Kidney Diseases: The Age of Molecular Markers.

Kidney diseases are conditions that increase the morbidity and mortality of those afflicted. Diagnosis of these conditions is based on parameters such as the glomerular filtration rate (GFR), measurement of serum and urinary creatinine levels and equations derived from these measurements (Wasung, Chawla, Madero. Clin Chim Acta 438:350-357, 2015). However, serum creatinine as a marker for measuring renal dysfunction has its limitations since it is altered in several other physiological situations, such as in patients with muscle loss, after intense physical exercise or in people on a high protein diet (Riley, Powers, Welch. Res Q Exerc Sport 52(3):339-347, 1981; Juraschek, Appel, Anderson, Miller. Am J Kidney Dis 61(4):547-554, 2013). Besides the fact that serum creatinine is a marker that indicates glomerular damage, it is necessary the discovery of new biomarkers that reflect not only glomerular damage but also tubular impairment. Recent advances in Molecular Biology have led to the generation or identification of new biomarkers for kidney diseases such as: Acute Kidney Failure (AKI), chronic kidney disease (CKD), nephritis or nephrotic syndrome. There are recent markers that have been used to aid in diagnosis and have been shown to be more sensitive and specific than classical markers, such as neutrophil gelatinase associated lipocalin (NGAL) or kidney injury molecule-1 (KIM-1) (Wasung, Chawla, Madero. Clin Chim Acta 438:350-357, 2015; George, Gounden. Adv Clin Chem 88:91-119, 2019; Han, Bailly, Abichandani, Thadhani, Bonventre. Kidney Int 62(1):237-244, 2002; Fontanilla, Han. Expert Opin Med Diagn 5(2):161-173, 2011). However, early diagnostic biomarkers are still necessary to assist the intervention and monitor of the progression of these conditions.

Predicted Equation for VO2 Based on a 20-Meter Multistage Shuttle Run Test for Children.

This study compared maximum oxygen consumption (VO2max) on a 20-meter multistage shuttle run test (20-Srt) with a cardiopulmonary exercise test (CPET) to determine a VO2max prediction equation for a 20-Srt in children aged 6-10 years. Eighty healthy children performed the CPET on a treadmill, while the 20-Srt took place on a sports court. Heart rate (HR) was measured and the expired gases were continuously measured breath-by-breath using a portable gas analyzer. The VO2max was lower (p<0.05) in CPET than 20-Srt for all, female, and male participants, respectively (46.3±7.9 vs. 48.7±4.6; 42.7±7.8 vs. 46.7±4.8; 49.3±6.8 vs. 50.4±3.9, mL·kg-1·min-1). The standard error estimates were between 3.0 and 3.6 and considered as not clinically relevant if less than 5 mL·kg-1·min-1. The intraclass correlation coefficient between the VO2 in CPET and in 20-Srt was 0.74 (CI95% 0.55-0.84) and considered moderately reliable. The linear multiple regression excluded sex, body mass index and fat-free mass and retained the maximum speed and age in the predictive equation. The 20-Srt estimates the VO2max with moderate reliability and the predictive equation was VO2maxpred=4.302+(maximum speed*5.613)-(age*1.523) for children aged 6-10 years.

Relationship of irisin expression with metabolic alterations and cardiovascular risk in type 2 diabetes mellitus: a preliminary study.

OBJECTIVE: The aim of this study was to investigate the role of irisin in type 2 diabetes mellitus and its association with metabolic alterations and obesity. METHODS: A cross-sectional case-control study was conducted on participants treated at Centro Universitário FMABC between August 2018 and July 2019, by comparing a control group (n=14) with type 2 diabetes mellitus patients (n=16). The control group consisted of participants aged above 21 years with no chronic diseases, diabetes, smoking, or illicit drug use. The type 2 diabetes mellitus group included patients aged above 21 years, who were diagnosed with type 2 diabetes for at least 5 years (glycated hemoglobin>7%). Exclusion criteria were not willing to continue, recent hospitalization, and failure to meet inclusion criteria. Biochemical parameters included blood glucose, glycated hemoglobin, plasma irisin levels, and irisin gene expression in peripheral blood. RESULTS: Type 2 diabetes mellitus patients exhibited significantly higher plasma glucose levels [143 (40) vs. 92 (13) mg/dL, *p<0.05] and glycated hemoglobin levels [7.1% (1.6) vs. 5.6% (0.5), *p<0.05] compared to the control group. Irisin gene expression in type 2 diabetes mellitus patients was lower 0.02288 (0.08050) than the control group 8.506e-006 (1.412e-005) (p=0.06). Correlation analysis revealed a positive association between irisin expression and body mass index in type 2 diabetes mellitus (Rho=0.5221, 95%CI -0.058 to 0.838, p=0.06), while plasma irisin showed a negative correlation with body mass index (Rho=-0.656, 95%CI -0.836 to 0.215, p=0.03). No significant correlations were found between plasma glucose or glycated hemoglobin levels and irisin expression. CONCLUSION: The data suggests that body mass index directly influences plasma irisin levels and the regulation of irisin gene expression, possibly linking irisin to adiposity changes observed in obesity-related type 2 diabetes mellitus.

