Análise da concordância entre o plano dietético Dietary Approaches to Stop Hypertension (DASH) e o padrão alimentar de pacientes hipertensos

A adoção do plano dietético Dietary Approaches to Stop Hypertension (DASH) tem sido enfatizado na população hipertensa como uma importante estratégia no controle dos níveis pressóricos elevados. O objetivo deste estudo foi analisar o consumo alimentar de macro e micronutrientes em pacientes hipertensos, em especial do sódio, cálcio, potássio e magnésio, e comparar com as recomendações dietéticas contidas no plano DASH. Estudo transversal envolvendo uma amostra de conveniência composta por 113 hipertensos entre 40 e 69 anos. A medida da pressão arterial (PA) foi determinada com aparelho eletrônico devidamente calibrado e a avaliação dietética obtida pelo questionário de freqüência do consumo alimentar. Os alimentos ingeridos foram convertidos em porções e distribuídos em diferentes grupos alimentares. A faixa de porções recomendadas pelo plano DASH foi determinada com base na média das necessidades energéticas desta amostra permitindo assim uma posterior comparação com o hábito alimentar dos hipertensos, utilizando um escore de pontos com pontuação máxima de 9 pontos. A amostra foi dividida em três grupos: grupo B que obteve 2,5 a 4,0 pontos (n=34; 30%), grupo M entre 4,5 a 5,0 pontos (n=43; 38%) e grupo A que obteve 5,5 a 8,0 pontos (n=36; 32%). Não foram observadas diferenças significativas na média da PA sistólica (14024 vs 13823 vs 13515 mmHg) e diastólica (8617 vs 8813 vs 8410 mmHg). Apesar do grupo A consumir mais proteínas e gordura monoinsaturada, foi detectado um excesso pronunciado na ingestão de gordura saturada, colesterol e das calorias totais, por este grupo de pacientes. No que tange a ingestão dos micronutrientes, o grupo A apresentou consumo significativamente maior de cálcio, potássio e magnésio, refletido pela maior ingestão de vegetais e frutas em comparação aos grupos B e M. A média de ingestão do sódio intrínseco foi significativamente maior no grupo A (4,12,0 vs 3,11,1 vs 2,71,1 g/dia). Foram detectadas, apenas no grupo A, correlações entre PA sistólica e o percentual de proteína (r = -0,5; p=0,002) e PA sistólica e o percentual de carboidrato (r = 0,4; p=0,02). Apenas um terço dos hipertensos avaliados apresentaram padrão alimentar mais concordante com o plano DASH e com maior ingestão de proteínas, gordura monoinsaturada, fibras, cálcio, potássio e magnésio. Entretanto, o consumo mais elevado de sódio, gordura saturada, colesterol e das calorias totais por este grupo de pacientes poderia restringir uma maior queda dos níveis pressóricos elevados.

270GHz, 580fs Optical Pulse Generation from a single-section quantum-dash fabry-pérot laser using frequency multiplication

Pulse generation from a mode-locked single-section 1.55μm quantum-dash FP laser is demonstrated under continuous-wave operation. A 270GHz, 580fs pulse train is achieved by applying frequency multiplication using fiber dispersion. ©2009 Optical Society of America.

Experimental study of quantum dot and dash lasers

Quantum dashes are elongated quantum dots. Polarized edge-photovoltage and spontaneous emission spectroscopy are used to study the anisotropy of optical properties in 1.5μm InGaAsP and AlGaInAs-based quantum dash lasers. Strain, which causes TM-polarized transitions to be suppressed at the band edge, coupled with carrier confinement and dash shape leads to an enhancement of the optical properties for light polarized along the dash long axis, in excellent agreement with theoretical results. An analysis of the integrated facet and spontaneous emission rate with total current and temperature reveals that, in both undoped and p-doped InGaAsP-based quantum dash lasers at room temperature, the threshold current and its temperature dependence remain dominated by Auger recombination. We also identify two processes which can limit the output power and propose that the effects of the dopant in p-doped InGaAsP-based lasers dominate at low temperature but decrease with increasing temperature. A high threshold current density in undoped AlGaInAs-based quantum dash laser samples studied, which degrade rapidly at low temperature, is not due to intrinsic carrier recombination processes. 1.3μm GaAs-based quantum dots lasers have been widely studied, but there remains issues as to the nature of the electronic structure. Polarized edge-photovoltage spectroscopy is used to investigate the energy distribution and nature of the energy states in InAs/GaAs quantum dot material. A non-negligible TM-polarized transition, which is often neglected in calculations and analyses, is measured close to the main TE-polarized ground state transition. Theory is in very good agreement with the experimental results and indicates that the measured low-energy TM-polarized transition is due to the strong spatial overlap between the ground state electron and the light-hole component of a low-lying excited hole state. Further calculations suggest that the TM-polarized transition reduces at the band edge as the quantum dot aspect ratio decreases.

