Combined lowering of low grade systemic inflammation and insulin resistance in metabolic syndrome patients treated with Ginkgo biloba

In a clinical pilot study with eleven metabolic syndrome patients, a simultaneous decrease in hs-CRP from 8.85 ± 4.09 to 4.92 ± 2.51 mg/L (-44.4%) (p < 0.0436) and HOMA-IR from 3.07 ± 0.63 to 2.60 ± 0.51 mU/L × mg/dL (-15.3%) (p < 0.0120) as well as a beneficial change of arteriosclerotic, inflammatory and oxidative stress biomarkers were detected after 2-month treatment with Ginkgo biloba. Furthermore, both IL-6 (-12.9%, p < 0.0407) and nanoplaque formation (-14.3%, p < 0.0077) were additionally reduced. According to a large clinical trial elucidating the importance of insulin resistance and low-grade systemic inflammation for cardiovascular disease and overall mortality risk, these data might indicate a CVD/total mortality risk reduction.

Extraperitoneal and intraperitoneal behavior of several biological meshes currently used to repair abdominal wall defects

BACKGROUND

This study compares the behavior of several cross- and noncrosslinked biomeshes (Permacol®, CollaMend®, Surgisis®, Tutomesh®, and Strattice®) currently used for abdominal wall repair when implanted intraperitoneally and extraperitoneally. Material and Methods. Intraperitoneal (IP) implants were fixed on the parietal peritoneum and partial abdominal wall defects (EP) were repaired using each of the biomeshes, in the rabbit abdominal wall. After 90 days of implant, the biomeshes were examined to assess biomesh degradation, collagen I and III expression (Sirius red staining) and the host macrophage response (immunohistochemistry). Results. Following implant, the thinner noncrosslinked biomeshes Tutomesh and Surgisis, were almost fully degraded in both models. In contrast, Strattice behavior was similar to crosslinked biomeshes, showing negligible degree of degradation. This mesh also showed high expression of collagen I, similar to the crosslinked. The noncrosslinked materials elicited lower macrophage counts, significantly so for Strattice. In IP and EP models, Permacol showed similarly high macrophages while counts were lower for CollaMend and Surgisis in the EP model. Conclusions. The intra or extraperitoneal implant of the different meshes did not affect host tissue incorporation or mesh degradation. The crosslinked biomeshes induced a more intense macrophage response regardless of their IP or EP location.

Vitamin E protection of obesity-enhanced vascular calcification in uremic rats

This study aimed to determine the extent of extraskeletal calcification in uremic Zucker rats, by comparing obese and lean phenotypes, and to evaluate the influence of vitamin E (VitE) on the development of calcifications in both uremic rats and human vascular smooth muscle cells (HVSMCs) cultured in vitro. Zucker rats of lean and obese phenotypes with normal renal function [control (C); C-lean and C-obese groups] and with uremia [5/6 nephrectomy (Nx); Nx-lean and Nx-obese groups] and uremic rats treated with VitE (Nx-lean + VitE and Nx-obese + VitE groups) were studied. Uremic groups were subjected to Nx, fed a 0.9% phosphorus diet, and treated with calcitriol (80 ng/kg ip). The aortic calcium concentration was significantly higher ( P < 0.05) in Nx-obese rats (10.0 ± 2.1 mg/g tissue) than in Nx-lean rats (3.6 ± 1.3 mg/g tissue). A decrease in plasma glutathione peroxidase activity was observed in Nx-obese rats compared with Nx-lean rats (217.2 ± 18.2 vs. 382.3 ± 15.5 nmol·min−1·ml−1, P < 0.05). Treatment with VitE restored glutathione peroxidase activity and reduced the aortic calcium concentration to 4.6 ± 1.3 mg/g tissue. The differences in mineral deposition between Nx-lean, Nx-obese, Nx-lean + VitE, and Nx-obese + VitE rats were also evidenced in other soft tissues. In HVSMCs incubated with high phosphate, VitE also prevented oxidative stress and reduced calcium content, bone alkaline phosphatase, and gene expression of core-binding factor-α1. In conclusion, uremic obese rats develop more severe calcifications than uremic lean rats and VitE reduces oxidative stress and vascular calcifications in both rats and cultures of HVSMCs.

[Central serous chorioretinopathy of unusual etiology: A report of 2 cases]

OBJECTIVE

Describe 2 rare causes of central serous chorioretinopathy.

