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1.
Rev. chil. cardiol ; 39(1): 24-33, abr. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1115446

ABSTRACT

INTRODUCCIÓN: Los ratones SR-B1 KO/ApoER6 1h/h que son alimentados con una dieta rica en grasas saturadas, desarrollan enfermedad coronaria aterosclerótica severa, complicaciones isquémicas e insuficiencia cardíaca, con alta mortalidad. Los estudios con este modelo se han enfocado fundamentalmente en la enfermedad coronaria y menos en el remodelado cardíaco. El OBJETIVO del trabajo ha sido caracterizar el remodelado miocárdico, evaluar la evolución temporal de la función ventricular izquierda y la sobrevida asociada a enfermedad cardíaca por ateromatosis. MÉTODO: Ratones homocigotos SR-B1 KO/ApoER6 1h/h fueron alimentados por 8 semanas con dieta aterogénica o dieta normal y se comparó la sobrevida en ambos grupos. A las 4 semanas se realizó un ecocardiograma bidimensional. En los ratones eutanasiados se evaluó en la pared cardíaca fibrosis miocárdica y tamaño de los cardiomiocitos por morfometría, apoptosis con técnica de TUNEL e infiltración por células inflamatorias mononucleares (ED1) por inmunohistoquímica. RESULTADOS: En el grupo que recibió dieta aterogénica la sobrevida se redujo en 46,7% (p < 0.001), debido a muerte súbita y a falla cardíaca progresiva. En este grupo, a las 4 semanas se observó dilatación de cavidades izquierdas y disminución de la fracción de eyección del ventrículo izquierdo en comparación con el grupo control (79,3 ± 1,3% vs 66 ± 3,7%, p<0,01). También se observó aumento de la masa cardíaca relativa de 2.1 veces (p<0,001) y del peso pulmonar relativo en 80% (p<0,001), sin cambios en las dimensiones de los cardiomiocitos. En el miocardio de los ratones que recibieron dieta aterogénica hubo un aumento de la fibrosis cardíaca de 7.9 veces (p < 0.01) y del número de cardiomiocitos apoptóticos en 55.9 veces (p < 0.01), junto a un aumento del número de células inflamatorias mononucleares ED1. CONCLUSIONES: En el modelo de falla cardíaca severa de etiología isquémica con alta mortalidad en el ratón homocigoto SR-B1 KO/ApoER6 1h/h sometido a una dieta aterogénica, con falla cardíaca izquierda por disfunción sistólica, el remodelado patológico del miocardio está dado fundamentalmente por apoptosis y fibrosis. También se observa un aumento discreto de macrófagos en la pared cardíaca. Es posible que el edema parietal también pueda ser un mecanismo de remodelado relevante en este modelo.


Abstract: SR-B1 KO/ApoER6 1h/h mice fed a high saturated fat diet develop severe coronary atheromatosis, and cardiac failure with a high mortality rate. Cardiac remodeling under these conditions has not been well studied. AIM: To evaluate the time course of left ventricular function, cardiac remodeling and survival associated to the administration of an atherogenic diet. METHOD: Homozygote SR-B1 KO/ApoER6 1h/h mice received an atherogenic diet for 8 weeks. Mice receiving a normal diet served as controls. Survival rate, myocardial fibrosis, cardiomyocyte size, apoptosis and infiltration by inflammatory or mononuclear cells were compared between groups. A TUNEL technique was used to evaluate apoptosis. RESULTS: A 46.7% survival reduction compared to controls was observed in the experimental group (p<0.01), due to left ventricular and atrial dilatation associated to a decrease in ejection fraction (79,3 ± 1,3% vs 66 ± 3,7%, p<0,01, respectively). Also, an increased cardiac weight, 2.6 times greater was observed in the experimental group, compared to controls. Mice receiving the atherogenic diet showed an 80% increased lung weight. There was no evident change in cardiomyocytes, but there was more (7.9 times) cardiac fibrosis (p<0.01) and 55.9 times more apoptotic cells. (p<0.01), along with a greater number of inflammatory cells and ED1 mononuclear cells. CONCLUSION: Mice receiving an atherogenic diet develop heart failure and reduced survival rate. This is associated with cardiac remodeling with underlying apoptosis an ventricular wall fibrosis. It is posible that wall edema might contribute to the observed cardiac remodeling.


Subject(s)
Animals , Mice , Ventricular Remodeling , Diet, Atherogenic , Heart Failure/etiology , Hyperlipidemias/pathology , Ischemia/etiology , Fibrosis , Survival Analysis , Ventricular Function, Left , Apoptosis , Mice, Knockout , Ventricular Dysfunction , Disease Models, Animal , Heart Failure/physiopathology , Heart Failure/mortality , Heart Failure/pathology , Ischemia/physiopathology , Ischemia/mortality , Ischemia/pathology
2.
Rev. Assoc. Med. Bras. (1992) ; 65(8): 1067-1073, Aug. 2019. graf
Article in English | LILACS | ID: biblio-1041054

ABSTRACT

SUMMARY OBJECTIVE Diabetes is a risk factor for acute kidney injury (AKI). However, its mechanism of pathogenesis has not been elucidated. The aim of the study was to investigate the role of inflammation and the toll-like receptor 7 (TLR7) in ischemic AKI for diabetes. METHODS A high glucose hypoxia-reoxygenation model of human renal tubular epithelial (HK-2) cells was used to generate AKI induced by ischemia-reperfusion in diabetes. The activity of cells was measured by CCK-8 assay and LDH activity. Inflammatory cytokines were assessed by ELISA. TLR7, MyD88, and NF-κB expressions were examined by western blotting. Apoptosis was evaluated by flow cytometry. RESULTS The high glucose group and low glucose group were subjected to hypoxia-reoxygenation. The low glucose group developed only mild cell damage, apoptosis, and inflammatory response. In contrast, an equivalent hypoxia-reoxygenation injury provoked severe cell damage, apoptosis, and inflammatory response in the high glucose group. Expression of TLR7 and its related proteins were measured in the high glucose group before and after hypoxia-reoxygenation. The high glucose group exhibited more significant increases in TLR7 expression following hypoxia-reoxygenation than the low glucose group. In addition, the expression of TLR7 and its related proteins after hypoxia-reoxygenation were higher in the high glucose group than in the low glucose group. Inhibition of TLR7 provides significant protection against ischemic injury in diabetes. CONCLUSION Our results suggest that diabetes increases the vulnerability to ischemia-induced renal injury. This increased vulnerability originates from a heightened inflammatory response involving the TLR7 signal transduction pathway.


