Impact of hypertension severity on arterial stiffness, cerebral vasoreactivity, and cognitive performance / Impacto da gravidade da hipertensão na rigidez arterial, vasorreatividade cerebral e desempenho cognitivo

ABSTRACT. Aging, hypertension (HTN), and other cardiovascular risk factors contribute to structural and functional changes of the arterial wall. Objective: To evaluate whether arterial stiffness (AS) is related to cerebral blood flow changes and its association with cognitive function in patients with hypertension. Methods: 211 patients (69 normotensive and 142 hypertensive) were included. Patients with hypertension were divided into 2 stages: HTN stage-1 and HTN stage-2. The mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA) and a battery of neuropsychological (NPE) tests were used to determine cognitive function. Pulse wave velocity was measured using the Complior®. Carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. Middle cerebral artery flow velocity was measured by transcranial Doppler ultrasonography. Results: Both arterial stiffness parameters and cerebral vasoreactivity worsened in line with HTN severity. There was a negative correlation between breath holding index (BHI) and arterial stiffness parameters. Cognitive performance worsened in line with HTN severity, with statistical difference occurring mainly between the HTN-2 and normotension groups on both the MMSE and MoCA. The same tendency was observed on the NPE tests. Conclusion: Hypertension severity was associated with higher AS, worse BHI, and lower cognitive performance.

RESUMO. A idade, hipertensão arterial (HA), e outros fatores de risco cardiovascular contribuem para as alterações estruturais e funcionais da parede arterial. Objetivo: Avaliar o quanto a rigidez arterial está relacionada com as alterações do fluxo sanguíneo cerebral e sua associação com a função cognitiva em pacientes com hipertensão. Métodos: Foram incluídos 211 pacientes (69 normotensos e 142 hipertensos). Os pacientes com hipertensão foram divididos em dois estágios: HA-1 e HA-2. O mini exame do estado mental (MEEM), Montreal Cognitive Assessment (MoCA) e uma bateria de testes neuropsicológicos foram usados para avaliar a função cognitiva. A velocidade da onda de pulso foi medida usando o Complior®. As propriedades da artéria carótida foram avaliadas usando o ultrassom de radiofrequência. A pressão arterial central e o índice de incremento foram obtidos usando a tonometria de aplanação. A velocidade de fluxo sanguíneo da arterial cerebral média foi medida pelo ultrassom com Doppler Transcraniano. Resultados: Tanto os parâmetros da rigidez arterial quanto a vasorreatividade cerebral foram piores com a gravidade da hipertensão. Houve uma correlação negativa entre o índice de apnéia e os parâmetros da rigidez arterial. O desempenho cognitivo foi pior com a gravidade de hipertensão arterial com diferença estatística ocorrendo principalmente entre os grupos HA-2 e normotensão tanto no MEEM quanto no MoCA. A mesma tendência foi observada em relação aos testes neuropsicológicos. Conclusão: A gravidade de hipertensão arterial foi associada com maior rigidez arterial, pior índice de apneia, e menor desempenho cognitivo.

Relationship between change of fundus vascular change with stage and risk stratification of essential hypertension and cardiac function / 重庆医学

Objective To explore the relationship between the fundus vascular changes with the stage and risk stratification of essential hypertension(EH) and the cardiac function.Methods One hundred patients with EH in our hospital from April 2011 to March 2016 were selected and divided into the control group(n=29),Ⅰ-Ⅱ group(n=56) and Ⅲ-Ⅳ group(n=15) according to the Keith-Wagener fundus grading.The stage and risk stratification of EH (mild,moderate,severe),cardiac function indexes[left ventricular end-diastolic inner diameter (LVEDD),left ventricular wall thickness (LVPWT),interventricular septum thickness (LVST),left ventricular mass index (LVMI),carotid intima-media thickness (IMT),left ventricular ejection fraction (LVEF)] were compared among 3 groups.Results The proportions of mild hypertension in the control group,Ⅰ-Ⅱ group and Ⅲ-Ⅳ group were 55.17％,21.43％ and 6.67％ respectively,the proportions of moderate hypertension were 31.03％,30.36％ and 26.67 ％ respectively,which of severe hypertension were 13.79 ％,48.21 ％ and 66.67 ％ respectively,the differences were statistically significant(x2 =5.568,P=0.019).The cardiac indexes of LVEDD,LVPWT,etc.had statistical differences among the control group,Ⅰ-Ⅱ group and Ⅲ-Ⅳ group(P＜0.05).The fundus vascular changes were positively correlated with the stages and risk stratification of EH (r=0.742,P =0.002),while LVMI (r =0.674,P =0.028) and IMT (r =0.598,P =0.014) were negatively correlated with LVEF(r=-0.623,P=0.035).Conclusion The fundus vascular changes have close correlation with the stage and risk stratification of EH and cardiac function,which could be used as an important index for judging the hypertensive severity and target organ damage situation

