Western-style diet changes murinometric and metabolic parameters of rat offspring in time-specific windows / A dieta do estilo ocidental altera parâmetros murinométricos e metabólicos da própria de rat em janelas específicas

The present study evaluated the effects of the western-style diet in the time-specific windows of rodents. Male Wistar rats were divided into three groups fed on a Control diet during all experimental period (CC); a western-style diet after lactation (CW); and a westernized diet throughout entire experimental period (WW). Body weight, food and energy intake, abdominal fat, glucose tolerance, biochemical parameters and serum hormones were evaluated. Higher body weight (CC=408.6±11.3g; CW=474.1±9.2g; WW=475.8±16.3g, p<0.001), increased abdominal fat (CC=12.6±0.8g; CW=34.1± 2.3g; WW=33.2± 2.4g, p<0.001), reduced food intake (CC=26.3±0.8g; CW=17.0±0.6; WW=18.4±0.9g, p<0.001), and similar energetic intake were found among the groups fed on the western-style diet regardless to the exposure time. Also, the area under the curves of glucose tolerance test, glucose, triacylglycerol, VLDL-c and total cholesterol blood levels were higher in the western-style diet groups compared to the control groups (p<0.01). However, levels of hormones were different according to specific windows of dietary exposure. The CW group showed higher corticosterone (CC=263.4± 109.1;CW= 339.9±16.6; WW=305.5±16.2ng/mL, p<0.001) and leptin levels (CC=8.2 0.7;CW=14.5 1.4;WW=9.1 0.7ng/mL p<0.001); and the WW group showed raised insulin levels (CC=6.7±0.3;CW=8.0±0.3;WW=10.5±0.8ng/mL, p<0.001). Then, the western-style diet enhanced signals of metabolic imbalance in both groups, but the outcomes varied according to the windows of dietary exposure

Maternal Moderate Physical Training during Pregnancy Attenuates the Effects of a Low-Protein Diet on the Impaired Secretion of Insulin in Rats: Potential Role for Compensation of Insulin Resistance and Preventing Gestational Diabetes Mellitus

The effects of pregestational and gestational low-to-moderate physical training on insulin secretion in undernourished mothers were evaluated. Virgin female Wistar rats were divided into four groups as follows: control (C, n = 5); trained (T, n = 5); low-protein diet (LP, n = 5); trained with a low-protein diet (T + LP, n = 5). Trained rats ran on a treadmill over a period of 4 weeks before mate (5 days week(-1) and 60 min day(-1), at 65% of VO2max). At pregnancy, the intensity and duration of the exercise were reduced. Low-protein groups were provided with an 8% casein diet, and controls were provided with a 17% casein diet. At third day after delivery, mothers and pups were killed and islets were isolated by collagenase digestion of pancreas and incubated for a further 1 h with medium containing 5.6 or 16.7 mM glucose. T mothers showed increased insulin secretion by isolated islets incubated with 16.7 mM glucose, whereas LP group showed reduced secretion of insulin by isolated islets when compared with both C and LP + T groups. Physical training before and during pregnancy attenuated the effects of a low-protein diet on the secretion of insulin, suggesting a potential role for compensation of insulin resistance and preventing gestational diabetes mellitus.National Council for Scientific and Technological Development (CNPq)National Council for Scientific and Technological Development (CNPq)Foundation to Support Science and Research from Pernambuco State (FACEPE)Foundation to Support Science and Research from Pernambuco State (FACEPE)Sao Paulo Research Foundation (FAPESP)Sao Paulo Research Foundation (FAPESP)Coordination for the Improvement of Higher Level Personnel (CAPES)Coordination for the Improvement of Higher Level Personnel (CAPES)Deans Office for Research/University of Sao PauloDean's Office for Research/University of Sao Paul

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

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Effects of L-gultamine on the signaling pathways of protein synthesis and degradation in skeletal muscle and intracellular free aminoacids contente in cultured miotubes.

