Objective Sleep Duration Is Prospectively Associated With Endothelial Health.

Study Objectives: The mechanisms linking short sleep duration to cardiovascular disease (CVD) are poorly understood. Emerging evidence suggests that endothelial dysregulation may lie along the causal pathway linking sleep duration to cardiovascular risk, although current evidence in humans is based on cross-sectional studies. Our objective was to evaluate the prospective association between objectively assessed sleep duration and clinical indices of endothelial health. Methods: A total of 141 medically healthy adults underwent an overnight laboratory sleep study when they were between the ages of 21 and 60 years. Total sleep time was objectively assessed by polysomnography at study entry. Endothelial health, including brachial artery diameter (BAD) and flow-mediated dilation (FMD), was measured 18.9 ± 4.6 years later. Medical health and psychiatric status were assessed at both time points. Approximately half of the sample had a lifetime history of major depressive disorder. Results: In univariate analyses, shorter sleep duration was associated with increased BAD (ß = -0.24, p = .004) and decreased FMD (ß = 0.17, p = .042). BAD, but not FMD, remained significantly associated with sleep duration after adjusting for sex, age, body mass index (BMI), smoking, diabetes, hypertension, and lifetime history of major depressive disorder (MDD) at T2. The association between sleep duration and BAD was stronger than the association between BAD and an aggregate measure of CVD risk including three or more of the following risk factors: male sex, age ≥ 65 years, smoker, BMI ≥ 30, diabetes, hypertension, and MDD. Conclusions: Objectively assessed short sleep duration was prospectively associated with increased BAD over a 12- to 30-year period.

Low vaspin levels are related to endothelial dysfunction in patients with ankylosing spondylitis.

Vaspin is a novel adipocytokine associated with glucose tolerance and chronic inflammation. Some studies reveal that vaspin may be involved in cardiovascular diseases. Our objective was to investigate the relationship between serum vaspin levels and endothelial function in patients with ankylosing spondylitis. One hundred and twenty patients with newly diagnosed ankylosing spondylitis and 100 healthy subjects were studied. Serum vaspin levels were measured with enzyme-linked immunosorbent assay. High resolution ultrasound was used to measure brachial artery diameter at rest, after reactive hyperemia (flow-mediated dilation, FMD) and after sublingual glyceryltrinitrate. Serum vaspin level in patients was 1.92±1.03 ng/mL, which was significantly lower than that in healthy subjects (2.88±0.81 ng/mL). By dividing the distribution of serum vaspin levels into quartiles, FMD levels increased gradually with the increase of serum vaspin levels in patients (P<0.01). Univariate analysis showed a correlation between vaspin and FMD (r=0.73, P=0.003), low-density lipoprotein cholesterol (r=-0.45, P=0.033), high-density lipoprotein cholesterol (r=0.63, P=0.025), fasting blood glucose (r=-0.79, P=0.006), triglycerides (TG) (r=-0.68, P=0.036), systolic blood pressure (r=-0.35, P=0.021), C-reactive protein (r=-0.67, P=0.011), homeostatic model assessment of insulin resistance (HOMA-IR) (r=-0.77, P=0.023) and erythrocyte sedimentation rate (r=-0.88, P=0.039) in patients. Multivariate analysis indicated that serum vaspin levels were independently associated with FMD, HOMA-IR and TG in patients. Our study found that serum vaspin levels were decreased in patients with ankylosing spondylitis and were associated with FMD levels. Vaspin may serve as an independent marker for detecting early stage atherosclerosis in patients with ankylosing spondylitis.

Low vaspin levels are related to endothelial dysfunction in patients with ankylosing spondylitis

