Search

Heart allotransplantation has become one of the methods of choice in the treatment of severe heart failure. In the face of its difficulties, such as the unmet balance between organ supply and demand, the use of xenotransplantation (XTx) might be an attractive option shortly, even more with the ongoing progress achieved regarding the avoidance of hyperacute rejection and primary organ disfunction, maintenance of xenograft function and control of xenograft growth. To make possible this translational challenge, some points must be taken into account indeed, and they are the equipoise of human benefit and animal suffering, the risk of unknown infections, a well prepared informed consent, ethical and religious beliefs, and the role of cardiac XTx in a ventricular assistance device era.

Made available in DSpace on 2021-06-25T10:46:23Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) The aim of this study is to evaluate whether the alterations in glucose metabolism and insulin resistance are mechanisms presented in cardiac remodelling induced by the toxicity of cigarette smoke. Male Wistar rats were assigned to the control group (C; n = 12) and the cigarette smoke-exposed group (exposed to cigarette smoke over 2 months) (CS; n = 12). Transthoracic echocardiography, blood pressure assessment, serum biochemical analyses for catecholamines and cotinine, energy metabolism enzymes activities assay; HOMA index (homeostatic model assessment); immunohistochemistry; and Western blot for proteins involved in energy metabolism were performed. The CS group presented concentric hypertrophy, systolic and diastolic dysfunction, and higher oxidative stress. It was observed changes in energy metabolism, characterized by a higher HOMA index, lower concentration of GLUT4 (glucose transporter 4) and lower 3-hydroxyl-CoA dehydrogenase activity, suggesting the presence of insulin resistance. Yet, the cardiac glycogen was depleted, phosphofructokinase (PFK) and lactate dehydrogenase (LDH) increased, with normal pyruvate dehydrogenase (PDH) activity. The activity of citrate synthase, mitochondrial complexes and ATP synthase (adenosine triphosphate synthase) decreased and the expression of Sirtuin 1 (SIRT1) increased. In conclusion, exposure to cigarette smoke induces cardiac remodelling and dysfunction. The mitochondrial dysfunction and heart damage induced by cigarette smoke exposure are associated with insulin resistance and glucose metabolism changes. Department of Internal Medicine Botucatu Medical School São Paulo State University-UNESP Faculty of Nutrition UFG – Univ Federal de Goiás Department of Chemical and Biological Sciences São Paulo State University-UNESP Department of Pathology and Legal Medicine Ribeirão Preto Medical School University of São Paulo Experimental Research Unit – UNIPEX Botucatu Medical School São Paulo State University-UNESP Department of Internal Medicine Botucatu Medical School São Paulo State University-UNESP Department of Chemical and Biological Sciences São Paulo State University-UNESP Experimental Research Unit – UNIPEX Botucatu Medical School São Paulo State University-UNESP CAPES: 001 FAPESP: 2014/24197-0 FAPESP: 2016/14547-0 FAPESP: 2016/25676-5

SUMMARY BACKGROUND: The aim of this study is to evaluate the peptidylarginine deiminase 4 (PAD 4) concentration and PADI4 polymorphisms as predictors of acute kidney injury (AKI) development, the need for renal replacement therapy (RRT), and mortality in patients with septic shock. METHODS: We included all individuals aged ≥ 18 years, with a diagnosis of septic shock at ICU admission. Blood samples were taken within the first 24 hours of the patient's admission to determine serum PAD4 concentration and its PADI4 polymorphism (rs11203367) and (rs874881). Patients were monitored during their ICU stay and the development of SAKI was evaluated. Among the patients in whom SAKI developed, mortality and the need for RRT were also evaluated. RESULTS: There were 99 patients, 51.5% of whom developed SAKI and of these, 21.5% needed RRT and 80% died in the ICU. There was no difference between PAD4 concentration (p = 0.116) and its polymorphisms rs11203367 (p = 0.910) and rs874881 (p = 0.769) in patients in whom SAKI did or did not develop. However, PAD4 had a positive correlation with plasma urea concentration (r = 0.269 and p = 0.007) and creatinine (r = 0.284 and p = 0.004). The PAD4 concentration and PADI4 polymorphisms were also not associated with RRT and with mortality in patients with SAKI. CONCLUSION: PAD4 concentration and its polymorphisms were not associated with SAKI development, the need for RRT, or mortality in patients with septic shock. However, PAD4 concentrations were associated with creatinine and urea levels in these patients. RESUMO OBJETIVO: Avaliar a concentração da peptidilarginina deiminase 4 (PAD4) e os polimorfismos de PADI4, como preditores de desenvolvimento de lesão renal aguda, necessidade de terapia renal substitutiva (TRS) e mortalidade em pacientes com choque séptico. MÉTODOS: Foram incluídos indivíduos com idade ≥18 anos, com diagnóstico de choque séptico na admissão na Unidade de Terapia Intensiva (UTI). Amostras de sangue foram coletadas nas primeiras 24 horas após a admissão do paciente para determinar a concentração sérica de PAD4 e seus polimorfismos PADI4 (rs11203367) e (rs874881). Os pacientes foram acompanhados durante a internação na UTI e tiveram avaliados desenvolvimento da lesão renal aguda séptica (Sepsis-induced acute kidney injury - Saki), necessidade TRS e mortalidade. RESULTADOS: Foram avaliados 99 pacientes; 51,5% desenvolveram Saki e, desses, 21,5% necessitaram de TRS e 80% morreram na UTI. Não houve diferença entre a concentração de PAD4 (p=0,116) e seus polimorfismos rs11203367 (p=0,910) e rs874881 (p=0,769) entre os pacientes. No entanto, o PAD4 apresentou correlação positiva com a concentração plasmática de ureia (r=0,269; p=0,007) e creatinina (r=0,284; p=0,004). A concentração de PAD4 e os polimorfismos da PADI4 também não foram associados à TRS e à mortalidade em pacientes com Saki. CONCLUSÕES: A concentração de PAD4 e seus polimorfismos não foram associados ao desenvolvimento de Saki, à necessidade de TRS ou à mortalidade em pacientes com choque séptico. No entanto, as concentrações de PAD4 foram associadas às concentrações de creatinina e ureia nesses pacientes.

Made available in DSpace on 2020-12-12T02:08:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-07-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) The objective of this study was to evaluate Spondias mombin L. (SM) pulp and its influence on cardiac remodelling after myocardial infarction (MI). Male Wistar rats were assigned to four groups: a sham group (animals underwent simulated surgery) that received standard chow (S; n = 20), an infarcted group that received standard chow (MI; n = 24), an infarcted group supplemented with 100 mg of SM/kg bodyweight/d, (MIS100; n = 23) and an infarcted group supplemented with 250 mg of SM/kg bodyweight/d (MIS250; n = 22). After 3 months of treatment, morphological, functional and biochemical analyses were performed. MI induced structural and functional changes in the left ventricle with worsening systolic and diastolic function, and SM supplementation at different doses did not influence these variables as analysed by echocardiography and an isolated heart study (P >.05). However, SM supplementation attenuated cardiac remodelling after MI, reducing fibrosis (P =.047) and hypertrophy (P =.006). Biomarkers of oxidative stress, inflammatory processes and energy metabolism were further investigated in the myocardial tissue. SM supplementation improved the efficiency of energy metabolism and decreased lipid hydroperoxide in the myocardium [group S (n = 8): 267.26 ± 20.7; group MI (n = 8): 330.14 ± 47.3; group MIS100 (n = 8): 313.8 ± 46.2; group MIS250: 294.3 ± 38.0 nmol/mg tissue; P =.032], as well as decreased the activation of the inflammatory pathway after MI. In conclusion, SM supplementation attenuated cardiac remodelling processes after MI. We also found that energy metabolism, oxidative stress and inflammation are associated with this effect. In addition, SM supplementation at the highest dose is more effective. Internal Medicine Department Botucatu Medical School São Paulo State University (UNESP) School of Nutrition Sciences Faculty of Health Sciences University of Ottawa Chemistry and Biochemistry Department Institute of Biosciences São Paulo State University (UNESP) Internal Medicine Department Botucatu Medical School São Paulo State University (UNESP) Chemistry and Biochemistry Department Institute of Biosciences São Paulo State University (UNESP) FAPESP: 2014/23215-5 FAPESP: 2015/18502-8 FAPESP: 2018/03082-1

Made available in DSpace on 2022-04-29T08:33:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-03-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Universidade Estadual Paulista Aim: This study aimed to evaluate the association between serum myostatin levels, hospital mortality, and muscle mass and strength following ST-segment elevation myocardial infarction (STEMI). Methods: This was a prospective observational study. Within 48 hours of admission, bioelectrical impedance and handgrip strength were assessed and blood samples collected for myostatin evaluation. Hospital mortality was recorded. A multiple logistic regression model was also constructed, adjusted by parameters that exhibited significant differences in the univariate analysis, to evaluate the association between myostatin levels and hospital mortality. Results: One hundred and two (102) patients were included: mean age was 60.5±10.6 years, 67.6% were male, and 6.9% died during hospital stay. Univariate analysis showed that patients with lower myostatin levels had higher mortality rates. Serum myostatin levels positively correlated with handgrip strength (r=0.355; p

Made available in DSpace on 2022-04-29T08:32:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-06-01 Purpose: The Global Leadership Initiative on Malnutrition (GLIM) is a new nutritional assessment tool but must be validated in different scenarios. Thus, our objective was to evaluate the association between the GLIM criteria with hospital mortality in patients receiving parenteral nutrition (PN). Methods: This was a retrospective clinical study, with clinical and surgical patients receiving PN during hospitalization. Nutritional status was assessed by the GLIM criteria and demographics, laboratorial, anthropometric, and nutritional data were collected. The GLIM criteria include a phenotypic criteria (low BMI < 20 kg/m2 if < 70 years or < 22 kg/m2 if > 70 years) and etiologic criteria (CRP > 1.0 mg/dL). All patients were followed up during the PN period and the hospital mortality was the primary outcome. The logistic regression model was performed to assess hospital mortality. Results: Among the 90 patients evaluated, 46.6% died during hospital stay and 21.1% had malnutrition. The age was 63 (46–74) years, 61.1% were men, and regarding the underlying diseases, 74.4% of the patients had gastrointestinal disorders, 3.3% polytrauma, and 22.38% other diseases. CRP mean was 31.3 ± 19.3 mg/dL and the median of BMI was 24.8 (21.6–28.5) kg/m2. In a logistic regression model adjusted by sex and age, the serum albumin concentration was associated with hospital mortality rate (OR: 0.321; 95% CI: 0.142–0.727; p: 0.006). Despite this adjustment, the diagnosis of malnutrition was not associated with hospital mortality (OR: 1.498; 95% CI: 0.496–4.521; p: 0.473). Conclusion: GLIM-defined malnutrition is not associated with hospital mortality in patients receiving PN. Also, the evaluation of inflammatory markers seems to be more important than only as etiologic criteria.sss Department of Internal Medicine Botucatu Medical School São Paulo State University - UNESP, Av. Prof. Mário Rubens Guimarães Montenegro, s/n, UNESP - Campus de Botucatu Faculty of Nutrition Federal University of Goiás - UFG Department of Internal Medicine Botucatu Medical School São Paulo State University - UNESP, Av. Prof. Mário Rubens Guimarães Montenegro, s/n, UNESP - Campus de Botucatu

