A cirurgia de restauração circulatória arterial no paciente portador de isquemia crítica de membros inferiores apresenta indicações clínicas e técnica operatória já bastante estudadas e definidas. Ainda hoje, no entanto, um considerável número de enxertos evolui para oclusão. Entre as causas relacionadas à falência precoce, podemos destacar a resistência do leito distal receptor do enxerto. Interessou-nos estudar a existência de correlação hemodinâmica entre a Ecografia-Doppler, a Arteriografia pré-operatória, e medidas diretas intra-operatórias de resistência do leito arterial receptor do enxerto. Foram estudadas 68 operações de revascularização de membros inferiores portadores de isquemia crítica. A Ecografia-Doppler foi considerada tecnicamente satisfatória em 93,2%. Foi verificada a presença de correlação hemodinâmica positiva entre os métodos descritos acima (Teste de Pearson), particularmente para as artérias distais. Concluímos que a Ecografia-Doppler, além de definir as características anatômicas da artéria a ser revascularizada, pode auxiliar no estudo hemodinâmico do leito arterial receptor do enxerto e dessa forma auxiliar na definição do prognóstico do enxerto e no estabelecimento da melhor estratégia terapêutica a ser tomada ainda no período pré-operatório / The clinical indications and the surgical technique regarding arterial revascularization in patients with critical lower limb ischemia have been thoroughly studied and well determined in the literature. However, a considerable number of grafts evolutes to occlusion even nowadays. Among the factors known to contribute to early graft failure the resistance of the outflow arterial bed stands out. The purpose of this study is to verify Duplex Scanning hemodynamic correlation power with preoperative arteriography and direct intraoperative resistance measurements. Sixty-eight (68) lower limb revascularizations were studied. Preoperative Duplex Scanning was considered satisfactory in 93,2% of the cases. A positive hemodynamic correlation among the methods described above (Pearson\'s correlation test), particularly for distal arteries, has been verified. We conclude that preoperative Duplex Scanning, apart from defining the anatomic characteristics of the artery to be revascularized, can be helpful in the hemodynamic study of the arterial bed receiving the graft, making it easier to establish the graft prognosis and define the best therapeutic strategy to be adopted in the preoperative period.

Cheung Ho Yan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 164-175). / Abstracts in English and Chinese. / Abstract --- p.i / Acknowledgements --- p.vi / Publications based on the work in this thesis --- p.vii / Table of content --- p.viii / Abbreviations --- p.xii / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter 1.1 --- Traditional Chinese Medicine --- p.1 / Chapter 1.1.1 --- Danshen --- p.2 / Chapter 1.1.2 --- Chemical constituents --- p.5 / Chapter 1.1.3 --- Pharmacological effects --- p.7 / Chapter 1.1.3.1 --- On blood vessels --- p.7 / Chapter 1.1.3.2 --- On blood pressure --- p.8 / Chapter 1.1.3.3 --- On heart --- p.8 / Chapter 1.1.3.4 --- On myocardial ischaemia and reperfusion --- p.9 / Chapter 1.1.3.5 --- On platelet activity --- p.10 / Chapter 1.1.3.6 --- Other actions --- p.11 / Chapter 1.1.4 --- Clinical studies --- p.12 / Chapter 1.2 --- The Vascular System --- p.13 / Chapter 1.2.1 --- The circulation network --- p.13 / Chapter 1.2.2 --- Physiology of blood vessels --- p.13 / Chapter 1.2.3 --- Control of vascular lone --- p.14 / Chapter 1.3 --- Mechanisms of Vasodilatation --- p.16 / Chapter 