Tratamiento con sildenafilo en disfunción ventricular izquierda e hipertensión pulmonar asociada / Treatment with sildenafil in left ventricular dysfunction and associated pulmonary hypertension

RESUMEN Introducción: la hipertensión pulmonar es un hallazgo frecuente en la insuficiencia cardíaca. El uso del sildenafilo en estos casos es una práctica habitual, pero aún controversial por lo limitado de los estudios realizados. Objetivo: comparar las variables ecocardiográficas de hemodinamia pulmonar, en pacientes con disfunción sistólica ventricular izquierda e hipertensión pulmonar secundaria severa, antes y después del uso del sildenafilo. Materiales y métodos: se realizó un estudio de cohorte, donde se incluyeron 19 pacientes; se realizó un seguimiento de dos años. Se analizaron variables clínicas, de laboratorio y ecocardiográficas. Se evaluaron las principales variables de hemodinamia pulmonar antes del uso del sildenafilo y a las doce semanas de su indicación. Se realizó una curva de supervivencia al concluir el seguimiento. El nivel de significación estadístico empleado fue de p < 0,05. Resultados: la edad promedio fue de 56,16 ± 15,77 años y predominó el sexo masculino, con un 73,7 %. La supervivencia al término del seguimiento fue de 78,9 %. Las principales variables ecocardiográficas de hemodinamia pulmonar mostraron una reducción significativa a las doce semanas del tratamiento con sildenafilo. La supervivencia de los pacientes con una reducción del 25 % de las presiones pulmonares en el ecocardiograma realizado a las doce semanas del tratamiento, fue mayor al terminar el estudio (100 % vs 33 %, log-rank test p = 0,001). Conclusiones: posterior al uso del sildenafilo se encontró una reducción significativa de las variables de hemodinamia pulmonar en el ecocardiograma evolutivo. La sobrevida fue mayor en los pacientes que presentaron dicha reducción (AU).

ABSTRACT Introduction: pulmonary hypertension is a common finding in heart failure. The use of sildenafil in these cases is a common practice, but still controversial due to the limited number of studies carried out. Objective: to compare echocardiographic variables of pulmonary hemodynamics, in patients with left ventricular systolic dysfunction and severe secondary pulmonary hypertension, before and after the use of sildenafil. Materials and methods: a cohort study was led, including 19 patients; a two-year follow-up was carried out. Clinical, laboratory and echocardiographic variables were analyzed. The main pulmonary hemodynamics variables were evaluated before the use of sildenafil and 12 weeks after its indication. A survival curve was performed at the end of the follow-up. The statistical significance level used was p < 0.05. Results: the average age was 56.16 ± 15.77 years, and male sex predominated with 73.3 %. Survival at the end of the follow up was 78.9 %. The main echocardiographic variables of pulmonary hemodinamics showed a significant reduction at 12 weeks of treatment with sildenafil. The survival of patients with a 25 % reduction in pulmonary pressures in the echocardiogram performed at 12 weeks of treatment was greater at the end of the study (100 % vs 33 %, log-rank test p = 0.001). Conclusions: after using sildenafil, a significant reduction of pulmonary hemodynamics variables was found in the evolutionary echocardiogram. Survival was higher in patients who had this reduction (AU).

A Recurrent Case of Constrictive Pericarditis after Pericardiectomy Using ePTFE Pericardial Substitution / 日本心臓血管外科学会雑誌

A 67-year-old man developed the recurrence of postoperative constrictive pericarditis. He had two operation histories : the one was CABG for old myocardial infarction and the other was pericardiectomy for postoperative pericarditis at 57 and 59 years old respectively. Both operations were performed in our hospital. We used an ePTFE sheet for covering the heart in the pericardiectomy. The course post operation was good, but eight years after the pericardiectomy, he had abdominal distension and leg edema. Detailed studies revealed a recurrence of constrictive pericarditis, and reoperation was performed. The re-operative finding showed thickened sclerotic tissues on both sides of an ePTFE sheet which was applied to the cardiac surface during the previous surgery. No abnormal tissue was detected where the ePTFE sheet was not applied. The ePTFE sheet and the sclerotic tissues were removed under cardiopulmonary bypass support, and then diastolic dysfunction improved dramatically. His chest was closed without applying an ePTFE sheet. His post-operative course was uneventful and he was discharged on the 20th postoperative day. The ePTFE sheet was highly suspected as a cause of the recurrent constrictive pericarditis. An ePTFE sheet-induced constrictive pericarditis should be considered as one of the postoperative complications even in the mid and long-term period. The ePTFE sheet is useful for preventing heart or vascular injury when we perform resternotomy, but in rare cases, there is some possibility of association with a risk of pericarditis.

Reduction in pregnancies and litters in mice couples with splenectomized male

ABSTRACT Purpose The spleen is relevant in blood purification, hematopoiesis, metabolism, and immune response to antigens, in addition to the storage and control on the release of metals and amino acids. Its functions concerning reproduction characteristics are still unknown. The objective was to study the influence of splenectomies on reproduction. Methods This study analyzed 25 mice couples, distributed into five groups: group 1 - control, no surgery: group 2 - control, submitted to laparotomy and laparorrhaphy only; group 3 - splenectomy in male mice; group 4 - splenectomy in female mice; group 5 - splenectomy in male and female mice. The animals were studied as regards the number of gestations and offspring generated in each gestation. Results A decrease in both the number of gestations and the number of offspring was verified in the male mice that had received a splenectomy when coupled with normal female mice. It is important to emphasize lower reproduction level when paired asplenic males with normal females, otherwise, the couples in which both mice had been splenectomized did not present change in the reproduction pattern. Conclusions A reduction in the number of pregnancies and litters occurs in mice couples when the male mice were previously splenectomized.

