Anxiety can significantly explain bolus perception in the context of hypotensive esophageal motility: Results of a large multicenter study in asymptomatic individuals

This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving'. © 2017 John Wiley & Sons, Inc. All rights reserved. This author accepted manuscript is made available following 12 month embargo from date of publication (May 2017) in accordance with the publisher’s archiving policyBackground Previous studies have not been able to correlate manometry findings with bolus perception. The aim of this study was to evaluate correlation of different variables, including traditional manometric variables (at diagnostic and extreme thresholds), esophageal shortening, bolus transit, automated impedance manometry (AIM) metrics and mood with bolus passage perception in a large cohort of asymptomatic individuals. Methods High resolution manometry (HRM) was performed in healthy individuals from nine centers. Perception was evaluated using a 5‐point Likert scale. Anxiety was evaluated using Hospitalized Anxiety and Depression scale (HAD). Subgroup analysis was also performed classifying studies into normal, hypotensive, vigorous, and obstructive patterns. Key Results One hundred fifteen studies were analyzed (69 using HRM and 46 using high resolution impedance manometry (HRIM); 3.5% swallows in 9.6% of volunteers were perceived. There was no correlation of any of the traditional HRM variables, esophageal shortening, AIM metrics nor bolus transit with perception scores. There was no HRM variable showing difference in perception when comparing normal vs extreme values (percentile 1 or 99). Anxiety but not depression was correlated with perception. Among hypotensive pattern, anxiety was a strong predictor of variance in perception (R2 up to .70). Conclusion and Inferences Bolus perception is less common than abnormal motility among healthy individuals. Neither esophageal motor function nor bolus dynamics evaluated with several techniques seems to explain differences in bolus perception. Different mechanisms seem to be relevant in different manometric patterns. Anxiety is a significant predictor of bolus perception in the context of hypotensive motility

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Does Altitude of Birth Influence the Performance of National- to Elite-Level Colombian Cyclists?

To determine whether the altitude of birth/childhood influences the values in peak power output (PPO) and estimated maximum oxygen uptake (estVO2max) in male Colombian road cyclists of different performance levels. This study also aimed to determine whether cyclists born at high altitudes tend to be more successful. Eighty riders aged between 17 and 22 years of 3 performance levels (U23 world-class level, WC, n = 8; U23 national level, N23, n = 41; junior national level, J, n = 31) and 3 altitude levels (&lt;800 m, low; 800-2000 m, moderate; &gt;2000 m, high) performed an ergocycle maximal incremental test to exhaustion at an altitude of 2570 m. Altogether, while cyclists born at an altitude &gt;2000 m represented ∼50% of the analyzed sample, there was a significantly higher proportion (84%) of these cyclists who had participated as professionals in a Grand Tour (χ2[1, N = 80] = 4.58, P &lt; .05). Riders of the low group had lower values of PPO and estVO2max than cyclists of moderate and high altitudes, while no differences were noted between moderate- and high-altitude groups. In N23, PPO and estVO2max were lower in the low- than in the moderate-altitude group, while in the J cyclists, PPO and estVO2max were lower in the low-altitude compared with both moderate- and high-altitude groups. Among the cyclists tested at altitude in junior and U23, there is an overrepresentation of individuals who reached an elite level and were born at a high altitude (&gt;2000 m). As no clear differences were observed between moderate- and high-altitude cyclists, the higher prevalence of elite cyclists in the latter group may originate from various-still unclear-mechanisms

Estudio del efecto del confinamiento por la COVID-19 sobre ciertas variables psicológicas en una población deportista de tecnificación y/o alto rendimiento en las Islas Baleares

[spa] Como respuesta a la amenazadora progresión de la pandemia por COVID en 2020, el 14 de marzo de dicho año el Gobierno español ordenó el confinamiento domiciliario de la población mediante la declaración del estado de alarma. En este contexto de excepcionalidad, el Centre de Tecnificació Esportiva Illes Balears. (CTEIB) decidió realizar un estudio sobre el impacto psicológico de dicho confinamiento sobre la población deportista de la comunidad, utilizando con tal fin una muestra del CTEIB y de deportistas de alto rendimiento. Partiendo de los estudios anteriores sobre la afectación psicológica registrada en grupos de población sometidos a confinamientos prolongados (viajes espaciales, expediciones árticas, etc.), las variables contempladas en nuestro estudio se agruparon en cinco posibles órdenes de impacto mental y comportamental que podían afectar negativamente la población deportista estudiada. Se estudiaron así mediante pruebas psicométricas estandarizadas o bien mediante cuestionarios ad hoc diseñados para esta situación los siguientes factores: cambios o distorsiones en la percepción subjetiva temporal, la direccionalidad del foco atencional y la percepción de la imagen corporal y de autoeficacia; variaciones significativas en los estados de ánimo; preservación de la autoidentidad y la imagen social como deportista; disminución de la capacidad de afrontamiento debido a respuestas de ansiedad y temor ante el futuro profesional, y finalmente la posible alteración de los hábitos alimentarios. Se presentan y discuten así en el presente trabajo los principales resultados obtenidos en cada una de estas dimensiones del estudio, cuya principal finalidad es aportar información para poder anticipar tendencias desadaptativas en vistas a un futuro confinamiento. Se considera así que el conocimiento alcanzado puede ser de utilidad para anticipar, y en su caso controlar, dichos posibles desajustes en futuras situaciones de confinamiento o cese de la actividad físico-técnica por alguna otra adversidad. Debido a la adaptación a las normas de publicación de la revista Enginy, sólo presentamos los datos más relevantes del estudio, al que se puede acceder en su formato completo a través de este enlace: https://drive.google.com/file/d/1CTwMSdKKUv5OvYX7gaZ6trtXqi3w9yLs/view?usp=sharin