Rate of readmission among hospitalized heart failure (HF) patients is used as an indicator of quality and efficiency of healthcare. A low sodium diet is a component of the accepted treatment for HF. Instruction by dietitians may help reduce dietary sodium without negatively affecting quality of life. The effect of low sodium diet education on hospital readmission within 30 and 45 days of discharge for HF patients (N=52) was conducted. Chi-square analysis determined education did not significantly affect remittance within 30 (P=.143) or 45 days (P=.474). Patients readmitted within 30 days were older (P=.005). Men were more likely to be readmitted than women within 30 (P=.021) and 45 days (P=.019). Higher NT-proBNP levels were observed in individuals readmitted within 30 (P=.011) and 45 days (P=.010). Low sodium diet education did not affect readmission but older age, male sex, and higher NT-proBNP values increased the rate of readmission.

Title: Changes of the catecholamins, serotonine and lactate levels during sport climbing on a climbing wall depending on the leader climber's style of belaying. Goals: The Goal of this thesis is to build on the bachelor thesis and develop its goals. The research is focused on a detection of blood hormonal changes before performance, right after it and after a 15- minute pacification depending on a style of a personal profile and style of belaying of the climbers. Hormonal changes have been compared during the performance on two climbing routes of the same difficulty and different styles of belaying. Methods: The randomized research sample consisted of 10 women, climbers, who climbed two routes using the OS (on sight) style on the level of maximum effort. One of the routes was climbed with clipping in protection points against the second route, which was climbed without protection points. The research was performed using a blood collection from v. brachialis and spinning off the blood plasma of the collected blood. Lactate was determined on Siemens Adria 1800 in a routine laboratory, serotonine was determined using LS-MS/MS with a gradient elution. Catecholamines were determined using LS-MS/MS with an isocratic elution. The survey composed of three psychological questionnaires (DMV, RCAI, Eysenck's...

O exercício aeróbico é recomendado para indivíduos pré-hipertensos como prevenção da hipertensão arterial. Uma única sessão de exercício aeróbico promove hipotensão pósexercício. Estudos prévios com normotensos observaram menor hipotensão pós-exercício pela manhã do que ao final da tarde, porém, estes estudos não incluíram uma situação controle (sem exercício) e avaliaram apenas alguns determinantes hemodinâmicos desse fenômeno. Dessa forma, o objetivo deste estudo foi analisar e comparar a resposta da pressão arterial (PA) e seus determinantes hemodinâmicos e mecanismos autonômicos após uma sessão de exercício aeróbico realizado pela manhã (9:00 h) e ao final do dia (18:30 h), relacionando os resultados obtidos com os efeitos deste exercício em alguns marcadores neuro-hormonais do ritmo circadiano. Para tanto, 16 homens pré-hipertensos participaram de 4 sessões experimentais conduzidas em ordem aleatória: duas pela manhã e duas ao final do dia. Em cada fase do dia, foram realizadas uma sessão controle (repouso) e outra de exercício (cicloergômetro, 45 min, 50% VO2pico). A PA clínica, o débito cardíaco (DC), a resistência vascular periférica (RVP), o volume sistólico (VS), a frequência cardíaca (FC), a modulação autonômica cardíaca e vasomotora, a sensibilidade barorreflexa, o fluxo sanguíneo muscular, a capacidade vasodilatadora e as concentrações plasmáticas de noradrenalina e adrenalina foram medidos antes e após a intervenção em cada sessão. Além disso, a PA ambulatorial de 24 horas foi medida após as sessões e a concentração do metabólito da melatonina 6- sulfatoximelatonina produzida durante a noite anterior e posterior a cada sessão foi dosada. Os dados foram analisados pela ANOVA de 2 ou 3 fatores repetidos bem como pelo teste t ou teste de wilcoxon pareado e as associações foram calculadas pelas correlações de Pearson e Spearman. Foi aceito como significante P0,05. O exercício promoveu maior redução da PA sistólica pela manhã do que ao final do dia (-7±3 vs -3±4 mmHg, P<0,05), enquanto que a PA diastólica diminuiu de forma semelhante nestas duas fases do dia (-3±3 vs -3±3 mmHg, respectivamente). O DC diminuiu e a RVP tendeu a aumentar pós-exercício pela manhã, enquanto que estas variáveis não se modificaram pós-exercício ao final do dia (-460±771ml/min e +2,0±3,8 mmHg.min/l; +148±633ml/min e -1,4±2,8 mmHg.min/l, respectivamente). O VS diminuiu