Fourier phase index for extracting signatures of determinism and nonlinear features in time series.

Detecting determinism and nonlinear properties from empirical time series is highly nontrivial. Traditionally, nonlinear time series analysis is based on an error-prone phase space reconstruction that is only applicable for stationary, largely noise-free data from a low-dimensional system and requires the nontrivial adjustment of various parameters. We present a data-driven index based on Fourier phases that detects determinism at a well-defined significance level, without using Fourier transform surrogate data. It extracts nonlinear features, is robust to noise, provides time-frequency resolution by a double running window approach, and potentially distinguishes regular and chaotic dynamics. We test this method on data derived from dynamical models as well as on real-world data, namely, intracranial recordings of an epileptic patient and a series of density related variations of sediments of a paleolake in Tlaxcala, Mexico.

Long-term outcomes of symptomatic and asymptomatic patients undergoing carotid endarterectomy in an average-volume community hospital.

BACKGROUND: Long-term benefit of carotid endarectomy has not yet been fully investigated in average volume centers. Thus our purpose is to evaluate long-term results of carotid endarterectomies at a medium-volume hospital. METHODS: A retrospective analysis of carotid artery stenosis operated between 2008 and 2017 in a community hospital was done. Demographic and postoperative outcomes were evaluated in short and long-term by Kaplan-Meier survival analysis. RESULTS: 167 procedures in 159 patients were included. Average age was 72 years, and 65% were men. Twenty-nine percent of the patients were symptomatic and the rest asymptomatic. Median hospitalization was 3 (IQR 3-4) days and the mean follow-up was 56 months. No hospital mortality was recorded. At 120-month follow-up, freedom of stroke was 97.4%, death 97.3%, restenosis, 98.7% and all combined events 92.9% (log rank p = .042) Combined event-free survival was 84.4% in symptomatic patients, and 96.1% in asymptomatic patients (log rank p = .025). CONCLUSIONS: In a medium-volume hospital combined event-free survival was 84.4% in symptomatic patients and 96.1% in asymptomatic at a 10-year follow-up.

[Erratic consent and lability of discernment]. / Errances du consentement et labilité du discernement.

Consent and discernment are two important notions, constantly present in the daily life of psychiatric caregivers. The Haute Autorité de santé sheds valuable light on discernment by defining it in terms of five characteristics. As for consent, it is based on the fundamental principle of an agreement given on a proposal with a perception of the stakes by the different parties. The consequences within the multidisciplinary team are multiple, between the information recorded in the shared medical record, the care decisions according to the clinic and the impact on the patients' group. These are all serious ethical and practical difficulties.

Health Service Utilisation, Detection Rates by Family Practitioners, and Management of Patients with Common Mental Disorders in French Family Practice.

OBJECTIVE: Provide up-to-date detection rates for common mental disorders (CMD) and examine patient service-use since the Preferred Doctor scheme was introduced to France in 2005, with patients encouraged to register with and consult a family practitioner (FP) of their choice. METHODS: Study of 1133 consecutive patients consulting 38 FPs in the Montpellier region, replicating a study performed before the scheme. Patients in the waiting room completed the self-report Patient Health Questionnaire (PHQ) and Client Service-Receipt Inventory with questions on registration with a Preferred Doctor and doctor-shopping. CMD was defined as reaching PHQ criteria for depression, somatoform, panic or anxiety disorder. For each patient, FPs completed a questionnaire capturing psychiatric caseness. RESULTS: 81.2% of patients were seeing their Preferred Doctor on the survey-day. Of those with a CMD, 52.6% were detected by the FP. This increased with CMD severity and comorbidity. Detected cases were more likely to be consulting their Preferred Doctor (84.7% versus 79.4% for non-detected cases, p = 0.05) rather than another FP. They declared more visits to psychiatrists (17.2% versus 6.7%, p = 0.002). There was no association with consultation frequency or doctor-shopping, which both declined between the two studies. CONCLUSION: The CMD detection rate is relatively high, with no increase compared to our previous study, despite a decline in doctor-shopping. An explanation is the same high proportion of patients visiting their usual FP on the survey-day at both periods, suggesting a limited impact of the scheme on care continuity. FP action taken highlights the importance of improving detection for providing care to patients with CMDs.

