Made available in DSpace on 2014-06-11T19:35:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-01-31Bitstream added on 2014-06-13T20:07:09Z : No. of bitstreams: 1 rodrigues_mah_dr_botfm.pdf: 812559 bytes, checksum: 1b370f38ddce90d421297e38a1119fbd (MD5) / Avaliar marcadores clínicos e inflamatórios na doença hepática gordurosa não alcoólica (DHGNA) em mulheres na pós-menopausa com síndrome metabólica (SM). Estudo transversal, comparativo, envolvendo 180 mulheres na pósmenopausa (idade ≥45 anos e amenorréia ≥ 12 meses) acompanhada no Ambulatório de Climatério do Centro de Especialidades Médicas do Hospital Santa Casa de Belo Horizonte/Minas Gerais, de janeiro de 2011 a agosto de 2012. Os critérios de não inclusão foram: doença hepática (hepatites B e C, doença colestática, insuficiência hepática e tumor); uso de drogas que afetam o metabolismo hepático; etilistas; antecedente de HIV ou câncer; e obesidade mórbida. Foi diagnosticada SM na presença de três ou mais critérios: circunferência da cintura (CC) > 88cm; triglicerídeos (TG) ≥ 150mg/dL; HDL < 50mg/dL; pressão arterial ≥ 130/85mmHg; glicemia ≥ 100mg/dL. A DHGNA foi diagnosticada por meio da ultrassonografia abdominal. As participantes foram divididas em três grupos de acordo com a presença ou ausência de SM e/ou DHGNA: SM isolada (n=53); SM+DHGNA (n=67); sem SM ou DHGNA (controle, n=60). Foram realizadas avaliações clínicas, antropométricas e bioquímicas. O perfil inflamatório incluiu dosagens de adiponectina, interleucina-6 (IL-6) e fator de necrose tumoral alfa (TNF-α). Para análise estatística foram empregados os testes de Tukey, ANOVA, Qui-Quadrado, Correlação de Pearson e regressão logística (odds ratio-OR). As mulheres com SM+DHGNA mostraram-se obesas e com maior CC quando comparadas as mulheres com SM e controle (p<0.05). Assim como, apresentaram valores médios de glicemia e insulina superiores aos demais grupos, com resistência à insulina (RI) (p<0.05). Observou-se elevação dos valores médios de IL-6 e TNF-α e redução da adiponectina entre as mulheres com SM isolada ou associada... / to assess clinical and inflammatory markers in non-alcoholic fatty liver disease (NAFLD) in postmenopausal women with metabolic syndrome (MetS). In this cross-sectional study, 180 women (age ≥45 years and amenorrhea ≥ 12 months) followed the Belo Horizonte Specialty Clinic from January 2011 to August 2012, were included. Exclusion criteria were: liver disease (hepatitis B and C, cholestatic disease, liver insufficiency and tumor); use of drugs that affect the liver metabolism; alcoholics; HIV or cancer history; and morbid obesity. MetS was diagnosed as the presence of at least three components: waist circumference (WC) > 88 cm, triglycerides (TG) ≥ 150mg/dL, HDL <50mg/dL; blood pressure (BP) ≥ 130/85mmHg; glucose ≥ 100mg/dL. NAFLD was diagnosed by abdominal ultrasound. The participants were divided into three groups according to the presence or absence of MetS and/or NAFLD: MetS alone (n=53); MetS+NAFLD (n=67); or without NAFLD or MetS (controls, n=60). Clinic, anthropometric, and biochemical variables were measured. Inflammatory profile included adiponectin, interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α). Statistical analysis employed the ANOVA, Tukey test, Chi-square test, Pearson correlation, and logistic regression (odds ratio, OR). Women with MetS + NAFLD showed obesity, greater WC, higher glucose and insulin levels, with insulin resistance (IR) when compared to MetS alone and controls (p <0.05). Elevated values of IL-6 and TNF-α were observed as well as decreased adiponectin among women with MetS alone or MetS+NAFLD when compared to controls (p <0.05). In multivariate analysis, the variables considered at risk for the development...(Complet abstract click electronic access below)

