Effects of combined physical exercise on plasma lipid variables, paraoxonase 1 activity, and inflammation parameters in adults with obesity: a randomized clinical trial.

OBJECTIVE: We aimed to investigate whether combined physical exercise may affect plasma lipid variables, paraoxonase 1 (PON1) activity, and inflammation parameters in adults with obesity. METHODS: Thirty-six participants were recruited to complete the study protocol. The mean age was 37 ± 1 years, and the baseline body mass index was 33.0 ± 0.4 kg/m2. Participants were allocated to the control group (CG) and the exercise group (EG). The EG performed three weekly sessions of combined physical exercise for 16 weeks. Plasma lipid variables, PON1 activity, and inflammatory profile were determined before and after intervention. RESULTS: Total cholesterol levels decreased in both groups, without intergroup difference (time p = 0.001). Non-high-density lipoprotein cholesterol (HDL-C) levels decreased in both groups (time p = 0.001); however, they were lower in the EG than in the CG (p = 0.038). The EG had increased HDL-C levels, but the CG had decreased HDL-C levels (time*group p = 0.011). PON1 activity was reduced in both groups (time, p = 0.001). The Castelli risk Index I and II reduced in the EG and increased in the CG (time*group, p = 0.008 and p = 0.011, respectively). The inflammatory markers were not modified. CONCLUSION: Adults with obesity may benefit from regular practice of combined physical exercise training in many metabolic aspects that are related to protection against the development of cardiovascular disease.

Barriers associated with frequency of leisure-time physical activity among Brazilian adults of different income strata.

This study aimed to estimate the prevalence of the main perceived barriers to leisure-time physical activity (LTPA) and their associations with the frequency of LTPA in a representative sample of industrial workers from Brazil (n = 47,477), according to their income strata (low income: ≤$US280, middle income: $US281-$US1400, and high income: ≥$US1401). Data were collected between 2006 and 2008 via questionnaires about the main perceived barrier to LTPA and the frequency of LTPA. Multinomial logistic regression was performed to evaluate differences among groups. There was a lower prevalence of regular practice of LTPA in the low- (15.8%) and middle-income strata (18.2%) than among the individuals of the high-income stratum (27.6%). A large proportion of workers who regularly participated in LTPA reported no barriers (low: 43.1%; middle: 46.8%; high: 51.6%). Additional obligations and fatigue were the two most common perceived barriers in all family income strata among participants who engaged in different frequencies of LTPA. The odds for all perceived barriers showed a positive trend related to frequency of LTPA (from regular to no LTPA), with higher values according to income. In summary, the ordering of the main perceived barriers to LTPA differed according to workers' income stratum and frequency of engaging in LTPA.

Active commuting reduces sociodemographic differences in adherence to recommendations derived from leisure-time physical activity among Brazilian adults.

OBJECTIVE: To investigate the consequences of including active commuting, compared with the leisure domain only, in the prevalence and sociodemographic factors associated with attending the physical activity recommendations, in Brazilian adults. STUDY DESIGN: Population-based cross-sectional study. METHOD: Adults between 20 and 59 years of age (n = 1720) were face-to-face interviewed from September 2009 to January 2010. Sociodemographic indicators and leisure-time and commuting physical activity were assessed by a validated questionnaire. Poisson regression was used to estimate crude and adjusted prevalence ratio (PR) and 95% confidence interval (95% CI). RESULTS: The prevalence of adherence to recommendations when only leisure-time physical activity was considered was 15.5% (95% CI: 13.6; 17.4) and was associated with men (PR: 1.57, 95% CI: 1.25; 1.96), adults without a partner (PR: 1.38 95% CI: 1.05; 1.81) and higher educational level and income. The prevalence of adherence to physical activity recommendations after the combination of leisure-time and commuting was 29.1% (95% CI: 26.5; 31.6). Percentages differences in favor of men, white adults and those with higher educational level and income were no longer significant after the inclusion of active commuting. CONCLUSION: The inclusion of active commuting expands the percentage of adults who achieved the health-related physical activity recommendations and reduced important sociodemographic differences derived from the analysis of leisure-time physical activity alone. Public health strategies should consider the different domains of physical activity in the monitoring and promotion of a more active lifestyle.