Does nebivolol have renoprotective action in patients with chronic kidney disease conditions? An integrative review.

Systemic arterial hypertension (SAH) is a chronic disease of multifactorial origin and one of the main risk factors for major adverse cardiovascular events (MACE), which are the leading causes of morbidity and mortality worldwide. The pharmacological treatment of SAH involves five main classes of drugs, and Nebivolol (NEB) is one of those drugs, belonging to the class of third generation ß1-adrenoceptors selective blockers. NEB is composed of a racemic mixture of two enantiomers: d-nebivolol, which exerts antagonist effects on ß1-adrenoceptors, and l-nebivolol, a vascular ß3 receptor agonist. There are several studies that report different actions of NEB, not only for the treatment of SAH, but also as an antioxidant agent or even as a protector of renal damage. The aim of this systematic review was to investigate the available evidence regarding the effects of NEB on kidney diseases, evaluating its possible renoprotective action.

NGAL and SMAD1 gene expression in the early detection of diabetic nephropathy by liquid biopsy.

INTRODUCTION: Diabetic nephropathy (DN) is a disease that progresses with the slow and progressive decline of the glomerular filtration rate (GFR); the installation of this pathology is silent and one of the major causes of death in patients with diabetes. AIMS: To identify new molecular biomarkers for early identification of the onset of DN in patients with type II diabetes mellitus (DM2). We studied the expression profile of the genes; suppressor of mothers against decapentaplegic type 1 (SMAD1), neutrophil gelatinase-associated lipocalin (NGAL) and type IV collagen (COLIV1A) in peripheral blood and urine sediment samples. METHODS: Ninety volunteers, 51 with DM2 and 39 healthy, were recruited from the Faculdade de Medicina do ABC outpatient clinic. We conducted an interview and collected anthropometric data, as well as blood and urine samples for biochemical evaluation and real-time PCR amplification of the genes of interest. RESULTS: Gene expression data: peripheral blood NGAL (DM2 0.09758±0.1914 vs CTL 0.02293±0.04578), SMAD1 (blood: DM2 0.01102±0.04059* vs CTL 0.0001317±0.0003609; urine: DM2 0.7195±2.344* vs CTL 0.09812±0.4755), there was no significant expression of COLIV1A. These genes demonstrated good sensitivity and specificity in the receiving operating characteristic curve evaluation. CONCLUSION: Our data suggest the potential use of NGAL and SMAD1 gene expression in peripheral blood and urine samples as early biomarkers of DN.

The Impact of Inflammatory Profile on Selenium Levels in Hemodialysis Patients.

