Frequência cardíaca e exercício: aspectos prognósticos e interações com tônus vagal cardíaco

A frequência cardíaca (FC) no repouso (FC Rep), no exercício máximo (FC Max) e após o exercício (FC Rec) traz importantes informações para a saúde, e parte dessas respostas é modulada pelo tônus vagal cardíaco (TVC), que também oferece proteção cardíaca. Para uma melhor compreensão dos aspectos prognósticos da FC e de suas interações com o TVC, foram realizados três estudos: dois retrospectivos e um ensaio clínico randomizado. O primeiro testou se o TVC, estimado utilizando o índice vagal cardíaco (IVC), contribui para a FC Max (% do previsto: 208-0,7 x idade (anos)) em 1000 indivíduos saudáveis (39 14 anos; 719 homens). Regressão linear identificou que TVC explica apenas 1% da variabilidade da FC Max (% do previsto), com erro padrão da estimativa alto (~ 6,3%), indicando potencial papel complementar clínico para essas duas variáveis relacionadas ao exercício. O segundo estudo verificou se a análise de mortalidade utilizando FC de reserva (FC Res) e FC Rec de forma combinada descriminaria melhor a mortalidade que a análise de um destes itens e forma isolada. Dados de FC Res e FC Rec de 1.476 indivíduos (41 a 79 anos, 937 homens) foram calculados e divididos em quintis, os quais somados forneceram categorias de 2 a 10, produzindo um gradiente da FC (FC Grad) e refletindo a magnitude dos transientes iniciais e finais do exercício máximo. Análises de sobrevida foram realizadas usando os quintis mais baixos (Q1) dos escores do Grad FC, FC Res e FC Rec. Em um seguimento médio de 7,3 anos, 44 participantes morreram (3,1%). Houve uma tendência inversa entre os escores do Grad FC e a taxa de mortalidade (p<0,05), que passou de 1,2% para 13,5%, respectivamente, para os escores 10 e 2. Uma pontuação no Grad FC de 2 foi melhor preditor de mortalidade por todas as causas, quando comparado ao Q1 da FC Res e da FC Rec, com riscos relativos ajustados pela idade de 3,53 (p=0,01); 2,52 (p<0,05) e 2,57(p<0,05), respectivamente. Conclusão: Grad FC é um preditor de risco de mortalidade por todas as causas com desempenho superior ao das medidas isoladas de FC Res e FC Rec. Por último verificou-se a hipótese do aumento do TVC em participantes de um programa de exercício supervisionado (PES) com IVC baixo (≤ 1,30), através de um treinamento específico, utilizando a transição repouso-exercício no protocolo denominado treinamento vagal (TV). Estes foram randomizados num delineamento cruzado (duas etapas de oito semanas), com ou sem três sessões semanais de TV. Houve discreta melhora no IVC em 16 semanas (1,19 vs 1,22; p=0,02) dos 44 pacientes (64% homens; 65,5 11,4 anos) que finalizaram o estudo, mas não se pôde afirmar que a diferença no IVC se deveu ao período em que foi realizado o TV (p=0,36). Portanto, 16 semanas de PES, incluindo oito semanas com TV, aumentam a resposta vagal à transição repouso-exercício, embora não tenha sido possível atribuir os resultados exclusivamente ao TV. Os três estudos realizados contribuem para melhor compreensão da relevante interação entre FC, TVC e exercício

Aspectos da condição aeróbica e da flexibilidade em futebolistas profissionais e em participantes de programas de exercício supervisionado

