RESUMO
BACKGROUND: Cardiovascular trials have revealed the positive impact of GLP-1 receptor agonists (GLP-1 RAs) on cardiovascular outcomes in type 2 diabetes (T2D). However, the specific effects of endogenous GLP-1 on arterial stiffness and renal function remain understudied. This study aimed to explore the influence of endogenous GLP-1 response post-bariatric surgery on arterial stiffness and renal haemodynamic. METHODS: Thirty individuals with morbid obesity and without T2D, scheduled for Roux-en-Y Gastric Bypass (RYGB), were included. Clinical parameters, 3-hour oral glucose tolerance test (OGTT) with serial sampling for glycaemia, GLP-1 and insulin, carotid-femoral pulse wave velocity (cf-PWV), carotid distensibility coefficient (carotid-DC) and renal resistive index (RRI) measurements were conducted pre-surgery and 1-year post-surgery. Participants were categorized into high-response and low-response groups based on their post-surgery increase in GLP-1 (median increase of 104% and 1%, respectively, pre- vs. post-surgery). RESULTS: Post-surgery, high-response group demonstrated a greater reduction in cf-PWV (p = .033) and a greater increase (p = .043) in carotid DC compared to low-response group. These enhancements were observed independently of weight loss or blood pressure changes. High-response group exhibited a reduction in RRI (p = .034), although this association was influenced by improvement in pulse pressure. Finally, a multivariate stepwise regression analysis indicated that the percentage increase of GLP1, Δ-GLP1(AUC)%, was the best predictor of percentage decrease in cf-PWV (p = .014). CONCLUSIONS: Elevated endogenous GLP-1 response following RYGB was associated with improved arterial stiffness and renal resistances, suggesting potential cardio-renal benefits. The findings underscore the potential role of endogenous GLP-1 in influencing vascular and renal haemodynamics independent of traditional weight loss.
Assuntos
Derivação Gástrica , Peptídeo 1 Semelhante ao Glucagon , Obesidade Mórbida , Análise de Onda de Pulso , Rigidez Vascular , Humanos , Rigidez Vascular/efeitos dos fármacos , Rigidez Vascular/fisiologia , Masculino , Feminino , Peptídeo 1 Semelhante ao Glucagon/metabolismo , Obesidade Mórbida/cirurgia , Obesidade Mórbida/fisiopatologia , Adulto , Pessoa de Meia-Idade , Hemodinâmica/efeitos dos fármacos , Rim , Teste de Tolerância a Glucose , Diabetes Mellitus Tipo 2/fisiopatologia , Cirurgia BariátricaRESUMO
In the original publication of the article have been published in an incorrect form. The correct form is given below.
RESUMO
PURPOSE: Several foods and nutrients have been independently associated with systolic (SBP) and diastolic (DBP) blood pressure values. This study aimed to evaluate the effects of combined dietary habits on SBP and DBP values in a large cohort of healthy adults, with a cross-sectional design. Adherence of participants to four a priori dietary patterns was considered: the Healthy Eating Index 2010 (HEI-2010); the Dietary Approaches to Stop Hypertension (DASH); the Greek Mediterranean Diet Score (MDS); and the Italian Mediterranean Index (IMI). METHODS: Overall, 13,597 volunteers (35-64 years) were enrolled in 1993-1998 in the EPIC-Florence cohort. Information on dietary habits, anthropometry, smoking status, education, physical activity habits, previous diagnosis of hypertension and SBP and DBP measurements were collected at baseline. Multivariate regression models were performed on 10,163 individuals (7551 women) after excluding subjects with prevalent hypertension. RESULTS: IMI, DASH and HEI-2010 were significantly and inversely associated with SBP and DBP values in the total population. The strongest association emerged between IMI and SBP (ß - 1.80 excellent adherence vs low adherence, 95% CI - 2.99; - 0.61, p trend 0.001) and DBP (ß - 1.12, 95% CI - 1.869; - 0.39, p trend 0.001) values. In sub-group analyses, an inverse association also emerged between IMI and SBP and DBP values among females and between DASH and DBP among males. MDS was not associated with SBP or DBP. CONCLUSION: Overall, this study, carried out in a large cohort of healthy adults from Tuscany (Central Italy), showed inverse significant associations between specific a priori dietary patterns, identifying general models of health-conscious diet, and blood pressure values.