Vaspin is a novel adipocytokine associated with glucose tolerance and chronic inflammation. Some studies reveal that vaspin may be involved in cardiovascular diseases. Our objective was to investigate the relationship between serum vaspin levels and endothelial function in patients with ankylosing spondylitis. One hundred and twenty patients with newly diagnosed ankylosing spondylitis and 100 healthy subjects were studied. Serum vaspin levels were measured with enzyme-linked immunosorbent assay. High resolution ultrasound was used to measure brachial artery diameter at rest, after reactive hyperemia (flow-mediated dilation, FMD) and after sublingual glyceryltrinitrate. Serum vaspin level in patients was 1.92±1.03 ng/mL, which was significantly lower than that in healthy subjects (2.88±0.81 ng/mL). By dividing the distribution of serum vaspin levels into quartiles, FMD levels increased gradually with the increase of serum vaspin levels in patients (P<0.01). Univariate analysis showed a correlation between vaspin and FMD (r=0.73, P=0.003), low-density lipoprotein cholesterol (r=-0.45, P=0.033), high-density lipoprotein cholesterol (r=0.63, P=0.025), fasting blood glucose (r=-0.79, P=0.006), triglycerides (TG) (r=-0.68, P=0.036), systolic blood pressure (r=-0.35, P=0.021), C-reactive protein (r=-0.67, P=0.011), homeostatic model assessment of insulin resistance (HOMA-IR) (r=-0.77, P=0.023) and erythrocyte sedimentation rate (r=-0.88, P=0.039) in patients. Multivariate analysis indicated that serum vaspin levels were independently associated with FMD, HOMA-IR and TG in patients. Our study found that serum vaspin levels were decreased in patients with ankylosing spondylitis and were associated with FMD levels. Vaspin may serve as an independent marker for detecting early stage atherosclerosis in patients with ankylosing spondylitis.

Glycosylated hemoglobin is associated with decreased endothelial function, high inflammatory response, and adverse clinical outcome in non-diabetic STEMI patients.

OBJECTIVE: Chronic dysglycemia was recently identified as a predictor for adverse outcomes in patients with ST-elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention. Data for non-diabetic patients who underwent thrombolysis is scarce. In this context, we aimed to study the effect of HbA1c on cardiovascular outcome after STEMI. METHODS: A prospective cohort of 326 non-diabetic STEMI individuals was used for the analyses. We measured plasma glucose, hemoglobin A1c [HbA1c], lipid profile, C-reactive protein (CRP), and nitrate/nitrite (NOx) upon admission and five days after STEMI (D5). Flow-mediated dilation (FMD) was performed 30 days after STEMI. During clinical follow-up, we assessed patients for incident diabetes (progression to HbA1c ≥ 6.5%) and major adverse cardiac events (MACE), defined as a composite of fatal and non-fatal MI, sudden cardiac death, and angina requiring hospitalization. RESULTS: Using ROC-curve analysis, a 5.8% HbA1c best predicted MACE with a sensitivity of 75% and specificity of 53% (AUC 0.673, p = 0.001). Patients were categorized as high HbA1c if ≥ 5.8% and low HbA1c if <5.8%. Compared with patients with low HbA1c, those with high HbA1c presented with 20% higher CRP-D5 (p = 0.009) and 19% higher ΔCRP (p = 0.01), a 32% decrease in ΔNOx (p < 0.001), and 33% lower FMD (p < 0.001). After a median follow-up of 1.9 (1.1-2.8) years, patients with high HbA1c had more incident diabetes (HR 2.3 95% CI 1.01-5.2; p = 0.048) and MACE (HR 3.32 95% CI 1.09-10.03; p = 0.03). CONCLUSION: Non-diabetic STEMI patients with high HbA1c present with decreased endothelial function and increased inflammatory response and long-term risk of MACE.

Systematic review of anaemia and inflammatory markers in chronic obstructive pulmonary disease.

This systematic review synthesizes the relevant published articles on the prevalence of anaemia in patients with chronic obstructive pulmonary disease (COPD) and its relationship with inflammatory markers. The upregulation of erythropoietin in anaemia maintains homeostasis. However, anaemic COPD patients do not respond to increased levels of erythropoietin. The increased levels could be an indicator of the peripheral erythropoietin resistance in COPD. Anaemia and inflammation are associated with an increased risk of hospitalization and mortality in these patients. The understanding of anaemia in chronic inflammation is that anaemia is at least partially due to the excessive production of inflammatory cytokines, which can contribute to improvements in the management, prognosis, and survival of patients with COPD and anaemia.

Cardiac autonomic dysfunction and arterial stiffness among children and adolescents with attention deficit hyperactivity disorder treated with stimulants.