As melhorias funcionais após uma rotina regular de exercícios físicos nem sempre se traduzem em uma idêntica melhoria da condição aeróbica (AER). O objetivo foi identificar se uma rotina regular de exercícios é capaz de manter ou atenuar a queda do condicionamento aeróbico e funcional, bem como se a diferença nas melhorias nestas variáveis, em indivíduos idosos, pode ser explicada por variações em flexibilidade e força/potência muscular. No primeiro estudo, 176 jogadores profissionais de futebol foram divididos em tercis em relação à idade. Obtivemos o consumo de oxigênio (VO2) e frequência cardíaca (FC), além do perfil de flexibilidade global utilizando o Flexiteste (FLX). Dados de pré-temporada (2005-2011) dos tercis extremos (n=54), mais jovem (17-22 anos) e mais velhos (27-36 anos), foram comparados. Os efeitos do envelhecimento foram avaliados pela comparação do VO2, da FC e de regressões lineares de FLX versus valores previstos para a idade. Os resultados foram semelhantes para VO2max, 62,76,1 vs 63,26,2 mL.(kg.min)-1, (p=0,67), e para FLX, 435,9 vs 416,0, respectivamente (p=0,11), o tercil mais jovem apresentou valores mais altos de FCmáx, 1948,1 vs 1898,8 bpm, (p<0,01). Os jogadores não apresentaram a diminuição prevista no VO2max, enquanto FCmax e FLX diminuiram. No segundo estudo utilizou-se dados de 144 pacientes com idade de 6212 anos submetidos a testes de FLX, força/potência muscular e cardiopulmonar de exercício máximo em cicloergômetro de membros inferiores, após pelo menos 3 meses de participação em um programa de exercício supervisionado (PES). A correlação de Pearson foi calculada para avaliar as associações entre a diferença nas melhorias funcional e aeróbica (DEMFA) e as variações de FLX, força de preensão manual (FPM) e potência muscular (POT) e também entre os valores da primeira avaliação de AER e capacidade funcional (FUN) e as respectivas melhorias e o DEMFA. Após uma média de 32 meses de PES, houve aumento da FLX em 11,6% (p<0,01) e da POT em 14,7% (p<0,01), ajustadas para a idade, com preservação da FPM (p=0,47). Houve uma relação inversa entre os resultados da primeira avaliação e a melhoria AER (r=-0,28; p<0,01). Considerando os valores previstos, a AER aumentou menos do que a FUN - 21% versus 25% (p<0,01). A melhoria na FLX associou-se ao DEMFA (r=0,24; p<0,01). Assim, os estudos mostraram: a) ao manter uma rotina regular de exercícios, principalmente aeróbicos, o VO2 não reduz com a idade em futebolistas entre os 16 e 36 anos, apesar de uma redução na FCmax. b) a participação regular em um PES proporciona melhorias de componentes da aptidão física de pacientes promovendo a restauração dos resultados para equivalentes aos previstos para indivíduos saudáveis. c) uma melhoria da FLX contribui para uma maior melhoria da FUN do que da AER

Concepções de obesidade sobre pacientes gastroplastizados em periódicos biomédicos.

Este trabalho se propõe a analisar a abordagem biomédica sobre a recidiva de engorda, após a gastroplastia para tratamento da obesidade. Foram realizadas, na plataforma PubMed, buscas dos seguintes termos: weight regain AND bariatric surgery OR gastroplasty NOT diabetes. Juntamente com a seleção dos seguintes filtros: artigos sobre humanos, disponibilidade do texto completo, disponibilidade do resumo. Somente publicações entre 2010 e 2014 foram selecionadas. Estas foram analisadas com um questionário auxiliar de 46 perguntas sobre os seguintes temas: a alimentação dos pacientes, a abordagem da re-educação alimentar, o acompanhamento do pós-operado pelos profissionais de saúde, e as hipóteses para o sucesso da cirurgia. Como resultados, percebemos que não conseguir emagrecer o suficiente ou não manter o emagrecimento são consideradas algumas das complicações da gastroplastia, atingindo um grande número de pacientes. Estas complicações evidenciam que o método considerado mais eficaz no tratamento da obesidade mórbida também é falho e, em cerca de 8 anos, uma nova intervenção é necessária. O paciente pode voltar a se enquadrar na categoria de obeso, havendo casos de peso pós-cirúrgico maior que o pré-cirúrgico.

Vibration-assisted bone-graft compaction in impaction bone grafting of the femur

The complications of impaction bone grafting in revision hip replacement includes fracture of he femur and subsidence of the prosthesis. In this in vitro study we aimed to investigate whether the use of vibration, combined with a perforated tamp during the compaction of morsellised allograft would reduce peak loads and hoop strains in the femur as a surrogate marker of the risk of fracture and whether it would also improve graft compaction and prosthetic stability. We found that the peak loads and hoop strains transmitted to the femoral cortex during graft compaction and subsidence of the stem in subsequent mechanical testing were reduced. This innovative technique has the potential to reduce the risk of intra-operative fracture and to improve graft compaction and therefore prosthetic stability. © 2007 British Editorial Society of Bone and Joint Surgery.

