espacial e uma redução do número de neurônios granulares no giro denteado. Entretanto o comportamento do tipo ansioso e a histologia do núcleo central e complexo basolateral da amígdala foram semelhantes entre os grupos. CONCLUSÃO: Como observado em parte dos pacientes com PC, este modelo experimental prejudica a memória dependente do hipocampo. Entretanto, a combinação de intervenções não alterou a ansiedade e estrutura da amígdala.
BASIS: Cerebral palsy (CP) is a disorder of movement and posture, which may be associated with cognitive impairments. Such clinical condition is caused by non progressive injuries ocurred during the brain development. In the experimental context, animal models of this condition that can reproduce the phenotype and the structural changes seen in humans are scarce. OBJECTIVE: The present study investigated cognitive function and hippocampus and amygdala structure in rats submitted to a CP model. METHODS: Two experimental groups were used: 1) Control - offspring of rats injected with saline during pregnancy (n = 8) and 2) Cerebral Palsy - offspring of rats injected with lipopolysaccharide (LPS) during pregnancy (n = 8), submitted to perinatal anoxia and sensorimotor restriction for 30 days. The spatial memory was evaluated by the object-placement recog- nition task and anxiety like-behavior by elevated plus maze test. After the behavioral assessment, animals were euthanized and brains dissected for histological processing. RESULTS: The PC group showed spatial memory deficits and a reduction of granule neurons in the dentate gyrus. However, the anxiety like-behavior and the number of neurons in central nucleus and basolateral complex of the amygdala were similar between studied groups. CONCLUSION: This animal model affects the hippocampus dependent memory, a deficit seen in part of CP patients. However, the interventions used did not alter the anxiety like-behavior and amygdala structure.
Assuntos
Animais , Ratos , Paralisia Cerebral/complicações , Paralisia Cerebral/diagnóstico , Transtornos Cognitivos/etiologia , Experimentação Animal , Hipocampo/anatomia & histologia , Tonsila do Cerebelo/anatomia & histologia , Ansiedade , Paralisia Cerebral/induzido quimicamente , Ratos Wistar , Aprendizagem em Labirinto , Memória Espacial , Animais Recém-Nascidos , Corpos de NisslRESUMO
CONTEXT AND OBJECTIVE: Different functional respiratory alterations have been described in acromegaly, but their relationship with pulmonary tissue abnormalities is unknown. The objective of this study was to observe possible changes in lung structure and explain their relationship with gas exchange abnormalities. DESIGN AND SETTING: Cross-sectional analytical study with a control group, conducted at a university hospital. METHODS: The study included 36 patients with acromegaly and 24 controls who were all assessed through high-resolution computed tomography of the thorax (CT). Arterial blood gas, effort oximetry and serum growth hormone (GH) and insulin-like growth factor I (IGF-1) were also assessed in the patients with acromegaly. RESULTS: The abnormalities found in the CT scan were not statistically different between the acromegaly and control groups: mild cylindrical bronchiectasis (P = 0.59), linear opacity (P = 0.29), nodular opacity (P = 0.28), increased attenuation (frosted glass; P = 0.48) and decreased attenuation (emphysema; P = 0.32). Radiographic abnormalities were not associated with serum GH and IGF-1. Hypoxemia was present in seven patients; however, in six of them, the hypoxemia could be explained by underlying clinical conditions other than acromegaly: chronic obstructive pulmonary disease in two, obesity in two, bronchial infection in one and asthma in one. CONCLUSION: No changes in lung structure were detected through thorax tomography in comparison with the control subjects. The functional respiratory alterations found were largely explained by alternative diagnoses or had subclinical manifestations, without any plausible relationship with lung structural factors.
