The psychological impact of permanent cardiac pacemakers on pediatric patients and their parents: A case control study

BackgroundThis study assessed anxiety and depression in children with permanent pacemakers (PPM) and quality of life of their parents.MethodsNinety children (63.3% males and 36.6% females) and their parents were included in the study and were divided into three groups. The control group (Group 1) included 30 normal healthy children (57% males and 43% females), the PPM group (Group 2) included 30 age-matched children (70% males and 30% females) with PPM and structurally normal heart, while the Group 3 included 30 children (63% males and 37% females) with PPM and congenital heart disease (PPM + CHD). Psychological assessment of children and their parents was carried out using an interview-based questionnaires.ResultsPsychiatric disorders were more prevalent in PPM + CHD group including depression (P = 0.04), anxiety (P = 0.02) and lower parents’ QoL (P = 0.01). The PPM group had higher depression and lower parents’ QoL than the control group. Family income was independent factor for depression (r2 = −6.3, with P < 0.05). Sex of the child and CCU admission were independent factors for anxiety (r2 = −9.5, P < 0.05 & r2 = 10.5, P = 0.001) in PPM group.ConclusionChildren with pacemakers have higher psychiatric disorders and their parents have lower QoL.     

Association of insulin resistance,insulin and leptin levels with coronary in-stent restenosis

BackgroundIn-stent restenosis remains the major limitation of coronary stent implantation. Leptin is a hormone strongly related to insulin resistance (IR). Moreover, insulin resistance and hyperinsulinemia are common in patients with coronary heart disease (CHD), each of the previous metabolic and hormonal factors might be involved in restenosis after stent implantation.ObjectiveThis study was planned to evaluate the relationship between insulin resistance, insulin, leptin levels and coronary in-stent restenosis after coronary stent implantation in non-diabetic patients with CHD and to determine their value in prediction of restenosis.Patients and methodsThe study included 48 non-diabetic CHD patients with previous successful coronary stent implantation. They were divided into two groups according to the presence of in-stent restenosis on follow-up coronary angiography (6–9 months after stent implantation). The first group was CHD patients with in-stent restenosis which included 20 patients, the second group was CHD patients without restenosis which included 28 patients. All patients were subjected to complete clinical examination including determination of body mass index (BMI), waist to hip ratio (WHR) and laboratory investigations including fasting plasma glucose (FPG), fasting plasma insulin (FP insulin), lipid profile (total cholesterol, HDL-C, LDL-C, TG), glycoselated hemoglobin (HbA1c), plasma leptin, estimation of homeostasis model assessment of IR (HOMA-IR). All subjects were submitted to OGTT with estimation of 2-h post-prandial glucose (2-hPP glucose) and sum post-prandial insulin levels (sum PP insulin). Follow-up coronary angiography was done for all patients with the estimation of minimal luminal diameter (MLD), diameter stenosis % and late lumen loss.ResultsThere was highly significant increase in each of FP insulin, sum PP insulin, HOMA-IR, leptin, diameter stenosis % and late lumen loss (P < 0.001) and a highly significant decrease of MLD (P < 0.001) in CHD patients with in-stent restenosis when compared to CHD patients without in-stent restenosis. MLD is negatively correlated to each of FP insulin (r = −0.49, P < 0.001), sum PP insulin (r = −0.60, P < 0.001) HOMA-IR (r = −0.63, P < 0.001) and leptin (r = −0.55, P < 0.001) while late lumen loss was positively correlated to each of FP insulin (r = 0.98, P < 0.001), sum PP insulin (r = 0.70, P < 0.001), HOMA-IR (r = 0.67, P < 0.001) and leptin (r = 0.72, P < 0.001). Multiple regression analysis revealed that each of FP insulin, sum PP insulin, HOMA-IR and leptin can be considered an independent predictor of in-stent restenosis (P < 0.001).ConclusionOur study revealed that insulin resistance, fasting and post-prandial hyperinsulinemia and hyperliptinemia are considered predictors of coronary in-stent restenosis. Evaluation of HOMA-IR, insulin levels after standard OGTT and leptin levels are important tools in an attempt to recognize subjects at risk of early restenosis among non-diabetic, CHD patients undergoing percutaneous coronary revascularization and stent implantation.     

