Das Ziel dieser Arbeit war es, den Einfluss unterschiedlich zusammengesetzter Tränken auf den Säuren-Basen-Haushalt bei Kälbern mit experimentell induzierter metabolischer Azidose zu untersuchen. Bei gesunden Kälbern konnte nachgewiesen werden, dass die Fütterung von milchbasierten ORL mit einer [SID3] ≥92 mmol/l eine Erhöhung der Plasma-[SID3] zur Folge hat (BACHMANN et al. 2009b) und damit eine alkalische Wirkung auf den SBS. Zu prüfen galt die Hypothese, ob es bei Kälbern mit experimentell induzierter metabolischer Azidose zu einem stärkeren alkalisierenden Effekt nach Gabe einer Tränke mit einer hohen [SID3] kommt. Bessere alkalisierende Eigenschaften einer Tränke könnten potentiell genutzt werden, um den Genesungsprozess von Kälbern mit metabolischer Azidose zu beschleunigen. Material und Methoden Zur Verfügung standen zwölf Kälber der Rasse Holstein-Friesian im Alter von weniger als vier Lebenswochen. Unter Verwendung von in der Literatur beschriebenen Induktionsprotokollen konnte per Infusion bei jeweils sechs Tieren eine manifeste hyperchlorämische Azidose und bei weiteren sechs Kälbern eine D-/L-Laktatazidose ausgelöst werden. Die Tiere wurden im Anschluss mit Milchaustauscher, wasser- oder milchaustauscher-basierter oraler Rehydratationslösung getränkt bzw. blieben im nüchternen Zustand. Zur Bestimmung von Stewart-Parametern des Säuren-Basen-Haushaltes im Plasma wurden nach einem festgelegten zeitlichen Schema vor und nach Induktion sowie vor und nach der Tränkegabe venöse Blutproben entnommen. Ergebnisse Bedingt durch die Einleitungsprotokolle war die Interpretation der Messergebnisse durch den starken Anstieg des Plasmavolumens bedeutend erschwert. Die eingesetzten Induktionsprotokolle sind nicht für Untersuchungen des Säuren-Basen-Haushaltes bei Kälbern nach unterschiedlicher Fütterung geeignet. Aus diesem Grund kann die aufgestellte Hypothese, dass die Verabreichung von milchaustauscher-basierter ORL zu einer besseren alkalischen Wirkung bei Kälbern mit metabolischer Azidose führt, anhand der vorliegenden Ergebnisse weder abgelehnt noch bestätigt werden. Einige Untersuchungsergebnisse zeigten positive Effekte auf Parameter des SBS bei Kälbern, denen eine Tränke verabreicht wurde, im Vergleich zu nüchternen Tieren. Diese Parameter waren die Plasma-D-Laktatkonzentration, die Strong Ion Difference [SID3] und [SID4] und ionisiertes Calcium [Ca2+]. Die Effekte waren nicht auf eine bestimmte der drei eingesetzten Tränkevarianten zurückzuführen. Weiterhin konnte gezeigt werden, dass ein quadratischer Zusammenhang zwischen der berechneten Variable Strong Ion Gap [SIGAlb/TP] und den gemessenen D-/L-Laktatkonzentrationen im Plasma besteht. Dies könnte zukünftig genutzt werden, um Faktoren zu etablieren, welche die Ableitung der Plasma-D-/L-Laktatkonzentration bei durchfallkranken Kälbern mit ZNS-Symptomatik aus gängigen Parametern ermöglicht, ohne die Laktatkonzentration direkt messen zu müssen. Schlussfolgerungen Für zukünftige Untersuchungen dieser Art wäre ein Induktionsprotokoll wünschenswert, das sowohl eine metabolische Azidose bei gleichzeitiger Dehydratation der Kälber vereint und so die metabolischen Bedingungen durchfallkranker Kälber simuliert. Die Gabe von ORL als direkte Einmischung in Milch bzw. MAT wird kritisch betrachtet. Ein negativer Effekt bei der Gabe von MAT-basierter ORL konnte bei diesen Untersuchungen auf keinen der bestimmten Parameter des SBS im Vergleich zu den anderen Tränkezusammensetzungen festgestellt werden. Klinische Nebenwirkungen Bei dieser Untersuchung traten nach der mehrfachen Infusion von D-/L-Laktat unerwartete Nebenwirkungen auf. Die Verabreichung führte zu starken Irritationen der Vena jugularis externa und zu Ödembildungen. Erhöhte D-Laktatkonzentrationen werden beim Menschen und verschiedenen Tierarten als Marker für traumatische Prozesse, Ischämie, Diabetes, gastrointestinale und neurologische Störungen diskutiert. Die weitere gezielte Untersuchung des Einflusses der wiederholten oder anhaltenden Einwirkung von D-Laktat auf Epithelzellen könnte nach den vorliegenden Untersuchungsergebnissen einen weiteren Anhaltspunkt für die Aufklärung der genauen pathologischen Mechanismen des D-Laktates bieten.