similarmente pós-exercício em ambas as fases do dia (- 12±15 vs. -9±10 ml, P<0,05), enquanto que a FC aumentou mais ao final do dia (+7±5 vs. +10±5 bpm, P<0,05). Isto ocorreu, devido ao exercício promover aumento do balanço simpatovagal (BF/AF) somente ao final do dia (+1,5±1,6, P<0,05), enquanto que a modulação vasomotora (BFPAS) pós-exercício diminuiu apenas pela manhã (-0,5±0,9 mmHg2, P<0,05). A sensibilidade barorreflexa espontânea, avaliada pelo do ganho médio de sequências positivas e negativas (SBR±) diminuiu pós-exercício nas duas fases do dia. O exercício não teve nenhum efeito sobre o fluxo sanguíneo e a capacidade vasodilatadora do braço, mas aumentou a capacidade vasodilatadora da perna apenas quando o exercício foi realizado ao final do dia (+116±172 ua, P<0,05). Nas medidas ambulatoriais, o exercício realizado ao final do dia reduziu a PA de sono e no período entre a 5 e 7ª hora pós-exercício. O exercício não teve nenhum efeito sobre os níveis de noradrenalina, adrenalina e 6-sulfatoximelatonina. Dessa forma, não houve correlações consistentes entre o efeito do exercício nos níveis hormonais e nas variáveis hemodinâmicas, autonômicas e ambulatoriais em nenhuma das fases do dia. Em conclusão, em pré-hipertensos, uma única sessão de exercício aeróbico reduz a PA pósexercício tanto quando o exercício é realizado pela manhã quanto ao final do dia, mas o maior efeito hipotensor é observado quando o exercício é realizado pela manhã para a PA sistólica. Este maior efeito hipotensor sistólico se deve à queda do DC pela manhã, que ocorre devido à diminuição do volume sistólico e menor aumento da FC pós-exercício nesta fase do dia, o que é provocado pelo menor aumento do balanço simpatovagal e se acompanha de menor aumento na capacidade vasodilatadora da musculatura ativa nesta fase do dia. O efeito hipotensor do exercício, no entanto, ao final do dia se reflete em redução da PA de sono pósexercício. Os efeitos do exercício aeróbico, realizado em diferentes fases do dia, sobre a PA clínica e ambulatorial e seus mecanismos hemodinâmicos, autonômicas e vasculares não se relacionam aos efeitos deste exercício sobre as catecolaminas e a produção de melatonina / Aerobic exercise is recommended for prehypertensive individuals to prevent hypertension development. An aerobic exercise bout promotes post-exercise hypotension, and previous studies with normotensive individuals reported that post-exercise hypotension is lower when exercise is conducted in the morning than in the evening. However, these studies have not included a control situation (without exercise) and only evaluated some hemodynamic determinants of this phenomenon. Thus, the aim of this study was to analyze and to compare blood pressure (BP) responses and their hemodynamic determinants and autonomic mechanisms after an aerobic exercise performed in the morning (9:00a.m) and the evening 6:30p.m), associating these results with the effects of this exercise in some neurohormonal markers of circadian rhythms. For this, 16 prehypertensive men underwent 4 experimental sessions conducted in random order: two in the morning and two in the evening. At each time of day, one control (rest) and one exercise (cycle ergometer, 45 min, 50% of VO2peak) sessions were performed. Clinic BP, cardiac output (CO), systemic vascular resistance (SVR), stroke volume (SV), heart rate (HR), cardiac autonomic modulation, vasomotor modulation, baroreflex sensitivity, muscle blood flow, vasodilation and plasma concentrations of norepinephrine and epinephrine were measured before and after the intervention in each session. In addition, ambulatory BP was measured for 24 hours after the experimental sessions and the concentration of melatonin metabolite 6-sulfatoxymelatonin produced during the sleep before and after each session was assessed. Data were analyzed by 2 or 3-way ANOVA for repeated measures as well as by paired t test or Wilcoxon test, and the associations between variables were calculated by Pearson and Spearman correlations. P 0.05 was accepted as significant. Exercise produced a greater systolic BP reduction in the morning than the evening (-7 ± 3 -3 ± 4 mmHg, P<0.05), while the diastolic blood pressure decreased similarly in both times of day (-3±3 vs -3±3 mmHg, respectively, P<0.05). CO decreased and SVR tended to increased after exercise in the morning, while these variables did not change after exercise in the evening (-460 ± 771ml/min and +2.0 ± 3.8 mmHg.min/l; +148 633ml/min ± 2.8 and -1.4 ± mmHg.min/l , respectively). VS decreased similarly after exercise in both times of day (-12 ± 15 vs -9 ± 10 ml, P<0.05), while the HR increased more in the