RESUMO
Human endothelial dysfunction is a common feature in many diseases of pregnancy, such as gestational diabetes (GD). Metabolic changes include abnormal synthesis of nitric oxide (NO) and abnormal membrane transport of l-arginine and adenosine in primary cultures of human umbilical vein (HUVEC, macrovascular) and placental microvillus (hPMEC, microvascular) endothelial cells. These alterations are associated with modifications in the expression and activity of endothelial (eNOS) and inducible (iNOS) NO synthases, respectively, an effect that is maintained at least up to passage 5 in culture. HUVEC and hPMEC exhibit expression and activity of the human cationic amino acid transporter 1 (hCAT-1), equilibrative nucleoside transporters 1 (hENT1) and hENT2, as well as the corresponding SLC7A1, SLC29A1 and SLC29A2 gene promoter activities. Altered gene expression results from increased NO level, protein kinase C, mitogen-activated protein kinases, and hCHOP-C/EBPα transcription factor activation. Reduced ENT-mediated adenosine transport in GD is associated with stimulation of the l-arginine/NO pathway, and mainly due to reduced expression and activity of hENT1. In addition, hENT2 activity seems able to restore the reduced adenosine transport in GD. Additionally, insulin exerts a differential modulation of endothelial cells from macrocirculation compared with microcirculation, possibly due to expression of different insulin receptor isoforms. It is suggested that a common functional characteristic leading to changes in the bioavailability of adenosine and metabolism of l-arginine is evidenced by human fetal micro and macrovascular endothelium in GD.
Assuntos
Diabetes Gestacional/fisiopatologia , Endotélio Vascular/metabolismo , Endotélio Vascular/fisiopatologia , Microvasos/fisiopatologia , Placenta/irrigação sanguínea , Placenta/fisiopatologia , Diabetes Gestacional/metabolismo , Endotélio Vascular/citologia , Feminino , Humanos , Microvasos/citologia , Microvasos/metabolismo , Placenta/citologia , Placenta/metabolismo , GravidezRESUMO
BACKGROUND: Lately, autopsies are performed less frequently in hospitals, despite their importance as a diagnostic tool. AIM: To study the concordance between clinical diagnosis and postmortem study in patients that died in a teaching hospital. MATERIAL AND METHODS: Autopsy findings in 57 patients (aged 16 to 85 years old, 28 female) that died at a University hospital were analyzed. Clinical diagnoses were compared with those of the postmortem examination and the degree of concordance between both diagnoses was calculated. RESULTS: Seven major omissions (12.3%), whose knowledge could have changed the clinical course of patients, were detected. These omissions occurred in patients with complex diseases or due to limitations of diagnostic procedures. Also, seven omissions, found in severely ill patients, whose knowledge would not change the patient's evolution, were also detected. CONCLUSIONS: Autopsy still is a valuable tool to assess the quality of care for patients that die during their hospitalization.