EFFECTS OF PROBIOTICS SUPPLEMENTATION ON SKIN WOUND HEALING IN DIABETIC RATS

Background:

Chronic wounds in patients with Diabetes Mellitus often become incurable due to prolonged and excessive production of inflammatory cytokines. The use of probiotics modifies the intestinal microbiota and modulates inflammatory reactions.

Aim:

To evaluate the influence of perioperative supplementation with probiotics in the cutaneous healing process in diabetic rats.

Methods:

Forty-six rats were divided into four groups (C3, P3, C10, P10) according to the treatment (P=probiotic or C=control, both orally administered) and day of euthanasia, 3^rd or 10^th postoperative days. All rats were induced to Diabetes Mellitus 72 h before starting the experiment with alloxan. Supplementation was initiated five days before the incision and maintained until euthanasia. Scalpel incision was guided by a 2x2 cm mold and the wounds were left to heal per second-intention. The wounds were digitally measured. Collagen densitometry was done with Picrosirius Red staining. Histological parameters were analyzed by staining by H&E.

Results:

The contraction of the wound was faster in the P10 group which resulted in a smaller scar area (p=0.011). There was an increase in type I collagen deposition from the 3^rd to the 10^th postoperative day in the probiotic groups (p=0.016), which did not occur in the control group (p=0.487). The histological analysis showed a better degree of healing in the P10 group (p=0.005), with fewer polymorphonuclear (p<0.001) and more neovessels (p=0.001).

Conclusions:

Perioperative supplementation of probiotics stimulates skin wound healing in diabetic rats, possibly due to attenuation of the inflammatory response and increased neovascularization and type I collagen deposition.

Argon plasma coagulation of gastrojejunal anastomosis for weight regain after gastric bypass

BACKGROUND

The failure of approximately 20 % of obese patients who undergo Roux-en-Y gastric bypass (RYGB) to maintain weight loss over the following 18-24 months is related to the surgical procedure, to the patient, or both. Although the underlying mechanisms are uncertain, one factor that has been postulated is the dilation of the gastrojejunal anastomosis. The objective was to evaluate the safety and efficacy of the serial use of argon plasma coagulation (APC) in reducing the diameter of the dilated gastrojejunal anastomosis and post-RYGB weight regain.

METHODS

We carried out a prospective, nonrandomized study of 30 patients, with no control or sham group, monitoring RYGB weight regain associated with dilation of the gastrojejunal anastomosis over a postoperative period of 18 months. Each patient underwent three sessions of APC in the anastomosis separated by 8 weeks, with a final endoscopic examination 8 weeks after the last session.

RESULTS

There was a loss of 15.48 kg (range = 8.0-16.0 kg) of the 19.6 kg (range = 7.0-39.0 kg) of regained weight after RYGB and a reduction of 66.89 % in the final anastomotic diameter, with statistically significant reductions between each APC session. Previous body mass index significantly decreased up to the final examination, and the final weight was close to but not at the same level as the nadir.

CONCLUSIONS

Our study indicates that the use of APC to treat weight regain after RYGB is a safe and effective procedure and promotes a reduction in gastrojejunal anastomosis, final weight, and BMI, with a low rate of complications.

Heterogeneous methodology of racial/ethnic classification may be responsible for the different risk assessments for prostate cancer between Black and White men in Brazil

Objectives

To evaluate if the different results of prostate cancer risk between black and white Brazilian men may be associated with the varying methodology used to define participants as either Blacks or Whites.

Patients and Methods

We evaluated median PSA values, rate of PSA level ≥4.0 ng/mL, indications for prostate biopsy, prostate cancer detection rate, biopsy/cancer rate, cancer/biopsy rate, and the relative risk of cancer between blacks versus whites, blacks versus non-blacks (browns and whites), non-whites (browns and blacks) versus whites, African versus non-African descendants, and African descendants or blacks versus non-African descendants and non-blacks.