RESUMO OBJETIVO O diabetes é um fator de risco para a lesão renal aguda (LRA). No entanto, seu mecanismo de patogênese não foi elucidado. O objetivo do estudo foi investigar o papel da inflamação e do receptor Toll-like 7 (TLR7) na LRA isquêmica no diabetes. MÉTODOS Um modelo de hipóxia-reoxigenação de células epiteliais tubulares renais humanas (HK-2) na presença de concentrações altas de glicose foi utilizado para gerar LRA induzida por isquemia-reperfusão em diabetes. A atividade das células foi medida pelo ensaio Cell Counting Kit-8 (CCK-8) e pela atividade da lactato desidrogenase (LDH). As citocinas inflamatórias foram avaliadas por ensaio imunoenzimático (Elisa). A expressão de TLR7, do fator de diferenciação mieloide 88 (MyD88) e do fator de transcrição nuclear-κB (NF-κB) foi examinada por Western blotting. A apoptose foi avaliada por citometria de fluxo. RESULTADOS Os grupos glicose alta e glicose baixa foram submetidos à hipóxia-reoxigenação. O grupo de baixa glicose desenvolveu apenas danos celulares ligeiros, apoptose e uma resposta inflamatória. Em contraste, no grupo de alta glicose, uma lesão equivalente de hipóxia-reoxigenação provocou danos celulares graves, apoptose e uma resposta inflamatória. A expressão de TLR7 e suas proteínas relacionadas foi medida no grupo de alta glicose antes e após a hipóxia-reoxigenação. O grupo de alta glicose exibiu maiores aumentos na expressão de TLR7 após hipóxia-reoxigenação do que o grupo de baixa glicose. Além disso, a expressão de TLR7 e suas proteínas relacionadas após a hipóxia-reoxigenação foi maior no grupo com alto nível de glicose do que no grupo com baixo nível de glicose. A inibição do TLR7 fornece proteção significativa contra a lesão isquêmica no diabetes. CONCLUSÃO Nossos resultados sugerem que o diabetes aumenta a vulnerabilidade à lesão renal induzida por isquemia. Essa vulnerabilidade acrescida tem por origem uma resposta inflamatória aumentada envolvendo a via de transdução de sinal do TLR7.


Subject(s)
Humans , Diabetes Mellitus/metabolism , Toll-Like Receptor 7/metabolism , Acute Kidney Injury/metabolism , Ischemia/metabolism , Transfection , Signal Transduction , Cells, Cultured , RNA, Small Interfering , Diabetes Mellitus/physiopathology , Toll-Like Receptor 7/physiology , Acute Kidney Injury/physiopathology , Flow Cytometry , Ischemia/physiopathology
3.
Acta cir. bras ; 33(8): 723-735, Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-949372

ABSTRACT

Abstract It is well known that during hepatic operative procedures, it is often critical that the irrigation is interrupted to avoid possible bleeding, blood transfusions, variable intensities, and their short and long-term consequences. It was believed in the past that the flow interruption should not exceed 20 minutes, which limited the use of this maneuver. However, it has been postulated that ischemia could be maintained for more than 60 minutes in healthy livers. The present paper review includes: 1) A brief introduction to justify the rationale of the review design; 2) Aspects of the pathophysiology of the three stages of the liver ischemia-reperfusion injury; 3) The innate and acquired immunity; 4) Oxidative stress; 5) Apoptosis and autophagy, Some essential biomarkers (Tumor Necrosis Factor-α, nitric oxide, metalloproteinases); and, finally; 6) Preventive ("cheating") strategies, non-pharmacological and pharmacological options to treat the liver IR injury.


Subject(s)
Humans , Reperfusion Injury/physiopathology , Reperfusion Injury/therapy , Ischemic Preconditioning/methods , Ischemia/physiopathology , Ischemia/therapy , Liver/blood supply , Time Factors , Mitochondria, Liver/metabolism , Reperfusion Injury/metabolism , Tumor Necrosis Factor-alpha/metabolism , Cell Death/physiology , Oxidative Stress/physiology , Matrix Metalloproteinases/metabolism , Ischemia/metabolism , Nitric Oxide/metabolism
4.
Braz. j. med. biol. res ; 51(4): e7058, 2018. tab, graf
Article in English | LILACS | ID: biblio-889071

ABSTRACT

This study aimed to evaluate the feasibility and repeatability of the flash-replenishment method in contrast-enhanced ultrasound (CEUS) perfusion imaging and assess quantitatively microvascular perfusion in the liver. Twenty healthy New Zealand rabbits were submitted to CEUS perfusion imaging with continuous intravenous infusion. Using flash-replenishment kinetics, the dynamic process of depletion and refilling of microbubble contrast agent was recorded. The hepatic microvascular perfusion parameters were calculated, including region of interest, peak intensity (PI), area under the curve (AUC), and hepatic artery to vein transit time (HA-HVTT). A consistency test was performed for multiple measurements by the same operator and blind measurements by two different operators. The hepatic perfusion imaging of 3×108 bubbles/min had minimal error and the best imaging effect and repeatability. The variability of the perfusion parameter measured at 3 cm depth under the liver capsule was at a minimum with coefficient of variation of 3.9%. The interclass correlation coefficient (ICC) of measurements taken by the same operator was 0.985, (95% confidence interval, CI=0.927-0.998). Measurements taken by two operators had good consistency and reliability, with the ICC of 0.948 (95%CI=0.853-0.982). The PI and AUC of liver parenchyma after reperfusion were lower than before blocking; and HA-HVTT was significantly longer than before blocking (P<0.05). The flash-replenishment method in CEUS perfusion imaging showed good stability and repeatability, which provide a valuable experimental basis for the quantitative assessment of hepatic microvascular perfusion in clinical practice.


