Dysphagia and pulmonary complications in acute cerebrovascular disease: A retrospective observational study

INTRODUCTION

Dysphagia is a common post-stroke complication, which may result in serious pulmonary sequelae. Early detection of dysphagia and aspiration risk can reduce morbidity, mortality and length of hospitalization.

OBJECTIVES

This study aims to identify association between dysphagia and acute cerebrovascular disease, and evaluate the prevalence and impact of pulmonary complications on readmissions and mortality.

MATERIAL AND METHODS

Retrospective observational study based on 250 clinical records of patients with acute cerebrovascular disease: clinical history, neurological examination, imaging and Gugging Swallowing Screen in the first 48h. Patients were followed for 3 months via medical records to estimate 3-month mortality and readmissions.

RESULTS

Out of 250 clinical records analyzed, 102 (40.8%) were evaluated for dysphagia. The prevalence of dysphagia was 32.4%. The risk was higher in older patients (p<0.001), in severe stroke (p<0.001) and in the hemorrhagic subtype (p=0.008). An association was found with dysarthria and aphasia (p=0.003; p=0.017). Respiratory tract infections occurred in 14.4% of all patients (GUSS group 11.8% versus no GUSS group 16.2%), and in 75% of those with severe dysphagia (p<0.001). Mortality at 3 months was 24.2% in dysphagic patients, especially high in the severe dysphagia group (75%, p<0.001).

CONCLUSIONS

The type of cerebrovascular disease, NIHSS and GCS scores, age, dysarthria, and aphasia were significant associated factors to dysphagia. The prevalence of respiratory tract infections was higher in patients with no GUSS record, and no statistical significance was observed in related readmissions. Mortality at 3 months was superior in the severe dysphagia group.

Glutamine synthetase: an unlikely case of functional redundancy in Arabidopsis thaliana

Glutamine synthetase (GS, EC 6.3.1.2) is an essential enzyme in plant metabolism, catalysing the assimilation of inorganic nitrogen into the amino acid glutamine. GS is a key enzyme in plant growth and has received special attention due to its recognized roles in plant nitrogen use efficiency and crop productivity. It occurs in plants as a collection of isoenzymes, located in the cytosol (GS1) and plastids (GS2), consistent with the multiplicity of roles played in plant metabolism. It is considered that the different isoenzymes, involved in a wide variety of physiological processes throughout the plant life cycle, perform non-redundant and non-overlapping roles. In fact, specific and non-redundant roles of GS isoenzymes in nitrogen metabolism were observed in species like Oryza sativa and Zea mays. However, in A. thaliana the GS isoenzymes, five cytosolic and one plastidic, are suggested to have functional redundancy and an isoenzyme compensation mechanism, specific to this species, was described. This review integrates analyses on the likely roles of the distinct cytosol- and plastid-located GS isoenzymes in A. thaliana, highlighting the redundancy of the GS gene family specifically occurring in this model plant.

The magnitude of depression in heart failure patients and its association with NYHA class

Introduction

Depression is commonly present among HF patients and is associated with adverse clinical outcomes. However, research regarding its association with New York Heart Association (NYHA) class is still scarce.

Objectives

To evaluate the presence of depression symptoms in HF outpatients and analyze its association with NYHA class.

Methods

This study is part of a larger research project (Deus Ex-Machina/NORTE-01-0145-FEDER-00026). HF patients were recruited from an outpatient clinic at a University Hospital. Exclusion criteria were: unable to communicate, severe visual acuity deficit or NYHA class IV. Sociodemographic data and NYHA class were registered. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, with a score ≥10 indicating clinically relevant depression.

Results

A sample of 136 HF patients was included, with a median age of 59 (range: 24-81) years old, where 66% were men. Almost half of the patients (49%) were in NYHA class II, followed by class I (36%) and class III (15%). The median score of PHQ-9 was 4(range:0-18), with 26% showing clinically relevant depression. PHQ-9 total score was associated with NYHA class (p=0.001), with higher median scores in worse NYHA classes [class I: 3 (IQR: 5.5), class II: 4 (IQR: 8) and class III: 8.5 (IQR:9.3)].

Conclusions

In this study, depression was present in 26% of HF outpatients and was associated with more severe HF symptoms. Consequently, preventing, monitoring, and treating depression in the management of these patients is recommended. Further research is needed for a deeper analysis of this association.

Anxiety in heart failure patients and its association with NYHA class

Introduction

Heart failure (HF) is a worldwide public health problem and the main cause of morbidity and mortality in older people. Previous studies have demonstrated that psychological symptoms are associated with worse cardiovascular outcomes. Nevertheless, the research regarding the association between anxiety and HF is still scarce.

Objectives

To analyse the levels of anxiety in HF patients and its association with New York Heart Association (NYHA) class in HF patients.

Methods

This study takes part of a wider project named Deus Ex-Machina project (NORTE-01-0145-FEDER-00026). HF patients were recruited from an outpatient clinic at a University Hospital. Patient with inability to communicate, with severe visual impairment or with NYHA class IV were excluded. Sociodemographic data and NYHA class were recorded. Anxiety was assessed using the Generalized Anxiety Disorder-7 (GAD-7).

