Acute effects of strength exercise with blood flow restriction on the arterial resistance index / Efeitos agudos do exercício de força com restrição do fluxo sanguíneo sobre o índice de resistência arterial

ABSTRACT The present study aimed to evaluate the acute behavior of the brachial artery resistance index (BARI) and popliteal artery resistance index (PARI) in response to low intensity strength exercises involving small (SMG) and large muscle groups (LMG) performed with and without blood flow restriction. Eleven men (age 23 ± 3.29 years) underwent a four-arm, randomized, cross-over experiment: Small muscle group exercise (SMG), small muscle groups with blood flow restriction (SMG+BFR), large muscle groups (LMG) and large muscle groups with blood flow restriction (LMG+BFR). The behavior of BARI and PARI was evaluated at rest, immediately after exercise, and at 15 and 30 minutes during recovery. Data analysis showed a significant reduction of the BARI from rest to post-exercise only in the protocols involving SMG, regardless of the BFR (p <0.05). Protocols involving LMG, with or without BFR, did not affect PARI (p> 0.05), but were efficient to promote significant increases in BARI (p <0.05) immediately after exercise. Our findings indicate that the exercises involving SMG, regardless of BFR, are efficient to promote local vasodilatation (brachial artery), but without systemic effects. None of the analyzed protocols affected the PARI behavior.

RESUMO O presente estudo objetivou avaliar o comportamento agudo do índice de resistência da artéria braquial (IRAB) e da artéria poplítea (IRAP) em resposta a exercícios de força de baixa intensidade envolvendo pequenos (PGM) e grandes grupos musculares (GGM), realizado com e sem restrição de fluxo sanguíneo. Onze homens (idade 23 ± 3,29 anos) realizaram um experimento randomizado, cruzado, com quatro braços: Exercício para pequenos grupos musculares (PGM), pequenos grupos musculares com restrição de fluxo sanguíneo (PGM+RFS), grandes grupos musculares (GGM) e grandes grupos musculares com restrição de fluxo sanguíneo (GGM+RFS). O comportamento de IRAB e IRAP foi avaliado em repouso, mediatamente após o exercício, e aos 15 e 30 minutos da recuperação. A análise dos dados mostrou uma redução significativa do IRAB do repouso para o pós-exercício apenas nos protocolos de PGM com ou sem RFS (p <0,05). Protocolos envolvendo GGM, independentemente do BFR, não afetaram o IRAP (p> 0,05), porém, foram eficientes para promover aumentos significativos do IRAB (p <0,05) imediatamente após o exercício. Nossos achados indicam que os exercícios envolvendo PGM, independentemente da BFR, são capazes de promover a vasodilatação local (artéria braquial), porém, sem efeitos sistêmicos. Nenhum dos protocolos analisados afetou o comportamento do IRAP.

The importance of intra-aortic pulse pressure after anterior ST-segment elevation myocardial infarction

Abstract Objective: To evaluate the association of pulse pressure (PP) with mortality and major adverse cardiac events (MACE) in one-year period after anterior ST-elevation myocardial infarction (A-STEMI). Methods: A total of 261 consecutive patients whose blood pressure was measured with the aid of a catheter before primary percutaneous coronary intervention (PPCI) between August 2016 and February 2017 were included in the study. The patients were divided into three groups according to pulse pressure (PP) (Group 1, PP<35 mmHg; Group 2, 35≤PP≤50 mmHg; Group 3, PP>50 mmHg). Results: The mean age of the patients was 63.4±14.1 years, and 206 of them were male. The groups were similar in terms of age and diastolic blood pressure (DBP). The ratio of female patients in Group 1 was higher, and their systolic blood pressure (SBP) was lower than those from the other groups (P=0.005 vs. P=0.042). The rates of MACE and mortality were higher in Group 1. The predictive PP values were calculated to be 42.5 mmHg for development of MACE and 41.5 mmHg for mortality. One-year survival ratio was worse in Group 1 than in the others according to Kaplan-Meier analysis (P<0.001). Conclusion: The values of PP which was measured intra-aortically in patients with A-STEMI were associated with mortality and MACE in the one-year follow-up period.

