Raquel Rodrigues Britto

Role of Angiotensin-(1-7) in the Modulation of the Baroreflex in Renovascular Hypertensive Rats

In this study, we evaluated the effect produced by lateral ventricle (intracerebroventricular, I.C.V.) infusion of the selective angiotensin (Ang)-(1-7) antagonist, D-Ala7-Ang-(1-7) (A-779), in the modulation of the baroreflex control of heart rate in two-kidney, one clip renovascular hypertensive rats (2K1C) treated with the angiotensin-converting enzyme (ACE) inhibitor enalapril. Twenty days after the surgery to produce renovascular hypertension, I.C.V. cannulas were implanted in the rats with blood pressure (BP) greater than 145 mm Hg (n=33) and in sham-operated rats (n=32). Five days later, the rats were treated with enalapril (10 mg x kg(-1) x d(-1); 6 days, in the drinking water) or vehicle (tap water). On the sixth day of treatment, direct continuous BP recording and measurement of reflex changes in heart rate elicited by phenylephrine were made in conscious rats before and at 1 hour of I.C.V. infusion of saline (8 microL/h) or A-779 (4 microg/h). To evaluate the degree of ACE blockade produced by enalapril treatment, the pressor effect of Ang I (50 ng, I.V., and 100 ng, I.C.V.) and plasma ACE activity was determined. As expected, enalapril treatment in 2K1C produced a significant fall in BP, significant attenuation in the pressor response of Ang I (I.V.), and a reduction in plasma ACE activity. In addition, enalapril treatment increased the baroreflex sensitivity (0.76+/-0.04 versus 0.43+/-0.04 ms/mm Hg in 2K1C untreated rats). I.C.V. infusion of A-779 reverted the improvement in baroreflex sensitivity produced by enalapril treatment in 2K1C (from 0.80+/-0.07 to 0.42+/-0.08 ms/mm Hg) and also attenuated the baroreflex sensitivity in untreated 2K1C (0.36+/-0.05 versus 0.48+/-0.06 ms/mm Hg) and untreated sham-operated rats (1.21+/-0.05 versus 0.78+/-0.17 ms/mm Hg). These results suggest that central endogenous Ang-(1-7) is involved at least in part in the improvement of baroreflex sensitivity observed in 2K1C after peripheral chronic ACE inhibition.

Teste de caminhada de seis minutos em diferentes faixas etárias e índices de massa corporal

Six-minute walk test at different ages and body mass index Introduction: Submaximal tests have been chosen to evaluate functional status because of their practicality and low cost. Objective: To correlate the distance walked during a six-minute test with age and body mass index, and to verify the need for applying a second test. Method: 122 healthy Brazilians aged between 18 and 80 years who had a sedentary lifestyle performed two tests that consisted of walking as far as possible over a six-minute period. Their weights and heights were assessed by calculating the body mass index. The data were expressed as means and standard deviations. The statistical analyses were performed using Students t test, ANOVA and Pearsons correlation. Results: A strong correlation was found between the two distances walked when all the subjects were analyzed without age divisions. When the subjects were divided into three groups according to age, there were significant differences (p 60 years)= 457.39 m ± 64.1. The subjects with body mass index 25 and 35 (457.35 m ± 92.18). Conclusion: The results found in this study confirm the reproducibility of the six-minute walk test and the sensitivity that this test has for evaluating the performance and functional capacity of individuals with different ages and body mass index.

Inspiratory Muscular Training in Chronic Stroke Survivors: A Randomized Controlled Trial

