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1.
Am Heart J ; 239: 100-109, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34077743

RESUMO

BACKGROUND: Stable chest pain is a common indication for cardiac catheterization. We assessed the prognostic value of the Prospective Multicenter Imaging Study for Evaluation (PROMISE) Minimal-Risk Tool in identifying patients who are at very low risk of obstructive coronary artery disease (CAD) or downstream cardiovascular adverse outcomes. METHODS: We applied the PROMISE Minimal-Risk Tool to consecutive patients without known CAD who underwent elective cardiac catheterization for stable angina from January 1, 2000 to December 31, 2014 in the Duke Databank for Cardiovascular Disease (DDCD). Patients with scores >0.46 (top decile of lowest-risk from the PROMISE cohort) were classified as low-risk. Logistic regression modeling compared likelihood of freedom from obstructive coronary artery disease on index angiography, 2-year survival, and 2-year survival free of myocardial infarction (MI) and MI/revascularization between low- and non low-risk patients. Alternative cut points to define low- risk patients were also explored. RESULTS: Among 6251 patients undergoing cardiac catheterization for stable chest pain, 1082 (17.3%) were low-risk per the PROMISE minimal-risk tool. Among low risk patients, obstructive coronary artery disease was observed in 14.9% and left main disease (≥ 50% Stenosis) was rare (0.9%). Compared with other patients, low risk patients had a higher likelihood of freedom from obstructive coronary disease on index catheterization (85.1% vs. 44.2%, OR 4.84, 95% CI 4.06-5.77). Low risk patients had significantly higher survival (98.2% vs. 94.4%, OR 3.18, 95% CI 1.99-5.08), MI-free survival (97.2% vs. 91.9%, OR 3.03, 95% CI 2.07-4.45), and MI/revascularization-free survival (86.2 vs. 59.9%, OR 4.19, 95% CI 3.48-5.05) at 2 years than non-low risk patients. Operating characteristics for predicting the outcomes of interest varied modestly depending on the low-risk cut-point used but the positive predictive value for 2 year freedom from death was >98% regardless. CONCLUSION: The PROMISE minimal-risk tool identifies 17% of stable chest pain patients referred to cardiac catheterization as low risk. These patients have a low prevalence of obstructive CAD and better survival than non-low risk patients. While this suggests that these patients are unlikely to benefit from catheterization, further research is needed to confirm a favorable downstream prognosis with medical management alone.


Assuntos
Angina Estável , Estenose Coronária , Vasos Coronários/diagnóstico por imagem , Fatores de Risco de Doenças Cardíacas , Sobremedicalização , Infarto do Miocárdio , Medição de Risco/métodos , Angina Estável/complicações , Angina Estável/diagnóstico , Angina Estável/etiologia , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Estenose Coronária/diagnóstico , Estenose Coronária/epidemiologia , Estenose Coronária/fisiopatologia , Estenose Coronária/cirurgia , Feminino , Humanos , Masculino , Sobremedicalização/prevenção & controle , Sobremedicalização/estatística & dados numéricos , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Revascularização Miocárdica/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Prognóstico , Estados Unidos/epidemiologia
2.
Internist (Berl) ; 62(6): 672-678, 2021 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-33411015

RESUMO

Patients with type 2 diabetes who present with confusion and/or abdominal pains should be screened for sodium-glucose cotransporter 2 (SGLT-2)-induced diabetic ketoacidosis. Severe acidosis was diagnosed despite only moderately increased blood sugar levels. If so, immediate ICU treatment is essential.


Assuntos
Diabetes Mellitus Tipo 2 , Cetoacidose Diabética , Inibidores do Transportador 2 de Sódio-Glicose , Idoso , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Cetoacidose Diabética/diagnóstico , Cetoacidose Diabética/terapia , Humanos , Hipoglicemiantes , Masculino , Taquicardia , Taquipneia
3.
Eur J Appl Physiol ; 121(4): 1037-1048, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33427969

