Impaired Systolic Blood Pressure Recovery and Heart Rate Recovery After Graded Exercise in Patients With Metabolic Syndrome

The aim of this study was to evaluate and compare systolic blood pressure recovery and heart rate recovery (HRR) values obtained at various time intervals after maximal graded exercise treadmill testing between patients with metabolic syndrome (MS) and the controls without MS. To our knowledge, this is the first study indicating systolic blood pressure recovery (SBPR) impairment and its relations to HRR and other variables in this group of patients.The study population included 110 patients with MS (67 men, 43 women; mean age: 46 ± 9 years) and 110 control subjects who did not meet the criteria for MS (58 men, 52 women; mean age: 44 ± 10 years). All patients were selected from nonobese, apparently healthy sedentary individuals who had the ability to perform maximum exercise testing. SBPR was assessed by calculating the ratio of systolic blood pressure (SBP) obtained in the third minute of the recovery period to either the peak-exercise SBP or the SBP in the first minute of the recovery period after graded exercise testing. HRR values were calculated by subtracting the HR at the first, second, third, fourth, and fifth minutes of the recovery period from the HR reached at peak exercise.There was no significant difference found between the 2 groups with respect to age and sex distribution. As expected, patients with MS had higher waist circumference, fasting plasma glucose and serum triglyceride, and lower high-density lipoprotein cholesterol compared with control subjects. All HRR values calculated in the first, second, third, fourth, and fifth minutes were significantly detected lower in the MS group compared with the control group (HRR 1st: 32 ± 10 vs 36 ± 11; P = 0.009; HRR 2nd: 47 ± 10 vs 51 ± 11; P = 0.02; HRR 3rd: 53 ± 11 vs 58 ± 12; P = 0.001; HRR 4th: 57 ± 11 vs 64 ± 12; P < 0.001; HRR 5th: 60 ± 16 vs 69 ± 15; P < 0.001). In addition, calculated mean values for SBPR1 and SBPR2 were >1 in patients with MS (1.01 ± 0.2 vs 0.91 ± 0.1 and 1.01 ± 0.1 vs 0.94 ± 0.1) and these were statistically significant compared with the control group (P < 0.001 and P = 0.002, respectively). The existence of MS was found to be the only parameter that was independently and positively related to SBPR values in the study population.Our findings suggest that only the existence of MS itself, not the presence of any MS components, is independently associated with SBPRs. We are of the opinion that significantly impaired SBPR values, in addition to the decreased HRR values observed in this group of patients, such as those with MS, may especially help identify patients with potentially increased cardiovascular risk despite normal exercise stress testing findings.     

U-vein compressor improves early haemodynamic outcomes in radiocephalic arterio-venous fistulae in under 2-mm superficial veins

The radiocephalic arterio-venous fistula (RCAVF) has remained the access point for maintenance haemodialysis because of its low incidence of complications and high long-term patency rate. Distal radial-cephalic anastomosis just above the wrist is still the best site for an arterio-venous fistula (AVF). This provides a relatively long, straight cephalic vein for catheter insertion. It also leaves more proximal sites for future use should the radialcephalic fistula fail.A ‘failure-to-mature’ AVF is caused by intrinsically poor native vessels. Poor native vessels relate to the use of a suboptimal artery or vein to create the AVF.1     

QT Dispersion Increases with Aging

Background: Age‐related changes in cardiovascular system are well‐known. Arrhythmias in elderly patients constitute most of the urgencies, consultations, or hospitalizations. QT dispersion (QTd) is a simple noninvasive arrhythmogenic marker to demonstrate the electrical instability of the heart. The aim of this study was to investigate how QTd changes with increasing age by calculating the QTd in the elderly and younger subjects. Methods: One hundred and forty‐six consecutive subjects (62 males and 84 females; age range: 18–82 years) were enrolled in the study. Sixty‐seven of the subjects were 65 years and over (mean age, 70 ± 4), 79 were younger than 65 (mean age, 37 ± 11). A 12‐lead ECG was recorded. The longest and the shortest QT intervals were measured manually on these ECG recordings. QTd was calculated from the formula, QTd = QTmax ? QTmin. Results: Demographic features were similar between the two groups. QTd of the elderly group was found to be significantly higher than the younger group (35.6 ± 15.6 in elderly, 24.2 ± 12.4 in younger group, P < 0.001). A positive relationship was found between QTd and age (r = 0.415, P < 0.001). QTd was greater in female than in male (31.9 ± 16.7 ms vs 26.0 ± 11.3 ms, respectively, P = 0.018). Conclusions: Our study shows that QTd increases with advancing age. We think that long‐term follow‐up of these patients would be useful to show if there is any relationship between the clinical outcomes and the increase in QTd.     

