Longitudinal analysis of the relation between moderate long‐term stress and health

The main goal of the present work was to longitudinally examine consequences of long‐term moderately elevated levels of stress for various health outcomes. To address this issue, data covering 10 years was used from the ongoing Swedish population‐based prospective Betula Study. Based on the ratings on a validated self‐reported stress scale, matched subsamples between 40 and 65 years of age were divided into a high (n = 137) and low (n = 211) stress group. The reported incidence of cardiovascular, diabetes, psychiatric, tumour and musculoskeletal diseases was assessed 5 and 10 years after baseline (baseline = 1993–1995) without contaminating effects of past health history. The incidence of diseases 5 years after baseline assessment showed no differences between the groups. After 10 years, there was a significantly higher incidence of psychiatric diseases, mainly depression in the high‐stress group as well as a significant effect for tumours, although the number of cases was low. Although moderately elevated stress level may have a possible impact on psychiatric diseases especially depression and some tumours, it seems that prolonged moderate stress does not appear to be harmful to other stress‐related diseases. Copyright © 2007 John Wiley & Sons, Ltd.     

Altered neuropeptide Y Y1 responses in mesenteric arteries in rats with congestive heart failure

The aim of the present study was to elucidate if the potentiating effect of neuropeptide Y on various vasoactive agents in vitro is (1) altered in mesenteric arteries from rats with congestive heart failure and (2) mediated by the neuropeptide Y Y₁ receptor. The direct vascular effects of neuropeptide Y and its modulating effects on the contractions induced by endothelin-1-, noradrenaline-, 5-hydroxytryptamine (5-HT)-, U46619-(9, 11-dideoxy-11, 9-epoxymethano-prostaglandin F₂) and ATP, and acetylcholine-induced dilatations were studied in the presence and absence of the neuropeptide Y Y₁ antagonist, BIBP3226 (BIBP3226{(R)-N2-(diphenylacetyl)-N-[(4-hydroxyphenyl)methyl]- -arginine-amide}). Neuropeptide Y, per se, had no vasoactive effect in the arteries. The potency of endothelin-1 was significantly decreased in congestive heart failure rats. Neuropeptide Y and neuropeptide Y-(13–36) potentiated the endothelin-1-induced contraction in congestive heart failure mesenteric arteries. In 20% of the congestive heart failure rats, sarafotoxin 6c induced a contraction of 31±4%. Neuropeptide Y also potentiated U46619- and noradrenaline-induced contractions but not 5-HT-induced contractions in congestive heart failure arteries. In sham-operated animals neuropeptide Y potentiated noradrenaline- and 5-HT-induced contractions. These potentiations were inhibited by BIBP3226. Acetylcholine induced an equipotent relaxation in both groups which was unaffected by neuropeptide Y. In conclusion, neuropeptide Y responses are altered in congestive heart failure rats. The potentiating effect differs between vasoactive substances. Neuropeptide Y Y₁ and non-neuropeptide Y₁ receptors are involved.     

Secondary hypercalcemic hyperparathyroidism

Summary A search was made for patients with associated secondary hyperparathyroidism and hypercalcemia: 22 such cases were found in the literature and 22 were recorded among 92 patients operated upon because of parathyroid disease. In the remaining 70 patients the effect of the operation on the serum calcium level was investigated: persisting hypercalcemia after the operation was found in 28 per cent of the cases.The patients reporded in the literature possessed severe renal and skeletary changes and light microscopic evidence of parathyroid adenoma (2 cases), hyperplasia (15 cases), or hyperplasia and adenoma (5 cases).The other 22 patients had histories of long-standing renal disease, most often chronic pyelonephritis, of varying severity. Skeletary roentgenograms were often normal. Morphologic examination of the parathyroids showed adenoma (6 cases) or hyperplasia (16 cases). Postoperatively, normal serum calcium level was found in 9 cases and persisting hypercalcemia in 13 (=59 per cent) cases. One patient possessed also a malignant -cell insuloma and Zollinger-Ellison's syndrome.It is suggested that secondary hyperparathyroidism may develop in patients with only slight or moderate impairment of renal function, that hypercalcemia occurs more often than previously believed in secondary hyperparathyroidism, and that some cases of secondary hyperparathyroidism previously, erroneously have been classified as primary hyperparathyroidism.Supported by grants from the Swedish Medical Research Council (Project No. B72-17X-3499-01), the Swedish Cancer Society (Project No. 552-B71-01P), and the Medical Faculty, University of Umeå.     