Assuntos
Pressão Sanguínea , Dieta/métodos , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Adulto , Estudos de Coortes , Estudos Transversais , Abordagens Dietéticas para Conter a Hipertensão , Comportamento Alimentar , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
AIM: The present paper is a selective review on the methodology and clinical significance of techniques to assess specifically endothelial function, carotid mechanics and renal vascular function, particularly in the light of vascular dysfunction in metabolic syndrome and type 2 diabetes. DATA SYNTHESIS: Endothelial dysfunction appears to be earlier detectable in the microcirculation of patients with altered glucose metabolism, while it attains significance in the macrocirculation at more advanced disease stages. Smooth muscle cell dysfunction is now increasingly recognized to play a role both in the development of endothelial dysfunction and abnormal arterial distensibility. Furthermore, impaired glucose metabolism affects carotid mechanics through medial calcification, structural changes in extracellular matrix due to advanced glycation and modification of the collagen/elastin material stiffness. The assessment of renal vascular function by dynamic ultrasound or magnetic resonance imaging has recently emerged as an appealing target for identifying subtle vascular alterations responsible for the development of diabetic nephropathy. CONCLUSIONS: Vascular dysfunction represents a major mechanism for the development of cardiovascular disease in patients with abnormal glucose metabolism. Hence, the currently available non-invasive techniques to assess early structural and vascular abnormalities merit recommendation in this population, although their predictive value and sensitivity to monitor treatment-induced changes have not yet been established and are still under investigation.
Assuntos
Artérias Carótidas/fisiopatologia , Doenças das Artérias Carótidas/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Angiopatias Diabéticas/diagnóstico , Nefropatias Diabéticas/diagnóstico , Técnicas de Diagnóstico Cardiovascular , Endotélio Vascular/fisiopatologia , Hemodinâmica , Rim/irrigação sanguínea , Síndrome Metabólica/diagnóstico , Animais , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/etiologia , Angiopatias Diabéticas/fisiopatologia , Nefropatias Diabéticas/etiologia , Nefropatias Diabéticas/fisiopatologia , Diagnóstico Precoce , Humanos , Síndrome Metabólica/complicações , Síndrome Metabólica/fisiopatologia , Valor Preditivo dos Testes , PrognósticoRESUMO
BACKGROUND AND AIMS: The relevant role of physical activity (PA) in cardiovascular risk prevention is widely agreed. We aimed to evaluate, in a large Mediterranean population, the influence of PA on systolic (SBP) and diastolic blood pressure (DBP), taking into account individual characteristics and lifestyle habits. METHODS AND RESULTS: In the Florence section of the European Prospective Investigation into Cancer and Nutrition 10,163 individuals, 35-64 years, without a previous diagnosis of hypertension were recruited. Information on occupational and leisure-time PA and blood pressure were collected at recruitment, together with data on lifestyle, dietary habits and anthropometry. Multivariate regression models were applied to evaluate the effect of total, occupational and leisure-time PA on SBP and DBP. Mean values of SBP and DBP in the study subjects were 124.4 (SD 15.6) and 79.7 mmHg (SD 9.4), respectively. Overall, a total PA index and an index including cycling, fitness and occupational PA (Cambridge index) were inversely associated with DBP (beta -0.87, p-value 0.02 actives vs inactives, p for trend 0.02 and beta -0.84, p value 0.003 actives vs inactives, p for trend 0.002, respectively), while SBP was associated only with the latter index (beta -1.14, p-value 0.01 actives vs inactives, p for trend 0.006). An inverse association emerged between manual/heavy manual occupation and DBP (p 0.02, ref sedentary/standing occupation) and between increasing cycling activity and SBP (p for trend 0.04). CONCLUSIONS: In this large cohort of Mediterranean adults without a diagnosis of hypertension we confirm the role of overall PA in modulating SBP and DBP values. Cycling and manual occupations were associated with lower DBP values.