Clustering of physical inactivity in leisure, work, commuting and household domains among Brazilian adults.

OBJECTIVES: To identify the clustering of physical inactivity in leisure, work, commuting and household contexts, and the sociodemographic factors associated with the clustering of inactive behaviour in different domains among Brazilian adults. STUDY DESIGN: Cross-sectional population-based study. METHODS: The study was performed in Florianopolis, capital of Santa Catarina, one of the southern states of Brazil, from September 2009 to January 2010. Adults aged 20-59 years were interviewed. Physical inactivity in each domain was defined as non-participation in specific physical activities, using a validated Brazilian questionnaire. Clustering of physical inactivity was identified by the ratio between observed prevalence and expected prevalence of 16 different combinations. Multinomial logistic regression was used in the analysis of sociodemographic factors associated with clustering of physical inactivity. RESULTS: Of the 1720 interviewees, the greatest differences between the observed and expected proportions were observed in simultaneous physical inactivity in the leisure and household domains for men, and physical inactivity in the leisure domain alone for women (59% and 88%, respectively); these differences were higher than expected if the behaviours were independent. Physical inactivity in two or more domains was observed more frequently in men and in individuals with a higher per-capita family income. Ageing was associated with physical inactivity in three or four domains. CONCLUSIONS: Physical inactivity was observed in different domains according to gender. Men and older individuals with a higher per-capita family income were more likely to exhibit physical inactivity when all domains were considered together.

Mass spectrometry analysis of IgA1 hinge region in patients with IgA nephropathy.

BACKGROUND: Physicochemical alterations of the IgA molecule are supposed to play a pathogenetic role in IgA nephropathy (IgAN). The present study was carried out to analyze the structural variety of O-glycans on the IgA1 hinge region in IgAN. Sera from 9 IgAN patients and 9 healthy controls were individually examined to evaluate the IgA1 content and binding lectins (jacalin and Helix aspersa), using enzyme-linked immunosorbent assay (ELISA) techniques. The IgA1 from pooled sera were separated by affinity chromatography (jacalin), and the fragment containing the hinge region was prepared by pyridylethylation and trypsin treatment. The IgA fragments containing the hinge glycopeptide (33-mer hinge peptide core (HP) + O-glycans) were separated by jacalin affinity chromatography. Because we used jacalin, we only analyzed the Gal-3GalNAc residue containing IgA. The molecular weight (MW) of the IgA1 fragments was estimated using an ion trap mass spectrometer equipped with an electrospray ion source (ESI/MS). RESULTS: IgA1 concentration in pathological sera was higher than in the control serum (p<0.01). Compared with controls, serum IgA1 from IgAN patients showed significantly greater binding to the 2 lectins, jacalin (p<0.01) and Helix aspersa (HA, p<0.001), which are specific for O-linked Gal-beta1,3-GalNAc and GalNAc, respectively. Analyses of pooled sera showed that the number of O-glycosidic chains was comparable in IgAN and normal sera. With regards to the individual residues, we found that IgAN sera contained less sugar and galactose and sialic acid moieties than sera from control subjects, was reduced in IgAN sera, while terminal N-acetylgalactosamine levels were higher when compared with normal serum. CONCLUSIONS: Abnormalities of hinge region O-linked glycans were confirmed using advanced spectrometry technology. The pathogenetic implications for aggregation and defective removal of IgA1 are discussed.

Analysis of esophageal atrial recordings through wavelet packets decomposition.

