Does whole body vibration exercise improve oxidative stress markers in women with fibromyalgia?

The objective of this study was to investigate the effect of whole body vibration (WBV) exercise on oxidative stress markers in a group of women with fibromyalgia (FM) compared to a group of healthy women (CT). Twenty-one women diagnosed with FM and 21 age- and weight-matched healthy women were enrolled the study. Plasma oxidative stress markers (primary outcomes) were evaluated at rest and after WBV, and included thiobarbituric acid reactive substances (TBARS), iron reduction capacity (FRAP), superoxide dismutase antioxidant enzymes activity (SOD), and catalase (CAT). At rest, the FM group had higher TBARS (P<0.001) and FRAP (P<0.001), and lower CAT (P=0.005) compared to the CT. In the CT group, the WBV had no effect on TBARS (P=0.559) and FRAP (P=0.926), whereas it increased both SOD (P<0.001) and CAT (P<0.001). In the FM group, the WBV reduced TBARS (p <0.001), FRAP (P<0.001), and CAT (P=0.005), while it increased SOD (P=0.019). There was an interaction effect (moments vs groups) in the TBARS (effect size=1.34), FRAP (effect size=0.93), CAT (effect size=1.45), and SOD (effect size=1.44) (P<0.001). A single trial of WBV exercise improved all oxidant and antioxidant parameters towards a greater adaptation to the stress response in FM women.

Does whole body vibration exercise improve oxidative stress markers in women with fibromyalgia?

The objective of this study was to investigate the effect of whole body vibration (WBV) exercise on oxidative stress markers in a group of women with fibromyalgia (FM) compared to a group of healthy women (CT). Twenty-one women diagnosed with FM and 21 age- and weight-matched healthy women were enrolled the study. Plasma oxidative stress markers (primary outcomes) were evaluated at rest and after WBV, and included thiobarbituric acid reactive substances (TBARS), iron reduction capacity (FRAP), superoxide dismutase antioxidant enzymes activity (SOD), and catalase (CAT). At rest, the FM group had higher TBARS (P<0.001) and FRAP (P<0.001), and lower CAT (P=0.005) compared to the CT. In the CT group, the WBV had no effect on TBARS (P=0.559) and FRAP (P=0.926), whereas it increased both SOD (P<0.001) and CAT (P<0.001). In the FM group, the WBV reduced TBARS (p <0.001), FRAP (P<0.001), and CAT (P=0.005), while it increased SOD (P=0.019). There was an interaction effect (moments vs groups) in the TBARS (effect size=1.34), FRAP (effect size=0.93), CAT (effect size=1.45), and SOD (effect size=1.44) (P<0.001). A single trial of WBV exercise improved all oxidant and antioxidant parameters towards a greater adaptation to the stress response in FM women.

Inflammatory biomarkers responses after acute whole body vibration in fibromyalgia.

The aims of this study were 1) to characterize the intensity of the vibration stimulation in women diagnosed with fibromyalgia (FM) compared to a control group of healthy women (HW) matched by age and anthropometric parameters, and 2) to investigate the effect of a single session of whole body vibration (WBV) on inflammatory responses. Levels of adipokines, soluble tumor necrosis factor receptors (sTNFr1, sTNFr2), and brain-derived neurotrophic factor (BDNF) were determined by enzyme-linked immunosorbent assay. Oxygen consumption (VO2) was estimated by a portable gas analysis system, heart rate (HR) was measured using a HR monitor, and perceived exertion (RPE) was evaluated using the Borg scale of perceived exertion. Acutely mild WBV increased VO2 and HR similarly in both groups. There was an interaction (disease vs vibration) in RPE (P=0.0078), showing a higher RPE in FM compared to HW at rest, which further increased in FM after acute WBV, whereas it remained unchanged in HW. In addition, there was an interaction (disease vs vibration) in plasma levels of adiponectin (P=0.0001), sTNFR1 (P=0.000001), sTNFR2 (P=0.0052), leptin (P=0.0007), resistin (P=0.0166), and BDNF (P=0.0179). In conclusion, a single acute session of mild and short WBV can improve the inflammatory status in patients with FM, reaching values close to those of matched HW at their basal status. The neuroendocrine mechanism seems to be an exercise-induced modulation towards greater adaptation to stress response in these patients.

Inflammatory cytokines and plasma redox status responses in hypertensive subjects after heat exposure

Hypertension is characterized by a pro-inflammatory status, including redox imbalance and increased levels of pro-inflammatory cytokines, which may be exacerbated after heat exposure. However, the effects of heat exposure, specifically in individuals with inflammatory chronic diseases such as hypertension, are complex and not well understood. This study compared the effects of heat exposure on plasma cytokine levels and redox status parameters in 8 hypertensive (H) and 8 normotensive (N) subjects (age: 46.5±1.3 and 45.6±1.4 years old, body mass index: 25.8±0.8 and 25.6±0.6 kg/m2, mean arterial pressure: 98.0±2.8 and 86.0±2.3 mmHg, respectively). They remained at rest in a sitting position for 10 min in a thermoneutral environment (22°C) followed by 30 min in a heated environmental chamber (38°C and 60% relative humidity). Blood samples were collected before and after heat exposure. Plasma cytokine levels were measured using sandwich ELISA kits. Plasma redox status was determined by thiobarbituric acid reactive substances (TBARS) levels and ferric reducing ability of plasma (FRAP). Hypertensive subjects showed higher plasma levels of IL-10 at baseline (P<0.05), although levels of this cytokine were similar between groups after heat exposure. Moreover, after heat exposure, hypertensive individuals showed higher plasma levels of soluble TNF receptor (sTNFR1) and lower TBARS (P<0.01) and FRAP (P<0.05) levels. Controlled hypertensive subjects, who use angiotensin-converting-enzyme inhibitor (ACE inhibitors), present an anti-inflammatory status and balanced redox status. Nevertheless, exposure to a heat stress condition seems to cause an imbalance in the redox status and an unregulated inflammatory response.

Inflammatory cytokines and plasma redox status responses in hypertensive subjects after heat exposure.

Hypertension is characterized by a pro-inflammatory status, including redox imbalance and increased levels of pro-inflammatory cytokines, which may be exacerbated after heat exposure. However, the effects of heat exposure, specifically in individuals with inflammatory chronic diseases such as hypertension, are complex and not well understood. This study compared the effects of heat exposure on plasma cytokine levels and redox status parameters in 8 hypertensive (H) and 8 normotensive (N) subjects (age: 46.5±1.3 and 45.6±1.4 years old, body mass index: 25.8±0.8 and 25.6±0.6 kg/m2, mean arterial pressure: 98.0±2.8 and 86.0±2.3 mmHg, respectively). They remained at rest in a sitting position for 10 min in a thermoneutral environment (22°C) followed by 30 min in a heated environmental chamber (38°C and 60% relative humidity). Blood samples were collected before and after heat exposure. Plasma cytokine levels were measured using sandwich ELISA kits. Plasma redox status was determined by thiobarbituric acid reactive substances (TBARS) levels and ferric reducing ability of plasma (FRAP). Hypertensive subjects showed higher plasma levels of IL-10 at baseline (P<0.05), although levels of this cytokine were similar between groups after heat exposure. Moreover, after heat exposure, hypertensive individuals showed higher plasma levels of soluble TNF receptor (sTNFR1) and lower TBARS (P<0.01) and FRAP (P<0.05) levels. Controlled hypertensive subjects, who use angiotensin-converting-enzyme inhibitor (ACE inhibitors), present an anti-inflammatory status and balanced redox status. Nevertheless, exposure to a heat stress condition seems to cause an imbalance in the redox status and an unregulated inflammatory response.

Hypertension is associated with greater heat exchange during exercise recovery in a hot environment