CLINICAL CASES

Case 1: A 35 year old woman with loss of vision in her left eye, with a recent history of a flu vaccination. This could have been the process that triggered an immune response, with increased circulating immune complexes that favour choroidal ischemia.

CASE 2

A 41 year old man with loss of vision in his left eye. As history, had consumed cocaine, which could be related to its adrenergic effect adrenergic, and earlier excimer laser refractive surgery (LASIK).

CONCLUSION

In both cases there was a temporal relationship between cause and effect.

[Survival and complications analysis of 97 patients with bone metastases treated surgically]

BACKGROUND

The purpose of this paper is to assess the survival and the different factors predisposing to increased local and overall complications in a group of patients treated surgically for bone metastases.

MATERIAL AND METHODS

A total of 97 patients were included in our study, 45 females and 52 males. Mean age was 59 years (range 22-81) and the mean follow-up was 23 months (range 3-76). Were performed 104 surgical interventions. Patient survival was estimated with the Kaplan-Meier method. Complications, recurrences and the most significant factors were analyzed.

RESULTS

Overall patient survival was 73% at one year, 47% at 2 years, and 6% at 5 years. Patient survival was greater in patients with a histologic diagnosis of metastatic renal cancer (p > 0.05) and a higher incidence of local relapses (p > 0.05). Intralesional surgery significantly affected the relapses.

CONCLUSIONS

Patients with metastatic renal cancer had the greatest survival rate. However, they were associated with a higher rate of local relapses and postoperative failure.

Short communication: Goat colostrum quality: litter size and lactation number effects

The quality of colostrum of Murciano-Granadina goats was studied to establish the transition period and the time when milk can be marketed. Forty-three dairy goats were used: 19 primiparous (15 single births; 4 multiple births) and 24 multiparous (10 single births; 14 multiple births). Samples were collected every 12h during the first week postpartum. Physicochemical parameters and somatic cell count were determined. Analysis of variance with repeated measures was used to study the effect of different factors: postpartum time, litter size, lactation number, their interactions, and production level on colostrum. Postpartum time had a significant effect on all parameters studied, which decreased along the first week of lactation, whereas lactose, pH, and conductivity increased. Based on these results, colostrum secretion takes place until 36 h postpartum (hpp). In relation to other factors of variation studied, the lactation number influenced most colostrum components, whereas the litter size only affected the pH value, protein and lactose content. The production level influenced only the protein and dry matter contents, with an inverse relationship. Milk produced during the period between 36 and 96 hpp is considered transition milk, which should not be commercialized. Milk collected after 4d postpartum (96 hpp) could be marketed, ensuring that its composition does not present a risk in the dairy industry.

Postimplantation host tissue response and biodegradation of biologic versus polymer meshes implanted in an intraperitoneal position

BACKGROUND

This study compared the in vitro and in vivo behaviors at the peritoneal interface of a new polymer material (Bio-A) and of two biologic non-cross-linked materials (Tutomesh [Tuto] and Strattice [St]), all biodegradable.

METHODS

Omentum mesothelial cells from rabbits were seeded onto the three prosthetic materials tested. At 1, 4, 8, 16, and 24 h after implantation, mesothelial cover was performed using a scanning electron microscope (SEM). In the in vivo study, 3 × 3 cm mesh fragments were placed on the parietal peritoneum of the same rabbits and fixed at the four corners with individual stitches. The implants were randomized such that six fragments of each material were implanted in nine animals (2 per animal). Adhesion formation was quantified by sequential laparoscopy and image analysis 3, 7, and 14 days after implantation. The animals were killed at 90 days, and the meshes were subjected to microscopy and immunohistochemistry.

RESULTS

The in vitro mesothelial cover was significantly greater for St than for Bio-A at each time point. The percentage of cover for St was also higher than for Tuto 16 and 24 h after seeding and higher for Tuto than for Bio-A at all time points. Compared with the biologic meshes, significantly higher adhesion percentages were recorded for Bio-A. At 90 days after implantation, differences in absorption measured as percentage of reduction in mesh thickness were detected among all the meshes. The least absorbed was St. The neoperitoneum thickness was significantly greater for the biologic meshes than for the polymer mesh, although this variable also differed significantly between St and Tuto. Macrophage counts were higher for Bio-A than for the biologic meshes.

CONCLUSIONS

Greater mesothelial cover was observed in vitro for St. In vivo, adhesion formation and the macrophage response induced by Bio-A were greater than those elicited by the biologic materials. Bio-A and Tuto showed substantial biodegradation compared with St.

