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OBJECTIVES: The aim of this study was to evaluate systemic inflammatory factors and their relation to success or failure in a spontaneous ventilation test. METHODS: This cross-sectional study included a sample of 54 adult patients. Demographic data and clinical parameters were collected, and blood samples were collected in the first minute of the spontaneous ventilation test to evaluate interleukin (IL)-1β, IL-6, IL-8, and IL-10, tumour necrosis factor alpha (TNFα) and C-reactive protein. RESULTS: Patients who experienced extubation failure presented a lower rapid shallow breathing index than those who passed, and these patients also showed a significant increase in C-reactive protein 48 hours after extubation. We observed, moreover, that each unit increase in inflammatory factors led to a higher risk of spontaneous ventilation test failure, with a risk of 2.27 (1.001 - 4.60, p=0.049) for TNFα, 2.23 (1.06 - 6.54, p=0.037) for IL-6, 2.66 (1.06 - 6.70, p=0.037) for IL-8 and 2.08 (1.01 - 4.31, p=0.04) for IL-10, and the rapid shallow breathing index was correlated with IL-1 (r=-0.51, p=0.04). CONCLUSIONS: C-reactive protein is increased in patients who fail the spontaneous ventilation test, and increased ILs are associated with a greater prevalence of failure in this process; the rapid shallow breathing index may not be effective in patients who present systemic inflammation.

Objective: To investigate the effect of intermittent hypoxia-a model of obstructive sleep apnea (OSA)-on pancreatic expression of uncoupling protein-2 (UCP2), as well as on glycemic and lipid profiles, in C57BL mice. Methods: For 8 h/day over a 35-day period, male C57BL mice were exposed to intermittent hypoxia (hypoxia group) or to a sham procedure (normoxia group). The intermittent hypoxia condition involved exposing mice to an atmosphere of 92% N and 8% CO2 for 30 s, progressively reducing the fraction of inspired oxygen to 8 ± 1%, after which they were exposed to room air for 30 s and the cycle was repeated (480 cycles over the 8-h experimental period). Pancreases were dissected to isolate the islets. Real-time PCR was performed with TaqMan assays. Results: Expression of UCP2 mRNA in pancreatic islets was 20% higher in the normoxia group than in the hypoxia group (p = 0.11). Fasting serum insulin was higher in the hypoxia group than in the normoxia group (p = 0.01). The homeostasis model assessment of insulin resistance indicated that, in comparison with the control mice, the mice exposed to intermittent hypoxia showed 15% lower insulin resistance (p = 0.09) and 21% higher pancreatic β-cell function (p = 0.01). Immunohistochemical staining of the islets showed no significant differences between the two groups in terms of the area or intensity of α- and β-cell staining for insulin and glucagon. Conclusions: To our knowledge, this is the first report of the effect of intermittent hypoxia on UCP2 expression. Our findings suggest that UCP2 regulates insulin production in OSA. Further study of the role that UCP2 plays in the glycemic control of OSA patients is warranted.

INTRODUÇÃO: O monitoramento dos níveis de glicose é extremamente importante para prevenir o desenvolvimento de doenças e também para acompanhar e monitorar o tratamento da Diabetes Mellitus. Como é possível que os pacientes façam automonitorização da glicemia, surgem questionamentos sobre a validade do método a domicílio em relação ao método utilizado em laboratório. Tendo em vista que o glicosímetro é uma ferramenta de grande utilização, não somente em domicílio, mas também em ambiente hospitalar, seus resultados devem ser confiáveis para garantir a segurança da saúde do usuário. OBJETIVO: Comparar as técnicas de quantificação de glicose pelo glicosímetro comparado ao analisador bioquímico automatizado em laboratório de análises clínicas. MÉTODOS: Foi dosada a glicemia de 55 amostras de sangue em glicosímetro Contour TS (Bayer®) e em equipamento laboratorial Flexor El 200. RESULTADOS E CONCLUSÃO: Foi observada correlação positiva entre os dois métodos (r=0,981), e observado que há diferença estatística significativa. No entanto, esta diferença está de acordo com as recomendações do fabricante e órgãos reguladores da área.

