The Prevalence and Impact of Anergia (Lack of Energy) in Subjects With Heart Failure and its Associations With Actigraphy

BackgroundAnergia (lack of energy) is a newly delineated, criterion-based geriatric syndrome. Because heart failure (HF) is a common chronic condition among older adults and a because a cardinal symptom of HF is reduced energy, we characterized the degree of anergia in subjects with HF and evaluated its relevance to disease severity, functional performance, and quality of life.Methods and ResultsProspective 3-month cohort study among a convenience sample of 61 subjects (61 ± 15 years, 48% women, ejection fraction 41 ± 16%) with New York Heart Association (NYHA) Class I-III HF were studied. The criterion for anergia was based on the major criterion “sits around for lack of energy” and any 2 of 6 minor criteria. Principal measures in addition to demographic and clinical characteristics included functional performance (NYHA class, 6-minute walk, cardiopulmonary exercise testing), plasma B-type natriuretic peptide, and quality of life (SF-12 and Minnesota Living with Heart Failure Questionnaire). To evaluate the relevance of anergia to daily function, each subject wore an Actigraph, a watch-like wrist device that continuously and automatically monitors patient activity levels and energy expenditure, for 3 months. Anergia was prevalent in 39% of this population. Anergia was associated with decrements in functional capacity (higher NYHA Class and lower 6-minute walk distance) as well as reduction in quality of life, but was not associated with ejection fraction. Actigraphy data demonstrated that HF subjects with anergia spent significantly less time performing moderate physical activity and the peak activity counts per day were significantly lower than HF subjects without anergia. Additionally, the amplitude of circadian rhythm was lower, suggesting altered sleep and activity patterns in HF subjects with anergia compared with those without anergia. Over the 3 months of follow-up, there was a significant association between anergia and intercurrent hospitalization.ConclusionsAnergia is significantly associated with several of the cardinal domains of HF. Its presence is associated with demonstrable differences in both physical activity and circadian rhythm as measured by actigraphy and an increased risk of hospitalizations. Accordingly, anergia may be a target for intervention among HF subjects.     

Interest of post mortem analysis in diagnosis and etiopathogeny of ischemic myocardial infarction

The discovery of an ischaemic myocardial infarction during forensic or scientific autopsy is sometimes surprising when found in a young subject. It is therefore important to find out the etiology of vascular lesions to take preventive measures in the family. In post mortem, some complementary analysis can be performed to determine the diagnosis of ischaemic myocardial infarction and its etiopathogeny. Such analyses, routinely made in forensic practice, are rarely used by pathologists during scientific autopsy. Some biological mediums are stable enough to be used for biological, biochemical and even genetical analyses. We will study the different post mortem analyses, and see their interest and reliability.     

Vaginal adenoid cystic carcinoma: a case report

Adenoid cystic carcinoma generally arises from the salivary glands and is rarely found in the female genital tract. Infection with HPV is implicated in this cervical lesion. Differential diagnosis includes adenoid basal carcinoma, polymorphous low-grade adenocarcinoma and basaloid squamous cell carcinoma. Only one case of vaginal localisation was previously described. We report a case of adenoid cystic carcinoma in a 48-year-old woman with previous cervical HPV infection. Histological examination revealed nests of cells with peripheral palisading organisation and glandular lumina containing material produced by the tumor cells.     

Visual versus motor vector inversions in the antisaccade task: a behavioral investigation with saccadic adaptation

In the antisaccade task, subjects must execute an eye movement away from a visual target. Correctly executing an antisaccade requires inhibiting a prosaccade toward the visual target and programming a movement to the opposite side. This movement could be based on the inversion of the visual vector, corresponding to the distance between the fixation point and the visual target, or the motor vector of the unwanted prosaccade. We dissociated the two vectors by means of saccadic adaptation. Adaptation can be observed when systematic targeting errors are caused by the displacement of the visual target during the saccade. Adaptation progressively modifies saccade amplitude (defined by the motor vector) such that it becomes appropriate to the postsaccadic stimulus position and thus different from the visual vector of the target. If antisaccade preparation depended on visual vector inversion, rightward prosaccade adaptation should not transfer to leftward antisaccades (which are based on the same visual vector) but should transfer to rightward antisaccades (which are based on a visual vector inside the adaptation field). If antisaccade preparation depended on motor vector inversion, rightward prosaccade adaptation should transfer to leftward antisaccades (which are based on the same, adapted motor vector) but should not transfer to rightward antisaccades (which are based on a nonadapted motor vector). The results are in line with the first hypothesis, showing that vector inversion precedes saccadic adaptation and suggesting that antisaccade preparation depends on the inversion of the visual target vector.     

Roles of transforming growth factor-β in graft-versus-host and graft-versus-tumor effects

Transforming growth factor (TGF)-β is a pleiotropic cytokine with widespread and profound effects on immune cells. Consequently, it has generated considerable interest in relation to the immunologic outcomes after allogeneic hematopoietic cell transplantation. The TGF-β pathway has been shown to be an important modulator of alloimmunity, with direct consequences on graft-versus-host disease pathophysiology and graft-versus-tumor response. The TGF-β-related effects can be both beneficial and detrimental to the host, underscoring the complexity of TGF-β biology. This article reviews the evidence linking TGF-β to alloimmune responses in allogeneic hematopoietic cell transplantation and highlights foreseeable strategies that?would maximize the beneficial effects of TGF-β pathway modulation on both graft-versus-host disease pathophysiology and the graft-versus-tumor effect.     

Physical fitness in relation to later body composition in pre-school children

Objectives

Although physical fitness is considered a marker of health in youth, little is known whether physical fitness in pre-school age is related to later body composition. Thus, this study investigated (i) associations of physical fitness at 4.5 years of age with body composition 12 months later and (ii) whether improvements in physical fitness during the 12-month follow-up were associated with changes in body composition.