Patient Satisfaction and Efficacy of Full-Facial Rejuvenation Using a Combination of Botulinum Toxin Type A and Hyaluronic Acid Filler.

BACKGROUND: Combination treatments using hyaluronic acid (HA) fillers and botulinum toxin Type A (BoNT-A) are common in aesthetic medicine; however, this has been evaluated in only a few clinical studies. OBJECTIVE: To evaluate subject satisfaction, efficacy, and safety of BoNT-A (Speywood Unit; s.U) and a range of HA fillers for full-facial aesthetic rejuvenation. MATERIALS AND METHODS: A 6-month, multicenter, open-label clinical study, using BoNT-A (s.U) and 5 HA fillers to treat up to 13 facial zones. Subject satisfaction questionnaires were administered 3 weeks and 6 months after the last injection. Global aesthetic improvement and improvement on each treated zone as well as safety were evaluated. RESULTS: A high level of satisfaction was achieved throughout the study, with 96.5% of subjects at least satisfied with the full-facial aesthetic outcome at 3 weeks, and 92.9% at 6 months. More than 91% considered the treatment outcome to meet or surpass their expectations, and more than 94% would recommend the treatment to others. At Week 3, subject and investigator assessment showed aesthetic improvement for all subjects. The treatment was well tolerated. CONCLUSION: The combination of BoNT-A (s.U) and HA fillers results in high patient satisfaction and in an overall improvement of aesthetic outcomes and quality of life.

Long-Term Efficacy and Tolerability of a Medium G' HA Filler with Tri-Hyal Technology on the Rejuvenation of the Mobile Facial Zone.

Purpose: Injectable hyaluronic acid-based fillers are commonly used for the correction of skin contour irregularities and to smooth skin depressions formed by volume loss during the aging process. These fillers are particularly efficient to restore perioral skin depressions/wrinkles or to correct topographical anomalies. The European directives require a continuous evaluation of the performance of these medical devices, particularly for CE marked products. Methods: An 18-month prospective randomized single-blind study for the efficacy and safety of ART FILLER Universal (AFU) was performed on the lips, the nasolabial folds, and the marionettes lines. The evaluations were performed on 153 subjects enrolled in this study. The efficacy, the longevity, and the safety were evaluated for the injected areas via area specific clinical scoring after a single injection with the filler and with no re-touch. Results: We showed here that filler injection induced potent improvements of volume restoration after a single injection on all the treated areas. These beneficial properties of the filler were significant 3 weeks after injection and during the whole study period. Moreover, injections of the filler were well tolerated by the subjects. The recorded adverse events are routinely seen with HA fillers for face volume corrections, and most of these local reactions resolved within 14 days. Conclusion: AFU was well tolerated and showed a continuous efficacy for at least 18 months, in exploratory analyses.

A prospective multicenter clinical trial evaluating the efficacy and safety of a hyaluronic acid-based filler with Tri-Hyal technology in the treatment of lips and the perioral area.

BACKGROUND: Age-related changes of facial soft tissue cause clinical signs of facial aging such as lip atrophy, marionette lines, and an accentuated nasolabial fold. These changes can be modified using dermal fillers. AIMS: To evaluate efficacy, longevity, and safety of a cross-linked hyaluronic acid-based filler with Tri-Hyal technology in the treatment of lips, nasolabial folds, and marionette lines. MATERIALS AND METHODS: This prospective, multi-center trial evaluated injections of three different areas (lips, nasolabial fold alone, or with marionette wrinkles) with a soft tissue filler containing 25 mg/ml cross-linked hyaluronic acid and 0.3% lidocaine. Primary endpoint was the aesthetic correction 3 weeks after one injection session without touch-up. Follow-up was 18 months. Assessments were performed using the Global Aesthetic Score (GAS), clinical scoring based on photographic scales, high-frequency ultrasound imaging, and the Global Aesthetic Improvement Scale (GAIS). RESULTS: In total, 100 subjects were injected. GAS improved significantly for all treatment indications at 3 weeks (p < 0.0001). Success rates were highest for nasolabial folds (98.4%), followed by marionette lines (94.4%) and lips (73.5%). After 18 months post-injection, success was observed in 91%, 88%, and 33% of subjects injected into nasolabial folds, marionette lines, and lips, respectively. GAIS scored highest for nasolabial folds (SGAIS: 71%; IGAIS: 40%), followed by marionette lines (SGAIS: 56%; IGAIS: 33%) and lips (SGAIS: 30%; IGAIS: 22%) at 18 months follow-up. CONCLUSIONS: The filler demonstrated high efficacy and safety in all indications. Regional differences in longevity were evident. Thus, the necessity of regional retreatments should be discussed with patients before injection.

