Oral L-arginine modulates blood lactate and interleukin-6 after exercise in HIV-infected men.

The acute administration of L-arginine (L-arg), a nitric oxide (NO) precursor, reduces lactate (LAC) concentration after exercise in healthy individuals. Lower concentration of L-arg may enhance the action of some inflammatory cytokines in HIV-1 infected patients. We tested the hypothesis that acute L-arg administration may reduce post-exercise blood LAC and inflammatory cytokines levels in HIV-infected patients. 10 HIV-infected men performed 2 maximal incremental cardiopulmonary exercise tests, separated by one week. 30 min before each test, patients received oral placebo or 20 g of L-arg, in random order. Blood LAC, tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), and interleukin-10 (IL-10) were measured before and up to 60 min after exercise. L-arg administration had no significant effect on exercise performance. Compared to placebo, L-arg administration reduced maximal post-exercise blood LAC from 8.7±0.6 to 6.9±0.4 mmol.L-1 (p<0.05). L-arg administration had no significant effect on TNF-alpha or IL-10 concentrations, but increased post-exercise IL-6 (placebo=19±3pg.mL-1; L-arg=63±8 pg.mL-1; p<0.05). In HIV-1 infected men, acute administration of L-arg reduces post-exercise blood LAC and increases IL-6 levels, suggesting the activation of the L-arg-NO pathway, with possible anti-inflammatory consequences.

Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis.

AIMS/HYPOTHESIS: Supervised exercise programmes improve glycaemic control in type 2 diabetes, but training characteristics associated with reduction in HbA(1c) remain unclear. We conducted a systematic review with meta-regression analysis of randomised clinical trials (RCTs) assessing the association between intensity and volume of exercise training (aerobic, resistance or combined) and HbA(1c) changes in patients with type 2 diabetes. METHODS: Five electronic databases were searched (1980-2012) to retrieve RCTs of at least 12 weeks' duration, consisting of supervised exercise training vs no intervention, that reported HbA(1c) changes and exercise characteristics. Two independent reviewers conducted study selection and data extraction. RESULTS: Twenty-six RCTs (2,253 patients) met the inclusion criteria. In multivariate analysis, baseline HbA(1c) and exercise frequency explained nearly 58% of between-study variance. Baseline HbA(1c) was inversely correlated with HbA(1c) reductions after the three types of exercise training. In aerobic training, exercise volume (represented by frequency of sessions) was associated with changes in HbA(1c) (weighted r = -0.64), while no variables were correlated with glycaemic control induced by resistance training. In combined training, weekly volume of resistance exercise explained heterogeneity in multivariate analysis and was associated with changes in HbA(1c) levels (weighted r = -0.70). CONCLUSIONS/INTERPRETATION: Reduction in HbA(1c) is associated with exercise frequency in supervised aerobic training, and with weekly volume of resistance exercise in supervised combined training. Therefore, exercise volume is a major determinant of glycaemic control in patients with type 2 diabetes.

Non-steroidal anti-inflammatory use in the XV Pan-American Games (2007).

BACKGROUND: non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used in sports medicine to reduce time of incapacity. OBJECTIVE: to describe the frequency of NSAIDs use by athletes in the XV Pan-American Games. METHODS: all athletes who were tested by the anti-doping control filled a form. The voluntarily declared medications were recorded and categorised according to sport modality, sex, region and control situation according to the World Anti-Doping Agency. RESULTS: among the 1261 athletes tested (231 out-competition (OC) and 1030 in-competition (IC); 733 men and 528 women), 63% reported use of drugs, NSAIDs being the most frequently (64% of users) used medications. The use of medications was not significantly different between sexes or among different regions of the world. The number of users of only one type of NSAID was higher than those who used more than one type of NSAIDs or a combination with analgesics (335 vs 168 cases). IC reports presented higher use of NSAIDs than OC. CONCLUSION: athletes tested by the anti-doping control of the XV Pan-American Games reported a high frequency of NSAIDs use. The frequent utilisation in competition suggests that these medications might be used as ergogenic aid.