Renal and cardiovascular role of the neuropeptide Y Y1 receptor in ischaemic heart failure rats

The cardiovascular role of the neuropeptide Y Y1 receptors in-vivo and in-vitro in ischaemic heart failure was evaluated by using the novel neuropeptide Y Y1 selective antagonist BIBP 3226 (R-N2-(diphenylacetyl)-N-[(4-hydroxyphenyl)methyl]-D-arginine-amid e). In pithed rats, incremental doses of BIBP 3226 inhibited the exogenous neuropeptide Y induced pressor response in a dose-related fashion and a bolus injection of BIBP 3226 (0.5 mg kg(-1)) significantly shifted the pressor response curve of exogenous neuropeptide Y to the right. The potentiation effect to exogenous neuropeptide Y on the pressor response to preganglionic sympathetic nerve stimulation in ischaemic heart failure rats as well as on the contractile response to noradrenaline in renal arteries in sham-operated animals were also inhibited by the neuropeptide Y Y1 antagonist. In conscious ischaemic heart failure rats, incremental doses of BIBP 3226 (0.125-1 mg kg(-1)) significantly reduced basal blood pressure and heart rate. Compared with sham-operated rats, neuropeptide Y by itself induced no contraction and no potentiation on noradrenaline elicited contraction in renal artery of the ischaemic heart failure rat. Furthermore, under in-vivo conditions, BIBP 3226 did not influence basal renal function or the response to exogenous neuropeptide Y on urinary volume, urinary sodium and urinary potassium. Our results demonstrate that although there is a downregulation of the Y1 receptors by ischaemic heart failure, Y1 receptors are still mainly involved in cardiovascular actions of exogenous neuropeptide Y and play a role in maintaining basal blood pressure and heart rate in ischaemic heart failure. However, our data do not imply any significant role of Y1 receptors on basal renal function in the ischaemic heart failure rat model.     

Mild impairment of renal function (shrunken pore syndrome) is associated with increased risk for future surgery for aortic stenosis

Abstract

Recently, a new approach was proposed to detect mild impairment in renal function: a reduced ratio between estimated glomerular filtration rate (eGFR) calculated by cystatin C and eGFR calculated by creatinine. We aimed to evaluate if this ratio is associated with aortic stenosis (AS) requiring surgery. We identified 336 patients that first participated in population surveys and later underwent surgery for AS (median age [interquartile range] 59.8 [10.3] years at survey and 68.3 [12.7] at surgery, 48% females). For each patient, two matched referents were allocated. Cystatin C and creatinine were determined in stored plasma. eGFR_{cystatin C} and eGFR_creatinine and their ratio were estimated. Conditional logistic regression analyses were used to estimate the risk (odds ratio (OR) with [95% confidence interval (CI)]) related to one (ln) standard deviation increase in the ratio between eGFR_{cystatin C} and eGFR_creatinine. A high ratio was associated with lower risk for AS requiring surgery (OR [95% CI]) (OR 0.84 [0.73–0.97]), especially in women (0.74 [0.60–0.92] vs. 0.93 [0.76–1.13] in men). After further stratification for coronary artery disease (CAD), the association remained in women with CAD but not in women without CAD (0.60 [0.44–0.83] and 0.89 [0.65–1.23], respectively). In conclusion, a high ratio between eGFR_{cystatin C} and eGFR_creatinine was associated with lower risk for surgery for AS, especially in women. Mild impairment of renal function is thus associated with future risk for AS requiring surgery.     

