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Purpose of the work: To assess the impact of fixed night shift on the vigilance of paramedical staff. Methods: The present study is an exhaustive cross-sectional survey which has been conducted at the University Hospital of Monastir, Tunisia, and it is about 92 care agents working permanently the night. The study of vigilance is based on Epworth scale and Super Lab program. Results: The average age was equal to 42.53 ± 9.45 years with a sex ratio of 1.72. Nurses accounted for 72%. The average score of alertness assessed with Epworth scale was equal to 14.5 ± 6. The use of the Super Lab software has objectified a tendency towards the increase in the average time of reaction of accomplishment of the simple task and the positive cueing task, which was evaluated while starting the shift, during the half time of the work and at the end of the shift. In addition, the average rate of errors evaluated at the beginning, half-time and at the end of the work has increased during 3 tests (simple task, positive and negative cueing tasks) without this difference being statistically significant. Conclusion: The alteration of vigilance with an ascent of the error rate among fixed night shift workers is a reality, which puts in question, not only the health of paramedical staff but also the care safety provided by these teams.

[Background/aim] The aim of this study was to compare the effects of single and repeated trimetazidine (TMZ) administration against warm hepatic ischemia/reperfusion (I/R) injury and to explore the possible mechanisms affected by TMZ. [Materials and methods] Wistar rats were divided into 4 groups (n = 6). Sham: rats were subjected to dissection. I/R: rats were subjected to 60 min of partial hepatic ischemia followed by 24 h of reperfusion. TMZ1: Same as I/R group but rats were pretreated with a single dose of TMZ (10 mg/kg, intraperitoneal injection) 30 min before warm ischemia. TMZ3: Same as I/R but rats were treated with 10 mg/ kg TMZ for 3 successive days. [Results] TMZ treatment decreased liver injury, lipid peroxidation, and apoptosis. The repeated administration of TMZ conferred more protection than the single dose treatment concerning all studied parameters. In parallel, we noted a significant increase in phosphorylated adenosine monophosphate activated protein kinase (p-AMPK) and endothelial nitric oxide synthase (eNOS) levels in TMZ3 as compared to TMZ1. [Conclusion] Repeated administration of TMZ for 3 days was more efficient than a single dose of TMZ in protecting the liver against I/R induced apoptosis and lipid peroxidation. These effects implicate AMPK and eNOS activation., This study was funded by the Tunisian Ministry of Higher Education and Scientific Research.

Resume But Presenter les resultats du pre-conditionnement ischemique (PCI), du pre-conditionnement pharmacologique induit par la vitamine C (Vit C) et de l’association des deux conditionnements sur la reprise fonctionnelle des reins de rats apres une ischemie chaude prolongee. Materiel Nous avons utilise 46 rats repartis en 5 groupes experimentaux. Les reins du groupe sham (n=9) subissent uniquement une dissection du pedicule. L’ischemie (60 min, n=10) est induite par le clampage des deux reins. Le PCI (n=9) consiste en deux cycles successifs (5 min15 min) d’ischemie/reperfusion (IR). La Vit C (100 mg/Kg, n=9) est administree par voie intraveineuse 30 min avant 1’1 chaude. Le groupe Vit C+PCI (n=9) est I’association des deux traitements. La malonedialdehyde (MDA) tissulaire, la lactate deshydrogenase (LDH) plasmatique, le taux de reabsorption de sodium (TRNa) et la clairance de la creatinine (DFG) sont evalues apres 120 min de reperfusion des reins. Resultats Les reins ischemiques montrent une augmentation significative des concentrations de MDA et de LDH et une diminution significative du DFG et du TRNa, par comparaison au groupe sham. L’utilisation du PCI ou de la Vit C entraine une amelioration significative de la fonction renale, par rapport au groupe ischemie. L’association Vit C+PCI montre une legere amelioration des parametres experimentaux par rapport a ceux du groupe ischemie, mais n’ameliore pas le fonctionnement des reins par rapport a une utilisation separee du PCI ou de la Vit C. Conclusion Le PCI et la Vit C ameliorent les parametres fonctionnels des reins ischemiques. Cependant, les effets protecteurs sont attenues lorsque les deux traitements sont associes.

