Telemonitoramento da Insuficiência Cardíaca - A Experiência de um Centro / Telemonitoring in Heart Failure - A Single Center Experience

Resumo Fundamento A evolução natural da insuficiência cardíaca é uma pior progressiva e internações hospitalares recorrentes. São necessárias estratégias para se detectar descompensações em tempo hábil. O uso do telemonitoramento da insuficiência cardíaca é inconsistente. Objetivos Este estudo tem o objetivo de avaliar o impacto desse programa de telemonitoramento (PTM) em internações hospitalares e admissões em serviços de emergência. Métodos Este é um estudo retrospectivo observacional que analisou dados de todos os pacientes que se cadastraram no PTM de janeiro a 2018 a dezembro de 2019. Foram coletados dados demográficos, clínicos e relacionados ao PTM. O número de internações hospitalares e admissões em serviços de emergência do ano anterior e posterior ao cadastro foram comparados, utilizando-se o teste de Wilcoxon. Um p-valor bilateral de <0,05 foi considerado significativo. Resultados Um total de 39 pacientes foram cadastrados, com uma média de idade de 62,1 ± 14 anos e predominância de pacientes do sexo masculino (90%). As causas mais comuns de insuficiência cardíaca foram cardiomiopatia isquêmica e dilatada. A fração de ejeção média foi de 30% e o tempo mediano da duração da doença foi de 84 meses (FIQ 33-144). Pacientes que foram cadastrados por menos de um mês foram excluídos, com um total de 34 pacientes analisados. Os pacientes foram acompanhados no PTM por um período mediano de 320 dias. O número de admissões em serviços de emergência foi reduzido em 66% (p<0,001) e o número de internações hospitalares por insuficiência cardíaca foi reduzido em 68% (p<0,001). O PTM não teve impacto no número de internações hospitalares por outras causas. Conclusões Este estudo sugere que o PTM poderia reduzir a utilização de serviços de saúde em pacientes com insuficiência cardíaca.

Abstract Background The natural history of heart failure is a progressive decline and recurrent hospital admissions. New strategies to timely detect decompensations are needed. The use of telemonitoring in heart failure is inconsistent. Objectives This study aimed to evaluate the impact of this telemonitoring program (TMP) in hospitalizations and emergency department admissions. Methods This is a retrospective observational study, that analyzed data of all the patients who enrolled in the TMP program from January 2018 to December 2019. Demographic, clinical, and TMP-related data were collected. The number of hospitalizations and emergency department admissions from the year before and after enrollment were compared, using the Wilcoxon test. A two-sided p<0.05 was considered significant. Results A total of 39 patients were enrolled, with a mean age of 62.1 ± 14 years and a male predominance (90%). The most common causes of heart failure were ischemic and dilated cardiomyopathy. The mean ejection fraction was 30% and the median time of disease duration was 84 months (IQR 33-144). Patients who were enrolled for less than one month were excluded, with a total of 34 patients analyzed. Patients were followed in the TMP for a median of 320 days. The number of emergency department admissions was reduced by 66% (p<0.001), and the number of hospitalizations for heart failure was reduced by 68% (p<0.001). The TMP had no impact on the number of hospitalizations for other causes. Conclusions This trial suggests that a TMP could reduce health service use in patients with heart failure.

Telemonitoring in Heart Failure - A Single Center Experience. / Telemonitoramento da Insuficiência Cardíaca ­ A Experiência de um Centro.

BACKGROUND: The natural history of heart failure is a progressive decline and recurrent hospital admissions. New strategies to timely detect decompensations are needed. The use of telemonitoring in heart failure is inconsistent. OBJECTIVES: This study aimed to evaluate the impact of this telemonitoring program (TMP) in hospitalizations and emergency department admissions. METHODS: This is a retrospective observational study, that analyzed data of all the patients who enrolled in the TMP program from January 2018 to December 2019. Demographic, clinical, and TMP-related data were collected. The number of hospitalizations and emergency department admissions from the year before and after enrollment were compared, using the Wilcoxon test. A two-sided p<0.05 was considered significant. RESULTS: A total of 39 patients were enrolled, with a mean age of 62.1 ± 14 years and a male predominance (90%). The most common causes of heart failure were ischemic and dilated cardiomyopathy. The mean ejection fraction was 30% and the median time of disease duration was 84 months (IQR 33-144). Patients who were enrolled for less than one month were excluded, with a total of 34 patients analyzed. Patients were followed in the TMP for a median of 320 days. The number of emergency department admissions was reduced by 66% (p<0.001), and the number of hospitalizations for heart failure was reduced by 68% (p<0.001). The TMP had no impact on the number of hospitalizations for other causes. CONCLUSIONS: This trial suggests that a TMP could reduce health service use in patients with heart failure.

FUNDAMENTO: A evolução natural da insuficiência cardíaca é uma pior progressiva e internações hospitalares recorrentes. São necessárias estratégias para se detectar descompensações em tempo hábil. O uso do telemonitoramento da insuficiência cardíaca é inconsistente. OBJETIVOS: Este estudo tem o objetivo de avaliar o impacto desse programa de telemonitoramento (PTM) em internações hospitalares e admissões em serviços de emergência. MÉTODOS: Este é um estudo retrospectivo observacional que analisou dados de todos os pacientes que se cadastraram no PTM de janeiro a 2018 a dezembro de 2019. Foram coletados dados demográficos, clínicos e relacionados ao PTM. O número de internações hospitalares e admissões em serviços de emergência do ano anterior e posterior ao cadastro foram comparados, utilizando-se o teste de Wilcoxon. Um p-valor bilateral de <0,05 foi considerado significativo. RESULTADOS: Um total de 39 pacientes foram cadastrados, com uma média de idade de 62,1 ± 14 anos e predominância de pacientes do sexo masculino (90%). As causas mais comuns de insuficiência cardíaca foram cardiomiopatia isquêmica e dilatada. A fração de ejeção média foi de 30% e o tempo mediano da duração da doença foi de 84 meses (FIQ 33-144). Pacientes que foram cadastrados por menos de um mês foram excluídos, com um total de 34 pacientes analisados. Os pacientes foram acompanhados no PTM por um período mediano de 320 dias. O número de admissões em serviços de emergência foi reduzido em 66% (p<0,001) e o número de internações hospitalares por insuficiência cardíaca foi reduzido em 68% (p<0,001). O PTM não teve impacto no número de internações hospitalares por outras causas. CONCLUSÕES: Este estudo sugere que o PTM poderia reduzir a utilização de serviços de saúde em pacientes com insuficiência cardíaca.

