T-786→C polymorphism of the endothelial nitric oxide synthase gene is associated with insulin resistance in patients with ischemic or non ischemic cardiomyopathy

Background: Insulin resistance (IR) and endothelial dysfunction are frequently associated in cardiac disease. The T-786→C variant in the promoter region of the endothelial nitric oxide synthase (eNOS) gene has been associated with IR in both non-diabetic and diabetic subjects. Aim of the study was to assess the reciprocal relationships between T-786→C eNOS polymorphism and IR in ischemic and non-ischemic cardiomyopathy.Method: A group of 132 patients (108 males, median age 65 years) with global left ventricular (LV) dysfunction secondary to ischemic or non-ischemic heart disease was enrolled. Genotyping of T-786→C eNOS gene promoter, fasting glucose, insulin, and insulin resistance (defined as HOMA-IR index > 2.5) were determined in all patients.Results: Genotyping analysis yielded 37 patients homozygous for the T allele (TT), 70 heterozygotes (TC) and 25 homozygous for C (CC). Patients with CC genotype had significantly higher systemic arterial pressure, blood glucose, plasma insulin and HOMA index levels than TT. At multivariate logistic analysis, the history of hypertension and the genotype were the only predictors of IR. In particular, CC genotype increased the risk of IR (CI% 1.4-15.0, p < 0.01) 4.5-fold. The only parameter independently associated with the extent of LV dysfunction and the presence of heart failure (HF) was the HOMA index (2.4 CI% 1.1-5.6, p < 0.04).Conclusions: T-786→C eNOS polymorphism was the major independent determinant of IR in a population of patients with ischemic and non-ischemic cardiomyopathy. The results suggest that a condition of primitive eNOS lower expression can predispose to an impairment of glucose homeostasis, which in turn is able to affect the severity of heart disease. © 2012 Vecoli et al.; licensee BioMed Central Ltd

Improved myocardial perfusion in chronic diabetic mice by the up-regulation of pLKB1 and AMPK signaling

Previous studies related impaired myocardial microcirculation in diabetes to oxidative stress and endothelial dysfunction. Thus, this study was aimed to determine the effect of up-regulating pAMPK-pAKT signaling on coronary microvascular reactivity in the isolated heart of diabetic mice. We measured coronary resistance in wild-type and streptozotocin (STZ)-treated mice, during perfusion pressure changes. Glucose, insulin, and adiponectin levels in plasma and superoxide formation, NOx levels and heme oxygenase (HO) activity in myocardial tissue were determined. In addition, the expression of HO-1, 3-nitrotyrosine, pLKB1, pAMPK, pAKT, and peNOS proteins in control and diabetic hearts were measured. Coronary response to changes in perfusion pressure diverged from control in a time-dependent manner following STZ administration. The responses observed at 28 weeks of diabetes (the maximum time examined) were mimicked by L-NAME administration to control animals and were associated with a decrease in serum adiponectin and myocardial pLKB1, pAMPK, pAKT, and pGSK-3 expression. Cobalt protoporphyrin treatment to induce HO-1 expression reversed the microvascular reactivity seen in diabetes towards that of controls. Up-regulation of HO-1 was associated with an increase in adiponectin, pLKB1, pAKT, pAMPK, pGSK-3, and peNOS levels and a decrease in myocardial superoxide and 3-nitrotyrosine levels. In the present study we describe the time course of microvascular functional changes during the development of diabetes and the existence of a unique relationship between the levels of serum adiponectin, pLKB1, pAKT, and pAMPK activation in diabetic hearts. The restoration of microvascular function suggests a new therapeutic approach to even advanced cardiac microvascular derangement in diabetes

Covid-19 patient management in outpatient setting: A population-based study from southern italy