Investigou-se os efeitos da L-glutamina (1g/kg de massa corpórea) em camundongos jejuados por 24 horas. A L-glutamina atenuou a perda de massa muscular e a diminuição da área das fibras musculares esqueléticas causadas pelo jejum via Akt-mTOR. No sóleo, a L-glutamina estimulou a Akt (início da via), e no EDL ativou a S6 (final da via). Investigou-se também os efeitos da L-glutamina em miotubos (C2C12) cultivados por 48 horas. A diminuição de L-glutamina no meio (de 2 para zero mM) causou balanço proteico negativo e aumento do conteúdo dos aminoácidos livres, exceto dos produtos da glutaminólise, indicando estimulação de proteólise. O aumento de L-glutamina no meio (de 2 para 8 e 16 mM) não alterou o conteúdo intracelular de proteínas e dos aminoácidos livres. Na presença de 2 mM de glutamina no meio, a insulina teve efeito positivo no balanço proteico via Akt/mTOR/S6K, estimulando a S6K. Na ausência de glutamina, houve maior fosforilação de eIF2α estimulada por dexametasona e portanto menor síntese proteica.We investigated the effects of L-glutamine (1g/kg of body mass) on 24 h fasted mice. L-Glutamine attenuated the loss of muscle mass and the reduction of the skeletal muscle fibers area caused by fasting. This attenuation occurred via Akt-mTOR, however, glutamine stimulated Akt (upstream) in the soleus, whereas it activated S6 (dowstream) in EDL. The effects of L-glutamine on myotubes (C2C12) cultured for 48 hours were also examined. The reduction of L-glutamine in the medium (from 2 to zero mM) decreased protein content and increased contents of all amino acids, except products of glutaminolysis, indicating stimulation of proteolysis. The increased L-glutamine levels in the medium (from 2 to 8 and 16 mM) did not change the intracellular contents of protein and free amino acids. In the presence of 2 mM glutamine, insulin had a positive effect on total protein content through Akt/mTOR/S6K pathway, stimulating S6K. In turn, in the absence of L-glutamine, there was increased eIF2α phosphorylation stimulated by dexamethasone and thus less protein synthesis

Zinc Supplementation Improves Glucose Homeostasis in High Fat-Fed Mice by Enhancing Pancreatic β-Cell Function

Zinc is an essential component of the insulin granule and it possibly modulates insulin secretion and signaling. Since insulin resistance is a hallmark in the development of type 2 diabetes mellitus, this study aimed at investigating if zinc supplementation is able to improve glucose tolerance and β-cell function in a model of insulin resistance. Male C57BL/6 mice were distributed in four groups according to the diet: normal fat (NF); normal fat supplemented with ZnCl2 (NFZ); high-fat (HF); and, high-fat chow supplemented with ZnCl2 (HFZ). Intraperitoneal glucose (ipGTT) and insulin (ipITT) tolerance, glycemia, insulinemia, HOMA-IR, and HOMA-β were determined after 15 weeks in each diet. Glucose-stimulated insulin secretion (GSIS) was investigated in isolated islets. The insulin effect on glucose uptake, metabolism, and signaling was investigated in soleus muscle. ZnCl2 did not affect body mass or insulin sensitivity as assessed by ipITT, HOMA-IR, muscle glucose metabolism, and Akt and GSK3-β phosphorylation. However, glucose tolerance, HOMA-β, and GSIS were significantly improved by ZnCl2 supplementation. Therefore, ZnCl2 supplementation improves glucose homeostasis in high fat-fed mice by a mechanism that enhances β-cell function, rather than whole-body or muscle insulin sensitivity

Amoedação e oferta monetária em Minas Gerais: as Casas de Fundição e Moeda de Vila Rica

RESUMO As Casas de Fundição e Moeda de Vila Rica, que funcionaram entre 1724 e 1735, cunharam mais moeda do que as Casas da Moeda de Lisboa e do Rio de Janeiro juntas. Por si só, estes dados permitem levantar questões sobre a oferta monetária de um lado e outro do Atlântico. Neste artigo, de um lado, são apresentadas a contabilidade e as rotinas de amoedação das Casas de Vila Rica e, de outro, é analisado o volume de remessas líquidas feitas pelas Casas da Moeda e Fundição de Vila Rica, Rio de Janeiro e Bahia para a metrópole na primeira metade do século XVIII. Por fim, discute a monetização da economia brasileira no período e sinaliza para a necessidade de uma revisão urgente da perspectiva adotada largamente no que respeita à circulação monetária na colônia.ABSTRACT Between 1724 and 1735, the Mint House of Vila Rica produced more coins than its congener in Lisbon and Rio de Janeiro, even if both were taken together. As a matter of fact, these data allows us to raise issues about the monetary offer in both sides of the Atlantic. This article presents, besides the current accounts and routines of coinage, evidences demonstrating the volume of net remittances made by the Casas de Moeda e Fundição of Vila Rica, Rio de Janeiro and Bahia to the metropolis. It argues the monetization of Brazilian economy in the period and points out to the need for an urgent revision of the widely adopted approach in the field of the monetary circulation in the colony

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.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable