Metabolic and Endocrine correlates of cognitive function in healthy young women

Obesity has been associated with cognitive decline in longitudinal studies of older individuals. We hypothesized that the cognitive sequelae of obesity may be detectable in the reproductive years. In addition, we explored the hypothesis that these associations may be mediated by the hormonal milieu. In this study of 49 young healthy lean and overweight women aged 20–45, we investigated the association between performance on a battery of cognitive tests, body composition parameters (BMI, total fat, abdominal (visceral, subcutaneous and total) adipose tissue, and muscle), and hormone levels (insulin, adiponectin, leptin, IGF-1, estrogen, testosterone, and vitamin D). We found a significant negative association between both visceral adiposity and muscle, and performance in the domain of verbal learning and memory, after controlling for age and education. Other body composition parameters showed similar trends (0.05<p<0.10). Additionally, the degree of insulin resistance was negatively associated with executive function domain. None of the associations between the other hormones examined (adipokines, IGF-1, gonadal hormones and vitamin D) and cognitive function were significant. These preliminary findings suggest a possible association between obesity and cognitive function in healthy young women of reproductive age. More research is warranted into the potential modulatory effect of insulin resistance on this association

Coronal Shock Waves, EUV waves, and Their Relation to CMEs. I. Reconciliation of "EIT waves", Type II Radio Bursts, and Leading Edges of CMEs

We show examples of excitation of coronal waves by flare-related abrupt eruptions of magnetic rope structures. The waves presumably rapidly steepened into shocks and freely propagated afterwards like decelerating blast waves that showed up as Moreton waves and EUV waves. We propose a simple quantitative description for such shock waves to reconcile their observed propagation with drift rates of metric type II bursts and kinematics of leading edges of coronal mass ejections (CMEs). Taking account of different plasma density falloffs for propagation of a wave up and along the solar surface, we demonstrate a close correspondence between drift rates of type II bursts and speeds of EUV waves, Moreton waves, and CMEs observed in a few known events.Comment: 30 pages, 15 figures. Solar Physics, published online. The final publication is available at http://www.springerlink.co

Low-rate of complications after a long-term use of ateriovenous fistula (AVF) in hemophilic children

Background: Hemophilic children, undergoing regular prophylaxis or ITI, need a long-lasting uncomplicated venous access. Methods: Children lacking a venous access suitable for frequent infusions were eligible for AVF creation. AVF were accessed at home by parents. Doppler ultrasound of the limb and echocardiography were regularly performed. Results: Between 1999 and 2007, 43 AVF were created in 38 patients (FVIII/FIX &lt;2%; median age 2.6 years, range: 0.9\u201311.9; 23 with inhibitors). AVF did not mature in 6 children (16%) and 5 of them underwent a second procedure that was successful in 4. Overall successful maturation was obtained in 36 AVF (84%) that were first accessed after a median of 56 days (21\u2013135) and used for a median of 5.1 years (0.7\u20137.9) for ITI (20), prophylaxis (11) and on-demand treatment (5). Complications not preventing AVF use were: thrombosis of a venous branch (1. 3%) and transient distal ischaemia (4. 11%). Other complications were: aneurysmatic dilatation (4. 11%) observed after a median of 5.4 years (3.5\u20137.7), limb hypertrophy (1. 3%) after 5.4 years and AVF overflow (1. 3%) after 6.9 years. These complications were reason for surgical dismantlement and transition to peripheral veins after a median of 6.6 years (range: 3.5\u20137.1). Uncomplicated AVF were dismantled after 4\u20137.4 years in 2 children who developed adequate peripheral veins. Conclusions: AVF were satisfactorily safe in hemophilic children, allowing long-term home treatment in 36/38 (95%). Regular follow-up allows early remedial intervention in case of complications; however, transition to peripheral veins should be implemented as soon as possibl

Sequential combined bypassing therapy : a rescue option in refractory bleeds \u2013 the Italian experience

Background: Replacement therapy is ineffective in patients with high titre inhibitor and bypassing agents are required to induce clot formation. Unfortunately, whatever by-passing agent is initially used, some bleed (10-20%) cannot be controlled. A synergistic effect of sequential administration of two agents has been recently reported in patients who failed to respond to a single agent. Methods: Sequentially combined bypassing therapy (SCT) was used in 2 children (8 and 14 year-old) and 2 adults (40 and 45 year-old) with haemophilia A and high-responding inhibitors, unresponsive to the single treatment with APCC and rFVIIa. Results: The children were suffering from joint bleeds refractory to high doses of NovoSeven (up to 270 lg Kg-1every 2 h) and to high doses of FEIBA (up to 80 U Kg-1every 8 h). The adults had undergone major orthopaedic surgery (removal of knee prosthesis, knee arthrodesis), initially treated with NovoSeven up to 270 lg Kg-1every 2 h, with only an initial control (first 12-24 h), followed by significant bleed. One of these patients was switched to FEIBA 80 U Kg-1every 8 h without success. SCT was administered alternating one FEIBA dose (range 60-80 U Kg-18-12 h-1) to one NovoSeven dose (range 90-270 lg Kg-18-12 h-1). Complete bleeding control was achieved in 24-48 h. SCT was discontinued and patients underwent prophylaxis with FEIBA. No clinical adverse event was observed, but a rise of D-dimer levels occurred. Conclusions: SCT can represent a valid rescue treatment of refractory bleeds. An international survey on combined by-passing therapy has recently started (www.intersectsurvey.org

Thoracic Endovascular Aortic Repair (TEVAR) in Proximal (Type A) Aortic Dissection: Ready for a Broader Application?

OBJECTIVE: Thoracic endovascular aortic repair (TEVAR) has demonstrated encouraging results and is gaining increasing acceptance as a treatment option for aortic aneurysms and dissections. Yet, its role in managing proximal aortic pathologies is unknown-this is important because in proximal (Stanford type A) aortic dissections, 10% to 30% are not accepted for surgery and 30% to 50% are technically amenable for TEVAR. We describe our case series of type A aortic dissections treated by using TEVAR. METHODS: Between year 2009 and 2016, 12 patients with acute, subacute, or chronic type A aortic dissection with the proximal entry tear located between the coronaries and brachiocephalic artery were treated with TEVAR at 3 centers. Various stent-graft configurations were used to seal the proximal entry tear in the ascending aorta under rapid pacing. RESULTS: A total of 12 patients (9 male, 3 female), mean age 81 +/- 7 years, EuroSCORE II 9.1 +/- 4.5, underwent TEVAR for the treatment of type A aortic dissection. Procedural success was achieved in 11 of 12 patients (91.7%). There was 1 minor stroke and 1 intraprocedural death. No additional deaths were reported at 30 days. At 36 months, there were 4 further deaths (all from nonaortic causes). The mean survival of these 4 deceased was 23 months (range 15-36 months). Follow-up computed tomography demonstrated favorable aortic remodeling. CONCLUSIONS: TEVAR is feasible and reveals promising early results in selected patients with type A aortic dissection who are poor candidates for surgical repair. The current iteration of stent-graft technology, however, needs to be adapted to features specific to the ascending aorta