Aerobic training prevents cardiometabolic changes triggered by myocardial infarction in ovariectomized rats.

This study aimed to evaluate the impact of aerobic training (AT) on autonomic, cardiometabolic, ubiquitin-proteasome activity, and inflammatory changes evoked by myocardial infarction (MI) in ovariectomized rats. Female Wistar rats were ovariectomized and divided into four groups: sedentary + sham (SS), sedentary + MI (SI), AT + sham surgery (TS), AT + MI (TI). AT was performed on a treadmill for 8 weeks before MI. Infarcted rats previously subjected to AT presented improved physical capacity, increased interleukin-10, and decreased pro-inflammatory cytokines. Metabolomic analysis identified and quantified 62 metabolites, 9 were considered significant by the Vip Score. SS, SI, and TS groups presented distinct metabolic profiles; however, TI could not be distinguished from the SS group. MI dramatically increased levels of dimethylamine, and AT prevented this response. Our findings suggest that AT may be useful in preventing the negative changes in functional, inflammatory, and metabolic parameters related to MI in ovariectomized rats.

Imunohistoquímica na avaliação das doenças inflamatórias intestinais (DII)

As doenças inflamatórias intestinais são desordens de etiologia idiopática cujo diagnóstico histopatológico é dado por meio de marcadores imunohistoquímicos. Portanto, o objetivo do presente estudo foi revisar os mais recentes ensaios clínicos publicados, que se utilizaram da imunohistoquímica para a avaliação de marcadores úteis no diagnóstico, no tratamento e no acompanhamento de tais doenças. Para isso, realizou-se uma revisão bibliográfica dos trabalhos publicados entre 2014 e 2017, presentes nas bases de dados Pubmed/medline e Cochrane Library, a partir da busca pelos descritores "Inflammatory bowel disease" AND "immunohistochemistry". Os resultados evidenciaram que MMP-9 e calprotectina fecal são marcadores úteis para o diagnóstico das doenças inflamatórias intestinais. Além disso, as quantificações de TNF, IL-6 e Anti-TNF se mostraram úteis para o acompanhamento desses pacientes, principalmente na verificação de melhora ou piora do quadro clínico após a instituição da terapia farmacológica. Concluiu-se, então, que a imunohistoquímica é uma metodologia bastante promissora para a avaliação das DII e, por isso, mais pesquisas que visem a descobertas de outros marcadores e que contribuam para o cuidado desses pacientes devem ser estimuladas.

Uptake of Plasmin-PN-1 Complexes in Early Human Atheroma.

Zymogens are delivered to the arterial wall by radial transmural convection. Plasminogen can be activated within the arterial wall to produce plasmin, which is involved in evolution of the atherosclerotic plaque. Vascular smooth muscle cells (vSMCs) protect the vessels from proteolytic injury due to atherosclerosis development by highly expressing endocytic LDL receptor-related protein-1 (LRP-1), and by producing anti-proteases, such as Protease Nexin-1 (PN-1). PN-1 is able to form covalent complexes with plasmin. We hypothesized that plasmin-PN-1 complexes could be internalized via LRP-1 by vSMCs during the early stages of human atheroma. LRP-1 is also responsible for the capture of aggregated LDL in human atheroma. Plasmin activity and immunohistochemical analyses of early human atheroma showed that the plasminergic system is activated within the arterial wall, where intimal foam cells, including vSMCs and platelets, are the major sites of PN-1 accumulation. Both PN-1 and LRP-1 are overexpressed in early atheroma at both messenger and protein levels. Cell biology studies demonstrated an increased expression of PN-1 and tissue plasminogen activator by vSMCs in response to LDL. Plasmin-PN-1 complexes are internalized via LRP-1 in vSMCs, whereas plasmin alone is not. Tissue PN-1 interacts with plasmin in early human atheroma via two complementary mechanisms: plasmin inhibition and tissue uptake of plasmin-PN-1 complexes via LRP-1 in vSMCs. Despite this potential protective effect, plasminogen activation by vSMCs remains abnormally elevated in the intima in early stages of human atheroma.

Surgery of the aortic root: should we go for the valve-sparing root reconstruction or the composite graft-valve replacement is still the first choice of treatment for these patients? / Cirurgia da raiz da aorta: deve-se preservar a valva aórtica ou a operação com o tubo valvulado ainda é a primeira opção de tratamento para esses pacientes?

AbstractObjective:To compare the results of the root reconstruction with the aortic valve-sparing operation versus composite graftvalve replacement.Methods:From January 2002 to October 2013, 324 patients underwent aortic root reconstruction. They were 263 composite graft-valve replacement and 61 aortic valve-sparing operation (43 reimplantation and 18 remodeling). Twenty-six percent of the patients were NYHA functional class III and IV; 9.6% had Marfan syndrome, and 12% had bicuspid aortic valve. There was a predominance of aneurysms over dissections (81% vs. 19%), with 7% being acute dissections. The complete follow-up of 100% of the patients was performed with median follow-up time of 902 days for patients undergoing composite graft-valve replacement and 1492 for those undergoing aortic valve-sparing operation.Results:In-hospital mortality was 6.7% and 4.9%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns). During the late follow-up period, there was 0% moderate and 15.4% severe aortic regurgitation, and NYHA functional class I and II were 89.4% and 94%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns). Root reconstruction with aortic valve-sparing operation showed lower late mortality (P=0.001) and lower bleeding complications (P=0.006). There was no difference for thromboembolism, endocarditis, and need of reoperation.Conclusion:The aortic root reconstruction with preservation of the valve should be the operation being performed for presenting lower late mortality and survival free of bleeding events.