Subject(s)
Animals , Male , Female , Rabbits , Reperfusion Injury/diagnostic imaging , Ultrasonography/methods , Ischemia/physiopathology , Liver/blood supply , Liver Circulation/physiology , Blood Flow Velocity , Image Enhancement/methods , Random Allocation , Feasibility Studies , Reproducibility of Results , Contrast Media , Disease Models, Animal , Liver/diagnostic imaging , Microcirculation
5.
Int. braz. j. urol ; 43(6): 1075-1083, Nov.-Dec. 2017. tab
Article in English | LILACS | ID: biblio-892933

ABSTRACT

ABSTRACT Objectives: Based on imaging features, nephrometry scoring systems have been conceived to create a standardized and reproducible way to characterize renal tumor anatomy. However, less is known about which of these individual measures are important with regard to clinically relevant perioperative outcomes such as ischemia time (IT), estimated blood loss (EBL), length of hospital stay (LOS), and change in estimated glomerular filtration rate (eGFR) after robotic partial nephrectomy (PN). We aimed to assess the utility of the RENAL and PADUA scores, their subscales, and C-index for predicting these outcomes. Materials and Methods: We analyzed imaging studies from 283 patients who underwent robotic PN between 2008 and 2014 to assign nephrometry scores (NS): PADUA, RENAL and C-index. Univariate linear regression was used to assess whether the NS or any of their subscales were associated with EBL or IT. Multivariable linear regression and linear regression models were created to assess LOS and eGFR. Results: The three NS were significantly associated with EBL, IT, LOS, and eGFR at 12 months after surgery. All subscales with the exception of anterior/posterior were significantly associated with EBL and IT. Collecting system, renal rim location, renal sinus, exophytic/endophytic, and nearness to collecting system were significant predictors for LOS. Only renal rim location, renal sinus invasion and polar location were significantly associated with eGFR at 12 months. Conclusions: Tumor size and depth are important characteristics for predicting robotic PN outcomes and thus could be used individually as a simplified way to report tumors features for research and patient counseling purposes.


Subject(s)
Humans , Male , Female , Robotic Surgical Procedures , Glomerular Filtration Rate/physiology , Kidney Neoplasms/surgery , Nephrectomy/methods , Retrospective Studies , Blood Loss, Surgical , Treatment Outcome , Tumor Burden , Ischemia/etiology , Ischemia/physiopathology , Kidney Neoplasms/physiopathology , Middle Aged , Neoplasm Staging
6.
Int. j. cardiovasc. sci. (Impr.) ; 30(3): f:207-l:218, mai.-jun. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-836675

ABSTRACT

Fundamento: Embora muitas pesquisas tenham sido conduzidas com um determinado antioxidante ou mPTP individualmente, pouca atenção tem sido dada para os efeitos da co-administração de um antioxidante e um inibidor de mPTP sobre a disfunção cardíaca após a lesão de I/R. Objetivos: Este estudo objetiva determinar os efeitos do ácido gálico (como antioxidante) combinado com a ciclosporina A (CsA) (como inibidor de mPTP) na função cardíaca e endotelial na disfunção induzida por I/R (função de NO). Métodos: Ratos Wistar machos foram pré-tratados com ácido gálico (7,5, 15 ou 30 mg.kg-1 de peso corporal, diariamente) por um período de 10 dias. Em seguida, o coração foi isolado e exposto a isquemia de 30 minutos e perfundido por CsA (0,2 µM) 20 min durante o período de reperfusão. Resultados: Os dados mostraram que o tamanho do infarto foi significativamente diminuído por CsA e ácido gálico sozinho (p < 0,05, ANOVA unidirecional seguido de teste LSD). A combinação de ambos os fármacos, entretanto, apresentou efeitos de melhora mais significativos (p < 0,001). A combinação destes dois fármacos melhorou mais significativamente a taxa máxima de aumento e de queda da pressão ventricular (± dp.dt-1 máx), o duplo produto (DP), a pressão ventricular esquerda desenvolvida (PVED), a frequência cardíaca e o fluxo coronário quando comparada à aplicação de apenas um deles (p < 0,05, medidas repetidas ANOVA seguidas de teste de LSD). Conclusões: Em conclusão, o benefício de um antioxidante concomitante com um inibidor da mPTP poderia ter efeitos mais benéficos sobre a disfunção cardíaca induzida pela lesão I/R


Background: Although many researches have been conducted on either a certain antioxidant or mPTP individually, little attention has been drawn to the effects of co-administration of an antioxidant and mPTP inhibitor together on cardiac dysfunction after I/R injury. Objectives: This study aims at determining the effects of gallic acid (as Antioxidant) combined with cyclosporine A (CsA) (as mPTP inhibitor) on I/R induced cardiac and endothelial (role of NO) dysfunction. Methods: Male Wistar rats were pretreated with gallic acid (7.5, 15, or 30mg.kg-1 body weight, daily) for a period of 10 days. Then, the heart was isolated and exposed to 30-minute ischemia and perfused by CsA (0.2 µM) 20 min during reperfusion period. Results: The data have shown that infarct size was decreased significantly by CsA and gallic acid alone (p < 0.05, one way ANOVA followed by LSD test), however the combination of both drugs had more significant improving effects (p < 0.001). The combination of these two drugs improved more significantly maximum rate of rise and fall of ventricular pressure (±dp.dt-1 max), rate pressure product (RPP), left ventricular developed pressure (LVDP), heart rate and coronary flow rather than applying each one alone (p < 0.05, repeated measurement ANOVA followed by LSD test). Conclusion: In conclusion, benefiting from an antioxidant concomitant with an mPTP inhibitor could have more improving effects on the cardiac dysfunction induced by I/R injury


Subject(s)
Animals , Rats , Antioxidants , Cyclosporine/therapeutic use , Gallic Acid/therapeutic use , Ischemia/physiopathology , Rats , Reperfusion/methods , Analysis of Variance , Cardiovascular Diseases/physiopathology , Heart Rate , Heart/anatomy & histology , Models, Animal , Nitric Oxide Synthase , Reactive Oxygen Species , Ventricular Function
7.
Medicina (B.Aires) ; 77(2): 130-134, Apr. 2017. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-894447

ABSTRACT

Los protocolos que utilizan vasodilatadores para inducir isquemia en la centellografía de perfusión miocárdica han demostrado una exactitud diagnóstica elevada e incidencia muy baja de complicaciones graves. Sin embargo, el significado fisiológico y valor diagnóstico de diversas alteraciones electrocardiográficas asociadas al estrés vasodilatador ha sido escasamente evaluado más allá del segmento ST. Describimos cinco pacientes que presentan distorsión morfológica de la onda T en derivaciones electrocardiográficas torácicas asociada a diversos defectos de perfusión, discutiendo los potenciales aportes de estos cambios al diagnóstico y cuantificación de la isquemia miocárdica en los estudios de imagen que utilizan estrés con vasodilatadores.


The protocols using vasodilators to induce ischemia on myocardial perfusion scintigraphy have shown a high diagnostic accuracy and a very low incidence of serious complications. However, the physiological significance and diagnostic value of various electrocardiographic changes associated with vasodilator stress has not been deeply evaluated beyond the ST-segment. Five clinical cases presenting morphological distortion of the T-wave in electrocardiographic chest leads associated with varying degrees of perfusion defects are described, discussing potential contributions of these changes to the diagnosis and quantification of myocardial ischemia in imaging studies using vasodilator stress.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Stress, Physiological/drug effects , Vasodilator Agents/administration & dosage , Myocardial Perfusion Imaging/methods , Ischemia/diagnostic imaging , Electrocardiography , Ischemia/physiopathology , Ischemia/chemically induced
8.
Int. braz. j. urol ; 42(1): 118-122, Jan.-Feb. 2016. tab
Article in English | LILACS | ID: lil-777313

ABSTRACT

ABSTRACT Purpose Mean platelet volume (MPV) is used to measure platelet size and is defined as a potential marker of platelet reactivity. Higher MPV levels have been defined as a risk factor for increased incidence of intravascular thrombosis and its associated diseases. We aimed to determine whether a relationship exists between the MPV and veno-occlusive component of idiopathic ischemic priapism (IIP). Materials and methods Between 2010 and 2014, 38 subjects were analyzed in two groups. One was composed of 15 patients with diagnosis as IIP in our institute, and the other contained 23 healthy control subjects. Complete blood count reports were retrospectively evaluated in both groups. MPV, platelet count (PLT), platelet distribution width (PDW), white blood cells (WBC), red blood cells (RBC), hemoglobin (Hb), reticulocyte distribution width (RDW) were measured in both groups. : Results The mean ages were similar in IIP patients (45.86±15.82) and control subjects (47.65±10.99). The mean MPV values of IIP patients were significantly higher than control subjects (p<0.05). In contrast, also PLT counts were significantly lower in IIP patients, compared to control subjects (p<0.05). The mean hemoglobin and WBC values were significantly lower in control group (p<0.05). There was no significant difference of RBC, PDW and RDW values in both groups. Conclusions We found that the MPV was significantly higher in IIP patients compared to control subjects. The high MPV levels may have contributed to the veno-occlusive etiopathogenesis of IIP disease. We strongly suggest further prospective studies to recommend the use of MPV in routine practice.


Subject(s)
Humans , Male , Adult , Young Adult , Priapism/etiology , Priapism/blood , Blood Platelets/physiology , Mean Platelet Volume , Ischemia/etiology , Ischemia/blood , Priapism/physiopathology , Reference Values , Blood Cell Count , Blood Gas Analysis , Biomarkers/blood , Case-Control Studies , Retrospective Studies , Risk Factors , Statistics, Nonparametric , Ischemia/physiopathology , Middle Aged
9.
Einstein (Säo Paulo) ; 13(1): 129-135, Jan-Mar/2015. tab, graf
Article in English | LILACS | ID: lil-745869

ABSTRACT

Ischemia and reperfusion injury is an inevitable event in renal transplantation. The most important consequences are delayed graft function, longer length of stay, higher hospital costs, high risk of acute rejection, and negative impact of long-term follow-up. Currently, many factors are involved in their pathophysiology and could be classified into two different paradigms for education purposes: hemodynamic and immune. The hemodynamic paradigm is described as the reduction of oxygen delivery due to blood flow interruption, involving many hormone systems, and oxygen-free radicals produced after reperfusion. The immune paradigm has been recently described and involves immune system cells, especially T cells, with a central role in this injury. According to these concepts, new strategies to prevent ischemia and reperfusion injury have been studied, particularly the more physiological forms of storing the kidney, such as the pump machine and the use of antilymphocyte antibody therapy before reperfusion. Pump machine perfusion reduces delayed graft function prevalence and length of stay at hospital, and increases long-term graft survival. The use of antilymphocyte antibody therapy before reperfusion, such as Thymoglobulin™, can reduce the prevalence of delayed graft function and chronic graft dysfunction.


A lesão de isquemia e reperfusão é um evento inevitável no transplante de rim, tendo como consequências retardo na função do enxerto, aumento no tempo de hospitalização e dos custos, aumento no risco de rejeição aguda e potencial impacto negativo na evolução a longo prazo. Atualmente, vários fatores estão implicados na fisiopatologia da lesão de isquemia e reperfusão, podendo ser didaticamente divididos em dois paradigmas: hemodinâmico e imunológico. O paradigma hemodinâmico é classicamente descrito como a privação de oxigênio pela interrupção do fluxo sanguíneo, envolvendo diversos sistemas hormonais e pela produção de radicais livres de oxigênio após a reperfusão. O paradigma imunológico tem sido descrito mais recentemente e envolve as células do sistema imune, sobretudo as células T, como papel fundamental na lesão. De acordo com esses conceitos, novas estratégias de prevenção dos impactos da lesão de isquemia e reperfusão têm sido estudadas, especialmente formas mais fisiológicas de preservação do órgão, como a preservação em máquina de perfusão e o uso de anticorpos depletores de linfócitos antes da reperfusão. A perfusão em máquina reduz a prevalência de retardo na função do enxerto e o tempo de hospitalização, além de melhorar a sobrevida do enxerto a longo prazo. Já o uso de anticorpos depletores de linfócitos, como Timoglobulina®, antes da reperfusão, pode diminuir a prevalência de retardo na função do enxerto e a disfunção crônica do mesmo.


Subject(s)
Humans , Hemodynamics/physiology , Ischemia , Kidney Transplantation/adverse effects , Kidney/blood supply , Reperfusion Injury , Delayed Graft Function/physiopathology , Graft Rejection/physiopathology , Ischemia/immunology , Ischemia/physiopathology , Ischemia/prevention & control , Risk Factors , Reperfusion Injury/immunology , Reperfusion Injury/physiopathology , Reperfusion Injury/prevention & control , Time Factors
10.
Rev. bras. enferm ; 67(5): 759-765, Sep-Oct/2014. tab
Article in Portuguese | LILACS, BDENF | ID: lil-731225

ABSTRACT

Objetivou-se identificar o perfil sociodemográfico de idosos vítimas de trauma, caracterizar doenças preexistentes e medicamentos utilizados no domicílio; calcular índices de trauma e desfecho clínico. Estudo retrospectivo e exploratório, com a análise de dados secundários de um banco de dados de um hospital geral terciário, entre 2008 e 2010. Foram estudados 131 idosos, média de idade 69,9 anos, 73,3% homens, 55,1% casados, 54,7% aposentados; 65,6% possuíam doenças preexistentes e 48,9% usavam medicamentos no domicílio. Houve representatividade de quedas (31,3%), seguidas por atropelamento (28,2%), com cabeça/pescoço sendo a região mais acometida (59,5%). Prevaleceu o trauma moderado (44,3%), com condições de sobrevida após o evento (80,2%). Houve associação entre mecanismo do trauma e doença preexistente (p=0,01) e entre mecanismo do trauma e sexo (p=0,03). O conhecimento das variáveis envolvidas com idosos vítimas de trauma possibilita aos profissionais de saúde o planejamento de medidas preventivas, visando aprimorar sua assistência.