OBJECTIVE: To compare markers of cardiovascular health in youth diagnosed with attention deficit hyperactivity disorder (ADHD) by the use of stimulant medication with healthy controls. STUDY DESIGN: Children and adolescents (n = 85; mean age 11.2 ± 2.8 years; 66 boys) diagnosed with ADHD using a stimulant and 53 siblings without ADHD (mean age 11.1 ± 3.8 years; 28 boys) were included in this cross-sectional study. Measured variables included blood pressure, heart rate (HR), HR variability: SD of the RR interval and low frequency to high frequency ratio, carotid-radial pulse wave velocity, carotid artery augmentation index (AIx), radial artery AIx, brachial artery flow-mediated dilation, and digital reactive hyperemic index. RESULTS: Compared with control patients, participants with ADHD had greater resting systolic blood pressure (3.9 mm Hg, 95% CI [1.2-6.7], P = .005), diastolic blood pressure (5.5 mm Hg, 95% CI [3.2-7.8], P < .001), HR (9.2 beats/min, 95% CI [6.0-12.3], P < .001), low frequency to high frequency ratio (0.55, 95% CI [0.22-0.89], P = .001), carotid AIx (7.2%, 95% CI [1.9-12.5], P = .008), and pulse wave velocity (0.36 m/s, 95% CI [-0.05, 0.78], P = .089), and lower SD of the RR interval (-33.7 milliseconds, 95% CI [-46.1, -21.3], P < .001). Neither flow-mediated dilation nor reactive hyperemic index was significantly different. CONCLUSIONS: Children and adolescents being treated with a stimulant medication for ADHD exhibited signs of altered cardiac autonomic function, characterized by increased sympathetic tone, and showed evidence of arterial stiffening.

Assessment of endothelial function by flow-mediated dilation of the brachial artery in adolescents with a history of preeclampsia or a normotensive pregnancy / Avaliação da função endotelial através da dilatação mediada por fluxo da artéria braquial em adolescentes com história de pré-eclâmpsia ou de gestação normotensa

To determine the prevalence of endothelial dysfunction and its association with a history of mild and severe preeclampsia in adolescents. Methods: a cross-sectional study was carried out at the MEAC-UFC with 103 primiparous adolescents postpartum. The assessment of endothelial function was performed by way of flow-mediated dilatation of the brachial artery. Variables (age, body mass index, gestational age at delivery, systolic and diastolic blood pressure and flow-mediated dilation) were compared between groups. p<0.05 was considered to be statistically significant. Results: twenty-four (23.3 percent) patients had preeclampsia (PE): 11 mild and 13 severe. The overall prevalence of endothelial dysfunction was 23.3 percent (21.5 percent of patients with normotensive pregnancies and 29.2 percent of the PE patients: 18.2 percent of those with mild PE and 38.5 percent of those with severe PE). The figures were statistically significant for systolic blood pressure, p=0.007. Conclusions: patients with a history of PE have higher systolic blood pressure than patients with a history of normotensive pregnancy, but did not have more endothelial dysfunction...

Determinar a prevalência de disfunção endotelial e a associação com o antecedente de pré-eclâmpsia leve e grave em adolescentes. Métodos: estudo transversal conduzido na MEAC - UFC com 103 adolescentes primíparas no pós-parto. A avaliação da função endotelial foi realizada pela dilatação mediada por fluxo da artéria braquial. As variáveis (idade, índice de massa corporal, idade gestacional no parto, pressão arterial sistólica e diastólica e dilatação mediada por fluxo) foram comparadas entre os grupos. Considerou-se p<0,05 significância estatística. Resultados: vinte e quarto (23,3 por cento) pacientes tiveram pré-eclâmpsia (PE): 11 PE leve e 13 PE grave. A prevalência geral de disfunção endotelial foi de 23,3 por cento (21,5 por cento das pacientes com gestações normotensas e 29,2 por cento das PE: 18,2 por cento daquelas com PE leve e 38,5 por cento daquelas com PE grave). Houve significância estatística para pressão arterial sistólica, p=0,007. Conclusões: pacientes com história de PE apresentam pressão sistólica maior que pacientes com antecedente de gestação normotensa, mas não houve mais disfunção endotelial...

Brachial artery diameter and the right ventricle: the Multi-Ethnic Study of Atherosclerosis-right ventricle study.

BACKGROUND: Endothelial dysfunction is associated with left ventricular morphology and long-term cardiovascular outcomes. The purpose of this study was to assess the relationship between both baseline brachial artery diameter and peripheral endothelial function (assessed by brachial artery ultrasonography) and right ventricular (RV) mass, RV end-diastolic volume (RVEDV), and RV ejection fraction (RVEF). METHODS: The Multi-Ethnic Study of Atherosclerosis (MESA) performed cardiac MRI and brachial artery ultrasonography on participants without clinical cardiovascular disease. Baseline brachial artery diameter and flow-mediated dilation were assessed. RESULTS: The mean age was 60.9 years, and 49.4% of subjects were men (n = 2,425). In adjusted models, larger brachial artery diameter was strongly associated with greater RV mass (ß = 0.55 g, P < .001), larger RVEDV (ß = 3.99 mL, P < .001), and decreased RVEF (ß = -0.46%, P = .03). These relationships persisted after further adjustment for the respective left ventricular parameters. Flow-mediated dilation was not associated with RV mass or RVEF and was only weakly associated with RVEDV. CONCLUSIONS: Brachial artery diameter is associated with greater RV mass and RVEDV, as well as lower RVEF. Changes in the systemic arterial circulation may have pathophysiologic links to pulmonary vascular dysfunction or abnormalities in RV perfusion.