Results

Overall, 136 patients were included, with a mean age of 57(±13) years old. Most of them were men (66%) and married (76%), with mean education of 8 years (±4). Regarding NYHA class, 36%, 49% and 15% were at class I, II and III, respectively. The mean GAD-7 total score was 6.4 (±5.2) and 32% of patients showed moderate to severe anxiety symptoms. No association between the NYHA functional class and anxiety was found (p=0.106).

Conclusions

The results reveal that anxiety is frequent among HF patients. However, as found in previous studies, it was not associated with more severe HF symptoms. The coexistence of HF and anxiety deserves further studies, in order to build a better understanding of this association.

Cubane and cubanoid: Structural, optoelectronic and thermodynamic properties from DFT and TD-DFT method

In this paper, we report structural, electronic and optical properties of cubane (C₈H₈) and cubanoids (cubane-like molecules) using Density Functional Theory (DFT). The cubanoids are cubanes for which Carbon atoms have been substituted by Nitrogen (N), Phosphorus (P), Boron (B), Silicon (Si), Arsenic (As), Antimony (Sb) or Bismuth (Bi) atoms. These molecules presented exceptional stability with several different symmetry point groups, being the majority T_d. All calculated vibrational frequencies are positive for any studied molecules indicating that all these structures are in a stable state. The HOMO-LUMO gaps and DOS were calculated converged towards to values between 1.87 eV and 5.61 eV, actually showing promising electronic properties (Just for comparison, the cubane energy gap is 7.50 eV). The optical absorptions were also calculated for the cubanoid structure using the Time-Dependent Density Functional Theory (TD-DFT). Their dependence on the wavelength is analyzed, where five of theses structures absorb on the visible region. Finally, the extrapolation of thermodynamic properties indicates that these cubanoid could be potentially synthesized spontaneously, where four structures, the synthesis would occur for temperatures below 400 K, while for Si₄Bi₄H₄ structure, the synthesis would occur at room temperature.

164 Gonadotrophin-releasing hormone injection and colour flow Doppler ultrasound of the preovulatory follicle as a tool to increase pregnancy outcome after timed AI in beef cows

The aims of this study were to determine (1) the association between Doppler vascularisation scores (DVS) of the preovulatory follicle (POF) and fertility of beef cows submitted to timed AI (TAI) and (2) whether cows with low DVS benefit from a gonadotrophin-releasing hormone (GnRH) treatment at TAI. Multiparous lactating Nelore cows (Bos indicus; n=69) from a commercial beef farm in the state of Rondônia, Brazil, were enrolled in this study. Cows received 2mg of oestradiol benzoate intramuscularly (Bioestrogen, Biogénesis Bagó) and an intravaginal progesterone-releasing device (1.9g of progesterone; controlled internal drug release, CIDR) to synchronise follicular wave emergence on Day 0. The CIDR device was removed and cows were treated with 150μg of D-cloprostenol intramuscularly (prostaglandin F2α analogue; Croniben), 1mg of oestradiol cypionate intramuscularly, and 300IU of equine chorionic gonadotrophin (Novormon) intramuscularly on Day 8. Cows were then painted with a tail chalk marker to identify those displaying oestrus. All cows were submitted to TAI 48h after CIDR removal. At TAI, occurrence of oestrus was recorded and all cows were examined using transrectal ultrasonography. Blood flow of the POF was evaluated using colour Doppler imaging. Colour Doppler signals present on the follicular wall were subjectively scored using a 1-to-4 scale (1=absence or very low blood flow, and 4=intense blood flow detected on most of the follicular wall surface) adapted from Ginther (2007Ultrasonic Imaging and Animal Reproduction: Color-Doppler Ultrasonography, pages 87-114). Then, cows were divided into three groups according their DVS of the POF: (1) high DVS (DVS ≥3; n=36), (2) low DVS (DVS &lt;3; n=16), and (3) low DVS (DVS &lt;3; n=17) plus a GnRH treatment at TAI. The diameter of the POF was analysed using analysis of variance (PROC GLIMMIX of SAS; SAS Institute Inc.), and the means were compared among groups using Tukey's test. The proportion of cows that displayed oestrus and pregnancy rates was analysed using chi-square test. Cows in the high-DVS group had a larger POF than cows in the low-DVS and low-DVS-GnRH groups (13.2±0.2, 11.7±0.5, and 12.2±0.4, respectively; P&lt;0.05). The proportion of cows that displayed oestrus was greater (P&lt;0.05) in the high-DVS group (72%, 26/36) than in the low-DVS (37.5%, 6/16) or low-DVS-GnRH (53%, 9/17) groups. Finally, greater (P&lt;0.05) pregnancy rates were observed in cows from the high-DVS (47.2%; 17/36) and low-DVS-GnRH (52.9%; 9/17) groups than in cows from the low-DVS group (18.7%; 3/16). The preliminary results from this study demonstrated that diameter of POF is positively associated with DVS. Moreover, cows that presented POF with higher DVS are more likely to become pregnant, and the administration of GnRH to females with low DVS can increase the fertility of beef cows submitted to TAI protocols. This study received funding support from Embrapa (MP1/PC3 project no. 01.03.14.011.00.00) and from CNPq (universal project no. 407307/2016-8).