INTRODUCTION: Hemodialysis stands out as an eligible treatment for patients with chronic kidney disease. The subsequent inflammatory process resulting from this disease and hemodialysis per se is exacerbated in this therapy. Selenium (Se) is an essential trace element that can participate in the inhibition of pro-oxidant and pro-inflammatory processes and could be considered a measurement that indicates the progression of chronic kidney disease and inflammation. OBJECTIVES: The present study investigated selenemia in hemodialysis patients of the ABC region of São Paulo and aimed to establish the correlation between an inflammatory marker and selenemia in this conditions disease. METHODS: This is an observational cross-sectional study of the Faculdade de Medicina do ABC in patients submitted to hemodialysis three times a week for at least six months. The eligible group composed of 21 patients, who filled out forms and underwent biochemical tests (colorimetric enzyme methods, flow cytometer, turbidimetric method and mass spectrometry). RESULTS: The study population showed, women (70%), men (30%) with a mean age of 47 ± 17 years, Caucasians (36%) and non-Caucasian (64%), hypertensive (68%), smokers (53%) and non-smokers (64%). There was a hegemonic prevalence of systolic arterial hypertension (SAH) 68.1% in relation to diabetes mellitus (DM) (50%). Pre and post hemodialysis (HD) selenemia showed statistical significance, which did not occur with Creactive protein. There was a predominance of females in our sample; the pre- and post- HD selenemia were within the normal range of the reference values; there was a statistically significant correlation between pre and post-HD selenemia; there was no correlation with statistical significance between values of pre and post-HD C-reactive protein. CONCLUSION: Our data showed that there was no direct relationship between pre- and post- HD inflammation and pre- and post-HD selenemia.

Irisin and troponin I expression in dialysis patients submitted to remote ischemic preconditioning: a pilot study.

BACKGROUND: Renal replacement therapy continues to be related to high hospitalization rates and poor quality of life. All-cause morbidity and mortality in renal replacement therapy in greater than 20% per year, being 44 times greater when diabetes is present, and over 10 times that of the general population. Regardless of treatment, the 5-year survival is 40%, surpassing many types of cancers. Irisin is a hormone that converts white adipose tissue into beige adipose tissue, aggregating positive effects like fat mass control, glucose tolerance, insulin resistance, prevention of muscle loss, and reduction in systemic inflammation. OBJECTIVES: To determine the serum levels of troponin I in hemodialysis patients submitted to remote ischemic preconditioning (RIPC) associated with irisin expression. METHODS: This was a prospective, randomized, double-blind clinical trial with patients with chronic kidney disease submitted to hemodialysis for a 6-month period. Troponin I, IL-6, urea, TNF-α, and creatinine levels were determined from blood samples. The expressions of irisin, thioredoxin, Nf-kb, GPX4, selenoprotein and GADPH were also evaluated by RT-PCR. RESULTS: Samples from 14 hypertensive patients were analyzed, 9 (64.3%) of whom were type 2 diabetics, aged 44-64 years, and 50% of each sex. The difference between pre- and post-intervention levels of troponin I was not significant. No differences were verified between the RIPC and control groups, except for IL-6, although a significant correlation was observed between irisin and troponin I. CONCLUSION: Remote ischemic preconditioning did not modify irisin or troponin I expression, independent of the time of collection.

Ischemia/reperfusion is an independent trigger for increasing myocardial content of mRNA B-type natriuretic peptide.

This study aims to determine whether a relation exists between ischemia/reperfusion and myocardial B-type natriuretic peptide (BNP) mRNA expression independent of variations in intracavitary diastolic volume and consequently, of cardiomyocyte stretching. Twenty-three rats were subjected to the following conditions: control (C), 15 min of ischemia (I15), or ischemia plus 15 (R15), 30 (R30), or 45 (R45) min of reperfusion in the in situ hearts. Isolated hearts of sixteen additional rats (sham, n = 8; occlusion, n = 8) were perfused for studies in the absence of ventricular distension. All hearts were divided in two segments (ischemic and nonischemic). Ventricular distension was avoided by excluding the atria and mitral valves. In both experiments, BNP mRNA was quantified by real-time polymerase chain reaction in both nonischemic and ischemic regions. In the in situ hearts, myocardial BNP mRNA values at R15 (4.24 +/- 0.75) in the ischemic region were higher than in other groups (C: 1.43 +/- 0.81, P = 0.044; I15: 3.05 +/- 0.62, P = 0.048; R30: 0.76 +/- 0.84, P = 0.001; R45: 1.47 +/- 0.60, P = 0.046, [analysis of variance]). In isolated hearts without ventricular distension, myocardial BNP mRNA (arbitrary units) content at R15 in ischemic regions (4.54 +/- 0.26) was greater than in nonischemic regions in both occlusion (3.51 +/- 0.20, P < 0.001) and sham (3.38 +/- 0.25, P = 0.0001 and 3.47 +/- 0.19, P = 0.0001) groups. The present data show that ischemia/reperfusion is responsible for increased BNP mRNA myocardial content independent of changes of ventricular cavity diastolic volume.