CONTEXTO E OBJETIVO: Diferentes alterações funcionais respiratórias são descritas na acromegalia. Sua relação com anormalidades do tecido pulmonar é desconhecida. O objetivo foi observar possíveis alterações da estrutura pulmonar e explicar sua relação com anormalidades da troca gasosa. TIPO DE ESTUDO E LOCAL: Estudo transversal, analítico, com grupo de controle, realizado em um hospital universitário. MÉTODOS: Incluíram-se 36 pacientes com acromegalia e 24 controles que foram avaliados com tomografia computadorizada de alta resolução de tórax (TC); os acromegálicos também foram avaliados com gasometria arterial, oximetria de esforço e dosagens de hormônio de crescimento (GH) e fator de crescimento semelhante à insulina (IGF-1). RESULTADOS: As alterações encontradas na TC não foram estatisticamente diferentes entre os grupos acromegálico e de controle: bronquiectasia cilíndrica leve (P = 0,59), opacidades lineares (P = 0,29), opacidades nodulares (P = 0,28), aumento da atenuação (vidro fosco) (P = 0,48) e redução da atenuação (enfisema; P = 0,32). As alterações radiológicas não se relacionaram com as dosagens de GH e IGF-1. Hipoxemia estava presente em sete pacientes; contudo, em seis deles a hipoxemia poderia ser explicada por condição clínica subjacente diversa da acromegalia: doença pulmonar obstrutiva crônica em dois, obesidade em dois, infecção brônquica em um e asma em um. CONCLUSÕES: Não foram observadas alterações da estrutura pulmonar por tomografia de tórax, quando comparadas ao grupo de controle; as alterações funcionais respiratórias encontradas são explicáveis em grande parte por diagnósticos alternativos, ou se manifestam de forma subclínica, não apresentando relação plausível com o aspecto da estrutura pulmonar.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Acromegalia/fisiopatologia , Pulmão/anormalidades , Pulmão/fisiopatologia , Troca Gasosa Pulmonar/fisiologia , Acromegalia/sangue , Hipóxia/fisiopatologia , Gasometria , Estudos de Casos e Controles , Estudos Transversais , Teste de Esforço , Hormônio do Crescimento Humano/sangue , Fator de Crescimento Insulin-Like I/análise , Pulmão , Valor Preditivo dos Testes , Valores de Referência , Estatísticas não Paramétricas , Tomografia Computadorizada por Raios XRESUMO
A hipóxia tumoral modula uma série de mudanças genéticas adaptativas relacionadas ao desenvolvimento, invasão e metástase de diversos cânceres humanos, dentre os quais o carcinoma epidermóide de língua (CEL). O objetivo do presente trabalho foi realizar uma análise clínica, morfológica e imuno-histoquímica através da expressão do HIF-1α, GLUT-1 e da CA-IX em 57 casos de CEL, correlacionando essa expressão à parâmetros clínicos e morfológicos. Após uma análise descritiva dos dados referentes ao sexo, faixa etária, raça e hábitos dos pacientes, constatou-se que os resultados encontrados foram condizentes com a literatura. Os parâmetros clínicos e morfológicos analisados e a expressão desses marcadores de hipóxia foram submetidos à análise estatística (teste do Qui2), verificando-se que os mesmos podem ser utilizados como indicadores do comportamento biológico do CEL. Dentre os resultados da presente pesquisa, observou-se que a intensidade de expressão para o HIF-1α, localizada na maioria dos casos no citoplasma e núcleo, correlacionou-se estatisticamente com o estadiamento clínico (p = 0,011) e gradação histológica (p = 0,002). Quanto à relação entre a distribuição de marcação para o HIF-1α e metástase, o teste qui-quadrado (Qui2) demonstrou haver diferenças estatisticamente significativas entre os grupos analisados (p = 0,040). Dos 75,8% da amostra que tinham metástase, constatou-se a o predomínio da marcação difusa. A imunoexpressão citoplasmática/membranar do GLUT-1 exibiu uma correlação estatisticamente significativa com o estadiamento clínico (p = 0,002) e gradação histológica (p = 0,000)
Em relação à localização de marcação para o GLUT-1 na ilha tumoral, evidenciou-se predomínio da marcação periférica na maioria dos espécimes de baixo grau (78,6%). Na amostra de alto grau, prevaleceu a localização centro/periferia (55,8%). De acordo com o teste qui-quadrado (Qui2), a localização na ilha tumoral (p = 0,025) demonstrou haver diferenças estatisticamente significativas com a gradação histológica. A imunoexpressão da CA-IX, localizada na maioria dos casos na membrana e citoplasma, exibiu uma correlação estatisticamente significativa com a gradação histológica (p = 0,005). Com base nestes resultados, pode-se concluir uma ampla participação desses marcadores de hipóxia na carcinogênese oral, bem como a sua possível utilização como marcadores do comportamento biológico e da progressão tumoral em CEL. (AU)
