O presente estudo visou avaliar a influência da diabetes experimental no perfil nociceptivo orofacial de ratos. Foram utilizados 40 ratos Wistar, no qual 20 receberam injeção de estreptozotocina (STZ) para a indução da diabetes experimental (grupo diabetes), e 20 receberam solução de citrato de sódio (CS - grupo controle). Esses animais foram subdivididos em dois subgrupos de 10 ratos que apenas se diferenciaram com relação à substância que foi injetada no músculo masseter: solução salina isotônica (SI) [n=10: Cont-SI; n=10: Diab-SI] ou hipertônica (SH) [n=10: Cont-SH; n=10: Diab-SH]. Num primeiro momento foi feita a administração intraperitoneal de STZ ou CS e quatorze dias após, com os animais levemente anestesiados, foi realizada a injeção de 100 μL de solução SH-5% ou SI-0,9% na região média do músculo masseter esquerdo, numa profundidade de 5 mm e então foi quantificado, por dois minutos, o comportamento nociceptivo caracterizado pelo ato do rato sacudir/agitar a pata posterior ipsilateral o que é aceito como índice de nocicepção muscular. Uma hora após a avaliação comportamental nociceptiva, os ratos foram eutanasiados por sobredose de anestésico e o músculo masseter esquerdo foi retirado com auxílio de um bisturi circular; parte deste músculo foi utilizada para a análise da expressão de RNA para as citocinas pró inflamatórias [fator de necrose tumoral (TNFα), IL1β, IL6, ciclooxigenase 2 (COX-2)] e anti inflamatórias [IL- 2, IL- 10)] por meio da técnica de Reação em Cadeia da Polimerase quantitativa (qPCR); a parte restante foi corada pela técnica de hematoxilina-eosina e depois realizada a análise histopatológica descritiva em microscópio de luz. Foi observado um aumento significativo do comportamento nociceptivo nos ratos não diabéticos ou normoglicêmicos submetidos à injeção de SH (Cont-SH) em relação aos demais grupos que foram similares entre si. Na análise de citocinas, verificamos que o músculo masseter de ratos não diabéticos submetidos à injeção de SH (Cont-SH) apresentaram um aumento significativo da expressão relativa de TNFα em relação aos demais grupos que foram similares entre si; para a IL-1β também foi verificada um aumento da expressão relativa do grupo (Cont-SH) em relação aos grupos Cont-SI e Diab-SI, mas não em relação ao grupo Diab-SH e a IL-6 foi significativamente mais expressa no músculo masseter de ratos não diabéticos submetidos à injeção de SH em relação ao grupo Cont-SI, mas não foi diferente nos demais grupos. As demais citocinas avaliadas (COX-2, IL-2 e IL-10) não mostraram diferenças significativas entre os grupos. Na análise histopatológica não foram identificadas alterações significativas no tecido muscular, apenas um discreto infiltrado inflamatório no grupo Cont-SH. Diante dos resultados obtidos, podemos concluir que os ratos diabéticos apresentaram um reduzido comportamento nociceptivo, o que indica uma hiponocicepção química. / This study aimed to evaluate the influence of experimental diabetes in rats nociceptive orofacial profile. 40 Wistar rats were used, in which 20 received streptozotocin injection (STZ) to induce experimental diabetes (group), and 20 received sodium citrate solution (CS - control group). These animals were divided into two groups of 10 rats differed only with respect to the substance that has been injected into the masseter: isotonic saline (IS) [n = 10: Cont-IS; n = 10: Diab-IS] or hypertonic (HS) [n = 10: Cont-HS; n = 10: Diab-HS]. Initially was taken intraperitoneal administration of STZ or CS and fourteen days with lightly anesthetized animal, injection of 100 μL of 5% HS solution or 0.9% IS in the middle region of the left masseter muscle was performed at a depth of 5 mm and then was quantified for two minutes, the nociceptive behavior characterized by the rats act shake/agitating the ipsilateral hind paw which is accepted as muscle nociception index. One hour after the nociceptive behavioral evaluation, the rats were euthanized by overdose of anesthetic and the left masseter muscle was removed with the aid of a circular scalpel; part of this muscle was used for analysis of RNA expression for pro - inflammatory cytokines [tumor necrosis factor (TNF), IL1β, IL6, cyclooxygenase 2 (COX-2)], and anti - inflammatory [IL-2, IL - 10] by reaction technique of quantitative polymerase chain (qPCR); the remaining half was stained with hematoxylin-eosin and then conducted a descriptive histopathological analysis by light microscopy. It was observed a significant increase of nociceptive behavior in non-diabetic and normoglycemic rats with injection of HS (Cont-HS) compared to other groups that were similar to each other. In cytokine analysis, we find that the masseter muscle of non-diabetic rats with injection of (Cont-HS) showed a significant increase in TNF relative expression compared to the other groups that were similar to each other; for IL-1β was also found an increase of the group relative expression (Cont-HS) with respect to Cont-IS and Diab-IS groups, but not in relation to Diab-HS group and IL-6 was significantly expressed the masseter muscle of rats without diabetes underwent injection compared to Cont-IS group, but was not different in the other groups. On the evaluated cytokines (COX-2, IL-2 and IL-10) showed no significant differences between groups. Histologically significant changes were not found in muscle tissue, just a mild inflammatory infiltrate in the Cont-SH group. Based on these results, we conclude that the diabetic rats had a reduced nociceptive behavior, which indicates a chemical hyponociception.

