Comparison of Heart Autonomic Control between Hemodynamically Stable and Unstable Patients during Hemodialysis Sessions: A Bayesian Approach.

Intradialytic hypotension is a common complication during hemodialysis sessions. The analysis of successive RR interval variability using nonlinear methods represents a promising tool for evaluating the cardiovascular response to acute volemic changes. Thus, the present study aims to compare the variability of successive RR intervals between hemodynamically stable (HS) and unstable (HU) patients during a hemodialysis session, through linear and nonlinear methods. Forty-six chronic kidney disease patients volunteered in this study. Successive RR intervals and blood pressures were recorded throughout the hemodialysis session. Hemodynamic stability was defined based on the delta of systolic blood pressure (higher SBP-lower SBP). The cutoff for hemodynamic stability was defined as 30 mm Hg, and patients were stratified as: HS ([n = 21]: ≤29.9 mm Hg) or HU ([n = 25]: ≥30 mm Hg). Linear methods (low-frequency [LFnu] and high-frequency [HFnu] spectra) and nonlinear methods (multiscale entropy [MSE] for Scales 1-20, and fuzzy entropy) were applied. The area under the MSE curve at Scales 1-5 (MSE1-5), 6-20 (MSE6-20), and 1-20 (MSE1-20) were also used as nonlinear parameters. Frequentist and Bayesian inferences were applied to compare HS and HU patients. The HS patients exhibited a significantly higher LFnu and lower HFnu. For MSE parameters, Scales 3-20 were significantly higher, as well as MSE1-5, MSE6-20, and MSE1-20 in HS, when compared to HU patients (p < 0.05). Regarding Bayesian inference, the spectral parameters demonstrated an anecdotal (65.9%) posterior probability favoring the alternative hypothesis, while MSE exhibited moderate to very strong probability (79.4 to 96.3%) at Scales 3-20, and MSE1-5, MSE6-20, and MSE1-20. HS patients exhibited a higher heart-rate complexity than HU patients. In addition, the MSE demonstrated a greater potential than spectral methods to differentiate variability patterns in successive RR intervals.

Time-Course of Redox Status, Redox-Related, and Mitochondrial-Dynamics-Related Gene Expression after an Acute Bout of Different Physical Exercise Protocols.

We investigated the magnitude of exercise-induced changes in muscular bioenergetics, redox balance, mitochondrial function, and gene expression within 24 h after the exercise bouts performed with different intensities, durations, and execution modes (continuous or with intervals). Sixty-five male Swiss mice were divided into four groups: one control (n = 5) and three experimental groups (20 animals/group), submitted to a forced swimming bout with an additional load (% of animal weight): low-intensity continuous (LIC), high-intensity continuous (HIC), and high-intensity interval (HII). Five animals from each group were euthanized at 0 h, 6 h, 12 h, and 24 h postexercise. Gastrocnemius muscle was removed to analyze the expression of genes involved in mitochondrial biogenesis (Ppargc1a), fusion (Mfn2), fission (Dnm1L), and mitophagy (Park2), as well as inflammation (Nos2) and antioxidant defense (Nfe2l2, GPx1). Lipid peroxidation (TBARS), total peroxidase, glutathione peroxidase (GPx), and citrate synthase (CS) activity were also measured. Lactacidemia was measured from a blood sample obtained immediately postexercise. Lactacidemia was higher the higher the exercise intensity (LIC < HIC < HII), while the inverse was observed for TBARS levels. The CS activity was higher in the HII group than the other groups. The antioxidant activity was higher 24 h postexercise in all groups compared to the control and greater in the HII group than the LIC and HIC groups. The gene expression profile exhibited a particular profile for each exercise protocol, but with some similarities between the LIC and HII groups. Taken together, these results suggest that the intervals applied to high-intensity exercise seem to minimize the signs of oxidative damage and drive the mitochondrial dynamics to maintain the mitochondrial network, similar to low-intensity continuous exercise.

Effects of 17ß-Estradiol on Monocyte/Macrophage Response to Staphylococcus aureus: An In Vitro Study.

