This diploma thesis deals with home parenteral nutrition in the day and night regime and its effect on patients. Parenteral nutrition is usually administered at night so that patients can do normal daily activities and so that nutrition administered in this way has the least impact on their lives. Parenteral nutrition is not a physiological route of nutrient administration and it is not natural for the human body to process nutrients at night. The first part of the theoretical work presents parenteral nutrition and its composition, indications, contraindications and complications. The next part of the thesis describes home parenteral nutrition and its organisation which is necessary for this form of nutritional support to be implemented. It is necessary to monitor many laboratory values on parenteral nutrition, the theoretical part specifically mentions cholesterol, triacylglycerols, glycemia or liver function tests. One of the important parts is the chapter about circadian rhythms, hormones and metabolic changes in energy intake at night. Qualitative research was chosen for this work, which involved 17 patients on home parenteral nutrition. These patients were getting their nutrition during the night. Their laboratory values such as liver function tests, glycaemia and blood fats was evaluated and...

Devido a controvérsias sobre a freqüência, diagnóstico e possibilidade de progressão para doença crônica da degeneração gordurosa do fígado em portadores de obesidade mórbida, planejou-se uma investigação retrospectiva em pacientes candidatos à cirurgia bariátrica. Foram analisados 60 indivíduos com indicação de gastroplastia com derivação intestinal em Y de Roux. Os pacientes foram submetidos a questionário clínico, provas bioquímicas e posteriormente, à biópsia hepática intraoperatória. A freqüência de EHNA e esteatose hepática foi elevada, e detectou-se 5% de cirrose. Na análise univariada houve correlação de diversos testes bioquímicos com as enzimas hepáticas. Na análise multivariada a albumina foi a variável determinante; apesar de seu debilitado valor preditivo. Nestas condições, apenas a avaliação histológica configura-se como critério definitivo para diagnóstico e acompanhamento desta população / Because of controversies about frequency, diagnosis and possibility of progression toward chronic disease of fatty degeneration of the liver in morbidly obese patients, a retrospective study was done in patients who underwent bariatric surgery. Sixty individuals with indication for gastroplasty with Roux-en-Y jejunal bypass were enrolled. They were submitted to clinical questionnaire, biochemistry tests and subsequently, intraoperative liver biopsy. Frequency of NASH and steatosis was high, and 5.0% suffered from cirrhosis. In univariate analysis there was correlation between various biochemical measurements and liver enzymes. In multivariate analysis only serum albumin was a determinant variable, with low predictive value. The histological grading system remains the definitive criterion for diagnosis and follow-up of this population

Submitted by Sandra Pereira (srpereira@ufrrj.br) on 2016-08-30T17:45:35Z No. of bitstreams: 1 2011 - Janh Carlo de Amorim Ferreira.pdf: 452426 bytes, checksum: 152fed7ea96dd8772e716b4b9f21b433 (MD5) / Made available in DSpace on 2016-08-30T17:45:35Z (GMT). No. of bitstreams: 1 2011 - Janh Carlo de Amorim Ferreira.pdf: 452426 bytes, checksum: 152fed7ea96dd8772e716b4b9f21b433 (MD5) Previous issue date: 2011-04-26 / This study was performed at Hospital de Cl?nicas Veterin?rias do Centro Universit?rio Pl?nio Leite Itabora?, Rio de Janeiro (Veterinary Hospital of Pl?nio Leite University, Itabora?, Rio de Janeiro) to monitor the hepatic biochemical profile of cats and their clinical parameters when submitted to continuous infusion of propofol at a 0,3 mg/kg/min dosage, for 90 minutes, and comparing to results obtained from cats who received continuous infusion of saline solution. Both groups were analyzed during a pre-determined period of time totalizing 28 days of observation and analysis. The following enzymes activity levels were determined: Aminotransferase (AST), Alanina-Aminotransferase (ALT), Gamma Glutamyl Transpeptidase (GGT) and Alkaline Fosfatasis (FA); serum levels of Albumin (A), Total Bilirrubin (BT) and Total Serum Proteins (PT), yet registering Respiratory (FR) and Heart Rate (FC), Systolic Blood Pressure (PAS), Mean Arterial Blood Pressure (PAM), Diastolic Blood Pressure (PAD) and Oxygen Partial Saturation (SPO2). Twenty healthy cats were analyzed on this study, their weights varying from two to four kilos and ages between three to five years old, submitted to experimental procedures performed during the months of January and February, 2010. The analysis of these results showed a major difference (p<0,05) between the ALT serum activities at the following positions: T2 (30 minutes), T3 (60 minutes), T5 (12 hours) and T9 (28 days); AST serum activities at T2, FA serum activities at T2, T6 (seven days) and T8 (21 days), emphasizing the fact only at this last position the GP levels were greater than GC; in the heart rate at T1 position (the beginning of this experiment), without compromising animals physical condition. None of the animals presented averages above parameters of normality. The other parameters examined did not present any significant differences, concluding that total intravenous anesthesia using continuous infusion of propofol was safe to contain cats in invasive surgical procedures, therefore providing more information regarding the safe use of this drug in animals. / O trabalho foi desenvolvido no Hospital de Cl?nicas Veterin?rias do Centro Universit?rio Pl?nio Leite, em Itabora?, RJ, com o intuito de monitorar perfil bioqu?mico hep?tico e par?metros cl?nicos de gatos submetidos ? infus?o cont?nua de propofol (GP) na dose de 0,3 mg/kg/min, durante 90 minutos, e comparando-se com resultados observados em gatos do grupo controle (GC), que receberam infus?o cont?nua de solu??o fisiol?gica. Os dois grupos foram avaliados em espa?os de tempo pr?