Acute and chronic effects on central hemodynamics and arterial stiffness in professional rowers.

Controversial data exist on acute and chronic effects of competitive sports on central hemodynamics and arterial stiffness. We investigated chronic as well as acute training effects in professional rowers. The trial was planned as a non-randomized, controlled pilot-study comparing athletes and controls. 13 German national team rowers (24.1 ± 1.5 years) and 12 controls (23.8 ± 0.8 years) participated. Aortic, brachial hemodynamics and arterial stiffness were measured (Arteriograph, TensioMed(®), Hungary) before and after a standardized exercise test. Chronic heart rate (49 [Formula: see text] 2 bpm versus 70 [Formula: see text] 2 bpm, p < 0.05) as well as brachial diastolic pressure (65 [Formula: see text] 2 mmHg versus 74 [Formula: see text] 2 mmHg, p < 0.05) was significantly lower in rowers. Physical power (305 [Formula: see text] 63 versus 158 [Formula: see text] 60 W, p < 0.001) was better. Chronic aortic pulse pressure (41.6 [Formula: see text] 6.0 versus 35.2 [Formula: see text] 3.8 mmHg; p < 0.01) and AIx (9.1 [Formula: see text] 5.4 versus 7.0 [Formula: see text] 10.2; p < 0.01) were significantly higher in athletes. After the all-out test (acute effects) pulse wave velocity (rowers: 6.6 [Formula: see text] 1.2 m s(-1) versus 7.8 [Formula: see text] 1.6 m s(-1), p < 0.001; control group 6.0 [Formula: see text] 0.4 m s(-1) versus 8.0 [Formula: see text] 1.4 m s(-1), p = 0.005) and heart rate (rowers: 49 [Formula: see text] 2 bpm versus 91 [Formula: see text] 3 bpm, p < 0.001; control group 70 [Formula: see text] 2 bpm versus 92 [Formula: see text] 4 bpm, p < 0.001) increased significantly in both groups. The controls' aortic AIx (7.0 [Formula: see text] 10.2 versus 2.0 [Formula: see text] 6.0; p < 0.01) decreased significantly after exercise. Professional rowers showed higher chronic aortic pulse pressure and arterial stiffness. Given the risk associated with elevated aortic pulse pressure and AIx for development of cardiovascular diseases, longterm observations of professional rowers are needed with respect to arterial stiffness and prognosis. Furthermore the acute effects need additional research.

[Dyspnoea in Patients with Pulmonary Hypertension (PH) - a Survey in Spezialized German PH Centres]. / Dyspnoe bei Patienten mit Pulmonaler Hypertonie (PH) - Ergebnisse einer Befragung in deutschen PH-Zentren.

Dyspnoea is the predominant symptom in patients with pulmonary hypertension (PH) at diagnosis. However, since dyspnoea is nonspecific and often occurs in a number of common diseases, the presence of PH can easily be underdiagnosed.In addition, this symptom underlies a high variability in the subjective perception, therefore further diagnostic procedures are often delayed by the patients.A survey of the incidence and severity of dyspnoea in 372 patients with PAH was conducted by questionnaire in German centres. Age, sex distribution and the range of comorbidities corresponded to the findings of national and international registries.Approximately 99 % of patients reported the presence of dyspnoea on exertion, even at low loads.Remarkably, in 13 % of patients dyspnoea occurs as a paroxysmal symptom, which may lead to the differential diagnosis of bronchial asthma. In addition, the patients who were being followed in specialized PH centres reported an increase in dyspnoea during the last year.The results of the survey on the incidence of dyspnoea in patients with PAH are consistent with the findings of international studies.

[Limitation of operability. What does the internist need to know?]. / Einschränkung der Operationsfähigkeit. Was muss der Internist wissen?

The number of elderly people that are critically ill and are send for surgery is rising rapidly. As co-morbidities such as heart disease have huge impact on the perioperative risk, identification of specific risk factors should guide the pre- and perioperative management. Several risk scores and the guidelines published by the European Society of Cardiology recently are currently available and are reviewed in the current manuscript. Evaluation of the medical history of the individual patient and functional tests are the basis for further decisions. Patients that are suffering from co-morbidities or reduced physical fitness are identified as risk patients. Patients without risk factors can be sent for surgery without additional evaluation. In moderate risk patients medication should be optimized prior to surgery. Except emergency surgery cases critical illness should be identified and treated before surgery is initiated. Depending on the number of potential risk factors non-invasive cardiac stress tests are recommended. Depending on the results also coronary angiography/-angioplasty should be performed. Acute coronary syndromes or unstable angina should preferentially be treated prior to surgery.