Diet,body composition,and physical fitness influences on IGF-I bioactivity in women

ObjectiveInsulin-like growth factor I (IGF-I) is a metabolic-regulatory hormone that mediates a variety of physiologic functions. Body composition, fitness status and intake of certain micro- and macronutrients are associated with circulating concentrations of immunoreactive IGF-I. The influence of these factors on IGF-I bioactivity; however, is undetermined. We assessed the relationships between IGF-I bioactivity and lifestyle factors purportedly associated with IGF-I immunoreactivity.DesignIn a cross sectional study, fasted blood samples were obtained from 44 lightly active, college-age (20 ± 2 yrs) women. IGF-I bioactivity was estimated by an assay which determines the ability of serum IGFs to phosphorylate IGF-I receptors in cultured cells; free and total IGF-I were measured by immunoassay. Estradiol and progesterone were measured by immunoassay. Body mass index was calculated from measured height and weight, bone mineral density and body fat percentage measured by dual energy X-ray absorptiometry, and peak oxygen consumption (VO_2peak) determined during a graded treadmill protocol. A food frequency questionnaire measured habitual and a 5-day food record assessed short-term micro- and macronutrient intakes. Associations between bioactive, free and total IGF-I with body composition, sex hormones, VO_2peak, and dietary intake were assessed using univariate and multiple linear regression analyses.ResultsAssociations between bioactive IGF-I with age (r = ?0.36, P < 0.05), body fat percentage (r = ?0.32, P < 0.05), estradiol (r = 0.31, P < 0.05) and progesterone (r = 0.33, P < 0.05) concentrations, habitual alcohol (r = ?0.38, P < 0.05) and selenium intakes (r = 0.41, P < 0.01), free IGF-I with age (r = ?0.34, P < 0.05), estradiol (r = 0.48, P < 0.01) and progesterone (r = 0.52, P < 0.001) concentrations, habitual alcohol (r = ?0.33, P < 0.05) and isoflavone intakes (r = 0.30, P < 0.05) and total IGF-I with age (r = ?0.27, P < 0.05) and habitual alcohol intake (r = ?0.33, P < 0.05) were observed. Habitual alcohol intake was a negative predictor of bioactive, free and total IGF-I in multivariate models.ConclusionOf the lifestyle factors measured, the most robust relationship observed was a negative association between habitual alcohol intake and all measures of IGF-I. This finding suggests that alcohol intake may blunt the physiologic actions of the IGF-I axis.     

Association of Indoxyl Sulfate With Fibroblast Growth Factor 23 in Patients With Advanced Chronic Kidney Disease

BackgroundProtein-bound uremic toxins–indoxyl sulfate (IS) and p-cresyl sulfate (PCS)–can not only predict clinical outcomes but also may relate to bone-mineral disorders in patients with chronic kidney disease (CKD). However, the relationship between protein-bound uremic toxins and fibroblast growth factor 23 (FGF23) has not been studied before. The objective of this study was to explore the association of IS and PCS with FGF23 in a CKD-based cohort.MethodsThis is a cross-sectional study that enrolled 80 stable CKD stage 3 to 5 patients who met the inclusion criteria in a single medical center. Serum levels of IS, PCS and FGF23 were measured concurrently. General biochemistry and patient background were also investigated.ResultsSerum FGF23 and IS concentrations were elevated commensurately with deteriorating renal function. Pearson's analysis showed that FGF23 levels were significantly associated with blood urea nitrogen (r = 0.381, P < 0.05), creatinine (r = 0.632, P < 0.01), estimated glomerular filtration rate (r = –0.447, P < 0.05), phosphate (r = 0.543, P < 0.01), intact parathyroid hormone (r = 0.543, P < 0.01), IS (r = 0.432, P < 0.01) and PCS (r = 0.318, P < 0.05). After adjusting other confounding factors by stepwise multiple linear regression analysis, only creatinine (β = 0.82, P < 0.01), phosphate (β = 0.28, P = 0.02) and IS (β = 0.39, P = 0.04) retained statistically significant associations with FGF23. Moreover, serum levels of IS were higher in patients with high FGF23 concentration (> 90 pg/mL, median value) than those with lower FGF23 (P < 0.01).ConclusionsResults indicated that only IS but not PCS correlated independently with FGF23 in worsening CKD. IS may be an independent factor involved in regulation of bone-mineral metabolism.     