Made available in DSpace on 2015-06-17T19:34:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-10-03. Added 1 bitstream(s) on 2015-06-18T12:48:58Z : No. of bitstreams: 1 000831358.pdf: 440427 bytes, checksum: 614119cd43a68e503ea6c263f3fbaf2c (MD5) / Objetivo: avaliar os fatores de risco para baixa densidade mineral óssea (DMO) em mulheres na pós-menopausa tratadas de câncer de mama comparadas a mulheres na pós-menopausa sem câncer de mama. Métodos: Realizou-se estudo transversal, com 112 mulheres tratadas de câncer de mama comparadas a 224 mulheres na pós-menopausa (controle), atendidas em Hospital Universitário. Foram incluídas no grupo de estudo mulheres com amenorréia ≥12 meses e idade ≥45 anos, tratadas de câncer de mama e livre de doença há pelo menos cinco anos. O grupo controle foi constituído de mulheres com amenorréia ≥12 meses e idade ≥45 anos sem câncer de mama, pareadas pela idade e tempo de menopausa, na proporção 1:2. Por meio de entrevista foram avaliados fatores de risco para baixa DMO (osteopenia e osteoporose). A DMO foi mensurada pela absorciometria de raios-X de dupla energia (DEXA) em coluna lombar (L1 a L4) e colo de fêmur. Regressão logística (odds ratio-OR) foi utilizada para identificar fatores associados à baixa DMO. Resultados: A média de idade das pacientes tratadas de câncer de mama foi de 61.3 ± 9.7 anos com tempo médio de seguimento de 10.2 ± 3.9 anos. Considerando ambos os sítios avaliados (coluna e colo de fêmur), 77.7% das mulheres tratadas de câncer de mama e 74.5% do grupo controle apresentavam baixa DMO (p=0.302). Na avaliação isolada da DMO em coluna lombar não houve diferença entre os grupos (p=0.332). Contudo, na DMO de colo de fêmur, as pacientes com câncer de mama apresentaram maior ocorrência de osteopenia (45.1%) e osteoporose (22.3%) quando comparadas ao controle (39.3% e 9.0%, respectivamente) (p=0.0005). Avaliando os fatores de risco para baixa DMO entre as mulheres com câncer de mama encontrou-se que quimioterapia prévia associou-se com aumento no risco (OR 6.90; IC 95% 5.57-9.77), enquanto que exercício físico regular (OR 0.24; IC 95% 0.06-0.98) e índice de massa corpórea (IMC) ≥ 30 kg/m2 ... / Objective: To evaluate the risk factors for low bone mineral density (BMD) in postmenopausal breast cancer survivors compared to postmenopausal women without breast cancer. Methods: In this cross-sectional study, 112 breast cancer survivors were compared to 224 postmenopausal women (control), seeking healthcare at a University Hospital. Eligibility criteria included women with amenorrhea ≥ 12 months and age ≥ 45 years, treated for breast cancer and metastasis-free for at least five years. The control group consisted of women with amenorrhea ≥ 12 months, age ≥ 45 years and without breast cancer, matched by age and menopause status (in a proportion of 1:2 as sample calculation). The risk factors for low BMD (osteopenia and osteoporosis) were assessed by interviews. BMD was measured by dual energy X-ray absorptiometry (DEXA) at the lumbar spine (L1-L4) and femoral neck. Logistic regression model (odds ratio, OR) was used to identify factors associated with low BMD. Results: The mean (SD) age of breast cancer survivors was 61.3 (9.7) years, with a mean (SD) follow-up of 10.2 (3.9) years. Considering both sites assessed (spine and femoral neck), 77.7% of breast cancer survivors and 74.5% in the control group had low BMD (p = 0.302). The BMD at the lumbar spine did not differ between groups (p = 0.332). However, breast cancer survivors had a higher incidence of osteopenia (45.1%) and osteoporosis (22.3%) in the BMD at the femoral neck when compared to control (39.3% and 9.0%, respectively) (p = 0.0005). Univariate analyses, adjusted for age and time since menopause, revealed that chemotherapy (OR 6.90; CI 95% 5.57-9.77) was associated with higher risk for low BMD. Contrarily, regular physical exercise (OR 0.24; 95%CI 0.06-0.98) and body mass index (BMI) ≥ 30 kg/m2 (OR 0.09; 95% CI 0.02-0.37) reduced risk among breast cancer survivors. Smoking, use of hormone therapy, tamoxifen or anastrozole, history of fracture, rheumatoid ...

