Vitamin E suppresses aortic ultrastructural alterations induced by toxic doses of monosodium glutamate / La vitamina E suprime las alteraciones ultraestructurales aórticas inducidas por dosis tóxicas de glutamato monosódico

SUMMARY: An association between certain food additives and chronic diseases is reported. Current study determined whether administering toxic doses of the food additive monosodium glutamate (MSG) into rats can induce aortopathy in association with the oxidative stress and inflammatory biomarkers upregulation and whether the effects of MSG overdose can be inhibited by vitamin E. MSG at a dose of (4 mg/kg; orally) that exceeds the average human daily consumption by 1000x was administered daily for 7 days to the rats in the model group. Whereas, rats treated with vitamin E were divided into two groups and given daily doses of MSG plus 100 mg/ kg vitamin E or MSG plus 300 mg/kg vitamin E. On the eighth day, all rats were culled. Using light and electron microscopy examinations, a profound aortic injury in the model group was observed demonstrated by damaged endothelial layer, degenerated smooth muscle cells (SMC) with vacuoles and condensed nuclei, vacuolated cytoplasm, disrupted plasma membrane, interrupted internal elastic lamina, clumped chromatin, and damaged actin and myosin filaments. Vitamin E significantly protected aorta tissue and cells as well as inhibited MSG-induced tissue malondialdehyde (MDA), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). The highest used vitamin E dosage was more effective. Additionally, a significant correlation was observed between the aortic injury degree and tissue MDA, TNF-α, IL-6, and superoxide dismutase (SOD) levels (p=0.001). Vitamin E effectively protects against aortopathy induced by toxic doses of MSG in rats and inhibits oxidative stress and inflammation.

RESUMEN: Se reporta una asociación entre ciertos aditivos alimentarios y enfermedades crónicas. El objetivo de este estudio fue determinar si la administración de dosis tóxicas del aditivo alimentario glutamato monosódico (MSG) en ratas puede inducir aortopatía en asociación con el estrés oxidativo y la regulación positiva de los biomarcadores inflamatorios y si el efecto de una sobredosis de MSG se puede inhibir con vitamina E. Se administró MSG diariamente durante 7 días una dosis de (4 g/kg; por vía oral) que excede el consumo diario humano promedio, en 1000x a las ratas del grupo modelo. Mientras que las ratas tratadas con vitamina E se dividieron en dos grupos y se administraron dosis diarias de MSG más 100 mg/kg de vitamina E o MSG más 300 mg/kg de vitamina E. Todas las ratas fueron sacrificadas en el octavo día. Usando exámenes de microscopía óptica y electrónica, se observó una lesión aórtica profunda en el grupo modelo demostrada por una capa endotelial dañada, células musculares lisas degeneradas (SMC) con vacuolas y núcleos condensados, citoplasma vacuolado, membrana plasmática rota, lámina elástica interna interrumpida, cromatina agrupada y filamentos de actina y miosina dañados. La vitamina E protegió significativamente el tejido y las células de la aorta, además de inhibir el malondialdehído tisular (MDA) inducido por MSG, la interleucina-6 (IL-6) y el factor de necrosis tumoral alfa (TNF-α). La dosis más alta de vitamina E utilizada fue más efectiva. Además, se observó una correlación significativa entre el grado de lesión aórtica y los niveles tisulares de MDA, TNF-α, IL-6 y superóxido dismutasa (SOD) (p=0,001). La vitamina E efectivamente protege contra la aortopatía inducida por dosis tóxicas de MSG en ratas e inhibe el estrés oxidativo y la inflamación.

Gαq-RGS2 loop activator modulates the activity of vario us agonists on isolated heart and aorta of normal rats

The Gαq-RGS2 loop activator, 1-(5-chloro-2-hydroxyphenyl)-3-(4-(trifluoromethyl)-phenyl)-1H-1,2,4-triazol-5(4H)-one has demonstrated Gαq signaling inhibitor activity. Therefore, we aimed to study the effect of Gαq-RGS2 loop activator on isolated heart and aorta of normal rats. Heart and aorta were isolated from the sacrificed rats (n=6) and mounted on the langendroff's and organ bath assembly, respectively. The effect of various receptor-dependent (acetylcholine, angiotensin II and adrenaline) and independent (calcium chloride and sodium nitroprusside) agonists in absence and presence of Gαq-RGS2 loop activator on left ventricular systolic pressure (LVSP) and the contractile responseswere evaluated in isolated heart and aorta, respectively. Gαq-RGS2 loop activator (100 µM) significantly attenuated the adrenaline (p<0.001,) and angiotensin II (p<0.001) induced increase in LVSP in isolated heart and contractile response of adrenaline (p<0.01) and angiotensin II (p<0.01) in the aorta. However, effect calcium chloride did not significantly alter by Gαq-RGS2 loop activator. The effect of acetylcholinewas significantly (p<0.01, p<0.05) increased by Gαq-RGS2 loop activator in isolated heart and aorta. The effect of sodium nitroprusside significantly (p<0.01) potentiated by Gαq-RGS2 loop activator (100 µM) in isolated heart while it did not significantly alters in the aorta. Ultimately, the Gαq-RGS2 loop activator modulated the action of receptor-dependent agonists in isolated heart and aorta