Effects of altering pedal frequency on the slow component of pulmonary VO2 kinetics and EMG activity.

This study investigated the effects of pedal frequency on the slow component of pulmonary oxygen uptake ( V O(2)) kinetics during heavy exercise at the same relative intensity. We hypothesized that higher pedal frequency (expected to enhance fast-twitch muscle fiber recruitment) would be associated with greater slow component amplitude (A' (s)), surface electromyography (normalized root mean square; RMS) and blood lactate concentration ([lactate]). Eight subjects performed square-wave transitions to heavy exercise at 35 and 115 rpm. Furthermore, alternated cadences square-wave transitions (35-115 rpm) were performed to examine the potential effects of additional fast-twitch muscle fiber recruitment on the slow component. Significance was accepted when P<0.05. The A' (s) was greater at higher cadences (0.58+/-0.08 and 0.70+/-0.09 L.min (-1) at 115 and 35-115 rpm, respectively) than at 35 rpm (0.35+/-0.04 L.min (-1)). Greater EMG increase over time (DeltaRMS ((10-3 min))) and [lactate] were observed at 115 and 35-115 rpm compared with 35 rpm. There was a significant correlation between A' (s) and overall DeltaRMS ((10-3 min)) for all pedal frequencies combined (r=0.63; P=0.001). Pedal frequency had no effect on time constants or time delays. These findings are consistent with the concept that progressive recruitment of muscle fibers is associated with the V O(2) slow component.

Circuit weight training and cardiac morphology: a trial with magnetic resonance imaging.

BACKGROUND: Aerobic training (AT) and circuit weight training (CWT) improve peak oxygen uptake (VO(2)peak). During CWT the circulatory system is exposed to higher pressure, which could induce left ventricle morphological adaptations, possibly distinct from those derived from aerobic training. OBJECTIVE: To compare the effects of aerobic training and CWT upon morphological and functional cardiac adaptations detected by magnetic resonance imaging. METHODS: Twenty healthy sedentary individuals were randomly assigned to participate in a 12-week programme of aerobic training (n = 6), CWR (n = 7) or no intervention (n = 7, controls). Training programmes consisted of 36 sessions, 35 min each, 3 times per week, at 70% of maximal heart rate, and CWT included series of resistance exercises performed at 60% of 1 maximal repetition. Cardiopulmonary exercise testing and cardiac magnetic resonance imaging were performed before and after the intervention. RESULTS: There was a similar improvement in VO(2)peak following aerobic training (mean (SD) increment: 12 (4)%) and CWT (12 (4)%), while there was no change in the control group. Aerobic training (12 (6)%) and CWT (16 (5)%) improved strength in the lower limbs, and only CWT resulted in improvement of 13 (4)% in the strength of the upper limbs. However, there were no detectable changes in left ventricular mass, end-diastolic volume, stroke volume or ejection fraction. CONCLUSION: In previously sedentary individuals, short-term CWT and aerobic training induce similar improvement in functional capacity without any adaptation in cardiac morphology detectable by cardiac magnetic resonance imaging.

Acute water ingestion increases arterial blood pressure in hypertensive and normotensive subjects.

