Distinctive impaired cardiac autonomic modulation of heart rate variability in chronic Chagas' indeterminate and heart diseases

Introduction

Cardiac autonomic dysfunction occurs in Chagas' indeterminate and heart disease, but comparison of this disturbance between both forms was not yet performed.

Methods

Time- and frequency-domain 5-minute heart rate variability in supine and standing positions were evaluated in 17 subjects with Chagas' disease with the indeterminate form, 13 with heart disease and 15 controls. Trend of variability indices across the groups was also tested.

Results

In the supine position, reduced time-domain and absolute frequency-domain indices reflecting overall autonomic modulation were observed in both Chagas' disease groups. In the standing position, the coefficient of variation and those frequency-domain indices were also reduced, and the other time-domain indices were reduced only in the cardiac group. Heart rate variability indices hypothesized to reflect relative sympathetic and parasympathetic activity showed no alteration. A significant graded reduction was observed in the altered indices in both postures, from the control to the Chagas' indeterminate and heart disease groups.

Conclusion

Cardiac autonomic dysfunction, with preserved putative measures of sympathetic and parasympathetic modulation in relative terms, was less severe or absent in the indeterminate and pronounced in cardiac form of Chagas' disease.     

Kinetics of Cycle Length Dependence of Ventricular Repolarization:

Cycle Length Dependence of Repolarization. Introduction : Beat-to-beat adaptation of ventricular repolarization duration to cardiac cycle length and autonomic activity has not been previously characterized in the spontaneously beating human heart.
Methods and Results : The ECG of 14 healthy subjects was recorded from the supine and upright positions. Autonomic blockade was accomplished by atropine and propranolol. RR and RT intervals were measured by a computer algorithm, and the impulse response (h) from RR to RT computed. In the supine position the maximal adjustment of the RT interval occurred in the first beat following a change in cycle length (h_peak= 17.8 ± 1.6 msec/sec), but continued to be detectable for 3.8 seconds (2.9–4.7 sec). Propranolol attenuated the peak impulse response to 15.8 ± 4.0 msec/sec (P = NS). In the standing position the peak impulse response was increased to 25.2 ± 5.0 msec/sec (P = 0.004 vs supine), and the impulse response duration (h_dur) shortened to 1.4 seconds (1.3–1.6). This was reversed by beta blockade (h_peak= 10.7 ± 3.6 [P = 0.005 vs standing]; h_dur= 5.5 sec [4.8–6.1]). Parasympathetic and combined autonomic blockade resulted in too little residual heart rate variability to estimate the impulse response accurately. The slope of the regression of δRT and δRR in the supine position was 0.0177 ± 0.0016, which was closely correlated with the peak impulse response (r = 0.91).
Conclusions : System identification techniques can assist in characterizing the cycle dependence of veritricular repolarization and may provide new insights into conditions associated with abnormal repolarization.     

Asymptomatic leukocyturia and the autonomic nervous system in women

Background:   The present study sought to investigate the relationship between asymptomatic leukocyturia (ASL) and autonomic nervous function by power spectral analysis of the R-R intervals in women.
Methods:   One hundred and forty-two female outpatients aged 23–91 years were studied. We regarded ASL to be present if two consecutive samples were found to have 10 or more leukocytes/high-power field at ×400 magnification in a centrifuged midstream urine sample. The R-R intervals of all subjects were measured by the wavelet transform analysis system. This system detected R-R variation data distributed in two bands: low-frequency power (LF) (0.04–0.15 Hz) and high-frequency power (HF) (0.15–0.40 Hz). The ratio of LF to HF (LF/HF) was also determined. Post-void residual urine volume was measured using an automated, compact 3-D ultrasound device.
Results:   The patients with ASL had diabetes mellitus more frequently than those without ASL. Residual urine volume was significantly higher in the former than in the latter, while the HF values in both a recumbent position and a standing position were significantly lower in the former than in the latter ( P  = 0.003, P  = 0.001, respectively). However, there were no significant differences in LF or LF/HF values in either a recumbent or a standing position between the two groups. The HF values in both a recumbent position and in a standing position were independent indicators of ASL, even after adjustment for age, diabetes mellitus and residual urine volume.
Conclusion:   The present study reveals the relationship between ASL and impairment of the parasympathetic nervous system in women.     

