Autonomic Modulation in Duchenne Muscular Dystrophy During a Computer Task: A Prospective Transversal Controlled Trial Assessment by Non-linear Techniques.

Introduction: Due to functional and autonomic difficulties faced by individuals with Duchenne Muscular Dystrophy (DMD), the use of assistive technology is critical to provide or facilitate functional abilities. The key objective was to investigate acute cardiac autonomic responses, by application of Heart Rate Variability (HRV), during computer tasks in subjects with DMD via techniques based on non-linear dynamics. Method: HRV was attained via a Polar RS800CX. Then, was evaluated by Chaotic Global Techniques (CGT). Forty-five male subjects were included in the DMD group and age-matched with 45 in the healthy Typical Development (TD) control group. They were assessed for 20 min at rest sitting, and then 5 min whilst performing the maze task on a computer. Results: Both TD and DMD subjects exhibited a significantly reduced HRV measured by chaotic global combinations when undertaking the computer maze paradigm tests. DMD subjects presented decreased HRV during rest and computer task than TD subjects. Conclusion: While there is an impaired HRV in subjects with DMD, there remains an adaptation of the ANS during the computer tasks. The identification of autonomic impairment is critical, considering that the computer tasks in the DMD community may elevate their level of social inclusion, participation and independence.

Effect of air pollution on the autonomic modulation of heart rate in overweight adults.

OBJECTIVE: To analyze the effect of air pollution on heart rate variability in overweight individuals. METHODS: A total of 46 adult individuals, both sexes, aged between 18 and 49 years and with body mass index >25kg/m2 were analyzed. All volunteers were students from public schools of two cities in the state of São Paulo. The clinical, demographic and anthropometric data of each individual, as well as heart rate variability through time domain, geometric and frequency indices were collected. For the air quality analysis, the following variables were investigated: concentration of carbon dioxide, particulate matter, temperature and relative humidity. The analysis was carried out with descriptive and analytical statistics, adopting a level of significance of 5%. RESULTS: There was a reduction in overall heart rate variability in overweight individuals by the following indices: mean standard deviation of all normal RR intervals, long-term standard deviation of continuous RR intervals, ratio of short-and long-term standard deviation of continuous RR intervals. In addition, the indices responsible for parasympathetic control showed a downward trend in their values, as well as the low frequency index, which represented sympathetic action, although not significant. CONCLUSION: Overweight individuals exposed to air pollution had lower heart rate variability than the Control Group.

Effect of air pollution on the autonomic modulation of heart rate in overweight adults / Efeito da poluição atmosférica na modulação autonômica da frequência cardíaca em indivíduos com excesso de peso

ABSTRACT Objective: To analyze the effect of air pollution on heart rate variability in overweight individuals. Methods: A total of 46 adult individuals, both sexes, aged between 18 and 49 years and with body mass index >25kg/m2 were analyzed. All volunteers were students from public schools of two cities in the state of São Paulo. The clinical, demographic and anthropometric data of each individual, as well as heart rate variability through time domain, geometric and frequency indices were collected. For the air quality analysis, the following variables were investigated: concentration of carbon dioxide, particulate matter, temperature and relative humidity. The analysis was carried out with descriptive and analytical statistics, adopting a level of significance of 5%. Results: There was a reduction in overall heart rate variability in overweight individuals by the following indices: mean standard deviation of all normal RR intervals, long-term standard deviation of continuous RR intervals, ratio of short-and long-term standard deviation of continuous RR intervals. In addition, the indices responsible for parasympathetic control showed a downward trend in their values, as well as the low frequency index, which represented sympathetic action, although not significant. Conclusion: Overweight individuals exposed to air pollution had lower heart rate variability than the Control Group.

