<p>Objective - To correlate blood pressure and inflammatory markers with urine albumin analysed with a point-of-care testing (POCT) instrument, nephelometric determination of albumin and creatinine related urine albumin in elderly males.</p><p>Methods and Results - The study population consisted of 103 diabetic and 603 nondiabetic males (age 77 years) in a cross-sectional study in central Sweden. We analyzed urine albumin with a HemoCue® Urine Albumin POCT instrument and a ProSpec® nephelometer and creatinine related urine albumin. There were strong correlation between both systolic and diastolic blood pressure and all three urine albumin methods (p<0.0001). There were also significant correlations between the different urine albumin measurements and SAA, hsCRP and IL-6.</p><p>Conclusions - Hypertension has a strong impact on hyperfiltration in diabetic and nondiabetic elderly males.</p>

Objective - To correlate blood pressure and inflammatory markers with urine albumin analysed with a point-of-care testing (POCT) instrument, nephelometric determination of albumin and creatinine related urine albumin in elderly males. Methods and Results - The study population consisted of 103 diabetic and 603 nondiabetic males (age 77 years) in a cross-sectional study in central Sweden. We analyzed urine albumin with a HemoCue® Urine Albumin POCT instrument and a ProSpec® nephelometer and creatinine related urine albumin. There were strong correlation between both systolic and diastolic blood pressure and all three urine albumin methods (p&lt;0.0001). There were also significant correlations between the different urine albumin measurements and SAA, hsCRP and IL-6. Conclusions - Hypertension has a strong impact on hyperfiltration in diabetic and nondiabetic elderly males.

abstract: Peripheral Vascular Disease (PVD) is a debilitating chronic disease of the lower extremities particularly affecting older adults and diabetics. It results in reduction of the blood flow to peripheral tissue and sometimes causing tissue damage such that PVD patients suffer from pain in the lower legs, thigh and buttocks after activities. Electrical neurostimulation based on the "Gate Theory of Pain" is a known to way to reduce pain but current devices to do this are bulky and not well suited to implantation in peripheral tissues. There is also an increased risk associated with surgery which limits the use of these devices. This research has designed and constructed wireless ultrasound powered microstimulators that are much smaller and injectable and so involve less implantation trauma. These devices are small enough to fit through an 18 gauge syringe needle increasing their potential for clinical use. These piezoelectric microdevices convert mechanical energy into electrical energy that then is used to block pain. The design and performance of these miniaturized devices was modeled by computer while constructed devices were evaluated in animal experiments. The devices are capable of producing 500ms pulses with an intensity of 2 mA into a 2 kilo-ohms load. Using the rat as an animal model, a series of experiments were conducted to evaluate the in-vivo performance of the devices. / Dissertation/Thesis / Muscle Twitching Excited by the Implanted Ultrasound Powered Device / Rat Hindlimb Withdraw Reflex / Masters Thesis Bioengineering 2014

Para avaliar o efeito de uma refeição-teste rica em lipídeos, assim mimetizando o estado pós-prandial durante o dia, nos parâmetros metabólicos e na reatividade vascular, foram estudados quatro grupos de pacientes do sexo masculino, assim divididos: com diabetes mellitus Tipo 2 e sem doença arterial coronariana (DM, n = 10), com doença arterial coronariana e com diabetes mellitus Tipo 2 (DM + DAC, n = 11), com doença arterial coronariana e sem diabetes mellitus (DAC, n = 11) e Controle (n = 7). Todos os pacientes, após receberem uma dieta rica em gordura (60g) e pobre em hidratos de carbono (14g), foram avaliados em termos de perfil lipídico antes (0h) e 2h, 4h, 6h e 8h após a ingestão e realizada a avaliação da reatividade vascular nos tempos 0h, 4h e 8h. A reatividade vascular foi estudada por ultra-som de alta resolução, medindo-se a resposta vasodilatadora da artéria braquial durante hiperemia reativa (vasodilatação endotélio-dependente) e após administração de nitroglicerina (endotélio-independente). HbA1c não foi diferente entre os grupos do estudo, exceto, como