Properties and applications of injection locking in 1.55 μm quantum-dash mode-locked semiconductor lasers

Mode-locked semiconductor lasers are compact pulsed sources with ultra-narrow pulse widths and high repetition-rates. In order to use these sources in real applications, their performance needs to be optimised in several aspects, usually by external control. We experimentally investigate the behaviour of recently-developed quantum-dash mode-locked lasers (QDMLLs) emitting at 1.55 μm under external optical injection. Single-section and two-section lasers with different repetition frequencies and active-region structures are studied. Particularly, we are interested in a regime which the laser remains mode-locked and the individual modes are simultaneously phase-locked to the external laser. Injection-locked self-mode-locked lasers demonstrate tunable microwave generation at first or second harmonic of the free-running repetition frequency with sub-MHz RF linewidth. For two-section mode-locked lasers, using dual-mode optical injection (injection of two coherent CW lines), narrowing the RF linewidth close to that of the electrical source, narrowing the optical linewidths and reduction in the time-bandwidth product is achieved. Under optimised bias conditions of the slave laser, a repetition frequency tuning ratio >2% is achieved, a record for a monolithic semiconductor mode-locked laser. In addition, we demonstrate a novel all-optical stabilisation technique for mode-locked semiconductor lasers by combination of CW optical injection and optical feedback to simultaneously improve the time-bandwidth product and timing-jitter of the laser. This scheme does not need an RF source and no optical to electrical conversion is required and thus is ideal for photonic integration. Finally, an application of injection-locked mode-locked lasers is introduced in a multichannel phase-sensitive amplifier (PSA). We show that with dual-mode injection-locking, simultaneous phase-synchronisation of two channels to local pump sources is realised through one injection-locking stage. An experimental proof of concept is demonstrated for two 10 Gbps phase-encoded (DPSK) channels showing more than 7 dB phase-sensitive gain and less than 1 dB penalty of the receiver sensitivity.

The Dietary Approaches to Stop Hypertension (DASH) eating pattern in special populations.

The Dietary Approaches to Stop Hypertension (DASH) trial showed that a diet rich in fruits, vegetables, low-fat dairy products with reduced total and saturated fat, cholesterol, and sugar-sweetened products effectively lowers blood pressure in individuals with prehypertension and stage I hypertension. Limited evidence is available on the safety and efficacy of the DASH eating pattern in special patient populations that were excluded from the trial. Caution should be exercised before initiating the DASH diet in patients with chronic kidney disease, chronic liver disease, and those who are prescribed renin-angiotensin-aldosterone system antagonist, but these conditions are not strict contraindications to DASH. Modifications to the DASH diet may be necessary to facilitate its use in patients with chronic heart failure, uncontrolled diabetes mellitus type II, lactose intolerance, and celiac disease. In general, the DASH diet can be adopted by most patient populations and initiated simultaneously with medication therapy and other lifestyle interventions.

Impact of Kidney Function on Effects of the Dietary Approaches to Stop Hypertension (Dash) Diet.

OBJECTIVES: Although the Dietary Approaches to Stop Hypertension (DASH) diet lowers blood pressure in adults with hypertension, how kidney function impacts this effect is not known. We evaluated whether Estimated Glomerular Filtration Rate (eGFR) modifies the effect of the DASH diet on blood pressure, markers of mineral metabolism, and markers of kidney function. METHODS: Secondary analysis of the DASH-Sodium trial, a multicenter, randomized, controlled human feeding study that evaluated the blood pressure lowering effect of the DASH diet at three levels of sodium intake. Data from 92 participants with pre-hypertension or stage 1 hypertension during the 3450 mg /day sodium diet assignment contributed to this analysis. Stored frozen plasma and urine specimens were used to measure kidney related laboratory outcomes. RESULTS: Effects of the DASH diet on blood pressure, phosphorus, intact parathyroid hormone, creatinine, and albuminuria were not modified by baseline eGFR (mean 84.5 ± 18.0 ml/min/1.73 m(2), range 44.1 to 138.6 ml/min/1.73 m(2)) or the presence of chronic kidney disease (N=13%). CONCLUSIONS: The impact of the DASH diet on blood pressure, markers of mineral metabolism, and markers of kidney function does not appear to be modified by eGFR in this small subset of DASH-Sodium trial participants with relatively preserved kidney function. Whether greater reduction in eGFR modifies the effects of DASH on kidney related measures is yet to be determined. A larger study in individuals with more advanced kidney disease is needed to establish the efficacy and safety of the DASH diet in this patient population.