Υπερηχογραφική αξιολόγηση του διαφράγματος σε ασθενείς με καρδιακή ανεπάρκεια και διατηρημένο κλάσμα εξώθησης.

Εισαγωγή: Η ανοχή στην άσκηση των ασθενών με καρδιακή ανεπάρκεια και διατηρημένο κλάσμα εξώθησης (ΚΑΔΚΕ), η οποία εκφράζεται ποσοτικά με τη μέτρηση της κορυφαίας πρόσληψης οξυγόνου (peak VO2) κατά την δοκιμασία καρδιοαναπνευστικής κόπωσης, αποτελεί βασικό προγνωστικό παράγοντα θνησιμότητας και εξαρτάται από κεντρικούς και περιφερικούς παράγοντες όπως η μυϊκή δυσλειτουργία. Υπάρχουν ελάχιστες ενδείξεις, ωστόσο, σχετικά με την επίδραση των σκελετικών μυών και ιδίως του διαφράγματος και του τετρακέφαλου στην μειωμένη peak VO2 των ασθενών με ΚΑΔΚΕ. Συνεπώς σκοπός της παρούσας μελέτης ήταν η υπερηχογραφική διερεύνηση ύπαρξης δυσλειτουργίας του διαφράγματος και του τετρακέφαλου μυός σε ασθενείς με ΚΑΔΚΕ συγκριτικά με ομάδα ελέγχου και η συσχέτισή τους με την peak VO2. Μεθοδολογία: Σε αυτήν τη συγχρονική μελέτη συμμετείχαν 25 ασθενείς με ΚΑΔΚΕ και 25 υγιείς μάρτυρες αντίστοιχης ηλικίας και φύλου, οι οποίοι υποβλήθηκαν σε υπερηχογραφική αξιολόγηση της μετατόπισης του διαφράγματος κατά την ήρεμη (QBr) και βαθιά (DBr) αναπνοή, της εγκάρσιας διατομής του ορθού μηριαίου μυός (RFcsa) και του πάχους του τετρακέφαλου μυός (Qt) καθώς και σε καρδιοαναπνευστική δοκιμασία κόπωσης. Αποτελέσματα: Όλοι οι υπερηχογραφικοί δείκτες και η peak VO2 παρουσίασαν στατιστικά σημαντική διαφορά μεταξύ ασθενών και μαρτύρων (p<0.05). Υπήρξε σημαντική συσχέτιση της κορυφαίας πρόσληψης οξυγόνου με την Rfcsa (r=0.31, p=0.05), Qt (r=0.36, p<0.05), QBr (r=0.47, p<0.01), DBr (r=0.71, p<0.001) και τη δύσπνοια (RPD) (r=0.60, p<0.001). Η μετατόπιση του διαφράγματος κατά τη βαθιά αναπνοή είχε μεγαλύτερη βαρύτητα ως προς τη συσχέτιση με τη peak VO2 στο σύνολο του δείγματος (p<0.001) αλλά και στους ασθενείς με ΚΑΔΚΕ (p=0.019) και στην ομάδα ελέγχου (p<0.001) ξεχωριστά. Συμπέρασμα: Η υψηλή συσχέτιση της λειτουργικότητας του διαφράγματος και του τετρακέφαλου μυός με τη μειωμένη ανοχή στην άσκηση, ενισχύει τον ρόλο των σκελετικών μυών στη παθοφυσιολογία των συμπτωμάτων της ΚΑΔΚΕ. Η μετατόπιση του διαφράγματος κατά τη βαθιά αναπνοή έχει μεγαλύτερη βαρύτητα.Background: In patients with heart failure and preserved ejection fraction (HFpEF), exercise intolerance, measured by peak oxygen uptake (VO2), is a prognostic factor of morbidity. There is sparse information regarding skeletal muscles abnormalities and their relationship with exercise intolerance in these patients. Thus, we thought to investigate the difference of diaphragm function and quadriceps parameters measured by ultrasound, in HFpEF patients compared to healthy controls and the relation between the aforementioned parameters with exercise intolerance measured by peak VO2 uptake. Methods: In this cross-sectional study, 25 patients with HFpEF and 25 matched controls were included. Ultrasound (US) assessment of diaphragm excursion during quiet (QBr) and deep breathing (DBr), rectus femoris cross-sectional area (RFcsa), quadriceps thickness (Qt) and cardiopulmonary exercise testing (CPET) were performed the same day for all participants. Results: All US parameters and peak VO2 differ significantly between HFpEF patients and controls (p<0.05). The partial correlation coefficients among US parameters and peak VO2, after adjusting for group, age and gender revealed that greater peak VO2 was associated with higher Rfcsa (r=0.31, p=0.05), Qt (r=0.36, p<0.05), QBr (r=0.47, p<0.01), DBr (r=0.71, p<0.001) and reported dyspnea (RPD) (r=0.60, p<0.001). DBr was mostly associated with peak VO2 in total sample (p<0.001), in HFpEF (p=0.019) and control group (p<0.001) separately. Conclusions: The high correlation of diaphragm and quadriceps muscle status with exercise intolerance supports the role of skeletal muscles in the pathophysiology of symptom generation in HFpEF patients, while diaphragmatic excursion during deep breathing is of higher importance

