Nivel de actividad física y capacidad aeróbica en adultos con cardiopatía congénita

Els adults amb cardiopatia congènita (CC) tenen la capacitat aeròbica (CA) reduïda a causa de la pròpia malaltia i/o factors aliens com el nivell d'activitat física (AF). L'objectiu principal d'aquesta tesi doctoral és investigar els efectes de l'associació entre l'AF i la CA en adults amb CC. Aquest objectiu s'ha dividit en tres estudis: (1) Avaluar l'associació entre el nivell d'AF (MET-min/setmana) i la CA (consum pic d'oxigen VO2), així com també analitzar si l'augment dels nivells d'AF podria millorar la CA d'adults amb CC; (2) Estudiar l'evolució de la CA de pacients adults amb CC, així com analitzar els canvis de composició corporal en el seguiment a mig termini; (3) Investigar el percentatge de metges especialitzats en Cardiopatia Congènita (CC) que recullen informació sobre l’AF dels pacients amb CC i descriure la seva percepció de l'impacte de l'AF sobre la salut dels pacients. Els resultats de l'estudi I mostren que els adults amb CC tenen la CA (VO2) un 13% més baixa que els valors predits en condicions no patològiques. L'AF i CA es van associar positivament. En general, l'augment de 1000 MET-min/setmana es va associar amb un increment de 0.8 ml/kg/min en el VO2peak relatiu (p < 0.001) independentment del sexe i edat dels participants o severitat de la CC. En l'estudi II, en un període de seguiment mitjà de 4.5 (2.0) anys, observem una reducció significativa de la CA [VO2peak (5.6) ml/kg/min entre el període inicial i el seguiment (p = 0.003)]. Identifiquem una correlació positiva, amb una tendència a millor CA en pacients que acumulen més AF en una setmana (p = 0.063). Pel que fa al pes corporal, hi va haver un lleuger increment entre l'inici i el seguiment, (mitjana 1.5 (5.3) kg; p = 0.001), amb una associació negativa entre l' augment de pes i la CA i una tendència a millor CA en aquells pacients que mantenen o redueixen el pes corporal en el seguiment. L'estudi III mostra que 90% de metges especialitzats en CC afirmen registrar l'AF a la història clínica del pacient i, en general, l'AF va ser percebuda amb un impacte positiu en la salut dels pacients amb CC. Aquestes troballes suggereixen que la lleugera disminució de la CA, en els adults amb CC en el temps, és un signe d'evolució natural de la malaltia (estudi II) i que l'augment del nivell d'AF en adults amb CC millora significativament la CA, per tant, podria recomanar-se (estudi II), especialment quan els metges especialitzats en CC la perceben amb un impacte positiu en la salut i qualitat de vida dels pacients (estudi III).Los adultos con cardiopatía congénita (CC) tienen la capacidad aeróbica (CA) reducida debido a la propia enfermedad y/o factores ajenos como el nivel de actividad física (AF). El objetivo principal de esta tesis doctoral es investigar los efectos de la asociación entre la AF y la CA en adultos con CC. Este objetivo se ha dividido en tres estudios: (1) Evaluar la asociación entre el nivel de AF (MET-min/semana) y la CA (consumo pico de oxigeno VO2pico), así como también analizar si el aumento de los niveles de AF podría mejorar la CA de adultos con CC; (2) Estudiar la evolución de la CA de pacientes adultos con CC, así como analizar los cambios de peso corporal en el seguimiento a medio término; (3) Investigar el porcentaje de médicos especializados en Cardiopatía Congénita (CC) que recogen información sobre la (AF) de los pacientes con CC y describir su percepción del impacto de la AF sobre la salud de los pacientes. Los resultados del estudio I muestran que los adultos con CC tienen la CA (VO2pico) un 13% más baja que los valores predicho en condiciones no patológicas. La AF y CA se asociaron positivamente. En general, el aumento de 1000 MET-min/semana se asoció con un incremento de 0.8 ml/kg/min en el VO2pico relativo (p < 0.001) independiente del sexo y edad de los participantes o severidad de la CC. En el estudio II, en un periodo de seguimiento medio de 4.5 (2.0) años, observamos una reducción significativa de la CA [VO2pico media -1.3 (5.6) ml/kg/min entre el periodo inicial y el seguimiento (p = 0.003)]. Identificamos una correlación positiva, con una tendencia a mejor CA en pacientes que acumulan más AF en una semana (p = 0.063). En cuanto al peso corporal, hubo un ligero incremento entre el inicio y el seguimiento, (media 1.5 (5.3) kg; p = 0.001), con una asociación negativa entre el aumento de peso y la CA y una tendencia a mejor CA en aquellos pacientes que mantienen o reducen el peso corporal en el seguimiento. El estudio III muestra que 90% de médicos especializados en CC afirman registrar la AF en la historia clínica del paciente y en general, la AF fue percibida con el impacto positivo en la salud de los pacientes con CC. Estos hallazgos sugieren que la ligera disminución de la CA, en los adultos con CC en el tiempo, es un signo de evolución natural de la enfermedad (estudio II) y que el aumento del nivel de AF en adultos con CC mejora significativamente la CA, por lo tanto, podría recomendarse (estudio II), especialmente cuando los médicos especializados en CC la perciben con un impacto positivo en la salud y calidad de vida de los pacientes (estudio III).Adults with congenital Heart Disease (CHD) have reduced aerobic capacity (AC) due to the disease itself and/or external factors such as the level of physical activity (PA). The main objective of this doctoral thesis is to investigate the effects of the association between PA and AC in adults with CHD. This objective has been divided into three studies: (1) To evaluate the association between PA level (MET-min/week) and AC (peak oxygen consumption VO2peak), as well as to analyze whether increasing PA levels could improve AC in adults with CHD; (2) To study the evolution of the AC in adults with CHD, as well as to analyze changes in body composition in a mid-term follow-up; (3) To investigate the percentage of physicians specialized in CHD who collect information on the PA of patients with CHD and describe their perception of the impact of PA on patients' health. The results of Study I show that adults with CHD have AC (VO2peak) 13% lower than predicted values in non-pathological conditions. PA and AC were positively associated. Overall, the increase of 1000 MET-min/week was associated with an increase of 0.8 ml/kg/min in relative VO2peak (p < 0.001) regardless of participants' sex and age or severity of CHD. In Study II, at a mean follow-up period of 4.5 (2.0) years, we observed a significant reduction in AC [mean VO2peak -1.3 (5.6) ml/kg/min between baseline and follow-up (p = 0.003)]. We identified a positive correlation, with a tendency to a better AC in patients who accumulate more PA in a week (p = 0.063). In terms of body weight, there was a slight increase between baseline and follow-up, (mean 1.5 (5.3) kg; p = 0.001), with a negative association between weight gain and AC, and a tendency to improve AC in those patients who maintain or reduce body weight at follow-up. Study III shows that 90% of physicians specialized in CHD refer they record PA in the patient's clinical history and, in general, PA was perceived as a positive impact on the health of patients with CHD. These findings suggest that the slight decrease in AC in adults with CHD, over time, is a sign of natural disease history (study II) and that the increased level of PA in adults with CHD significantly improves AC, therefore, it could be recommended to perform PA (Study II), especially when doctors specialized in CHD perceive it as having a positive impact on health and patients' life expectancy (Study III)