Relación entre la presión de pulso y la enfermedad cerebrovascular aterotrombótica / Relation between pulse pressure and atherothrombotic cerebrovascular disease

Introducción: la presión de pulso es un importante marcador y/o predictor de riesgo de complicaciones ateroscleróticas agudas, donde está incluida la enfermedad cerebrovascular. Objetivos: determinar la relación entre la presión de pulso y la enfermedad cerebrovascular aterotrombótica en pacientes hipertensos y no hipertensos. Métodos: estudio explicativo, analítico, caso/control. El grupo de casos fue de 226 pacientes con diagnóstico de enfermedad cerebrovascular aterotrombótica, ingresados en la Sala de Ictus del Hospital General Docente Enrique Cabrera entre 2014-2016 y el grupo control de 226 sin enfermedad cerebrovascular. Se formaron dos grupos, uno con presión de pulso 60 mmhg y otro con presión de pulso < 60 mmHg en pacientes hipertensos y no hipertensos. Resultados: la media de la edad fue de 69,65 años y el 61,45 por ciento eran masculinos; la frecuencia de hipertensión arterial fue de 70,4 por ciento y la de fumadores, 35,4 por ciento y con PP≥ 60 mmHg, 62,0 por ciento. La asociación de la presión de pulso 60 mmHg con enfermedad cerebrovascular aterotrombótica en pacientes hipertensos resultó significativa con odds-ratio 4,72, Intervalo de Confianza 95 por ciento(2,79-7,98) y en pacientes no hipertensos también resultó significativa con odds-ratio 6,86 Intervalo de Confianza 95 por ciento (3,33-14,07). El riesgo atribuible en expuestos fue de 88,6 por ciento y el riesgo atribuible en la población de 50,4 por ciento. Conclusiones: la presión de pulso se asoció de forma significativa a la enfermedad cerebrovascular aterotrombótica en pacientes hipertensos y no hipertensos(AU)

Introduction: Pulse pressure is an important marker or predictor of risk for acute atherosclerotic complications, including cerebrovascular disease. Objectives: To determine the relationship between pulse pressure and atherothrombotic cerebrovascular disease in hypertensive and nonhypertensive patients. Methods: Explanatory, analytical, case control study. The case group consisted of 226 patients diagnosed with atherothrombotic cerebrovascular disease admitted to the Ictus Room at Enrique Cabrera General Teaching Hospital between 2014 and 2016, and the control group consisted of 226 patients without cerebrovascular disease. Two groups were formed, one with a pulse pressure higher than or equal to 60 mmHg and one with a pulse pressure under 60 mmHg in hypertensive and nonhypertensive patients. Results: Mean age was 69.65 years and 61.45 percent were male. The frequency of hypertension was 70.4 percent and that of smokers was 35.4 percent, and with PP≥60 mmHg, which represented 62.0 percent. The association of pulse pressure higher than or equal to 60 mmHg with atherothrombotic cerebrovascular disease in hypertensive patients was significant with odds ratio of 4.72, and confidence interval of 95 percent (2.79-7.98), while in nonhypertensive patients it was also significant with odd ratios of 6.86, and confidence interval of 95 percent CI (3.33-14.07). The attributable risk in exposed people was 88.6 percent and the attributable risk in the population was 50.4 percent. Conclusions: Pulse pressure was significantly associated with atherothrombotic cerebrovascular disease in both hypertensive and nonhypertensive patients(AU)

Avaliação da patência da artéria radial após cateterismo transradial / Evaluation of radial artery patency after transradial catheterization

INTRODUÇÃO: Embora a abordagem transradial tenha reduzido as complicações vasculares, a oclusão da artéria radial ainda é uma de suas limitações. O objetivo deste estudo foi avaliar a patência da artéria radial após cateterismo cardíaco transradial. MÉTODOS: Estudo de coorte prospectivo com pacientes submetidos a cateterismo cardíaco pela via transradial. Os procedimentos foram realizados com cateteres 5 F ou 6 F, com a administração de 5.000 U de heparina e 200 µg de nitroglicerina através do introdutor radial. O fluxo sanguíneo na artéria radial foi avaliado com o uso do Doppler antes, imediatamente após a retirada do curativo e 7 dias depois do procedimento. RESULTADOS: O estudo incluiu 120 pacientes, dos quais 42,5% eram do sexo masculino, com idade de 59,1 ± 10,6 anos, 25,8% eram diabéticos, com peso de 77,4 ± 14,2 kg e altura de 166 ± 8,1 cm. O número de cateteres utilizados foi de 2,3 ± 0,5 por paciente, 55,8% usando introdutores 6 F. A duração do procedimento foi de 14,8 ± 5,2 minutos, o tempo de punção foi de 129,7 ± 124,1 segundos e o tempo de fluoroscopia, de 4 ± 2,3 minutos. Espasmo e crossover para técnica femoral ocorreram em 20,8% e 1,7% dos procedimentos, respectivamente. Hematoma significativo ocorreu em 2,4% dos pacientes. Em uma semana de acompanhamento, observaram-se oclusões da artéria em 1,7% e redução do fluxo sanguíneo em 26,7% dos pacientes. CONCLUSÕES: A oclusão da artéria radial pós-procedimento diagnóstico utilizando a via de acesso radial é infrequente e não deve ser considerada limitação importante da técnica.