RESUMO

PURPOSE: Cardiovascular regulation during exercise, described using time series analysis, is expected to be attenuated after bed rest (BR) and this effect will be dampened by a reactive jumps countermeasure. METHODS: Twenty subjects (29 ± 6 years, 23.6 ± 1.7 kg m-2) were tested on a cycle ergometer 9 days (BDC-9) before the beginning of BR as well as 2 (R + 2) and 13 days (R + 13) after the end of BR, applying moderate pseudo-random binary (PRBS) work rate changes. Heart rate (HR) and mean arterial blood pressure (mBP) were measured beat-to-beat and interpolated to 1 s intervals. HR and mBP were cross-correlated [CCF(HR-mBP)] during the PRBS. Eleven subjects participated in a reactive jump countermeasure (JUMP) during the BR period, the other part of the group served as control group (CTRL). RESULTS: In the CTRL group, significantly lower CCF(HR-mBP) values during BDC-9 were observed compared to R + 2 during the lags 20-25 s and significantly higher values during the lags - 39 s to - 35 s. In the JUMP group, significantly lower CCFs were only observed at R + 2 compared with BDC-9 during the lags 23 s and 24 s, whereas the CCFs for BDC-9 were significantly higher at several lags compared with R + 13. CONCLUSION: Attenuations in the regulation of the cardiovascular system during cycling exercise after BR were found in the CTRL group of the RSL study. Cardiovascular regulation in the JUMP group was improved compared to values before the beginning of BR, suggesting the effectiveness of the reactive jumps countermeasure to mitigate the deleterious effects of prolonged BR.

4.
Z Rheumatol ; 79(2): 200-202, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32040754

RESUMO

An interdisciplinary collaboration is required in the medical care of chronically ill patients with complex illnesses. Especially in the field of internistic rheumatology, interdisciplinary work is essential to consider the complex somatic and psychosocial aspects of a chronic illness. Nevertheless, the aspects of interprofessional work in the study of medicine and psychology are insufficiently addressed. For this reason, a model project for interdisciplinary university teaching was conceived, which combines both subjects. The course was held for the first time in semester 2019/2020 and was rated excellent by the participants. The main goal of the course is the implementation of interprofessional work in the training of medical personnel. In addition, the discipline of internistic rheumatology could be brought closer to the students.


Assuntos
Currículo , Relações Interprofissionais , Equipe de Assistência ao Paciente/organização & administração , Psicologia , Reumatologia , Doença Crônica , Humanos , Estudantes de Medicina/psicologia , Universidades
5.
Can J Physiol Pharmacol ; 97(8): 738-745, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30917299

RESUMO

It was hypothesized that faster cardiorespiratory kinetics during exercise are associated with higher orthostatic tolerance. Cardiorespiratory kinetics of 14 healthy male subjects (30 ± 4 years, 179 ± 8 cm, 79 ± 8 kg) were tested on a cycle ergometer during exercise with changing work rates of 30 and 80 W. Pulmonary oxygen uptake ( ) was measured breath-by-breath and heart rate (HR), mean arterial blood pressure (MAP), and total peripheral resistance (TPR) were measured beat-to-beat. Muscular oxygen uptake ( ) was estimated from HR and . Kinetic parameters were determined by time-series analysis, using cross-correlation functions (CCFmax(x)) between the parameter and the work rate. Cardiovascular regulations of MAP, HR, and TPR during orthostatic stress were measured beat-to-beat on a tilt seat. Changes between the minima and maxima during the 6° head-down tilt and the 90° head-up tilt positions were calculated for each parameter (Δtilt-up). correlated significantly with ΔTPRtilt-up (r = 0.790, p ≤ 0.001). CCFmax(HR) was significantly correlated with ΔHRtilt-up (r = -0.705, p = 0.002) and the amplitude in HR from 30 to 80 W (rSP = -0.574, p = 0.016). The observed correlations between cardiorespiratory regulation in response to exercise and orthostatic stress during rest might allow for a more differential analysis of the underlying mechanisms of orthostatic intolerance in, for example, patient groups.


Assuntos
Fenômenos Fisiológicos Cardiovasculares , Exercício Físico/fisiologia , Decúbito Inclinado com Rebaixamento da Cabeça/fisiologia , Adulto , Pressão Sanguínea , Frequência Cardíaca , Humanos , Masculino , Resistência Vascular
6.
Andrology ; 7(3): 307-314, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30761772

RESUMO

BACKGROUND: The relation between endogenous testosterone concentrations and myocardial mass and function remains incompletely understood. OBJECTIVES: To determine the cross-sectional association between endogenous hormone levels with cardiac magnetic resonance measures of myocardial mass, structure, and function in community-dwelling men across a wide age range. METHODS: A total of 720 men from the Framingham Heart Study Offspring Cohort (age range 37-82, mean = 59.6 years) who underwent cardiac magnetic resonance imaging and had hormone levels measured. Total testosterone (measured using liquid chromatography-tandem mass spectrometry), sex hormone-binding globulin (measured using an immunofluorometric assay), and calculated free testosterone levels were assessed in male participants of the Framingham Heart Study Offspring Cohort at examination 7. Cardiac magnetic resonance imaging was performed between examinations 7 and 8 (2002-2006). RESULTS: Age-adjusted linear regression models showed statistically significant association between total testosterone levels and left ventricular mass (p = 0.009), left ventricular mass index (p = 0.006), cardiac output (p = 0.001), and main pulmonary artery diameter (p = 0.008); the association between total testosterone and these cardiac magnetic resonance measures was weak and was not significant after adjustment for established risk factors-age, body mass index, diabetes, and hypertension. Furthermore, calculated free testosterone level was not significantly associated with any measure of myocardial mass or function. Sex hormone-binding globulin level was significantly associated with left ventricular mass (p = 0.002), left ventricular mass index (p = 0.004), cardiac output (p = 0.003), left ventricular ejection fraction (p = 0.039), and main pulmonary artery diameter (p = 0.042) in age-adjusted models; these associations were also rendered non-significant after adjusting for cardiovascular risk factors. CONCLUSIONS: Neither testosterone nor sex hormone-binding globulin levels in men are associated significantly with myocardial mass and function independent of established cardiovascular risk factors.


Assuntos
Coração/fisiologia , Globulina de Ligação a Hormônio Sexual/metabolismo , Testosterona/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/sangue , Estudos de Coortes , Coração/anatomia & histologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Fatores de Risco
9.
Laryngorhinootologie ; 97(7): 457-464, 2018 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-29986366

RESUMO

Pregnancy rhinitis (PR), a common condition in pregnant women, is defined as long-lasting nasal congestion due to mucosal swelling and increased secretion without any signs of infection, allergy or tumor, starting at any time during pregnancy and disappearing within 2 weeks of delivery. Smoking and a sensitization to house dust mites are known risk factors. While a definitive pathophysiological concept for PR does not exist, hormonal influences are discussed. We present a stepwise therapeutic strategy for PR and an overview to the latest literature.


Assuntos
Complicações na Gravidez , Rinite , Feminino , Humanos , Gravidez
10.
Eur J Appl Physiol ; 118(9): 1885-1901, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29946969

RESUMO

PURPOSE: The effects of 60 days of head down tilt bed rest (HDBR) with and without the application of a reactive jump countermeasure were investigated, using a method which enables to discriminate between pulmonary ([Formula: see text]O2pulm) and muscular ([Formula: see text]O2musc) oxygen uptake kinetics to control for hemodynamic influences. METHODS: 22 subjects were randomly allocated to either a group performing a reactive jumps countermeasure (JUMP; n = 11, male, 29 ± 7 years, 23.9 ± 1.3 kg m- 2) or a control group (CTRL; n = 11, male, 29 ± 6 years, 23.3 ± 2.0 kg m- 2). Heart rate (HR) and [Formula: see text]O2pulm were measured in response to repeated changes in work rate between 30 and 80 W before (BDC-9) and two times after HDBR (R+ 2, R+ 13). Kinetic responses of HR, [Formula: see text]O2pulm, and [Formula: see text]O2musc were assessed applying time series analysis. Higher maxima in cross-correlation functions (CCFmax(x)) between work rate and the respective parameter indicate faster kinetics responses. Statistical analysis was performed applying multifactorial analysis of variance. RESULTS: CCFmax([Formula: see text]O2musc) and CCFmax([Formula: see text]O2pulm) were not significantly different before and after HDBR (P > 0.05). CCFmax(HR) decreased following bed rest (JUMP: BDC-9: 0.30 ± 0.09 vs. R+ 2: 0.28 ± 0.06 vs. R+13: 0.28 ± 0.07; CTRL: 0.35 ± 0.09 vs. 0.27 ± 0.06 vs. 0.33 ± 0.07 P = 0.025). No significant differences between the groups were observed (P > 0.05). Significant alterations were found for CCFmax of mean arterial blood pressure (mBP) after HDBR (JUMP: BDC-9: 0.21 ± 0.07 vs. R+ 2: 0.30 ± 0.13 vs. R+ 13: 0.28 ± 0.08; CTRL: 0.25 ± 0.07 vs. 0.38 ± 0.13 vs. 0.28 ± 0.08; P = 0.008). CONCLUSIONS: Despite hemodynamic changes, [Formula: see text]O2 kinetics seem to be preserved for a longer period of HDBR, even without the application of a countermeasure.