Aerobic Capacity in Adults with Congenital Heart Disease: More than VO2peak, a Follow-Up Study

Adults; Aerobic capacity; Congenital heart diseaseAdultos; Capacidad aeróbica; Cardiopatía congénitaAdults; Capacitat aeròbica; Cardiopatia congènitaTo control the development of people with congenital heart disease (CHD), it is important to follow their aerobic capacity (AC), especially when they exercise. This research aimed to study the progress of AC during a follow-up of adults with CHD. This is a longitudinal study which involved 127 adults with a mean age of 33.8 (11.1) years (57.5% female; 75 moderate CHD and 52 complex CHD) who had undergone two cardiopulmonary exercise tests (CEPT) in at least one year between the first and the second test. The AC and exercise performance (EP) (duration of exercise time, velocity and percentage of grade) were assessed using a ramp protocol over a treadmill. In a mean of 4.5 (2.0) years of follow-up, there was a significant decrease in AC. The VO2peak at baseline was 27.8 (27.7) mL/kg/min (82.9% (20.3%) predicted) versus 26.6 (7.8) mL/kg/min (79.3% (20.8%) predicted) at the end of follow-up. This decline was independent of the body weight increase. There was no significant difference in HRpeak and EP among periods. These results suggest a sign of favorable evolution of adults with CHD. More research is needed to study different factors that could contribute to AC reduction.This research was funded by SUR of DEC Generalitat de Catalunya and European Union, PhD grant number 2020FI_B2_00128. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript

Association of Self-Reported and Device-Measured Sedentary Behaviour and Physical Activity with Health-Related Quality of Life among European Older Adults

