Immunomodulatory effects of anesthetics in obese patients

Anesthesia and surgery have an impact on inflammatory responses, which influences perioperative homeostasis. Inhalational and intravenous anesthesia can alter immune-system homeostasis through multiple processes that include activation of immune cells(such as monocytes, neutrophils, and specific tissue macrophages) with release of pro-or anti-inflammatory interleukins, upregulation of cell adhesion molecules, and overproduction of oxidative radicals. The response depends on the timing of anesthesia, anesthetic agents used, and mechanisms involved in the development of inflammation or immunosuppression. Obese patients are at increased risk for chronic diseases and may have the metabolic syndrome, which features insulin resistance and chronic low-grade inflammation. Evidence has shown that obesity has adverse impacts on surgical outcome, and that immune cells play an important role in this process. Understanding the effects of anesthetics on immune-system cells in obese patients is important to support proper selection of anesthetic agents, which may affect postoperative outcomes. This review article aims to integrate current knowledge regarding the effects of commonly used anesthetic agents on the lungs and immune response with the underlying immunology of obesity. Additionally, it identifies knowledge gaps for future research to guide optimal selection of anesthetic agents for obese patients from an immunomodulatory standpoint.

Physical Activity Alters Superoxide Dismutase Activity and Intercellular Adhesion Molecule 1 Levels in Diabetes Mellitus Type 2 Patients

Background: Oxidative stress and inflammation are related to the pathophysiology of diabetes mellitus (DM), being involved in the development of micro-and macrovascular complications. Physical activity is beneficial for DM patients, but little is known about the relationship between redox and inflammation biomarkers and the level of physical activity in these patients. Based on this, this research aims to evaluate the effects of physical activity level on redox stress parameters and inflammatory markers in T2DM patients. Methods: Eighty-four patients with T2DM were divided according to their physical activity level: group A (n = 48), sedentary;group B (n = 11) active (3 times a week, 150 min) and group C (n = 25), highly active (5 times a week, 150 - 300 mins, at least). Anthropometric and biochemical parameters, superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities, as well as GSH, sRAGE and ICAM-1 levels were assessed. Results: Glycated haemoglobin, total cholesterol, and LDL-cholesterol levels were lower in the highly active group in comparison to other groups. Plasma SOD activity was higher in group C compared to Group A, while ICAM-1 levels were significantly higher in group B when compared to other groups. Conclusion: Our results suggest that the practice of physical activity is beneficial to T2DM patients, especially at high volume and frequency.

Heart regeneration:Past,present and future

The heart has been considered a post-mitotic organ without regenerative capacity for most of the last century.We review the evidence that led to this hypothesis in the early 1900s and how it was progressively modified,culminating with the report that we renew 50% of our cardiomyocytes during our lifetime.The future of cardiac regenerative therapies is discussed,presenting the difficulties to overcome before repair of the diseased heart can come into clinical practice.

Stem cell therapies in cardiac diseases: Current status and future possibilities

Cardiovascular diseases represent the world’s leading cause of death. In thisheterogeneous group of diseases, ischemic cardiomyopathies are the mostdevastating and prevalent, estimated to cause 17.9 million deaths per year.Despite all biomedical efforts, there are no effective treatments that can replacethe myocytes lost during an ischemic event or progression of the disease to heartfailure. In this context, cell therapy is an emerging therapeutic alternative to treatcardiovascular diseases by cell administration, aimed at cardiac regeneration andrepair. In this review, we will cover more than 30 years of cell therapy in cardiology,presenting the main milestones and drawbacks in the field and signalingfuture challenges and perspectives. The outcomes of cardiac cell therapies arediscussed in three distinct aspects: The search for remuscularization byreplacement of lost cells by exogenous adult cells, the endogenous stem cell era,which pursued the isolation of a progenitor with the ability to induce heart repair,and the utilization of pluripotent stem cells as a rich and reliable source ofcardiomyocytes. Acellular therapies using cell derivatives, such as microvesiclesand exosomes, are presented as a promising cell-free therapeutic alternative.

Turning scar into muscle

After the demonstration that somatic cells could be reprogrammed to a pluripotent state,exciting new prospects were opened for the cardiac regeneration field.It did not take long for the development of strategies to convert somatic cells directly into cardiomyocytes.Despite the intrinsic difficulties of cell reprogramming,such as low efficiency,the therapeutic possibilities created by the ability to turn scar into muscle are enormous.Here,we discuss some of the major advances and strategies used in direct cardiac reprogramming and examine discrepancies and concerns that still need to be resolved in the field.

Bee venom acupuncture reduces neuroinflammation modulating microglia/macrophage phenotype polarization in spinal cord injury compression model

Aim: The present study aimed to examine whether apipuncture (stimulation of acupuncture points with bee venom)at ST36 and GV3 acupoints promotes neuroprotection and reduces neuroinflammation by modulating M1 and M2 phenotype polarization.Methods: Wistar rats were treated with bee venom (BV) (0.08 mg/kg) injection at acupoints ST36 and GV3 [BV (ST36 + GV3)-spinal cord injury (SCI)] or BV injection at non-acupoints [BV (NP)-SCI] or no treatment (CTL-SCI)after SCI by compression. The spinal cord mRNA expression of iNOS, Arg-1 and TGF-β was measured by real time PCR and the levels of IBA-1;BCL-2;NeuN e CNPase was measured by western blotting. Locomotor performance was measured by Basso, Beattie, and Bresnahan (BBB) and grid-walking tests.Results: Apipuncture treatment was able to (1) ameliorate locomotor performance;(2) reduce inflammatory markers (Cox-2 levels) and activation of microglia and macrophages;(3) reduce the polarization of the M1 phenotype marker (iNOS) and increase M2 (Arg-1 and TGF-β) phenotypic markers;(4) promote neuroprotection by reducing the death of neurons and oligodendrocytes;and (5) increase the expression of the anti-apoptotic factor BCL-2.Conclusion: Apipuncture treatment induces locomotor recovery and neuroprotection after the compression model of spinal cord injury. Further, it reduces neuroinflammation by decreasing M1 polarization and increasing M2 phenotype.

Ten golden rules for individualized mechanical ventilation in acute respiratory distress syndrome

Considerable progress has been made over the last decades in the management of acute respiratory distress syndrome(ARDS).Mechanical ventilation(MV)remains the cornerstone of supportive therapy for ARDS.Lung-protective MV minimizes the risk of ventilator-induced lung injury(VILI)and improves survival.Several parame-ters contribute to the risk of VILI and require careful setting including tidal volume(V_(T)),plateau pressure(P_(plat)),driving pressure(ΔP),positive end-expiratory pressure(PEEP),and respiratory rate.Measurement of energy and mechanical power allows quantification of the relative contributions of various parameters(V_(T),P_(plat),ΔP,PEEP,respiratory rate,and airflow)for the individualization of MV settings.The use of neuromuscular blocking agents mainly in cases of severe ARDS can improve oxygenation and reduce asynchrony,although they are not known to confer a survival benefit.Rescue respiratory therapies such as prone positioning,inhaled nitric oxide,and extracorporeal support techniques may be adopted in specific situations.Furthermore,respiratory weaning protocols should also be considered.Based on a review of recent clinical trials,we present 10 golden rules for individualized MV in ARDS management.