Gut microbiota interactions with the immunomodulatory role of vitamin D in normal individuals

BackgroundDue to immunomodulatory properties, vitamin D status has been implicated in several diseases beyond the skeletal disorders. There is evidence that its deficiency deteriorates the gut barrier favoring translocation of endotoxins into the circulation and systemic inflammation. Few studies investigated whether the relationship between vitamin D status and metabolic disorders would be mediated by the gut microbiota composition.ObjectiveWe examined the association between vitamin D intake and circulating levels of 25(OH)D with gut microbiota composition, inflammatory markers and biochemical profile in healthy individuals.MethodsIn this cross-sectional analysis, 150 young healthy adults were stratified into tertiles of intake and concentrations of vitamin D and their clinical and inflammatory profiles were compared. The DESeq2 was used for comparisons of microbiota composition and the log2 fold changes (log2FC) represented the comparison against the reference level. The association between 25(OH)D and fecal microbiota (16S rRNA sequencing, V4 region) was tested by multiple linear regression.ResultsVitamin D intake was associated with its concentration (r = 0.220, p = 0.008). There were no significant differences in clinical and inflammatory variables across tertiles of intake. However, lipopolysaccharides increased with the reduction of 25(OH)D (p-trend < 0.05). Prevotella was more abundant (log2FC 1.67, p < 0.01), while Haemophilus and Veillonella were less abundant (log2FC − 2.92 and − 1.46, p < 0.01, respectively) in the subset with the highest vitamin D intake (reference) than that observed in the other subset (first plus second tertiles). PCR (r = − 0.170, p = 0.039), E-selectin (r = − 0.220, p = 0.007) and abundances of Coprococcus (r = − 0.215, p = 0.008) and Bifdobacterium (r = − 0.269, p = 0.001) were inversely correlated with 25(OH)D. After adjusting for age, sex, season and BMI, 25(OH)D maintained inversely associated with Coprococcus (β = − 9.414, p = 0.045) and Bifdobacterium (β = − 1.881, p = 0.051), but significance disappeared following the addition of inflammatory markers in the regression models.ConclusionThe role of vitamin D in the maintenance of immune homeostasis seems to occur in part by interacting with the gut microbiota. The attenuation of association of bacterial genera by inflammatory markers suggests that inflammation participate in part in the relationship between the gut microbiota and vitamin D concentration. Studies with appropriate design are necessary to address hypothesis raised in the current study.     

The relationship between cognition and depressive symptoms,and factors modifying this association,in Alzheimer’s disease: A multivariate multilevel model

ObjectivesTo examine whether there was a bidirectional association between cognition and depressive symptoms in Alzheimer’s disease (AD), and to explore the role of socio-demographic factors and daily performance in this association.MethodsWe conducted a longitudinal study of 104 community-dwelling patients with confirmed AD from Taiyuan, China. We assessed cognition and depressive symptoms (dependent variables) with the Montreal Cognitive Assessment (MoCA) and the Geriatric Depression Scale-30 (GDS-30), respectively. Socio-demographic information and daily performance were treated as explanatory variables. A multivariate multilevel model was built to investigate the interrelationship between patients’ cognition and depression, as well as the effect of related factors on both outcomes.ResultsMoCA scores were negatively correlated with GDS-30 both at the subject level (correlation coefficient r₃ = −0.68, χ² = 19.26, P < 0.001) and time point level (r₂ = −0.35, χ² = 35.68, P < 0.001) in patients with AD. Multivariate analysis showed several significant factors for cognitive function, including educational level, personality, hobbies, exercise, reading, aluminum utensil use, dietary restriction and hypertension (regression coefficients: 0.60, 0.52, 0.51, 0.48, 0.45, −0.48, 0.67, and −0.74, respectively). Significant factors for depressive symptoms included family status, employment before retirement, homemaking, reading, aluminum utensil use, dietary restriction, and hypertension (regression coefficients: 3.09, −1.33, −1.62, −1.31, 0.96, −1.15, and 1.14, respectively).ConclusionThese findings indicated that cognition was negatively associated with depression in patients with AD, and both were influenced by reading, aluminum utensil use, dietary restriction, and hypertension. Considering patient factors may help to slow the progression of dementia.     

Clinical profile and impact of family history of premature coronary artery disease on clinical outcomes of patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: analysis from the HORIZONS-AMI Trial

Background/PurposeFamily history of coronary artery disease (CAD) is a well-established risk factor of future cardiovascular events. The authors sought to examine the relationship between family history of CAD and clinical profile and prognosis of patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).Materials/MethodsBaseline features and clinical outcomes at 30 days and at 3 years from 3601 patients with STEMI enrolled in the HORIZONS-AMI trial were compared in patients with and without family history of premature CAD, which was present in 1059 patients (29.4%).ResultsThese patients were younger (median 56.7 vs. 62.1 years, P < 0.0001) and more often current smokers (52.4% vs. 43.5%, P < 0.0001), had more dyslipidemia (47.7% vs. 41.1%, P = 0.0003), less diabetes mellitus (14.1% vs. 17.5%, P = 0.01) and had shorter symptom onset to balloon times (median 213 vs. 225 min, P = 0.02). Patients with a family history of premature CAD had higher rates of final TIMI 3 flow (93.8% vs. 90.6%, P = 0.002), and myocardial blush grade 2 or 3 (83.2% vs. 78.0% P = 0.0008), and fewer procedural complications. Although the unadjusted 30-day and 3-year mortality rates were lower in patients with a family history of premature CAD (1.8% vs. 3.0%, P = 0.046 and 4.8% vs. 7.7%, P = 0.002, respectively), by multivariable analysis the presence of a family history of premature CAD was not an independent predictor of death at 3 years (HR [95%CI] = 1.00 [0.70, 1.44], P = 0.98).ConclusionsA family history of premature CAD is not an independent predictor of higher mortality.     