Made available in DSpace on 2015-06-17T19:34:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-05-22. Added 1 bitstream(s) on 2015-06-18T12:48:58Z : No. of bitstreams: 1 000825585.pdf: 1689621 bytes, checksum: 2ae56c6bf0599af95c9d0407ae9610f8 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Objetivo: Avaliar o efeito da suplementação isolada de vitamina D (VD) sobre a ocorrência de quedas e o equilíbrio postural em mulheres na pós-menopausa com histórico de quedas. Métodos: Foi conduzido ensaio clínico, duplo-cego, placebo-controlado envolvendo 160 mulheres, idade 50-65anos, amenorréia ≥12 meses, com histórico de quedas. As participantes foram randomizadas em dois grupos: VD 1000UI/dia via oral (n=80) ou placebo (n=80). O tempo de intervenção foi nove meses, com avaliações nos momentos, inicial e final. Foram avaliados: o equilíbrio pela estabilometria (plataforma de força computadorizada), a massa muscular pela densitometria de corpo total, e a força muscular pelo teste de pressão manual e teste do agachamento. Os valores séricos de 25(OH)D foram mensurados por HPLC. A análise estatística foi por intenção de tratamento (ITT), empregando-se ANOVA, Qui-Quadrado e Regressão Logística. Resultados: Após nove meses, valores médios de 25(OH)D aumentaram de 15,0±7,5 ng/ml para 27,5±10,4 ng/ml (+45.4%) no grupo VD, e diminuíram de 16,9±6,7 ng/ml para 13,8±6,0 ng/ml (-18.5%) no placebo (p<0.001). A ocorrência de quedas foi maior no grupo placebo (+46.3%) com risco ajustado de 1,95 (IC 95% 1,23-3,08) vezes maior de quedas e 2,80 (IC95% 1,43-5,50) vezes maior de quedas recorrentes quando comparado ao grupo VD (p<0.001). Observou-se redução da oscilação corporal pela estabilometria, com menor amplitude ântero-posterior (-35.5%) e latero-lateral (-37.0%) (p<0.001); e aumento da força muscular (+45.5%) pelo teste do agachamento (p=0.036) apenas no grupo VD. Nas mulheres do grupo placebo houve redução (-5.8%) na massa muscular (p=0.030). Conclusão: Em mulheres na pós-menopausa com histórico de quedas, a suplementação isolada de vitamina D repercutiu em menor ocorrência de quedas e melhora no equilíbrio postural e na força muscular / Objective: to evaluate the effect of isolated vitamin D (VitD) supplementation on the rate of falls and the postural balance in fallers postmenopausal women. Methods: In this double-blind placebo controlled trial 160 women with age 50-65 years, amenorrhea ≥ 12 months and history of falls were included. Participants were allocated at random to receive either 1,000UI VitD /day orally (n = 80) or placebo (n = 80). The intervention time was 9 months, with assessments at initial and final moments. Postural balance was assessed by stabilometry (computerized force platform). Muscle mass was estimated by Total-body DEXA and muscle strength by handgrip strength and chair-rising test. Serum levels of 25-hydroxyvitamin D [25(OH)D] were measured by HPLC. Data were analyzed according to intention-to-treat, using ANOVA, chi-square and logistic regression. Results: After 9 months, mean 25(OH)D levels increased from 15.0±7.5 ng/ml to 27.5±10.4 ng/ml (+45.4%) in the VitD group whereas decreased from 16.9±6.7 ng/ml to 13.8±6.0 ng/ml (-18.5%) in the placebo group (p<.001). The rate of fall was higher in the placebo (+46.3%, p<.001), that presented an adjusted risk of 1.9 (CI 95% 1.23-3.08) times higher of falls and 2.80 (CI 95% 1.43-5.50) times higher of recurrent falls than the VitD group. There was reduction in body sway by stabilometry, with lower amplitude of anteroposterior (-35.5%) and laterolateral (-37.0%) oscillation, only in the VitD group (p<.001). In this group, there was significant increased in muscle strength of the lower limbs by chair-rising test (+45.5%, p=0.036). Women in the placebo group presented significant reduction in the muscle mass (-5.8%) (p=0.030). Conclusion: Fallers postmenopausal women with isolated vitamin D supplementation had a lower rate of falls and improvement in postural balance and muscle strength / CAPES: 75807-3 / FAPESP: 2009/1444-1

Submitted by ENEIDA MARIA BOTEON SCHMITT null (eneidaboteon@gmail.com) on 2017-04-18T01:43:01Z No. of bitstreams: 1 dissertação final CD 2.pdf: 3225893 bytes, checksum: eb3e8776a9678d7f5dc7947fd43d1f7b (MD5) / Approved for entry into archive by Luiz Galeffi (luizgaleffi@gmail.com) on 2017-04-18T18:34:56Z (GMT) No. of bitstreams: 1 schmitt_emb_me_bot.pdf: 3225893 bytes, checksum: eb3e8776a9678d7f5dc7947fd43d1f7b (MD5) / Made available in DSpace on 2017-04-18T18:34:56Z (GMT). No. of bitstreams: 1 schmitt_emb_me_bot.pdf: 3225893 bytes, checksum: eb3e8776a9678d7f5dc7947fd43d1f7b (MD5) Previous issue date: 2017-02-21 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Objetivo: avaliar a associação entre deficiência de vitamina D e os marcadores de risco para síndrome metabólica (SM) em mulheres na pós-menopausa. Métodos: Realizou-se estudo clínico de corte transversal com 466 mulheres, idade entre 45-75 anos, atendidas em Hospital Universitário. Foram incluídas mulheres em amenorréia >12 meses e idade ≥ 45 anos, sem uso de medicações ou condições clínicas que interfiram nos valores da vitamina D e sem doença cardiovascular estabelecida. Foram coletados dados clínicos, antropométricos e laboratoriais [colesterol total (CT), HDL, LDL, triglicerídeos (TG), glicose, insulina e 25(OH) vitamina D]. Foram consideradas com SM as mulheres que apresentaram três ou mais critérios diagnósticos: circunferência da cintura (CC) > 88 cm; TG  150 mg/dL; HDL colesterol < 50 mg/dL; pressão arterial  130/85 mmHg; glicose  100 mg/dL. Foi considerada deficiência de vitamina D valores séricos de 25(OH)D < 30ng/mL. Para análise estatística foram empregados o teste t-student, a Distribuição Gama (variáveis assimétricas), teste do Qui-quadrado e a regressão logística (odds ratio-OR). Resultados: Valores suficientes de vitamina D foram detectados em 148 pacientes (31,8%) e deficientes em 318 pacientes (68,2%). As mulheres com baixos valores séricos de 25(OH)D eram mais velhas, com maior tempo de menopausa e apresentavam maiores valores de colesterol total, triglicerídeos, insulina e HOMA-IR (p<0.05). A SM foi diagnosticada em 57,9% (184/318) das mulheres com hipovitaminose D e em 39,8% (59/148) com valores de 25(OH)D suficientes (p=0.003). Na análise de risco ajustado para idade, tempo de menopausa e índice de massa corpórea, as pacientes com deficiência de vitamina D apresentaram maior risco para ocorrência da síndrome metabólica (OR 1.90; IC 95% 1.26-2.85), hipertrigliceridemia (OR 1.55; IC 95% 1.13-2.35) e HDL abaixo do desejável (OR 1.60; IC 95% 1.19-2.40) (p<0.05). Observou-se que a concentração média de 25(OH) D diminuiu de acordo com o aumento do número de componentes da SM (p=0.016). Conclusão: Em mulheres na pós-menopausa observou-se associação entre a hipovitaminose D e a síndrome metabólica. Em relação às mulheres com valores adequados de vitamina D, aquelas com deficiência apresentaram maior risco para ocorrência da síndrome metabólica, hipertrigliceridemia e baixos valores de HDL. / Objective: to evaluate the association between vitamin D deficiency and risk markers for metabolic syndrome (MetS) in postmenopausal women. Methods: An analytical cross sectional study was conducted with 466 women, aged 45-75 years, attended at University Hospital. Women in amenorrhea >12 months and age >45 years, without medication use or clinical conditions that interfere with vitamin D values, and without established cardiovascular disease were included. Clinical and anthropometric data were collected. Laboratory parameters, including total cholesterol, HDL, LDL, triglycerides (TG), glucose, insulin and 25 (OH) vitamin D were measured. Women showing three or more diagnostic criteria were diagnosed as having MetS: waist circumference > 88 cm, TG ≥ 150 mg/dL, HDL cholesterol <50 mg/dL, blood pressure  130/85 mmHg, glucose  100 mg/dL. Serum values of 25 (OH) D <30ng / mL were considered as vitamin D deficiency. For statistical analysis, the t-student test, the Gamma Distribution (asymmetric variables), the chi-square test and the logistic regression (OR-odds ratio) were used. Results: Sufficient vitamin D values were detected in 148 patients (31.8%) and deficiency in 318 patients (68.2%). Women with low serum 25 (OH) D levels were older, with a longer time since menopause, and had higher total cholesterol, TG, insulin and HOMA-IR levels (p <0.05). MetS was detected in 57.9% (184/318) of women with hypovitaminosis D and 39.8% (59/148) of those with sufficient 25 (OH) D values (p = 0.003). In the multivariate logistic regression analysis, the lowest 25(OH)D level (<30 ng/mL) was significantly associated with MetS (OR 1.90, 95% CI 1.26-2.85), high triglycerides (OR 1.55, 95% CI 1.13 -2.35) and low HDL (OR 1.60, 95% CI 1.19-2.40) (p <0.05), compared with 25(OH)D levels ≥30 ng/mL after adjusting for age, time since menopausa and body mass index. It was observed that the mean concentration of 25 (OH) D decreased according to the increase in the number of components of MetS (p = 0.016). Conclusions: Vitamin D deficiency in postmenopausal women was associated with higher prevalence of metabolic syndrome. Compared to women with adequate vitamin D levels, those with deficiency had a higher risk of metabolic syndrome, hypertriglyceridemia and low HDL values. / FAPESP: 2014/19832-3

Orientador: Eliana Cotta de Faria / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T18:07:22Z (GMT). No. of bitstreams: 1 Castanho_VeraSylvia_D.pdf: 1545828 bytes, checksum: e5e99c4b305a273ca51cb37d76941541 (MD5) Previous issue date: 2008 / Resumo: Esta tese envolveu estudos com 287 mulheres, 69 não menopausadas e 218 pós-menopausadas; destas 84 em e 124 sem terapia de reposição hormonal (TRH), todas atendidas em hospitais públicos da Universidade Estadual de Campinas, Estado de São Paulo. As voluntárias foram recrutadas junto aos ambulatórios de dislipidemias (n=193), do Hospital das Clínicas Unicamp, e do ambulatório de menopausa (n=94), do CAISM/Unicamp. Seu intervalo de idades foi de 20 a 82 anos. As pós-menopausadas apresentavam idade acima de 40 anos e amenorréia por período superior a um ano. O grupo em terapia de reposição hormonal foi subdividido de acordo com o tipo de TRH em 2 subgrupos: pacientes em uso de estrógenos isoladamente (0.625mg/dia, n=48) ou pacientes em reposição hormonal combinada com acetato de medroxiprogesterona, (2,5mg/dia, 10% e 5mg/dia, 90%, n=36), por no mínimo um ano. Caracterizaram a metodologia a definição da menopausa, através do preenchimento de questionário sobre o tempo de amenorréia natural, a determinação do uso e tipo de terapia de reposição hormonal por meio de entrevistas, seguidas de exame médico clínico. Foi objetivo a determinação dos efeitos do uso da terapia de reposição hormonal oral no período pós-menopausal, estrogênica ou estrogênica associada à progestágenos sobre diversos marcadores séricos de oxidação no plasma. Como evento ponto-final da aterosclerose precoce determinou-se os efeitos da menopausa e da menopausa tratada com reposição hormonal sobre a aterosclerose precoce carotidiana e sua regulação metabólica. A abordagem de efeitos metabólicos da TRH foi realizada com a determinação após uso da terapia de reposição hormonal oral das atividades de proteínas reguladoras do metabolismo das lipoproteínas plasmáticas: a lípase hepática, a lipoproteína lipase, a proteína de transferência de colesteril-éster e a proteína de transferência de fosfolípides. Foram analisados também os seguintes parâmetros: colesterol, não HDL colesterol (NHDLcol), colesterol de lipoproteínas de alta densidade (HDLcol), colesterol de lipoproteínas de baixa densidade (LDLcol), triglicérides (TG), apolipoproteínas (AI e B 100), lipoproteína (a) Lp(a), autoanticorpos anti-LDL oxidada, anticorpos anti-epítopos proteicos da apolipoproteína B oxidada (anti-D, anti-D2 e anti-A); atividades das proteínas de transferência de colesteril-éster (CETP) e de fosfolípides (PLTP), da lipase hepática (LH), da lipoproteína lipase (LPL), a atividade séricas da catalase, determinação do nitrato, substâncias reativas ao ácido tiobarbitúrico (TBARS) e PCR séricos. O parâmetro radiológico medido foi o espessamento íntimo-médio da camada carotídiana (EIM) das artérias carótidas comuns direita e esquerda (ultra-sonografia Doppler). A análise estatística dos dados foi realizada através do programa SAS. Procedeu-se à correções para idade e IMC, quando indicado. A analise de regressão linear múltipla foi utilizada para acessar a influência dos diversos parâmetros bioquímicos e antropométricos sobre a EIM carotídea. Foram observados vários efeitos bioquímicos e antropométricos pró-aterogênicos da menopausa: aumento do EIM, do IMC, da medida da cintura e títulos de autoanticorpos anti-LDL oxidada e anti-D. A terapia de reposição hormonal apresentou efeitos modificadores benéficos reduzindo a lipase hepática (maior magnitude com a terapia conjugada), aumento de HDLcol, redução de autoanticorpos anti-D2 e aumento da concentração da catalase, (maior magnitude na terapia combinada). Outros marcadores de estresse oxidativo os nitratos, as substancias reativas ao ácido tiobarbitúrico e os lipoperóxidos não se modificaram com a TRH. Nas análises multivariadas a TRH conjugada e estrogênica modulou a EIM através de três fatores: via triglicérides, CETP (negativo) e lipoperóxidos (ao contrário do grupo sem TRH, com sete fatores de regulação); a terapia estrogênica atuou apenas via TG. Houve influência positiva do tratamento sobre a regulação positiva pela PCR a qual desapareceu. Este estudo reitera o risco aumentado para a doença cardiovascular (DCV) pelo aumento de um conjunto de fatores de risco na mulher em pós-menopausa, fato já demonstrado em estudos prévios. A TRH foi benéfica do ponto de vista de melhora do perfil de lípides. Modificou favoravelmente a lípase hepática aumentando o colesterol da HDL, lipoproteína anti-aterogênica. A redução de autoanticorpos contra a oxidação apoproteica B100 e o aumento da atividade sérica da catalase demonstram capacidade antioxidante maior e dredução do estersse oxidativo plasmático. Não menos importante e apesar do efeito ter sido insuficiente amostra populacional para alterar a EIM, a TRH modificou a modulação da aterosclerose precoce no sentido de maior ateroproteção / Abstract: This thesis was composed of studies conducted on 287 women: pre menopausal (69) and post (218); the last with (n=84, WHRT) and without (n=134, WTRT) hormone replacement therapy (HRT), attended at the UNICAMP university hospitals, São Paulo state. The volunteers were recruited from Hospital de Clínicas (n=193) and CAISM hospital (n=94). They aged from 20 to 82 years (y). Postmenopausal women were 40y old and above and presented amenorrhea for at least 1 year. WHRT women were subdivided in 2 groups: one using conjugated estrogens (0.625mg/day, n=48) or estrogen associated with medroxyprogesterone acetate (2.5, 10% of all or 5mg/day 90% of all, n=36). The methodology was characterized by the menopause definition and through questionnaires and a clinical exam. The objective of this study was to verify if HRT, estrogenic or combined, modified plasmatic oxidative markers. The end-point for atherosclerosis was the measurement of common carotid intima-media thickness (IMT), as well as its metabolic regulation. The study also dtermined the activities of several proteins of lipid metabolism: lipoprotein lipase, hepatic lipase, cholesteryl ester and phospholipid transfer protein under HRT estrogenic or combined. ELISA, nephelometric, enzymatic and radiometric methods were used to determine several parameters: cholesterol, non HDL cholesterol (NHDLchol), HDL-cholesterol, LDL-cholesterol triglycerides (TG), apolipoproteins (AI e B 100), lipoprotein (a), Lp(a), autoantibodies against oxidized LDL, epitopes of oxidized apolipoprotein B100 (anti-D, anti-D2 e anti-A); activities of CETP, PLTP, HL LH and LPL, catalase, nitrates, TBARS, lipid peroxides, CRP. The radiologic common carotid intima-media thickness was done by Doppler ultrasound. The data were analyzed by the SAS statistical package. Multiple linear regression analyses were used to assess the influence of diverse biochemical markers on carotid IMT. In this study several postmenopausal anthropometric and biochemical effects were pro-atherogenic: increases in IMT, BMI (body mass index), WC (waist