State of vigilance,oestrogen replacement therapy,and lipid profile as modifiers of nocturnal movement-induced heart rate responses

Study objectives: To investigate the body movement‐associated heart rate responses during sleep in postmenopausal women and to evaluate the possible effect of transdermal oestrogen replacement therapy and metabolic factors on these responses. Design: A prospective double‐blind cross‐over placebo‐controlled trial. Setting: A university sleep research unit. Patients: Seventy‐one healthy postmenopausal women. Methods: The subjects underwent a whole‐night polysomnography including an electrocardiogram (ECG) and a sensitive whole‐body movement sensor channel. Body movements of 2–15 s duration with an artefact‐free ECG were identified and heart rate was automatically analysed for 30 s before and 60 s after movement. The movement‐induced reflex tachycardia and the following rebound bradycardia were measured for the awake state, non‐rapid eye movement (REM) sleep and REM sleep. Indices of the heart rate response correlated with age, body mass index (BMI) and high‐density lipoprotein (HDL)/low‐density lipoprotein (LDL) cholesterol ratio. Results: The tachycardia response to a body movement was stronger during sleep than in the awake state, being strongest in REM sleep. The rebound bradycardia following a tachycardia response was relatively similar in REM and in the awake states, but attenuated in non‐REM sleep. Oestrogen did not influence the heart rate response. Increasing age and BMI attenuated the response, while an increase in the HDL/LDL cholesterol ratio enhanced the rebound bradycardia response. Conclusions: Sleep powerfully modulates the rapid cardiac autonomic responses to internal stressors. Postmenopausal hormone replacement therapy does not influence these responses, but they are strongly modulated by lipid metabolism and closely correlated with age and BMI.     

Site-specific UBITh amyloid-beta vaccine for immunotherapy of Alzheimer's disease

The UBITh AD immunotherapeutic vaccine for Alzheimer's disease uses an amyloid-beta (Abeta) immunogen having two designer peptides that have been engineered to elicit anti-N terminal Abeta(1-14) antibodies while minimizing potential for the generation of adverse anti-Abeta immune responses. The vaccine has been further designed for minimization of inflammatory reactivities through the use of a proprietary vaccine delivery system that biases Th2 type regulatory T cell responses in preference to Th1 pro-inflammatory T cell responses. In vitro studies and in vivo studies in small animals, baboons and macaques show that anti-Abeta antibodies are generated with the expected N-terminus site-specificity, and that these antibodies have functional immunogenicities to neutralize the toxic activity of Abeta and promote clearance of plaque deposition. The antibodies appear to draw Abeta from the CNS into peripheral circulation. Results indicate that the UBITh AD vaccine did not evoke anti-Abeta cellular responses in a transgenic mouse model for AD. The vaccine was safe and well tolerated in adult Cynomolgus macaques during a repeat dose acute and chronic toxicity study.     

Safety of alemtuzumab in a nationwide cohort of Finnish multiple sclerosis patients

Journal of Neurology - Alemtuzumab is an effective disease-modifying therapy (DMT) for highly active multiple sclerosis (MS). However, safety concerns limit its use in clinical practice. To...     

Symptoms and signs of community-acquired pneumonia in children

OBJECTIVE: The aim of this investigation was to identify the clinical symptoms and signs of pneumonia in hospitalised patients with confirmed aetiologic diagnosis and to study whether it is possible to differentiate viral from bacterial pneumonia by these means. DESIGN: A 3-year prospective study. SETTING: Turku University Hospital, Turku, Finland. PATIENTS: 254 children with radiologically confirmed community-acquired pneumonia. MAIN OUTCOME MEASURES: Data on symptoms and signs were collected from the hospital records of patient files. A standardised case record form was used. RESULTS: Eleven percent of the patients presented the illness without any respiratory symptoms. Patients with viral pneumonia versus those with bacterial pneumonia were younger (means 2.8 vs 4.1 years) and more often had acute otitis media (41% vs 18%), dyspnea (48% vs 25%) and rhonchi on auscultation (47% vs 26%). Thoracic pain, headache and decreased breathing sounds were more common in patients with bacterial pneumonia. CONCLUSIONS: Although the clinical findings in viral pneumonia showed some differences from those in bacterial pneumonia, they were largely overlapping. This similarity and the frequent occurrence of mixed infections make it impossible to differentiate between viral and bacterial pneumonia simply by clinical symptoms and signs.     

