Influence of cardiac autonomic neuropathy on cardiac repolarisation during incremental adrenaline infusion in type 1 diabetes

Aims/hypothesis We examined the effect of a standardised sympathetic stimulus, incremental adrenaline (epinephrine) infusion on cardiac repolarisation in individuals with type 1 diabetes with normal autonomic function, subclinical autonomic neuropathy and established autonomic neuropathy. Methods Ten individuals with normal autonomic function and baroreceptor sensitivity tests (NAF), seven with subclinical autonomic neuropathy (SAN; normal standard autonomic function tests and abnormal baroreceptor sensitivity tests); and five with established cardiac autonomic neuropathy (CAN; abnormal standard autonomic function and baroreceptor tests) underwent an incremental adrenaline infusion. Saline (0.9% NaCl) was infused for the first hour followed by 0.01 μg kg−1 min−1 and 0.03 μg kg−1 min−1 adrenaline for the second and third hours, respectively, and 0.06 μg kg−1 min−1 for the final 30 min. High resolution ECG monitoring for QTc duration, ventricular repolarisation parameters (T wave amplitude, T wave area symmetry ratio) and blood sampling for potassium and catecholamines was performed every 30 min. Results Baseline heart rate was 68 (95% CI 60, 76) bpm for the NAF group, 73 (59, 87) bpm for the SAN group and 84 (78, 91) bpm for the CAN group. During adrenaline infusion the heart rate increased differently across the groups (p = 0.01). The maximum increase from baseline (95% CI) in the CAN group was 22 (13, 32) bpm compared with 11 (7, 15) bpm in the NAF and 10 (3, 18) bpm in the SAN groups. Baseline QTc was 382 (95% CI 374, 390) ms in the NAF, 378 (363, 393) ms in the SAN and 392 (367, 417) ms in the CAN groups (p = 0.31). QTc in all groups lengthened comparably with adrenaline infusion. The longest QTc was 444 (422, 463) ms (NAF), 422 (402, 437) ms (SAN) and 470 (402, 519) ms (CAN) (p = 0.09). T wave amplitude and T wave symmetry ratio decreased and the maximum decrease occurred earlier, at lower infused adrenaline concentrations in the CAN group compared with NAF and SAN groups. AUC for the symmetry ratio was different across the groups and was lowest in the CAN group (p = 0.04). Plasma adrenaline rose and potassium fell comparably in all groups. Conclusions/interpretation Participants with CAN showed abnormal repolarisation in some measures at lower adrenaline concentrations. This may be due to denervation adrenergic hypersensitivity. Such individuals may be at greater risk of cardiac arrhythmias in response to physiological sympathoadrenal challenges such as stress or hypoglycaemia

The effects of moderate alterations in adrenergic activity on acute appetite regulation in obese women: a randomised crossover trial

Background: Previous evidence has demonstrated that serum leptin is correlated with appetite in combination with, but not without, modest exercise. Aim: The present experiments investigated the effects of exogenous adrenaline and α/β adrenoceptor blockade in combination with moderate exercise on serum leptin concentrations, appetite/satiety sensations and subsequent food intake in obese women. Methods: A total of 10 obese women ((mean ± SEM), age: 50 (1.9) years, body mass index 36 (4.1) kg/m2, waist 104.8 (4.1) cm) participated in two separate, double-blind randomised experimental trials. Experiment 1: moderate exercise after α/β adrenergic blocker (labetalol, 100 mg orally) versus moderate exercise plus placebo; experiment 2: adrenaline infusion for 20 minutes versus saline infusion. Appetite/satiety and biochemistry were measured at baseline, pre- and immediately post-intervention, then 1 hour post-intervention (i.e., before dinner). Food intake was assessed via ad libitum buffet-style dinner. Results: No differences were found in appetite/satiety, subsequent food intake or serum leptin in any of the studies (experiment 1 or experiment 2). In experiment 1, blood glucose was higher (p < 0.01) and plasma free fatty acids lower (p = 0.04) versus placebo. In experiment 2, plasma free fatty acids (p < 0.05) increased after adrenaline versus saline infusion. Conclusions: Neither inhibition of exercise-induced adrenergic activity by combined α/β adrenergic blockade nor moderate increases in adrenergic activity induced by intravenous adrenaline infusion affected acute appetite regulation

Evidence for orbital and North Atlantic climate forcing in alpine Southern California between 125 and 10 ka from multi-proxy analyses of Baldwin Lake