1.3.1 --- Endothelium derived relaxant factors (EDRFs) --- p.16 / Chapter 1.3.1.1 --- Nitric oxide (NO) --- p.16 / Chapter 1.3.1.2 --- Prostacyclin (PGI：) --- p.17 / Chapter 1.3.1.3 --- Endotheliun-derived hyperpolarization factors (EDHFs) --- p.18 / Chapter 1.3.1.3.1 --- Epoxyeicosatrienoic acids (EETs) --- p.19 / Chapter 1.3.1.3.2 --- Potassium ion (IC) --- p.20 / Chapter 1.3.1.3.3 --- Gap junction --- p.20 / Chapter 1.3.2 --- Signal transduction pathways --- p.21 / Chapter 1.3.2.1 --- Guanylyl cyclase-cGMP pathway --- p.21 / Chapter 1.3.2.2 --- Adenylyl cyclase-cAMP pathway --- p.22 / Chapter 1.3.3 --- Ion channels in vascular smooth muscle cell --- p.24 / Chapter 1.3.3.1 --- Potassium channels (K+ channels) --- p.24 / Chapter 1.3.3.2 --- Calcium channels (Ca2+ channels) --- p.24 / Chapter 1.3.3.3 --- Chloride channel (Cl channel) --- p.25 / Chapter 1.3.4 --- Receptor-operated mechanisms --- p.27 / Chapter 1.3.4.1 --- Muscarinic receptors --- p.27 / Chapter 1.3.4.2 --- Adrenoceptors --- p.27 / Chapter 1.3.4.3 --- Histamine receptors --- p.28 / Chapter 1.3.4.4 --- CGRP receptors --- p.29 / Chapter 1.3.4.5 --- Tachykinin receptors --- p.30 / Chapter 1.4 --- Aims of the studies --- p.31 / Chapter CHAPTER 2 --- MATERIALS AND METHODS --- p.32 / Chapter 2.1 --- Extraction of Water and Lipid-solubie Fractions from Danshen --- p.32 / Chapter 2.1.1 --- Preparation of water-soluble and lipid-soluble fractions --- p.33 / Chapter 2.2 --- Experiments on Rat Knee Joint --- p.35 / Chapter 2.2.1 --- Animals --- p.35 / Chapter 2.2.2 --- Materials --- p.35 / Chapter 2.2.3 --- Preparatory protocols --- p.37 / Chapter 2.2.3.1 --- Anaesthesia of animals --- p.37 / Chapter 2.2.3.2 --- Cannulation of trachea --- p.37 / Chapter 2.2.3.3 --- Cannulation of carotid artery --- p.38 / Chapter 2.2.3.4 --- Blood pressure measurement --- p.38 / Chapter 2.2.4 --- Measurement of knee joint blood flow --- p.39 / Chapter 2.2.4.1 --- Preparation for measurement of knee joint blood flow --- p.41 / Chapter 2.2.5 --- Experimental protocols --- p.41 / Chapter 2.2.5.1 --- Danshen on knee joint blood flow --- p.41 / Chapter 2.2.5.2 --- Antagonists on Danshen --- p.41 / Chapter 2.2.5.3 --- Positive controls --- p.43 / Chapter 2.2.6 --- Image analysis --- p.44 / Chapter 2.2.7 --- Data analysis --- p.44 / Chapter 2.3 --- Experiments on Rat Femoral Artery --- p.45 / Chapter 2.3.1 --- Animals --- p.45 / Chapter 2.3.2 --- Materials --- p.45 / Chapter 2.3.2.1 --- Chemicals --- p.45 / Chapter 2.3.2.2 --- Physiological salt solution --- p.48 / Chapter 2.3.3 --- Preparatory protocols --- p.48 / Chapter 2.3.3.1 --- Small vessel myograph --- p.48 / Chapter 2.3.3.2 --- Isolation and mounting of tissue --- p.49 / Chapter 2.3.4 --- Experimental protocols --- p.50 / Chapter 2.3.4.1 --- Studies on the vasodilator response to Danshen --- p.50 / Chapter 2.3.4.2 --- Studies of antagonists on Danshen --- p.50 / Chapter 2.3.4.2.1 --- Endothelium-dependent mechanisms --- p.51 / Chapter 2.3.4.2.2 --- Endothelium-independent mechanisms --- p.54 / Chapter 2.3.4.2.3 --- K+ channel blockers --- p.54 / Chapter 2.3.4.2.4 --- Positive controls --- p.55 / Chapter 2.3.4.3 --- Danshen on Ca2+-induced contraction --- p.56 / Chapter 2.3.5 --- Data analysis --- p.57 / Chapter CHAPTER 3 --- RESULTS --- p.58 / Chapter 3.1 --- Danshen on Rat Knee Joint Blood Flow --- p.58 / Chapter 3.1.1 --- Topical administration of Danshen --- p.58 / Chapter 3.1.2 --- Antagonists on Danshen --- p.59 / Chapter 3.1.2.1 --- Muscarinic receptor antagonist --- p.59 / Chapter 3.1.2.2 --- β-adrenoceptor antagonist --- p.60 / Chapter 3.1.2.3 --- Histamine receptor antagonists --- p.60 / Chapter 3.1.2.4 --- Nitric oxide synthase inhibitor --- p.61 / Chapter 3.1.2.5 --- Cyclo-oxygenase inhibitors --- p.62 / Chapter 3.1.2.6 --- CGRPi receptor antagonist --- p.62 / Chapter 3.1.2.7 --- NK1 receptor antagonist --- p.63 / Chapter 3.1.2.8 --- Potassium channel inhibitor --- p.64 / Chapter 3.1.2.9 --- "Combination of cyclo-oxygenase inhibitor, nitric oxide synthase inhibitor and CGRP1 receptor antagonist" --- p.64 / Chapter 3.1.3 --- Antagonists on water-soluble fraction of Danshen --- p.91 / Chapter 3.1.3.1 --- Nitric oxide synthase inhibitor --- p.91 / Chapter 3.1.3.2 --- Cyclo-oxygenase inhibitors --- p.91 / Chapter 3.1.3.3 --- CGRP1 receptor antagonist --- p.92 / Chapter 3.1.3.4 --- NK1 receptor antagonist --- p.92 / Chapter 3.1.3.5 --- Potassium channel inhibitor --- p.92 / Chapter 3.2 --- Danshen on Rat Femoral Artery --- p.99 / Chapter 3.2.1 --- Danshen on precontracted arterial ring --- p.99 / Chapter 3.2.2 --- Endothelium-dependent mechanisms --- p.106 / Chapter 3.2.3 --- Endothelium-independent mechanisms --- p.114 / Chapter 3.2.4 --- K+ channel blockers --- p.119 / Chapter 3.2.4.1 --- Effect on Danshen --- p.119 / Chapter 3.2.4.2 --- Effect on water-soluble and lipid-soluble fractions of Danshen --- p.121 / Chapter 3.2.4.3 --- Effect on Danshensu --- p.122 / Chapter 3.2.5 --- Danshen on Ca2+-induced contractions --- p.133 / Chapter CHAPTER 4 --- DISCUSSION --- p.138 / Chapter 4.1 --- In Vivo Studies of Danshen on Rat Knee Joint Blood Flow --- p.139 / Chapter 4.2 --- In Vitro Studies of Danshen on Isolated Rat Femoral Artery --- p.148 / Chapter 4.2.1 --- Comparisons of the use of different precontractors --- p.148 / Chapter 4.2.2 --- Investigations on endothelium-dependent mechanisms --- p.151 / Chapter 4.2.3 --- Investigations on endothelium-independent mechanisms --- p.152 / Chapter 4.2.4 --- Effects of K+ channel blockers --- p.154 / Chapter 4.2.5 --- Inhibition of Ca2+ influx in vascular smooth muscle --- p.157 / Chapter 4.3 --- Comparisons of Results from In Vivo and In Vitro Studies --- p.159 / Chapter 4.4 --- Future Studies --- p.161 / Chapter 4.5 --- Conclusion --- p.162 / REFERENCES --- p.164

O objetivo deste trabalho foi estudar a expressão protéica de mdm2 e avaliar a sua relação com alguns aspectos anatomopatológicos, visando também identificar fatores prognósticos no que diz respeito à sobrevida livre de recidiva local (SLRL), sobrevida livre de metástase (SLM) e sobrevida global (SG), em pacientes portadores de lipossarcoma primário de extremidades. Vinte e cinco entre 50 pacientes admitidos no Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – IOT/HC/FMUSP, entre 1968 e 2004, foram eleitos para o estudo. As probabilidades de sobrevida acumuladas foram feitas pela técnica de Kaplan-Meier e as curvas de sobrevida comparadas pelo teste de Log Rank. A validade estatística foi estabelecida para valores de p<0,05. As associações entre os índices positivo ou negativo para o mdm2 com outras variáveis foram feitas utilizando-se o teste exato de Fischer. A expressão imunoistoquímica da proteína mdm2 não foi considerada de valor prognóstico em nenhuma das sobrevidas estudadas (SLRL, SLM ou SG). Os fatores adversos que influenciaram o risco de recidiva local na análise univariada foram: o gênero masculino (p = 0,023), subtipo histológico pleomórfico (p = 0,027) e alto grau histológico (p=0,007). Em relação a SLM a idade inferior a 50 anos (p = 0,040), o gênero masculino (p = 0,040), o subtipo pleomórfico (p < 0,001), o alto grau histológico (p = 0,003) tiveram um pior prognóstico. Os fatores adversos para SG foram: idade inferior a 