BACKGROUND: Although the transradial approach has reduced vascular complications, radial artery occlusion is still considered one of its limitations. The aim of this study was to evaluate radial artery patency after transradial cardiac catheterization. METHODS: Prospective cohort study of patients undergoing cardiac catheterization using the transradial approach. Procedures were performed with 5 F and 6 F catheters with the administration of 5,000 IU of heparin and 200 µg of nitroglycerin through the radial sheath. Radial artery blood flow was assessed by Doppler before, immediately after bandage removal and 7 days after the procedure. RESULTS: The study included 120 patients of which 42.5% were males, with 59.1 ± 10.6 years of age, 25.8% were diabetic, weighing 77.4 ± 14.2 kg and height of 166 ± 8.1 cm. The number of catheters used was 2.3 ± 0.5 per patient, 55.8% using 6 F sheaths. Duration of the procedure was 14.8 ± 5.2 minutes, puncture time was 129.7 ± 124.1 seconds and fluoroscopy time was 4 ± 2.3 minutes. Radial spasm and crossover to the femoral technique occurred in 20.8% and 1.7% of the procedures, respectively. Significant hematoma was observed in 2.4% of the patients. At 1 week of follow-up, arterial occlusion was observed in 1.7% and reduced blood flow in 26.7% of the patients. CONCLUSIONS: Radial artery occlusion following diagnostic procedure using the transradial approach is rare and should not be considered as an important technique limitation.

Avaliação de ateromatose subclínica em pacientes HIV/aids: determinação da velocidade de onda de pulso e da espessura média-íntima de carótidas / Evaluation of subclinical atheromatous disease in HIV/AIDS patients: assessment of pulse wave velocity (PWV) and carotid intimamedia thickness (IMT)

A terapia anti-retroviral altamente potente (HAART), determinou uma melhora significativa do prognóstico dos pacientes vivendo com HIV/aids. Contudo, a presença de toxicidades agudas e crônicas, incluindo risco aumentado de doenças cardiovasculares, acarretou novas implicações para a qualidade e expectativa de vida destes pacientes. O objetivo deste estudo foi determinar o risco cardiovascular de pacientes HIV/aids tratados e nãotratados com esquema HAART. De 02/2008 a 07/2009 foram incluídos 118 indivíduos entre 18 e 70 anos, procedentes do Instituto de Infectologia Emílio Ribas e do Hospital Universitário da USP, além de voluntários saudáveis. Os indivíduos foram distribuídos em 4 grupos: (1) pacientes com infecção pelo HIV em uso de HAART; (2) pacientes com infecção pelo HIV sem tratamento (naïve); (3) pacientes diabéticos não insulino-dependentes (DM); (4) controle. Foram avaliados em todos os participantes: parâmetros bioquímicos, teste de tolerância oral à glicose, PCR ultra-sensível, microalbuminúria, sorologias para hepatite B e hepatite C, ECG, EMI, VOP, escore de risco de Framingham (ERF) e presença de síndrome metabólica (SM). Os pacientes DM tinham idade mais avançada (51,7 ± 9,7 anos) e 75, 8% eram do sexo feminino. Os dados foram ajustados para a idade (média ± erro-padrão). A relação cintura-quadril foi maior no grupo HAART que no controle (0,94 ± 0,01 vs. 0,88 ± 0,01, p< 0,0001); a pressão arterial sistólica média aferida no dia da visita foi maior no grupo HAART comparado ao grupo naive e controle (124,7 ± 2,3 vs. 118,1 ± 2,4 vs. 119,8 ± 2,2 mmHg, respectivamente; p= 0,001 e p= 0,005), e a pressão arterial diastólica média foi maior no grupo HAART que no naive (78,2 ± 1,8 vs. 75,9 ± 1,9 mmHg, respectivamente; p= 0,03); os níveis séricos de triglicérides estavam mais elevados no grupo HAART comparado aos grupos naive e controle (233,7 ± 193,4 vs. 137,3 ± 108,6 vs. 147,2 ± 87,3 mg/dL, respectivamente; p= 0,03 e p=0,04); microalbuminúria...

