Defecto en la homeostasis del oxido nítrico. Mecanismo común subyacente de la insulino-resistencia, la hiperactividad simpática y la morbi-mortalidad cardiovascular [Defective nitric oxide homeostasis. Common underlying mechanism between insulin resistance, sympathetic overactivity and cardiovascular morbidity and mortality]

Obesity, insulin resistance and associated cardiovascular complications are reaching epidemic proportions worldwide and represent a major public health problem. Over the past decade, evidence has accumulated indicating that insulin administration, in addition to its metabolic effects, also has important cardiovascular actions. The sympathetic nervous system and the L-arginine-nitric oxide pathway are the central players in the mediation of insulin's cardiovascular actions. Based on recent animal and human research, we demonstrate that both defective and augmented NO synthesis represent a central defect triggering many of the metabolic, vascular and sympathetic abnormalities characteristic of insulin-resistant states. These observations provide the rationale for the use of pharmaceutical drugs releasing small and physiological amounts of NO and/or inhibitors of NO overproduction as a future treatment for insulin resistance and associated comorbidities.

Densidade e diversidade fenotípica de bactérias diazotróficas endofíticas em solos de mineração de bauxita, em reabilitação

Bactérias diazotróficas endofíticas contribuem para o desenvolvimento das plantas por meio da fixação biológica do nitrogênio, produção e liberação de substâncias reguladoras do crescimento vegetal, podendo, assim, facilitar a revegetação de solos degradados por atividades antrópicas. No entanto, pouco se conhece sobre as populações destas bactérias em solos ou plantas de áreas de mineração. Objetivando avaliar o efeito de diferentes tipos de vegetação e tempo de reabilitação de áreas degradadas por mineração de bauxita na densidade e diversidade de algumas espécies de bactérias diazotróficas endofíticas, realizaram-se, em duas épocas, amostragens de solo, de dois ambientes distintos, submetidos a diferentes processos de reabilitação. A densidade, avaliada pelo número mais provável, utilizando os meios de cultura: NFb, JNFb e Fam, para Azospirillum brasilense e A. lipoferum, Herbaspirillum spp. e A. amazonense, respectivamente, variou de 0 a 2,0 x 10(4) bactérias por grama de solo e mostrou que o tipo de vegetação influiu nas populações destas bactérias. Foram encontradas densidades maiores em solos revegetados com gramíneas: braquiária (Brachiaria decumbens), capim-azevém (Lolium multiflorum) e capim-gordura (Melinis minutiflora). Contudo, estas densidades podem ser consideradas baixas, se comparadas às de solos agrícolas, e não apresentaram relação com o tempo de reabilitação da área. Foram encontrados 36 fenótipos culturais em meio batata, entre os 72 isolados obtidos dos três meios de cultura utilizados. A partir destes, foram formados sete grandes grupos com similaridade superior ou igual a 63 %, dos quais cinco, representando 62,5 % do total de isolados obtidos, continham as estirpes-tipo de Burkholderia brasilensis, Herbaspirillum seropedicae e Azospirillum spp. (A. brasilense, A. amazonense, A. lipoferum, A. irakense). Apesar da baixa densidade, este grupo de bactérias apresentou alta diversidade fenotípica no ambiente estudado.

Caracterização fenotípica e diversidade de bactérias diazotróficas associativas isoladas de solos em reabilitação após a mineração de bauxita