In patients with severe autonomic dysfunction, water ingestion elicits an acute pressor response. Hypertension may be associated with changes in cardiovascular autonomic modulation, but there is no information on the acute effects of water ingestion in patients with hypertension. In this study, we compared the effect of acute water ingestion on haemodynamic and autonomic responses of hypertensive and normotensive individuals. Eight patients with mild hypertension were compared to 10 normotensive individuals. After 30 min resting in the supine position all subjects ingested 500 ml of water. At baseline and after water ingestion, venous blood samples for plasma volume determination were collected, and electrocardiographic tracings, finger blood pressure, forearm blood flow and muscle sympathetic nerve activity (MSNA) were obtained. Water ingestion resulted in similar and minor reduction in plasma volume. Systolic and diastolic blood pressure increased in both hypertensive (mean+/-s.d.: 19/14+/-6/3 mm Hg) and normotensive subjects (17/14+/-6/3 mm Hg). There was an increase in forearm vascular resistance and in MSNA. Heart rate was reduced (hypertensive: 5+/-1 beats/min, normotensive: 5+/-6 beats/min) and the high-frequency component of heart rate and systolic blood pressure variability was increased. In hypertensive and normotensive individuals, acute water ingestion elicits a pressor response, an effect that is most likely determined by an increased vasoconstrictor sympathetic activity, and is counterbalanced by an increase in blood pressure and heart rate vagal modulation.

Abnormal response of left ventricular systolic function to submaximal exercise in post-partial left ventriculotomy patients.

Patients with heart failure who have undergone partial left ventriculotomy improve resting left ventricular systolic function, but have limited functional capacity. We studied systolic and diastolic left ventricular function at rest and during submaximal exercise in patients with previous partial left ventriculotomy and in patients with heart failure who had not been operated, matched for maximal and submaximal exercise capacity. Nine patients with heart failure previously submitted to partial left ventriculotomy were compared with 9 patients with heart failure who had not been operated. All patients performed a cardiopulmonary exercise test with measurement of peak oxygen uptake and anaerobic threshold. Radionuclide left ventriculography was performed to analyze ejection fraction and peak filling rate at rest and during exercise at the intensity corresponding to the anaerobic threshold. Groups presented similar exercise capacity evaluated by peak oxygen uptake and at anaerobic threshold. Maximal heart rate was lower in the partial ventriculotomy group compared to the heart failure group (119 +/- 20 vs 149 +/- 21 bpm; P < 0.05). Ejection fraction at rest was higher in the partial ventriculotomy group as compared to the heart failure group (41 +/- 12 vs 32 +/- 9%; P < 0.0125); however, ejection fraction increased from rest to anaerobic threshold only in the heart failure group (partial ventriculotomy = 44 +/- 17%; P = non-significant vs rest; heart failure = 39 +/- 11%; P < 0.0125 vs rest; P < 0.0125 vs change in the partial ventriculotomy group). Peak filling rate was similar at rest and increased similarly in both groups at the anaerobic threshold intensity (partial ventriculotomy = 2.28 +/- 0.55 EDV/s; heart failure = 2.52 +/- 1.07 EDV/s; P < 0.0125; P > 0.05 vs change in partial ventriculotomy group). The abnormal responses demonstrated here may contribute to the limited exercise capacity of patients with partial left ventriculotomy despite the improvement in resting left ventricular systolic function.

[Disability and quality of life of stroke survivors: evaluation nine months after discharge]. / Incapacidad y calidad de vida del paciente afectado por un accidente vascular cerebral: evaluación nueve meses después del alta hospitalaria.

INTRODUCTION AND AIM: After acute episode, a great number of individuals who survive a stroke have impairments that impede them to carry out with autonomy a set of basic activities of daily life and instrumental activities of daily life. The clinical evaluation health self perception is a useful element on patient's recovering process. The purpose of this study was to evaluate post-stroke functional health status and quality of life. PATIENTS AND METHODS: After identification of a cohort of admitted patients at a general hospital, those were contacted by phone nine months after discharge. The collected tool sent by mail included the COOP WONCA charts, Frenchay Activities Index, Barthel Index, Rankin scale and a set of socio-demographic variables. RESULTS: Participants survival rate was of 81%. The physical functioning and the capacity to perform daily activities were the most affected ones, impairing the patients of making a set of basic and instrumental daily activities. The emotional state and health self-perception are also correlated to disability. CONCLUSIONS: The results suggest a significative percentage of stroke survivors maintaining a moderate or severe disability (47.8%) requiring the presence of caregiver helping self-care. Collected data enhances that stroke survivors have severe physical dysfunction associated to emotional and psychological disturbances.

