Made available in DSpace on 2015-07-22T20:50:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-09-28. Added 1 bitstream(s) on 2015-08-11T03:26:13Z : No. of bitstreams: 1 Publico-12890a.pdf: 1928691 bytes, checksum: e1cbc3ab85af6e4bc90c10550766fe7d (MD5). Added 1 bitstream(s) on 2015-08-11T03:26:13Z : No. of bitstreams: 2 Publico-12890a.pdf: 1928691 bytes, checksum: e1cbc3ab85af6e4bc90c10550766fe7d (MD5) Publico-12890b.pdf: 1540336 bytes, checksum: 7786d4d28a3b5762f4bd7f7137c3c3c0 (MD5) / A ativacao de receptores B1 de cininas no endotelio vascular desencadeia vias de sinalizacao que resultam na elevacao do Ca+2 intracelular e ativacao da enzima oxido nitrico sintase (NOS), seguido por producao de NO e vasodilatacao. Embora a inducao do receptor B1 e sua funcao durante a inflamacao tenha sido abordada por diversos estudos, a importancia de receptores B1 na homeostase vascular em condicoes fisiologicas nao esta totalmente elucidada. Para esclarecer essa questao, o presente estudo analisou a funcao endotelial e a producao de NO em camundongos nocaute do receptor B1 (B1 -/-) e selvagens (WT). O leito arteriolar mesenterico foi perfundido por solucao Krebs e respostas vasculares para Acetil-colina (ACh), nitroprussiato de sodio (SNP) e norepinefrina (NE) foram analisadas por um sistema de aquisicao de dados. Niveis plasmaticos de NO (ƒÊmol/L) foram analisados por deteccao dos derivados nitritos/nitratos atraves de metodo de quimioluminescencia e a producao vascular de NO foi avaliada em cortes histologicos de arteriolas mesentericas incubadas com DAF-2 DA, um marcador fluorescente de NO (unidades arbitrarias, u.a.). A atividade da NOS (pmol/mg.min) foi mensurada atraves da conversao bioquimica de L-[3H]arginina para L-[3H]citrulina em homogenatos de vasos mesentericos na presenca de substrato e co-fatores. Celulas endoteliais primarias foram incubadas com DAF-2 DA e as imagens obtidas em microscopio confocal foram analisadas por densitometria optica (u.a.). Celulas foram estimuladas com ACh [1 mmol/L] na presenca ou ausencia de Larginina, o substrato da NOS, ou tetrahidrobiopterina (BH4), co-fator da NOS, ou acido ascorbico, composto antioxidante. Producao de anion superoxido (u.a.) foi avaliada em celulas endoteliais incubadas com di-hidroetidina, um marcador fluorescente de anion superoxido, na presenca ou ausencia de BH4 ou acido ascorbico. Arteriolas mesentericas de B1 -/- exibiram severo comprometimento da vasodilatacao mediada por ACh, sem alteracoes na resposta ao NPS e NE. Os niveis circulantes de NO foram consideravelmente reduzidos em B1 -/- (49,6 } 10,5*; n=6) vs WT (141,9 } 17,3; n=6 ), acompanhado por reducao da producao basal de NO em arteriolas mesentericas de B1 -/- (0,16 } 0,03*; n=6) quando comparado a WT (0,58 } 0,08; n=4). A atividade da NOS foi elevada em amostras de B1 -/- (3,4 } 0,58*; n=4) em comparacao a WT (1,9 } 0,05; n=5). A producao de NO mediada por ACh foi significantemente reduzida em celulas endoteliais de B1 -/- (35,8 } 3,1*; n=4) quando comparado a celulas de WT (66,9 } 3,2; n=4). A producao de NO em celulas endoteliais de B1 -/- foi revertida por incubacao com BH4 (54,3 } 1,7; n=4) e acido ascorbico (101,8 } 6,0; n=4), mas nao por L-arginina, enquanto incubacao de celulas endoteliais de WT com BH4, acido ascorbico ou L-arginina nao teve efeito. A producao elevada de anion superoxido em celulas endoteliais de B1 -/- (77,1 } 2,5*; n=4) quando comparado a WT (29,3 } 6,9; n=4) foi revertida pela incubacao com acido ascorbico (35,3 } 6,4; n=3). O severo comprometimento da vasodilatacao mediada pelo endotelio acompanhado por reducao da biodisponibilidade de NO, apesar do aumento da atividade da NOS, sugere a exacerbacao da inativacao de NO em endotelio de B1 -/-. A producao elevada de anion superoxido em endotelio de B1 -/- provavelmente e responsavel pela exacerbacao da inativacao de NO nestes animais. Adicionalmente, a inativacao de BH4 por peroxinitrito pode acarretar em desacoplamento da NOS e producao de anion superoxido pela enzima. / Activation of B1 receptor in the vascular endothelium triggers diverse signaling pathways that results in elevation of intracellular Ca2+ and Nitric Oxide Synthase (NOS) activation, followed by NO production and vasodilation. Although much has been investigated about the B1-induction and functionality during inflammation, the importance of B1 subtype in normal vessels remains unclear. To clarify this question, the present study analyzed endothelial function and endothelial NO generation in B1 receptor knockout (B1 -/-) and Wild Type (WT) mice. Mesenteric arteriolar bed was perfused with Krebs solution and vascular responses to Acetilcholine (ACh), sodium nitroprusside (SNP) and norepinephrine (NE) were evaluated by a data acquisition system. Plasmatic NO levels (μmol/L) were analyzed by NO derivatives nitrate and nitrite using NO Analyzer (NOATM280, Sievers Instruments) and vascular NO generation was assessed in mesenteric arterioles slices using DAF -2 DA, a fluorescent cell permeable dye for NO (arbitrary units, a.u.). NOS activity (pmol/mg.min) was measured by the biochemical conversion of L-[3H] arginine to L-[3H] citrulline in homogenates of mesenteric vessels in the presence of optimal levels of substrate and co-factors. Primary endothelial cells were incubated with DAF-2 DA and images obtained in a confocal microscope were analyzed by optic densitometry (a.u.). Cells were stimulated with ACh [1 mmol/L] in presence or absence of the NOS substrate Larginine, or the co-factor tetrahydrobiopterin (BH4), or the antioxidant compound ascorbic acid. Production of superoxide anion (a.u.) was assessed in endothelial cells incubated with dihydroethidine, a fluorescent cell permeable dye for superoxide anion, in the presence or absence of BH4 or ascorbic acid. Mesenteric arterioles from B1 -/- exhibited a severe impairment of ACh-vasodilation for all tested doses, with