The objective was to identify the sociodemographic profile of the elderly victims of trauma, to characterize preexisting conditions and medications taken at home, and to calculate indices of trauma and clinical outcomes. This is a retrospective and exploratory analysis from a database of a general hospital between 2008 and 2010. There were studied 131 elderly, mean age 69.9 years, 73.3% male, 55.1% married, 54.7% retired, 65.6% had preexisting conditions and 48.9% used drugs at home. There was a representative number of falls (31.3%), followed by running over (28.2%), with the head/neck region being the most affected (59.5%). Moderate trauma prevailed (44.3%), with conditions of survival after the event (80.2%). There was an association between mechanism of trauma and preexisting disease (p=0.01) and between mechanism of trauma and sex (p=0.03). The knowledge of the variables involved with the elderly victims of trauma enables healthcare professionals to plan preventive measures aimed at improving the assistance. Key words: Aged; Wounds and Injuries; Disease; Drug Utilization.


Se objetivó identificar el perfil sociodemográfico de ancianos víctimas de trauma, caracterizar condiciones preexistentes y medicamentos tomados en casa, y calcular índices de trauma y evolución clínica. Se realizó un análisis retrospectivo y exploratorio de una base de datos de un hospital general terciario entre 2008 y 2010. Se estudiaron 131 ancianos, media of 69,9 años, 73,3% hombres, 55,1% casados, 54,7% jubilados, 65,6% tienen condiciones preexistentes y 48,9% estaban tomando medicación en casa. Hubo representación de las caídas (31,3%), seguido de atropello (28,2%). La región cabeza/cuello fue el más afectado (59,5%). Prevaleció trauma moderado (44,3%), con condiciones de supervivencia después del evento (80,2%). Se observó una asociación entre mecanismo de lo trauma y enfermedad previa (p=0,01) y entre mecanismo de lo trauma y sexo (p=0,03). El conocimiento de las variables que intervienen con ancianos víctimas de trauma permite a los profesionales de la salud planificar medidas preventivas para mejorar su asistencia.


Subject(s)
Animals , Male , Rats , Dobutamine/pharmacology , Jejunum/blood supply , Jejunum/drug effects , Solanaceous Alkaloids/pharmacology , Carbon Dioxide/metabolism , Intestinal Mucosa/blood supply , Intestinal Mucosa/drug effects , Ischemia/drug therapy , Ischemia/physiopathology , Rats, Sprague-Dawley , Regional Blood Flow/drug effects , Reperfusion Injury/drug therapy , Reperfusion Injury/physiopathology
11.
Braz. j. med. biol. res ; 47(10): 886-894, 10/2014. graf
Article in English | LILACS | ID: lil-722168

ABSTRACT

Administration or expression of growth factors, as well as implantation of autologous bone marrow cells, promote in vivo angiogenesis. This study investigated the angiogenic potential of combining both approaches through the allogenic transplantation of bone marrow-derived mesenchymal stem cells (MSCs) expressing human basic fibroblast growth factor (hbFGF). After establishing a hind limb ischemia model in Sprague Dawley rats, the animals were randomly divided into four treatment groups: MSCs expressing green fluorescent protein (GFP-MSC), MSCs expressing hbFGF (hbFGF-MSC), MSC controls, and phosphate-buffered saline (PBS) controls. After 2 weeks, MSC survival and differentiation, hbFGF and vascular endothelial growth factor (VEGF) expression, and microvessel density of ischemic muscles were determined. Stable hbFGF expression was observed in the hbFGF-MSC group after 2 weeks. More hbFGF-MSCs than GFP-MSCs survived and differentiated into vascular endothelial cells (P<0.001); however, their differentiation rates were similar. Moreover, allogenic transplantation of hbFGF-MSCs increased VEGF expression (P=0.008) and microvessel density (P<0.001). Transplantation of hbFGF-expressing MSCs promoted angiogenesis in an in vivo hind limb ischemia model by increasing the survival of transplanted cells that subsequently differentiated into vascular endothelial cells. This study showed the therapeutic potential of combining cell-based therapy with gene therapy to treat ischemic disease.


Subject(s)
Animals , Humans , Male , Extremities/blood supply , /metabolism , Gene Expression , Ischemia/physiopathology , Mesenchymal Stem Cell Transplantation , Mesenchymal Stem Cells/metabolism , Neovascularization, Physiologic/physiology , Antigens, Surface/analysis , Bone Marrow Cells/metabolism , Cell Differentiation , Disease Models, Animal , Green Fluorescent Proteins , Ischemia/therapy , Mesenchymal Stem Cells/cytology , Muscle, Skeletal/blood supply , Random Allocation , Rats, Sprague-Dawley , Transplantation, Homologous , Vascular Endothelial Growth Factor A/metabolism
12.
São Paulo; s.n; s.n; 2014. 145 p. tab, graf, ilus.
Thesis in Portuguese | LILACS | ID: biblio-847279