50 anos (p = 0,040); o gênero masculino (p = 0,040); o subtipo pleomórfico (p < 0,001) e o alto grau histológico (p = 0,003). / The purpose of this was to study the expression by imunohistochemistry of mdm2 and your correlation with anatomopathological selected variables, aiming at identifying prognostic factors concerning to local recurrence free survival (LRFS), metastases free survival (MFS) and overall survival (OS) in patients with liposarcomas primary extremities. This study included 25 patients registred in the Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - Brazil, from 1968 to 2004. The accumulated survival probabilities were calculated by Kaplan-Meier method and survival curves were compared using the logrank test. Statistical significance was defined as a p value less than 0,05. Associations between expression of mdm2 and other variables were analyzed using Fischer’s exact test. The expression by imunohistochemistry of mdm2 was not significant factor for LRFS, MFS or OS. The adverse factors for LRFS in univariate analysis were male gender (p = 0,023), pleomorfic histologic subtypes (p = 0,027) and high grade tumor (p = 0,007). For MFS age < 50 years (p = 0,040), male gender (p = 0,040), pleomorfic histologic subtypes (p < 0,001) and high grade tumor (p = 0,003) had worse prognostic. Negative prognostic factors for OS were age < 50 years (p = 0,040), male gender (p = 0,040), pleomorfic histologic subtypes (p < 0,001) and high grade tumor (p = 0,003).

The purpose of this study was to determine the reliability of two new alternative portable methods for measuring maximal isometric force measures while performing the standard mid-thigh pull. One method, the bar grip method, required the use of the trunk and upper extremity muscles, while the second method, the pelvic belt method, did not. Both methods demonstrated good test-retest reliability via randomized repeated measures over 24-36 hours. Interestingly, the pelvic belt method generally demonstrated average maximal forces up to 65% higher than the bar method. There was a good relationship between both methods. These new alternative methods could provide strength coaches an option for a more efficient, cost-effective, portable means for the mid-thigh pull test.

Disertacijoje nagrinėjama pacientų, dėl didelės energijos bukos traumos patyrusių dauginius kūno sužalojimus, kojų ilgųjų kaulų lūžių gydymo įtaka mirčiai. Ištirtas ir su tarptautiniu standartu palygintas pacientų su dauginiais kūno sužalojimais būklės vertinimas ir gaivinimas ikihospitaliniu laikotarpiu. Įvertintas asmenų, patyrusių dauginius kūno sužalojimus, sužalojimų pobūdis, sunkumas, komplikacijos ir baigtis. Įvertinti dauginių kūno sužalojimų gydymo rezultatai, atsižvelgiant į operacinį ar konservatyvų kojų ilgųjų kaulų lūžių gydymą suvienodintose pagal amžių ir sužalojimo sunkumą pacientų grupėse. Nustatyti veiksniai, turintys ���taką pacientų su dauginiais kūno sužalojimais mirčiai. / Influence of lower extremity long bone fracture treatment of severe polytrauma patients after high energy blunt trauma is evaluated. Pre-hospital initial assessment and management of patients with multiple injuries is estimated and compared with the international standard. The nature, injury severity, complications and the outcome of the patients who suffered multiple injuries are evaluated. The treatment results of multiple injuries taking into account lower extremity long bone fractures operative or conservative treatment in pair matching groups of patients are evaluated. The factors that has impact on mortality of the polytrauma patients are determinated.

Tyrimo objektas: asmenų, patyrusių galvos smegenų infarktą, eisenos kokybė. Tyrimo problema. Pagrindiniai eisenos kokybę įtakojantys veiksniai yra liemens funkcija ir kojų raumenų jėga. Patyrus galvos smegenų infarktą sutrinka gebėjimas eiti, eisena tampa asimetrinė, sumažėja ėjimo greitis ir padidėja energijos sąnaudos. Kompensuojant pažeistą kojų raumenų ir liemens funkciją naudojami neoptimalūs ėjimo modeliai. Darbo tikslas: Nustatyti, kokio tipo pratimai – liemens funkcijos lavinimo ar kojų raumenų stiprinimo - turi didesnį poveikį asmenų, patyrusių galvos smegenų infarktą, kokybiniams ėjimo fazių rodikliams. Uždaviniai: 1) įvertinti liemens funkciją lavinančių pratimų poveikį ligonių ėjimo fazių rodikliams; 2) įvertinti kojų raumenų stiprinimo pratimų poveikį ligonių ėjimo fazių rodikliams; 3) palyginti skirtingų kineziterapijos programų poveikį ligonių ėjimo fazių rodikliams. Tyrimo metodika: Penkiasdešimt tiriamųjų – asmenų, prieš 2 savaites patyrusių galvos smegenų infarktą - buvo suskirstyti į dvi grupes po 25 ligonius. Pirmosios grupės ligoniams didžiausią dėmesį kineziterapijos metu skyrėme liemens funkcijos lavinimui, antrosios grupės ligoniams - ėjime dalyvaujančių kojų raumenų stiprinimui. Eisenos rodiklių pokyčius vertinome Brunel pusiausvyros testu (angl. BBA) ir Wiskonsino eisenos skale (angl. WGS). Rezultatai ir išvados. 1. Liemens funkciją lavinantys pratimai statistiškai reikšmingai pagerino asmenų, patyrusių galvos smegenų infarktą, eisenos kokybę. 2... [toliau žr. visą tekstą] / Research object: gait quality of people who sustain the stroke. Research problem. The main factors of gait quality are a trunk control and a force of lower limbs muscular tissues. The stroke affects the ability to walk, the walking becomes asymmetric, and walking speed is slower consequently it increases the expenditure of energy. Non-optimal walking models are used to compensate touched lower limbs muscles and trunk control. The aim of this paper is to determine what kind of training and strenghening exercises after a stroke for a trunk control and lower limbs muscles have more intense influence for qualitative indexes of gait phases. Objectives: 1. to estimate trunk control training exercises effect on a patient’s gait phases; 2. to estimate strengthening exercises of lower limbs muscular tissues effect on a patient’s gait phases; 3. to compare various physical therapy programs effect on a patient’s gait phases. Research methods: fifty patients who had sustained a stroke two weeks ago were divided into two equal groups. During the physical therapy one patients group granted attention to a trunk control training and another group to lower limbs muscular tissues strengthening by some walking exercises. The factors of changed gait were measured by Brunel balance assessment and Wisconsin gait scale. Conclusions. 1. Trunk control training exercises significantly improve patient’s gait quality. 2. Lower limbs muscles strengthening exercises significantly improve patient’s who... [to full text]