Pre-diabetes induces ultrastructural alterations in the large blood vessel aorta in rats / La prediabetes induce alteraciones ultraestructurales en la aorta de los grandes vasos sanguíneos en ratas

Excessive consumption of carbohydrate and fat increases the risk of cardiovascular disease. We sought to determine the potential ultrastructural alterations in large blood vessels induced by a high fat and fructose diet (HFD) in a rat model of prediabetes. Rats were either fed with HFD (model group) or a standard laboratory chow (control group) for 15 weeks before being sacrificed. The harvested thoracic aorta tissues were examined using transmission electron microscopy (TEM), and blood samples were assayed for biomarkers of pre-diabetes.TEM images showed that HFD induced profound pathological changes to the aortic wall layers, tunica intima and tunica media ultrastructures in the pre-diabetic rats as shown by apoptotic endothelial cells with pyknotic nuclei, damaged basal lamina, deteriorated smooth muscle cells that have irregular plasma membranes, shrunken nucleus with clumped nuclear chromatin, damaged mitochondria and few cytoplasmic lipid droplets and vacuoles. In addition, HFD significantly (p<0.05) decreased adiponectin and increased biomarkers of lipidemia, glycaemia, inflammation, oxidative stress, vascular injury such as soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion protein 1 (sVCAM-1), endothelin-1 (ET-1), and coagulation and thrombosis such as Von Willebrand factor (vWF), and plasminogen activator inhibitor-1 (PAI-1), compared to normal levels of these parameters in the control group. Thus, we demonstrated that feeding rats with a HFDisable to develop a pre-diabetic animal model that is useful to study the aortic ultrastructural alterations.

El consumo excesivo de carbohidratos y grasas aumenta el riesgo de enfermedades cardiovasculares. Intentamos determinar las posibles alteraciones ultraestructurales en los grandes vasos sanguíneos, inducidas por una dieta alta en grasas y fructosa (HFD) en un modelo de rata de prediabetes. Las ratas se alimentaron con HFD (grupo modelo) o una comida de laboratorio estándar (grupo de control) durante 15 semanas antes de ser sacrificadas. Los tejidos de la aorta torácica recolectados se examinaron mediante microscopía electrónica de transmisión (TEM) y las muestras de sangre se analizaron para detectar biomarcadores de prediabetes. Las imágenes TEM mostraron que HFD indujo cambios patológicos profundos en las capas de la pared aórtica, túnica íntima y túnica media en la ratas pre-diabéticas como lo muestran las células endoteliales apoptóticas con núcleos picnóticos, lámina basal dañada, células musculares lisas deterioradas que tienen membranas plasmáticas irregulares, núcleo encogido con cromatina nuclear aglomerada, mitocondrias dañadas y pocas gotitas lipídicas citoplásmicas y vacuolas. Además, HFD presentó disminución significativa de adiponectina (p <0,05), y aumento de biomarcadores de lipidemia, glucemia, inflamación, estrés oxidativo, lesión vascular como la molécula de adhesión intercelular soluble 1 (sICAM-1), proteína de adhesión de células vasculares soluble 1 (sVCAM-1), endotelina 1 (ET-1), y la coagulación y la trombosis, como el factor de Von Willebrand (vWF), y el inhibidor del activador del plasminógeno-1 (PAI -1), en comparación con los niveles normales de estos parámetros en el grupo de control. Por tanto, la alimentación de ratas con HFD es capaz de desarrollar un modelo animal prediabético que es útil para estudiar las alteraciones ultraestructurales aórticas.