ABSTRACT

Bicarbonato é uma importante espécie química para os seres vivos, sendo o principal tampão celular, alem de apresentar uma negligenciada atividade redox. Isquemia é um evento no qual existe inibição do aporte de nutrientes e oxigênio, sendo a reperfusão o retorno do fluxo de nutrientes e oxigênio, que é acompanhada por alta produção de radicais livres e morte celular. Nessa tese estudamos o efeito da presença de bicarbonato durante a isquemia-reperfusão. Em nosso modelo nós mantivemos o pH constante e modulamos a quantidade de bicarbonato enquanto células, órgãos e animais foram submetidos a isquemia-reperfusão. Utilizamos condições sem a presença de bicarbonato, a concentração basal sanguínea e uma concentração mais alta simulando o acúmulo de bicarbonato em condições isquêmicas. Nesses diversos modelos mostramos que a presença de bicarbonato aumenta o dano provocado por isquemia-reperfusão e provoca um aumento do acúmulo de proteínas oxidadas. A presença do bicarbonato não modifica a respiração, produção de espécies reativas de oxigênio, ou a morfologia mitocondrial, também não detectamos mudança na atividade do proteassoma e nos indicadores de autofagia geral. Entretanto detectamos um acúmulo de marcadores autofágicos na fração mitocondrial indicando inibição da mitofagia. Essa inibição foi confirmada ao detectarmos o acúmulo de uma proteína degradada especificamente por mitofagia enquanto não houve mudança em outra degradada pelo proteassoma. Além disso, ao inibirmos farmacologicamente a autofagia, reproduzimos o fenótipo causado pelo bicarbonato mesmo na sua ausência. Em conclusão, a presença de bicarbonato é deletéria em condições de isquemia/reperfusão devido a inibição da mitofagia


Bicarbonate is an important molecule in all living being, acting as the main cellular buffer. However, its biological and redox activity has been mostly neglected to date. Ischemia is an event in which an inhibition of nutrient availablity and oxygen flow occurs, while reperfusion is the return of nutrients and oxygen, accompanied of a burst of reactive oxygen species production and cell death. Here, we studied the effects of bicarbonate during cardiac ischemia-reperfusion. In our model, we kept the pH stable and changed the concentration of the bicarbonate. We then subjected cells, organs and animals to ischemia-reperfusion under conditions where there was no presence, basal blood concentration or a higher concentration of bicarbonate. In these diverse models, we found that the presence of bicarbonate increased damage after a ischemia-reperfusion, and promoted the accumulation of oxidized proteins. Bicarbonate did not change respiration, production of reactive oxygen species or the morphology of the mitochondria. There were also no changes in proteasome activity and in global autophagy markers, although there was an accumulation of mitophagy markers. We also found that mitophagy was responsible for the increased damage observed, since pharmacological inhibiting of autophagy abolished the increased damage caused by the presence of bicarbonate. In conclusion the presence of bicarbonate is deleterious in ischemia-reperfusion due mitophagy inhibition


Subject(s)
Animals , Male , Female , Rats , Bicarbonates/analysis , Carbon Dioxide/analysis , Ischemia/physiopathology , Mitochondria , Mitophagy , Reperfusion
13.
Acta cir. bras ; 29(supl.3): 17-21, 2014. tab, graf
Article in English | LILACS | ID: lil-726242

ABSTRACT

PURPOSE: To evaluate effects of ischemic preconditioning and Cilostazol on muscle ischemia-reperfusion injury. METHODS: Male Wistar rats were submitted to muscle ischemic and reperfusion injury (4h of the left common iliac artery occlusion followed by 1h of reperfusion). Five experimental groups were constituted: Control group (n=4); Ischemia-Reperfusion (IR, n=5); Ischemic preconditioning group (IP, n=6); Ischemia-Reperfusion group treated with cilostazol (IRCi, n=6) and Ischemic preconditioning group treated with cilostazol (IPCi, n=6). At the end, left gracile muscle was removed and embedded in paraffin. Histopathology, neutrophil infiltration, myocyte necrosis and edema were analyzed. RESULTS: When compared with the control group, IR group showed increased neutrophil infiltration, severe necrosis and edema. There was significant difference between myocytes necrosis of IR group and IP group. There was no difference between the histopathological changes between IP, IRCi and IPCi groups. CONCLUSIONS: The model of IR caused severe muscle injury in the rat hind limb and ischemic preconditioning has a protective effect, reducing myocyte necrosis, however, treatment with cilostazol and also the association between cilostazol and preconditioning has no protective effect on the skeletal muscle subjected to ischemia and reperfusion injury. .


Subject(s)
Animals , Male , Ischemia/therapy , Ischemic Preconditioning/methods , Muscle, Skeletal/blood supply , Reperfusion Injury/therapy , Tetrazoles/pharmacology , Hindlimb , Ischemia/physiopathology , Ischemic Preconditioning/adverse effects , Models, Animal , Muscle Fibers, Skeletal/drug effects , Muscle Fibers, Skeletal/pathology , Muscle, Skeletal/physiopathology , /pharmacology , Random Allocation , Rats, Wistar , Reperfusion Injury/physiopathology
14.
Acta cir. bras ; 28(9): 657-663, Sept. 2013. ilus
Article in English | LILACS | ID: lil-684440

ABSTRACT

PURPOSE: To investigate the impact of selective hepatic artery clamping (SHAC) in hepatocellular function. METHODS: Three groups of Wistar male rats were subjected to SHAC ischemia period of 60min: Group A continuous SHAC were subjected to SHAC ischemia period of 60min, Group B intermittent SHAC of 30min with 5min of reperfusion and Group C intermittent SHAC of 15min with 5min of reperfusion. Animals without SHAC were included-Group D. To evaluate hepatocellular function blood markers and hepatic extraction function (HEF) using 99mTc-mebrofenin were performed before and after surgery. Flow cytometry was used to analyze oxidative stress and cell viability. RESULTS: A mortality rate of 7.6% in Group A was observed. HEF maintained normal values between the groups. Flow cytometry demonstrated no significant differences between the groups in viability, type of cell death as well as in the production of reactive oxygen species. CONCLUSIONS: The selective hepatic artery clamping compared to other clamping techniques results on increased cell viability and decreased hepatocyte death. The SHAC is a potential alternative to decrease per-operative bleeding while maintaining hepatocellular function.


Subject(s)
Animals , Male , Rats , Hepatic Artery/surgery , Hepatocytes/physiology , Liver/blood supply , Liver/cytology , Cell Survival , Constriction , Flow Cytometry , Ischemia/physiopathology , Models, Animal , Oxidative Stress , Peroxides/analysis , Rats, Wistar , Reperfusion , Reactive Oxygen Species/metabolism , Time Factors
15.
Article in English | WPRIM | ID: wpr-218257

ABSTRACT

OBJECTIVE: To evaluate the impact on wound healing and long-term clinical outcomes of endovascular revascularization in patients with critical limb ischemia (CLI). MATERIALS AND METHODS: This is a retrospective study on 189 limbs with CLI treated with endovascular revascularization between 2008 and 2010 and followed for a mean 21 months. Angiographic outcome was graded to technical success (TS), partial failure (PF) and complete technical failure. The impact on wound healing of revascularization was assessed with univariate analysis and multivariate logistic regression models. Analysis of long-term event-free limb survival, and limb salvage rate (LSR) was performed by Kaplan-Meier method. RESULTS: TS was achieved in 89% of treated limbs, whereas PF and CF were achieved in 9% and 2% of the limbs, respectively. Major complications occurred in 6% of treated limbs. The 30-day mortality was 2%. Wound healing was successful in 85% and failed in 15%. Impact of angiographic outcome on wound healing was statistically significant. The event-free limb survival was 79.3% and 69.5% at 1- and 3-years, respectively. The LSR was 94.8% and 92.0% at 1- and 3-years, respectively. CONCLUSION: Endovascular revascularization improve wound healing rate and provide good long-term LSRs in CLI.