Results

From 1544 participants, there were 51.4% whites, 37.2% browns, 11.4% blacks, and 5.4% African descendants. Median PSA level was 0.9 ng/mL in whites, browns, and non-African descendants, compared to 1.2 ng/mL in blacks, and African descendants or blacks, and 1.3 ng/mL in African descendants. Indications for prostate biopsy were present in 16.9% for African descendants, 15.9% of black, 12.3% of white, 11.4% for non-African descendants, and 9.9% of brown participants. Prostate cancer was diagnosed in 30.3% of performed biopsies: 6.2% of African descendants, 5.1% of blacks, 3.3% of whites, 3.0% of non-African descendants, and 2.6% of browns.

Conclusions

Median PSA values were higher for Blacks versus Whites in all classification systems, except for non-white versus white men. The rate of prostate biopsy, prostate cancer detection rate, and relative risk for cancer was increased in African descendants, and African descendants or blacks, compared to non-African descendants, and non-African descendants and non-blacks, respectively.

Influence of preoperative feeding on the healing of colonic anastomoses in malnourished rats

BACKGROUND

Malnutrition influences healing of gastrointestinal anastomoses. The authors hypothesize that colonic anastomotic healing is decreased by malnutrition and might be improved by preoperative feeding.

METHODS

Eighty adult male Wistar rats were divided into 4 groups: (1) control rats 1 (C1), fed regular chow ad libitum for 21 days; (2) malnourished pair-fed rats (M), fed 50% of the food ingested by the control rats for 21 days; (3) preoperative nutrition rats (PRE), fed 50% of the average of the controls for 21 days and then fed preoperative nutrition with regular chow ad libitum for 1 week before the operation; and (4) control rats 2 (C2), fed regular chow ad libitum for 28 days. On days 21 (C1 and M) and 28 (PRE and C2), rats underwent 2 colonic transections and, subsequently, 2 end-to-end anastomoses. Rats were killed on postoperative day 5. The anastomoses were resected for tensile strength and histological analysis.

RESULTS

PRE rats showed increased maximal tensile strength vs the M group (0.09+/-0.01 vs 0.15+/-0.01; P<.05) and similar values of maximal tensile strength as the controls (0.15+/-0.01 vs 0.15+/-0.02; P=.91). Collagen type I was higher in controls vs the PRE group (6.13+/-0.39 vs 4.90+/-1.53; P<.05); nevertheless, the PRE group showed higher collagen type I than M rats (4.90+/-0.36 vs 3.83+/-0.35; P<.05).

CONCLUSIONS

Preoperative feeding for 7 days increases the maximal tensile strength, as well as the percentage area of mature collagen, approaching similar values as the control group.

[Effect of watery extract of Orbignya phalerata (babassu) in the gastric healing in rats: morphological and tensiometric study]

INTRODUCTION

The large use of plants in the prevention and treatment of different diseases is a milenar practice. In Brazil due to it's rich flora there is a huge material for research and use in popular medicine. The babassu (Orbignya phalerata) is a native tree from North of the Brazil and has a high concentration at the State of Maranhão. The powder of it's mesocarp is known as amid, and has been used as meal and medication due to the known activity against antiinflammatory reaction, pain, pyrexia and immunomodulation.

PURPOSE

To analyze the effect of mesocarp of Orbignya phalerata (babassu) in gastric wound healing in rats under morphologic and tensiometric aspects.

METHOD

Forty Wistar rats, male, adults were submitted to a longitudinal incision of 1 cm in the gastric body and sutured with separated stitches of polypropylene 6.0. After this common procedure the animals were allocated in the aleatory way in two groups Orbignya (GO) and Control (GC) with 20 animals each one. In the GO was used intraperitoneal doses of 50 mg/kh of Orbignya phalerata extract and in the GC water 1 ml/kg. Each group was divided in two subgroups of ten rats according to the period of death, at 3rd and 7th post-operative days. After the death, the abdominal cavity was evaluated and the stomach withdrawn. For the comparative analysis between the groups the macroscopic and histological parameters of wound healing were utilized.