As gramíneas, usadas comumente para reabilitação de áreas degradadas, podem formar associações em suas raízes com bactérias fixadoras de nitrogênio e, assim, contribuir para a sustentabilidade do ecossistema. Por outro lado, a diversidade microbiana exerce papel relevante na resiliência dos processos biológicos do solo, que incluem a fixação biológica de N2. O presente estudo teve como objetivo a caracterização fenotípica de 72 isolados de bactérias diazotróficas associativas Gram-negativas, oriundos de áreas sob diferentes estratégias de reabilitação, após a mineração da bauxita em Poços de Caldas (MG), por meio da inoculação de amostras de solo nos meios de cultivo NFb, Fam e JNFb. Estirpes tipo e referência de espécies de Azospirillum, Herbaspirillum e Burkholderia foram usadas para comparação, uma vez que são capazes de crescer nestes meios. O dendrograma de similaridade baseado em sete características culturais dos isolados em meio de cultivo GNA revelou grande diversidade, sendo obtidos 50 grupos a 81 % de similaridade. A tolerância a NaCl em meio de cultivo batata/sacarose/ácido málico variou de 0 a 50 g L-1, permitindo separar os isolados e estirpes tipo em cinco grupos. O diâmetro celular variou de 0,61 a 1,21 µm, e 13 isolados diferiram das estirpes tipo e referência. Os padrões de proteína total, obtidos por eletroforese em gel de poliacrilamida (SDS-PAGE), foram bastante diversos, possibilitando a formação de 15 grupos com similaridade a 75 %. Não houve relação entre os grupos formados pelas várias características estudadas, tampouco destes com as áreas de origem dos isolados. Os meios de cultivo Fam e JNFb detectaram, além das espécies-alvo, outras não identificadas. A alta dissimilaridade da maioria dos isolados em relação a estirpes tipo, principalmente com relação aos padrões eletroforéticos de proteína total, admite a possibilidade da presença de novas espécies entre eles.

Training and accreditation in cardiovascular magnetic resonance in Europe: a position statement of the working group on cardiovascular magnetic resonance of the European Society of Cardiology.

Cardiovascular magnetic resonance (CMR) has become an established imaging modality which provides often unique information on a wide range of cardiovascular diseases. The European Society of Cardiology (ESC) training curriculum reflects the emerging role of CMR by recommending that all trainees obtain a minimum level of training in CMR and by defining criteria for subspecialty training in CMR. 1 The wider use of CMR requires the definition of standards for data acquisition, reporting, and training in CMR across Europe. At the same time, training and accreditation in all cardiac imaging methods should be harmonized and integrated to promote the training of cardiac imaging specialists. The recommendations presented in this document are intended to inform the discussion about standards for accreditation and certification in CMR in Europe and the discussion on integrated imaging training. At present, the recommendations in this position statement are not to be interpreted as guidelines. Until such guidelines are available and nationally ratified, physicians will be able to train and practice CMR according to current national regulations.

Bilan préopératoire pour la chirurgie cardio-vasculaire en urgence [Preoperative assessment in emergency cardiovascular surgery].

In the emergency situation, preoperative patient work-up for cardio-vascular surgery is quite different from the elective setting. We have analyzed a consecutive series of 5576 cases out of which 823 underwent emergency procedures (14.8%). The most frequent problems requiring emergent intervention were peripheral vascular (186 cases; 22.6% of the emergent procedure), followed by coronary artery disease (156 cases; 19.0%), thoracic aortic aneurysms (86 cases; 10.4%), abdominal aortic aneurysms (54 cases; 6.6%), congenital heart disease (36 cases: 4.4%), heart and heart lung transplantation (31 cases; 3.8%), problems with cardiac rythm (25 cases: 3.0%), and others (267 cases: 32.4%). Classification by proportion of urgent procedures with reference to elective operations shows a different picture. As a matter of fact transplantations were always emergency procedures (100%), whereas repair of aortic dissections type A and B was an emergency procedure in 81.5%. Emergency thoracic and abdominal aortic aneurysm repair accounted for 30% and 20% respectively and the corresponding proportion for peripheral vascular surgery is 19%. However, emergency surgery for acute coronary ischemia, valvular and congenital heart disease accounted for somewhat less than 10% for each group of these pathologies. Systematic pre-operative diagnostic work-up is a recognized tool for procedure related risk assessment and superior management of diseases. However, hemodynamic instability and other time related events correlated with negative outcome, are the main driving forces for accelerated diagnostic pathways

Dosage-dependent effects of Akt1/protein kinase Balpha (PKBalpha) and Akt3/PKBgamma on thymus, skin, and cardiovascular and nervous system development in mice.