Context To evaluate lung and liver changes in two experimental models using intraperitoneal carbon tetrachloride (CCl4) and bile duct ligation (BDL). Methods Twenty-four male Wistar rats were divided into a control group (CO) and an experimental group (EX). We evaluated the liver transaminases (AST, ALT, AP), arterial blood gases (PaO2, PCO2 and SpO2) and lipid peroxidation by TBARS (substances that react to thiobarbituric acid) and chemiluminescence. We also evaluated the antioxidant enzyme superoxide dismutase (SOD) and histology of lung tissue and liver. Results There were significant differences in AST, ALT, ALP and PaO2 between CO group and EX group (P

OBJETIVO: A ventilação mecânica constitui um dos pilares terapêuticos da unidade de terapia intensiva, entretanto, deve-se avaliar os efeitos deletérios por ela ocasionados, logo objetivamos avaliar o estresse oxidativo de pacientes internados em unidade de terapia intensiva submetidos à ventilação mecânica invasiva. MÉTODOS: Estudo transversal onde foram incluídos 12 pacientes que estavam em ventilação mecânica invasiva. As coletas sanguíneas (3 mL) foram realizadas no primeiro e último dia em que o paciente estava submetido a ventilação mecânica invasiva e utilizou-se o plasma para avaliação das substâncias que reagem ao ácido tiobarbitúrico (TBARS) e os glóbulos vermelhos para dosagem de superóxido dismutase (SOD) e da catalase. RESULTADOS: Os pacientes apresentaram média de idade de 64,8±17,6 anos; volume corrente de 382±44,5 mL e APACHE II de 15±7. Quando comparado o TBARS inicial e ao final da ventilação houve diferença significativa (3,54±0,74 vs. 4,96±1,47; p=0,04). Em relação às enzimas antioxidantes não houve diferença. Observa-se correlação entre as variáveis PaO2/FiO2 e TBARS (r = 0,4); SOD e PaO2/FiO2 (r = 0,51) e SOD e APACHE II (r = 0,56). Quanto ao desfecho da internação, 6 pacientes foram a óbito. CONCLUSÃO: Pacientes submetidos à ventilação mecânica invasiva podem apresentar alteração do estado redox, marcado pelo aumento no TBARS e redução das enzimas antioxidantes.

CONTEXT: Cirrhosis is a progressive chronic hepatopathy which constitutes an irreversible stage of liver dysfunction. OBJECTIVES: To evaluate the oxidative stress in the blood of cirrhotic rats treated with the antioxidant melatonin. METHODS: Cirrhosis was induced through inhalation of carbon tetrachloride. Liver integrity was evaluated by measuring serum enzymes, oxidative damage measured by lipoperoxidation, and antioxidant enzyme activity in erythrocytes. Lipoperoxidation, total nitrates, collagen, and histology by picrosirius staining were evaluated in the livers of these animals (n = 15), which were divided in three groups: control, carbon tetrachloride, and carbon tetrachloride + melatonin. Melatonin (20 mg/kg) was administered intraperitoneal from week 10 of carbon tetrachloride inhalation. In order to shorten the cirrhosis induction time, phenobarbital (0.3 g/L) was added to the animals' drinking water. RESULTS: A significant impairment in the liver integrity of melatonin-treated animals as compared to cirrhotic animals was observed. In rat erythrocytes and liver, lipoperoxidation was significantly increased in the cirrhotic rats as compared to controls, as measured through thiobarbituric acid reactive substances, and significantly decreased in melatonin-treated animals as compared to cirrhotic ones. In blood, a decrease in superoxide dismutase and glutathione peroxidase enzymes was detected in the cirrhotic group as compared to the control group, with increased superoxide dismutase activity when melatonin was administered. A reduction in the levels of total nitrates was detected in the hepatic tissue of the animals in the carbon tetrachloride group as compared to the control group and an increase of these levels in the carbon tetrachloride + melatonin group. As for hepatic collagen, we found a significant increase in the carbon tetrachloride group as compared to the controls and a regression of these values in the treated group. In histology, the rats in the carbon tetrachloride group showed fibrosis and formation of fibrotic nodules, characterizing liver cirrhosis; there was reduction of nodules and fibrosis in the melatonin treated group. CONCLUSION: The data allow us to suggest that the observed oxidative stress is related to the damages caused by carbon tetrachloride and that the use of melatonin can minimize these damagesCONTEXTO: A cirrose é uma hepatopatia crônica e progressiva que constitui estágio irreversível de disfunção hepática. É associada a alterações na circulação sistêmica. OBJETIVOS: Avaliar o estresse oxidativo no sangue de ratos cirróticos e tratados com antioxidante melatonina. MÉTODOS: A cirrose foi induzida através da inalação de tetracloreto de carbono. Foram avaliadas as provas de integridade hepática através das medidas das enzimas séricas, o dano oxidativo medido pela lipoperoxidação e a atividade das enzimas antioxidantes no eritrócito. No fígado desses animais, foram avaliados a lipoperoxidação, os nitratos totais, colágeno e histologia através de picrosíruis. Os animais (n = 15) foram divididos em três grupos experimentais: controle, tetracloreto de carbono e tetracloreto de carbono + melatonina. A melatonina foi administrada por via intraperitonial após a 10ª semana de inalação na concentração de 20 mg/kg. Com o objetivo de abreviar o tempo de indução, foi administrado para todos animais, fenobarbital na água de beber na concentração de 0,3 g/L. RESULTADOS: Observou-se redução significativa nas provas de integridade hepática nos animais tratados com melatonina, em relação aos animais cirróticos. Nos eritrócitos e fígados dos ratos, foi observado aumento significativo da lipoperoxidação nos ratos cirróticos em comparação com os controles, através da medida das substâncias que reagem ao ácido tiobarbitúrico, e redução nos animais tratados com melatonina. No sangue, observou-se diminuição dos valores das enzimas superóxido dismutase e glutationa peroxidase do grupo cirrótico em comparação ao grupo controle, elevando a atividade da superóxido dismutase quando administrada melatonina. Na avaliação dos nitratos totais, no tecido hepático, observou-se redução dos valores nos animais do grupo tetracloreto de carbono em comparação ao grupo CO e um aumento desses valores nos ratos do grupo tratado com melatonina. Na medida do colágeno hepático, encontrou-se aumento significativo do grupo tetracloreto de carbono em relação ao controle e regressão desses valores no grupo tratado. Através da histologia, os ratos do grupo tetracloreto de carbono apresentaram presença de fibrose e formação de nódulos fibróticos, caracterizando a cirrose hepática; após o tratamento com a melatonina, houve redução dos nódulos e da fibrose. CONCLUSÃO: Com esses dados, pode-se sugerir que a análise do estresse oxidativo no sangue está relacionado ao dano hepático causado pelo tetracloreto de carbono e que o uso de melatonina pode minimizar esses danos