Efficacy of the 'tennis ball technique' versus nCPAP in the management of position-dependent obstructive sleep apnoea syndrome

Background and objective:   Avoidance of sleep in the supine position is recommended in the management of position-dependent OSA hypopnoea syndrome (OSAHS). Our aim was to evaluate the efficacy of a thoracic anti-supine band (TASB), designed to mimic the so-called 'tennis ball technique', compared with nasal CPAP (nCPAP).
Methods:   Twenty adults with mild to moderately severe position-dependent OSAHS (mean AHI ± SD) 22.7 ± 12.0/H (range 6.0–51.2); AHI supine, 59.6 ± 27.5/H, were included in a randomized cross-over trial. Portable sleep studies were undertaken at baseline and after 1 month on each treatment. A successful treatment outcome was defined as AHI ≤ 10/H.
Results:   Mean AHI was 12.0 ± 14.5/H with the TASB and 4.9 ± 3.9/H with nCPAP ( P  = 0.02; 95% confidence interval for the difference: −13.1 to −1.0). With the TASB, treatment 'success' was achieved in 13/18 subjects, whereas 'success' was achieved in 16/18 subjects using nCPAP ( P  = 0.004). In the two subjects with baseline AHI < 10/H, AHI remained below 10 for both therapies. The TASB successfully reduced time spent in the supine position. Mean percentage supine sleep time was 6.3 ± 5.9% with the TASB, and 35.4 ± 34.1% with nCPAP ( P  < 0.001). No significant differences in sleep efficiency or subjective responses were observed between treatments.
Conclusions:   Control of body position during sleep using an anti-supine device mimicking the so-called 'tennis ball technique' provides benefit in the management of position-dependent OSAHS in subjects who meet strict inclusion criteria. The overall improvement is, however, less than for nCPAP.     

Association between insulin resistance and cognitive function in elderly diabetic patients

Background:   Recently, cognitive impairment in elder diabetic subjects has sparked considerable interest. Insulin resistance (IR) is one of the central pathologies in diabetes mellitus, and several studies have shown that IR is associated with cognitive impairment in non-diabetic elderly subjects. However, the involvement of IR in cognitive dysfunction in the diabetic elderly has remained to be elucidated.
Methods:   In the current study we measured IR with the euglycemic insulin clamp technique, and assessed cognitive function in 13 elderly diabetic patients (mean age, 69.1 ± 4.4). Several tests to assess cognitive function including Mini-Mental State Examination (MMSE) were performed, and clinical indices were evaluated. IR was evaluated by metabolic clearance rates (MCR).
Results:   The Spearman's rank correlation coefficient between MCR and MMSE scores was 0.587 ( P  = 0.035). When subjects were divided into two groups at the median MCR (5.0 mL/kg/min), the lower MCR (high IR) group ( n  = 5) had significantly lower MMSE scores than the higher group ( n  = 8). The Spearman's rank correlation coefficient was –0.641 ( P  = 0.018) between hs-CRP and MMSE scores. When subjects were divided into two groups at the median of high-sensitivity C-reactive protein (hs-CRP) (594.0 µg/dL), the higher hs-CRP group ( n  = 6) had significantly lower MMSE scores than the lower group ( n  = 7).
Conclusion:   The current study shows that higher IR measured with the euglycemic insulin clamp technique and higher hs-CRP is associated with lower MMSE scores in non-demented diabetic elderly patients.     

