Validation d'une nouvelle technique de mesure de la pression artérielle chez l'obèse morbide

L'obésité est devenue une préoccupation de santé majeure de nos jours affectant une grande partie de la population mondiale. La forme la plus sévère d'obésité, soit l'obésité morbide, est également en augmentation. Une des problématiques reliées à cette population est la mesure de la pression artérielle. Le membre supérieur de ces patients est souvent de forme conique, assez gros et court, ce qui rend la mesure inadéquate, très difficile, voire irréalisable de façon précise. L'objectif de la présente étude était de valider une nouvelle technique de mesure de la pression artérielle à l'avant-bras chez l'obèse morbide. Des études ont été réalisées dans le passé avec une approche semblable, mais la taille des échantillons étaient très petite, ce qui n'était donc pas adéquat pour moduler la pratique médicale. Afin d'introduire cette nouvelle technique de mesure de la pression artérielle à l'avant-bras dans la pratique médicale, nous avons opté pour un échantillon plus grands de sujets et un nombre élevé de mesures de la pression artérielle a été fait. Trois groupes de patients ont été évalués à l'aide d'une canule artérielle installée à l'avant-bras et d'un brassard standard de taille appropriée installé à l'avant-bras contra latéral ou au bras contra latéral. Des mesures de pression artérielle ont donc été prises à des intervalles réguliers avec un appareil automatique de mesure de pression artérielle, afin de comparer la mesure prise avec celle effectuée à l'aide de la canule artérielle à l'avant-bras contra latéral considérée comme étant la mesure étalon. Les résultats suggèrent que les deux techniques corrèlent bien ensemble mais que la technique du brassard installé à l'avant-bras tend à surestimer de 8 mmHg en ce qui a trait à la pression artérielle systolique et de sous-estimer de 1 mmHg la pression artérielle diastolique mesurée par la canule artérielle

Certification of breast centres in Germany: proof of concept for a prototypical example of quality assurance in multidisciplinary cancer care

<p>Abstract</p> <p>Background</p> <p>The main study objectives were: to develop a set of requirements of comprehensive breast centres; to establish a nationwide voluntary certification programme for breast centres based on such requirements, a certified quality management system (QMS), and scheduled independent, external audits and periodic recertification; and to demonstrate the general acceptance of such a certification programme with a view to introducing similar certification programmes for other major cancers.</p> <p>Methods</p> <p>Breast centres introduced a QMS and voluntarily participated in an external certification procedure based on guideline-derived Requirements of Breast Centres specifically developed for the application procedure, all subsequent audits and recertification. All data (numbers of pending and successful applications, sites/centre, etc.) were collected by a newly founded, independent organisation for certification of cancer services delivery. Data analysis was descriptive.</p> <p>Results</p> <p>Requirements of Breast Centres were developed by the German Cancer Society (DKG), the German Society of Senology (DGS) and other relevant specialist medical societies in the form of a questionnaire comprising 185 essential items based on evidence-based guidelines and the European Society of Breast Cancer Specialists' (EUSOMA) requirements of specialist breast units. From late 2002 to mid 2008, the number of participating breast centres rose from 1 to 175. As of mid 2008, 77% of an estimated 50,000 new breast cancers in Germany were diagnosed and treated at certified breast centres, 78% of which were single-site centres.</p> <p>Conclusion</p> <p>Nationwide voluntary certification of breast centres is feasible and well accepted in Germany. Dual certification of breast centres that involves certification of breast services to guideline-derived requirements in conjunction with independent certification of a mandatory QMS can serve as a model for other multidisciplinary site-specific cancer centres.</p

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Nitrile and neoprene rubber nanocomposites

The goal of this project was to determine whether the addition of organically modified montmorillonite clay improved mechanical properties and decreased permeation of a chemical warfare agent simulant in nitrile and neoprene rubber. The modification types were chosen using TEM and XRD testing. The chosen modified clay was mixed into the rubber in varying percentages. The clay did not seem to improve the mechanical or barrier properties for neoprene. The clay seemed to improve only the barrier properties for nitrile