Stress-related asthma and family therapy: Case study

This paper applies the Biobehavioral Family Model (BBFM) of stress- related illness to the study and treatment of an adolescent with intractable asthma. The model is described, along with supportive research findings. Then a case study is presented, demonstrating how the model is clinically applied. We tell the story of an asthmatic adolescent presenting for therapy due to her intense asthmatic crises, and the case is presented to exemplify how the BBFM can help understand the family-psychobiological contribution to exacerbation of disease activity, and therefore guide treatment towards the amelioration of severe physical symptoms. Facets of the patient’s intra-familial interactions are consistent with the BBFM, which support clinical validation of the model. In the case described, it is likely that additional asthma medications would not have had the desired ameliorative effect, because they did not target the family relational processes contributing to the symptoms. The recognition of the influences of family relational processes on the disease was crucial for effective intervention. The therapy incorporates and weaves together BBFM understanding of family patterns of interaction and physiological/medical concerns integrated with Bowenian intervention strategies. This case study validates the importance and usefulness of BBFM for intervention with stress-sensitive illnesses such as asthma

Continuity equation is the echocardiographic method of choice to assess degenerative mitral stenosis

We present a rare case of a patient with severe, symptomatic degenerative calcific mitral stenosis (MS). Calcification of mitral valve annulus (MVA) is a frequent finding in elderly patients. It can be isolated or associated more often with mitral valve insufficiency than MS. In rare cases, it results in severe MS. An accurate measurement of MVA in degenerative calcific MS is problematic because the limiting orifice is near the annulus and not at the leaflet tips as in rheumatic MS. Continuity equation is the best echocardiographic method to assess the MVA in degenerative MS, correlating well with invasive methods. Real-time three-dimensional echocardiography is a promising tool and provides an accurate measurement of MVA in calcific MS, with a very good correlation compared to continuity equation. On the other hand, the use of pressure half-time is often inaccurate and should be avoided, while two-dimensional planimetry is difficult and not reliable in degenerative MS. The values of mean gradient and systolic pulmonary artery pressure depend on several factors and should be only supportive signs and should not be considered as surrogate markers of the severity of MS. (Cardiol J 2011; 18, 5: 577–580

Adrenoceptor-stimulated inflammatory response in stress-induced serum amyloid A synthesis