Akt/protein kinase B (PKB) plays a critical role in the regulation of metabolism, transcription, cell migration, cell cycle progression, and cell survival. The existence of viable knockout mice for each of the three isoforms suggests functional redundancy. We generated mice with combined mutant alleles of Akt1 and Akt3 to study their effects on mouse development. Here we show that Akt1-/- Akt3+/- mice display multiple defects in the thymus, heart, and skin and die within several days after birth, while Akt1+/- Akt3-/- mice survive normally. Double knockout (Akt1-/-) Akt3-/-) causes embryonic lethality at around embryonic days 11 and 12, with more severe developmental defects in the cardiovascular and nervous systems. Increased apoptosis was found in the developing brain of double mutant embryos. These data indicate that the Akt1 gene is more essential than Akt3 for embryonic development and survival but that both are required for embryo development. Our results indicate isoform-specific and dosage-dependent effects of Akt on animal survival and development.

Eficiência e diversidade fenotípica de bactérias diazotróficas que nodulam caupi [Vigna unguiculata (L.) Walp] e feijoeiro (Phaseolus vulgaris L.) em solos de mineração de bauxita em reabilitação

A atividade de mineração provoca degradação ambiental em várias partes do mundo, e técnicas de revegetação, empregando diversas espécies vegetais, têm sido indicadas, com vistas em reabilitar essas áreas. A eficiência e a diversidade de grupos-chave de bactérias, como as que nodulam leguminosas e fixam N2 (BNLFN), são de extrema importância, uma vez que estas participam de processos de ciclagem de nutrientes e contribuem para a sustentabilidade dessas áreas. Com o objetivo de avaliar a eficiência e a diversidade de BNLFN, coletaram-se amostras de solo de áreas mineradas, sob diferentes estratégias e cronosseqüências de reabilitação, no verão de 1999, para instalação de ensaios, empregando feijoeiro e caupi como espécies de plantas-isca de BNLFN. Na floração, coletaram-se as plantas e avaliaram-se matéria seca da parte aérea, número, matéria fresca e atividade de nódulos. Não houve influência das diferentes estratégias de reabilitação na eficiência das populações de BNLFN no crescimento do feijoeiro. A diversidade fenotípica dos isolados de BNLFN foi avaliada por meio das características culturais destes em meio de cultivo 79. Após a caracterização fenotípica de 328 isolados de feijoeiro e 420 de caupi, verificou-se que este é mais indicado que o feijoeiro nos estudos de nodulação, eficiência e diversidade de BNLFN. O impacto negativo da mineração é maior na diversidade fenotípica cultural de BNLFN do que na nodulação das plantas-isca utilizadas. A revegetação contribuiu para aumentar a diversidade dessas bactérias em solos de áreas de mineração de bauxita, especialmente quando ocorreu a introdução de leguminosas.

Measures of health and disease in Africa: are current methods giving us useful information about trends in cardiovascular diseases?

An enormous burst of interest in the public health burden from chronic disease in Africa has emerged as a consequence of efforts to estimate global population health. Detailed estimates are now published for Africa as a whole and each country on the continent. These data have formed the basis for warnings about sharp increases in cardiovascular disease (CVD) in the coming decades. In this essay we briefly examine the trajectory of social development on the continent and its consequences for the epidemiology of CVD and potential control strategies. Since full vital registration has only been implemented in segments of South Africa and the island nations of Seychelles and Mauritius - formally part of WHO-AFRO - mortality data are extremely limited. Numerous sample surveys have been conducted but they often lack standardization or objective measures of health status. Trend data are even less informative. However, using the best quality data available, age-standardized trends in CVD are downward, and in the case of stroke, sharply so. While acknowledging that the extremely limited available data cannot be used as the basis for inference to the continent, we raise the concern that general estimates based on imputation to fill in the missing mortality tables may be even more misleading. No immediate remedies to this problem can be identified, however bilateral collaborative efforts to strength local educational institutions and governmental agencies rank as the highest priority for near term development.