Impact of Beta-Blockade on Exercise Capacity in Subjects with Type 2 Diabetes

Background: Beta-blockers are prescribed to subjects with type 2 diabetes with coronary disease to reduce all-cause mortality. However, this medication reduces exercise capacity in non diabetic individuals. The purpose of this study was to evaluate the impact of beta-blockade on exercise capacity in diabetic subjects free of coronary disease. Methods: Ten sedentary men with type 2 diabetes participated in this study. Subjects were treated with oral hypoglycemic agents and/or diet. Exercise capacity was evaluated using an incremental protocol performed on a cycle ergometer. Subjects were evaluated without (WBB group) and following the use of a beta-blocker (Atenolol 100 mg, id) for 5 consecutive days (BB group). Results: Per study design, subjects were their own control. The BB situation was characterized by a lower resting heart rate (HR) (54&#177;4 vs 74&#177;12 bpm; P < 0.001) and a trend toward a lower resting systolic blood pressure (SBP) (123&#177;11 vs 131&#177;14 mmHg; P=0.1) compared to the WBB evaluation. Even with comparable peak workload achieved (193&#177;27 vs 200&#177;22 watts), there was a 13 % reduction in relative and absolute values of peak oxygen uptake (25.8&#177;3.4 vs 29.7&#177;4.1 ml&#183;kg-1&#183;min-1; P < 0.05 and 2.5&#177;0.5 vs 2.9&#177;0.6 L&#183;min-1 respectively; P < 0.001), a 35 % reduction in peak HR (110&#177;9 vs 169&#177;14 bpm; P < 0.001) and a 21 % reduction in peak SBP (167&#177;24 vs 211&#177;20 mmHg; P < 0.001) in the BB compared to the WBB situation. Also, the BB situation showed a lower peak minute-ventilation (97&#177;15 vs 120&#177;24 L/min; P < 0.05) compared with WBB. Conclusion: These results suggest that in subjects with type 2 diabetes free of coronary disease, the use of a beta-blockers impedes cardio-respiratory function at peak exercise beyond compensatory mechanisms leading to a decreased exercise capacity

Impact of &#946;-blocker treatment and nutritional status on glycemic response during exercise in patients with type 2 diabetes

Purpose: Most individuals with type 2 diabetes are affected by hypertension and thus have higher risk of cardiac complications. In addition to behavioural modifications, such as healthy food choices and regular physical activity, &#946;-blocker treatment may be considered to reduce morbidity and mortality, especially after a cardiovascular event. However, this medication is generally associated with a deleterious impact on glucose metabolism. The objective of the study was to assess the impact of &#946;-blocker treatment on glucose response during exercise in patients with type 2 diabetes, free of cardiovascular complications. Methods: Ten sedentary men, treated with diet and/or hypoglycemic agents have performed four exercise sessions at 60% of their &#65532;O2peak, in the fasted state or 2 hours following a standardized breakfast, with and without &#946;-blockers (atenolol 100 mg id for five consecutive days). Blood samples were drawn during the resting period, at 15-min intervals during the exercise session and during the recovery period. Results: A reduction of blood glucose levels was observed following the exercise session in the postprandial state (48% and 44% reduction with and without &#946;-blockers respectively; P < 0.001). One hour of exercise performed in the fasted state had a minimal impact on glucose and insulin levels, whether with or without &#946;-blockers. &#946;-blocker treatment was not associated with increased baseline blood glucose or insulin levels in the fasted or the postprandial situation. Conclusion: Dietary status has a more important impact on plasma glucose and insulin modulation than short-term use of &#946;-blockers

Blood Pressure Measurement in Morbid Obesity: Comparison between Forearm and Intra-Arterial Assessment of Blood pressure

Background: Obesity is associated with high blood pressure. Measurement of blood pressure (BP) in morbid obesity with a larger cuff bladder may be erroneous due to the anatomy of their upper limb and/or a nonsuitable cuff bladder. The objective of the study was to compare a non-invasive technique of BP measurement on the forearm with an appropriate standard blood cuff bladder to an invasive method (intra-arterial measurement in the radial artery) in two groups of subjects; non obese (NO) and morbidly obese (MO). Methods: Twenty-seven NO subjects with a mean body mass index (BMI) of 25,6 &#177; 2,7 kg/m2 were evaluated using two different techniques for blood pressure measurement. Measures were performed, in a supine position, at the forearm level with a standard cuff bladder (Welch Allyn, NY, USA) and on the opposite forearm using an intra-arterial access. The NO group was compared to 20 MO subjects with a mean BMI of 5,1 &#177; 8,7 kg/m2. The MO group was evaluated during a bariatric surgery procedure, with regular intervals (10 to 15 min) using the same two methods described above. Results: A difference was observed between the two techniques of blood pressure measurements (P < 0.05 and P < 0.01 intra-arterial vs. cuff bladder for the NO and the MO groups respectively) (see Table). Correlations between the two techniques were observed in the NO group (P < 0.001) for the systolic BP (r=0,823) and the diastolic BP (r=0,769). Similar correlations were also observed in the MO group for the systolic BP (r=0,792, P < 0,001) and the diastolic BP (r=0,830, P < 0,001; Table). *** Table in Full Text PDF. *** Conclusion: Although different, BP measurements at the forearm level in MO subjects seems to be clinically valid. This technique may be used in this specific population as an alternative for the measurement of BP

Dysfunctional cGMP Signaling Leads to Age-Related Retinal Vascular Alterations and Astrocyte Remodeling in Mice

The nitric oxide&ndash;guanylyl cyclase-1&ndash;cyclic guanylate monophosphate (NO&ndash;GC-1&ndash;cGMP) pathway is integral to the control of vascular tone and morphology. Mice lacking the alpha catalytic domain of guanylate cyclase (GC1&minus;/&minus;) develop retinal ganglion cell (RGC) degeneration with age, with only modest fluctuations in intraocular pressure (IOP). Increasing the bioavailability of cGMP in GC1&minus;/&minus; mice prevents neurodegeneration independently of IOP, suggesting alternative mechanisms of retinal neurodegeneration. In continuation to these studies, we explored the hypothesis that dysfunctional cGMP signaling leads to changes in the neurovascular unit that may contribute to RGC degeneration. We assessed retinal vasculature and astrocyte morphology in young and aged GC1&minus;/&minus; and wild type mice. GC1&minus;/&minus; mice exhibit increased peripheral retinal vessel dilation and shorter retinal vessel branching with increasing age compared to Wt mice. Astrocyte cell morphology is aberrant, and glial fibrillary acidic protein (GFAP) density is increased in young and aged GC1&minus;/&minus; mice, with areas of dense astrocyte matting around blood vessels. Our results suggest that proper cGMP signaling is essential to retinal vessel morphology with increasing age. Vascular changed are preceded by alterations in astrocyte morphology which may together contribute to retinal neurodegeneration and loss of visual acuity observed in GC1&minus;/&minus; mice

High-resolution positron emission tomography/computed tomography imaging of the mouse heart

Different animal models have been used to reproduce coronary heart disease but in the last years mice became the animals of choice, because of their short life cycle and the possibility of genetic manipulation. Various techniques are currently used for cardiovascular imaging in mice, including high-resolution ultrasound, X-ray computed tomography (CT), magnetic resonance imaging and nuclear medicine procedures. In particular, molecular imaging with cardiac positron emission tomography (PET) allows to evaluate noninvasively changes in myocardial perfusion, metabolism, apoptosis, inflammation, and gene expression or to measure changes in left ventricular functional parameters. With technological advancements, dedicated small laboratory PET/CT imaging has emerged in cardiovascular research, providing in vivo a non-invasive, serial and quantitative assessment of left ventricular function, myocardial perfusion and metabolism at a molecular level. This non-invasive methodology might be useful in longitudinal studies monitoring cardiac biochemical parameters and might facilitate studies to assess the effect of different interventions after acute myocardial ischemia