Assuntos
Pressão Sanguínea , Exercício Físico , Hipertensão/prevenção & controle , Estilo de Vida , Comportamento de Redução do Risco , Adulto , Estudos Transversais , Dieta Saudável , Feminino , Hábitos , Nível de Saúde , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Itália , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
BACKGROUND: Hypertension (EH) and type 2 diabetes (T2DM) are major causes of chronic kidney disease (CKD) and identification of predictors of CKD onset is advisable. We aimed to assess whether dynamic renal resistive index (DRIN), as well as other markers of systemic vascular damage, are able to predict albuminuria onset and estimated glomerular filtration rate (eGFR) decline in patients with T2DM or EH. METHODS: In this prospective observational cohort study, 27 T2DM and 43 EH patients, free of CKD at baseline, were followed-up for 4.1 ± 0.6 years. Resistive Index (RI), endothelium-dependent (FMD) and independent vasodilation in the brachial artery (after glyceryl trinitrate - GTN - 25 µg s.l.), carotid-femoral Pulse Wave Velocity (PWV), Augmentation Index (AIx), DRIN (%RI change after GTN 25 µg s.l.) were evaluated. RESULTS: Patients developing microalbuminuria were older, more frequently T2DM, with higher UACR at baseline, and showed higher DRIN (-2.8 ± 6.7 vs -10.6 ± 6.4 %, p = 0.01) and PWV (9.9 ± 1.3 vs 7.9 ± 1.5 m/s, p = 0.004) at baseline. The best predictors of microalbuminuria onset were DRIN > -5.16 % in T2DM (sensitivity 0.83, specificity 0.80) and PWV > 8.6 m/s in EH (sensitivity 0.96, specificity 1.00). Individuals whose eGFR declined (n = 27) had higher eGFR at baseline, but similar vascular characteristics; however in EH showing eGFR decline, baseline DRIN and PWV were higher. PWV showed a steeper progression during follow-up in patients developing albuminuria (Visit-outcome interaction: p = 0.01), while DRIN was early compromised but no further impaired (Visit-outcome interaction: p = 0.04). CONCLUSIONS: PWV and DRIN are able to predict microalbuminuria onset in newly diagnosed EH and T2DM. DRIN is early compromised in T2DM patients developing microalbuminuria.
Assuntos
Albuminúria/fisiopatologia , Artéria Braquial/diagnóstico por imagem , Diabetes Mellitus Tipo 2/fisiopatologia , Hipertensão/fisiopatologia , Rim/diagnóstico por imagem , Artéria Renal/diagnóstico por imagem , Vasodilatação/fisiologia , Adulto , Fatores Etários , Idoso , Albuminúria/epidemiologia , Artéria Braquial/fisiopatologia , Estudos de Coortes , Taxa de Filtração Glomerular , Humanos , Rim/irrigação sanguínea , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Onda de Pulso , Artéria Renal/fisiopatologia , Circulação Renal , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/fisiopatologia , UltrassonografiaRESUMO
OBJECTIVES: Sleep disturbances are frequently observed in rheumatic diseases including systemic lupus erythematosus (SLE). This study aimed at evaluating the prevalence of insomnia, poor sleep quality and their determinants in a cohort of SLE patients. METHODS: Eighty-one consecutive SLE female patients were evaluated in a cross-sectional study. The Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Beck Depression Inventory (BDI) and the Self-rating Anxiety Scale (SAS) were administered. Patients with previous diagnosis of obstructive sleep apnea or restless legs syndrome were excluded. Fifty-three women with hypertension (without SLE) were enrolled as control group (H). RESULTS: In the SLE cohort poor sleep quality (65.4% vs 39.6%, p < 0.01) and difficulty in maintaining sleep and/or early morning awakening (65.4% vs 22.6%, p < 0.001), but not insomnia (33.3% vs 22.6%, p = ns), were more prevalent than in H. Depressive symptoms were present in 34.6% of SLE vs 13.2% H patients (p < 0.001) while state anxiety was more common in H patients (H 35.8% vs SLE 17.3%, p < 0.005). SLE was associated with a 2.5-times higher probability of presenting poor sleep quality in comparison to H (OR 2.5 [CI 1.21-5.16]). After adjusting for confounders, both depressive symptoms (OR 4.4, [1.4-14.3]) and use of immunosuppressive drugs (OR 4.3 [CI 1.3-14.8]) were significantly associated with poor sleep quality in SLE patients. Furthermore, poor sleep quality was not associated either with disease duration or activity. CONCLUSIONS: In a cohort of SLE women, insomnia and poor sleep quality, especially difficulties in maintaining sleep, were common. Depressive symptoms might be responsible for the higher prevalence of poor sleep quality in SLE.