Strength training preserves the bone mineral density of postmenopausal women without hormone replacement therapy.

OBJECTIVE: The study was designed to evaluate the effects of strength training (ST) on the bone mineral density (BMD) of postmenopausal women without hormone replacement therapy. METHOD: Subjects were randomized into untrained (UN) or trained (TR) groups. The TR group exercised three ST sessions per week for 24 weeks, and body composition, muscular strength, and BMD of the lumbar spine and femur neck were evaluated. RESULTS: Body weight, mass index, and fat percentage were lower after 24 weeks only in the TR group (p < .05). SR also improved the one repetition maximum test in 46% and 39% of upper and lower limbs, respectively. The percentage of demineralization was higher in the UN group than in the TR group at the lumbar spine and femoral neck (p < .05). DISCUSSION: Results indicated that 24 weeks of ST improved body composition parameters, increased muscular strength, and preserved BMD in postmenopausal women.

Remote ischemic preconditioning in myocardial protection in hemodialysis patients.

BACKGROUND: Remote ischemic preconditioning (RIPC) is a procedure that generates a brief period of ischemia followed by reperfusion. The role of RIPC in protecting myocardial ischemia during hemodialysis is not yet established. The aim of the study was to evaluate RIPC myocardial protection as evaluated by ultrasensitive I troponin in hemodialysis outpatients. PATIENTS AND METHODS: A double-blind randomized trial with two groups: intervention submitted to RIPC and control group without RIPC. Intervention group received RIPC in three consecutive hemodialysis sessions. Blood samples were taken before and after each session. Blood urea nitrogen for calculation of single-pool Kt/v and ultrasensitive I troponin were measured to evaluate dialysis adequacy and myocardial injury. RESULTS: A total of 47 patients were randomized. About 60.8% were men and 54% were diabetic. The mean single-pool Kt/v was 1.51 in the intervention group and 1.49 in control. The ultrasensitive troponin I measured no significant change from the time of collection: before or after dialysis. CONCLUSION: The RIPC applied in three consecutive sessions did not demonstrate superiority to control, therefore another study tested RIPC in 12 consecutive sessions with a positive result in myocardial protection. In our study, more than half of the patients were diabetic. Diabetic patients have a trend to show a lower response to RIPC because of the greater presence of collateral coronary circulation. In summary, in this model there was no interference of RIPC in ultrasensitive troponin I values, but troponin had a high negative predictive value for myocardial infarction in all tested models.

Relationship of irisin expression with metabolic alterations and cardiovascular risk in type 2 diabetes mellitus: a preliminary study

SUMMARY OBJECTIVE: The aim of this study was to investigate the role of irisin in type 2 diabetes mellitus and its association with metabolic alterations and obesity. METHODS: A cross-sectional case-control study was conducted on participants treated at Centro Universitário FMABC between August 2018 and July 2019, by comparing a control group (n=14) with type 2 diabetes mellitus patients (n=16). The control group consisted of participants aged above 21 years with no chronic diseases, diabetes, smoking, or illicit drug use. The type 2 diabetes mellitus group included patients aged above 21 years, who were diagnosed with type 2 diabetes for at least 5 years (glycated hemoglobin>7%). Exclusion criteria were not willing to continue, recent hospitalization, and failure to meet inclusion criteria. Biochemical parameters included blood glucose, glycated hemoglobin, plasma irisin levels, and irisin gene expression in peripheral blood. RESULTS: Type 2 diabetes mellitus patients exhibited significantly higher plasma glucose levels [143 (40) vs. 92 (13) mg/dL, *p<0.05] and glycated hemoglobin levels [7.1% (1.6) vs. 5.6% (0.5), *p<0.05] compared to the control group. Irisin gene expression in type 2 diabetes mellitus patients was lower 0.02288 (0.08050) than the control group 8.506e-006 (1.412e-005) (p=0.06). Correlation analysis revealed a positive association between irisin expression and body mass index in type 2 diabetes mellitus (Rho=0.5221, 95%CI -0.058 to 0.838, p=0.06), while plasma irisin showed a negative correlation with body mass index (Rho=-0.656, 95%CI -0.836 to 0.215, p=0.03). No significant correlations were found between plasma glucose or glycated hemoglobin levels and irisin expression. CONCLUSION: The data suggests that body mass index directly influences plasma irisin levels and the regulation of irisin gene expression, possibly linking irisin to adiposity changes observed in obesity-related type 2 diabetes mellitus.