no changes in the response to SNP and NE. Circulating NO was markedly decreased in B1 -/- (49.6 ± 10.5*; n=6) vs WT (141.9 ± 17.3; n=6 ), accompanied by reduced basal NO release in mesenteric arterioles from B1 -/- (0.16 ± 0.03*; n=6) when compared to WT (0.58 ± 0.08; n=4). NOS activity was elevated in mesenteric homogenates from B1 -/- (3.4 ± 0.58*; n=4) in comparison to WT (1.9 ± 0.05; n=5). ACh-induced NO release was markedly reduced in primary cultured endothelial cells from B1 -/- (35.8 ± 3.1*; n=4) in comparison to WT cells (66.9 ± 3.2; n=4). NO release in endothelial cells from B1 -/- was reversed by incubation with BH4 (54.3 ± 1.7; n=4) and ascorbic acid (101.8 ± 6.0; n=4), but not by L-arginine, while incubation of endothelial cells from WT with BH4, ascorbic acid or L-arginine had no effect. Elevated production of superoxide anion in endothelial cells from B1 -/- (77,1 ± 2,5*; n=4) in comparison to WT (29,3 ± 6,9; n=4) was reversed by incubation with ascorbic acid (35,3 ± 6,4; n=3). The severe impairment in the endothelial-mediated vasodilation accompanied by decreased NO bioavailability, despite the augmented NOS activity, strongly indicates an exacerbation of NO inactivation. Reduced NO availability may be preceded by exacerbation of NO inactivation by superoxide anion, which can leads to inactivation of BH4 in vascular endothelium, resulting in NOS uncoupling and NOS derived production of superoxide anion. / TEDE

Apesar dos grandes avanços na medicina perioperatória, as operações vasculares ainda estão associadas a elevada morbi-mortalidade. A fisiopatologia dos eventos perioperatórios é complexa, envolvendo a instabilização de placas ateroscleróticas, o que não é contemplado nos algoritmos para estratificação de risco cardíaco perioperatório. Acreditamos que a identificação de características relacionadas à instabilização de placas incipientes, como alterações na reatividade vascular e maior atividade inflamatória, pode melhorar a acurácia da estimativa de risco e a análise do comportamento perioperatório destas características pode elucidar importantes mecanismos fisiopatológicos. Estudamos 100 pacientes com indicação de operação vascular e aferimos por meio de ultrassom-Doppler de artéria braquial, a hiperemia reativa (HR), marcador de função microvascular, e a dilatação mediada pelo fluxo (DMF), marcador de função endotelial, antes e após a operação. Analisamos também os níveis de proteina-C reativa ultra-sensível (PCR-us). A operação foi realizada em 96 pacientes e 27 deles apresentaram algum evento até o 30º dia pós-operatório: 4 óbitos cardíacos, 5 infartos agudos do miocárdio, 2 acidentes vasculares cerebrais isquêmicos, 2 elevações isoladas de troponina, 1 embolia de pulmão, 2 reoperações e 11 óbitos não cardíacos. Detectamos disfunção endotelial em 70% dos pacientes, mas não observamos nenhum padrão característico de comportamento perioperatório da DMF, ou associação significativa entre a mesma e os eventos. Observamos significativo aumento da PCR-us após a intervenção cirúrgica (0,5mg/dL x 3,01mg/dL, P=0,001), mas sem associação com eventos. Identificamos forte associação entre disfunção microvascular, representada pela menor velocidade de fluxo na artéria braquial durante a hiperemia reativa, e eventos: 81 cm/s + 20 x 95 cm/s + 28 ( P= 0,02). Concluímos que a identificação de disfunção microvascular no pré-operatório pode estratificar o risco de complicações perioperatórias e que embora não tenhamos observado piora da vasodilatação mediada pelo fluxo, não podemos afastar que haja piora da função endotelial no perioperatório. O aumento de PCR-us denota grande diátese inflamatória, que pode estar relacionada à disfunção endotelial. / Despite great advances in perioperative care, major vascular surgeries are still related to high morbidity and mortality. The pathophysiology of perioperative cardiac events is complex and comprehends atherosclerotic plaque instability, witch is not contemplated in the current algorithms for cardiac risk estimation. We hypothesized that the identification of characteristics related to predisposition for plaque instability, such as abnormalities in the vascular reactivity, is very promising and the characterization of this parameter`s behavior in the perioperative setting contributes to the better understanding of event\'s pathophysiology. We prospectively studied a cohort of 100 patients, candidates for elective major vascular surgery and assessed, by Doppler ultrasound in the brachial artery, reactive hyperemia(RH), a marker of microvascular function, and flow mediated dilation(FMD), a marker of endothelial function, before and after surgery. We also obtained C-reactive protein-high sensitive assay (CRP-hs) before and after surgery. Ninety six patients were submitted to the planned vascular surgery and 27 patients had an event up to the 30º postoperative day. We observed 4 cardiac deaths, 5 acute myocardial infarctions, 2 isolated troponin elevations, 2 ischemic strokes, 1 pulmonary embolism, 2 reoperations and 11 noncardiac deaths. Results: although there was no significant difference in the preoperative FMD between patients with and without events: 4.83% + 6.81 x 5.88% + 6.00 (p= .457), respectively, low RH response, measured as lower peak flow velocity in RH, was associated to events: 81 cm/s + 20 x 95 cm/s + 28 (p=0,02). There was no significant difference in the preoperative CRP-hs between groups (median: 0.51mg/dL (IQR 2.12) x 0.41mg/dL (IQR 0.59), p= .234). There was no significant difference between FMD before and after surgery but we detected an almost 6-fold increase in CRP-hs after surgery: 0.50mg/dL x 3.01mg/dL (p < .001), respectively. Our study demonstrated that microvascular dysfunction is closely related to perioperative events after major vascular surgery and is a better marker of perioperative risk than endothelial dysfunction, in specific conditions.