Long-Term Clinical and Hemodynamic Outcomes after Heart Transplantation in Patients Pre-Treated with Sildenafil. / Resultados Clínicos e Hemodinâmicos de Longo Prazo após o Transplante de Coração em Pacientes Pré-Tratados com Sildenafil.

BACKGROUND: Elevated pulmonary vascular resistance remains a major problem for heart transplant (HT) candidate selection. OBJECTIVE: This study sought at assess the effect of pre-HT sildenafil administration in patients with fixed pulmonary hypertension. METHODS: This retrospective, single-center study included 300 consecutive, HT candidates treated between 2003 and 2013, in which 95 patients had fixed PH, and of these, 30 patients were treated with sildenafil and eventually received a transplant, forming Group A. Group B included 205 patients without PH who underwent HT. Pulmonary hemodynamics were evaluated before HT, as well as 1 week after and 1 year after HT. Survival was compared between the groups. In this study, a p value < 0.05 was considered statistically significant. RESULTS: After treatment with sildenafil but before HT, PVR (-39%) and sPAP (-10%) decreased significantly. sPAP decreased after HT in both groups, but it remained significantly higher in group A vs. group B (40.3 ± 8.0 mmHg vs 36.5 ± 11.5 mmHg, p=0.022). One year after HT, sPAP was 32.4 ± 6.3 mmHg in group A vs 30.5 ± 8.2 mmHg in group B (p=0.274). The survival rate after HT at 30 days (97% in group A versus 96% in group B), at 6 months (87% versus 93%) and at one year (80% vs 91%) were not statistically significant (Log-rank p=0.063). After this first year, the attrition rate was similar among both groups (conditional survival after 1 year, Log-rank p=0.321). CONCLUSION: In patients with severe PH pre-treated with sildenafil, early post-operative hemodynamics and prognosis are numerically worse than in patients without PH, but after 1 year, the medium to long-term mortality proved to be similar. (Arq Bras Cardiol. 2021; 116(2):219-226).

FUNDAMENTO: A resistência vascular pulmonar elevada ainda é um grande problema na seleção de candidatos ao transplante cardíaco. OBJETIVO: Nosso objetivo foi avaliar o efeito da administração de sildenafila pré-transplante cardíaco em pacientes com hipertensão pulmonar fixa. MÉTODOS: O estudo retrospectivo, de centro único, incluiu 300 candidatos a transplante cardíaco consecutivos tratados entre 2003 e 2013. Destes, 95 pacientes tinham hipertensão pulmonar fixa e, dentre eles, 30 pacientes foram tratados com sildenafila e acabaram passando pelo transplante, formando o Grupo A. O Grupo B incluiu 205 pacientes sem hipertensão pulmonar que passaram pelo transplante cardíaco. A hemodinâmica pulmonar foi avaliada antes do transplante, 1 semana e 1 ano após o transplante. A taxa de sobrevivência foi comparada entre os grupos. Neste estudo, um P valor < 0,05 foi considerado estatisticamente significativo. RESULTADOS: Após o tratamento com sildenafila, mas antes do TxC, a RVP (-39%) e a PAPs (-10%) diminuíram significativamente. A PAPs diminuiu após o TxC em ambos os grupos, mas permaneceu significativamente alta no grupo A em relação ao grupo B (40,3 ± 8,0 mmHg versus 36,5 ± 11,5 mmHg, P=0,022). Um ano após o TxC, a PAPs era 32,4 ± 6,3 mmHg no Grupo A versus 30,5 ± 8,2 mmHg no Grupo B (P=0,274). O índice de sobrevivência após o TxC 30 dias (97% no grupo A versus 96% no grupo B), 6 meses (87% versus 93%) e um ano (80% versus 91%) após o TxC não foi estatisticamente significativo (Log-rank P=0,063). Depois do primeiro ano, o índice de mortalidade era similar entre os dois grupos (sobrevivência condicional após 1 ano, Log-rank p=0,321). CONCLUSÃO: Nos pacientes com HP pré-tratados com sildenafila, a hemodinâmica pós-operatória inicial e o prognóstico são numericamente piores em pacientes sem HP, mas depois de 1 ano, a mortalidade em médio e longo prazo são semelhantes. (Arq Bras Cardiol. 2021; 116(2):219-226).

Resultados Clínicos e Hemodinâmicos de Longo Prazo após o Transplante de Coração em Pacientes Pré-Tratados com Sildenafil / Long-Term Clinical and Hemodynamic Outcomes after Heart Transplantation in Patients Pre-Treated with Sildenafil

Resumo Fundamento A resistência vascular pulmonar elevada ainda é um grande problema na seleção de candidatos ao transplante cardíaco. Objetivo Nosso objetivo foi avaliar o efeito da administração de sildenafila pré-transplante cardíaco em pacientes com hipertensão pulmonar fixa. Métodos O estudo retrospectivo, de centro único, incluiu 300 candidatos a transplante cardíaco consecutivos tratados entre 2003 e 2013. Destes, 95 pacientes tinham hipertensão pulmonar fixa e, dentre eles, 30 pacientes foram tratados com sildenafila e acabaram passando pelo transplante, formando o Grupo A. O Grupo B incluiu 205 pacientes sem hipertensão pulmonar que passaram pelo transplante cardíaco. A hemodinâmica pulmonar foi avaliada antes do transplante, 1 semana e 1 ano após o transplante. A taxa de sobrevivência foi comparada entre os grupos. Neste estudo, um P valor < 0,05 foi considerado estatisticamente significativo. Resultados Após o tratamento com sildenafila, mas antes do TxC, a RVP (-39%) e a PAPs (-10%) diminuíram significativamente. A PAPs diminuiu após o TxC em ambos os grupos, mas permaneceu significativamente alta no grupo A em relação ao grupo B (40,3 ± 8,0 mmHg versus 36,5 ± 11,5 mmHg, P=0,022). Um ano após o TxC, a PAPs era 32,4 ± 6,3 mmHg no Grupo A versus 30,5 ± 8,2 mmHg no Grupo B (P=0,274). O índice de sobrevivência após o TxC 30 dias (97% no grupo A versus 96% no grupo B), 6 meses (87% versus 93%) e um ano (80% versus 91%) após o TxC não foi estatisticamente significativo (Log-rank P=0,063). Depois do primeiro ano, o índice de mortalidade era similar entre os dois grupos (sobrevivência condicional após 1 ano, Log-rank p=0,321). Conclusão Nos pacientes com HP pré-tratados com sildenafila, a hemodinâmica pós-operatória inicial e o prognóstico são numericamente piores em pacientes sem HP, mas depois de 1 ano, a mortalidade em médio e longo prazo são semelhantes. (Arq Bras Cardiol. 2021; 116(2):219-226)