Oxidative status of the myocardium in response to different intensities of physical training.

The intensity of exercise determines the metabolic pathway and the energetic substrate that is spent. Our study sought to identify the effects of different intensities of swimming on myocardial oxidative status and the blood lipid profile. Eighty Wistar rats (male and female) submitted to different intensities of a swimming regimen (low, LS; moderate, MS; or high, HS) for 16 weeks. Samples of blood and myocardium from the left ventricle were collected to determine lipid profiles and oxidative status. Reactive oxygen species (ROS) and antioxidant capacity against peroxyl radicals (ACAP), lipid profiles and lipid peroxidation was analyzed. ROS levels and ACAP were higher in male rats than in female rats overall (p<0.05). However, ACAP in the myocardium was significantly elevated in LS female rats compared to the MS and HS female rats, which had a significantly lower ACAP compared to all other groups. LS and MS training in both sexes and HS training (in females) led to significant decreases in the heart's lipid peroxidation. Amelioration of the lipid profile and reduction in oxidative damage contributed to a physiological state that benefits cardiovascular function in exercised animals. The results show that low and moderate intensity exercise promotes beneficial adaptations.

Off-pump coronary artery bypass grafting does not reduce lymphocyte activation.

OBJECTIVE: In this study, we test the hypothesis that off-pump coronary bypass surgery might result in less lymphocyte activation than on-pump coronary surgery. We also study the behavior of lymphocyte activation markers during and after surgery. BACKGROUND: Coronary artery bypass surgery is known to be associated with changes of inflammatory mediators, immune function, and early phase lymphocyte activation, which could cause postoperative lymphopenia and lymphocyte unresponsiveness. METHODS: We studied lymphocyte activation response in 28 patients randomized to off-pump (n = 13) or on-pump (n = 15) coronary artery bypass surgery. Expression of CD25, CD26, CD69, and DR on T (CD3+) and B (CD19+) lymphocytes on peripheral blood was assessed through flow cytometry. RESULTS: The response of T lymphocytes and their activation markers, as well as B lymphocytes and their activation markers, was similar after on- and off-pump surgery. Overall, T lymphocytes decreased to the lowest level 9 h after surgery and tended to increase later. For B lymphocytes, there was early reduction with increase on the 1st postoperative day. There was early activation of CD69+ and late activation of CD25+ on T lymphocytes. For B lymphocytes, there was early activation of CD69+ and late activation of DR+. CONCLUSIONS: (1) Compared to on-pump cardiopulmonary bypass, off-pump surgery does not reduce lymphocyte activation. (2) Coronary bypass surgery causes the early activation of lymphocytes, as evidenced by the increased expression of lymphocyte activation markers.

The role of secondary hyperparathyroidism in left ventricular hypertrophy of patients under chronic hemodialysis.

End-stage renal disease (ESRD) patients frequently develop structural cardiac abnormalities, particularly left ventricular hypertrophy (LVH). The mechanisms involved in these processes are not completely understood. In the present study, we evaluated a possible association between parathyroid hormone (PTH) levels and left ventricular mass (LVM) in patients with ESRD. Stable uremic patients on intermittent hemodialysis treatment were evaluated by standard two-dimensional echocardiography and their sera were analyzed for intact PTH. Forty-one patients (mean age 45 years, range 18 to 61 years), 61% males, who had been on hemodialysis for 3 to 186 months, were evaluated. Patients were stratified into 3 groups according to serum PTH: low levels (< 100 pg/ml; group I = 10 patients), intermediate levels (100 to 280 pg/ml; group II = 10 patients) and high levels (> 280 pg/ml; group III = 21 patients). A positive statistically significant association between LVM index and PTH was identified (r = 0.34; P = 0.03, Pearson's correlation coefficient) in the sample as a whole. In subgroup analyses, we did not observe significant associations in the low and intermediate PTH groups; nevertheless, PTH and LVM index were correlated in patients with high PTH levels (r = 0.62; P = 0.003). LVM index was also inversely associated with hemoglobin (r = -0.34; P = 0.03). In multivariate analysis, after adjustment for age, hemoglobin, body mass index, and blood pressure, the only independent predictor of LVM index was PTH level. Therefore, PTH is an independent predictor of LVH in patients undergoing chronic hemodialysis. Secondary hyperparathyroidism may contribute to the elevated cardiovascular morbidity associated with LVH in ESRD.

Plant zonation in a tropical irregular estuary: can large occurrence zones be explained by a tradeoff model?

Estuaries present an environmental gradient that ranges from almost fresh water conditions to almost marine conditions. Salinity and flooding are the main abiotic drivers for plants. Therefore, plant zonation in estuaries is closely related to the tidal cycles. It is expected that the competitive abilities of plants would be inversely related to the tolerance toward environmental stress (tradeoff). Thus, in estuaries, plant zonation tends to be controlled by the environment near the sandbar and by competition away from it. This zonation pattern has been proposed for regular non-tropical estuaries. For tropical estuaries, the relative importance of rain is higher, and it is not clear to what extent this model can be extrapolated. We measured the tidal influence along the environmental gradient of a tropical irregular estuary and quantified the relative importance of the environment and the co-occurrence degree. Contrary to the narrow occurrence zone that would be expected for regular estuaries, plants presented large occurrence zones. However, the relative importance of the environment and competition followed the same patterns proposed for regular estuaries. The environmental conditions allow plants to occur in larger zones, but these zones arise from smaller and infrequent patches distributed across a larger area, and most species populations are concentrated in relatively narrow zones. Thus, we concluded that the zonation pattern in the Massaguaçu River estuary agrees with the tradeoff model.

Exercise responses before and after long-term treatment with oral milrinone in patients with severe heart failure.

Administration of the positive inotropic vasodilator milrinone results in immediate improvement in the maximal and submaximal metabolic responses to exercise. To determine whether these effects persist during long-term therapy, nine patients with severe congestive heart failure were evaluated by upright maximal exercise testing before therapy (baseline), after 10 +/- 1 weeks of oral therapy, and during double-blind, placebo-controlled readministration of intravenous milrinone after withdrawal of oral drug for 24 hours. During long-term oral therapy, maximal oxygen uptake was unchanged (baseline 792 +/- 72 ml per minute, oral therapy 820 +/- 83 ml per minute), whereas the anaerobic threshold was increased significantly from 570 +/- 53 ml per minute to 681 +/- 61 ml per minute. After withdrawal of milrinone, maximal oxygen uptake and anaerobic threshold decreased significantly; subsequent intravenous administration caused significant increases in maximal oxygen uptake and anaerobic threshold, back to the values measured during oral therapy. After oral milrinone withdrawal, maximal oxygen uptake decreased below baseline values, suggesting progression of the underlying disease. The anaerobic threshold expressed as a percent of maximal oxygen uptake was significantly increased during oral therapy (baseline 73 +/- 2 percent, oral therapy 84 +/- 2 percent) and remained significantly increased after drug withdrawal, suggesting a peripheral circulatory effect. These results indicate that in selected patients with severe congestive heart failure, milrinone exerts persistent effects on the metabolic responses to both maximal and submaximal exercise. Because of progressive deterioration in exercise capacity during long-term oral therapy, the effects of milrinone may not be apparent unless it is withdrawn. The relation of milrinone therapy to disease progression is not known.

Immediate effects of milrinone on metabolic and sympathetic responses to exercise in severe congestive heart failure.