Diabetes mellitus y enfermedad periodontal: aspectos fisiopatológicos actuales de su relación / Diabetes mellitus and periodontal disease: current pathophysiological aspects of their relationship

La diabetes mellitus constituye un factor de riesgo de la enfermedad periodontal. Asimismo la gravedad y extensión del daño periodontal se relaciona directamente con el control de la diabetes mellitus en quienes la padecen. De hecho, la prevención de las afecciones periodontales en el paciente diabético es el mejor tratamiento del que se dispone en la actualidad; de manera que el conocimiento y la actualización permanente de los aspectos fisiopatológicos en la correlación de ambas entidades, resulta clave para seleccionar y ejecutar una temprana y adecuada terapia, con el fin no solo de reducir la morbilidad de la infección local, sino también de influir indirectamente en la salud general. Tomando en consideración dichos argumentos, se decidió comentar sobre el tema.

Diabetes mellitus constitutes a risk factor of periodontal disease. Also the severity and extension of the periodontal damage is directly related to the diabetes mellitus control in those who suffer from it. In fact, the prevention of the periodontal disorders in the diabetic patient is the best treatment available at the present time; so that the knowledge and the permanent updating of the pathophysiological aspects in the correlation of both entities, are important to select and to carry out an early and appropriate therapy, not only to reduce the morbidity of the local infection, but also to influence indirectly in the general health. Taking into consideration these arguments, it was decided to make a comment on the topic.

Efeitos da simpaticotomia endoscópica sobre as artérias carótidas e vertebrais na terapêutica cirúrgica da hiperidrose primária

PURPOSES: Analyze, in patients with primary hyperhidrosis (PH) who was undergone to videothoracoscopic sympathicotomy, the degree of vascular denervation after surgical transection of the thoracic sympathetic chain by measuring ultrasonografic parameters in carotid and vertebral arteries. METHODS: Twenty-four patients with PH underwent forty-eight endoscopic thoracic sympathicotomy and were evaluated by duplex eco-doppler measuring systolic peak velocity (SPV), diastolic peak velocity (DPV), pulsatility index (PI) and resistivity index (RI) in bilateral common, internal and external carotids, besides bilateral vertebral arteries. The exams were performed before operations and a month later. Wilcoxon test was used to analyse the differences between the variables before and after the sympatholisis. RESULTS: T3 sympathicotomy segment was the most frequent transection done (95,83%), as only ablation (25%) or in association with T4 (62,50%) or with T2 (8,33%). It was observed increase in RI and PI of the common carotid artery ( p 0,05). The DPV of internal carotid artery decreased in both sides (p 0,05). The SPV and the DPV of the right and left vertebral arteries also increased (p 0,05). Asymmetric findings were observed so that, arteries of the right side were the most frequently affected. CONCLUSIONS: Hemodynamic changes in vertebral and carotid arteries were observed after sympathicotomy for PH. SPV was the most often altered parameter, mostly in the right side arteries, meaning significant asymmetric changes in carotid and vertebral vessels. Therefore, the research findings deserve further investigations to observe if they have clinical inferences.