OBJECTIVE To assess the effectiveness of inspiratory muscular training (IMT) on measures of strength, resistance, functional performance, and quality of life (QOL) for chronic stroke survivors. DESIGN Double-blinded randomized controlled trial. SETTING Research laboratory. PARTICIPANTS Subjects (N=21) with stroke (11 men, 10 women; maximal inspiratory pressure [MIP] <90% of predicted values) were randomly assigned to the experimental (n=11) and control groups (n=10); 18 participants completed all testing and training. INTERVENTIONS Interventions were based on home-based training, with resistance adjusted biweekly to 30% of MIP for the experimental group. The control group underwent the same protocol without the threshold resistance valve. Both groups received home training 30 minutes a day 5 times a week for 8 weeks. MAIN OUTCOME MEASURES MIP, inspiratory muscular endurance (IME), functional performance, and QOL. RESULTS There were significant between-group differences for the MIP and IME measures. Significant changes were observed for only the experimental group for MIP (67.8±14.6 at baseline to 102.2±26.0cmH(2)O at posttraining) and IME (31.8±19.3 to 49.2±21.1cmH(2)O). No statistically significant differences were observed for measures of functional performance and QOL. CONCLUSIONS Significant short-term effects of the IMT program for inspiratory strength and endurance were observed in chronic stroke survivors. These findings gave some indications that IMT may benefit people with stroke, and it is feasible to be included in rehabilitation interventions with this population.

Pressões respiratórias máximas: valores encontrados e preditos em indivíduos saudáveis

Maximal respiratory pressures: actual and predicted values in healthy subjects Objective: To compare actual values for maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) found in a sample of healthy individuals from the State of Minas Gerais (Brazil) with the values predicted from the equations put forward by Neder et al. 3 . Method: Using an analog manovacuometer, 100 healthy subjects (54 women and 46 men aged 20-80 years old) were studied. Statistical analysis was performed using parametric or non-parametric tests, depending on the distribution of the variables, and p< 0.05 was considered to be significant. Results: For MIP in women, the mean of the actual values was significantly lower than the mean of the predicted values (68.24 ± 29.48 vs. 86.53 ± 8.76; p= 0.000) and there was a moderate and significant correlation (r= 0.557; p< 0.000). For MIP in men, no significant difference was observed between the actual and predicted values (104.67 ± 42.66 vs. 116.78 ± 14.02; p= 0.055) and there was a low and non-significant correlation (r= 0.236; p= 0.115). For MEP in women, there was no significant difference between the actual and predicted values (80.37 ± 33.32 vs. 85.88 ± 10.90; p= 0.164) and there was a low and non-significant correlation (r= 0.149; p= 0.283). For MEP in men, the mean of the actual values was significantly higher than the mean of the predicted values (142.28 ± 43.89 vs. 126.30 ± 14.19; p= 0.017) and there was a low and non-significant correlation (r= 0.159; p= 0.290). Conclusion: Considering that concordance between actual and predicted values requires the lack of difference and the existence of correlation between them, the equations proposed by Neder et al. 3 were not successful in predicting MIP and MEP values in the population studied.

Breathing pattern, thoracoabdominal motion and muscular activity during three breathing exercises

The objective of the present study was to evaluate breathing pattern, thoracoabdominal motion and muscular activity during three breathing exercises: diaphragmatic breathing (DB), flow-oriented (Triflo II) incentive spirometry and volume-oriented (Voldyne) incentive spirometry. Seventeen healthy subjects (12 females, 5 males) aged 23 +/- 5 years (mean +/- SD) were studied. Calibrated respiratory inductive plethysmography was used to measure the following variables during rest (baseline) and breathing exercises: tidal volume (Vt), respiratory frequency (f), rib cage contribution to Vt (RC/Vt), inspiratory duty cycle (Ti/Ttot), and phase angle (PhAng). Sternocleidomastoid muscle activity was assessed by surface electromyography. Statistical analysis was performed by ANOVA and Tukey or Friedman and Wilcoxon tests, with the level of significance set at P < 0.05. Comparisons between baseline and breathing exercise periods showed a significant increase of Vt and PhAng during all exercises, a significant decrease of f during DB and Voldyne, a significant increase of Ti/Ttot during Voldyne, and no significant difference in RC/Vt. Comparisons among exercises revealed higher f and sternocleidomastoid activity during Triflo II (P < 0.05) with respect to DB and Voldyne, without a significant difference in Vt, Ti/Ttot, PhAng, or RC/Vt. Exercises changed the breathing pattern and increased PhAng, a variable of thoracoabdominal asynchrony, compared to baseline. The only difference between DB and Voldyne was a significant increase of Ti/Ttot compared to baseline. Triflo II was associated with higher f values and electromyographic activity of the sternocleidomastoid. In conclusion, DB and Voldyne showed similar results while Triflo II showed disadvantages compared to the other breathing exercises.

Reference equations for the six-minute walk distance based on a Brazilian multicenter study

Background It is important to include large sample sizes and different factors that influence the six-minute walking distance (6MWD) in order to propose reference equations for the six-minute walking test (6MWT). Objective To evaluate the influence of anthropometric, demographic, and physiologic variables on the 6MWD of healthy subjects from different regions of Brazil to establish a reference equation for the Brazilian population. Method In a multicenter study, 617 healthy subjects performed two 6MWTs and had their weight, height, and body mass index (BMI) measured, as well as their physiologic responses to the test. Delta heart rate (∆HR), perceived effort, and peripheral oxygen saturation were calculated by the difference between the respective values at the end of the test minus the baseline value. Results Walking distance averaged 586±106m, 54m greater in male compared to female subjects (p<0.001). No differences were observed among the 6MWD from different regions. The quadratic regression analysis considering only anthropometric and demographic data explained 46% of the variability in the 6MWT (p<0.001) and derived the equation: 6MWDpred=890.46-(6.11×age)+(0.0345×age2)+(48.87×gender)-(4.87×BMI). A second model of stepwise multiple regression including ∆HR explained 62% of the variability (p<0.0001) and derived the equation: 6MWDpred=356.658-(2.303×age)+(36.648×gender)+(1.704×height)+(1.365×∆HR). Conclusion The equations proposed in this study, especially the second one, seem adequate to accurately predict the 6MWD for Brazilians.

Potentiation of the hypotensive effect of bradykinin by angiotensin-(1-7)-related peptides.

In this study, we evaluated the bradykinin potentiating activity and ACE inhibitory activity of several Ang-(1-7)-related peptides: Ang-(2-7), Ang-(3-7), Ang-(4-7), Ang-(1-6), Ang-(1-5) and the selective antagonist of Ang-(1-7): D-[Ala7]Ang-(1-7) (A-779). In vivo experiments were performed in freely moving Wistar rats. ACE activity was evaluated by a fluorometric assay in rat plasma using Hip-His-Leu as a substrate. Intravenous injections of Ang-(1-7) (2.2 nmol) transformed the effect of a single dose of bradykinin (1 nmol) into the effect produced by a double dose. A similar bradykinin potentiating activity was demonstrated for Ang-(2-7) and Ang-(3-7). On the other hand, Ang-(1-5), Ang-(1-6), Ang-(4-7) and A-779 did not change the hypotensive effect of bradykinin in doses ranging from 8 up to 25 nmols. The hypotensive effect of bradykinin was increased by intravenous infusion (0.3 ng/min) of Ang-(1-7) > Ang-(2-7) > Ang-(3-7). Conversely, Ang-(1-5), Ang-(1-6), Ang-(4-7) or A-779 did not change the hypotensive effect of bradykinin. ACE inhibition with Ang-(1-7) related peptides occurred in the order: Ang-(2-7) > or = Ang-(3-7) > Ang-(1-7) [>>] Ang-(1-5) > Ang-(4-7) > or = Ang-(1-6) > or = A-779. A-779 in concentrations up to 10(-5) M did not change the ACE inhibitory activity of Ang-(1-7). These results suggest that Ang-(1-7), Ang-(2-7) and Ang-(3-7) can modulate bradykinin actions in vivo. More important, our data pointed out that alternative mechanisms besides interaction with ACE are required to explain the bradykinin potentiating activity of Ang-(1-7).

Assessment of tidal volume and thoracoabdominal motion using volume and flow-oriented incentive spirometers in healthy subjects