Subject(s)
Adult , Aged , Aged, 80 and over , Analysis of Variance , Endovascular Procedures/adverse effects , Female , Foot/blood supply , Humans , Ischemia/physiopathology , Limb Salvage , Male , Middle Aged , Retrospective Studies , Risk Factors , Survival Rate , Treatment Outcome , Wound Healing/physiology
16.
Rev. bras. cardiol. (Impr.) ; 25(4): 330-339, jul.-ago. 2012.
Article in Portuguese | LILACS | ID: lil-652623

ABSTRACT

O estágio dos sintomas do paciente com doença isquêmica de membros inferiores determina o tipo detratamento. Apesar das terapias já conhecidas um grupo desses pacientes não é candidato ao tratamento cirúrgicoou continua com dor mesmo após o tratamento, o que afeta a sua qualidade de vida. O entendimento dosmecanismos moleculares envolvidos no desenvolvimento vascular possibilita respeitar e compreender os benefíciose limites das terapias moleculares para o tratamento das doenças isquêmicas de membros inferiores. Neste artigodescreve-se a perspectiva atual da terapia celular e da terapia gênica no tratamento da isquemia crítica demembros inferiores.


Subject(s)
Humans , Peripheral Arterial Disease/complications , Ischemia/physiopathology , Lower Extremity , Cell- and Tissue-Based Therapy/methods , Cell- and Tissue-Based Therapy , Genetic Therapy/methods , Genetic Therapy , Risk Factors
17.
Acta cir. bras ; 26(6): 490-495, Nov.-Dec. 2011. ilus
Article in English | LILACS | ID: lil-604199

ABSTRACT

PURPOSE: To describe a method for the assessment of gait dynamics in rats submitted to limb ischemia. METHODS: Twenty-four male Wistar rats (150-160g) were used. Twelve animals were submitted to limb ischemia by ligation of the common left iliac artery (ischemic group: n = 12); and a sham-operated group was used as control (n=12). After a recovery period of 6 weeks, gait dynamics was assessed by counting the complete footprints and the number of hindlimb-floor contacts during a treadmill test for five minutes at a speed of 12 m.min-1 and angulation of 15°. The number of contacts of the left hindlimb was divided by the right hindlimb values (LRR) for group comparisons. Ischemic disability was quantified by comparing the area under curve (AUC) created by plotting each contact versus time for each hindlimb. The left hindlimb ischemic disability index (LHDI), which was compared between groups, was defined by the formula: LHDI = (1- AUC left / AUC right) x 100. RESULTS: Surgery was well tolerated by all animals. Rats did not suffer tissue loss or ulcerations. Complete footprint LRR was 0.3 ± 0.08 for the ischemic group and 1.3 ± 0.9 for controls (p=0.0043). Number of contacts LLR was 0.5 ± 0.2 for the ischemic group and 1.0 ± 0.1 for the control group (p=0.0051). LHDI was 56.83 ± 10.67 for the ischemic group and 2.50 ± 13.10 for the control group (P = 0.031). CONCLUSION: Assessment of gait dynamics in rats submitted to limb ischemia could be done by footprint analysis and hindlimb contact recording during a treadmill test.


OBJETIVO: Descrever um método para avaliar a dinâmica da marcha em ratos submetidos à isquemia de membro pélvico. MÉTODOS: Vinte e quatro ratos Wistar machos (150-160g) foram utilizados neste estudo experimental. Doze animais foram submetidos à isquemia de membro pélvico por meio da ligadura da artéria ilíaca comum esquerda (grupo isquêmico: n=12); e doze animais foram submetidos à cirurgia simulada e usados como controle (grupo controle: n=12). Após seis semanas de recuperação, foi realizada avaliação da dinâmica da marcha por meio da contagem de impressões plantares e da contagem de contatos pata-solo durante teste com esteira durante cinco minutos, velocidade 12 m.min-1 e angulação de 15°. Os valores do número de contatos do membro pélvico esquerdo foram divididos pelos do membro pélvico direito (razão esquerda-direita - LRR) para comparação entre os grupos. A quantificação da incapacitação isquêmica foi feita comparando a área sob a curva (AUC) da representação gráfica dos contatos versus tempo para cada membro pélvico. O índice de incapacitação isquêmica do membro pélvico esquerdo (LHDI), que foi comparado entre os grupos, foi definido pela fórmula: LHDI = (1- AUC esquerda / AUC direito) x 100. RESULTADOS: A cirurgia foi bem tolerada por todos os animais. Nenhum rato apresentou necrose tecidual ou ulceração. A LRR das impressões plantares completas foi 0,3 ± 0,08 no grupo isquêmico e 1,3 ± 0,9 no grupo controle (p=0,0043). A LRR do número de contatos foi 0,5 ± 0,2 no grupo isquêmico e 1,0 ± 0,1 no grupo controle (p=0,0051). O LHDI foi 56,83 ± 10,67 no grupo isquêmico e 2,50 ± 13,10 no grupo controle (p=0,031). CONCLUSÃO: Avaliação da dinâmica da marcha em ratos submetidos à isquemia de membro pélvico pôde ser feita por meio da contagem de impressões plantares e da contagem de contatos pata-solo durante teste com esteira.