Assuntos
Depressão/epidemiologia , Lúpus Eritematoso Sistêmico/epidemiologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Adulto , Ansiedade/epidemiologia , Estudos Transversais , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/psicologia , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/psicologia , Pessoa de Meia-Idade , Prevalência , Escalas de Graduação Psiquiátrica , Inquéritos e QuestionáriosRESUMO
AIMS/HYPOTHESIS: Endothelium-derived factors are thought to be physiological modulators of large artery stiffness. The aim of the study was to investigate whether endothelial function could be a determinant of arterial stiffness in essential hypertensive patients, in relation with the concomitant presence of type 2 diabetes mellitus. METHODS: The study included 341 participants (84 hypertensive patients with and 175 without type 2 diabetes mellitus, 82 matched controls). Brachial artery endothelium-dependent flow-mediated dilation (FMD) was determined by high-resolution ultrasound and computerised edge detection system. Applanation tonometry was used to measure carotid-femoral pulse wave velocity (PWV). RESULTS: Hypertensive patients with diabetes had higher PWV (10.1 ± 2.3 m/s vs 8.6 ± 1.4 m/s, p < 0.001) and lower FMD (3.51 ± 2.07 vs 5.16 ± 2.96%, p < 0.001) than non-diabetic hypertensive patients, who showed impaired vascular function when compared with healthy participants (7.9 ± 1.6 m/s and 6.68 ± 3.67%). FMD was significantly and negatively correlated to PWV only in hypertensive diabetic patients (r = -0.456, p < 0.001), but not in hypertensive normoglycaemic patients (r = -0.088, p = 0.248) or in healthy participants (r = 0.008, p = 0.946). Multivariate analysis demonstrated that, in the diabetic group, FMD remained an independent predictor of PWV after adjustment for confounders (r(2) = 0.083, p = 0.003). Subgroup analysis performed in non-diabetic hypertensive patients revealed that neither obesity nor the metabolic syndrome affected the relationship between FMD and PWV. CONCLUSIONS/INTERPRETATION: Endothelial dysfunction is a determinant of aortic stiffness in hypertensive diabetic patients but not in hypertensive patients without diabetes. These results suggest that type 2 diabetes mellitus on top of hypertension might worsen arterial compliance by endothelium-related mechanisms.
Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Endotélio Vascular/fisiopatologia , Hipertensão/fisiopatologia , Rigidez Vascular/fisiologia , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Endotélio Vascular/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , UltrassonografiaRESUMO
BACKGROUND: Yellow fever (YF) may be very serious, with mortality reaching 50%. Live attenuated virus YF vaccine (YFV) is effective, but may present, although rare, life-threatening side effects and is contraindicated in immunocompromised patients. However, some transplant patients may inadvertently receive the vaccine. METHODS: A questionnaire was sent to all associated doctors to the Brazilian Organ Transplantation Association through its website, calling for reports of organ transplanted patients who have been vaccinated against YF. RESULTS: Twelve doctors reported 19 cases. None had important side effects. Only one had slight reaction at the site of YFV injection. Eleven patients were male. Organs received were 14 kidneys, 3 hearts, and 2 livers. Twelve patients received organs from deceased donors. Mean age at YFV was 45.6 ± 13.6 years old (range 11-69); creatinine: 1.46 ± 0.62 mg/dL (range 0.8-3.4); post-transplant time: 65 ± 83.9 months (range 3-340); and time from YFV at the time of survey: 45 ± 51 months (range 3-241). Immunosuppression varied widely with different drug combinations: azathioprine (7 patients), cyclosporine (8), deflazacort (1), mycophenolate (10), prednisone (11), sirolimus (3), and tacrolimus (4). CONCLUSIONS: YFV showed no important side effects in this cohort of solid organ transplanted patients. However, owing to the small number of studied patients, it is not possible to extend these findings to the rest of the transplanted population, assuring safety. Therefore, these data are not strong enough to safely recommend YFV in organ transplanted recipients, as severe, even life-threatening side effects may occur.