In this paper the processing of esophageal atrial electrograms by means of wavelet packets (WP) decomposition is presented. WP is described as a flexible, signal-adaptive, tool, which can be easily tuned to enhance characteristics of esophageal signals. Two aspects are mainly investigated: (i) the possibility to obtain automatic, reliable detection of atrial activation in 24h Holter recordings and (ii) the development of an algorithm for discrimination between atrial flutter (AFLU) and atrial fibrillation (AF) episodes. WP decomposition was used as a framework for pre-processing the esophageal signal and to build a set of orthonormal sub-signals which can be selected and combined according to the signal processing task to be performed: (i) in the detection of atrial activation, sub-band signal characteristics were explored at different scales by using the modulus maxima criteria and (ii) in the discrimination between AFLU and AF the coarser approximation of the esophageal signal was studied by spectral analysis. A reliable detection of atrial activation was obtained (Sensitivity (SE): 99.08%; positive predictability (+P): 98.98%). In addition a quantitative index able to discriminate between AFLU (SE: 97.5%; +P: 98.7%) and AF (SE: 98.7%; +P: 97.5%) episodes was introduced.

[An epidemiological study of the health conditions of Milan traffic police with respect to pollution from vehicular traffic]. / Indagine epidemiologica sulle condizioni di salute dei vigili urbani di Milano in rapporto all'inquinamento da traffico veicolare.

An investigation on the health effects of occupational exposure to motor vehicle exhaust and environmental pollutants was carried out on traffic wardens in Milan (Italy). Randomized samples of 292 traffic wardens (exposed group) and 60 hospital staff members (control group) underwent a physical examination and laboratory tests. No significant difference was observed between the exposed and control groups as regards general morbidity, apart from musculo-skeletal disorders in females. The mean blood lead level (PbB) among traffic wardens was 15.2 micrograms/dl compared with 11.7 in control (p less than 0.01). The carboxyhaemoglobin concentration (COHb) in traffic wardens at the beginning of the shift was 2.8% for smokers and 1.2% for non-smokers (3.0% and 0.9% respectively in controls). At the end of the shift COHb in the exposed group was 4.3% for smokers and 2.5% for non-smokers (p less than 0.01). PbB was significantly correlated (r = 0.17) with Median Nerve Motor Conduction Velocity (NCV) in the exposed but not in the control group. The same pattern was observed for the correlation of PbB and Systolic Blood Pressure (SBP) (r = -0.24). COHb was significantly correlated with HDL cholesterol (r = -0.20) in the exposed group only. It is questionable whether very low PbB levels can affect NCV and SBP directly or rather whether PbB, as well as COHb, should be regarded as tracers of exposure to those urban pollutants leading also to cardiovascular and nervous disorders.

Renal function in IgA nephropathy with established renal failure.

This article discusses the feasibility of fitting a straight line to the reciprocal serum creatinine (1/SCr) values obtained from 32 patients with IgA mesangial nephropathy and established renal insufficiency. Three models were tested for fit: linear, logarithmic and quadratic. The decline of renal function, once renal failure has been established, is neither constant nor regular in all patients with this fairly well-diagnosed glomerular disease. Therefore we cannot rely on simple mathematical models to compare sequences of serum creatinine values or to forecast decline in renal function in patients with IgA nephropathy.

[An experimental model for the rational treatment of arrhythmias: a clinical study with quinidine]. / Modello sperimentale per un razionale trattamento delle aritmie: studio clinico con la chinidina.

Fourteen patients with supraventricular and/or ventricular ectopic beats selected by clinical, dynamic ECG and exercise test, underwent a basal continuous ECG recording (Holter) and then were given 400 mg of quinidine orally. The concentrations of the drug were determined in blood samples taken 30 minutes before, and 1, 2, 4, 6, 8, 12, and 24 hours after administration. On the same day patients were also monitored by continuous ECG recording (Holter). One week later, after a washout period, the same subjects were treated with 200 mg of quinidine orally 4 times a day for two weeks. On day 1, 2, 4, 7 and 14 quinidine was determined in plasma, and on day 7 and 14 a 24 hour ECG recording was also done. On the basis of pharmacokinetic parameters obtained from the acute test, the chronic levels of the drug were predicted. Predicted values were superimposable to those observed. Thus, the kinetics of single-dose quinidine is able to predict the steady-state levels after repeated dosing. During acute administration there was an increase in QTc interval and a decrease in ectopic beats. These effects correlated with a sigmoid pattern with acute quinidine levels. Concentrations producing 50% of the effect (EC50) could be calculated from these curves. In spite of similar steady-state blood levels of quinidine, some patients after chronic therapy did not respond to treatment (non responders). Non responders could be predicted by the acute test because they had greater EC50 values of QTc increase: patients with EC50 greater than 2 mg/L were all non responders.