Premature subclinical atherosclerosis in pediatric inflammatory bowel disease.

OBJECTIVES: To investigate the risk for developing an early endothelial dysfunction based on increased intima media thickness (IMT) and reduced flow-mediated dilation (FMD) in children with inflammatory bowel disease (IBD), and to evaluate the role of traditional and nontraditional risk factors in determining premature atherosclerosis. STUDY DESIGN: We studied 27 patients with Crohn's disease (CD) and 25 patients with ulcerative colitis (UC) (mean age, 15.2 years; mean duration of disease, 48.05 months); 31 subjects served as controls. Demographic data (age, sex, family history of diabetes, cardiovascular disease, hypertension, hypercholesterolemia), traditional risk factors for atherosclerosis (blood pressure, body mass index, active and passive smoking, dyslipidemia), and UC and CD activity indexes (Pediatric Ulcerative Colitis Activity Index and Pediatric Crohn's Disease Activity Index, respectively) were collected. The IMT of the carotid arteries was measured by high-resolution B-mode ultrasound, and endothelial function was evaluated by FMD in the brachial artery in response to reactive hyperemia. RESULTS: Compared with controls, patients with CD had significantly greater exposure to passive smoking and had lower body mass index and high-density lipoprotein cholesterol values. IMT was significantly higher in patients than controls (P < .0001), and the percentage of FMD was significantly lower in both patients with CD (P < .0001) and patients with UC (P < .01) versus controls. In multivariate analysis, diagnosis of IBD was an independent risk factor for atherosclerosis. CONCLUSION: Premature endothelial dysfunction occurs in pediatric IBD. This represents a new challenge in the management of pediatric IBD, leading to prevention strategies of cardiovascular disease.

Carotid-radial pulse wave velocity as a discriminator of intrinsic wall alterations during evaluation of endothelial function by flow-mediated dilatation.

UNLABELLED: Flow-mediated dilatation (FMD) is the most accepted technique for the evaluation of endothelial function. However, it has been show a great inter-subject variability limiting its clinical use. Carotid-radial pulse wave velocity (PWVcr) was proposed as an alternative tool for the evaluation of endothelial function. At the present, there is no doubt that PWVcr reduces its values in response to reactive hyperemia test (RHT) in healthy subjects. AIMS: a) to determine simultaneously the temporal profile of FMD, PWVcr and shear rate in response to RHT and b) to describe and analyze how subjects "FMD responders" or "non-responders" behave regards to PWVcr changes. METHODS: 34 Healthy young subjects were included. The PWVcr (strain gauge mechanotransducers), brachial diameter (B-Mode ultrasound and blood flow velocity (Doppler ultrasound) were measured before (baseline) the cuff was inflated and after its deflation (5 minutes). 10(th) percentiles FMD and PWVcr changes in the population were used for the definition of the subjects ("responders and non-responders"). RESULTS: Changes in PWVcr, brachial arterial diameter and shear rate were evidenced after the cuff release (p<0.05). There were differences in the PWV and FMD temporal profiles. Within "FMD responders" there were "PWV responders and non-responders". CONCLUSION: Assessing RHT-related changes in PWVcr in the context of a FMD evaluation, could be useful as a discriminator of intrinsic wall alterations giving additional information of vascular dynamics.

