Symptom phenotypes in pulmonary arterial hypertension: The PAH "symptome".

Women with pulmonary arterial hypertension (PAH) experience multiple symptoms, including dyspnea, fatigue, and sleep disturbance, that impair their health-related quality of life (HRQOL). However, we know little about phenotypic subgroups of patients with PAH with similar, concurrent, multiple symptoms. The objectives of this study were to define the "symptome" by symptom cluster phenotypes and compare characteristics such as biomarkers, cardiac structure and function (echocardiography), functional capacity (6-min walk distance), and HRQOL between the groups. This cross-sectional study included 60 women with PAH. Subjects completed an assessment battery: Pulmonary Arterial Hypertension Symptom Scale, Pittsburgh Sleep Quality Index, Multidimensional Dyspnea Profile, Patient-Reported Outcomes Measurement Information System (PROMIS®) Physical Function, PROMIS® Sleep-Related Impairment, and the emPHasis-10. Subjects also underwent transthoracic echocardiography, phlebotomy, 6-min walk distance, and actigraphy. The three symptoms of dyspnea, fatigue, and sleep disturbance were used to define the symptom clusters. Other PAH symptoms, plasma and serum biomarkers, cardiac structure and function (echocardiography), exercise capacity (6-min walk distance), sleep (actigraphy), and HRQOL were compared across phenotypes. The mean age was 50 ± 18 years, 51% were non-Hispanic white, 32% were non-Hispanic Black and 40% had idiopathic PAH. Cluster analysis identified Mild (n = 28, 47%), Moderate (n = 20, 33%), and Severe Symptom Cluster Phenotypes (n = 12, 20%). There were no differences for age, race, or PAH etiology between the phenotypes. WHO functional class (p < 0.001), norepinephrine levels (p = 0.029), right atrial pressure (p = 0.001), physical function (p < 0.001), sleep onset latency (p = 0.040), and HRQOL (p < 0.001) all differed significantly across phenotypes. We identified three distinctive symptom cluster phenotypes (Mild, Moderate, and Severe) for women with PAH that also differed by PAH-related symptoms, physical function, right atrial pressure, norepinephrine levels, and HRQOL. These phenotypes could suggest targeted interventions to improve symptoms and HRQOL in those most severely affected.

Slow-paced respiration therapy to treat symptoms in pulmonary arterial hypertension.

OBJECTIVE: To determine the feasibility of using slow-paced respiration therapy to treat symptoms in women with pulmonary arterial hypertension (PAH). BACKGROUND: People with PAH report increased dyspnea, fatigue and sleep disturbance that can impair health-related quality of life (HRQOL). METHODS: Ten women with PAH received 8-weeks of daily, 15 min sessions using slow-paced respiration therapy via the RESPeRATE™ device. Participants had baseline and follow up assessments including plasma norepinephrine and interleukin-6 (IL-6), self-report questionnaires to measure dyspnea, fatigue, depressive symptoms, sleep and HRQOL along with 7-day actigraphy and sleep diaries. RESULTS: The mean age was 50 years. Adherence to the intervention was 92%. There was decrease in median IL-6 levels [1.3 ± 0.5 to 1.1 ± 0.4, 95% CI (0.03-0.43)] over the study period. Sleep disturbance decreased, depressive symptoms decreased and HRQOL scores decreased (higher scores indicate worse HRQOL). CONCLUSIONS: In this pilot study, slow-paced respiration therapy is feasible in patients with PAH and may improve symptoms and lower IL-6.

Reassesment of the Fecundity of California Sheephead.

Fecundity estimates used in a 2004 stock assessment to evaluate the overall health of the population of California sheephead Semicossyphus pulcher were based primarily on two studies. The first estimated the total fecundity of only nine individuals captured near Santa Catalina Island, California, and the second estimated batch fecundity of individuals taken from only one artificial reef. In order to develop a current and more comprehensive estimate of fecundity, we collected California sheephead from seven locations off southern California throughout the spawning season (July through September). To estimate both total fecundity and batch fecundity, we categorized and counted oocytes from ovarian subsamples of 28 and 24 (respectively) mature females (stage 3, spawning capable; determined by histological analysis). Total and batch fecundity increased with somatic mass, standard length, and ovary mass. We found total fecundity to increase with somatic mass to a power of 5.5, which is considerably greater than the value (2.95) reported previously. Our observations therefore highlight the importance of large females in the reproductive potential of the California sheephead stock. Regression analysis indicates that ovary mass is the most accurate biological indicator of fecundity for California sheephead and should be used for subsequent stock analyses.

Use of Morphology and Endocrinology to Predict Sex in California Sheephead: Evidence of Altered Timing of Sex Change at Santa Catalina Island, California.

To estimate the health of the California sheephead Semicossyphus pulcher fishery, a 2004 stock assessment used available biological data that were collected decades prior to an increase in fishing pressure. However, a recent study has found that sex ratios, growth rates, survivorship, and average sizes of females and males have changed in response to size-selective fishing in some California sheephead populations. To better understand the potential changes in protogynous California sheephead, this study sought to determine (1) whether external morphology was still an accurate method of predicting sex in sexually dimorphic California sheephead at Santa Catalina Island, California, and (2) whether nonlethal blood sampling and plasma hormone analysis could be used to predict sex for future stock assessments. Sex was determined using gonadal histology and compared with several specific external morphological characters. Estradiol and 11-ketotestosterone plasma concentrations were also compared across sexed individuals. The rate of error when using external morphology alone to predict sex was 58%. In contrast, sex steroid concentrations varied significantly across sexes; estradiol concentrations were significantly greater in females than in transitioning and male individuals during the breeding season, and 11-ketotestosterone concentrations were significantly lower among females. Gonadal histology showed that 21% of the fish caught during the breeding season were classified as transitional, in stark contrast to historical data. The inability to accurately predict sex using external morphology alone suggests that commonly used methods of surveying California sheephead populations (e.g., diver surveys) may be inaccurate. Nonlethal blood sampling and subsequent plasma hormone analysis may offer an alternative method for assessing sex in California sheephead. Because California sheephead are not reproductively functional during transition and because we found such a large proportion in transition during the breeding season at Santa Catalina Island, we believe there is a need for continued assessment of the reproductive potential in this population of California sheephead.