Evidence on treatments for early-stage COVID-19 in outpatient setting is sparse. We explored the pattern of use of drugs prescribed for COVID-19 outpatients’ management in Southern Italy in the period February 2020–January 2021. This population-based cohort study was conducted using COVID-19 surveillance registry from Caserta Local Health Unit, which was linked to claims databases from the same catchment area. The date of SARS-CoV-2 infection diagnosis was the index date (ID). We evaluated demographic and clinical characteristics of the study drug users and the pattern of use of drugs prescribed for outpatient COVID-19 management. Overall, 40,030 patients were included in the analyses, with a median (IQR) age of 44 (27–58) years. More than half of the included patients were asymptomatic at the ID. Overall, during the study period, 720 (1.8%) patients died due to COVID-19. Azithromycin and glucocorticoids were the most frequently prescribed drugs, while oxygen was the less frequently prescribed therapy. The cumulative rate of recovery from COVID-19 was 84.2% at 30 days from ID and it was lower among older patients. In this study we documented that the drug prescribing patterns for COVID-19 treatment in an outpatient setting from Southern Italy was not supported from current evidence on beneficial therapies for early treatment of COVID-19, thus highlighting the need to implement strategies for improving appropriate drug prescribing in general practice

Impaired myocardial metabolic reserve and substrate selection flexibility during stress in patients with idiopathic dilated cardiomyopathy.

Under resting conditions, the failing heart shifts fuel use toward greater glucose and lower free fatty acid (FFA) oxidation. We hypothesized that chronic metabolic abnormalities in patients with dilated cardiomyopathy (DCM) are associated with the absence of the normal increase in myocardial glucose uptake and maintenance of cardiac mechanical efficiency in response to pacing stress. In 10 DCM patients and 6 control subjects, we measured coronary flow by intravascular ultrasonometry and sampled arterial and coronary sinus blood. Myocardial metabolism was determined at baseline, during atrial pacing at 130 beats/min, and at 15 min of recovery by infusion of [(3)H]oleate and [(13)C]lactate and measurement of transmyocardial arteriovenous differences of oxygen and metabolites. At baseline, DCM patients showed depressed coronary flow, reduced uptake and oxidation of FFA, and preferential utilization of carbohydrates. During pacing, glucose uptake increased by 106% in control subjects but did not change from baseline in DCM patients. Lactate release increased by 122% in DCM patients but not in control subjects. Cardiac mechanical efficiency in DCM patients was not different compared with control subjects at baseline but was 34% lower during stress. Fatty acid uptake and oxidation did not change with pacing in either group. Our results show that in DCM there is preferential utilization of carbohydrates, which is associated with reduced flow and oxygen consumption at rest and an impaired ability to increase glucose uptake during stress. These metabolic abnormalities might contribute to progressive cardiac deterioration and represent a target for therapeutic strategies aimed at modulating cardiac substrate utilization

Institutional analysis and education: curriculum reform in public and private universities

This text discusses some professional practices carried out in the field of higher education in a context of curriculum changes in the medical and nursing courses of a public university (Universidade Federal Fluminense - UFF - in Niterói, RJ, Brazil) and in the nutrition course of a private university (Universidade Metodista - UNIMEP - in Piracicaba, sp, Brazil). Based on concepts from institutional analysis, we investigate similarities and differences between the public and private processes of curriculum reform, as well as aspects of our own professional histories. This paper was produced in the context of disciplines and seminars in institutional analysis for the Graduate Program in Collective Health at the Department of Preventive and Social Medicine of the School of Medical Sciences at UNICAMP, conducted between 2002 and 2004 under the responsibility of the last-mentioned co-author of this article.O texto aborda uma reflexão sobre certas práticas profissionais realizadas no campo da Educação Universitária, num contexto de transformações curriculares dos cursos de medicina e enfermagem de uma universidade pública - a Universidade Federal Fluminense (UFF), de Niterói (RJ) -, e do curso de nutrição de uma universidade particular - a Universidade Metodista de Piracicaba (UNIMEP). À luz de alguns conceitos da análise institucional, analisamos certas semelhanças e diferenças entre os dois processos de reforma curricular, nisso considerando também aspectos das nossas trajetórias profissionais. O trabalho foi produzido no âmbito de disciplinas e seminários de análise institucional do curso de pós-graduação em saúde coletiva do Departamento de Medicina Preventiva e Social, da Faculdade de Ciências Médicas da UNICAMP, ministrados, de 2002 a 2004, sob responsabilidade da última co-autora deste artigo.18121

