Upper airway factors that protect against obstructive sleep apnoea in healthy older males.

The prevalence of obstructive sleep apnoea (OSA) increases with age, yet the risk factors for OSA in older people remain poorly understood. This study aimed to define the age-related changes in upper airway morphology in carefully matched groups of healthy older (>60 years, n=11) and younger (<40 years, n=14) males, using direct (magnetic resonance imaging (MRI)) and indirect (acoustic reflection) imaging. The median (interquartile range) combined retropalatal and retroglossal pharyngeal length was greater in older than in younger males (older 8.8 (7.8-9.0) cm, younger 7.8 (7.0-8.3) cm; p=0.03), as was the soft palate cross-sectional area (older 43.1 (36.0-48.8) cm(2), younger 35.3 (30.5-40.5) cm(2); p=0.03), parapharyngeal fat pad diameter (older 1.7 (1.4-2.2) cm, younger 1.2 (1.0-1.8) cm; p=0.03) and cross-sectional area of the fat pads (older 13.8 (9.1-17.1) cm(2); younger 7.4 (5.9-13.0) cm(2); p=0.02) as measured by MRI. Using acoustic reflection, pharyngeal calibre (older 4.8 (3.8-6.6) cm(2), younger 3.4 (2.8-4.6) cm(2); p=0.03), pharyngeal volume (older 35.1 (30.9-55.4) cm(3), younger 27.2 (22.7-44.2) cm(3); p=0.04) and glottis area (older 2.7 (2.1-3.9) cm(2), younger 1.3 (1.1-1.9) cm(2); p=0.003) were also larger in older participants compared with younger participants. There was no difference in craniofacial measures between groups, including volumetric data and hyoid bone position. The larger pharyngeal calibre observed in older males may be compensating for an age-related enlargement in pharyngeal soft tissue that predisposes to OSA.

Cardiovascular responsiveness to sympathoexcitatory stress in subjects with and without mild hypertension.

PURPOSE: This study compared blood pressure, heart rate variability (HRV) and forearm blood flow, at rest and in response to sympathoexcitatory stressors between normotensive and mildly hypertensive participants. METHODS: Participants aged 30-79 years with normal blood pressure (n = 49) or mild hypertension (n = 17), with no history of taking antihypertensive medication, were recruited. Participants completed a cold pressor test (CPT) followed by an ischaemic handgrip test (IHGT). Blood pressure, HRV, forearm blood flow and vascular resistance were measured at rest and in response to each test. RESULTS: The CPT and IHGT evoked greater increases in mean arterial blood pressure in hypertensive participants (CPT: 10 ± 2 mmHg, IHGT: 9 ± 1 mmHg) compared with normotensive participants (CPT: 5 ± 1 mmHg, IHGT: 3 ± 1 mmHg; P < 0.05). Resting high frequency power, which is a parameter of HRV associated with parasympathetic cardiac modulation, was lower in hypertensive participants (hypertensive: 31.73 ± 4.07 nu; normotensive: 42.08 ± 2.22 nu; P = 0.026) and was negatively correlated with systolic blood pressure (r = -0.272, P = 0.03) and mean arterial pressure across all participants (r = -0.258, P < 0.05). There were no differences in HRV or forearm blood flow responses to the CPT or IHGT between groups. CONCLUSION: This study demonstrated that sympathoexcitatory stress evoked by the CPT and IHGT induces an augmented blood pressure response in individuals with mild hypertension, which supports the notion that autonomic dysfunction is likely to contribute to the pathogenesis of hypertension. It remains to be determined whether the hypertensive response is mediated through alterations in cardiac activity, peripheral vascular resistance or both.

Autonomic dysfunction in essential hypertension: A systematic review.