Rationale Stressful life events are suggested to contribute to the development of various pathologies, such as cardiovascular disorders, whose etiopathogenesis is highly associated with elevated levels of serum amyloid A (SAA) proteins. SAA synthesis inthe liver isregulated bya complex network ofcytokines actingindependently orinconcert withvarious hormones/stimulants including the stress-activated sympathetic nervous system. Objective This study aims to investigate the underlying mechanisms that regulate the stress-induced hepatic synthesis of SAA, with particular focus on adrenoceptors (AR), major components of the sympathoadrenal response to stress. Methods and results We demonstrated that repeated stress elevates IL-1β, IL-6, and TNFα serum levels in mice, accompanied by increased synthesis and secretion of hepatic SAA1/2 and SAA3, an effect that was blocked by AR antagonists. Moreover, stimulation ofα1- andβ1/2-ARsmimics thestress effectonSAA1/2 regulation, whereas α2-AR stimulation exhibitsa relatively weakimpactonSAA.InsupportoftheessentialcytokinecontributionintheAR-agonistinducedSAAproductionisthefactthat theanti-inflammatorydrug,sodiumsalicylate,preventedtheAR-stimulatedhepaticSAA1/2synthesisbyreducingIL-1βlevels, whereasIL-1βinhibitionwithAnakinramimicsthissodiumsalicylatepreventiveeffect,thusindicatingacrucial rolefor IL-1β. Interestingly, the AR-driven SAA3 synthesis was elevated by sodium salicylate in a TNFα-dependent way, supporting diverse and complex regulatory roles of cytokines in SAA production. In contrast to α1/α2-AR, the β1/2-AR-mediated SAA1/2 and SAA3 upregulation cannot be reversed by fenofibrate, a hypolipidemic drug with anti-inflammatory properties. Conclusion Taken together, these findings strongly support a critical role of the AR-stimulated inflammatory response in the hepatic SAA production under stressful conditions, highlighting distinct AR type-specific mechanisms that regulate the hepatic synthesis of SAA1/2 and SAA3.This research was supported by the European Union (European Regional Development Fund-ERDF) and the Greek national funds through the Operational Program "THESSALY-MAINLAND GREECE AND EPIRUS-2007-2013" of the National Strategic Reference Framework (NSRF 2007-2013, Grant 346985/80753) and the National Cancer Institute Intramural Research Program.info:eu-repo/semantics/publishedVersio

Plasticity in life history traits of a cyprinid fish in an intermittent river

The extreme seasonal environmental variation of intermittent rivers has a profound effect on freshwater fish communities. Yet, few studies have examined the consequences of the seasonal cycles of flooding and drying to fish condition and reproduction in these ecosystems. In this study, we compared the body condition, reproduction and diet of two chub populations from two adjacent sites (a perennial and an intermittent site) on the main stem of a Mediterranean river (Evrotas River, S. Greece). The study was conducted in spring 2017, three months after flow resumption and before the onset of chub reproductive period. Condition (net weight adjusted for length) of fish did not differ significantly between the two sites, despite lower aquatic macroinvertebrate availability at the intermittent site. Fish at the intermittent site compensated for the lower aquatic prey availability by increasing their feeding intensity and by shifting to higher terrestrial prey consumption. In addition, chub liver weight (adjusted for length) and gonadal weight (adjusted for length) were significantly higher at the intermittent site, indicating higher somatic and reproductive investment. These results highlight the resilience of fish populations inhabiting streams with extreme variation in flow, due to natural and/or anthropogenic drought

Adrenoceptor‐related decrease in serum triglycerides is independent of PPARα activation

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151956/1/febs14966.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151956/2/febs14966_am.pd

Planetary space weather: scientific aspects and future perspectives

International audienceIn this paper, we review the scientific aspects of planetary space weather at different regions of our Solar System, performing a comparative planetology analysis that includes a direct reference to the circum-terrestrial case. Through an interdisciplinary analysis of existing results based both on observational data and theoretical models, we review the nature of the interactions between the environment of a Solar System body other than the Earth and the impinging plasma/radiation, and we offer some considerations related to the planning of future space observations. We highlight the importance of such comparative studies for data interpretations in the context of future space missions (e.g. ESA JUICE; ESA/JAXA BEPI COLOMBO). Moreover, we discuss how the study of planetary space weather can provide feedback for better understanding the traditional circum-terrestrial space weather. Finally, a strategy for future global investigations related to this thematic is proposed

Derivation of relativistic SEP properties through neutron monitor data modeling

The Ground Level Enhancement (GLE) data recorded by the worldwide Neutron Monitor (NM) network are useful resources for space weather modeling during solar extreme events. The derivation of Solar Energetic Particles (SEPs) properties through NM-data modeling is essential for the study of solar-terrestrial physics, providing information that cannot be obtained through the exclusive use of space techniques; an example is the derivation of the higher-energy part of the SEP spectrum. We briefly review how the application of the Neutron Monitor Based Anisotropic GLE Pure Power Law (NMBANGLE PPOLA) model (Plainaki et al. 2010), can provide the characteristics of the relativistic SEP flux, at a selected altitude in the Earth's atmosphere, during a GLE. Technically, the model treats the NM network as an integrated omnidirectional spectrometer and solves the inverse problem of the SEP-GLE coupling. As test cases, we present the results obtained for two different GLEs, namely GLE 60 and GLE 71, occurring at a temporal distance of ~ 11 years