Assuntos
Transplante de Órgãos , Vacina contra Febre Amarela/administração & dosagem , Febre Amarela/prevenção & controle , Vírus da Febre Amarela/imunologia , Adulto , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Inquéritos e Questionários , Vacinação/métodosRESUMO
AIM/HYPOTHESIS: Renal resistive index is a useful measure for quantifying alterations in renal blood flow. In the present study we evaluated resistive index at baseline and after vasodilation induced by nitroglycerine in normoalbuminuric patients with type 2 diabetes or essential hypertension, relating the values to indices of systemic vascular dysfunction. METHODS: Newly diagnosed treatment-naïve type 2 diabetic (n = 32) and hypertensive patients (n = 49) were compared with 27 age- and sex-matched healthy controls. Renal resistive index was obtained by duplex ultrasound at baseline and after 25 µg sublingual nitroglycerine. Endothelium-dependent (flow-mediated dilation) and -independent (response to nitroglycerine) vasodilation in the brachial artery was assessed by computerised edge detection system. Carotid-femoral pulse-wave velocity and augmentation index were assessed by applanation tonometry. Nitrotyrosine levels, an index of oxidative stress, were also measured. RESULTS: Resistive index was higher in diabetic than in hypertensive patients and controls (p < 0.001), while changes in resistive index induced by nitroglycerine were lower in hypertensive patients compared with controls (p < 0.01), and were further reduced in type 2 diabetic patients. Hypertensive and diabetic patients showed significantly increased arterial stiffness, nitrotyrosine levels and reduced endothelial function than controls (p < 0.05). Changes in resistive index induced by nitroglycerine were independently related to serum glucose, reactive hyperaemia and aortic pulse-wave velocity in the overall population. CONCLUSIONS/INTERPRETATION: These results support the dynamic evaluation of renal resistive index as an early detector of renal vascular alterations in the presence of type 2 diabetes and hypertension, even before the onset of microalbuminuria.
Assuntos
Albuminúria/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Hipertensão/fisiopatologia , Rim/irrigação sanguínea , Fluxo Sanguíneo Regional/fisiologia , Adulto , Albuminúria/sangue , Albuminúria/epidemiologia , Glicemia/metabolismo , Estudos de Casos e Controles , Comorbidade , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Hipertensão/sangue , Hipertensão/epidemiologia , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Nitroglicerina/farmacologia , Estresse Oxidativo/fisiologia , Tirosina/análogos & derivados , Tirosina/sangue , Ultrassonografia , Vasodilatação/efeitos dos fármacos , Vasodilatação/fisiologia , Vasodilatadores/farmacologiaRESUMO
Conventional methods of imaging membrane potential changes have limited spatial resolution, particularly along the axis perpendicular to the cortical surface. The laminar organization of the cortex suggests, however, that the distribution of activity in depth is not uniform. We developed a technique to resolve network activity of different cortical layers in vivo using two-photon microscopy of the voltage-sensitive dye (VSD) ANNINE-6. We imaged spontaneous voltage changes in the barrel field of the somatosensory cortex of head-restrained mice and analyzed their spatiotemporal correlations during anesthesia and wakefulness. EEG recordings always correlated more strongly with VSD signals in layer (L) 2 than in L1. Nearby (<200 mum) cortical areas were correlated with one another during anesthesia. Waking the mouse strongly desynchronized neighboring cortical areas in L1 in the 4- to 10-Hz frequency band. Wakefulness also slightly increased synchrony of neighboring territories in L2 in the 0.5- to 4.0-Hz range. Our observations are consistent with the idea that, in the awake animal, long-range inputs to L1 of the sensory cortex from various cortical and thalamic areas exert top-down control on sensory processing.