Effects of adipose tissue distribution on maximum lipid oxidation rate during exercise in normal-weight women

AimFat mass localization affects lipid metabolism differently at rest and during exercise in overweight and normal-weight subjects. The aim of this study was to investigate the impact of a low vs high ratio of abdominal to lower-body fat mass (index of adipose tissue distribution) on the exercise intensity (Lipox_max) that elicits the maximum lipid oxidation rate in normal-weight women.MethodsTwenty-one normal-weight women (22.0 ± 0.6 years, 22.3 ± 0.1 kg.m⁻²) were separated into two groups of either a low or high abdominal to lower-body fat mass ratio [L-A/LB (n = 11) or H-A/LB (n = 10), respectively]. Lipox_max and maximum lipid oxidation rate (MLOR) were determined during a submaximum incremental exercise test. Abdominal and lower-body fat mass were determined from DXA scans.ResultsThe two groups did not differ in aerobic fitness, total fat mass, or total and localized fat-free mass. Lipox_max and MLOR were significantly lower in H-A/LB vs L-A/LB women (43 ± 3% VO_2max vs 54 ± 4% VO_2max, and 4.8 ± 0.6 mg min⁻¹ kg FFM⁻¹ vs 8.4 ± 0.9 mg min⁻¹ kg FFM⁻¹, respectively; P < 0.001). Total and abdominal fat mass measurements were negatively associated with Lipox_max (r = –0.57 and r = –0.64, respectively; P < 0.01) and MLOR [r = –0.63 (P < 0.01) and r = –0.76 (P < 0.001), respectively].ConclusionThese findings indicate that, in normal-weight women, a predominantly abdominal fat mass distribution compared with a predominantly peripheral fat mass distribution is associated with a lower capacity to maximize lipid oxidation during exercise, as evidenced by their lower Lipoxmax and MLOR.     

Anaemia,but not iron deficiency,is associated with clinical symptoms and quality of life in patients with severe heart failure and palliative home care: A substudy of the PREFER trial

BackgroundTo explore the relationships between anaemia or iron deficiency (ID) and symptoms, quality of life (QoL), morbidity, and mortality.MethodsA post-hoc, non-prespecified, explorative substudy of the prospective randomized PREFER trial. One centre study of outpatients with severe HF and palliative need managed with advanced home care. Associations between anaemia, ID, and the Edmonton Symptom Assessment Scale (ESAS), Euro QoL (EQ-5D), Kansas City Cardiomyopathy Questions (KCCQ) were examined only at baseline but at 6 months for morbidity and mortality.ResultsSeventy-two patients (51 males, 21 females), aged 79.2 ± 9.1 years. Thirty-nine patients (54%) had anaemia and 34 had ID (47%). Anaemia was correlated to depression (r = 0.37; p = 0.001), anxiety (r = 0.25; p = 0.04), and reduced well-being (r = 0.26; p = 0.03) in the ESAS; mobility (r = 0.33; p = 0.005), pain/discomfort (r = 0.27; p = 0.02), and visual analogue scale of health state (r = − 0.28; p = 0.02) in the EQ-5D; and physical limitation (r = − 0.27; p = 0.02), symptom stability; (r = − 0.43; p < 0.001); (r = − 0.25; p = 0.033), social limitation;(r = − 0.26; p = 0.03), overall summary score; (r = − 0.24, p = 0.046) and clinical summary score; (r = − 0.27; p = 0.02) in the KCCQ. ID did not correlate to any assessment item. Anaemia was univariably associated with any hospitalization (OR: 3.0; CI: 1.05–8.50, p = 0.04), but not to mortality. ID was not significantly associated with any hospitalization or mortality.ConclusionAnaemia, but not ID, was associated although weakly with symptoms and QoL in patients with advanced HF and palliative home care.     