Evaluation of Collagen Fibers, MMP2, MMP9, 8-OHdG and Apoptosis in the Aorta of Ovariectomized LDL Knockout Mice Submitted to Aerobic Exercise / Avaliação de Fibras de Colágeno, MMP2, MMP9, 8-OH-Dg e Apoptose na Aorta de Ratas LDL Nocaute Ovariectomizadas Submetidas a Exercício Aeróbico

Abstract Background: In menopause, there is greater cellular exposure to oxidative stress, related to the decreased antioxidative effects of estrogen. These metabolic changes favor the progression of cardiovascular diseases, such as atherosclerosis. Abnormal function of the aorta - the most important artery - is associated with many cardiovascular diseases. Collagen, especially types I and III, is one of the most important aortic wall components and it can be affected by many factors, including menopause. The 8-OHdG is one of the main markers of DNA oxidative damage induced by reactive oxygen species (ROS). Objective: We aimed to investigate effects of moderate aerobic training on the ascending aorta of LDL-knockout (LDL-KO) and ovariectomized female mice. Methods: A total of 15 C57BL/6 mice and 15 LDL-KO mice were divided into experimental groups. The thickness and volume density of types I and III collagen fibers were performed by morphoquantitative analysis, whereas the MMP-2 and MMP-9 and 8-OHdG were detected by immunohistochemistry and apoptosis was detected by the TUNEL assay. The significance level for all tests was p < 0.05. Results: Exercise causes an increase in the thickness of the aorta in LDL-KO groups, particularly accentuated in the ovariectomized groups. The type I collagen fibers showed an increase in volume density influenced by training in both Control groups and in the LDL-KO group. Type III collagen density decreased in both groups. The MMP-2 showed moderade immunostaining in the tunica media in LDL-KO groups, which did not occur in the control groups and the MMP-9 stained irregularly in all tissues. The marker 8-OhdG was stronger in the exercise training groups. Additionally, the ovariectomy, the exercise training and the LDL-KO treatments increased apoptosis. Conclusion: These results suggest that moderate-intensity aerobic exercise in ovariectomized mice associated to an increase in LDL rate possibly increases oxidative stress and apoptosis induction.

Resumo Fundamento: Na menopausa, há maior exposição celular ao estresse oxidativo, relacionada à diminuição dos efeitos antioxidantes do estrogênio. Essas alterações metabólicas favorecem a progressão das doenças cardiovasculares, como a aterosclerose. A função anormal da aorta - a artéria mais importante - está associada a muitas doenças cardiovasculares. O colágeno, especialmente os tipos I e III, é um dos mais importantes componentes da parede da aorta e pode ser afetado por muitos fatores, incluindo a menopausa. Por sua vez, 8-OHdG é um dos principais marcadores de danos oxidativos do DNA induzidos por espécies reativas de oxigênio (EROS). Objetivo: Investigar os efeitos do treinamento aeróbico moderado na aorta ascendente de camundongos fêmeas, nocaute para LDL (LDL-KO) e ovariectomizadas. Métodos: Um total de 15 animais C57BL/6 e 15 animais LDL-KO foram divididos em grupos experimentais. A espessura e a densidade de volume das fibras de colágeno tipos I e III foram realizadas por análise morfoquantitativa; MMP-2 e MMP-9 e 8-OHdG foram detectadas por imunohistoquímica; e a apoptose foi detectada pelo ensaio TUNEL. O nível de significância adotado para todos os testes realizados foi p < 0,05. Resultados: o exercício causa aumento da espessura da aorta em grupos LDL-KO, particularmente acentuada em grupos ovariectomizados. As fibras de colágeno de tipo I mostraram aumento da densidade de volume influenciado pelo treinamento em animais controle e LDL-KO. A densidade do colágeno tipo III diminuiu em ambos os grupos. A MMP-2 mostrou imunomarcação moderada na túnica média em animais LDL-KO; em grupos controle, a MMP-9 marcou irregularmente em todos os tecidos. O marcador 8-OHdG foi mais forte nos grupos de treinamento de exercícios. Além disso, a ovariectomia, o treinamento físico e os tratamentos de LDL-KO aumentaram a apoptose. Conclusão: Esses resultados sugerem que exercícios aeróbicos de intensidade moderada em camundongos ovariectomizados associados ao aumento da taxa de LDL, possivelmente, aumentam o estresse oxidativo e a indução da apoptose.