A randomized, double-blind, placebo-controlled protocol was used to determine whether milrinone exerts an immediate effect on exercise performance in patients with severe congestive heart failure. In each of 14 patients with New York Heart Association class III or IV congestive heart failure, intravenous milrinone (mean 57 +/- 5 micrograms/kg) and placebo were randomly administered just before maximal progressive upright cycle ergometry. The duration of exercise was significantly longer with milrinone than with placebo treatment (placebo 11.0 +/- 0.6 minutes, milrinone 12.5 +/- 0.9 minutes, p = 0.01). Compared with placebo, milrinone caused a higher peak oxygen uptake (placebo 10.8 +/- 0.6 ml/kg/min, milrinone 12.4 +/- 0.7 ml/kg/min, p = 0.001) and oxygen uptake at the anaerobic threshold (placebo 7.8 +/- 0.4 ml/kg/min, milrinone 9.2 +/- 0.4 ml/kg/min, p = 0.001). At peak exercise intensity, systolic blood pressure (placebo 119 +/- 5 mm Hg, milrinone 131 +/- 5 mm Hg, p = 0.001) and heart rate (placebo 114 +/- 5 beats/min, milrinone 126 +/- 6 beats/min, p = 0.001) were both increased with milrinone. Likewise, at matched submaximal exercise intensities, heart rate (placebo 111 +/- 19 beats/min, milrinone 117 +/- 20 beats/min, p less than 0.05) and systolic blood pressure (placebo 116 +/- 19 mm Hg, milrinone 121 +/- 19 mm Hg, p = 0.04) were higher with milrinone; plasma norepinephrine (placebo 1,692 +/- 208 ng/liter, milrinone 1,320 +/- 216 ng/liter, p = 0.05) and blood lactate concentrations (placebo 2.2 +/- 0.2 mM, milrinone 1.9 +/- 0.2 mM, p less than 0.05) were lower.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of two aerobic training intensities on ambulatory blood pressure in hypertensive patients: results of a randomized trial.

The effect of different intensities of aerobic exercise on blood pressure remains uncertain. The goal of this trial was to compare the effect of two different levels of aerobic physical training on 24-hour ambulatory blood pressure. In this double-blind parallel-group trial, 28 sedentary hypertensive patients (mean diastolic blood pressure of 90 to 104 mm Hg) were randomly assigned to 10 weeks of physical training at 20% (Group I) or 60% (Group II) of their maximal workload on a cycle ergometer (mean load of 32 and 85 watts, respectively). Maximal oxygen consumption was estimated by the time spent on a mechanical braked Monark bicycle (Monark, Sáo Paulo, Brazil). Indexes of physical fitness were determined by cycle ergometer tests before and after the experimental period. The principal outcome variable was mean 24-hour ambulatory blood pressure. Mean 24 hour systolic blood pressure fell from 137.2+/-14.9 to 135.2+/-12.7 mm Hg in Group I and from 144.4+/-13.3 to 138.6+/-12.9 in Group II (mean between group difference of -2.1 mm Hg, P = 0.479, adjusted for baseline blood pressure). Mean diastolic blood pressure fell from 9.21+/-10.0 to 89.3+/-7.7 mm Hg in Group I and from 93.3+/-5.8 to 90.6+/-6.8 mm Hg in Group II (mean adjusted difference of -0.06, P = 0.765). Nighttime blood pressure did not change in either group. Across all participants, a reduction in systolic blood pressure was significantly associated with improved physical fitness as manifest by increased physical work capacity at heart rate of 130 bpm (PWC130), increased systolic blood pressure at PWC130, and decreased maximum heart rate measured during the cycle ergometer test We conclude that aerobic training programs at 20% and 60% of the maximum work capacity have similar effects on ambulatory blood pressure.

Preserved left ventricular systolic and diastolic function in normoalbuminuric insulin-dependent diabetic patients with glomerular hyperfiltration.