Undifferentiated pleomorphic sarcoma presenting as an exophytic pedunculated tumor on the left scapula

Undifferentiated pleomorphic sarcoma is a common soft tissue sarcoma. Unfortunately, any attempt to describe the line of differentiation fails. It represents a final common pathway in tumors that undergoes progression towards dedifferentiation. We report a man with an undifferentiated pleomorphic sarcoma presenting as an exophytic pedunculated tumor of the left scapula. Histopathology analysis revealed spindle-shaped cells with great pleomorphism and numerous mitoses. Immunohistochemistry showed diffuse expression of vimentin. Wide local excision was performed after an oncology consultation. After two-years of follow-up, the patient has shown no evidence of recurrence or metastases.

Implications of biological factors on accumulation of persistent organic pollutants in Antarctic notothenioid fish

In the present study, the possible associations between selected persistent organic pollutants (POPs) and biological factors were assessed in different tissues of two Antarctic notothenioid fish: Notothenia rossii (NOR) and Trematomus newnesi (TRN) collected at Potter Cove, King George Island/Isla 25 de Mayo, South Shetland Islands. Specifically, association patterns between biological factors (body size, lipid content, body condition) and POP concentrations (polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT) and metabolites, polybrominated diphenyl ethers (PBDEs), and hexachlorocyclohexane (HCH), hexachlorobenzene (HCB), chlordanes (CHLs) and methoxylated polybrominated diphenyl ethers (MeO-PBDEs)), were explored by using two approaches: multivariate analyses (principal component analysis: PCA) and intraspecific correlations. Integrating results suggest that biological factors such as size, KI and tissue type seemed to be associated to selective accumulation of POPs for immature specimens of N. rossii, and KI and tissue type for mature specimens of T. newnesi. Each particular factor should be considered when choosing N. rossii or T. newnesi as sentinels for POPs pollution in Antarctic marine environments. Further, both nototheniids showed a selective accumulation pattern in their gonads of penta-chlorinated biphenyls (penta-CBs; 55.5 and 29ngg^-1 lw for N. rossii and T. newnesi, respectively) and organochlorine pesticides such as DDTs (199 and 13.3ngg^-1 lw, for N. rossii and T. newnesi respectively), and of polybrominated diphenyl ethers (PBDEs) in gills (97.2 and 22.1 for ngg^-1 lw, for N. rossii and T. newnesi, respectively), highlighting the importance of these tissues in monitoring studies of pollution in fish. The current study expands the knowledge concerning the biological factors to be investigated when specific pollutants are monitored and supports the importance of tissue type for the selective accumulation of POPs in Antarctic fish. Additionally, a contribution to the scarce data on concentration of MeO-PBDEs in Antarctic marine organisms, particularly in the highly diverse perciform suborder Notothenioidei is provided.

Update on metabolism and nutrition therapy in critically ill burn patients

Major burn injury triggers severe oxidative stress, a systemic inflammatory response, and a persistent hypermetabolic and hypercatabolic state with secondary sarcopenia, multiorgan dysfunction, sepsis and an increased mortality risk. Calorie deficit, negative protein balance and antioxidant micronutrient deficiency after thermal injury have been associated to poor clinical outcomes. In this context, personalized nutrition therapy with early enteral feeding from the start of resuscitation are indicated. Over the last four decades, different nutritional and pharmacological interventions aimed at modulating the immune and metabolic responses have been evaluated. These strategies have been shown to be able to minimize acute malnutrition, as well as modulate the immunoinflammatory response, and improve relevant clinical outcomes in this patient population. The purpose of this updating review is to summarize the most current evidence on metabolic response and nutrition therapy in critically ill burn patients.

Paget disease of the male breast

Paget disease of the breast is an uncommon tumor of the nipple-areola complex that usually presents as an erythematous and erosive lesion. We report the case of a 61-year-old man that presented with a three-year history of an erythematous lesion of the right areola, first treated with topical corticosteroids without benefit. He was then referred to our dermatology department and the clinical suspicion of Paget disease was considered. The diagnosis was later confirmed by biopsy. This case report highlights the importance of clinical recognition of this entity along with other diseases that mimic these skin changes in order to allow earlier diagnosis and proper follow-up.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Effectiveness of insole use in rheumatoid feet: a randomized controlled trial

OBJECTIVES

To assess the effectiveness of foot orthoses with regard to pain, function, quality of life, and global perceived effect in patients with rheumatoid arthritis (RA).

