Cardiovascular Responses During Resistance Exercise in Patients with Parkinson Disease

Background: Patients with Parkinson disease (PD) present cardiovascular autonomic dysfunction which impairs blood pressure control. However, cardiovascular responses during resistance exercise are unknown in these patients. Objective: Investigate the cardiovascular responses during resistance exercise performed with different muscle masses, in patients with PD. Design: Two groups, repeated-measures design. Setting: Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo. Participants: Thirteen patients with PD (4 women, 62.7±1.3 years, stages 2-3 of modified Hoehn and Yahr scale; "on" state of medication) and thirteen paired controls without PD (7 women, 66.2±2.0years) Interventions: Both groups performed, in a random order, bilateral and unilateral knee extension exercises (2 sets, 10–12 RM, 2 min of interval). Main Outcome Measurements: Systolic blood pressure (SBP) and heart rate (HR) were assessed before (pre) and during the exercises. Results: Independent of set and exercise type, SBP and HR increases were significantly lower in PD than the control group (combined values: +45±2 vs. +73±4 mmHg and +18±1 vs. +31±2 bpm, P =.003 and .007, respectively). Independently of group and set, the SBP increase was greater in the bilateral than the unilateral exercise (combined values: +63±4 vs +54±3 mmHg, P=.002), while the HR increase was similar. In addition, independently of group and exercise type, the SBP increase was higher in the 2nd than the 1st set (combined values: +56±4 vs +61±4 mmHg, P=.04), while the HR increases were similar. Conclusions: Patients with PD present attenuated 25 increases in SBP and HR during resistance exercise in comparison with healthy subjects. These results support that resistance exercise is safe and well tolerated for patients with PD from a cardiovascular point of view supporting its recommendation for this population

Strength and power training did not modify cardiovascular responses to aerobic exercise in elderly subjects

Resistance training increases muscle strength in older adults, decreasing the effort necessary for executing physical tasks, and reducing cardiovascular load during exercise. This hypothesis has been confirmed during strength-based activities, but not during aerobic-based activities. This study determined whether different resistance training regimens, strength training (ST, constant movement velocity) or power training (PT, concentric phase performed as fast as possible) can blunt the increase in cardiovascular load during an aerobic stimulus. Older adults (63.9 ± 0.7 years) were randomly allocated to: control (N = 11), ST (N = 13, twice a week, 70-90% 1-RM) and PT (N = 15, twice a week, 30-50% 1-RM) groups. Before and after 16 weeks, oxygen uptake (VO2), systolic blood pressure (SBP), heart rate (HR), and rate pressure product (RPP) were measured during a maximal treadmill test. Resting SBP and RPP were similarly reduced in all groups (combined data = -5.7 ± 1.2 and -5.0 ± 1.7%, respectively, P < 0.05). Maximal SBP, HR and RPP did not change. The increase in measured VO2, HR and RPP for the increment in estimated VO2 (absolute load) decreased similarly in all groups (combined data = -9.1 ± 2.6, -14.1 ± 3.9, -14.2 ± 3.0%, respectively, P < 0.05), while the increments in the cardiovascular variables for the increase in measured VO2 did not change. In elderly subjects, ST and PT did not blunt submaximal or maximal HR, SBP and RPP increases during the maximal exercise test, showing that they did not reduce cardiovascular stress during aerobic tasks

A Shift to Human Body Temperature (37°C) Rapidly Reprograms Multiple Adaptive Responses in \u3ci\u3eEscherichia coli\u3c/i\u3e That Would Facilitate Niche Survival and Colonization