A new method for venom extraction from venomous fish, green scat

Scatophagus argus argus (Green Scat) is a pretty aquarium fish. Its hard spines are venomous and can cause painful injury. In this study 60 specimens of Green Scat were collected periodically from coastal waters of Boushehr (south of Iran) from May 2011 to April 2012. Anatomical features of venomous spines were investigated. Scat venom was extracted from the spines in a new manner for keeping the specimens alive. The nature of venom was tested by SDS-PAGE. Ethical issues and animal welfare principles such as rapid and instantaneous anesthetizing, post operation disinfection and fast recovery of the specimens was practiced in order to minimize the complications. This method enhanced the purity and quantity of venom as demonstrated by 12 separated proteins in electrophoresis. New ethical issues were developed to surviving the specimens and prolong viability as well.

Short- and long-term changes in joint co-contraction associated with motor learning as revealed from surface EMG.

In the field of motor control, two hypotheses have been controversial: whether the brain acquires internal models that generate accurate motor commands, or whether the brain avoids this by using the viscoelasticity of musculoskeletal system. Recent observations on relatively low stiffness during trained movements support the existence of internal models. However, no study has revealed the decrease in viscoelasticity associated with learning that would imply improvement of internal models as well as synergy between the two hypothetical mechanisms. Previously observed decreases in electromyogram (EMG) might have other explanations, such as trajectory modifications that reduce joint torques. To circumvent such complications, we required strict trajectory control and examined only successful trials having identical trajectory and torque profiles. Subjects were asked to perform a hand movement in unison with a target moving along a specified and unusual trajectory, with shoulder and elbow in the horizontal plane at the shoulder level. To evaluate joint viscoelasticity during the learning of this movement, we proposed an index of muscle co-contraction around the joint (IMCJ). The IMCJ was defined as the summation of the absolute values of antagonistic muscle torques around the joint and computed from the linear relation between surface EMG and joint torque. The IMCJ during isometric contraction, as well as during movements, was confirmed to correlate well with joint stiffness estimated using the conventional method, i.e., applying mechanical perturbations. Accordingly, the IMCJ during the learning of the movement was computed for each joint of each trial using estimated EMG-torque relationship. At the same time, the performance error for each trial was specified as the root mean square of the distance between the target and hand at each time step over the entire trajectory. The time-series data of IMCJ and performance error were decomposed into long-term components that showed decreases in IMCJ in accordance with learning with little change in the trajectory and short-term interactions between the IMCJ and performance error. A cross-correlation analysis and impulse responses both suggested that higher IMCJs follow poor performances, and lower IMCJs follow good performances within a few successive trials. Our results support the hypothesis that viscoelasticity contributes more when internal models are inaccurate, while internal models contribute more after the completion of learning. It is demonstrated that the CNS regulates viscoelasticity on a short- and long-term basis depending on performance error and finally acquires smooth and accurate movements while maintaining stability during the entire learning process.

Effect of organophosphate, diazinon on some immunophysiological, haematological and histological variable of Rutilus frisii kutum (Kamensky,1901)

