ABSTRACT Cardiac surgery causes a series of disturbances in human physiology. The correction of systemic hemodynamic variables is frequently ineffective in improving microcirculatory perfusion and delivering oxygen to the tissues. We present the case of a 52-year-old male submitted to mitral valve replacement (metallic valve) and subaortic membrane resection. Sublingual microcirculatory density and perfusion were evaluated using a handheld CytoCam camera before surgery and in the early postoperative period. In this case, systemic hemodynamic variables were compromised despite an actual improvement in the microcirculatory parameters in comparison to the preoperative evaluation, possibly due to the correction of the structural cardiac defects. physiology tissues 52yearold yearold 52 year old metallic resection period evaluation defects 5

RESUMO O efluente sanitário bruto é um dos responsáveis pela poluição de rios urbanos, e a instalação de estações de tratamento de efluentes (ETE) exige uma avaliação comparativa do comportamento desses rios antes e depois da ETE. Este trabalho objetivou avaliar a qualidade da água do rio São Domingos (RSD) após o início da operação da ETE Catanduva (SP), cujas eficiências médias de remoção foram: demanda bioquímica de oxigênio (93,71%), nitrogênio amoniacal (73,12%), fósforo total (25,70%), turbidez (85,16%) e ST (31,75%). Foram utilizados 768 dados coletados pela Companhia Ambiental do Estado de São Paulo a montante e a jusante de Catanduva (SP). Obras de dragagem realizadas durante o período avaliado foram responsáveis por um significativo decréscimo temporário na qualidade da água do RSD em Catanduva. Após dois anos do início da operação da ETE, houve significativa melhoria na qualidade do RSD, com redução das concentrações médias de DBO (de 20,97 para 5,73 mg.L−1), nitrogênio amoniacal (de 3,84 para 0,99 mg.L−1) e Escherichia coli (de 105 para 104 UFC.100 mL−1) e aumento da concentração de oxigênio dissolvido (de 0,90 para 3,12 mg.L−1). A análise de componentes principais indicou que a qualidade do rio a jusante de Catanduva está-se aproximando da boa qualidade verificada a montante da cidade. Esses dados sugerem que o RSD pode futuramente ser classificado como Classe 3 (Resolução do Conselho Nacional do Meio Ambiente — CONAMA n° 357/05) e até ser utilizado para abastecimento humano, reduzindo a elevada demanda de água subterrânea na região.

ABSTRACT Non-treated wastewater is responsible for the pollution of urban rivers, and it is mandatory to evaluate the behavior of these rivers before and after the construction of a Wastewater Treatment Plant (WWTP). The aim of this study was to evaluate the water quality of São Domingos River (SDR) after the start of the Catanduva/SP WWTP operation, whose average removal efficiencies were: biochemical oxygen demand (BOD; 93.71%), ammonia nitrogen (73.12%), total phosphorus (25.70%), turbidity (85.16%), and total solids (31.75%). We used 768 data collected upstream and downstream of the city of Catanduva/SP, previously analyzed by CETESB (state environmental agency). Dredging works carried out during the evaluated period were responsible for a significant temporary worsening in the water quality of the SDR in Catanduva. Two years after the beginning of the Catanduva WWTP, there was a significant improvement in SDR water quality, with a reduction in the average concentrations of BOD (20.97 to 5.73 mg.L−1), ammonia nitrogen (3.84 for 0.99 mg.L−1), and Escherichia coli (105 to 104 CFU.100 mL−1) were reduced; and DO concentration (0.90 to 3.12 mg.L−1) increased. The Principal Component Analysis (PCA) indicated that the water quality of the river downstream of Catanduva is approaching the same quality verified upstream of the city. These data suggest that SDR may be considered a Class 3 river (Resolution CONAMA 357/05) in the future and may even be used for human supply, reducing the high demand for groundwater in the region.