seria de se esperar, nos Controles, que foi normal (média ± DP) (DAC: 6,3 ± 0,6% vs DM + DAC: 7,6 ± 1,6% vs DM: 6,8 ± 1,7% vs Controle: 5,43 ± 0,45%). Por outro lado, a glicemia e insulina de jejum foram significativamente menores dos DAC e grupo Controle, sendo similar nos dois grupos. Dos outros parâmetros metabólicos, apenas o ácido úrico foi significativamente maior no grupo DAC (p = 0,025) em comparação aos outros. Vasodilatação da artéria braquial pós-isquemia antes do teste de sobrecarga foi semelhante entre os grupos (DAC: 7,44 ± 4,30% vs 7,01 ± 4,53% no DM vs 10,34 ± 5,10% no DM+DAC vs 9,91 ± 2,97% no grupo Controle. A vasodilatação após administração de nitrato (realizada no dia anterior ao teste de sobrecarga lipídica) também se manteve dentro da normalidade nos quatro grupos, sem diferença entre eles (DAC: 19,85 ± 8,66% vs 15,68 ± 11,43% no DM vs 21,24 ± 11,82% no DM+DAC e 20,05 ± 3,73% no grupo Controle). HOMAIR (Homeostasis Model for Assessment of insulin resistance) aumentou progressivamente nos grupos DAC, DM e DM+DAC, respectivamente, sendo significativamente menor no grupo Controle. Após sobrecarga, os níveis de triglicerídeos aumentaram significativamente nos quatro grupos, com pico nos tempos 4h e 6h (p < 0,001 nos quatro grupos para 2h, 4h, 6h e 8h vs 0h). O colesterol total apresentou aumento, com p < 0,001 para 4h e 6h e p = 0,0019 para 8h, em comparação com 0h, nos quatro grupos. O LDL-colesterol (p = 0,001) e o HDL-colesterol (p < 0,001) apresentaram decréscimo em todos os tempos após o teste em relação ao basal. Não houve diferença significativa entre os quatro grupos no perfil lipídico após sobrecarga de gordura. A glicemia foi significativamente mais baixa nos grupos DAC e Controle do que nos grupos DM e DM+DAC. Nos grupos DAC e Controle, a glicemia manteve-se inalterada durante o teste. Os grupos DM e DM+DAC apresentaram um decréscimo significativo nos níveis glicêmicos nos tempos 4h, 6h e 8h. (p<0,001 para todos os grupos em relação ao tempo 0h). O comportamento da insulinemia foi semelhante entre os grupos e todos mostraram elevação nos tempos 2h (p<0,001) vs 0h, havendo progressiva queda no decorrer dos tempos, chegando aos níveis basais na oitava hora. A reatividade vascular foi semelhante entre os quatro grupos e não houve diferença nas medidas após sobrecarga. No grupo DM ocorreu uma redução limítrofe na reatividade vascular após a ingestão da sobrecarga lipídica (p = 0,0556). A vasodilatação pós-nitroglicerina também foi semelhante entre os grupos, assim como os resultados obtidos antes e após sobrecarga quando comparados entre si. Este estudo permitiu concluir que a hiperlipemia pós-sobrecarga lipídica nos grupos DAC, DM, DM+DAC e Controle resultou em hiperinsulinemia sem elevação glicêmica, mas sem efeito significativo da reatividade vascular, tanto quando avaliada pela hiperemia reativa (endotélio-dependente), quanto quando estimulada com vasodilatador (endotélio-independente) / To assess the effect of a high-fat meal to simulate to post-prandial state during the day, on the metabolic parameters and endothelial function, four groups of male patients with Coronary Heart Disease and without Diabetes Mellitus (DAC, n= 11); with known Type 2 Diabetes Mellitus and no Coronary Heart Disease (DM, n= 10); and with both Type 2 Diabetes and Coronary Heart Disease (DM+DAC, n = 11) as well as seven healthy controls (Control n = 7) were evaluated before and after receiving a high fat (60g) low carbohydrate (14g) meal test. Lipid profile (basal and 2, 4, 6 and 8 hours after the meal-test) and Vascular reactivity (2, 4 and 8h) were measured. Vascular reactivity was evaluated using high-resolution ultrasound and assessing brachial artery\'s vasodilatory responses during reactive hyperemia (endothelium-dependent vasodilatation), and after nitroglycerin administration, an endotheliumindependent vasodilator. Mean ± SD HbA1c was not significantly by different between groups (DAC: 6.3 ± 0.6% vs DM + DAC: 7.6 ± 1.6% vs DM: 6.8 ± 1,7%) except, as expected in the Control (5.43 ± 0.45%). Furthermore, fasting plasma glucose and insulin were significantly lower in the DAC and Control being however similar in both groups. DAC group had significant by higher uric acid levels than the other three groups (p = 0.025). Post-ischemia brachial artery vasodilation was similar among groups before lipid overload (DAC: 7.44 ± 4.30% vs 7.01 ± 4.53% no DM vs 10.34 ± 5.10% no DM+DAC vs 9.91 ± 2.97% in the Control). Basal change in the brachial artery diameter after sublingual nitrate, performed the day before the fat test, was also within the accepted normal range in all four groups, with no difference in between them (DAC: 19.85 ± 8.66% vs 15.68 ± 11.43 in DM vs 21.24 ± 11.82% in DM+DAC and 20.05 ± 3.73% in the Control). Homeostasis Model for Assessment of insulin sensitivity (HOMAIR) increased significantly and progressively from DAC to DM and to DM+DAC groups, however being significantly lower in the Control. After the fat overload test all four groups had a major increase in triglyceride levels peaking at 4h and 6h after the ingestion (p<0.001) for four groups for 2h, 4h, 6h and 8h vs 0h). Total cholesterol had a increase at all times of sampling (p < 0.001), while LDL-cholesterol (p < 0.001) and HDL-cholesterol (p = 0.001) decreased after the test-meal. Overall, there were no statistical differences among the four groups regarding post load-lipid profile. Glycemia was statistically lower in DAC and Control versus DM and DM+DAC groups. In DAC and Control glicemia was unchanged during testing, DM and DM+DAC groups had a considerable glycemic decrease at times 4h, 6h and 8h after fat-load (p<0.001, for both groups vs 0h). Insulin behaviors was similar among all four groups all of which showed higher levels at 2h (p<0.001 vs 0h, there being a progressive decrease during the test becoming within the basal range at the 8th hour. Vascular reactivity was similar within the four groups and there was no difference through the different measures after fat-loading. In the diabetic group without coronary hearth disease there was a borderline reduction in vascular reactivity after the fat load (p = 0.0556). Vasodilation after nitroglycerin was comparable among the groups again with no differences in the response before and after fat-loading. In conclusion this study showed than the post-load hyperlipemia in DAC,DM, DM+DAC and Control groups resulted in hyperinsulinemia without hyperglycemia and had no significant effects on vascular reactivity both endothelial dependent (hyperemia reactivity) and independent

>Magister Scientiae - MSc / Scientific studies have shown that chronic diseases of lifestyle (CDL) such as hypertension and diabetes mellitus are major causes of mortality and morbidity, accounting for about 60% of the disease burden globally. Available statistics for Swaziland indicate that hypertension and heart diseases are on the increase and are responsible for 33,540 and 3,146 cases per year respectively. Regular physical activity (PA) is widely recognised as a means for the primary and secondary prevention of CDL due to their multi-factorial beneficial effects on an individual‟s health. Therefore, the aim of this study was to determine PA participation among adults with hypertension in Mbabane, Swaziland and the extent to which they are encouraged to be physically active. A cross-sectional design, utilising quantitative methods was employed in the study and three validated standardised interview administered questionnaires were used to collect data from both hypertensive individuals and health professionals. A sample size of 422 hypertensive individuals and 72 health professionals was included in the study. Statistical Package for Social Sciences (SPSS) version 20 was used to analyse the data. Descriptive statistics were employed to summarise data and was expressed as means, standard deviation, frequencies and percentages. The Students‟t-test was used to compare mean age and PA. Chi-square tests were used to test for associations between categorical variables with significant levels set at 5% (p < 0.05). Blood pressure was classified into controlled (≤ 140/≤ 90 mmHg) and uncontrolled (≥ 140/≥ 90 mmHg). PA was dichotomised into active (> 600 MET-minute/week) and sedentary (< 599 METminute/ week). BMI was classified as underweight (<18.5), normal (18.5-24.9), overweight (25-29.9) and obese (>30). The findings of the current study revealed that a considerable number of individuals with hypertension (53%) were physically inactive with poorly controlled blood pressure (57%). A statistical significance was found between mean age and PA (sedentary and active) (P= 0.000 ˂ 0.05). iii The study also revealed that the perceived benefits of PA as reported by individuals with hypertension outweighed the perceived barriers. In