400 research outputs found
Metoprolol compared to carvedilol deteriorates insulin-stimulated endothelial function in patients with type 2 diabetes - a randomized study
<p>Abstract</p> <p>Aim</p> <p>Studies of beta blockade in patients with type 2 diabetes have shown inferiority of metoprolol treatment compared to carvedilol on indices of insulin resistance. The aim of this study was to examine the effect of metoprolol versus carvedilol on endothelial function and insulin-stimulated endothelial function in patients with type 2 diabetes.</p> <p>Method</p> <p>24 patients with type 2 diabetes were randomized to receive either 200 mg metoprolol succinate or 50 mg carvedilol daily. Endothelium-dependent vasodilation was assessed by using venous occlusion plethysmography with increasing doses of intra-arterial infusions of the agonist serotonin. Insulin-stimulated endothelial function was assessed after co-infusion of insulin for sixty minutes. Vaso-reactivity studies were done before and after the two-month treatment period.</p> <p>Results</p> <p>Insulin-stimulated endothelial function was deteriorated after treatment with metoprolol, the percentage change in forearm blood-flow was 60.19% Âą 17.89 (at the highest serotonin dosages) before treatment and -33.80% Âą 23.38 after treatment (p = 0.007). Treatment with carvedilol did not change insulin-stimulated endothelial function. Endothelium-dependent vasodilation without insulin was not changed in either of the two treatment groups.</p> <p>Conclusion</p> <p>This study shows that vascular insulin sensitivity was preserved during treatment with carvedilol while blunted during treatment with metoprolol in patients with type 2 diabetes.</p> <p>Trial registration</p> <p>Current Controlled Trials NCT00497003</p
Age and body mass index affect fit of spirometry Global Lung Function Initiative references in schoolchildren.
Background
References from the Global Lung Function Initiative (GLI) are widely used to interpret children's spirometry results. We assessed fit for healthy schoolchildren.
Methods
LuftiBus in the School was a population-based cross-sectional study undertaken in 2013-2016 in the canton of Zurich, Switzerland. Parents and their children aged 6-17â
years answered questionnaires about respiratory symptoms and lifestyle. Children underwent spirometry in a mobile lung function lab. We calculated GLI-based z-scores for forced expiratory volume in 1â
s (FEV1), forced vital capacity (FVC), FEV1/FVC and forced expiratory flow for 25-75% of FVC (FEF25-75) for healthy White participants. We defined appropriate fit to GLI references by mean values between +0.5 and -0.5 z-scores. We assessed whether fit varied by age, body mass index, height and sex using linear regression models.
Results
We analysed data from 2036 children with valid FEV1 measurements, of whom 1762 also had valid FVC measurements. The median age was 12.2â
years. Fit was appropriate for children aged 6-11â
years for all indices. In adolescents aged 12-17â
years, fit was appropriate for FEV1/FVC z-scores (meanÂąsd -0.09Âą1.02), but not for FEV1 (-0.62Âą0.98), FVC (-0.60Âą0.98) and FEF25-75 (-0.54Âą1.02). Mean FEV1, FVC and FEF25-75 z-scores fitted better in children considered overweight (-0.25, -0.13 and -0.38, respectively) than normal weight (-0.55, -0.50 and -0.55, respectively; p-trend <0.001, 0.014 and <0.001, respectively). FEV1, FVC and FEF25-75 z-scores depended on both age and height (p-interaction 0.033, 0.019 and <0.001, respectively).
Conclusion
GLI-based FEV1, FVC, and FEF25-75 z-scores do not fit White Swiss adolescents well. This should be considered when using reference equations for clinical decision-making, research and international comparison
Age and body mass index affect fit of spirometry Global Lung Function Initiative references in schoolchildren
BACKGROUND: References from the Global Lung Function Initiative (GLI) are widely used to interpret children's spirometry results. We assessed fit for healthy schoolchildren.
METHODS: LuftiBus in the School was a population-based cross-sectional study undertaken in 2013-2016 in the canton of Zurich, Switzerland. Parents and their children aged 6-17â
years answered questionnaires about respiratory symptoms and lifestyle. Children underwent spirometry in a mobile lung function lab. We calculated GLI-based z-scores for forced expiratory volume in 1â
s (FEV), forced vital capacity (FVC), FEV/FVC and forced expiratory flow for 25-75% of FVC (FEF) for healthy White participants. We defined appropriate fit to GLI references by mean values between +0.5 and -0.5 z-scores. We assessed whether fit varied by age, body mass index, height and sex using linear regression models.