RESUMO Objetivo: Analisar o efeito da poluição atmosférica na variabilidade da frequência cardíaca em indivíduos com excesso de peso. Métodos: Foram analisados 46 indivíduos adultos, de ambos os sexos, com idade entre 18 e 49 anos e índice de massa corporal >25kg/m2. Todos os voluntários eram estudantes da Educação de Jovens e Adultos em duas cidades do estado de São Paulo. Foram coletadas informações clínicas, demográficas e antropométricas de cada indivíduo, bem como a variabilidade da frequência cardíaca, por meio dos índices do domínio do tempo, geométricos e de frequência. Para a análise da qualidade do ar, foram investigadas as variáveis concentração de dióxido de carbono, material particulado, temperatura e umidade do ar. A análise se deu por estatística descritiva e analítica, adotando-se nível de significância de 5%. Resultados: Ocorreu redução na variabilidade da frequência cardíaca geral nos indivíduos com excesso de peso por meio dos índices geométricos (desvio padrão a longo prazo dos intervalos RR contínuos, e a razão entre as variações curta e longa dos intervalos RR) e o domínio do tempo (desvio padrão da média de todos os intervalos RR normais). Índices responsáveis pelo controle parassimpático mostraram-se com tendência de queda em seus valores, bem como o índice de baixa frequência que representava a ação do simpático, embora com valores não significativos. Conclusão: Indivíduos com excesso de peso expostos à poluição atmosférica apresentaram menor variabilidade da frequência cardíaca em comparação ao Grupo Controle.

Elastic Tubing Resistance Training and Autonomic Modulation in Subjects with Chronic Obstructive Pulmonary Disease.

This study addresses evidence concerning elastic tubing resistance training (ET) on autonomic modulation in patients with chronic obstructive pulmonary disease (COPD). Autonomic dysfunction is common in COPD and contributes to the development of arrhythmias and sudden death. Along with autonomic dysfunction, muscle dysfunction is related to functional limitations and prognosis of the disease. This study investigated the effects of ET on autonomic modulation, muscle strength, and walking distance in COPD. Subjects were divided into two groups, ET (n = 20; 66,5 ± 8,9 y; 25,5 ± 3,5 kg/m2; FEV1/FVC: 50,3 ± 11,0) and conventional training (n = 19; 66,0 ± 6,9; 27,1 ± 4,3; FEV1/FVC: 55,05 ± 9,56). Both groups undertook 24 sessions for 60 minutes, 3 times in a week. The significance level was p ≤ 0,05. Autonomic modulation was evaluated using heart rate variability in the time (rMSSD, ms) and frequency domain (HF, ms). Strength for upper and lower limbs was measured using dynamometry and walking distance was measured using a 6-minute walking test. There were no significant differences in the outcomes between groups. There was an increment to rMSSD [(16,7 ± 11,0 versus 20,8 ± 14,9) versus (14,2 ± 10,0 versus 17,4 ± 12,1)], HF [(141,9 ± 191,3 versus 234,9 ± 335,7) versus (94,1 ± 123,5 versus 177,6 ± 275,5)], shoulder abduction [(50,1 ± 19,6 versus 56,9 ± 20,4) versus (50,5 ± 19,0 versus 56,9 ± 19,3)], knee flexion [(101,9 ± 34,0 versus 116,8 ± 43,3) versus (98,6 ± 21,5 versus 115,1 ± 30,8)], and walking test [(433,0 ± 84,8 versus 468,9 ± 90,8) versus (397,4 ± 99,8 versus 426,3 ± 101,6)] after training for ET and conventional training, respectively. In conclusion, ET improves autonomic modulation in COPD with additional benefits for strength and cardiorespiratory capacity similar to conventional training.

Cardiac autonomic modulation impairments in advanced breast cancer patients.

AIM: To compare cardiac autonomic modulation in early- versus advanced-stage breast cancer patients before any type of cancer treatment and investigate associated factors. METHODS AND RESULTS: This cross-sectional study included women (30-69 years old) with primary diagnosis of breast cancer and women with benign breast tumors. We evaluated cardiac modulation by heart rate variability and assessed factors of anxiety, depression, physical activity, and other relevant medical variables. Patients were divided into three groups based on TNM staging of cancer severity: early-stage cancer (n = 42), advanced-stage cancer (n = 37), or benign breast tumors to serve as a control (n = 37). We analyzed heart rate variability in time and frequency domains. The advanced-stage cancer group had lower vagal modulation than early-stage and benign groups; also, the advance-stage group had lower overall heart rate variability when compared to benign conditions. Heart rate variability was influenced by age, menopausal status, and BMI. CONCLUSIONS: Heart rate variability seems to be a promising, non-invasive tool for early diagnosis of autonomic dysfunction in breast cancer and detection of cardiovascular impairments at cancer diagnosis. Cardiac autonomic modulation is inversely associated with breast cancer staging.

Heart Rate Variability and Cardiopulmonary Dysfunction in Patients with Duchenne Muscular Dystrophy: A Systematic Review.