Eine optimale Regulation der Koronardurchblutung ist für die Aufrechterhaltung der kardialen Pumpfunktion und damit der systemischen Perfusion von größter Bedeutung. Da Einschränkungen der Durchblutungszunahme des Herzmuskels Einschränkungen des maximalen myokardialen Sauerstoffverbrauchs und damit der Herzleistung zur Folge haben, ist es notwendig, die Koronardurchblutung kurzfristig an die jeweilige Stoffwechsellage des Herzens anzupassen (metabolische Koronarflussregulation). Die lokal-metabolischen Mechanismen gehören zu den wirksamsten Komponenten der Regulation der myokardialen Durchblutung und funktionieren auch am isolierten (denervierten) Herz. Dabei ist die hyperkapnie- und azidoseinduzierte Koronardilatation ein wesentlicher Bestandteil der metabolischen Koronarflussregulation. Die vorliegende Arbeit befasst sich mit der Hypothese der Abhängikeit der hyperkapnieinduzierten Koronardilatation von einer intakten NO-Produktion. Das Koronarsystem des isolierten WT-Mausherzens reagiert auf akute Hyperkapnie (91 % O2, 9 % CO2) mit einer deutlichen Koronarflusssteigerung von ca. 35 % über dem Basalfluss.Es konnte gezeigt werden das Stickstoffmonoxid (NO) und ATP-abhängige Kaliumkanäle (K+ATP-Kanäle) für die Koronarflussregulation der Maus eine ausschlagebende Rolle spielen und neben der Aufrechterhaltung des Basalflusses auch an der Vermittlung der hyperkapnieinduzierten Koronardilatation maßgeblich beteiligt sind.Interessanterweise ist bei einem Fehlen der endothelialen NO-Synthase durch genetischen Knockout die hyperkapnieinduzierte Flussantwort in Kinetik und Ausmaß vollständig erhalten. Die Vermittlung kann dabei durch andere Mechanismen kompensiert werden, wie zum Beispiel einer verstärkten Aktivität der K+ATP-Kanäle. Prostaglandine und neuronale NO-Synthase scheinen sowohl beim Wildtypherzen als auch bei Herzen mit fehlender NO-Synthase für die hyperkapnieinduzierte Koronardilatation von untergeordneter Bedeutung. Nach chronischer pharmakologischer Blockade der NO-Synthase durch zweiwöchige L-NAME Tränkung bleibt die hyperkapnieinduzierte Koronardilatation erhalten durch NOS-unabhängige Mechanismen. Die hyperkapnieinduzierte Flussantwort ist bei Herzen von weiblichen eNOSKO Tieren vorhanden, erscheint jedoch gegenüber den männlichen Mäusen geringer ausgeprägt. Daher wird vermutet, dass die Mediatorsysteme der endothelabhängigen Koronarflussregulation geschlechtsspezifisch bzw. geschlechtsabhängig sind.

Mitochondrial diseases are caused by gene mutations in either mitochondrial DNA (mtDNA) or nuclear DNA (nDNA) and they are among one of the most common forms of inherited disorders. It is estimated that 1 out of every 5000 individuals will develop a mitochondrial disease in their lifetime. Due to the crucial and widespread functionality of mitochondria in human cells, prolonged diseases of the mitochondria affect cells of the brain, heart, liver, muscles and kidneys and can lead to multi-organ failure in some patients. Inherited or acquired mitochondrial diseases can present at any stage of life, affecting both children and adults. Since its discovery, the mitochondrial genome has been analyzed and sequenced with increasing ease and this process has helped recognize various mitochondrial disorders as the root of genetic diseases. This paper will explore the unique properties of the mitochondrion and its genome, examine the relationship between mtDNA and some common myopathies such as Leigh syndrome (LS) or maternally inherited Leigh syndrome (MILS), mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) in order to explore commonalities and differences in their inheritance patterns and their effect on mitochondrial function. Although studies have shown that these conditions generally affect the process of oxidative phosphorylation in mitochondria, because of the wide variety of presentations of this disease, further research is needed to understand the different etiologies, as well as to explore novel therapies to treat them.

L’optimisation hémodynamique péri-opératoire est une stratégie qui vise à maximaliser le transport artériel en oxygène et/ou le volume d’éjection systolique lors de chirurgie à risque. Ce concept a beaucoup évolué lors de ces trente dernières années, vers une approche plus simple, plus réalisable en pratique clinique et moins invasive. Les principales thérapeutiques utilisées dans les différents protocoles d’optimisation hémodynamique sont le remplissage vasculaire, l’administration d’agents inotropes et de vasopresseurs. Cependant, les conséquences physiopathologiques de l’agression chirurgicale peuvent impacter grandement les modalités d’administration et l’efficacité des thérapeutiques précitées. Dans la première étude, nous avons décrit l’impact de l’acidose respiratoire et métabolique (fréquemment rencontrées lors de chirurgie majeure et/ou de coeliochirurgie) sur l’efficacité des agents α et β-adrénergiques sur le myocarde sain de rat. Dans un deuxième travail nous avons mis en évidence que le remplissage vasculaire ne pouvait pas être guidé par des indices dynamiques de précharge dépendance lors du clampage chirurgicale de l’aorte abdominale sous-rénale, dans un modèle porcin. Enfin, dans la troisième étude, nous avons montré dans un modèle clinique, que le positionnement en décubitus ventral lors d’une chirurgie du rachis entrainait des modifications majeures des interactions cardiorespiratoires et que les indices dynamiques devaient être interprétés avec prudence pour guider le remplissage vasculaire dans ce contexte. Ces études translationnelles soulignent trois situations fréquentes impactant l’efficacité et/ou les modalités d’administration des thérapeutiques nécessaires à une optimisation hémodynamique peropératoire / The aim of perioperative haemodynamic optimization is to maximize oxygen delivery and/or stroke volume during high risk surgery. This concept has evolved during the last thirty years, to a simpler, more feasible and less invasive approach. Main treatments used in different hemodynamic optimization protocols are fluid loading, inotropes and vasopressors administration. However, pathophysiological consequences of surgical stress can greatly impact the mode of administration and the efficacy of the above therapeutics. In the first study, we described the impact of respiratory and metabolic acidosis (frequently encountered during major surgery and/or laparoscopic surgery) on the effectiveness of α and β-adrenergic agents in healthy rat myocardium. In a second work, we demonstrated that intravenous fluids cannot be guided by dynamic indices of preload dependency during surgical clamping of the infrarenal abdominal aorta in a porcine model. Finally, in the third study, we demonstrated in a clinical model, that positioning in prone position during spine surgery induced major changes in cardiorespiratory interactions and dynamic indices should be interpreted with caution to guide fluid therapy in this context. These translational studies highlight three common situations impacting the effectiveness and/or administration of therapeutic necessary for intraoperative hemodynamic optimization.