circumference), antibodies against oxidized LDL and anti-apoD antibodies titers. HRT showed beneficial actions, decreasing HL activity, reducing anti-D2 antibody titers, increasing HDLchol and catalase activity. The nitrate concentration, TBARS and hydroperoxides showed no changes with HRT. HRT improved the women¿s lipid profiles but not ApoAI and B100. decreased hepatic lipase and increased HDLchol, an anti-atherogenic lipoprotein, reduced anti-D2 and increased catalase activity. Although HRT was insufficient to modify IMT, the multivariate analysis demonstrated that conjugated and estrogen HRT modulated IMT through triglycerides concentration, CETP (negative) and lipid peroxides a situation differently from non-treated women that presented 7 modulators; under estrogenic treatment only TG regulated IMT. As well the hormone treatment influenced favorably excluding the effects positive of CRP. This study reinforces the higher risk of CAD in post-menopausal women and the beneficial action of HRT by improving lipid profiles. It changed favorably HL, HDL-cholesterol, decreased antibodies against oxidized apoB100 and increased catalase activity indicating reduced oxidative stress; not less important are the results showing that HRT although not changing carotid IMT, modified beneficially the relationship of precocious atherosclerosis and its modulators suggesting an atheroprotective action / Doutorado / Patologia Clinica / Doutor em Ciências Médicas

The maintenance of inner ear fluids homeostasis and their biochemical integrity are essential for the well functioning of hearing and equilibrium. Alterations in women s hormonal levels during menstrual cycle, menopause, and pregnancy can cause inner ear homeostasis disorders and, thus, related hearing and vestibular symptoms. The aim of this research was to evaluate hearing and equilibrium in postmenopausal women. The participants were 27 postmenopausal women with ages ranging from 45 to 58 who were not or are not upon hormonal reposition. All of them were submitted to anamnesis, otorhinolaryngological examination, basic hearing evaluation, and vectoelectronystagmography. In relation to anamnesis, significant prevalence of symptoms as headache, insomnia, anxiety, and nausea was observed. The complaint of dizziness was observed in 66, 66 percent of the 27 participants, while the complaint of tinnitus was detected in 40,74 percent of them. As for hearing, 48,15 percent of the postmenopausal women presented alteration in their audiometric results, while in reference to equilibrium, 40,74 percent of them showed alterations in their vectoelectronystagmography results. So, from these results, it can be concluded that postmenopause women present complaints about dizziness and tinnitus as well as present some alterations in their hearing and equilibrium. / A manutenção da homeostase dos fluidos do ouvido interno e sua integridade bioquímica são essenciais para o bom funcionamento da audição e do equilíbrio. As alterações hormonais no organismo da mulher durante o ciclo menstrual, menopausa e gravidez podem provocar distúrbios nessa homeostase, gerando sintomas auditivos e labirínticos. Este estudo teve por objetivo avaliar a audição e o equilíbrio em mulheres na pós-menopausa. Participaram deste estudo 27 mulheres com idade variando de 45 à 58 anos, que se encontravam na pós-menopausa, que não fazem e não fizeram uso de reposição hormonal.Todas foram submetidas a anamnese, exame otorrinolaringológico, avaliação audiológica básica e avaliação vectoeletronistagmografica. Quanto aos resultados da anamnese, pode-se observar grande prevalência de sintomas como: cefaléia, insônia, ansiedade e enjôo. A queixa de tontura esteve presente em 66,66% das mulheres e a queixa de zumbido em 40,74%. Quanto à audição, 48,15% das mulheres apresentaram audiometria alterada e quanto ao equilíbrio, 40,74% apresentaram alteração na vecto-eletronistagmografia. Assim, através da análise dos dados pode-se concluir que a mulheres na pós-menopausa apresentam queixa clínica de tontura e zumbido e alterações na audição e no equilíbrio.