Ácidos grasos omega 3 en la dilatación mediada por flujo de la arteria braquial en individuos con disfunción endotelial / Omega 3 fatty acids in flow-mediated dilation of the brachial artery in patients with endothelial dysfunction

Las enfermedades cardiovasculares son la principal causa de muerte en Venezuela. La disfunción endotelial (DE) puede ser medida con la dilatación mediada por flujo de la arteria braquial (DMFAB). Se ha afirmado que los ácidos grasos omega 3 ayudan a regular la disfunción endotelial. Establecer la relación existente entre los ácidos grados omega 3 y la disfunción endotelial, al administrar 1 gramo al día por 2 semanas y evaluar la variación en la prueba de dilatación mediada por flujo de la arteria braquial. 25 individuos con prueba positiva para disfunción endotelial al tener DMFAB menor al 10%. Los pacientes recibieron ácidos grasos omega 3 a dosis de 1000 mg diario por dos semanas y se repitió la prueba. Se midieron los niveles séricos de fibrinógeno, proteína C reactiva (PCR) y ácido úrico entre otros, antes y después del tratamiento. El porcentaje de dilatación en la prueba de DMFAB, aumentó posterior al tratamiento con ácidos grasos omega 3. De igual forma los niveles séricos de PCR, fibrinógeno y ácido úrico disminuyeron posterior al tratamiento. Los suplementos de ácidos grasos omega 3 a razón de 1000 mg diario por 2 semanas mejoran la disfunción endotelial en pacientes con factores de riesgo cardiovascular. A su vez, los marcadores serológicos disminuyen con la administración de ácidos grasos omega 3...

Cardiovascular diseases are the leading cause of death in Venezuela. When there is an Endothelial dysfunction (ED) can be measured with flow-mediated dilatation of the brachial artery (DMFAB). Omega 3 fatty acids have been associated with the regulation of this entity. 25 subjects with positive test for endothelial dysfunction measured by DMFAB of less than 10%. The patients were given omega-3 fatty acids 1000 mg daily for two weeks. Serum tests performed were fibrinogen, CRP and uric acid among others, before and after treatment. The rate of expansion by DMFAB test increased after treatment with omega-3 fatty acids. Similarly serum levels of CRP, fibrinogen and uric acid decreased after treatment. Omega 3 fatty acids at a rate of 1000 mg daily for 2 weeks improved endothelial dysfunction in patients with CRF. Serological markers decrease with the administration of omega 3 fatty acids to the mentioned dose...

Validity of a new method to estimate mean arterial pressure at brachial level.

The value of mean arterial pressure (MBP) is of clinical importance, and is required for peripheral resistance calculation as well as for central blood pressure calibration procedures. MBP is usually estimated at the upper arm using systolic and diastolic sphygmomanometers pressure values, as 33% of pulse pressure (PP) above diastolic pressure. In a previous work, we proposed to use 38%. The aim of this study was to investigate the validity of the proposed formula to calculate MBP, when assessing subjects with a wide range of blood pressure and pulse wave velocity (PWV) levels. In 73 volunteers (56 ± 10 years, range: 27-82; pulse pressure: 59 ± 12 mmHg, range: 43-86; PWV: 10 ± 2 m/s, range: 8-17) arterial pressure waveforms were obtained at the left brachial artery by applanation tonometry. Diastolic (DBP) and systolic (SBP) brachial pressure were obtained with oscillometric device. Brachial-radial PWV was obtained at the same arm using mechano-transducers. MBP computed as 38% of PP above diastolic pressure, introduces an error of only 0.1% in brachial MBP estimation, independent of pressure and PWV levels.

[Obesity and altered arterial structure in young women with micropolycystic ovary syndrome]. / Obesidade e alteração da estrutura arterial em mulheres jovens com síndrome dos ovários micropolicísticos.

PURPOSE: to compare echographical cardiovascular risk factors between obese and non-obese patients with micropolycystic ovarian syndrome (MPOS). METHODS: in this transversal study, 30 obese (Body Mass Index, BMI>30 kg/m(2)) and 60 non-obese (BMI<30 kg/m(2)) MPOS patients, aging between 18 and 35 years old, were included. The following variables were measured: flow-mediated dilatation (FMD) of the brachial artery, thickness of the intima-media of the carotid artery (IMT), anthropometric data, systolic arterial pressure (SAP) and diastolic arterial pressure (DAP). The women had no previous medical treatment and no comorbidity besides MPOS and obesity. For statistical analysis, the non-paired tand Mann-Whitney's tests were used. RESULTS: obese weighted more than non-obese patients (92.1+/-11.7 kg versus 61.4+/-10.7 kg, p<0.0001) and had a larger waist circumference (105.0+/-10.4 cm versus 78.5+/-9.8 cm, p<0.0001). The SBP of obese patients was higher than that of the non-obese ones (126.1+/-10.9 mmHg versus 115.8+/-9.0 mmHg, p<0.0001) and the IMT was also bigger (0.51+/-0.07 mm versus 0.44+/-0.09 mm, p<0.0001). There was no significant difference between the groups as to FMD and carotid rigidity index (beta). CONCLUSIONS: obesity in young women with MPOS is associated with higher blood pressure and alteration of arterial structure, represented by a thicker intima-media of the carotid artery.