The SRC family kinase LYN redirects B cell receptor signaling in human SLP65-deficient B cell lymphoma cells.

SLP65 represents a critical component in (pre-) B cell receptor signal transduction but is compromised in a subset of pre-B cell-derived acute lymphoblastic leukemia. Based on these findings, we investigated (i.) whether SLP65-deficiency also occurs in mature B cell-derived lymphoma and (ii.) whether SLP65-deficient B cell lymphoma cells use an alternative B cell receptor signaling pathway in the absence of SLP65. Indeed, expression of SLP65 protein was also missing in a fraction of B cell lymphoma cases. While SLP65 is essential for B cell receptor-induced Ca2+ mobilization in normal B cells, B cell receptor engagement in SLP65-deficient as compared to SLP65-reconstituted B cell lymphoma cells resulted in an accelerated yet shortlived Ca2+-signal. B cell receptor engagement of SLP65-deficient lymphoma cells involves SRC kinase activation, which is critical for B cell receptor-dependent Ca2+-mobilisation in the absence but not in the presence of SLP65. As shown by RNA interference, the SRC kinase LYN is required for B cell receptor-induced Ca2+ release in SLP65-deficient B cell lymphoma cells but dispensable after SLP65-reconstitution. B cell receptor engagement in SLP65-deficient B cell lymphoma cells also resulted in tyrosine-phosphorylation of the proliferation- and survival-related MAPK1 and STAT5 molecules, which was sensitive to silencing of the SRC kinase LYN. Inhibition of SRC kinase activity resulted in growth arrest and cell death specifically in SLP65-deficient lymphoma cells. These findings indicate that LYN can short-circuit conventional B cell receptor signaling in SLP65-deficient B cell lymphoma cells and thereby promote activation of survival and proliferation-related molecules.

S100A1: a regulator of myocardial contractility.

S100A1, a Ca(2+) binding protein of the EF-hand type, is preferentially expressed in myocardial tissue and has been found to colocalize with the sarcoplasmic reticulum (SR) and the contractile filaments in cardiac tissue. Because S100A1 is known to modulate SR Ca(2+) handling in skeletal muscle, we sought to investigate the specific role of S100A1 in the regulation of myocardial contractility. To address this issue, we investigated contractile properties of adult cardiomyocytes as well as of engineered heart tissue after S100A1 adenoviral gene transfer. S100A1 gene transfer resulted in a significant increase of unloaded shortening and isometric contraction in isolated cardiomyocytes and engineered heart tissues, respectively. Analysis of intracellular Ca(2+) cycling in S100A1-overexpressing cardiomyocytes revealed a significant increase in cytosolic Ca(2+) transients, whereas in functional studies on saponin-permeabilized adult cardiomyocytes, the addition of S100A1 protein significantly enhanced SR Ca(2+) uptake. Moreover, in Triton-skinned ventricular trabeculae, S100A1 protein significantly decreased myofibrillar Ca(2+) sensitivity ([EC(50%)]) and Ca(2+) cooperativity, whereas maximal isometric force remained unchanged. Our data suggest that S100A1 effects are cAMP independent because cellular cAMP levels and protein kinase A-dependent phosphorylation of phospholamban were not altered, and carbachol failed to suppress S100A1 actions. These results show that S100A1 overexpression enhances cardiac contractile performance and establish the concept of S100A1 as a regulator of myocardial contractility. S100A1 thus improves cardiac contractile performance both by regulating SR Ca(2+) handling and myofibrillar Ca(2+) responsiveness.

Severe, resistant spasm of the left main coronary artery--a serious pitfall.

A case of severe, resistant spasm of the left main coronary artery, which was not relieved even after 600 micrograms of intracoronary nitroglycerine over 30 minutes, is described. The case was mistakenly taken for fixed stenosis and would have been subjected to percutaneous transluminal coronary angioplasty with stenting at the same sitting, had not the case been fortuitously deferred. On repeat angiography after one week, the left main was found to be normal. Some guidelines to avoid such a situation are suggested.