Made available in DSpace on 2021-06-25T11:02:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-05-31 Introduction: Muscle mass depletion, overhydration, and inflammatory state have been related to impaired physical function in chronic kidney disease patients. The relationship between bioelectrical impedance analysis (BIA) parameters, such as hydration status and phase angle (PhA), with physical function in peritoneal dialysis (PD), is still not well-established. Therefore, the objective was to evaluate the association of BIA parameters (overhydration index and PhA) and inflammatory markers with physical function in patients on PD. Methods: The present cross-sectional study enrolled PD patients. Multifrequency BIA was performed to obtain overhydration index and PhA. The Short Physical Performance Battery (SPPB) test battery was applied to assess physical function. The time to complete the 4-m gait test and sit-to-stand test was also considered for physical function assessment. The inflammatory markers tumor necrosis factor-alpha and C-reactive protein levels were determined. Multiple linear regression models were performed, with the physical function variables as dependent variables, adjusted for age, diabetes, and sex. Results: Forty-nine PD patients were enrolled, 53.1% (n = 26) women; mean age, 55.5 ± 16.3 years. There were significant correlations between PhA and SPPB (r = 0.550, p < 0.001), time of 4-m gait test (r = −0.613, p < 0.001) and sit-to-stand test and (r = −0.547, p < 0.001). Overhydration index was significantly correlated with SPPB, 4-m gait test (r = 0.339, p = 0.017), and sit-to-stand test (r = 0.335, p = 0.019). Inflammatory markers were not significantly correlated with physical function parameters. In the multiple linear regression analysis, PhA was associated with physical function parameters, even after adjustments. Overhydration index was associated with all physical function tests only in the models with no adjustments. Conclusion: PhA was independently associated with physical function in PD patients. Inflammatory markers and overhydration index were not associated with physical function. Clinical Hospital of Botucatu Medical School Multiprofessional Specialization in Adult and Elderly Health São Paulo State University UNESP Internal Medicine Department Botucatu Medical School São Paulo State University UNESP Graduate Program in Health Sciences Medicine Faculty Federal University of Uberlândia (UFU) Clinical Hospital of Botucatu Medical School Multiprofessional Specialization in Adult and Elderly Health São Paulo State University UNESP Internal Medicine Department Botucatu Medical School São Paulo State University UNESP

Made available in DSpace on 2021-06-25T11:00:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-05-01 Objective: The aim of this study was to compare the efficacy of flower therapy for the treatment of anxiety in overweight or obese adults with that of a placebo. The authors examined improvement in sleep patterns, reduction in binge eating, and change in resting heart rate (RHR). Design: This was a randomized, double-blind, placebo-controlled clinical trial with a parallel-group design and two arms. Setting/Location: Clinical Research Unit, Medical School, São Paulo State University, Botucatu, SP, Brazil. Subjects: The study included 40 participants in the placebo group and 41 in the intervention group. Participants were of both genders, from 20 to 59 years of age, overweight or obese, with moderate to high anxiety. Interventions: The participants were divided into two random groups: one group was treated with Bach flower remedies (BFR) (bottles containing 30 mL of 30% hydro-brandy solution with two drops each of Impatiens, White Chestnut, Cherry Plum, Chicory, Crab Apple, and Pine), and the other group was given a placebo (same solution without BFR). The patients were instructed to orally ingest the solution by placing four drops directly in the mouth four times a day for 4 weeks. Outcome measures: The primary outcome was anxiety (State-Trait Anxiety Inventory [STAI]). Secondary outcomes were sleep (Pittsburgh Sleep Quality Index [PSQI]), binge eating (Binge Eating Scale [BES]), and RHR (electrocardiogram). Results: Multivariate analysis showed significant reductions in scores for the following variables in the intervention group when compared with the placebo group: STAI (ß =-0.190; p < 0.001), PSQI (ß =-0.160; p = 0.027), BES (ß =-0.226; p = 0.001), and RHR (ß =-0.07; p = 0.003). Conclusions: The anxiety symptoms, binge eating, and RHRs of the individuals treated with flower therapy decreased, and their sleep patterns improved when compared with those treated with the placebo. Registered at the Brazilian Registry of Clinical Trials (no. RBR-47-kfxh). Nursing Department Medical School São Paulo State University (Unesp) School of Nursing University of Campinas (Unicamp) Medical Clinic Department Medical School São Paulo State University (Unesp) Biostatistics Department Institute of Biosciences São Paulo State University (Unesp) Nursing Department Medical School São Paulo State University (Unesp) Medical Clinic Department Medical School São Paulo State University (Unesp) Biostatistics Department Institute of Biosciences São Paulo State University (Unesp)

Heart allotransplantation has become one of the methods of choice in the treatment of severe heart failure. In the face of its difficulties, such as the unmet balance between organ supply and demand, the use of xenotransplantation might be an attractive option in the near future, even more with the ongoing progress achieved regarding the avoidance of hyperacute rejection and primary organ disfunction, maintenance of xenograft function and control of xenograft growth. To make possible this translational challenge, some points must be taken into account indeed, and they are the equipoise of human benefit and animal suffering, the risk of unknown infections, a well prepared informed consent, ethical and religious beliefs, and the role of cardiac xenotransplantation in a ventricular assistance device era.

Patients with chronic kidney disease (CKD) have a higher risk of death than the general population, the main cause being cardiovascular disease (CVD). Nutrition plays a key role in the prevention and treatment of CVD and kidney diseases. Currently, new evidence reinforces the importance of specific foods and general dietary patterns rather than isolated nutrients for cardiovascular risk. In addition, dietary patterns and healthy eating habits seem extremely relevant in decreasing risk factors. Epidemiologic and clinical intervention studies have suggested that late-night dinner and skipping breakfast are associated with an increased risk of obesity, insulin resistance, and CVD. In CKD, despite important changes in nutritional counseling in recent decades, less attention has been paid to meal timing and frequency. Therefore, the purpose of this review is to discuss the evidence of meal timing and frequency in CKD development and prognosis, presented under three main topics: risk of developing CKD, importance of dietary habits, and implications of fasting.

Made available in DSpace on 2021-06-25T10:52:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-04-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background: The purpose of this study was to evaluate urea to albumin ratio (UAR) as predictor of mortality in patients with septic shock. Methods: We included all individuals aged ≥ 18 years, with the diagnosis of septic shock at Intensive Care Unit (ICU) admission. Laboratorial and clinical data was recorded within the first 24 h of the patient's admission. Serum urea and albumin concentration were used for UAR calculation. All patients were followed during their ICU stay and the mortality rate was recorded. Results: 222 patients were included in the analysis; the mean age was 62.3 ± 15.1 years and 66% were male. Mortality rate during the ICU stay was 59.9% and the median UAR was 40.7 (24.5–66.1). The UAR was also higher in patients who died in the ICU and was positively correlated with APACHE II, SOFA score and CRP. The ROC ICU mortality development (AUC: 0.617; CI 95%: 0.541–0.693; p: 0.003) at the cutoff of ≥47.25. Furthermore, UAR values were associated with ICU mortality when adjusted by age, sex and APACHE II (OR: 1.011; CI95%:1.000–1.022; p = 0.043) and when adjusted by lactate (OR: 1.014; CI95%:1.003–1.024; p = 0.009). Conclusions: Our data suggest that UAR could play a role as predictor of ICU mortality in patients with septic shock. Department of Internal Medicine Botucatu Medical School UNESP – Univ Estadual Paulista Faculty of Nutrition Univ Federal de Goias UFG Department of Internal Medicine Botucatu Medical School UNESP – Univ Estadual Paulista CAPES: 2014/17262-0 FAPESP: 2017/21554-5

Made available in DSpace on 2020-12-12T01:50:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-09-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background & aims: Stroke is the leading cause of disability in adult life. Oropharyngeal dysphagia occurs in 65–90% of patients, and its identification in the acute phase of stroke can prevent complications. The aim of this study was to verify whether oropharyngeal dysphagia during stroke hospitalization is associated with functional capacity, as assessed by the modified Rankin Scale (mRs), and mortality 90 days after stroke. Materials and methods: A prospective cohort study evaluating 201 patients hospitalized in the Stroke Unit was carried out. Dysphagia was evaluated during hospitalization using both a specific protocol to evaluate swallowing biomechanics and the Functional Oral Intake Scale (FOIS), in which FOIS 1–3 reflects tube feeding, 4–5 reflects oral feeding requiring food consistency changes, and 6–7 reflects oral feeding with no changes in food consistency. An mRs≥3 at 90 days after discharge was considered disability. The data were adjusted for the National Institute of Health Stroke Scale score, sex, age, stroke-associated pneumonia, type of stroke, and presence of thrombolysis. The significance level was set at 5%. Results: Of the 201 patients evaluated, 42.8% (86) who had dysphagia were older, had a higher severity of stroke, and pneumonia rate. A FOIS score of 6–7 was a protective factor against disability (mRs≥3) (OR: 0.17; CI: 0.005–0.56; p = 0.004), and tube feeding use at hospital discharge increased the risk of mRs≥3 (OR: 14.97; CI: 2.68–83.65; p = 0.002) and mortality (OR: 9.79; CI: 2.21–43.4; p = 0.003) within 90 days after stroke. Pneumonia was the leading cause of death, however dysphagia and tube feeding at discharge were associated with death from any cause. Conclusion: Dysphagia or tube feeding use at discharge are markers of poor prognosis after the first stroke. Our data suggest the importance of early evaluation of dysphagia and closely monitoring the tube fed patients following stroke. Department of Internal Medicine Sao Paulo State University (Unesp) Medical School Department of Neurology Psychology and Psychiatry Sao Paulo State University (Unesp) Medical School Department of Internal Medicine Sao Paulo State University (Unesp) Medical School Department of Neurology Psychology and Psychiatry Sao Paulo State University (Unesp) Medical School

