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Introdução: A participação dos neutrófilos como mediadores de infecção, trombose e neoplasia tem sido descrita em vários cenários. Além de seu papel na imunidade inata, sabe-se que os neutrófilos contribuem para ativação de inflamação, coagulação, imunossupressão através da formação de redes extracelulares de neutrófilos (NETs -neutrophil extracellular traps) em resposta a estímulos antigênicos e de ácidos nucleicos. Entretanto, pouco se sabe sobre o papel da NETose no cenário do transplante hepático, situação em que há um estado inflamatório persistente, exacerbado por vários eventos, inclusive transfusão de hemocomponentes. Ainda, sabe-se que os pacientes hepatopatas são bastante complexos do ponto de vista hemostático e a identificação de possíveis marcadores preditores de transfusão e hemoderivados potencialmente auxiliaria no manejo clínico destes pacientes. O objetivo deste estudo foi avaliar o papel de NETs como preditores de transfusão de hemocomponentes, bem como estabelecer uma correlação entre NETs e complicações em transplante hepático. Materiais e métodos: Foram quantificados DNA livre pela técnica de PicoGreen (dsDNAAssay Kit (ThermoFisherScientific, EUA) e H3 citrulinado por ELISA (clone 11D3, ELISA, Cayman), marcadores de remanescentes de NETs, no pré-operatório, intraoperatório e pós-operatório de 93 pacientes submetidos a transplante hepático em um hospital terciário em São Paulo-SP. Os pacientes foram seguidos desde a internação até a alta hospitalar e foram avaliados os seguintes desfechos clínicos: transfusão de hemocomponentes, uso de hemoderivados e antifibrinolíticos, rejeição, trombose, infecção e disfunção de órgãos. Resultados: Observamos uma ascensão dos níveis de H3 citrulinado e DNA livre do pré-operatório para o intraoperatório, com posterior declínio pré-alta hospitalar, de maneira estatisticamente significativa, (p < 0.0001), confirmando a ocorrência de NETOse exacerbada no intraoperatório do transplante hepático. Ainda, demonstramos que a liberação de NETs no intraoperatório foi preditora de óbito intra-hospitalar (OR = 1,168, CI 95% = 1,021-1,336, p = 0,024). Não se observou nenhuma associação entre NETose e transfusão, nem uso de hemoderivados. Entretanto, observou-se que a liberação de H3 citrulinado foi associada a menor uso de ácido tranexâmico durante o transplante (OR:0,824, CI95%0,705-0,964, p:0,016). Não foram observadas outras associações entre NETose no intraoperatório e demais desfechos clínicos negativos (rejeição, trombose, infecção ou disfunção de órgãos). Conclusão: Não foi possível estabelecer correlação entre NETose e necessidades transfusionais nos pacientes submetidos a transplante hepático. Entretanto, o presente estudo evidenciou uma associação significativa entre NETose e óbito intra-hospitalar. Dada a relevância da associação entre NETose e óbito e o papel central dos NETs na inflamação do transplante hepático, consideramos que NETs podem ser potenciais biomarcadores de inflamação nestes pacientes. Ainda, o desenvolvimento de terapêuticas focando na inibição de NETose poderia ser uma estratégia plausível para redução de efeitos deletérios da inflamação exacerbada inerente ao transplante. Mais estudos são necessários a fim de confirmar esta hipótese.

Objective: To identify the independent variables associated with death within 4 days after the first sepsis-induced organ dysfunction., Methods: In this prospective observational study, severe sepsis and septic shock patients were classified into 3 groups: Group 1, survivors; Group 2, late non-survivors; and Group 3, early non-survivors. Early death was defined as death occurring within 4 days after the first sepsis-induced organ dysfunction. Demographic, clinical and laboratory data were collected and submitted to univariate and multinomial analyses., Results: The study included 414 patients: 218 (52.7%) in Group 1, 165 (39.8%) in Group 2, and 31 (7.5%) in Group 3. A multinomial logistic regression analysis showed that age, Acute Physiology and Chronic Health Evaluation II score, Sepsis-related Organ Failure Assessment score after the first 24 hours, nosocomial infection, hepatic dysfunction, and the time elapsed between the onset of organ dysfunction and the sepsis diagnosis were associated with early mortality. In contrast, Black race and a source of infection other than the urinary tract were associated with late death. Among the non-survivors, early death was associated with Acute Physiology and Chronic Health Evaluation II score, chronic renal failure, hepatic dysfunction Sepsis-related Organ Failure Assessment score after 24 hours, and the duration of organ dysfunction., Conclusion: Factors related to patients' intrinsic characteristics and disease severity as well as the promptness of sepsis recognition are associated with early death among severe septic patients.