A dieta Mediterrânea (DM) tem sido amplamente estudada do ponto de vista epidemiológico porém, o efeito pleno específico da DM, bem como os mecanismos pelos quais esse padrão dietético contribui para redução do risco cardiovascular em prevenção secundária, são desconhecidos. Isso ocorre, em parte, devido à dificuldade de aderência observada em ensaios clínicos de intervenção dietética, especialmente estudos comparativos com dietas hipolipemiantes, por exemplo, a dieta TLC, Therapeutic Lifestyle Changes Diet (TLCD) do National Cholesterol Education Program-ATPIII. Assim, realizamos um estudo clínico, controlado, não randomizado, comparando o perfil de risco cardiovascular de dieta Mediterrânea (DM) versus dieta TLC (DTLC) em 40 pacientes com doença arterial coronariana, homogeneamente selecionados (45-65 anos de idade, homens, que tiveram ao menos um evento coronariano nos 2 últimos anos) e intensamente medicados. Uma questão paralela foi entender os efeitos de ambas as dietas nos processos de inflamação, disfunção endotelial e do estresse oxidativo, fatores-chave na aterogênese e particularmente importantes na prevenção secundária. Os hábitos culturais e dietéticos foram relevantes para alocação dos pacientes nos grupos de dieta Mediterrânea (n = 21; dieta rica em grãos integrais, vegetais, frutas, oleaginosas 10 g/dia, azeite de oliva extra-virgem 30 g/dia e vinho tinto 250 ml/dia) ou dieta TLC (n = 19; suplementada com fitosteróis 2g/dia através de creme vegetal 20 g/dia). Escores de aderência validados na literatura e específicos às dietas mostraram resultado > 90% no índice de aderência aos dois padrões dietéticos. Alguns efeitos foram comuns à dieta Mediterrânea e à dieta TLC. Com ambas, houve redução significativa de peso, índice de massa corporal (kg/m²), variáveis de composição corporal e pressão arterial. Além disso, ambas as dietas promoveram redução dos níveis plasmáticos de ADMA e da relação L-arginina/ADMA. A reatividade da artéria braquial dependente do endotélio permaneceu inalterada em ambos os grupos; no entanto, pacientes sob DM e sob DTLC melhoraram a velocidade de fluxo no momento basal (pré-hiperemia vascular). Outros efeitos foram específicos a cada padrão dietético. Com a DM, foram observados diminuição na contagem total de leucócitos versus DTLC (p =0.025) e aumento nos níveis de HDL-colesterol em 3 mg/dL (p = 0.053) versus DTLC, que mantiveram níveis de HDL-C inalterados. O diâmetro basal da artéria braquial aumentou com a DM, mas não com a DTLC. Com a DTLC, houve redução estatisticamente significante versus DM nas variáveis lipídicas colesterol total, LDL-colesterol (p < 0.05) e LDL oxidada (p = 0.009), embora a razão LDL oxidada/LDL total não tenha se alterado. Níveis séricos/plasmáticos de apolipoproteína A-1, lipoproteína(a), glicose, mieloperoxidase, sICAM, sVCAM, e as razões glutationa reduzida/oxidada em plasma e eritrócitos não se alteraram em ambos os grupos. Em conjunto, estes dados indicam um perfil de efeitos da DM e DTLC compatíveis com redução do risco cardiovascular, mesmo em pacientes intensamente medicados, em prevenção secundária. Embora estes efeitos tenham sido equivalentes entre DM e DTLC, eles parecem ser mediados tanto por alguns mecanismos comuns, como alguns mecanismos específicos de cada dieta / The Mediterranean Diet (MD) has been widely studied with respect to epidemiology, but mechanisms whereby the Mediterranean Diet (MD) is cardioprotective are unclear. This is partly because of the difficulties of adherence in clinical trials of dietary intervention, particularly trials comparing it to traditional lipid-restraining diets, e.g., Therapeutic Lifestyle Changes Diet (TLCD) from National Cholesterol Education Program ATPIII. We performed a controlled, non-randomized clinical trial comparing the cardiovascular risk profile of the Mediterranean Diet (MD) versus the TLC Diet (TLCD) in 40 selected, highly-homogeneous, and intensively medicated patients with coronary heart disease (45-65 years, males, at least one coronary event over prior 2 years). In addition, we sought to investigate both diets effects on inflammation, endothelial dysfunction and oxidative stress, all key factors in atherogenesis and particularly important in secondary prevention. Dietary/cultural habits were the basis to allocate patients for 3 months to either MD (n = 21; rich in whole grains, vegetables, fruits, nuts 10g/day, extra-virgin olive oil 30g/day, red wine 250ml/day) or TLCD (n = 19; plus phytosterols 2g/day). Specific scores showed that both diets had >90% adherence. Some effects were common to both diets. Patients in both groups showed a significant reduction in weight, body mass index, body composition and blood pressure. Also, both groups presented a reduction in plasma levels of ADMA and L-arginine/ADMA ratio. Endothelial-dependent brachial artery reactivity remained unaltered in both groups. However, patients under MD and TLCD improved flow velocity at baseline (prior to hyperemia). Nevertheless, other effects were specific to each diet. With MD, there was significant decrease in leukocyte count vs. TLCD (p = 0.03) and average increase in HDL-cholesterol by 3 mg/dL (p = 0.053) versus TLCD. The brachial arterials basal diameter increased with MD but not with TLCD. However, with TLCD there was a statistically significant reduction of lipid variables: total cholesterol, LDL-cholesterol (p < 0.05) and oxidized LDL (p = 0.009) vs. MD even though the ratio of oxidized / total LDL remained unaltered. Plasma and serum levels of apolipoprotein A-1, lipoprotein(a), glucose, myeloperoxidase, sICAM, sVCAM, and glutathione reduced/oxidized ratio in plasma and erithrocytes also remained unaltered in both groups. Together, these results demonstrate a pattern of effects of MD and TLCD compatible with cardiovascular risk reduction, in secondary prevention, even in intensely medicated patients. Although these effects were equivalent between MD and TLCD, they seem to be mediated by some common mechanisms, as well as by each diets specific mechanisms

