Daniel Franci

Taurine enhances the anorexigenic effects of insulin in the hypothalamus of rats.

Taurine is known to modulate a number of metabolic parameters such as insulin secretion and action and blood cholesterol levels. Recent data have suggested that taurine can also reduce body adiposity in C. elegans and in rodents. Since body adiposity is mostly regulated by insulin-responsive hypothalamic neurons involved in the control of feeding and thermogenesis, we hypothesized that some of the activity of taurine in the control of body fat would be exerted through a direct action in the hypothalamus. Here, we show that the intracerebroventricular injection of an acute dose of taurine reduces food intake and locomotor activity, and activates signal transduction through the Akt/FOXO1, JAK2/STAT3 and mTOR/AMPK/ACC signaling pathways. These effects are accompanied by the modulation of expression of NPY. In addition, taurine can enhance the anorexigenic action of insulin. Thus, the aminoacid, taurine, exerts a potent anorexigenic action in the hypothalamus and enhances the effect of insulin on the control of food intake.

A simplified ultrasound-based edema score to assess lung injury and clinical severity in septic patients

BACKGROUND Lung ultrasound (US) is an excellent tool to assess lung edema in a myriad of different clinical situations. We hypothesized that lung US might also be a good prognostic and management instrument in septic patients, regardless of disease severity. METHODS This was a prospective observational cohort study at an urban academic emergency department (ED). Inclusion criteria were as follows: septic patients, at least 18 years old, admitted at the ED of a tertiary hospital. A simplified lung edema scoring system (SLESS) was developed, and 6 thoracic regions were evaluated. Four different lung US patterns were considered, from normal aeration to total consolidation. To evaluate disease severity, the SLESS was compared with the Mortality in Emergency Department Sepsis Score and the third version of the Simplified Acute Physiology Score scoring systems. Aiming to assess the effect of the lung edema in the gas exchange, the SLESS was compared with the Pao2/fraction of inspired oxygen ratio. RESULTS Sixty-one patients were enrolled in a 3-month period. The SLESS had a good correlation with the Mortality in Emergency Department Sepsis Score and Simplified Acute Physiology Score (r = 0.53 and r = 0.55, respectively; P < .001 for both) and a negative correlation with the Pao2/fraction of inspired oxygen ratio (r = -0.62; P < .001). The SLESS also showed correlation with the respiratory rate (r = 0.45; P = .0003). The odds ratio for death related to the SLESS was 1.370 (95% confidence interval, 1.109-1.691; P = .0035). CONCLUSION The SLESS is an easy and practical scoring system. It might be a useful tool to predict severity of disease in sepsis patients. The SLESS might also be able to be correlated with the oxygen exchange.

Cognitive Load and Self-Determination Theories Applied to E-Learning: Impact on Students' Participation and Academic Performance

Background Emergency clerkships expose students to a stressful environment that require multiple tasks, which may have a direct impact on cognitive load and motivation for learning. To address this challenge, Cognitive Load Theory and Self Determination Theory provided the conceptual frameworks to the development of a Moodle-based online Emergency Medicine course, inspired by real clinical cases. Methods Three consecutive classes (2013–2015) of sixth-year medical students (n = 304) participated in the course, during a curricular and essentially practical emergency rotation. “Virtual Rounds” provided weekly virtual patients in narrative format and meaningful schemata to chief complaints, in order to simulate real rounds at Emergency Unit. Additional activities such as Extreme Decisions, Emergency Quiz and Electrocardiographic challenge offered different views of emergency care. Authors assessed student´s participation and its correlation with their academic performance. A survey evaluated students´ opinions. Students graduating in 2015 answered an online questionnaire to investigate cognitive load and motivation. Results Each student produced 1965 pageviews and spent 72 hours logged on. Although Clinical Emergency rotation has two months long, students accessed the online course during an average of 5.3 months. Virtual Rounds was the most accessed activity, and there was positive correlations between the number of hours logged on the platform and final grades on Emergency Medicine. Over 90% of students felt an improvement in their clinical reasoning and considered themselves better prepared for rendering Emergency care. Considering a Likert scale from 1 (minimum load) to 7 (maximum load), the scores for total cognitive load were 4.79±2.2 for Virtual Rounds and 5.56±1.96 for real medical rounds(p<0,01). Conclusions A real-world inspired online course, based on cognitive and motivational conceptual frameworks, seems to be a strong tool to engage students in learning. It may support them to manage the cognitive challenges involved in clinical care and increase their motivation for learning.

