Principal Dimensions of the Framingham Type A Scale: Differential Relationships to Cardiovascular Reactivity and Anxiety

Abstract

The present investigation sought to identify the principal dimensions of the Framingham Type A scale (FTAS) and then to examine their physiological and psychological correlates. A factor analysis of the FTAS items, which was cross-validated, revealed two factors. Items concerning achievement and competitive-striving loaded primarily on the first factor. Scores on a subscale composed of these items (labeled Competitive Drive) were related to systolic blood pressure reactivity during an interpersonal task but were unrelated to anxiety. FTAS items concerning impatient, time urgent, and domineering propensities loaded primarily on the second factor. Scores on a subscale composed of these items (labeled Speed and Impatience) were not related to cardiovascular reactivity during the task but were related to anxiety. Results are discussed in terms of the psychological heterogeneity of the Type A behavior pattern and possible differences between dimensions of the overall Type A pattern and their association with different manifestations of coronary heart disease.     

Associations between insulin-like growth factor I,vascular endothelial growth factor and its soluble receptor 1 in umbilical serum and endothelial cells obtained from normotensive and preeclamptic pregnancies

Abstract

The aim of this study was to investigate the associations between insulin-like growth factor I (IGF-I) with vascular endothelial growth factor (VEGF) and its soluble receptor 1 (sFlt-1) in umbilical serum and to study the effects of IGF-I upon sFlt-1 synthesis in human umbilical vein endothelial cells (HUVEC) in normotensive (NT) and preeclamptic (PE) pregnancies. As compared with the NT group, umbilical serum IGF-I and VEGF levels were lower in the PE group, while sFlt-1 concentrations were higher. Levels of sFlt-1 correlated with IGF-I in the NT group and with VEGF in the PE group. Basal concentration of sFlt-1 in HUVEC culture media was higher in the PE group. IGF-I stimulated sFlt-1 synthesis only in the NT group. In summary, umbilical serum sFlt-1 is associated with IGF-I in normotensive pregnancy and with VEGF in preeclampsia. IGF-I stimulates sFlt-1 synthesis in endothelial cells in normotensive but not in PE pregnancies.     

Collagen I gel promotes homogenous osteogenic differentiation of adipose tissue-derived mesenchymal stem cells in serum-derived albumin scaffold

Repair of bone defects is a difficult clinical problem for reconstructive surgeons. Bone tissue engineering using an appropriate scaffold with cells is a new therapy for the repair of bone defects. The aim of this study was to evaluate the in vitro osteogenesis of canine adipose tissue-derived mesenchymal stem cells (Ad-MSCs) cultured in a combination of collagen I gel and a porous serum-derived albumin scaffold. A serum-derived albumin scaffold was prepared with canine serum by cross-linking and freeze-drying procedures. Ad-MSCs were seeded into serum-derived albumin scaffolds with or without collagen I gel, and were exposed to osteogenic differentiation conditions in vitro. After 28?days of in vitro culture, the distribution and osteogenic differentiation of Ad-MSCs cultured in the scaffold were evaluated by scanning electron microscopy, histology, immunohistochemistry, alkaline phosphatase (ALP) activity assay, and calcium colorimetric assay. Ad-MSCs showed more homogeneous distribution and osteogenic differentiation in the scaffold with collagen I gel than without collagen I gel. ALP activity and extracellular matrix mineralization in the construct with type I collagen were significantly higher than in the construct without type I collagen (p?<?0.05). In conclusion, the combination of collagen I gel and the serum-derived albumin scaffold enhanced osteogenic differentiation and homogenous distribution of Ad-MSCs.     

