Frequency components of systolic blood pressure variability reflect vasomotor and cardiac sympathetic functions in conscious rats

In this study, after confirming the suppression of autonomic nervous function by isoflurane anesthesia using autonomic antagonists, we pharmacologically investigated the involvement of vasomotor and cardiac sympathetic functions in systolic blood pressure variability (SBPV) frequency components in conscious rats at rest and during exposure to low-ambient temperature (LT-exposure, 9°C for 90 min). Under unanesthesia, phentolamine administration (α-adrenoceptor antagonist, 10 mg/kg) decreased the mid-frequency component (MF 0.33–0.73 Hz) and inversely increased the high-frequency component (HF 1.3–2.5 Hz). The increased HF was suppressed by subsequent treatment with atenolol (β-adrenoceptor antagonist, 10 mg/kg), but not with atropine (muscarinic receptor antagonist, 10 mg/kg). Moreover, phentolamine administration after atenolol decreased MF, but did not increase HF. LT-exposure increased MF and HF; however, phentolamine pretreatment suppressed the increased MF during LT-exposure, and atenolol pretreatment dose-dependently decreased the increased HF. These results suggest that MF and HF of SBPV may reflect α-adrenoceptor-mediated vasomotor function and β-adrenoceptor-mediated cardiac sympathetic function, respectively, in the conscious state

Mononeuropatia múltipla periférica confluente associada a hepatite B aguda: relato de caso

A thirty three year-old, male patient was admitted at the Hospital of the São Paulo University School of Medicine, at the city of São Paulo, Brazil, with complaint of pains, tingling and decreased sensibility in the right hand for the last four months. This had progressed to the left hand, left foot and right foot, in addition to a difficulty of flexing and stretching in the left foot. Tests were positive for HBeAg, IgM anti-HBc and HBsAg, thus characterizing the condition of acute hepatitis B. The ALT serum level was 15 times above the upper normal limit. Blood glucose, cerebral spinal fluid, antinuclear antibodies (ANA) and anti-HIV and anti-HCV serum tests were either normal or negative. Electroneuromyography disclosed severe peripheral neuropathy with an axon prevalence and signs of denervation; nerve biopsy disclosed intense vasculitis. The diagnosis of multiple confluent mononeuropathy associated to acute hepatitis B was done. This association is not often reported in international literature and its probable cause is the direct action of the hepatitis B virus on the nerves or a vasculitis of the vasa nervorum brought about by deposits of immune complexes.Um paciente de 33 anos, do sexo masculino, foi internado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil, queixando-se de dores, formigamento e diminuição da sensibilidade em mão direita há quatro meses, que progrediram para mão esquerda e ambos os pés, com surgimento de dificuldade de flexão e extensão do pé esquerdo. As pesquisas de anti-HBc IgM, HBeAg e HBsAg foram positivas, caracterizando quadro de hepatite B aguda, com ALT atingindo valores quinze vezes acima da normalidade. Os exames de glicemia, FAN, líquor, sorologias anti-HIV e anti-HCV foram normais ou negativos. A eletroneuromiografia mostrou intensa neuropatia periférica de predomínio axonal, com sinais de desnervação; a biópsia de nervo demonstrou intensa vasculite. Foi feito o diagnóstico de mononeuropatia múltipla confluente associada a hepatite B aguda. Esta associação é pouco referida na literatura internacional, e tem como causa provável uma ação direta do vírus da hepatite B sobre os nervos ou uma vasculite da vasa nervorum causada pela deposição de imunocomplexos

Association between components of metabolic syndrome and elevated intraocular pressure

Background: Glaucoma is a group of eye diseases which result in damage to the optic nerve and ultimately vision loss. Elevated intraocular pressure (IOP) remains as the one major known risk factor for both the development and progression of glaucoma. Metabolic syndrome (MS) have been found to relate to elevated IOP. The aim of the study is to examine the association between MS and IOP by comparing central corneal thicknesses (CCT).Methods: The study was carried out with 169 subjects consists of 94 were clinically diagnosed MS patients and 75 are healthy controls. Serum fasting glucose, triglyceride and HDL cholesterol levels were measured, and waist circumference, body mass index and blood pressure of all patients were recorded. Ophthalmological examinations, including IOP and CCT measurements were done on everyone.Results: Higher IOP was observed in subjects with MS than those without MS. There was significant difference in the CCT values between the groups with and without MS (p<0.05). Most of the MS components were associated with IOP and CCT (p<0.05).Conclusions: The study concludes that components of MS have strong association with IOP and CCT. The prevalence of MS is increasing rapidly in developing countries and the main cause for MS is sedentary lifestyle. Since there is relationship between MS and IOP, lifestyle intervention might have therapeutic potential to reduce IOP. Further studies are warranted to bring about the possible underlying relationship between components of MS and IOP

Estimating outflow facility parameters for the human eye using hypotensive pressure-time data