Effects of ganglioside therapy on experimental CS2 neuropathy.

Both in animals and in man the inhalation of CS2 vapor induces a chronic polyneuropathy with primary lesions in the axons of peripheral nerves. Since it was reported in several studies that the administration of gangliosides improves nerve regeneration and the functional recovery of nerves damaged by section as well as cryodegeneration, a study was undertaken to evaluate the effects of bovine-brain gangliosides administration on the experimental CS2 neuropathy in the rat. One hundred and fifty male rats were intoxicated with CS2 by a discontinuous inhalation exposure to 700 ppm for 12 weeks until a clear neuropathy developed. Thereafter the animals were subdivided at random into five groups and treated in different ways: 10 mg/kg BW gangliosides, 0.5 mg/kg gangliosides, 0.5 mg/kg vitamin B1, and 1 mg/kg vitamin B6, physiological solution, and controls without any treatment. The recovery from neuropathy was controlled for 18 weeks of treatment and assessed periodically by means of clinical, electromyographic, and morphological examination. The results of morphological studies showed more pronounced regeneration activity in the rats treated with the high dose of gangliosides than in all others, while no differences among the groups could be observed as far as clinical and neurophysiological parameters are concerned. The mechanism supporting this ganglioside-induced effect has so far not been ascertained, and further studies on this subject are in progress.

Confidential enquiry into avoidable vehicle accident deaths in the province of Modena, Italy.

The authors describe the methods and results of a kind of study confidential enquiries into avoidable deaths very rarely performed in the Mediterranean area. After assessing some quali/ quantitative evaluation criteria, an independent expert panel investigated the quality of each step in emergency health care. Information was collected by clinical and forensic reports (clinical method). Of 102 cases, 4 were avoidable deaths and 18 probably avoidable. These results, which are comparable with other similar ones found in Italy (autoptic method) and abroad, have been useful in highlighting some health care errors: in particular, in on-site care and in emergency department diagnosis and treatment. Other avoidable factors emerging were the inappropriateness of transporting severe trauma cases to a small hospital lacking proper equipment and trained staff, and the importance of staff training in first emergency care of severe trauma on ambulance. This situation had been highlighted previously and led to implementation of trauma centres. The methods implemented turned out to be quite statistically reproducible and have been used in local health care planning, especially in the rearrangement of ambulance deployment and emergency staff training.

Immunological status of aged subjects with reference to serological evidence of autoimmunity.

When a group of 104 aged subjects was screened for autoimmune reactions, positive reactions for the rheumatoid factor and/or autoantibodies (ANA, anti-thyroid, PCA, anti-smooth muscle, anti-mitochondria) were recorded in 40.4%. Immunological functions were studied in 32 positive aged subjects, 32 age- and sex-matched negative controls, and 32 young subjects. Some differences attributable to the process of aging were quite evident, such as a depression in the percentage of E rosette forming peripheral lymphocytes and in their response to PHA, and an increase in the percentage of IgG-bearing peripheral lymphocytes and in the serum levels of IgA and three complement fractions (C'3, C'4, and C'3-PA). No clear-cut picture was noted when autoimmunity-positive and -negative, aged subjects were compared. However, some differences between sexes suggest that autoimmune reactions are linked to a depressed T cell function mainly in males, whereas the reverse is true for females.