Eficacia y seguridad de una alternativa a la terapia hormonal de la menopausia: extracto purificado de polen / Efficacy and safety of an alternative to menopausal hormone therapy: purified cytoplasm of pollen

Los síntomas vasomotores (SVM) se encuentran entre los síntomas más comunes de la transición a la menopausia. Más del 70% de las mujeres de mediana edad informan SVM en algún momento durante la transición a la menopausia, y para un tercio de las mujeres los SVM son muy frecuentes o graves. Muchas mujeres recurren a terapias naturales para tratar los SVM. Esta revisión se centra en una de esas opciones naturales: el extracto purificado de polen (Serelys®). Se realizó una búsqueda e identificación de artículos publicados hasta octubre de 2022 recopilados de sistemas de búsqueda electrónicos, como Google Scholar, MEDLINE, PubMed y Scopus. Las palabras de búsqueda fueron “Vasomotor symptoms”, “menopause” AND “pollen”. Los estudios preclínicos señalan un mecanismo de acción en su implicación sobre el sistema serotoninérgico, así como su unión a los receptores de dopamina. Los estudios clínicos demuestran la seguridad y el efecto positivo sobre los SVM.

Vasomotor symptoms (VMS) are among the most common symptoms of the menopausal transition. More than 70% of middle-aged women report VMS at some point during the menopausal transition, and for a third of women, VMS is very common or severe. Many women turn to natural therapies to treat VMS. This review focuses on one such natural option, purified pollen extract (Serelys®). The information available until October 2022 was collected via the library and electronic search systems such as Google Scholar, MEDLINE, PubMed, and Scopus. The search words were: “Vasomotor symptoms”, “menopause” AND “pollen”. Preclinical studies point to a mechanism of action in its involvement in the serotonergic system, as well as its binding to dopamine receptors. Clinical studies demonstrate the safety and positive effect on VMS.

Thermographic analysis and autonomic response in the hands of patients with leprosy

Abstract: Background: Low temperatures and slow blood flow may result from peripheral neuropathy caused by leprosy, and the simple detection of cold fingers could already be a preliminary classification for these patients. Objective: To investigate whether infrared thermography would be able to measure this change in temperature in the hands of people with leprosy. Method: The study assessed 17 leprosy patients who were under treatment at the National Reference Center for Sanitary Dermatology and Leprosy, Uberlândia/MG, and 15 people without leprosy for the control group. The infrared camera FLIR A325 and Therma CAM Researcher Professional 2.9 software were used to measure the temperature. The room was air-conditioned, maintaining the temperature at 25°C; the distance between the camera and the limb was 70 cm. The vasomotor reflex of patients was tested by a cold stress on the palm. Results: The study showed a significant interaction between the clinical form of leprosy and temperature, where the control group and the borderline-borderline form revealed a higher initial temperature, while borderline-lepromatous and lepromatous leprosy showed a lower temperature. Regarding vasomotor reflex, lepromatous leprosy patients were unable to recover the initial temperature after cold stress, while those with the borderline-tuberculoid form not only recovered but exceeded the initial temperature. Conclusion: Thermography proved a potential tool to assist in the early detection of neuropathies, helping in the prevention of major nerve damage and the installation of deformities and disabilities that are characteristic of leprosy.

Cerebral vasomotor reactivity assessment using Transcranial Doppler and MRI with apnea test

Differently from previous studies that used Transcranial Doppler (TCD) and functional MRI (fMRI) for cerebral vasomotor reactivity (CVR) assessment in patients with carotid stenosis (CS), we assessed CVR using an identical stimulus, the Breath-Holding Test (BHT). We included 15 patients with CS and 7 age-matched controls to verify whether fMRI responded differently to BHT between groups and to calculate the agreement rate between tests. For TCD, impaired CVR was defined when the mean percentage increase on middle cerebral artery velocities was ≤31% on 3 consecutive 30-s apnea intercalated by 4-min normal breathing intervals. For fMRI, the percent variation on blood oxygen level-dependent (BOLD) signal intensity in the lentiform nucleus (LN) ipsilateral to the CS (or both LNs for controls) from baseline breathing to apnea was measured. The Euclidian differences between the series of each subject and the series of controls and patients classified it into normal or impaired CVR. We found different percent variations on BOLD-signal intensities between groups (P=0.032). The agreement was good in Controls (85.7%; κ=0.69) and overall (77.3%; κ=0.54). We conclude that BHT was feasible for CVR assessment on fMRI and elicited different BOLD responses in patients and controls, with a good overall agreement between the tests.