A Trombomodulina é um marcador endotelial da doença aterosclerótica, e seu uso como preditor da doença arterial obstrutiva periférica (DAOP) deve ser comprovada. Avaliou-se 41 pacientes com claudicação intermitente e 40 com isquemia crítica. A Trombomodulina plasmática (TMp) foi quantificada em todos os pacientes, através de método imunoenzimático (ELISA). As hipóteses de normalidade e de homogeneidade de variância foram provadas, respectivamente, pelos testes de Shapiro-Wilk e de Levene. A comparação da TMp entre ambos os grupos foi realizada empregando-se o teste t de Student. A utilização de pacientes com Claudicação Intermitente e com Isquemia Crítica é interessante como modelo de estudo e deve ser empregado para avaliar diferentes marcadores de prognóstico da DAOP. Não foi observada diferença estatisticamente significante nos níveis de TMp nos grupos, não permitindo utilizar-se a TMp para avaliar o prognóstico da doença arterial obstrutiva periférica (DAOP) / Thrombomodulin (TM) is an endothelial marker of arterosclerotic disease and its use as a predictor of Peripheral Arterial Disease (PAD) must be proven. Forty-one patients having intermittent claudication and forty having critical ischemia were evaluated. Plasmatic Thrombomodulin (TMp) was quantified in all patients using the immunoenzymatic method (ELISA). The hypotheses of normality and variance homogeneity were proven, respectively, using the Wilk-Shapiro and Levene Tests. The comparison of the TMp between both groups was carried out using the Student-T Test. The utilization of patients with Intermittent Claudication and Critical Ischemia is interesting as a study model and should be used to evaluate different prognostic markers of PAD. No statistically significant difference was observed in the TMp levels between the groups, thus not permitting the use of TMp to evaluate the prognostics of Peripheral Arterial Disease (PAD)

Introdução: O aumento da massa ventricular esquerda e a disfunção endotelial são importantes fatores de risco cardiovascular em hipertensos e normotensos. Estudos investigando a associação entre massa ventricular esquerda e disfunção endotelial, utilizando diversas metodologias, são contraditórios. A tonometria arterial periférica (PAT) é um método não invasivo, validado e reprodutível que permite analisar simultaneamente além da função endotelial, outros aspectos da função vascular, como a amplitude de pulso basal (BPA), que reflete o tônus vascular basal, e a contribuição da reflexão da onda de pulso (PAT-AIx). Estas características podem colaborar para a compreensão da associação entre massa ventricular esquerda e função endotelial em hipertensos. Objetivo: Analisar a correlação entre a função endotelial, obtida pela PAT, e a massa ventricular esquerda, em pacientes com hipertensão arterial sistêmica, com e sem hipertrofia ventricular esquerda (HVE). Métodos: Em estudo transversal, foi avaliada a associação entre massa ventricular esquerda e função endotelial em 46 pacientes hipertensos ambulatoriais do Hospital da Universidade Federal do Ceará, com idade de 40 a 60 anos e pressão arterial menor que 180/110mmHg, sem outros FRCV. Todos os pacientes realizaram avaliação clínica e laboratorial, ecocardiograma e PAT. HVE foi definida como índice de massa ventricular esquerda (IMVE) > 48 g/m2,7 para homens e > 44 g/m2,7 para mulheres. Através da PAT, foram medidos o índice de hiperemia reativa (RHI), a razão PAT (PAT ratio), o PAT-AIx e a BPA. Correlação entre variáveis contínuas foi estimada através do Coeficiente de Correlação de Pearson ou Spearman. Comparações de distribuições de variáveis contínuas foram realizadas através do Teste t Student ou do Teste da Soma dos Postos de Mann-Whitney. Proporções foram comparadas através do Teste Exato de Fisher. Resultados de comparações foram considerados significativamente diferentes quando o valor-p foi < 0,05. A associação entre massa ventricular esquerda e função endotelial foi avaliada através de regressão linear ou regressão logística. Resultados: Houve correlação significativa do IMVE (g/m2,7) com PAT-AIx (r= 0,304; p=0,043), com RHI (r=0,321; p= 0,046) e com PAT ratio (r=0,347; p=0,03). Esta associação foi independente de confundidores. Dezoito pacientes (39,1%) apresentavam HVE. Dentre os índices de função vascular, apenas a PAT-AIx diferiu entre os pacientes com e sem HVE (p=0,025), sendo os maiores valores encontrados no grupo com HVE. A presença de HVE foi associada ao PAT-AIx (razão de chances= 2,804 [1,29]; p=0,025), mas não foi associada com os demais índices de função vascular, independente de confundidores. Onze pacientes (23,9%) não usavam anti-hipertensivos; neste grupo, o IMVE (g/m2,7) foi associado ao RHI (coef=10,64 [3,11]; p=0,009) e ao PAT ratio (coef=22,85 [7,29]; p=0,014). Conclusão: Em hipertensos de grau leve a moderado, o índice de massa ventricular esquerda (g/m2,7) tem correlação positiva com a função endotelial digital e