INTRODUÇÃO: A adiposidade tem sido associada à aterosclerose em vários estudos clínicos. No entanto, poucos estudos de autópsia tem investigado a relação entre adiposidade e aterosclerose sistêmica e os estudos existentes compararam medidas antropométricas e/ou gordura visceral com aterosclerose, porém não avaliaram a aterosclerose em vários sítios em um mesmo indivíduo, avaliando frequentemente apenas a aterosclerose nas artérias coronárias, utilizaram medidas aproximadas de estenose das artérias coronárias, os tamanhos das amostras foram pequenos e os indivíduos eram mais jovens ou de meia-idade. OBJETIVO: Investigar a associação entre adiposidade, mensurada através de medidas antropométricas e a massa de gordura visceral abdominal e torácica com a aterosclerose nas artérias aorta, coronárias, carótidas e cerebrais. MÉTODOS: Trata-se de um estudo transversal em que foram avaliados 240 sujeitos com 30 anos ou mais. Foram coletados dados sociodemográficos, fatores de risco cardiovasculares, medidas antropométricas e massas de gorduras pericárdica e visceral abdominal. O grau de aterosclerose nas artérias aorta, carótidas, coronárias e cerebrais foi avaliado através de medidas morfométricas e o coração foi avaliado quanto à presença de infarto do miocárdio. Foi realizada avaliação da associação entre medidas antropométricas e massa de gordura visceral com a aterosclerose. RESULTADOS: A gordura pericárdica foi associada ao grau de aterosclerose da aorta (p = 0,03). As gorduras viscerais abdominal (p = 0,006) e total (p = 0,006) apresentaram associação com o número de placas nas artérias coronárias. A relação cintura-quadril (RCQ) foi associada ao grau de aterosclerose da artéria aorta (p = 0,005), índice de estenose das artérias coronárias (p = 0,03) e ao número de placas nas artérias coronárias (p = 0,04). CONCLUSÕES: Dentre as medidas antropométricas, a RCQ e as gorduras pericárdica, viscerais abdominal e total foram as mais correlacionadas com o grau de aterosclerose nas diferentes artérias / INTRODUCTION: Adiposity has been associated with atherosclerosis in several clinical studies. However, few autopsy studies have investigated the relationship between adiposity and systemic atherosclerosis and the previous studies compared anthropometric measurements and/or visceral fat with atherosclerosis, but they did not evaluate the atherosclerosis in several sites in the same individual, evaluating only atherosclerosis in coronary arteries, they used approximate stenosis measurements of the coronary arteries, the sample sizes were small and the individuals were younger and middle-aged. AIM: To investigate the association between adiposity, measured by anthropometric measurements and the weight of abdominal visceral and pericardial fat with atherosclerosis in the aorta, coronary, carotid and cerebral arteries. METHODS: This is a cross-sectional study which evaluated 240 subjects aged 30 or more. We collected demographic data, cardiovascular risk factors, anthropometric measurements and weight of pericardial and abdominal visceral fat. The degree of atherosclerosis in the aorta, carotid, coronary and cerebral arteries was evaluated by morphometric measurements and the heart was evaluated for the presence of myocardial infarction. The association between anthropometric measurements and weight of visceral fat with atherosclerosis was evaluated. RESULTS: Pericardial fat was associated with the degree of atherosclerosis of the aorta (p = 0.03). The abdominal (p=0.006) and overall (p=0.006) visceral fat were associated with the number of plaques in the coronary arteries. The waist-to-hip ratio (WHR) was associated with the degree of atherosclerosis of the aorta (p=0.005), stenosis index of the coronary arteries (p=0.03) and the number of plaques in the coronary arteries (p=0.04). CONCLUSIONS: WHR, pericardial, abdominal and total visceral fat were the measurement most correlated with the degree of atherosclerosis in different arteries