Implications of alcoholic cirrhosis in atherosclerosis of autopsied patients / Implicações da doença hepática alcoólica na aterosclerose de pacientes autopsiados

Summary Introduction: Alcoholism is a major public health problem, which has a high social cost and affects many aspects of human activity. Liver disease is one of the first consequences of alcohol abuse, and steatosis, liver cirrhosis and hepatitis may occur. Other organs are also affected with pathological changes, such as pancreatitis, cardiomyopathies, dyslipidemias and atherosclerosis. Objective: To identify the occurrence and degree of atherosclerosis in alcohol-dependent individuals with liver cirrhosis, observing macroscopic and microscopic changes in lipid and collagen deposits and in the liver. We also aimed to verify the association of lipid and collagen fiber deposits with gender, age and body mass index, and to relate alcoholism, liver cirrhosis and atherosclerosis. Method: We performed a study based on autopsy reports of patients with alcoholic liver cirrhosis, with analysis of aorta and liver fragments to verify the occurrence and degree of atherosclerosis, as well as collagen contents. Results: Microscopic atherosclerosis was higher in young subjects (early injury) and in patients with alcoholic liver cirrhosis. The macroscopic analysis of atherosclerosis in aortas showed that patients in more advanced age groups presented more severe classifications. Atherosclerosis, both micro and macroscopically, and the percentage of fibrosis in the liver and aorta were more expressive in females. Conclusion: Cirrhotic patients presented a higher percentage of fibrosis and lipidosis, and may represent a group susceptible to the accelerated progression of cardiovascular diseases. Investigative studies contribute to targeting health-promoting interventions, reducing the mortality and costs of treating cardiovascular disease.

Resumo Introdução: O alcoolismo é um grande problema de saúde pública, de elevado custo social e que afeta vários aspectos da atividade humana. Hepatopatia é uma das primeiras consequências do abuso de álcool, podendo ocorrer esteatose, cirrose hepática e hepatite. Outros órgãos, porém, também são afetados, ocorrendo alterações patológicas, como pancreatite, cardiomiopatias, dislipidemias e aterosclerose. Objetivo: Identificar a ocorrência e a intensidade de aterosclerose em alcoolistas com cirrose hepática, observando alterações macro e microscópicas do depósito lipídico e de fibras colágenas e fígado. Verificar a associação de depósito lipídico e de fibras colágenas com gênero, idade e índice de massa corporal (IMC). Relacionar alcoolismo, cirrose hepática e aterosclerose. Método: Foi realizado estudo com base em laudos de autópsias de pacientes com cirrose hepática alcoólica, sendo estudados aortas e fígados para verificar a ocorrência e a intensidade de aterosclerose, bem como a quantidade de colágeno encontrada. Resultados: A aterosclerose microscópica foi maior em jovens (lesão inicial) e em pacientes com cirrose hepática alcoólica. A análise macroscópica da aterosclerose nas aortas mostrou que pacientes com faixas etárias mais avançadas apresentaram classificações mais intensas. A aterosclerose, tanto micro quanto macroscopicamente, e a porcentagem de fibrose no fígado e na aorta foram mais expressivas no gênero feminino. Conclusão: Os pacientes cirróticos apresentaram maior porcentagem de fibrose e lipidose, e podem representar um grupo susceptível à acelerada progressão de doenças cardiovasculares. Estudos investigativos contribuem para o direcionamento das intervenções promotoras da saúde, reduzindo a mortalidade e os custos no tratamento das doenças cardiovasculares.

The Beneficial Effect of Renin-Angiotensin-Aldosterone System Blockade in Marfan Syndrome Patients after Aortic Root Replacement

PURPOSE: In this study, we evaluated the long term beneficial effect of Renin-Angiotensin-Aldosterone System (RAAS) blockade therapy in treatment of Marfan aortopathy. MATERIALS AND METHODS: We reviewed Marfan syndrome (MFS) patients who underwent aortic root replacement (ARR) between January 1996 and January 2011. All patients were prescribed beta-blockers indefinitely. We compared major aortic events including mortality, aortic dissection, and reoperation in patients without RAAS blockade (group 1, n=27) to those with (group 2, n=63). The aortic growth rate was calculated by dividing the diameter change on CT scans taken immediately post-operatively and the latest scan available. RESULTS: There were no differences in clinical parameters except for age which was higher in patients with RAAS blockade. In group 1, 2 (7%) deaths, 5 (19%) aortic dissections, and 7 (26%) reoperations occurred. In group 2, 3 (5%) deaths, 2 (3%) aortic dissections, and 3 (5%) reoperations occurred. A Kaplan-Meier plot demonstrated improved survival free from major aortic events in group 2. On multivariate Cox, RAAS blockade was an independent negative predictor of major aortic events (hazard ratio 0.38, 95% confidence interval 0.30-0.43, p=0.002). Mean diameter change in descending thoracic and supra-renal abdominal aorta was significantly higher in patients without RAAS blockade (p<0.05). CONCLUSION: In MFS patients who underwent ARR, the addition of RAAS blockade to beta-blocker was associated with reduction of aortic dilatation and clinical events.