-determinados, totalizando 28 dias de observa??es e an?lises. Foram determinadas as atividades s?ricas de aspartatoaminotransferase (AST), alanina-aminotransferase (ALT), gama-glutamil transpeptidase (GGT) e fosfatase alcalina (FA), determinadas as concentra??es s?ricas de Albumina (A), Bilirrubina total (BT) e Prote?nas Totais s?ricas (PT), registrando-se ainda as Frequ?ncias Respirat?rias (FR) e Card?acas (FC), Temperatura Retal (T), Press?es Arteriais Sist?licas (PAS), M?dias (PAM) e Diast?licas (PAD) e Satura??o parcial de O2 (SPO2). Foram utilizados no estudo 20 gatos h?gidos, com pesos variando entre dois e quatro kg e idades entre tr?s e cinco anos, que foram submetidos aos procedimentos experimentais no per?odo compreendido entre janeiro e fevereiro de 2010. A an?lise dos resultados demostraram que houve diferen?a significativa (p<0,05) nas atividades s?ricas de ALT nos momentos T2 (30 minutos), T3 (60 minutos), T5 (12 horas) e T9 (28 dias); nas atividades s?ricas de AST no momento T2; nas atividades s?ricas de FA nos momentos T2, T6 (7 dias) e T8 (21 dias), sendo que, somente neste ultimo momento as dosagens do GP foram maiores que no GC; na frequ?ncia card?aca no momento T1 (in?cio do experimento), sem causar qualquer comprometimento ? sa?de dos animais. Nenhum dos animais apresentou m?dias acima dos par?metros de normalidade. Os outros par?metros analisados n?o tiveram diferen?as significativas, concluindo-se que a anestesia intravenosa total com uso de propofol em infus?o cont?nua foi segura para conten??o de gatos em procedimentos incruentos, contribuindo assim para maiores informa??es em rela??o ao uso desse f?rmaco nesses animais

Devido a controvérsias sobre a freqüência, diagnóstico e possibilidade de progressão para doença crônica da degeneração gordurosa do fígado em portadores de obesidade mórbida, planejou-se uma investigação retrospectiva em pacientes candidatos à cirurgia bariátrica. Foram analisados 60 indivíduos com indicação de gastroplastia com derivação intestinal em Y de Roux. Os pacientes foram submetidos a questionário clínico, provas bioquímicas e posteriormente, à biópsia hepática intraoperatória. A freqüência de EHNA e esteatose hepática foi elevada, e detectou-se 5% de cirrose. Na análise univariada houve correlação de diversos testes bioquímicos com as enzimas hepáticas. Na análise multivariada a albumina foi a variável determinante; apesar de seu debilitado valor preditivo. Nestas condições, apenas a avaliação histológica configura-se como critério definitivo para diagnóstico e acompanhamento desta população / Because of controversies about frequency, diagnosis and possibility of progression toward chronic disease of fatty degeneration of the liver in morbidly obese patients, a retrospective study was done in patients who underwent bariatric surgery. Sixty individuals with indication for gastroplasty with Roux-en-Y jejunal bypass were enrolled. They were submitted to clinical questionnaire, biochemistry tests and subsequently, intraoperative liver biopsy. Frequency of NASH and steatosis was high, and 5.0% suffered from cirrhosis. In univariate analysis there was correlation between various biochemical measurements and liver enzymes. In multivariate analysis only serum albumin was a determinant variable, with low predictive value. The histological grading system remains the definitive criterion for diagnosis and follow-up of this population

A stationary or portable infusion pump can be used to administer home parenteral nutrition (HPN). The stationary pump (SP) must be fasten to the infusion stand, so patients administer infusions in night mode to maintain their quality of life and mobility in the daytime. However, administering the HPN at nighttime can cause complications. Conversely, the portable pump (PP) does not have to be fasten to the infusion stand and the infusions can be administered in day mode during activities, as the PP can be placed in a special backpack. The aim of this diploma thesis is to evaluate the administration of HPN in day mode in patients with a PP and further to evaluate and compare the results of quality of life and liver function tests results in patients with a PP and a SP. HPN patients with a PP and a SP completed the HPN-QOL questionnaire in the nutritional clinic at the 4th internal clinic of the General University Hospital in Prague during outpatient visits. In addition to that, patients with a PP completed a questionnaire focused on the administration of HPN in day mode. Liver function tests results (total bilirubin, ALT, AST, GGT, ALP, cholinesterase and albumin) were obtained from patients' medical records. A total of 14 respondents with a PP and 14 respondents with a SP were included in the...

Il sistema immunitario è costituito da una varietà di cellule, molecole e processi biologici che interagiscono per prevenire le invasioni microbiche, riconoscere le molecole estranee ed eliminare le fonti esistenti di lesioni cellulari, ripristinando le normali funzioni tissutali una volta risolto il problema. L'immunità innata è la prima linea di difesa contro le invasioni di agenti patogeni. Nelle vacche da latte, il suo funzionamento subisce gravi alterazioni durante il periodo di transizione (TP). In questa fase è stata segnalata una compromissione delle funzioni delle cellule polimorfonucleate (PMN) correlate alla produzione di metaboliti reattivi dell'ossigeno (ROM), all’attività della mieloperossidasi (MPO), alla chemiotassi e alla fagocitosi. I PMN bovini hanno un alterata espressione dei geni codificanti per tali funzioni tra -1 e 2 settimane dal parto, rispetto al livello rilevato 4 settimane dopo il parto per gli stessi geni. La causa esatta delle disfunzioni immunitarie che si verificano nel periparto non è mai stata chiaramente identificata. In esse possono contribuire diversi fattori, principalmente imputati alle alterazioni metaboliche tipiche del periparto (cambiamenti nell’assetto ormonale, limitazione della risposta immunitaria materna al fine di mantenere la gravidanza, alterazioni nel bilancio energetico e stato di stress ossidativo). Tuttavia, la durata e l’entità delle disfunzioni immunitarie può aumentare qualora subentri uno stato di squilibrio fisiologico (PI). In tali condizioni, le alterazioni metaboliche del periparto sfuggono al controllo dei meccanismi omeostatici e omeoretici, ed una infiammazione sistemica è la conseguenza frequente di questo squilibrio. Lo stato infiammatorio sistemico è scatenato da un aumento dei livelli di citochine proinfiammatorie (PIC), che è collegato ad un aumento della temperatura corporea al parto, e che tipicamente inficia le funzionalità epatiche, modificando le priorità anaboliche dell'organo in fase di inizio lattazione. A seguito di tale slittamento, il fegato produce più α-globuline, note come proteine positive di fase acuta (+APP), cioè aptoglobina, ceruloplasmina e siero amiloide alfa (SAA). Al contrario, riduce la sintesi di albumina, retinol binding protein (RBP), paraoxonasi (PON) e lipoproteine, note come proteine negative di fase acuta (-APP), e sequestra minerali, quali zinco e ferro, dal flusso ematico. L'infiammazione porta all'attivazione dei PMN, mentre la ridotta