Abstract Background: Congenital heart disease in adults shares some features with heart failure (HF), including exercise intolerance, ventilatory inefficiency, inflammatory and neurohormonal activation, cardiac arrhythmias and myocardial fibrosis. Over the last years, cardiopulmonary exercise test has gained importance in the diagnostic and prognostic evaluation of congenital heart diseases, as has already occurred in HF. Objective: To describe the behavior of hemodynamic, metabolic and ventilatory parameters in response to exercise in adults with congenital heart disease. Methods: Observational cross-sectional study evaluating 31 adults with congenital acyanotic or cyanotic heart disease, treated clinically, surgically or percutaneously, referred for cardiopulmonary exercise test. A descriptive analysis of the data was performed. Results: Patients aged 35.7 ± 14.2 years were included. Oxygen consumption (VO2) was 44.86 ± 18.01% of predicted at peak exercise and 36.92 ± 12.93% of predicted maximal VO2 at anaerobic threshold. We found an oxygen uptake efficiency slope (OUES) of 1.49 ± 0.89 (61.43 ± 26.63% of predicted), oxygen pulse of 58.90 ± 22.24% and increment in systolic arterial pressure during exercise was 31.42 ± 21.60 mmHg. Conclusion: Adults with congenital heart disease had similar responses to heart failure patients during exercise - reduced aerobic capacity, ventilatory inefficiency for oxygen consumption and limited inotropic response to exercise, characterized by reduced oxygen pulse and small increase in systolic arterial pressure.

Este estudo investigou a distribuição espacial e temporal de espécies toxigênicas de fitoplâncton entre outubro de 2010 e abril de 2012 na Baía de Guaratuba, Estado do Paraná, Brasil, onde as atividades de maricultura têm se intensificado nos últimos anos. As maiores abundâncias de Pseudo-nitzschia calliantha e P. pungens (até 7,3 x 104 células L-1), diatomáceas causadoras do envenenamento amnésico por consumo de molusco (ASP), foram correlacionadas com valores mais elevados de temperatura (de dezembro a abril), salinidade (>20) e concentrações de silicato (variando de 6,0 a 90,0 µM). A ocorrência destas diatomáceas na baía aparentemente depende do desenvolvimento de mecanismo de inoculação na água costeira adjacente e de seu subsequente transporte pelas correntes de maré para o interior do estuário. Durante o período de estudo, no entanto, a abundância celular de Pseudo-nitzschia permaneceu baixa, provavelmente devido à limitação do crescimento por falta de fosfato, especialmente na área externa. Além disso, espécies nocivas de Dinophysis, um dinoflagelado responsável pela produção de toxinas diarreicas (DSP), foram registradas em todas as campanhas mensais de amostragem. As maiores abundâncias de D. acuminata, D. caudata e D. tripos foram associadas com a camada logo acima da haloclina, nas regiões da baía onde a estratificação da coluna de água foi mais frequente. Em algumas ocasiões, a abundância de células de D.acuminata (até 3,2 x 103 células L-1) em áreas utilizadas para cultivo de moluscos bivalves para consumo humano, superou níveis considerados perigosos. Estes resultados indicam a necessidade de implantação de um programa de monitoramento de microalgas nocivas na Baía de Guaratuba.

This study investigated the spatial and temporal distributions of toxigenic phytoplankton species between October 2010 and April 2012 in Guaratuba Bay, Paraná state, Brazil, where aquaculture has been intensified in recent years. The highest abundances of Pseudo-nitzschia calliantha and P. pungens (up to 7.3 x 104 cells L-1), diatoms which cause amnesic shellfish poisoning (ASP), were correlated with higher values of temperature (from December to April, salinity (>20) and silicate concentrations (ranging from 6.0 to 90.0 µm). The occurrence of these harmful diatoms in the bay also appeared to depend upon the development of seeding mechanisms in the adjacent coastal water and its subsequent advection by tidal currents to the interior of the estuary. During the study period, Pseudo-nitzschia cell abundance remained low to moderate probably as a result of growth limitation by phosphate shortage, especially in the outer area of the estuary. In addition, harmful species of Dinophysis, dinoflagellates responsible for diarrhetic shellfish poisoning (DSP) events, were recorded in every sampling campaign. The highest abundances of D. acuminata, D. caudata and D. tripos were associated with the upper halocline layer in regions of the bay where water column stratification was more frequent. On some occasions, cell abundances of D. acuminata (up to 3.2 x 103 cells L-1) exceeded levels considered harmful in areas used to cultivate bivalve mollusks for human consumption. These novel results strongly indicate the necessity of implementing a monitoring program for harmful microalgae in Guaratuba Bay.