Obstructive sleep apnea syndrome and sleep quality in hypertensive patients.

INTRODUCTION: Obstructive sleep apnea and hypopnea syndrome (OSAHS) is one of the developmental factors of high blood pressure (HBP), a relevant global public health problem. OSAHS is characterized by the reduction or complete cessation of respiratory airflow due to intermittent airway collapse. Additionally, significant changes in sleep rhythm and pattern are observed in these patients. OBJECTIVE: To evaluate the association between OSAHS and sleep quality in essential and resistant hypertensives. METHOD: A cross-sectional, observational study evaluated 43 hypertensive patients treated at the outpatient clinics of the Faculdade de Medicina do ABC (FMABC) who were medicated with two or more antihypertensive drugs and divided into nonresistant or resistant to treatment. RESULTS: Group I (using up to two antihypertensive agents - 60.47% of the sample) presented mean systolic blood pressure (SBP) of 127.5±6.4 mmHg, mean diastolic blood pressure (DBP) of 79.6±5.2 mmHg, mean body mass index (BMI) of 27.2±5.3 kg/m2 and mean age of 51.2±15.1 years. Group II (using more than two antihypertensive drugs - 37.2% of the sample) presented mean SBP of 132.1±9.3 mmHg, mean DBP of 84.5±5.8 mmHg, mean BMI of 27.2±7.2 kg/m2 and mean age of 55.5±13.4 years. The patients presented low quality of sleep/sleep disorder evaluated by the Pittsburgh Sleep Quality Index (PSQI), which represents a preponderant factor for OSAHS. CONCLUSION: Patients at high risk for OSAHS had poor sleep quality and high levels of DBP, suggesting a causal relation between these parameters. However, they did not present a higher prevalence of resistant high blood pressure (RHBP).

Inflammatory biomarker kinetics after mechanical and bioprosthetic valve replacement.

INTRODUCTION: valve disease is an important cause of heart failure. There is a direct relationship between valve deterioration and the patient's inflammatory status and cytokines: interleukin-6, interleukin-1, tumor necrosis factor, and C-reactive protein, involved in this major state of inflammation. OBJECTIVE: to report a series of cases of valve replacement, using a bioprosthetic or mechanical valve, and the inflammatory profile of them. METHODS: patients older than 18 years and with bioprosthetic or mechanical valve placed for a minimum of 6 months and maximum of 2 years were included. In addition to the demographic characteristics of each patient, inflammatory markers were measured and a comparison was made of echocardiographic results before (based on medical records) and after surgery. A total of 46 patients were enrolled, 23 with mechanical valve and 23 with bioprosthetic valve. RESULTS: of the 46 patients, 20 presented complete data were included, 12 with bioprosthetic and 8 with mechanical valve. There was no difference between types of prosthesis or implant site for the values of inflammatory markers although they were all above reference range. DISCUSSION: patients undergoing aortic mechanical valve implant benefited more than those undergoing bioprosthetic implant and both with much better results than those of valve replacements performed on mitral valve. In short, there was no difference in relation to inflammatory biomarkers.

Predominance of STEMI and severity of coronary artery disease in a cohort of patients hospitalized with acute coronary syndrome: a report from ABC Medical School.

INTRODUCTION: acute coronary syndromes (ACS) represent a widely prevalent health issue with high mortality in Brazil and worldwide. The severity of ACS is not known in patients in the city of São Bernardo do Campo a municipality contiguous and adjacent to the city of São Paulo. OBJECTIVES: to study the profile of coronary disease in patients hospitalized with ACS who underwent coronary angiography in the emergency room between 2012 and 2013. METHODS: this is an observational study that included consecutive patients with ACS admitted to the emergency room of a hospital. Data collection was performed using medical records with the following variables: sex, age, risk factors for cardiovascular disease, coronary angiography. RESULTS: the sample in this period included 131 patients, of which 64.8% were men. The most prevalent diagnosis was ST-elevation myocardial infarction (STEMI) (57.2%) followed by non-ST-elevation myocardial infarction (NSTEMI) (22.1%) and unstable angina (UA) (20.6%). There were no significant differences in the epidemiology and risk factors between the diagnoses, except that heart failure was more prevalent in patients with UA. DISCUSSION: there were no differences between groups regarding the coronaries involved; however, STEMI patients showed similar numbers of multi- and singlevessel lesions, NSTEMI patients showed more multivessel lesions, and UA patients showed more multivessel lesions or lesion-free arteries. Although multivessel lesions were prevalent in all groups, STEMI patients showed a significantly higher number of single-vessel lesions compared with the other acute coronary syndromes. CONCLUSION: the study demonstrated a predominance of STEMI in the studied population, which differs from the usual results in ACS.