Doctor of Philosophy / Department of Diagnostic Medicine/Pathobiology / Daniel U. Thomson / A series of studies were conducted in order to develop, test, implement, and utilize an objective and comprehensive gross pathology scoring system for cattle at slaughter. Individual lung, liver, and rumen gross pathology data was collected from 19,229 head of cattle and corresponding individual pre-harvest and carcass data for a subset of 13,226 head.. Across the entire population 22.6% and 9.8% of cattle displayed mild and severe lesions, respectively. Severe lung lesions at the time of slaughter were associated with a decreased ADG of 0.07 kg/ day and a carcass weight 7.1 kg less than that of their cohorts with no visible signs of pulmonary BRDC lesions (P < 0.01). Overall, 68.6 % of cattle observed had normal livers, free from abscesses and other abnormalities. Cattle with a severe liver abscess at the time of slaughter were associated with a 0.10 kg/day during the feeding period (P < 0.01). Of cattle severely affected by liver abscesses (A+, 4.6%), 14.9% also displayed severe BRDC lung lesions and 28.3 % of cattle displayed mild BRDC lung lesions. Rumenitis lesions were observed in 24.1% of the overall study population. Severe rumenitis lesions were associated with a significant decrease in average daily gain and carcass weight (0.03kg/day and 2.20 kg, respectively, P < 0.01). The system was also implemented on a population of cull cows at a commercial abattoir in the Great Lakes region of the U.S. (n=1,461; 87% Holstein, 13% other cows). Severe liver abscesses, were observed in 18.5% of cull cows at slaughter. Severe rumenitis lesions or rumenitis scars were observed in 10% and severe BRDC lesions were observed in 10.3% o of the population. A prospective study of a commercially available, direct fed microbial oral drench of Megasphaera elsdenii (NCIMB 41125) was conducted in 4,863 head of yearling feeder cattle. No significant effects of treatment were detected for final live weight (599 vs. 601 kg; P=0.79) or hot carcass weight (386 vs. 387 kg P=0.81) for Con and M.e., respectively. Fourteen point two percent and 14.0% of Con and M.e., respectively displayed a liver abscess of varying severity at the time of slaughter. Overall, 8.27 and 7.96% % of Con and M.e. cattle were observed with an altered rumen epithelial health status. The ordinal odds ratio of a M.e. treated animal having a more severe liver abscess score or rumen health score was not significant (Estimate: 0.96, 95% C.L. 0.733-1.259, P=0.771; Estimate: 1.01, 95% C.L. 0.625-1.63 P=0.96, respectively.) Comprehensive monitoring of gross pathology at slaughter is commercially plausible and provides valuable data for veterinarians, nutritionists and management personnel.