Duchenne muscular dystrophy (DMD) is a genetic recessive disorder with progressive muscle weakness. Despite the general muscle wasting, degeneration and necrosis of cardiomyocytes have been the main causes of morbidity and death in individuals with DMD. Cardiac failure is generally preceded by disturbances in heart rate variability (HRV), and non-invasive measurement of the autonomic nervous system has been an important tool to predict adverse cardiovascular events. Hence, the application of HRV to study autonomic modulation in DMD individuals, and the establishment of correlations between HRV and heart/lung diseases, age, and mortality will have the potential to improve quality of life and life expectancy of individuals with DMD. In order to evaluate the state of the art in this field, we conducted a systematic search in Medline/PubMed and BVS (virtual library in health) databases. We selected 8 studies using pre-defined criteria and meta-analysis revealed decreased parasympathetic activity and increased sympathetic predominance in individuals with DMD as major observations. Moreover, there is a strong association between diminished HRV and myocardial fibrosis with DMD. These patterns are evident in patients at early-stage DMD and become more prominent as disease severity and age increase. Thus, data minning clearly indicates that HRV assessment can be used as a predictor for sudden death in individuals with DMD. The use of the HRV, which is inexpensive, ubiquitously available in clinics and hospitals, and a non-invasive analysis tool, can save lives and decrease the morbity in DMD by alerting care givers to consider autonomic nervous system intervention.

Cardiac autonomic modulation of children with Down syndrome.

The aim of this study is to analyze the autonomic modulation in children with Down syndrome (DS). The study was conducted with a convenience sample of children with DS and without heart disease, from the Genetics Clinic of the Hospital Infantil Darcy Vargas and APAE São Paulo, São Paulo, SP, Brazil. The control group was matched for sex and age. The analysis of autonomic modulation was performed using the indices of heart rate variability (HRV). The children remained in the supine position with spontaneous breathing for 20 min. Heart rate was recorded beat-to-beat. HRV analysis was performed in time and frequency domain. For data analysis, we used Student's t test: unpaired and Mann-Whitney. It was considered statistically significant at p < 0.05. From 75 children with DS, 50 were excluded, a total of 25 children [16 boys, 8.6 (1.4) years] participated in this study, and the control group also consisted of 25 children [16 boys, 9.0 (1.2) years] without the syndrome. The BMI of the volunteers with DS was higher than the controls [19.1 (2.9) vs. 15.8 (1.2), p < 0.0001]. There were differences between groups in the indices in frequency domain: LFms(2) [1242.1 (788.25) vs. 786.44 (481.90), p = 0.040], LFun [69.104 (11.247) vs. 57.348 (11.683), p = 0.0004], HFun [30.896 (11.247) vs. 42.520 (11.634), p = 0.0004] and LF/HF [2.594 (1.104) vs. 1.579 (0.9982), p = 0.0004]. No differences were observed in time domain indices. The results indicate increased indices representing the sympathetic branch of the autonomic nervous system and those that indicate the overall modulation in children with DS.

Do patients with electrocardiographic Brugada type 1 pattern have associated right bundle branch block? A comparative vectorcardiographic study.

AIMS: Previous studies have reported right bundle branch block in Brugada syndrome. Subsequent analysis of electrocardiograms (ECGs) found one-third of cases classified as right bundle branch block did not meet criteria of a wide final S wave in the left leads. We aimed to study the role of the vectorcardiogram to characterize Brugada type 1 ECG pattern. METHODS AND RESULTS: Compare Frank-method vectorcardiogram in 11 patients with Brugada type 1 ECG pattern (BrS group) with vectorcardiogram of 20 healthy individuals with ECGs depicting incomplete right bundle branch block (IRBBB group) and 12 patients with complete right bundle branch block (CRBBB group). Initial 10-20 ms vector of the QRS loop in the horizontal plane (HP): BrS and IRBBB groups: Vector heading anterior and leftward. CRBBB group: Vector directed anterior and rightward. Right end conduction delay of the QRS loop: BrS group: Upper right quadrant of the frontal plane, right posterior quadrant of the HP. IRBBB group: Upper right quadrant of the frontal plane (30%) and right anterior quadrant of the HP (90%). CRBBB group: Upper right quadrant on the frontal plane (30%); all cases in the right anterior quadrant of the HP. 0 point (onset of QRS loop) and J point (end of QRS loop) relationship: BrS group: Not coincidental. IRBBB and CRBBB groups: Coincidental. T loop morphology, size, and appearance: BrS group: Circular, with symmetrical afferent and efferent limbs in 10 cases (90%). IRBBB and CRBBB groups: Elliptical or linear with slow inscription of efferent limb and rapid inscription of afferent limb. CONCLUSIONS: Vectorcardiograms in patients with Brugada type 1 ECG pattern have distinctive characteristics compared with healthy individuals with incomplete and CRBBB. These differences relate to the spatial location of the end conduction delay (right superior and posterior quadrant in the BrS group) and the morphology, size, and velocity of inscription of afferent and efferent limbs of the T loop (circular, small, of symmetrical limbs) and with a 1:1 length/width ratio.