Obesidade e alteração da estrutura arterial em mulheres jovens com síndrome dos ovários micropolicísticos / Obesity and altered arterial structure in young women with micropolycystic ovary syndrome

OBJETIVO: comparar os fatores ecográficos de risco cardiovascular em pacientes obesas e não obesas, com síndrome dos ovários micropolicísticos (SOMP). MÉTODOS: foram incluídas 30 pacientes obesas com SOMP (Índice de massa corporal, IMC>30 kg/m²) e 60 não obesas (IMC<30 kg/m²), com idade entre 18 e 35 anos neste estudo transversal. Foram avaliados: a dilatação mediada por fluxo (DMF) da artéria braquial, espessura íntima-média da artéria carótida (IMT), o índice de rigidez da artéria carótida (β), as medidas antropométricas, pressão sanguínea sistólica (PAS) e diastólica (PAD). As mulheres estavam sem nenhum tratamento prévio e nenhuma delas apresentava qualquer comorbidade (além da SOMP e/ou da obesidade).Na análise estatística, foram utilizados os testes t não-pareado ou de Mann-Whitney. RESULTADOS: as pacientes obesas com SOMP apresentaram maior peso em relação às não obesas (92,1±11,7 kg versus 61,4±10,7 kg, p<0,0001), bem como a medida da cintura que também, foi mais elevada nas pacientes obesas (105,0±10,4 cm versus 78,5±9,8 cm, p<0,0001). A PAS das pacientes obesas foi superior quando comparadas às não obesas (126,1±10,9 mmHg versus 115,8±9,0 mmHg, p<0,0001) e a IMT também foi maior nas obesas (0,51±0,07 mm versus 0,44±0,09 mm, p<0,0001). Não houve diferença entre os grupos quanto à dilatação mediada por fluxo (DMF) da artéria braquial ou ao índice de rigidez da artéria carótida (β). CONCLUSÕES: a obesidade em portadoras jovens de SOMP está associada a níveis pressóricos mais elevados e à alteração da estrutura arterial, representada pela maior espessura íntima-média da artéria carótida.

PURPOSE: to compare echographical cardiovascular risk factors between obese and non-obese patients with micropolycystic ovarian syndrome (MPOS). METHODS: in this transversal study, 30 obese (Body Mass Index, BMI>30 kg/m²) and 60 non-obese (BMI<30 kg/m²) MPOS patients, aging between 18 and 35 years old, were included. The following variables were measured: flow-mediated dilatation (FMD) of the brachial artery, thickness of the intima-media of the carotid artery (IMT), anthropometric data, systolic arterial pressure (SAP) and diastolic arterial pressure (DAP). The women had no previous medical treatment and no comorbidity besides MPOS and obesity. For statistical analysis, the non-paired tand Mann-Whitney's tests were used. RESULTS: obese weighted more than non-obese patients (92.1±11.7 kg versus 61.4±10.7 kg, p<0.0001) and had a larger waist circumference (105.0±10.4 cm versus 78.5±9.8 cm, p<0.0001). The SBP of obese patients was higher than that of the non-obese ones (126.1±10.9 mmHg versus 115.8±9.0 mmHg, p<0.0001) and the IMT was also bigger (0.51±0.07 mm versus 0.44±0.09 mm, p<0.0001). There was no significant difference between the groups as to FMD and carotid rigidity index (β). CONCLUSIONS: obesity in young women with MPOS is associated with higher blood pressure and alteration of arterial structure, represented by a thicker intima-media of the carotid artery.