Eunotia é um gênero de diatomáceas altamente diverso na região neotropical. A considerável variabilidade morfológica encontrada nas valvas de várias espécies deste gênero resultam em uma taxonomia muito confusa. Neste estudo, 12 táxons de Eunotia aderidos a Podostemumspp. foram investigados usando microscopia óptica (MO). Adicionalmente, microscopia eletrônica de varredura (MEV) foi utilizada para investigar a morfologia ultraestrutural de táxons mais abundantes. Amostras foram coletadas em quatro rios do Estado de Santa Catarina entre março de 2009 e julho de 2010. A diatomoflórula deste estado é pobremente conhecida em relação aos estados vizinhos no sul do país. Eunotia biseriatoides é um taxon com características intermediárias entre Eunotia e Perinotiae a circunscrição destes gêneros é discutida aqui.Eunotia odebrechtiana é muito similar morfologicamente a E. biseriatoides e a sinonimização é proposta, bem como a transferência da variedade E. odebrechtianavar. essequiboensis è espécie E. biseriatoides. A ultraestrutura de E. epithemioides é apresentada pela primeira vez em MEV, revelando a posição atípica da rimoportula dentro deste gênero. Uma nova variedade, E. pseudosudetica var.rotundata var. nov., foi proposta e comparada com a variedade típica. Com exceção de E. veneris, todos os outros 11 táxons apresentados aqui são novos registros para Santa Catarina.

Eunotia is a highly diverse diatom genus in the Neotropics. Considerable morphological variability of the valve showed in several species of the genus resulted in a quite confused taxonomy. Twelve Eunotiataxa attached to Podostemum spp. were investigated using the light microscopy (LM). Additionally, scanning electron microscopy (SEM) was used in order to investigate the fine morphology of most abundant taxa. Samples were collected from four rivers from the State of Santa Catarina between March 2009 and July 2010. The freshwater diatom flora from this south Brazilian state is poorly known in relation to its neighboring states. Eunotia biseriatoides has intermediate features betweenEunotia and Perinotia, and the circumscription of these genera is discussed here. Eunotia odebrechtiana is very similar in morphology to E. biseriatoides, and the synonymy is proposed, as well as the transfer of the variety E. odebrechtiana var.essequiboensis to the species E. biseriatoides. The fine structure of E. epithemioides is showed for the first time in SEM, revealing the unusual position of the rimoportula in this genus. A new variety, E. pseudosudetica var. rotundata var. nov., was proposed and compared with the typical one. Except by E. veneris, all other eleven taxa presented here are new records for the State of Santa Catarina, Brazil.