The highly active antiretroviral therapy (HAART), led to a significant improvement in the prognosis of patients living with HIV/AIDS. However, the presence of acute and chronic toxicities, including increased risk of cardiovascular disease, yielded further implications for the quality and life expectancy of these patients. The aim of this study was to determine the cardiovascular risk of HIV/AIDS patients treated and untreated with HAART. From february/2008 to july/2009 we enrolled 118 subjects between 18 and 70 years, attending at the Institute of Infectious Diseases Emilio Ribas and the University Hospital from USP, as well as healthy volunteers. The subjects were divided into 4 groups: (1) patients with HIV-infection on HAART; (2) patients with untreated HIV-infection (ART-naive); (3) diabetic patients not insulin-dependent (DM); (4) controls. Were evaluated in all participants: biochemical parameters, oral glucose tolerance test, high-sensitivity Creactive protein, microalbuminuria, serologies for hepatitis B and hepatitis C, ECG, carotid IMT, PWV, Framingham risk score (FRE) and the presence of metabolic syndrome (MS). The DM patients were older (51.7 ± 9.7 years) and 75.8% were female. The data were adjusted for age (mean ± standard error). The waist-to-hip ratio was higher in the HAART-treated patients than in the controls (0.94 ± 0.01 vs. 0.88 ± 0.01, p< 0.0001), the mean systolic blood pressure measured on the day of the visit was higher in the HAARTtreated patients compared to the ART-naive and controls (124.7 ± 2.3 vs. 118.1 ± 2.4 vs. 119.8 ± 2.2 mmHg, respectively, p= 0.001 and p= 0.005), and the mean diastolic blood pressure was higher in the HAART-treated patients than in the ART-naive (78.2 ± 1.8 vs. 75.9 ± 1.9 mmHg, respectively, p= 0.03); serum triglycerides were higher in the HAART-treated patients compared to the ART-naive subjects and controls (233.7 ± 193.4 vs. 137.3 ± 108.6 vs. 147.2 ± 87.3 mg/dL, respectively, p= 0.03 and p= 0.04)...

Acute effect of 30 degrees, 60 degrees and 80 degrees head-down tilt on blood pressure in young healthy human subjects.

There are very few reports on the acute cardiovascular responses to head-down tilt of more than 30 degrees on blood pressure (BP) and heart rate (HR) in human subjects. The aim of the present study was to determine the BP and HR response to five minutes of 30 degrees, 60 degrees and 80 degrees head-down tilt in healthy human subjects. The study was conducted on 20 healthy male volunteers aged 18-20 years. In this study, 30 degrees head-down tilt produced no significant change in BP and HR. With 60 degrees and 80 degrees head-down tilt, there was a significant graded increase in diastolic pressure and a decrease in pulse pressure (P<0.01 for both). This pressor response is most likely due to raised intracranial tension and/or hypoxemia in this condition. The decrease in pulse pressure is possibly due to excessive cardiopulmonary blood volume resulting in a decreased stroke volume. Our study confirms earlier findings that acute 30 degrees head-down tilt produces no significant changes in BP and HR. However, the mechanisms leading to increases in BP that occurred with 60 degrees and 80 degrees acute head-down tilt need to be investigated.

Pulse technique pyrolysis of some arylsilanes and their thermal reaction with aliphatic, aromatic alcohols over Ni-Y-Zeolite

P-tolyltrimethylsilane and phenyltrimethylsilane were subjected in the gas phase to pyrolysis and thermolysis reactions with alcohols and phenols at different temperatures over Ni-Y-zeolite using a pulse catalytic technique. The obtained alkoxy- and phenoxy- trimethylsilanes with other side products were identified by gas liquid chromatographic analysis. The yield in each case varied with the reaction temperature. The highest yield was obtained at 250C. The different pathways of these thermolytic reactions were discussed and the results were assigned