RESULTS

There were no abscess, fistulae and haematom in the animals of the study. Abdominal adhesions were observed in both groups of the animals at 3rd and 7th post-operative days. Dehiscence of the gastrography was identified in one 3rd day rat of subgroups GO. The resistance to air insufflation was higher in GO 3rd day (p=0.087). The analysis of histological parameters showed statistical difference related to wound coaptation in favor to subgroup GO 7th post-operative day.

CONCLUSIONS

The extract of mesocarp of Orbignya phalerata in dose and path utilized positively interfered on the gastrography when compared with control group in animals at 7th post-operative day.

[Topic use of aqueous extract of Orbignya phalerata (babassu) in rats: analysis of its healing effect]

INTRODUCTION

The mesocarp of Babassu (Orbignya phalerata) has been used in experimental studies trying to check its pro-inflammatory effect.

PURPOSE

To analyse comparatively the histological changes made by the water extract of Babassu in skin surgical wounds.

METHODS

Sixty Wistar adult male rats were used. The experimental procedure was a circle skin incision of 2 cm in diameter made with a metal punch. After this procedure done in all animals, they were randomized in two groups of 30. In the control group, the phytotherapeutic agent wasn't used but saline solution. In the experimental group, the water extract of Orbignya phalerata was used in the cut sites. All animals were followed and killed after seven, 14 and 21 days. Comparative histological analysis was made among the groups.

RESULTS

In the microscopic view, a significant reepitelization effect on the healing process of the experimental group in relation to the control group in the 7th and 14th days, was recognized.

CONCLUSION

The use of the mesocarp of Orbignya phalerata in skin surgical wounds contributed positively in the healing process in rats.

[Surgical bladder wounds treated with Orbignya phalerata aqueous extract: controlled study in rats]

INTRODUCTION

Wound healing is a complex process that deals with different biological and immunological systems and is essential to keep the organism integrity. Three well-defined phases occur: inflammatory, proliferative and maturation. A failure or lengthy phase may result in a delay or absence of it.

PURPOSE

The aim of this paper is to analyse comparatively the histological alteration provided by the use of the aqueous extract of Orbignya phalerata, in the healing process of bladder surgical wounds.

METHODS

Forty adult, male Wistar rats were used. The experimental procedure consisted of a longitudinal 2 cm long bladder incision and single layer interrupted suture of 5-0 polyglactine 910. Post-operatively, the rats were randomly divided into two groups of 20. The substance was not used in the control group. The Orbignya phalerata aqueous solution was used in the study group. The animals were observed and killed three and seven days later. Comparative histological analysis was accomplished between the groups.

RESULTS

Significant statistical differences were observed in the neo-formation variables (p= 0.001), chronic inflammation (p= 0.002) and fibroblastic proliferation (p= 0.023). Acute inflammation was very evident in the control group.

CONCLUSION

The time factor of wound healing showed homogeneity between experimental and control groups, however faster in the experimental one. The Orbignya phalerata had a favoring healing effect in the surgical incision on rats bladder.

Effect of pantoprazole administered subcutaneously on the healing of sutured gastric incisions in rats

BACKGROUND

The properties of proton pump inhibitors most investigated are related to peptic diseases and upper gastrointestinal bleeding, but their influence on the healing of sutured gastric incisions has not been assessed. In the present study we evaluated the effect of subcutaneously administered pantoprazole on the healing of sutured gastric incisions in rats.

METHODS

Sixty rats were divided into a pantoprazole group and a control group. All rats were submitted to gastric suture in the gastric body and in the gastric fundus and had their gastric pH measured. The pantoprazole group received 20 mg/kg pantoprazole and the control group received 0.9% isotonic NaCl, both subcutaneously t.i.d. Healing analysis was carried out using collagen picrosirius red F3BA staining, and breaking strength was measured on the 4th and 7th postoperative days in all groups.