Human movement behaviours such as physical activity (PA) and sedentary behaviour (SB) during waking time have a significant impact on health-related quality of life (HRQoL) in older adults. In this study, we aimed to analyse the association between self-reported and device-measured SB and PA with HRQoL in a cohort of community-dwelling older adults from four European countries. A subsample of 1193 participants from the SITLESS trial (61% women and 75.1 ± 6.2 years old) were included in the analysis. The association between self-reported and objective measures of SB and PA with HRQoL were quantified using Spearman’s Rho coefficients. The strength of the associations between self-reported and device-measured PA and SB with self-rated HRQoL (mental composite score, MCS; physical composite score, PCS) were assessed through multivariate multiple regression analysis. Self-reported and device-measured PA and SB levels showed significant but poor associations with PCS (p < 0.05). The association with MCS was only significant but poor with self-reported light PA (LPA) and moderate-to-vigorous PA (MVPA). In conclusion, the findings of this study suggest that both self-reported and device-measured PA of all intensities were positively and significantly associated, while SB was negatively and significantly associated with the PCS of the SF-12

A Novel Model of Mixed Vascular Dementia Incorporating Hypertension in a Rat Model of Alzheimer's Disease.

Alzheimer's disease (AD) and mixed dementia (MxD) comprise the majority of dementia cases in the growing global aging population. MxD describes the coexistence of AD pathology with vascular pathology, including cerebral small vessel disease (SVD). Cardiovascular disease increases risk for AD and MxD, but mechanistic synergisms between the coexisting pathologies affecting dementia risk, progression and the ultimate clinical manifestations remain elusive. To explore the additive or synergistic interactions between AD and chronic hypertension, we developed a rat model of MxD, produced by breeding APPswe/PS1ΔE9 transgenes into the stroke-prone spontaneously hypertensive rat (SHRSP) background, resulting in the SHRSP/FAD model and three control groups (FAD, SHRSP and non-hypertensive WKY rats, n = 8-11, both sexes, 16-18 months of age). After behavioral testing, rats were euthanized, and tissue assessed for vascular, neuroinflammatory and AD pathology. Hypertension was preserved in the SHRSP/FAD cross. Results showed that SHRSP increased FAD-dependent neuroinflammation (microglia and astrocytes) and tau pathology, but plaque pathology changes were subtle, including fewer plaques with compact cores and slightly reduced plaque burden. Evidence for vascular pathology included a change in the distribution of astrocytic end-foot protein aquaporin-4, normally distributed in microvessels, but in SHRSP/FAD rats largely dissociated from vessels, appearing disorganized or redistributed into neuropil. Other evidence of SVD-like pathology included increased collagen IV staining in cerebral vessels and PECAM1 levels. We identified a plasma biomarker in SHRSP/FAD rats that was the only group to show increased Aqp-4 in plasma exosomes. Evidence of neuron damage in SHRSP/FAD rats included increased caspase-cleaved actin, loss of myelin and reduced calbindin staining in neurons. Further, there were mitochondrial deficits specific to SHRSP/FAD, notably the loss of complex II, accompanying FAD-dependent loss of mitochondrial complex I. Cognitive deficits exhibited by FAD rats were not exacerbated by the introduction of the SHRSP phenotype, nor was the hyperactivity phenotype associated with SHRSP altered by the FAD transgene. This novel rat model of MxD, encompassing an amyloidogenic transgene with a hypertensive phenotype, exhibits several features associated with human vascular or "mixed" dementia and may be a useful tool in delineating the pathophysiology of MxD and development of therapeutics

Determining cut-off points in functional assessment scales in stroke

[EN] BACKGROUND: A wide variety of well-validated assessment scales of functioning and disability have been developed for stroke population. However, these instruments have limitations in their interpretation. Therefore, determining cut-off points for their categorization becomes necessary. OBJECTIVES: To determine cut-off points for the BI, FIM and FAM scales to differentiate clinical disability categories and to establish the relationship between mRS and DOS scales. METHODS: One hundred and six adults with ischemic or haemorrhagic stroke were mainly recruited from a rehabilitation facility (Hospitales Nisa, Valencia, Spain). RESULTS: A high correlation was observed between the DOS and mRS scales (Kendall's tau-b = 0.475; p = 0.000) although a certain amount of disagreement between the two scales was detected. The cut-off points were 62.90 (95% CI, 57.26-69.29) and 21.30 (95% CI, 16.34-26.03) for the BI; 70.62 (95% CI, 66.65-75.22) and 38.29 (95% CI, 34.07-42.25) for the FIM; and 116.07 (95% CI, 110.30-122.68) and 66.02 (95% CI, 59.20-72.35) for the FAM. CONCLUSION(S): DOS was observed to be more demanding than the mRS, in terms of patient independence. Additionally, the lower cut-off points separating the levels of severe and moderate disability in the BI, FIM and FAM were determined. These findings would facilitate practitioners clinical interpretation of disability levels in post-stroke patients.Balasch I Bernat, M.; Balasch Parisi, S.; Noe Sebastian, E.; Dueñas Moscardo, L.; Ferri Campos, J.; Lopez Bueno, L. (2015). Determining cut-off points in functional assessment scales in stroke. NeuroRehabilitation. 37(2):165-172. doi:10.3233/NRE-151249S16517237