We employed a new, multi-proxy record from Baldwin Lake (∼125–10 ka) to examine drivers of terrestrial Southern California climate over long timescales. Correlated bulk organic and biogenic silica proxy data demonstrated high-amplitude changes from 125 to 71 ka, suggesting that summer insolation directly influenced lake productivity during MIS 5. From 60 to 57 ka, hydrologic state changes and events occurred in California and the U.S. Southwest, though the pattern of response varied geographically. Intermediate, less variable levels of winter and summer insolation followed during MIS 3 (57–29 ka), which likely maintained moist conditions in Southern California that were punctuated with smaller-order, millennial-scale events. These Dansgaard-Oeschger events brought enhanced surface temperatures (SSTs) to the eastern Pacific margin, and aridity to sensitive terrestrial sites in the Southwest and Southern California. Low temperatures and reduced evaporation are widespread during MIS 2, though there is increasing evidence for moisture extremes in Southern California from 29 to 20 ka. Our record shows that both orbital-scale radiative forcing and rapid North Atlantic temperature perturbations were likely influences on Southern California climate prior to the last glacial. However, these forcings produced a hydroclimatic response throughout California and the U.S. Southwest that was geographically complex. This work highlights that it is especially urgent to improve our understanding of the response to rapid climatic change in these regions. Enhanced temperature and aridity are projected for the rest of the 21st century, which will place stress on water resources

Apparatus for a Search for T-violating Muon Polarization in Stopped-Kaon Decays

The detector built at KEK to search for T-violating transverse muon polarization in K+ --> pi0 mu+ nu (Kmu3) decay of stopped kaons is described. Sensitivity to the transverse polarization component is obtained from reconstruction of the decay plane by tracking the mu+ through a toroidal spectrometer and detecting the pi0 in a segmented CsI(Tl) photon calorimeter. The muon polarization was obtained from the decay positron asymmetry of muons stopped in a polarimeter. The detector included features which minimized systematic errors while maintaining high acceptance.Comment: 56 pages, 30 figures, submitted to NI

Search for the decay K+ to pi+ gamma gamma in the pi+ momentum region P>213 MeV/c

We have searched for the K+ to pi+ gamma gamma decay in the kinematic region with pi+ momentum close to the end point. No events were observed, and the 90% confidence-level upper limit on the partial branching ratio was obtained, B(K+ to pi+ gamma gamma, P>213 MeV/c) < 8.3 x 10-9 under the assumption of chiral perturbation theory including next-to-leading order ``unitarity'' corrections. The same data were used to determine an upper limit on the K+ to pi+ gamma branching ratio of 2.3 x 10-9 at the 90% confidence level.Comment: 15 pages, 3 figures; no change in the results, accepted for publication in Physics Letters

Both “illness and temptation of the enemy”: melancholy, the medieval patient and the writings of King Duarte of Portugal (r. 1433–38)

Recent historians have rehabilitated King Duarte of Portugal, previously maligned and neglected, as an astute ruler and philosopher. There is still a tendency, however, to view Duarte as a depressive or a hypochondriac, due to his own description of his melancholy in his advice book, the Loyal Counselor. This paper reassesses Duarte's writings, drawing on key approaches in the history of medicine, such as narrative medicine and the history of the patient. It is important to take Duarte's views on his condition seriously, placing them in the medical and theological contexts of his time and avoiding modern retrospective diagnosis. Duarte's writings can be used to explore the impact of plague, doubt and death on the life of a well-educated and conscientious late-medieval ruler

All-sky search for long-duration gravitational wave transients with initial LIGO

We present the results of a search for long-duration gravitational wave transients in two sets of data collected by the LIGO Hanford and LIGO Livingston detectors between November 5, 2005 and September 30, 2007, and July 7, 2009 and October 20, 2010, with a total observational time of 283.0 days and 132.9 days, respectively. The search targets gravitational wave transients of duration 10-500 s in a frequency band of 40-1000 Hz, with minimal assumptions about the signal waveform, polarization, source direction, or time of occurrence. All candidate triggers were consistent with the expected background; as a result we set 90% confidence upper limits on the rate of long-duration gravitational wave transients for different types of gravitational wave signals. For signals from black hole accretion disk instabilities, we set upper limits on the source rate density between 3.4×10-5 and 9.4×10-4 Mpc-3 yr-1 at 90% confidence. These are the first results from an all-sky search for unmodeled long-duration transient gravitational waves. © 2016 American Physical Society