Disruption of a long distance regulatory region upstream of SOX9 in isolated disorders of sex development.

BACKGROUND: The early gonad is bipotential and can differentiate into either a testis or an ovary. In XY embryos, the SRY gene triggers testicular differentiation and subsequent male development via its action on a single gene, SOX9. The supporting cell lineage of the bipotential gonad will differentiate as testicular Sertoli cells if SOX9 is expressed and conversely will differentiate as ovarian granulosa cells when SOX9 expression is switched off. RESULTS: Through copy number variation mapping this study identified duplications upstream of the SOX9 gene in three families with an isolated 46,XX disorder of sex development (DSD) and an overlapping deletion in one family with two probands with an isolated 46,XY DSD. The region of overlap between these genomic alterations, and previously reported deletions and duplications at the SOX9 locus associated with syndromic and isolated cases of 46,XX and 46,XY DSD, reveal a minimal non-coding 78 kb sex determining region located in a gene desert 517-595 kb upstream of the SOX9 promoter. CONCLUSIONS: These data indicate that a non-coding regulatory region critical for gonadal SOX9 expression and subsequent normal sex development is located far upstream of the SOX9 promoter. Its copy number variations are the genetic basis of isolated 46,XX and 46,XY DSDs of variable severity (ranging from mild to complete sex reversal). It is proposed that this region contains a gonad specific SOX9 transcriptional enhancer(s), the gain or loss of which results in genomic imbalance sufficient to activate or inactivate SOX9 gonadal expression in a tissue specific manner, switch sex determination, and result in isolated DSD.

Does Menopausal Hormone Therapy, Exercise, or Both Improve Pain and Function in Postmenopausal Women With Greater Trochanteric Pain Syndrome? A 2 × 2 Factorial Randomized Clinical Trial.

BACKGROUND: Greater trochanteric pain syndrome (GTPS) is a debilitating chronic condition, most prevalent in postmenopausal women. A positive association between high estrogen levels and tendon health may exist, and postmenopausal women have reduced estrogen. Menopausal hormone therapy (MHT) may reduce the incidence of tendon abnormality, particularly when combined with exercise. PURPOSE: To determine the effect of MHT and exercise on tendon pain and function in postmenopausal women with GTPS. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: Postmenopausal women (N = 132; n = 12, lost to follow-up) with GTPS were randomized into MHT and placebo transdermal cream groups combined with tendon-specific or sham exercise. All groups received education about avoiding gluteal tendon compression and load management throughout 12 weeks of intervention. The primary outcome was the Victorian Institute of Sport Assessment for gluteal tendinopathy (VISA-G), and secondary outcomes were measured at baseline and at 12 and 52 weeks. The Global Rating of Change was assessed at 12 and 52 weeks. A linear mixed-effects model was used to assess differences. Body mass index (BMI) was included as a covariate. RESULTS: All participant groups improved over time (baseline vs 12 weeks, P < .001; baseline vs 52 weeks, P < .001). There was no difference among exercise groups measured by all outcomes (VISA-G: baseline, P = .97, mean difference [MD] = 0.10; 12 weeks, P = .49, MD = 2.15; 52 weeks, P = .32, MD = -3.08). There was a significant interaction effect between cream and BMI; therefore, the population was stratified by BMI levels (<25, <30, ≥30). The MHT groups (with exercise and education) had significantly better VISA-G outcomes (baseline, P = .04, MD = -11.20, 95% CI = -21.70 to -0.70; 12 weeks, P < .001, MD = -20.72, 95% CI = -31.22 to -10.22; 52 weeks, P = .002, MD = -16.71, 95% CI = -27.21 to -6.22) and secondary measure scores as compared with placebo at all time points when BMI was <25. CONCLUSION: MHT or placebo combined with tendon-specific or sham exercise plus education reduced pain and increased function for this population. For women with a BMI <25, MHT with any exercise plus education was better than placebo. A targeted exercise or sham exercise strategy is effective when prescribed with education about avoiding gluteal tendon compression and load management. REGISTRATION: ACTRN12614001157662 (Australian New Zealand Clinical Trials Registry).