One of the first environmental cues sensed by a microbe as it enters a human host is an upshift in temperature to 37°C. In this dynamic time point analysis, we demonstrate that this environmental transition rapidly signals a multitude of gene expression changes in Escherichia coli. Bacteria grown at 23°C under aerobic conditions were shifted to 37°C, and mRNA expression was measured at time points after the shift to 37°C (t = 0.5, 1, and 4 h). The first hour is characterized by a transient shift to anaerobic respiration strategies and stress responses, particularly acid resistance, indicating that temperature serves as a sentinel cue to predict and prepare for various niches within the host. The temperature effects on a subset of stress response genes were shown to be mediated by RpoS and directly correlated with RpoS, DsrA, and RprA levels, and increased acid resistance was observed that was dependent on 23°C growth and RpoS. By 4 h, gene expression shifted to aerobic respiration pathways and decreased stress responses, coupled with increases in genes associated with biosynthesis (amino acid and nucleotides), iron uptake, and host defense. ompT, a gene that confers resistance to antimicrobial peptides, was highly thermoregulated, with a pattern conserved in enteropathogenic and uropathogenic E. coli strains. An immediate decrease in curli gene expression concomitant with an increase in flagellar gene expression implicates temperature in this developmental decision. Together, our studies demonstrate that temperature signals a reprogramming of gene expression immediately upon an upshift that may predict, prepare, and benefit the survival of the bacterium within the host

Characteristics associated with responsiveness to isometric handgrip training in medicated hypertensives: Secondary data anaylysis

Objective: Isometric handgrip training (IHT) has been shown to reduce blood pressure (BP) in hypertensives. However, factors that predict responsiveness to IHT are largely unknown. The aim of this study was to investigate the patient characteristics associated with the anti-hypertensive response to IHT using a recommended statistical approach for evaluating interindividual responses. Methods: Data from four randomized controlled trials were joined, totaling 81 patients undergoing IHT (48.8% women; 60±11 yr) and 90 control patients (45.6% women; 62±12 yr). IHT consisted of 4x2-minute isometric contractions at 30% of maximal voluntary contraction, performed three times/week for 8-12 weeks. BP was measured at baseline and following IHT and control interventions. The interindividual variation was assessed by the standard deviation of the individual responses (SDir), and linear regression analyses were conducted to explore response predictors. Results: IHT significantly decreased both systolic (-5.4; 95%CI: -9.5 to -1.3 mmHg) and diastolic (-2.8; 95%CI: -5.1 to -0.6 mmHg) BPs. The interindividual variation of BP change was moderate for systolic (SDir=5.2 mmHg, 0.30 standardized units) and low for diastolic (SDir=1.7 mmHg, 0.15 standardized units). Sex, age, and body mass index were not associated with the anti-hypertensive effect of IHT. However, a higher baseline systolic BP (b=-0.467, p<0.001) and absence of dihydropyridine calcium channel blockers use (b=0.340, p=0.001) were associated with greater BP reductions. Conclusion: IHT reduced BP in medicated hypertensive patients regardless of age, sex, and BMI. Patients with a higher baseline systolic BP and those not prescribed dihydropyridine calcium channel blockers were more responsive to IHT

Patterns of regional gray matter loss at different stages of schizophrenia: A multisite, cross-sectional VBM study in first-episode and chronic illness.