Sex-specific parameters of ascending aorta, descending aorta and pulmonary trunk by computed tomographic angiography with impact of age, hypertension, smoking and diabetes / Parámetros específicos de la parte ascendente de la aorta, parte descendente de la aorta y tronco pulmonar analizados mediante angiografía por tomografía computadorizada relacionados con el sexo, impacto de la edad, hipertensión, tabaquismo y diabetes

This study aims at establishing whether transverse diameter (TD) and cross sectional-area (CSA) of the ascending aorta (AA), descending aorta (DA) and pulmonary trunk (PT) measured by computerized tomographic angiography (CTA) altered by sex, age, hypertension, smoking and diabetes. CTA examinations of the TD and CSA of the AA, DA and PT of 100 patients aged 49.5±16.9 years (range 16­78 years) selected between January 2009 to May 2011 from those referred to Radiology Department, Jordan University Hospital, Faculty of Medicine, University of Jordan, Amman, Jordan for advanced evaluation. Measurements were made in the axial plane at the upper border of the six thoracic vertebrae. Patients were divided into three age groups. Significance of differences in parameters between age groups was calculated. Assessment ratios were considered. It was found that parameters of the three arteries were significantly larger in men than in women (P= < 0.05) and increased with age. Hypertension increased diameters of AA and DA in both genders (P= 0.001) and of PT in men (P= 0.01). Smoking significantly decreased parameters of PT in men (P= 0.01). Diabetes increased parameters of the three arteries in both genders, significantly increased parameters of PT in men (P= <0.05) and parameters of DA in women (P= <0.05). It is concluded that studied parameters were larger in men and increased with age of our patients. Distinctive differences in measurements appeared in hypertensive, smokers, and diabetic patients.

El objetivo fue determinar si el sexo, edad, hipertensión, tabaquismo y la diabetes alteran el diámetro transversal (DT) y área transversal (AT) de la parte ascendente de la aorta (AA), parte descendente de la aorta (AD) y tronco pulmonar (TP), medidos por angiografía por tomografía computadorizada (ATC). Exámenes de ATC de 100 pacientes de 49,5±16,9 años (rango 16­78 años) fueron seleccionados entre enero del año 2009 a mayo del año 2011 por el Departamento de Radiología, Hospital de la Universidad de Jordania, Facultad de Medicina de la Universidad de Jordania, Amman, Jordania para una evaluación avanzada del DT y AT de la AA, AD y TP. Las mediciones se realizaron en el plano axial en el margen superior de las seis vértebras torácicas. Los pacientes fueron divididos en tres grupos según edad. Se determinó la existencia de significancia estadística de los diferentes parámetros entre los grupos etarios. La evaluación de las razones también fueron consideradas. Se encontró que los parámetros de las tres arterias fueron significativamente mayores en los hombres que en las mujeres (p= <0,05) y que aumentaron con la edad. La hipertensión aumentó los diámetros de la AA y AD en ambos sexos (p= 0,001) y del TP en los hombres (p= 0,01). En fumadores disminuyeron significativamente los parámetros del TP en los hombres (p= 0,01). La diabetes aumentó los parámetros de las tres arterias en ambos sexos. Ademas, aumentaron significativamente los parámetros del TP en los hombres (p= <0,05) y los parámetros de la AD en las mujeres (p = <0,05). Se concluye que los parámetros estudiados eran mayores en los hombres y aumentaron con la edad de nuestros pacientes. Diferencias distintivas en las mediciones aparecieron en hipertensos, fumadores y pacientes diabéticos.

Representações sociais de educação em saúde em tempos de AIDS / Social representations of health education in a time of AIDS / Representaciones sociales de educación para la salud en la era del SIDA

Estudo qualitativo e descritivo, cujo objetivo foi identificar e analisar as representações sociais de educação em saúde à pessoa vivendo com HIV entre profissionais de saúde. Os cenários foram três serviços de atenção à DST/HIV/AIDS, em Belém-PA, Brasil, e 37 profissionais de saúde participaram da pesquisa. A coleta de dados deu-se em 2012-2013 por meio de entrevista em profundidade; a análise utilizou o software Alceste 4.10. Com base no conjunto dos resultados foi possível vislumbrar que a educação em saúde pode ser compreendida a partir de categorias: a configuração do agir educativo; as condições sine qua non: educação no trabalho e estrutura da unidade; o processo pedagógico. Conclui-se que as representações sociais configuram-se como orientação-informação para precaução-prevenção e revelam-se no movimento do agir persistente ao emergente, o que suscita uma educação em saúde permanente para se chegar à integralidade nos serviços.