Atrial and vascular oxidative stress in patients with heart failure.

Heart failure is characterized by a great number of metabolic and histological defects, however, previous studies did not provide strong evidence of a correlation between the antioxidant status of myocardial tissue itself and cardiac function. The goal of our study was to assess, in patients with heart failure consecutive to dilated cardiomyopathy (DCM), alterations in norepinephrine (NE), lipid peroxidation (malonedialdehyde: MDA) and iron levels in different parts of the myocardium and aorta, in relation to functional parameters. Biopsied heart samples were obtained from 12 DCM patients and from 4 brain-dead organ donors (Controls). The left ventricular ejection fraction (LVEF) was reduced to 19.1±2.6% in DCM. For all patients, the distribution of NE in the atria, ventricles and vessels was different, but NE content in control hearts was systematically higher than in cardiomyopathy patients. MDA levels tended to be higher in the different samples from the DCM group in comparison with the values obtained in the C group; the values were significantly decreased (p<0.05) in endocardium and the aortic samples. In the right atrium there was a significant correlation between NE content and LVEF and between MDA and iron concentrations. These findings could give further insights into the relationship between iron metabolism disturbances and the severity of cardiovascular diseases.

[The links between justice and public health: a major issue for psychiatry and the public authorities]. / Santé publique et mesures de justice. Une problématique centrale posée à la psychiatrie et aux pouvoirs publics.

The level of cooperation between legal and healthcare professionals in psychiatry has increased significantly as a result of the greater emphasis on safety and security and the increasing tendency to place mental disorders in a judicial or legal context. As a result of the many new laws that have been passed since 1998, psychiatrists are increasingly required "to treat criminal recidivism and prevent violent behavior". These issues have been highlighted by the scientific, medical and legal community, though without ever resulting in any action by the public authorities. Based on an examination of the care provided to a prisoner before, during and after incarceration, this study suggests that despite the existing regulatory framework and the abundance of data on the provision of care (including psychiatric care), a comprehensive review of the current system is required. To what extent is care management effective and consistent? Are the stated economic objectives achievable? This paper argues that in a prison context the range of healthcare options needs to be clearly defined and laid out in order to provide mental health patients and mental health professionals with a realistic vision of care provision.

Three-dimensional virtual and printed models for planning adult cardiovascular surgery.

BACKGROUND: The objective of this study was to explore the usefulness of virtual models and three-dimensional (3D) printing technologies for planning complex non-congenital cardiovascular surgery. METHODS: Between July 2018 and December 2019, adult patients with different cardiovascular structural diseases were included in a clinical protocol to explore the usefulness of Standard Tessellation Language (STL)-based virtual models and 3D printing for prospectively planning surgery. A qualitative descriptive analysis from the surgeon's viewpoint was done based on the characteristics, advantages and usefulness of 3D models for guiding, planning and simulating the surgical procedures. RESULTS: A total of 14 custom 3D-printed heart and great vessel replicas with their corresponding 3D virtual models were created for preoperative surgical planning. Six of 14 models helped to redefine the surgical approach, 3 were useful to verify device delivery, while the rest did not change the surgical decision. In all open surgery cases, cardiac and vascular anatomy accuracy of virtual and physical 3D replicas was validated by direct visualisation of the organs during surgery. Printing was achieved through an external provider associated with the Hospital, who printed the final prototype in 5-7 days. Printed production cost was between 100 and 500 USD per model. CONCLUSIONS: In the current study, the selected 3D printed models presented different advantages (visual, tactile, and instrumental) over the traditional flat anatomical images when simulating and planning some complex types of surgery. Notwithstanding 3D printing advantages, STL-based virtual models were pre-printing useful tools when instrumentation on a physical replica was not required.

Resection of retroperitoneal soft-tissue sarcoma involving the abdominal aorta.

