Antihypertensive treatment in critical limb ischaemia

Peripheral artery disease (PAD) is defined as atherosclerotic arterial occlusive disease of the lower extremities, manifesting as intermittent claudication (IC, pain induced by walking) or critical limb ischaemia (CLI, rest pain or ulcerations). PAD guidelines recommend strict control of cardiovascular risk factors, and European guidelines on hypertension recommend a blood pressure (BP) target < 140/90 mm Hg also in PAD patients. As the pressure in the affected extremity might be of relevance for the prognosis concerning limb salvage in CLI, the traditional approach was to avoid beta-blockers and allow a slightly higher BP in CLI. Both theoretical considerations and observational data support aggressive BP lowering also in CLI; however, in the absence of randomized studies on BP lowering in this setting it cannot be definitely established that current recommendations on BP lowering apply also in CLI

The metabolic syndrome - What is it and how should it be managed?

A cluster of metabolic factors have been merged into an entity named the metabolic syndrome. Although the characteristics of this syndrome have varied over time the presently used definition was established in 2009. The presence of three abnormal findings out of five components qualifies a person for the metabolic syndrome: elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure and elevated fasting plasma glucose. Cut points have been defined for all components apart from waist circumference, for which national or regional values are used. The metabolic syndrome predicts cardiovascular disease and type 2 diabetes. This associated risk does not exceed its components whereof elevated blood pressure is the most frequent. A successful management should, however, address all factors involved. The management is always based on healthy lifestyle choices but has not infrequently to be supported by pharmacological treatment, especially blood pressure lowering drugs. The metabolic syndrome is a useful example of the importance of multiple targets for preventive interventions. To be successful management has to be individualized not the least when it comes to pharmacological therapy. Frail elderly people should not be over-treated. Knowledge transfer of how risk factors act should be accompanied by continuous trust building and motivation. In complex situations with a mix of biological risk factors, adverse social conditions and unhealthy lifestyle, everything cannot be changed at once. It is better to aim for small steps that are lasting than large, unsustainable steps with relapses to unhealthy behaviours. A person with the metabolic syndrome will always be afflicted by its components, which is the reason that management has to be sustained over a very long time. This review summarizes the knowledge on the metabolic syndrome and its management according to present state of the art.Peer reviewe

Alexandra Kollontai and three Swedish female physicians – friendly relationships around the Soviet ambassador in Stockholm 1930–1945

Alexandra Kollontai was the Soviet ambassador to Sweden in the years 1930 to 1945. In Sweden she gained many friends in the peace- and women’s movement and among these were several female physicians. This article describes and investigates the friendships between Swedish female physicians and Alexandra Kollontai. The three physicians focused on are Ada Nilsson (1872–1964), Andrea Andreen (1888–1972) and Nanna Svartz (1890–1986). It is found that Kollontai and the physicians became proper friends, although initial contacts between them had political or medical causes

Persistent currents through a quantum impurity: Protection through integrability

We consider an integrable model of a one-dimensional mesoscopic ring with the conduction electrons coupled by a spin exchange to a magnetic impurity. A symmetry analysis based on a Bethe Ansatz solution of the model reveals that the current is insensitive to the presence of the impurity. We argue that this is true for any integrable impurity-electron interaction, independent of choice of physical parameters or couplings. We propose a simple physical picture of how the persistent current gets protected by integrability.Comment: 5 pages, minor update

Typy mikroflory a ryzyko rozwoju choroby sercowo-metabolicznej — szansa na skuteczne przeciwdziałanie?

U każdego człowieka istotny odsetek całkowitej masy ciała (1–2 kg) stanowi mikroflora fizjologiczna przewodu pokarmowego. Wyniki najnowszych badań, na podstawie mapowania mikrobiomu, wykazały, że u zdrowego człowieka bogactwo i różnorodność mikroflory przewodu pokarmowego są większe niż u osób otyłych lub też u pacjentów cierpiących na chorobę sercowo-metaboliczną, a nawet na długotrwałe nadciśnienie tętnicze; u tych osób stwierdza się florę odmienną i uboższą (dysbioza). Próba przeciwdziałania przez podaż niektórych składników żywieniowych, jak dieta śródziemnomorska czy nabiał, taki jak jogurt bogaty w kolonie Lactobacillae, dają nadzieję na uzyskanie poprawy funkcji narządów, poprawę metabolizmu i obniżenie ryzyka rozwoju choroby. Konieczne jest przeprowadzenie randomizowanych, kontrolowanych badań interwencyjnych mających na celu zbadanie hipotezy sugerującej możliwość uzyskania korzyści zdrowotnych przez podjęcie zewnętrznych działań modyfikujących dietę

The association between glucometabolic disturbances, traditional cardiovascular risk factors and self-rated health by age and gender: A cross-sectional analysis within the Malmö Preventive Project

<p>Abstract</p> <p>Background</p> <p>The increased risk of cardiovascular disease (CVD) in diabetic compared to non-diabetic subjects seems to decrease with age. Whether this age-related reduction applies to CVD risk factors, and whether it is limited to established diabetes mellitus (DM) or also applies to pre-diabetic conditions are not well known.</p> <p>Methods</p> <p>Using a cross-sectional design we compared the strength of the correlation between glucometabolic disturbances (by grouping), CVD risk factor burden and self-rated health, in two age groups: middle-aged (57-69 years) and older (70-86 years) subjects, (63% men), participating in the Malmö Preventive Project Re-examination Study (n = 18,238). Simple (unadjusted) logistic regression analysis was applied to estimate between-group differences and trends. Interaction analysis was applied to estimate differences between age groups.</p> <p>Results</p> <p>CVD risk factor burden and the proportion of subjects reporting poor self-rated health increased with increasing glucometabolic disturbance for men and women in both age groups (p-trend < 0.0001 for all). The slope of the trend curve with increasing CVD risk factor burden was significantly steeper for older women than for older men (p-interaction = 0.002). The slope of the trend curve for poor self-rated health was significantly steeper for middle-aged than for older men (p-interaction = 0.005), while no difference was observed between the age groups among women (p-interaction = 0.97).</p> <p>Conclusions</p> <p>We found no reduction in risk factor accumulation with increasing glucometabolic disturbance between middle-aged and older subjects. Our results indicate life-long CVD risk factor clustering with increased glucometabolic disturbance, and suggest that previously observed age-related reduction in excess CVD risk for subjects with DM might be due to a survival bias. However, our observations indicate more pronounced risk factor clustering and worse self-rated health with increased glucometabolic disturbance in older women than in older men.</p

Reasoning about goal-directed real-time teleo-reactive programs

The teleo-reactive programming model is a high-level approach to developing real-time systems that supports hierarchical composition and durative actions. The model is different from frameworks such as action systems, timed automata and TLA+, and allows programs to be more compact and descriptive of their intended behaviour. Teleo-reactive programs are particularly useful for implementing controllers for autonomous agents that must react robustly to their dynamically changing environments. In this paper, we develop a real-time logic that is based on Duration Calculus and use this logic to formalise the semantics of teleo-reactive programs. We develop rely/guarantee rules that facilitate reasoning about a program and its environment in a compositional manner. We present several theorems for simplifying proofs of teleo-reactive programs and present a partially mechanised method for proving progress properties of goal-directed agents. © 2013 British Computer Society

Low fasting plasma insulin is associated with atrial fibrillation in men from a cohort study - the Malmö preventive project

Background: Type 2 diabetes has been associated with increased incidence of atrial fibrillation (AF) and cardiovascular disease. Controversy remains regarding the role of insulin in the epidemiology of AF risk. The aim of the present study was to study the association between fasting plasma insulin (FPI) and incidence of AF, as well as any effect modification by fasting blood glucose (FBG) or 2 h post-load blood glucose and body mass index (BMI). Methods: The study population consisted of 6052 men and 1014 women followed for an average of 26.2 years. There were 983 cases of incident AF. Analysis was performed using Cox regression and competing risks regression approaches. The population was analysed as a whole, and by subgroups according to glucose levels and BMI. Results: After adjustment for age, height, weight, systolic blood pressure and smoking there was a significant inverse association between FPI and AF (hazard ratio; HR) for 4th vs. 1st quartile: 0.69 (95% confidence interval (CI): 0.57-0.83, p < 0.0001) in the cohort as a whole. Among men the corresponding values were HR 0.64 (95% CI 0.52-0.78, p < 0.001) and among women HR 1.16 (95% CI 0.69-1.93, p = 0.58); p-value for interaction 0.06. The protective effects of insulin tended to be weaker in subjects with elevated fasting glucose, implying that the relation between FPI and incident AF could be dependent on the status of individual's glucose metabolism. Conclusions: High levels of FPI are associated with lower risk of incident AF in a middle-aged population with a long follow-up