Effect of neighborhood factors on diabetes self-care behaviors in adults with type 2 diabetes

ObjectiveThe objective of this study was to identify latent variables for neighborhood factors and diabetes self-care and examine the effect of neighborhood factors on diabetes self-care in adults with type 2 diabetes.Research design and methods615 subjects were recruited from an academic medical center and a Veterans affairs medical center in the southeastern United States. Validated scales were used to assess neighborhood factors and diabetes-related self-care. Confirmatory factor analysis (CFA) was used to determine the latent constructs. Structural equation modeling (SEM) was then used to assess the relationship between neighborhood factors and diabetes self-care.ResultsBased on a theoretical framework, CFA yielded four latent variables for neighborhood factors (neighborhood violence, access to healthy food, social support, and neighborhood esthetics) and one latent variable diabetes self-care (including diet, exercise, foot care, blood sugar testing and medication adherence). SEM showed that social support (r = 0.28, p < 0.001) and access to healthy foods (r = −0.16, p = 0.003) were significantly associated with self-care behaviors, while neighborhood violence (r = −0.06, p < 0.001) and esthetics (r = −0.07, p = 0.278) were not χ² (180, N = 611) = 192, p = 0.26, RMSEA = 0.01, CFI = 0.999). In the final trimmed model, social support (r = 0.31, p < 0.001) and access to healthy foods (r = −0.20, p < 0.001) remained significantly associated with self-care behaviors χ² (76, N = 611) = 60, p = 0.91, RMSEA = 0.00, CFI = 1.0).ConclusionThis study developed latent factors for neighborhood characteristics and diabetes self-care and found that social support and access to healthy foods were significantly associated with diabetes self-care and should be considered as targets for future interventions.     

Abdominal obesity and low-grade systemic inflammation as markers of subclinical organ damage in type 2 diabetes

AimThis study aimed to explore the associations between abdominal obesity, inflammatory markers and subclinical organ damage in 740 middle-aged patients with type 2 diabetes.MethodsWaist circumference (WC) and sagittal abdominal diameter (SAD) were measured, and blood samples were analyzed for C-reactive protein (CRP) and IL-6. Carotid intima–media thickness (IMT) was evaluated by ultrasonography, and aortic pulse wave velocity (PWV) measured with applanation tonometry.ResultsAbdominal obesity as determined by SAD and WC was significantly correlated with IL-6 (WC: r = 0.27, P < 0.001; SAD: r = 031, P < 0.001), CRP (WC: r = 0.29, P < 0.001; SAD: r = 0.29, P < 0.001), IMT (WC: r = 0.09, P = 0.013; SAD: r = 0.11, P = 0.003) and PWV (WC: r = 0.18, P < 0.001; SAD: r = 0.21, P < 0.001). In multiple linear regressions with IMT and PWV as dependent variables, and age, gender, statin use, systolic blood pressure (SBP), body mass index (BMI), CRP and HbA_1c as independent variables, both SAD and WC remained associated with IMT and PWV. On stepwise linear regression and entering both SAD and WC, the association between SAD and PWV was stronger than the association between WC and PWV.ConclusionBoth SAD and WC are feasible measures of obesity, and both provide information on inflammation, atherosclerosis and arterial stiffness in type 2 diabetes, while SAD appears to be slightly more robustly associated with subclinical organ damage than WC.     

Does active Crohn's disease have decreased intestinal antioxidant capacity?

Background and aimsOxidative stress is presumed to play an important role in Crohn's disease (CD) pathogenesis. Nevertheless, the evaluation of the intestinal antioxidant capacity through the analysis of glutathione peroxidase activity in CD remains to be determined.Methods20 CD outpatients and 16 volunteers going through colonic cancer screening were enrolled. Colonoscopy with biopsies was performed in all individuals. Samples from inflamed and non-inflamed mucosa were taken when there was CD endoscopic activity. Spectrophotometric assays were performed to measure tissue glutathione peroxidase (GPx) activity, and total (GSH_T) and oxidized (GSSG) glutathione in all samples. Demographics and clinical characteristics were collected from clinical charts.ResultsInflamed CD mucosa presented reduced GPx activity compared to non-inflamed CD mucosa (42.94 mU/mg protein vs 79.62 mU/mg protein, P < 0.05) and control mucosa (42.94 mU/mg protein vs 95.08 mU/mg protein, P < 0.001). GSH_T concentration was reduced in inflamed mucosa when compared to non-inflamed CD mucosa (0.78 μmol/g vs 1.98 μmol/g, P < 0.01) and the control group (0.78 μmol/g vs 2.11 μmol/g, P < 0.001). A significant correlation was detected between GPx activity and GSSG (r = − 0.599), disease duration (r = 0.546), and thiopurine treatment (r = − 0.480) in non-inflamed CD mucosa.ConclusionOur findings suggest that reduced GPx activity is present in inflamed CD mucosa. In addition, endoscopic activity, disease duration and thiopurine therapy could be associated with mucosal decreased antioxidant activity.     