ResumoObjetivo:Analisar comparativamente os resultados da operação de preservação da valva aórtica e do tubo valvulado nas reconstruções da raiz da aorta.Métodos:No período de janeiro de 2002 a outubro de 2013, 324 pacientes foram submetidos à reconstrução da raiz da aorta. Foram 263 tubos valvulados e 61 preservações da valva aórtica (43 reimplantes e 18 remodelamentos). 26% dos pacientes estavam em classe funcional III e IV; 9,6% com síndrome de Marfan e 12% apresentavam valva aórtica bivalvulada. Houve predomínio dos aneurismas sobre as dissecções (81% contra 19%), sendo 7% de dissecções agudas. O seguimento completo de 100% dos pacientes foi realizado com tempo mediano de seguimento de 902 dias para pacientes submetidos à tubo valvulado e de 1492 para aqueles submetidos à preservação da valva aórtica.Resultados:A mortalidade hospitalar foi de 6,7% contra 4,9% respectivamente para tubo valvulado e preservação da valva aórtica (ns). No seguimento tardio, a insuficiência aórtica importante foi de 0% e 5,8%, e a insuficiência cardíaca crônica, classe funcional I e II de 89,4% e 94%, respectivamente, para tubo valvulado e preservação da valva aórtica (ns). A reconstrução da raiz da aorta com a preservação da valva aórtica apresentou menor mortalidade tardia (P=0,001) e menos complicações hemorrágicas (P=0,006). Não houve diferença para tromboembolismo, endocardite ou necessidade de reoperação.Conclusão:A reconstrução da raiz da aorta com a preservação valvar deve ser a operação a ser realizada por apresentar menor mortalidade e sobrevida livre de eventos hemorrágicos.

Surgery of the aortic root: should we go for the valve-sparing root reconstruction or the composite graft-valve replacement is still the first choice of treatment for these patients?

OBJECTIVE: To compare the results of the root reconstruction with the aortic valve-sparing operation versus composite graft-valve replacement. METHODS: From January 2002 to October 2013, 324 patients underwent aortic root reconstruction. They were 263 composite graft-valve replacement and 61 aortic valve-sparing operation (43 reimplantation and 18 remodeling). Twenty-six percent of the patients were NYHA functional class III and IV; 9.6% had Marfan syndrome, and 12% had bicuspid aortic valve. There was a predominance of aneurysms over dissections (81% vs. 19%), with 7% being acute dissections. The complete follow-up of 100% of the patients was performed with median follow-up time of 902 days for patients undergoing composite graft-valve replacement and 1492 for those undergoing aortic valve-sparing operation. RESULTS: In-hospital mortality was 6.7% and 4.9%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns). During the late follow-up period, there was 0% moderate and 15.4% severe aortic regurgitation, and NYHA functional class I and II were 89.4% and 94%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns). Root reconstruction with aortic valve-sparing operation showed lower late mortality (P=0.001) and lower bleeding complications (P=0.006). There was no difference for thromboembolism, endocarditis, and need of reoperation. CONCLUSION: The aortic root reconstruction with preservation of the valve should be the operation being performed for presenting lower late mortality and survival free of bleeding events.

Matriz extracelular na aorta ascendente humana: quantificação morfométrica do colágeno em aortas normais e análise topográfica da matrilisina, estromelisia e plasmina em dissecções e aneurismas não-inflamatórios / Extracellular matriz in the human ascending aorta: morphometric quantification of collagen in normal aortas and topographic analysis of matrilysin, stromelysin and plasmin in dissection and non inflammatory aneurisms

Nas dissecções e aneurismas não-inflamatórios da aorta ascendente há aumento de material mucóide (aspecto que corresponde a proteoglicanos). Analisamos por reações de imunoperoxidase a distribuição de estromelisina (MMP-7), matrilisina (MMP-3) e plasmina, enzimas que agem em proteoglicanos, em cortes de aortas humanas com tais doenças e em controles. Nos casos com qualquer dessas doenças MMP-7 e MMP-3 se acumularam nas áreas de depósito mucóide, e a plasmina ao redor delas. Tais enzimas podem estar envolvidas nessas doenças. Adicionalmente, avaliamos por morfometria o colágeno nas duas metades da camada média da aorta; sua quantidade foi menor na metade externa, onde as dissecções ocorrem / In dissections and non-inflammatory aneurysms of the ascending aorta there is an increase in mucoid (proteoglycan) deposition. We analyzed by immunoperoxidase the distribution of stromelysin (MMP-7), matrilysin (MMP-3) and plasminogen/plasmin, enzymes that act on proteoglycans, in sections of human aortas with these diseases and in controls. In cases with any of these diseases MMP-7 and MMP-3 were accumulated in the areas of mucoid degeneration, and plasmin around them. Such enzymes could thus be involved in these diseases. We also evaluated by morphometry the amount of collagen in the two halves of the aortic media. There is less collagen at the external half, in which dissections occur...