Abstract Background Elevated pulmonary vascular resistance remains a major problem for heart transplant (HT) candidate selection. Objective This study sought at assess the effect of pre-HT sildenafil administration in patients with fixed pulmonary hypertension. Methods This retrospective, single-center study included 300 consecutive, HT candidates treated between 2003 and 2013, in which 95 patients had fixed PH, and of these, 30 patients were treated with sildenafil and eventually received a transplant, forming Group A. Group B included 205 patients without PH who underwent HT. Pulmonary hemodynamics were evaluated before HT, as well as 1 week after and 1 year after HT. Survival was compared between the groups. In this study, a p value < 0.05 was considered statistically significant. Results After treatment with sildenafil but before HT, PVR (-39%) and sPAP (-10%) decreased significantly. sPAP decreased after HT in both groups, but it remained significantly higher in group A vs. group B (40.3 ± 8.0 mmHg vs 36.5 ± 11.5 mmHg, p=0.022). One year after HT, sPAP was 32.4 ± 6.3 mmHg in group A vs 30.5 ± 8.2 mmHg in group B (p=0.274). The survival rate after HT at 30 days (97% in group A versus 96% in group B), at 6 months (87% versus 93%) and at one year (80% vs 91%) were not statistically significant (Log-rank p=0.063). After this first year, the attrition rate was similar among both groups (conditional survival after 1 year, Log-rank p=0.321). Conclusion In patients with severe PH pre-treated with sildenafil, early post-operative hemodynamics and prognosis are numerically worse than in patients without PH, but after 1 year, the medium to long-term mortality proved to be similar. (Arq Bras Cardiol. 2021; 116(2):219-226)

Wild mouse & laboratory mouse historical aspects, genetic selection and welfare / Camundongo selvagem & camundongo de laboratório aspectos históricos, seleção genética e bem estar

The mouse is the most used animal model in biomedical pre clinical trials. Its phylogeny descends from the genus Mus, subgenus Mus and species Mus musculus. The origin of this animal as an experimental model is due to the capture of wild subspecies mainly Mus musculus domesticus, Mus musculus musculus, Mus musculus castaneus and the hybrid subspecie Mus musculus molosinus. For centuries, diverse breeders with diverse geographical locations have been breeding and swapping selected individuals from among them, which has promoted very large genetic variability and difficulty in accurately recording subspecies that gave rise to both isogenic strains and outbred stocks individuals. The couple Abbie Lathrop and Leo Loeb in Massachusetts (United States of America) are the most cited in this activity. But it was documented, mainly at the origin of the inbred lineages, however, Swiss outbred stock that other unknownsuppliers were selecting albino mice and supplying to research institutes. Currently, we believe in the theory of the subspecies Mus musculus laboratorius existence in house facilities. Because through years suffering artificial evolutionary and selective pressuresthe extreme adaptability of this animal (which made it possible to be captured in the wild and reproduce in captivity) also made the restriction of space in the laboratory enviroment. However, we must take into consideration, with great respect for this animal, that despite its adaptability, its welfare is linked to the expression of its intrinsic natural behavior to the species M. musculus. Thus we have the obligation to provide mating and management directed at reducing the aggressiveness of adult males; searchingfor equipment and materials to the mouse preference; avoiding abrupt changes inenvironment and routine and proper handling...

O camundongo é o modelo animal mais utilizado em ensaios biomédicos. Sua filogenia descende do gênero Mus, subgênero Mus e espécie Mus musculus. A origem desse animal como modelo experimental, deve-se a captura de subespécies selvagens como as Mus musculus domesticus, Mus musculus musculus, Mus musculus castaneuse do híbrido Mus musculus molosinus. Durante séculos, diversos criadores, comdiversas localizações geográficas, realizaram o acasalamento e troca de indivíduos selecionados entre eles, o que promoveu uma variabilidade genética muito grande e uma dificuldade de precisão de registros das subespécies que deram origem tanto as linhagens isogênicas e os indivíduos outbred stocks. O casal Abbie Lathrop e Leo Loebem Massachusetts nos Estados Unidos são os mais citados nessa atividade. Porém sua origem foi documentada, principalmente em relação à linhagem inbred, contudo em relação ao Swiss outbred stock os relatos sugerem que outros fornecedores desconhecidos realizavam a seleção de camundongos albinos e forneciam a instituosde pesquisa. Atualmente, acreditamos na teoria da existência da subespécie Musmusculus laboratorius, pois através de anos sofrendo pressões evolutivas e seletivas artificiais, a extrema capacidade de adaptabilidade desse animal (que o possibilitou ser capturado na natureza e se reproduzir em cativeiro) também tornou adaptado à restrição de espaço em biotério. Contudo, devemos levar em consideração, com muito respeito a esse animal, que apesar dessa adaptabilidade, o seu bem estar é inerente a expressão do comportamento natural intrínsseco da espécie M. musculus. Dessa forma temos a obrigação de propiciar acasalamento e manejo direcionado a redução da agressividade de indivíduos machos adultos, busca por equipamentos emateriais que sejam de preferência do animal, evitar mudanças abruptas de ambiente e rotina e manipulação adequada...

Wild mouse & laboratory mouse historical aspects, genetic selection and welfare / Camundongo selvagem & camundongo de laboratório aspectos históricos, seleção genética e bem estar

The mouse is the most used animal model in biomedical pre clinical trials. Its phylogeny descends from the genus Mus, subgenus Mus and species Mus musculus. The origin of this animal as an experimental model is due to the capture of wild subspecies mainly Mus musculus domesticus, Mus musculus musculus, Mus musculus castaneus and the hybrid subspecie Mus musculus molosinus. For centuries, diverse breeders with diverse geographical locations have been breeding and swapping selected individuals from among them, which has promoted very large genetic variability and difficulty in accurately recording subspecies that gave rise to both isogenic strains and outbred stocks individuals. The couple Abbie Lathrop and Leo Loeb in Massachusetts (United States of America) are the most cited in this activity. But it was documented, mainly at the origin of the inbred lineages, however, Swiss outbred stock that other unknownsuppliers were selecting albino mice and supplying to research institutes. Currently, we believe in the theory of the subspecies Mus musculus laboratorius existence in house facilities. Because through years suffering artificial evolutionary and selective pressuresthe extreme adaptability of this animal (which made it possible to be captured in the wild and reproduce in captivity) also made the restriction of space in the laboratory enviroment. However, we must take into consideration, with great respect for this animal, that despite its adaptability, its welfare is linked to the expression of its intrinsic natural behavior to the species M. musculus. Thus we have the obligation to provide mating and management directed at reducing the aggressiveness of adult males; searchingfor equipment and materials to the mouse preference; avoiding abrupt changes inenvironment and routine and proper handling...(AU)