The relationship between retinal nerve fiber layer thickness and carotid intima media thickness in patients with type 2 diabetes mellitus

AimsThe aim of the present study was to investigate retinal nerve fiber layer (RNFL) thickness in patients with type 2 diabetes mellitus (T2D) using spectral-domain optical coherence tomography and to evaluate the relationship between RNFL thickness and carotid intima media thickness (CIMT).MethodsThis study included 171 patients with T2D (53.2 ± 8.8 years) and age matched 61 healthy controls (51.9 ± 8.1 years). We evaluated anthropometric and metabolic parameters as well as RNFL and CIMT measurements in patients with T2D and controls. The Mann–Whitney U test was used to compare the continuous variables and the Chi-square test was used to compare categorical variables. Spearmanʼs rank correlation test was used for calculation of associations between variables.ResultsThe average RNFL thickness was 84.82 ± 11.22 μm in patients with T2D and 92.35 ± 8.45 μm in healthy controls (p < 0.001). Mean CIMT values were higher in patients with T2D (0.80 ± 0.1 mm) than the healthy subjects (0.72 ± 0.1 mm) (p < 0.001). A significant negative correlation was found between age and all quadrants of RNFL. There was a negative correlation between average RNFL thickness and HbA1c (r = −0.176), uric acid (r = −0.145), CIMT (r = −0.190) and presence of carotid plaque (r = −0.193). The superior RNFL thickness was negatively associated with HbA1c (r = −0.175), CIMT (r = −0.207) and carotid plaque (r = −0.176). There was also an inverse correlation between the inferior RNFL thickness and HbA1c (r = −0.187) and carotid plaque (r = −0.157).ConclusionThinning of RNFL might be associated with atherosclerosis in patients with T2D.     

Arterial stiffness and the autonomic nervous system during the development of Zucker diabetic fatty rats

AimThis study aimed to investigate the role played by sympathovagal balance in arterial stiffness, a common feature of insulin resistance and type 2 diabetes.MethodsWe investigated the relationship between autonomic nervous system activity and arterial stiffness in Zucker diabetic fatty rats (ZDF: Gmi-fa/fa) and their age-matched controls (lean: ?/fa). Using simultaneous catheterization of the proximal and distal aorta, we measured intra-arterial blood pressure (BP), heart rate (HR), their variability (spectral analysis) and aortic pulse wave velocity (PWV) in a series of at least six conscious rats aged 6, 12, 18 and 24 weeks.ResultsBP and PWV increased with age (P < 0.001) in both strains with no differences between strains, despite the insulin resistance already present at 6 weeks in ZDF rats. HR was significantly lower (P < 0.001) in ZDF than in lean rats. In ZDF compared with lean rats, the low-frequency (LF) component of the systolic BP variations and the LF/high-frequency (HF) component of the pulse interval (PI) variation ratio were reduced (P < 0.01 and P < 0.05, respectively), while the HF component of the PI (HF-PI) variation was raised (P < 0.05). PWV was negatively correlated with HF-PI (r = −0.37, P < 0.01), but not with biochemical parameters. HF-PI was an independent variable explaining the variation in PWV.ConclusionDuring the development of disease of ZDF rats, sympathovagal balance might account for the lack of increase in PWV.     

Altered molecular signature of intestinal microbiota in irritable bowel syndrome patients compared with healthy controls: A systematic review and meta-analysis

BackgroundMany studies have reported significant changes in intestinal microbiota in irritable bowel syndrome (IBS) patients based on quantitative real-time PCR analysis.AimsWe aimed to review the alterations in intestinal microbiota.MethodsAn online search up to June 9, 2016, was conducted. This systematic review and meta-analysis included differential expression of intestinal microbiota in patients with IBS versus healthy controls (HCs) and subgroup analysis. We assessed the quality of the included studies using an original assessment tool.ResultsA total of 13 articles involving 360 IBS patients and 268 healthy controls were included. The quality assessment scores for these articles ranged from 5 to 8. Significant differences in expression in IBS patients were observed for Lactobacillus (SMD = −0.85, P < 0.001, I² = 28%), Bifidobacterium (SMD = −1.17, P < 0.001, I² = 79.3%), and Faecalibacterium prausnitzii (SMD = −1.05, P < 0.001, I² = 0.0%) but not Bacteroides-Prevotella group, Escherichia coli or other genera or species. Subgroup analysis showed that diarrhea-predominant IBS patients had significantly different expression of Lactobacillus (SMD = −1.81, P < 0.001) and Bifidobacterium (SMD = −1.45, P < 0.001).ConclusionDown-regulation of bacterial colonization including Lactobacillus, Bifidobacterium and F. prausnitzii was observed in IBS patients, particularly in diarrhea-predominant IBS (IBS-D). Microbiota changes participate in the pathogenesis of IBS and may underlie the efficacy of probiotic supplements.     

