DENISE AYA OTSUKI
Projetos de Pesquisa
Unidades Organizacionais
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- TREATMENT WITH HUMAN UMBILICAL CORD-DERIVED MESENCHYMAL STEM CELLS IN A PIG MODEL OF SEPSIS-INDUCED ACUTE KIDNEY INJURY: EFFECTS ON MICROVASCULAR ENDOTHELIAL CELLS AND TUBULAR CELLS IN THE KIDNEY(2023) MAIA, Debora Rothstein Ramos; OTSUKI, Denise Aya; RODRIGUES, Camila Eleuterio; ZBORIL, Sabrina; SANCHES, Talita Rojas; NETO, Amaro Nunes Duarte; ANDRADE, Lucia; AULER, Jose Otavio CostaBackground: Approximately 50% of patients with sepsis develop acute kidney injury (AKI), which is predictive of poor outcomes, with mortality rates of up to 70%. The endothelium is a major target for treatments aimed at preventing the complications of sepsis. We hypothesized that human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) could attenuate tubular and endothelial injury in a porcine model of sepsis-induced AKI. Methods: Anesthetized pigs were induced to fecal peritonitis, resulting in septic shock, and were randomized to treatment with fluids, vasopressors, and antibiotics (sepsis group; n = 11) or to that same treatment plus infusion of 1 x 106 cells/kg of hUC-MSCs (sepsis+MSC group; n = 11). Results: At 24 h after sepsis induction, changes in serum creatinine and mean arterial pressure were comparable between the two groups, as was mortality. However, the sepsis+MSC group showed some significant differences in comparison with the sepsis group: lower fractional excretions of sodium and potassium; greater epithelial sodium channel protein expression; and lower protein expression of the Na-K-2Cl cotransporter and aquaporin 2 in the renal medulla. Expression of P-selectin, thrombomodulin, and vascular endothelial growth factor was significantly lower in the sepsis+MSC group than in the sepsis group, whereas that of Toll-like receptor 4 (TLR4) and nuclear factor-kappa B (NF-kappa B) was lower in the former. Conclusion: Treatment with hUC-MSCs seems to protect endothelial and tubular cells in sepsis-induced AKI, possibly via the TLR4/NF-kappa B signaling pathway. Therefore, it might be an effective treatment for sepsis-induced AKI.
- Computed Tomography Assessment of Tidal Lung Overinflation in Domestic Cats Undergoing Pressure-Controlled Mechanical Ventilation During General Anesthesia(2022) MARTINS, Alessandro R. C.; AMBROSIO, Aline M.; FANTONI, Denise T.; PINTO, Ana Carolina B. C. F.; VILLAMIZAR-MARTINEZ, Lenin Arturo; SOARES, Joao H. N.; OTSUKI, Denise A.; MALBOUISSON, Luiz Marcelo S.ObjectiveThis study aimed to evaluate lung overinflation at different airway inspiratory pressure levels using computed tomography in cats undergoing general anesthesia. Study DesignProspective laboratory study. AnimalsA group of 17 healthy male cats, aged 1.9-4.5 years and weighing 3.5 +/- 0.5 kg. MethodsSeventeen adult male cats were ventilated in pressure-controlled mode with airway pressure stepwise increased from 5 to 15 cmH(2)O in 2 cmH(2)O steps every 5 min and then stepwise decreased. The respiratory rate was set at 15 movements per min and end-expiratory pressure at zero (ZEEP). After 5 min in each inspiratory pressure step, a 4 s inspiratory pause was performed to obtain a thoracic juxta-diaphragmatic single slice helical CT image and to collect respiratory mechanics data and an arterial blood sample. Lung parenchyma aeration was defined as overinflated, normally-aerated, poorly-aerated, and non-aerated according to the CT attenuation number (-1,000 to -900 HU, -900 to -500 HU, -500 to -100 HU, and -100 to +100 HU, respectively). ResultAt 5 cmH(2)O airway pressure, tidal volume was 6.7 +/- 2.2 ml kg(-1), 2.1% (0.3-6.3%) of the pulmonary parenchyma was overinflated and 84.9% (77.6%-87.6%) was normally inflated. Increases in airway pressure were associated with progressive distention of the lung parenchyma. At 15 cmH(2)O airway pressure, tidal volume increased to 31.5 +/- 9.9 ml kg(-1) (p < 0.001), overinflated pulmonary parenchyma increased to 28.4% (21.2-30.6%) (p < 0.001), while normally inflated parenchyma decreased 57.9% (53.4-62.8%) (p < 0.001). Tidal volume and overinflated lung fraction returned to baseline when airway pressure was decreased. A progressive decrease was observed in arterial carbon dioxide partial pressure (PaCO2) and end-tidal carbon dioxide (ETCO2) when the airway pressures were increased above 9 cmH(2)O (p < 0.001). The increase in airway pressure promoted an elevation in pH (p < 0.001).