Assuntos
Potenciais Somatossensoriais Evocados , Células Piramidais/fisiologia , Córtex Somatossensorial/fisiologia , Vigília , Animais , Eletroencefalografia , Corantes Fluorescentes/análise , Camundongos , Camundongos Endogâmicos C57BL , Microscopia de Fluorescência/métodos , Fótons , Células Piramidais/citologia , Córtex Somatossensorial/citologiaRESUMO
We propose herein a mathematical model to predict the COVID-19 evolution and evaluate the impact of governmental decisions on this evolution, attempting to explain the long duration of the pandemic in the 26 Brazilian states and their capitals well as in the Federative Unit. The prediction was performed based on the growth rate of new cases in a stable period, and the graphics plotted with the significant governmental decisions to evaluate the impact on the epidemic curve in each Brazilian state and city. Analysis of the predicted new cases was correlated with the total number of hospitalizations and deaths related to COVID-19. Because Brazil is a vast country, with high heterogeneity and complexity of the regional/local characteristics and governmental authorities among Brazilian states and cities, we individually predicted the epidemic curve based on a specific stable period with reduced or minimal interference on the growth rate of new cases. We found good accuracy, mainly in a short period (weeks). The most critical governmental decisions had a significant temporal impact on pandemic curve growth. A good relationship was found between the predicted number of new cases and the total number of inpatients and deaths related to COVID-19. In summary, we demonstrated that interventional and preventive measures directly and significantly impact the COVID-19 pandemic using a simple mathematical model. This model can easily be applied, helping, and directing health and governmental authorities to make further decisions to combat the pandemic.
Assuntos
COVID-19/epidemiologia , Brasil/epidemiologia , COVID-19/transmissão , Cidades/epidemiologia , Humanos , Modelos Estatísticos , Pandemias , SARS-CoV-2/isolamento & purificação , Fatores de TempoRESUMO
Hypertensive emergencies (HE) and urgencies (HU) are frequent causes of patients referral to Emergency Department (ED) and the approach may be different according to local clinical practice. Our aim was to explore awareness, management, treatment and counselling after discharge of HE and HU in Italy, by mean of an on-line survey. The young investigator research group of the Italian Society of Hypertension developed a 23-item questionnaire spread by e-mail invitation to the members of Italian Scientific societies in the field of Hypertension. 665 questionnaires were collected from EDs, Emergency and Urgency Medicine, Cardiology or Coronary Units, Internal Medicines, Intensive care, Stroke units. Symptoms considered suspicious of acute organ damage were: chest pain (89.0%), visual disturbances (89.8%), dyspnoea (82.7%), headache (82.1%), dizziness (52.0%), conjunctival haemorrhages (41.5%), tinnitus (38.2%) and epistaxis (34.4%). Exams more frequent prescribed were: electrocardiogram (97.2%), serum creatinine (91.4%), markers of cardiomyocyte necrosis (66.2%), echocardiography (65.1%). The use of intravenous or oral medications to treat HEs was 94.7% and 3.5%, while for HUs 24.4% and 70.8% respectively. Of note, a surprisingly high percentage of physicians (22 % overall, 24.5% in North Italy) used to prescribe sublingual nifedipine. After discharge, home blood pressure monitoring and general practitioner re-evaluation were more frequently suggested, while ambulatory blood pressure monitoring and hypertension specialist examination were less prescribed. The differences observed across the different macro-areas, regarded prescription of diagnostic test and drug administration. This survey depicts a complex situation of shades and lights in the real-life management of HE and HU in Italy.