Inflammatory lung edema correlates with echocardiographic estimation of capillary wedge pressure in newly diagnosed septic patients

Purpose: Lung ultrasound is an accurate and accessible tool to quantify lung edema. Furthermore, left ventricle filling pressures (LVFP) can be assessed with transthoracic echocardiography (TTE) by the E/e′ ratio (E/e′). The present study aimed to assess the correlation between E/e′ and lung edema quantified by a simplified lung ultrasound score (LUS) in newly admitted septic patients. Materials and methods: In this prospective observational cohort, septic adult patients admitted at the emergency department of a tertiary hospital were included. LUS consisted of four different patterns of lung edema (from normal aeration to parenchymal consolidation). To compare lung edema with LVFP, E/e′ was calculated immediately before or within 5 min of fluid therapy. Results: Fifty patients were enrolled in 3 months. The LUS correlated with E/e′ (r = 0.58, P < 0.0001). The LUS also increased among E/e′ quartiles (Q) (Q1: E/e′ ≤ 4.49; Q2: 4.49 < E/e′ ≤ 5.49; Q3: 5.49 < E/e′ ≤ 7.11; Q4: >7.11; P = 0.0003 for Q1 and 4; 2 and 4); and LUS was significantly higher in abnormal (≥8) vs. normal (<8) values of E/e′ (11.29 vs 8.49, P = 0.007). Conclusion: In newly admitted septic patients, lung edema is positively correlated with LVFP prior to fluid therapy. This finding might help find future targets for fluid resuscitation in sepsis. HighlightsPoint of care ultrasound is sensitive to identify lung edema in recently admitted septic patients.Point of care ultrasound can be used to assess diastolic dysfunction in septic patients.Lung edema correlates positively with LVFP even before fluid therapy.Point of care ultrasound is a promising tool to guide fluid management.

Circulating levels of the angiogenesis mediators endoglin, HB-EGF, BMP-9 and FGF-2 in patients with severe sepsis and septic shock

Purpose: Endothelial barrier dysfunction is a hallmark of sepsis, and is at least partially mediated by pathways that regulate endothelial barrier assembly during angiogenesis. Not surprisingly, increased levels of key angiogenic proteins such as VEGF‐A and Angiopoietin‐2 have been described in sepsis. The purpose of this study was to investigate if additional pathways that regulate endothelial barrier integrity during angiogenesis could also be involved in the host response of sepsis. Material and methods: We evaluated circulating levels of four proteins involved in angiogenesis, not previously studied in sepsis, in a cohort of 50 patients with severe sepsis and septic shock. Results: Circulating levels of BMP‐9 and FGF‐2 were similar in patients and healthy volunteers. In contrast, patients with septic shock presented 1.5‐fold higher levels of endoglin (P = 0.004), and 2‐fold lower levels of Heparin‐Binding EGF‐like growth factor (HB‐EGF) (P = 0.002) when compared to healthy individuals. Of note, HB‐EGF deficiency has been recently demonstrated to be detrimental to survival in a murine model of sepsis. Conclusions: Endoglin and HB‐EGF could be involved in the host response of sepsis. Additional studies are warrant to investigate their role as biomarker or therapeutic targets in sepsis. HighlightsSevere sepsis and septic shock are associated with higher circulating endoglin levels.Severe sepsis and septic shock are associated with lower circulating HB‐EGF levels.FGF‐2 and BMP‐9 circulating levels are not changed in severe sepsis and septic shock.