com o PAT-AIx. A associação independe do uso de anti-hipertensivos e dos níveis pressóricos / Background: Increased left ventricular mass and endothelial dysfunction are important cardiovascular risk factors in hypertensive and normotensive. Studies investigating the association between left ventricular mass and endothelial dysfunction, using different methodologies, are contradictory. Peripheral arterial tonometry (PAT) is a noninvasive, reproducible and validated method which allows simultaneously analyze endothelial function in addition other aspects of vascular function, as the basal pulse amplitude (BPA), which reflects the basal vascular tone, and contribution of the pulse wave reflection (PAT-AIx). These characteristics may contribute to the understanding of the association between endothelial function and left ventricular mass in hypertensive. Objective: To analyze the correlation between endothelial function obtained with the PAT in patients with hypertension, with and without left ventricular hypertrophy (LVH). Methods: In a cross-sectional study, we evaluated the association between endothelial function and left ventricular mass in 46 outpatient hypertensive patients of the Walter Cantídio Universitary Hospital, Federal University of Ceara, Brazil, aged 40-60 years and blood pressure under 180 / 110mmHg, no other CVRF. All patients underwent clinical and laboratory evaluation, echocardiography and PAT. LVH was defined as left ventricular mass index (LVMI) > 48 g / m2.7 for men and > 44 g / m2.7 for women. By PAT, were measured reactive hyperemia index (RHI), the PAT ratio, the PAT-AIx and the BPA. Correlation between continuous variables was estimated using the Pearson or Spearman correlation coefficient. Student\'s t-tests or Wilcoxon\'s rank sum test (Mann-Whitney) were used to examine differences between the groups in normally distributed or not-normally-distributed continuous variables, respectively. Fisher exact test was used to examine the difference in proportions. A p value < 0.05 was considered statistically significant. Linear regression and logistic regression analysis were used to evaluate the association between left ventricular mass and endothelial function. Results: LVMI (g /m2.7) was positively associated with PAT-AIx (r = 0.304; p = 0.043), with RHI (r = 0.321; p = 0.046) and PAT ratio (r = 0.347; p = 0.03). This association was independent of confounders. Eighteen patients (39.1%) had LVH. Among the indices of vascular function, only the PAT-AIx differed between patients with and without LVH (p = 0.025), with higher values found in the group with LVH. The presence of LVH was associated with PAT-AIx (odds ratio = 2.804 (1.29); p = 0.025), but was not associated with other indices of vascular function, independent of confounders. Eleven patients (23.9%) did not use antihypertensive medication; in this group, LVMI (g / m2.7) was associated with RHI (beta coefficient (se) = 10.64 (3.11); p = 0.009) and the PAT ratio (beta coefficient (se) = 22.85 (7.29); p = 0.014). Conclusion: In mild to moderate systemic hypertension, left ventricular mass index (g / m2.7) has positive correlation with digital endothelial function and the PAT-AIx. The association is independent of the use of antihypertensive medication and blood pressure levels

Adultos com insuficiência cardíaca (IC) desencadeada por cardiomiopatia dilatada idiopática (CMDid) apresentam disfunção endotelial. Esta, por sua vez, está relacionada a baixo prognóstico. Assim, o objetivo principal desse estudo foi avaliar a função endotelial de crianças com CMDid e com IC por CMDid prévia e função de ejeção do ventrículo esquerdo (FEVE) preservada. O estudo, então, foi composto por três grupos. O grupo CMDid foi composto de 15 crianças com CMDid e FEVE<40%.O grupo IC foi composto de 16 crianças com IC por CMDid prévia e FEVE > 50%. O grupo controle (CON) foi composto de 11 crianças saudáveis. As crianças dos três grupos foram submetidas a avaliações de função endotelial pelo índice de hiperemia reativa (RHI), ergoespirometria e classificação da classe funcional. Os resultados mostram que a estatura das crianças do CMDid foi menor que a das crianças do CON (1,20 ± 0,20 contra 1,40 ± 0,10; p=0,02). A FEVE foi significativamente menor no CMDid (35,2 ± 10,4) em comparação com a no IC (59,1 ± 5,9) e no CON (62,5 ± 3,4; p=0,0001). Os valores de RHI do CON se apresentaram significativamente 31% maiores que o CMDid e 25% maiores no IC, de forma que houve efeito principal significativo estatisticamente apenas para o grupo em relação à variável RHI [F(2,39)=10,310;p < 0,001; ?2=0,35; poder = 0,98].As crianças do CMDid apresentaram os valores de RHI e de pressão arterial sistólica no pico do exercício significantemente menores que as crianças do IC e do CON. A FEVE esteve moderadamente correlacionada com os valores do RHI (r=0,46; p < 0,006). Para cada unidade de medida de RHI, houve um acréscimo de 10,5 no VO2max. Os menores valores de RHI estiveram diretamente correlacionados com os menores valores de VO2max (r=1; p =< 0,01). A classificação de Weber foi significativamente associada às três classes funcionais (da criança, do responsável e do médico) / Adults with heart failure (HF) due to idiopathic dilated cardiomyopathy (DCM) have endothelial dysfunction. The latter is related to poor prognosis. Therefore, the primary aim of this study was to evaluate endothelial function in children with DCM, with HF due to previous DCM and preserved left ventricular ejection