The objective of the present study was to evaluate incentive spirometers using volume- (Coach and Voldyne) and flow-oriented (Triflo II and Respirex) devices. Sixteen healthy subjects, 24 +/- 4 years, 62 +/- 12 kg, were studied. Respiratory variables were obtained by respiratory inductive plethysmography, with subjects in a semi-reclined position (45 masculine). Tidal volume, respiratory frequency, minute ventilation, inspiratory duty cycle, mean inspiratory flow, and thoracoabdominal motion were measured. Statistical analysis was performed with Kolmogorov-Smirnov test, t-test and ANOVA. Comparison between the Coach and Voldyne devices showed that larger values of tidal volume (1035 +/- 268 vs 947 +/- 268 ml, P = 0.02) and minute ventilation (9.07 +/- 3.61 vs 7.49 +/- 2.58 l/min, P = 0.01) were reached with Voldyne, whereas no significant differences in respiratory frequency were observed (7.85 +/- 1.24 vs 8.57 +/- 1.89 bpm). Comparison between flow-oriented devices showed larger values of inspiratory duty cycle and lower mean inspiratory flow with Triflo II (0.35 +/- 0.05 vs 0.32 +/- 0.05 ml/s, P = 0.00, and 531 +/- 137 vs 606 +/- 167 ml/s, P = 0.00, respectively). Abdominal motion was larger (P < 0.05) during the use of volume-oriented devices compared to flow-oriented devices (52 +/- 11% for Coach and 50 +/- 9% for Voldyne; 43 +/- 13% for Triflo II and 44 +/- 14% for Respirex). We observed that significantly higher tidal volume associated with low respiratory frequency was reached with Voldyne, and that there was a larger abdominal displacement with volume-oriented devices.

Precisão e acurácia da cirtometria em adultos saudáveis

OBJECTIVE To determine the intrarater and interrater reliability of cirtometry (measurements of the circumference of the chest and abdomen taken during respiratory movements) as well as its correlation with pulmonary volumes measured by respiratory inductive plethysmography. METHODS A total of 40 healthy individuals were evaluated. The mean age was 28 years. The measurements were taken in the supine position at three different time points: at rest, at maximal inspiration, and at maximal expiration. Two trained investigators, each of whom was blinded as to the results obtained by the other, performed the measurements. The Friedman test was used to determine intrarater reliability, and the Wilcoxon test, together with the intraclass correlation coefficient, were used to determine interrater reliability. The correlation between the cirtometry measurements and the plethysmography results was obtained using Spearmans correlation coefficient. The level of significance was set at 0.05 for all tests. RESULTS Intrarater reliability was satisfactory. Regarding interrater reliability, statistically significant differences (2.8 cm at the most) were found in all sets of measurements. However, through the analysis of the intraclass correlation coefficient, the investigators were found to be responsible only for a small portion of the variability (1.2-5.08%) found among the measurements. When the cirtometry measurements were compared to the volumes measured by respiratory inductive plethysmography, low correlations (range, r = 0.170-0.343) were found. CONCLUSIONS The findings of this study suggest that, although cirtometry is a reliable measurement, it does not accurately measure pulmonary volumes.

Correlação entre classificação clínica ceap e qualidade de vida na doença venosa crônica

OBJECTIVES To evaluate the quality of life (QOL) of patients with chronic venous disease (CVD) and to analyze the relationship between QOL and disease severity. METHODS This was a cross-sectional study with a convenience sample of 50 participants with a diagnosis of CVD. The participants were classified according to disease severity using the CEAP clinical classification (Clinical manifestations, Etiological factors, Anatomical distribution of disease, Pathophysiological findings). They were then divided into two groups: CEAP 1, 2 and 3 (less clinically compromised) and CEAP 4, 5 and 6 (more clinically compromised). QOL was evaluated using the SF-36 questionnaire. The Mann-Whitney U test was used to compare the SF-36 scores between the groups. The Spearman correlation was used to evaluate the association between QOL and the CEAP. Differences were considered statistically significant with p < 0.05. The SPSS statistical software version 16.0 was used for the analyses. RESULTS Seventy-four percent of the sample was female. The mean age was significantly higher (p<0.001) among participants classified as CEAP 4, 5 and 6 (56.6+/-10.3) than among those classified as CEAP 1, 2 and 3 (40.6+/-10.7). All the domains of the physical component of the SF-36 presented significantly lower scores in the CEAP 4, 5 and 6 group (p<0.05), thus showing greater physical and functional impairment. Only the domains of the physical component presented statistically significant negative correlations with the CEAP. CONCLUSIONS The physical and functional characteristics were more impaired, especially in the more severe forms of CVD. These findings may contribute to a better understanding of the effects of CVD on QOL and better management of therapeutic interventions in this population.