addition, the majority of health professionals were found to be poor counsellors of PA (58%). Most health professionals informed their patients on becoming physically active but did not include important components of PA counselling such as the types of PA, intensity and duration. The common reasons for not including PA as part of the daily routine include: not my area of specialty and lack of time. These factors could significantly contribute to sedentary behaviour among hypertensive individuals in developing countries such as Swaziland. For this reason, an urgent need for PA promotion programmes which will motivate hypertensive individuals to participate in sufficient levels of PA as recommended by public health research has been established. The programmes should include educating health professionals on current trends in the promotion of PA. A combination of these approaches will help to reduce morbidity and mortality from cardio-vascular disease (CVD), in particular hypertension.

No / Objectives It is hypothesised that endothelial cell reactive antibodies (ECRA) play a role in the progression of PAD through activation of endothelial cells and the release of inflammatory cytokines. We aimed to test this hypothesis by assessing levels of ECRA, E-selectin and IL-6 in patients with PAD of varying severity in a case controlled study. Design, materials, methods Patients were assessed clinically and with ankle¿brachial pressure indices. Patients with critical ischaemia (CI, n=30), stable claudicants (SC, n=30), and age-matched controls (AMC, n=20) were studied. Antibody, E-selectin and IL-6 levels were measured using ELISA. Results ECRA levels were significantly raised in the CI group over AMC. IL-6 levels were significantly elevated in both SC and CI over the control group and in CI over SC. There were no significant differences in E-selectin levels between the AMC, SC and CI. Conclusion Our findings support the hypothesis that autoantibodies play a role in promoting PAD by elevating IL-6. The absence of an elevation in E-selectin in this study may be due to its short half-life, and casts doubt on its value as a marker of inflammation in atherosclerosis.

Idiopathic normal pressure hydrocephalus (INPH) is a dementia treatable by insertion of a cerebrospinal fluid shunt. It has been suggested that INPH has similar pathophysiological mechanisms as cerebrovascular disease, but the vascular risk factor (VRF) profile of INPH patients has not been assessed using a modern epidemiological approach. The cognitive symptoms of INPH resemble the symptoms of depression, but the prevalence of depression among INPH patients is unknown. In addition, few studies investigate the impact of shunting on the quality of life (QoL), and no study has investigated the impact of comorbidity on QoL in INPH patients. The objective of this dissertation was to present the VRF profile of INPH and to investigate the hypothesis that INPH may be a subgroup of vascular dementia. Additional objectives were to assess the prevalence of depression in INPH patients and to investigate the impact of shunting and comorbidities on QoL in INPH. In the first cohort, the prevalence of possible INPH was assessed through clinical and radiological examinations in patients with a transient ischemic attack (TIA), consecutively admitted to the same hospital during 2006-2008. In the second cohort, VRFs, vascular disease and QoL were analysed in INPH patients consecutively shunted 2008-2010 in five out of six neurosurgical centres in Sweden. Patients remaining after inclusion (n=176, within the age-span 60-85 years and not having dementia) were compared to population-based age- and gender-matched controls (n=368, same inclusion criteria as for the INPH patients). Assessed VRFs were: hypertension, diabetes, obesity, hyperlipidemia, psychosocial factors (stress and depression), smoking, alcohol intake, physical activity and, dietary pattern. Cardiovascular, cerebrovascular and peripheral vascular disease as well as QoL were also assessed. Parameters were assessed through questionnaires, clinical examinations, measurements, ECG and, blood samples. In the first cohort, 4% of the TIA patients had clinically and radiologically verified INPH. In the second cohort, VRFs were overrepresented among the INPH patients compared with the controls. The VRFs independently associated with INPH were: hyperlipidemia (Odds ratio (OR): 2.4, 