Cardiac rehabilitation in chronic heart failure: effect of an 8-week, high-intensity interval training versus continuous training

Freyssin C, Verkindt C, Prieur F, Benaich P, Maunier S, Blanc P. Cardiac rehabilitation in chronic heart failure: effect of an 8-week, high-intensity interval training versus continuous training.ObjectiveTo compare the effects of an 8-week, high-intensity interval training protocol versus continuous training.DesignRandomized controlled trial.SettingCardiac rehabilitation center.ParticipantsPatients (N=26; mean age ± SD, 54±12y) with chronic heart failure were enrolled in a cardiac rehabilitation program for 8 weeks.InterventionsPatients were randomly assigned into 2 groups that performed either interval training (IT) or continuous training (CT). IT consisted of 3 sessions of 12 repetitions of 30 seconds of exercise at very high intensity, followed by 60 seconds of complete rest. The CT group performed CT exercises, which consisted of 45 minutes of aerobic exercise.Main Outcome MeasuresParameters of gas exchanges: peak oxygen consumption (Vo₂peak), first ventilator threshold (VT1), distance at six-minute walk test (6MWT), and level of anxiety and depression were measured.ResultsThe IT group increased significantly their Vo₂peak, the duration of the exercise test, the oxygen pulse, oxygen consumption at the VT1, and the distance walked during the 6MWT. The CT group only increased the time at the VT1 and the distance performed at the 6MWT. The improvement in the time at the VT1 was significantly higher for the IT group than for the CT group.ConclusionsThis study shows that IT at very high intensity for patients with heart failure appears to be more effective than CT in improving indices of submaximal exercise capacity.     

Mutation of the Cyba gene encoding p22phox causes vestibular and immune defects in mice

In humans, hereditary inactivation of either p22(phox) or gp91(phox) leads to chronic granulomatous disease (CGD), a severe immune disorder characterized by the inability of phagocytes to produce bacteria-destroying ROS. Heterodimers of p22(phox) and gp91(phox) proteins constitute the superoxide-producing cytochrome core of the phagocyte NADPH oxidase. In this study, we identified the nmf333 mouse strain as what we believe to be the first animal model of p22(phox) deficiency. Characterization of nmf333 mice revealed that deletion of p22(phox) inactivated not only the phagocyte NADPH oxidase, but also a second cytochrome in the inner ear epithelium. As a consequence, mice of the nmf333 strain exhibit a compound phenotype consisting of both a CGD-like immune defect and a balance disorder caused by the aberrant development of gravity-sensing organs. Thus, in addition to identifying a model of p22(phox)-dependent immune deficiency, our study indicates that a clinically identifiable patient population with an otherwise cryptic loss of gravity-sensor function may exist. Thus, p22(phox) represents a shared and essential component of at least 2 superoxide-producing cytochromes with entirely different biological functions. The site of p22(phox) expression in the inner ear leads us to propose what we believe to be a novel mechanism for the control of vestibular organogenesis.     

Chronic diarrhea,hemorrhagic colitis,and hemolytic-uremic syndrome associated with HEp-2 adherent Escherichia coli in adults infected with human immunodeficiency virus in Bangui,Central African Republic

In human immunodeficiency virus (HIV)-infected adults from the Central African Republic, the occurrence of chronic diarrhea due to HEp-2 adherent Escherichia coli (EAEC) harboring virulence markers (eaeA, BFP, EAF, astA determinant of EAST/1, positive FAS test, enteropathogenic E. coli O serogroup) was shown to be associated with AIDS. We also show that EAEC that produce verotoxin (Stx2) but do not harbor the genetic markers for classical enterohemorrhagic E. coli are involved in hemorrhagic colitis and hemolytic-uremic syndrome in patients with HIV.     