competenza immunitaria comunemente riportata in TP è stata associata ad un effetto opposto sui leucociti. Pertanto, questi dovrebbero essere considerati come due fenomeni distinti, ma lo stato di PI potrebbe essere considerato un denominatore comune, direttamente correlato al rischio di patologie in avvio di lattazione. Le strategie nutrizionali per ottimizzare l'immunità delle vacche da latte durante il TP dovrebbero quindi essere focalizzate sulla riduzione del grado di PI correlato al parto. Tra tali strategie nutrizionali, dovrebbe essere presa in considerazione la corretta gestione delle fonti energetiche per adattarle alle variazioni dei fabbisogni. Inoltre, il profilo degli acidi grassi delle fonti lipidiche può contribuire nel modificare le funzioni immunitarie. Infine, la somministrazione di prodotti supplementari con attività antiossidanti o antinfiammatorie, così come di specie donatrici di gruppi metilici, potrebbero essere strategie utili a favorire la funzionalità immunitaria delle bovine durante il TP. In una prospettiva più ampia, sebbene strategie nutrizionali e supplementi possano talora mitigare le alterazioni immunitarie, possiamo concludere che l'adozione di pratiche volte a minimizzare il PI durante il periodo di transizione sia la strategia più efficace per prevenire le disfunzioni. Al fine di chiarire il legame tra le alterazioni che si verificano nel periparto e le disfunzioni immunitarie delle bovine da latte sono stati condotti tre esperimenti. Bovine di razza frisona sono state alloggiate in poste individuali a stabulazione fissa e monitorate regolarmente per le condizioni corporee (BCS), il peso (BW), l'assunzione di alimenti (DMI), la produzione di latte (MY) e il tempo di ruminazione. Campioni di sangue sono stati raccolti regolarmente per valutare un ampio profilo ematochimico e per testare le funzioni dei globuli bianchi mediante stimolazioni ex-vivo. Inoltre, la diapedesi dei PMN è stata testata in vivo mediante test della carragenina e sono stati raccolti campioni di rumine a 30 giorni dal parto (DFC). Il primo esperimento era volto a chiarire le cause dei cambiamenti metabolici che si verificano al momento della messa in asciutta, ed il contributo del livello produttivo in tali alterazioni. Infatti, i profondi cambiamenti nell’alimentazione, gli adattamenti gastrointestinali, del metabolismo e dei parametri immunitari che si verificano nelle bovine alla messa in asciutta sono note scatenare il rilascio di cortisolo, indurre segnali di infiammazione sistemica ed alterare il bilancio redox. Produzioni di latte elevate al momento della messa in asciutta hanno un ruolo nell'aggravare tali condizioni. Nel nostro studio, un gruppo di 13 bovine è stato asciugato a 55 giorni dalla data prevista per il parto. Gli animali sono stati divisi in due gruppi in base alla produzione media dell'ultima settimana di lattazione, assumendo un cut-off di 15 kg * d-1: bassa (LM; 6 animali) e alta produzione (HM; 7 animali). I dati sono stati sottoposti ad ANOVA utilizzando un modello per misure ripetute, assumendo il livello produttivo al termine della lattazione, il tempo e la loro interazione come effetti fissi. L'aumento delle quantità di fibra nella razione di asciutta ha ridotto la DMI e aumentato il tempo di ruminazione. La migrazione dei leucociti nella ghiandola mammaria per contribuire alla fase di involuzione ha ridotto la loro abbondanza nel sangue e aumentato la loro attività. Tale attivazione dei leucociti nella mammella ha aumentato l'abbondanza di specie reattive dell’azoto nel plasma e innescato un'infiammazione sistemica in tutti gli animali (aumento delle +APP e riduzione delle -APP). Tale infiammazione ha compromesso le funzioni epatiche (aumento delle concentrazioni di gamma-glutamil transferasi -GGT- bilirubina e fosfatasi alcalina -ALP-). Sia la produzione di specie dell’azoto che lo stato infiammatorio sistemico hanno contribuito all'esaurimento degli antiossidanti circolanti (gruppi tiolici -SHp-, tocoferolo, β-carotene, potere antiossidante ferrico riducente -FRAP- e capacità antiossidante contro specie reattive dell'ossigeno -ORAC-). Gli animali con una produzione più elevata alla messa in asciutta hanno mostrato la peggiore condizione, probabilmente per i più profondi cambiamenti metabolici che hanno affrontato dopo l'interruzione delle mungiture, e per la fase involutiva verosimilmente più dispendiosa. Questo studio evidenzia la messa in asciutta come una fase critica per gestire la salute delle vacche da latte, e suggerisce un potenziale legame della messa in asciutta con le alterazioni delle funzioni immunitarie che si verificano nel periparto. Nel secondo esperimento si sono cercati di identificare i cambiamenti del sistema immunitario che precedono l'insorgenza della chetosi, al fine di chiarire il loro ruolo nella comparsa della malattia. Pertanto, 13 bovine sono state monitorate tra -48 e 35 DFC e suddivise in due gruppi sulla base dei loro livelli plasmatici di beta idrossibutirrato (BHB): inferiore (CTR, 7 animali) o superiore a 1,4 mMol / L (KET; 6 animali). I dati sono stati sottoposti ad ANOVA utilizzando un modello per misure ripetute, assumendo lo stato di salute, il tempo e la loro interazione come effetti fissi. Le vacche KET hanno avuto una maggiore attivazione del sistema immunitario prima del parto (maggiori concentrazioni plasmatiche di PIC, MPO e specie ossidanti e maggiori produzione di interferone gamma in risposta alla stimolazione con Mycobacterium avium) alterazioni della funzionalità epatica (più alta concentrazione sanguigna di GGT) e minori minerali plasmatici. Elevati livelli plasmatici di NEFA, BHB e glucosio nelle vacche KET suggeriscono uno stato di insulinoresistenza e una marcata mobilizzazione del grasso corporeo durante il periodo di asciutta. Tali andamenti dei parametri relativi al metabolismo energetico durante l’asciutta sono stati associati alla riduzione della DMI al momento del parto e al peggioramento del bilancio energetico negativo ad avvio lattazione. Ciò ha causato a sua volta una riduzione di MY e accresciuto ulteriormente la mobilizzazione dei grassi in avvio di lattazione. Compromissione della funzionalità epatica e attivazione dei leucociti durante il periodo di asciutta hanno determinato una marcata risposta infiammatoria di fase acuta nelle vacche KET dopo il parto (maggiori concentrazioni di +APP minori concentrazioni di RBP), ed ulteriormente compromesso la funzionalità epatica (maggiori concentrazioni di glutammato-ossalacetato transaminasi -AST-GOT- e bilirubina). I leucociti delle vacche KET hanno mostrato ridotte funzioni infiammatorie dopo stimolazione