Individuals with systemic arterial hypertension have a higher risk of heat-related complications. Thus, the aim of this study was to examine the thermoregulatory responses of hypertensive subjects during recovery from moderate-intensity exercise performed in the heat. A total of eight essential hypertensive (H) and eight normotensive (N) male subjects (age=46.5±1.3 and 45.6±1.4 years, body mass index=25.8±0.8 and 25.6±0.6 kg/m2, mean arterial pressure=98.0±2.8 and 86.0±2.3 mmHg, respectively) rested for 30 min, performed 1 h of treadmill exercise at 50% of maximal oxygen consumption, and rested for 1 h after exercise in an environmental chamber at 38°C and 60% relative humidity. Skin and core temperatures were measured to calculate heat exchange parameters. Mean arterial pressure was higher in the hypertensive than in the normotensive subjects throughout the experiment (P<0.05, unpaired t-test). The hypertensive subjects stored less heat (H=-24.23±3.99 W·m−2vs N=-13.63±2.24 W·m−2, P=0.03, unpaired t-test), experienced greater variations in body temperature (H=-0.62±0.05°C vsN=-0.35±0.12°C, P=0.03, unpaired t-test), and had more evaporated sweat (H=-106.1±4.59 W·m−2vs N=-91.15±3.24 W·m−2, P=0.01, unpaired t-test) than the normotensive subjects during the period of recovery from exercise. In conclusion, essential hypertensive subjects showed greater sweat evaporation and increased heat dissipation and body cooling relative to normotensive subjects during recovery from moderate-intensity exercise performed in hot conditions.

Hypertension is associated with greater heat exchange during exercise recovery in a hot environment.

Individuals with systemic arterial hypertension have a higher risk of heat-related complications. Thus, the aim of this study was to examine the thermoregulatory responses of hypertensive subjects during recovery from moderate-intensity exercise performed in the heat. A total of eight essential hypertensive (H) and eight normotensive (N) male subjects (age=46.5±1.3 and 45.6±1.4 years, body mass index=25.8±0.8 and 25.6±0.6 kg/m2, mean arterial pressure=98.0±2.8 and 86.0±2.3 mmHg, respectively) rested for 30 min, performed 1 h of treadmill exercise at 50% of maximal oxygen consumption, and rested for 1 h after exercise in an environmental chamber at 38°C and 60% relative humidity. Skin and core temperatures were measured to calculate heat exchange parameters. Mean arterial pressure was higher in the hypertensive than in the normotensive subjects throughout the experiment (P<0.05, unpaired t-test). The hypertensive subjects stored less heat (H=-24.23±3.99 W·m-2vs N=-13.63±2.24 W·m-2, P=0.03, unpaired t-test), experienced greater variations in body temperature (H=-0.62±0.05°C vsN=-0.35±0.12°C, P=0.03, unpaired t-test), and had more evaporated sweat (H=-106.1±4.59 W·m-2vs N=-91.15±3.24 W·m-2, P=0.01, unpaired t-test) than the normotensive subjects during the period of recovery from exercise. In conclusion, essential hypertensive subjects showed greater sweat evaporation and increased heat dissipation and body cooling relative to normotensive subjects during recovery from moderate-intensity exercise performed in hot conditions.

Whole body vibration and post-activation potentiation: a study with repeated measures.

The objective of this study was to assess the acute effect of different intensities of whole body vibration (WBV) on muscle performance. 8 recreationally trained males were randomly subjected to one of 3 experimental conditions: (A) WBV 2 mm [45 Hz and 2 mm], (B) WBV 4 mm [45 Hz and 4 mm], and (C) no WBV. To assess PAP, the peak concentric torque of knee flexors and extensors was measured during a set of 3 unilateral knee flexor-extensions at 60°/s(-1) in an isokinetic dynamometer. The power output and height during vertical jumps were also evaluated. These measurements were performed both before and after the experimental conditions and then compared. Comparing the knee flexion data from the conditions with and without WBV indicate that WBV potentiated the peak torque during unilateral knee flexion in the isokinetic test (p < 0.05). In addition, the power output (p = 0.01) and vertical height of jump (p = 0.03) were also potentiated by WBV. However, increasing the vibratory stimulus did not further potentiate the results. Thus, it is suggested that WBV be used before explosive events competition because WBV promotes post-activation potentiation.

Use of stents for small coronary arteries. Results of the Multi-Link 2.5 Portuguese Registry.