OBJETIVOS: Analisar, em pacientes submetidos a simpaticotomia videotoracoscópica para tratamento da Hiperidrose Primária (HP), as conseqüências hemodinâmicas da desnervação vascular das artérias carótidas e vertebrais após a trans-secção cirúrgica da cadeia simpática torácica (simpaticotomia), através da mensuração de parâmetros ultra-sonográficos. MÉTODO: Vinte e quatro pacientes portadores de HP submetidos a quarenta e oito simpaticotomias torácicas endoscópicas foram avaliados através da mensuração da velocidade de pico sistólico (VPS), velocidade de pico diastólico (VPD), índice de pulsatibilidade (IP) e índice de resistência (IR) nas artérias carótidas comuns, internas e externas, além da artéria vertebral bilateralmente usando o eco-doppler duplex scan. As avaliações foram realizadas antes da intervenção cirúrgica e trinta dias após o procedimento. O teste de Wilcoxon foi usado na análise das diferenças entre as variáveis antes e depois da simpaticotomia. RESULTADOS: A simpaticotomia no nível de T3 foi a trans-secção mais realizada (95,83%), seja isoladamente (25%) ou associada a T4 (62,50%) ou a T2 (8,33%). Houve aumento significativo no IR e no IP da artéria carótida comum bilateralmente (p 0,05). A VPD da artéria carótida interna diminuiu em ambos os lados (p 0,05). A VPS e a VPD da artéria vertebral direita também aumentaram (p 0,05). Achados assimétricos foram observados, de modo que artérias do lado direito foram as mais freqüentemente afetadas. CONCLUSÕES: Alterações hemodinâmicas foram observadas nas artérias vertebral e carótida após simpaticotomia para tratamento de HP. VPS foi o parâmetro mais freqüentemente alterado, principalmente nas artérias do lado direito, representando alterações assimétricas significantes nas artérias carótida e vertebral. Entretanto, são necessárias pesquisas subseqüentes para verificar se essas alterações são definitivas ou temporárias, uma vez que as inferências clínicas somente terão validação se as alterações forem permanentes.

An experimental study of healing of the partially severed flexor tendon in chickens

There is a lack of clinical and experimental studies of the treatment of incompletely transected tendons. The controversy concerning the source of flexor tendon nutrients is of important clinical concern in healing of the injured tendon; thus, the flexor tendon blood supply has cited as a reason for using specific tendon suture techniques, and as a rationale for preserving the superficialis tendon and its vincula during tendon repair surgery. Our knowledge of the normal physiology of digital flexor tendons and the mechanism of their healing process is deficient. The aim of this study was to investigate the relative importance of the synovial fluid and the blood supply respectively for the healing of partially severed flexor tendons. We observed the sequential histological and vascular changes which occur in healing of the partial lacerations in the dorsal and plantar aspects of the tendons. We observed the vascularities of the two partially severed tendon groups after injection of microfil and india ink through the femoral artery. In the healing process there was no sequential histological difference between the dorsal and the plantar severed tendons. The vascularity patterns of the healing tendons were significantly increased and the hypervascularity of dorsal severed tendons was greater than that of plantar severed tendons. Partially severed tendons were completely healed without surgical repair with dense collagen fibers without adhesion in most cases. We concluded from this study that the blood vessels appeared to play a significant role in the healing of the severed flexor tendons. An intact synovial environment did not seem to be required for healing of the severed tendon. It is not necessary to surgically repair the partially severed tendon for prevention of rupture and adhesion.

AN EXPERIMENTAL MORPHOLOGICAL STUDY OF THE INTRAMURAL VASCULAR CHANGES AFTER LIGATING THE LEFT CORONARY ARTERY IN RATS / 解剖学报

Intramural vescular changes in the healing process after myocardial infarction were studied by the methods of histological section after ligating the left coronary artery of 119 rats. The intramural vascular patterns in the left ventricular free wall of the rat heart are similar to those of the human and the rabbit, but the patterns in the interventricular septum of the rat heart are only similar to those of the rabbit. The left ventricutar free wall contains 3,903?48 capillaries per mm~2 on the average. The capillaries in all areas run parallel with the myocardial fibres. After figuring the left coronary artery of the rat heart,the intramural vascular changes may be divided into three stages, i.e.avascularity, hypervascularity and hypovascularity, which coincide with the healing process of myocardial infarction. It is suggested that the coronary collateral circulation begins within the first two days, and increases gradually during 3 to 7 days after myocardial infarction. The evolutionary process of blood vessels in experimental myocardial infarction of rats is more rapid than that in the human and in the rabbit, but the process itself is similar to each other.