Adiposity is associated with blunted cardiovascular, neuroendocrine and cognitive responses to acute mental stress

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited - Copyright @ 2012 Jones et al.Obesity and mental stress are potent risk factors for cardiovascular disease but their relationship with each other is unclear. Resilience to stress may differ according to adiposity. Early studies that addressed this are difficult to interpret due to conflicting findings and limited methods. Recent advances in assessment of cardiovascular stress responses and of fat distribution allow accurate assessment of associations between adiposity and stress responsiveness. We measured responses to the Montreal Imaging Stress Task in healthy men (N=43) and women (N=45) with a wide range of BMIs. Heart rate (HR) and blood pressure (BP) measures were used with novel magnetic resonance measures of stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR) and arterial compliance to assess cardiovascular responses. Salivary cortisol and the number and speed of answers to mathematics problems in the task were used to assess neuroendocrine and cognitive responses, respectively. Visceral and subcutaneous fat was measured using T2*-IDEAL. Greater BMI was associated with generalised blunting of cardiovascular (HR:β=−0.50 bpm.unit−1, P=0.009; SV:β=−0.33 mL.unit−1, P=0.01; CO:β=−61 mL.min−1.unit−1, P=0.002; systolic BP:β=−0.41 mmHg.unit−1, P=0.01; TPR:β=0.11 WU.unit−1, P=0.02), cognitive (correct answers: r=−0.28, P=0.01; time to answer: r=0.26, P=0.02) and endocrine responses (cortisol: r=−0.25, P=0.04) to stress. These associations were largely determined by visceral adiposity except for those related to cognitive performance, which were determined by both visceral and subcutaneous adiposity. Our findings suggest that adiposity is associated with centrally reduced stress responsiveness. Although this may mitigate some long-term health risks of stress responsiveness, reduced performance under stress may be a more immediate negative consequence.This work is funded by the UK National Institute of Health Research (NIHR), Siemens Medical Systems, British Heart Foundation (BHF), NIHR Senior Research Fellowship & The Fondation Leducq, BHF Intermediate Fellowship

Physiological and clinical consequences of relief of right ventricular outflow tract obstruction late after repair of congenital heart defects.

BACKGROUND: Right ventricular outflow tract obstruction (RVOTO) is a common problem after repair of congenital heart disease. Percutaneous pulmonary valve implantation (PPVI) can treat this condition without consequent pulmonary regurgitation or cardiopulmonary bypass. Our aim was to investigate the clinical and physiological response to relieving RVOTO. METHODS AND RESULTS: We studied 18 patients who underwent PPVI for RVOTO (72% male, median age 20 years) from a total of 93 who had this procedure for various indications. All had a right ventricular outflow tract (RVOT) gradient >50 mm Hg on echocardiography without important pulmonary regurgitation (less than mild or regurgitant fraction <10% on magnetic resonance imaging [MRI]). Cardiopulmonary exercise testing, tissue Doppler echocardiography, and MRI were performed before and within 50 days of PPVI. PPVI reduced RVOT gradient (51.4 to 21.7 mm Hg, P<0.001) and right ventricular systolic pressure (72.8 to 47.3 mm Hg, P<0.001) at catheterization. Symptoms and aerobic (25.7 to 28.9 mL.kg(-1).min(-1), P=0.002) and anaerobic (14.4 to 16.2 mL.kg(-1).min(-1), P=0.002) exercise capacity improved. Myocardial systolic velocity improved acutely (tricuspid 4.8 to 5.3 cm/s, P=0.05; mitral 4.7 to 5.5 cm/s, P=0.01), whereas isovolumic acceleration was unchanged. The tricuspid annular velocity was not maintained on intermediate follow-up. Right ventricular end-diastolic volume (99.9 to 89.7 mL/m2, P<0.001) fell, whereas effective stroke volume (43.7 to 48.3 mL/m2, P=0.06) and ejection fraction (48.0% to 56.8%, P=0.01) increased. Left ventricular end-diastolic volume (72.5 to 77.4 mL/m2, P=0.145), stroke volume (45.3 to 50.6 mL/m2, P=0.02), and ejection fraction (62.6% to 65.8%, P=0.03) increased. CONCLUSIONS: PPVI relieves RVOTO, which leads to an early improvement in biventricular performance. Furthermore, it reduces symptoms and improves exercise tolerance. These findings have important implications for the management of this increasingly common condition