Procalcitonin as a prognostic factor in severe acute exacerbation of chronic obstructive pulmonary disease

Background and objective:   Little is known about the value of procalcitonin in predicting mortality in patients with an exacerbation of COPD. This study evaluated the clinical and biological predictors of intensive care unit (ICU) mortality in patients with a severe acute exacerbation of COPD.
Methods:   A prospective observational cohort study was conducted of consecutive patients with severe acute exacerbation of COPD requiring intubation and mechanical ventilation. At ICU admission, data were collected on the patients' clinical condition, blood leukocyte count, C-reactive protein and procalcitonin. Cox proportional hazards model was used to determine the risk factors for ICU mortality.
Results:   One hundred and sixteen patients were included in this study. Mean age was 67 years. The mean simplified acute physiology score was 43. Sixty-five per cent of study patients had chronic respiratory insufficiency. Bacteria were cultured at levels considered significant in 36% of study patients. Logistic organ dysfunction score (hazard ratio (95% CI) = 1.19 (1.03–1.37), P  = 0.013), rapidly fatal underlying disease (3.33 (1.40–7.87), P  = 0.003) and procalcitonin level (1.01 (1–1.03), P  = 0.018) were independently associated with increased risk for ICU mortality. Non-invasive mechanical ventilation use before intubation was independently associated with reduced risk for ICU mortality (0.34 (0.14–0.84), P  = 0.020).
Conclusions:   In patients with severe acute exacerbation of COPD requiring intubation and mechanical ventilation, logistic organ dysfunction score, rapidly fatal underlying disease and procalcitonin are independently associated with increased risk for ICU mortality. Non-invasive mechanical ventilation use before intubation was independently associated with reduced risk for ICU mortality.     

Klotho gene promoter polymorphism and cognitive impairment

Aim:   To study the association between the klotho gene polymorphism and cognitive impairment in community-living men and women.
Methods:   The subjects consisted of 2234 community-living Japanese men and women aged 40–79 years. The klotho gene promoter polymorphism G- 395 A was identified and cognitive function was assessed using the Japanese Wechsler Adult Intelligence Scales – Revised Short Forms ( JWAIS-R SF) and Mini-Mental State Examination (MMSE). Brain infarction and atrophy were assessed by brain magnetic resonance imaging (MRI). The differences in cognitive function, infarction and atrophy were compared between the GG type and GA/AA type of the klotho gene G- 395 A polymorphism.
Results:   The distribution of the klotho gene G- 395 A polymorphism was GG 1639 (73.4%), GA 539 (24.1%), and AA 56 (2.5%). There was no significant difference in intelligence quotient (IQ) between the GG type and GA/AA type in the subjects aged 40–59 years. However, the IQ level was significantly different in terms of the klotho genotype for subjects aged 60–79 years ( P  = 0.004). The mean and SE of IQ levels of the subjects with the GG type and the GA/AA type at nucleotide −395 were 99.8 ± 0.5 and 102.6 ± 0.8, respectively. There were also significant differences in three subtests of JWAIS-R SF – Information, Similarities, and Picture Completion – for subjects aged 60–79 years. Also, the MMSE score was slightly lower for the GG type than for the GA/AA type ( P  = 0.099). However, there were no differences in the findings of brain MRI.
Conclusion:   There were statistically significant differences in cognitive function for klotho gene promoter polymorphism G- 395 A only in subjects aged 60 or over. This polymorphism may be associated with age-related cognitive impairment.     

Heart Rate Variability Assessment of the Effect of Physical Training on Autonomic Cardiac Control

Background: The effect of exercise interventions on autonomic nervous system (ANS) control of the heart by heart rate variability (HRV) is often investigated in just one position. It was hypothesized that results of exercise‐induced changes on ANS are dependent on body position and that it is possible to distinguish between exercise induced changes in vagal and sympathetic influence by taking measurements in different body positions. Methods: One hundred eighty‐three (male = 100, female = 83) healthy volunteers, between 18 and 22 years, participated in a prospective twelve week medium to high intensity exercise intervention study with a self‐control design. The influence of the exercise intervention was investigated on supine, rising, and standing as well as on the orthostatic response. Time domain, frequency domain and nonlinear (Poincaré) HRV analysis were performed. Results: The exercise intervention lead to a significant increase (P < 0.05) in vagal influence during supine, rising, and standing. Sympathetic control in the supine position was decreased and increased during rising and standing. In the initial orthostatic response to rising from the supine position, the exercise intervention lead to increased (P < 0.05) vagal withdrawal as well as increased sympathetic control. The orthostatic response measured as the difference between standing and supine indicated only an exercise induced increase in sympathetic control. Conclusions: Exercise‐induced changes in sympathetic and parasympathetic ANS control differ, depending on posture and period of measurement. Exercise induced changes in parasympathetic and sympathetic outflow, respectively, can be extracted from measurements from supine, through the orthostatic response, to standing, thereby detecting changes in ANS that are otherwise obscured.     