A dieta tem forte influência sobre a formação de carga ácida no metabolismo dos pacientes com doença renal crônica (DRC), portanto é um fator que pode influenciar na gravidade da acidose metabólica. Esta é uma condição comumente encontrada em estágios mais avançados da DRC. Proteínas vegetais, como a proteína texturizada de soja (PTS), poderiam proporcionar uma formação de carga ácida menor e, pelo seu conteúdo de isoflavonas, consideradas antioxidantes, contribuiriam para a melhora do estresse metabólico. O objetivo do estudo foi avaliar os efeitos da substituição de fontes proteicas de origem animal por fonte vegetal (soja), durante uma semana, em parâmetros sanguíneos e urinários de acidose em pacientes com DRC. Foram avaliados 28 pacientes com DRC estadios 3, 4 e 5 antes e após a substituição de fontes de proteínas animais de uma refeição principal (almoço ou jantar) por PTS ao longo de 7 dias. Antes e após a intervenção foram avaliados: ingestão alimentar por registros, a carga ácida potencial dos alimentos (CAPA), exames clínicos de rotinas, antropometria (peso, altura e IMC), composição corporal por bioimpedância de espectroscopia multifrequencial (BIS), parâmetros de acidez sanguínea e urinária (bicarbonato e pH urinário) e marcadores de estresse oxidativo (CAT e AOPP). Para análise de resultados foram utilizados testes não paramétricos de Mann-Whitney e também testes de correlação de Spearman que foram empregados para avaliação de associações entre as variáveis. O valor de p<0,05 foi considerado para a significância estatística. Encontramos que em9 uma semana de intervenção com PTS houve aumento significativo nos marcadores de BIC e pH sanguíneos, assim como no pH urinário. A maioria dos pacientes saíram do estado de acidose metabólica. O marcador de estresse oxidativo CAT mostrou melhora, porém o AOPP não apresentou aumento significativo. Em relação a composição corporal, houve diminuição do peso e aumento nos marcadores de hiperhiratação (HH), porém aumento na massa livre de gordura (MLG) e massa gorda (MG). Esses resultados mostram que a diminuição de CAPA na dieta, pela inclusão da PTS pode gerar uma melhora na acidose metabólica e no estresse oxidativo, consolidando que o manejo dietético através da inclusão de proteína vegetal pode ser uma abordagem nutricional importante no tratamento do paciente com DRC. / The diet has a strong influence on the formation of the acid load in the metabolism of patients with CKD, and this is a factor that can influence the severity of metabolic acidosis. It is a condition commonly found in more advanced stages of CKD. Vegetable proteins, such as textured soy protein (PTS), could provide a lower acid charge formation and, because of their content of isoflavones, considered antioxidants, would contribute to the improvement of metabolic stress. The objective of this study was to evaluate the effects of replacing animal protein source to plant source (soybean) for one week and analyze the blood and urine parameters of acidosis in patients with CKD. We evaluated 28 patients with CKD stages 3, 4 and 5 before and after replacing animal protein sources of the main meal, either lunch or dinner, with PTS over 7 days. Before and after the intervention it was evaluated: feed intake per records, Load Acid Potential Food (CAPA), clinical routines, anthropometry (weight, height and BMI), body composition by bioelectrical impedance multifrequency spectroscopy (BIS), blood and urine parameters (Bicarbonate and urinary pH) and oxidative stress markers (CAT and AOPP) Mann-Whitney non-parametric tests were used to analyze the results, as well as the Spearman\'s correlation tests to evaluate associations between the variables. The p value <0.05 was considered for statistical significance. We found that in one week of intervention with PTS there was a significant increase in BIC markers and blood pH, as well as urinary pH. Most of the patients were not in the state of metabolic acidosis. The CAT oxidative stress marker showed11 improvement, but AOPP showed no significant increase. Regarding body composition, there was a decrease in weight and an increase in the hyper hydration markers, but an increase in fat free mass and fat mass. These results show that the decrease of CAPA in the diet and the inclusion of the PTS can generate an improvement in metabolic acidosis and oxidative stress, consolidating the dietary management using plant protein inclusion and this can be an important nutritional approach in the treatment of patients with DRC.

Die Azidose gehört zu den stärksten dilatatorischen Stimuli zerebraler Arterien. Obwohl schon 1890 von Roy und Sherrington beschrieben, sind die Faktoren, die die Vasodilatation zerebraler Arterien auf Azidose vermitteln, bis heute nicht bekannt. Untersuchungen über die Rolle des schnell flüchtigen Bioradikals Stickstoffmonoxid (NO) haben gezeigt, daß NO bei der azidotischen Vasodilatation zerebraler Arterien als Modulator agiert. Darüber hinaus nimmt NO in der neurovaskulären Kopplung, d.h. bei der Vermittlung der regionalen Blutflußantwort nach neuronaler Stimulation, eine permissive Funktion ein. Die Vasodilatation auf Azidose wurde in der vorliegenden Arbeit als Modellstimulus zur Untersuchung der NO-abhängigen Dilatation zerebraler Arterien verwendet. Dabei wurde die Rolle der Kaliumkanäle und die Funktion des cGMP an der Vasodilatation auf Azidose mittels spezifischer Inhibitoren untersucht. Die Experimente erfolgten an der isolierten und perfundierten A. cerebri media der Ratte. Bei der Untersuchung der