95%CI: 1.4-4.0), diabetes (OR: 2.2, 95%CI: 1.2-3.9), obesity (OR: 5.4, 95%CI: 2.5-11.8) and, psychosocial factors (OR: 5.3, 95%CI: 3.2-8.9). When adding the VRFs that were overrepresented in INPH, although not independently (physical inactivity and hypertension), these six VRFs accounted for 24% of the INPH cases in the elderly population (population attributable risk %: 24). Depression was overrepresented in shunted INPH patients compared to the controls (46% vs. 13%, p&lt;0.001) and the main predictor for low QoL was a coexisting depression (p&lt;0.001). In conclusion, the results of the INPH-CRasH study are consistent with a vascular pathophysiological component of INPH and indicate that INPH may be subgroup of vascular dementia. In clinical care and research, a complete risk factor analysis as well as screening for depression and a measurement for quality of life should be included in the work-up of INPH patients. The effect of targeted interventions against modifiable VRFs and anti-depressant treatment in INPH patients should be evaluated. / Idiopatisk normaltryckshydrocefalus (INPH, från engelskans ”idiopathic normal pressure hydrocephalus”) är en neurokirurgiskt behandlingsbar demens. Behandlingen är att operera in en shunt som dränerar cerebrospinalvätska från ventriklarna. Det har föreslagits att INPH skulle kunna orsakas av liknande patofysiologiska mekanismer som vid cerebrovaskulär sjukdom, men den vaskulära riskfaktorprofilen hos INPH-patienter har aldrig undersökts i en modern epidemiologisk studie. De kognitiva symtomen vid INPH påminner om symtomen vid depression, men prevalensen av depression hos INPH-patienter är okänd. Få studier undersöker hur shuntning påverkar livskvalitet och ingen studie har undersökt hur komorbiditet påverkar livskvaliteten vid INPH. Syftet med den här avhandlingen var att undersöka den vaskulära riskfaktorprofilen hos INPH-patienter samt att utforska hypotesen att INPH skulle kunna vara en undergrupp till vaskulär demens. Ytterligare ett syfte med avhandlingen var att undersöka hur många INPH-patienter som har depression samt undersöka hur shunting och komorbiditet påverkar livskvalitet vid INPH. I den första kohorten undersöktes kliniska och radiologiska fynd som tydde på INPH hos de patienter som blivit diagnostiserade med en TIA (från engelskans: transient ischemic attack) 2006-2008 på Norrlands Universitetssjukhus i Umeå. I den andra kohorten undersöktes konsekutivt shuntade INPH-patienter 2008-2010 från fem av sex neurokirurgiska kliniker i Sverige. De patienter som inkluderades i studien (n=176, ålder: 60-85 år, ej dementa) jämfördes med köns- och åldersmatchade kontroller från normalpopulationen (n=368, samma inklusionskriterier som för INPH-patienterna). De riskfaktorer som undersöktes var: hypertension, hyperlipidemi, diabetes, fetma, psykosociala faktorer (stress och depression), rökning, alkohol, fysisk aktivitet och diet. Även kardiovaskulära och cerebrovaskulära sjukdomar undersöktes, liksom perifer vaskulär sjukdom samt livskvalitet. Datainsamling skedde genom frågeformulär, kliniska undersökningar, mätningar, EKG och blodprov. I den första kohorten hade 4% av TIA-patienterna kliniskt och radiologiskt verifierad INPH. I den andra kohorten var vaskulära riskfaktorer överrepresenterade hos INPH-patienterna jämfört med iv normalpopulationen. Hyperlipidemi (OR: 2.4, 95%CI: 1.4-4.0), diabetes (OR: 2.2, 95%CI: 1.2-3.9), fetma (OR: 5.4, 95%CI: 2.5-11.8) och psykosociala faktorer (OR: 5.3, 95%CI: 3.2-8.9) var associerade med INPH oberoende av kön, ålder och de andra riskfaktorerna. Hypertension och fysisk inaktivitet var också associerade med INPH, dock inte oberoende av övriga riskfaktorer. Sammanlagd PAR% (från engelskans: population attributable risk %) för de här sex riskfaktorerna var 24%. INPH-patienterna hade depression i högre utsträckning än kontrollerna (46% vs. 13%, p&lt;0.001), och depression var den viktigaste prediktorn för låg livskvalitet. Resultaten tyder på att vaskulär sjukdom och vaskulära riskfaktorer är involverade i den patofysiologiska mekanismen vid INPH. INPH kan vara en undergrupp till vaskulär demens. En fullständig riskfaktoranalys och screening för depression bör ingå i den preoperativa utvärderingen såväl som i forskning på INPH-patienter, och ett mått på livskvalitet bör införas. Effekten av riktade insatser mot såväl vaskulära riskfaktorer som depression vid INPH bör utvärderas.