Expression of Serum Vascular Endothelial Growth Factor and Angiopoietin Receptor Tie-2 in Essential Hypertension

ABSTRACT Objective: To investigate the serum levels of a vascular endothelial growth factor (VEGF), an angiogenic factor and a soluble angiopoietin receptor Tie-2 (sTie-2) in patients with essential hypertension. Methods: In the present study 90 individuals (56 males and 34 females, mean age 48 ± 7 years) have been divided into 3 groups: 30 patients with hypertension, 30 healthy individuals with a family history of hypertension and 30 healthy individuals with no family history of hypertension. All individuals have been evaluated in terms of blood pressure and biochemical parameters. The levels of VEGF and Tie-2 receptor have been evaluated by using the enzyme-linked immunosorbent assay method. Results: The findings suggested that the serum VEGF, sTie-2 receptor, low-density lipoprotein and triglycerides levels in the hypertensive patients were significantly higher than those in the control group (p < 0.05). However, the level of high-density lipoprotein cholesterol in the patients was significantly lower than in those in the control group (p < 0.05). In correlation analysis, a positive correlation was found statistically significant between the values of VEGF and sTie-2 (r = 0.405, p = 0.026). Conclusion: As a result of this study, our data indicate that serum levels of VEGF and Tie-2 receptor may be related to the primary hypertension. This study could inspire to further studies to explore the roles of VEGF and Tie-2 receptor in essential hypertension.

The Use of Two-Dimensional Strain Measured by Speckle Tracking in the Identification of Incipient Ventricular Dysfunction in HIV-Infected Patients on Antiretroviral Therapy, Untreated HIV Patients and Healthy Controls / O Uso do Strain Bidimensional Obtido pelo Speckle Tracking na Identificação da Disfunção Ventricular Incipiente em Pacientes Infectados pelo HIV em Uso de Terapia Antirretroviral, Pacientes HIV não Tratados e Controles Saudáveis

Abstract Background: Most cardiovascular abnormalities in patients infected with the human immunodeficiency virus (HIV) have been associated with myocardial damage directly caused by the virus. Some cases, however, may be associated with adverse effects from antiretroviral therapy (ART). New ventricular function assessment techniques are capable of detecting early changes in the cardiac function of HIV-infected patients using or not using ART. The usefulness of these techniques has been little employed in these patients. Objectives: To investigate the potential influence of antiretroviral therapy (ART) on the occurrence of subclinical left ventricular systolic dysfunction evaluated by myocardial strain rate analysis using two-dimensional speckle tracking echocardiography (2-D Echo) in treated HIV patients compared to untreated patients and healthy individuals. Methods: Sixty-eight HIV-infected patients with no cardiovascular symptoms, normal left ventricular (LV) ejection fraction (> 0.55 on 2-D Echo) were divided into three groups: 11 patients not using antiretroviral therapy (NT), 24 using protease inhibitor (PI) and 33 using non-nucleoside reverse transcriptase inhibitor (NNRTI). We also studied 30 normal non-HIV infected individuals (Ctrl). Demographic, clinical, biochemical and anthropometric data were collected. Preliminary transthoracic echocardiography included study of myocardial strain using two-dimensional speckle tracking. We studied strain and strain rate in the seventeen left ventricular (LV) myocardial segments in the longitudinal, circumferential and radial axes. Statistical analysis of the data was done with IBM SPSS - version 20 for Windows. Upon analysis of the data, namely the normality of independent variables in the different groups and the homogeneity of the variances between the groups, Kruskal-Wallis' non-parametric test was done, followed by Dunn's multiple comparison tests to test the significance of the differences between the values measured in the study groups. A significance level of 5% was adopted for decision-making on statistical tests. Results: The mean age of HIV patients was 40 ± 8.65 years and the mean age of controls was 50 ± 11.6 years (p < 0.001). Median LV global longitudinal strain (GLS) of NT patients (-17.70%), PI patients (-18.27%) and NNRTIs (-18.47%) were significantly lower than that of the Ctrl group (-20.77%; p = 0.001). There was no significant difference in mean SLG between treated patients (PI, NNRTI) and untreated (NT) patients. No significant differences were observed in mean circumferential and radial strain, nor on circumferential and radial strain rates between the NT, PI, NNRTI and Ctrl groups. Conclusion: The data suggest that HIV patients present, on myocardial strain measured by speckle tracking, signs of early LV systolic dysfunction that seem to be unrelated to the presence of ART. The prognostic significance of this condition in these patients deserves further studies.

Resumo Fundamento: A maior parte das alterações cardiovasculares dos pacientes infectados pelo vírus da imunodeficiência humana (HIV) tem sido associada ao dano miocárdico causado diretamente pelo vírus. Alguns casos, porém, podem estar associados a efeitos adversos da terapia antirretroviral (TARV). Novas técnicas de avaliação da função ventricular são capazes de detectar modificações precoces na função cardíaca do paciente infectado pelo HIV em uso ou não de TARV. A utilidade dessas técnicas tem sido pouco empregada nesses pacientes. Objetivos: Investigar possível influência da terapia antirretroviral (TARV) na ocorrência de disfunção sistólica ventricular esquerda subclínica avaliada pela análise da taxa de deformação miocárdica (strain) por meio do speckle tracking ao ecocardiograma bidimensional (E2D) em pacientes portadores do HIV tratados, comparados com pacientes não tratados e indivíduos saudáveis. Métodos: Sessenta e oito pacientes infectados pelo HIV assintomáticos do ponto de vista cardiovascular, com fração de ejeção do ventrículo esquerdo (VE) normal (>0,55 pelo E2D) foram divididos em três grupos: 11 pacientes sem tratamento antirretroviral (ST), 24 em uso de inibidor de protease (IP) e 33 em uso de inibidor de transcriptase reversa não nucleosídeo (ITRNN). Foram estudados também 30 indivíduos normais não infectados pelo HIV (Ctrl). Foram coletados dados demográficos, clínicos, bioquímicos e antropométricos. A ecocardiografia transtorácica foi realizada incluindo no estudo inicial o estudo da deformação miocárdica pela técnica bidimensional (speckle tracking). Estudamos o strain e a sua taxa de deformação (strain rate) nos dezessete segmentos miocárdicos do ventrículo esquerdo (VE) nos eixos longitudinal, circunferencial e radial. A análise estatística dos dados foi feita com o programa IBM SPSS - versão 20 para Windows. Depois de analisados os dados, nomeadamente a normalidade das variáveis independentes nos diferentes grupos e a homogeneidade das variâncias entre os grupos, decidiu-se utilizar o teste não paramétrico de Kruskal-Wallis seguido dos testes de comparações múltiplas pelo procedimento de Dunn, para testar a significância das diferenças entre os valores medidos nos grupos em estudo. Foi considerado o nível de significância de 5% para a tomada de decisão nos testes estatísticos realizados. Resultados: A média das idades dos pacientes com HIV foi de 40 ± 8,65 anos e a idade média dos controles foi de 50 ± 11,6 anos (p < 0,001). Os valores medianos do strain longitudinal global do VE (SLG) dos pacientes ST (-17.70%), dos pacientes IP (-18.27%) e ITRNN (-18.47%) foram significativamente menores do que o grupo Ctrl (-20,77%; p = 0,001). Não houve diferença significante nos valores médios do SLGentre os pacientes tratados (IP, ITRNN) e não tratados (ST). Não foram observadas diferenças significantes nos valores médios do strain circunferencial e radial, nem nas taxas de deformação circunferencial e radial entre os grupos ST, IP, ITRNN e Ctrl. Conclusão: Os dados sugerem que pacientes com HIV apresentam, à análise da deformação miocárdica ao speckle tracking, sinais de disfunção sistólica incipiente do VE que parece não ter relação com a presença de TARV. O significado prognóstico dessa alteração nesses pacientes merece estudos futuros.