Signaltransduktion von NO auf Ebene des cGMP wurde eine ausgeprägte Abhängigkeit der azidotischen Vasodilatation von cGMP beobachtet. Durch Restitution des basalen cGMP-Spiegels nach vorheriger Inhibition der löslichen Guanylatzyklase wurde gezeigt, daß NO über cGMP bei der Vermittlung dieser Reaktion als Modulator wirkt. Unter Blockade der einzelnen Kaliumkanalfamilien konnte eine Beteiligung der KCa an der Vasodilatation auf Azidose sowie am Gefäßtonus unter Ruhebedingungen beobachtet werden. Für eine Beteiligung der KATP, der KV und der Kir an diesen Reaktionen wurden dagegen keine Hinweise gefunden. Ebenso sprechen die Untersuchungen unter Blockade der Na+/K+-ATPase gegen eine Beteiligung dieses Enzyms an der Azidosereaktivität zerebraler Arterien. Um ein mögliches Zusammenwirken der Kaliumkanäle zu erfassen, wurde die Vasodilatation auf Azidose unter Blockade von jeweils zwei Kaliumkanaltypen untersucht. Unter Hemmung der KCa und der KATP, sowie unter Hemmung der BKCa und der KATP wurde keine Vasodilatation mehr auf Azidose beobachtet. Die Ergebnisse sprechen dafür, daß die Vasodilatation der A. cerebri media auf Azidose durch BKCa und KATP in redundanter Weise vermittelt wird. Dabei scheinen KCa die Funktion der KATP vollständig substituieren zu können. Die Resultate dieser Arbeit bilden den Ausgangspunkt für derzeit laufenden Untersuchungen über die funktionelle Modulation der KATP und der BKCa durch das NO/cGMP-System. Weiterhin bilden die vorliegenden Untersuchungen eine wichtige Grundlage zur Überprüfung der zentralen Rolle der KCa und der KATP auf weitere, durch das NO/cGMP-System modulierten Stimuli, wie z.B. der funktionellen Stimulation. Die in dieser Arbeit vorgestellten Experimente wurden mit Mitteln der Deutschen Forschungsgemeinschaft (SFB 507), der Hermann und Lilly Schilling Stiftung, sowie der Humboldt Universität zu Berlin gefördert. / Acidosis is one of the most potent vasodilators in the cerebral circulation. Although first described 1890 by Roy and Sherrington the mechanisms of vasodilation to acidosis are still unknown. Experimental data show, that nitric oxide (NO) is a modulator but not a mediator of cerebral arterial pH reactivity. NO also acts as a modulator of neurovascular coupling in the rat somatosensory cortex. We used the experimental in vitro model of the isolated and perfused middle cerebral artery (MCA) to elucidate the general mechanisms of NO-modulated dilations. The present study was performed to clarify the role of cGMP and potassium channels for mediation of acidosis-induced dilation of cerebral arteries. The results indicate, that vasodilation to acidosis is mediated by cGMP. Restoring the basal cGMP-level we could demonstrate a permissive role of cGMP in the vasodilation to acidosis. We could also show that KCa are active under resting conditions and are able to contribute to the relaxation of the MCA to acidosis. Other potassium channels like KATP, Kir, KV and the Na+/K+ATPase appeared not to be involved in the process of dilation to acidosis. After administration of a selective inhibitor of KATP in addition to an inhibitor of KCa the relaxation to acidosis was completely abolished. Simultaneous application of selective inhibitors of KATP and BKCa also prevented from vasodilation to acidosis. These results indicate, that relaxation to acidosis is mediated by activation of KATP and BKCa. This potassium channels seem to have a redundant activity, in such a way that KCa could substitute for KATP. The present findings are a starting point for further studies concerning the modulation of KATP and BKCa by the NO/cGMP-System. This studies are a basis for coming experiments to determine the role of KATP and BKCa in the neurovascular coupling.

A acidose metabólica causa perda de mineral ósseo e a estimulação mecânica causa remodelamento ósseo adaptativo. A reabsorção óssea que caracteriza essas mudanças ósseas depende da acidificação extracelular pela secreção vetorial de H+ pelos osteoclastos. A H+-ATPase vacuolar em paralelo com o trocador Cl-/H+ (CLC7) são os mecanismos conhecidos envolvidos na reabsorção óssea, entretanto, os osteoclastos também expressam canais para H+ dependentes a voltagem. Este trabalho foi realizado para avaliar a contribuição dos canais para H+ na função celular visando à compreensão de seu relacionamento com a H+-ATPase vacuolar e o CLC7 (1); analisar se o fluxo de fluido extracelular modifica a secreção de H+ (2) e avaliar a diferenciação dos osteoclastos in vitro sob acidose metabólica devido à redução do HCO3- (3). Osteoclastos de ratos Wistar foram obtidos diretamente dos animais ou foram diferenciados in vitro (com M-CSF e RANKL) e semeados sobre vidro, plástico ou substratos mineralizados em <font face=\"Symbol\">&#945;-MEM + 10% SFB, em pH 7,4 ou 6,9, e então mantidos em incubadora com 5% CO2, a 37<font face=\"Symbol\">&#176;C. A diferenciação celular foi avaliada pela contagem de células TRAP-positivas ou de núcleos marcados por DAPI. A secreção de H+ foi avaliada por epifluorescência, utilizando-se BCECF-AM, sensível a pH. Os registros do pH intracelular foram feitos na vigência de soluções tamponadas por HEPES, na ausência de CO2/HCO3- (pH 7,4, 300 mOsm/L H2O, a 37<font face=\"Symbol\">&#176;C), na presença ou ausência de perfusão contínua de fluido extracelular a uma velocidade de 5 ml/min. Na ausência de perfusão, os osteoclastos exibiram variações cíclicas do pHi (acidificação e alcalinização espontâneas), com período de 12 a 45 minutos (n = 35) e amplitude de 0,12 a 1,43 unidades de pHi. As