The acute toxicity and effects of diazinon on some haematological parameters of kutum (Rutilus frisii kutum, Kamensky, 1901) weighing 613.33 g±157.06 g were studied under static water quality conditions at 15°C ± 2ºC in winter and spring 2009. The effective physical and chemical parameters of water were pH= 7-8.2, dh= 300mg/L (caco3), DO= 7 ppm and T= 15°C±2ºC. The first test was primarily to determine the effects of acute toxicity (LC5096 h) of the agricultural toxicant diazinon (emulsion 60%) on kutum male brood stocks. For this purpose, 4 treatments were used to test toxicity; each treatment was repeated in 3 tanks with 9 fish per treatment and with 180 litres water capacity. After obtaining the final results, the information was analysed statistically with Probit version 1.5 (USEPA, 1985), and we determined the LC10, LC50 and LC90 values at 24 hours, 48 hours, 72 hours and 96 hours; the maximum allowable concentration value (LC5096 h divided by 10) (TRC, 1984); and the degree of toxicity. The second stage of testing consists of four treatments: LC0= 0 as experimental treatment, treatment A with a concentration of LC1= 0.107 mg/L, treatment B with concentration of LC5= 0.157 mg/L, treatment C with concentration of MAC value= 0.04 mg/L. Male brood stocks of kutum were treated with these concentrations for 45 days. Experiments were carried out under static conditions based on the standard TRC, 1984 method over 45 days. Our results show that long-term exposure to diazinon causes a decrease in the erythrocyte count (RBC), haemoglobin (Hb), haematocrit (PCV), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), leucocyte count (WBC), lymphocyte, testosterone, iron (Fe), sodium (Na), lactate dehydrogenase (LDH), and cholinesterase (CHeS). In addition, diazinon also causes an increase in prolymphocyte, aspartate aminotransferase (AST), cholesterol, alkaline phosphatase (ALP) and adrenaline (P<0.05). There are no significant effects on monocyte, eosinophil, magnesium (Mg), chloride (Cl), glucose (BS), urea (BUN), uric acid (U.A), triglyceride (TG), calcium (Ca), albumin (Alb), total protein (TP), cortisol, noradrenaline and high density lipoprotein (HDL) levels in kutum male brood stocks (P>0.05). Pathology results showed toxin diazinon no effect on average weight and fish body length, the average weight of heart, brain, spleen, liver, kidney and liver index but caueses decrease of gonad weigth and gonad index and also, cause complications of tissue necrosis, vascular congestion, inflammation in the liver, a sharp reduction in the number of glomeruli, necrosis, vascular congestion and haemorage in the kidney, capsule thickening and fibrosis, atrophy, vascular congestion, macrophages release increased, increasing sediment Hemosiderine and thickening of artery walls in the spleen, atrophy, fibrosis and necrosis in testis , vascular congestion, increased distance between the myocardium and fibrous string in heart and neuronal loss, vascular congestion and edema in the brain of kutum male brood stocks.

A six sensor method for measuring acoustic properties in ducts.

An accurate description of sound propagation in a duct is important to obtain the sound power radiating from a source in both near and far fields. A technique has been developed and applied to decompose higher-order modes of sound emitted into a duct. Traditional experiments and theory based on two-sensor methods are limited to the plane-wave contribution to the sound field at low frequency. Due to the increase in independent measurements required, a computational method has been developed to simulate sensitivities of real measurements (e.g., noise) and optimize the set-up. An experimental rig has been constructed to decompose the first two modes using six independent measurements from surface, flush-mounted microphones. Experiments were initially performed using a loudspeaker as the source for validation. Subsequently, the sound emitted by a mixed-flow fan has been investigated and compared to measurements made in accordance with the internationally standardized in-duct fan measurement method. This method utilizes large anechoic terminations and a procedure involving averaging over measurements in space and time to account for the contribution from higher-order modes. The new method does not require either of these added complications and gives detail about the underlying modal content of the emitted sound.

Guidewire retention following central venous catheterisation: a human factors and safe design investigation.

BACKGROUND: Central Venous Catheterisation (CVC) has occasionally been associated with cases of retained guidewires in patients after surgery. In theory, this is a completely avoidable complication; however, as with any human procedure, operator error leading to guidewires being occasionally retained cannot be fully eliminated. OBJECTIVE: The work described here investigated the issue in an attempt to better understand it both from an operator and a systems perspective, and to ultimately recommend appropriate safe design solutions that reduce guidewire retention errors. METHODS: Nine distinct methods were used: observations of the procedure, a literature review, interviewing CVC end-users, task analysis construction, CVC procedural audits, two human reliability assessments, usability heuristics and a comprehensive solution survey with CVC end-users. RESULTS: The three solutions that operators rated most highly, in terms of both practicality and effectiveness, were: making trainees better aware of the potential guidewire complications and strongly emphasising guidewire removal in CVC training, actively checking that the guidewire is present in the waste tray for disposal, and standardising purchase of central line sets so that differences that may affect chances of guidewire loss is minimised. CONCLUSIONS: Further work to eliminate/engineer out the possibility of guidewires being retained is proposed.