Airborne concentration and deposition of trace metals and metalloids in an urban area downwind of a manganese alloy plant

The evaluation of the content of metals and metalloids in particulate matter (PM) and in atmospheric deposition in areas impacted by local industries is essential from an environmental and health risk perspective. In this study, the PM10 levels and atmospheric deposition fluxes of potentially toxic metals and metalloids were quantified at three urban sites of the Cantabrian region (northern Spain), located at different distances downwind of a Mn alloy plant. The content of Mn, V, Fe, Ni, Cu, Zn, As, Mo, Cd, Sb and Pb in PM10 and in the water-soluble and insoluble fractions of the deposition was determined by ICP-MS. Among the studied elements, the highest concentrations in PM10 and deposition rates were found for Mn, Fe, Zn and Pb, associated with the Mn alloy industry, and for Cu, related to non-exhaust traffic emissions. The levels of Mn, Fe, Zn and Pb in PM10 were higher in autumn, when the most frequent winds blow from the S-SW, whereas their highest deposition rates were found in winter and autumn, which are characterized by high monthly average precipitations. The water-soluble fraction of the atmospheric deposition of most metals increased with distance from the Mn alloy plant. The highest water-soluble fractions were found for Ni (72%), Zn (62%), Cu (60%) and Mn (49%). These results will be useful for the health risk assessment of the metal exposure associated with Mn alloy plants, as well as for the evaluation of the metal burden to soil, water and ecosystems related to this industrial activity.This work was financially supported by the Spanish Ministry of Economy and Competitiveness (MINECO) through the CTM2013-43904R Project. Ana Hernández-Pellón would like to thank the Ministry of Economy and Competitiveness (MINECO) for the FPI grant awarded, reference number BES-2014-068790

X-ray emission from the Sombrero galaxy: discrete sources

We present a study of discrete X-ray sources in and around the bulge-dominated, massive Sa galaxy, Sombrero (M104), based on new and archival Chandra observations with a total exposure of ~200 ks. With a detection limit of L_X = 1E37 erg/s and a field of view covering a galactocentric radius of ~30 kpc (11.5 arcminute), 383 sources are detected. Cross-correlation with Spitler et al.'s catalogue of Sombrero globular clusters (GCs) identified from HST/ACS observations reveals 41 X-rays sources in GCs, presumably low-mass X-ray binaries (LMXBs). We quantify the differential luminosity functions (LFs) for both the detected GC and field LMXBs, whose power-low indices (~1.1 for the GC-LF and ~1.6 for field-LF) are consistent with previous studies for elliptical galaxies. With precise sky positions of the GCs without a detected X-ray source, we further quantify, through a fluctuation analysis, the GC LF at fainter luminosities down to 1E35 erg/s. The derived index rules out a faint-end slope flatter than 1.1 at a 2 sigma significance, contrary to recent findings in several elliptical galaxies and the bulge of M31. On the other hand, the 2-6 keV unresolved emission places a tight constraint on the field LF, implying a flattened index of ~1.0 below 1E37 erg/s. We also detect 101 sources in the halo of Sombrero. The presence of these sources cannot be interpreted as galactic LMXBs whose spatial distribution empirically follows the starlight. Their number is also higher than the expected number of cosmic AGNs (52+/-11 [1 sigma]) whose surface density is constrained by deep X-ray surveys. We suggest that either the cosmic X-ray background is unusually high in the direction of Sombrero, or a distinct population of X-ray sources is present in the halo of Sombrero.Comment: 11 figures, 5 tables, ApJ in pres

Search for New Physics with Jets and Missing Transverse Momentum in pp collisions at sqrt(s) = 7 TeV

A search for new physics is presented based on an event signature of at least three jets accompanied by large missing transverse momentum, using a data sample corresponding to an integrated luminosity of 36 inverse picobarns collected in proton--proton collisions at sqrt(s)=7 TeV with the CMS detector at the LHC. No excess of events is observed above the expected standard model backgrounds, which are all estimated from the data. Exclusion limits are presented for the constrained minimal supersymmetric extension of the standard model. Cross section limits are also presented using simplified models with new particles decaying to an undetected particle and one or two jets

Performance of the CMS Cathode Strip Chambers with Cosmic Rays

The Cathode Strip Chambers (CSCs) constitute the primary muon tracking device in the CMS endcaps. Their performance has been evaluated using data taken during a cosmic ray run in fall 2008. Measured noise levels are low, with the number of noisy channels well below 1%. Coordinate resolution was measured for all types of chambers, and fall in the range 47 microns to 243 microns. The efficiencies for local charged track triggers, for hit and for segments reconstruction were measured, and are above 99%. The timing resolution per layer is approximately 5 ns