Walking-Induced Fatigue Leads to Increased Risk in Older Adults

Background- For older adults, falls are a serious health problem, with more than 30% of people older than 65 suffering a fall at least once a year. One element often overlooked in the assessment of falls is whether a person\u27s balance, walking ability, and overall falls risk is affected by performing activities of daily living such as walking. Objective- This study assessed the immediate impact of incline walking at a moderate pace on falls risk, leg strength, reaction time, gait, and balance in 75 healthy adults from 30 to 79 years of age. Subjects were subdivided into 5 equal groups based on their age (group 1, 30-39 years; group 2, 40-49 years; group 3, 50-59 years; group 4, 60-69 years; group 5, 70-79 years). Methods- Each person\u27s falls risk (using the Physiological Profile Assessment), simple reaction time, leg strength, walking ability, and standing balance were assessed before and after a period of incline walking on an automated treadmill. The walking task consisted of three 5-minute trials at a faster than preferred pace. Fatigue during walking was elicited by increasing the treadmill incline in increments of 2 degrees (from level) every minute to a maximum of 8 degrees. Results- As predicted, significant age-related differences were observed before the walking activity. In general, increasing age was associated with declines in gait speed, lower limb strength, slower reaction times, and increases in overall falls risk. Following the treadmill task, older adults exhibited increased sway (path length 60-69 years; 10.2 ± 0.7 to 12.1 ± 0.7 cm: 70-79 years; 12.8 ± 1.1 to 15.1 ± 0.8 cm), slower reaction times (70-79 years; 256 ± 6 to 287 ± 8 ms), and declines in lower limb strength (60-69 years; 36 ± 2 to 31 ± 1 kg: 70-79 years; 32.3 ± 2 to 27 ± 1 kg). However, a significant increase in overall falls risk (pre; 0.51 ± 0.17: post; 1.01 ± 0.18) was only seen in the oldest group (70-79 years). For all other persons (30-69 years), changes resulting from the treadmill-walking task did not lead to a significant increase in falls risk. Conclusions: As most falls occur when an individual is moving and/or fatigued, assessing functional properties related to balance, gait, strength, and falls risk in older adults both at rest and following activity may provide additional insight

Treatment of gastroparesis: a multidisciplinary clinical review

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75594/1/j.1365-2982.2006.00760.x.pd

Closed-Time Path Integral Formalism and Medium Effects of Non-Equilibrium QCD Matter

We apply the closed-time path integral formalism to study the medium effects of non-equilibrium gluon matter. We derive the medium modified resummed gluon propagator to the one loop level in non-equilibrium in the covariant gauge. The gluon propagator we derive can be used to remove the infrared divergences in the secondary parton collisions to study thermalization of minijet parton plasma at RHIC and LHC.Comment: Final version, To appear in Physical Review D, Minor modification, reference adde

Infrared Behaviour of The Gluon Propagator in Non-Equilibrium Situations

The infrared behaviour of the medium modified gluon propagator in non-equilibrium situations is studied in the covariant gauge using the Schwinger-Keldysh closed-time path formalism. It is shown that the magnetic screening mass is non-zero at the one loop level whenever the initial gluon distribution function is non isotropic with the assumption that the distribution function of the gluon is not divergent at zero transverse momentum. For isotropic gluon distribution functions, such as those describing local equilibrium, the magnetic mass at one loop level is zero which is consistent with finite temperature field theory results. Assuming that a reasonable initial gluon distribution function can be obtained from a perturbative QCD calculation of minijets, we determine these out of equilibrium values for the initial magnetic and Debye screening masses at energy densities appropriate to RHIC and LHC. We also compare the magnetic masses obtained here with those obtained using finite temperature lattice QCD methods at similar temperatures at RHIC and LHC.Comment: 21 pages latex, 4 figures, final version to be published in Phys. Rev.

Glucose effects on gastric motility and tone evoked from the rat dorsal vagal complex

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66102/1/j.1469-7793.2001.t01-1-00141.x.pd

The endocrine tumor summit 2008: appraising therapeutic approaches for acromegaly and carcinoid syndrome

The Endocrine Tumor Summit convened in December 2008 to address 6 statements prepared by panel members that reflect important questions in the treatment of acromegaly and carcinoid syndrome. Data pertinent to each of the statements were identified through review of pertinent literature by one of the 9-member panel, enabling a critical evaluation of the statements and the evidence supporting or refuting them. Three statements addressed the validity of serum growth hormone (GH) and insulin-like growth factor-I (IGF-I) concentrations as indicators or predictors of disease in acromegaly. Statements regarding the effects of preoperative somatostatin analog use on pituitary surgical outcomes, their effects on hormone and symptom control in carcinoid syndrome, and the efficacy of extended dosing intervals were reviewed. Panel opinions, based on the level of available scientific evidence, were polled. Finally, their views were compared with those of surveyed community-based endocrinologists and neurosurgeons

