Pressure Load: The Main Factor for Altered Gene Expression in Right Ventricular Hypertrophy in Chronic Hypoxic Rats

BACKGROUND: The present study investigated whether changes in gene expression in the right ventricle following pulmonary hypertension can be attributed to hypoxia or pressure loading. METHODOLOGY/PRINCIPAL FINDINGS: To distinguish hypoxia from pressure-induced alterations, a group of rats underwent banding of the pulmonary trunk (PTB), sham operation, or the rats were exposed to normoxia or chronic, hypobaric hypoxia. Pressure measurements were performed and the right ventricle was analyzed by Affymetrix GeneChip, and selected genes were confirmed by quantitative PCR and immunoblotting. Right ventricular systolic blood pressure and right ventricle to body weight ratio were elevated in the PTB and the hypoxic rats. Expression of the same 172 genes was altered in the chronic hypoxic and PTB rats. Thus, gene expression of enzymes participating in fatty acid oxidation and the glycerol channel were downregulated. mRNA expression of aquaporin 7 was downregulated, but this was not the case for the protein expression. In contrast, monoamine oxidase A and tissue transglutaminase were upregulated both at gene and protein levels. 11 genes (e.g. insulin-like growth factor binding protein) were upregulated in the PTB experiment and downregulated in the hypoxic experiment, and 3 genes (e.g. c-kit tyrosine kinase) were downregulated in the PTB and upregulated in the hypoxic experiment. CONCLUSION/SIGNIFICANCE: Pressure load of the right ventricle induces a marked shift in the gene expression, which in case of the metabolic genes appears compensated at the protein level, while both expression of genes and proteins of importance for myocardial function and remodelling are altered by the increased pressure load of the right ventricle. These findings imply that treatment of pulmonary hypertension should also aim at reducing right ventricular pressure

Avaliação clínica da infiltração facetaria no tratamento da dor lombar crônica por síndrome facetaria: estudo prospectivo Evaluación clínica de la infiltración de las facetas en el tratamiento del dolor crónico de espalda baja por el síndrome de faceta síndrome: estudio prospectivo Clinical evaluation of the lumbar facet joint blocks in treatment of chronic low back pain: a prospective study

OBJETIVO: Avaliar os resultados do bloqueio facetário lombar com anestésico local e corticóide em pacientes com lombalgia crônica por síndrome facetária. MÉTODOS: Realizou-se um estudo prospectivo em 30 pacientes com lombalgia crônica por síndrome facetária, os quais foram submetidos à infiltração facetária com bupivacaína a 0,25% e acetato de metilpredinisolona sob controle radioscópico, e foram seguidos e avaliados seguindo as escalas Visual Analógica da Dor, Oswestry Disability Index e os Critérios de MacNab nos quais 17 foram do sexo feminino e 13 do sexo masculino. RESULTADOS: Foi observada diminuição significativa (p<0,05) da dor pela Escala Visual Analógica. Obtivemos 73,3% de resultados satisfatórios na primeira semana, 63,3% no primeiro mês, 43,3% em 3 meses, e 36,6% no final de 6 meses. O índice de complicações foi muito baixo. CONCLUSÃO: O bloqueio facetário utilizando corticóide e anestésico local se mostrou-se efetivo, seguro e de fácil realização. No entanto houve recidiva em mais de 50% dos casos dentro de 6 meses.<br>OBJETIVO: Evaluar los resultados del bloqueo facetario lumbar, con anestésico local y corticoide, en pacientes con dorsalgia crónica por síndrome facetario. MÉTODOS: Se realizó un estudio prospectivo en 30 pacientes, 17 del sexo femenino y 13 del sexo masculino, con dorsalgia crónica por síndrome facetario, quienes fueron sometidos a la infiltración facetaria con bupivacaína a 0,25% y acetato de metilpredinisolona bajo control radioscópico, y fueron acompañados y evaluados siguiendo las escalas Visual Analógica del Dolor, Oswestry Disability Index y los Criterios de MacNab. RESULTADOS: Se observó una disminución significativa (p<0,05) del dolor según la Escala Visual Analógica del Dolor. Obtuvimos 73,3% de resultados satisfactorios en la primera semana, 63,3% en el primer mes, 43,3% en 3 meses, y 36,6% al final de 6 meses. El índice de complicaciones fue muy bajo. CONCLUSIÓN: El bloqueo facetario, utilizando corticoide y anestésico local, se mostró eficaz, seguro y de fácil realización, no obstante, con recidiva en la mayor parte de los casos dentro de 6 meses.<br>OBJECTIVE: To evaluate the lumbar facet block with local anesthetics and corticosteroids in patients with chronic low back pain of facet joint origin. METHODS: We conducted a prospective study on 30 patients with chronic low back pain in facet syndrome who underwent facet infiltration with bupivacaine 0.25% and methylprednisolone acetate under radioscopic control; the subjects were followed and evaluated following the Visual Analogue Scale of Pain , Oswestry Disability Index and MacNab criteria; 17 of them were female and 13 male. RESULTS: Reduction of pain was found by Visual Analogue Scale significant (p <0.05). We obtained 73.3% of satisfactory results in the first week, 63.3% in the first month, 43.3% in third months, and 36.6% at the end of 6 months. The complication rate was very low. CONCLUSION: Facet blocka using local anesthetic and steroid was effective, safe and easy to perform. Neverthelees, there was recurrence of most cases within six months