Irisin and troponin I expression in dialysis patients submitted to remote ischemic preconditioning: a pilot study / Expressão de irisina e troponina I em pacientes em diálise submetidos a pré-condicionamento isquêmico remoto: um estudo piloto

ABSTRACT Background: Renal replacement therapy continues to be related to high hospitalization rates and poor quality of life. All-cause morbidity and mortality in renal replacement therapy in greater than 20% per year, being 44 times greater when diabetes is present, and over 10 times that of the general population. Regardless of treatment, the 5-year survival is 40%, surpassing many types of cancers. Irisin is a hormone that converts white adipose tissue into beige adipose tissue, aggregating positive effects like fat mass control, glucose tolerance, insulin resistance, prevention of muscle loss, and reduction in systemic inflammation. Objectives: To determine the serum levels of troponin I in hemodialysis patients submitted to remote ischemic preconditioning (RIPC) associated with irisin expression. Methods: This was a prospective, randomized, double-blind clinical trial with patients with chronic kidney disease submitted to hemodialysis for a 6-month period. Troponin I, IL-6, urea, TNF-α, and creatinine levels were determined from blood samples. The expressions of irisin, thioredoxin, Nf-kb, GPX4, selenoprotein and GADPH were also evaluated by RT-PCR. Results: Samples from 14 hypertensive patients were analyzed, 9 (64.3%) of whom were type 2 diabetics, aged 44-64 years, and 50% of each sex. The difference between pre- and post-intervention levels of troponin I was not significant. No differences were verified between the RIPC and control groups, except for IL-6, although a significant correlation was observed between irisin and troponin I. Conclusion: Remote ischemic preconditioning did not modify irisin or troponin I expression, independent of the time of collection.

RESUMO Introdução: A terapia de substituição renal continua associada a altas taxas de hospitalização e baixa qualidade de vida. A morbimortalidade por todas as causas na terapia de substituição renal é superior a 20% ao ano, sendo 44 vezes maior quando a diabetes está presente e mais de 10 vezes a da população em geral. Independentemente do tratamento, a sobrevida em 5 anos é de 40%, superando muitos tipos de câncer. A irisina é um hormônio que converte tecido adiposo branco em tecido adiposo bege, agregando efeitos positivos como o controle de massa gorda, tolerância à glicose, resistência à insulina, prevenção de perda muscular e redução da inflamação sistêmica. Objetivos: Determinar os níveis séricos de troponina I em pacientes em hemodiálise submetidos ao pré-condicionamento isquêmico remoto (PCIR) associado à expressão da irisina. Métodos: Estudo clínico prospectivo, randomizado, duplo-cego, com pacientes com doença renal crônica submetidos à hemodiálise por um período de 6 meses. Os níveis de troponina I, IL-6, uréia, TNF-α e creatinina foram determinados a partir de amostras de sangue. As expressões de irisina, tioredoxina, Nf-kb, GPX4, selenoproteína e GADPH foram também avaliadas por RT-PCR. Resultados: Foram analisadas amostras de 14 pacientes hipertensos, 9 (64,3%) dos quais eram diabéticos tipo 2, com idades entre 44 e 64 anos e 50% de cada gênero. A diferença entre os níveis pré e pós-intervenção de troponina I não foi significativa. Não houve diferenças entre os grupos PCIR e controle, exceto pela IL-6, embora tenha sido observada correlação significativa entre irisina e troponina I. Conclusão: O pré-condicionamento isquêmico remoto não modificou a expressão de irisina ou troponina I, independentemente do tempo de coleta.

Myocardial infarction scar plication in the rat: cardiac mechanics in an animal model for surgical procedures.