Tyrimo objektas. 27–90 metų asmenys, sergantys pirmojo ir antrojo tipo diabetu ir periferinių arterijų liga, gydyti Vilniaus universiteto kraujagyslių chirurgijos centre Vilniaus miesto universitetinėje ligoninėje 1997–2011 m. Tyrimo tikslas. Nustatyti Vilniaus universiteto kraujagyslių chirurgijos centre Vilniaus miesto universitetinėje ligoninėje gydytų pacientų, sergančių diabetu, periferinių arterijų ligos ypatumus, PAL padarinius ir PAL padarinių rizikos veiksnius. Tyrimo medžiaga ir metodai. Išanalizuotos 925 pacientų, sergančių 1 ir 2 tipo diabetu ir 1997–2011 metais gydytų Vilniaus universiteto kraujagyslių chirurgijos centre Vilniaus miesto universitetinėje ligoninėje nuo periferinių arterijų ligos istorijos. Statistinė analizė atlikta SPSS 19.0 for Windows programų paketu. Pasirinktas statistinio reikšmingumo lygmuo &#945;=0,05. Rezultatai. Ištyrėme 387 moterų ir 538 vyrų, duomenis. Vidutinis tiriamųjų amžius buvo 67,99±9,47 metų. 95,6 proc. tiriamųjų sirgo 2 tipo diabetu. Vidutinė sirgimo diabetu trukmė buvo 12,95±9,91 metų. Diabetinę angiopatiją turėjo 47,8 proc. tiriamųjų, nefropatiją – 34,9 proc., retinopatiją – 14,6 proc., polineuropatiją – 33,7 proc.. Statistiškai reikšmingai dažniau nefropatija, retinopatija ir polineuropatija buvo nustatyta pacientams, sergantiems 1 tipo diabetu. Pacientai dažniausiai sirgo širdies ir kraujagyslių sistemos ligomis. 21,2 proc. tiriamųjų jau buvo patyrę galūnių amputacijas. Vidutinė hospitalizacijos trukmė buvo 17,3±10,80... [toliau žr. visą tekstą] / Object of the research. 27–90 years old patients having the type 1 and type 2 diabetes mellitus and peripheral artery disease, who were treated at the Vilnius University Vascular Surgery Center in the Vilnius town University Hospital in the year 1997–2011. The aim of our research was. To analyse aspects of peripheral artery disease in patients with diabetes mellitus, who were cured at Vilnius University Vascular Surgery Center in the Vilnius town University Hospital as well as to determine the consequenses of PAD and the risk factors PAD. Material and methods of the research. 925 cases of the type 1 and type 2 diabetes mellitus were explored at the Vilnius University Vascular Surgery center in the Vilnius town University hospital in the year 1997–2011, who received treatment for the peripheral artery disease. The statistic survey has been done using the program pack SPSS 19.0 for Windows. Statistic importance level &#945;=0.05. Results. Data about 378 women and 538 men have been explored. An average age of all the patients was 67.99±9.47 years. 95.6% of patients had the type 2 diabetes mellitus. An average duration of having disease was 12.95±9.91 years, 47.8% of cases had diabetic angiopathy, 34.9% of patients had nephropaty, 14.6% of cases had retinopathy, 33.7% of all the cases had polyneuropathy. According to the statistic importance rates retinopathy, nephropathy, polyneuropathy are more often among patients with the type 1 diabetes mellitus. Cardiovascular diseases were... [to full text]

This thesis deals with diseased peripheral blood vessels, namely thrombosis of veins affecting limbs and the pelvic area and acute arterial blockages in extremities. In addition to data concerning these illnesses, the thesis also presents the treatment of these patients and treatment of those patients who are given anti-coagulants either preventatively or as part of treatment. The empirical portion includes quantitative research through an anonymous survey instrument. The respondents were nurses who worked in internal, surgery, or general units of intensive care in university and regional hospitals. The goal of the research was to determine whether nurses are aware of the general areas of non-coronary blood-vessel