ex-vivo con lipopolisaccaridi batterici (minore produzione di PIC e maggiore produzione di lattato). Queste alterazioni potrebbero essere guidate dall'azione combinata dei metaboliti legati alla mobilizzazione dei lipidi e delle azioni antinfiammatorie volte a prevenire un'infiammazione eccessiva. Ciò suggerisce che le alterazioni dei parametri immunitari osservate prima del parto siano altamente correlate con la probabilità di sviluppare chetosi in avvio di lattazione. Nel terzo esperimento è stato somministrato un prodotto immunostimolante dalla comprovata efficacia nel migliorare le funzioni leucocitarie degli animali immunodepressi e nel ridurre l'incidenza delle malattie infettive delle bovine ad inizio lattazione. La sua modalità di azione non è mai stata chiarita, e un’indagine approfondita sul suo effetto metabolico potrebbe evidenziarne l’efficacia anche nei confronti dei disordini metabolici del periodo di transizione. Pertanto, un gruppo di10 bovine è stato monitorato da -62 a 42 DFC. Il gruppo trattato (TRT, 5 animali) ha ricevuto 32,5 g di Omnigen-AF® (Phibro Animal Health Corporation) due volte al giorno (65 g d-1), mentre il gruppo di controllo (CTR, 5 animali) non ha ricevuto alcun supplemento. I dati sono stati sottoposti ad ANOVA utilizzando un modello per misure ripetute, assumendo il trattamento, il tempo e la loro interazione come effetti fissi. La somministrazione dell’immunostimolante alla messa in asciutta non ha influenzato BW, BCS, MY, composizione del latte e del fluido ruminale e nemmeno modificato la concentrazione di neutrofili del sangue. Tuttavia, ha aumentato il tempo di ruminazione e migliorato il metabolismo energetico dopo il parto (concentrazioni di NEFA e BHB inferiori). Le bovine TRT avevano maggiori concentrazioni ematiche di linfociti e i loro leucociti avevano una maggiore efficienza nel rispondere alla stimolazione con lipopolisaccaridi batterici (produzione di lattato inferiore e minore consumo di glucosio). Nonostante questi effetti positivi sulle cellule immunitarie, l'immunostimolante non ha influenzato le concentrazioni di +APP dopo il parto. Inoltre, l’immunostimolante ha ridotto le concentrazioni di albumina, PON e antiossidanti dopo il parto, suggerendo la compromissione di alcune funzioni epatiche negli animali trattati. Tuttavia, la mancanza di qualsiasi effetto sui biomarcatori di funzionalità (bilirubina) e danno epatico (GGT, AST-GOT, ALP) smentisce una reale compromissione delle attività epatiche a seguito del trattamento. Gli effetti positivi nel favorire il recupero delle funzioni del rumine, riducendo la mobilizzazione dei grassi corporei dopo il parto, suggeriscono che l'immunostimolante sia una strategia efficace nella prevenzione dei disturbi metabolici del periodo di transizione. / Immune system is made of a variety of cells, molecules and biological processes that interacts to prevent microbial invasions, recognize foreign molecules and eliminate existing sources of cellular injuries to restore tissues to their normal functions once problem has been solved. Innate immunity is the primary defense line against pathogens invasions. Its functioning typically undergoes severe alterations during transition period (TP) of dairy cows. An impairment of polymorphonuclear cells (PMN) functions related to reactive oxygen metabolites (ROM) production, myeloperoxidase (MPO) activity, chemotaxis and phagocytosis has been reported in this phase. Bovine PMN have an altered abundance in mRNA transcripts encoding for such functions between -1 and 2 weeks from calving, in comparison to the level found at 4 weeks after calving for the same genes. The exact cause of immune dysfunctions occurring in peripartum has never been clearly identified. Reduced immune competence could arise from the interaction of different factors affected from the typical peripartum trends (i.e. changes in endocrine asset, limitations of maternal immune responses against the allogeneic conceptus, alterations in energy balance and oxidative stress status). Nevertheless, its duration could be modified when peripartal changes exceed the control of homeorhetic and homeostatic mechanisms, leading to the physiological imbalance (PI) condition. Such a condition could also trigger the inflammatory-like status. It consists in a prepartal raise of pro-inflammatory cytokines (PICs) levels, that is linked to a raise in body temperature at calving, and that typically affects liver metabolism, implying severe losses in hepatic functions and a shift of anabolic priority of the organ in early lactation. The liver produces more α-globulins, known as positive acute phase proteins (APP), i.e. haptoglobin, ceruloplasmin and serum amyloid alpha (SAA). Conversely, it reduces the synthesis of albumin, retinol binding protein, paraoxonase (PON) and lipoproteins, known as negative APP and sequesters minerals, as zinc and iron, from blood flow. Inflammation lead to the activation of PMN, while the reduced immune competence commonly reported in TP has been associated to an opposite effect on leukocytes. Thus, these should be considered as two distinct phenomena, but they could arise from a common cause with a different magnitude and duration. Nutritional strategies to optimize dairy cow’s immunity during TP should be focused on reducing the PI degree related to calving, as this condition could be referred as a common denominator between immune dysfunction and diseases causes. Among such nutritional strategies, the correct management of energy sources to fit with altered requirements should be considered. Furthermore, fatty acids profile of lipid sources administered could also modify immune functions. Finally, the administration of supplementary products exerting antioxidant or anti-inflammatory activities, as well as methyl donors species, could be beneficial for dairy cows immunity in TP. In a wider perspective, although feed additives and nutritional strategy could be effective in mitigate immune alterations, we can conclude that adoption of proper management practices aimed to avoid PI condition in peripartal period of dairy cows could be the most effective strategy to prevent dysfunctions. Three experiments have been designed to elucidate the linkage between sudden changes occurring in peripartum and immune alterations in dairy cows. Throughout such experiments Holstein dairy cows were housed in tied stalls and monitored regularly for body condition score (BCS), body weight (BW), dry matter intake (DMI), milk yield (MY) and rumination time. Blood samples were collected regularly to assess a wide hematochemical profile and to test white blood cell