To describe how 17ß-estradiol (E2) influence in the monocyte/macrophage response induced by S. aureus in in vitro models of murine peritoneal macrophages (MPMs) and human peripheral blood monocytes (HPBM). MPMs (2 x 105/ml) were isolated from sham (n=3) and ovariectomized (OVX) females (n = 3) and males (n = 3) after induction by thioglycolate. The MPMs obtained from OVX females and males were treated for 24 hours with 17ß-estradiol (E2) (10-7 M), and after that, inoculation with S. aureus was carried out for 6 hours. The macrophages were collected and destined to evaluate the relative gene expression of TNF-α, IL-1ß, IL-6, IL-8 and TLR2. For the in vitro model of HPBMs, six men and six women of childbearing age were selected and HPBMs were isolated from samples of the volunteers' peripheral blood. In women, blood was collected both during menstruation and in the periovulatory period. HPBMs were inoculated with S. aureus for 6 hours and the supernatant was collected for analysis of cytokines by Luminex and the HPBMs were removed for analysis of 84 genes involved in the host's response to bacterial infections by RT-PCR array. Previous treatment with E2 decreased the gene expression and production of proinflammatory cytokines, such as TNF-α, IL-1ß and IL-6 and decreased the expression of TLR2 tanto em MPMs quanto em HPBMs. The analysis of gene expression shows that E2 inhibited the NFκB pathway. It is suggested that 17ß-estradiol acts as an immunoprotective in the monocyte/macrophage response induced by S. aureus.

Hyperuricemia is associated with sympathovagal imbalance in older adults.

PURPOSE: This study aimed to compare heart rate variability (HRV) parameters obtained through symbolic analysis (SA), between older adults with and without hyperuricemia. METHODS: This is a cross-sectional study including 202 community-dwelling old adults, which was clinically stratified as with or without hyperuricemia, according to the cutoff point of serum uric acid ≥ 6 mg/dL for women and ≥ 7 mg/dL for men. Successive RR intervals were recorded along 5 min and analyzed with SA method. 0 V%, 1 V% and 2 V% patterns were quantified and compared between groups. Comparisons were carried out through parametric or nonparametric tests, according to the data distribution characteristics, evaluated by Kolmogorov-Smirnov test. The significance level was set as p ≤ 0.05 for all statistical procedures. RESULTS: The prevalence of hyperuricemia was 67.8 %, and the hyperuricemic older adults exhibited significant higher values for V0% and lower values for V2% parameters when compared to normouricemic older adults. CONCLUSION: These results suggesting a sympathovagal imbalance in hyperuricemic older adults, characterized by greater sympathetic predominance (0 V%) and lower vagal modulation (2 V%) at rest conditions.

Sarcopenia is associated to an impaired autonomic heart rate modulation in community-dwelling old adults.

PURPOSE: The aims of this study were to compare the autonomic heart control parameters from sarcopenic and non-sarcopenic community-dwelling elders. METHODS: This is a cross-sectional study including 76 community-dwelling old adults, which was clinically stratified as sarcopenic or non-sarcopenic, according to the current recommendations. They were submitted to 5-min recordings of successive RR intervals. The analysis of the RR intervals variability was carried out in time (mean RR, RMSSD, pNN50, SDNN and triangular index) and frequency domains (LFnu, HFnu and LF/HF ratio), and with nonlinear methods (SD1, SD2, and D2). The parameters of autonomic heart rate modulation (AHRM) were adjusted for potential confounders: sex, diabetes, beta-blockers use, cardiovascular disease, body mass index and physical activity level, smoking habit. Normality of the data was tested by Kolmogorov-Smirnov test and, since most variables did not exhibit a normal distribution the Mann-Whitney test was used to compare the parameters of AHRM. The significance level was set as p ≤ 0.05 and all statistical procedures were performed with SPSS®. RESULTS: Adjusted parameters of AHRM obtained from time domain and nonlinear methods were significantly different between sarcopenic and non-sarcopenic elders (p < 0.05), while parameters obtained from frequency domain analysis did not were different between groups (p > 0.05). CONCLUSION: Sarcopenic old adults exhibited lower parasympathetic-associated modulation, suggesting a poor cardioprotection associated to this condition.

Avaliação do acesso aos exames laboratoriais para pacientes atendidos nas Unidades de Saúde da Família de Vitória da Conquista, BA / Evaluation of access to laboratory tests for patients treated in the health units of Vitória da Conquista family, BA

O direito à saúde no Brasil foi construído através de modificações diversas, impulsionadas por diferentes acontecimentos históricos, econômicos, sociais e políticos. Com a promulgação da Constituição Federal de 1988, o direito à saúde passou a ser um direito fundamental, permitindo o surgimento do Sistema Único de Saúde (SUS). O SUS formalmente passou a garantir acesso gratuito a diversos tipos de serviços de saúde, mas não necessariamente implicou na garantia efetiva desse acesso. Ao falar nos serviços de saúde ofertados pelo SUS, é razoável mostrar que os exames laboratoriais existem como ferramentas fundamentais para permitir a integralidade da atenção à saúde tão necessária aos seus usuários. Dentro deste contexto, o presente estudo objetivou avaliar o acesso aos exames laboratoriais para os pacientes atendidos nas Unidades de Saúde da Família (USF), do município de Vitória da Conquista, BA. Trata-se de um estudo transversal de abordagem quantitativa, cuja coleta de dados foi realizada por meio de um questionário semiestruturado, adaptado da Pesquisa Nacional de Saúde, que investigou características do usuário atendido na USF, serviço prestado pela USF e serviço para encaminhamento e realização de exames laboratoriais. As USFs selecionadas foram Urbis V, Recanto das Águas, Iguá e São Sebastião. A população foi composta por indivíduos adultos atendidos em USFs do município de Vitória da Conquista, com idade igual ou superior a 20 anos. Realizou-se análise descritiva assim como univariada e multivariada. Comparou-se o número de pacientes que realizaram o exame laboratorial em menos de um ano àqueles com exame laboratorial ocorrido há mais de um ano. Verificou-se que, dos 522 pacientes entrevistados nas USFs, 453 realizaram exame laboratorial, sendo que 359 atendimentos aconteceram no Laboratório Público. Houve maior prevalência para realização de exames laboratoriais há mais de um ano em pacientes com faixa etária de 30-39 anos de idade, da zona rural e sem consulta médica nos 12 últimos meses. Esse estudo é inédito na nossa região, traz resultados sobre o acesso aos exames laboratoriais, e,mesmo havendo limitações, foi capaz de indicar a situação atual do serviço na seara laboratorial. Também apontou para a necessidade de alguns ajustes, a fim de subsidiar melhorias e incrementos na prestação de serviço, de modo a melhorar a qualidade do atendimento proposto pelo SUS.

The right to health in Brazil was built through several changes, driven by different historical,economic, social and political events. With the enactment of the 1988 Federal Constitution, theright to health has become a fundamental right, allowing the emergence of Unified Health Sys-tem- SUS. SUS formally guarantee free access to various types of health services, but not necessarilyimplied the effective guarantee of the access. Speaking in the health services offered by SUS, it isreasonable to show that laboratory tests exist as essential tools to enable the com-prehensivenessof health care so necessary to its users. Within this context, this study aimed to evaluate the accessto laboratory tests for patients attended at Family Health Units - USF, in Vitória da Conquista city,BA. This is a cross-sectional study with a quantitative approach, which data collection wasperformed using a semi-structured questionnaire adapted from the National Health Survey, whichinvestigated user characteristics attended at USF, service pro-vided by USF and the service forrouting and execution of laboratory tests. The selected USFs were Urbis V, Recanto das Águas,Iguá and São Sebastião. The population consisted of adults attended in USFs from Vitória daConquista city, aged equal or more than 20 years. A descrip-tive analysis as well as univariate andmultivariate analysis were perfomerd. The study com-pared the number of patients whounderwent laboratory examination in less than a year to those with laboratory tests occurred morethan one year. It was found that, of 522 patients interviewed in USFs, 453 underwent laboratorytests, and 359 were executed in the Public Laboratory. There was a higher prevalence oflaboratory tests for more than a year in patients aged 30-39 years old, from countryside and nomedical visit in the last 12 months. This study is unprecedented in our region, it brings results onthe access to laboratory tests, and, even with limitations, was able to indicate the current status ofthe service in the laboratory issue. It also pointed the need for some adjustments in order tosupport improvements and increases in service delivery to improve the quality of care proposed bySUS.