Željko Župan

Effects of enoxaparin in the rat hippocampus following traumatic brain injury

Purpose of this study was to investigate the effects of low molecular weight heparin, enoxaparin, on different parameters of the hippocampal damage following traumatic brain injury (TBI) in the rat. TBI of moderate severity was performed over the left parietal cortex using the lateral fluid percussion brain injury model. Animals were s.c. injected with either enoxaparin (1mg/kg) or vehicle 1, 7, 13, 19, 25, 31, 37, and 43 h after the TBI induction. Sham-operated, vehicle-treated animals were used as the control group. Rats were sacrificed 48h after the induction of TBI. Hippocampi were processed for spectrophotometric measurements of the products of oxidative lipid damage, thiobarbituric acid-reactive substances (TBARS) levels, as well as the activities of antioxidant enzymes, superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px). Moreover, the Western blotting analyses of the oxidized protein levels, expressions of cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), pro- and mature-interleukin-1β (pro-, and mature-IL-1β), and active caspase-3 were performed. COX-2 expressions were also explored by using immunohistochemistry. Glial fibrillary acidic protein immunochistochemistry was performed with the aim to assess the level of astrocytic activity. Fluoro-Jade B staining was used to identify the level and extent of hippocampal neuronal injury. TBI caused statistically significant increases of the hippocampal TBARS and oxidized protein levels as well as COX-2, pro-IL-1β, and active caspase-3 overexpressions, but it did not significantly affect the SOD and GSH-Px activities, the iNOS, and mature-IL-1β expression levels. TBI also induced hippocampal reactive astrocytosis and neurodegeneration. Enoxaparin significantly decreased the hippocampal TBARS and oxidized protein levels, COX-2 overexpression and reactive gliosis, but it did not influence the SOD and GSH-Px activities, pro-IL-1β and active caspase-3 overexpressions as well as neurodegeneration following TBI. These findings demonstrate that enoxaparin may reduce oxidative damage, inflammation and astrocytosis following TBI in the rat and could be a candidate drug for neuroprotective treatment of this injury.

A single dose of PPARγ agonist pioglitazone reduces cortical oxidative damage and microglial reaction following lateral fluid percussion brain injury in rats

Neuroprotective actions of the peroxisome proliferator-activated receptor-γ (PPARγ) agonists have been observed in various animal models of the brain injuries. In this study we examined the effects of a single dose of pioglitazone on oxidative and inflammatory parameters as well as on neurodegeneration and the edema formation in the rat parietal cortex following traumatic brain injury (TBI) induced by the lateral fluid percussion injury (LFPI) method. Pioglitazone was administered in a dose of 1mg/kg at 10min after the brain trauma. The animals of the control group were sham-operated and injected by vehicle. The rats were decapitated 24h after LFPI and their parietal cortices were analyzed by biochemical and histological methods. Cortical edema was evaluated in rats sacrificed 48h following TBI. Brain trauma caused statistically significant oxidative damage of lipids and proteins, an increase of glutathione peroxidase (GSH-Px) activity, the cyclooxygenase-2 (COX-2) overexpression, reactive astrocytosis, the microglia activation, neurodegeneration, and edema, but it did not influence the superoxide dismutase activity and the expressions of interleukin-1 beta, interleukin-6 and tumor necrosis factor-alpha in the rat parietal cortex. Pioglitazone significantly decreased the cortical lipid and protein oxidative damage, increased the GSH-Px activity and reduced microglial reaction. Although a certain degree of the TBI-induced COX-2 overexpression, neurodegeneration and edema decrease was detected in pioglitazone treated rats, it was not significant. In the injured animals, cortical reactive astrocytosis was unchanged by the tested PPARγ agonist. These findings demonstrate that pioglitazone, administered only in a single dose, early following LFPI, reduced cortical oxidative damage, increased antioxidant defense and had limited anti-inflammatory effect, suggesting the need for further studies of this drug in the treatment of TBI.

Peritoneal Dialysis Catheter Placement Using an Ultrasound-Guided Transversus Abdominis Plane Block

Background: Peritoneal dialysis (PD) catheter placement is usually performed using general or local anesthesia. We present our PD catheter placement experience using an ultrasound-guided transversus abdominis plane (TAP) block, which is a regional anesthesia technique. Methods: In this study, we analyzed 33 patients from our center with ESRD who underwent PD catheter placement using a TAP block between June 2011 and April 2014. Results: The TAP block was successful for 29/33 (87.9%) patients. Four patients (12.1%) had pain at the incision site and required general anesthesia. There were no anesthesia-, surgery- or catheter-related complications. Conclusion: ESRD patients have a substantial number of comorbidities that can be negatively influenced by general anesthesia. Because regional anesthesia has no systemic effect, this procedure could be recommended for this group of patients. A TAP block is an effective, safe method and can be used as the principal anesthesia technique for PD catheter placement.

Successful treatment of fulminant Lyme myocarditis with mechanical circulatory support in a young male adult: a case report

We describe the case of fulminant myocarditis due to Lyme disease and use of mechanical circulatory support (MCS) for the treatment of the Lyme carditis associated with refractory cardiogenic shock. Fulminant Lyme myocarditis in young adult male patient led to a sudden onset of acute, severe biventricular heart failure with progressive cardiogenic shock, and multiorgan failure immediately after admission. The previously healthy 28-year-old man was admitted to hospital with dyspnea, atrial flutter with 160/min ventricles rate, normotension, cardiomegaly, and incipient cardiogenic pulmonary edema on chest x-ray. Within the next 24 hours, the acute heart failure (AHF) progressed to the refractory cardiogenic shock with severe systemic hypotension, respiratory distress, anuria, liver congestion, and laboratory evidence of extremely high level of the anaerobic metabolism in the arterial blood (pH 7.16; HCO3 12.3 mmol/L; BE -14.6; lactates level 17 mmol/L). The transesophageal echo imaging showed severe dilatation and global biventricular akinesis, with left ventricular ejection fraction of 5%. The diagnosis of acute fulminant myocarditis of unknown etiology was reached. Since the patient did not respond rapidly to vasoactive and supportive therapy, MCS was immediately inserted. Broad differential diagnosis of fulminant myocarditis was considered and disseminated Borrelia infection was serologically confirmed and appropriate antimicrobial therapy was started from the fifth day after admission. MCS used over the next 26 days was successfully integrated with pharmacologic support and artificial ventilation in therapy. The patient was discharged from hospital after 65 days with a complete restoration of bilateral heart ejection fraction. This case shows that the clinical course of the Lyme carditis can present uncommonly with profound cardiovascular collapse and the MSC implementation should be considered in the early stage of drug resistant hemodynamic instability. Rapid transfer to the cardiac center where the MCS is available for all patients with signs and symptoms of AHF due to confirmed or suspected Lyme carditis would be recommended, as this treatment could be the only life-saving method.

Contents Vol. 39, 2015

Annual Congress of the 230 Chinese Blood Purification Center Administration Committee September 25–28, 2014, Guangzhou Guest Editor: Tao Wei (Beijing) Letter to the Editor 238 The Urokinase Lock-Therapy for Hemodialysis Occluded Central Venous Catheters Li Cavoli, G.; Schillaci, O.; Zagarrigo, C.; Servillo, F.; Li Cavoli, T.V.; Palmeri, M.; Rotolo, U. (Palermo)