functions through ex-vivo challenges. Furthermore, PMN diapedesis has been tested in-vivo through a carrageenan-skin test and rumen samples were collected at 30 days from calving (DFC). The first experiment was aimed in investigate the main causes of metabolic changes occurring at dry-off and the contribution of MY in such alterations. In fact, dry-off is related to deep changes in feeding behavior, gastro intestinal adaptations, metabolism and immune parameters in high-yielding cow’s career. Indeed, the release of cortisol, signals of systemic inflammation and altered redox balance have been reported immediately after milking interruption, and high MY have a role in aggravating such conditions. In our study, a group of 13 Holstein dairy cows were dried off at 55 days from expected calving day, and regularly monitored from -7 to 34 days from dry-off (DFD). Animals were retrospectively divided in two groups according to their average MY in the last week of lactation, assuming a cut-off of 15 kg*d-1: low MY (6 cows) and high MY (7 cows). Data were submitted to ANOVA using a mixed model for repeated measures including MY at dry-off, time and their interaction as fixed effects. Increased fiber amounts of dry ration reduced DMI and increased rumination time. Leukocytes migration into mammary gland to contribute in the involution phase decreased their abundance in blood at dry-off, and their activity. Such activation of leukocytes at mammary site increased the abundance of nitrogen species in plasma and triggered a systemic inflammation in all the animals, as reflected from increased concentrations of positive and reduced concentrations of negative APPs. Such inflammation impaired liver functions, as suggested from the increased gamma-glutamyl transferase (GGT), bilirubin and alkaline phosphatase (ALP) concentrations. Both the production of nitrogen species and the systemic inflammatory status contributed in the depletion of antioxidant system in blood (thiol groups -SHp-, tocopherol, β-carotene, ferric reducing antioxidant power -FRAP- and oxygen reactive antioxidant capacity -ORAC-). Animals with higher MY at dry-off showed the worst condition, likely for the deeper metabolic changes they faced at milking interruption, and to the greater amount of mammary parenchyma to be reabsorbed. This study highlights the dry-off as a thorny point to manage dairy cows’ health and depose for a relationship between dry-off and immune alteration that typically occurs at calving. The second experiment was aimed in investigate changes occurring in the immune system prior to ketosis onset to elucidate their role in disease occurrence. Thus, a group of 13 Holstein dairy cows were monitored from -48 to 35 DFC and retrospectively divided into 2 groups basing on their plasma BHB levels: lower (CTR; 7 cows) or higher than 1.4 mMol/L (KET; 6 cows). Data were submitted to ANOVA using a mixed model for repeated measures including health status, time and their interaction as fixed effects. KET cows had a greater activation of the immune system prior to calving (higher plasma concentrations of PICs, myeloperoxidase and oxidant species, and greater interferon gamma responses to Mycobacterium avium) impaired liver functions (higher blood concentration of GGT) and lower plasma minerals. High plasma NEFA, BHB and glucose levels in KET cows suggest an insulin resistance status and a marked mobilization of body fat occurring during dry period. They were also associated to reduced DMI around calving and worse negative energy balance in early lactation. This caused in turn reduced MY and increased fat mobilization in early lactation. Impairment of liver function and activation of leukocytes during the dry period accentuated the acute phase response in KET cows after calving (greater concentrations of positive APPs and lower concentration of retinol binding protein), further impairing liver function (higher blood concentrations of glutamate-oxaloacetate transaminase -AST-GOT- and bilirubin). Leukocytes of KET cows had reduced inflammatory functions after an ex vivo stimulation assay (lower production of PICs and greater production of lactate). These alterations on WBC could be driven by the combined action of metabolites related to the mobilization of lipids and of anti-inflammatory actions aimed to prevent over exuberant inflammation. This suggests that prepartal trends of immune parameters be highly related with the likelihood of developing diseases in early lactation. The third experiment consisted in the administration of Omnigen-AF (OAF), an immune stimulant that is effective in increasing leukocytes functions in immunosuppressed animals and in reducing incidence of infectious diseases in early lactating dairy cows. Its mode of action has never been elucidated, and a wider perspective of its metabolic effect could highlight its effectiveness in facing metabolic disorders of transition period also. Thus, a group of 10 Holstein dairy cows were divided into 2 groups: treated group (TRT; 5 cows) received 32.5 g of Omnigen-AF® (Phibro Animal Health Corporation) twice a day (65 g d-1) as top-dress on the morning and afternoon feeds, while control group (CTR; 5 cows) did not receive any supplementation. From -62 to 42 DFC animals were monitored regularly. Data were submitted to ANOVA using a mixed model for repeated measures including treatment, time and their interaction as fixed effects. Administration of OAF at dry-off did not affect BW, BCS, milk yield, milk and rumen fluid composition, and neither affected blood neutrophils concentrations. Nevertheless, it increased rumination time and improved the energy metabolism after calving (lower NEFA and BHB concentrations). TRT cows had an increased lymphocytes abundance at blood level, and their leukocytes had greater efficiency in facing biological stressors during the peripartum (lower lactate production and lower glucose consumption after a challenge with bacterial lipopolysaccharides). Despite these positive effects on immune cells, OAF did not affect the positive APPs concentrations after calving. A reduced abundance of albumin, PON and antioxidants also occurred with OAF after calving, suggesting some impairment of hepatic functions to occur. Nevertheless, the lack of any effect on main biomarkers related to liver function (bilirubin) and liver damage (GGT, AST-GOT, ALP) dismisses a real impairment of liver activities to occur with OAF. Positive effects in favoring the recovery of rumen functions, reducing mobilization of body fats after calving suggest OAF to be an effective strategy in preventing metabolic disorders of transition period.

