Markers of endothelial activation and autoantibodies in rheumatoid arthritis

Rheumatoid arthritis (RA) is an inflammatory chronic disease characterized by the production of antibodies and participation of the vascular endothelium in its pathogenesis. OBJECTIVES: to analyze the correlation of serum levels of the intercellular adhesion molecule 1 (ICAM-1), von Willebrand factor (vWF), Rheumatoid factor (RF), and anti-cyclic citrulinated peptide (anti-CCP) with clinical, laboratory, and radiological parameters of RA. METHODS: Serum levels of ICAM-1, vWF, RF, and anti-CCP were measured in 38 RA patients and 24 controls. Disease activity was measured by the DAS-28 score and functional capa-city was assessed using the HAQ score. The American College of Rheumatism criteria defined the functional class. Hand and fist X-rays were analyzed using the Sharp's score. Statistical analysis utilized the chi-square, Student's t, Kolmogorov-Smirnov, and Mann-Whitney tests, as appropriate, as well as the Spearman's correlation coefficient. RESULTS: Age range was from 52 ± 12.5 and 49 ± 9.4 years-old in RA and controls, respectively. Disease duration range was 68 ± 66.6 months. Serum vWF levels had a positive significant correlation to disease evolution, whereas RF and anti-CCP correlated to the Sharp score. Serum vWF and ICAM-1 levels correlated to DAS-28, while only vWF correlated with HAQ and Sharp scores. CONCLUSION: This study shows that RF and anti-CCP autoantibody levels are correlated to disease prognosis rather than activity. Serum vWF levels are positively correlated to both activity and severity parameters of the disease.A artrite reumatóide (AR) é uma doença crônica inflamatória, caracterizada pela produção de auto-anticorpos e participação do endotélio vascular em sua patogênese. OBJETIVOS: Analisar a correlação da molécula de adesão intercelular (ICAM-1), o fator de von Willebrand (vWF), o fator reumatóide (FR) e o anticorpo antipeptídeo citrulinado cíclico (anti-CCP) com parâmetros de atividade clínica, laboratorial e alterações radiológicas da AR. MÉTODOS: Em 38 pacientes e 24 indivíduos que não apresentavam artrite reumatóide foram dosados FR, anti-CCP, vWF e ICAM-1 no soro. A atividade da doença foi definida pelo escore do DAS-28. O Health Assessment Questionnaire (HAQ) definiu a capacidade funcional, e os critérios revisados do American College of Rheumatology, a classe funcional. Radiografias de mãos e punhos quantificaram o índice de Sharp modificado. RESULTADOS: A idade dos pacientes foi de 52 ± 12,5 anos e dos indivíduos que não apresentavam artrite reumatóide, de 49 ± 9,4 anos. O tempo de doença foi de 68 ± 66,6 meses. O vWF apresentou correlação significativa com o tempo de evolução da doença. Os auto-anticorpos tiveram correlação significativa com o índice de Sharp. A correlação do vWF e a ICAM-1 foi significativa com o DAS-28, mas apenas o vWF se correlacionou com o HAQ e com índice de Sharp. CONCLUSÃO: Esse estudo demonstrou que os auto-anticorpos não estão correlacionados com a atividade da doença, mas com seu prognóstico e sua gravidade por meio da relação destes com o índice de Sharp. O vWF apresentou correlação significativa com os parâmetros de atividade e gravidade da doença.Universidade Estadual de Ciências da Saúde de AlagoasUniversidade Federal de São Paulo (UNIFESP)Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)Associação Fundo de Incentivo à Psicofarmacologia Medicina LaboratorialUniversidade de São Paulo Faculdade de Medicina Laboratório de Poluição Atmosférica ExperimentalFaculdade de Medicina do ABCUNIFESP-EPM Departamento de PsicobiologiaUNIFESP, EPM, Depto. de PsicobiologiaSciEL

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Legislative Documents

Also, variously referred to as: House bills; House documents; House legislative documents; legislative documents; General Court documents

Mesenteric vascular reactivity.

<p>Effect of treatment with ASE (200mg/Kg/day) and exercise training (30 min/day; 5 days per week) on vasodilator effects of ACh (A) and NG (B), and vasoconstrictor effects of NE (C) in mesenteric arterial bed from type 2 diabetic rats. Data are mean ± SEM, n = 10 for all groups. *Significantly different (<i>p ≤ 0</i>.<i>05</i>) from Controls; ⁺Significantly different (<i>p ≤ 0</i>.<i>05</i>) from Sedentary D.</p

Expression of insulin cascade and pAMPK protein.

<p>Effect of treatment with ASE (200mg/Kg/day) and exercise training (30 min/day; 5 days per week) on IR (A), AKT (B), pAKT (C), GLUT-4 (D) and pAMPK expressions in skeletal muscle from type 2 diabetic rats. Data are mean ± SEM, n = 4 for all groups. Using one-way ANOVA: *Significantly different (<i>p ≤ 0</i>.<i>05</i>) from Controls; ^●Significantly different (<i>p ≤ 0</i>.<i>05</i>) from Training C; ⁺Significantly different (<i>p ≤ 0</i>.<i>05</i>) from Sedentary D; ^$Significantly different (<i>p ≤ 0</i>.<i>05</i>) from Training D; ^δSignificantly different (<i>p ≤ 0</i>.<i>05</i>) from ASE Sedentary D. Using unpaired Student's t-test: ^&Significantly different (<i>p ≤ 0</i>.<i>05</i>) from Sedentary D.</p

Effects of ASE (200mg/Kg/day) and exercise training (30 min/day; 5 days per week) on glucagon-like peptide-1 (GLP-1), leptin, and anti-inflammatory cytokine serum levels in type 2 diabetic animals.

<p>Effects of ASE (200mg/Kg/day) and exercise training (30 min/day; 5 days per week) on glucagon-like peptide-1 (GLP-1), leptin, and anti-inflammatory cytokine serum levels in type 2 diabetic animals.</p

Glycemic levels and body weight.

<p>Effect of treatment with ASE (200mg/Kg/day) and exercise training (30 min/day; 5 days per week) on blood glucose levels (A) and body weight (B) in type 2 diabetic rats. Data are mean ± SEM, n = 10 for all groups. *Significantly different (p<0.05) from Controls; ⁺Significantly different (<i>p ≤ 0</i>.<i>05</i>) from Sedentary D; ^$Significantly different (<i>p ≤ 0</i>.<i>05</i>) from Training D; ^δSignificantly different (<i>p ≤ 0</i>.<i>05</i>) from ASE Sedentary D.</p

Insulin resistance and β-cell function.

<p>Effect of treatment with ASE (200mg/Kg/day) and exercise training (30 min/day; 5 days per week) on serum insulin levels (A), HOMA-IR (B) and HOMA-B (C) indexes in type 2 diabetic rats. Data are mean ± SEM, n = 6 for all groups. *Significantly different (<i>p ≤ 0</i>.<i>05</i>) from Controls; ⁺Significantly different (<i>p ≤ 0</i>.<i>05</i>) from Sedentary D. ^$Significantly different (<i>p ≤ 0</i>.<i>05</i>) from Training D.</p