Background: Prolonged invasive mechanical ventilation and reintubation are associated with adverse outcomes and increased mortality. Daily screening to identify patients able to breathe without support is recommended to reduce the length of mechanical ventilation. Noninvasive positive-pressure ventilation has been proposed as a technique to shorten the time that patients remain on invasive ventilation., Methods: We conducted a before-and-after study to evaluate the efficacy of an intervention that combined daily screening with the use of noninvasive ventilation immediately after extubation in selected patients. The population consisted of patients who had been intubated for at least 2 days., Results: The baseline characteristics were similar between the groups. The intervention group had a lower length of invasive ventilation (6 [4;9] vs. 7 [4;11.5] days, p = 0.04) and total (invasive plus noninvasive) ventilator support (7 [4;11] vs. 9 [6;8], p = 0.01). Similar reintubation rates within 72 hours were observed for both groups. In addition, a lower ICU mortality was found in the intervention group (10.8% vs. 24.3%, p = 0.03), with a higher cumulative survival probability at 60 days (p = 0.05). Multivariate analysis showed that the intervention was an independent factor associated with survival (RR: 2.77; CI 1.14-6.65; p = 0.03), whereas the opposite was found for reintubation at 72 hours (RR: 0.27; CI 0.11-0.65; p = 0.01)., Conclusion: The intervention reduced the length of invasive ventilation and total ventilatory support without increasing the risk of reintubation and was identified as an independent factor associated with survival.

Understanding the effects of ionizing radiations are key to determining their optimal use in therapy and assessing risks from exposure. The development of microbeams where radiations can be delivered in a highly temporal and spatially constrained manner has been a major advance. Several different types of radiation microbeams have been developed using X-rays, charged particles and electrons. For charged particles, beams can be targeted with sub-micron accuracy into biological samples and the lowest possible dose of a single particle track can be delivered with high reproducibility. Microbeams have provided powerful tools for understanding the kinetics of DNA damage and formation under conditions of physiological relevance and have significant advantages over other approaches for producing localized DNA damage, such as variable wavelength laser beam approaches. Recent studies have extended their use to probing for radiosensitive sites outside the cell nucleus, and testing for mechanisms underpinning bystander responses where irradiated and non-irradiated cells communicate with each other. Ongoing developments include the ability to locally target regions of 3D tissue models and ultimately to target localized regions in vivo. With future advances in radiation delivery and imaging microbeams will continue to be applied in a range of biological studies., (2010 Elsevier B.V. All rights reserved.)

This study investigated the role of DNA double strand breaks and DNA base damage in radiation-induced bystander responses in Chinese hamster ovary (CHO) cell lines. Two CHO repair-deficient clones, xrs5 (DNA double strand break repair-deficient) and EM9 (DNA base excision repair-deficient) were used in addition to the wild type (CHO). The Gray Cancer Institute ultrasoft X-ray microprobe is a powerful tool for investigating the bystander response, because it permits the irradiation of only a single nucleus of a cell, as reported previously. In order to investigate the bystander effect in each repair-deficient cell line, we irradiated a single cell within a population and scored the formation of micronuclei. When a single nucleus in the population was targeted with 1 Gy, elevated numbers of micronuclei were induced in the neighbouring unirradiated cells in the EM9 and xrs5 cell lines, whereas induction was not observed in CHO. The induction of micronuclei in xrs5 was significantly higher than that in EM9. Under these conditions, the surviving fraction in the neighbouring cells was significantly lower in xrs5 than in the other cell lines, showing a higher cell killing effect in xrs5. To confirm that bystander factors secreted from irradiated cells caused these effects, we carried out medium transfer experiments using conventional X-irradiation. Medium conditioned for 24 h with irradiated cells was transferred to unirradiated cells and elevated induction of micronuclei was observed in xrs5. These results suggest that DNA double strand breaks rather than base damage are caused by factors secreted in the medium from irradiated cells.

Studies of the effects of radiation at the cellular level have generally been carried out by exposing cells randomly to the charged-particle tracks of a radiation beam. Recently, a number of laboratories have developed techniques for microbeam irradiation of individual cells. These approaches are designed to remove much of the randomness of conventional methods and allow the nature of the targets and pathways involved in a range of radiation effects to be studied with greater selectivity. Another advantage is that the responses of individual cells can be followed in a time-lapse fashion and, for example, processes such as "bystander" effects can be studied clearly. The microbeam approach is of particular importance in mechanistic studies related to the risks associated with exposure to low fluences of charged particles. This is because it is now possible to determine the actions of strictly single particle tracks and thereby mimic, under in vitro conditions, exposures at low radiation dose that are significant for protection levels, especially those involving medium- to high-LET radiations. Overall, microbeam methods provide a new dimension in exploring mechanisms of radiation effect at the cellular level. Microbeam methods and their application to the study of the cellular effects of single charged-particle traversals are described., (c2002 COSPAR. Published by Elsevier Science Ltd. All rights reserved.)

Understanding the effects of single-particles from conventional radiation biology experiments is problematic due to the stochastics of particle tracks. This complicates the determinations of risk associated with low doses. We have developed a charged particle microbeam, which allows individually counted particles to be delivered to precise cellular locations. The system is capable of delivering a single charged particle with > 99% efficiency. Of these particles 90% are delivered with a resolution of +/- 2 micrometers and 96% with a resolution of +/- 5 micrometers. We have carried out preliminary studies in Chinese hamster V79 cells to monitor the effectiveness of low energy protons at inducing cytological damage. We have used the micronucleus assay as a measure of predominantly lethal chromosome damage. The effects of a single 3.2 MeV proton delivered individually to cells could be measured, with less than 2% of the exposed cells producing micronuclei 24 hours later. The yield of micronuclei formation was essentially linear up to the highest dose (30 particles per cell nucleus) delivered. Ultimately, the ability to target particles to different parts of the cell nucleus may start to impact on models available for chromosome aberration formation and chromosomal Organisation and mechanisms underlying genomic instability.