Are patient-related pre-operative factors influencing return to work after total knee arthroplasty

BackgroundOsteoarthritis is one of the leading causes of disability in working-age patients. The total number of working-age patients undergoing total-knee arthroplasty (TKA) is continuously increasing. The purpose of this study was to identify predictive factors related to general health, health risk behaviors and socioeconomic status influencing the rate of return to work after a TKA.MethodsOverall there were 151,901 patients included in the Finnish Public Sector (FPS) study. The response rate varied between 65 and 73% during the study period. We used Cox proportional hazard models to examine patient-related predictive factors that may influence the rate of return to work after TKA in a cohort of patients (n = 452; n = 362 female; mean age 56.4 years). Predictive factors were measured on average 3.6 years before the operation.ResultsOf the patients, 87% returned to work within one year after TKA at a mean of 116 calendar days. In multivariate analysis, patients at sick-leave ≤ 30 days during the last year before surgery were 2.2 times (95% confidence interval 1.72–2.92) more likely to return to work compared with those with > 30 days of sick-leave. Compared with patients in manual work, those in higher or lower level non-manual work showed a 2.6-fold (1.95–3.52) and 1.5-fold (1.15–1.92) increased probability of returning to work. Age, sex, health risk behaviors, obesity, physical comorbidities, common mental disorders, and other studied health-related factors were not associated with the rate of return to work.ConclusionsNon-manual job, good self-rated general health and preoperative sick leave ≤ 30 days are associated with a higher rate of return to work.     

Vasodilation of epicardial coronary artery can be measured with transthoracic echocardiography

Transthoracic Doppler echocardiography (TTE) has been introduced as a noninvasive tool to measure coronary flow velocity reserve (CFVR). Velocity measurement, however, fails to take into account epicardial coronary artery vasodilation during hyperemia and this may cause underestimation of CFVR measurements. Therefore, we sought to determine whether the vasodilation of epicardial coronary artery can be measured during cold pressor test (CPT) and adenosine infusion simultaneously with the flow velocity measurement using TTE. We studied 41 healthy nonsmoking men with a linear high-frequency 8.0-MHz transducer. The CPT and adenosine infusion dilated the diameter of the distal left anterior descending coronary artery (LAD) from 1.4 +/- 0.4 mm to 1.5 +/- 0.4 mm (14 +/- 13%, p < 0.01) and from 1.4 +/- 0.4 mm to 1.8 +/- 0.5 mm (31 +/- 19%, p < 0.01), respectively. The CPT increased flow velocity and calculated coronary blood flow rate (velocity time integral x cross-sectional area) from 0.23 +/- 0.05 m/s to 0.36 +/- 0.13 m/s (31 +/- 34%, p < 0.01) and from 8.1 +/- 4.2 mL/min to 11.4 +/- 6.0 mL/min (47 +/- 51%, p < 0.01). CFVR and calculated coronary blood flow rate reserve were 3.9 +/- 1.0 and 6.0 +/- 1.9, respectively. In Bland-Altman analysis, velocity measurements underestimated the vasodilation response of the CPT and adenosine compared with the measurements where epicardial diameter dilation was taken into account. Intra- and interobserver variability of diameter measurements was low (coefficient of variation [CV] 2.6 to 6.5%). Day-to-day, within-day and intersonographer variabilities were of similar magnitude (CV 4.6 to 8.2%), suggesting good reproducibility. This study demonstrates that TTE can be used to assess changes in both epicardial coronary artery diameter and flow velocity simultaneously in the distal LAD artery.