Assuntos
Exercício Físico/fisiologia , Decúbito Inclinado com Rebaixamento da Cabeça/fisiologia , Frequência Cardíaca/fisiologia , Músculos/fisiologia , Oxigênio , Adulto , Pressão Arterial/fisiologia , Repouso em Cama , Humanos , Cinética , Masculino
11.
Eur J Appl Physiol ; 118(9): 1845-1856, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29934765

RESUMO

PURPOSE: The aim of the study was to test whether or not the arteriovenous oxygen concentration difference (avDO2) kinetics at the pulmonary (avDO2pulm) and muscle (avDO2musc) levels is significantly different during dynamic exercise. METHODS: A re-analysis involving six publications dealing with kinetic analysis was utilized with an overall sample size of 69 participants. All studies comprised an identical pseudorandom binary sequence work rate (WR) protocol-WR changes between 30 and 80 W-to analyze the kinetic responses of pulmonary ([Formula: see text]) and muscle ([Formula: see text]) oxygen uptake kinetics as well as those of avDO2pulm and avDO2musc. RESULTS: A significant difference between [Formula: see text] (0.395 ± 0.079) and [Formula: see text] kinetics (0.330 ± 0.078) was observed (p < 0.001), where the variables showed a significant relationship (rSP = 0.744, p < 0.001). There were no significant differences between avDO2musc (0.446 ± 0.077) and avDO2pulm kinetics (0.451 ± 0.075), which are highly correlated (r = 0.929, p < 0.001). CONCLUSION: It is suggested that neither avDO2pulm nor avDO2musc kinetic responses seem to be responsible for the differences between estimated [Formula: see text] and measured [Formula: see text] kinetics. Obviously, the conflation of avDO2 and perfusion ([Formula: see text] ) at different points in time and at different physiological levels drive potential differences in [Formula: see text] and [Formula: see text] kinetics. Therefore, [Formula: see text] should, in general, be considered whenever oxygen uptake kinetics are analyzed or discussed.


Assuntos
Pulmão/metabolismo , Pulmão/fisiologia , Músculo Esquelético/metabolismo , Músculo Esquelético/fisiologia , Consumo de Oxigênio/fisiologia , Oxigênio/metabolismo , Adulto , Exercício Físico/fisiologia , Teste de Esforço , Feminino , Frequência Cardíaca/fisiologia , Humanos , Cinética , Masculino , Troca Gasosa Pulmonar/fisiologia
12.
Int J Cardiol ; 268: 125-131, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-29861102

RESUMO

BACKGROUND: Interventional closure of left atrial appendage (LAAC) represents an alternative for stroke prevention in patients with non-valvular atrial fibrillation. Whether LAAC may affect metabolomic pathways has not been investigated yet. This study evaluates the impact of LAAC on the metabolism of essential amino acids, kynurenine and creatinine. METHODS: Peripheral blood samples of prospectively enrolled patients undergoing successful LAAC were taken before (T0) and 6 months after (T1, mid-term follow-up). Targeted metabolomic profiling was performed using electrospray ionization liquid chromatography-mass spectrometry (ESI-LC-MS/MS) and MS/MS measurements focusing on metabolism of essential amino acids. RESULTS: 44 patients with non-valvular AF (mean CHA2DS2-VASc score 4, mean HAS-BLED score 4) were enrolled. Changes in metabolites of essential amino acids, myocardial contraction and bioenergetic efficacy, such as phenylalanine (percentage change 8.2%, p = 0.006), tryptophan (percentage change 20.3%, p = 0.0006), tyrosine (percentage change 20.2%, p = 0.0001), creatinine (percentage change 7.2%, p > 0.05) and kynurenine (percentage change 8.3%, p = 0.0239) were found at mid-term follow-up. CONCLUSIONS: LAAC may affect the metabolism of essential amino acids and bioenergetic efficacy. ClinicalTrials.gov Identifier: NCT02985463.


Assuntos
Aminoácidos Essenciais/sangue , Apêndice Atrial/metabolismo , Apêndice Atrial/cirurgia , Metabolismo Energético/fisiologia , Metabolômica/métodos , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Espectrometria de Massas por Ionização por Electrospray/métodos , Resultado do Tratamento , Dispositivos de Oclusão Vascular
13.
Sci Rep ; 8(1): 5894, 2018 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-29650978

RESUMO

Patients with non-valvular atrial fibrillation (AF) and a high risk for oral anticoagulation can be treated by percutaneous implantation of left atrial appendage occlusion devices (LAAC) to reduce the risk of cardio-embolic stroke. This study evaluates whether LAAC may influence lipid metabolism, which has never been investigated before. Patients with successful LAAC were included consecutively. Venous peripheral blood samples of patients were collected immediately before (T0, baseline) and 6 months after (T1, mid-term) LAAC. A targeted metabolomics approach based on electrospray ionization liquid chromatography-mass spectrometry (ESI-LC-MS/MS) and MS/MS measurements was performed. A total of 34 lipids revealed a significant change from baseline to mid-term follow-up after successful LAAC. Subgroup analysis revealed confounding influence by gender, age, diabetes mellitus type II, body mass index, left ventricular ejection fraction, creatinine and NT-proBNP. After multivariable adjustment within logistic regression models, these 34 lipids were still significantly altered after LAAC. Successful percutaneous LAAC may affect lipid metabolism and thereby may potentially affect pro-atherogenic and cardio-toxic effects.


Assuntos
Apêndice Atrial/metabolismo , Fibrilação Atrial/sangue , Diabetes Mellitus Tipo 2/sangue , Lipídeos/sangue , Metaboloma , Intervenção Coronária Percutânea/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Índice de Massa Corporal , Creatinina/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Diabetes Mellitus Tipo 2/cirurgia , Ecocardiografia Transesofagiana , Feminino , Humanos , Metabolismo dos Lipídeos , Lipídeos/classificação , Modelos Logísticos , Masculino , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Espectrometria de Massas por Ionização por Electrospray , Volume Sistólico/fisiologia , Espectrometria de Massas em Tandem
14.
Internist (Berl) ; 59(4): 309-315, 2018 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-29427012

RESUMO

BACKGROUND: The systolic blood pressure intervention trial (SPRINT) published in 2015 has opened up new discussions on whether a lower blood pressure target as recommended by the current guidelines would be better for some patient groups. OBJECTIVES: To review patient groups in which lower blood pressure targets would not be better. MATERIALS AND METHODS: The results of SPRINT, its post-hoc and subgroup analyses, other studies and newer studies, as well as metaanalyses on the topic of blood pressure targets are reviewed and discussed. Studies with patients excluded from the SPRINT study were also analysed. The current international guidelines and recommendations of the Deutsche Hochdruckliga e. V. DHL® are included. RESULTS: Blood pressure monitoring methods differed considerably in the previously published studies. The low blood pressure value in SPRINT was mainly achieved due to the unusual method of blood pressure monitoring used and, as such, cannot be compared with blood pressure values in other studies. Based on current evidence, "the lower the better" should not be recommended in the following patient groups: older patients, in particular infirm older patients, patients with diabetes, patients without coronary heart disease or with low cardiovascular risk. CONCLUSIONS: When determining a blood pressure target, the method of blood pressure monitoring should be defined. A lower blood pressure target has been shown to be better in some well defined patient groups. However, adverse events due to antihypertensive medications should always be taken into account. Given the multiple exclusion criteria in trials and the results of many studies, "new" lower blood pressure targets could not be recommended in a large population of patients.


Assuntos
Pressão Sanguínea , Hipertensão/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Determinação da Pressão Arterial , Feminino , Idoso Fragilizado , Fidelidade a Diretrizes , Humanos , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Valores de Referência
15.
Arch Gynecol Obstet ; 297(3): 667-674, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29330635

RESUMO

PURPOSE: Hypotension due to spinal anesthesia is a well-known side effect in pregnant women receiving caesarean section. Little is known about its impact on fetal blood circulation. METHODS: 40 women with uncomplicated singleton term pregnancies prepared for caesarean section were prospectively evaluated by Doppler sonography before and immediately after spinal anesthesia. RESULTS: In 90% of the women, blood pressure significantly decreased after spinal anesthesia and 42.5% of the patients suffered from severe hypotension. We found a significant negative correlation between maternal blood pressure change and the resistant index (RI) of the umbilical artery (rs = - 0.376, p = 0.017) and a significant positive correlation between maternal blood pressure and fetal middle cerebral artery. CONCLUSION: Healthy fetuses seem to compensate well in situations with decreased uteroplacental blood flow due to maternal hypotension measured by means of RI changes in the fetal umbilical and middle cerebral artery. This raises the question if growth-restricted and/or preterm fetuses are able to compensate similarly or if general anesthesia would be a method of choice.