oscilações não foram abolidas por concanamicina (100 mM) (n = 3), por NPPB (100 <font face=\"Symbol\">mM) (n = 3), na ausência de Na+ extracelular (n = 5) ou na ausência de Cl- extracelular (n = 3). O fluxo de fluido aboliu as oscilações e a ausência de Cl- extracelular modificou significativamente seu padrão. Na ausência de perfusão, a secreção de H+ após acidificação intracelular induzida foi abolida por Zn2+ (100 <font face=\"Symbol\">mM) (n = 5). Além disso, na presença de perfusão, a secreção de H+ após acidificação intracelular induzida foi abolida por NPPB (n = 4) e não foi abolida por bafilomicina (200 nm) (n = 3). A acidose metabólica não modifica o número de osteoclastos diferenciados in vitro, entretanto, o tratamento das culturas com Zn2+ causou redução do numero de células mononucleares e aumento relativo do número de osteoclastos multinucleados em relação ao controle tanto em pH 7,4 quanto em pH 6,9. / Metabolic acidosis can cause a loss of bone mineral and the mechanic stimulation can cause adaptative bone remodeling. The bone resorption characteristic of these bone changes aforementioned depends on the extracellular acidification by osteoclastmediated proton secretion. The H+ secretion by vacuolar H+-ATPase together with Clsecretion through a Cl-/H+ exchanger (CLC7) are the known mechanisms involved in the bone resorption; however, osteoclasts also express voltage-gated proton channels. The proposed aims of these work were to evaluate the contribution of proton channels in the osteoclast function for better understanding its relation with vacuolar H+-ATPase and CLC7 (1); to analyze whether the flow of extracellular fluid modifies the H+ secretion or not (2); and to analyse the osteoclast differentiation in vitro under metabolic acidosis due to HCO3- reduction (3). Osteoclasts were freshly isolated or generated from bone marrow precursor cells (using M-CSF and RANK- L) from of Wistar rats. The cells were placed on glass coverslips, plastic coverslips, or on mineralized substrate in <font face=\"Symbol\">&#945;-MEM + 10% FBS, pH 7.4 or 6.9, and then maintained in a 5% CO2 incubator at 37<font face=\"Symbol\">&#176;C. The differentiation was analyzed by counting of TRAP-stained cells or DAPIstained nuclei. The H+ secretion was analysed by epifluorescence, using the pHsensitive dye BCECF-AM. The intracellular pH record was done using a standard HEPES-buffered solution free of CO2/HCO3- (pH 7.4, 300 mOsm/L H2O, at 37<font face=\"Symbol\">&#176;C), with or without continuous perfusion of extracellular fluid at a rate of 5 ml/min. In the absence of perfusion, the osteoclasts exhibit cyclic pHi variations (spontaneous acidification and alkalinization), with a period of 12 to 45 minutes (n = 35) and amplitude difference between maximal and minimal pHi of 0.12 to 1.43 units pHi. These oscillations were not abolished in the presence of oncanamycin (100 mM) (n = 3), NPPB (100 <font face=\"Symbol\">mM) (n = 3), in the absence of Na+ (n = 5) or in the absence of Cl- (n = 3) in the extracellular solution. The fluid flow itself abolished the pH oscillations and the absence of extracellular Cl- modifies significantly these patterns. In the absence of perfusion, the H+ secretion after induced intracellular acidification was abolished by Zn2+ (100 <font face=\"Symbol\">mM) (n = 5). In addition, in the presence of perfusion, the H+ secretion after induced intracellular acidification was abolished by NPPB (n = 4) and was not abolished by bafilomycin (200 nm) (n = 3). Metabolic acidosis does not modify the number of osteoclasts differentiated in vitro, however, when the cell culture was treated with Zn2+, there was a significant reduction in the number of mononuclear cells and a relative increase in the number of multinucleated osteoclasts compared to control, both in pH 7.4 and pH 6.9 medium.

Justificativa e Objetivos: Acidose é uma desordem muito frequente em pacientes cirúrgicos. Neste cenário, permanecem incertas as implicações clínicas da acidose e características de cada tipo. Portanto, é relevante tentar elucidar o papel de cada tipo de acidose no prognóstico de pacientes cirúrgicos de alto risco. Método: Trata-se de estudo multicêntrico observacional prospectivo, realizado em três diferentes hospitais. Os pacientes que necessitassem no pós-operatório de cuidados intensivos foram incluídos no estudo consecutivamente. Pacientes com baixa expectativa de vida (câncer sem perspectiva de tratamento), pacientes com insuficiência hepática (child B ou C), insuficiência renal (Clearence de creatinina < 50 mL/min ou hemodiálise prévia), diagnóstico de diabetes previamente foram excluídos. Os pacientes classificados na admissão da UTI quanto ao tipo de acidose que desenvolviam no pós-operatório imediato foram acompanhados até 30 dias e alta hospitalar. Tal classificação avaliou acidose metabólica, pela quantificação da diferença de base menor que -4 mmol/L, anion gap corrigido pela albumina (AG) e lactato aumentados, quando maiores que 12 e 2 mmo/L, respectivamente. Então, os pacientes foram classificados como acidose metabólica hiperlactatemica, aumentado e normal (hipercloremica) anion gap corrigido pela albumina. Resultados: O total de 618 pacientes foram incluídos durante dois anos. A incidência de acidose metabólica foi 59,1% na UTI, porém 148 (23,9%) apresentaram hipercloremica, 131 (21,2%) revelaram hiperlactatemia, 86 (13,9%) AG aumentado e em 253 (40,9%) não ocorreu acidose metabólica. Dentre todas as cirurgias, pacientes de cirurgia gastrointestinal foram associados a maiores porcentagens de acidose metabólica 46,2% versus 19,8% sem acidose, P < 0,05. Interessantemente, acidose com hipercloremia apresentou mais altos valores de cloro na admissão da UTI 115,0 ± 5,7 meq/L (P < 0,05) e receberam maiores quantidades de solução fisiológica 0,9% no intraoperatório 3000,0 (2000,0 - 4000,0) mL (P < 0,05). Entretanto, apesar dos pacientes não apresentarem diferenças entre escores de gravidade (SAPS 3, SOFA e ASA), idade e tempo cirúrgicos, ocorreram diferenças em relação a complicações e mortalidade no pós-operatório quando os pacientes mantinham acidose após 12 horas de pós-operatório. Pacientes com lactato e AG aumentados no pós-operatório imediato apresentaram maiores complicações, seguido dos pacientes com hipercloremia, e os sem acidose, respectivamente 68,8%; 68,6%; 65,8% e 59,3%, P = 0,03. Cardiovascular e renal disfunções foram as principais complicações e o grupo hiperlactatemia mostrou maior incidência em comparação aos outros grupos. O mesmo foi verificado em relação à mortalidade hospitalar e em 30 dias de seguimento os grupos hiperlactatemia, AG aumentado, hipercloremicos e sem acidose foram respectivamente 30,1% (HR 1,61, IC 95% 1,02 - 2,53); 24,3% (HR 1,37, IC 95% 0,76 - 2,46); 18,4% (HR 1,55, IC 95% 0,90 - 2,67) e 10,3%, Log-Rank = 0,03. Conclusão: A incidência de acidose metabólica em pacientes cirúrgicos de alto risco no pós-operatório é elevada, principalmente a do tipo hipercloremia. Pacientes cirúrgicos que desenvolvem acidose metabólica, dependendo das características, apresentam piores prognósticos em relação aos pacientes sem acidose, além disso, este estudo demonstra que diferentes etiologias de acidose metabólica estão associadas com diferentes taxas de mortalidade e morbidade no pós-operatório / Background: Acidosis is a very frequent disorder in surgical patients. In this patient set there remains uncertainty the clinic implications from acidosis and characteristics postoperatively. Therefore, it is very important to evaluate the role of each acidosis type in outcome for high-risk surgical patients. Methods: Multicenter prospective observational study was performed in three different hospitals. The patients who needed postoperative ICU were involved in the study consecutively. Patients with low life expectancy (cancer without treatment), hepatic failure, renal failure, and diabetic diagnosis were excluded. The patients were followed until 30 days and hospital discharge. On ICU admission, immediately postoperative period, the patients were classified to each type of acidosis. The classification evaluated metabolic acidosis as base excess < -4 mmol/L and high albumin-corrected anion gap (AG) and hyperlactatemia, both > 12 and > 2 mmol/L, respectively. So, the metabolic acidosis classification patients were related to hyperlactatemic, high and normal (hyperchloremic) albumin-corrected anion gap. Results: The study enrolled 618 patients during 2 years. Overall, the acidosis incidence was 59.1% on ICU admission, 148 (23.9%) hyperchloremic, 131 (21.2%) hyperlactatemia, 86 (13.9%) a high anion gap and in 253 (40.9%) there was no metabolic acidosis. The hyperchloremic group presented the highest chlorine level, 115.0 ± 5.7 meq/L (P < 0.05) and highest administration of 0.9% physiologic solution intraoperatively, 3000,0 (2000,0 - 4000,0) mL (P < 0.05). However, in spite of patients didn\'t present difference in profile demographic and score prognostic, those who remain after 12 hours with acidosis, depend on groups classification in postoperatively showed greater ICU complications, respectively, hyperlactatemia group 68.8%; high anion gap 68.6%; hyperchloremic 65.8% and no acidosis 59.3%, P = 0.03. Cardiovascular and renal dysfunctions were the main complications and hyperlactatemia group showed the highest in all of them. The same was verified in related to 30 days follow-up and hospital mortality rate respectively 30.1% (HR 1.61, IC 95% 1.02 - 2.53) hyperlactatemic; 24.3% (HR 1.55, IC 95% 0.90 - 2.67) high anion gap; 18.4% (HR 1.37, IC 95% 0.76 - 2.46) hyperchloremic and 10.3% no acidosis group, Log-Rank = 0.03. Conclusions: Metabolic acidosis in surgical patients is a very important complication postoperatively, mainly hyperchloremic. Patients who developed metabolic acidosis postoperatively depend on group classification presented worst outcomes compared to no acidosis patients; this result showed that different kinds of acidosis represented different outcomes postoperatively

INTRODUÇÃO: A bexiga neurogênica é considerada um fator de risco importante para insuficiência renal crônica. A preservação da função renal é um dos principais objetivos do tratamento nefrourológico dos portadores desta doença. OBJETIVOS: Descrever as características demográficas de 58 pacientes com bexiga neurogênica congênita, as características anatômicas e funcionais do trato urinário superior e inferior desta população ao início do seguimento e ao final da coleta dos dados e identificar fatores de risco associados à piora de função glomerular e tubular nesta população, utilizando como marcadores a quantificação do ritmo de filtração glomerular e o desenvolvimento de microalbuminúria e acidose metabólica. MÉTODOS: Estudo retrospectivo de uma coorte de 58 pacientes portadores de bexiga neurogênica congênita com seguimento mínimo de seis meses, matriculados no ambulatório de Disfunções Miccionais da Infância da Unidade de Nefrologia Pediátrica do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. O período de coleta de dados foi encerrado em janeiro de 2006. Os