INTRODUÇÃO. A definição de insuficiência hepática pós-operatória (IHP) não é ainda padronizada, dificultando a comparação de inovações em procedimentos hepáticos e tornando complexo o uso de possíveis intervenções terapêuticas pós- operatórias em um momento adequado. CASUÍSTICA E MÉTODOS. Entre 1998 e 2002, 775 resecções hepáticas eletivas, dos quais 531 (69%) por doenças malignas e 464 (60%) consistindo em hepatectomias maiores, foram incluídas de maneira prospectiva em um banco de dados. O parênquima hepático não-tumoral foi anormal em 330 pacientes (43%) incluindo esteatose em mais que 30% dos hepatócitos em 107 (14%), fibrose sem cirrose em 237 (43%) e cirrose em 94 (12%). Foi analisado o impacto sobre a mortalidade da ocorrência de tempo de protrombina (TP) menor que 50% e bilirrubina total sérica (BT) maior que 50 µmol/L (3 mg/dl) (critério 50-50) nos dias pós-operatórios (PO) 1, 3, 5 e 7. RESULTADOS. A cinética pós-operatória do TP e da BT foram diferentes. O menor nível de TP foi no primeiro dia pós-operatório (PO) e o pico de BT foi no terceiro dia PO. A tendência ao retorno para valores pré-operatórios destes dois fatores bioquímicos se firmou claramente no quinto DPO. A mortalidade operatória global foi de 3.4% (26 pacientes), incluindo 21 (81%) casos com parênquima não-tumoral anormal e 20 (77%) após uma hepatectomia maior. O índice de mortalidade foi maior em pacientes com TP < 50% ou BT > 50 µmol/L (3 mg/dl) no pós-operatório. A conjunção de TP < 50% e BT > 50 µmol/L (3 mg/dl) no quinto DPO foi potente fator preditivo de mortalide, a qual atingiu 59% quando esta associação ocorreu. CONCLUSÕES. A partir do quinto dia PO, a associação de TP > 50% e BT > 50 µml/L (3 mg/dl) (critério 50-50) foi preditor prático e acurado de índice de mortalidade após hepatectomia. Propõe-se assim este critério como definição de insuficiência hepática pós-operatória. / INTRODUCTION. Definition of postoperative liver failure (PLF) is not standardized, rendering complex the comparison of novelties in liver procedures and also the use of possible postoperative therapeutic interventions in due time. METHODS. Between 1998 and 2002, 775 elective liver resections, whence 531 (69%) were for malignancies and 464 (60%) for major resections, were included in a prospective database. The non- tumorous hepatic parenchima was abnormal in 330 patients (43%) including steatosis > 30% in 107 (14%), non-cirrhotic fibrosis in 237 (43%) and cirrhosis in 94 (12%). The clinical impact of Prothrombin Time (PT) < 50% and Serum Bilirubin (SB) > 50µmol/L (3 mg/dl) (50-50 criteria) on postoperative days (POD) 1, 3, 5 and 7 was analyzed. RESULTS. Kinetic of postoperative PT and SB were different. Lowest PT levels were on POD1 and the peak of SB was on POD 3. The tendency to return to preoperative values of these two biochemical factors was clearly affirmed on POD 5. Operative mortality was 3.4% (26 patients), including 21 (81%) cases with abnormal liver parenchyma and 20 (77%) following major hepatectomies. Mortality rate was increased in patients with PT < 50% or SB > 50µmol/L (3mg/dl). The conjunction of PT < 50% and SB > 50µmol/L (3 mg/dl) on POD 5 was a strong predictive factor of increased mortality, which reached 59%. CONCLUSIONS We found that after postoperative day 5, the association of PT > 50% and SB > 50µml/L (3 mg/dl) (50-50 criteria) was a simple and accurate predictor of mortality after hepatectomy. These results allow us to propose this criteria as a definition of postoperative liver failure.

INTRODUÇÃO. A definição de insuficiência hepática pós-operatória (IHP) não é ainda padronizada, dificultando a comparação de inovações em procedimentos hepáticos e tornando complexo o uso de possíveis intervenções terapêuticas pós- operatórias em um momento adequado. CASUÍSTICA E MÉTODOS. Entre 1998 e 2002, 775 resecções hepáticas eletivas, dos quais 531 (69%) por doenças malignas e 464 (60%) consistindo em hepatectomias maiores, foram incluídas de maneira prospectiva em um banco de dados. O parênquima hepático não-tumoral foi anormal em 330 pacientes (43%) incluindo esteatose em mais que 30% dos hepatócitos em 107 (14%), fibrose sem cirrose em 237 (43%) e cirrose em 94 (12%). Foi analisado o impacto sobre a mortalidade da ocorrência de tempo de protrombina (TP) menor que 50% e bilirrubina total sérica (BT) maior que 50 µmol/L (3 mg/dl) (critério 50-50) nos dias pós-operatórios (PO) 1, 3, 5 e 7. RESULTADOS. A cinética pós-operatória do TP e da BT foram diferentes. O menor nível de TP foi no primeiro dia pós-operatório (PO) e o pico de BT foi no terceiro dia PO. A tendência ao retorno para valores pré-operatórios destes dois fatores bioquímicos se firmou claramente no quinto DPO. A mortalidade operatória global foi de 3.4% (26 pacientes), incluindo 21 (81%) casos com parênquima não-tumoral anormal e 20 (77%) após uma hepatectomia maior. O índice de mortalidade foi maior em pacientes com TP < 50% ou BT > 50 µmol/L (3 mg/dl) no pós-operatório. A conjunção de TP < 50% e BT > 50 µmol/L (3 mg/dl) no quinto DPO foi potente fator preditivo de mortalide, a qual atingiu 59% quando esta associação ocorreu. CONCLUSÕES. A partir do quinto dia PO, a associação de TP > 50% e BT > 50 µml/L (3 mg/dl) (critério 50-50) foi preditor prático e acurado de índice de mortalidade após hepatectomia. Propõe-se assim este critério como definição de insuficiência hepática pós-operatória. / INTRODUCTION. Definition of postoperative liver failure (PLF) is not standardized, rendering complex the comparison of novelties in liver procedures and also the use of possible postoperative therapeutic interventions in due time. METHODS. Between 1998 and 2002, 775 elective liver resections, whence 531 (69%) were for malignancies and 464 (60%) for major resections, were included in a prospective database. The non- tumorous hepatic parenchima was abnormal in 330 patients (43%) including steatosis > 30% in 107 (14%), non-cirrhotic fibrosis in 237 (43%) and cirrhosis in 94 (12%). The clinical impact of Prothrombin Time (PT) < 50% and Serum Bilirubin (SB) > 50µmol/L (3 mg/dl) (50-50 criteria) on postoperative days (POD) 1, 3, 5 and 7 was analyzed. RESULTS. Kinetic of postoperative PT and SB were different. Lowest PT levels were on POD1 and the peak of SB was on POD 3. The tendency to return to preoperative values of these two biochemical factors was clearly affirmed on POD 5. Operative mortality was 3.4% (26 patients), including 21 (81%) cases with abnormal liver parenchyma and 20 (77%) following major hepatectomies. Mortality rate was increased in patients with PT < 50% or SB > 50µmol/L (3mg/dl). The conjunction of PT < 50% and SB > 50µmol/L (3 mg/dl) on POD 5 was a strong predictive factor of increased mortality, which reached 59%. CONCLUSIONS We found that after postoperative day 5, the association of PT > 50% and SB > 50µml/L (3 mg/dl) (50-50 criteria) was a simple and accurate predictor of mortality after hepatectomy. These results allow us to propose this criteria as a definition of postoperative liver failure.