Introdução: As células do músculo liso vascular (CMLV) são quiescentes nos vasos adultos, com baixa capacidade de migração e de secreção de matriz extracelular, caracterizando fenótipo contrátil. Evidências apontam para a heterogeneidade fenotípica das CMLV ao longo da árvore arterial: há distribuição heterogênea de doenças e de resposta a determinadas drogas nos diferentes vasos, além de variabilidade de expressão dos genes de proteínas contráteis de músculo liso entre eles. O papel das CMLV, em fase adulta, é classicamente descrito como restrito à regulação do tônus de pequenos vasos, sendo insignificante a contribuição da mecânica das CMLV para a complacência das artérias elásticas. Existe a hipótese de que a viscoelasticidade das CMLV contribua para a mecânica final das artérias, sendo o enrijecimento dessas células associado à rigidez arterial. Objetivo: Estudar a variabilidade das propriedades mecânicas e de expressão proteica das CMLV, ao longo da árvore arterial, buscando identificar moduladores regionais para esse fenótipo. Avaliar se situações clínicas sabidamente associadas à rigidez arterial (envelhecimento, sexo feminino pós-menopausa, ancestralidade genética africana, diabetes mellitus e tabagismo) cursam com enrijecimento de CMLV. Métodos: 1) Estudou-se a composição e a organização da camada média de diferentes artérias. As CMLV desses vasos foram avaliadas quanto à viscoelasticidade de citoplasma (G), por meio do ensaio de Citometria Magnético Ótica de Oscilação e, quanto à expressão proteica global, usando cromatografia multidimensional e espectrometria de massas em tandem de alta resolução (Proteômica Shotgun). Os dados mecânicos obtidos foram correlacionados com as características da matriz extracelular (MEC) dos vasos de origem (porcentagem de elastina e quantidade de MEC). Em paralelo, foi realizado experimento de estiramento cíclico (10%/1Hz) das CMLV das diferentes artérias por 24 e 48h, seguido pela mensuração de rigidez de citoplasma. 2) Foram isoladas as CMLV de fragmentos de artéria mamária de 80 pacientes submetidos à cirurgia de revascularização do miocárdio, células essas que foram avaliadas quanto à viscoelasticidade de citoplasma (G, G\' e G\'\'). Elaborou-se modelo estatístico para avaliar se as variáveis clínicas idade, sexo feminino, ancestralidade africana, tabagismo e diabetes mellitus estavam associadas a alterações de mecânica celular. Resultados: 1) A viscoelasticidade das CMLV variou significativamente entre as artérias. As CMLV provenientes de artérias distais (artérias femoral e renal) mostraram-se significativamente mais rígidas que as CMLV de aorta torácica (p < 0,001). Identificou-se correlação negativa entre rigidez de CMLV e quantidade de MEC / elastina na camada média vascular. O regime de estiramento cíclico por 48h reduziu globalmente a rigidez das CMLV. As CMLV provenientes da aorta torácica expressaram maior quantidade de proteínas relacionadas com a estrutura e a organização do citoesqueleto em relação às CMLV da artéria femoral. 2) Constatou-se variabilidade interindividual de viscoelasticidade de CMLV e associação entre tabagismo e sexo feminino com enrijecimento de CMLV. Conclusões: As CMLV são heterogêneas quanto às propriedades mecânicas, à organização do citoesqueleto e à expressão proteica ao longo da árvore arterial, reforçando o conceito de plasticidade fenotípica das CMLV. A mecânica das CMLV é modulada pelas características da MEC e pela tensão circunferencial cíclica aplicada às paredes vasculares pelo fluxo sanguíneo. Mulheres pós-menopausa e tabagistas exibem enrijecimento de CMLV, sendo esse fato um provável contribuinte para a rigidez arterial associada a essas condições e um possível alvo terapêutico a ser avaliado futuramente / Rational: Vascular smooth muscle cells (VSMC) lose their ability to migrate and secrete extracellular matrix (ECM) with the end of vascular development, condition known as contractile phenotype and reversible in the presence of vascular injury. There is evidence of heterogeneity of VSMC phenotype along arterial tree, as the distribution of diseases (atherosclerosis) and the response to drugs vary between different vessels, as well as the expression of smooth muscle-contractile protein genes. The role played by VSMC mechanics on determining large arteries\' compliance was always considered irrelevant. It has been hypothesized that the VSMC mechanical properties are important for vascular mechanics, especially in the pathological scenario, where VSMC stiffening may be associated with arterial rigidity. Goals: Study the variation of VSMC mechanics and protein expression along arterial tree, identifying regional modulators of this phenotype. Evaluate if clinical situations associated with arterial rigidity (ageing, post-menopausal women, African ancestry, diabetes mellitus and smoking) concur with VSMC stiffening. Methods: 1) Different arteries were studied in terms of composition and organization of their media layer. VSMC isolated from these arteries were evaluated regarding cytoplasm viscoelasticity, measured using Optical Magnetic Twisting Cytometry Assay (OMTC), and protein expression, using two-dimensional liquid chromatography and tandem mass spectrometry (Shotgun Proteomics). Mechanical data were correlated with ECM characteristics (percentage of elastin and ECM amount) of the vessels of origin. In parallel, VSMC of different arteries were subjected to cyclic stretching (10%/1Hz) during 24 and 48h, followed by the measurement of their cytoplasm rigidity. 