issues and of the idiosyncrasies of treatment of patients with warfarin and heparin, and whether the nurses were aware of the idiosyncrasies of treatment of patients with non-coronary arterial blockages. We discovered that nurses were most aware of the idiosyncrasies of treatment of patients with warfarin and heparin. On the other hand, the nurses had almost no awareness of the idiosyncrasies of treatment of patients with non-coronary arterial blockages. Exactly half of the respondents were aware of the general areas of non-coronary blood-vessel issues. The conclusion of the thesis...

Introdução: A Doença Vascular do Enxerto (DVE), um processo envolvendo fatores de natureza inflamatória e proliferativa, é a principal causa de morte após o Transplante Cardíaco (TxC), com incidência acima de 50 % ao fim do quinto ano. É possível que a intervenção farmacológica nesses fatores possa resultar na inibição da proliferação de células musculares lisas vasculares e melhora da DVE. Neste sentido, em trabalho anterior desta Instituição, o paclitaxel, agente antiproliferativo usado no tratamento do câncer, foi capaz de regredir as lesões ateromatosas em coelhos com aterosclerose induzida por dieta rica em colesterol. Naquele trabalho, o paclitaxel foi concentrado nas lesões utilizando-se uma nanopartícula lipídica, parecida com a lipoproteína de baixa densidade (LDL), mas sem a parte protéica, denominada LDE. Tendo em vista as dificuldades do tratamento da DVE em pacientes e da grande importância dessa doença para o êxito do procedimento, novas alternativas terapêuticas devem ser procuradas, e o uso do paclitaxel associado à LDE pode ser uma rota interessante, tendo em vista que as bases inflamatórias e proliferativas da DVE são semelhantes às da doença cardiovascular aterosclerótica, onde a LDE-paclitaxel mostrou-se eficiente. Objetivos: Verificar se o tratamento com LDE-Paclitaxel reduz a incidência e o grau de DVE de coelhos submetidos a transplante cardíaco heterotópico. Analisar a biodistribuição da LDE em coelhos submetidos a transplante cardíaco heterotópico. Método: TxC heterotópico em posição cervical foi realizado utilizando-se 21 coelhos da raça New Zealand vermelhos como doadores e 21 coelhos brancos como receptores (peso ± 3 kg). Os coelhos receptores receberam dieta com acréscimo de 0,5 % de colesterol e ciclosporina A na dose de 10 mg/kg/dia via oral como imunossupressor. Foram divididos em 2 grupos: um grupo, constituído de 11 animais, foi tratado com LDE-Paclitaxel na dose de 4 mg/kg/semana, durante 6 semanas, por via endovenosa. O outro grupo (controle) compôs-se de 10 animais tratados com 3 mL de solução fisiológica por via endovenosa, semanalmente, durante 6 semanas. A biodistribuição da LDE foi determinada em 4 animais do grupo controle, injetando-se a LDE marcada com éter de colesterol radioativo 24 h antes do sacrifício, seguindose a contagem de radioatividade nos corações e outros tecidos após extração lipídica. Após o sacrifício dos animais, retiraram-se os corações nativo e transplantado para análise histológica com coloração H/E e Verhoeff-van Gieson. A área transversal das artérias coronárias foi estimada pela medida da lamina elástica interna e da área do lúmen. A porcentagem de estenose foi calculada da diferença entre área do lúmen do vaso e a área da lamina elástica interna. Análise estatística com ANOVA e o teste T, com valor p <= 0,05 considerado significante. Resultados: A captação da LDE pelo coração transplantado foi quase 4 vezes maior do que no coração nativo (p<=0,0001). Nos animais tratados com LDE-paclitaxel, houve uma dramática melhora no status das artérias coronárias dos corações transplantados, ocorrendo um acentuado aumento de 3 vezes na área da luz dos vasos (p<=0,031) e