Complete surgical resection of soft-tissue sarcomas (STSs) frequently requires complex multivisceral resections, which is the most important factor related to overall survival and local recurrence. Major vascular involvement is not rare in patients with primary retroperitoneal STSs. We present a 54-year-old woman with a retroperitoneal STS encasing the infrarenal abdominal aorta. The patient underwent complete oncological resection with vascular reconstruction using a bi-iliac vascular graft. Major blood vessel involvement is not a contraindication for STS surgery with a curative intent.

Spatial index relating urban environment to health lifestyle and obesity risk in men and women from different age groups.

The challenge in the search for relationships between urban space, physical mobility, and health status, is detecting indicators able to link the environment with healthy life habits. Therefore, the objective was to design an urban index for the identification of urban environment propensity for physical activity (PA) and to determine how it relates to lifestyle and anthropometric parametrization of obesity. Participants (N = 318-60.4% women and 39.6% men) were recruited from a mid-sized city with epidemiology and morbidity rates below the average for the mid-west region of Brazil. Body mass index (BMI) was measured and a questionnaire was applied to gather information about PA and life habits. The spatial urban health index (SUHI) was designed in a geographic information system using data from demographic, environmental and urban physical features. The relationship between BMI and PA was verified with multiple linear regression, controlled for SUHI levels. Regarding the BMI of the population, 69.5% were classified in the eutrophic or overweight ranges, with no effect of gender and age. The SUHI classified 63.7% of the urban area favorable to PA. The PA routine was adequate (≥3 sessions with ≥1 h each) for ~80% of the population, as well as healthy habits such as non smoking (~94%) and non alcohol abuse (~55%). The SUHI strengthens the relationships of BMI to weekly frequency (r = -0.68; t = -9.4; p<0.001) and session duration (r = -0.66; t = -2.8; p<0.001) for the whole group by improving the explanatory coefficient in ~25% (R2Adj = 0.61 to R2Adj = 0.85). The SUHI indicated that the urban environment is able to promote healthy life habits by diminishing the "obesogenic" features of the city when physical structures are planned to facilitate PA, whatever the gender and age group.

Effect of dietary plants on the production of immunoglobulins A in healthy Wistar rats / Efeito de plantas dietéticas na produção de imunoglobulinas A em ratos Wistar saudáveis

Introduction: some plants such as turmeric, cinnamon, and okra are known to have therapeutic functions such as antioxidant and anti-inflammatory activity. Furthermore, an immunomodulatory role has been observed in the production of antibodies, in particular immunoglobulin A (IgA), which mediates a variety of protective functions for the organism. Objective: the aim of the present study was to investigate the effect of dietary plants on the production of IgA in healthy Wistar rats. Methods: thus, 48 male Wistar rats of 90 days of age were allocated to four groups. The animals were treated for 14 days with dried turmeric, cinnamon, or okra (50, 50, 12.5 mg/day, respectively) in phosphate buffered saline, or with only phosphate buffered saline by gavage. The animals received water and feed ad libitum. Body mass and relative weight ofperitoneal fat, adrenal gland, kidney, spleen, liver and thymus, biochemical parameters, and IgA levels were analyzed. Results: no significant changes were observed in the body mass, relative weight of organs and tissues, and biochemical parameters. An increase in serum IgA levels was observed in animals treated with turmeric or cinnamon. Conclusion: we conclude that the treatment with turmeric and cinnamon increased IgA production. Therefore, our study supports the idea that dietary supplementation with these plants may improve humoral immunity.

Introdução: algumas plantas como a cúrcuma, a canela e o quiabo são conhecidas por apresentar funções terapêuticas, como atividade antioxidante e anti-inflamatória. Além disso, tem sido observado um papel imunomodulador sobre a produção de anticorpos, em especial a imunoglobulina A (IgA), a qual medeia uma variedade de funções protetoras para o organismo. Objetivo: o objetivo do presente estudo foi investigar o efeito de plantas dietéticas na produção de IgA em ratos Wistar saudáveis. Métodos: destarte, 48 ratos machos Wistar com 90 dias de idade foram alocados em quatro grupos. Os animais foram tratados por 14 dias com cúrcuma seca, canela ou quiabo (50, 50, 12,5 mg/dia, respectivamente) em solução salina tamponada com fosfato ou apenas solução salina tamponada com fosfato, por gavagem. Os animais receberam água e ração ad libitum. Foram analisados a massa corporal e o peso relativo da gordura peritoneal, glândula adrenal, rim, baço, fígado e timo, parâmetros bioquímicos e níveis de IgA. Resultados: não foram observadas alterações significativas na massa corporal, no peso relativo dos órgãos e tecidos e nos parâmetros bioquímicos. Foi observado aumento dos níveis séricos de IgA nos animais tratados com cúrcuma ou canela. Conclusão: podemos concluir que o tratamento com cúrcuma e canela aumentou a produção de IgA. Portanto, nosso estudo suporta a ideia de que a suplementação alimentar com essas plantas pode melhorar a imunidade humoral.

Paediatric phenotype of Kallmann syndrome due to mutations of fibroblast growth factor receptor 1 (FGFR1).

Kallmann syndrome characterised by hypogonadotropic hypogonadism (HH) and anosmia is genetically heterogeneous with X-linked, autosomal dominant and autosomal recessive forms. The autosomal dominant form due to loss of function mutation in the fibroblast growth factor receptor 1 (FGFR1) accounts for about 10% of cases. We report here three paediatric cases of Kallmann syndrome with unusual phenotype in two unrelated patients with severe ear anomalies (hypoplasia or agenesis of external ear) associated with classical features, such as cleft palate, dental agenesis, syndactylia, micropenis and cryptorchidism. We found de novo mutation in these two patients (Cys178Ser and Arg622Gly, respectively), and one inherited Arg622Gln mutation with intrafamilial variable phenotype. These genotype-phenotype correlations indicate that paediatric phenotypic expression of FGFR1 loss of function mutations is highly variable, the severity of the oro-facial malformations at birth does not predict gonadotropic function at the puberty and that de novo mutations of FGFR1 are relatively frequent.

Growth curves for congenital adrenal hyperplasia from a national retrospective cohort.

BACKGROUND: In congenital adrenal hyperplasia (CAH), adjusting hydrocortisone dose during childhood avoids reduced adult height. However, there are currently no CAH-specific charts to monitor growth during treatment. Our objective was to elaborate growth reference charts and bone maturation data for CAH patients. METHODS: We conducted a retrospective observational cohort study, in 34 French CAH centers. Patients were 496 children born 1970-1991 with genetically proven 21-hydroxylase deficiency. Their growth and bone maturation data were collected until age 18 together with adult height, puberty onset, parental height, and treatment. The mean (SD) heights were modeled from birth to adulthood. The median±1 SD and ±2 SDs model-generated curves were compared with the French references. A linear model for bone maturation and a logistic regression model for the probability of short adult height were built. RESULTS: Growth charts were built by sex for salt wasting (SW) and simple virilizing (SV) children treated before 1 year of age. In girls and boys, growth was close to that of the general French population up to puberty onset. There was almost no pubertal spurt and the mean adult height was shorter than that of the general population in girls (-1.2 SD, 156.7 cm) and boys (-1.0 SD, 168.8 cm). Advanced bone age at 8 years had a strong impact on the risk of short adult height (OR: 4.5 per year advance). CONCLUSIONS: The 8-year bone age is a strong predictor of adult height. It will help monitoring the growth of CAH-affected children.

Exercise as a Therapeutic and Supporting Strategy for Climacteric Symptoms: an EvidenceBased Review / Exercício Físico como Estratégia Terapêutica e Coadjuvante nos Sintomas do Climatério: Revisão Baseada em Evidências

Climacteric is a natural process characterized by the female hormones reduction and increased symptoms that interfere in the woman's quality of life. The objective was to raise scientific evidence on the physical exercise effects as a therapeutic strategy on climacteric symptoms. This systematic review study accessed the Virtual Health Library (VHL) and consulted articles from the last 10 years, with the following eligibility criteria; inclusion, scientific articles published in the last 10 years, with clinical, quasi-experimental, cross-sectional design and case studies conducted with women in the climacteric. Articles published before 2010 with delineations were excluded; epidemiological, systematic review, meta-analyzes, experimental studies with animal model. The studies included in the review were read in full, critically analyzed and categorized. The findings showed that active women have a reduction in vasomotor and somatic symptoms of the climacteric, also collaborating in the prevention of diseases prevalent in this period. Aerobic physical exercise improves physical fitness and quality of life indicators of climacteric women. In clinical practice, aerobic exercise can be considered an auxiliary strategy in the climacteric symptoms treatment and female health improvement. (AU)

O climatério é um processo natural caracterizado pela redução dos hormônios femininos e aumento de sintomas que interferem na qualidade de vida da mulher. Objetivou-se levantar evidências científicas sobre os efeitos do exercício físico como estratégia terapêutica na sintomatologia climatérica. Este estudo de revisão sistemática acessou a Biblioteca Virtual de Saúde (BVS) e consultou artigo dos últimos 10 anos, com os seguintes critérios de elegibilidade; inclusão, artigos científicos com delineamento clínico, quase-experimental, transversal e estudos de caso realizados com mulheres no climatério. Foram excluídos artigos publicados anterior a 2010, com delineamentos; epidemiológico, revisão sistemática, metanálises, estudos experimentais com modelo animal. Os estudos incluídos na revisão foram lidos na integra, analisados criticamente e categorizados. Os achados demonstraram que mulheres ativas apresentam redução dos sintomas vasomotores e somáticos do climatério, também colabora na prevenção de doenças prevalentes nesse período. O exercício físico aeróbio melhora a aptidão física e indicadores de qualidade de vida de mulheres climatéricas. Na prática clínica o exercício aeróbio pode ser considerado uma estratégia auxiliar no tratamento dos sintomas do climatério e melhora da saúde feminina. (AU)

Influence of Angiotensin-Converting Enzyme Inhibitors (ACEi) on Angiogenesis Induced by Physical Exercise / Influência dos Inibidores da Enzima Conversora de Angiotensina (iECA) Sobre a Angiogênese Induzida pelo Exercício Físico

Abstract Angiotensin-converting enzyme inhibitors (ACEi) are used to reduce blood pressure and vascular resistance by modulating the ACE activity responsible for the angiotensin II formation. However, different ACEi seem to influence exercise-induced angiogenesis. The objective of this review was to investigate the effects of different ACEi on vessel growth in skeletal muscle induced by exercise training. The present study is characterized by a narrative literature review design, the databases of Scielo, Google Scholar and PubMed were consulted. There are different groups of ACEi , sulfhydryl group such as captopril and a carboxyl group such as perindiporil and enalapril that can influence their effects on ACE activity. It is already known that exercise promotes the increase of vessels from vessels already existing in the skeletal musculature, a process known as angiogenesis and contributes to the blood pressure reduction (BP). Although these different responses are still scarce, vessel endothelial growth factor (VEFG) and nitric oxide (NO) may participate. Thus, the use of different ACEi can influences the angiogenesis responses induced by exercise, being one of the important mechanisms for BP reduction. The choice of ACEi group should be carefully analyzed for hypertensive individuals who practice physical exercise. (AU)

Resumo Os inibidores da enzima conversora de angiotensina (iECA) são utilizados para redução da pressão arterial e resistência vascular modulando a atividade da ECA responsável pela formação da angiotensina II. Entretanto, diferentes iECAs parecem influenciar a angiogênese induzida pelo exercício físico. Desta maneira objetivo desta revisão foi investigar os efeitos de diferentes iECA sobre o crescimento de vasos no musculo esquelético induzido pelo exercício físico. O presente estudo caracteriza-se um delineamento de revisão de literatura narrativa, foram consultadas as bases de dados do Scielo, Google acadêmico e PubMed. Existem grupos distintos dos iECAs, grupo sulfidrila como o captopril e o grupo carboxila como o perindiporil e grupo que pode influenciar seus efeitos sobre a atividade da ECA. Já é sabido que O exrcício promove o aumento de vasos a partir de vasos já existentes na musculatura esquelética, processo conhecido como angiogênese e colabora para redução da pressão arterial (PA). Entretanto os iECAs parecem influenciar esta resposta do aumento da densidade capilar no músculo esquelético. Embora ainda sejam escassos estas diferentes respostas podem ter as participações do fator de crescimento endotelial de vasos (VEFG) e o óxido nítrico (NO). Desta maneira o uso dos grupos do iECAs podem influenciar as resposta da angiogênese induzido pelo exercício sendo um dos mecanismos importantes pela redução da PA. A escolha do grupo de iECA deve ser analisada com cautela para indivíduoS hipertensos que praticam exercício físico. (AU)