Seroconversion to hepatitis C virus antibodies in patients with acute posttransfusion non-A,non-B hepatitis in Sweden

Summary Seventy-four patients in 1978 and 316 in 1986, all transfused during open-heart surgery in Stockholm, Sweden, were studied prospectively for the development of posttransfusion non-A, non-B (NANB) hepatitis, seroconversion to hepatitis C virus antibodies (anti-HCV) (C-100), time lag to seroconversion to anti-HCV and outcome of posttransfusion NANB/C hepatitis. Anti-HCV was tested up to six months after transfusions in patients from 1978 and up to one year after transfusions in patients from 1986. Fifty-four percent of the patients who developed posttransfusion NANB hepatitis seroconverted to anti-HCV, 7/15 (47%) in 1978 and 8/13 (62%) in 1986. Four (27%) of the 15 patients who seroconverted to anti-HCV were anti-HCV reactive within one week, 12 (80%) within eight weeks and all within 18 weeks after the onset of hepatitis. The ELISA optical density/cut-off (OD/CO) ratio was above 4.0 in all patients with hepatitis C who seroconverted. One transfused patient with normal serum aminotransferase levels throughout follow-up seroconverted after six months. He had a temporary positive anti-HCV reactivity with a maximal ELISA OD/CO ratio for anti-HCV of only 1.2, which became negative three years later. Development of chronic hepatitis was noticed in 9/15 (60%) patients who seroconverted to anti-HCV and in 5/13 (38%) patients with posttransfusion NANB hepatitis who did not seroconvert.

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Anti-HBC-Serokonversion bei Patienten mit akuter Non-A, Non-B-Hepatitis nach Transfusion in Schweden

Zusammenfassung 74 Patienten, die 1978, und 316 Patienten, die 1986 während offener Herzchirurgie in Stockholm, Schweden, Transfusionen erhielten, wurden in eine prospektive Studie aufgenommen und im Hinblick auf das Auftreten einer Non-A, Non-B-Posttransfusions-hepatitis, Serokonversion für Hepatitis C Virus-Antikörper (anti-HCV, C-100), Zeitspanne bis zur Serokonversion für anti-HCV und Verlauf der NANB/C-Posttransfusionshepatitis untersucht. Bei Patienten, die 1978 transfundiert worden waren, wurden Untersuchungen auf anti-HCV bis zu sechs Monate nach der Transfusion und bei 1986 Transfundierten bis zu einem Jahr nach Transfusion durchgeführt. Eine Serokonversion zu anti-HCV trat bei 54% der Patienten mit NANB-Posttransfusions-hepatitis ein, 7/15 (47%) der Patienten aus dem Jahr 1978 und 8/13 (62%) aus dem Jahr 1986. Die Serokonversion zu anti-HCV trat bei vier der 15 Patienten (27%) schon innerhalb einer Woche ein, bei 12 (80%) innerhalb acht Wochen und bei allen innerhalb 18 Wochen nach Beginn der Hepatitis. Bei den Patienten mit Hepatitis C, die eine Serokonversion entwickelten, lag der Quotient von ELISA Meßwert zu Grenzwert (Optical density/ Cut-off, OD/CO) in allen Fällen über 4,0. Ein Patient, bei dem nach der Transfusion stets normale Serum- Aminotransferase-Spiegel vorlagen, zeigte nach sechs Monaten eine Serokonversion. Er war vorübergehend anti-HCV positiv, der ELISA OD/CO- Quotient für anti-HCV betrug maximal 1,2; nach drei Jahren war er seronegativ. Bei neun der 15 Patienten (60%) war eine chronische Hepatitis nach Serokonversion für anti-HCV zu beobachten. Unter den 13 Patienten mit NANB-Posttransfusionshepatitis, die keine Serokonversion zeigten, entwickelten fünf eine chronische Hepatitis (38%).

     

Differences in medical treatment and clinical characteristics between men and women with heart failure – a single-centre multivariable analysis

European Journal of Clinical Pharmacology - The aims of this study were to examine sex differences in a heart failure population with regards to treatment and patient characteristics and to...