Concordancia del volumen telediastólico final del ventrículo izquierdo medido por monitor ultrasónico y ecocardiografía / Concordance of the final telediastolic volume of the left ventricle measured by ultrasonic monitor and echocardiography / Concordância do volume telediastolólico final do ventrículo esquerdo medido por monitor ultra-sônico e ecocardiografia

Resumen: Antecedentes: La sepsis se ha asociado a alta mortalidad y disfunción cardiaca; la ecocardiografía es técnicamente difícil; el operador dependiente requiere personal capacitado y equipo disponible, por lo que la fórmula de Smith & Madigan (SMII), a través del monitor ultrasónico de gasto cardiaco, es un sustituto adecuado del inotropismo, pudiéndose inferir el volumen telediastólico final del ventrículo izquierdo (VDFVI) como un indicador de precarga. Métodos: En 56 pacientes diagnosticados con shock séptico, se midieron las siguientes fórmulas usando monitor ultrasónico de gasto cardiaco y comparándose con el volumen telediastólico final por ecocardiografía. SMII = (VS × (PAM - PVC + Gp))/(7.5 × SC × TF) VDFVI = VS × 2.7/SMII. Resultados: Comparamos los resultados medidos por ecocardiografía y fórmula de Smith & Madigan, usando el método de Bland & Altman, obtuvimos un R2=0.92, un coeficiente de Linn de 0.92 con LC95% más alto 32.45, LC95% inferior-39.45 y una tasa de error de 32%. Conclusión: La fórmula de Smith & Madigan podría ser útil para el cálculo de volumen telediastólico final del ventrículo izquierdo; aunque debemos determinar si esta medida es útil para tomar decisiones clínicas, ya que el porcentaje de error es mayor al 20%.

Abstract: Background: Sepsis has been associated with high mortality and cardiac dysfunction, echocardiography is technically difficult, depends on the operator, requires trained personnel and available equipment, so the Smith & Madigan formula (SMII) through the cardiac output monitor Ultrasonic is an adequate substitute of inotropism, being able to infer the final end-diastolic volume of the left ventricle (VDFVI) as indicator of preload. Methods: In 56 patients diagnosed with septic shock, the following formulas were measured by an ultrasonic cardiac output monitor and compared with final end-diastolic volume by echocardiography. SMII = (VS × (PAM-PVC + Gp))/(7.5 × SC × TF) VDFVI = VS × 2.7/SMII. Results: We compared the results measured by echocardiography and the Smith & Madigan formula, using the Bland & Altman method, we obtained an R2 = 0.92, a Linn coefficient of 0.92 with an LC95% higher 32.45, LC95% Lower - 39.45 and a 32% error rate. Conclusion: The Smith & Madigan formula could be useful for the calculation of final end-diastolic volume of the left ventricle. Although the percentage of error is greater than 20%, we must determine if this measure is useful for making clinical decisions.

Resumo: Contexto: A sepse tem sido associada com alta mortalidade e disfunção cardíaca. O ecocardiograma é tecnicamente difícil, operador dependente, requer pessoal treinado e equipamentos disponíveis de modo que a fórmula de Smith & Madigan (SMII) através do monitor ultra-sônico de débito cardíaco é um substituto adequado do inotropismo, sendo capaz de inferir o volume diastólico final do ventrículo esquerdo (VDFVI) como um indicador de pré-carga. Métodos: Foram mensuradas as seguintes fórmulas em 56 pacientes com diagnóstico de choque séptico, por meio de um monitor ultra-sônico do débito cardíaco e comparadas ao volume telediastólico ao final pelo ecocardiograma. SMII = (VS × (PAM-PVC + Gp))/(7.5 × SC × TF) VDFVI = VS X 2.7/SMII. Resultados: Comparou-se os resultados medidos pela ecocardiografia e a fórmula de Smith & Madigan utilizando o método de Bland & Altman, obtivemos um R2 = 0.92, um coeficiente de Linn de 0.92 com um LC95% maior 32.45, LC95% Inferior - 39.45 e uma Taxa de erro de 32%. Conclusão: A fórmula de Smith & Madigan poderia ser útil para o cálculo do volume telediastólico final do ventrículo esquerdo. Embora a porcentagem de erro seja maior que 20% devemos determinar se essa medida é útil para tomar decisões clínicas.

A Case of Constrictive Pericarditis Occurring One Month after Coronary Artery Bypass Graft / 日本心臓血管外科学会雑誌

A 81-year-old man underwent CABG for angina pectoris. The grafts were all patent in postoperative coronary angiography and he was discharged on postoperative day 24. Pericardial and pleural effusion appeared in 1 month after surgery. After pericardial and pleural effusion drainage, we started steroid therapy. However, his symptoms did not improve. We performed pericardiectomy under the diagnosis of constrictive pericarditis. Diastolic dysfunction improved after the surgery, and he was discharged on postoperative day 117.