2) VSMC were isolated from fragments of mammary artery of 80 patients subjected to coronary bypass surgery and evaluated regarding their viscoelasticity (G, G\' e G\'\'). A statistic model was elaborated to address if the clinical variables age, female sex, African ancestry, smoking and diabetes mellitus were associated with changes of VSMC mechanics. Results: 1) VSMC viscoelasticity varied significantly amongst the studied arteries. VSMC from heart-distant arteries (femoral and renal arteries) were stiffer than VSMC from thoracic aorta (p < 0,001). There was a negative correlation between VSMC rigidity and the amount of ECM / percentage of elastin within the media layer. 48h-cyclic stretching was associated with a global reduction of VSMC rigidity. VSMC of thoracic aorta expressed significantly more proteins associated with cytoskeleton structure and organization than VSMC of femoral artery. 2) There was a significant inter-individual variation of VSMC viscoelasticity. Smoking and female sex were associated with VSMC stiffening. Conclusion: VSMC mechanics, cytoskeleton organization and protein expression are heterogeneous along arterial tree. VSMC mechanical properties are modulated by ECM characteristics and by regional mechanical forces. This reinforces the concept of phenotypic heterogeneity of VSMC. Post-menopausal women and smokers exhibit stiffer VSMC, representing an important factor for the understanding of the arterial rigidity associated with these conditions and also a possible future therapeutic target

O objetivo é comparar o fluxo sanguíneo total (FS) e a reserva de fluxo coronariano (RFC) aos ramos revascularizados pelas artérias torácica interna esquerda (ATIE) e radial (AR) nos enxertos compostos com os enxertos isolados. Foi realizado um ensaio clínico randomizado de 42 pacientes que foram distribuídos em grupo A ou ATIE e AR composta em Y(n=14), grupo B ou ATIE e AR composta modificada(n=14) e grupo C ou ATIE pediculada para DA e AR aorto-coronariana(n=14). Os pacientes foram submetidos a fluxometria no pós-operatório imediato. A RFC foi de 2,1 ± 0,44, 1,96 ± 0,3 e 2,06±0,42 nos grupos A,B e C, (p=0.7208 A, B x C) e o FS, em ml/min, foi 110±30, 145±59 e 136±58, respectivamente (p=0.3232 A,B x C). Concluindo, não houve diferença significativa do FS total e nem da RFC nos grupos estudados / The objective is to compare the total blood flow (Bf) and coronary flow reserve (CFR) to the left coronary branches that were revascularized with left internal thoracic (LITA) and radial artery (RA) in composite and independent arterial grafts. A randomized trial was realized and 42 patients assigned in group A or composite LITA-RA in a Y configuration (n=14), group B or modified composite LITA-RA(n=14) and group C or pedicled LITA to LAD and aorto-coronary RA (n=14). Patients were submitted to postoperative Bf velocity analysis. CFR was 2,1 ± 0,44, 1,96 ± 0,3 e 2,06±0,42 in groups A,B and C (p=0.7208 A, B x C) and Bf, in ml/min, was 110±30, 145±59 and 136±58, respectively (p=0.3232 A, B x C). In conclusion there was no difference in Bf and CFR in the groups studied

<p>Three-dimensional rotational angiography (3D-RA) is an established method within the field of interventional neuroradiology. The method has also a great potential in other areas with a complicated arterial anatomy. The purpose of this study was firstly to develop an investigative protocol for 3D-RA in renal transplanted patients with threatening allograft failure in diagnosing stenosis in the transplanted renal artery; secondly the protocol was evaluated and compared with a modified protocol including reduced contrast medium load. Furthermore, the advantages of the 3D reconstructions compared to the angiographic images were evaluated, likewise if an extended angle of rotation reduced the artifacts in the 3D reconstructions. The two protocols were compared with regard to image quality and acute nephrotoxicity. The accuracy of Doppler ultrasonography and the result of percutaneous transluminal angioplasty (PTA) were also assessed.