Isquemia e reperfusão (I/R) de vasos mesentéricos que acarretam insuficiência vascular aguda são acompanhadas de insuficiência em múltiplos órgãos e estão associados a altas morbidade e mortalidade. Os benefícios da solução hipertônica e da pentoxifilina foram testados isoladamente e em conjunto para melhorar o fluxo sanguíneo e o estado de oxigenação dos tecidos com redução da reação inflamatória e de apoptose, tanto no intestino quanto no pulmão enquanto órgão alvo. Foram utilizados 24 ratos Wistar machos pesando entre 200 e 250g distribuídos em 4 grupos (n=6). Foram submetidos à laparotomia e período de isquemia por clampeamento dos vasos mesentéricos por 40 minutos. O período de reperfusão foi de 80 minutos. A cada 40 minutos foram realizadas coletas de sangue arterial para gasometria. Os animais foram alocados nos grupos: grupo I/R (IR) onde I/R foi realizada e os animais receberam 4ml/kg de solução salina isotônica. O grupo solução salina hipertônica (SH) recebeu 4ml/kg de solução hipertônica a 7,5% e o grupo pentoxifilina (PTX) recebeu 30mg/kg de pentoxifilina diluída em NaCl 0,9% em um volume total de 4ml/kg ao final da isquemia intestinal. O grupo solução salina hipertônica+pentoxifilina (SH+PTX) recebeu ambas as soluções com volume total de 4m/kg no mesmo momento. As biopsias de intestino e pulmão foram colhidas ao final do experimento e foram submetidas à coloração em HE e à imuno-histoquímica para COX 2, caspase-3 clivada e Bcl-2. Os valores de sO2 revelaram diferença estatisticamente significante aos 40 (p=0,0099) e 80 (p=0,0074) minutos de reperfusão na comparação do grupo IR com os grupos SH e SH+PTX. Os valores de lactato foram estatisticamente significantes aos 40 minutos (p=0,0069) e 80 minutos (p=0,0098) de reperfusão, entre os grupos IR e os grupos SH e SH+PTX. A avaliação histológica em HE no tecido intestinal evidenciou diferença estatisticamente significantes na comparação dos grupos SH (p=0,0200), PTX (p=0,0200) e HS+PTX (p=0,0412) com o grupo IR, assim como no tecido pulmonar, que evidenciou diferenças estatisticamente significantes na comparação de IR com SH (p=0,006), PTX (p=0,0433) e SH+PTX (p=0,0040). A marcação citoplasmática de COX 2 revelou diferença estatisticamente significante ao comparar o grupo IR com o grupo SH+PTX (p=0,0015), Na avaliação do tecido pulmonar foi observado o grupo IR estabelecendo diferenças estatisticamente significantes na comparação com os grupos SH (p=0,0455), PTX (0,0143) e SH+PTX (p=0,0455). A avaliação de apoptose por imunohistoquímica para caspase 3 clivada evidenciou diferença com significância estatística ente os grupos IR e SH (p=0,0085) e os grupos PTX e SH (p=0,0120) em tecido intestinal. Em tecido pulmonar, entre IR e PTX (p=0,0090) e SH e PTX (p=0.0412). A marcação citoplasmática de Bcl-2 evidenciou que somente entres os grupos IR e SH+PTX (p=0,0012) se estabeleceu significância estatística em tecido intestinal No pulmão a diferença foi evidenciada em relação ao grupo IR e os grupos SH (p=0,0128), PTX (p=0,0085) e SH+PTX (p=0,0066). Conclui-se que o uso associado de pentoxifilina e solução salina hipertônica oferece os melhores resultados dos pontos de vista metabólico, inflamatório e da inibição da apoptose / Ischemia-reperfusion (I/R) of the mesenteric vessels cause acute vascular insufficiency and is followed by multiple organs failure and high morbidity and mortality. The benefits of hypertonic saline (NaCl 7,5%) and pentoxifylline were tested to improve metabolic and oxygen status of tissues with reduced inflammatory reaction and apoptosis, both in the gut as in the lung as target organ. 24 male Wistar rats weighing 200 to 250g. They underwent laparotomy and ischemia by clamping the mesenteric vessels for 40 minutes. The reperfusion period was 80-minute long. Every 40 minutes, blood was collected for arterial gas analysis. The animals were set into 4 groups (n=6): I/R (IR) received isotonic saline just before reperfusion (4ml/kg). Hypertonic saline group (HS) received 7.5% hypertonic saline solution (4ml/kg) and Pentoxifylline group (PTX) received pentoxifylline (30mg/kg)diluted in NaCl 0.9% at the end of the mesenteric ischemia. Hypertonic saline+pentoxifylline group (SH-PTX) received both solutions at the same doses. Biopsies of intestine and lung were collected at the end of the experiment and were subjected to HE staining and immunohistochemistry staining to COX 2, cleaved caspase-3 and Bcl-2. About the values of sO2, a statistically significant difference was established when groups were compared at 40 (p=0.0099) minutes and 80 (p=0.0074) of reperfusion. The lactate values were statistically significant after 40 (p=0.0069) and 80 (p=0.098) minutes of reperfusion as well. Histological evaluation with HE revealed a statistically significant difference in the comparison of SH (p=0.0200), PTX (p=0.0200) and HS + PTX (p=0.0412) groups compared to IR group in intestine tissue and SH (p=0.0006), PTX (p=0.0433) and HS + PTX (p=0.040) in lung tissue. Cytoplasmic staining of COX 2 revealed a statistically significant difference when comparing IR (p=0.0015) to HS+PTX in intestinal tissue. The