Impact of valvuloarterial impedance on 2-year outcome of patients undergoing transcatheter aortic valve implantation

BACKGROUND: Elderly patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) often have increased calcification and fibrosis of the aorta. Indices that account for the severity of valvular obstruction and systemic vascular impedance may better assess total left ventricular afterload. The aims of the present study were to evaluate changes in valvuloarterial impedance (Zva), systemic arterial compliance, and systemic vascular resistance after TAVI and to investigate the prognostic value of these parameters. METHODS: A total of 116 patients (49% men; mean age, 81 +/- 8 years) with symptomatic severe aortic stenosis underwent TAVI. Zva, systemic arterial compliance, and systemic vascular resistance were measured at baseline and 1 and 12 months after TAVI. The primary end point was all-cause mortality. RESULTS: After TAVI, there was a significant reduction in Zva (from 5.40 +/- 1.52 mm Hg/mL/m(2) at baseline to 4.13 +/- 1.17 mm Hg/mL/m(2) at 1 month and 4.35 +/- 1.38 mm Hg/mL/m(2) at 1 year, P /= 5 mm Hg/mL/m(2) were lower compared with those with Zva < 5 mm Hg/mL/m(2) (82% vs 91%, respectively, log-rank P = .04). On multivariate Cox proportional-hazards analysis, baseline Zva was independently associated with all-cause mortality (hazard ratio, 1.48; 95% confidence interval, 1.05-2.07; P = .025). CONCLUSIONS: In patients undergoing TAVI, there is a significant postprocedural reduction in Zva, but there is no reduction in systemic arterial compliance or vascular resistance. Baseline Zva is an independent predictor of overall mortality at 2-year follow-up

International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine

Abstract Creatine is one of the most popular nutritional ergogenic aids for athletes. Studies have consistently shown that creatine supplementation increases intramuscular creatine concentrations which may help explain the observed improvements in high intensity exercise performance leading to greater training adaptations. In addition to athletic and exercise improvement, research has shown that creatine supplementation may enhance post-exercise recovery, injury prevention, thermoregulation, rehabilitation, and concussion and/or spinal cord neuroprotection. Additionally, a number of clinical applications of creatine supplementation have been studied involving neurodegenerative diseases (e.g., muscular dystrophy, Parkinson’s, Huntington’s disease), diabetes, osteoarthritis, fibromyalgia, aging, brain and heart ischemia, adolescent depression, and pregnancy. These studies provide a large body of evidence that creatine can not only improve exercise performance, but can play a role in preventing and/or reducing the severity of injury, enhancing rehabilitation from injuries, and helping athletes tolerate heavy training loads. Additionally, researchers have identified a number of potentially beneficial clinical uses of creatine supplementation. These studies show that short and long-term supplementation (up to 30 g/day for 5 years) is safe and well-tolerated in healthy individuals and in a number of patient populations ranging from infants to the elderly. Moreover, significant health benefits may be provided by ensuring habitual low dietary creatine ingestion (e.g., 3 g/day) throughout the lifespan. The purpose of this review is to provide an update to the current literature regarding the role and safety of creatine supplementation in exercise, sport, and medicine and to update the position stand of International Society of Sports Nutrition (ISSN)

The developmental psychopathology of social anxiety and phobia in adolescents

The highest incidence rates for social anxiety disorder (SAD) occur during the period from late childhood to early adulthood. A number of factors that increase vulnerability for the development of SAD have been proposed in the literature, including genes, temperament, biological factors, cognitive factors, parent factors, life events, peer experiences, performance deficits, general learning mechanisms, and cultural factors. These proposed aetiological factors have been given different weightings in theoretical accounts of the aetiology of SAD. Genes, temperament, cognitive factors, parent factors, life events, and peer experiences are generally emphasised in theoretical accounts, while biological factors, performance deficits, general learning mechanisms, and cultural factors have received less emphasis. The proposed aetiological factors have also been empirically examined to varying extents in the literature. In general, the majority of research into the proposed aetiological factors has been limited by the use of cross-sectional designs and the recruitment of individuals already diagnosed with SAD. Further research is needed to obtain better evidence to evaluate the aetiological role of the proposed factors. Such research will ultimately help to develop efficacious early intervention and prevention strategies for SAD

Paternal obesity and programming of offspring health

The physical and nutritional environment experienced by the mother prior to and during conception is imperative to the outcome of pregnancy and offspring health. In addition there is now mounting evidence that paternal exposures and conditions at the time of conception are also an important determinant of pregnancy outcome and offspring health. Specifically, male obesity is now demonstrated to have detrimental impacts on fertility and fetal development during subsequent pregnancy and can exert programming effects on the phenotype of offspring lasting up to two generations. We summarise the evidence of the effect of environmental exposures on seminal plasma and sperm, focusing on the effects of obesity, and what bearing this has for offspring both in humans and animal models. The current knowledge of what might form the molecular basis of the phenomena of paternal programming of offspring health are also reviewed with consideration given to signals from both seminal plasma and sperm.Tod Fullston, Helana S. Shehadeh, John E. Schjenken, Nicole O. McPherson, Sarah A. Robertson, Deirdre Zander-Fox, and Michelle Lan