Determinants of atherosclerosis in an Egyptian cohort of systemic sclerosis: Relation to disease activity and severity

BackgroundSystemic sclerosis (SSc) is a rare multi-system autoimmune disease characterized by vascular abnormalities with an increased prevalence of macrovascular disease.Aim of the workTo evaluate macro-vascular disease (atherosclerosis) in SSc patients and determine its relation to the disease activity and severity.Patients and methodsTwenty-five SSc patients and 20 matched controls were included. The modified Rodnan skin score (mRss) and disease severity by Medsger’s severity score were assessed. Carotid intima-media thickness (IMT) and flow mediated vasodilatation (FMD) of the brachial artery were measured. Traditional vascular risk factors were assessed by thorough history taking and laboratory investigations.ResultsThe age of the patients ranged from 15 to 60 years and they were 22 females and 3 males. 15 had limited and 10 diffuse cutaneous SSc. All SSc patients had an increased IMT (1.24 ± 0.29 mm) which was normal in the control subjects (0.77 ± 0.09 mm) (p < 0.0001). SSc patients had significantly lower HDL, thickened IMT and lower FMD than controls (p = 0.005, p < 0.0001 and p < 0.0001 respectively). The younger age of disease onset was significantly associated with more FMD impairment (r = −0.4, p = 0.04) and Medsger’s severity score (r = 0.5, p = 0.009). The mRss and Medsger’s severity score significantly correlated with the IMT (r = 0.84, p = 0.01 and r = 0.56, p = 0.003 respectively). A significant negative correlation was found between FMD and IMT (r = −0.77, p < 0.0001). Medsger’s severity score significantly correlated with FMD (r = −0.44, p = 0.02).ConclusionSSc is associated with an increased risk of atherosclerosis when compared to age and sex-matched controls. Determinants of this include; younger age of disease onset and more sever disease and low levels of HDL.     

Association of fructosamine to indices of dyslipidemia in older adults with type 2 diabetes

AimsTo evaluate the association of serum fructosamine values to lipid profiles and to other indices of glycemia both at baseline and over time in adults with type 2 diabetes (T2DM).MethodsForty adults aged 45 or older with T2DM, not taking insulin, and an HbA1c of 6–10% were enrolled in a randomized controlled trial regarding the effects of an 8-week yoga program on glycemia and related cardiovascular disease risk indices in adults with T2DM. Fasting blood was drawn to assess glycemia (HbA1c, glucose, and fructosamine) and dyslipidemia (LDL, HDL, total cholesterol, cholesterol:HDL ratio, LDL:HDL ratio, and triglycerides) pre and post-intervention. Because the relation of fructosamine to other indices of glycemia and to lipid profiles did not differ between treatment groups either at baseline or over time, groups were pooled for analysis.ResultsBaseline fructosamine values were significantly correlated with HbA1c (r = 0.77, P < 0.0001), glucose (r = 0.72, P < 0.0001), LDL:HDL ratio (r = 0.46, P = 0.01), cholesterol:HDL ratio (r = 0.55, P = 0.002), and triglycerides (r = 0.39, P = 0.032), but not to other lipid indices at baseline. Change in fructosamine over 8 weeks was significantly correlated with change in HbA1c (r = 0.63, P = 0.0001), glucose (r = 0.39, P = 0.029), cholesterol (r = 0.65, P < 0.0001), LDL (r = 0.55, P = 0.001), LDL:HDL ratio (r = 0.53, P = 0.003), and cholesterol:HDL ratio (r = 0.52, P = 0.002), and was more strongly related to change in lipid values than were other indices of glycemia.ConclusionsFructosamine was significantly correlated with measures of dyslipidemia and glycemia both at baseline and over time, and may represent a relatively sensitive and low cost index of short to medium term change in both glycemia and certain lipid profiles. However, findings from this small pilot study should be interpreted with caution, and warrant replication in larger prospective studies.     