Performances on the Timed Up and Go Test and subtasks between fallers and non-fallers in older adults with cognitive impairment / Performances no teste Timed Up and Go e subtarefas em idosos com comprometimento cognitivo, caidores e não caidores

ABSTRACT This work aimed to compare performances on the Timed Up and Go (TUG) test and its subtasks between faller and non-faller older adults with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD). A prospective study was conducted, with 38 older adults with MCI and 37 with mild AD. Participants underwent an assessment at baseline (the TUG and its subtasks using the Qualisys ProReflex system) and the monitoring of falls at the six-month follow up. After six months, 52.6% participants with MCI and 51.3% with AD fell. In accordance with specific subtasks, total performance on the TUG distinguished fallers from non-fallers with AD, fallers from non-fallers with MCI and non-fallers with MCI from non-fallers with AD. Although no other difference was found in total performances, non-fallers with MCI and fallers with AD differed on the walking forward, turn and turn-to-sit subtasks; and fallers with MCI and non-fallers with AD differed on the turn-to-sit subtask.

RESUMO O objetivo deste trabalho foi comparar o desempenho do Timed up and go test (TUG) e suas subtarefas entre idosos caidores e não caidores com comprometimento cognitivo leve (CCL) e doença de Alzheimer (DA) leve. Um estudo prospectivo foi conduzido, com 38 idosos com CCL e 37 com DA leve. Foi realizada uma avaliação inicial (TUG e subtarefas por meio do sistema Qualisys Pro Reflex) e um monitoramento de quedas por 6 meses. Após 6 meses, 52.6% pessoas com CCL e 51.3% com DA caíram. Em concordância com subtarefas específicas, a performance total do TUG distinguiu caidores de não caidores com DA, caidores de não caidores com CCL e não caidores com CCL de não caidores com DA. Embora nenhuma outra diferença foi encontrada na performance total do TUG, não caidores com CCL e caidores com DA apresentaram diferenças nas performances das subtarefas marcha ida, retornar e virar-se para sentar; e caidores com CCL e não caidores com DA diferiram na subtarefa virar-se para sentar.

Naming and verbal learning in adults with Alzheimer's disease, mild cognitive impairment and in healthy aging, with low educational levels / Nomeação e aprendizagem verbal na doença de Alzheimer, no comprometimento cognitivo leve e no envelhecimento sadio com baixa escolaridade

ABSTRACT Language assessment seems to be an effective tool to differentiate healthy and cognitively impaired aging groups. This article discusses the impact of educational level on a naming task, on a verbal learning with semantic cues task and on the MMSE in healthy aging adults at three educational levels (very low, low and high) as well as comparing two clinical groups of very low (0-3 years) and low education (4-7 years) patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) with healthy controls. The participants comprised 101 healthy controls, 17 patients with MCI and 19 with AD. Comparisons between the healthy groups showed an education effect on the MMSE, but not on naming and verbal learning. However, the clinical groups were differentiated in both the naming and verbal learning assessment. The results support the assumption that the verbal learning with semantic cues task is a valid tool to diagnose MCI and AD patients, with no influence from education.

RESUMO A linguagem tem se mostrado uma ferramenta eficiente para diferenciar grupos de idosos saudáveis dos com deficiências cognitivas. O artigo objetiva discutir o impacto do nível educacional na nomeação, na aprendizagem verbal (AV) com pistas semânticas e no MEEM no envelhecimento saudável em três níveis de escolaridade (muito baixa: 0-3 anos, baixa: 4-7 anos e alta: >8 anos) e em dois grupos clínicos de escolaridade muito baixa e baixa (Doença de Alzheimer - DA - e Comprometimento Cognitivo Leve - CCL), comparados a controles saudáveis. Participaram 101 controles, 17 CCL e 19 DA. Comparações entre grupos saudáveis demonstraram um efeito da escolaridade no MEEM, mas não nas tarefas de nomeação e de AV. Considerando as comparações entre os grupos clínicos, tanto a nomeação quanto a AV os diferenciaram. Os resultados corroboram a pressuposição de que a tarefa de AV com pistas semânticas é válida para diagnosticar CCL e DA, não sendo influenciada pela escolaridade.

Eixo XPC-P53-H202 e disfunção mitocondrial: qual é o fator central? / XPC-p53-H2O2 axis and mitochondrial disfunction: Which is the key player

A ausência de XPC, uma proteína canonicamente envolvida em reparo de DNA por excisão de nucleotídeos, está associada a vários fenótipos característicos de disfunção mitocondrial como o desequilíbrio entre os complexos da cadeia transportadora de elétrons (CTE), redução no consumo de oxigênio, maior produção de peróxido de hidrogênio, e maior sensibilidade a agentes que causam estresse mitocondrial. Contudo, uma descrição mecanística da relação entre deficiência de XPC e disfunção mitocondrial ainda não está bem estabelecida. Aqui mostramos que a deficiência de XPC está associada ao aumento na expressão do supressor de tumor p53. Essa alteração é acompanhada pelo aumento da expressão de diversas proteínas que participam em importantes funções mitocondriais. A inibição de p53 reverte a superexpressão de algumas dessas proteínas. O tratamento com o inibidor do Complexo III da CTE antimicina A induz aumento da expressão de p53 de forma mais acentuada na linhagem Xpc-/-, enquanto o tratamento com o antioxidante N-acetilcisteína diminue a produção basal de H2O2, expressão de p53 e sensibilidade aumentada ao tratamento com antimicina A. Em conjunto, nossos resultados suportam a hipótese de que o aumento da produção de H2O2 em células Xpc-/- tem um papel causal na regulação da expressão de p53 e na disfunção mitocondrial

Although XPC has been initially implicated in the nucleotide excision DNA repair pathway, its deficiency is associated with mitochondrial dysfunction, including unbalanced electron transport chain (ETC) activity, lower oxygen consumption, increased hydrogen peroxide production, and greater sensitivity to mitochondrial stress. However, a mechanistic understanding of the role of XPC in regulating mitochondrial function is still not well established. Here we show that XPC deficiency is associated with increased expression of the tumor suppressor p53, which is accompanied by increased expression of several proteins that participate in important mitochondrial functions. Inhibition of p53 reverses the overexpression of some of these proteins. In addition, treatment with the ETC inhibitor antimycin A induces p53 expression more robustly in the Xpc-/- cells, while treatment with the antioxidant N-acetylcysteine decreases basal H2O2 production, p53 expression and sensitivity to antimycin A treatment. Together, our results support a model in which increased H2O2 production in Xpc-/- causes upregulation of p53 expression and mitochondrial dysfunction