BACKGROUND: The immediate effects of surgical reduction of left ventricle cavity on cardiac mechanics have not been well defined. METHODS: Cardiac mechanics were analyzed before and after myocardial infarction scar plication in 11 isolated infarcted rat hearts. RESULTS: Despite a decrease in myocardial stiffness, an increase in chamber stiffness was noted after myocardial infarction scar plication. Systolic function was favored in more than one way. For the same diastolic pressures, maximal developed pressures were higher after myocardial infarction scar plication, and the slope of the systolic pressure-volume relationship was steeper afterwards as compared with before; this means that Frank-Starling recruitment is accentuated in smaller cavities. In addition, the developed net forces needed to generate these pressures were clearly lower afterward than before, indicating reduced ventricular afterload. CONCLUSIONS: The study results show that diastolic function is harmed and systolic function is favored by myocardial infarction scar plication. We suggest that preoperative evaluation of the degree of diastolic dysfunction and impairment of the Frank-Starling mechanism may help to identify patients who may have a poor postoperative outcome due to diastolic or systolic dysfunction.

A randomized trial of the topical effect of antifibrinolytic epsilon aminocaproic Acid on coronary artery bypass surgery without cardiopulmonary bypass.

We assessed the effect of the topical application of epsilon-aminocaproic antifibrinolytic acid (EACA) on the pericardium of patients submitted to coronary artery bypass graft (CABG) without the use of cardiopulmonary bypass (CPB). This is a prospective, randomized, and double-blind study. We evaluated 26 patients with chronic coronary heart disease indicated for CABG without CPB (EACA and placebo groups). The analysis of the postoperative hematological results showed no difference between groups in hemoglobin and hematocrit. There was no difference between the groups regarding the postoperative bleeding through the drains in the first 24 hours, 48 hours, and accumulated loss until removal of drains. The use of EACA in patients undergoing CABG without CPB presented no difference in the reduction of the amount of bleeding and the need for blood transfusions.

Obstructive sleep apnea syndrome and sleep quality in hypertensive patients / Síndrome da apneia obstrutiva do sono e qualidade do sono em hipertensos

Summary Introduction: Obstructive sleep apnea and hypopnea syndrome (OSAHS) is one of the developmental factors of high blood pressure (HBP), a relevant global public health problem. OSAHS is characterized by the reduction or complete cessation of respiratory airflow due to intermittent airway collapse. Additionally, significant changes in sleep rhythm and pattern are observed in these patients. Objective: To evaluate the association between OSAHS and sleep quality in essential and resistant hypertensives. Method: A cross-sectional, observational study evaluated 43 hypertensive patients treated at the outpatient clinics of the Faculdade de Medicina do ABC (FMABC) who were medicated with two or more antihypertensive drugs and divided into nonresistant or resistant to treatment. Results: Group I (using up to two antihypertensive agents - 60.47% of the sample) presented mean systolic blood pressure (SBP) of 127.5±6.4 mmHg, mean diastolic blood pressure (DBP) of 79.6±5.2 mmHg, mean body mass index (BMI) of 27.2±5.3 kg/m2 and mean age of 51.2±15.1 years. Group II (using more than two antihypertensive drugs - 37.2% of the sample) presented mean SBP of 132.1±9.3 mmHg, mean DBP of 84.5±5.8 mmHg, mean BMI of 27.2±7.2 kg/m2 and mean age of 55.5±13.4 years. The patients presented low quality of sleep/sleep disorder evaluated by the Pittsburgh Sleep Quality Index (PSQI), which represents a preponderant factor for OSAHS. Conclusion: Patients at high risk for OSAHS had poor sleep quality and high levels of DBP, suggesting a causal relation between these parameters. However, they did not present a higher prevalence of resistant high blood pressure (RHBP).