evening (+7 ± 5 vs +10 ± 5 bpm, P<0.05). This occurred because exercise increased sympathovagal balance only in the evening (+1.5 ± 1.6, P<0.05), whereas vasomotor modulation decreased only after exercise performed in the morning (-0.5 ± 0.9 mmHg2, P<0.05). Spontaneous baroreflex sensitivity, measured by the average gain of positive and negative sequences (± SBR) decreased after the exercise in both times of day. The exercise did not affect arm blood flow and vasodilatory capacity, but increased leg vasodilation when exercise was performed in the evening (+116 ± 172 au, P<0.05). In regard to ambulatory measures, the exercise performed in the evening reduced asleep BP and BP measured 5-7hr post-exercise. The exercise did not have any effect in the norepinephrine, epinephrine and 6- sulphatoxymelatonin. Thus, there was not consistent correlation between the effect of exercise in hormone levels and in hemodynamic, autonomic and ambulatory responses. In conclusion, in prehypertensives, a single bout of aerobic exercise reduces post-exercise BP regardless if the exercise is performed in the morning or in the evening, however a greater hypotensive effect is observed in the morning for systolic BP. This greater systolic hypotensive effect is due to the decrease in CO in the morning, related to a decrease in SV and a lower increase in HR after the exercise performed in the morning, which is caused by a lower increase in sympathovagal balance and is accompanied by a smaller increase in active muscles vasodilatory capacity in the morning. The hypotensive effect of evening exercise leads to a reduction in asleep BP. The effects of exercise, performed at different times of day, on postexercise clinic and ambulatory BP as well in its hemodynamic, autonomic and vascular determinants are not related to the effects of this exercise in catecholamines and melatonin production

The mammalian Na+/H+ exchanger isoform 1 (NHE1) is a ubiquitously expressed membrane protein that regulates intracellular pH. In the myocardium, NHE1 has been implicated in ischemia/reperfusion (I/R) and cardiac hypertrophy (CH). Hormonal, autocrine and paracrine stimuli, acidosis, cardiotoxic metabolites released during I/R and CH increases NHE1 protein expression and activity. The involvement of NHE1 in CH and I/R has been further supported with the use of NHE1 inhibitors, which have been beneficial in the prevention/regression of several models of CH and I/R injury. Despite the fact that elevation of NHE1 expression and activity have been demonstrated in several models of heart disease, it was unclear whether elevation of NHE1 protein expression was sufficient to induce a specific cardiac pathology, or whether activation of the protein was required. To understand the direct role of NHE1 in CH and I/R, an in vivo and in vitro gain-of-function model, expressing varying levels and activities of NHE1 were examined. In vivo, our N-line mice expressed wild type NHE1 and our K-line mice expressed constitutively active NHE1. In vitro, neonatal rat ventricular cardiomyocytes were infected with the IRM adenovirus containing wild type NHE1 or the K-IRM adenovirus containing active NHE1. We demonstrated that expression of constitutively active NHE1 promotes CH to a much greater degree than expression of wild type NHE1 alone, both in vivo and in vitro. This NHE1-dependent hypertrophic response occurred independent of signaling pathways involved in CH including, mitogen activated protein kinases, p90 ribosomal S6 kinase, calcineurin and glycogen synthase kinase. The NHE1-dependent hypertrophic effect also occurred independent of gender. In addition, the expression of active NHE1 increased the susceptibility of intact mice to neurohormonal stimulation and progressed the hypertrophic response. When these hearts expressing active NHE1 were subjected to I/R using the ex vivo working heart perfusion model, fatty acid (FA) oxidation and glycolysis rates increased, thus generating greater ATP production rates. This was associated with cardioprotective effects in the myocardium, as well as a more energetically efficient myocardium. Expression of the endoplasmic reticulum (ER) stress response proteins, calreticulin and PDI were also shown to be increased relative to controls, and may contribute to the cardioprotection observed. We demonstrate that active NHE1 induces cardioprotection and alters cardiac metabolism in working hearts subjected to I/R. Overall, our results suggest that expression of active NHE1 has a double edged sword effect, on one side it induces CH while on the other side, it protects the heart against I/R injury.

No description available.