Effect of anesthesia at different depths on postoperative cognitive disfunction and inflammatory response in the elderly patients undergoing abdominal operation / 新乡医学院学报

Objective To investigate the effect of anesthesia at different depths on postoperative cognitive disfunction (POCD) and inflammatory response in the elderly patients undergoing abdominal operation.Methods A total of 90 elderly patients who underwent abdominal operation in the Affiliated Hospital of Shaanxi University of Chinese Medicine from June 2014 to June 2016 were divided into observation group and control group according to the depth of anesthesia,45 cases in each group.The patients in the two groups were performed with combined intravenous and inhalation anesthesia,the bispeetral index (BIS) value was maintained at 30-39 during the operation in the observation group,and the BIS value was maintained at 50-59 during the operation in the control group.The mean arterial pressure (MAP) and heart rate(HR) of patients in the two groups were recorded at the time points of entering the operation room(T0),5 minutes after tracheal cannula(T1),opening abdominal cavity (T2),closing abdominal cavity (T3) and tracheal cannula extubation (T4).The mini-mental state examination (MMSE) score of the patients in the two groups was performed before operation and the first,third,seventh day after operation;and the incidence of POCD was recorded.The levels of serum interleukin-6(IL-6) and S-100β protein were detected at the time points of before operation,the end of the operation and the first,third day after operation in the two groups.Results Five cases in the control group and six cases in the observation group were eliminated,39 cases in the observation group and 40 cases in the control group were evaluated finally.The MAP at T1 and T2 was significantly lower than that at T0 in the two groups (P ＜ 0.05).There was no significant difference in the MAP between T3,T4 and T0 in the two groups(P ＜ 0.05).There was no significant difference in the HR each time point in each group(P ＜ 0.05).There was no significant difference in the MAP and HR between the two groups at each time point(P ＜ 0.05).There was no significant difference in the MMSE score between the two groups before operation(P ＜ 0.05).The MMSE score of patients at the first and third day after operation was significantly lower than that before operation and the seventh day after operation in the two groups (P ＜ 0.05).There was no significant difference in the MMSE score between before operation and the seventh day after operation in the two groups(P ＜0.05).The MMSE score in the observation group was significantly higher than that in the control group at the first and third day after operation (P ＜ 0.05).There was no significant difference in the MMSE score between the two groups at the seventh day after opera tion(P ＜ 0.05).The incidences of POCD at the first,third and seventh day after operation in the observation group were 28.21％ (11/39),15.38％ (6/39) and 7.69％ (3/39) respectively;and they were 50.00％ (20/40),37.50％ (15/40) and 20.00％ (8/40) respectively in the control group.The incidence of POCD in the observation group was significantly lower than that in the control group at the first and third day after operation (x =3.934,4.949;P ＜ 0.05).There was no significant difference in the incidence of POCD between the two groups at the seventh day after operation(x2 =2.496,P ＜ 0.05).There was no significant difference in the levels of serum IL-6 and S-100β protein between the two groups before operation (P ＜0.05).The levels of serum IL-6 and S-100β protein at the end of operation and the first,third day after operation were significantly higher than those before operation in the two groups(P ＜ 0.05).The levels of serum IL-6 and S-100β protein in the observation group were significantly lower than those in the control group at the end of operation and the first,third day after operation (P ＜ 0.05).Conclusion Deep anesthesia (BIS value is maintained at 30-39) can reduce the levels of inflammatory factors,the incidence of POCD after operation and the brain damage in the elderly patients with abdominal operation.

Mushroom poisoning complicated with multiple organ disfunction syndrome:A case report and literature review / 吉林大学学报(医学版)

Objective:To report one case of mushroom poisoning complicated with multiple organ disfunction syndrome treated by sequential blood purification,and to explore the treatment method and principle of mushroom poisoning complicated with multiple organ disfunction syndrome.Methods:Hemoperfusion was performed in the patient,once every other day,combined with sequential blood purification of hemoperfusion and hemodialysis, and supplemented by hormone therapy and anti-infection.Results:The patient was out of danger,and the vital signs were stable;liver function,kidney function and blood routine were recovered.Conclusion:Early application of hemoperfusion combined with sequential blood purification can effectively treat the mushroom poisoning complicated with multiple organ disfunction syndrome and thrombotic microangiopathy,and improve the prognosis.

Análisis de fase mediante "Gated-SPECT" de perfusión miocárdica para valorar el sincronismo mecánico del ventrículo / Phase analysis to measure left ventricular dyssynchrony by Gated-SPECT myocardial perfusion imaging showed by two different software

Resumen Introducción y objetivos: El análisis de fase mediante Gated-SPECT de perfusión miocárdica (GS-PMI) es una nueva herramienta para medir la asincronía ventricular izquierda con importantes aplicaciones clínicas futuras en resincronización e insuficiencia cardiaca. Se puede medir mediante dos programas (ECTb o QGS C-S). El objetivo es demostrar su factibilidad y verificar si existen diferencias entre ambos. Metodología: Estudio analítico, observacional y retrospectivo en pacientes con GS-PMI normales. Los parámetros obtenidos fueron: la desviación estándar de la fase (DE) y el ancho de banda de histograma (AH). La evaluación de la diferencia entre los grupos se realizó usando pruebas para muestras independientes después de analizar la distribución de datos. Nivel de significación p<0,05. Se utilizó SPSS IBM V.21®. Resultados: Total pacientes: 193 (104 hombres). Edad media: 64 años (24-89).61/193 procesados con QGS C-S y 132/193 con ECTb. Postestrés: la media de la DE fue 6º±3,7º, con mediana de 5º y rango intercuartílico (IR):3.6º. La media de AH fue 22,7º±10º, con mediana de 18º y IR:11.5º. Postreposo: la media de la DE fue 5,76º±4,82º y la mediana 4,5º con IR: 3.1º. La media de AH fue 21.67º± 14.06º y la mediana 18º, IR:12º. Entre ambos programas se encontraron diferencias significativas en la DE en postestrés (p=0,001) y postreposo (p=0,019), sin diferencias en el AH postestrés (p=0,31) y postreposo (p=0,18). Conclusión: Realizar el análisis fase de análisis por GS-PMI es factible. Sin embargo, la DE mostró diferencias significativas entre los dos programas. Aunque los valores mostrados podrían ser utilizados como valores normales, se recomienda que estos se obtengan y utilicen para cada programa por separado.