</p><p>3D-RA was consecutively performed in 57 renal transplanted patients with suspicion of renal artery stenosis. A significant stenosis was found in 49% of the patients. The 3D reconstructions profiled 43% of the transplant renal artery stenoses better than the angiographic images. An extended angle of rotation reduced the artifacts. There was no statistical difference regarding image quality between the two protocols, and the renal function was equally affected in both protocols. Doppler ultrasonography sensitivity was 100%; specificity was 48% and positive predictive value 67%. PTA had a technical success rate of 92% and a clinical success rate of 75% after 3 months.</p><p>3D-RA is a helpful supplement in cases with complicated vascular anatomy, especially when PTA may be indicated. The 3D reconstructions profile the course of the artery more frequently than the angiographic images and support PTA. The 3D reconstructions are degraded of artifacts. Sampling artifacts can be diminished by increased C-arm rotation and increased number of projections. The distortions caused by beam hardening remain to be solved.</p>

Three-dimensional rotational angiography (3D-RA) is an established method within the field of interventional neuroradiology. The method has also a great potential in other areas with a complicated arterial anatomy. The purpose of this study was firstly to develop an investigative protocol for 3D-RA in renal transplanted patients with threatening allograft failure in diagnosing stenosis in the transplanted renal artery; secondly the protocol was evaluated and compared with a modified protocol including reduced contrast medium load. Furthermore, the advantages of the 3D reconstructions compared to the angiographic images were evaluated, likewise if an extended angle of rotation reduced the artifacts in the 3D reconstructions. The two protocols were compared with regard to image quality and acute nephrotoxicity. The accuracy of Doppler ultrasonography and the result of percutaneous transluminal angioplasty (PTA) were also assessed. 3D-RA was consecutively performed in 57 renal transplanted patients with suspicion of renal artery stenosis. A significant stenosis was found in 49% of the patients. The 3D reconstructions profiled 43% of the transplant renal artery stenoses better than the angiographic images. An extended angle of rotation reduced the artifacts. There was no statistical difference regarding image quality between the two protocols, and the renal function was equally affected in both protocols. Doppler ultrasonography sensitivity was 100%; specificity was 48% and positive predictive value 67%. PTA had a technical success rate of 92% and a clinical success rate of 75% after 3 months. 3D-RA is a helpful supplement in cases with complicated vascular anatomy, especially when PTA may be indicated. The 3D reconstructions profile the course of the artery more frequently than the angiographic images and support PTA. The 3D reconstructions are degraded of artifacts. Sampling artifacts can be diminished by increased C-arm rotation and increased number of projections. The distortions caused by beam hardening remain to be solved.

Vainikinių arterijų tyrimas daugiapjūviu kompiuteriniu tomografu (DKT) į klinikinę praktiką įdiegtas nesenai. Tai neinvazyvus tyrimo metodas, kurį galima atlikti ir ambulatoriniams pacientams. Tačiau greta savo privulumų, jis turi ir trūkumų – dėl nuolatinio vainikinių arterijų judėjimo širdies ciklo metu gali atsirasti liekamųjų judesio artefaktų atkuriant vaizdus. Jų tikimybė priklauso ne tik nuo aparato, kuriuo atliekamas tyrimas, techninių charakteristikų, bet ir nuo širdies veiklos ypatumų. Yra atlikta nemažai tyrimų, įvertinančių vainikinių arterijų vaizdų kokybės priklausomybę nuo širdies susitraukimų dažnio, jo variabilumo, kitų faktorių. Kairiosios Hiso pluošto kojytės blokados, sąlygojančios nesinchronišką skilvelių susitraukimą ir atsipalaidavimą, įtaka vaizdų kokybei tyrinėta mažai. Šiame tyrime buvo palyginta vaizdų kokybė tarp pacientų, kuriems nustatyta visiška kairiosios Hiso pluošto kojytės blokada ir nėra laidžiosios sistemos sutrikimų, grupių. Analizuota vainikinių arterijų įvertinimo visuose širdies ciklo rekonstrukciniuose intervaluose įtaka vaizdų kokybės vidurkiui. Nustatyta, kokia yra DKT tyrimo diagnostinė