Association of lung function with physical, mental and cognitive function in early old age

Lung function predicts mortality; whether it is associated with functional status in the general population remains unclear. This study examined the association of lung function with multiple measures of functioning in early old age. Data are drawn from the Whitehall II study; data on lung function (forced expiratory volume in 1 s, height FEV(1)), walking speed (2.44 m), cognitive function (memory and reasoning) and self-reported physical and mental functioning (SF-36) were available on 4,443 individuals, aged 50-74 years. In models adjusted for age, 1 standard deviation (SD) higher height-adjusted FEV(1) was associated with greater walking speed (beta=0.16, 95% CI: 0.13, 0.19), memory (beta=0.09, 95% CI: 0.06, 0.12), reasoning (beta=0.16, 95% CI: 0.13, 0.19) and self-reported physical functioning (beta=0.13, 95% CI: 0.10, 0.16). Socio-demographic measures, health behaviours (smoking, alcohol, physical activity, fruit/vegetable consumption), body mass index (BMI) and chronic conditions explained two-thirds of the association with walking speed and self-assessed physical functioning and over 80% of the association with cognitive function. Our results suggest that lung function is a good 'summary' measure of overall functioning in early old age.     

Are serum thyrotropin levels within the reference range associated with endothelial function?

Aims: High serum thyrotropin (TSH) levels within the reference rangemight be associated with an increased cardiovascular risk. Inthe present study, we investigated the association between serumTSH levels and flow-mediated dilation (FMD) as a measure ofendothelial dysfunction. Methods and results: The study population comprised 1364 subjects (670 women) aged25–85 years with serum TSH levels between 0.25 and 2.12mIU/L recruited from 5-year follow-up of the Study of Healthin Pomerania. No interventions were performed. Measurementsof FMD and nitrate-mediated dilation (NMD) were performed inthe supine position using standardized ultrasound techniques.FMD and NMD values below the median of each distribution wereconsidered decreased. Analyses adjusted for age, sex, smoking,and systolic and diastolic blood pressure revealed a non-significantinverse trend between serum TSH levels and FMD (P = 0.130).Subjects with serum TSH levels above the highest quartile hadlower median FMD values relative to subjects with serum TSHlevels below the lowest quartile (4.86 vs. 5.43%, P < 0.05).A linear inverse trend between serum TSH levels and decreasedFMD barely missed statistical significance (P = 0.138). Subjectswith high serum TSH levels had higher odds of decreased FMDrelative to subjects with low serum TSH levels (odds ratio 1.42;95% confidence interval 1.02; 1.96; P < 0.05). These associationswere more pronounced in men than in women. There were no suchassociations for NMD. Conclusion: Serum TSH levels within the upper reference range are associatedwith impaired endothelial function. Our findings contributeto the discussion on whether the upper TSH reference limit shouldbe redefined.     

采用经胸高频超声观察大鼠心脏结构与功能的增龄性改变

目的 应用高频超声测定Wistar大鼠心脏结构和功能,探讨其增龄性改变的规律.方法 选用1、2、5、12、20月龄的雄性健康Wistar大鼠60只(每组12只),各组大鼠分别行经胸超声心动图检查,测定心脏结构与功能参数,最后处死大鼠取左心室称质量.结果 随增龄左心房内径、舒张末期左心室内径、室间隔及左心室后壁厚度、左心室心肌质量均增加(P<0.05),超声评估左心室质量与解剖称左心室质量结果呈正相关(r=0.78,P<0.01),各组左心室射血分数、短轴缩短率差异无统计学意义(均P>0.05);等容舒张时间随增龄延长(P<0.01);组织多普勒二尖瓣环舒张早期峰值(Ea)自2月龄后开始随增龄逐渐下降,舒张晚期峰值(Aa)呈上升趋势,Ea/Aa在1、2、5月龄组>1,12、20月龄组<1.多因素分析结果显示,月龄是左心房内径、舒张末期左心室内径、二尖瓣环舒张早期峰值的影响因素.结论 高频超声能够评价大鼠的心脏结构与功能的改变;老龄大鼠心房、心室内径均增加,左心室壁增厚,收缩功能无明显改变,而舒张功能已减低.     