Genomic organization and evolution of double minutes/homogeneously staining regions with MYC amplification in human cancer

The mechanism for generating double minutes chromosomes (dmin) and homogeneously staining regions (hsr) in cancer is still poorly understood. Through an integrated approach combining next-generation sequencing, single nucleotide polymorphism array, fluorescent in situ hybridization and polymerase chain reaction-based techniques, we inferred the fine structure of MYC-containing dmin/hsr amplicons harboring sequences from several different chromosomes in seven tumor cell lines, and characterized an unprecedented number of hsr insertion sites. Local chromosome shattering involving a single-step catastrophic event (chromothripsis) was recently proposed to explain clustered chromosomal rearrangements and genomic amplifications in cancer. Our bioinformatics analyses based on the listed criteria to define chromothripsis led us to exclude it as the driving force underlying amplicon genesis in our samples. Instead, the finding of coexisting heterogeneous amplicons, differing in their complexity and chromosome content, in cell lines derived from the same tumor indicated the occurrence of a multi-step evolutionary process in the genesis of dmin/hsr. Our integrated approach allowed us to gather a complete view of the complex chromosome rearrangements occurring within MYC amplicons, suggesting that more than one model may be invoked to explain the origin of dmin/hsr in cancer. Finally, we identified PVT1 as a target of fusion events, confirming its role as breakpoint hotspot in MYC amplification

A GNR e as Operações de Apoio à Paz: Legitimidade e limites de actuação

O presente trabalho de investigação aplicada está subordinado ao tema: ―A GNR e as Operações de Apoio à Paz: Legitimidade e Limites de Actuação‖. As operações de apoio à paz são uma realidade do mundo actual e a participação da GNR nestas operações tem sido uma constante. Neste sentido, a legitimidade desta participação tem sido ao longo dos anos questionada, tese esta que é debatida neste trabalho. Para além da legitimidade, são também aqui debatidos quais são os limites de actuação desta força militar em operações deste tipo. Neste contexto, desenvolve-se um estudo através da pergunta de partida: "De que forma a participação nas OAP é importante para a GNR? E para o País?." Os principais objectivos do trabalho são responder às perguntas supra mencionadas, verificar a legitimidade da participação da GNR neste tipo de operações, compreender o conceito das regras de empenhamento e a sua criação e, finalmente , identificar a importância destas regras para a decisão de um comandante. O trabalho iniciou-se com uma fase exploratória, procedendo-se em seguida à pesquisa com particular incidência em livros, legislação e textos relacionados com o tema, tendo sido tam bém utilizada a internet como fontes de informação sobre as operações de apoio à paz. A investigação de campo baseou-se na análise de conteúdo das entrevistas efectuadas, o que permitiu responder às perguntas de investigação através da verificação das hipó teses formuladas. Após a análise dos dados, conclui-se que a GNR tem legitimidade para participar nestas operações, o que está contemplado na sua lei orgânica, e que, em simultâneo, estas participações revelam elevada importância não só para a GNR como para o País. No entanto, para que exista uma melhor preparação das forças que executam estas missões será necessário que o novo Centro de Treino e Aprontamento para Forças de Missões Internacionais entre em funcionamento com uma estrutura diferente da planeada. O presente trabalho foi realizado entre Janeiro e Março de 2009.Abstract This investigation project was developed under the theme: ―The GNR (Portuguese Republican National Guard) and the Peace Operations: Legitimacy and Action Limits. The peace-support operations are a reality in our contemporary world and the GNR's participation in these operations has been a constant. Considering this, the legitimacy of such participations has been questioned over the years, fact that led to the thesis discussed along this work. In addition to legitimacy, the limits of military force in such operations are also debated. In this context, this project was based on two former question s: "What is the meaning of the GNR participation in the peace operations? And for the country?". The main goals of the project are answering the questions above, confirming the legitimacy of GNR's participation in such operations, understanding the rules of engagement and its creation and, at last, identifying the rules importance for a commander’s decision. The project began with an exploratory phase, followed by a research work supported by books, legislation and texts on the subject as well as the Internet as sources of information on peace-support operations. The field research was developed by analysing the conducted interviews, which allowed the research to answer the questions while checking the assumptions previously made. After analyzing the data, it is concluded that the GNR is entitled to participate in these operations, which is included in its organic law, and, simultaneously, these actions reveal high importance not only for the GNR but for the country also. Nevertheless, in order to get a better preparation of the forces that will carry out these missions, changes in structure and functioning of the new Training Centre are needed. This work was developed from January to March 2009