Microbiological Challenges in the Diagnosis of Chronic Q Fever

Diagnosis of chronic Q fever is difficult. PCR and culture lack sensitivity; hence, diagnosis relies mainly on serologic tests using an immunofluorescence assay (IFA). Optimal phase I IgG cutoff titers are debated but are estimated to be between 1:800 and 1:1,600. In patients with proven, probable, or possible chronic Q fever, we studied phase I IgG antibody titers at the time of positive blood PCR, at diagnosis, and at peak levels during chronic Q fever. We evaluated 200 patients, of whom 93 (46.5%) had proven, 51 (25.5%) had probable, and 56 (28.0%) had possible chronic Q fever. Sixty-five percent of proven cases had positive Coxiella burnetii PCR results for blood, which was associated with high phase I IgG. Median phase I IgG titers at diagnosis and peak titers in patients with proven chronic Q fever were significantly higher than those for patients with probable and possible chronic Q fever. The positive predictive values for proven chronic Q fever, compared to possible chronic Q fever, at titers 1:1,024, 1:2,048, 1:4,096, and ≥1:8,192 were 62.2%, 66.7%, 76.5%, and ≥86.2%, respectively. However, sensitivity dropped to <60% when cutoff titers of ≥1:8,192 were used. Although our study demonstrated a strong association between high phase I IgG titers and proven chronic Q fever, increasing the current diagnostic phase I IgG cutoff to >1:1,024 is not recommended due to increased false-negative findings (sensitivity < 60%) and the high morbidity and mortality of untreated chronic Q fever. Our study emphasizes that serologic results are not diagnostic on their own but should always be interpreted in combination with clinical parameters.     

Age-related changes in cardiac autonomic control during sleep

Aging is commonly associated with decreased sleep quality and increased periodic breathing (PB) that can influence heart rate variability (HRV). Cardiac autonomic control, as inferred from HRV analysis, was determined, taking into account the sleep quality and breathing patterns. Two groups of 12 young (21.1 +/- 0.8 years) and 12 older (64.9 +/- 1.9 years) volunteers underwent electroencephalographic, cardiac, and respiratory recordings during one experimental night. Time and frequency domain indices of HRV were calculated in 5-min segments, together with electroencephalographic and respiratory power spectra. In the elderly, large R-R oscillations in the very-low frequency (VLF) range emerged, that reflected the frequency of PB observed in 18% of the sleep time. PB occurred more frequently during rapid eye movement sleep (REM) sleep and caused a significant (P < 0.02) increase in the standard deviation of normal R-R intervals (SDNN) and absolute low-frequency (LF) power. With normal respiratory patterns, SDNN, absolute VLF, LF, and high frequency (HF) power fell during each sleep stage (P < 0.01) compared with young subjects, with no significant sleep-stage dependent variations. An overall decrease (P < 0.01) in normalized HF/(LF + HF) was observed in the elderly, suggesting a predominant loss of parasympathetic activity which may be related to decreased slow-wave sleep duration. These results indicate that two distinct breathing features, implying different levels of autonomic drive to the heart, influence HRV in the elderly during sleep. The breathing pattern must be considered to correctly interpret HRV in the elderly.     

Persistence of colonization of intestinal mucosa by a probiotic strain,Lactobacillus casei subsp. rhamnosus Lcr35, after oral consumption

The colonization by the probiotic Lactobacillus casei subsp. rhamnosus Lcr35 of the gastrointestinal tracts of mice and humans was studied. The mice were orally given 10(9) CFU of Lcr35 either once or three times at 24-h intervals. A 16S ribosomal nucleic probe used in hybridization assays detected Lcr35 in the feces of mice for up to 3 days after the feeding, at a level of 10(8) to 10(9) CFU/g of feces. In the human assay, 12 healthy volunteers were enrolled in a randomized trial and ingested Lcr35 at a dosage of 10(8) or 10(10) or 10(12) CFU every day for 7 days. Then, after a 3-week posttreatment period, there was a second intake period similar to the first one. Analysis of fecal samples showed significant increases in the number of lactobacilli during the first intake period, whatever the dose given. The greatest increases were observed in subjects harboring the lowest indigenous population of Lcr35-like bacteria. During the 3-week posttreatment period, the number of CFU slightly decreased over time, and an increase, although not a statistically significant one, was observed during the second test period. These findings suggest that Lcr35 is able to survive within the gastrointestinal tract.     