METHOD

A double-blind randomized controlled trial (RCT) was carried out. Eighty women with RA were randomly assigned to an experimental group (EG) or a control group (CG). The EG used an insole with metatarsal and medial arch supports and the CG used a flat insole for 6 months. Evaluations performed at baseline and after 45, 90, and 180 days by a blinded assessor were: foot pain while walking and at rest, function, quality of life, and global perceived effect with treatment.

RESULTS

The groups were homogeneous for all parameters at baseline. A statistically significant improvement (p < 0.001) was found in the EG regarding pain while walking (mean difference: -2.2 for the right foot and -2.1 for the left foot) and at rest (mean difference: -0.3 for the right foot and -0.5 for the left foot) in comparison to CG. There were no differences in any other observed measures. The time of insole use correlated with foot pain and function in the EG.

CONCLUSIONS

Foot orthoses with metatarsal and medial arch supports decreases pain during walking and at rest in both feet in patients with RA. Time of insole use correlated with improvements in pain and function.

Quality of Life, Health, and Sleep of Air Traffic Controllers with Different Shift Systems

BACKGROUND

Air traffic controllers (ATC) work shifts and their work schedules vary according to the characteristics of each airport. The human body adapts to shiftwork differently. These adjustments affect the health-disease process, predisposing ATC to risk conditions associated with sleep deprivation and lack of night sleep, which can lead to conditions such as cardiovascular diseases, mood disorders, anxiety, and obesity. This study investigated the characteristics of health, sleep, and quality of life of ATC exposed to 8-h alternate work shifts and 6-h rotational work shifts.

METHODS

The study was cross-sectional with convenience samples consisting of 84 ATC from two international airports in Brazil. We applied questionnaires to collect data about socioeconomic conditions, quality of life, sleep, and physical activity levels. We also collected health data regarding nutritional status, body composition, and blood pressure. We analyzed the differences between ATC from the two airports considering the variables of sleep, quality of life, and health.

RESULTS

Differences were found between the groups in terms of body fat percentage (30.7% and 27.8%), scores of overall quality of life (56.2 and 68), concentration (3.37 and 3.96), energy (3.12 and 3.62), and sleep time on working days (5:20 h and 6:15 h).

CONCLUSION

ATC under 8-h alternate shifts showed lower scores for quality of life, higher body fat, and less sleep time on working days, which characterizes inadequate shiftwork for this population.

Epidemiology of Herpes Simplex Virus Infection in Pregnancy: A Pilot Study

Herpes simplex virus (HSV) infection is one of the most common sexually transmitted viral diseases worldwide. HSV type 2 causes most genital herpes and HSV type 1 is usually transmitted via non-sexual contacts. We studied 109 pregnant women between January 2007 and December 2008, in relation to their age, condom use, number of sexual partners, age at first intercourse, parity and smoking habits. The aim of this study is to evaluate the prevalence of HSV cervical infection and HSV co-infection with other genital microorganisms associated with poor neonatal outcome. Our results show that of the 109 outpatients enrolled, 30% were HSV1 and/or HSV2 positive, of whom 30% were infected with both HSV1 and HSV2, 18% were infected with HSV1 alone and 52% with HSV2 alone. A significant association between HSV1 and HSV2 infection was found, and the prevalence of HSV2 infection in women infected with HSV1 was 63%. The prevalence of HSV1/2 varied in the presence of other vaginal microorganisms but a statistical significant association was not found. This pilot study is probably too small to obtain statistically significant results. Nevertheless, using these observed results, we calculated that about 530 patients with comparable features should be enrolled to detect an increase of 50% in HSV infection due to the presence of other genital infections and potential risk factors.

Presence of D1- and D2-like dopamine receptors in the rat, mouse and bovine multiciliated ependyma

The multiciliated ependyma forms an epithelial-like layer that could act as a selective barrier between the brain parenchyma and cerebrospinal fluid. In the present study, tyrosine hydroxylase-containing fibres have been detected in the basal pole of the ependymal cells of the lateral ventricles of rat, mouse and calf. The use of antibodies against at least two different peptide sequences of each D(2), D(3), D(4) and D(5) dopamine receptor subtype has allowed their detection in: (i) sections of mouse, rat and bovine lateral ventricles, by means of immunocytochemistry; and (ii) membrane protein extracts obtained from the ependymal layer of the bovine lateral ventricles, using immunoblotting. The immunocytochemical study has shown the presence of all these subtypes of dopamine receptors in the ependymal cells. Immunoblotting demonstrated similar immunoreactive bands for all receptor subtypes in both ependymal and corpus striatum membrane extracts.

Sexual problems among women and men aged 40–80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors

The Global Study of Sexual Attitudes and Behaviors (GSSAB) is an international survey of various aspects of sex and relationships among adults aged 40-80 y. An analysis of GSSAB data was performed to estimate the prevalence and correlates of sexual problems in 13,882 women and 13,618 men from 29 countries. The overall response rate was modest; however, the estimates of prevalence of sexual problems are comparable with published values. Several factors consistently elevated the likelihood of sexual problems. Age was an important correlate of lubrication difficulties among women and of several sexual problems, including a lack of interest in sex, the inability to reach orgasm, and erectile difficulties among men. We conclude that sexual difficulties are relatively common among mature adults throughout the world. Sexual problems tend to be more associated with physical health and aging among men than women.