RESULTS: We analysed data from 2036 children with valid FEV measurements, of whom 1762 also had valid FVC measurements. The median age was 12.2â
years. Fit was appropriate for children aged 6-11â
years for all indices. In adolescents aged 12-17â
years, fit was appropriate for FEV/FVC z-scores (meanÂąsd -0.09Âą1.02), but not for FEV (-0.62Âą0.98), FVC (-0.60Âą0.98) and FEF (-0.54Âą1.02). Mean FEV, FVC and FEF z-scores fitted better in children considered overweight (-0.25, -0.13 and -0.38, respectively) than normal weight (-0.55, -0.50 and -0.55, respectively; p-trend <0.001, 0.014 and <0.001, respectively). FEV, FVC and FEF z-scores depended on both age and height (p-interaction 0.033, 0.019 and <0.001, respectively).
CONCLUSION: GLI-based FEV, FVC, and FEF z-scores do not fit White Swiss adolescents well. This should be considered when using reference equations for clinical decision-making, research and international comparison
Prognostic significance of infectious episodes occurring during first-line therapy for diffuse large B-cell lymphoma - A nationwide cohort study
Agreement of parent- and child-reported wheeze and its association with measurable asthma traits
Objectives
In epidemiological studies, childhood asthma is usually assessed with questionnaires directed at parents or children, and these may give different answers. We studied how well parents and children agreed when asked to report symptoms of wheeze and investigated whose answers were closer to measurable traits of asthma.
Methods
LuftiBus in the school is a cross-sectional survey of respiratory health among Swiss schoolchildren aged 6â17 years. We applied questionnaires to parents and children asking about wheeze and exertional wheeze in the past year. We assessed agreement between parentâchild answers with Cohen's kappa (k), and associations of answers from children and parents with fractional exhaled nitric oxide (FeNO) and forced expiratory volume in 1âs over forced vital capacity (FEV1/FVC), using quantile regression.
Results
We received questionnaires from 3079 children and their parents. Agreement was poor for reported wheeze (kâ=â0.37) and exertional wheeze (kâ=â0.36). Median FeNO varied when wheeze was reported by children (19âppb, interquartile range [IQR]: 9â44), parents (22âppb, IQR: 12â46), both (31âppb, IQR: 16â55), or neither (11 ppb, IQR: 7â19). Median absolute FEV1/FVC was the same when wheeze was reported by children (84%, IQR: 78â89) and by parents (84%, IQR: 78â89), lower when reported by both (82%, IQR: 78â87), and higher when reported by neither (87%, IQR: 82â91). For exertional wheeze findings were similar. Results did not differ by age or sex.
Conclusion
Our findings suggest that surveying both parents and children and combining their responses can help us to better identify children with measurable asthma traits
Evaluation of the double-tracer gas single-breath washout test in a pediatric field study.
BACKGROUND
The early-life origins of chronic pulmonary diseases are thought to arise in peripheral small airways. Predictors of ventilation inhomogeneity, a proxy of peripheral airway function, are understudied in schoolchildren.
RESEARCH QUESTION
Is the double-tracer gas single-breath washout (DTG-SBW) measurement feasible in a pediatric field study setting? What are the predictors of the DTG-SBW derived ventilation inhomogeneity estimate in unselected schoolchildren?
STUDY DESIGN AND METHODS
In this prospective cross-sectional field study, a mobile lung function-testing unit visited participating schools in Switzerland. We applied DTG-SBW, fraction of exhaled nitric oxide (FeNO), and spirometry measurements. The DTG-SBW is based on tidal inhalation of helium (He) and sulfur-hexafluoride (SF6) and the phase III slope (SIIIHe-SF6) is derived. We assessed feasibility, repeatability, and associations of SIIIHe-SF6 with the potential predictors anthropometrics, presence of wheeze (i.e. parental report of ⼠1 episode of wheeze in the prior year), FeNO, forced expiratory volume in the first second (FEV1), and FEV1/forced vital capacity (FVC).
RESULTS
In 1782 children, 5223 DTG-SBW trials were obtained. The DTG-SBW was acceptable in 1449 (81.3%) children, coefficient of variation was 39.8%. SIIIHe-SF6 was independently but weakly positively associated with age and BMI. In 276 (21.2%) children, wheeze was reported. SIIIHe-SF6 was higher by 0.049 g.mol.L-1 in children with wheeze as compared to those without and remained associated with wheeze after adjusting for age and BMI in a multi-variable linear regression model. SIIIHe-SF6 was not associated with FeNO, FEV1, and FEV1/FVC.