Subject(s)
Animals , Male , Rats , Gait/physiology , Hindlimb/blood supply , Iliac Artery/physiopathology , Ischemia/physiopathology , Hindlimb/physiopathology , Iliac Artery/surgery , Rats, Wistar
18.
Acta cir. bras ; 26(1): 58-63, jan.-fev. 2011. ilus, graf, tab
Article in English | LILACS | ID: lil-572235

ABSTRACT

Purpose: Angiogenesis involves many mediators including integrins, and the tripeptide RGD is a target amino acid recognition sequence for many of them. Hindlimb ischemia is a simple and convenient animal model however standardization of the injection procedures in the devascularized and control limb is lacking, thus rendering difficult the interpretation of results. The aim of this investigations was to evaluate neovascularization in a hindlimb murine model by means of 99mTc-HYNIC-ß-Ala-RGD. Methods: 99mTc-HYNIC-RGD analog was prepared using coligands. Ischemia was induced in Wistar rats by double- ligation of the common femoral artery. Radiolabeled RGD was injected after 2h, as well as 1, 3, 5, 7, 10 and 14 days. Uptake was evaluated by planar imaging and biodistribution studies. Results: The highest ratio between ischemia and control was achieved at the 7th day (2.62 ± 0.95), with substantial decrease by the 14th day. For pertechnetate the 7th day ratio was 0.87 ± 0.23. Scintigraphic image confirmed different uptakes. Conclusion: 99mTc-HYNIC-RGD analog concentrated in ischemic tissue by the time of widespread angiogenesis and pertechnetate confirmed reduction in blood flow. In this sense, the protocol can be recommended for ischemic models.


Objetivo: A angiogênese em resposta a fenômenos isquêmicos envolve vários mediadores como as integrinas, sendo que o tripeptídeo RGD possui uma seqüência de aminoácidos com reconhecimento para este alvo. O modelo animal de isquemia de pata traseira é simples e conveniente, porém não há uma padronização do procedimento de injeção e controle radioisotópico em membro desvascularizado, dificultando, portanto a interpretação de resultados. O objetivo deste estudo foi avaliar a neovascularização em modelo murino de isquemia de pata traseira através do radiotraçador 99mTc-HYNIC-ß-Ala-RGD. Métodos: O análogo 99mTc-HYNIC-RGD foi preparado usando coligantes. A isquemia foi induzida em ratos Wistar por dupla-ligação da artéria femoral comum na prega inguinal. Peptídeo RGD radiomarcado foi injetado após 2h, assim como 1, 3, 5, 7, 10 e 14 dias. A captação foi avaliada por imagem planar e estudos de biodistribuição. Resultados: A maior diferença de captação entre isquemia e pata controle foi obtida no 7º dia (2,62 ± 0,95), com decréscimo acentuado no 14º dia. Para o pertecnetato a razão no 7º dia foi 0,87 ± 0,23. A imagem cintilográfica confirmou as diferentes captações. Conclusões: O análogo 99mTc-HYNIC-RGD concentrou-se no tecido isquêmico na etapa em que a angiogênese é mais acentuada, e o estudo do pertecnetato confirmou a redução no fluxo sanguíneo. Desta maneira, este protocolo diagnóstico pode ser recomendado para modelos isquêmicos.


Subject(s)
Animals , Male , Rats , Hindlimb/blood supply , Ischemia/physiopathology , Neovascularization, Physiologic/physiology , Organotechnetium Compounds , Radiopharmaceuticals , Amino Acid Sequence , Conserved Sequence , Hindlimb/metabolism , Hindlimb , Ischemia , Oligopeptides , Organotechnetium Compounds/pharmacokinetics , Rats, Wistar , Radiopharmaceuticals/pharmacokinetics , Tissue Distribution
19.
Av. cardiol ; 30(3): 256-259, sept. 2010. ilus, tab
Article in Spanish | LILACS | ID: lil-607808

ABSTRACT

La angina cafalalgica cardíaca es un fenómeno poco frecuente como manifestación de un evento coronario agudo. Presentamos un caso típico de ésta manifestación que se asocia a la presencia de vasospasmo coronario y flujo coronario muy lento a nivel epicárdico y miocárdico. La presencia de palpitaciones durante la cefalea advirtió a la paciente del probable origen cardíaca de sus síntomas.


Headache angina or heart headache is a rare phenomenon as a manifestation of an acute coronary event. We report a typical case of this event that is associated with the presence of coronary vasospasm and slow coronary flow on myocardial and epicardial levels. The presence of palpitations during the headache warned the patient of probable cardiac origin of their symptoms.


Subject(s)
Humans , Female , Aged , Cardiovascular Diseases , Headache/etiology , Electrocardiography/methods , Blood Pressure/physiology , Coronary Vasospasm/diagnosis , Ischemia/physiopathology , Venezuela , gamma-Glutamyltransferase/physiology
20.
Clinics ; 65(4): 383-387, 2010. tab
Article in English | LILACS | ID: lil-546312

ABSTRACT

OBJECTIVES: To investigate whether oxidized low-density lipoprotein is a suitable predictor of peripheral arterial disease severity. The role of oxidized low-density lipoprotein in the pathogenesis of atherosclerosis has already been investigated. Its relevance as a predictor of the appearance and worsening of coronary arterial disease is also well known. However, the same is not true regarding peripheral arterial disease. METHOD: Eighty-five consecutive patients with an ankle-brachial pressure index (ABPI) < 0.9 and the presence of either intermittent claudication or critical lower leg ischemia were included. The plasma level of IgG autoantibodies against oxidized low-density lipoprotein was evaluated through an enzyme-linked immunosorbent assay. The results were categorized into quartiles according to the ankle-brachial pressure index (a marker of peripheral arterial disease severity), and significant differences were investigated with the Kruskal-Wallis test. RESULTS: There was no significant difference between the quartiles for this population (p = 0.33). No correlation was found between the ankle-brachial pressure index and oxidized low-density lipoprotein levels in subjects with clinically evident peripheral arterial disease with a wide range of clinical manifestations. CONCLUSIONS: Oxidized low-density lipoprotein is not a good predictor of peripheral arterial disease severity.


Subject(s)
Aged , Female , Humans , Male , Ankle Brachial Index , Atherosclerosis , Lipoproteins, LDL , Peripheral Vascular Diseases , Atherosclerosis/blood , Atherosclerosis/physiopathology , Blood Pressure , Biomarkers/blood , Coronary Artery Disease/physiopathology , Intermittent Claudication/blood , Intermittent Claudication/physiopathology , Ischemia/blood , Ischemia/physiopathology , Leg/blood supply , Lipoproteins, LDL/blood , Lipoproteins, LDL/physiology , Predictive Value of Tests , Peripheral Vascular Diseases/blood , Peripheral Vascular Diseases/physiopathology , Risk Factors , Severity of Illness Index , Statistics, Nonparametric
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