© 2014 Informa Healthcare USA, Inc. All rights reserved. Renal ischemia reperfusion (I/R) injury, which occurs during renal surgery or transplantation, is the major cause of acute renal failure. Trimetazidine (TMZ), an anti-ischemic drug, protects kidney against the deleterious effects of I/R. However its protective mechanism remains unclear. The aim of this study is to examine the relevance of Akt, endothelial nitric oxide synthase (eNOS), and hypoxia inducible factor-1α (HIF-1α) on TMZ induced protection of kidneys against I/R injury. Wistar rats were subjected to 60 min of warm renal ischemia followed by 120 min of reperfusion, or to intraperitoneal injection of TMZ (3 mg/kg) 30 min before ischemia. In sham operated group renal pedicles were only dissected. Compared to I/R, TMZ treatment decreased lactate dehydrogenase (845 ± 13 vs. 1028 ± 30 U/L). In addition, creatinine clearance and sodium reabsorption rates reached 105 ± 12 versus 31 ± 11 μL/min/g kidney weight and 95 ± 1 versus 68 ± 5%, respectively. Besides, we noted a decrease in malondialdehyde concentration (0.33 ± 0.01 vs. 0.59 ± 0.03 nmol/mg of protein) and an increase in glutathione concentration (2.6 ± 0.2 vs. 0.93 ± 0.16 μg GSH/mg of protein), glutathione peroxidase (95 ± 4 vs. 61 ± 3 μg GSH/min/mg of protein), and superoxide dismutase (25 ± 3 vs. 11 ± 2 U/mg of protein) and catalase (91 ± 12 vs. 38 ± 9 μmol/min/mg of protein) activities. Parallely, we noted a significant increase in p-Akt, eNOS, nitrite and nitrate (18 ± 2 vs. 8 ± 0.1 pomL/mg of protein), HIF-1α (333 ± 48 vs. 177 ± 14 μg/mg of protein) and heme oxygenase-1 (HO-1) levels regarding I/R. TMZ treatment improves renal tolerance to warm I/R. Such protection implicates an activation of Akt/eNOS signaling pathway, HIF-1α stabilization and HO-1 activation.

Importance of the field: Good organ preservation is a determinant of graft outcome after revascularization. The necessity of increasing the quality of organ preservation, as well as of extending cold storage time, has made it necessary to consider the use of pharmacological additives. Areas covered in this review: The complex physiopathology of cold-ischemia-reperfusion (I/R) injury - and in particular cell death, mitochondrial injury and endoplasmic reticulum stress - are reviewed. Basic principles of the formulation of the different preservation solutions are discussed. What the reader will gain: Current strategies and new trends in static organ preservation using additives such as trimetazidine, polyethylene glycols, melatonin, trophic factors and endothelin antagonists in solution are presented and discussed. The benefits and mechanisms responsible for enhancing organ protection against I/R injury are also discussed. Graft preservation was substantially improved when additives were added to the preservation solutions. Take home message: Enrichment of preservation solutions by additives is clinically useful only for short periods. For longer periods of cold ischemia, the use of such additives becomes insufficient because graft function deteriorates as a result of ischemia. In such conditions, the preservation strategy should be changed by the use of machine perfusion in normothermic conditions. © 2010 Informa UK Ltd., This study was supported by the Ministerio de Sanidad y Consumo (PI081988), CIBER-ehd, Instituto Carlos III, Madrid and Ministerio de Asuntos Exteriores y de Cooperacion Internacionales (A/020255/08), (A/029087/09), Madrid. MA Zaouali is a fellow of the Societat Catalana de Trasplantament.

Background: Although recent studies indicate that renal ischemic preconditioning (IPC) protects the kidney from ischemia-reperfusion (I/R) injury, the precise protective mechanism remains unclear. In the current study, we investigated whether early IPC could upregulate hypoxia inducible transcription factor-1 (HIF-1) expression and could reduce endoplasmic reticulum (ER) stress after renal I/R and whether pharmacological inhibition of nitric oxide (NO) production would abolish these protective effects. Methods. Kidneys of Wistar rats were subjected to 60 min of warm ischemia followed by 120 min of reperfusion (I/R group), or to 2 preceding cycles of 5 min ischemia and 5 min reperfusion (IPC group), or to intravenously injection of N G-nitro-L- arginine methylester (L-NAME, 5 mg/kg) 5 min before IPC (L-NAME+IPC group). The results of these experimental groups were compared to those of a sham-operated group. Sodium reabsorption rate, creatinine clearance, plasma lactate dehydrogenase (LDH) activity, tissues concentrations of malonedialdehyde (MDA), HIF-1 and nitrite/nitrate were determined. In addition, Western blot analyses were performed to identify the amounts of Akt, endothelial nitric oxide synthase (eNOS) and ER stress parameters. Results: IPC decreased cytolysis, lipid peroxidation and improved renal function. Parallely, IPC enhanced Akt phosphorylation, eNOS, nitrite/nitrate and HIF-1 levels as compared to I/R group. Moreover, our results showed that IPC increased the relative amounts of glucose-regulated protein 78 (GRP78) and decreased those of RNA activated protein kinase (PKR)-like ER kinase (PERK), activating transcription factor 4 (ATF4) and TNF-receptor-associated factor 2 (TRAF2) as judged to I/R group. However, pre treatment with L-NAME abolished these beneficial effects of IPC against renal I/R insults. Conclusion: These findings suggest that early IPC protects kidney against renal I/R injury via reducing oxidative and ER stresses. These effects are associated with phosphorylation of Akt, eNOS activation and NO production contributing thus to HIF-1 stabilization. The beneficial impact of IPC was abolished when NO production is inhibited before IPC application. © 2012 Mahfoudh-Boussaid et al; licensee BioMed Central Ltd., This work was supported by the Tunisian Ministry of Higher Education and Scientific Research and The Spanish Ministry of Foreign Affairs and Cooperation/AECID (A/031197/10).