This is a qualitative and descriptive study, which aimed at identifying and analyzing social representations of health education to HIV patients among health professionals. The setting included three healthcare DST/HIV/AIDS services in Belém-PA, Brazil, and 37 health professionals participated in the study. Data collection was conducted in 2012-2013 on the basis of in-depth interviews and analysis was made on Alceste 4.0 software. Final results indicated that health education can be comprehended in light of categories: educational action; sine qua non: education and training at work, and unit structure; teaching-learning process. Conclusions show that social representations are set as guidance-information for precaution-prevention and that they come forth along continuous and emerging action flow, bringing about permanent health education to ensure healthcare services in full.

Estudio cualitativo y descriptivo, que objetivó identificar y analizar las representaciones sociales de educación en salud a la persona viviendo con HIV entre profesionales de salud. Los escenarios fueron tres servicios de atendimiento al DST/HIV/ SIDA, en Belém-PA, Brasil, y 37 profesionales de salud participaran del estudio. La colecta de datos se dio en 2012-2013, por medio de entrevista en profundidad y el análisis utilizo el software Alceste 4.10. Con base en el conjunto de los resultados fue posible vislumbrar que la educación en salud puede ser comprendida a partir de categorías: la configuración del acto educativo; las condiciones sine qua non: educación en el trabajo y estructura de la unidad; el proceso pedagógico. Se concluye que las representaciones sociales se configuran como orientación-información para precaución-prevención y se revelan en el movimiento del acto persistente al emergente, lo que suscita una educación en salud permanente para llegarse a la integralidad en los servicios.

Aortic Pathologies and Pregnancy: A Special Focus on Connective Tissue Disorders.

Pregnancy represents a physiological status which, due to clear and typical hormonal and hemodynamic changes, is frequently accompanied by a high morbidity of aortic structures, in all of its segments. Such morbidity might become patent when a pregestational situation exists, especially with the mother suffering from connective tissue disorders. Nevertheless, morbid occurrences that will be met only during pregnancy are well known, with particular pathophysiological and etiological theories, as well as a diversity of treatments proposed in such an unusual setting. The authors discuss the main pathologies of aorta that are seen during pregnancy, from a theoretical point of view, and from a historical perspective as well. A special focus is made to the connective tissue disorders, and the theoretical considerations are illustrated with images of dissecting aneurysms of aorta.

Indicators of surgical treatment of patent ductus arteriosus in preterm neonates in the first week of life / Indicadores para o tratamento cirúrgico na persistência do ducto arterial em neonatos prematuros na primeira semana de vida

OBJECTIVE: To identify clinical and echocardiographic indicators of the necessity for early surgical closure of patent ductus arteriosus in preterm neonates. METHODS: The prospective study was conducted at the Neonatal Unit of Hospital Municipal Odilon Behrens between 2006 and 2010. The study population comprised 115 preterm neonates diagnosed with patent ductus arteriosus in the first week after birth, of whom 55 (group S) were submitted to clinical and or surgical closure and 60 (group NS) received non-surgical treatment. The parameters analyzed were birth weight, diameter of the ductus arteriosus (DAD), left atrial-to-aortic root diameter ratio (LA:Ao), the quotient of DAD² and birth weight (mm²/kg), and ductal shunting. RESULTS: The study population comprised 58 males and 57 females. The average birth weight of group S (924 ± 224.3 g) was significantly (P=0.049) lower than that of group NS (1012.3 ± 242.8 g). The probability of the preterm neonates being submitted to surgical closure was 62.1% (P=0.006) when the DAD2/birth weight index was > 5 mm²/kg, 72.2% (P=0.001) when the LA:Ao ratio was > 1.5, and 61.2% when ductal shunting was high (P=0.025). CONCLUSION: The parameters DAD²/birth weight index > 5 mm²/kg, LA:Ao ratio > 1.5 and high ductal shunting were statistically significant indicators (P<0.05) of the need for surgical closure of patent ductus arteriosus in low birth weight preterm neonates. Moreover, when an LA:Ao ratio > 1.5 was associated with the occurrence of shock, the probability of surgical closure increased to 78.4%.