Outbreak of jaundice and hemorrhagic fever in the Southeast of Brazil in 2001: detection and molecular characterization of yellow fever virus

Between January and March 2001, an outbreak of jaundice and hemorrhagic fever occurred in the state of Minas Gerais, Southeast region of Brazil, in which a mortality rate of 53% was reported. Seroconversion, virus isolation, histopathological and immunohistochemical findings, and reverse transcription-polymerase chain reaction (RT-PCR) identified yellow fever virus (YFV) as the etiological agent responsible for the outbreak. Partial nucleotide sequence analysis from a fragment of the YFV genome spanning parts of nonstructural (NS) 5 gene and 3' noncoding region (3' UTR) showed that the YFV involved in this outbreak belongs to South American genotype I and differs from the Brazilian virus identified in 1996.

A family of 12 human genes containing oxysterol-binding domains

Oxysterol-binding proteins (OSBPs) have been described in a wide range of eukaryotes, and are often found to be part of a multi-gene family. We have used bioinformatics and data mining as a starting point for identifying new family members in humans based on the presence of the OSBP signature EQVSHHPP. In addition to OSBP and the recently reported OSBP2, we have found 10 other genes encoding oxysterol-binding domains. Here, we report cDNA and deduced peptide sequences of the previously unknown OSBPs and compare the peptides and genes. All of the genes encode a pleckstrin homology domain, except OSBPL2. However, two of the peptides, OSBPL2 and OSBPL1A, consist of the OSBP domain only. A second OSBPL1 transcript (OSBPL1B) contains 15 additional upstream exons, with a deduced peptide containing a pleckstrin homology domain. Cladistic analysis divides the human OSBP genes into five groups, whose members share similarities in sequence and gene structure; RT-PCR analysis indicates that expression patterns among group members vary widely.

Different patterns of renal osteodystrophy in Iberoamerica

The various forms of renal osteodystrophy are predominant hyperparathyroid bone disease, mixed uremic osteodystrophy, low turnover osteomalacia, and adynamic bone disease. The present study analyses a total number of 1,209 bone biopsies from 5 different countries (Brazil, Uruguay, Argentina, Portugal, and Spain). Low turnover osteomalacia and mixed uremic osteodystrophy were more common in Brazil, Uruguay, and Argentina than in Portugal and Spain whereas predominant hyperparathyroid bone disease was seen more often in Portugal and Spain. In all centers, independent of the aluminum staining technique used, the extent of aluminum deposited in bone was greater in patients presenting with low bone turnover, whether from low turnover osteomalacia or adynamic bone disease, than in the predominant hyperparathyroid bone disease. In summary, even though recent reports have indicated that, over the last decade, the incidence of aluminum-induced toxicity was reduced, aluminum still seems to be implicated in a great percentage of symptomatic low bone remodelling lesions in Iberoamerica.

RC-IAL cell line: sensitivity of rubella virus grow

OBJECTIVE

The rapid growth of the rubella virus in RC-IAL2 with development of cytopathic effect, in response to rubella virus infection, is described. For purposes of comparison, the rubella virus RA-27/3 strain was titered simultaneously in the RC-IAL, Vero, SIRC and RK13 cell lines.

METHODS

Rubella virus RA-27/3 strain are inoculated in the RC-IAL cell line (rabbit Kidney, Institute Adolfo Lutz). Plates containing 1.5x10(5) cells/ml of RC-IAL line were inoculated with 0.1ml s RA-27/3 strain virus containing 1x 10(4)TCID50/0.1ml. A 25% cytopathic effect was observed after 48 hours and 100% after 96 hours. The results obtained were compared to those observed with the SIRC, Vero and RK13 cell lines. Rubella virus was detected by immunohistochemistry.

RESULTS

With the results, it was possible to conclude that the RC-IAL cell line is a very good substrate for culturing rubella virus. The cells inoculated with rubella virus were examined by phase contrast microscopy and showed the characteristic rounded, bipolar and multipolar cells. The CPE in RC-IAL was observed in the first 48 hours and the curve of the increased infectivity was practically the same as observed in other cell lines.

CONCLUSIONS

These findings are important since this is one the few cell lines described in the literature with a cytopathic effect. So it can be used for antigen preparation and serological testing for the diagnosis of specific rubella antibodies.