Application of passive seismic to the detection of buried hollows

Pilot studies involving the use of passive seismic techniques in a range of geological settings and applications, e.g., mapping bedrock, studies of soil erosion and Quaternary mapping have shown that it is a versatile, non-invasive and economic technique. This paper presents the findings of three case studies that trialled the use of passive seismic techniques for the detection and characterisation of buried hollows in carbonate rocks, comprising: i) a buried hollow in the Cretaceous Chalk at Ashford Hill in the Kennet Valley, a tributary of the River Thames, UK; ii) buried karst in the foundation excavations for wind turbines in Carboniferous Limestone at Brassington, Wirksworth, Derbyshire, UK, and iii) defining the extent of solution hollows that host terrestrial Miocene deposits, near Friden, Newhaven, Derbyshire, UK. Whilst case studies ii) and iii) are focused on areas of buried dolines, the geological context of the Ashford Hill site is more complex; comprising a deformation hollow with an uplifted “pinnacle” of chalk bedrock at the centre. The data were collected using a (Tromino), a three-component, broadband seismometer to measure background ambient noise (microtremors induced by wind, ocean waves, industrial machinery, road and rail traffic, etc.). The Tromino is small, portable with an operating range of 0.1 Hz to 1,024 Hz and interpreted using proprietary software (Grilla), which subjects the data to Fourier transformation and smoothing. Where possible, estimated shear wave velocities used in the Grilla Software modelling, based on peaks identified on the H/V spectrum, have been calibrated using borehole data or parallel geophysical techniques. In each case, the karst features were defined by Nakamura’s horizontal to vertical (H/V) spectral ratio technique, where microtremors are converted to show impedance contrasts (velocity x density), or a pseudo layered seismic stratigraphy of the near surface along each profile. An additional benefit of the use of this technique is its depth of penetration and potential for defining the structural and lithological context of the hollows, thereby contributing to the process understanding associated with their formation. To this end the technique has helped define discontinuity (fault, joint or bedding) guidance of the hollows.S. Castellaro, Mrs J. Renwick, West Coast Energy Ltd (GDF Suez), Mr Roger Durrant (Raymond Brown Construction Ltd

A systematic review of the effect of footwear, foot orthoses and taping on lower limb muscle activity during walking and running

Background: External devices are used to manage musculoskeletal pathologies by altering loading of the foot, which could result in altered muscle activity that could have therapeutic benefits. Objectives: To establish if evidence exists that footwear, foot orthoses and taping alter lower limb muscle activity during walking and running. Study design: Systematic literature review. Methods: CINAHL, MEDLINE, ScienceDirect, SPORTDiscus and Web of Science databases were searched. Quality assessment was performed using guidelines for assessing healthcare interventions and electromyography methodology. Results: Thirty-one studies were included: 22 related to footwear, eight foot orthoses and one taping. In walking, (1) rocker footwear apparently decreases tibialis anterior activity and increases triceps surae activity, (2) orthoses could decrease activity of tibialis posterior and increase activity of peroneus longus and (3) other footwear and taping effects are unclear. Conclusion: Modifications in shoe or orthosis design in the sagittal or frontal plane can alter activation in walking of muscles acting primarily in these planes. Adequately powered research with kinematic and kinetic data is needed to explain the presence/absence of changes in muscle activation with external devices. Clinical relevance: This review provides some evidence that foot orthoses can reduce tibialis posterior activity, potentially benefitting specific musculoskeletal pathologies