- Effects of bilateral topical administration of repeated doses of rocuronium bromide as a mydriatic agent in Amazon parrots (Amazona aestiva and Amazona amazonica)(2021) DONGO, Pamela S. J.; PINTO, Debora G.; GUIMARAES, Marta B.; OTSUKI, Denise A.; SAFATLE, Angelica M. V.; BOLZAN, Aline A.The effects of bilateral topical application of repeated doses of rocuronium in parrots are unknown, motivating this research. These effects were evaluated in 24 healthy adult Amazon parrots (12 Amazona aestiva and 12 Amazona amazonica). Three different doses of rocuronium bromide (10 mg/mL) were applied with a micropipette onto the cornea: a single instillation of 20 mu L/eye; two instillations of 20 mu L/eye, spaced 15 minutes apart; and three instillations of 20 mu L/eye, spaced 15 minutes apart. Pupillary diameter (PD) was measured with a digital caliper before treatments (TO), every 15 minutes during the first hour postadministration (T15, T30, T45, T60), hourly for 6 hours (T120, T180, T240, T300, T360), and after 24 hours (T24h). Significant differences were observed between TO and T15 -T120 with a single instillation and between TO and T15-T360 with double and triple instillations. The maximum median PDs were 3.47 mm (T45 one instillation), 3.88 mm (T45 two instillations), and 4.09 mm (T30 three instillations). PD returned to baseline at T180 with one instillation and at T24h with double and triple instillations. All protocols showed similar PD values at TO and T24h. Transient lower eyelid paresis was the only adverse effect observed. Bilateral topical administrations of two and three repeated rocuronium bromide doses produced adequate mydriasis in Amazon parrots and may be indicated for longer ophthalmic procedures.
- Transient Pulmonary Artery Hypertension in Holstein Neonate Calves(2020) YASUOKA, Melina Marie; MONTEIRO, Bruno Moura; FANTINATO-NETO, Paulo; PAIANO, Renan Braga; FANTONI, Denise Tabacchi; OTSUKI, Denise Aya; BIRGEL JUNIOR, Eduardo HarrySimple Summary At birth, calves are challenged to maintain their vital functions that were previously supported by the placenta of cows. Failures in the neonatal adaptation process can occur during this and can cause the death of neonates. The present study aimed at the invasive hemodynamic evaluation of calves during the first 30 days of life to elucidate the changes in calves during this stage of life. In conclusion, the results of this research show a transient pulmonary arterial hypertension during the process of adapting to extrauterine life. The neonatal period is a challenging phase for calves, and during this phase constant adaptations are required. The aim of the present study was to evaluate the invasive hemodynamics with the Swan-Ganz catheter in neonate calves to understand adaptive changes during the first 30 days of life. A prospective and observational study was conducted with 10 Holstein calves. Assessments of the right atrial pressure (RAP), right ventricular pressure (RVP), pulmonary artery pressure (PAP), pulmonary capillary pressure (PW), cardiac output (CO), heart rate (HR), pulmonary vascular resistance (PVR), and blood gas levels were performed. The analyses of PAP, PVR, PW, HR, sO(2), and arterial blood gases differed (p < 0.05) between the evaluated periods. Our results indicated transient pulmonary artery hypertension during the process of extrauterine adaptation during the first 30 days of life. This hypertension must be considered as physiological and consequent to the neonatal adaptation process.