Effects of dietary polyunsaturated fatty acids and nucleotides on tissue fatty acid profiles of rats with carbon tetrachloride-induced liver damage

The deficiency of polyunsaturated fatty acids (PUFA) that occurs in plasma of patients with liver cirrhosis has been assessed in rats with severe steatosis and mild liver necrosis induced by repeated administration of low doses of carbon tetrachloride (CCl(4)). The contribution of both dietary (n-3) long-chain PUFA and nucleotides to the recovery of the altered fatty acid profiles of tissue lipids of these rats has also been studied. Two groups of rats were used. The first was intraperitoneally injected 0.15 ml of a 10% (v/v) CCl(4)solution in paraffin per 100 g of body weight, three times a week for 9 weeks; the second received paraffin alone. After the treatment, six rats of each group were killed. Afterwards, the remaining controls were fed a semipurified diet (SPD) for 3 weeks, and the remaining rats in the CCl(4)group were divided into three new groups: the first was fed the SP diet; the second was fed the SP diet supplemented with 1% (n-3) polyunsaturated fatty acids (PUFA diet); and the third was fed the SP diet supplemented with 250 mg nucleotides per 100 g diet (NT diet). Fatty acids of plasma, erythrocyte membranes and liver microsomes were analyzed. Decreases in linoleic and arachidonic acids in both total plasma lipids and liver microsomal phospholipids were the main findings due to CCl(4)treatment. The rats that received CCl(4)and the PUFA diet showed the lowest levels of (n-6) PUFA and the highest levels of (n-3) PUFA in liver microsomal phospholipids, as well as a significant increase of (n-3) PUFAs in total plasma lipids. The animals that received the NT diet showed no signs of fatty infiltration and exhibited the highest levels of (n-6) PUFAs in liver microsomal phospholipids. These results show that CCl(4)affects fatty acid metabolism which is accordingly reflected in altered tissue fatty acid profiles, and that balanced diets containing PUFA and nucleotides are important for the recovery of the damaged liver in rats.

Salt sensitivity is associated with insulin resistance in essential hypertension

The relationship between salt sensitivity and insulin resistance was investigated in nondiabetic, nonobese (body mass index < or = 28) untreated patients with uncomplicated, mild-to-moderate essential hypertension. Alterations in insulin-mediated glucose disposal were assessed by means of the insulin suppression test. Subjects were classified as salt sensitive and salt resistant according to their blood pressure response to low and high salt intake. Fasting serum glucose levels were within normal limits and did not differ between salt sensitive and salt resistant hypertensives, irrespectively of the level of salt intake. Fasting serum insulin levels increased in salt sensitive patients when on a high intake of salt. The insulin suppression test revealed the existence of marked differences in insulin-mediated glucose uptake between salt sensitive and salt resistant hypertensives. Much higher steady-state glucose values (nanomoles of glucose/ liter) were obtained during the insulin suppression test in salt sensitive than in salt-resistant hypertensives (7.4+/-1.6 v 3.5+/-0.1 under low salt; and 12.5+/-1.1 v 4.3+/-0.1 under high salt intake). The product of glucose times insulin obtained at steady state during low and high salt intakes were 2.5 and 5 times greater, respectively, in salt sensitive than in salt resistant hypertensives. Therefore, the impairment in insulin-mediated glucose disposal observed in salt sensitive hypertensives was present both under low salt (60 to 70 mEq/day) and high salt intake (300 mEq/day). However, it was exacerbated under high salt intake. These results suggest that untreated salt sensitive hypertensives have a considerable impairment in insulin-mediated glucose disposal because of a state of insulin resistance. High salt intake increased BP, induced hyperinsulinemia, and worsened insulin-mediated glucose disposal only in salt sensitive patients. We propose that salt sensitivity contributes, separately from hypertension, to insulin resistance and thus be considered per se as an additional risk factor in the development of cardiovascular disease. Salt sensitivity and insulin resistance may be genetically associated conditions.

Dietary nucleotides correct plasma and liver microsomal fatty acid alterations in rats with liver cirrhosis induced by oral intake of thioacetamide

BACKGROUND/AIMS

Dietary nucleotides modulate a number of metabolic processes, including long-chain polyunsaturated fatty acid metabolism. In this study, we evaluated the effect of dietary nucleotides on plasma and liver microsomal fatty acid profiles in a rat model of liver cirrhosis induced by oral intake of thioacetamide.

METHODS

Fifty-four female Wistar rats were assigned to one of the following groups: rats in the thioacetamide group (n=45) were given 300 mg thioacetamide/l in their drinking water for 4 months, and rats in the control group (n=9) received water during the same period. After 4 months of treatment, 9 rats in each group were killed. The remaining rats in the thioacetamide group were divided into two new groups, and the animals in each were allowed to recover for 1 or 2 weeks on either a nucleotide-free diet or the same diet supplemented with 50 mg of each of the following: AMP, GMP, CMP, IMP and UMP per 100 g diet.

RESULTS

Saturated (mainly stearic acid), monounsaturated, and n-6 long-chain polyunsaturated fatty acids (mainly arachidonic acid), and also the unsaturation index decreased in plasma of rats with experimental cirrhosis. Administration of the diet supplemented with nucleotides to thioacetamide-treated rats corrected plasma levels of saturated, n-6 long-chain polyunsaturated fatty acids and the unsaturation index. In liver microsomes, the cirrhotic rats showed lower levels of protein and higher levels of palmitic, oleic, linoleic and arachidonic acids. Protein concentrations and levels of all the above-mentioned fatty acids were corrected with the nucleotide-enriched diet.