<div>Osteoporosis is the most common bone disease in older adults and is characterized by low bone mass and increased fragility. Women are at a higher risk for osteoporosis because of the rapid loss of bone during menopause. The decline of estrogen is accompanied by an increased bone resorption and a decreased bone formation which results in negative bone balance. Due to adverse effects on the uterus, breast and cardiovascular system, hormone replacement therapy has been discouraged. Nutritional strategies for osteoporosis prevention are being sought. It has been suggested that (poly)phenol-rich fruits may have bone protective effects. Blueberries are one of the richest sources of (poly)phenols, thus the aim of this dissertation was to determine whether a blueberry-enriched diet could aid in bone loss prevention in the ovariectomized rat model.</div><div><br></div><div>There are hundreds of blueberry varieties which differ in (poly)phenol profiles and content. Five blueberry varieties (Ira, Montgomery, SHF2B1-21:3, Onslow and Wild Blueberry) were chosen to assess the bioavailability of its individual (poly)phenols. Bioavailability of individual phenolic metabolites was determined through a pharmacokinetic study in ovariectomized rats. The results showed that Montgomery blueberry had significantly higher bioavailability of malvidin, cyanidin and myricetin metabolites, while Ira had significantly higher bioavailability of quercetin metabolites, thus suggesting that the absorption of blueberry polyphenols and their potential to reach target tissues differed between blueberry varieties.</div><div><br></div><div>It is important to assess what is the most appropriate dose of blueberry necessary to exert beneficial effects on bone. To determine the most adequate dose of wild blueberry to prevent bone loss in ovariectomized rats, a randomized crossover study was carried out to assess the effects of four different blueberry doses on net bone calcium retention over a 10-day treatment period. The results showed that the only dose to significantly increase net bone calcium retention by 25.6% (p = 0.0426) was the 5% blueberry diet (% w/w), while the higher doses of 10% and 15% had no effect on net bone calcium retention. This informed the last study where Montgomery blueberry and wild blueberry at a 5% dose (% w/w) were chosen to investigate the effects of an 8-week chronic feeding study on calcium metabolism, kinetics, bone microarchitecture and strength and polyphenol metabolism and distribution. A chronic consumption of the wild blueberry resulted in a trend towards minimal trabecular bone loss protection in comparison to the control diet (p=0.08). Kinetic modeling of calcium showed that the Montgomery blueberry had anabolic effects on bone through significantly increasing calcium absorption and bone deposition. The phenolic metabolism differed among blueberry varieties due to each berry’s polyphenol content and profiles and a chronic consumption of blueberry resulted in significant changes in absorption and metabolism of polyphenols. The bone marrow was investigated to determine whether there was any accumulation of phenolic acids in the tissue. Hippuric acid accumulation was significantly higher with the Montgomery blueberry treatments in comparison to control diet. Interestingly, hippuric acid content in the bone marrow was significantly and positively correlated with bone deposition calculated from kinetic modeling. Although no differences were observed on bone mineral density, strength, and microarchitecture, previous studies with a duration of 12-14 weeks have shown significant protection of a blueberry-enriched diet on bone mineral density. Because our study showed a trend for increased trabecular bone (p = 0.08) with the blueberry treatments, we conclude that an 8-week treatment was insufficient time to detect significant differences between the control and blueberry treatments. Since previous researchers before us have reported significant attenuation to bone loss immediately after OVX, it is possible that blueberry that in our study, blueberry was unable to rescue bone once lost after ovariectomy.<br></div><div><br></div><div>A blueberry-enriched diet resulted in a minimal protection to bone after stabilized to OVX, but showed significant increases in calcium absorption and bone turnover in ovariectomized rats. Colonic metabolite profiles from the chronic consumption of blueberry significantly changed over time, thus providing an insight into the effects of blueberry consumption on polyphenol metabolism.<br></div><div><br></div>

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京都大学 / 新制・課程博士 / 博士(医学) / 甲第23771号 / 医博第4817号 / 新制||医||1056(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 藤渕 航, 教授 阪上 優, 教授 小杉 眞司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM