Ocena aktywności autonomicznego układu nerwowego związanej z odruchową regulacją układu sercowo-naczyniowego i oddychania

Derangements within autonomic nervous system take part in the natural history of cardiovascular disease. Current paper presents three categories of methods measuring autonomic status: direct methods (e.g. laboratory tests measuring circulating catecholamine levels or based on isotopes, microneurography), indirect methods applied at rest (e.g. analysis of heart rate variability, spectral and sequence methods of arterial baroreflex sensitivity assessment) and indirect methods, associated with the exposure to physiological stimuli (e.g. Ewing’s battery, central and peripheral chemoreceptor sensitivity assessment, invasive methods of arterial baroreflex sensitivity assessment). This review provides an insight into the physiology of reflex regulatory mechanisms within cardiorespiratory system, including their complex and unstable nature. Kardiol Pol 2010; 68, 8: 951-95

Impact of marathon performance on muscles stiffness in runners over 50 years old

IntroductionThe research examines the relationship between marathon performance and muscle stiffness changes from pre to marathon in recreational runners aged 50+ years.MethodsThirty-one male long-distance runners aged 50–73 years participated in the experiment. The muscle stiffness of quadriceps and calves was measured in two independent sessions: the day before the marathon and 30 min after the completed marathon run using a Myoton device.Results and DiscussionThe 42.195-km run was completed in 4.30,05 h ± 35.12 min, which indicates an intensity of 79.3% ± 7.1% of HRmax. The long-term, low-intensity running exercise (marathon) in older recreational runners and the low level of HRmax and VO2max showed no statistically significant changes in muscle stiffness (quadriceps and calves). There was reduced muscle stiffness (p = 0.016), but only in the triceps of the calf in the dominant (left) leg. Moreover, to optimally evaluate the marathon and adequately prepare for the performance training program, we need to consider the direct and indirect analyses of the running economy, running technique, and HRmax and VO2max variables. These variables significantly affect marathon exercise

Nurses participation in the treatment or patients with diabetic foot syndrome

Powyższa praca poświęcona jest zespołowi stopy cukrzycowej. Jest to przewlekłe powikłanie cukrzycy, którego leczenie jest procesem trudnym i interpersonalnym.Praca składa się z trzech rozdziałów.Rozdział 1 to omówienie istoty choroby, klasyfikacji cukrzycy oraz sposoby jej leczenia.Rozdział 2 przybliża szerzej zagadnienie zespołu stopy cukrzycowej.W rozdziale 3 została przedstawiona rola pielęgniarki jako edukatorki oraz jej udział w diagnostyce, rehabilitacji i opiece nad chorym z zespołem stopy cukrzycowej.This work is dedicated to diabetic foot syndrome. It is a chronic complication of diabetes mellitus, the treatment is a difficult and interpersonal process.The work consists of three chapters.Chapter 1 is a discuss about the nature of the disease, the classification of diabetes mellitus and ways to treat it.Chapter 2 brings the wider issue of diabetic foot syndrome.In Chapter 3 was presented role of nurses as a educator and nurse’s involvement in the diagnosis, rehabilitation and care of patients with diabetic foot syndrome

Baroreceptor sensitivity and diabetes mellitus

Diabetes mellitus (DM) is a disease of increasing incidence and prevalence. Arterial baroreceptors are stretch-sensitive receptors, which in a reflex manner are involved in the homeostatic control of arterial blood pressure. Diabetic subjects have depressed baroreflex sensitivity (BRS), although the exact pathomechanisms are unclear. In this review, we discuss the features, clinicaland prognostic implications of reduced BRS for diabetic patients and the potential involvement of cardiovascular autonomic neuropathy and atherosclerosis. Finally, we demonstrate evidence on interventions (e.g. pioglitazone, alpha-lipoic acid, leptin, fluvastatin, physicaltraining etc.) which could improve BRS and ameliorate cardiovascular autonomic dysfunction in diabetic patients

Patterns of Locus of Control in People Suffering from Heart Failure: An Approach by Clustering Method

Background and Objectives: The assumption of responsibility in dealing with chronic diseases is of relevance in a resource-oriented and not only deficit-oriented medicine, especially in dealing with chronic diseases, including patients with chronic heart failure. The aim of the present study is to examine, based on the model of “locus of control”, whether there are different patterns that would be relevant for a more targeted education and support of self-management in dealing with heart failure. Materials and Methods: For this purpose, a sample (n = 758) from 11 Polish cardiology centers have been assessed using the standardized self-assessment scale Multidimensional Health Locus of Control (MHLC), consisting of three dimensions: (i) internal localization of health control; (ii) external control by powerful others; (iii) external control by chance. Results: Using these three criteria, nine different clusters were extracted (mean size: 84 ± 33 patients, min 31, max 129). Three clusters included over 100 patients, whereas only two included less than 50 people. Only one cluster gathered 42 patients who will be able to cooperate with professionals in the most fruitful way. There were two clusters, including patients with beliefs related to the risk of ignoring professional recommendations. Clusters where patients declared beliefs about others’ control with low internal control should also be provided with specific help. Conclusions: The division into clusters revealed significant variability of belief structures about health locus of control within the analyzed group. The presented methodological approach may help adjust education and motivation to a selected constellation of beliefs as a compromise between group-oriented vs. individual approach

Przewlekła niewydolność serca. Wzmożona aktywność ergoreceptorów mięśni szkieletowych a nietolerancja wysiłku

Background: In chronic heart failure (CHF), skeletal muscle abnormalities may lead to the overactivation of ergoreceptors which in turn may cause sympathetic overactivation and increased ventilatory response to exercise.Aim: To assess ergoreceptor reflex response to exercise and to evaluate whether ergoreceptor overactivity is related to the progression of CHF.Methods: In 69 patients with CHF (66 males, mean age 62.7±11.6 years, NYHA class I/II/III/IV - 11/32/24/2 patients, respectively) and 24 controls without CHF (22 males, mean age 59±4.6 years) the ergoreflex contribution to the ventilatory and haemodynamic responses to exercise was evaluated. Moreover, in 13 patients with CHF, reproducibility of the measurements was assessed by repeating the test 1 to 7 days later.Results: Enhanced ergoreflex effects on ventilation (1.9±1.6 vs 0.14±0.7 l/min,

Reduction in Circulating Testosterone Relates to Exercise Capacity in Men With Chronic Heart Failure

Background: We investigated whether anabolic deficiency was linked to exercise intolerance in men with chronic heart failure (CHF). Anabolic hormones (testosterone, dehydroepiandrosterone sulfate, insulin-like growth factor 1 [IGF1]) contribute to exercise capacity in healthy men. This issue remains unclear in CHF. Methods and Results: We Studied 205 men with CHF (age 60 +/- 11 years, New York Heart Association [NYHA] Class I/II/III/IV: 37/95/65/8; LVEF [lelt ventricular ejection fraction]: 31 +/- 8%). Exercise capacity was expressed as peak oxygen consumption (peak VO2), peak O-2 pulse, and ventilatory response to exercise (VE-VCO2 slope). In multivariable models, reduced peak VO2 (and reduced peak O-2 pulse) was associated with diminished serum total testosterone (TT) (P < .01) and free testosterone (eFT; estimated front TT and sex hormone globulin levels) (P < .01), which was independent of NYHA Class, plasma N-terminal pro-brain natriuretic peptide, and age. These associations remained significant even after adjustment for an amount of leg lean tissue. In multivariable models, high VE-VCO2 slope was related to reduced serum IGF1 (P < .05), advanced NYHA Class (P < .05), increased plasma NT-proBNP (P < .0001), and borderline low LVEF (P = .07). In 44 men, reassessed after 2.3 +/- 0.4 years, a reduction in peak VO2 (and peak O-2 Pulse) was accompanied by a decrease in TT (P < .01) and eFT (P <= .01). Increase in VE-VCO2 slope was related only to an increase in plasma NT-proBNP (P < .05). Conclusions: In men with CHF, low circulating testosterone independently relates to exercise intolerance. The greater the reduction of serum TT in the course of disease, the more severe the progression of exercise intolerance. Whether testosterone supplementation would improve exercise capacity in hypogonadal men with CHF requires further Studies. (J Cardiac Fail 2009;15:442-450