O camundongo é o modelo animal mais utilizado em ensaios biomédicos. Sua filogenia descende do gênero Mus, subgênero Mus e espécie Mus musculus. A origem desse animal como modelo experimental, deve-se a captura de subespécies selvagens como as Mus musculus domesticus, Mus musculus musculus, Mus musculus castaneuse do híbrido Mus musculus molosinus. Durante séculos, diversos criadores, comdiversas localizações geográficas, realizaram o acasalamento e troca de indivíduos selecionados entre eles, o que promoveu uma variabilidade genética muito grande e uma dificuldade de precisão de registros das subespécies que deram origem tanto as linhagens isogênicas e os indivíduos outbred stocks. O casal Abbie Lathrop e Leo Loebem Massachusetts nos Estados Unidos são os mais citados nessa atividade. Porém sua origem foi documentada, principalmente em relação à linhagem inbred, contudo em relação ao Swiss outbred stock os relatos sugerem que outros fornecedores desconhecidos realizavam a seleção de camundongos albinos e forneciam a instituosde pesquisa. Atualmente, acreditamos na teoria da existência da subespécie Musmusculus laboratorius, pois através de anos sofrendo pressões evolutivas e seletivas artificiais, a extrema capacidade de adaptabilidade desse animal (que o possibilitou ser capturado na natureza e se reproduzir em cativeiro) também tornou adaptado à restrição de espaço em biotério. Contudo, devemos levar em consideração, com muito respeito a esse animal, que apesar dessa adaptabilidade, o seu bem estar é inerente a expressão do comportamento natural intrínsseco da espécie M. musculus. Dessa forma temos a obrigação de propiciar acasalamento e manejo direcionado a redução da agressividade de indivíduos machos adultos, busca por equipamentos emateriais que sejam de preferência do animal, evitar mudanças abruptas de ambiente e rotina e manipulação adequada...(AU)

Laboratório de mudança: método para compreensão da crise entre universidade pública e sociedade / Change laboratory: a method for understating the crisis between public university and society

Resumo O objetivo deste artigo é analisar se um método de intervenção formativa contribui para que os profissionais de atividades colaborativas formem uma compreensão histórica dos problemas enfrentados em crises interinstitucionais e criem soluções para essas situações. Apresentamos o método Laboratório de Mudança (LM), inspirado na Teoria da Atividade Histórico-Cultural (TAHC). Ele é ilustrado com um caso empírico de intervenção na qual foi identificada a gênese histórica e as contradições que levaram à crise entre uma universidade pública e um centro de saúde escola. Para o estudo foram utilizados dados obtidos a partir de registros efetuados ao longo da intervenção, entre 2013 e 2015, assim como entrevistas e comentários dos participantes. Como resultado, eles analisaram historicamente suas atividades e desenharam novos cenários de colaboração futura, visando uma solução para a crise, no âmbito de possíveis relações acadêmico-pedagógicas vinculadas ao Sistema Único de Saúde (SUS). A análise sugere a existência de contradições nos objetos das atividades de assistência à saúde e educação que podem estar no cerne da relação problemática entre outras instituições semelhantes que precisam desenvolver atividades colaborativamente. O LM, enquanto metodologia de intervenção formativa, integra diagnóstico, aprendizagem, protagonismo dos participantes e criação de soluções como parte de um mesmo processo.

Abstract The purpose of this article is to analyze if a method of developmental intervention helps the professionals of the activities in interinstitutional crises to form a historical understanding of the problems faced and to create solutions for them. We present a method called Change Laboratory (CL), inspired by the Theory of Historical-Cultural Activity (THCA). It is illustrated with an empirical case of intervention where the historical genesis and the contradictions that led to the crisis in the collaborative relationship between a public university and an educational health center were identified, between 2013 and 2015. Data obtained from records made during the intervention as well as interviews and comments from the participants were used for the study. As a result, the participants analyzed their activities historically and designed the future collaboration activity aimed at a solution to the crisis, within the scope of possible academic-pedagogical relations linked to the Brazilian National Health System (SUS). The analysis suggests contradictions in the objects of health care and education activities that may be at the heart of the problematic relationship among institutions that need to develop activities collaboratively. The CL as a methodology of developmental intervention integrates diagnosis, learning, the participants' protagonism and the creation of solutions as part of the same process.

Relação entre a universidade pública e a sociedade: contribuições do Laboratório de Mudanças / Relationship between the Public University and the Society contributions of the Laboratory of Changes

Pesquisas intervencionistas baseadas na Teoriada AtividadeHistórico-Cultural (TAHC), do aprendizado expansivo e que utilizam o método dialógico auxiliam no encontro de soluções para crises interinstitucionais complexas que exigem decisões urgentes e de impacto na sociedade. O objetivo do estudo foi aplicar e analisar a metodologia intervencionista Laboratório de Mudanças (LM), seus princípios esuas meta-ferramentas em um caso empírico de distanciamento institucional entre a Faculdade de Saúde Pública da Universidade de São Paulo (FSP/USP) e o Centro de Saúde Escola Geraldo de Paula Souza (CSEGPS). Trata-se de uma pesquisa de intervenção formativa na modalidade de estudo de caso que ocorreu entre 2013 e 2016. Foram realizadas análise de documentos e observação exploratória para coleta de dados etnográficos,entrevistas semiestruturadas, reuniões de planejamento e sessões do LM. O referencial teórico utilizado para análise dos dados foi a metodologia do LM. O uso do princípio de dupla estimulação de Vygostsky ajudou os participantes e pesquisadores a identificar as contradições nos Sistemas de Atividades (SAs) e desvelar a gênese histórica e sistêmica dos problemas que culminaram na crise e no afastamento nas relações de colaboração em atividades acadêmicas. Oresgate das origens das contradições manifestadas como conflitos e distúrbios e a análise dessas contradições serviu para retroalimentar o processo de aprendizagem dos participantes.A Linha do Tempo foi uma das meta-ferramentas utilizadas que auxiliou a identificar que no passado havia uma convergência entre os objetos da FSP/USP e do CSGPS e os eventos críticos decorrentes de mudanças nas políticas econômicas, de saúde e educação, que dentre outros fatores internos às instituições influenciaram direta e indiretamente para o distanciamento, a ruptura e a crise vivenciada.A análise histórica foi um elemento essencial no processo para a aprendizagem organizacional e expansiva porque favoreceua manifestação do protagonismo dos atores envolvidos.Ao final da intervenção, a visão que os atores tinham sobre os problemas foi expandida para o entendimento de uma crise da universidade pública com a sociedade, que foi compreendida como crise de legitimidade da universidade pública. Houve ampliação de conceitos que possibilitaram aos atores visualizar soluções e desenhar a atividade de colaboração futura, no âmbito de quais seriam as relações acadêmico-pedagógicas e o processo de trabalho no SistemaÚnico de Saúde (SUS). Apesar da pesquisater sido realizada 9 em um contexto de incerteza institucional, onde havia falta de decisões políticas sobre o destino de uma das instituições, a intervenção formativa com o LM, que associa pesquisa com a extensão, foi considerada uma poderosa ferramenta para o desenvolvimento da aprendizagem e do protagonismo dos atores, com capacidade de produzir transformações nos SAs