RESULTS

Gastric pH was higher in the pantoprazole group. In the fundus, the pantoprazole group had a higher measurement of breaking strength and a higher proportion of type-I over type-III collagen on the 7th postoperative day. In the body, the pantoprazole group had a higher proportion of type-I over type-III collagen on the 4th and 7th postoperative days.

CONCLUSIONS

Pantoprazole given subcutaneously promoted a reduction in gastric acid secretion and was associated with improved healing of the sutured gastric incision in the fundus (squamous epithelium) of rats. These findings suggest that pantoprazole has healing properties in sutured gastric incisions with potential benefits in gastric surgery.

Ação do extrato de Jatropha gossypiifolia L. (pião roxo) na cicatrização de anastomose colônica: estudo experimental em ratos

INTRODUÇÃO: A fitoterapia vem despertando crescente interesse na comunidade científica em relação às suas potenciais propriedades cicatriciais. Poucos são os estudos com metodologia científica existentes na literatura, constituindo-se assim um campo aberto para novas investigações. OBJETIVOS: Analisar a ação da Jatropha gossypiifolia L. (pião roxo) na cicatrização de anastomose colônica em ratos. MÉTODOS: Quarenta ratos Wistar foram submetidos à secção de toda a circunferência do cólon, sendo logo anastomosada com oito pontos separados usando fio monofilamentar de polipropileno 6-0. Aleatoriamente, os animais foram distribuídos em grupo controle (GC), contendo 20 ratos, nos quais foi administrada solução de cloreto de sódio a 0,9% por via intraperitoneal (1ml/kg) e grupo Jatropha (GJ), também com 20 nos quais foi administrado o extrato hidroalcoólico de Jatropha gossypiifolia L. por via intraperitoneal (1ml/kg). Cada um dos grupos foi subdividido em dois subgrupos de dez animais de acordo com a data de sacrifício, três e sete dias (GC3/ GC7 e GJ3/GJ7). Após o sacrifício foi retirada parte do cólon compreendendo 1 cm acima e abaixo da anastomose e submetido ao teste de resistência à insuflação de ar atmosférico. A seguir, foi aberta e retirada uma porção de 1,0 x 0,5cm de tamanho colocada em formol a 10% para análise histológica, na qual foram usadas a coloração de Hematoxilina-Eosina e o Tricrômico de Masson. RESULTADOS: Na avaliação do teste de pressão de ruptura entre os grupos houve significância estatística quando avaliados em relação à data de sacrifício Assim no terceiro dia a média no GC (25,4 mmHg.) e no GJ (76,4 mmHg.) estabeleceu p = 0.013, e no sétimo dia a média no GC (187,3 mmHg.) e no GJ (135,1 mmHg.) estabeleceu p = 0.014. Ao analisar as variáveis microscópicas entre os grupos no 3º dia, somente não houve diferença significativa nas variáveis edema e polimorfonucleares. Já no 7º dia todas as variáveis analisadas apresentaram diferença significativa. CONCLUSÕES: Na resistência mecânica pôde-se concluir que houve influência positiva da jatropha na aquisição de força na anastomose no terceiro dia. Entretanto, no sétimo dia o GC suplantou siginificativamente a pressão de ruptura obtida no GJ, sugerindo diminuição da ação da Jatropha em fase mais avançada da cicatrização. Na avaliação histológica pôde-se verificar avanço no processo inflamatório agudo no GJ3 em relação ao GC3, mantendo-se ainda mais intenso na fase crônica quando comparados os dois grupos no sétimo dia.