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) techniques offer the opportunity to understand the physiological processes involved in the distribution of the contrast agent in vivo. This work utilises a liver specific contrast agent (gadoxetate) and demonstrates the potential use of these techniques to study transporter-mediated process in vivo. In vitro experiments investigated gadoxetate’s interaction with uptake and efflux transporters at the cellular level, ideally a prerequisite to understand the contribution of transporter proteins in in vivo pharmacokinetics. MRI was used to measure the accumulation of gadoxetate in fresh rat hepatocytes. Furthermore, LC-MS/MS methodology was optimised in conjunction with two in vitro systems to determine the role of transporters in gadoxetate uptake and efflux. HEK-OATP1B1 transfected cells were used to optimise the LC-MS/MS technique and Caco-2 cell monolayers were used to examine whether gadoxetate is a substrate of the efflux transporters, Pgp and BCRP. Subsequent studies demonstrated the use of DCE-MRI techniques to study transporter-mediated processes. Two pharmacokinetic models were proposed to quantify the uptake and efflux of gadoxetate in vivo. The suitability of the models in describing the liver concentration profiles of gadoxetate was assessed in pre-clinical and clinical reproducibility studies. Further pre-clinical experiments demonstrated the ability of the proposed DCE-MRI techniques to monitor changes in the uptake and efflux rate estimates of gadoxetate into hepatocytes, through co-administration of the transporter inhibitor, rifampicin, at two doses. The work presented demonstrates the potential use of DCE-MRI techniques as a diagnostic probe to assess transporter-mediated processes and drug-drug interactions (DDIs) in vivo.

<p>Raloksifen je predstavnik selektivnih modulatora estrogenih receptora koji se koristi u terapiji osteoporoze i invazivnog oblika raka dojke u postmenopauzi. Raloksifen se relativno dobro resorbuje iz gastrointestinalnog trakta, ali pri prvom prolasku kroz jetru podleže biotransformaciji u značajnom procentu, &scaron;to je uzrok njegove niske biolo&scaron;ke raspoloživosti. Bioraspoloživost kod ljudi iznosi 2%, a kod Wistar pacova 39%. Različite supstance se koriste da bi se pobolj&scaron;ala bioraspoloživost lekova. Žučne kiseline, kao &scaron;to je deoksiholna kiselina, omogućavaju bolji prolazak kroz biolo&scaron;ke membrane drugim supstancama, te mogu povećati bioraspoloživost lekova. Apigenin je &scaron;iroko rasprostranjeni flavonoid koji inhibi&scaron;e različite metaboličke puteve i na taj način može usporiti metabolizam i eliminaciju i povećati koncentraciju lekova u krvi. Ciljevi ovog istraživanja su bili da se ispita da li apigenin i natrijum-deoksiholat mogu povećati bioraspoloživost raloksifena, njihov uticaj na biohemijske parametre i parametre hemostaze, kao i da se ispita antioksidativni potencijal apigenina. Ispitan je i uticaj apigenina na akutno o&scaron;tećenje jetre usled primene toksične doze paracetamola. U istraživanju su kori&scaron;ćeni zdravi, beli pacovi mu&scaron;kog roda, soja Wistar. U ogledu su ukupno kori&scaron;ćene 84 eksperimentalne životinje. Sva ispitivanja na životinjama je odobrila Etička komisija Univerziteta u Novom Sadu. Raloksifen je primenjen intravenski i per os, dok su natrijum-deoksiholat i apigenin aplikovani peroralno. Uzorci krvi, urina i fecesa su kori&scaron;ćeni za određivanje farmakokinetskih parametara, dok su za određivanje biohemijskih, hemostatskih i parametara oksidativnog stresa kori&scaron;ćeni serum i uzorci jetre laboratorijskih životinja. Pretretman natrijum-deoksiholatom je doveo do smanjenja koncentracije raloksifena u krvi zbog olak&scaron;anog i brzog prodora raloksifena u periferne kompartmane. Time je značajno produženo poluvreme eliminacije i srednje vreme zadržavanja raloksifena i značajno je povećan volumen distribucije raloksifena. Apigenin je doveo do manjeg pada koncentracije raloksifena u prvim satima nakon intravenske primene raloksifena, dok su koncentracije raloksifena bile značajno vi&scaron;e nakon osmog časa od primene leka. Uticaj raloksifena na biohemijske parametre je bio značajno veći nakon intravenske nego nakon peroralne primene. Nakon intravenske primene raloksifena je značajno povećana aktivnost enzima jetre, ALP, ALT, AST i GGT, dok su pokazatelji funkcije bubrega, urea, mokraćna kiselina i kreatinin bili sniženi. U grupama koje su pretretirane natrijum-deoksiholatom i apigeninom vrednosti ovih parametara bile su niže u odnosu na grupu tretiranu samo raloksifenom. Statistički najznačajniji uticaj je imala primena trojne kombinacije, raloksifena, natrijum-deosiholata i apigenina, koja je dovela do značajnog pada aktivnosti enzima jetre, i u odnosu na grupu tretiranu raloksifenom i u odnosu na kontrolnu grupu. Kod životinja tretiranih kombinacijom apigenina i paracetamola pokazatelji toksičnosti su bili značajno niži, naročito vrednosti ALT i ALP, u odnosu na grupu koja je dobijala samo paracetamol. Hepatotoksičnost izazvana toksičnom dozom paracetamola je potvrđena i histopatolo&scaron;kim promenama na jetri, koje nisu primećene u grupi životinja tretiranih kombinacijom apigenina i paracetamola. Ispitivanjem je utvrđeno da apigenin može da spreči paracetamolom indukovano povećanje nivoa MDA, &scaron;to ukazuje da apigenin pozitivno utiče na očuvanje integriteta ćelije. Aktivnost enzima CAT i GR u homogenatima jetre je bila značajno povećana nakon primene toksične doze paracetamola u odnosu na kontrolnu grupu. Aktivnost enzima CAT i GR u grupi tretiranoj kombinacijom apigenina i paracetamola je bila približna vrednostima u kontrolnoj grupi. Na