INTRODUCTION: Greater sympathetic drive has been established in the early stages of essential hypertension, suggesting that neurohormonal dysregulation may be key to its aetiology and progression. The aims of this review are to discuss evidence of the role of autonomic dysfunction in essential hypertension and proposed mechanisms, and also some applications of this knowledge to current management strategies of essential hypertension. METHODS: A computer search was performed using the PUBMED database for peer reviewed original articles comparing autonomic function tested via heart rate variability (HRV), muscle sympathetic nerve activity (MSNA) or plasma noradrenaline levels in normotensive (mean blood pressure (BP) of ≤140/90 mmHg or ≤135/85 mmHg if measured via home BP measurements) and hypertensive groups (mean resting BP of ≥140/90 mmHg (or ≥135/85 mmHg if measured via home BP measurements). Subjects were excluded with secondary causes of hypertension or autonomic dysfunction. RESULTS: A total of 17 studies were included for discussion. The main findings of this study include that of reduced baroreflex sensitivity, believed to be secondary to increased arterial stiffness, is hypothesised to be implicated in the pathogenesis of essential hypertension. Also, angiotensin converting enzyme inhibitors were not as effective on markers of autonomic control of blood pressure when compared with alternative anti-hypertensive drugs. CONCLUSIONS: Consistent research is needed to establish the effectiveness of pharmacotherapies at each of stage of hypertension, and on markers of autonomic dysfunction. Consistent study designs will enable more accurate accumulation of data across multiple studies, and appropriate application of such data into clinical practice.

Paracetamol poisoning in the UK: a meeting report from Pharmacology 2013.

Pharmacology 2013; a meeting of the British Pharmacological Society Queen Elizabeth II Conference Centre, Westminster, London, UK, 17-19 December 2013 Pharmacology 2013 is the annual meeting of the British Pharmacological Society, and was held on 17-19th December 2013 at the Queen Elizabeth II Conference Centre in Westminster, London. This report will discuss the symposium entitled 'Paracetamol poisoning in the United Kingdom - where are we now and what is the future?' Paracetamol overdose is a common and important presentation to emergency departments. This symposium and report aim to highlight current practice legislation surrounding the purchase of paracetamol and its compounds, and novel biomarkers for the diagnosis and identification of high-risk groups who require efficient instigation of treatment.

Highlights on corticospinal damage and movement control from the commemorative symposium honoring the retirement of Professor Roger Lemon.

A symposium entitled "Motor control: from the periphery to the cortex and back' was held at the University College London Institute of Neurology to commemorate the retirement of Professor Roger Lemon, whose research has significantly advanced the field of fine motor cortical control. This report focuses on discussions at the symposium regarding the descending tracts associated with motor control, highlighting the neurological response and subsequent rehabilitation of motor pathway damage resulting from cerebrovascular insults.

Advances on regulatory T cells from the 15th International Congress of Immunology.

The International Congress of Immunology is the largest congregation of immunologists and meets every three years. This year, the congress was held in Milan and included talks on both basic and translational aspects of immunology. Talks on the field of regulatory T cell biology and function are highlighted in this report.

Commentary on "estimation of newborn risk for child or adolescent obesity: lessons from longitudinal birth cohorts".

Childhood obesity is an increasingly prevalent problem, associated with obesity later in life, and a sequalae of health problems such as metabolic syndrome and an increased risk of coronary heart disease. Poor nutrition and a lack of physical activity are said to be causes of obesity development, with genetic factors and heritability also implicated. However, there are established, identifiable risk factors associated with the future development of obesity, both in childhood, and adolescence. These include parental weight before pregnancy, gestational weight gain, pre-pregnancy maternal smoking, as well as numerous socioeconomic factors.(1-4) Studies have also shown that once obese, children can find it very difficult to lose the excess weight,(5) with long-term management methods having shown poor efficacy.(5) Therefore, preventative strategies are becoming a high priority to battle the ever-increasing epidemic of childhood obesity. This study by Morandi et al.(6) is the first longitudinal study to analyse the predictive properties of early life risk factors for obesity, and propose a subsequent predictive algorithm to identify newborns most at risk of becoming obese in childhood and adolescence. Morandi et al.'s study aimed to develop a clinically useful formula, which could be used to identify the risk of future obesity in newborns, thereby enabling more efficient implementation of prevention strategies.(6) The lifetime Northern Finland Birth Cohort 1986 (NFBC 1986) was used to form predictive equations for both childhood and adolescent obesity, based on established risk factors: parental BMI, birth weight, maternal gestational weight gain, and socioeconomic factors. A genetic score was also created based on 39 BMI/obesity-associated polymorphisms. Validation studies were performed on both a retrospective cohort of children from Veneto, Italy, and a prospective cohort of children from Massachusetts, USA.