Interventionist Research based on the Cultural-Historical Activity Theory (CHAT), of expansive learning and which uses the dialog method helps in the quest for solutions for complex institutional crises which call for urgent decisions which impact society. The objective of the study was to apply and analyze the interventionist Change Laboratory (CL) methodology, its principles and its meta-tools to an empirical case of the institutional distancing of the School Public Health of the University of São Paulo (SPH/USP) from the Educational Health Center Geraldo de Paula Souza (EHCGPS). This is a formative interventionist research in the case study mode which occurred between 2013 and 2016. A documentary analysis and exploratory observation were undertaken for the collection of ethnographic data, as also were semi-structured interviews, planning meetings and CL sessions. The theoretical frame of reference used for the data analysis was the CL method. The use of Vygostsky\'s double-stimulation principle helped the participants and researchers to identify the contradictions in the Activity Systems (ASs) and reveal the historical and systemic genesis of the problems which culminated in the crisis and the distancing in the collaborative relationship in academic activities. The recovery of the origins of the contradictions revealed as conflicts and disturbances and the analysis of these contradictions served to retro-feed the participants\' learning process. The Time-line was one of the meta-tools used which helped to identify the convergence which had existed in the past between the objectives of the SPH/USP and the EHCGPS and the critical events which arose from the changes in the policies, at one and the same time economic, of health and of education which, among other internal factors of the institutions concerned contributed both directly and indirectly to the distancing, the rupture and the crisis experienced. The historical analysis was an element essential to the organizational and expansive learning process because it favored the expression of the activity of the authors involved. At the end of the intervention, the vision which the actors hadof the problems involved was enlarged into the understanding of the crisis of the public university in its relationship with society, understood as a crisis of the legitimacy of the public university. There was a broadening of concepts which enabled the actors to visualize solutions and plan the activity of future collaboration within the ambit of what the academic-pedagogical relations and the process of the working of the Unified 11Health System (UHS) would be. Despite the research\'s having been undertaken in a context of institutional uncertainty, in which there was a lack of political decision as to the fate of one of the institutions concerned, the formative intervention using the CL, which associates research and extension work, was considered a powerful tool for the enlargement of learning and the actors\' participation, capable of transforming the ASs

Exploitation of pulsed flows for on-line dispersive liquid-liquid microextraction: Spectrophotometric determination of formaldehyde in milk.

Formaldehyde is often added to foods as a preservative, but it is highly toxic to humans, having been identified as a carcinogenic substance. It has also been used for the adulteration of milk in order to diminish the bacteria count and increase the shelf life of the product. Herein, we present a green dispersive liquid-liquid microextraction procedure in a flow-batch system for the determination of formaldehyde in milk. Pulsed flows were exploited for the first time to improve the dispersion of the extractant in the aqueous phase. The Hantzsch reaction was used for the derivatization of formaldehyde and the product was extracted with the ionic liquid (IL) trihexyltetradecylphosphonium chloride with methanol as the disperser. The flow-batch chamber was made of stainless steel with the facility for resistive heating to speed up the derivatization reaction. Spectrophotometric measurements were directly carried out in the organic phase using an optical fiber spectrophotometer. The limit of detection and coefficient of variation were 100 µg L(-1) and 3.1% (n=10), respectively, with a linear response from 0.5 to 5.0 mg L(-1), described by the equation A=0.088+0.116CF (mg L(-1)) in which A is absorbance and CF is formaldehyde concentration in mg L(-1). The estimated recoveries of formaldehyde from spiked milk samples ranged from 91% to 106% and the slopes of the analytical curves obtained with reference solutions in water or milk were in agreement, thus indicating the absence of matrix effects. Accuracy was demonstrated by the agreement of the results with those achieved by the reference fluorimetric procedure at the 95% confidence level. The proposed procedure allows for 10 extractions per hour, with minimized reagent consumption (120 µL of IL and 3.5 µL acetylacetone) and generation of only 6.7 mL waste per determination, which contribute to the eco-friendliness of the procedure.

Lowering Pulmonary Wedge Pressure after Heart Transplant: Pulmonary Compliance and Resistance Effect / Redução da Pressão Capilar Pulmonar após Transplante Cardíaco: Complacência Pulmonar e Efeito Resistência

AbstractBackground:Right ventricular (RV) afterload is an important risk factor for post-heart transplantation (HTx) mortality, and it results from the interaction between pulmonary vascular resistance (PVR) and pulmonary compliance (CPA). Their product, the RC time, is believed to be constant. An exception is observed in pulmonary hypertension because of elevated left ventricular (LV) filling pressures.Objective:Using HTx as a model for chronic lowering of LV filling pressures, our aim was to assess the variations in RV afterload components after transplantation.Methods:We retrospectively studied 159 patients with right heart catheterization before and after HTx. The effect of Htx on hemodynamic variables was assessed.Results:Most of the patients were male (76%), and the mean age was 53 ± 12 years. HTx had a significant effect on the hemodynamics, with normalization of the LV and RV filling pressures and a significant increase in cardiac output and heart rate (HR). The PVR decreased by 56% and CPA increased by 86%. The RC time did not change significantly, instead of increasing secondary to pulmonary wedge pressure (PWP) normalization after HTx as expected. The expected increase in RC time with PWP lowering was offset by the increase in HR (because of autonomic denervation of the heart). This effect was independent from the decrease of PWP.Conclusion:The RC time remained unchanged after HTx, notwithstanding the fact that pulmonary capillary wedge pressure significantly decreased. An increased HR may have an important effect on RC time and RV afterload. Studying these interactions may be of value to the assessment of HTx candidates and explaining early RV failure after HTx.

ResumoFundamento:A pós-carga do ventrículo direito (VD) é um fator de risco importante para avaliar a mortalidade decorrente de transplante cardíaco (HTx) e resulta da interação entre a resistência vascular pulmonar (RVP) e a complacência pulmonar (CPA). Acredita-se que o produto da interação, o RC-time, seja constante. Entretanto, é exceção a hipertensão pulmonar devido às elevadas pressões de preenchimento do ventrículo esquerdo (VE).Objetivos:Ao utilizar o HTx como modelo para redução crônica das pressões de preenchimento do VE, nosso objetivo foi avaliar as variações nos componentes pós-carga do VD após o transplante.Métodos:Foram estudados, retrospectivamente, 159 pacientes com cateterismo cardíaco direito realizado antes e após o HTx. O impacto do HTx nas variáveis hemodinâmicas foi avaliado.Resultados:A maioria dos pacientes foi do sexo masculino (76%) e a média de idade foi 53 ± 12 anos. O HTx teve um efeito significativo na hemodinâmica, com normalização do VE e das pressões de preenchimento de VD e no aumento significativo do débito cardíaco e da freqüência cardíaca (FC). A RVP diminuiu 56% e a CPA aumentou 86%. Em vez de aumentar como era esperado, o RC-time não alterou significativamente e teve papel secundário em relação à normalização da pressão capilar pulmonar (PECP) após o HTx. O aumento esperado no RC timecom PWP reduzido foi atenuado pelo aumento da FC (devido à denervação autonômica do coração). Esse efeito ocorreu independentemente da diminuição da PCPConclusões:O RC-time permaneceu inalterado após HTx, entretanto a PECP diminuiu significativamente. O aumento da FC pode ter impacto importante no RC-time e na pós-carga do VD. O estudo dessas interações pode ser de grande valor para avaliar os candidatos HTx e explicar a falência do VD ocorrida logo após o HTx.

Lowering pulmonary wedge pressure after heart transplant: pulmonary compliance and resistance effect.

BACKGROUND: Right ventricular (RV) afterload is an important risk factor for post-heart transplantation (HTx) mortality, and it results from the interaction between pulmonary vascular resistance (PVR) and pulmonary compliance (CPA). Their product, the RC time, is believed to be constant. An exception is observed in pulmonary hypertension because of elevated left ventricular (LV) filling pressures. OBJECTIVE: Using HTx as a model for chronic lowering of LV filling pressures, our aim was to assess the variations in RV afterload components after transplantation. METHODS: We retrospectively studied 159 patients with right heart catheterization before and after HTx. The effect of Htx on hemodynamic variables was assessed. RESULTS: Most of the patients were male (76%), and the mean age was 53 ± 12 years. HTx had a significant effect on the hemodynamics, with normalization of the LV and RV filling pressures and a significant increase in cardiac output and heart rate (HR). The PVR decreased by 56% and CPA increased by 86%. The RC time did not change significantly, instead of increasing secondary to pulmonary wedge pressure (PWP) normalization after HTx as expected. The expected increase in RC time with PWP lowering was offset by the increase in HR (because of autonomic denervation of the heart). This effect was independent from the decrease of PWP. CONCLUSION: The RC time remained unchanged after HTx, notwithstanding the fact that pulmonary capillary wedge pressure significantly decreased. An increased HR may have an important effect on RC time and RV afterload. Studying these interactions may be of value to the assessment of HTx candidates and explaining early RV failure after HTx.

Functional Capacity of Oldest Old Living in a Long-stay Institution in Rio De Janeiro, Brazil.

[Purpose] A significant increase in the number of oldest old has occurred worldwide. The aim of this study was to characterize the functional capacity of the oldest old residents in a long-stay institution in Rio de Janeiro, Brazil. [Subjects and Methods] All participants were evaluated according to the following metrics: anthropometry, body composition (bioelectrical impedance), handgrip strength, balance (Berg scale and stabilometry), ankle mobility (electrogoniometry), physical capacity (six-minute walk test), quality of life (WHOQOL-OLD), and dietary habits (questionnaire). [Results] Twenty elderly subjects with a mean age of 85.75 ± 5.22 years and a mean fat percentage of 39.02 ± 5.49% participated in the study. The group at risk of falls (n = 8) had a lower handgrip strength and walked a shorter distance over the course of six minutes compared with the group not at risk of falls. The obese group (n = 15) had higher values for stabilometric variables than the nonobese group. There was a positive and significant correlation between ankle joint mobility and physical capacity (r = 0.47). [Conclusion] High values for obesity and low values for handgrip strength and physical capacity were associated with worse body balance. Low values for ankle mobility were also associated with worse physical capacity in this population.

Simultaneous interstitial pneumonitis and cardiomyopathy induced by venlafaxine.

Venlafaxine is a serotonin-norepinephrine reuptake inhibitor used as an antidepressant. Interindividual variability and herb-drug interactions can lead to drug-induced toxicity. We report the case of a 35-year-old female patient diagnosed with synchronous pneumonitis and acute cardiomyopathy attributed to venlafaxine. The patient sought medical attention due to dyspnea and dry cough that started three months after initiating treatment with venlafaxine for depression. The patient was concomitantly taking Centella asiatica and Fucus vesiculosus as phytotherapeutic agents. Chest CT angiography and chest X-ray revealed parenchymal lung disease (diffuse micronodules and focal ground-glass opacities) and simultaneous dilated cardiomyopathy. Ecocardiography revealed a left ventricular ejection fraction (LVEF) of 21%. A thorough investigation was carried out, including BAL, imaging studies, autoimmune testing, right heart catheterization, and myocardial biopsy. After excluding other etiologies and applying the Naranjo Adverse Drug Reaction Probability Scale, a diagnosis of synchronous pneumonitis/cardiomyopathy associated with venlafaxine was assumed. The herbal supplements taken by the patient have a known potential to inhibit cytochrome P450 enzyme complex, which is responsible for the metabolization of venlafaxine. After venlafaxine discontinuation, there was rapid improvement, with regression of the radiological abnormalities and normalization of the LVEF. This was an important case of drug-induced cardiopulmonary toxicity. The circumstantial intake of inhibitors of the CYP2D6 isoenzyme and the presence of a CYP2D6 slow metabolism phenotype might have resulted in the toxic accumulation of venlafaxine and the subsequent clinical manifestations. Here, we also discuss why macrophage-dominant phospholipidosis was the most likely mechanism of toxicity in this case.