evaluation of the lung tissue for COX 2 showed IR group setting statistically significance when compared to HS 9p=0,045), PTX (0.0143) and HS+PTX (p=0.0455) groups. The evaluation of apoptosis by immunohistochemistry for cleaved caspase 3 revealed that there was a significant difference between IR versus SH (p=0.0085) and PTX versus HS (p= 0.0120) in intestinal tissue and IR versus PTX (p=0,0090) and PTX versus SH (p=0.0412) in lung tissue. The cytoplasmic Bcl-2 expression shows that only between groups IR versus HS+PTX (p = 0.0012) statistical significance was established in intestinal tissue. Lung tissue showed the difference was evidenced in relation to IR versus SH (p=0.0128), PTX (p=0.0085) and HS+PTX (p=0.0066). It may be concluded that the combined use of pentoxifylline and hypertonic saline offers best results on metabolic, inflammatory and apoptosis inhibitory aspects

Orientadores: José Dirceu Ribeiro, Carlos Emílio Levy / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T05:15:22Z (GMT). No. of bitstreams: 1 Ferreira_AdrianaCarolinaMarques_M.pdf: 1197514 bytes, checksum: 10b9c6c66730ad6487f8cc77ed1cde9c (MD5) Previous issue date: 2014 / Resumo: Introdução: A eficiente detecção de microrganismos nas vias aeríferas de pacientes com fibrose cística (FC) possibilita antibioticoterapia dirigida, melhor manejo ambulatorial e promove maior preservação da função pulmonar. Métodos para melhorar a identificação bacteriana estão em estudo, porém, não fica claro na literatura o papel da solução salina hipertônica (SSH) no auxílio da detecção desses microrganismos. Objetivo: Verificar a eficácia da SSH a 7% na identificação de microorganismos nas secreções das vias aeríferas em pacientes com FC e comparar com variáveis clinicas e laboratoriais. Método: Incluídos 64 pacientes com FC, com coleta de escarro ou swab de secreção de orofaringe pré e após inalação com SSH-7%. A identificação bacteriana foi realizada pelas técnicas de rotina no laboratório de Microbiologia. Resultados: Dos pacientes, 34(53,1%) eram do sexo feminino, com idade média de 12,11(±5,12). Do total de culturas microbiológicas realizadas (704 antes e após a SSH-7%), não houve diferença estatisticamente significante entre os resultados positivos, sendo 101 antes e 118 depois (OR=0,8319, IC=0,622-1,111). O mesmo foi observado para o número de espécies identificadas, sendo inicialmente identificados 7 microrganismos diferentes, e após a SSH-7% 11(p=0,1895), contudo houve aumento na identificação de 4(36,36%) espécies diferentes. Na análise semi-quantitativa e tipo de material (escarro ou swab) não houve diferença (p>0,05). No total foram obtidos após a SSH-7%, 25 resultados positivos que eram negativos e o contrário ocorreu para 9 pacientes. Não houve efeitos colaterais devido a SSH-7%.Conclusão: Apesar de não ocorrer diferença estatisticamente significativa, pode-se observar maior número de resultados positivos,detecção de maior número de patógenos e de espécies diferentes de microrganismos e aumento de amostras de escarro no lugar do swab após o uso da SSH-7% / Abstract: Introduction: The efficient detection of microorganisms in airways of cystic fibrosis (CF) patients allows targeted antibiotic therapy, better outpatient care and, consecutively, lung function preservation. Methods to improve bacteria identification have been studied. The role of hypertonic saline solution (HSS) in sputum collection, for bacteria identification, is not clear yet. Aim: Verify the effectiveness of HSS in the identification of microorganisms in airway secretions in patients and compare with clinical and laboratory variables. Methods: The study enrolled 64 CF patients, with a sputum sample or swab before and after inhalation with HSS 7%. Bacterial identification was performed by routine laboratory techniques in microbiology. Results: Of the 64 patients, female: 34 (53.1%); mean age: 12.11 (±5.12) years. Of the total microbiological analysis performed (704 before and after of 7% HSS), there was no difference between positive results between the positive results, being, 101 before and 118 after (OR= 0.832, CI= 0.622-1.111). The same was observed for the number of microorganisms species, being initially identified 7 species and after, 11 species (p= 0.1895), an increase of four different species (36.36%). In semi-quantitative analysis, there was no difference (p> 0.05). After of 7% HSS, 25 new positive results were observed and the opposite occurred in nine patients. No collateral effects were observed due to 7% HSS. Conclusion: Although statistically significant difference does not occur, the 7% HSS allowed a greater number of microbiological identification in sputum from airways, as in absolute number and as different microorganisms¿ species / Mestrado / Saude da Criança e do Adolescente / Mestra em Ciências

Abstract During surgery of the aortic arch and pediatric heart surgery, the blood flow to the brain has to be interrupted at times to allow a bloodless operation field and adequate conditions for surgical repair. During this no-flow period the brain is exposed to a high risk of ischaemic injury, as it will become irreversibly damaged after 5 minutes of circulatory arrest at 37°C. Additional time can be gained by cooling the patient with an extracorporeal heart-lung machine, as hypothermia reduces the cerebral metabolic rate and allows longer safe periods of circulatory standstill. This method of cerebral protection, called hypothermic circulatory arrest (HCA), is widely used in clinical practice. Thus the brain becomes susceptible to ischaemic injury after 30 minutes of HCA at 15°C. Lower temperatures than this are not practicable, however, as they require longer periods of cardiopulmonary bypass, which may further aggravate cerebral injury. To ensure a better outcome for patients undergoing these operations, additional ways of protecting the brain are required. The present work focuses on neuroprotective biochemical and fluid therapy methods for use during HCA, employing a surviving porcine model. Fructose-1,6-bisphosphate (FDP), a high-energy intermediate of glycolysis, was examined for potential neuroprotective properties in two cerebral injury settings associated with HCA. First, FDP was administered before and after a 75-minute period of HCA at a brain temperature of 18°C. This led to better survival, neurological recovery and brain histopathological findings and had supportive effects on brain metabolism (I). Second, a 25-minute period of HCA along with an iatrogenic embolic load produced by microsphere injection was used to generate a massive ischaemic injury to the brain. In this setting FDP did not affect the neurological outcome but had a clear supportive impact on cerebral metabolism (II). In addition, cerebral histopathological samples taken during the first study were analysed by electron microscopy, which revealed significant preservation of the ultrastructure in the FDP-treated animals (III). Hypertonic saline dextran (HSD) is a novel fluid therapy method which has been shown to enhance the outcome after hypovolaemic shock with or without head injury and is potentially very effective in reducing ischaemia-reperfusion injury. Its administration led to a decrease in intracranial pressure, improved brain metabolism, faster and better recovery and less histopathologically observable morphological damage (IV). The findings indicate that both FDP and HSD have significant neuroprotective properties and should be assessed in humans as well.

Adenosine 5’ triphosphate (ATP) is a molecule central to life for its role as the cellular energy currency, and a purine nucleotide which serves as a building block of RNA. Thus, on the backdrop of an indispensible intracellular role of ATP, its identification as an extracellular signaling molecule in early 1970s came as a surprise. A novel doctrine, termed as ‘purinergic signaling’, was thus put forth. By definition, purinergic signaling consists of the signaling events triggered by binding of extracellular ATP- a purine nucleotide, and its breakdown products (viz., ADP, AMP, and adenosine) to their cognate receptors, which in turn are termed as ‘purinergic receptors’. Based on their ligand affinity, purinergic receptors are classified into two groups- P1 and P2 receptors. P2 receptors are further subclassified as P2X and P2Y receptors. Till date, four P1 receptors (viz. A1, A2a, A2b, and A3), seven P2X receptors (P2X1-7), and eight P2Y receptors (P2Y1, P2Y2, P2Y4, P2Y6, P2Y11, P2Y12, P2Y13, and P2Y14) have been cloned and characterized. Conceptually, the first step of purinergic signaling is the release of ATP from an intact cell on encountering a stimulant or a modulator. The main mechanisms of such cellular ATP release include vesicular exocytosis and the release through conductive channels. ATP thus released, binds to its cognate receptors (i.e. P2X receptors, and certain P2Y receptors) and triggers the ‘purinergic signaling’ pathway that modulates the cellular response. In addition to purinergic receptors, cells also express ATP degrading enzymes on their surface, which break ATP down into ADP, AMP, and adenosine. ADP and adenosine, in turn, bind to their cognate receptors (certain P2Y receptors, and P1 receptors respectively) and further contribute to shaping the cellular response to a given cue. Thus, purinergic signaling is a highly dynamic process with pleiotropic downstream effects. First demonstrated in the context of neurotransmission, the phenomenon of purinergic signaling is now widely recognized and has been shown to play a role in regulating functional responses of cells of diverse origins, immune cells being one of them. Purinergic signaling in lymphocytes- an important subset of immune cells- is a common thread for the present research exercise, wherein we have addressed two sets of questions, one of academic curiosity and the other of clinical interest. In the former and the major part, we have examined whether purinergic signaling plays a role in functional aspects of ‘gamma delta (γδ) T cells’, which represent a unique subset of lymphocytes. Whereas, the latter part elaborates on the already identified involvement of purinergic signaling in T cell stimulatory action of ‘hypertonic saline (HS)’, which is used to treat trauma patients. The thesis, thus, is divided into five parts- the ‘Introduction’, ‘Aims and Scope of the study’, ‘Chapter 1’, ‘Chapter 2’, and ‘Summary of the work’. Understanding the questions posed in the present context, strategy designed to answer them, and eventually the experimental results answering these questions invoke basic knowledge of purinergic signaling, which has been attempted to be conferred through the ‘Introduction’ section. The discovery of purinergic signaling, its central theme, and individual molecular players involved in this signaling pathway are highlighted here. From the viewpoint of the present research endeavor, salient findings from the current literatureabout the involvement of purinergic signaling in the functional activities of various subsets of immune cells- are reviewed towards the end of this section. The ‘Introduction’ is followed by definition of the objectives for the present exercise, which are enlisted under ‘Aims and scope of the study’. Here, a brief overview of the background data that led us towards these objectives precedes the actual list of questions which we have approached. Purinergic signaling has been shown to play a role in the activation of ‘conventional αβ T’ cells. So we asked whether a similar purinergic signaling pathway also operates in unconventional γδ T cells. Thus, ‘Chapter 1’ is dedicated to answering the first set of questions about the role of purinergic signaling in γδ T cell activation. The chapter starts off by introducing γδ T cells. The topics such as discovery of γδ T cells, ontology, development, diversity, and distribution of these cells, and most importantly- their antigenic specificity and response are reviewed herein. The details of the experimental procedures employed to answer the defined objectives follow this introduction. We have carried out our experiments on γδ T cells in human circulation. For in vitro stimulation, we have used anti-CD3 + anti-CD28-coated beads (beads) or isopentenyl pyrophosphate (IPP), a γδ T cell specific stimulant. We observed that, circulating human γδ T cells rapidly release ATP on stimulation with beads or IPP. Pannexin-1 and connexin hemichannels, as well as vesicular exocytosis contribute to the ATP release. Real time RT-PCR data revealed that γδ T cells predominantly express purinergic receptors A2a, P2X1, P2X4, P2X7, and P2Y11. Of these, the inhibition of P2X4 receptors downregulated cytokine expression by γδ T cells post- in vitro stimulation, and also inhibited cytotoxic activity of γδ T cells towards Daudi cells. Selective translocation of P2X4 receptors to the immunological synapse was seen to be the underlying mechanism for these effects. Collectively, these data suggested that autocrine/paracrine purinergic signaling through P2X4 receptors indeed plays an important role in the functional aspects of circulating human γδ T cells. The experimental results are compiled in ‘Chapter 1’; which concludes with the ‘Discussion’ on the mentioned findings, and possible in vivo applications. ‘Chapter 2’ deals with the role of purinergic signaling in HS resuscitation. In addition to restoring the hemodynamic parameters, fluid replacement with small volumes of concentrated NaCl solution (HS) has been reported to reverse the suppression of T cells commonly found in the trauma subjects. Through an in vitro study using Jurkat cells as a model for primary human T cells, it has been shown earlier that, on HS exposure T cells release ATP- which binds to P2X7 receptors and promotes calcium influx. HS treatment also elicits phosphorylation of p38; and put together, Ca2+ influx and phosphorylated p38 synergize with TCR-induced stimulation resulting in the enhancement of transcriptional upregulation of IL-2. However, the mechanism of release of ATP on HS treatment and the possible involvement of P2X1 and P2X4 receptors expressed by T cells had not been addressed in this study. These very questions thus formed the objectives of the second part of present work. Experiments aimed to answer these questions showed that on HS treatment, Jurkat cells release ATP through pannexin-1 hemichannels. The released ATP binds to purinergic receptors P2X1, P2X4, and P2X7. This in turn triggers the downstream signaling cascade leading to phosphorylation of p38 and upregulation of IL-2 transcription, hence augmenting the T cell function. An overview of HS resuscitation, experimental protocols and results, and the discussion on the pathophysiological relevance of these findings comprise ‘Chapter 2’. Hence, we have found the answers to the questions we began with. The results are listed in a point-wise manner under the ‘Summary of the work’. Taken together, our data shows that: (i) Purinergic signaling does play a role in the functional aspects of circulating human γδ T cells. The release of ATP by γδ T cells post-stimulation, and autocrine/paracrine signaling through P2X4 receptors are the main components in this context. (ii) ATP release through pannexin-1 hemichannels, and autocrine/paracrine signaling through P2X1, P2X4, and P2X7 receptors underlie the mechanism of action of HS.

Objective: Establish and validate an experimental pain model that will create pain for at least 20-minutes and then use the model to determine if: 1) cryotherapy decreases experimentally induced pain, 2) experimentally induced pain contributes to arthrogenic muscle inhibition, and 3) cold application influences pain or arthrogenic muscle inhibition. To answer these questions we conducted two experiments, the results of which are presented in two manuscripts. Methods: Seventy (n = 30 for experiment I and n = 40 for experiment II), physically active healthy male subjects participated. Interventions: Independent variables used for experiment I were condition (5% hypertonic saline infusion/cryotherapy, no-saline infusion/cryotherapy, 5% hypertonic saline infusion/sham) and time (precondition, every minute during a condition, and 10 minutes following each condition). For experiment II, independent variables were treatment (saline infusion, saline infusion/cryotherapy, saline infusion/sham, and no-saline infusion) and time (pretreatment, posttreatment, and 30-minutes posttreatment). Dependent variables measured were pain perception, knee surface and ambient temperatures, and Hmax, and Mmax measures (experiment II only). Results: Saline caused more pain than no-saline at minutes 3, 4, and 5 during infusion. Pain caused by saline and sham application remained constant from 4 minutes during application through 1 minute following application. Cold application decreased pain for 16 minutes. Pain resulted in arthrogenic muscle inhibition following and 30 minutes following saline infusion. Cryotherapy removed inhibition following but not 30 minutes following application. Pain for the saline groups increased following infusion as measured with the pain rating index and visual analogue scale. According to pain rating index, cryotherapy did not decrease pain; however, cryotherapy decreased pain as measured with the visual analogue scales. No change in temperature occurred during the non-cooling conditions. Ambient temperatures fluctuated less than 1°C. Conclusion: Saline infusion caused anterior knee pain for over 20 minutes and resulted in arthrogenic muscle inhibition. Cryotherapy disinhibited the quadriceps motoneuron pool and reduced pain as measured with visual analogue scales. Cryotherapy did not decrease pain as measured with the McGill pain questionnaire.

Context: Knee pain is experienced by many people. Because of this, authors have started researching the effects of pain on lower extremity mechanics and also on static and dynamic postural control. However, the effects of pain are difficult to study due to associated confounding variables. Objective: We asked: (1) Will experimentally-induced anterior knee pain alter perceived pain using the visual analogue scale? ; (2) will perceived pain affect postural control as measured by center-of-pressure during static and dynamic movement? Design: Crossover. Setting: Biomechanics laboratory. Participants: Fifteen healthy subjects. Intervention: Each subject participated in single leg quiet stance, landing, and walking trials under three conditions (pain, sham, control), at three different times for each condition (pre-injection, injection, and post-injection). Main Outcome Measures: The dependent variables were measured at pre-injection, injection, and post-injection. Pain was measured using the visual analogue scale across all three times during each condition. Center-of-pressure sway was measured during single leg quiet stance to calculate the average center-of-pressure velocity in the anterior-posterior and medial-lateral directions. The center-of-pressure time to stabilization was measured in anterior-posterior, medial-lateral, and vertical directions, and center-of-pressure trajectory excursion was measured in the medial-lateral direction during walking. Results: Perceived pain was significant (P < 0.05) but did not affect postural control as measured by center-of-pressure medial-lateral and anterior-posterior sway during single leg quiet stance, in time to stabilization during landing, and in medial-lateral excursion during walking. Conclusions: Injection of hypertonic saline resulted in statistically significant perceived pain but did not affect postural control as measured by center-of-pressure medial-lateral and anterior-posterior sway during single leg quiet stance, in time to stabilization during landing, and medial-lateral excursion during walking.

No description available.

Sepse é a resposta inflamatória sistêmica do hospedeiro à infecção, que pode ser desencadeada por bactérias, vírus ou fungos. Há aumento da produção de mediadores inflamatórios como citocinas, quimiocinas espécies reativas de oxigênio e do recrutamento de neutrófilos. A administração de solução salina hipertônica 7,5% (SH) acarreta na modulação da resposta inflamatória e hemodinâmica culminando na redução da morbidade e mortalidade em modelos de pancreatite e choque hemorrágico. No presente trabalho, estudamos os efeitos da SH na sepse, induzida por ligadura e perfuração cecal (CLP) em camundongos Balb/C, divididos em 3 grupos: CLP sem nenhum tratamento (CLP); CLP tratado com solução salina isotônica 0,9% (SS) e CLP tratado com SH 7,5% (SH); um quarto grupo foi utilizado como controle, no qual não foi induzido sepse ou administrado tratamento (C); ambos os tratamentos foram aplicados 30 min. após CLP. Lavado peritoneal, intestino e pulmão foram coletados após 6h, 12h e 24h para a análise de citocinas (TNF-, IL-6 e IL-10), produção de oxido nítrico, peroxidação lipídica, infiltração de neutrófilos, moléculas de adesão (ICAM-1 e VCAM-1) e quimiocinas (CXCL-1). O grupo SH mostrou aumento de sobrevida (60%) em comparação aos grupos SS (46,6%) e CLP (33,3%) após 168h. SS apresentou aumento na produção de TNF- (27,3 ± 3,05 pg/ml) em 12h comparado ao grupo CLP (14,07 ± 1,68 pg/ml) e SH (19,66±3,19pg/ml); O efeito da SH na concentração de TNF permanece até 24h (6,2 ± 3,5 pg/ml vs. CLP 73,40± 49,52 pg/ml); a produção de IL-10 em 24h aumentaram nos grupos CLP (CLP - 3,12 ± 0,46 pg/ml) e SS (2,9 ± 0,9 pg/ml) em relação ao grupo SH (0,59 ± 0,34 pg/ml). Em 24h a produção de nitrito mostrou-se reduzida no grupo SH (6,77 ± 0,82 pg/ml) comparado com SS (10,65 ± 1,08 pg/ml), no pulmão. No intestino, a produção de nitrito, em 6h, diminuiu no grupo SH (1,27 ± 0,19 pg/ml) comparado com CLP (2,44 + 0,51 pg/ml). No grupo SH houve redução do infiltrado de neutrófilos no pulmão em 24h, através da redução de moléculas de adesão e concentração de mieloperoxidase, em comparação com CLP (29,4 + 5,7 ng/mg ; 3,02 + 0,41 mU/mg). Nossos resultados indicam que SH modula a resposta inflamatória, além de melhorar a sobrevida de animais submetidos à sepse experimental / Sepsis is a systemic inflammatory response to infection triggered by bacteria, virus and fungi. There is a rise in inflammatory mediators as citokynes, chemokynes, reactive oxygen species and neutrophil recruitment (1). The hypertonic saline solution (SH) has been showed to improve hemodynamic and inflammatory response. We studied the hypertonic solution effects in sepsis through cecal ligation and puncture (CLP) in mice Balb-C, divided in 3 groups: CLP without treatment (CLP); CLP treated with isotonic saline solution 0,9% - 34mg/Kg (SS); CLP treated with hypertonic saline solution 7,5% - 4ml/Kg (SH); and a 4th group indicating the basal values without both CLP and treatment (C); both treatments were administrated 30 min after CLP. The lung, gut and peritoneal fluid were collected after 6h, 12h and 24h to analyze cytokines levels, oxide nitric, lipid peroxidation and neutrophil infiltration. The SH group showed higher survival rats (60%) when compared to SS (46,6%) and CLP (33,3%) after 168h (7 days). TNF- level in the SS group (27,3 ± 3,05 pg/ml) was increased at 12h when compared to CLP (14,07 ± 1,68 pg/ml) and SH (19,66±3,19pg/ml); and at 24h the SH (6,2 ± 3,5 pg/ml) decreased its level when compared to CLP (73,40± 49,52 pg/ml); IL-10 level at 24h was increased in CLP (CLP - 3,12 ± 0,46 pg/ml) and SS (2,9 ± 0,9 pg/ml) in relation to SH (0,59 ± 0,34 pg/ml). In 24h, the quantification of nitrite decreased in SH (6,77 ± 0,82 pg/ml) compared with SS (10,65 ± 1,08 pg/ml) in lung. In intestine, nitrite levels diminished in SH (1,27 ± 0,19 pg/ml) in relation to CLP (2,44 + 0,51 pg/ml) in 6h. SH group reduced the neutrophil infiltration in lung, through adhesion molecule and myeloperoxidase at 24h (ng/mg;1,49 + 0,24 mU/mg) in relation to CLP(29,4 + 5,7 ng/mg ; 3,02 + 0,41 mU/mg). Our results suggest that the volume replacement of both treatments modulate pro and anti-inflammatory mediators of an inflammatory response to infection, but hypertonic solution presented a more effective effect