Resumo Introdução: A síndrome da apneia e a hipopneia obstrutiva do sono (SAHOS) estão inseridas entre os fatores de desenvolvimento da hipertensão arterial sistêmica (HAS), um relevante problema de saúde pública mundial. A SAHOS é caracterizada pela redução ou cessação completa do fluxo aéreo respiratório, decorrente do colapso intermitente das vias respiratórias. Adicionalmente, observam-se nos pacientes importantes alterações no ritmo e padrão do sono. Objetivo: Avaliar a associação entre SAHOS e qualidade de sono em hipertensos essenciais e resistentes. Método: Estudo observacional, transversal avaliou 43 pacientes hipertensos provenientes dos ambulatórios da Faculdade de Medicina do ABC (FMABC) medicados com dois ou mais anti-hipertensivos, divididos em não resistentes ou resistentes ao tratamento. Resultados: Grupo I (que utilizava até dois anti-hipertensivos - 60,47% da amostra) apresentou pressão arterial sistêmica (PAS) média de 127,5±6,4 mmHg, pressão arterial diastólica (PAD) média de 79,6±5,2 mmHg, índice de massa corpórea (IMC) médio de 27,2± 5,3 kg/m2 e idade média de 51,2±15,1 anos. Grupo II (que utilizava mais que dois anti-hipertensivos - 37,2% da amostra) apresentou PAS média de 132,1±9,3 mmHg, PAD média de 84,5±5,8 mmHg, IMC médio de 27,2±7,2 kg/m2 e idade média de 55,5±13,4 anos. Os pacientes apresentaram baixa qualidade de sono/distúrbio do sono avaliada pelo PSQI, o que representa um fator preponderante para SAHOS. Conclusão: Os pacientes com alto risco para SAHOS tiveram pior qualidade de sono e elevados níveis de PAD, sugerindo uma relação causal entre esses parâmetros. Contudo, não apresentaram maior prevalência de hipertensão arterial resistente.

Prior exercise training does not prevent acute cardiac alterations after myocardial infarction in female rats.

OBJECTIVE: This study aimed to investigate whether previous exercise training could prevent or attenuate acute cardiac alterations after myocardial infarction. METHODS: Female rats were submitted to swim training (1 h/day; 5 days/week) or allowed to remain sedentary for 8 weeks. Afterwards, they were randomly assigned to left coronary artery occlusion or sham surgery. After this procedure, the rats remained sedentary for one week until euthanasia. Cardiac structural and functional analyses were performed using Doppler echocardiography. The rats that had a moderate or large infarct size were included in the evaluations. The data (mean ± SEM) were analyzed using a two-way ANOVA model followed by Tukey's post-hoc test. RESULTS: After the surgery, no significant difference between the exercise and sedentary groups was observed in the left ventricular infarct sizes (34.58 ± 3.04 vs. 37.59 ± 3.07). In another group of rats evaluated with Evans blue 1 h after myocardial infarction, no siginificant difference in the area at risk was observed between the exercised and sedentary rats (49.73 ± 1.52 vs. 45.48 ± 3.49). The changes in the left ventricular fractional areas for the exercised and sedentary myocardial infarction groups (36 ± 2% and 39 ± 3%, respectively) were smaller than those for the exercise sham surgery (ES, 67 ± 1%) and sedentary sham surgery (SS, 69 ± 2%) groups. The E/A was higher in the sedentary myocardial infarction (4.4 ± 0.3) and exercised myocardial infarction (5.5 ± 0.3) rats than in the SS (2.4 ± 0.1) and ES (2.2 ± 0.1) rats. CONCLUSION: Previous swim training of female rats does not attenuate systolic and diastolic function alterations after myocardial infarction induced by left coronary artery occlusion, suggesting that cardioprotection cannot be provided by exercise training in this experimental model.

Memantine effects on liver and adrenal gland of rats exposed to cold stress.

BACKGROUND: Memantine attenuates heart stress due cold stress, however, no study focused its effects on liver and adrenal gland. We evaluated its effects on lipid depletion in adrenal gland and glycogen depletion in liver of rats exposed to cold stress. METHODS: Male rats divided into 4 groups: 1)Control (CON); 2)Memantine (MEM); 3)Induced cold stress (IH) and; 4)Induced cold stress memantine (IHF). Memantine were administrated by gavage (20 mg/kg/day) during eight days. Cold stress were performed during 4 hours once at - 8°C. Lipid and glycogen depletion were presented as its intensity levels. RESULTS: Rats exposed to cold stress presented the highest glycogen (p < 0.001) and lipid depletion (p < 0.001) in liver and adrenal gland, respectively. We noted that memantine significantly reduced lipid depletion in adrenal gland and glycogen depletion in liver. CONCLUSION: Memantine prevented glycogen depletion in liver and lipid depletion in adrenal gland of rats under a cold stress condition.