INTERPRETATION
The DTG-SBW is feasible in a pediatric field study setting. On the population level, age, body composition and wheeze are independent predictors of peripheral airway function in unselected schoolchildren. The variation of the DTG-SBW possibly constrains its current applicability on the individual level
Evaluation of the Double-Tracer Gas Single-Breath Washout Test in a Pediatric Field Study
BACKGROUND: The early life origins of chronic pulmonary diseases are thought to arise in peripheral small airways. Predictors of ventilation inhomogeneity, a proxy of peripheral airway function, are understudied in schoolchildren.
RESEARCH QUESTION: Is the double-tracer gas single-breath washout (DTG-SBW) measurement feasible in a pediatric field study setting? What are the predictors of the DTG-SBWderived ventilation inhomogeneity estimate in unselected schoolchildren?
STUDY DESIGN AND METHODS: In this prospective cross-sectional field study, a mobile lung function testing unit visited participating schools in Switzerland. We applied DTG-SBW, fraction of exhaled nitric oxide (FENO), and spirometry measurements. The DTG-SBW is based on tidal inhalation of helium and sulfur-hexafluoride, and the phase III slope (SIIIHeSF6) is derived. We assessed feasibility, repeatability, and associations of SIIIHe-SF6 with the potential predictors of anthropometrics, presence of wheeze (ie, parental report of one or more episode of wheeze in the prior year), FENO, FEV1, and FEV1/FVC.
RESULTS: In 1,782 children, 5,223 DTG-SBW trials were obtained. The DTG-SBW was acceptable in 1,449 children (81.3%); the coefficient of variation was 39.8%. SIIIHe-SF6 was independently but weakly positively associated with age and BMI. In 276 children (21.2%), wheeze was reported. SIIIHe-SF6 was higher by 0.049 g.mol.L-1 in children with wheeze
compared with those without and remained associated with wheeze after adjusting for age and BMI in a multivariable linear regression model. SIIIHe-SF6 was not associated with FENO, FEV1, and FEV1/FVC.
INTERPRETATION: The DTG-SBW is feasible in a pediatric field study setting. On the population level, age, body composition, and wheeze are independent predictors of peripheral airway function in unselected schoolchildren. The variation of the DTG-SBW possibly constrains its current applicability on the individual level
Pretreatment hemoglobin adds prognostic information to the nccn-ipi in patients with diffuse large b-cell lymphoma treated with anthracycline-containing chemotherapy
Angiopoietin-like protein 4 is an exercise-induced hepatokine in humans, regulated by glucagon and cAMP
Objective: Angiopoietin-like protein-4 (ANGPTL4) is a circulating protein that is highly expressed in liver and implicated in regulation of plasma triglyceride levels. Systemic ANGPTL4 increases during prolonged fasting and is suggested to be secreted from skeletal muscle following exercise.
Methods: We investigated the origin of exercise-induced ANGPTL4 in humans by measuring the arterial-to-venous difference over the leg and the hepato-splanchnic bed during an acute bout of exercise. Furthermore, the impact of the glucagon-to-insulin ratio on plasma ANGPTL4 was studied in healthy individuals. The regulation of ANGPTL4 was investigated in both hepatic and muscle cells.
Results: The hepato-splanchnic bed, but not the leg, contributed to exercise-induced plasma ANGPTL4. Further studies using hormone infusions revealed that the glucagon-to-insulin ratio is an important regulator of plasma ANGPTL4 as elevated glucagon in the absence of elevated insulin increased plasma ANGPTL4 in resting subjects, whereas infusion of somatostatin during exercise blunted the increase of both glucagon and ANGPTL4. Moreover, activation of the cAMP/PKA signaling cascade let to an increase in ANGPTL4 mRNA levels in hepatic cells, which was prevented by inhibition of PKA. In humans, muscle ANGPTL4 mRNA increased during fasting, with only a marginal further induction by exercise. In human muscle cells, no inhibitory effect of AMPK activation could be demonstrated on ANGPTL4 expression.
Conclusions: The data suggest that exercise-induced ANGPTL4 is secreted from the liver and driven by a glucagon-cAMP-PKA pathway in humans. These findings link the liver, insulin/glucagon, and lipid metabolism together, which could implicate a role of ANGPTL4 in metabolic diseases
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