Abstract Introduction and objectives:Phase analysis by Gated-SPECT myocardial perfusion imaging (G-MPI) is a new tool to measure left ventricular dyssynchrony with important clinical applications in near future (heart failure and resynchronization) and can be measured by two software (ECTb o QGS C-S). The aim is to show its feasibility and verify whether there is difference between the programs. Methodology: Analytical observational and retrospective study in patients with normal G-MPI. The parameters were the phase standard deviation (SD) and the histogram bandwidth (HB) in post-stress and rest tests. Assessment of the difference between groups was performed using tests for independent samples after analyze the distribution of data. The significance level (p) was 0,05 and the software used was SPSS IBM V.21® Results: Total:193 patients (104 men).64 years old ± (24-89).61/193 processed with QGS C-S and 132/193 with ECTb. Post-stress tests: mean of the SD was 6º±3.7º,the median was 5º,interquartile range (IR):3.6º.The mean of HB was 22.7º±10º and the median was 18º IR:11.5º. Post-rest tests: mean of the SD was 5.76º±4.82º and median was 4.5º IR: 3.1º.The overall mean of HB was 21.67º±14.06º and median was 18º IR: 12º. Between the data from both software, significant differences were found in SD in post-stress(p=0.001)and post-rest tests(p=0.019)and no significant differences were found in HB in post-stress(p= 0.31)or post-rest tests(p=0.18). Conclusion: Phase analysis by G-MPI is feasible. However SD showed significant differences between the two groups. Although the values showed could be used as normal values, it is recommended that these have to be obtained and used for each software separately.

Impacto do sobrepeso na disfunção sexual feminina: revisão da literatura / Impact of overweight in sexual dysfunction female: review of literature

Este estudo objetiva revisar a literatura sobre o impacto da obesidade/sobrepeso nas disfunções sexuais femininas. A pesquisa foi realizada nas bases de dados SciELO, LILACS e Scholar, utilizando os descritores "disfunção sexual" e "sobrepeso" ou "obesidade" em português e os seus equivalentes em inglês ("sexual dysfunction" e "overweight" ou "obesity") em artigos publicados entre 2005 e 2015. Os critérios de exclusão foram: ser somente resumo e artigo completo não ser disponível online ou somente estudo de disfunção sexual masculina. Foram encontrados 98 artigos na base de dados SciELO, 975 na base de dados LILACS e 297 no Scholar; destes foram incluídos apenas sete artigos tendo em vista que todos os outros apresentavam algum critério de exclusão. A maioria dos artigos avaliados foi positiva ao relacionar a disfunção sexual em mulheres e a obesidade/sobrepeso. Alguns artigos também relacionaram a síndrome metabólica com a disfunção sexual feminina (DSF), sendo essa síndrome muito relacionada com a obesidade, principalmente a obesidade visceral, um fator de risco cardiovascular. Observamos pouca diferença no instrumento utilizado pelos autores, a maioria utilizando o Female Sexual Function Index (FSFI). Pode-se concluir que s índices de sobrepeso e obesidade vêm crescendo significativamente no mundo, e, após este trabalho, observarmos forte e consistente relação entre a disfunção sexual e o excesso de peso. O FSFI demonstrou ser um instrumento eficaz no estudo da DSF. Porém, nenhum estudo pode comprovar uma relação de causa e efeito, pois se tratam de estudos transversais. Não foi encontrado nenhum estudo de intervenção observando a relação entre a perda de peso e a melhora na função sexual de mulheres, o que corroboraria a hipótese de que a obesidade seria um fator importante na DSF.(AU)

This study aims to review the literature on the impact of obesity/overweight in sexual dysfunctions. The survey was conducted in databases SciELO, LILACS and Scholar, using the descriptors "sexual dysfunction" and "obesity/overweight" in English and their synonyms in Portuguese ("disfunção sexual" and "obesidade" or "sobrepeso"), in scientific papers published between 2005 and 2015. Exclusion criteria: being an abstract, full text not available online or only related to male sexual dysfunction. 98 articles were found in the SciELO database, 975 in the LILACS database and 297 in Scholar; from these were included only seven articles, given that everyone else had some requirement of the exclusion criteria. Most reviewed articles found positive association between sexual dysfunction in women and obesity/overweight. Some articles also linked the metabolic syndrome with female sexual dysfunction, which is closely related with obesity, especially visceral obesity, and is a cardiovascular risk factor. There was little difference in the methodology used by the authors, most of them using the Female Sexual Function Index (FSFI). It can be concluded that overweight and obesity rates have been significantly growing in the world, and, after this work, we observe strong and consistent relationship between sexual dysfunction and overweight. The FSFI proved to be an effective tool in the study of female sexual dysfunction. However, no study could prove a cause-effect relationship, since they were cross-sectional studies. No intervention study observing the relationship between weight loss and sexual function improvement in women was found, which would corroborate the hypothesis that obesity could be an important factor in female sexual dysfunction.(AU)

Efficacy analysis of sequential blood purification treatment of bee poisoning complicated by multiple organ disfunction syndrome / 中华实用儿科临床杂志

Objective To study the efficacy of sequential blood purification treatment of bee poisoning complicated by multiple organ disfunction syndrome (MODS).Methods The 11 cases of children with bee poisoning and MODS from Wuhan Children's Hospital were treated with sequential blood purification therapy,and they were treated with plasma exchange (PE),hemoperfusion (HP) and sequential continuous renal replacement therapy (CRRT) simultaneously in the early stage,and then were treated with intermittent hemodialysis (IHD) in the remission stage.Different modes of purification treatment were applied in different stages.The trends of liver function,renal function and myocardial enzymes were observed in 11 cases before and after therapy,later a retrospective analysis was performed,and the efficacy of sequential blood purification was studied.Results Ten in 11 cases of children were treated with HP,CRRT and IHD therapy,and among them 6 cases were treated with PE on the first day of admission.One case,the youngest of children admitted to hospital less than 24 hours,died of sudden cardiac arrhythmia due to toxic myocarditis.In ten cases of the children after treatment,their myocardial enzymes returned to normal at first,and then jaundice and hepatic function improved,and renal function gradually improved after 10 days.Two weeks after discharge,through reviewing of the liver and kidney function,myocardial enzymes returned to normal indicators.In review of urine,5 cases were accompanied with microscopic hematuria,3 cases were accompanied with hematuria and proteinuria,and 2 cases were completely normal.The improved cure rate was 91％ (10/11 cases).Conclusions Sequential blood purification treatment is the main and effective means for severe bee poisoning complicated with MODS in children in the early stage.