Impact of physical,cognitive, and psychological functions on incident homebound status after discharge among hospitalized older patients: A clinical-based prospective study

PurposePhysical and cognitive/psychological functions are risk factors for incident homebound status. However, there are only a few studies exploring the factors related to homebound status in hospitalized older patients. The aim of this study was to determine the relationship between physical, and cognitive/psychological function at discharge among hospitalized older patients and the risk of undergoing homebound status after discharge.MethodsWe analyzed the cohort data of hospitalized older patients (age ≥65 years) with internal medical problems. The main outcome was the incidence of homebound status a month after discharge. Physical functions were measured by handgrip strength (HG), knee extension strength (KES), one-leg stance (OLS), and walking speed (WS). Cognitive and psychological functions were assessed using the Mini-Mental State Examination (MMSE) and Geriatric Depression Scale-5 (GDS-5), respectively. Poisson regression models were used to estimate the risk ratios (RR) and 95 % confidence intervals (CIs) of the relationships between physical, cognitive, and psychological functions as well as the homebound status.ResultsA total of 178 participants who completed the follow-up were analyzed mean age (standard deviation) 76.2 (6.9) years. A month after discharge, 23 participants were deemed homebound, for a cumulative incidence (95 %CI) of 12.9 % (8.0 %–17.8 %). The RR (95 %CI) estimated by Poisson regression were 3.51 (1.30–9.48), 0.15 (0.03-0.72) and 0.11 (0.01-0.92) for low KES, maximum WS and comfortable WS, respectively. However, HG, OLS, MMSE, and GDS-5 were not significantly associated with the incidence of homebound status.ConclusionPhysical functions can predict the incidence of homebound status after discharge among hospitalized older patients.     

Cardiac function and dysfunction in the fetus

Evaluation of fetal cardiac function is one of the most important components of fetal echocardiography. Fetal cardiac dysfunction is closely linked to risk of intrauterine fetal demise, in many, but not all cases is indicative of worse postnatal prognosis and may prompt the use of medications or interventions to optimize outcomes. There may be implications for termination versus continuation of pregnancy, an indication for early delivery, a change in location and even mode of delivery. In extreme cases, fetal cardiac dysfunction may prompt prenatal or early neonatal listing for cardiac transplantation. There are several important differences between the fetal and postnatal circulatory physiology which affect echocardiographic assessment of cardiac dysfunction. In this review, we examine the echocardiographic findings according to their underlying pathophysiology with reference to common causes.     

高血压病患者肺通气功能和弥散功能的变化

目的　探讨不同分级、危险度分层的原发性高血压病 (essential hypertension,EH )患者的肺功能改变及其临床意义。方法　对 6 7例未经正规治疗的 EH患者和 6 3例血压正常者的肺通气功能 (用力肺活量 FVC、第一秒用力呼气量FEV1 、最大呼气中段流量 MMEF、最大通气量 MVV)和弥散功能 (肺一氧化碳弥散量 DLCOSB)进行前瞻性单盲对照研究。结果　 (1) EH组 FVC、FEV1 、MMEF、MVV、DLCOSB与正常对照组比较差异有显著性 (P<0 .0 0 1)。(2 ) 2、3级 EH患者肺功能较 1级 EH患者肺功能降低 ,两者在 FVC、FEV1 的差异有非常的显著性 (P<0 .0 0 1) ,而在 MMEF、MVV、DLCOSB的差异无显著性 (P>0 .0 5 )。(3)与低危组相比 ,中危组 EH患者的各项肺功能指标都有所降低 ,但其中仅 FEV1的差异具有显著性 (P<0 .0 5 ) ;高危 /极高危组 EH患者的肺功能皆降低 ,其中 FVC、FEV1 、MMEF的差异具有显著性(P<0 .0 2～ 0 .0 0 1) ,而 MVV、DLCOSB的差异无显著性 (P>0 .0 5 )。 (4)与中危组相比 ,高危极高危组 EH患者肺功能降低 ,其中 FVC、FEV1 的差异具有显著性 (P<0 .0 0 1) ,而 MMEF、MVV、DLCOSB的差异不具有显著性 (P>0 .0 5 )。结论　 EH患者肺通气功能和弥散功能减低 ,并有随血压分级和危险度分层的加重而减低趋势     