Hipertensão arterial sistêmica / Systemic arterial hypertension

A hipertensão arterial sistêmica (HAS) é uma doença crônico-degenerativa, multifatorial, na maioria das vezes assintomática, de evolução lenta e progressiva que pode prejudicar a função de diversos órgãos nobres, como coração, cérebro, rins e olhos. O presente artigo enfoca a hipertensão arterial primária com aspectos epidemiológicos, diagnósticos, tratamento farmacológico e não farmacológico. A HAS constitui um grande problema social, visto que pode produzir lesões em órgãos-alvo em idade precoce e, portanto, produtiva do indivíduo, ocasionando altos custos socioeconômicos.Segundo o DATASUS, foi a quinta causa de morbidade em 2008 e a quinta causa de morbidade e mortalidade em 2006. O diagnóstico da HAS é feito com detalhada anamnese e exame físico, associados a duas ou mais mensurações pressóricas com valores maiores ou iguais a 140/90 mmHg, em dias e horários diferentes, observando-se a correta técnica, em indivíduos acima dos 18 anos.Para o tratamento da HAS é necessário inicialmente estratificar o risco, definir os objetivos, metas e as condições, mantendo a qualidade de vida.Deve ser dada ênfase ao tratamento não farmacológico, com modificações no estilo de vida e, quando não suficiente, associar o tratamento farmacológico, considerando ainda os casos especiais, como o diabetes mellitus, coronariopatia e insuficiência cardíaca.

Clinical value of lead aVR.

Lead aVR is the only lead in the surface ECG that does not face the "typically" relevant walls of the left ventricle. Historically, its value has been neglected most likely due to its unusual configuration and direction, which appeared to have little correlation with other more congruous and easily diagnostic frontal leads. The isolation of the unipolar leads in the Standard surface ECG presentation may also have played an important role. Even with this "unfair" neglect, we know nowadays that it is very sensitive to locate obstructed epicardial coronary arteries. Besides helping distinguishing the culprit lesion of an infarct, lead aVR also helps recognizing other conditions that could be of clinical significance such as pericarditis, Brugada syndrome, fascicular blocks of the right branch, ectopic left atrial rhythms, etc. The purpose of this review is to revise the clinical value of lead aVR in the recognition of frequent and not so frequent clinical conditions.

The association between air pollution and blood pressure in traffic controllers in Santo André, São Paulo, Brazil.

BACKGROUND: Urban air pollutants are associated with cardiovascular events. Traffic controllers are at high risk for pollution exposure during outdoor work shifts. OBJECTIVE: The purpose of this study was to evaluate the relationship between air pollution and systemic blood pressure in traffic controllers during their work shifts. METHODS: This cross-sectional study enrolled 19 male traffic controllers from Santo André city (São Paulo, Brazil) who were 30-60 years old and exposed to ambient air during outdoor work shifts. Systolic and diastolic blood pressure readings were measured every 15 min by an Ambulatory Arterial Blood Pressure Monitoring device. Hourly measurements (lags of 0-5h) and the moving averages (2-5h) of particulate matter (PM(10)), ozone (O(3)) ambient concentrations and the acquired daily minimum temperature and humidity means from the São Paulo State Environmental Agency were correlated with both systolic and diastolic blood pressures. Statistical methods included descriptive analysis and linear mixed effect models adjusted for temperature, humidity, work periods and time of day. RESULTS: Interquartile increases of PM(10) (33 µg/m(3)) and O(3) (49 µg/m(3)) levels were associated with increases in all arterial pressure parameters, ranging from 1.06 to 2.53 mmHg. PM(10) concentration was associated with early effects (lag 0), mainly on systolic blood pressure. However, O(3) was weakly associated most consistently with diastolic blood pressure and with late cumulative effects. CONCLUSIONS: Santo André traffic controllers presented higher blood pressure readings while working their outdoor shifts during periods of exposure to ambient pollutant fluctuations. However, PM(10) and O(3) induced cardiovascular effects demonstrated different time courses and end-point behaviors and probably acted through different mechanisms.