OBJETIVO: Identificar parâmetros clínicos e ecocardiográficos para a indicação do tratamento cirúrgico precoce da persistência do ducto arterial. MÉTODOS: Esse estudo prospectivo foi conduzido na Unidade Neonatal do Hospital Municipal Odilon Behrens entre 2006 e 2010. A população estudada compreendeu 115 neonatos prematuros diagnosticados com persistência do ducto arterial na primeira semana após o nascimento, dos quais 55 (grupo S) foram submetidos ao tratamento clínico e ou cirúrgico e 60 (grupo NS) ao tratamento clínico. Os parâmetros analisados foram peso ao nascer, diâmetro do ducto arterial (DAD), relação diâmetro do átrio esquerdo pelo diãmetro da aorta (AE/Ao), índice DAD2/peso ao nascer e fluxo no ducto. RESULTADOS: O estudo abrangeu 58 pacientes do sexo masculino e 57 do feminino. O peso médio ao nascer do grupo S (924 ± 224,3 g) foi significativamente (P=0,049) menor do que do grupo NS (1012,3 ± 242,8 g). A probabilidade dos neonatos prematuros serem submetidos à cirurgia foi 62.1% (P=0,006) quando o índice DAD2/peso ao nascer era > 5 mm2/kg, 72,2% (P=0,001) quando a razão LA:Ao era > 1,5 e 61,2% (P=0,025) quando o fluxo no ducto era alto. CONCLUSÃO: Os parâmetros DAD²/peso ao nascer > 5 mm²/kg, razão LA:Ao > 1,5 e alto fluxo no ducto foram preditores estatisticamente significativos (P<0,05) da necessidade de fechamento cirúrgico do persistência do ducto arterial em neonatos prematuros com baixo peso ao nascer. Adicionalmente, quando a razão LA:Ao > 1,5 estava associada ao choque, a probabilidade de tratamento cirúrgico aumentou para 78,4%.

Histological and histochemical studies of the aorta and pulmonary trunk in STZ-induced diabetic wistar rats treated with momordica charantia / Estudio histológico e histoquímico de la aorta y el tronco pulmonar en ratas wistar diabéticas inducidas por STZ y tratadas con momordica charantia

Diabetes mellitus (DM) is a serious metabolic disorder with micro and macro-vascular complications that result in a significant morbidity and mortality. The present study investigated the effects of Momordica charantia (M. charantia) on histological changes of the aorta and pulmonary trunk in streptozotocin-induced diabetic Wistar rats. Forty healthy adult Wistar rats of both sexes were randomly assigned into five groups A, B, C, D and E of eight rats each. Group A were the control (normal rats); B were the experimentally-induced diabetic rats; C were diabetic rats treated with methanolic extracts of M. charantia for two weeks (withdrawal group); D were diabetic rats treated with methanolic extracts of M. charantia for four weeks. E was diabetic rats treated glimepiride for four weeks. Tissues were harvested, processed routinely in paraffin wax and stained with routine and special stains. Histological results revealed morphological alterations in the aorta and pulmonary trunk of diabetic rats. Histochemical analysis also revealed abnormal deposition of glycogen in these vessels of diabetic rats. M. charantia and glimperide attenuated the morphological alterations and reduced the glycogen deposits. In conclusion M. charantia has a promising ameliorative effect on the morphology of the aorta and pulmonaty trunk in STZ-induced diabetic wistar rats and by extension, may be relevant in the management of cardiovascular alteration associated with DM.

La diabetes mellitus (DM) es una enfermedad metabólica grave con complicaciones micro y macro vasculares que resultan en una significativa morbilidad y mortalidad. El presente estudio investigó los efectos de Momordica charantia (M. charantia) sobre los cambios histológicos de la aorta y el tronco pulmonar en ratas Wistar con diabetes inducida por estreptozotocina. Cuarenta ratas Wistar adultas sanas de ambos sexos fueron asignadas al azar en cinco grupos A, B, C, D y E, 8 ratas cada grupo. El grupo A fue control (ratas normales); el grupo B fue de ratas diabéticas inducidas experimentalmente; el grupo C fue de ratas diabéticas tratadas con extractos metanólicos de M. charantia por dos semanas (grupo de retirada); grupo D fue de ratas diabéticas tratadas con extractos metanólicos de M. charantia durante cuatro semanas, y el grupo E fue de ratas diabéticas tratadas con glimepirida durante cuatro semanas. Los tejidos obtenidos se incluyeron en parafina y se tiñeron con técnica de rutina y tinciones especiales. Los resultados histológicos revelaron alteraciones morfológicas en la aorta y el tronco pulmonar de las ratas diabéticas. El análisis histoquímico reveló también la deposición anormal de glucógeno en estos vasos de ratas diabéticas. Tanto M. charantia y glimperida atenuaron las alteraciones morfológicas y redujeron los depósitos de glucógeno. En conclusión, la M. charantia tiene un efecto de mejora prometedor sobre los cambios en la morfología de la aorta y el tronco pulmonar en ratas Wistar diabéticas inducidas por STZ y, por extensión, pueden ser relevantes en el manejo de alteraciones cardiovasculares asociadas con la DM.