BACKGROUND: Structural brain abnormalities in schizophrenia have been repeatedly demonstrated in magnetic resonance imaging (MRI) studies, but it remains unclear whether these are static or progressive in nature. While longitudinal MRI studies have been traditionally used to assess the issue of progression of brain abnormalities in schizophrenia, information from cross-sectional neuroimaging studies directly comparing first-episode and chronic schizophrenia patients to healthy controls may also be useful to further clarify this issue. With the recent interest in multisite mega-analyses combining structural MRI data from multiple centers aiming at increased statistical power, the present multisite voxel-based morphometry (VBM) study was carried out to examine patterns of brain structural changes according to the different stages of illness and to ascertain which (if any) of such structural abnormalities would be specifically correlated to potential clinical moderators, including cumulative exposure to antipsychotics, age of onset, illness duration and overall illness severity. METHODS: We gathered a large sample of schizophrenia patients (161, being 99 chronic and 62 first-episode) and controls (151) from four previous morphometric MRI studies (1.5 T) carried out in the same geographical region of Brazil. Image processing and analyses were conducted using Statistical Parametric Mapping (SPM8) software with the diffeomorphic anatomical registration through exponentiated Lie algebra (DARTEL) algorithm. Group effects on regional gray matter (GM) volumes were investigated through whole-brain voxel-wise comparisons using General Linear Model Analysis of Co-variance (ANCOVA), always including total GM volume, scan protocol, age and gender as nuisance variables. Finally, correlation analyses were performed between the aforementioned clinical moderators and regional and global brain volumes. RESULTS: First-episode schizophrenia subjects displayed subtle volumetric deficits relative to controls in a circumscribed brain regional network identified only in small volume-corrected (SVC) analyses (p < 0.05, FWE-corrected), including the insula, temporolimbic structures and striatum. Chronic schizophrenia patients, on the other hand, demonstrated an extensive pattern of regional GM volume decreases relative to controls, involving bilateral superior, inferior and orbital frontal cortices, right middle frontal cortex, bilateral anterior cingulate cortices, bilateral insulae and right superior and middle temporal cortices (p < 0.05, FWE-corrected over the whole brain). GM volumes in several of those brain regions were directly correlated with age of disease onset on SVC analyses for conjoined (first-episode and chronic) schizophrenia groups. There were also widespread foci of significant negative correlation between duration of illness and relative GM volumes, but such findings remained significant only for the right dorsolateral prefrontal cortex after accounting for the influence of age of disease onset. Finally, significant negative correlations were detected between life-time cumulative exposure to antipsychotics and total GM and white matter volumes in schizophrenia patients, but no significant relationship was found between indices of antipsychotic usage and relative GM volume in any specific brain region. CONCLUSION: The above data indicate that brain changes associated with the diagnosis of schizophrenia are more widespread in chronic schizophrenia compared to first-episode patients. Our findings also suggest that relative GM volume deficits may be greater in (presumably more severe) cases with earlier age of onset, as well as varying as a function of illness duration in specific frontal brain regions. Finally, our results highlight the potentially complex effects of the continued use of antipsychotic drugs on structural brain abnormalities in schizophrenia, as we found that cumulative doses of antipsychotics affected brain volumes globally rather than selectively on frontal-temporal regions

Bizarre behavior during intracarotid sodium amytal testing (Wada test): are they predictable? Reações bizarras durante o teste do amital sódico intracarotídeo (TASI ou Teste de Wada): é possível prevê-las?

The intracarotid sodium amytal test (ISAT or Wada Test) is a commonly performed procedure in the evaluation of patients with clinically refractory epilepsy candidates to epilepsy surgery. Its goal is to promote selective and temporary interruption of hemispheric functioning, seeking to define language lateralization and risk for memory compromise following surgery. Behavioral modification is expected during the procedure. Even though it may last several minutes, in most cases it is subtle and easily manageable. We report a series of patients in whom those reactions were unusually bizarre, including agitation and aggression. Apart of the obvious technical difficulties (patients required physical restraining) those behaviors potentially promote testing delay or abortion and more importantly, inaccurate data. We reviewed those cases, seeking for features that might have predicted their occurrence. Overall, reactions are rare, seen in less than 5% of the ISAT procedures. The barbiturate effect, patients' psychiatric profiles, hemisphere dominance or selectiveness of the injection were not validated as predictors. Thorough explanation, repetition and simulation may be of help in lessening the risk of those reactions.<br>O teste do amital sódico intracarotídeo (TASI ou teste de Wada) é procedimento comum na avaliação de pacientes portadores de epilepsia clinicamente refratária candidatos a cirurgia de epilepsia. Tem por objetivo promover interrupção seletiva e temporária da função hemisferial, definindo lateralização de linguagem e risco de comprometimento de memória no pós-operatório. São esperadas mudanças comportamentais durante o teste, as quais podem durar vários minutos, porém, em geral, são sutis e facilmente manejáveis. Relatamos uma série de casos em que ocorreram comportamentos pouco usuais, bizarros, incluindo agitação e agressividade. Estes comportamentos comprometem o teste (paciente deve ser contido), podendo levar a atrasos ou mesmo abortamento do mesmo, além de produzir dados menos confiáveis. Os casos foram revisados, visando a definição de preditores de sua ocorrência. Estas reações são raras (5% dos casos). Efeito barbitúrico, perfil psiquiátrico, dominância cerebral e seletividade da injeção não puderam ser validados como preditores. Explicações detalhadas, repetição e simulações podem ser utéis na prevenção deste tipo de ocorrência