Efeito do extrato hidroalcoólico de Aroeira (Schinus terebinthifolius Raddi) na cicatrização de anastomoses colônicas: estudo experimental em ratos

INTRODUÇÃO: A cicatrização é evento biológico complexo envolvendo inflamação, quimiotaxia, proliferação celular, diferenciação e remodelação. Na medicina popular brasileira, utiliza-se a Aroeira para tratar as mais diversas situações patológicas No Estado do Maranhão - Brasil, a Aroeira é extensivamente utilizada no tratamento de afecções do aparelho respiratório, digestivo e ginecológico. As anastomoses intestinais sempre foram motivo de preocupação para cirurgiões e constituem, até hoje assunto polêmico e repleto de controvérsias. Entre as causas de insucesso da anastomose intestinal destacam-se as fístulas e deiscências. OBJETIVO: Avaliar o efeito do extrato hidroalcoólico de Aroeira (Schinus terebinthifolius Raddi) no processo de cicatrização de anastomoses colônicas em ratos. MÉTODOS: Foram utilizados 40 ratos da linhagem Wistar divididos em dois grupos (grupo Aroeira e grupo controle), aleatoriamente, composto de 20 animais cada, de acordo com o tratamento recebido (extrato da Aroeira ou solução salina a 0,9%) após a anastomose, e subdividiu-se cada grupo em dois subgrupos (C3 e C7 e A3 e A7,) de acordo com o dia de eutanásia (ao 3º e 7º dias). As variáveis utilizadas para mensuração foram: análise macroscópica, microscópica e tensiométrica. As interações entre os grupos foram analisadas pelo teste não-paramétrico de Mann-Whitney. RESULTADOS: Quanto ao grau de adesão, não foi observado diferença significativa entre os grupos Aroeira e controle tanto no 3º quanto no 7º dia. Quando se comparam os subgrupos do ponto de vista microscópico no 3º dia, a diferença entre o grupo que recebeu o extrato da Aroeira e o grupo controle foi significativa nas variáveis congestão (p = 0,005), polimorfonucleares (p = 0,034), mononucleares (p = 0,023), proliferação fibroblástica (p = 0,023) e na fase de cicatrização (p = 0,001). Na análise do 7º dia, todas as variáveis da análise microscópica foram significativas o que levou a 100% dos ratos do grupo Aroeira apresentarem inflamação crônica contra 20% do grupo controle. Em relação ao teste de pressão de ruptura, não houve diferença estatisticamente significante entre os grupos controle e Aroeira. CONCLUSÃO: Observou-se efeito favorável da Aroeira, a nível microscópico, no processo de cicatrização de anastomoses de cólon.

Análise da cicatrização na Linha Alba com uso de extrato aquoso de Orbignya phalerata (babaçu): estudo controlado em ratos

INTRODUÇÃO: O mesocarpo do babaçu (Orbignya phalerata) tem sido utilizado em estudos experimentais para verificar a sua ação antiinflamatória. No Maranhão, é muito utilizado como alimento e como remédio popular para cicatrização de ferimentos. OBJETIVO: Avaliar macroscópica, histológica e tensiometricamente, a ação do extrato de Orbygnia phalerata no processo de cicatrização de laparotomias medianas em ratos. MÉTODOS: Quarenta ratos da linhagem Wistar, adultos, machos, foram utilizados em procedimento experimental que consistiu em uma incisão na linha alba e síntese em plano único com pontos separados de fio de polipropileno 5-0. Após esse procedimento comum, os animais foram distribuídos em dois grupos de 20. Ao grupo chamado controle, foi utilizado injeção intraperitoneal, em dose única de 1mL de soro fisiológico para cada quilo de peso. Ao grupo experimento, utilizou-se solução aquosa de babaçu na dose de 50 mg por quilo de peso. Os animais foram acompanhados e mortos após três e sete dias, procedendo-se, a seguir, à análise tensiométrica e histológica. RESULTADOS: O exame macroscópico não mostrou presença de aderências importantes entre a linha alba e os órgãos intra-abdominais nos grupos de estudo. A avaliação histológica mostrou efeito marginalmente significativo (p=0,086) para inflamação aguda nos grupos controle e experimento de três dias e efeito significativo (p=0,003) para a reação gigantocelular (p=0,003). Diferença significativa (p-=0,023) foi observada para inflamação aguda no grupos controle experimento de sete dias. Na análise intra-grupo (controle três e sete), foi observado efeito marginalmente significativo (p=0,094 e p=0,05) respectivamente para as variáveis inflamação aguda e crônica. Na análise somente entre os grupos experimentos, as variáveis reação gigantocelular (0,002) e colagenização (0,016) apresentaram resultado significativo. A avaliação tensiométrica mostrou diferença significativa em relação ao grupo experimento de sete dias, que ofereceu melhor resistência do que os outros grupos. CONCLUSÃO: As avaliações histológica e macroscópica não mostraram diferenças significativas entre o extrato e a solução salina; quanto à tensiométrica, o grupo experimento de sete dias apresentou diferença significativa em relação ao grupo controle de mesmo período de pós-operatório, sugerindo indícios de que o uso do extrato administrado intraperitonealmente favorece o processo de cicatrização.