Simultaneous interstitial pneumonitis and cardiomyopathy induced by venlafaxine / Pneumonite intersticial e miocardiopatia simultâneas induzidas por venlafaxina

Venlafaxine is a serotonin-norepinephrine reuptake inhibitor used as an antidepressant. Interindividual variability and herb-drug interactions can lead to drug-induced toxicity. We report the case of a 35-year-old female patient diagnosed with synchronous pneumonitis and acute cardiomyopathy attributed to venlafaxine. The patient sought medical attention due to dyspnea and dry cough that started three months after initiating treatment with venlafaxine for depression. The patient was concomitantly taking Centella asiatica and Fucus vesiculosus as phytotherapeutic agents. Chest CT angiography and chest X-ray revealed parenchymal lung disease (diffuse micronodules and focal ground-glass opacities) and simultaneous dilated cardiomyopathy. Ecocardiography revealed a left ventricular ejection fraction (LVEF) of 21%. A thorough investigation was carried out, including BAL, imaging studies, autoimmune testing, right heart catheterization, and myocardial biopsy. After excluding other etiologies and applying the Naranjo Adverse Drug Reaction Probability Scale, a diagnosis of synchronous pneumonitis/cardiomyopathy associated with venlafaxine was assumed. The herbal supplements taken by the patient have a known potential to inhibit cytochrome P450 enzyme complex, which is responsible for the metabolization of venlafaxine. After venlafaxine discontinuation, there was rapid improvement, with regression of the radiological abnormalities and normalization of the LVEF. This was an important case of drug-induced cardiopulmonary toxicity. The circumstantial intake of inhibitors of the CYP2D6 isoenzyme and the presence of a CYP2D6 slow metabolism phenotype might have resulted in the toxic accumulation of venlafaxine and the subsequent clinical manifestations. Here, we also discuss why macrophage-dominant phospholipidosis was the most likely mechanism of toxicity in this case.

A venlafaxina é um inibidor de recaptação de serotonina e noradrenalina utilizado como antidepressivo. A variabilidade individual ou interações entre fitoterápicos e fármacos podem causar toxicidade induzida por drogas. Relatamos o caso de uma paciente de 35 anos diagnosticada com pneumonite intersticial e miocardiopatia dilatada atribuídas à venlafaxina. A paciente procurou atendimento médico devido a dispneia e tosse seca, que começaram três meses após iniciar tratamento com venlafaxina para depressão. Concomitantemente tomava suplementos fitoterápicos contendo Centella asiatica e Fucus vesiculosus. A radiografia e a CT de tórax revelaram doença pulmonar parenquimatosa (micronódulos difusos e opacidades em vidro fosco) e, simultaneamente, foi diagnosticada uma miocardiopatia por ecocardiograma, que revelou uma fração de ejeção ventricular esquerda (FEVE) de 21%. Uma investigação ampla foi realizada, incluindo LBA, estudos de imagem, detecção de doenças autoimunes, cateterismo cardíaco direito e biópsia miocárdica. Após a exclusão de outras etiologias e a aplicação da Escala de Probabilidade de Reações Adversas a Medicamentos de Naranjo, foi assumido o diagnóstico de pneumonite/miocardiopatia síncronas associadas à venlafaxina. Já foi demonstrado que os suplementos fitoterápicos utilizados pela paciente podem inibir a isoenzima do complexo enzimático citocromo P450, responsável pelo metabolismo da venlafaxina. Após a descontinuação da venlafaxina, verificou-se uma rápida melhora clínica com regressão das alterações radiológicas e normalização da FEVE. Este é um importante caso de toxicidade cardiopulmonar induzida por droga. A administração circunstancial de inibidores da isoenzima CYP2D6 e a presença de um fenótipo de metabolização lenta de CYP2D6 podem ter resultado na acumulação tóxica da venlafaxina e na manifestação clínica subsequente. Aqui, é discutida a hipótese de a fosfolipidose macrofágica ser o mecanismo de toxicidade.

Composição corporal e expansão torácica em indivíduos que vivem e convivem com atrofia muscular espinhal tipo II e III / Body composition and chest expansion of type II and III Spinal muscular atrophy patients

Introdução: pacientes com atrofia muscular espinhal apresentam fraqueza muscular, problemas ortopédicos, complicações alimentares e declínio da função respiratória. Alterações na massa magra e na massa gorda também são esperadas. Objetivo: verificar a composição corporal e a expansão torácica de pacientes com atrofia muscular espinhal tipo II e III. Método: foram avaliados 14 indivíduos, sete no Grupo I (pacientes) com 9 (7 - 12)anos, 29,7 (23,5 - 60,0) kg; e sete no Grupo II (sem a doença) com 9 (9-12) anos, 31,0 (27,8 - 54,1) kg. A análise da composição corporal foi obtida pela bioimpedância elétrica monofrequencial. Os perímetros de tórax, quadril e abdômen foram medidos com uma fita métrica. As análises estatísticas foram realizadas no programa SPSS (p < 0,05). Resultados: os pacientes apresentaram maior impedância: 1416,9 (850,5 - 1559,1) vs788,0 (68 3, 6 - 853,8), P < 0,05; e percentual de gordura: 31,2 (23,9 - 46,6) vs 19,1 (14,9 - 27,0) por cento, P<0,05. A diferença entre a perimetria de tórax em inspiração forçada e em expiração forçada foi menor para os pacientes em comparação com o Grupo II: 3,0 (0,8 - 4,4) vs. 5,0 (3,9 - 6,5) cm, P < 0,05. Conclusão: pacientes com amiotrofia muscular espinhal apresentaram maior adiposidade e menor expansão torácica.(AU)

INTRODUCTION: spinal muscular atrophy patients present muscle weakness, orthopedic problems, nutritional complications and respiratory impairment. Lean mass and fat mass modifications are also expected in this population. OBJECTIVE: to verify the body composition and chest expansion of type II and III spinal muscular atrophy patients. METHODS: fourteen individuals were evaluated: seven patients in Group I of 9 (7-12) years of age, weighing 29.7 (23.5-60.0) kg; and seven children without the disease in Group II of 9 (9-12) years, weighing 31.0 (27.8-54.1) kg. Patients' monofrequency bioelectrical impedance was used for analyze body composition. Chest, hip and abdominal girths were measured by a flexible steel tape. The SPSS program was used to statistical analysis (p < 0.05). RESULTS: patients presented higher impedance: 1416.9 (850.5-1559.1) vs 788.0 (683.6-853.8), P < 0.05; and fat percentage: 31.2 (23.9-46.6) vs 19.1 (14.9-27.0)%, P < 0.05. The difference between forced inspiration and forced expiration thorax girth was smaller for patients when comparing to Group II: 3.0 (0.8-4.4) vs. 5.0 (3.9-6.5) cm, P<0.05. CONCLUSIONS: patients with spinal muscular atrophy presented higher adiposity and lower chest expansion.(AU)