Prevención de ictus en pacientes con diabetes mellitus tipo 2 o prediabetes. Recomendaciones del Grupo de Estudio de Enfermedades Cerebrovasculares de la Sociedad Española de Neurología

ObjectiveTo update the Spanish Society of Neurology's guidelines for stroke prevention in patients with type 2 diabetes or prediabetes, analysing the available evidence on the effect of metabolic control and the potential benefit of antidiabetic drugs with known vascular benefits in addition to conventional antidiabetic treatments in stroke prevention.DevelopmentPICO-type questions (Patient, Intervention, Comparison, Outcome) were developed to identify practical issues in the management of stroke patients and to establish specific recommendations for each of them. Subsequently, we conducted systematic reviews of the PubMed database and selected those randomised clinical trials evaluating stroke as an independent variable (primary or secondary). Finally, for each of the PICO questions we developed a meta-analysis to support the final recommendations.ConclusionsWhile there is no evidence that metabolic control reduces the risk of stroke, some families of antidiabetic drugs with vascular benefits have been shown to reduce these effects when added to conventional treatments, both in the field of primary prevention in patients presenting type 2 diabetes and high vascular risk or established atherosclerosis (GLP-1 agonists) and in secondary stroke prevention in patients with type 2 diabetes or prediabetes (pioglitazone).     

Extending Physician ReACH: Influencing patient activation and behavior through multichannel physician communication

Objective

Despite evidence-based recommendations, physical activity as a self-management technique is underutilized. Many physical activity interventions require significant resources, ranging from repeated phone follow-up with nursing staff to intensive sessions with cooperating physical therapists. This intervention, Extending Physician ReACH (Relationship And Communication in Healthcare), examined physician to patient communication tactics for promoting walking exercise to patients with type 2 diabetes, using limited clinic time and financial resources.

Methods

This was a single-site, six-month prospective intervention, which implemented theoretically driven, evidenced-based information factor strategies. Of the 128 volunteers who participated in the initial clinic visit, 67 patients with type 2 diabetes completed the six-month intervention.

Results

Significant intervention effects were detected risk perception, social norms, and patient activation.

Conclusions

This study was designed to identify information factors that could affect physician success in motivating patients with type 2 diabetes to enact the ADA physical activity recommendations.

Practice implications

The success of this intervention models a strategy through which clinicians can reach beyond “one-shot” persuasion without placing onerous time and resource demands on physicians.     

Harnessing the Immunomodulatory Properties of Sertoli Cells to Enable Xenotransplantation in Type I Diabetes

Islet transplantation has emerged as a viable long‐term means of treating type I diabetes. This is largely due to the success of the “Edmonton protocol” which has produced insulin independence in 85% of patients 1 year after transplantation of allogeneic islets together with a non‐steroid immunosuppressive regimen. While these data provide a clear and unequivocal demonstration that islet transplantation is a viable treatment strategy, the shortage of suitable donor tissue together with the debilitating consequences of life‐long immunosuppression necessitate the development of novel means to enable transplantation of all type 1 diabetics including the young juvenile diabetics. One potential means of enabling islet transplantation takes advantage of the ability of Sertoli cells to provide local immunoprotection to co‐grafted islets, including those from xenogeneic sources. Sertoli cells are normally found in the testes where one of their functions is to provide local immunologic protection to developing germ cells. In animal models, allogeneic and xenogeneic islets survive and function for extended periods of time when grafted into the testes. Moreover, isolated Sertoli cells protect co‐grafted allogeneic and xenogeneic islets from immune destruction and reverse diabetes in immunocompetent and autoimmune animals. These benefits are discussed in the context of several potential underlying biological mechanisms.     

The impact of obstructive sleep apnoea severity on cardiac structure and injury

BackgroundObstructive sleep apnoea (OSA) is an important factor in the development and progression of heart failure (HF). The prevalence of OSA is higher in patients with HF than in the general population. We sought to test the hypothesis that OSA severity was predictive of ventricular function and cardiac injury [as assessed by high-sensitivity cardiac troponin I(hs-cTnI)].MethodsA total of 60 patients were recruited after evaluation for sleep disturbances using the Jenkins Sleep Questionnaire (JSQ) and Epworth Sleepiness Scale (ESS). Subsequently, they underwent polysomnography thus confirming the diagnosis of OSA and were equally divided into three groups according to OSA severity grade. Following polysomnography, the next morning patients underwent venous blood sampling and echocardiography.ResultsWe observed a statistically significant association (P = 0.009) between diastolic dysfunction grades and severity grades of OSA. All the three diastolic dysfunction variables E/A ratio, deceleration time and E/e’ ratio had a significant association(P < 0.05) with severity grades of OSA. There was a marginally significant positive correlation (ρ = 0.3244, p = 0.04) between AHI events per hour and mitral E/e’ ratio. There was a statistically significant association(P < 0.001) between hs-cTnI value among different severity grades of OSA.ConclusionsHere in our study, we found OSA a potential risk factor for development of myocardial injury and diastolic dysfunction. Severe grades of OSA are associated with higher grades of diastolic dysfunction and circulating levels of hs-cTnI. These data are consistent with the notion of a vicious cycle of frequent apnoea's or hypoxemia and recurrent myocardial injury, which could increase the risk of heart failure especially diastolic dysfunction in OSA.     

胰岛素样生长因子I通过改善线粒体功能保护新生大鼠心肌细胞免于凋亡

 目的：探讨线粒体机制在胰岛素样生长因I(IGF-I)保护心肌细胞中的作用。方法：体外培养新生大鼠心肌细胞,过氧化氢处理诱导凋亡,JC-1线粒体膜电位检测法和透射电镜观察心肌细胞线粒体膜电位和形态的改变,Annexin V-FITC/PI双染色法、caspase-3活性测定、DNA-ladder分析和Hoechst 33258染色方法观察心肌细胞凋亡的情况。结果：过氧化氢可诱导心肌细胞凋亡,siRNA下调Kruppel 样因子9（KLF9）48 h后,心肌细胞线粒体膜电位下降率明显降低,由对照组的(24.0±1.6)%,降为IGF-I处理组的(18.3±1.2)%和KLF9下调组的(15.2±1.2)%;线粒体形态明显改善;DNA片段化改善;caspase-3活性降低,与对照组相比IGF-I处理组降低(1.30±0.28)倍,KLF9下调组降低(1.31±0.43)倍;Annexin V-FITC/PI双染法显示细胞凋亡率对照组为（42.5±1.8）%,IGF-I处理组为（22.4±4.2）%,KLF9下调组为（32.5±3.5）%;Hoechst 33258染色结果显示凋亡小体减少,KLF9下调组与IGF-I的抗心肌细胞凋亡效果相似。结论：IGF-I通过下调KLF9表达改善线粒体功能,保护心肌细胞免于凋亡。     

Caveolae在高糖诱导的大鼠肾小球系膜细胞细胞外基质合成中的作用

 目的：探讨胞膜小凹(caveolae)在高糖(HG)诱导大鼠肾小球系膜细胞(MCs)细胞外基质(extracellular matrix,ECM)表达过程中的作用。方法：传代培养的大鼠MCs同步化后分为：(1)正常糖组;(2)HG组;(3)HG+甲基-β-环糊精(β-MCD)组;(4)HG+β-MCD+胆固醇组。用Western blotting检测小凹蛋白1(Cav-1)、磷酸化小凹蛋白1(p-Cav-1-Y14)和Ⅰ型胶原(ColⅠ)蛋白的表达水平,用实时定量PCR检测细胞中Cav-1 mRNA表达变化,用ELISA方法检测上清中纤维连接蛋白(FN)的蛋白含量。结果： (1)高糖状态下, 系膜细胞 FN和ColⅠ 蛋白表达水平均显著增加(均P<0.05)。(2)高糖培养显著增加p-Cav-1-Y14水平(P<0.01),而对Cav-1 mRNA及蛋白表达无明显影响(P>0.05)。(3)β-MCD预处理抑制了高糖诱导的 p-Cav-1-Y14升高(P<0.01)及FN表达(P<0.05),但对高糖诱导的Col I表达无影响;β-MCD的作用可被胆固醇抑制。结论：高糖可显著增加系膜细胞1型胶原及纤维连接蛋白的合成。高糖诱导的纤维连接蛋白合成与Cav-1磷酸化水平增加有关。