Made available in DSpace on 2020-12-12T02:18:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 The objective of this study was to analyze the impact of different modalities and intensities of exercise training on cardiac remodeling started early after experimental myocardial infarction (MI). Male Wistar rats, weighing 200-250 g, were subjected to experimental MI. After 5 days, the animals were allocated into three experimental groups and observed for three months: S (sedentary control animals), C (animals subjected to continuous low-intensity training), and HIT (animals subjected to high-intensity interval training). Low-intensity exercise training was performed at a treadmill speed corresponding to 40% VO2 max, which was kept unchanged throughout the entire session (i.e., continuous low-intensity training). High-intensity interval training was performed in such a way that rats run during 3 min at 60% VO2 max, followed by 4-minute intervals at 85% VO2 max (i.e., high-intensity interval training). After the follow-up period, we studied hypertrophy and ventricular geometry, functional alterations in vivo and in vitro, oxidative stress, apoptosis, and cardiac energetic metabolism. Our data showed that both high-intensity interval and continuous low-intensity modalities improved cardiac energetic metabolism variables in comparison with sedentary infarcted animals. In addition, high-intensity interval training decreased cardiac oxidative stress, associated with improved diastolic function. On the other hand, the continuous low-intensity group showed impairment of cardiac function. Therefore, altogether, our data suggest that high-intensity interval training could be the best modality for early physical exercise after MI and should be better studied in this clinical scenario. Internal Medicine Department Botucatu Medical School São Paulo State University (UNESP) Chemistry and Biochemistry Department Institute of Biosciences of Botucatu São Paulo State University (UNESP) Internal Medicine Department Botucatu Medical School São Paulo State University (UNESP) Chemistry and Biochemistry Department Institute of Biosciences of Botucatu São Paulo State University (UNESP)

Made available in DSpace on 2020-12-12T02:11:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-06-01 Background: Stroke is associated with electrocardiogram (ECG) abnormalities. However, the role of strain pattern as predictor of poor neurologic outcome and mortality after stroke has not yet been demonstrated. Hypothesis: ECG abnormalities, with a particular focus on ST-segment changes, are predictors of mortality and neurologic disability 90 days after stroke. Methods: Patients with up to 24 hours of stroke were prospectively recruited. An ECG was taken at the time of admission. The patients' clinical evolution was evaluated during hospitalization and after discharge by means of a prescheduled return in 90 days. The degree of disability was measured by the modified Rankin scale (mRs). In relation to the mRs, patients were divided into those with scores from 0 to 2 and those with scores equal to or greater than 3 at the end of the observation period. Results: Of the 112 patients studied, 29 (25.8%) died during the study period. Patients who died presented higher National Institute of Health Stroke Scale and mRs scores on admission, elevated biomarkers of myocardial necrosis, and abnormalities on the ECG. The prevalence of ECG abnormalities was 63%. A logistic regression model showed that strain pattern and T-wave alterations were predictors of mortality (odds ratio [OR]: 12.970, 95% confidence interval [CI]: 1.519-110.723, P =.019; OR: 3.873, 95% CI: 1.135-13.215, P =.031, respectively) and mRs at 90 days (OR: 12.557, 95% CI: 1.671-94.374, P =.014; OR: 15.970, 95% CI: 3.671-69.479, P

Made available in DSpace on 2018-12-11T17:20:55Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-08-20 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) The objective of our study was to evaluate the influence of the superoxide dismutase 1 (SOD1) polymorphisms on erythrocyte SOD1 activity and the mortality of patients with septic shock. We prospectively evaluated 175 patients aged over 18 years with septic shock upon ICU admission. However, 38 patients were excluded. Thus, 137 patients were enrolled in the study. Blood samples were taken within the first 24 h of the patient's admission to determine erythrocyte SOD1 activity and nine SOD1 gene polymorphisms. The mean patient age was 63 ± 16 years, 58% were men, and ICU mortality rate was 66%. The patients who died were older and more severely ill, with higher Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, as well as higher lactate, urea, and protein carbonyl levels. In the logistic regression model, erythrocyte SOD1 activity was associated with ICU mortality. This relationship was also maintained in the highest tertile of SOD1 activity (odds ratio [OR]: 0.02; 95% confidence interval [CI]: 0.00–0.78; p = 0.037). Only SNP rs2070424 of the SOD1 gene influenced erythrocyte SOD1 activity. For patients with the AA allele, the activity of SOD1 was lower in relation to G-carriers (A/G+G/G genotype) (p = 0.019). None of the nine SOD1 SNPs were associated with ICU mortality. In conclusion, the SNP rs2070424 of the SOD1 gene interferes with erythrocyte SOD1 activity, and higher activity of SOD1 was associated with decreased mortality in patients with septic shock. Department of Internal Medicine Botucatu Medical School UNESP – Univ Estadual Paulista Department of Food and Experimental Nutrition Faculty of Pharmaceutical Science USP - University of São Paulo Chemistry and Biochemistry Department Institute of Biosciences Univ Estadual Paulista (UNESP) Department of Nutrition School of Public Health USP – University of São Paulo Department of Internal Medicine Botucatu Medical School UNESP – Univ Estadual Paulista Chemistry and Biochemistry Department Institute of Biosciences Univ Estadual Paulista (UNESP) FAPESP: 2014/07988-4 FAPESP: FAPESP−2014/17262-0

Made available in DSpace on 2018-12-11T17:17:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-05-01 Background: Nutritional status may influence outcome after stroke. It is possible that some obese individuals present reduced fat-free mass. Aims: We aimed to determine if bedside evaluation of body composition by the body mass index (BMI), adductor pollicis muscle thickness (APMT) and arm muscle area (AMA), and the combination of low APMT or AMA with obesity are associated with disability 90 days after stroke. Methods: A cohort study evaluating 120 patients hospitalized at the Stroke Unit was carried out. Data were expressed as average ± standard deviation or median and percentiles. Obesity was evaluated by BMI and fat-free mass by the APMT and AMA. Receiver operating characteristic (ROC) curves and multivariate logistic regression analysis were used to measure whether APMT and obesity were associated with modified Rankin Scale (mRS) ≥3 (disability) within 90 days of stroke. The data were adjusted for National Institutes of Health Stroke Scale (NIHSS), sex, age, type of stroke, and thrombolysis. The significance level was 5%. Results: Of 120 patients, we came up with the following demographics: men: 66 (55.0%); mean age: 66.6 ± 13.2 years; ischemic stroke: 109 (90.8%); mean NIHSS: 4 (2-10); thrombolysis: 18 (16.5%). Considering mRS ≥3, ROC curve analysis showed that the value of the cutoff for APMT was

Made available in DSpace on 2019-10-06T15:59:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-10-01 Background/Aims: The objective of our study was to evaluate the effects of zinc supplementation on cardiac remodeling following acute myocardial infarction in rats. Methods: Animals were subdivided into 4 groups and observed for 3 months: 1) Sham Control; 2) Sham Zinc: Sham animals receiving zinc supplementation; 3) Infarction Control; 4) Infarction Zinc. After the followup period, we studied hypertrophy and ventricular geometry, functional alterations in vivo and in vitro, changes related to collagen, oxidative stress, and inflammation, assessed by echocardiogram, isolated heart study, western blot, flow cytometer, morphometry, and spectrophotometry. Results: Infarction induced a significant worsening of the functional variables. On the other hand, zinc attenuated both systolic and diastolic cardiac dysfunction induced by infarction. Considering the infarct size, there was no difference between the groups. Catalase and superoxide dismutase decreased in infarcted animals, and zinc increased its activity. We found higher expression of collagens I and III in infarcted animals, but there was no effect of zinc supplementation. Likewise, infarcted animals had higher levels of IL-10, but without zinc interference. Nrf-2 values were not different among the groups. Infarction increased the amount of Treg cells in the spleen as well as the amount of total lymphocytes. Zinc increased the amount of CD4+ in infarcted animals, but we did not observe effects in relation to Treg cells. Conclusion: zinc attenuates cardiac remodeling after infarction in rats; this effect is associated with modulation of antioxidant enzymes, but without the involvement of collagens I and III, Nrf-2, IL-10, and Treg cells. São Paulo State University (Unesp) Botucatu Medical School Internal Medicine Department São Paulo State University (Unesp) Institute of Biosciences of Botucatu Chemistry and Biochemistry Department São Paulo State University (Unesp) Institute of Biosciences of Botucatu Microbiology and Immunology Department Flow Citometry Laboratory Amaral Carvalho Fundation São Paulo State University (Unesp) Botucatu Medical School Internal Medicine Department São Paulo State University (Unesp) Institute of Biosciences of Botucatu Chemistry and Biochemistry Department São Paulo State University (Unesp) Institute of Biosciences of Botucatu Microbiology and Immunology Department

Made available in DSpace on 2018-12-11T17:12:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-08-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) The objective of this study was to evaluate the influence of tomato or lycopene supplementation on cardiac remodeling after myocardial infarction (MI). Male Wistar rats were assigned to four groups: the sham group (animals that underwent simulated surgery) that received a standard chow (S; n=18), the infarcted group that received a standard chow (MI; n=13), the infarcted group supplemented with lycopene (1 mg of lycopene/kg body weight/day) (MIL; n=16) and the infarcted group supplemented with tomato (MIT; n=16). After 3 months, morphological, functional and biochemical analyses were performed. The groups MIL and MIT showed decreased interstitial fibrosis induced by infarction. Tomato supplementation attenuated the hypertrophy induced by MI. In addition, tomato and lycopene improved diastolic dysfunction evaluated by echocardiographic and isolated heart studies, respectively. The MI group showed higher levels of cardiac TNF-α compared to the MIL and MIT groups. Decreased nuclear factor E2-related factor 2 was measured in the MIL group. Lipid hydroperoxide levels were higher in the infarcted groups; however, the MIT group had a lower concentration than did the MI group [S=223±20.8, MI=298±19.5, MIL=277±26.6, MIT=261±28.8 (nmol/g); n=8; P

