Usefulness of B-type natriuretic peptide in hypertensive patients with exertional dyspnea and normal left ventricular ejection fraction and correlation with new echocardiographic indexes of systolic and diastolic function

B-type natriuretic peptide (BNP) levels increase in systolic heart failure (HF). However, the value of BNP in hypertensive patients with suspected diastolic HF (symptoms suggestive of HF but normal ejection fraction) and its relation to myocardial function in these patients is unclear. We prospectively studied 72 ambulatory hypertensive subjects (40 women, mean age 58 +/- 8 years) with exertional dyspnea and ejection fraction greater than or equal to50%. Diastolic function was evaluated with transmitral and pulmonary venous Doppler, mitral annular velocities (pulsed-wave tissue Doppler), and flow propagation velocity (color M-mode). Systolic function was assessed with strain and strain rate derived from color tissue Doppler imaging. BNP was related to myocardial function and the presence or absence of global diastolic dysfunction. By conventional Doppler criteria, 34 patients had normal left ventricular diastolic function and 38 had isolated diastolic dysfunction. BNP values were higher in patients with diastolic dysfunction (46 +/- 48 vs 20 +/- 20 pg/ml, p = 0.004) and were related independently to blood pressure, systolic strain rate, left atrial function (p < 0.01 for all), and age (p = 0.015). Patients with diastolic dysfunction and pseudonormal filling had higher BNP levels compared with impaired relaxation (89 +/- 47 vs 35 +/- 42 pg/ml, p = 0.001). However, 79% of patients with diastolic dysfunction had BNP levels within the normal range. We conclude that in ambulatory hypertensive patients with symptoms suggestive of mild HF and normal ejection fraction, BNP is related to atrial and ventricular systolic parameters, blood pressure, and age. Although elevated in the presence of diastolic dysfunction, the BNP level mostly is in the normal range and, therefore, has limited diagnostic value in stable patients with suspected diastolic HF. (C) 2003 by Excerpta Medica, Inc.

Usefulness of myocardial tissue Doppler echocardiography to evaluate left ventricular dyssynchrony before and after biventricular pacing in patients with idiopathic dilated cardiomyopathy

Tissue Doppler imaging allows assessment of left ventricular dyssynchrony and resynchronization after biventricular pacing.

Ventricular dysfunction in early diabetic heart disease: detection, mechanisms and significance

The detection of preclinical heart disease is a new direction in diabetes care. This comment describes the study by Vinereanu and co-workers in this issue of Clinical Science in which tissue Doppler echocardiography has been employed to demonstrate subtle systolic and diastolic dysfunction in Type 11 diabetic patients who had normal global systolic function and were free of coronary artery disease. The aetiology of early ventricular dysfunction in diabetes relates to complex intramyocardial and extramyocardial mechanisms. The initiating event may be due to insulin resistance, and involves abnormal myocardial substrate utilization and uncoupling of mitochondrial oxidative phosphorylation. Dysglycaemia plays an important role via the effects of oxidative stress, protein kinase C activation and advanced glycosylation end-products on inflammatory signalling, collagen metabolism and fibrosis. Extramyocardial mechanisms involve peripheral endothelial dysfunction, arterial stiffening and autonomic neuropathy. The clinical significance of the ventricular abnormalities described is unknown. Confirmation of their prognostic importance for cardiac disease in diabetes would justify routine screening for presymptomatic ventricular dysfunction, as well as clinical trials of novel agents for correcting causal mechanisms. These considerations could also have implications for patients with obesity and the metabolic syndrome.

Plasma zinc and immune markers in runners in response to a moderate increase in training volume

Changes in plasma zinc concentration and markers of immune function were examined in a group of 10 male runners (n = 10) following a moderate increase in training over four weeks. Seven sedentary males acted as controls. Fasting blood samples were taken at rest, before (T0) and after T4) four weeks of increased (+ 16 %) training and after two weeks of reduced (- 31 %) training (W. Blood was analysed for plasma zinc concentration, differential leucocyte counts, lymphocyte subpopulations and lymphocyte proliferation using incorporation of H-3-thymidine. The runners increased their training volume by 16 % over the four weeks. When compared with the nonathletes, the runners had lower concentrations of plasma zinc (p = 0.012), CD3(+) (p = 0.042) and CD19(+) lymphocytes (p = 0.010) over the four weeks. Lymphocyte proliferation in response to Concanavalin A stimulation was greater in the runners (p = 0.0090). Plasma zinc concentration and immune markers remained constant during the study. Plasma zinc concentration correlated with total leucocyte counts in the athletes at T6 (r = -0.72, p < 0.05) and with Pokeweed mitogen stimulation in the nonathletes at T6 (r = -0.92, p < 0.05). Therefore, athletes are unlikely to benefit from zinc supplementation during periods of moderately increased training volume.