Quality of assessement of CMR images in the setting of the European cardiovascular magnetic resonance registry : description and validation of standardized criteria

l'imagerie par résonance magnétique (IRMC) est une technologie utilisée depuis les aimées quatre¬-vingts dans le monde de la cardiologie. Cette technique d'imagerie non-invasive permet d'acquérir Ses images du coeur en trois dimensions, dans n'importe quel, plan, sans application de radiation, et en haute résolution. Actuellement, cette technique est devenue un référence dans l'évaluation et 'l'investigation de différentes pathologies cardiaques. La morphologie cardiaque, la fonction des ventricules ainsi que leur contraction, la perfusion tissulaire ainsi que la viabilité tissulaire peuvent être caractérisés en utilisant différentes séquences d'imagerie. Cependant, cette technologie repose sur des principes physiques complexes et la mise en pratique de cette technique se heurte à la difficulté d'évaluer un organe en mouvement permanent. L'IRM cardiaque est donc sujette à différents artefacts qui perturbent l'interprétation des examens et peuvent diminuer la précision diagnostique de cette technique. A notre connaissance, la plupart des images d'IRMC sont analysées et interprétées sans évaluation rigoureuse de la qualité intrinsèque de l'examen. Jusqu'à présent, et à notre connaissance, aucun critère d'évaluation de la qualité des examens d'IRMC n'a été clairement déterminé. L'équipe d'IRMC du CHUV, dirigée par le Prof J. Schwitter, a recensé une liste de 35 critères qualitatifs et 12 critères quantitatifs évaluant la qualité d'un examen d'IRMC et les a introduit dans une grille d'évaluation. L'objet de cette étude est de décrire et de valider la reproductibilité des critères figurant dans cette grille d'évaluation, par l'interprétation simultanée d'examens IRMC par différents observateurs (cardiologues spécialisés en IRM, étudiant en médecine, infirmière spécialisée). Notre étude a permis de démontrer que les critères définis pour l'évaluation des examens d'IRMC sont robustes, et permettent une bonne reproductibilité intra- et inter-observateurs. Cette étude valide ainsi l'utilisation de ces critères de qualité dans le cadre de l'imagerie par résonance magnétique cardiaque. D'autres études sont encore nécessaires afin de déterminer l'impact de la qualité de l'image sur la précision diagnostique de cette technique. Les critères standardisés que nous avons validés seront utilisés pour évaluer la qualité des images dans le cadre d'une étude à échelle européenne relative à l'IRMC : "l'EuroCMR registry". Parmi les autres utilités visées par ces critères de qualité, citons notamment la possibilité d'avoir une référence d'évaluation de la qualité d'examen pour toutes les futures études cliniques utilisant la technologie d'IRMC, de permettre aux centres d'IRMC de quantifier leur niveau de qualité, voire de créer un certificat de standard de qualité pour ces centres, d'évaluer la reproductibilité de l'évaluation des images par différents observateurs d'un même centre, ou encore d'évaluer précisément la qualité des séquences développées à l'avenir dans le monde de l'IRMC.

Physical activity and pregnancy: cardiovascular adaptations, recommendations and pregnancy outcomes.