INTRODUCTION: Stents are being used with increasing frequency in percutaneous transluminal coronary angioplasty (PTCA) but their use in small vessels is still controversial, due to the possibility of excessively high rates of adverse events and restenosis. OBJECTIVE: To assess the safety and clinical efficacy of ACS RX Multi-Link (ML) 2.5 mm stents, in "de novo" coronary stenosis. DESIGN: Prospective Registry, with 6 months clinical follow-up, involving all Portuguese centers of Interventional Cardiology. POPULATION: Between April 7 and November 20 1998, 102 patients were enrolled, 82 male and with ages ranging from 30 to 86 years (average 58 +/- 11). Clinical presentation for PTCA was stable angina in 53%, unstable angina in 36% and silent ischemia in 11%. There was a history of previous myocardial infarction in 29% of patients. The main risk factors were hypertension (58%), hyperlipidemia (57%), smoking (25%) and diabetes (20%). Multivessel coronary artery disease was present in 46% of patients and left ventricular function was normal in 89%. Of the 217 existing lesions, 188 (87%) were treated: 35 with balloon angioplasty and 153 with stent implantation, 114 of which were ML 2.5 mm: 79 of 15 mm in length and 35 of 25 mm. METHODS: Angiographic success with ML stent implantation and major adverse cardiac events (MACE)--myocardial infarction (MI), coronary artery bypass graft (CABG), new target vessel revascularizations and death--were evaluated during hospital stay, and at 1 and 6 months clinical follow-up. RESULTS: Angiographic success was 97.4%. In one patient it was not possible to cross the lesion, in another there was stent migration and in a third distal coronary flow after stenting was TIMI grade 1. Clinical success was 96.1% and there were no cases of death, Q-wave MI or urgent CABG. Two patients had non-Q wave MI and two required urgent repeat angioplasty. Subacute stent thrombosis occurred in 1 patient. There were no additional MACE at 1 month follow-up. At 6-month follow-up (in 97% of patients) MACE had occurred in 14.1%: 2 deaths (one non-cardiac), 3 MI (one non-Q) and 14 new PTCA (one in a non-ML stent). There was no need for CABG in any patient. Six-month survival rate was 97.9%, 94.9% were free of infarction and 84.8% were free of infarction and new revascularization. CONCLUSIONS: Multi-Link 2.5 mm stent implantation appears to be safe and efficient with a low incidence of immediate and 6-month adverse events in the range of centers and operators of the Registry.

[Angioplasty with stenting in single vessel disease: non invasive methods for detecting restenosis]. / Angioplastia com colocação de stent na doença de um vaso: métodos não invasivos para detecção de reestenose.

OBJECTIVE: To compare the value of the myocardial perfusion imaging with 99Tc sestamibi (MIBI) with clinical data and stress EKG (SEKG) variables, in the detection of angiographic restenosis (AR: lesion > 50%), in a group of patients (pts) with single vessel disease (angiographic lesion above 70% in one epicardial artery), submitted to coronary angioplasty (PTCA) with stenting. POPULATION AND METHODS: Fifty-nine pts, followed prospectively, (49 males and 10 females aged 57 +/- 10) were submitted to 61 angioplasties, with dilatation of 59 vessels, and with stenting in 63 (1.07 stent/vessel). Clinical evaluation was performed in the first, third and sixth month, SEKG with MIBI in the fourth month and recatheterization for angiographic control in the sixth month. The pts were divided in two groups: R-positive angiographic restenosis (AR)--14 pts: NR--without AR--45 pts; the angiographic restenosis rate was 23.7%. The patients' history, cause of admission, procedure characteristics, medication at discharge, clinical events during follow-up, variables of stress EKG associated with myocardial perfusion and angiographic control were analyzed. RESULTS: The cause of admission was the same in both groups (MI in R group: 28.6%; NR: 46.7%; p = ns). There was no difference in the discharge medication. The R group was more symptomatic (Angina: R = 50.0% vs NR = 11.1%; p < 0.001 clinical restenosis rate = 11.8%), and had more revascularization procedures (PTCA: R = 57.1% vs NR = 2.8%; p < 0.001/Bypass surgery: R = 14.3% vs NR = 0%; p = 0.01). This group had abnormal stress EKG more frequently (42.9 vs 20.0%, p = ns) and ischemia in the myocardial perfusion scintigraphy (57.1 vs 6.7% p < 0.001). [table: see text] CONCLUSION: The clinical and diagnostic tests evaluated in this study showed a limited sensitivity in the detection of angiographic restenosis in a group of patients with single vessel disease submitted to coronary angioplasty and stenting. Myocardial scintigraphy was the best method for the detection of angiographic restenosis, showing a high specificity and a reasonable sensitivity.