OBJECTIVE: An awareness of the repeatability of biological measures is required to properly design and calculate sample sizes for longitudinal interventional studies. We investigated the day-to-day repeatability of measures of systemic microvascular reactivity using laser Doppler perfusion monitoring. METHODS: We performed laser Doppler perfusion monitoring in combination with skin iontophoresis using acetylcholine and sodium nitroprusside as well as post-occlusive reactive and thermal hyperemia twice within two weeks. The repeatability was assessed by calculating the within-subject standard deviations, limits of agreement, typical errors and intra-class correlation coefficients between days 1 and 2. The ratio of the within-subject standard deviation to the mean values obtained on days 1 and 2 (within-subject standard deviation/GM) was used to determine the condition with the best repeatability. RESULTS: Twenty-four healthy subjects, aged 24.6 + 3.8 years, were recruited. The area under the curve of the vasodilatory response to post-occlusive reactivity showed marked variability (within-subject standard deviation/GM = 0.83), while the area under the curve for acetylcholine exhibited less variability (within-subject standard deviation/ GM = 0.52) and was comparable to the responses to sodium nitroprusside and thermal treatment (within-subject standard deviations/GM of 0.67 and 0.56, respectively). The area under the blood flow/time curve for vasodilation during acetylcholine administration required the smallest sample sizes, the area under the blood flow/time curve during post-occlusive reactivity required the largest sample sizes, and the area under the blood flow/time curves of vasodilation induced by sodium nitroprusside and thermal treatment required intermediate sizes. CONCLUSIONS: In view of the importance of random error related to the day-to-day repeatability of laser Doppler perfusion monitoring, we propose an original and robust statistical methodology for use in designing prospective clinical studies.

OBJETIVO: Avaliar o efeito da metformina (Met) na disfunção endotelial da circulação renal de coelhos não diabéticos induzida por concentrações de glicose usualmente observadas em pacientes com diabetes tipo 2 (DM2) em tratamento ambulatorial. METODOLOGIA: Rins isolados de coelhos não diabéticos foram expostos por 3h a concentrações normais (100mg/dl) e elevadas (270mg/dl) de glicose na presença ou ausência de Met (100µM). Os níveis de glicose utilizados correspondem à mediana da glicemia pós-prandial (270mg/dl) obtida 2h após o café da manhã em 780 pacientes com DM2 atendidos em nosso serviço. A reatividade vascular (RV) dependente do endotélio (DE) foi avaliada com acetilcolina (ACh) e independente do endotélio (IE) com nitroprussiato de sódio (NPS). RESULTADO: Houve redução significativa na vasodilatação DE no grupo com infusão elevada de glicose em comparação ao controle (redução máxima na pressão de perfusão de respectivamente 25 ± 3 vs. 41 ± 3%; p< 0,01). No grupo de infusão com concentrações elevadas de glicose associada à infusão contínua de Met, a resposta vasodilatadora DE foi restaurada sem haver diferença significativa com o grupo controle (redução da pressão de perfusão respectivamente de 43 ± 1,5% e 41 ± 3%, p> 0,05). A Met não alterou a vasodilatação induzida pela ACh na presença de níveis normais de glicose. Finalmente, a vasodilatação renal induzida por NPS não foi modificada pela infusão conjunta de glicose e Met. CONCLUSÃO: Níveis de glicose observados em pacientes com DM2 em tratamento ambulatorial são capazes de provocar alterações agudas na RV no modelo experimental estudado, sendo estes efeitos totalmente abolidos pela Met. Os mecanismos envolvidos nesta ação protetora da Met merecem investigações específicas.

OBJECTIVE: To assess the effects of metformin (Met) on the endothelial dysfunction of the renal circulation of non-diabetic rabbits acutely induced by levels of glucose usually observed in diabetic patients in daily clinical practice. METHODS: Isolated perfused kidneys from non-diabetic rabbits were exposed for 3h to normal (100mg/dl - control group) or high (270mg/dl) D-glucose with or without Met (100µM). The glucose levels used correspond to 2h post-breakfast median values (272mg/dl) obtained from a cohort of 780 type 2 diabetic (DM2) outpatients seen in our service. Vascular reactivity was evaluated with endothelium-dependent (ED) [acetylcholine - ACh] and independent (EI) [sodium nitroprusside - SNP] vasodilating agents. RESULTS: Kidneys perfused with high glucose had ED maximal vasodilation blunted in comparison to controls (respectively 25 ± 3 and 41 ± 3%; p< 0.01). A 3h Met infusion restored the vasodilating effect of ACh in the renal circulation in the presence of high glucose, no different from controls (respectively 43 ± 1.5 vs. 41 ± 3% p> 0.05). Met did not affect maximum vasodilation induced by ACh in the presence of normal glucose levels. Finally, renal vasodilation induced by SNP was not modified by simultaneous infusion of glucose and Met. CONCLUSIONS: Acute hyperglycemia corresponding to the range observed in patients with DM2 induces endothelial dysfunction in the renal circulation of normal rabbits. Acute treatment with Met was able to protect the renal circulation against the effects of high glucose. The mechanisms involved in this protector effect deserve further investigation.