Darbo objektas: Fugl – Meyer skalės apatinės galūnės motorinės funkcijos vertinimo dalis ir jos pritaikomumas lietuvių kalba. Darbo problema: pasaulyje galvos smegenų insultas yra viena iš didžiausių visuomenės sveikatos problemų. Dažniausia šios ligos pasekmė – galūnių judesių valdymo sutrikimai. Apie 72 proc. patyrusiųjų GSI yra stebimi kojų judesių valdymo sutrikimai. Siekiant sumažinti galvos smegenų insulto pasekmes, svarbu tinkamai įvertinti reabilitacijos efektyvumą, apimant visas ligos paveiktas sritis. Lietuvoje patyrusiųjų galvos smegenų insultą reabilitacijos efektyvumo įvertinimui oficialiai naudojami instrumentai, kuriais vertinama kasdienė veikla ir pažintinės funkcijos, tačiau nėra oficialiai naudojamo instrumento, tinkamo motorinės funkcijos pažeidimams įvertinti. Fugl – Meyer skalės apatinės galūnės motorinės funkcijos vertinimo dalis, dėl gerų rezultatų įvertinimo kriterijų, yra plačiai naudojama pasaulyje, tačiau Lietuvoje ji nėra pritaikyta. Darbo tikslas: pateikti lietuviškai parengtą Fugl – Meyer judesių atsigavimo po insulto skalės apatinės galūnės motorinės funkcijos vertinimo dalį ir įvertinti jos tinkamumą pritaikomumui lieuvių kalba. Darbo uždaviniai: 1. Išsiaiškinti Lietuvoje pritaikytus instrumentus, skirtus patyrusiųjų galvos smegenų insultą apatinės galūnės motorinės funkcijos vertinimui ir palyginti su kitų šalių praktika. 2. Išsiaiškinti ir įgyvendinti vertinimo instrumento vertimo į gimtąją kalbą procesą. 3. Įvertinti Fugl – Meyer... [toliau žr. visą tekstą] / Object: the Fugl-Meyer assessment scale the part of the lower extremity motor performance and it validation in lithuanian language. Subject: A stroke is a major public health problem. The most frequent result leading stroke is the disorder of the limb motion control. About 72 percent of stroke patients have lower extremity motor function disorders. According The World Health Organization rehabilitation effectiveness assessment must include all areas affected by the disease. It is important to note that the results of stroke rehabilitation outcome measures should be systematically described and classified in an appropriate way. There are two types of instruments for rehabilitation effectiveness assessment for the patients with stroke in Lithuania. One of them assess daily living activities and the other assess psychological functions. However there are no instrument officially applied for evaluation of the motor disfunctions. According to scientific literature articles, one of the most reliable and valid scale of affected lower extremity true recovery, is Fugl – Meyer Assessment scale the part of the lower extremity motor performance. Aim: to present the Fugl-Meyer assessment scale the part of the lower extremity motor performance and assess it validation in lithuanian language. Goals: 1. To investigate the instruments using for assessment of the lower extremity motor function in patients with stroke in Lithuania and to compare with other countries practices. 2. To... [to full text]

INTRODUÇÃO: A implantação de stent auto-expansível de nitinol para o tratamento das lesões oclusivas femoro-poplíteas tem sido associado com maus resultados a longo prazo. O everolimus administrado via oral para inibir reestenoses do stent foi investigado recentemente em animais com bons resultados, porém sua segurança e eficácia não têm sido estudada em seres humanos. O propósito deste estudo piloto foi avaliar o impacto da terapia antiproliferativa com everolimus administrado via oral por 28 dias na diminuição de reestenose após implante de stent auto-expansível de nitinol para tratamento de lesões oclusivas da artéria femoral superficial. MÉTODOS E RESULTADOS: Trinta e quatro pacientes foram recrutados para este estudo randomizado, prospectivo. O grupo que recebeu everolimus via oral foi constituído por 15 pacientes e o grupo que não recebeu medicação composto por 19 pacientes. As características basais