Thiago Dipp

The effects of periodized concurrent and aerobic training on oxidative stress parameters, endothelial function and immune response in sedentary male individuals of middle age.

The vascular endothelium plays a key role in arterial wall homeostasis by preventing atherosclerotic plaque formation. A primary causal factor of endothelial dysfunction is the reactive oxygen species. Aerobic exercise is ascribed as an important adjuvant therapy in endothelium‐dependent cardiovascular disease. However, little is known about the effects of concurrent (aerobicu2009+u2009strength) training on that. For a comparison of the effects of aerobic and concurrent physical training on endothelial function, oxidative stress parameters and the immunoinflammatory activity of monocytes/macrophages, 20 adult male volunteers of middle age were divided into a concurrent training (CT) programme group and an aerobic training group. The glutathione disulphide to glutathione ratio (GSSG/GSH) and plasma lipoperoxide (LPO) levels, as well as flow‐mediated dilation (FMD), monocyte/macrophage functional activity (zymosan phagocytosis), body lipid profiles, aerobic capacity (maximal oxygen uptake) and strength parameters (one‐repetition maximum test), were measured before and after the exercise training programmes. The CT exhibited reduced acute effects of exercise on the GSSG/GSH ratio, plasma LPO levels and zymosan phagocytosis. The CT also displayed improved lipid profiles, glycaemic control, maximal oxygen uptake and one‐repetition maximum test values. In both the aerobic training and the CT, training improved the acute responses to exercise, as inferred from a decrease in the GSSG/GSH ratios. The aerobic sessions did not alter basal levels of plasma LPO or macrophage phagocytic activity but improved FMD values as well as lipid profiles and glycaemic control. In summary, both training programmes improve systemic redox status and antioxidant defences. However, the aerobic training was more efficient in improving FMD in the individuals studied. Copyright

Força muscular respiratória e capacidade funcional na insuficiência renal terminal

OBJECTIVE: to evaluate the association of respiratory muscle strength with functional capacity, lower limb strength and biochemical variables in hemodialysis (HD) patients. METHODS: a cross-sectional study involving 30 patients (18 male), 53.4 ± 12.9 years, 41.1 ± 55.7 months on HD therapy. Maximal inspiratory pressure (PImax), maximal expiratory pressure (PEmax), distance completed in a six-minute walk test (6MWT) and number of repetitions in sit-and-stand test (STST) were evaluated. The biochemical variables were recorded in the database routine work service. RESULTS: LogEPmax and 6MWT values were significantly lower than the predicted values (p = 0.015; p < 0.001, respectively). logPImax and logPEmax were correlated with number of repetitions in STST (r = 0.476, p = 0.008; r = 0.540, p = 0.002, respectively) and with phosphorus blood levels (r = 0.422, p = 0.020; r = 0.639, p < 0.001, respectively). 6MWT was correlated with logPEmax (r = 0.511; p = 0.004) and with number of repetitions in STST (r = 0.561; p = 0.001). CONCLUSION: PEmax reduction in patients with ESRD on HD is associated with functional capacity, lower limb strength and phosphorus blood levels, and may at least partly represent the low physical and functional performance of these patients.

Endothelial function in patients with slow coronary flow and normal coronary angiography

Atherosclerotic heart disease usually manifests as angina and is diagnosed by stress imaging tests and coronary angiography (1), but some patients with typical angina and documented myocardial ischemia have normal coronary arteries (2), a clinical picture called cardiac syndrome X (3). Endothelial (4) and microvascular (5) dysfunction have been suggested to play a pathogenic role in this situation. Patients with slow coronary flow (SCF) (6) and endothelial dysfunction (7) are both at increased risk for cardiovascular events. Several methods to measure endothelial injury can provide clinical opportunities to identify these patients (8), but the evaluation of endothelial function in arterial and venous vascular beds has not yet been performed. The aim of this study was to evaluate the arterial and venous endothelial functions in patients with stable angina and normal coronary anatomy but SCF on a cardiac angiogram.

VEGF 165 gene therapy for patients with refractory angina: mobilization of endothelial progenitor cells

Background Vascular endothelial growth factor (VEGF) induces mobilization of endothelial progenitor cells (EPCs) with the capacity for proliferation and differentiation into mature endothelial cells, thus contributing to the angiogenic process. Objective We sought to assess the behavior of EPCs in patients with ischemic heart disease and refractory angina who received an intramyocardial injections of 2000 µg of VEGF 165 as the sole therapy. Methods The study was a subanalysis of a clinical trial. Patients with advanced ischemic heart disease and refractory angina were assessed for eligibility. Inclusion criteria were as follows: signs and symptoms of angina and/or heart failure despite maximum medical treatment and a myocardial ischemic area of at least 5% as assessed by single-photon emission computed tomography (SPECT). Exclusion criteria were as follows: age > 65 years, left ventricular ejection fraction < 25%, and a diagnosis of cancer. Patients whose EPC levels were assessed were included. The intervention was 2000 µg of VEGF 165 plasmid injected into the ischemic myocardium. The frequency of CD34+/KDR+ cells was analyzed by flow cytometry before and 3, 9, and 27 days after the intervention. Results A total of 9 patients were included, 8 males, mean age 59.4 years, mean left ventricular ejection fraction of 59.3% and predominant class III angina. The number of EPCs on day 3 was significantly higher than that at baseline (p = 0.03); however, that on days 9th and 27th was comparable to that at baseline. Conclusion We identified a transient mobilization of EPCs, which peaked on the 3th day after VEGF 165 gene therapy in patients with refractory angina and returned to near baseline levels on 9th and 27thdays.