Assuntos
Raquianestesia/efeitos adversos , Cesárea , Feto/irrigação sanguínea , Hipotensão/etiologia , Placenta/irrigação sanguínea , Ultrassonografia Doppler/métodos , Artérias Umbilicais/fisiologia , Cordão Umbilical/efeitos dos fármacos , Útero/irrigação sanguínea , Adulto , Anestesia Geral , Anestesia Obstétrica/efeitos adversos , Pressão Sanguínea , Feminino , Humanos , Hipotensão/epidemiologia , Recém-Nascido , Artéria Cerebral Média/fisiologia , Gravidez , Resultado da Gravidez
16.
Eur J Appl Physiol ; 118(2): 429-438, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29250707

RESUMO

PURPOSE: The aim of the study was to test for significant differences in non-invasively estimated muscle oxygen uptake ([Formula: see text]) kinetics, assessed by a square-wave exercise protocol (STEP) as well as by a time series approach with pseudorandom binary sequence (PRBS) work rate (WR) changes. METHODS: Seventeen healthy and active individuals (10 women, 7 men; 23 ± 2 years old; height 175 ± 11 cm; body mass 73 ± 14 kg [mean ± SD]) completed five repetitions of WR transitions from 30 to 80 W for the STEP approach and two sequences of pseudorandom binary WR changes between 30 and 80 W for the PRBS approach. Pulmonary oxygen uptake ([Formula: see text]) was measured breath by breath. [Formula: see text] kinetics were estimated during phase II [Formula: see text] in the STEP approach and during the pseudorandom binary sequence WR changes in the PRBS approach. RESULTS: No significant differences were observed between different models of the STEP and the PRBS approach for estimation of [Formula: see text] kinetics (p > 0.05). In addition, a very high variability between the models was determined for [Formula: see text] kinetics [mean time constants (τ) difference: - 2.5 ± 11.4 s]. A significant correlation for τ of [Formula: see text] between the STEP approach with experimentally determined phase I [Formula: see text] lengths and the PRBS approach was noticed (r = 0.536; p < 0.05). CONCLUSIONS: Both approaches (STEP and PRBS) are not significantly different for estimating the [Formula: see text] kinetics, but the very high variability impairs the predictability between the models. However, the determination of the length of phase I [Formula: see text] should be as appropriate as possible because predefined duration lengths can result in overestimations in [Formula: see text] kinetics.


Assuntos
Teste de Esforço/métodos , Exercício Físico , Músculo Esquelético/fisiologia , Consumo de Oxigênio , Adulto , Teste de Esforço/normas , Feminino , Frequência Cardíaca , Humanos , Masculino , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/metabolismo , Fluxo Sanguíneo Regional
17.
Respir Physiol Neurobiol ; 247: 156-166, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29024783

RESUMO

PURPOSE: The aim of the study was to compare the responses of pulmonary (V˙O2pulm) and muscle (V˙O2musc) oxygen uptake kinetics before (PRE) and after (POST) six weeks of endurance exercise training. METHODS: Nine untrained individuals performed pseudo-random binary sequences work rate changes between 30W and 80W at PRE and POST training intervention. Heart rate (HR) and V˙O2pulm were measured beat-to-beat and breath-by-breath, respectively. V˙O2musc was estimated applying the approach of Hoffmann et al. (Eur J Appl Physiol 113: 1745-1754, 2013). RESULTS: Maximal oxygen uptake showed significant increases from PRE (3.2±0.3Lmin-1) to POST (3.7±0.2Lmin-1; p<0.05). For HR, V˙O2pulm and V˙O2musc kinetics no significant changes from PRE to POST training intervention were observed (p>0.05). CONCLUSIONS: Discrepancies in the adaptations of the involved exercise induced physiological systems seem to be responsible for the observed significant alterations in maximal V˙O2 after six weeks of the training intervention in contrast to no changes in the kinetics responses.