Regular physical activity is associated with improved physiological, metabolic and psychological parameters, and with reduced risk of morbidity and mortality. Current recommendations aimed at improving the health and well-being of nonpregnant subjects advise that an accumulation of > or =30 minutes of moderate physical activity should occur on most, if not all, days of the week. Regardless of the specific physiological changes induced by pregnancy, which are primarily developed to meet the increased metabolic demands of mother and fetus, pregnant women benefit from regular physical activity the same way as nonpregnant subjects. Changes in submaximal oxygen uptake (VO(2)) during pregnancy depend on the type of exercise performed. During maternal rest or submaximal weight-bearing exercise (e.g. walking, stepping, treadmill exercise), absolute maternal VO(2) is significantly increased compared with the nonpregnant state. The magnitude of change is approximately proportional to maternal weight gain. When pregnant women perform submaximal weight-supported exercise on land (e.g. level cycling), the findings are contradictory. Some studies reported significantly increased absolute VO(2), while many others reported unchanged or only slightly increased absolute VO(2) compared with the nonpregnant state. The latter findings may be explained by the fact that the metabolic demand of cycle exercise is largely independent of the maternal body mass, resulting in no absolute VO(2) alteration. Few studies that directly measured changes in maternal maximal VO(2) (VO(2max)) showed no difference in the absolute VO(2max) between pregnant and nonpregnant subjects in cycling, swimming or weight-bearing exercise. Efficiency of work during exercise appears to be unchanged during pregnancy in non-weight-bearing exercise. During weight-bearing exercise, the work efficiency was shown to be improved in athletic women who continue exercising and those who stop exercising during pregnancy. When adjusted for weight gain, the increased efficiency is maintained throughout the pregnancy, with the improvement being greater in exercising women. Regular physical activity has been proven to result in marked benefits for mother and fetus. Maternal benefits include improved cardiovascular function, limited pregnancy weight gain, decreased musculoskeletal discomfort, reduced incidence of muscle cramps and lower limb oedema, mood stability, attenuation of gestational diabetes mellitus and gestational hypertension. Fetal benefits include decreased fat mass, improved stress tolerance, and advanced neurobehavioural maturation. In addition, few studies that have directly examined the effects of physical activity on labour and delivery indicate that, for women with normal pregnancies, physical activity is accompanied with shorter labour and decreased incidence of operative delivery. However, a substantial proportion of women stop exercising after they discover they are pregnant, and only few begin participating in exercise activities during pregnancy. The adoption or continuation of a sedentary lifestyle during pregnancy may contribute to the development of certain disorders such as hypertension, maternal and childhood obesity, gestational diabetes, dyspnoea, and pre-eclampsia. In view of the global epidemic of sedentary behaviour and obesity-related pathology, prenatal physical activity was shown to be useful for the prevention and treatment of these conditions. Further studies with larger sample sizes are required to confirm the association between physical activity and outcomes of labour and delivery.

Prevalence of cardiovascular risk factors in a middle-income country and estimated cost of a treatment strategy.

BACKGROUND: We assessed the prevalence of risk factors for cardiovascular disease (CVD) in a middle-income country in rapid epidemiological transition and estimated direct costs for treating all individuals at increased cardiovascular risk, i.e. following the so-called "high risk strategy". METHODS: Survey of risk factors using an age- and sex-stratified random sample of the population of Seychelles aged 25-64 in 2004. Assessment of CVD risk and treatment modalities were in line with international guidelines. Costs are expressed as USD per capita per year. RESULTS: 1255 persons took part in the survey (participation rate of 80.2%). Prevalence of main risk factors was: 39.6% for high blood pressure (> or =140/90 mmHg or treatment) of which 59% were under treatment; 24.2% for high cholesterol (> or =6.2 mmol/l); 20.8% for low HDL-cholesterol (<1.0 mmol/l); 9.3% for diabetes (fasting glucose > or =7.0 mmol/l); 17.5% for smoking; 25.1% for obesity (body mass index > or =30 kg/m2) and 22.1% for the metabolic syndrome. Overall, 43% had HBP, high cholesterol or diabetes and substantially increased CVD risk. The cost for medications needed to treat all high-risk individuals amounted to USD 45.6, i.e. 11.2 dollars for high blood pressure, 3.8 dollars for diabetes, and 30.6 dollars for dyslipidemia (using generic drugs except for hypercholesterolemia). Cost for minimal follow-up medical care and laboratory tests amounted to 22.6 dollars. CONCLUSION: High prevalence of major risk factors was found in a rapidly developing country and costs for treatment needed to reduce risk factors in all high-risk individuals exceeded resources generally available in low or middle income countries. Our findings emphasize the need for affordable cost-effective treatment strategies and the critical importance of population strategies aimed at reducing risk factors in the entire population.

Risk of cardiovascular events and blood pressure control in hypertensive HIV-infected patients: Swiss HIV Cohort Study (SHCS).