e do procedimento foram similares entre os dois grupos. Todos os pacientes tinham isquemia crônica do membro inferior e oclusão da artéria femoral superficial (média da lesão de 83,14 mm no grupo sem medicação e 105 mm no grupo everolimus). O objetivo primário do estudo foi a redução da porcentagem média do diâmetro da reestenose intra-stent após seis meses da angioplastia avaliada por angiografia quantitativa. A porcentagem média do diâmetro das reestenoses foi 46,9% no grupo tratado com everolimus e 44,5% no grupo que não recebeu a medicação (p=0,81). Não foram observados efeitos colaterais graves nos grupos. No acompanhamento clínico aos 24 meses não houve diferenças significativas entre os grupos em relação a eventos clínicos. A patência primária, primária assistida e secundária em 24 meses, foi 42%, 74% e 79% no grupo sem medicação e 27%, 73% e 73% no grupo tratado com everolimus. CONCLUSÃO: O everolimus via oral por 28 dias em doses altas é seguro e bem tolerado, com baixo índice de efeitos colaterais, porém não é eficaz na redução da porcentagem média do diâmetro da reestenose intra-stent em pacientes com implante de stents auto-expansíveis de nitinol nas lesões oclusivas complexas da artéria femoral superficial. / INTRODUCTION: The implantation of a self-expanding of nitinol stent in the treatment of femoropopliteal occlusive lesions has been associated with a poor outcome in a long term setting. Everolimus administered orally to inhibit restenosis of the stent was investigated recently in animals with good results, but its safety and efficacy has not been studied in humans. The purpose of this pilot study was to evaluate the impact of antiproliferative therapy with everolimus administered orally for 28 days in the reduction of restenosis after implantation of self-expandable nitinol stent for treatment of occlusive lesions of the superficial femoral artery. METHODS AND RESULTS: Thirty-four patients were recruited for this randomized, prospective study. The group that received oral Everolimus was consisted of 15 patients and the group that received no medication was 19 patients. The baseline characteristics and procedure were similar in both groups. All the patients had chronic lower limb ischemia and occlusion of the superficial femoral artery (mean of the lesion of 83.14 mm in the group without medication and 105 mm in the everolimus group). The primary objective of the study was to evaluate the reduction of the average percentage of the diameter of in-stent restenosis six months after angioplasty assessed by quantitative angiography. The in-stent mean percent diameter stenosis was 46.9% in the group treated with everolimus and 44.5% in the group that received no medication (p = 0.81). There were no serious side effects seen in either group in the clinical follow up at 24 months. There was no significant difference between groups in relation to clinical events. The primary patency, assisted primary and secondary in 24 months was 42%, 74% and 79% in the group without medication and 27%, 73% and 73% in the group treated with Everolimus. CONCLUSION: Everolimus administered orally for 28 consecutive days to stent implantation in high doses proves to be safe and well tolerated, with low rate of side effects, but it is not effective in reducing the average percentage of diameter of in-stent restenosis in patients with implantation of self-expandable nitinol stent in complex occlusive lesions of the superficial femoral artery.