Study of urinary 8-hydroxydeoxyguanosine as a biomarker of oxidative DNA damage in diabetic nephropathy patients

Increased oxidative stress induced by hyperglycemia may contribute to the pathogenesis of diabetic complications. Urinary 8-hydroxydeoxyguanosine (8-OHdG) has been reported to serve as a sensitive biomarker of oxidative DNA damage and also of oxidative stress. This article studied oxidative DNA damage in patients with diabetic nephropathy and in healthy control subjects by urinary 8-OHdG evaluations. Contents of 8-OHdG in urine were analyzed by capillary electrophoresis with end-column amperometric detection (CE-AD) after a single-step solid-phase extraction (SPE). Levels of urinary 8-OHdG in diabetic nephropathy patients with macroalbuminuria was significant higher than in control subjects (5.72 +/- 6.89 mumol/mol creatinine versus 2.33 +/- 2.83 mumol/mol creatinine, P = 0.018). A significant difference of 24 h urinary 8-OHdG excretions exists between the patients with macroalbuminuria and the patients with nonnoalbuminuria (19.2 +/- 16.8 mug/24 h versus 8.1 +/- 1.7 mug/24 h, P = 0.015). There was a positive correlation between urinary excretion of 8-OHdG and glycosylated hemoglobin (HbA(1)c) (r = 0.287, P = 0.022). A weak correlation exists between the levels of 8-OHdG and triglyceride (r = 0.230, P = 0.074). However, the urinary 8-OHdG contents are not correlated with blood pressure and total cholesterol. The increased excretion of urinary 8-OHdG is seen as indicating an increased systemic level of oxidative DNA damage in diabetic nephropathy patients. (C) 2004 Elsevier B.V. All rights reserved.

Shallow gas in the muddy sediments of Eckernförde Bay, Germany

The seafloor of central Eckernförde Bay is characterised by soft muddy sediments that contain free methane gas. Bubbles of free gas cause acoustic turbidity which is observed with acoustic remote sensing systems. Repeated surveys with subbottom profiler and side scan sonar revealed an annual period both of depth of the acoustic turbidity and backscatter strength. The effects are delayed by 3–4 months relative to the atmospheric temperature cycle. In addition, prominent pockmarks, partly related to gas seepage, were detected with the acoustic systems. In a direct approach gas concentrations were measured from cores using the gas chromatography technique. From different tests it is concluded that subsampling of a core should start at its base and should be completed as soon as possible, at least within 35 min after core recovery. Comparison of methane concentrations of summer and winter cores revealed no significant seasonal variation. Thus, it is concluded that the temperature and pressure influences upon solubility control the depth variability of acoustic turbidity which is observed with acoustic remote sensing systems. The delay relative to the atmospheric temperature cycle is caused by slow heat transfer through the water column. The atmospheric temperature cycle as ‘exiting function’ for variable gas solubility offers an opportunity for modelling and predicting the depth of the acoustic turbidity. In practice, however, small-scale variations of, e.g., salinity, or gas concentration profile in the sediment impose limits to predictions. In addition, oceanographic influences as mixing in the water column, variable water inflow, etc. are further complications that reduce the reliability of predictions.

Feasibility of biodegradable PLGA common bile duct stents: An in vitro and in vivo study

The current study investigates the feasibility of using a biodegradable polymeric stent in common bile duct (CBD) repair and reconstruction. Here, poly(l-lactide-co-glycolide) (PLGA, molar ratio LA/GA = 80/20) was processed into a circular tube- and dumbbell-shaped specimens to determine the in vitro degradation behavior in bile. The morphology, weight loss, and molecular weight changes were then investigated in conjunction with evaluations of the mechanical properties of the specimen. Circular tube-shaped PLGA stents with X-ray opacity were subsequently used in common bile duct exploration (CBDE) and primary suturing in canine models. Next, X-ray images of CBD stents in vivo were compared and levels of serum liver enzymes and a histological analysis were conducted after stent transplantation. The results showed that the PLGA stents exhibited the required biomedical properties and spontaneously disappeared from CBDs in 4-5 weeks. The degradation period and function match the requirements in repair and reconstruction of CBDs to support the duct, guide bile drainage, and reduce T-tube-related complications.

Characterization of prolidase activity using capillary electrophoresis with tris(2,2'-bipyridyl)ruthenium(II) electrochemiluminescence detection and application to evaluate collagen degradation in diabetes mellitus

A new method for prolidase (PLD, EC 3.4.13.9) activity assay was developed based on the determination of proline produced from enzymatic reaction through capillary electrophoresis (CE) with tris(2,2'-bipyridyl)ruthenium(11) [Ru(bpy)(3)(2+)] electrochemiluminescence detection (ECL). A detection limit of 12.2 fmol (S/N = 3) for proline, corresponding to 1.22 x 10(-8) units of prolidase catalyzing for 1 min was achieved. PLD activity determined by CE-ECL method was in agreement with that obtained from the classical Chinard's one. CE-ECL showed its powerful resolving ability and selectivity as no sample pretreatmentwas needed and no interference existed. The clinical utility of this method was successfully demonstrated by its application to assay PLD activity in the serum of diabetic patients in order to evaluate collagen degradation in diabetes mellitus (DM). The results indicated that enhanced collagen degradation occurred in DM.

Docking and molecular dynamics study on the inhibitory activity of coumarins on aldose reductase

In order to explore the inhibitory mechanism of coumarins toward aldose reductase (ALR2), AutoDock and Gromacs software were used for docking and molecular dynamics studies on 14 coumarins (CM) and ALR2 protease. The docking results indicate that residues TYR48, HIS110, and TRP111 construct the active pocket of ALR2 and, besides van der Waals and hydrophobic interaction, CM mainly interact with ALR2 by forming hydrogen bonds to cause inhibitory behavior. Except for CM1, all the other coumarins take the lactone part as acceptor to build up the hydrogen bond network with active-pocket residues. Unlike CM3, which has two comparable binding modes with ALR2, most coumarins only have one dominant orientation in their binding sites. The molecular dynamics calculation, based on the docking results, implies that the orientations of CM in the active pocket show different stabilities. Orientation of CM1 and CM3a take an unstable binding mode with ALR2; their conformations and RMSDs relative to ALR2 change a lot with the dynamic process. While the remaining CM are always hydrogen-bonded with residues TYR48 and HIS110 through the carbonyl O atom of the lactone group during the whole process, they retain the original binding mode and gradually reach dynamic equilibrium.

冠状动脉旁路移植术后抑郁焦虑状态随访和分析

To explore the presence of depression, anxiety and cardiac events after coronary artery bypass grafting (CABG) prospectively and comparably. To analysis influential factors of depression and anxiety ( peri-operation and 1 year after operation ), and the effection on cardiac events in the year after operation. We followed the patients who underwent scheduled consecutive CABG. We interviewed patients to assess depression, anxiety symptoms using self-rating depression scale( SDS) and self-rating anxiety scale（SAS）before operation , before discharge and 1 year after operation. And cardiac events were also identified. All patients were divided into the group with depression and/or anxiety symptoms or the other group without depression and/or anxiety symptoms 3 times according to depression and anxiety symptoms before operation , before discharge and 1 year after operation. 69 patients completed the follow-up.24 patients (34.8%) had depression and/or anxiety symptoms before CABG, 31 patients (44.9%) had depression and/or anxiety symptoms before discharge, and 10 patients (14.5%) had depression and/or anxiety symptoms 1 year after operation. 6 patients(8.7%) had cardiac events, and 5 patients were re-admitted. Arhythmia before and after operation, the quantity of blood vessel grafted, length of stay , depression and anxiety symptoms before operation, cardiac events may lead to depression and anxiety symptoms 1 year after operation. The use of cardiopulmonary bypass grafting (CPB), Arhythmia after operation, the prolonged length of stay are influential factors of cardiac events. Though the incidence of depression and/or anxiety symptoms 1 year after operation is lower than before operation and before discharge, it is high still. Arhythmia before and after operation, the more blood vessels grafted, the prolonged length of stay , depression and anxiety symptoms before operation and cardiac events could be risk factors of depression and anxiety symptoms 1 year after operation. Much attention must be paid to this phenomenon. Heavy patient's condition, complicated surgery are risk factors of cardiac events, and bad emotion before operation and before discharge are independent to cardiac events. Key words： perspective research; depression；anxiety; coronary artery bypass grafting; follow up