[Evaluation of the prognostic value of cardiac troponin i in patients with unstable angina]. / Avaliar o valor prognóstico da troponina cardíaca I em doentes com angina instável.

OBJECTIVE: The purpose of this study was to evaluate the in-hospital and follow-up prognostic value of cardiac troponin I in patients admitted in the Coronary Care Unit and discharged with the diagnosis of unstable angina. POPULATION AND METHODS: 118 patients were admitted in the Coronary Care Unit, discharged with the diagnosis of unstable angina with a follow-up of 13.5 months. Cardiac Troponin I (cTnI) was measured on admission, 4 and 12 hours later. For the purposes of the study, we chose a cut-off value of 0.4 ng/mL as the minimal acceptable concentration of cTnI. The patients were divided in two groups: Group A (n = 82) if all measurements with cTnI < or = 0.4 ng/mL and Group B (n = 36) if any measurement with cTnI > 0.4 ng/mL. In both groups, multiple coronary events during hospitalisation and follow-up were evaluated: death; acute myocardial infarction; angina; hospitalisation; coronary surgery or angioplasty; and also the severity of coronary artery disease and the number of patients without coronary events. The results were compared by the Student's unpaired t-test and by chi-square test. RESULTS: Age, sex and vascular risk factors were similar in both groups. There was a statistically significant increase in angina and coronary surgery with increasing levels of cardiac troponin I (Group B) (13 vs 5, p < 0.0001), multiple vessel disease (16 vs 18, p < 0.0008) and myocardial infarction (12% vs 0%, p < 0.03). Sixty patients had no coronary events in Group A compared to thirteen in Group B (p < 0.0001). There were no significant differences between the groups with respect to hospitalisation and angioplasty (17% in Group B vs 7% in Group A) and death (3% vs 0%). CONCLUSIONS: In this population with unstable angina, cardiac troponin I level greater than 0.4 ng/mL measured in the 12 hours after admission provides useful prognostic information. It permits the early identification of patients with an increased risk of in-hospital and follow-up cardiac events and could be correlated with the severity of coronary artery disease.

[Serum markers for ischemic myocardial damage]. / Marcadores séricos de lesão isquémica do miocárdio.

Assays of serum enzymes, such as aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK) and isoenzyme MB, are widely performed in the early phase of suspected ischemic myocardial injury. However, these enzymes are not restricted to cardiac muscle tissue and increases in their serum concentrations have been observed in non-cardiac conditions. The levels of CK, and especially those of the myocardial specific isoform (CK-MB), have served as essential components for clinical decision in emergency rooms for over 25 years. This standard diagnostic test is far from perfect in specificity and the time delay necessary for the detection of a rise in levels. The clinician needs specific and sensitive biological parameters that can be rapidly measured in serum immediately after ischemic damage. In the last years, several new serum markers of myocardial damage have been developed. Currently, an important place is reserved for some non-enzyme muscle constituents, such as myoglobin and troponin sub-units, which have better specificity and allow an earlier detection of myocardial damage. The immunoassay of human cardiac troponin is a specific and sensitive diagnostic method for acute and sub-acute myocardial damage. It is ideal for the detection of myocardial necrosis in complex clinical situations when the usual enzymatic markers may be ineffective. An important prognostic value of troponin levels, especially troponin T, is currently under investigation. Myoglobin is a protein with low molecular weight that is abnormally high in serum two hours after myocardial infarction. Despite their high sensitivity, the use of serum measurements in the emergency room is controversial because of their low specificity, requiring the exclusion of skeletal muscle damage. Sensitivity could be lost in patients with renal function damage. The measurement of CK-MB protein weight (CK-MBmass) is another marker that has been confirmed as more accurate than CK-MB activity assays, especially in patients presented within four hours after the onset of chest pain, but could be inaccurate in several circumstances. In this research article, the authors describe the most important parameters of enzymatic and non-enzymatic markers, the kinetics of serum release, the clinical applications and the problems.

Corrected transposition of the great arteries. Repair of regurgitant tricuspid, mitral and pulmonary valves.

A 68 year old male patient with corrected transposition of the great arteries in situs solitus (SLL) underwent successful repair of regurgitant tricuspid, mitral and pulmonary valves. An aneurysm of the pulmonary artery, found incidentally during surgery, was also repaired.