Assuntos
Exercício Físico/fisiologia , Pulmão/fisiologia , Músculo Esquelético/fisiologia , Consumo de Oxigênio/fisiologia , Adulto , Teste de Esforço , Terapia por Exercício , Frequência Cardíaca/fisiologia , Humanos , Cinética , Masculino , Oxigênio/metabolismo , Resistência Física/fisiologia , Projetos Piloto
18.
Mucosal Immunol ; 11(3): 846-860, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29186109

RESUMO

CD44 is a transmembrane molecule appearing in numerous isoforms generated by insertions of alternatively spliced variant exons (CD44v) and having various binding partners. CD44v7 on T cells was proposed to promote colitis by preventing T-cell apoptosis. Here we demonstrate that Cd44v7-deficient T cells - like Cd44 wild-type (Cd44WT) T cells - provoked disease in two different colitis models: the model induced by CD4+CD45RBhigh T-cell transfer into Rag2-deficient mice and a new model based on ovalbumin (OVA)-specific T-cell transfer into Rag-sufficient, OVA-challenged mice. In contrast, CD44v7 absence on macrophages in recipient mice prevented colitis. Prevention was associated with the downregulation of signal transducer and activator of transcription 3 (STAT3)-activating and Foxp3-counteracting interleukin-6 (IL-6), lower numbers of phospho-STAT3-containing lymphocytes, and higher Foxp3+ T-cell counts in the colon. Consequently, the protected colons showed lower IL-12, IL-1ß expression, and decreased interferon-γ levels. Importantly, stimulation of T cells by Cd44v7-deficient macrophages induced upregulation of Foxp3 in vitro, while cotransfer of Cd44WT macrophages into Cd44v7-deficient mice reduced Foxp3+ T-cell counts and caused colitis. Accordingly, the CD44v7 ligand osteopontin, whose levels were elevated in Crohn's disease, specifically induced IL-6 in human monocytes, a cytokine also increased in these patients. We suggest macrophage-specific targeting of the CD44v7 pathway as a novel therapeutic option for Crohn's disease.


Assuntos
Colite/imunologia , Doença de Crohn/imunologia , Receptores de Hialuronatos/metabolismo , Macrófagos/fisiologia , Subpopulações de Linfócitos T/fisiologia , Linfócitos T Reguladores/fisiologia , Adulto , Processamento Alternativo , Animais , Células Cultivadas , Técnicas de Cocultura , Citocinas/metabolismo , Modelos Animais de Doenças , Éxons/genética , Feminino , Fatores de Transcrição Forkhead/metabolismo , Humanos , Receptores de Hialuronatos/genética , Mediadores da Inflamação/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Knockout , Camundongos Transgênicos , Osteopontina/metabolismo
19.
Metabolomics ; 14(2): 20, 2018 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-30830322

RESUMO

The article Occlusion of left atrial appendage aff ects metabolomic profile:focus on glycolysis, tricarboxylic acid and urea metabolism, written by K. Sattler, M. Behnes, C. Barth, A. Wenke, B. Sartorius, I. El-Battrawy, K. Mashayekhi, J. Kuschyk, U. Hoffmann, T. Papavasiliu, C. Fastner, S. Baumann, S. Lang, X. Zhou, G. Yücel, M. BorggrefeI, Akin, was originally published Online First without open access.

20.
Ther Clin Risk Manag ; 13: 863-869, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28744135

RESUMO

BACKGROUND: Previous studies revealed that patients with Takotsubo cardiomyopathy (TTC) have a higher mortality rate than the general population. It is still unclear whether sex differences may influence long-term prognosis of TTC patients. The purpose of this study was to determine whether sex differences do influence the short- and long-term outcomes of TTC. METHODS AND RESULTS: A total of 114 patients with TTC were admitted to the University Medical Centre Mannheim from January 2003 to September 2015 and entered into the TTC database of the University Medical Centre Mannheim, and retrospectively analyzed. Patients were diagnosed by the Mayo Clinic criteria. All-cause mortality over mean follow-up of 1,529±1,121 days was revealed. Significantly more male patients died within long-term follow-up compared to female TTC patients (log-rank test; P=0.01). Most males died of noncardiac causes. In multivariate Cox regression analysis, the male sex (P=0.02, hazard ratio [HR] 2.8, 95% CI 1.1-7.2), the ejection fraction ≤35% (P=0.01, HR 3.3, 95% CI 1.2-9.2) and glomerular filtration rate <60 mL/min (P<0.01, HR 3.1, 95% CI 1.4-7.0) figured out as independent predictors of the adverse outcome. CONCLUSION: This study shows that males suffering from TTC reveal a higher long-term all-cause mortality rate than females over a 5 year follow-up period.

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