[Analysis of healing in the Alba Linea with the use of Orbignya phalerata (babassu) water extract. Controlled study in rats]

INTRODUCTION

The babassu mesocarp (Orbignya phalerata) has been used in experimental research studies focused on its antiinflammatory action. In state of Maranhão--Brazil it is widely used not only as food, but also as popular medicine in wound healing process.

PURPOSE

To evaluate the action of Orbignya phalerata extract in macroscopic, histologic and tensiometric aspects in the healing process of median laparotomy in rats.

METHODS

Forty male adult Wistar rats were submitted to an incision in the alba linea, sutured back in one plan with separated stitches of polypropylene 5-0. After regular procedure, the animals were divided into two groups of 20 rats each. To the group named control an intraperitoneal, dose of 1.0 ml of saline solution per kilogram of body weight was done. To the experimental group, the same thing was also done, but instead of saline solution it was injected water solution of babassu, in a dose of 50 mg/kg. The animals were observed in the following days. All of them were killed within a three and seven day post-operative period schedule, and then a histological and tensiometric analysis was carried out.

RESULTS

On macroscopic examination no relevant adherence, between the alba linea and the abdominal organs in the study groups, was found. Histological evaluation presented marginal significant effects (p=0.86) to acute inflammation and significant effects (p=0.003) to giant cell reaction in both control and experimental three days groups. Significant difference was observed to acute inflammation in both seven days control and experimental groups. In the intragroup analysis (control three and seven) some marginal significant effect was in relationship to acute and chronic inflammation. In the inter-experimental groups analysis, only the giant cell reactions (0.002) and colagenization had significant results. The tensiometric evaluation showed in the seven day experimental group more resistance then others.

CONCLUSION

The macroscopic and histological evaluation didn't show any significant difference between the experimental and control groups, but the tensiometric evaluation at the 7th day experimental group had significant difference compared to the control group, signaling that the use of the extract of babassu intraperitoneally injected can improve the healing process.

Donor quality of life after living donor liver transplantation

Living donor liver transplantation (LDLT) for children and adults has gained widespread acceptance due to the severe organ shortage. LDLT provides potential recipients with timely transplantation, but this procedure engenders a potentially significant risk to the donor. This study analyzed medical, functional, and psychological donor outcomes after LDLT. Nineteen donors (mean age 33.9 +/- 12 years), who underwent hepatectomy for LDLT (13 right lobectomy for adult LDLT) from March 1998 to November 2002, were interviewed at a median of 13 months after donation (range, 2 to 58 months). According to the Clavien System classification, major complications occurred in three donors (16%), and minor in four (21%). The mean length of hospital stay was 5.7 +/- 1.6 days. Five patients (27%) needed rehospitalization. Complete recovery was achieved at a mean time of 8.5 +/- 3.5 weeks. All 19 donors were able to return to predonation activities. The donor's relationship to the recipient and to their families was improved after donation in all cases; 12 (63%) cited a positive psychological impact on their lives. About 90% would donate again and 84% would recommend donation to someone contemplating it. In conclusion, all donors are alive and well after donation and were able to return to their predonation occupation. Most of them felt that this experience changed their lives for the better and would donate again. Donor safety and quality of life should remain the priority in all donation processes.