Assessment of thyroid and adrenal function in patients with familial amyloidotic polyneuropathy

This study was performed to evaluate thyroid and adrenal function in patients with familial amyloidotic polyneuropathy. Twenty-four patients without any clinical overt endocrinological dysfunction were studied. None of the patients showed laboratory evidences of hypo- or hyperthyroidism. A short ACTH-stimulation test was performed in 17 of the patients. A low cortisol response to ACTH stimulation, suggesting adrenocortical insufficiency, was found in four (24%) of the patients, and an intermediate response interpreted as suspected hypofunction was found in three (18%) patients. Low serum dehydroepiandrosterone sulphate levels, suggesting adrenal hypofunction, were found in six (25%) of the patients. We believe that the possibility of glucocorticoid insufficiency should always be considered in patients with familial amyloidotic polyneuropathy.     

异体输血对消化道出血患者凝血功能及部分免疫功能的影响

[目的]探讨异体输血对消化道出血患者凝血功能及部分免疫功能的影响。[方法]入选消化性溃疡出血、血红蛋白65~75g/L的患者40例,其中不给予输血治疗20例作为对照组,给予输注少白红细胞2~4U的20例作为输血组,并分别于输血组的输血前、输血后采取2组患者静脉血,检测其凝血功能及外周血中自然杀伤(NK)细胞、IgG、IgA、IgM、CD3~+、CD4~+、CD8~+、CD4~+/CD8~+的变化情况。[结果]输血组输血前与对照组各项指标均无显著差异,输血后NK细胞、CD3~+、CD4~+、CD4~+/CD8~+、IgG较输血前显著减少(P0.05),IgA、IgM与输血前变化不显著;输血组输血前、输血后1d凝血功能指标变化均差异不显著(P0.05)。[结论]异体输血对纠正患者失血性贫血有疗效,但对患者免疫功能抑制明显,对于异体输血量在一定范围内的患者凝血功能无明显影响。     

高压氧治疗对急性心肌梗塞患者溶栓后心功能的影响

目的：观察高压氧治疗对溶栓后急性心肌梗塞患者心功能的影响。方法：42例急性心肌梗塞（AMI）患者接受尿激酶溶栓治疗，其中有16例于溶栓后6h接受60min的高压氧治疗（HPOT），为HPOT组，未进行HPOT的26例为AMI对照组。三周后所有病人行超声心动图检查。结果：HBOT组患者的左心室心缩末容积，每搏量，左室射血分数较AMI对照组明显改善（P均〈0．05）。结论：高压氧治疗可改善溶栓后急性心肌梗塞患者的心功能。     

抑郁症患者甲状腺功能与植物神经功能的关系

目的研究抑郁症患者甲状腺功能和植物神经功能的变化。方法研究我院门诊患者单相抑郁症38例,双相抑郁症组42例,正常对照组30例。用汉密顿量表(17项版本)进行精神测评。用化学发光法测定血清FT3、FT4、TSH的水平,用植物神经平衡指数来评定植物功能。结果与对照组比较,单相抑郁症患者血清FT3水平下降,FT4水平上升,TSH水平无变化,双相抑郁症患者血清FT3水平下降、FT4水平上升更显著(P<0.01)。单相抑郁和双相抑郁患者植物神经功能评定均提示交感神经活性增强。与轻度抑郁症相比,重度抑郁症患者血清FT3水平下降、FT4水平上升和植物神经平衡指数上升更显著(P<0.01)。结论抑郁症患者交感神经活性增强,其血清FT3水平下降、FT4水平上升。     

The interaction of ancrod with human platelets

Ancrod, a serine protease purified from the venom of Agkistrodon rhodostoma, has been used as a therapeutic anticoagulant for a number of indications, including replacement of heparin in patients with heparin-induced thrombocytopenia. Ancrod has similar fibrinolytic activity to thrombin, but ancrod specifically cleaves only the alpha chain of fibrinogen, producing the characteristic fibrinopeptides A, AP and AY. Because ancrod has been used in patients with heparin-induced thrombocytopenia, it is important to ensure that ancrod does not directly affect the platelets and potentially increase the hemostatic effect. The effect of ancrod on platelets has not been well established, and there is not agreement in published studies. Additionally, some of the studies are over 15 years old and pre-date sensitive assays such as glycoprotein analysis. For these reasons, we investigated the interaction of ancrod with human platelets using direct and indirect, functional and biochemical techniques. Incubation of platelets with ancrod alone did not induce platelet aggregation or the release of dense-granule contents. Pre-incubation of platelets with ancrod did not augment or inhibit the maximal aggregation achieved with thrombin, nor did it affect the amount of serotonin release from dense granules caused by activation by thrombin. Studies of ancrod-treated platelets using monoclonal antibody-mediated radioimmunoprecipitation demonstrated that high concentrations of ancrod did not cause measurable cleavage of either the glycoproteins Ib-IX or IIb-IIIa. Incubation of radiolabeled platelets with ancrod-treated plasma also had no effect on the platelet glycoproteins, indicating that ancrod does not indirectly affect the major surface receptors. Direct binding studies using radiolabeled ancrod did not demonstrate specific binding to the platelet surface. Together these studies indicate that ancrod does not directly affect nor bind to platelets in vitro . The hypocoagulant state and subsequent platelet function defect resulting from the use of ancrod appears to be limited to the removal of fibrinogen from the circulation.     

The increasing detection of asymptomatic left ventricular dysfunction in patients with type 2 diabetes mellitus without overt cardiac disease: Data from the SHORTWAVE study

Aims

Type 2 diabetes mellitus (DM) is associated with higher risk of heart failure. Over the last three decades several studies demonstrated the presence of asymptomatic systolic and/or diastolic left ventricular (LV) dysfunction (asymLVD) in patients with normal LV ejection fraction (LVEF). Purpose of our study was to assess the prevalence and factors associated with asymLVD in DM patients by echocardiographic indexes more sensitive than LVEF and transmitral flow detected by pulsed Doppler.

Methods

386 DM patients without overt cardiac disease were enrolled from January to October 2011. Stress-corrected midwall shortening (sc-MS) and mitral annular peak systolic velocity (S′) were considered as indexes of systolic function of circumferential and longitudinal myocardial fibers, respectively. Early diastolic velocity of transmitral flow was divided by early diastolic Tissue Doppler velocity of mitral annulus for identifying diastolic LVD.

Results

asymLVD was detected in 262 patients (68%). 106 (27%) had isolated systolic asymLVD, 61 (16%) isolated diastolic asymLVD; in 95 (25%) systolic and diastolic asymLVD coexisted. Patients with asymLVD were older, had lower glomerular filtration rate, higher levels of glycated hemoglobin, C reactive protein, LV mass, relative wall thickness and prevalence of valve calcifications. Older age (HR 1.1 [1.02–1.18], p = 0.01), aortic valve calcifications (HR 6.3 [1.31–30.31], p = 0.02), LV concentric geometry defined as relative wall thickness ≥0.43 (HR 15.44 [2.96–80.44], p = 0.001) were independent predictors of asymLVD at multivariate analysis.

Conclusions

Using suitable echocardiographic indexes, asymLVD is detectable in two/third of DM patients without overt cardiac disease and is predicted by older age, cardiac valve calcifications and LV concentric remodeling.     

Bronchodilator responsiveness in wheezy infants predicts continued early childhood respiratory morbidity

Objective: Spirometry including bronchodilator responsiveness is considered routine in the workup of asthma in older children. However, in wheezy infants the existence of bronchodilator responsiveness and its prognostic significance remain unclear. Methods: Infants (< 2 years) with chronic or recurrent wheezing or coughing were evaluated by infant pulmonary function testing (PFT). Maximal expiratory flow at the point of functional residual capacity (V?_maxFRC) was measured before and 20 minutes after salbutamol administration. Only infants with an obstructive profile (V?_maxFRC < 80% predicted) were included. The infants were divided into two groups with regard to whether or not a response to salbutamol was observed on PFT. A response was defined as a mean V?maxFRC after salbutamol administration exceeding the upper confidence interval limit of individual pre-bronchodilator V?_maxFRC measurements. Follow-up data was gathered after a mean of 2 years. Measurements and Main Results: Sixty infants were included in the study of which 32 (53%) demonstrated responsiveness to bronchodilators. The infants in the responsive group had a significantly higher frequency of physician visits for wheezing than the non-responders (3.0 mean visits/yr vs. 1.5 respectively, P = 0.03), and had a higher likelihood of having received asthma medication in the last year of the follow-up period (84% vs. 50% respectively, RR: 1.68[1.10–2.56]). At the end of the follow-up period, more parents in the responsive group reported continued respiratory disease (71% vs. 22%, RR:3.21[1.30–7.95]). Conclusions: Bronchodilator responsiveness can be demonstrated by infant PFT in infants with recurrent wheezing and can predict increased respiratory morbidity until 3 years of age.     

Effect of propofol and ketamine anesthesia on cognitive function and immune function in young rats

Objective:To investigate the effects of propofol and ketamine on the cognitive function and immune function in young rats.Method:A total of 80 young rats were randomly divided into four groups:Control group,ketamine group(experimental group A),propofol group(experimental group B),ketamine and propofol group(experimental group Q.All rats had continuous injection for three times,serum IL-2,IL-4 and II.-10 and whole brain IL-I P level,hippocampal neuronal apoptosis level were measured.The cognitive ability in rats was tested by water maze.Results:Water maze test showed on the 1st d,the maze test latency of the control group,the experimental group B and the experimental group C water were decreased gradually;Compared with the control group after 3 days,the latency of the experimental group A,experimental group B and experimental group C were all decreased,the crossing circle times were also reduced.Hippocampal neuron apoptosis were(2.3±1.7)%,(14.7±6.9)%,(4.2±3.3)%,(10.2±4.8r%in control group,experimental group A,experimental group B and experimental group C,respectively.The neurons apoptosis of experimental group A was significantly increased.The serum IL-4 and 1L-10 of the experimental group A,experimental group B and experimental group C after anesthesia were significantly higher than the control group.The whole brain IL-1β of the experimental group A,experimental group B and experimental group C were significantly lower than the control group.Conclusions:Propofol can reduce anesthesia effect of ketamine on the cognitive function and immune function in the young rats.     

心脏舒张功能的年龄性变化早于收缩功能

目的：本研究目的是为了明确心脏舒张和收缩这２种功能年龄性变化的时间关系。方法：采用多普勒超声心动图对１３９名正常人的心脏舒张和收缩功能进行同时记录。结果：２０～２９、３０～３９、４０～４９、５０～５９、≥６０岁等５组的早期充盈峰速／晚期充盈峰速的比值分别为２．１８±０．４５、２．０４±０．５４、１．６３±０．５９、１．５２±０．４４和１．４５±０．５９；早期充盈分数分别为０．７６±０．０４、０．７５±０．０６、０．６８±０．０７、０．６８±０．０７和０．６９±０．０８；心输出量指数分别为３．５±１．３、３．３±１．１、３．０±０．９、２．８±０．９和２．８±０．９Ｌ·ｍｉｎ－１／ｍ２；射血前期／左心室射血时间比值分别为０．２５６±０．０７０、０．２６４±０．０５０、０．２５４±０．０５０、０．２４４±０．０４０和０．２８５±０．０３０。相关性和方差分析表明，心脏收缩功能没有明显年龄相关性变化（Ｐ＞０．０５）；舒张功能呈显著的年龄相关性变化（Ｐ＜０．０１），并且在４０岁以后就开始发生显著改变（Ｐ＜０．０１）。结论：心脏舒张功能年龄性变化先于收缩功能而发生     