Cardiac Sympathetic Dominance and Systemic Inflammation in COPD

Cardiac autonomic dysfunction is an independent determinant of adverse outcomes in many diseases. The available literature on the relative changes in sympathetic and parasympathetic components in chronic obstructive pulmonary disease (COPD) is equivocal, the clinical and physiological correlates are poorly defined and association with markers of systemic inflammation has not been explored. As both autonomic dysfunction and systemic inflammation may contribute to cardiovascular morbidity in COPD, we hypothesized that these may be associated. Sixty three stable patients of COPD and 36 controls underwent spirometry, estimation of diffusion capacity, six-minute walk test and measurements of serum interleukin-6 (IL-6) and high-sensitivity C-Reactive protein. Cardiac autonomic activity was evaluated by standard five-minute heart rate variability (HRV) recordings to obtain time- and frequency-domain indices and the averaged heart rate. We observed that HRV indices of overall autonomic modulation, the standard deviation of time intervals between consecutive normal beats (SDNN) and total power, were greater in patients with higher levels of indices of both parasympathetic and sympathetic activity. The heart rate was significantly higher in patients indicating an overall sympathetic dominance and was inversely correlated with diffusion capacity. Serum IL-6 was inversely correlated with pNN50, an index of parasympathetic activity, and positively with LF/HF ratio, a measure of sympathetic: parasympathetic balance. None of the HRV indices was significantly correlated with physiological measures of severity. It was concluded that patients with COPD have increased cardiac autonomic modulation with sympathetic dominance. This is associated with decreased lung diffusion capacity and systemic inflammation.     

Arterial pulse wave velocity in elderly patients with dementia

Background:   Cardiovascular events influence the quality of life and mortality of elderly patients. Arterial stiffness measured by aortic pulse wave velocity is a useful means of predicting the presence of cardiovascular diseases, even in subjects over 70 years old. This procedure is non-invasive, but the usefulness and easiness of aortic pulse wave velocity for patients with dementia are still unclear. Therefore, to determine how useful and easy it is to measure aortic pulse wave velocity, we evaluated arterial stiffness in patients with or without dementia who required care and support for their daily life.
Methods:   Fifty-nine subjects over 70-years-old who suffered from dementia were enrolled in this study. After we excluded arteriosclerosis obliterans (ankle-brachial pressure index < 0.80; n =  10) by arterial pulse wave velocity, we classified these subjects into two groups: subjects with Alzheimer's disease ( n  = 25) and subjects with vascular dementia ( n  = 24) who were diagnosed by magnetic resource imaging and mini-mental state examination.
Results:   The authors of the present paper could easily and precisely evaluate arterial stiffness of all patients. The mean pulse wave velocity of right and left brachial-tibial arteries in subjects with Alzheimer's disease (1740 ± 385 cm/s) was significantly lower than those subjects with vascular dementia (2436 ± 586; P  < 0.001).
Conclusion:   The data included in the present study indicate that subjects with Alzheimer's disease had decreased arterial stiffness and would show a lower risk of cardiovascular diseases compared to subjects with other diseases including vascular dementia.     

Predictors for failed dose reduction of inhaled corticosteroids in childhood asthma

Background and objective:   Studies of Western populations have shown that increased exhaled nitric oxide (FeNO) and/or sputum eosinophils (sp-Eos) are predictive of asthma exacerbations. However, the utility of these measurements in different populations and settings is unknown. This study aimed to determine the predictors for failure of reduction of inhaled corticosteroid (ICS) doses in children with stable asthma.
Methods:   Fifty children (median age 11.8 years, interquartile range (IQR) 5.9 years) had their dose of ICS halved every 8 weeks until they reached the study end-point (exacerbation or weaned off ICS). Spirometry, FeNO and induced sputum cells were measured at baseline and at each stage of ICS reduction.
Results:   Eleven subjects suffered an asthma exacerbation and the remainder was successfully weaned off ICS. Subjects with an exacerbation were older (15.4 years (IQR 5.4) vs 11.4 years (IQR 3.9), P  = 0.019) and more likely to be boys ( P  = 0.035). FeNO (median 156 p.p.b. (IQR 131) vs 76.1 p.p.b. (IQR 79.5), P  = 0.013) and sp-Eos (17.3% (IQR 33.8%) vs 7.1% (IQR 9.9%), P  = 0.019) were significantly greater in those who had an exacerbation. The areas under the receiver operating characteristic curves for FeNO (0.78, 95% CI: 0.59–0.97, P  = 0.013) and sp-Eos (0.76, 95% CI: 0.56–0.96, P  = 0.016) were similar ( P  = 0.88) and both were significantly greater than that for FEV₁% predicted (0.12, 95% CI: 0.08–0.56, P  = 0.0013).
Conclusions:   Older boys with raised FeNO and sp-Eos are at higher risk of failure of reduction in their ICS dose. Monitoring airway inflammation in children with asthma using FeNO or sp-Eos is clinically useful in guiding ICS dose reduction in a non-Western outpatient setting.     

Interleukin-6 (IL-6) –572C→G promoter polymorphism is associated with type 2 diabetes risk in Koreans

Objective  Increased levels of inflammatory markers, such as interleukin-6 ( IL -6), are associated with type 2 diabetes (T2DM). We investigated the association of IL-6 gene polymorphisms with T2DM and circulating levels of IL -6 in Koreans.
Subjects  A total of 1477 subjects with normal glucose tolerance and 476 T2DM patients were included.
Measurements  We examined IL-6 – 174G→C, –572C→G, –597G→A and –1363G→T promoter region polymorphisms. The main outcome measures were the odds ratio (OR) on T2DM risk and serum concentrations of IL -6 and high-sensitivity C-reactive protein (hs-CRP).
Results  Homozygosity for the rare G allele IL-6 – 572C→G was associated with a higher risk of T2DM [OR 1·69 (95%CI 1·11–2·58), P  = 0·015]. Serum IL -6 concentrations were associated with the IL-6 – 572C→G genotype in control subjects (G/G: 2·33 ± 0·41: C/G: 1·53 ± 0·09: C/C: 1·72 ± 0·08 ng/l, P  = 0·023). Also in the control group, subjects homozygous for the rare G allele showed significantly higher concentrations of hs-CRP than C/C and C/G carriers (G/G: 13·6 ± 2·9: C/G: 9·2 ± 0·6: C/C: 7·8 ± 0·4 mg/l, P  = 0·003). The C-allele at the IL-6 – 174 SNP was very rare (< 0·01) and –597G→A and –1363G→T were monomorphic in this population.
Conclusions  Our data demonstrate that the IL-6 – 572G/G genotype is associated with higher serum IL -6 and hs-CRP concentrations and with increased risk for T2DM.     

Activity of the neurohormonal system and its relationship to autonomic abnormalities in decompensated heart failure.

