MARCELO DE LIMA OLIVEIRA
Projetos de Pesquisa
Unidades Organizacionais
LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas, Faculdade de Medicina
3 resultados
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- TCD assessment in fulminant hepatic failure: Improvements in cerebral autoregulation after liver transplantation(2024) PASCHOAL-JR, Fernando M.; NOGUEIRA, Ricardo C.; RONCONI, Karla de Almeida Lins; OLIVEIRA, Marcelo de Lima; ALMEIDA, Kelson James; ROCHA, Ivana Schmidtbauer; PASCHOAL, Eric Homero Albuquerque; PASCHOAL, Joelma Karin Sagica Fernandes; D'ALBUQUERQUE, Luiz Augusto Carneiro; TEIXEIRA, Manoel Jacobsen; PANERAI, Ronney B.; BOR-SENG-SHU, EdsonIntroduction and Objectives: Acute liver failure, also known as fulminant hepatic failure (FHF), includes a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction and hepatic encephalopathy. The objective of this study was to assess cerebral autoregulation (CA) in 25 patients (19 female) with FHF and to follow up seventeen of these patients before and after liver transplantation.Patients and Methods: The mean age was 33.8 years (range 14-56, SD 13.1 years). Cerebral hemodynamics was assessed by transcranial Doppler (TCD) bilateral recordings of cerebral blood velocity (CBv) in the middle cerebral arteries (MCA).Results: CA was assessed based on the static CA index (SCAI), reflecting the effects of a 20-30 mmHg increase in mean arterial blood pressure on CBv induced with norepinephrine infusion. SCAI was estimated at four time points: pretransplant and on the 1st, 2nd and 3rd posttransplant days showing a significant difference between pre-and posttransplant SCAI (p = 0.005). SCAI peaked on the third posttransplant day (p = 0.006). Categorical analysis of SCAI showed that for most patients, CA was reestablished on the second day post-transplant (SCAI > 0.6).Conclusions: These results suggest that CA impairment pretransplant and on the 1st day posttransplant was re-established at 48-72 h after transplantation. These findings can help to improve the management of this patient group during these specific phases, thereby avoiding neurological complications, such as brain swelling and intracranial hypertension.(c) 2023 Fundacion Clinica Medica Sur, A.C.
- Ischemic stroke caused by large-artery atherosclerosis: a red flag for subclinical coronary artery disease(2023) ARAUJO, Ana Luiza Vieira de; SANTOS, Raul D.; BITTENCOURT, Marcio Sommer; DANTAS, Roberto Nery; OSHIRO, Carlos Andre; NOMURA, Cesar Higa; BOR-SENG-SHU, Edson; OLIVEIRA, Marcelo de Lima; LEITE, Claudia da Costa; MARTIN, Maria da Graca Morais; ALVES, Maramelia Miranda; SILVA, Gisele Sampaio; SILVA, Victor Marinho; CONFORTO, Adriana BastosBackgroundThe coronary calcium score (CAC) measured on chest computerized tomography is a risk marker of cardiac events and mortality. We compared CAC scores in two multiethnic groups without symptomatic coronary artery disease: subjects in the chronic phase after stroke or transient ischemic attack and at least one symptomatic stenosis >= 50% in the carotid or vertebrobasilar territories (Group(athero)) and a control group (Group(control)). MethodsIn this cross-sectional study, Group(athero) included two subgroups: Group(ExtraorIntra), with stenoses in either cervical or intracranial arteries, and Group(Extra&Intra), with stenoses in at least one cervical and one intracranial artery. Group(control) had no history of prior stroke/transient ischemic attacks and no stenoses >= 50% in cervical or intracranial arteries. Age and sex were comparable in all groups. Frequencies of CAC >= 100 and CAC > 0 were compared between Group(athero) and Group(control), as well as between Group(ExtraorIntr), Group(Extra&Intra), and Group(control), with bivariate logistic regressions. Multivariate analyses were also performed. ResultsA total of 120 patients were included: 80 in Group(athero) and 40 in Group(control.) CAC >0 was significantly more frequent in Group(athero) (85%) than Group(control) (OR, 4.19; 1.74-10.07; p = 0.001). Rates of CAC >= 100 were not significantly different between Group(athero) and Group(control) but were significantly greater in Group(Extra&Intra) (n = 13) when compared to Group(control) (OR 4.67; 1.21-18.04; p = 0.025). In multivariate-adjusted analyses, ""Group(athero)"" and ""Group(Extra&Intra)"" were significantly associated with CAC. ConclusionThe frequency of coronary calcification was higher in subjects with stroke caused by large-artery atherosclerosis than in controls.
- Integrative assessment of cerebral blood regulation in COPD patients(2024) CORRE, Daniel I.; DE-LIMA-OLIVEIRA, Marcelo; NOGUEIRA, Ricardo C.; CARVALHO-PINTO, Regina M.; BOR-SENG-SHU, Edson; PANERAI, Ronney B.; CARVALHO, Celso R. F.; SALINET, Angela S. M.Cerebrovascular responses were compared between COPD and non-COPD participants. The association between COPD severity and cognitive function was also investigated. Cerebral blood velocity in the middle cerebral artery, blood pressure, and end-tidal CO2 were recorded at rest, followed by a brain activation paradigm, and an inhaled gas mixture (5% CO2) to assess cerebral autoregulation (CA), neurovascular coupling (NVC) and cerebrovascular reactivity to carbon dioxide (CVRCO2), respectively. Pulmonary function, blood gas analysis (COPD) and cognitive function (MoCA test) were also performed. No difference in baseline (systemic and cerebral parameters) and CA was found between 20 severe COPD and 21 non-COPD. Reduced NVC and CVRCO2 test were found in the COPD group. Lower pulmonary function was positively correlated with CA, NVC and CVRCO2 in COPD patients. Cognitive impairment (MoCA<26) was associated with lower NVC responses (COPD and non-COPD) and lower pulmonary function (COPD). Both mechanisms, CVRCO2 and NVC, were lower in COPD patients. Moreover, disease severity and cognitive impaired were associated with worse cerebrovascular regulation.