Impacto dos stents e do sirolimus por via oral na vasomotilidade coronariana dependente e independente do endotelio / Impact of stenting and oral sirolimus on endothelium-dependent and independent coronary vasomotion

FUNDAMENTO: Não há consenso sobre o impacto do implante de stent sobre a função endotelial no longo prazo. Há relatos de disfunção endotelial aumentada com stent com sirolimus quando comparado com o stent metálico convencional (BMS). OBJETIVO: Este estudo visa a avaliar o impacto do BMS e o efeito do sirolimus por via oral sobre a função endotelial. MÉTODOS: Quarenta e cinco pacientes foram randomizados em três grupos: BMS + altas doses de sirolimus oral (dose inicial de 15 mg, seguida de 6 mg/dia durante quatro semanas); BMS + baixa dose de sirolimus (6 mg, seguida de 2 mg por dia durante quatro semanas) e BMS sem sirolimus. Mudanças na vasoconstrição ou vasodilatação, em um segmento de 15 milímetros começando pelo extremo distal do stent em resposta a acetilcolina e nitroglicerina, foram avaliadas por angiografia quantitativa. RESULTADOS: Os grupos apresentaram características angiográficas semelhantes. A variação percentual de diâmetro em resposta a acetilcolina foi semelhante em todos os grupos, nos dois momentos (p = 0,469). Quatro horas após o implante de stent, o segmento alvo apresentou uma disfunção endotelial que se manteve após oito meses em todos os grupos. Em todos os grupos, a vasomotricidade independente de endotélio em resposta a nitroglicerina foi semelhante, às quatro horas e aos oito meses, com diâmetro do segmento alvo aumentado após a infusão de nitroglicerina (p = 0,001). CONCLUSÃO: A disfunção endotelial esteve igualmente presente no segmento distal de 15 milímetros do segmento tratado, às 4 horas e aos 8 meses após implante do stent. O sirolimus administrado por via oral durante quatro semanas para evitar a reestenose não afetou o estado de vasomotricidade endotélio dependente e independente.

BACKGROUND: There is no consensus regarding the impact of stenting on long-term endothelial function. There have been reports of increased endothelial dysfunction with sirolimus-eluting stents as compared to bare metal stenting (BMS). OBJECTIVE: This study aims to assess the impact of BMS and the effect of oral sirolimus on endothelial function. METHODS: Forty-five patients were randomized into three groups: BMS + high-dose oral sirolimus (initial dose of 15 mg, followed by 6 mg/day for four weeks); BMS + low-dose sirolimus (6 mg followed by 2 mg daily for four weeks); and BMS without sirolimus. Changes in vasoconstriction or vasodilation in a 15 mm segment starting at the distal stent end in response to acetylcholine and nitroglycerin were assessed by quantitative angiography. RESULTS: The groups had similar angiographic characteristics. The percent variation in diameter in response to acetylcholine was similar in all groups at the two time points (p = 0.469). Four hours after stenting, the target segment presented an endothelial dysfunction that was maintained after eight months in all groups. In all groups, endothelium-independent vasomotion in response to nitroglycerin was similar at four hours and eight months, with increased target segment diameter after nitroglycerin infusion (p = 0.001). CONCLUSION: The endothelial dysfunction was similarly present at the 15 mm segment distal to the treated segment, at 4 hours and 8 months after stenting. Sirolimus administered orally during 4 weeks to prevent restenosis did not affect the status of endothelium-dependent and independent vasomotion.