OBJETIVO: Avaliar os efeitos agudos de concentrações de glicose usadas para o diagnóstico do diabetes mellitus, na reatividade vascular (RV) de rim isolado de coelhos normais. METODOLOGIA: Rins isolados de coelhos normais foram agudamente expostos (3hs) a concentrações normais (5,5mM) e elevadas (7, 7,8 e 11,1mM) de glicose. A RV foi avaliada com acetilcolina. RESULTADO: Houve redução significativa na vasodilatação dependente do endotélio no grupo com glicose 11,1mM em comparação ao controle (redução máxima na pressão de perfusão de 24±3 vs. 41±4%; p<0,05), mas não ocorreram diferenças significativas entre os grupos com glicose 7 e 7,8mM e o controle (reduções máximas na pressão de perfusão de 39±4 e 34±3, respectivamente, vs. 41±4%, p>0,05). CONCLUSÃO: Níveis de glicose utilizados para o diagnóstico pós-TOTG de DM são capazes de provocar alterações agudas na RV. Estes efeitos não foram observados com os valores diagnósticos de jejum. Especulamos que a glicemia pós-TOTG possa estar mais relacionada com a presença de disfunção endotelial do que os níveis diagnósticos de jejum e, por isto, se correlacione melhor com o risco cardiovascular.

OBJECTIVE: To assess the acute effects of glucose levels used in diagnosis of diabetes mellitus on vascular reactivity in the isolated rabbit kidney. METHODS: Isolated rabbit kidneys were acutely exposed (3hs) to normal (5.5mM) and high (7, 7.8 and 11.1mM) glucose concentrations. Vascular reactivity was evaluated with acetylcholine. RESULTS: Kidneys perfused with glucose 11.1mM (maximal reduction in the perfusion pressure of 24±3 vs. 41±4%; p<0.05), but not with 7 and 7.8mM (maximal reduction in the perfusion pressures of 39±4 e 34±3%, respectively, vs. 41±4%, p>0.05) showed significantly decreased endothelium-dependent relaxations compared to control. CONCLUSIONS: High glucose levels typically observed after an oral glucose challenge can acutely alter vascular reactivity. We speculated that post-OTTG glucose levels are more strongly related to endothelial dysfunction and this is the reason why it is more correlated with cardiovascular disease.

OBJECTIVE: To assess the acute effects of high glucose concentrations on vascular reactivity in the isolated non diabetic rabbit kidney. METHODS: Rabbits were anaesthetized for isolation of the kidneys. Renal arteries and veins were cannulated for perfusion with Krebs-Henselleit solution and measurement of perfusion pressure. After 3 hours of perfusion with glucose 5,5 mM (control ) and 15 mM, the circulation was submitted to sub maximal precontraction (80% of maximal response) trough continuous infusion of noradrenaline 10 mM. Vascular reactivity was then assessed trough dose-responses curves with endothelium-dependent (acetylcholine) and independent (sodium nitroprusside) vasodilators. The influence of hyperosmolarity was analyzed with perfusion with mannitol 15mM. RESULTS: A significant reduction in the endothelium-dependent vasodilation in glucose 15mM group was observed compared to that in control, but there was no difference in endothelium-independent vasodilation. After perfusion with mannitol 15 mM, a less expressive reduction in endothelium-dependent vasodilation was observed, only reaching significance in regard to the greatest dose of acetylcholine. CONCLUSION: High levels of glucose similar to those found in diabetic patients in the postprandial period can cause significant acute changes in renal vascular reactivity rabbits. In diabetic patients these effects may also occur and contribute to diabetes vascular disease.