vertė identifikuojant hemodinamiškai reikšmingas vainikinių arterijų stenozes. Kadangi DKT tyrimas susijęs su jonizuojančia spinduliuote, įvertinti rentgeno vamzdžio srovės stiprumo moduliavimo ypatumai. Taip pat nustatyta širdies susitraukimų dažnio, jo variabilumo įtaka vaizdų kokybei, esant visiškai kairiosios Hiso pluošto kojytės blokadai. / Multislice computed tomography (MSCT) coronary angiography is one of the latest usage area of the computed tomography technology. It s a non-invasive diagnostic tool, wich can be performed in ambulant patients. MSCT coronary angiography beside it's advantages has some drawbacks. The main drawbacks are lower spatial resolution and residual motion artifacts in MSCT images. Therefore quality of coronary images and diagnostic value of MSCT angiography differs, depending on patient's clinical characteristics, especially on heart contraction features during scanning. Asynchronic contraction and relaxation of the right and left ventricles, caused of bundle branch block can also influence image quality of MSCT coronary angiography. To date, there are only few studies, conducted to analyse diagnostic performance of MSCT coronary angiography in patients with left bundle branch block. Although influence of heart rate, heart rate variability and the other factors (for example, age, sex, body mass index) on MSCT image quality are quite well investigated. Thus, the present study were designed to investigate the influence of complete left bundle branch block on image quality of MSCT coronary angiography more detail in comparison with control patients group without electrical conduction disturbances, reveal the diagnostic value of MSCT angiography to identify hemodinamicaly significant coronary stenosis.

Arteries respond to changes in global mechanical parameters (pressure, flow rate, and longitudinal stretching) by remodeling to restore local parameters (circumferential stress, shear stress, and axial strain) to baseline levels. Because a change in a single global parameter results in changes of multiple local parameters, the effects of individual local parameters on remodeling remain unknown. This study uses a novel approach to study remodeling in organ culture based on independent control of local mechanical parameters. The approach is illustrated by studying the effects of circumferential and shear stress on remodeling-related biological markers. Porcine carotid arteries were cultured for three days at a circumferential stress of 50 kPa or 150 kPa or, in separate experiments, a shear stress of 0.75 Pa or 2.25 Pa. At high circumferential stress, matrix synthesis, smooth muscle cell proliferation, and cell death are significantly greater, but matrix metalloproteinase-2 (MMP-2) and pro-MMP-2 activity are significantly less. In contrast, biological markers measured were unaffected by shear stress. Applications of the proposed approach for improved understanding of remodeling, optimizing mechanical conditioning of tissue engineered arteries, and selection of experimentally motivated growth laws are discussed.

Το θέμα της παρούσης εργασίας είναι η μελέτη της μη μόνιμης αιματικής ροής στις στεφανιαίες αρτηρίες της καρδιάς σε φυσιολογική κατάσταση, με στένωση καθώς και με αποκατάσταση της ροής με αναστομωτικό κλάδο. Για τον σκοπό αυτό χρησιμοποιούνται συμπεράσματα από τη διεθνή βιβλιογραφία γύρω από τους παράγοντες που μπορεί να οδηγήσουν στην ανάπτυξη στενώσεων, καθώς και κατευθυντήριες γραμμές για την διαμόρφωση των γεωμετρικών μοντέλων Στο πρώτο κομμάτι γίνεται μία αναφορά στις κυριότερες καρδιαγγειακές παθήσεις, που αποτελούν και την υπ αριθμόν ένα αιτία θανάτου παγκοσμίως. Γίνεται αναφορά στους επεμβατικούς τρόπους αντιμετώπισης της στεφανιαίας νόσου με έμφαση στην αορτοστεφανιαία παράκαμψη (bypass). Ακολουθεί μία σύντομη επισκόπηση της βιβλιογραφίας και εξαγωγή των βασικών συμπερασμάτων που θα αποτελέσουν την βάση για την κριτική των αποτελεσμάτων. Εν συνεχεία επεξηγείται αναλυτικά ο τρόπος με τον οποίο παράγονται τα γεωμετρικά μοντέλα, καθώς και οι περιπτώσεις που αναλύθηκαν. Ακολουθεί ο τρόπος κατασκευής του υπολογιστικού πλέγματος, πάνω στο οποίο επιλύονται οι εξισώσεις Navier- Stokes για ασυμπίεστο ρευστό. Τέλος με βάση τα αποτελέσματα από την εκτέλεση του κώδικα για όλες τις περιπτώσεις γίνεται μία προσπάθεια για εξαγωγή συμπερασμάτων. Εξάγονται με βάση την μελέτη των μοντέλων κάποιες ενδεικτικές κατευθυντήριες γραμμές ως προς το ποιες γεωμετρίες και τρόποι αναστόμωσης τείνουν