Frequência das dinfunções temporomandibulares (DTM) e sua relação com a ansiedade e a depressão entre usuários que procuram o setor de odontologia em uma unidade de saúde / Frequency of temporomandibular disorders (TMD) and their relationship with anxiety and depression among dental patients of a health care unit

As Disfunções Temporomandibulares (DTM) são distúrbios da Articulação Temporomandibular (ATM) comuns em crianças e adolescentes, tendendo a aumentar sua prevalência na fase adulta. Uma vez que poucos estudos discutem a prevalência de DTM em serviços de Atenção Primária (APS), o objetivo do presente estudo foi verificar a frequência das DTMs e sua relação com a ansiedade e a depressão em usuários que procuraram o setor de odontologia de uma unidade de APS. A amostra foi composta por 257 pacientes adultos (maiores de 18 anos) atendidos, de forma consecutiva, na unidade. Para avaliação do grau de DTM entre os pacientes do estudo, foi utilizado questionário proposto por Maciel,15 constituído de 10 perguntas objetivas, que apontam a presença de DTM. Para avaliação da ansiedade, foi usada a Escala Hospitalar de Ansiedade e Depressão (HADS), validada por Marcolino.16 Essa escala possui 14 itens fechados, dos quais 7 são voltados para a ansiedade (HADS-A) e 7 para a depressão (HADS-D). A frequência de DTM encontrada foi de 86,7%, sendo que as DTMs moderadas e severas estavam presentes na maioria dos sujeitos (55,7%), enquanto os não portadores e portadores leves de DTM representaram 45,3% da amostra. Observou-se, também, uma correlação significante entre DTM e ansiedade e depressão (p<0,05) em relação aos não portadores. Esses dados assumem uma relevância ainda maior, por se tratar do contexto de uma unidade de APS, a qual se configura como porta de entrada para o atendimento em saúde do indivíduo.

The Temporomandibular Disorders (TMD) are disorders of the temporomandibular joint (TMJ) common in children and adolescents, tending to increase their prevalence in adulthood. Since few studies discuss the prevalence of TMD in Primary Care Services (PCS), the purpose of this study was to determine the frequency of TMD and its relationship with anxiety and depression in users who searched for the dental treatment in a health unit. The sample comprised 257 adults (18 years) consecutively treated in the dental service of this unit. To assess the degree of TMD among patients in the study, a proposed by Maciel15 was used. This questionnaire consists of 10 objective questions that indicate the presence of TMD. To evaluate anxiety, it was used a Hospital Anxiety and Depression Scale (HADS) validated by Marcolino.16 This scale has 14 items closed, being seven targeted for anxiety (HADS-A) and 7 for depression (HADS-D). The frequency of moderate and severe was 86.7% and TMD were present in most subjects (55.7%), while non-carriers and carriers of light TMD represented 45.3% of the sample. We also observed a significant correlation between TMD and anxiety and depression (p<0,05) compared to non-carriers. These facts assume greater importance because PCS configure a gateway to the health care of the individual.

Enfermedad de parkinson: criterios diagnósticos, factores de riesgo y de progresión, y escalas de valoración del estadio clínico / Parkinson's disease: diagnostic criteria, risk factors and progression, and assessment scales clinical stage

La enfermedad de Parkinson es la segunda enfermedad degenerativa más común en el mundo después del Alzheimer. En Colombia hay una prevalencia estimada de 4,7 (IC95%: 2,2 a 8,9) por 1,000 habitantes y se detecta con mayor frecuencia en personas mayores de 60 años, lo que representa un alto costo para las familias y para el sistema de salud. Actualmente se utilizan para el diagnóstico los criterios del Banco de Cerebros del Reino Unido, sin embargo, hay otros criterios que pueden ser útiles para proyectos de investigación. Se ha demostrado que hay múltiples factores de riesgo y de progresión asociados con la enfermedad, y que deben tenerse en cuenta durante la evaluación clínica, la cual debería siempre realizarse en conjunto con las escalas de seguimiento.

Parkinson's disease is the second most common degenerative disease in the world after Alzheimer's disease. Colombia has an estimated prevalence of 470 (95% CI 2.2 to 8.9) per 1,000 people, more frequently found in people over 60 years, which represents a high financial burden imposed on families and health care system. The criteria currently used for the diagnostic are those compiled in the Brain Bank of the UK; however, other criteria may be useful for research. There are multiple risk and progression factors which have been proven to have an association with parkinson's disease, and that should be considered during clinical assessment, which should always be carried out additionally with follow scales.

Prevalencia de tiroideopatías en pacientes con diabetes tipo 2 / Prevalence of Thyroid Disease in Patients with Type 2 Diabetes