O exercício aeróbico é recomendado para indivíduos pré-hipertensos como prevenção da hipertensão arterial. Uma única sessão de exercício aeróbico promove hipotensão pósexercício. Estudos prévios com normotensos observaram menor hipotensão pós-exercício pela manhã do que ao final da tarde, porém, estes estudos não incluíram uma situação controle (sem exercício) e avaliaram apenas alguns determinantes hemodinâmicos desse fenômeno. Dessa forma, o objetivo deste estudo foi analisar e comparar a resposta da pressão arterial (PA) e seus determinantes hemodinâmicos e mecanismos autonômicos após uma sessão de exercício aeróbico realizado pela manhã (9:00 h) e ao final do dia (18:30 h), relacionando os resultados obtidos com os efeitos deste exercício em alguns marcadores neuro-hormonais do ritmo circadiano. Para tanto, 16 homens pré-hipertensos participaram de 4 sessões experimentais conduzidas em ordem aleatória: duas pela manhã e duas ao final do dia. Em cada fase do dia, foram realizadas uma sessão controle (repouso) e outra de exercício (cicloergômetro, 45 min, 50% VO2pico). A PA clínica, o débito cardíaco (DC), a resistência vascular periférica (RVP), o volume sistólico (VS), a frequência cardíaca (FC), a modulação autonômica cardíaca e vasomotora, a sensibilidade barorreflexa, o fluxo sanguíneo muscular, a capacidade vasodilatadora e as concentrações plasmáticas de noradrenalina e adrenalina foram medidos antes e após a intervenção em cada sessão. Além disso, a PA ambulatorial de 24 horas foi medida após as sessões e a concentração do metabólito da melatonina 6- sulfatoximelatonina produzida durante a noite anterior e posterior a cada sessão foi dosada. Os dados foram analisados pela ANOVA de 2 ou 3 fatores repetidos bem como pelo teste t ou teste de wilcoxon pareado e as associações foram calculadas pelas correlações de Pearson e Spearman. Foi aceito como significante P0,05. O exercício promoveu maior redução da PA sistólica pela manhã do que ao final do dia (-7±3 vs -3±4 mmHg, P<0,05), enquanto que a PA diastólica diminuiu de forma semelhante nestas duas fases do dia (-3±3 vs -3±3 mmHg, respectivamente). O DC diminuiu e a RVP tendeu a aumentar pós-exercício pela manhã, enquanto que estas variáveis não se modificaram pós-exercício ao final do dia (-460±771ml/min e +2,0±3,8 mmHg.min/l; +148±633ml/min e -1,4±2,8 mmHg.min/l, respectivamente). O VS diminuiu similarmente pós-exercício em ambas as fases do dia (- 12±15 vs. -9±10 ml, P<0,05), enquanto que a FC aumentou mais ao final do dia (+7±5 vs. +10±5 bpm, P<0,05). Isto ocorreu, devido ao exercício promover aumento do balanço simpatovagal (BF/AF) somente ao final do dia (+1,5±1,6, P<0,05), enquanto que a modulação vasomotora (BFPAS) pós-exercício diminuiu apenas pela manhã (-0,5±0,9 mmHg2, P<0,05). A sensibilidade barorreflexa espontânea, avaliada pelo do ganho médio de sequências positivas e negativas (SBR±) diminuiu pós-exercício nas duas fases do dia. O exercício não teve nenhum efeito sobre o fluxo sanguíneo e a capacidade vasodilatadora do braço, mas aumentou a capacidade vasodilatadora da perna apenas quando o exercício foi realizado ao final do dia (+116±172 ua, P<0,05). Nas medidas ambulatoriais, o exercício realizado ao final do dia reduziu a PA de sono e no período entre a 5 e 7ª hora pós-exercício. O exercício não teve nenhum efeito sobre os níveis de noradrenalina, adrenalina e 6-sulfatoximelatonina. Dessa forma, não houve correlações consistentes entre o efeito do exercício nos níveis hormonais e nas variáveis hemodinâmicas, autonômicas e ambulatoriais em nenhuma das fases do dia. Em conclusão, em pré-hipertensos, uma única sessão de exercício aeróbico reduz a PA pósexercício tanto quando o exercício é realizado pela manhã quanto ao final do dia, mas o maior efeito hipotensor é observado quando o exercício é realizado pela manhã para a PA sistólica. Este maior efeito hipotensor sistólico se deve à queda do DC pela manhã, que ocorre devido à diminuição do volume sistólico e menor aumento da FC pós-exercício nesta fase do dia, o que é provocado pelo menor aumento do balanço simpatovagal e se acompanha de menor aumento na capacidade vasodilatadora da musculatura ativa nesta fase do dia. O efeito hipotensor do exercício, no entanto, ao final do dia se reflete em redução da PA de sono pósexercício. Os efeitos do exercício aeróbico, realizado em diferentes fases do dia, sobre a PA clínica e ambulatorial e seus mecanismos hemodinâmicos, autonômicas e vasculares