να ευνοήσουν περισσότερο την ανάπτυξη της αθηρωματικής πλάκας αλλά και ποιες αποκαθιστούν την ροή του αίματος. / The subject of the following thesis is the study of the unsteady blood flow in the coronary arteries of the heart in normal conditions, during stenotic conditions and after restoration of the flow with an anastomotic branch. For this purpose, we use the conclusions from the international literature on the factors that can lead to the further development of stenoses, as well as guidelines on the formation of the geometrical models. In the first part we reference the most significant pathologic conditions of the heart which are the number one leading cause of death world widely. We also mention the invasive techniques with which doctors treat the coronary heart disease, emphasizing on the aorto-coronary bypass technique. Furthermore there is a review on the literature on the subject and extraction of the main conclusions we are going to use in the evaluation of the computational results We continue explaining in detail the way that the geometrical models where produced, as well as the cases which were analyzed. There is also an explanation of the way we constructed the computational grids on which we solve the incompressible Navier – Stokes equations. Finally, based on the computational results we obtain by executing the program for all the different cases we extract the basic conclusions. Based on the study of the models we try to give some basic guidelines regarding which geometries and anastomotic techniques tend to favor the further development of the atherosclerotic plaques , but also which ones restore the blood flow to the normal levels

Orientador: Roberto Jorge da Silva Franco / Resumo: Introdução: A doença renal crônica (DRC) tem uma inter-relação complexa com outras doenças. A literatura relata a associação direta entre declínio da função renal e comprometimento cognitivo, o qual está relacionado com pior qualidade de vida (QV). Alterações na hemodinâmica cerebral podem desempenhar papel relevante na patogenia da disfunção cognitiva entre pacientes em hemodiálise (HD). Recentemente, surgiram evidências que apoiam o papel da atividade física na prevenção ou no adiamento do declínio cognitivo. Objetivo: Avaliar os efeitos do treinamento aeróbico intradialítico sobre o fluxo sanguíneo cerebral, função cognitiva e QV em pacientes com DRC que realizam HD. Casuística e Métodos: Estudo clínico controlado e randomizado de intervenção fisioterápica, com análise de intenção de tratar. Trinta pacientes foram submetidos a teste ergométrico, avaliação do fluxo sanguíneo cerebral, avaliação da rigidez arterial, teste de função cognitiva e questionário de QV. O grupo de intervenção (GI), com quinze pacientes, foi submetido a treinamento aeróbico intradialítico, três vezes por semana, durante quatro meses. O grupo controle (GC), com quinze pacientes, não teve intervenção. Todos os pacientes foram reavaliados após o término do protocolo de atividade física ou após quatro meses da primeira avaliação, para o grupo controle. Resultados: No GI, os resultados mostraram melhora estatisticamente significante da função cognitiva (p<0,001), velocidade máxima do fluxo sanguíneo da a... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Chronic kidney disease (CKD) has a complex interrelationship with other diseases. The literature reports a direct association between decline in kidney function and cognitive impairment, which is associated with worse quality of life (QoL). Changes in cerebral hemodynamics may play a role in the pathogenesis of cognitive impairment among patients on hemodialysis (HD). Recently, there is evidence to support the physical activity role in preventing or delaying cognitive decline. Objective: To evaluate the effects of intradialytic aerobic training on cerebral blood flow, cognitive function and QoL in patients with CKD in HD. Methods: randomized controlled trial of physiotherapy intervention, with analysis intention to treat. Thirty patients underwent exercise testing, evaluation of cerebral blood flow, arterial stiffness, cognitive function test and QoL questionnaire. Fifteen patients in intervention group (IG) underwent intradialytic aerobic exercise three times a week for four months. Others fifteen patients in control group (CG) had no intervention. All patients were reassessed after the physical activity protocol or four months after the first evoluation, for the control group. Results: In IG, results showed statistically significant improvement of cognitive function (p <0.001), maximum blood flow velocity of the basilar artery (p = 0.029) and QoL in the fields dialysis staff encouragement (p = 0.025) and pain (p = 0.008). The variable arterial stiffness was no... (Complete abstract click electronic access below) / Doutor