CONCLUSIONS

Dietary nucleotides contribute to correcting plasma and liver microsomal fatty acid alterations in rats with liver cirrhosis induced by chronic oral administration of thioacetamide.

Relations between fasting serum insulin, glucose, and dihydroepiandrosterone-sulfate concentrations in obese patients with hypertension: short-term effects of antihypertensive drugs

A randomized, single-blind, placebo-controlled study was conducted in 82 obese patients with mild to moderate essential hypertension, to determine the incidence of hyperinsulinemia, the relations between fasting insulin and dihydroepiandrosterone-sulfate (DHEA-S) levels, and the short-term effects of antihypertensives on DHEA-S and insulin serum concentrations. Increased insulin/glucose ratios (IGR) suggestive of insulin resistance were found in half of our patients. Hyperinsulinemic and normoinsulinemic obese patients with hypertension had comparable fasting glucose and DHEA-S concentrations and comparable blood pressure (BP) levels. Thus no relations were found between fasting insulin and DHEA-S levels. Fasting hyperinsulinemia was found in only half of the obese subjects with hypertension, suggesting that not all obese patients with hypertension are at the same high cardiovascular risk. Short-term treatment with captopril, prazosin, verapamil, atenolol, or hydrochlorothiazide (HCTZ) reduced BP; greater BP reduction was observed with drugs with vasodilatory effects. Captopril, prazosin, and verapamil reduced fasting insulin levels, whereas atenolol and hydrochlorothiazide did not. The former drugs reduced fasting insulin levels that were either within normal limits or in the hyperinsulinemic range. None of the drug treatments produced significant increases in serum DHEA-S concentrations, although some of them considerably reduced fasting insulin levels. No relations between insulin and DHEA-S levels were observed either at baseline or at the end of the antihypertensive treatment. The BP reduction resulting from the peripheral vasodilation may explain the insulin-reducing action of captopril, verapamil, and prazosin. These results further emphasize the large heterogeneity present in the pathophysiologic mechanisms operating in obesity and hypertension.

Arachidonic acid products-mediated contraction induced by bradykinin in relaxed mesenteric arterial rings from Holtzman rats

This study describes the contractile action of bradykinin on rat isolated mesenteric arterial rings and a possible mechanism responsible for this action. Bradykinin induced dose-dependent contraction of relaxed mesenteric arterial rings from Holtzman rats, but not from Wistar rats. A second bradykinin challenge in the same ring induced a very small effect or no effect at all. Destruction of the endothelium did not modify the response to bradykinin. des-Arg9-[Leu8]bradykinin failed to antagonize bradykinin's action. HOE 140 (D-Arg- [Hyp3, Thi5,D-Tic7,Oic8]bradykinin) reduced bradykinin-induced contractions. Indomethacin abolished the contractile response to bradykinin; prostaglandin F2 alpha induced a long-lasting contraction, dissimilar from that induced by bradykinin; L-655,240 (3-[1-(4-chlorobenzyl)-5-fluoro-3-methyl-indol-2-yl]-2,2-dimethyl propanoic acid), an antagonist of the thromboxane receptor, inhibited bradykinin-induced contractions. These results suggest that bradykinin-induced contraction in mesenteric arterial rings is indirect, through activation of bradykinin B2 receptors, resulting in liberation of prostanoids from outside the endothelium. Thromboxane A2 is probably an intermediate in this response but we cannot exclude the participation of other prostanoids.

Serum amino acid changes in rats with thioacetamide-induced liver cirrhosis

To date, no attempt has been made to study alterations occurring in the amino acid profile in chronic models of thioacetamide-induced liver cirrhosis. In this work, changes in serum amino acids and proteins in rats with thioacetamide-induced liver cirrhosis are reported, together with changes in enzyme activities in the liver and serum. Seventeen female Wistar rats were used. Eight rats were given 300 mg thioacetamide/l in drinking water for 4 months and nine rats were given water ad libitum during the same time-period. Significant increases in glycine, alanine, serine, methionine, glutamate, ornithine, phenylalanine, tyrosine, histidine and proline were observed in rats with the resulting experimental liver cirrhosis. Threonine, taurine, glutamine, lysine and citrulline tended to increase while isoleucine, leucine, aspartate, arginine and tryptophan tended to decrease. Total and nonessential amino acids increased significantly in cirrhotic animals. Total essential and aromatic amino acids tended to increase in the thioacetamide-treated group, whereas branched chain amino acids tended to decrease in the same group. Regarding serum proteins, a decrease in albumin concentration in the thioacetamide-treated animals was the only change detected. The liver enzyme activities under observation (aspartate and alanine aminotransferases, glutamate dehydrogenase and threonine deaminase) were lower in the thioacetamide group. Decreases were significant for both transaminases and threonine deaminase. Results for serum activities showed that transaminases did not change in thioacetamide-treated rats in comparison with controls. In contrast, alkaline phosphatase rose dramatically in cirrhotic rats. We conclude that the serum amino acid pattern in this chronic model of liver cirrhosis resembles in part that of the corresponding human disease.