Objetivo: Determinar la frecuencia de bocio, disfunción y autoinmunidad tiroidea en una muestra poblacional de pacientes con diabetes tipo 2. Material y métodos: Se analizaron pacientes con diagnóstico de diabetes tipo 2, según los criterios de la American Diabetes Association 2007, asistidos en forma consecutiva en consultorios de endocrinología, desde el 1 de julio al 31 de octubre de 2011. Resultados: Se recabaron datos de 190 pacientes, promedio de edad de 61,7 años (rango 27-85), 103 eran mujeres (54,2 %). Se determinaron anticuerpos antitiroideos en 139 pacientes. Ciento tres (54,2 %) pacientes presentaban disfunción tiroidea, 84 (44,2 %) ya tenían diagnóstico previo y se detectaron 19 (10,0 %) nuevos casos a partir del estudio. El hipotiroidismo clínico fue la disfunción tiroidea más frecuente (68 pacientes [35,8 %]). Cincuenta y dos pacientes presentaban bocio (27,4 %), la mayoría multinodular (36 pacientes [18,9 %]). Treinta y dos pacientes tenían autoinmunidad positiva (23,0 %). No se observaron diferencias significativas al dividir los pacientes en mayores y menores de 65 años respecto a la frecuencia de disfunción tiroidea (57,8 % contra 51,0 %) ni respecto a la de bocio (25,6 % contra 29 %). En cambio, fue significativa la diferencia en la proporción de autoinmunidad positiva entre ambos grupos (13,1 % y 30,8 %) (P < 0,05). Se halló un porcen­taje en mujeres y varones de disfunción tiroidea de 70,8 % y 34,5 % (P <0,0001), de bocio en 41,7 % y 10,3 % (P < 0,0001) y de anticuerpos antitiroideos positivos de 27,9 % y 15,1 % (P no significativa), respectivamente. Conclusiones: Se observó una frecuencia de disfunción tiroidea de 54,2 %, mayor que en todos los estudios revisados. La importancia de detectar tiroideopatías en los diabéticos tipo 2 radica en el diagnóstico de una patología tratable y que puede contribuir al aumento del riesgo cardiovascular de estos pacientes. Rev Argent Endocrinol Metab 51:123-129, 2014 Los autores declaran no poseer conflictos de interés.

Aim: To assess the frequency of goiter, thyroid dysfunction and autoimmunity in a group of patients with type 2 diabetes. Material and Methods: We evaluated a group of patients with diagnosis of type 2 diabetes, who presented at the Endocrinology department from July 1st to October 31st, 2011. The diagnosis of diabetes was based on the American Diabetes Association criteria. Results: Data from 190 patients were analyzed. The mean age was 61.7 years (range 27-85); 103 were women (54.2%). Thyroid autoantibody measurements were available in 139 patients. The total frequency of thyroid dysfunction was 54.2 % (103 patients), 84 patients (44.2 %) with previous diagnosis and 19 patients (10.0 %) with new diagnosis. The most frequent thyroid dysfunction was overt hypothyroidism (68 patients [35.8 %]). Goiter was present in 52 patients (27.4 %), most of them had multinodular goiter (36 patients [18.9 %]). Thy­roid autoantibodies were positive in 32 patients (23.0 %). We classified patients into two groups according to age: patients over 65 (group 1) and patients under 65 (group 2). No significant difference in the frequency of thyroid dysfunction (57.8 % versus 51.0 %) and goiter (25.6 % versus 29.0 %) were found between these groups. However, there was a significant difference in the proportion of thyroid autoimmunity according to age (13.1 % and 30.8 %, P <0.05, respectively). When separating patients into women and men, the percentage of thyroid dysfunction was 70.8 % and 34.0 % (P <0.0001), the percentage of goiter was 41.7 % and 10.3 % (P <0.0001) and the percentage of thyroid autoimmunity was 27.9 % and 15.1 % (not statistically significant), respectively. Conclusions: The frequency of thyroid dysfunction was 54.2 %, which was the highest rate according to the studies reviewed. Detection of thyroid dysfunction in patients with type 2 diabetes is clinically important since it is a treatable disease that may contribute to an increased cardiovascular risk in these patients. Rev Argent Endocrinol Metab 51:123-129, 2014 No financial conflicts of interest exist.

Percepción de la mujer gestante sobre su función sexual / The pregnant woman's knowledge about her sexual function

Introducción: para comprender la conducta sexual humana durante el embarazo es necesario valorar áreas sumamente extensas como las de tipos anatómicas, fisiológicas y socioculturales. Objetivo: identificar la percepción que tienen las mujeres gestantes sobre su función sexual. Material y método: investigación longitudinal, prospectiva y analítica en el Policlínico Universitario "Hermanos Cruz" de la provincia de Pinar del Río, entre abril de 2009 y febrero de 2010. El universo quedó conformado por todas las mujeres embarazadas captadas precozmente de los grupos básicos de trabajo 1, 2 y 3 (n = 218); para la selección de la muestra se escogieron al azar 21 consultorios, y de ellos, se seleccionaron las primeras siete gestantes captadas antes de las 13 semanas de embarazo (n = 147); se empleó un cuestionario el que fue aplicado en los tres trimestres del embarazo, para la validación de los resultados se empleó la prueba de ji cuadrado con nivel de significación de p<0,05. Resultados: la edad promedio de las mujeres fue de 28,6 años, el 46,26% eran trabajadoras, con predominio del preuniversitario como escolaridad, la primigesta y un promedio de 2,8 años de tiempo de matrimonio. La mediana de la frecuencia del coito fue de 1 en el primero y tercer trimestre, existiendo una disminución de dicha frecuencia en ambos trimestre, también en estos períodos disminuyó la percepción del deseo y la excitación sexual, así como la apreciación cualitativa del orgasmo. Conclusiones: las mujeres perciben su función sexual muy perturbada durante el proceso de gestación.

Introduction: to understand the human sexual behavior during pregnancy it is required to assess broadly comprehensive areas such as anatomical, physiological and sociocultural. Objective: to identify the pregnant women´s knowledge about their sexual behavior. Material and method: analytical, prospective, longitudinal research in Hermanos Cruz Outpatient Polyclinic in Pinar del Río Province, between April 2010 and February 2011. The universe was made up of all pregnant women early caught from the basic work groups 1, 2 and 3 (n=218). To choose the sample 21 doctor´s offices were randomly chosen, and from these the first 7 pregnant women caught within the first 13 weeks of pregnancy (n=147). A questionnaire made up by the authors was used in three trimesters. To evaluate the statistical significance the Gamma and Friedman chi-square test was used at 95% of accuracy. Results: the mean age of women was 28.6 years, 46.26% were workers, predominantly with pre-university schooling, primigravida and an average time of 2.8 years of marriage. Median coital frequency was 1 in the first and third quarters, and there is a decrease in the frequency in both quarters, even in these periods perception of desire and arousal decreased, and so did the qualitative assessment of orgasm, by which variations are shown in the various terms (p <0.05). Conclusions: during gestation changes in coital frequency occurred, and so did sexual desire and arousal and orgasm phases of the sexual response.