Composição corporal e expansão torácica em indivíduos que vivem e convivem com atrofia muscular espinhal tipo II e III / Body composition and chest expansion of type II and III Spinal muscular atrophy patients

Introdução: pacientes com atrofia muscular espinhal apresentam fraqueza muscular, problemas ortopédicos, complicações alimentares e declínio da função respiratória. Alterações na massa magra e na massa gorda também são esperadas. Objetivo: verificar a composição corporal e a expansão torácica de pacientes com atrofia muscular espinhal tipo II e III. Método: foram avaliados 14 indivíduos, sete no Grupo I (pacientes) com 9 (7 - 12)anos, 29,7 (23,5 - 60,0) kg; e sete no Grupo II (sem a doença) com 9 (9-12) anos, 31,0 (27,8 - 54,1) kg. A análise da composição corporal foi obtida pela bioimpedância elétrica monofrequencial. Os perímetros de tórax, quadril e abdômen foram medidos com uma fita métrica. As análises estatísticas foram realizadas no programa SPSS (p < 0,05). Resultados: os pacientes apresentaram maior impedância: 1416,9 (850,5 - 1559,1) vs788,0 (68 3, 6 - 853,8), P < 0,05; e percentual de gordura: 31,2 (23,9 - 46,6) vs 19,1 (14,9 - 27,0) por cento, P<0,05. A diferença entre a perimetria de tórax em inspiração forçada e em expiração forçada foi menor para os pacientes em comparação com o Grupo II: 3,0 (0,8 - 4,4) vs. 5,0 (3,9 - 6,5) cm, P < 0,05. Conclusão: pacientes com amiotrofia muscular espinhal apresentaram maior adiposidade e menor expansão torácica.

INTRODUCTION: spinal muscular atrophy patients present muscle weakness, orthopedic problems, nutritional complications and respiratory impairment. Lean mass and fat mass modifications are also expected in this population. OBJECTIVE: to verify the body composition and chest expansion of type II and III spinal muscular atrophy patients. METHODS: fourteen individuals were evaluated: seven patients in Group I of 9 (7-12) years of age, weighing 29.7 (23.5-60.0) kg; and seven children without the disease in Group II of 9 (9-12) years, weighing 31.0 (27.8-54.1) kg. Patients' monofrequency bioelectrical impedance was used for analyze body composition. Chest, hip and abdominal girths were measured by a flexible steel tape. The SPSS program was used to statistical analysis (p < 0.05). RESULTS: patients presented higher impedance: 1416.9 (850.5-1559.1) vs 788.0 (683.6-853.8), P < 0.05; and fat percentage: 31.2 (23.9-46.6) vs 19.1 (14.9-27.0)%, P < 0.05. The difference between forced inspiration and forced expiration thorax girth was smaller for patients when comparing to Group II: 3.0 (0.8-4.4) vs. 5.0 (3.9-6.5) cm, P<0.05. CONCLUSIONS: patients with spinal muscular atrophy presented higher adiposity and lower chest expansion.

Metabolic programming during lactation stimulates renal Na+ transport in the adult offspring due to an early impact on local angiotensin II pathways.

BACKGROUND: Several studies have correlated perinatal malnutrition with diseases in adulthood, giving support to the programming hypothesis. In this study, the effects of maternal undernutrition during lactation on renal Na(+)-transporters and on the local angiotensin II (Ang II) signaling cascade in rats were investigated. METHODOLOGY/PRINCIPAL FINDINGS: Female rats received a hypoproteic diet (8% protein) throughout lactation. Control and programmed offspring consumed a diet containing 20% protein after weaning. Programming caused a decrease in the number of nephrons (35%), in the area of the Bowman's capsule (30%) and the capillary tuft (30%), and increased collagen deposition in the cortex and medulla (by 175% and 700%, respectively). In programmed rats the expression of (Na(+)+K(+))ATPase in proximal tubules increased by 40%, but its activity was doubled owing to a threefold increase in affinity for K(+). Programming doubled the ouabain-insensitive Na(+)-ATPase activity with loss of its physiological response to Ang II, increased the expression of AT(1) and decreased the expression of AT(2) receptors), and caused a pronounced inhibition (90%) of protein kinase C activity with decrease in the expression of the α (24%) and ε (13%) isoforms. Activity and expression of cyclic AMP-dependent protein kinase decreased in the same proportion as the AT(2) receptors (30%). In vivo studies at 60 days revealed an increased glomerular filtration rate (GFR) (70%), increased Na(+) excretion (80%) and intense proteinuria (increase of 400% in protein excretion). Programmed rats, which had normal arterial pressure at 60 days, became hypertensive by 150 days. CONCLUSIONS/SIGNIFICANCE: Maternal protein restriction during lactation results in alterations in GFR, renal Na(+) handling and in components of the Ang II-linked regulatory pathway of renal Na(+) reabsorption. At the molecular level, they provide a framework for understanding how metabolic programming of renal mechanisms contributes to the onset of hypertension in adulthood.

Venous thrombosis risk: effects of palm oil and hydrogenated fat diet in rats.

OBJECTIVE: We tested whether diets containing partially hydrogenated fat (PHVO, rich in trans fatty acids) or palm oil (PO, rich in saturated fat-C16 palmitic fatty acid) had different effects on the propensity for venous thrombosis, a marker of haemostatic cardiovascular risk. METHODS: Female Wistar rats were fed normolipidic diets containing PHVO or PO during lactation, and their young male pups were fed the same diets from weaning until the 180th day of life. We evaluated platelet fatty acid composition, serum lipids, platelet aggregation, clotting time, and venous thrombus formation. RESULTS: A significant and cumulative incorporation of trans fatty acid was observed only in the platelet lipids from the PHVO group, associated with an increased sensitivity to adenosine diphosphate (ADP) and venous thrombus formation in vivo. Platelets from rats raised on the PO diet also exhibited platelet aggregation induced by ADP and an increase in venous thrombus weight, with a concomitant increase in serum triglycerides. CONCLUSION: The prolonged replacement of dietary hydrogenated fat by PO impaired platelet aggregability and venous thrombosis, suggesting an increased risk of thromboembolic diseases.