Normal flow-mediated vasodilatation of the brachial artery and carotid artery intima-media thickness in subclinical hypothyroidism

Subclinical hypothyroidism (SHT) is a disease for which exact therapeutic approaches have not yet been established. Previous studies have suggested an association between SHT and coronary heart disease. Whether this association is related to SHT-induced changes in serum lipid levels or to endothelial dysfunction is unclear. The aim of this study was to determine endothelial function measured by the flow-mediated vasodilatation of the brachial artery and the carotid artery intima-media thickness (IMT) in a group of women with SHT compared with euthyroid subjects. Triglycerides, total cholesterol, HDL-C, LDL-C, apoprotein A (apo A), apo B, and lipoprotein(a) were also determined. Twenty-one patients with SHT (mean age: 42.4 ± 10.8 years and mean thyroid-stimulating hormone (TSH) levels: 8.2 ± 2.7 µIU/mL) and 21 euthyroid controls matched for body mass index, age and atherosclerotic risk factors (mean age: 44.2 ± 8.5 years and mean TSH levels: 1.4 ± 0.6 µIU/mL) participated in the study. Lipid parameters (except HDL-C and apo A, which were lower) and IMT values were higher in the common carotid and carotid bifurcation of SHT patients with positive serum thyroid peroxidase antibodies (TPO-Ab) (0.62 ± 0.2 and 0.62 ± 0.16 mm for the common carotid and carotid bifurcation, respectively) when compared with the negative TPO-Ab group (0.55 ± 0.24 and 0.58 ± 0.13 mm, for common carotid and carotid bifurcation, respectively). The difference was not statistically significant. We conclude that minimal thyroid dysfunction had no adverse effects on endothelial function in the population studied. Further investigation is warranted to assess whether subclinical hypothyroidism, with and without TPO-Ab-positive serology, has any effect on endothelial function.

Normal flow-mediated vasodilatation of the brachial artery and carotid artery intima-media thickness in subclinical hypothyroidism.

Subclinical hypothyroidism (SHT) is a disease for which exact therapeutic approaches have not yet been established. Previous studies have suggested an association between SHT and coronary heart disease. Whether this association is related to SHT-induced changes in serum lipid levels or to endothelial dysfunction is unclear. The aim of this study was to determine endothelial function measured by the flow-mediated vasodilatation of the brachial artery and the carotid artery intima-media thickness (IMT) in a group of women with SHT compared with euthyroid subjects. Triglycerides, total cholesterol, HDL-C, LDL-C, apoprotein A (apo A), apo B, and lipoprotein(a) were also determined. Twenty-one patients with SHT (mean age: 42.4 +/- 10.8 years and mean thyroid-stimulating hormone (TSH) levels: 8.2 +/- 2.7 microIU/mL) and 21 euthyroid controls matched for body mass index, age and atherosclerotic risk factors (mean age: 44.2 +/- 8.5 years and mean TSH levels: 1.4 +/- 0.6 microIU/mL) participated in the study. Lipid parameters (except HDL-C and apo A, which were lower) and IMT values were higher in the common carotid and carotid bifurcation of SHT patients with positive serum thyroid peroxidase antibodies (TPO-Ab) (0.62 +/- 0.2 and 0.62 +/- 0.16 mm for the common carotid and carotid bifurcation, respectively) when compared with the negative TPO-Ab group (0.55 +/- 0.24 and 0.58 +/- 0.13 mm, for common carotid and carotid bifurcation, respectively). The difference was not statistically significant. We conclude that minimal thyroid dysfunction had no adverse effects on endothelial function in the population studied. Further investigation is warranted to assess whether subclinical hypothyroidism, with and without TPO-Ab-positive serology, has any effect on endothelial function.

Vascular dysfunction in glycogen storage disease type I.

OBJECTIVE: To determine cardiovascular disease risk in a larger cohort of patients with glycogen storage disease (GSD) I through the use of noninvasive measures of arterial function and anatomy. STUDY DESIGN: Carotid intima media thickness (IMT), radial artery tonometry, and brachial artery reactivity were performed in 28 patients with GSD I (13F/15M, mean age 23 years) and 23 control subjects (19F/4M, mean age 23 years). RESULTS: The primary outcome measure, mean left distal IMT was greater in the GSD cohort (0.500+/-0.055 mm) than in the control group (0.457+/-0.039 mm) (P= .002, adjusted for age, sex, and body mass index). Mean augmentation index measured by radial artery tonometry was higher in the GSD cohort (16.4%+/-14.0%) than in the control group (2.4%+/-8.7%) (P< .001). No significant difference was observed between mean brachial artery reactivity in the GSD cohort (6.3%+/-4.9% change) versus control subjects (6.6%+/-5.1% change) (P= .46). CONCLUSIONS: GSD I is associated with arterial dysfunction evident by increased IMT and augmentation index. Patients with GSD I may be at increased risk for cardiovascular disease.