We have previously developed a new theory for pressure dependent outflow from the human eye, and tested the model using experimental data at intraocular pressures above normal eye pressures. In this paper, we use our model to analyze a hypotensive pressure-time dataset obtained following application of a Honan balloon. Here we show that the hypotensive pressure-time data can be successfully analyzed using our proposed pressure dependent outflow model. When the most uncertain initial data point is removed from the dataset, then parameter estimates are close to our previous parameter estimates, but clearly parameter estimates are very sensitive to assumptions. We further show that (i) for a measured intraocular pressure-time curve, the estimated model parameter for whole eye surface hydraulic conductivity is primarily a function of the ocular rigidity, and (ii) the estimated model parameter that controls the rate of decrease of outflow with increasing pressure is primarily a function of the convexity of the monotonic pressure-time curve. Reducing parameter uncertainty could be accomplished using new technologies to obtain higher quality datasets, and by gathering additional data to better define model parameter ranges for the normal eye. With additional research, we expect the pressure dependent outflow analysis described herein may find applications in the differential diagnosis, prognosis and monitoring of the glaucomatous eye

当科うつ病入院患者における治療経過中の血圧変動

うつ病と高血圧などの心血管系疾患ついては関連を示唆する多くの報告があるが、一定の見解には至っていない。そこで今回我々は、抑うつ症状の悪化を契機に当科に入院した大うつ病性障害患者12名の入院後1週間の平均血圧と症状改善後の安定期の平均血圧を調査・検討した。その結果、全12例の平均では入院時（117/71mmHg）と安定期（114/71mmHg）で血圧に差はなかったが、単一エピソード群（3名：131/78→ 105/67）で反復性群（9名：112/68→ 116/72）と比較して入院時に上昇していた血圧が安定期には低下する傾向が認められた。また、高齢の単一エピソード群には症状の悪化と血圧の上昇が相関している症例も存在した。以上から、高齢の初発例では血圧上昇を起こしやすい可能性も考えられ、診察する際には留意する必要があると思われた

Exercício físico supervisionado em adolescentes com anorexia nervosa: revisão sistemática

Diversos estudos abordam a prática da atividade física supervisionada em tratamento de anorexia nervosa, porém divergem em relação aos possíveis benefícios/prejuízos. Nosso objetivo foi revisar sistematicamente os efeitos do exercício físico supervisionado sobre o índice de massa corporal (IMC) em adolescentes durante o tratamento para anorexia nervosa. Foram consultadas as bases de dados: PubMed, EMBASE, Cochrane e SCOPUS. Os termos de busca utilizados foram: exercise, anorexia e adolescente, sendo selecionados artigos baseados nos desfechos de interesse de IMC. Foi encontrado um total de 591 artigos. Destes, foram selecionados três, que analisaram os efeitos do exercício físico supervisionado sobre o IMC em adolescentes durante o tratamento para anorexia nervosa. Não houve prejuízos em relação ao peso das pacientes, porém os ganhos não foram tão evidentes por marcadores clínicos ou biológicos. Há uma carência de estudos que avaliem a validade de atividade física durante o tratamento de anorexia em adolescentes

European Shareholder Rights Directive proposals: a critical analysis in mapping with the UK Stewardship Code?

The proposed amendments to the EU Shareholders’ Rights Directive purport to improve shareholder rights and powers in investee companies. In general, these initiatives provide minority shareholders with confidence in corporate governance and could be useful as a supply-side stimulating measure to encourage investor interest in pan-European equity\ud markets, therefore contributing to the much-needed European initiative to develop deep and liquid capital markets in order to provide corporate finance.1 This paper focuses on the Articles that purport to develop ‘shareholder stewardship’ on the part of institutional shareholders. The Articles seem to be derived from the UK Stewardship Code which legitimises and encourages active corporate governance roles for shareholders, therefore boosting their corporate governance rights. However, this paper critically questions that apparent resemblance, and argues that the Articles borrow the cloak of the stewardship concept to introduce regulatory measures for investment management practice, and the purpose and function of these Articles may not accord with the essential ‘corporate governance’ paradigm that that Directive is framed in

Endocrine adjuvant therapy might impair cardiac autonomic regulation in breast cancer survivors

Introduction: Cardiovascular diseases and mortality represent a major issue in breast cancer survivors (BCS). Unhealthy lifestyle and some side effects of long term adjuvant therapy may contribute to increase cardiovascular risk. Autonomic Nervous System (ANS) impairment may contribute to initial cardiovascular alteration and early detection of its malfunction in clinical settings could help foster cardiovascular health in these patients. Methods: This observational study involved 229 outpatient subjects subdivided into three groups: 1) BCS under long term Adjuvant Endocrine Therapy (AET), 2) BCS not on AET, 3) matched healthy controls. Autoregressive spectral analysis of cardiovascular variabilities furnished markers of ANS control, considering simple time and frequency domain classifiers (such as RR variance), and meta-classifiers (such as the index alpha, combining RR and arterial pressure oscillatory information, or ANSI, a percent ranked multivariate unitary index of Autonomic control). Patients\u2019 history, medical examination, blood tests and a lifestyle questionnaire, focusing on exercise, nutrition, and stress, were also employed. Results: Amplitude indices of ANS regulation (in particular RR variance) appeared progressively (p&lt;0.001) reduced from Controls to Patients not receiving (AET-) and to those receiving (AET+) endocrine therapy; similar changes were observed for meta-classifiers (particularly ANSI: 65.2 \ub1 21.7; 56.9 \ub1 27.7; 43.1 \ub1 26.2, p&lt;0.001)). Conclusion: Endocrine therapy is associated with impaired autonomic regulation. Autoregressive spectral analysis of heart rate variability may be an affordable and convenient tool to furnish, in a clinical setting, early markers of cardiovascular dysregulation, which may possibly contribute to an overall increased cardiovascular risk