Influence of administration of long-chain polyunsaturated fatty acids on process of histological recovery in liver cirrhosis produced by oral intake of thioacetamide

Patients with liver cirrhosis frequently show some degree of protein-energy malnutrition and obviously require nutritional support. In this study, the treatment of rats consisted of the ad libitum oral intake of a 300 mg/liter thioacetamide solution, used as drinking water for four months. Thioacetamide treatment produced a severe alteration in the plasma fatty acid profile with significant decreases of these, which mimicked changes described in human cirrhosis. This hepatotoxic agent causes nodular cirrhosis, with loss of the normal architecture of the liver and disruption of the vascular pattern. The goal of the study was to evaluate the influence of n-3 and n-6 series long-chain polyunsaturated fatty acid dietary supplementation in experimental animals and to assess the effects of those dietary components on structural recovery in the liver. Significant increases of saturated and monounsaturated fatty acids as well as n-6 polyunsaturated fatty acids were seen only in the animals given the n-6 polyunsaturated fatty acid supplemented diet. However, only rats given the standard diet exhibited some degree of histological regeneration.

Dietary long-chain polyunsaturated fatty acids influence the recovery of thioacetamide-induced liver cirrhosis in rats

BACKGROUND

The aim of this study was to evaluate the dietary supplementation with omega-3 and omega-6 long-chain polyunsaturated fatty acids on the fatty acid composition of plasma and red blood cell membranes in rats with thioacetamide-induced liver cirrhosis.

METHODS

Thirty-eight female Wistar rats were given 300 mg thioacetamide/L in drinking water for 4 months to induce the experimental liver cirrhosis. Sixteen rats were used as controls. After treatment with thioacetamide, nine rats of each group were killed. Then, thioacetamide-treated rats were divided into three new groups, each receiving a different diet for 2 weeks: a semipurified diet (n = 9), the same diet supplemented with omega-3 long-chain polyunsaturated fatty acids (n = 10), or the same semipurified diet supplemented with omega-3 and omega-6 long-chain polyunsaturated fatty acids simultaneously (n = 10). The remaining control rats were fed the semipurified diet. Liver histology and plasma and erythrocyte fatty acid composition were assessed.

RESULTS

An apparent improvement of the histological damage took place in the rats fed the omega-3+ omega-6-supplemented diet. The diet supplemented with polyunsaturated fatty acids of the omega-3 series induced increases in the omega-3 long-chain polyunsaturated fatty acid levels in total plasma lipids, plasma lipid fractions and in erythrocyte phospholipids, and decreases in omega-6 long-chain polyunsaturated fatty acids in erythrocyte phospholipids during the recovery of rats with thioacetamide-induced liver cirrhosis. The administration of the diet supplemented with both omega-3 and omega-6 long-chain polyunsaturated fatty acids contributed to increase the levels of total plasma saturated, monounsaturated, and omega-6 long-chain polyunsaturated fatty acids from cirrhotic rats.

CONCLUSION

We conclude that the simultaneous supply of long-chain fatty acids of the omega-3 and the omega-6 series can be beneficial to improve the fatty acid status of this experimental model of liver cirrhosis.

Changes in fatty acid composition of plasma, liver microsomes, and erythrocytes in liver cirrhosis induced by oral intake of thioacetamide in rats

The aim of this study was to evaluate the changes in fatty acid composition of lipids of plasma, erythrocytes, and liver microsomes in rats with liver cirrhosis induced by oral intake of thioacetamide and to determine to what extent the experimental model reproduces the fatty acid tissue alterations reported in human cirrhosis. Two groups of rats were studied. The control group received water ad libitum, and the experimental group received 0.03% w/v thioacetamide in drinking water for 2, 4, and 6 months. At these times, lipids of plasma, erythrocytes, and liver microsomes were extracted, and their fatty acid compositions were determined. Thioacetamide intake led to macronodular and micronodular cirrhosis at 2 months. These alterations progressed at 4 months and eventuated in liver tumors at 6 months. Thioacetamide-treated rats showed a drop in total plasma fatty acids, higher percentages of palmitic acid in all lipid fractions, and lower levels of stearic acid in erythrocyte lipids and liver microsomal phospholipids. Oleic acid increased in plasma cholesteryl esters and phospholipids, as well as in erythrocyte lipids and liver microsomal phospholipids. In plasma lipids and liver microsomal phospholipids, the percentages of arachidonic and docosahexaenoic acids decreased. The latter also decreased in erythrocyte lipids. In addition, liver microsomes showed a higher cholesterol/lipid phosphorus molar ratio. The experimental model of cirrhosis obtained by intake of thioacetamide in drinking water for 4 months reproduces many of the fatty acid tissue alterations that appear in human cirrhosis and may serve to ascertain the biochemical mechanisms involved in these changes.