Assuntos
Emergências , Hipertensão , Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial , Cuidados Críticos , Serviço Hospitalar de Emergência , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , ItáliaRESUMO
Out-of-office blood pressure (BP) measurement is encouraged by recent hypertension guidelines for assessing BP phenotypes. These showed acceptable reproducibility in the short term, but few data exist about long-term reproducibility, particularly for chronic kidney disease (CKD) patients. We evaluated changes of the BP phenotypes at 6 and 12 months in 280 consecutive non-dialysis CKD outpatients (186 males, age 71 ± 12 years, eGFR 38 ± 13 ml/min/1.73), without any change in drug therapy. Elevated BP is defined as office BP > 140/90 and home BP > 135/85 mmHg for defining the following BP phenotypes: sustained uncontrolled hypertension (SUCH); white-coat uncontrolled hypertension (WUCH); masked uncontrolled hypertension (MUCH); and controlled hypertension (CH). At baseline, the prevalence of the phenotypes was SUCH 36.6%, CH 30.1%, WUCH 25.4% and MUCH 7.9%, and it was similar at 6 months and 12 months. On the other hand, individual phenotype reproducibility at 12 months was poor both overall (38.0%) and across the different phenotypes (SUCH 53.9%, WUCH 32.4% and CH 32.1%, MUCH 9.1%). Patients who were not maintaining the same phenotype (non-concordant) were not distinguished by age, sex, BMI, eGFR, presence of diabetes or cardiovascular disease, or pharmacological therapy. When reproducibility of BP phenotypes both at 6 months and at 12 months was assessed, it was very low (19.6%), particularly for MUCH (0%), CH (14%) and WUCH (15.5%), while it was 31% for SUCH. In a CKD cohort, the overall prevalence of the different BP phenotypes defined by office and home BP remains constant over time. However, only 38% of patients maintained the same phenotype at 12 months, suggesting a poor reproducibility over time for the BP phenotypes.
Assuntos
Pressão Sanguínea/fisiologia , Fenótipo , Insuficiência Renal Crônica/complicações , Hipertensão do Jaleco Branco/genética , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Pressão Sanguínea/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal Crônica/fisiopatologia , Fatores de Risco , Estatísticas não Paramétricas , Hipertensão do Jaleco Branco/fisiopatologiaRESUMO
Uncovering the physiological correlates of dreams is one of the most ambitious aim of multidisciplinary neuroscientific research. Here we investigated Autonomic Nervous System (ANS) dynamics associated with a dream recall, with a particular focus on the complexity assessment on cardiovascular control. We recorded electrocardiogram and arterial blood pressure signals from eight healthy subjects during rapid-eye-movement sleep before awakenings. Recordings were then split into two groups: the ones with a dream experience, and the ones without recall of dream experiences. The randomness of cardiovascular variability series was assessed through Sample Entropy metrics, which did not show any statistical difference between groups. On the other hand, a multiscale complexity analysis based on Distribution Entropy and Fuzzy Entropy revealed that a higher cardiovascular complexity is associated with a dreaming experience.
Assuntos
Eletrocardiografia , Frequência Cardíaca , Sono REM , Sonhos , Eletrocardiografia/estatística & dados numéricos , Entropia , Humanos , Rememoração MentalRESUMO
The characterization of individual neurons by Golgi and Cajal has been the basis of neuroanatomy for a century. A new challenge is to anatomically describe, at cellular resolution, complete local circuits that can drive behavior. In this essay, we review the possibilities to obtain a model cortical column by using in vitro and in vivo pair recordings, followed by anatomical reconstructions of the projecting and target cells. These pairs establish connection modules that eventually may be useful to synthesize an average cortical column in silico. Together with data on sensory evoked neuronal activity measured in vivo, this will allow to model the anatomical and functional cellular basis of behavior based on more realistic assumptions than previously attempted.