Adsorption of supercritical fluids in non-porous and porous carbons: analysis of adsorbed phase volume and density

In this paper, we revisit the surface mass excess in adsorption studies and investigate the role of the volume of the adsorbed phase and its density in the analysis of supercritical gas adsorption in non-porous as well as microporous solids. For many supercritical fluids tested (krypton, argon, nitrogen, methane) on many different carbonaceous solids, it is found that the volume of the adsorbed phase is confined mostly to a geometrical volume having a thickness of up to a few molecular diameters. At high pressure the adsorbed phase density is also found to be very close to but never equal or greater than the liquid phase density. (C) 2003 Elsevier Science Ltd. All rights reserved.

A experi??ncia da ENAP na forma????o inicial para a carreira de Especialista em Pol??ticas P??blicas e Gest??o Governamental ??? EPPGG: 1988 a 2006 - Volume 1

A pesquisa apresentada neste documento analisa, interpreta e sistematiza o material das onze edi????es do curso, desenvolvidas pela ENAP, de 1988 a 2006. Consideremos que esta ?? uma hist??ria que merece ser conhecida, permitindo extrair, dos acertos e erros, importantes li????es, as quais a ENAP, com o prop??sito de contribuir para seu cont??nuo aprimoramento, deseja compartilhar com as demais Escolas de Governo, institui????es e profissionais dedicados ao of??cio de forma????o de servidores p??blicos

A experi??ncia da ENAP na forma????o inicial para a carreira de Especialista em Pol??ticas P??blicas e Gest??o Governamental ??? EPPGG: 1988 a 2006 - Volume 2

A pesquisa apresentada nestes dois cadernos analisa, interpreta e sistematiza o material das onze edi????es do curso forma????o, desenvolvidas pela ENAP, entre 1988 e 2006. A obra pretende mostrar as influ??ncias de valores e de diferentes perspectivas que as atividades sofreram ao longo desse per??odo. O curso est?? diretamente associado ?? cria????o da ENAP e, em agosto de 2008, completou 20 anos

Colet??nea planejamento e or??amento governamental: volume 1: pref??cio

Pref??cio da colet??nea, estabelece seu objetivo de fornecer material did??tico focado no desenvolvimento profissional da administra????o p??blica brasileira.

Colet??nea planejamento e or??amento governamental: volume 1: introdu????o

Esta introdu????o, al??m de apresentar e contextualizar cada tem??tica, objetiva ser um texto did??tico b??sico para os cursos da ENAP. Nesse sentido, traz, adicionalmente, uma s??ntese dos temas desenvolvidos nos respectivos textos da colet??nea.

Colet??nea planejamento e or??amento governamental: volume 1: o plano como aposta

O texto sintetiza os principais fundamentos do m??todo PES. Esse m??todo contrap??e-se ao planejamento tradicional e prop??e uma abordagem tecnopol??tica do planejamento.

Colet??nea planejamento e or??amento governamental: volume 1: o quadro l??gico - um m??todo para planejar e gerenciar mudan??as

O texto traz uma s??ntese do Enfoque do Quadro L??gico e constr??i um exemplo da matriz de planejamento do projeto, que ilustra para o leitor a estrutura do QL

Colet??nea planejamento e or??amento governamental: volume 1: a experi??ncia brasileira em planejamento econ??mico - uma s??ntese hist??rica

O texto faz uma s??ntese did??tica dos planos de desenvolvimento e de estabiliza????o econ??mica implementados no Brasil, nas ??ltimas seis d??cadas. O relato abrange desde os primeiros exerc??cios de planejamento, no imediato p??s-Segunda Guerra Mundial, at?? os ??ltimos PPAs e, ainda, faz refer??ncias ??s tentativas de planejamento de longo prazo com o ???Brasil 2020???, no governo Fernando Henrique.

Colet??nea planejamento e or??amento governamental: volume 1: a retomada do planejamento governamental no Brasil e seus desafios

O texto apresenta um cen??rio dos avan??os recentes no planejamento governamental. Em sua primeira parte, procura referenciar o debate atual acerca das possibilidades, das limita????es e dos avan??os introduzidos pelo PPA, especialmente a partir de 2000, com destaque para a integra????o ???plano-or??amento???, por meio de programas formulados com origem em problemas ou demandas da sociedade; um plano e um or??amento orientados para resultado; e o novo sistema de planejamento e or??amento como pe??a fundamental para a implanta????o da gest??o por resultados no Pa??s. A segunda parte do texto refere-se ao modelo de gest??o do plano. S??o apresentados os fundamentos do modelo de sua gest??o e os avan??os propostos para o PPA 2004-2007. Em s??ntese, a gest??o do plano ?? fundamentada no princ??pio da responsabiliza????o e nos processos de monitoramento, avalia????o e retroalimenta????o do ciclo do gasto p??blico

Colet??nea planejamento e or??amento governamental: volume 1: a metodologia de gest??o estrat??gica do NAE

O texto incorpora uma diversidade de ferramentas de planejamento estrat??gico. Sua principal caracter??stica ?? a de ver o planejamento estrat??gico como um processo e n??o apenas como um projeto que se finda com a antevis??o de cen??rios prospectivos e suas poss??veis solu????es estrat??gicas.