Abdominal pain in an adult with Type 2 diabetes: A case report

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Autonomic neuropathy predisposes to rosiglitazone-induced vascular leakage in insulin-treated patients with type 2 diabetes: a randomised, controlled trial on thiazolidinedione-induced vascular leakage

Contains fulltext : 88447.pdf (publisher's version ) (Closed access)AIMS/HYPOTHESIS: The mechanism of fluid-related complications caused by thiazolidinedione derivatives is unclear. One potential mechanism is thiazolidinedione-induced arterial vasodilatation, which results in vascular leakage and a fall in blood pressure, normally counterbalanced by sympathetic activation and subsequent renal fluid retention. We hypothesised that thiazolidinedione-induced vascular leakage will be particularly prominent in patients with autonomic neuropathy. METHODS: We conducted a randomised, double-blind, placebo-controlled, parallel study in 40 patients with type 2 diabetes on insulin treatment recruited from a university medical centre. The randomisation was performed by a central office using a randomisation schedule. Both treatment groups, placebo (n = 21) and rosiglitazone (n = 19), were stratified for sex and level of autonomic neuropathy as assessed by Ewing score (or=2.5). We investigated the effects of 16 weeks of treatment with rosiglitazone 4 mg twice daily on vascular leakage (transcapillary escape rate of albumin, TERalb), body weight, extracellular volume and plasma volume. RESULTS: Thirty-nine patients were included in the analysis. In patients with high Ewing scores (n = 16), rosiglitazone increased TERalb significantly (DeltaTERalb: rosiglitazone +2.43 +/- 0.45%/h, placebo -0.11 +/- 0.15%/h, p = 0.002), while rosiglitazone had no effect in the patients with low Ewing scores (n = 23). Rosiglitazone-induced increases in TERalb and Ewing score at baseline were correlated (r = 0.65, p = 0.02). There was no correlation between Ewing score and rosiglitazone-induced changes in fluid variables. One subject was withdrawn from the study because of atrial fibrillation. CONCLUSIONS/INTERPRETATION: Rosiglitazone may increase vascular leakage in insulin-treated patients with type 2 diabetes with autonomic neuropathy. Autonomic neuropathy did not exaggerate rosiglitazone-induced fluid retention. Therefore, autonomic neuropathy should be considered as a risk factor for thiazolidinedione-induced oedema, not for thiazolidinedione-induced fluid retention. TRIAL REGISTRATION: ClinicalTrials.gov NCT00422955. FUNDING: GlaxoSmithKline.1 september 201

Cardiac autonomic neuropathy in patients with diabetes and no symptoms of coronary artery disease: comparison of 123I-metaiodobenzylguanidine myocardial scintigraphy and heart rate variability

PURPOSE The purpose of this study was to evaluate the prevalence of cardiac autonomic neuropathy (CAN) in a cohort of patients with type 2 diabetes, truly asymptomatic for coronary artery disease (CAD), using heart rate variability (HRV) and (123)I-metaiodobenzylguanidine ((123)I-mIBG) myocardial scintigraphy. METHODS The study group comprised 88 patients with type 2 diabetes prospectively recruited from an outpatient diabetes clinic. In all patients myocardial perfusion scintigraphy, CAN by HRV and (123)I-mIBG myocardial scintigraphy were performed. Two or more abnormal tests were defined as CAN-positive (ECG-based CAN) and one or fewer as CAN-negative. CAN assessed by (123)I-mIBG scintigraphy was defined as abnormal if the heart-to-mediastinum ratio was 25%, or the total defect score was >13. RESULTS The prevalence of CAN in patients asymptomatic for CAD with type 2 diabetes and normal myocardial perfusion assessed by HRV and (123)I-mIBG scintigraphy was respectively, 27% and 58%. Furthermore, in almost half of patients with normal HRV, (123)I-mIBG scintigraphy showed CAN. CONCLUSION The current study revealed a high prevalence of CAN in patients with type 2 diabetes. Secondly, disagreement between HRV and (123)I-mIBG scintigraphy for the assessment of CAN was observed.Cardiovascular Aspects of Radiolog