Tilt-table testing as a predictor of + Gz tolerance

BACKGROUND: G-tolerance assessment is an essential element of both military pilot and pilot candidate evaluation. AIMS: Attempt at prediction of individual relaxed + Gz tolerance on the basis of head-up tilt (HUT) testing. SETTINGS AND DESIGN: In two stages, 20 healthy men at the mean age 21.5 years took part in this study. The first stage, a 45 min, HUT test was performed using the Westminster protocol. During the second stage each underwent a centrifuge evaluation in response to gradual onset rate profiles. METHODS AND MATERIAL: In each subject, heart rate (HR) and blood pressure (BP) before and at 2, 15 and 45 min of the tilt-test were recorded. The gravity-load centrifuge (GOR) studies were carried out [following the standard GOR programme, at 0.1 G/s rate of gravity load increase until the gravity load tolerance limit (loss of peripheral vision) was reached]. STATISTICAL ANALYSIS USED: Relationships between variables were explored using Kendall′s tau-B correlation coefficient. The critical P-level was one-tailed 0.05. RESULTS: In four of 20 subjects (20%), vasovagal syncope occurred during the tilt test. G-level tolerance of this group (of +Gz accelerations) lay in the range from +4 to +8.1 Gz, (+5.72 ? 0.86 Gz average) and was comparable to the group without syncope. Loss of consciousness did not occur in any subjects during the centrifuge test. No statistically significant correlation was observed between HR and BP during tilt test and tolerance to +Gz accelerations. CONCLUSIONS: The result of tilt testing, carried out according to the Westminster protocol, was not useful in predicting individual tolerance to +Gz gravity loads

Metabolic syndrome is associated with similar long-term prognosis in non-obese and obese patients. An analysis of 45 615 patients from the nationwide LIPIDOGRAM 2004-2015 cohort studies

Aims We aimed to evaluate the association between metabolic syndrome (MetS) and long-term all-cause mortality. Methods The LIPIDOGRAM studies were carried out in the primary care in Poland in 2004, 2006 and 2015. MetS was diagnosed based on the National Cholesterol Education Program, Adult Treatment Panel III (NCEP/ATP III) and Joint Interim Statement (JIS) criteria. The cohort was divided into four groups: non-obese patients without MetS, obese patients without MetS, non-obese patients with MetS and obese patients with MetS. Differences in all-cause mortality was analyzed using Kaplan-Meier and Cox regression analyses. Results 45,615 participants were enrolled (mean age 56.3, standard deviation: 11.8 years; 61.7% female). MetS was diagnosed in 14,202 (31%) by NCEP/ATP III criteria, and 17,216 (37.7%) by JIS criteria. Follow-up was available for 44,620 (97.8%, median duration 15.3 years) patients. MetS was associated with increased mortality risk among the obese (hazard ratio, HR: 1.88 [95% CI, 1.79-1.99] and HR: 1.93 [95% CI 1.82-2.04], according to NCEP/ATP III and JIS criteria, respectively) and non-obese individuals (HR: 2.11 [95% CI 1.85-2.40] and 1.7 [95% CI, 1.56-1.85] according to NCEP/ATP III and JIS criteria respectively). Obese patients without MetS had a higher mortality risk than non-obese patients without MetS (HR: 1.16 [95% CI 1.10-1.23] and HR: 1.22 [95%CI 1.15-1.30], respectively in subgroups with NCEP/ATP III and JIS criteria applied). Conclusions MetS is associated with increased all-cause mortality risk in non-obese and obese patients. In patients without MetS obesity remains significantly associated with mortality. The concept of metabolically healthy obesity should be revised