Síntomas vasomotores en la mujer climatérica / Vasomotor symptoms in climateric woman

Introducción: los síntomas más precoces y característicos del período climatérico son los síntomas vasomotores, los cuales se producen por la pérdida intermitente del control vasomotor por la falta de retroalimentación negativa del estradiol sobre el hipotálamo. Objetivo: aportar un conocimiento actualizado sobre la fisiopatología de la sintomatología vasomotora presentada en la mujer climatérica. Métodos: se realizó una revisión bibliográfica actualizada sobre la sintomatología vasomotora relacionada con el síndrome climatérico. Se revisaron textos, revistas y monografías. Resultados: se confeccionaron cuadros resúmenes y esquemas de la fisiopatología de los síntomas, así como una propuesta de algoritmo para el manejo de los síntomas vasomotores en la Atención Primaria de Salud. Conclusiones: las modificaciones perimenopáusicas suelen comenzar durante la quinta década de la vida. En este período, los síntomas más precoces son los sofocos y sudoraciones que afectan al 75 - 85 por ciento de las mujeres

Introduction: the more precocious and characteristic symptoms of climateric period are the vasomotor symptoms, which are produced due to the intermittent loss of vasomotor control by lack of a negative feedback of estradiol on the hypothalamus. Objective: to provide an updated knowledge on the physiopathologic features of vasomotor symptomatology in climateric woman. Methods: authors carried out an updated bibliographic review on above mentioned symptomatology related to climateric syndrome, as well as texts, journals and monographs. Results: summarized pictures and schemes of the physiopathologic features of symptoms, as well as a proposal of algorithm for management of vasomotor symptoms in the Health Primary Care. Conclusions: the perimenopause modifications may to begin during the fifth decade of life. In this period the earlier symptoms include: suffocations and sweatings involving the 75-85 percent of women

Tônus e diâmetro arterial coronário não se correlacionam com o grau de denervação autonômica em pacientes com cardiopatia chagásica crônica / Coronary artery diameter and baseline tonus do not correlate with degree of cardiac parasympathetic impairment in patients with chronic chagas cardiomypathy

Introdução: Portadores de cardiopatia chagásica crônica (CCC) apresentam precoce e intensa disautonomia, postulando-se potenciais anormalidades vasomotoras coronárias e conseqüente isquemia e fibrose miocárdica. Esta investigação correlacionou o grau de denervação parassimpática cardíaca com o diâmetro e o tônus arterial coronário. Método: Em 18 pacientes com CCC (55 ± 9 anos, 8 do gênero masculino) e 23 voluntários normais (37 ± 11 anos, 16 do gênero masculino), avaliou-se a sensibilidade barorreflexa (SBR) com monitoração contínua da pressão arterial (PA) e indução de aumentos transitórios da PA por administração endovenosa de fenilefrina (50 µg a 150 µg). Cateterismo cardíaco com cinecoronariografia basal e 5 minutos após 5 mg de dinitrato de isossorbida (DNIS) foi realizado em pacientes chagásicos. Análise quantitativa do diâmetro arterial coronário foi realizada off-line nas duas condições. O tônus basal arterial coronário foi estimado pelo aumento porcentual do diâmetro após DNIS. A fração de ejeção do ventrículo esquerdo (FEVE) foi calculada pelo método de Dodge biplanar na ventriculografia de contraste, usando-se ecocardiografia bidimensional para o diâmetro diastólico (DDVE) e estimativa da massa do ventrículo esquerdo. Resultados: Verificou-se acentuada redução da SBR (4,1 ± 1,7 ms/mmHg) na CCC comparativamente aos controles (15,0 ± 1,5 ms/mmHg) (p < 0,001). O diâmetro coronário médio foi de 2,2 ± 0,3 mm, correlacionando-se significativamente com variáveis expressando remodelamento cardíaco: FEVE (p = 0,017, R = 0,554), DDVE (p = 0,0036, R = 0,648) e massa VE (p = 0,022, R = 0,534). Não foi observada correlação significante entre diâmetro coronário e SBR (p = 0,457, R = 0,187). O tônus arterial coronário basal foi de 13 ± 17%, sem correlação com qualquer variável, incluindo o diâmetro coronário (p = 0,386, R = 0,218) e a SBR (p = 0,822, R = 0,057). Conclusões: A denervação parassimpática não parece influenciar o diâmetro e o tônus arterial coronário basal na CCC.