fraction (LVEF). The study was composed by three groups. CMDid group was composed by 15 DCM children with LVEF < 40%.ICgroup was composed by 16 HF children (by previous DCM) with LVEF > 50%. Control group (CON) was composed by 11 healthy children. All children were assessed by endothelial function via reactive hyperemia-peripheral artery tonometry (RH-PAT) testing, CPT and functional class classification. The results point that CMDid children were shorter than CON (1.20 ± 0.20 contra 1.40 ± 0.10; p=0.02). LVEF was significantly lower in children from CMDid (35.2 ± 10.4) compared to those from IC (59.1 ± 5.9) and from CON (62.5 ± 3.4; p=0.0001). CON had significant higher RHI values than CMDid in 31% and than IC in 25%.There was statistically significant main effect only for group in relation to the variable RHI [F(2,39)=10.310;p < 0.001; ?2=0.35; power = 0.98]. Children in CMDidhad significantly lower values of RHI and lower systolic pressure at peak of exercise than ICand CON. LVEF was moderate correlated to RHI values (r=0.46; p < 0.006). For each point of RHI, there is an addition of 10.5 in the VO2max. Lower RHI values were correlated to lower VO2max values (r=1; p =< 0.01).Weber\'s classification was significantly associated to the three functional classes (children\'s self report, parents\' and medical\'s)

Ca2+-activated potassium channels (KCa) and canonical transient receptor potential (TRPC) channels are essential to endothelial function. In ischemic heart disease, or in cardiac surgery, coronary endothelium is subjected to ischemia-reperfusion (I-R) / hypoxia-reoxygenation (H-R) injury. Hyperkalemic cardioplegic or organ preservation solutions used in cardiac surgery including heart transplantation also impair endothelial function. The present study was designed to mainly investigate whether endothelial dysfunction occurring in H-R or in hyperkalemic exposure is attributable to alterations of intermediate- and small-conductance KCa (IKCa and SKCa) channels, or TRPC channels, in particular, the TRPC3 channel. / Exposure to 60-min hypoxia followed by reoxygenation inhibited the vasorelaxant response of coronary arteries to IKCa / SKCa activator 1-EBIO. H-R reduced endothelial IKCa and SKCa currents and downregulated IKCa expression in PCECs. 1-EBIO enhanced endothelial K+ current that was blunted by H-R. / Exposure to hyperkalemic solutions decreased Ca2+ influx via TRPC3 in PCECs. The reduced Ca2+ influx in PCECs and the attenuated EDHF-mediated vasorelaxation in porcine coronary arteries, which were caused by hyperkalemic or cardioplegic / organ preservation solutions, were restored by OAG. / In PCECs, hypoxia for 60-min with reoxygenation reduced TRPC3 current and Ca2+ influx via TRPC3, which was accompanied by decreased NO release and endothelium-dependent vasorelaxation of porcine coronary arteries. The compromised endothelial function was restored by OAG. The translocation of TRPC3 to endothelial membrane was inhibited by H-R. / In TRPC3-overexpressing HEK293 cells, followed by reoxygenation, short-time hypoxia (10-min) enhanced, whereas prolonged hypoxia (60-min) reduced the current induced by TRPC3/6/7 activator OAG. / Our results indicate that: (1) Endothelial IKCa, SKCa and TRPC3 play an important role in regulating vascular tone; TRPC3 contributes to NO release from endothelial cells and is also involved in the function of EDHF. (2) H-R (60-30 min) reduces endothelial IKCa and SKCa currents with downregulation ofthe protein expression of IKCa. (3) H-R has dual effect on TRPC3 with short-time hypoxia (lO-min) enhancing whereas prolonged hypoxia (60-min) decreasing the electrophysiological activity of this channel. H-R (60-30 min) inhibits the translocation of TRPC3 to endothelial membrane. Furthermore, H-R inhibits Ca2+ influx via TRPC3 and such inhibition is associated with a decrease of NO production. (4) The activator of IKCa / SKCa or TRPC protects coronary endothelium against H-R injury. In coronary endothelium exposed to hyperkalemic or cardioplegic / organ preservation solutions, TRPC activator also exhibits protective effect. / The above findings are likely to have significant implications in ischemic heart disease and in modem cardiopulmonary surgery. / Whole-cell membrane currents of IKCa, SKCa, or TRPC3 were recorded by patch-clamp in primary cultured porcine coronary endothelial cells (PCECs). TRPC3 current was also studied in human embryonic kidney cells (HEK293 cells) transiently overexpressed with TRPC3 gene. Protein or mRNA expression of these channels was detected by Western blot or RT-PCR. Intracellular Ca2+ concentration was measured by Ca2+ imaging technique. Isometric force study was performed in a wire myograph and endothelial nitric oxide (NO) release was measured electrochemically by using a NO-specific microsensor in porcine coronary small arteries. / Huang, Junhao. / "December 2010." / Adviser: Qin Yang. / Source: Dissertation Abstracts International, Volume: 73-04, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 138-165). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Wu Min. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 87-114). / Abstracts in English and Chinese. / Declaration --- p.i / Acknowledgement --- p.ii / Publication list --- p.iii / Abstract (English) --- p.xi / Abstract (Chinese) --- p.xiv / Abbreviations --- p.xvi / List of figures / tables --- p.xviii / Chapter Chapter 1. --- General Introduction --- p.1 / Chapter 1.1 --- Endothelial function in the regulation of vascular tone --- p.1 / Chapter 1.1.1 --- NO --- p.2 / Chapter 1.1.2 --- PGI2 --- p.5 / Chapter 1.1.3 --- EDHF --- p.6 / Chapter 1.2 --- Alteration of endothelial functions after preservation with cardioplegia /organ preservation solutions in the coronary and pulmonary microcirculations --- p.18 / Chapter 1.2.1 --- Cardioplegia/organ preservation solutions --- p.21 / Chapter 1.2.2 --- Effect of Cardioplegia/organ preservation solutions on endothelial function --- p.22 / Chapter 1.2.2.1 --- Effect of K+ on endothelial function --- p.23 / Chapter 1.2.2.2 --- Effect of other components on endothelial function --- p.24 / Chapter Chapter 2. --- Materials and Methods --- p.26 / Chapter 2.1 --- Isometric force study in coronary/pulmonary resistance arteries --- p.26 / Chapter 2.1.1 --- Preparation of vessels --- p.26 / Chapter 2.1.1.1 --- Preparation of porcine coronary small arteries --- p.26 / Chapter 2.1.1.2 --- Preparation of porcine pulmonary small arteries --- p.26 / Chapter 2.1.2 --- Technique of setting up --- p.29 / Chapter 2.1.2.1 --- Mounting of small vessels --- p.29 / Chapter 2.1.2.2 --- Normalization procedure for small vessels --- p.29 / Chapter 2.1.3 --- EDHF-mediated vasorelaxation --- p.30 / Chapter 2.1.3.1 --- Precontraction and stimuli of EDHF --- p.30 / Chapter 2.1.3.2 --- """True"" response of EDHF" --- p.31 / Chapter 2.1.4 --- Data acquisition and analysis --- p.32 / Chapter 2.2 --- Electrophysiological study --- p.32 / Chapter 2.2.1 --- Preparation of small porcine coronary/pulmonary arteries --- p.32 / Chapter 2.2.2 --- Preparation of microelectrode --- p.32 / Chapter 2.2.3 --- Impaling of microelectrode --- p.33 / Chapter 2.2.4 --- Recording of membrane potential --- p.33 / Chapter 2.3 --- Statistical analysis --- p.34 / Chapter 2.4 --- Chemicals --- p.34 / Chapter Chapter 3. --- Effects of Celsior Solution on Endothelial Function in Resistance Coronary Arteries Compared to St. Thomas' Hospital Solution --- p.37 / Chapter 3.1 --- Abstract --- p.37 / Chapter 3.2 --- Introduction --- p.38 / Chapter 3.3 --- Experimental design and analysis --- p.40 / Chapter 3.3.1 --- Vessel preparation --- p.40 / Chapter 3.3.2 --- Normalization --- p.40 / Chapter 3:3.3 --- "Relaxation study: BK-induced, EDHF-mediated relaxation" --- p.41 / Chapter 3.3.4 --- Cellular electrophysiological study: EDHF-mediated cellular hyperpolarization and associated relaxation --- p.41 / Chapter 3.3.5 --- Data analysis --- p.42 / Chapter 3.4 --- Results --- p.43 / Chapter 3.4.1 --- Relaxation study --- p.43 / Chapter 3.4.1.1 --- Resting force --- p.43 / Chapter 3.4.1.2 --- U46619-induced precontraction --- p.43 / Chapter 3.4.1.3 --- EDHF-mediated relaxation --- p.43 / Chapter 3.4.2 --- Electrophysiological studies --- p.44 / Chapter 3.4.2.1 --- Resting membrane potential --- p.44 / Chapter 3.4.2.2 --- EDHF-mediated cellular hyperpolarization --- p.45 / Chapter 3.4.2.3 --- Cellular hyperpolarization-associated relaxation --- p.45 / Chapter 3.5 --- Discussion --- p.46 / Chapter 3.5.1 --- Effects of Celsior solution on endothelial function --- p.47 / Chapter 3.5.2 --- Effects of ST solution on EDHF-mediated function --- p.48 / Chapter 3.5.3 --- Comparison between Celsior and ST solutions on EDHF-mediated function --- p.48 / Chapter 3.5.4 --- Clinical implications --- p.49 / Chapter Chapter 4. --- Effects of Perfadex and Celsior Solution on Endothelial Function in Resistance Pulmonary Arteries --- p.57 / Chapter 4.1 --- Abstract --- p.57 / Chapter 4.2 --- Introduction --- p.58 / Chapter 4.3 --- Experimental design and analysis --- p.59 / Chapter 4.3.1 --- Vessel Preparation --- p.59 / Chapter 4.3.2 --- Normalization --- p.60 / Chapter 4.3.3 --- Isometric force study --- p.60 / Chapter 4.3.4 --- Electrophysiological studies --- p.61 / Chapter 4.3.5 --- Data analysis --- p.61 / Chapter 4.4 --- Results --- p.62 / Chapter 4.4.1 --- Relaxation study: EDHF-mediated relaxation --- p.62 / Chapter 4.4.1.1 --- Resting force --- p.62 / Chapter 4.4.1.2 --- U46619-induced precontraction --- p.62 / Chapter 4.4.1.3 --- EDHF-mediated relaxation --- p.62 / Chapter 4.4.2 --- Electrophysiological studies --- p.63 / Chapter 4.4.2.1 --- Resting membrane potential --- p.63 / Chapter 4.4.2.2 --- EDHF-mediated cellular hyperpolarization --- p.64 / Chapter 4.4.2.3 --- Cellular hyperpolarization-associated relaxation --- p.64 / Chapter 4.5 --- Discussion --- p.65 / Chapter 4.5.1 --- Effects of Celsior solution on endothelial function during cardiopulmonary surgery --- p.65 / Chapter 4.5.2 --- Effects of Perfadex solution on EDHF-mediated endothelial function --- p.66 / Chapter 4.5.3 --- Comparison between Celsior and Perfadex solutions on EDHF-mediated function --- p.66 / Chapter 4.5.4 --- Clinical implications --- p.67 / Chapter Chapter 5. --- Exploration of the Nature of EDHF - the Effect of H2O2 on the Membrane Potential in the Rat Small Mesenteric Arteries --- p.73 / Chapter Chapter 6. --- General Discussion --- p.75 / Chapter 6.1 --- EDHF-mediated endothelial function in porcine coronary and pulmonary circulation --- p.75 / Chapter 6.1.1 --- Role of EDHF in the regulation of porcine coronary arterial tone --- p.75 / Chapter 6.1.2 --- Role of EDHF in the regulation of porcine pulmonary arterial tone --- p.76 / Chapter 6.2 --- Alteration of EDHF-mediated endothelial functions after exposure to organ preservation solutions --- p.77 / Chapter 6.2.1 --- Effects of hyperkalemic solution on EDHF-mediated endothelial function in coronary and pulmonary circulation --- p.78 / Chapter 6.2.2 --- Effects of low-potassium-based preservation solution on EDHF-mediated endothelial function in pulmonary circulation --- p.79 / Chapter 6.2.3 --- Comparison between hyperkalemic solution and low-potassium-based preservation solution on EDHF-mediated endothelial function --- p.80 / Chapter 6.2.4 --- Effects of other component of organ preservation solutions on EDHF-mediated endothelial function --- p.81 / Chapter 6.3 --- Clinical implications --- p.82 / Chapter 6.4 --- The effect of H202 on the membrane potential in rat small mesenteric arteries --- p.83 / Chapter 6.5 --- Limitation of the study --- p.84 / Chapter 6.6 --- Future investigations --- p.85 / Chapter 6.7 --- Conclusions --- p.85 / References --- p.87