BACKGROUND: Prevalence of hypertension in HIV infection is high, and information on blood pressure control in HIV-infected individuals is insufficient. We modeled blood pressure over time and the risk of cardiovascular events in hypertensive HIV-infected individuals. METHODS: All patients from the Swiss HIV Cohort Study with confirmed hypertension (systolic or diastolic blood pressure above 139 or 89 mm Hg on 2 consecutive visits and presence of at least 1 additional cardiovascular risk factor) between April 1, 2000 and March 31, 2011 were included. Patients with previous cardiovascular events, already on antihypertensive drugs, and pregnant women were excluded. Change in blood pressure over time was modeled using linear mixed models with repeated measurement. RESULTS: Hypertension was diagnosed in 2595 of 10,361 eligible patients. Of those, 869 initiated antihypertensive treatment. For patients treated for hypertension, we found a mean (95% confidence interval) decrease in systolic and diastolic blood pressure of -0.82 (-1.06 to -0.58) mm Hg and -0.89 (-1.05 to -0.73) mm Hg/yr, respectively. Factors associated with a decline in systolic blood pressure were baseline blood pressure, presence of chronic kidney disease, cardiovascular events, and the typical risk factors for cardiovascular disease. In patients with hypertension, increase in systolic blood pressure [(hazard ratio 1.18 (1.06 to 1.32) per 10 mm Hg increase], total cholesterol, smoking, age, and cumulative exposure to protease inhibitor-based and triple nucleoside regimens were associated with cardiovascular events. CONCLUSIONS: Insufficient control of hypertension was associated with increased risk of cardiovascular events indicating the need for improved management of hypertension in HIV-infected individuals.

Carbono orgânico, nitrogênio total, biomassa e atividade microbiana do solo em duas cronosseqüências de reabilitação após a mineração de bauxita

A mineração é uma das atividades antrópicas que causa grande impacto nos ecossistemas e o grau de degradação depende da intensidade de interferência no solo, do volume explorado e do rejeito produzido. Os microrganismos do solo e sua atividade, por participarem de funções-chave, podem fornecer indicações sobre o real estado de reabilitação de áreas mineradas. O objetivo deste trabalho foi avaliar o impacto da atividade de mineração em duas cronosseqüências com diferentes estratégias (revegetação) de reabilitação em solos de área de mineração de bauxita sobre diversos atributos: C de compostos orgânicos (CO), N total do solo (Nt), biomassa microbiana, atividade enzimática e respiração do solo. O estudo foi desenvolvido em áreas pertencentes a Alcoa S/A, em dois ambientes distintos: (a) em áreas com vegetação típica de campo, predominantemente herbácea, em altitude inferior a 1.000 m, e (b) em áreas de montanhas, no topo do planalto, incluindo remanescentes de cobertura vegetal nativa representada por floresta subtropical subcaducifólia, a uma altitude de 1.600 m, denominadas serra, com características diferenciadas quanto à estratégia e ao tempo de reabilitação, variando de áreas recém-mineradas à áreas com 19 anos de reabilitação. Coletaram-se amostras compostas com três repetições em oito áreas no campo e nove na serra, em duas profundidades (0-10 e 10-20 cm), no inverno e verão. A mineração de bauxita provocou grande impacto nos atributos estudados, causando reduções nos seus valores de até 99 %. Tanto no campo como na serra, os teores de CO, de Nt, a biomassa microbiana e a atividade enzimática aumentaram com as diferentes estratégias de reabilitação. Entretanto a resposta dos atributos estudados foi diferenciada em função do tempo de reabilitação. A biomassa microbiana e a atividade enzimática apresentaram recuperação muito rápida, atingindo valores semelhantes aos das áreas de referência a partir do primeiro ano, enquanto para o CO e o Nt estes só foram alcançados de modo consistente em períodos mais longos de reabilitação (18 anos). O coeficiente metabólico (qCO2) foi indicativo do estresse provocado pela mineração, mas não diferenciou os diferentes tempos de reabilitação. Os resultados deste estudo mostram que os atributos essenciais ao funcionamento adequado do solo são recuperáveis pela revegetação.