de redução da estenose em 45% (p<=0,0008). Conclusões: A LDE é capaz de concentrar-se no coração transplantado, o que possibilita o direcionamento do paclitaxel para o enxerto. O tratamento com LDE-paclitaxel reduziu acentuadamente a DVE, o que pode abrir uma nova perspectiva para o controle da doença vascular do enxerto. / Introduction: Cardiac Allograft Vasculopathy (CAV), a process involving factors of inflammatory and proliferative nature, is the leading cause of death after heart transplantation (HT), with incidence above 50% after the fifth year. It is possible that pharmacological intervention on these factors may result in inhibiting the proliferation of vascular smooth muscle cells and improves the CAV. Thus, in previous studies of this institution, paclitaxel, an antiproliferative agent used in cancer treatment, was able to recede the atheromatous lesions in rabbits with atherosclerosis induced by high cholesterol diet. In that study, paclitaxel was concentrated in the lesions using a lipid nanoparticle, similar to low density lipoprotein (LDL) but without the protein part, called LDE. Given the difficulties of the treatment of CAV in HT patients and the great importance of this disease to the success of the procedure, new therapeutic alternatives must be sought, and the use of paclitaxel associated to LDE can be an interesting route, given that the bases inflammatory and proliferation of CAV are similar to those of atherosclerotic cardiovascular disease, where the LDE-paclitaxel was efficient. Objectives: To determine whether treatment with LDE-paclitaxel reduces the incidence and degree of CAV in rabbits undergoing heterotopic heart transplantation. To analyze the biodistribution of LDE in rabbits undergoing heterotopic heart transplantation. Methods: Heterotopic HT in cervical position was performed using 21 New Zealand red rabbits as donors and 21 white rabbits as recipients (weight ± 3 kg). The receptors rabbits were fed regular chow with added 0.5% cholesterol and with cyclosporine A, 10 mg / kg / day orally as immunosuppressants. They were divided into two groups: one consisting of 11 animals was treated with LDE-paclitaxel at a dose of 4 mg / kg / week for 6 weeks intravenously. The other group (control) was composed of 10 animals treated with 3 ml of saline intravenously weekly for six weeks. The biodistribution of LDE was determined in four control animals, by injecting the LDE labeled with radioactive cholesteryl ether 24 h before sacrifice, followed by radioactivity count in the hearts and other tissues after lipid extraction. After sacrificing the animals, we excised the native and transplanted hearts for histological staining with H / E and Verhoeff-van Gieson. The cross-sectional area of the coronary arteries was estimated by measuring the internal elastic lamina and the lumen area. The percentage of stenosis was calculated from the difference between the area of the vessel lumen and the area of internal elastic lamina. Statistical analysis with ANOVA and T test with p value <= 0.05 was considered significant. Results: The uptake of LDE for the transplanted heart was almost fourfold higher than in the native heart (p<=0.0001). In animals treated with LDE-paclitaxel, there was a dramatic improvement in the status of the coronary arteries of the transplanted hearts, indicating by a marked increase of three times of the vascular lumen area (p<=0.031) and reduction of stenosis in 45% (p<=0.0008). Conclusions: The LDE is able to concentrate on the transplanted heart, which enables the targeting of paclitaxel to the graft. Treatment with LDE-paclitaxel markedly reduced CAV in the transplanted heart, which may open a new perspective for control of Cardiac Allograft Vasculopathy.