Background. The aim of this study was to evaluate the use of liquid perfluorocarbon (PFC) as an adjuvant substance for lung preservation and assess its role in pulmonary protection after transplantation. Methods. Seventy-two rat lungs were flushed with low-potassium dextran (LPD) solution and randomized into three main groups: control with LPD alone and experimental with 3 (PFC3) and 7 mL/kg (PFC7) of endobronchial PFC instilled just after harvest. Each group was divided into four subgroups according to preservation time (3, 6, 12, and 24 hours). Afterwards, we performed lung transplantation using rat lungs preserved for 12 hours with LPD alone or with 7 mL/kg of endobronchial PFC. Results. There was a significant increase in oxidative stress in the control group at 6 h of cold ischemic time compared with the PFC3 and PFC7 groups. The apoptotic activity and NF-κB expression were significantly higher in the control group compared with the PFC groups at 3, 12, and 24 h of cold preservation. After transplantation, the NF-κB, iNOS, and nitrotyrosine expression as well as caspase 3 activity were significantly lower in the PFC groups. Conclusion. The use of endobronchial PFC as an adjuvant to the current preservation strategy improved graft viability.

Sleep apnea is a breathing disorder that results from momentary and cyclic collapse of the upper airway, leading to intermittent hypoxia (IH). IH can lead to the formation of free radicals that increase oxidative stress, and this mechanism may explain the association between central sleep apnea and nonalcoholic steatohepatitis. We assessed the level of inflammation in the lung and liver tissue from animals subjected to intermittent hypoxia and simulated sleep apnea. A total of 12 C57BL/6 mice were divided into two groups and then exposed to IH (n=6) or a simulated IH (SIH) (n=6) for 35 days. We observed an increase in oxidative damage and other changes to endogenous antioxidant enzymes in mice exposed to IH. Specifically, the expression of multiple transcription factors, including hypoxia inducible factor (HIF-1α), nuclear factor kappa B (NF-κB), and tumor necrosis factor (TNF-α), inducible NO synthase (iNOS), vascular endothelial growth factor (VEGF), and cleaved caspase 3 were shown to be increased in the IH group. Overall, we found that exposure to intermittent hypoxia for 35 days by simulating sleep apnea leads to oxidative stress, inflammation, and increased activity of caspase 3 in the liver and lung.