osnovu rezultata istraživanja može se zaključiti da natrijum-deoksiholat i apigenin značajno utiču na farmakokinetiku raloksifena. Primena natrijum-deoksiholata dovela je do pada koncentracije raloksifena u krvi, značajnog prelaska raloksifena iz krvi u periferne kompartmane i povećanja njegovog volumena distribucije, dok je apigenin značajno usporio metabolizam i eliminaciju raloksifena i doveo do njegovog produženog zadržavanja u krvi. Natrijum-deoksiholat i apigenin su pokazali pozitivan uticaj na biohemijske parametre, parametre hemostaze i smanjenje nivoa oksidativnog stresa. Kombinacija natrijum-deoksiholata i apigenina je pokazala sinergistički uticaj na navedene parametre, odnosno dovela je do značajnih promena u odnosu na pojedinačnu primenu ovih supstanci. Rezultati ispitivanja ukazuju na to da apigenin smanjuje stepen lipidne peroksidacije i da dovodi do značajnog povećanja enzimskih antioksidantnih mehanizama odbrane kod pacova kod kojih je hepatotoksičnost indukovana paracetamolom.</p> / <p>Raloxifene is selective estrogen receptor modulator used in treatment of osteoporosis and invasive breast cancer in postmenopausal women. Raloxifene is well absorbed from the gastrointestinal tract, but undergoes extensive first-pass metabolism, which results in very low bioavailability of raloxifene, 2% in humans, and 39% in Wistar rats. Various supstances are used for increasing bioavailability of other drugs. Bile acids, such as deoxycholic acid, promote transport of other supstances through biological membranes, and consequently, may increase their bioavailability. Apigenin is a widespread flavonoid, which inhibits different metabolic pathways. Thus, apigenin can slow down metabolism and elimination of drugs, and raise drug concentration in blood. Aims of this study were to investigate if apigenin and sodium deoxycholate could increase bioavailability of raloxifene, their influence on biochemical and hemostasis parameters, and to investigate antioxidative potential of apigenin. Furthermore, influence of apigenin on acute liver damage after toxic dose of paracetamol was examined. In vivo experiments were performed on 84 laboratory healthy male Wistar rats. All experiments were approved by Ethics Committee of University of Novi Sad. Raloxifene was applied intravenously and per os, while sodium deoxycholate and apigenin were given perorally. Blood, urine and feces samples were used for pharmacokinetic parameters measurement, whereas serum and liver samples were used for evaluation of biochemical, hemostasis and oxidative stress parameters. Pretreatment of sodium deoxycholate led to raloxifene blood concentration decrease due to easier penetration of raloxifene in peripher compartments. As a result, raloxifene half-life and mean residence time were significantly longer and volume of distribution was increased. Apigenin caused lower decrease in raloxifene concentration in first few hours after raloxifene intravenous application, while raloxifene concentrations after apigenin pretreatment were significantlny higher 8 hours after raloxifene application. Influence of raloxifene on biochemical parameters was more significant after intravenous than after per os application. Intravenous application of raloxifene led to increased activity of liver enzymes, ALP, ALT, AST and GGT, while parameters of kidney function, urea, uric acid and creatinine were decreased in comparison to the control group. In experimental groups pretreated with sodium deoxycholate and apigenin these parameters were lower than in the group treated only with raloxifene. Statistically the most significant effects were in the group treated with combination of raloxifene, sodium deoxycholate and apigenin, which caused significant decrease in activity of liver enzymes compared both with raloxifene and control group of animals. In experimental animals treated with combination of apigenin and paracetamol bioindicators of paracetamol toxicity were significantly lower, especially activity of ALT and ALP, in comparison to the group treated only with paracetamol. Hepatotoxicity induced by toxic dose of paracetamol was also confirmed by histopathological alterations in liver, which were not observed in the experimental group treated with combination of apigenin and paracetamol. In this study it was confirmed that apigenin could prevent paracetamol-induced MDA level increase, which suggests that apigenin have positive effects on cell integrity. Activity of CAT and GR in liver homogenates was significantly increased after toxic dose of paracetamol in comparison to the control group, while activity of these enzymes in the group treated with apigenin and paracetamol was similar to values in the control group. Results of this study showed that sodium deoxycholate and apigenin can significantly change pharmacokinetic parameters of raloxifene. Sodium deoxycholate caused signicant decrease in raloxifene blood concentration, extensive distribution from blood to peripheral compartments and increase of raloxifene volume of distribution. Apigenin inhibited metabolism and elimination of raloxifene and thus prolonged half-life and mean residence time of raloxifene. Sodium deoxycholate and apigenin showed positive effects on biochemical and hemostasis parameters and decreased the level oxidative stress. Combination of sodium deoxycholate and apigenin showed synergistic effects on these parameters in comparison to effects of separate application of sodium deoxycholate and apigenin. The result of our study indicates that apigenin inhibits the level of lipid peroxidation and significantly increase the enzyme antioxidant defence mehanisms in paracetamol induced hepatotoxicity in rats.</p>