BACKGROUND: The syndrome of congestive heart failure (CHF) entails complex autonomic and hormonal responses. Profound abnormalities in autonomic function, characterized by sympathetic overactivity and parasympathetic withdrawal, exert direct deleterious effects on the heart and contribute to progressive circulatory failure. We investigated the relationship of heart rate variability (HRV) with levels of neurohormones in plasma. METHODS AND RESULTS: We studied 64 patients admitted to the hospital for treatment of decompensated CHF (mean age, 59 +/- 2 years; New York Heart Association class III [72%] and IV [28%]). Time- and frequency-domain HRV indices were obtained from 24-hour Holter recordings. Neurohormonal activation was assessed by measuring plasma renin activity and aldosterone and norepinephrine levels. In the time domain, norepinephrine correlated negatively with average NN interval (r = -.34; P =.007), SDNN (r = -.35; P =.005), and SDANN (r = -.36; P =.004). In the frequency domain, norepinephrine was negatively associated with the total power (r = -.39; P =.001) and ultralow power (r = -.43; P =.0005). No correlation was found between indices indicative of parasympathetic modulation, except for a borderline correlation with the high-frequency power (r = -.25; P =.048). CONCLUSIONS: Reduced HRV may be associated with increased norepinephrine levels in patients with severe CHF. The ability of long-term HRV parameters to reflect in part the activation of diverse hormonal systems may explain their greater prognostic power for risk stratification in patients with CHF.     

Cough-reflex sensitivity to inhaled capsaicin in COPD associated with increased exacerbation frequency

Background and objective:   The causes of exacerbations in COPD patients are poorly understood. This study examined the association between cough-reflex sensitivity in patients with stable COPD and the frequency of subsequent exacerbations.
Methods:   The sampling frame for cases and controls for this study was patients attending a hospital outpatient clinic. cough-reflex sensitivity was evaluated using the log concentration of capsaicin causing five or more coughs (log C₅). Subsequent COPD exacerbations were identified prospectively via symptom-based diaries over a 12-month period.
Results:   The study group comprised 45 COPD subjects and 10 controls. Mean log C₅ was lower in the COPD group than in the control group (0.97 (95% confidence interval (CI): 0.76–1.18) versus 1.26 (95% CI: 0.81–1.71), P  = 0.095). In the COPD group, log C₅ was negatively correlated with serum CRP level ( r  = −0.36, P  = 0.02) and significantly associated with the exacerbation frequency ( r  = −0.38, P  = 0.01). Stepwise multiple regression analysis showed that cough-reflex sensitivity was significantly associated with exacerbation frequency ( r ² = 0.15, P  = 0.01).
Conclusions:   Hypersensitivity of the cough reflex to inhaled capsaicin might reflect airway inflammation in stable COPD patients, which predisposes to frequent exacerbations.     

Hemodynamic changes in Alzheimer's and Binswanger's diseases as evaluated by second-derivative finger photoplethysmography

Background:   Hemodynamics is often the focus of dementia research, but methodological difficulties have precluded such research. To clarify the role of hemodynamic factors in the pathogenesis of dementing illness, the newly developed, second-derivative finger photoplethysmography (SD-PTG), which can provide hemodynamic indices, was studied in 173 patients with dementia.
Methods:   The subject group consisted of 41 patients with Binswanger's disease (BD group), 31 patients with Alzheimer's disease with severe periventricular lucency (PVL; AD + PVL group), and 101 patients with Alzheimer's disease without PVL. The SD-PTG findings as well as the clinical findings of each group were compared with those of 114 controls without dementia. The heights of the a-, b-, c-, d-, and e-waves on SD-PTG waveforms were measured, and b/a and d/a ratios were used as indices of distensibility of the aorta and peripheral vascular impedance in the systemic circulation, respectively.
Results:   The b/a ratio was significantly higher in the BD and AD + PVL groups than in the AD − PVL group ( P  < 0.01). The d/a ratio was significantly lower in the BD group than in the AD + PVL, AD − PVL, and control groups ( P  < 0.01). The d/a ratio in the BD group correlated significantly with mini-mental state examination (MMSE) score ( r  = 0.47, P  = 0.0023).
Conclusions:   The results indicate that decreased distensibility of the aortic wall is associated with the white matter lesions in both types of dementia, while the low d/a ratio and the correlation between the d/a ratio and the MMSE score in the BD group indicate that increased peripheral impedance was associated with more extensive involvement of the white matter and cognitive decline in Binswanger's disease.     