Electrovectorcardiographic diagnosis of left septal fascicular block: anatomic and clinical considerations.

Several publications considering anatomical, histological, pathological, electrocardiographic, vectorcardiographic, and electrophysiologic studies have shown that the left bundle branch splits into three fascicles or in a "fan-like interconnected network" in the vast majority of human hearts. The left His system is trifascicular with a left anterior, a left posterior, and a left septal fascicle (LSF). Consequently, the classic term "hemiblock," to describe the block of one of the fascicles, established several decades ago by the Rosembaum's school, should be updated. Electrovectorcardiographic changes resulting from conduction abnormalities of the left anterior and left posterior fascicles are commonly diagnosed, mainly by their changes in the frontal plane. However, the existence of conduction defects of the LSF remains controversial. The ECG/VCG hallmark of LSF block is prominent anterior QRS forces (PAF) on the horizontal plane. This ECG/VCG phenomena should be distinguished from other conditions that also produce anterior QRS shift in the HP as: normal variants, right ventricular enlargement, misplaced precordial leads, lateral myocardial infarction, right bundle branch block, Wolff-Parkinson-White, obstructive and nonobstructive forms of hypertrophic cardiomyopahty, diastolic left ventricular enlargement, endomiocardial fibrosis, Duchenne muscular dystrophy, and dextroposition. The two highly frequent etiologies of LSFB are ischemia (coronary artery disease (CAD) with critical proximal obstruction of the left anterior descending coronary artery) and, in Latin America, Chagas' cardiomyopathy. The aims of this review are to revise the evidence of the existence of a trifascicular left Hissian system and to help in the ECG/VCG recognition of the LSFB.

Evaluation of arterial blood pressure and renal sodium handling in a model of female rats in persistent estrus.

The aim of this study was to evaluate the arterial blood pressure and renal function of female rats in persistent estrus. Twenty-five female Wistar-Hannover rats were randomly divided into two groups: Group I (control, n = 15) and experimental (persistent estrus, n = 10). A tail-cuff system was used to measure blood pressure at 12 weeks of life. Parameters to evaluate renal function were taken into consideration. A significant increase in arterial pressure and a significant decrease in fractional sodium excretion were found in the androgenized animals compared to controls. There was no difference between the two groups with respect to glomerular filtration rate or in fractional potassium excretion. An increase in blood pressure and a reduction in fractional sodium excretion occur in female rats in persistent estrus.

Anti-hypertensive drugs have different effects on ventricular hypertrophy regression.

OBJECTIVES: There is a direct relationship between the regression of left ventricular hypertrophy (LVH) and a decreased risk of mortality. This investigation aimed to describe the effects of anti-hypertensive drugs on cardiac hypertrophy through a meta-analysis of the literature. METHODS: The Medline (via PubMed), Lilacs and Scielo databases were searched using the subject keywords cardiac hypertrophy, antihypertensive and mortality. We aimed to analyze the effect of anti-hypertensive drugs on ventricle hypertrophy. RESULTS: The main drugs we described were enalapril, verapamil, nifedipine, indapamina, losartan, angiotensin-converting enzyme inhibitors and atenolol. These drugs are usually used in follow up programs, however, the studies we investigated used different protocols. Enalapril (angiotensin-converting enzyme inhibitor) and verapamil (Ca(++) channel blocker) caused hypertrophy to regress in LVH rats. The effects of enalapril and nifedipine (Ca(++) channel blocker) were similar. Indapamina (diuretic) had a stronger effect than enalapril, and losartan (angiotensin II receptor type 1 (AT1) receptor antagonist) produced better results than atenolol (selective beta1 receptor antagonist) with respect to LVH regression. CONCLUSION: The anti-hypertensive drugs induced various degrees of hypertrophic regression.

Immunohistochemical expression of E-cadherin in sclerosing adenosis, ductal carcinoma in situ and invasive ductal carcinoma of the breast.