Uma pesquisa-ação-intervenção em Saúde Bucal Coletiva: contribuindo para a produção de novas análises

Este artigo tem como objetivo apresentar a estratégia metodológica produzida e exercitada durante o desenvolvimento de uma pesquisa de doutorado que tomou como quadro teórico-metodológico a abordagem da Análise Institucional na Saúde Coletiva. Pretende, também, contribuir para o debate sobre as abordagens metodológicas que colocam em pauta a relação entre o pesquisador e o ato de pesquisar. Ao longo da investigação, a pesquisa-ação foi se configurando e se (entre)cruzando com a pesquisa-intervenção, num percurso que estamos denominando pesquisa-ação-intervenção. Desse modo, a pesquisadora, os momentos da pesquisa e da produção teórico-metodológica foram construídos/constituídos ao mesmo tempo, num processo mediatizado pelos saberes e pelos não-saberes dos sujeitos implicados com esta investigação. Podemos dizer que houve dois processos articulados de ação-intervenção: um da pesquisadora no e com o grupo, e, outro, dos participantes do grupo, profissionais do Sistema Único de Saúde do município de Campinas em seu cotidiano, na produção do cuidado em Saúde Bucal.This article describes the methodological strategy created during the research carried out for a doctoral degree, with Institutional Analysis in Collective Health being used as the theoretical and methodological framework. The article is thus meant as a contribution to the debate on methodological approaches to the relationships between researchers and their act of researching. During the investigation, action-research operated as a crossroad between intervention and research, along a path we refer to as intervention-research-action. The research stages and the theoretical-methodological production were constructed concurrently, in a process mediated by the knowledge and questions of the subjects related to this investigation. Knowledge production in the area of oral health care was made through two articulated processes of intervention-action: one of the researcher in and within the group, other of the participants in the group, namely professionals in public health in their everyday life work in oral health care

Italian adaptation of the Uniform Data Set Neuropsychological Test Battery (I-UDSNB 1.0): development and normative data

Background: Neuropsychological testing plays a cardinal role in the diagnosis and monitoring of Alzheimer’s disease. A major concern is represented by the heterogeneity of the neuropsychological batteries currently adopted in memory clinics and healthcare centers. The current study aimed to solve this issue. Methods: Following the initiative of the University of Washington’s National Alzheimer’s Coordinating Center (NACC), we presented the Italian adaptation of the Neuropsychological Test Battery of the Uniform Data Set (I-UDSNB). We collected data from 433 healthy Italian individuals and employed regression models to evaluate the impact of demographic variables on the performance, deriving the reference norms. Results: Higher education and lower age were associated with a better performance in the majority of tests, while sex affected only fluency tests and Digit Span Forward. Conclusions: The I-UDSNB offers a valuable and harmonized tool for neuropsychological testing in Italy, to be used in clinical and research settings