Albumin, Apolipoprotein E-ɛ4 and Cognitive Decline in Community-Dwelling Chinese Older Adults

OBJECTIVES: To examine the association between serum albumin and cognitive impairment and decline in community-living older adults.
DESIGNS: Population-based cohort study, followed up to 2 years; serum albumin, apolipoprotein E (APOE)-ɛ4, and cognitive impairment measured at baseline and cognitive decline (≥2-point drop in Mini-Mental State Examination (MMSE) score). Odds ratios were controlled for age, sex, education, medical comorbidity, hypertension, diabetes mellitus, cardiac disease, stroke, smoking, alcohol drinking, depression, APOE-ɛ4, nutritional status, body mass index, anemia, glomerular filtration rate, and baseline MMSE.
SETTINGS: Local area whole population.
PARTICIPANTS: One thousand six hundred sixty-four Chinese older adults aged 55 and older.
RESULTS: The mean age of the cohort was 66.0±7.3, 65% were women, mean serum albumin was 42.3±3.1 g/L, and mean MMSE score was 27.2±3.2. Lower albumin tertile was associated with greater risk of cognitive impairment in cross-sectional analysis (low, odds ratio (OR)=2.30, 95% confidence interval (CI)=1.31–4.03); medium, OR=1.59, 95% CI=0.88–2.88) versus high ( P for trend=.002); and with cognitive decline in longitudinal analyses: low, OR=1.73, 95% CI=1.18–2.55; medium, OR=1.32, 95% CI=0.89–1.95, vs high ( P for trend=.004). In cognitively unimpaired respondents at baseline (MMSE≥24), similar associations with cognitive decline were observed ( P for trends <.002). APOE-ɛ4 appeared to modify the association, due mainly to low rates of cognitive decline in subjects with the APOE-ɛ4 allele and high albumin.
CONCLUSION: Low albumin was an independent risk marker for cognitive decline in community-living older adults.     

Spontaneous baroreflex sensitivity in (pre)adolescents

OBJECTIVE: To present normal spontaneous baroreflex sensitivity (BRS) values and investigate the influence of posture, sex, age, pubertal stage, body mass index (BMI), and physical activity level on BRS in (pre)adolescents. BRS is a sensitive measure of both sympathetic and parasympathetic cardiovascular regulation that may help detect early subclinical autonomic dysfunction. DESIGN: A cross-sectional cohort study in a large sample of 10-13-year-old Dutch (pre)adolescents from the general population. METHODS: Short-term spontaneous BRS was determined non-invasively by Portapres in both the supine and standing position. BRS was calculated by power spectral analysis using the discrete Fourier method (frequency band 0.07-0.14 Hz). Univariate statistical methods and multiple regression analyses were applied. RESULTS: BRS in a standing position was lower than in a supine position (9.0 +/- 4.9 versus 15.3 +/- 9.1 ms/mmHg; t = 27.8, P < 0.001). Girls had lower BRS values than boys in both postures (supine 14.3 +/- 8.7 versus 16.4 +/- 9.4 ms/mmHg, beta = 0.12, P < 0.001; standing 8.4 +/- 4.4 versus 9.5 +/- 5.4 ms/mmHg, beta = 0.08, P = 0.012), independent of age, pubertal stage, BMI, and physical activity. Lower limits (P2.5) for normal BRS values in supine and standing positions were for girls 3.6 and 2.2 ms/mmHg and for boys 3.9 and 2.5 ms/mmHg, respectively. BRS declined with age in the standing position (beta = -0.13, P < 0.001). In obese (pre)adolescents, BMI was negatively associated with BRS during standing (Kendall's tau = -0.26, P = 0.010). CONCLUSION: The BRS of (pre)adolescents was negatively related to female sex, age, and obesity. A reduced BRS in obese (pre)adolescents might be a candidate predictor of future cardiovascular health, and therefore warrants further exploration.     