E-cadherin (EC) is an important glycoprotein cell-adhesion molecule that appears to play a significant role in the progression of breast lesions. The objective of this study was to evaluate EC expression in sclerosing adenosis, ductal carcinoma in situ and invasive ductal carcinoma. Samples of breast lesions from 44 women were used in this study, comprising cases of sclerosing adenosis (n = 11), ductal carcinoma in situ (DCIS) (n = 10) and invasive ductal carcinoma (n = 23). Immunohistochemical evaluation of EC expression was assessed semiquantitatively and considered negative (<10% of cells with stained cytoplasmic membranes), positive+ (10-50% of cells stained) or positive++ (> 50% of cells stained). Fisher's exact test was used to compare the distribution of staining intensity in the lesions (P< 0.05). There was a progressive loss of EC expression from benign to malignant lesions. This difference was statistically significant when sclerosing adenosis was compared with DCIS (P < 0.0002), when sclerosing adenosis was compared with invasive ductal carcinoma (P < 0.008) and when DCIS was compared with invasive ductal carcinoma (P < 0.007). The present findings point to a significant association between reduced EC expression and the progression and aggressivity of breast lesions. Diagn. Cytopathol. 2010. (c) 2009 Wiley-Liss, Inc.

Anti-hypertensive drugs have different effects on ventricular hypertrophy regression: [review]

OBJECTIVES: There is a direct relationship between the regression of left ventricular hypertrophy (LVH) and a decreased risk of mortality. This investigation aimed to describe the effects of anti-hypertensive drugs on cardiac hypertrophy through a meta-analysis of the literature. METHODS: The Medline (via PubMed), Lilacs and Scielo databases were searched using the subject keywords cardiac hypertrophy, antihypertensive and mortality. We aimed to analyze the effect of anti-hypertensive drugs on ventricle hypertrophy. RESULTS: The main drugs we described were enalapril, verapamil, nifedipine, indapamina, losartan, angiotensin-converting enzyme inhibitors and atenolol. These drugs are usually used in follow up programs, however, the studies we investigated used different protocols. Enalapril (angiotensin-converting enzyme inhibitor) and verapamil (Ca++ channel blocker) caused hypertrophy to regress in LVH rats. The effects of enalapril and nifedipine (Ca++ channel blocker) were similar. Indapamina (diuretic) had a stronger effect than enalapril, and losartan (angiotensin II receptor type 1 (AT1) receptor antagonist) produced better results than atenolol (selective â1 receptor antagonist) with respect to LVH regression. CONCLUSION: The anti-hypertensive drugs induced various degrees of hypertrophic regression.

Fluoxetine effects on mitochondrial ultrastructure of right ventricle in rats exposed to cold stress.

OBJECTIVE: To assess fluoxetine effects on mitochondrial structure of the right ventricle in rats exposed to cold stress. METHODS: The experimental study procedures were performed in 250-300g male EPM-Wistar rats. Rats (n=40) were divided into four groups: 1) Control group (CON); 2) Fluoxetine (FLU); 3) Induced hypothermia (IH) and; 4) Induced hypothermia treated with fluoxetine (IHF). Animals of FLU group were treated by the administration of gavages containing 0.75 mg/kg/day fluoxetine during 40 days. The induced hypothermia was obtained by maintaining the groups 3 and 4 in a freezer at -8 degrees C for 4 hours. The animals were sacrificed and fragments of the right ventricle (RV) were removed and processed prior to performing electron microscopic analysis. RESULTS: The ultrastructural changes in cardiomyocytes were quantified through the number of mitochondrial cristae pattern (cristolysis). The CON (3.85%), FLU (4.47%) and IHF (8.4%) groups showed a normal cellular structure aspect with preserved cardiomyocytes cytoarchitecture and continuous sarcoplasmic membrane integrity. On the other hand, the IH (34.4%) group showed mitochondrial edema and lysis in cristae. CONCLUSION: The ultrastructural analysis revealed that fluoxetine strongly prevents mitochondrial cristolysis in rat heart, suggesting a protector effect under cold stress condition.

[Professional or household performance of patients with breast cancer undergoing chemotherapy]. / Desempenho profissional ou doméstico das pacientes em quimioterapia para câncer de mama.