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)

Sickle cell anemia (SCA), homozygous form of sickle cell disease, is the most common hereditary hemoglobinopathy, characterized by the production of abnormal hemoglobin (HbS) which, in deoxygenated state, deforms and hardens the red cells with multisystemic manifestations. The clinical complications can be grouped in two subphenotypes: vasculopathy and viscosity-vaso-occlusion. Vasculopathy is associated to hemolysis intensity and contributes to chronic dysfunction of several organs, with endothelial participation. Endothelial dysfunction is associated to hemolysis laboratory markers (hemoglobin level, reticulocyte count, lactate dehydrogenase and bilirubin levels) and can manifest as abnormal vascular reactivity in visceral, peripheral and central blood flow studies, assessed by Doppler ultrasound. The aim of this study was to investigate the arterial vascular resistance state in the kidneys, lower limbs and orbits by means of dopplervelocimetry in SCA patients, and its relationship with hemolysis biomarkers. Two groups were examined in this cross-sectional study. One group consisted of 71 outpatients with SCA; the other group was a control group, consisting of 32 age- and sex-matched, apparently healthy subjects. All participants were assessed by means of Doppler ultrasound and laboratory tests. All biomarkers were abnormal in the SCA patients compared with the control subjects (p < 0.0001). Doppler sonography evaluation revealed altered velocities and elevated resistance indices RI (resistive index) and PI (pulsatility index) in SCA group compared to control group (p < 0.0001). The relationship analysis between hemolysis biomarkers and vascular resistance indices showed significant association. In the kidneys, strong inverse correlation was observed between hemoglobin level and RI and PI in all arteries; moderate direct correlation was detected between lactate dehydrogenase and the resistance indices in segmental arteries. In the lower limbs, moderate direct correlation was observed between reticulocyte count and peak systolic velocity (PSV) in the anterior tibial and posterior tibial arteries; strong inverse correlation was detected between hemoglobin and PSV in all arteries. In orbits, moderate direct correlation was found between reticulocyte count and resistance indices in ophthalmic artery; and strong inverse correlation was observed between hemoglobin and RI and PI in the central retinal artery. This research demonstrated that arterial vascular resistance in the kidneys, lower limbs and orbits, assessed by means of Doppler ultrasound, is elevated in SCA patients, and shows moderate to strong correlation with hemolysis biomarkers. / Anemia falciforme (AF), forma homozigótica da doença falciforme, é uma das hemoglobinopatias hereditárias mais comuns, caracterizada pela produção de hemoglobina anormal (HbS) que, no estado desoxigenado, deforma e enrijece as hemácias, promovendo manifestações multissistêmicas. As complicações clínicas podem ser agrupadas em dois subfenótipos: vasculopatia e viscosidade-vaso-oclusão. A vasculopatia está associada à intensidade da hemólise e contribui para a disfunção crônica de diversos órgãos, com a participação do endotélio. A disfunção endotelial está associada a marcadores laboratoriais de hemólise (hemoglobina, contagem de reticulócitos, desidrogenase láctica e bilirrubinas) e pode manifestar-se como reatividade vascular anormal em estudos de fluxo sanguíneo visceral, periférico e central, avaliado por ultrassonografia Doppler. O objetivo deste trabalho foi investigar o estado de resistência vascular arterial nos rins, membros inferiores e órbitas por meio de dopplervelocimetria em portadores de AF, e sua relação com biomarcadores de hemólise. Dois grupos foram examinados neste estudo transversal. Um grupo consistiu de 71 pacientes portadores de AF; o outro, controle, formado por 32 sujeitos saudáveis, pareados por gênero e idade. Todos os participantes foram avaliados por meio de ultrassonografia Doppler e de testes laboratoriais. Todos os biomarcadores foram anormais nos portadores de AF em comparação aos controles (p < 0,0001). A avaliação dopplerfluxométrica evidenciou velocidades alteradas e índices de resistência vascular IR (índice de resistência) e IP (índice de pulsatilidade) elevados no grupo AF em relação ao grupo controle (p < 0,0001). A análise da relação entre os marcadores de hemólise e os índices de resistência vascular mostrou associação significativa. Nos rins, forte correlação inversa foi observada entre nível de hemoglobina e IR e IP em todas as artérias; moderada correlação direta foi encontrada entre desidrogenase láctica e os índices de resistência nas artérias segmentares. Nos membros inferiores, moderada correlação direta foi detectada entre contagem de reticulócitos e velocidade de pico sistólico nas artérias tibial anterior e tibial posterior; forte correlação inversa foi observada entre hemoglobina e velocidade de pico sistólico em todas as artérias. Nas órbitas, moderada correlação direta foi encontrada entre contagem de reticulócitos e os índices de resistência na artéria oftálmica; e forte correlação inversa foi detectada entre hemoglobina e IR e IP na artéria central da retina. O trabalho demonstrou que a resistência vascular arterial dos rins, membros inferiores e órbitas, aferida por meio de dopplervelocimetria, é elevada em portadores de AF, com moderada a forte correlação com os biomarcadores de hemólise.