Anti-HBs Cellular Immune Response in Kidney Recipients before and 4 Months after Transplantation

Patients with renal failure represent a population at risk for hepatitis B, since only 50 to 60% of them develop protective humoral responses after vaccination. As this could be due to an altered regulation of cellular immune responses, the objectives of the present study were to evaluate the proliferative abilities of lymphocytes from patients with chronic renal failure after stimulation in vitro with a mitogen (pokeweed mitogen [PWM]) or HBsAg. In order to differentiate between the immunodeficiency associated with renal failure and that due to immunosuppression posttransplantation, the same subjects were tested before and 4 months after kidney transplantation. The lymphoproliferation assay used was performed by flow cytometry, which is based on sequential analysis of the cell cycle and which allows analysis of cytokine production. Serologically, the group of 36 patients tested comprised 22% nonresponders, 30% poor responders, and 48% responders. Lymphocyte growth was observed for all patients after stimulation with PWM, indicating that these cells had the capacity to proliferate in vitro. The level of lymphoproliferation in response to PWM was significantly reduced after transplantation, yet both before and after transplantation, all serologic nonresponders developed cellular responses to at least two vaccines. No correlation between humoral and cellular responses was shown. Proliferating cells were lymphocytes, which mostly secreted interleukin 4 (IL-4) and IL-10 for the three serologic groups. This study suggests that even when repeated vaccination fails to induce significant antibody levels in patients with renal failure, specific HBs cellular responses develop, and these may prove to be efficient in protecting these patients against hepatitis B.     

Whole body immersion and hydromineral homeostasis: effect of water temperature

This experiment was designed to assess the effects of prolonged whole body immersion (WBI) in thermoneutral and cold conditions on plasma volume and hydromineral homeostasis.10 navy “combat swimmers” performed three static 6-h immersions at 34°C (T34), 18°C (T18) and 10°C (T10). Rectal temperature, plasma volume (PV) changes, plasma proteins, plasma and urine ions, plasma osmolality, renin, aldosterone and antidiuretic hormone (ADH) were measured. Results show that compared to pre-immersion levels, PV decreased throughout WBI sessions, the changes being markedly accentuated in cold conditions. At the end of WBI, maximal PV variations were ?6.9% at T34, ?14.3% at T18, and ?16.3% at T10. Plasma osmolality did not change during and after T34 immersion, while hyperosmolality was present at the end of T18 immersion and began after only 1 h of T10 immersion. In the three temperature conditions, significant losses of water (1.6–1.7 l) and salt (6–8 g) occurred and were associated with similar increases in osmolar and free water clearances. Furthermore, T18 and T10 immersions increased the glomerular filtration rate. There was little or no change in plasma renin and ADH, while the plasma level of aldosterone decreased equally in the three temperature conditions. In conclusion, our data indicate that cold water hastened PV changes induced by immersion, and increased the glomerular filtration rate, causing larger accumulated water losses. The iso-osmotic hypovolemia may impede the resumption of baseline fluid balance. Results are very similar to those repeatedly described by various authors during head-out water immersion.     

Anxiety trait modulates psychophysiological reactions, but not habituation processes related to affective auditory stimuli.

BACKGROUND: It is well known that there are specific peripheral activation patterns associated with the emotional valence of sounds. However, it is unclear how these effects adapt over time. The personality traits influencing these processes are also not clear. Anxiety disorders influence the autonomic activation related to emotional processing. However, personality anxiety traits have never been studied in the context of affective auditory stimuli. METHODS: Heart rate, skin conductance, zygomatic muscle activity and subjective rating of emotional valence and arousal were recorded in healthy subjects during the presentation of pleasant, unpleasant, and neutral sounds. Recordings were repeated 1 week later to examine possible time-dependent changes related to habituation and sensitization processes. RESULTS AND CONCLUSION: There was not a generalized habituation or sensitization process related to the repeated presentation of affective sounds, but rather, specific adaptation processes for each physiological measure. These observations are consistent with previous studies performed with affective pictures and simple tones. Thus, the measures of skin conductance activity showed the strongest changes over time, including habituation during the first presentation session and sensitization at the end of the second presentation session, whereas the facial electromyographic activity habituated only for the neutral stimuli and the heart rate did not habituate at all. Finally, we showed that the measure of personality trait anxiety influenced the orienting reaction to affective sounds, but not the adaptation processes related to the repeated presentation of these sounds.