The tumor hypoxia modulates a series of genetic changes related to adaptive development, invasion and metastasis of various human cancers, among which squamous cell carcinoma of the tongue (SCCT). The objective of this study was to analyze clinical, morphological and immunohistochemical expression by HIF-1α, GLUT-1 and CA-IX in 57 cases of CEL and correlated this expression to clinical parameters and morphological. After a descriptive analysis of data on gender, age, race, and habits of patients, it was found that the results were consistent with the literature. The clinical and morphological parameters analyzed and the expression of these markers of hypoxia were subjected to statistical analysis (Qui2 test), verifying that they can be used as indicators of the biological behavior of CEL. Among the results of this study, we observed that the intensity of expression for HIF-1α, in most cases located in the cytoplasm and nucleus, statistically correlated with clinical staging (p = 0.011) and histological grading (p = 0.002).
As for the relationship between the distribution of labeling for HIF-1α and metastasis, the chi-square (Qui2) showed that there was statistically significant differences between the groups (p = 0.040). 75.8% of the sample who had metastases, there was the predominance of diffuse marking. The immunoexpression cytoplasmic/membrane GLUT-1 showed a statistically significant correlation with the clinical stage (p = 0.002) and histological grading (p = 0.000). Concerning the location of markings for GLUT-1 tumor on the island, there was a predominance of peripheral marking specimens in most low-grade (78.6%). In the sample of high-grade, prevailed the location center/periphery (55.8%). According to the chi-square (Qui2), the location on the island of the tumor (p = 0.025) showed statistically significant difference in histological grading. The immunoreactivity of CA-IX, in most cases located in the membrane and cytoplasm, exhibited a statistically significant correlation with histological grading (p = 0.005). Based on these results, we can conclude a broad participation of these markers of hypoxia in oral carcinogenesis and its possible use as markers of biological behavior and tumor progression in CEL. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Farmacológicos/análise , Carcinoma de Células Escamosas/patologia , Imuno-Histoquímica , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/patologia , Distribuição de Qui-Quadrado , Distribuição por Idade e Sexo , Distribuição por Etnia , Ensaios Clínicos como Assunto/métodos , Estatísticas não Paramétricas , Microscopia de PolarizaçãoRESUMO
O advento da ventilação mecânica moderna trouxe inúmeros benefícios para o manejo anestésico e de pacientes críticos em unidades de cuidados intensivos. Acompanhando essa evolução vieram as complicações relacionadas ao controle ventilatório do paciente. A atelectasia é o principal evento complicador pulmonar dos pacientes submetidos à anestesia geral. As manobras de recrutamento alveolar são uma opção na tentativa de aumentar as unidades alveolares abertas, evitando, assim, a atelectasia pulmonar. Esse efeito pode ser mais ou menos duradouro, a depender da estratégia adotada para o recrutamento. O conhecimento das formas de recrutamento e suas peculiaridades, dos pacientes candidatos a essas manobras e do momento de realização das mesmas é extremamente importante, na tentativa de evitar as complicações per e pós-operatórias relacionadas ao colapso alveolar.
The advent of modern mechanical ventilation brought numerous benefits to the anesthetized and critically ill patients in intensive care management. Accompanying this evolution came the complications related to the patient?s ventilatory control. Atelectasis is the main event complicating pulmonary patients undergoing general anesthesia. The alveolar recruitment maneuvers are an option in an attempt to increase alveolar units open, thus preventing pulmonary atelectasis. This effect can be more or less permanent, depending on the strategy for recruitment. Knowledge of the methods of recruitment and its peculiarities, the eligible patients and the best time to perform these maneuvers, are extremely important in an attempt to avoid postoperative complications related to alveolar collapse.