Background: Stroke is the leading cause of disability in adult life. Oropharyngeal dysphagia occurs in 65-90% of patients, and its identification in the acute phase of stroke can prevent complications. Objective: Verify whether Functional Oral Intake Scale (FOIS) score during stroke hospitalization is associated with functional capacity, as assessed by the modified Rankin Scale (mRs), and mortality 90 days after stroke. Methods: A prospective cohort study evaluating 201 patients hospitalized in the Stroke Unit was carried out. Dysphagia was evaluated during hospitalization using both a specific protocol to evaluate swallowing biomechanics and FOIS, in which FOIS 1-3 - tube feeding, 4-5 - oral feeding requiring food consistency changes, and 6-7 - oral feeding with no changes in food consistency. mRs≥3 90 days after discharge was considered disability. The data were adjusted for the NIHSS score, sex, age, type of stroke, and presence of thrombolysis. Significance level of 5%. Results: Of the 201 patients evaluated, 42.8% (86) who had dysphagia were older, had a higher severity of stroke, and pneumonia rate . A FOIS score of 6-7 may be a protective factor against disability (mRs≥3) (OR:0.17; CI:0.005-0.56; p=0.004), and FOIS 1-3 at hospital discharge increased the risk of mRs≥3 (OR:14.97; CI: 2.68-83.65; p=0.002) and mortality (OR:9.79; CI:2.21-43.4; p=0.003) within 90 days after stroke. Pneumonia was the leading cause of death, however dysphagia and FOIS 1-3 at discharge were associated with death from any cause. Important to highlight that the interaction of FOIS 1-3 at discharge and pneumonia further enhanced mortality chance (OR:113; CI:1.40-9.097; p=0.035). Conclusion: Dysphagia or FOIS 1-3 at discharge are markers of poor prognosis after stroke. Our data suggest the importance of early evaluation of dysphagia and closely monitoring the tube fed patients following stroke.

Made available in DSpace on 2020-12-10T19:50:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-02-03 Introduction. Stroke can lead to musculoskeletal and respiratory dysfunction, chronic deconditioning, and functional limitations, as well as long-term complications. Objective. The aim of this study was to evaluate the association between respiratory function and grip strength in the acute phase of stroke and stroke severity, disability, and autonomy in the long term. Methods. This was a cohort study including 46 patients in the stroke unit. The stroke patients were assessed in the stroke unit at the following moments: at admission by the clinical and haemodynamic stability, demographic and anthropometric data, hand grip strength, stroke severity by National Institutes of Health Stroke Scale (NIHSS) score, and respiratory function using a manovacuometer; during hospitalization by clinical complications and the length of stay; and at hospital discharge and 90 days after discharge by the degrees of functional capacity and dependence using NIHSS, modified Rankin scale (mRs), and Barthel index. Data analysis was performed by multiple linear regression to verify the association between respiratory function and grip strength and the outcomes. Results. The median length of stay in the stroke unit was 7 days. A negative correlation was found between the palmar prehension strength on the unaffected side and mRs at discharge (beta=-0.034, p=0.049). The NIHSS scores at discharge (beta=-0.016, p=0.011) were negatively correlated with the MEP. The Barthel index at discharge was positively correlated with the palmar prehension strength on the unaffected side (beta=0.480, p=0.023). Conclusion. It was concluded that a loss of grip strength is associated with a loss of ability and autonomy at discharge and poor respiratory function is associated with stroke severity at discharge. Univ Estadual Paulista, UNESP, Botucatu Med Sch, Botucatu, SP, Brazil Fed Univ Triangulo Mineiro UFTM, Dept Appl Phys Therapy, Uberaba, MG, Brazil Univ Estadual Paulista, UNESP, Botucatu Med Sch, Rehabil Ctr, Botucatu, SP, Brazil Univ Estadual Paulista, UNESP, Botucatu Med Sch, Stroke Unit, Botucatu, SP, Brazil Univ Estadual Paulista, UNESP, Botucatu Med Sch, Dept Internal Med, Botucatu, SP, Brazil Univ Estadual Paulista, UNESP, Botucatu Med Sch, Dept Neurol Psychol & Psychiat, Botucatu, SP, Brazil Univ Estadual Paulista, UNESP, Botucatu Med Sch, Botucatu, SP, Brazil Univ Estadual Paulista, UNESP, Botucatu Med Sch, Rehabil Ctr, Botucatu, SP, Brazil Univ Estadual Paulista, UNESP, Botucatu Med Sch, Stroke Unit, Botucatu, SP, Brazil Univ Estadual Paulista, UNESP, Botucatu Med Sch, Dept Internal Med, Botucatu, SP, Brazil Univ Estadual Paulista, UNESP, Botucatu Med Sch, Dept Neurol Psychol & Psychiat, Botucatu, SP, Brazil

Thiamin is a hydrosoluble vitamin that plays a role in several biological processes, mainly in glucose metabolism. There are several risk factors for developing thiamin deficiency, such as malnutrition, refeeding syndrome, gastrointestinal surgery, and alcoholism. Recently, the role of thiamin in critically ill patients has gained prominence, and the prevalence of thiamin deficiency was found to be increased in patients with severe burns, major surgery, septic shock, end-stage renal disease, and heart failure. In adults, thiamin deficiency presents as encephalopathy, dry beriberi (with neurological signs and symptoms), or wet beriberi (with cardiovascular signs and symptoms). Thiamin deficiency can be diagnosed clinically, and all clinicians should be aware of this disease, especially in patients with risk factors for thiamin deficiency. Thiamin supplementation should be started as early as possible in patients suspected to have thiamin deficiency. Treatment is safe, inexpensive, simple, and life-saving. Diagnosis is confirmed on a positive response to treatment.

Made available in DSpace on 2019-10-06T15:58:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-10-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) The objective of our study was to evaluate the association between peptidylarginine deiminase 4 (PAD4) concentration and its polymorphisms with mortality in patients with septic shock. We prospectively evaluated 175 patients aged over 18 years with septic shock upon intensive care unit (ICU) admission. However, 48 patients were excluded. Thus, 127 patients were enrolled in the study. At the time of the patients’ enrollment, demographic information was recorded. Blood samples were taken within the first 24 hours of the patient’s admission to determine serum PAD4 concentrations and its polymorphism PADI4_89 [rs11203366], PADI4_94 [rs2240340] and PADI4_104 [rs1748033]. The mean age was 63.3 ± 15.2 years, 56.7% were male, PAD4 concentration was 4.62 (2.48-6.20) ng/mL and the ICU mortality rate was 67.7%. The patients who died in the ICU had higher APACHE II and Sequential Organ Failure Assessment (SOFA) scores. In addition, PAD4 concentration was higher in patients who died during ICU stay. However, there were no differences regarding PADI4 polymorphisms and ICU mortality. In the logistic regression models, PAD4 concentrations were associated with ICU mortality when adjusted for APACHE II score and lactate (OR: 1.477; CI 95%: 1.186-1.839; P

Embolic stroke of undetermined source (ESUS) is an important group of cryptogenic strokes that are in evidence due recent ongoing trials. We reviewed medical records at discharge from the stroke unit of all patients who met ESUS criteria and attended our institution between February 2016 and July 2017. Among 550 stroke patients, 51 had ESUS. We found that hypertension (60%), diabetes mellitus (34%), and smoking (36%) were the most prevalent risk factors. The mean National Institutes of Health Stroke Scale (NIHSS) scores were 7 at admission and 4 at discharge, while median scores on the modified Rankin scale were 0 and 2 at admission and discharge, respectively. Our sample had similar ages, risk factors prevalence and NIHSS scores at admission and discharge when compared with European and North American cohorts. Although a small cohort, our study suggests that the ESUS population is similar in countries with different health financing. RESUMO Acidentes vasculares cerebrais (AVC) embólicos de fonte indeterminada (ESUS) é um grupo importante de pacientes com AVC criptogênico que estão em evidência devido a recentes ensaios clínicos. Foram revisados os prontuários médicos na alta da unidade de AVC de todos os pacientes que preencheram os critérios para ESUS atendidos em nossa instituição entre fevereiro de 2016 e julho de 2017. Entre 550 AVCs, 51 eram pacientes com ESUS. Hipertensão (60%), diabetes mellitus (34%) e tabagismo (36%) foram os fatores de risco mais prevalentes. Os escores médios do National Institutes of Health Stroke Scale (NIHSS) foram 7 na admissão e 4 na alta, enquanto os escores médios na escala de Rankin modificada (mRs) foram 0 e 2 na admissão e alta, respectivamente. Nossa amostra teve idade, prevalência de fatores de risco, escores NIHSS na admissão e alta, quando comparados com coortes europeias e norte-americanas semelhantes. Apesar de ser uma pequena coorte, nosso estudo sugere que a população ESUS é semelhante em países com diferentes níveis de financiamento em saúde.

The objective of the present study was to evaluate protein carbonyl concentration as a predictor of AKI development in patients with septic shock and of renal replacement therapy (RRT) and mortality in patients with SAKI. This was a prospective observational study of 175 consecutive patients over the age of 18 years with septic shock upon Intensive Care Unit (ICU) admission. After exclusion of 46 patients (27 due to AKI at ICU admission), a total of 129 patients were enrolled in the study. Demographic information and blood samples were taken within the first 24 h of the patient’s admission to determine serum protein carbonyl concentrations. Among the patients who developed SAKI, the development of AKI was evaluated, along with mortality and need for RRT. The mean age of the patients was 63.3 ± 15.7 years, 47% were male and 51.2% developed SAKI during ICU stay. In addition, protein carbonyl concentration was shown to be associated with SAKI. Among 66 patients with SAKI, 77% died during the ICU stay. Protein carbonyl concentration was not associated with RRT in patients with SAKI. However, the ROC curve analysis revealed that higher levels of protein carbonyl were associated with mortality in these patients. In logistic regression models, protein carbonyl level was associated with SAKI development (OR: 1.416; 95% CI: 1.247–1.609; P

Background: Advances in critical care have increased survival chances and the demand for a scientific approach to outcome prediction. The present study aimed to investigate the associations of clinical information, demographic and laboratory data with mortality; and to elaborate and validate a regression equation for mortality prediction in a medical intensive care unit (ICU). Methods: This study included 202 patients and took place in a medical ICU at the Botucatu Medical School Hospital, Brazil. In Phase 1, 123 patients admitted to ICU between September 2003 and October 2004 was retrospectively analyzed and allowed equation elaboration. In Phase 2, the mortality equation was prospectively applied in 79 patients consecutively admitted to ICU between August and December 2006. Results: Among Phase 1 patients, 55% were males and mean age was 5819 years. Mortality Original Research Article Rafacho et al.; BJMMR, 10(1): 1-8, 2015; Article no.BJMMR.19176 2 rate was 29%. Multivariate analysis revealed that shock (p=0.002) and hypoalbuminemia (p=0.024) were associated with higher mortality rate. When regression equation was applied in Phase 2 patients, higher equation values were shown for nonsurvivors (0.512; -1.008 -0.512) than for survivors (-1.008; -1.290 -1.008) (p=0.03). The equation also had good precision, 1.8% (IC95%; 1.1-4.7), and low bias, -3.1% (IC95%; -27.1 -20.8). Areas under the receiver operating characteristic (ROC) curve showed no statistical differences between APACHE II (0.750.06) and the equation (0.660.07) (p=0.27). Conclusions: Our data suggest that a simple and accurate prognostic equation can be used to predict ICU mortality.

Made available in DSpace on 2018-12-11T17:11:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-04-04 Background: Over the past years, several cardiac risk indices were evaluated and modified, including Goldman, Detsky, and Lee scores. The predictive capacity of these scores in hip fracture patients is lacking. Thus, our objective was to compare the Goldman, Detsky, and Lee scores as predictors of mortality in 6 months after hip fracture. Methods: We prospectively evaluated 80 consecutive patients with hip fractures, over the age of 65 admitted to an orthopedic ward at Botucatu Medical School. Patient demographic information, Goldman, Detsky and Lee scores were recorded. All patients were followed for 6 months after hip fracture, and mortality was recorded. Multiple logistic regression analyses were performed for mortality prediction. Results: The mortality rate was 23% after a 6-month follow-up period. Patients who died had advanced age and the majority of them were male. They also had lower values of handgrip strength, and higher values of creatinine and urea. In the multiple logistic regression models when adjusted by age, gender, handgrip strength and creatinine, Goldman’s score (OR:3.025; 95%CI:1.022-8.953; p:0.046), but not Detsky (OR:2.328; 95%CI:0.422-12.835; p:0.332) and Lee (OR:1.262; 95%CI:0.649-2.454; p:0.494), was associated with mortality 6 months after hip fracture. Each 1 category increase in Goldman score increased the mortality to more than 3-fold. Conclusions: In conclusion, our data suggest that Goldman score, but not Detsky or Lee indices, predicts mortality associated with hip fracture at up to 6 months post-injury. Internal Medicine Department Botucatu Medical School UNESP - Univ Estadual Paulista, Rubião Júnior s/n Surgery and Orthopedic Department Botucatu Medical School UNESP - Univ Estadual Paulista Internal Medicine Department Botucatu Medical School UNESP - Univ Estadual Paulista, Rubião Júnior s/n Surgery and Orthopedic Department Botucatu Medical School UNESP - Univ Estadual Paulista

Background: Chronic kidney disease (CKD) and metabolic syndrome are characterized by overlapping disorders, including glucose intolerance, hypertension, dyslipidemia, and, in some cases, obesity. However, there are no specific criteria for the diagnosis of metabolic syndrome in CKD. Metabolic syndrome can also be associated with increased risk of mortality. Some traditional risk factors may protect dialysis patients from mortality, known as "reverse epidemiology." Metabolic syndrome might undergo reverse epidemiology. The objectives were to detect differences in frequency and metabolic characteristics associated with three sets of diagnostic criteria for metabolic syndrome, to evaluate the accuracy of insulin resistance (IR) and inflammation to identify patients with metabolic syndrome, and to investigate the effects of metabolic syndrome by three sets of diagnostic criteria on mortality in chronic hemodialysis patients.An observational study was conducted. Diagnostic criteria for metabolic syndrome proposed by National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), International Diabetes Federation (IDF), and Harmonizing the Metabolic Syndrome (HMetS) statement were applied to 98 hemodialysis patients.The prevalence of metabolic syndrome was 51%, 66.3%, and 75.3% according to NCEP ATP III, IDF, and HMetS criteria, respectively. Diagnosis of metabolic syndrome by HMetS was simultaneously capable of revealing both inflammation and IR, whereas NCEP ATP III and IDF criteria were only able to identify IR. Mortality risk increased in the presence of metabolic syndrome regardless of the criteria used.The prevalence of metabolic syndrome in hemodialysis varies according to the diagnostic criteria used. IR and inflammation predict metabolic syndrome only when diagnosed by HMetS criteria. HMetS was the diagnostic criteria that can predict the highest risk of mortality.

Background: The effects of modern therapy on functional recovery after acute myocardial infarction (AMI) are unknown.Objectives:To evaluate the predictors of systolic functional recovery after anterior wall AMI in patients undergoing modern therapy (reperfusion, aggressive platelet antiaggregant therapy, angiotensin-converting enzyme inhibitors and beta-blockers).Methods:A total of 94 consecutive patients with AMI with ST-segment elevation were enrolled. Echocardiograms were performed during the in-hospital phase and after 6 months. Systolic dysfunction was defined as ejection fraction value < 50%.Results:In the initial echocardiogram, 64% of patients had systolic dysfunction. Patients with ventricular dysfunction had greater infarct size, assessed by the measurement of total and isoenzyme MB creatine kinase enzymes, than patients without dysfunction. Additionally, 24.5% of patients that initially had systolic dysfunction showed recovery within 6 months after AMI. Patients who recovered ventricular function had smaller infarct sizes, but larger values of ejection fraction and E-wave deceleration time than patients without recovery. At the multivariate analysis, it can be observed that infarct size was the only independent predictor of functional recovery after 6 months of AMI when adjusted for age, gender, ejection fraction and E-wave deceleration time.Conclusion: In spite of aggressive treatment, systolic ventricular dysfunction remains a frequent event after the anterior wall myocardial infarction. Additionally, 25% of patients show functional recovery. Finally, infarct size was the only significant predictor of functional recovery after six months of acute myocardial infarction. Fundamento: Os efeitos da terapêutica moderna na recuperação funcional após o infarto agudo do miocárdio não são conhecidos.Objetivos: Avaliar os fatores preditores da recuperação funcional sistólica após infarto agudo do miocárdio de parede anterior em pacientes submetidos à terapia moderna (reperfusão, antiagregação plaquetária agressiva, inibidores da enzima conversora da angiotensina e betabloqueadores).Métodos: Foram incluídos 94 pacientes consecutivos com infarto agudo do miocárdio com supradesnivelamento do segmento ST. Ecocardiogramas foram realizados na fase intra-hospitalar e após 6 meses. Disfunção sistólica foi definida pela presença de fração de ejeção de valor < 50%.Resultados: No ecocardiograma inicial, 64% dos pacientes apresentaram disfunção sistólica. Os pacientes com disfunção ventricular apresentaram tamanhos maiores de infarto, avaliados pelas enzimas creatinofosfoquinase total e isoenzima MB, que os pacientes sem disfunção. Adicionalmente, 24,5% dos pacientes inicialmente com disfunção sistólica apresentaram recuperação no período de 6 meses após o infarto agudo do miocárdio. Os pacientes que recuperaram a função ventricular apresentaram menores tamanhos de infarto, mas maiores valores da fração de ejeção e tempo de desaceleração da onda E que pacientes sem recuperação. Na análise multivariada, observa-se que o tamanho de infarto foi o único fator preditor independente de recuperação funcional após 6 meses de infarto, quando ajustado pela idade, sexo, fração de ejeção e tempo de desaceleração da onda E.Conclusão: Apesar do tratamento agressivo, a disfunção ventricular sistólica continua a ser um evento frequente após o infarto de parede anterior. Adicionalmente, 25% dos pacientes apresentam recuperação funcional. Finalmente, o tamanho do infarto foi o único fator preditor de recuperação funcional após seis meses do infarto agudo do miocárdio.

Background— This study was aimed to evaluate the influence of vitamin D (V D ) deficiency on cardiac metabolism, morphology, and function. Thus, we investigated the relationship of these changes with the length of the nutrient restriction. Methods and Results— Male weanling Wistar rats were allocated into 4 groups: C2 (n=24), animals were fed an AIN-93G diet with 1000 IU V D /kg of chow and were kept under fluorescent light for 2 months; D2 (n=22), animals were fed a V D -deficient AIN-93G diet and were kept under incandescent light for 2 months; C4 (n=21) animals were kept in the same conditions of C2 for 4 months; and D4 (n=23) animals were kept in the same conditions of D2 for 4 months. Biochemical analyses showed lower β-hydroxyacyl coenzyme-A dehydrogenase activity and higher lactate dehydrogenase activity in V D -deficient animals. Furthermore, V D deficiency was related to increased cytokines release, oxidative stress, apoptosis, and fibrosis. Echocardiographic data showed left ventricular hypertrophy and lower fractional shortening and ejection fraction in V D -deficient animals. Difference became evident in the lactate dehydrogenase activity, left ventricular weight, right ventricle weight, and left ventricular mass after 4 months of V D deficiency. Conclusions— Our data indicate that V D deficiency is associated with energetic metabolic changes, cardiac inflammation, oxidative stress, fibrosis and apoptosis, cardiac hypertrophy, left chambers alterations, and systolic dysfunction. Furthermore, length of the restriction influenced these cardiac changes.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:44:06Z No. of bitstreams: 1 S1807-59322013000600772.pdf: 276226 bytes, checksum: aad541fa64e9338d10e7093649eb6002 (MD5) Made available in DSpace on 2013-08-22T18:44:06Z (GMT). No. of bitstreams: 1 S1807-59322013000600772.pdf: 276226 bytes, checksum: aad541fa64e9338d10e7093649eb6002 (MD5) Previous issue date: 2013-06-01 Made available in DSpace on 2013-09-30T19:32:07Z (GMT). No. of bitstreams: 2 S1807-59322013000600772.pdf: 276226 bytes, checksum: aad541fa64e9338d10e7093649eb6002 (MD5) S1807-59322013000600772.pdf.txt: 32655 bytes, checksum: 47b52c41730f9289701227488bd856ca (MD5) Previous issue date: 2013-06-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:08:44Z No. of bitstreams: 2 S1807-59322013000600772.pdf: 276226 bytes, checksum: aad541fa64e9338d10e7093649eb6002 (MD5) S1807-59322013000600772.pdf.txt: 32655 bytes, checksum: 47b52c41730f9289701227488bd856ca (MD5) Made available in DSpace on 2014-05-20T15:08:44Z (GMT). No. of bitstreams: 2 S1807-59322013000600772.pdf: 276226 bytes, checksum: aad541fa64e9338d10e7093649eb6002 (MD5) S1807-59322013000600772.pdf.txt: 32655 bytes, checksum: 47b52c41730f9289701227488bd856ca (MD5) Previous issue date: 2013-06-01 OBJECTIVES: ,,,,,The prevalence of electrocardiographic and echocardiographic abnormalities in chronic obstructive pulmonary disease according to disease severity has not yet been established. The aim of this study was to assess the prevalence of electrocardiographic and echocardiographic abnormalities in chronic obstructive pulmonary disease patients according to disease severity. ,,,, ,,,, ,,,,,METHODS: ,,,,,The study included 25 mild/moderate chronic obstructive pulmonary disease patients and 25 severe/very severe chronic obstructive pulmonary disease patients. All participants underwent clinical evaluation, spirometry and electrocardiography/echocardiography. ,,,, ,,,, ,,,,,RESULTS: ,,,,,Electrocardiography and echocardiography showed Q-wave alterations and segmental contractility in five (10%) patients. The most frequent echocardiographic finding was mild left diastolic dysfunction (88%), independent of chronic obstructive pulmonary disease stage. The proportion of right ventricular overload (p

Fatty acids are the main substrates used by mitochondria to provide myocardial energy under normal conditions. During heart remodeling, however, the fuel preference switches to glucose. In the earlier stages of cardiac remodeling, changes in energy metabolism are considered crucial to protect the heart from irreversible damage. Furthermore, low fatty acid oxidation and the stimulus for glycolytic pathway lead to lipotoxicity, acidosis, and low adenosine triphosphate production. While myocardial function is directly associated with energy metabolism, the metabolic pathways could be potential targets for therapy in heart failure.

Background: The nutritional status at the time of stroke, may influence the functional capacity after the event. There are controversial data indicating that obesity may be related to better prognosis. It is possible that some obese individuals present reduced fat-free mass. Objective: To identify if bedside evaluation of body composition by the body mass index (BMI), muscle mass measured by adductor pollicis muscle thickness (APMT), arm muscle area (AMA) and the combination of low APMT or AMA with obesity are associated with poor functional status and mortality, 90 days after stroke. Methodology: Were evaluated 120 patients hospitalized at Stroke Unit. Data was expressed by average ± standard deviation or median and percentiles. Obesity was evaluated by BMI and fat-free mass was estimated by the APMT, which is the only directly measured muscle, and AMA. Roc curve and multivariate logistic regression analysis were used to measure whether the APMT and obesity were associated with RANKIN ≥3 (greater dependence and death), after 90 days of the event. The data were adjusted by the NIHSS, sex, age, type of stroke and thrombolysis. Significance level was 5%. Results: Of 120 patients, 54 (45.0%) were women and 66 (55.0%) men; age 66.6 ± 13.2 years; 109 patients (90.8%) had ischemic stroke and 11 (9.16%) hemorrhagic; NIHSS 4 (2-10). Among patients with ischemic stroke, 18 (16.5%) were thrombolized. Considering RANKIN ≥3, Roc curve analysis showed that the value of the cutoff for APMT was Conclusion: Lower APMT alone or in combination with obesity was associated with poor functional status. The body composition assessment was performed at bedside, in the setting of Stroke Unit, with simple methods that may be feasible and useful to predict Stroke prognosis.

Made available in DSpace on 2014-10-01T13:08:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-10-01Bitstream added on 2014-10-01T14:03:06Z : No. of bitstreams: 1 S1807-59322013001001344.pdf: 291060 bytes, checksum: 41110d27a04e63761798fde7a33cf3f1 (MD5) OBJECTIVE: After acute myocardial infarction, during the cardiac repair phase, periostin is released into the infarct and activates signaling pathways that are essential for the reparative process. However, the role of periostin in chronic cardiac remodeling after myocardial infarction remains to be elucidated. Therefore, the objective of this study was to investigate the relationship between tissue periostin and cardiac variables in the chronic cardiac remodeling induced by myocardial infarction. METHODS: Male Wistar rats were assigned to 2 groups: a simulated surgery group (SHAM; n = 8) and a myocardial infarction group (myocardial infarction; n = 13). After 3 months, morphological, functional and biochemical analyses were performed. The data are expressed as means±SD or medians (including the lower and upper quartiles). RESULTS: Myocardial infarctions induced increased left ventricular diastolic and systolic areas associated with a decreased fractional area change and a posterior wall shortening velocity. With regard to the extracellular matrix variables, the myocardial infarction group presented with higher values of periostin and types I and III collagen and higher interstitial collagen volume fractions and myocardial hydroxyproline concentrations. In addition, periostin was positively correlated with type III collagen levels (r = 0.673, p = 0.029) and diastolic (r = 0.678, p = 0.036) and systolic (r = 0.795, p = 0.006) left ventricular areas. Considering the relationship between periostin and the cardiac function variables, periostin was inversely correlated with both the fractional area change (r = -0.783, p = 0.008) and the posterior wall shortening velocity (r = -0.767, p = 0.012). CONCLUSIONS: Periostin might be a modulator of deleterious cardiac remodeling in the chronic phase after myocardial infarction in rats. Universidade Estadual Paulista (UNESP) Botucatu Medical School Internal Medicine Department Universidade Estadual Paulista (UNESP) Botucatu Medical School Internal Medicine Department

Made available in DSpace on 2018-12-11T17:06:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-12-01 Background: Oxidative stress is a key feature of sepsis and could be a common pathophysiological pathway between septic shock and acute kidney injury (AKI) Our objective was to evaluate the erythrocyte superoxide dismutase (SOD1) activity as predictor of AKI in patients with septic shock. Methods: This is a prospective observational study that evaluated 175 consecutive patients over the age of 18 years with septic shock upon intensive care unit (ICU) admission. However, 43 patients were excluded (27 due to AKI at ICU admission). Thus, 132 patients were enrolled in the study. At the time of the patients’ enrollment, demographic information was recorded. Blood samples were taken within the first 24 h of the patient’s admission to determine the erythrocyte SOD1 activity. All patients were followed throughout the ICU stay, and the development of AKI was evaluated. In addition, we also evaluated 17 control subjects. Results: The mean age of patients with septic shock was 63.2 ± 15.7 years, 53 % were male and the median ICU stay was 8 days (4–16). Approximately 50.7 % developed AKI during the ICU stay. The median erythrocyte SOD1 activity was 2.92 (2.19–3.92) U/mg Hb. When compared to control subjects, septic shock patients had a higher serum malondialdehyde concentration and lower erythrocyte SOD1 activity. In univariate analysis, erythrocyte SOD1 activity was lower in patients who developed AKI. The ROC curve analysis revealed that lower erythrocyte SOD1 activity was associated with AKI development (AUC 0.686; CI 95 % 0.595–0.777; p

Summary Introduction: The mortality rate attributed to ST-segment elevation myocardial infarction (STEMI) has decreased in the world. However, this disease is still responsible for high costs for health systems. Several factors could decrease mortality in these patients, including implementation of cardiac intensive care units (CICU). The aim of this study was to evaluate the effect of CICU implementation on prescribed recommended treatments and mortality 30 days after STEMI. Method: We performed a retrospective study with patients admitted to CICU between 2005 and 2006 (after group) and between 2000 and 2002, before CICU implementation (before group). Results: The after group had 101 patients, while the before group had 143 patients. There were no differences in general characteristics between groups. We observed an increase in angiotensin-converting enzyme inhibitors, clopidogrel and statin prescriptions after CICU implementation. We did not find differences regarding number of patients submitted to reperfusion therapy; however, there was an increase in primary percutaneous angioplasty compared with thrombolytic therapy in the after group. There was no difference in 30-day mortality (before: 10.5%; after: 8.9%; p=0.850), but prescription of recommended treatments was high in both groups. Prescription of angiotensin-converting enzyme inhibitors and beta-blocker decreased mortality risk by 4.4 and 4.9 times, respectively. Conclusion: CICU implementation did not reduce mortality after 30 days in patients with STEMI; however, it increased the prescription of standard treatment for these patients. Resumo Introdução: Apesar da diminuição da mortalidade por infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAM-ST) no mundo, a doença ainda acarreta elevados custos e morbidade. Muitas medidas contribuem para a redução da mortalidade, dentre elas a criação de unidades intensivas coronarianas (UCO). Objetivo: Avaliar o impacto da criação de uma UCO na prescrição de tratamentos preconizados e na mortalidade em 30 dias em pacientes com IAM-ST. Método: Foi realizado estudo retrospectivo e foram coletados dados de prontuários de pacientes internados na UCO de 2005 a 2006 (grupo depois). Esses dados foram comparados com dados do serviço de 2000 a 2002, previamente à criação da UCO (grupo antes). Resultados: Havia 101 e 143 pacientes nos grupos depois e antes, respectivamente. Não houve diferenças em relação às características populacionais e às características do infarto entre os períodos. Observamos aumento na prescrição de iECA, clopidogrel e estatinas. Apesar da ausência de mudanças no número de pacientes que receberam terapia de reperfusão, houve aumento de angioplastias primárias em detrimento ao uso de trombolíticos no período posterior à criação da UCO. Não observamos diminuição da mortalidade em 30 dias após IAM-ST (antes: 10,5%; depois: 8,9%; p=0,850), mas a prescrição de tratamentos preconizados foi alta em ambos os períodos. O uso de iECA e de betabloqueador diminuiu o risco de morte em 4,4 e 4,9 vezes, respectivamente. Conclusão: Em pacientes com IAM-ST, a criação da UCO não reduziu a mortalidade em 30 dias, mas houve aumento na prescrição de tratamentos preconizados.

Made available in DSpace on 2018-12-11T17:02:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-06-01 Aims The objective of this study was to evaluate the association of phase angle (PhA) with advanced liver fibrosis in patients chronically infected with hepatitis C virus (HCV). Main methods One hundred sixty consecutive patients chronically infected with HCV were treated at the Hepatitis C outpatient care setting of our hospital from April 2010 to May 2011 and prospectively evaluated. Bioelectrical impedance analysis measurements were performed during the first hospital visit. Biochemical measurements and liver biopsy data were collected from the patients' medical records and included in the analysis only if they were performed within three months of the inclusion of the patient in the study. Key findings One hundred sixty consecutive patients were evaluated and 25 patients were excluded. A total of 135 patients with 49.8 ± 11.4 years old were studied. Among these patients, 60% were male and the PhA was 6.5 ± 0.8°. Regarding the stage of fibrosis, patients with advanced fibrosis were older and had more insulin resistance and more inflammation compared with patients that had mild fibrosis. Logistic regression analysis revealed that PhA was a predictor of advanced fibrosis even when adjusted for gender, age, HOMA-IR, HDL-cholesterol and AST (OR: 0.227; CI 95%: 0.090-0.569; p: 0.013). The best PhA cut-off points associated with advanced fibrosis for the combined data, for females and for males were 6.43°, 5.94° and 6.72°, respectively. Significance PhA was predictor of advanced liver fibrosis in patients chronically infected with HCV. In the sample evaluated, for each one-degree decrease in PhA, the risk of advanced fibrosis increased more than four-fold. Department of Internal Medicine Botucatu Medical School UNESP - Univ Estadual Paulista Departamento de Clínica Médica Faculdade de Medicina de Botucatu, Rubião Júnior s/n Department of Internal Medicine Botucatu Medical School UNESP - Univ Estadual Paulista Departamento de Clínica Médica Faculdade de Medicina de Botucatu, Rubião Júnior s/n

Background In 1992, the Brazilian Society for Food and Nutrition launched a journal called Cadernos de Nutricao, whose goal was to publish review articles of interest for the Brazilian nutrition researchers and professionals’ community. Then, in 2000, the journal title changed to Nutrire and the scope was reformulated to include original research articles so as to reflect the extraordinary growth of the Brazilian scientific output in the areas of nutrition and food science that had occurred in the previous years. Finally, last year, aiming to internationalize the journal and professionalize its management, the Society took another major step partnering with BioMed Central, a prestigious publisher which pioneered open-access publishing. I am now pleased to introduce you to Nutrire in its new phase as well as to invite you to consider the journal for your next research article. Nutrire is a Latin word for “to nourish.” The process of nourishing or being nourished has passed through important transformations in the last decades. We have to deal not only with old nutritional problems such as malnutrition and micronutrients deficiencies but also with modern maladies such as obesity, cardiovascular disease, and cancer. The development of new technologies has enabled the investigation of nutrients and their interactions with genetics at a molecular level. In the era of nutrigenetics and nutrigenomics, researchers have been able to explore the genetic basis of individual differences in response to the same nutritional intakes [1]. These are just examples of new, exciting areas of research in nutrition and food sciences. There are many others, such as epigenetics and nutritional therapy, and they may explain not only the growing number of researchers interested in these topics but also the explosive growth of

Made available in DSpace on 2018-12-11T17:06:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-12-15 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Background Considering the high morbidity and mortality after myocardial infarction (MI), the study of compounds with potential benefits for cardiac remodeling is reasonable. Green tea (GT) (Cammellia sinensis) is the most consumed beverage in the world. The potential action mechanisms of GT include anti-inflammatory, anti-apoptotic, antioxidant, and lipid-lowering properties. Objective This study analyzed the effects of GT on cardiac remodeling following coronary occlusion in rats. Methods Male Wistar rats were divided into four groups: control (C), control green tea (GT), myocardial infarction (MI), and myocardial infarction and green tea (MI–GT). GT and MI–GT were fed with standard chow with 0.25% Polyphenon 60 (Sigma-Aldrich Canada, Oakville, ON, Canada). After 3 months of observation, echocardiographic and isolated heart study, oxidative stress, energy metabolism, serum lipids, extracellular matrix, and apoptosis were evaluated. Results GT reduced cardiac hypertrophy and improved systolic and diastolic dysfunction. Concerning oxidative stress, GT reduced protein carbonyl, increased Nrf-2, and restored antioxidant enzyme activity to the control pattern. Energy metabolism was affected by MI that presented with lower fatty acid oxidation and accumulation of triacylglycerol, increased serum lipids, impairment of the citric acid cycle, and oxidative phosphorylation. GT stimulated the glucose pathway and mitochondrial function after MI by increasing pyruvate dehydrogenase, Complex I, ATP synthase, and glycogen storage. In addition, MI changed the extracellular matrix including MMP-2 and TIMP-1 activity and increased apoptosis by 3-caspase, all of which were attenuated by GT. Conclusion GT attenuated cardiac remodeling after MI, associated with improvement in systolic and diastolic dysfunction. Oxidative stress, energy metabolism, apoptosis, and extracellular matrix alterations are all potential mechanisms by which GT may take part. Internal Medicine Department Botucatu Medical School UNESP — Univ Estadual Paulista Chemistry and Biochemistry Department Institute of Bioscience UNESP — Univ Estadual Paulista Internal Medicine Department Botucatu Medical School UNESP — Univ Estadual Paulista Chemistry and Biochemistry Department Institute of Bioscience UNESP — Univ Estadual Paulista FAPESP: 2010/13532-2 CNPq: 476673/2011-9

Background: Tobacco smoke exposure is an important risk factor for cardiac remodeling. Under this condition, inflammation, oxidative stress, energy metabolism abnormalities, apoptosis, and hypertrophy are present. Pentoxifylline has anti‑inflammatory, anti-apoptotic, anti-thrombotic and anti-proliferative properties. Objective: The present study tested the hypothesis that pentoxifylline would attenuate cardiac remodeling induced by smoking. Methods: Wistar rats were distributed in four groups: Control (C), Pentoxifylline (PX), Tobacco Smoke (TS), and PX-TS. After two months, echocardiography, invasive blood pressure measurement, biochemical, and histological studies were performed. The groups were compared by two-way ANOVA with a significance level of 5%. Results: TS increased left atrium diameter and area, which was attenuated by PX. In the isolated heart study, TS lowered the positive derivate (+dp/dt), and this was attenuated by PX. The antioxidants enzyme superoxide dismutase and glutathione peroxidase were decreased in the TS group; PX recovered these activities. TS increased lactate dehydrogenase (LDH) and decreased 3-hydroxyacyl Coenzyme A dehydrogenases (OH-DHA) and citrate synthase (CS). PX attenuated LDH, 3-OH-DHA and CS alterations in TS-PX group. TS increased IL-10, ICAM-1, and caspase-3. PX did not influence these variables. Conclusion: TS induced cardiac remodeling, associated with increased inflammation, oxidative stress, apoptosis, and changed energy metabolism. PX attenuated cardiac remodeling by reducing oxidative stress and improving cardiac bioenergetics, but did not act upon cardiac cytokines and apoptosis. Resumo Fundamento: Exposição à fumaça de cigarros é um fator significativo de risco para a remodelação cardíaca. Nesta condição, estão presentes inflamação, estresse oxidativo, anormalidades do metabolismo energético, apoptose e hipertrofia. A pentoxifilina tem propriedades anti-inflamatórias, anti-apoptóticas, anti-trombóticas e anti-proliferativas. Objetivo: O presente estudo testou a hipótese de que a pentoxifilina atenuaria a remodelação cardíaca induzida pelo fumo. Métodos: Ratos Wistar foram distribuídos em quatro grupos: Controle (C), Pentoxifilina (PX), Fumaça de Cigarro (FC), e PX-FC. Depois de dois meses, foram feitos ecocardiografia, medição de pressão arterial invasiva e estudos bioquímicos e histológicos. Os grupos foram comparados por ANOVA de duas vias com nível de significância de 5%. Resultados: FC aumentou o diâmetro e a área do átrio esquerdo, o que foi atenuado pela PX. No estudo de coração isolado, FC diminuiu a derivada positiva (+dp/dt), o que foi atenuado por PX. Os antioxidantes enzima superóxido-dismutase e glutationa peroxidase foram reduzidos no grupo FC; PX recuperou essas atividades. FC aumentou o lactato desidrogenase (LDH) e reduziu as desidrogenases 3-hidroxiacil Coenzima A (OH-DHA) e citrato sintase (CS). PX atenuou alterações de LDH, 3-OH-DHA e CS no grupo PX-FC. FC aumentou IL-10, ICAM-1 e caspase-3. PX não teve influência nestas variáveis. Conclusão: FC induziu remodelação cardíaca, associada a um aumento de inflamação, estresse oxidativo, apoptose e metabolismo energético alterado. PX atenuou remodelação cardíaca, reduzindo estresse oxidativo e melhorando bioenergética cardíaca, mas não agiu nas citocinas cardíacas nem na apoptose.

Made available in DSpace on 2018-12-11T17:04:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-11-01 Aldosterone plays a pivotal role in the pathophysiology of systolic heart failure. However, whether early aldosterone antagonism improves cardiac remodeling during persistent pressure overload is unsettled. We evaluated the effects of aldosterone antagonist spironolactone on cardiac remodeling in rats with ascending aortic stenosis (AS). Methods Three days after inducing AS, weaning rats were randomized to receive spironolactone (AS-SPR, 20 mg/kg/day) or no drug (AS) for 18 weeks, and compared with sham-operated rats. Myocardial function was studied in isolated left ventricular (LV) papillary muscles. Statistical analyses: ANOVA or Kruskal–Wallis tests. Results Echocardiogram showed that LV diastolic (Sham 8.73 ± 0.57; AS 8.30 ± 1.10; AS-SPR 9.19 ± 1.15 mm) and systolic (Sham 4.57 ± 0.67; AS 3.61 ± 1.49; AS-SPR 4.62 ± 1.48 mm) diameters, left atrial diameter (Sham 5.80 ± 0.44; AS 7.15 ± 1.22; AS-SPR 8.02 ± 1.17 mm), and LV mass were higher in AS-SPR than AS. Posterior wall shortening velocity (Sham 38.5 ± 3.8; AS 35.6 ± 5.6; AS-SPR 31.1 ± 3.8 mm/s) was lower in AS-SPR than Sham and AS; E/A ratio was higher in AS-SPR than Sham. Developed tension was lower in AS and AS-SPR than Sham. Time to peak tension was higher in AS-SPR than Sham and AS after post-rest contraction. Right ventricle weight was higher in AS-SPR than AS, suggesting more severe heart failure in AS-SPR than AS. Interstitial collagen fractional area and myocardial hydroxyproline concentration were higher in AS than Sham. Metalloproteinase-2 and -9 activity, evaluated by zymography, did not differ between groups. Conclusion Early spironolactone administration causes further hypertrophy in cardiac chambers, and left ventricular dilation and dysfunction in rats with AS-induced chronic pressure overload. Department of Internal Medicine Botucatu Medical School Sao Paulo State University UNESP Itapeva Social and Agrarian Sciences College FAIT Federal University of Mato Grosso do Sul Department of Internal Medicine Botucatu Medical School Sao Paulo State University UNESP

Cardiac or ventricular remodeling is characterized by molecular, cellular, and interstitial alterations that lead to changes in heart size, mass, geometry and function in response to a given insult. Currently, tobacco smoke exposure is recognized as one of these insults. Indeed, tobacco smoke exposure induces the enlargement of the left-sided cardiac chambers, myocardial hypertrophy, and ventricular dysfunction. Potential mechanisms for these alterations include hemodynamic and neurohormonal changes, oxidative stress, inflammation, nitric oxide bioavailability, matrix metalloproteinases and mitogen-activated protein kinase activation. This review will focus on the concepts, relevance, and potential mechanisms of cardiac remodeling induced by tobacco smoke.

The aim of the present study was to evaluate the Mini Nutritional Assessment (MNA), the Nutritional Risk Screening (NRS) 2002 and the American Society of Anesthesiologists Physical Status Score (ASA) as predictors of gait status and mortality 6 months after hip fracture. A total of eighty-eight consecutive patients over the age of 65 years with hip fracture admitted to an orthopaedic unit were prospectively evaluated. Within the first 72 h of admission, each patient's characteristics were recorded, and the MNA, the NRS 2002 and the ASA were performed. Gait status and mortality were evaluated 6 months after hip fracture. Of the total patients, two were excluded because of pathological fractures. The remaining eighty-six patients (aged 80·2 (sd 7·3) years) were studied. Among these patients 76·7 % were female, 69·8 % walked with or without support and 12·8 % died 6 months after the fracture. In a multivariate analysis, only the MNA was associated with gait status 6 months after hip fracture (OR 0·773, 95 % CI 0·663, 0·901; P= 0·001). In the Cox regression model, only the MNA was associated with mortality 6 months after hip fracture (hazard ratio 0·869, 95 % CI 0·757, 0·998; P= 0·04). In conclusion, the MNA best predicts gait status and mortality 6 months after hip fracture. These results suggest that the MNA should be included in the clinical stratification of patients with hip fracture to identify and treat malnutrition in order to improve the outcomes.

Regardless significant therapeutic advances, mortality and morbidity after myocardial infarction (MI) are still high. For a long time, the importance of right ventricle (RV) function has been neglected. Recently, RV dysfunction has also been associated with poor outcomes in the setting of heart failure. The shape, location, and contraction conditions make the RV chamber assessment technically challenging.Our study identified clinical characteristics and left ventricle (LV) echocardiographic data performed 3-5 days after MI that could be associated with RV dysfunction (RV fractional area change [FAC]35%) 6 months after MI.The RV dysfunction group consisted of 11 patients (RV FAC 29.4% ± 5.2) and the no RV dysfunction group of 71 patients (RV FAC 43.7% ± 5.1); (P0.001). Both groups presented the same baseline clinical characteristics. Left atrium (LA), interventricular septum (IVS), and left ventricular posterior wall (LVPW) were larger in RV dysfunction than in no RV dysfunction. Conversely, E wave deceleration time (EDT) was lower in RV dysfunction when compared with no RV dysfunction. Left atrium(adj) (adjusted by gender, age, infarct size, and body mass index) (odds ratio [OR], 1.22; confidence interval [CI], 1.016-1.47; P = 0.032), interventricular septum(adj) (OR, 1.49; CI, 1.01-2.23; P = 0.044), and E wave deceleration time(adj) (OR, 0.98; CI, 0.97-0.98; P = 0.029) assessed soon after MI predicted RV failure after 6-months.LV diastolic dysfunction, resulting from anterior MI and assessed 3-5 days after the event, may play an important role in predicting RV dysfunction 6 months later.

Made available in DSpace on 2013-09-27T14:54:30Z (GMT). No. of bitstreams: 1 WOS000302804900013.pdf: 252282 bytes, checksum: 2973404343f71f98db03232dc31a7a88 (MD5) Previous issue date: 2012-05-03 Made available in DSpace on 2013-09-30T18:38:40Z (GMT). No. of bitstreams: 1 WOS000302804900013.pdf: 252282 bytes, checksum: 2973404343f71f98db03232dc31a7a88 (MD5) Previous issue date: 2012-05-03 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:51:14Z No. of bitstreams: 1 WOS000302804900013.pdf: 252282 bytes, checksum: 2973404343f71f98db03232dc31a7a88 (MD5) Made available in DSpace on 2014-05-20T13:51:14Z (GMT). No. of bitstreams: 1 WOS000302804900013.pdf: 252282 bytes, checksum: 2973404343f71f98db03232dc31a7a88 (MD5) Previous issue date: 2012-05-03 Botucatu Medical School Background: The AIN-93 diet was proposed by the American Institute of Nutrition with the objective of standardising studies in experimental nutrition. Our objective was to analyze the effects of AIN-93 diet after myocardial infarction in rats.Methods: Post weaning, the animals were divided into two groups: control (C, n=62), fed the standard diet of our laboratory (Labina); AIN-93 Group (n=70), fed the AIN-93 diet. Achieving 250 g, the animals were subjected to myocardial infarction.Results: Early mortality was increased in AIN-93 animals, associated with lower serum levels of calcium, magnesium, potassium, sodium, and phosphorus. on the other hand, after 90 days, AIN-93 showed smaller normalized left ventricular dimensions. The caloric and carbohydrate intake was smaller, but the fat intake was higher in AIN-93 rats. AIN-93 group also showed increased levels of beta-hydroxyacylcoenzyme A dehydrogenase and citrate synthase. In addition, serum levels of insulin and cardiac levels of malondialdehyde, metalloproteinases-2 and -9, and TNF-alpha and IFN-gamma were decreased in the AIN-93 group.Conclusion: AIN-93 diet increased early mortality, while attenuated the chronic remodeling process after experimental coronary occlusion. Therefore, this diet has biological effects and should be use with attention in this model. (C) 2010 Elsevier B.V. All rights reserved. UNESP São Paulo State Univ, Botucatu Med Sch, Dept Internal Med, Botucatu, SP, Brazil São Paulo State Univ, Inst Biosci, Dept Microbiol & Immunol, Botucatu, SP, Brazil UNESP São Paulo State Univ, Botucatu Med Sch, Inst Biol Sci, Dept Chem & Biochem, Botucatu, SP, Brazil UNESP São Paulo State Univ, Fac Agr Sci, Agroind Technol & Management Dept, Botucatu, SP, Brazil UNESP São Paulo State Univ, Botucatu Med Sch, Dept Internal Med, Botucatu, SP, Brazil São Paulo State Univ, Inst Biosci, Dept Microbiol & Immunol, Botucatu, SP, Brazil UNESP São Paulo State Univ, Botucatu Med Sch, Inst Biol Sci, Dept Chem & Biochem, Botucatu, SP, Brazil UNESP São Paulo State Univ, Fac Agr Sci, Agroind Technol & Management Dept, Botucatu, SP, Brazil

Made available in DSpace on 2013-09-27T14:54:31Z (GMT). No. of bitstreams: 1 WOS000312617200009.pdf: 741557 bytes, checksum: 1d8ed96b189668ac8d85325afa301b91 (MD5) Previous issue date: 2012-01-01 Made available in DSpace on 2013-09-30T18:38:41Z (GMT). No. of bitstreams: 1 WOS000312617200009.pdf: 741557 bytes, checksum: 1d8ed96b189668ac8d85325afa301b91 (MD5) Previous issue date: 2012-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:51:15Z No. of bitstreams: 1 WOS000312617200009.pdf: 741557 bytes, checksum: 1d8ed96b189668ac8d85325afa301b91 (MD5) Made available in DSpace on 2014-05-20T13:51:15Z (GMT). No. of bitstreams: 1 WOS000312617200009.pdf: 741557 bytes, checksum: 1d8ed96b189668ac8d85325afa301b91 (MD5) Previous issue date: 2012-01-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Background/Aims: Renin-angiotensin-aldosterone system blockade with a mineralocorticoid-receptor antagonist has not yet been studied in exposure to tobacco smoke (TS) models. Thus, this study investigated the role of spironolactone on cardiac remodeling induced by exposure to tobacco smoke. Methods: Male Wistar rats were divided into 4 groups: a control group (group C, n=11); a group with 2 months of cigarette smoke exposure (group TS-C, n=13); a group that received spironolactone 20 mg/kg of diet/day and no cigarette smoke exposure (group TS-S, n=13); and a group with 2 months of cigarette smoke exposure and spironolactone supplementation (group S, n=12). The rats were observed for a period of 60 days, during which morphological, biochemical and functional analyses were performed. Results: There was no difference in invasive mean arterial pressure among the groups. There were no interactions between tobacco smoke exposure and spironolactone in the morphological and functional analysis. However, in the echocardiographic analysis, the TS groups had left chamber enlargement, higher left ventricular mass index and higher isovolumetric relaxation time corrected by heart rate compared with the non-TS groups. In vitro left ventricular diastolic function also worsened in the IS groups and was not influenced by spironolactone. In addition, there were no differences in myocardial levels of IFN-gamma, TNF-alpha, IL-10, ICAM-1 and GLUT4 [TS: OR 0.52, 95%CI (-0.007; 0.11); Spironolactone: OR -0.01, 95%CI (-0.07;0.05)]. Conclusion: Our data do not support the participation of aldosterone in the ventricular remodeling process induced by exposed to cigarette smoke. Copyright (C) 2012 S. Karger AG, Basel Univ Estadual Paulista UNESP, Botucatu Med Sch, Dept Internal Med, Botucatu, SP, Brazil São Paulo State Univ, Inst Biosci, Dept Microbiol & Immunol, Botucatu, SP, Brazil Univ Estadual Paulista UNESP, Botucatu Med Sch, Dept Internal Med, Botucatu, SP, Brazil São Paulo State Univ, Inst Biosci, Dept Microbiol & Immunol, Botucatu, SP, Brazil FAPESP: 10/10187-2 CNPq: 473091/2010-0