INTRODUÇÃO: Estudos recentes em modelos experimentais de sepse demonstraram as propriedades antioxidante e anti-inflamatória do etilpiruvato. Diferentes modelos experimentais também demonstraram que pequenos volumes de solução salina hipertônica (7,5%) melhoram a hemodinâmica, a microcirculação e modulam o sistema imunológico. Este estudo teve como objetivo investigar os efeitos do etil-piruvato, da solução salina hipertônica e da solução de Ringer lactato sobre a microcirculação mesentérica em modelo de sepse induzida por Escherichia coli viva em ratos. MÉTODOS: Ratos Wistar machos receberam por via endovenosa uma suspensão de E. coli ou foram submetidos ao procedimento cirúrgico do grupo falso-operado. Após três horas da infusão bacteriana os animais foram randomizados em: grupo controle não tratado, grupo tratado com solução de Ringer lactato (4mL/kg i.v.); grupo tratado com solução de Ringer lactato (4 mL/kg i.v.) associado a etil-piruvato (50mg/kg) e grupo tratado com solução salina hipertônica (7,5%, 4 mL/kg i.v.). Após 24 horas da bacteremia, as interações leucócito-endotélio foram investigadas por microscopia intravital, e a expressão de P-selectina e da molécula de adesão intercelular (ICAM)-1 determinada por imuno-histoquímica. Leucograma e contagem de plaquetas foram realizadas no início do estudo, 3 horas e 24 horas após a inoculação de E. coli. RESULTADOS: Os grupos não tratado e tratado com solução de Ringer lactato exibiram um aumento no número de leucócitos rollers (~ 2,5 vezes), leucócitos aderidos (~ 3,0 vezes), e de leucócitos migrados (~ 3,5 vezes) comparados ao grupo falso operado. O tratamento com etil-piruvato reduziu o número de leucócitos rollers, aderidos e migrados aos níveis obtidos no grupo falso operado (p > 0,05). Efeitos semelhantes foram observados nos animais tratados com a solução salina hipertônica (p > 0,05). A expressão de P-selectina e de ICAM-1 aumentou significativamente na microcirculação mesentérica no grupo não tratado, comparado ao grupo falso operado (p < 0,001). Todos os tratamentos reduziram a expressão de ambas moléculas de adesão, sendo os grupos tratados com etil-piruvato e solução salina hipertônica mais eficazes. A infusão de bactérias provocou leucopenia significante, seguida por leucocitose com granulocitose, e concomitante redução progressiva no número de plaquetas. CONCLUSÕES: Os dados apresentados sugerem que o etil-piruvato e a solução salina hipertônica (7,5%) eficientemente reduziram a resposta inflamatória na microcirculação mesentérica no presente modelo experimental de sepse induzida por E. coli viva; associada, pelo menos em parte, a menor expressão de moléculas de P-selectina e ICAM-1 / BACKGROUND: Experimental studies on sepsis have demonstrated that ethyl pyruvate is endowed with antioxidant and anti-inflammatory properties. It has been shown that small volumes of hypertonic saline solution (7.5%) improve hemodynamics, the microcirculation, and modulate the immune system. This study aimed to investigate the effects of ethyl pyruvate, hypertonic saline and lactated Ringer\'s solution on mesenteric microcirculation in a sepsis model induced by live Escherichia coli in rats. METHODS: Male Wistar rats were underwent an intravenous suspension of E. coli bacteria or submitted to the sham procedure. After 3h of bacteria infusion rats were randomized into: control, without treatment; treated with lactated Ringer\'s solution (4 mL/kg, i.v.); treated with lactated Ringer\'s solution (4mL/kg, i.v.) plus ethyl pyruvate (50mg/kg), and treated with hypertonic saline solution (7.5%, 4 mL/kg i.v.). At 24h after bacteria infusion leukocyte-endothelial interactions were investigated by intravital microscopy, and the expression of P-selectin and intercellular adhesion molecule (ICAM)- 1 evaluated by immunohistochemistry. White blood cell and platelet counts were determined at baseline, 3h and 24h after E. coli inoculation. RESULTS: Both non-treated and lactated Ringer\'s-treated groups exhibited an increase in the number of rolling leukocytes (~2.5-fold), adherent (~3.0-fold), and migrated cells (~3.5-fold) compared to sham. Treatment with Ringer\'s ethyl pyruvate solution reduced the number of rolling, adherent and migrated leukocytes to the levels attained in the sham group (p > 0.05). Similar effects were observed when animals were treated with hypertonic saline (p > 0.05). The expression of P-selectin and ICAM-1 significantly increased on mesenteric microvessels in non-treated group compared with sham (p < 0.001). All treatments reduced the expression of both adhesion molecules being ethyl pyruvate and hypertonic saline solution more effective than lactated Ringer\'s solution. Infusion of bacteria caused a significant leucopenia (3h), followed by a leucocytosis with granulocytosis (24h). There was an intense and progressive reduction in the number of platelets. No differences were observed after treatment with the different solutions. CONCLUSIONS: Data presented suggest that ethyl pyruvate and hypertonic saline solution (7.5%) efficiently reduce the inflammatory response at mesenteric microcirculation in an experimental model of sepsis induced by live E. coli associated, at least in part, with a down-regulation of P-selectin and ICAM-1