Capillary lactic acid validation in an ED

INTRODUCTION

One of the most used methods to evaluate patients with a high risk not responding to clinical treatment is the measurement of blood levels of lactic acid (LA). The objective of this study was to compare the sensitivity and specificity of an LA test for capillary and venous blood with LA test for arterial blood in a population of patients with tissue hypoperfusion and to evaluate the time needed for each test.

MATERIALS AND METHODS

The following factors were evaluated: the performance of venous and capillary LA in relation to arterial LA, and the time needed to elicit each method from patient admission to mortality according to initial LA.

RESULTS

Seventy-nine patients with a median age of 58 years were admitted. The area under the curve for capillary LA was 82% (95% confidence interval [CI], 73-91). The best cutoff point was 2.35, with a sensitivity of 81% (95% CI, 65-90) and a specificity of 70% (95% CI, 53-83). The average time from patient admission until arterial, venous, and capillary LA values were obtained was 112, 117, and 77 minutes, respectively. The patients who died within 3, 30, and 60 days showed an average arterial LA of 5.9, 1.9, and 2.2, respectively.

CONCLUSION

The utilization of capillary and venous LA is an effective method of evaluation and risk stratification for patients with different degrees of tissue hypoperfusion. The time needed to elicit capillary LA proved much faster with respect to arterial and venous LA.

Melatonin prevents dopaminergic cell loss induced by lentiviral vectors expressing A30P mutant alpha-synuclein

Two hallmarks of Parkinson's disease (PD) are dopaminergic cell loss and the presence of cytoplasmic inclusions (Lewy bodies). Different point mutations in alpha-synuclein, the main constituent of Lewy bodies, have been identified in familial PD. Alpha-synuclein also constitutes one of the main components of Lewy bodies in sporadic cases of PD. Moreover, oxidant stress and generation of free radicals from both mitochondrial impairment and dopamine metabolism are considered to play critical roles in PD etiopathogenesis. Melatonin, a known potent antioxidant secreted by the pineal gland, may protect against the effect of several Parkinsonogenic compounds that are associated with progressive impairment of mitochondrial function and increased oxidative damage. However, the neuroprotective effect of melatonin has never been tested in the newly available genetic models of PD based on the viral expression of mutated alpha-synuclein. Lentiviral vectors encoding A30P mutant human alpha-synuclein (lenti-A30P) were stereotactically injected into the right substantia nigra of adult male Sprague-Dawley rats and neuroprotection was examined by administration of melatonin or vehicle from two days before nigral administration of lenti-A30P until eight weeks after injection. It was found that lenti-A30P induced a significant TH⁺ cell-loss both in the medial and lateral substantia nigra versus the contrallateral side injected with lenti-eGFP. However, melatonin administration showed a total neuroprotective effect in both regions of the substantia nigra. In conclusion, the data here show that melatonin is neuroprotective against mutant alpha-synuclein-induced injury in the substantia nigra.

Surgical lung biopsy for diffuse lung disease. Our experience in the last 15 years

INTRODUCTION

Surgical lung biopsy is a technique that presents a morbi-mortality rate of considerable importance. We analyze our experience with surgical lung biopsies for the diagnosis of diffuse lung disease and the effect produced on the indications for surgical biopsy in these pathologies after the publication of the consensus of the ATS (American Thoracic Society) and ERS (European Respiratory Society) for Idiopathic Pulmonary Fibrosis (IPF).

PATIENTS AND METHODS

We performed a retrospective review of 171 patients operated between January 1997 and December 2011. We divided the series into 2 groups: group 1 (operated between 1997 and 2002) and group 2 (operated between 2003 and 2011). Suspected preoperative diagnosis, respiratory status, pathological postoperative diagnoses, percentage of thoracotomies, mean postoperative stay and perioperative morbidity and mortality were analyzed.

RESULTS

Group 1 consisted of 99 patients and group two 72. The most frequent postoperative diagnoses were: usual interstitial pneumonia and extrinsic allergic alveolitis. There were ten (5.84%) deaths. Death was caused by progressive respiratory failure that was related to interstitial lung disease in 7 (70%) of 10 cases, alveolar haemorrhage in 2 (20%) and heart failure in 1 (10%).

CONCLUSIONS

Since the publication of the ATS and ERS consensus on the IPF, we have observed a noticeable decrease in the number of indications for surgical lung biopsy. This technique, though simple, has a considerable morbidity and mortality.