Assuntos
Córtex Cerebral/anatomia & histologia , Córtex Cerebral/fisiologia , Simulação por Computador , Modelos Neurológicos , Rede Nervosa/anatomia & histologia , Animais , Humanos , Rede Nervosa/fisiologia , Vias Neurais , Neurônios/citologia , Neurônios/fisiologiaRESUMO
OBJECTIVE: Recently great attention has been paid to innovative cardiovascular biomarkers obtained from wave separation (WS), wave intensity (WI) and reservoir-wave (RW) theories. All these approaches share a requirement for pressure information. The aim of this study was to evaluate differences in WS-, WI- and RW-derived parameters obtained achieving pressure waveforms in different ways. APPROACH: Twenty-two individuals (49 ± 17 years, 59% males) were examined. Common carotid blood flow waveforms were obtained from pulsed-wave Doppler images. Carotid pressure waveforms were achieved in four different ways: (1) with applanation tonometry, used as a reference method; (2) linear scaling from an ultrasound (US)-derived diameter curve; (3) exponential scaling from a US-derived diameter curve; and (4) linear scaling from an accelerometric-derived diameter signal. For each case, the reflection magnitude (RM) and index (RI) were obtained from the WS. The amplitude of the first positive peak (W 1), of the second positive peak (W 2) and of the negative peak (W b) were calculated from the WI, while the maximum of the reservoir (maxPr) and the excess (maxPex) pressure were achieved from the RW. MAIN RESULTS: According to the intra-class coefficient values, the agreement between the standard method and all the others was excellent for the RM (linear: 0.82; exponential: 0.83; accelerometric: 0.86), RI (linear: 0.84; exponential: 0.85; accelerometric: 0.87), maxPr (linear: 0.97; exponential: 0.96; accelerometric: 0.97) and maxPex (linear: 0.85; exponential: 0.87; accelerometric: 0.89), while only a fair/good level was reached for W 1 (linear: 0.67; exponential: 0.77; accelerometric: 0.52), W 2 (linear: 0.52; exponential: 0.69; accelerometric: 0.83) and W b (linear: 0.60; exponential: 0.44; accelerometric: 0.50). SIGNIFICANCE: Measuring carotid pressure waveforms with different approaches does not influence the cardiovascular parameters obtained by WS and RW; those derived by WI are affected by the carotid pressure curve employed.
Assuntos
Pressão Sanguínea , Artérias Carótidas/fisiologia , Processamento de Sinais Assistido por Computador , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-IdadeRESUMO
Common cerebral small vessel disease (cSVD) abnormalities are a common neuroradiological finding, especially in the elderly. They are associated with a wide clinical spectrum that leads to an increasing disability, impaired global function outcome and a reduced quality of life. A strong association is demonstrated with age and hypertension and other common vascular risk factors, including diabetes mellitus, dyslipoproteinemia, smoking, low vitamin B12 level, and hyperomocysteinemia. Although these epidemiological associations suggest a systemic involvement, etiopathogenetic mechanisms remain unclear. This review focuses on the potential role of endothelial dysfunction and oxidative stress in the pathogenic cascade leading to cSVD. We stressed on the central role of those pathways, and suggest the importance of quantifying the cerebral (and non-only) "endotheliopathic and oxidative load" and its clinical presentation that could lead to a better determination of vascular risk degree. In addition, understanding underlying pathogenic mechanisms could allow us to slow down the progression of vascular damage and, therefore, prevent the disability due to reiterated microvascular damage.
Assuntos
Vasos Sanguíneos/fisiopatologia , Doenças de Pequenos Vasos Cerebrais/fisiopatologia , Hipertensão/fisiopatologia , Estresse Oxidativo/genética , Idoso , Doenças de Pequenos Vasos Cerebrais/epidemiologia , Endotélio/fisiopatologia , Humanos , Hipertensão/epidemiologia , Qualidade de Vida , Fatores de RiscoRESUMO
Third molar extraction is one of the most frequent interventions in dentistry. Nevertheless, there is scarce evidence on the host response of individuals with impacted or semi-impacted third molars and the possible effects of surgical removal. A case-control study of 40 patients was designed to evaluate 1) the differences in biomarkers of systemic inflammation, vascular function, and metabolism (high-sensitive C-reactive protein, lipids, fibrinogen, oxidative stress, and endothelial function analysis) and 2) the acute and short-term effects of surgical removal in patients with bilateral impacted or semi-impacted third molars compared to controls with no third molars. Patients undergoing third molar extraction exhibited greater levels of systemic inflammation, oxidative stress, and triglycerides than controls. Raised white blood cell counts as well as peaks of serum levels of C-reactive protein and fibrinogen were noticed in the first postoperative week. Three months after the extraction, all markers returned to baseline values. Malondialdehyde, an indicator of oxidative stress indicator, was significantly reduced after third molar removal. Semi-impacted or impacted third molars are associated with higher systemic inflammation, and their removal may represent a useful human model to study acute inflammation and determine beneficial systemic effects ( ClinicalTrials.gov NCT03048175).