Use of a non-specific immunomodulation therapy as a therapeutic vasculogenesis strategy in no-option critical limb ischemia patients

Background/aimsInflammatory mediators contribute to the impairment of vasculogenesis by reducing endothelial progenitor cells (EPCs) mobilization in atherosclerotic vasculopathy.We tested the hypothesis that administration of an oxygen/ozone mixture (IMT) might counteract this pathophysiological mechanism and enhance limb tissue perfusion in patients with critical limb ischemia (CLI).MethodsRandomized patients with rest pain or ischemic ulcers and transcutaneous oxygen tension (TcPO₂) <40 mmHg and/or toe pressure <50 mmHg received placebo (n = 74) or a non-specific immunomodulation therapy (IMT) (n = 77), autologous blood exposed to oxygen/ozone gas mixture by intragluteal injection, on day 1, 2, 7, and once a week thereafter for at least 22 weeks. Patients were evaluated for changes in TcPO₂, levels of circulating EPCs (CD34/KDR-positive cells) and inflammation (tumor necrosis factor-α—TNF-α).ResultsTcPO₂ and CD34/CD133-positive cells increased at 22 weeks in IMT group (P < 0.01) whereas no changes were observed in placebo group. TNF-α levels decreased at 6 months in IMT group (P < 0.001) whereas no changes were observed in placebo group. There was a strong positive correlation between CD34/KDR-positive cells and TcPO₂ (r = 0.56, P < 0.01). Moreover, there was an inverse correlation between CD34/KDR-positive cells and TNF-α (r = ?0.51, P < 0.01).ConclusionsIntramuscular injection of IMT may improve wound healing and limb salvage in patients with CLI.     

Brain hyperintensity location determines outcome in the triad of impaired cognition,physical health and depressive symptoms: A cohort study in late life

Purpose of the studyBrain hyperintensities, detectable with MRI, increase with age. They are associated with a triad of impairment in cognitive ability, depression and physical health. Here we test the hypothesis that the association between hyperintensities and cognitive ability, physical health and depressive symptoms depends on lesion location.Design and methods244 members of the Aberdeen 1936 Birth Cohort were recruited to this study. 227 participants completed brain MRI and their hyperintensities were scored using Scheltens’s scale. 205 had complete imaging, cognitive, physical health and depressive symptom score data. The relationships between hyperintensity location and depressive symptoms, cognitive ability and physical health were examined by correlation and structural equation analysis.ResultsWe found that depressive symptoms correlated with hyperintensity burden in the grey matter (r = 0.14, p = 0.04) and infratentorial regions (r = 0.17, p = 0.01). Infratentorial hyperintensities correlated with reduced peak expiratory flow rate (r = −0.26, p < 0.001) and impaired gait (r = 0.13, p = 0.05). No relationship was found between white matter and periventricular (supratentoral) hyperintensities and depressive symptoms. Hyperintensities in the supratentorial and infratentorial regions were associated with reduced cognitive performance. Using structural equation modelling we found that the association between hyperintensities and depressive symptoms was mediated by negative effects on physical health and cognitive ability.ConclusionsHyperintensities in deep brain structures are associated with depressive symptoms, mediated via impaired physical health and cognitive ability. Participants with higher cognitive ability and better physical health are at lower risk of depressive symptoms.     

Illness perceptions in IBD influence psychological status,sexual health and satisfaction,body image and relational functioning: A preliminary exploration using Structural Equation Modeling

Background and aimsThis study aimed to characterize the relationships between illness perceptions, body image and self-consciousness, sexual health (sexual problems and sexual satisfaction), anxiety and depression, and marital and family functioning in patients with IBD.MethodsSeventy-four IBD patients (44 CD, 13 males, 61 females, mean age 38 years) completed an online questionnaire. Illness perceptions explored with the Brief Illness Perceptions Questionnaire, and anxiety and depression measured using the Hospital Anxiety and Depression Scale, Sexual Problems Scale, Sexual Satisfaction Scale, Marital Functioning Scale, Family Functioning Scale, and Body Image and Self-Consciousness During Intimacy Scale.ResultsExploratory Structural Equation Modeling (SEM) provided a final model with an excellent fit (χ² (25) = 27.84, p = .32, χ²/N = 1.11, CFI > 0.99, RMSEA < 0.04, SRMR < 0.07, GFI > 0.93). Illness perceptions had a significant direct influence on depression (β = 0.49, p < 0.001), anxiety (β = 0.55, p < 0.001), and family functioning (β = − 0.17, p < 0.001). Several mediating pathways were also found involving sexual problems, sexual satisfaction, and body image and self-consciousness during intimacy. Being female was associated with increased sexual problems but increased sexual satisfaction.ConclusionsThe findings provide further evidence for the adverse impact of patient IBD-related illness perceptions on anxiety and depression. The findings also provide the preliminary evidence for the impact of illness perceptions and psychological comorbidity in relation to sexual health and relationship and family functioning. These aspects of psychological processing provide a framework and direction for further research into the nature of IBD and its influence on the patient and their family.