Pacientes sépticos podem evoluir para choque séptico, destes 40% sobrevivem. Caracterizamos o modelo experimental, avaliamos fatores envolvidos na inflamação e avaliamos a modulação causada por purinas (ATP/ADP) na quantificação de superóxido (O2-) e na reatividade vascular da aorta isolada. Os resultados sugerem que na aorta isolada de animais endotoxêmicos, ATP e ADP aumentam a síntese de óxido nítrico (NO), porém somente o ATP reduz a biodisponibilidade de O2-, provavelmente pelo reacoplamento da NO sintase endotelial / Septic patients can evolve for septic shock and 40% of these survive. We characterize the experimental model we evaluate involved factors in the inflammation and evaluate the modulation caused by purines (ATP/ADP) in the superoxide quantification (O2-) and in the vascular reactivity of isolated aorta. The results suggest that in isolated aorta of endotoxemics rats, ATP and ADP increase the endothelial nitric oxide synthase (NOS) however just ATP reduces the bio availability of O2-, probably for the re-couples of the endothelial NOS synthase

Introdução: A hipertensão arterial sistêmica (HA) pode estar associada à diminuição na produção e liberação do óxido nítrico derivado do endotélio (NO). O uso do sildenafil leva ao aumento de monofosfato de guanosina cíclica (GMPc), um importante mediador de NO. Contudo, pouco se sabe sobre os efeitos da inibição da fosfodiesterase tipo 5 (PDE5) na monitorização da pressão arterial 24-h (MAPA), pressão arterial durante exercício, noraepinefrina (Nor) e capacidade ao exercício, principalmente após transplante de coração (TX). Métodos: Nós estudamos 22 pacientes pós TX, os quais foram randomizados, tomando dose única de sildenafil (50mg) ou placebo (50mg), aproximadamente uma hora antes de iniciar o protocolo. No dia 1, os pacientes realizaram avaliação clínica, teste cardiopulmonar de caminhada de seis minutos (TES) seguido de teste de esforço cardiopulmonar (TE), Após o término dos testes em esteira, foi colocado o MAPA. Determinamos em repouso (rep), último minuto do TES (6) e pico do TE (Ex): FC (bpm) PAS e PAD (mmHg), VO2(ml/kg/min), Slope VE/VCO2, tempo de exercício (TE, min), distância (TES, Km) e Nor (pg/ml). No dia 2 o protocolo foi repetido, realizando-se o cross-over. Dezessete pacientes apresentavam HA. Resultados: (Pl e Sil respectivamente), Sil reduziu (p<0.05): PAS-rep(138±7 vs 122±18); PAD-rep(83±12 vs 78±12); PAS-6(156± 20 vs 137± 22); PAD-6(82±13 vs 77±14); PAS-Ex(155± 27vs 124±36); PAD-Ex(79±16 vs 66± 16); PAS 24-h(121±10 vs 114±9), PAD 24-h(80±6 vs 76±5), PAS vigília(122±11 vs 115±9), PAD vigília(81± 6 vs 76±5) e PAS noturna(119±12 vs 112±10), PAD noturna(78±7 vs 73±8); e aumentou Nor-repouso(483±165 vs 622±211). Sil não alterou rep, 6 e EX: FC, VO2 e Slope. Conclusão: O ciclo NO-cGMP parece desempenhar papel importante no controle da pressão arterial em TX. Sendo que, a inibição da PDE5 parece apresentar efeitos benéficos no controle da hipertensão arterial em TX, podendo ser utilizada concomitantemente a terapia anti-hipertensiva usual. / Background: Systemic hypertension (SH) can be associated with a decrease in endothelium-dependent nitric oxide (NO). Sildenafil determines increment in cyclic guanosine monophosphate (cGMP) that a mediator of NO. However, little is known about the effects of PDE5 inhibition on 24-hour ambulatory (ABP) and exercise blood pressure, noreprinephrine (Nor) and exercise capacity, specially after heart transplantation (HT). Methods: We studied 22 HT pts that on the 1st day underwent a cardiopulmonary (CP) self-controlled treadmill 6walk test(6) and, after, an ECG monitored CP treadmill maximal exercise test(Ex) within 60 and 90 min after oral Sildenafil (Sil,50mg) or placebo(Pl) given at random, and ABP. We determined at basal position(b), last min of 6 and the peak Ex the HR(bpm), SBP and DBP (mmHg), VO2(ml/kg/min), Slope VE/VCO2, exercise time(ET, min), distance(D, Km) and Nor(pg/ml). Also, after CP tests 24-h SBP and DBP were monitored. It was repeated on the 2nd day when the cross-over was done. Seventeen pts had SH. Results: (Pl and Sil respectively), Sil reduced (p<0.05): b- SBP(138±7 vs 122±18); b-DBP(83±12 vs 78±12); 6-SBP(156± 20 vs 137± 22); 6-DBP(82±13 vs 77±14); Ex-SBP(155± 27vs 124±36); Ex-DBP(79±16 vs 66± 16); 24-h SBP(121±10 vs 114±9) and DBP(80±6 vs 76±5), daytime SBP(122±11 vs 115±9) and DBP(81± 6 vs 76±5) and nighttime SBP(119±12 vs 112±10) and DBP(78±7 vs 73±8); and increase b-Nor(483±165 vs 622±211). Sil did not change in b, 6 and EX; HR, Nor, VO2 and Slope. Conclusion: NO-cGMP pathway seems to play a role in blood pressure control in HT. The PDE5 inhibition could have potential beneficial effects on hypertensive HT in addition to antihypertensive therapy.