não se relacionam aos efeitos deste exercício sobre as catecolaminas e a produção de melatonina / Aerobic exercise is recommended for prehypertensive individuals to prevent hypertension development. An aerobic exercise bout promotes post-exercise hypotension, and previous studies with normotensive individuals reported that post-exercise hypotension is lower when exercise is conducted in the morning than in the evening. However, these studies have not included a control situation (without exercise) and only evaluated some hemodynamic determinants of this phenomenon. Thus, the aim of this study was to analyze and to compare blood pressure (BP) responses and their hemodynamic determinants and autonomic mechanisms after an aerobic exercise performed in the morning (9:00a.m) and the evening 6:30p.m), associating these results with the effects of this exercise in some neurohormonal markers of circadian rhythms. For this, 16 prehypertensive men underwent 4 experimental sessions conducted in random order: two in the morning and two in the evening. At each time of day, one control (rest) and one exercise (cycle ergometer, 45 min, 50% of VO2peak) sessions were performed. Clinic BP, cardiac output (CO), systemic vascular resistance (SVR), stroke volume (SV), heart rate (HR), cardiac autonomic modulation, vasomotor modulation, baroreflex sensitivity, muscle blood flow, vasodilation and plasma concentrations of norepinephrine and epinephrine were measured before and after the intervention in each session. In addition, ambulatory BP was measured for 24 hours after the experimental sessions and the concentration of melatonin metabolite 6-sulfatoxymelatonin produced during the sleep before and after each session was assessed. Data were analyzed by 2 or 3-way ANOVA for repeated measures as well as by paired t test or Wilcoxon test, and the associations between variables were calculated by Pearson and Spearman correlations. P 0.05 was accepted as significant. Exercise produced a greater systolic BP reduction in the morning than the evening (-7 ± 3 -3 ± 4 mmHg, P<0.05), while the diastolic blood pressure decreased similarly in both times of day (-3±3 vs -3±3 mmHg, respectively, P<0.05). CO decreased and SVR tended to increased after exercise in the morning, while these variables did not change after exercise in the evening (-460 ± 771ml/min and +2.0 ± 3.8 mmHg.min/l; +148 633ml/min ± 2.8 and -1.4 ± mmHg.min/l , respectively). VS decreased similarly after exercise in both times of day (-12 ± 15 vs -9 ± 10 ml, P<0.05), while the HR increased more in the evening (+7 ± 5 vs +10 ± 5 bpm, P<0.05). This occurred because exercise increased sympathovagal balance only in the evening (+1.5 ± 1.6, P<0.05), whereas vasomotor modulation decreased only after exercise performed in the morning (-0.5 ± 0.9 mmHg2, P<0.05). Spontaneous baroreflex sensitivity, measured by the average gain of positive and negative sequences (± SBR) decreased after the exercise in both times of day. The exercise did not affect arm blood flow and vasodilatory capacity, but increased leg vasodilation when exercise was performed in the evening (+116 ± 172 au, P<0.05). In regard to ambulatory measures, the exercise performed in the evening reduced asleep BP and BP measured 5-7hr post-exercise. The exercise did not have any effect in the norepinephrine, epinephrine and 6- sulphatoxymelatonin. Thus, there was not consistent correlation between the effect of exercise in hormone levels and in hemodynamic, autonomic and ambulatory responses. In conclusion, in prehypertensives, a single bout of aerobic exercise reduces post-exercise BP regardless if the exercise is performed in the morning or in the evening, however a greater hypotensive effect is observed in the morning for systolic BP. This greater systolic hypotensive effect is due to the decrease in CO in the morning, related to a decrease in SV and a lower increase in HR after the exercise performed in the morning, which is caused by a lower increase in sympathovagal balance and is accompanied by a smaller increase in active muscles vasodilatory capacity in the morning. The hypotensive effect of evening exercise leads to a reduction in asleep BP. The effects of exercise, performed at different times of day, on postexercise clinic and ambulatory BP as well in its hemodynamic, autonomic and vascular determinants are not related to the effects of this exercise in catecholamines and melatonin production

No description available.