Intervenciones de enfermería al paciente durante el retiro del balón de contrapulsación intraaórtico / Nursing interventions to the patient during removal of intra-aortic balloon counterpulsation", "_i": "

La utilización de la tecnología en la atención de las personas en estado crítico busca mejorar su condición de salud. Ante este escenario, el profesional de enfermería debe poseer las competencias esenciales y específicas para otorgar cuidados de calidad y seguridad, incluso requiere demostrar autonomía en la toma de decisiones en el ámbito de su competencia profesional, factor que fortalece la valoración, el seguimiento e identificación de posibles complicaciones. Por lo tanto, en el presente artículo se abordan las intervenciones de enfermería oportunas dirigidas al paciente durante el retiro del balón de contrapulsación intraaórtico con la finalidad de establecer una guía que oriente la práctica segura, y así delimitar las complicaciones vasculares posteriores.

The use of technology in the care of people in critical condition seeks to improve their health. Given this scenario, the nursing professional must possess specific core competences to provide quality care and show autonomy in decision-making in the field of their professional competence, a factor that strengthens the assessment, monitoring and identification of complications. Therefore, this article addresses the appropriate nursing interventions directed to the patient during withdrawal of intra-aortic balloon counterpulsation in order to establish a guide that orients safe practice and thus keep down subsequent vascular complications.

Sudden death caused by aortic dissection: 63 cases of forensic pathological analysis / 法医学杂志

OBJECTIVE@#To explore the cause of death, clinical manifestations and forensic pathological features of death cases caused by aortic dissection.@*METHODS@#Sixty-three cases of aortic dissection were selected from forensic medical center, Sun Yat-sen University from 2001 to 2011 and retrospectively analyzed.@*RESULTS@#The patients were mostly young and middle-aged male, aged from 30 to 49 years old. The DeBakey type II was the most common pathological type and the main cause of death was pericardial tamponade. The most common symptom was abdominal pain. However, the location of aorta dissection did not always correlate with the location of pain. Some cases showed no obvious clinical symptoms. The rupture was usually located in ascending aorta with atherosclerosis and pathological changes of hypertension.@*CONCLUSION@#It is significant for diagnosis and evaluation the cause of death of aortic dissection by knowing the clinical symptoms and forensic pathological features.

Anesthetic management of a patient with Marfan syndrome and severe aortic root dilatation undergoing cholecystectomy and partial hepatic resection

Due to high mortality associated with aortic dissection, anesthetic management of patients with Marfan syndrome with severe aortic root dilation is a challenging situation. We describe the anesthetic management of a patient with Marfan syndrome with severe aortic root dilation, who required major surgery like cholecystectomy with partial liver resection under general anesthesia. A 47-year-old female presented to pre-anesthetic clinic for cholecystectomy with partial hepatic resection for gall bladder carcinoma. Clinical features, transthoracic echocardiography and computed tomography of thorax supported a diagnosis of Marfan syndrome with severely dilated aortic root. Aortic dissection in patients with Marfan syndrome and severely dilated aortic root can be precipitated by major hemodynamic changes under anesthesia. Careful hemodynamic monitoring and avoidance of hemodynamic swings can prevent this life-threatening event

Aortic runoff as a sign of intracranial arteriovenous malformation: report of two cases

Intracranial arteriovenous malformation rarely causes pulmonary hypertension and congestive heart failure in the newborn. Its diagnosis is challenging because cardiomegaly may suggest an intra-cardiac structural lesion. We present two newborns, one 2-day-old male and the other 11-day-old female, with intracranial arteriovenous malformation and misdiagnosis of congenital heart disease. Precise echocardiography revealed the secondary signs of cranial arteriovenous malformation and had the major role in early diagnosis