O diabetes é uma doença crônica que afeta mais de 8% da população mundial. As alterações vasculares estão relacionadas às principais complicações do diabetes. A aldosterona contribui para a disfunção endotelial após a ativação do receptor mineralocorticóide (MR). Recentemente, foi demonstrado que a aldosterona ativa o receptor de estrógeno acoplado à proteína G (GPER). A ativação de GPER está relacionada a efeitos benéficos na vasculatura. Entretanto, ainda não existem estudos em artérias de resistência relacionando aldosterona e GPER e essa interação no diabetes. Dessa forma, o presente estudo testou a hipótese de que a aldosterona ativando receptores GPER promove efeitos benéficos na vasculatura, mas esses efeitos estão diminuídos no diabetes. Os objetivos foram investigar os níveis de expressão de GPER nos animais controle e db/db [camundongos com mutação no receptor de leptina que desenvolvem obesidade e diabetes tipo 2], quais efeitos da aldosterona são mediados por ativação de GPER e quais mecanismos envolvidos nessa ativação e verificar se estão alterados no diabetes. O grupo diabético apresentou maior expressão de GPER, mas não de MR. A aldosterona promoveu aumento da resposta máxima contrátil à fenilefrina (PE) somente no grupo controle, que foi revertido pelo uso do antagonista de GPER, G15. No grupo diabético, a resposta à PE já é aumentada, o uso dos antagonistas de MR e GPER reduziram a resposta da PE. A aldosterona ainda reduziu a potência de relaxamento da acetilcolina (ACh) em ambos os grupos, por ativação de MR. O antagonismo de GPER por G15 promoveu um redução adicional na potência do relaxamento no grupo controle, mas não afetou a resposta do grupo diabético. Esses achados confirmam a hipótese de que GPER exerce um papel benéfico na vasculatura e esse efeito é perdido no diabetes. Nossos resultados contribuem para a compreensão dos mecanismos que a aldosterona influencia os danos vasculares no diabetes através da ativação de receptores MR e GPER. / Diabetes is a chronic disease that affects more than 8 % of the world population. Vascular changes are related to the major complications of diabetes. Aldosterone contributes to endothelial dysfunction after activation of the mineralocorticoid receptor (MR). It was recently shown that aldosterone also activates the G protein-coupled estrogen receptor (GPER) and induces non genomic effects. The activation of GPER by estrogen or G1 is related to beneficial effects on the vasculature. However, there are no studies demonstrating the relationship between aldosterone and GPER in diabetes mellitus. Therefore, we hypothesized that the beneficial effects of aldosterone mediated by the activation of GPER receptors on vascular reactivity are decreased in diabetes mellitus. Female control and diabetic (db/db) mice [leptin receptor knockout mice that develop obesity and type 2 diabetes] were used. We determined the expression of GPER and the effect of aldosterone in the presence of MR and GPER antagonists in arteries from control and db/db mice and the major signaling pathways involved. The diabetic group showed increased GPER expression, but not MR. In the presence of aldosterone the control increased the maximal contractile response to phenylephrine (PE), and this increase was reversed by the use of GPER antagonist, G15. The response to PE is already increased in the diabetic group. Although aldosterone did not cause further increase the use of MR and GPER antagonists reduced the maximum response to PE at the same level of control. Aldosterone also reduced the potency of acetylcholine (ACh)-induced relaxation in both groups by the activation of MR. GPER antagonism caused further decrease in the potency of ACh-induced relaxation in the control group, while not affecting the response of the diabetic group. These findings confirm the hypothesis that the beneficial effects of aldosterone mediated by the activation of GPER receptors are decreased in diabetes mellitus. Our results contribute to understanding the mechanisms that aldosterone influences the vascular damage in diabetes through activation of MR and GPER receptors.