Effects of Intradialytic Neuromuscular Electrical Stimulation on Strength and Muscle Architecture in Patients With Chronic Kidney Failure: Randomized Clinical Trial

This study aimed to evaluate the effects of neuromuscular electrical stimulation (NMES) on muscle strength and architecture, functional capacity, and endothelial function in patients with chronic kidney failure (CKF) on hemodialysis (HD). Twenty-one patients with CKF on HD were randomized into a control group (CG; nu2009=u200910) and neuromuscular electrical stimulation group (NMESG; nu2009=u200911) who received NMES in the quadriceps muscle for 8 weeks, 3 times/week (20-34 min) during HD sessions. The muscle strength of the lower limbs was evaluated by dynamometry and sit-and-stand test (SST); muscle architecture through ultrasonography; functional capacity by the distance covered in a 6-min walk test and the endothelial function by flow-mediated dilatation technique of the brachial artery. There was an increase in the strength of the lower limbs in the NMESG compared to the CG (dynamometry: 43.28u2009±u200916.94 vs. 35.84u2009±u200916.89, Pu2009=u20090.006; SST: 16.10u2009±u20096.51 vs. 12.50u2009±u20094.7, Pu2009=u20090.029). There was a significant reduction in pennation angles of the right vastus lateralis (RVL) and left vastus lateralis (LVL) in the CG when compared to the NMESG (RVL: 11.93 [10.70-15.11] vs. 13.57 [11.81-15.96], Pu2009=u20090.039; LVL: 11.62 [9.00-14.20] vs. 15.52 [12.86-20.02], Pu2009=u20090.042). There was no change in functional capacity and in the endothelial function for CG and NMESG, respectively. In conclusion, NMES increases muscle strength and has a protective effect against muscle atrophy of the lower limbs of patients with chronic kidney failure on HD.

Higher Mean Blood Pressure is Associated With Autonomic Imbalance But Not With Endothelial Dysfunction in Young Soccer Players

BACKGROUNDnBlood pressure (BP) should be kept within a narrow range to allow adequate tissue perfusion. In particular, heart-rate variability (HRV) can be used to assess autonomic cardiovascular modulation, and flow-mediated dilation (FMD) can provide valuable information about the ability of the cardiovascular system to adapt to different pressures. Our objective in the study described here was to investigate the effect of a difference of 10mm Hg in mean arterial pressure (MAP) on endothelial function and autonomic balance in young and normotensive soccer players.nnnMETHODSnTwenty-nine young male soccer players (mean age 17.7 years) were divided into two groups according to their MAP (mm Hg): MAP-84 and MAP-94. The BP, FMD, HRV and maximum oxygen uptake (VO2max) of each group were measured.nnnRESULTSnSystolic BP (SBP) and diastolic BP (DBP) were significantly higher (P < 0.0001 and P < 0.006, respectively) in the MAP-94 group. There were no differences in VO2max and endothelial function in the two groups (P < 0.7699). However, the standard deviation (SD) of normal RR intervals (SDNN) and the square root of the mean squared differences in successive RR intervals (RMSSD) were significantly lower in the MAP-94 than in the MAP-84 group (P < 0.0001 and P < 0.005, respectively). In the MAP-94 group, both the high-and low-frequency components were significantly (P < 0.001, P < 0.021, P < 0.017, respectively) lower in both absolute and normalized units, whereas the LF/HF ratio was significantly (P < 0.012) higher.nnnCONCLUSIONSnCollectively, our findings indicate that in young soccer players, autonomic cardiovascular modulation is impaired when MAP is increased by 10mm Hg, even within an optimal range of BP and regardless of endothelial function and VO2max.

Functional electrical stimulation training on functional capacity and blood pressure variability in a centenarian woman: case study

BACKGROUNDnFunctional electrical stimulation (FES) is a rehabilitation method that can revert alterations provoked by aging, such as reductions in functional capacity and modifications on blood pressure variability (BPV).nnnOBJECTIVESnTo evaluate the training effects of FES on functional capacity and BPV in a centenarian woman.nnnMETHODSnA 101-year-old woman without previous disease underwent FES training for 12 weeks, with three 40 min sessions/week. FES was applied at a frequency of 20 Hz with a 0.5 ms pulse, 5 s contraction time, 10 s relaxation time, the maximum tolerable intensity and with progressive overload. Functional capacity was assessed with a six-minute walk test (6MWT) and proximal lower limb strength was assessed with a sit-and-stand test (STST). BPV was measured by continuous recording of pulse pressure and calculated by spectral analysis. All variables were measured before and after FES training.nnnRESULTSnAfter training there was a 70% increase in distance walked in the 6MWT, a 300% increase in the number of STST repetitions, an 8 mmHg reduction in systolic blood pressure (SBP) and a 4 mmHg reduction in diastolic blood pressure (DBP) and mean blood pressure (MBP). Reductions in SBP (11.8 mmHg²), DBP (2.3 mmHg²) and MBP (6.0 mmHg²) variability were also observed.nnnCONCLUSIONSnThree months of FES training improved functional capacity and BPV in a centenarian woman.

Intradialytic neuromuscular electrical stimulation reduces DNA damage in chronic kidney failure patients: a randomized controlled trial

Abstract Background: Chronic kidney failure (CKF) patients on renal replacement therapies exhibit elevated levels of DNA lesions and this is directly related to high mortality. Objective: This study aimed to evaluate the effect of neuromuscular electrical stimulation (NMES) on genomic damage in CKF patients on conventional haemodialysis (HD). Methods: Twenty-one patients with CKF on HD were randomized into control (CG =10) or neuromuscular electrical stimulation (NMESGu2009=u200911) groups. NMES was applied on the quadriceps muscle during the HD session, three times a week, for 8 weeks in NMESG. DNA damage in blood was evaluated by the alkaline comet assay prior to follow-up, after 4 and 8 weeks of intervention. Results: Intradialytic NMES in CKF patients induced a significant decrease in DNA damage after four [49.9 (3.68) vs 101.5 (6.53); pu2009=u20090.000] than eight [19.9 (2.07) vs 101.5 (6.53); pu2009=u20090.000] weeks compared to baseline. Genomic damage was also significantly less after four [NMESG: 49.9 (3.68) vs CG: 92.9 (12.61); pu2009=u20090.001] than after eight [NMESG: 19.9 (2.07) vs CG: 76.4 (11.15); pu2009=u20090.000] weeks compared to CG. Conclusions: This study demonstrates for the first time that intradialytic NMES is able to reduce DNA damage in blood of CKF patients.

VEGF gene therapy cooperatively recruits molecules from the immune system and stimulates cell homing and angiogenesis in refractory angina

BACKGROUND New vessels are formed in response to stimuli from angiogenic factors, a process in which paracrine signaling is fundamental. OBJECTIVE To investigate the cooperative paracrine signaling profile in response to Vascular Endothelial Growth Factor (VEGF) gene therapy in patients with coronary artery disease (CAD) and refractory angina. METHOD A cohort study was conducted in which plasma was collected from patients who underwent gene therapy with a plasmid expressing VEGF 165 (10) and from surgical procedure controls (4). Blood samples were collected from both groups prior to baseline and on days 3, 9 and 27 after the interventions and subjected to systemic analysis of protein expression (Interleukin‐6, IL‐6; Tumor Necrosis Factor‐&agr;, TNF‐&agr;; Interleukin‐10, IL‐10; Stromal Derived Factor‐1 &agr;, SDF‐1&agr;; VEGF; Angiopoietin‐1, ANGPT‐1; and Endothelin‐1, ET‐1) using the enzyme‐linked immunosorbent assay (ELISA). RESULTS Analysis showed an increase in proinflammatory IL‐6 (p = 0.02) and ET‐1 (p = 0.05) on day 3 after gene therapy and in VEGF (p = 0.02) on day 9. A strong positive correlation was found between mobilization of endothelial progenitor cells and TNF‐&agr; on day 9 (r = 0.71; p = 0.03). Furthermore, a strong correlation between &bgr;‐blockers, antiplatelets, and vasodilators with SDF‐1&agr; baseline in the group undergoing gene therapy was verified (r = 0.74; p = 0.004). CONCLUSION Analysis of cooperative paracrine signaling after VEGF gene therapy suggests that the immune system cell and angiogenic molecule expression as well as the endothelial progenitor cell mobilization are time‐dependent, influenced by chronic inflammatory process and continuous pharmacological treatment. HIGHLIGHTSVEGF gene therapy is influenced by chronic inflammatory process.Immune system cell and angiogenic expression are time‐dependent by gene therapy.VEGF gene therapy is influenced by continuous pharmacological treatment.Gene therapy provided an angiogenic process at time line.

TCT-158 Treating Periodontal Disease in Patients With ST-Elevation Myocardial Infarction: A Randomized Clinical Trial

RESULTS The total of 31,760 patients were included in the study of which 12,951 (41%) were pretreated with UH/LMWH and 1,154 (4%) were pretreated with GP. The number of treated segments was 61,011 of which 32,446 (53%) were occluded prior to primary PCI. Non-patent IRA was associated with higher risk of death at 30 days (adjusted OR 1.6; 95% CI 1.47 to 1.89; P<0.000). Pretreatment with UH/LMWH (adjusted OR 0.82; 95% CI 0.79 to 0.86; P<0.001) and/or GP (adjusted OR 0.86; 95% CI 0.77 to 0.95; P1⁄40.003) was associated with higher probability for patent IRA.