Lower bone mineral density in geriatric patients with monoclonal gammopathy of undetermined significance

The aim of this study was to investigate the prevalence of monoclonal gammopathy of undetermined significance (MGUS) in a geriatric population in Turkey and compare bone mineral densities and related laboratory parameters of MGUS patients with those who do not have MGUS. Among 1,012 patients enrolled, monoclonal band was detected in serum samples of 22 patients (2.17%), most of which were IgG type. Further tests revealed multiple myeloma and lung carcinoma in two patients. The remaining 20 patients were diagnosed with MGUS (1.97%). The clinical and laboratory parameters of patients with and without MGUS were mostly comparable; however, bone mineral density measurements of patients with MGUS were significantly lower than those without MGUS (p = 0.007). We suggest evaluation of geriatric patients with MGUS for the presence of osteopenia/osteoporosis considering the high frequency observed in this study.     

Vitamin D status of Turkish type 1 diabetic patients

IntroductionVitamin D was associated with the pathogenesis, treatment and prognosis of type 1 and type 2 diabetes mellitus. The aim of this study is to assess vitamin D status of Turkish adult type 1 DM patients and compare them with health controls and also to assess the relationship of vitamin D and glycemic control.MethodStudy was designed as cross-sectional and conducted in a tertiary Hospital diabetes unit. 296 type diabetic patients and 151 healthy controls was included to the study. Venous samples were collected into plain tubes after overnight fasting. Serum 25-hydroxyvitamin D level was measured by radioimmunoassay technique. Statistical analysis was performed with SPSS 15.0.Results25-Hydroxyvitamin D levels were similar between patients with type 1 diabetes (22, 9 ± 17, 4 ng/ml) and controls (24, 5 ± 19, 3 ng/ml) (p = 0,382). Most of the participants have 25-Hydroxyvitamin D deficiency. As shown in Table 2 serum 25-Hydroxyvitamin D level was not associated with most of the biochemical or anthropometric parameters.ConclusionAs a result there were no difference between type 1 diabetics and healthy controls according to their vitamin D levels. Further studies with a larger sample of patients will improve our understanding of the relation of vitamin D and diabetes.     

Clinical gap changes after porcelain firing cycles of zirconia fixed dentures

PURPOSE

The aim of this study was to measure the changes on the marginal and internal adaptation of zirconia based anterior fixed partial dentures after the porcelain firing process.

MATERIALS AND METHODS

A total of 34 anterior fixed partial dentures using LAVA CAD/CAM system (3M ESPE, Germany) were applied. Two silicone replicas were obtained: one is obtained before porcelain firing process (initial) and the other is obtained after porcelain firing process (final), followed by the examination under a binocular stereomicroscope. Kruskal Wallis and Wilcoxon Signed Ranks tests were used for the statistical analysis (P<.05).

RESULTS

No statistically significant difference was found between initial and final marginal gap values (P>.05). At the internal gap measurements, final marginal area values (59.54 µm) were significantly lower than the initial marginal area values (68.68 µm)(P<.05). The highest and the lowest internal gap values were observed at the incisal/occlusal area and at the marginal area, respectively. In addition, lower internal gap values were obtained for canines than for central incisors, lateral incisors and premolars at the incisal area (P<.05).

CONCLUSION

The firing cycles did not affect the marginal gap of Lava CAD/CAM system, but it is controversial for the internal gap.