Background: Chronic Chagas Cardiomyopathy (CCC) induces early severe cardiac dysautonomia, potentially causing derangements in the regulation of coronary vasomotion and leading to myocardial ischemia and fibrosis. We assessed the correlation between dysautonomia severity and coronary artery diameter and tonus. Methods: Eighteen patients with CCC (55±9 yrs, 8 males) and 23 normal volunteers (37±11 yrs, 16 males) were investigated. Both groups underwent evaluation of baroreflex sensitivity (BRS) by means of invasive arterial pressure (AP) monitoring and transient increases of AP induced by intravenous phenilephrinefrin injections (50-150µg). Patients with CCC had cardiac catheterization and coronary angiography at baseline and 5 min. after administration of 5mg of isosorbide-dinitrate (ISDN). Quantitative coronary analysis was performed off-line for both conditions (baseline and post-ISDN). Baseline coronary artery tonus was calculated by the percent diameter increase after ISDN. LVEF was calculated by Dodge biplane method from contrast ventriculography and 2D-echocardiogram was used for the measurement of LV diastolic diameter and mass. Results: CCC patients showed severe reduction of the BRS (4.1 ± 1.7 ms/mmHg) as compared to controls (15.0 ± 1.5 ms/mmHg), p < 0.001. Mean coronary artery diameter was 2.2 ± 0.3 mm, and was significantly correlated with parameters of LV remodeling: LEFF (p = 0.017, R = 0.554), LVDD (p = 0.0036, R = 0.648) and LV mass (p = 0.022, R = 0.534). No significant correlation occurred between coronary diameter and the BRS (p = 0.457, R = 0.187). Baseline coronary tonus was 13 ± 17%, without correlation with any variables, including coronary diameter (p = 0.386, R = 0.218) and BRS (p = 0.822, R = 0.057). Conclusions: Cardiac parasympathetic impairment does not seem to determine coronary artery diameter and tonus in patients with CCC.

Mechanisms of depressor effect of norepinephrine injected into subnucleus commissuriu of nucleus solitarius tractus in rabbits / 华中科技大学学报（医学）（英德文版）

This experiment aimed to investigate the effect of adrenergic system in the subnucleus commissuriu of nucleus solitrius tractus (CNTS) on renal nerve discharges. Norepinephrine (NE) was microinjected into the CNTS of rabbits and mean arterial blood pressure (MAP) and renal nerve discharges (FRND) were synchronously recorded. The results indicated that (1) microinjection of norepinephine into the CNTS of rabbit could significantly attenuate the frequency of renal nerve discharge, and at the same time decrease markedly the mean arterial pressure. (2) Microinjection of 0.3 nmol yohimbin into CNTS had no significant influence on FRND and MAP, but could attenuate and even reverse the effects of NE on FRND and MAP. These results suggest that microinjection of NE into CNTS may activate the alpha-adrenorecptor located in CNTS and secondarily produce a depressor effect by attenuating the activity of periphenal sympathetic nervous system.

Bases fisiologicas de la clinica y del tratamiento del shock / Physiological basis of the evolution and treatment of shock

Los estados de shock ocurren cuando el sistema circulatorio no puede sostener un estado de perfusión celular adecuado y el aporte de nutrientes a los tejidos se reduce a niveles críticos. Si esta condición no es compensada rápidamente suele desarrolarse daño celular irreversible y disfunción orgánica múltiple. En los shock hipovolémicos, cardiogénicos y vasculares obstructivos la resistencia vascular sistémica está aumentada y la oxigenación arterial pulmonar disminuida. El shock distributivo es causado primariamente por una severa disfunción vasomotora que origina pérdida del tono arteriolar, aumento del lecho de capacitancia y trastornos distributivos del flujo. El gasto cardíaco y el volumen intravascular pueden estar disminuidos, ser normales o estar incrementados en presencia de hipotensión en el shock distributivo. El patrón característico de la función cardíaca en el shock séptico consiste en reducción de la fracción de eyección ventricular izquierda y derecha, aumento de los volúmenes de fin de diástole y de fin de sístole de ambos ventrículos y volúmenes sistólicos normales.

Aspectos reciente en la fisiopatología de la hipertensión arterial / New aspects in the physiopathology of arterial hypertension

En este trabajo analizamos los conocimientos recientes sobre los diversos mecanismos que se han relacionado con la fisiopatología de la hipertensión arterial esencial, su relación con el daño orgánico, principalmente aterosclerótico, las bases para tratamientos más específicos en el futuro, y la posibilidad de correcciones de tales alteraciones con los fármacos disponibles en la actualidad