Usefulness of troglitazone administration to obese hyperglycaemic patients with near-normoglycaemia

Aims:   We assessed the effectiveness of 400 mg/day of troglitazone administered to hyperglycaemic patients with near-normoglycaemia who were obese and who had hyperinsulinaemia.
Results:   The area under the plasma glucose curve in oral glucose tolerance tests (OGTT) significantly decreased from 39.8 ± 19.4–20.5 ± 10.2 mg/dL · h and the area under the insulin-response curve from 31.8 ± 22.5–12.2 ± 5.7 μU/ml · h 4 months after the start of treatment. The level of HbA1c significantly improved from 6.6 ± 0.2 to 6.3 ± 0.2% (p < 0.05) by 1 month after administration, and that of serum 1,5-anhydroglucitol (1,5-AG) from 12.6 ± 1.1–18.3 ± 2.5 μ/ml (p < 0.05). In some cases, recovery of the first-phase insulin secretion was observed.
Conclusions:   These findings suggest that the administration of this insulin sensitizer is useful in the treatment of obese Japanese subjects with borderline or mild diabetics accompanied by hyperinsulinaemia.     

Clinical features predicting the detection of abnormalities by double balloon endoscopy in patients with suspected small bowel bleeding

Background and Aim:  Although double balloon endoscopy (DBE) has demonstrated a high diagnostic yield in suspected small bowel bleeding, it is not known whether DBE is of equal value to all patients with suspected small bowel bleeding or of greater benefit in selected subgroups. We aimed to determine whether any clinical features predict an increased likelihood of finding a lesion in patients with suspected small bowel bleeding.
Methods:  We retrospectively analyzed clinical features of 43 consecutive patients (M : F = 26:17, age 13–82 years) who underwent DBE because of suspected small bowel bleeding. Data associated with DBE procedure were collected prospectively. Predictive factors for the detection of a lesion were determined by comparison of clinical features between patients with positive DBE findings and those with negative findings.
Results:  Potential bleeding sources were discovered in 30 patients (69.8%) out of 43. Duration of bleeding was longer in patients with positive DBE findings than in those with negative findings (195 ± 311 vs 18 ± 17 days, P  = 0.015). Number of bleeding episodes was higher in patients with positive DBE findings (2.2 ± 1.2 vs 1.3 ± 0.5, P  = 0.011). The odds ratio for the detection of bleeding focus on DBE for patients with two or more bleeding episodes, relative to those with only one current bleeding episode was 5.67 (95% CI: 1.12–28.81, P  = 0.036) in multivariate analysis.
Conclusion:  DBE may be the most useful in patients with suspected small bowel bleeding if they have a history of frequent bleeding episodes over a long period.     

Self-reported depressive state can be a predictor of engagement in work by community-dwelling elderly 2 years later

Background:   Depression is one of the most common medical disorders in elderly community-dwelling persons. The present study prospectively examined the relationship between depressive state in elderly persons and their engagement in work and/or activities during the subsequent 2 years.
Methods:   The study subjects were 603 persons who were engaged in work/activities at baseline. Their mean age ± standard deviation was 71 ± 5.1 years and 299 (49.6%) were men. The final outcome regarding engagement in work was based on whether they held a job or were engaged in activities, such as farming or gardening, every day.
Results:   At baseline, the mean SDS score was 35.5 ± 8.8 (20–63). The number of people engaged in work after 2 years decreased with increasing intensity of depressive state. Those who were engaged in work after 2 years were younger ( P  = 0.001), male ( P  = 0.047), married ( P  = 0.001), and with better financial conditions ( P  = 0.048). They were also independently able to fulfil BADL ( P  = 0.006), did not have a history of stroke ( P  = 0.040), were not regularly taking medication ( P  = 0.001) and were not depressed ( P  = 0.001). After adjustment for these covariates, depressive state was a significant independent explanatory variable, and a moderate to severe depressive state (i.e. SDS score of 48 or more) was significantly associated with less engagement in work compared with an SDS score of 39 or less (odds ratio, 2.35; 95%CI, 1.40–4.59).
Conclusion:   Depressive state is associated with an increased risk of decline in engagement in work.