- Can a Therapeutic Strategy for Hypotension Improve Cerebral Perfusion and Oxygenation in an Experimental Model of Hemorrhagic Shock and Severe Traumatic Brain Injury?(2023) BALZI, Ana Paula de Carvalho Canela; OTSUKI, Denise Aya; ANDRADE, Lucia; PAIVA, Wellingson; SOUZA, Felipe Lima; AURELIANO, Luiz Guilherme Cernaglia; MALBOUISSON, Luiz Marcelo SaBackgroundRestoration of brain tissue perfusion is a determining factor in the neurological evolution of patients with traumatic brain injury (TBI) and hemorrhagic shock (HS). In a porcine model of HS without neurological damage, it was observed that the use of fluids or vasoactive drugs was effective in restoring brain perfusion; however, only terlipressin promoted restoration of cerebral oxygenation and lower expression of edema and apoptosis markers. It is unclear whether the use of vasopressor drugs is effective and beneficial during situations of TBI. The objective of this study is to compare the effects of resuscitation with saline solution and terlipressin on cerebral perfusion and oxygenation in a model of TBI and HS.MethodsThirty-two pigs weighing 20-30 kg were randomly allocated into four groups: control (no treatment), saline (60 ml/kg of 0.9% NaCl), terlipressin (2 mg of terlipressin), and saline plus terlipressin (20 ml/kg of 0.9% NaCl + 2 mg of terlipressin). Brain injury was induced by lateral fluid percussion, and HS was induced through pressure-controlled bleeding, aiming at a mean arterial pressure (MAP) of 40 mmHg. After 30 min of circulatory shock, resuscitation strategies were initiated according to the group. The systemic and cerebral hemodynamic and oxygenation parameters, lactate levels, and hemoglobin levels were evaluated. The data were subjected to analysis of variance for repeated measures. The significance level established for statistical analysis was p < 0.05.ResultsThe terlipressin and saline plus terlipressin groups showed an increase in MAP that lasted until the end of the experiment (p < 0.05). There was a notable increase in intracranial pressure in all groups after starting treatment for shock. Cerebral perfusion pressure and cerebral oximetry showed no improvement after hemodynamic recovery in any group. The groups that received saline at resuscitation had the lowest hemoglobin concentrations after treatment.ConclusionsThe treatment of hypotension in HS with saline and/or terlipressin cannot restore cerebral perfusion or oxygenation in experimental models of HS and severe TBI. Elevated MAP raises intracranial pressure owing to brain autoregulation dysfunction caused by TBI.
- Cardiac arrest animal model: a simple device for small animals' chest compression(2017) VANE, Matheus F.; CARMONA, Maria Jose Carvalho; OTSUKI, Denise A.; MAIA, Debora R. R.; VANE, Lucas F.; VANE, Luiz A.; ARAUJO FILHO, Elson Alberto Fernandes de; XAVIER, Marcelo; AULER JUNIOR, Jose Otavio Costa
- Assessment of left ventricle myocardial deformation in a hemorrhagic shock swine model by two-dimensional speckle tracking echocardiography(2022) VASCONCELLOS, Henrique Doria de; SAAD, Karen Ruggeri; SAAD, Paulo Fernandes; OTSUKI, Denise Aya; CIUFFO, Luisa A.; LESTER, Laeben; KOIKE, Marcia Kiyomi; ARMSTRONG, Anderson da Costa; LIMA, Joao A. C.; MONTERO, Edna Frasson de SouzaBACKGROUND Trauma-induced secondary cardiac injury has been associated with significant adverse cardiovascular events. Speckle tracking echocardiography is a novel technology that allows an accurate and reproducible cardiac structure and function assessment. We evaluated the left ventricle (LV) myocardial deformation by speckle tracking echocardiography in a hemorrhagic shock (HS) swine model. METHODS Seven healthy male Landrace pigs were included in this study. Severe HS was reached through three sequentially blood withdraws of 20% of estimated blood volume, and it was maintained for 60 minutes. Volume resuscitation was performed using all precollected blood volume. A 1.8- to 4.2-MHz phased-array transducer was used to acquire the two-dimensional echocardiography images. Strain measurements were obtained semiautomatically by wall motion tracking software. Results are presented as medians and interquartile ranges and compared using Wilcoxon rank-sum test. A p value of <0.05 was considered statistically significant. RESULTS The median weight was 32 (26.1-33) kg, and the median total blood volume withdrawn was 1,100 (1,080-1,190) mL. During the severe HS period, the median arterial systemic pressure was 39 (36-46) mm Hg, and the cardiac index was 1.7 (1.6-2.0) L/min/m(2). There was statistically significant absolute decrease in the global longitudinal strain 2 hours postresuscitation comparing with the basal measurements (-9.6% [-10.7 to -8.0%] vs. -7.9% [-8.1 to -7.4%], p = 0.03). There were no statistically significant differences between the basal and 2 hours postresuscitation assessments in the invasive/noninvasive hemodynamic, other two-dimensional echocardiogram (LV ejection fraction, 49.2% [44-54.3%] vs. 53.2% [51.5-55%]; p = 0.09), and circumferential strain (-10.6% [-14.4 to -9.0%] vs. -8.5% [-8.6 to -5.2%], p = 0.06) parameters. CONCLUSION In this experimental swine model of controlled HS, LV global longitudinal strain analysis accurately characterizes the timing and magnitude of subclinical cardiac dysfunction associated with trauma-induced secondary cardiac injury.
- Effects of dexmedetomidine on hemodynamic, oxygenation, microcirculation, and inflammatory markers in a porcine model of sepsis(2022) CARNICELLI, Paulo; OTSUKI, Denise Aya; MONTEIRO FILHO, Adalberto; KAHVEGIAN, Marcia Aparecida Portela; IDA, Keila Kazue; AULER-JR, Jose Otavio Costa; ROUBY, Jean-Jacques; FANTONI, Denise TabacchiPurpose: To determine whether dexmedetomidine aggravates hemodynamic, metabolic variables, inflammatory markers, and microcirculation in experimental septic shock. Methods: Twenty-four pigs randomized into: Sham group (n = 8), received saline; Shock group (n = 8), received an intravenous infusion of Escherichia coli O55 (3 x 10(9) cells/mL, 0.75 mL/kg, 1 hour); Dex-Shock group (n = 8), received bacteria and intravenous dexmedetomidine (bolus 0.5 mcg/kg followed by 0.7 mcg/kg/h). Fluid therapy and/ornorepinephrine were administered to maintain a mean arterial pressure > 65 mmHg. Hemodynamic, metabolic, oxygenation, inflammatory markers, and microcirculation were assessed at baseline, at the end of bacterial infusion, and after 60, 120, 180, and 240 minutes. Results: Compared to Shock group, Dex-Shock group presented a significantly increased oxygen extraction ratio at T180 (23.1 +/- 9.7 vs. 32.5 +/- 9.2%, P = 0.0220), decreased central venous pressure at T120 (11.6 +/- 1 vs. 9.61 +/- 1.2 mmHg, P = 0.0214), mixed-venous oxygen saturation at T180 (72.9 +/- 9.6 vs. 63.5 +/- 9.2%, P = 0.026), and increased plasma lactate (3.7 +/- 0.5 vs. 5.5 +/- 1 mmol/L, P = 0.003). Despite the Dex-Shock group having a better sublingual vessel density at T240 (12.5 +/- 0.4 vs. 14.4 +/- 0.3 mL/m(2); P = 0.0003), sublingual blood flow was not different from that in the Shock group (2.4 +/- 0.2 vs. 2.4 +/- 0.1 mL/kg, P = 0.4418). Conclusions: Dexmedetomidine did not worsen the hemodynamic, metabolic, inflammatory, or sublingual blood flow disorders resulting from septic shock. Despite inducing a better sublingual vessel density, dexmedetomidine initially and transitorily increased the mismatch between oxygen supply and demand.
- Sildenafil in endotoxin-induced pulmonary hypertension: an experimental study(2023) KEMPER, Daniella Aparecida Godoi; OTSUKI, Denise Aya; MAIA, Debora Rothstein Ramos; MOSSOCO, Cristina de Oliveira; MARCASSO, Rogerio Anderson; CUNHA, Ligia Cristina Camara; JR, Jose Otavio Costa Auler; FANTONI, Denise TabacchiBackground: Sepsis and septic shock still represent great challenges in critical care medicine. Sildenafil has been largely used in the treatment of pulmonary arterial hypertension, but its effects in sepsis are unknown. The aim of this study was to investigate the hypothesis that sildenafil can attenuate endotoxin-induced pulmonary hypertension in a porcine model of endotoxemia. Methods: Twenty pigs were randomly assigned to Control group (n = 10), which received saline solution; or to Sildenafil group (n = 10), which received sildenafil orally (100 mg). After 30 min-utes, both groups were submitted to endotoxemia with intravenous bacterial lipopolysaccharide endotoxin (LPS) infusion (4 & mu;g.kg-1.h-1) for 180 minutes. We evaluated hemodynamic and oxy-genation functions, and also lung histology and plasma cytokine (TNFa, IL-1(3, IL6, and IL10) and troponin I response. Results: Significant hemodynamic alterations were observed after 30 minutes of LPS contin-uous infusion, mainly in pulmonary arterial pressure (from Baseline 19 & PLUSMN; 2 mmHg to LPS30 52 & PLUSMN; 4 mmHg, p < 0.05). There was also a significant decrease in PaO2/FiO2 (from Baseline 411 & PLUSMN; 29 to LPS180 334 & PLUSMN; 49, p < 0.05). Pulmonary arterial pressure was significantly lower in the Sildenafil group (35 & PLUSMN; 4 mmHg at LPS30, p < 0.05). The Sildenafil group also presented lower values of systemic arterial pressure. Sildenafil maintained oxygenation with higher PaO2/FiO2 and lower oxygen extraction rate than Control group but had no effect on intrapulmonary shunt. All cytokines and troponin increased after LPS infusion in both groups similarly.Conclusion: Sildenafil attenuated endotoxin-induced pulmonary hypertension preserving the correct heart function without improving lung lesions or inflammation.& COPY; 2021 Published by Elsevier Editora Ltda. on behalf of Sociedade Brasileira de Anestesiologia. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).