L-精氨酸对COPD患者心肺功能的影响

目的探讨L-精氨酸对COPD患者肺功能及心功能的影响。方法将60例COPD患者随机分为常规组和观察组各30例。常规组给予平喘、吸氧、强心、祛痰、抗感染、利尿、纠正内环境紊乱等治疗;观察组在此基础上使用L-精氨酸进行治疗。比较两组患者治疗前后的肺功能及心功能改变。结果治疗后两组PAP、MIP、MEP、FEV1(%)、FEV1/FVC(%)均较治疗前显著改善(P0.05)。观察组治疗后PAP(mmHg)、MIP(kPa)、MEP(kPa)、FEV1(%)、FEV1/FVC(%)值分别为22.5、7.2、10.6、58.4、66.2,显著高于常规组35.4、6.3、9.2、54.2、63.1(P0.05)。两组治疗后LVEDV、EF、CI均较治疗前有所改善,但差异并无显著性(P0.05)。结论 L-精氨酸与常规治疗相比可以显著改善患者的肺功能并有效降低肺动脉压;其对患者心功能的影响有待于更进一步的研究。     

Multimorbidity and functional impairment–bidirectional interplay,synergistic effects and common pathways

This review discusses the interplay between multimorbidity (i.e. co‐occurrence of more than one chronic health condition in an individual) and functional impairment (i.e. limitations in mobility, strength or cognition that may eventually hamper a person's ability to perform everyday tasks). On the one hand, diseases belonging to common patterns of multimorbidity may interact, curtailing compensatory mechanisms and resulting in physical and cognitive decline. On the other hand, physical and cognitive impairment impact the severity and burden of multimorbidity, contributing to the establishment of a vicious circle. The circle may be further exacerbated by people's reduced ability to cope with treatment and care burden and physicians’ fragmented view of health problems, which cause suboptimal use of health services and reduced quality of life and survival. Thus, the synergistic effects of medical diagnoses and functional status in adults, particularly older adults, emerge as central to assessing their health and care needs. Furthermore, common pathways seem to underlie multimorbidity, functional impairment and their interplay. For example, older age, obesity, involuntary weight loss and sedentarism can accelerate damage accumulation in organs and physiological systems by fostering inflammatory status. Inappropriate use or overuse of specific medications and drug–drug and drug–disease interactions also contribute to the bidirectional association between multimorbidity and functional impairment. Additionally, psychosocial factors such as low socioeconomic status and the direct or indirect effects of negative life events, weak social networks and an external locus of control may underlie the complex interactions between multimorbidity, functional decline and negative outcomes. Identifying modifiable risk factors and pathways common to multimorbidity and functional impairment could aid in the design of interventions to delay, prevent or alleviate age‐related health deterioration; this review provides an overview of knowledge gaps and future directions.     

Relationships of vascular function with measures of ambulatory blood pressure variation

Background

Characteristics of short-term blood pressure (BP) variation may influence cardiovascular disease risk via effects on vascular function.

Objective

In a cross-sectional study of a group of treated hypertensive and untreated largely normotensive subjects we investigated the relationships of measures of short-term BP variation with brachial artery vasodilator function.

Methods

A total of 163 treated hypertensive (n = 91) and untreated largely normotensive (n = 72) men and women were recruited from the general population. Measures of systolic and diastolic BP variation were calculated from 24 h ambulatory BP assessments and included: (i) rate of measurement-to-measurement BP variation (SBP-var and DBP-var); and (ii) day-to-night BP dip (SBP-dip and DBP dip). Endothelium-dependent vasodilation was assessed as flow-mediated dilation (FMD) and endothelium-independent vasodilation was assessed in response to glyceryl trinitrate (GTN). Relationships were explored using univariate and multivariate linear regression.

Results

The relationships of brachial artery vasodilator function with BP variation were not significantly different between treated hypertensive and untreated subjects, therefore these groups were combined for analysis. In univariate analysis, higher SBP-var (P < 0.001) and lower DBP-dip (P = 0.004) were associated with lower FMD; and higher SBP-var (P = 0.002) and lower SBP-dip (P = 0.003) and DBP-dip (P = 0.001) were associated with lower GTN-mediated dilation. In multivariate analysis, lower SBP-dip (P = 0.007) and DBP-dip (P = 0.03) were independently associated with lower GTN response.

Conclusions

Our results indicate that a lower day-to-night BP dip is independently associated with impaired smooth muscle cell function. Although rate of BP variation was associated with measures of endothelial and smooth muscle cell function, relationships were attenuated after accounting for age and BP.