OBJECTIVES: Evaluate patients with breast cancer undergoing chemotherapy with respect to their epidemiologic and clinical variables as well as performance at work or at home. METHODS: this was a cross-sectional study including 52 women interviewed during breast cancer chemotherapy, stratified in two groups: those who continued to work and do household tasks, and did not continue to work or do household tasks. Patients were from two public hospitals in the State of São Paulo, one in Santo Andre and the other in São Bernardo do Campo. The WPAI - GH (Work Productivity and Activity Impairment) questionnaire was used to evaluate work and household performance of professionals or housewives, respectively. RESULTS: Mean age of the patients was 55.7 (SD=13.8), most were Caucasian (88.5%), married (55.8%), employed (65.3%) and the majority had to stop working because of treatment (51.0%), at more advanced stage (p<0.05), fatigue and nausea (p<0.05). Mean WPAI - GH was 67.04 (|SD = 5.62) for patients who stopped working and 49.17 (SD = 6.89) for those who continued to work (Mann-Whitney U test: p = 0.04). CONCLUSION: Chemotherapy leads to a decrease in performance of a sizable fraction of women with breast cancer undergoing chemotherapy. A more advanced stage of neoplasia was positively associated with withdrawal from these activities probably due to side effects such as fatigue and nausea.

Fluoxetine effects on mitochondrial ultrastructure of right ventricle in rats exposed to cold stress / Efeitos da fluoxetina sobre a ultraestrutura mitocondrial no ventrículo direito de ratos expostos ao estresse pelo frio

OBJECTIVE: To assess fluoxetine effects on mitochondrial structure of the right ventricle in rats exposed to cold stress. METHODS: The experimental study procedures were performed in 250-300g male EPM-Wistar rats. Rats (n=40) were divided into four groups: 1) Control group (CON); 2) Fluoxetine (FLU); 3) Induced hypothermia (IH) and; 4) Induced hypothermia treated with fluoxetine (IHF). Animals of FLU group were treated by the administration of gavages containing 0.75 mg/kg/day fluoxetine during 40 days. The induced hypothermia was obtained by maintaining the groups 3 and 4 in a freezer at -8ºC for 4 hours. The animals were sacrificed and fragments of the right ventricle (RV) were removed and processed prior to performing electron microscopic analysis. RESULTS: The ultrastructural changes in cardiomyocytes were quantified through the number of mitochondrial cristae pattern (cristolysis). The CON (3.85 percent), FLU (4.47 percent) and IHF (8.4 percent) groups showed a normal cellular structure aspect with preserved cardiomyocytes cytoarchitecture and continuous sarcoplasmic membrane integrity. On the other hand, the IH (34.4 percent) group showed mitochondrial edema and lysis in cristae. CONCLUSION: The ultrastructural analysis revealed that fluoxetine strongly prevents mitochondrial cristolysis in rat heart, suggesting a protector effect under cold stress condition.

OBJETIVO: Analisar os efeitos da fluoxetina sobre a estrutura mitocondrial do ventrículo direito de ratos expostos ao estresse pelo frio. MÉTODOS: Os procedimentos do estudo foram realizados em ratos Wistar-EPM (250-300g) machos. Os ratos (n=40) foram divididos em quatro grupos: 1) Controle (CON); 2) Fluoxetina (FLU); 3) Induzidos à hipotermia (IH) e; 4) Induzidos à hipotermia tratados com fluoxetina (IHF). O grupo FLU foi tratado com gavagem contendo 0,75 mg/kg/dia de fluoxetina durante 40 dias. O estresse induzido pelo frio foi realizado mantendo os grupos 3 e 4 em um freezer (-8ºC) por quatro horas. Os animais foram sacrificados e fragmentos do ventrículo direito (VD) foram removidos e processados antes de serem conduzidos para a microscopia eletrônica. RESULTADOS: As alterações ultraestruturais dos cardiomiócitos foram quantificadas pelo número padrão de cristas mitocondriais (cristólises). Os grupos CON (3,85 por cento), FLU (4,47 por cento) e IHF (8,4 por cento) mostraram aspecto normal de suas estruturas celulares com a citoarquitetura dos cardiomiócitos preservada com integridade sarcoplasmática contínua. Por outro lado, o grupo IH (34,4 por cento) apresentou edema mitocondrial e lise nas cristas. CONCLUSÃO: A análise ultraestrutural revelou que a fluoxetina previne fortemente cristólises mitocondriais em miocárdio de ratos, sugerindo possível efeito protetor na condição de estresse induzido pelo frio.