This study was conducted to test the hypothesis that normotensive, normoalbuminuric IDDM patients with glomerular hyperfiltration may present functional or structural cardiac abnormalities. Eleven normoalbuminuric and normotensive IDDM patients with normal glomerular filtration rate and 11 patients with hyperfiltration were compared with a group of 17 age and sex matched controls. Glomerular filtration rate was measured by the 51Cr-EDTA technique and hyperfiltration was defined as a glomerular filtration rate higher than 134 ml/min/1.73 m2. Phonocardiogram, M-mode and pulsed Doppler two-dimensional echocardiograms were performed to evaluate resting left ventricular dimensions, systolic and diastolic function. Left ventricular dimensions, fractional shortening, mean velocity of fiber shortening, early and late diastolic peak filling velocity, deceleration time, mitral flow velocity integral, and isovolumic relaxation time were similar (ANOVA P > 0.05) in normal controls, diabetic patients with normal glomerular filtration rate, and diabetic patients with hyperfiltration. In conclusion, the results of our controlled observations indicate that normoalbuminuric and normotensive IDDM patients who have normal glomerular filtration rate or hyperfiltration have no Doppler-echocardiographic evidence of functional and structural abnormalities.

Intensity-related exercise albuminuria in insulin dependent diabetic patients.

Normoalbuminuric insulin-dependent diabetic (IDDM) patients may present higher rates of urinary albumin excretion after submaximal exercise at a standard intensity. To evaluate whether the urinary albumin excretion of IDDM patients is increased after maximal and submaximal exercise when exercise intensities are adjusted according to individual lactate thresholds, 16 normoalbuminuric IDDM patients (mean time from diagnosis 8 years) and 13 normal controls exercised for 20 min at intensities corresponding to 90% of the first and second lactate thresholds and to maximal tolerance on different days. Urinary albumin excretion, blood lactate concentration, heart rate and blood pressure were measured. Metabolic and cardiovascular responses to submaximal and maximal exercise were similar for patients and controls. After exercise at 90% of the first lactate threshold neither patients or controls demonstrated significant changes in urinary albumin excretion. After exercise at 90% of the second lactate threshold both patients and controls demonstrated a similar increase in urinary albumin excretion. After maximal exercise both patients and controls demonstrated marked and similar elevation in the urinary albumin excretion. There was a significant correlation (r = 0.74, P < 0.001) between blood lactate levels at the end of exercise and the decimal logarithm of post-exercise urinary albumin excretion of the diabetic patients. Thus, when exercise intensities are adjusted for lactate thresholds, normoalbuminuric IDDM patients present normal intensity-related urinary albumin excretion during exercise. These data suggest that previously observed differences in exercise induced albuminuria in IDDM patients might be related to inappropriate standardization of submaximal exercise intensities.

Increased plasma levels of soluble vascular cellular adhesion molecule-1 in patients with chest pain and angiographically normal coronary arteries.

AIMS: To assess plasma levels of vascular cellular adhesion molecule-1, a marker of endothelial dysfunction, in patients presenting with coronary syndromes submitted to coronary angiography. METHODS AND RESULTS: Plasma levels of soluble vascular cellular adhesion molecule-1 were measured by enzymatic immunoabsorbent assay in eight patients with angina-like chest pain and angiographically normal coronary arteries; in 14 patients with stable angina and in 18 patients with unstable angina, both with coronary lesions by angiography, and in 10 healthy volunteers. Levels of soluble vascular cellular adhesion molecule-1 were higher in unstable angina patients (1777+/-161 SE pg ml(-1)) compared to patients with stable angina (1178+/-206 SE pg ml(-1), P<0.05). Moreover, patients with angina-like chest pain and normal coronary arteries had significantly higher soluble vascular cellular adhesion molecule-1 levels (2307+/-295 SE pg ml(-1)) compared to stable angina patients (P<0.05), but similar levels compared to unstable angina patients. Patient groups had higher values of soluble vascular cellular adhesion molecule-1 compared to the control group (734+/-97 SE pg ml(-1)). CONCLUSIONS: Increased levels of soluble vascular cellular adhesion molecule-1 are associated with coronary artery disease in patients with anatomically established lesions. In patients free of flow-limiting lesions and angina-like chest pain, high levels of this marker may indicate endothelial dysfunction.