Un año de experiencia en colgajos perforantes / One year of experience in perforator flap

El avance de la cirugía reconstructiva y especialmente de la microcirugía, nacida hace solamente tres décadas, ha sido exponencial. Hoy no sólo se busca cubrir defectos sin complicaciones vasculares, sino que el nuevo desafío es tratar de recuperar función y estética y, al mismo tiempo, conseguir la mínima morbilidad en el sitio donante. El mejor ejemplo de este desarrollo son los colgajos perforantes. Un colgajo perforante es un colgajo fascio cutáneo pediculizado únicamente por sus vasos perforantes. Su confiabilidad ha sido puesta en duda durante la última década por múltiples publicaciones que los catalogan como difíciles de realizar por el tamaño de los vasos así como por su errática anatomía. Este mito ha caído principalmente a punto de partida de publicaciones orientales y una mayor experiencia en occidente. Actualmente, el índice de supervivencia casi alcanza el 98 % debido al refinamiento de las técnicas y los instrumentos...La intención de este trabajo es mostrar nuestra experiencia en la utilización de estos colgajos, habiéndolos utilizado en una variedad de defectos tanto en reconstrucción de cabeza y cuello como de partes blandas. En el último año se han realizado en nuestra institución un total de 16 colgajos perforantes, entre ellos el más común fue el ALT (antero lateral thigh) y con menor frecuencia el DIEP (deep inferior epigastric artery perforator flap), el TAP (thoraco dorsal artery perforator flap) y el TFLP (tensor fascia lata perforator flap). La tasa de éxito fue del 94 %, con mínima morbilidad en la zona dadora.

The avance of reconstructive surgery and specially of microsurgery, born only three decades ago has been exponential. Today we not only try to cover defects without vascular complications but we try to recover function and aesthetics with minimal door site morbidity. The best example of this development have been perforator flaps. A perforator flap is fascio cutaneos flap only vascularized by it's perforators. Their viability has been doubtged because of multiple publications that catalog then as dificult to perform because of the small pedicles and their erratic anatomy. This myth has fallen mainly because of asiatic publications and more experience in western countries. Today the succes rate reaches 98 %. The intention of this paper is to show our experience performing this kind of flaps, in a variety of defects. During the past year we have perfomed at our institution a total of 16 perforator flaps, among them the most common was the ALT (antero lateral thigh) and with less frecuency DIEP (deep inferior epigastric artery perforator flap), the TAP (thoraco dorsal artery perforator flap) and the TFLP (tensor fascia lata perforator flap). The succes rate was of 94 % with minimal donor site morbidity.

The superficial ulnar artery: development and clinical significance

The principal arteries of the upper limb show a wide range of variation that is of considerable interest to orthopedic surgeons, plastic surgeons, radiologists and anatomists. We present here a case of superficial ulnar artery found during the routine dissection of right upper limb of a 50-year-old male cadaver. The superficial ulnar artery originated from the brachial artery, crossed the median nerve anteriorly and ran lateral to this nerve and the brachial artery. The superficial ulnar artery in the arm gave rise to a narrow muscular branch to the biceps brachii. At the elbow level the artery ran superficial to the bicipital aponeurosis where it was crossed by the median cubital vein. It then ran downward and medially superficial to the forearm flexor muscles, and then downward to enter the hand. At the palm, it formed the superficial and deep palmar arches together with the branches of the radial artery. The presence of a superficial ulnar artery is clinically important when raising forearm flaps in reconstructive surgery. The embryology and clinical significance of the variation are discussed.

As principais artérias do membro superior apresentam uma ampla variação, que é relativamente importante a cirurgiões ortopédicos e plásticos, radiologistas e anatomistas.Apresentamosumcaso de artéria ulnar superficial encontrada durante dissecção de rotina de membro superior direito de um cadáver masculino de 50 anos de idade.Aartéria ulnar superficial originava-se da artéria braquial, cruzava o nervo mediano anteriormente e percorria lateralmente esse nervo e a artéria braquial. A artéria ulnar superficial no braço deu origem a um ramo muscular estreito do músculo bíceps braquial. Ao nível do cotovelo, a artéria percorria superficialmente a aponeurose bicipital, onde era cruzada pela veia cubital mediana. Percorria, então, em sentido descendente e medialmente superficial aos músculos flexores do antebraço, e então descendia para entrar na mão. Na palma, essa artéria formava os arcos palmares superficial e profundo junto com os ramos da artéria radial.Apresença de uma artéria ulnar superficial é clinicamente importante ao levantar retalhos do antebraço em cirurgias reconstrutivas.Aembriologia e relevância clínica da variação são discutidas.