resultados obtidos no estudo foram descritos por médias e desvios padrões, medianas, valores mínimos e máximos, ou por frequências e percentuais. A comparação entre a avaliação inicial e a final para variáveis quantitativas contínuas foi feita usando-se o teste t de Student para amostras pareadas. A associação entre variáveis dicotômicas foi feita considerando-se o teste exato de Fisher. Para avaliação da evolução dos pacientes e comparação de subgrupos definidos por variáveis dicotômicas, foram construídas curvas de Kaplan-Meier e aplicado o teste de Long-rank. Valores de p<0,05 indicaram significância estatística. RESULTADOS: Das 58 crianças avaliadas, 33 eram do sexo feminino (56,9%). A idade média com que as crianças chegaram ao serviço foi de 4,2±3,5 anos, a média de tempo de seguimento foi de 3,8±3,1 anos. A etiologia predominante de bexiga neurogênica foi mielomeningocele, em 42 dos 58 pacientes (72,4%). O encaminhamento à Unidade ocorreu por infecção urinária em 48 (82,8%) casos, por enurese em 5 (8,6%) e por retenção urinária em 5 (8,6%). Dentre os 49/58 (84,5%) pacientes com ITU de repetição ao início do seguimento, 41/49 (83,7%) pacientes apresentaram melhora no período de seguimento. A hipertensão arterial foi diagnosticada em 11 (19,3%) das crianças na avaliação inicial e em 18 (31%) na avaliação final. A média do RFG inicial foi de 146,7±70,1 mL/1,73m2/min e a média final de 193,6±93,6 mL/1,73m2/min, com p=0,0004. A microalbuminúria estava presente em 20 (54,1%) dos exames na avaliação inicial e em 26 (61,9%) na avaliação final. A acidose metabólica estava presente em 11 (19%) dos exames na avaliação inicial e em 19 (32,8%) na avaliação final. As crianças que chegaram à Unidade de Nefrologia mais precocemente (< 3 anos) foram aquelas que mais apresentaram acidose metabólica no decorrer do acompanhamento (p=0,01). Os pacientes que não tinham acidose metabólica ao final do estudo apresentaram valores menores de Z-escore peso final (p= 0,048), Zescore altura/estatura inicial (p= 0,047) e Z-escore altura/estatura final (p=0,022) com relação aos pacientes do grupo que evoluiu com acidose. CONCLUSÃO: Pacientes com bexiga neurogênica congênita evoluem com acometimento renal glomerular e tubular precoce, cujo manejo demanda acompanhamento por profissional especializado. / INTRODUCTION: Neurogenic bladder is considered an important risk factor for chronic renal failure. In these patients, preservation of renal function is one of the most important goals of nephro-urological treatment. PURPOSE: To describe demographic data of 58 children with congenital neurogenic bladder, the anatomic and functional characteristics of their upper and lower urinary tracts at the beginning of the follow-up and at the end of the data collection period and to identify risk factors associated with worsening of the glomerular and tubular functions using as markers the quantitation of glomerular filtration rate and the development of microalbuminuria and metabolic acidosis. METHODS: Retrospective study of a cohort of 58 children with congenital neurogenic bladder treated at the Voiding Dysfunction Clinic, Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, with a minimum follow-up period of 6 months. The period of data collection ended in January 2006. The obtained results were described as means, standard deviations, medians, minimum and maximum values, or as frequencies and percentages. The comparison between the initial and final evaluations for continuous quantitative variables was done using the Student´s t test for paired samples. The association between dichotomous variables was performed considering the Fisher´s exact test. For evaluation of patients` outcomes and comparison of subgroups defined by dichotomous variables, Kaplan-Meier curves were performed and Long-rank test was applied. P values < 0.05 indicated statistical significance. RESULTS: 58 children were evaluated with 33 females (56,9%). The mean age at presentation to the service was 4.2 ± 3.5 years, the mean follow-up period was 3.8 ± 3.1 years. Myelomeningocele was the leading aetiology, corresponding to 42/58 patients (72.4%). Referral to the service occurred in 48 (82.8%) patients due to urinary tract infection, in 5 (8.6%) due to enuresis and in 5 (8.6%) due to urinary retention. Recurrent urinary tract infections were found in 49/58 patients (84.5%) at the beginning and 41/49 (83.7%) had improvement during the follow-up period. Systemic Hypertension was diagnosed in 11 (19.3%) children at the first visit and in 18 (31%) in the final evaluation. The initial mean glomerular filtration rate was 146.7 ±70.1 mL/1.73m²/min and the final mean was 193.6±mL/1.73m²/min, p = 0.0004. Microalbuminuria was found in 20 (54.1%) samples in the initial evaluation and in 26 (61.9%) in the final evaluation. Metabolic acidosis was present in 11 (19%) samples in the initial evaluation and in 19 (32.8%) in the final assessment. The children who most developed metabolic acidosis during the follow-up period were those who presented earlier to the service (< 3 years of age), p= 0.01. The group of patients that did not present metabolic acidosis at the end of the study had lower values of final weight z-score (p=0.048), initial height/stature z-score (p=0.047) and final height/stature z-score (p=0.022) than the patients of the group that developed acidosis. CONCLUSIONS: Children with congenital neurogenic bladder develop early compromise of renal glomerular and tubular functions and require adequate management by specialized professionals.